Judge Reprimands Lindsay Clancy Psychiatrist in Court

[00:00:00] Speaker 1: You had an ad that was in on the computer that if somebody wanted to reach out to a doctor, they could see your ad amongst many others, right? [00:00:12] Speaker 2: Well, I don't think there was an ad. I think we have a website that had some information about myself. [00:00:18] Speaker 1: Okay. Now, in August of 22, up until when you saw Lindsay, how many patients in that month or so had you treated for postpartum psychosis? [00:00:33] Speaker 2: How many patients in a month? Up until that month? [00:00:36] Speaker 1: Well, I'm asking you about when you started working in August of 22 or after, and you are now on your own as an employee. How many patients had you treated before you saw Lindsay, Clancy, postpartum psychosis? [00:00:52] Speaker 2: Well, in the span of one month, I would say none because it's a very rare disorder. [00:00:57] Speaker 1: Okay. But it exists, doesn't it? [00:01:00] Speaker 2: Absolutely. [00:01:01] Speaker 1: And one of the things would be the diagnosis that people hear, right? [00:01:07] Speaker 2: That is a symptom of psychosis, absolutely. [00:01:10] Speaker 1: And that's legitimate, isn't it? [00:01:12] Speaker 2: It is a legitimate diagnosis, absolutely. [00:01:14] Speaker 1: Now, not the diagnosis. People that have postpartum psychosis hear voices, do they not? [00:01:21] Speaker 2: Many do. The disorder can manifest differently in different people, but yes, many people do hear voices. [00:01:31] Speaker 1: How about postpartum depression? How many people in that month or so, before you met Lindsay, did you treat for postpartum depression? [00:01:42] Speaker 2: In the span of one month, it's really hard to pinpoint that. Maybe a couple. [00:01:50] Speaker 1: Maybe a couple? And do you recall how long you treated them for? [00:01:59] Speaker 2: Again, it's hard to really pin down the individuals in a short span of time. [00:02:05] Speaker 1: Can you tell the jury what you put in your ad or in the Aster website that you indicated that described you? [00:02:16] Speaker 2: I don't recall. [00:02:17] Speaker 1: Well, one of the things you did is that you said that you basically were a specialist in the postpartum people that have postpartum psychiatry. You indicated that on your website, didn't you? [00:02:33] Speaker 2: Are you able to read the actual document? I don't remember exactly the wording. [00:02:38] Speaker 1: You've been working now for how many years now? Three, since you saw Lindsay? One more? [00:02:43] Speaker 2: Almost four, yes. [00:02:44] Speaker 1: You haven't changed your ad on the website, have you? [00:02:48] Speaker 2: I have not personally, no. [00:02:51] Speaker 1: And you've read it probably a bunch of times, right? [00:02:54] Speaker 2: I've read it a couple times, but I don't spend a lot of time on my website. [00:02:59] Speaker 1: Okay. Do you recall that you indicated that you were specializing in any particular aspect of psychiatry? [00:03:09] Speaker 2: Yes. It probably includes a special interest in women's health, in perinatal psychiatry, in trauma-related disorders, anxiety. And, you know, there may be some other things that were mentioned. [00:03:26] Speaker 1: Yeah, like women that have babies and they're suffering from postpartum depression, right? [00:03:31] Speaker 2: Absolutely. [00:03:32] Speaker 1: You advertised that after a month working for ASTA, right? [00:03:37] Speaker 2: That's listed as one of my interests, definitely. [00:03:40] Speaker 1: And again, forgive me, how many women did you treat for postpartum depression in that month and a half before you met Lindsay? [00:03:49] Speaker 2: I don't know, maybe a couple, but I've treated many of them in the residency, which was just immediately before. [00:03:57] Speaker 1: So when a person needs to see a psychiatrist, generally they're not well. Is that fair? [00:04:07] Speaker 2: Some are not well. It really can vary. [00:04:10] Speaker 1: So when someone comes to see a psychiatrist like you, it's because they need help, right? [00:04:17] Speaker ?: Yes. [00:04:18] Speaker 1: And when they come to you because they need help, for example, with Lindsay Clancy, she came to you because of your ad, right? Or your website for ASTA, what you said about yourself. [00:04:33] Speaker 2: I don't know exactly how she found us. [00:04:36] Speaker 1: Well, do you know why she came to see you? [00:04:41] Speaker 2: I'm not sure exactly. [00:04:44] Speaker 1: Friday, we spent a long period of time going through your initial or the initial intake that she had to fill out. Is that correct? Do you recall that? Yes, we did. And the district attorney kept asking you, and this is in September 12th, is that when that form was filled out? [00:05:04] Speaker 2: I believe she completed the form on the 12th. The appointment was on the 15th. [00:05:10] Speaker 1: So what does a person do? Do they call you or do they talk to somebody in the administration? How do you get the form to fill out? [00:05:18] Speaker 2: Yes, our administration handles that. [00:05:21] Speaker 1: And what do they do? How does that happen? [00:05:25] Speaker 2: They send them the documents, probably by email, and the patient fills them out. Actually, it might be all within the portal. That we use. [00:05:42] Speaker 1: Within the portal? The patient portal, yes. Okay, and that means that you go online and you can access Aster Mental Health, and then all these little drop-down boxes would come up? [00:05:51] Speaker 2: Something like that. [00:05:53] Speaker 1: Are you aware? Is it something like that, or are you aware of what it does? [00:05:58] Speaker 2: So, because I don't handle the scheduling and the sending of forms, I don't know exactly what it looks like. [00:06:05] Speaker 1: Well, this is the form that you're giving a person that needs help because they're possibly mentally ill. Is that right? [00:06:11] Speaker 2: Yes, and what's important is that I review the forms and we go through them in the appointment. Absolutely. Oh, yes. [00:06:20] Speaker 1: Now, understand that the records, Exhibit 219, I believe, the jury will have access to the Tufts records. Okay, you're aware of that, right? You know this is it? [00:06:36] Speaker 2: Yes. [00:06:37] Speaker 1: Because you have talked to the prosecution about what an exhibit is, and you know that your records are now in evidence before this jury, right? [00:06:47] Speaker 2: If that's what you say, yes. [00:06:49] Speaker 1: I wouldn't take what I said. [00:06:52] Speaker 2: Well, I don't know the details of how this works. [00:06:56] Speaker 1: Have you talked to them prior to your testimony? [00:06:58] Speaker 2: No. [00:06:59] Speaker 1: You haven't talked to the VA's office? [00:07:01] Speaker 2: No, not at all. [00:07:03] Speaker 1: You're a defendant in a very large lawsuit, are you not? Yes. [00:07:13] Speaker 2: Yes. [00:07:15] Speaker 1: You wouldn't happen to be represented by an attorney, would you? [00:07:19] Speaker 2: I am. [00:07:20] Speaker 1: And the fact that you have an attorney is you're right under the Constitution. It doesn't mean that you're guilty of anything, right? [00:07:27] Speaker 2: Right. [00:07:28] Speaker 1: Okay. And you know that the outcome of this case is very, very major to the outcome of your lawsuit. [00:07:41] Speaker 2: I don't actually know that. [00:07:47] Speaker 1: So, do you understand that if, in fact, it's determined that you advertised as an expert in postpartum and in postpartum psychiatry, and you've had a month experience plus a residency, would you consider that to be negligent or misrepresentation? [00:08:08] Speaker 2: I do not believe that I have been negligent. [00:08:11] Speaker 1: Do you understand what misrepresentation means? Yes. With a month under your belt plus your residency, do you really want this jury to believe that you were an expert? Have you advertised that? [00:08:22] Speaker 2: I don't think that's exactly the wording that I used. I think I said that it was an interest of mine. [00:08:27] Speaker 3: Do you want what? Do you want the answer? No. Go ahead. Go ahead. You need to answer that. [00:08:31] Speaker 2: I just think the wording was that it's an interest of mine. I don't believe I called myself an expert. [00:08:39] Speaker 1: Are you an expert in postpartum? [00:08:42] Speaker 2: I may be. I don't know. I think it depends on what you define an expert as. [00:08:49] Speaker 1: Well, when a patient comes to you and they fill out the form, you agree with me that your records reflect that form that she filled out on September 12th of 2022, right? [00:09:06] Speaker 2: Yes. [00:09:07] Speaker 1: And the form that the district attorney went through, hands-takingly with you, is basically, it looks something like this, right? That's one of the forms that you've got people to fill out, right? Right? [00:09:28] Speaker 2: Yes. [00:09:29] Speaker 1: See the little check mark? [00:09:32] Speaker 2: Yes. [00:09:33] Speaker 1: Who puts the check mark? [00:09:34] Speaker 2: The patient. [00:09:35] Speaker 1: So, how many pages, because I don't want to go through all the pages yet. How many pages does a patient, well, how many pages did Lindsay go through to check the boxes that asked her? [00:09:49] Speaker 2: There were a lot of pages. [00:09:52] Speaker 1: It was a lot. And 20? [00:09:54] Speaker 2: Yeah, maybe between 10 and 20. [00:09:56] Speaker 1: Okay. And basically, there were all little checks in boxes, correct? [00:10:01] Speaker 2: Not just checks. [00:10:03] Speaker 1: No? So, does the person then answer questions by typing in an answer, such as, do you have any opinion, legal problems? No. Have you ever been arrested? No. Things of that nature, right? [00:10:18] Speaker 2: Those are some of the questions. [00:10:20] Speaker 1: And the questions also, do they ask the patient what medications they were on? Yes. Before seeing you? [00:10:29] Speaker 2: Yes. [00:10:29] Speaker 1: And Lindsay told you that she was on SSRIs in the past, right? [00:10:35] Speaker 2: Yes. [00:10:35] Speaker 1: And SSRI means what? [00:10:38] Speaker 2: A selective serotonin reuptake inhibitor. And that's pretty powerful stuff. It's an effective treatment for depression and anxiety. Well, it affects the serotonin levels in the brain, doesn't it? Yes. [00:10:52] Speaker 1: It rewires the brain, doesn't it? [00:10:54] Speaker 2: It doesn't rewire the brain. It increases the serotonin. And many individuals with depression have low levels of serotonin. [00:11:04] Speaker 1: So, Lindsay told you that she had been prescribed an SSRI when she was in nursing school. Is that right? [00:11:13] Speaker 2: Yes. [00:11:13] Speaker 1: What was the SSRI? [00:11:16] Speaker 2: Prozac. [00:11:17] Speaker 1: And how long was she on the Prozac? [00:11:20] Speaker 2: I'm not sure. [00:11:22] Speaker 1: Did you ever ask? [00:11:23] Speaker 2: I probably asked. [00:11:25] Speaker 1: Probably asked. Isn't it true? Don't you guys have a saying that it's not written, it didn't happen? You take copious notes, do you not? [00:11:33] Speaker 2: It's impossible to write down every single thing that's said. So, I write down what is clinically relevant, clinically necessary. But there's a lot that is discussed over an hour that is not able to be written down. [00:11:50] Speaker 1: Such as the fact that a person was on an SSRI when they were in nursing school is not an important fact to find out. [00:11:58] Speaker 2: Oh, no, that's important. [00:12:00] Speaker 1: Sorry. No problem. I'm not doing, you know, the Sophie Cunningham idea. I'm just asking a question. That's all. And you can answer it, okay? How about if she had a reaction to Prozac? [00:12:14] Speaker 2: I asked her about the Prozac. [00:12:16] Speaker 1: Is that written in your notes? [00:12:17] Speaker 2: Yes. [00:12:18] Speaker 1: And what did she say? [00:12:20] Speaker 2: I mean, she said that she took it for a period of time. She didn't mention any side effects. [00:12:25] Speaker 1: Oh, she didn't tell you that she had side effects. I see. So, when a patient comes to see you with a month under your belt and they're sick and they're looking for help, you wait for them to volunteer facts to you? [00:12:40] Speaker 2: She volunteered a lot of information. She knew very well what her medical history was and was able to provide that for me. [00:12:48] Speaker 1: Such as what? That she was in nursing school and took Prozac? [00:12:52] Speaker 2: That's part of it. [00:12:54] Speaker 1: And she told you that, right? Yes. And she was pretty upfront and honest with you, wasn't she, in answering these questions, right? I believe that she was. We all spent some time talking about the fact that she declared that she had consumed alcohol, that she felt guilty about it. You recall that on Friday? We dwelled on that for a while, didn't we? [00:13:14] Speaker 2: Yeah, yes. That was a component, yes. [00:13:16] Speaker 1: I mean, that's something that's important, right? [00:13:19] Speaker 2: Yes. [00:13:20] Speaker 1: What was her, what was her drink of choice? [00:13:24] Speaker 2: I'm not sure. [00:13:25] Speaker 1: Did you ever ask her? [00:13:27] Speaker 2: I'm not sure. We were not concerned that her level of alcohol use was. [00:13:37] Speaker 3: Well, the VA certainly was, right? You're right. All right, well, he is, and everybody knows. Doctor, wait for the question, all right? And then same thing, I'll have counsel wait until you finish your answer, all right? Go ahead, Ms. Rennington. [00:13:50] Speaker 1: So is it important, doctor, for you, as a physician, to know your patient, in other words, know who they have? Yes. And you know that Lindsay was a nurse, correct? [00:14:06] Speaker 2: Yes. [00:14:07] Speaker 1: You know that she graduated, obviously, from college, right? Yes. Is she a good student? [00:14:15] Speaker 2: I don't recall. [00:14:17] Speaker 1: Do you know when she got married? [00:14:20] Speaker 2: I don't recall that specific detail. Did you ask her? I don't know. I knew she was married. [00:14:27] Speaker 1: She had three kids, right? Yes. And the reason that you knew that she was married is because you spoke to her husband, Patrick, correct? [00:14:36] Speaker 2: He attended one of the appointments, and I spoke with him on that date. [00:14:44] Speaker 1: Ah. And did you say, hi, nobody, and did you give me a handshake when you came to your office? [00:14:50] Speaker 2: It was telemedicine. [00:14:52] Speaker 1: It was what? [00:14:53] Speaker 2: Telemedicine. [00:14:54] Speaker 1: Telemedicine. Is it fair to say that after, what is it, 14, what have you said to the jury, 14 appointments that you had with Lindsay during that period from September until January? 14, yes. Every single one of them were by telemedicine. [00:15:18] Speaker 2: Yes. [00:15:19] Speaker 1: Until you came in this courtroom Friday, you never saw this woman in person, did you? [00:15:24] Speaker 2: Correct. [00:15:25] Speaker 1: Were you ever concerned about her mental health as a person? [00:15:32] Speaker 2: Absolutely. [00:15:33] Speaker 1: She was crying. She told you symptoms that she couldn't get out of bed. Isn't that right? [00:15:40] Speaker 2: At one time, she said it was difficult to get out of bed. [00:15:43] Speaker 1: Oh, difficult to get out. Why was it difficult for Lindsay Clancy to get out of bed? Because she was very depressed. And did you give her a hug? Oh, no, you're on telemedicine, so you couldn't give her a hug, could you? You didn't have any chance to even look at her in person, did you? [00:15:59] Speaker 2: I could look at her. It was always a video appointment. I couldn't give her a hug, but that's not actually something that psychiatrists typically do. With patients. [00:16:10] Speaker 1: I imagine. Now, I'm looking at you, and you've got the witness here, cutting you off in half, right? So I can't see from your waist down, your legs, your feet, your hands, anything. That's the same you that you have on the telemedicine, right? [00:16:29] Speaker 2: Yes. [00:16:30] Speaker 1: Isn't it fair to say that you've studied and that you've learned that there are objective manifestations that patients may have that would be a tell, like if you're playing poke, you have a tell, that would be an indicia of the fact that they're stressed or emotionally disturbed, right? Yes. Like hand-wringing, right? [00:16:53] Speaker 2: Yes. [00:16:54] Speaker 1: Were you able to see the hands ringing when you were on telemedicine? [00:16:58] Speaker 2: Um, I don't believe, I don't recall seeing her hands. [00:17:03] Speaker 1: You recall, you know how people sit there and they do this with their leg and their leg bounces because they're going through some type of emotional stress? You couldn't even see her legs, could you? [00:17:13] Speaker 2: I couldn't see her legs, but I knew that she was under stress. [00:17:17] Speaker 1: So, when she came to you, um, September 15th, I believe, is the first time that we all actually discussed her condition, correct? [00:17:34] Speaker 2: Yes. [00:17:35] Speaker 1: And looking at the medical records, which the jury would be able to know that, it says, visit date. September 15th, 2022, and you can look, you can look along with me if you wish, um, indicates why she came to see you, right? Yes. Right? Yes? Yes. Okay. Why did she come to see you? According, not, not guessing and speculating, never mind the TV, you just look at your notes. Tell me what brought Lindsay Clancy to your office. [00:18:13] Speaker 2: Postpartum anxiety. [00:18:16] Speaker 1: Is that it? Is that what you noted in the records? [00:18:19] Speaker 2: Well, those were her words when asked, what are the problems for which you are seeking help? [00:18:25] Speaker 1: I see. Postpartum anxiety. Now, as a psychiatrist, meeting with this young woman, after a month or so of working as a psychiatrist or pastor, there are tests that you administer to a woman who's in postpartum to find out what type of anxiety they have, right? [00:18:49] Speaker 2: Well, there are some screening tests, but the most important thing is what the patient tells you and what my assessment is in the session. [00:18:58] Speaker 1: I see. And that would carry through the Tufts evaluations for all 14 of those meetings is what the patient tells you, right? [00:19:08] Speaker 2: Yes, and what I observe in the session. [00:19:11] Speaker 1: Through the television? [00:19:13] Speaker 2: Through the computer. [00:19:16] Speaker 1: What, if you can tell me, is the Edenberg test? [00:19:23] Speaker 2: It is a scale that looks at symptoms of postpartum depression. [00:19:30] Speaker 1: And when you administer it, that's a major test, isn't it, for a doctor to evaluate a patient for PPD? [00:19:38] Speaker 2: I wouldn't say it's a major test. [00:19:40] Speaker 1: It's a pretty big one, though, isn't it? It's the only one that measures the postpartum depression, right? [00:19:46] Speaker 2: It's a common one. [00:19:47] Speaker 1: It's a what? [00:19:48] Speaker 2: Common. Commonly used. [00:19:50] Speaker 1: Commonly? All right, so when you used it on Lindsay, when was that administered to her? [00:19:56] Speaker 2: I did not use it on Lindsay. [00:19:59] Speaker 1: Why? [00:20:01] Speaker 2: We used the PHQ-9, which is a... [00:20:05] Speaker 1: What is the PHQ-9? [00:20:06] Speaker 2: It's a depression screening form. [00:20:09] Speaker 1: That's like generalized anxiety disorder, general depression. It's got nothing to do with a woman suffering from postpartum depression, does it? [00:20:16] Speaker 2: I disagree. [00:20:18] Speaker 1: Well, do you agree that people, perhaps, that may know a little more than you, determine that the Edenberg scale is the appropriate scale to administer it to a pregnant or postpartum woman? Yes. It's a state as to form. You're familiar with the Edenberg scale, right? [00:20:34] Speaker 2: I've heard of it. [00:20:35] Speaker 1: And can you explain to me how it's graded? [00:20:38] Speaker 2: No, I cannot. [00:20:42] Speaker 1: There are 30 questions in it, are there not? [00:20:46] Speaker 2: I don't use this scale, so I don't know how many questions there are. [00:20:50] Speaker 1: So, the Edenberg scale, do you even know that for someone that is depressed in their condition of postpartum would be 15? Anything over that? They're in severe depression? [00:21:05] Speaker 2: Okay. [00:21:06] Speaker 1: Do you know that her first Edenberg test that was administered to her put her at a 23? Injection. No rule. Severe depression? [00:21:17] Speaker 2: I was not aware of this test. I was not aware that this had been administered to her. [00:21:26] Speaker 1: Well, you know that, except for the Prozac that she had when she was a nurse, what, 23, 24, 23 years old? She hadn't, other than seeing her own doctor for having a baby, she hadn't seen any doctors. You knew that, right? [00:21:46] Speaker 2: I didn't know exactly which doctor she sees. I think we, you know, we ask about your primary care doctor. But she did not report any other medical issues that she was under treatment for. [00:22:01] Speaker 1: So is it important for Dr. Jennifer Tufts to know whether or not a patient who is coming to you for help has a prior medical history, other than what they might tell you? [00:22:15] Speaker 2: Well, when patients are able to advocate for themselves and share their medical history, we rely on what they tell us. [00:22:27] Speaker 1: Was she able to advocate for herself, in your opinion, when she came to see you and you evaluated her in September? [00:22:35] Speaker 2: Absolutely. [00:22:36] Speaker 1: About October? [00:22:38] Speaker 2: Yes. [00:22:39] Speaker 1: About November? [00:22:40] Speaker 2: Yes. [00:22:41] Speaker 1: About December? [00:22:43] Speaker 2: Yes. [00:22:44] Speaker 1: And your medical records, you would agree, show that during that period of time that she was deteriorating, was a word that was used on Friday. Isn't that right? So. No, no, no, so. You used the word deteriorating on Friday, did you not? [00:23:06] Speaker 2: She was a little bit worse at certain appointments. And the deteriorating word, which is not my word choice, is what is in the note because I had to select that. [00:23:16] Speaker 1: Because why? You have some kind of a program that you have to check the box and you have to bring down the drop box? You can't take a pen and write something down about a patient? [00:23:26] Speaker 2: There are certain parts of the note where I can write whatever I feel is necessary, but that specific aspect of the note is a button where you have to click one of three choices. [00:23:39] Speaker 1: So when the jury's going through your medical records, one of the things that they're going to see is that when you meet with a patient, you have a form that you fill out where it says, if you feel like you're going to harm yourself or somebody else, make sure you go to the emergency room, right? Yes. If you have any urges to harm yourself or others, go to the nearest emergency room. That's in every single time that you meet with a patient, right? [00:24:11] Speaker 2: Yes. [00:24:13] Speaker 1: And it indicates that if there's any, call the suicide prevention and crisis hotline. If you feel that you're in crisis, you may text home to a particular number at any time. What's a suicide hotline? [00:24:33] Speaker 2: It's a phone number that patients in crisis can call and speak to a trained counselor. [00:24:42] Speaker 1: Now, a psychiatrist, you'd agree with me, is not a counselor. That's for sure, right? [00:24:47] Speaker 2: Well, a psychiatrist has training in therapy as well as in medicine. [00:24:52] Speaker 1: Did you give Lindsay Clancy any therapy? [00:24:55] Speaker 2: There was some therapy incorporated in our sessions, but we did. Like what? Providing emotional support, listening to her. [00:25:05] Speaker 3: Hold on. She can finish her answer. No, she can't. Hold on. Everybody. She can. You ask the question. We're going to let her finish, and then you can follow up with any questions you want. Go ahead, Doc. [00:25:19] Speaker 1: Anything else you want to say? [00:25:21] Speaker 2: So, her sessions were largely focused on the medication management, but there was an aspect of therapy including those items. [00:25:30] Speaker 1: Okay, and the sessions were for what? 17 minutes? No. How long were they? [00:25:35] Speaker 2: 25 to 30 minutes. [00:25:37] Speaker 1: So, 25 to 30 minutes on the television, and were you face the TV screen with her for the full 25 minutes? [00:25:46] Speaker 2: Yes. [00:25:47] Speaker 1: And that's not noted in your records. It says 17 minutes on all your records, does it? [00:25:51] Speaker 2: So, if you look closely, it says the therapy component was for 17 minutes. It doesn't say the entire duration is 17 minutes. [00:26:05] Speaker 1: So, what do you do when you're trying to give therapy as a psychiatrist to a patient that can't see you? [00:26:12] Speaker ?: What do you do? What do you do for therapy? [00:26:16] Speaker 2: It depends on the person. [00:26:17] Speaker 1: Well, how about what do you do for therapy with her? [00:26:23] Speaker 2: I listened to her, I listened to her concerns, and provided support. I tried to provide her with hope that eventually things would improve. [00:26:39] Speaker 1: So, you listened to her concerns, and you'd agree with me that her concerns were, for example, that she actually was unable to sleep. Sleep is one of her concerns, right? [00:26:54] Speaker 2: She was having a lot of difficulty with sleep. [00:26:58] Speaker 1: On the September 15th meeting, you indicate that her mood was okay, but her affect was anxious, and you called it incongruent. [00:27:08] Speaker 2: So, one of the things that you talked about Friday is when a patient presents with an incongruent, something like that, I don't remember, appearance. [00:27:38] Speaker 1: Perhaps, that would mean that they're saying, I'm okay, but they don't look like they're okay, right? [00:27:46] Speaker 2: Well, it could. I don't think her affect and her mood were really that incongruent at that time. I think that she didn't appear terribly depressed. I didn't say she was terribly depressed in that initial visit, but she said she was anxious, and she appeared anxious. That's pretty congruent. [00:28:13] Speaker 1: Okay. So, did you put in the report that she was congruent or incongruent? [00:28:22] Speaker 2: So, that is not an option for me to indicate in that section, but it was congruent. [00:28:29] Speaker 1: You're like a robot. You can't take a pen and write something down. You have to do the Dropbox and the Xs on the computer. [00:28:38] Speaker 2: Well, if it's on the computer, I'm limited by the options that are out there. [00:28:45] Speaker 1: You're a doctor. Why are you limited? [00:28:48] Speaker 2: Because of the technology. [00:28:51] Speaker 1: What technology? The fact that there's a form on a computer? You're trying to treat a human being who comes to you for help. [00:28:59] Speaker 2: And that's what's most important. What's most important was the treatment, not what is checked off on a box. [00:29:07] Speaker 1: Makes sense. So, you were unable to make a note as to whether or not her affect and her mood appeared to be in conflict and that she would have been incongruent and that she had poor insight. You couldn't write that down. Is that right? Because the box doesn't let you. [00:29:30] Speaker 2: Correct. [00:29:34] Speaker 1: So, basically, she's telling you that, I'm okay. Well, actually, when she came, do you know that she never saw, other than when she was in nursing school, would it surprise you, a psychiatrist? And that was only for like a week when she got to Prozac in nursing school because she was afraid of public speaking? Did you know that? [00:29:53] Speaker 2: I was aware that she did not have a significant past psychiatric history. I was aware of that. [00:30:01] Speaker 1: Okay. So, you were the first psychiatrist that she had the pleasure of meeting. Is that correct? [00:30:09] Speaker 2: Yeah. I think it was. [00:30:14] Speaker 1: And isn't that important for you as a doctor to take a history? [00:30:18] Speaker 2: I did take a history. [00:30:19] Speaker 1: So, can you tell us? You're testifying here for the government. Tell us whether or not she had any past psychiatric history other than in nursing school for a week to the present. [00:30:28] Speaker 2: She did not report any other past psychiatric history other than the Prozac and Bulbitron. [00:30:35] Speaker 1: So, when a patient comes to see you and you're treating to help that patient, if they don't report something to you, you don't know about it apparently, right? [00:30:45] Speaker 2: Well, I think it depends. There are certainly things I can assess, but if it's related to their history, I do need them to tell me. [00:30:55] Speaker 1: Well, you can't assess it unless you ask, right? [00:30:59] Speaker 2: Unless I ask or they volunteer it or they pull it out. Of course. [00:31:02] Speaker 1: We already talked about the volunteering. How about you as a doctor when you're evaluating a patient coming to you for help, do you ask them questions? [00:31:12] Speaker 2: Yes. [00:31:13] Speaker 1: You didn't ask her prior history. [00:31:15] Speaker 2: I did. What did she tell you? She said that her prior history was what we discussed about the Prozac and the nursing school. [00:31:25] Speaker 1: So, basically, other than hoping to give her hope, is what you said, for the therapy, how do you give someone hope for therapy? The other doctor. [00:31:48] Speaker 2: Try to encourage them. [00:31:51] Speaker 1: What did you encourage her on September 15th? Sorry? What did you encourage her to give her hope on September 15th? [00:31:57] Speaker 2: What did I encourage her? Yeah. I don't remember exactly the words. It was almost four years ago. Did you write it down in your records? No, we don't write those details of everything that was said. [00:32:10] Speaker 1: Well, that's the therapy you're talking about, right? Yes? Yes. And you don't write down the therapy you give a patient in the records, right? [00:32:16] Speaker 2: Well, I write something about it. I mentioned that. Excuse me. [00:32:20] Speaker 3: Hold on. Hold on. Say yes or no? Hold on. You let her finish the question. Listen to the question and answer just what they asked. Okay? Go ahead. You can rephrase that question, counsel. No, I'll let her answer it. All right. [00:32:32] Speaker 2: I mentioned that I provided supportive therapy. [00:32:37] Speaker 1: What is supportive therapy? [00:32:39] Speaker 2: It's listening to the patient's concerns and providing emotional support and validation. [00:32:45] Speaker 1: So emotional support and validation all sounds good. Here's a young woman who was, what, 29, 30 years old, came to see you? [00:32:56] Speaker ?: Yes. [00:32:57] Speaker 1: And came to see you for help, right? [00:33:00] Speaker 2: Yes. [00:33:00] Speaker 1: Told you she couldn't sleep and she was anxious, correct? Yes. You know that she was postpartum, correct? [00:33:06] Speaker ?: Yes. You know that as a patient who was postpartum. [00:33:10] Speaker 1: By the way, what is your opinion of the period of postpartum where one could have postpartum depression and, more importantly, postpartum psychosis? What's the time frame? [00:33:24] Speaker 2: It's typically one year. [00:33:26] Speaker 1: So she was well within that time frame, correct? [00:33:30] Speaker 2: Yes. [00:33:33] Speaker 1: And you tried to provide therapy by giving her hope. And how long do you figure? Did that take five minutes, ten minutes, two minutes? [00:33:42] Speaker 2: I'm not sure. I think it was different in each session. Okay. [00:33:47] Speaker 1: So the only thing that you diagnosed Lindsay with on September 15th was GAD, generalized anxiety. It was generalized anxiety disorder, correct? [00:33:55] Speaker 2: It was generalized anxiety disorder as well as an adjustment disorder with depressed mood. [00:34:03] Speaker 1: And you prescribed medications to her, right? Yes. And the medication that you provided to her was the CERFALINE, right? Yes. And the CERFALINE would be ZOLA, right? [00:34:17] Speaker 2: Yes. [00:34:18] Speaker 1: Now this is a little chart that shows the prescriptions that Lindsay was on. And you are the yellow colors. They're the tops. Okay. You can see that. Do you agree with me on September 15th, you prescribed CERFALINE, ZOLAFT, 30, count, on September 15th, 25 milligrams, right? [00:34:44] Speaker 2: Yes. [00:34:52] Speaker 1: Have you ever read the website for CERFALINE? [00:34:58] Speaker 2: The website for CERFALINE? Yeah. [00:35:01] Speaker 1: I mean, CERFALINE, ZOLAFT, is a chemical that is marketed as a pharmaceutical, right? [00:35:10] Speaker ?: Yes. [00:35:11] Speaker 1: Right? Yes. It's a pill, right? [00:35:15] Speaker 2: Yes. [00:35:16] Speaker 1: And as we said, it's an SSRI tool, correct? Yes. Do you know that ZOLAFT is not indicated for generalized anxiety? Why did you give it ZOLAFT? [00:35:28] Speaker 2: It is a very effective medication for generalized anxiety disorder. [00:35:33] Speaker 1: So you're familiar with the drug labeling for ZOLAFT, is that correct? [00:35:40] Speaker 2: Generally. [00:35:41] Speaker 1: Generally. Are you aware of what the manufacturer of ZOLAFT indicates it can be used for, to treat? [00:35:58] Speaker 2: I'm aware that it's used to treat various forms of anxiety disorders, as well as major depression. [00:36:06] Speaker 1: So when Lindsay came to see you, you know that she had stopped breastfeeding her son, right? [00:36:15] Speaker 2: Not at the time of the first appointment. [00:36:17] Speaker 1: When did she stop breastfeeding? In October? [00:36:20] Speaker 2: Something around then. [00:36:23] Speaker 1: You know that she had little or no psychiatric history, other than seeing you, correct? [00:36:29] Speaker 2: And the Prozac, yes. [00:36:30] Speaker 1: You know that, in fact, that she had stopped drinking whatever it was that she was drinking, because you never asked, right? [00:36:38] Speaker 2: I was not concerned about her level of drinking. [00:36:42] Speaker 1: Well, it's in your form, right? [00:36:44] Speaker 2: That was at the intake, but I... [00:36:48] Speaker 1: You know that she wasn't drinking when you were meeting with her, correct? [00:36:53] Speaker 2: Yeah, that's what she told me. [00:36:54] Speaker 1: Okay. And you believe what she told you, right? [00:36:57] Speaker 2: Yes. [00:36:59] Speaker 1: So when she sees you, she's not on any psychiatric, antitropics, or whatever they're called, medications, correct? She wasn't on any medication. [00:37:09] Speaker 2: Correct. [00:37:10] Speaker 1: And she had stopped drinking anything, whatever it may have been, right? [00:37:17] Speaker 2: I'm not sure when she completely stopped drinking, but yes. [00:37:20] Speaker 1: You don't know when she started, when she stopped, what she drank, do you? [00:37:23] Speaker 2: Well, I was not concerned that she was an alcoholic. [00:37:27] Speaker 1: Answer yes or no. Did you have any idea? Because we spent a long time on Friday talking about her guilt and having... That she drank alcohol. You don't know what she drank, when she drank, when she started, when she stopped, do you? [00:37:41] Speaker 2: I know some details about her alcohol use, but it was overall minimal. [00:37:47] Speaker 1: What were the details then? Tell me what the details were. It was that one little box that was checked off. What other details were there? [00:37:54] Speaker 2: That she drank one to two servings five times a week. [00:38:02] Speaker 1: And you don't know where, what it was? You have no idea, right? [00:38:07] Speaker 2: I think she had mentioned at some point that it was calming. It was something that was helpful. It was what? I'm sorry. Calming. Calming. [00:38:16] Speaker 1: Okay, so it was numbing. It was like trying to numb something, I guess, right? [00:38:21] Speaker 2: That's one way of saying it. [00:38:23] Speaker 1: I mean, you've treated... I imagine you've treated veterans that have post-traumatic stress disorder, right? Yes. And would you agree with me that many times when people have an anxiety disorder or PTSD, or whatever the case may be, they try to numb their feelings. Is that fair? [00:38:39] Speaker 2: Sometimes they do. [00:38:41] Speaker 1: And sometimes they use alcohol, right? [00:38:43] Speaker 2: Sometimes they do. [00:38:44] Speaker 1: But we don't know what alcohol is. So we don't even know if it was a beer. Do we? [00:38:48] Speaker 2: I didn't think that was relevant for her. [00:38:51] Speaker 1: So with all of that, well, with that information, you then prescribed Zoloft to her, correct? Yes. You went over the side effects of Zoloft, certainly, and I imagine, with her, right? Yes. Did you tell her that one of the known side effects is suicidal thoughts and actions and ideation? [00:39:15] Speaker 2: Well, that's specifically in children, so I don't think I mentioned that because it wasn't relevant. [00:39:21] Speaker 1: Not really. Suicidal ideation and homicidal ideation, there's a black box warning on Zoloft, along with SSRIs, right? [00:39:33] Speaker 2: Under age? Yes, or no? For children and adults younger than Lindsay. [00:39:38] Speaker 1: Excuse me, doctor. I apologize. Can you just listen to my question and answer it yes or no? Is there a black box warning on Zoloft? [00:39:48] Speaker 2: Yes. [00:39:48] Speaker 1: Okay. And a black box warning is required or prescribed by what? The FDA? [00:39:57] Speaker 2: Probably. [00:39:58] Speaker 1: Probably. And it basically warns that, especially with young people or young adults, that it may cause suicidal or, God forbid, homicidal ideation. Yes? [00:40:17] Speaker 2: Yes. [00:40:18] Speaker 1: And you're aware that, in fact, the FDA has determined that that goes up possibly to a 23, 24, 25-year-old. You know that, right? [00:40:31] Speaker 2: I think 24 is what they say. 24. [00:40:34] Speaker 1: I'll give you 24. It's possible, is it not, that the SSRIs that get into a person's brain affect a person that's three or four years older than the FDA cut off with suicidal ideation or homicidal ideation? It's possible? [00:40:58] Speaker 2: There's a lot of development that happens in the brain between ages, like, up to 24 and closer to 30. The brain is fully matured at past age 24, and so it's less vulnerable than in a younger individual. [00:41:15] Speaker 1: So, with 24, you're suggesting there's a cut off. Are you suggesting to the jury that a drug that increases the risk of suicide in a 24-year-old patient cannot increase the risk of suicide in a 29- or a 30-year-old patient? Just a little bit. [00:41:31] Speaker 2: There's, I don't believe there's evidence that it causes that at all in individuals over 24. [00:41:38] Speaker 1: So, as a psychiatrist who had the ability to issue these types of medications to patients and citizens, what research would you do on Zola and suicidal ideation, homicidal ideation? [00:41:53] Speaker 2: I was taught extensively about SSRIs and suicidal ideation in my training. In Vermont, right? In Vermont, in Boston, yes. [00:42:04] Speaker 1: Okay. So, in Vermont was when you get your medical degree, right? [00:42:07] Speaker ?: Yes. [00:42:08] Speaker 1: And in Boston would be when you were a resident, right? [00:42:11] Speaker ?: Yes. [00:42:12] Speaker 1: And then you had board certification on general psychiatry, right? Yes. You can have a certification on a sub-specialty, right? [00:42:23] Speaker 2: There are certain sub-specialties, yes. [00:42:25] Speaker 1: Right. And some of the sub-specialties deal with postpartum or women that are pregnant and have babies and have psychiatric symptomology. [00:42:35] Speaker 2: There's no board certification for perinatal or reproductive psychiatry. [00:42:40] Speaker 1: Well, there are plenty of classes that are recognized as, for example, at Harvard Medical School, there's an annual class or symposium, if you will, for postpartum. Have you ever been to that? [00:42:56] Speaker 2: No, sir. [00:42:57] Speaker 1: What have you done to research or to improve your education? I understand you went to med school and that you were a resident. What programs, continuing education, symposiums, have you attended since you got the ability to prescribe these medicines to people? [00:43:19] Speaker 2: I have not attended a symposium. [00:43:21] Speaker 1: Have you attended anything? [00:43:24] Speaker 2: I have not, but I have done a lot of reading on my own of research and guidelines about this area in psychiatry. [00:43:36] Speaker 1: Did you tell Lindsay when you were going, because one of the things that you guys are always concerned about is what's called informed consent, right? Yes. And what is informed consent? What does that mean? In a medical sense, not just like out in the street or something. [00:43:50] Speaker 2: Explaining to a patient the risks and benefits of treatment and possible alternatives and making sure that the patient understands what you're saying. [00:44:05] Speaker 1: Now, when you were going over the symptomology or when you were going over the side effects of Zoloft, one of the side effects of Zoloft is, and I quote, severe trouble sleeping, right? [00:44:18] Speaker ?: Yes. [00:44:19] Speaker 1: Did you tell her that? [00:44:20] Speaker 2: Well, insomnia is listed as a side effect. [00:44:27] Speaker 1: No, no, no, no, no, no. You already said yes. You know it. We just, did you tell her that Zoloft has a side effect of giving the patient severe trouble sleeping? That's all. [00:44:40] Speaker 2: So, I didn't use the word severe, because it typically doesn't cause severe trouble sleeping. But I thought you were referring to when she told me that she did have severe trouble sleeping. [00:44:52] Speaker 1: Well, that's what she told you, right? That she had severe trouble sleeping, right? She told me, yes. Yes. And you know that one of the side effects of Zoloft is, let's say, trouble sleeping. You know that, right? Yes. Your answer is yes. The jury has to be able to hear. Yes. And why would you prescribe Zoloft to a young woman who's postpartum, who's coming to you with anxiety, who's telling you she can't sleep, she's got all of these symptoms, and you prescribe a medication that would have a side effect of trouble sleeping? [00:45:29] Speaker 2: So, individuals have very varied responses to medications. Some have no side effects. Some have one or two. It's impossible to predict that Zoloft is a top choice, a first-line medication for her. Says who? Says who? It's the general consensus among psychiatrists. [00:45:49] Speaker 3: Again, we can't have both of you talk at the same time. So, let her finish her answer, and then I'll give you plenty of time to follow up any questions regarding her answer. So, can you finish your answer on that? [00:46:06] Speaker 2: There's extensive research supporting the use of sertraline in this instance, and the general consensus among psychiatrists is that it's a first-line safe medication. for individuals, including postpartum women.