On that day, a little 4-year-old girl named Rebecca Riley died of an overdose after being diagnosed with ADHD and bipolar disorder by Dr Kayoko Kifuji, at Tufts New England Medical Center in Boston, and placed on a three-drug cocktail.
The legal filings in the criminal case that followed this tragedy show the other two Riley children, ages 6 and 11 at the time of Rebecca's death, also diagnosed with bipolar disorder and ADHD, and had been on the same three-drug cocktail for years, with all costs for Dr Kifuji's services and the drug prescriptions billed to Medicaid.
When investigators interviewed Dr Kifuji, she said Rebecca had been a patient since August 2004. She had based her diagnoses of the 28-month-old child on the "family mental illness history" as described by the mother, and "Rebecca's behavior" as described by the mother and "briefly observed" by Dr Kifuji during office visits, which "occurred from every two weeks to every other month and Rebecca's two older siblings were also seen," according to an affidavit filed by State Police Officer, Anna Brooks on February 5, 2007.
The filing shows that Dr Kifuji prescribed Depakote, an anti-seizure drug; Seroquel, an antipsychotic, and Clonidine, a blood pressure medication. None of these drugs were approved for pediatric use, together or alone, for any condition.
The parents, Carolyn and Michael Riley, were originally charged with first degree murder and accused of having Rebecca diagnosed mentally unstable to collect Social Security disability benefits and of intentionally giving her too much medication to cause her death. However, a Massachusetts judge has since lowered the charges to second-degree murder due to a finding of insufficient evidence of premeditation.
The prosecutor appealed the judge's ruling. However, the problem with the prosecution's theory is that, without a willing accomplice like Dr Kifuji, the Rileys' could not have set up this type of scheme.
When interviewed by police, Carolyn Riley described the daily regimen of giving the drugs to Rebecca. She said the child was prescribed 125mg Depakote sprinkle capsules to control her mood, with 3 in the morning and 3 at night. She would administer the drug by breaking the capsules open and sprinkling the contents on Rebecca's tongue, she said.
Seroquel was prescribed to help Rebecca calm down and stay asleep. She received 25 mg in the morning and 175 mg at night. Carolyn said Dr Kifuji also prescribed Clonidine tablets that dissolved instantly to help Rebecca calm down and sleep. She was given .1 mg tablets, which her mother would divide in half, so that Rebecca took a half tablet in the morning, a half at noon, another half tablet at 3:00 pm and two full tablets at bedtime.
In visualizing this child's drugging procedure, it's important to remember that the same medications also had to be doled out to the other two children every day.
Abundance of red flags
According to police reports, all three Riley children were visibly over-drugged. The neighbors described them as "zomebielike" and "robotic," and staff at Rebecca's preschool said she was like a "floppy doll," with tremors so bad that she could barely stand up at times.
The filings show Rebecca's teacher was repeatedly contacting the school nurse due to concerns over the child's flat affect and shakiness dating back to the spring of 2006.
The school principal reported that she had to help Rebecca get off the bus and walk up the stairs several times because the child was shaking so badly and that her face and hands were notably swollen and puffy.
The preschool staff told investigators that Rebecca was lethargic and listless every day when she arrived at school in the fall of 2006, but seemed to come alive at about two o'clock in the afternoon when the mediation wore off.
They recounted that Rebecca had a constant need to urinate but would void very little and was so weak that she could often not pull up her pants. They told police that Dr Kifuji said the need to urinate was caused by the medication.
The school nurse told investigators that she had informed Dr Kifuji that school personnel had never observed any behaviors in Rebecca consistent with a diagnosis of ADHD or bipolar disorder that would justify prescribing the three drugs.
Police interviewed a social worker who attempted to provide therapy to Rebecca and her sister once a week at their home from May 2006 through July 2006. The social worker was also concerned about the types of drugs and the amounts prescribed to Rebecca because "she found it unusual in her experience, especially since she did not observe any behavior consistent with the diagnosis," the filing states.
She recalled that both girls were frequently asleep when she arrived and she had "repeatedly urged Carolyn Riley to speak with Dr. Kifuji about lowering the dosage and variety of medication that Rebecca and her sister were on," it notes.
The social worker stated that "she never observed any aberrant behavior in Rebecca and really wanted to reduce her medication so they could work on her alleged issues and/or see evidence of the illness(es)," according to the filing.
She produced notes from a phone call to Dr Kifuji on May 24, 2006, in which she told the doctor about the side effects of the drugs and noted, Dr Kifuji "... also has concerns. Feels children require too much medication, did not want to give them that much but Mom kept saying children weren't sleeping, was hoping prescribing Depakote and then keep medications down..."
The medical examiner, Dr Elizabeth Bundock, told investigators that the amount of Clonidine alone in Rebecca's system was fatal. "She further noted that Rebecca's heart and lungs were damaged and found that this was due to prolonged abuse of these prescription drugs, rather than one incident," according to the filing.
In dying of an overdose of Clonidine, Dr Bundock stated that Rebecca would have died a slow and painful death:
"Her heart would not have pumped fast enough to circulate blood into her lungs and other major organs, causing these organs to slowly shut down. Her lungs would have gradually filled with fluid, resulting in pulmonary edema and congestive heart failure. The symptoms of pulmonary edema and congestive heart failure would include, pale, cool, clammy skin, a cough, uncontrollable at times, which would sound sharp."
"Towards the end of her life, Rebecca would probably have become incoherent as her organs began to shut down, her skin would have been pale and she would eventually lose consciousness."
"Rebecca would have become restless, uneasy and agitated towards the end of her life as she felt her lungs filling up, she would be gasping or breathing heavy and would sound like her chest was congested. Eventually she would die."
In the days before her death, relatives told investigators that Rebecca was vomiting, and would not eat or sleep, and became so disoriented and incoherent that she would not even answer to her own name.
The social worker told investigators that she had filed two complaints with the Department of Social Services in 2006. The first based on her observations that Carolyn was neglecting her children and "appeared heavily drugged and unable to respond." And a second after Rebecca's sister disclosed that Michael Riley had hit her.
Carolyn's brother and his girlfriend told investigators that they saw Michael grab Rebecca's brother by the neck and bang his head against the window of a pickup truck "in an apparent uncontrollable rage," the police affidavit reports.
Carolyn obtained a restraining order against Michael in October 2006, but allowed it to lapse a few weeks later.
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The Department of Social Services removed the two older Riley children from the home when Rebecca died and placed them in foster care.
Next Week: Betrayal of innocence, Psychiatric Drugging of Children Intolerable--Part 3.
This report was written as a 3-part series (click here to read Part 1) by Evelyn Pringle as part of the Pharmaceutical Litigation Roundup series and sponsored by the Baum, Hedlund, Aristei & Goldman law firm. Pringle is a columnist for Scoop Independent News and an investigative journalist focused on exposing corruption in government and corporate America .