Name: margalit
Location: Massachusetts, United States Professional writer, educational advocate, opinionated ultra liberal mother of 18 year old twins, living life in the slow lane due to hypertrophic cardiomyopathy, congestive heart failure, and diabetes.

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Wednesday, February 07, 2007

Beyond all understanding (Updated)

Yesterday a story broke in Boston that has me absolutely furious. A couple were arrested for obstensibly killing their 4 year old daughter with drugs. Not illegal drugs. No cocaine in that household. With drugs prescribed for this child, and her two siblings. Very hardcore drugs for bipolar disorder and ADHD. Drugs that were prescribed by a really terrible doctor from Tufts-New England Medical Center, Dr. Kayoko Kifuji. This is a board certified psychiatrist who gave this poor child a diagnosis of bipolar disorder and ADHD at 2.5 years of age. Unbelievable! Outrageous!

The parents, Michael Riley, 34, and Carolyn Riley, 32, of Hull MA, had three children. 4-year-old Rebecca Riley, and two siblings, a sister who is now 6 and a brother now 11. All of these children were diagnosed as bipolar by Dr Kifuji. All of them.

Prosecutors say the parents killed their daughter by regularly giving her drug overdoses, ostensibly to keep her calm and help her sleep. It was unclear yesterday how the family could have obtained so many psychotropic drugs for so long. The Rileys administered higher doses of the prescription drugs when Rebecca acted up or when they wanted her to sleep, police say in the 27-page affidavit. The affidavit says that investigators uncovered "an alarming pattern where the Rileys frequently seemed to run out of Rebecca's medication" and Carolyn Riley sought additional supplies, even when they didn't have a prescription.

The medical examiner's report indicates Rebecca died of intoxication caused by a combination of valproic acid, an antiseizure drug sometimes used in children to calm aggression; a cough suppressant; an antihistamine; and clonidine. She had also been prescribed Seroquel for bipolar disorder, but that was not found in her body.

Clonidine normally comes in tiny tablets, and a child might be started on a quarter of a tablet, said Dr Sam Kelley, a child psychiatrist and medical director of the Massachusetts Society for the Prevention of Cruelty to Children, who added that parents must very carefully administer the drug.

"It's a very small dose, highly monitored, because the drug can cause a dangerous drop in blood pressure, " he said. "And if you give two or three pills, it puts a child into coma."

In 2005, the state Department of Social Services began investigating whether Carolyn Riley had neglected her children. In June 2005, DSS ordered Michael Riley out of the home following allegations that he had sexually abused his wife's daughter from another relationship and said he was only allowed to visit the children under supervision by a social worker.

After Rebecca's death, the agency put Rebecca's siblings in foster homes and started investigating why Michael Riley was at the home unsupervised when she died.

So much about this story infuriates me. Why was a child this young prescribed such medications? Why was she given a diagnosis of bipolar disease when you can't even begin to diagnose it until much later on. Ditto for ADHD.

Granted, the parents are poor, uneducated, and probably following what a doctor told them because they didn't know any better. They didn't know to question this doctor's diagnosis, nor her treatment. Which is a terrible thing.

But on the other hand, it is apparent that they quickly learned that these meds can be used to keep a child quiet, and they used them inappropriately. Plus, they figured out how to obtain more drugs than they had prescriptions for by saying that they lost the bottle, or dropped them down the sink, or whatever. Which leads me to wonder why a pharmacist was allowing Mrs Riley to obtain more drugs than she had scripts for.

The biggest problem I have with this story is that the doctor wasn't prosecuted. I know nothing about this doctor other than what I've read and seen on the news, but geesh. Anyone who has a young child knows that a 2.5 year old is willful, and a 4 year old is argumentative and demanding. What else is new? To drug them and give them diagnosises that are ridiculous for a child that age is nothing but an invitation for a Tom Cruise intervention. What the hell was this doctor thinking?

I'm a parent of a bipolar child with ADHD. Nobody knows better than I do what it means to live with a kid that bounces off the walls, has deep depressions and some manic periods. My kid cycles pretty rapidly. Bipolar disorder is rampant in my family, and it isn't strange that I have a kid with this disorder. It runs in families. But my kid wasn't diagnosed until he was 11, and even that is controversially early. Had he not had the genetic component, the doctors would not have diagnosed him that young.

My son takes medications for his ADHD and bipolar disorder. Several of them. Several times/day. Those medications are life savers for my son. He honestly cannot function without them. It could take him hours to solve 10 math problems without his medications. I believe that used properly, such medications are safe for children to use. But never, NEVER for kids who are 2.5 years old. You can't diagnose a child that young. They barely have personalities of their own at that age.

What really angers me about this is that professionals, from the doctor to the pharmacist to the DSS social workers were involved with this family, and yet the child died of neglect. How does this happen? How did a child of 2.5 get Depakine, an anticonvulsant, prescribed for her. She isn't an epileptic. She didn't have convulsions or seizures. Why wasn't this questioned? What about giving her Seroquel, a neuroleptic which is an atypical antipsychotic drug. This is a drug used for mania in bipolar disorder. It is NOT safe for young children. Never mind a toddler. Clonadine is a drug originally used for hypertension. It is now also used for treating insomnia, but in high doses can cause a dangerous drop in blood pressure in high doses. Rebecca was given high doses of Clonadine to make her sleep when she was annoying her parents.

Why didn't someone look at this family and say, "They need help. They aren't coping. They need family counseling. They need someone in the household 3 times a week for family meetings." DSS does this. I know they do. But they didn't with this family. Why?

So many questions. So many many people responsible for the death of this poor child. But the parents aren't the only ones culpable. Pull that doctor's license. Close down that pharmacy. Fire that DSS worker. Everyone needs to be responsible for this child's death. Not just the parents.


DSS culpability called into question. This will be interesting as DSS has had to put up with MASSIVE cuts by our least favorite ex-governor, Mitt the Twit. Note that DSS never checked up on the medical diagnosis or treatment, taking the mother's word as truthful. They never once questioned the diagnosis. NEVER!

Other doctors rally to defense of Dr Kifuji. Who would have thunk it? I'm SHOCKED, I tell you. Shocked!

Dr Kifuji agrees to stop practicing to Board of Registration in Medicine. Well, at least there is this tiny bit of good news. She won't be passing out dangerous meds to toddlers anytime soon. Thank goodness for small favors.

This story is just starting to unfold, and as it does, there is a distinct smell of rotton garbage. The pharmacy, a Walgreens, evidentally has been cleared in the investigation. They evidentally questioned the Rileys about why there were so many 'lost' and 'damaged' prescriptions and refused to refill at least one without the doctor's approval. OK... but why did they replace the other ones without calling the doctor. Maybe if they had, the doctor would have refused these parents more meds to drug this poor child.

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Blogger Animae said...

Wow, I just wandered to your site and read this post. Those parents and that doctor just tarnished the mental health movement. It's tough enough as it is for people who have to deal with bipolar or other health issues (either themselves or indirectly with family members), without having incompetence such as this being thrown all over the news. But it's a great lesson for all those out there to really question and understand their medication. Thanks for the post.

7/2/07 2:58 PM  
Blogger Po M said...

Very well said. But unfortunately there's no adequate response to it because there's no explaining away the death of a child this young under these deplorable circumstances. That doctor, in my view, bears criminal liability in this case. I hope someone in law enforcement or the medical community notices that.

7/2/07 6:49 PM  

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