DSS seeking medical experts

The state's top social services official yesterday defended how his agency handled the case of 4-year-old poisoning victim Rebecca Riley, saying that she "did not fall through the cracks."

But Harry Spence, commissioner of the Department of Social Services, said his department needs more medical expertise to help social workers review the diagnoses and drugs prescribed by doctors treating children overseen by the agency.

JudyAnn Bigby, secretary of Health and Human Services, said she would appoint an independent physician in the next few days to be on call to help DSS, until the agency develops a medical review system.

"I will assure you that if we get additional medical personnel, our capacity to assess the medical quality of children will improve," Spence said. "My hope would be that as a result, lives that otherwise might be lost could be saved."

Investigators continue to examine the death of Rebecca, whose parents have been charged with first-degree murder by allegedly giving her an intentional overdose of a drug prescribed for hyperactivity.

Last summer, DSS investigated a therapist's concerns that Riley and her 6-year-old sister and 11-year-old brother were overmedicated. The agency was assured by doctors for all the children and their mother, Carolyn Riley, that the family was receiving proper medication and decided not to seek an independent medical review, Spence said.

"The department . . . did not drop that inquiry, but completed that inquiry with assurances from medical experts that the care was appropriate and sufficient," he said, disputing the headline on a story in yesterday's Globe that reported that the agency sought an independent review of the family's medical treatment only after Rebecca was found dead Dec. 13 in Hull.

Spence said that review, conducted by Children's Hospital Boston, found the amount of medication the children had been prescribed was not appropriate. Dr. Kayoko Kifuji, the psychiatrist who diagnosed Rebecca and prescribed drugs for attention deficit and bipolar disorders, agreed Wednesday to stop treating patients while the state investigates her role in the case.

"Children's certainly raised questions about the medication, the propriety of the amounts, and the administration of the medication," he said in a telephone interview. He declined to be more specific about the hospital's recommendations. A spokesman for Children's Hospital also declined to comment.

Spence said his agency, which had been involved with the Riley children since December 2002, is still examining how it handled Rebecca's case, but that so far it appeared his workers did not fail the girl. "We have certainly not found a terrible failure," he said at a press conference at the agency's headquarters in South Boston. "This child did not fall through the cracks."

DSS was concerned, Spence said, about Michael Riley, Rebecca's father, being near the couple's children even after a judge decided last summer that he could be around the children unsupervised following allegations of sexual abuse of his 13-year-old stepdaughter.

Last October, Carolyn Riley agreed to seek a restraining order after her husband allegedly grabbed their 11-year-old son by the neck and slammed his head against the back window of a pickup truck. She allowed the restraining order to lapse, but told DSS officials during a Nov. 10 meeting that she was renewing it and that Michael Riley would not be moving back in with the family.

Agency workers tried to visit with the family, but Carolyn Riley failed to return their calls, so on Dec. 12, DSS officials decided to arrange a surprise visit soon afterward. Rebecca was found dead the next day on the floor of her parents' bedroom.

Immediately afterward, the agency sought the independent review of the children's medication and diagnoses.

Spence said he contacted three psychiatrists to ask them to consider treating the surviving Riley children. They all refused, he said.

"Our interpretation of their explanation was that there was a reluctance to engage in second-guessing of fellow professionals," Spence told the Globe.

Their refusals underscore the difficulty DSS generally faces trying to find physicians willing to provide an independent medical opinion, Spence said.

The agency had been working to establish a panel of medical specialists following the controversy over Haleigh Poutre, now 12, who was beaten into a coma in 2005 and from whom DSS almost prematurely withdrew life support.

But DSS found that many doctors were unwilling to participate, worried about possible liability and not having access to records on the DSS children, Spence said.

Some doctors also fret over becoming involved in the controversy that usually swirls around DSS cases, he said. But the agency will continue trying to put together the panel and rely on the state-appointed physician as a stopgap measure, he said.

"It just gives us as an opportunity to have an independent assessment of what otherwise we are totally dependent on," he said, "which is the judgment of the doctors who are actually providing the treatment."

House Speaker Salvatore F. DiMasi said yesterday that two committees are investigating the prescription of psychotropic drugs to children.

"The death of a child is always a tragedy, but the facts that have emerged so far surrounding the senseless death of Rebecca Riley are particularly gut-wrenching," he said in a statement.

On his first "Ask the Governor" call-in program on WTKK radio yesterday, Governor Deval Patrick called Rebecca's death "a terrible, terrible case." But he said that DSS manages other tough cases well and that "I want to be careful not to attack the whole agency."

Maria Cramer can be reached at mcramer@globe.com.