DSS dropped inquiry before girl, 4, was found dead: Got assurances on medications — (The Boston Globe)

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The Boston Globe

By Maria Cramer, Globe Staff

February 8, 2007

The state Department of Social Services received a report raising concerns about whether Rebecca Riley was taking too many powerful prescription drugs last summer, but dropped the issue after receiving assurances from her mother and doctors that the treatment was appropriate.

Despite the concerns raised by a therapist, the agency did not seek an independent review of the child’s treatment until after the 4-year-old died from an overdose on Dec. 13.

DSS spokeswoman Denise Monteiro said yesterday that the agency sought the second opinion after Rebecca died because it was concerned about her 6-year-old sister and 11-year-old brother, who had received similar diagnoses and medication. DSS immediately took custody of Rebecca’s siblings and put them in foster homes.

Monteiro would not disclose the conclusions of the review, which DSS received last month.

“After the child died, there was so much questioning about medication, we decided to seek an independent second opinion,” said Monteiro. “We hadn’t received an autopsy report about her death, and we were concerned that the two children could face similar trauma.”

Rebecca’s parents were arraigned Tuesday on first-degree murder charges that they gave her a fatal dose of an antihyperactivity drug. The child’s psychiatrist, Dr. Kayoko Kifuji of Tufts-New England Medical Center, agreed yesterday to stop treating patients while the state investigates her role in the case.

State lawmakers said yesterday they plan to hold a hearing in which psychiatrists, physicians, pharmacists, and others would discuss whether young children are being overprescribed powerful drugs.

“The Rebecca Riley case represents a tremendous failure by the state, parents, physician, and pharmacy, and highlights the need for closer scrutiny of the medications being administered to children,” said Representative Peter J. Koutoujian, a member of the Committee on Child Abuse and Neglect.

Legislative leaders created the panel, which wrapped up its first set of hearings this week, amid harsh criticism of DSS over some high-profile cases: Haleigh Poutre, a Westfield 11-year-old whose life support was almost withdrawn prematurely by DSS in January 2006; and Dontel Jeffers, a 4-year-old Boston boy allegedly beaten to death by his foster mother in 2005.

In Rebecca’s case, Koutoujian said, he wanted to know why the agency was unable to save the girl despite its history with her family.

The state, the child’s parents, the psychiatrist, and the pharmacies that filled the girl’s prescriptions all share some responsibility for her fate, he said.

“You’ve got four levels that could have caught something, and the confluence of misses that created a window for tragedy,” said Koutoujian, a Newton Democrat.

DSS has been involved with the Riley family since December 2002, when it investigated alleged neglect of the oldest child.

Last June, the agency received another complaint about the family after the eldest son was taken to a local hospital. Doctors told agency representatives that the boy was hospitalized because of a medical condition, Monteiro said.
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Last July, DSS representatives met with doctors, neurologists, and other medical professionals treating Rebecca, her siblings, and their mother, Carolyn Riley, now 32, after a therapist who visited their house in Weymouth told the agency Carolyn Riley seemed sluggish and drugged.

Carolyn Riley later told investigators she takes Paxil for depression and anxiety.

“We were assured that the levels and the amount were within the guidelines,” Monteiro said. “We were assured by the mother’s doctors as well that the mother was not receiving too much medication.”

The therapist from South Bay Mental Health Center in Weymouth later told police that she was concerned by the type and amount of medication prescribed for Rebecca and that Kifuji expressed similar concerns in a phone conversation in May, according to an affidavit in support of the couple’s arrest that was written by State Police investigators and released Tuesday.

Last October, the agency received another complaint, said Monteiro. The affidavit said that Michael Riley, 34, grabbed the same child by the neck and slammed his head against the back window of a pickup truck.

Carolyn Riley agreed to file a restraining order against her husband, but, according to the affidavit, she allowed the order to lapse.

In a follow-up meeting on Nov. 10 — the last DSS contact with the family before Rebecca’s death — Carolyn Riley said that the restraining order had not expired and that she planned to move her family to Hull, Monteiro said.

“We wanted to meet with her and the children and reassure that things are going good,” Monteiro said. “She assured us that the husband would not be coming to live with the family.”

But two weeks before Rebecca’s death, Michael Riley moved back into the house, despite being told by DSS not to be with the children unsupervised.

About 6:30 a.m. on Dec. 13, a breathless Michael Riley called 911. “My daughter passed away in the night,” he told the operator.

Police found her dead, wearing only a pink pull-up diaper and lying on her left side on top of clothes and a stuffed brown bear, according to the affidavit.

Within days, Monteiro said, DSS filed a request with the Probate and Family Court to seek a review of the children’s treatment from an independent medical agency. “We wanted a second opinion on everything,” she said.

Hull Police Chief Richard Billings said yesterday that officers continue to investigate the child’s death, but he declined to say whether there would be any charges against Kifuji or any pharmacists who provided the medication.

Between Aug. 15 and Nov. 27, the Rileys obtained 15 refills of clonidine, the drug that eventually killed Rebecca, from a Walgreens in Weymouth, the affidavit said.

Michael Polzin, a spokesman for Walgreens, said the drugstore chain was contacted by a State Police officer who said the company is not under investigation.

“We are deeply saddened to hear about this,” Polzin said. “As far as the medication that was taken, we filled a valid prescription authorized by the patient’s physician, and all of the appropriate drug information and directions were given to the family.”

Koutoujian said he plans to ask pharmacists, physicians, psychiatrists, and other medical specialists to testify at the hearing, which he said would be held in March. .

“The role of this committee will not be to assess blame,” he said. “We’ve got to know what went wrong here, so this travesty is never replicated in the future.”

Maria Cramer can be reached at mcramer@globe.com.

 

Original article no longer available

Beacon Hill Responds To Death Of Girl, 4 –  Lawmakers Consider Practice Of Prescribing Drugs To Children

Boston Channel

POSTED: 6:11 am EST February 8, 2007

BOSTON — The overdose death of a 4-year-old Hull girl is now getting attention from Beacon Hill as the doctor who prescribed those drugs turned in her license.

NewsCenter 5’s Steve Lacy reported that legislators on a committee that deals with child abuse and neglect have been meeting for the past month and now many lawmakers are asking what should be done to better protect children.

The December death of Rebecca Riley, 4, of a prescription drug overdose has some legislators looking at the growing practice of prescribing behavior-altering medications to children.

“Many experts have suggested that you can’t diagnose a 2- or 3-year-old with schizophrenic or bi-polar disorder. And then the over-medication and the number of medications that this girl was taking are certainly a concern to us,” Rep. Peter Koutoujian, of Waltham, said.

The push for greater legislative oversight of prescription medications comes as a Boston Globe report revealed that the state Department of Social Services looked into concerns about Rebecca Riley’s daily prescription drug regimen, but failed to order a review of the girl’s case until after her death.

The original inquiry was shelved after DSS received assurances from the girl’s mother and doctors that her use of the drugs was appropriate. An autopsy after the child’s Dec. 13 death showed that Rebecca Riley died from a lethal combination of several drugs, including medications she was taking for attention deficit hyperactivity disorder.

Dr. Kayoko Kifuji, the New England Medical Center doctor who diagnosed Riley, surrendered her medical license Wednesday.

“This is a voluntary agreement, a negotiated agreement, between Dr. Kifuji and the Board of Medicine. It requires an immediate cessation of practice,” the board’s Nancy Achin Audesse said.

No dates have been set on Beacon Hill for hearings about the practice of prescribing powerful medications to young children. According to a study by George Washington University, anti-depressant use among school-age children doubled between 1998 and 2002.