Lindsay Clancy Trial: Defense Turns the State’s Witness Against the Prosecution

[00:00:00] Speaker 1: Today, we're going to look at the testimony of Dr. Shaw. She was a psychiatrist who consulted with the medical team during Lindsay Clancy's hospital stay. It has some interesting things to it. Stick around. Hi, Tony DeWitt here. I am a retired Missouri attorney who has now unretired so that I can bring you some commentary on trials and that sort of thing. Because I deal generally with legal topics, I'm not offering any legal advice and I'm not intending to form any lawyer-client relationships with any of you. I'm simply presenting some information. I am a content creator. I am not currently practicing law, although I do maintain my license in the state of Missouri. This is a trial channel and today we're discussing a trial. In fact, this is what we're discussing today. This is a recap for our newer viewers. On January 24, 2023, Lindsay Clancy's three young children died in their Duxbury, Massachusetts home. The state says Clancy deliberately planned their deaths and understood what she was doing. The defense acknowledges that she caused deaths, but argues she was suffering from severe postpartum psychosis and was not criminally responsible. The central question is not who caused the deaths, that's known, but whether Clancy was legally responsible when they occurred. I've been a little hard on psychiatrists from time to time on this channel. I think Dr. Shaw may have just restored my faith in their profession. She did a really good job of testifying and did it in a way that made it clear she wasn't taking sides. So I really enjoyed this entire, you know, the entire testimony, but I'm going to limit it to a little bit of the prosecution and a little bit of the defense, just so you're not here all day. So with that introduction, let's get started. [00:02:08] Speaker 2: And what is your role there? I'm Associate Chief of the Division of Psychiatry and Medicine, leading the Consultation Liaison Psychiatry Service at Brigham. [00:02:17] Speaker 3: And what is the Consultation and Liaison Service? [00:02:21] Speaker 2: Yeah, so Consultation Liaison Psychiatry is a sub-specialty of psychiatry that works at the interface of psychiatry and medicine. So we work both in the inpatient and outpatient settings. In this particular instance, we get called by other health care providers that may need help with their patients or have a question related in the psychiatric realm. And so I would see a patient that's admitted to the hospital and help provide recommendations to the physicians and the rest of the care team that's caring for that patient. [00:02:52] Speaker 3: So basically, say, at the Brigham, if a patient's being treated there and a medical doctor is treating them and thinks that they need a consultation with a psychiatrist, your department would be called? That's correct. And how long have you been with the Brigham? [00:03:07] Speaker 2: 19 years. [00:03:09] Speaker 3: Now, I want to direct your attention to January of 2023. Did you interact with a patient named Lindsay Clancy? I did. And was that on January 29th, 2023? Yes, that was the first of a handful of times that I saw her. And why did you meet with Lindsay Clancy on January 29th, 2023? [00:03:28] Speaker 2: So my team was seeing Ms. Clancy for a number of reasons, including for psychiatric safety risk assessment. She had come in reporting an attempt, which is a common reason why my team would be called, is to continue to ensure that patients are safe when they're in the hospital. So we make recommendations about kind of safety status, you know, what can we do to help keep a patient safe. But then we also make recommendations related to medications. So that's why my team was following her. So that was one of the reasons why I saw her on the 29th, is to continue that assessment. I was also called to ask a new, I was asked a new question that day, a consult question on whether she was able to make the decision to change her healthcare proxy from her at the time husband to her parents. [00:04:21] Speaker 3: And when you consult to help determine whether someone's capable of making a decision like that, changing their healthcare proxy, are you evaluating their medical decision-making capacity? That's correct. How do you go about doing that? [00:04:38] Speaker 1: I have been critical of the prosecutors in asking dumb questions, but this one is a good question. What's the process? How do you go about doing that? This is actually dealing with the mental state. So it does go to the direct issue at contest in the case. And that's a good way to ask that question. Let's see what the answer comes out as. [00:05:01] Speaker 2: So there's generally four parts to medical decision-making capacity. The first is whether somebody's able to voice a choice and whether that choice is consistent over time. The second is whether they understand the situation under which they're making that choice. The third part is appreciation of the risks and benefits. And the fourth part is kind of being able to reason or rationalize that information to be able to come to a choice and how they came to that choice. [00:05:32] Speaker 3: Now, if you're doing this evaluation to determine someone's capacity to make decisions, would a traumatic brain injury factor into that evaluation? It could. When you evaluated Lindsay Clancy, was she able to voice a choice to you about who she wanted to be her health care proxy? Yes. And is she speaking to you or writing this down? She's speaking. So she's already been extubated at that point? That's correct. And she's speaking to you, and were you aware that Patrick Clancy was her health care proxy? I was told that by her primary medical team. And when you talked to Ms. Clancy, did she tell you who she wanted to take over that role? She did. And who was that? Both her parents. And you talked about that needing to be a consistent choice. How did you ensure that was a consistent choice with her? Yeah. [00:06:25] Speaker 2: So we waited to make the change from Patrick Clancy to her parents until the next day for a variety of reasons. We wanted to ensure that that choice was consistent over time, and especially because the day that I saw her, she had just gone through some pretty major medical events, including she had a major spine surgery, a decompression and a fusion. She had gone through some oxygen desaturations overnight, so was not breathing as well. Her heart rate was up, all of which then led to her being what we call delirious. She was quite, she was confused overnight to the point where she asked her nurse, am I delirious? And she was also experiencing some visual hallucinations. So that was one of the reasons why I was called in to make sure that she was able to make that decision to change her health care proxy. And then in addition, the team had also voiced concerns that she had come in after a reported attempt, and so making sure that she was able to make that decision of sound mind. And so we actually waited until the next day when she could be reassessed. At that point, her delirium had cleared, and she was continuing to make that consistent choice to change her health care proxy to her parents. [00:07:39] Speaker 3: And in fact, you noted in the medical records that the hallucinations were part of an issue with oxygen? [00:07:52] Speaker 2: It could be. That could be one of the reasons. Delirium is usually due to a variety of different medical reasons, and oxygen desaturation could be one of them. She had also just recently had anesthesia related to a surgery that she had on her spine, so that could be another reason. And then her heart rate was also actually quite elevated, so that could be another reason. [00:08:13] Speaker 3: Is it common for patients who are just coming off of anesthesia from surgery, who have an issue with oxygen and other medical issues that you described, to have visual hallucinations? They can. [00:08:26] Speaker 2: It's not that everybody does, but they can. And delirium can be quite common after surgery, and particularly anesthesia. [00:08:34] Speaker 3: And those hallucinations that she was having, those were resolved by the next day. They were over by the next day, correct? That's correct. And her choice to change her health care proxy to her parents was consistent the following day, correct? That's right. You also talked about the patient has to understand the risks and benefits of the decision, correct? That's correct. How do you make sure the patient understands that? [00:08:57] Speaker 1: That's another good question. How do you make sure they understand that? How do you understand, how can you ensure that they really understand the risks and benefits? This attorney is doing a much better job doing this witness than I've seen previously with the other folks. And I'm not sure which attorney this is because we can't see her on camera. But she does seem to understand how to ask the right questions of a medical provider. And that's encouraging to see. And as you can see, the doctor is just dishing it straight down the line, right out of the book. And she comes across as a very credible expert. I'm interested, however, though, in why they're asking about these hallucinations. Clearly, she had a command hallucination, according to her and according to the witness that is supposed to testify. And so, if that's the case, are they trying to link these? Hard to tell. Certainly, at the time she had that, she wasn't post-anesthesia. She wasn't post-operative. And she hadn't had any oxygen desaturations. So, maybe they're trying to tie those together. I don't know. They're not really doing a good job of explaining why they're requesting this testimony from this witness. That's my only real criticism so far on this witness. [00:10:30] Speaker 2: Yeah, so one of the things we do is really ask patients to take us through their thought process of why they're making that decision and what led to them making that decision at that moment in time. So, we're able to kind of see their thought process and ensure that they're understanding, you know, what it means to remove one person and add another. [00:10:49] Speaker 3: And what was Ms. Clancy's thought process in explaining that to you? [00:10:52] Speaker 2: Yeah, she was saying that her parents are quite supportive to her and that she was thinking that she would have to change her health care proxy from her husband to somebody else. And we didn't necessarily go into the reasons as to, you know, why she would have to change it. But she explained that she was very close with her parents. They would see each other frequently given that they lived in close geographic proximity and that she felt that they were very supportive to her and would have her best interests in mind should we need to invoke the health care proxy or that she couldn't, if she couldn't make her own medical decisions. [00:11:25] Speaker 3: So, was there a concern on her part that her husband wouldn't have her best interests in mind at that point in time? [00:11:30] Speaker 1: In case you're wondering, the objection here is going to be to speculation. How, you know, how would she know what the real reason is? If she had asked, you know, did she say that? That's a different question. So, the objection, as you'll see, was sustained. [00:11:50] Speaker 4: Sustained. [00:11:53] Speaker 3: You also talked about the patient, you have to make sure the patient's thinking about the information rationally. How do you go about doing that? [00:12:01] Speaker 2: Yeah, so one of the things we do is really ensure that the patient understands the situation and, you know, all of the kind of parts around it. So, this comes into play much more when it's about a specific medical intervention, like an invasive medical procedure or something like an amputation or a surgery. With a health care proxy, one of the things you want to make sure is that the person that they want to change their health care proxy to or appoint, does their health care proxy make sense in the context of their life? And, you know, Ms. Clancy was able to talk about how her parents were quite involved in her life. And so, that's one of the things that we would assess. [00:12:39] Speaker 3: And then the last thing was making sure the patient understands the risk if the change doesn't happen. Did you go over that with Ms. Clancy and how did you do that? [00:12:48] Speaker 2: Yeah, I did go over that with her. We talked a little bit about how it could mean that she would not have a health care proxy were she not to appoint her parents. And so, we went through that, you know, it's always, in health care, we always talk about how it's great to have a health care proxy just in case you become unable to make medical decisions. And who would you want that to be? [00:13:08] Speaker 3: And during this conversation with the defendant going over all these points, did you ever have difficulty understanding her? I did not. Did she ever appear to have difficulty understanding you? [00:13:18] Speaker 2: So, the first day when I saw her on January 29th, she described herself as feeling confused. And I definitely witnessed that as well. We went through a bedside cognitive evaluation, and she definitely made some mistakes on some of the cognitive evaluation. Therefore, I did diagnose her at that time with delirium. [00:13:38] Speaker 1: You see that a lot in ICU patients. When you're in the ICU, you are in need of some pretty substantial care, the trauma or the insult to your body, whether it's from surgery or a disease process or something else, has been pretty severe. And a lot of times, the only way the mind can deal with that is to just wander off on a frolic and detour of its own. So, you do get some delirium in the ICU, and it's a common thing. Nobody worries too much about it. And I like the way this doctor is explaining things, and she's explaining them in a way that the jury can understand. A lot of times, technical experts will just use words that they understand, but other people don't. And this witness is doing a good job. She's being a great witness for the prosecution here because the prosecution is not having to ask her to explain things. And whenever a witness can do that for you, it's a good thing. [00:14:44] Speaker 3: And then she was re-evaluated the following day, and there were no issues with her understanding, and the delirium was gone, correct? That's correct. And were you aware during this evaluation that Ms. Clancy did not have a brain injury? I'm sorry, can you repeat the question? Were you aware that Ms. Clancy did not have a brain injury at that time? [00:15:06] Speaker 2: So, one of the things that we look at is any kind of relevant medical information that might be available to us. And I noticed that her Glasgow coma scale when she was transferred to Brigham and Women's Hospital was a 10, which would indicate that she could potentially have had a moderate brain injury. But I don't recall thinking about whether, you know, specifically whether she had a brain injury. [00:15:28] Speaker 3: Were you aware that a CAT scan was done, page 110, of the records, and... On the CAT scan, the impression was no acute intracranial findings, so no brain injury. [00:15:49] Speaker 2: I did review the head imaging that was available at the time. You can have a normal CAT scan and still have a brain injury. [00:16:00] Speaker 1: I love how she's keeping the prosecution honest, because that's absolutely true. Your head imaging can be perfectly fine, and you can still have a head injury or a brain injury, because it's really difficult to image the brain in the same way that you can look at a foot and say, "Wow, that's bruised." Usually, it's just assumed, I think, in many cases, that when you've had significant trauma like this, that there might very well be a brain injury, whether it's available to you on the imaging or not. And so, she's not letting any false narratives creep in here. She's going to bat for the patient and for science and saying, "Hey, well, you know, don't go off half-cocked here, because you can have a brain injury." Like I said, she's doing a marvelous job, and she's looking right at this questioner, and just giving it right back. And I would have to think that the jury evaluates her testimony here as being quite honest. Now, I'm cutting it off right there, because the next probably seven, eight minutes of this direct exam, she goes over the same thing over and over and over again, that there was no ideation of the kind that I can't mention on here, that there was no homicidal ideation, and that there were no hallucinations, and no visual or audio hallucinations. She must have gone over that three or four times. And at some point, I think, Mr. Reddington got annoyed with that, and asked the judge for a little relief, they had a sidebar. She came back and finished up by asking one more time about all of that, and then she said thanks a lot, and tendered to witness to Mr. Reddington. Mr. Reddington didn't waste any time in getting her to give him some information that would address some of the issues that had been raised by the state in the case in a way that I don't think the state was prepared for. I don't think they expected him to ask these questions, because if they had, they would have laid the groundwork maybe a little bit better. But watch this. This is the classic way you take a witness who has been called to work against you and figure out the areas of agreement and get those areas of agreement into the record. [00:18:39] Speaker 4: So, Doctor, from your testimony, and correct me if I'm wrong, was she, to your opinion and your experience, an honest patient telling you what her symptoms were? Affection. That's an evaluation in the psychiatric. I'll allow that question. Yes. In other words, she didn't go off and try to exaggerate to you and say I'm seeing visions, and I'm hearing voices, and I'm homicidally ideated, and I'm homicidally ideated. She didn't say any of those things to you, did she? [00:19:17] Speaker 1: No. Now, that may sound kind of silly at this point, to put that out there in the way that he did, but he is knocking one brick out of that prosecution wall at a time, and that's the way you do it. Leading questions, one at a time, hit, hit, hit, hit, hit, and that's what he's going to do all through the way here. [00:19:41] Speaker 4: She actually denied them, right? Correct. So, this is not, in your opinion, someone who was trying to exaggerate her conditions for some legal reason, correct? [00:19:51] Speaker 1: No. I like that. Honest as opposed to strategic. She's not setting up a defense here. She's just telling the shrink, you know, how the cow ate the cabbage. [00:20:03] Speaker 4: And you obviously were in close contact with her for about a month, right? That's right. Just a couple of questions. The counsel asked you whether or not, and I think it may have been in the beginning in January, that you had difficulty understanding her, obviously, after removing the tubes and everything else. You're able to talk with her, correct? Correct. And you knew that one of the concerns, if you will, was postpartum issues. You knew that, right? Yes. And in your experience as a psychiatrist, you're familiar with the concept of postpartum psychosis, correct? Yes. And you know that people can communicate and plan and act on plans, even if they're in the middle of a psychosis, right? Yes. [00:20:52] Speaker 1: Brilliant. This is not an expert hired by the defense. This is the prosecution's witness. And she just knocked a big hole in their attempt to prove intentional conduct here. In that, she said, yeah, people can do that in the middle of a psychosis or a psychotic episode. And him using her in that way to get that point into the record on a neutral witness, in other words, not somebody he's paid to testify, but rather somebody who came in to give facts based on her interaction, doctor-patient, with Lindsay Clancy. That is a powerful strategic move for him to make. [00:21:39] Speaker 4: You don't have to be drooling and stumbling and unable to walk and talk to be in a psychosis, do you? [00:21:46] Speaker ?: No. [00:21:47] Speaker 4: So in other words, a person can be in a psychosis and can communicate to friends, family, people, talk, correct? [00:21:54] Speaker 1: Our defense attorney made a mistake right there. She nodded her head. She didn't audibly answer and say yes. Now, the court reporter may have taken down Nod's head, but the bottom line is, if you want to protect the record, you get an audible answer. You should have said, is that a yes? And he didn't do that. But if that's the worst he's done today, I think he's still doing pretty darn good. [00:22:20] Speaker 4: So you didn't, as counsel asked, you didn't have any difficulty understanding her, she wasn't slurring her words or anything like that, when she was able to talk? [00:22:28] Speaker ?: Right. [00:22:28] Speaker 4: Okay. One of the things that, when she was admitted, and then without going through, I'm not going to go through all the stuff we've already talked about with the medical condition and everything else, you indicated that she was very, very ill, correct? Correct. Did she appear to be cooperative to you when you would interact with her? Yes. As a doctor, as a psychiatrist, you're familiar with bipolar, the concept of a bipolar diagnosis, correct? Correct. Can you tell me what bipolar means? [00:23:04] Speaker 1: Now he's going to get in all this information about bipolar disorder. And again, he is steadily knocking a brick out of the wall of the prosecution's case every time he does this because of the status of this witness and because of who called them. [00:23:19] Speaker 2: Yeah, so bipolar disorder is a mood disorder, categorized as a mood disorder, where patients have distinct depressive episodes, as well as, depending on the type of bipolar disorder, either hypomanic episodes or manic episodes, to the point where they don't sleep for days, they still have lots of energy, there's this decreased need for sleep, there could be irritability, there could be impulsiveness, racing thoughts. A lot of patients describe that they're out of control of their behavior, and then severe episodes can also include psychosis. [00:23:53] Speaker 1: I'm reminded of the Pink Floyd song. All in all, it's just another brick in the wall, or in this case, a brick out of the wall. [00:24:00] Speaker 4: And in reference to bipolar, as you were referring to, when somebody is hypomanic, what does hypomanic mean? [00:24:08] Speaker 2: Yeah, it's a lesser degree of mania, so when patients are hypomanic, they don't always experience things like psychosis, but they might experience some of the other symptoms that I described, including racing thoughts, kind of moving too quickly, talking too quickly, being irritable. [00:24:25] Speaker 4: And as it relates to the hypomania, would that include things such as somebody who is getting up early in the morning and exercising, or cleaning out their house, or selling their property out of a garage, and having difficulty sleeping, and they're awake all night? [00:24:41] Speaker ?: Yes. [00:24:42] Speaker 1: And of course, all of that fits Ms. Clancy's profile. [00:24:46] Speaker 4: As a psychiatrist, one of the things you were concerned about when you were first started to deal with her, as well as when you were releasing her, if you will, is the medication that she had on board, so to speak, when she came into the hospital, right? Yes. Do you remember, and I know it's difficult to recall offhand, but do you recall the medications that she was actually under from purposes of taking her blood when it was tested? [00:25:12] Speaker 1: Now, Mr. Reddington is going to go through all of these drugs with a psychiatrist, and I don't think we really need to go into all that. He does a marvelous job with it. He gets in some of the side effects, some of the uses of these drugs, what class they are, maybe not because he wants the jury to remember all this, but because it will now be familiar to them when his experts get up there and talk about the risks that were attendant to some of these drugs, so he does a masterful job with it, and then he ends his cross-examination this way. [00:25:54] Speaker 4: And Ambien, correct? Correct. And Zolpidem. Zolpidem. [00:26:00] Speaker 2: Yep, Zolpidem is the generic name of Ambien. [00:26:02] Speaker 4: Oh, okay. Some of these drugs, they also have what's called a warning or a black box warning. Isn't that right? Yes. Can you tell me what that means? [00:26:12] Speaker 2: Yeah, so in studies that have been done, some of them show that, especially after starting an antidepressant, it can increase someone's risk of sexuality. Many of those studies showed that it was mostly in adolescents and young adults, but it can happen in adults as well. [00:26:34] Speaker 4: And Celexa was also a drug. Is that an SSRI, too? It is. And all of these drugs that we just went through were all prescribed from September, end of September, until January? Yes, September 2022. One month period. Yes. It's an awful lot of drugs to be prescribed in four months, isn't it? Sustained. [00:26:59] Speaker 1: He's asking for an expert opinion from somebody who hasn't been qualified as an expert, except it's the prosecution's witness, and they're objecting to the qualification of their own witness. Now, that probably didn't come across to the jury, but that was the basis of the objection. And, of course, as I've often said, sometimes it's not the answer to a question that matters. Sometimes it's just having asked the question. Because when someone hears about this long chain of drugs that she's been prescribed, they're probably thinking, wow, that is an awful lot of drugs in four months. And that's common sense. You don't have to be an expert to use common sense, and that's what he's hoping the jury is going to do. Thank you. [00:27:49] Speaker 2: Thank you. [00:27:51] Speaker 1: All this time, he's been keeping his powder dry. He has been letting the prosecution ask leading questions, not objecting to stuff like that, letting them get stuff in the record, not obstructing them, keeping out of their way. And, obviously, he doesn't get the same courtesy, but that's okay. You would rather be the underdog in a case like this, because the underdog gets a little benefit of the sympathy. And I've heard from a lot of you about these two mean girls, and that's what I'm calling them now, the mean girls. And the mean girls like to go after this pretty young girl over here who obviously has had a huge problem with her mental status and did a horrible thing. No question about that. But none of you like the way they are going after Lindsay Clancy. They've been just throwing the horror up there. Now, they get a witness that essentially goes against them in a lot of things, and their response is to do a redirect. Now, I'm not going to put you through the redirect. It's classic mean girls again. But the long and short of it is all of their attempts to paint her as not critically injured when she coded, not really having a psychiatric problem or having a made-up psychiatric problem, when clearly the psychiatrist believes she does have a pretty severe problem, and not having an issue with polypharmacy, which clearly she has an issue with polypharmacy. That will work against them at some point. Now, does that mean they're not still going to conviction, going to get a conviction? I don't know. They could still get a conviction. I'm not predicting it one way or the other. This is a tough case. Honest to goodness, I don't know how I'd vote if I was on this jury. But again, I haven't seen all of the data yet. I haven't seen all of the testimony. But from what I have seen, it's a tough case. And they're not doing the job they ought to be doing, which is showing a little bit of humanity. I have a good friend. You know, I've been on her channel before, Mo. And she said the same thing to me today in an email. She said she is amazed by the lack of humanity of these two prosecutors. And frankly, I am too. So that's what I have for you today. Thank you so much for being here. Thank you for letting me ramble on and interrupt and talk about these things. And to the person who said that I've been a little sassier lately, thank you for noticing. I'm glad you did. Have a terrific day. And I'll catch you next time. Thanks for watching my video. I really appreciate it. And today, as you go about your business, would you try to do just one kind thing for somebody? It doesn't have to be a big thing. You can open a door for somebody who has their arms full. You could buy somebody a Coke. You could let the manager know when somebody did a really good job for you at the grocery store or at Walmart or someplace else. There are all kinds of things we can do to make people's lives better. And a lot of times, people will always remember to go to the manager and complain. They very seldom remember to go to the manager and say, hey, you know, that guy over there in produce is top notch. And I think it's really important to do that because I want to make the world a better place. I know you're here probably because you want to make the world a better place. So let's do that. Now, let's be respectful of one another. And thank God we live in the greatest country in the free world. I do think that the good folks at YouTube have a few things they want to show you up here that you might be interested in. And if you are, I'd appreciate you clicking. Thanks. Have a great day.