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Girl's death puts doctor at center of controversy

Questions raised on prescriptions

Six years ago, an 11-year-old boy from Belchertown was experiencing wild mood swings. Counseling sessions did not calm his sometimes violent eruptions. Then one day, the child and his mother walked into the Springfield office of Dr. Kayoko Kifuji, a petite, soft-spoken child psychiatrist who had come to the United States from Japan six years earlier.

She listened intently to Griffin Reid and his mother, taking particular interest in their family history, which included mental illness. Soon, the doctor diagnosed the boy with early signs of bipolar disorder, his mother said. Within a few sessions, the doctor wrote prescriptions for mood-stabilizing drugs. Now, Griffin, 17, is on lithium pills under Kifuji's care and credits the psychiatrist with giving him a future.

"I probably would be kicked out of school by now if she didn't come into my life," Griffin said.

Kifuji and her prescription pad are now at the center of controversy, following the death of one of her youngest patients, a 4-year-old Hull girl who police say died from an overdose of a sedating drug used for bipolar disorder. The parents of Rebecca Riley are accused of intentionally over-medicating the girl and were charged this month with first-degree murder.

Prosecutors have not said whether Kifuji is a target of a criminal probe, saying only that their investigation into the girl's death remains open. Kifuji began treating Rebecca for bipolar disorder and attention deficit hyperactivity disorder starting at age 2 1/2 , and had prescribed three psychotropic drugs. She also treated her two older siblings for similar psychiatric problems.

The State Police have questioned Kifuji about what kind of instructions she gave to Rebecca's mother about dosages, and how closely the doctor monitored how often the prescriptions were being refilled. The psychiatrist, who is now on staff at Tufts-New England Medical Center, has voluntarily suspended her practice while the state's medical licensing board investigates the case.

Kifuji and her attorney, J.W. Carney Jr., declined to comment for this article.

Many who know her describe Kifuji as a compassionate, hard-working doctor who listens carefully to patients and parents. The 52-year-old clinician began training as a child psychiatrist relatively late in her career. In her research, she has explored the biological origins of psychiatric illnesses, putting significant emphasis on family history in treatment.

Since coming to the United States in 1994, she has thrown herself into work inside one of the city's major teaching hospitals, winning the affection of many colleagues, staff, medical students, and patients who praise her dedication.

"She works longer hours than anyone in the department," said Dr. Bernard Katz, a retired psychiatrist at Tufts-New England Medical Center who hired her. "And she takes pride in it."

After Rebecca's death, many parents who have brought their children to Kifuji say her reputation has been unfairly tarnished when the blame should fall solely on Rebecca's parents. Top officials at Tufts-New England have defended the doctor.

Some doctors object to the suggestion that Kifuji relied too heavily on medication in treatment, and point out that nearly all of today's child psychiatrists prescribe medications to treat severely disturbed young children, after other therapies fail. And because so few psychotropic drugs are approved by the government for use by children, psychiatrists often have little choice but to utilize low doses of the drugs made for adults.

The children Kifuji sees, said Katz, have serious behavioral problems and often come from troubled families. Those who criticize her do not realize her deep desire to end the children's suffering. But others say Kifuji was known to pursue pharmacalogical treatments more quickly than others in the field. One doctor, who knows her professionally, said she was the psychiatrist to whom you would refer patients you thought needed psychotropic medications, as opposed to more of the "talking approach" treatment.

"She was someone who was an expert in psychopharmacology," said the doctor, who asked not to be identified because he does not want to be drawn into the controversy about her case.

Dawn Bruneau, a mother of four from Chicopee, said she stopped bringing her 8-year-old son to see Dr. Kifuji in 2003. She said Kifuji diagnosed her son at age 7 with bipolar disorder, which has been confirmed by other psychiatrists. But Bruneau said Kifuji, then in Springfield, was particularly aggressive in proposing multiple medications early on, which Bruneau believed worsened her son's symptoms or caused no improvement.

"I was uncomfortable with the pushing of the medications," she said.

Bruneau said she ultimately switched to another psychiatrist, whose more restrained approach to medications led to an improvement in her son's behavior.

Harry Spence, the commissioner of the Department of Social Services, has said that an independent review by Children's Hospital of Kifuji's prescriptions for Rebecca, requested by the agency after the girl died, found the medication amounts to be "inappropriate."

The State Police investigator's report said 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 drugs have not been tested and approved by the federal government for psychiatric use in children, but the law does not stop doctors from prescribing these and other drugs to children if they do so safely based on their medical judgment.

The police report also outlined a distressing pattern of Rebecca's mother's ability to obtain re fills of her medications, even when some pharmacists and a local therapist, who worked with the Riley family, raised questions to the doctor about the girl's medications. Michael Bourbeau, attorney for Rebecca's mother, said the mother insists that Kifuji sanctioned the giving of an extra dose of clonidine, the drug blamed in her death, if the girl had trouble sleeping at night. Kifuji has vehemently denied that during interviews with police.

Kifuji moved into child psychiatry after working for about a decade as a pediatrician in Japan, with a specialty in treating allergies. At Tokyo Women's Medical College, she earned her medical degree, as well as a doctorate in medical science. Just before her 40th birthday, she came to Boston to participate in a rigorous triple-board residency program at Tufts-New England. It took five years and she was eventually licensed to practice pediatrics, child and adult psychiatry.

In 2000, Kifuji went to Springfield to Baystate Behavioral Health, a community mental health clinic serving children and families, where she worked until 2003. She chose Springfield, in part, because her visa to study in this country required her to spend a certain amount of time working, after training, in an area with a shortage of child psychiatrists, Katz said.

In the summer of 2003, she returned to Tufts-New England as a staff psychiatrist, where she also pursued research and teaching. Last year she co authored a paper on medical conditions with psychiatric manifestations, and recently became a member of the Academy of Psychosomatic Medicine, an organization for psychiatrists with an interest in patients who suffer combined psychological and general medical illnesses.

Numerous parents say they are grateful to Kifuji for stabilizing their children's troubled behavior, which enabled their young ones to focus on school and make friends.

A 34-year-old Waltham mother said until she met Kifuji, she could not find a child psychiatrist in Boston who would see her 2-year-old son. She said he was suffering from severe anxiety due to his Fragile X syndrome, a genetic condition that can lead to severe disabilities. She said her son was a "nervous wreck," biting his fingernails to the point of bleeding.

"In a city known for its medical prowess, there was no medical professional willing to speak to us about psychiatric issues for toddlers," said the mother, who asked to remain nameless to protect her son's privacy.

When she brought her son to see Dr. Kifuji in Boston during the past year, the doctor conducted a thorough examination of the boy and listened to a detailed account of his behavior. She soon agreed to try him on a low dosage of risperidone , an antipsychotic medication sometimes used for behavioral problems in children. She said, within two weeks, the boy's anxiety decreased significantly. "It was like night and day," she said.

It remains unclear exactly what prompted Kifuji to travel across the Pacific Ocean to change medical specialties, and establish a new life in America. Kifuji is the primary breadwinner in her Somerville home because her husband, a writer, has been struggling with significant medical problems, Katz said. Kifuji does not have children of her own, but has worked hard taking care of other people's children, particularly highly troubled children from difficult family situations, colleagues say.

"Kayoko was treating these very unstable families that nobody else would treat," Katz said.

Patricia Wen can be reached at wen@globe.com.

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