Steps Toward a Cure

February 21, 2010

Her mother’s murder trial has been over for a couple of weeks now, but I’m still haunted by little Rebecca Riley.  Why did no one manage to rescue this 4-year-old child as her parents pumped her full of powerful psychotropic drugs, drugs that would kill her? And how could the doctor who blithely prescribed those drugs have escaped even the slightest penalty?

by Yvonne Abraham
Boston Globe Columnist

Tufts Medical Center, where Dr. Kayoko Kifuji works, has had almost nothing to say about the case, other than to blandly defend the doctor’s care for Rebecca as professional and appropriate.

The silence is understandable, I suppose – Kifuji faces a malpractice suit brought on behalf of Rebecca’s estate, one Tufts is right to worry will cost the hospital dearly – but it is ultimately indefensible. And so I put some questions to Tufts last week. Why is Kifuji still employed there? Is the hospital dealing with other children the way Kifuji dealt with Carolyn Riley’s? Has anything changed since that poor kid’s awful death?

They wouldn’t address the first question, of course. But I was invited to sit down with Dr. John Sargent, chief of child psychiatry, to talk about the others. He came to Tufts just over a year ago, championing an approach to treating children that seems worlds away from Kifuji’s.

She continued to prescribe drugs for the Riley children despite numerous red flags – some raised by health professionals alarmed that the children were so heavily medicated. Where Kifuji shut others out, Sargent said he believes therapists should seek out the opinions of other counselors, health care workers, educators, social workers.

“You have to take a holistic approach,’’ he said. “You look at a number of factors outside your office. I want to know the kid’s life out there. . . . I expect that of everybody who works with me.’’

Sargent also demands that his staff spend plenty of time watching the children in their care: how they play, how they interact with their parents, how they handle challenges. The Riley children were sometimes asleep in their strollers during visits to Kifuji.

He says he uses great caution before he prescribes mood-altering drugs for kids. A no-brainer, though not, it would seem, for Kifuji.

Sargent says a shift in psychiatric treatment of children has been underway for at least five years across the whole field – not just at Tufts, and not necessarily as a response to Riley’s 2006 death.

But he conceded this much: “Any time you’re involved in a situation that has an outcome you wish hadn’t happened, it makes you look at what you’re doing. The leadership has changed and the focus of the leadership has changed.’’

Kifuji is very closely supervised these days, according to the hospital. On Thursday, Sargent called her “a tremendously dedicated, gracious, hard-working person who truly loves children.’’

Obviously, she didn’t kill Rebecca. Carolyn Riley did. (Riley’s husband, Michael, is also charged in the murder). A grand jury declined to indict the doctor in Rebecca’s death. Two Tufts reviews found that Kifuji didn’t break any rules.

But that doesn’t make her actions any less disturbing. Kifuji’s decisions put those drugs in the Rileys’ hands. And they’re decisions some other doctors refused to make: At one stage, Carolyn was traveling 100 miles to see Kifuji in Boston because nobody in Springfield would give her the drugs she wanted.

In recruiting Sargent, well-known for looking beyond the prescription pad in treating kids, Tufts has made a major move in the right direction. Listening to him talk about his caring, careful approach to his work, I was comforted by the possibility that some good might come from Rebecca’s death.

But as long as Kifuji remains on his staff, I’ll have my doubts.

Yvonne Abraham is a Globe columnist. She can be reached at Abraham@globe.com.

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