© 2007 The Patriot Ledger - Everyone Failed Rebecca

Tot’s doc takes leave

Physician voluntarily ceases practice during inquiry

By RYAN MENARD
The Patriot Ledger

Behavioral disorders drug

Physicians divided over use of clonidine

Some say it’s safe for toddlers, with supervision

By DANIELLE AMEDEN
MetroWest Daily News

A 4-year-old walked through Dr. Perveen Rathore’s door three months ago, wearing something that made the doctor uneasy: a 24-hour clonidine drug patch on her skin.

“I was really uncomfortable with the patch because with clonidine, it’s essentially acting as a medicator for blood pressure,” said Rathore, a psychiatrist with a practice in Westboro. There, she treats children like her young patient, who was diagnosed with attention deficit hyperactivity disorder.

“I took her off the patch,” Rathore said. “I’m very cautious who I’m giving clonidine to.”

In the wake of 4-year-old Rebecca Jeanne Riley’s overdose death in December in Hull, and the arrest of her parents on first-degree murder charges, pediatricians and psychiatrists are split over whether prescribed drugs such as clonidine are safe for toddlers with documented behavioral disorders.

While some like Rathore are concerned about prescribing the anti-hypertension drug to youngsters, others say it is not dangerous for children to take clonidine, as long as correct dosages are administered and treatment continues.

“Carefully monitored, it’s a relatively safe drug, and there’s been a lot of experience with it,” said Dr. John Fromson, chairman of psychiatry at MetroWest Medical Center. “It’s commonly prescribed, and it’s well-known and it’s certainly within the standard of practice.

“Any medication in the wrong hands, taken inappropriately, can cause serious side effects and even death whether it’s Tylenol or vitamins or anything,” Fromson said.

Several of the 115 residential students at the New England Center for Children in Southboro are taking clonidine, said Pam Peck, director of health services at the private, nonprofit school for autistic children.

Through close monitoring and drug administration, the drug has been an effective treatment for the students, who are about 10 years old.

“As far as the safety guide, it’s not an unsafe drug to use,” and is preferred to some ADHD treatment alternatives, Peck said.

“If the behavior warranted it ... the (school) psychiatrist would consider this over an antipsychotic (drug), absolutely, because of the lesser side effects,” said Carol Mitchell-Boudreau, a family nurse practitioner who runs the center’s psychiatric clinic.

Clonidine is not thought to be dangerous as long as it is prescribed in “appropriate doses on the appropriate kid,” said Dr. John Cocchiarella, who has practiced at Milford Pediatrics for 36 years.

“I’ve been watching it probably for close to 10 years, and I’ve never been aware of any adverse effects,” he said. “Generally, it is considered quite safe.”

While originally approved by the FDA as a treatment for high blood pressure in adults, Cocchiarella said clonidine’s mild sedative effects make it an option for patients with disorders like ADHD.

“I would have no qualms about using it, assuming the parents aren’t going to give the child a bottleful when you’re not looking,” he said. “I would not use those medicines in a child that young, but you’ve got to know the circumstances.”

Rebecca Riley’s parents, Michael and Carolyn, pleaded innocent Tuesday to murder charges in the death of their daughter, who was diagnosed with ADHD and bipolar disorder at age 21/2.

Prosecutors allege the couple deliberately overmedicated her with a combination of clonidine, the anti-seizure medication Depakote that is also used to treat bipolar disorder and two over-the-counter cold drugs.

The psychiatrist who diagnosed a toddler with bipolar disorder and prescribed the drugs that killed the girl, is no longer practicing medicine but will continue to get paid.

Dr. Kayoko Kifuji, a child psychiatrist at Tufts-New England Medical Center, agreed to an immediate voluntary suspension of her license, the state Board of Registration in Medicine announced yesterday.

A statement from Tufts-New England said Kifuji will continue to be paid but is currently on leave. The statement released last night also called the Dec. 13 death of Kifuji’s patient, 4-year-old Rebecca Jeanne Riley, “a terrible tragedy.”

Michael, 34, and Carolyn Riley, 32, of Hull pleaded innocent Tuesday to charges of murdering their daughter Rebecca by intentionally overdosing her with drugs prescribed by Kifuji. Medical examiners say Rebecca had been given a lethal dose of clonidine, one of three drugs ordered by the doctor after she diagnosed the girl with attention deficit hyperactivity disorder and bipolar disorder.

Rebecca Jeanne Riley, 4, died Dec. 13 of a drug overdose.

Riley Family Photo

Rebecca Jeanne Riley, 4, died Dec. 13 of a drug overdose.

Rebecca was 28 months old when Kifuji diagnosed her and began writing prescriptions. She also diagnosed and prescribed drugs for Rebecca’s 11-year-old brother and 6-year-old sister.

Kifuji’s lawyer, Jay Carney, said his client is innocent of any wrongdoing in the case. “She absolutely did not over-prescribe and her medical records will back that up 100 percent,” Carney said. “The dosage was appropriate. The drug was appropriate and the monitoring was appropriate.”

Also allegedly contributing to Rebecca’s death were a combination of Depakote, an anti-seizure medicine used to treat bipolar disorder, and two over-the-counter cold medicines. Rebecca had also taken Seroquel, another bipolar disorder drug prescribed by Kifuji, but it was not cited as a factor in her death.

In an affidavit filed by police investigators in the case, the Rileys reported that Kifuji said they could give Rebecca an extra half-dose of clonidine, usually used to treat high blood pressure in adults, to help her sleep. Carolyn Riley said she gave Rebecca the extra dose of clonidine before she died Dec. 13.

But Kifuji told investigators that she never told the Rileys it would be OK to give the girls an extra half clonidine tablet to get them to sleep. “No! Never!” Kifuji told investigators when asked about whether she allowed the extra medication, according to the affidavit.

The affidavit also said the Rileys were allowed to fill clonidine prescriptions when they should have had an ample supply. Kifuji told police that in the early fall, Carolyn Riley claimed to have lost one bottle of clonidine and accidentally let water into a second bottle. The doctor told police she authorized two more prescriptions for the drug.

She also said that she was “shocked” when Carolyn Riley told her that she had upped Rebecca’s dose of clonidine. Kifuji said she told the mother the increased dose could kill the girl by lowering her blood pressure too much.

While Plymouth County prosecutors and police continue the criminal investigation surrounding the young girl’s death, the state medical board will be conducting its own inquiry and using different standards. Even if Kifuji is never charged in the criminal case, she may face disciplinary action by the board if they find she committed acts “that tend to undermine the public’s confidence in the practice of medicine,” or worse.

Kifuji voluntarily agreed to stop practicing medicine until the board completes its own investigation.

Last year, 13 other physicians made similar voluntary agreements with the board to stop practicing medicine. In 2005, there were 15 similar agreements and 14 in 2004. The board oversees about 30,000 doctors in Massachusetts and typically disciplines about 75 to 80 doctors a year, board spokesman Russell Aims said.

A board-certified pediatrician and psychiatrist, Kifuji graduated in 1981 from Tokyo Women’s Medical College and was first licensed to practice in Massachusetts in 1999. Until yesterday, she was medical director of the Adult Psychiatry Consultation and Emergency Psychiatry Service, the PDD Autism Clinic and the Child and Adolescent Eating Disorder Service at Tufts-New England.

Ryan Menard may be reached at rmenard@ledger.com

Material from the Associated Press was used in this report.