FULL TESTIMONY: Kingsbury Club Director, Friend & Psychiatrist Dr Alia in Lindsay Clancy Trial — AB1E

[00:00:00] Speaker 1: I'm gonna ask you to keep your voice up as best you can and speak into that [00:00:13] Speaker 2: microphone okay okay that's good all right come on good morning good morning could you please introduce yourself to the jury spelling your first and last [00:00:22] Speaker 3: name for the record it is Kimberly Hardy k-i-m-b-e-r-l-e-e-h-a-r-d-y and what [00:00:30] Speaker 2: city or state do you currently live in Cypress Texas and back in 2023 where did you live Brockton Massachusetts and in 2023 where did you work Kingsbury Club where is the Kingsbury Club in Kingston and how long did you work for that club [00:00:48] Speaker 3: four years what is the Kingsbury Club it is a tennis club but it also has like a gym it's kind of like a Y where people can come and drop their kids off in the playroom and stuff like that is it a private facility yes so members only yes [00:01:05] Speaker 2: and you mentioned dropping kids off what was your role at the Kingsbury Club so I [00:01:11] Speaker 3: was the child service director so I ran all the kids programming and the playroom so [00:01:17] Speaker 2: what was or what is the playroom at the Kingsbury Club so the playroom is a room [00:01:21] Speaker 3: where parents can drop their kids off for two hours a day so that they can work [00:01:26] Speaker 2: out and what's the procedure when a parent or guardian drops a child off at the [00:01:31] Speaker 3: playroom we have our system where we sign them in and that's something on the [00:01:37] Speaker 2: computer that logs when the child comes in yes and it also logs when the child leaves correct yes now what's the protocol for who can drop off and pick up a [00:01:47] Speaker 3: child at the playroom so parents usually we say whoever drops off should be the one picking up as well unless the parent notifies us that another parent will be [00:01:59] Speaker 2: picking up and as far as that system that you have to log the drop-off and pick up it's fair to say that system is geared to towards the guardian who drops off and pick up correct so it's a separate log for each child based on who the guardian is yes now what is the security like at the Kingsbury Club so it'll how do you get [00:02:24] Speaker 3: into the club oh you sign in you have a key fob and you go to the front desk and [00:02:29] Speaker 2: you'll sign in are you familiar with some members using like a scan app to sign in and as far as where the playroom is in in the club where is it in relation to kind of when you come in the [00:02:43] Speaker 3: front doors it is right to the right there is a long hallway and at the end of [00:02:48] Speaker 2: the hallway that's the playroom now is there kind of a rule there at the Kingsbury Club when you drop your child at the playroom that you have to remain on property yes and other than the gym and the tennis courts what other facilities are on property we have a pool and a spa do I'm gonna draw your attention to or sorry one more background question you mentioned that there's other programs that the Kingsbury Club runs for children right and you as the child service director were involved in that yes is there a particular age that the children can start participating in the other group activities camp starts at five and at [00:03:30] Speaker 3: that point - we had tennis that started at five but swim lessons can start from [00:03:36] Speaker 2: babies okay and so is there an age limit to the kids that could be in the playroom at [00:03:42] Speaker 3: any given point typically we only take three months old up up to like age ten normally they don't want to be in there and then [00:03:55] Speaker 2: then you said that the time limit is two hours per day yes is there a schedule or sign up in advance or was there one in 2023 if a member wanted to bring their kid [00:04:06] Speaker 3: into the playroom yes but in 2023 parents normally didn't sign up in advance because we were just getting back from Colvin and we have low numbers so we just [00:04:17] Speaker 2: took walk-ins and it was a first-come first-serve yes are you familiar or were you familiar with Cora and Dawson Clancy yes did you often see them in the playroom at the Kingsbury Club yes and who would be the party that would drop them off and pick them up mainly Patrick did you or were you present in the playroom when Lindsay Clancy at times drop them off and pick them up yes and when Lindsay Clancy came to drop off and pick up the children did you interact with her yes and how would you describe her demeanor during those interactions um she just seemed very shy maybe just to focus on the time frame well that's fair um I'm going to draw your attention to maybe the September of 2022 to January of 2023 that fall into the winter did you see Lindsay Clancy drop the kids off at the playroom during that time period yes and you had the occasion to interact with her mm-hmm and during that time period in the fall to winter um what were [00:05:21] Speaker 3: your observations of her demeanor she just seemed shy um she was just we'd come in and pick up I would usually try start a conversation with her but nothing else yeah just shy okay and it was only Cora and [00:05:38] Speaker 2: Dawson that came to the playroom correct were you aware that there was a third child yes um and is do you know of any reason why that child didn't come with the other two um I asked a couple times um because [00:05:51] Speaker 3: I said that he can come in because he's over three months um and the answer was because they were scared of [00:05:59] Speaker 1: sickness I'm sorry was the objection oh the answer was you could just find out so this conversation that [00:06:06] Speaker 2: you had when you said that you asked about um Callen was that with um Lindsay or Patrick Lindsay okay and [00:06:14] Speaker 3: so what did she tell you about um Callen she was nervous about colds because it was cold and flu season [00:06:20] Speaker 2: okay and so obviously when Cora and Dawson came there would be other children in the playroom as well right yes um when um Lindsay would drop the kids off during this time period between September 2022 and January of 2023 um did she ever tell you what her plans were at the club no did you see or make observations of how she was dressed when she dropped them off yeah she have workout outfits on and would she um come back before the end of that two hours to pick the kids up yes did you notice anything different about her when she came back to pick the kids up during this time frame no was she ever late picking them up no um did you ever learn that she had left the property um after bringing them to the playroom no and that is a very strict rule at the club yes do you recall the last time that you saw um Lindsay Clancy and Cora and Dawson at the Kingsbury club yes um do you recall approximately when that was in January would it have been closer to New Year's or a few weeks into the month I think it was a few weeks in and how is it that you remember um them on that particular day just their usual selves they came in played um nothing um if I tell you that Cora and Dawson were dropped off by Lindsay on um January 13th at 9 07 um is that sound right to you and that they were also dropped off um on January 17th at 9 30 a.m does that sound right yeah did Cora and Dawson usually come in the mornings yes around that time and what time does the playroom open we open at 8 and what time does it close it closes at 2. did you ever um have occasion to see Cora and Dawson in the playroom during that time September to January um later in the afternoon sometimes not usual um is it fair to say that generally when Lindsay dropped them off they came in the morning yeah and um is there anything about that day with Cora that last day that you saw her that sticks out in your mind not that I recall what kinds of things would the kids [00:08:40] Speaker 3: do in the playroom they like to color they would play with um the dolls dress up toys um the cars [00:08:49] Speaker 2: the train set and one on one of those last days that you saw Cora did she draw a picture yes did she take it with her or did she give it to you she left it your honor at this time I would move to admit um the kingsbury club records as the next exhibit [00:09:09] Speaker 1: right they may be admitted [00:09:13] Speaker 4: exhibit 218 [00:09:17] Speaker 2: um thank you thank you nothing further thank you all right council good morning good morning um so [00:09:23] Speaker 5: you you saw Lindsay with her children uh dropping them off picking them up uh on a fairly regular basis is that correct and Patrick of course right yes um did you ever see how she acted around them did she appear to be you know happy to be with them and take care of them or did [00:09:40] Speaker 3: she appear to be angry with them or at all no never angry she seemed happy to be with them she always picked up on time and they were always excited to see her and and you certainly weren't close enough [00:09:54] Speaker 5: to her to know if she had any personal issues in her life as far as psych you know her mind or her body or anything like that right no um you are you would be aware though that uh on occasion people are advised by their doctors or psychiatrists to exercise it might be a good thing for them to do is that yes thank you thank you that's all thank you any redirect no thank you thank you you may step down thank you [00:10:29] Speaker 2: all right come over the commonwealth would call sarah carney please [00:10:45] Speaker 5: good morning stop right there raise your right hand good morning [00:11:08] Speaker 6: morning [00:11:23] Speaker 1: all right good morning all right all right council thank you good morning [00:11:29] Speaker 2: would you please tell the jurors your first and last name sure sarah carney and how do you spell your first name uh s-a-r-a-h and the last name uh c-a-r-n-e-y and what city or town do you live in uh duxbury massachusetts and uh are you married yes and who's your husband uh kyle carney and do you have children yes how old are your children uh five and two um did you do you know the clancy family [00:11:55] Speaker 4: yes and how do you know them uh went to school with pat and then lindsey later and so when you say [00:12:02] Speaker 2: you went to school with pat fair to say you went to salve yes and um did you know pat before school uh no and did you become friends with him in school yes when you graduated from um college did you remain friends with patrick yes and it um is your husband also a friend of patrick's yes did they meet at college or just someplace else in college um at some point um did you come to know lindsey clancy yes and um do you remember approximately when you were introduced to her um a few years after college maybe 12 13 years ago okay and where were you living then when you first met her uh boston okay how about pat was he living in boston as well i believe so and um what was your relationship like with patrick after college were you close uh yes friends close and um as he began a relationship with lindsey did you become friendly with her yeah did you have that same relationship with lindsey that you had with pat uh no um as time passed on did your families um remain friendly yes and eventually um both your families ended up living in the same town in duxbury correct yes what um what was the relationship like between your families um in starting in 2019 uh close friendly um went to [00:13:34] Speaker 4: the beach together you know had them over at our house went to their house that kind of thing and as [00:13:39] Speaker 2: um the clancy's start having children and you started having children did that remain throughout yeah probably fewer times just because we're all busy but yeah and um were you around after each of the clancy children um were born meaning after cora was born you were you were still part of patrick's life yeah did you notice any changes in lindsey after cora was born no and how about dawson when dawson came along did you notice any changes in lindsey after dawson was born no and then callen who was born in may of 2022 were you still friendly with them and still doing those um trips and going to each other's houses beach trips um so did you notice anything different about lindsey after calen was born no um do you recall observing lindsey or seeing lindsey when she was pregnant with calen uh yes fair to say she was um a pretty active person yes and even in pregnancy being very pregnant she was physically active yes do you recall um what kind of exercise she did or seeing her exercise or [00:14:49] Speaker 4: um i remember her posting videos of her exercising and the kids are in the background and um where would the [00:14:57] Speaker 2: exercising happen could you tell where it was in their house i'm not sure have you been inside their house before yes um so you know that they had the living room area on the first floor and basement [00:15:09] Speaker 4: area was finished two moves the living room i've never been to the basement okay so what did in that [00:15:13] Speaker 2: video what did you observe the kids doing in the background uh playing on the couch playing with toys and um when you observe this video fair to say it was um kind of like a beach body type exercise [00:15:30] Speaker 4: sure i'm not sure what that means [00:15:33] Speaker 2: did you see any um equipment in the video like uh workout equipment i don't recall do you recall previously indicating that you saw the kids playing with exercise bands in the videos sure if that's what i said i don't recall now i'm drawing your attention to the summer of 2022 and the fall of 2022 were you still going to the beach and um getting together with the clancys i believe so yes other than going to the beach what other kinds of activities would you invite them to do with your family [00:16:06] Speaker 4: um they probably came over to our house once or twice um throughout the course of the fall of 2022 [00:16:16] Speaker 2: did you notice any changes in lindsay's physical uh health um i think i saw her one time at drop off and she just seemed thinner more you know i'm sorry okay um did you ever have a conversation with her at drop off about your observations no um how about just observing her overall demeanor did you notice anything change about her um in the fall into the winter of 2022 no um did you ever have any conversations with her about um what postpartum depression or sleep issues no and i'm going to draw your attention to january 22nd 2023 that was a weekend do you recall that weekend yes and did you have um something happening at your house that that your family invited the clancys to yes we had a bonfire and who who came from the clancy family to the bonfire [00:17:13] Speaker 4: uh pat lindsay cora and dawson where was calen if you know uh at home with lindsay's parents [00:17:21] Speaker 2: did you have the occasion to speak with lindsay on that day yes and fair to say prior to that day you hadn't really seen her much that winter correct um were you um happy to see her that day yeah and what were your observations of her that day her demeanor did she seem normal or off or uh just quiet but fairly normal did you have the occasion to speak with her just you and her yes and was that outside at the bonfire or somewhere else in your house uh in the kitchen and did you ask her anything um [00:17:54] Speaker 4: i was talking to her about my children my daughter's allergies and then i the conversation lulled and [00:18:00] Speaker 2: i asked her how she was doing and what did she tell you good and um did you have any further conversation or ask any follow-up questions no um why didn't you follow up uh because i figured if she wanted to [00:18:14] Speaker 4: explain or deep dive into it she would wasn't going to press her and but on this occasion she [00:18:20] Speaker 2: she just said fine and you kind of moved on to the next topic yes and um throughout the course of that day or that afternoon that you were with her did you notice anything change about how she was communicating with you like did she start to talk fast or seem confused in any way no um was there anything that happened at that interaction that made them abruptly leave [00:18:46] Speaker 4: um no i think it was like nap time for the kids okay um and was that the last time you saw or talk to [00:18:54] Speaker 5: lindsay yes i think right i think all right so um what was the time frame that you knew um lindsay not patrick i know you were very friendly with patrick yep what was the time frame that you knew lindsay 12 ish 12 years and would you say that you were close to her or were you social or how social social um and on occasion you had the opportunity to be in their house the upstairs portion of it that you indicated never in the basement of the office area right right just the kitchen level okay um can you tell us like in the fall of 22 approximately how many times you and your your husband kyle saw lindsay and her husband pat together not kyle with pat or you with pat um i think it was just the one time at drop off one time at drop off okay um you had occasion to ask her advice about the babies and things of that nature on occasion did you not yep she was always helpful to you or forthcoming yes and this uh the last time you saw her on january 22nd this was a bonfire is that what it was yep and that was where in your backyard in our backyard was it in the daytime or the nighttime uh around lunchtime lunchtime and do you recall how long they were there for the bonfire a few hours and they were there with uh the two older kids and calen was home with her parents right yes and she appeared to be quiet to you uh yes and she appeared to your observation around that time frame to be to be thinner than what you had seen before yes but you'd agree with me that you guys weren't that close that she would confide in you correct correct that's all we have thank you [00:20:56] Speaker 2: ma'am all right any redirect um as far as your observations of lindsay over the course of 12 years better say she was always quiet with you yes thank you all right thank you ma'am let me step [00:21:09] Speaker 1: down thank you thank you [00:21:19] Speaker 2: come on the commonwealth would call so thank you thank you thank you thank you thank you thank you thank you thank you thank you thank you [00:21:33] Speaker ?: thank you thank you thank you thank you thank you thank you thank you thank you thank you thank you [00:21:46] Speaker 5: you [00:22:00] Speaker 6: all right [00:22:18] Speaker 1: i'm going to ask you when you sit down if you speak loudly so the jury can hear you and speak into that microphone okay thank you thank you council thank you good morning good morning could you please um [00:22:35] Speaker 6: tell the jury your first and last name um my first name is alia last name is goodhart can you spell your first name for the record a l i a and your last name please uh g o o d h e a r [00:22:53] Speaker 2: and what do you do for work i'm a psychiatrist and um can you tell us a little bit about your [00:22:58] Speaker 6: educational background to be a psychiatrist um i did my i got my medical degree from the state university of new york in brooklyn the health sciences center and i came to boston to do my four-year residency at the harvard longwood psychiatry residency program i also trained uh for an additional three years at the boston psychoanalytic uh institute and got my advanced training in advanced training pro i attended the advanced [00:23:35] Speaker 2: training program and um yeah are you licensed here in massachusetts um to practice as a psychiatrist i am are you licensed in any other states no um so you said that you're a medical doctor with a specialization in psychiatry correct correct um can you tell us a little bit about your um work history [00:23:55] Speaker 6: in that field um yes i've worked in several different settings uh when i first started out i was working at beth israel um in integrated care which means essentially that um you work with primary care physicians and if they have patients that they have questions about they can consult you and if there's a need you can continue to manage the patient psychopharm medications and if it's simple they can continue to do it but you're available to do for them to consult with and to discuss cases after that i went to emerson hospital where i worked on the inpatient psychiatric unit for a total of nine years i left for one year to be the medical director at another freestanding hospital after that i worked at the women's prison in framingham for a year and a half and after that an outpatient clinic at affiliated with tufts i had a private practice for two years and then i've been working at mclean for the last five years okay and what is mclean hospital it's a freestanding psychiatric hospital that is part of the mass general brigham system what kind of services does that facility offer to patients um they have you know lots of services uh including inpatient outpatient substance abuse trauma focused um there are lots of specializations eating disorder programs they have residential programs they have partial programs so there's a really broad bit off and what is your role at mclean i work on one [00:25:46] Speaker 2: of the inpatient psychiatric units and tell us a little bit about what an inpatient psychiatric unit is [00:25:53] Speaker 6: um patients who come to our unit uh are if you are referred to us by the emergency department um because it's been determined that they need inpatient level of care you can come voluntarily or you can be sent involuntarily and once you arrive we work with the patient uh until you know they're there for a certain period of time which isn't predetermined it is flexible so it depends on what's going on and when you're on an inpatient unit it's it's not just that you're seeing the psychiatrist you're working as a team so they're nurses they're mental health workers there are social workers and the way it works at mclean is that every day you have a meeting where people discuss what's been going on and you share any information that you have and you you know that that kind of guides treatment it's um if i'm on the unit while i see the patient i'm not there 24 24 7. um but the mental health staff and the nursing staff are there and they contribute to the assessment of the patient so in that team approach when you have mental health [00:27:28] Speaker 2: workers nurses social workers that work with you um there's fair to say some combination of that team [00:27:36] Speaker 6: present all the time yes there are three shifts and each shift has mental health workers and nurses [00:27:45] Speaker 2: and in that team approach sometimes particular members of those that team may have direct contact [00:27:51] Speaker 6: with the patient correct absolutely uh each shift uh each patient is assigned a mental health worker and a nurse they have they're offered a check-in which is basically time to sit and talk about how they're doing and what's going on and if they're upset or distressed um and so you know you there is [00:28:14] Speaker 2: documentation of that and that happens on a regular basis and even when members of the particular treatment team don't have direct contact with a patient they are still there and observing what's going on right correct and are they trained to do that absolutely and so even if they don't um have a conversation with somebody that's documented they're still observing to be able to report back if there's any concerns that they observe during any given shift is that fair to say yes okay um now you mentioned that um the inpatient um unit at mclean that most they come from the er departments of the [00:28:52] Speaker 6: surrounding hospitals yes um so you can't just walk in not uh not at mclean for the inpatient for in [00:29:00] Speaker 2: any uh right correct okay um and so oftentimes when a patient comes from the emergency department or is [00:29:07] Speaker 6: referred over there how do they get there they have to be sent on a section 12 uh most of the time um well then it doesn't make sense so they're usually sent on a section 12 especially if they're going to be sent in an ambulance and then when they uh arrive at mclean they are seen at the cec which is [00:29:31] Speaker 2: the clinical evaluation center if i could just stop for you for one second can you tell us what a section [00:29:36] Speaker 6: 12 is a section 12 is a section 12 is basically a doctor or social worker or psychologist states that you are um being referred to a hospital for admission um because you have a mental health condition [00:29:56] Speaker 2: and the section 12 could be um something that the patient voluntarily elects to do right um [00:30:03] Speaker 6: that's a that's a section 10. the section 12 is um it it means that you have to go there if you go there and they evaluate that you're fine and you decide you don't want to be at the hospital [00:30:20] Speaker 2: you can choose to leave and they'll have to let you go so when you say that a person comes transported from an er on a section 12 they also can come transported on a 10 as well a voluntary [00:30:32] Speaker 6: a section 12 is required for transportation because in the time between when they leave the hospital and they're supposed to get to you you want to make sure that something could happen and then they could leave so you want to make sure that the physician sees them at that end and then somebody sees them at the other end to ensure that something hasn't changed so they it's evaluation okay and at the emergency [00:30:58] Speaker 2: department um there is a a particular type of evaluation that's done before somebody is sent over to mclean correct correct what from the mass general what is that usually referred to it's called the acute [00:31:12] Speaker 6: psychiatric consultation aps no so the services acute psychiatric services and it's an evaluation so it's a complete evaluation uh by either a nurse practitioner or a psychiatrist and they go over things like why are you coming now what is your history have you ever had problems before what's your family history they document how you're presenting they inquire about symptoms and that's how they they find out what medications you're on and then they based on that they decide whether you need you know there could be several options they can recommend inpatient treatment they can recommend partial hospital program but the patient doesn't have to do either if they're not you know unsafe they can choose to leave but most of the time people take the recommendation and they've presented because they are seeking help [00:32:11] Speaker 2: and unless they're the patient is deemed unsafe in that involuntary realm it's their choice correct now you mentioned that when they come to mclean that they first come through and have a cec what is that it's a clinical evaluation center what happens at that stage at mclean they're seen by [00:32:38] Speaker 6: a psychiatrist and there's a nurse as well they review the history that was obtained at the emergency department and they inquire about any they actually do another evaluation just like at the aps basically reviewing all the history but also asking their own questions and if they have any concerns [00:33:07] Speaker 2: they document them there and you said this evaluation is done by a psychiatrist correct and when a person comes into mclean um can they come at any hour of the day or night correct and when they first make make it to the um clinic of the clinical evaluation center it's always they're always seen by a psychiatrist yes um now once they do this evaluation gather all the information do they also do kind of a physical exam to make sure that there's no medical issues to address yes and um after all the information is gathered what what what is done at the evaluation center so um they basically enter the order may have some more no worries um can you repeat the question sure um when a patient is evaluated or seen in the clinical [00:34:04] Speaker 6: evaluation center what happens after the evaluation is done so they determine the level of checks that the patient should be on once they get to the unit because there are several units there at least four inpatient units um they decide what medications the patient is going to be able to get thank you uh until the they are seen by a psychiatrist on the unit and when you say level of check um what does that mean um everybody uh who is on the unit there's a mental health worker assigned the task of ensuring that all the patients who are supposed to be on the unit are present and that they're uh safe um and the lowest level is 15-minute checks um if there's concern about somebody it goes up to five-minute checks and uh if they're extremely unsafe it goes to a one-to-one and what does one-to-one mean uh there would be a staff person with the [00:35:17] Speaker 2: patient at all times and again um this determination of of which unit to be on and what level um of security or what level of check is done by the psychiatrist that performs that first evaluation correct now when um a person who comes through the cec then gets sent to the unit do they walk to the unit on their own or how do they get to the unit they're escorted to the unit and you said there's four inpatient psych units is that correct um now when the person arrives at the unit what happens they're [00:35:54] Speaker 6: seen by a nurse and a mental health worker their belongings are they go through the belongings to ensure that there's nothing unsafe there's certain things that are not allowed on a psych unit the nurse reviews their history and take some vital signs um sees if they need any medication and then they [00:36:18] Speaker 2: show them to their room and the unit and again um people come through the cec at all hours of the day and night correct yes so this whole process is is pretty seamless and could happen at any point yes um now you mentioned um previously that uh the length of stay or how long a person is on the unit or uh inpatient varies right yes um is there any sort of minimum that's required when a person comes in for an inpatient stay at mclean no and um if they are voluntarily there um can they leave at any time [00:36:58] Speaker 6: as long as um they the psychiatrist and the team assesses them and determines that they don't pose [00:37:06] Speaker 2: an imminent risk to themselves or anybody else now what if they're there on a section 12 is there a [00:37:14] Speaker 5: time limit or a minimum amount of time they have to be there she wasn't there on section 12 she was on a [00:37:18] Speaker 2: voluntary we haven't gotten there yet i'm just asking background questions about the facility i'll [00:37:24] Speaker 6: allow some background questions but let's kind of move it along so section 12 entails that you that the team and the psychiatrist have has three days to evaluate the patient to determine whether they pose a danger to themselves or others and if at the end of that time they do determine that uh the person poses a risk then they have to apply uh for commitment which would mean going in front of a judge who would decide if the patient should remain hospitalized or be discharged and if the um if at the end of the [00:38:02] Speaker 2: three days you deem them to be safe are they allowed to leave yes and um is there something in the field of psychiatry or in your training and experience in your time at mclean about being discharged against [00:38:16] Speaker 1: medical advice um he wasn't discharged ama all right we'll allow the the set the uh really the terms and [00:38:25] Speaker 5: where we are so you can go into that ama is not applicable if we can approach you know i don't think [00:38:30] Speaker 1: you heard me i did hear you all right well then i'm going to allow that question there your rights are [00:38:37] Speaker 6: safe yeah i've noted it go ahead council thank you i think uh we tend not to do against medical advice because if we are concerned about somebody's safety we would not discharge them so you have another [00:38:56] Speaker 2: procedure available to you if you were concerned for somebody's safety yes and that's the this procedure you described about seeking um in order for further commitment correct okay thank you um now when a person comes and goes through that process and is placed on their unit and settled in um what is the plan after that how often do they see providers they're assessed by a psychiatrist every [00:39:24] Speaker 6: single day that they're there um they have nurses who are checking in with them mental health workers they're offered group programming um and medical monitoring vital signs [00:39:38] Speaker 2: um yeah what types of group programming are offered to people while they're inpatient at mclean [00:39:46] Speaker 6: uh we offer skills groups which are um things like uh they're meant to teach patients skills so that they can tolerate distress they can kind of observe their thoughts it's meant to shore up their skills then there are some groups which are more just relaxed i guess such as uh going for fresh air walks or going to the recreation center um just you know drawing or coloring and um yeah and are there other um things offered to patients what's there [00:40:30] Speaker 2: on a unit um to assist them in their care like um counseling yeah those are the check-ins and they [00:40:37] Speaker 6: when they meet with the psychiatrist or and the social worker there the counseling happens in those sessions as well and also by the nurses and the mental health staff okay um now does this procedure [00:40:53] Speaker 2: or does how this um how it operates for any given patient does it change if there's a holiday or a weekend [00:41:01] Speaker 6: i think um they're still seen they're still seen by a psychiatrist she's thinking if she knows i have [00:41:09] Speaker 7: no objection i'm going to object to the way she's answering all right she's why don't you rephrase [00:41:14] Speaker 2: the question i will thank you as far as um your experience at mclean hospital is there um does the [00:41:22] Speaker 6: schedule change when there's a weekend or a holiday the the group schedule might change but then the staffing [00:41:30] Speaker 2: schedule doesn't change so the availability and the mental health worker that sees the patient the social worker that checks in and the psychiatrist and nurse the team all stays the same even on a weekend or a [00:41:41] Speaker 6: holiday other than the social worker okay um and and when i say stay the same it could be different [00:41:47] Speaker 2: individuals but it's somebody from that group correct yes okay um so as far as your role as a psychiatrist how do you get assigned patients when they are admitted to mclean [00:42:02] Speaker 6: inpatient it's random um there are beds that are open and i carry a certain number of patients and other psychiatrists have a certain number of patients and whoever has an opening gets the admission do you have [00:42:20] Speaker 2: to be there when the patient is admitted to have the patient assigned to you no and so do you rely on other psychiatrists to perform those um tasks before you meet a patient yes i'm going to draw your attention to a particular patient by the name of lindsay clancy that arrived at mclean um in the early morning hours of january 1st of 2023 do you recall that patient yes have you had the ability to review the records related to that patient prior to coming in today yes and um do you know where she came from the emergency department at mgh okay and um did she come voluntarily or did she come [00:43:02] Speaker 6: um on some sort of section again for transportation it's always a section but then she signed in [00:43:09] Speaker 2: voluntarily which is the section 10. okay um so your um to your knowledge she was brought in the early morning hours via ambulance correct and um did she go through that process of the clinical evaluation center in the um early morning hours approximately 4 a.m on the first yes and who saw her there um i think [00:43:34] Speaker 6: the psychiatrist's name was dr outlaw okay and you're familiar with dr jasmine outlaw i've never met her okay but she is a psychiatrist on staff and i i don't know what on staff what you mean by on staff [00:43:48] Speaker 2: well she works at the plane correct and so um you were able to review the information she gathered in that first evaluation yes and um in reviewing that information did you identify that the patient was identified as medically stable right meaning she didn't have any acute medical issues that you had to worry about correct and um she was screened on the suicide screening correct what was the chief complaint of the patient when when she arrived at mclean [00:44:26] Speaker 6: she was and have she was um finding it hard to sleep if she didn't take medications [00:44:39] Speaker 2: okay um and do you recall reviewing in the records that um it was noted that she reported that she felt numb yes and that she was having some issues uh managing medication i don't know what you mean by that well that she had some complaints about um side effects or symptoms of medication yes um when the psychiatrist and the see the clinical evaluation center um gathered the information fair to say that it's primarily based on what's reported to the doctor by the patient yes um at mclean do you have access to a patient's full psychiatric history or all their records from other places it depends um where [00:45:27] Speaker 6: the patient is coming from i think that um dr outlaw did take an excerpt of the aps evaluation that was done at mgh so i assume that she had access to that but i'm sorry i got assumptions like [00:45:46] Speaker 1: i mean i should have a different way to know she doesn't know yeah all right as far as the full [00:45:51] Speaker 2: record of this particular patient that you were assigned to and responsible for you reviewed all of the notes and information gathered by dr outlaw on that first interaction with the patient correct yes and um you indicated a little while ago in your testimony that mclean is affiliated with the brigham hospital and mass general so is it fair to say that those records from mass general are available to you at mclean yes and again you indicated that um that aps evaluation is something that's done at the emergency room right yes and is it is it common that that information come along with the patient [00:46:34] Speaker 1: i actually don't know no good just if you can answer that you don't know i don't know okay all right [00:46:41] Speaker 2: next question in this instance when you reviewed the records were you aware or did you see that there was some note to the aps evaluation from the mass general er i saw the excerpt of the aps evaluation in dr outlaw's note okay and that excerpt from the aps evaluation was conducted by somebody by the name of dr hogan correct correct and um did you review a portion of the record indicating that um the patient said to dr hogan or reported thoughts of wishing to be dead but no plan yes and that there was no violent or homicidal ideation right yes and that that was observed at mass general to have no evidence of psychosis mania obsessions or current anxiety symptoms correct so that's information that you knew before you've met with the patient yes and as far as what's reported when the patient comes to mclean and in this instance when lindsey clancy came are you aware she reported during that clinical um evaluation center evaluation that at the beginning of december she had started serequil and remeron and started to have intrusive and suicidal thoughts yes that she attributed that to medication yes okay and so what was the plan the first plan that came out of that clinical evaluation center evaluation of ms clancy she was um continued [00:48:18] Speaker 6: on the medications she was admitted on you know uh the plan they do the checks they decide what medical monitoring you need but she basically was admitted and the medications were the same and what was the [00:48:35] Speaker 2: security level or how long were the checks assigned to her after this evaluation 15 minutes and was she considered to be a high risk upon coming into this inpatient unit or was she minimal risk low minimal yeah and were you aware of what's called the provisional diagnosis that was assigned to this patient when she [00:49:01] Speaker 6: arrived i don't recall what the provisional diagnosis was but i do know that they do assign a diagnosis i don't recall it i i must have seen it in the records but i think they're like five different diagnoses [00:49:19] Speaker 2: um just referring to what's already been marked as exhibit 79 i'm going to draw your attention to page 24. [00:49:25] Speaker 6: thank you right okay i think i remember yes okay does that refresh your memory as to the provisional diagnosis yes what was it major depressive disorder severe without without psychotic features [00:49:40] Speaker 2: okay now what what does the provisional diagnosis mean to you when you're assigned a patient that this is [00:49:48] Speaker 6: the assessment of the psychiatrist who saw her at that time okay do you have to stick with that diagnosis [00:49:54] Speaker 2: or are you free to change that based on your experiences with the patient um i did the diagnosis i give the [00:50:01] Speaker 6: the patient is dependent on what my interactions are and the observations of the team okay now um for this [00:50:11] Speaker 2: particular patient miss clancy on january 1st um when she got situated onto the unit after that first evaluation by dr outlaw are you aware that she was then seen later in that day on january 1st yes and were you the doctor who saw her or was there somebody else it was a different psychiatrist okay and who was the psychiatrist that saw her on january 1st it was dr madwa and that would be dr elizabeth madwa correct again is she a psychiatrist as well yes and so um this occurred um while you were not in the hospital right yes and um were you able to review the notes the admission notes of dr madwa regarding her interactions with this patient on january 1st at approximately 12 47 pm yes and again um as far as these interactions go with the patient and the psychiatrist it's more [00:51:10] Speaker 6: of a conversation right i'm sorry could you repeat the question yeah it's a conversation when you meet [00:51:15] Speaker 2: with a patient yes you ask them how they're feeling oh get information that you think is necessary is [00:51:23] Speaker 6: that fair to say it's a conversation and also um you gather information okay and so um do you rely on [00:51:30] Speaker 2: things that were reported before yes okay um but you also ask follow-up questions right correct and as far as your review of dr madwa's interaction with um miss clancy on january 1st um is it clear to you that she did that yes you reviewed her history with her and and spoke with her about how she was feeling yes um at the time she spoke with dr madwa um you're aware she said that she denied feeling depressed and denied any passive death wishes or suicidal thoughts but reports feeling numb yes she reports she can't feel any emotion other than mild anxiety at now being in a hospital setting yes um after um miss clancy was seen by dr madwa um were you aware of what the plan was regarding her medication yes what was the plan um [00:52:26] Speaker 6: miss clancy complained uh one of the there were several symptoms one of the things that she did complain about was the numbness and dr madwa uh did you know hear that um and hear her concern and that she had been sensitive to many different medications so she um well let me ask if i can ask a question you finish with your answer um so she did she determined that it was possible that the numbness the patient was complaining of was a side effect of the medication she was on and the plan was to taper that medication and observe the patient to see whether the numbness uh went away and also if any other [00:53:32] Speaker 2: symptoms became evident so the medications you were aware of the medications that miss clancy came into mclean [00:53:40] Speaker 6: on right yes and what medications were those seroquel um at 100 milligrams a day um at a valium um two milligrams i don't remember the frequency i think it was per day and again we're [00:54:02] Speaker 1: gonna let her finish yeah i'm just saying that she looks at the records yeah uh so seroquel [00:54:09] Speaker 2: um valium um and benadryl do you remember or do you recall remeron being one of the um drugs that were described or reported by um miss clancy uh when she came in that she reported taking from in the past yes and um again in that report from the patient about past um history do you recall her indicating that one of the providers had suspected um a bipolar disorder yes um in your interactions with miss clancy and your review of the interaction she had with other psychiatrists did she appear to agree with that diagnosis [00:55:03] Speaker 6: did you know appear to agree uh miss clancy please raise that question please [00:55:08] Speaker 2: miss clancy did she she disagreed with the diagnosis okay um the fact that she came in and she was on 100 milligrams of um seroquel or or more would that have been something that was significant to you in considering a bipolar diagnosis [00:55:32] Speaker 6: circle is used for several purposes it is not just used for bipolar illness okay and um miss clancy also [00:55:43] Speaker 2: reported um coming to mclean issues with insomnia correct yes is seroquel um sometime used in low doses to address insomnia yes now um as far as the plan from january 1st um you indicated that dr modva recommended um reducing the seroquel and then monitoring symptoms correct yes were you aware that um miss clancy saw dr modva again on january 2nd yes and again that was prior to your first um point of contact with her yes as far as what you know from reviewing the record um you were aware that the that miss clancy reported that um she slept well on um lesser dose of seroquel yes did she report any delusions hallucinations or suicidal or homicidal ideation no okay and as far as after the check-in with dr modva on the second was the plan to continue to decrease the [00:57:04] Speaker 6: seroquel uh dr modva was going to continue her on 75 milligrams and then the next day she would have gone down to 50 milligrams [00:57:21] Speaker 2: and on these first few days um that uh lindsey clancy was at mclean hospital from january 1st until you actually saw her on january um 3rd you're aware that in addition to seeing dr outlaw at the um intake and dr modva on two occasions on the first and the second that um there were also notes in the record for you to review from nurses who interacted with her on um january 1st at 5 20 a.m right yes from nurse um january 1st at 6 28 a.m yes a nurse interacting with her on january 1st at 10 34 a.m yes and that she actually participated in a group activity with a social worker at 12 03 p.m on the first yes and that a nurse um interacted with her and no made notes on two at 207 p.m on the first yes and that she um saw a mental health worker at 9 33 p.m on the first yes and in relation to january 2nd she um a nurse made note of interaction with her on um 9 46 on the [00:58:30] Speaker 6: second right i remember there were interactions i don't remember the exact time um but fair to say on [00:58:36] Speaker 2: the second she interacted with nurses and most in dr modva yes based on your review now going to january 3rd um that was the first face-to-face contact you had with the patient correct yes prior to meeting with her had you reviewed all of these notes and all of the information um up to that date yes and did you go through again a report of history with her yes were you able to make an assessment of her mental status during that interaction with her yes and what were your observations of her mental status [00:59:20] Speaker 6: um i can't i mean um i can remember certain elements but i don't remember i i mean she she was dressed in uh you know she was appropriately dressed uh her speech was of normal rate and volume um behaviorally she was polite and cooperative um her mood i don't remember exactly it's a quote so i don't remember exactly what she quoted her mood as being can you you could it would be in the medical record [00:59:53] Speaker 1: um i'm just gonna approach if that's okay yeah and just so the records are exhibit 79 yes all right so [01:00:11] Speaker 2: those records you'll have those with you okay um so i have hold six pages 61 through 66 but i think that's your note if you can just take a look at your note if you can just take a look at that yeah does that refresh your memory as to um what your observations were of her mood yes what was her anxious okay and did you observe signs of anxiety or did she um tell you that she felt anxious she appeared anxious and um her affect did you observe it to be um congruent to her mood yes and um you exert exam you examined her and found her to um have linear thinking and appear goal directed right yes and um as far as addressing kind of why she was there and what your recommendations were ultimately what were you trying to address or accomplish in a treatment plan with uh miss clancy that that's a very broad question okay um i could break it down if that's okay yes um so as far as once you had a chance to sit and talk with her what did she identify to you to be her main concerns that she wanted to address during her stay at mclean [01:01:52] Speaker 6: she did not uh want to be dependent on an anti-psychotic medication uh which is what serequil's class is even though it's used for insomnia and other indications depression um she didn't want to be [01:02:12] Speaker 2: dependent on serequil to be able to fall asleep okay and so um fair to say she was very concerned about wanting to sleep at night yes and um she was very concerned about her symptomology or what she was experiencing by way of symptoms from various medications right yes and that um concept or the phrase numbness did she use that a few times yes and again um you mentioned dr madvo was concerned about the numbness with the medication in your experience with serequil was is that also a common side effect [01:02:50] Speaker 6: for people to feel numb um it's uh it can be one of the side effects that people can have okay um and [01:03:02] Speaker 2: as far as the suicidal statements that you were aware of from the prior reports did you go through that with her about whether she presented to you with suicidal ideation um can you ask me that again sure um did you talk to her about her thoughts of suicide yes and um did you talk to her about whether she had any specific plan yes um did she have any plan no had she reported that she had ever had a plan for suicide no and um did she tell you there were reasons why she thought she wouldn't commit suicide yes what were [01:03:42] Speaker 6: those reasons her children and her family her mother so after this um face-to-face interaction with her and [01:03:53] Speaker 2: kind of going through her history and having reviewed um what you had the information you had about her what did you develop as a plan for her while she was at mclean i continued with uh the plan to taper her [01:04:08] Speaker 6: off serequil and to monitor whether her symptoms improved but also to see if she could sleep while she was off of serequil um and to really observe symptoms and mood during this first interaction with [01:04:30] Speaker 2: her was there any conversation about how long she would stay or what her plan might be after she left [01:04:36] Speaker 6: mclean um i i uh i when we met the first time uh lindsay said that her she had her daughter's birthday coming up on the weekend and that it had been planned months ahead of that date and she was hoping that she could be there um that weekend so she could be with the kids and family who was [01:05:09] Speaker 2: going to come for the birthday party now the um concept of kind of tapering her off the serequil and monitoring her symptoms did that seem like a realistic goal to you yes um and now after having spoken to her and developing this plan were you also cognizant or um thinking about the potential for a bipolar disorder yes diagnosis and so how does that how did that affect how you approached this plan to taper [01:05:44] Speaker 6: again um we would have we would have can we were observing for any symptoms that would indicate that she might have [01:05:56] Speaker 2: bipolar disorder and where she had reported that she had issues with sleep was that also something of concern to you if there was the potential for a bipolar disorder yes and reduction of medication what was [01:06:09] Speaker 6: the concern for the sleep um i think people's mental health is negatively affected if they cannot sleep whether it's bipolar disorder or depression um and so sleep is important okay and so so person um that might [01:06:31] Speaker 2: you might be considering for a bipolar diagnosis um would lack of sleep make you watch for symptoms of [01:06:37] Speaker 6: hypomania yes sleep is one of sleep deprivation can lead to bipolar a bipolar episode a hypomanic manic episode [01:06:49] Speaker 2: so you wanted to monitor her patterns in her sleep and her mood to see if there was any evidence of that correct yes in this um first interaction where you identified um a plan did you also make a suggestion about a particular medication that um she might consider after the seroquel has been had been discontinued [01:07:20] Speaker 6: yes what was what was the alternative medication if you will it was um cymbalta which is an antidepressant [01:07:31] Speaker 2: and that was that something that you intended to prescribe for her while she was there or was it something that you suggested that she could consider as an outpatient [01:07:40] Speaker 6: um it was just a consideration it would depend on how she was doing after she was off of the circle [01:07:48] Speaker 2: okay um now what about um the other the valium was there a plan to address uh tapering or weeding her off valium or an alternative to valium [01:08:00] Speaker 6: um yes i switched her from valium to ativan um okay because uh it has a shorter half-life um and you know in my experience it's it manages uh anxiety well [01:08:20] Speaker 2: and um were you aware that she had um taken ativan before yes and um did she report any concerns about ativan or benzodiazepines in general yes what was the concern she reported to you [01:08:36] Speaker 6: um she stated that her husband had concerns about her being on a benzodiazepine [01:08:50] Speaker 2: during this interaction with her on the january 3rd did you observe any signs of psychosis no and in the notes and the interactions with the providers prior to your meeting between january 1st and january 3rd did anyone ever know any symptoms or concerns for psychosis no and you're aware that um miss clancy was also still in that what was considered the postpartum period right she had had a child in may of 2022 [01:09:26] Speaker 6: that's a um tricky question to answer because different organizations or agencies um assign postpartum a different length of time [01:09:39] Speaker 2: the eight okay and so in your training experience and your experience as a person who diagnoses yes um did you consider postpartum as part of what you had to figure out here with this patient or was it really not a consideration it was okay and why was it for you [01:10:00] Speaker 6: i mean she had a child and their risk of postpartum depression postpartum psychosis is [01:10:09] Speaker 2: um a serious consideration okay now after this first meeting with um miss clancy on the third were you able to um give her your in your own opinion a diagnosis yes what was that [01:10:29] Speaker 6: um you said after the third right okay so that would mean one meeting yes um i gave her um a diagnosis of insomnia second bit of mental health condition because um one day of observation wasn't sufficient me it's sufficient for me to figure out if she truly um you know to give a solid diagnosis because um it sticks with the patient right fair to say you [01:11:01] Speaker 2: just didn't have enough information at that point correct okay so again you saw her on um january 3rd and um that was approximately nine [01:11:21] Speaker 6: and 9 15 a.m right if that's what it says uh yeah well if i [01:11:28] Speaker 2: at the top of your in inpatient progress note on page 61 of the uh exhibit if i say the data service reads 1 3 23 at 9 15 would that be where you would note the time you were scheduled to speak with the patient yes okay um and you're aware that on that same day on january 3rd that in addition to meeting with you that she met with a social worker at 10 0 7 a.m right uh yes the social worker and i would have met with her together okay um but then the social worker would have their own note if there was any interaction um that they were noting and also a nurse as well yes um and that on the third that miss clancy participated in a group at 12 02 p.m correct yes and um engaged with a mental [01:12:16] Speaker 6: health worker at 12 22 p.m right i do know that she engaged with the mental health worker the times are [01:12:24] Speaker 2: okay not something i recall um if i indicate that the records show she did another group at 2 36 p.m would that sound right yes um that she then declined her group at 3 50 p.m yes and um then saw another mental health worker in the evening before presumably she went to bed night uh 8 52 p.m yes okay did you see her on um january 4th yes and so again is this the same um same protocol you meet you talk you discuss um did you talk to her about how the previous night sleep went yes and how was that night's sleep [01:13:08] Speaker 6: she reported sleeping well well i don't remember the exact words but she said she slept okay yeah um and [01:13:16] Speaker 2: do you remember having a conversation with her again on that day january 4th about going home yes and [01:13:23] Speaker 6: what did she say about that um originally i think we were thinking we had talked about discharge on um friday um and she was she stated that she was anxious being in the hospital and that she wanted to be discharged so she could be home with her family and her children and so did she [01:13:54] Speaker 2: ask to leave earlier than friday yes and when she asked to leave earlier than friday um what was your response to that [01:14:03] Speaker 6: um whenever we um i said she could leave provided uh she had psychiatric follow-up the next day and why did you do that the i wanted to do that um if she wasn't able to sleep that night after discharge that she could speak with somebody about it so that they could come up with a plan to ensure she could sleep and to monitor [01:14:39] Speaker 2: how she was doing off of the medication and was there a kind of a secondary reason um that you had asked that she make sure she make an appointment before discharge yes it was also to assess whether [01:14:54] Speaker 6: um she could think clearly and follow directions and get it together to we asked her to set up the appointment herself and she was able to do that she responded within an hour she told the nurse the social worker that she had gotten an appointment and she even the social worker had asked her for a fax number so that we could discharge the sum we could send the discharge summary and she provided the fax number [01:15:23] Speaker 2: as well and now on this day that you had met her on on january 4 or january 4th she um she reported that she slept well do you recall what dose of seroquel she was down to at that point had she reached zero um on which day on the fourth when you saw her [01:15:47] Speaker 6: i'd have to walk myself through this so i know she was on 75 milligrams uh the night of the first 75 milligrams the night of the second on the night of the third we decreased it to 50 milligrams on the night of the fourth she would have been on 25 milligrams okay [01:16:06] Speaker 2: and fair to say that um on the fourth your plan was to continue to taper her so that she wouldn't she would be at zero for seroquel take no seroquel on thursday night right correct and that um she would be restarted on ativan and that she'd have the trazodone available if she needed it [01:16:33] Speaker 6: she was already uh on ativan during her admission and was taking it at night she also had trazodone uh which is uh which can which is a sleep medication it it has sedating properties so it can be used for sleep uh so yes she had that she had the option to take that as well [01:17:00] Speaker 2: and so did you have a concern about her um leaving on on thursday the 5th um without having monitored her at um no seroquel [01:17:19] Speaker 6: i did not have any um concerns about her safety or [01:17:28] Speaker 2: her risk for anybody else okay but as far as from a diagnostic perspective um would you have preferred to have more information about her sleep patterns and her mood yes okay um now you said that you didn't have a concern for her safety so what um in your time that you were with her that you met with her and all the information that you reviewed what were identified as um maybe protective factors that [01:17:51] Speaker 6: made you feel comfortable that she was safe she was um there's several things um she was future oriented she was jilly uh invested in her children she was a caring mother just like um a caring mother she had her parents uh around to help her she had family and supports um being sure that she would have outpatient psychiatric care for follow-up um she didn't have a history of suicide she had no history of psychosis postpartum psychosis um you know she had a stable place to live um so the statement that um she made to [01:18:44] Speaker 2: you of that she wouldn't have um completed the act of suicide because of her kids or her mom was that something that you considered absolutely and um the fact that during the time she from admission on january 1st to the time she was discharged on january 5th that she didn't um make statements supporting suicidal ideation was that a factor that you considered yes and at no time during the time she was at mclean did she ever indicate that she had ever ever reported or had thoughts of harming [01:19:19] Speaker 6: anyone else did she she had never stated that she had any thoughts of harming anybody else [01:19:31] Speaker 2: and ultimately at the end of that conversation with her or the hour later she was able to secure that appointment that you asked her to on her own correct and so what knowing that now the discharge is moved up a day what was your plan for medication for her upon discharge [01:19:50] Speaker 6: um she would have continued on the atvan uh to help her sleep at night uh that was a short-term plan once she was feeling better or was able to sleep or her mood came back to baseline she could taper off of it uh she had trazodone to use as needed um [01:20:13] Speaker 2: and melatonin and as far as your recommendations for medication it would be no more seroquel i guess let me ask that question a different way yes you didn't give her a new prescription for a different doses of seroquel did you no and did you advise her to take seroquel when she was home if she [01:20:35] Speaker 6: felt that she needed it i would assume she would take what i had prescribed [01:20:50] Speaker 2: um just to back up one second as part of um this treatment team plan um for patients at mclean hospital is it fair to say that um either you or other members of the team either a mental health worker or social worker a nurse sometimes reach out to collaterals in order to try to gather information and assess the patient yes and in this instance are you aware that somebody reached out to patrick clancy to speak with him about his wife and her care yes and um were you aware that he reported that um she hadn't ever had suicidal thoughts yes and that um he actually reported to the social worker that she was concerned about dependency yes but she had told you that her husband was concerned is that correct yes and that he felt that she had succumbed to social pressure to take psychiatric medications because [01:21:52] Speaker 6: her friends were taking them that's what he told the social worker and you're aware that he had um [01:21:57] Speaker 2: made uh statements that he was unhappy with the medical care she was receiving at mclean he said i don't think were you aware that he said he was very unhappy with the medical care she received [01:22:10] Speaker 6: she received yes she didn't specify he didn't specify mclean okay thank you um and as as far as you're [01:22:17] Speaker 2: aware um the patient themselves ms clancy she never complained that she wasn't getting seen by staff or doctors was she she never complained of that um did she ever file any sort of um complaint with um the hospital no and is there a mechanism for a person to file a complaint if they feel like they're not being treated absolutely and is that information posted all over the units it is posted on the unit and the forms have available and um a person even if they're not on a one-to-one or directly interacting with a mental health worker or social worker do they always have the ability to request to speak to somebody absolutely and so even when um maybe somebody from their team is and not there or working is there somebody always on call a mental health worker a social worker a psychiatrist a nurse for a person to speak to if they felt they needed to yes and in addition to um you're meeting with her on january 4th and after coming up with that plan for discharge on the 5th are you aware that she then continued to engage in groups on the 5th and that she continued to engage with mental health workers and social workers yes and um do you recall when she was discharged on the 5th was it in the morning or in the evening [01:23:40] Speaker 6: afternoon uh probably around three ish is my recall okay [01:23:46] Speaker 2: and upon discharge was she provided with information um that she could use when she was home like resources yes and um do you recall that um she had asked about resources to find a new doctor at some point uh she she yes and that um she ultimately reported to the social worker that she felt comfortable managing at home yes i may have one moment sure so upon discharge what did you actually prescribe her [01:24:36] Speaker 6: um a 14-day supply of ativan and a 14-day supply of trazodone [01:24:44] Speaker 2: okay okay and um when you were having conversations with her about um her thoughts of suicide or her thoughts of wanting to die um was she expressly asked if she wanted to kill herself yes and um what was her answer if you recall she denied that she denied that yes and where she specifically asked if she had a plan to kill herself yes and did she what was her answer to that she denied it and was she specifically asked if she wanted to harm anyone else yes and did she provide an answer for that she denied it and those are standard questions you would ask at every interaction with her correct yes and prior to discharge she would also be asked those questions again correct yes because if her answers changed at any point it would have changed your plan right yes thank you nothing further thank you mr reddington [01:25:56] Speaker 5: i'd just like to um start off just by asking um district attorney asked you about resources that were provided to her what were the resources we had this um [01:26:12] Speaker 6: we had discussed uh going on psychology today where i'm sorry she was aware of the website psychology today website yes she was given the name of a case manager through her insurance uh who she could contact for assistance in finding new providers [01:26:37] Speaker 5: so other than telling her about the website for psychology today and talking about her insurance company and what they would allow for her to reach out for what other providers is that what it was can you can you restate that sure of course you you reference her insurance company yes that's that's a major consideration in medical treatment is it not what a person has for insurance no no no i don't understand what you mean by that you know what insurance is i mean as far as like a person paying their bills for medical treatment or psychiatric treatment i the insurance is important [01:27:23] Speaker 6: because who you can see is limited by what insurance you have so that's what i was asking as far as [01:27:30] Speaker 5: the insurance you you you referenced that on the resources when the da asked you about resources and i asked you what were the resources and you said going on the website for psychology today right yes and that you spoke to her about her insurance right we gave her the name of a case manager [01:27:49] Speaker 6: who she could contact and her telephone number in case she wanted to find other providers they would be able to look at their database and figure out what providers would be within the distance she was comfortable with whether they were male or female if she had a preference and if she had any preference [01:28:08] Speaker 5: about any specialization okay and in reference to the insurance what is the insure you answered the question about insurance i'm just asking what is the involvement of insurance in that offer of resources i don't understand your question right maybe i didn't understand your answer that's why i apologize you had indicated that in addition to telling her to go on the website for psychology today that you spoke about her insurance and other providers that would be permitted i guess under her insurance [01:28:49] Speaker 6: not every patient the fact that she had a case manager at blue cross blue shield was an added benefit because they could assist her in finding providers that's what i meant all right other than [01:29:06] Speaker 5: the case manager from blue cross blue shield and to do research off of the website for psychology today [01:29:16] Speaker 6: what resources were provided to this woman there are numerous resources that are printed on the after visit summary i don't know each and every one of them but i think they would be in the medical record [01:29:34] Speaker 5: okay and that's something that is provided to a patient when they leave yes she came in on a voluntary is that correct in other words i know she was transported by an ambulance but nevertheless it was that she and her husband patrick wanted her to be treated at mclean correct [01:29:58] Speaker 6: she came in and signed in on a voluntary uh in other words there were no orders of a court no judge [01:30:06] Speaker 5: ordering that she be committed or anything like that is that correct yes all right and she came in on was it was was it new year's eve january 1st yes um and do you remember what time she came in i think she arrived at the cec around four now would you agree that on new year's eve in mclean hospital that that ward is pretty much running on a skeleton crew [01:30:40] Speaker 6: you're uh i i can't speak to something i'm not there [01:30:45] Speaker 5: well you know it's obviously you're not there but what about other people was skeleton crew new [01:30:50] Speaker 6: year's eve you would have to ask somebody who was there [01:30:53] Speaker 5: well you've worked there for what seven years five five years and and what is the ward that she was on [01:31:02] Speaker 6: ab1 south 81 south a as an apple b as in boy bun south south [01:31:12] Speaker 5: and how many doctors work at a b south on whatever shifts that you may have [01:31:24] Speaker 6: there are four psychiatrists at a sign who work on ab1 south now sorry go ahead that yes that's it [01:31:35] Speaker 5: and does that include you yes and how many approximately how many nurses work on ab south [01:31:43] Speaker 6: i wouldn't know but i know that there is a nurse assigned to each team and that there are four games [01:31:52] Speaker 5: sometimes yeah in general four teams one ab south right yes okay and when you say a team that consists of what a psychiatrist a nurse perhaps or what a psychiatrist a nurse a social worker [01:32:10] Speaker 6: and an assigned mental health worker [01:32:15] Speaker 5: and what are the shifts that this team would work there are three shifts okay and would that be like you know seven or eleven [01:32:24] Speaker 6: eleven or four that type of thing i think there's seven hour shifts or eight hour shifts i don't know [01:32:28] Speaker 5: the exact times all right and are you assigned a shift or do you just go whenever you want we are not assigned shifts and when she was brought when she was presented to the hospital um she went through that initial evaluation that you told us about the cec is that correct [01:32:53] Speaker 6: uh i'm sorry [01:32:55] Speaker 5: cec maybe you were talking about this yeah can you repeat the question sure when she admitted herself [01:33:03] Speaker 6: and was escorted onto a b south that's where she was evaluated she was evaluated in the cec by the psychiatrist then she was it came to the unit and was seen by dr madwell later the same day [01:33:20] Speaker 5: so she met two psychiatrists on january first okay so you have a woman that has admitted herself to mclean yeah on new year's for help right yes um and she was evaluated at the cec is that on that ward or is that a different part of the hospital it's a different part okay and how long does that [01:33:44] Speaker 6: evaluation typically take i have i can't speak to that i don't work in the cec what are you doing to see [01:33:52] Speaker 5: what what happens in the cec did this person sit down and they entered they get interviewed or what do they do there's a full psychiatric uh evaluation and a full psychiatric evaluation consists of what [01:34:08] Speaker 6: the his um achieve complaint a history of so basically a history of present illness which would be what brings the person into the hospital okay they review past psychiatric history substance use history social history family history they do a mental status exam uh and then they make an assessment and and they [01:34:34] Speaker 5: would be the cec psychiatrist and that would be the psychiatrist that you were referring to dr outlaw dr outlaw now how long does the cec typically take i do not know it depends on the speed of the person seeing the patient i imagine that um at some point a psychiatrist or a social worker or somebody must get into the prior history that the patient had prior to coming to your doorstep right that is a part of the evaluation yes okay and you had a chance as the district attorney asked you as to whether or not you were able to review the medical records uh that involved lindsey clancy's treatment at mclean hospital for the four and a half days right i was able to review the cec note which had an [01:35:41] Speaker 6: an excerpt of the mgh evaluation and notes that were available to me since january 1st at mclean now as [01:35:51] Speaker 5: a psychiatrist i mean she's when she goes to the hospital she's your patient right she's your patient yes yes and as a doctor what you want to do is get all the information that's available on why this person is in your locked ward right yes so did you do inquiry into her prior history or was that left to the cec person or the social work that is part of the evaluation and the evaluation is cec and when i see her as well all right so do you sometimes when i say you i mean you or the social worker or the cec person do you talk to people like third party i think you said third party contacts yes all right the social worker does okay so and you reviewed the record so when did the social worker talk to um the first psychiatrist that she went to see the social worker contacted patrick well i know you told us that he contacted patrick and that patrick gave some history about the benzodiazepines that he was concerned about and he thought she wasn't getting good medical care is that correct yes all right you know that she had medical treatment before [01:37:12] Speaker 6: she came to mclean yes okay who's who's her psychiatrist the nurse practitioners she was seeing prior to coming [01:37:22] Speaker 5: to mclean i was aware of that person would that be a nurse practitioner gelada yes did you speak to [01:37:31] Speaker 6: her no did you look at her records i did not have access to them why not they aren't in the same [01:37:39] Speaker 5: medical record system well the same medical record system is just so that you have access to mgh you have actually access to brigham and women's hospital because it's all part of some big computer information access you have what about other health care providers [01:37:56] Speaker 6: can you get access to their records not in not immediately well how about if you have a release [01:38:04] Speaker 5: signed by a patient under the hipaa law you know what the hipaa law is obviously right yes and just tell me what does that actually mean that a patient allows someone to look at their medical records yes and lynchie was very very cooperative with you guys wasn't she yes did anyone ever ask her to sign a hipaa release for anyone to get access to nurse practitioner gelada's records no how about psychiatrist tufts records no how about nurse practitioner paul's records no [01:38:39] Speaker 6: who's latisha dukes she was a social worker i think that lindsey saw at south shore at the perinatal program [01:38:50] Speaker 5: okay and do you know when she went to the south shore rhode island perinatal program [01:38:56] Speaker 6: i know it was prior to admission i don't remember the exact dates do you know what recommendations that [01:39:03] Speaker 5: she had received at that point no other than the medication do you know what medication she was actually on when she presented to mclean hospital circle and valium what is it circle and valium you knew that dr tufts was the first psychiatrist that she actually consulted correct i believe so and when i again if you don't know just say you don't know yes okay and and i think you've made reference to the fact that maybe the da made reference in questioning you about the fact that she uh was looking for doctors to uh for some type of medication or something is that [01:39:54] Speaker 6: fair i uh that's a very vague statement i don't know what you mean okay [01:40:01] Speaker 5: well actually she saw dr tufts because dr tufts advertised that she was an expert in perinatal care [01:40:09] Speaker 1: right section no overruled [01:40:16] Speaker 6: oh sorry um i wouldn't know why she saw dr tufts do you know what medication dr tufts prescribed to her from what lindsay told me yes what uh zoloft was the first all right so dr tufts according to lindsay [01:40:38] Speaker 5: provided her lindsay with zoloft which is an ssri correct it's an antidepressant in that class yes okay so when you say an antidepressant in that class the class would be selective serotonin reuptake inhibitor right yes and that's pretty powerful stuff isn't it i don't know what you mean by powerful no well are you supposed to prescribe zoloft or sertraline to a person that has bipolar [01:41:16] Speaker 6: i think it all depends on what you're seeing when you see the patient so it's important i would [01:41:23] Speaker 5: imagine then to be fair in your evaluation of this young woman that came to your hospital for help on new year's to find out what any evaluations were of her condition her presentation her symptomology when she saw that first psychiatrist dr tufts right lindsay was um cooperative and [01:41:49] Speaker 6: she was forthcoming i had no reason to think that she would not provide us within what other providers thought just like she told us that tufts said she uh was worried about bipolar disorder and i'm sorry i apologize [01:42:07] Speaker 5: yeah tufts advised her that she was worried sorry it was um gelata yes okay sorry thank you that's all right no problem and again if you if you have records you want to look at them that's fine because i know it's tough to have all the stuff in your head yes um thank you and so dr tufts prescribed the zoloft to her and and you knew that right after the initial prescription of zoloft do you know how many milligrams per [01:42:36] Speaker 6: how many milligrams she was prescribed initially by dr tufts lindsay i think stated it was 25. [01:42:42] Speaker 5: okay and then dr tufts increased it to what 100 lindsay said it was increased to 50. 50 all right so and again you you're in a i don't know if it's appropriate to say but you're in a mental institution right that's where you work at mclean hospital okay and it's a locked ward right yes and she's a patient that's coming to you for help right yes is it appropriate for a doctor to take what that patient is telling you as a history or do you have to verify it or talk to other health care providers to make sure that they're not just running [01:43:16] Speaker 6: off and making something up i had no reason to believe that she was not a reliable reporter because [01:43:22] Speaker 5: she seemed very forthright right yes she seemed very honest in her disclosure of her symptomology right yes um one of the things or one of the tools that uh you in the mental health field have access to is psychiatric testing right yes okay you have for example uh one tool and i think psychologists and there are psychologists that are on staff i would imagine at mclean as well no not on that unit um as a psychiatrist you don't administer psychiatric or psychological testing do you no all right but for example um you know you've got the the beck uh inventory test or the what's called the mmpi test [01:44:11] Speaker 6: you're familiar with those right these are forms and yeah forms that the patient can fill out right and one [01:44:18] Speaker 5: of the tests is the mmpi which is minnesota multi-phasic personality inventory test right i have heard of that okay and you know that one of the things that it determines is if they call it the k scale whether or not somebody is lying or minimizing or not minimizing but lying about [01:44:37] Speaker 6: their symptomology right i don't know much about the scale well that's a tool [01:44:44] Speaker 5: that can give someone information as to the person's presentation of their symptomology that that would be important as to their honesty of whether or not they're trying to minimize or whether or not they're trying to falsely project their symptomology right i don't know what you're asking me okay you know were you aware that there were ever any psychological testing administered to lindsay um mpi or beck or anything i no okay how many times did she call or reach out to help for a suicide hotline i wouldn't i don't know wouldn't that be something important to find out if the person who you're suggesting was denying suicidality or suicidal ideation upon your evaluation that that she called out to [01:45:46] Speaker 6: suicide hotlines she was telling she she told us that she was having suicidal thoughts right but had no intent or plan so i do know that she was struggling with suicidal ideation right [01:46:03] Speaker 5: anybody else that you talked to or did you talk to anybody else i i know the social worker talked to patrick and he did give the information he gave okay so what i'm asking is as you're investigating the the history of this patient you're not aware no idea that she had reached out on not one but two occasions to a suicide hotline is that correct yes all right did you know that when she was first prescribed the zoloft by dr tops at 25 milligrams then increased to 50 milligrams that she then reported that she was unable to sleep she shared with us yeah sorry i'm sorry i didn't go right ahead no problem what is it i'm gonna let you finish the question okay thank you no big deal it's just that she reported that she went for 48 hours without sleep [01:47:07] Speaker 6: i don't remember that time quoted i know she had difficulty sleeping [01:47:17] Speaker 5: you indicated in your testimony that um and i quote i would have preferred to have more information [01:47:23] Speaker 6: about her sleep patterns right do you remember saying that uh following the changes in the medications [01:47:34] Speaker 5: that we were making so sleep pattern would be just what it says sleep pattern like you sleep from nine at night till seven in the morning or yes whatever your pattern would be right yes why is a sleep pattern important for you as a psychiatrist trying to evaluate your patient [01:47:51] Speaker 6: because difficulty sleeping is a symptom of several different conditions and it can worsen several different conditions and you know that she had reported severe anxiety right [01:48:08] Speaker 5: she was struggling with anxiety yes struggling with anxiety and she was having not just insomnia but she had very very severe insomnia didn't she she wasn't able to sleep and and you would prefer to have more information about sleep patterns is what you said i'm not putting words in your mouth that's what you said [01:48:30] Speaker 6: i know that we were able to observe her sleep while she was on the unit once she left the unit i would not know how she was sleeping which is why we referred her to somebody else so that they could continue to monitor her symptoms [01:48:47] Speaker 5: obviously so let's put the time that you are observing her or that your social workers are investigating to whatever extent they did her background what were her sleep patterns that were important to you [01:49:05] Speaker 6: prior to new year's 2023 the amount of sleep is important yeah and you said that you already said [01:49:13] Speaker 5: i would have preferred to have more information about her sleep patterns after she was in if i was going [01:49:21] Speaker 6: to continue to evaluate her i would want to observe her sleep is what i meant oh so you didn't mean that as [01:49:27] Speaker 5: as an evaluator of her prior medical history trying to get a history of your patient for purposes of diagnosis and treatment that you wanted to know what her sleep patterns were you didn't mean that you meant prior [01:49:42] Speaker 6: i've the history of whether somebody's struggling with insomnia is important and the patient can relay that to me [01:49:55] Speaker 5: okay you ever heard of patients that minimize their symptoms and lie about their symptoms sometimes yes okay so it's important to corroborate what the person is telling you right i mean you know you want to talk to somebody else objective to find out what if any [01:50:16] Speaker 6: evidence there is of symptomology and we did that with i'm sorry we so when a patient presents and they're talking to us it is not just about what they are saying it's about their body language their eye contact you can get a sense of whether a person is being honest or whether they're lying and we are not you know we're providers the patient is there to get help they are going to tell us what is bothering them and what they're concerned about that's why they're [01:50:57] Speaker 5: in the hospital this woman was in a locked wood she couldn't walk off your your unit could she [01:51:04] Speaker 6: that is what a psychiatric unit is right and she was very sick wasn't she i don't know what you mean by very sick really [01:51:17] Speaker 5: you indicated that you would assume that she would take what i prescribed do you do that with all of your patients assume that when they have mental disease or a defect that they would do what they're told [01:51:28] Speaker 6: if they are cooperative and they have been cooperative and reliable yes [01:51:40] Speaker 5: one of the things that's reference would be she stated that she had intrusive thoughts [01:51:45] Speaker 6: um from what i from what stated in the medical record thoughts of um suicide okay and how often would she have intrusive thoughts i don't recall it if the frequency [01:52:11] Speaker 5: would you agree with me that um in addition to anxiety and in addition to inability to sleep that she was in what was self-described as a brain fog right she complained of feeling [01:52:32] Speaker 6: yeah she you can complain of feeling foggy she also complained about uh that she felt as if she was [01:52:41] Speaker 5: a zombie right she did not use those words anybody else use that word describing her in your investigation no did patrick tell you that he was concerned about the medications that she had been prescribed over the past two or three months yes and you knew what the medications were that she was prescribed correct she told us she told you okay um and she told you that she was prescribed in addition to the ssri zoloft that was increased from 25 to 100 that she was then told i was aware i'm sorry 50 correct she was then told to [01:53:21] Speaker 6: stop taking the zoloft by dr tufts right she reported not being able to sleep and they agreed that she would [01:53:29] Speaker 5: not take the zoloft okay so so the answer is yes she was told to stop taking the zoloft by dr tufts right [01:53:37] Speaker 6: i i think you would have to ask dr tufts that well i will but i'm asking you as investigating i know that she stopped taking the zoloft and that she saw dr tufts so i assume that they would have come to [01:53:50] Speaker 5: that agreement all right so as you're evaluating this patient um you're assuming that she [01:53:59] Speaker 6: voluntarily stopped taking the zoloft because she wasn't able to sleep and she discussed it with dr tufts [01:54:07] Speaker 5: she did you knew that she told us she did okay um how many patients have you treated how many women have you treated that were suffering from postpartum psychosis [01:54:32] Speaker 6: i don't recall i don't remember but i think it would stick in my memory so i don't think that i probably have [01:54:40] Speaker ?: probably have [01:54:42] Speaker 6: you don't think you probably have i don't i don't think i have i haven't seen any how about