Psychiatrist admits she approved higher drug dosage in Riley trial

Based on the doctor’s three hours on the witness stand this morning, Kifuji came off as a clinician who seemed to follow the lead of the 35-year-old Hull mother in treating her children.

Carolyn Riley is charged with first-degree murder in the death of her youngest daughter, 4-year-old Rebecca, and the girl’s father, Michael Riley, also faces the same charges, but is being tried separately.

This 55-year-old doctor has been the most-anticipated witness in this case that has generated nationwide controversy over the use of mood-altering drugs on very young children. Her testimony today was her first public statements in this case.

Prosecutors portray her as operating on the fringe of the medical profession, quick to prescribe
potent drugs for toddlers, and shockingly gullible to what the government says were the schemes of troubled, mercenary parents.

They say Rebecca's parents made up behavioral problems in their children, using this clinician as a way to get "happy medicine" or "sleep medicine" for the youngsters, and to help the struggling family qualify for disability benefits.

Rebecca died of an alleged overdose of psychotropic drugs on Dec. 13, 2006, according to a state autopsy report. The girl’s father, Michael Riley, has also been charged with first degree murder. He has pleaded not guilty and will be tried separately.

Carolyn Riley's defense has argued that the girl died of a rapid-onset pneumonia, and that Carolyn Riley routinely followed the doctor’s orders in dispensing medications to her three children, all of whom were eventually diagnosed with bipolar and hyperactivity disorders, and seen by Kifuji.

The relationship between Kifuji and Carolyn Riley was portrayed today as relatively minimal and business-like, resulting in the psychiatrist exhibiting a high degree of trust in the mother’s account of her children’s behavior, as well as a willingness to look past obvious transgressions committed by the mother in her dispensing of medication.

For instance, the two met each other for the first time in April 2003 when Carolyn Riley brought her older daughter, Kaitlynne, then 2, to see Kifuji who was then practicing at a clinic a Bay State Medical Center in Springfield.

After a one-hour meeting in her office, the psychiatrist diagnosed Kaitlynne as having bipolar illness and immediately prescribed Depakote based largely on the mother’s depiction of the girl as physically aggressive to her older brother, and the girl saying she sometimes saw “monsters” and “ghosts.”

Over the next several months, as the mother reported Kaitlynne having continued problems, including sleep issues, the psychiatrist raised the possibility of adding clonidine. At that time, the mother acknowledged she had already been trying out clonidine on Kaitlynne, having taken some of these prescription pills from a bottle designated for her oldest son, Gerard.

“Did that concern you?” the prosecutor asked.

“Yes,” Kifuji replied.

While Kifuji told Carolyn Riley that a parent cannot just introduce new medications without a doctor’s approval, the psychiatrist went ahead and added clonidine to Kaitlynne’s regimen of prescription pills.

Kifuji, who went through medical school in Toyko before coming to the United States in 1994 to pursue psychiatric training, had faced possible criminal charges after Rebecca died at her parents' bedside on Dec. 13, 2006.

Even if her diagnosis and treatment of Rebecca fell within the standards of care in her field, investigators looked into the extent to which she turned a blind eye to Rebecca’s mother’s alleged disturbing behaviors, such as repeating asserting she needed extra refills or describing extreme aggressive behavior in the child that her preschool teachers and social workers never observed.

But, after a lengthy investigation, a grand jury last summer declined to indict the doctor. After that announcement, Kifuji resumed her clinical practice at Tufts Medical Center, work that she had suspended as part of a voluntary agreement with the state's medical licensing board soon after Rebecca died. Still, however, she faces a medical malpractice lawsuit filed by the estate of Rebecca Riley.

According to a State Police report, Kifuji prescribed three medications for the girl: 750 milligrams a day of Depakote, an anti-seizure drug also used as a mood-stabilizer; 200 milligrams a day of Seroquel, an antipsychotic drug; and .35 milligrams a day of clonidine, a blood pressure drug also used as a sedative.

The autopsy report found that Rebecca died "due to the combined effects" of the clonidine, Depakote, and medications found in cold medicine.