Bailiff 1 (00:02):
This court is now in session. Please be seated.
Clerk (00:04):
Good morning, Your Honor. May I proceed?
William Sullivan (00:06):
Yes, please.
Clerk (00:07):
Your Honor, before the court today, we have the matter of Commonwealth v. Lindsay Clancy. Ms. Clancy is present. She is represented by attorney Kevin Reddington. The Commonwealth is represented by Assistant District Attorney Jennifer Sprague and Assistant District Attorney Shanan Buckingham.
William Sullivan (00:19):
All right. Well, good morning, counsel.
Clerk (00:22):
Morning.
William Sullivan (00:22):
Hi, good morning, Ms. Clancy. All right. Counsel, can I see you sidebar?
Bailiff 2 (00:24):
Court. All rise. [inaudible 00:00:36].
Bailiff 1 (00:36):
Oyez, oyez, oyez! All persons having anything to do before the Honorable William Sullivan, Justice. The Superior Court now sits in Plymouth within before the Commonwealth. Drawing any of your attendance and you shall be heard. God save the Commonwealth of Massachusetts. This court is now in session. Please be seated.
Clerk (01:32):
Good morning, Your Honor. May I proceed?
William Sullivan (01:32):
Yes, please.
Clerk (01:33):
Your Honor, before the court today, we have a continuation of the jury trial in the matter of Commonwealth v. Lindsay Clancy. Ms. Clancy is present. She is represented by attorney Kevin Reddington, but Commonwealth is represented by Assistant District Attorney Jennifer Sprague and Assistant District Attorney Shanan Buckingham.
William Sullivan (01:50):
All right. Thank you, Madam Clerk. Good morning, everyone.
Audience (01:51):
Good morning.
William Sullivan (01:54):
So what I'm going to do, as you probably expect, I'm going to ask you those questions to make sure everybody's able to follow my instructions. Go a little bit into our schedule and then we'll return to the evidence on this case.
(02:08)
So first question, has any member of the jury read, seen, heard, or overheard anything from any source that would affect your ability to be a fair and impartial juror in this case?
Jury (02:20):
None.
William Sullivan (02:20):
Last question is, is there any other serious matter or concern bearing on your service as a juror in this case that anybody needs to bring to my attention at this time?
Jury (02:29):
No.
William Sullivan (02:29):
Again, thank you so much for following those instructions. Again, as I always say, I hesitate to give you the schedule because I'm probably 50% right, 50% wrong. But the intention today, the thought is we'll probably go most of today. All right? And then at the end of the day before I send you home, I'm going to talk to the lawyers, kind of see what the schedule is for next week so you can plan as best you can and also kind of see where we are in regards to the timeline and the estimate of the case. So I'll try and give you as much of that information today before I send you home. All right? So with that, I will return to the case on trial. Commonwealth, call your next witness please.
Jennifer Sprague (03:15):
Commonwealth would call Kimberley Hardy as witness today.
Bailiff 2 (03:18):
Good morning. Stop right there and raise your right hand for the clerk.
Clerk (03:43):
Good morning. Do you solemnly swear that the testimony and the evidence you shall give to the court and the jury in the matter now pending between the Commonwealth and the defendant shall be the truth, the whole truth, and nothing but the truth so help you God? Thank you. You may have a seat.
Bailiff 2 (03:45):
Watch your step, please.
William Sullivan (03:45):
Hi, good morning.
Kimberlee Hardy (03:58):
Good morning.
William Sullivan (03:59):
I'm going to ask you to keep your voice up as best you can and speak into that microphone. Okay?
Kimberlee Hardy (04:04):
Okay.
William Sullivan (04:05):
That's good. All right. Commonwealth.
Jennifer Sprague (04:07):
Thank you. Good morning.
Kimberlee Hardy (04:08):
Good morning.
Jennifer Sprague (04:09):
Could you please introduce yourself to the jury, spelling your first and last name for the record?
Kimberlee Hardy (04:13):
It is Kimberlee Hardy. K-I-M-B-E-R L-E-E H-A-R-D-Y.
Jennifer Sprague (04:19):
And what city or state do you currently live in?
Kimberlee Hardy (04:22):
Cypress, Texas.
Jennifer Sprague (04:23):
And back in 2023, where did you live?
Kimberlee Hardy (04:27):
Brockton, Massachusetts.
Jennifer Sprague (04:29):
And in 2023, where did you work?
Kimberlee Hardy (04:31):
Kingsbury Club.
Jennifer Sprague (04:33):
Where is the Kingsbury Club?
Kimberlee Hardy (04:34):
In Kingston.
Jennifer Sprague (04:35):
And how long did you work for that club?
Kimberlee Hardy (04:38):
Four years.
Jennifer Sprague (04:39):
What is the Kingsbury Club?
Kimberlee Hardy (04:40):
It is a tennis club, but it also has a gym. It's kind of like a Y where people can come and drop their kids off in the playroom and stuff like that.
Jennifer Sprague (04:51):
Okay. Is it a private facility?
Kimberlee Hardy (04:53):
Yes.
Jennifer Sprague (04:53):
So members only?
Kimberlee Hardy (04:54):
Yes.
Jennifer Sprague (04:55):
And you mentioned dropping kids off. What was your role at the Kingsbury Club?
Kimberlee Hardy (05:00):
So I was the child service director, so I ran all the kids programming and the playroom.
Jennifer Sprague (05:07):
So what is the playroom at the Kingsbury Club?
Kimberlee Hardy (05:09):
So the playroom is a room where parents can drop their kids off for two hours a day so that they can work out.
Jennifer Sprague (05:17):
And what's the procedure when a parent or a guardian drops a child off at the playroom?
Kimberlee Hardy (05:21):
We have our system where we sign them in.
Jennifer Sprague (05:25):
And that's something on the computer that logs when the child comes in?
Kimberlee Hardy (05:29):
Yes.
Jennifer Sprague (05:29):
And it also logs when the child leaves, correct?
Kimberlee Hardy (05:32):
Yes.
Jennifer Sprague (05:33):
Now, what's the protocol for who can drop off and pick up a child at the playroom?
Kimberlee Hardy (05:38):
So parents. Usually, we say whoever drops off should be the one picking up as well, unless the parent notifies us that another parent will be picking up.
Jennifer Sprague (05:49):
And as far as that system geared towards the guardian who drops off and picks up?
Kimberlee Hardy (06:00):
Correct.
Jennifer Sprague (06:00):
So it's a separate log for each child based on who the guardian is?
Kimberlee Hardy (06:05):
Yes.
Jennifer Sprague (06:06):
Now, what is the security like at the Kingsbury Club? How do you get into the club?
Kimberlee Hardy (06:14):
Oh, you sign in. You have a key fob and you go to the front desk and you'll sign in.
Jennifer Sprague (06:20):
Are you familiar with some members using a scan app to sign in?
Kimberlee Hardy (06:26):
Yes.
Jennifer Sprague (06:27):
And as far as where the playroom is in the club, where is it in relation to when you come in the front doors?
Kimberlee Hardy (06:33):
It is right to the right. There is a long hallway and at the end of the hallway, that's the playroom.
Jennifer Sprague (06:40):
Now, is there kind of a rule there at the Kingsbury Club when you drop your child at the playroom that you have to remain on property?
Kimberlee Hardy (06:48):
Yes.
Jennifer Sprague (06:49):
And other than the gym and the tennis courts, what other facilities are on property?
Kimberlee Hardy (06:54):
We have a pool and a spa.
Jennifer Sprague (06:58):
I'm going to draw your attention to ... Sorry, one more background question.
Kimberlee Hardy (07:02):
Mm-hmm.
Jennifer Sprague (07:02):
You mentioned that there's other programs that the Kingsbury Club runs for children, right?
Kimberlee Hardy (07:07):
Mm-hmm.
Jennifer Sprague (07:08):
And you as the child service director were involved in that?
Kimberlee Hardy (07:10):
Yes.
Jennifer Sprague (07:11):
Is there a particular age that the children can start participating in the other group activities?
Kimberlee Hardy (07:18):
Camp starts at five, and at that point too, we had tennis that started at five, but swim lessons can start from babies.
Jennifer Sprague (07:27):
Okay. And so is there an age limit to the kids that could be in the playroom at any given point?
Kimberlee Hardy (07:34):
Typically, we only take three months old up, up to age 10. Normally, they don't want to be in there.
Jennifer Sprague (07:44):
And then you said that the time limit is two hours per day?
Kimberlee Hardy (07:48):
Yes.
Jennifer Sprague (07:49):
Is there a schedule or sign-up in advance, or was there one in 2023 if a member wanted to bring their kid into the playroom?
Kimberlee Hardy (07:56):
Yes, but in 2023, parents normally didn't sign up in advance because we were just getting back from COVID and we had low numbers, so we just took walk-ins.
Jennifer Sprague (08:07):
And it was a first come, first serve?
Kimberlee Hardy (08:09):
Yes.
Jennifer Sprague (08:11):
Are you familiar or were you familiar with Cora and Dawson Clancy?
Kimberlee Hardy (08:14):
Yes.
Jennifer Sprague (08:15):
Did you often see them in the playroom at the Kingsbury Club?
Kimberlee Hardy (08:19):
Yes.
Jennifer Sprague (08:19):
And who would be the party that would drop them off and pick them up?
Kimberlee Hardy (08:25):
Mainly Patrick.
Jennifer Sprague (08:28):
Did you or were you present in the playroom when Lindsay Clancy at times dropped them off and picked them up?
Kimberlee Hardy (08:33):
Yes.
Jennifer Sprague (08:36):
And when Lindsay Clancy came to drop off and pick up the children, did you interact with her?
Kimberlee Hardy (08:42):
Yes.
Jennifer Sprague (08:43):
And how would you describe her demeanor during those interactions?
Kimberlee Hardy (08:47):
She just seemed very shy.
Kevin Reddington (08:49):
Maybe just to focus on the timeframe.
Jennifer Sprague (08:51):
Well, that's fair. I'm going to draw your attention to maybe the September of 2022 to January of 2023, that fall into the winter. Did you see Lindsay Clancy drop the kids off at the playroom during that time period?
Kimberlee Hardy (09:04):
Yes.
Jennifer Sprague (09:05):
And you had the occasion to interact with her?
Kimberlee Hardy (09:06):
Mm-hmm.
Jennifer Sprague (09:07):
And during that time period in the fall to winter, what were your observations of her demeanor?
Kimberlee Hardy (09:12):
She just seemed shy. She was just would come in and pick up. I would usually try to start a conversation with her, but nothing else. Yeah, just shy.
Jennifer Sprague (09:25):
Okay. And it was only Cora and Dawson that came to the playroom?
Kimberlee Hardy (09:28):
Correct.
Jennifer Sprague (09:29):
Were you aware that there was a third child?
Kimberlee Hardy (09:31):
Yes.
Jennifer Sprague (09:32):
And do you know of any reason why that child didn't come with the other two?
Kimberlee Hardy (09:38):
I asked a couple times because I said that he can come in because he's over three months, and the answer was because they were scared of sickness.
Kevin Reddington (09:49):
[inaudible 00:09:50].
William Sullivan (09:50):
I'm sorry, what's the objection?
Kevin Reddington (09:51):
Who. The answer was from who.
William Sullivan (09:53):
If you could just find out.
Jennifer Sprague (09:54):
So this conversation that you had when you said that you asked about Callan, was that with Lindsay, or Patrick?
Kimberlee Hardy (10:02):
Lindsay.
Jennifer Sprague (10:03):
Okay. And so what did she tell you about Callan?
Kimberlee Hardy (10:06):
She was nervous about colds because it was cold and flu season.
Jennifer Sprague (10:10):
Okay. And so, obviously, when Cora and Dawson came, there would be other children in the playroom as well, right?
Kimberlee Hardy (10:15):
Yes.
Jennifer Sprague (10:18):
When Lindsay would drop the kids off during this time period between September of 2022 and January of 2023, did she ever tell you what her plans were at the club?
Kimberlee Hardy (10:28):
No.
Jennifer Sprague (10:29):
Did you see or make observations of how she was dressed when she dropped them off?
Kimberlee Hardy (10:32):
Yeah, she had workout outfits on.
Jennifer Sprague (10:35):
And would she come back before the end of that two hours to pick the kids up?
Kimberlee Hardy (10:40):
Yes.
Jennifer Sprague (10:40):
Did you notice anything different about her when she came back to pick the kids up during this timeframe?
Kimberlee Hardy (10:45):
No.
Jennifer Sprague (10:46):
Was she ever late picking them up?
Kimberlee Hardy (10:47):
No.
Jennifer Sprague (10:50):
Did you ever learn that she had left the property after bringing them to the playroom?
Kimberlee Hardy (10:56):
No.
Jennifer Sprague (10:58):
And that is a very strict rule at the club, correct?
Kimberlee Hardy (11:00):
Yes.
Jennifer Sprague (11:02):
Do you recall the last time that you saw Lindsay Clancy and Cora and Dawson at the Kingsbury Club?
Kimberlee Hardy (11:07):
Yes.
Jennifer Sprague (11:08):
Do you recall approximately when that was?
Kimberlee Hardy (11:11):
In January.
Jennifer Sprague (11:13):
Would it have been closer to New Year's or a few weeks into the month?
Kimberlee Hardy (11:17):
I think it was a few weeks in.
Jennifer Sprague (11:19):
And how is it that you remember them on that particular day?
Kimberlee Hardy (11:24):
Just their usual selves. They came in, played, nothing.
Jennifer Sprague (11:31):
Okay. If I tell you that Cora and Dawson were dropped off by Lindsay on January 13th at 9:07, does that sound right to you?
Kimberlee Hardy (11:43):
Mm-hmm.
Jennifer Sprague (11:43):
And that they were also dropped off on January 17th at 9:30 AM, does that sound right?
Kimberlee Hardy (11:51):
Mm-hmm. Yeah.
Jennifer Sprague (11:52):
Did Cora and Dawson usually come in the mornings?
Kimberlee Hardy (11:54):
Yes.
Jennifer Sprague (11:55):
Around that time? And what time does the playroom open?
Kimberlee Hardy (11:57):
We open at 8:00.
Jennifer Sprague (11:59):
And what time does it close?
Kimberlee Hardy (12:00):
It closes at 2:00.
Jennifer Sprague (12:03):
Did you ever have occasion to see Cora and Dawson in the playroom during that time, September to January later in the afternoon?
Kimberlee Hardy (12:13):
Sometimes. Not usual.
Jennifer Sprague (12:15):
Is it fair to say that generally when Lindsay dropped them off, they came in the morning?
Kimberlee Hardy (12:19):
Yeah.
Jennifer Sprague (12:21):
And is there anything about that day with Cora, that last day that you saw her that sticks out in your mind?
Kimberlee Hardy (12:27):
Not that I recall.
Jennifer Sprague (12:29):
What kinds of things would the kids do in the playroom?
Kimberlee Hardy (12:31):
They liked to color. They would play with the dolls, dress up toys, the cars, the train set.
Jennifer Sprague (12:40):
And on one of those last days that you saw Cora, did she draw a picture?
Kimberlee Hardy (12:45):
Yes.
Jennifer Sprague (12:46):
Did she take it with her, or did she give it to you?
Kimberlee Hardy (12:48):
She left it.
Jennifer Sprague (12:54):
Your Honor, at this time, I would move to admit the Kingsbury Club records as the next exhibit.
William Sullivan (12:58):
All right. They may be admitted.
Clerk (13:03):
Exhibit 218.
Jennifer Sprague (13:06):
Thank you. Nothing further. Thank you.
William Sullivan (13:09):
All right, counsel.
Kevin Reddington (13:10):
Morning.
Kimberlee Hardy (13:10):
Good morning.
Kevin Reddington (13:13):
So you saw Lindsay with her children dropping them off, picking them up on a fairly regular basis, is that correct?
Kimberlee Hardy (13:20):
Yes.
Kevin Reddington (13:20):
And Patrick, of course, right?
Kimberlee Hardy (13:21):
Yes.
Kevin Reddington (13:23):
Did you ever see how she acted around them? Did she appear to be happy to be with them and take care of them, or did she appear to be angry with them at all?
Kimberlee Hardy (13:33):
No, never angry. She seemed happy to be with them. She always picked up on time and they were always excited to see her.
Kevin Reddington (13:41):
And you certainly weren't close enough to her to know if she had any personal issues in her life as far as her mind or her body or anything like that, right?
Kimberlee Hardy (13:51):
No.
Kevin Reddington (13:54):
You would be aware though that, on occasion, people are advised by their doctors or psychiatrists to exercise. It might be a good thing for them to do. Is that-
Kimberlee Hardy (14:04):
Yes.
Kevin Reddington (14:05):
Thank you. That's all I have.
Kimberlee Hardy (14:06):
Thank you.
William Sullivan (14:07):
Any redirect?
Jennifer Sprague (14:08):
No, thank you.
William Sullivan (14:10):
Thank you. You may step down.
Kimberlee Hardy (14:10):
Thank you.
William Sullivan (14:10):
Thank you.
Bailiff 2 (14:10):
Assist her please.
William Sullivan (14:19):
All right. Commonwealth.
Jennifer Sprague (14:20):
The Commonwealth would call Sarah Carney, please.
Bailiff 2 (14:55):
Good morning, ma'am. Stop right there. Raise your right hand to the clerk.
Clerk (14:56):
Good morning. Do you solemnly swear that the testimony and the evidence you shall give to the court and the jury in the matter now pending between the Commonwealth and the defendant shall be the truth, the whole truth, and nothing but the truth so help you God? Thank you. You may have a seat, ma'am.
Bailiff 2 (14:56):
Watch your step, please.
William Sullivan (15:13):
All right. Good morning.
Sarah Carney (15:14):
Good morning.
William Sullivan (15:15):
All right, counsel.
Jennifer Sprague (15:17):
Thank you. Good morning.
Sarah Carney (15:18):
Good morning.
Jennifer Sprague (15:19):
Could you please tell the jurors your first and last name?
Sarah Carney (15:21):
Sure. Sarah Carney.
Jennifer Sprague (15:23):
And how do you spell your first name?
Sarah Carney (15:24):
S-A-R-A-H.
Jennifer Sprague (15:25):
And the last name?
Sarah Carney (15:27):
C-A-R-N-E-Y.
Jennifer Sprague (15:28):
And what city or town do you live in?
Sarah Carney (15:30):
Duxbury, Massachusetts.
Jennifer Sprague (15:32):
And are you married?
Sarah Carney (15:34):
Yes.
Jennifer Sprague (15:34):
And who's your husband?
Sarah Carney (15:35):
Kyle Carney.
Jennifer Sprague (15:37):
And do you have children?
Sarah Carney (15:38):
Yes.
Jennifer Sprague (15:39):
How old are your children?
Sarah Carney (15:40):
Five and two.
Jennifer Sprague (15:43):
Do you know the Clancy family?
Sarah Carney (15:44):
Yes.
Jennifer Sprague (15:45):
And how do you know them?
Sarah Carney (15:47):
Went to school with Pat and then met Lindsay later.
Jennifer Sprague (15:50):
And so when you say you went to school with Pat, fair to say you went to Salve?
Sarah Carney (15:54):
Yes.
Jennifer Sprague (15:55):
And did you know Pat before school?
Sarah Carney (15:58):
No.
Jennifer Sprague (15:59):
And did you become friends with him in school?
Sarah Carney (16:01):
Yes.
Jennifer Sprague (16:01):
When you graduated from college, did you remain friends with Patrick?
Sarah Carney (16:06):
Yes.
Jennifer Sprague (16:06):
And is your husband also a friend of Patrick's?
Sarah Carney (16:09):
Yes.
Jennifer Sprague (16:10):
Did they meet at college or just someplace else?
Sarah Carney (16:13):
In college.
Jennifer Sprague (16:15):
At some point, did you come to know Lindsay Clancy?
Sarah Carney (16:19):
Yes.
Jennifer Sprague (16:20):
And do you remember approximately when you were introduced to her?
Sarah Carney (16:24):
A few years after college, maybe 12, 13 years ago.
Jennifer Sprague (16:29):
And where were you living then when you first met her?
Sarah Carney (16:34):
Boston.
Jennifer Sprague (16:35):
Okay. How about Pat? Was he living in Boston as well?
Sarah Carney (16:38):
I believe so.
Jennifer Sprague (16:38):
And what was your relationship like with Patrick after college? Were you close?
Sarah Carney (16:45):
Yes, friends. Close.
Jennifer Sprague (16:47):
And as he began a relationship with Lindsay, did you become friendly with her?
Sarah Carney (16:53):
Yeah.
Jennifer Sprague (16:53):
Did you have that same relationship with Lindsay that you had with Pat?
Sarah Carney (16:58):
No.
Jennifer Sprague (17:01):
As time passed on, did your families remain friendly?
Sarah Carney (17:06):
Yes.
Jennifer Sprague (17:06):
And eventually, both your families ended up living in the same town in Duxbury, correct?
Sarah Carney (17:11):
Yes.
Jennifer Sprague (17:14):
What was the relationship like between your families starting in 2019?
Sarah Carney (17:21):
Close, friendly, went to the beach together, had them over at our house, went to their house, that kind of thing.
Jennifer Sprague (17:28):
And as the Clancy started having children and you started having children, did that remain throughout?
Sarah Carney (17:34):
Yeah, probably fewer times just because we're all busy, but yep.
Jennifer Sprague (17:38):
And were you around after each of the Clancy children were born? Meaning after Cora was born, you were still part of Patrick's life?
Sarah Carney (17:49):
Yeah.
Jennifer Sprague (17:50):
Did you notice any changes in Lindsay after Cora was born?
Sarah Carney (17:54):
No.
Jennifer Sprague (17:55):
And how about Dawson when Dawson came along? Did you notice any changes in Lindsay after Dawson was born?
Sarah Carney (18:01):
No.
Jennifer Sprague (18:02):
And then Callan, who was born in May of 2022, were you still friendly with them and still doing those trips and going to each other's houses, beach trips?
Sarah Carney (18:10):
Yep.
Jennifer Sprague (18:11):
So did you notice anything different about Lindsay after Callan was born?
Sarah Carney (18:15):
No.
Jennifer Sprague (18:20):
Do you recall observing Lindsay or seeing Lindsay when she was pregnant with Callan?
Sarah Carney (18:26):
Yes.
Jennifer Sprague (18:26):
Fair to say she was a pretty active person?
Sarah Carney (18:30):
Yes.
Jennifer Sprague (18:30):
And even in pregnancy, being very pregnant, she was physically active?
Sarah Carney (18:34):
Yes.
Jennifer Sprague (18:34):
Do you recall what kind of exercise she did or seeing her exercise?
Sarah Carney (18:39):
I remember her posting videos of her exercising and the kids were in the background.
Jennifer Sprague (18:45):
And where would the exercising happen? Could you tell where it was in their house?
Sarah Carney (18:50):
I'm not sure.
Jennifer Sprague (18:51):
Have you been inside their house before?
Sarah Carney (18:53):
Yes.
Jennifer Sprague (18:54):
So you know that they had the living room area on the first floor and basement area was finished?
Sarah Carney (18:59):
After a few moves in the living room, I've never been to the basement.
Jennifer Sprague (19:01):
Okay. So in that video, what did you observe the kids doing in the background?
Sarah Carney (19:06):
Playing on the couch, playing with toys.
Jennifer Sprague (19:11):
And when you observed this video, fair to say it was kind of like a beach body type exercise?
Sarah Carney (19:19):
Sure. I'm not sure what that means.
Jennifer Sprague (19:23):
Did you see any equipment in the video, like workout equipment?
Sarah Carney (19:27):
I don't recall.
Jennifer Sprague (19:29):
Do you recall previously indicating that you saw the kids playing with exercise bands in the videos?
Sarah Carney (19:35):
Sure, if that's what I said. I don't recall.
Jennifer Sprague (19:39):
Now, I'm drawing your attention to the summer of 2022 and the fall of 2022. Were you still going to the beach and getting together with the Clancys?
Sarah Carney (19:48):
I believe so, yes.
Jennifer Sprague (19:50):
Other than going to the beach, what other kinds of activities would you invite them to do with your family?
Sarah Carney (19:56):
They probably came over to our house once or twice.
Jennifer Sprague (20:03):
Throughout the course of the fall of 2022, did you notice any changes in Lindsay's physical health?
Sarah Carney (20:12):
I think I saw her one time at drop-off and she just seemed thinner. More frail.
Jennifer Sprague (20:16):
I'm sorry?
Sarah Carney (20:16):
Thinner.
Jennifer Sprague (20:17):
Okay. Did you ever have a conversation with her at drop-off about your observations?
Sarah Carney (20:22):
No.
Jennifer Sprague (20:24):
How about just observing her overall demeanor? Did you notice anything change about her in the fall into the winter of 2022?
Sarah Carney (20:32):
No.
Jennifer Sprague (20:33):
Did you ever have any conversations with her about postpartum depression or sleep issues?
Sarah Carney (20:39):
No.
Jennifer Sprague (20:42):
And I'm going to draw your attention to January 22nd, 2023. That was a weekend. Do you recall that weekend?
Sarah Carney (20:51):
Yes.
Jennifer Sprague (20:52):
And did you have something happening at your house that your family invited the Clancys to?
Sarah Carney (20:57):
Yes, we had a bonfire.
Jennifer Sprague (20:59):
And who came from the Clancy family to the bonfire?
Sarah Carney (21:03):
Pat, Lindsay, Cora, and Dawson.
Jennifer Sprague (21:06):
Where was Caroline, if you know?
Sarah Carney (21:08):
At home with Lindsay's parents.
Jennifer Sprague (21:10):
Did you have the occasion to speak with Lindsay on that day?
Sarah Carney (21:13):
Yes.
Jennifer Sprague (21:13):
And fair to say, prior to that day, you hadn't really seen her much that winter?
Sarah Carney (21:17):
Correct.
Jennifer Sprague (21:18):
Were you happy to see her that day?
Sarah Carney (21:21):
Yeah.
Jennifer Sprague (21:21):
And what were your observations of her that day, her demeanor? Did she seem normal, or off?
Sarah Carney (21:28):
Just quiet, but fairly normal.
Jennifer Sprague (21:32):
Did you have the occasion to speak with her, just you and her?
Sarah Carney (21:35):
Yes.
Jennifer Sprague (21:35):
And was that outside of the bonfire, or somewhere else in your house?
Sarah Carney (21:39):
In the kitchen.
Jennifer Sprague (21:40):
And did you ask her anything?
Sarah Carney (21:43):
I was talking to her about my children, my daughter's allergies, and then the conversation mulled and I asked her how she was doing.
Jennifer Sprague (21:51):
And what did she tell you?
Sarah Carney (21:53):
Good.
Jennifer Sprague (21:55):
And did you have any further conversation or ask any follow-up questions?
Sarah Carney (21:59):
No.
Jennifer Sprague (22:00):
Why didn't you follow up?
Sarah Carney (22:02):
Because I figured if she wanted to explain or deep dive into it, she would. I wasn't going to press her.
Jennifer Sprague (22:09):
But on this occasion, she just said fine, and you kind of moved on to the next topic?
Sarah Carney (22:13):
Yes.
Jennifer Sprague (22:15):
And throughout the course of that day or that afternoon that you were with her, did you notice anything change about how she was communicating with you? Did she start to talk faster or seem confused in any way?
Sarah Carney (22:27):
No.
Jennifer Sprague (22:28):
Was there anything that happened at that interaction that made them abruptly leave?
Sarah Carney (22:36):
No? I think it was nap time for the kids.
Jennifer Sprague (22:39):
Okay. And was that the last time you saw or talked to Lindsay?
Sarah Carney (22:44):
Yes.
Jennifer Sprague (22:47):
Nothing further. Thank you.
William Sullivan (22:47):
All right. Mr. Reddington?
Kevin Reddington (22:55):
Good morning. So what was the timeframe that you knew Lindsay, not Patrick? I know you were very friendly with Patrick.
Sarah Carney (23:02):
Yep.
Kevin Reddington (23:03):
What was the timeframe that you knew Lindsay?
Sarah Carney (23:06):
12 years.
Kevin Reddington (23:08):
And would you say that you were close to her or were you social? Or how-
Sarah Carney (23:14):
Social.
Kevin Reddington (23:15):
Social?
Sarah Carney (23:15):
Yep.
Kevin Reddington (23:17):
And on occasion, you had the opportunity to be in their house, the upstairs portion of it that you indicated never in the basement or the office area, right?
Sarah Carney (23:27):
Right. Just the kitchen level.
Kevin Reddington (23:28):
Okay. Can you tell us in the fall of '22, approximately how many times you and your husband, Kyle, saw Lindsay and her husband Pat together? Not Kyle with Pat or you with Pat.
Sarah Carney (23:44):
I think it was just the one time at drop off.
Kevin Reddington (23:48):
One time at drop off. Okay. You had occasion to ask her advice about the babies and things of that nature on occasion, did you not?
Sarah Carney (24:00):
Yep.
Kevin Reddington (24:00):
She was always helpful to you or forthcoming?
Sarah Carney (24:03):
Yes. Yes.
Kevin Reddington (24:04):
And the last time you saw her on January 22nd, this was a bonfire. Is that what it was?
Sarah Carney (24:10):
Yep.
Kevin Reddington (24:11):
And that was where, in your backyard?
Sarah Carney (24:11):
In our backyard.
Kevin Reddington (24:13):
Was it in the daytime or the nighttime?
Sarah Carney (24:15):
Around lunchtime.
Kevin Reddington (24:16):
Lunchtime. And do you recall how long they were there for the bonfire?
Sarah Carney (24:21):
A few hours.
Kevin Reddington (24:23):
And they were there with the two older kids and Callan was home with her parents, right?
Sarah Carney (24:27):
Yes.
Kevin Reddington (24:28):
And she appeared to be quiet to you?
Sarah Carney (24:31):
Yes.
Kevin Reddington (24:32):
And she appeared, to your observation, around that timeframe to be thinner than what you had seen before?
Sarah Carney (24:38):
Yes.
Kevin Reddington (24:39):
But you'd agree with me that you guys weren't that close that she would confide in you, correct?
Sarah Carney (24:44):
Correct.
Kevin Reddington (24:45):
That's all we have. Thank you, ma'am.
William Sullivan (24:46):
All right. Any redirect?
Jennifer Sprague (24:49):
As far as your observations of Lindsay over the course of 12 years, fair to say she was always quiet with you?
Sarah Carney (24:55):
Yes.
Jennifer Sprague (24:58):
Thank you. Nothing further.
William Sullivan (24:58):
Right, thank you, ma'am. You may step down. Thank you.
Sarah Carney (24:59):
Thank you.
William Sullivan (24:59):
Commonwealth.
Jennifer Sprague (25:10):
The Commonwealth would call Alia Goodheart.
Bailiff 2 (25:11):
Right there. Stop right there. Raise your right hand for the clerk please.
Clerk (26:02):
Good afternoon. Do you solemnly swear that the testimony and the evidence you shall give to the court and the jury in the matter now pending between Commonwealth and the defendant shall be the truth, the whole truth, and nothing but the truth so help you God? Thank you. You may have a seat.
Bailiff 2 (26:02):
Watch your step, please.
William Sullivan (26:05):
All right. Good morning, Doctor.
Alia Goodheart (26:06):
Good morning.
William Sullivan (26:07):
All right. I'm going to ask you when you sit down, if you speak loudly so the jury can hear you and speak into that microphone. Okay?
Alia Goodheart (26:13):
Thank you.
William Sullivan (26:14):
All right. Thank you. Counsel.
Jennifer Sprague (26:21):
Thank you. Good morning.
Alia Goodheart (26:22):
Good morning.
Jennifer Sprague (26:23):
Could you please tell the jury your first and last name?
Alia Goodheart (26:27):
My first name is Alia. Last name is Goodheart.
Jennifer Sprague (26:30):
Can you spell your first name for the record?
Alia Goodheart (26:32):
A-L-I-A.
Jennifer Sprague (26:35):
And your last name, please?
Alia Goodheart (26:37):
G-O-O-D-H-E-A-R-T.
Jennifer Sprague (26:43):
And what do you do for work?
Alia Goodheart (26:45):
I'm a psychiatrist.
Jennifer Sprague (26:46):
And can you tell us a little bit about your educational background to be a psychiatrist?
Alia Goodheart (26:52):
I got my medical degree from the State University of New York in Brooklyn, the Health Sciences Center. And I came to Boston to do my four-year residency at the Harvard Longwood Psychiatry Residency Program. I also trained for an additional three years at the Boston Psychoanalytic Institute and got my advanced training in ... I attended the advanced training program. Yeah.
Jennifer Sprague (27:28):
Are you licensed here in Massachusetts to practice as a psychiatrist?
Alia Goodheart (27:33):
I am.
Jennifer Sprague (27:33):
Are you licensed in any other states?
Alia Goodheart (27:35):
No.
Jennifer Sprague (27:37):
Okay. So you said that you're a medical doctor with a specialization in psychiatry, correct?
Alia Goodheart (27:41):
Correct.
Jennifer Sprague (27:42):
Can you tell us a little bit about your work history in that field?
Alia Goodheart (27:48):
Yes. I've worked in several different settings. When I first started out, I was working at Beth Israel in integrated care, which means essentially that you work with primary care physicians, and if they have patients that they have questions about, they can consult you. And if there's a need, you can continue to manage the patient's psychopharm medications. And if it's simple, they can continue to do it, but you're available for them to consult with and to discuss cases.
(28:20)
After that, I went to Emerson Hospital where I worked on the inpatient psychiatric unit for a total of nine years. I left for one year to be the medical director at another freestanding hospital. After that, I worked at the women's prison in Framingham for a year and a half. And after that, an outpatient clinic affiliated with Tufts. I had a private practice for two years, and then I've been working at McLean for the last five years.
Jennifer Sprague (28:56):
Okay. And what is McLean Hospital?
Alia Goodheart (29:01):
It's a freestanding psychiatric hospital that is part of the Mass General Brigham system.
Jennifer Sprague (29:09):
What kind of services does that facility offer to patients?
Alia Goodheart (29:12):
They have lots of services, including inpatient, outpatient, substance abuse, trauma focused. There are lots of specializations, eating disorder programs. They have residential programs, they have partial programs. So there's a really broad bit of.
Jennifer Sprague (29:32):
And what is your role at McLean?
Alia Goodheart (29:34):
I work on one of the inpatient psychiatric units.
Jennifer Sprague (29:38):
And tell us a little bit about what an inpatient psychiatric unit is.
Alia Goodheart (29:47):
Patients who come to our unit are referred to us by the emergency department because it's been determined that they need inpatient level of care. You can come voluntarily or you can be sent involuntarily. And once you arrive, we work with the patient until they're for a certain period of time, which isn't predetermined, it is flexible. So it depends on what's going on.
(30:24)
And when you're on an inpatient unit, it's not just that you're seeing the psychiatrist, you're working as a team. So there are nurses, they're mental health workers, there are social workers. And the way it works at McLean is that every day you have a meeting where people discuss what's been going on and you share any information that you have and that kind of guides treatment. If I'm on the unit while I see the patient, I'm not there 24/7, but the mental health staff and the nursing staff are there and they contribute to the assessment of the patient.
Jennifer Sprague (31:15):
So in that team approach, when you have mental health workers, nurses, social workers that work with you, there's fair to say some combination of that team present all the time?
Alia Goodheart (31:27):
Yes. There are three shifts and each shift has mental health workers and nurses.
Jennifer Sprague (31:35):
And in that team approach, sometimes particular members of that team may have direct contact with the patient, correct?
Alia Goodheart (31:42):
Absolutely. Each patient is assigned a mental health worker and a nurse. They're offered a check-in, which is basically time to sit and talk about how they're doing and what's going on and if they're upset or distressed. And so there is documentation of that and that happens on a regular basis.
Jennifer Sprague (32:08):
And even when members of the particular treatment team don't have direct contact with a patient, they're still there and observing what's going on, right?
Alia Goodheart (32:16):
Correct.
Jennifer Sprague (32:17):
And are they trained to do that?
Alia Goodheart (32:18):
Absolutely.
Jennifer Sprague (32:19):
And so even if they don't have a conversation with somebody that's documented, they're still observing to be able to report back if there's any concerns that they observed during any given shift. Is that fair to say?
Alia Goodheart (32:30):
Yes.
Jennifer Sprague (32:32):
Now, you mentioned that the inpatient unit at McLean, that they come from the ER departments of the surrounding hospitals?
Alia Goodheart (32:43):
Yes.
Jennifer Sprague (32:44):
So you can't just walk in?
Alia Goodheart (32:46):
Not at McLean.
Jennifer Sprague (32:48):
For the inpatient in any-
Alia Goodheart (32:50):
Right. Correct.
Jennifer Sprague (32:51):
Okay. And so oftentimes, when a patient comes from the emergency department or is referred over there, how do they get there?
Alia Goodheart (33:00):
They have to be sent on a Section 12. Most of-
Alia Goodheart (33:00):
They have to be sent on a Section 12 most of the time. Well, then it doesn't make sense. So they're usually sent on a Section 12, especially if they're going to be sent in an ambulance. And then when they arrive at McLean, they are seen at the CEC, which is the Clinical Evaluation Center.
Jennifer Sprague (33:23):
If I could just stop you for one second. Can you tell us what a Section 12 is?
Alia Goodheart (33:27):
A Section 12 is basically a doctor or social worker or psychologist states that you are being referred to a hospital for admission because you have a mental health condition.
Jennifer Sprague (33:45):
And the Section 12 could be something that the patient voluntarily elects to do, right?
Alia Goodheart (33:54):
That's a Section 10. The Section 12 is, it means that you have to go there. If you go there and they evaluate that you're fine and you decide you don't want to be at the hospital, you can choose to leave and they'll have to let you go.
Jennifer Sprague (34:12):
So when you say that a person comes transported from an ER on a Section 12, they also can come transported on a 10 as well, a voluntary?
Alia Goodheart (34:21):
A Section 12 is required for transportation. Because in the time between when they leave the hospital and they're supposed to get to you, you want to make sure that... Something could happen and then they could leave. So you want to make sure that the physician sees them at that end and then somebody sees them at the other end to ensure that something hasn't changed. So it's evaluation.
Jennifer Sprague (34:46):
Okay. And at the emergency department, there is a particular type of evaluation that's done before somebody is sent over to McLean, correct?
Alia Goodheart (34:55):
Correct.
Jennifer Sprague (34:56):
From the Mass General, what is that usually referred to?
Alia Goodheart (34:58):
It's called the Acute Psychiatric Consultation APS. So the service is Acute Psychiatric Services and it's an evaluation. So it's a complete evaluation by either a nurse practitioner or a psychiatrist. And they go over things like, why are you coming now? What is your history? Have you ever had problems before? What's your family history? They document how you're presenting. They inquire about symptoms. And that's how they find out what medications you're on.
(35:35)
And then based on that, they decide whether you need... There could be several options. They can recommend inpatient treatment. They can recommend partial hospital program, but the patient doesn't have to do either. If they're not unsafe, they can choose to leave. But most of the time people take the recommendation and they've presented because they are seeking help.
Jennifer Sprague (36:01):
And unless the patient is deemed unsafe in that involuntary realm, it's their choice.
Alia Goodheart (36:09):
Correct.
Jennifer Sprague (36:10):
Now, you mentioned that when they come to McLean that they first come through and have a CEC. What is that?
Alia Goodheart (36:16):
It's a Clinical Evaluation Center.
Jennifer Sprague (36:22):
What happens at that stage at McLean?
Alia Goodheart (36:25):
They're seen by a psychiatrist and there's a nurse as well. They review the history that was obtained at the emergency department and they inquire about any... They actually do another evaluation just like at the APS, basically reviewing all the history, but also asking their own questions. And if they have any concerns, they document them there.
Jennifer Sprague (36:59):
And you said this evaluation is done by a psychiatrist?
Alia Goodheart (37:02):
Correct.
Jennifer Sprague (37:03):
And when a person comes into McLean, can they come at any hour of the day or night?
Alia Goodheart (37:09):
Correct.
Jennifer Sprague (37:09):
And when they first make it to the Clinical Evaluation Center, they're always seen by a psychiatrist?
Alia Goodheart (37:17):
Yes.
Jennifer Sprague (37:18):
Now, once they do this evaluation, gather all the information, do they also do kind of a physical exam to make sure that there's no medical issues to address?
Alia Goodheart (37:26):
Yes.
Jennifer Sprague (37:27):
And after all the information is gathered, what is done at the evaluation center?
Alia Goodheart (37:35):
So they basically enter the order.
(37:39)
May I have some water, please?
Judge William Sullivan (37:40):
Oh, sure. [inaudible 00:37:43]. Sorry.
Alia Goodheart (37:44):
No worries.
Judge William Sullivan (37:45):
Up [inaudible 00:37:46] my fault.
Alia Goodheart (37:48):
Can you repeat the question?
Jennifer Sprague (37:49):
Sure. When a patient is evaluated or seen in the Clinical Evaluation Center, what happens after the evaluation's done?
Alia Goodheart (37:56):
So they determine the level of checks that the patient should be on once they get to the unit, because there are several units there, at least four inpatient units. They decide what medications the patient is going to be able to get, thank you, until they are seen by a psychiatrist on the unit.
Jennifer Sprague (38:21):
And when you say level of check, what does that mean?
Alia Goodheart (38:25):
Everybody who is on the unit, there's a mental health worker assigned the task of ensuring that all the patients who are supposed to be on the unit are present and that they're safe. And the lowest level is 15-minute checks. If there's concern about somebody, it goes up to five-minute checks. And if they're extremely unsafe, it goes to a one-to-one.
Jennifer Sprague (39:02):
And what does one-to-one mean?
Alia Goodheart (39:04):
There would be a staff person with the patient at all times.
Jennifer Sprague (39:09):
And again, this determination of which unit to be on and what level of security or what level of check is done by the psychiatrist that performs that first evaluation, correct?
Alia Goodheart (39:20):
Correct.
Jennifer Sprague (39:25):
Now, when a person who comes through the CEC then gets sent to the unit, do they walk to the unit on their own or how do they get to the unit?
Alia Goodheart (39:33):
They're escorted to the unit.
Jennifer Sprague (39:35):
And you said there's four inpatient psych units, is that-
Alia Goodheart (39:38):
Correct.
Jennifer Sprague (39:40):
Now, when the person arrives at the unit, what happens?
Alia Goodheart (39:43):
They're seen by a nurse and a mental health worker. They go through the belongings to ensure that there's nothing unsafe. There's certain things that are not allowed on a psych unit. The nurse reviews their history and takes some vital signs, sees if they need any medication, and then they show them to their room and the unit.
Jennifer Sprague (40:10):
And again, people come through the CEC at all hours of the day and night, correct?
Alia Goodheart (40:15):
Yes.
Jennifer Sprague (40:16):
So this whole process is pretty seamless and could happen at any point?
Alia Goodheart (40:21):
Yes.
Jennifer Sprague (40:23):
Now you mentioned previously that the length of stay or how long a person is on the unit or inpatient varies, right?
Alia Goodheart (40:32):
Yes.
Jennifer Sprague (40:33):
Is there any sort of minimum that's required when a person comes in for an inpatient stay at McLean?
Alia Goodheart (40:40):
No.
Jennifer Sprague (40:41):
And if they are voluntarily there, can they leave at any time?
Alia Goodheart (40:47):
As long as the psychiatrist and the team assesses them and determines that they don't pose an imminent risk to themselves or anybody else.
Jennifer Sprague (41:00):
Now, what if they're there on a Section 12? Is there a time limit or a minimum amount of time they have to be there?
Kevin Reddington (41:06):
We're going to object, Your Honor. She wasn't there on Section 12. She was on a voluntary.
Jennifer Sprague (41:10):
We haven't gotten there yet. I'm just asking background questions about the facility.
Judge William Sullivan (41:14):
I'll allow some background questions, but let's kind of move it along.
Alia Goodheart (41:18):
So Section 12 entails that the team and the psychiatrist has three days to evaluate the patient to determine whether they pose a danger to themselves or others. And if at the end of that time they do determine that the person poses a risk, then they have to apply for commitment. Which would mean going in front of a judge who would decide if the patient should remain hospitalized or be discharged.
Jennifer Sprague (41:48):
And if at the end of the three days you deem them to be safe, are they allowed to leave?
Alia Goodheart (41:55):
Yes.
Jennifer Sprague (41:56):
And is there something in the field of psychiatry or in your training and experience in your time at McLean about being discharged against medical advice?
Kevin Reddington (42:08):
She wasn't discharged AMA.
Judge William Sullivan (42:10):
We'll allow them to set the terms and where we are. So you can go into that.
Kevin Reddington (42:16):
AMA is not applicable.
Jennifer Sprague (42:18):
If we can approach.
Judge William Sullivan (42:18):
Yeah. You know, I don't think you heard me.
Kevin Reddington (42:21):
I did hear you.
Judge William Sullivan (42:21):
All right? Well then I'm going to allow that question. Your rights are safe.
Kevin Reddington (42:27):
[inaudible 00:42:27] my objection.
Judge William Sullivan (42:27):
Yeah, I've noted it. Go ahead, counsel.
Jennifer Sprague (42:30):
Thank you.
Alia Goodheart (42:33):
I think we tend not to do against medical advice because if we are concerned about somebody's safety, we would not discharge them.
Jennifer Sprague (42:45):
So you have another procedure available to you if you were concerned for somebody's safety?
Alia Goodheart (42:49):
Yes.
Jennifer Sprague (42:50):
And that's the procedure you described about seeking an order for further commitment?
Alia Goodheart (42:55):
Correct.
Jennifer Sprague (42:56):
Okay. Thank you. Now, when a person comes and goes through that process and is placed on their unit and settled in, what is the plan after that? How often do they see providers?
Alia Goodheart (43:11):
They're assessed by a psychiatrist every single day that they're there. They have nurses who are checking in with them, mental health workers. They're offered group programming and medical monitoring, vital signs. Yeah.
Jennifer Sprague (43:31):
What types of group programming are offered to people while they're inpatient at McLean?
Alia Goodheart (43:36):
We offer skills groups, which are things like they're meant to teach patients skills so that they can tolerate distress. They can kind of observe their thoughts. It's meant to shore up their skills. Then there are some groups which are more just relaxed, I guess. Such as going for fresh air walks or going to the recreation center, just drawing or coloring. Yeah.
Jennifer Sprague (44:15):
And are there other things offered to patients once they're on a unit to assist them in their care, like counseling?
Alia Goodheart (44:24):
Yeah, those are the check-ins. And when they meet with the psychiatrist and the social worker, the counseling happens in those sessions as well. And also by the nurses and the mental health staff.
Jennifer Sprague (44:41):
Okay. Now, does this procedure, or how it operates for any given patient, does it change if there's a holiday or a weekend?
Alia Goodheart (44:51):
I think they're still seen by a psychiatrist.
Kevin Reddington (45:00):
She's thinking. If she knows, I have no objection. I'm going to object to the way she's answering that.
Judge William Sullivan (45:01):
All right. Why don't you rephrase the question?
Jennifer Sprague (45:04):
I will. Thank you. As far as your experience at McLean Hospital, does the schedule change when there's a weekend or a holiday?
Alia Goodheart (45:16):
The group schedule might change, but the staffing schedule doesn't change.
Jennifer Sprague (45:21):
So the availability and the mental health worker that sees the patient, the social worker that checks in, and the psychiatrist and nurse, the team all stays the same even on a weekend or a holiday?
Alia Goodheart (45:31):
Other than the social worker.
Jennifer Sprague (45:34):
Okay. And when I say stay the same, it could be different individuals-
Alia Goodheart (45:39):
Correct.
Jennifer Sprague (45:39):
... but it's somebody from that group, correct?
Alia Goodheart (45:39):
Yes.
Jennifer Sprague (45:41):
Okay. So as far as your role as a psychiatrist, how do you get assigned patients when they are admitted to McLean inpatient?
Alia Goodheart (45:53):
It's random. There are beds that are open and I carry a certain number of patients and other psychiatrists have a certain number of patients and whoever has an opening gets the admission.
Jennifer Sprague (46:09):
Do you have to be there when the patient is admitted to have the patient assigned to you?
Alia Goodheart (46:14):
No.
Jennifer Sprague (46:15):
And so do you rely on other psychiatrists to perform those tasks before you meet a patient?
Alia Goodheart (46:21):
Yes.
Jennifer Sprague (46:23):
I'm going to draw your attention to a particular patient by the name of Lindsay Clancy that arrived at McLean in the early morning hours of January 1st of 2023. Do you recall that patient?
Alia Goodheart (46:36):
Yes.
Jennifer Sprague (46:36):
Have you had the ability to review the records related to that patient prior to coming in today?
Alia Goodheart (46:40):
Yes.
Jennifer Sprague (46:41):
And do you know where she came from?
Alia Goodheart (46:45):
The emergency department at MGH.
Jennifer Sprague (46:48):
Okay. And did she come voluntarily or did she come on some sort of section?
Alia Goodheart (46:55):
Again, for transportation, it's always a section, but then she signed in voluntarily, which is the Section 10.
Jennifer Sprague (47:02):
Okay. So to your knowledge, she was brought in the early morning hours via ambulance?
Alia Goodheart (47:09):
Correct.
Jennifer Sprague (47:10):
And did she go through that process of the Clinical Evaluation Center in the early morning hours, approximately 4:00 AM on the 1st?
Alia Goodheart (47:19):
Yes.
Jennifer Sprague (47:20):
And who saw her there?
Alia Goodheart (47:23):
I think the psychiatrist's name was Dr. Outlaw.
Jennifer Sprague (47:26):
Okay. And you're familiar with Dr. Jasmine Outlaw?
Alia Goodheart (47:29):
I've never met her.
Jennifer Sprague (47:30):
Okay. But she is a psychiatrist on staff?
Alia Goodheart (47:32):
Correct. I did-
Jennifer Sprague (47:32):
And-
Alia Goodheart (47:34):
I don't know what on staff... What you mean by on staff?
Jennifer Sprague (47:38):
Well, she works at McLean.
Alia Goodheart (47:39):
Correct.
Jennifer Sprague (47:40):
And so you were able to review the information she gathered in that first evaluation?
Alia Goodheart (47:48):
Yes.
Jennifer Sprague (47:49):
And in reviewing that information, did you identify that the patient was identified as medically stable, right? Meaning she didn't have any acute medical issues that you had to worry about?
Alia Goodheart (48:00):
Correct.
Jennifer Sprague (48:00):
And she was screened on the suicide screening?
Alia Goodheart (48:05):
Correct.
Jennifer Sprague (48:07):
What was the chief complaint of the patient when she arrived at McLean?
Alia Goodheart (48:15):
She was finding it hard to sleep if she didn't take medications.
Jennifer Sprague (48:29):
Okay. And do you recall reviewing in the records that it was noted that she reported that she felt numb?
Alia Goodheart (48:36):
Yes.
Jennifer Sprague (48:37):
And that she was having some issues managing medication?
Alia Goodheart (48:41):
I don't know what you mean by that.
Jennifer Sprague (48:44):
Well, that she had some complaints about side effects or symptoms of medication.
Alia Goodheart (48:47):
Yes.
Jennifer Sprague (48:50):
Now, when the psychiatrist in the Clinical Evaluation Center gathered the information, fair to say that it's primarily based on what's reported to the doctor by the patient?
Alia Goodheart (49:04):
Yes.
Jennifer Sprague (49:06):
At McLean, do you have access to a patient's full psychiatric history or all of their records from other places?
Alia Goodheart (49:14):
It depends where the patient is coming from. I think that Dr. Outlaw did take an excerpt of the APS evaluation that was done at MGH. So I assume that she had access to that.
Kevin Reddington (49:32):
Your Honor, I'm sorry. Assumptions. I'd like-
Alia Goodheart (49:35):
I mean, she would have had-
Jennifer Sprague (49:36):
I can ask it a different way.
Judge William Sullivan (49:36):
If she doesn't know, she doesn't know, all right?
Jennifer Sprague (49:40):
As far as the full record of this particular patient that you were assigned to and responsible for, you reviewed all of the notes and information gathered by Dr. Outlaw on that first interaction with the patient, correct?
Alia Goodheart (49:52):
Yes.
Jennifer Sprague (49:53):
And you indicated a little while ago in your testimony that McLean is affiliated with the Brigham Hospital-
Alia Goodheart (50:00):
Correct.
Jennifer Sprague (50:01):
... and Mass General. So is it fair to say that those records from Mass General are available to you at McLean?
Alia Goodheart (50:10):
Yes.
Jennifer Sprague (50:11):
And again, you indicated that that APS evaluation is something that's done at the emergency room, right?
Alia Goodheart (50:18):
Yes.
Jennifer Sprague (50:19):
And is it common that that information come along with the patient?
Kevin Reddington (50:24):
Objection.
Alia Goodheart (50:24):
I don't know.
Judge William Sullivan (50:25):
Good. Just if you could answer that. You don't know?
Alia Goodheart (50:29):
I don't know.
Judge William Sullivan (50:30):
Okay. All right. Next question.
Jennifer Sprague (50:31):
In this instance, when you reviewed the records, were you aware or did you see that there was some note to the APS evaluation from the Mass General ER?
Alia Goodheart (50:40):
I saw the excerpt of the APS evaluation in Dr. Outlaw's note.
Jennifer Sprague (50:47):
Okay. And that excerpt from the APS evaluation was conducted by somebody by the name of Dr. Hogan, correct?
Alia Goodheart (50:53):
Correct.
Jennifer Sprague (50:55):
And did you review a portion of the record indicating that the patient said to Dr. Hogan or reported thoughts of wishing to be dead, but no plan?
Alia Goodheart (51:07):
Yes.
Jennifer Sprague (51:08):
And that there was no violent or homicidal ideation, right?
Alia Goodheart (51:11):
Yes.
Jennifer Sprague (51:12):
And that was observed at Mass General to have no evidence of psychosis, mania, obsessions, or current anxiety symptoms?
Alia Goodheart (51:19):
Correct.
Jennifer Sprague (51:19):
So that's information that you knew before you met with the patient?
Alia Goodheart (51:25):
Yes.
Jennifer Sprague (51:28):
And as far as what's reported when the patient comes to McLean, and in this instance when Lindsey Clancy came, are you aware she reported during that Clinical Evaluation Center evaluation that at the beginning of December she had started Seroquel and Remeron and started to have intrusive and suicidal thoughts?
Alia Goodheart (51:47):
Yes.
Jennifer Sprague (51:48):
That she attributed that to medication?
Alia Goodheart (51:50):
Yes.
Jennifer Sprague (51:51):
Okay. And so what was the plan, the first plan that came out of that Clinical Evaluation Center evaluation of Ms. Clancy?
Alia Goodheart (52:03):
She was continued on the medications she was admitted on. The plan, they do the checks. They decide what medical monitoring you need, but she basically was admitted and the medications were the same.
Jennifer Sprague (52:23):
And what was the security level, or how long were the checks assigned to her after this evaluation?
Alia Goodheart (52:28):
15 minutes.
Jennifer Sprague (52:31):
And was she considered to be a high risk upon coming into the inpatient unit or was she minimal risk?
Alia Goodheart (52:41):
Low. Minimal. Yeah.
Jennifer Sprague (52:44):
And were you aware of what's called the provisional diagnosis that was assigned to this patient when she arrived?
Alia Goodheart (52:52):
I don't recall what the provisional diagnosis was, but I do know that they do assign a diagnosis. I don't recall it. I must have seen it in the records, but I think they're like five different diagnoses.
Jennifer Sprague (53:09):
Just referring to what's already been marked as Exhibit 79. I'm going to draw your attention to page 24.
Alia Goodheart (53:19):
Thank you. Okay. I think I remember. Yes.
Jennifer Sprague (53:19):
Okay. Does that refresh your memory as to the provisional diagnosis?
Alia Goodheart (53:22):
Yes.
Jennifer Sprague (53:22):
And what was it?
Alia Goodheart (53:23):
Major depressive disorder, severe without psychotic features.
Jennifer Sprague (53:30):
Now, what does the provisional diagnosis mean to you when you're assigned a patient?
Alia Goodheart (53:36):
That this is the assessment of the psychiatrist who saw her at that time.
Jennifer Sprague (53:41):
Do you have to stick with that diagnosis or are you free to change that based on your experiences with the patient?
Alia Goodheart (53:49):
The diagnosis I give the patient is dependent on what my interactions are and the observations of the team. Okay.
Jennifer Sprague (53:59):
Now for this particular patient, Ms. Clancy, on January 1st, when she got situated onto the unit after that first evaluation by Dr. Outlaw, are you aware that she was then seen later in that day on January 1st?
Alia Goodheart (54:15):
Yes.
Jennifer Sprague (54:16):
And were you the doctor who saw her or was there somebody else?
Alia Goodheart (54:20):
It was a different psychiatrist.
Jennifer Sprague (54:21):
Okay. And who was the psychiatrist that saw her on January 1st?
Alia Goodheart (54:25):
It was Dr. Madva.
Jennifer Sprague (54:27):
And that would be Dr. Elizabeth Madva?
Alia Goodheart (54:30):
Correct.
Jennifer Sprague (54:31):
Again, is she a psychiatrist as well?
Alia Goodheart (54:32):
Yes.
Jennifer Sprague (54:33):
And so this occurred while you were not in the hospital, right?
Alia Goodheart (54:40):
Yes.
Jennifer Sprague (54:41):
And were you able to review the notes, the admission notes of Dr. Madva regarding her interactions with this patient on January 1st at approximately 12:47 PM?
Alia Goodheart (54:52):
Yes.
Jennifer Sprague (54:53):
And again, as far as these interactions go with the patient and the psychiatrist, it's more of a conversation, right?
Alia Goodheart (55:01):
I'm sorry, could you repeat the question?
Jennifer Sprague (55:03):
Yeah. It's a conversation when you meet with a patient.
Alia Goodheart (55:06):
Yes.
Jennifer Sprague (55:06):
You ask them how they're feeling, get information that you think is necessary. Is that fair to say?
Alia Goodheart (55:12):
It's a conversation and also you gather information.
Jennifer Sprague (55:16):
Okay. And so do you rely on things that were reported before?
Alia Goodheart (55:21):
Yes.
Jennifer Sprague (55:22):
Okay. But you also ask follow up questions, right?
Alia Goodheart (55:25):
Correct.
Jennifer Sprague (55:25):
And as far as your review of Dr. Madva's interaction with Ms. Clancy on January 1st, is it clear to you that she did that?
Alia Goodheart (55:36):
Yes.
Jennifer Sprague (55:36):
Reviewed her history with her and spoke with her about how she was feeling?
Alia Goodheart (55:40):
Yes.
Jennifer Sprague (55:41):
At the time she spoke with Dr. Madva, you're aware she said that she denied feeling depressed and denied any passive death wishes or suicidal thoughts, but reports feeling numb?
Alia Goodheart (55:52):
Yes.
Jennifer Sprague (55:52):
She reports she can't feel any emotion other than mild anxiety at now being in a hospital setting?
Alia Goodheart (55:59):
Yes.
Jennifer Sprague (56:00):
Okay. After Ms. Clancy was seen by Dr. Madva, were you aware of what the plan was regarding her medication?
Alia Goodheart (56:09):
Yes.
Jennifer Sprague (56:10):
And what was the plan?
Alia Goodheart (56:15):
Ms. Clancy complained there were several symptoms. One of the things that she did complain about was the numbness. And Dr. Madva did hear that and hear her concern and that she had been sensitive to many different medications. So she-
Jennifer Sprague (56:46):
Well, let me ask, if I can ask a question.
Kevin Reddington (56:48):
Were you finished with your answer?
Alia Goodheart (56:53):
So she determined that it was possible that the numbness the patient was complaining of was a side effect of the medication she was on. And the plan was to taper that medication and observe the patient to see whether the numbness went away and also if any other symptoms became evident.
Jennifer Sprague (57:23):
So the medications, you were aware of the medications that Ms. Clancy came into McLean on, right?
Alia Goodheart (57:30):
Yes.
Jennifer Sprague (57:31):
And what medications were those?
Alia Goodheart (57:33):
Seroquel at 100 milligrams a day. Valium, two milligrams. I don't remember the frequency. I think it was per day, and-
Kevin Reddington (57:51):
Your Honor, [inaudible 00:57:52]-
Judge William Sullivan (57:51):
Again, we're going to let her finish.
Kevin Reddington (57:52):
Yeah. I'm just saying [inaudible 00:57:54] she looks at the records.
Judge William Sullivan (57:54):
Yeah.
Alia Goodheart (57:57):
So Seroquel, Valium, and Benadryl.
Jennifer Sprague (58:06):
Do you remember or do you recall Remeron being one of the drugs that were described or reported by Ms. Clancy when she came in that she reported taking Remeron?
Alia Goodheart (58:19):
In the past, yes.
Jennifer Sprague (58:20):
Okay. And again, in that report from the patient about past history, do you recall her indicating that one of the providers had suspected bipolar disorder?
Alia Goodheart (58:39):
Yes.
Jennifer Sprague (58:41):
In your interactions with Ms. Clancy and your review of the interaction she had with other psychiatrists, did she appear to agree with that diagnosis?
Alia Goodheart (58:51):
Did who appear to agree?
Jennifer Sprague (58:54):
Ms. Clancy.
Kevin Reddington (58:55):
Rephrase that question, please.
Alia Goodheart (58:57):
Ms. Clancy?
Jennifer Sprague (58:57):
Yes.
Alia Goodheart (58:58):
She disagreed with the diagnosis.
Jennifer Sprague (58:59):
Okay. The fact that she came in and she was on 100 milligrams of Seroquel or more, would that have been something that was significant to you in considering a bipolar diagnosis?
Alia Goodheart (59:21):
Seroquel is used for several purposes. It is not just used for bipolar illness.
Jennifer Sprague (59:29):
Okay. And Ms. Clancy also reported coming to McLean issues with insomnia, correct?
Alia Goodheart (59:36):
Yes.
Jennifer Sprague (59:37):
Is Seroquel sometime used in low doses to address insomnia?
Alia Goodheart (59:41):
Yes.
Jennifer Sprague (59:44):
Now, as far as the plan from January 1st, you indicated that Dr. Madva recommended reducing the Seroquel and then monitoring symptoms, correct?
Alia Goodheart (59:56):
Yes.
Jennifer Sprague (01:00:06):
Okay. Were you aware that Ms. Clancy saw Dr. Madva again on January 2nd?
Alia Goodheart (01:00:12):
Yes.
Jennifer Sprague (01:00:16):
And again, that was prior to your first point of contact with her?
Alia Goodheart (01:00:21):
Yes.
Jennifer Sprague (01:00:25):
As far as what you know from reviewing the record, you were aware that Ms. Clancy reported that she slept well on a lesser dose of Seroquel?
Alia Goodheart (01:00:38):
Yes.
Jennifer Sprague (01:00:40):
Did she report any delusions, hallucinations, or suicidal or homicidal ideation?
Alia Goodheart (01:00:45):
No.
Jennifer Sprague (01:00:46):
Okay. And as far as after the check-in with Dr. Madva on the 2nd, was the plan to continue to decrease the Seroquel?
Alia Goodheart (01:00:56):
Dr. Madva was going to continue her on 75 milligrams, and then the next day she would have gone down to 50 milligrams.
Jennifer Sprague (01:01:10):
And on these first few days that Lindsay Clancy was at McLean Hospital from January 1st until you actually saw her on January 3rd, you're aware that in addition to seeing Dr. Outlaw at the intake and Dr. Madva on two occasions on the 1st and the 2nd, that there were also notes in the record for you to review from nurses who interacted with her on January 1st at 5:20 AM, right?
Alia Goodheart (01:01:44):
Yes.
Jennifer Sprague (01:01:45):
From nurse January 1st at 6:28 AM?
Alia Goodheart (01:01:48):
Yes.
Jennifer Sprague (01:01:49):
A nurse interacting with her on January 1st at 10:34 AM?
Alia Goodheart (01:01:52):
Yes.
Jennifer Sprague (01:01:53):
And that she actually participated in a group activity with a social worker at 12:03 PM on the 1st?
Alia Goodheart (01:01:58):
Yes.
Jennifer Sprague (01:01:58):
And that a nurse interacted with her and made notes at 2:07 PM on the 1st?
Alia Goodheart (01:01:59):
Yes.
Jennifer Sprague (01:01:59):
And that she saw a mental health worker at 9:33 PM on the 1st?
Alia Goodheart (01:02:00):
Yes.
Jennifer Sprague (01:02:01):
And in relation to January 2nd, a nurse made note of interaction with her on 9:46 on the 2nd, right?
Alia Goodheart (01:02:21):
I remember there were interactions. I don't remember the exact time.
Jennifer Sprague (01:02:23):
Okay. But fair to say on the 2nd, she interacted with nurses and Dr. Madva?
Alia Goodheart (01:02:29):
Yes.
Jennifer Sprague (01:02:30):
Based on your review. Now, going to January 3rd, that was the first face-to-face contact you had with the patient, correct?
Alia Goodheart (01:02:38):
Yes.
Jennifer Sprague (01:02:38):
Prior to meeting with her, had you reviewed all of these notes and all of the information up to that date?
Alia Goodheart (01:02:44):
Yes.
Jennifer Sprague (01:02:48):
And did you go through, again, a report of history with her?
Alia Goodheart (01:02:55):
Yes.
Jennifer Sprague (01:02:58):
Were you able to make an assessment her mental status during that interaction with her?
Alia Goodheart (01:03:03):
Yes.
Jennifer Sprague (01:03:03):
And what were your observations of her mental status?
Alia Goodheart (01:03:11):
I can remember certain elements, but I don't remember... I mean, she was appropriately dressed. Her speech was of normal rate and volume. Behaviorally, she was polite and cooperative. Her mood, I don't remember exactly. It's a quote, so I don't remember exactly what she quoted her mood as being. It would be in the medical record.
Jennifer Sprague (01:03:42):
Yeah, one moment. I'm just going to approach if that's okay.
Judge William Sullivan (01:03:56):
You may, yeah. And just so the records are Exhibit 79?
Jennifer Sprague (01:03:59):
Yes.
Judge William Sullivan (01:03:59):
All right. So those records, you'll have those with you. Okay.
Jennifer Sprague (01:04:03):
So I have pulled pages 61 through 66. I think that's your note. If you can just take a look at that and let me know when you're [inaudible 01:04:12].
Alia Goodheart (01:04:12):
Yeah.
Jennifer Sprague (01:04:30):
Does that refresh your memory as to what your observations were of her mood?
Alia Goodheart (01:04:35):
Yes.
Jennifer Sprague (01:04:35):
What was her mood?
Alia Goodheart (01:04:37):
Anxious.
Jennifer Sprague (01:04:38):
Okay. And did you observe signs of anxiety or did she tell you that she felt anxious?
Alia Goodheart (01:04:45):
She appeared anxious.
Jennifer Sprague (01:04:47):
And her affect, did you observe it to be congruent to her mood?
Alia Goodheart (01:04:55):
Yes.
Jennifer Sprague (01:04:55):
And you examined her and found her to have linear thinking and appear goal directed, right?
Alia Goodheart (01:05:02):
Yes.
Jennifer Sprague (01:05:05):
Okay. And as far as addressing why she was there and what your recommendations were, ultimately, what were you trying to address or accomplish in the treatment plan with Ms. Clancy?
Alia Goodheart (01:05:26):
That's a very broad question.
Jennifer Sprague (01:05:28):
Okay. I could break it down if that's okay.
Alia Goodheart (01:05:30):
Yes.
Jennifer Sprague (01:05:31):
So as far as once you had a chance to sit and talk with her, what did she identify to you to be her main concerns that she wanted to address during her stay at McLean?
Alia Goodheart (01:05:41):
She did not want to be dependent on an antipsychotic medication, which is what Seroquel class is, even though it's used for insomnia and other indications, depression. She didn't want to be dependent on Seroquel to be able to fall-
Alia Goodheart (01:06:00):
She didn't want to be dependent on Seroquel to be able to fall asleep.
Jennifer Sprague (01:06:06):
Okay. And so, fair to say she was very concerned about wanting to sleep at night?
Alia Goodheart (01:06:11):
Yes.
Jennifer Sprague (01:06:13):
And she was very concerned about her symptomology, or what she was experiencing by way of symptoms from various medications, right?
Alia Goodheart (01:06:19):
Yes.
Jennifer Sprague (01:06:20):
And that concept or the phrase numbness, did she use that a few times?
Alia Goodheart (01:06:28):
Yes.
Jennifer Sprague (01:06:29):
And again, you mentioned Dr. Madva was concerned about the numbness with the medication. In your experience with Seroquel, is that also a common side effect, for people to feel numb?
Alia Goodheart (01:06:44):
It can be one of the side effects that people can have.
Jennifer Sprague (01:06:48):
Okay. And as far as the suicidal statements that you were aware of from the prior reports, did you go through that with her, about whether she presented to you with suicidal ideation?
Alia Goodheart (01:07:06):
Can you ask me that again?
Jennifer Sprague (01:07:07):
Sure. Did you talk to her about her thoughts of suicide?
Alia Goodheart (01:07:13):
Yes.
Jennifer Sprague (01:07:13):
And did you talk to her about whether she had any specific plan?
Alia Goodheart (01:07:17):
Yes.
Jennifer Sprague (01:07:18):
Did she have any plan?
Alia Goodheart (01:07:20):
No.
Jennifer Sprague (01:07:20):
Had she reported that she had ever had a plan for suicide?
Alia Goodheart (01:07:23):
No.
Jennifer Sprague (01:07:24):
And did she tell you there were reasons why she thought she wouldn't commit suicide?
Alia Goodheart (01:07:30):
Yes.
Jennifer Sprague (01:07:30):
And what were those reasons?
Alia Goodheart (01:07:32):
Her children and her family, her mother.
Jennifer Sprague (01:07:39):
So after this face-to-face interaction with her, and kind of going through her history, and having reviewed the information you had about her, what did you develop as a plan for her while she was at McLean?
Alia Goodheart (01:07:53):
I continued with the plan to taper her off Seroquel, and to monitor whether her symptoms improved, but also to see if she could sleep while she was off of Seroquel, and to really observe symptoms and mood.
Jennifer Sprague (01:08:18):
During this first interaction with her, was there any conversation about how long she would stay, or what her plan might be after she left McLean?
Alia Goodheart (01:08:32):
When we met the first time, Lindsay said that she had her daughter's birthday coming up on the weekend, and that it had been planned months ahead of that date. And she was hoping that she could be there that weekend, so she could be with the kids and family who was going to come for the birthday party.
Jennifer Sprague (01:09:00):
Now, the concept of kind of tapering her off the Seroquel and monitoring her symptoms, did that seem like a realistic goal to you?
Alia Goodheart (01:09:10):
Yes.
Jennifer Sprague (01:09:12):
And now, after having spoken to her and developing this plan, were you also cognizant or thinking about the potential for a bipolar disorder diagnosis?
Alia Goodheart (01:09:27):
Yes.
Jennifer Sprague (01:09:27):
And so how did that affect how you approached this plan to taper?
Alia Goodheart (01:09:33):
Again, we were observing for any symptoms that would indicate that she might have bipolar disorder.
Jennifer Sprague (01:09:47):
And where she had reported that she had issues with sleep, was that also something of concern to you if there was the potential for a bipolar disorder?
Alia Goodheart (01:09:55):
Yes.
Jennifer Sprague (01:09:56):
And reduction of medication. What was the concern for the sleep?
Alia Goodheart (01:10:03):
I think people's mental health is negatively affected if they cannot sleep, whether it's bipolar disorder or depression. And so sleep is important.
Jennifer Sprague (01:10:16):
Okay. And so a person that you might be considering for a bipolar diagnosis, would lack of sleep make you watch for symptoms of hypomania?
Alia Goodheart (01:10:28):
Yes. Sleep deprivation can lead to a bipolar episode, a hypomanic, manic episode.
Jennifer Sprague (01:10:38):
So you wanted to monitor her patterns in her sleep and her mood to see if there was any evidence of that, correct?
Alia Goodheart (01:10:44):
Yes.
Jennifer Sprague (01:10:51):
In this first interaction where you identified a plan, did you also make a suggestion about a particular medication that she might consider after the Seroquel had been discontinued?
Alia Goodheart (01:11:11):
Yes.
Jennifer Sprague (01:11:13):
What was the alternative medication, if you will?
Alia Goodheart (01:11:16):
It was Cymbalta, which is an antidepressant.
Jennifer Sprague (01:11:20):
And was that something that you intended to prescribe for her while she was there, or was it something that you suggested that she could consider as an outpatient?
Alia Goodheart (01:11:29):
It was just a consideration. It would depend on how she was doing after she was off of the Seroquel.
Jennifer Sprague (01:11:37):
Okay. Now, what about the Valium? Was there a plan to address tapering or weeding her off Valium, or an alternative to Valium?
Alia Goodheart (01:11:50):
Yes. I switched her from Valium to Ativan, because it has a shorter half-life. And in my experience, it manages anxiety well.
Jennifer Sprague (01:12:09):
And were you aware that she had taken Ativan before?
Alia Goodheart (01:12:13):
Yes.
Jennifer Sprague (01:12:14):
And did she report any concerns about Ativan, or benzodiazepines in general?
Alia Goodheart (01:12:21):
Yes.
Jennifer Sprague (01:12:21):
And what was the concern she reported to you?
Alia Goodheart (01:12:27):
She stated that her husband had concerns about her being on a benzodiazepine.
Jennifer Sprague (01:12:39):
During this interaction with her on the January 3rd, did you observe any signs of psychosis?
Alia Goodheart (01:12:46):
No.
Jennifer Sprague (01:12:47):
And in the notes and the interactions with the providers prior to your meeting, between January 1st and January 3rd, did anyone ever note any symptoms or concerns for psychosis?
Alia Goodheart (01:13:00):
No.
Jennifer Sprague (01:13:01):
And you're aware that Ms. Clancy was also, still in what was considered the postpartum period, right? She had had a child in May of 2022?
Alia Goodheart (01:13:15):
That's a tricky question to answer, because different organizations or agencies assign postpartum a different length of time.
Jennifer Sprague (01:13:29):
Okay. And so in your training and experience, in your experience as a person who diagnoses, did you consider postpartum as part of what you had to figure out here with this patient?
Alia Goodheart (01:13:44):
Yes.
Jennifer Sprague (01:13:44):
Or was it really not a consideration?
Alia Goodheart (01:13:46):
It was.
Jennifer Sprague (01:13:47):
Okay. And why was it for you?
Alia Goodheart (01:13:49):
I mean, she had a child, and the risk of postpartum depression, postpartum psychosis is a serious consideration.
Jennifer Sprague (01:14:01):
Okay. Now, after this first meeting with Ms. Clancy on the 3rd, were you able to give her, in your own opinion, a diagnosis?
Alia Goodheart (01:14:14):
Yes.
Jennifer Sprague (01:14:14):
And what was that?
Alia Goodheart (01:14:18):
You said after the 3rd?
Jennifer Sprague (01:14:21):
Right.
Alia Goodheart (01:14:21):
Okay. So that would mean one meeting?
Jennifer Sprague (01:14:24):
Yes.
Alia Goodheart (01:14:26):
I gave her a diagnosis of insomnia with a mental health condition, because one day of observation wasn't sufficient for me to figure out if she truly ... to give a solid diagnosis, because it sticks with the patient.
Jennifer Sprague (01:14:49):
Right. Fair to say you just didn't have enough information at that point?
Alia Goodheart (01:14:51):
Correct.
Jennifer Sprague (01:14:52):
Okay. So again, you saw her on January 3rd, and that was approximately 9:15 AM, right? Do you recall-
Alia Goodheart (01:15:12):
If that's what it says, yeah.
Jennifer Sprague (01:15:14):
Well, at the top of your inpatient progress note on page 61 of the exhibit, if I say the date of service reads 1/3/23 at 9:15, would that be where you would note the time you were scheduled to speak with the patient?
Alia Goodheart (01:15:31):
Yes.
Jennifer Sprague (01:15:32):
Okay. And you're aware that on that same day, on January 3rd, that in addition to meeting with you, that she met with a social worker at 10:07 AM, right?
Alia Goodheart (01:15:43):
Yes. The social worker and I would have met with her together.
Jennifer Sprague (01:15:46):
Okay. But then the social worker would have their own note if there was any interaction that they were noting, and also a nurse as well, right?
Alia Goodheart (01:15:56):
Yes.
Jennifer Sprague (01:15:57):
And that on the 3rd, that Ms. Clancy participated in a group at 12:02 PM, correct?
Alia Goodheart (01:16:02):
Yes.
Jennifer Sprague (01:16:04):
And engaged with a mental health worker at 12:22 PM, right?
Alia Goodheart (01:16:09):
I do know that she engaged with the mental health worker. The times are not something I recall.
Jennifer Sprague (01:16:16):
If I indicate that the records show she did-
Alia Goodheart (01:16:19):
Yes.
Jennifer Sprague (01:16:20):
... another group at 2:36 PM, would that sound right?
Alia Goodheart (01:16:23):
Yes.
Jennifer Sprague (01:16:24):
And that she then declined a group at 3:50 PM?
Alia Goodheart (01:16:27):
Yes.
Jennifer Sprague (01:16:28):
And then saw another mental health worker in the evening, before, presumably, she went to bed, 8:52 PM?
Alia Goodheart (01:16:34):
Yes.
Jennifer Sprague (01:16:36):
Okay. Did you see her on January 4th?
Alia Goodheart (01:16:40):
Yes.
Jennifer Sprague (01:16:42):
And so again, is this the same protocol? You meet, you talk, you discuss. Did you talk to her about how the previous night's sleep went?
Alia Goodheart (01:16:54):
Yes.
Jennifer Sprague (01:16:55):
And how was that night's sleep?
Alia Goodheart (01:16:57):
She reported sleeping well.
Jennifer Sprague (01:16:59):
Well?
Alia Goodheart (01:17:00):
I don't remember the exact words, but she said she slept.
Jennifer Sprague (01:17:05):
And do you remember having a conversation with her again on that day, January 4th, about going home?
Alia Goodheart (01:17:11):
Yes.
Jennifer Sprague (01:17:12):
And what did she say about that?
Alia Goodheart (01:17:15):
Originally, I think we had talked about discharge on Friday, and she stated that she was anxious being in the hospital, and that she wanted to be discharged so she could be home with her family and her children.
Jennifer Sprague (01:17:41):
And so did she ask to leave earlier than Friday?
Alia Goodheart (01:17:45):
Yes.
Jennifer Sprague (01:17:47):
And when she asked to leave earlier than Friday, what was your response to that?
Alia Goodheart (01:17:58):
I said she could leave, provided she had psychiatric follow up the next day.
Jennifer Sprague (01:18:06):
And why did you do that?
Alia Goodheart (01:18:10):
I wanted to ensure that, if she wasn't able to sleep that night after discharge, that she could speak with somebody about it so that they could come up with a plan to ensure she could sleep, and to monitor how she was doing off of the medication.
Jennifer Sprague (01:18:32):
And was there kind of a secondary reason, that you had asked that she make sure she make an appointment before discharge?
Alia Goodheart (01:18:39):
Yes. It was also to assess whether she could think clearly, and follow directions, and get it together. We asked her to set up the appointment herself, and she was able to do that. She responded within an hour. She told the social worker that she had gotten an appointment, and the social worker had asked her for a fax number so that we could send the discharge summary, and she provided the fax number as well.
Jennifer Sprague (01:19:13):
And now on this day that you had met her, on January 4th, she reported that she slept well. Do you recall what dose of Seroquel she was down to at that point? Had she reached zero?
Alia Goodheart (01:19:31):
On which day?
Jennifer Sprague (01:19:32):
On the 4th, when you saw her.
Alia Goodheart (01:19:36):
I'd have to walk myself through this. So I know she was on 75 milligrams the night of the 1st, 75 milligrams the night of the 2nd. On the night of the 3rd, we decreased it to 50 milligrams. On the night of the 4th, she would have been on 25 milligrams.
Jennifer Sprague (01:19:52):
Okay. And fair to say that on the 4th, your plan was to continue to taper her so that she would be at zero for Seroquel, take no Seroquel on Thursday night, right?
Alia Goodheart (01:20:06):
Correct.
Jennifer Sprague (01:20:11):
And that she would be restarted on Ativan, and that she'd have the Trazodone available if she needed it?
Alia Goodheart (01:20:22):
She was already on Ativan during her admission, and was taking it at night. She also had Trazodone, which is a sleep medication. It has sedating properties so it can be used for sleep. So yes, she had the option to take that as well.
Jennifer Sprague (01:20:49):
And so did you have a concern about her leaving on Thursday the 5th without having monitored her at no Seroquel?
Alia Goodheart (01:21:08):
I did not have any concerns about her safety or a risk for anybody else.
Jennifer Sprague (01:21:19):
But as far as from a diagnostic perspective, would you have preferred to have more information about her sleep patterns and her mood?
Alia Goodheart (01:21:26):
Yes.
Jennifer Sprague (01:21:28):
Now you said that you didn't have a concern for her safety. So in your time that you were with her, that you met with her, and all the information that you reviewed, what were identified as maybe protective factors that made you feel comfortable that she was safe?
Alia Goodheart (01:21:46):
There's several things. She was future-oriented. She was clearly invested in her children. She was a caring mother, just like a caring mother. She had her parents around to help her. She had family and supports, be ensured that she would have outpatient psychiatric care for follow up. She didn't have a history of suicide. She had no history of psychosis, postpartum psychosis. She had a stable place to live.
Jennifer Sprague (01:22:31):
The statement that she made to you that she wouldn't have completed the act of suicide because of her kids or her mom, was that something that you considered?
Alia Goodheart (01:22:41):
Absolutely.
Jennifer Sprague (01:22:43):
And the fact that during the time from admission on January 1st to the time she was discharged on January 5th, that she didn't make statements supporting suicidal ideation, was that a factor that you considered?
Alia Goodheart (01:22:58):
Yes.
Jennifer Sprague (01:23:01):
And at no time during the time she was at McLean, did she ever indicate that she had ever reported or had thoughts of harming anyone else, did she?
Alia Goodheart (01:23:10):
She had never stated that she had any thoughts of harming anybody else.
Jennifer Sprague (01:23:20):
And ultimately at the end of that conversation with her, or the hour later, she was able to secure that appointment that you asked her to, on her own?
Alia Goodheart (01:23:29):
Correct.
Jennifer Sprague (01:23:31):
And so knowing that now the discharge has moved up a day, what was your plan for medication for her upon discharge?
Alia Goodheart (01:23:40):
She would have continued on the Ativan to help her sleep at night. That was a short-term plan. Once she was feeling better, or was able to sleep, or her mood came back to baseline, she could taper off of it. She had Trazodone to use as needed, and melatonin.
Jennifer Sprague (01:24:04):
And as far as your recommendations for medication, it would be no more Seroquel? I guess, let me ask that question a different way.
Alia Goodheart (01:24:15):
Yes.
Jennifer Sprague (01:24:15):
You didn't give her a new prescription for a different doses of Seroquel, did you?
Alia Goodheart (01:24:20):
No.
Jennifer Sprague (01:24:21):
And did you advise her to take Seroquel when she was home if she felt that she needed it?
Alia Goodheart (01:24:25):
I would assume she would take what I had prescribed.
Jennifer Sprague (01:24:39):
Just to back up one second. As part of this treatment team plan for patients at McLean Hospital, is it fair to say that either you or other members of the team, either a mental health worker, or social worker, or a nurse, sometimes reach out to collaterals in order to try to gather information and assess a patient?
Alia Goodheart (01:25:02):
Yes.
Jennifer Sprague (01:25:02):
And in this instance, are you aware that somebody reached out to Patrick Clancy to speak with him about his wife and her care?
Alia Goodheart (01:25:09):
Yes.
Jennifer Sprague (01:25:10):
And were you aware that he reported that she hadn't ever had suicidal thoughts?
Alia Goodheart (01:25:20):
Yes.
Jennifer Sprague (01:25:21):
And that he actually reported to the social worker that she was concerned about dependency?
Alia Goodheart (01:25:28):
Yes.
Jennifer Sprague (01:25:29):
But she had told you that her husband was concerned. Is that correct?
Alia Goodheart (01:25:32):
Yes.
Jennifer Sprague (01:25:36):
And that he felt that she had succumbed to social pressure to take psychiatric medications because her friends were taking them?
Alia Goodheart (01:25:43):
That's what he told the social worker.
Jennifer Sprague (01:25:45):
And you're aware that he had made statements that he was unhappy with the medical care she was receiving at McLean?
Alia Goodheart (01:25:52):
He said ... I don't think-
Jennifer Sprague (01:25:55):
Were you aware that he said he was very unhappy with the medical care she received? [inaudible 01:25:59]-
Alia Goodheart (01:25:59):
She received, yes. He didn't specify McLean.
Jennifer Sprague (01:26:02):
Okay. Thank you. And as far as you're aware, the patient themselves, Ms. Clancy, she never complained that she wasn't getting seen by staff or doctors, was she?
Alia Goodheart (01:26:14):
She never complained of that.
Jennifer Sprague (01:26:16):
Did she ever file any sort of complaint with the hospital?
Alia Goodheart (01:26:21):
No.
Jennifer Sprague (01:26:22):
And is there a mechanism for a person to file a complaint if they feel like they're not being treated-
Alia Goodheart (01:26:28):
Absolutely.
Jennifer Sprague (01:26:29):
And is that information posted all over the units?
Alia Goodheart (01:26:32):
It is posted on the unit and the forms are available.
Jennifer Sprague (01:26:36):
And a person, even if they're not on a one-to-one, or directly interacting with a mental health worker or social worker, do they always have the ability to request to speak to somebody?
Alia Goodheart (01:26:46):
Absolutely.
Jennifer Sprague (01:26:46):
And so even when, maybe, somebody from their team is not there or working, is there somebody always on call, a mental health worker, a social worker, a psychiatrist, a nurse for a person to speak to if they felt they needed to?
Alia Goodheart (01:27:00):
Yes.
Jennifer Sprague (01:27:03):
And in addition to your meeting with her on January 4th, and after coming up with that plan for discharge on the 5th, are you aware that she then continued to engage in groups on the 5th, and that she continued to engage with mental health workers and social workers?
Alia Goodheart (01:27:22):
Yes.
Jennifer Sprague (01:27:23):
And do you recall when she was discharged on the 5th? Was it in the morning or in the evening?
Alia Goodheart (01:27:29):
Afternoon. Probably around three-ish is my recall.
Jennifer Sprague (01:27:33):
Okay. And upon discharge, was she provided with information that she could use when she was home? Like resources?
Alia Goodheart (01:27:46):
Yes.
Jennifer Sprague (01:27:46):
And do you recall that she had asked about resources to find a new doctor at some point?
Alia Goodheart (01:27:58):
Yes.
Jennifer Sprague (01:27:59):
And that she ultimately reported to the social worker that she felt comfortable managing at home?
Alia Goodheart (01:28:06):
Yes.
Jennifer Sprague (01:28:07):
If I may have one moment.
Judge Sullivan (01:28:09):
Sure.
Jennifer Sprague (01:28:20):
So upon discharge, what did you actually prescribe her?
Alia Goodheart (01:28:26):
A 14-day supply of Ativan and a 14-day supply of Trazodone.
Jennifer Sprague (01:28:33):
Okay. And when you were having conversations with her about her thoughts of suicide or her thoughts of wanting to die, was she expressly asked if she wanted to kill herself?
Alia Goodheart (01:28:50):
Yes.
Jennifer Sprague (01:28:51):
And what was her answer, if you recall?
Alia Goodheart (01:28:54):
She denied that.
Jennifer Sprague (01:28:56):
She denied that?
Alia Goodheart (01:28:57):
Yes.
Jennifer Sprague (01:28:58):
And was she specifically asked if she had a plan to kill herself?
Alia Goodheart (01:29:02):
Yes.
Jennifer Sprague (01:29:03):
And what was her answer to that?
Alia Goodheart (01:29:06):
She denied it.
Jennifer Sprague (01:29:07):
And was she specifically asked if she wanted to harm anyone else?
Alia Goodheart (01:29:11):
Yes.
Jennifer Sprague (01:29:12):
And did she provide an answer for that?
Alia Goodheart (01:29:14):
She denied it.
Jennifer Sprague (01:29:15):
And those are standard questions you would ask at every interaction with her, correct?
Alia Goodheart (01:29:19):
Yes.
Jennifer Sprague (01:29:20):
And prior to discharge, she would also be asked those questions again, correct?
Alia Goodheart (01:29:24):
Yes.
Jennifer Sprague (01:29:24):
Because if her answers changed at any point, it would have changed your plan, right?
Alia Goodheart (01:29:28):
Yes.
Jennifer Sprague (01:29:30):
Thank you. Nothing further. Thank you.
Judge Sullivan (01:29:37):
Mr. Reddington?
Kevin Reddington (01:29:46):
Just like to start off just by asking, district attorney asked you about resources that were provided to her. What were the resources?
Alia Goodheart (01:30:01):
We had discussed going on Psychology Today, where-
Kevin Reddington (01:30:05):
I'm sorry?
Alia Goodheart (01:30:07):
She was aware of the website Psychology Today.
Kevin Reddington (01:30:10):
Website?
Alia Goodheart (01:30:11):
Yes. She was given the name of a case manager through her insurance, who she could contact for assistance in finding new providers.
Kevin Reddington (01:30:26):
So other than telling her about the website for Psychology Today, and talking about her insurance company, and what they would allow for her to reach out for what? Other providers? Is that what it was?
Alia Goodheart (01:30:45):
Can you restate that?
Kevin Reddington (01:30:46):
Sure, of course. You referenced her insurance company.
Alia Goodheart (01:30:50):
Yes.
Kevin Reddington (01:30:50):
I mean, that's a major consideration in medical treatment, is it not? What a person has for insurance?
Alia Goodheart (01:30:57):
No.
Kevin Reddington (01:30:58):
No?
Alia Goodheart (01:30:59):
I don't understand what you mean by that.
Kevin Reddington (01:31:01):
You know what insurance isl. I mean, as far as a person paying their bills for medical treatment or psychiatric treatment.
Alia Goodheart (01:31:09):
The insurance is important because who you can see is limited by what insurance you have.
Kevin Reddington (01:31:17):
So that's what I was asking. As far as the insurance, you referenced that on the resources, when the DA asked you about resources, and I asked you what were the resources? And you said going on the website for Psychology Today, right?
Alia Goodheart (01:31:30):
Yes.
Kevin Reddington (01:31:31):
And that you spoke to her about her insurance, right?
Alia Goodheart (01:31:34):
We gave her the name of a case manager who she could contact, and her telephone number, in case she wanted to find other providers. They would be able to look at their database and figure out what providers would be within the distance she was comfortable with, whether they were male or female, if she had a preference, and if she had any preference about any specialization.
Kevin Reddington (01:31:59):
Okay. And in reference to the insurance, what is the ... You answered the question about insurance. I'm just asking what is the involvement of insurance in that offer of resources?
Alia Goodheart (01:32:15):
I don't understand your question.
Kevin Reddington (01:32:17):
All right. Maybe I didn't understand your answer. That's why I apologize. You had indicated that in addition to telling her to go on the website for Psychology Today, that you spoke about her insurance, and other providers that would be permitted, I guess, under her insurance.
Alia Goodheart (01:32:43):
The fact that she had a case manager at Blue Cross Blue Shield was an added benefit, because they could assist her in finding providers. That's what I meant.
Kevin Reddington (01:32:53):
All right. Other than the case manager from Blue Cross Blue Shield, and to do research off of the website for Psychology Today, what resources were provided to this woman?
Alia Goodheart (01:33:10):
There are numerous resources that are printed on the after-visit summary. I don't know each and every one of them, but I think they would be in the medical record.
Kevin Reddington (01:33:23):
Okay. And that's something that is provided to a patient when they leave?
Alia Goodheart (01:33:29):
Yes.
Kevin Reddington (01:33:32):
She came in on a voluntary, is that correct? In other words, I know she was transported by an ambulance, but nevertheless, it was that she and her husband, Patrick, wanted her to be treated at McLean, correct?
Alia Goodheart (01:33:47):
She came in and signed in on a voluntary.
Kevin Reddington (01:33:51):
In other words, there were no orders of a court, no judge ordering that she be committed, or anything like that. Is that correct?
Alia Goodheart (01:33:59):
Yes.
Kevin Reddington (01:34:00):
All right. And she came in on, was it New Year's Eve? January 1st?
Alia Goodheart (01:34:07):
Yes.
Kevin Reddington (01:34:08):
And do you remember what time she came in?
Alia Goodheart (01:34:12):
I think she arrived at the CEC around four.
Kevin Reddington (01:34:15):
Now, would you agree that on New Year's Eve in McLean Hospital, that that ward is pretty much running on a skeleton crew?
Alia Goodheart (01:34:31):
I can't speak to something, I'm not there.
Kevin Reddington (01:34:35):
Obviously you're not there, but what about other people? Was skeleton crew New Year's Eve? Or was it-
Alia Goodheart (01:34:40):
You would have to ask somebody who was there.
Kevin Reddington (01:34:43):
Well, you've worked there for what, seven years?
Alia Goodheart (01:34:45):
Five.
Kevin Reddington (01:34:46):
Five years. And what is the ward that she was on?
Alia Goodheart (01:34:50):
AB1 South.
Kevin Reddington (01:34:53):
81 South?
Alia Goodheart (01:34:54):
A as in apple, B as in boy, 1, South.
Kevin Reddington (01:35:01):
South. And how many doctors work at AB South, on whatever shifts that you may have?
Alia Goodheart (01:35:13):
There are four psychiatrists assigned who work on AB1 South. And-
Kevin Reddington (01:35:19):
Now ... Sorry, go ahead.
Alia Goodheart (01:35:21):
Yeah, that's it.
Kevin Reddington (01:35:24):
And does that include you?
Alia Goodheart (01:35:25):
Yes.
Kevin Reddington (01:35:27):
And approximately how many nurses work on AB South?
Alia Goodheart (01:35:32):
I wouldn't know, but I know that there is a nurse assigned to each team, and that there are four teams, sometimes ... Yeah, in general.
Kevin Reddington (01:35:43):
Four teams on AB South, right?
Alia Goodheart (01:35:48):
Yes.
Kevin Reddington (01:35:49):
And when you say a team, that consists of what? A psychiatrist, a nurse perhaps, or what?
Alia Goodheart (01:35:55):
A psychiatrist, a nurse, a social worker, and an assigned mental health worker.
Kevin Reddington (01:36:04):
And what are the shifts that this team would work?
Alia Goodheart (01:36:08):
There are three shifts.
Kevin Reddington (01:36:09):
Okay. And would that be like seven to 11 or 11 to four, that type of thing?
Alia Goodheart (01:36:14):
I think they're seven-hour shifts or eight-hour shifts. I don't know the exact times.
Kevin Reddington (01:36:18):
All right. And are you assigned a shift, or do you just go whenever you want?
Alia Goodheart (01:36:24):
We are not assigned shifts.
Kevin Reddington (01:36:26):
And when she was presented to the hospital, she went through that initial evaluation that you told us about, the CEC. Is that correct?
Alia Goodheart (01:36:43):
I'm sorry, can you-
Kevin Reddington (01:36:44):
CEC, maybe you were talking about the CE-
Alia Goodheart (01:36:45):
Yeah. Can you repeat the question?
Kevin Reddington (01:36:47):
Sure. When she admitted herself and was escorted onto AB South, that's where she was evaluated?
Alia Goodheart (01:37:00):
She was evaluated in the CEC by the psychiatrist. Then she came to the unit and was seen by Dr. Madva later the same day. So she met two psychiatrists on January 1st.
Kevin Reddington (01:37:13):
Okay. So you have a woman that has admitted herself to McLean on New Year's for help, right?
Alia Goodheart (01:37:22):
Yes.
Kevin Reddington (01:37:24):
And she was evaluated at the CEC. Is that on that ward, or is that a different part of the hospital?
Alia Goodheart (01:37:30):
It's a different part.
Kevin Reddington (01:37:31):
Okay. And how long does that evaluation typically take?
Alia Goodheart (01:37:36):
I can't speak to that. I don't work in the CEC.
Kevin Reddington (01:37:41):
What happens in the CEC? Does person sit down and they get interviewed, or what do they do?
Alia Goodheart (01:37:47):
There's a full psychiatric evaluation.
Kevin Reddington (01:37:51):
And a full psychiatric evaluation consists of what?
Alia Goodheart (01:38:00):
A chief complaint, or history of ... So basically a history of present illness, which would be what brings the person into the hospital.
Kevin Reddington (01:38:09):
Okay.
Alia Goodheart (01:38:09):
They review past psychiatric history, substance use history, social history, family history. They do a mental status exam, and then they make an assessment.
Kevin Reddington (01:38:22):
And they would be the CEC?
Alia Goodheart (01:38:24):
Psychiatrist.
Kevin Reddington (01:38:26):
And that would be the psychiatrist that you were referring to?
Alia Goodheart (01:38:29):
Dr. Outlaw.
Kevin Reddington (01:38:30):
Dr. Outlaw. Now, how long does the CEC typically take?
Alia Goodheart (01:38:36):
I do not know.
Kevin Reddington (01:38:37):
I imagine-
Alia Goodheart (01:38:40):
It depends on the speed of the person seeing the patient.
Kevin Reddington (01:38:46):
I imagine that at some point a psychiatrist, or a social worker, or somebody must get into the prior history that the patient had prior to coming-
Kevin Reddington (01:39:00):
... history that the patient had prior to coming to your doorstep, right?
Alia Goodheart (01:39:08):
That is a part of the evaluation, yes.
Kevin Reddington (01:39:11):
Okay. And you had a chance, as the district attorney asked you, as to whether or not you were able to review the medical records that involved Lindsay Clancy's treatment at McLean Hospital for the four and a half days, right?
Alia Goodheart (01:39:25):
I was able to review the CEC note, which had an excerpt of the MGH evaluation and notes that were available to me since January 1st at McLean.
Kevin Reddington (01:39:40):
Now, as a psychiatrist... I mean, when she goes to the hospital, she's your patient, right?
Alia Goodheart (01:39:47):
She's-
Kevin Reddington (01:39:47):
She's your patient?
Alia Goodheart (01:39:47):
Yes.
Kevin Reddington (01:39:48):
Yes. And as a doctor, what you want to do is get all the information that's available on why this person is in your locked ward, right?
Alia Goodheart (01:39:58):
Yes.
Kevin Reddington (01:39:59):
So did you do inquiry into her prior history or was that left to the CEC person or the social worker?
Alia Goodheart (01:40:08):
That is part of the evaluation.
Kevin Reddington (01:40:12):
And the evaluation is CEC?
Alia Goodheart (01:40:14):
And when I see her as well.
Kevin Reddington (01:40:15):
All right. So do you sometime... when I say you, I mean you or the social worker or the CEC person, do you talk to people like third party, I think you said third party contacts?
Alia Goodheart (01:40:29):
Yes.
Kevin Reddington (01:40:29):
All right.
Alia Goodheart (01:40:31):
The social worker does.
Kevin Reddington (01:40:32):
Okay. And you reviewed the records. When did the social worker talk to the first psychiatrist that she went to see?
Alia Goodheart (01:40:42):
The social worker contacted Patrick.
Kevin Reddington (01:40:45):
Well, I know you told us that he contacted Patrick and that Patrick gave some history about the benzodiazepines, that he was concerned about and he thought she wasn't getting good medical care. Is that correct?
Alia Goodheart (01:40:57):
Yes.
Kevin Reddington (01:40:57):
All right. You know that she had medical treatment-
Alia Goodheart (01:41:00):
Yes.
Kevin Reddington (01:41:00):
... before she came to McLean?
Alia Goodheart (01:41:03):
Yes.
Kevin Reddington (01:41:03):
Okay. Who is her psychiatrist?
Alia Goodheart (01:41:08):
The nurse practitioners she was seeing prior to coming to McLean. I was aware of that person.
Kevin Reddington (01:41:15):
Would that be Nurse Practitioner Jollotta?
Alia Goodheart (01:41:18):
Yes.
Kevin Reddington (01:41:19):
Did you speak to her?
Alia Goodheart (01:41:20):
No.
Kevin Reddington (01:41:21):
Did you look at her records?
Alia Goodheart (01:41:23):
I did not have access to them.
Kevin Reddington (01:41:24):
Why not?
Alia Goodheart (01:41:26):
They aren't in the same medical record system.
Kevin Reddington (01:41:30):
Well, the same medical record system is just so that you have access to MGH, you have access to Brigham and Women's Hospital because it's all part of some big computer information access you have. What about other healthcare providers? Can you get access to their records?
Alia Goodheart (01:41:49):
Not immediately.
Kevin Reddington (01:41:50):
Well, how about if you have a release signed by a patient under the HIPAA law? You know what the HIPAA law is obviously, right?
Alia Goodheart (01:42:00):
Yes.
Kevin Reddington (01:42:00):
And just tell me, what does that actually mean, that a patient allows someone to look at their medical records?
Alia Goodheart (01:42:05):
Yes.
Kevin Reddington (01:42:06):
And Lindsay was very, very cooperative with you guys, wasn't she?
Alia Goodheart (01:42:10):
Yes.
Kevin Reddington (01:42:11):
Did anyone ever ask her to sign a HIPAA release for anyone to get access to Nurse Practitioner Jollotta's records?
Alia Goodheart (01:42:18):
No.
Kevin Reddington (01:42:19):
How about Psychiatrist Tufts' records?
Alia Goodheart (01:42:22):
No.
Kevin Reddington (01:42:23):
How about Nurse Practitioner Paul's records?
Alia Goodheart (01:42:26):
No.
Kevin Reddington (01:42:28):
Who's Leticia Dukes?
Alia Goodheart (01:42:30):
She was a social worker. I think that Lindsay saw at South Shore at the perinatal program.
Kevin Reddington (01:42:39):
Okay. And do you know when she went to the South Shore Rhode Island Perinatal Program?
Alia Goodheart (01:42:45):
I know it was prior to admission. I don't remember the exact dates.
Kevin Reddington (01:42:49):
Do you know what recommendations that she had received at that point?
Alia Goodheart (01:42:54):
No. Other than the medication.
Kevin Reddington (01:42:57):
Do you know what medication she was actually on when she presented to McLean Hospital?
Alia Goodheart (01:43:03):
Seroquel and Valium.
Kevin Reddington (01:43:07):
What is it?
Alia Goodheart (01:43:08):
Seroquel and Valium.
Kevin Reddington (01:43:15):
You knew that Dr. Tufts was the first psychiatrist that she actually consulted, correct?
Alia Goodheart (01:43:24):
I believe so.
Kevin Reddington (01:43:26):
And again, if you don't know, just say you don't know.
Alia Goodheart (01:43:28):
Yes.
Kevin Reddington (01:43:32):
Okay. And I think you made reference to the fact... or maybe the DA made reference in questioning you about the fact that she was looking for doctors for some type of medication or something. Is that fair?
Alia Goodheart (01:43:46):
That's a very vague statement. I don't know what you mean.
Kevin Reddington (01:43:49):
Okay. Well, actually she saw Dr. Tufts because Dr. Tufts advertised that she was an expert in perinatal care, right?
Speaker 1 (01:43:59):
Objection.
Speaker 2 (01:44:00):
Overruled.
Alia Goodheart (01:44:05):
Oh, sorry. I wouldn't know why she saw Dr. Tufts.
Kevin Reddington (01:44:10):
Do you know what medication Dr. Tufts prescribed to her?
Alia Goodheart (01:44:15):
From what Lindsay told me, yes.
Kevin Reddington (01:44:17):
What?
Alia Goodheart (01:44:21):
Zoloft was the first.
Kevin Reddington (01:44:24):
All right. So Dr. Tufts, according to Lindsay, provided her, Lindsay, with Zoloft, which is an SSRI, correct?
Alia Goodheart (01:44:35):
It's an antidepressant in that class, yes.
Kevin Reddington (01:44:37):
Okay. So when you say an antidepressant in that class, the class would be selective serotonin reuptake inhibitor, right?
Alia Goodheart (01:44:47):
Yes.
Kevin Reddington (01:44:48):
And that's pretty powerful stuff, isn't it?
Alia Goodheart (01:44:51):
I don't know what you mean by powerful.
Kevin Reddington (01:44:53):
No? Well, are you supposed to prescribe Zoloft or Sertraline to a person that has bipolar?
Alia Goodheart (01:45:05):
I think it all depends on what you're seeing when you see the patient-
Kevin Reddington (01:45:10):
All right.
Alia Goodheart (01:45:10):
... in...
Kevin Reddington (01:45:11):
So it's important, I would imagine then, to be fair in your evaluation of this young woman that came to your hospital for help on New Year's to find out what any evaluations were of her condition, her presentation, her symptomology when she saw that first psychiatrist, Dr. Tufts, right?
Alia Goodheart (01:45:33):
Lindsay was cooperative and she was forthcoming. I had no reason to think that she would not provide us with what other providers thought, just like she told us that Tufts said she was worried about bipolar disorder. And-
Kevin Reddington (01:45:55):
I apologize.
Alia Goodheart (01:45:56):
Yeah.
Kevin Reddington (01:45:56):
Tufts advised her that she was worried about-
Alia Goodheart (01:45:59):
No, sorry. It was-
Kevin Reddington (01:45:59):
Jollotta?
Alia Goodheart (01:45:59):
Yes.
Kevin Reddington (01:45:59):
Okay.
Alia Goodheart (01:45:59):
Sorry. Thank you.
Kevin Reddington (01:46:03):
That's all right. No problem. And again, if you have records or you want to look at them, that's fine because I know it's tough to have all the stuff in your head.
Alia Goodheart (01:46:09):
Yes. Thank you.
Kevin Reddington (01:46:12):
And so Dr. Tufts prescribed the Zoloft to her, and you knew that right after the initial prescription of Zoloft. Do you know how many milligrams she was prescribed initially by Dr. Tufts?
Alia Goodheart (01:46:27):
Lindsay, I think, stated it was 25.
Kevin Reddington (01:46:31):
Okay. And then Dr. Tufts increased it to what, 100?
Alia Goodheart (01:46:36):
Lindsay said it was increased to 50.
Kevin Reddington (01:46:40):
50. All right. And again, you're in a... I don't know if it's appropriate to say, but you're in a mental institution, right? That's where you work at McLean-
Alia Goodheart (01:46:46):
Yes.
Kevin Reddington (01:46:47):
... Hospital? okay. And it's a locked ward, right?
Alia Goodheart (01:46:49):
Yes.
Kevin Reddington (01:46:50):
And she's a patient that's coming to you for help, right?
Alia Goodheart (01:46:52):
Yes.
Kevin Reddington (01:46:53):
Is it appropriate for a doctor to take what that patient is telling you as a history or do you have to verify it or talk to other healthcare providers to make sure that they're not just running off and making something up?
Alia Goodheart (01:47:08):
I had no reason to believe that she was not a reliable reporter.
Kevin Reddington (01:47:11):
Because she seemed very forthright, right?
Alia Goodheart (01:47:14):
Yes.
Kevin Reddington (01:47:15):
She seemed very honest in her disclosure of her symptomology, right?
Alia Goodheart (01:47:18):
Yes.
Kevin Reddington (01:47:20):
One of the things or one of the tools that you and the mental health field have access to is psychiatric testing, right?
Alia Goodheart (01:47:29):
Yes.
Kevin Reddington (01:47:30):
Okay. You have, for example, one tool, and I think psychologists... And there are psychologists that are on staff, I would imagine at McLean as well.
Alia Goodheart (01:47:41):
No, not on that unit.
Kevin Reddington (01:47:46):
As a psychiatrist, you don't administer psychiatric or psychological testing, do you?
Alia Goodheart (01:47:51):
No.
Kevin Reddington (01:47:51):
All right. But, for example, you've got the Beck inventory test or what's called the MMPI test. You're familiar with those, right?
Alia Goodheart (01:48:01):
These are forms that the patient can fill out.
Kevin Reddington (01:48:05):
Right. And one of the tests is the MMPI, which is Minnesota Multiphasic Personality Inventory Test, right?
Alia Goodheart (01:48:14):
I have heard of that.
Kevin Reddington (01:48:16):
Okay. And you know that one of the things that it determines is if... they call it the K Scale, whether or not somebody is lying or minimizing, or not minimizing, but lying about their symptomology, right?
Alia Goodheart (01:48:29):
I don't know much about the scale.
Kevin Reddington (01:48:32):
Well, that's a tool that can give someone information as to the person's presentation of their symptomology. That would be important as to their honesty of whether or not they're trying to minimize or whether or not they're trying to falsely project their symptomology, right?
Alia Goodheart (01:48:57):
I don't know what you're asking me.
Kevin Reddington (01:48:59):
Okay. Were you aware that there were ever any psychological testing administered to Lindsay? MM-
Alia Goodheart (01:49:07):
No.
Kevin Reddington (01:49:07):
... PI or Beck or anything?
Alia Goodheart (01:49:10):
No.
Kevin Reddington (01:49:13):
Okay. How many times did she call or reach out to help for a suicide hotline?
Alia Goodheart (01:49:23):
I don't know.
Kevin Reddington (01:49:23):
Wouldn't that be something important to find out if the person who you're suggesting was denying suicidality or suicidal ideation upon your evaluation that she called out to suicide hotlines?
Alia Goodheart (01:49:40):
She told us that she was having suicidal thoughts but had no intent or plan. So I do know that she was struggling with suicidal ideation.
Kevin Reddington (01:49:50):
Right. Anybody else that you talked to or did you-
Alia Goodheart (01:49:54):
Actua-
Kevin Reddington (01:49:54):
... talk to anybody else?
Alia Goodheart (01:49:56):
I know the social worker, Dr. Patrick-
Kevin Reddington (01:49:58):
Patrick.
Alia Goodheart (01:49:59):
... and he did give the information he gave.
Kevin Reddington (01:50:03):
Okay. So what I'm asking is, as you're investigating the history of this patient, you're not aware, no idea that she had reached out on not one but two occasions to a suicide hotline. Is that correct?
Alia Goodheart (01:50:18):
Yes.
Kevin Reddington (01:50:19):
All right. Did you know that when she was first prescribed the Zoloft by Dr. Tufts at 25 milligrams, then increased to 50 milligrams, that she then reported that she was unable to sleep-
Alia Goodheart (01:50:38):
She shared-
Kevin Reddington (01:50:38):
... for 40-
Alia Goodheart (01:50:38):
... that with us.
Kevin Reddington (01:50:40):
What's that?
Alia Goodheart (01:50:40):
Sorry. I'm sorry. I didn't-
Kevin Reddington (01:50:41):
Go right ahead. No problem. What is it?
Alia Goodheart (01:50:44):
I'm going to let you finish the question.
Kevin Reddington (01:50:46):
Okay. Thank you. No big deal. It's just that she reported that she went for 48 hours without sleep?
Alia Goodheart (01:50:56):
I don't remember that time quoted. I know she had difficulty sleeping.
Kevin Reddington (01:51:06):
You indicated in your testimony that, and I quote, "I would've preferred to have more information about her sleep patterns." Right? Do you remember saying that?
Alia Goodheart (01:51:20):
Following the changes in the medications that we were making.
Kevin Reddington (01:51:25):
So sleep pattern would be just what it says, sleep pattern, like you sleep from night till seven in the morning or-
Alia Goodheart (01:51:30):
Yes.
Kevin Reddington (01:51:31):
... 12:00 at night, whatever your pattern would be, right?
Alia Goodheart (01:51:33):
Yes.
Kevin Reddington (01:51:34):
And why is a sleep pattern important for you as a psychiatrist trying to evaluate your patient?
Alia Goodheart (01:51:40):
Because difficulty sleeping is a symptom of several different conditions and it can worsen several different conditions.
Kevin Reddington (01:51:51):
And you know that she had reported severe anxiety, right?
Alia Goodheart (01:51:57):
She was struggling with anxiety, yes.
Kevin Reddington (01:51:58):
Struggling with anxiety. And she was having not just insomnia, but she had very, very severe insomnia, didn't she?
Alia Goodheart (01:52:09):
She wasn't able to sleep.
Kevin Reddington (01:52:11):
And you would prefer to have more information about sleep patterns is what you said. I'm not putting words in your mouth. That's what you said.
Alia Goodheart (01:52:19):
I know that we were able to observe her sleep while she was on the unit. Once she left the unit, I would not know how she was sleeping, which is why we referred her to somebody else so that they could continue to monitor her symptoms.
Kevin Reddington (01:52:36):
Obviously. So let's put the time that you are observing her or that your social workers are investigating to whatever extent they did, her background. What were her sleep patterns that were important to you prior to New Year's 2023?
Alia Goodheart (01:52:59):
The amount of sleep is important.
Kevin Reddington (01:53:01):
Yeah. And you said that. You already said, "I would've preferred to have more information about her sleep patterns."
Alia Goodheart (01:53:07):
After she was... If I was going to continue to evaluate her, I would want to observe her sleep is what I meant.
Kevin Reddington (01:53:14):
Oh, so you didn't mean that as an evaluator of her prior medical history, trying to get a history of your patient for purposes of diagnosis and treatment, that you wanted to know what her sleep patterns were. You didn't mean that you meant prior?
Alia Goodheart (01:53:31):
The history of whether somebody's struggling with insomnia is important and the patient can relay that to me.
Kevin Reddington (01:53:44):
Okay. You ever heard of patients that minimize their symptoms and lie about their symptoms sometimes?
Alia Goodheart (01:53:52):
Yes.
Kevin Reddington (01:53:53):
Okay. So it's important to corroborate what the person is telling you, right? I mean, you want to talk to somebody else objective to find out what, if any, evidence there is of symptomology.
Alia Goodheart (01:54:08):
And we did that with-
Kevin Reddington (01:54:10):
I'm sorry?
Alia Goodheart (01:54:18):
So when a patient presents and they're talking to us, it is not just about what they are saying. It's about their body language, their eye contact. You can get a sense of whether a person is being honest or whether they're lying. And we are providers. The patient is there to get help. They're going to tell us what is bothering them and what they're concerned about. That's why they're in the hospital.
Kevin Reddington (01:54:47):
This woman was in a locked ward. She couldn't walk off your unit, could she?
Alia Goodheart (01:54:53):
That is what a psychiatric unit is.
Kevin Reddington (01:54:56):
Right. And she was very sick, wasn't she?
Alia Goodheart (01:55:01):
I don't know what you mean by very sick.
Kevin Reddington (01:55:03):
Really? You indicated that you would assume that, "She would take what I prescribed." Do you do that with all of your patients? Assume that when they had mental disease or a defect, that they would do what they're told?
Alia Goodheart (01:55:19):
If they are cooperative and they have been cooperative and reliable, yes.
Kevin Reddington (01:55:29):
One of the things that's referenced would be... She stated that she had intrusive thoughts. Remember that?
Alia Goodheart (01:55:33):
Yes.
Kevin Reddington (01:55:33):
What were the intrusive thoughts?
Alia Goodheart (01:55:42):
From what's stated in the medical record, thoughts of suicide.
Kevin Reddington (01:55:49):
Okay. And how often would she have the intrusive thoughts?
Alia Goodheart (01:55:54):
I don't recall if... the frequency.
Kevin Reddington (01:56:00):
Would you agree with me that in addition to anxiety and in addition to inability to sleep, that she was in what was self-described as a brain fog, right?
Alia Goodheart (01:56:17):
She complained of feeling... Yeah. You can complain of feeling foggy.
Kevin Reddington (01:56:25):
She also complained about that she felt as if she was a zombie, right?
Alia Goodheart (01:56:32):
She did not use those words.
Kevin Reddington (01:56:33):
Anybody else use that word describing her in your investigation?
Alia Goodheart (01:56:37):
No.
Kevin Reddington (01:56:39):
Did Patrick tell you that he was concerned about the medications that she had been prescribed over the past two or three months?
Alia Goodheart (01:56:46):
Yes.
Kevin Reddington (01:56:47):
And you knew what the medications were that she was prescribed, correct?
Alia Goodheart (01:56:51):
She told us.
Kevin Reddington (01:56:52):
She told you. Okay. And she told you that she was prescribed, in addition to the SSRI Zoloft that was increased from 25 to 100, that she was-
Alia Goodheart (01:57:05):
I-
Kevin Reddington (01:57:05):
... then told-
Alia Goodheart (01:57:05):
I was aware that-
Kevin Reddington (01:57:06):
I'm sorry, 50.
Alia Goodheart (01:57:07):
Correct.
Kevin Reddington (01:57:08):
She was then told to stop taking the Zoloft by Dr. Tufts, right?
Alia Goodheart (01:57:14):
She reported not being able to sleep and they agreed that she would not take the Zoloft.
Kevin Reddington (01:57:19):
Okay. So the answer is yes. She was told to stop taking the Zoloft by Dr. Tufts, right?
Alia Goodheart (01:57:26):
I think you would have to ask Dr. Tufts that question.
Kevin Reddington (01:57:29):
Well, I will. But I'm asking you as investigating her
Alia Goodheart (01:57:33):
I know that she stopped taking the Zoloft-
Kevin Reddington (01:57:36):
But was it in-
Alia Goodheart (01:57:36):
... and that she saw Dr. Tufts. So I assume that they would have come to that agreement.
Kevin Reddington (01:57:40):
All right. So as you're evaluating this patient, you're assuming that she voluntarily stopped taking the Zoloft?
Alia Goodheart (01:57:52):
Because she wasn't able to sleep and she discussed it with Dr. Tufts.
Kevin Reddington (01:57:56):
She did. You knew that.
Alia Goodheart (01:57:58):
She told us she did.
Kevin Reddington (01:57:59):
Okay. How many patients have you treated, or how many women have you treated that were suffering from postpartum psychosis?
Alia Goodheart (01:58:21):
I don't recall. I don't remember, but I think it would stick in my memory. So I don't think that I probably have.
Kevin Reddington (01:58:31):
You don't think you probably have?
Alia Goodheart (01:58:34):
I don't think I have.
Kevin Reddington (01:58:36):
How about-
Alia Goodheart (01:58:36):
I haven't seen any.
Kevin Reddington (01:58:38):
How about postpartum depression?
Alia Goodheart (01:58:41):
Yes.
Kevin Reddington (01:58:42):
And how many patients have you treated with postpartum depression?
Alia Goodheart (01:58:46):
Over the last 20 years, I wouldn't... there are lots of patients I have seen. I don't keep a record of what diagnoses and what people I see.
Kevin Reddington (01:59:02):
Now, one of the things that you, when I say you collectively, I mean psychiatrists, psychologists, use in your evaluations and diagnoses of patients would be what's referred to as the DSM, correct?
Alia Goodheart (01:59:20):
Yes.
Kevin Reddington (01:59:21):
And that would be... DSM, it means diagnostic statistical manual, right?
Alia Goodheart (01:59:27):
Yes.
Kevin Reddington (01:59:28):
And it started out with DSM-I, then it went to II, then it went to II-R, meaning revised. And then there were a number of revisions. And now we're all the way up to DSM-5, correct?
Alia Goodheart (01:59:39):
Yes.
Kevin Reddington (01:59:40):
And DSM-5, also the most recent would be dash TR. What does TR mean?
Alia Goodheart (01:59:48):
I don't actually know.
Kevin Reddington (01:59:52):
So the DSM, the Diagnostic Statistical Manual, it's about this thick, right? If you have a regular sized book. I just have a little one book.
Alia Goodheart (02:00:03):
I think so.
Kevin Reddington (02:00:04):
Okay. Do you rely on or do you use in your evaluation of patients the Diagnostic Statistical Manual?
Alia Goodheart (02:00:13):
The diagnoses are based on the criteria that are stated in there.
Kevin Reddington (02:00:19):
Okay. So you do use, for diagnosis purposes, what is stated in the DSM, correct?
Alia Goodheart (02:00:28):
Yes.
Kevin Reddington (02:00:29):
And it's kind of like a cookbook. I mean, it basically tells you what the ingredients of a particular mental disease or defect would be, right?
Alia Goodheart (02:00:37):
Yes.
Kevin Reddington (02:00:38):
And you know that it's basically a group of people that get together and they discuss what should or should not be included in the manual that psychiatrists and psychologists use to diagnose patients, right?
Alia Goodheart (02:00:53):
Yes.
Kevin Reddington (02:00:55):
And they try to keep up to date and stay on top of any recent developments, right?
Alia Goodheart (02:01:02):
I would... I don't know.
Kevin Reddington (02:01:02):
Okay.
Alia Goodheart (02:01:06):
I can't speak to it.
Kevin Reddington (02:01:07):
That's all right. So here we are in 2026, not 1928. Is postpartum depression in the DSM?
Alia Goodheart (02:01:21):
I think it's a subcategory.
Kevin Reddington (02:01:23):
You think it's a subcategory of what?
Alia Goodheart (02:01:27):
Depression.
Kevin Reddington (02:01:29):
Depression. How about psychosis? Postpartum psychosis in 2026. Is that in this manual?
Alia Goodheart (02:01:39):
I don't exactly know where it is.
Kevin Reddington (02:01:42):
Have you ever seen it in this manual?
Alia Goodheart (02:01:46):
I don't recall paying attention to where it's categorized.
Kevin Reddington (02:01:51):
So if you're treating a woman who is, as you put it, postpartum because she had the child, and then you told the jury, "Well, there's a timeframe, a cutoff as to whether or not a person is still postpartum, still subject to mood swings, and still subject to hormone imbalance," and there's a cutoff, is what you said, right?
Alia Goodheart (02:02:16):
Different organizations use different definitions.
Kevin Reddington (02:02:21):
How about you? You're here for the government testifying in this case. What's your understanding of a cutoff of postpartum, if there is one?
Alia Goodheart (02:02:30):
For the DSM-5, it is four weeks. For ACOG, which is the American Academy of Obstetrics or something, I don't remember what that stands for, it's 12 weeks. For the CDC, it's 12 months. For the CDC, it's 12 months.
Kevin Reddington (02:02:49):
Okay. So CDC would be Center for Disease Control, right?
Alia Goodheart (02:02:51):
Yes.
Kevin Reddington (02:02:53):
So they're pretty much all over the place as far as the timeframe that a woman can still be involved with postpartum symptomology, right?
Alia Goodheart (02:03:02):
Yes.
Kevin Reddington (02:03:03):
Have you ever heard of a doctor by the name of Meg Spinelli?
Alia Goodheart (02:03:08):
No.
Kevin Reddington (02:03:09):
Have you read anything about the efforts being made to have the DSM-6 coming out include-
Speaker 1 (02:03:18):
Objection.
Speaker 2 (02:03:19):
No. Overruled.
Kevin Reddington (02:03:21):
... postpartum psychosis?
Alia Goodheart (02:03:23):
I'm sorry, what's the question?
Kevin Reddington (02:03:25):
Have you read or are you aware of efforts being made to include postpartum psychosis in the DSM-6 that will be coming out within a couple of months?
Alia Goodheart (02:03:43):
I think it's clear that there is question about where it should be placed or categorized.
Kevin Reddington (02:03:54):
Okay. So are you aware of any efforts being made to include postpartum psychosis in the DSM-6 when it comes out?
Alia Goodheart (02:04:06):
Vaguely.
Kevin Reddington (02:04:07):
Vaguely. How vague?
Alia Goodheart (02:04:09):
I don't know.
Kevin Reddington (02:04:09):
You don't know?
Alia Goodheart (02:04:11):
I know that there's question about where it should be categorized and that the DSM is reviewed every time and they try to move things around based on what clinicians and researchers think.
Kevin Reddington (02:04:26):
What, if any, impact does the thyroid have on a woman who has just had a baby and is in the postpartum period? Whatever they decided, six months, four months, a year. What impact does the thyroid have?
Alia Goodheart (02:04:48):
I am not an internal medicine physician. I am a doctor. What I do know about the thyroid is that the thyroid can affect one's mood and anxiety, whether one is pregnant or not.
Kevin Reddington (02:05:09):
So is it fair to say that thyroid levels are important in evaluating a woman who is in postpartum?
Alia Goodheart (02:05:23):
It's one tiny component of the entire-
Kevin Reddington (02:05:28):
Any component.
Alia Goodheart (02:05:29):
It is one component.
Kevin Reddington (02:05:30):
Okay. So what does that mean?
Alia Goodheart (02:05:40):
It's one of the tests.
Kevin Reddington (02:05:41):
It's a tiny component. What does that mean?
Speaker 1 (02:05:42):
Can you let her finish?
Kevin Reddington (02:05:42):
Sure. We'll let her finish. Go ahead.
Alia Goodheart (02:05:42):
It's one of the tests that can be done when a patient is admitted.
Kevin Reddington (02:05:45):
Okay. Was it done by McLean Hospital?
Alia Goodheart (02:05:50):
No.
Kevin Reddington (02:05:52):
What?
Alia Goodheart (02:05:52):
No.
Kevin Reddington (02:05:56):
Are you aware that your records indicate that she had a thyroid read that are part of the records?
Alia Goodheart (02:06:08):
My recall is that the TSH was not from 2022 or 2023.
Kevin Reddington (02:06:17):
Right. It was from 2000 and... What? From-
Alia Goodheart (02:06:22):
I wouldn't know. You'd have to defer to the record.
Kevin Reddington (02:06:26):
So in other words, it was imported into McLean records by, I guess, computer access or something from MGH years before, right?
Alia Goodheart (02:06:43):
Things move forward, yes.
Kevin Reddington (02:06:45):
I'm sorry?
Alia Goodheart (02:06:46):
Labs do populate from the past.
Kevin Reddington (02:06:50):
Okay. So in the past, as a psychiatrist, as her treating psychiatrist at McLean Hospital trying to do an investigation, evaluate this woman to tell her what your diagnosis was and what you guys can do to help her out, did you look at the thyroid reads?
Alia Goodheart (02:07:11):
It was one of the labs that I would've reviewed.
Kevin Reddington (02:07:13):
You would've reviewed. Okay. As you're sitting here today, do you have any memory about what the thyroid reads were?
Alia Goodheart (02:07:20):
It was within normal limits.
Kevin Reddington (02:07:22):
And that would be coming from how long before? A year? Two? Three?
Alia Goodheart (02:07:27):
I don't remember.
Kevin Reddington (02:07:28):
So there were no actual thyroid tests done while she was at the hospital at McLean, right?
Alia Goodheart (02:07:34):
No.
Kevin Reddington (02:07:35):
What is the Edinburgh EPDS or something like that? What is that?
Alia Goodheart (02:07:43):
It's a scale.
Kevin Reddington (02:07:45):
A scale. What kind of a scale?
Alia Goodheart (02:07:53):
It's a postpartum scale for depression.
Kevin Reddington (02:07:56):
And it's used by psychiatrists and psychologists to evaluate the risk factor of a woman who is involved with postpartum, right?
Alia Goodheart (02:08:06):
I think it's to assess the level of depression.
Kevin Reddington (02:08:10):
In a woman who's involved with postpartum, not some guy that got injured on a soccer field, right?
Alia Goodheart (02:08:15):
Yes.
Kevin Reddington (02:08:17):
So what does the EPDS mean? I'm probably butchering that. What is that an acronym for?
Alia Goodheart (02:08:22):
Edinburgh's Postpartum Depression Scale or something.
Kevin Reddington (02:08:29):
Okay. The Edinburgh Postpartum Depression Scale. Was that administered to Lindsay when she was in for the four days and a half that she was in your hospital?
Alia Goodheart (02:08:39):
No.
Kevin Reddington (02:08:39):
Why not?
Alia Goodheart (02:08:43):
Because we don't necessarily administer scales.
Kevin Reddington (02:08:47):
You don't necessarily what?
Alia Goodheart (02:08:49):
We don't administer scales.
Kevin Reddington (02:08:50):
Why? That's an accepted tool to evaluate a patient as a psychiatrist or a psychologist, isn't it?
Alia Goodheart (02:09:00):
It is a tool, but it doesn't in the end determine the diagnosis.
Kevin Reddington (02:09:08):
Oh no, of course not, because the doctor who supposedly has access to the person's medical history and all of the other aspects of your evaluation is the one that gives the diagnosis, right?
Alia Goodheart (02:09:22):
The psychiatrist makes the diagnosis based on the presentation, the history of the patient.
Kevin Reddington (02:09:29):
Right. So far what we've got is a presentation of the patient who was in the locked wards at McLean Hospital and the presentation was from her, right?
Alia Goodheart (02:09:40):
Her presentation is how she presents, how she is observed. It's not what she's telling us.
Kevin Reddington (02:09:47):
Well, isn't what she's telling you part of what you consider?
Alia Goodheart (02:09:50):
Yes.
Kevin Reddington (02:09:51):
Okay. And what Patrick's telling you is part of what you consider?
Alia Goodheart (02:09:54):
Yes.
Kevin Reddington (02:09:55):
So other than what Lindsay, who was in the locked ward, tells you and her husband who tells you, what, if any, investigation did you do?
Alia Goodheart (02:10:11):
We did not do any additional collateral contact.
Kevin Reddington (02:10:17):
And you didn't do any tests either, right? You didn't do a... Did you do a blood test?
Alia Goodheart (02:10:23):
Psychiatry as a field is not dependent on blood tests. If it was that-
Kevin Reddington (02:10:29):
Well-
Alia Goodheart (02:10:29):
... simple, it would be much better for everybody. It's based on the evaluation of the patient who's sitting in front of you.
Kevin Reddington (02:10:38):
So you're suggesting to this jury that it's not a valid medical step for one to take to take blood from a person who is on a cocktail of drug medications to find out what their levels are?
Alia Goodheart (02:10:55):
No, not a regular procedure at all.
Kevin Reddington (02:10:59):
Okay. Now, McLean did not take any blood. McLean did not do the Edinburgh scale, but that would be something that you would be interested in, right? As to whether or not anyone else gave her the Edinburgh Depression Scale?
Alia Goodheart (02:11:15):
Let me clarify one thing. McLean did draw blood. They did do testing. There was no testing for levels of drugs.
Kevin Reddington (02:11:26):
Drugs.
Alia Goodheart (02:11:26):
Just let me clarify that so that-
Kevin Reddington (02:11:28):
That's fine.
Alia Goodheart (02:11:28):
Okay.
Kevin Reddington (02:11:30):
So they took a CBC or maybe a blood count evaluation, but it had nothing to do with what was onboard, as they say, as far as tricyclics, antipsychotics, SSRIs, anything, right?
Alia Goodheart (02:11:45):
They check for substances of abuse, but nothing else.
Kevin Reddington (02:11:50):
Well, there were no substances of abuse in her blood, were there?
Alia Goodheart (02:11:53):
No.
Kevin Reddington (02:11:55):
How about the tricyclics, the antipsychotics, the SSRIs, the benzodiazepines, the Z-drugs that they call some of their categories? They don't test for that.
Kevin Reddington (02:12:00):
... the Z drugs that they call some of their categories. They didn't test for that, did they?
Alia Goodheart (02:12:07):
Those are not tested on a regular basis for anybody.
Kevin Reddington (02:12:11):
How about on her basis?
Alia Goodheart (02:12:14):
I don't know why I would have tested for those.
Kevin Reddington (02:12:19):
Well, how about-
Alia Goodheart (02:12:20):
What would have been the indication?
Kevin Reddington (02:12:22):
How about if she presents and the history that she's giving you is that she was on a number of drugs for that three-month period, or three-and-a-half-month period. Would it be of interest to you as to what was on board in her blood?
Alia Goodheart (02:12:36):
Medications have different half-lives. So if she had taken something, it would depend on what the half-life was. If it was a day, it would be out of her system. We would not be able to catch it at that time. It would depend on what she'd been taking and what was in her bloodstream at that point.
Kevin Reddington (02:13:04):
So the admission note that was noted in the medical records would be on page 64 of the medical records that you were presented by the district attorney. Do you remember that?
Alia Goodheart (02:13:22):
I don't remember what page it's on, but-
Kevin Reddington (02:13:24):
That's understandable. Okay.
Alia Goodheart (02:13:31):
Thank you.
Kevin Reddington (02:13:40):
Sure. No problem. Can you tell me what... I'm looking at Exhibit 79, page 63. And that would be the record from McLean Hospital. Is that right?
Alia Goodheart (02:13:51):
Yes.
Kevin Reddington (02:13:53):
Okay. Can you tell me what this means when it says clinical summary?
Alia Goodheart (02:13:57):
That says the social worker's note.
Kevin Reddington (02:13:59):
Okay. And is that what this is?
Judge (02:14:01):
Doctor, can you maybe move that microphone just so that...
Kevin Reddington (02:14:04):
Sorry about that. That's the social worker's note?
Alia Goodheart (02:14:08):
Correct.
Kevin Reddington (02:14:08):
And that's what the district attorney was questioning you on, when she referred you to symptomology?
Alia Goodheart (02:14:17):
Was this a conversation with Patrick? I'm not sure what... I don't recall what you're talking about.
Kevin Reddington (02:14:23):
All right. You can read along with me. All right?
Alia Goodheart (02:14:26):
Okay.
Kevin Reddington (02:14:28):
Clinical summary. It says, "The case was discussed in rounds." And would that be like on Grey's Anatomy, you have rounds and they see patients in the rooms and that type of thing?
Alia Goodheart (02:14:38):
No.
Kevin Reddington (02:14:39):
No. What does it mean when it says in rounds?
Alia Goodheart (02:14:41):
It's when we meet in the morning, the social worker, the psychiatrist, the nurse, and the charge nurse, the utilization reviewer.
Kevin Reddington (02:14:51):
Okay. So that's why it says on page 63, "Discussed in rounds. SW and PIC met with Lindsay as part of the intake interview," right?
Alia Goodheart (02:15:01):
Yes.
Kevin Reddington (02:15:03):
Okay. "Presenting problem." Then it says HX, that's history, right. "And psychosocial HX, history, was discussed," correct?
Alia Goodheart (02:15:13):
Yes.
Kevin Reddington (02:15:13):
"At that point, she stated that she was hoping to be home by next weekend for her daughter's birthday," right?
Alia Goodheart (02:15:19):
Mm-hmm.
Kevin Reddington (02:15:21):
And that then she relates her history as far as having a third baby on May 26th. That would be Callan, right?
Alia Goodheart (02:15:29):
Yes.
Kevin Reddington (02:15:29):
The youngest baby? And she then told you all that 12 weeks after she delivered, the baby wasn't taking the bottle. Was around the time that she was supposed to go back to work. Husband also went back to work and she was experiencing a lot of... And then someone puts in quotes, "situational anxiety." Is that correct?
Alia Goodheart (02:15:50):
That's what it states.
Kevin Reddington (02:15:51):
All right. So as a result... Is that coming from her, or that word situational anxiety, was that her words because it's in quotes or was that you guys put that in there?
Alia Goodheart (02:16:00):
I didn't write that note.
Kevin Reddington (02:16:01):
Okay. But you factored that in, in your investigation, right?
Alia Goodheart (02:16:05):
I read it.
Kevin Reddington (02:16:08):
Okay. And as a result of this, she subsequently saw a psychiatrist that prescribed her Zoloft, right?
Alia Goodheart (02:16:15):
Yes.
Kevin Reddington (02:16:16):
And that would be Dr. Tufts, right?
Alia Goodheart (02:16:18):
Yes.
Kevin Reddington (02:16:19):
And one week after prescribing that, it says after one week of taking it, that she developed insomnia, correct?
Alia Goodheart (02:16:34):
Yes.
Kevin Reddington (02:16:34):
Okay. So that's an indication of a reaction that the patient had to the medication that was prescribed to her, being the SSRIs, Zoloft, right?
Alia Goodheart (02:16:46):
It could be a side effect, yes.
Kevin Reddington (02:16:47):
Could be. Okay. And the psychiatrist told her to stop taking Zoloft, right?
Alia Goodheart (02:16:55):
That's what it states.
Kevin Reddington (02:16:57):
And do you know from your investigation and your evaluation of Lindsay Clancy, when the doctor told her to stop taking Zoloft? I mean, you can guess, was it like a week later, a couple of days later?
Alia Goodheart (02:17:14):
I don't recall off the top of my head, but if that information was available, it would be in my note.
Kevin Reddington (02:17:21):
Can you find your note in here? I just don't know how to navigate that. Would it help you if you had a break or a little recess just to look at this?
Alia Goodheart (02:17:44):
No.
Kevin Reddington (02:17:51):
No?
Alia Goodheart (02:17:51):
I can find it right now.
Kevin Reddington (02:17:51):
Okay.
Judge (02:17:52):
You know, Mr. Reddington, that's probably not a bad idea. We've been sitting here. We kind of missed that morning recess, so we're going to take that at this point, just a short morning recess. Let all of you kind of stretch your legs a little bit, and then we'll come right back. Okay?
Bailiff (02:18:05):
Court, all rise. Jurors, close your notebooks. Please them on your chairs, please. This way, please.
Alia Goodheart (02:18:27):
You said I can... I should...
Kevin Reddington (02:18:28):
Your Honor, can she have permission to take that and look at it, the exhibit, out of the courtroom?
Judge (02:18:35):
I think it's probably best, if you want to look at it, keep that in the courtroom.
Kevin Reddington (02:18:40):
Yeah. Okay. All right. So you can look at it, but just you'd have to stay in the courtroom.
Alia Goodheart (02:18:43):
Can I get a break?
Kevin Reddington (02:18:44):
Okay. She wants to take a break. As we all do.
Judge (02:18:48):
Leave it here. All right. So we'll be in a short recess. We'll come back. Okay. Thank you.
Bailiff (02:18:52):
All rise.
Speaker 3 (02:18:52):
I've been here every single day [inaudible 02:19:06]
Judge (02:19:06):
The witness back on the stand.
Kevin Reddington (02:19:08):
Your Honor, first of all, I want to raise an issue with you. And I think it's really-
Judge (02:19:13):
Well, why don't we... Come on and go to the side-
Kevin Reddington (02:19:13):
No, I don't want to go to the sidebar. I really don't want to go to the sidebar.
Judge (02:19:16):
I need to know what you're going to talk about before...
Kevin Reddington (02:19:18):
I want to tell you that they got picked up on a hot mic saying, "Shut her up," during the playing of that autopsy.
Judge (02:19:25):
All right. All right.
Kevin Reddington (02:19:28):
This is not like Handmaid's Tales where you're going to tape their mouth up.
Judge (02:19:31):
I'm not doing that at all. I just want to find out what the issue is. There's a lot of privileged issues, and then you can tell me that, and then if-
(02:19:41)
All right. All right. Ready for the jury?
Speaker 4 (02:20:07):
[inaudible 02:20:07].
Judge (02:20:07):
Yeah. Wait a minute.
Alia Goodheart (02:20:11):
Can I keep this here? Judge?
Bailiff (02:20:12):
Court. All rise. Jurors entering. This court's now in session. Please be seated.
Clerk (02:20:56):
Your Honor, for the purpose of the record, we return back to the trial of Commonwealth versus Lindsay Clancy. All parties are present, including the defendant and including the 18 jurors.
Judge (02:21:05):
All right. Mr. Reddington?
Alia Goodheart (02:21:05):
I wanted to find-
Kevin Reddington (02:21:05):
I think it's page 63. I'm pretty sure.
Alia Goodheart (02:21:15):
My note?
Kevin Reddington (02:21:16):
Yes. I believe it's... you look for it. [inaudible 02:21:24] well, you know what [inaudible 02:21:27] don't worry about it. Okay. Doctor, you'd agree with me that your notes are contained in exhibit 79, correct?
Alia Goodheart (02:21:34):
Yes.
Kevin Reddington (02:21:36):
Okay. And one of the things that you had mentioned is that at the end of Lindsay's treatment at your hospital, she was discharged, ultimately, correct?
Alia Goodheart (02:21:48):
Yes.
Kevin Reddington (02:21:48):
And that was not against medical advice, was it?
Alia Goodheart (02:21:52):
No.
Kevin Reddington (02:21:54):
And finally, you had made reference to the fact that postpartum psychosis is a serious consideration for you or your staff when you're evaluating a patient in McLean, correct?
Alia Goodheart (02:22:05):
Yes.
Kevin Reddington (02:22:05):
Postpartum. And one of the recommendations that you made was that she should follow up with other healthcare providers. And if I understand correctly, she actually sent a text or an email or something and confirmed that she did, within the hour, right?
Alia Goodheart (02:22:24):
She made an appointment with Dr. Tufts for the next morning.
Kevin Reddington (02:22:32):
Right. And she told you guys that, right?
Alia Goodheart (02:22:34):
She told the social worker that.
Kevin Reddington (02:22:36):
So she was very responsive to your advice about, "You should reach out to your provider," and she did that, right?
Alia Goodheart (02:22:42):
Yes.
Kevin Reddington (02:22:42):
That's all I have. Thank you.
Judge (02:22:45):
All right. All right. Counsel, redirect?
Jennifer Sprague (02:22:47):
Dr. Goodheart, you're familiar with the discharge paperwork that a patient gets, right?
Alia Goodheart (02:23:05):
Yes.
Jennifer Sprague (02:23:06):
I'm going to show you what's been marked as Exhibit 146. Is that familiar to you?
Alia Goodheart (02:23:14):
Yes.
Jennifer Sprague (02:23:15):
And you know that to be discharge paperwork for... Or what's called the after-visit summary for Lindsay Clancy at her stay from McLean, correct?
Alia Goodheart (02:23:21):
Yes.
Jennifer Sprague (02:23:22):
And in this discharge paperwork, there's actually two packets. So it's pages one of six, and then there's another one, one of seven. You see that?
Alia Goodheart (02:23:31):
Yes.
Jennifer Sprague (02:23:32):
And it gives instructions on if you need immediate help. It gives phone numbers, right?
Alia Goodheart (02:23:37):
Yes.
Jennifer Sprague (02:23:38):
It gives a crisis plan and where to call for the suicide prevention lifeline, right?
Alia Goodheart (02:23:43):
Yes.
Jennifer Sprague (02:23:44):
It gives instructions on what the patient's supposed to do, or what you've talked about as far as what to do as follow-up, right?
Alia Goodheart (02:23:51):
Yes.
Jennifer Sprague (02:23:52):
And in this instance, it says, "What's next? Call Cassandra Wolfson. Give her a call for assistance with finding community behavioral health providers." And that's identified as the Blue Cross Blue Shield case manager, right?
Alia Goodheart (02:24:04):
Yes.
Jennifer Sprague (02:24:05):
And was that based on a conversation that you had with Ms. Clancy about the fact that she wanted a new provider?
Alia Goodheart (02:24:14):
She had a psychiatrist, or a prescriber. She stated that she was going to be assigned a therapist by the individuals at the South Shore. And if she wanted to have more options or more choices, she could always call that person to get more choices.
Jennifer Sprague (02:24:40):
So she was looking for an additional provider?
Alia Goodheart (02:24:43):
Yeah.
Jennifer Sprague (02:24:44):
Okay. And also part of this discharge packet, you see that there's a section that's labeled community services, right?
Alia Goodheart (02:24:52):
Yes.
Jennifer Sprague (02:24:52):
And there are a number of online resources, as well as the direction to contact your primary care physician and insurance company, right?
Alia Goodheart (02:24:59):
Yes.
Jennifer Sprague (02:24:59):
Okay. And so these are resources that were discussed, and told, and available to her when she was discharged from McLean?
Alia Goodheart (02:25:08):
Yes.
Jennifer Sprague (02:25:09):
Now, in addition to the resources that were given at discharge, you're aware she did participate in particular groups that would have given her some information and skills while she was there, right?
Alia Goodheart (02:25:20):
Yes.
Jennifer Sprague (02:25:20):
And those skills were about illness and symptom management, correct?
Alia Goodheart (02:25:25):
Yes.
Jennifer Sprague (02:25:26):
Self-compassion was another one, right?
Alia Goodheart (02:25:28):
Yes.
Kevin Reddington (02:25:28):
I'm going to object. This is beyond the scope of cross, which is I think is a legitimate objection, so.
Judge (02:25:33):
All right. Sustained.
Jennifer Sprague (02:25:41):
Counsel on cross-examination kept referring to the unit at McLean as the locked unit, right?
Alia Goodheart (02:25:49):
Yes.
Jennifer Sprague (02:25:50):
You remember that line of questioning? And fair to say, it is locked for the safety of the patients, right?
Alia Goodheart (02:25:56):
Yes.
Jennifer Sprague (02:25:57):
And in this circumstance with Ms. Clancy, when she arrived from Mass General via ambulance, she voluntarily agreed to be at this locked facility until it was safe for her to leave?
Alia Goodheart (02:26:07):
Yes.
Jennifer Sprague (02:26:08):
Now, when she came in, she was identified, I think you said, as low risk?
Alia Goodheart (02:26:12):
Yes.
Jennifer Sprague (02:26:14):
And at the lowest level of checks, correct?
Alia Goodheart (02:26:17):
Yes.
Jennifer Sprague (02:26:19):
And she was very vocal with you about how long she wanted to stay, and when she wanted to leave?
Alia Goodheart (02:26:24):
Yes.
Jennifer Sprague (02:26:25):
And you respected that, and you worked with her to come up with a plan, correct?
Alia Goodheart (02:26:28):
Yes.
Jennifer Sprague (02:26:29):
And when counsel says she wasn't discharged against medical advice, would you have preferred more time with this patient to assess her symptomology?
Kevin Reddington (02:26:39):
Objection.
Judge (02:26:40):
Overruled.
Alia Goodheart (02:26:43):
I think you're asking me to go back and do-
Jennifer Sprague (02:26:49):
Well, at the time. Let's talk about the time that you had the conversation with her about leaving early.
Alia Goodheart (02:26:55):
Yes. Yes.
Jennifer Sprague (02:26:56):
You said her original plan was to stay till at least Friday, right?
Alia Goodheart (02:27:01):
I think I didn't have a set time on when she would leave. I take it a day at a time, based on how the patient is doing.
Jennifer Sprague (02:27:09):
And at the time that she indicated that she wanted to bump up her discharge to Thursday-
Alia Goodheart (02:27:14):
Yes.
Jennifer Sprague (02:27:14):
... had you had the opportunity to observe her symptoms for more than a day or two?
Alia Goodheart (02:27:19):
Yes.
Jennifer Sprague (02:27:21):
Had you been able to identify if any of the issues that she came in with were resolved?
Alia Goodheart (02:27:30):
Yes.
Jennifer Sprague (02:27:30):
And so she was sleeping better, right?
Alia Goodheart (02:27:33):
Yes.
Jennifer Sprague (02:27:34):
Was there any indication that her mood had vastly improved?
Alia Goodheart (02:27:40):
Her mood had improved. I don't know what you mean by vastly.
Jennifer Sprague (02:27:44):
Well, did you have enough time to get to the root causes of why she was having the insomnia, or why she was feeling numb?
Alia Goodheart (02:27:53):
No.
Jennifer Sprague (02:27:53):
Okay. And so with more time, would that have been something that you could have explored more, at least?
Alia Goodheart (02:27:59):
Yes.
Jennifer Sprague (02:28:03):
And you were asked on cross-examination about asking Lindsay Clancy to sign releases. And you said that you did not do that in this case, correct?
Alia Goodheart (02:28:12):
Yes.
Jennifer Sprague (02:28:13):
With more time with a particular patient, is it possible that you could have determined that you needed that more information and then asked her to sign releases?
Kevin Reddington (02:28:23):
Objection.
Judge (02:28:23):
Sustained.
Jennifer Sprague (02:28:25):
Well, as far as your protocol for asking for releases, is it something that you do with every patient?
Alia Goodheart (02:28:31):
No.
Jennifer Sprague (02:28:32):
What are the circumstances that would lead you to ask for releases to be signed?
Kevin Reddington (02:28:36):
Again, it's outside the scope of cross. Objection.
Judge (02:28:37):
Overruled. I'll allow that.
Alia Goodheart (02:28:42):
It depends on how the patient is presenting, whether they appear reliable, whether their history that they're giving is consistent across different times when they were evaluated. For example, she was evaluated in the emergency department, in the CEC, then on the unit by Dr. Madwa and myself. And also we had obtained collateral information from Patrick. And so I didn't feel like there was any urgent need to obtain the collateral from the other providers. And she was telling us what she liked and what she disliked about what the providers were doing.
Jennifer Sprague (02:29:25):
Okay. And so you were responding to those conversations-
Alia Goodheart (02:29:29):
Yes.
Jennifer Sprague (02:29:29):
... in coming up with a plan?
Alia Goodheart (02:29:30):
Yes.
Jennifer Sprague (02:29:31):
And again, the team is not just you and your team, but also the patient, as well?
Alia Goodheart (02:29:36):
Yes.
Jennifer Sprague (02:29:36):
And during this time period that she was there, in addition to what she was reporting, you were also making observations of her?
Alia Goodheart (02:29:47):
Absolutely.
Jennifer Sprague (02:29:48):
And was there anything inconsistent about what she was reporting, to what your observations of her were?
Alia Goodheart (02:29:52):
No.
Jennifer Sprague (02:29:55):
When she arrived at McLean, you were advised of what medication she had been on, correct?
Alia Goodheart (02:30:04):
Yes.
Jennifer Sprague (02:30:05):
And any of the treatment plans that you or any of your colleagues recommended, did they require different medications?
Alia Goodheart (02:30:16):
I'm not sure I understand your question.
Jennifer Sprague (02:30:18):
Well, you were asked about the blood work.
Alia Goodheart (02:30:25):
Yes.
Jennifer Sprague (02:30:26):
And so you indicated that McLean does draw blood upon admission, right?
Alia Goodheart (02:30:31):
Yes.
Jennifer Sprague (02:30:31):
But that you did not look at the blood work, or ask, or evaluate it for levels of medications?
Alia Goodheart (02:30:37):
Correct.
Jennifer Sprague (02:30:38):
Was there any reason to do that, based on the medication regimen that you were advised that she had been on?
Alia Goodheart (02:30:42):
No.
Jennifer Sprague (02:30:43):
And with your treatment plan as far as medication, would there have been a reason to do that, to either verify or not verify that she already had things in her system?
Alia Goodheart (02:30:51):
No.
Jennifer Sprague (02:30:58):
You were asked on cross-examination about the defendant reporting that she complained of brain fog or being foggy. Do you recall that?
Alia Goodheart (02:31:06):
Yes.
Jennifer Sprague (02:31:07):
Do you also recall that she was observed by nurses to have improved memory and improved concentration, excuse me, over the time that she had been at McLean?
Alia Goodheart (02:31:20):
Yes.
Jennifer Sprague (02:31:29):
You were asked on cross-examination about suicide hotline and-
Alia Goodheart (02:31:34):
Yes.
Jennifer Sprague (02:31:35):
Are you familiar with suicide hotlines?
Alia Goodheart (02:31:37):
Yes.
Jennifer Sprague (02:31:38):
And what do they assess for when you call one?
Alia Goodheart (02:31:43):
Imminent, I mean, risk. And if somebody's calling and they're feeling suicidal, I think the point is for them to send somebody or to help them through it.
Jennifer Sprague (02:31:55):
So it's a point of intervention, correct?
Alia Goodheart (02:31:57):
Correct.
Jennifer Sprague (02:31:58):
But in order for a person to receive intervention, they have to identify that they have an intent or a plan?
Alia Goodheart (02:32:05):
Yes.
Jennifer Sprague (02:32:06):
And to your knowledge, based on your experience and your conversations with this particular patient, did she ever indicate that she ever said she had a plan?
Alia Goodheart (02:32:15):
No.
Jennifer Sprague (02:32:23):
You were asked some questions about the DSM-5, and I actually have a big version of the most recent version, the DSM-5 TR, meaning text revision. You're familiar with this book?
Alia Goodheart (02:32:35):
Thank you for clarifying that. Yes.
Jennifer Sprague (02:32:38):
And counsel asked you some questions about postpartum depression and postpartum psychosis, and whether they appear here in the DSM-5.
Alia Goodheart (02:32:48):
Yes.
Jennifer Sprague (02:32:49):
Do you recall that line of questioning? And fair to say they do appear, they're not their own category, correct?
Alia Goodheart (02:32:54):
Yes.
Jennifer Sprague (02:32:55):
But they do appear in conversation of bipolar disorder, bipolar disorder one, having major depressive symptoms or episodes, as well as psychosis?
Alia Goodheart (02:33:09):
Yes.
Jennifer Sprague (02:33:11):
And it's very brief mention, but it's in here. Is that correct?
Alia Goodheart (02:33:16):
Yes.
Jennifer Sprague (02:33:21):
Okay. And as a psychiatrist, this is just a tool that you could use?
Alia Goodheart (02:33:27):
Yes.
Jennifer Sprague (02:33:27):
What other things do you rely upon when making a diagnosis other than a tool like this?
Alia Goodheart (02:33:34):
Observation of the patient, the history that they're relating, the information from family and other... That's essentially it. And other records if available.
Jennifer Sprague (02:33:52):
Okay. And you use that information based on your own training and experience-
Alia Goodheart (02:33:57):
Yes.
Jennifer Sprague (02:33:57):
... to come up with a diagnosis?
Alia Goodheart (02:33:59):
Yes.
Jennifer Sprague (02:33:59):
And your diagnosis, does that have to agree with anyone else?
Alia Goodheart (02:34:03):
No.
Jennifer Sprague (02:34:04):
And when you're treating a patient that comes before you for help at McLean, you're treating the patient in front of you, or you're treating the patient from several months ago?
Alia Goodheart (02:34:14):
You take the history into consideration, but you're treating the patient in front of you because that's the presentation.
Jennifer Sprague (02:34:21):
Thank you. I have no further questions.
Judge (02:34:23):
All right. Mr. Reddington?
Kevin Reddington (02:34:24):
No, thank you. Thank you, Judge.
Judge (02:34:27):
All right. Thank you, Doctor.
Alia Goodheart (02:34:27):
Thank you.
Prosecutor 2 (02:34:35):
Commonwealth calls Dr. Jennifer Tufts.
Bailiff (02:34:36):
Good afternoon, ma'am.
Dr. Jennifer Tufts (02:34:36):
Good afternoon.
Bailiff (02:34:36):
Can you stop right here and raise your right hand for the clerk, please?
Clerk (02:36:01):
Good afternoon. Do you solemnly swear that the testimony of the evidence you shall give to the court and the jury in the matter now coming between the Commonwealth and the defendant shall be the truth, the whole truth, and nothing but the truth, so help you God?
Dr. Jennifer Tufts (02:36:06):
Yes.
Clerk (02:36:08):
Thank you, ma'am. You may have a seat.
Bailiff (02:36:10):
Watch your step here.
Judge (02:36:14):
All right. Good afternoon, doctor.
Dr. Jennifer Tufts (02:36:16):
Good afternoon.
Judge (02:36:17):
I'd ask you to keep your voice up and speak into that microphone. All right?
Dr. Jennifer Tufts (02:36:19):
Okay.
Judge (02:36:22):
Counsel.
Prosecutor 2 (02:36:22):
Thank you, Your Honor. Good afternoon. Can you please state and spell your name for the record?
Dr. Jennifer Tufts (02:36:26):
Jennifer Tufts. J-E-N-N- I-F-E-R T-U-F-T-S.
Prosecutor 2 (02:36:33):
Your date of birth?
Dr. Jennifer Tufts (02:36:34):
December 31st, 1989.
Prosecutor 2 (02:36:38):
Where do you work?
Dr. Jennifer Tufts (02:36:39):
Aster Mental Health.
Prosecutor 2 (02:36:41):
And how long have you worked there?
Dr. Jennifer Tufts (02:36:43):
For three and a half years.
Prosecutor 2 (02:36:45):
What is your role there?
Dr. Jennifer Tufts (02:36:47):
I'm a psychiatrist.
Prosecutor 2 (02:36:49):
And how long have you been a psychiatrist?
Dr. Jennifer Tufts (02:36:52):
I've been officially a fully licensed psychiatrist for close to four years.
Prosecutor 2 (02:37:00):
I want to ask you if you could just explain to us your educational background and your training background that qualifies you to be a psychiatrist.
Dr. Jennifer Tufts (02:37:08):
Absolutely. So I went to medical school at University of Vermont, graduated in 2018 with an MD. I did a postgraduate training in psychiatry at Boston Medical Center. That was four years, going into 2022. And then I began working at Aster Mental Health in 2022.
Prosecutor 2 (02:37:34):
And are you a licensed psychiatrist in Massachusetts?
Dr. Jennifer Tufts (02:37:37):
Yes.
Prosecutor 2 (02:37:40):
While you were working at Aster Mental Health, did you have a patient named Lindsay Clancy?
Dr. Jennifer Tufts (02:37:45):
Yes.
Prosecutor 2 (02:37:47):
And at this time, Your Honor, I'd move to submit the records of Lindsay Clancy for Aster Mental Health as the next exhibit.
Judge (02:37:53):
Okay. They may be admitted.
Prosecutor 2 (02:38:09):
[inaudible 02:37:59] Do you recall when you first saw Lindsay Clancy as a patient?
Dr. Jennifer Tufts (02:38:13):
Yes.
Prosecutor 2 (02:38:14):
When was that?
Dr. Jennifer Tufts (02:38:16):
It was in September of 2022.
Prosecutor 2 (02:38:20):
And was that first appointment on September 15th, 2022?
Dr. Jennifer Tufts (02:38:25):
I believe that it was.
Prosecutor 2 (02:38:27):
And prior to a patient coming in for their first appointment, is there paperwork that they fill out, either online or that's provided to them to fill out?
Dr. Jennifer Tufts (02:38:39):
Yes.
Prosecutor 2 (02:38:39):
And what type of paperwork is that?
Dr. Jennifer Tufts (02:38:42):
It's fairly extensive. It includes past health history, past psychiatric history, medications they have taken in the past. It includes names of any therapists or other doctors they work with, usually primary care. It includes any report of substances that they may use, or may have used in the past. It includes a number of scales, so scales assessing things like anxiety, depression, ADHD. So it's a fairly lengthy document.
Prosecutor 2 (02:39:23):
Are you aware that Lindsay Clancy filled out those documents on September 12th, 2022, three days prior to her first appointment?
Dr. Jennifer Tufts (02:39:31):
Yes.
Prosecutor 2 (02:39:32):
And did you have an opportunity to review what Lindsay filled out prior to meeting with her for that first appointment?
Dr. Jennifer Tufts (02:39:38):
Yes.
Prosecutor 2 (02:39:39):
Okay. And do you recall what you learned from those documents about her prior mental health treatment?
Dr. Jennifer Tufts (02:39:47):
Yes.
Prosecutor 2 (02:39:47):
What was that?
Dr. Jennifer Tufts (02:39:49):
That she had previously taken some medication. I believe it was in nursing school. It may have been fairly brief, but she had tried the medication Prozac.
Prosecutor 2 (02:40:03):
Do you recall that she also listed that she had tried Wellbutrin as well while she was on the Prozac?
Dr. Jennifer Tufts (02:40:10):
That was listed as well.
Prosecutor 2 (02:40:12):
Okay. And do you recall that when she listed that she took the Prozac and the Wellbutrin while in nursing school, she listed that she had no side effects from those medications?
Dr. Jennifer Tufts (02:40:22):
That is correct.
Prosecutor 2 (02:40:23):
Prozac, is that an SSRI?
Dr. Jennifer Tufts (02:40:26):
Yes.
Prosecutor 2 (02:40:26):
Okay. So Lindsay reported that she had previously taken an SSRI while in nursing school with no side effects, correct?
Dr. Jennifer Tufts (02:40:34):
Correct.
Prosecutor 2 (02:40:38):
Did she also report that she had no history of any kind of abuse that had occurred to her at any point in her life?
Dr. Jennifer Tufts (02:40:44):
Correct.
Prosecutor 2 (02:40:46):
What did she report in regards to alcohol consumption?
Dr. Jennifer Tufts (02:40:51):
I believe she reported one to two drinks at a time and possibly up to five times a week.
Prosecutor 2 (02:41:00):
And is there a portion, when the patient fills that in how much they drink, is there a question there about whether they feel guilty about that?
Dr. Jennifer Tufts (02:41:10):
Yes.
Prosecutor 2 (02:41:11):
And what was her response?
Dr. Jennifer Tufts (02:41:13):
Am I allowed to go check that just to make sure?
Prosecutor 2 (02:41:15):
Is there an objection to her reviewing the records?
Kevin Reddington (02:41:17):
Nope.
Prosecutor 2 (02:41:17):
Yes.
Dr. Jennifer Tufts (02:41:36):
She indicated yes.
Prosecutor 2 (02:41:38):
And so in that section, is it correct that she listed that she was drinking five times per week and feeling guilty at that time about it?
Dr. Jennifer Tufts (02:41:47):
Yes.
Prosecutor 2 (02:41:50):
And did she list her height as five foot six in those documents? I believe on that same page, page 20?
Dr. Jennifer Tufts (02:42:01):
Yes.
Prosecutor 2 (02:42:04):
Now, did that initial survey or questionnaire that she filled out get into what symptoms she was experiencing at the time?
Dr. Jennifer Tufts (02:42:12):
Yes.
Prosecutor 2 (02:42:12):
And what symptoms did she report experiencing at that time?
Dr. Jennifer Tufts (02:42:28):
Anxiety attacks, decreased appetite, depressed mood, easily distracted, excessive worry, guilt, unable to feel pleasure, unable to fall asleep, and racing thoughts.
Prosecutor 2 (02:42:44):
And would it be fair to say that there's a checklist of symptoms and the patient checks off which ones they're experiencing, correct?
Dr. Jennifer Tufts (02:42:51):
Yes.
Prosecutor 2 (02:42:52):
And so on that list, engage in risky behaviors, that was not checked off, correct?
Dr. Jennifer Tufts (02:42:59):
Correct.
Prosecutor 2 (02:43:00):
And excessive energy wasn't checked off, correct?
Dr. Jennifer Tufts (02:43:03):
Correct.
Prosecutor 2 (02:43:04):
Feelings of hopelessness, feelings of abandonment, feelings of emptiness, none of those were checked off, correct?
Dr. Jennifer Tufts (02:43:09):
Correct.
Prosecutor 2 (02:43:12):
Impulsive behavior, that was not checked off, correct?
Dr. Jennifer Tufts (02:43:15):
Correct.
Prosecutor 2 (02:43:19):
Now, was there also a suicide risk assessment form that Ms. Clancy filled out?
Dr. Jennifer Tufts (02:43:25):
Yes.
Prosecutor 2 (02:43:26):
And what is a suicide risk assessment?
Dr. Jennifer Tufts (02:43:30):
Well, it assesses various factors that may increase a person's risk of committing suicide.
Prosecutor 2 (02:43:39):
And the form that Ms. Clancy filled out, the first question is, "Have you been so distressed you seriously wish to end your life?" And her response was no, correct?
Dr. Jennifer Tufts (02:43:51):
I'm just looking for it now.
Prosecutor 2 (02:43:56):
Page 23.
Dr. Jennifer Tufts (02:43:56):
Correct.
Prosecutor 2 (02:43:57):
And the second question is, "Has anything happened recently to make you feel you don't want to live?" And her answer was no, correct?
Dr. Jennifer Tufts (02:44:03):
Correct.
Prosecutor 2 (02:44:05):
There's question three, "A specific plan. Do you have a specific plan of how you would kill yourself?" And her answer was no, correct?
Dr. Jennifer Tufts (02:44:12):
Correct.
Prosecutor 2 (02:44:14):
Fourth question is, "Access to weapons or means of hurting yourself?" And the answer is no, correct?
Dr. Jennifer Tufts (02:44:20):
Correct.
Prosecutor 2 (02:44:22):
The fifth question is, "Made a serious suicide attempt," and the answer was no, correct?
Dr. Jennifer Tufts (02:44:26):
Correct.
Prosecutor 2 (02:44:27):
The sixth question, "Purposely done something to hurt yourself." Again, no, correct?
Dr. Jennifer Tufts (02:44:31):
Correct.
Prosecutor 2 (02:44:33):
Seventh question, "Heard voices telling you to hurt yourself?" Her answer was no, correct?
Dr. Jennifer Tufts (02:44:38):
Correct.
Prosecutor 2 (02:44:41):
Number nine, "Having thoughts of killing or seriously hurting someone else?" The answer was no, correct?
Dr. Jennifer Tufts (02:44:47):
Correct.
Prosecutor 2 (02:44:48):
Number 10, "Heard voices telling you to hurt others." The answer was no, correct?
Dr. Jennifer Tufts (02:44:54):
Correct.
Prosecutor 2 (02:44:56):
"Hurt someone or destroyed property on purpose," the answer was no, correct?
Dr. Jennifer Tufts (02:44:59):
Correct.
Prosecutor 2 (02:45:02):
In fact, the answer-
Prosecutor 2 (02:45:02):
In fact, the answers to every question on this suicide checklist was no, correct?
Dr. Jennifer Tufts (02:45:11):
Correct.
Prosecutor 2 (02:45:16):
Was there also a substance use assessment form that was filled out on page 24?
Dr. Jennifer Tufts (02:45:20):
Yes.
Prosecutor 2 (02:45:21):
And there were no issues with substance use, correct?
Dr. Jennifer Tufts (02:45:25):
Correct.
Prosecutor 2 (02:45:31):
Is there also an ADHD self-report scale that's filled out?
Dr. Jennifer Tufts (02:45:39):
There usually is.
Prosecutor 2 (02:45:40):
Direct you to page 25. Okay. And ADHD, is that attention deficit hyperactive disorder?
Dr. Jennifer Tufts (02:45:59):
Yes.
Prosecutor 2 (02:46:00):
And given the answers that Ms. Clancy gave on that self-reporting form, were there any concerns about attention deficit hyperactive disorder?
Dr. Jennifer Tufts (02:46:10):
Not significantly.
Prosecutor 2 (02:46:12):
Were there any concerns at all?
Dr. Jennifer Tufts (02:46:14):
Well, she reported often to some of the questions, yes.
Prosecutor 2 (02:46:20):
And is that significant to you based on your training and experience?
Dr. Jennifer Tufts (02:46:25):
You have to look at this form within the entire picture of the patient. So, no, I didn't suspect that Lindsay had ADHD.
Prosecutor 2 (02:46:36):
So, these forms are a tool and you used them together along with your observations of the patient to come to conclusions, is that correct?
Dr. Jennifer Tufts (02:46:44):
Yes.
Prosecutor 2 (02:46:47):
There was also a, I believe it's entitled a GAD screening. Is that generalized anxiety disorder?
Dr. Jennifer Tufts (02:46:54):
Yes.
Prosecutor 2 (02:46:54):
Okay. And did Ms. Clancy fill that out as well? Page 27.
Dr. Jennifer Tufts (02:47:08):
Sorry, my pages are a little bit different than yours.
Prosecutor 2 (02:47:10):
Oh, I apologize.
Dr. Jennifer Tufts (02:47:11):
I'll find it. Okay.
Prosecutor 2 (02:47:30):
Ms. Clancy's answers to these questions, did they give you cause for concern based on your training and experience?
Dr. Jennifer Tufts (02:47:39):
They were highly suggestive of anxiety and anxiety disorder.
Prosecutor 2 (02:47:44):
And for example, number one, feeling nervous, anxious, or on edge, she responded nearly every day, correct?
Dr. Jennifer Tufts (02:47:50):
Correct.
Prosecutor 2 (02:47:52):
Not being able to stop or control worrying, she answered nearly every day, correct?
Dr. Jennifer Tufts (02:47:56):
Yes.
Prosecutor 2 (02:47:57):
And so, several of these questions were either nearly every day or several days, correct?
Dr. Jennifer Tufts (02:48:02):
Yes.
Judge William F. Sullivan (02:48:03):
I apologize. Can I just ask what page that are?
Prosecutor 2 (02:48:04):
27. And then, is there also a patient questionnaire that the patient fills out? I think it's-
Dr. Jennifer Tufts (02:48:25):
Yes, I believe so. Yes.
Prosecutor 2 (02:48:26):
And what is the purpose of this patient questionnaire?
Dr. Jennifer Tufts (02:48:37):
I'm not sure exactly which one you're referring to, it might be the one that asks about things like, whether the symptoms affect their daily living, what their history is... Is that what you're looking at?
Prosecutor 2 (02:48:52):
It's entitled, Tools-PHQ-9 Patient Questionnaire. And the date is 09/12.
Judge William F. Sullivan (02:48:59):
If you want to go over and show her.
Dr. Jennifer Tufts (02:49:01):
Are you able to? Thank you.
Prosecutor 2 (02:49:01):
Yes.
Dr. Jennifer Tufts (02:49:01):
Okay. Yes.
Prosecutor 2 (02:49:14):
So, this form that's entitled, PHQ-9 Patient Questionnaire, what is the purpose of that form?
Dr. Jennifer Tufts (02:49:19):
It's a screening tool for depression.
Prosecutor 2 (02:49:21):
Okay. And can you talk about the defendant's answers to those questions and what they told you based on your training and experience?
Dr. Jennifer Tufts (02:49:32):
Well, some of the answers were positive, so that really indicates that she should be assessed for depression. She might have it.
Prosecutor 2 (02:49:40):
Okay. And when you say positive, what do you mean by positive?
Dr. Jennifer Tufts (02:49:47):
So, for example, she said for number two, feeling down, depressed, and hopeless more than half of the days, a positive response means indicating yes.
Prosecutor 2 (02:50:00):
So, it's not a positive happy response, it's a positive this might be an issue response?
Dr. Jennifer Tufts (02:50:04):
Yes.
Prosecutor 2 (02:50:08):
And that's, the next form, A1, Initial Diagnostic Assessment...
Dr. Jennifer Tufts (02:50:23):
Yes.
Prosecutor 2 (02:50:25):
There is a place there again... Well, this is for September 15th, the day you actually met her, correct?
Dr. Jennifer Tufts (02:50:32):
Yes.
Prosecutor 2 (02:50:32):
So, the patient fills out the forms in advance of meeting with you, do they then again fill out the forms when they meet with you?
Dr. Jennifer Tufts (02:50:40):
No, these are the same forms.
Prosecutor 2 (02:50:41):
Same forms, just a different date on them?
Dr. Jennifer Tufts (02:50:44):
Yes, because they're included in the intake note, which is what I write, but some of the information is from the patient's self-report.
Prosecutor 2 (02:50:53):
Okay. So, would it be a combination of the forms they fill out and then what you observe and ask about during your initial meeting?
Dr. Jennifer Tufts (02:51:00):
Yes.
Prosecutor 2 (02:51:01):
And that initial meeting with Ms. Clancy, was that in person or was that a telehealth?
Dr. Jennifer Tufts (02:51:05):
Telehealth.
Prosecutor 2 (02:51:06):
Okay. Who controls whether it's an in-person meeting or a telehealth, you or the patient?
Dr. Jennifer Tufts (02:51:13):
Both.
Prosecutor 2 (02:51:14):
Both. And if a patient told you, "I don't want to do telehealth, I only want to do in person," is that an option?
Speaker 5 (02:51:20):
Objection.
Dr. Jennifer Tufts (02:51:20):
Yes.
Speaker 5 (02:51:20):
[inaudible 02:51:23].
Judge William F. Sullivan (02:51:22):
Go ahead.
Dr. Jennifer Tufts (02:51:23):
Sorry.
Judge William F. Sullivan (02:51:23):
I'll let that stand.
Prosecutor 2 (02:51:27):
And can you just tell us, when you met with Ms. Clancy on that first day, did you ask her questions such as, "Do you have suicidal intent?"
Dr. Jennifer Tufts (02:51:44):
Yes.
Prosecutor 2 (02:51:45):
What was her response?
Dr. Jennifer Tufts (02:51:46):
That she did not.
Prosecutor 2 (02:51:47):
Did you ask her if she had homicidal intent?
Dr. Jennifer Tufts (02:51:50):
Yes.
Prosecutor 2 (02:51:50):
What was her response?
Dr. Jennifer Tufts (02:51:52):
She did not.
Prosecutor 2 (02:51:53):
Did you ask her if she was experiencing any auditory hallucinations or visual hallucinations?
Dr. Jennifer Tufts (02:51:59):
Yes.
Prosecutor 2 (02:52:00):
What was her response?
Dr. Jennifer Tufts (02:52:01):
She did not.
Prosecutor 2 (02:52:03):
Did you ask her questions to determine if she was experiencing any symptoms of mania?
Dr. Jennifer Tufts (02:52:08):
Yes.
Prosecutor 2 (02:52:09):
What types of questions you asked to determine that?
Dr. Jennifer Tufts (02:52:13):
Well, a lot of it can be assessed without asking, but questions may look like, "Have you ever had a period of time in your life where you were excessively energetic and euphoric?" I might leave it there and then follow up with some of the other symptoms.
Prosecutor 2 (02:52:33):
Did any of the questions you asked Ms. Clancy related to mania or manic episodes, did any of her answers to those questions indicate that she had experienced mania or manic episodes?
Dr. Jennifer Tufts (02:52:46):
No.
Prosecutor 2 (02:52:57):
Now, in that first meeting, what's your exam process? How do you start the meeting and how does it flow?
Dr. Jennifer Tufts (02:53:06):
Sure. So, I start the meeting by introducing myself, explaining what we're going to be doing for the day, then I ask the patient why they're there. We talk about why they're there, I assess for different mood symptoms, anxiety symptoms, psychosis symptoms, mania symptoms, safety concerns. Then we start talking about the history, we start talking about the past psychiatric history, the past medical history, substance use. We start talking about other medicines that they have tried in the past or may still be taking. And it's not always in that order, but that's the general order, sometimes things come up sooner. And we talk a bit about what the patient's goals are, what they're looking for in this time period, and then I may give some of my recommendations.
Prosecutor 2 (02:54:15):
And did you follow that process for that initial meeting with Lindsay Clancy?
Dr. Jennifer Tufts (02:54:19):
Yes.
Prosecutor 2 (02:54:20):
Now, you mentioned that part of the initial evaluation is looking for signs of psychosis, is that correct?
Dr. Jennifer Tufts (02:54:28):
Yes.
Prosecutor 2 (02:54:29):
What types of things are you looking for to see if someone's experiencing psychosis?
Dr. Jennifer Tufts (02:54:33):
So, there are a number of things. They start with how the patient appears, so some signs of psychosis might be that they appear disheveled. I assess what their attitude is, if they might be agitated or very uncooperative, that's a red flag. I will assess what their speech is like. Is it very loud? Is it very fast? Or sometimes it could be the opposite where they're not really even speaking at all. I assess what their mood is like, what they're saying that they're feeling and how they appear visually. I assess what their thoughts are like. So, are their thoughts disorganized where it's really hard to understand, they're jumping around and you can't follow their line of though. I assess what the thought content is. If it's particularly about anything very bizarre or very paranoid, that would be potentially indicative of psychosis.
Prosecutor 2 (02:55:45):
And you conducted that type of evaluation on Lindsay Clancy in that first meeting, is that correct?
Dr. Jennifer Tufts (02:55:50):
Yes, that assessment is done with every patient.
Prosecutor 2 (02:55:53):
And did you note any signs or symptoms of psychosis with Ms. Clancy that day?
Dr. Jennifer Tufts (02:55:59):
No.
Prosecutor 2 (02:56:00):
Do you also, in addition to the observations you're making of the patient that day, are you also asking questions about their past behavior and things that have happened to them in the past that might indicate whether psychosis is an issue?
Dr. Jennifer Tufts (02:56:16):
Yes.
Prosecutor 2 (02:56:17):
And what types of things are you asking them about their past?
Dr. Jennifer Tufts (02:56:20):
Well, I may ask, "Have you ever heard voices? Have you ever seen something that other people didn't see?"
Prosecutor 2 (02:56:27):
And did you ask those questions of Ms. Clancy?
Dr. Jennifer Tufts (02:56:31):
I believe I did.
Prosecutor 2 (02:56:32):
And what was her response?
Dr. Jennifer Tufts (02:56:33):
No.
Prosecutor 2 (02:56:40):
As part of this evaluation, are you making an assessment about the patient's judgment and insight?
Dr. Jennifer Tufts (02:56:47):
Yes.
Prosecutor 2 (02:56:47):
And when we talk about psychiatry, what are we talking about when we say judgment?
Dr. Jennifer Tufts (02:56:53):
So, judgment indicates their decision-making process and whether it is a logical decision-making process or perhaps not.
Prosecutor 2 (02:57:06):
And same question in terms of insight, what does that mean in psychiatry when you're assessing their insight?
Dr. Jennifer Tufts (02:57:12):
So, that's more about a patient's awareness, both of their inner feelings, as well as mental health a bit more broadly.
Prosecutor 2 (02:57:23):
And in terms of orientation, when you're assessing a patient, what does that mean?
Dr. Jennifer Tufts (02:57:29):
Orientation is awareness of where someone is, who someone is, what day it is, what's going on.
Prosecutor 2 (02:57:38):
And based on your evaluation of Lindsay Clancy that first day, September 15th, 2022, did she appear to have any issues with judgment, insight or orientation?
Dr. Jennifer Tufts (02:57:48):
No.
Prosecutor 2 (02:57:52):
Do you also assess the patient's memory?
Dr. Jennifer Tufts (02:57:56):
Yes.
Prosecutor 2 (02:57:57):
And how do you do that?
Dr. Jennifer Tufts (02:57:58):
Well, it depends. Often, unless there is a specific concern about memory or dementia, it's based off of my conversation with them. Are they able to recall medications that they have taken? Are they able to recall things that they have done with a lot of detail and specificity?
Prosecutor 2 (02:58:21):
And did there appear to be any issues with Lindsay Clancy's memory in your evaluation of her?
Dr. Jennifer Tufts (02:58:25):
No.
Prosecutor 2 (02:58:26):
And what about attention and concentration, what are you looking for as a psychiatrist when evaluating attention and concentration?
Dr. Jennifer Tufts (02:58:34):
I'm looking for whether they're paying attention to the conversation, if they can follow it, or maybe if they get distracted, it seems like they're not listening, something like that.
Prosecutor 2 (02:58:47):
Did Lindsay Clancy appear to have any issues with attention or concentration?
Dr. Jennifer Tufts (02:58:51):
No.
Prosecutor 2 (02:58:53):
There was something in the records called, "Fund of knowledge," what does that mean?
Dr. Jennifer Tufts (02:58:59):
So, basis of knowledge. What someone understands about the world. So, maybe if somebody has a very low education, they might have a low fund of knowledge.
Prosecutor 2 (02:59:14):
And was there any issue with Lindsay Clancy's fund of knowledge?
Dr. Jennifer Tufts (02:59:18):
No.
Prosecutor 2 (02:59:19):
Are you also assessing mood?
Dr. Jennifer Tufts (02:59:21):
Yes.
Prosecutor 2 (02:59:22):
And how do you assess the mood of a patient, and why do you assess it?
Dr. Jennifer Tufts (02:59:27):
Well, it's very important, the mood is based on what the patient says, what they say about how they're feeling.
Prosecutor 2 (02:59:37):
Okay. And so, are there circumstances where a patient might say they're feeling happy, but you make observations that they appear depressed?
Dr. Jennifer Tufts (02:59:47):
Yes.
Prosecutor 2 (02:59:48):
Okay. And so, when we see mood in the records, that refers to how the patient is reporting their mood is?
Dr. Jennifer Tufts (02:59:56):
Yes.
Prosecutor 2 (02:59:57):
So, if it says appropriate mood and affect, or actually, if it says patient description of their emotional state, it says okay, does that mean the patient said okay?
Dr. Jennifer Tufts (03:00:06):
Yes.
Prosecutor 2 (03:00:07):
Is there a place in the record where you describe what your observations of the mood are?
Dr. Jennifer Tufts (03:00:13):
That's the affect.
Prosecutor 2 (03:00:14):
Affect. Okay. And so affect is how the patient presents?
Dr. Jennifer Tufts (03:00:19):
Yes.
Prosecutor 2 (03:00:20):
This first meeting with Lindsay, what was her mood?
Dr. Jennifer Tufts (03:00:24):
It was okay.
Prosecutor 2 (03:00:26):
And what was her affect?
Dr. Jennifer Tufts (03:00:28):
Anxious.
Prosecutor 2 (03:00:29):
So, she was reporting to you she felt okay, you were seeing she looked a little anxious?
Dr. Jennifer Tufts (03:00:35):
Yes.
Prosecutor 2 (03:00:41):
Or what is it about a person that tells you they look anxious? What were you seeing with Lindsay Clancy that told you she looked anxious?
Dr. Jennifer Tufts (03:00:49):
It's hard to recall exactly what she seemed like, sometimes a person might look anxious, I-
Speaker 5 (03:00:58):
Sometimes, your Honor.
Judge William F. Sullivan (03:00:59):
All right. Sustained.
Prosecutor 2 (03:01:02):
In your general observations of patients, what things would you look for in a patient to determine whether their affect is anxious?
Dr. Jennifer Tufts (03:01:11):
Is their voice quivering? Are they shaking a little bit? Do they appear very nervous?
Prosecutor 2 (03:01:22):
And what is psychomotor behavior?
Dr. Jennifer Tufts (03:01:26):
So, psychomotor behavior refers to someone's body and their movements, so sometimes that can be abnormal.
Prosecutor 2 (03:01:39):
Okay. And did you notice anything abnormal about Lindsay Clancy's psychomotor behavior?
Dr. Jennifer Tufts (03:01:44):
No.
Prosecutor 2 (03:01:46):
This first meeting, was that approximately 40 minutes?
Dr. Jennifer Tufts (03:01:50):
It was a little bit longer than that, maybe 50 to 60 minutes.
Prosecutor 2 (03:01:55):
Is that typical for that first meeting where you're doing this initial assessment?
Dr. Jennifer Tufts (03:01:59):
Yes.
Prosecutor 2 (03:02:00):
And did she appear alone in that virtual meeting or was she with anyone?
Dr. Jennifer Tufts (03:02:06):
Alone.
Prosecutor 2 (03:02:07):
And what are treatment modality and interventions? In general.
Dr. Jennifer Tufts (03:02:19):
So, that section is referring to therapy treatment modalities, it's not asking about medications. So, different forms of therapy that might be done in the session.
Prosecutor 2 (03:02:34):
And what would be treatment goals?
Dr. Jennifer Tufts (03:02:40):
Goals that we are working on or will plan to work on since this is only the first visit.
Prosecutor 2 (03:02:46):
So, how do you determine for an individual patient the treatment modality or interventions that are needed?
Dr. Jennifer Tufts (03:02:54):
It depends on the patient.
Prosecutor 2 (03:02:55):
So, basically on what you're seeing, what you're hearing, and the history they provide?
Dr. Jennifer Tufts (03:03:01):
Yes.
Prosecutor 2 (03:03:01):
And how do you determine treatment goals?
Dr. Jennifer Tufts (03:03:05):
So, a lot of that is driven by what the patient's goals are.
Prosecutor 2 (03:03:10):
And you mentioned earlier that as part of your evaluation, you asked the patient why they've come to you, what they're concerned about. Do you recall Lindsay's response to that question, why she was there, what she was concerned about?
Dr. Jennifer Tufts (03:03:24):
I believe her biggest concern was about anxiety.
Prosecutor 2 (03:03:29):
And what was the treatment modality or interventions that you determined would be needed for Lindsay Clancy based on this initial evaluation?
Dr. Jennifer Tufts (03:03:42):
So, I recommended a medication, sertraline, as well as individual therapy.
Prosecutor 2 (03:03:48):
And the medication sertraline, is that Zoloft?
Dr. Jennifer Tufts (03:03:51):
Yes.
Prosecutor 2 (03:03:52):
Okay. And when you say you recommended the Zoloft to her, was that you telling her you have to take this medication or did you have a discussion about it?
Dr. Jennifer Tufts (03:04:04):
A discussion.
Prosecutor 2 (03:04:05):
And during that discussion, did you get the patient, Ms. Clancy's, input on whether she wanted to take the medication or what her thoughts were about the medication?
Dr. Jennifer Tufts (03:04:16):
Yes.
Prosecutor 2 (03:04:16):
And do you recall the details of that conversation with her?
Dr. Jennifer Tufts (03:04:21):
I recall that she was generally reluctant to take medications, but at this point she was considering it, and was interested in learning about what medications might be helpful for her.
Prosecutor 2 (03:04:37):
And as part of that discussion, did you explain what the medication was and the side effects and all of that?
Dr. Jennifer Tufts (03:04:44):
Yes.
Prosecutor 2 (03:04:45):
And did she have any questions for you based on your explanation of what the medication was for and what the side effects could be?
Dr. Jennifer Tufts (03:04:52):
I'm not sure.
Prosecutor 2 (03:04:54):
And why did you recommend that particular medication?
Dr. Jennifer Tufts (03:04:58):
So, it's a first line medication used for treating anxiety disorders, it also is a first line treatment when women are breastfeeding, it's the safest SSRI for babies.
Prosecutor 2 (03:05:13):
And when you say a first line medication, what does that mean?
Dr. Jennifer Tufts (03:05:16):
It just means it's one of the medications that is recommended first. Sometimes you have to try a number of different medications, but that is often a first choice.
Prosecutor 2 (03:05:30):
And is that based on studies and the experience of the psychiatric profession?
Dr. Jennifer Tufts (03:05:35):
Yes.
Prosecutor 2 (03:05:39):
What was the dosage that you recommended or prescribed for her for the Zoloft?
Dr. Jennifer Tufts (03:05:44):
25 milligrams.
Prosecutor 2 (03:05:46):
And were there instructions on the prescription in terms of how many milligrams to take the first week and then how many to take the second week?
Dr. Jennifer Tufts (03:05:55):
Yes, it was 25 milligrams for one week and then increasing to 50 milligrams.
Prosecutor 2 (03:06:02):
And that was your initial prescription and what should have been on the pill bottle, correct?
Dr. Jennifer Tufts (03:06:06):
Yes.
Prosecutor 2 (03:06:07):
Was there ever a call from the defendant where she called you and said that she was having trouble with the 25 milligrams and you recommended her go to the 50 milligrams?
Dr. Jennifer Tufts (03:06:20):
No.
Prosecutor 2 (03:06:24):
You said you also recommended therapy, is that correct?
Dr. Jennifer Tufts (03:06:27):
Yes.
Prosecutor 2 (03:06:28):
And Astra Mental Health, did they have therapists on staff that you referred Ms. Clancy to?
Dr. Jennifer Tufts (03:06:35):
Yes.
Prosecutor 2 (03:06:36):
And do you know if she took advantage of that resource?
Dr. Jennifer Tufts (03:06:41):
She did.
Prosecutor 2 (03:06:42):
Do you know which therapist she saw?
Dr. Jennifer Tufts (03:06:44):
Yes.
Prosecutor 2 (03:06:45):
Who was that?
Dr. Jennifer Tufts (03:06:46):
Jennifer McAllister.
Prosecutor 2 (03:06:48):
And how does it work when a patient is at Astra Mental Health, they're being seen by a psychiatrist, they're being seen by a therapist, is there someone that's in charge of the treatment of the patient, that oversees everything, or is it all just individual?
Dr. Jennifer Tufts (03:07:08):
The psychiatrist is in charge.
Prosecutor 2 (03:07:10):
Okay. So, you would have been in charge of Ms. Clancy's treatment?
Dr. Jennifer Tufts (03:07:13):
Yes.
Prosecutor 2 (03:07:14):
And as part of being in charge of her treatment, would you review the records from her therapy sessions to inform and guide your treatment of her?
Dr. Jennifer Tufts (03:07:24):
Yes.
Prosecutor 2 (03:07:27):
What were the treatment goals for the defendant?
Dr. Jennifer Tufts (03:07:32):
I don't recall exactly what her words were.
Prosecutor 2 (03:07:35):
Would the goals be what your patient tells you?
Dr. Jennifer Tufts (03:07:39):
Yes.
Prosecutor 2 (03:07:58):
Okay. I'm going to approach and just ask that you look at page 41 of the records for Exhibit 219, to the treatment goals section. Would that refresh your memory?
Dr. Jennifer Tufts (03:08:08):
Yes.
Prosecutor 2 (03:08:10):
And what were the treatment goals according to Ms. Clancy?
Dr. Jennifer Tufts (03:08:14):
So, these are not her words, there's a list in the electronic medical record where I can indicate which ones might apply, where I can type out my own. So, the treatment goals based on what we had decided on together were symptom reduction and improved functioning.
Prosecutor 2 (03:08:36):
And you said that Ms. Clancy had been a little reluctant about starting a medication, did she tell you why she was reluctant?
Dr. Jennifer Tufts (03:08:46):
Yes.
Prosecutor 2 (03:08:46):
And why was that?
Dr. Jennifer Tufts (03:08:48):
She was worried about having side effects.
Prosecutor 2 (03:08:50):
And did she mention which specific side effects or just side effects in general?
Dr. Jennifer Tufts (03:08:56):
I though it was in general.
Prosecutor 2 (03:08:58):
And as a result of that concern, is that when you went over the potential side effects of Zoloft?
Dr. Jennifer Tufts (03:09:04):
Yes.
Prosecutor 2 (03:09:06):
And after having that discussion and you explaining the side effects of Zoloft, how did the two of you leave it in terms of whether she was going to take the medication or not?
Dr. Jennifer Tufts (03:09:19):
I told her what my recommendation was, that she should start the sertraline, I'm not sure if she told me definitively if she was going to take it or not. She might have needed some time to think about it.
Prosecutor 2 (03:09:37):
And based on your evaluation with Ms. Clancy, everything you learned about her history and how she presented that day, did you have an initial diagnosis?
Dr. Jennifer Tufts (03:09:49):
Yes.
Prosecutor 2 (03:09:49):
And what was that?
Dr. Jennifer Tufts (03:09:51):
It was a generalized anxiety disorder, and it was an adjustment disorder with depressed mood.
Prosecutor 2 (03:09:59):
What is generalized anxiety disorder?
Dr. Jennifer Tufts (03:10:02):
It's an anxiety disorder where an individual may have a lot of different worries. They may also have physical feelings of anxiety, but they're worried about a lot of things, not really just one thing specifically.
Prosecutor 2 (03:10:18):
And what is adjustment disorder with depressed mood?
Dr. Jennifer Tufts (03:10:22):
So, adjustment disorder refers to a fact that there may be symptoms, but they are kind of secondary to the situation. So, they don't meet the full criteria, say, of a major depressive disorder, but there were some symptoms of depression.
Prosecutor 2 (03:10:43):
Okay.
Judge William F. Sullivan (03:10:46):
Is this a good place to start?
Prosecutor 2 (03:10:50):
Yes.
Judge William F. Sullivan (03:10:50):
All right. Members of the jury, it's 1:00, we're going to take the afternoon recess. I'm going to ask you to be ready to come back at 2:00. And again, same instructions and orders, during the break, don't read anything about this case or similar cases, don't do any research, don't talk about this. Just kind of relax as best you can for the next hour, we'll bring you back in, we'll continue with the evidence this afternoon. Okay.
Speaker 6 (03:11:13):
Court, all rise. [inaudible 03:11:20]. This way, please.
Judge William F. Sullivan (03:11:46):
All right. Doctor, you may step down.
Speaker 6 (03:11:47):
[inaudible 03:11:50].
Judge William F. Sullivan (03:11:49):
All right. Before we recess, I just want to make a, I guess, a comment. I just want to make it real clear-
Speaker 6 (03:11:58):
You may be seated.
Judge William F. Sullivan (03:12:00):
... that there is to be no inappropriate comments or disruptive comments to be made inside of this courtroom. If anybody is found to make those, they will be immediately escorted out and barred for the balance of this. All right? I just want to make that real clear. And just in case you're wondering, there are microphones all around. And so, if we hear, if I get a report of that, there's going to be some serious issues and serious problems. So, I just wanted to put that out for everybody so it's crystal clear. There's going to be no warnings, no yellow cards, you're out. All right? So, I just want to make that real clear. And so with that, we'll be in recess on this matter until 2:00.
Speaker 6 (03:12:44):
Court, all rise.
(03:12:58)
The court stands in recess, please exit the courtroom.
(03:13:01)
Thank you.
Unknown (03:13:01):
[inaudible 03:13:02].
Speaker 6 (03:13:02):
This court is back in session, you may be seated.
Speaker 7 (03:13:32):
So, for the purpose of the record, we return back to the matter of Commonwealth v. Lindsay Clancy. All parties are present, including the defendant, excluding the jury.
Judge William F. Sullivan (03:13:39):
All right. Counsel, we ready for the jury?
Prosecutor 2 (03:13:41):
Can we be seen briefly at sidebar?
Judge William F. Sullivan (03:13:42):
Sure.
(03:13:42)
[inaudible 03:15:17]. Look, we have the witness on the stand.
Speaker 6 (03:13:42):
Yeah, stand by, we're going to put the witness on the stand and I'll call you in.
Judge William F. Sullivan (03:13:42):
I know. But my...
Speaker 6 (03:13:42):
Just watch your step as you take the stand, thank you.
Dr. Jennifer Tufts (03:13:42):
Yes, sir.
Speaker 7 (03:13:42):
[inaudible 03:15:52].
Dr. Jennifer Tufts (03:13:42):
Yes.
Speaker 7 (03:13:42):
Thank you.
Judge William F. Sullivan (03:13:42):
All right. We all set?
Speaker 6 (03:13:42):
Court, all rise. [inaudible 03:16:04].
(03:13:42)
This court's now in session, please be seated.
Speaker 7 (03:16:32):
Your Honor, for the purpose of the record, we returned back to the trial of Commonwealth v. Lindsay Clancy. All parties are present, including the defendant and including the 18 jurors.
Judge William F. Sullivan (03:16:40):
All right. Attorney Sprague.
Prosecutor 2 (03:16:42):
Thank you, Your Honor. So, Dr. Tufts, back on that first appointment with Ms. Clancy on September 15th, 2022, as part of the record, did you detail a section history of present illness?
Dr. Jennifer Tufts (03:17:00):
Yes.
Prosecutor 2 (03:17:01):
And in that section, you put in here, "Initial presentation, nursing school, Prozac helped, got treatment after second baby, two for anxiety. Zoloft one week, was nervous about breastfeeding, initial side effects." Can you just tell us where that information came from?
Dr. Jennifer Tufts (03:17:23):
My conversation with the patient.
Prosecutor 2 (03:17:25):
Okay. And where it says Zoloft one week, was nervous about breastfeeding, what does that mean?
Dr. Jennifer Tufts (03:17:31):
So, she had tried Zoloft before, during the postpartum period after her second baby.
Prosecutor 2 (03:17:41):
And did she tell you whether she had any side effects when she took Zoloft after her second baby?
Dr. Jennifer Tufts (03:17:47):
She mentioned something about initial side effects, which are pretty common for many people, I didn't detail what those side effects were, but they sounded like the very normal ones that people might experience that are...
Dr. Jennifer Tufts (03:18:00):
Normal ones that people might experience that are transient in the beginning of the treatment.
Prosecutor 2 (03:18:06):
And what would those side effects be?
Dr. Jennifer Tufts (03:18:07):
Possibly upset stomach, appetite issues.
Speaker 8 (03:18:11):
I apologize. Can we know what related to this patient rather than somebody?
Speaker 9 (03:18:18):
All right. So why don't you ask if she remembers what the defendant said the side effects were?
Prosecutor 2 (03:18:25):
Do you remember what the defendant said the side effects were?
Dr. Jennifer Tufts (03:18:28):
I don't remember them exactly, but they were ones that did not seem concerning.
Prosecutor 2 (03:18:34):
And in your experience, in your training and experience as a psychiatrist who prescribed Zoloft, what are the common side effects that patients deal with from this medication?
Dr. Jennifer Tufts (03:18:46):
So in the first couple weeks of treatment, we described that there's a lot of serotonin in the gut, as well as the brain. So the medicine often affects the gut first. So you might have diarrhea, constipation, difficulties with appetite, nausea, things like that.
Prosecutor 2 (03:19:03):
And you also wrote in the note about history of present illness, three months postpartum, also four and two-year-old feeling overwhelmed. Is that correct?
Dr. Jennifer Tufts (03:19:14):
Yes.
Prosecutor 2 (03:19:15):
And that came from the patient, Ms. Clancy?
Dr. Jennifer Tufts (03:19:17):
Yes.
Prosecutor 2 (03:19:18):
And furthermore, you wrote that the baby needing more attention, other kids more challenging too. Is that coming from the patient?
Dr. Jennifer Tufts (03:19:28):
Yes.
Prosecutor 2 (03:19:30):
And does she also describe she's having trouble leaving the baby, too anxious to do anything when she leaves, physical tension, heart racing, worries he won't eat or sleep because he's refusing the bottle?
Dr. Jennifer Tufts (03:19:42):
Yes.
Prosecutor 2 (03:19:44):
And did she say that makes her irritable?
Dr. Jennifer Tufts (03:19:46):
Yes.
Prosecutor 2 (03:19:47):
And in that same note is where you detail that she denied audio hallucinations, visual hallucinations, correct?
Dr. Jennifer Tufts (03:19:53):
Yes.
Prosecutor 2 (03:19:55):
And you also detail suicidal ideation, homicidal ideation, denies no concern about hurting baby. The no concern about hurting baby, is that a note, an observation you're making or something that came from Ms. Clancy?
Dr. Jennifer Tufts (03:20:12):
It came from our conversation.
Prosecutor 2 (03:20:16):
So at some point in time, she told you she had no concerns about harming the baby?
Dr. Jennifer Tufts (03:20:21):
Yes. It was-
Speaker 8 (03:20:22):
I object.
Speaker 9 (03:20:25):
[inaudible 03:20:25] objection. You could rephrase that question.
Prosecutor 2 (03:20:28):
What did she tell you about her thoughts about the baby?
Dr. Jennifer Tufts (03:20:32):
I asked if there were those thoughts and she denied them.
Prosecutor 2 (03:20:40):
And did you also provide information to her about what to do if in between appointments there were emergencies or issues?
Dr. Jennifer Tufts (03:20:55):
Yes, I believe that I did. I usually do when I meet a patient.
Prosecutor 2 (03:21:00):
And in the page describing treatment follow-up plan, which would be in the initial diagnostic assessment from September 15th in that treatment follow-up plan section, there's a part there that says, "If having urges to harm self or others, go to the nearest emergency room, call 911, or call the National Suicide Prevention and Crisis Hotline," correct?
Dr. Jennifer Tufts (03:21:25):
Yes.
Prosecutor 2 (03:21:26):
Is this page given to the patient?
Dr. Jennifer Tufts (03:21:30):
They can access it online on the portal.
Prosecutor 2 (03:21:32):
So Ms. Clancy would have the ability to go on here, look at the portal, and see what to do if she was having a crisis?
Dr. Jennifer Tufts (03:21:38):
Yeah, just this plan section. Yes.
Prosecutor 2 (03:21:41):
Just the treatment plan section?
Dr. Jennifer Tufts (03:21:42):
Yes.
Prosecutor 2 (03:21:42):
So is it that she would have to search through the records or is that something you can click on to see the treatment plan?
Dr. Jennifer Tufts (03:21:49):
I'm not sure exactly what it looks like for a patient.
Prosecutor 2 (03:21:51):
Okay. But that's one of the sections that's available to the patient, Lindsay Clancy, if she goes onto the portal?
Dr. Jennifer Tufts (03:21:57):
Yes.
Prosecutor 2 (03:21:59):
There's also in here, if you feel you're in crisis, you may text home to a certain text number from anywhere in the United States. Is that correct?
Dr. Jennifer Tufts (03:22:06):
Yes.
Prosecutor 2 (03:22:06):
And what does that do when you text home to that text number?
Dr. Jennifer Tufts (03:22:09):
It connects you to a counselor.
Prosecutor 2 (03:22:16):
Now, what was the treatment or follow-up plan for Ms. Clancy?
Dr. Jennifer Tufts (03:22:21):
To start the sertraline, to start individual therapy, and to follow up with myself.
Prosecutor 2 (03:22:28):
So your recommendation wasn't just that she take pills, you recommended that she attend therapy, correct?
Dr. Jennifer Tufts (03:22:34):
Yes.
Prosecutor 2 (03:22:44):
And when you recommended the therapy and the medication, did you also go over with Ms. Clancy alternatives to the medication that you were recommending?
Dr. Jennifer Tufts (03:23:02):
I believe she was aware that the alternative was that she could not take a medication, which is what she had been doing before.
Prosecutor 2 (03:23:14):
And after you went over all of this information with Ms. Clancy, did she convey to you that she understood the plan and was agreeable to the plan?
Dr. Jennifer Tufts (03:23:24):
Yes.
Prosecutor 2 (03:23:28):
What is informed consent?
Dr. Jennifer Tufts (03:23:30):
Informed consent means you communicate with a patient what the risks and benefits are of treatment, and they understand that, and they agree to the treatment.
Prosecutor 2 (03:23:47):
And did Ms. Clancy show that she had informed consent to everything you discussed?
Dr. Jennifer Tufts (03:23:54):
Yes.
Prosecutor 2 (03:23:59):
Now, was your next appointment with Ms. Clancy on September 28th, 2022?
Dr. Jennifer Tufts (03:24:04):
Yes, it was.
Prosecutor 2 (03:24:06):
And so during that appointment, did you discuss the medication, the Zoloft that you had prescribed to her?
Dr. Jennifer Tufts (03:24:13):
Yes.
Prosecutor 2 (03:24:14):
And what did you learn from Ms. Clancy about whether or not she had taken that medication?
Dr. Jennifer Tufts (03:24:19):
She shared that she decided not to take it.
Prosecutor 2 (03:24:22):
Did she tell you that she had picked it up but had decided not to take it?
Dr. Jennifer Tufts (03:24:25):
Yes.
Prosecutor 2 (03:24:28):
Did she tell you how she was feeling?
Dr. Jennifer Tufts (03:24:31):
She said a little bit better.
Prosecutor 2 (03:24:33):
And did she elaborate on that?
Dr. Jennifer Tufts (03:24:36):
The baby was getting some more sleep, so she was also able to get some more sleep and that helped her feel better.
Prosecutor 2 (03:24:44):
And at this appointment, did you go through a mental status exam of Ms. Clancy?
Dr. Jennifer Tufts (03:24:50):
Yes.
Prosecutor 2 (03:24:51):
And what is a mental status exam?
Dr. Jennifer Tufts (03:24:53):
So a mental status exam is an assessment of the patient at the point of meeting. It can change at different times, but it's comprehensive referring to how the patient appears, how they cooperate, how they speak, how they describe their thoughts, how they're able to communicate with you, and what their mood is like.
Prosecutor 2 (03:25:19):
And do you do that at every appointment with every patient?
Dr. Jennifer Tufts (03:25:22):
Yes.
Prosecutor 2 (03:25:23):
And so on the September 28th, 2022, when you met with Lindsay Clancy for that second meeting, did you do a mental status examination?
Dr. Jennifer Tufts (03:25:32):
Yes, I did.
Prosecutor 2 (03:25:32):
And what was the result of that?
Dr. Jennifer Tufts (03:25:36):
Is it okay if I read it from the note or do you just want me to-
Prosecutor 2 (03:25:39):
There's no objection.
Speaker 9 (03:25:42):
Go ahead. You may.
Dr. Jennifer Tufts (03:25:43):
She was alert. She was oriented. She was appropriate. Her rapport, meaning how she worked with me was appropriate. Dressed appropriately. Euthymic, meaning not depressed, not angry, kind of a normal mood. Her affect was full. Her speech was appropriate. Her thought content and a process were appropriate. She did not mention any hallucinations. At this point, I mentioned her insight was poor. Her judgment was excellent. Her cognition did not show any deficits, and there was normal psychomotor activity.
Prosecutor 2 (03:26:33):
And why did you list that her insight was poor?
Dr. Jennifer Tufts (03:26:37):
So I think that that must have been related to the fact that at this point, she did have some very clinically significant anxiety. Usually when people come to a psychiatrist, they believe that their symptoms are significant and that a medication is something that might be prescribed. But despite these symptoms, she still didn't want to try the medicine.
Prosecutor 2 (03:27:08):
And what is the difference between a psychiatrist and a psychologist?
Dr. Jennifer Tufts (03:27:13):
So a psychiatrist is a medical doctor. We go to medical school and then we specialize in psychiatry. A psychologist does not go to medical school. They may do a lot of research in their training. They may learn a lot about psychotherapy, but they don't learn about the human body, about how we metabolize medications, and things like that.
Prosecutor 2 (03:27:37):
And so a psychiatrist, can a psychiatrist prescribe medication?
Dr. Jennifer Tufts (03:27:41):
Yes.
Prosecutor 2 (03:27:41):
Can a psychologist prescribe medication?
Dr. Jennifer Tufts (03:27:43):
No.
Prosecutor 2 (03:27:46):
Now, in the medical records, Exhibit 219, Page 47, it lists here recent lab work, no lab results were found. Is it that you had ordered lab work and you couldn't find the results or that none were ordered?
Dr. Jennifer Tufts (03:28:06):
None were ordered.
Prosecutor 2 (03:28:07):
And why is that?
Dr. Jennifer Tufts (03:28:08):
It was not necessary.
Prosecutor 2 (03:28:10):
And why isn't it necessary at that point for Ms. Clancy to order blood work?
Dr. Jennifer Tufts (03:28:14):
There's no blood work that is commonly done when a patient presents with generalized anxiety disorder and no other medical complications.
Prosecutor 2 (03:28:25):
What types of situations would you order blood work for?
Dr. Jennifer Tufts (03:28:30):
There could be a lot. Certain medications require laboratory monitoring. Maybe something that could affect the kidneys or could affect the thyroid, could affect the cholesterol. These are things that we monitor to make sure that the medicine is prescribed safely.
Prosecutor 2 (03:28:50):
And so Zoloft, is that not one of the ones that would need to be monitored because of its potential effects on the body?
Dr. Jennifer Tufts (03:28:56):
Correct.
Prosecutor 2 (03:28:59):
And at that time, she reported to you she wasn't even taking it yet, correct?
Dr. Jennifer Tufts (03:29:03):
Correct.
Prosecutor 2 (03:29:05):
And your appointment that day, I think according to the records, it was approximately 17 minutes long. Is that correct?
Dr. Jennifer Tufts (03:29:12):
So can I explain that?
Prosecutor 2 (03:29:14):
Absolutely.
Dr. Jennifer Tufts (03:29:14):
Because I think there's a bit of a misunderstanding. So the 17 minutes, I think people are looking at the note where it says a therapy start time of 10:00 AM, a therapy end time of 10:17. So they're calculating 17 minutes. But those timestamps are specifically related to the therapy portion of the exam. They're not reflective of the complete duration of time when I met with her.
Prosecutor 2 (03:29:44):
So what would be the complete time that you met with her on that day?
Dr. Jennifer Tufts (03:29:49):
So I don't know the exact amount of minutes, but the appointments are 25-minute appointments. So it would be more or less a few minutes, about 25.
Prosecutor 2 (03:30:01):
And so the 17 minutes that are for the therapy portion of the appointment, what comprises therapy? What does that involve?
Dr. Jennifer Tufts (03:30:09):
It really varies based on the person, based on the situation. It can involve providing some emotional support.
Speaker 8 (03:30:21):
I apologize. Can we talk about Lindsey Clancy rather than in general? That's all.
Prosecutor 2 (03:30:25):
It's admissible.
Speaker 9 (03:30:26):
I'm going to allow a little bit of the background so that then we'll move into the defendant.
Prosecutor 2 (03:30:31):
Thank you. So you were saying that therapy portion is kind of talking to the patient, seeing how they are, and getting an assessment of their current mental state?
Dr. Jennifer Tufts (03:30:44):
Yes.
Prosecutor 2 (03:30:45):
And the other eight minutes typically, what happens in those eight minutes?
Dr. Jennifer Tufts (03:30:49):
That's more focused on specifically medications and medication management.
Prosecutor 2 (03:30:56):
So these appointments that you had with Lindsay Clancy, when it says 17 minutes, that's the therapy, the talk portion of the appointment. And then there was a separate portion where medication was discussed?
Dr. Jennifer Tufts (03:31:08):
Yes. In the real world, those two segments are intertwined. So it's not necessarily that we say, "This is the end of your therapy component." It's a bit more seamless than that.
Prosecutor 2 (03:31:23):
Now, in your training and experience in the way you conduct your practice, if you're having a therapy portion or you're conducting therapy with a client and that 25 minutes has run out, is it a hard stop or is there an option to continue?
Dr. Jennifer Tufts (03:31:38):
It's not a hard stop. I do have limitations because I have other patients that are waiting. But if there's something urgent, I can go a little bit over. If there's an emergency, I can cancel the next patient if I have to.
Prosecutor 2 (03:31:52):
And these 25 minute appointments that you have, if a patient were to request a longer appointment with you, is that available?
Dr. Jennifer Tufts (03:32:01):
It's an option.
Prosecutor 2 (03:32:02):
Did Lindsay Clancy ever request a longer appointment time with you?
Dr. Jennifer Tufts (03:32:05):
No.
Prosecutor 2 (03:32:16):
Now, that appointment on September 28th, 2022, was that also a virtual appointment?
Dr. Jennifer Tufts (03:32:26):
Yes.
Prosecutor 2 (03:32:27):
And did Ms. Clancy appear to be alone in that virtual appointment?
Dr. Jennifer Tufts (03:32:32):
Yes.
Prosecutor 2 (03:32:33):
And based on your conversations and assessment of her on that day, what was the plan going forward?
Dr. Jennifer Tufts (03:32:45):
So at this point, she was improving and we decided to pause on the medication question and have her meet with one of our therapists.
Prosecutor 2 (03:32:58):
So that first appointment was on September 15th. You recommended therapy. The next appointment was September 28th. So had Lindsay not scheduled a therapy appointment yet with Jennifer McAllister at that point?
Dr. Jennifer Tufts (03:33:13):
I'm not sure when she called to schedule that.
Prosecutor 2 (03:33:17):
But that was the plan going forward that your recommendation was that she attend therapy with Jennifer McAllister?
Dr. Jennifer Tufts (03:33:23):
Yes.
Prosecutor 2 (03:33:25):
And did Ms. Clancy seem receptive to that plan?
Dr. Jennifer Tufts (03:33:28):
Yes.
Prosecutor 2 (03:33:30):
Did she tell you she was going to make an appointment with Ms. McAllister?
Dr. Jennifer Tufts (03:33:34):
Yes.
Prosecutor 2 (03:33:40):
Now, according to the records, the next appointment was October 3rd, 2022, just five days later. Was there a reason that you had such a short time span between that September 28th appointment and the October 3rd appointment with Ms. Clancy?
Dr. Jennifer Tufts (03:34:00):
I believe that the patient must have scheduled the appointment on her own and that's why the span time was rather short.
Prosecutor 2 (03:34:08):
Do you recall Ms. Clancy reaching out to you about getting paperwork for a maternity leave extension?
Dr. Jennifer Tufts (03:34:16):
Yes.
Prosecutor 2 (03:34:17):
And did she reach out to you through the portal for Astra Health?
Dr. Jennifer Tufts (03:34:25):
Yes.
Prosecutor 2 (03:34:25):
And did you respond to her on that portal?
Dr. Jennifer Tufts (03:34:28):
Yes.
Prosecutor 2 (03:34:28):
And did you fill out paperwork for her to extend her maternity leave?
Dr. Jennifer Tufts (03:34:35):
I think that I did.
Prosecutor 2 (03:35:05):
Okay. And so there is a message from Ms. Clancy to you on September 30th, 2022 in the portal that states, "Hi, Dr. Tufts. Thanks again for all your help at our last two appointments. While I am feeling just better enough to function without medication, I did reach out to my employer about extending my leave for reasons of postpartum anxiety/depression. I don't feel mentally well enough to return to taking care of patients with a baby at home that still won't take the bottle. I know this will trigger my anxiety too much and also having to stay up all night as a nurse. I don't feel it's possible right now. They asked that my provider could fill out a form so they could process this request. Can I please send you the form to fill out?" And you responded on September 30th, 2022 at 2:41 PM. "This type of paperwork often requires a lot of information, so it's best if we go through it together in an appointment." Do you recall that?
Dr. Jennifer Tufts (03:36:12):
Yes.
Prosecutor 2 (03:36:12):
So would that have been why the October 3rd appointment was set up?
Dr. Jennifer Tufts (03:36:16):
That may have been, yes.
Prosecutor 2 (03:36:21):
Okay. And then do you recall receiving a message from Ms. Clancy on October 10th, 2022 stating, " Hi, Dr. Tufts. There is a part on the serious health condition form that you filled out for me that needs to be changed. On the second page, you put, I could work a reduced schedule of eight hours per day, two days per week. However, we discussed not working at all until January 1st. I think we talked about when I returned to work, that is what I could do, but that the way it appears on the form makes it seem like I can do that now. Do you still have the form to make the adjustment or do I need to send it back to you?" And then you responded that you would send back an updated version. Is that correct?
Dr. Jennifer Tufts (03:37:01):
Yes.
Prosecutor 2 (03:37:02):
So do you recall having a conversation with Ms. Clancy at the October 3rd appointment about not returning to work and how long she should be out of work for?
Dr. Jennifer Tufts (03:37:14):
I recall having a conversation about that.
Prosecutor 2 (03:37:17):
And that January 1st date, was that something you decided or something Ms. Clancy requested?
Dr. Jennifer Tufts (03:37:23):
I think it was something that we decided together.
Prosecutor 2 (03:37:28):
And in that appointment on October 3rd, did Ms. Clancy tell you that she was on the verge of taking the medication?
Dr. Jennifer Tufts (03:37:36):
Yes.
Prosecutor 2 (03:37:37):
And did you discuss that with her?
Dr. Jennifer Tufts (03:37:39):
Yes.
Prosecutor 2 (03:37:40):
And what was that discussion?
Dr. Jennifer Tufts (03:37:42):
Well, she was having more anxiety again. It seemed like maybe it had started getting better and then it was where it had been when she initially reached out. And so she was feeling like a medication might be helpful.
Prosecutor 2 (03:38:00):
And did Ms. Clancy tell you at that appointment that she wanted to try therapy before taking the medication?
Dr. Jennifer Tufts (03:38:06):
Yes.
Prosecutor 2 (03:38:07):
But she had not had an appointment with Jennifer McAllister yet, correct?
Dr. Jennifer Tufts (03:38:13):
I'm not sure what date her first appointment was with Jennifer McAllister.
Prosecutor 2 (03:38:29):
Showing you Page 57 of Exhibit 219. An initial therapy assessment by Jennifer McAllister on October 3rd, 2022. Would that have been the first time she saw Ms. McAllister?
Dr. Jennifer Tufts (03:38:46):
Yes.
Prosecutor 2 (03:38:48):
So that's on that same day that you saw her. It looks like from the records you saw her at 11:30. Is that correct?
Dr. Jennifer Tufts (03:38:56):
I don't have the time on my paper, but I'm sure that's correct.
Prosecutor 2 (03:39:00):
Okay. So apparently she saw you about the work form and then she had an appointment with Ms. McAllister. Is that correct?
Dr. Jennifer Tufts (03:39:09):
Yes.
Prosecutor 2 (03:39:11):
And it says here in the records that Jennifer McAllister is an LMHC. What is that?
Dr. Jennifer Tufts (03:39:16):
A licensed mental health counselor.
Prosecutor 2 (03:39:19):
And so is a counselor, a licensed mental health counselor, someone who can conduct therapy sessions?
Dr. Jennifer Tufts (03:39:24):
Yes.
Prosecutor 2 (03:39:27):
And why is it in your practice that you have a psychiatrist who does therapy and prescribes medication, but in addition, you would have a therapist doing counseling?
Dr. Jennifer Tufts (03:39:39):
So today a lot of psychiatry is practiced as a team. At least that's how we practice at my office. So oftentimes the therapist is able to see the patient every single week. They're able to focus in more depth on certain aspects of the patient's wellbeing. And so it's helpful to have one person paying extra attention to the therapy component, especially when the psychiatrist does have to spend a lot of time discussing the medications and thinking about the medications.
Prosecutor 2 (03:40:24):
And so is that the teamwork approach that Lindsay Clancy received in her treatment at Aster Mental Health?
Dr. Jennifer Tufts (03:40:34):
Yes.
Prosecutor 2 (03:40:35):
And in that October 3rd assessment with Ms. McAllister, you reviewed those notes and records so that you could properly treat Ms. Clancy, correct?
Dr. Jennifer Tufts (03:40:46):
Yes.
Prosecutor 2 (03:40:47):
And in that first meeting with Ms. McAllister, the defendant described her relationship with her parents as very supportive and stable, correct?
Dr. Jennifer Tufts (03:40:58):
I don't have Jennifer's notes in front of me.
Prosecutor 2 (03:41:02):
Showing you Page 60. You want to just review the notes?
Dr. Jennifer Tufts (03:41:07):
Sure.
Prosecutor 2 (03:41:08):
Look up when you're finished. Does that refresh your memory as to the notes that you reviewed from Lindsay's session with McAllister?
Dr. Jennifer Tufts (03:41:41):
Yes.
Prosecutor 2 (03:41:42):
And so in that session, Ms. Clancy stated that her parents were very supportive and stable?
Dr. Jennifer Tufts (03:41:49):
Yes.
Prosecutor 2 (03:41:50):
And she also mentioned having the support of an older sister who only lived two and a half hours away. Is that correct?
Dr. Jennifer Tufts (03:41:57):
That's what she stated in the note to John.
Prosecutor 2 (03:42:00):
Did she also say that she was not close with her in-laws who lived in Situate? She would see them often as they were her husband's parents, but she didn't generally allow them to watch the children. Is that correct?
Dr. Jennifer Tufts (03:42:13):
That's what I read.
Prosecutor 2 (03:42:15):
And there's a quote in here, "Don't have a particular reason why they don't bug me about it either." Is that correct?
Dr. Jennifer Tufts (03:42:21):
That's what I read.
Prosecutor 2 (03:42:27):
And October 3rd, 2022, when you met with her that day, did you again do a mental status exam?
Dr. Jennifer Tufts (03:42:34):
Yes.
Prosecutor 2 (03:42:34):
Had anything changed in that mental status exam from the September 28th meeting that you had with her?
Dr. Jennifer Tufts (03:42:43):
Can I review it?
Prosecutor 2 (03:42:43):
Yes.
Dr. Jennifer Tufts (03:43:20):
There isn't anything that stands out to me right now.
Prosecutor 2 (03:43:22):
And I think that what you put on the October 3rd date was that her insight was still poor?
Dr. Jennifer Tufts (03:43:30):
Yes.
Prosecutor 2 (03:43:30):
And was that for the same reasons you described earlier?
Dr. Jennifer Tufts (03:43:33):
Yes.
Prosecutor 2 (03:43:35):
The next time that you saw Ms. Clancy, was that on October 20th, 2022?
Dr. Jennifer Tufts (03:43:41):
Yes.
Prosecutor 2 (03:43:42):
And what information did you learn on that date about whether or not she was taking the Zoloft you had prescribed?
Dr. Jennifer Tufts (03:43:49):
So she told me that she decided to start the Zoloft.
Prosecutor 2 (03:43:53):
And did she tell you how long she had been taking it?
Dr. Jennifer Tufts (03:43:57):
For one week.
Prosecutor 2 (03:43:59):
And did she tell you that the previous night she had increased the dose?
Dr. Jennifer Tufts (03:44:03):
Yes.
Prosecutor 2 (03:44:04):
And that's what was in the original prescription, correct? Take the pills at 25 milligrams for one week and then increase to 50?
Dr. Jennifer Tufts (03:44:11):
Yes.
Prosecutor 2 (03:44:12):
So if that had been done, taking the pills for one week would be seven pills, and then increasing the dosage the next night would be two pills?
Dr. Jennifer Tufts (03:44:22):
Yes.
Prosecutor 2 (03:44:23):
And so that would be nine pills?
Dr. Jennifer Tufts (03:44:25):
Yes.
Prosecutor 2 (03:44:27):
When she told you she increased the dose, she told you she now feels awful. Is that correct?
Dr. Jennifer Tufts (03:44:32):
Yes.
Prosecutor 2 (03:44:34):
And what was it that was bothering her?
Dr. Jennifer Tufts (03:44:37):
She was having increased difficulty sleeping. She had loss of appetite, diarrhea. She was feeling her mood was down. She was tearful and feeling very foggy and feeling very anxious.
Prosecutor 2 (03:44:54):
Now, what is the lowest dose of Zoloft that you would prescribe a patient or could prescribe?
Dr. Jennifer Tufts (03:45:01):
The smallest pill is 25.
Prosecutor 2 (03:45:03):
And what's the highest dose of Zoloft?
Dr. Jennifer Tufts (03:45:05):
200.
Prosecutor 2 (03:45:07):
Okay. So she was on the lowest dose of 25. Is that correct?
Dr. Jennifer Tufts (03:45:10):
Yes.
Prosecutor 2 (03:45:11):
And then according to what she told you, she had increased for one night to 50 milligrams. Is that correct?
Dr. Jennifer Tufts (03:45:16):
Yes.
Prosecutor 2 (03:45:20):
Did she also tell you she was scared to start something new?
Dr. Jennifer Tufts (03:45:23):
Yes.
Prosecutor 2 (03:45:24):
Is that in terms of another medication?
Dr. Jennifer Tufts (03:45:27):
Yes.
Prosecutor 2 (03:45:27):
So what was your discussion with Ms. Clancy when she's telling you that she's having these issues with Zoloft, but she's afraid to try something new?
Dr. Jennifer Tufts (03:45:35):
So we discussed what to do moving forward. So we discussed whether it would make sense to switch to a different medication at that point. And at that moment, because of her negative experience with the Zoloft, she did not want to start a new medication at that point.
Prosecutor 2 (03:45:58):
At this meeting with her, did you ask her if she had any suicidal thoughts?
Dr. Jennifer Tufts (03:46:03):
Yes.
Prosecutor 2 (03:46:03):
What was her response?
Dr. Jennifer Tufts (03:46:05):
No.
Prosecutor 2 (03:46:06):
Did you ask her if she had any homicidal ideation or thoughts?
Dr. Jennifer Tufts (03:46:09):
Yes.
Prosecutor 2 (03:46:10):
What was her response?
Dr. Jennifer Tufts (03:46:11):
No.
Prosecutor 2 (03:46:12):
Did you ask her if she was hearing any voices or seeing any visual hallucinations?
Dr. Jennifer Tufts (03:46:19):
I'm not sure if I asked that in that appointment, but she was very clearly not psychotic.
Prosecutor 2 (03:46:25):
And why do you say that?
Dr. Jennifer Tufts (03:46:27):
Because of how I described some of the signs of psychosis that are on the mental status exam. None of those were present.
Prosecutor 2 (03:46:38):
What was her affect during this meeting?
Dr. Jennifer Tufts (03:46:49):
It was depressed.
Prosecutor 2 (03:46:51):
And did you write that she was... Strike that. What was it about her affect that made you write that she was depressed?
Dr. Jennifer Tufts (03:47:03):
She visually appeared like she was feeling sad.
Prosecutor 2 (03:47:10):
And her mood, how did she report that to you?
Dr. Jennifer Tufts (03:47:13):
That was depressed as well and anxious.
Prosecutor 2 (03:47:18):
What about her though, content and process that day?
Dr. Jennifer Tufts (03:47:21):
That was appropriate.
Prosecutor 2 (03:47:23):
And her speech?
Dr. Jennifer Tufts (03:47:25):
It was appropriate.
Prosecutor 2 (03:47:26):
And her judgment and cognitive skills?
Dr. Jennifer Tufts (03:47:29):
Her judgment was excellent and her cognition didn't have any deficits.
Prosecutor 2 (03:47:35):
And her psychomotor activity?
Dr. Jennifer Tufts (03:47:37):
Normal.
Prosecutor 2 (03:47:39):
So the main change here from previous visits was that she appeared depressed and anxious?
Dr. Jennifer Tufts (03:47:46):
Yes.
Prosecutor 2 (03:47:48):
Although she had appeared anxious that first visit, correct?
Dr. Jennifer Tufts (03:47:50):
Yes.
Prosecutor 2 (03:47:51):
So to make sure we have the timeline correct, the first visit she appeared anxious. The second visit, she appeared to be doing better. The third visit, she still had that poor insight when you met about the paperwork, and then this fourth visit she appears depressed. Is that correct?
Dr. Jennifer Tufts (03:48:08):
Yes.
Prosecutor 2 (03:48:09):
Okay. Did she also tell you that she was worried about getting suicidal thoughts?
Dr. Jennifer Tufts (03:48:27):
Yes.
Prosecutor 2 (03:48:29):
So that would've come directly from her, correct?
Dr. Jennifer Tufts (03:48:31):
Yes.
Prosecutor 2 (03:48:31):
And what were the details of that conversation?
Dr. Jennifer Tufts (03:48:35):
So it was one of the things that she was anxious about. It was a fear of one day having suicidal thoughts if she were to continue to feel poorly.
Prosecutor 2 (03:48:50):
Okay. And showing you Page 77 of Exhibit 219, I know you said earlier you weren't sure if you asked her about audio or visual hallucinations, but just directing your attention to the interval history, if that refreshes your memory.
Dr. Jennifer Tufts (03:49:07):
Yes.
Prosecutor 2 (03:49:08):
Did you ask her about audio hallucinations and visual hallucinations?
Dr. Jennifer Tufts (03:49:13):
On the 21st I did.
Prosecutor 2 (03:49:16):
Okay. All right. So then there was an appointment the following day on October 21st?
Dr. Jennifer Tufts (03:49:19):
Yes.
Prosecutor 2 (03:49:21):
So why did she have an appointment that following day?
Dr. Jennifer Tufts (03:49:24):
Because she was feeling pretty poorly after starting the Zoloft, so we were following her closely.
Prosecutor 2 (03:49:32):
And at that point, you knew that she had had an appointment on the 3rd with Ms. McAllister, correct?
Dr. Jennifer Tufts (03:49:42):
Yes.
Prosecutor 2 (03:49:43):
And do you know whether or not she had followed up making another appointment or was struggling with that?
Dr. Jennifer Tufts (03:49:53):
She was planning on making another appointment. I don't know when that second appointment was scheduled.
Prosecutor 2 (03:50:05):
That first appointment where she was seeming depressed and having issues with Zoloft on October 20th, did you tell her to stop taking the medication at that point?
Dr. Jennifer Tufts (03:50:14):
Yes, I did.
Prosecutor 2 (03:50:15):
Okay. And did you discuss other options with her other than medication, like natural remedies?
Dr. Jennifer Tufts (03:50:21):
Yes.
Prosecutor 2 (03:50:22):
And what type of natural remedies did you discuss with Ms. Clancy?
Dr. Jennifer Tufts (03:50:26):
So I mentioned things like fish oils, something called L-methylfolate or seam. These are supplements.
Prosecutor 2 (03:50:36):
And why would you offer alternative remedies to a patient?
Dr. Jennifer Tufts (03:50:41):
So it was because she seemed reluctant to start a prescribed medication. I thought she might be more open to something that was natural.
Prosecutor 2 (03:50:52):
So you weren't pushing her to take a prescription medication, correct?
Dr. Jennifer Tufts (03:50:57):
No.
Prosecutor 2 (03:51:04):
Now, on October 21st, when you saw her, did she tell you that she hadn't been able to get any sleep the night before?
Dr. Jennifer Tufts (03:51:11):
Yes.
Prosecutor 2 (03:51:13):
You've already said she told you she wasn't having audio or visual hallucinations, correct?
Dr. Jennifer Tufts (03:51:18):
Yes.
Prosecutor 2 (03:51:18):
Did you ask her if she was having suicidal ideation or homicidal ideation?
Dr. Jennifer Tufts (03:51:22):
Yes.
Prosecutor 2 (03:51:23):
What was her response?
Dr. Jennifer Tufts (03:51:24):
No.
Prosecutor 2 (03:51:26):
What was her affect that day?
Dr. Jennifer Tufts (03:51:27):
She was depressed.
Prosecutor 2 (03:51:42):
Did she tell you during your conversation that day that she had been anxious all day, not depressed or irritable, getting better?
Dr. Jennifer Tufts (03:51:51):
Yes.
Prosecutor 2 (03:51:52):
Okay. So she's telling you she's not depressed, but her affect to you appeared depressed. Is that correct?
Dr. Jennifer Tufts (03:51:58):
Yes.
Prosecutor 2 (03:52:00):
And is that for the same reasons you stated earlier, those visual cues that you saw?
Dr. Jennifer Tufts (03:52:04):
Yes.
Prosecutor 2 (03:52:06):
Did she appear hyper or manic in any way?
Dr. Jennifer Tufts (03:52:10):
No.
Prosecutor 2 (03:52:10):
Was there any changes in her rate of speech or pattern of speech?
Dr. Jennifer Tufts (03:52:14):
No.
Prosecutor 2 (03:52:16):
Was there any difference in her mental status exam?
Dr. Jennifer Tufts (03:52:26):
No.
Prosecutor 2 (03:52:33):
This appointment, was this appointment virtual as well?
Dr. Jennifer Tufts (03:52:36):
Yes.
Prosecutor 2 (03:52:37):
Had all your appointments up to this point been virtual?
Dr. Jennifer Tufts (03:52:39):
Yes.
Prosecutor 2 (03:52:40):
Was she alone in that virtual meeting?
Dr. Jennifer Tufts (03:52:43):
Yes.
Prosecutor 2 (03:52:45):
What was the plan that was formulated on October 21st?
Dr. Jennifer Tufts (03:52:59):
The plan was that she start a medication called Ativan to be taken as needed, which means not necessarily every day, but in the instance of severe anxiety.
Prosecutor 2 (03:53:14):
How did you explain to Ms. Clancy when to take the medication?
Dr. Jennifer Tufts (03:53:20):
I don't remember exactly how I explained that.
Prosecutor 2 (03:53:22):
Okay. So in general, as a psychiatrist, when you're prescribing a medication like Ativan and you're telling a patient to take as needed, what does that mean?
Dr. Jennifer Tufts (03:53:33):
It means when the symptoms are present, and in this case in particular, when the symptoms are severe.
Prosecutor 2 (03:53:42):
So with Ms. Clancy, what were the symptoms that she was experiencing that made you decide that Ativan would be an appropriate medication?
Dr. Jennifer Tufts (03:53:51):
Anxiety.
Prosecutor 2 (03:53:53):
So would it be when she was feeling anxious, feeling those symptoms of the anxiety, that she should take the medication?
Dr. Jennifer Tufts (03:53:58):
Yes.
Prosecutor 2 (03:53:59):
What was the dose again?
Dr. Jennifer Tufts (03:54:00):
0.5.
Prosecutor 2 (03:54:02):
What's the lowest dose of Ativan you can give?
Dr. Jennifer Tufts (03:54:05):
0.5.
Prosecutor 2 (03:54:05):
What's the highest dose?
Dr. Jennifer Tufts (03:54:08):
Maybe two.
Prosecutor 2 (03:54:10):
So you started her at the lowest dose, the 0.5?
Dr. Jennifer Tufts (03:54:12):
Yes.
Prosecutor 2 (03:54:18):
Was there a specific timeframe that you wanted her to try this in?
Dr. Jennifer Tufts (03:54:23):
Yes. This was for one week.
Prosecutor 2 (03:54:26):
Was the prescription for a one week amount or is it hard to tell that because it's as needed?
Dr. Jennifer Tufts (03:54:35):
It's hard to tell that without seeing exactly how many pills were prescribed.
Prosecutor 2 (03:54:43):
Was there also, again, a recommendation to go to Ms. McAllister for therapy?
Dr. Jennifer Tufts (03:54:48):
Yes.
Prosecutor 2 (03:54:59):
When were you recommending follow-up with Ms. Clancy?
Dr. Jennifer Tufts (03:55:03):
One week.
Prosecutor 2 (03:55:04):
Why a short turnaround at this point?
Dr. Jennifer Tufts (03:55:08):
Because she was still having very significant symptoms.
Prosecutor 2 (03:55:14):
Did you in fact see her on October 26th, 2022?
Dr. Jennifer Tufts (03:55:17):
Yes.
Prosecutor 2 (03:55:27):
At that appointment, what was Ms. Clancy's affect?
Dr. Jennifer Tufts (03:55:36):
Depressed.
Prosecutor 2 (03:55:38):
What was her mood according to her?
Dr. Jennifer Tufts (03:55:40):
It was anxious and depressed.
Prosecutor 2 (03:55:43):
Did you discuss with her whether she was taking the Ativan and whether it was working?
Dr. Jennifer Tufts (03:55:51):
She said that it was not helpful for her sleep, but it made her feel less anxious.
Prosecutor 2 (03:55:59):
In this appointment, there was a discussion of Benadryl. Is that correct?
Dr. Jennifer Tufts (03:56:06):
She reported that Benadryl was something she had tried and it was helpful. It was taken over the counter.
Prosecutor 2 (03:56:13):
Had you recommended or told her to take the Benadryl at that point?
Dr. Jennifer Tufts (03:56:18):
I don't think so.
Prosecutor 2 (03:56:20):
So when you met with her and she told you that she had taken the Benadryl and it had helped, what was your reaction to that?
Dr. Jennifer Tufts (03:56:27):
I was glad that something was helping.
Prosecutor 2 (03:56:31):
Did she tell you how often she was taking it or how much of it she was taking?
Dr. Jennifer Tufts (03:56:36):
I don't recall.
Prosecutor 2 (03:56:40):
Did you ask her that day if she had any suicidal or homicidal ideation?
Dr. Jennifer Tufts (03:56:44):
Yes.
Prosecutor 2 (03:56:44):
What was the response?
Dr. Jennifer Tufts (03:56:45):
No.
Prosecutor 2 (03:56:46):
Did you see any signs of psychosis that day?
Dr. Jennifer Tufts (03:56:49):
No.
Prosecutor 2 (03:56:51):
Up to that point on October 26th, 2022, had you ever had any difficulties in communicating with Ms. Clancy?
Dr. Jennifer Tufts (03:56:59):
No.
Prosecutor 2 (03:57:00):
Ever any difficulties understanding her or thinking she wasn't understanding what you were saying?
Dr. Jennifer Tufts (03:57:05):
No.
Prosecutor 2 (03:57:08):
At this appointment on October 26th, 2022, did she tell you that she had scheduled an appointment for therapy with Ms. McAllister?
Dr. Jennifer Tufts (03:57:18):
I don't remember. Oh, yes, she did. She said she has an upcoming appointment.
Prosecutor 2 (03:57:23):
What was the plan after meeting with Ms. Clancy on the 26th?
Dr. Jennifer Tufts (03:57:38):
At that point, we discussed trying a new medication because she felt that whatever side effects were caused by the Zoloft had resolved, but she still had the same anxiety that she had had beforehand. So we discussed starting the medication BuSpar at five milligrams twice a day.
Prosecutor 2 (03:57:57):
What is the lowest dose of BuSpar?
Dr. Jennifer Tufts (03:57:59):
Five milligrams.
Prosecutor 2 (03:58:00):
What is the highest dose you can prescribe?
Dr. Jennifer Tufts (03:58:03):
The pills probably come up to 30 and multiple 30 pills taken per day.
Prosecutor 2 (03:58:10):
So you could prescribe someone more than 30 milligrams per day?
Dr. Jennifer Tufts (03:58:14):
A total dose of 60.
Prosecutor 2 (03:58:16):
Okay. So you started her again at the lowest dose?
Dr. Jennifer Tufts (03:58:20):
Yes.
Prosecutor 2 (03:58:22):
Why did you choose BuSpar?
Dr. Jennifer Tufts (03:58:25):
BuSpar is very well-tolerated. It's a very mild medicine, especially for someone who is experiencing side effects from another medication.
Prosecutor 2 (03:58:36):
What does BuSpar do?
Dr. Jennifer Tufts (03:58:38):
It lowers anxiety.
Prosecutor 2 (03:58:41):
Was she to continue taking the Ativan with the BuSpar?
Dr. Jennifer Tufts (03:58:45):
She could continue taking it as needed if she were to have those extreme moments of anxiety.
Prosecutor 2 (03:58:52):
So would it be that the BuSpar was twice a day and then if she felt really anxious, she could take an Ativan?
Dr. Jennifer Tufts (03:58:59):
Yes, because given that low dose of the buspirone, it might not have been enough of a dose to be effective right away.
Prosecutor 2 (03:59:06):
BuSpar and buspirone are the same thing?
Dr. Jennifer Tufts (03:59:09):
Yes. Sorry.
Prosecutor 2 (03:59:11):
There's also a note in here prescribing hydroxyzine 25 milligrams daily as needed for anxiety. What is that?
Dr. Jennifer Tufts (03:59:19):
Hydroxyzine is an antihistamine. It's similar to the Benadryl that she had been taking for sleep. So I recommended that she try the hydroxyzine. It is a safer medicine to take compared to the Ativan. So if someone is feeling very anxious and they can take a hydroxyzine and that prevents them from needing to take the Ativan, that's good. So I wanted her to at least try that option instead.
Prosecutor 2 (03:59:49):
So you gave her several options on how to deal with the anxiety as it appeared each day. Is that correct?
Dr. Jennifer Tufts (03:59:54):
Yes.
Prosecutor 2 (03:59:55):
Why take hydroxyzine, which is an antihistamine, instead of just taking the Benadryl?
Dr. Jennifer Tufts (04:00:02):
They're very similar, but hydroxyzine is indicated for anxiety, whereas Benadryl is really indicated for allergies.
Prosecutor 2 (04:00:13):
You discussed this plan with Ms. Clancy and did she agree to that plan?
Dr. Jennifer Tufts (04:00:18):
Yes.
Prosecutor 2 (04:00:20):
In discussing it with her, did you go over all the possible side effects and the interactions of the medications that you had prescribed?
Dr. Jennifer Tufts (04:00:26):
Yes.
Prosecutor 2 (04:00:27):
Did she voice any concerns about any of that?
Dr. Jennifer Tufts (04:00:29):
No. I mean, I think she was still apprehensive about starting a new medicine and about potential side effects, but nothing specific.
Prosecutor 2 (04:00:41):
So it was a general concern about medication in general?
Dr. Jennifer Tufts (04:00:44):
Yes.
Prosecutor 2 (04:00:45):
But after you had the conversation and explained what you were recommending and prescribing, did she agree to that plan?
Dr. Jennifer Tufts (04:00:52):
Yes.
Prosecutor 2 (04:00:54):
Was there any change in her mental status that day?
Dr. Jennifer Tufts (04:00:57):
No.
Prosecutor 2 (04:01:08):
Now going to the next time that you saw Ms. Clancy, was that October 30... I'm sorry, was her next appointment on October 31st with Jennifer McAllister?
Dr. Jennifer Tufts (04:01:19):
Yes.
Prosecutor 2 (04:01:21):
So you were able to review in the records in preparation for your next appointment that she had in fact went to a therapy appointment. Is that correct?
Dr. Jennifer Tufts (04:01:30):
Yes.
Prosecutor 2 (04:01:35):
And the therapy appointment, was that approximately an hour long appointment with Ms. McAllister?
Dr. Jennifer Tufts (04:01:39):
Yes.
Prosecutor 2 (04:01:43):
When was your next appointment with Ms. Clancy?
Dr. Jennifer Tufts (04:01:48):
November 2nd.
Prosecutor 2 (04:01:55):
On that date, was that also a virtual appointment?
Dr. Jennifer Tufts (04:01:59):
Yes.
Prosecutor 2 (04:02:00):
Do you know whether the therapy appointment with Ms. McAllister was in person or virtual?
Dr. Jennifer Tufts (04:02:07):
I'm not 100% sure, but I think it was virtual.
Prosecutor 2 (04:02:11):
Okay. And up to this point, had Ms. Clancy ever told you that she didn't want to do virtual, that she wanted to come in person?
Dr. Jennifer Tufts (04:02:20):
No.
Prosecutor 2 (04:02:22):
Now, on this November 2nd appointment, did you have a discussion about the BuSpar?
Dr. Jennifer Tufts (04:02:27):
Yes.
Prosecutor 2 (04:02:28):
What was that discussion?
Dr. Jennifer Tufts (04:02:30):
She did not start it. She was too afraid to start a new medication.
Prosecutor 2 (04:02:37):
Did she tell you that she had continued with the Ativan and the Benadryl?
Dr. Jennifer Tufts (04:02:42):
She said she continued with the Ativan.
Prosecutor 2 (04:02:45):
Ativan. Was there any further discussion about the Benadryl or the other antihistamine that you had prescribed, the hydroxyzine? Hope I'm saying that correctly.
Dr. Jennifer Tufts (04:02:55):
You are. And I'm not sure. I don't think there was much conversation about the Benadryl or the hydroxyzine.
Prosecutor 2 (04:03:00):
Okay. What was her affect that day?
Dr. Jennifer Tufts (04:03:09):
It appeared appropriate.
Prosecutor 2 (04:03:13):
What was her mood? How did she report feeling?
Dr. Jennifer Tufts (04:03:16):
Euthymic.
Prosecutor 2 (04:03:17):
What does that mean?
Dr. Jennifer Tufts (04:03:18):
Euthymic means a normal mood, not necessarily sad or angry or euphoric. It's just neutral, in the middle.
Prosecutor 2 (04:03:29):
Would that have been a word coming from Ms. Clancy or just the word you used to describe?
Dr. Jennifer Tufts (04:03:33):
It's a clinical word.
Prosecutor 2 (04:03:34):
Clinical. Did you ask her if she had any suicidal or homicidal ideation?
Dr. Jennifer Tufts (04:03:41):
Yes.
Prosecutor 2 (04:03:41):
What was her response?
Dr. Jennifer Tufts (04:03:42):
No.
Prosecutor 2 (04:03:43):
Did you see any signs of psychosis present in her that day?
Dr. Jennifer Tufts (04:03:45):
No.
Prosecutor 2 (04:03:47):
That day, did you discuss alternatives to Ativan?
Dr. Jennifer Tufts (04:03:52):
Yes.
Prosecutor 2 (04:03:52):
Why were you discussing alternatives to the Ativan?
Dr. Jennifer Tufts (04:03:56):
Because Ativan was not a medication I intended for her to be taking for a long period of time. It was a short-term medication.
Prosecutor 2 (04:04:05):
Why is that?
Dr. Jennifer Tufts (04:04:06):
Because it does have a risk of dependency when people take it for a long period of time and especially at high doses.
Prosecutor 2 (04:04:14):
So did you bring up this discussion about alternatives to Ativan or did Ms. Clancy ask about it?
Dr. Jennifer Tufts (04:04:21):
I think that was something I brought up.
Prosecutor 2 (04:04:24):
What were the alternatives that you discussed with her?
Dr. Jennifer Tufts (04:04:28):
Remeron, trazodone, pregabalin, and hydroxyzine.
Prosecutor 2 (04:04:34):
What was it about those medications that you thought they would be appropriate for Ms. Clancy?
Dr. Jennifer Tufts (04:04:40):
That they might be safer medications that could also help her with sleep, also help her with some of the anxiety.
Prosecutor 2 (04:04:49):
How are they safer?
Dr. Jennifer Tufts (04:04:51):
So they don't have that risk of the dependency.
Prosecutor 2 (04:04:56):
While you're interacting with her and discussing the alternatives to Ativan, what was her mental status that day? Was there any change in it?
Dr. Jennifer Tufts (04:05:14):
No.
Prosecutor 2 (04:05:16):
So after this discussion with her about the alternatives, was there a decision made on how to proceed?
Dr. Jennifer Tufts (04:05:24):
Yes. We discussed tapering the Ativan by 0.25 milligrams every two weeks.
Prosecutor 2 (04:05:38):
What does tapering mean?
Dr. Jennifer Tufts (04:05:40):
It means slowly reducing.
Prosecutor 2 (04:05:41):
Why do you slowly reduce the medication?
Dr. Jennifer Tufts (04:05:45):
When you are taking Ativan, like I mentioned, the risks of dependency, there's also risks of withdrawal symptoms if a medication like that is abruptly stopped. So that's why we gradually decrease it.
Prosecutor 2 (04:06:00):
So if the plan was to decrease it by 0.25 milligrams a week, what amount was she taking per week?
Dr. Jennifer Tufts (04:06:08):
It was by 0.25 milligrams every two weeks.
Prosecutor 2 (04:06:11):
Two weeks. Okay.
Dr. Jennifer Tufts (04:06:12):
So at first, we were decreasing it from one to 0.75.
Prosecutor 2 (04:06:15):
Okay. So it was a one milligram pill that she was taking and then she would just take less and less and less until she wasn't taking it any longer?
Dr. Jennifer Tufts (04:06:26):
Yes.
Prosecutor 2 (04:06:27):
Okay. And then, had you with Ms. Clancy decided on a replacement for the Ativan?
Dr. Jennifer Tufts (04:06:37):
At this point, I don't think there was a medicine that we had decided on.
Prosecutor 2 (04:06:42):
Okay. So the plan at that point was just to taper off the Ativan, but nothing was added at that point?
Dr. Jennifer Tufts (04:06:46):
Yes.
Prosecutor 2 (04:06:52):
Did you next see Ms. Clancy on November 22nd, 2022?
Dr. Jennifer Tufts (04:06:57):
Yes.
Prosecutor 2 (04:06:59):
Do you recall why there was a 20-day gap between seeing her on the 2nd and then seeing her on the 22nd?
Dr. Jennifer Tufts (04:07:08):
Well, I'm not sure. I would really be guessing if I said.
Prosecutor 2 (04:07:13):
Okay. Did you learn at that appointment on November 22nd of 2022 that Ms. Clancy had started another program?
Dr. Jennifer Tufts (04:07:23):
Yes.
Prosecutor 2 (04:07:23):
What program was that?
Dr. Jennifer Tufts (04:07:24):
It was a South Shore Perinatal Mental Health Clinic.
Prosecutor 2 (04:07:30):
Was that the first that you learned of Ms. Clancy being involved in that program?
Dr. Jennifer Tufts (04:07:34):
Yes.
Prosecutor 2 (04:07:36):
Did she tell you she was thinking about doing it or that she was already enrolled in that program?
Dr. Jennifer Tufts (04:07:40):
That she was enrolled in it. It sounded like she was going to be transferring her care there.
Prosecutor 2 (04:07:46):
Okay. Did she tell you that she was starting a new medication?
Dr. Jennifer Tufts (04:07:52):
Yes.
Prosecutor 2 (04:07:53):
What did she tell you she was starting?
Dr. Jennifer Tufts (04:07:54):
She said she was going to start Prozac.
Prosecutor 2 (04:07:58):
Did she also tell you what she was currently using for medication?
Dr. Jennifer Tufts (04:08:03):
Yes.
Prosecutor 2 (04:08:04):
What was that?
Dr. Jennifer Tufts (04:08:04):
The Ativan and the Benadryl.
Prosecutor 2 (04:08:07):
Did she tell you that was for sleep as needed?
Dr. Jennifer Tufts (04:08:10):
Yes.
Prosecutor 2 (04:08:11):
So you had put in place a plan on November 2nd to tape her off the Ativan, but on November 22nd, she was still on the Ativan. Is that correct?
Dr. Jennifer Tufts (04:08:22):
Yes.
Prosecutor 2 (04:08:23):
And had she tapered off or reduced the dose, to your knowledge?
Dr. Jennifer Tufts (04:08:36):
I don't have it documented exactly what dose she was taking on that date. She was just still taking the medicine.
Prosecutor 2 (04:08:42):
Still taking it. Okay. On that date, did Ms. Clancy deny suicidal and homicidal ideation?
Dr. Jennifer Tufts (04:08:50):
Yes.
Prosecutor 2 (04:08:50):
Did she show any signs of psychosis?
Dr. Jennifer Tufts (04:08:55):
No.
Prosecutor 2 (04:08:57):
Did she also tell you that she was going to be transferring her therapy care to that South Shore Perinatal Health Clinic?
Dr. Jennifer Tufts (04:09:05):
Yes.
Prosecutor 2 (04:09:07):
So basically, at that point, the plan was for her to receive her mental health care at the South Shore Perinatal Clinic and no longer see you? Was that the plan?
Dr. Jennifer Tufts (04:09:16):
Yes.
Prosecutor 2 (04:09:18):
Okay. Was there also discussion of a return to work letter that day?
Dr. Jennifer Tufts (04:09:21):
Yes.
Prosecutor 2 (04:09:22):
And did she request that from you?
Dr. Jennifer Tufts (04:09:24):
Yes.
Prosecutor 2 (04:09:26):
Did you give her a return to work letter?
Dr. Jennifer Tufts (04:09:28):
Yes.
Prosecutor 2 (04:09:30):
Was that authorizing her to return to work immediately or on January 1st as the previous form had said?
Dr. Jennifer Tufts (04:09:39):
I don't remember what date it was for her to return to work. I don't think it was immediate.
Prosecutor 2 (04:09:50):
Did you then have a further appointment with Ms. Clancy on December 1st, 2022?
Dr. Jennifer Tufts (04:10:00):
Yes.
Prosecutor 2 (04:10:01):
And how is it that she was planning on transferring care to the South Shore Perinatal Clinic on November 22nd, but then on December 1st, she has an appointment with you?
Dr. Jennifer Tufts (04:10:14):
Patients can schedule their own appointments. I'm not involved in the scheduling. I can schedule a patient an appointment if someone asks me to, but they can schedule it without my awareness. So she had scheduled it.
Prosecutor 2 (04:10:27):
Okay. So she hadn't reached out to you in advance to ask about it. She just scheduled an appointment with you for December 1st, 2022. Is that correct?
Dr. Jennifer Tufts (04:10:34):
Yes.
Prosecutor 2 (04:10:35):
Okay. And in that appointment, did she tell you that she ended up not returning to work?
Dr. Jennifer Tufts (04:10:42):
Yes.
Prosecutor 2 (04:10:46):
What was discussed at that appointment?
Dr. Jennifer Tufts (04:10:49):
That she wasn't getting better.
Prosecutor 2 (04:10:52):
In what ways wasn't she getting better?
Dr. Jennifer Tufts (04:10:55):
She had tried the Ativan taper, but without the Ativan, she was having a lot of difficulty sleeping. So she tried a few different medications, a few different medication combinations, but she was having trouble with them.
Prosecutor 2 (04:11:13):
Did she tell you what types of medication she had tried?
Dr. Jennifer Tufts (04:11:17):
Yes.
Prosecutor 2 (04:11:18):
What were those?
Dr. Jennifer Tufts (04:11:19):
Trazodone 50 to 150 milligrams was minimal effect. Ativan and Benadryl combination was helpful. Then she added the Prozac 10 milligrams with the Ativan and Benadryl to help with the sleep, but she still had worse sleep, so that was stopped. Then she tried a combination of Remeron with Klonopin, but she felt disoriented, had rebound anxiety, and it was of minimal help. Then she tried Remeron and Seroquel. And actually that was prescribed, but she didn't take it.
Prosecutor 2 (04:12:04):
These medications that she was talking to you about, those weren't prescribed by you, correct?
Dr. Jennifer Tufts (04:12:08):
Correct.
Prosecutor 2 (04:12:09):
Did she tell you that those had been prescribed by her provider at South Shore Perinatal Clinic?
Dr. Jennifer Tufts (04:12:13):
Yes.
Prosecutor 2 (04:12:14):
And what is trazodone?
Dr. Jennifer Tufts (04:12:20):
The category is an antidepressant, but the doses that we use are low, so it's really a sleep medicine.
Prosecutor 2 (04:12:28):
What is the lowest dose of trazodone?
Dr. Jennifer Tufts (04:12:30):
50.
Prosecutor 2 (04:12:31):
And what is the highest?
Dr. Jennifer Tufts (04:12:32):
It can go very high, up to maybe 600.
Prosecutor 2 (04:12:35):
Okay. So the 50 to 150 milligrams that Ms. Clancy told you she had taken, is that on the lower end of the dosage?
Dr. Jennifer Tufts (04:12:44):
Yes. It's the commonly prescribed dose, again, because it's mostly used as a sleep medicine. So those are the normal ranges.
Prosecutor 2 (04:12:52):
Okay. And Prozac, I think you had said earlier was an SSRI?
Dr. Jennifer Tufts (04:12:57):
Yes.
Prosecutor 2 (04:12:58):
That was a medication Ms. Clancy had told you she had taken in nursing school, correct?
Dr. Jennifer Tufts (04:13:02):
Yes.
Prosecutor 2 (04:13:03):
With no side effects then?
Dr. Jennifer Tufts (04:13:04):
Yes.
Prosecutor 2 (04:13:05):
And she told you on December 1st, 2022, that the Prozac had worsened her sleep?
Dr. Jennifer Tufts (04:13:11):
Yes.
Prosecutor 2 (04:13:13):
Then, what is Remeron?
Dr. Jennifer Tufts (04:13:15):
Remeron is mirtazapine.
Prosecutor 2 (04:13:17):
What's that?
Dr. Jennifer Tufts (04:13:18):
It's another antidepressant.
Prosecutor 2 (04:13:20):
What is Klonopin?
Dr. Jennifer Tufts (04:13:22):
It is a benzodiazepine like the Ativan.
Prosecutor 2 (04:13:26):
So prescribing Remeron as an antidepressant and Klonopin as an anxiety medication, is that an unusual combination?
Dr. Jennifer Tufts (04:13:35):
No.
Prosecutor 2 (04:13:39):
Then she told you she had been prescribed Remeron and Seroquel, but hadn't started that, correct?
Dr. Jennifer Tufts (04:13:43):
I think she had started the Remeron, but maybe hadn't started the Seroquel yet.
Prosecutor 2 (04:13:49):
Okay. Did she also tell you that she was having some intrusive thoughts on the Remeron, so she was planning on stopping?
Dr. Jennifer Tufts (04:13:57):
Yes.
Prosecutor 2 (04:13:57):
Did she tell you what those intrusive thoughts were?
Dr. Jennifer Tufts (04:14:00):
She said it was a feeling like I'm going to die.
Prosecutor 2 (04:14:04):
Not a feeling that she wanted to kill herself, but a feeling like she was going to die?
Dr. Jennifer Tufts (04:14:07):
Yes.
Prosecutor 2 (04:14:10):
Did you ask her if she had suicidal ideation?
Dr. Jennifer Tufts (04:14:12):
Yes.
Prosecutor 2 (04:14:12):
What was her response?
Dr. Jennifer Tufts (04:14:14):
She denied having suicidal ideation, but she was feeling pretty badly. She said she was close to it, meaning close to having some suicidal thoughts, and that she was feeling very hopeless, but she didn't have any active thoughts of hurting herself. Didn't have any intention of doing anything. Didn't have any plans.
Prosecutor 2 (04:14:40):
Did she also tell you, and this is a quote in the records on page 144, "I think it's my problem. I keep reaching out to different people and not sticking with the plan"?
Dr. Jennifer Tufts (04:14:51):
That's what I documented.
Prosecutor 2 (04:14:54):
Did you discuss that with her, that concern that she kept reaching out to different people and wouldn't stick with the plan?
Dr. Jennifer Tufts (04:15:01):
Yes. I advised that she have one person who is managing the medications.
Prosecutor 2 (04:15:10):
Why is that important?
Dr. Jennifer Tufts (04:15:13):
So that it's very clear what's happening.
Prosecutor 2 (04:15:20):
What is the importance, if any, of sticking with a plan, a mental health plan?
Dr. Jennifer Tufts (04:15:27):
Well, the importance of sticking with a plan, obviously, the psychiatrist comes up with a plan for very particular reasons. And so sticking with the plan is advisable.
Prosecutor 2 (04:15:43):
When you prescribed psychiatric medications, do those medications take effect immediately?
Dr. Jennifer Tufts (04:15:48):
No.
Prosecutor 2 (04:15:51):
How does that effect start to happen in a person?
Dr. Jennifer Tufts (04:15:54):
Well, it depends which medicine. Some medicines do work very quickly, like the benzodiazepines, Ativan and Klonopin. But the medicines that prevent anxiety, the medicines that prevent depression, those do take a long time to actually kick in.
Prosecutor 2 (04:16:11):
Why is that?
Dr. Jennifer Tufts (04:16:13):
The way that the medications interact with the brain, the serotonin receptors, the way that they change the neurotransmitters, it takes time for those changes to happen.
Prosecutor 2 (04:16:26):
Okay. Now, did you also talk to Ms. Clancy about bipolar disorder that day?
Dr. Jennifer Tufts (04:16:35):
Yes.
Prosecutor 2 (04:16:36):
Why did you do that?
Dr. Jennifer Tufts (04:16:38):
It was mentioned because of the poor reaction she had had to some of her medications, the insomnia. So we discussed whether these side effects she was experiencing indicated she had bipolar disorder, but when that was assessed, it was not deemed that she had bipolar disorder.
Prosecutor 2 (04:17:05):
And why was that?
Dr. Jennifer Tufts (04:17:06):
Because she really didn't meet the criteria.
Prosecutor 2 (04:17:10):
What criteria didn't she meet?
Dr. Jennifer Tufts (04:17:13):
There's a number of different criteria for bipolar disorder, specifically looking at mania because she did have some symptoms of depression, but the other side is mania. The most important one is euphoria. So actually seven days of continued euphoria with very high energy levels, that's the most important one. But then in addition to that, you need some other things, like potentially pressured speech, grandiosity, which is a person feeling superhuman or godlike. You might see increased risk-taking behaviors. Usually those are significant risks like somebody having affairs or using drugs, things that really negatively impact their life. The person might have a decreased need for sleep, which is not just insomnia, but it's truly not needing the sleep and having enormous amounts of energy otherwise.
Prosecutor 2 (04:18:16):
What is pressured speech?
Dr. Jennifer Tufts (04:18:17):
It means talking very fast, so fast that it's really hard to interrupt them.
Prosecutor 2 (04:18:23):
Did you ask Ms. Clancy on December 1st, questions that would potentially elicit whether or not she met that criteria?
Dr. Jennifer Tufts (04:18:33):
Yes.
Prosecutor 2 (04:18:34):
Did any of her responses to your questions indicate any instances of mania in her past or present?
Dr. Jennifer Tufts (04:18:41):
No.
Prosecutor 2 (04:18:49):
What was the plan going forward from that day?
Dr. Jennifer Tufts (04:18:54):
At this point, she was still seeing the doctors or the providers at South Shore, and so they were still managing her medications. So the plan was that she had an appointment with them tomorrow. She was considering taking the Seroquel without the Remeron because she had had side effects with that, but that wasn't decided on. That was something to consider. We also talked about starting a medicine called Lamotrigine. I just gave her some information about the medicine. We also talked about her going to a partial hospitalization program, which provides extra support for people who are really struggling.
Prosecutor 2 (04:19:40):
Lamotrigine, is that Lamictal?
Dr. Jennifer Tufts (04:19:41):
Yes.
Prosecutor 2 (04:19:44):
Did you prescribe it to her that day or just discuss that option with her?
Dr. Jennifer Tufts (04:19:47):
Just discussed on that day.
Prosecutor 2 (04:19:49):
Why did you discuss that option with her?
Dr. Jennifer Tufts (04:19:52):
Because it was clear that she had depressive symptoms and she was not tolerating some of the other antidepressants. So I thought that that might be another option to explore.
Prosecutor 2 (04:20:07):
You also discussed with her a partial hospitalization program?
Dr. Jennifer Tufts (04:20:11):
Yes.
Prosecutor 2 (04:20:12):
Why did you do that?
Dr. Jennifer Tufts (04:20:13):
Because she was really having a hard time. She had mentioned those thoughts of feeling hopeless and the intrusive thoughts. So I referred her to a program that would provide extra support. It would be a program that she went to every single day. Not hospitalized. She could still stay at home and be with her family, but that she would have all day care every day for as long as that was needed.
Prosecutor 2 (04:20:43):
What program was that that you referred her to?
Dr. Jennifer Tufts (04:20:45):
The HRI program.
Prosecutor 2 (04:20:48):
What does HRI stand for?
Dr. Jennifer Tufts (04:20:49):
It's a hospital. I'm not sure what it stands for.
Prosecutor 2 (04:20:52):
Where is that program located?
Dr. Jennifer Tufts (04:20:54):
It's in Massachusetts. I think Brookline.
Prosecutor 2 (04:20:57):
When you referred her, when you You talked about that program with Ms. Clancy and referred her to that program, what was her response?
Dr. Jennifer Tufts (04:21:05):
Well, I gave her the information for it. It's a program where the patient can call and schedule their intake appointment, so I gave her that information.
Prosecutor 2 (04:21:13):
Okay. Was there any concern at that point? You had mentioned earlier that it's important to have one provider prescribing medication knowing what you're taking. You knew she was going to the South Shore Perinatal Program. Was there any concern about discussing medications with her, like Lamictal on the 1st, when you knew she was seeing these other providers?
Dr. Jennifer Tufts (04:21:40):
Well, she continued to see me in more of a supportive role, and I was just trying to help her give her as much information that could potentially be helpful. So it was something for her to discuss with the other providers.
Prosecutor 2 (04:21:58):
Did you ever reach out to South Shore to get those records or ask Lindsay for some type of waiver to get the South Shore records?
Dr. Jennifer Tufts (04:22:06):
No, I didn't. The reason why is because she was very aware of what the medications were. She was very able to communicate what the different treatment decisions were. She was very medically sophisticated, so I didn't think it was necessary.
Prosecutor 2 (04:22:27):
And you were aware she was a labor and delivery nurse, correct?
Dr. Jennifer Tufts (04:22:30):
Yes.
Prosecutor 2 (04:22:30):
So you were aware she was familiar with medications and she was able to communicate with you on a level that's not a typical patient, correct?
Dr. Jennifer Tufts (04:22:38):
Yes.
Prosecutor 2 (04:22:40):
Did you next see her on December 16th, 2022?
Dr. Jennifer Tufts (04:22:45):
Yes.
Prosecutor 2 (04:22:46):
Did you make that appointment with her or did she reach out as she did on the December 1st and make her own appointment?
Dr. Jennifer Tufts (04:22:53):
I'm not sure.
Prosecutor 2 (04:22:53):
Okay. And that appointment on December 16th, 2022, what did you discuss with her that day?
Dr. Jennifer Tufts (04:23:04):
She was still not feeling well. She said, "I'm having a really rough time." Though she said she found something that was helpful for her sleep, Valium and quetiapine, which is Seroquel. She said it finally works, but feeling very depressed during the day, no motivation. Had some SI, suicidal ideation. So she went to Mass General emergency room, declined inpatient. She was feeling hopeless, but didn't have any intent or suicidal plans.
Prosecutor 2 (04:23:41):
So when she told you that she had had some suicidal ideation, did you ask her specifics about that?
Dr. Jennifer Tufts (04:23:51):
Yes.
Prosecutor 2 (04:23:52):
What was her response?
Dr. Jennifer Tufts (04:23:54):
She described it as this hopelessness, like a fear of not getting better.
Dr. Jennifer Tufts (04:24:00):
Like a fear of not getting better.
Prosecutor 2 (04:24:04):
Did she have a plan to kill herself or a plan of how to kill herself?
Dr. Jennifer Tufts (04:24:09):
No.
Prosecutor 2 (04:24:11):
And you mentioned she told you she went to Mass General Hospital Emergency Department because of these feelings; is that correct?
Dr. Jennifer Tufts (04:24:17):
Yes.
Prosecutor 2 (04:24:18):
And did she tell you that they had offered her an inpatient program at McLean and she had turned them down?
Dr. Jennifer Tufts (04:24:25):
Yes.
Prosecutor 2 (04:24:26):
Did she tell you why she turned them down?
Dr. Jennifer Tufts (04:24:29):
I don't remember.
Prosecutor 2 (04:24:33):
Did she tell you about plans... Well, did she tell you what she was taking for medication at that point in the plans for medication?
Dr. Jennifer Tufts (04:24:40):
She said she was taking a mixture of the Valium and the quetiapine. And there was a plan to increase the quetiapine, but currently she was taking 200 milligrams.
Prosecutor 2 (04:24:53):
And did she also talk to you about the Women and Infants Program in Rhode Island?
Dr. Jennifer Tufts (04:25:03):
Yes.
Prosecutor 2 (04:25:04):
And what did she tell you about that?
Dr. Jennifer Tufts (04:25:05):
She said that she was referred and appointments were being scheduled.
Prosecutor 2 (04:25:10):
And were you familiar with that program?
Dr. Jennifer Tufts (04:25:12):
I've heard about it.
Prosecutor 2 (04:25:13):
Okay. What type of program is it?
Dr. Jennifer Tufts (04:25:15):
It's one of those partial hospitalization programs that I had mentioned, but it is focused on postpartum, so I thought that that was a good fit.
Prosecutor 2 (04:25:38):
Did she tell you during this appointment that she thought that her depression was related to the Seroquel?
Dr. Jennifer Tufts (04:25:47):
Yes.
Prosecutor 2 (04:25:48):
And did she tell you why she thought that?
Dr. Jennifer Tufts (04:25:51):
She thought there was some coinciding of the timing in which she started the Seroquel and started feeling more depressed.
Prosecutor 2 (04:26:04):
And did you note in the records that it was unclear if Seroquel was causing the depression as reported? She was more depressed the last visit before taking it?
Dr. Jennifer Tufts (04:26:15):
Yes.
Prosecutor 2 (04:26:16):
Can you just explain that, what your observations were?
Dr. Jennifer Tufts (04:26:18):
Yeah. I wasn't sure if the Seroquel was making her worse because she did already seem depressed before she had started the Seroquel, so I wasn't sure. I thought it was possible, but-
Prosecutor 2 (04:26:33):
What was the plan going forward from that appointment?
Dr. Jennifer Tufts (04:26:37):
The plan was for her to go to this Women and Infants Program and, if she was having more suicidal thoughts, to go back to the emergency room.
Prosecutor 2 (04:26:47):
And was she also planning to start Lamictal 25 milligrams daily?
Dr. Jennifer Tufts (04:26:53):
Yes. At that moment, given how the depression was continuing and worsening, I did feel like after we had discussed the Lamictal numerous times that I did need to step in and prescribe that for her.
Prosecutor 2 (04:27:11):
And you prescribed the 25 milligram daily dose for her?
Dr. Jennifer Tufts (04:27:14):
Yes.
Prosecutor 2 (04:27:15):
What's the lowest level of Lamictal that you would prescribe?
Dr. Jennifer Tufts (04:27:17):
25.
Prosecutor 2 (04:27:18):
And what's the highest?
Dr. Jennifer Tufts (04:27:21):
In psychiatry, typically 200, but, I mean, it really can go up to 400 or 500.
Prosecutor 2 (04:27:27):
And so again, you prescribed the lowest dose to start with, correct?
Dr. Jennifer Tufts (04:27:30):
Yes.
Prosecutor 2 (04:27:31):
And was she to continue with the Seroquel that she had been prescribed by the South Shore Perinatal Program?
Dr. Jennifer Tufts (04:27:39):
Yes.
Prosecutor 2 (04:27:40):
And what about Valium?
Dr. Jennifer Tufts (04:27:45):
I didn't make a recommendation on the Valium. I think there was a plan already in place on tapering it that I supported.
Prosecutor 2 (04:27:56):
And did you do anything in terms of reaching out to her providers at South Shore Perinatal to let them know you were adding a prescription, or did you communicate with Ms. Clancy about letting her providers know?
Dr. Jennifer Tufts (04:28:10):
I communicated with Lindsay about that. And she was so good at giving me all of these updates about what she did with them, I figured she would tell them when she next saw them.
Prosecutor 2 (04:28:25):
And did she tell you that she would update them?
Dr. Jennifer Tufts (04:28:27):
I believe so.
Prosecutor 2 (04:28:31):
Was the next time you saw Ms. Clancy on January 6th, 2023?
Dr. Jennifer Tufts (04:28:37):
Yes.
Prosecutor 2 (04:28:38):
And how did that appointment come about?
Dr. Jennifer Tufts (04:28:45):
Again, I don't often do the scheduling. I'm not sure exactly whether I had scheduled that or she had.
Prosecutor 2 (04:28:56):
Did you learn during that appointment that Ms. Clancy had just been discharged from McLean Hospital?
Dr. Jennifer Tufts (04:29:02):
Yes.
Prosecutor 2 (04:29:03):
And what, if anything, did Ms. Clancy tell you about her current mental state and what had happened between your last appointment on December 16th and now this appointment on January 6th?
Dr. Jennifer Tufts (04:29:18):
She was continuing to feel depressed and attributing it to the Seroquel that she had been taking, so the idea was going to McLean so that she could be safely taken off of the Seroquel.
Prosecutor 2 (04:29:35):
And was it at McLean, according to Ms. Clancy, that she had tapered off the Seroquel?
Dr. Jennifer Tufts (04:29:40):
Yes.
Prosecutor 2 (04:29:40):
And so on January 6th, did she tell you what she was prescribed at that time?
Dr. Jennifer Tufts (04:29:45):
Yes.
Prosecutor 2 (04:29:46):
And what was that?
Dr. Jennifer Tufts (04:29:47):
Trazodone 100 milligrams, Ativan one milligram, and melatonin five milligrams.
Prosecutor 2 (04:29:54):
Okay. And are these all low doses of these medications?
Dr. Jennifer Tufts (04:29:58):
Yes.
Prosecutor 2 (04:29:59):
Did you ask her if she had current suicidal ideation?
Dr. Jennifer Tufts (04:30:02):
Yes.
Prosecutor 2 (04:30:03):
And what did she say?
Dr. Jennifer Tufts (04:30:04):
No.
Prosecutor 2 (04:30:05):
Did you ask her if she had homicidal ideation?
Dr. Jennifer Tufts (04:30:07):
Yes.
Prosecutor 2 (04:30:08):
And what was her response?
Dr. Jennifer Tufts (04:30:09):
No.
Prosecutor 2 (04:30:10):
Did you observe any signs or symptoms of psychosis in her presentation, answers, or behavior?
Dr. Jennifer Tufts (04:30:15):
No, I did not.
Prosecutor 2 (04:30:18):
Did you ask her about whether she was having side effects from these medications, the Trazodone and the Ativan and the melatonin?
Dr. Jennifer Tufts (04:30:25):
Yes.
Prosecutor 2 (04:30:26):
What was her response?
Dr. Jennifer Tufts (04:30:28):
The only side effect she felt was that potentially when the Ativan would wear off... She would take it at night and then in the morning it would wear off, and she would feel more anxious after it wore off.
Prosecutor 2 (04:30:41):
And in terms of the Trazodone, did she say she had any side effects from the Trazodone?
Dr. Jennifer Tufts (04:30:46):
No.
Prosecutor 2 (04:30:48):
And melatonin, what is melatonin?
Dr. Jennifer Tufts (04:30:50):
Melatonin is a chemical that the brain makes that tells us it's time to go to sleep. It's associated with the circadian rhythm. It's not a prescription, actually, it's a medicine that you can pick up over the counter at the pharmacy.
Prosecutor 2 (04:31:05):
And is it just to help regulate sleep?
Dr. Jennifer Tufts (04:31:07):
Yes.
Prosecutor 2 (04:31:11):
What was her mood according to Ms. Clancy on that date?
Dr. Jennifer Tufts (04:31:18):
She was feeling numb.
Prosecutor 2 (04:31:20):
Numb?
Dr. Jennifer Tufts (04:31:21):
Numb.
Prosecutor 2 (04:31:23):
Did that cause you any concern?
Dr. Jennifer Tufts (04:31:26):
Yes.
Prosecutor 2 (04:31:27):
And why is that?
Dr. Jennifer Tufts (04:31:28):
Well, she still appeared quite depressed.
Prosecutor 2 (04:31:32):
And in what way? Was that her affect?
Dr. Jennifer Tufts (04:31:35):
It was, yes. Her affect was congruent, meaning it was the same as her mood.
Prosecutor 2 (04:31:45):
Just so we can understand, if I tell you I'm happy and I appear happy, is that congruent?
Dr. Jennifer Tufts (04:31:52):
Yes.
Prosecutor 2 (04:31:53):
And if I tell you I'm happy, but I appear sad, is that incongruent?
Dr. Jennifer Tufts (04:31:56):
Yes.
Prosecutor 2 (04:31:57):
And is that important when evaluating a patient?
Dr. Jennifer Tufts (04:32:00):
Yes.
Prosecutor 2 (04:32:00):
And why is that?
Dr. Jennifer Tufts (04:32:02):
Sometimes it's not congruent, and there could be all sorts of reasons why, but it's just something to pay attention to.
Prosecutor 2 (04:32:10):
Okay. And so on this day, though, her mood and her affect were congruent?
Dr. Jennifer Tufts (04:32:16):
Yes.
Prosecutor 2 (04:32:16):
Okay. And was there a plan formulated on that day?
Dr. Jennifer Tufts (04:32:28):
Yes. The plan on that day was to increase the Trazodone to 150 milligrams. She had previously taken that dose and tolerated it well. And she had just come off of the Seroquel at Mass General, or sorry, at McLean, so we were still in a phase where we were monitoring to see if the depression might get better off of that medicine.
Prosecutor 2 (04:32:56):
And is that why you didn't immediately prescribe a new antidepressant?
Dr. Jennifer Tufts (04:33:00):
Yes.
Prosecutor 2 (04:33:02):
And was she to continue the Ativan at one milligram per night and the melatonin at five milligrams per night?
Dr. Jennifer Tufts (04:33:09):
Yes.
Prosecutor 2 (04:33:13):
And I believe in this note under condition, you wrote deteriorating?
Dr. Jennifer Tufts (04:33:17):
Yes.
Prosecutor 2 (04:33:18):
And why is that?
Dr. Jennifer Tufts (04:33:21):
It sounds like a very strong word. I will give some context that it's not my choice of a word. I have three options when I'm filling that out. I can say a patient is improving, unchanged, or deteriorating. She wasn't improving and she wasn't really unchanged. She appeared a little bit worse than the last time I had seen her, so the best word is to say deteriorating.
Prosecutor 2 (04:33:48):
Okay. Was there anything about her presentation or affect, things that she told you that led you to believe that she was in imminent danger of harming herself or someone else?
Dr. Jennifer Tufts (04:33:59):
No, there wasn't. She was feeling depressed, and we had a plan to address that.
Prosecutor 2 (04:34:08):
Is there something you can do if you have a patient who you think is at risk of harming themselves or others?
Dr. Jennifer Tufts (04:34:13):
Yes.
Prosecutor 2 (04:34:14):
And what is that?
Dr. Jennifer Tufts (04:34:16):
I could issue a Section 12, which would mandate that they be brought to a hospital for treatment or at least for evaluation and then possible treatment.
Prosecutor 2 (04:34:27):
And did you feel that was necessary at that time with Ms. Clancy?
Dr. Jennifer Tufts (04:34:31):
No.
Prosecutor 2 (04:34:32):
And when you're evaluating a patient, taking the history, looking at their current state, looking at the answers they give you to the questions, are you reliant on the information that they give you?
Dr. Jennifer Tufts (04:34:46):
Yes.
Prosecutor 2 (04:34:47):
If a patient withholds important information, is it hard to make a diagnosis or a plan?
Dr. Jennifer Tufts (04:34:53):
Yes.
Prosecutor 2 (04:34:56):
Was your next appointment with Ms. Clancy on January 9th, 2023?
Dr. Jennifer Tufts (04:35:01):
Yes.
Prosecutor 2 (04:35:04):
And what was discussed at that appointment?
Dr. Jennifer Tufts (04:35:07):
She said that the Trazodone increase was helpful. She was still getting that rebound anxiety the day after she took the Ativan. The mood was okay, but she was feeling like she was still flat. She wasn't able to cry, but she said she was able to laugh a little bit and hadn't been having recent thoughts of suicidal ideation.
Prosecutor 2 (04:35:33):
Had not been?
Dr. Jennifer Tufts (04:35:34):
Had not been.
Prosecutor 2 (04:35:35):
And did you also ask her if she had any homicidal ideation?
Dr. Jennifer Tufts (04:35:39):
Yes.
Prosecutor 2 (04:35:39):
And what was her response?
Dr. Jennifer Tufts (04:35:40):
No.
Prosecutor 2 (04:35:42):
Did you notice any signs or symptoms of psychosis?
Dr. Jennifer Tufts (04:35:45):
No, I did not.
Prosecutor 2 (04:35:47):
Did you have a discussion with her about trying an antidepressant?
Dr. Jennifer Tufts (04:35:55):
Yes, I did.
Prosecutor 2 (04:35:56):
And what was that discussion?
Dr. Jennifer Tufts (04:35:59):
At this point, she had been off of the Seroquel for a couple weeks, and she wasn't getting better so I thought that suggested the Seroquel might not have been what was causing depression and it was depression, so that was what we needed to treat.
Prosecutor 2 (04:36:17):
And what were your suggestions for treatment of the depression?
Dr. Jennifer Tufts (04:36:22):
We considered some different options. We didn't pick a medicine on that date, but we considered amitriptyline and Wellbutrin.
Prosecutor 2 (04:36:32):
And Wellbutrin was one of the medications she had taken when she was in nursing school, correct?
Dr. Jennifer Tufts (04:36:37):
Yes.
Prosecutor 2 (04:36:39):
And you discussed those medications on the 9th. Why wasn't a decision made that day?
Dr. Jennifer Tufts (04:36:45):
Because we had made a different medication change. Because of that rebound anxiety with the Ativan, we decided to switch that to diazepam, which is Valium. And it has a longer half-life, meaning it's broken down by the body much more slowly, so you're less likely to get that rebound anxiety. And also the nice thing about the diazepam is it's easier to stop gradually. Every week or every couple weeks, you can increase the dose by just one or two milligrams. It's a lot easier to stop, so I felt that that was a better alternative. And she also wanted to be off of the Ativan and be able to sleep without that kind of medicine.
Prosecutor 2 (04:37:30):
And I don't think I asked you this before, but what is rebound anxiety?
Dr. Jennifer Tufts (04:37:35):
It just means that when the medication that treats the anxiety gets out of the system, the anxiety comes back and it comes back even worse.
Prosecutor 2 (04:37:46):
And you explained it a little bit, but what is a half-life of a medication? And what does that mean in terms of the body processing it and how it affects you?
Dr. Jennifer Tufts (04:37:53):
Yeah. It's a little bit complicated, but it's basically the time it takes for half of the medicine to be broken down by the body.
Prosecutor 2 (04:38:05):
And that tells you or indicates to you how long it lasts in the system?
Dr. Jennifer Tufts (04:38:10):
Yes.
Prosecutor 2 (04:38:11):
And so you were saying that Valium, the diazepam, the Valium might avoid the rebound anxiety because it's slower to leave the body; is that right?
Dr. Jennifer Tufts (04:38:20):
Yes.
Prosecutor 2 (04:38:27):
Okay. Did Ms. Clancy send you... After this appointment on the 9th, January 9th, did she send you emails on January 11th, 2023 asking you about your knowledge and thoughts on ketamine therapy and whether that would be a good option for her?
Dr. Jennifer Tufts (04:38:44):
Yes, she did.
Prosecutor 2 (04:38:46):
And what was your response to that? If you can't find it, I can bring it up to you.
Dr. Jennifer Tufts (04:38:59):
I think I have it. I mentioned that it's a great option, but it can be hard to get the insurance coverage for it. Usually you need to have demonstrated that you've tried four different antidepressants first, and so that it might be necessary to try another medicine first.
Prosecutor 2 (04:39:25):
Okay. In that email where she was asking you about ketamine therapy, did she say, "I'm still feeling a very low mood, no motivation, just very depressed. This has been going on for months now and I'm getting desperate for something that would work quickly to get me out of this depressed state"? Do you remember that being part of the email?
Dr. Jennifer Tufts (04:39:45):
Yes.
Prosecutor 2 (04:39:46):
Had she indicated thoughts like that to you before, wanting something that would work quickly to help her feel better quickly?
Dr. Jennifer Tufts (04:39:53):
I mean, she may have said that once or twice.
Prosecutor 2 (04:39:59):
Do you know where... Strike that. Did you ever recommend ketamine therapy to you, or is this something she broached to you in this email for the first time?
Dr. Jennifer Tufts (04:40:09):
It was something I had considered because at this point she was starting to be a bit treatment resistant, and ketamine is a treatment for treatment resistant depression. It's a reasonable thought, but I didn't think we were at that point yet.
Prosecutor 2 (04:40:31):
And you mentioned that insurance companies usually require you to try four antidepressants; is that correct?
Dr. Jennifer Tufts (04:40:36):
Yes.
Prosecutor 2 (04:40:37):
And when you say treatment resistant, is that someone who is in depression, but the typical medications aren't working for them?
Dr. Jennifer Tufts (04:40:46):
Yes.
Prosecutor 2 (04:40:48):
And did you have an appointment with Ms. Clancy on January 16th, 2023?
Dr. Jennifer Tufts (04:41:00):
Yes, I did.
Prosecutor 2 (04:41:01):
And what was your interaction with Ms. Clancy on January 16th?
Dr. Jennifer Tufts (04:41:07):
Her mood was still very low. She was still depressed. She was able to get out of bed and take care of her basics like hygiene and eating. Her concentration was fine and she was doing what she needed to do to take care of her baby, though she subjectively felt like the bonding was forced with the baby.
Prosecutor 2 (04:41:32):
She told you that, that the bonding felt forced with the baby?
Dr. Jennifer Tufts (04:41:35):
Yes.
Prosecutor 2 (04:41:36):
Did you ask her if she had suicidal or homicidal ideation?
Dr. Jennifer Tufts (04:41:40):
I did.
Prosecutor 2 (04:41:40):
And what was her response?
Dr. Jennifer Tufts (04:41:41):
No.
Prosecutor 2 (04:41:42):
Did she show any of the signs or symptoms of psychosis on that day?
Dr. Jennifer Tufts (04:41:45):
No, she did not.
Prosecutor 2 (04:41:50):
Well, did you have a discussion about a Valium taper?
Dr. Jennifer Tufts (04:41:54):
Yes.
Prosecutor 2 (04:41:55):
And why did you have that discussion? Who brought that up?
Dr. Jennifer Tufts (04:41:59):
That was because she really did not want to have to take a benzodiazepine medication every day for sleep, so we discussed how to come off of that medication safely.
Prosecutor 2 (04:42:13):
And that again, is that taper off to take a little bit less each time?
Dr. Jennifer Tufts (04:42:16):
Yes.
Prosecutor 2 (04:42:18):
And did she agree with that plan?
Dr. Jennifer Tufts (04:42:20):
Yes.
Prosecutor 2 (04:42:23):
Was a decision made at that point on which, if any, antidepressant to take?
Dr. Jennifer Tufts (04:42:32):
No, we had not made a decision. Oh, sorry, sorry. At this point, we did. We did go ahead and decide to try the amitriptyline.
Prosecutor 2 (04:42:45):
And what is amitriptyline?
Dr. Jennifer Tufts (04:42:48):
It is a tricyclic antidepressant.
Prosecutor 2 (04:42:50):
What does that mean?
Dr. Jennifer Tufts (04:42:52):
It's an older antidepressant. It's been around for very many years. It helps treat insomnia and some pain, headache conditions as well.
Prosecutor 2 (04:43:05):
And the dose that you prescribed, did you say it was 10 milligrams?
Dr. Jennifer Tufts (04:43:09):
Yes.
Prosecutor 2 (04:43:10):
Is that the lowest dose?
Dr. Jennifer Tufts (04:43:11):
Yes.
Prosecutor 2 (04:43:12):
And what's the highest dose?
Dr. Jennifer Tufts (04:43:14):
Can get quite high. Maybe 150.
Prosecutor 2 (04:43:18):
Okay. And so again, you started her at the lowest dose. Why was it that throughout this time you're treating her and trying these different medications that you always start at the lowest dose with her?
Dr. Jennifer Tufts (04:43:29):
That's standard practice because the medications, they have side effects, and the lower the dose, the more mild the side effects are. And it gives the patient time to acclimate to the medicine. And then you gradually increase it, depending on how they're tolerating it.
Prosecutor 2 (04:43:52):
And what was the plan going... Well, strike that. What was her mood and affect that day?
Dr. Jennifer Tufts (04:43:59):
It was depressed. Mood was depressed. Affect was depressed and flat.
Prosecutor 2 (04:44:05):
And at that point in time where she's denying suicidal ideation, denying homicidal ideation, showing no signs of psychosis, were there any grounds for you or any reason for you to seek a Section 12?
Dr. Jennifer Tufts (04:44:20):
No.
Prosecutor 2 (04:44:24):
Your next appointment with her was January 23rd, 2023; is that correct?
Dr. Jennifer Tufts (04:44:29):
Yes.
Prosecutor 2 (04:44:30):
And again, all of these appointments were virtual appointments, correct?
Dr. Jennifer Tufts (04:44:34):
Yes.
Prosecutor 2 (04:44:36):
During this appointment, what was her mood and affect?
Dr. Jennifer Tufts (04:44:43):
Mood was depressed. Affect was depressed and flat.
Prosecutor 2 (04:44:48):
Did she tell you she had started the amitriptyline?
Dr. Jennifer Tufts (04:44:50):
She did.
Prosecutor 2 (04:44:51):
And did she tell you if there were any side effects to that?
Dr. Jennifer Tufts (04:44:55):
It didn't appear that there were side effects.
Prosecutor 2 (04:44:58):
What was the conversation or interaction with her that day on the 23rd?
Dr. Jennifer Tufts (04:45:03):
She said she was doing all right, a little more anxious. And the anxiety was described as the feeling of her heart racing. She had a decreased appetite as well. She was on only two milligrams of Valium at this point and feeling more anxious in the morning. Mood was the same, flat, anxious, no motivation, numb. She has to force herself to get out of bed and out of the house, but is able to do that. And she is sleeping okay.
Prosecutor 2 (04:45:38):
And did you ask her if she had suicidal ideation or homicidal ideation on the 23rd?
Dr. Jennifer Tufts (04:45:43):
Yes, I did.
Prosecutor 2 (04:45:44):
What was her response?
Dr. Jennifer Tufts (04:45:45):
No.
Prosecutor 2 (04:45:46):
And did you notice any symptoms or signs of psychosis that day?
Dr. Jennifer Tufts (04:45:50):
No.
Prosecutor 2 (04:45:51):
Was there any difference in her rate of speech or speech pattern?
Dr. Jennifer Tufts (04:46:00):
No.
Prosecutor 2 (04:46:01):
Was there any difference in her ability to think or communicate in any way?
Dr. Jennifer Tufts (04:46:09):
No.
Prosecutor 2 (04:46:10):
Was there any change in your evaluation of her judgment or insight?
Dr. Jennifer Tufts (04:46:15):
No.
Prosecutor 2 (04:46:16):
Did you still consider her insight poor at that point?
Dr. Jennifer Tufts (04:46:20):
I did.
Prosecutor 2 (04:46:21):
And why were you still considering her insight poor?
Dr. Jennifer Tufts (04:46:26):
I think there were just a couple of things that came up throughout our 14 visits that suggested that to me, like I explained earlier. But later on, it had to do with her over attribution. It seemed to the medications about certain symptoms that she was feeling, meaning like how she felt about the Seroquel, how she felt that that was making her depressed when, in reality, I think she was just depressed. It was related to her thoughts about medications and how she was feeling.
Prosecutor 2 (04:47:11):
Would it be accurate to state that instead of accepting that she was depressed, she was placing the blame on the medication?
Speaker 11 (04:47:19):
Objection.
Speaker 10 (04:47:19):
Sustained.
Prosecutor 2 (04:47:22):
In your mental status exam of her on the 23rd, how was her appearance?
Dr. Jennifer Tufts (04:47:31):
She was appropriately dressed.
Prosecutor 2 (04:47:33):
How was your rapport with her?
Dr. Jennifer Tufts (04:47:35):
It was appropriate.
Prosecutor 2 (04:47:38):
How was her speech?
Dr. Jennifer Tufts (04:47:39):
It was appropriate.
Prosecutor 2 (04:47:41):
How was her thought content and process?
Dr. Jennifer Tufts (04:47:43):
Appropriate.
Prosecutor 2 (04:47:46):
How was her cognitive abilities?
Dr. Jennifer Tufts (04:47:50):
There were no deficits.
Prosecutor 2 (04:47:51):
And her psychomotor activity?
Dr. Jennifer Tufts (04:47:54):
Normal.
Prosecutor 2 (04:48:00):
What was the plan going forward on that day?
Dr. Jennifer Tufts (04:48:07):
We were going to continue the same dose of the diazepam because she was feeling a bit more of the anxiety so we said to slow down the taper. And we increased the amitriptyline to 20 milligrams, thinking that that would also help with the sleep.
Prosecutor 2 (04:48:28):
And at any point in time, did she tell you she was planning to kill herself?
Dr. Jennifer Tufts (04:48:37):
No.
Prosecutor 2 (04:48:39):
At any point in time on the 23rd, did she say she was planning to kill her children?
Dr. Jennifer Tufts (04:48:42):
No, absolutely not.
Prosecutor 2 (04:48:44):
At any point in time during your interaction with her in that session, was there anything about her affect or demeanor, her behavior that indicated to you that she was a danger to herself or others?
Dr. Jennifer Tufts (04:48:56):
No.
Prosecutor 2 (04:48:56):
Was there any reason based on your evaluation of her in that session that would give you grounds to file a Section 12 on her that day?
Dr. Jennifer Tufts (04:49:06):
No.
Prosecutor 2 (04:49:10):
Throughout your time treating Ms. Clancy, did you continue to recommend that she attend individual therapy?
Dr. Jennifer Tufts (04:49:17):
Yes.
Prosecutor 2 (04:49:17):
And why is that?
Dr. Jennifer Tufts (04:49:20):
It's very important.
Prosecutor 2 (04:49:22):
And is there a reason it's important? Or what are the benefits?
Dr. Jennifer Tufts (04:49:25):
Yeah. Many studies have been done to show the efficacy of therapy as a component of treatment for depression and anxiety. Some people may only do medicine, some people may only do therapy, but the best response is a combination.
Prosecutor 2 (04:49:48):
Thank you, Doctor. I have nothing further.
Speaker 10 (04:49:49):
All right. Counsel, can I see everybody in sidebar? Doctor, you may step down. Thank you.
Speaker 12 (04:50:41):
Watch your step, please.
Speaker 10 (04:50:53):
All right, members of the jury, we're going to break at this point. I'm going to excuse you till Monday morning at 9:00. The schedule I'm going to suggest will be similar to today. It should be pretty much a full day. We are still, if not on schedule, ahead of schedule. I just want to let you know that.
(04:51:15)
Now you're going to have the weekend, and so I just want to reiterate those instructions I've been giving you every day because you know the questions I'm going to ask you on Monday. And so I'm going to instruct you and remind you don't talk about this case with anyone, don't do any research on this case, don't take any field trips and happen to drive by any place that you have questions about. It's also very important that you don't read anything about this case or similar cases that might come up. And don't listen to anything. Don't watch anything.
(04:51:49)
You've gotten a fair amount of evidence so far, we've been here for a couple of weeks, but you don't have all the evidence. And so it's important for you to keep an open mind, and the best way to do that is basically shut your mind off until Monday. I know it's been a long couple of weeks for you, so I hope you have a nice weekend. Get rested. We'll see everybody on Monday. And again, thank you so much for all your time and your work on this. And I really do hope you have a nice weekend, and we'll see you Monday.
Speaker 12 (04:52:18):
Court, all rise. Jury, [inaudible 04:52:22] chairs. This way, please.
Speaker 13 (04:52:23):
This court's in session. Please be seated.
Speaker 10 (04:52:59):
All right. And Counsel, if I could ask you to come one more time, basically just talk about the schedule for Monday. All right, we'll be in recess on this matter until 9:00 on Monday. Thank you.
Speaker 13 (04:53:24):
Court. All rise.
