Doctor says mother gave child double dose at times

Despite these admissions, Dr. Kayoko Kifuji of Tufts Medical Center said she was justified in prescribing potent psychotropic drugs for the girl at age 2 and trusting that the mother would generally administer them appropriately.

Kifuji told jurors at Carolyn Riley’s first-degree murder trial in Plymouth Superior Court that she realized that it can be “concerning’’ when young children are given mood-stabilizing medications, but defended her decision to ultimately put Rebecca on three drugs for bipolar and hyperactivity disorders.

“Based on her diagnosis, I felt confident prescribing these medications,’’ Kifuji said, frequently referring to written notes to refresh her memory.

Kifuji, who appeared on the stand yesterday only after the state granted her immunity from prosecution, was one of the trial’s most-anticipated witnesses. Carolyn Riley has been charged, along with her husband, with giving Rebecca a fatal overdose in December 2006. Michael Riley will be tried separately.

During more than five hours of testimony yesterday, the 55-year-old psychiatrist said that she initially diagnosed Rebecca with hyperactivity disorder and prescribed sedating medication, clonidine, after a one-hour consultation with her and her mother in August 2004. Kifuji acknowledged, under questioning, that she made this decision without consulting other clinicians or preschool staff who knew the child. She said she relied heavily on her mother’s accounts of aggressive behavior, sleep problems, and a family history of mental illness.

Kifuji took a similar diagnostic approach during her treatment of Rebecca’s sister, Kaitlynne, according to her testimony. In April 2003, the doctor diagnosed Kaitlynne, then age 2, with bipolar illness and put her on the medication Depakote after a one-hour session with the mother and child.

In both cases, Kifuji appears to have based her medical decisions almost purely on Carolyn Riley’s statements, even after the mother revealed that she had given her children extra medication on occasions.

First Plymouth Assistant District Attorney Frank J. Middleton Jr. has portrayed Kifuji 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 parents.

Prosecutors say Rebecca’s parents concocted behavioral problems for their children and used Kifuji as a way to get “happy medicine’’ or “sleep medicine’’ for the youngsters and to help the struggling family qualify for disability benefits.

Kifuji, who received her early medical training in Tokyo before coming to the United States in the mid-1990s, had also faced potential criminal charges for her role in Rebecca’s death, but, after a lengthy investigation, a grand jury last summer declined to indict the doctor.

After that announcement, Kifuji resumed seeing patients 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. The Board of Registration in Medicine agreed last year to allow her to return to practicing psychiatry.

Kifuji still faces a medical malpractice lawsuit filed by the estate of Rebecca Riley.

Rebecca died of an alleged overdose of psychotropic drugs on Dec. 13, 2006, according to a state autopsy report. The defense has argued that the girl died of rapid-onset pneumonia and that Carolyn Riley routinely followed the doctor’s orders in dispensing medications to her three children, all of whom were diagnosed with bipolar and hyperactivity disorders and seen by Kifuji.

As described by Kifuji yesterday, her psychiatric practice seemed focused on pharmaceutical approaches, with far less attention paid to direct conversations with her young patients or probing the child’s family background for signs of emotional strife or financial hardships that could affect their lives.

Kifuji acknowledged that she did not seek input from Rebecca’s preschool teachers or social workers, many of whom described her as sweet and cuddly but sometimes overmedicated; and she rarely spoke to Rebecca’s father or other doctors.

Kifuji also revealed yesterday that the mother frequently increased dosages of medications, and even introduced new ones, without the doctor’s authorization. Kifuji said she warned the mother not to do that in the future, but also sometimes made official what the mother had been doing informally.

For instance, Rebecca was initially prescribed one tablet of clonidine, a sedating, mood-stabilizing drug each night.

But within a few days, Carolyn Riley acknowledged she was giving the girl two full tablets. Eventually, Kifuji said, she authorized that dosage each night.