A Bipolar Child Murdered: "Zombie-Like," A Psychiatrist In Trouble

There's more news out of Boston on the bipolar child murdered sadness I wrote about the other day. Rebecca Riley was her name. She was four-years-old and was found dead last December. Her parents stand charged with her murder, allegedly by overdosing her with the ADHD drug clonidine, which is apparently damn toxic. She was diagnosed with bipolar disorder and ADHD at two-and-one-half years old. She was also taking Depakote, a cough suppressant, an antihistamine and, reportedly, had also been prescribed or had taken Seroquel.

Now, the psychiatrist who was treating her has agreed to not practice medicine until the case is resolved, after entering into an agreement with the state medical board. That tells you something about just how nutty this case is--I've reported on misbehaving docs for years and docs don't agree to any limits on their practice unless something ugly was going on. State medical boards are generally spineless and don't try to limit doctors' practices unless something really ugly was going on.

That said, there are still too many unknowns in this case to draw any firm conclusions, except to say that this whole bipolar child thing has run way out of control. There is interesting skepticism coming from the mouths of area doctors on the case:

"'I tend to prescribe fewer rather than more medications,' said Tom Weigel, a child psychiatrist with the Hallowell Center in Sudbury. 'Once you get past one or two medications, it’s not well researched what the interactions might be.'”

And:

"For Rebecca’s ADHD, Dr. Kayoko Kifuji of Tufts-New England Medical Center prescribed 0.35 milligrams of Clonidine a day, which is high for a 4-year-old, several psychiatrists said.

'I rarely ever prescribe over 0.2 milligrams' for kids, [another doc] Kelley said.

Weigel said he’s never diagnosed a child that young with bipolar disorder. He also said he’s never put a 4-year-old on a combination of antipsychotic, antihypertensive and mood stabilizing drugs. Rebecca was lethargic at school and at home and a neighbor described her as zombie-like, according to interviews in an affidavit filed in Plymouth District Court. In November 2006, her doctor noted that a school nurse said Rebecca was sleepy and like a 'floppy doll' at school one morning, according to the affidavit.

The Department of Social Services, which had been monitoring the family, was also concerned about Rebecca’s health. DSS requested an independent medical opinion in June 2006, but her treatment and diagnoses were confirmed. After Rebecca died, DSS sought an independent medical opinion for her two young siblings, who were also taking drugs for bipolar disorder and ADHD. The doctors concluded that both children’s medication needed to be altered."

And:

"Michael Riley's lawyer, John Darrell, said neither parent knew enough about appropriate treatment to have challenged Kifuji. 'You've got two poor parents here of minor means financially, of minor education,' he said.

Yesterday, Tufts-New England Medical Center stood behind [the psychiatrist] Kifuji, who has worked there for four years and is board certified in adult and pediatric psychiatry. Her licensing record had no violations.

'Rebecca Riley's death is a terrible tragedy,' the hospital said in a statement issued late yesterday afternoon. 'The care we provided was appropriate and within responsible professional standards. The appropriate care of our patients is our greatest duty. Dr. Kifuji has outstanding credentials and is respected within her field.'"

Yes, everyone with an MD is god-like and well-respected. Over on Psych Central, a psychologist offered these thoughts:

"But it’s my opinion that if the psychiatrist was doing her job, she would’ve never diagnosed such a young child with such serious disorders so early on in the young infant’s life, nor prescribed such strong psychiatric medications for the concerns."

I have a hunch we haven't heard the last of this story. Sadly.