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Case spotlights disability system

First Riley trial set to begin Tuesday

Rebecca died in 2006 of an alleged overdose of psychiatric drugs. Rebecca died in 2006 of an alleged overdose of psychiatric drugs.
By Patricia Wen
Globe Staff / January 17, 2010

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BROCKTON - Two decades ago, Congress was abuzz over scandals involving indigent parents who fabricated behavioral problems in their children to get disability payments for mental disorders. Stunned by news of these so-called “crazy checks,’’ US lawmakers in 1996 enacted tougher standards for children to qualify for such benefits.

But in a highly unusual criminal trial set to start on Tuesday, prosecutors are expected to allege that stricter eligibility rules did not stop a financially strapped Hull couple, Carolyn and Michael Riley, from concocting an elaborate scheme involving powerful psychotropic drugs. By 2006, everyone in the family was on the federal disability rolls, except for the youngest child, 4-year-old Rebecca, whose application had been denied. As the parents were appealing that decision, Rebecca died in December 2006 of an alleged overdose of psychiatric drugs that she had been prescribed for bipolar and hyperactivity disorders.

The parents now face first-degree murder charges.

The case triggered nationwide controversy over how psychiatrists could prescribe such potent drugs to young children, but it also provided a rare glimpse into how struggling families utilize and potentially exploit the government’s disability system, in particular the fast-growing cash-assistance program to help indigent families with mentally disabled children.

“It’s difficult to know how much abuse there is,’’ said MIT economics professor David Autor, who has written extensively about federal disability programs. “But it has always been open to strategic behavior on the part of parents.’’

The parents have denied any ulterior motives in their actions, saying they are in despair over Rebecca’s death, which they have attributed to pneumonia. Their defense attorneys say the parents, while struggling with their own emotional problems, cared enough to get early intervention for their children. The parents, they said, were simply following the instructions of their children’s psychiatrist, Dr. Kayoko Kifuji of Tufts Medical Center, in dispensing the drugs.

In the upcoming case - in which the mother will be tried first, followed by the father in a separate trial - prosecutors are expected to portray both parents as seeing Rebecca as an extra source of disability income as early as age 2 1/2. In 2004, the child became a patient of Kifuji, who had already been treating Rebecca’s older siblings.

Rebecca’s mother allegedly told the psychiatrist that the girl’s behavior was erratic and disruptive, and she had trouble sleeping. Based on the mother’s accounts, and the family’s psychiatric history, Kifuji ultimately diagnosed Rebecca with bipolar and hyperactivity disorders, and prescribed Depakote, Seroquel, and Clonidine, a treatment plan similar to her siblings.

As soon as Rebecca got her first diagnosis in 2004, her father began applying for Social Security benefits for Rebecca, and kept trying even though he was twice rejected.

During 2005 and most of 2006, Rebecca’s mother would have numerous contacts with Kifuji over the drugs, including how much she could give and how to get refills. By June 2006, one of the girl’s therapists reported the family to the Department of Social Services, now the Department of Children and Families, saying the mother was neglectful to her children. By November 2006, a nurse at Rebecca’s preschool reported that the girl often seemed overmedicated, looking at times like a “floppy doll.’’

Meanwhile, Supplemental Security Income, or SSI, disability checks sustained the family’s finances. Both parents, who worked only sporadically, qualified for medical and psychological reasons, while the two oldest children were on disability primarily for psychiatric conditions. Federal officials say they cannot divulge a family’s disability payments; however, given that the typical monthly payment for each SSI disability recipient in Massachusetts is $700 a month, authorities say, the Riley family could have received about $2,800 a month or $33,600 a year.

To obtain benefits under SSI, parents must not exceed certain income limits, and show, based on tougher standards set in 1996, that their child’s mental condition limited his or her daily life in a marked and severe way, among other effects.

Prosecutors say that Rebecca’s parents were so focused on these checks that they ignored her rapidly declining health in early December 2006. On Dec. 11, she allegedly vomited in Quincy’s Social Security office, causing the father to erupt in anger when the family had to leave the office early. In the early morning hours of Dec. 13, she died while sleeping on the floor next to her parents’ bed.

The government says an autopsy report found the girl died from excessive amounts of psychiatric medications, though the defense attorneys say their medical experts dispute the autopsy findings and the parents could not have anticipated how quickly Rebecca’s health spiraled out of control that day.

With opening statements in Carolyn Riley’s trial set to begin this week in Plymouth County Superior Court in Brockton, numerous workers from the Social Security Administration are on the witness list, as well as relatives and friends who are expected to testify about the parents’ preoccupation with disability benefits. A judge, who reviewed grand jury testimony, stated there is ample testimony suggesting that “the defendants had a financial interest in having Rebecca and the other children diagnosed with bipolar and ADHD.’’

It remains unclear just how alert Kifuji might have been to the possibility that Rebecca’s parents might have been financially motivated to keep their daughter on drugs, or exaggerate symptoms, for the sake of disability benefits. The psychiatrist, who was the subject of a grand jury probe but was not indicted, is expected to testify, her lawyer said.

Some pediatricians and lawyers who work among low-income families say they believe childhood disability insurance fraud for mental disorders is rare, though they are alert to possible misrepresentations when dealing with indigent or troubled parents. Dr. Marilyn Augustyn, who specializes in behavioral pediatrics at Boston Medical Center, said some low-income parents inquire after hearing about others getting disability checks for children with hyperactivity disorder. Some have asked, she said, “Maybe I could get SSI? My kids are active too.’’

Augustyn said that the bureaucracy of securing benefits is “a nightmare,’’ and she believes generally only the most determined, and deserving, families will go through all the steps.

At the time that Rebecca’s parents were applying for benefits, the nation continued to see a soaring number of children receiving disability benefits for mental disorders.

From 2000 to 2008, for instance, the number of children with a listed diagnosis of mental disorder (excluding those listed under mental retardation) rose from about 260,000 to 596,000, a 150 percent increase.

And during those same years, the mental disorder diagnosis grew faster compared with other categories. It went from being roughly 32 percent to 52 percent of all children receiving disability benefits.

Many child advocates say these rising numbers show the government takes seriously the impact of mental disabilities on children and families, and are confident that scams are only a tiny fraction of all claims.

Jonathan Lasher of the Office of Inspector General for the Social Security Administration, said his office does not track fraud in childhood mental disabilities, though “it is safe to say that we see many types of feigned or exaggerated disability claims in the course of our investigative work.’’

Dr. Eli Newberger, the former medical director of child protection at Children’s Hospital Boston, said the only way to prevent fraud is for the child’s clinicians to look broadly at his or her family’s life, including economic stresses and the parents’ psychological states. Referring to the Riley case, Newberger said, “The clinicians were asleep at the switch.’’

It remains unclear whether Rebecca’s mother, now 35, will take the stand.

On a CBS “60 Minutes’’ show about the case in September 2007, Carolyn Riley told Katie Couric in a jailhouse interview that she was no longer sure Rebecca had bipolar disorder. When asked what went wrong, the mother replied hesitantly, “I don’t know. . . . Maybe she was just hyper for her age.’’

Patricia Wen can be reached at wen@globe.com.