Child Abuse, Review doctor's work again

Boston Globe
Editorial
May 3, 2010

IF THE medical care given to 4-year-old Rebecca Riley appears appropriate to the state panel that oversees doctors, that panel needs to take a new look at the case.

Rebecca was the victim of one of the most appalling child abuse cases in recent memory; in December 2006, she died on her parents’ bedroom floor of an overdose of powerful psychotropic drugs. They had been prescribed by Dr. Kiyoko Kifuji, a child psychiatrist at Tufts Medical Center, who relayed details of her treatment on the witness stand during the murder trials of Rebecca’s parents. Kifuji’s testimony — given under immunity — was so disturbing and seemingly cavalier that Plymouth District Attorney Timothy Cruz has asked the state Board of Registration of Medicine to reopen its review of her license. “If what Dr. Kifuji did in this case is the acceptable standard of care for children in Massachusetts,’’ Cruz said, “then there is something very wrong in this state.’’ He’s right.

The issue of acceptable medical care is separate from the question of responsibility for Rebecca Riley’s death. (Rebecca’s parents were both convicted of murder.) A grand jury declined to indict Kifuji for manslaughter, though a wrongful death civil suit against her is pending. After a full review, the state Board of Registration of Medicine allowed her to resume seeing patients last fall. The board’s proceedings are kept private, but in typical cases, it reviews medical records and hears testimony from experts in the field. In Kifuji’s case, the panel likely heard defenses of the controversial practice of giving powerful psychotropic drugs to small children.

It’s not the board’s role to arbitrate among different schools of thought within a medical field. But even if one grants that medication — when prescribed responsibly and monitored closely — can help children with extreme and dangerous symptoms, Kifuji’s actions remain highly questionable. She diagnosed Rebecca with bipolar disorder and attention deficit hyperactivity disorder based largely on her mother’s description, sometimes during brief visits when Rebecca was asleep. She kept prescribing medication even when Rebecca’s mother increased the dosage to unauthorized levels. Kifuji also refilled prescriptions more than once when the mother said she had lost the pills. The doctor disregarded concerns raised by a family friend, pharmacists, a therapist, and a preschool nurse who complained that the child was as limp as “a floppy doll.’’

Parental observations are critical in child psychiatric cases, and the parents of young patients shouldn’t be presumed dishonest or dangerous from the start. But a responsible clinician — especially one trained to examine behavioral nuances — should be able to detect when a parent is malicious or untrustworthy. In the case of the Rileys, the signs were numerous and extreme.

Doctors have a legal obligation to report child abuse. By extension, their treatment of children should come with particular vigilance and caution. The medical board should reopen Kifuji’s case to determine whether she truly did everything she could to prevent the death. If anything positive can come from Rebecca Riley’s short, miserable, tragic life, it’s an affirmation that, when it comes to treating the state’s youngest, most vulnerable patients, doctors should be held to the highest of standards.

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