A state trooper's affidavit said a Walgreen's pharmacy filled a number of clonidine prescriptions for the Riley's when they should have had an ample supply and that several times, Dr Kifuji approved extra pills because Carolyn Riley said she had run out or lost her supply.
Carolyn Riley told investigators that Dr Kifuji had authorized the extra doses to help Rebecca get to sleep, the affidavit said. The trooper also reported that Dr Kifuji received calls from a therapist and a nurse at Elden Johnson Early Childhood Center, where Rebecca was a student, saying they were concerned about her medication.
The affidavit shows that no testing was conducted on Rebecca in making the diagnosis of attention deficit or bipolar disorder and that Dr Kifuji said she diagnosed Rebecca based on the parents' statements and "brief visits" in her office as frequently as twice a month and as seldom as once every two months.
In July 2006, a social worker treating Rebecca filed a complaint with the agency reporting that Carolyn Riley was "neglecting her children" and "appeared heavily drugged and unable to respond" on one of her visits to the family home.
The social worker said that during one visit, Carolyn told her that urine on the floor was from when Rebecca had taken a nap on the floor, according to an affidavit from investigators, and the social worker said she had to tell Carolyn to clean the floor.
When checking out the social worker's complaint, the DSS Commissioner said all the doctors and a psychiatric hospital caring for one of the children in July 2006 said the medications were appropriate and there was no one else to consult, so the department did not substantiate the complaint.
The medical examiner's office determined that Rebecca died from "intoxication due to the combined effects" of the drugs clonidine, Depakote, dextromethorphan, and chlorpheniramine, the district attorney's office said in a statement.
The official autopsy report states that Rebecca died of the "combined effects" of the drugs and that her lungs and heart were damaged by "prolonged abuse of these prescription drugs, rather than one incident."
Those findings have some experts wondering whether the medical examiner may be a member of the 85% of doctors identified by the New England Journal of Medicine study who are unaware of the serotonin syndrome as a clinical diagnosis.
The statement released by the DA states, "This occurred as a result of the intentional overdose of Rebecca with clonidine," and the manner of death "was determined to be homicide."
Rebecca's parents have both been charged with murdering their daughter.
However, psychiatrist Dr Grace Jackson, a leading authority on psychotropic drugs, takes issue with the claim of the manner of death being homicide.
"I'd put my money on serotonin syndrome as the cause of death," she says, "a potentially lethal condition of serotonin excess, leading to signs and symptoms which include autonomic instability, heart dysrhythmias (sudden death), hyperthermia (high fever), changes in mental status (including possible coma), hyperreflexia, and myoclonus."
"In this case," Dr Jackson says, "the primary culprits were dextromethorphan and chlorpheniramine, an antihistamine which also boosts serotonin levels."
"It is probably quite likely," she explains, "that the family had not been warned by any doctor or pharmacist that this combination of medications could cause death – particularly, in a toddler."
"It is also possible," she adds, "that the psychiatrist did not realize that the family was administering dextromethorphan to the child --- it might have been given from an over-the-counter cough remedy by unsuspecting parents."
Carolyn Riley told investigators that Dr Kifuji had authorized the extra doses to help Rebecca get to sleep, the affidavit said. The trooper also reported that Dr Kifuji received calls from a therapist and a nurse at Elden Johnson Early Childhood Center, where Rebecca was a student, saying they were concerned about her medication.
The affidavit shows that no testing was conducted on Rebecca in making the diagnosis of attention deficit or bipolar disorder and that Dr Kifuji said she diagnosed Rebecca based on the parents' statements and "brief visits" in her office as frequently as twice a month and as seldom as once every two months.
In July 2006, a social worker treating Rebecca filed a complaint with the agency reporting that Carolyn Riley was "neglecting her children" and "appeared heavily drugged and unable to respond" on one of her visits to the family home.
When checking out the social worker's complaint, the DSS Commissioner said all the doctors and a psychiatric hospital caring for one of the children in July 2006 said the medications were appropriate and there was no one else to consult, so the department did not substantiate the complaint.
The medical examiner's office determined that Rebecca died from "intoxication due to the combined effects" of the drugs clonidine, Depakote, dextromethorphan, and chlorpheniramine, the district attorney's office said in a statement.
The official autopsy report states that Rebecca died of the "combined effects" of the drugs and that her lungs and heart were damaged by "prolonged abuse of these prescription drugs, rather than one incident."
Those findings have some experts wondering whether the medical examiner may be a member of the 85% of doctors identified by the New England Journal of Medicine study who are unaware of the serotonin syndrome as a clinical diagnosis.
The statement released by the DA states, "This occurred as a result of the intentional overdose of Rebecca with clonidine," and the manner of death "was determined to be homicide."
Rebecca's parents have both been charged with murdering their daughter.
However, psychiatrist Dr Grace Jackson, a leading authority on psychotropic drugs, takes issue with the claim of the manner of death being homicide.
"I'd put my money on serotonin syndrome as the cause of death," she says, "a potentially lethal condition of serotonin excess, leading to signs and symptoms which include autonomic instability, heart dysrhythmias (sudden death), hyperthermia (high fever), changes in mental status (including possible coma), hyperreflexia, and myoclonus."
"In this case," Dr Jackson says, "the primary culprits were dextromethorphan and chlorpheniramine, an antihistamine which also boosts serotonin levels."
"It is probably quite likely," she explains, "that the family had not been warned by any doctor or pharmacist that this combination of medications could cause death – particularly, in a toddler."
"It is also possible," she adds, "that the psychiatrist did not realize that the family was administering dextromethorphan to the child --- it might have been given from an over-the-counter cough remedy by unsuspecting parents."
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