Psychiatrist testifies in Mass. trial of mom accused in drug overdose of toddler

Mass. psychiatrist testifies in mom-overdose trial

BROCKTON, Mass. — A psychiatrist for a 4-year-old girl whose mother is accused of giving her a fatal prescription drug overdose acknowledged Monday that she repeatedly increased the dosages after the mother reported the girl was aggressive and had trouble sleeping.

Dr. Kayoko Kifuji, testifying at Carolyn Riley’s murder trial under a grant of immunity from prosecutors, said she diagnosed Rebecca Riley with attention-deficit hyperactivity disorder after meeting her once in August of 2004, when the girl was 28 months old.

Nine months later, shortly after Rebecca turned 3, Kifuji said she diagnosed her with bipolar disorder after her mother, Carolyn Riley, told Kifuji that the girl suddenly started having mood swings.

Kifuji said she approved higher and higher dosages of psychotropic drugs for Rebecca, even after Carolyn Riley told her she had increased the doses on her own without first seeking her approval.

“I told her that it was necessary for her to discuss any change of the medication in any of her children before she does that,” Kifuji said.

Prosecutors allege that Carolyn Riley and her husband, Michael, routinely overmedicated Rebecca and her two siblings to keep them quiet and out of their way. They also claim that Carolyn Riley fabricated symptoms of mental illness in Rebecca in an attempt to get mental disability benefits from the federal government.

The Rileys, who are being tried separately, insist that they followed Kifuji’s advice in the amount of medication they gave their daughter. The defense maintains that the girl died in December 2006 of a fast-moving pneumonia, not a drug overdose.

According to a state medical examiner, Rebecca died of a combination of Clonidine, a blood pressure medication the girl had been prescribed for ADHD; Depakote, an antiseizure and mood-stabilizing drug prescribed for bipolar disorder; and two over-the-counter drugs, a cough suppressant and an antihistamine.

The girl’s death reignited debate in the psychiatric community about whether young children can accurately be diagnosed with bipolar disorder and whether they should be given powerful psychiatric drugs typically used by adults.

Kifuji, a staff psychiatrist at Tufts Medical Center, had faced possible criminal charges after Rebecca died, but after a long investigation, a grand jury refused to indict her. She has denied any wrongdoing.

Kifuji was granted immunity by prosecutors after she told the judge — with the jury out of the room — that she would invoke her Fifth Amendment right against self-incrimination.

At times during her testimony, it seemed like Kifuji was on trial as Assistant District Attorney Frank Middleton aggressively questioned her about the large number of pills she prescribed for Rebecca, even after she received calls from a school nurse and social worker who said they were concerned that the girl appeared lethargic and overmedicated.

Kifuji said Carolyn Riley told her repeatedly that her daughter would hit, punch and scratch her siblings, and that she had a severe sleep problem.

Kifuji said she did become concerned after the Rileys’ pharmacy called her to report that Carolyn had sought more Clonidine by claiming she lost one bottle of pills and ruined another bottle by getting water inside it. After that, Kifuji said she began prescribing Clonidine in 10-day supplies instead of 30-day supplies.

Middleton focused on a visit to Kifuji’s office on Dec. 7 — six days before Rebecca died — when Carolyn Riley reported that her daughter was “doing really well.”

Kifuji said she discussed tapering Rebecca off Clonidine at her next visit, if she was still doing well.

Middleton asked Kifuji if, at that point, she was concerned that Rebecca was still on such high dosages. He calculated that during that last visit, Kifuji authorized prescriptions for a total of 835 pills, which included two months worth of three different medications.

Kifuji said she believed Rebecca needed those dosages to control her symptoms.

“I felt comfortable in prescribing those medications,” she said.

When Middleton asked her if 835 pills was her idea of “tapering” the drugs, she pointed out that the Rileys were not able to get all the pills at the same time.

Kifuji is scheduled to continue her testimony Tuesday, when she will be cross-examined by Carolyn Riley’s lawyer.

Kifuji still faces a medical malpractice lawsuit filed by Rebecca Riley’s estate.