Kifuji on the Defense

The controversial Dr. Kifuji, prescribing psychiatrist for Rebecca Riley, appears to have evaded any criminal responsibility by exchanging her testimony for immunity. She is, however, up against a malpractice suit and some of the things that have come up are startling in terms of just how Rebecca’s very early death transpired and the role Kifuji played in all of it. I know I’ve brought up the doctor’s role in this before but every new fact that comes out is more frightening and infuriating than the last.

The Patriot Ledger ran an article that covers many of the almost too-bad-to-be-true circumstances that point to the fact that if Rebecca and Dr. Kifuji had never met, Rebecca might still be here. Regardless of your opinions on children and drugs, this case was wrong all around and the result of at least three people’s indefensible actions. Kifuji was more a drug dealer than a psychiatrist and while that’s not particularly uncommon, the young ages of her patients makes her a standout, even among the over-drugging crowd and the predictable end result in Rebecca’s case shows her to be  both reckless and ill qualified.

From the Patriot Ledger article:

Years before she became a board-certified psychiatrist, Dr. Kayoko Kifuji was diagnosing children as young as 2 as bipolar and hyperactive – and prescribing powerful cocktails of mood-altering drugs to quiet them.

By the time Kifuji finally passed the psychiatric board exam – on her fourth try – one of her youngest patients, Rebecca Riley, had a little more than a year to live.

The lack of involvement on Kifuji’s part was shocking. She saw Rebecca primarily for twenty minute sessions to adjust doses. Often she just used these sessions to put on paper her approval for the adjustments her mother was already making, having increased doses on her own and experimented with drug cocktails using drugs prescribed (also by Kifuji) to Rebecca’s siblings.

She relied almost exclusively on what Carolyn told her about the kids when diagnosing them and ordering increasing amounts of drugs for them.

Kifuji also trusted the mother to keep tabs on Rebecca’s heart rate and blood pressure for signs of problems with the four drugs she was on. Kifuji, a pediatrician who later became a psychiatrist, told Novotny during the deposition that she didn’t realize she had a blood pressure cuff in her office and could check the girl’s vital signs herself until after Rebecca was dead. She said she didn’t take Rebecca’s pulse with her fingers because Carolyn Riley told her the child’s pulse “was within normal range.”

Even a well intentioned mother shouldn’t be solely in charge of monitoring a child’s heart rate and blood pressure let alone a woman hell bent on gaining access to more and stronger drugs at the expense of her daughter’s health. Also, any pediatrician turned psychiatrist should think of performing such simple tasks as second nature. If not that, then what is a doctor for? How do you not even know you have basic medical equipment in your office? How does a doctor fail to check a child’s pulse? Oh, that’s right — her mother said. If that’s all there is to doctoring, it’s no wonder some might see her as just a drug dispenser. They can do the rest at home, it’s a mere technicality that you must be licensed to prescribe.

• Asked why she didn’t report Carolyn Riley to child welfare authorities after learning that the mother had increased the children’s doses at least twice without checking with her first, Kifuji said: “I just can’t report to the DSS. I need to … my role is to work with the parent and not judging them.”
• Asked if she ever told Carolyn not to give Rebecca cold medicine on top of all the drugs the child was on, Kifuji says no, “but it’s because Rebecca didn’t get sick, and I was never asked ”

Right — let a mother chemically abuse and experiment on a child but whatever you do, don’t judge and certainly don’t  give them any more information than they asked for. The article goes on to point out other times that Kifuji refilled prescriptions before they should have run out, never asking for an explanation, just dishing out more and more drugs.

She prescribed clonidine – the drug that killed Rebecca – during the child’s first visit to control the “impulsivity” that Carolyn Riley described. Rebecca was 2 at the time.

Impulsivity at two hardly makes a child a psychiatric oddity but when you look at some of her notes regarding Rebecca’s apparently troubling behavior it’s easy to get the notion that Kifuji sees childhood as a disorder unto itself.

“Then consistently hyper all the time. Climbs up to top of jungle gym without any fears and thinking. Gets into everything. Just walk up to someone and smack them. Never gets aggressive. Hits kicks and spits when she’s being disciplined and laughs. Started to say things scared her. Whines and fusses a lot.”

Kifuji described the toddler as dysarthric, meaning she could not properly pronounce some words.

“A bit tired since yesterday. Coming down on flu. Fine as long as she takes clonidine. Sleeps throughout. Without clonidine gets very hyper and impulsive.”

“Climbs up on top of bureau. Tantrums or sobbing when she was told to clean up her toys” and “she wasn’t listening to her mother.”

This child was drugged for one reason — she was stricken with a case of toddlerhood. Dr. Kifuji seems to see no distinction between behavior and disease. Now that psychiatry has largely gotten away from talk therapy, we’re supposed to see psychiatrists as doctors of the brain — linking behavior to dysfunction in the brain. If that’s the case, Kifuji doesn’t make it very well. She’s like a mad scientist but without the science.

She explained that some researchers believe the area of the brain called the amygdala is different in people with bipolar disease. But she admitted she didn’t know where the amygdala is in the brain.

Of course you don’t need to know the brain at all to dispense drugs in the manner that Kifuji had begun making a career of (there is a timeline of Rebecca’s “treatment” at the bottom of the article). You only need to know that if you sedate a child enough, you can drug the behavior out of them. Sure, that child may be a “floppy doll” sitting in the corner but a quiet floppy doll and certainly not disruptive and if enough people will pay you to drug the childhood out of their children to one extent or another, then you’re in business.

Yes, the parents physically gave the drugs to Rebecca but they were used as a weapon and that weapon was provided by Dr. Kifuji. If she had given them a blackjack instead and told them how many times you have to hit a kid for effective behavioral treatment, this would be a different case entirely. Our view of prescribed medicine as care makes us resistant to the notion that drugs can be poison but they clearly can be and often are, particularly with psych drugs. When this happens, we need to respond accordingly.

There are no less than three guilty parties here in a case of chemical assault that ended in a child’s death. It’s bad enough that Dr. Kifuji was granted immunity making it impossible to hold her criminally accountable, even as more facts come to light pointing to her role not in anything resembling care but in a death. If she is not held civilly and professionally accountable, we’re saying her actions are acceptable, even desirable and we’re signing off on a prescription for some seriously detrimental treatment. I’m relieved to see she’s at least going to be made to answer for her actions. She’s certainly got a lot to answer for in this suit. Now we’ll have to wait and see what passes as accountability these days.

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Michael Riley Convicted

…and Dr. Kifuji might not be off the hook after all. In a clear case of parents’ drugging of their children that’s gone beyond abusive, first Carolyn and now Michael Riley have been convicted of murdering their four year old daughter. From the Boston Globe:

Capping one of the most unusual child abuse cases in Massachusetts history, a South Shore father was convicted yesterday of first-degree murder for killing his 4-year-old daughter with an overdose of a psychotropic drug, which he and his wife had nicknamed “happy medicine’’ and routinely dispensed to their three children to manage their day-to-day behavior…

Prosecutors said Rebecca’s parents fabricated their children’s behavioral problems, making up reports of hallucinations and violent outbursts, in order to obtain drugs to sedate them and to help them qualify for government benefits for families with disabled children.

To be clear, we’re not talking about a couple of parents who might have overdone it or a child that had a freak response to slightly liberal drugging. The Rileys did all they could to obtain drugs and when they had them, they used them to poison their children into a state of quiet compliance. Rebecca was on psychotropic drugs since she was two, as were her siblings. In addition to the chemical abuse, Michael was also physically abusive and had even been removed from the home when charged with attempted rape, indecent assault, battery and giving pornography to a minor — his stepdaughter. He returned just two weeks before Rebecca died.

When you have a family so abusive, broken and damaged that a father that could do that sort of thing and be welcomed back to the home — with the children and by the mother — what sort of care can we expect them to give to their children’s minds and how could anyone think they would act responsibly with such powerful drugs that should never have been given to them in the first place? One way that at least one part of a host of problems could have been eliminated would have come down to a responsible doctor. There was none. Not only was Dr. Kifuji aware of Michael’s abuses, she was instrumental in his returning to the home.

A Weymouth Housing Authority manager testified that Michael Riley, 37, had been banned since 2005 from spending overnights in the family’s apartment there, the result of pending charges that included providing pornography to a minor. A social worker said the father’s alleged beating of his son in 2006 triggered a renewed child-abuse investigation, and the mother, while remaining devoted to the father, filed a restraining order to protect the boy. A house guest also testified that the Rileys’ three children often seemed “more timid’’ when their father was around…

Kifuji diagnosed at least two of the Riley children, while toddlers, with mental disorders after only a one-hour consultation, did not order appropriate blood work while they were on potent pills, and seemingly ignored input from preschool teachers and other clinicians who said the children seemed weak and overmedicated.

It looks like Kifuji might still have to answer for her beyond liberal dispensing of drugs and her negligent psychiatric “care” after all — and why shouldn’t she? While she may not get the full measure of the law, she may have to start worrying about her status as a psychiatrist. For the sake of the children she’s still seeing at Tufts, one can only hope.

After the verdict, Plymouth District Attorney Timothy J. Cruz said he plans to ask the Board of Registration of Medicine to reopen its investigation of Kifuji, who he has said turned a blind eye to the numerous signs that the parents were troubled and reckless in dispensing drugs.

“Dr. Kifuji is unfit to have a medical license,’’ he said. “If what Dr. Kifuji did in this case is the acceptable standard of care for children in Massachusetts, then there is something very wrong in this state.’’

Kifuji testified in both cases, but only after being granted immunity from prosecution.

Cruz said he plans to assemble the transcripts of her testimony, among other things, to present to the licensing board. That information, prosecutors said, showed negligence in how she assessed and followed patients, not just that she subscribes to the controversial belief — as do some other prominent psychiatrists — that toddlers can be diagnosed with bipolar disorder.

The Rileys are certainly near the end of the spectrum of child drugging and the severity of this case makes it seem like a singular event. It is not. Instead of just focusing on the severity of this one instance, we should question the culture of drugs and control that has allowed us, even in much milder and seemingly harmless instances, to use drugs to turn off the part of children that makes them children. In so many instances, we’ve gone well past the point of not letting kids be kids to not letting kids be human

This is an extreme and terrible case with the Riley children being drugged, one of them to death, in order to keep them under control from the time they were toddlers — not for acting out, not for being out of control kids but for being children. In the end Rebecca Riley was given a lethal dose of Clonidine, a blood pressure medication used off label to treat withdrawal from narcotics and alcohol, for crying out for her mother while she struggled with pneumonia.This is tragic and disgusting every way you look at it.

Jurors Speak Up with Hands Tied

In a break from the typical dismissive response to death by psych drugs, which is to assume everybody did their best and a bad but faultless thing happened, jurors in the Carolyn Riley case are outraged at the conduct of Dr. Kayoko Kifuji. Rightly so. Kifuji diagnosed children as mentally ill for exhibiting the defining behaviors of childhood. She Diagnosed a three year old child with pediatric bipolar disorder (which was absent from the DSM draft released the day after the conviction). She passed out cocktails of serious drugs to two year old children like they were Flintstone’s vitamins — drugs that aren’t approved for use in children and are usually used judiciously even in adults. She let the parents experiment on all of their kids with these drugs and, following their lead, prescribed per those experiments — so yes, the jury was outraged.

From the Boston Globe:

“Every one of us was very angry,’’ said one juror, who requested anonymity to avoid retaliation for her role in Tuesday’s second-degree murder conviction of Carolyn Riley. “Dr. Kifuji should be sitting in the defendant’s chair, too.’’

Another juror said that while the 12-member panel found that the 35-year-old mother was primarily responsible for Rebecca’s death, many jurors were “off the wall’’ when they heard the testimony of Dr. Kayoko Kifuji of Tufts Medical Center. She said they were struck by how quickly Kifuji diagnosed Rebecca with bipolar and hyperactivity disorders, as well as how little the doctor seemed to supervise the mother’s dispensing of medications.

“It blew me away,’’ said that juror, who asked to remain unidentified for fear of reprisals.

Rebecca’s psychiatrist was the focus of some of the most powerful reactions from the jurors after a three-week trial that left them emotionally and physically exhausted.

Not only has she not been convicted of a crime, she will go undisciplined by courts and the medical establishment even outside of the criminal trials surrounding the Rebecca Riley case which can only add to the frustrated outrage of the jurors.

Other than the nationwide publicity given to the Riley case, in which Kifuji is mentioned repeatedly, the only overt sign that Kifuji had potentially questionable conduct is on the Board of Registration of Medicine’s website…Still, when asked if the board’s investigation concluded that Kifuji acted within acceptable medical standards, spokesman Russell Aims responded by saying that the board “closed the complaint against Dr. Kifuji without discipline.’’ He said the board, however, “reserves the right to reopen a case if new information comes to light.’’

The psychiatrist will not face criminal prosecution. A grand jury last summer declined to indict her, and Kifuji testified in Carolyn Riley’s trial only after being granted immunity from prosecution.

Prosecutors contend the Rileys “duped” Kifuji into authorizing the drugs but that doesn’t say much for her as a doctor does it? “Duped” doesn’t begin to explain diagnosing toddlers as bipolar, her cavalier approach to diagnosing and prescribing in general or her indifference to the misuse of drugs like depakote and clonidine. Kifuji had access to Rebecca herself, providing ample opportunity to make her own assessments. She chose instead to go on the word of the parents in brief and drug centered visits. She admitted that she found the Rileys’ actions unsettling. Maybe they were just not unsettling enough to interfere with business. While the prosecution and Kifuji’s lawyers tried to paint her as the good and upstanding doctor who got fooled, in the end she comes out looking like the prime example of psychiatrist-as-drug-dealer — not unlike the physician in every town that addicts know to visit for his liberal dispensing of narcotics — and the Rileys were repeat business. If you’re going to hand out drugs that easily, without concern for how they’re being used and on whom, you don’t get to claim ignorance.

In a country where a gun manufacturer or salesperson can be held responsible for the crimes of someone who legally buys or even steals a handgun (which I’m against), it’s shocking that Kifuji is able to walk away from this without penalty. She is a doctor and with that paycheck and perceived authority comes an obligation to think past the drugs that keep you in business and consider the well being of the people in your care. I sincerely hope her other child patients fare better but it doesn’t seem likely. The only things that seem to have changed for Kifuji since Rebecca’s death are the amount of attention she’s received and a new sense of impunity.

Carolyn Riley Convicted

Well, the verdict is in. Carolyn Riley has been found guilty of second degree murder in the prescription drug induced death of her four year old daughter, Rebecca. I don’t know where to begin or what to say, really. We’re not talking about a child who had a freak reaction to a medication. Rebecca was a child abused with massive amounts of powerful drugs as a result of scheming parents and a negligent doctor and ultimately given an overdose of a sedative she never should have had. The Riley parents fabricated lists of symptoms for their children in order to get drugs to sedate them and when one of them, Rebecca, got pneumonia, they responded with more sedatives to quiet her complaints. When you have two parents who put all of their kids on heavy psych drugs at the age of two in order to control them, a doctor who sees diseases in the most basic childhood behaviors but not abuses when they are laid out in front of her and almost nobody paying attention, things turn horrible in no time at all — and that’s just the overview. The closer you look, the uglier it gets. I don’t even know how to approach some of the things that came to light during the trial but I have to wonder how many red flags have to be ignored before it all comes down to the death of a toddler diagnosed first as having attention deficit disorder, then at three, bipolar disorder — all for acting her age.

Boston Globe on the conviction: (emphasis mine)

A South Shore mother was found guilty today of second-degree murder in the death of her 4-year-old daughter who never woke up one night in December 2006 after ingesting toxic levels of psychotropic drugs…

The case had drawn national attention to the growing use of psychotropic drugs on very young children. When Rebecca died, she and her two older siblings were all on three potent psychiatric medications for bipolar and hyperactivity disorders. All of them went on those medications at age 2…

Prosecutors…depicted Carolyn Riley as an unusual type of child abuser, a woman who routinely overused sedating psychiatric pills to control her energetic toddlers and induce sleep. Prosecutors said she went to a lethal extreme in the hours before her daughter died on Dec. 13, 2006, dispensing as much as twice the girl’s daily dosage of clonidine at once as the girl was already battling a respiratory illness…

Prosecutors said the mother also had a scheme to obtain federal disablity checks through fraudulent claims that her children were mentally disabled…The state asserted that Carolyn Riley always put her husband’s needs over her children’s, and the night Rebecca received her fatal overdose, the husband was irate about the sick child’s repeated efforts to enter her parents’ bedroom, moaning, “Mommy … Mommy.”

and on the doctor: (who is still practicing and faced no charges)

Dr. Kayoko Kifuji acknowledged that when she first met Rebecca Riley, at age 2, she had initially diagnosed her with having attention-deficit hyperactivity disorder after only a one-hour meeting. She authorized the mother to give one prescription tablet of clonidine, a sedative, each night. But within a few days, Carolyn Riley acknowledged she was giving the girl two full tablets.

“Did she ask for you to authorize the double dose?” asked Plymouth First Assistant District Attorney Frank J. Middleton Jr.

“No,”

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.

And what transgressions they were. While the whole situation speaks volumes about the Riley parents, Kifuji is no saint in all of this. Diagnosing toddlers as mentally ill and putting them on adult psychotropics is disturbing enough but to turn a blind eye to blatant chemical abuses against children is reprehensible. It could have all been over if she had put the brakes on then — but that’s not how she does things.

…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.

What more can I say? This child didn’t stand a chance. Her father, Michael (another saint) will be tried separately for the same charges.