Riley's estate gets $2.5 million in lawsuits settlement with psychiatrist

The Patriot Ledger
Lane Lambert
Jan 25, 2011

BOSTON -- The attorney for Rebecca Riley’s estate said Tufts Medical Center psychiatrist Dr. Kayoko Kifuji has settled a civil lawsuit for $2.5 million.

The Suffolk Superior Court settlement comes almost a year after the 4-year-old Hull girl’s parents, Michael and Carolyn Riley, were convicted of murdering her in December 2006 with an overdose of Clonidine, which Kifjui had prescribed.

Rebecca was 2 when Kifuji diagnosed her with bipolar disorder and attention deficit hyperactivity disorder. Rebecca was given Clonidine for attention-deficit hyperactivity disorder and Depakote for the bipolar condition.

Benjamin Novotny of the Boston law firm Lubin & Meyer confirmed the settlement Monday. The amount is the limit for Kifuji’s malpractice insurance with Tufts, where she continues to practice.
The settlement has been put into trusts for Rebecca’s older brother and sister, for education and other expenses. Their parents’ convictions keep them from claiming a share of the money.
“This is the best possible result,” Novotny said. “We got everything we could.”

In a prepared statement Monday night, Tufts said the interests of Rebecca’s brother and sister are best served by the settlement, rather than a lengthy civil trial that would again subject all those who cared about Rebecca to “the painful details brought forth during the criminal trials.”
Novotny said Tufts has also agreed to start an awareness program, so young doctors know the dangers of over-prescribing such drugs. Tufts declined comment on that but said the hospital will be looking for ways to expand education programs for caregivers who treat “psychiatrically ill children in troubled homes.”

Michael Riley was convicted of first-degree murder and Carolyn Riley of second-degree murder. The case revived a nationwide controversy over whether such drugs should be prescribed for children as young as Rebecca.

Kifuji drew widespread outrage for her role with the family, especially after she escaped indictment by a Plymouth County grand jury and regained her medical license.

Rebecca was found dead and lightly clad on the floor of her parents’ bedroom on Dec. 13, 2006. Plymouth County prosecutors said the Rileys deliberately overdosed Rebecca because they were unable to secure federal Supplemental Security Income (SSI) for Rebecca, as they had for their other two children.

Trial testimony showed that Kifuji relied mainly on Carolyn Riley’s reports of Rebecca’s behavior, while numerous witnesses said they’d raised concerns about the effects of the drugs right up to the night Rebecca died.

Kifuji testified under immunity at the Rileys’ separate trials, and proved to be a cautious, frustrating witness for prosecutors and defense attorneys alike.

Kifuji voluntarily gave up her medical license when the Rileys were charged in February 2007. A court administrator filed the civil lawsuit for Rebecca’ estate in 2008.

Kifuji was cleared of criminal charges by a grand jury in the summer of 2009. A couple of months later a state medical board said she could practice again. She regained her medical license and returned to Tufts. The civil case didn’t move forward until the Riley trials were completed in March, 2010.

Novotny said the lawsuit was settled in late December but that the money was placed into Rebecca’s brother and sister’s trusts in the last few days. Her brother is reportedly in foster care, while her sister may soon be adopted.

He said the lawsuit appeared doubtful after Kifuji was cleared and the Rileys were convicted, but was settled in part because of public outcry and questions about the medical care Rebecca Riley got.

Lane Lambert may be reached at llambert@ledger.com.
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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.

© Copyright 2010 Globe Newspaper Company.

Jurors outraged by psychiatrist's conduct Felt she should share culpability in toddlers death

By Patricia Wen
Globe Staff
February 11, 2010

BROCKTON - The jury that convicted a South Shore woman this week of killing her 4-year-old daughter with an overdose of psychotropic drugs was also outraged by the conduct of the child’s psychiatrist and hoped the doctor would be held responsible in some way for the girl’s death, according to several jurors interviewed a day after the verdict.

“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.

While Kifuji’s attorney defended the psychiatrist and said jurors saw “only pieces of the full extent of diagnosis and treatment’’ of the girl, several jurors said they feel Kifuji bears some responsibility for the child’s overdose of psychiatric drugs, which were dispensed by a troubled mother.

Kifuji is facing a medical malpractice case filed by the estate of Rebecca Riley, though that case is not expected to go to trial for at least a year.

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.

In a section dealing with disciplinary matters, the website lists the dates, from February 2007 to September 2009, in which Kifuji started and was permitted to end a “voluntary agreement’’ to stop practicing psychiatry.

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.

With her Boston attorney, Bruce Singal, at her side in court, Kifuji had initially declined to testify by invoking her right against self-incrimination. That move forced the government to grant her immunity as the only way to compel her to testify.

Singal defended the 55-year-old psychiatrist, saying by e-mail yesterday that her treatment of Rebecca has been “reviewed and cleared on numerous levels.’’ He said a Tufts Medical Center review found her care appropriate.

Singal went on to say that he is confident that any thorough examination of the doctor’s care of Rebecca would show she acted “in the best interests of this seriously ill child, and diagnosed and treated her in full accord with acceptable medical standards.’’

Several jurors in the mother’s trial said they never questioned whether Carolyn Riley was culpable, and an acquittal was never a possibility. When faced with a choice between first-degree murder and two lesser options of second-degree murder and manslaughter, the panel was divided.

Throughout much of their discussions, roughly half the members tilted toward a conviction of first-degree murder, one juror sought a manslaughter conviction, and the rest were focused on a second-degree murder conviction, according to a third juror, who also asked to remain anonymous.

Jurors wrestled over the meaning of “malice,’’ a condition they felt was necessary for a murder conviction but not for manslaughter. Ultimately, they decided the mother acted with malice through her routine use of pills to sedate her toddler, and her dispensing of toxic levels of clonidine in the hours before the girl died on Dec. 13, 2006. They united on a second-degree murder conviction, instead of a first-degree murder conviction, as a compromise.

The jurors said that during the 19 hours of deliberations behind closed doors, many wept while looking at photos of the girl’s body on the floor next to her parents’ bed. They said everyone felt the girl had pneumonia, but that she would not have died without dangerous levels of drugs in her body.

Patricia Wen can be reached at wen@globe.com
© Copyright 2010 Globe Newspaper Company.