About this transcript: This is a full AI-generated transcript of FULL COURT TESTIMONY: Dr. Tufts Defends Treatment of Lindsay Clancy During Cross-Examination — AB1E from DWS News, published August 13, 2026. The transcript contains 17,188 words with timestamps and was generated using Whisper AI.
"trying to think of or maybe it feels like um you know maybe you're you're thinking of things a little bit more slowly than you normally would and how often was she dwelling on suicide at what point at the point she told you that she had anxiety insomnia brain fog crying inconsolably what do you..."
[00:00:00] Speaker 1: trying to think of or maybe it feels like um you know maybe you're you're thinking of things a little bit more slowly than you normally would and how often was she dwelling on suicide
[00:00:16] Speaker 2: at what point at the point she told you that she had anxiety insomnia brain fog crying inconsolably what do you think you can get to that it's over 26th heading into november 2nd do you recall i'll rephrase it do you recall going into the november month meeting with her and she told you that she had brain fog
[00:00:56] Speaker 1: it was mentioned at some point i don't see that on the 26th specifically all right so let's talk
[00:01:03] Speaker 2: about brain fog did you ask her what that meant because when you say subjective that means that's her interpretation that's in her head she's telling me right yes as opposed to objective which would be what people in general would think right yes so when she's telling you in addition to the anxiety in addition to the crying in addition to the stress that she was undergoing she was worrying about suicide she talked about brain fog so you must have asked her what does that mean
[00:01:32] Speaker 1: subjectively what does that mean subjectively means in in the patient's you know own opinion that's what
[00:01:39] Speaker 2: their experience is okay so she's the one that's inside her head right yes so what were the symptoms what is it when a patient tells you that they have brain fog is that something you would consider as being a potential side effect of the medications that you would put around
[00:01:57] Speaker 1: it depends on what i mean it sometimes it could be and and sometimes it could be unrelated it's a symptom of depression as well so sometimes it's it's hard to tell what it's attributed to
[00:02:12] Speaker 2: so at this point heading into november your answer was to prescribe more medication three more drugs right you prescribed ativan um or increase the ativan what was she what was her load for ativan at this point do you remember sorry what was her milligrams if that's right or nanograms whatever it is on the ativan on the script that you had provided her objection if we could just have a date
[00:02:36] Speaker 1: i think you said if you could answer that which which date are we referring to for the ativan because
[00:02:42] Speaker 2: there were i'm sorry i already objected he already said you can answer it when did you increase her
[00:02:48] Speaker 1: ativan and to what level so she was prescribed ativan 0.5 milligrams right and then um when i next saw her um she said it was a little bit helpful um so i i said you could increase it and see if one milligram is more helpful
[00:03:14] Speaker 2: did she increase it yes and and when was the next time you saw her to talk to her on the television or on the computer
[00:03:24] Speaker 1: um well i saw her on the 26th and then i saw her on the 31st i'm sorry how was she on the 31st halloween how was she that's not my note that's her therapy note
[00:03:41] Speaker 2: okay so how about this november 2nd was that the next time you saw her i saw her on november 2nd and she told you that she was hesitant to use the medications the buspar and the hydroxyzine right
[00:03:55] Speaker 1: um she said she was hesitant to try the buspar she was scared of the drug she was scared of the drugs
[00:04:01] Speaker 2: right she was afraid to take a medication she wasn't doctor shopping and asking you to give her drugs so she could get high she was asking you for help isn't that right yes and she was afraid to take the drugs and told you that she was afraid to take the drugs right she told me she was afraid to take the busparone did you advise her or counsel her or give her therapy about that validations yes and what did you tell her
[00:04:32] Speaker 1: um well i advised her of you know the the risks what were the risks well the risks of of medicine like we had said um sedation or dizziness okay how about interfering with sleep um abuse prone doesn't
[00:04:52] Speaker 2: usually interfere with sleep not usually did you ask her about um any uh thoughts of suicide or being close to having thoughts of suicide yes did she indicate to you that she had any thoughts of suicide at all not at that date did she use those words or is that a box that you checked off
[00:05:14] Speaker 1: i don't remember her exact words but we we talked about suicide or you know thoughts of hurting yourself
[00:05:21] Speaker 2: right and there's a distinction between and your records in the notation between suicidal ideation and and i quote worrying about thinking about suicide would you agree with that yes and what did she mean when she told you as her doctor that she was worrying about thinking about suicide you mean in the in the prior appointment i'm talking about a woman that's sitting in front of you on your television or your computer telling you that she was worried about thinking about suicide well on on the second she didn't say that okay when was the next time that she told you that she was worried about or thinking
[00:06:06] Speaker 1: about or suicidal ideation that was the december 1st visit okay so go back to the november 2nd visit would
[00:06:24] Speaker 2: you agree with me that she after you talked with her for that period however long it was that you then brought up four medications to her recommending that they might be safer and i quote safer alternatives
[00:06:40] Speaker 1: would you agree with that um i see the word alternatives not safe for alternatives do you
[00:06:49] Speaker 2: remember talking to her about remeron yes did you recommend that she take remeron no did you ever prescribe remeron no and is that mirtazapine as far as his generic name yes and remeron is an antidepressant isn't that right yes um and you did not feel that that would be an appropriate medication for her to take at that time it was a very reasonable option but we didn't decide to start it so is this a collaboration in other words you and and the patient you would both make a decision as to when to start a drug or is it your decision and advice to the patient well it's
[00:07:32] Speaker 1: ultimately my decision but the patient's thoughts about the matter are very important at the end of the day the patient has to go home and take it themselves i'm not i'm not there to ensure that that is
[00:07:45] Speaker 2: happening or not so you had a november 22nd appointment right yes and and it was at that time that she told you that she had been to see south shore perinatal clinic right yes and did she tell you why she was seeing someone from the south shore perinatal clinic
[00:08:14] Speaker 1: um i i think she told me that it was because they were exclusively focused on treating perinatal conditions yeah but so were you right not exclusively i'm a general psychiatrist i see
[00:08:30] Speaker 2: um and did she mention the name of any doctor or nurse practitioner that she was seeing at the south shore
[00:08:36] Speaker 1: perinatal clinic um yes who'd she mention um i think she said something about um julie paul yes okay and a woman by the name of nurse gelada um i i heard her name a little bit later okay yes
[00:08:56] Speaker 2: um did she advise that in fact by script she was using ativan and benadryl um and you told her to taper off the ativan at that appointment right
[00:09:11] Speaker 1: had she taped it off the ativan um i i think i told her to i gave her a prescribed taper prior to that
[00:09:22] Speaker 2: appointment what does that mean what does that mean you gave her a prescribed taper so i i told her
[00:09:30] Speaker 1: that she should reduce her dose by 0.25 milligrams every two weeks until the medication was stopped did she do that um i mean i i don't believe that she completely stopped it no no you don't believe or she didn't well trying to give the jury facts yeah she said she was taking out of van so so no she didn't completely stop it had she tapered um i'm not sure how much she had reduced the dose because i
[00:10:01] Speaker 2: wasn't prescribing it again right so did you know that she had been or had she been to any emergency wards between that period of time that you last saw her and when you were seeing her on this meeting
[00:10:17] Speaker 1: i know she went to the er sorry er but i i think it was after that okay which er did she go to do you
[00:10:24] Speaker 2: know um i think she went to mass general do you know why she went to the er um because of depression so was she treated at the er did they make any to your knowledge as her doctor make any recommendations
[00:10:42] Speaker 1: i'm not sure what they told her but they ultimately good they ultimately discharged her they didn't admit
[00:10:49] Speaker 2: her go ahead sorry sorry um was she put on any medication not from the er when you looked at the records from south shore perinatal clinic what did they indicate about suicidal ideation worrying about suicide close to suicide anything i didn't have access to those records you're gonna keep your voice up so everybody can hear you you what i did not have access to those
[00:11:22] Speaker 1: records because we're a completely separate clinic seriously she's visiting with you as a patient and you
[00:11:31] Speaker 2: can't access her medical records is what you're telling this jerry i did not have access to them no could you could could she have signed a release a hipaa form yes she could have and you could have
[00:11:45] Speaker 1: got the records yes but you didn't i did not feel like it was necessary because she provided all the relevant information about her treatment there how do you know
[00:12:00] Speaker 2: she's got mental disease and she's seen when she's on all this cocktail of drugs how do you know that she is an accurate historian at this point in her life it felt very accurate when she was able to
[00:12:15] Speaker 1: recall the names of the medicines doses of the medicines specific days she she provided a lot of incredibly detailed information so it it it showed me she was was capable of doing that so when you talked
[00:12:31] Speaker 2: to her husband pat how many times did you talk to her husband pat i think i was living with her i think it was once and he came to your office right no he didn't he got on the television on the computer screen right yes and when was that
[00:12:51] Speaker 3: uh i think it was the december 16th visit so what's ready before we get to that okay probably a good uh spot to stop take the more we're going to take the morning recess uh and then we'll come right back okay
[00:13:06] Speaker 2: okay all right sure you've told you no votes facing on your chest you all sit for the jury yes all right george andrews
[00:13:51] Speaker 4: this course now session please be seated 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 the 18 jurors
[00:14:12] Speaker 2: all right thank you mr rington um if you would just please look at your medical records that you have in front of you i believe and just go back to the october 20th where you have i believe interval history sure october 20th sorry so looking at the interview history that's when that you decided to start zoloft it says a week ago right that's when the patient started okay and if she then increased the dose and it says last night right and what did what was what was she telling you on the computer screen when when you were talking to her what did she say about increasing the dose of the zoloft
[00:15:11] Speaker 1: that she felt awful she couldn't sleep um had insomnia which became worse when she increased the dose she didn't want to eat she was having diarrhea food felt really unappealing she was more depressed on it crying all day yesterday which is not normal for her she had some mental fog and was terrified to start
[00:15:40] Speaker 2: something new did she also tell you about her anxiety level anxiety was really bad even before men
[00:15:49] Speaker 1: now hard to differentiate overnight racing thoughts paranoid of getting suicidal thoughts something bad happening doesn't want to be alone
[00:16:04] Speaker 2: that must have given you that must have given you concern that you had a pretty sick patient on your hands
[00:16:09] Speaker 5: at that point right i was concerned yes um so you gave her some therapy did you
[00:16:17] Speaker 1: i gave her some therapy in conjunction with discussing all of her symptoms and assessing her and managing
[00:16:24] Speaker 2: medication okay and again i apologize you have to keep your voice up so people can hear you way down here um so when you say that you were talking about the symptoms and um what did you do just talk
[00:16:35] Speaker 1: about the same thing that we've just gone over the symptoms there were a number of them to discuss in more detail that's that's the summary okay so did she discuss it in detail yes did she tell you that
[00:16:54] Speaker 2: her symptomology at this point on october 20th was so bad that she had to have her mother come and stay with her her mom was coming to provide support yes she wasn't coming to provide support she was coming to stay with them to live with them wasn't she yes i don't know for how long but yes did you bother to ask her why is her mother having to stay with them because she needed some help do you know how long her mother stay with them do you know that she ended up sleeping in the basement do you know that she ended up sleeping with her mother i don't so you decided that you'd stop the zoloft and you would monitor closely right
[00:17:44] Speaker 1: yes what does that mean you monitor closely well i saw her the next day so that's that's monitoring
[00:17:50] Speaker 2: an example okay so this would be on october 21st that you saw her the next day is that correct yes now on the 20th you made reference to the fact that you also recommended that you try fish oil and things of that nature natural remedies yes okay um you also wanted to look into what's called zolreso z-u-l-r-e-s-s-o
[00:18:18] Speaker 1: yes what's zolreso it is a treatment for postpartum depression uh and when you say that you were looking
[00:18:27] Speaker 2: into it what did you do did you find out if it was available and if she could participate in the program
[00:18:34] Speaker 1: i did some digging online to see where it is done and how to do it i hadn't officially recommended it so i i had not started that for her it's not really an easy medicine and i could just start what i'm sorry sorry it's it's not a medication i could start on my own it is um it's infused through an iv in a hospital um so it's a bit difficult to coordinate it's a 60-hour infusion right
[00:19:07] Speaker 2: it's a long infusion that that sounds right and it's about two and a half days of infusion and it has to be under hospital circumstance and the only hospital around here is in lowdown right yes and did you ever recommend that you do that
[00:19:24] Speaker 1: it was something to consider i couldn't make the official recommendation because that's not something i prescribed why because um because you can't think that about the pharmacy well no obviously you have
[00:19:39] Speaker 2: to go to a hospital setting and basically have an infusion through your veins for 60 hours or 2.5 days but why didn't you look into it or recommend that she do that well i i did look into it so what happened
[00:19:56] Speaker 1: she ended up um actually going to a partial hospitalization program at the hospital that that does it um i don't believe the program is completed but but she went and um i advised her to discuss it with them because they have access to that medicine i don't have access to it of course is this women
[00:20:19] Speaker 2: in infants hospital in rogan island that you're talking about yes so when you looked at the medical records for women and infants hospital did they make records to your inquiry for the zola resa i never
[00:20:32] Speaker 1: received records from women and infants did you ever look at them or even online online yeah like online like you do when you talk to patients no i i never had access to them why it's similar to south shore it's a completely separate hospital that i don't have access to i don't work
[00:20:54] Speaker 2: well of course you don't work there but you're a doctor and you're treating a patient that medical records that you could access through a hippo release right yes why didn't you do that
[00:21:11] Speaker 1: well she didn't ultimately end up having any treatment there so it didn't seem necessary
[00:21:20] Speaker 2: she didn't end up having a treatment there so it didn't seem necessary you can't just walk into that place and say hey i'd like some zoresa okay
[00:21:31] Speaker 1: i don't exactly know how it works
[00:21:46] Speaker 2: and then again on that date which would be october 20 when the viewers are looking at the records you checked off the the boxes again on objective findings mental status exam appearance speech things of that nature correct excuse me for one minute so when she was telling you on that date that she was parent and quoting your records paranoid of getting suicidal thoughts and something bad happening doesn't want to be alone what did she mean by that
[00:22:43] Speaker 1: well those were a lot of a lot of hard words right isn't that a concern
[00:22:49] Speaker 2: your patient is telling you she doesn't want to be alone why didn't she want to be alone
[00:22:54] Speaker 1: she was very anxious and had the feeling like something bad might happen
[00:23:01] Speaker 2: okay did her mother ultimately and dad come to stay with them yes how long did they stay with them i don't know when you talk to the mother and the father did you say to them what is she doing what how does she appear is she in bed all day what did they tell you
[00:23:20] Speaker 1: they never called my office so i never spoke with them they they never called your office they never called me or sent a message so i did not have communication with them so it's their
[00:23:33] Speaker 2: fault but they didn't call you the doctor again so do you think maybe it would be reasonable if you're the doctor and you're investigating the patient's symptomology that you might when you know that the parents are staying with it that you would
[00:23:50] Speaker 1: make a phone call yourself it's not typical when you have an adult who is able to advocate for
[00:23:57] Speaker 2: themselves to speak with their parents so while she is telling you about her symptomology and tearfulness and crying and unable to get up and anxiety and the medications and the mental illness that she had you felt that she could advocate for herself yes okay on the television on the computer the next time you saw her was on october 26 is that correct and you can pull up your record yes now and if you look again at the interval history where you put down what's going on in the patient's life that time this is when she indicated that she's back to where she felt that she was before zoloft which was not great and that you guys were considering a new medication is that right yes and then you started her on ativan as we talked about right yes um and then you started her on the buspirone
[00:24:59] Speaker 1: right well she had already been served on the ativan and then added the buspirone so my question
[00:25:05] Speaker 2: was you started her on buspirone right yes okay um and also you added hydroxylene as needed right yes and you continued the ativan correct yes did you discuss side effects with her at that point yes um did you also discuss that starting remeron or pregabalin pregabalin pregabalin yes what did you tell her about remeron and pregabalin i don't think i went into any detail about those medicines um just that those might be things to consider in the future and then you saw her on october 31st right
[00:25:56] Speaker 1: that was her i think that was just a therapy appointment with a different different provider would that be
[00:26:08] Speaker 2: jennifer mccallister yes so it's a different provider in the sense that she works for astor right oh yes it just wasn't myself right so on october 31st they did a suicide assessment or or she did right mccallister well i know you weren't there but these are medical records that have been introduced into evidence that the jury's going to have in the jury room mccallister did a suicide assessment apparently right i'm sure she assessed no no no look at the record please where where do you see it sorry where it says suicide assessment there's only four pages for october 31st well actually there's there would be eight
[00:27:01] Speaker 1: because it's two sides so that is the assessment that you go through if somebody reports any um thoughts of suicide then you you ask those questions but you go into a lot more detail about them so here you have a
[00:27:14] Speaker 2: patient who's already reported to you as a psychiatrist that she's got suicidal ideation worried about suicide worried about killing herself days before october 31st and a suicide assessment was done by mccallister
[00:27:34] Speaker 1: right right i wasn't there you would have to ask her oh maybe i will if she comes in why don't you tell me what the record shows
[00:27:47] Speaker 2: did they do a suicide assessment did you check off the little boxes i'm looking for that section
[00:27:58] Speaker 1: it says it says that patient denies suicidal or homicidal ideation at this time okay so again this is on october 31st right
[00:28:10] Speaker 2: yes the patient within a period of a couple of days in meetings with you that mccallister has access to because the records are within your business right it's not my business has reported suicidal ideation and fear and dwelling about killing herself and afraid of those thoughts right
[00:28:39] Speaker ?: i just wanted the absolutely um
[00:28:53] Speaker 1: so um so yes uh you know what yes the answer is yes she had she had placed those concerns right
[00:29:01] Speaker 2: so as a result of voicing those concerns is it your understanding that mccallister did not do any of the suicide assessment questions because when she reported that she wasn't suiciding
[00:29:18] Speaker 1: it appears that she asked about suicide right you already told us that i'm asking you about excuse me
[00:29:27] Speaker 2: thank you i'm not asking you you told us three times now that she said she was not suicidal when she spoke to mccallister i'm asking you about the suicide assessment for the third time you see it in front of you okay can you tell me did lindsay answer any of the questions that were asked over the two pages possibly three of the suicide assessment yeah three done by mccallister i don't see anything
[00:30:01] Speaker 1: written here so was there a suicide assessment i don't know because it wasn't there i don't know if you don't know from looking at the records right from looking at the records i don't see evidence of additional suicidal questions beyond asking if it was there or not
[00:30:23] Speaker 2: so the suicidal assessment doctor is in the medical records it consumes almost four pages does it not yes yes okay and all of the questions like asking have you felt life is not worth living is death something you thought about recently are you dwelling on that what what leads up to the thoughts what are the thoughts all those questions right for four pages right yes and there is not one notation indicated that that test was ever administered to her on october 31st correct correct but it was it looks like it was asked in other ways okay november 2nd oh it was asked in other ways is that with the little check box where it says deny suicidal ideation can i read something that you have indicated repeatedly that she denied suicidal ideation right yes okay the suicidal assessment was not administered according to the record that's in front of you by mccallister yes the additional suicidal assessment yes november 2nd by the way as a psychiatrist not a psychologist you have the ability to prescribe medication obviously right and that's when you talked about the dea number and all of that correct which you had for about a month other than when you were a resident right so you're prescribing these ssris and antipsychotics and antitropics or whatever they are and it's important as to the metabolism of your patient with those drugs isn't it okay keep your voice up what does metabolism mean
[00:32:23] Speaker 1: the body breaking down the medication
[00:32:28] Speaker 2: so how is it that you can determine how the body of your patient is breaking down the medication that is in their brain and they're complaining about all of these symptoms how as a doctor do you determine how the body's breaking it down
[00:32:46] Speaker 1: we don't typically have any specific testing that we do to understand that
[00:32:55] Speaker 2: how about a blood test it's not done for that meaning a blood test is not done to determine the metabolism of your patient of your medications um are you referring to genetic testing no i'm asking about the metabolism i'm not talking about genetics i'm talking about the metabolism of the ssris in our body okay um you can tell that metabolism rate through blood testing right
[00:33:27] Speaker 1: not in the way that you're describing okay what way would it be um there is genetic testing that can give information about metabolism like what it can uh talk about um different enzymes that a person might have um to suggest it provides information about the enzymes that a person might have the genes for
[00:34:08] Speaker 2: okay so it provides the enzymes that a person might have the genes for forgive me i'm having difficulty with that what does that mean it's a little complicated yeah if you don't expect a patient that's going through what she was going through to understand that would you not did did you guys do the enzyme test
[00:34:29] Speaker 1: they are not typically done why because um again it's it's genetics so it's not as simple as testing for enzyme or not you can test someone's genome like we have the ability to test the entire human genome now um but it's it which is great but this the clinical um you know use of that is not there yet so while we can test these things it does not yield meaningful clinical information so it's not commonly done
[00:35:12] Speaker 2: what is the sorry what is the cytopro p4-50 system
[00:35:19] Speaker 1: that's one of the enzymes i'm talking about
[00:35:21] Speaker 2: so the cytopro p-450 system talks about and tests for the breakdown of psychiatric meds in the blood right
[00:35:32] Speaker 1: it's not in the way that you're describing it
[00:35:34] Speaker 2: all i'm describing it is that it's a test
[00:35:41] Speaker 1: um it just yes this is a test that is done but it doesn't tell you what medications a patient will do better on it's not useful in that way so what's it useful for i mean i i don't find it terribly useful
[00:36:00] Speaker 2: how long has the cytopro p450 system been in use in your field sorry how long has the cytopro p450 system been in use in your field psychiatry well it's an enzyme in the body well i know what it is i'm asking you about the system the testing
[00:36:19] Speaker 1: how long have they been using that the genetic testing um whatever it is it's just very new very
[00:36:27] Speaker 2: does insurance coverage sometimes sometimes so it is nevertheless a legitimate test to determine the breakdown of psychiatric meds in a patient's blood correct it exists yes it exists well it exists but you didn't use it right
[00:36:52] Speaker 1: it would not have made a difference in what in your opinion in her treatment because you go by the
[00:36:58] Speaker 2: checks in the checkbox and what she self-reports right no not not just the checks in the checkbox oh
[00:37:06] Speaker 1: that's it's an organ in the human body it's an organ in the human body that regulates hormones
[00:37:20] Speaker 2: and what if any import and impact do thyroid levels have in your evaluation of a woman who is in the throes of postpartum depression what is the purpose of the test to determine the thyroid levels
[00:37:47] Speaker 1: well you can you can test something like the tsh
[00:37:52] Speaker 2: well i don't know what tsh is i'm sorry where's the tsh
[00:37:55] Speaker 1: thyroid stimulating hormone okay thank you that's something that can be tested um typically by maybe a pcp primary care or endocrinologist if they have concerns about someone's thyroid function
[00:38:14] Speaker 2: were you aware of a study that was a major study that was peer-reviewed what is peer-reviewed like
[00:38:23] Speaker 1: that it uh was was reviewed by um other researchers in in similar fields
[00:38:43] Speaker 2: can be published right yes and you'd agree with me that in the medical field it's a big deal to have publishing articles on your resume right yes and and how many articles have you published about postpartum
[00:39:00] Speaker 1: depression postpartum psychosis anything um i have published something but it's not a full article it's just a a small thing okay are you aware of the uh
[00:39:16] Speaker 2: psychiatry uh psychiatry um magazine article dealing with uh in 2021 thyroid function in postpartum psychosis and exploratory study have you ever heard of anything about that let alone read an article about it no are you aware that there are studies that have compared thyroid function between psychosis with postpartum onset ppo psychosis without postpartum onset pwpo and normal postpartum you're aware of that no but you're supposed to be an expert or you specialize or you have an interest in treating women that have suffered from postpartum correct yes have you written any articles at all about postpartum depression
[00:40:03] Speaker 1: anxiety psychosis no i'm not a researcher i'm a clinician have you read any of the articles
[00:40:10] Speaker 2: such as thyroid function and postpartum psychosis i've read many articles there are thousands i have not read that specific articles thousands thousands of articles on postpartum psychosis and the thyroid no not on that specific topic so when the aster doctors are treating it's your testimony to this jury that testing whether it's blood testing or whether it's the cytopro p4 testing is not necessary because jennifer tufts doesn't think it's necessary right
[00:40:55] Speaker 1: it does not yield information that would influence treatment really so if there was elevation in
[00:41:02] Speaker 2: the thyroid that wouldn't impact on your treatment at all your evaluation your investigation
[00:41:09] Speaker 1: sorry i thought you would mention the the cytochrome issue are we talking about that one or are we
[00:41:14] Speaker 2: talking about the thyroid we're talking about the thyroid yeah so if there were tests that revealed elevation in the thyroid level is it your testimony that you wouldn't care
[00:41:32] Speaker 1: if i somehow found out that a patient had elevated thyroid levels i would advise them to talk to their primary care or maybe get an endocrinologist to to discuss it did you ever recommend that lindsay get
[00:41:48] Speaker 2: an endocrinologist no the reason the answer is no and you basically did not have any information that you could use to even realize that there might have been a thyroid issue with this woman that was postpartum right because you didn't do any blood tests
[00:42:13] Speaker 1: there was no clinical reason to obtain a blood test all right so you continue on with your your meetings
[00:42:20] Speaker 2: by the computer correct yes november 2nd um you can get november 2nd out you got it
[00:42:35] Speaker 1: november 22nd
[00:42:39] Speaker 2: no it looks like november 2nd i apologize that's what i'm looking at tufts jennifer md clancy lindsay follow-up note november 2nd okay and you're still diagnosing her with generalized anxiety disorder gad right yes you add in there an adjustment disorder with depressed mood i guess because of what she had been telling you okay um looking at the uh psychiatric condition you know that it's improving right
[00:43:18] Speaker ?: yes
[00:43:20] Speaker 2: and then you determine that you will decrease the ativan to 0.75 milligrams per for two weeks and then decrease it to 0.5 milligrams for two weeks and consider alternatives for sleep anxiety is that correct yes and then you know if she's having urges to harm herself or others to go to the nearest emergency room and call 9-1-1 and things of that nature correct so is that a form that you basically press a button because it seems to be kind of like a general generic advice call 9-1-1 if you're feeling suicidal and things of that nature
[00:44:04] Speaker 1: well that's advice that we provide for every single patient okay um and then you note that
[00:44:11] Speaker 2: half the encounter was on counseling or coordination of care on november 2nd right
[00:44:18] Speaker 1: yes that's a typical statement that's that's it's just a part of documentation that
[00:44:25] Speaker 2: doctors use all right um now on november 2nd you were suggesting the four drugs that she would start would be remeron trazodone fragavalin and hydroxyzine right
[00:44:39] Speaker 1: those are those are just things we were considering oh it wasn't starting all of those i see um on november
[00:44:47] Speaker 2: 22nd now that would be almost three weeks later right you saw her right and did you ask her about whether or not she was still having suicidal thoughts or worrying about suicidal thoughts for example did you ask her that yes and how do you know that because the box is checked
[00:45:13] Speaker 1: it's written in my mouth what does it say patient denies as i okay what did you ask her about that i don't remember the exact words but i i know that i asked about that did you ask her about how things
[00:45:27] Speaker 2: were going at home with the mother and father staying there um that i don't i don't remember um i didn't document how her parents were doing okay well i don't really care about how her parents were doing i'm asking about whether or not you asked her how it was working out while her parents were there helping
[00:45:45] Speaker 1: out if you did fine if you didn't that's fine too i don't think that i did um okay okay that's all
[00:45:54] Speaker 2: that's fine december 1st was the next appointment correct and you can look at the interval history yes um now on that december 1st appointment this is uh after she had transferred to social yes she disclosed to you that she had been seeing social right yes we already talked about the fact that you never got the records from social so you don't know other than what lindsay reported to you what medications she was on right right i mean what she was what she was telling me right and she told you that she was doing the
[00:46:37] Speaker 1: ativan taper right well she said she had she had tried doing that but that um then she was having
[00:46:47] Speaker 2: more sleep having difficulty sleeping is what what she indicated to you right yes and she tried other meds that you had suggested but stated that she was having difficulty with those meds including trazodone
[00:46:58] Speaker 1: right um well the trazodone she didn't have a problem with it just didn't seem like it was
[00:47:05] Speaker 2: particularly helpful did you prescribe the trazodone or somebody else this was somebody else so do you
[00:47:12] Speaker 1: know what the milligrams were that she was on it says she tried between 50 and 150 milligrams all right now
[00:47:22] Speaker 2: did she at some point try remera she said that she did did you suggest in your discussions that she try remera um no i did not did she indicate to you that she had rebound anxiety and intrusive thoughts
[00:47:42] Speaker 1: that she was going to die recall that well she said worse depression and intrusive thoughts
[00:47:51] Speaker 2: okay did she tell you what the intrusive thoughts were um it was the feeling like i'm going to die did she then uh have a script for prozac 10 milligrams that's what she said and she said that she couldn't sleep and had worse sleep so that had to be stopped right yes she then she tried she was on clonopin right yes and what is clonopin and on december 1st is when she told you again that she was close to having suicidal ideation feeling hopeless you recall that now on the interval history on that date you would indicated that she can't sleep she can't sleep she's panicking she had worse depression intrusive thoughts she was numb nothing mattered i feel like i'm going to die denies suicidal ideation but quote yesterday close to it feeling hopeless did you give her therapy and validations after she told you that did what did you do you got a woman that's telling you that she she's hopeless she doesn't care if she dies she can't sleep what did you do to validate on your therapy
[00:49:29] Speaker 1: um i told her that this was this was something that we we could address that there was hope that there were treatments and there are um you know different types of treatment programs that are more uh more supportive like partial hospitalization programs so she knew that she still had had options and a reason to help did you ever suggest to her that
[00:49:56] Speaker 2: maybe you ought to come in to see me rather than talk on the computer um discussing uh talking with her
[00:50:04] Speaker 1: over the video did not seem like an issue um it didn't seem like there was anything that i was missing or that there was any need to see her in person now you'd agree with me that in december of 2022
[00:50:20] Speaker 2: covet was all that right it wasn't completely all done were you still nervous about dealing with people and wearing masks and stuff or were you able to sit down and talk to somebody face to face
[00:50:32] Speaker 1: we were definitely feeling more comfortable about being face to face with people but i think you
[00:50:39] Speaker 2: know it was still something that we thought about you discussed trying seracle with her at that point right
[00:50:48] Speaker 1: i didn't really discuss it she well she had told me that that was um
[00:50:57] Speaker 2: that was something that she had discussed with her other provider so looking at your notes does it say also discussed it says yes but i wasn't i wasn't making a recommendation about the seracle it was just a
[00:51:21] Speaker 1: medicine i was providing her more information on so so you were telling her about the seracle you're providing information yes we were talking about the seracle right right
[00:51:51] Speaker 2: you also discussed with her the possibility of undiagnosed bipolar disorder did you not it was discussed and undiagnosed bipolar disorder was in your opinion as a result of not a reaction but extreme
[00:52:12] Speaker 1: reaction to the ssri's right not so not as a result of the ssris but that react does your excuse me does
[00:52:22] Speaker 2: your note say and i quote also discussed possibility of undiagnosed bipolar disorder given extreme reaction to ssris and insomnia period does it say that yes those are your notes right
[00:52:39] Speaker 1: yes the way you were saying it made it sound a little bit different before but that's exactly
[00:52:43] Speaker 2: what i wrote i read it directly from your note right how did it sound different i don't know it
[00:52:48] Speaker 1: sounded different the first time you said it than the second so did she have bipolar no did you make that decision that night that day i i assessed that with her um pretty much every every time that i saw her and and she never had mania what about um mood stabilizer like lamictol did you discuss that with her yes what is lamictol it's an anti-convulsant um but it's it's used
[00:53:19] Speaker 2: um in treating mood disorders so what was the uh the end result of your meeting with her on december 1st
[00:53:32] Speaker 1: yeah well so at this time i was um but we had a plan for her to pursue a partial hospitalization program where was that well the one one that i recommended was hri what is that hri it's a hospital in brookline and did she ultimately go to another hospital she ultimately went to the women and infants hospital for one day and those are the
[00:54:11] Speaker 2: records that you didn't get right correct okay um and you decided that she did not have bipolar disorder because in your opinion she did not meet and i call it the criteria right and that would be the criteria and the dsm right yes and the dsm of course is the diagnostic statistical manual one of the that would be the criteria right um you know to help us in our in our treatment but it's not
[00:54:58] Speaker 1: it it's not it it's not the psychiatry bible that that people sometimes think that it is right um
[00:55:07] Speaker 2: hypomanic bipolar disorder how many days does that require
[00:55:13] Speaker 1: um under the dsm a hypomanic episode lasts for at least four days and is that per the dsm yes
[00:55:25] Speaker 2: you remember on friday you said that the most important criteria is seven days with continued high energy levels yes so is it is it seven days or is it four days and who says
[00:55:36] Speaker 1: well mania is is seven days hypomania is four
[00:55:49] Speaker ?: yes
[00:55:50] Speaker 2: do you know in your records that she indicated that she was really struggling and it was as a result of that you recommended that hospital program right do you agree that she had in your opinion a severe mental disturbance at that point that was manifesting itself
[00:56:08] Speaker 1: she had a moderate heading towards severe moderate heading towards severe mental issue okay
[00:56:23] Speaker 2: um you'd agree with me that she had increased anxiety right yes she had very very uh increased
[00:56:32] Speaker 1: depression right um well she she she did she said okay so as you're answering the rest can you just answer yes or no i'm sorry i was just trying to check the record okay you can check the record all
[00:56:47] Speaker 2: you want but if i ask you a question respectfully can you just not go on and ramble answer yes and no that's all thank you now mental issues like anxiety that was diagnosed the depression that was diagnosed and the fact that she indicated yet again that she was close to suicidal ideation quote worried about suicidal thoughts but you indicated that she wasn't suffering from suicidal ideation on that day is that fair she denied it but she told you that she was worried about suicidal
[00:57:34] Speaker 1: ideation and having suicidal thoughts right well this yes this was the time she said she was worried that she was close to having suicidal thoughts so did you ask her what does that mean does that mean
[00:57:45] Speaker 2: she's standing at the edge of the stairs and she's thinking about falling down the stairs or what what does that mean i'm close to suicidal ideation so i asked about that and that's that's when she said
[00:57:57] Speaker 1: she described it further as using the word hopeless
[00:58:07] Speaker 2: so did you prescribe the lamocrine on that occasion or no no on december 16th that's the next appointment she had right yes that'd be two weeks later right yes she was still not well correct she told you she was having a really rough time
[00:58:36] Speaker 1: she was sleeping but she was still feeling very broken in your notes does it say that she was having a
[00:58:42] Speaker 2: really rough time yes so when i ask you if your notes reflected that she said she was having a really rough time why do you feel compelled to say she was sleeping it's an important detail yeah i guess how about the rough time what did that mean what was what were the symptoms of having a really rough time for the skin do you want to yeah i'd like you to answer that
[00:59:16] Speaker 1: so finally words referring to the valium but very depressed during the day no motivation some si do you want me to continue sure went to mgh emergency room for si declined to inpatient feeling hopeless no intent or plan and feels like depression related to sarah paul
[00:59:42] Speaker 2: okay now that's the question on friday that will strike that so what was the si suicidal ideation yes and can you read that back to me again what did she say about si so that when when she went to the
[00:59:57] Speaker 1: hospital um she went because she had no motivation some si some si meaning that she had some suicidal ideation
[01:00:08] Speaker 2: right yes in her words yeah in her words as opposed to thinking about having suicidal ideation or worrying about suicidal ideation she actually indicated that she had suicidal ideation right so that's a yes or no well it's in your notes that she said that right yes what is in my health
[01:00:38] Speaker 1: do you understand my question um i don't want to get confused right now do you have any way of questions sure of course we spent some time talking about
[01:00:48] Speaker 2: thinking about suicidal ideation worrying about suicidal ideation now saying she had suicidal ideation right she said yes well this is the only source of information that you're getting apparently is what she's telling you right yes so what suicidal ideation did she have is she thinking of cutting her throat is she thinking of throwing herself off a building or running out in front of a car what no what was
[01:01:22] Speaker 1: she thinking of so i i asked her those those important follow-up questions like what uh so what do you mean when you say i'm feeling suicidal okay um and that's when she said it means i'm feeling hopeless um and then i asked you you know do you you know have have intention of hurting yourself do you have a plan for hurting yourself and she denied those and that's where you left it um i mean i'm sure more was said but that's the the most important part of that clinical encounter and and did you give a therapy
[01:02:01] Speaker 2: by the computer on that date too yes what did you what did you do for therapy about her suicidal ideation
[01:02:08] Speaker 1: and saying she wanted to kill us well we you know we explored what that what that meant um and you know what what to do if if you're feeling that way to do what call 9-1-1 to go to the emergency room
[01:02:25] Speaker 2: did you discuss prescribing serequil to her or was she getting serequil did serequil enter into
[01:02:30] Speaker 1: your discussion at all we talked about it i was not prescribing it for her what is serequil
[01:02:46] Speaker 2: so at the conclusion of your meeting on december 16th basically what you took away is that she had now increased to suicidal ideation was feeling hopeless uh all the rest of the things that we've talked about
[01:03:00] Speaker 1: and then she what just moved on went home well she was assessed in the emergency room um and was not admitted and i assessed her on the day again and while she was certainly struggling struggling she did not um require her hospitalization at that moment so she was um she was planning on going to do an infant program and i
[01:03:28] Speaker 2: supported that did you know that around that time she confessed to her husband that she was having now no thoughts of harming the children no would that have been something you were concerned about
[01:03:43] Speaker 1: if i heard that i would have been very concerned you would have called dcf right
[01:03:48] Speaker 2: i might have and did when you spoke to pat did you ever ask him what his observations were of her spiraling into november and december not that one time that he stuck his face on the computer and talked to you
[01:04:05] Speaker 1: did you ever talk to him he never called me again or you never called at all i never spoke with him again
[01:04:10] Speaker 2: so he is a husband of a woman just had a baby who was postpartum with all of these symptoms that we talked about all of the drugs that you were prescribing and that she was dealing with trying to get help you never talked to her husband about what he observed because he didn't call you well we did speak on that
[01:04:32] Speaker 1: visit which visit the 16th or i think that that's the one that he was at you think it was it's not noted in the record it's not noted but i remember some of what we talked about and so in reading that record it seems like that's the likely one that he was at
[01:04:59] Speaker 2: december 16th on your objective findings you note that her mood was depressed right yes what does that mean did she just say i'm depressed or did she give you symptoms
[01:05:15] Speaker 1: i mean you checked a little box yeah i mean she's saying she's depressed okay so you're the doctor
[01:05:22] Speaker 2: you checked a little box what did your patient tell you about her symptoms that she was depressed on that date was she crying was she able to get out of bed was she worshiping at the porcelain god what was going on in her life
[01:05:39] Speaker 1: she was she said she was having a really tough time
[01:05:45] Speaker 2: her affect was flat right yes and again depressed you check it off twice one under mood and one under affect right yes and then the next page it says recent lab work that wouldn't be blood testing would it i mean aster does aster do blood testing
[01:06:12] Speaker 1: we don't have a verbotimist or a lab no
[01:06:16] Speaker 2: well why does it say recent lab work typed into your form when you check off the little boxes
[01:06:22] Speaker 1: that's something that auto populates it's a template that it's a lot many different it's a template the whole notice is something that psychiatrists or you know probably all across the country use
[01:06:35] Speaker 2: probably you can't diagnose someone's illness by a template okay no you filled in no lab results were
[01:06:43] Speaker 1: found right there were none in the computer yes i didn't type that in though it just so who typed it in it was auto populated
[01:06:54] Speaker 2: so on the next page where it talks about symptom goals treatment goals i'm sorry symptom reduction and improved functioning what does that mean
[01:07:08] Speaker 1: symptom reduction is to have fewer um fewer mental health symptoms and improved functioning means um you know improved uh you know day-to-day uh life functioning you know things that she's doing in her daily life
[01:07:29] Speaker 2: really did you tell her all that you get a young woman that's obviously mentally ill very sick she's deteriorating whether you like that word or it's automatically imported what on that date did you do never mind all those words you just
[01:07:49] Speaker 1: said what did you tell her on the television or the computer i told her to go to the partial hospitalization program and if she was having more suicidal thoughts again or felt like she was at risk of letting herself or anybody else that she should go immediately to the emergency room how long did that
[01:08:12] Speaker 2: meeting take probably about 30 minutes and was there any was that the therapy that you provided telling her to go to the emergency room i mean that was probably the component so the plan excuse me on december 16th was to follow up with women and infants right yes did she yes do you know when i don't know exactly then you you were considering a brexaniline or brexanilone infusion right that's the same thing you wrote out okay and that didn't go anywhere right that was that's the end of that uh it says start lamictal 25 milligrams daily right yes continue serequil right what was the milligram for the serequil up to at this point
[01:09:21] Speaker 1: well she had told me it was 200. i did not write that prescription so that's what her provider had
[01:09:29] Speaker 2: prescribed her okay so you can ask somebody to show me the bottle pill bottle you can ask somebody to show me the cvs receipt you can ask somebody you can call to verify right okay but you anyway she said that she was on serequil 200 milligrams right and had stopped with the value right yes and then you go on with that form thing saying if you have urges to harm yourself or others you got to call 911 crisis hotlines and everything else right that's the next two paragraphs that are in that report right
[01:10:05] Speaker ?: yes
[01:10:09] Speaker 2: was her mother and father still staying with her on december 16th if you know with pat and the kids i'm not sure did you ever ask anybody other than her
[01:10:20] Speaker 1: how she was doing i i asked her husband when he was at that appointment yeah that's the other
[01:10:27] Speaker 2: appointment how about now we're talking december 16th into into the month of december did you ever ask anyone how she was doing i think he was at that visit you think he was at the visit how do you how did he tell what did he say to you about how she was doing he said she wasn't doing well she's got an objection
[01:10:52] Speaker 1: go ahead he said she wasn't doing well anything else yeah um he felt that it it might have been in his opinion his opinion was that it was related to when she started his hairball and he basically
[01:11:08] Speaker 2: said you guys are turning her into a zombie right are those his words i don't have that written you may have said that does that kind of hit you though you might remember that you might have been as some people worry about suicide you might be thinking in your brain that he did say you're turning her into a zombie it's possible it's very possible okay um next meeting after the december 16th was it was it december 16th is that what we were just done in yes okay the next meeting was january 6th okay um and how does this happen does does the patient call i know you don't set up these appointments somebody has to deal with somebody in the administration or whatever but do you like on december 16th say to lindsay call me or set up an appointment for january 6th or do they have to do it themselves
[01:12:20] Speaker 1: so at the end of an appointment i typically will schedule their next appointment so did you schedule january 6th i think that when she scheduled herself that was the day after she got out of mclean right yeah usually the hospital coordinates the discharge appointment well if i tell you that in fact the
[01:12:42] Speaker 2: hospital told her to set up the appointment within an hour she set up the appointment is that in your notes it's not in my notes do you remember that that was a pretty a pretty big deal when she was in mclean locked wards for four and a half days right yes and she's your patient and she's really gone downhill bad right she wasn't doing well and she admitted herself to the white wards at mclean right yes what was the diagnosis at mclean
[01:13:23] Speaker 1: i believe they diagnosed her with major depression did they recommend any medication they took her off of the
[01:13:31] Speaker 2: serifal they took her off of it off okay so did you look at the mclean records yes definitely and those were employed easily because you're part of the same structure or whatever no but after someone is
[01:13:48] Speaker 1: hospitalized um the hospital usually faxes it to their doctor all right so if i tell you that the mclean
[01:13:55] Speaker 2: records um are really pretty baloonless um that's not what they fax they fax you like a two-page discards on it right yes you didn't get that kind of fax right so what did mclean tell you look in your notes
[01:14:18] Speaker ?: Thank you.
[01:14:48] Speaker 1: Which part do you want me to read?
[01:14:52] Speaker 2: Did you ever have her sign a release for McLean? Did you ever get access to the McLean records? I had access to the discharge summary. Okay, so put the discharge summary aside, because that's what they faxed you a couple of pages. What about the records?
[01:15:08] Speaker 1: No, but that's typically not.
[01:15:10] Speaker 2: No, never mind typically. The answer is no. You never got the records, right?
[01:15:15] Speaker 1: A discharge summary is a record.
[01:15:18] Speaker 2: Did you talk to the doctor that discharged her?
[01:15:22] Speaker 1: No, no one called me.
[01:15:24] Speaker 2: No what?
[01:15:26] Speaker 1: No, no one called me. I wasn't notified about the hospitalization until she was discharged.
[01:15:33] Speaker 2: So you just sit there behind your computer and wait for people, Patrick, wait for the doctor from McLean, wait for the sick person who's the patient to call you? And if these people don't call you, it doesn't exist apparently, right?
[01:15:50] Speaker 1: No, not exactly. I had no way of knowing she was even at McLean.
[01:15:54] Speaker 2: Well, you did once she got discharged, right?
[01:15:56] Speaker 1: Yeah, but that was after the fact.
[01:15:58] Speaker 2: Right. So did you care why she was in McLean?
[01:16:01] Speaker 1: Of course.
[01:16:03] Speaker 2: And why was she in McLean? Because she was depressed. And what was the, does your record indicate that she was discharged yesterday under interval history?
[01:16:22] Speaker ?: Yes.
[01:16:23] Speaker 2: And discharged from where?
[01:16:26] Speaker 1: Well, I said NGH.
[01:16:28] Speaker 2: Is that Mass General Hospital?
[01:16:30] Speaker 1: Yes.
[01:16:32] Speaker 2: And she was currently on Trazodone?
[01:16:36] Speaker 5: Yes.
[01:16:38] Speaker 2: And she indicated that the goal was to come off Seroquel?
[01:16:43] Speaker 1: Yes.
[01:16:44] Speaker 2: And she described herself as still being very numb?
[01:16:49] Speaker ?: Yes.
[01:16:50] Speaker 2: She couldn't sleep, right?
[01:16:58] Speaker 1: That's not entirely true.
[01:17:00] Speaker 2: Am I lying? I'm reading the medical records here. Sleep, taking ativan and Trazodone, slept five hours broken, wondering about increasing Trazodone and switching to valentine. What is that?
[01:17:16] Speaker 1: Well, I think she was having trouble sleeping. It wasn't that she wasn't sleeping.
[01:17:19] Speaker 2: Ah, I see. Okay. So was the Trazodone increased at that point?
[01:17:29] Speaker ?: Yes.
[01:17:34] Speaker 2: How about on January 9th? Did you see her through the computer or whatever then?
[01:17:50] Speaker ?: Yes.
[01:17:52] Speaker 2: And did you prescribe medication to her on that date?
[01:17:59] Speaker ?: Yes.
[01:18:00] Speaker 2: And was that diazepam?
[01:18:03] Speaker ?: Yes.
[01:18:04] Speaker 2: 14 count, one milligram? No, I'm sorry. 14 count, five milligrams.
[01:18:10] Speaker ?: That sounds right.
[01:18:12] Speaker 2: Okay. Did you also, on January 12th, three days after January 9th meeting, prescribe additional medication to her?
[01:18:23] Speaker 1: I'm not sure. I don't have a record from January 12th.
[01:18:25] Speaker 2: Do you recall on January 12th that, in fact, you prescribed Trazodone 150 milligrams, 30 count?
[01:18:37] Speaker ?: Yes.
[01:18:41] Speaker 2: Three days later, or a couple of days later, January 16th, do you recall prescribing amitriptyline?
[01:18:51] Speaker ?: Yes.
[01:18:53] Speaker 2: What does amitriptyline mean?
[01:18:55] Speaker 1: Tricyclic antidepressant.
[01:18:57] Speaker 2: What does a tricyclic antidepressant mean?
[01:19:04] Speaker 1: Well, it's an older antidepressant. It's called a tricyclic because it has three rings. You look at the chemical itself like a tricycle. But it's an older but efficacious medicine for depression and anxiety as well as insomnia.
[01:19:24] Speaker 2: On January 16th, look at your interval history. Did she indicate to you that her mood was very low, no motivation?
[01:19:36] Speaker 4: Yes.
[01:19:38] Speaker 2: Numb?
[01:19:39] Speaker ?: Yes.
[01:19:41] Speaker 2: Able to force herself out of bed, taking care of basics, eating, concentration fine, caring for baby, bonding feels forced. Is that what she told you? Yes. Through the computer, right?
[01:20:02] Speaker ?: Yes.
[01:20:03] Speaker 2: What did that tell you? Were you concerned about this woman, postpartum, well within the year from the CDC at that point with these symptoms that she's telling you about?
[01:20:12] Speaker 1: I was concerned that she was depressed.
[01:20:15] Speaker 2: And in all of the times that you spoke to her, you can agree with me that she appeared to be honest and forthright telling you what she felt, right?
[01:20:24] Speaker 1: That's what I thought she was, yes.
[01:20:26] Speaker 2: Do you have any reason to think that she was lying to you?
[01:20:29] Speaker 1: No.
[01:20:33] Speaker 2: Diazepam taper on January 16th. Five milligrams, last two nights, slept for four hours, and then a light sleep, maybe two hours, stretches. Did she express that she was still having concerns about side effects from medications?
[01:20:56] Speaker 1: Not at that point.
[01:20:57] Speaker 2: So what does ROS mean under interval history that we're looking at?
[01:21:03] Speaker 1: UOS symptoms.
[01:21:04] Speaker 2: Okay. And then it says patient denies SIHI, that would be suicidal ideation, homicidal ideation, correct?
[01:21:13] Speaker ?: Yes.
[01:21:14] Speaker 2: Denies other questions or concerns, and you recommend a low dose of amitriptyline for depression, correct?
[01:21:21] Speaker ?: Yes.
[01:21:24] Speaker 2: Patient agrees with the treatment, and you guys were also going to explore ketamine treatment, ketamine treatment. Escaketamine.
[01:21:37] Speaker ?: Yes.
[01:21:38] Speaker 6: Now, patients telling you what to do and how to handle them? No. Were you alone responsible for the evaluation, diagnosis, and treatment of your patients?
[01:21:48] Speaker 1: For the most part, but if I had questions or, you know, needed to talk it through, I had help.
[01:21:54] Speaker 6: And approximately how many patients did you treat during those four years? Thousands. And those were all psychiatric patients, correct? Yes. You said approximately 50 of those patients were patients dealing with postpartum depression or some postpartum issues. Is that correct?
[01:22:13] Speaker ?: Yes.
[01:22:13] Speaker 6: You also said you had some specialized or specific training in that area. Can you describe that for us?
[01:22:19] Speaker 1: Yes. I did a specialized elective with a specifically perinatal psychiatrist where I worked in an obstetrics clinic, and I saw patients who were pregnant and postpartum.
[01:22:32] Speaker 6: And how long was that clinic for?
[01:22:34] Speaker 1: It was for about a year.
[01:22:36] Speaker 6: And so for a year, you were evaluating and diagnosing and treating women with postpartum issues? Yes. And that's separate and apart from your residency?
[01:22:47] Speaker 1: It's a part of the residency. It's an elective.
[01:22:49] Speaker 6: So for one year out of the four, that was specifically designated to postpartum issues?
[01:22:56] Speaker 1: Yes. It wasn't every single day, but it was continuing the same patients for about a year.
[01:23:02] Speaker 6: So you would follow those same patients throughout the year? Is that what you're saying? Yes. And you were asked about postpartum psychosis, and you said it was rare. How rare is it?
[01:23:15] Speaker 1: I'm not sure of the statistic, but low.
[01:23:18] Speaker 6: Low. Have you dealt with patients in your four years of residency that had other types of psychosis?
[01:23:27] Speaker 1: Yes, many.
[01:23:28] Speaker 6: And psychosis, whether it's from postpartum or some other mental illness, does it present the same, or does it matter what the underlying illness is?
[01:23:38] Speaker 1: I mean, it can present different based on the individual, but it's the same general disorder.
[01:23:46] Speaker 6: And so what are the symptoms or signs that you look for to determine whether someone has psychosis?
[01:23:51] Speaker 1: So you look at them, you assess their appearance, are they disheveled, and then you look at how cooperative they are, how they're engaging in your interview, are they answering your questions or maybe refusing to answer your questions, maybe being very aggressive. You look at their speech, whether they're speaking very fast, very loud, or the opposite, like maybe not really even speaking much at all. You look at what their thoughts are like, and we assess thoughts by what they're saying. That's how we know what people are thinking. And whether what they say makes sense linearly, or whether someone's jumping around and you can't follow them. We also assess the thoughts for their content. If someone is speaking about things that are very bizarre, things that are very paranoid, if someone is talking or making noises, or it seems like they're communicating with somebody that's not in the room, those are all things, behaviors that we assess for.
[01:25:03] Speaker 6: So although you'd never treated someone with postpartum psychosis, you had evaluated, diagnosed, and treated people with other types of psychosis. Is that correct? Yes. Did you see any signs of psychosis in any of your interactions with Lindsay Clancy?
[01:25:17] Speaker 1: No.
[01:25:19] Speaker 6: Defense counsel mentioned that part of your residency was during COVID. Did mental health issues just stop during COVID?
[01:25:25] Speaker 1: Of course not. They often got worse.
[01:25:28] Speaker 6: And so it's fair to say you still kept busy seeing patients on a daily basis? Yes. You also mentioned that some of the patients you saw in your residency, it was outpatient care. Is that correct? Yes. Is that similar to the care you were providing to Lindsay Clancy? Yes. And was that all four years you were providing outpatient care to psychiatric patients?
[01:25:53] Speaker 1: For three of the four.
[01:25:57] Speaker 6: You were also asked about telehealth. Is telehealth appointments in psychiatric care standard in the industry? Yes. And how long has that been standard? Since COVID. And is it a fairly common and accepted practice at this point? Yes. Most of the session, for a psychiatric session, you're talking to someone, right? Yes. Does looking at someone through a computer screen somehow inhibit how you hear the answers? No, it does not. Or inhibit the way you ask your questions?
[01:26:30] Speaker 1: No.
[01:26:31] Speaker 6: And defense counsel asked you about, you know, not being able to see below the waist someone's shaking or moving, but if someone's sitting and they're bouncing, can you see it elsewhere? Can you see other movement?
[01:26:43] Speaker 1: Yeah, sometimes it can reverberate in different parts of the body.
[01:26:49] Speaker 6: You were also asked about the Edinburgh scale. You said you don't use it, right? Yes. You said you use the PHQ-9. Why do you use that instead of the Edinburgh scale?
[01:26:59] Speaker 1: It's not my choice. That's the practice at ASTAR of what we use.
[01:27:04] Speaker 6: And the PHQ-9, what does that look for? It assesses various symptoms of depression. And postpartum depression, are there questions on the PHQ-9 that look for the signs and symptoms of postpartum depression?
[01:27:21] Speaker 1: Not specifically postpartum depression, but the symptoms of postpartum depression are symptoms of depression that occur during postpartum. It's the same symptoms.
[01:27:32] Speaker 6: So the PHQ-9 is asking the patient questions that would reveal whether or not they might be depressed, but not whether or not they just had a baby. Correct. And then with your interaction with the patient, you're able to know whether or not they are in the postpartum phase. Yes. And so would it be fair to say that you take the PHQ-9 plus the information you learned from the patient, put it together and come up with a diagnosis? Yes. When you take a history from a patient, you were asked about taking history from Ms. Clancy. How important is it that the patient give you accurate information?
[01:28:10] Speaker 1: It's very important.
[01:28:12] Speaker 6: And why is that?
[01:28:14] Speaker 1: Well, that information is being used to make treatment decisions. And a lot of things can be assessed. You know, the things that I described before, that's very helpful. But we can't see what someone else's thoughts exactly are. So the person does have to tell them to us.
[01:28:37] Speaker 6: And would you agree that people in the medical field, such as nurses, are acutely aware of the necessity of an accurate medical history and symptom presentation? Yes. You mentioned that the defendant was able to advocate for herself. In what ways did she show you that?
[01:28:55] Speaker 1: In scheduling her own appointments, in presenting herself to the emergency room when things were really not going well.
[01:29:16] Speaker 5: She said she was able to advocate for herself and to the patient.
[01:29:19] Speaker ?: She said she was able to advocate for herself. She said she was able to advocate for herself. She said she was able to advocate for herself. She said she was able to advocate for herself.
[01:29:23] Speaker 5: And she said she was able to advocate for herself. And she said she was able to advocate for herself.
[01:29:25] Speaker ?: She said she was able to advocate for herself. She said she was able to advocate for herself. And she said she was able to advocate for herself. She said she was able to advocate for herself. She said she was able to advocate for herself. She said she was able to advocate for herself. She said she was able to advocate for herself. She said she was able to advocate for herself. She said she was able to advocate for herself. She said she was able to advocate for herself. She said she was able to advocate for herself. She said she was able to advocate for herself. She said she was able to advocate for herself. She said she was able to advocate for herself. She said she was able to advocate for herself. She said she was able to advocate for herself.
[01:29:44] Speaker 5: She said she was able to advocate for herself.
[01:29:45] Speaker ?: She said she was able to advocate for herself. She said she was able to advocate for herself. She said she was able to advocate for herself. She said she was able to advocate for herself. She said she was able to advocate for herself. She said she was able to advocate for herself.
[01:29:51] Speaker 5: She said she was able to advocate for herself. She said she was able to advocate for herself.
[01:29:55] Speaker ?: She said she was able to advocate for herself.
[01:29:55] Speaker 5: She said she was able to advocate for herself.
[01:29:58] Speaker ?: She said she was able to advocate for herself. She said she was able to advocate for herself. She said she was able to advocate for herself. She said she was able to advocate for herself.
[01:30:02] Speaker 5: She said she was able to advocate for herself. She said she was able to advocate for herself. She said she was able to advocate for herself. She said she was able to advocate for herself.
[01:30:06] Speaker ?: She said she was able to advocate for herself. She said she was able to advocate for herself. She said she was able to advocate for herself. She said she was able to advocate for herself. She said she was able to advocate for herself. She said she was able to advocate for herself. She said she was able to advocate for herself.
[01:30:13] Speaker 5: She said she was able to advocate for herself. She said she was able to advocate for herself.
[01:30:15] Speaker 6: She said she was able to advocate for herself. She said she was able to advocate for herself. She said she was able to advocate for herself. She said she was able to advocate for herself. She said she was able to advocate for herself. She said she was able to advocate for herself. She said she was able to advocate for herself. She said she was able to advocate for herself.
[01:30:23] Speaker 1: She said she was able to advocate for herself.
[01:30:24] Speaker 6: She said she was able to advocate for herself. She said she was able to advocate for herself. She said she was able to advocate for herself. She said she was able to advocate for herself. She said she was able to advocate for herself. She said she was able to advocate for herself. She said she was able to advocate for herself. She said she was able to advocate for herself. She said she was able to advocate for herself. She said she was able to advocate for herself. She said she was able to advocate for herself.
[01:30:35] Speaker 1: Because that's how you really understand what a person is feeling.
[01:30:44] Speaker 6: Now, is it accurate to state that in every one of your sessions with Ms. Clancy, you told her about individual therapy and encouraged her to attend individual therapy?
[01:30:56] Speaker 1: That was the treatment recommendation each time. I'm not sure if I explicitly mentioned it each time, but I did many times.
[01:31:04] Speaker 6: And you, in fact, wrote it on the work form that we talked about previously on page 104 of the records. It lists, was the patient referred to other health care providers for evaluation or treatment? It says yes. If yes, state the nature of such treatments and expected duration of treatment. And it says individual weekly therapy, correct? Yes. And this is the form that the defendant asks you to fill out, correct? Yes. And you sent it back to her. And the first version she wanted you to make some corrections on, correct? Yes. But she didn't ask you to change that portion, correct? No. And in fact, on the second version on page 107 of the record, it still says individual weekly therapy recommended, correct for follow-up?
[01:31:52] Speaker 1: Yes.
[01:31:53] Speaker 6: Would it be accurate to state that the defendant only saw Jennifer McAllister twice the entire time that she was with your practice for therapy? Yes. You were asked about Zoloft being used for general anxiety disorder. Is that a common drug used for general anxiety disorder? Yes. And why is that?
[01:32:16] Speaker 1: Because it's effective and it's safe.
[01:32:18] Speaker 6: You were also asked about the suicide warning on it, that there is a suicide warning. Is that for all ages? No. What ages or groups is that suicide warning for?
[01:32:29] Speaker 1: It's really for children and adolescents. They do say up to 24 years. But it's really children and adolescents.
[01:32:38] Speaker 6: Would it be accurate to state that the defendant was 32 years old when she saw you?
[01:32:42] Speaker 1: That sounds right.
[01:32:45] Speaker 6: Well, if you want to check the records. I can check. Yes. Is that correct? Yes. Okay. So 32 years old is not three to four years older than 24, correct? No. Why didn't you have to titrate the 50 milligrams of Zoloft? You mean to stop it?
[01:33:08] Speaker 1: Yes. Because it's still a very low dose. So it can be stopped right away.
[01:33:15] Speaker 6: So it wasn't necessary? Not necessary. The defendant waited about a month after receiving the prescription before taking the medication, correct? Yes. And she only took the medication when she decided she was ready to take it, correct? Yes. So she was taking in the information you gave her, correct? Yes. She was making her own decisions, correct? Yes. She was not forced to, correct? Yes. She actually had an appointment in between when you first prescribed it and when she started taking it, where she was still discussing with you whether or not she wanted to take it. Is that correct? Yes. Is that part of the advocating for herself that you were talking about? Yes. Is that part of the medical sophistication that she possessed that you were talking about? Yes.
[01:34:07] Speaker 2: Your Honor, at some point in light of the fact this is direct, I have to object.
[01:34:12] Speaker 3: Sure. Yeah, if you could just not ask the leading question. Sure.
[01:34:16] Speaker 6: I want to direct your attention to the September 12, 2022 form that the defendant filled out. Page 16 of the record. Oh, we have different page numbers, right? We do.
[01:34:31] Speaker 1: But if you just tell me what you're looking at, I can find it. The past psychiatric history.
[01:34:49] Speaker 6: Okay. What did she tell you, Ms. Clancy, tell you about the, where it says, if yes, list the reason and dates, what did she tell you?
[01:34:59] Speaker 1: Um, she said, anxiety, September, 2013 to September, 2014, postpartum anxiety, May, 2020.
[01:35:10] Speaker 6: And on the following page under the, um, past or current site psychiatric medications, which ones did she list?
[01:35:20] Speaker 1: Um, Prozac, 50 milligrams and Wellbutrin, 100 milligrams.
[01:35:28] Speaker 6: Is there a column there that says effective yes or no? Yes. What was the defendant's answer with whether or not Prozac was effective? Yes. What was her answer as to whether or not Wellbutrin was effective?
[01:35:41] Speaker 1: Yes.
[01:35:42] Speaker 6: Is there another column there that said experienced side effects?
[01:35:46] Speaker 1: Yes.
[01:35:47] Speaker 6: Did she check off any side effects experience for Prozac?
[01:35:51] Speaker 1: No.
[01:35:52] Speaker 6: Did she check off any, uh, side effects experience for Wellbutrin? No. Going to the October 20th, 2022 appointment. You were asked about this on cross-examination, about documenting side effects in your notes. Did you document the side effects that the defendant reported from the Zoloft on October 20th, 2022? Yes. And what did you document?
[01:36:48] Speaker 1: Well, I checked the box for GI, but I also talked about the side effects and the interval history.
[01:36:57] Speaker 6: And so what does GI mean? Gastrointestinal. So that means stomach issues? Yeah. And what did you put in your notes?
[01:37:08] Speaker 1: Couldn't sleep, insomnia, worse on an increased dose, doesn't want to eat, diarrhea, food really unappealing, was more depressed on it, crying all day, yesterday, not normal, mental fog, terrified to start something new.
[01:37:26] Speaker ?: Okay.
[01:37:27] Speaker 6: And so you did document the side effects that she reported to you, correct? Yes. You also documented in the interval history, paranoid of getting suicidal thoughts. Was that the defendant's phrasing? Yes. And is there a difference between someone being worried about having suicidal thoughts and someone actually having suicidal thoughts? Yes. And what's the difference in terms of how a psychiatrist sees it?
[01:37:56] Speaker 1: So that's the difference between what someone, what a patient might answer and then what the psychiatrist actually assesses. So say a patient might say they're having suicidal thoughts, but when they describe them, they're not actual suicidal thoughts. They're fears of suicidal thoughts. So that's, that's the difference there. And I'm sorry, I think I forgot exactly what your question was.
[01:38:26] Speaker 6: What's the difference in your training and experience between someone having fears of suicidal thoughts and actually having suicidal thoughts?
[01:38:34] Speaker 1: Well, so if it's, if it's a fear, then it means that they're not actually having suicidal thoughts. It's a negative.
[01:38:43] Speaker 6: And does that affect the way you proceed with treatment?
[01:38:46] Speaker 1: Um, yes, in some ways. Yes. How? Well, you, you still proceed with treatment. It's still concerning, um, but it is a level of concern that can be managed on an outpatient basis, not requiring hospitalization.
[01:39:04] Speaker 6: And so according to the defendant, she was not yet having suicidal thoughts at that time. Yes. So when defense counsel asked you repeatedly why you didn't document how many times she had those thoughts, she hadn't had those actual thoughts yet. Correct?
[01:39:20] Speaker ?: Correct.
[01:39:21] Speaker 6: That was later in December. Is that right? Yes. Now, she also told you that she was worried about something, that something bad might happen. So she arranged for her mother to stay. Is that correct?
[01:39:35] Speaker 1: Um, well, she arranged for her mother to stay. I'm not sure if that was because she was afraid something bad was happening. Um, or it just seemed like they needed more help.
[01:39:47] Speaker 6: Okay. So you, you don't recall the two being together as a thought? Correct. And the fact that she was struggling and arranged to have her mother stay, got support, advocated for herself. Would those be protective factors? Yes. How so?
[01:40:04] Speaker 1: Um, so if, if, if someone demonstrates that they can advocate for themselves, that they can seek help if, uh, symptoms worsen, then that shows that they, um, they have good judgment. They can be, they can be trusted, um, to, um, to present for care if, if, you know, serious safety concerns were to arise.
[01:40:31] Speaker 6: So based on your training experience with Ms. Clancy, where she says she's having, she's worried about getting suicidal thoughts and she has her mom come stay with her. Do you see that as a positive decision? Yes. You were asked, um, about not asking the defendant if she had called the suicide hotline. Um, if a patient denies suicidal ideation. Would you typically ask them if they had called a suicide hotline?
[01:41:02] Speaker 1: No.
[01:41:03] Speaker 6: And why not?
[01:41:05] Speaker 1: Because I, you know, I wouldn't think that they would have, you know, if, if a patient were to call a suicide hotline, I would think that they would be telling me they're having suicidal thoughts as well.
[01:41:23] Speaker 6: You were asked about, um, prescribing hydroxyzine, hydroxyzine, out of an abuse bar. Um, did you tell the defendant how to take those medications? Yes. What were your instructions?
[01:41:36] Speaker 1: So the Ativan was to take as needed for severe anxiety. The abuse bar was to be an everyday medicine and the hydroxyzine. We had started that to see if she could use that as an alternative to the Ativan. So to take it instead of the Ativan. But if the Ativan wasn't, or sorry, if the hydroxyzine wasn't working, she still had the Ativan to use, which is, it's stronger.
[01:42:08] Speaker 6: So there was never, was there ever an instruction for her to take all three at the same time? No. And you were asked about the contraindications of Ativan and Benadryl. Do you recall that? Yes. Um, was, are there contraindications for taking the two together?
[01:42:23] Speaker 1: It's, it's not an absolute contraindication. You have to be careful that the person is not excessively sedated, you know, meaning like they're, they're so sleepy, um, that it's, it's hard for them to, you know, engage in normal activities because they're so sleepy or maybe they might feel a little bit dizzy. Um, but, uh, it's not an absolute contraindication. You just have to monitor them.
[01:42:49] Speaker 6: And is that one of the reasons that you prescribe the hydroxyzine?
[01:42:52] Speaker 1: Sorry, is, is what one of the reasons is the, the, the fact that the two of them together
[01:42:58] Speaker 6: Ativan and Benadryl, um, but let me strike that question. Why did you provide, prescribe the, uh, hydroxyzine?
[01:43:07] Speaker 1: So she had been taking Benadryl, um, which is not a prescription medication. It's not classically in within the scope of psychiatry, um, but it's very similar to hydroxyzine. And so I thought that, you know, hydroxyzine might be a better alternative than the Benadryl.
[01:43:25] Speaker 6: Okay. And I'm just going to direct you to your November 2nd, 2022 interval history. Now, would it be fair to say that on the November 2nd date, um, the defendant reported she was fine all day, evenings, bedtime, get anxious, Ativan helps, sleeping great on it. Now, would it be fair to say that on the November 2nd date, um, the defendant reported she was fine all day, evenings, bedtime, get anxious, Ativan helps, sleeping great on it, afraid to try something else, but knows it's not a long-term solution. Is that correct? Yes. And what part of that, um, did the defendant tell you was not a long-term solution? Uh, taking the Ativan.
[01:44:11] Speaker ?: And why is that?
[01:44:11] Speaker 1: Um, because it was indicated for short-term use only, um, the people can struggle more with dependence if they're taking it for a very long period of time.
[01:44:25] Speaker 6: And, um, was there a plan developed based on that concern?
[01:44:31] Speaker 1: Um, yes, there was. What was the plan? To reduce the dose by 0.25 milligrams every two weeks until she was off it.
[01:44:38] Speaker 6: So the defendant was able to express to you a concern she had about the medication, you had a conversation about it, and you addressed that with her and came up with a plan, is that right? Yes. She also told you that day that she was in therapy and exercising daily, correct? Yes. Did the defendant ever tell you that she went to the South Shore Hospital Emergency Department on November 16, 2022? I don't recall that. Did she tell you that they had prescribed trazodone to her at that time?
[01:45:12] Speaker 1: I don't recall that.
[01:45:13] Speaker 6: Did she ever tell you that she was trying some alternative methods like weed gummies? No. Do you have any way of knowing these things if the patient doesn't tell you?
[01:45:25] Speaker 1: No.
[01:45:26] Speaker ?: No. No. No.
[01:45:29] Speaker 6: No. No. No. No.
[01:45:33] Speaker ?: No.
[01:45:33] Speaker 6: No. No. No. No. No.
[01:45:38] Speaker ?: No. No.
[01:45:38] Speaker 6: No.
[01:45:39] Speaker ?: No.
[01:45:39] Speaker 6: No.
[01:45:40] Speaker 1: Yes.
[01:45:41] Speaker 6: Up until that point, had she consistently denied suicidal ideation or intent or a plan? Yes. Had she consistently denied homicidal ideation, intent or a plan? Yes. What's the difference? Well, let me ask you this. When you talk to a patient, do you ask them, do you have suicidal ideation? Not usually. Not in that way. How do you get that information from them? What types of questions do you ask?
[01:46:08] Speaker 1: It depends how the course of the conversation is going. I might ask if they're having thoughts of hurting themselves, if they, you know, sometimes wish that they weren't alive. It can be a lot of different words, and sometimes I use, you know, the patient's own words, but things like that.
[01:46:28] Speaker 6: And is there a difference between having thoughts of suicide versus having the intent and a plan to do it? Yes. And are there different types of treatment or things that you would do if someone has intent or plan to do it?
[01:46:46] Speaker 1: Yes. That would generally require hospitalization.
[01:46:50] Speaker 6: And so if Ms. Clancy had told you she had thoughts of hurting herself, or actually, sorry about that, if she told you that she had a plan to hurt herself or a plan to hurt her children, would you have moved to commit her? Yes. And that would be a section 12? Yes. You were asked about the October 31st therapy session with Jennifer McAllister, and I know you weren't present from that. You're just going from the records. But you did say that in that session, the defendant denied suicidal ideation and homicidal ideation, correct?
[01:47:31] Speaker 1: Yeah, that's what's documented.
[01:47:32] Speaker 6: Would there be any reason, based on your training experience, to do that further suicidal intent assessment?
[01:47:40] Speaker 1: No.
[01:47:40] Speaker 6: Why not?
[01:47:41] Speaker 1: Because if someone is denying suicidal ideation, they're just going to deny every other detail about suicide.
[01:47:53] Speaker 6: But that further evaluation, is that very specific questions about planning for suicide, how you do it, all of those things? Yes.
[01:48:02] Speaker ?: Okay.
[01:48:04] Speaker 6: You were also asked about evaluating the defendant for bipolar, and you said that she, based on your conversations with her, there were no signs of mania, correct?
[01:48:14] Speaker 1: Correct.
[01:48:15] Speaker 6: What are the types of questions you ask a patient to determine if they've experienced an episode of mania?
[01:48:22] Speaker 1: Well, a lot of it is what I can see in the session. I might also ask about some of those symptoms, like decreased need for sleep, or racing thoughts, or increased risk-taking activities. But even if they're reporting those things, I would have to really see it for myself to diagnose that.
[01:48:47] Speaker 6: And what would you see physically?
[01:48:50] Speaker 1: So, I might see that the person is talking very fast, and it's almost impossible to interrupt their rate of speech. And it might also be very loud. They might be hyperactive, not able to sit still. They might be yelling and jumping from one thought to another without any linear connection between the thoughts. They might, yeah, I guess that's probably what I would observe in terms of behaviors.
[01:49:27] Speaker 6: Did you observe any of those behaviors with Lindsay Clancy?
[01:49:30] Speaker 1: No, it was the opposite.
[01:49:32] Speaker 6: What do you mean it was the opposite?
[01:49:34] Speaker 1: So, you know, the opposite of euphoria is dysphoria or depression. The opposite of hyperactivity is tiredness and fatigue. So, you know, in a way, it was the opposite of mania that I observed.
[01:49:51] Speaker 6: And in terms of the questions you asked about her past behavior, were any of the answers that she gave indicative of mania?
[01:49:59] Speaker ?: No.
[01:50:03] Speaker 6: You were asked about discussing Seroquel with the defendant, even though you weren't the prescriber. Why did you discuss that medication with her?
[01:50:11] Speaker 1: Because the patient was asking about it and her husband was also asking me about it. They really wanted my opinions about it. It wasn't necessarily that I was prompting this line of conversation.
[01:50:29] Speaker 6: And what did you tell them about it?
[01:50:31] Speaker 1: Well, I shared that it has very good evidence for treating depression. And I may have shared that Seroquel does different things at different doses, right? So sometimes people are concerned that it is called an antipsychotic. But it actually doesn't function as an antipsychotic until you get up to really high doses, like 800 milligrams. So in low doses, it's more of a sleep medicine or an antidepressant. So I think that I explained that to them, and it's obviously a very important part of it. But they were also concerned about that causing the depression that she was experiencing. So we talked a bit about how you would tell. You know, it kind of can be hard to tell whether a medicine is causing that or it's just occurring because of depression.
[01:51:30] Speaker 6: What did you tell them in terms of how to tell?
[01:51:33] Speaker 1: But it's really based on the timing, if you were to notice a significant decline after starting or increasing the medication.
[01:51:42] Speaker 6: And prior to Ms. Clancy taking the Seroquel, had you noticed signs of depression in her? Yes. And after she was off of the Seroquel in January, did you see signs of depression in her? Yes. So that was completely off of the Seroquel, both before and after, still showing signs of depression? Yes. During January, the defendant told you she had trouble getting out of bed?
[01:52:14] Speaker 1: Is there a specific visit?
[01:52:16] Speaker 6: I think it was right after she got out of the hospital. Maybe your first or second visit with her.
[01:52:37] Speaker 1: I see that on the 16th, she did say that she was able to force herself out of bed and take care of basics, so on and so forth.
[01:52:48] Speaker 6: Were you aware that she had gone to the Museum of Science with her family on January 8th and spent a few hours there interacting with the exhibits and the children?
[01:52:56] Speaker 1: No.
[01:52:57] Speaker 6: Were you aware on January 15th, the day before that session, she had been to the Cape Codder down in Hyannis with the family, interacting with the kids and going down little water slides and all of that?
[01:53:08] Speaker ?: No.
[01:53:09] Speaker 6: Were you aware that on January 14th, she watched all three kids while Pat went to a brunch and was fine?
[01:53:17] Speaker ?: No.
[01:53:17] Speaker 6: Were you aware that on January 16th, her husband took Cora skiing and she was alone with the boys all day and had no issues?
[01:53:25] Speaker ?: No.
[01:53:28] Speaker 6: You were asked about the thyroid and how that can affect mental health and postpartum. Were you aware that at both South Shore Hospital and Brigham and Women's Hospital, her thyroid limits were in normal range?
[01:53:45] Speaker 1: No, I was not.
[01:53:48] Speaker 6: You received a discharge summary from McLean Hospital? Yes. What's contained in the discharge summary?
[01:53:55] Speaker 1: So, it includes information about how the patient initially presented, what they said when they first came to the hospital and their initial assessment from the psychiatrist that they spoke with. It talks a bit about their course, their treatment course, how things progressed, any changes that were made. And then it talks about how the patient appears on the day of discharge.
[01:54:24] Speaker 6: Does it also include what medications they were prescribed and what the diagnosis might have been? Yes. And was that sufficient in terms of your review of the information that you needed to know about your patient at that time?
[01:54:41] Speaker 1: Yes. That was a very helpful amount of information that I would typically review that amount of information for a patient after the hospital.
[01:54:54] Speaker 6: Now, you were asked about your January 23rd, 2023 session with the defendant. Defense counsel asked if you had, you know, recommended a hospital evaluation for her on that day and you said no. Why not?
[01:55:12] Speaker 1: Because she was completely denying any suicidal ideation or homicidal ideation. Um, there were no signs of psychosis or mania, um, so there were no, um, serious, uh, signs that her safety or that anyone else's safety was at risk.
[01:55:37] Speaker 6: And during that session, did she ever tell you that she planned to harm herself or the children? No. If she had done that, what would you have done?
[01:55:45] Speaker 1: I would have, um, it depends exactly how it would have played out. Um, you know, it, it might, it would, it would definitely include hospitalization. Um, if, if the children were in immediate harm, it might include enlisting help from my staff so that they could call the police while I'm on the phone with her. Um, you know, I think it, it depends, but I would, I would address it promptly.
[01:56:12] Speaker 6: You were asked by defense counsel about the amitriptyline that you prescribed on January 16th, 2023. Um, that initial prescription was for 10 milligrams, correct?
[01:56:24] Speaker 1: Yes.
[01:56:24] Speaker 6: Um, would you agree with me that this shows that the prescription was filled on that same day, January 16th, 2023? Yes. And out of this pill bottle here, um, there were 30 pills in this prescription, correct? Yes. And there are only eight, there are eight pills missing from this bottle. So filled on January 16th, 16th, 17th, 18th, 19th, 20th, 21st, 22nd, 23rd would be eight days, correct? Mm-hmm. And on the 23rd is when you said she could raise it to 20 milligrams? Yes. So if there are only eight pills missing, she never took that additional dose, correct?
[01:57:23] Speaker 1: That's what I would think based on what you just said.
[01:57:26] Speaker 6: So the amitriptyline, increasing it to, from 10 milligrams to 20 milligrams, wouldn't have pushed her over the edge, correct?
[01:57:34] Speaker 1: Um, well, if she didn't take 20 milligrams, then that's correct.
[01:57:46] Speaker 6: I have nothing further, thank you.
[01:57:49] Speaker 3: All right.
[01:57:49] Speaker ?: All right.
[01:57:49] Speaker 3: Can we cross?
[01:57:53] Speaker 2: Briefly. So one of the, uh, questions that prosecutor asked you pertain to, um, whether or not you could reach out to a third party. You recall that question, like mother or father, husband? Yes. And we already on cross talked about that, that you didn't, and they didn't call you, but then the DA also raised that, and you said you didn't have HIPAA permission. Did you recall just telling that to the jury?
[01:58:28] Speaker 1: Yes. That was an additional detail.
[01:58:30] Speaker 2: All right. What does that mean?
[01:58:33] Speaker 1: Um, well, uh, HIPAA is the privacy law for patients, um, which we have to respect and honor, um, very diligently. Um, so we, we are not allowed to talk, uh, about a patient's treatment to anyone. We're not even allowed to, um, say that they are a patient at our clinic, um, unless they were to waive those HIPAA rights.
[01:58:59] Speaker 2: And, and she was, was very cooperative, would have been more than willing to have to talk to her mother, father, and her husband, right? Conjecture. Sustained. Well, did you ever tell her, ask her to sign a HIPAA?
[01:59:13] Speaker 1: So that was not the main reason why it wasn't done. It wasn't...
[01:59:17] Speaker 2: Did you ever ask her to sign a HIPAA?
[01:59:22] Speaker 1: A release, you mean? Yeah. Yes. Um, no, I did not ask her to sign a release.
[01:59:28] Speaker 2: And if she did sign a release, even though her mother, her father, her husband didn't call you, you could have then reached out to them, right?
[01:59:39] Speaker 1: I could have, but it is not typically something that is done when you have an adult patient who's able to speak for themselves.
[01:59:47] Speaker 2: Yeah, what is that? It's not typically done when?
[01:59:49] Speaker 1: When you have an adult patient who is able to speak for themselves.
[01:59:54] Speaker 2: My God, you don't call the parents that she's living with because they're helping her or her husband?
[01:59:59] Speaker 1: No.
[02:00:02] Speaker 2: Because why? She's able to advocate for herself?
[02:00:07] Speaker 1: Yes.
[02:00:10] Speaker 2: Um, the prosecutor yet again raises the issue of the, uh, the marijuana. Do you recall that question?
[02:00:21] Speaker 1: Yes.
[02:00:22] Speaker 2: She wasn't smoking marijuana, was she?
[02:00:25] Speaker 1: She did not tell me she was smoking marijuana.
[02:00:28] Speaker 2: Did she tell you that she was using marijuana?
[02:00:31] Speaker ?: No.
[02:00:31] Speaker 2: Did she tell you that she was using gummies?
[02:00:36] Speaker 1: No.
[02:00:37] Speaker 2: Did she, because gummies in plural is what the DA asked you, right? She was using gummies?
[02:00:42] Speaker 1: Yes.
[02:00:43] Speaker ?: Okay.
[02:00:43] Speaker 2: Now, I asked you about getting access to the woman and infant's hospital records, which you did not. Which you did not, right? I did not. And we already went over that. You could have, if you, if you asked for them with a HIPAA form, right?
[02:01:00] Speaker 6: Objection. You didn't ask about those records.
[02:01:02] Speaker 2: I don't care if she asked about the records.
[02:01:04] Speaker 6: It was on the scope.
[02:01:05] Speaker 2: Overruled. You can ask that question. You asked, she asked you about marijuana gummies, right? Yes. Okay. Your Honor, I would offer the woman and infant's hospital records from Rhode Island, dealing with Lindsay Clancy.
[02:01:24] Speaker 6: No objection.
[02:01:25] Speaker 2: Okay.
[02:01:26] Speaker 3: They may be admitted.
[02:01:29] Speaker 6: I just want to look at them at some point to make sure it's a clean copy.
[02:01:32] Speaker 3: Sure, yeah. Before it goes to the jury, you can review it.
[02:01:39] Speaker 2: And it's important for a, excuse me, it's important for a patient to be forthright when asked questions by their provider, right?
[02:01:56] Speaker 1: Yes.
[02:01:56] Speaker 2: And you always, in your opinion, found her to be forthright, right?
[02:01:59] Speaker 1: Yes. In the middle of November, she tried taking a marijuana edible to help her sleep, which caused her to have increased anxiety and palpitations.
[02:02:27] Speaker 2: So, the records, if you had obtained them, you would have seen that it was not marijuana, it was not gummies, plural. It was one gummy that she tried, and it wouldn't work out, right?
[02:02:41] Speaker 1: Based on what I just read. Yes.
[02:02:47] Speaker 2: Then you told us that there's a difference between a thought of suicide versus a plan of suicide, one of which would result, in your words, were a commit, a commitment, right? Yes. What does that mean? Thought versus plan equals commit.
[02:03:08] Speaker 1: A suicidal plan means that they are, you know, they know exactly what they're going to do to end their life, you know, what they're going to use, maybe when they're going to do it. They've researched it. And that presents an immediate threat, and that is something that would require hospitalization.
[02:03:35] Speaker 2: District Attorney had asked you also about the thyroid levels, and you indicated, or she indicated, that they were in the low range at Mass General Hospital. Read, is that correct?
[02:03:47] Speaker 1: I thought she said they were normal.
[02:03:49] Speaker 2: Oh, I thought she said low, but normal or low, MGH, Mass General Hospital, right?
[02:03:57] Speaker 1: Sorry, what's the question?
[02:03:59] Speaker 2: District Attorney asked you whether or not they were thyroid reads. Do you remember that question?
[02:04:03] Speaker 1: She said her thyroid had been tested.
[02:04:05] Speaker 2: The question now is, do you remember that question that she asked you that you answered with no problem? Yes. Okay. And your response was that, my memory, because the jury's accounts, that it was low reads, MGH, and South Shore Hospital. Is that right?
[02:04:30] Speaker 1: I thought she said that it was normal, or within normal limits.
[02:04:33] Speaker 2: Almost fine. We'll go with normal. So, your memory is that there were thyroid blood level reads of Lindsay Clancy from two health care providers. Is that correct? Yes. One would be Mass General Hospital, right?
[02:04:52] Speaker 1: I don't remember exactly. I think she said yes. I think she said Mass General.
[02:04:57] Speaker 2: Okay. Do you remember where the other hospital health care provider was?
[02:05:01] Speaker 1: It might have been South Shore.
[02:05:03] Speaker 2: Do you know what date those were?
[02:05:06] Speaker 1: No.
[02:05:07] Speaker 2: Those are old reads, weren't they? I don't know. One of the things that the district attorney asked you about on a number of occasions that seems to be important is if the person that you're treating has, I guess, what do they call it, pressured speech?
[02:05:23] Speaker 1: Yes.
[02:05:23] Speaker 2: And you told us repeatedly that you never detected that Lindsay had pressured speech, right?
[02:05:29] Speaker 1: Correct.
[02:05:30] Speaker 2: I'm sorry?
[02:05:31] Speaker 1: Correct.
[02:05:33] Speaker 2: Looking at the record from October 21st, would you?
[02:05:44] Speaker 6: Any objection is writing on this?
[02:05:46] Speaker 2: Oh, all right. You know what? I'll ask you to just look at it.
[02:05:50] Speaker 3: You might take a look at it, and if you want to get the actual exhibit, we could do that.
[02:05:55] Speaker ?: All right.
[02:05:56] Speaker 2: So, forget all about my sloppy writing. I'm looking here on October 21st of 22. Is that correct? Right up there?
[02:06:03] Speaker ?: Yes.
[02:06:03] Speaker 2: Okay. Yes. And can you just read this paragraph here for us?
[02:06:10] Speaker 1: No. Sorry. No sleep last night. Falls asleep after 40 minutes. Heart racing. Severe anxiety. Worrying about kids, baby, sleep. Yawns, but not drowsy. Not hyper-pressured speech.
[02:06:25] Speaker 2: What was that?
[02:06:25] Speaker 1: Not hyper-not-pressured speech is what I meant. I know it doesn't say not, but that is exactly what I meant.
[02:06:32] Speaker 2: Wait, when did you see this that you noticed that it did not say not?
[02:06:36] Speaker 1: I don't care what it says. I know what I meant.
[02:06:40] Speaker 2: Well, when you wrote this, you did not say not pressured speech. You said in the medical record, pressured speech, right?
[02:06:51] Speaker 1: No.
[02:06:52] Speaker 2: It doesn't say that?
[02:06:54] Speaker 1: Yeah, the word not is right before not hyper-comma pressured speech. The two are following the not.
[02:07:02] Speaker 2: When you put down in a medical record, heart racing, comma, severe anxiety, comma, worried about kids, comma, baby, comma, sleep, comma, yawns, but not drowsy, period. Not hyper, comma, pressured speech. That's what you wrote, right?
[02:07:21] Speaker 1: She did not have pressured speech.
[02:07:22] Speaker 2: Yes, doctor.
[02:07:23] Speaker 1: I wrote that, but you're misinterpreting my note.
[02:07:25] Speaker 2: Am I reading this correctly, and the jury will be able to look at it, that you put not hyper, comma, pressured speech. Did I read that right?
[02:07:40] Speaker 1: Yes, but your interpretation is incorrect.
[02:07:44] Speaker 2: As opposed to yours? No, I have.
[02:07:50] Speaker 3: Just in regards to what was raised there.
[02:07:52] Speaker 6: Yes, just two brief issues, approaching you with your records from October 21st, 2022, the section labeled speech, where there are all the boxes where you can put pressure, word salad, all of the different things, what do you check off for speech on October 21st, 2022?
[02:08:10] Speaker 1: Appropriate.
[02:08:13] Speaker 6: And the defense asked you about the thyroid levels. Was it, would it be accurate to state that I asked you if you were aware that her levels were normal at Seltzer Hospital and Brigham and Women's Hospital?
[02:08:27] Speaker 1: Yes.
[02:08:28] Speaker 6: And your answer was no, correct?
[02:08:31] Speaker 1: No, I was not aware.
[02:08:32] Speaker 6: Because you don't have those records, correct?
[02:08:34] Speaker 1: Correct.
[02:08:35] Speaker 6: Thank you.
[02:08:36] Speaker 2: Do we have any clue as to how old they were?
[02:08:41] Speaker 1: I don't know. You're asking me about something I never saw.
[02:08:46] Speaker ?: All right.
[02:08:47] Speaker 2: Nothing further.
[02:08:47] Speaker 3: All right. Anything further? All right. Thank you, doctor. Let me step down. Thank you.
[02:09:01] Speaker 6: Your Honor, the Commonwealth would move to submit the certified copy of the Spalding Rehabilitation Records. No objection.
[02:09:07] Speaker 2: That's by agreement.
[02:09:08] Speaker 3: Okay. By agreement of council, the Spalding Rehabilitation Records will be introduced.
[02:09:13] Speaker 4: Get the 221. Can I call the next witness?
[02:09:24] Speaker 1: Yes.
[02:09:24] Speaker 3: Please, council.
[02:09:25] Speaker 1: I want to call Julie Paul.
[02:09:38] Speaker ?: Thank you.