Pathologist: Rebecca Riley died of pneumonia, toxic level of drugs

Vargas’s testimony also differs from the state autopsy report that did not mention pneumonia, saying instead that Rebecca died of a deadly mixture of psychiatric medications, specifically clonidine, as well as chemicals found in cold medicines.

The pathologist’s statements in the Plymouth County Superior courtroom of Judge Charles Hely set the stage for what is likely to be a battle of medical specialists in the days to come. Dr. Elizabeth Bundock of the medical examiner’s office may testify Friday.

While this case has drawn nationwide attention to the use of psychiatic medications on young children, the cause of death is a key to the government's first-degree murder case. Rebecca’s father, Michael Riley, faces the same charge, but is being tried separately.

Prosecutors are expected to argue that Rebecca’s parents repeatedly over-medicated their daughter with clonidine, and, in the hours before her death on Dec. 13, 2006, had given that drug to the girl in toxic amounts while ignoring her intensifying symptoms of pneumonia – vomiting, coughing, and an increasingly confused state.

Vargas did say that she thought the level of clonidine found in Rebecca’s dead body – 12 nanograms per milliliter – was in the toxic range and alone could have been fatal. However, she also said that the pneumonia was a type that is “overwhelming” and can also lead to death.

The girl was found dead next to her parents’ bed in Hull. Over her brief life, she had been on three psychiatric drugs. She was diagnosed by Dr. Kayoko Kifuji of Tufts Medical Center – the psychiatrist for all three of the Riley children. The girl was diagnosed with hyperactivity disorder at age 2, and then shortly after she was 3, with bipolar disorder.

Prosecutors contend that her parents fabricated behavioral symptoms in the girl to obtain drugs to sedate her, and to help the family qualify for federal disability benefits. Before Rebecca died, both parents and Rebecca’s two older siblings had received a total of about $2,300 a month in federal disability benefits related to mental disorders.

The parents had also been trying to obtain disability benefits for Rebecca but were twice denied.

Also today, Jeffrey Jampel, a Brookline psychologist who assists the Social Security Administration in evaluations, testified that during a 75-minute assessment with Rebecca and her parents on March 11, 2005, he observed an overall well-adjusted child who showed no signs of mental disability. He testified that he did not see any indication that Rebecca – then 2 – suffered from attention-deficit hyperactivity disorder. He also said that the mother did not indicate that the girl had aggressive or other extreme behaviors. His report contributed to the ultimate denial of benefits.

Two months after this meeting with Jampel, the mother took Rebecca to see Kifuji, according to testimony this week from Kifuji. At this visit on May 3, 2005, the mother told the psychiatrist that her daughter’s mood swings were extreme, and the child was driving her “crazy.” After that visit, Kifuji diagnosed Rebecca as bipolar and put her on stronger psychotropic drugs.