Psychiatrist GRILLED in BRUTAL Cross-Examination — Lindsay Clancy Trial Day 10

[00:00:00] Speaker 1: hello hidden gems what a day day 10 was dr jennifer tufts on the stand the majority of the day getting grilled it was it was brutal honestly take a listen to this clip [00:00:16] Speaker 2: can you just read this paragraph here for us no sorry no sleep last night falls asleep after 40 minutes heart racing severe anxiety worrying about kids baby sleep yawns but not drowsy not hyper pressured speech what was that not hyper not pressured speech is what i meant i know it [00:00:41] Speaker 3: doesn't say not but that is exactly what i meant when did you see this that you noticed that it did [00:00:46] Speaker 2: not say not i don't care what it says i know what i meant yeah i don't care what it says i know [00:00:56] Speaker 1: what i meant things got tense in that courtroom between dr tufts and kevin reddington i have thoughts about today we're headed into week three of lindsey clancy trial it's monday and i'm going to save those thoughts for a little bit later because we have a lot to go through because monday opened with the defense starting their cross-examination of dr jennifer tufts we knew that was going to happen reddington first went over her background typical she confirmed that she is a psychiatrist and trained at the university of vermont from 2014 to 2018. and then she had a residency at boston medical center four years she clarified not to as he tried to claim at first rotating through psychiatry internal medicine inpatient admissions emergency evals she said that residents rotate all different aspects of psychiatry as well as internal medicine so they have a foundational knowledge right of all those medical topics she's also board certified it's a big deal for doctors reddington lingered though on the pandemic years pointing out that much of her residency happened under masks and social distancing he pushed her on whether she ever touched patients like shook hands hugged anyone she explained that she she still worked in person but some outpatient visits switched to telemedicine after the pandemic right from there he walked through the transition from residency to becoming fully licensed pointing out that she received her unrestricted massachusetts license and board certification in september of 2022 again remember lindsay clancy killed her three children january 2023 so shortly after she told him that she began practicing independently at aster mental health the month before though august 2022 he kept circling back to how new she was in independent practice right which makes sense take take a take a listen to this and then i have thoughts we'll talk so august of [00:03:16] Speaker 3: 22 you start working at astor august of 22 you get your dea license individually that authorized you to [00:03:23] Speaker 2: prescribe medication correct yes and it was when that you saw lindsay clancy i believe our first visit was [00:03:33] Speaker 3: september 15th of 2022. so you you were practicing as a psychiatrist for a little more than a month [00:03:45] Speaker 2: i was practicing independently with my full credentials for for about a month um but the training is just [00:03:53] Speaker 3: immense that that goes on before that absolutely it must be but that's a residency that you're talking about right yes and you know in residence all i know is great is anatomy but i mean you're working under a doctor the doctors are supervising you and they tell you what to do and then you report to them correct [00:04:09] Speaker 2: they don't really tell you what to do um they're there as a resource if you need additional support um but i i followed many um of my own patients i was the only person in the room with them and um you know my notes were signed off by an attending physician and that attending was was available for [00:04:29] Speaker 3: any support i needed so in august of 22 when you started working at astor you actually filled out [00:04:40] Speaker 2: a form for your advertising is that correct i believe that was handled by other people at the practice and who would that be um well we have um non-clinical staff that handle the administrative [00:04:57] Speaker 3: matters okay but but you're a doctor and you're out there to the public you're advertising yourself [00:05:04] Speaker 2: and your services to the public is that fair um i believe yes i i'm not directing the the marketing of [00:05:11] Speaker 3: our office but yes okay never mind your office i'm talking about you you had an ad that was in on the computer that if somebody wanted to reach out to a doctor they could see their ad amongst many others [00:05:28] Speaker 2: right well i don't think there was an ad i think we have a website that had some information about myself [00:05:36] Speaker 3: 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 how many patients in in a month up until that month the last thing you did you say about when you started working in august of 22 what after you are now on your own as an employee how many patients have you treated before you saw those in clancy postpartum psychosis [00:06:08] Speaker 2: well in the span of one month i would say none because it's a very rare disorder okay but it exists [00:06:15] Speaker 3: doesn't it absolutely yeah one of the things would be the questions that people hear right um that is a symptom of psychosis absolutely and that's legitimate isn't it it is a legitimate diagnosis absolutely not the diagnosis people that have postpartum psychosis here places do they not [00:06:37] Speaker 2: many do i the the disorder can manifest differently in different people but but yes many people do hear [00:06:46] Speaker 3: voices how about postpartum depression how many people in that month or so before you met lindsay did [00:06:56] Speaker 4: you treat for postpartum depression um in the span of one month i it's it's really hard to pinpoint that [00:07:04] Speaker 3: maybe a couple maybe a couple um do you recall how long you treated them for um [00:07:16] Speaker 2: again it's it's hard to really pin down the individuals in a short span of time can you tell [00:07:22] Speaker 3: the jury what you put in your ad or in the aster website that you indicated that described you i don't recall one of the things you did is that you said that you basically were a specialist in the postpartum uh people that you have psychiatry you you indicated down on the website yeah um are you [00:07:50] Speaker 2: able to to read the actual document i don't remember exactly the wording you've been working now for how [00:07:56] Speaker 3: many years ago three since you saw this one more almost four yes you haven't changed your ad on the website have you i i know i have not personally now and you've read it probably a bunch of times right i've read it a couple times but i don't spend a lot of time on my website okay um do you recall that you indicated that you were specializing in any particular aspect of psychiatry yes it probably includes a [00:08:29] Speaker 2: special interest in women's health in perinatal psychiatry in trauma-related disorders um anxiety um and you know there there may be some other things that were mentioned yeah like women that [00:08:44] Speaker 3: have babies and they're suffering from postpartum depression right absolutely you advertise that after a month you're working for aster right that's listed as one of my interests definitely and again forgive me how many women did you treat for postpartum depression in that month and a half before you [00:09:04] Speaker 2: met lindsay i don't know maybe a couple but i've treated i've treated many of them in the residency which [00:09:11] Speaker 3: was just immediately before so when a person needs to see a psychiatrist generally they're not well is that fair some are not well it really can vary so when someone comes to see a psychiatrist like you it's because they need help right yes 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 asking what you said about yourself i don't know exactly how she found us well do you know why she came to see you i'm not sure exactly friday we spent a long period of time going through your initial or the initial intake that she had to fill up is that correct you recall that yes we did um and the district attorney kept asking you and this is in september 12th is that when that form was filled out [00:10:20] Speaker 2: i believe she completed the form on the 12th the appointment was on the 15th so what does a person [00:10:28] Speaker 3: do do they call you or do they talk to somebody in administration how do you get the form to fill [00:10:33] Speaker 2: out yes our administration handles that and what do they do how does that happen um they send them the [00:10:45] Speaker 5: documents probably by email um and the patient fills them out um actually um it might be all within the [00:10:56] Speaker 3: portal um that we use within the portal the patient world okay and that means that you go online and you can access astor mental health and then all these little drop down boxes would come up something like that um are you are you aware is something like that or is are you aware of what it what it does [00:11:15] Speaker 2: so because i don't handle the the scheduling and send you a form so i don't know exactly what it looks [00:11:21] Speaker 3: like this is the form you're giving a person that needs help because they're possibly mentally ill is [00:11:26] Speaker 2: that right yes and and what's important is that i i review the forms and we go through them in the [00:11:34] Speaker 3: appointment absolutely yes now understand that the uh your records the 219 i believe the jury will have access to the tufts records okay you're aware of that right yes 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 um if that's what you say yes uh i wouldn't take [00:12:07] Speaker 2: what i say well if you don't know that's fine i don't know the details of how this works all right [00:12:12] Speaker 3: have you talked to them prior to your testimony no you haven't talked to the va's office no not at all you're a defendant in a very large lawsuit are you not yes you wouldn't happen to be represented by an attorney would you i am and the fact that you have an attorney is you're right under the constitution it doesn't mean you're guilty of anything right right okay and you know that the outcome of this case is very very major to the outcome of your lawsuit [00:13:00] Speaker 1: i don't actually know that really interesting loved hearing a lot of your voices there in chat a lot of varying opinions you know um i think this probably is one of dr tuft's most stressful days of her life thousands of people watching her and judging her on the stand um did she do everything right we'll talk about that in a little bit uh but let's talk about reddington for a little bit um reddington a lot of very opinions here i'm interested to know what the jury is thinking a lot of you thinking that he was rude that he was condescending towards or other people thinking he was doing an excellent job for the defense one thing i also thought was interesting in fact i'm gonna find this comment it was a great comment um yeah i want to talk about this not sure how i feel about it but i feel the blame is being put on the doctor but there's only so much they can do when you go home and you're alone one thing that i think that reddington is doing a great job on and that is from a defense perspective is you're right he is placing the blame really on somebody else it's extra interesting to me because this is a i always talk about this being a a why done it trial right it's not a whodunit trial it's a why done it trial and yet he's kind of like figuring out a way to make it a whodunit is there's something called soddy in law s-o-d-d-i some other dude did it soddy and in lindsay clancy's case it's pretty clear who the responsible party is everybody's agreed to it lindsay killed her children yet he is finding someone else to blame which is typically a good defense strategy he's not outwardly saying that that um dr tufts killed the children but he is certainly implying negligence and uh care that wasn't appropriate for lindsay clancy now the varying opinions here whether the care was negligent or not is varying but certainly interesting to see your opinions on this matter um there were some things that um i disagreed with that ready and was saying about her and her expertise and other things i thought oh dear my goodness um but you're right four years of residency and four years of medical school she's certainly more experienced than most of us in psychiatry except for the psychiatrists in chat as well as um the expert thing was interesting to me too he kept saying expert he he referred to he referred to sorry one second what's is my mic okay hello hello is my audio okay [00:16:05] Speaker 6: hello hello [00:16:14] Speaker 1: anyway i think other things that reddington does that are interesting is how he frames things we'll get into that a little bit later because first you know the expert being an expert really focusing on her lack of experience you're right everyone has to start somewhere but she was a new uh psychiatrist compared to others with years of experience anyway he moved to the intake form lindsay filled out on september 12th the one that the da had gone through page by page on friday he asked how many pages it was she estimated 10 to 20. he asked who checked the boxes she said the patient he asked whether lindsay disclosed past ssri use she said yes prozac in nursing school he asked whether lindsay reported side effects she said no he tried to suggest um that she waited for lindsay to volunteer information she pushed back saying lindsay offered a lot of information on her own and understood her medical history well and you know she knew that she was talking to a nurse she is well spoken when it comes to medical care i'm sure he brought up the alcohol disclosure the guilt lindsay wrote about and reminded her how long the da had spent on that friday she agreed it was part of the picture but not a major concern and then he dug right into lindsay's life her education her marriage her three children he asked whether she knew those details she said yes she she did he asked whether she'd ever met patrick in person and she said no their one interaction was through telemedicine which which uh reddington kept referring to as the tv that was another great thing that he framed it wasn't telemedicine or zoom it was the tv you saw her through the tv and that became the his next theme telemedicine aka tv he pointed out that every single appointment 14 in total was virtual he referred to it as the television he emphasized the fact that she never saw lindsay's full body right which means her non-verbals he never saw her hands her legs any physical tells of distress she acknowledged that she could not see those things and i will say this that is important you know i i watch the trials from home and i watch them in the courtroom there are things you see in person that you do not see when you're on the television but she still knew lindsay was under significant stress despite not being able to see her he asked if she could hug her and she explained that wouldn't happen in a regular setting in person either psychiatrists usually don't hug their patients and then he asked why lindsay came to her in the first place she looked at her notes and she told him that the reason documented in the record was postpartum anxiety that's interesting so not postpartum depression postpartum anxiety and then reddington brought in testing take a listen nice postpartum anxiety now as a [00:19:28] Speaker 3: psychiatrist meeting with this young woman after a month of so much working as a psychiatrist or pastor there are tests that you administer to a woman who's in postpartum find out what type of anxiety they have [00:19:45] Speaker 2: right there are some screening tests but the most important thing is what the patient tells you and what my [00:19:54] Speaker 3: assessment is in the session i see and that will carry through the tufts evaluations for all 14 of those meetings what the patient tells you right yes and what i observe in the session through the telephone through the computer what if you can tell me is the edenberg test [00:20:21] Speaker 2: it is a scale that looks at symptoms of postpartum depression and when you administer that's a that's [00:20:30] Speaker 3: a major test isn't it for a doctor to evaluate a patient for ppd i wouldn't say it's a major test it's a pretty big one though isn't it it's really one that measures the postpartum depression right [00:20:44] Speaker 2: it's a common one it's a what common commonly used [00:20:49] Speaker 3: so when you use it on lindsay when was that administered i did not use it on lindsay why [00:20:59] Speaker 2: we use the phq9 which is phq9 it's a depression screening form that's that's like generalized anxiety [00:21:08] Speaker 3: disorder general depression it's got nothing to do with a woman suffering from postpartum depression does it i disagree 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 to a pregnant or postpartum woman you're familiar with the edenberg scale right i've heard of it and can you explain to me how it's great no i cannot [00:21:41] Speaker 2: there are 30 questions in it are there not i don't use this scale so i don't know how many questions there [00:21:47] Speaker 3: are 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 okay you know that her first the edenberg test that was administered to her put her at a 23 [00:22:15] Speaker 2: i i was not aware of this test i was not aware that this had been administered to her [00:22:27] Speaker 6: you know the testing thing is interesting to me [00:22:30] Speaker 1: the edenberg scale i think that not every psychiatrist uses the same testing that that is true actually not every psychiatrist needs to use the same testing but to not know about it was surprising to me to say she didn't know about that testing because she uses other testing and i don't think it was a good look just my personal that was personal thoughts but um that was one thing anyway from there reddington tried to paint her as someone who relied too heavily on what information lindsay volunteered although i will say that is oftentimes how psychiatrists learn information is what the patient volunteers but he asked but he went for it he went for it and he asked whether it was important for a psychiatrist to know a patient's medical history beyond what they say and she explained that when patients can advocate for themselves doctors rely on their reports he asked whether lindsay was able to advocate for herself she said yes across every month she treated her he then brought up that word deteriorating deteriorating which had come up on friday she classified that it wasn't her personal word choice it was it was a multiple choice word right it was one of the preset options in the electronic chart she explained that she had to select from a drop down and that specific aspect of the note is a button where you have to click on one of three choices and that opened that opened the door for him to attack the technology which yeah attack the technology you know sometimes i wonder if we're relying too much on technology he pushed the idea that she couldn't freely write what she observed that she was boxed in by forms and check marks she kept reminding him that the treatment itself mattered more than the formatting and she also highlighted the standard safety language in her notes the part that tells patients to go to the emergency room if they feel they might harm themselves and others and she confirmed that it appears in every visit he asked about the self-harm hotline what it was she explained it was a number for patients in crisis to reach a trained counselor and then he asked about the therapy component of their sessions the therapy component he asked about whether she gave lindsay therapy and she said yes supportive therapy in other words listening validating offering hope but he pointed out that this therapy was usually just a few minutes and she told him it varied but he pointed out that the records listed 17 minutes she explained the 17 minutes referred only to the therapy portion not the full session he kept pushing asking what supportive therapy even meant she described it as listening to concerns providing emotional support validating feelings she said in other words quote i listened to her concerns and provided support i tried to provide her hope that eventually things would improve end quote next he walked through the symptoms lindsay reported early on the anxiety the trouble sleeping the postpartum sort of decline the timeline the time frame he asked how long postpartum depression or psychosis could occur she told him typically within a year meaning lindsay was well within that window right right callan was only eight months old he asked what she diagnosed on september 18th and she told him that she had diagnosed her with generalized anxiety disorder and an adjustment disorder with depressed mood and then he moved straight into medications specifically zoloft she confirmed that she prescribed 25 milligrams 30 tablets he tried to argue that zoloft wasn't indicated for generalized anxiety but she disagreed saying it was effective for generalized anxiety disorder he asked whether she knew what the manufacturer listed it for and she said that she was aware it treated various anxiety disorders and major depression both he kept circling back to alcohol asking whether she knew what lindsay drank when she drank how much she drank she told him she wasn't concerned about alcohol misuse and that lindsay's intake was minimal she described it as calming for lindsay then came the black box warning he asked whether she told lindsay that zoloft carried a risk for ideation both suicidal and homicidal she explained that the warning applied to children and young adults under 24 so she did not emphasize that because lindsay was older so he pushed the idea that the risk could extend beyond 24 but she told him she didn't believe there was evidence of that he asked what research she'd done on zoloft and ideation and she said that her training covered ssris extensively he asked whether she had attended postpartum symposiums or continuing education programs meaning ce's that's where your ce's she said that she hadn't but she'd done a lot of reading on her own and then he returned to informed consent take a listen to this and what is informed consent what [00:28:01] Speaker 3: does that mean in a medical sense not just like on the street or something [00:28:06] Speaker 2: explaining to a patient the risks and benefits of treatment and possible alternatives and making sure [00:28:16] Speaker 3: that the patient understands what you're saying 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 yes did you tell her that [00:28:38] Speaker 2: well insomnia is listed as a side effect no no no you already said yes you know it we just [00:28:45] Speaker 3: did you tell her that zoloft has a side effect of giving the patient severe trouble sleeping that's [00:28:54] Speaker 2: all 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 well that's [00:29:08] Speaker 3: what she told him right that she had severe trouble sleeping right she told me yes and you know that one 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 telling you in case you can't sleep she's got all of these symptoms and you prescribe a medication that would have a side effect or trouble sleeping so individuals [00:29:46] Speaker 2: 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 says who um it says it's it's the general [00:30:03] Speaker 7: consensus yeah you can't have both of you talk at the same time so let me finish the answer and then i'll give you plenty of time to follow up any uh questions regarding the answer so [00:30:20] Speaker 2: you finish your answer on that there's extensive research supporting the use of searcher lean in this in this instance and the general consensus among psychiatrists is that it's a first line safe medication for individuals including postpartum women how about the kids shoot other kids in [00:30:40] Speaker 3: high schools in high school for the lawsuits that come out of that and so on do you forget about them okay okay sorry sorry what the question was question was in response to your observation about of all psychiatrists of psychiatrists and it's a very very safe wonderful first line fraud and research how about the kids that kill other kids in schools with the lawsuits that arise out of the use of ssri so have you ever researched that i i don't know much about that you know about the ssris messing with some of the brain they go up and they shoot people for no reason right i'm not aware that that's the link to ssris so you didn't really talk to her about increased risk of suicide when 24 year olds are down because she's four or five years older than that you didn't talk to her about the trouble sleeping that could be a side effect but it describes that there's other drugs that you could have given her that would be perfectly safe in common and allow someone who knows psychiatric history to sleep better right not necessarily okay so you prescribed her with the zoloft it was 25 milligrams right yes and when you prescribed her with the zoloft 25 milligrams was that increased up to [00:32:11] Speaker 2: up to uh 0.05 milligrams or did you increase it at some point the instructions were to increase it to [00:32:19] Speaker 3: 50 after one week after one week yes um and you expected that she would listen to your instructions [00:32:26] Speaker 2: right yes and she did right she waited about a month but then yes she did why did she wait a month i think it took her some time to decide whether that was truly what she wanted to do right she was [00:32:40] Speaker 3: afraid of the drugs wasn't she she was afraid of side effects and she didn't want to take the pills [00:32:45] Speaker 5: did she she eventually did want to take the pills because she wanted to feel better a month later right [00:32:53] Speaker 3: yes so you prescribe the zoloft ssri and then you tell her after a week to increase it and she doesn't take that medication for a month correct correct correct and then she did take the medication right yes and and did you meet with her or talk to her before she actually started to [00:33:22] Speaker 2: implement that particular regimen i had met with her beforehand but i was not aware of when she made the [00:33:33] Speaker 3: decision to go ahead and take it so you met her on the 15th of september right yes when was the next time you met her can i check sure of course absolutely you can look anything you want september 28th and on september 28th did you discuss with her the fact that she was afraid to take the zola yes and did you recommend that she do that well she said that she was feeling better at that point and it's a real easy question when you talked with her did you recommend that she increase or take the zola at that visit at that visit i don't think that i did okay so when did she actually take the zola [00:34:24] Speaker 2: um she told me in her october 20th visit that she had taken it one week prior and she told you that [00:34:42] Speaker 3: when she increased it in accordance with your instructions she went off the rails right i don't think she used those words but she had what words did she use for you as her doctor she felt awful awful why did she feel awful did she have a stomach ache did she have a headache why [00:35:03] Speaker 2: she did she feel awful um she did have some stomach aches she had some diarrhea and had a difficult time eating um she also had increased anxiety um she had some more depressed feelings um she had more [00:35:20] Speaker 3: difficulty sleeping and what was your advice to her as her doctor on the 28th of october after she told you about the effect of zola's head on it i told her to stop it stop the medication [00:35:38] Speaker 1: well reddington pushed her on whether stopping an ssri abruptly was safe and she explained that at 50 milligrams it was fine to stop immediately he asked what happened next and she said that lindsay fell back to her baseline still not great and was considering a new medication he asked whether lindsay had researched medications herself tough said no and she gave a recommendation so he keeps circling back to sleep right because we know that lindsay was not sleeping and he kept pointing out that zoloft can affect sleep and that lindsay already struggled with insomnia she explained that that site that side effects are temporary for many people and that zoloft is still a first line choice and then he tried to test her knowledge of these medications throwing out drug names using labor and delivery she did not recognize them and he used that to draw a line between what she wasn't expected to know and what she should know as a psychiatrist she told him she didn't expect lindsay to understand a lot about psychiatric medications and that it was her job to guide her he asked whether she knew lindsay had postpartum anxiety after her second child she said yes he asked whether she documented the side effects lindsay had back then and she said she didn't write them down because they were common they were temporary so he kind of explains this though it's another failure saying she didn't remember them because she didn't document them yet she prescribed zoloft again in 2022 then he moved into the emotional side of lindsay's symptoms he asked whether lindsay used the word overwhelmed during september october november she said yes he asked whether she believed lindsay was simply overwhelmed by having three kids tough said no she knew lindsay was genuinely struggling he asked what therapy she gave lindsay during those months she said supportive psychotherapy listening validating encouraging he pushed her to be specific and she told him she didn't remember the exact words because they buried by session and then came december 1st the first time suicidal thoughts entered the picture [00:38:02] Speaker 6: tough said lindsay denied being suicidal [00:38:11] Speaker 1: she described it saying that quote she denied feeling suicidal but felt that she was getting close to feeling that way end quote so that she wasn't but getting close to feeling that way she explained that lindsay was afraid she might eventually develop those self-harming thoughts he asked how frequently those thoughts occurred and she said she didn't have the frequency documented but she usually [00:38:35] Speaker 3: asked that question would you agree with me that many times patients especially psychiatric patients may minimize your symptomology patients sometimes do and sometimes when a woman has just had a child and has other little kids at home that they're worried about the government taking kids away from them because you're a mandated reporter right you're a mandated reporter right i am and if she told you [00:39:08] Speaker 2: i'm not necessarily i think it really depends on the context but but having suicidal thoughts alone is [00:39:24] Speaker 3: is not a reportable condition all right so basically we know that she was close to having suicidal thoughts to kill herself whatever that means we don't know how frequently she was having them yeah [00:39:39] Speaker 5: um today i don't know how frequently but at that point i believe i did know how frequently they were [00:39:47] Speaker 3: so as a result of that you then gave a therapy i imagine right you can tell yes and what therapy did you give her in november of 22. i gave her supportive psychotherapy and what does that [00:40:00] Speaker 2: mean it sounds great what is what do you do uh it it's um listening to the patient and providing [00:40:08] Speaker 3: sorry listening to the patient as one may say they're having oh hold on sustained next question so right next question listening to the patient that would be when for example one of your patients tells you after all the treatment that you would provide prior to that all the symptomology that she had anxiety and all of that that she's close to having suicidal thoughts that would i imagine impacted me yes so what did you do with this psychotherapy [00:40:56] Speaker 2: so i provided emotional support and validation and encouragement um something like i i understand this is a very difficult time and it really you know it varies on the individual sure how about myself i don't remember the exact [00:41:25] Speaker 3: therapeutic words that i used okay how long did you give a third how long did you give a third [00:41:31] Speaker 2: validation and all that stuff i i don't remember exactly the duration about ten minutes [00:41:38] Speaker 3: maybe through the television okay so as we pointed out you tell the people that come to see you when i say you i mean collectively ask their medical that you would expect that if a person is in crisis as you guys say or is suicidal that they would have to go to a computer or their cell phone right they would have to punch in your office right [00:42:06] Speaker 2: look out the number we advise them to call 9-1-1 or go to the emergency room as quickly as possible [00:42:15] Speaker 3: how about suicide hotlines you give them advice that's that's an option as well yeah sure did she call [00:42:21] Speaker 2: suicide hotlines i was not aware that she did did you ever ask her i don't think i specifically asked [00:42:30] Speaker 3: that question specifically did you ask her anything to be around the bush maybe you asked her anything [00:42:35] Speaker 2: about suicide hotlines i don't think i asked her about suicide hotlines would it surprise you to know [00:42:43] Speaker 3: that she called suicide hotline in that time frame not once but twice and was turned away you guys were the front liners aren't you [00:43:00] Speaker 2: it does surprise me yes it does what it surprises me that she called them twice [00:43:07] Speaker 3: and you never asked her if she had ever called the suicide hotline did you [00:43:12] Speaker 5: i don't think that i did [00:43:16] Speaker 3: yeah i understand you you were doctor you were trying to do it like that you obviously this is just horrible is it yes she continued on with her treatment with you correct yes [00:43:36] Speaker 1: well after that he moved into medication changes on october 21st she prescribed ativan on october 26th she added busporin and then he asked about side effects and she said busporone was generally mild maybe tiredness dizziness or an upset stomach he asked whether lindsay was taking ativan at the same time as she said yes and that lindsay was compliant tufts also agreed that lindsay had been taking benadryl as needed over the counter one dose at a time reddington pushed her on whether she asked if lindsay ever increased it she said she didn't remember asking and then he went into the interaction between benadryl and ativan pointing out that the combination can depress the central nervous system she tried to explain the nuance but he cut her off insisting on a yes or no answer he asked whether she discussed that interaction with lindsay on october 26th she said that she did not recall and from there he circled back to those thoughts of self-harm on october 26th lindsay denied ideation and tufts had it documented exactly that way patient denies ideation self-harm ideation he tried to draw a sharp line between ideation and being close to those self-harming thoughts and reminding her that lindsay had told her she was close to feeling self-harming things suicide feeling suicidal at the previous visit he asked whether she followed up on that and she said yes and lindsay told her that she wasn't feeling that way anymore and then he asked about how long that appointment lasted she said that the full visit was 25 to 30 minutes even though the therapy portion was shorter then he moved into hydroxyzine she prescribed that on october 26th as an alternative to benadryl he walked through the list benadryl ativan busboron hydroxyzine basically a cocktail of interacting drugs she explained that they weren't meant to all be taken at once he asked whether she ever told lindsay to keep a diary of her medications or side effects she said that she didn't instruct her to do that he asked whether she recommended it she said no remember lindsay did it though for herself she explained that they met frequently and went through everything during their appointments he painted the picture that lindsay was getting worse heading into november crying more more anxiety more insomnia brain fog and worrying about self-harm toughs didn't recall those symptoms being significantly exacerbated in that exact window he asked about brain fog and she described it as a subjective feeling something like slowed thinking or trouble finding words he asked whether she considered brain fog a potential medication side effect and she said it depended because brain fog can also be a symptom of depression then he moved into ativan but that note belonged to lindsay's therapist not tough so so the next time tufts saw her was november 2nd and on november 2nd lindsay told her she was hesitant and scared to take buspirone and hydroxyzine he asked whether she counseled her about that fear she said yes explaining the list the risks like sedation or dizziness he asked having sound issues again oh feedback thanks you guys thanks for letting us know we're trying yeah lily is you know clearly she's a very uh hyper dog she's running around hitting the wires i wish we could blame lily right now like the dog in our homework but clearly lily is innocent back there so no blaming lily [00:47:54] Speaker 6: better better better okay yay yay yay [00:48:03] Speaker 1: all right okay yeah we're back we're back we're back all right yeah people wondering whether i was a robot or not a coughing robot yeah no i'm here and uh the mic mic uh problems can prove it all right so we were talking about sedation or busy dizziness and then reddington asked whether she asked about suicidal thoughts at that visit and she said yes and lindsay denied he pressed her on whether she checked a box or whether lindsay said the words she didn't remember the exact phrasing uh more feedback issues but they discussed self-harm directly at that moment he asked when when those thoughts came up again and she told him it was december 1st the same date that she'd mentioned earlier and then he moved into remeron she had discussed it with lindsay as an alternative but did not prescribe it he asked whether she recommended it she said no explaining that medication decisions were collaborative right but ultimately lindsay's decision and next came the november 22nd appointment lindsay told her that she'd gone to south shore perinatal clinic tufts said that lindsay explained that the clinic specialized in perinatal conditions he asked whether she knew the names of the providers she said lindsay mentioned julie paul and then later she heard the name nurse gelada he asked whether lindsay was still using ativan and benadryl she said yes he asked whether she told lindsay to taper off ativan she said that she had asked her to taper off the ativan reducing it by 0.25 milligrams every two weeks he asked whether lindsay followed that taper she said lindsay had not fully stopped he asked whether lindsay had gone to any emergency rooms she said that she knew lindsay went to mass general for depression and was discharged without being admitted he asked whether she had access to salstra's records she said no because they were a separate clinic and so then he asked whether lindsay could have signed a release she said yes he asked why she didn't request the records she said that she didn't feel it was necessary because lindsay provided detailed information about her treatment there so he challenged whether lindsay was an accurate historian given her mental state and tuft said lindsay recalled medication names doses and dates with precision which showed that she was capable of providing accurate information and then he asked how many times she spoke with lindsay's husband she said only once during a telemedicine appointment on december 16th or as kevin reddington says the television and that's where the judge paused things for the morning recess and then when court came back from recess reddington picked her up right where he had left off drilling into the october 20th appointment the day lindsay told dr tufts that increasing her zoloft dose had sent her spiraling tufts looked at her notes and walked through what lindsay had reported she said quotes she felt awful couldn't sleep had insomnia didn't want to eat was having diarrhea more depressed crying all day yesterday mental fog terrified to start something new was on quotes her anxiety had spiked too lindsay told her that racing thoughts kept her up overnight that she felt paranoid she might get self-harming thoughts that she didn't want to be alone because she feared something bad might happen tufts agreed she was concerned she said that she gave lindsay therapy alongside the medication discussion listening validating trying to help her process everything she was feeling lindsay also told her that her mother was coming to stay with them tufts said she knew the mother was coming to provide support but she didn't know how long she stayed she didn't know she slept in the basement and didn't know she slept with lindsay she said lindsay was still able to advocate for herself so she did not typically reach out to parents of adult patients so after hearing how badly lindsay reacted to zoloft tufts stopped the medication and planned to monitor her closely she saw her again the very next day october 21st she also recommended fish oil and other natural supplements and she started looking into other options like iv infusion treatment for postpartum depression she explained that zolresso required a 60-hour hospital stay and wasn't something that she could prescribe herself she said that she researched where it was offered women and infants hospital in rhode island but she never accessed the records and never formally recommended the treatment she said lindsay later attended a partial hospitalization program at the same hospital and she advised her to discuss this infusion therapy with them reddington pushed her on why she didn't request records from women and infants she said lindsay didn't receive treatment there so she didn't think it was necessary he pushed again [00:53:04] Speaker 6: asking why she did not request records from south [00:53:14] Speaker 1: from south shore perinatal either she said lindsay gave detailed information about her treatment so she felt she had what she needed then he moved to october 26th lindsay told her she felt back to where she'd been before zoloft still not great and wanted to consider a new medication tufts that's when tufts added the busprone continued ativan and added hydroxyzine as needed she said that she discussed side effects she's also mentioned remeron and as a future possibility but did not go into detail and then again came [00:53:49] Speaker 3: halloween october 31st tell about that so here you have a patient who's already reported to you as a psychiatrist that she's got suicidal ideation worried about suicide worried about killing herself days before october 31st and a suicide assessment was done by mcallister right i wasn't there you would have to ask her oh maybe i will if she comes in why don't you tell me what the record shows did they do a suicide assessment did she check off the little boxes i'm looking for that section [00:54:36] Speaker 2: um it says a patient denies suicidal or homicidal ideation at this time okay so again this is on october [00:54:49] Speaker 3: 31st right yes the patient within a period of a couple of days in meetings with you that mcallister has access to because the records are within your business right it's not my business but yes has reported suicidal ideation and fear and dwelling about killing yourself and afraid of those thoughts right [00:55:20] Speaker 2: i just want to be absolutely um clear so um so um so yes uh you know with a little while earlier she had she had voiced those concerns right [00:55:42] Speaker 3: so as a result of voicing those concerns is it your understanding that mcallister did not do any of the suicide assessment questions because unzie reported that she wasn't suicidal [00:55:58] Speaker 2: i it appears that she asked about suicide [00:56:03] Speaker 3: okay you already told us that i'm asking you about excuse me hold on ask this question thank you i'm not asking you you've told us three times now that she says she was not suicidal when she spoke to mcallister i'm asking you about the suicide assessment for the third time you see it in front of you yes okay can you tell me did lindsay answer any of the questions that were asked over the two pages possibly three of the suicide assessment yeah three done by mcallister i don't see anything written here [00:56:44] Speaker 2: so was there a suicide assessment i don't know because i wasn't there i don't know what they don't know [00:56:51] Speaker 3: from looking at the records right [00:56:55] Speaker 2: from looking at the records i don't see evidence of additional suicidal questions beyond asking if it was [00:57:02] Speaker 3: there or not so the suicidal assessment doctor is in the medical records it consumes almost four pages does it not yes yes okay and all of the questions like asking have you felt life is not worth living is that something you thought about recently are you dwelling on that what what leads up to the thoughts what are the thoughts all those questions right for four pages right yes and there is not one notation indicated that that test was ever administered to her on october 31st correct [00:57:45] Speaker 6: correct but it was it looks like it was asked another way [00:57:51] Speaker 1: well from there first off how's the audio we did a little switch of an audio box um lily back there helped us as you can see she's working real hard so i hope our audio is better testing testing one two testing making sure anyway from there he shifted into metabolism asking how she determined how lindsay's body was breaking down psychiatric medications and she explained that psychiatrists don't typically test metabolism directly and that blood tests aren't used for that purpose he asked about genetic testing specifically the cyp 450 system she said that the testing existed but wasn't clinically useful enough to guide medication choices and he asked whether insurance covered it she said sometimes he asked whether she used it she said no because it wouldn't have changed lindsay's treatment he then moved into thyroid function she explained that thyroid levels don't impact her evaluation of postpartum depression he asked whether she knew about the peer-reviewed study on thyroid function and postpartum psychosis she said no he asked whether she'd written any articles on postpartum depression anxiety or psychosis she said no explaining she was a clinician not a researcher reddington kept pressing on what he saw as gaps in dr tuft's medical investigation he asked whether she'd read specific articles about thyroid function and postpartum psychosis she told him that she had read many articles over the years but not that particular one then he went back to the idea that she had not ordered blood tests or the p450 testing she told him again that those tests would not have changed treatment because they don't yield clinically useful information for psychiatric medication choices well then he pivoted and he pivoted to thyroid levels asking whether elevated thyroid numbers would matter she said if she learned a patient had abnormal thyroid levels she'd advise them to speak with their primary care doctor or an endocrinologist he asked whether she ever recommended that lindsay see an endocrinologist she said no he pointed out she wouldn't have known whether there was a thyroid issue because she didn't order blood tests she told him there was no clinical reason to order them and from there he moved into the november 2nd appointment she confirmed that she still diagnosed lindsay with generalized anxiety disorder and adjustment disorder with depressed mood she noted that lindsay's condition appeared to be improving she documented a taper plan for ativan decreasing to 0.75 milligrams for two weeks and then 0.5 milligrams for two weeks she also noted the standard emergency instructions go to the er call 911 call the hotline if she felt at risk in other words she had options he asked whether that emergency language was just a button she pressed but she said it was advice given to every patient he pointed out that she had discussed four possible medications on november 2nd remeron trazodone hydroxyzine and i'll work my best on this one pregab pregabalin pregabalin hydroxyzine trazodone remeron and pregabalin and she said that those were just options that they were considering not medications that she was starting just they were talking about them then we get to november 22nd she confirmed she asked about self-harming thoughts and that lindsay denied them he asked about whether she asked about how things were going at home with her parents staying there she said that she didn't think she asked cember first was the next appointment and by then lindsay had transferred to south shore perinatal tufts reminded him she did not did not have access to those records she only knew what lindsay reported lindsay told her that she had tried tapering ativan but that's when her sleep worsened which means ativan was helping her sleep she tried trazodone between 50 and 150 milligrams another medication that's supposed to help you be able to sleep it didn't help she tried remeron she tried prozac 10 milligrams but couldn't sleep and had worse sleep so that was stopped she was also on clonopin and then came the intrusive thoughts those intrusive thoughts tufts described them as worse depression and intrusive thoughts feeling like i'm going to die lindsay told her she was close to to self-harm ideation and feeling hopeless hopeless is frightening tufts documented it exactly that way too writing quote denies ideation but yesterday close to it feeling hopeless end quote that's that's what she wrote she said she gave therapy validation reassurance reminding lindsay that there were treatment options like partial hospitalization programs he asked whether she ever suggested lindsay come in person instead of telemedicine aka the television she said no she didn't feel like she was missing anything by seeing her on video he asked whether covid was over by then she said people were more comfortable than yeah meeting in person but it was still something that they thought about he pointed out that her notes said they discussed syroquil she said they talked about it because lindsay's other providers had recommended it syroquil is again it's an anti-psychotic he asked whether she discussed undiagnosed bipolar disorder she said yes actually to that because lindsay had extreme reactions to the ssris and severe insomnia which would maybe point right to undiagnosed bipolar disorder her note said quote also discussed the possibility of undiagnosed bipolar disorder given extreme reaction to ssris and insomnia that's she wrote that he asked whether she diagnosed bipolar disorder she said she said no lindsay never had mania she said he asked whether she discussed a drug called la let's see lamictal lamictal lamictal lamictal lamictal thanks guys lamictal she said yes explaining that it was used for mood disorders he asked what the plan was after that december 1st appointment and she said she wasn't prescribing medications at that point but she recommended a partial hospitalization program at hri in brookline lindsay ultimately went to the women and infants hospital for one day we know that those were the records tough though did not have because she never got those records he asked whether she used the dsm-5 criteria she said yes that's for psychologists and psychiatrists he asked about the difference between mania and hypomania and she explained that mania requires seven days hypomania four and then we're to december 16th almost a month away from the horrific day a little bit over lindsay told her then just a little over a month before that day that she was having a really rough time tufts added that she was sleeping but still feeling poorly he asked why she mentioned sleep and she said it was an important detail she read from her notes again quote very depressed during the day no motivation some si meaning self-harming ideation went to mgh emergency room or si so she goes in the er for that declined declined in patient feeling hopeless feels like depression related to siraquil end quote that's fascinating he asked whether some si meant right that ideation she said yes so in other words she went to the er for that because that's how bad it was he asked what this ideation meant in this context and she said she asked lindsay follow-up questions whether she had intent or a plan to follow through lindsay denied both no intent no plan he asked what therapy she gave she said she explored what those feelings meant and discussed what to do if they worsened like going to the er he asked whether siraquil came up she said yes they talked about it but she wasn't prescribing it he asked whether she knew lindsay had confessed to her husband that she was thought of harming the children and she said no she did not share that with her he asked whether she would have been concerned about that she said yes he asked whether she would have called dcf you know department of children family services she said that she might have which i'm going to pause and point out that's one reason some people don't fully share everything going on in their lives because if lindsay's feeling like a terrible mother and she has thoughts of harming her children the last thing she's probably going to want is dcsf showing up at her house right anyway i'm not saying that's why she didn't mention it i don't know why she didn't mention it i'm just saying that sometimes that is why people don't mention it sadly when they are there to help right and dcf could have helped anyway then kevin reddington asked whether she had ever talked to patrick clancy again and she said no he never called her and she only spoke with him once during that telemedicine visit that she believed was december 16th he asked what lindsay told her about being depressed that day and she said that lindsay told her she was having a really rough time her affect was flat it's almost what she's like every day in the courtroom her mood was depressed he pointed out that her template included a section for recent lab work she explained that aster didn't have a lab the template auto-populated with quote no lab results found he asked what quote symptom reduction and improved functioning meant so she explained it meant fewer mental health symptoms and better day-to-day functioning then he asked whether she told lindsay that she said yes then he asked what she actually told lindsay that day and she said she told her to go to the partial hospitalization program like go there and if she felt at risk of hurting herself or anyone else she should go immediately to the emergency room so by the time the questions got to the december 16th appointment pattern was familiar lindsay sat in front of her computer exhausted and overwhelmed and tufts tried to figure out how to help her through a screen that visit lasted about 30 minutes tough said the therapy she offered was was in the conversation which included reassurance validation guidance the same recommended emergency instructions that she always gave when someone was struggling the plan that day was for lindsay to follow up with women and infants hospital tough said that she believed lindsay did go but she didn't know the exact date she also noted that they were considering another drug brexanilone the infusion in rhode island but that never materialized her notes from that day showed a few medication changes that lamictal was started at 25 milligrams seriquil continued and lindsay told her that she was on 200 milligrams prescribed by another provider tufts didn't verify the bottle or or even call the pharmacy she simply went by what lindsay reported the standard emergency language appeared again in the note the part that says if she has urges to harm herself or if she has urges to harm others she should call 9-1-1 or the crisis hotline that template showed up in every visit when reddington asked whether lindsay's parents were still staying with her tough said that she was not sure he asked whether she ever reached out to anyone besides lindsay to understand how she was doing again she said she only spoke to patrick clancy once she remembered him saying lindsay wasn't doing well and that he believed ciraquil was making things worse she said that he may have said she looked like a zombie after december 16th the next appointment was january 6th tufts explained that lindsay likely scheduled that one herself usually the hospital coordinates discharge appointments but she wasn't certain lindsay had just spent four and a half days in the locked unit and mclean she admitted herself because she was not doing well so in other words she took her advice she went herself to inpatient and tufts and mclean diagnosed her with major depression major which was different than what tufts had diagnosed her with they discontinued the ciraquil she received a discharge summary just just a couple of pages not the full records she didn't speak to the doctor who discharged lindsay she said she didn't know lindsay was hospitalized until after she was released and then on january 6th getting nearer to this day it's heartbreaking day january 6th lindsay told her she was still numb still struggling after being hospitalized still unable to sleep consistently she was taking ativan and trazodone the trazodone was increased and then three days later on january 9th tufts prescribed diazepam on january 12th she prescribed trazodone 150 milligrams on january 16th she prescribed amitriptyline an antidepressant she explained that it was older but effective for depression anxiety and insomnia during that january 16th visit now we're getting to that week terrific week the january 16th lindsay tells her that her mood was very low she had no motivation she felt numb she could force herself out of bed but only for basic tasks remember patrick referred to her as a zombie that's so telling i want to talk about that in a little bit she said caring for the baby felt forced tuft said she believed that lindsay was honest and forthright throughout their treatment she didn't think lindsay was lying to her january 16th note showed a diazepam taper five milligrams for the last two nights four hours of sleep followed by light sleep lindsay denied either ideation that day and tufts recommended a low dose of amitriptyline emitriptyline for depression they also discussed exploring ketamine treatment so then reddington asked whether tufts knew that lindsay was researching medications constantly looking up drug interactions ketamine and other treatments and she said no she had not asked january 23rd the day before the day before [01:13:33] Speaker 3: january 23rd friday you testified that she said her mood was depressed and you noted that her affect was depressed and flat right yes she also reported that her heart was racing right yes she had no motivation is what she told you right yes she told you that she had been feeling numb and no emotion for 17 days straight is what she told [01:14:06] Speaker 2: you right i'm not sure about 17 days straight but that's how she was feeling [01:14:13] Speaker 3: you didn't reach out to her mother and father at that point they didn't call you i guess right no and patrick couldn't call you at that point right no so she's sitting in front of her computer getting help from her doctor on january 23rd and what did you do [01:14:37] Speaker 2: well i thought about how i could best help her the medicines that she tried and what her current symptoms were and it made sense to slowly titrate the amitriptyline so that we could get her to a dose that reduced her depression so that she would feel better it increased the amitriptyline [01:15:07] Speaker 3: yes that pushed you over the edge [01:15:11] Speaker 6: i don't think so [01:15:16] Speaker 1: and that's where the court broke for the afternoon recess don't worry broke for the afternoon recess we're still going i mean it was the longest cross exam like clearly kevin reddington is showing his hand at what his defense is going to be by cross examining this witness for so long but a very very important witness because if she's going to be not guilty by insanity her mental health doctors everything right so after lunch though ada spray gets up for redirect because we just spent the whole morning with kevin reddington really pushing dr tufts so sprague stood up for redirect and she started by going back over tufts training she it was like kind of like deja vu of friday for a little bit she starts pointing out that even during residency tufts was already a doctor that is true responsible for evaluating diagnosing and treating patients on her own that is a fact she explained that she wasn't sitting in a room with someone telling her what to do she handled her own cases and if she needed guidance she could consult an attending physician she told sprague that she had treated thousands of psychiatric patients over those four years sprague walked her back through the postpartum experience she had during residency the elective she did with a perinatal psychiatrist the year that she spent in the clinic seeing pregnant and postpartum women tufts explained that she followed those same patients over time evaluating diagnosing and treating them throughout their pregnancies and postpartum periods sprague asked about postpartum psychosis how rare it was tufts said she didn't know the exact statistic but it was low she said that she had treated many patients with other forms of psychosis and that psychosis presents in similar ways regardless of the underlying cause she described what she looks for appearance engagement speech thought patterns bizarre or paranoid content signs someone may be responding to things that aren't there she told sprague she never saw any signs of psychosis in lindsay and sprague also addressed the coveted questions from cross-exam so she asked whether mental health issues stopped during the pandemic it's tough said of course not in fact they probably worsen during the pandemic right they you know they were definitely getting worse for many she confirmed she still stopped patients daily during the pandemic including outpatient care for three of her four residency years and she explained that telehealth became a standard since covid widely accepted in psychiatry she said that talking through a screen did not change how she asked questions or how she heard the answers sprague pushed back on the idea that tufts couldn't see movement below the waist tough said that she could still see signs of agitation elsewhere bouncing fidgeting movements that reverberates through the body then sprague moved through the edenburg scale right the edenburg scale is important it's a testing for postpartum depression 10 questions tufts not only doesn't use it she implied she didn't know what it was so tufts explains that aster used the phq9 instead that can be a replacement for generalized depression not postpartum but generalized uh and and she used that instead because she chose it but because also that it was standard practice the phq9 screens for depression it can screen for postpartum depression too and postpartum depression is still depression the symptoms do overlap she said that she combined the phq9 with the patient's history to make her diagnosis i will just throw out that that is true it can be in replacement but the edenburg scale is only 10 questions it could have easily been added but anyway we'll keep going brigg asked about the importance of accurate history tough said it was critical because treatment decisions depend on what the patient reports she explained that nurses like lindsay tend to understand how important accurate reporting is she also pointed out that lindsay advocated for herself lindsay was scheduling appointments right lindsay was going to the er when she felt she needed help that was a sign that lindsay was capable of getting help and knowing what she needed so sprague then asked about therapy tough said therapy is mostly listening right it's it's understanding what the patient is feeling she said that she encouraged lindsay to attend individual therapy throughout their time together she pointed out that lindsay only saw the therapist twice sprague then addressed zoloft she asked whether it was commonly used in generalized anxiety disorder tough said yes because it's effective because it's safe she clarified that the warnings of self-harm applied to children and adolescents up to age 24 lindsay was 32. she explained that stopping zoloft at 50 milligrams did not require tapering because it was still a low dose sprague highlighted that lindsay waited a month before taking zoloft and only took it when she decided she was ready she said lindsay made her own decisions and that was part of her ability to advocate for herself sprague then decided to get into the intake form lindsay had filled out on september 12th lindsay had listed past anxiety she listed postpartum anxiety she listed prozac and wellbutrin and marked both medications as effective with no side effects the sprague used that to counter the idea that tufts failed to document history and then we're to october 20th again the october 20th appointment and on this redirect the one where lindsay describes her reaction to zoloft sprague asked whether tufts documented the side effects and tough said yes and then she read them out loud quote couldn't sleep insomnia doesn't want to eat diarrhea more depressed crying all day mental fog terrified to start something new end quote she also documented lindsay's fear of [01:21:34] Speaker 8: getting suicidal thoughts take a listen to start something new and so you did document the side effects that she reported to you correct yes you also documented in the interval history paranoid of getting suicidal thoughts was that the defendant's phrasing yes and is there a difference between someone being worried about having suicidal thoughts and someone actually having suicidal thoughts yes and what's the difference in terms of of how a psychiatrist sees it [01:22:10] Speaker 2: so that's that's the difference between what someone what a patient might answer and then what the psychiatrist actually um assesses so so say a patient might say they're having suicidal thoughts but when they describe them they're not actual suicidal thoughts they're um fears of suicidal thoughts um so that's that's the difference there and i'm sorry i think i forgot exactly what your question was what's the [01:22:39] Speaker 8: difference um in your training and experience between someone having fears of suicidal thoughts and actually [01:22:46] Speaker 2: having suicidal thoughts well so if it's if it's a fear then it means that they're not actually having suicidal thoughts [01:22:55] Speaker 8: it's a negative and does that affect the way you proceed with treatment [01:22:59] Speaker 2: um yes in in some ways yes how um well you you still proceed with treatment it's still concerning um but it is a a level of concern that can be managed on an outpatient basis not requiring [01:23:15] Speaker 8: hospitalization and so according to the defendant she was not yet having suicidal thoughts at that time yes so when defense counsel asked you repeatedly why you didn't document how many times she had those thoughts she hadn't had those actual thoughts yet correct correct that was later in december is that right yes now she also um told you that she was worried about something that something bad might happen [01:23:45] Speaker 2: so she arranged for her mother to stay is that correct um well she arranged for her mother to stay i'm not sure if that was because she was afraid something bad was happening um or it just seemed like they needed [01:23:59] Speaker 8: more help okay so you you don't recall the two being together as a thought correct and the fact that she was struggling she was struggling and arranged to have her mother stay got support advocated for [01:24:13] Speaker 2: herself um would those be protective factors yes how so um so if if someone demonstrates that they can advocate for themselves that they can seek help if uh symptoms worsen then that shows that they um they have good judgment they can be they can be trusted um to um to present for care if if you know serious safety concerns [01:24:43] Speaker 8: were to arise so based on your training experience with miss clancy where she says she's having she's worried about getting suicidal thoughts and she has her mom come stay with her do you see that as a positive decision yes you were asked um about not asking the defendant if she had called the suicide hotline um if a patient denies suicidal ideation would you typically ask them if they had called a suicide hotline no and why not [01:25:18] Speaker 2: because i you know i wouldn't think that they would have you know if if a patient were to call a suicide hotline i would think that they would be telling me they're having suicidal thoughts as well [01:25:36] Speaker 1: so sprague clarified the medication instructions ativan is needed us prone daily hydroxyzine is an alternative to ativan she asked whether tufts ever instructed lindsey to take all three at once and tufts said no she asked about the ativan taper tufts explained that lindsey expressed concern about long-term use they discussed it and they created a taper plan together sprague used that to show lindsey was engaged and thoughtful about her treatment sprague asked whether lindsey ever told her about the er visit on november 16th the trazodone prescription or we're trying weed gummies note that weed gummies tufts said no she said she had no way of knowing things the patient didn't report but then we get to december first so take a listen to this [01:26:33] Speaker 8: now on december 1st 2022 defense asked you about that date um that's the date that she again said she had the fear of thoughts of suicide is that correct yes up until that point um had she consistently denied suicidal ideation or intent or a plan yes had she consistently denied homicidal ideation intent or a plan yes what's the difference um well let me ask you this when you talk to a patient do you ask them do you have suicidal ideation not usually what do you not not in that way how do you get that [01:27:08] Speaker 2: information from them what types of questions do you ask it depends how the course of the conversation is going um i might ask if if they're having thoughts of hurting themselves if they you know sometimes wish that they weren't alive it it can be a lot of different words and sometimes i use you know the [01:27:27] Speaker 8: patient's own words um but things like that and is there a difference between having thoughts of a suicide of suicide versus having the intent and a plan to do it yes and are there different types of treatment or things that you would do if some if someone has intent or plan to do it yes that would generally require hospitalization and so if miss clancy had told you she had thoughts of hurting herself or actually straight back if she told you that she had a plan to hurt herself or a plan to hurt [01:28:01] Speaker 1: her children would you have moved to commit her yes so sprague addressed the october 31st therapy session she asked whether there was any reason to administer the full uh ideation assessment if lindsay denied ideation and tufts said no because someone denying ideation would deny every detail in the assessment and then sprague asked about bipolar disorder tufts explained how she evaluates mania and mania is described she says as fast speech loud speech hyperactivity inability to sit still jumping from thought to thought she said she never saw any signs of mania with lindsay once redirect finished reddington right back up in right back in he started with the hippa issue sprague had asked why tufts didn't reach out to lindsay's parents or patrick right and tufts explained that she didn't have a release well then reddington seized on that like we knew that like when you say you'd have a release why not he asks whether she even asked lindsay to sign one and she said no so he really pushed this idea that even without the family calling her she could have reached out if she had had permission tufts repeated that that wasn't typical to contact family when an adult patient could advocate for themselves okay he pressed again though asking why she wouldn't call the parents who were living with her and helping her she said she she stayed with her answer lindsay was able to speak for herself and she was forthcoming and an adult patient so she wouldn't typically call the parents and then reddington brings up that marijuana remember when i said remember weed gummies well spraig had asked whether lindsay had ever told her she used gummies weed gummies plural and tufts had said no well reddington pointed out the spray could use the word again gummies plural he asked whether lindsay he asked whether lindsay had ever told her she used marijuana at all she said no and he reminded her though that she didn't have the women and infants records and then he introduced them here they are here's the records of the marijuana the weed gummies and it states are you ready for this it states in the record quote in the middle of november she tried taking a marijuana edible a marijuana edible to help her sleep which caused her to have increased anxiety and palpitations end quote so he used that to show that it was not multiple gummies there was no plural it was one and lindsay had not told her about it so then from there he went back to ideation self-harm thoughts versus having self-harm plans and he explained to her again what commitment the difference between a thought and a plan right she told him a plan meant knowing exactly how one intended to follow through with the ideation their method the timing something researched and imminent that would require hospitalization then he revisited the thyroid questions break had said lindsay's thyroid levels were normal at south shore and brigham runnington asked whether she remembered that she said yes he asked whether those were old readings she said she didn't know then he got into pressured speech remember how we started this episode it's live about the pressured speech so he reminded her that she testified repeatedly that lindsay never showed pressured speech he pulled up the october 21st record and had her read it [01:31:55] Speaker 3: hey galissa let's talk about it so forget all about my sloppy writing i'm looking here on october 21st of 22 is that correct right up there yes okay yes and can you just read this paragraph here for us [01:32:10] Speaker 2: no sorry no sleep last night falls asleep after 40 minutes heart racing severe anxiety worrying about kids baby sleep yawns but not drowsy not hyper pressured speech what was that not hyper not pressured speech is what i meant i know it doesn't say not but that is exactly what i meant wait when did you see [01:32:34] Speaker 3: this that you noticed that it did not say not i don't care what it says i know what i meant well when you wrote this you did not say not pressured speech you said in the medical record pressured [01:32:49] Speaker 2: speech right no doesn't say that yeah the word is the word not is right before not hyper comma [01:32:59] Speaker 3: pressured speech the two are following the not to you when you put down in a medical record heart racing comma severe anxiety comma worried about kids comma baby comma sleep comma yawns but not drowsy period not hyper comma pressured speech that's what you wrote right she did not have pressure speech i wrote that but you're misinterpreting my note am i reading this correctly and the jury will be able to look at it that you put not hyper comma pressured speech did you did i read that right yes but your [01:33:41] Speaker 7: interpretation is incorrect as opposed to yours go ahead just in regards to what was raised there yes just [01:33:53] Speaker 8: two brief um approaching you with your records from october 21st 2022 the section uh labeled speech where there are all the boxes where you can put pressure towards salad all of the different things what do you check off for speech on october 21st 2022 appropriate and defense asked you about the thyroid levels was it would it be accurate to state that i asked you if you were aware that her levels were normal celtier hospital and brigham and woman's hospital um yes and your answer was no correct no i was not aware because you don't have those records correct [01:34:35] Speaker 3: correct thank you do we have any clue as to how old they were i don't know you're asking me about [01:34:43] Speaker 7: something i never saw all right nothing further all right anything further all right thank you doc [01:34:52] Speaker 1: i want to know your thoughts on that i mean i get what dr tufts is saying but she meant not hyper pressured speech because somebody actually asked what is pressured speech anyway it would be probably kind of like a hyper speech a pressured speech would be when you have a lot of anxiety and you can feel someone's tone right like think about it i have to hurry i have this and this and this you're not yelling necessarily you can yell with pressured speech pressurized speech but you're like i don't know what to do and i have to do this and i have to do this and i'm running around and i and you can like feel the anxiety in somebody it's kind of hyper it's kind of pressurized so i do kind of believe dr tufts that she meant not hyper pressured speech not only that but she talks about lindsay in the same notes yawning and she talks about a flat affect so those would be the opposite of pressurized hyper speech hyper and pressurized could be combined so i do believe dr tufts and i do believe what she meant i think it's an interesting thing for the for kevin reddington to grab hold of you said that she had pressurized speech look here which i don't know how that would you know come into play but uh yeah you clearly tell that she was just done and she was like that is not what i meant not hyper pressurized speech but i saw varying opinions there um i was talking to grayson earlier about it and i think we had some varying opinions on it um i want to know what you guys think about this that's why i started with this because different people are seeing this differently and and was she a feisty witness or was she finally just done with cross and standing up for herself i'd love to know what you guys think in comments in chat right now but also in comments later so you know anyway someone said i don't care but that's what she wrote but look at your sentence i don't care that's what she wrote or is it i don't care that's what she wrote that one punctuation changes your whole statement you know um anyway and what would it mean if she did have pressurized speech that day would that change her treatment i don't know the final witness of the day was julie paul a psychiatric mental health nurse practitioner she spent 17 years as a labor delivery nurse so yeah i thought that was going to be just dr tough on the stand the entire day but no we get to julie paul another very important witness and she spent 17 years as a labor and delivery nurse earned her midwifery degree in 2006 and completed her psychiatric nurse practitioner degree in 2018. she also held a perinatal mental health certification from postpartum support international in 2018 she created the perinatal behavioral health program at south [01:37:55] Speaker 9: shore hospital take a listen and so um the perinatal behavioral health clinic um explain to us a little [01:38:04] Speaker 10: bit about how that came about sure there's a lack of resources on the south shore for perinatal for pregnant postpartum people with mood disorders so i really felt compelled because i had a couple clients that really struggled with mental health issues as a nurse midwife and really wanted additional education and be able to prescribe for them so and take care of them in a proper way so i went back got my second p and then worked with south shore hospital to establish the program and where was the program actually located it was located right in weemouth massachusetts and you said you worked with the [01:38:37] Speaker 9: south shore hospital correct so the clinic is is tied to south shore hospital in the south shore health system yes it is um now when did you start that program specifically when was it up and running 2018 is when i started in october of 2018. and what um did you do that by yourself or did you have other [01:38:57] Speaker 10: practitioners that were doing that with you initially it was just me i started doing it two days a week and then grew the program gradually over the next year or two and what um makes up this program other than you so at the time when it was just me i just saw patients two days a week and then gradually built up to five days a week and we included a therapist and the team two different prescribers we also worked with women with substance use disorders as well so we had additional support that way and then when the building grew we also had substance the bridge clinic on the other side and then we were on the other side of that program and what's a bird the bridge clinic the bridge clinic is works with people with [01:39:38] Speaker 9: substance use disorders and all of this is kind of under that umbrella of um what's classified as south shore behavioral health correct that's correct now as the clinic grew did you enroll their change i'm sorry can you repeat that as the clinic grew to what you described as having additional therapists and other prescribers on staff did your role there change at all i became the director of the program and um as director of the program did you still see patients yes i did and was that at the same level um as it had before or did it decrease because of your administrative roles it actually [01:40:17] Speaker 10: increased because i increased my hours to five days a week i did have a little bit of administrative time [01:40:22] Speaker 9: okay and um can you tell us a little bit about how the clinic would work for a woman who is coming in either um during the birth period or prior to birth and after birth what kinds of things would they be [01:40:39] Speaker 10: offered at the clinic so i'd receive a referral and then the client would come in he would do a 90 minute intake when they left um when it was just me it was i was using outside um therapists that sort of thing but as the program grew we had moms groups run by doulas we had um therapists that we brought in that was brought in from aspire but part of our program embedded within our program and i brought in the two additional prescribers as well as nursing staff and when you talk about um people as prescribers and your role [01:41:11] Speaker 9: as a psychiatric nurse practitioner who could prescribe what were you offering to patients as part of this [01:41:17] Speaker 10: clinic as a prescriber we were offering the proper medication for anxiety depression mood disorders really any psychiatric disorder that came in mostly for pregnant and postpartum people up to two years postpartum we also offered like therapy um focused on sleep hygiene really looked at the whole person [01:41:35] Speaker 9: not just medication management and fair to say that um the medication is one piece and the therapy is another piece and this is part of a team approach that you had at the clinic that's what address all these um resources for patients that's correct so while you as the psychiatric nurse practitioner might have been a prescriber you were you also engaged in um the therapy or psychotherapy i would do [01:42:00] Speaker 10: supportive therapy but i'm not a therapist i mainly am responsible for assessing diagnosing prescribing but i also really understand the importance of sleep nutrition and exercise [01:42:16] Speaker 9: and so um being that you had a history of working as a midwife and working as a nurse in labor and and delivery do you have a lot of experience with uh moms or women who are in that postpartum period yes and how about um your experiences with um diagnosing and prescribing for women in that period do you have [01:42:35] Speaker 10: experience in that in the labor and delivery realm as a nurse midwife yes i diagnosed like labor and that sort of thing and even depression anxiety not to the extent of higher acuity psychiatric conditions [01:42:49] Speaker 9: but as a psychiatric nurse practitioner i did okay and as far as your role at the perinatal behavioral health clinic fair to say that your primary patient base was all going to be women who are either pregnant or after birth correct and a part of this team approach at the clinic um is it also to work on developing a treatment plan for patients when they come in correct and so what encompasses a treatment plan generally generally [01:43:22] Speaker 10: if it were a situation where we were um referring them for therapy then we would work with the therapist to kind of work bring in the client to figure out what their needs are and then really stress whatever the therapist works on certain aspects of the therapy that we kind of work together but in not in tandem kind of we talk but not to the extent we each are in our own disciplines okay [01:43:46] Speaker 9: and as far as the resources um that the clinic had available to you is it fair to say that um there are certain types of therapy for instance um cognitive behavioral therapy or dialectic behavioral therapy that are not necessarily encompassing with the social workers that you work with at the clinic [01:44:05] Speaker 10: our social workers primarily did um cognitive behavioral therapy we did group therapy for more social support what i did mainly was just supportive therapy okay and um would you oftentimes [01:44:18] Speaker 9: through the clinic refer clients out to other local community providers yes we would know um as the psychiatric nurse practitioner um is medication play an important role when you are dealing with a particular patient that came into the clinic yes it does play a role and how is it that you determine what's the appropriate um medication track for any given patient we do proper [01:44:45] Speaker 10: screening and then we do in a complete interview with the client and then based on what their responses are together we work as a team to develop the best medication options or treatment options for that [01:44:56] Speaker 9: client when you say work as a team does that include the patient themselves absolutely the patient is [01:45:01] Speaker 10: the most important part of the team [01:45:08] Speaker 1: so paul as many of you mentioned in that in the chat yes she knew susan clancy or knows her patrick's mother since she worked with her as a midwife because patrick's mother is also in in care and nursing so on november 20th 2022 susan susan clancy contacted her saying that her daughter-in-law lindsay was struggling postpartum so after confirming lindsay had given permission paul called her that same day and the purpose was to hear lindsay's own account her history symptoms and whether she'd be a good fit for the clinic lindsay said that she'd done well for the first 12 weeks after calen's birth but then when patrick returned to work she began struggling with anxiety she felt overwhelmed and had racing thoughts all things paul said were typical postpartum experiences lindsay said that she had seen a psychiatrist and had gone to the south shore er in november november 2000 2006 it was november 16th to be exact 2023 she reported trying zoloft for one week using ativan and benadryl for sleep having questions about buspar and being prescribed trazodone after the er visit and she said ativan and benadryl helped she worried about dependence and had weaned herself off trazodone helped her fall asleep but not stay asleep she also said that she didn't want to be on long-term medications paul encouraged her to use what she already had which was ativan and benadryl just for that night and said that they would discuss other options the next morning they talked about ssris versus benzodiazepines and paul explained that ssris were preferable long term and throughout the call paul assessed safety lindsay denied suicidal ideation denied thoughts of harming herself or harming her little ones denied hallucinations and showed no signs of delusions she also denied drug tobacco marijuana and alcohol use and said that she had stopped the breastfeeding paul scheduled an in-person intake for november 21st intakes are typically face-to-face unless there was a barrier and you couldn't make it in follow-ups could be virtual she only insisted on in-person visits if someone seemed confused disorganized or needed labs or drug screens at the intake lindsay met with a nurse for screenings and then spent an hour with paul and her main complaint was simple she could not sleep paul said that was extremely common postpartum so she has a typical symptoms that she is displaying lindsay said she felt overwhelmed at home with three children and that her anxiety had increased around 12 weeks postpartum she had similar anxiety after her second child she had managed it with breathing meditation and yoga so she was practicing some mindfulness she said that she had tried one one cbd gummy but it did not help they reviewed her psychiatric history zoloft ativan uspar and earlier use of prozac propranolol and wellbutrin in college which she said it worked aside from some sexual side effects she said that she'd planned to return to work in october but delayed it due to this anxiety so paul performed multiple screenings she did perform the eidenberg postnatal depression scale the gad7 the mood disorders questionnaire columbia suicide suicide severity rating scale and the 5 ps for substance use lindsay scored 21 out of 21 on on the g87 extreme anxiety and 23 out of 30 on the eidenberg scale 23 out of 30. so in other words the self-harm question was the only negative question there were no substance abuse use concerns paul recommended starting prozac since lindsay had responded well to it in the past she prescribed 10 milligrams for four days and then planned to increase to 20 milligrams she paired it with ativan temporarily to offset early ssri activation and explained that ssris take four to six weeks to reach therapeutic levels they discussed tapering ativan once program prozac settled the lindsay understood the plan and asked appropriate questions according to paul paul also set her up with cognitive behavioral therapy or cbt throughout the clinic with leticia duke scheduling the first appointment for december 2nd the intake lasted 90 minutes total paul told lindsay she would soon be leaving the clinic because she was moving back to new hampshire so her care with paul would be short term she transferred lindsay's care on november 30th and communicated that through my chart before the transfer they exchanged several my chart messages and a few phone calls and from there buckingham moved into the medication change period the part where lindsay began struggling with prozac and paul had to adjust her treatment in real time [01:50:24] Speaker 9: okay so on november 25th did you um prescribe her some additional medications [01:50:30] Speaker 10: i did so she wasn't tolerating the prozac so we had a conversation about stopping the prozac i gave her she was really having a hard time sleeping so i gave her a one-time dose of ambien and then i also prescribed mirtazapine which is another antidepressant but it works really good for sedation and anxiety so it started that at 7.5 milligrams told her to stop the prozac and i also paired it with clonopin but i told her explicitly not to take the ativan just to take the clonopin to help its longer acting benzodiazepine to help her with sleep and longer acting anxiety support when [01:51:07] Speaker 9: well we got this new medication up and running and so um in your conversations with her about her concerns about the prozac um fair to say she reported to you that she was feeling disconnected out of it a little bit spacey does that sound right yes that's correct and so you said your recommendation at that point was to discontinue the prozac correct and as far as the prozac went um she hadn't taken it for very long had she she took it for three days three days correct and um again you had that conversation with her about kind of waiting it out for the four to six weeks but based on what she was reporting to you did you have any concerns about her stopping the prozac after [01:51:47] Speaker 10: only three days she when a client doesn't have buy-in to the medication it's awful it doesn't work as well so i was working with lindsay to try and find a medication that would make her feel more comfortable she was feeling very uncomfortable very anxious and the prozac she just wasn't tolerating the activation from the prozac so mirtazapine is a little bit more calming which i [01:52:08] Speaker 9: thought she would resonate with better okay and um so again this is not one of those follow-up visits on a telehealth or a face-to-face so um were you relying heavily on what she was reporting to you yes and um again in that my chart message you did indicate to stop the prozac benadryl and atafan and don't take while taking clonopin right correct and in your practice as a psychiatric nurse practitioner who prescribes medication is it common that you have to kind of trial different medications to find the right one to work for any given patient yes it's pretty common practice in psychiatry and for to say there's no way to anticipate how a particular patient is going to respond to any particular treatment medication treatment correct so after um prescribing the clonopin clonopin the mirtazapine and giving her that single dose of ambien um did you do anything or or um set anything up to follow up with her after um changing those [01:53:24] Speaker 10: prescriptions i just told her to keep she can my chart message me over the weekend it was the holiday weekend so i made sure she knew i was available to answer her questions and fair to say she did in [01:53:35] Speaker 9: fact um my chart you send you my chart messages over the course of that weekend correct yes and so um starting at 751 on november 26th um she reported to you kind of how that night went didn't she yes where she said i did better last night i took 7.5 mirtazapine and 0.5 clonopin at bedtime slept fairly well on and off until 3 45 and then she asked do you think increasing the mirtazapine will help me stay asleep longer i can survive like this but would be helpful to get to sleep until at least five thoughts thank you lindsay yes did you respond to that message i did and what did you advise her to do when she asked about increasing the mirtazapine and wanting to stay asleep longer i said she could trial the 15 milligrams and again is that something that is common for you to do in prescribing that maybe you have to adjust the dosage dosage yes did you have any concerns that increasing the mirtazapine up to 15 would have had any issues or problems no and then again on on november 27th you had a correspondence with her starting at 9 59 a.m where she again reports to you how she did that night is that something you encouraged her to do to just give you a nightly or like a follow-up the next day check in to let you know how she was or what she was experiencing by way of symptoms i do that with [01:54:59] Speaker 10: a lot of clients that are really anxious i like to make myself available to them so that they have that reassurance okay um so this wasn't this wasn't kind of unexpected it wasn't out of the ordinary for me [01:55:11] Speaker 9: and so on the 27th she um indicated she slept well taking the 15 mirtazapine and a 0.5 clonopin feel rested but super disconnected with myself in reality and describes it was a scary feeling thinking of stopping clonopin tonight and just taking the mirtazapine do you recall that i do communication and um she acknowledges that i've only taken it two nights so that it should so that should be right okay or sorry i've only taken it two nights so that should be okay right do you recall her asking that [01:55:43] Speaker 10: she's referring to the clonopin and yes she did she was really anxious about being dependent on benzodiazepines so i think her goal was to not be on them and if she was gonna she the disorientation might have been because of all the sedation from the mirtazapine which is a common side effect which is why we chose that and she knew that um and adding the clonopin maybe removing that might have helped [01:56:04] Speaker 9: with some of the sedative factors for so did you find there to be any issues with um stopping the clonopin or or her deciding not to take it after two days no i did not and in fact you indicated and told her that would that should help with the disorientation right yes it might okay um and so that was on november 27th and fair to say that there was another communication vmi chart on november 28th with lindsay clancy yes there was and um at this point she was asking for um or there was some back and forth about needing a note for work correct correct and is um that's something that you had talked about with her about um getting another note for work yes that's what i do that often and in fact um you kind of went back and forth with her and ultimately she said never mind that she didn't qualify for short-term disability anymore and she's just going to be on personal leave correct so on the 28th there was no back and forth about her um taking the medicine and the effects or how [01:57:19] Speaker 10: she was feeling she actually had a panic attack earlier in the day before those communications about work and i recommended she take 0.5 of adam and go for a run and i also recommended that she considered doing the partial hospitalization program at women and infants and um what was her response to [01:57:36] Speaker 9: the recommendation for the partial hospitalization program at that time she felt it wasn't going to work [01:57:40] Speaker 10: logistically for her or her family okay and why did you um recommend maybe going for a run to get rid of some of the adrenaline from the anxiety and running has been a really good thing for her in the past and [01:57:51] Speaker 1: i thought it would help calm her yeah fascinating so on november 29th lindsay messages at 6.05 am saying that she had taken 15 milligrams of emiron and cbd and slept only slightly better well paul wasn't working that day but rebecca gelada had an opening so she offered the appointment right she said that she was already in the process of transferring her patients to rebecca and another new hire and rebecca's experience made her a good fit so by november 30th paul formally transferred lindsay's care lindsay's care lindsay thanked her and wished her luck paul said she had no further contact with lindsay after that and no additional communication with susan clancy beyond the initial referral and that is where the judge ended for the day telling the jury that did pick up with cross examination of nurse paul in the morning which i suspect will also be fire because we've been hearing we've been hearing a lot um i think that about the defense's defense right if this is not guilty by reasons of insanity insanity um her mental health is everything and so i'm sure that cross tomorrow will also be fire and we will be here to follow it all follow it all i pinned a few things that i want to talk about um thank you for your thoughts thank you everyone so i see some people that said that their opinions have changed about this case that's fascinating i think one thing that i'm learning i'm just going to talk about me all i can do is talk about me but and i'll share some of your thoughts thoughts is it's very clear to me that lindsay clancy was suffering with mental health now that's not an excuse there are a lot of people who commit crimes with mental health that um are not excused for that but it is clear that she was suffering something unique uh to me and very severe um that there was a lack of communication between doctors that perhaps lindsay didn't fully understand the depth of her mental health i think that's common or perhaps she didn't want to share everything because of shame you know i don't know this comment i want to read so i think it's interesting nurses are taught to compartmentalize to do their job lindsay probably compartmentalized for emotions and moods for as long as she could socially and at home i think that it was in lindsay's nature to just try to stay calm right to just kind of be calm i watch her parents in the courtroom um and of course it's very very sad for them to be there i can't imagine them ever showing any emotion that isn't you know sadness or despair it's so sad whether they're there but it's a very flat affect from them as well and um lindsay is either in tears or has a flat affect i think that when we watch old videos of her i think that you're right i think she is a stable steady person she likely was not fully grasping what she was experiencing right there's also the fear of people taking your children away or of being a bad mother if you say i want to harm my children i don't i don't know but i think what i do know or feel confident in right now with me looking at the evidence is that she was suffering deeply from mental illness and she was desperately trying to get help that's where i am um anyway a lot of people that are in the in this you know just because a test exists does not mean you need to use it some people thinking this doctor is severely responsible other people thinking that she was doing her job uh a lot of a lot of varying comments um will she testify or should lindsay clancy testify i don't think she should personally um no i don't think she should one thing that i thought was interesting too was patrick clancy's description of lindsay being a zombie that is that is something other than herself right that is somebody that gets up without feeling and goes to the emotions of what she's supposed to do when she wakes up and is not her right it's like saying like my wife is not in there that is a description that catches me him saying that she's a zombie a zombie what are your thoughts um reddington i i'm very interested varying opinions and whether he's going to make the jury angry or whether he's simply defending his client um or if he's rubbing the jury the wrong way varying opinions here he fiercely defends lindsay that's for sure um fiercely even you know touching her on the back comforting her i think he does a really great job like i said framing things you know that the tv is the telehealth the um he kept saying that she said that she was an expert in postpartum i went to the website and she does list expertise areas with bullet points and then in the specific sentence she says she has an interest in postpartum yes expertise can be expert if you are an expertise in something usually an expert but i do think it's a little bit more abstract than stating on a website i am an expert so i'm not saying that it doesn't mean expert but it's certainly a little bit more abstract the website than reddington explains it and another way he framed something that was really interesting was kept saying it's an ad you're advertising your services and she said well this is i i don't know this is my bio that is on our company's website you know a bio but it's an advertisement so he does have a way of using these sort of words and framing things in a way that kind of i think confuses um people or the jury um you know so i also people have mentioned his his age 74 he is still he's he seems sharp and he seems ready to defend lindsay i'm certainly curious what the jury is thinking also i also want to address i did an interview this weekend and with susan smith's prosecutor if everyone remembers susan smith a woman who killed her two children and she did not get the death penalty and she was even up for parole she's in her 50s and she was up for parole two years ago so this same prosecutor had a stand before a parole board 30 years later and uh state why she should stay behind bars and she was not she was not given parole and he'll have to do that every two years now from now on susan smith a woman who lied on public television saying that a black man had hijacked her and taken her children and ultimately she let them drive into john d long lake and they drowned her two little boys michael and alexander and before that i had interviewed andrea yates defense attorney and i got more pushback by interviewing susan smith's prosecutor and saying that there were some similarities in this case um ultimately the similarity is that these two women killed their children and have confessed to that and have admitted that there's there's no other person to blame susan smith confessed so susan smith's trial was also a why done at trial with very different circumstances and i pointed out the very different circumstances i'm just wanting to explore things during this trial a lot of people comparing this case to susan smith a lot of people comparing this case to andrea yates so i found attorneys on both cases to discuss so we can learn the differences and see how we feel about the evidence presented so far and none of them have the very specific evidence that we've seen so far in lindsey clancy's case it's unique [02:06:59] Speaker 6: but [02:07:01] Speaker 1: no susan smith was not found to be suffering from postpartum she did have a 14 month old was one of the victims and the defense argued fiercely um susan smith's mental health and that i think is what saved her from the death penalty but susan smith also did some things i want to point out that lindsey clancy we have not seen in the evidence at all susan smith lied to the public tried to blame somebody else for doing this had an elaborate story sort of like emmanuel harrow for those that followed that case she manipulated the public she she stayed and kept that story for nine days nine days she um she was a very very manipulative person she talked about her children crying for their mother and ultimately the prosecutor believes as do i that she probably did experience that because it took the car a long time to to drown in the lake that it wasn't sudden that it floated for a little bit so i do not believe after that interview i do not believe that lindsey clancy is another susan smith i don't at all andrea yates on the other hand a woman who was actually found guilty at her first trial and then at a second trial find found not guilty by reasons you know of insanity um i don't know if lindsey clancy fits her exactly either that there was um she had a bald spot in her hair that she was trying to rub out 666 there was a massive religious component that her eyes had no pupils her attorney explained so that she was completely glazed over she too had been getting a lot of mental health five children five lost so i shared these interviews for people to just explore not for a point not for an agenda um but because these are the cases that people have been discussing i see right now from what i've seen so far we've only heard from the prosecution i'm seeing more similarities with andrea yates and susan smith but um lindsey clancy is her very own unique case and um the defense strongly strongly believing not just the defense but her family and patrick with his non-profit believing that this was a psychosis of sorts that she was a wonderful mother and she was mentally ill and this was horrific one [02:09:40] Speaker 6: one second lily lily wants out of the studio one second i can't reach the door okay we can do this we can do this okay go ahead okay when lily is free [02:10:13] Speaker 1: that is interesting you're right andrea yates did wait until an hour where she was left alone with her children right because she was having her mother-in-law coming over and helping with the children because she was not doing well and in the one hour she was waiting for her mother-in-law that's when she did it you know um also andrea yates is a defense attorney saying that um he still considers her a daughter talks to her often visits her and even let her know about the interview where she was supportive so that we could talk about these issues of postpartum mental health so um so if there's any other interviews or cases that you'd like us to explore while we are following lindsay clancy let me know let me know because i think that the more we understand this case the better and i'd love to do some more interviews so let me know um yeah i think so learning the differences in these cases is incredibly important um yeah i don't know where you guys are but as far as the prosecution goes they haven't shown me much more of a motive oh the other big thing with the susan smith case is the motive right that she was in love with somebody having an affair and this person didn't want children so he was ending this affair so there's another motive there in lindsay clancy case the prosecution's brought no other motive here except for that she was mentally ill um i'm waiting for the prosecution to show more and i i haven't seen anything yet even her journal says she wants to to connect more with patrick and that he deserves that and she's feeling sorry for him and wants to [02:12:04] Speaker 6: connect to him but i am waiting [02:12:16] Speaker 1: people are asking how grayson is doing um she's hanging in there it's been very difficult she's been with family and i believe that helps and so thank you for all your well wishes while she is experiencing a tragedy in her life and thanks to everyone who's noticed the new background it's a work in progress some people saying it's a little red behind me we're going to be working with lighting and some bookshelves and some other uh things but we are we're giving our studio here a little glow up so thank you for those that have noticed [02:12:51] Speaker 6: yeah let's see what else you guys are saying [02:12:59] Speaker 1: right motive is not required it's intent that matters in this case this is again a why done it case like motive you don't have to prove motive but yes it would certainly help in this case right if [02:13:09] Speaker 6: if the prosecution at least [02:13:12] Speaker ?: i think [02:13:21] Speaker 6: what else have you guys said thank you to the people [02:13:29] Speaker 1: all of a sudden i got a i don't know if it was i got a vocal fry or the witness did but i mean i can talk with a vocal fry if you guys like that i can but i'm not going to no hair bow today i do wonder if maybe the pushback is perhaps why i'd be very curious as to why no hair bow it's not the only day she hasn't worn a hair bow there have been other days the prosecution of buckingham has not worn a hair bow so this isn't her first day not wearing a hair bow but it is interesting to know that she's not wearing one oh yeah a lot of conspiracy theories about patrick so many that [02:14:31] Speaker 6: i've had friends reach out that have been following this case [02:14:37] Speaker 1: asking are the things about patrick true you know what are they saying about patrick in court and the bottom line is nothing and the one thing that i heard while i was in court as you know that i'll never unhear is this 911 call and let me just explain patrick in it because we have the knowledge of what's going on in the house and patrick is staying with lindsay you feel yourself getting very anxious or i got very anxious because i did not realize how long he stays with lindsay before checking on the children it was actually a very large amount of time and you're you're anxious because you're like go check the kids go check the kids you want them to do that and you know what he's about to find but i can say this he had no inkling he had no clue it didn't even cross his mind that she might have done something to the kids that much i'll say and that 911 call made it clear he had no idea it had not even been a thought what if she did something to the kids he thought he was going to run down and find the kids after helping his wife he had no idea so and right if patrick had been you having an affair they would have been using that as a motive right there's no there's no affair um also people surprised he's remarried right now it's been three years so much can happen in three years you know um that doesn't seem fast to me if it'd been six months or one year i don't understand the oh it's so fast that he's been remarried um i don't he's a family man he suffered the loss of his entire family it seems like he has found love again with a doctor and i'm happy for him thank you for sharing the studies have shown that severe psychosis is entirely absent in the vast majority of the right right in school um you know what john has uh dr john has discussed the difference the differences and we'll certainly ask him many of you are asking for dr john's opinion yes he is catching up yes he has things to say yes we're going to be doing a few shows so stay tuned um this week because we will be hearing from dr john criminal psychologist on uh this channel so thank you thank you to those who like this video thank you for those who subscribe who support us um it means so much we couldn't do this without all of you thank you to our moderators they're amazing these trials are are crazy aren't they like the going live and the the moderating and the following our moderators are just incredible and thank you to everyone for the really um profound comments that i'm seeing and pasting and sharing um what you feel i agree with this defense is setting the stage for the defense case i bet we see tufts again so do i i think she'll be back on for the defense but maybe not maybe he he maybe he is satisfied with what she shared today who knows you know defense prosecution is quite the game of cat and mouse right if he brings in tufts again they get to cross-examine her again so maybe he'll be content with what they did today thank you for watching from sweden [02:18:27] Speaker 6: all right [02:18:30] Speaker 1: okay i think we're good thanks you guys right patrick was clearly in utter shock never suspected it i'll just share that thank you for sending your care for our producer she's going through a lot thank you all right you guys are telling me to go rest thanks i will i will go rest i appreciate it thank you everyone for being here um until tomorrow we'll continue following every bit of this trial and check out our like i said our episode on both with susan smith's prosecutor and then andrea yates defense attorney i think both really interesting points shows how they differ and how they're similar in these cases all right we'll see you everyone bye bye