Friday, February 5, 2010

Wrapping Up the Riley Case

Previously: The Sickest Trial I Ever Saw

Poor Little Rebecca Riley

Picking up where we left off:

"Mother portrayed as drug obsessed; Girl’s pharmacist takes stand in trial" by Patricia Wen, Globe Staff | January 28, 2010

BROCKTON - A Walgreens pharmacist from Weymouth testified that Carolyn Riley frequently approached her counter asking for early refills of the girl’s clonidine prescriptions. Once, pharmacist Lily Tuleva said, when she balked at the refill, the mother “began screaming.’’

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According to prosecutors Frank J. Middleton Jr. and Heather Bradley, Rebecca’s parents fabricated behavioral problems in their children to obtain psychotropic drugs to sedate them and to help the family qualify for federal disability benefits for mental disorders. By the time Rebecca died, the three Riley children were all diagnosed with bipolar and hyperactivity disorders and were on several potent psychotropic medications.

(Blog editor just sitting here shaking his head)

Also, the parents and the two oldest children each received about $600 a month in federal disability benefits. When Rebecca died, the Rileys were in the midst of fighting for disability checks on her behalf.

Defense attorneys Michael Bourbeau and Victoria Bonilla say Rebecca’s mother was a caring mother who was struggling to raise three children with profound mental health problems. They say that if the mother obtained extra clonidine pills, it was because Dr. Kayoko Kifuji, the psychiatrist, allowed some flexibility in her dispensing of the drugs and wrote prescriptions allowing for extra tablets under certain circumstances, such as sleep problems.

The defense has also said it will ultimately provide medical experts to show that Rebecca’s death was due to rapid-onset pneumonia, which began as a coldlike illness in the days before her death, and that her parents could not have anticipated the devastating outcome....

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"Girl died of pneumonia, doctor says; Physician testifies toxic drug levels also played a role" by Patricia Wen, Globe Staff | January 29, 2010

BROCKTON - A pathologist from Children’s Hospital Boston testified yesterday that 4-year-old Rebecca Riley died when an aggressive bacterial pneumonia moved quickly through her small body weakened by toxic levels of sedating drugs.

When asked by First Assistant Plymouth District Attorney Frank J. Middleton Jr. to identify what Rebecca died of, Dr. Sara Vargas said she believed both the severe illness and medications, specifically clonidine, played a role.

“I believe she died of acute bacterial pneumonia in a setting of toxic levels of drugs,’’ Vargas said in the first-degree murder trial of Rebecca’s mother, Carolyn Riley....

Vargas’s testimony, however, also at least partially backed up the defense case that a fast-moving lung infection, one that would catch even conscientious parents off guard, may have caused the girl’s death.

The pathologist described the child’s pneumonia as “overwhelming’’ and said it may have started as a coldlike illness that rapidly transformed into life-threatening pneumonia.

Vargas did indicate that clonidine played a role in the girl’s death. She said Rebecca had toxic levels of clonidine that would have undermined her ability to battle the bacterial infection.

She said clonidine can depress breathing and other bodily functions, exacerbating the girl’s illness.

“The more sedation, the more risk,’’ Vargas said in her testimony in the courtroom of Plymouth County Superior Court Judge Charles Hely.

Vargas said a review of the girl’s tissue samples showed signs of organs damaged by excessive drug consumption, adding that Rebecca had a potentially fatal level of clonidine in her system when she died.

Vargas’s testimony sets up a critical phase of the trial: the battle of medical specialists.

Both sides agree the child was gravely ill on the night of Dec. 12, 2006. She was frequently vomiting, coughing, and walking about in a confused mental state.

But they differ on the role that clonidine played in the death and the extent to which the parents ignored their responsibility to seek urgent medical care....

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"Prosecutors question mother’s credibility; Role of drugs is focus in the death of 4-year-old girl" by Patricia Wen, Globe Staff | January 30, 2010

BROCKTON - A Hull woman accused of killing her 4-year-old daughter with an overdose of psychotropic drugs has been portrayed by prosecutors as lying about the most profound matters, such as how many pills she gave the girl just before she died.

But testimony presented yesterday in Plymouth County Superior Court suggested that Carolyn Riley may have been far from truthful on more mundane issues, such as missing gifts cards at Walmart and Stop & Shop....

The mother’s credibility and the role that psychiatric drugs played in Rebecca’s death were key issues yesterday as the mother’s first-degree murder trial completed its second full week. The child’s father faces the same charges, but he will be tried separately.

A pediatrician from Children’s Hospital Boston, who specializes in poison control, testified yesterday that she is convinced that Rebecca died of a lethal overdose of clonidine, one of three psychotropic medications the girl was on.

Dr. Michele Burns Ewald testified that the girl’s clonidine levels were life-threatening and that she has seen patients with even lower levels who looked “close to death.’’

Her testimony differed slightly from another Children’s Hospital physician, Dr. Sara Vargas, a pathologist who said Thursday that Rebecca probably died from the combined effects of an aggressive pneumonia and toxic levels of clonidine.

The defense is expected to present specialists to say that fast-acting pneumonia caused her death, not drugs.

Dr. Elizabeth Bundock, who conducted an autopsy of Rebecca, began her testimony yesterday and will resume Monday. She has previously identified an overdose of clonidine as the major cause of death.

Clonidine is a blood pressure medication often used as a sedative for children with attention-deficit hyperactivity disorder. Rebecca and her two older siblings were each prescribed several psychotropic drugs for bipolar and hyperactivity disorders, and all were under the care of Dr. Kayoko Kifuji, a Tufts Medical Center psychiatrist.

Rebecca and her older sister were diagnosed by Kifuji at age 2.

How the hell do you even know at that age?

This is sick!

Prosecutors allege that Kifuji was fooled by troubled parents who fabricated their children’s behavioral problems so that they could obtain sedating drugs and to help the family qualify for federal disability benefits.

Tufts Medical Center has stood by Kifuji, who had voluntarily stopped practicing after Rebecca’s death, but has since returned after a grand jury declined last summer to indict her.

Yesterday, a hospital spokeswoman issued an additional statement, saying its own investigation, aided by outside specialists, reinforced their view that “Dr. Kifuji’s care was appropriate and was not the cause of Rebecca’s untimely and tragic death.’’

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This whole case makes me want to puke.


What kind of parents and doctors let their kids get doped up this way?

"Hull mother’s recounting of girl’s death differs from earlier testimony" by Patricia Wen, Globe Staff | February 2, 2010

BROCKTON - Carolyn Riley sounded flat and halting as she recounted in a taped police interview how she thought her 4-year-old daughter had only a mild illness the day before she died.

“I just thought it was a cold,’’ the 35-year-old Hull mother, her voice often barely audible, said in the recording played to jurors yesterday in her first-degree murder trial.

Riley, who is accused of killing her daughter with a fatal overdose of psychotropic drugs, voluntarily submitted to the interview only five hours after Rebecca’s body was found at her parents’ bedside in Hull around 6 a.m. on Dec. 13, 2006. During much of the 75-minute interview with State Trooper Anna Brookes, Riley sounded like a parent with nothing to hide, recounting the multitude of mood-altering drugs that Rebecca and her two older siblings were taking for bipolar and hyperactivity disorders and naming the various physicians and psychiatrists that were in touch with the family.

On the tape, she described the day of Dec. 12, when she said Rebecca began vomiting and became feverish. The mother said she gave the girl cold medications, Tylenol, and sips of water. When Rebecca wanted to sleep in her parents’ bed that night and later requested to sleep on the floor next to the bed, the mother said, she went along, even giving her a blanket and stuffed bear....

Around 6 a.m. on Dec. 13, the mother said on tape that she woke up, walked past Rebecca’s body, and woke up her 11-year-old son to get ready for school. When she returned, she noticed a foamy substance near Rebecca’s mouth and nose. She bent down to feel her daughter’s cool and limp body, and then yelled to her husband that Rebecca might be dead. Michael Riley then called 911.

The police interview was the first time jurors heard the defendant speak about the case, and the panel will probably hear another interview with Carolyn Riley today, this one recorded by the CBS show, “60 Minutes,’’ with Katie Couric.

Damage control on Katie Couric's show?

It remains unclear if the mother will take the stand in her own defense....

Her recorded statements, however, differed from earlier testimony from the family’s housemates....

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"Jurors in trial of accused mother hear taped interviews; Carolyn Riley has yet to testify in her defense" by Patricia Wen, Globe Staff | February 3, 2010

BROCKTON - A South Shore mother has yet to testify in her own defense and may never do so. However, jurors in her murder trial had the chance yesterday to observe her through two videotaped interviews, one led by a state trooper, another by Katie Couric of CBS News....

Riley, 35, projected the image of a meek woman confronting forces beyond her control: a husband who showed flashes of anger, social workers who reported her to child-protection authorities for neglect, and Social Security bureaucrats controlling her family’s limited income.

When asked on Feb. 5, 2007, the day of her arrest, to explain what disability enables her to qualify for federal benefits, Riley answered in a barely-audible voice, “My workers filled out the form for me.’’

When Trooper Anna Brookes prodded further, the mother replied, “I don’t know.’’ She then went on to say that she suffers migraines, depression, and anxiety, among other things, and takes many drugs herself.

In several ways, her story changed from one interview to the other.

She reported Rebecca was sick only a day before she died, then later said it was two days. She initially denied giving any extra drugs to Rebecca beyond her regular dosages; however, in a later interview, she acknowledged giving an extra half-tablet of a .1 milligram clonidine, a sedative, which she asserted her psychiatrist allowed if Rebecca had trouble sleeping.

Before her arrest, Riley said she gave Rebecca that extra half-tablet of clonidine roughly twice a month; later, she said it was about twice a week.

Her view of the psychiatrist, which was initially favorable, became far more critical by the time she sat for the CBS “60 Minutes’’ show, which aired in September 2007....

Yeah, the drugs didn't affect the lying so much.

Riley told Couric that she thought “the doctor was too quick to put her [Rebecca] on medication.’’

You were feeding her the stuff and go the doctor to up the dosage (didn't have to twist arms, but)!

When asked if Rebecca’s bipolar diagnosis was wrong, the defendant replied, “probably.’’

She said she “trusted that the doctors knew what they were talking about.’’

The defendant seemed most animated when talking about her husband, Michael Riley, 37, who is also being tried, separately, on a charge of first-degree murder.

Prosecutors have portrayed him as a violent influence and suggested that the mother overdosed Rebecca - possibly giving her seven full clonidine tablets at once, twice her daily dosage - in response to Michael’s demands that the sick child quiet down.

Off with their heads. Let God sort 'em out.

One officer asked on tape about her dependence on her husband and assumed that she could not drive because Michael Riley did most of the driving.

“I’m perfectly able to drive!’’ she snapped.

Carolyn Riley also reiterated that neither she nor her husband ever struck Rebecca. Those answers came in response to bruises found on Rebecca’s body after she died.

The trial, which is in its third week, is expected to go to the jury by tomorrow.

Not a moment too soon.

The defense may begin its case today and present medical experts who will say that Rebecca died of rapid-onset pneumonia, not an overdose of drugs.

Prosecutors have presented a state medical examiner and other medical specialists, who say the child died after she was given a fatal mix of psychotropic drugs, including clonidine. The state says the parents also showed a “malicious’’ failure to get medical attention for their gravely sick daughter.

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"Defense presents case for pneumonia; Grandmother says girl well cared for" by Patricia Wen, Globe Staff | February 4, 2010

BROCKTON - Defense attorneys for a South Shore mother, who is accused of killing her preschooler with a drug overdose, began presenting their case yesterday, calling a forensic pathologist and the defendant’s mother to take the witness stand and challenge the prosecutor’s charges....

Dr. Jonathan Arden, a former chief medical examiner in Washington, D.C., and now a private consultant, testified that his review of the case shows Rebecca died of “atypical pneumonia,’’ not an overdose of drugs, specifically clonidine.

“I’m confident this is a bacterial pneumonia,’’ he said.

The case, now in its third week, is expected to go to the jury by tomorrow....

That's what you said yesterday.

When questioned by prosecutor Heather Bradley, Arden acknowledged that Rebecca’s reported clonidine levels of 12 nanograms per milliliter were high compared to the therapeutic level of .5 to 4.5 nanograms per milliliter. But he insisted that measuring clonidine levels at death is unreliable in her case, and he believes her level was not life-threatening.

During cross-examination, Arden also disclosed that he typically charges $400 an hour for his work and $4,000-a-day for court appearances, a tab that, in this case, is picked up by the state.

Oh, YOU are PAYING for the TESTIMONY, are you, TAXPAYERS?

What a HEFTY TAB, huh?

Hear that flushing sound? This guy's credibility just went with it.

Another defense witness, Robert Alan Middleberg, a forensic toxicologist from NMS Labs in Willow Grove, Penn., had testified earlier this week, appearing in the middle of the prosecution case because of scheduling issues. Middleberg said the medical examiner used a “blind needle stick’’ method of getting a clonidine blood sample from Rebecca’s leg, rather than a more careful method that requires multistep incisions.

He also said that drugs diffuse differently in a body after death, making accurate assessments difficult....

Dr. Sara Vargas, a pathologist from Children’s Hospital, was a prosecution witness who partly backed up Arden’s view. She cited an aggressive pneumonia as a cause of the death, though she also cited staphylococcus or streptococcus bacteria as possible triggers.

She added, however, that both the pneumonia and toxic levels of sedating drugs acted together to kill the child. She said the drugs probably suppressed the ability of her heart and lungs to battle the pneumonia.

That's murder in my mind (for money, ugh)!!!

Beyond the medical testimony, the defense also put on Valerie Berio, the defendant’s mother, who testified that her granddaughter was well cared for....

Through tears, she pointed to family photographs of the Riley family before Rebecca’s death. She acknowledged wondering whether Rebecca’s often-hyper behavior was simply due to “the terrible twos.’’

You think? Just being a little girl in a f***ed-up home?

When asked why she never questioned Carolyn Riley about putting Rebecca on drugs, Berio answered, “I trusted her judgment.’’

That might not have been the best decision.

After all, she was also loaded up on drugs.

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I feel like I need a bath, readers, that's what I feel like.


"Juror deliberations next in Riley trial; Closing arguments paint two portraits" by Patricia Wen, Globe Staff | February 5, 2010

BROCKTON - Jurors are expected to start deliberating today on whether a South Shore mother is a tragic figure whose daughter died of a rare, aggressive illness or a heartless con artist who used psychiatric drugs to kill her child....

Even when prosecutors displayed blown-up photographs of her daughter’s body as it was discovered - clad only in a pull-up diaper, sprawled on the floor next to her parents’ bed and smeared with lung secretions - Riley showed little visible emotion, or looked down.

Earlier this week, jurors watched a clip from a CBS “60 Minutes’’ show when Katie Couric asked about her placid demeanor, saying, “You almost seem numb.’’ Riley answered haltingly, “Yes.’’

She did not take the stand in her own defense....

The child’s controversial psychiatrist, Dr. Kayoko Kifuji of Tufts Medical Center. Kifuji agreed to testify only after invoking her right against self-incrimination and being granted immunity from prosecution....

While testifying in this case, Kifuji acknowledged that she relied almost exclusively on the mother’s description of her child’s behavior before making a diagnosis and prescribing drugs.

Doctor's diagnosis, huh? So how much were you getting in kickbacks, lady?

After a one-hour consultation, she diagnosed Rebecca at age 2 as having attention deficit hyperactivity disorder, and she found her to have bipolar disorder at age 3 after the mother complained that the child was driving her “crazy.’’

I'm sensing an UNFIT MOTHER, aren't you?

Kifuji had previously spent one hour with Rebecca’s older sister, Kaitlynne, when she was 2, before diagnosing her with bipolar disorder and authorizing drugs. This happened even though an early intervention specialist who had seen Kaitlynne nearly every week since birth, and who said she was present at that 2003 meeting, spoke out against drugs and said the child only displayed typical toddler behavior.

But here is the prescription anyway.

But defense attorneys have said Carolyn Riley simply trusted Kifuji and saw her out of genuine concern for her children. They also said their medical experts say Rebecca ultimately died of rapid-onset pneumonia, not drugs.

Attorney Michael Bourbeau described the pneumonia as remarkably aggressive and, in explaining Rebecca’s death, said that “the pills had no effect.’’

Yeah, I know, just doing their job.

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Glad I'm not on that jury. I'd have asked to be excused.