Rebecca Riley

• Part 1: A beautiful child
• Part 2: Periodic and circular insanity
• Part 3: Accident prone
• Part 4: A healthy productive life
• Part 5: Major therapeutic advances
• Part 6: Rebecca Riley
• Part 7: The bipolar brain is miswired
• Part 8: A tale of two psychiatrists
• Part 9: A devastation beyond belief

In August of 2004, two-year-old Rebecca Riley was diagnosed with bipolar disorder and ADHD after a one-hour consultation by Doctor Kayoko Kifuji of Tufts-New England Medical Center. Dr. Kifuji prescribed clonidine for the child, eventually upping the dose to 0.35 milligrams a day, along with 750 milligrams of Depakote and 200 milligrams of Seroquel. None of these drugs have been approved by the federal government for use in young children. Carolyn repeatedly claimed to that her daughter's clonidine pills had been lost or ruined and obtained extra prescriptions for them. She also told investigators that with Dr. Kifuji's permission she would occasionally give Rebecca extra clonidine when she was having trouble sleeping. When questioned, Dr. Kifuji vehemently denied ever telling Carolyn it was okay to give her daughter extra clonidine, and stated that in fact she threatened to report Carolyn to the Department of Social Services if she ever did it again. A therapist told investigators that she made repeated visits to the Riley home to work with Rebecca and her older sister. On her first visit, she recalled, there was a puddle of urine on the living room rug. Carolyn thoughtfully advised her not to step in it but made no effort to clean it up until the therapist told her to do so. According to the therapist, Carolyn herself appeared heavily drugged. The therapist made a report to the authorities, but nothing came of it. The therapist was not the only one concerned about Rebecca's welfare. Rebecca's teacher and the nurse at her preschool noted that the child appeared lethargic and too tired to play. She was barely able to get off the school bus or walk up stairs without help. Often, the child slept right through her visits with Dr. Kifuji. Carolyn herself once fell asleep in the middle of a parent-teacher conference.

In addition, Rebecca's face was swollen and puffy, and she frequently came to school without a snack, wearing inappropriate clothing or shoes that were obviously too big for her. Rebecca's special education school bus driver also noticed that on one trip Rebecca fell asleep and was almost impossible to rouse. The same driver also transported Rebecca's older brother to school and stated that he typically smelled so foul that she would have to open the windows while he was in the vehicle. On 14 November 2006 Carolyn and her children, along with Carolyn's half-brother Jim and his fiancée Kelly, all moved out of public housing and into a new dwelling at 70 Lynn Avenue. By the end of the month Michael, who had been living with his mother, joined them. On Thursday 7 December 2006, a prescription for thirty-five clonidine tablets was filled for Rebecca. According to the dosages prescribed by Dr. Kifuji, Rebecca now had enough clonidine to last her through 7 January of the next year. Unfortunately, Rebecca herself would not last that long. On Saturday 9 December, Jim and Kelly noted Rebecca was not feeling well, spending most of the day sleeping. That night she began coughing, emitting what Jim recalled as whooping sounds. The next day, Sunday, both Jim and Kelly urged Carolyn to take her daughter to the doctor. That afternoon, Rebecca climbed up into Kelly's lap. Kelly would later recall the child was extremely hot, her skin and clothing soaked in sweat. Carolyn gave her child some Tylenol and also brought her a cup of red liquid, saying it was cough syrup; Kelly would later recall that the liquid in the cup was about an inch deep. The child spat out the medicine. Jim and Kelly repeatedly urged the Rileys to take get medical attention for their daughter, and they promised to do so.

The next day, Monday, Carolyn recalls, her daughter felt hot when she woke up. Carolyn gave her three Children's Tylenol. The family took Rebecca to an appointment at the Social Security Administration. Rebecca threw up in the office and so the family canceled the appointment. They then went to Walmart where Rebecca threw up again, in the parked car. Michael recalled seeing Depakote sprinkles in the vomit. After they got back home, Jim and Kelly again urged the Rileys to take their daughter to a doctor, and again they promised to do so. Rebecca threw up repeatedly that day. The day after that, Tuesday, Rebecca seemed dazed and "out of it." Jim finally decided he had had enough. He grabbed Michael by the shirt and shouted "If you won't bring her to the hospital, then I'll beat you so the ambulance will come and take both of you!" Michael assured Jim that he had made an appointment with the doctor the next day. That night, while Michael and Carolyn were off on an errand, Rebecca came out of her bedroom several times, crying for her mommy. Rebecca later walked into Kelly's room and stood there, silent, not saying anything or acknowledging Kelly's presence. When Kelly picked Rebecca up to take her back to her own room, something was wrong. Usually, when she picked up Rebecca, the child would wrap her arms and legs around Kelly like a monkey, but this time Rebecca seemed as stiff as a board. When Michael and Carolyn returned, Kelly conveyed her concerns to them, and begged them to take her to the hospital. The Rileys dismissed her concerns and reiterated that they had a doctor's appointment scheduled for Rebecca the next day (the doctor's office later told investigators they had no record of anyone making an appointment for Rebecca). That night Rebecca repeatedly left her room and cried out for her mommy. Michael angrily shouted at her to "get back in your room!" At 12:48 AM Wednesday morning, Jim, a tow truck driver by profession, was awakened by a page from the Hull Police Department, requesting a tow. He heard a noise emanating from the room Rebecca shared with her sister. Rebecca was gurgling "like something was stuck in her throat." Jim pounded on the door to Michael and Carolyn's room, then kicked in the door and demanded that they help the child immediately. Carolyn got up and brought Rebecca to their room. Meanwhile, the Hull Police Department called again, canceling the tow. Jim went back to bed, believing that Michael and Carolyn were finally going to do something to help Rebecca. The following morning, Michael's alarm clock went off at 6:00 AM. He hit the snooze alarm several times, then finally awakened and called 911. Authorities summoned to the home found Rebecca lying unresponsive on a pile of magazines and papers, clad in only a diaper and gold pierced stud earrings. Blood and vomit had emanated from her mouth and nose and pooled on the rug. She was pronounced dead on the scene. Investigators found three clonidine tablets left out of 35 that had been dispensed just six days before. The medical examiner found Rebecca had potentially lethal levels of clonidine in her blood when she died, along with signs of long-term damage to her heart and lungs, which was ascribed to the effects of the prescription drugs she had been given. Rebecca's brother and sister were immediately removed from the custody of their parents and placed in foster care. Rebecca's mother and father both were charged with first-degree murder. In exchange for testifying against the couple, Dr. Kifuji was granted immunity from prosecution. Carolyn was convicted of second-degree murder, and Michael was convicted of murder in the first degree. Both convictions were subsequently upheld by the Supreme Judicial Court of Massachusetts. Next: Part 7: "The bipolar brain is miswired" List of Sources

• Commonwealth of Massachusetts: Affidavit in Support of Application for Arrest Warrant.
• CBS News 2007. Who killed Rebecca Riley?
• Cramer, M. and R. Mishra 2007. Girl fed fatal overdoses. Boston Globe 7 February 2007.
• Kowalczyk, L. 2007. Psychiatrist to suspend practice. Boston Globe 8 February 2007.
• Scott, A. 2007. Backlash on bipolar diagnosis in children. Boston Globe 17 June 2007.
• Wen, P. 2009. Psychiatrist will not be prosecuted in girl's death. Boston Globe 2 July 2009.