An unusual medical malpractice suit filed in Boston alleges a psychiatrist who treated a 4-year-old girl for bipolar disorder is liable for her death from a prescription drug overdose –- even though her parents have been charged with intentionally overmedicating her.

Rebecca Riley

The death of Rebecca Riley has become a "cause célèbre" for those who believe it is impossible to diagnose bipolar disorder in young children and that the drugs used to medicate the condition do more harm than good. PBS featured her in a recent “Frontline” documentary entitled “The Medicated Child.”

Dr. Kayoko Kifuji, a psychiatrist at Tufts-New England Medical Center, diagnosed Riley with both bipolar disorder and attention deficit hyperactivity disorder when she was only 28 months old and put her on a regimen of three powerful psychotropic drugs –- clonidine, Seroquel and Depakote.

Riley died at her family's home in Hull, Mass., on Dec. 13, 2006 and court records indicate the amount of clonidine in her system alone was fatal. Prosecutors have charged her parents with murder, alleging they falsely said their daughter was mentally unstable so she would qualify for Social Security disability benefits and then deliberately overmedicated her.

But in the malpractice complaint filed earlier this month, the administrator of Riley's estate alleges that Kifuji “negligently, carelessly, and without regard for the plaintiff's decedent's health and well-being, treated the plaintiff's decedent in a manner resulting in the plaintiff's decedent death.”

The drugs “made her a 4-year-old zombie," plaintiff's attorney Andrew C. Meyer told the Boston Globe. “We don't believe that she did suffer from bipolar or that this was the appropriate medication.”

Meyer also believes any conviction of Riley's parents for murder would not let Kifuji off the hook. “The primary responsibility falls on this doctor,” he said. “The failure of this doctor to respond to the warnings she was given and to thoroughly investigate the symptoms that her medication was causing ended with this very sad result here of a young girl dying.”

Diagnosing children with bipolar disorder has become fashionable since psychiatrists at Massachusetts General Hospital published research in 1995 indicating the disorder was much more common in children than previously thought. A 2006 study of mentally ill children in community hospitals found the proportion of children diagnosed as bipolar increased from less than 3 percent in 1990 to 15 percent in 2000.

Kifuji could well argue that, in this context, her treatment of Riley was within the standard of care. Some psychiatrists lean toward diagnosing early in childhood rather than leave a potential problem untreated.

"Rebecca Riley's death is a terrible tragedy," Tufts-New England Medical Center said in a statement. "The care we provided was appropriate and within responsible professional standards."

But there is virtually no scientific research on bipolar disorder in children less than 6 years old. “Diagnosing and treating preschoolers is what I would call uncharted waters,” the director of the Pediatric Bipolar Program at Mass. General told the Globe in a February 2007 article.

According to Meyer, moreover, a nurse at Riley's preschool warned Kifuji six weeks before her death that she suspected the child was overmedicated because Riley was often too tired to participate in school activities and appeared like a “floppy doll.” Kifuji did not reduce her medication after examining the child, Meyer said.

The attorney for Riley's father, John Darrell, has said neither parent knew enough about appropriate treatment to challenge Kifuji. "You've got two poor parents here of minor means financially, of minor education," he said.

By Matthew Heller
4/14/08