# Commonwealth v. Lindsay Clancy - complete trial transcript, compressed All 22 trial days in one file, 10,197 speaker turns, compressed from the 2,061,817-token published archive to ~180k tokens (fits a 200k-token context window). Source: public Rev transcripts at lindsayclancytrial.com/transcripts, retrieved 2026-09-08. Reading the format - `TAG:` is the speaker; tags are listed below. `[Q=X A=Y]` opens an examination stretch, so following `Q:` lines are X and `A:` lines are Y until the next header, tag or day heading. - `[m:ss]` / `[h:mm:ss]` lines reproduce the source reader's timestamp verbatim, emitted every 15 turns as a locator back into the published day page. The source mixes clocks between video parts, so they are not elapsed time. - Utterance text was compressed with Microsoft LLMLingua-2 (llmlingua-2-xlm-roberta-large-meetingbank) at rate 0.45: low-information words are deleted, surviving words keep their original order and spelling. Digits and the 98 most frequent case entities (names, places, drugs, dates) are force-preserved, so every mention of them survives. Grammar is broken by design and function words are often missing. - Turns of 6 words or fewer ("Yes.", "Objection.", "Sustained.") are verbatim. Speaker tags, turn boundaries and timestamps are verbatim. - Nothing is paraphrased or summarised: surviving wording is source wording. Absence of a word does not mean it was not said. - To fit this budget, 25,368 of 35,565 turns were dropped: courtroom ritual ("all rise", swearing-in, "watch your step"), bare acknowledgements, then the lowest information-density question/answer units. Rulings, objections, verdict, exhibit references and the defendant's own turns were protected. Per-day headings state how many turns survived, so gaps are visible. ## Speaker tags - REDDINGTON = Kevin J. Reddington - BUCKINGHAM = Shanan Buckingham - SPRAGUE = Jennifer Sprague - COURT = Judge William F. Sullivan (the bench) - TUFTS = Jennifer Tufts - P.CLANCY = Patrick Clancy - MACK = Avram Mack - PROSECUTION = Prosecution, speaker not attributed in source - JOLOTTA = Rebecca Jolotta - CLERK = Clerk / court officer reading the docket - WITNESS = Witness, name not attributed in source - HEILBRUN = Kirk Heilbrun - CONDIE = Donald Condie - GOODHEART = Alia Goodheart - DUKES = Latiesha Dukes - CHIAPPINI = Timothy Chiappini - SPK1 = Unidentified speaker (source label kept) - WHIFFIN = Ian Whiffin - SPK3 = Unidentified speaker (source label kept) - PAUL = Julie Paul - AMEDEE = Rachelle Amedee - NEGRI = Eitan Negri - HARTNETT = Maureen Hartnett - PAVAO = Kevin Pavao - MCDONOUGH = Kelly McDonough - ROSSI = Elaine Rossi - S.CLANCY = Susan Clancy - SHAH = Sejal Shah - LAWLER = Dan Lawler - MAFFEO = Mark Anthony Maffeo - SPK37 = Unidentified speaker (source label kept) - SPK40 = Unidentified speaker (source label kept) - ZEIZEL = Paul Zeizel - SAATHOFF = Gregory Saathoff - MUSGROVE = Paula Musgrove - RESNICK = Phillip Resnick - BISWAS = Jhilam Biswas - HALL = Stephen Hall - THORNDIKE = Emily Thorndike - SPK10 = Unidentified speaker (source label kept) - SPK4 = Unidentified speaker (source label kept) - COUNSEL = Counsel, side not attributed in source - C.CLANCY = Christopher Clancy - SPK17 = Unidentified speaker (source label kept) - RABBITT = Joseph Rabbitt - CARPIO = Christina Carpio - LAPOSATA = Elizabeth Laposata - BEVINS = Amy Bevins - JOSEPHINE = Brian Josephine - DOUGHERTY = Daniel Dougherty - GRIFFITHS = Hillary Griffiths - SPK5 = Unidentified speaker (source label kept) - SHELGREN = Saria Shelgren - OLSON = Barbara Olson - CAVANAUGH = Sheila Cavanaugh - DWYER = Patrick Dwyer - COLLINS = Meghan Collins - S.CARNEY = Sarah Carney - OLOUGHLIN = Jonathan O'Loughlin - COSTANZO = Robert Costanzo - CHIACHIO = Andrew Chiachio - MELO = Cory Melo - MCKELLIGAN = Joshua McKelligan - HARDY = Kimberlee Hardy - HUSSEY = PJ Hussey - OZGA = Allison Ozga - SPK20 = Unidentified speaker (source label kept) - NUDD = Loring Nudd - SANTOS = John Santos - SPK2 = Unidentified speaker (source label kept) - STASHYN = Katarina Stashyn - ROBERTS = Nicholas Roberts - SPK6 = Unidentified speaker (source label kept) - NETTE = Keith Nette - LAWLOR = Lawlor - CASAVANT = David Casavant - STOFFERS = Rose Stoffers - STRATTON = Jennifer Stratton - VOLFOVICH = Michael Volfovich - SPK24 = Unidentified speaker (source label kept) - KRAUSE = Angela Krause - CAHILL = Vincent Cahill - HAMP = Margaret Hamp - SPK14 = Unidentified speaker (source label kept) - SNYDER = Michael Snyder - YELLE = Lisa Yelle - ZIMMERMANN = Alicia Zimmermann - CARNEY = Kyle Carney - SPK9 = Unidentified speaker (source label kept) - CAPRARO = Andrew Capraro - SPK7 = Unidentified speaker (source label kept) - TENEROWICZ = Mark Tenerowicz - JANAE = Julia Janae - LIPPARD = Richard Lippard - CROOK = Sherri Crook - L.CLANCY = Lindsay Clancy - DALEY = Cameron Daley - STONEBRIDGE = Renee Stonebridge - ARCADIPANE = Melissa Arcadipane - SPK8 = Unidentified speaker (source label kept) - SPK11 = Unidentified speaker (source label kept) - SPK18 = Unidentified speaker (source label kept) - JURY = Jury / juror - SPK41 = Unidentified speaker (source label kept) - KAUFMAN = Benjamin Kaufman - FLYNN = Robert Flynn - SPK38 = Unidentified speaker (source label kept) - SPK12 = Unidentified speaker (source label kept) - SPK42 = Unidentified speaker (source label kept) - FARIOLI = Mark Farioli - SPK23 = Unidentified speaker (source label kept) - SPK22 = Unidentified speaker (source label kept) - BRADLEY = Nicole Bradley - SPK16 = Unidentified speaker (source label kept) - CALCIO = Calcio - SPK19 = Unidentified speaker (source label kept) - OCONNELL = Leah O'Connell - SPK15 = Unidentified speaker (source label kept) - SPK13 = Unidentified speaker (source label kept) - AUSTIN = Terri Austin - SPK21 = Unidentified speaker (source label kept) - NIEVES = Joanna Nieves - SPK35 = Unidentified speaker (source label kept) - SPK25 = Unidentified speaker (source label kept) - SPK27 = Unidentified speaker (source label kept) - SPK43 = Unidentified speaker (source label kept) - SPKX = Unidentified speaker (source label kept) - SPK34 = Unidentified speaker (source label kept) ## Day 1 (407 of 1229 turns kept) [00:00] REDDINGTON: Yeah. CLERK: morning Your Honor. proceed? CLERK: court today jury trial Commonwealth versus Lindsay Clancy Ms.Clancy present represented by Attorney Kevin Reddington Commonwealth represented by Assistant District Attorney Jennifer Sprague Assistant District Attorney Shannon Buckingham Honor COURT: Thanks Thank you technology apologize ask couple questions instructions last week first question member jury read seen heard overheard case affect ability fair impartial as juror? answered no negative. Number three last question any other serious matter concern service juror attention? Thank you for instructions Madam Clerk? CLERK: seated. Members jury indictments Docket Number 2383CR00198, Offense charge of murder jurors for Commonwealth of Massachusetts present Lindsay M.Clancy of Duxbury county Plymouth January 24th, 2023Duxbury Plymouth assault beat Cora Clancy to murder kill murder Cora Clancy Docket Number 2383CR00198, Offense charge of murder jurors Commonwealth Massachusetts present Lindsay M.Clancy of Duxbury county Plymouth January 24th, 2023Duxbury Plymouth assault beat Dawson Clancy intent to murder kill murder Dawson Clancy Docket Number 2383CR0019 Offense 003 charge of murder jurors Commonwealth of Massachusetts present Lindsay MClancy Duxbury county of Plymouth January 24th, 2023Duxbury Plymouth assault beat Callan Clancy intend murder kill murder Callan Clancy indictments defendant bar pleads not guilty trial places country you sworn try issues If guilty say so not guilty say so no more. Members jury hearken evidence COURT: Thank you,Madam Clerk. members of the jury, first time I can call you members jury you don't become jury in this case. take that great oath given. oath given to jurors for hundreds of years in Commonwealth Massachusetts you've sworn to try this case. We confidence you're to do that. give a pre-charge orientation procedures case goes forward terminology idea principles of law apply to facts. explain it after into opening statements of counsel criminal case defendant charged by indictment on three counts indictment not evidence of defendant's guilt formal way of accusing person of crime to bring her courtroom for trial not draw inference of guilt from indictments or charged. in every criminal case defendant presumed to innocent unless until proven guilty beyond reasonable doubt. law requires Commonwealth prosecution to prove defendant guilty beyond reasonable doubt. law not require defendant to prove innocence or produce evidence. end of trial must find defendant not guilty unless Commonwealth proved beyond reasonable doubt defendant committed each or offenses charged.I'll formally instruct reasonable doubt later charge proved beyond reasonable doubt if after compared considered evidence abiding conviction moral certainty charge true your duty jury to determine Commonwealth proved case against defendant beyond reasonable doubt decision based on evidence law courtroom during trial defendant charged three counts of murder two degrees of murder first second degree If find defendant guilty of murder decide degree murder Commonwealth alleges defendant committed murder first degree theories deliberate premeditation extreme atrocity or cruelty to prove defendant guilty Commonwealth must prove beyond reasonable doubt defendant criminally responsible time crime committed Commonwealth bears burden proving defendant committed crime charged defendant criminally responsible conduct defendant no burden to prove lack of criminal responsibility Criminal responsibility legal term person not criminally responsible if mental disease or defect lacks capacity to appreciate criminality or wrongfulness conduct or conform conduct to requirements law end of trial go over legal principles greater detail outline of law on charges over how trial proceed done pre-charge attorneys Commonwealth and defendant present opening statements.Commonwealth goes first.Assistant District Attorney opening for Commonwealth. after defense may choose to make opening statement. could defer to give later in trial or not give opening burden of proof not on defendant After opening statements. opening statements important but not evidence just roadmaps. see where case going see each party's position not evidence important for to keep in mind. After opening statements Commonwealth opportunity to introduce evidence in support of charges. After defendant may present evidence in her behalf but not obligated. Remember government Commonwealth has burden of proof defendant doesn't have to produce evidence case may be some rebuttal evidence.'ll go over case when evidence? evidence is generally from testimony. witnesses testify from. may some documents videos audios. in addition to evidence we to take a view. view go to number of spots and sites relevant in case probably sometime later this week or next week. keep advised check weather and how we to go. generally evidence. After evidence done go into closing arguments of attorneys.important, not evidence? after closing arguments I talk to you again I give judge's charge instructions I explain the law you take facts find during trial apply law I to arrive at verdict. I'll explain law more detailed at end of trial go over everybody's function in trial My function simple to see case is tried orderly, fair efficient. function to decide on questions of law during trial instruct you what law you to apply. your duty as jurors to accept the law your function to determine facts You are sole exclusive judges of facts You determine what evidence to believe important evidence what conclusions believable evidence leads to consider weigh testimony of witnesses you determine whether to believe witness extent believe witness your responsibility to resolve conflicts testimony during trial your duty to determine where truth lies your function. comment sometimes making rulings on objections evidence issues talking to attorneys to witnesses.Don't try to read into what I'm doing.no opinion your verdict if you think trying to read between lines don't no opinion. during trial may hear three lawyers objecting Don't hold against attorneys. their job generally objections go towards admissibility of evidence or questioning. might different form needed they supposed to do. don't hold against either side if making objections sometimes I'll rule from here. may be objection. If say sustained means agree with objection question asked different way. If say overruled means disagree with objection question can go forward answer be given shorthand we use. times during trial to talk to counsel at sidebar. sidebar over here In this courtroom sidebar talk to counsel here because law requires make decisions outside hearing we do that over here annoying But here quicker than if leave courtroom file out one by one to jury room court officer says all in jury room." Then talk to lawyers resolve file back quicker. things move case along. apologize if we doing them but that's reason we do it.reason we do it in courtroom. If doing sidebar conference if to stand up stretch bad back comfortable chairs maybe sitting there for while do that. at sidebar don't discuss with other jurors if to stretch, can. if during trial communicate let court officer know they'll let me know I'll talk to attorneys deal with concerns issues until case submitted after final instructions not discuss with anyone even fellow jurors or family friends employees important keep open mind not decide case until entire case submitted case gets going harder even in jury room can't start deliberating until hear all evidence can start talking evidence know law apply allow you case goes forward to take notes take notes can don't have to Some find helpful remember Some distracting up to you your option notes are your notes can't let take them home at end of each day they're collected put in secure place Nobody reads them attorneys don't At end of trial they're destroyed some people if hand out in couple minutes.Now want to go over cautions to start trial First keep open mind.Don't form judgments conclusions views aspect case. haven't heard all evidence keep open mind throughout case until case given deliberations. Two don't talk about this case with family friends acquaintances Three don't talk to witnesses parties attorneys involved. They instructed not to talk. want you be comfortable if you pass by involved if they don't say anything don't hold it against them Don't think they're not respectful following instructions want you be comfortable throughout trial another caution during serve on jury may be reports about case in newspapers social media television may be tempted to look or listen.Don't do instruction do not read anything about case Don't listen to anything. If something turn it off. if talking say can't talk blame me. sometimes during trial evidence presented produces emotional reaction might happen in case as jurors to follow law law says separate emotional reaction from informational value weight of evidence find facts based only on evidence. remind Don't do research on this case.If questions about things go forward not to do independent research. we've three experienced lawyers. They'll get information need to right verdict. can't do research. don't visit scene of place described during testimony. no field trips. we may be taking view or see places later in trial only time should be there under supervision of court officers, court attorneys there only time allowed. reason for cautions clear need to ensure fair and just trial to all parties. if follow instructions schedule generally start at 9:00. go to 11:00. might be off kilter today procedures. Go to 11:00 then go till 1:00 break from 1:00 to 2:00 generally go 2:00 to 3:30 or 4:00 case may not be sitting every day may have to break early on certain days. try give much notice explain where we are as we go through case. not sitting tomorrow. Something up nothing to do with participants can't sit. thought hopefully go most of day today, then Wednesday, Thursday, Friday.week goes on I'll address for next week'll try to keep you up to date schedule progress on case wanted address in pre-charge instructions preliminary intended to acquaint with procedure framework of case forward. talk later in trial more detailed explanation of law obligations. you try case according to oath took as jurors promise try issues between defendant Commonwealth according to evidence law follow oath try case without fear prejudice bias sympathy you'll arrive at true just verdict. confident. have confidence in yourself You can do this lawyers and I asked questions decided chose you people make decision everyone has confidence in you have confidence in yourself sitting on jury delivering just verdict see if Commonwealth prepared to give opening statements.Commonwealth Ms.Buckingham? Sorry. CLERK: Thank you Your Honor. Morning ladies gentlemen.Cora turned five sweet silly smart loved sparkly dresses bows princesses baby dolls tried convince preschool teachers her name was Sophia loved Disney character Sophia the First Dawson he three boy's boy rambunctious funny full energy loved trucks construction trucks fire trucks spoke raspy voice Callan eight months old smiling chunky cheeks sweet baby here they strangled deliberately killed by defendant January 24th 2023 wrapped exercise bands around kids' necks pulled until bodies limp lifeless Dawson Cora Callan job not easy evidence difficult to see hear process Testimony of witnesses family friends teachers Clancy family heartbreaking You'll photographs crime scene You'll testimony from first responders Clancy home at 47 Summer Street Duxbury January 24th You'll evidence about defendant observations physical appearance demeanor You'll testimony friends family doctors list witnesses long Law enforcement firefighters friends family teachers crime scene investigators forensic scientists toxicologists medical examiners expertsexpect next weeks you present clear picture Clancy household January 24th 2023. ask keep open mind hearing evidence during trial don't use common sense life experience bring as jurors to courtroom take you into deliberation room end trial what happened? January 24th, 2023 recently snowed Tuesday. Tuesdays Cora and Dawson usually went to preschool attended Learning Sprouts Preschool Duxbury didn't attend Tuesdays this day were home day Cora, turned five had appointment at doctor's annual checkup defendant brought her morning to doctor's Defendant's husband Patrick Clancy home caring for Callan Dawson while defendant took Cora to doctor You'll Patrick defendant exchanged text messages Patrick sends photo of Dawson dressed jumping for joy text to defendant at doctor defendant sends text Cora Johnny mask to Patrick defendant Cora returned home Patrick went basement office work defendant caring for kids day put Callan down nap bundled up Cora Dawson took them outside backyard played in snow built snowman defendant sent pictures of snowman kids snow to Patrick working basement mom in Connecticut there weekend gone homeday proceeds normal You'll Patrick good day late afternoon 4:00 p.m. defendant searched for kids' MiraLAX Takeout Three V opened Apple Maps route house to Three V Restaurant Plymouth. time far restaurant family eaten before wasn't normal takeout spot called CVS asked about kids' Pedia-Lax MiraLAX doctor doctor recommended laxative for Cora stomach issues complained upset tummy school You'll issues didn't like go bathroom school embarrassed suggested Pedia-Lax she calls CVS confirms have it at local CVS in Kingston sends text to Patrick asks if wants takeout Three V okay didn't feel like cooking dinner long day He says "Sure." calls order Patrick leaves house 5:15 evening everything normal Dawson eating chicken nuggets green beans couch Patrick leaves to go Three V stop at CVS clock starts defendant knows Patrick stop at CVS go Three V five miles from house to restaurant knows approximately time to go come back takes children basement separates Dawson from Cora Callan exercise bands around each child's neck until deadleaves bands around child's neck goes upstairs kitchen she gets knife proceeds to second floor misses call from Patrick He at CVS She calls back talk 14 seconds Nothing concern to Patrick He proceeds task she proceeds She goes second floor master bedroom locks door crushes pills attempts to take own life uses knife wrists neck moves bed away from wall window opens window goes out lands on cold hard ground 6:00 p.m. Patrick comes home takeout bag CVS bag with medicine enters house mudroom kitchen places bags down quiet calls to kids No answer calls defendant No answer phone dials Lindsay defendant's phone No answer goes upstairs finds master bedroom door locked opens sees blood window open goes backyard finds defendant on ground outside window moaning mumbling 6:11 p.m. calls 911 for help First responders arrive still on phone 911 responders arrive backyard tend to defendant Patrick tells need to find kids." asked defendant where kids were in basement He still on phone with 911 finds each child with exercise band around neck screams for help says "She killed kids." Efforts to resuscitate Cora Dawson futile first responders Duxbury surrounding communities persistent kept resuscitate to hospital. arrived hospital nothing more medical staff could do for Cora Dawson. staff Beth Israel heartbeat on Callan never started breathing never regained consciousness no brain activity transferred to Boston Children's Hospital died three days later January 27th. defendant taken to South Shore Hospital transported to Brigham and Women's in Boston. had multiple traumas spinal injuries superficial injuries to wrists neck paralyzed. trial defendant claims after Patrick left house or called CVS heard voice male voice never heard before voice told last chance to kill kids kill herself took action voice no direction or details voice killed children. killed voice stopped. consider information trial consider source timing substance of her statements about voice hear from forensic psychologists psychiatrists about command hallucinations voices hear before testimony keep in mind details of voice details when voice spokeimportant remember trial not a case about Lindsay Clancy today. case about Lindsay Clancy on January 24th, 2023 time crimes. not woman in psychosis January 24th 2023. woman acted intentionally rationally swiftly to specific goal, to kill.You'll hear evidence about things she did that day days leading up to incident murders You'll her spending time with family friends You'll appearing in good spirits doing better day interacted with at doctor's office took care of kids talked to on phone via text message evidence not psychotic day defendant classic overachiever in school personal life nursing career. control every detail of life family's life. contrast to pictures doting mother dedicated nurse side of Lindsay Clancy different extremely controlling meticulous manipulative. days laid out with specificity Strict schedules Food planned Sleep scheduled minute. time after Callan born last baby family had to adjust summer was great after Patrick finished paternity leave back to work full-time no longer nanny watch baby laundry house hard for to maintain control bond with kids withheld information from husband doctors.reported serious symptoms inconsistent with daily activities January 24th, 2023 defendant made calculated decision woman no longer liked life harder to control saw opportunity to escape selfish choice to take it Cora Dawson Callan first before her own life not public debate about women's mental health medical system case about defendant Lindsay Clancy no dispute dealing with mental health issues prior to murders medical records doctors mental health professionals talk about treatment prescriptions hospital visits evidence defendant had means access to mental health chose to deal with mental health issues worst way manipulate providers quick easy fix didn chose alternate route sought different doctor changed medications disengaged from treatment plan After four months in treatment deliberate intentional decision want to try anymore no one care of kids had to take them with her Despite precision timing swiftness of killings overcoming interruption of Patrick's phone call anticipate complete act by killing herself people with mental illness commit crimes responsible mental illness not end of inquiry guilt or innocencewhether person appreciate wrongfulness criminality conduct conform to law know what doing control actions? evidence defendant executed first Dawson,Cora, finally Callan. strangled life each with no hesitation deliberate premeditation extreme atrocity cruelty criminally responsible for murders evidence knew what she doing drew husband out father opportunity time to carry out murders maintained control conduct conform conduct attempted to kill herself escape consequences conclusion case ask return guilty of murders of Cora Clancy,Dawson Clancy Callan Clancy, defendant committed crimes REDDINGTON: I do Your Honor might use easel placed in front of TV screen jurors [inaudible thank jurors for time away from life jobs family Coming to court listening to trial service provided by you as citizens in this case God people listen to horrific things jurors beautiful system pass between [inaudible language to old England jurors pass between government them she places herself on country owe allegiance to oath consideration time common sense bring life experience to trial render verdict jurors take job seriously people never forget this case thank you for service. Government says not referendum on women's having babies postpartum psychosis depression but is hear consistent with Honor instructions obligation government brought charge charge Cruz DA front brought charge knew facts of case charge kill soul of young woman bring evidence jury she knows killed children We'll listen to evidence issue of consideration is woman's mind hear evidence government said Lindsay was parent-pleaser. She person in school had friends friends You'll hear evidence from sixth grade high school college nursing school.hear evidence Lindsay in high school She was high-achiever gymnastics stopped gymnastics hurt herself didn't like back flips was very athletic. evidence after birth last child days ran a 5K physically fit Her life watched ate did life activities was mother. loved her children. DA said about kids life she knows 1,000 times more than they know as a mother daily evidence she decorate rooms she and Patrick achievement wonderful life met in Boston She was young nurse school He working in his industry in love got married bought nice house People say living in mansion. No living in humble house Duxbury to struggle to pay for house not view not enough photographs. photographs video auto-computerized animated display get on bus ride look at house guy and wife now living doesn't look like when Lindsay and Patrick living there with three kids videos show home looked like that day prior You'll in every room things hanging on walls alphabets colors numbers pictures of cartoon characters Movies toys erector sets trucks over living room no dining room.large thing for baby in surrounded by toys Every room had toys children loved nurtured cared for by her She didn't want to get rid of kids selfish life government indicates loved children to death. photographs in case evaluate show that Some in videos state police took case massive production by district attorney's office district attorneys assistant district attorneys assistants district attorneys state police crime laboratory detectives state police armed men interview witnesses investigate case victim witness advocate lady deals with witnesses massive operation considering evidence two young people living this life working. Patrick not because of COVID not didn't want to work in office worked out of basement in office basement there Lindsay lived it will testify to doesn't have testify identify distraught position horror courtroom testify to through as husband and wife wife pregnant had three kids After second child had postpartum hear evidence important could lead to bipolar.don't do taboo if somebody bipolar don't put them on antidepressant Zoloft SSRI selective serotonin re-uptake inhibitors. messes with brain. don't do but done in this case. reason. done Lindsay went to doctors in September 2022. July and August 2022 happy lovely family. September things went sideways. government saying remember opening prepare case point at aspects case to show guilt conniving. In this case she faked suicide. Little cuts, scratches in opening statement arraignment she asked for lawyer. evidence she was in bedroom after horrific act in basement stood front of full length mirror took knife kitchen cut her throat in mirror. no fake suicide. her when she brought to hospital hospital appearance at South Shore Hospital South Shore Hospital had wonderful care treatment against her will to save her life. Fake suicide, little scratches. photograph taken at South Shore Hospital of her neck wrist showing split in skin bedroom floor next to bed with blood. knife next to cup.gift saying kids white residue inside cup pills crushed with leftover lemonade night before knife sleep aids deep sleep pillow spray couldn't sleep for months photographs of injuries to neck fake suicide speculation police evidence hung on window ledge slid down wall house evidence flung threw herself out window striking head on ground causing Jefferson fracture of neck shattered exploded thoracic spine Shattered cervical spine first disc broke every rib Jefferson fracture not consistent with fake suicide consistent with Superman thrown off horse people tragedy dive into swimming pool fracture in neck paralyzed paralyzed not courtroom Paralyzed rest of life living own hell knows what happened with kids wanted to die in hospital evidence of Brigham and Women's Hospital transferred from South Shore Hospital into Brigham and Women's Hospital emergency room emergency treatment Brigham Women's Hospital couldn't move much equipment wires breathing tubes machines spread out like crucified on bed treated surrounded by armed police officersin hallway guarding hallway against what Guarding hallway room guiding bed She's handcuffed to bed goes to South Shore Hospital Government speculates facts she cold calculating said heard voices after brought psychologist Dr. Zeisel, room to see her had to move heaven earth You'll evidence they wouldn't let visitors couldn't see family for over a week cops wouldn't let her room was armed camp to move court order to see her in bed suggest she heard voices command hallucinations telling me to kill kids kill myself." After talked to Paul Zeisel lawyer brought him into hospital evidence Paul Zeisel respected psychologists embedded with military in Afghanistan works for government shooting FBI CIA cops involved interviewing people for post-traumatic stress he was man to talk to young woman in hospital room hospital he was with me not tell her command voices gave her cell phone call Patrick evidence from woman at Bergen Women's Hospital saw Lindsay of coma with religious services hospital first thing Lindsay wanted to know where's my family? told her about happened command voicesbefore she met me Paul Zeisel. keep focused on evidence easy to manipulate. no fake suicide no plan to fake her sickness. young woman with husband tried hard to get help needed saw doctor government says she shopped for doctors wanted to get give her drugs evidence she went online looked for neonatal post-baby delivery in trouble couldn't sleep had insomnia phone on sleep only two hours a night, three hours a night lucky In September went to see Dr.Tufts. Jennifer Tufts doctor Jennifer Tufts gave prescription for Zoloft, antidepressant SSRI didn't take Zoloft for weeks breastfeeding afraid to have baby have do with drugs couldn't do it longer Took Zoloft spun out of control evidence she was bipolar Zoloft got it effect on her week month couldn't sleep unable to emote no emotions feelings react had to take care of kids. government says she able to talk to people neighbors." do it because they don't call them. We're call them.People knew Lindsay as mother Lindsay teachers kids indicate mother she was neighbors friends people saw her during. hear evidence from Patrick effect sickness had on her She looking into it. her Google searches Google about care postpartum type drugs? addicted to benzodiazepines? possible ketamine treatment? insomnia? thoughts to kill myself? Ways to kill. kill Government lashes onto that. God She's looking up ways to kill. basis of prosecution. not righteous prosecution They looking for evidence to show ridiculous concept she wanted to kill her kids didn't want to be mother. woman was nurse worked for best hospitals in labor delivery labor delivery nurses dedicated she was Cora named after first baby delivered as nurse Cora Cora first delivery woman dedicated life to helping people good person nurse great mom. as time went on please help me help government will say "God she was able to talk to people wasn't drooling putting tin foil inside hat to schools people." We have video of her and Patrick kids at Museum of Science. they having a good time.video shows them at Cape Codder kids in bathing suits she fine good face September 12th '22 looked for psychiatrist hooks up with Dr. Jennifer Tufts Early October '22 initial appointment October 20th '22 reports adverse reaction selective serotonin reuptake inhibitor Zoloft November 16th South Shore Hospital emergency room depressed maxed out lack of sleep unable to emote couldn't laugh cry feeling robot South Shore Hospital referred engaged with South Shore Perinatal Behavioral Health Patrick's mother Patrick Mrs.Clancy nurse respected works South Shore Hospital labor and delivery Lindsay Lindsay South Shore Perinatal Behavioral Health drugs referred by mother nurse November 21st '22 engaged at South Shore Perinatal Behavioral Health on one drug drugs prescribed Jennifer Tufts September 15th '22 Sertraline Zoloft Lorazepam October 21st Jennifer Tufts hydroxyzine Jennifer Tufts Lorazepam Jennifer Tufts Buspirone Jennifer Tufts Lorazepam increased Jennifer Tufts Buspirone one to five milligrams Jennifer Trazodone Fluoxetine 10 milligrams Julie Paul Julie Paul worked at South Shore Hospital help from South Shore Perinatal Behavioral Health. More medications spiraling Pat lived testify end of November around Thanksgiving reporting disassociation confusion put her on Remeron around Thanksgiving Things bad mother father from Connecticut lived care kids she walking zombie rock on sofa crying banging head into pillow Patrick observed dealt with parents Her parents help faking doesn't want to be mother? parents there Mother father wonderful Mother retired Dad took pictures of high school kids for yearbooks December after Thanksgiving went holidays to Connecticut visit family December 4th calls suicide hotline help December 5th evaluated by Aspire Crisis Team You'll evidence December 6th appointment with Nurse Gelada.Nurse Gelada not looking for more doctors Paul retired left another job Nurse Paul treating prescribing meds leaves Nurse Gelada She your person you deal with wasn't looking for other doctors additional medication dealing with Gelada. appointment with Nurse Gelada Pat goes upset Gelada evidence she over-medicated possible puts her on more medicationputs her on December 2022Nurse Gelada on chart in blue Nurse Gelada puts her on quetiapine 25 milligrams. November 30th, December 6th diazepam five. December 7th diazepam December 7th quetiapine December 9th diazepam five December 13th diazepam goes back to Jennifer Tufts couldn't handle dealing with Rebecca Gelada wanted to wean off drugs Gelada told stay course December 19th, 21st 22nd dealing with quetiapine 300 milligrams suggest go to Mass General Hospital Mass General Hospital Mass General day program or Rhode Island Women and Infants Programs." goes to Women and Infants Program day group with mothers medication medical records can't help postpartum." medications clear there day not suffering from postpartum Postpartum doctors nurses knew suffering from postpartum turning into psychosis January five Aliyah Goodhart from Mc Lean Hospital puts her on Trazodone 50 milligrams. Lorazepam one milligram hospital goes New Year's Eve and Patrick decide two car Family kids goes hospital locked wards hospital there for five days four days in.doesn't see doctor once no discussion of medications end You'll medical records daughter's birthday wanted to leave fifth fourth not discharge against medical advice cleared her okay luck Go home." went home birthday party government witnesses show At trampoline birthday party Cora still living in nightmare January 9th Jennifer Tufts puts on diazepam Jennifer Tufts Trazodone 150 milligrams January 13th Rebecca Gelada puts her on diazepam at Rhode Island nurse and babies hospital service people treating reached out Gelada medication Gelada never called back evidence medical records Patrick called Gelada wean off didn't want more drugs wanted drugs Julia on vacation in a week." Jennifer Tufts puts on diazepam two milligrams January 16th. Amitriptyline 10 milligrams January 16th diazepam Tufts Gelada last script diazepam two milligrams January 23rd December 20th and 22nd evaluated at woman's infants partial hospitalization program Rhode Island December 30th returned to Mass General Hospital emergency room December 31st after Mass General told to go to hospital Mc Lean New Year's Eve, December 20th '22 admitted to Mc Lean Hospital for psychiatric treatment January 6th '23 post-discharge follow-up appointment with Dr.Tufts. January 10, 16 23, appointment at Dr.Tufts, Dr.Tufts Dr.Tufts. day before killings Dr.Tufts medications she on filled took didn't take manipulating doctors not telling doctor suicidal suicidal ideation December told Patrick psychosis thoughts hurting children woman get medication medical treatment deserved suffering from psychosis basement no motive loves children intended to kill herself didn't fake Threw herself out window hospital said DNR not resuscitate not want DNR't wanted to die wants to die. dealing with prosecution hear from witnesses emotional. thank you for service. Thank you, Judge. SPK3: Clear full room Thank you CLERK: Your Honor Commonwealth calls Patrick Clancy CLERK: Good morning state spell your name for record? P.CLANCY: June 15th, 1988. P.CLANCY: New York. P.CLANCY: 14 years. CLERK: previously married to Lindsay Clancy? [02:16:27] P.CLANCY: Correct. P.CLANCY: She's wearing a pink shirt. P.CLANCY: In South Boston. P.CLANCY: Through my cousin. P.CLANCY: July 2013. P.CLANCY: September 2015. P.CLANCY: In Quincy. P.CLANCY: One year. P.CLANCY: Two years. CLERK: Did you eventually get married? P.CLANCY: December 2016. P.CLANCY: Cora. P.CLANCY: December 24th, 2017. CLERK: defendant taken psychiatric medication in nursing school? P.CLANCY: 47 Summer Street. [02:18:33] P.CLANCY: I believe it was July 2018. P.CLANCY: working for startup Automation Anywhere. P.CLANCY: May 2020. P.CLANCY: Eventually, yeah. P.CLANCY: Yeah. P.CLANCY: Mass General Hospital. P.CLANCY: Three years maybe. P.CLANCY: Yeah. CLERK: she take psychiatric medications? P.CLANCY: Not know of had anxiety CLERK: had anxiety correct? P.CLANCY: Yeah. CLERK: Good? Okay. CLERK: anxiety start closer to back to work? CLERK: One shift? [02:22:13] P.CLANCY: Yeah. CLERK: And was that a 12-hour shift? CLERK: Per diem. CLERK: After 20 weeks moved to two shifts? P.CLANCY: Yeah. P.CLANCY: Several years. P.CLANCY: September 30th, 2019. P.CLANCY: Yeah. P.CLANCY: Pretty traumatic. CLERK: Page 13? If I may approach. P.CLANCY: Yeah. P.CLANCY: 18 CLERK: 18 weeks. P.CLANCY: Yeah. P.CLANCY: Probably consistent. [02:26:54] CLERK: After Dawson 's birth defendant on psychiatric medication Dawson? CLERK: psychiatric hospitalizations or commitments? CLERK: Cora birth treatments? P.CLANCY: Maybe at some point. Yeah. P.CLANCY: Yeah. P.CLANCY: Yeah. P.CLANCY: Callan. P.CLANCY: May 26th, 2022. P.CLANCY: Correct. CLERK: defendant maternity leave after Callan birth? P.CLANCY: Yeah. P.CLANCY: She never went back. P.CLANCY: I want to say 18 weeks. P.CLANCY: 12 weeks. P.CLANCY: Yeah. [02:30:37] CLERK: months beach boat visiting friends signs of anxiety in defendant? P.CLANCY: Yeah. CLERK: exhibit behavior concerned to call doctor or commit her? CLERK: anxiety behavior? P.CLANCY: went back to work late August. CLERK: fall of 2022Cora Dawson attending preschool? P.CLANCY: Learning Sprouts. CLERK: Learning Sprouts located? CLERK: often P.CLANCY: Full days Monday, Wednesday Friday half day Thursday P.CLANCY: 9:00 to 4:00. CLERK: 9:00 a.m to 4:0 p.m? P.CLANCY: 9:00 to 12:30. might some days started early can't remember. P.CLANCY: Both of us. CLERK: Together or take turns? [02:35:01] P.CLANCY: Usually we would take turns. P.CLANCY: Yeah. CLERK: Does Elaine Rossi sound familiar? P.CLANCY: Yeah. P.CLANCY: Correct. CLERK: Cora and Dawson at school? P.CLANCY: Yeah. P.CLANCY: Yep. CLERK: Organized. P.CLANCY: Yeah. P.CLANCY: Yeah. CLERK: Okay. Did Lindsay work out? P.CLANCY: Probably, yeah. P.CLANCY: Increased anxiety and definitely stressed out. P.CLANCY: Yeah. [02:40:25] CLERK: when she stressed out showing anxiety how manifest? CLERK: recall attending wedding September 17th, 2022? P.CLANCY: Yeah. P.CLANCY: New Hampshire. CLERK: at wedding recall conversation with Lindsay about medication? P.CLANCY: walking downtown she said start taking Zoloft." CLERK: why start taking Zoloft? P.CLANCY: help with anxiety going back to work." CLERK: how getting Zoloft? P.CLANCY: asked "How get Zoloft? prescription." she ask doctor give it you." CLERK: going to see psychiatrist? P.CLANCY: Months later, yeah. P.CLANCY: Jennifer Tufts. CLERK: Lindsay when started seeing Dr. Jennifer Tufts? CLERK: Lindsay when received medication started it? [02:42:57] CLERK: conversation with Lindsay about medication? P.CLANCY: Probably the end of October. CLERK: what Lindsay tell about medication how taking it? P.CLANCY: don't remember exactly learned she taking Zoloft. don't remember much taking seeing how it went P.CLANCY: wasn't improving gradually becoming more depressed state. CLERK: she telling at wedding going to ask take medication see psychiatrist already had prescription. correct? CLERK: did Lindsay tell how long she took medication? CLERK: did she Lindsay advised to double dose Zoloft? P.CLANCY: Yeah. CLERK: Lindsay? CLERK: notice changes in sleep during on medication? P.CLANCY: Eventually, yeah. P.CLANCY: Yeah. P.CLANCY: Maybe a couple of weeks. P.CLANCY: Correct. [02:48:10] CLERK: Zoloft prescription only took seven pills? CLERK: After conversation Lindsay double dose Zoloft notice difference in her demeanor or behavior? P.CLANCY: yes't if connected with doubling Zoloft she kept getting worse P.CLANCY: Mid-October to the end of December. CLERK: From this medication? P.CLANCY: don't know which medication from P.CLANCY: with Jennifer Tufts wasn't working only getting worse thought better if worked with perinatal psychiatrist. CLERK: mother's nurse at South Shore Hospital? P.CLANCY: Yeah. P.CLANCY: Yeah. Her name is Julie Paul. CLERK: South Shore Perinatal Clinic? CLERK: saw Julie Paul P.CLANCY: Correct. CLERK: Julie Paul left office? CLERK: who Lindsay saw after Julie Paul? [02:51:03] P.CLANCY: Rebecca Jolotta. CLERK: Rebecca Jolotta nurse practitioner? CLERK: saw licensed social worker therapist Leticia Dukes at South Shore Perinatal Clinic? CLERK: After switching to Julie Paul Rebecca Jolotta did Lindsay start coming home with different prescription bottles? CLERK: some medications she came home with during time with Dr.Tufts? P.CLANCY: Correct. CLERK: accurate to you provided District Attorney's Office with printout from CVS Pharmacy of prescriptions filled for Lindsay from September through January September 2022 through January 2023? COURT: Any objection? No, of course not. COURT: Sure members jury anything entered as exhibit have in deliberating room marked as exhibit Thank you CLERK: while she taking medications were you always watching monitoring what she took? P.CLANCY: Yeah. CLERK: attention to February 6th, 2023 did go to District Attorney's Office or attorney provide bag of prescription medication to Lindsay? P.CLANCY: police took bag of prescription medications that night kids passed away bag I in truck supposed Nurse Practitioner Jolotta said bring them to police station never got P.CLANCY: Correct. Yeah. CLERK: all medications prescribed in past to Lindsay she no longer taking correct? [02:54:58] COURT: objection to exhibits she doesn't have to keep showing objection SPK7: I'll assume if you objection CLERK: for record, bag with nine pill bottles as exhibit two marked. CLERK: exhibit two Zoloft prescribed by Dr.Tufts filled September 15th, 2022.'t aware only seven pills taken correct? P.CLANCY: That's correct. CLERK: another prescription for Ativan filled October 26th, 2022 aware only six pills taken bottle? CLERK: October 26th, 2022. CLERK: Let's see. 30 pills. P.CLANCY: don't have exact numbers adjustments made on dosage Ativan aligns CLERK: ask about one more Trazodone prescribed November 16th, 2022 by doctor from South Shore Hospital, 30 pills. aware only seven and a half pills taken prescription? CLERK: recall most amount of pills prescribed? maximum number of medications on time? CLERK: most prescribed three most of two medications prescribed? CLERK: November 16th, 2022Lindsay visit South Shore Hospital? CLERK: why South Shore Hospital? P.CLANCY: went 48 hours without sleeping. [03:00:38] CLERK: aware didn't tell medical staff hospital symptoms medication left used marijuana? P.CLANCY: Between November and December? CLERK: Between September and November. P.CLANCY: Yeah. P.CLANCY: Yeah. P.CLANCY: Yeah. CLERK: photo from food truck event as Exhibit three photo train event Exhibit four. Three and four somewhere publish? CLERK: exhibit three Lindsay,Cora,Callan at event? P.CLANCY: Yeah. CLERK: Exhibit four Lindsay with all three kids at event in November? P.CLANCY: Yeah. P.CLANCY: Yeah. P.CLANCY: South Hamilton. CLERK: photo marked as Exhibit five CLERK: Five marked Exhibit five Lindsay here on left? [03:04:24] CLERK: Rough shape? P.CLANCY: Yeah. P.CLANCY: She wasn't talking much low energy depressed sister-in-law gave her big hug P.CLANCY: Yeah. P.CLANCY: Yeah. P.CLANCY: December 3rd, 2022 stayed home P.CLANCY: Yeah. P.CLANCY: Yeah, that looks accurate. CLERK: first photo of all five. Six. second one is Exhibit seven. six all at tree farm? P.CLANCY: Yeah. CLERK: Exhibit seven kids? CLERK: Around December 6th, 2022Lindsay starting new medication? CLERK: don't remember date starting new medication? CLERK: remember Lindsay starting medication Seroquel P.CLANCY: before December 6th [03:08:42] P.CLANCY: Awful. P.CLANCY: big spiral started lose weight became depressed hard time P.CLANCY: suicidal. CLERK: suicidal plan to kill herself? CLERK: first time suicidal thoughts? CLERK: heard her before suicidal thoughts? P.CLANCY: Yeah. CLERK: Okay. You and Lindsay? P.CLANCY: Yeah. CLERK: to August 22nd, 2022 click on link Surface Pro titled Methods of Suicide? CLERK: August 22nd, 2022 before Lindsay on medications correct? P.CLANCY: Correct. CLERK: December she told she having thoughts What's reaction suicidal thoughts? P.CLANCY: Yeah. P.CLANCY: Yeah. [03:12:03] P.CLANCY: Yeah. P.CLANCY: Correct. P.CLANCY: Correct. P.CLANCY: Yeah. P.CLANCY: Yeah. Okay. P.CLANCY: never saw Lindsay harm kids P.CLANCY: result of statements appointment set up at her parents' house in Wallingford for Thanksgiving described feeling on medication felt addicted to P.CLANCY: taking Seroquel might've taking Trazodone or Remeron not sure CLERK: recall testifying called parents needed asked doctor concerned prescribed 10 medications in over two months didn't make sense after parents remote meeting with Rebecca Dilauda." in person." P.CLANCY: That sounds correct. P.CLANCY: That sounds correct. P.CLANCY: Correct. CLERK: December 15th, 2022Lindsay go to Mass General Hospital emergency department? P.CLANCY: Yeah. P.CLANCY: reasoning told dad wanted to commit suicide told dad want to die didn't bother me [03:17:24] CLERK: at Mass General saw medical staff correct? P.CLANCY: Yeah. P.CLANCY: Women and Infants in Providence. CLERK: Lindsay saying she suicidal asked if had plan? CLERK: after Mass General December 15th Women and Infants Hospital Rhode Island postpartum program? P.CLANCY: Correct. CLERK: December Lindsay still working at Kingsbury Club correct CLERK: recall her Kingsbury Club December 6th, 13th 16th 17th 18th? CLERK: feeling suicidal doesn't have plan no longer thoughts of harming children P.CLANCY: Correct. P.CLANCY: Yeah. P.CLANCY: Yeah. P.CLANCY: Yeah. P.CLANCY: Probably. CLERK: returned to Mass General Hospital emergency department December 31st correct [03:21:33] P.CLANCY: still talking thoughts suicide exhausted time to go to Mc Lean didn't diagnosis didn't know what wrong hoping McLane evaluate best path CLERK: submit two photos exhibit. CLERK: exhibit eight selfie at hospital correct P.CLANCY: Yep. CLERK: Mass General suicidal thoughts transferred to Mc Lean Hospital P.CLANCY: Yeah. P.CLANCY: Yeah. P.CLANCY: Yeah. P.CLANCY: Yeah. CLERK: participated in group therapy January 1st 45 minutes illness symptom management CLERK: declined further group therapy treatment January 3rd CLERK: January 4th participated group 40 minutes medication management CLERK: participated group January 5th expressive therapy 45 minutes COURT: right see everybody about 2:00. Thank you P.CLANCY: Correct. [04:43:32] COURT: aware she discharged January 5th, 2023? COURT: marked next four exhibits marked 9 to 12. showing exhibit 9.Cora, correct? tell about Cora January 2023 her interests? COURT: Counsel see sidebar? tell about Cora 's interest COURT: Exhibit 10.Dawson, correct? COURT: Dawson interested 2023? COURT: Exhibit 11,Callan eight months old correct? P.CLANCY: Correct. COURT: Happy baby exhibit 12. picture indicate sizes January 2023? COURT: After Lindsay released Mc Lean Hospital birthday party for Cora January 7th, 2023? P.CLANCY: Yeah. COURT: Cora seated front Lindsay singing happy birthday? P.CLANCY: Yeah. Okay. P.CLANCY: Yeah. COURT: birthday videos next exhibit admitted 13Cora 's birthday party until January 23rd, 2023 check Lindsay? P.CLANCY: Every day. [04:49:52] COURT: ask suicidal thoughts? P.CLANCY: Yeah. COURT: family Museum of Science January 8th, 2023? P.CLANCY: That's Dawson. P.CLANCY: Cora. P.CLANCY: Lindsay. P.CLANCY: Yeah. COURT: permission play video Your Honor see sidebar moved submit still photograph video discussion sidebar submit full video exhibit for timeline video exhibit submit copy later full video provided Museum of Science timeline created following family museum snippets from video. Museum of Science video. CLERK: Exhibit C, so marked. COURT: museum timeline next exhibit. CLERK: Exhibit 14, so marked. COURT: after Museum of Science. recall defendant interact with children at exhibits required manipulating knobs materials showing children exhibits? P.CLANCY: Lindsay always interact with kids including Museum of Science COURT: after trip Museum of Science remember Charlie Horse Restaurant with kids Lindsay? COURT: what type of place Charlie Horse Restaurant? [05:00:54] P.CLANCY: Because she seemed much better. P.CLANCY: Yeah. P.CLANCY: About two hours. COURT: attention to January 15th, 2023Lindsay kids go Cape Codder in Hyannis? P.CLANCY: Yeah. P.CLANCY: Yeah. P.CLANCY: It's Dawson. P.CLANCY: Lindsay. P.CLANCY: Yeah. P.CLANCY: Yep. P.CLANCY: Yeah. P.CLANCY: Yep. P.CLANCY: Yeah. P.CLANCY: Yeah. COURT: go to 11:22 go 14:06. 16:25 Start at 16:25Cora Lindsay go down slide together [05:08:53] P.CLANCY: Yeah. P.CLANCY: Yeah. P.CLANCY: Yeah. P.CLANCY: Yeah. P.CLANCY: Yeah. COURT: submit Cape Cod photos timeline admit exhibit with guidelines at sidebar discussion portion may be admitted. 15What's 15 attention to January 16th, 2023 go skiing that day? P.CLANCY: Yeah. P.CLANCY: Cora. P.CLANCY: Adam Schwabak. COURT: Lindsay home with Callan Dawson day skiing Cora? P.CLANCY: Yeah. P.CLANCY: Yeah. P.CLANCY: Yeah. P.CLANCY: Correct. CLERK: move marked next three exhibits [05:16:15] CLERK: Exhibit 16, 17 18 marked first photo marked Exhibit 16 start conversation sending photo of you Cora skiing? P.CLANCY: Yeah. CLERK: showing Exhibit 17,Lindsay respond sending photo of Dawson? P.CLANCY: Yeah. P.CLANCY: Yeah. CLERK: comfortable leaving Callan Dawson home? P.CLANCY: Yeah. P.CLANCY: That sounds right. Yeah. P.CLANCY: Yeah. CLERK: Lindsay 's parents visit weekend January 21st 22nd? P.CLANCY: Yeah. P.CLANCY: The Carneys. P.CLANCY: Lindsay, myself, Dawson and Cora. P.CLANCY: Yeah. P.CLANCY: Yeah. [05:19:12] CLERK: next exhibit? CLERK: Exhibit 19.Lindsay doing better weekend P.CLANCY: Overall, yeah. CLERK: showing Exhibit 19. didn't mark still photo Museum of Science next exhibit? CLERK: Exhibit 20. Monday after parents home Connecticut Monday 23rd January Cora Dawson go to school? P.CLANCY: Yeah. P.CLANCY: Yeah. P.CLANCY: Yeah. P.CLANCY: Yeah. P.CLANCY: Yeah. CLERK: Tuesday January 24th, 2023 working? CLERK: Yes. Tuesday the 24th. P.CLANCY: Yeah. CLERK: Cora 's doctor's appointment 8:00 AM? P.CLANCY: Yeah. [05:21:56] P.CLANCY: Lindsay. P.CLANCY: Yeah. P.CLANCY: Yeah. P.CLANCY: dressed first time P.CLANCY: Yeah. P.CLANCY: Yeah. P.CLANCY: Yeah. CLERK: photo of Dawson next exhibit photo Cora following CLERK: Exhibit 21 22? 21 22. texting with Lindsay understand text messages? P.CLANCY: Yeah. P.CLANCY: 8:30. CLERK: starting 7:00 AM 24th 8:17 AM photo sent of Dawson? P.CLANCY: Yeah. CLERK: replies 8: 18 AM reply from Lindsay? P.CLANCY: Yeah. [05:25:56] P.CLANCY: Yeah. Yeah. CLERK: text messages next exhibit? CLERK: Exhibit 23. one photo sent? P.CLANCY: Yeah. CLERK: next exhibit CLERK: Exhibit 24. often remember going upstairs interact with Lindsay kids? P.CLANCY: She seemed happy. CLERK: point during day she texting she having suicidal thoughts? CLERK: One of her best days? P.CLANCY: Yeah. CLERK: direct attention to 4:53 PM day receive text from Lindsay about dinner? P.CLANCY: Yeah. P.CLANCY: Yep. P.CLANCY: Yep. P.CLANCY: Probably three times. [05:28:40] P.CLANCY: Chestnut Grill. another West End Grill. P.CLANCY: Yeah. P.CLANCY: Yep. CLERK: she send another text at 4:56 PM look at menu? P.CLANCY: Yeah. CLERK: send text at 5:06 PM about Callan? P.CLANCY: Yeah. P.CLANCY: Yeah. P.CLANCY: Yeah. CLERK: 5:08 PM respond? P.CLANCY: Yeah. P.CLANCY: Yeah. P.CLANCY: Yep. P.CLANCY: Lindsay. P.CLANCY: Normal. [05:32:06] COURT: Counsel see both sidebar here? Members jury break for day excuse you till Wednesday morning don't come tomorrow remind ask same questions asked this morning research or saw anything affect ability to remain fair impartial keep open mind don't do research don't talk about case don't go online look anything Don't take road trips see you Wednesday morning Same instructions from officers thank you for time effort see you on Wednesday COURT: Counsel anything else address before Wednesday? ## Day 2 (665 of 2115 turns kept) [45:00] COURT: Hi. Good morning, Counsel. COURT: Good morning, Ms. Clancy. COURT: Before see Counsel at sidebar briefly? final. ready for jury COURT: Thank you Madam Clerk good morning everyone COURT: Nice to see everyone go through ask questions follow instructions go over today's schedule discuss week's schedule idea where going ask questions Excusefirst question has any member jury read seen heard case your ability fair impartial juror? COURT: Next question. any other serious matter or concern on your service as juror needs to bring to my attention? thank you for following instructions. schedule we to follow today continue with case with Commonwealth 's witness on stand Monday take. today Might be broken up. may couple of breaks during course keep to minimum take break at one o'clock come back this afternoon probably go to between 3:00 and 4:00. tomorrow same schedule. Tomorrow's Thursday. Friday planning to go on view. as judge I can control things can't control weather. checked. weather should be fine talk more about tomorrow in forget on Friday to have jacket, or comfortable shoes, go into more. schedule anticipate for rest of week. on Friday do view come back usually in morning. then come back probably go to around 3:00 or 4:00 on Friday discuss next week's schedule and in timeline of this case.'ll try keep you up to date in case. may unanticipated breaks to take. to return now to Commonwealth 's case.Commonwealth had witness on stand time ask Ms.Sprague recall witness SPRAGUE: Thank you Your Honor recall Patrick Clancy SPRAGUE: Thank you, Your Honor. Good morning. P.CLANCY: Good morning. SPRAGUE: Monday asked questions about Surface Pro defendant home access looked at site suicide methods August 22nd look at site suicide methods August 23rd, 2022? P.CLANCY: I don't believe so. SPRAGUE: photo next exhibit COURT: All right. Any objection? [Q=SPRAGUE A=P.CLANCY] Q: approximately 5:15 PM she texted "Pedia-Lax"? A: Sounds correct. [08:51:00] Q: section right pediatric medication section? A: Yeah. Q: section looking medication do something? A: I called Lindsay. Q: call 5:33 PM? A: Yeah. Q: receive call back minute later 5:34 PM? A: Yeah. That's correct. P.CLANCY: Yeah. P.CLANCY: Yeah. P.CLANCY: That's correct. P.CLANCY: Yeah. SPK1: CVS receipt next exhibit SPK3: Exhibit 26. SPK1: original CVS video marked exhibit CVS timeline condensed version following exhibit [11:28:00] COURT: E27 and E28. SPK3: Exhibit 26, 27 28 marked P.CLANCY: Yeah. SPK2: No objection. SPK1: empty case marker Exhibit 29? P.CLANCY: Probably around 10 minutes. P.CLANCY: Yeah. P.CLANCY: Yeah. P.CLANCY: I think Lindsay ordered it. P.CLANCY: Yep. P.CLANCY: Correct. SPK1: ThreeV video next exhibit SPK3: Exhibit 30 so marked, Your Honor. SPK1: receipt marked next exhibit SPK3: Exhibit 39. [17:42:00] P.CLANCY: Home. P.CLANCY: same route One exit highway went home P.CLANCY: guess 10 to 12 minutes P.CLANCY: A Chevy Silverado. P.CLANCY: Yeah. SPK1: kind car Lindsay drive? P.CLANCY: Yeah. SPK1: photographs of interior home front back marked sequentially next exhibits? SPK3: 32 through 37, 38. So marked. SPK1: marked Exhibit 32. front of house main door? SPK1: Exhibit 33. relation to main front door? P.CLANCY: Yep. SPK1: Exhibit 34. what portion of house? SPK1: facing front door left fence there correct? Exhibit 35 more of same fence on left? SPK1: Exhibit 36 looking at backyard from left side area where fence? [21:11:00] P.CLANCY: Yeah. SPK1: Exhibit 37 what seeing here? SPK1: Exhibit 38 direct view of back of house? P.CLANCY: Yeah. P.CLANCY: Yeah. P.CLANCY: Our bedroom. P.CLANCY: That's the upstairs bathroom. P.CLANCY: That was Dawson's bedroom. P.CLANCY: The living room. P.CLANCY: Downstairs bathroom. P.CLANCY: Yeah. P.CLANCY: Yeah. P.CLANCY: Yeah. P.CLANCY: Yeah, that's accurate. SPK1: two photos marked next two exhibits [23:49:00] SPK3: Exhibits 39 and 40. SPK1: Exhibit 39. where sliding glass doors? P.CLANCY: Yeah. P.CLANCY: Yeah. P.CLANCY: Yeah. P.CLANCY: The garage. SPK1: Exhibit 40 placed bags on island in kitchen? P.CLANCY: Yeah. P.CLANCY: Yeah. P.CLANCY: Everyone. SPK1: Did anyone answer? P.CLANCY: Yeah. P.CLANCY: Correct. P.CLANCY: Yeah. SPK1: marked as next exhibit [02:19:00] SPK3: Exhibit 41. P.CLANCY: Yeah. SPK1: approximately 6:09 PM? P.CLANCY: Yeah. P.CLANCY: Yeah. P.CLANCY: Yeah. P.CLANCY: Yeah. SPK1: photo marked as next exhibit SPK3: Exhibit 42. P.CLANCY: Yeah. P.CLANCY: Yeah. SPK1: next exhibit SPK3: Exhibit 43. P.CLANCY: Yeah. SPK1: three photos marked next three exhibits [07:04:00] SPK3: Exhibit 44, 45, 46. SPK1: Exhibit 44 entrance to room room? P.CLANCY: Yeah. SPK1: Exhibit 45 mirror right of bureau? P.CLANCY: Yep. SPK1: Exhibit 46 getting closer to window? P.CLANCY: Yeah. P.CLANCY: Yeah. SPK1: Exhibit 42 no blood on walls or bedding correct? P.CLANCY: Yeah. P.CLANCY: That was Lindsay's phone. P.CLANCY: Yeah. SPK1: marked next exhibit SPK3: Exhibit 47. P.CLANCY: Yeah. [10:58:00] SPK1: Exhibit 38 window correct? top right? P.CLANCY: Correct. P.CLANCY: Yeah. P.CLANCY: Yeah. SPK1: marked as next exhibit SPK3: Exhibit 48. SPK1: Exhibit 48. window's open correct? P.CLANCY: Yeah. P.CLANCY: Yeah. SPK1: observed wounds correct 911 operator asked instructed apply pressure if needed? P.CLANCY: Correct. P.CLANCY: Correct. P.CLANCY: Yeah. P.CLANCY: Yeah. P.CLANCY: Yeah. [01:03:34] P.CLANCY: Directly below the stairs. P.CLANCY: Yeah. P.CLANCY: Yeah. P.CLANCY: Four or five minutes. Okay. P.CLANCY: Yeah. P.CLANCY: Yeah. P.CLANCY: Yeah. P.CLANCY: Immediately went left. P.CLANCY: Yeah. P.CLANCY: She's face down. P.CLANCY: Yeah. SPK1: Sorry? P.CLANCY: Yeah. P.CLANCY: Same as Cora. P.CLANCY: Yeah. [01:07:47] P.CLANCY: Yeah. P.CLANCY: I tried to find Dawson. P.CLANCY: Yeah. P.CLANCY: Yeah. P.CLANCY: Yeah. SPK5: Yeah, please. P.CLANCY: Yeah. P.CLANCY: Yeah. P.CLANCY: Yeah. SPK4: Your Honor move submit 911 call next exhibit P.CLANCY: Yeah. SPK4: Beth Israel Deaconess Plymouth? P.CLANCY: Yeah. P.CLANCY: Yeah. P.CLANCY: Yeah. [01:11:11] SPK4: Callan transported to Children's Hospital? P.CLANCY: Yeah. SPK4: anyone tell not leave kids alone Lindsay? SPK4: she moment of psychosis? SPK4: mentioned psychosis before? P.CLANCY: No didn't know psychosis until after happened SPK4: I just have exhibits after. SPK5: Counsel see briefly sidebar? SPK4: Honor move submit evidence clothing Cora Clancy night January 24th, 2023 pajama pants pajama shirt pink robe marked one exhibit SPK6: Exhibit one. SPK4: Dawson 's clothing dinosaur underwear record gray T-shirt long sleeve shirt next exhibit SPK6: Exhibit two. SPK4: Callan 's pajamas next exhibit SPK6: Exhibit three. SPK4: Yellow exercise band with Dawson next exhibit [01:18:19] SPK6: Exhibit four. SPK4: Black exercise band Cora next exhibit SPK6: Exhibit five. SPK4: blue exercise band Callan next exhibit SPK6: Exhibit six. SPK4: Honor ask 911 call played. SPK5: Members jury Sometimes trial evidence introduced produces jurors emotional response understandable feel sympathy empathy evidence jurors oath follow law law separate emotional reaction from informational value weight evidence not influenced by unpleasant nature evidence including testimony exhibitsmust find facts in case based only on evidence. can't find base decision on sympathy anger passion prejudice pity or against either side verdict must based solely on evidence introduced my instructions other limiting instructions remind as go through this. play exhibit 911 call. correct? SPK4: Yep. COURT: Counsel see you at sidebar please? take five- minute break Then back address scheduling with counsel five-minute recess. SPK13: Kevin Reddington there with photos after Commonwealth 's opening statement brought babies said superficial wounds? look." effective. drugs different versions doses given by different medical professionals defense leaning into postpartum depression accelerated by these drugs huge part of equation."Reddington opening she given drugs should not have been given given REDDINGTON: After second child had postpartum. hear evidence important could lead to bipolar. don't do taboo if bipolar't put them on antidepressant Zoloft SSRI selective serotonin reuptake inhibitors messes with brain't done in this case SPK12: Patrick expand on direct examination she may not finished entire bottle subject to different doses finished one bottle started another bottle." explain that issue. SPK13: they back on record go into courtroom see if wait for jury or anything else they jumping back to sidebar before jury use opportunity grab commercial break get you back into courtroom.expect Patrick Clancy back stand cross-examination We'll Stay SPK11: Which ones want? exhibits in box prescription bottles here need those? SPK14: Thank you Your Honor Commonwealth calls Angela Krause [02:46:26] SPK14: Thank you, Your Honor. Good morning. KRAUSE: 5/19/77. KRAUSE: CVS Pharmacy. KRAUSE: Kingston. KRAUSE: 189 Summer Street. KRAUSE: Four years at that location. KRAUSE: General manager. KRAUSE: For CVS? KRAUSE: Nine years. SPK14: direct attention to Tuesday, January 24th, 2023 working that day? KRAUSE: Closing. KRAUSE: I'd say roughly 3:00 to 11:00. SPK14: 3:00 PM to 11:00 PM SPK14: direct attention to 4:48 PM receive phone call while working? KRAUSE: Female. [02:48:36] KRAUSE: carried Pedia-Lax in aisles 13 and 20. SPK14: Exhibit 28, footage recognize store? SPK17: showing exhibit 26. receipt provided to police? SPK17: Your Honor Commonwealth call Saria Sweeney SPK20: Come here. SPK18: Hey, good morning. SHELGREN: Absolutely. SHELGREN: Shelgren, S-H-E-L-G-R-E-N. SHELGREN: 9/3/89. SHELGREN: Since 2019. SHELGREN: In Cordage Park, in Plymouth. SPK17: attention Tuesday, January 24th, 2023 working night? SHELGREN: evening shift arrive between 4:45 and 5:00. SHELGREN: Typically, between 8:00 and 9:00. SPK17: attention 5:10 P.M. receive call for takeout order? [02:54:46] SPK17: Mediterranean power bowl with protein? SPK17: attention 5:54 P.M. order picked up? SPK17: pull Exhibit 30 footage depicted in video? SPK17: Exhibit 31, recognize this? SPK18: Attorney Reddington? JANAE: defense direct examination narrative questions prosecutors say Clancy acted intentionally used exercise bands to strangle children defense says victim suffering from postpartum psychosis jurors hearing Patrick Clancy from CVS manager interacted with Patrick Clancy prosecutors wife sent him away carry out.testimony done another witness stand pick up inside courtroom SPK18: Hey, good morning. SHELGREN: Sure. Absolutely. SHELGREN: Shelgren, S-H-E-L-G-R-E-N. SHELGREN: 9/3/89. SHELGREN: Since 2019. SHELGREN: In Cordage Park, in Plymouth. SPK17: directing attention to Tuesday, January 24th, 2023 working that night? SHELGREN: work evening shift arrive between 4:45 and 5:00. SHELGREN: Typically, between 8:00 and 9:00. [03:05:40] SPK17: directing attention to 5:10 P.M. receive call for takeout order? SPK17: Mediterranean power bowl with protein? SPK17: attention to 5:54 P.M. order picked up? SPK17: pull up Exhibit 30 footage depicted in video? SPK17: showing marked Exhibit 31. recognize this? SPK18: Attorney Reddington? AUSTIN: judge giving early break enabling take in heard get past emotional two witnesses CVSThree V witness saw Patrick Clancy before finding wife ground three children killed possibility to avoid two witnesses Reddington not cross-examine Both short could have stipulated jury why wasting time prosecution listening to ordered? trying to show defendant Lindsay Clancy knew planned organized defense could stipulate expert psychotic and planned not mutually exclusive maybe doesn't want to admit people to go on didn't offer to stipulate probably would've stipulated JANAE: talk Terri more defense attorney tried to stipulate things case rejected by court prosecution. wanted to stipulate everything involving death of children didn't want clothing autopsy photos crime scene photos first responders testifying he said during pretrial motions "I would stipulate all. don't have guilt phase. She's admitting guilt not admitting not insane could have phase focuses on her mental health. Was psychosis she didn't understand right from wrong?" court should have agreed with him didn't happen? AUSTIN: prosecution has right to make argument. saw argument prosecution got snippy defense doesn't want to hear I right to bring on my case could have been skip guilt phase could instances where small minor witnesses't necessary waste time court judge could have encouraged prosecution to affidavit from each people stipulate to what they say No one objecting came." she's put on her case. judge giving her leeway defense Reddington amazing defense attorney he made argument judge not having it. JANAE: witness sets up jurors going on soon jury view agreed to judge ordered they going to go to CVS ThreeV home heard from witnesses at locations important. reason Terri why people needed to come stipulate share with jury things to anchor locations seeing in person JANAE: in-person looking at exhibits versus inside courtroom exhibits viewers know look at exhibits on website courttv.com evidence gallery updated every day break while break inside courtroom back talk more about case live interview with inside courtroom during emotional 911 call blocked from public apparent heavy evidence Don't Welcome back to Court TV Live Julia Jenae continuing coverage of Plymouth, Massachusetts case against Lindsay Clancy mom on trial for killing three kids deny defense says postpartum psychosis not held criminally responsible first witness for prosecution Patrick Clancy father and former husband of defendant bring in someone inside courtroom for emotional moments today Director of Photography for Law and Crime and Court TV, Richie Morganson with us Morganstern in Boston, Massachusetts Richie thank you for joining usyou're on lunch break appreciate your time been eyes and ears in courtroom for moments off record difficult for journalists take to moment 911 call audio turned down for public you still hear what played. JANAE: glad you're share emotion judge told jurors to separate emotion from facts prosecution wanted to share Patrick Clancy didn't want to be in room he asked for it to not be shown public. Did you gather anything helpful to understand Lindsay Clancy psychotic break? from motion call prosecution says volume in his voice rises when finds a child rises finds another child shows JANAE: viewers know this could be reasons they put it in motion prosecution wanted to bring evidence to jury devastating may hurt more than help moving case for her not insane not criminally responsible exercise bands tied certain way tied like shoelace first time not second time his voice swiftness wails when he finds children shows horrific she would have held exercise band for long't she double knotted it and left. details jurors take in difficult but important. prosecution can help jurors determine whether someone cold calculated premeditated murder or psychotic break. clear for jurors or emotion feel heavy hard to get through facts judge told pay attention to facts? SPK23: strangled deliberately meticulously killed by defendant January 24th 2023. SPK22: woman suffering from psychosis went to basement. [03:36:39] JANAE: Welcome back to Court TV Live following day two of case against Lindsay Clancy. clips from opening statements jurors heard emotional horrific evidence trial testimony of ex-husband of defendant father of three children. court on lunch break jurors taking break may longer difficult testimony evidence once reconvene take live back inside Plymouth County, Massachusetts courtroom look back at timeline case important prosecution wants jurors to feel every moment crime defense says doesn't bear criminal responsibility mental state major time points 4:02 PM defendant searched for "Kids Miralax" phone 4:13 PM searches "Take out Three V." restaurant heard from hostess from Three V. 30 minutes later called CVS talked about children's Miralax prosecution brought to stand manager store 4:53 PM text to Patrick asking wanted takeout from Three V. calls at 5:10 PMThree VLindsay to hostess place order hostess nothing out of ordinary normal call order placed for 5:15 PM Patrick leaves houseseen on surveillance video 10, 15 minutes later at CVS first Patrick calls Lindsay right prescription She doesn't answer she calls back tells Patrick medicine to get she not seem out of ordinary Nothing alarmed phone 5:37 made purchase at CVS. 5:54 picks up takeout Three V Remember left home at 5:15 arrives home 6:09 PM Less than hour passed home jurors heard courtroom 911 call wife outside lawn children inside basement trial attorney Terri Austin analyzing case timeline anything stands out helpful jury determining criminal responsibility? AUSTIN: condensed timeline 45 minutes less than an hour between he left home back from CVS picking up food. prosecution to show was planned. defendant sent Patrick to pick up drugs for little girl for Cora, up food for all. She ordered food no problem. two witnesses from one CVS one Three V Restaurant said she sounded normal on phone trying to show timeline means planned intentional. She took enough time mapped it out knows how long errands murdered children. intentional, premeditated planned murder defense side Reddington cross-examination of Patrick Clancy clear no idea anything to happen had Patrick Clancy thought something happen would not have left would have had parents come had her institutionalized stayed by her side medical experts support theory psychosis possible for her to plan have dinner have voices in telling to kill children to save children she had to do voice couldn't control herself. Remember under law in Massachusetts two-pronged approach cognitive and volitional. She show not aware of wrongfulness wasn't to conform to requirements law show medical experts defend her. JANAE: Terri mentioning voices psychosis reminds me of Patrick's testimony today asked about visiting wife after incident talking on phone she used word psychosis prosecutor asked heard her use word psychosis before?" he said "I didn't know psychosis until this happened." trial difficult details he been through with wife anxiety postpartum depression hadn't heard before about psychosis sometimes trial someone first time understanding what that means. AUSTIN: right not can't predict psychotic episode If could wouldn't have psychotic episodes'd prevent it weaknesses in case Patrick wasn't told about medications about she through not heard word psychosis. Maybe Lindsay Clancy didn't know it was psychosis. Maybe after happened she cognizant to figure out don't know what happened God she figured out going through psychotic break or talked to doctors when hospital difficult to know what not medical experts. medical experts help through psychotic break not surprised he never heard that word don't think she was aware if she knew psychotic break this would not have happened.Both did best could to avoid this happening. SPK24: Duxbury Massachusetts quiet seaside town shattered by tragedy.Lindsay Clancy, young nurse devoted wife mother of three seen as picture of perfection police say behind smiles family photos darkness took hold cold January night investigators say she strangled children Cora Dawson baby Callan before own life Clancy 's husband Patrick returned to scene unimaginable horror trusted nurse faces murder charges defense claims severe postpartum psychosis Prosecutors call calculated Her attorneys say symptom of mind lost to illness JANAE: husband's testimony on pause Plymouth County, Massachusetts courtroom Lindsay Clancy trial continues sides battle over criminal responsibility waiting to ex-husband father of three victims Patrick Clancy to witness stand direct examination over cross-examination soon on lunch break live look courtroom photojournalist Richie Morganstern state has many witnesses lined up possibility Patrick may not return stand guest trial attorney Terri Austin helping break down jurors decide difficult one they believe she did it exact reason for deaths of children? determine she was legally sane understood actions askprosecutor or defense attorney keep jurors thinking narrow part outside horror medication You've keep them on task did she understand appreciate criminality actions? if not find her guilty. AUSTIN: we see defense do more. prosecution broad in presentation. going through timeline jury understood what particularly relates to that day prosecution trying to lay out what occurred point out timeline perspective defendant knew what she was doing knew it was wrong could have conformed her conduct. defense say no argument this happened." try to get that out through cross-examinations cross-examination Patrick Clancy other cross-examinations prosecution's case. closing arguments Reddington focus on question jury whether not someone could appreciate what she was doing was wrong could she conform her behavior? if not if believe listen to medical experts possible she could have postpartum not depression psychosis hearing voices in not to conform behavior not understand she doing wrong planning this because voice telling her. psychosis is hallucinations. delusion.You've medical experts see more when defense case defense closing. AUSTIN: funny when he said thought heard don't know if during openings GoFundMe New Yorker magazine thought heard he she had thoughts of suicide harming children question asked by prosecution in January She made specific timeframe hearing inconsistencies. saw comments on YouTube channel viewers confused prosecution trying beforehand in January did know she had tendencies? he not know in January know prior to store leaving her herself JANAE: January. AUSTIN: slight weakness in defense case he didn't know more think whole timeline September, January before happened more he knows better looks for defense means Lindsay sharing things with him she not hiding anything they together trying nothing untowards happens to Lindsay or children forgiveness he doesn't remember exact times of she said't big point held against defense but weakness in their case they don't have burden of proof prosecution has burden of proof don't show she was criminally responsible case shifting burden starts with you saying show defense perspective mental illness then back on prosecution burden to show she was criminally responsible.don't think they have enough here little holes he not sure timing she told medication psychosis illness. don't big enough problem hurt defense. JANAE: In Massachusetts prosecution burden to show she not insane or didn't appreciate criminality versus defense in some jurisdictions. Terri, react to Richie Morganstern inside courtroom for 911 call? AUSTIN: saw photos of her crying holding hands difficult for jury to hear listen to 911 call watch her not a malingerer not faking she should be on suicide watch 24/7 hearing 911 call difficult for jurors for photographer anyone heard devastating for her. She regrets till day she dies judge charging jury instructing Don't let sympathy. look at facts law." affect jury she genuine in 911 call SPK25: Coming- JANAE: moment after 911 call played Lindsay Clancy reaction people courtroom she sobbing throughout 911 call she has attendants with her still in hospital housed after courtroom two attendants two nurses check on her okay during trial prosecution says former labor and delivery nurse rational methodical attorneys say no she in severe mental health crisis when little Cora Dawson and Callan died. Patrick Clancy on stand detailed for jurors what discovered day.Prosecutor had go through each room house noticed first wife then son next son daughter kept composure throughout testimony agreed by parties left hear 911 call see clothes children wearing exercise bands used in death. wait for court start bring panel of guests talk about case prosecution successful especially claim malingering or faking by defendant. Joining discuss criminal defense attorney Jo-Anna Nieves former deputy public defender LA County Philip Dube. see difficult day for jurors. Philip Dube start with you. What stands out today versus first day difficult listen to beginning from Patrick Clancy? SPK27: pleasure to be with Jo-Anna. She has great legal acumen terrific Morning, afternoon poor jury through tedious monotonous irrelevant testimony about demeanor in drug store missed opportunity not to cross-examine clerks and store manager they lack of training. don't duties obligations job CVS pharmacy but not trained in recognizing psychosis hallucinations delusional disorder. They there to ring up sales reconcile books shelves stocked. would have said "You didn't get training in nursing school medical school not familiar with outward symptoms of certain disorders." not everybody drug store exhibiting symptoms anybody line vomiting needed medication?" if't seen don't know to recognize forms psychosis delusional disorder jury prosecutor why call these people to stand? look like they incompetent to recognize symptoms of mentally ill. prosecution's case fell short with witnesses. [04:11:14] NIEVES: think it's they're suggesting big ask to get jury to believe she saw one two five providers prescribed medication seeking treatment did outpatient program confiding in husband for long con of setting up fake suicide she kill kids get away. big ask to digest theory. JANAE: Philip hearing prosecution saying she wanted to take them with her suggesting murder suicide had plan before taking lives children trying to escape consequences by jumping out window. two things they giving to jury problematic? JANAE: Jo-Anna they trying to give jury motive jury want to know motive. If't legal insanity what reason? NIEVES: case wants to understand what head at crime committed crux of case. Was she in touch with reality not? thinking? appreciate wrongfulness comport herself as required by law? prosecution could have weave anticipated expert testimony contradict defense's testimony in opening statements highlight expecting from experts support claims calculation and deliberation not organized fashion from experiencing psychosis. opening touch on subjects laid groundwork for direction seeing now. REDDINGTON: Looks like Lindsay's handwriting? P.CLANCY: Yep. COURT: Any objection? SPK34: objection there they going on sidebar bring back guests standing by Joanna Nieves watching Patrick back on stand What picking up on cross-examination? more relaxed than direct examination? P.CLANCY: Yeah. REDDINGTON: You play guitar? P.CLANCY: Yep. P.CLANCY: Yeah. COURT: Any objection? SPK35: Exhibit 58. REDDINGTON: put Exhibit 58 up jurors see boxed out window standing in kitchen looking into room through boxed out window [05:29:23] P.CLANCY: Yeah. COURT: Any objection? SPK35: Exhibit 59. SPK35: Exhibit 60 and 61. COURT: Sure. Yeah. Counsel. SPK35: Exhibits 63 through 75. P.CLANCY: That's Cora. REDDINGTON: Moving... SPK37: Moving forward June of 2021. who P.CLANCY: That's Cora and Dawson. SPK37: end of July 2021 P.CLANCY: That's us with Cora and Dawson. SPK37: Okay. August 2021. SPK37: Okay. End of August 2021. P.CLANCY: It's Cora and Dawson. [05:40:52] P.CLANCY: It's Cora and Dawson. SPK37: December one of '21. P.CLANCY: It's Cora and Dawson. P.CLANCY: Yeah. SPK37: September of '21. P.CLANCY: That's Lindsay and Cora. P.CLANCY: Yeah. SPK37: End of September of '21.Callan SPK37: Dawson September '21Callan born when P.CLANCY: May 2022. SPK37: Christmas Eve, December 24th of 2021 P.CLANCY: That's Cora's birthday. P.CLANCY: Yeah. P.CLANCY: Correct. P.CLANCY: I believe it was January 7th. [05:42:28] P.CLANCY: birthday with friends people available Christmas Eve SPK37: Christmas Eve, right. P.CLANCY: Yep. SPK37: September 1st of '22 Remember taken P.CLANCY: Yeah, that's with Callan and Dawson. SPK37: Backyard September of '22 before '23 P.CLANCY: good summer on Cape Cod SPK37: This picture was on Cape Cod? P.CLANCY: Yeah. P.CLANCY: Yeah. COURT: Any objection? SPK37: Purpose? SPK38: Sidebar. COURT: Sure. Yeah. SPK38: No objection, Your Honor. [05:45:27] L.CLANCY: know if not P.CLANCY: Yeah. SPK38: Objection. COURT: Sustained. If you could rephrase that. L.CLANCY: Yep. P.CLANCY: December 2nd. P.CLANCY: Correct. P.CLANCY: 12:45 PM. P.CLANCY: Correct. SPK38: Objection. That was December 3rd. COURT: All right. Sustained. P.CLANCY: Yeah. P.CLANCY: It's December 2nd at 6:13 PM. P.CLANCY: Correct. COURT: Exhibit 76 making copy mark that? marked yet earlier one keep straight latest email Exhibit 77 [05:51:22] SPK38: Two pages? SPK38: Exhibit 76 and 77. SPK37: Exhibit 76 email from to. delete people on email Honor mark it as exhibit approach indicate date and time on top sent email to staff members or people work with? P.CLANCY: It's January 24th at 5:24. SPK37: sent from Surface Pro? COURT: That would be Exhibit 76. P.CLANCY: May 26th, 2022. P.CLANCY: Yeah. SPK37: happened September, October 2022? P.CLANCY: Just increased stress and anxiety. SPK37: Now, Jennifer Tufts is a psychiatrist? P.CLANCY: Yeah. P.CLANCY: never went to her office South Shore. SPK37: remember Lindsay went see Jennifer Tufts? SPK37: remember DA asked used computer to Google suicide August '22. remember her asking question? [05:54:42] SPK37: No show web history of computer question asked August '22 Googled suicide responded no P.CLANCY: Correct. SPK37: know guy Tim Hall? P.CLANCY: I think you mean Tom Hall? SPK37: Tom Hall apologize Who's Tom Hall? P.CLANCY: He committed suicide. SPK37: show Surface Pro records August '22 recall Googling name Tom Hall access new albums records? P.CLANCY: remember briefly listening to Tom Hall's music P.CLANCY: Correct. P.CLANCY: Yep. SPK37: says Tom Hall. P.CLANCY: Yeah. SPK37: What Tom Hall? P.CLANCY: It says his Wikipedia page. SPK37: shows Googled goes Wikipedia above says suicide methods? [05:57:07] P.CLANCY: Yeah. SPK37: didn't DA Google suicide methods P.CLANCY: I didn't Google suicide methods, no. P.CLANCY: Yeah. SPK37: suggest moved down searches afternoon looking at Tom Hall brought to ways to commit suicide Tom Hall Google search again Tom Hall date same time looking to see about guy killed himself? COURT: Any objection? COURT: Oh yeah. SPK37: marked Exhibit E for ID refresh memory sir inadvertently touched Wikipedia for suicide for Tom Hall, singer right? SPK37: recall medication Lindsay put on by Dr.Tufts? P.CLANCY: She started with Zoloft. SPK37: counsel asked about Lindsay on Zoloft SSRI antidepressant medication past remember question? P.CLANCY: Yeah. SPK37: remember her asking conversation going on Zoloft already been to Tufts Tufts got script from? P.CLANCY: Correct. P.CLANCY: Yeah. [06:02:01] SPK37: recall. dedicated to taking medications as instructed by doctors saw? P.CLANCY: She always took them as instructed. SPK37: remember diary of milligrams type of medication date took reactions? recall? P.CLANCY: Yeah. P.CLANCY: Yeah. P.CLANCY: "Good moms have scary thoughts." COURT: All right. Any objection? SPK37: Okay. Great. Thank you. SPK38: No objection to not offering SPK38: No objection. P.CLANCY: Julie Paul. SPK37: Julie Paul was at South Shore in Labor and Delivery? P.CLANCY: Yeah. Correct. SPK37: mother nurse at South Shore Hospital? SPK37: L Labor Delivery Same mother refer Lindsay to this person to consult? [06:07:33] P.CLANCY: Yeah. P.CLANCY: No, I never met Julie Paul. SPK37: Lindsay on Zoloft from Dr.Tufts, psychiatrist correct? P.CLANCY: Correct. SPK37: What month When saw Nurse Paul? P.CLANCY: Maybe October, but I'm not sure. SPK37: Did Nurse Paul prescribe medication? SPK38: Objection. SPK37: recall had reactions to Zoloft placed on by Dr.Tufts? SPK38: Objection. SPK37: huge problem one point she on medication from Tufts gone 48 hours without sleep? P.CLANCY: Yeah. P.CLANCY: switched doctors same practice. SPK37: Did Dr.Jollotta, put her on medication? P.CLANCY: Yeah. [06:11:18] SPK37: what was medication? P.CLANCY: Mainly Seroquel and benzodiazepines, Ativan. P.CLANCY: Apparently. SPK38: Objection. SPK37: benzo Ativan, correct? P.CLANCY: Correct. P.CLANCY: Yeah. P.CLANCY: Probably around 20 minutes. P.CLANCY: Early December. P.CLANCY: Yeah. SPK37: Yep. P.CLANCY: Early December December 6th. SPK37: good memory remember medication prescribed by Jollotta? SPK37: Yep. P.CLANCY: Yeah. [06:14:16] P.CLANCY: No Lindsay didn't want take more benzodiazepines more Seroquel. trying to get off medication. get on right medication P.CLANCY: worse Seroquel increased to 400 milligrams. SPK40: 400? P.CLANCY: Yep. P.CLANCY: Yeah. SPK40: In Rhode Island. SPK40: Women and Infants Center for Women's Behavioral Health recall? SPK40: remember she went to Women's Behavioral Health? P.CLANCY: Yeah. SPK40: offer certified copies of Women and Infants Hospital records SPK42: Exhibit that for identification. P.CLANCY: Yeah. P.CLANCY: I took Dawson skiing. P.CLANCY: Wisconsin. P.CLANCY: Yeah. [06:17:49] P.CLANCY: Yeah. P.CLANCY: Yeah. SPK41: Objection? SPK41: All right. Sustained at this time. SPK40: Did people at Women's Infants facility in Rhode Island prescribe medication? SPK42: Objection. SPK41: Sustained. SPK42: Objection. P.CLANCY: Yeah. SPK40: Her parents? P.CLANCY: Yeah. P.CLANCY: She switched back to Jennifer Tuffs. SPK40: McLean Hospital locked ward facility? P.CLANCY: Correct. P.CLANCY: Yeah. [06:23:45] SPK40: she saw doctor psychiatrist from Mc Lean Hospital? P.CLANCY: Yeah. SPK40: Call her? P.CLANCY: evaluation call clearly depressed. SPK41: Sustained. SPK41: Yeah. SPK40: Did Dr. Goodheart prescribe medication? P.CLANCY: recommended medication. SPK40: How many medications did she recommend? SPK42: Yes. Yeah. SPK40: after Mc Lean records SPK41: Any objection? SPK40: go to hospital give bag medications card thank you for being here get anything from Mc Lean? SPK40: remember Dr. Goodheart telling Lindsay to Google? SPK40: Googled hundreds of times medication [06:26:20] P.CLANCY: Yeah. P.CLANCY: Yeah. P.CLANCY: Yeah. P.CLANCY: Yep. P.CLANCY: Yeah. P.CLANCY: Yeah. SPK40: In January recall she continue take notes of medications? P.CLANCY: Yep. P.CLANCY: dosage medication how she feeling. P.CLANCY: Yeah. P.CLANCY: Yeah. SPK41: Any objection? SPK42: Sixteen. P.CLANCY: Yeah. P.CLANCY: Finished basement. Yeah. [06:29:18] P.CLANCY: Yeah. SPK40: 40-hour week or longer? P.CLANCY: varied roughly 40 hours. P.CLANCY: worked from home since 2018. P.CLANCY: Yeah. P.CLANCY: 2022 SPK40: November of 2022. P.CLANCY: New York. P.CLANCY: Two nights. P.CLANCY: Lindsay. SPK40: Sorry? P.CLANCY: Yep. P.CLANCY: Yeah. SPK40: she had books about parenting? pregnancy and postpartum anxiety workbook. workbooks work diagrams? SPK43: Sixty seven. [06:32:58] P.CLANCY: postpartum depression and anxiety patient information sheet. P.CLANCY: Yeah. SPK42: No objection. SPK42: Exhibit 81. P.CLANCY: Yep. P.CLANCY: Yeah. SPK40: Postpartum depression and anxiety. P.CLANCY: Yeah. SPK40: book or notes documenting daily effect from postpartum? SPK40: offer records of Dr. Jennifer Tuffs as mental health records. SPK42: No objection. SPK43: Exhibit for identification. SPK40: John see exhibit for identified yesterday document obtained from CVS. correct SPK40: sets forth medications purchased by Lindsay prescription from physicians seen during P.CLANCY: Correct. [06:36:41] P.CLANCY: had them in bag provider adjust medications remember Lindsay had prescription of Ativan wanted increase dosage effective give old prescription to husband discard continue taking from new prescription. SPK40: DA yesterday scripts pills with 30 count 27 three gone because she wasn't taking medication not the case. told to do right? P.CLANCY: Correct Without context different picture SPK40: Exhibit two pills turned in correct? in your bag car? P.CLANCY: I remembered it's exhibit two though. SPK40: Wednesday, January 24th troopers located four medication bottles 26th 2:30 afternoon bottles documented by police. When turned items into police? P.CLANCY: Yeah. Yeah. P.CLANCY: Yeah. P.CLANCY: Yeah. P.CLANCY: Correct. P.CLANCY: Yeah. SPK40: inside drawer recall number of items?Trazodone,Lindsay Clancy prescribed January five, 2023. Quetiapine, January Quetiapine 100 milligrams prescribed Lindsay Clancy December 21st. Lorazepam. all empty P.CLANCY: Yeah. P.CLANCY: Yeah. P.CLANCY: Yeah. [06:40:36] P.CLANCY: It's her Apple Watch. P.CLANCY: Yep. P.CLANCY: Apparently. P.CLANCY: Yeah. P.CLANCY: Yeah. P.CLANCY: Is there objection? SPK41: Yeah. SPK40: Watch. SPK42: No objection. SPK41: put as one exhibit? SPK43: 82 P.CLANCY: Just one. P.CLANCY: Correct. P.CLANCY: Yeah. SPK42: Objection. We could go to sidebar. [06:42:40] SPK41: see counsel sidebar P.CLANCY: Yeah. P.CLANCY: Yeah. P.CLANCY: Yep. SPK41: Come. SPK41: Yeah. SPK42: No objection. COURT: Any objection? PROSECUTION: No objection. COUNSEL: district attorney asked about exhibits of window in bedroom 20 feet drop to ground P.CLANCY: Right. PROSECUTION: No objection. P.CLANCY: Yeah. COUNSEL: hornet thing top window not good picture Underneath hornet exhibit blood drops smears COURT: Any objection? [06:52:31] [Q=PROSECUTION A=P.CLANCY] Q: Your Honor you Mr.Clancy shown email marked as exhibit sent to coworkers January 24th, 2023 at 5:24 PM correct? A: Yeah. Q: watched footage going into CVS Kingston at 5:32 PM correct A: Correct. Q: walked in at 5:32 PM A: Correct. Q: sent at 5:15 PM A: Right. Q: how far away Kingston CVS? A: Three minutes. Q: after text sent 5:15 PM around 5:18 or 5:20 PM arrived at CVS A: Right. Q: 't go in until 5:32 PM A: I don't know. Q: after text Lindsay about Pedia-Lax before 5:32 PM in car [06:54:50] A: Correct. Yes. Q: anniversary December 3rd not December 2nd A: Right. Q: text messages marked next exhibit COURT: Any objection? COUNSEL: Nope. CLERK: 487 [Q=PROSECUTION A=P.CLANCY] Q: cross-examination Lindsay took medications as instructed weren't always with every pills correct A: took as directed Q: can't say took every pill instructed didn't watch every time A: not standing next every Q: asked defense counsel accidentally went to site on methods suicide might've happened not sure correct A: don't remember listening to Tom T. Hall Q: August 23rd, 2022 9:40 AM signed into Lindsay 's Facebook account Surface Pro A: No. [06:58:52] Q: 9:43 PM Tom Hall site accessed recall A: Yeah. Q: 9:45 AM person hit link accident link suicide methods aware? A: No. Q: reason logging Lindsay 's Facebook account Wikipedia looking at suicide methods five minutes? A: didn't log into Lindsay 's Facebook possible looked at Tom Hall's Wikipedia page Q: remember spending three minutes on methods of suicide site reading? A: don't remember four years ago Q: remember site clicking link to in Australia commit suicide? A: No. Q: Dr. Goodheart recommending medications medication recommended? A: though Cymbalta amitriptyline Q: Trazodone 50 milligrams thought Dr. Goodheart recommended medication prescription given by Dr. Goodheart correct? A: another one lorazepam prescribed while she staying there Q: filled at CVS sent to Mc Lean? [07:03:24] A: issue didn't have medications Mc Lean needed brought Q: discharged January 5th, A: Right. Q: document CVS prescription for trazodone 50 milligrams by Dr. Alia Goodheart filled January 5th, 2023? A: Right. Q: Dr. Goodheart prescribe medication for Lindsay trazodone Ativan not Cymbalta correct? A: recommended Cymbalta wasn't prescribed Q: Dr.Tufts prescribed five milligrams diazepam January 9th, 2023 correct? A: Right. Q: amitriptyline January 16th 10 milligrams amitriptyline prescribed Lindsay issues with depression correct? A: Correct. Q: medications taken prior to Mc Lean, no longer on gone correct?McLean A: not sure don't know if all Q: conversations with wife about taking? only prescribed trazodone Ativan when left Mc Lean amitriptyline added 16th? three medications? A: thought taking trazodone before Mc Lean [07:06:02] Q: not sure about what taking when A: Not exact dates remember taking trazodone before Mc Lean Q: only prescribed Zoloft once beginning A: Right. Q: higher dose different dose Zoloft still taking seven pills misrepresents Zoloft took A: switched stopped to Prozac. Q: Prozac't many pills taken correct A: eventually stopped Q: take few pills side effects switch medication correct A: Yes. Q: after Mc Lean only on trazodone,Ativan 16th adding amitriptyline correct? A: Right. Q: Would December sound right? A: Yeah. Or end of November. Yeah. Q: November 4th through 7th to San Francisco? [07:08:44] A: Yeah. Q: who care of Dawson and Callan in San Francisco Cora? A: Lindsay. Q: during trip to New York after San Francisco Cora any issues problems Lindsay caring for kids? A: Nothing bad happened anxiety depression bad Q: progressed January better A: Definitely, yeah. Q: January 24th, 2023 testified of best days A: Yeah. Q: looking for from defense counsel Exhibit 84 packet Lindsay writing Callan 's schedule A: Right. Q: Lindsay sending notes between Elaine A: Possibly. Q: October 6th "Ate at 8:15 Fell asleep at 8:40 Changing tables bathroom If wakes before 9:40 give 15 minutes to sleep sleep till 10:15 If still asleep at 10:40 wake Feeding at 11:00 AM try bottle If doesn after 15 minutes make oatmeal Two tablespoons oatmeal thin with breast milk heat 5 to 10 seconds." specific directions she Callan cared for A: Yeah. [07:14:44] COUNSEL: records fair Lindsay concerned mother give instructions to people infant? P.CLANCY: Yeah, I would've done the same. COUNSEL: discussion about prescriptions scripts from doctors believed she on trazodone Dr. Izadpanah Kayvon November 16th '22 prescribed 50 milligrams of trazodone on buspirone and fluoxetine memory November 50? P.CLANCY: remember trazodone part of medication plan. PROSECUTION: see which one please? No objection. ## Day 3 (308 of 1860 turns kept) [00:00] COURT: Good morning, counsel. COURT: Good morning, Ms. Clancy. CLERK: Good morning, Your Honor. proceed? CLERK: before court today continuation of jury trial Commonwealth versus Lindsay Clancy Ms.Clancy present represented by attorney Kevin Reddington Commonwealth represented by Assistant District Attorney Jennifer Sprague Assistant District Attorney Shannon Buckingham COURT: hope had nice restful evening last night Thank you for patience ask questions follow instructions go over schedule for today and tomorrow. first questions any member of jury read seen heard anything from source affect ability to be fair impartial in case? COURT: Thank you for following instructions schedule today anticipated go morning to 11 o'clock We'll break at 11:00 come back We'll afternoon break at one o'clock go into afternoon between 3:00 and 4:00 today's schedule Tomorrow's schedule view in morning go to spots mentioned in testimony go over more tomorrow getting out going together in bus with court officers staff attorneys myself out bus word for footwear double check weather go into that more by end of day case forgetthought after that we'll come back We'll probably go again till between 3:00 and 4:00. that's schedule end of day tomorrow address where we are timeline overall schedule idea return to case on trial Commonwealth presenting evidence. Attorney Sprague. SPRAGUE: Your Honor Commonwealth calls Officer Stephen Hall COURT: All right. Good morning. [Q=SPRAGUE A=HALL] Q: Good morning. state spell your name for record? A: My name Stephen Hall. Q: And your date of birth? A: 3/ 26/1983. Q: How long been Duxbury Police officer? A: Since 2015, so roughly 11 years. Q: What shift were you working? [05:55:00] A: The 4:00 to midnight. Q: 4:00 PM to midnight? A: Yes. Q: attention 6:11 PM. receive dispatch to 47 Summer Street Duxbury? A: I did. Q: how long to 47 Summer Street? A: Seven to 10 minutes. Q: 47 Summer Street A: Yes. Q: show exhibits marked. Exhibit 32 and 33. house responded to? A: Yes. Q: Exhibit 34. left side of house? A: It is. Q: Exhibit 35 gate went in? A: It is. [07:36:00] Q: First officer on scene? A: I arrived simultaneously with Officer Josephine. Q: Exhibit 38. back of house? A: It is. Q: Exhibit 37. area defendant entered backyard? A: Yes. Q: after Patrick Clancy home call on radio? A: Yes. Q: Exhibit 41. stairs went to? A: Yes. REDDINGTON: no objection Your Honor read further or look report SPRAGUE: marked next exhibits REDDINGTON: No objection. SPRAGUE: Four exhibits. CLERK: Exhibits 89 to 92. [15:49:00] SPRAGUE: exhibit 89. view down stairs turn to right? HALL: Yes. SPRAGUE: exhibit 90. exercise bands tied to closet door? HALL: Yes. SPRAGUE: marked next two exhibits REDDINGTON: No objection. CLERK: Exhibit 93 and 94. SPRAGUE: Exhibit 93. pointing out saw his body HALL: Just of this area. SPRAGUE: Record pointed to area yellow exercise band SPRAGUE: Exhibit four at position later learn child's name Dawson Clancy? HALL: I did. REDDINGTON: Honor record don't need lay foundation agree to photographs No objection don't go through foundations SPRAGUE: marked as next exhibits? JURY: Exhibits 95 to 102, so marked. [20:36:00] [Q=SPRAGUE A=HALL] Q: Exhibit 95 saw went down stairs left first view? A: Yes. Q: exhibit 96 further view into room? A: Yes. Q: show Exhibit 96 again point where saw each child A: another [inaudible] in area Q: closeup marked next exhibit broader photo following- CLERK: Exhibits 103 and 104. SPRAGUE: photos marked next exhibits CLERK: Exhibit 105 through 108. HALL: Thanks. COURT: Attorney Sprague SPRAGUE: Commonwealth calls Officer Brian Josephine. [Q=SPRAGUE A=JOSEPHINE] Q: What's your date of birth, sir? A: June 13th, 1990. [05:11:00] Q: January 2023 role with Duxbury Police Department? A: school resource officer for Alden and Chandler worked with kids kindergarten through fifth grade Q: 8:00 PM? A: Yes, ma'am. Q: dispatch 6:11 PM 47 Summer Street Duxbury? A: Yes, we did. Q: Exhibit 33. mudroom went to inside house or door to mudroom? A: went to door mudroom check if unlocked back of house Q: Exhibit 33 went by cars around house right? A: Yes, that's correct. Q: showing Exhibit 37 coming around house garage left porch deck? A: Yes, that's correct. [Q=BUCKINGHAM A=JOSEPHINE] Q: Exhibit 92 doorway into bathroom? A: Yes, it is. Q: Exhibit 93 inside bathroom? [14:47:00] A: Yes, it is. Q: Exhibit 93 referenced gym bag bag left child's toy? A: Yes. Q: Exhibit 94 yellow exercise band correct? A: Yes. Q: showing Exhibit 97 red-brown stain on rug referring? A: Yes. Q: Thank you, sir. Nothing further. COURT: Attorney Reddington? BUCKINGHAM: Commonwealth calls PJ Hussey. REDDINGTON: objecting Renewing objection filed repetitious nature- COURT: sidebar CLERK: trial of Commonwealth v.Lindsay Clancy All parties present including defendant 18 jurors BUCKINGHAM: Yes. Commonwealth calls PJ Hussey. SPK2: Good morning, sir. [23:55:00] [Q=BUCKINGHAM A=HUSSEY] Q: Good morning state spell name record A: PJ Hussey, H-U-S- E-Y. Q: And your date of birth? A: 5/5/1963. Q: Where do you work? A: Duxbury Fire Department. Q: current role Duxbury Fire Department? A: captain shift commander Q: What does a shift commander do? A: Oversees operations town firefighting medical services Q: Okay. A: Yeah. Q: certain time A: 24-hour shift 8:00 morning to 8:00 next morning Q: working 8:00 morning January 24th [02:24:00] A: Yes. Q: shift end 8:00 January 25th A: Correct. Q: working shift commander 24th? A: Yes. Q: recall call after 6:00 PM dispatching 47 Summer Street Duxbury? A: Yes. Q: many vehicles personnel responded? A: car shift commander car ambulance 1 engine number 2. Q: Okay. And what were you doing? A: supervising call handled appropriately as shift commander. Q: Showing marked Exhibit 37. see area in backyard that night on screen? A: Yes. Q: in Exhibit 37. showing again screen marked as Exhibit 50. window right represent window basement office? A: Yes. Yeah. [06:56:00] Q: later learn child was Dawson Clancy? A: Yes. Q: Cora Clancy and Callan Clancy? A: Yes. Q: situation start treating patient move to something else someone take over? A: had myself as shift commander EMT four paramedics initial paramedics with Ms.Clancy beginning found other patients left paramedic with Ms.Clancy, paramedic with Dawson, two paramedics with two other kids in other room. COURT: Attorney Buckingham. BUCKINGHAM: Honor Commonwealth call Loring Nudd next witness REDDINGTON: Same objection for the record, Judge. [Q=BUCKINGHAM A=NUDD] Q: Thank you. Good morning. A: Good morning. Q: What's that? A: Everybody knows me as Chuck. Q: And that would be Daniel Dougherty? A: Daniel Dougherty. Yeah. [01:02:56] Q: go to 47 Summer Street? A: We do. Q: nature of call initial call with female gone out window possibly suicide? A: second-floor fall. SPK5: Correct. SPK5: Correct. SPK5: Correct. SPK5: Correct. SPK3: Here in Plymouth? SPK5: Correct. SPK5: Correct. SPK4: Attorney Reddington? SPK4: Attorney Buckingham. BUCKINGHAM: Commonwealth call Keith Nette next witness REDDINGTON: Same objection, Your Honor. [01:12:25] [Q=BUCKINGHAM A=NETTE] Q: Thank you. Good morning. A: Good morning. Q: How long with Duxbury Fire Department? A: About 17 years. Q: currently working for Duxbury Fire Department role? A: I'm captain shift commander Q: At Duxbury Fire work 24-hour shifts A: Correct. Q: this case January 24th after 6:00 PM heard call out correct? A: Correct. Q: Sergeant Homestead Duxbury officer A: Correct. Q: treatment paramedic Heath offer Dawson in back ambulance? A: tried start IV started IO IV Tried intubation advanced airway medications continued CPR Q: medication deliver through IODawson? [01:17:17] A: Epinephrine. Q: Were you able to intubate Dawson? A: Yes, Kevin Heath did. Q: Which hospital? A: EI Plymouth. Q: efforts give medication epinephrine start heart? A: No. Q: Thank you. All right. Attorney Reddington? SPK3: Commonwealth call Patrick Dwyer next witness REDDINGTON: Same objection for the record. SPK3: Thank you. Good morning. DWYER: Patrick Dwyer. DWYER: D-W-Y-E-R. DWYER: firefighter paramedic at Duxbury Fire Department SPK3: how long worked for Duxbury Fire Department? [01:22:47] SPK3: Were you on a 24-hour shift? DWYER: Correct. SPK3: 6:00 after 6:00 PM dispatched to 47 Summer Street? DWYER: On Franklin Street. SPK3: dispatch 47 Summer Street how long took from Station two to location? DWYER: Jennifer Stratton. DWYER: Correct. SPK3: dispatch Station two engine dispatched to 47 Summer Street correct? DWYER: That's correct. SPK3: show marked Exhibit number 34. screen? SPK3: 47 Summer Street? SPK3: Exhibit 38. sliding glass doors? DWYER: Correct. SPK3: previously marked Exhibit 95. left side basement? SPK3: Exhibit 96 see father? [01:26:37] SPK3: How many children? DWYER: Two. DWYER: The five-year-old girl. SPK3: exhibit 96 depict general area five-year-old child? SPK3: photograph exhibit 96 lot of equipment? SPK3: Exhibit 101 more equipment equipment? SPK3: exhibit 96 middle red spot on floor fair place Cora? DWYER: Probably closer to the cardiac monitor. SPK3: exhibit 101 cardiac monitor better? SPK3: emergency staff help rendering aid Cora? DWYER: Marshfield. DWYER: Marshfield Ambulance. DWYER: Yes Andrew Wilkins Ryan Henry Carrie Cover SPK3: And Carrie was driving? DWYER: Beth Israel Plymouth. [01:33:45] SPK3: efforts continued transport from Duxbury to Beth Israel Plymouth? DWYER: Thanks. SPK3: Commonwealth calls Jennifer Stratton. REDDINGTON: Same objection, Your Honor. SPK4: Hey, good morning. SPK4: Great. Thank you. Yeah, Treesh Brake. STRATTON: July 11th, 1986. STRATTON: Duxbury Fire Department. STRATTON: 12 years. STRATTON: About 13. SPK3: direct attention January 24th, 2023 working day? SPK3: 24-hour shift started 8:00 AM? SPK3: part of crew dispatched to 47 Summer Street after 6:00 PM? SPK3: how long from station at 247 Summer Street? STRATTON: Maybe four or five minutes. [01:39:01] SPK3: Exhibit 100 room entered? SPK3: Exhibit 98 area Callan found? SPK3: Exhibit 98 nine pajamas stethoscope blue exercise bands? SPK3: I'm sorry. Was either attempt successful? STRATTON: deep strangulation marks circumference neck SPK3: care transferred to medical staff Beth Israel Deaconess Plymouth SPK3: Nothing further. Thank you. SPK7: Yeah, please. SPK3: Commonwealth calls Robert Costanzo. SPK4: Sure. Yeah. COSTANZO: It's Robert Costanzo, C-O-S-T-A-N- Z-O. COSTANZO: 04/24/1985. [Q=BUCKINGHAM A=COSTANZO] Q: And your date of birth please? A: 4/24/1985. Q: Where do you work? [01:45:05] A: Pembroke Fire Department. Q: after 6:00 PM call Duxbury Fire Department for mutual aid? A: Yes. Q: Who was your partner? A: Dan Smith. Q: recall which hospital went to? A: South Shore Hospital. COSTANZO: The patient. REDDINGTON: T5 through T6, T4, 6, 7, 8 exploded fractured. know? COSTANZO: No. COURT: Commonwealth redirect. COURT: All right. Anything further? BUCKINGHAM: Commonwealth calls Daniel Dougherty. REDDINGTON: No objection. SPK9: Good morning, sir. [01:57:09] [Q=BUCKINGHAM A=DOUGHERTY] Q: [inaudible] Good morning. state spell your name for record? A: Daniel Dougherty, D-O-U-G-H-E-R-T-Y. Q: And your date of birth? A: 8/27/1986. Q: Where do you work? A: Duxbury Fire Department. Q: How long with Duxbury Fire Department? A: Five and a half years, full-time. Q: working 24-hour shift? A: Yes. Q: after 6:00 PM respond to 47 Summer Street Duxbury? A: Yes. Q: What's an OPA device? A: plastic device depresses tongue keep airway open COURT: Redirect? [02:07:02] BUCKINGHAM: aware Ms.Clancy went to South Shore Hospital correct? DOUGHERTY: Yes. COURT: Anything further? Thank you, sir. BUCKINGHAM: Commonwealth calls Vincent Cahill. REDDINGTON: No objection. SPK9: Good morning, sir. SPK9: Mind the step please, sir. CAHILL: Morning, Your Honor. [Q=BUCKINGHAM A=CAHILL] Q: And your date of birth, please? A: 11/11/1996. Q: 6:11 PM dispatched to 47 Summer Street Duxbury? A: Yes, ma'am. Q: firefighters take over care of Callan? A: Yes. Q: showing Exhibit 96. couch bed ottoman on top placed ottoman? [02:11:40] A: Yes, ma'am. Q: marked next exhibit COURT: Any objection? BUCKINGHAM: Exhibit 109. nothing further Thank you. COURT: Counsel? CAHILL: Thank you, Your Honor. BUCKINGHAM: Your Honor approach sidebar. COURT: Members jury talking to counsel couple of issues to hammer out done rather than wait excuse you for day schedules don't match excuse until tomorrow morning tomorrow morning plan go on view explain more in detail tomorrow ask be here ready to come at nine o'clock address ask same questions give information about view instruction. go to couple of areas.You're going to look at these areas. lawyers be there point out significant. we'll come back We'll continue with testimony. may end up early tomorrow schedules. I talk to counsel see where we are overall schedule impression we ahead of schedule. excuse you till tomorrow morning wait excuse you till tomorrow ask be here at 9:00 check weather be on view in morning witnesses in afternoon. remember ask questions.Don't read anything, don't talk don't do research don't take field trips see you tomorrow morning. Thank you. ## Day 4 (154 of 845 turns kept) [01:25:00] BUCKINGHAM: Commonwealth call Mark Anthony Maffeo stand REDDINGTON: waiting Your Honor record same objection standing objection MAFFEO: Thanks. MAFFEO: Good morning, Your Honor. COURT: All right. Attorney Buckingham, please. [Q=BUCKINGHAM A=MAFFEO] Q: Thank you. Good morning, sir. A: Good morning. Q: tell jury first last name A: Yes. Mark Anthony Maffeo. Q: And where are you employed, sir? A: Duxbury Police Department. Q: Nine? A: Yes. Q: What's current rank assignment Duxbury Police Department? A: Patrol Sergeant. [03:12:00] Q: Detective Jamali where tell go? A: Initially reported 42 Summer Street Duxbury Q: later aware home at 47 Summer Street home Patrick and Lindsay Clancy correct? A: That's correct. Q: people transported South Shore Hospital only Lindsay Clancy sent location correct? A: That's correct. Q: later advised ambulance sent to Beth Israel Plymouth? A: Correct. REDDINGTON: no objection to photographs BUCKINGHAM: admit next four exhibits [Q=BUCKINGHAM A=MAFFEO] Q: draw attention screen showing Exhibit 110. individual depicted in photograph? A: Lindsay Clancy. Q: Exhibit 111Lindsay Clancy? A: Yes. Q: injuries observed January 24th neck? [06:59:00] A: Correct. Q: 112 Exhibit 112. photograph arm extended cuts middle observe January 24th? A: I did. Q: Exhibit 113 other arm observe cuts arm? A: Yes. Q: move admit next exhibits COURT: Any objection? REDDINGTON: no objection to photographs BUCKINGHAM: 114. Seven. Thank you COURT: Thank you, Madam Reporter. BUCKINGHAM: after custody items other law enforcement arrive at South Shore Hospital? MAFFEO: Yes. BUCKINGHAM: And who arrived? MAFFEO: Trooper Lawlor Mass State Police Officer Lippard Duxbury Police COURT: Sustained. [12:05:00] [Q=BUCKINGHAM A=MAFFEO] Q: Okay. But you recall Officer Lippard? A: Yes. Q: 47 Summer Street correct? A: Correct. Q: said 42 A: You're right. Yep. 47 Summer. Q: present Massachusetts State Police Detectives Unit executed search warrant 47 Summer Street? A: I was. COURT: Counsel? REDDINGTON: Donna see exhibits introduced? [inaudible MAFFEO: Good morning. COURT: Any objection? [Q=REDDINGTON A=MAFFEO] Q: Fair and accurate depiction? A: Correct. Q: showing another exhibit introduced evidence Exhibit 112 area wrist correct? [15:34:00] A: Correct. Q: cut Exhibit 111 shows cuts neck correct? A: Correct. COURT: Any objection? BUCKINGHAM: admitted Sergeant Murphy BUCKINGHAM: No objection. LIPPARD: Exhibit 126. REDDINGTON: State Police got search warrant MAFFEO: Correct. REDDINGTON: Okay. Also blood drops? MAFFEO: Correct. MAFFEO: Correct. COURT: All right. Any objection to that? COURT: Hold on a second, Counsel. REDDINGTON: Sorry. [14:00] CLERK: 127 through 135. So marked. COURT: Attorney Buckingham, any redirect? BUCKINGHAM: Just briefly. BUCKINGHAM: Thank you. Nothing further. REDDINGTON: execute search warrants find evidence relevant MAFFEO: Correct. BUCKINGHAM: Nothing further. MAFFEO: Thank you, Your Honor. COURT: All right. Attorney Buckingham, please. [Q=BUCKINGHAM A=LIPPARD] Q: Thank you. Good morning. A: Morning. Q: tell jurors first last name? A: Richard Lippard. Q: What's current assignment Duxbury Police? A: Patrolman. [05:45:00] Q: working January 24th, 2023? A: Yes. Q: South Shore Hospital emergency department? A: Emergency department. COUNSEL: Outside? SPK1: Yeah. COUNSEL: Thank you. Nothing further. [Q=REDDINGTON A=SPK1] Q: went directly South Shore? A: Correct. Q: see state police hospital? A: South Shore Hospital not Boston Q: back after day? A: To South Shore Hospital? COUNSEL: Objection. SPK2: Overruled. [13:03:00] SPK1: Anybody coming to visit. REDDINGTON: Yes. SPK1: next morning 10:00 REDDINGTON: relieved by who? SPK1: Officer Daly Duxbury Police Department Officer Johnson Duxbury Police Department COUNSEL: sidebar? COUNSEL: Thank you, Your Honor. SPK2: Yes please. [Q=COUNSEL A=TENEROWICZ] Q: Good afternoon state spell name record? A: Mark Joseph Tenerowicz.-O-W--C-Z Q: date of birth? A: 02/28/69. Q: And where did you work? A: Beth Israel Deaconess Plymouth. Q: observe trauma body? [17:55:00] A: believe old bruises on legs ruptured blood vessels on face. Q: what treat Dawson? A: continued CPR continued IV fluids gave doses adrenaline restart heart confirmed breathing tube right position gave medicines treat presumed acid buildup blood gave calcium heart beat effectively Q: 19:28 7:28 PM? A: That's correct. SPK2: All right. Anything further? SPK2: All right. Good afternoon, Doctor. REDDINGTON: for record Your Honor note same objection. SPK2: Same ruling. [Q=COUNSEL A=KAUFMAN] Q: And your date of birth, sir? A: September 10th, 1984. Q: And where do you currently work? A: Beth Israel in Plymouth. Q: what treating Callan? A: came in put in breathing tube IV established dose epinephrine look directly at heart with ultrasound heart started beating after dose continued compressions giving breaths through breathing tube Plymouth Hospital pediatrics ability care level pediatric patients on phone with Boston Children's Hospital preparations definitive care [01:32:00] Q: examination testing determine Callan brain function? A: no point exhibit brain function not neurologist not definitive person emergency medicine scale Glasgow Coma Scale from three to 15. different variations for pediatrics he scored lowest in coma no brain response during entire time care Q: Thank you, Doctor. COURT: Thank you, Doctor. Attorney Buckingham? BUCKINGHAM: Honor Commonwealth call Melissa Arcadipane. COURT: Hi, good afternoon. Attorney Buckingham, please. [Q=BUCKINGHAM A=ARCADIPANE] Q: Thank you Good afternoon. tell jurors your first last name? A: Melissa Arcadipane. Q: work for South Shore Hospital? A: Yes. Q: aware preservation notice served on South Shore Hospital for blood urine of Lindsay Clancy January 24th, 2023? A: I was. Q: Okay. Nothing further. Thank you. COUNSEL: Honor Commonwealth move to submit certified medical records from Beth Israel Deaconess Plymouth for Cora Clancy,Dawson Clancy Callan Clancy in one binder. REDDINGTON: No objection. [09:37:00] BUCKINGHAM: If we could approach sidebar? COURT: Yes. Jury talking counsel break for today talking schedule if not on schedule, at schedule because work when you not here Counsel going over exhibits part of breaks excuse you long week take break till Monday Monday schedule anticipation start 9: 00 later ask be here ready at 9:00 matters talk to counsel late start Monday anticipations go most of day well on schedule not ahead remind not here for couple of days important.You've heard some evidence haven't heard all evidence heard law apply this keep open mind. best way don't talk this with anyone Don't do research.Don't watch anything. If something comes on turn off.like I said if talking to it blame me judge said not to talk not listen shut them down. appreciate work put look forward to seeing you Monday hope nice weekend see you then. thank you. COURT: All right. Now anything else address before Monday morning? Counsel? SPK4: Court's in recess. exit courtroom. Thank you. ## Day 5 (664 of 3020 turns kept) [00:00] COURT: Good morning, everyone. hope restful weekend. want tell first going go through questions follow instructions Then go over today's schedule return to Commonwealth 's presentation of evidence. ask questions. First question has any member of jury read, seen or overheard anything source about aspect this case affect your ability to be fair and impartial? Next question any other serious matter or concern your service as juror bring attention? thank you for following instructions. today's schedule always correct decisions about scheduling on me sometimes consideration other factors don't speculate why we go late or early certain days don't hold it against either side. person making decisions is me aware of thought is today go into afternoon if changes, I'll let you know return to Commonwealth 's case.Commonwealth call your next witness please. BUCKINGHAM: Thank you, Your Honor.Commonwealth call Michael Snyder. COURT: Oh, sure. Yeah. REDDINGTON: Thank you. Apologies. COURT: All right. Good morning, Doctor. COURT: Attorney Buckingham, please. [Q=BUCKINGHAM A=SNYDER] Q: Good morning sir. tell jurors your first last name? A: Yep. Michael Snyder. Q: how long worked at Beth Israel? A: Since 2014, 12 years. Q: assigned to treat one patient A: Correct. Q: prior to EMS arriving learn more about Cora 's presentation? A: heard all three in cardiac arrest Cora still working on doing CPR pediatric advanced life support medications to restart heart used defibrillator to shock heart restart still doing CPR when arriving Q: medications provided? [07:04:00] A: prior to given epinephrine primary medication in cardiac arrest Q: Why is that significant to you? A: two medications epinephrine cause pupils dilate if brain damaged lose signals make pupils smaller if brain injury Q: treatment continue with medications? A: Yes. Q: how long treating Cora continue? A: in emergency room roughly 30 minutes Q: at approximately 19:28 or 7: 28, declare Cora deceased? A: Yes. COURT: Thank you, Doctor. SNYDER: Thanks. SPRAGUE: Commonwealth calls Dr. Andrew Capraro. COURT: All right. Good morning, Doctor. [Q=SPRAGUE A=CAPRARO] Q: And your date of birth, please? A: July 9th, 1970. [17:05:00] Q: observations about physical condition? A: cold on arrival limp not making purposeful movements pupils fixed dilated ligature marks about neck swelling neck Q: swelling and injury be caused by strangulation, injury of brain? A: Most certainly. Q: And what were those consistent with? A: Strangulation likely from object linear aspect of bruising. COURT: Thank you, Doctor. Please step down. SPRAGUE: Commonwealth calls Dr. David Casavant. COURT: All right. Good morning, Doctor. CASAVANT: Good morning. Good morning, Your Honor. COURT: Attorney Sprague. [Q=SPRAGUE A=CASAVANT] Q: And your date of birth, sir? A: 5/2/63. Q: And where do you currently work? A: work at Boston Children's Hospital in Medical-Surgical ICU. [19:00] Q: how long worked at Boston Hospital? A: 18 years. Q: when pupils stay open wide when shine light what indicate medically? A: eyes direct extension of brain focus on them area of investigation lack of response to light indicates abnormality in this case brain injury. medications can keep eyes open eye exam not the case with Callan [Q=BUCKINGHAM A=CASAVANT] Q: describe brain death testing? A: brain death testing at Boston Children's strict testing includes things mentioned work with checklist neurologic colleagues go through expect responses through nerve sets ICU physician neurologist there neurologist neurology team perform brain death testing test repeated 24 hours later no piece different or incongruous with diagnosis of brain death. Q: his reaction results on apnea test? A: apnea test do all brain testing one day wait 24 hours for second one. expect carbon dioxide will increase. written in for protocol increase by 20 or get to level 60. normal CO2 around 40. first time first day went to 59.7, not 60. in protocol has to get to 60 or increase by 20. talked to colleagues including neurology close.'s 59.7 not 60." repeated test later to valid. checked with everyone to doing right thing. agreed second time went to 87. everything else same. things look at not on medications no changes in temperature no abnormalities of salts blood electrolytes. conditions exact same. repeated later back positive. Q: Why is that? A: to if lingering effects of medications if anything changed in patient's level alertness or response, meets requirements 24 hours later. COURT: Attorney Reddington. BUCKINGHAM: Your Honor Commonwealth move admit Boston Children's Hospital records Callan Clancy evidence two volumes. COURT: Any objection? REDDINGTON: Honor no objection both have records want them in evidence no objection records signed releases Beth Israel,Brigham and Women's South Shore. all can go in BUCKINGHAM: Kelly McDonough. [20:29:00] COURT: Okay. Sure. COURT: Hey, good morning. [Q=BUCKINGHAM A=MCDONOUGH] Q: Good morning. tell jurors first last name? A: Kelly McDonough. Q: spell last name record? A: M-C-D-O-N-O-U-G-H. Q: educational background? A: medical school University of New England Maine residency Kent Hospital Rhode Island worked Carney Hospital Dorchester South Shore Hospital since 2021. Q: primarily emergency department South Shore Hospital? A: Correct. Q: aware of patient Lindsay Clancy date of birth 8/11/90? A: Yes. Q: show photos marked marked exhibit number 111 accurate representation of neck injuries observed? A: Yes. Q: exhibit 113 other wrist Same observe assessment trauma one assessments acute? [03:18:00] A: I assume that they're acute. Q: South Shore Hospital pneumatic tube system? A: Correct. Q: strike artery or vein different pressure systems blood comes out different? A: Yes. Q: Your Honor move to enter evidence South Shore Hospital medical records Lindsay Clancy from January 24th, 23 next exhibit. BUCKINGHAM: move enter next exhibit certified copy imaging records South Shore Hospital Lindsay Clancy from January 24th, 2023 [Q=REDDINGTON A=MCDONOUGH] Q: she on pain medication? A: I don't remember. Q: difficulty being intubated? not under medication sedation unconscious hurts to be intubated A: wouldn't intubate without induction medicines Q: I'm sorry? A: 12 Q: And what is normal? A: 98.6. [01:13:17] Q: blood? blood transfusion at South Shore Hospital Medical Center? A: I don't recall. COURT: Any redirect? BUCKINGHAM: Okay. Thank you. Nothing further. BUCKINGHAM: Commonwealth call Rose Stoffers next witness COURT: Morning. Hi, Attorney Buckingham, please. [Q=BUCKINGHAM A=STOFFERS] Q: Thank you. Good morning. A: Morning. Q: tell jurors your first last name? A: Rose Stoffers. Q: how long worked for state police? A: Since January of 2019. Q: part of different unit State Police Crime Lab Crime Scene Response Unit? A: Correct. Q: South Shore Hospital purpose called? [01:21:20] A: instructions document defendant injuries Forensic Scientist Hartnett taking swabs document areas swab REDDINGTON: Objection. BUCKINGHAM: admit next exhibit COURT: Any objection? REDDINGTON: no objection to photographs SPK2: Exhibit 140. [Q=BUCKINGHAM A=STOFFERS] Q: Sergeant showing marked Exhibit 140. A: Yes. Q: injuries observed areas body documented? A: took first photo her closeup face neck area documented hands sides wrist area underneath gauze nurses assisted opening neck brace took photos neck Q: South Shore Hospital January 24th recall called another location later same lab number? A: Yes. Q: January 6th, 2023 A: February 6th. Q: Trooper Rabbit what ask do? [01:27:03] A: asked photograph bag of medication documents inside bag brought office Q: Okay. Nothing further. COURT: Attorney Reddington. COURT: Anything further, Attorney Buckingham? L.CLANCY: Mm-hmm. [inaudible]. COURT: Honor Commonwealth call Rachelle Amedee COURT: And good morning. SPK3: Inquire? SPK3: Thank you. Good morning. AMEDEE: nurse at Brigham and Women's Hospital trauma surgical ICU AMEDEE: Almost 27 years. AMEDEE: bachelor's in nursing from Salem State University AMEDEE: 20 years this week. AMEDEE: The trauma surgical ICU. AMEDEE: Eight years. [02:07:57] SPK3: January 2023 working same unit? AMEDEE: worked night shift 7:00 PM, 7:00 AM AMEDEE: Night shift. SPK3: In Weymouth, the South Shore Hospital? AMEDEE: South Shore. SPK3: patient identified potential suicide risk? AMEDEE: She coded. SPK3: event occurred 3:30 in morning AMEDEE: two police officers outside room [Q=BUCKINGHAM A=AMEDEE] Q: able give commands care for her able follow? A: Yes. Q: follow A: Simple, yeah, commands. Q: What kinds of commands? A: squeeze hand wiggle toes basic neuro check alert follow understand [02:16:36] Q: still on sedation medication? A: No. Q: address sleep? A: plan start first sleeping medication don't remember which one wait hours see if worked if not try another medication REDDINGTON: Objection. COURT: see counsel? go ahead BUCKINGHAM: Just one moment. COURT: All right. Commonwealth, any objection? BUCKINGHAM: 141A and B. [Q=REDDINGTON A=AMEDEE] Q: Okay. You're very soft-spoken. A: Sorry. Q: keep voice up jurors hear A: got ICU around 3: 00 AM Q: Moving forward January 28th, 29, 30 into February 1st, 2nd February 2nd counsel asked reach out lawyer correct A: Yes. [02:26:28] Q: I'm sorry? A: Surgical ICU. Q: Okay. A: She gets infused rapidly. Q: Down here. A: Yeah. Q: present illness history 32-year-old female history postpartum depression A: Yes. Q: agree recall notation patient critically ill postpartum psychosis page 72? BUCKINGHAM: Objection. REDDINGTON: knew came from South Shore Hospital AMEDEE: Yes. REDDINGTON: discussion about postpartum psychosis AMEDEE: Yes. AMEDEE: 01/25. [02:37:08] REDDINGTON: January 25. AMEDEE: Oh, sorry. Yeah. AMEDEE: January 25th. [Q=REDDINGTON A=AMEDEE] Q: Okay. Does it say what time? A: 9:00 AM. 9:03 AM. Q: Hopefully raises the temp, right? A: Yeah. Q: reference to pressors A: blood pressure medication [Q=BUCKINGHAM A=SPK5] Q: aware identified history patient history postpartum mood symptoms not psychosis? A: look at note don't remember Q: fully evaluated by psychiatric team A: I knew she saw psych, yes. Q: identified inherent uncertainty in diagnosis A: I do not remember. [02:46:35] Q: Because she coded? A: Yeah. Q: didn't instruct do anything further with injuries A: Yes. Right. REDDINGTON: District attorney asked evaluation psychiatric teams determination inherent uncertainty psychiatric teams when psychiatric teams evaluating? REDDINGTON: event reference to postpartum depression psychosis correct? COURT: Anything further? BUCKINGHAM: The Commonwealth would call Meghan Collins. SPK9: Officer Stoke, please. [Q=BUCKINGHAM A=COLLINS] Q: Thank you. Good afternoon. A: Hi. Q: tell jury first last name? A: Meghan Collins. Q: Where'd you go? A: Sacred Heart. [02:50:08] Q: And what shift was that? A: 7:00 A to 7:00 P. Q: 7:00 AM to 7:00 PM? answer out loud A: Okay. Yes. Q: with her entire day 25th 7:00 AM to 7:00 PM shift? A: Yes. Q: What happens if individual under sedation intubated? A: patient dependent majority tolerate breathing tube uncomfortable give medications comfortable tube SPK8: So that was new exhibits? SPK10: It's 142 and 143. [Q=BUCKINGHAM A=COLLINS] Q: show screen Exhibit 142 and 143 injuries on her neck correct? A: That's correct. Q: January 26th 7:00 AM to 7:00 PM shift recall patient required additional sedation due to tube intolerance? A: Yes. Q: started on low dose propofol [02:57:01] A: That is correct. Q: assessment about thoracic injuries cervical injuries A: I do not diagnose. Q: see patients intubation extubated exhibit signs confusion or delirium? A: Yes. It's called ICU delirium. Q: purpose present? A: consulted psychiatry team evaluate determine capacity role ICU nurse advocacy patient alert providers changes in mental status Q: recall who present other than psych doctors psychiatric unit? A: social worker, myself lawyer present. COURT: Attorney Buckingham? [Q=PROSECUTION A=SHAH] Q: Commonwealth calls Dr. Shah. A: Thanks, Your Honor. Q: What's your date of birth? A: 5-8-81. Q: What do you do for living? [03:05:57] A: I'm a psychiatrist. Q: describe education training background psychiatrist A: undergraduate in Philadelphia University of Pennsylvania medical school at Jefferson Medical College Philadelphia moved. to Boston residency in psychiatry at Brigham and Women's Hospital Beth Israel Deaconess fellowship in consultation liaison psychiatry at Brigham and Women's Hospital stayed faculty member Q: And what is your role there? A: Associate Chief of Division of Psychiatry and Medicine leading consultation liaison psychiatry service at Brigham. Q: consultation liaison service? A: consultation liaison psychiatry subspecialty of psychiatry interface psychiatry medicine work inpatient and outpatient settings called by other healthcare providers need help patients question psychiatric realm see patient admitted to hospital provide recommendations to physicians care team Q: Brigham if patient treated medical doctor consultation with psychiatrist your department called A: That's correct. Q: meet with Lindsay Clancy January 29th, 2023? A: team seeing Ms.Clancy for psychiatric safety risk assessment suicide attempt ensure patients safe in hospital make recommendations about safety status recommendations related medications team following saw her 29th continue assessmentcalled to ask new. asked new question consult question on she decision change healthcare proxy from husband to parents. Q: talked needing consistent choice. ensure consistent choice with her? A: waited change from Patrick Clancy to parents until next day for variety reasons wanted to ensure choice consistent over time day saw her she gone through major medical events major spine surgery decompression fusion oxygen desaturations overnight not breathing Her heart rate up led to delirious confused overnight asked nurse "Am I delirious?" experiencing visual hallucinations reasons called in to decision to change healthcare proxy team voiced concerns after reported suicide attempt decision of sound mind waited until next day reassessed delirium cleared consistent choice to change healthcare proxy to parents Q: noted in medical records hallucinations part of issue with oxygen? A: could be reasons Delirium due to different medical reasons oxygen desaturation could be one recently had anesthesia related to surgery on spine could another reason heart rate elevated could another reason [03:12:16] Q: common for patients coming off anesthesia from surgery issue with oxygen medical issues to have visual hallucinations? A: They can not delirium common after surgery particularly anesthesia Q: hallucinations she resolved by next day over next day correct? A: That's correct. REDDINGTON: Objection. COURT: Sustained. PROSECUTION: difficulty understanding you? SHAH: first day saw January 29th described feeling confused witnessed bedside cognitive evaluation made mistakes her with delirium [Q=SPRAGUE A=SHAH] Q: seeing her days later correct A: Correct. Q: asked her if hallucinations delusions first day She denied those A: During my evaluation, yes. Q: denied suicidal intent homicidal intent correct A: Yes. Q: didn't see behavior responding to voices or hallucination [03:20:23] A: no with nurse Ms Clancy reported visual hallucinations overnight Q: Overnight after surgery? A: That's right. Q: to Ms.Clancy again on February 19th, 2023? A: Yes. Q: What were the other reasons? A: ongoing safety evaluation psychiatric safety risk medication evaluation medications right level right dosage right medications ongoing evaluation mental status Q: she denied suicidal intent correct A: That's correct. Q: denied auditory or visual hallucinations correct A: Yes. Q: She said had no suicidal intent no homicidal intent correct? A: Correct. Q: No auditory or visual hallucinations, correct? A: Correct. [03:23:06] Q: made note low mood today physical legal situation meet criteria for major depressive episode." correct A: Yes. COURT: Can I see Counsel? [Q=SPRAGUE A=SHAH] Q: last visit February 22nd, 2023 A: Yes. Q: denied suicidal homicidal ideation A: Yes. Q: denied audio hallucination visual hallucination else A: Yes. Q: Objection. REDDINGTON: That's an evaluation in the psychiatric. [Q=REDDINGTON A=SHAH] Q: didn't exaggerate seeing visions hearing voices suicidally homicidally ideated didn say A: No. Q: knew postpartum issues A: Yes. [03:26:31] Q: psychiatrist familiar with postpartum psychosis correct A: Yes. Q: people can communicate plan act on plans in psychosis A: Yes. Q: don't have to be drooling stumbling unable to walk talk in psychosis A: No. Q: person can psychosis communicate to friends family people talk correct A: Yes. Q: doctor psychiatrist familiar with bipolar diagnosis correct A: Correct. Q: bipolar means A: Bipolar disorder mood disorder patients have distinct depressive episodes hypomanic or manic episodes don't sleep for days lots energy decreased need for sleep irritability impulsiveness racing thoughts patients out of control of behavior severe episodes include psychosis Q: reference to bipolar hypomanic what does hypomanic mean? A: lesser degree of mania patients hypomanic don't always experience like psychosis might experience other symptoms including racing thoughts moving quickly talking quickly being irritable. Q: As psychiatrist concerned about her releasing her medication she had on board when hospital? [03:29:19] A: Yes. Q: difficult to recall recall medications she under from taking blood when tested? A: first hospital Q: Yeah, if you know. A: medication list previous incident on amitriptyline, diazepam prescribed lorazepam one other Q: toxicology report done on her January 24th taking blood familiar with analyze for toxicology? toxicology medications type of drugs she had on board, booze, cocaine A: Yes. Q: agree her blood reflected on trazodone? A: Yes. Q: what trazodone is? A: Trazodone antidepressant medication often utilized as sleep aid side effects is sedation patients difficulty sleeping placed on trazodone. Q: Trazodone share qualities of SSRI? not SSRI shares similar qualities? A: Yes. Q: tell me what SSRI means? A: It selective serotonin reuptake inhibitor class of medications antidepressants. [03:31:44] Q: SSRI s include Zoloft, A: Correct. Q: Would also include Prozac, for example? A: Yes. Q: psychiatrist aware Zoloft SSRIProzac not prescribed to patient bipolar? A: can be prescribed prescribed together with another medication protective patients bipolar disorder depression prescribed antidepressant protective Q: reference SSRI selective serotonin reuptake inhibitor what mean? A: depression patients lacking serotonin in brain Q: What is serotonin A: Serotonin neurotransmitter hormone in brain works on brain works body brain nerve endings helps mood regulation patients with depression lacking serotonin selective serotonin reuptake inhibitor prevents serotonin sucked back into cell allows for serotonin more available Q: What is SSAI? selective serotonin antagonist? A: medications do opposite. Q: psychiatrist her history knew she seeing psychiatrists prior to suicide attempt correct A: Correct. Q: prescribed drugs by psychiatrists [03:33:44] A: Correct. Q: Hydroxyzine, what is hydroxyzine? A: used for reasons psychiatric purposes often as anti-anxiety medication Q: type of medication? mood stabilizer? A: It is also anti-seizure medication in psychiatric realm used as mood stabilizer. Q: talked about Prozac.SSRI, correct? A: Correct. Q: Quetiapine, okay. And what is Seroquel? A: Seroquel is an antipsychotic medication. Q: she prescribed trazodone. also prescribed amitriptyline? A: Yes. Q: Some drugs have suicide warning black box warning A: Yes. Q: means? A: studies show after starting antidepressant increase risk of suicidality studies mostly in adolescents young adults can happen in adults [03:36:17] Q: Four-month period? A: Yes. SPRAGUE: Objection. COURT: Sustained. [Q=SPRAGUE A=SHAH] Q: Where getting information about what she on when? A: collect information during assessments look through record what prescribed talk with other providers prescribe context assessments require to determine what she on before using different set medications treat different symptoms Q: From the defendant? A: Correct. Q: she reporting took medications surprised one zero pills taken? A: I don't think I'm surprised, no. Q: prescription timeframe prior to admitted hospital only prescribed trazodone,Valium, amitriptyline three medications? A: Yes, I was aware. [Q=REDDINGTON A=SHAH] Q: Thoughts of hurting, suicidal ideation important to evaluate? A: Yes. Q: reference to Counsel's comment about three medications prior suicide not aware doctors telling her discontinue medication start new medication different medication depending doctor not aware [03:40:36] A: No. Q: finally did she sign DNR not resuscitate? A: asked day after first evaluation capacity assessment to change healthcare proxy reporting serious suicide attempt change code status continued chat conclusion mental health stable before code status COURT: Commonwealth? SPRAGUE: Nothing further. SHAH: Thank you, Your Honor. COURT: Thank you Madam Clerk Commonwealth ready to call next witness? SPK17: Yes Honor Commonwealth calls Dr. Biswas SPK16: Good afternoon, ma'am. COURT: All right. Good afternoon, Doctor. COURT: All right. Good afternoon, Doctor. [Q=SPRAGUE A=BISWAS] Q: And your date of birth? A: Date of birth is 9/12/1982. Q: What do you do for a living? A: forensic psychiatrist work at Brigham and Women's Hospital [04:57:32] Q: forensic psychologist A: forensic psychiatrist specialty training work courts forensic evaluations also adult psychiatrist work at Brigham and Women's Hospital adult psychiatrist consult-liaison unit Q: describe education training background work A: grew up South Shore went Dartmouth College medical school UMass Chan Medical School psychiatry residency at Harvard Longwood Brigham Women's Boston subspecialty training forensic psychiatry UMass Chan Medical School Q: 26th? capacity interact with her forensic psychiatrist or member staff at Brigham and Women's? A: interacted with her as member staff psychiatry staff at Brigham and Women's Hospital Q: particular role day January 26th, 2023? A: on consult-liaison service psychiatry service called by medical and surgical specialties evaluate provide psychiatric recommendations Q: around 2:14 PM interaction? A: between 2:00 and 3:00 Q: asking her questions goal? address or assess? A: depends Psychiatrists called for all issues in hospital situation asked around diagnostic clarity likely suicide event evaluate her for safety before surgery? Q: familiar with characteristics of psychosis? A: Yes. Q: typical signs symptoms of psychosis? [05:04:07] A: depends ranges across spectrum of symptoms category different types symptoms for psychosis different for everyone negative symptoms internal isolating not responding not reacting positive symptoms more outward focused paranoid darting eyes responding to internal stimuli voices within delusion all symptoms different for each person Q: conversation with Ms.Clancy notice internal or external signs of psychosis? A: documented note Q: note her thinking linear goal oriented thoughtful didn't responding to internal stimuli? A: typical language in psychiatric mental statuses Q: What is internal stimuli? A: difficult for patients to articulate hearing perceptual disturbances hallucinations auditory hallucinations hearing voices active see individuals interacting with voices didn't see moment Q: obvious signs of psychosis thoughts disorganized thinking't linear not making sense word salad throwing in words making sentences don't make sense? A: described symptoms in serious mental illness psychotic disorder with active symptoms. REDDINGTON: don't know what means. Objection. SPRAGUE: assessment professionally of responses awareness? BISWAS: Yes to assess confused or oriented disorganized anxious won't sleep? assessing suicidality called into room for assessing before surgical intervention answer question? [Q=REDDINGTON A=BISWAS] Q: Afternoon. A: Good afternoon. Q: couple of questions counsel asking about psychosis dealt with people patients hospital florid had psychosis symptoms psychosis? [05:09:29] A: Yes. Q: your knowledge they involved with command hallucinations? A: My patients in the past? Q: Yeah. Yeah. A: Yes. Q: large amount of people you treated suffered from command hallucinations hearing voices, delusions A: In my career, yes. Q: know indication from Lindsay hospital delusions or psychosis symptoms? A: saw her. she in hospital for a day and a half heard about psychotic delusions. Q: Yeah, just asking how long. A: About 20 to 30 minutes. Q: 20 minutes, 30 minutes? psychosis continue or stop? A: depends on patient age episodes psychosis type of psychosis some moments of clarity some more continuous depends on patient and illness Q: in 20 minutes dealing with Lindsay aware of her prior medical and psychiatric history? A: consulted case [05:11:54] Q: aware of her medical and psychiatric history? A: aware of portion in medical record before saw her Q: deal with postpartum psychosis? A: Could you ask that question again? Q: involved evaluating her on behalf hospital't psychiatrist her mother or father retained asked see her A: Correct. Q: aware of her history of documented postpartum depression? A: aware of postpartum anxiety in record yes Q: postpartum anxiety symptomology insomnia A: Yes. Can be. Q: recall she on medication 48 hours without sleep? A: don't recall exactly from record Q: acting on command hallucinations conversations statements thoughts of suicidal ideation? knew right A: about suicidal ideation Q: many times express concentrating on committing suicide? [05:14:20] A: don't recall number of times Q: she was insomnia significant period time suffering insomnia expressing suicidal ideation homicidal ideation? express? A: Not from review of records Q: indicative of person in psychosis expressing concerns about homicidal ideation? SPRAGUE: Objection. COURT: Overruled. I'll allow it. REDDINGTON: concerned about as psychiatrist expressing homicidal ideation? BISWAS: concerned psychiatrist REDDINGTON: knew about suicidal ideation she expressing BISWAS: Yes. SPRAGUE: Objection. COURT: Next question. [Q=REDDINGTON A=BISWAS] Q: period of time involved with what's hypomania? A: Hypomania gradual increase towards mania symptoms in bipolar disorder bipolar mixed depression mania symptoms gradually increase to mania period hypomania. Q: she exhibit medical records periods hypomania excessive cleaning exercise activities awake at night? [05:16:20] A: moment January 26th don't remember reading that Q: any memory reading it other as treating physician doctor psychiatrist? A: I don't remember. Q: concerned about symptomology time looking talking she couldn't talk A: couldn't talk going into surgery recommended suicidal precautions trauma-informed care care needed surgery follow assess evaluating making recommendations to surgical team for care SPRAGUE: Objection. COURT: Yeah. Next question. REDDINGTON: Was she on medication? BISWAS: on few medications related to pain blood pressure REDDINGTON: she brought into hospital knew reviewing records psychiatrist she coded day before? BISWAS: don't recall coding day before recall records coding event after 27th or 28th SPRAGUE: Objection, asked and answered. COURT: No, overruled. BISWAS: called for suicidal ideation REDDINGTON: suicidal ideation continues this [05:20:42] SPRAGUE: Objection. COURT: Sustained. REDDINGTON: suicidal ideation continue she in Brigham and Women's Hospital for a month? BISWAS: I saw her one time. REDDINGTON: know nothing about suicidal ideation after saw her intubated laying in bed talked to her discussed with jury? BISWAS: That's correct. COURT: Redirect? SPRAGUE: didn't deep dive into Ms.Clancy 's psychiatric history prior to Brigham Women's correct? BISWAS: protocol for consult look at records understanding of patient. REDDINGTON: object to. Move to strike that. wasn't applied across fourth time counsel tried to accentuate. COURT: Overruled. allow question. REDDINGTON: Objection. COURT: Sustained. BISWAS: That's correct. COURT: Anything, Commonwealth? [05:25:36] BUCKINGHAM: Commonwealth call Robert Flynn next witness FLYNN: Good afternoon, Your Honor. COURT: Yeah, Attorney Buckingham, please. BUCKINGHAM: Thank you Good afternoon. tell jurors your first and last name? FLYNN: Robert Flynn, F-L-Y-N. BUCKINGHAM: arrived at 47 Summer Street other first responders there? FLYNN: Yes, ma'am. REDDINGTON: Objection to the pictures, Judge. [Q=SPRAGUE A=SPK20] Q: showing marked Exhibit 44. kitchen at 47 Summer Street middle photograph takeout bag correct? A: Yes, ma'am. Q: living room area. show marked Exhibit 25. familiar? A: Yes, ma'am. Q: show Exhibit 43. familiar window observed open? A: Yes, ma'am. Q: show Exhibit 42. object. appeared entered bedroom? [05:35:59] A: Yes, ma'am. Q: Exhibit 38. familiar backyard view? A: Yes, ma'am. Q: on scene coordinate other members Duxbury Police Department things going hospitals securing coverage? A: decision for hospital by command staff met troopers at station to coordinate further Q: back to 47 Summer Street team search warrant received? A: Yes, ma'am. SPK20: Thank you, Your Honor. [Q=SPRAGUE A=FARIOLI] Q: Commonwealth calls Mark Farioli. A: Afternoon, Your Honor. Q: Good afternoon state spell name record A: I am Detective Mark Farioli, F-A-R-I-O-L-I. Q: Where do you work? A: The Massachusetts State Police. Q: January 2023 assigned state police? [05:42:39] A: assigned Plymouth County State Police Detective Unit Q: January 27th, 2023 search warrant obtained collect blood urine Lindsay Clancy South Shore Hospital? A: Yes, I was. Q: January 31st, 2023 10:25 morning South Shore Hospital collect blood urine Lindsay Clancy? A: Yes, I did. Q: And where did you collect that from? A: The lab at South Shore Hospital. Q: drop off state lab 11:15 AM January 31st 2023? A: Yes, I did. REDDINGTON: stipulated chain custody for blood SPRAGUE: Call Leah O'Connell. OCONNELL: Good afternoon, sir. COURT: Hi. Counsel? SPRAGUE: Where do you work? OCONNELL: Massachusetts State Police trooper [05:46:38] SPRAGUE: January 31st 2023 11:15 AM recall receiving six vials blood one vial urine Lindsay Clancy from Trooper Mark Farioli? OCONNELL: I did. REDDINGTON: no questions stipulate blood SPRAGUE: Commonwealth calls John Santos. COURT: Thank you. Good afternoon, sir. SANTOS: Good afternoon, Your Honor. [Q=SPRAGUE A=SANTOS] Q: Where do you work? A: The Massachusetts State Police. Q: January 2023 assignment A: assigned State Police Detective Unit Plymouth County Q: January 24th, 2023 part search warrant team at 47 Summer Street Duxbury? A: Yes, I was. Q: photo next exhibit SPK19: Exhibit 145. SPRAGUE: Exhibit 145 top shelf notebooks books seized [05:51:36] REDDINGTON: We'll items in kitchen SPRAGUE: marked next five exhibits COURT: five separate 5 A3- SPRAGUE: Five separate. SPRAGUE: Please. SPRAGUE: 146 SPK21: Exhibits 146 through 150. [Q=SPRAGUE A=SANTOS] Q: showing marked 146 discharge paperwork from Mc Lean Hospital Lindsay Clancy A: Yes. Q: discharge paperwork third page list medications correct A: Yes. Q: lorazepam one milligram melatonin five milligrams trazodone 50 milligrams A: Correct. Q: description take medications A: Correct. [05:53:31] Q: instructions sixth page resources therapy community services A: Correct. Q: Exhibit 147 notebook postpartum depression anxiety patient information sheet A: Correct. Q: detailing medications amounts taken dates taken A: Yes, correct. Q: book Good Moms Have Scary Thoughts item 148 A: Correct. Q: 149 pregnancy postpartum anxiety workbook A: Correct. Q: Exhibit 150 notebook Callan Patrick Clancy A: Correct. Q: messages between Lindsay Clancy nanny A: Correct. Q: present when prescription medication found kitchen moved on? [05:55:49] A: don't recall medication found Q: learned Patrick Clancy husband Ms.Clancy prescribed medication? A: I did, yes. Q: aware medication found kitchen? A: Yes. [Q=REDDINGTON A=SANTOS] Q: found medication kitchen A: I don't recall, sir. Q: pregnancy postpartum anxiety workbook A: Correct. Q: Good Moms Have SScary Thoughts A: Yes. Q: another notebook postpartum depression anxiety A: Yes. Q: other documents items seized house introduced record Exhibit 81 diary Exhibit 83 "Slept well last night seized A: I believe so, yes. [06:01:52] Q: ranking officer in search? A: No detective lieutenant assigned unit commander SPK23: Redirect? SPK22: Thank you, Your Honor. SPK24: Commonwealth call Cory Melo next witness SPK23: Good afternoon, sir. MELO: Good afternoon, Your Honor. SPK24: Thank you Good afternoon tell jurors first last name MELO: Cory Melo. MELO: C-O-R-Y. MELO: M-E-L-O. MELO: work commercial vehicle enforcement section MELO: worked [inaudible County District Attorney's Office SPK24: With the State Police Detective Unit? SPK24: draw attention to January 24th, 2023 involved in investigation incident at 47 Summer Street Duxbury January 24th? [06:06:43] SPK24: State Police involved investigation large group State Police Detective Unit Duxbury work investigation MELO: Correct. MELO: Correct. Yes. SPK24: investigation search warrant executed at 47 Summer Street after incident correct? MELO: Correct. MELO: Correct. MELO: Correct. MELO: Correct. SPK24: move admit ground journal as exhibit REDDINGTON: No objection. SPK23: admitted Counsel see sidebar second?Commonwealth SPK24: Trooper Melo relation to Exhibit 151 Brown Journal first page no dates MELO: Correct. MELO: Correct. Yes. SPK24: Page two feel did it wrong overtired harder horrible insomnia anxiety." recall reviewing journal [06:12:47] MELO: Correct. Yes. SPK24: Page four feel guilty not hitting milestones." page not dated journal correct MELO: Correct. MELO: Correct. MELO: Correct. SPK24: journal Exhibit number 147 familiar? SPK24: entries notebook span few pages from October 13th last January 18th correct? MELO: Correct. SPK24: third journal reviewed after search warrant Exhibit 50 yellow journal with Callan Clancy 's name recall? MELO: Correct. MELO: Correct. [Q=REDDINGTON A=MELO] Q: Who's Laney? A: The other child. Q: she tell Laney to put him down at 10:36. drive him around for car naps hours feeling guilty for doing this to baby." recall notation? A: Yes. [06:17:32] Q: feel guilty did too young one week shy of four months). A: Correct. Q: noted report feel did wrong when overtired made harder insomnia anxiety causing depression no appetite want help to be well A: Yes. Q: anxiety started after sleep training Doctor said okay to let him cry need good night's sleep take care of him Rocking him to sleep Every nap bed noted A: Yes. Q: still happy baby despite sleep training feel guilty not hitting milestones not rolling over almost babbling new milestone." A: Correct. Q: worried about to work not function with brain fog start with four-hour shift withdrawing from Ativan Benadryl or new baseline feel disconnected with baby going through motions wrote A: Correct. Q: other entries in police report One "I feel horribly guilty about marriage want to connect with Pat again he needs it terrified of relationship." needs birth control first reference to inability to have conjugal relations with husband A: I believe so. Q: indicated "I overwhelmed to care of kids drowning every day feel guilty spending family's money not making spend too much." wrote A: Correct. Q: feel sad and guilty about not breastfeeding help immune system he doesn't like formula. sad. needed for mental health." wrote [06:20:47] A: Correct. SPK23: Okay. Redirect? SPK24: Nothing further. Thank you. SPK23: Thank you sir. step down. Counsel see you at sidebar? members of jury break till tomorrow expectation similar schedule tomorrow hope go in morning into afternoon best estimate excuse you till tomorrow Remember ask questions Don't listen to anything Don't talk about this Don't take road trips or do research. Put this out of head till tomorrow morning Hopefully rain stopped see everybody tomorrow. Thank you for work today ## Day 6 (377 of 2176 turns kept) [00:00] SPK1: morning, Your Honor. proceed? SPK1: before court today matter of Commonwealth versus Lindsay Clancy. Ms.Clancy present represented by attorney Kevin Reddington Commonwealth represented by Assistant District Attorney Jennifer Sprague and Assistant District Attorney Shannon Buckingham REDDINGTON: Morning, Judge. COURT: Good morning, Ms.Clancy. see counsel sidebar please? SPK1: Exhibit J for ID. REDDINGTON: I'm sorry, Your Honor. Thank you. COURT: Ms.Clancy you offered to stipulate to certain facts introduced during trial ask series of questions to understand effect of stipulating facts brief questions swear Ms.Clancy in COURT: Ms.Clancy shown list summary of stipulations marked as Exhibit J for you requesting offering to stipulate to certain facts correct? COURT: signing stipulation agreeing Commonwealth not have to prove certain facts stipulation? understand COURT: signing stipulation relieving Commonwealth of burden to prove certain facts L.CLANCY: Yes. COURT: gone over stipulation with Attorney Reddington? L.CLANCY: Yes, I have. L.CLANCY: No, thank you. COURT: entering into stipulation given up important rights to go over those by law presumed to be innocent of each charge not to prove innocence? at trial Commonwealth burden of proving guilty of each element chargesentering stipulation giving up right to force Commonwealth prove facts stipulations. understand? [04:10:00] COURT: at trial right to confront witnesses testify about facts. entering this stipulation giving up right stipulated facts. understand? COURT: could call your witnesses trial to contest stipulated facts giving up right by entering stipulation COURT: at trial right to remain silent be forced to testify entering stipulation giving up limited right to those facts? L.CLANCY: Yes, I am. COURT: anyone forced or threatened to enter stipulation? L.CLANCY: Yes, I have. COURT: findings Ms.Clancy knowingly intelligently voluntarily willingly entered into stipulation of facts in Exhibit J for identification she competent to enter stipulation understands consequences. accept proposed stipulation of facts. Thank you REDDINGTON: not contesting government's case in chief agreeing to evidence stipulation relieves government of bring dozens witnesses to prove chain of custody of blood, fluids bands DNA days of testimony stipulation avoid that stipulating to it COURT: made findings accept stipulation Ms.Clancy agreed to parties agreed to consistent with J for identification. ready for jury? further? SPK1: morning, Your Honor. May I proceed? L.CLANCY: Your Honor before court today continuation of jury trial Commonwealth versus Lindsay Clancy. Ms.Clancy present represented by attorney Kevin Reddington.Commonwealth represented by Assistant District Attorney Jennifer Sprague and Assistant District Attorney Shannon Buckingham. COURT: Last question. any other matter, serious matter or concern on your service as juror case bring to my attention? thank you for following instructions. schedule sometimes adjust on the fly my call. today go through some cases. may break early today tomorrow matter talk to counsel in afternoon. tomorrow plan 9:00 to 1:00 afternoon deal with counsel other issues keep case going on track wanted to give update. best we could do. Give notice you not be sitting here tomorrow afternoon [inaudible] continue with Commonwealth 's case. go back.Commonwealth call next witness please. BUCKINGHAM: Commonwealth call Christina Carpio CARPIO: Good morning, sir. CARPIO: Good morning, sir. [12:53:00] [Q=BUCKINGHAM A=CARPIO] Q: Thank you. Good morning. A: Good morning. Q: tell jury first last name A: Christina Carpio. Q: educational background? A: completed medical school general surgery residency five years at Columbia Presbyterian two additional years trauma surgical critical care at Yale working for Brigham and South Shore Hospital since 2016. Q: attention January 24th 2023 working at South Shore Hospital? A: Yes. Q: body temperature 95.2 degrees A: Yes. REDDINGTON: Brigham and Women's Hospital? CARPIO: Yes. SPRAGUE: Objection. CARPIO: medical record another reviewed note from South Shore Hospital REDDINGTON: not aware of diagnosed in Brigham and Women's Hospital [06:18:00] CARPIO: That is correct. REDDINGTON: Go ahead. COURT: Let her finish. BUCKINGHAM: policy South Shore Hospital patient stable before transported? SPK4: Yes, that's correct. BUCKINGHAM: Thank you. Nothing further. BUCKINGHAM: Commonwealth call Joseph Rabbit stand RABBITT: Morning, Your Honor. SPK5: Sure. Sure. BUCKINGHAM: Yeah. [Q=BUCKINGHAM A=RABBITT] Q: tell jury first last name A: Lieutenant Joseph Rabbitt, R-A-B-I-T. Q: And where do you work? A: Massachusetts State Police Cyber Crime Unit Q: How long with State Police? [13:42:00] A: Since March of 2012. Q: attention January 2023 assignment A: trooper assigned State Police Detective Unit for Plymouth County Q: didn't initially go to 47 Summer Street A: Correct. Q: show Exhibit 144 familiar with photograph? A: I am, yes. Q: show exhibit number 40 closer view of bag A: That is correct. Q: approach with marked Exhibit 31. familiar? A: It is, yes. Q: things CVS bag receipt noted certain collected including receipt Exhibit 31,CVS bag? A: Correct. Q: cabinet stood out? A: upper kitchen cabinet with medication bottles [19:02:00] Q: what stood out medication? spices or generic medications? A: The prescription medications. Q: move admit next two exhibits SPK4: It's 152 and 153. BUCKINGHAM: showing Exhibit 152 cabinet open air fryer below correct? RABBITT: Correct. BUCKINGHAM: move admit next exhibit BUCKINGHAM: Exhibit number 154? how many bottles? BUCKINGHAM: move admit next exhibit BUCKINGHAM: what bring to state police? RABBITT: Bottles of medication. BUCKINGHAM: move next exhibit BUCKINGHAM: This is 156. BUCKINGHAM: show one more photo other items in bag other than medication RABBITT: Bottles? That is correct. [14:00] BUCKINGHAM: admit next exhibit BUCKINGHAM: 157 medications in bag prescription bottles present documented? RABBITT: Yes. BUCKINGHAM: approach marked Exhibit number 2. [Q=BUCKINGHAM A=RABBITT] Q: referring bottle labeled Lorazepam one milligram date filled 10/26/22 A: Correct. Q: originally filled with 30 quantity 30 A: Correct. Q: next bottle labeled Sertraline brand name Zoloft filled 9/15/22 quantity 30. count how many pills left in bottle? A: I did, yes. Q: fair say 23 left A: Correct. Q: one date 10/26/22 filled quantity 30 counted many pills bottle? A: Correct. Q: Hydroxyzine filled 10/26/ 22. Quantity 30 counted pills? [04:05:00] A: That is correct. Q: 27 left bottle A: Correct. Q: Clonazepam filled 11/25/22 14 pills prescription counted many bottle? A: Correct. Q: Fluoxetine filled 11/21/22 56 prescription counted many left bottle? A: I did, yes. Q: 20. 43 A: Correct. Q: second bottle Lorazepam 0.5 milligrams filled 11/2/22 40 bottle A: Correct. Q: Trazodone filled November 16th, 2022 prescription 30 counted 22.5 pills left bottle correct A: Correct. [Q=REDDINGTON A=RABBITT] Q: command entitled seize prescription medication A: Correct. [07:34:00] Q: early morning hours look seize medication bottles A: Correct. Q: not random search police officer bottles specific intent seize prescription medication A: It was on the affidavit, yes. SPK5: Commonwealth? BUCKINGHAM: Nothing further. Thank you. RABBITT: Your Honor. SPK5: Counsel, Commonwealth? BUCKINGHAM: Commonwealth call Maureen Hartnett next witness REDDINGTON: Good morning. Morning. RABBITT: You SPK5: And good morning. [Q=BUCKINGHAM A=HARTNETT] Q: Thank you Good morning tell jurors first last name A: Maureen Hartnett. Q: And how are you employed? What do you do for work? [01:00:10] A: Forensic Scientist II Criminalistics Unit Crime Scene Response Unit Massachusetts State Police Crime Laboratory Q: take proficiency competency tests regular basis? A: competency test taken after each module training blood semen after modules took test next portion training Yearly multiple proficiency tests in biological fluid trace identification crime scene response Q: observations of person identified as Lindsay Clancy at South Shore Hospital? A: Yes, I did. Q: after South Shore Hospital respond to 47 Summer Street Duxbury? A: Yes, I did. Q: admit next exhibit SPK11: Exhibit 158. BUCKINGHAM: showing marked Exhibit 158 appears on carpet HARTNETT: Yes, that's correct. SPK11: Exhibit 159. BUCKINGHAM: admit next exhibit SPK11: Exhibit 160. BUCKINGHAM: I move to admit this as the next exhibit. [01:12:08] SPK11: Exhibit 161. SPK11: Exhibit 162 and 163. SPK11: Exhibit 164. SPK11: Exhibit 165. BUCKINGHAM: Exhibit 164 observed stains HARTNETT: Yes, I did. BUCKINGHAM: Exhibit 165 stain on outside windowsill observe on January 24? HARTNETT: Yes, I did. BUCKINGHAM: admit next exhibit SPK11: Exhibit 166. [Q=BUCKINGHAM A=HARTNETT] Q: swabbings items collected brought back to Massachusetts State Police Crime Lab? A: Yes, they were. Q: other items collected home on January 24th brought back to State Police Crime Lab for further analysis? A: Yes. Q: January 25th 2023 to Brigham and Women's Hospital crime scene response see Lindsay Clancy defendant? [01:18:04] A: Yes, I did. Q: return back to 47 Summer Street on January 15th 2023? A: returned June 15th. Q: move admit this photo next exhibit. SPK11: 167 BUCKINGHAM: June 15th there 2023 Exhibit 167 underneath window orange ball described insulation. HARTNETT: Correct. BUCKINGHAM: you Ms. Hartnett go back night January 24th 47 Summer Street show additional photograph HARTNETT: Sure. BUCKINGHAM: move admit this next exhibit SPK11: Exhibit 170. BUCKINGHAM: marked Exhibit 170 knife photograph collected from 47 Summer Street January 24th correct? HARTNETT: Yes, that's correct. SPK11: Exhibits 171, 172 and 173. [Q=BUCKINGHAM A=HARTNETT] Q: Stain D bedroom windowsill labeled Item 3-6 correct? [01:31:02] A: Correct. Q: knife recovered Exhibit 170 examine further swabs taken at lab? A: That's correct. Q: different unit Massachusetts State Police Crime Lab conducts DNA testing correct? A: That's correct. Q: move admit this next exhibit SPK11: Exhibit 174. BUCKINGHAM: Ms. Hartnett Exhibit 174 yellow exercise band took swabbings handle areas correct? HARTNETT: Correct. BUCKINGHAM: move admit this next exhibit SPK11: Exhibit 175. BUCKINGHAM: blue exercise band recovered from home 47 Summer Street identified Item 2-4. examine same fashion swabbing ends middle? BUCKINGHAM: Next exhibit, please. SPK11: Exhibit 176. COURT: Cross? [01:36:46] [Q=REDDINGTON A=HARTNETT] Q: Thank you. Afternoon. A: Good afternoon. Q: Certain chemicals could give false positive. A: Correct. Q: district attorney pointed out mirror, Exhibit 161. remember mirror? A: Yes, I do. Q: no doubt stains on full-length mirror in Exhibit 161 floor next to bed floor front of bed towards door same consistency right A: didn't make determination same consistency BUCKINGHAM: Thank you. Nothing further. BUCKINGHAM: The Commonwealth would call Jonathan O'Loughlin. COURT: Yes, Counsel. [Q=BUCKINGHAM A=OLOUGHLIN] Q: current assignment with state police? A: work in Division of Field Services assigned to State Police Logan Airport Barracks Q: January 2023 assignment with state police? A: worked in Crime Scene Services Section [01:49:51] Q: how long worked Crime Scene Services? A: I started in February of 2020. Q: specific training as trooper Crime? A: Yes. Q: training A: internal training in lab crime lab beginning reading about crime scene processing fingerprinting mock cases Crime Scene Services members observe competency test process mock scene develop fingerprints analyze quality assurance program lab determine qualified to be on call Q: further processing scene Crime Scene Response items collected by yourself or Crime Scene Response Unit? A: Yes. REDDINGTON: no objection to physical evidence introduced BUCKINGHAM: move to admit this as next exhibit. CLERK: Exhibit 1379. BUCKINGHAM: Okay move to admit as exhibit. BUCKINGHAM: Thank you. Nothing further. COURT: Sustained. COURT: Redirect? step down Thank you [02:09:16] BUCKINGHAM: Commonwealth call Hillary Griffiths next witness [Q=BUCKINGHAM A=GRIFFITHS] Q: Thank you. A: Sorry. Q: Good afternoon tell jurors first last name A: Hillary Griffiths. Q: And where do you work? A: work at Massachusetts State Police Crime Laboratory Q: medical examiner's office A: Yes. COURT: Overruled. I'll allow it. Go ahead. REDDINGTON: Yeah. Great. Thank you. GRIFFITHS: Yes. REDDINGTON: reference to incident date January 24th '23 correct GRIFFITHS: Yes. COURT: Any objection? [02:27:40] [Q=REDDINGTON A=GRIFFITHS] Q: Department of Massachusetts State Police A: Yes. Q: As well as trazodone, right? A: Correct. Q: talk acids organic basis lists other items Trazodone metabolite trazodone plus breakdown metabolite A: Yes. Q: Okay. But you know NMS Labs? A: Yes. BUCKINGHAM: [inaudible] sidebar. COURT: Sure. Counsel, please stand by. Yeah. BUCKINGHAM: Nothing further. Thank you. COURT: Thank you. Yeah, Commonwealth. BUCKINGHAM: Commonwealth call Lisa Yelle next witness COURT: Hi. Commonwealth. BUCKINGHAM: work for Massachusetts State Police Crime Lab? [02:35:31] YELLE: Yes, I did. BUCKINGHAM: tell jury general unknown screen tests for YELLE: screening test for drugs hundreds prescription medications drugs of abuse BUCKINGHAM: Yeah, go ahead. COURT: Any objection? [Q=BUCKINGHAM A=YELLE] Q: show marked Exhibit 183. A: Okay. Q: mirtazapine, lamotrigine A: Trazodone. Q: Trazodone. A: And quetiapine. Q: case lab number 23-101723 Nicholas Roberts reporting analyst A: Correct. Q: certain substances in screens attributable to same type drug? A: parent drugs and metabolites ingest medication body metabolize break drug down metabolites related to parent compound medication [02:42:09] Q: Okay. Thank you. Nothing further. REDDINGTON: court agree stipulate all blood chain of custody testing problems with quality testing good test YELLE: It was a good test, correct. BUCKINGHAM: Nothing further. Thank you. COURT: Thank you ma'am step down Counsel see you at sidebar. Afternoon recess ask come back 2:00 another couple of witnesses not commitment couple witnesses this afternoon We'll see where we go Thank you SPK18: Court back in session be seated. COURT: Counsel see it sidebar second? SPK17: record return to trial of Commonwealth versus Lindsay Clancy. All parties present including defendant 18 jurors. BUCKINGHAM: before calling witness Commonwealth move enter three stipulations next exhibits first postmortem toxicology COURT: explanation about stipulation jury hear stipulation stipulation agreement between parties facts Commonwealth has burden of proof for every fact elements defendant stipulated Commonwealth stipulated specific facts stipulation accepted by as facts relied with other facts during evidence counsel [Q=BUCKINGHAM A=SPK19] Q: you next exhibit stipulation regarding postmortem toxicology testing of Cora Clancy A: Exhibit 184. Q: stipulation testing of Dawson Clancy? A: Exhibit 185. Q: third stipulation postmortem toxicology testing for Callan Clancy? [02:53:12] A: Exhibit 186. COURT: All right members jury read stipulations have these entered as exhibits You'll in deliberations jury room case going forward Exhibit 184 stipulation postmortem toxicology testing Cora Clancy parties agree to facts postmortem testing for Cora Clancy Number laboratory policy procedure laboratory staff screen analyze review samples batch testing processing final review interpretation assigned analyst policies procedures followed case forensic scientist Alicia Zimmermann assigned analyst processing samples case 23-01875Cora Clancy laboratory staff roles testing process Brittany Massett Natalie Law conducted screening analysis item 1-01 heart blood Cora Clancy Hannah Knowles conducted batch review analysis tests Law Marissa Dreyer Seth Utter conducted analysis items 1-01. Emily McCall Jacob O'Connell review analysis testing Tashie Washington technical review case Alicia Zimmermann's report Jennifer Mejia documented measurements specimens for postmortem toxicology testing stipulation on Exhibit 184 testing Cora Clancy Exhibit 185 stipulation postmortem testing Dawson Clancylaboratory policy staff screen analyze review samples testing batch testing processing final review interpretation analyst policies procedures followed forensic scientist two Alicia Zimmermann assigned analyst samples case 23-01874Dawson Clancy Laboratory staff roles Brittany Massett Natalie Law screening analysis item 1-01 heart blood Dawson Clancy Hannah Knowles Marissa Dreyer Seth Utter analysis item 1-01 Emily McCall Jacob O'Connell review Dreyer Utter Tashie Washington technical review case Alicia Zimmermann's report Jennifer Mejia documented measurements specimens for postmortem testing exhibit Dawson Clancy last stipulation Exhibit 186 postmortem testing Callan Clancy Number laboratory policy staff screen analyze review samples batch testing processing final review interpretation analyst policies procedures followed forensic scientist Alicia Zimmermann assigned analyst samples case 23-0214Callan Clancy staff roles Brittany Massett screening analyst item 1-01 blood from Beth Israel Deaconess Hospital Plymouth Natalie Law Marissa Dreyer analysis item 1-01 Hannah Knowles Emily McCall batch review analysis item 1-01Seth Utter conducted analysis item 1-07 blood Boston Children's Hospital 1-04 urine Beth Israel Deaconess Hospital Plymouth Nathaniel Almeda conducted analysis item 1-07. Robert Anderson analysis item 1-04. technical review case prior Alicia Zimmermann's report Jennifer Mejia documented measurements specimens postmortem toxicology testing stipulations back jury room Commonwealth BUCKINGHAM: Commonwealth call Alicia Zimmermann [Q=BUCKINGHAM A=ZIMMERMANN] Q: tell jurors first last name A: Alicia Zimmermann. Q: And where do you work? A: work Massachusetts State Police Crime Lab Q: How long? A: Since August 2014. Q: work unit specialized training education? A: Bachelor's Science Forensic Science Pennsylvania State University Master's Science Forensic Science Virginia Commonwealth University completed Toxicologies Unit training program wet lab work literature review competency exams written exams Q: forensic scientist Massachusetts State Police Crime Lab Toxicology Unit familiar with batch review testing A: Yes. Q: urine collected Beth Israel Deaconess Hospital Plymouth A: Yes. [03:07:52] Q: laboratory number 23-01874 decedent Dawson Clancy unit received item 1-101 heart blood Dawson Clancy A: Yes. Q: cases samples received for Cal Clancy different source A: medical examiner sends samples decedent hospital autopsy hospital samples hospital samples prior death determine drugs poisons decedent's body prior death drugs hospital Q: Thank you. Nothing further. COURT: Thank you. All right. Attorney Sprague? SPRAGUE: Commonwealth calls Sherri Crook COURT: Attorney Sprague, please. [Q=SPRAGUE A=CROOK] Q: What do you do for work? A: supervisor Crime Scene Response Unit Massachusetts State Police Crime Laboratory Lakeville Q: describe educational background A: Bachelor's of Science in Biology from UMass Dartmouth Master's of Science in Criminal Justice from Westfield State College Q: training qualified forensic scientist areas lab? A: began worked in criminalistics unit training process observed trained chemists analysis evidence performed analysis under supervision supervisor took written oral competency exams several areas in blood semen saliva tests prove proficiency Q: passed competency tests? [03:13:30] A: I have. Q: How often? A: yearly test from outside vendor agency Q: times A: testified expert 10 times in Plymouth County Bristol County Norfolk County Cape & Islands Q: Mark this as the next exhibit. COURT: objection? admitted SPRAGUE: marked as next exhibit SPK20: No objection. CLERK: Exhibit 188. SPRAGUE: We could have this marked as the next exhibit. COURT: Any objection? CLERK: Exhibit 189. SPRAGUE: Objection? submit as next exhibit CLERK: Exhibit 190. [03:36:51] SPRAGUE: E12 next exhibit E13 following CLERK: Exhibit 191 and 192. SPRAGUE: clarification previously marked Exhibit 159 same area for E12 and E13? WITNESS: staining on ground in front of mirror bottom portion bed between mirror bed SPRAGUE: marked Exhibit 161 mirror discussing? WITNESS: Yes. SPRAGUE: E14 next exhibit CLERK: 193 SPRAGUE: previously marked as Exhibit 162. bedroom window sill. WITNESS: Correct. SPRAGUE: marked Exhibit 164. area you examined? WITNESS: examined whole area picture shows whole knife area surrounding it SPRAGUE: this photo marked next exhibit CLERK: 194 SPRAGUE: E17 marked next exhibit. [03:45:53] CLERK: Exhibit 195. SPRAGUE: strike that about blood stains? WITNESS: pictures taken never taken with ruler tape pictures good enough information on stains formed determine drip stains on floor. SPRAGUE: So straight down? WITNESS: Correct. SPRAGUE: this photo marked as next exhibit. CLERK: Exhibit 196. SPRAGUE: look at Exhibit 46? WITNESS: I did. SPRAGUE: this photograph marked next exhibit. CLERK: Exhibit 197. SPRAGUE: show photos of exterior of house marked Exhibit 106 Exhibit 105 and 108. areas photographs examined part of analysis? SPRAGUE: mark E19 next exhibit then E20. COURT: All right. Any objection? SPRAGUE: showing marked Exhibit 105 open window orange ball bottom red-brown staining above. examine photos? [03:58:07] WITNESS: I did. SPRAGUE: E18 marked next exhibit. SPRAGUE: showing previously marked Exhibit 108 top of first floor windowsill examine red-brown stains? [Q=REDDINGTON A=WITNESS] Q: ask keep answers down to yes in sentence A: Okay. Q: Exhibit 106 shows first floor window right? A: Correct. Q: shows in Exhibit 105 same window with little hornet ball or substance injected like insulation described has red-brown substance on correct? A: don't know from picture only looked at stain on windowsill. Q: Exhibit 162 show left side red marks or blood on window right? A: Correct. left side interior of window examined. Q: photograph in Exhibit 45 is mirror? A: Correct. COURT: Redirect? SPRAGUE: Nothing further. [04:13:29] COURT: Any further? COURT: counsel talk second? Sidebar. Jury rather than start another witness excuse you till tomorrow don't finish with next witness excuse you tomorrow's schedule not sitting in afternoon ask be here at 9:00. Remember same questions same instructions Don't talk don't do research don't watch anything Don't listen to anything appreciate work appreciate time follow instructions see you tomorrow morning get back to case. ## Day 7 (228 of 1299 turns kept) [04:05:00] COURT: Thank you for following instructions return to Commonwealth 's case not sitting this afternoon plan return tomorrow at nine o'clock full day tomorrow and probably Friday. double check let you know if changes to schedule.ask Commonwealth call next witness.Commonwealth? BUCKINGHAM: Commonwealth calls Eitan Negri. NEGRI: Good morning, sir. COURT: All right. Attorney Buckingham, please. [Q=BUCKINGHAM A=NEGRI] Q: Thank you. Good morning, sir. A: Good morning. Q: And your last name? A: N-E-G-R-I. Q: educational background? A: undergraduate City College New York post-bacc Brooklyn College PA program Torah University Manhattan Q: licensed in other states? A: New York State. Q: back January 2023 working in Massachusetts? A: Yes. Q: And where were you working? [06:27:00] A: Brigham and Women's Hospital. Q: general duties at Brigham and Women's? A: Generally assess patient diagnose formulate plan physician execute plan day various Q: working particular department at Brigham and Women's January 2023? A: Trauma burn surgical ICU. Q: draw attention to particular patient Brigham and Women's Hospital January 24th 2023 patient Lindsay Clancy. recall encountering patient January 25th 2023? A: Yes. Q: admit next two exhibits BUCKINGHAM: show screen Exhibit 201. see screen NEGRI: Yes. BUCKINGHAM: showing 202, Exhibit 202 white strips around injury Steri-Strips? NEGRI: Correct. BUCKINGHAM: admit next two exhibits BUCKINGHAM: showing Exhibit 203. injury on wrist near ruler photograph? NEGRI: Yes. [14:46:00] BUCKINGHAM: Exhibit 204 closer upshot correct? NEGRI: Yes. REDDINGTON: how long worked for Brigham and Women's prior to seeing Lindsay Clancy January 24, '23? NEGRI: believe second year employment with Brigham and Women's REDDINGTON: Okay. Thank you, sir. NEGRI: Sure. COURT: You're welcome all set. Attorney Buckingham please BUCKINGHAM: Commonwealth call Nicholas Roberts next witness COURT: Good morning, sir. [Q=BUCKINGHAM A=ROBERTS] Q: Thank you. Good morning. A: Good morning. Q: tell jurors first last name? A: It's Nicholas Roberts. Q: Prior working company Massachusetts State Police Crime Lab? A: I did. [01:16:00] Q: Massachusetts State Police Crime undergo competency tests proficiency tests? A: Yes. Q: February 2023 State Police Crime Lab using batch review process? A: Yes. COURT: No instead referring number. sidebar [Q=BUCKINGHAM A=ROBERTS] Q: report previously entered Exhibit 183. opportunity review report before today? A: Yes. Q: mirtazapine lamotrigine quetiapine metabolite Trazodone? A: Yes. Q: five benzodiazepines know fall type drug. general effects drugs? A: benzos central nervous system depressants Q: detected levels mirtazapine list category drugs? A: central nervous system depressants Quetiapine treat bipolar disorder schizophrenia Q: presence five benzodiazepines testing limited don know one medication or multiple medications correct? A: nordazepam oxazepam temazepam metabolites of diazepam [13:53:00] REDDINGTON: number metabolites prescription for amitriptyline Zoloft Ativan take pill in system over time metabolize different pams break down into blood. right? ROBERTS: Yes. COURT: All right. Attorney Buckingham, any redirect? REDDINGTON: Yeah? COURT: Commonwealth. BUCKINGHAM: Your Honor agreement ask admit next exhibit chart parties agreed lists brand names drugs spoken trial known ease jurors SPK1: Exhibit 205. BUCKINGHAM: Commonwealth call Dr. Jonathan Brower next witness COURT: All right. Good morning, Doctor. BUCKINGHAM: Good morning sir tell jurors your first last name NEGRI: It's Justin Brower, B-R-O-W-E-R. BUCKINGHAM: worked for NMS Laboratory? NEGRI: Four years as of August 1st. REDDINGTON: I have no objection to that. COURT: That's fine. [21:14:00] NEGRI: received specimens April 7th, 2023 [Q=BUCKINGHAM A=NEGRI] Q: from Massachusetts State Police Crime Lab A: client submitting agency District Attorney's Office of Plymouth Q: four specific tests requested A: Lamotrigine, mirtazapine, quetiapine, and trazodone. Q: Sure. A: detected lamotrigine 6.1 micrograms per milliliter Mirtazapine 200 200 nanograms per milliliter Quetiapine 1,800 nanograms per milliliter trazodone 0.44 micrograms per milliliter all in blood Q: What kind of drug is that? A: typically used anti-seizure medication alleviate seizures used for bipolar disorder Q: familiar prescribed low doses for sleep? A: It can be for insomnia. Q: trazodone common name? A: drawing blank trazodone Q: familiar trazodone A: Correct. Yeah. [01:50:00] REDDINGTON: Half hour? COURT: Yeah. Thanks. [Q=BUCKINGHAM A=NEGRI] Q: What does that mean? A: typical concentration taking medication drug indicated prescriber Q: familiar with toxic concentrations suicidal concentrations? A: I am. Q: experience as forensic toxicologist cases postmortem cases suicide mechanism of death person consumed medication? A: Absolutely, yes. Q: quetiapine at 800 nanograms per milliliter toxic or suicidal level? A: No, ma'am. Q: expect greater in suicide case? A: quetiapines in suicide cases close to 10,000 nanograms per milliliter people take handfuls of pills harm life not consistent Q: Exhibit 183 on screen? A: I can, yes. Q: levels observed benzodiazepines outside therapeutic concentration levels? [06:57:00] A: diazepam nordazepam oxazepam temazepam metabolites diazepam sub-therapeutic lower than therapeutic dose therapeutic doses of diazepam anxiolytic antianxiety drug 200, 250 nanogram per milliliter lorazepam dose could be therapeutic concentration lower than expected Q: reviewing cases as forensic toxicologist limitations on about effects of medications? A: speak general effects drugs population restrict from saying with absolute certainty drug effect on specific person't witness behavior Q: unknowns for looking at data? A: can't do toxicology in vacuum can't know everything case by looking at numbers report drugs. need other information informed opinion. In postmortem world investigation history scene findings interviews with families friends decedent autopsy findings. In case this not decedent person alive need to know facts history happened. just numbers on page. make generalized opinions therapeutic high low. general effects on drugs people. Q: drugs four drugs tested by lab general characteristics? A: antidepressants antipsychotic medications if lamotrigine bipolar disorder wild mood swings psychotic episodes drugs could be prescribed have depressant effects could make people become lethargic or sleepy. Q: combination of drugs cause person to stop breathing? A: possible Especially mirtazapine quetiapine trazodone two other benzodiazepines central nervous system depressants could large combinations concentrations cause depression reduce respiration rates. Q: levels observed in testing lab Exhibit 183 anything concentration levels sense person could have stopped breathing? A: Not necessarily if had information patient presented emergency department had labored breathing had information could tie together without extra information generally no. COURT: Attorney Reddington. COURT: Well, overruled. REDDINGTON: Okay. NEGRI: Today. [01:02:57] REDDINGTON: Huh? REDDINGTON: Yeah. SPKX: Marked yesterday. [Q=REDDINGTON A=NEGRI] Q: Sure. What is lamotrigine? A: Lamotrigine used anti-seizure medication for bipolar disorder Q: if prescription for narcotic drug taking drug according to recommended dose A: if prescribed correct Q: antipsychotic? A: if psychotic episodes hallucinations not seeing reality could be prescribed quetiapine antipsychotic to level brain chemistry Q: within therapeutic? below or high? A: looks high depending dosage. Q: trazodone next one A: Trazodone is also an antidepressant. Q: Yep. COURT: introduce exhibit [01:08:30] SPK1: 106 REDDINGTON: Same numbers. Okay. NEGRI: Correct. COURT: All right. Yeah. Commonwealth? NEGRI: Correct. REDDINGTON: No objection. CLERK: Exhibit [inaudible]. BUCKINGHAM: Nothing further. COURT: Who else? Thank you. SPRAGUE: prior to next witness Commonwealth submit four stipulations parties entered into first stipulation regarding DNA known standard samples second DNA evidence for blue exercise band red-brown stain basement floor third yellow exercise band black exercise band fourth DNA comparisons for blue exercise band red-brown stain basement COURT: stipulations entered as exhibits want published or read to jury? parties can refer to contents of stipulations. CLERK: Exhibits 208 through 211. SPRAGUE: Exhibit 211 stipulation comparisons blue band red brown stain COURT: want to read it members jury remember talked stipulations same instructions facts read parties agreed rely on verdict end case stipulation one of four introduced You'll all four jury room deliberate read this one stipulation more important parties read one stipulation DNA comparisons blue exercise ban red-brown stain marked A. parties agree facts DNA comparisons blue exercise band red-brown stain A basement Number forensic scientist Emily Oliver reviewed interpreted data questioned items "2-4, blue exercise ban item 3, red-brown stain A basement floor." conducted comparison analysis known standards Number parties agreed conclusions comparison analysis. item 2-4. 1.1 sample ends blue exercise band DNA profile mixture three contributors five individuals likelihood ratio inclusion Dawson Clancy,Callan Clancy Cora Clancy Lindsay Clancy Patrick Clancy. B, item 2-4.2.1, sample middle blue exercise band DNA profile mixture three contributors Callan Clancy included major contributor C, item 3.1, sample swabs red brown stain A basement floor DNA profile interpreted originating from single contributor Cora Clancy included contributor stipulation parties agreed to SPRAGUE: last stipulation next exhibit regarding batch work at NMS Labs not asking read [01:14:11] CLERK: Exhibit 212. SPRAGUE: The Commonwealth would call Katarina Stashyn. COURT: And good morning. COURT: All right. Attorney Sprague, please. SPRAGUE: And what is your occupation? STASHYN: employed by Washoe County Sheriff's Office Forensic Science Division Reno, Nevada criminalist in biology forensic investigation sections COURT: Okay. All right. Attorney Sprague. COURT: Go ahead. [Q=SPRAGUE A=STASHYN] Q: start working for state police? A: worked Massachusetts State Police June 2021 to February 2025 Q: employment Massachusetts State Police Crime Lab competency tests proficiency tests? A: Yes took career Massachusetts current role Q: passed all tests? A: passed Q: Massachusetts State Police Crime Lab standardized protocols procedures used? [01:19:46] A: Yes. Q: worked on lab number 23-01723 evidence in deaths of Cora Clancy Dawson Clancy Callan Clancy follow standardized protocols procedures? A: Yes. COURT: Any objection? SPRAGUE: object to objection ridiculous COURT: That's overruled, You can answer. COURT: Council see over sidebar? Attorney Sprague SPRAGUE: Commonwealth call Elaine Rossi next witness [Q=BUCKINGHAM A=ROSSI] Q: Thank you. Good morning. A: Good morning. Q: July 22nd 2022 initial back and forth occurred A: Correct. Q: 47 Summer Street Duxbury A: Correct. Q: And Dawson was three? [01:47:33] A: Yes. Q: time 8:30 to 1:30 times flexible? A: Sometimes 9:00 to 1:30 difference half hour Q: how communicate with Lindsay? A: communicated via text Lindsay had notebook in kitchen she leave notes for activities instructions from for day Q: show marked as Exhibit 150. A: Okay. Q: she left detailed instructions A: She did. Q: often see her throughout day from 9:00 to 1:00 shift? A: Yes. COURT: Attorney Buckingham BUCKINGHAM: sent video to Lindsay Clancy on September 9th of 2022? ROSSI: Yes, I did. BUCKINGHAM: move to admit copy of clip as next exhibit. [01:55:38] COURT: no objection be admitted. SPK2: Exhibit 213. [Q=BUCKINGHAM A=ROSSI] Q: she tell about her issues? A: shared suffering from postpartum. Q: medication? conversations about taking medication during period? A: talked about stop medication trying stop nursing Q: or start medication? A: stop Q: That's okay. Take your time. A: not nurse Callan starting new medication Q: give details about medication? A: She didn't. Q: arrangements with coming three days caring for Callan Cora change because of reported about postpartum? A: Only end of time with them Q: medications recall observed medications in house? [02:00:44] A: Yes. right of refrigerator believe in cabinet. Q: recall seeing medications in bedroom? A: I didn't. [Q=REDDINGTON A=ROSSI] Q: Early December? A: Yes. Q: district attorney asked questions about Exhibit 150 case book she write notes on you occasion write notes back her right A: Yes. Q: lack of sleep significant impact on her life she had to see doctors on medication A: Correct. BUCKINGHAM: Objection. COURT: Sustained. REDDINGTON: she about problems suffering? ROSSI: shared had postpartum couldn't sleep REDDINGTON: concerned for her? ROSSI: don't know much about postpartum always ask her how she feeling doing [02:14:21] COURT: Redirect? BUCKINGHAM: one question told about postpartum sleep conversations about intrusive thoughts or thoughts harming herself? COURT: step down. Thank you Counsel see you? members of jury not sit this afternoon break point ask come back tomorrow at nine o'clock Remember instructions Don't talk don't do research don't listen don't talk with tomorrow start with testimony tomorrow Thank you ## Day 8 (166 of 922 turns kept) [01:50:00] SPK3: for return back to trial of Commonwealth versus Lindsay Clancy. All parties present including defendant 18 jurors. SPK5: Thank you. Commonwealth calls Amy Bevins. [Q=SPRAGUE A=BEVINS] Q: Thank you. Good afternoon. state spell your name for record? A: Amy Bevins. A-M-Y B-E-V-I-N-S. Q: And your date of birth? A: 08/22/90. Q: Do you know Lindsay Clancy? A: Yes. Q: Do you know where Lindsay went? A: Quinnipiac University. Q: Ms.Clancy in nursing school she taking mental health medication? A: I can't recall. Q: struggling with anxiety? A: Nothing that I can recall. Q: see her in Connecticut in November 2022? [08:26:00] A: Yes. Q: text conversation? A: She shared taking medication dark thoughts tapering off medication trialing new ones remove side effects more helpful therapeutic Q: fair to say Lindsay had side effects dark thoughts because of medication weaning off moving to something else help? A: Yes. Q: traveled to Massachusetts visited Lindsay Spaulding Rehab Center? A: Yes. [Q=REDDINGTON A=BEVINS] Q: Afternoon. nervous.Don't go back how far? A: Almost 29 years. Q: recall conversations with her December 2022 about medications asking questions about particular medication? A: don't recall exact timeframe Q: one asked you conversations Lindsay friend about medications indicated quote page 12 "She knows open about mental health big advocate of mental health asked if I tried medication." remember saying? A: Yes. Q: recall her asking your experience? had knowledge of medications correct? A: As a patient. [19:06:00] Q: recall medication she asked about? A: Yes. Q: recall text message exchange she asked about medications she taking difficulties? A: Yes. Q: remember she asked aware of side effects of medications? A: I don't recall. Q: after text threads understanding Lindsay she confided having dark thoughts A: long time after conversation about medication remember first time heard concern around her mental health. Q: she told having problems difficulties with medication dark thoughts remember? A: Towards the end of January 2023. SPK6: Counsel? SPRAGUE: Nothing further. SPRAGUE: Commonwealth calls Christopher Clancy. SPK6: Good afternoon, sir. [Q=SPRAGUE A=C.CLANCY] Q: state spell your name for record? [22:19:00] A: Yes. Christopher William Clancy. C-H-R-I-S-T-O-P-H-E-R W C-L-A-N-C-Y. Q: And what's your date of birth? A: 7/26/61. Q: Is Patrick Clancy your son? A: Yes. Q: following day Christmas to Lindsay 's home before mass? A: Yes. Q: recall before after conversation hugged each other went separate ways? A: Yes. Q: Okay. A: Yeah. Q: January 24th, 2023. A: Yes. REDDINGTON: Thank you. Good afternoon. C.CLANCY: Good afternoon. [01:00:22] SPRAGUE: Can we go to sidebar? REDDINGTON: she's nurse labor and delivery at South Shore? C.CLANCY: Yes. SPRAGUE: Yeah. SPK6: Commonwealth. SPRAGUE: Nothing further. C.CLANCY: Yeah. SPK6: Commonwealth see you here [inaudible Start next witness couple minutes break till 2:00 ready to come back at 2:00 Same instructions during break Don't talk about case Don't do research Don't look into this case or similar cases see you at 2:00. nice break. Thank you. SPK11: Yeah. CLERK: afternoon Your Honor returned trial Commonwealth versus Lindsay Clancy parties present including defendant 18 jurors COURT: Madam Clerk jury afternoon return to case Attorney Sprague SPRAGUE: Commonwealth calls Kyle Carney COURT: Sure. Hi, good afternoon, sir. [Q=SPRAGUE A=CARNEY] Q: state spell name record A: Yeah. Kyle Carney, K-Y-L-E C-A-R-N-E-Y. [02:38:38] Q: And your date of birth, please? A: July 6th, 1991. Q: Who's your wife? A: Sarah Carney. Q: When did you meet Patrick Clancy? A: 2009 Q: When did you meet Lindsay Clancy? A: Maybe 12 years ago. Q: interact with Lindsay Clancy gatherings? A: Yes. Q: notice changes in Lindsay Clancy after birth Cora Dawson? A: No. Q: fall 2022 January 2023 see Patrick Clancy? A: Yes. CARNEY: Thanks. [02:44:20] SPK10: Commonwealth call Andrew Chiachio next witness CHIACHIO: Good afternoon, Your Honor. COURT: Counsel. SPK10: afternoon tell jurors first last name? CHIACHIO: Andrew Chiachio. CHIACHIO: I work for the State Police. CHIACHIO: Since December of 2013. CHIACHIO: work Plymouth County State Police Detective Unit SPK10: long State Police Unit? CHIACHIO: Five years. SPK10: attention back January 24th 2023 working State Police Unit District Attorney's Office? SPK10: recall went 47 Summer Street? CHIACHIO: Correct. SPK10: 189 Summer Street SPK10: arrived 17:32:32 exited store 17:37:08 [02:48:00] CHIACHIO: The ThreeV restaurant. CHIACHIO: In Plymouth. SPK10: address 10 Cordage Park Circle SPK10: video surveillance Patrick Clancy arriving 17:54:14 paid for bag food left store front 17:55:01 CHIACHIO: District Attorney's Office CHIACHIO: Correct. SPK10: Including Paula Musgrove SPK10: And who's Paula Musgrove? CHIACHIO: The Defendant's mother. SPK10: June 12th 2023 apply receive search warrant 47 Summer Street? CHIACHIO: Correct. REDDINGTON: Objection. hearsay cross-examined above. CHIACHIO: Correct. CHIACHIO: The Defendant. CHIACHIO: Correct. [02:53:29] CHIACHIO: Sergeant Josh McKelligan, DPH Police Chief Michael Riggs Attorney Reddington. CHIACHIO: Correct. SPK10: Facebook group Attachment Parenting for Littles. CHIACHIO: Correct. SPK10: confirm Facebook page name of Lindsay Marie Clancy? SPK10: confirm post by person Lindsay Marie Clancy Facebook page Lindsay Marie Clancy May 5th, 2021 to attachment Parenting for Littles group? COURT: No objection? Okay. SPK10: Facebook post posted by Lindsay Marie Clancy May 5th, 2021? SPK10: move to admit as next exhibit. COURT: No objection. That may be admitted. SPK10: Sergeant Calcio showing Exhibit 217 screen Facebook post from Attachment Parenting for Littles Facebook group? CALCIO: Correct. SPK10: Facebook page of Lindsey Marie Clancy? REDDINGTON: Exhibit 217 Parenting for Littles post by Lindsay, correct? CALCIO: Correct. [02:58:30] CALCIO: Thank you, Your Honor. COURT: jury motion or hearing with lawyers while excuse for today Come back tomorrow, 9:00 time estimate? on schedule ahead of schedule excuse till tomorrow stay here do more things remind keep open mind Don't talk with anyone Don't do research see case similar case don't read listen watch Don't research questions Don't take field trips Don't driving by areas double check done that All right? you've worked hard this case want continue follow instructions excuse you until tomorrow. expect. every time usually wrong expect full day tomorrow. Okay? hope you nice evening stay cool see you tomorrow. thank you. CLERK: Your Honor, record return to matter Commonwealth versus Lindsay Clancy. All parties present excluding jury. REDDINGTON: Thank you Honor murder trial serious business working hard on discovery voluminous. Hundreds of pages of state police interviews government have cops people interviewing videos chemists detectives local cops. They want cup coffee send five cops get except for son Patrick helps getting coffee frustrated they objecting two weeks ago need time to review cross-examine doctors on basic items evidence one witnesses adding new to discovery sole practitioner. past May June July. three months murder rape two back-to-back federal trials ended one week before empaneled case worked hard case with expert witnesses civilian witnesses private investigators provide everything them they doing same haven't objected to thing offered put AutoCAD computer animated display disc on my desk last week didn't complain exclude no problem Put in pile move on." suggest need time to cross-examine both. had trials with both prosecutors experienced familiar with trial of major criminal cases.feel they're capable of to cross examine Dr. Vukovich a board certified emergency medicine physician. His report indicates at South Shore Hospital Brigham and Women's Hospital photographs. evidence looked South Shore doctors testified to nature of injuries type of injury she suffered injuries to right and left wrist neck. dealing with suicide attempts legitimate suicide attempt. no secrets nothing new to prepare cross-examine Dr. Laposata doctor known I using services for past decade both attorneys familiar with her. She's not bringing anything new bringing opinion based upon evidence medical records, x-rays indicia of injury suffered. talking about Lindsay hanging off window Spider-Man slide down side house ridiculous She dove out window hit head suffered Jefferson fracture of spine typical for this injury. dives into shallow pool injury kids on boat drunk jumps off mast into shallow water Cape Cod get injury. Superman thrown off horse six feet same injury She not bringing esoteric theory case need time to prepare.Brigham Women's Hospital records reference to Jefferson fracture from jump She assists me on autopsy photographs indicia of injuries her opinion if bruises to babies inflicted by her wrong Dr. Laposata consistent with EMT God first responders in panic to care of kids to trucks vehicles intraosseous injection into legs shins thighs bruises from medical intervention not Lindsay Clancy she testify to don't need time to prepare cross-examine Dr. Conti signed affidavit based upon medical records case government presented case to grand jury Lindsay sign release government medical records We'll case predicated upon medical records psychiatric records We signed every release got every document into grand jury copies Conti testify to failure to comply with standard of care psychiatrists psychologists Dr.Tufts Nurse Practitioner Jollotta other individual from Mc Lean Hospital all records had for years don't need time to prepare for cross-examination weeks ago counsel gave copies of reports and affidavit affidavit from Conti they have disclosed my opinion of opinions doctors testifying report carries outsuggest court strip Lindsay 's ability present evidence support defense not in interest of justice like hear DA stand say interest of justice case weeks ago got information not prepared cross-examine testifying witnesses Your Honor agree disingenuous argument She said "Rule 14 matters applies government defense exclude witnesses." if messed up trial schedule caused not written reports years prepare cross-examine witnesses my fault deprives her effective assistance counsel deprive defense. pathologist emergency room doctor doctor testify to standards apply doctors call witnesses interesting calling Tufts,Jollotta other individuals Mc Lean treating physicians her lined up testify against her case. bring it. give ammunition to counter it. REDDINGTON: not giving opinion of criminal responsibility. REDDINGTON: standard of care to causation He doesn't use can use his opinion first doctor spoke to Dr.Tufts presents bipolar presentation Tufts prescribes SSRI applies rational psychiatrist He qualified to testify REDDINGTON: Dr. Conti was my toxicologist treating. physician opinion appropriateness of treatment received especially prescriptions Dr. Laposata pathologist nothing Dr. Zeisel psychologist Dr.Resnick psychiatrist in infanticide not addressing issue Dr. Spinelli postpartum depression psychosis expert Dr. Conti my expert for toxicology level of care received defense argument need time to cross-examine prepare results in exclusion COURT: Okay. Commonwealth. SPRAGUE: you Dr. Conti affidavit addresses standard of care civil issue defense counsel pivot testify about treatment defendant in toxicology affidavit qualifications not a toxicologist physician licensed in Massachusetts residency in general psychiatry child and adolescent psychiatry forensic psychiatry not toxicologist not just same records for cross-examination fair more to cross-examination than underlying dataknowing more about expert look into publications prior testimony prepare to rebut anything late disclosure one week prior to trial unfair to Commonwealth. Dr. Conti testifying to limited to her treatment prescribed covered by other three experts defense has talk about treatment prescription effects redundant unfair to Commonwealth to add fourth expert same things other three experts when prepare for this expert. Dr. Laposata two and a half page letter to attorney Reddington outlining her thoughts doesn't say opinions based materials reviewed relying on insufficient report delayed disclosure. talks about Jefferson fracture causing injuries if had information previously could have obtained own expert to mechanism of injury Jefferson fractures told until week before trial she potentially be witness report on July 26th two and a half page letter COURT: didn't we have multiple trauma surgeons neurosurgeons testified treated her? ask consistent with. from Dr. Laposata's note not sure allow opinions serious suicide consistent with landing on individual's head SPRAGUE: trauma surgeon from South Shore Hospital testify injuries Ms.Clancy sustained level one transported to another hospital doctors trained operate didn't think she knowledge training experience to testify about nature injuries trauma surgeon from Brigham and Women's Hospital with military overseas in Middle East unavailable. had known issue fracture would have endeavored to get another expert replace doctor treated her Brigham and Women's didn't know issue until week before trial letter dated July 26th doesn't tell us records reports medical journals training opinions based on COURT: Commonwealth inferred not a serious suicide attempt SPRAGUE: position Commonwealth isn't wasn't serious suicide attempt. methods chosen insufficient to achieve goal reasons argue in closing't disclose theory never said wasn't serious suicide attempt never said fake suicide attempt develop from testimony methods chosen were unsuccessful not saying wasn't serious attempt.think reasons clearer when doctors testimony our position she kill herself night various reasons unsuccessful killing herself successful killing children SPRAGUE: And just note our objection. COURT: concerned with opinion admissible opinion he's reviewed medical records it's his opinion injuries commonly observed in serious suicide attempts. [03:50:00] COURT: suicide attempts. That's an opinion. REDDINGTON: doctors waxed about suicide COURT: concerned how to parse out what he looked at? hundred other cases go through all going to take a look take under advisement doesn't mean he may have other opinions look at he talked about observations as emergency room doctor reluctant to allow individual's opinion this suicide attempt COURT: he can't give opinion my opinion suicide attempt he could testify looked at cuts phrase superficial mixed up more medical term COURT: if call doctor he say significant cut different than saying suicide attempt never opinion not a suicide attempt jury COURT: Yeah. REDDINGTON: Yep. REDDINGTON: Nope. COURT: take under advisement inclined to look at Dr. Conti's report compare to other reports inclined to let Dr. Laposata testify injuries consistent with fall on the head. last doctor look at his language not allowing in his opinion this suicide attempt.he may testify other observations took from records. REDDINGTON: Understood note my objection. COURT: note Commonwealth 's defendant's objection take under advisement renew objections REDDINGTON: Great. SPRAGUE: commonwealth objection REDDINGTON: medical records government talks Jefferson Fracture two weeks ago raised objection can't know argue until they argue didn't know fake suicide or she didn't jump out window wait to see opening Now rebut it. REDDINGTON: Yeah. Sorry. [03:56:29] REDDINGTON: Thank you, Judge. ## Day 9 (1114 of 2984 turns kept) [04:00] CLERK: Good morning, Your Honor proceed? CLERK: court matter of Commonwealth v.Lindsay Clancy Clancy present represented by attorney Kevin Reddington Commonwealth represented by Assistant District Attorney Jennifer Sprague Assistant District Attorney Shanan Buckingham COURT: good morning Ms.Clancy Counsel see sidebar? CLERK: Good morning Your Honor proceed? CLERK: continuation of jury trial Commonwealth v.Lindsay Clancy Clancy present represented by attorney Kevin Reddington Commonwealth represented by Assistant District Attorney Jennifer Sprague Assistant District Attorney Shanan Buckingham COURT: Thank you Madam Clerk Good morning everyone COURT: ask questions follow instructions schedule return to evidence first question has any member of jury read seen heard overheard anything source affect ability to be fair impartial juror? JURY: None. COURT: thank you for following instructions hesitate to give schedule probably 50% right, 50% wrong intention today go most today end of day before send home talk to lawyers see schedule for next week plan see timeline estimate of case give information today before send home return to case on trial.Commonwealth call next witness SPRAGUE: Commonwealth call Kimberley Hardy witness today COURT: That's good. All right. Commonwealth. SPRAGUE: Thank you. Good morning. HARDY: Good morning. SPRAGUE: Where is the Kingsbury Club? HARDY: In Kingston. [09:50:00] COURT: I'm sorry, what's the objection? [Q=SPRAGUE A=HARDY] Q: recall last time saw Lindsay Clancy Cora Dawson at Kingsbury Club? A: Yes. Q: Cora Dawson come in mornings? A: Yes. Q: And what time does it close? A: It closes at 2:00. Q: see Cora Dawson in playroom September to January in afternoon? A: Sometimes. Not usual. Q: move to admit Kingsbury Club records as next exhibit CLERK: Exhibit 218. SPRAGUE: Thank you. Nothing further. Thank you. REDDINGTON: people advised by doctors or psychiatrists to exercise good thing HARDY: Yes. COURT: Any redirect? [14:20:00] SPRAGUE: Commonwealth call Sarah Carney COURT: All right. Good morning. [Q=SPRAGUE A=S.CARNEY] Q: Thank you. Good morning. A: Good morning. Q: tell jurors first and last name? A: Sure. Sarah Carney. Q: And the last name? A: C-A-R-N-E-Y. Q: And who's your husband? A: Kyle Carney. Q: conversations about postpartum depression or sleep issues? A: No. Q: Nothing further. Thank you. REDDINGTON: timeframe knew Lindsay? S.CARNEY: 12 years. [23:15:00] REDDINGTON: Social? S.CARNEY: Yep. SPRAGUE: Thank you. Nothing further. COURT: Commonwealth. SPRAGUE: The Commonwealth would call Alia Goodheart. COURT: All right. Good morning, Doctor. [Q=SPRAGUE A=GOODHEART] Q: Thank you. Good morning. A: Good morning. Q: And your last name, please? A: G-O-D-H-E-A-R-T. Q: what do for work? A: I'm a psychiatrist. Q: educational background to be psychiatrist? A: medical degree State University of New York Brooklyn Health Sciences Center came Boston four-year residency Harvard Longwood Psychiatry Residency Program trained additional three years Boston Psychoanalytic Institute advanced training attended advanced training program Q: licensed in Massachusetts to practice as psychiatrist [03:33:00] A: I am. Q: medical doctor specialization in psychiatry A: Correct. Q: work history A: worked in several different settings Beth Israel integrated care work with primary care physicians patients questions consult manage patient psychopharm medications available consult discuss cases After Emerson Hospital worked inpatient psychiatric unit nine years left one year medical director another freestanding hospital After worked women's prison in Framingham year and a half outpatient clinic affiliated Tufts. private practice two years working at Mc Lean last five years Q: Okay. And what is McLean Hospital? A: freestanding psychiatric hospital part of Mass General Brigham system Q: role at Mc Lean? A: work on inpatient psychiatric units Q: inpatient psychiatric unit A: Patients to our unit referred by emergency department need inpatient care can come voluntarily or sent involuntarily arrive we work with patient for certain period time predetermined flexible depends on on inpatient unit not just seeing psychiatrist working as team nurses mental health workers social workers Mc Lean every day meeting discuss share information guides treatment on unit not there 24/7 mental health staff and nursing staff contribute to assessment patient Q: From Mass General referred to A: Acute Psychiatric Consultation APS service Acute Psychiatric Services evaluation complete evaluation by nurse practitioner or psychiatrist over why coming now history problems What's family history document presenting inquire about symptoms find out medications on based decide need. several options can recommend inpatient treatment partial hospital program patient doesn't have to do either If not unsafe can choose to leave most people take recommendation seeking help. Q: What happens at stage at Mc Lean? A: seen by psychiatrist nurse review history at emergency department inquire about do another evaluation like at APS reviewing history asking questions concerns document [12:59:00] Q: evaluation done by psychiatrist A: Correct. Q: first Clinical Evaluation Center always seen by psychiatrist A: Yes. Q: patient evaluated Center what happens after evaluation? A: determine level of checks patient on unit several units four inpatient units decide medications until seen by psychiatrist on unit Q: determination of unit level of security check done by psychiatrist first evaluation A: Correct. Q: person arrives at unit what happens? A: seen by nurse mental health worker go through belongings ensure nothing unsafe certain things not allowed on psych unit nurse reviews history takes vital signs medication show them to room unit Q: if voluntarily can they leave A: long as psychiatrist team assesses determines't pose imminent risk GOODHEART: Section 12 entails team psychiatrist has three days to evaluate patient determine pose danger to or others if determine person poses risk apply for commitment. going of judge decide if patient remain hospitalized or be discharged. SPRAGUE: something in field psychiatry your training experience Mc Lean about being discharged against medical advice? REDDINGTON: She wasn't discharged AMA. [18:27:00] REDDINGTON: [inaudible] my objection. [Q=SPRAGUE A=GOODHEART] Q: when person process placed on unit settled in plan after? How often see providers? A: assessed by psychiatrist every day nurses checking in mental health workers offered group programming medical monitoring vital signs Q: other things offered patients on unit care like counseling? A: check-ins with psychiatrist social worker counseling happens in sessions by nurses mental health staff Q: procedure change if holiday or weekend? A: still seen by psychiatrist REDDINGTON: no objection object [Q=SPRAGUE A=GOODHEART] Q: availability mental health worker social worker psychiatrist nurse team stays same even on weekend or holiday? A: Other than the social worker. Q: role as psychiatrist assigned patients admitted Mc Lean inpatient? A: random beds open I carry certain number patients other psychiatrists have certain number patients opening gets admission Q: rely on other psychiatrists perform tasks before patient? A: Yes. Q: she through process Clinical Evaluation Center early morning hours 4:00 AM 1st? [23:19:00] A: Yes. Q: And who saw her there? A: psychiatrist Dr. Outlaw Q: familiar with Dr. Jasmine Outlaw? A: I've never met her. Q: psychiatrist on staff A: Correct. I did- Q: screened on suicide screening A: Correct. Q: chief complaint patient Mc Lean? A: hard to sleep medications Q: issues managing medication A: I don't know what you mean by that. Q: complaints about side effects of medication A: Yes. [50:00] Q: psychiatrist in Clinical Evaluation Center gathered information primarily based on reported by patient? A: Yes. Q: McLean access to patient's full psychiatric history or records? A: depends patient Dr. Outlaw excerpt of APS evaluation at MGH had access Q: McLean affiliated with Brigham Hospital A: Correct. REDDINGTON: Objection. [Q=SPRAGUE A=GOODHEART] Q: observed at Mass General no evidence of psychosis, mania obsessions anxiety symptoms A: Correct. Q: reported patient Mc Lean instance Lindsey Clancy came aware she reported Clinical Evaluation Center evaluation beginning of December started Seroquel Remeron intrusive suicidal thoughts? A: Yes. Q: That she attributed that to medication? A: Yes. Q: what plan first plan Clinical Evaluation Center evaluation of Ms.Clancy? A: She continued on medications admitted on plan checks decide medical monitoring admitted medications same [04:44:00] Q: aware of provisional diagnosis assigned to patient when arrived? A: don't recall provisional diagnosis assign diagnosis records five different diagnoses Q: referring to Exhibit 79 draw attention to page 24. A: remember Q: provisional diagnosis A: Yes. Q: And what was it? A: Major depressive disorder severe without psychotic features Q: provisional diagnosis mean patient? A: assessment of psychiatrist who saw her Q: stick with diagnosis or free to change based on experiences patient? A: diagnosis dependent on interactions observations of team Q: you doctor who saw her or somebody else? A: It was a different psychiatrist. Q: who psychiatrist saw her on January 1st? [06:25:00] A: It was Dr. Madva. Q: Dr. Elizabeth Madva? A: Correct. Q: psychiatrist? A: Yes. Q: review notes admission notes of Dr. Madva interactions with patient January 1st 12:47 PM? A: Yes. Q: interactions with patient and psychiatrist conversation? A: repeat question? Q: she spoke with Dr. Madva denied feeling depressed passive death wishes suicidal thoughts reports feeling numb? A: Yes. Q: feel emotion mild anxiety in hospital setting A: Yes. Q: After Ms.Clancy seen by Dr. Madva aware of plan regarding her medication? A: Yes. [08:10:00] Q: And what was the plan? A: Ms.Clancy complained symptoms numbness Dr. Madva concern sensitive to medications GOODHEART: determined possible numbness side effect of medication plan to taper medication observe patient see numbness away other symptoms evident SPRAGUE: medications aware of medications Ms.Clancy Mc Lean on SPRAGUE: And what medications were those? COURT: Yeah. [Q=SPRAGUE A=GOODHEART] Q: interactions with Ms.Clancy review interaction with other psychiatrists agree with diagnosis? A: Did who appear to agree? Q: Yes. A: She disagreed with the diagnosis. Q: she on 100 milligrams of Seroquel or more significant in considering bipolar diagnosis? A: Seroquel used for several purposes not just bipolar illness. Q: Seroquel used in low doses address insomnia? A: Yes. Q: aware Ms.Clancy saw Dr. Madva January 2nd? [01:00:12] A: Yes. Q: Ms.Clancy reported slept well on lesser dose Seroquel? A: Yes. Q: report delusions hallucinations suicidal homicidal ideation? A: No. Q: nurse January 1st 6:28 AM A: Yes. Q: nurse interacting January 1st 10:34 AM A: Yes. Q: participated in group activity with social worker 12:03 PM 1st A: Yes. Q: nurse interacted made notes at 2:07 PM 1st? A: Yes. Q: saw mental health worker 9:33 PM 1st? A: Yes. [01:03:56] COURT: records Exhibit 79 [Q=SPRAGUE A=GOODHEART] Q: observe signs of anxiety felt anxious? A: She appeared anxious. Q: identify main concerns address stay Mc Lean? A: not dependent on antipsychotic medication Seroquel used for insomnia depression didn't want dependent Seroquel fall Seroquel asleep Q: concerned about symptomology symptoms from various medications A: Yes. Q: Dr. Madva concerned about numbness with medication Seroquel common side effect feel numb? A: side effects. Q: suicidal statements aware prior reports go through with her presented suicidal ideation? A: Can you ask me that again? Q: talk about thoughts suicide? A: Yes. Q: reported plan for suicide? A: No. [01:07:24] Q: reasons thought wouldn't commit suicide? A: Yes. Q: after spoken developing plan cognizant about potential for bipolar disorder diagnosis? A: Yes. Q: reduction of medication concern for sleep? A: mental health negatively affected if sleep bipolar disorder or depression sleep important Q: considering bipolar diagnosis lack of sleep watch for symptoms hypomania? A: Sleep deprivation lead to bipolar episode hypomanic manic episode Q: first interaction identified plan suggestion about medication after Seroquel discontinued? A: Yes. Q: alternative medication? A: Cymbalta antidepressant Q: Valium plan to address tapering Valium alternative to Valium? A: switched from Valium to Ativan, shorter half-life manages anxiety well Q: aware she taken Ativan before? [01:12:13] A: Yes. Q: report concerns about Ativan benzodiazepines? A: Yes. Q: interaction January 3rd observe signs of psychosis? A: No. Q: notes interactions with providers prior meeting between January 1st and January 3rd note symptoms concerns for psychosis? A: No. Q: Ms.Clancy in postpartum period had child in May 2022 A: tricky question different organizations assign postpartum different length time Q: training experience consider postpartum patient? A: Yes. Q: why A: had child risk of postpartum depression psychosis serious consideration Q: after first meeting with Ms.Clancy on 3rd diagnosis? A: Yes. [01:14:24] Q: Yes. A: gave diagnosis of insomnia with mental health condition one day observation solid diagnosis sticks patient Q: inpatient progress note on page 61 date of service reads 1/3/23 at 9:15 note time scheduled to speak with patient? A: Yes. Q: 3rd Ms.Clancy participated in group at 12:02 PM A: Yes. Q: another group at 2:36 PM A: Yes. Q: declined group at 3:50 PM A: Yes. Q: saw another mental health worker evening before bed 8:52 PM A: Yes. Q: see her on January 4th? A: Yes. Q: asked to leave earlier than Friday response? [01:17:58] A: said she could leave provided had psychiatric follow up next day Q: And why did you do that? A: wanted to ensure if she sleep night after discharge could speak with plan to ensure sleep monitor off medication Q: day met her January 4th she reported slept well. recall dose of Seroquel? reached zero? A: On which day? Q: restarted on Ativan,Trazodone available if needed? A: was already on Ativan during admission taking at night had Trazodone, sleep medication sedating properties used for sleep had option to take that Q: diagnostic perspective preferred more information about sleep patterns mood? A: Yes. Q: concern for safety. time with information reviewed identified protective factors made feel comfortable she safe? A: several things future-oriented invested in children caring mother had parents around help family supports ensured outpatient psychiatric care for follow up history of suicide no history of psychosis postpartum psychosis stable place to live. Q: statement she wouldn't completed suicide because of kids or mom considered? A: Absolutely. Q: during from admission January 1st to discharged January 5th didn't make statements supporting suicidal ideation factor considered? A: Yes. [01:23:31] Q: discharge moved up a day plan for medication upon discharge? A: continued Ativan to help sleep short-term plan Once feeling better sleep mood baseline could taper off had Trazodone use as needed and melatonin Q: recommendations for medication no more Seroquel? A: Yes. Q: didn't give new prescription for different doses Seroquel A: No. Q: aware he reported she hadn't had suicidal thoughts? A: Yes. Q: felt she succumbed to social pressure to take psychiatric medications friends taking? A: told social worker Q: always on call mental health worker social worker psychiatrist nurse speak to? A: Yes. Q: upon discharge prescribe her? A: 14-day supply of Ativan 14-day Trazodone. Q: conversations about thoughts of suicide asked if she wanted to kill herself? [01:28:50] A: Yes. Q: Thank you. Nothing further. Thank you. [Q=REDDINGTON A=GOODHEART] Q: I'm sorry? A: aware of website Psychology Today. Q: insurance person paying bills for medical treatment or psychiatric treatment A: insurance important see limited by insurance Q: came in New Year's Eve? January 1st? A: Yes. Q: 81 South? A: A apple, B boy, 1, South. Q: South how many doctors work at AB South shifts? A: four psychiatrists assigned work on AB1 South Q: Four teams on AB South, right? A: Yes. Q: team consists of psychiatrist nurse [01:35:55] A: psychiatrist nurse social worker assigned mental health worker Q: admitted herself escorted onto AB South evaluated A: evaluated in CEC by psychiatrist unit seen by Dr. Madva met two psychiatrists January 1st Q: in CEC? person interviewed A: There's a full psychiatric evaluation. Q: full psychiatric evaluation A: chief complaint history of. present illness hospital Q: Okay. A: review past psychiatric history substance use history social history family history mental status exam make assessment. Q: And they would be the CEC? A: Psychiatrist. Q: psychiatrist referring to? A: Dr. Outlaw. Q: psychiatrist social worker must get into prior history patient coming A: part of evaluation [01:39:40] Q: as psychiatrist. when she goes to hospital's your patient? A: She's- Q: reviewed records social worker talk to first psychiatrist she? A: The social worker contacted Patrick. Q: Okay. Who is her psychiatrist? A: nurse practitioners prior to Mc Lean aware of person Q: Would that be Nurse Practitioner Jollotta? A: Yes. Q: How about Psychiatrist Tufts' records? A: No. Q: How about Nurse Practitioner Paul's records? A: No. Q: Who's Leticia Dukes? A: She was social worker Lindsay saw at South Shore perinatal program Q: know recommendations she received? [01:42:54] A: No. Other than the medication. Q: medication she on when presented to Mc Lean Hospital? A: Seroquel and Valium. Q: Dr.Tufts first psychiatrist she consulted correct? A: I believe so. Q: made reference to she looking for medication A: vague statement know SPK1: Objection. SPK2: Overruled. [Q=REDDINGTON A=GOODHEART] Q: medication Dr.Tufts prescribed? A: From what Lindsay told me, yes. Q: What? A: Zoloft was the first. Q: Dr.Tufts Lindsay provided her Lindsay with Zoloft SSRI A: antidepressant [01:44:53] Q: prescribe Zoloft or Sertraline to person bipolar? A: depends on seeing patient Q: important to be fair in evaluation of young woman hospital for help on New Year's find evaluations of her condition presentation symptomology when saw first psychiatrist Dr.Tufts A: Lindsay cooperative forthcoming no reason to think she not provide with what other providers thought Tufts worried about bipolar disorder Q: Okay. A: Sorry. Thank you. Q: Dr.Tufts prescribed Zoloft knew after initial prescription Zoloft know how many milligrams prescribed initially by Dr.Tufts? A: Lindsay stated was 25. Q: tools mental health field access to psychiatric testing A: Yes. Q: As psychiatrist don't administer psychiatric or psychological testing A: No. Q: How many times she call for suicide hotline? A: I don't know. Q: important to find if person denying suicidality suicidal ideation called to suicide hotlines? [01:49:40] A: told suicidal thoughts no intent or plan struggling with suicidal ideation Q: investigating history patient not aware she reached out two occasions to suicide hotline correct? A: Yes. Q: first prescribed Zoloft by Dr.Tufts at 25 milligrams increased to 50 milligrams reported unable to sleep- A: She shared- Q: testimony preferred more information about sleep patterns." remember A: Following changes in medications Q: sleep pattern important for psychiatrist patient? A: difficulty sleeping symptom of several different conditions can worsen conditions Q: she reported severe anxiety A: She was struggling with anxiety, yes. Q: very severe A: She wasn't able to sleep. Q: didn't mean as evaluator her prior medical history for diagnosis treatment wanted know her sleep patterns prior A: history of struggling insomnia important patient can relay to me [01:54:47] Q: woman in locked ward couldn't walk off unit A: psychiatric unit Q: What were the intrusive thoughts? A: medical record thoughts of suicide. Q: agree in addition to anxiety inability to sleep she in self brain fog A: complained of feeling. foggy Q: Patrick concerned about medications prescribed past or three months? A: Yes. Q: knew medications prescribed correct A: She told us. Q: She told prescribed SSRIZoloft increased from 25 to 100 A: I- Q: I'm sorry, 50. A: Correct. Q: told to stop taking Zoloft by Dr.Tufts [01:57:14] A: reported not able to sleep agreed not take Zoloft Q: answer yes told to stop taking Zoloft by Dr.Tufts A: ask Dr.Tufts question Q: investigating her A: she stopped taking Zoloft Q: evaluating patient assuming she voluntarily stopped taking Zoloft? A: wasn't able to sleep discussed with Dr.Tufts Q: How many patients treated women suffering from postpartum psychosis? A: don't recall remember stick in memory probably Q: How about postpartum depression? A: Yes. Q: how many patients treated with postpartum depression? A: Over last 20 years lots of patients seen don't keep record of diagnoses people Q: psychiatrists psychologists use in evaluations diagnoses referred DSM, correct? A: Yes. [01:59:21] Q: DSM means diagnostic statistical manual A: Yes. Q: DSM Diagnostic Statistical Manual thick regular sized book little one book A: I think so. Q: rely on or use evaluation Diagnostic Statistical Manual? A: diagnoses based on criteria stated there Q: use for diagnosis purposes stated in DSM, correct? A: Yes. Q: group of people discuss what should not included in manual psychiatrists psychologists use to diagnose patients A: Yes. Q: in 2026, not 1928 postpartum depression in DSM? A: I think it's a subcategory. Q: subcategory of? A: Depression. Q: Depression. psychosis?Postpartum in 2026. in this manual? [02:01:39] A: don't know where it Q: treating woman postpartum child told jury timeframe cutoff person still postpartum subject to mood swings hormone imbalance cutoff you said right? A: Different organizations use different definitions. Q: you here for government testifying case.What's your understanding of cutoff of postpartum? A: DSM -5 four weeks. ACOG American Academy of Obstetrics 12 weeks. CDC 12 months 12 months Q: all over place timeframe woman involved with postpartum symptomology? A: Yes. SPK1: Objection. SPK2: No. Overruled. [Q=REDDINGTON A=GOODHEART] Q: ... postpartum psychosis? A: I'm sorry, what's the question? Q: read aware of efforts to include postpartum psychosis in DSM -6 coming within couple months? A: question about where it placed categorized. Q: aware of efforts to include postpartum psychosis in DSM -6? A: Vaguely. [02:04:26] Q: impact thyroid on woman baby in postpartum period? six months four months a year impact thyroid? A: not internal medicine physician doctor thyroid affect mood anxiety pregnant or not Q: thyroid levels important in evaluating woman in postpartum? A: one tiny component of entire Q: past as psychiatrist treating psychiatrist at Mc Lean Hospital investigation evaluate woman diagnosis help look at thyroid reads? A: one of labs would've reviewed. Q: scale. scale A: It's a postpartum scale for depression. Q: used by psychiatrists psychologists to evaluate risk factor of woman involved with postpartum A: assess level of depression Q: In woman involved with postpartum not guy injured on soccer field A: Yes. Q: what EPDS mean? acronym for? A: Edinburgh's Postpartum Depression Scale or something. Q: Edinburgh Postpartum Depression Scale administered to Lindsay when in four days and a half in hospital? [02:08:39] A: No. Q: Why not? A: Because we don't necessarily administer scales. Q: accepted tool to evaluate patient as psychiatrist psychologist A: tool doesn't determine diagnosis Q: not doctor access to person medical history aspects evaluation gives diagnosis A: psychiatrist makes diagnosis based on presentation history patient Q: didn't do tests blood test? A: Psychiatry not dependent on blood tests Q: not valid medical step for to take blood from person on cocktail of drug medications to find levels? A: not regular procedure Q: McLean did not take blood Mc Lean do Edinburgh scale interested gave her Edinburgh Depression Scale A: McLean did draw blood testing no testing for levels of drugs. Q: That's fine. A: Okay. [02:12:22] Q: if she presents history was on drugs for three-month-half-month interest what was on board in her blood? A: Medications have different half-lives if she taken something on half-life If day out of her system not catch it on what she taking what in her bloodstream. Q: That's understandable. Okay. A: Thank you. Q: No problem looking at Exhibit 79, page 63 record from Mc Lean Hospital A: Yes. Q: social worker's note? A: Correct. Q: What when says in rounds? A: when we meet in morning social worker psychiatrist nurse charge nurse utilization reviewer. Q: "Presenting problem." says HX history psychosocial HX, history discussed correct? A: Yes. Q: youngest baby? 12 weeks after delivered baby wasn't taking bottle supposed to go back to work Husband went back to work experiencing "situational anxiety." correct? A: That's what it states. Q: result. from her situational anxiety her words quotes or? [02:16:00] A: I didn't write that note. Q: result she saw psychiatrist prescribed her Zoloft, A: Yes. Q: indication of reaction patient to medication prescribed SSRI s,Zoloft, A: side effect yes. Q: psychiatrist told her stop taking Zoloft right? A: That's what it states. Q: know from your investigation evaluation of Lindsay Clancy when doctor told her stop taking Zoloft? was week later, days later? A: don't recall if information available in my note. Q: Your Honor permission to take look at exhibit out of courtroom? REDDINGTON: No don't want to go to sidebar REDDINGTON: picked up on hot mic saying "Shut her up during autopsy. CLERK: for record return to trial of Commonwealth versus Lindsay Clancy. All parties present including defendant 18 jurors. [Q=REDDINGTON A=GOODHEART] Q: Yes [inaudible don't worry Doctor agree notes in exhibit 79 correct? A: Yes. [02:21:54] Q: reference to postpartum psychosis serious consideration evaluating patient in Mc Lean correct? A: Yes. Q: Postpartum she follow up with other healthcare providers she sent text email confirmed within hour A: made appointment with Dr.Tufts next morning. [Q=SPRAGUE A=GOODHEART] Q: show marked as Exhibit 146. familiar? A: Yes. Q: gives instructions need immediate help phone numbers A: Yes. Q: crisis plan call for suicide prevention lifeline A: Yes. Q: gives instructions patient do follow-up A: Yes. Q: says "What's next? Call Cassandra Wolfson for assistance finding community behavioral health providers." identified as Blue Cross Blue Shield case manager A: Yes. Q: based on conversation with Ms.Clancy wanted new provider? [02:24:14] A: had psychiatrist prescriber assigned therapist by at South Shore. wanted more options choices call person more choices. REDDINGTON: object beyond scope of cross legitimate objection COURT: All right. Sustained. REDDINGTON: Objection. COURT: Overruled. REDDINGTON: Objection. COURT: Sustained. REDDINGTON: outside scope of cross. Objection COURT: Overruled. I'll allow that. [Q=SPRAGUE A=GOODHEART] Q: arrived at Mc Lean, advised of medication on A: Yes. Q: treatment plans recommended require different medications? A: not sure understand question Q: not look at blood work evaluate for levels of medications? A: Correct. [02:30:38] Q: reason to do based on medication regimen advised on? A: No. Q: treatment plan medication reason to verify or not she had things in system? A: No. Q: asked cross-examination about suicide hotline A: Yes. Q: Are you familiar with suicide hotlines? A: Yes. Q: assess for when call? A: Imminent risk if calling feeling suicidal point send help Q: counsel asked questions about postpartum depression psychosis appear in DSM -5. A: Yes. Q: appear conversation bipolar disorder major depressive symptoms episodes psychosis A: Yes. Q: as psychiatrist tool use [02:33:27] A: Yes. Q: other things rely upon diagnosis other than tool? A: Observation patient history information from family other records if available Q: diagnosis A: Yes. Q: diagnosis agree with? A: No. PROSECUTION: Commonwealth calls Dr. Jennifer Tufts. COURT: Counsel. [Q=PROSECUTION A=TUFTS] Q: Thank you Your Honor Good afternoon state spell name for record A: Jennifer Tufts. J-E-N- I-F-E-R T-U-F-T-S. Q: Your date of birth? A: December 31st, 1989. Q: Where do you work? A: Aster Mental Health. [02:36:45] Q: What is your role there? A: I'm a psychiatrist. Q: how long been psychiatrist? A: fully licensed psychiatrist four years Q: explain educational background training background psychiatrist A: went medical school at University of Vermont graduated 2018 MD postgraduate training psychiatry Boston Medical Center four years 2022 began working at Aster Mental Health 2022 Q: licensed psychiatrist in Massachusetts A: Yes. Q: Aster Mental Health patient named Lindsay Clancy? A: Yes. Q: move submit records of Lindsay Clancy for Aster Mental Health next exhibit [Q=PROSECUTION A=TUFTS] Q: type of paperwork? A: extensive includes past health history psychiatric history medications taken past names of therapists doctors with usually primary care report of substances use past scales assessing anxiety depression ADHD lengthy document. Q: Lindsay Clancy filled out documents on September 12th, 2022 three days prior to first appointment A: Yes. [02:39:47] Q: What was that? A: previously taken medication in nursing school tried medication Prozac Q: recall listed tried Wellbutrin while on Prozac? A: That was listed as well. Q: took Prozac Wellbutrin nursing school no side effects medications? A: That is correct. Q: Prozac, is that an SSRI? A: Yes. Q: portion patient drink question about feel guilty? A: Yes. Q: objection to reviewing records? REDDINGTON: Nope. [Q=PROSECUTION A=TUFTS] Q: listed drinking five times per week feeling guilty? A: Yes. Q: symptoms? [02:42:28] A: Anxiety attacks decreased appetite depressed mood easily distracted excessive worry guilt unable to feel pleasure unable to fall asleep racing thoughts Q: suicide risk assessment form Ms.Clancy filled out? A: Yes. Q: suicide risk assessment? A: assesses factors increase risk of suicide Q: Page 23. A: Correct. Q: fifth question "Made serious suicide attempt answer no correct? A: Correct. Q: Number 10 "Heard voices telling to hurt others." answer no correct? A: Correct. Q: answer answers to every question suicide checklist no correct? A: Correct. Q: Direct to page 25. ADHD attention deficit hyperactive disorder? A: Yes. [02:46:47] Q: GAD screening generalized anxiety disorder? A: Yes. Q: Ms.Clancy 's answers cause for concern training experience? A: suggestive of anxiety disorder Q: entitled Tools-PHQ-9 Patient Questionnaire date 09/12. [Q=PROSECUTION A=TUFTS] Q: form PHQ-9 Patient Questionnaire purpose? A: It's a screening tool for depression. Q: defendant's answers training experience? A: some answers positive indicates assessed for depression might have Q: positive? A: number two feeling down, depressed hopeless half days positive response means yes. Q: next form A1, Initial Diagnostic Assessment. A: Yes. SPK5: Objection. COURT: Go ahead. [02:51:23] TUFTS: Sorry. [Q=PROSECUTION A=TUFTS] Q: met with Ms.Clancy first day ask questions suicidal intent?" A: Yes. Q: auditory hallucinations or visual hallucinations? A: Yes. Q: first meeting exam process? start meeting flow? A: start meeting introducing myself explaining day ask patient why there assess for mood symptoms anxiety psychosis mania symptoms safety concernsstart talking history past psychiatric medical history substance use start other medicines tried past or still taking not always order general order sometimes things come up sooner talk patient's goals looking for this time period may give recommendations. Q: mentioned initial evaluation looking for signs of psychosis correct? A: Yes. Q: What types of things looking for if experiencing psychosis? A: number of things. start with how patient appears signs of psychosis might appear disheveled assess attitude agitated or uncooperative red flag assess speech loud? fast? Or sometimes opposite not speaking assess mood feeling appear visually assess thoughts thoughts disorganized hard to understand jumping around can't follow line assess thought content about bizarre or paranoid potentially indicative of psychosis. Q: note any signs or symptoms of psychosis with Ms.Clancy that day? A: No. Q: addition to observations patient asking questions about past behavior indicate psychosis issue? A: Yes. [02:56:47] Q: psychiatry judgment? A: judgment indicates decision-making process logical decision-making process or not Q: same question insight what mean in psychiatry assessing insight? A: more about patient's awareness inner feelings mental health broadly Q: And how do you do that? A: depends unless specific concern about memory or dementia based off conversation. they recall medications taken? recall things done with detail and specificity? Q: attention and concentration looking for psychiatrist evaluating? A: looking for they paying attention to conversation follow or distracted not listening Q: circumstances where patient feeling happy observations appear depressed? A: Yes. SPK5: Sometimes, your Honor. COURT: All right. Sustained. [Q=PROSECUTION A=TUFTS] Q: first meeting approximately 40 minutes? A: longer maybe 50 to 60 minutes Q: treatment modality and interventions? general [03:02:19] A: section referring to therapy treatment modalities not asking about medications different forms of therapy in session Q: evaluation asked patient why come what concerned about recall Lindsay 's response concerned? A: biggest concern about anxiety Q: treatment modality or interventions needed for Lindsay Clancy based initial evaluation? A: recommended medication, sertraline individual therapy. Q: medication sertraline Zoloft? A: Yes. Q: recommended Zoloft telling take medication or discussion about? A: A discussion. Q: during discussion patient Ms.Clancy 's input on medication or thoughts about medication? A: Yes. Q: recall details of conversation with her? A: recall she generally reluctant to take medications considering it interested in learning medications helpful Q: discussion explain medication side effects? A: Yes. [03:04:45] Q: questions based explanation medication side effects? A: I'm not sure. Q: why recommend that medication? A: first line medication for treating anxiety disorders first line treatment women breastfeeding safest SSRI for babies Q: first line medication? A: means recommended first Sometimes try different medications often first choice Q: based on studies experience psychiatric profession? A: Yes. Q: dosage recommended prescribed for her Zoloft? A: 25 milligrams. Q: instructions on prescription how many milligrams first week second week? A: 25 milligrams one week then increasing to 50 milligrams Q: how work when patient at Astra Mental Health seen by psychiatrist therapist someone in charge of treatment patient oversees everything or individual? A: The psychiatrist is in charge. Q: approach look at page 41 records for Exhibit 219 treatment goals section refresh memory? [03:08:08] A: Yes. Q: said Ms.Clancy reluctant starting medication why reluctant? A: Yes. Q: result concern went over potential side effects Zoloft? A: Yes. Q: after discussion explaining side effects Zoloft how two leave whether she take medication or not? A: told her recommendation start sertraline not sure if she told definitively take or not might needed time think Q: based on evaluation with Ms.Clancy her history initial diagnosis? A: Yes. Q: And what was that? A: generalized anxiety disorder adjustment disorder with depressed mood. Q: What is generalized anxiety disorder? A: anxiety disorder individual different worries physical feelings anxiety worried things not one thing Q: adjustment disorder with depressed mood? A: adjustment disorder refers symptoms secondary to situation don't meet full criteria major depressive disorder some symptoms depression [03:10:50] COURT: Members jury's 1:00 afternoon recess ready come back at 2:00 same instructions orders during break don't read about case or similar cases don't do research don't talk relax next hour bring back continue with evidence afternoon PROSECUTION: seen briefly at sidebar? COURT: All right. Attorney Sprague. [Q=PROSECUTION A=TUFTS] Q: section "Initial presentation nursing school Prozac helped treatment after second baby anxiety Zoloft one week nervous about breastfeeding initial side effects." where information from? A: My conversation with the patient. Q: Zoloft one week nervous about breastfeeding what mean? A: tried Zoloft before postpartum period after second baby Q: side effects Zoloft after second baby? A: mentioned initial side effects common didn detail normal ones transient beginning treatment Q: experience psychiatrist prescribed Zoloft common side effects medication? A: first weeks treatment serotonin in gut brain medicine affects gut first diarrhea constipation difficulties appetite nausea Q: wrote note history of present illness three months postpartum four two-old overwhelmed correct? A: Yes. Q: note denied audio hallucinations visual hallucinations A: Yes. [03:19:55] Q: suicidal ideation homicidal ideation denies no concern about hurting baby no concern about hurting baby note observation or Ms.Clancy? A: It came from our conversation. SPK9: [inaudible] objection rephrase question [Q=PROSECUTION A=TUFTS] Q: page describing treatment follow-up plan initial diagnostic assessment from September 15th part says "If urges to harm self or others, go to nearest emergency room, call 911 or National Suicide Prevention and Crisis Hotline correct? A: Yes. Q: recommended therapy medication with Ms.Clancy alternatives to medication? A: she aware alternative not take medication Q: during appointment discuss medication Zoloft prescribed? A: Yes. Q: learn from Ms.Clancy about medication? A: She decided not to take it Q: There's no objection. A: alert oriented appropriate Her rapport Dressed appropriately Euthymic not depressed not angry normal mood Her affect full Her speech appropriate Her thought content process appropriate mention hallucinations insight poor Her judgment excellent Her cognition deficits normal psychomotor activity Q: why insight poor? A: related to clinically significant anxiety psychiatrist symptoms significant medication might be prescribed despite didn't want to try medicine [03:27:08] Q: difference between psychiatrist and psychologist? A: psychiatrist is medical doctor medical school specialize in psychiatry psychologist medical school may do research learn about psychotherapy don't learn human body medications Q: psychiatrist can prescribe medication? A: Yes. Q: Can a psychologist prescribe medication? A: No. Q: medical records, Exhibit 219, Page 47 recent lab work no lab results found. ordered lab work couldn't find results none ordered? A: None were ordered. Q: why necessary for Ms Clancy to order blood work? A: no blood work commonly done when patient with generalized anxiety disorder no other medical complications. Q: What types of situations order blood work for? A: Certain medications require laboratory monitoring affect kidneys thyroid cholesterol monitor medicine prescribed safely Q: Zoloft not monitored potential effects on body? A: Correct. Q: other eight minutes? [03:30:49] A: focused on medications medication management Q: appointments with Lindsay Clancy 17 minutes therapy talk portion separate portion medication discussed A: real world two segments intertwined not end of therapy more seamless Q: Lindsay Clancy request longer appointment time? A: No. Q: based on conversations assessment plan going forward? A: she improving decided to pause medication question her meet with. Q: message from Ms.Clancy September 30th, 2022 "Hi, Dr.Tufts Thanks for help last two appointments feeling better function without medication out to employer about extending leave for postpartum anxiety/depression don't feel mentally well to return patients with baby home won't take bottle trigger anxiety stay up all night as nurse't possible. asked provider fill out form process request send form fill out?" you responded September 30th, 2022 at 2:41 PM. "This paperwork requires information best go through together in appointment." recall? A: Yes. Q: appointment October 3rd Ms.Clancy on verge of taking medication? A: Yes. Q: And what was that discussion? A: more anxiety started better feeling medication might be helpful Q: Ms.Clancy wanted to try therapy before taking medication? A: Yes. [03:38:29] Q: Page 57 Exhibit 219. initial therapy assessment by Jennifer McAllister October 3rd, 2022 first time she saw Ms. McAllister? A: Yes. Q: why your practice psychiatrist therapy prescribes medication therapist counseling? A: today psychiatry practiced as team at my office therapist patient every week focus depth on patient's wellbeing helpful to one person extra attention to therapy especially psychiatrist time discussing medications Q: teamwork approach Lindsay Clancy received in treatment at Aster Mental Health? A: Yes. Q: Page 60. review notes A: Sure. Q: next time saw Ms.Clancy October 20th, 2022? A: Yes. Q: information about she taking Zoloft prescribed? A: decided to start Zoloft. Q: previous night increased dose? A: Yes. Q: pills one week seven pills increasing dosage next night two pills [03:44:22] A: Yes. Q: increased dose now feels awful correct? A: Yes. Q: lowest dose of Zoloft prescribe patient? A: The smallest pill is 25. Q: highest dose of Zoloft? A: 200 Q: she on lowest dose of 25. correct? A: Yes. Q: in terms of another medication? A: Yes. Q: your discussion with Ms.Clancy when she having issues with Zoloft, afraid to try something new? A: discussed moving forward. to switch to different medication negative experience with Zoloft, she not want to start new medication. Q: meeting ask her if she had suicidal thoughts? A: Yes. [03:46:12] Q: hearing voices or seeing visual hallucinations? A: not sure if asked she not psychotic. Q: And why do you say that? A: described signs of psychosis on mental status exam None present. Q: her affect during meeting? A: It was depressed. Q: write she affect she depressed? A: visually appeared feeling sad. Q: her mood report to? A: depressed and anxious. Q: main change from previous visits appeared depressed and anxious? A: Yes. Q: timeline first visit appeared anxious second visit better third visit poor insight paperwork fourth visit depressed. correct? A: Yes. Q: worried about suicidal thoughts? [03:48:27] A: Yes. Q: details of conversation? A: anxious fear of suicidal thoughts if continue to feel poorly. Q: showing Page 77 Exhibit 219 sure if asked about audio or visual hallucinations directing attention to interval history refreshes memory A: Yes. Q: ask about audio visual hallucinations? A: On the 21st I did. Q: why appointment following day? A: feeling poorly after starting Zoloft following closely Q: first appointment depressed issues with Zoloft October 20th tell stop taking medication? A: Yes, I did. Q: discuss other options medication natural remedies? A: Yes. Q: why offer alternative remedies? A: reluctant to start prescribed medication thought open to natural [03:50:52] Q: weren't pushing take prescription medication A: No. Q: You've wasn't having audio or visual hallucinations A: Yes. Q: ask suicidal or homicidal ideation? A: Yes. Q: What was her affect that day? A: She was depressed. Q: anxious all day not depressed or irritable getting better? A: Yes. Q: not depressed affect appeared depressed A: Yes. Q: plan formulated October 21st A: start medication Ativan taken as needed not every day severe anxiety Q: explain Ms.Clancy when to take medication? [03:53:20] A: don't remember explained Q: psychiatrist prescribing medication Ativan telling patient take as needed what mean? A: when symptoms present severe. Q: with Ms.Clancy, symptoms made decide Ativan appropriate medication? A: Anxiety. Q: she feeling anxious take medication? A: Yes. Q: What was the dose again? A: 0.5. Q: What's lowest dose Ativan? A: 0.5. Q: What's the highest dose? A: Maybe two. Q: started her at lowest dose 0.5? A: Yes. [03:55:14] Q: see her October 26th, 2022? A: Yes. Q: Ms.Clancy 's affect? A: Depressed. Q: her mood? A: It was anxious and depressed. Q: discuss taking Ativan working? A: not helpful for sleep made feel less anxious Q: suicidal or homicidal ideation? A: Yes. Q: signs of psychosis? A: No. Q: plan after meeting Ms.Clancy 26th? A: discussed trying new medication side effects Zoloft resolved same anxiety starting medication BuSpar at five milligrams twice a day Q: lowest dose of BuSpar? [03:57:59] A: Five milligrams. Q: highest dose prescribe? A: pills 30 30 pills per day Q: prescribe more than 30 milligrams per day? A: A total dose of 60. Q: started her at lowest dose A: Yes. Q: Why did you choose BuSpar? A: BuSpar well-tolerated mild medicine for experiencing side effects from another medication Q: What does BuSpar do? A: It lowers anxiety. Q: continue taking Ativan with BuSpar? A: continue taking it needed if extreme moments of anxiety. Q: BuSpar twice a day then if anxious take Ativan? A: Yes low dose of buspirone might not enough effective [03:59:11] Q: note prescribing hydroxyzine 25 milligrams daily for anxiety A: Hydroxyzine antihistamine similar to Benadryl for sleep recommended try hydroxyzine safer medicine compared to Ativan if anxious take hydroxyzine prevents needing Ativan good wanted try option Q: gave several options to deal with anxiety each day correct A: Yes. Q: Why take hydroxyzine antihistamine instead of Benadryl? A: similar hydroxyzine indicated for anxiety Benadryl indicated for allergies Q: discussing over possible side effects interactions of medications? A: Yes. Q: general concern about medication? A: Yes. Q: next appointment with Ms.Clancy? A: November 2nd. Q: What was that discussion? A: start afraid to start new medication Q: continued with Ativan and Benadryl? [04:02:42] A: continued with Ativan Q: Ativan further discussion about Benadryl or other antihistamine hydroxyzine? A: You are not sure much conversation about Benadryl or hydroxyzine. Q: Clinical. ask her if suicidal or homicidal ideation? A: Yes. Q: see signs of psychosis her that day? A: No. Q: discuss alternatives to Ativan? A: Yes. Q: Why alternatives Ativan? A: Ativan not medication intended for her long short-term medication Q: Why is that? A: risk of dependency long especially high doses Q: bring up discussion about alternatives Ativan or Ms.Clancy ask? A: brought up [04:04:24] Q: alternatives discussed with her? A: Remeron, trazodone, pregabalin, and hydroxyzine. Q: medications appropriate for Ms.Clancy? A: safer medications help sleep anxiety. Q: discussing alternatives Ativan her mental status? change? A: No. Q: after discussion alternatives decision made on to proceed? A: Yes discussed tapering Ativan by 0.25 milligrams every two weeks Q: slowly reduce medication? A: Ativan risks of dependency risks withdrawal symptoms if medication abruptly stopped gradually decrease Q: Ms.Clancy decided on replacement for Ativan? A: 't medicine decided on Q: plan to taper off Ativan, nothing added? A: Yes. Q: see Ms.Clancy November 22nd, 2022? [04:06:57] A: Yes. Q: learn November 22nd 2022 Ms.Clancy started another program? A: Yes. Q: What program was that? A: South Shore Perinatal Mental Health Clinic Q: starting new medication? A: Yes. Q: What did she tell you she was starting? A: start Prozac. Q: what using for medication? A: Yes. Q: What was that? A: The Ativan and the Benadryl. Q: plan November 2nd to tape off Ativan November 22nd still on Ativan. correct? A: Yes. [04:08:23] Q: tapered off or reduced dose? A: don't documented dose taking still taking medicine Q: Ms.Clancy deny suicidal and homicidal ideation? A: Yes. Q: show signs of psychosis? A: No. Q: getting better? A: tried Ativan taper without Ativan difficulty sleeping tried different medications combinations trouble. Q: types of medication tried? A: Yes. Q: What were those? A: Trazodone 50 to 150 milligrams minimal effect Ativan Benadryl combination helpful added Prozac 10 milligrams with Ativan Benadryl help sleep worse sleep stopped. tried combination Remeron with Klonopin felt disoriented rebound anxiety minimal help tried Remeron and Seroquel. prescribed didn't take it Q: medications she weren't prescribed by you correct? A: Correct. Q: And what is trazodone? [04:12:20] A: category antidepressant doses low sleep medicine Q: lowest dose of trazodone? A: 50 Q: 50 to 150 milligrams Ms.Clancy taken lower end of dosage? A: commonly prescribed dose mostly used sleep medicine normal ranges. Q: Prozac SSRI? A: Yes. Q: medication Ms.Clancy taken in nursing school correct? A: Yes. Q: December 1st, 2022Prozac worsened her sleep? A: Yes. Q: What is Klonopin? A: benzodiazepine Ativan Q: prescribing Remeron antidepressant and Klonopin anxiety medication unusual combination? A: No. [04:14:10] Q: suicidal ideation? A: Yes. Q: What was her response? A: denied suicidal ideation feeling badly close to it suicidal thoughts hopeless active thoughts of hurting herself intention plans Q: discuss concern she reaching out to different people wouldn't stick with plan? A: advised one person managing medications Q: importance of sticking with plan mental health plan? A: plan psychiatrist plan for particular reasons sticking plan advisable Q: prescribed psychiatric medications take effect immediately? A: No. Q: How effect start in person? A: depends medicine Some medicines work quickly like benzodiazepines,Ativan Klonopin medicines prevent anxiety depression take long time to kick in Q: Why is that? A: medications interact with brain serotonin receptors change neurotransmitters takes time for changes Q: Why did you do that? [04:16:38] A: mentioned poor reaction to medications insomnia discussed side effects indicated bipolar disorder assessed not deemed bipolar disorder Q: What criteria didn't she meet? A: different criteria for bipolar disorder specifically mania symptoms depression important euphoria seven days of continued euphoria high energy levels important need other things pressured speech grandiosity feeling superhuman or godlike increased risk-taking behaviors significant risks like affairs using drugs negatively impact life decreased need for sleep not just insomnia not needing sleep enormous amounts energy Q: plan going forward? A: she still seeing doctors at South Shore managing medications plan appointment tomorrow considering taking Seroquel without Remeron side effects't decided on talked about starting medicine Lamotrigine gave information about medicine going to partial hospitalization program extra support for people struggling. Q: discuss option with her? A: clear she had depressive symptoms not tolerating other antidepressants thought might another option to explore Q: concern? important to have one provider prescribing medication knowing what you taking she going to South Shore Perinatal Program concern about discussing medications like Lamictal 1st seeing other providers? A: she continued see me supportive role trying to help give information helpful for her discuss with other providers Q: reach out to South Shore get records Lindsay waiver South Shore? A: No didn't she aware of medications able to communicate treatment decisions medically sophisticated didn't necessary Q: familiar with medications not typical patient A: Yes. Q: next see her December 16th, 2022 A: Yes. [04:22:53] Q: appointment December 16th 2022 what discuss? A: not feeling well rough time." found helpful for sleep,Valium quetiapine Seroquel feeling depressed no motivation suicidal ideation went to Mass General emergency room declined inpatient feeling hopeless intent or suicidal plans Q: she told you had suicidal ideation ask specifics? A: Yes. Q: mentioned went to Mass General Hospital Emergency Department because feelings correct? A: Yes. Q: Did she tell plans. taking for medication? A: taking mixture of Valium and quetiapine plan to increase quetiapine currently taking 200 milligrams Q: talk about Women and Infants Program in Rhode Island? A: Yes. Q: type program? A: partial hospitalization programs focused on postpartum good fit Q: thought depression related to Seroquel? A: Yes. Q: why thought? [04:25:51] A: coinciding of timing started Seroquel feeling more depressed Q: note records unclear if Seroquel causing depression? more depressed last visit before taking it? A: Yes. Q: explain observations? A: wasn't sure if Seroquel making her worse depressed before started Seroquel possible Q: plan forward appointment? A: plan for to go to Women and Infants Program if more suicidal thoughts go back to emergency room Q: planning to start Lamictal 25 milligrams daily? A: Yes moment depression worsening discussed Lamictal need to prescribe for her Q: prescribed 25 milligram daily dose her? A: Yes. Q: And what's the highest? A: psychiatry typically 200 can go up to 400 or 500 Q: prescribed lowest dose start correct? A: Yes. [04:28:31] Q: next time saw Ms.Clancy January 6th, 2023? A: Yes. Q: Ms.Clancy tell about current mental state between last appointment December 16th and appointment January 6th? A: depressed attributing to Seroquel taking idea to Mc Lean safely taken off Seroquel. Q: And what was that? A: Trazodone 100 milligrams,Ativan one milligram melatonin five milligrams. Q: low doses of medications? A: Yes. Q: ask suicidal ideation? A: Yes. Q: observe signs or symptoms of psychosis presentation behavior? A: No, I did not. Q: side effects from medications Trazodone Ativan melatonin? A: Yes. Q: What was her response? [04:30:28] A: only side effect Ativan wear off. night morning feel more anxious after Q: Trazodone side effects from Trazodone? A: No. Q: And why is that? A: Well, she still appeared quite depressed. Q: plan formulated day? A: Yes plan to increase Trazodone to 150 milligrams previously taken dose tolerated well come off Seroquel at Mass General Mc Lean monitoring to if depression might get better off medicine Q: she continue Ativan at one milligram per night melatonin five milligrams per night? A: Yes. Q: anything her presentation affect led believe imminent danger of harming herself? A: No feeling depressed had plan to address Q: patient withholds important information hard to make diagnosis plan? A: Yes. Q: next appointment with Ms.Clancy January 9th, 2023 A: Yes. [04:35:04] Q: discussed? A: Trazodone increase helpful still rebound anxiety day after took Ativan. mood okay feeling still flat wasn't cry laugh recent thoughts of suicidal ideation Q: signs symptoms of psychosis? A: No, I did not. Q: And what was that discussion? A: off Seroquel for couple weeks wasn't getting better suggested Seroquel might not causing depression depression needed to treat Q: suggestions for treatment depression? A: considered different options medicine considered amitriptyline Wellbutrin. Q: Wellbutrin one medications taken nursing school A: Yes. Q: discussed medications 9th decision made that day? A: different medication change rebound anxiety Ativan switch to diazepam Valium longer half-life broken down body more slowly less likely rebound anxiety diazepam easier to stop gradually Every increase dose by one or two milligrams easier to stop better alternative.she wanted to be off Ativan sleep without medicine. Q: 't asked what is rebound anxiety? A: means when medication treats anxiety gets out system anxiety comes back worse. Q: explained what is half-life of medication? body processing affects you? [04:37:53] A: complicated time for half of medicine to be broken down by body Q: Valium diazepam Valium might avoid rebound anxiety slower to leave body right? A: Yes. Q: email she asking about ketamine therapy she "I still feeling low mood no motivation depressed for months desperate for something work quickly to out of depressed state"? remember part email? A: Yes. Q: recommend ketamine therapy she broached email first time? A: considered she starting treatment resistant ketamine is treatment for resistant depression reasonable thought didn't at point yet Q: treatment resistant someone in depression typical medications aren't working? A: Yes. Q: interaction with Ms.Clancy on January 16th? A: Her mood still low depressed able to get out bed care of basics like hygiene eating Her concentration fine care of baby felt bonding forced with baby. Q: ask her if had suicidal or homicidal ideation? A: I did. Q: show signs or symptoms of psychosis day? A: No, she did not. [04:41:55] Q: why discussion? Who brought up? A: because she want to take benzodiazepine medication for sleep discussed how to come off medication safely Q: dose prescribed 10 milligrams? A: Yes. Q: Is that the lowest dose? A: Yes. Q: And what's the highest dose? A: Can get quite high. Maybe 150. Q: started at lowest dose Why medications start at lowest dose? A: standard practice medications have side effects lower dose more mild side effects gives patient time to acclimate medicine gradually increase depending on Q: plan her mood and affect day? A: depressed flat Q: denying suicidal ideation homicidal ideation showing no signs of psychosis grounds for to seek Section 12? A: No. Q: During appointment mood and affect? [04:44:43] A: depressed flat Q: conversation interaction her on 23rd? A: doing right more anxious heart racing decreased appetite on only two milligrams of Valium feeling more anxious in morning Mood flat anxious no motivation numb force herself to get out of bed house sleeping okay Q: ask her if she had suicidal or homicidal ideation on 23rd? A: Yes, I did. Q: notice symptoms or signs of psychosis that day? A: No. Q: why considering her insight poor? A: couple things throughout 14 visits suggested later her over attribution. seemed to medications about symptoms feeling felt Seroquel making her depressed reality was just depressed related to thoughts about medications Q: accurate to state instead of accepting she depressed placing blame on medication? SPK11: Objection. SPK10: Sustained. PROSECUTION: plan forward day? TUFTS: continue same dose of diazepam feeling more anxiety slow down taper increased amitriptyline to 20 milligrams help sleep PROSECUTION: reason it important? benefits? [04:49:25] TUFTS: studies show efficacy of therapy treatment for depression and anxiety Some do medicine, therapy best response is combination. SPK10: Counsel see everybody in sidebar? Doctor, step down. Thank you. SPK10: members jury break excuse you till Monday morning at 9:00. schedule similar to today full day still if not on schedule ahead of schedule have weekend reiterate instructions know questions ask on Monday.I'm instruct remind don't talk case don't do research don't take field trips drive by place questions. important don't read case or similar cases don't listen Don't watch anything.You've fair amount of evidence so far here couple weeks don't have all evidence important to keep open mind best shut mind off until Monday. long couple weeks hope have nice weekend Get rested We'll see everybody Monday. thank you for time work hope nice weekend see you Monday. SPK13: Court. All rise. ## Day 10 (944 of 2458 turns kept) [14:00] COURT: All right. Next any other serious matter or concern your service as juror in case attention? Thank you for following instructions today's schedule we number of witnesses. not sure how long it go may break early today depending on case. remember when broke on Friday witness Dr.Tufts.Commonwealth finished direct examination witness return to stand cross-examination by defendant begin recall that witness. [Q=REDDINGTON A=TUFTS] Q: Thank you. Good morning, doctor. A: Good morning. Q: Dr.Tufts you presently a psychiatrist correct? A: Correct. Q: And where was the residency? A: Boston Medical Center. Q: what do as psychiatric resident? A: lot different things rotate in aspects of psychiatry internal medicine knowledge admit patients into inpatient hospital manage emergencies Decide patients psychiatrically carry panel of outpatients. Q: board certification certification in general psychiatry. correct A: Yes, sir. Q: Yes. A: It was September 12th, 2022. Q: When started working as physician psychiatrist? A: started working as physician psychiatrist during residency training program started practicing independently at Aster Mental Health in August 2022. [06:18:00] Q: August of 2022? A: Yes. Q: what is Aster? group of doctors medical center? A: outpatient practice owned by psychiatrist psychiatrists therapists Q: in August '22 hired by Aster How many women treated in residency postpartum? A: postpartum depression postpartum period? Q: How many women in postpartum period prior to August '22? A: Many hard to exact number specific training in population Q: two-year period how many women in postpartum period treated as resident? A: hard exact number at least 50. Q: two-year period treated 50 people postpartum what is postpartum? A: four-year period not two-year period Q: saw 50 people in four-year period postpartum after having baby A: other patients Q: after residency hired by Aster began in August '22 practice as practicing psychiatrist? [09:30:00] A: Yes. Q: when got DEA license prescribe medication to citizens? A: during residency had DEA license affiliated with Boston Medical Center started at Aster had my own DEA number around August Q: August '22 start working at Aster August '22 got DEA license authorized prescribe medication correct? A: Yes. Q: saw Lindsay Clancy A: first visit September 15th Q: practicing as psychiatrist more than a month? A: practicing independently full credentials about a month training immense before that Q: August '22 up until saw Lindsay how many patients month treated for postpartum psychosis? A: patients month Q: started working August '22 for Aster now own as employee How many patients treated before saw Lindsay Clancy for postpartum psychosis? A: one month none rare disorder Q: voices people hear A: symptom of psychosis [13:12:00] Q: And that's legitimate, isn't it? A: It is a legitimate diagnosis. Absolutely. Q: Ignore People postpartum psychosis hear voices A: Many do disorder manifest differently many hear voices Q: postpartum depression? How many people month before met Lindsay treat? A: one month hard to pinpoint Maybe couple Q: specialist in postpartum. psychiatry indicated on website A: read actual document? don't remember wording Q: recall specializing in aspect psychiatry? A: Yes includes special interest women's health perinatal psychiatry trauma-related disorders anxiety other things mentioned Q: like women babies suffering from postpartum depression A: Absolutely. Q: How many women treat for postpartum depression in month and a half before met Lindsay? A: don't maybe couple treated many in residency before Q: person needs see psychiatrist generally not well fair? [16:09:00] A: Some not well can vary Q: someone psychiatrist need help A: Yes. Q: understand records, Exhibit 219 jury access to Tufts records aware exhibit? A: Yes. Q: talked to prosecution about exhibit records in evidence before jury A: If that's what you say, yes. SPRAGUE: Objection. COURT: Overruled. REDDINGTON: have attorney right under constitution doesn't mean guilty SPRAGUE: Objection. COURT: Overruled. [Q=REDDINGTON A=TUFTS] Q: if determined advertised as expert in postpartum psychiatry month experience plus residency consider negligent or misrepresentation? A: not believe been negligent Q: Are you an expert in postpartum? [20:47:00] A: may be depends on define expert Q: You see the little check mark? A: Yes. Q: What's a lot? 10, 20? A: Yeah, maybe between 10 and 20. Q: questions ask patient medications on? A: Yes. Q: Before seeing you? A: Yes. Q: And that's pretty powerful stuff. A: effective treatment for depression anxiety Q: It rewires the brain, doesn't it? A: doesn't rewire brain increases serotonin individuals with depression have low levels serotonin. Q: What was the SSRI? A: Prozac. [23:20:00] Q: how long was she on Prozac? A: I'm not sure. Q: Excuse me. A: Sorry. Q: No problem not doing Sophie Cunningham asking question answer reaction to Prozac? A: I asked her about the Prozac. Q: in nursing school took Prozac? A: That's part of it. Q: she declared consumed alcohol felt guilty recall Friday? dwelled A: Yes. That was a component. Yes. SPRAGUE: Objection. Give witness time to answer [Q=REDDINGTON A=TUFTS] Q: difficult to get out difficult Lindsay Clancy get out of bed? A: Because she was very depressed. Q: give her hug? on telemedicine couldn't give hug didn chance look at her in person A: video appointment couldn't give hug not psychiatrists typically do with patients [06:02:00] Q: Why did she come to see you? Not guessing speculating TV look at notes what brought Lindsay Clancy to office A: Postpartum anxiety. Q: Postpartum anxiety as psychiatrist young woman month tests administer to woman postpartum find type of anxiety A: screening tests important patient tells my assessment in session Q: Edinburgh test? A: scale looks at symptoms postpartum depression Q: big one only one measures postpartum depression A: It's a common one. Q: Common. A: Commonly used. Q: What is PHQ-9? A: It's a depression screening form. Q: like generalized anxiety disorder general depression nothing to do with woman postpartum depression A: I disagree. Q: agree Edinburgh scale appropriate scale pregnant or postpartum woman? [08:31:00] SPK1: Objection. COURT: Sustained as to form. REDDINGTON: Edinburgh scale [inaudible] for someone depressed postpartum 15? over that severe depression? TUFTS: Okay. SPK1: Objection. COURT: Overruled. [Q=REDDINGTON A=TUFTS] Q: Severe depression? A: not aware of this test not administered to her Q: except Prozac she nurse 23, 24 23 years old't seeing own doctor for having baby seen doctors A: didn't know which doctor she sees report other medical issues under treatment Q: What about October? A: Yes. Q: How about November? A: Yes. Q: What about December? [10:45:00] A: Yes. Q: indicates if "Call suicide prevention and crisis hotline crisis text "home" to number time."What's suicide hotline A: phone number patients in crisis call speak to trained counselor Q: psychiatrist not a counselor A: psychiatrist has training in therapy medicine SPK1: Objection. COURT: Hold on everybody. SPK1: I'm sorry, Judge. COURT: asked question. let her finish follow up with questions. Go ahead, Doc. [Q=REDDINGTON A=TUFTS] Q: anything else you want to say? A: her sessions focused on medication management aspect of therapy including items. Q: How long were they? A: 25 to 30 minutes. Q: what do you do when give therapy as psychiatrist to patient? What with A: It depends on the person. [15:31:00] Q: talked Friday patient presents with incongruent appearance they saying I'm okay don't look like okay A: her affect mood incongruent she didn't appear terribly depressed initial visit anxious appeared anxious congruent Q: she telling you I'm okay when she came. never saw her other than in nursing school surprise psychiatrist only for a week Prozac nursing school afraid of public speaking A: aware she have significant past psychiatric history Q: you first psychiatrist she meeting correct? A: Yeah. I think it was. Q: testifying for government she had past psychiatric history other than nursing school for weekly Prozac A: She report other past psychiatric history other than Prozac and Wellbutrin Q: What did she tell you? A: prior history was discussed about Prozac in nursing school. Q: encourage her September 15th? A: Sorry? Q: she was postpartum correct? A: Yes. Q: as patient postpartum opinion period postpartum postpartum depression postpartum psychosis?What's timeframe [21:26:00] A: It's typically one year. Q: diagnosed Lindsay September 15th GAD generalized anxiety disorder correct? A: generalized anxiety disorder adjustment disorder depressed mood Q: prescribed medications right A: Yes. Q: medication provided sertraline A: Yes. Q: sertraline Zoloft A: Yes. Q: chart shows prescriptions Lindsay yellow columns agree September 15th prescribed Sertraline Zoloft 30 count September 15th 25 milligrams A: Yes. Q: sertraline Zoloft chemical marketed as pharmaceutical A: Yes. Q: Zoloft not indicated for generalized anxiety? give her Zoloft? A: effective medication generalized anxiety disorder [23:35:00] Q: familiar with drug labeling Zoloft, correct? A: Generally. Q: Generally aware manufacturer Zoloft indicates used treat? A: used treat various forms anxiety disorders major depression Q: stop breastfeeding October? A: Something around then. Q: little no psychiatric history seeing you correct A: And the Prozac, yes. Q: not on psychiatric anti-tropics medications correct on medication A: Correct. Q: agree people anxiety disorder PTSD try numb feelings fair? A: Sometimes they do. Q: Okay information prescribed Zoloft her correct? A: Yes. Q: went over side effects of Zoloft sertraline with her right? [03:11:00] A: Yes. Q: known side effects suicidal thoughts actions ideation? A: specifically in children mentioned relevant Q: Suicidal ideation homicidal ideation black box warning on Zoloft, other SSRI s A: Under- Q: Doctor listen question answer yes or no? black box warning Zoloft? A: Yes. Q: warns especially young people adults may cause suicidal God homicidal ideation A: Yes. In- Q: 24. 24. possible SSRI s brain affect three or four years older FDA cutoff with suicidal ideation homicidal ideation? possible A: development in brain between ages 24 30 brain matured past age 24. less vulnerable younger individual Q: 24 suggesting cutoff drug increases risk suicide in 24-year-old patient increase risk suicide 29 or 30-year-old patient A: evidence causes in individuals over 24. Q: psychiatrist medications research on Zoloft suicidal ideation homicidal ideation? A: taught extensively about SSRI s suicidal ideation in training [06:15:00] Q: board certification on general psychiatry A: Yes. Q: subspecialties deal with postpartum women pregnant babies psychiatric symptomology A: no board certification for perinatal reproductive psychiatry Q: classes recognized Harvard Medical School annual class for postpartum been to? A: No, sir. Q: Have you attended anything? A: not done reading research guidelines about this area psychiatry Q: symptomology side effects of Zoloft side effects Zoloft "Severe trouble sleeping A: Yes. Q: No Zoloft side effect severe trouble sleeping A: didn't use word "severe" typically doesn't cause severe trouble sleeping referring to she severe trouble sleeping Q: side effects of Zoloft trouble sleeping A: Yes. Q: why prescribe Zoloft to young woman postpartum anxiety can't sleep symptoms medication side effect of trouble sleeping? [09:30:00] A: individuals varied responses to medications Some no side effects Some one or two impossible to predict Zoloft top choice first line medication for Q: lawsuits against Zoloft, right A: extensive research supporting use sertraline consensus among psychiatrists first line safe medication for including postpartum women Q: kids that shoot kids in high school from lawsuits against Zoloft? read about them? SPK1: Objection. COURT: Overruled. [Q=REDDINGTON A=TUFTS] Q: question response to psychiatrists think it safe first line drug research kids that kill kids schools with lawsuits use SSRI s? researched that? A: I don't know much about that. Q: didn't talk increased risk of suicide in 24-year-olds four five years older trouble sleeping side effect describes other drugs safe common allow no psychiatric history sleep better A: Not necessarily. Q: prescribed her with Zoloft. 25 milligrams A: Yes. Q: Zoloft 25 increased up to 0.05 milligrams or increase? A: instructions to increase to 50 after one week Q: After one week? [01:00:09] A: Yes. Q: expected she listen to instructions A: Yes. Q: prescribe Zoloft,SSRI after a week to increase she doesn't take medication for a month A: Correct. Q: she medication A: Yes. Q: Sure, of course. Absolutely. You can look at anything you want. A: September 28th. Q: September 28th discuss she afraid to take Zoloft? A: Yes. Q: easy question. talked with her recommend she increase or take Zoloft? A: visit don't think did Q: when she take Zoloft? A: She told October 20th visit taken it one week prior [01:02:28] Q: increased it instructions went off rails? A: 't used words said Q: Awful. Why feel awful? stomachache? headache? A: stomachaches diarrhea difficult time eating increased anxiety depressed feelings difficulty sleeping. Q: your advice as doctor 28th October after effect Zoloft? A: told her to stop it Stop medication. Q: Zoloft SSRI patient taking Zoloft in 0.05 spent Friday afternoon over drugs 0.05 milligrams lowest dose prescribed invariably correct? A: goes up to 200 starting dose. Q: psychiatrists agree with 0.05 A: 50 Q: What tell patients SSRI weaning off SSRI? A: Depends dose high dose slowly decrease dose opposite of titration low dose stop it. Q: didn't concerns about telling her immediately stop taking Zoloft. put her on another drug? A: Not immediately. Q: Okay 26th October she tell her condition? [01:05:26] A: she feeling back to before Zoloft not great considering new medication Q: research on medication what medication wanted? telling jury? A: didn't specify medication wanted try something else still having significant anxiety Q: agree prior to telling stop Zoloft concerns Zoloft affects anxiety sleep hope treats anxiety balancing brain chemistry increasing serotonin? A: Yes. Q: Even after the Zoloft, right? A: Yes. Q: expect young woman labor and delivery nurse know psychiatric medication what methagene? know A: I'm sorry? Q: obligation to know about psychiatric medications? A: Yes. Q: gauge Lindsay 's knowledge ability judge medication good? A: my role didn't expect her know details about different psychiatric medications Q: important know woman coming postpartum issues had prior problems prior deliveries? A: Yes. [01:10:00] Q: prior issues prior babies? A: had anxiety symptoms prior. After child second child born Q: took Zoloft?Zoloft SSRI after having Dawson? A: took about a week. Q: isn't indicative of psychiatric issues after second child? A: Yes she not describe severe. Q: As psychiatrist ask her severe or wait for them tell? A: description not sound severe Q: Tell me about bipolar. What's bipolar? A: Bipolar is mood disorder depressive mania. Q: understanding if person difficult birth psychiatric attributes not prescribe SSRI s could be bipolar? A: difficult birth contraindication to SSRI Q: after she second child took Zoloft, detail side effects don't remember side effects agree Lindsay had history of mental problems during postpartum? A: had history of anxiety postpartum Q: prescribed SSRI? [01:13:18] A: Yes. Q: not documenting side effects important to document side effects drug before prescribed Zoloft second time? She had. had side effects with Zoloft important to document second time Zoloft? A: not feel necessary to document specific side effects Q: if someone postpartum symptomology related if on Zoloft after second child had side effects don't important to document side effects right? A: depends side effects. SPK2: Objection. COURT: Overruled. Go ahead. [Q=REDDINGTON A=TUFTS] Q: prescribed Zoloft again in 2022? A: Yes. Q: diagnosed her psychiatric condition prescribed psychiatric meds right? A: I prescribed psychiatric medications, yes. Q: prescribed Zoloft told her to increase it she told having difficulties told her stop. give therapy saw her? A: Yes. Q: she came overwhelmed diagnosed mental illness prescribed psychiatric condition psychiatric meds what therapy give? on television still give therapy? A: I do. [01:17:42] Q: if one patients becomes suicidal. she tell to November '22 dwelling on suicidal thoughts? A: while before mentioned suicidal thoughts Q: Go right ahead. A: December 1st. Q: December 1st what she tell? A: denied feeling suicidal close to feeling suicidal SPK2: Objection. COURT: Overruled. [Q=REDDINGTON A=TUFTS] Q: she tells having suicidal thoughts close to it? A: denied suicidal thoughts felt getting close to it Q: document patient. patient postpartum distress close to suicide thoughts kill herself important A: important aware she having thoughts Q: What thoughts? A: fearful could become suicidal Q: she told asked how frequently these thoughts? [01:20:42] A: don't have documented how frequently question usually ask suicidal thoughts. SPK2: Objection. COURT: Sustained. REDDINGTON: Did she tell you or ask about suicidal thoughts? TUFTS: Yes. REDDINGTON: agree patients especially psychiatric patients minimize symptomology? TUFTS: Patients sometimes do. SPK2: Objection. COURT: Overruled. [Q=REDDINGTON A=TUFTS] Q: if she told having suicidal thoughts close to homicidal." You'd report? A: Not necessarily depends on context suicidal thoughts alone not reportable condition Q: know she was close to suicidal thoughts kill herself don't know how frequently A: Today don't know how frequently but that point believe did know frequently they were Q: what therapy her in November '22? A: I gave her supportive psychotherapy. [01:23:01] Q: Sorry. Listening to the patient- SPK2: Objection. COURT: Hold on. Sustained. Next question. COURT: Right. Next question. [Q=REDDINGTON A=TUFTS] Q: Judge Listening to patient when tells after treatment symptomology insomnia anxiety close to suicidal thoughts impact on you? A: Yes. Q: psychotherapy? A: provided emotional support validation Q: About 10 minutes? A: Maybe. Q: tell people Aster Medical expect if person in crisis or suicidal go to computer or cell phone punch in office A: advise to call 911 or emergency room quickly Q: suicide hotlines? give advice to call? A: That's an option as well, yes. Q: Sure. Did she call suicide hotlines? [01:25:15] A: not aware she did Q: non-specifically? ask her anything about suicide hotlines A: don't asked her about suicide hotlines Q: surprise she called suicide hotline twice turned away? front line SPK2: Objection. COURT: Overruled. [Q=REDDINGTON A=TUFTS] Q: never asked her if she called suicide hotline A: I don't think that I did. Q: next medication her on? October 26th date A: October 26th. Q: Is that when you prescribed Ativan? A: I prescribed that on the 21st. Q: Sorry? A: prescribed Ativan 21st Q: prescribe anything October 26th appointment? [01:27:29] A: Yes. Q: agree side effects of buspirone? A: Every medication has side effects, but- Q: she taking other medication? A: taking some Ativan Q: Ativan prescribe her? A: Yes. Q: prescribe Ativan? A: The 21st. Q: didn't document how much taking A: available one dose over the counter Q: re-up dose over counter? A: didn't tell me did Q: Ativan and Benadryl contraindicated serious impact to central nervous system depressant effects? A: explain depressant [01:30:17] COURT: All right. Next question. [Q=REDDINGTON A=TUFTS] Q: discuss about Benadryl combined with Ativan on October 26th? A: I don't recall. Q: October 26th worried about suicidal thoughts? A: She denied that. Q: And what does it say? A: Patient denies suicidal ideation. Q: huge difference between suicidal ideation and thoughts of suicide close to A: Not exactly. Q: what do you do? say "Do have." check box any suicidal ideation?" she says no you check box? A: No, it's not that simple. Q: ask her last time spoke close to suicidal thoughts killing. pursue 26th of October?" A: Yes. Q: October 26th she taking over the counter Benadryl, asked what prescribed you said Ativan, A: Yes. [01:32:37] Q: asked about contraindication of Ativan and Benadryl, A: You asked me about that, yes. Q: purpose of Buspar? for anxiety? A: Yes. Q: she's on Benadryl over the counter,Ativan, benzodiazepine, Buspar SSRI, prescribe hydroxyzine same day A: 't all taken same time Q: she taking medications as required A: That's what I was told. Q: tell her keep diary of medications side effects? A: didn't instruct her Q: recommend if on all meds having effect write it down." When time date? A: didn't tell her to do that Q: agree prior to next appointment November 2nd she significantly worse after medication make note she had depression crying more anxiety insomnia increased brain fog worrying about suicide? A: couple weeks after starting medicines don't recall symptoms significantly exacerbated. Q: how often she dwelling on suicide? [01:36:17] A: At what point? Q: she told had anxiety insomnia brain fog crying inconsolably? SPK3: Objection. date. [Q=REDDINGTON A=TUFTS] Q: she addition to anxiety crying stress worrying about suicide talked brain fog asked her what does that mean? Subjectively? A: Subjectively means patient's opinion experience Q: symptoms? patient brain fog potential side effect of medications? A: It depends. Q: On what? A: sometimes could be unrelated symptom of depression hard to tell attributed Q: into November answer prescribe more medication three more drugs prescribed Ativan increased Ativan. What was her load for Ativan? A: Sorry? Q: milligrams or nanograms on Ativan script provided? SPK3: Objection. date. TUFTS: Which date referring to for Ativan? [Q=REDDINGTON A=TUFTS] Q: She already objected. [01:38:45] A: Oh. Q: When increase her Ativan to what level? A: she prescribed Ativan 0.5 milligrams. Q: hesitant to use medications BuSpar hydroxyzine A: hesitant to try BuSpar Q: scared of drugs A: afraid to take medication Q: Not usually? ask her about thoughts of suicide or close suicide? A: Yes. Q: she indicate thoughts of suicide? A: Not at that date. Q: use words or box checked off? A: don't remember exact words talked about suicide or thoughts hurting yourself Q: distinction between suicidal ideation and "Worrying about, thinking about suicide." agree? A: Yes. [01:41:36] Q: what she mean told doctor "Worrying about thinking suicide"? A: You mean in the prior appointment? Q: talking about woman worried about thinking suicide A: 2nd didn't say that Q: next time told worried about suicidal ideation? A: That was the December 1st visit. Q: back November 2nd visit agree after talked brought up four medications safer "Safer alternatives." agree? A: see word alternatives not safer alternatives Q: not feel appropriate medication take? A: reasonable option didn't decide to start it Q: Yeah, but so were you, right? A: Not exclusively. I'm a general psychiatrist. Q: Paul? A: Yes. Q: she advise script using Ativan and Benadryl, told her to tape off Ativan at appointment tapered off Ativan? [01:45:17] A: told her gave prescribed taper prior to appointment Q: What mean gave? A: told her she reduce dose by 0.25 milligrams every two weeks until medication stopped Q: Trying to give the jury facts. A: She taking Ativan. didn't completely stop Q: Had she tapered? A: not sure how much reduced dose wasn't prescribing again Q: why she went to ER? A: Because of depression. Q: Go ahead. A: Sorry. Q: put on medication? A: Not from the ER. Q: records from South Shore Perinatal Clinic indicate suicidal ideation worrying suicide close to suicide? A: didn't have access to records [01:47:24] Q: Why not? A: Because we're a completely separate clinic. Q: Seriously? SPK3: Objection. REDDINGTON: She mental disease seeing you on cocktail of drugs accurate historian? TUFTS: felt accurate recall names medicines doses specific days provided detailed information showed capable CLERK: returned to trial of Commonwealth v.Lindsay Clancy All parties present including defendant 18 jurors [Q=REDDINGTON A=TUFTS] Q: Sure. October 20th. Sorry. A: Okay. Q: interview history decided to start Zoloft. a week ago A: patient started Q: increased dose last night A: Yes. Q: what she telling on computer screen? about increasing dose Zoloft? A: felt awful couldn't sleep Had insomnia worse increased dose didn't want to eat having diarrhea Food unappealing more depressed crying all day yesterday not normal mental fog terrified to start something new [01:52:41] Q: anxiety level? A: Anxiety bad before med Now hard to differentiate Overnight racing thoughts paranoid of suicidal thoughts bad happening Doesn't want to be alone Q: gave her therapy? A: gave therapy discussing symptoms assessing managing medication Q: suicidal ideation? thinking of cutting throat? throwing herself off building running cab? A: No. Q: With what? A: feeling suicidal?" feeling hopeless." asked intention of hurting yourself plan for hurting yourself?" denied Q: therapy about suicidal ideation wanted to kill herself? A: explored meant do feeling Q: conclusion of meeting December 16th she increased suicidal ideation feeling hopeless moved on went home A: assessed in emergency room not admitted assessed day again struggling not require hospitalization planning on going to [inaudible] program supported that. Q: he husband of woman had baby postpartum with symptoms drugs prescribing she dealing with trying help never talked to her husband about he observed didn't call you A: on visit Q: December 16th objective findings note her mood depressed [02:42:09] A: Yes. Q: what mean? she say depressed or give symptoms? checked box A: means she's depressed Q: you doctor checked box. What did patient tell about symptoms depressed? she crying get out of bed worshiping at force of God? life? A: tough time. Q: depressed check off twice One under mood one under affect A: Yes. Q: Template. A: note psychiatrists country use Q: can't diagnose illness by template A: No. Q: young woman mentally ill sick deteriorating. What date did you do? What tell her television computer? A: told her to go to partial hospitalization program if suicidal thoughts or risk of hurting herself go immediately to emergency room. Q: How long did that meeting take? A: Probably about 30 minutes. [02:45:58] Q: same thing wrote out? A: Yeah. Q: She's got an objection, Judge. PROSECUTION: Objection. COURT: Overruled. REDDINGTON: Go ahead. REDDINGTON: Anything else? PROSECUTION: Objection. COURT: Overruled. Overruled. [Q=REDDINGTON A=TUFTS] Q: hit you might remember? people worry about suicide thinking he turning her into zombie." possible A: It's very possible. Q: Next meeting After December 16th A: Yes. Q: next meeting January 6th A: Yes. [02:50:19] Q: What was the diagnosis at McLean? A: diagnosed her with major depression Q: Did they recommend any medication? A: took her off Seroquel Q: And why was she in McLean? A: Because she was depressed. Q: Is that Mass General Hospital? A: Yes. Q: And she was currently on Trazodone? A: Yes. Q: lying? reading medical records Sleep taking Ativan Trazodone Slept five hours broken increasing Trazodone switching to Valium. A: trouble sleeping sleeping Q: Trazodone increased? A: Yes. Q: prescribe medication? [02:55:00] A: Yes. Q: January 12th three days after January 9th meeting prescribe additional medication? A: not sure record from January 12th Q: recall January 12th prescribed Trazodone 150 milligrams 30 count A: Yes. Q: What does a tricyclic antidepressant mean? A: older antidepressant tricyclic three tricycle older efficacious medicine for depression anxiety insomnia Q: concerned about woman postpartum year from CDC symptoms? A: concerned she depressed Q: Diazepam taper January 16th five milligrams two nights Slept four hours light sleep two hour stretches concerns about side effects from medications? A: Not at that point. Q: Okay says "Patient denies SIHI suicidal homicidal ideation correct? A: Yes. Q: Denies questions concerns recommend low dose amitriptyline for depression correct? A: Yes. [02:58:38] Q: she on computer looking up medication treatments ketamine treatments A: No. Q: answer no. January 23rd Friday testified mood depressed affect depressed flat A: Yes. Q: she sitting front computer getting help from doctor January 23rd do A: thought help with medicines tried current symptoms slowly titrate amitriptyline dose reduced depression feel better COURT: Dr. Lee. Stand. Counsel discuss before break? COURT: Thank you Madam Clerk.Commonwealth redirect [Q=PROSECUTION A=TUFTS] Q: responsible for evaluation diagnosis treatment of patients? A: questions help Q: how many patients treat during four years? A: Thousands. Q: all psychiatric patients correct? A: Yes. Q: 50 patients postpartum depression issues correct? [03:05:01] A: Yes. Q: specialized training describe A: specialized elective with perinatal psychiatrist worked in obstetrics clinic saw patients pregnant postpartum Q: a year evaluating diagnosing treating women with postpartum issues A: Yes. Q: one year out of four designated to postpartum issues? A: Yes't every day continuing same patients for about a year. Q: asked about postpartum psychosis said rare. How rare? A: not sure of statistic, but low. Q: Low dealt with patients in four years residency other types of psychosis? A: Yes, many. Q: psychosis from postpartum or other mental illness present same or matter underlying illness? A: can present different based individual same general disorder Q: symptoms signs for to determine psychosis? A: assess appearance disheveled? cooperative engaging in interview answering questions or refusing answer aggressive? speech speaking fast loud or not speaking much thoughts assess thoughts by saying makes sense or jumping assess thoughts for content speaking bizarre paranoid talking making noises communicating with not in room behaviors assess for [03:07:52] Q: never treated with postpartum psychosis evaluated, diagnosed treated people with other types of psychosis correct? A: Yes. Q: see signs of psychosis in interactions with Lindsay Clancy? A: No. Q: all four years providing outpatient care to psychiatric patients? A: For three of the four. Q: Three of four asked about telehealth telehealth appointments in psychiatric care standard industry? A: Yes. Q: Most session psychiatric session talking to someone A: Yes. Q: PHQ-9 look for? A: It assesses various symptoms of depression. Q: postpartum depression questions PHQ-9 signs symptoms postpartum depression? A: Not specifically postpartum depression symptoms during postpartum same symptoms Q: PHQ-9 asking patient questions reveal depressed not had baby [03:10:29] A: Correct. Q: interaction patient know postpartum phase? A: Yes. Q: fair to take PHQ-9 information learned patient put together diagnosis? A: Yes. Q: Listening more important in therapy for psychiatrist to talk or listen? A: Listen. Q: asked about Zoloft used for general anxiety disorder common drug? A: Yes. Q: asked suicide warning for all ages? A: No. Q: What ages or groups is that suicide warning for? A: children and adolescents up to 24 years Q: didn't titrate 50 milligrams of Zoloft? A: You mean to stop it? [03:15:58] Q: Yes. A: low dose be stopped away Q: defendant waited month after prescription before taking medication correct? A: Yes. Q: took medication when ready A: Yes. Q: The past psychiatric history. A: Okay. Q: What she tell Clancy list reason dates A: said anxiety September 2013 to September 2014, postpartum anxiety May 2020. Q: past current psychiatric medications which ones list? A: Prozac 50 milligrams Wellbutrin 100 milligrams Q: defendant's answer Prozac effective? A: Yes. Q: check side effects Prozac? [03:18:39] A: No. Q: October 20th, 2022 appointment asked documenting side effects in notes document side effects defendant reported Zoloft October 20th 2022? A: Yes. Q: notes A: "Couldn't sleep Insomnia Worse increased dose Doesn't want eat Diarrhea Food unappealing depressed Crying Mental fog Terrified to start new." Q: documented "Paranoid of suicidal thoughts." defendant's phrasing? A: Yes. Q: difference between worried suicidal thoughts suicidal thoughts? A: Yes. Q: difference psychiatrist A: patient psychiatrist suicidal thoughts not actual suicidal fears of suicidal thoughts difference Q: What's difference in training experience between fears of suicidal thoughts suicidal thoughts? A: if fear means not having suicidal thoughts negative. Q: according to defendant she not having suicidal thoughts A: Yes. [03:23:20] Q: based on training experience with Ms.Clancy worried about suicidal thoughts mom stay with her positive decision? A: Yes. Q: asked about not asking defendant if called suicide hotline If patient denies suicidal ideation ask if called suicide hotline? A: No. Q: And why not? A: wouldn't think If patient suicide hotline having suicidal thoughts Q: asked about prescribing hydroxyzine,Ativan BuSpar tell defendant how to take medications? A: Yes. Q: What were your instructions? A: Ativan for severe anxiety BuSpar everyday medicine hydroxyzine alternative to Ativan Ativan if hydroxyzine working Ativan use stronger Q: instruction for to take all three at same time? A: No. Q: asked about contraindications of Ativan and Benadryl. recall A: Yes. Q: two together Ativan Benadryl Why prescribe hydroxyzine? [03:25:56] A: taking Benadryl, not prescription medication psychiatry similar to hydroxyzine thought hydroxyzine better alternative than Benadryl Q: Okay direct to November 2nd, 2022 interval history fair November 2nd defendant reported fine all day Evenings bedtime anxious.Ativan helps Sleeping great Afraid to try something else knows not long-term solution correct? A: Yes. Q: part defendant tell not long-term solution? A: Taking the Ativan. Q: What was the plan? A: reduce dose by 0.25 milligrams every two weeks until off it. Q: defendant concern about medication conversation addressed came up plan right? A: Yes. Q: defendant went to South Shore Hospital Emergency Department November 16th, 2022? A: I don't recall that. Q: prescribed Trazodone? A: I don't recall that. Q: December 1st, 2022 Defense asked about date she said fear of thoughts of suicide correct? A: Yes. [03:28:30] Q: consistently denied suicidal ideation or intent plan? A: Yes. Q: What's difference. A: Not usually. Not in that way. Q: difference between thoughts of suicide versus intent plan? A: Yes. Q: if Ms.Clancy thoughts of hurting herself. plan to hurt herself or children would moved to commit her? A: Yes. Q: Section 12? A: Yes. Q: asked about October 31st therapy session with Jennifer McAllister present defendant denied suicidal ideation and homicidal ideation correct? A: Yeah, that's what's documented. Q: reason based on training experience to further suicidal intent assessment? A: No. Q: Why not? [03:30:30] A: if denying suicidal ideation deny every other detail about suicide Q: further evaluation specific questions about planning for suicide how? A: Yes. Q: types of questions ask patient to determine if experienced episode of mania? A: see in session might ask about symptoms decreased need for sleep racing thoughts increased risk-taking activities see it for to diagnose Q: opposite A: opposite of euphoria is dysphoria depression opposite hyperactivity is tiredness fatigue opposite of mania observed Q: asked about discussing Seroquel with defendant't prescriber Why discuss medication? A: patient asking husband asking me wanted my opinions prompting conversation Q: tell them it A: shared good evidence for treating depression Seroquel does different things at different doses Sometimes called antipsychotic doesn't function as antipsychotic until high doses 800 milligrams low doses more sleep medicine or antidepressant explained important part concerned about causing depression talked hard to tell whether medicine causing or because of depression Q: tell them? A: based on timing notice significant decline after starting increasing medication Q: Prior to Ms.Clancy taking Seroquel noticed signs of depression? A: Yes. [03:34:39] Q: after off Seroquel January signs depression? A: Yes. Q: completely off Seroquel before after still showing signs of depression A: Yes. Q: aware gone to Museum of Science January 8th spent hours interacting with exhibits children A: No. Q: asked about thyroid mental health postpartum South Shore Hospital Brigham and Women's Hospital thyroid limits normal range? A: No, I was not. Q: received discharge summary from Mc Lean Hospital A: Yes. Q: What's contained in the discharge summary? A: includes information patient presented hospital initial assessment from psychiatrist course treatment course progressed changes patient day of discharge Q: medications prescribed diagnosis A: Yes. Q: asked about January 23rd, 2023 session with defendant Defense counsel recommended hospital evaluation said no Why not [03:38:01] A: denying suicidal ideation or homicidal ideation no signs of psychosis or mania no serious signs safety safety at risk Q: Showing bottle Exhibit 155 amitriptyline agree shows prescription filled same day January 16th, 2023? A: Yes. Q: eight pills missing she never took additional dose correct? A: think based said Q: Objection. Sustained. PROSECUTION: Objection. Didn't ask about these records. PROSECUTION: beyond scope Overruled answer question REDDINGTON: offer woman infants hospital records Rhode Island dealing Lindsay Clancy PROSECUTION: No objection. [Q=REDDINGTON A=TUFTS] Q: approach Exhibit 220 second paragraph middle of November read first sentence A: middle of November tried marijuana edible sleep caused increased anxiety palpitations Q: difference between thought of suicide versus plan suicide commit commitment A: Yes. Q: Thought versus plan equals commit [03:45:57] A: suicidal plan means know end life researched presents immediate threat require hospitalization Q: never detected Lindsay pressured speech A: Correct. Q: I'm sorry? A: Correct. PROSECUTION: Objection. His writing on this. SPK9: look at get actual exhibit REDDINGTON: read paragraph TUFTS: No sleep last night Falls asleep after 40 minutes Heart racing severe anxiety Worrying about kids baby sleep not drowsy Not hyper pressured speech REDDINGTON: medical record heart racing severe anxiety worried about kids baby sleep not drowsy Not hyper pressured speech TUFTS: She did not have pressured speech. REDDINGTON: Nothing further. Thank you. REDDINGTON: No objection. That's by agreement. SPK10: Exhibit 221. SPK9: Yes. Please, counsel. [03:52:14] SPK11: afternoon Raise right hand for clerk SPK9: Counsel, step please. SPK9: All right. Good afternoon. SPK9: All right. Yes, Attorney Buckingham, please. [Q=BUCKINGHAM A=PAUL] Q: Thank you. Good afternoon. A: Good afternoon. Q: tell jury first last name A: Julie Paul. Q: what do work? A: psychiatric mental health nurse practitioner board certified Q: educational background A: graduated 1991 St. Anson College nursing degree Worked labor delivery nurse 17 years graduated 2006 Frontier Nursing University midwifery degree 2018 graduated Frontier Nursing University psychiatric nurse practitioner degree perinatal mental health certification Postpartum Support International 2018. Q: licensed in Massachusetts psychiatric nurse practitioner? A: Yes, I am. Q: required Massachusetts? [03:54:02] A: attended certified program two years additional training certification exam ANCC Q: work history background A: New Hampshire worked labor delivery nurse Massachusetts 2006 certified nurse midwife 2018 started Perinatal Behavioral Health Program South Shore Hospital psychiatric nurse practitioner Q: Perinatal Behavioral Health Clinic A: lack of resources South Shore for pregnant postpartum people mood disorders compelled clients struggled with mental health issues wanted additional education prescribe got Psych worked with South Shore Hospital establish program Q: worked with South Shore Hospital A: Correct. Q: clinic tied to South Shore Hospital South Shore Health System A: Yes, it is. Q: And what's the Bridge Clinic? A: Bridge Clinic works with substance use disorders Q: prescribers psychiatric nurse practitioner what offering to patients? A: proper medication for anxiety depression mood disorders any psychiatric disorder for pregnant postpartum people up to two years postpartum offered therapy on sleep hygiene whole person not just medication management Q: medication one piece therapy another piece part of team approach at clinic A: That's correct. [03:58:23] Q: psychiatric nurse practitioner prescriber also engaged in therapy psychotherapy? A: supportive therapy not therapist responsible for assessing diagnosing prescribing understand importance of sleep nutrition exercise Q: history of working as midwife nurse in labor and delivery experience with moms postpartum period? A: Yes. Q: experiences diagnosing prescribing for women period? A: labor delivery midwife diagnosed labor depression anxiety psychiatric conditions nurse practitioner Q: medication important role dealing with particular patient clinic? A: Yes, it does play a role. Q: how determine appropriate medication track for patient? A: do screening complete interview with client based on responses work team to develop best medication options treatment for client Q: training experience with postpartum women acceptable period to determine postpartum? A: Anywhere within the first year. Q: purpose of calling Lindsay Clancy? A: wanted to get her side of history Sue struggling in postpartum period wanted to know struggling good candidate for program Q: identify she in postpartum period? [04:03:56] A: asked birth of Callan said May 26th, 2022 Q: after determining postpartum baby home ask questions learn information about experience earlier postpartum after birth? A: did She well first 12 weeks excited happy Patrick back to work struggle with anxiety Q: knew Patrick her husband Patrick Clancy? A: Correct. Q: learn engaged with other treatment prior to contacting conversation? A: met with psychiatrist didn name been in emergency room few days prior Q: November 16th 2022? A: Correct. Q: addition to seeing psychiatrist identify medications taking? A: did trialed Zoloft for one week trialing Ativan and Benadryl, worked best help sleep questions about BuSpar Didn prescribed or not questions BuSpar Q: mention about combination of Ativan and Benadryl in treatment history concern? A: taking it for two weeks worked well concerned about dependence self-weaned herself off Q: aware prescribed Trazodone after? A: Yes After emergency room prescribed Trazodone. [04:06:18] Q: indicate Trazodone relief to sleep issues? A: able to fall asleep difficulty staying asleep Q: not on long-term medications? A: Yes, she did. Q: immediate need for sleep? address phone call? A: encouraged her to take medication on hand if Benadryl Ativan working take help sleep talked next morning about different options Q: initial phone call conversation about options risks of SSRI s or continued use of benzodiazepines? A: viewed on SSRI most time preferable than benzodiazepines long periods address concern about addiction dependency medication Q: result of conversation determine she suicidal ideations? A: Yes asked her if wanted to harm herself or children she said no. Q: ask experienced auditory hallucinations? A: I did. Q: visual hallucinations? ask? A: I did. Q: delusions ask delusions? [04:09:00] A: didn't ask specifically about delusions Q: talking with individual keep in mind ideas of delusion? A: Yes, I do. Q: conversation November 20th identify she experiencing delusions? A: No, I did not. Q: seen in experience with new moms clinic postpartum? A: It's very typical. Q: person gives history of background prior births experiences with mental health professionals psychiatric history follows patient subsequent visits? A: Yes. Q: through each instance person thoughts of suicide or harming themselves or others? A: every visit standard questions ask suicidal homicide ideation or auditory or visual hallucinations Q: reported she on Zoloft stopped insomnia overwhelmed mind racing talk about intrusive thoughts? A: I did. Q: reiterating around 12 weeks Patrick back to work increased anxiety? A: Correct. [04:15:06] Q: manage second pregnancy without medication? A: told yes. Q: November 21st intake date ask about drug use? A: Correct. Q: learned prior psychiatric medications on? A: Yes on Zoloft Ativan prescribed BuSpar didn't indicate taken Q: report of recent course treatment talk anxiety course treatment anxiety issues A: Oh, yes. Q: ... further back in her history? A: Yes In college trialed Prozac propranolol Wellbutrin Q: indicated did well on medications in nursing school? A: Correct only side effect sexual side effects Q: Yes, sorry. A: thought 22nd planned to go back to work October delayed pushed forward to November anxiety Q: screenings during visits postpartum period specific screenings? [04:17:41] A: Yes Edinburgh Postnatal Depression Scale GAD Generalized Anxiety Depression Scale Mood Disorders Questionnaire Scale Columbian Suicidal Scale Five Ps for substance use disorders pregnancy postpartum Q: each screens this patient? A: significantly high in GAD-7 generalized anxiety scored 21 out of 21, screening not diagnostic experiencing extreme anxiety Edinburgh Postnatal Depression Scale scored 23 out of 30.one look for most scale number 10 she negative suicidality. Q: Okay why look at that one? consider most? A: shows significant depression thoughts of harming themselves Q: Edinburgh scale could fluctuate with postpartum mom depending on situation? A: Yes. Q: plan with Ms.Clancy? A: So, we had discussed starting Prozac. Q: Okay. Why Prozac? Why start there? A: she history successful past good indicator instead multiple medications start with ones that work gave 10 milligrams first four days no adverse reactions increase to 20 milligrams if tolerated well Q: medications she already on Ativan Benadryl Trazodone? plan for those? A: encouraged her to take Ativan.Prozac activating anxiety worse pair with Ativan beginning help comfortable with anxiety didn't interfere with sleep Q: Prozac what class of medication? A: SSRI selective serotonin reuptake inhibitors [04:20:10] Q: commonly prescribed to treat depression? A: Yes. It's a first line treatment. Q: You said first line treatment? A: Correct. Q: pairing medication SSRI with another medication common practice with psychiatric medications? A: Yes. Q: for medication to get system stabilize? A: Generally side effects first week or two therapeutic level about four to six weeks Q: People start feel better then right? A: Correct. Q: advising she continued Ativan concerns about continuing benzodiazepine, indicate plan to taper or reduce? A: Yes. Once activating symptoms went away look at reducing moving away from Ativan towards BuSpar. Q: talking plan risks benefits plan she understand engage conversation? A: Yes. She verbally understood instructions. Q: plan moving forward was medication only recommendation or other recommendations? [04:22:10] A: No. set her up with talk therapy Latiesha Dukes Q: result of her contacting message conversation November 23rd? A: communicated 22nd sent message she nervous about starting Prozac encouraged her to start Prozac. communicated 23rd by phone or MyChart message indicated she taken medication started 22nd Q: aware she already patient in South Shore Health System Network with primary care physician Margaret Anastasia? A: Yes. Q: concerns she about starting Prozac know she start Prozac? A: She started Prozac 22nd November Q: November 25th prescribe additional medications? A: did she wasn't tolerating Prozac conversation about stopping Prozac. hard time sleeping gave one-time dose Ambien prescribed mirtazapine another antidepressant works good for sedation anxiety started at 7.5 milligrams told stop Prozac. paired with Klonopin told not to take Ativan just take Klonopin to help. longer acting benzodiazepine help sleep longer acting anxiety support while new medication up running Q: conversations about concerns Prozac reported feeling disconnected spacey A: Yes, that's correct. Q: recommendation to discontinue Prozac? A: Correct. Q: Prozac she hadn't taken long A: She took it for three days. [04:30:01] Q: Three days? A: Correct. Q: conversation about waiting four to six weeks concerns about stopping Prozac after three days? A: client doesn't have buy-in to medication awful doesn't work well working with Lindsay to find medication make her feel more comfortable feeling uncomfortable anxious Prozac wasn't tolerating activation Prozac mirtazapine more calming thought resonate better Q: MyChart message stop Prozac,Benadryl Ativan don't take while taking Klonopin? A: Correct. Q: your practice as psychiatric nurse practitioner medication common to trial different medications to find right for patient? A: Yes common practice in psychiatry Q: no way to anticipate particular patient to medication treatment A: Correct. Q: after prescribing Klonopin mirtazapine single dose of Ambien follow up after changing prescriptions? A: told her to keep. MyChart message weekend holiday weekend available to answer questions Q: common to in prescribing adjust dosage? A: Yes. Q: on 28th no back and forth about taking medicine effects feeling [04:35:45] A: had panic attack communications work recommended take 0.5 of Ativan go for run consider partial hospitalization program at Women &Infants. Q: recommend run? A: get rid of adrenaline from anxiety running good calm her down Q: message at 6:05 AM she reported took 15 Remeron and CBD worked slightly A: Correct. Q: get from mirtazapine with Klonopin or other- A: Klonopin needed medication honored her choice to decide take or not Q: she tried breathing meditation muscle relaxation ended take Ativan? A: Correct. Q: conversation with her MyChart messages about Ativan continue to take? A: understood she wouldn't take it until conversation understanding wouldn't taking it while taking Klonopin. Q: further contact with Sue Clancy about Lindsay Clancy care after first contact November 20th, 2022? A: I don't recall that. COURT: members of jury couple minutes break Commonwealth finished direct start with cross-examination of witness start tomorrow break till tomorrow Remember instructions Don't talk about case Don't read similar cases Don't Don't take field trips Don't do research instructions ask questions We'll come start. be ready at 9:00 issue talk to counsel might cause delay keep minimized We'll get you in here tomorrow Thank you for work nice evening We'll see you tomorrow. ## Day 11 (652 of 1919 turns kept) [04:00] CLERK: morning Your Honor. proceed? CLERK: before court today matter of Commonwealth versus Lindsay Clancy. Ms.Clancy present represented by Attorney Kevin Reddington Commonwealth represented by Assistant District Attorney Jennifer Sprague Assistant District Attorney Shanan Buckingham REDDINGTON: motion speaks woman Her Emily Thorndike LICSW Massachusetts owns independent operator clinical social work Wise Mind Therapy resume graduated Dover-Sherborn High School Bachelor of Arts in Sociology from Hartwick College master's degree from BC 2019 licensed in Massachusetts at Mc Lean Hospital short term unit doctor testifying Lindsay five days January '22 into '23 worked five years mental health specialist May 2014 to May 2019. clinical social worker manager from 2019, 2021 seven years seven months experience full-time employee one year supervisor left from motion concerned lawsuits fired difficulties claims for harassment hostile workplace? nothing friends still employees work at Mc Lean. know woman never met her Her involvement in case after Mc Lean five-star institution doctors psychiatrists psychotherapists counselors interview Ms.Clancy refusing care treatment not case Patrick testified observationscourt aware Patrick's testimony landed on no staff available other than kids behind plexiglass on cell phones. She colored took walks no therapy. didn't speak to therapists or counselors. jury left with image Mc Lean five-star hospital affiliated "with Harvard far from truth in my opinion doesn't matter opinion cross-examine woman posted video on TikTok received email from active community TikTok check video week ago saw her video not stand for lies misrepresentations from witness stand about Mc Lean Hospital." said to private investigator Bob Jones can't find woman had pseudonym name He wrote called left messages She never got back for three days. He went to her house sat in her driveway She home work interacted waved didn't want to scare she said thought." wife written her letter nurse trying to reach out no response She tells Bob thought you guys were all AI didn't know real though it was spam." He gave me her number. I spoke to her She told me what I put in affidavit motion.she available ready testify employee's observations over seven years including supervisor woeful environment Mc Lean Hospital offers especially New Year's enjoy New Year's New Year's day after weekend Monday nobody there important rebut inference created examination DA COURT: Yeah. REDDINGTON: Thank you, Judge. COURT: Yeah. Commonwealth? COURT: question about standard staffing programs available holiday weekend Commonwealth 's witness said "I don't know that." maybe parties could agreement about establishing somebody still working there says weekend after wasn't holiday X people there X programs available. holiday weekend do or don't." battle on motion understand Commonwealth 's objections people watched trial say disagree testify troubling talking about facts If other witness not worked there not sure we'd hearing BUCKINGHAM: don't know she said wasn't aware of difference't aware who was there weekend wasn't working slight distinction witness was available Counsel could have crossed her subject objection addressed witness on stand witness under summons if counsel recall her can avenues could pursue line of rebuttal short of calling witness proposed point Commonwealth express COURT: Come on. Yeah. SPK1: All All rise. Jurors entering All persons do before Honorable William Sullivan, Justice of Superior Court sitting Plymouth Commonwealth Draw near give attendance be heard. God saved Commonwealth of Massachusetts. court in session. be seated. CLERK: morning, Your Honor. proceed? CLERK: before court today continuation of jury trial Commonwealth versus Lindsay Clancy. Ms.Clancy present represented by attorney Kevin Reddington.Commonwealth represented by Assistant District Attorney Jennifer Sprague and Assistant District Attorney Shanan Buckingham. JURY: Good morning, Your Honor. COURT: Thanks for patience late to start appreciate waiting go through questions talk about schedule back into trial first question has any member of jury read seen heard overheard anything about aspect case affect ability fair impartial juror? Second question any other serious matter or concern service as juror bring attention? thank you for following instructions today's schedule aspect similar to yesterday return to case We'll break around 11:00 break from 1:00 to 2:00 go into afternoon depending on case testimony end of day bring counsel We'll talk about timeline of case scheduled for week going forward give this afternoon before send home return. witness. Ms. Paul on stand Commonwealth finished direct examination about to begin cross-examination of witness ask witness retake stand SPK1: Good morning, ma'am. [04:09:00] COURT: All right. Good morning. REDDINGTON: Thank you, Judge. Morning, Nurse Paul. PAUL: Good morning. REDDINGTON: Excellent. good. dedicated person to field helping pregnant women after birth during postpartum period right? PAUL: Correct. COURT: Objection? BUCKINGHAM: No objection. BUCKINGHAM: Commonwealth call Rebecca Jollotta next witness JOLOTTA: Okay. Thank you, Your Honor. COURT: All right. Yes. Attorney Buckingham, please. [Q=BUCKINGHAM A=JOLOTTA] Q: Thank you. Good morning. A: Good morning. Q: tell jurors your first last name? A: Rebecca Jolotta. Q: what do do for work? [08:22:00] A: I'm a psychiatric nurse practitioner. Q: training education become psychiatric nurse practitioner? A: bachelor's degree University of Connecticut Allied Health Sciences master's in counseling psychology 2013 William James College Newton worked mental health field as clinician various positions back to school RN in Massachusetts since 2017. MSN 2019 became licensed credentialed psychiatric nurse practitioner Q: And where do you currently work? A: South Shore Health. Q: how long worked for South Shore Health? A: Since 2021. Q: how work South Shore Health? role started? A: working general practice psychiatric nurse practitioner interested in women's mental health training become specialized job opportunity available applied Q: training specialized women's health? A: postpartum support international certifying body perinatal mental health did two-day. training plus third day psychopharmacology track took examination passed Q: certified by Postpartum Support International? A: I am. Q: clinic patient base service? A: specialize in working with women pregnant and postpartum up to two years after birth offer medication management clinician on staff counseling few nurses work in program work with moms for psychiatric disorders including addiction [12:13:00] Q: psychiatric disorders in women postpartum A: Postpartum depression anxiety postpartum psychosis bipolar disorder panic disorder obsessive compulsive disorder Q: postpartum psychosis experience treating women? A: I have, yes. Q: postpartum depression anxiety A: Hundreds. Q: medication management A: Yes. Q: part of psychiatric nurse practitioner A: It is. Q: working with social workers A: provide short-term counseling specialize in up to two years postpartum Q: postpartum period year after birth A: Correct. Q: clinic support for women up to two years? [15:14:00] A: acknowledge highest risk period first three months postpartum Some women struggle later first year symptoms emerge 9, 10 months in cover treat get them stable Q: time to get stable? A: Absolutely. Q: 2022 Julie leaving how many psychiatric nurse practitioners at clinic? A: Three. Q: That includes Julie? A: Yes. Q: Who was the other nurse practitioner? A: Andrea Warden. Q: prior to Julie leaving right A: Correct. Q: nuts and bolts start to finish or rely on previous information disclosed? A: relied on previous information where she grew up school past clinical history medication trials add my own clinical assessment Q: aware history previously on medications from another provider? A: Correct. Yes. [20:30:00] Q: started with Zoloft and Ativan Benadryl? A: Yes. Q: visited South Shore Hospital emergency room A: I believe it was November 16th. Q: went to ER November 16th prescribed her Trazodone? A: I am. Q: Her first contact with clinic November 20th A: Correct. Q: Julie originally prescribed Prozac changed medication plan? A: Yes, I was aware. JOLOTTA: taking mirtazapine, Remeron for four nights started November 25th her November 29th't appreciating difference from mood, anxiety insomnia fall asleep for two hours up for three hours needing Ativan help [Q=BUCKINGHAM A=JOLOTTA] Q: not appreciating much difference after four nights training normally see with medication? A: Yes. I wasn't surprised by that. Q: Remeron calming effect on anxiety good fit A: Correct. Yep. [23:22:00] Q: complaining sleep issues has secondary component could help? A: good choice for depression prominent anxiety insomnia decreased appetite can increase appetite Q: medication like Remeron or mirtazapine take time to work or see results? A: Yes. Q: timeframe for drug? A: tell patients four to six weeks at given dose idea improvements in first two weeks full clinical benefit take a month, sometimes eight weeks Q: addition to medication recommendation add cognitive behavioral therapy to treatment plan? A: Yes. Q: indication engaging in cognitive behavioral psychotherapy? A: No. Q: relation medication follow-up conversations about concerns with Remeron? A: Yes explained takes time to work only four days give more time made additional recommendations Q: Okay. What were the recommendations for? A: Julie tried 5 mg of Ambien suggested try 10. Ambien controlled release formulation wake-ups night controlled release outer layer 60% dose helps sleep inner layer 40% dose keeps asleep good option while waiting for Remeron to work underlying depression anxiety causing poor sleep treating try alternatives. Q: she express concerns about taking medications for sleep like benzodiazepines? [03:17:00] A: She did. Q: What did she say about that? A: concerned about taking benzo mentioned rebound anxiety once dose wears off anxiety above baseline benzodiazepine half-life of medication Ativan between 8 and 24 hours taking it in middle of night next morning feel more anxious concerned about getting physically dependent on it needed to take it for nights Q: used term rebound anxiety her terminology? A: Yes, it was. Q: terminology in psychiatric care? A: Yes. It's a clinical term. Q: plan to address sleep help complaint Ambien not a choice next recommendation? A: discussed hydroxyzine as-needed medication for anxiety not benzodiazepine carry risk of rebound anxiety or tolerance dependence could help sleep offered as alternative Q: same terminology lorazepam with A: Sorry, Ativan. Yeah. Q: conversation about medication treatment proposing plan she engage? A: Yep. It was [inaudible] collaborative. Q: day whose choice medication regimens? A: The patient. [06:55:00] Q: options in instances? A: to competency capacity to make decisions Sometimes might get legal or ethics team involved determination patient needs healthcare proxy decisions Q: traditionally manic symptoms look for? A: mnemonic Dig Fast quick D is distractability Patient highly distracted to extraneous stimuli pressured speech grandiosity run for office be president." interest Sleep poor two hours sleep "Go." Increased goal-directed activity painting exterior interior different projects no decompression time feeling tired general symptoms of mania Sometimes psychosis associated Q: mania and psychosis two different things? A: Yes. Q: screenings identify signs of psychosis? A: Absolutely. Q: signs of psychosis A: Signs subtle responding to stimuli eyes tracking not paying attention guarded delusional thought process think get them no basis Q: responding to internal stimuli person hears auditory hallucinations sees things't there? A: Yes. Q: she reports didn't want to wait know things fresh mind "Last night didn't take Ativan dose night before at 1:00 AM slept four hours 9:30 to 1:45 dosed off for 45 minutes from 4:30 to 5:00 Today horrible intrusive thoughts felt deeply depressed took 0.5 of Ativan at 6:00 PM now thoughts gone took5Ativan 6:00 PM thoughts gone feel good recall message A: I do. Q: Okay. no more communication her until December 6th? [01:45:22] A: Correct believe December 3rd Saturday Q: aware Lindsay Clancy out office December 5th? A: Yes. Q: Lindsay Clancy there by herself or with else? A: She brought in her husband, Patrick. REDDINGTON: Objection. Objection. COURT: What's the objection? REDDINGTON: objection not right She now 21 Edinburgh scale Prior testimony not near 21. deteriorated [Q=BUCKINGHAM A=JOLOTTA] Q: she indicate experiencing auditory or visual hallucinations? A: No. Q: Any delusions? A: No. Q: suicidal ideation plan intent? A: No. Q: observations signs of psychosis? [01:50:29] A: No. COURT: Go ahead. [Q=BUCKINGHAM A=JOLOTTA] Q: Lindsay Patrick report connection with Zoloft medication in September concern? A: Yes. Q: express Clancy thoughts about diagnosis interactions last weeks? A: I did. Q: And what was that? A: discussed possibility of underlying bipolar disorder based factors she activating response to Zoloft unusual taking Zoloft 48 hours without sleep not tired raised clinical suspicion difficulty tolerating other antidepressant medications wondering potentially underlying mood disorder bipolar disorder Q: information past psychiatric history indicators about manic episodes? A: No recall Julie's note Lindsay filled mood disorder questionnaire screener assess history of mania and bipolar disorder Lindsay negative screen three questions One question 13 symptoms score 7 out of 13 question onequestion two asks symptoms happening same period time? asks any functional impairment symptoms. recall three symptoms not sleeping Zoloft not feeling tired racing thoughts trouble concentrating None other symptoms endorse same period time don't can't remember functional impairment believe minor impairment. Q: Okay. fact reported full screen revealed negative for potential mania. A: MDQ less specific bipolar II or bipolar not specified. bipolar I and bipolar II Both have mania symptoms diagnosis Bipolar I more severe patient might be hospitalized or causes greater functional impairment Bipolar II shorter duration less functional impairment. Q: determining diagnostically bipolar disorder particular tool to assess? A: MDQ interview asking patient about symptoms if recall time past patients can't remember manic glad to have Patrick in visit help look at Lindsay 's history longitudinally Q: tools MDQ screening tools practice another tool to assess person criteria with bipolar I or bipolar II? [01:58:43] A: others not used. Q: not end all all guide tells specific criteria determine if episodes manic or depressive bipolar? A: Yes. Q: some concerns reported did rise to level diagnostic criteria for bipolar disorder? A: Not at that time. Q: explained thoughts about reactions to medication reported prior symptoms Patrick and Lindsay receptive to diagnosis? A: recall Patrick "My wife not bipolar."Lindsay looked She say anything Q: more specific information from Patrick during meeting? additional specific information assess change diagnosis? A: No. Q: recommendations about tapering medication? A: Yes. Q: last reported she tried not taking it horrible thoughts felt deeply depressed then took felt better realistic to recommend completely stopping? A: No. Q: what is taper? recommend tapers? A: recommend tapers to slowly get somebody off something tapers useful dose anxious to stop not ready keep on longer met her November 29th multiple concerns about benzodiazepines did CIWA assessment determine withdrawal from benzodiazepines or alcohol wanted to show assessing taking seriously [02:03:05] Q: And what does that mean? A: Minimal to no withdrawal only symptoms reported anxiety Her blood pressure normal Her pulse normal no nausea no vomiting no tremor no tactile disturbances withdrawal bugs crawling pins needles auditory disturbances No sweats no headache She oriented. Q: knowing she wasn't in withdrawals Ativan recommend taper alternative? A: I did. Q: What was that? A: recommended Valium. she discussed rebound anxiety first visit above baseline once benzo wears off Valium has long half-life hundred hours longer clinical duration action to offset chance experience rebound anxiety often used tapering on shorter acting benzos common practice to switch to longer acting benzos Q: conversations about other medications at issue mirtazapine Seroquel? A: Yes. Q: she express desire trialing Prozac? A: Both Lindsay husband expressed preference Q: agreed with? A: shared concerns could be bipolar differential diagnosis typical diagnoses typically SSRI s contraindicated she history tolerate Prozac at 20 milligrams okay with no mania thought they do could do it try it Q: What does that mean? A: typically not if bipolar disorder put on SSRIProzac Zoloft can create scenario flipping between manic depressed symptoms rapid cycling not antidepressants SSRI s never prescribed in bipolar disorder often want mood stabilizer on board Q: plan she to restart Prozac? [02:07:20] A: Yes recommending Prozac earlier November 30th recommended Q: after meeting December 6th additional communications with Lindsay Clancy via MyChart messaging December 7th? A: Yes. Q: Yeah. 10:19 AM. A: cut off discussed mentioned husband made good point yesterday Despite taking Ativan evening five hour stretch sleep improvement dispel notion benzodiazepines only helping sleep less than target six to eight hours Ativan Valium help sleep next step try higher dose Seroquel feeling subsequent loss of energy exhaustion fatigue lack of sleep?" Q: Seroquel creeping up dosage from using treat insomnia to treat else bipolar? A: Correct. Q: loss of energy exhaustion fatigue ask? A: Patients have insomnia anxious depressed typically exhausted tired next day patient underlying bipolar two hours of sleep not feel tired unusual Q: her questions response not feeling tired respond message? A: sent succession don't feel tired do Valium with Seroquel?" respond If not sleeping well with Valium alone no need to continue prescribe short taper off benzos not tired significant reaction to Zoloft at 50 milligrams concerned underlying mood and bipolar disorder.know you husband agree send information to review." sent her list of symptoms bipolar risk factors she refer. Q: recommend her? A: explain importance of knowing if bipolar significant SSRIZoloft Prozac contraindicated recommendation do 100 milligrams Seroquel tonight 200 milligrams Seroquel tomorrow 300 milligrams 12/9 400 12/10 hold there hold Prozac concerned hypomanic mixed manic state. Q: after sent message 12:32 she respond at 2:53 stick with plan needed refill Seroquel 30 25 milligram tablets? A: few earlier messages provided alternative option thinking Prozac add Zyprexa combination pill Prozac Zyprexa Symbyax for bipolar." prescribe separately take both same effect." asked her which one prefer responded do Seroquel with Valium taper." [02:16:06] Q: suggested alternative at 12:37 A: Correct. Q: December 8th 6:35 AM message "Did well last night Need Valium Feeling panicky Don't ready to taper quickly planned." A: Yes. Q: hesitant to taper slower? A: felt she anxious dependent trying facilitate process tapering off clinically thinking cover symptoms anxiety titrated Seroquel Seroquel clinical trials show good efficacy for anxiety Q: her response hesitant to taper she took five milligrams Valium left afraid take Ativan. A: Correct. Q: recommended take Ativan alternative Valium? A: No. Q: talks about dosage administration for every drug A: Yes. Q: Seroquel different recommended dosages for different mental illnesses A: Correct. Q: bipolar differential diagnosis recommending titrate up to 400 consistent with she bipolar diagnosis? [02:22:07] A: mixed manic state possible hypomanic state mixed manic state patient symptoms poor sleep no loss energy feel depressed numb suicidal presentation clinically acute unstable wanted to get manic symptoms under control get her sleep Q: up to 400 milligrams recommended dosage range for bipolar disorder Seroquel? A: manic presentation titrate over days weeks up to 800 milligrams Q: And that's in Rhode Island? A: Rhode Island. Q: familiar with perinatal or postpartum programs? A: They specialize. Q: next MyChart exchange December 12th 2022 A: Correct. Q: December 12th recall who initiated contact via MyChart? A: Lindsay. Q: Monday where should she been if following instructions? A: 400 milligrams. Q: concerns about fluctuating heart rate with her? A: Yes explained medications Seroquel cause orthostatic hypotension blood pressure doesn't compensate goes low feel dizzy mechanism is alpha adrenergic blockades alpha receptors help adrenaline part picture Seroquel often accompanied by orthostatic tachycardia to heart rate both common in first days of medication exposure or dose increased generally benign non-harmful self-limiting goes away over time sometimes necessitates slowing dose titration or dividing dose into smaller doses [02:27:59] Q: she expressed desire to get off medications altogether A: Correct. Q: response to concern? A: said aware of risks on Seroquel long positive benefit on mood anxiety if benefit risk worsening mood anxiety upon stopping medication discussed tapering off Valium fine with send taper schedule off medication might help see baseline experiencing significant severe symptoms of postpartum depression needs to treated." acknowledge medication alone not always best option part of puzzle Other treatments include counseling support exercise healthy diet yoga relaxation techniques recommend partial hospitalization program treatment methods for relief." Q: messages continued December 12th correct A: Correct. Q: at 2:44Lindsay messages "Thank you Rebecca orthostatic benign known side effect." she tells more about prior nights last three nights taken 2.5 milligrams Valium 200Seroquel. like makes sleep deeply soundly seven to eight hours don't like feel morning most day." "Incredibly depressed unmotivated. What recommend tonight?" next message after explained side effects? A: Yes. Q: what recommend address concerns incredibly depressed unmotivated? A: recommended continuing 200Seroquel she's sleeping. recommended up 400 sufficient activation symptoms She sleeping 2.5 of Valium advised give time Seroquel work mood continue accumulate good nights sleeps good recovering feeling better moving forward take them tonight discuss further visit tomorrow. Q: after met person her December 6th subsequent communications December 7th changing medication plan further communication December 9th now December 12th plan her come in person 13th A: That was my recommendation, yes. Q: recommend in person? A: communicating she had significant symptoms depression mixed symptoms with mania anxiety symptoms severe significant wanted to touch base weekly see her in person okay with virtual rather see treat than not cancel visit Q: meet her December 13th at 10:30 correct [02:33:37] A: Correct. Q: taking anything else daily? A: Valium, 2.5 once daily at night Q: reported sleeping better significant symptoms of depression A: Correct. Q: complained of racing heartbeat tachycardia A: orthostatic tachycardia recommended holding longer at 200 milligrams on 200 milligrams for four nights continue full seven nights discussing taper Benzos plan slowly phase them out decrease from 2.5 milligrams daily to two milligrams for seven days reassess next visit in a week provided psychoeducation behavioral activation CBT techniques for depression recommended postpartum.net support groups consider partial hospitalization Q: observe signs of psychosis? A: No. Q: suicidal ideation? A: thoughts harming herself not at that visit REDDINGTON: Objection. follow up? No allow REDDINGTON: Laughter from witness Judge sorry Objection overruled Next question. Court all rise [inaudible close notebooks Fix chairs Objection overruled Next question [Q=BUCKINGHAM A=JOLOTTA] Q: ask interaction her 13th experiencing suicidal ideation? A: Yes. [02:38:57] Q: What were they? A: Intrusive suicidal thoughts. Q: sleeping better depressed symptoms correct? A: Correct. Q: And December 16th, 12:50 PM. A: No apologize next contact telephone call December 15th Q: December 15th 3:53 PM phone call report?Lindsay A: worst day Lindsay persistent intrusive thoughts of suicide No active plan Lindsay Patrick agree higher level care necessary Discussed options likely go to MGH ED perinatal psychiatry inpatient psychiatric unit Lindsay deciding about Mc Lean advised keep us posted sign ROI release information communicate with treatment providers higher level care Lindsay verbalized understanding agreement Q: phone call 12-15 prompted recommendation emergency department? A: described worst day persistent intrusive thoughts of suicide ready to for higher level care Q: talked process going emergency department potential for Mc Lean inpatient? A: recall advising go nearest ER BIPlymouth or South Shore Health get evaluated if need higher level care inpatient psych facilities inpatient psych units may waiting for bed at first opening in state Amesbury or Newburyport MGH has Blake 11 psychiatry unit prioritize admissions from emergency department MGH and Mc Lean combined under MGB if MGH ED no beds at Blake 11 might reach out to Mc Lean get into Mc Lean Q: message she updating asking if stay same track for medication A: Yes. Q: response? December 16th 1:14. [02:46:11] A: Lindsay Leticia called about information Women &Infants Target dose for Seroquel treating depression 300 milligrams increase to 300 milligrams continue Valium Q: why recommend increasing to 300 after recommended staying at 200Seroquel? A: FDA recommended dose for treating depression bipolar depression Seroquel 300 milligrams Q: she went to see previous psychiatrist December 16th A: Yes. Q: her messages 2:11 PM she spoke with original psychiatrist ER visit recommended adding 25 milligrams Lamictal stabilize mood." agree? talked about Lamictal before? A: No. Q: response 2:26 PM using mood stabilizer A: Yes lamotrigine works for mood stabilization depression talked side effects Q: side effects A: recommended slow titration increasing dose due risk SJS Stevens-Johnson Syndrome serious higher risk Lamictal FDA recommends slow titration 25 milligrams two weeks 50 milligrams two weeks 100 milligrams quick cause benign side effect skin changes not fever malaise pharyngitis swollen lymph nodes watch for rash purpuric tender Benign rash spotty non-confluent non-tender no systemic features fever medication well tolerated Take with food minimize risk GI nausea send to pharmacy with dose change Seroquel luck hearing back from Women &Infants? Q: December 16th recall last version medication recommendations? A: From me? Q: added medication what on prescribed list for you her as of December 16th? A: asked her if needed send lamotrigine she had psychiatrist send [02:50:36] Q: medications she advised to take at December 16th? A: Lamotrigine, 25 milligrams,Seroquel 300 milligrams Valium two milligrams Q: learned other psychiatrist called in lamotrigine prescription A: Correct. Q: next time spoke with her? A: 12-16 Friday spoke Monday, December 19th Q: communications via MyChart started at 11:04 AM December 19th A: Yes. Q: response? A: she has appointment should be in program Should cancel or reschedule starting medication? glad you into program this week call reschedule on vacation next week might be two weeks out touch base again Q: Okay. A: Her message at 8:05 PM responded next morning Q: Okay. At 10:57? A: Yes. Q: thoughts about her report she discharged recommendation for tapering Seroquel Seroquel? [02:56:03] A: not opposed concerned she discharged could benefit from groups added support separate from medication changes not medication route groups and therapy are treatment needed intrusive thoughts concerning caused distress.on vacation next week hesitant start taper not available for questions open to starting taper want available as happens. connected to previous psychiatrist someone to consult Q: sent message at 10:57 opposed to tapering Seroquel? A: understood helping her sleep she felt depressed wanted to come off. Q: coming off medication good option for? A: hesitant. could be done need recommend group support therapy other treatment. Q: only aware communicating with previous psychiatrist A: Correct. Q: December 21st after recommendation not start taper available consult with psychiatrist response from her at 3: 57? A: On December 21st? Q: Yes. A: I see 3:47. Q: psychiatrist at Women &Infants recommended general mental health PHP partial hospitalization program A: Correct. Q: McLean open to looking to schedule with CBT therapist in Duxbury other therapist appointments this next week follow up recommend starting taper? need smaller pills 300 milligrams." her response A: other psychiatrist appointments [03:02:03] Q: December 21st, 2022 at 4:26 PM in MyChart message A: Right. Q: standard or slow taper off Seroquel at 300 milligram dose? A: taking it for few weeks yes If months would've done slower taper Q: Okay Perinatal Behavioral Health Clinic at South Shore December 30th Patrick Clancy called about wife? A: Correct. Q: last contact South Shore Perinatal Behavioral Health Clinic with Lindsay Clancy? A: Yes. JOLOTTA: wondering if she come back Mass PMP log controlled scripts she had medications filled from previous psychiatrist Dr.Tufts REDDINGTON: object move to strike not responsive to question about Mc Lean CLERK: Overruled. BUCKINGHAM: never came back to clinic? JOLOTTA: Correct. BUCKINGHAM: advocate for herself knowledge about medications? JOLOTTA: Yes. [03:07:25] CLERK: Counsel see sidebar? excuse till two o'clock Same instructions No research No talking about case nice break We'll see back around two o'clock CLERK: Yeah. SPK7: Court Jurors entering court in session be seated. CLERK: return to trial of Commonwealth v.Lindsay Clancy All parties present including 18 jurors Thank you Madam Clerk Reddington REDDINGTON: Thank you, Judge. Good afternoon. REDDINGTON: housekeeping matters medical records from Women &Infants Hospital exhibit marked for ID offer now? CLERK: Commonwealth, any objection? BUCKINGHAM: Exhibit 220. REDDINGTON: Exhibit F BUCKINGHAM: another smaller packet not in marked as Exhibit 220. REDDINGTON: Yeah. CLERK: All right keep marked for identification? If different between Exhibit 220 and identification enter it. REDDINGTON: Thank you Dawn. Your Honor ask of reference to Diagnostic Statistical Manual-5-TR bipolar related disorders 15 pages of single space typing hard for people to absorb offer section DSM as exhibit look REDDINGTON: Okay. Sure. [Q=REDDINGTON A=JOLOTTA] Q: know times she had psychiatrist treating her since end of September early October [03:13:11] A: she psychiatrist treated in September Q: continued to see Dr.Tufts through October November December reaching out to you for help? A: aware she took Zoloft in October still seeing Dr.Tufts in November called her in December Q: She didn't really hide anything? A: Nope. Q: told about medications fears concerns medications A: Correct. Q: described District symptomology including suicidal ideation worrying about suicide feeling heavy lethargic can't get out of bed A: Correct. Q: provided many prescriptions for antipsychotics selective serotonin reuptake inhibitors benzodiazepines A: prescribed other medications. Q: She was what? A: Prescribed other medications. Q: ask other medications? A: Yes. [03:16:22] Q: difficulty determining who providing prescriptions for medications? A: No. Q: Okay. And what is buspirone? A: medication treat anxiety Q: And hydroxyzine, what is that? A: It is an antihistamine medication. Q: Sertraline Prozac A: Zoloft. Q: Zoloft, Prozac. They're both SSRIs, right? A: Yes. Q: Prescribed trazodone, 50 milligrams, right? A: Yes. Q: November 25? A: first visit with Julia November 21st Q: Julie left New Hampshire work picked up November 30th 22. [03:20:58] A: November 29th. Q: script November 30th for quetiapine 25 milligrams week later increase to 100 milligrams? A: November 30th anticipated utilizing four-week course treatment for sleep anxiety clinical symptoms changed opted use for mood stabilization Q: working with? psychiatrists? A: No. Q: person woman recently had baby postpartum range presents symptomology cause concern? Suicidal ideation? A: Lindsay common to treat patients Q: women postpartum A: Postpartum who may have suicide, oh. JOLOTTA: Her symptoms serious not treat postpartum [Q=REDDINGTON A=JOLOTTA] Q: Yeah, it was December 9th. A: December 9th. Yes. Q: December 19th prescribed 300 milligrams quetiapine 30 count A: Correct. Q: December 19th Three days later December 21st prescribed additional quetiapine 100 milligrams 14 count [03:25:03] A: Correct. Q: not able to prescribe medications can't use name A: Right. Q: DEA license to prescribe medications A: Correct. Q: know she Googling 60, 70, 100 times a night benzodiazepines Seroquel medications? A: I did not know that. Q: ask her where she acquired her ability to know medications? A: don't understand question Q: wouldn't know medications labor and delivery nurse uses helping woman giving birth A: Not necessarily. Q: knew she gone to Rhode Island program for Women &Infants Center Behavioral Health Day Program in Providence,Rhode Island knew A: I did. Q: went to Women's &Infants Hospital December 20th A: She did. [03:29:10] Q: woman seeing Dr.Tufts psychiatrist A: Right. Q: knew didn't get access to Tufts records didn't know Tufts knew before dealing with psychiatrist A: Yes. Q: turned away after eight hours assessment group session concern she suffering from. what diagnosis? A: I'm not sure. Q: Why was it? A: I do not know their diagnosis. Q: she diagnosed? different diagnoses general anxiety disorder GAD differential? A: differential in medicine patient cough differentials bronchitis, pneumonia strep throat different diagnoses Q: they wouldn't accept her into postpartum program concern she over-medicated by drugs out? A: I can't speak to that. Q: she diagnosed depression due to adverse drug effects? A: I cannot speak to that. Q: invested December. December 20th same day she finished evaluated woman invested in evaluated by Dr. Diaz recommended recommended tapering Seroquel starting 200 milligrams tonight follow up with outpatient provider attempted to reach current outpatient provider Rebecca Jollotta, receive call back [03:32:59] A: never received call from Women &Infants. COURT: Keep exhibit for identification double check pages referred contained within Exhibit 220? REDDINGTON: Yep. [Q=REDDINGTON A=JOLOTTA] Q: record indicates she seen by psychiatrist November 17th note Started Zoloft 25 increased to 50 milligrams A: Yes. Q: took Zoloft 50 milligrams for one night unable to sleep discontinued effect A: Yes. Q: contraindicated to bipolar 1 or 2 not place on selective serotonin reuptake inhibitor drug Prozac or Zoloft A: Correct. Q: What's effect A: cause rapid cycling swing from mania to depression symptoms rapidly Q: scales counsel asked depression scale Edinburgh scale Edinburgh scale for evaluation of woman in postpartum period severely depressed A: Yes. Q: Edinburgh scale first time saw her? A: 17 [03:39:10] Q: what is EPDS? A: Edinburgh Postpartum Depression Scale. Q: That's severely depressed, isn't it? A: Yes. Q: in six days decompensated from Edinburgh Scale 17 to Edinburgh Scale 23, A: 23 on November 21st and 17 November 29th Q: November 20th day before Edinburgh scale 23, jury access records reporting struggling with postpartum anxiety A: I can't speak to that. Q: Okay. A: Yeah. Q: first time met with Lindsay? A: November 29th. Q: agree symptomology of mania woman postpartum period being disoriented A: Not necessarily. Q: saw her November 29th diagnosed had postpartum anxiety [03:44:25] A: Mm-hmm. Q: restless every day A: Correct. Q: GAD score of 14 November 29th? A: Moderate anxiety. Q: medications prescribed in evidence jury look at scripts exhibit without every day next time saw her November 30th A: messaged with her November 30th Q: record patient message in Perinatal Behavioral Health Program of South Shore Health, November 30, 2022? A: Yes, I'm looking at the messages. Q: Excessive exercise? A: Sometimes. BUCKINGHAM: Objection. COURT: Overruled. [Q=REDDINGTON A=JOLOTTA] Q: looked for mania notice? factor into diagnoses? A: Yes. [03:51:37] Q: complaining about she over-medicated A: concerned about symptoms started once medicated Q: she says slept four hours beginning night 9:30 dozed off 45 minutes said "Today had horrible intrusive thoughts deeply depressed." A: Yes. Q: as invested nurse practitioner receive message from woman postpartum been through symptomology seen not good results concerned person saying horrible intrusive thoughts" A: Yes. Q: result of seeing December 3rd Lindsay Clancy history had horrible intrusive thoughts what did you do? call her? A: She told took Ativan now thoughts gone felt good. Q: message "Today had horrible intrusive thoughts Deeply depressed took 0.5 of Ativan 6:00 PM thoughts gone" A: Yes. Q: How many people treated for postpartum psychosis? A: Five. Q: And visual hallucinations likewise? A: Not all. Q: voices auditory hallucination? [03:55:27] A: Yes. Q: Visual hallucination, not all, but some? A: Yes. Q: ask her meant? A: if had plans or intent for suicide changed different times during treatment Q: December 2nd received sent note Lindsay sounds more like depression than side effects of drugs A: Correct. Q: not uncommon to hear." quote never felt anything like this before don't feel like myself sounds like postpartum depression." correct? A: Correct. Q: she expressing symptomology of depression side effects you indicated working sounds like postpartum depression right? A: Correct. Q: does postpartum depression mean effect on patient? A: Postpartum depression like depression any time patient's life unique considerations typically occurs first three months after baby can happen any first year different than regular major depressive disorder significant hormone fluctuations when deliver baby Sometimes breastfeed wean set off additional hormone shifts anxious presentation obsessive thoughts occur greater regularity in postpartum depression than major depression outside postpartum Q: prescribed medication her? A: After sent information postpartum still December 2nd? [03:58:50] Q: end result? prescribe medication for? A: I did. Q: seen records she individual dealing with problems insomnia symptomology for over a month and a half medications changing much helping? A: That does sound familiar. Q: big black letters December 2nd, '22 behavioral health history find on records? If time she indicated been to ER for anxiety symptoms insomnia heart palpitations remember that? A: I don't see that. Q: All right. indicate date Ms. Dukes saw Lindsay? A: December 2nd. Q: December 2nd she complaining of symptomology Lindsay heart palpitations A: describing had heart palpitations went to ER for anxiety symptoms. Q: went ER patient's report addiction to Ativan, can't sleep noted had weight loss A: Correct. Q: Leticia Dukes notes called Aspire Crisis Support Lindsay A: Yes. Q: What is Aspire Crisis Support? [04:05:23] A: Aspire community mental health program operates local 24 hour emergency services program for psychiatric emergency services Q: psychiatrists nurse practitioners RNs psychiatric world tell patients in crisis suicidal ideation call these numbers A: Yes. Q: notes December 5th Pat, patient's husband joined visit reporting anxiety significantly worse since starting psychiatric medications bottom A: That is what that says. Q: spoke to Pat told 10,000 times worse since started medication A: recall Q: upset about medication? A: I would say he was concerned. Q: jury concerned pissed off about medication to wife? BUCKINGHAM: Objection. Asked and answered. COURT: No, overruled. [Q=REDDINGTON A=JOLOTTA] Q: Concerned address concerns? A: That day? Q: Any day. [04:08:46] A: day collaborated with them to take her off certain medications. Q: Again, she's diagnosed postpartum anxiety, right? A: Correct. Q: Severe what? A: Severe signs of postpartum depression. Q: period she indicated wanted to get off medication drugs you were on vacation that week A: Yes. Q: Did somebody cover? A: She said follow up with other psychiatrist for taper out to our program while on vacation Q: I couldn't understand your words. A: she had appointment with psychiatrist work on taper in contact with other providers our program including Leticia Dukes while on vacation Q: Rebecca Gelata telephone encounter December 9th A: Correct. Q: What were they? A: Panic symptoms racing heart intense fear Sudden rushes intense anxiety [04:14:15] Q: intrusive thoughts she? A: don't recall specific thoughts asking about safety thoughts of suicide Q: Patrick told she has thoughts of suicide A: Lindsay as well. Q: asking you as invested healthcare provider told woman advise investigation revealed patient intrusive thoughts." A: recall intrusive suicidal thoughts Q: providers program indications husband's number of times suicidal ideation you prescribe more drugs? A: At this occasion, I prescribed Valium. Q: sentence "Incredibly depressed unmotivated to do anything remember her A: Yes. Q: symptomatology person suffering from postpartum anxiety depression incredibly depressed unmotivated to do anything A: Correct. Q: she unmotivated depressed go shopping? drive stopped driving A: I was not aware of that. Q: December 12th saw Leticia Dukes reporting thoughts of SI suicidal ideation no plan contacted Crisis starting PHP in Norwalk [04:17:48] A: Partial hospitalization program. Q: reporting suicidal ideation A: Correct. Q: difference between suicidal ideation thoughts suicide DSM A: Suicidal ideation can be a spectrum. Q: December 13th telemedicine perinatal behavioral unit concern about suicidal ideation book Edinburgh Postnatal Depression Scale now 20. still severe A: Correct. Q: record exhibit Women and Infants December 20th differential diagnosis concern about medications Rebecca Gelata No return call don't recall know what happened after Mc Lean A: went to Mc Lean Q: treating person decompensated voluntarily admitted to locked ward mental institution important to Rebecca Gelata to find diagnosis treatment patient? A: Yes. BUCKINGHAM: Objection. COURT: Overruled. BUCKINGHAM: Calling speculation. REDDINGTON: Not hardly. [04:22:36] REDDINGTON: That's all I got, Your Honor. COURT: All right. Attorney Buckingham? BUCKINGHAM: Gelata Lindsay Clancy patient at South Shore Perinatal Behavioral Health Clinic between November 20th and December 13th November 20th first contact with Julie Paul JOLOTTA: Yes. BUCKINGHAM: information about contact psychiatrist limited to shared JOLOTTA: Correct. BUCKINGHAM: asked about providing different medications approach Exhibit one [Q=BUCKINGHAM A=JOLOTTA] Q: show second page small look prescribed medications Lindsay Clancy January 2023? A: None. Q: January 12th 2023 Jennifer Tufts correct A: Correct. Q: January 5th 2023 Alia Goodheart correct A: Correct. Q: January 16th, Jennifer Tufts? A: Correct. [04:25:09] Q: Jennifer Tufts for Diazepam Jennifer Tufts last prescription December 22nd, 2022 A: Correct. Q: back medications December 6th and 7th prescribing same medication common change prescriptions to adjust dosage? A: Yes. Q: start new medications give automatic 30-day supply not course medication? A: Correct. Q: prescribing odd dosages odd number of pills? A: Yes. Q: December 6th Diazepam prescribed one pill A: Yes. Q: And then December 7th, two pills? A: Yes. Q: December 9th 5 milligram dose eight pills A: Yes. Q: December 30th 2 milligram dose seven pills [04:26:46] A: Yes. Q: Seroquel November 30th first prescribed low 25 milligram dose for insomnia 30 pills A: Yes. Q: changed plan December 7th new prescription higher dose A: Yes. Q: 100 milligrams at 22 pills A: Correct. Q: adjust dosages number of pills give specific instructions take medication? A: Yes. Q: expect patient follow instructions disregard previous prescriptions? A: Yes. Q: South Shore Perinatal Behavioral Health have partial hospitalization program? A: Not at this time. Q: She gave details about told wasn't benefit from groups told medication history issues believed she should come off Seroquel? A: Yes. [04:29:02] Q: have records diagnosis had report from patient about recommending? A: Yes. Q: Counsel bounced around dates communications contact December November 30th into December 1st talking about postpartum depression? A: Let me double check, please. Q: presentation clinic initial focus treatment for postpartum depression anxiety not? A: Yes. Q: began more contact trial different medication regimens differential diagnosis started emerge? A: Yes. Q: responded appropriately with medication recommended A: Yes. Q: What does that mean? A: assessing immediate safety if plan to kill myself knife." calling 911 sectioning person thoughts of suicide." plan? intent? recall Lindsay she having thoughts of suicide not disclose plan No intent husband aware on call Q: times met with had messages Lindsay Clancy talked about intrusive thoughts suicidal thoughts articulate had plan? A: No. Q: intrusive thoughts person postpartum mom intrusive thoughts your training experience treated moms with postpartum depression anxiety psychosis common complaint [04:33:49] A: Yes. Q: they depressed unmotivated common hear from new moms. A: Yes. Q: experience treating postpartum psychosis hear voices or not concerns contact with Lindsay Clancy suffering? A: I did not. Q: Objection. COURT: Counsel see you over? Sidebar. prediction day close break for day ask come back tomorrow at nine o'clock similar schedule follow tomorrow well on schedule ahead of schedule don't want jinx excuse you till tomorrow Remember instructions Don't read about this case or similar cases Don't do research Don't talk anything Don't take field trips Don't driving by certain places put this out of head till tomorrow long day appreciate hope nice evening come back tomorrow morning We'll follow same schedule. thanks. great evening We'll see you tomorrow. ## Day 12 (524 of 2137 turns kept) [03:00] CLERK: Good morning, Your Honor. proceed? CLERK: Honor before court matter of Commonwealth versus Lindsay Clancy Ms.Clancy present represented by attorney Kevin Reddington Commonwealth represented by Assistant District Attorney Jennifer Sprague Assistant District Shannon Buckingham COURT: Good morning, Ms. Clancy. L.CLANCY: Morning, Your Honor. COURT: before talk to counsel about today's schedule see at sidebar set for jury? COURT: Yeah. SPK1: persons before Honorable William, Justice of Superior Court sitting in Plymouth for Commonwealth Honor give attendance be heard. God save Commonwealth of Massachusetts court in session be seated. CLERK: Good morning Your Honor proceed CLERK: court continuation of jury trial Commonwealth versus Lindsay Clancy Ms.Clancy present represented by attorney Kevin Reddington Commonwealth represented by Assistant District Attorney Jennifer Sprague Assistant District Attorney Shannon Buckingham COURT: thank you Madam Clerk Good morning ask questions follow instructions talk about today's schedule questions First question member of jury read seen heard overheard anything source about case affect ability to be fair impartial? COURT: Last question other serious matter or concern service as juror attention? Thank you for following instructions continue with Commonwealth 's presentation of evidence anticipation go similar to last days into afternoon after talk with counsel schedule for rest of weekleave today probably have better idea schedule rest of week next week. return to Commonwealth 's case. Attorney Buckingham? BUCKINGHAM: Honor Commonwealth call Daniel Lawler to stand SPK2: Good morning sir Stop Raise right hand for clerk LAWLER: Good morning, Your Honor. [Q=BUCKINGHAM A=LAWLER] Q: And where are you employed? [04:34:00] A: With the Massachusetts State Police. Q: What's rank with state police? A: Sergeant. Q: work assignment with Plymouth County District Attorney's Office State Police Detectives Unit? A: Yes. Q: how long with Plymouth County DA's Office State Police Detectives Unit? A: From March 2021 until June 2025. Q: incident occurred at 47 Summer Street Duxbury A: Yes. Q: arrived at South Shore Hospital Duxbury police detective on scene? A: Yes. Q: And the Crime Scene Response Unit? A: Yes. Q: observe Lindsay Clancy at South Shore Hospital? A: Yes. [08:24:00] REDDINGTON: putting gloves on no objection judge BUCKINGHAM: move admit tank top next exhibit. CLERK: Exhibit 223. BUCKINGHAM: I would move to admit these as the next exhibit. CLERK: Exhibit 224. BUCKINGHAM: Cut down the middle? LAWLER: Yes. BUCKINGHAM: Move to admit this as the next exhibit. CLERK: Exhibit 225. [Q=BUCKINGHAM A=LAWLER] Q: South Shore Hospital January 24th, 2023 other hospitals? A: Yes. Q: Which hospital did you go to? A: Boston Children's Hospital. Q: early morning hours January 25th 2023 search warrant obtained for home of 47 Summer Street Duxbury? A: Yes. [16:10:00] Q: show marked Exhibit 155 witness [Q=BUCKINGHAM A=LAWLER] Q: Sergeant bag marked Exhibit 155 four pill bottles look familiar? A: Yes. Q: first one labeled Trazodone. inventory A: Just count them. Q: Trazodone filled on January 12th, 2023 with 30 counted to determine many left A: Correct. Q: last one amitriptyline, 10 milligrams date filled January 16th, 2023. Quantity: 30. counted how many left in this bottle? A: Correct. Q: 22 in this bottle? A: Correct. Q: person went in know if attorney, doctor? A: not attorney't doctor. psychiatrist. [Q=REDDINGTON A=LAWLER] Q: Yes. I'm sorry. A: Approximately 7:30 PM. [22:59:00] Q: media insane over location house hospitals everywhere A: recall media at house not sure about hospitals Q: you knew had search warrant authorized search for items including medications pills pill bottles right A: Yes. Q: Surgical intensive care. A: Yeah. Q: direct said he was not a doctor psychiatrist knew he had something to do with head doctor, psychiatrist psychologist LAWLOR: Correct. BUCKINGHAM: Objection. COURT: see counsel at sidebar? members of jury sometimes talk to lawyers longer at sidebar ask you to go back to jury room for couple of minutes then bring back in resume with testimony. COURT: counsel record clear jury's out of room conduct short voir dire on issue at sidebar allow Mr.Reddington to ask questions allow Commonwealth to also ask questions. Go ahead, counsel. COURT: Attorney Buckingham. LAWLOR: Correct. COURT: Yeah, please. REDDINGTON: And Sergeant McKelligan... Joshua? [21:15:00] LAWLOR: Yes. BUCKINGHAM: Objection. Form of question. REDDINGTON: Two? LAWLOR: Yes, sir. COURT: Redirect, Ms. Buckingham. BUCKINGHAM: Nothing further. BUCKINGHAM: Objection. Beyond the scope. COURT: Sustained. All right Anything further? Thank you sir. LAWLOR: Thanks, Your Honor. BUCKINGHAM: Commonwealth call Latiesha Dukes next witness SPK4: Good morning, mam. SPK4: Come, take a seat. [Q=BUCKINGHAM A=DUKES] Q: How do you spell Dukes? A: D-U-K-E-S. Q: What did you do there? [04:07:00] A: perinatal clinic worked as perinatal clinician short-term therapy birth to postpartum supported connection to care therapy or higher levels care intensive outpatient therapy partial hospitalization inpatient care Q: rely on report assessing diagnostically treatment plan offering therapy A: Yes. Q: assessments perform? A: typically perform psychosocial assessment behavioral health history current presentation reason for therapy specific diagnosis current concern recent crisis trauma risk assessment Q: sessions minimum or maximum time limit? A: program birth to postpartum two years If over two years lack of connection care beyond typically two years Q: services offered for her? referred to you? A: referred for postpartum anxiety and depression symptoms Q: first intake psychosocial history Lindsay Clancy A: Yes. Q: engaged with psychiatrist in nursing school prescribed medication correct A: Yes. Q: prior to clinic engaged with psychiatrist A: Yes. [01:00:36] Q: And what were the concerns? A: Her concerns were anxiety lack of sleep depression passive suicidal ideation thoughts of wanting to die Q: she reported on different medications A: Yes. Q: medications managed by nurse practitioners clinic A: Yes. Q: your role as social worker often into weeds with patients about medication? A: not social worker mental health counselor Q: I'm sorry. A: overview of medications don't prescribing or medications Q: focus of role in counseling services to women with postpartum anxiety and depression A: create treatment plan to address concerns anxiety depression symptoms work on coping skills building community supports if referral to higher level care Q: conclusions diagnosis based on interaction with patient? A: Yes. REDDINGTON: If medical record objection prefer not leading no problem if she reads from record [01:02:31] COURT: no DUKES: All right. Sure. That's fine. DUKES: Sure thing. Thank you. COURT: Sure. Yeah. [Q=BUCKINGHAM A=DUKES] Q: What is a mental status exam? A: mental status exam assessing patient reporting concerns about safety suicidal ideation homicidal ideation intrusive thoughts worry hallucinations delusions Q: observations of facial expressions? A: tearful discussing anxiety symptoms Q: what she say about thought content? A: worry about infant had addiction to Ativan. Q: assessment assessed suicidal thoughts correct? A: Correct. Q: anxiety sleep identify concerns around substance abuse issues? A: concerns about misuse of Ativan. Q: expressed concern focused on one medication medication Ativan correct? [01:08:26] A: Yes. Q: why not find issue based assessment? A: Based on assessment supposed using used correctly to remedy anxiety symptoms Q: after spent hour assessments spoken history opinion about diagnosis? A: Yes. Q: presentation opinion about diagnosis? A: opinion diagnosis postpartum anxiety Q: recommendations treatment plan? A: recommendations outpatient therapy continued medication weekly visits COURT: That's fine. DUKES: Thank you. Yep. [Q=BUCKINGHAM A=DUKES] Q: what say about weekend? A: reported difficult weekend intrusive thoughts about wanting to die contacted Aspire Crisis Support met clinician virtually told not meet criteria for inpatient treatment due to no SI plan suicidal ideation plan Q: signs of psychosis mania homicidal ideation? A: No. [01:14:09] Q: Sure. A: visit no suicidal ideation. Q: referral for her to clinic or provide other information? A: discussed information with provider psychiatrist and medication provider Q: send Lindsay Clancy information about psychological testing? A: Yes. Q: Do you know why? A: she wanted extra support outside opinion diagnosis medication Q: meetings discuss medication side effects? A: Yes. Q: signs of delusions or paranoia? A: No. Q: How about psychosis? A: No. Q: Yep. May I approach? [01:21:52] [Q=BUCKINGHAM A=DUKES] Q: why recommend Women &Infants higher level of care? A: continued passive suicidal ideation crisis intervention Women Infants for postpartum women infant come to program with. Q: Lindsay Clancy consent to referral? A: Yes. Q: she continued passive suicidal ideation meeting assess suicidal ideation? A: passive suicidal ideation? Q: thoughts of suicide? A: Yes. Q: thoughts suicide wanting to die? A: reported continued suicidal ideation REDDINGTON: Where is this page 13? BUCKINGHAM: Yep. BUCKINGHAM: observe signs of mania, delusion paranoia? DUKES: No. BUCKINGHAM: signs psychosis observed? [01:32:19] DUKES: No. BUCKINGHAM: Yeah. REDDINGTON: Thanks. SPK7: returned back to trial of Commonwealth versus Lindsay Clancy All parties present including defendant 18 jurors. [Q=REDDINGTON A=DUKES] Q: Thank you, Your Honor. Morning. A: Good morning. Q: woman in postpartum comes to South Shore Health for help can't see medical records from people like Nurse Paul and Nurse Jollota written A: You can see the records, yes. Q: 2nd of December look along under behavioral health intake. Your pages numbered mine not find one page behavioral health intake on December 2nd jurors have this as exhibit going through pages A: One second. Yes, I have it. Q: Especially in psychiatry person not lying or hiding honest A: Yes. Q: Lindsay disclosed in 2012, nursing school had Prozac nervous about public speaking on Prozac, A: One second. Q: prescribed Ativan by psychiatrist Jennifer Tufts, [01:40:30] A: Just reviewing. Q: "Prior to attending Shore program, second paragraph? A: Yes. Q: "Patient was prescribed Ativan by psychiatrist Jennifer Tufts A: prescribed Zoloft. Q: misreading apologize approach History and current functioning behavioral health history, paragraph 1 References Prozac, A: Yes. Q: second paragraph prior to attending Shore program she disclosed was prescribed Ativan, A: So which one are you wanting- Q: "Prior to attending Shore program patient prescribed Ativan, A: Yes. Q: prescribed benzodiazepine by treating psychiatrist concerned about taking medication A: Yes. Q: concerned about becoming addicted to medication benzo like Ativan, right? A: concerned about addicted to medication yes [01:42:19] Q: last paragraph says "When no longer taking Ativan." A: Yes. Q: explained had issues with sleep heart palpitations went to ER for anxiety. A: Correct. Q: felt had addiction to Ativan. couldn't sleep A: Yes. Q: Okay. So the next page [inaudible]. A: Mine it goes to 12-5. Q: saw her December 2nd after Ativan weight loss anxiety prescribed Remeron and Seroquel. drugs A: No, I don't do medication. Q: difficult names started Remeron and Seroquel. since starting medication had thoughts no longer wants to be here A: No longer wants to be here- Q: Try to kill herself? A: assessing for suicidal ideation "no longer want to be here" qualifies as passive suicidal ideation. Q: talked Remeron and Seroquel not helping sleep. Yesterday took Ativan, [01:45:23] A: Yes. Q: "Due to intrusive SI suicidal ideation thoughts A: Yes. Q: indicate intrusive suicidal ideation thoughts yesterday December 1st? what meant? ask her what she meant? A: had thoughts about no longer wanting to be here. Q: talks about Onset "Three months after baby born had unmanageable anxiety correct? A: Correct. Q: what she tell anxiety about? A: One second. Q: Under Onset indicated "Three months after baby born unmanageable anxiety district attorney asked A: Yes. Q: continued with sentence. What was her anxiety about? A: About her children, especially the baby. Q: unmanageable anxiety? A: constantly worried something happen to children or bad baby [01:47:21] Q: Under Social notes indicate "She reported talks about anxiety with mom, husband mother-in-law correct? A: Correct. Q: Yep. A: Yes. Q: opinion Lindsay substance abuse problems other fear about prescribed Ativan right A: Correct. Q: why do that? A: To cope with anxiety. Q: When? A: Last use was November 15th, 2022. Q: district attorney asked about mental status exam facial expression facial expression showed anxiety right A: Correct. Q: Yes, please. Yep. A: Anxiety, fear, apprehension, sadness. Q: facial expression exported anxiety [01:52:21] A: Correct. Q: Depression? A: Yes. Q: expressed anxiety and numbness A: Yes. Q: thoughts worried about baby new baby infant addicted to Ativan A: Yes. Q: under risk assessment on December 2nd asked admitted to suicidal ideation A: Yes. Q: current medications on Quetiapine Seroquel A: Yes. Q: Fluoxetine or Prozac, right? A: Correct. Q: Lorazepam or Ativan, right? A: Yes. [01:54:33] Q: seeking counseling for postpartum anxiety A: Yes. Q: indicate based on history patient meets criteria for postpartum anxiety A: Yes. Q: PHP? A: Yes. Partial hospitalization program. Q: noted postpartum anxiety December 2nd notes A: Yes. Q: How many times? A: Four. Q: Unless there's another intervening period. A: December 12th December 5th Q: she contacted Aspire Crisis Support A: Yes. Q: met with Aspire clinician? [01:57:55] A: met clinician virtually told not meet criteria for inpatient treatment due not suicidal ideation plan Q: she been in counseling therapy seeing psychiatrists on medications past three months wanted to kill herself didn't want couldn't care if died told didn't have plan couldn't help A: Correct. Q: Okay. Page 28. A: Page 28. Q: record she looking at actual exhibit evidence COURT: Any objection? [Q=REDDINGTON A=DUKES] Q: talking symptom management reporting difficult weekend experienced intrusive thoughts wanted to die plan suicidal plan contacted Crisis weekend Aspire A: Right. Q: two times contacted Aspire not once A: Correct. Q: December 20th after not getting anywhere Aspire times two dealing with Jollota times Tufts trying to get her into program good for woman postpartum problems A: Correct. Q: surprised they indicated could not help her she over-medicated? A: Repeat the question. [02:04:15] Q: surprise you they couldn't treat her woman with postpartum psychosis depression anxiety because opinion she suffering from over-medication? A: It would surprise me, yes. Q: records from women and infants indicate same day reached out to Nurse Gelada asked her to discuss medication Gelada never got back? A: I was not aware of that. Q: too much medications? A: No, I'm not sure. Q: Mass General Center for Women's Mental Health year ago issued major study recommendations for dealing with women postpartum periods? familiar A: No, I'm not familiar with that. Q: suggest Mass General Hospital article about postpartum period agree 85% of women pregnant experience mood disturbance? agree A: No, I wouldn't agree with that. Q: agree 10 to 15% women develop significant symptoms of depression or anxiety? A: I agree. Q: postpartum psychiatric illness divided into three categories One 50s postpartum blues agree? A: Yes. Q: You've heard that expression before? [02:09:18] A: Correct. Q: And it's fairly common? A: Correct. Q: Number two postpartum depression different issue A: Yes. Q: three postpartum psychosis A: Yes. Q: postpartum depression prior to postpartum psychosis consists of symptoms symptomology diagnose woman pregnant baby after with postpartum depression certain symptoms look for A: Correct. Q: Okay. depressed or sad mood? A: Yes. Q: Change in appetite. lost 10, 15 pounds? A: Yes. Q: Suicidal thoughts? A: Yes. [02:11:33] Q: didn plan had suicidal thoughts A: Correct. Q: under Mass General Hospital research project for women postpartum issues hit postpartum depression symptoms correct? A: Correct. Q: if increases severity significant anxiety symptoms may occur Not generalized anxiety Significant anxiety symptoms right A: Correct. Q: determine by test administered to person postpartum status Edinburgh test A: Correct. Q: various diagnoses postpartum person obsessive compulsive disorder, OCD? A: Correct. Q: And it's pretty serious stuff? A: Yes. Q: if diagnosed as bipolar shouldn't prescribe SSRIProzac or Zoloft? A: I'm not sure of that. Q: agree cases postpartum depression symptoms utilize Edinburgh Postnatal Depression Scale 10 item questionnaire identify women postpartum depression severity score of 12 or greater raises concern indicates need for thorough evaluation [02:14:07] A: Correct. Q: postpartum psychosis third category?Postpartum most severe form of postpartum psychiatric illness A: Correct. Q: occurs averages about 2 out of 1,000 women A: Correct. Q: two out of thousand people number Fenway Park full playing Yankees 37,700 people 37,000 multiply by two 74 women possibly have postpartum psychosis? A: Not sure of that number, but... Q: agree 2 out of 1,000 studies statistics Fenway Park 37,000 seats times 2 74. A: Okay. Q: dealing with postpartum psychosis agree present with episode bipolar illness? A: No. Q: Turning every direction for help A: Correct. COURT: Attorney Buckingham. [Q=BUCKINGHAM A=DUKES] Q: new process own intake assess diagnostics mental illness [02:17:30] A: Correct. Q: role role in medication management A: No, I don't. Q: note read current medications based on prefills patient historical records clinic A: Yes. Q: December 12th talked Lindsay Clancy Women and Infants Program A: Correct. Q: recommended Women and Infants A: Correct. Q: ultimate plan assessment didn't qualified for program provided options for inpatient treatments medication management partial hospitalization general mental health A: No. [Q=REDDINGTON A=DUKES] Q: Virtual visit? A: Yes. Q: Able to laugh? A: Yeah. [02:21:35] Q: looking December 19th telemedicine Latiesha Dukes perinatal behavior health program form date service December 19th psychotherapy PCP Margaret primary care Margaret Anastasi Perinatal behavioral health program quote telehealth visit dot phrase video visit "Therapeutic intervention 32 years old Married female postpartum anxiety Symptom management low mood numbness." A: What date are you looking at? Q: not suicidal ideation need crisis intervention didn't kill herself A: Correct. BUCKINGHAM: Objection. COURT: Overruled. [Q=REDDINGTON A=DUKES] Q: Mental status exam. Appearance, hygiene, WNL. A: Within normal limits. Q: Okay Clothing normal Eye contact Build Posture Body movement normal? A: Yes. Q: Behavior is cooperative? A: Yes. BUCKINGHAM: Nothing further. Thank you. BUCKINGHAM: Commonwealth call Cameron Daley next witness SPK10: Good afternoon- [02:28:16] DALEY: Afternoon. DALEY: Afternoon, Your Honor. [Q=BUCKINGHAM A=DALEY] Q: Thank you tell jury your first last name? A: Cameron Daley. Q: And where do you work? A: Duxbury Police Department. Q: And that individual was Lindsay Clancy? A: Correct. Q: Two? A: Yes. Q: Oh, okay. A: I arrived at 10:00 AM. Q: Thank you. Nothing further. BUCKINGHAM: Correct. BUCKINGHAM: Correct. [02:31:52] COURT: Anything? BUCKINGHAM: Nothing further. DALEY: Thank you, Your Honor. COURT: Council second sidebar minute. COURT: Counsel see you at sidebar? BUCKINGHAM: Your Honor go back to sidebar SPRAGUE: Prior to witness move to enter next exhibit excerpted pages South Shore Health System Perinatal Behavioral Health Program last witness Leticia Dukes. COURT: Okay. Any objection? SPRAGUE: Exhibit 226. call Nicole Bradley next witness COURT: All right. Same finding. BRADLEY: Okay. Yeah. COURT: Thank you. Yes, Commonwealth. SPRAGUE: tell jury your first last name? BRADLEY: Yep. Nicole Bradley. REDDINGTON: Objection to record [02:40:37] COURT: Then there'll be no objection. SPRAGUE: between January 25th 2023 and December February 3rd 2023 Sheriff's Department hospital watch on patient Lindsey Clancy BRADLEY: Yes, I am. CLERK: Exhibit 227. SPRAGUE: Commonwealth calls Dr. Renee Stonebridge. REDDINGTON: Same objection decided by judge not contested not necessary. COURT: Same finding Same analysis. CLERK: Good afternoon, ma'am. COURT: All right, Ms. Sprague. Thank [Q=SPRAGUE A=STONEBRIDGE] Q: occasion medical examiner autopsy send brain eyes examine? A: Yes. Q: why sent you? A: criteria for neuropathology consult children under two receive brain spinal cord circumstances eyes dura suspicion of homicidal injury head blunt trauma cases come to me Sometimes cases surprise autopsy head unexpected.see hard diagnose not neuropathology trained tumor unexpected rare neurologic disease requires further neuropathologic evaluation Q: determine by seeing hemorrhages what caused them? A: Hemorrhages are general finding. given entirety of case knowing autopsy findings consistent with something asphyxial. [02:47:30] Q: why something asphyxial. means strangulation type, correct? A: Yes, it can be. Q: Why these hemorrhages occur in eye? A: asphyxial element person could be from many different things blood in head if compression of neck causes asphyxia compression blood gets stuck in head area. blood can't flow back down through body little tiny blood vessels in eyes skin mouth head region get blocked with blood can't move. blood vessels burst leads to hemorrhages. Q: Which then led to brain death? A: Correct. Yes. CLERK: Stop, please? SPRAGUE: Commonwealth calls Doctor- COURT: members jury revisit instruction given trial. important to understand sometimes evidence presented in trial creates emotional reaction. as jurors oath to follow law instructing law says separate emotional reaction from informational value weight evidence. verdict based solely on evidence based on sympathy or anger passion prejudice. keep that in mind. going to go to next witness? SPRAGUE: Commonwealth calls Dr. Barbara Vidal Olson. REDDINGTON: Same objection. COURT: All right. Good afternoon, Doctor. [Q=SPRAGUE A=OLSON] Q: How long have you worked there? A: Since 2021. Q: performing autopsy specific process procedure? [02:58:13] A: Yes autopsy composed many parts first part documentation review second part examination of body broken into two parts first part external examination identifying characteristics decedent eye color hair color evidence natural disease trauma outside body second part internal examination Y-like incision on chest abdomen examine soft tissues bones organs evidence natural disease trauma examine brain Q: autopsy on Cora Clancy January 25th, 2023 A: Yes. Q: And what were those? A: neck had ligature furrow ligature object external force to neck neck furrow pattern of injury develops underneath side compression Cora ligature furrow linear horizontally oriented area of pallor paleness around neck distinct superior inferior edges front part neck lower half furrow additional red abrasions one to two millimeters back neck superior inferior edges developed linear bruising Q: furrow A: external compression by object on neck pattern of injury beneath be imprint pattern developed injuries bruising abrasions L.CLANCY: I can't [inaudible]. COURT: All right. Counsel, sidebar please. COURT: Yeah, please. CLERK: Your Honor record return to trial Commonwealth versus.Lindsay Clancy. All parties present including defendant 18 jurors. COURT: All right. Attorney Sprague. [Q=SPRAGUE A=OLSON] Q: photo 7784 tell injuries photo A: photo looking at body from left ligature furrow linear area of pallor distinct superior and inferior edge small punctate hemorrhages petechial hemorrhages face Q: show photo 7782 injuries? [03:11:01] A: photo front of neck ligature furrow distinct area linear area of pallor lower half scattered red abrasions Q: injuries on her neck what tell training experience determine cause of death wounds A: ligature furrow horizontally oriented with significant petechial hemorrhages consistent with ligature strangulation Q: And what is ligature strangulation? A: ligature object external force to neck strangulation done by someone else Q: effect on body? mechanism of death? A: ligature strangulation results in asphyxial deaths Asphyxia body deprived of oxygen specifically brain compression on outside of neck blood oxygen delivered body right side of heart delivers blood to lungs breathing respiration oxygen into blood moves to right side heart pushed out to body through blood vessels arteriesoxygen released at targeted site recirculates to right side heart through blood vessels veins process starts continuous circulation compression of neck airways reduce reduction in ability breathe or complete inhibition compressions of veins neck blood drain from head blood backwards flow pressure meets arterial blood results in increase blood pressure vessels increase intracranial pressure compression artery no oxygenated blood delivered to brain Q: how long for loss of consciousness? A: specific time for interval multiple variables case by case type of ligature used force against neck intensity duration of altercation complete oxygen deprivation loss of consciousness can occur 10 to 30 seconds brain damage at one-minute mark irreversible damage death early five minutes variables might accelerate or decelerate timeframe REDDINGTON: It's obvious what she means. Objection. COURT: Overruled. You can ask. REDDINGTON: Objection. COURT: Sustained. Sustained. SPRAGUE: factors for 10 seconds or 30 seconds? OLSON: multiple variables force ligature against neck ligature intensity duration of altercation [03:21:00] SPRAGUE: If someone strangled to unconsciousness strangulation stops can they wake up? OLSON: Without intervention it's very unlikely. SPRAGUE: recall testifying ligature around neck pass out REDDINGTON: Objection. COURT: Can I see you at sidebar. COURT: Sustained. Hold on. Sustained. Next question. [Q=SPRAGUE A=OLSON] Q: testimony can strangle for 30 seconds let go then die? A: complete oxygen deprivation general timeframe. 30 seconds specific number Once strangulation occurs brain starts subjected to lack of oxygen ligature present or not oxygen deprivation irreversible brain damage occurring Q: form opinion cause of death Cora? A: Yes. Q: And what was that? A: Asphyxia. Q: And was that by manual strangulation? A: By strangulation. Q: Mechanical strangulation, I mean. [03:24:00] A: Yes. Q: examine autopsy on Dawson Clancy? A: Yes. Q: photo 2149. What seeing? A: Dawson neck similar Cora linear horizontally oriented ligature furrow area pallor around neck distinct superior inferior edges backside of neck appreciate abrasions line parallel with inferior superior edges furrow. Q: photo 2147 What photograph? A: distinct area of pallor on neck ligature furrow with diffuse petechial hemorrhages of skin face Q: photo 2151 What depicted photograph? A: similar photograph to distinct area of pallor ligature furrow superior inferior edges diffuse petechial hemorrhages face Q: cause damage prominent dispersed face? A: petechial hemorrhages rupturing of small vessels in skin more present Dawson indicative moments blood through furrow ligature momentary increases in blood pressure more petechial hemorrhages Q: cause blood flow? A: movement against carotid arteries carotid arteries thicker muscular veins likely to push through with blood movement of ligature person handling ligature Dawson himself. Q: could be from Dawson struggling or more pressure force of ligature? A: Yes Changes in pressure ligature. [03:30:18] Q: examination of Dawson determine cause of death? A: Yes. Q: And what was that? A: Asphyxia. Q: move to submit original photos of Cora and Dawson for identification other shown to jury as exhibits. CLERK: Exhibits N and O for identification. COURT: over defendant's objection same analysis other photographs may be admitted. SPRAGUE: photos of Cora and Dawson next exhibits CLERK: It's 228 and 229. SPRAGUE: death certificate of Cora Marie Clancy next exhibit. REDDINGTON: no objection to death certificate. SPRAGUE: death certificate of Dawson William Clancy next exhibit nothing further OLSON: Thank you, Your Honor. COURT: anything to address before tomorrow morning? ## Day 13 (464 of 1629 turns kept) [04:00] CLERK: Good morning Honor proceed CLERK: matter of Commonwealth v.Lindsay Clancy Clancy present represented by Attorney Kevin Reddington Commonwealth by Assistant District Attorney Jennifer Sprague Assistant District Attorney Shanan Buckingham REDDINGTON: Morning, Your Honor. COURT: Morning, Ms. Clancy. L.CLANCY: Morning, Your Honor. CLERK: Good morning, Your Honor. May I proceed? CLERK: continuation of jury trial Commonwealth v.Lindsay Clancy Clancy present represented by attorney Kevin Reddington Commonwealth by Assistant District Attorney Jennifer Sprague Assistant District Attorney Shanan Buckingham COURT: for instructions schedule today different progress of case anticipate hear witnesses today may break early issues not sitting tomorrow not sitting on this casesuggestion not to come in relax. we'll come in Monday at 9:00. expect most days going forward mostly schedule last maybe three or four days. wanted give information early confirm today. probably earlier day today not sitting tomorrow return to Commonwealth 's presentation of evidence Commonwealth call next witness please? SPRAGUE: Thank you. Commonwealth calls Kyle Pavao. COURT: Sure. Yeah. PAVAO: Morning, sir. COURT: Good morning, sir. PAVAO: Good morning, Your Honor. [Q=SPRAGUE A=PAVAO] Q: Thank you Good morning state spell name for record A: Kyle Pavao. K-Y-L-E, last name P-A-V-A-O. [08:22:00] Q: And where do you work? A: Massachusetts State Police. Q: How long have you worked there? A: Eight years 18 law enforcement experience Q: in Cyber Crime Unit? A: three and a half years Q: examine extraction Surface Pro seized from 47 Summer Street Duxbury September 16th, 2025? A: I did. Q: working on computer Surface Pro A: Correct. Q: initial review extraction visit website Suicide Methods August 23rd, 2022? A: It did. Q: site Suicide Methods what learn A: When I went back? Q: Yeah. Go ahead. [19:07:00] A: first Facebook visit at 9:40 morning Q: 9:40 AM on August 23rd, 2022? A: Correct. Q: after visit Lind.say.969 Facebook page A: search Spotify music for singer Tom Hall Q: With permission? A: That was at 9:42. Q: two minutes after Facebook A: Correct. Q: And was that at 9:44:18 AM? A: Yes. Q: Then what happened next? A: Google search for Tom Hall Q: And was that at 9:44:30 AM? A: Yes. [21:11:00] Q: Wayback website Tom Hall page on Wikipedia August 23rd, 2022? A: I did. Q: marked next exhibit REDDINGTON: No objection. REDDINGTON: no objection to documents COURT: It says Tom T. Hall. SPRAGUE: Tom Hall, yes. SPK1: 232 [Q=SPRAGUE A=PAVAO] Q: What happened there? A: description Wikipedia page Tom Hall's death wording shooting related ultimate suicide Q: hyperlink bring person? A: original artifact Wikipedia Suicide Method directed to shooting section page Q: how long person spent on page Suicide Methods page accessed? A: No. Q: Want to look at your report? [01:10:00] A: At 9:45 AM. Q: 9:45 AM Suicide Methods page accessed correct? A: use Wayback Machine see August 23rd, 2023? Q: Yes. A: marked next exhibit SPK1: 233 PAVAO: observed another Wikipedia page Grafton Bridge [Q=SPRAGUE A=PAVAO] Q: from hyperlink Suicide Methods page? A: Yes. Q: page eight Exhibit 233 jumping section hyperlink to bridge A: Correct. Q: Suicide Methods page accessed 9:45 AM Grafton Bridge webpage accessed? A: It was shortly after that. Q: 9:48? A: Correct. [03:13:00] Q: three minutes after Suicide Methods page hyperlink Grafton Bridge clicked? A: Correct. Q: other activity besides Suicide Methods page Grafton Bridge three minutes? A: I did not, no. Q: marked as Exhibit 234 SPK1: Exhibit 234. PAVAO: Correct. COURT: Sustained. If you could- [Q=REDDINGTON A=PAVAO] Q: attached to Plymouth County DA's office or working? A: assigned to Cyber Crime Unit Q: Cyber Crime Unit works with DA's office Plymouth A: Crime Unit independent statewide unit Q: For example, like suicide? A: Suicide would be one. Q: after search for suicide unable else came across entry August 23rd timeframe Surface Pro computer 9:40 in morning right [07:47:00] A: The... Can you rephrase that? PAVAO: Sorry. [Q=REDDINGTON A=PAVAO] Q: whose Google Gmail account? A: That I don't know. Q: October report 20. '25 or '22? A: 25. Q: October '25 district attorney's office asked conduct search of computer A: trooper in Plymouth State Police Detective Unit reached out Q: Justin Paul. A: Correct. Q: On Spotify? A: After Spotify search Q: timeframe went to hyperlink to methods of suicide correct? A: That is correct. Q: leaving with jury August 23rd 9:40 morning jumping from Tom Hall to Wikipedia account suicide page occurred between 9:40 and 10 o'clock morning [14:21:00] A: Correct. Q: led to Wikipedia about suicide A: That is correct. Q: October report searches from Surface Pro A: Yes. Q: recall representative sample Surface Pro computer jumping to December 5 not August '22 December '22 Google searches psychiatrist over-prescribed A: Yes. Q: Searches for medications, right? A: Yes. Q: Including Lamictal, right? A: Correct. Q: Can benzos reveal bipolar disorder? Right? A: Yes. Q: Lamictal versus Zolofy Zoloft search A: Yes, correct. [17:51:00] Q: Ketamine therapy on January 18th 2023 correct A: Yes. Q: result dealing with DA in July 26th '26 prepared report purpose find more details "methods of suicide" page A: Correct. Q: webpage not search for methods of suicide Tom Hall and music A: That is correct. Q: don't want to leave with jury Lindsay looking up ways to commit suicide in August '22 A: presenting facts presented SPRAGUE: They're already in evidence. CLERK: Exhibit 235, exhibit for identification. SPRAGUE: looked at day search suicide methods other places visited August 23rd, 2022 correct? PAVAO: Correct, 2022. SPRAGUE: visit Grafton Bridge Wikipedia page 9:48 AM correct? Not 10:00 AM PAVAO: That visit was at 9:48, correct. COURT: All right. Anything further? [01:52:00] SPRAGUE: Commonwealth calls Timothy Chiappini. [Q=SPRAGUE A=CHIAPPINI] Q: Where do you work? A: work Commonwealth of Massachusetts Department of State Police Q: worked State Police A: graduated academy March 2012. Q: What is your current assignment? A: unit commander Critical Incident Technical Investigations Team Q: assignment January 2023? A: assigned State Police Detective Unit Plymouth County District Attorney's Office Q: zoom in explain different columns A: columns automatically generated software supplemental report Cellebrite Physical Analyzer Software Analysis Tool stipulate certain parameters content timeframes investigation multiple columns top reflecting different types data timestamp description source file timeline report reflects columns predetermined by software Q: December 21st, 2022 2:57 PM correct? A: Yes. Eastern Time. Q: from Lindsay owner to Allison correct? A: Yes. [01:04:26] Q: general depression mental health program Mc Lean Hospital text message sent from Lindsay 's phone to Allison? A: Correct. Q: search PDF term Patrick medications populate text messages searches keywords A: Yes. Q: what report showing? A: singular item from documents section Project Tree known as analysis component of Cellebrite Physical Analyzer one single document. Q: next one What report from December 26th, 2022 to January 24th, 2023? same search for information data on phone during? A: timeline report is chronological report of events on device same categories as previous exhibit first item within date parameters calendar entry. Q: January 20th, 2023 A: Yes. Q: So basically categorized? A: Correct. Q: November 3rd. [Q=SPRAGUE A=CHIAPPINI] Q: scroll down to October 25th entry read this portion of note difficulty A: sad depressed not parent third child like first want treat like first not feasible stopped breastfeeding feel not connected with Cal resent other children prevent treating Cal like first not fair depressed last evening Cora Dawson school rough evening want to feel love connection with kids internal conflict wanted to have lot of kids don't want Cal to be last figuring out to do before another." fence about starting new medication for anxiety/depression want to feel happy relax take care of kids deeply relax hang out with Pat fall into deep sleep for eight hours pour into myself hour and a half Cal planned desired want give him love deserves." guess be third child not first third child exist know he'll be okay hard for me hate he put himself to sleep sad not breastfeeding anymore right choices." [01:14:18] Q: If you could continue. A: sleep training needed baby slept night opportunity to catch up on sleep If time for me to nap every day not case't When Cal naps I take care of Cora Dawson feels cruel we not do that to Cal but reality is we did what we had to do." feel slightly traumatized by sleep training present when severely sleep deprived paranoid did was right thing breastfeeding goes hand in hand with sleep training started sleeping most night daily struggle to keep milk supply supplements eating drinking enough to keep supply up pumping extra hard with Cora Dawson tried to leave Cal go out with Cora Dawson stressed about pumping Cal at home not taking bottle battle of if pump or not did right thing need to leave Cal with someone get fed need to present with other kids." want fourth child need good therapist on fence about starting new med not want to feel happy authentically happy not fake need to feel happier than last evening depressed not enjoying children sad needed breastfeeding off plate." struggling hard wanted to parent each kids like first can't depressingroot cause of problems feel not parenting kids makes sad try best today." "Things love doing help appreciate enjoy kids activities started depression after Cora started getting up out with her felt better signing Cal up for baby music class great Fridays my day with him fallen out of habit of doing fun for myself with Pat need to work on that." positive note great deep night sleep terrified of something happening kids doing wrong development generation inundated with information about parenting wrong scary things insane last five years filled mind with parenting unhealthy." Q: note created December 22nd, 2022 modified January 23rd, 2023 correct A: Yes. Q: photographs accessed changed A: evening hours January 23rd, 2023 Q: next report displaying A: timeline report first event starting January 24th, 2023 4:00 PM Q: January 24th 2023 4:00 PM to 8:00 PM A: encompasses everything before timeframe last entry 7:02:01 PM Q: things done phone between 4:00 and 8:00 PM January 24th, 2023 A: detected by forensic tool extraction type Q: 4:13 PM Apple Maps Three V Restaurant at 4:13 PM? A: Yes. Q: Because that changes constantly, correct? [01:29:46] A: Yes. Q: scroll phone call outgoing call 4:48:21 to 781-585-6581CVS 189 Summer Street Kingston A: Yes. Q: 4:53 PM message 80 defendant's phone 4:53:09Lindsay to Patrick Clancy A: Yes. Q: response from Lindsay to Patrick message 84? A: Yes. Q: message 92 Patrick to Lindsay A: Yes. Q: 94 at 5:06 PMLindsay to Patrick short nap message 96 A: Yes. Q: message 97 at 5:06ThreeV menu searched A: Yes. Q: 98 search for Pedia-Lax A: Correct. [01:33:33] Q: message 97 January 24th, 2023 5:06:45 search for Three V menu same date time search Pedia-Lax A: And what's the question? Q: 5:07 PM message 115 from Patrick to Lindsay 5:08 PM Scallop and Pork Belly Risotto." A: Yes. Q: recall 508-927-4046 number Three V restaurant A: Yes. Q: scroll down further searches at 5:13 PM starting 128 for Pedia-Lax? A: That's correct. Q: 5:33 PM 146 message 146 message from Lindsay to Patrick 5:15 PM "Pedia-Lax liquid stool softener A: Yes. Q: 1:47 5:33:51 PM phone call from Patrick's phone to Lindsay 's phone A: Yes. Q: call lasted 14 seconds A: Correct. Q: reports submitted disk next exhibit [01:39:53] REDDINGTON: No objection. SPRAGUE: Exhibit 236 defendant's phone access information on calendar phone CHIAPPINI: I did. SPRAGUE: marked next exhibit SPRAGUE: one more exhibit done COURT: Okay. That's fine. SPRAGUE: move admitted next exhibit CHIAPPINI: All right. REDDINGTON: Yeah. Thank you. [Q=REDDINGTON A=CHIAPPINI] Q: Yes, Your Honor. Thank you. Morning. A: Morning, sir. Q: cell phone Lindsey's cell phone A: Yes, sir. Q: district attorney asked reference Exhibit 237 Cellebrite report caption for extraction Cellebrite report A: supplemental report from Physical Analyzer software [01:48:32] Q: Cellebrite asked Looking at Exhibit 237 second page top tell right what depicting right? little box. [Q=REDDINGTON A=CHIAPPINI] Q: know see little box? [inaudible] quote you exhibit district attorney asked look at 237 right? A: Yes, sir. Q: look down next one says what date? A: August 23rd, 2022. 10:00 AM. Q: tell entry? A: subject is 10:00 AMCallan Kingston Vaccine. Q: date subject A: start time August 23rd, 2022, 5:00 PM subject entry 9:45 Kingston Dawson, ear check. Q: Exhibit 235 what this document. A: recognize screen capture from Axiom phone extraction Q: And what's the website? A: Mail.google.com. Q: Does 180,000 sound about right? A: It does. [01:56:44] Q: No. I'm sorry. The exhibit. A: calendar supplemental report Q: Excuse me, Your Honor. [Q=REDDINGTON A=CHIAPPINI] Q: Speak with Mr. Barano bring report today? report not all exhibits A: No, sir. Q: agree concerns investigator looking for buzzwords like suicide? A: not sure understand question Q: looking for different topics suicide, drugs killing kids investigate buzzwords A: Yes, sir. COURT: Sure. Yeah. [Q=REDDINGTON A=CHIAPPINI] Q: Thank you drag [inaudible] down continuity marked Exhibit R, S, T for identification not exhibit jury question agree phone identifier numbers listed same on three exhibits? A: Yes, sir. Q: Hold that. The exhibit [inaudible]. A: Yes, sir. Q: handed Exhibit 237 exhibit district attorney questioned [02:01:25] A: supplemental report Cellebrite software calendar application Q: document calendar seeing doctor 9:45 and 10:00 appointments A: That's correct. SPRAGUE: Exhibit 238. [Q=REDDINGTON A=CHIAPPINI] Q: Exhibit 238 captioned mommy text message thread between Lindsey mother A: For January of 2023, sir, yes. Q: Exhibit 238 representative example look September 28th at 6:18 morning A: Sir, can you repeat that date? Q: September 28th didn do September January A: exhibit for January 2023 Q: Sure. A: Yes, sir. Q: Lindsey to mother January 3rd 8:35 morning A: At 59 seconds, sir? Q: Yeah. [02:04:38] A: Anxious about meeting psychiatry team." Q: next message January 3rd 8:37 morning A: In 31 seconds? Q: Yeah. A: mommy to Lindsey Sleep good last night?" Q: January 8th A: That's correct. Q: 9:48 morning mother asking questions Lindsey sleeping A: message at 9:48:15 from mommy to Lindsey Q: date January 10th A: 2023, 9:48:21 AM. Q: January 10th Not 23rd A: January 10th, 2023 at 9:48:21 Q: Yeah. A: January 10th 2023 9:53:01 AM feeling better day?" mommy to Lindsey [02:07:39] Q: January 12th, 11:09 morning A: Yes, sir. Q: What did mommy say? A: mommy to Lindsey January 12th 2023 11:09:32 AM feeling better?" Q: January 16th. January 14th at 1:05 afternoon. pull one up? A: Yes, sir. One moment. Q: Sat Dec 30 1899 01:05:00 GMT-0600 (Central Standard Time) A: AM or PM? Q: Yes, sir. Yep. January 14th. A: message from Lindsey to mommy January 14th, 2023, 1:05:13 PM. Q: 16th of January pull one up January 16th at 10:20. A: message from Lindsey to mommy January 16th 2023, 10:20:24 AM. Q: continuing January 18th agree she inquired mother asked starting new med?" said did started two nights ago." mother asking about medications how felt doing A: One moment get to point Q: exhibit jurors have it look good on that [02:10:52] A: Okay. Don't I answer the question? Q: other searches searches medical questions bipolar symptoms psychosis? DKA without high blood sugar? Page Trazodone effect of Trazodone?Wellbutrin feel Trazodone?Ativan addiction.Prozac Trazodone saw her search phone Cellebrite A: I recall those searches, sir. COURT: Any objection? CLERK: Exhibit 239. COURT: Great. Thank you. [Q=REDDINGTON A=CHIAPPINI] Q: date of search? A: January 19th, 2023, 9:58:01 AM. Q: psychosis? search for psychosis A: If I may? Q: Yeah, of course. A: keyword search, "psychosis Google search Q: Google January 20th? A: January 20th, 2023, 8:39:00 PM. Q: recall pages she Googled inquiring suicide? [02:15:07] A: Yes, sir. Q: when Googling suicide? A: December 29th, 2022, 1:02:14 PM. Q: larger package searches "Trazodone correct A: Yes "Trazodone " one keyword multiple Google searches Q: Okay. Zoloft? A: Correct. Q: Yeah, sure. A: Earliest entry December 31st, 2022 4:07:48 PM Last entry December 31st, 2022 7:06:39 PM Q: timeframe A: January 20th, 2023, 8:11:57 PM. Q: What is it? A: January 16th, 2023, 9:14:47 AM. Q: What's the timeframe? A: December 29th, 2022, 8:52:37 AM. [02:18:05] Q: What's the timeframe? A: December 31st, 2022, 7:12:58 PM. Q: December 21st or 31st A: December 31st, 2022, sir. Q: What's the timeframe? A: entry January 20th, 2023 8:39:00 PM Q: And what's the timeframe? A: January 16th, 2023, 9:23:13 AM. Q: keyword search "postpartum Google "postpartum depression" aspects A: Yes, sir. Q: ending A: earliest entry December 6th, 2022 9:17:05 AM last entry January 20th, 2023 8:13:48 PM Q: time started? A: earliest entry December 29th, 2022 9:00 AM, 37 seconds last entry January 13th, 2023 1:38:42 PM Q: timeframe [02:21:03] A: searches indicate January 18th, 2023 11:26 AM to 11:27 AM Q: next "Ativan Ativan What's search Ativan A: The earliest timeframe, sir? Q: Yeah. A: December 31st, 2022, 7:06:30 PM. Q: amitriptyline search end A: January 16th, 2023 11:01:28 AM last entry January 23rd, 2023 8:17:58 PM Q: January 19th 2023 searching "hallucinations"? A: Yes, sir. 10:33:49 AM. COURT: Sure, yeah. CHIAPPINI: You're welcome, sir. SPRAGUE: No objection. CLERK: Exhibits 240 through 260, submarked. [Q=REDDINGTON A=CHIAPPINI] Q: next December 31st? A: "Children's Motrin stores." [02:27:17] Q: Next one. A: "Six month old wale windows." Q: Okay. Next one. A: "Earth's Best Organic Baby Food." Q: Next one. A: "Earth's Best Organic Infant." Q: Next one. A: "Earth's Best Organic Infant Formula." Q: Next one. A: "Nova Plymouth," N-O-V-A. Q: Next one. A: "Best kids movies." Q: Next one. A: "Nova Trampoline Lark." Q: Next one. [02:27:50] A: "Unicorn picture." Q: date now? A: last item ADC Temple Touch Thermometer date January 17th, 2023 Time 2:19:03 PM. Q: date? A: last date "MiraLAX for kids January 24th, 2023 4:47:31 PM. CHIAPPINI: Yeah. CLERK: Exhibit 262. [Q=REDDINGTON A=CHIAPPINI] Q: date time? A: January 24th, 2023, 8:19:45 AM. Q: Yeah, sure. A: Next item January 24th, 2023 8:36:17 AMLindsay Pat loved image reflection used feature iMessage like image Q: Sure. A: January 24th, 2023 8:42: 16 AM Patrick to Lindsay "How's it going?" SPRAGUE: text messages evidence exhibit 23. COURT: Commonwealth redirect. [02:34:28] [Q=SPRAGUE A=CHIAPPINI] Q: exhibits defense counsel searches psychosis drugs available disc Exhibit 236 search word mentions? A: Yes. Q: exhibit 258? search psychosis searches psychosis symptoms January 19th, 2023 correct A: That's correct. Q: person phone looking symptoms psychosis A: keyword search psychosis symptoms Q: questions chats Lindsay mother exhibit 238 A: Yes, ma'am. Q: text message Lindsay 's mother Lindsay January 22nd, 2023 Sunday after Saturday visit mother "Enjoyed seeing everyone weekend Nice see you doing better." A: That's correct. CHIAPPINI: That's correct, sir. SPRAGUE: Objection. COURT: If I can see counsel, sidebar. COURT: All right. Attorney Sprague, anything further? COURT: members jury 1:00, 1:01 don't hold afternoon recess ready come back 2:00 next witness instructions samebreak don't talk case't do research't read listen see you back 2:00. thank you. [02:40:52] REDDINGTON: Before we break, Judge, I apologize. COURT: Yeah. REDDINGTON: introduced records from South Shore Health put cover page wrong page reference actual medical record objection to substitute status? appointment. SPRAGUE: Oh, no objection. REDDINGTON: Yeah, sure. CLERK: Honor record turn back to matter Commonwealth versus Lindsay Clancy All parties present excluding Jury SPRAGUE: Thank Honor Commonwealth calls Joshua McKelligan [Q=SPRAGUE A=MCKELLIGAN] Q: Good afternoon state spell name for record? A: Joshua McKelligan. M-C-K-E-L-I-G-A-N. Q: Where do you work? A: Massachusetts State Police. Q: How long with state police? A: Since December of 2013. Q: January 2023 assigned? A: Plymouth County District Attorney's Office [02:45:15] Q: State Police Detective Unit Plymouth County DA's office group of troopers work there A: Yes. Q: learn? A: About 6:45 PM. Q: Between three and 4 AM? A: Yes. Q: early morning hours January 25th, 2023 A: Yes. Q: submit scene video from home next exhibit COURT: Any objection? SPK7: 264 SPRAGUE: three photos marked next exhibit on disc? COURT: objection admitted? SPK7: Exhibit 265. SPRAGUE: investigation Patrick Clancy defendant on psychiatric medication? [02:54:26] MCKELLIGAN: Yes. SPRAGUE: included prescription medication in search warrant? MCKELLIGAN: Yes. REDDINGTON: Objection not his attorney SPRAGUE: observe family defendant interacting children exhibits at museum? MCKELLIGAN: Yes. SPRAGUE: Exhibit 14 play small portion not played previously [Q=SPRAGUE A=MCKELLIGAN] Q: point in video 11:58:30 what happening? A: Cora beginning to play with exhibit Patrick standing off Lindsay Clancy with Callan Dawson watching. Q: record pointed to Patrick towards top of screen Dawson near entrance to exhibit? A: Yes. Yes. Q: throughout video defendant seen instructing children showing how to work exhibit operating control panel? A: Yes. Q: switch defendant helps Dawson with same exhibit? A: Yes. [03:00:22] Q: participate in interviewing her Dr. Barbara Vidal Olson? A: Yes. Q: portion proposed testimony explaining how someone dies from strangulation? A: Yes. REDDINGTON: Objection. COURT: Counsel, sidebar. SPRAGUE: meeting with medical examiner constant pressure need applied after person unconscious in strangulation to affect death? COURT: Go ahead. SPRAGUE: several more minutes of strangulation? COURT: Thank you counsel jury might break early today recess on this matter excuse you Monday morning don't come tomorrow suggest take next couple days rest up long weeks appreciate work remind of instructions longer stretch at home talking to people remind do not talk about this case with anyone Don't do research about this case or similar cases If questions don't do research Don't try educate yourself on issues or facts heard in case Don't make road trips places fill in gaps. remind you keep open mind. easy to nod say yes at beginning of case but now heard evidence haven't heard all evidence. haven't heard closing arguments of attorneys haven't heard law you apply. reminded you to do that. important wanted remind you thank you for work done work going to do hope you have nice weekend see you on Monday. still well on track'll see you on Monday.We'll continue with trial. have nice weekend. Thank you. COURT: All right SI want see counsel sidebar address Commonwealth 's motion trial court security logs. COURT: Counsel? BUCKINGHAM: Your Honor Commonwealth asking court allow Commonwealth defense have copies of log advised trial court security for people back lockup area visit defendant during trial. myself and ADASprague witnessed points medical staff go back with defendant not motion other individuals not counsel permitted to go back there not alleging inappropriate staff security staff followed protocols aware Dr. Zeizel been back there witnessed priest allowed back there advised visitors kept as log when come exit days times Commonwealth alleging information necessary for cross-examine defense witnesses Dr. Zeizel potential bias he's there back there presented as expert witness on criminal responsibility ethical rules forensic psychiatrists psychologists follow might subject to cross-examination relationship with defendant could area for cross-examination court records not in care, custody control of Commonwealth filed motion as rule 17 motion asking for access to records for this defendant during trial. COURT: Let's stay focused on- ## Day 14 (292 of 1434 turns kept) [04:00] CLERK: morning, Your Honor. proceed? CLERK: before court today matter of Commonwealth versus Lindsay Clancy. Ms.Clancy present represented by attorney Kevin Reddington Commonwealth represented by Assistant District Attorney Jennifer Sprague Assistant District Attorney Shannon Buckingham COURT: Good morning, Ms. Clancy. L.CLANCY: Morning, Your Honor. CLERK: Good morning Your Honor proceed? COURT: Please. CLERK: court today continuation of jury trial Commonwealth versus Lindsay Clancy. Ms.Clancy present represented by attorney Kevin Reddington Commonwealth represented by Assistant District Attorney Jennifer Sprague Assistant District Attorney Shannon Buckingham COURT: Well, good morning everyone. COURT: thank you for following instructions today's schedule stop and start bear with us break after short time bring back in nature of cases Commonwealth close portion of evidence today defendant opportunity to present witnesses evidence burden of proof on Commonwealth If defendant offers evidence Commonwealth opportunity offer rebuttal evidence next phase after Commonwealth rests go more see where we are everything fit procedurally go forward return to Commonwealth 's case. Attorney Sprague. SPRAGUE: Your Honor Commonwealth calls Ian Whiffin COURT: All right. Attorney Sprague, please. [Q=SPRAGUE A=WHIFFIN] Q: asked locate Apple Health data information relevant investigation incident 47 Summer Street Duxbury January 24th, 2023 A: I was, yes. Q: received copy extraction Lindsay Clancy 's iPhone 13, correct A: Correct. [17:21:00] Q: 11:46? A: Yes. Q: 5:23 PM last recording heart rate 57 A: Correct. Q: searches January 12th, 2023 19:48 7:48 PM correct A: Correct. Q: search title "How Quickly Wellbutrin Work for Depression?" user search A: search Q: Wellbutrin? A: Wellbutrin "Work for Depression Google Search title page Google assigns Google Q: 7:49 search Lamictal for depression A: depression spelled B user typed Q: 7:55 PM user typed Elavil for depression A: Correct. Q: page 16 January 18th, 2023 10:25 search ketamine for suicidal ideation correct [08:47:00] A: Correct. Q: January 19th, 2023 page 17 symptoms postpartum psychosis January 19th A: Correct. Q: 9:30 AM another search psychosis symptoms A: Yes. Q: page 17, January 24th searches kids MiraLAX 02:02 PM takeout 3v 4:13 PM correct A: That's correct. Q: CVS Pharmacy 4:47 PM A: Correct. Q: Apple note created December 22nd, 2022 10:23 AM modified 10:23 AM January 23rd, 2023 correct A: Correct. Q: 5:34 PM outgoing call from Lindsay 's phone to Patrick's A: Correct. Q: 14 seconds A: Correct. [15:31:00] Q: 6:09 PM another incoming call from Patrick to Lindsay unanswered A: That's correct. Q: metadata first one captured South Shore Medical Center correct A: Correct. Q: 4:13 PM, 16:13 January 24th highlighted green A: 16:13:23 until 16:14:50 Apple Maps application used visible screen Q: 5:13 device unlock A: Yes. Q: flight climb ended 5:38 A: two flight climbs Q: calls phone realizes 5:38 another flight climbed A: Correct. Q: submit report next exhibit REDDINGTON: No objection. SPK3: 1566 [05:22:00] [Q=REDDINGTON A=WHIFFIN] Q: Thank you, Your Honor. Morning. A: Good morning. Q: watch stopped recording information 5:23 PM A: last heart rate 5:23:52 Q: further activity following morning 25th January, 6:00 morning A: ended analysis 24th Q: 5:40, 5:45 A: Correct. Q: till 5:58, 6:00 PM A: Purely the data on the device. Q: Yeah. A: didn't go back Q: testified case Commonwealth versus Victor Arrington Suffolk Superior Court Boston support accuracy artifact information A: Correct. Q: Yeah. [01:00:09] A: 9:34 device visited location COURT: Any objection? SPRAGUE: No objection. SPK3: Exhibit 267. [Q=REDDINGTON A=WHIFFIN] Q: Different page? A: That looks like this page 12. Q: All right. 19:11 7:11 morning? A: 7:11 PM. Q: PM.Trazodone and Benadryl. hour later trazodone headache, Google search Trazodone ibuprofen Trazodone Tylenol to 20:32 8:32 PM.Trazodone and Tylenol interactions right? A: Correct. Q: Yes quickly Wellbutrin work for depression? Googled? A: Correct. Q: Followed by Lamictal depression Elavil depression sleep deprived Ketamine for suicidal ideation? A: Correct. Q: searches suicidal ideation, drugs,Trazodone mixtures nature [01:04:50] A: It does. Q: what modified? counsel asked modifications nature asking modified? A: don't have all front possible to see snippets back over time recall 22nd of December created started with same sentence few spelling differences time snippet two sentences rest Q: look page 22, January 24th at 8:19 morning cell phone number 781-375-8564. what say? A: "Cutie." Q: P-H-E-W? A: Yeah. Yes. Q: appendix? A: Appendix One Lindsay Clancy phone is 1,300 web search visits. COURT: Any objection? SPRAGUE: No objection. SPK4: Exhibit 268. COURT: Any objection? SPRAGUE: No objection. SPK4: 269 [01:13:03] REDDINGTON: Report Number Five says Surface Pro laptop to Patrick Clancy. WHIFFIN: Correct. SPRAGUE: No objection. SPK4: 270 REDDINGTON: jump to January 25, 2023 7:00 in morning? WHIFFIN: Yes. REDDINGTON: example January 25 at 8:00 in morning distance travel, steps counted distance 47 meters or feet? WHIFFIN: Yes. Meters. SPRAGUE: earlier defense counsel put exhibits of indexes for data phone and computers correct? WHIFFIN: Correct. SPRAGUE: From 5:38 PM to 6:09 PM other flights climbed from watch or phone? WHIFFIN: Don't believe there was, no. SPRAGUE: move to submit full extraction next exhibit copied now put disk envelope in place REDDINGTON: No objection. COURT: Anything on that, Commonwealth? [01:22:40] SPRAGUE: Commonwealth rests. SPRAGUE: sorry exhibits. mistake by agreement. SPK4: 272A, B. SPRAGUE: Mass General Institute of Health Professions transcript. SPK4: Exhibit 273. SPRAGUE: The PF transcript. SPRAGUE: The PF transcript. SPK4: 274 SPRAGUE: employment records from Mass General Hospital. SPK4: Exhibit 275. REDDINGTON: Great. Thank you. REDDINGTON: passed to court rule 25. memoranda cite court case Commonwealth versus Brunette-Selveira decided end of May '26 by Appeals Court in Massachusetts case Boston Municipal Court defendant charged with assault and battery on police officer evidence defendant acting erratically evidence defendant suffering from mental illness government rested case suggestion to court evidence presented on case against Ms.Clancy, suggest not rise to level under rule 25 Latimore standard evidence decided light favorable to government stage Brunette-Selveira case places negative obligation to prove negative on government. suggest Honor evidence overwhelming young woman suffering from mental disease defect occupying her waking hours life considered all avenues attempted to go to healthcare providers had medication acting in state observed by witnesses suffering from mental disease, defect horrific incident. under Brunette- Selveira case no evidence from government rebut evidence lack of criminal responsibility. under Brunette-Selveira cases suggest required finding of not guilty should be entered. argue to court under Brunette-Selveira standard evidence matter should be reduced from premeditated malice of forethought cruelty atrocity to second degree. not arguing Commonwealth versus Gray or progeny manslaughter but court discretion has ability right to reduce charge to second degree murder or enter required finding. SPRAGUE: Thank you, Your Honor. case defense counsel cited presentation Commonwealth 's evidence Commonwealth rested Defense called expert defendant not criminally responsible Commonwealth relied on cross-examination witness call further witnesses motion filed for required finding at close evidence required under Commonwealth versus Lawson Brunette Silva cites good law SJC case, 475 Mass 806 2016 court says motion for required finding not guilty lack of criminal responsibility brought at close evidence not close Commonwealth 's case defense plans presenting experts testified defendant not criminally responsible Commonwealth rebuttal case with own experts time place for motion at close of evidence not now [Q=REDDINGTON A=HAMP] Q: Ready. Ready for the jury, Judge. A: Good afternoon, Your Honor. [01:36:31] Q: Tell us your name. A: It's Margaret Hamp. Q: Where? A: At Mass General. SPRAGUE: patients mental illness psychiatric medications HAMP: Sometimes. SPRAGUE: working labor and delivery training handle patients certain medications HAMP: Limited training, yes. SPRAGUE: affects birth plan delivery long-term medication SPRAGUE: aware Zoloft safe for pregnant breastfeeding moms HAMP: Yes. SPRAGUE: remain medication compliant manage HAMP: Yes. SPRAGUE: Thank you. Nothing further. REDDINGTON: experience dealing with patients birthed child district attorney Zoloft expressing issues parent aware incidents Lindsay woman concern wanted to hurt herself child? [01:44:49] HAMP: particular patient Lindsay on staff when arrived unit had plans to harm herself while pregnant. had conversation Lindsay new summer started conversation about mental health in pregnancy postpartum asked her if heard of Andrea Yates case she hadn't explained she cried said how could mother hurt children? REDDINGTON: Thank you. All set. SPRAGUE: Commonwealth? COURT: Hey, good afternoon. COURT: Great. Thank you. Counsel. [Q=REDDINGTON A=OZGA] Q: Thank you, Judge. Afternoon. Tell your name spell A: Allison Ozga, A-L-I-S-O-N. Last name O-Z-G-A. Q: tell jury observed about her demeanor symptomology decompensating? symptoms? A: communication with Lindsay Pat reporting mood worsening depression more suicidal thoughts. Insomnia issue not feeling like herself Q: during period suicidal thoughts issue depression seeing doctors? A: Yes. Q: seeing doctors if on medication? what effect on her? A: first thing said about doctors in October saw doctor for Zoloft had awful reaction Zoloft Q: What else recall? A: end of December not feeling well Her mood down feeling numb hopeless end of month had suicidal ideation every day for a month. [01:51:55] Q: recall end of month New Year's she voluntarily admitted herself? A: Yes. Q: at Mc Lean Hospital know how she got out Mc Lean Hospital? A: understanding weaning off medication discharged five days later Q: see her or talk to after left Mc Lean Hospital wean off medication? don't know medication A: I believe it was Seroquel. Q: tell observed her decompensating symptoms suicidal ideation depression feeling scary When she out Mc Lean what appear say? A: believe said felt good plan starting feel better Q: One survived passed? A: Yes. Q: see her in South Shore Hospital? A: No. Q: transferred to another hospital after South Shore? A: Yes. SPRAGUE: recall police spoke to Lindsay Thursday, January 19th, 2023 seemed okay? [01:57:26] OZGA: Yes. REDDINGTON: call Paula Musgrove MUSGROVE: Good afternoon, Your Honor. REDDINGTON: know she issues depression anxiety suicidal ideation? MUSGROVE: At that point, no. SPRAGUE: No objection. CLERK: Exhibit 276. MUSGROVE: "Mom stay with sick Something wrong horrible insomnia don't know how get through day started taking medicine for anxiety made things worse scary don't want to be alone." SPRAGUE: Objection. It's already in evidence. COURT: mark for identification text referred read within Exhibit 276 offered COURT: within Exhibit 276 thread offered SPRAGUE: Exhibit W for identification. COURT: Yeah. Okay. [Q=REDDINGTON A=MUSGROVE] Q: What kind of photography? A: School picture photography. [02:10:07] Q: knew she was on medication A: Yes. Q: When was that? A: That was late November, early December. Q: recall end of January statement about medication mind? A: Yes. Q: What did she say? A: couldn't remember anything medication destroying mind't her "This isn't me want to feel better enjoy kids again." COURT: see counsel briefly sidebar? ready for jury? CLERK: returned to trial of Commonwealth versus Lindsay Clancy All parties present including defendant 18 jurors. COURT: Thank you Madam Clerk. Theresa Brigg [Q=SPRAGUE A=MUSGROVE] Q: Thank you, Your Honor. Good afternoon. A: Afternoon. Q: asked about text messages in October now in exhibit 276 texts on 20th she asked you to come hard time A: Yes. [02:20:16] Q: after next day she trouble wanted you there went day there for a week text on October 20th not included in exhibit October 24th at 2:36 PM text "How are things today?" she responds "Good." remember? A: Yes. Q: page marked as next exhibit. COURT: Any objection? CLERK: 277 [Q=SPRAGUE A=MUSGROVE] Q: consider her committed to psychiatric facility? A: No. Q: Exhibit 238 your text messages Lindsay January 2023 page 17 January 4th, 2023 day before she discharged from Mc Lean. she sent text "Think coming home tomorrow evening talked to doctor follow-up appointment with other psychiatrist Rebecca Friday morning she okay leaving Thursday around five." remember messages? A: Yep. Q: page 29, text messages Lindsay January 8th ask how things going today she says "Good going to science museum." fun Sleep good last night?" she did less Ativan good." remember? A: don't recall exact text messages Q: asked her 14th feel different since off Seroquel?" She "Not as much talk to psychiatrist Monday." little still don't feel like you corrects ask if get outside with kids today try." similar conversations about medication she doing medication A: Yes, I did. Q: following day checking in feeling better?" She "A little bit." "Still taking same medication?" She "Yes appointment with psychiatrist." know how it goes." she responds back after appointment.recommended antidepressant mood low Seroquel asked her felt wants to feel like herself up for trying wants get back to who she was A: Correct. [02:33:00] Q: she told you was amitriptyline. right? remember that? A: I don't remember the medication. Q: 18th January 18th you reaching out she says Hi mom I'm doing right How about you?" you say good thinking about visiting weekend she sounds good." ask about exercise walking on treadmill at gym asked started new medication feeling better "Feel okay not great two nights ago." takes to feel effects?" weeks." feeling now better than few weeks ago?" she said "Yes." remember that A: don't remember specific text remember texting daily about feeling different medication-wise can't remember specific text reading if they there done by us Q: 19th of January checking in feeling today? different with new medication?" She feeling all right Nothing new takes weeks to work okay." asked sleeping well "Decently kids get up a lot." same check-ins daily seeing how she doing sleeping A: Correct. REDDINGTON: check later exhibits district attorney introduced evidence showed Exhibit 276 list of texts dated October 19th remember? black one copies't green and blue.recall introduced evidence? recall her questioning? MUSGROVE: On October 19th? REDDINGTON: introduced Exhibit 276 date October 19th text thread. MUSGROVE: Oh, yes. I'm sorry. SPRAGUE: Objection. COURT: Sustained. REDDINGTON: district attorney suggested something missing left out fair say Exhibit 277 different date? Look at date date DA talking about? see? MUSGROVE: 10/3. REDDINGTON: introduced evidence Cellebrite record Exhibit 238 state police district attorney's office printed out month of January. recall testimony? [02:43:37] MUSGROVE: Yes. Yes. COURT: I see counsel sidebar, please. SPK13: 278 [inaudible]. SPRAGUE: asked about Exhibit 271 text messages October 23rd and October 24th establish left home week of 20th correct? said "How are things today?" said good implying no longer with them correct? COURT: Good afternoon Mr.Reddington, hold off? give instruction REDDINGTON: Yep. COURT: Members jury instruction apply to this witness witnesses testified earlier witnesses testify after expert witnesses Generally cases tried courts witnesses testify to facts personal knowledge seen heard felt variety cases issues arise beyond experiences laypersons allow person with specialized training experience expert witness to testify not to facts opinions reasons opinions on issues within witness's field of expertise irrelevant material case witness specialized training experience not put witness higher level than other witness.treat expert witness like any other witness as any other witness up to you to decide accept testimony witness including opinions. up to you decide accept facts relied on by expert decide conclusions draw from witness testimony. free to reject testimony witness whole or part. If determine opinion not based on sufficient education experience, witness motivated by bias or interest keep you alone decide facts if conclude expert's opinion not based on facts may reject testimony whole or part expert witnesses do not decide cases. Juries do. expert witness like any other witness you alone make judgment about credibility weight to expert's testimony conclusions draw. go into more at end extensive instructions at end of trial. Mr.Reddington [Q=REDDINGTON A=VOLFOVICH] Q: Newton-Wellesley? A: Yes. Q: by American Board of Emergency Medicine? A: Correct. Q: You're presently employed. Where is it? A: Newton-Wellesley Hospital primarily. do additional shifts at Emerson Hospital in Concord. Q: medical school? Where go to med school? A: St. Louis University School of Medicine. [02:49:40] Q: What year did you graduate? A: 2011 Q: Obviously licensed in the Commonwealth. A: Yes, sir. Q: interrupt. What a G6? A: GCS, Glasgow Coma Scale. Q: Slow down don't understand What is GCS? A: Glasgow Coma Scale. series of things determine responsive eyes opening spontaneously speak understand saying moving moving spontaneously follow commands Q: South Shore Hospital stabilize her? A: stabilize her by placing breathing tube in neck throat help breathing obtain imaging start on medications to sedate artificially raise blood pressure rewarming her trauma team decision better served at hospital with higher level of care Q: experience for years in emergency room treat people tried to commit suicide or successfully committed suicide by cutting throat? A: Multiple times. Q: Multiple times. medical certainty injury injuries consistent with other suicide attempts? SPRAGUE: Objection. COURT: Sustained. [02:54:25] REDDINGTON: look like effort to pretend or fake of suicide? SPRAGUE: Objection. COURT: Sustained. SPRAGUE: Anything further? COURT: Next question. [Q=REDDINGTON A=VOLFOVICH] Q: familiar with hesitation wounds in suicide attempt? A: Yes, to some extent. Q: she transported by Med Flight or Life Flight to Boston hospital? A: She was. Q: what hospital? A: Brigham Women's Hospital in Boston. Q: suffer particular event night recall from records? A: did after in surgical ICU moving her blood pressure dropped pulse faint suffered complete cardiac arrest required two rounds of cardiopulmonary resuscitation with compressions medications before revived. Q: going out of window strike ground? A: She did. [02:59:52] SPRAGUE: Objection. COURT: see counsel at sidebar? COURT: Counsel see you in sidebar? COURT: Members of jury stop and start stop now for day come back talk to counsel about setting things up logistically for tomorrow plan start at 9:00 full day witnesses excuse you until tomorrow at 9:00 remind don't talk about this case Don't read similar cases Don't do research Don't listen to Don't post anything ask follow instructions give questions hope have nice evening We'll see you tomorrow morning Thank you. COURT: Counsel see sidebar regards to tomorrow? Not long marked for identification impounded. REDDINGTON: Thank you, Your Honor. COURT: Thank you Counsel Anything address before tomorrow morning Commonwealth? ## Day 15 (530 of 1697 turns kept) [10:00] CLERK: Honor court matter of Commonwealth versus Lindsay Clancy Clancy present represented by Attorney Kevin Reddington Commonwealth represented by Assistant District Attorney Jennifer Sprague Assistant District Attorney Shanan Buckingham COURT: All right. Good morning, Ms. Clancy. L.CLANCY: Good morning, Your Honor. CLERK: Good morning Your Honor proceed? CLERK: court today continuation of jury trial Commonwealth versus Lindsay Clancy Clancy present represented by Attorney Kevin Reddington Commonwealth represented by Assistant District Attorney Kenneth Stray Assistant District Attorney Shanan Buckingham COURT: All right. Thank you, Madam Clerk. CLERK: You're welcome. COURT: thank you for following instructions talk today's schedule point in trial stop starts go through similar day today appreciate patience deal with counsel case moving forward gaps stops reason keeps case moving schedule today similar to yesterday return to defendant presenting case. Attorney Reddington? REDDINGTON: call Sue Clancy. S.CLANCY: Susan Clancy. COURT: Hi. Good morning. [Q=REDDINGTON A=S.CLANCY] Q: Thank you. Good morning. A: Good morning. Q: you and Chris mother and father of Patrick? A: Correct. [06:21:00] Q: 38 years in labor and delivery? A: Correct. Q: fair to say you keep up with recent developments in postpartum psychosis depression? A: mainly was in delivery room Q: aware of physicians forefront postpartum studies medicine? A: Yes. Q: tell who Meg Spinelli? A: don't know Meg Spinelli well spoken times specializes in postpartum mental health Q: recommendations for her? A: reached out to colleagues running clinic for women struggling postpartum Q: Would that be the South Shore? A: Yes, correct. Q: Did Lindsay see Julie? A: I believe she did. COURT: Any objection? [13:01:00] BUCKINGHAM: Your Honor Commonwealth same objection previously made COURT: Commonwealth 's objection be admitted COURT: Thank you. Commonwealth? [Q=BUCKINGHAM A=S.CLANCY] Q: And what hospital was that? A: South Shore Hospital. Q: ... on November 16th- A: Correct. Q: at South Shore Hospital A: Yes. Q: She drove herself to the hospital? A: Correct. Q: she in emergency room seen by doctor provided medication there doctor? A: Yes. Q: aware doctor ER doctor gave trazodone to help sleep A: Yes. [18:39:00] Q: provide Julie Paul's contact information? A: She suggested Julie. Q: Lindsay defendant communicated via text about issues with sleep medication A: Yes. Q: ER visit trazodone prescribed recall conversation about okay to increase it if relief? A: doctor told her repeated Q: aware she increasing dose A: I did not know that. Q: taking new medications after saw Julie A: Yes. Q: after prescribed medication recall Lindsay thought she developed benzo dependency? A: I vaguely remember that. Q: response "Why scared? if don't take? afraid of? about Ambien trying help her figure out medication A: lot of medications Q: wasn't prescribed all medications different combinations as options [02:58:00] A: It seemed confusing. Q: she clear tells medications taking Ativan Remeron A: Probably. Q: respond "Exactly." she depressed thinks brought on by medication A: I don't remember that. Q: November 30th 7:52 never depressed brought by medication." A: She probably said that. Q: remember breakfast on Christmas Day? A: Yes. REDDINGTON: Objection. [Q=BUCKINGHAM A=S.CLANCY] Q: at house between January 7th and January 24th A: I don't remember. Q: January 7th January Pat and Lindsay went to Cape Codder with kids A: I'm aware of that. Q: don't know help she asked for other than medication [09:23:00] A: No. Q: Nothing further. REDDINGTON: mentioned go to Women and Infants program in Rhode Island perinatal and postpartum S.CLANCY: Yes. REDDINGTON: gave numbers suicide hotlines S.CLANCY: Yes. COURT: Come on. [Q=BUCKINGHAM A=S.CLANCY] Q: everything described connected to medication after postpartum period A: I don't know. Q: labor and delivery nurse postpartum period up to a year A: I've heard it could be longer. Q: sent from women and infants with several options inpatient treatment medication management partial hospitalization program general mental health outpatient management sent away A: Okay. Q: Nothing further. COURT: Go ahead. One. [14:01:00] REDDINGTON: That's correct. COURT: think after we talk take short break logistically everything set up with doctor system. appreciate help technically setting up. defendant provided five or six exhibits counsel wanted to introduce through Dr. Laposata.Commonwealth you had opportunity to look at these? COURT: discuss those in open court opportunity to saw these this morning Commonwealth hear objections then hear from defendant SPRAGUE: main objection is drawing inaccurate window well in wrong place her falling and landing in slide four where window well placed in photograph can pass up photograph to court in evidence couple times talks discretionary not mislead jury present information not accurate drawing inaccurate objecting to these slides COURT: Commonwealth objection window well in wrong place on drawing SPK1: late disclosure don't know if created testify scale not main objection is it's inaccurate. REDDINGTON: window well depicted on diagram accurately measurements taken by gentleman computer animation with information medical provided by Dr. Laposata shows X-rays included. exhibits she shows she falls she hits her head.Commonwealth suggesting confused how she ended up. shows landed on head gets Jefferson fracture falls back legs facing out from house laying in snow depicted there If issue with window well off according to government could raise on cross window well was six inches to left instead right never struck her irrelevant." useful for jury to review copies made for jurors court DAs Dr. Laposata has it taken diagram, window where body lands right actual X-ray. Dr. Laposata can compare injuries Jefferson fracture photograph shows blood in snow area window well suggest window well on page six way depicted don't know objection ask court allow this in COURT: Yeah. REDDINGTON: What's wrong with three? SPRAGUE: [inaudible] objection. COURT: objection noted take short break set up Zoom call. make changes to jury book presented only slides in book REDDINGTON: Four, five and six. REDDINGTON: not a book stapled together exhibits REDDINGTON: Four, five and six. REDDINGTON: Perfect. Thank you. [23:27:00] SPK9: Hello? REDDINGTON: Wait a minute. Hold on. REDDINGTON: Hold on, Doc. REDDINGTON: Yes. Donald Condie, G-O-N-D-I-E. REDDINGTON: don't know objection COURT: Yeah. BUCKINGHAM: objection provided with affidavit. original affidavit counsel agreed referred to standard of care not issue in this case reflects opinions in civil case provided another affidavit same paragraphs deletes ultimate opinion section adds Dr.Tufts and Nurse Gelada aware Lindsay symptoms suicidal ideation critically deteriorating condition care failed to take reasonable steps unclear from affidavit what testify to reiterate everything presented in records defense counsel expert testimony criminal responsibility error about medication regimens defendant on months? if case suggest cumulative testimony doesn't need to be presented this to jury COURT: similar to objection regarding cumulative. defense hasn't put it first witness cumulative analysis be done if follow-up expert addressing these areas? COURT: main objection may to Dr. Spinelli depends on her testimony overlaps with Dr. Condie's. COURT: Yeah. REDDINGTON: appreciate you recognize we not yet put on a doc don't accept their evidence their doctors. Our doctors first doctor qualified psychopharmacologist expect to elicit treatment she received medications she on effect her condition seeking medical help not criminal responsibility him lack of criminal responsibility psychopharmacology treatment she received not criticizing Gelada did Tufts detail her condition according to medical records medications provided experienced in jury cases know when you lose jury not Dr. Zeisel Dr. Spinelli wax for bore jury to to chase Dr. Spinelli well-qualified doctor on postpartum psychosis depression treating pregnant woman postpartum perinatal client patient Dr. Zeisel general psychologist discussing issues involved with Lindsay for three years, 46 times seen her focus their testimony on those fields't necessary for to have Dr. Condie on voir dire hear not him rambling or going off script. He signed affidavit better than medical reportthey plenty cross-examine REDDINGTON: That's correct. COURT: right over Commonwealth objection allow Dr. Condie's testimony line with affidavit not testify standard of care opinion original statement. COURT: God bless you. REDDINGTON: Yes. Thank you, Judge. Dr. Condie. [09:42:00] COURT: All right. Good morning, Doctor. CONDIE: Morning, Your Honor. [Q=REDDINGTON A=CONDIE] Q: what do you do for work? A: I'm child, adolescent adult clinical forensic psychiatrist. Q: background school medical degree A: graduated Tulane University graduate school University of New Orleans medical school Louisiana State University New Orleans Boston Massachusetts Mental Health Center train psychiatry Q: And where is that? A: Massachusetts Mental Health Center at 74 Fenwood Road building demolished now 75 Fenwood Road Boston. Q: board certifications? A: board certified in adult child adolescent psychiatry Q: focus on medications in psychiatry A: career treating state system psychotic disorders mood disorders Q: worked with more than hundred people serious psychotic disorders A: Massachusetts Mental Health Center state inpatient facility many people with no insurance or MassHealth insurance half patients had psychosis or major depressive disorder Q: career psychosis major depressive disorder focus treatment on women pregnant or babies help postpartum period? [01:01:20] A: Yes. Q: Tell us about that. A: starting residency 1983 patients at Massachusetts Mental Health Center pregnant psychosis people delivered child hospitalized psychotic depression suicidal ideation encountered few frequently since 14 years chief medical officer of Vinfen large agency contracts from Department of Mental Health Department of Mental Retardation in Massachusetts Connecticut ran 350 group homes 10 people per home 3,500 patients people pregnant taking medications for psychosis Sometimes after delivery severity psychosis familiar with phenomenon Q: '83, '90 2000, 2026 40 years A: A little more than 40 years. Q: 1990 through 2012, affiliated with forensic child psychiatry Mass General Hospital A: Yes. Q: affiliated through 2013 Mass General forensic case consults A: Yes. Q: specialty lecturing Harvard medical students A: general psychiatry child and psychiatry forensic psychiatry Q: offer CV exhibit SPK15: Commonwealth. SPK16: No objection. [Q=REDDINGTON A=CONDIE] Q: You've never evaluated for criminal responsibility [01:05:29] A: That's correct. I have not. Q: conversations about medications women pregnant or postpartum A: Yes. Q: Excuse me tell jury summary documentation medical records police reports on case review? A: reviewed records of Rebecca Jollotta nurse practitioner Dr. Jennifer Tufts psychiatrist saw Ms.Clancy reviewed Brigham and Women's Hospital records Women &Infants records Mc Lean records might leaving something out. Q: Thank you. A: allergies kicking up review records start with Dr.Tufts ' records understanding Ms.Clancy planning to work labor and delivery nurse at Mass General worked 12 midnight to 12:00 AM shift after first two deliveries postpartum anxiety consulted Dr.Tufts Q: after third child Callan treatment with Dr.Tufts treating physician A: Yes. Q: describe them? A: sparse many check boxes records not sentences describe during sessions. Q: recall medications Dr.Tufts prescribed Lindsay? A: first medication was Zoloft, 25 milligrams. Q: Tell Zoloft A: Zoloft- [01:10:13] Q: effect person? A: Zoloft is selective serotonin reuptake inhibitor antidepressant started used around 1988Prozac first Zoloft second combats anxiety depressive symptoms causing jitteriness increasing anxiety potential side effects beneficial effects. Q: she prescribed original 25 milligrams Zoloft, did she take or defer taking? A: recollection records had prescribed not take for couple weeks not wish take medication. still breastfeeding medications Zoloft likely appear in breast milk Q: dosage increased? A: increased from 25 milligrams to 50 milligrams. Q: what happened when Lindsay took 50 milligrams Zoloft prescribed by Dr.Tufts? A: records indicate had rapid difficulties insomnia for 48 hours couldn't sleep activation medications cause Q: mid-October began taking Zoloft, records indicate week after starting medication increasing dose reported October to Dr.Tufts felt.Tufts? A: being numb not being herself feeling worse not better Antidepressants take two to three four to six weeks to useful effects side effects happen quickly Q: indicate crying all day experiencing mental fog terrified to stat new anxiety worse? tell to Dr.Tufts end of October? A: recall things in record. Q: What she say to Dr.Tufts? A: Dr.Tufts reported Lindsay 's psychiatric condition deteriorating checkbox on records Q: What Lindsay say her symptoms? [01:15:06] A: racing thoughts feeling not like herself depression worse Dr.Tufts thought of trying medication Zulresso. Q: need by injection? A: Zulresso no longer marketed successful medication requires 60 hour continuous IV infusion Q: Okay. A: costs $34,000 for medication not monitoring. Q: What's next thing happened with Dr.Tufts and Lindsay Clancy? A: affidavit she stopped taking medication Zoloft felt better Zoloft less anxious. Q: What was the next medication? A: Benadryl difficulty sleeping worried son coughing about children's health. Q: other symptomology November into December relate to Dr.Tufts medical records? A: talked about dizziness feeling sedated sleep used term brain fog symptoms postpartum depression continued about anxiety Q: Who was that? A: started treatment with Rebecca Jollotta nurse practitioner at South Shore Perinatal Program Q: symptom of psychosis be disassociated not in touch with reality? A: can be Dissociation people feel like things not real [01:19:52] Q: common with women postpartum psychosis A: It certainly can be, yes. Q: other symptomologies of postpartum psychosis? A: psychosis means lack of understanding of what's real not person with psychosis can have delusions false beliefs believe told by God to. have hallucinations Q: What kind of hallucinations? A: Most people have auditory hallucinations not visual hallucinations Q: Okay. As opposed to what? A: As opposed to visual hallucinations. Q: Visual reviewing medical records Lindsay had auditory no visual hallucinations but auditory voices? A: times reported heard a voice Q: Nurse Practitioner Jollotta Nurse Jollotta prescribed additional medications to Lindsay during from November through December? A: Yes. Q: What was the word you just used? A: BuSpar brand name for buspirone anti-anxiety medication Q: similar to not same as selective serotonin reuptake inhibitor Zoloft Prozac [01:22:49] A: similar has antidepressant effect effect on serotonin adrenal adrenergic system Q: Lindsay prescribed Prozac Remeron Benadryl other medications similar to SSRI s correct? A: Yes. Q: What effect on women baby? A: Well, many women experience postpartum blues. Q: What is postpartum blues? A: It's a feeling of- I'm sorry? Q: '50s thing What's postpartum blues? A: feeling low energy sad Not as serious long as postpartum depression Q: postpartum depression? next level? A: more serious condition woman can't connect to baby feels isolated no energy insomnia Q: if woman unable to sleep feels losing contact connection with infant stressing about contact unable to emote love can't relate to people out of reality disassociative state symptoms of postpartum depression leading to postpartum psychosis? A: Yes, they are. Q: Why? A: some women become anemic depends on blood loss during birth checking hemoglobin levels important thyroid affected by delivery baby some women postpartum develop inflammation of thyroid thyroid important gland regulates parts body [01:30:59] Q: psychiatrist treating patient postpartum after baby run thyroid test A: two thyroid tests test for thyroid stimulating hormone up body make more thyroid hormone not enough in circulation Q: reference to postpartum depression postpartum psychosis familiar with DSMDSM A: 5-TR. Q: Diagnostic Statistical Manual of Mental Disorders. 5 said TR test revision? A: Correct. Q: What is bipolar disorder? A: Bipolar newer name for manic depressive illness describes illness moods go up manic phase down depressed phase different categories of bipolar disorder Bipolar I most serious Bipolar II similar fluctuations mood both people spend more time being depressed than manic Q: Okay. A: extremely optimistic spend money foolishly worry win lottery psychotic thoughts bipolar mania unreasonable expectations destined to win lottery or serious cases believe God speaking special thing life Q: woman postpartum prescribed by doctor or nurse practitioner Jollotta A: nurse practitioner Julie Paul recommended long run Q: nothing wrong with woman to Kingsbury taking kids to local gym swimming pool exercise in postpartum stage A: No. Q: Where? [01:36:28] A: went to Mass General Emergency Room December South Shore Emergency Room previously Q: discharged after a day? A: records stated thought she having complications from medications than postpartum issues not good candidate for program. Q: suicide hotlines people told to call? A: Yes. Q: if woman in postpartum experiencing difficulties describing symptomology medications feel like to kill yourself supposed to call telephone number A: advice but some advice given Q: she given help by Aspire hotline? A: records say she told by Aspire suicide plan not require higher level care inpatient admission Q: she been to Nurse Jollotta contacted Aspire two occasions went to Rhode Island Hospital recommendation left after not accepted After calling suicide hotlines husband went to emergency room A: Yes. Q: bipolar disorder consideration treating as psychiatrist woman for help expressing concerns about symptoms? A: Yes. Q: Why? A: some people with bipolar disorder depression prominent symptom becomes suicidal can commit suicide serious possibility considered [01:40:21] Q: nurse practitioners consider possible diagnosis? A: records indicate Ms.Clancy frequently asked if plan to kill herself after reported passive suicidal ideation reported frequently in records Q: reference to treatment with Nurse Practitioner Jollotta Nurse Jollotta consider secondary possibility of bipolar disorder? A: Yes. Q: symptoms? A: often felt spacey not normal self felt hung over morning medicines. medicine make people sleepy beginning doses described sleeping dose low dose of medication sleep Q: 12th prescribed trazodone 150 milligrams by Dr.Tufts A: Yes. Q: over 1,000 pages A: Yes. Q: Bible of Psychiatry or cookbook? A: dictionary list of definitions Q: dictionary contain about postpartum psychosis for woman? A: one mention on page 148 Q: rest of world don't care about DSM other information [01:45:24] A: World Health Organization publishes International Classification of Disease 11th edition lists postpartum psychosis as separate entity insurance companies use for billing purposes Q: Right. Not this? A: familiar with other countries treat pregnant women in postpartum condition doctor for medical treatment? BUCKINGHAM: Objection. REDDINGTON: differ from United States of America? BUCKINGHAM: Objection. COURT: Sustained. CONDIE: Go ahead. [Q=BUCKINGHAM A=CONDIE] Q: Good afternoon. A: Afternoon. Q: Your curriculum vitae. A: Yes. Q: majority of entries experience presentations teaching fellowships revolve around child adolescent psychiatry correct? A: I wouldn't say the majority. Q: CV worked with postpartum women? [01:47:27] A: It doesn't say that specifically. Q: testimony in 1983 at Massachusetts mental Health Center worked with postpartum women correct A: patients pregnant or delivered hospitalized Q: Okay. A: Mr.Clancy for 90 to 100 minutes Q: medical treatment defendant hesitant about taking medications recall paragraph 11? A: Yes. Q: sought psychiatrist not therapist psychotherapist psychologist psychiatrist first contact in postpartum period correct A: Correct. Q: psychiatrists prescribe medications don't offer psychotherapy A: all psychiatrists trained to do psychotherapy can prescribe medication Q: records defendant reactions to low dose of Zoloft testimony blood test helped A: Yes. Q: blood test four or five months postpartum help prescribers? A: blood test level of antidepressant in blood average, expected dose too high or low [01:50:56] Q: yield results if taking medication for less than a week? A: Yes. Q: indicate four to six weeks expect medication effect correct? A: It sometimes takes that long, yes. Q: indicated reviewing records Jennifer Tufts notes series record boxes testimony A: few sentences mostly check boxes Q: important for treating psychiatrist consider considering patient's presentation A: Yes. Fair to say. Q: referenced affidavit defendant reported increased symptoms Zoloft didn't sleep 48 hours after increasing dose Remember record A: Yes, from 25 to 50. Q: person takes seven pills one week at 25 milligrams increase dose without more pills missing? A: took three or four pills few days 25 enough pills two 25s increase dose to 50 Q: prescription reads 30 filled 7 missing pill bottle located months later taken 7 pills one pill each day A: Not stopped taking medication quickly not which pill bottle didn't review police report Q: day presented to Mass General Hospital [01:55:30] A: Yes. Q: reviewing records Latiesha Dukes social worker mental health South Shore Perinatal Behavioral Health Clinic discussions with defendant about women and infants before presentation Mass General ER December 15th? A: Yes. Q: mentioned review medications lamotrigine recall? A: Yes. Q: medication prescribed to defendant December 2022 correct? A: Correct. Q: You've reviewed testified initial dose low dose 25 milligrams. A: Correct. Q: familiar common dosage low dose address sleep issues? A: It is, yes. Q: at Mc Lean, started to reduce dosage each night? A: believe plan at Mc Lean, yes Q: And Valium as needed and trazodone? A: That sounds correct, yes. [02:00:20] Q: review records different medications she on from October through January wasn't on all medications same time correct? A: No, not at the same time. Q: only on maybe three medications one time? A: Three might've been four Q: expressed particular medications wished to return to like Ativan correct? A: ambivalent about Ativan records worried was addicted it. Q: Ativan tended work for her correct A: made feel less anxious Q: described felt intrusive thoughts bad experience took Ativan thoughts gone not A: not intrusive thoughts gone feel less anxious took Q: conversations about hallucinations auditory hallucinations indicated testimony defendant a voice never reported to Jennifer Tufts heard voice? A: She did not. Q: Thank you. Nothing further. [Q=REDDINGTON A=CONDIE] Q: fear? A: records Ms.Clancy reported worried children taken away by Department of Children and Families if severe symptoms as healthcare professional boards of registration take dim view of people treatment for psychiatric illnesses might have concerned about nursing license speculation. [02:03:30] Q: agree don't have to see proverbial unicorn in corner health provider suffering from psychosis? A: Yes, that's true. Q: tell about symptomology psychosis grinds on for day week month or comes nowhere? quickly. A: Objection. COURT: Overruled. BUCKINGHAM: Objection. Beyond the scope... COURT: Overruled. BUCKINGHAM: Nothing further. COURT: All right. Anything further? COURT: Thank you, Doctor sit down sidebar scheduling? jury break till 2:00 next break resolve technology issue if resolved call one witness If not call another witness get done during break skills technology need longer than hour recess till 2:00 come back for next witness Thank you CLERK: Honor Commonwealth versus Lindsay Clancy. All parties present excluding jury. CLERK: return back to trial of Commonwealth versus Lindsay Clancy. All parties present including defendant 18 jurors. COURT: Counsel? REDDINGTON: tell us work history please. LAPOSATA: Since board certified 1983 had faculty positions in St Louis University School of Medicine assistant medical examiner city of St. Louis moved to Pennsylvania, Philadelphia ran autopsy service at hospital University of Pennsylvania faculty appointment research lab taught forensic pathology to medical students city of Philadelphia medical examiner After assistant medical examiner for state of Delaware 1993 selected chief medical examiner for state of Rhode Island position held until 2005 started independent consulting practice. [02:17:07] REDDINGTON: tell jurors medical records looked at? LAPOSATA: For Dawson Clancy? COURT: Is there any objection? REDDINGTON: Sure. That'd be great. COURT: jury pass out copies of exhibit follow testimony ask pass back to courtroom CLERK: 281 REDDINGTON: Doctor reference to Dawson Clancy review medical records photographs autopsy reports Dawson Clancy? REDDINGTON: photographs autopsy photographs [Q=REDDINGTON A=LAPOSATA] Q: autopsy photographs review? A: Yes, I did. Q: autopsy photographs of young children infants adults people examined prior autopsy during autopsy? A: Oh, yes. Many. Q: question notice on autopsy photographs children bruises to jury? aware of testimony? A: Yes bruises consistent with active children jumping running. Q: in your practice as pathologist occasion observe self-inflicted wounds to wrist or neck in suicide attempt? [02:24:08] A: Oh, many times. SPRAGUE: Objection. COURT: Sustained. REDDINGTON: neck? penetrate fascia or skin? To what degree? LAPOSATA: Yes linear superficial incised wounds to her neck several one or two went deeper bleeding from wounds on wrist numerous attempts at cutting skin hesitation marks classic finding in suicide attempts. incisions cut through skin cut blood vessels under skin photos Lindsay hospital bedroom significant bloodshed from cutting injuries COURT: Attorney Sprague. LAPOSATA: That's absolutely correct. COURT: objection? they may be admitted. SPK20: 1682 [Q=SPRAGUE A=LAPOSATA] Q: Doctor in report to defense counsel talked about strangulation of children? A: I did. Q: woman killed eight-year-old daughter by asphyxia testified A: Manual strangulation. Yes. Q: in 2011 asked complete." "Unconsciousness due to oxygenation within 10 to 20 seconds." complete compression of blood vessels of neck become unconscious within 10 to 20 seconds." hypothetically strangulation alone is 10 to 20 seconds." "If effectively continuously applied like lateral vascular neck restraint struggle't didn't testify it was 5 to 10 secondstestified 10 to 20 seconds struggling could longer correct? A: Yes, but that case was- [02:46:33] COURT: Hold on, Doctor. LAPOSATA: Sorry. SPRAGUE: asked in trial, Doctor question once unconsciousness set in agree consistent application of pressure suffocation strangulation or compressions chest for two to three minutes continuously while child unconscious correct?" answered fair statement." question said before yourself correct?" answered "Yes." asking your opinion." "After Camden unconscious after two to three minutes continuous application one three answered "Correct." LAPOSATA: no memory reading correctly. SPRAGUE: 2011, testified strangle someone 10 to 20 seconds to unconsciousness continue strangle for two to three minutes for death occur said correct. medical knowledge? LAPOSATA: different case not ligature manual. LAPOSATA: many ways occur pressure important understanding become unconscious children victims of ligature strangulation Fry case manual strangulation body compression different type asphyxia SPRAGUE: asked once unconsciousness set in agree consistent application of pressure suffocation strangulation compressions for two to three minutes more?" answered "Correct." not all three. either one could cause death after three minutes correct? [Q=SPRAGUE A=LAPOSATA] Q: asked unconsciousness set agree consistent application pressure suffocation strangulation compressions chest for two to three minutes continuously unconscious." said fair statement." correct A: become dead brain-dead physiology unconscious within 5 to 10 seconds unconscious not dead continued constriction blood flow continuously applied for brain to die Q: Correct. A: happened to Clancy children ligatures wrapped around went unconscious in 5 to 10 20 seconds less 20 seconds ligature not manual strangulation immediately compressed unconsciousness within 10 seconds death within 4 to 10 minutes Q: continuous pressure around neck A: ligature strangulation Q: Thank you. [02:50:46] A: Not manual. [Q=REDDINGTON A=LAPOSATA] Q: ligature strangulation manual strangulation A: different Manual strangulation used hand pressed either side of neck stopped blood flow brain carotid artery pump oxygenated blood brain can't drain out through jugular veins continuous pressure blood can't get flow out like stopping pipe unconscious within 5 to 10 seconds continued pressure brain dies difference between manual and ligature manual off and on jugular vein on either side of neck using hand compress one let goperson strangle struggle remove hand different sequence brain death asphyxia wrapping round loop resistance band ligature compresses vessels no off back complete one-time immediate non-varying compression exercise ligature causes unconsciousness 4 to 10 seconds Q: reference to manual strangulation use hands press thumbs common fracture of hyoid bone correct? A: Yes can happen U-shaped bone underneath jaw cause brain death from lack of oxygen different pathophysiologic process Q: counsel Rhode Island case questions manual strangulation reference to suffocation strangulation compression of chest nothing to do with ligature strangulation correct? A: different mechanism of injury COURT: Sprague. SPRAGUE: ligature causes unconsciousness pressure continuously applied for minutes cause death correct? COURT: All right. Anything further? REDDINGTON: question ligature require person to stand over body continuously apply pressure to ligature or walk? SPRAGUE: Yeah. Thank you. LAPOSATA: Thank you, Your Honor. LAPOSATA: Thank you, Your Honor. LAPOSATA: Goodbye. [02:59:25] SPK20: record returned to Commonwealth versus Lindsay. all parties present excluding jury SPK20: returned to trial,Commonwealth versus Lindsay Clancy All parties present including defendant 18 jurors. REDDINGTON: Call Dr. Paul Zeizel COURT: All right. Good afternoon, Doctor. ZEIZEL: Good afternoon, Your Honor. [Q=REDDINGTON A=ZEIZEL] Q: difference between psychiatrist and psychologist? A: psychiatrist four years medical school residency in specific field medicine psychologist graduate school four years gets PhD or PsyD doctor of psychology difference in clinical practice psychologists trained in counseling testing interpretation testing continues various treatment modalities working with children adolescents couples familiesextend neuropsych testing guardianship child custody cases many variants psychologists treatment testing evaluation mental health conditions Q: Can psychologists prescribe medication? A: Generally no Department of Defense psychologists military overseas prescribe medication 99% psychologists have prescription privileges. Q: testing referenced what referring to testing? A: testing across various domains person concerns about intellectual functioning for child school psychologist or educational psychologist testing on cognitive levels functioning neuropsych testing ADD attention deficit disorder ADHD other testing forensic testing integration of mental health and law requires psychologist know different types forensic testing issues pertaining to deception malingering personality assessment sociopathy DSM -5-TR antisocial personality disorder guardianship conservatorship custody issues parenting risk assessments for jobs government top secret positions police officers military Q: KScale she lying exaggerating malingering fake disease or defect? A: Yes, it had a K Scale. SPRAGUE: Objection. REDDINGTON: discuss faking or exaggerating opinion based review discovery case medical certainty Lindsay Clancy evaluation malingering lying exaggerating? [03:09:04] ZEIZEL: Yes, I do. SPRAGUE: Objection. ZEIZEL: She not faking no evidence malingering presented as honest citizen. [Q=REDDINGTON A=ZEIZEL] Q: How long were you in Afghanistan? A: in Afghanistan November 2007 to mid-February 2011. Q: What day? A: February 4th. Q: Tell jurors your memory A: conversation with Ms.Clancy asked if she knew where she was did mental status exam brief exam orientation to time place location She didn't know where was sure time knew who was remembers what happened fuzzy foggy on medication for pain post-surgery hospital room Q: We go back about 20 years? A: Yes. Q: How many times seen Lindsay since January '24? A: So, I've met with- SPK22: Objection. Relevance. COURT: Yeah. Sustained. [03:26:26] COURT: No, overruled. SPK22: Honor objection move to strike not responsive to question COURT: answer Lisa stricken. ZEIZEL: mental health not historical information Static information date of birth never change Dynamic issues subject to change like weather health mood evaluation Ms.Clancy involved triple homicide case requires examiner ensure she stand trial mental health stable court proceedings REDDINGTON: additional component suicidal ideation since custody Brigham Women's transferred years ago to Tewksbury? SPK22: Objection. Can we approach? [Q=REDDINGTON A=ZEIZEL] Q: timeframe focusing evaluation mental state after Callan postpartum? A: timeframe started September 2022 through January 2023 Q: first time expressing anxiety concerns insomnia went Dr.Tufts prescribed SSRI? A: Yes. Q: fall 2022 Dr.Tufts prescribed first SSRI A: Zoloft, yes. Q: indicia symptomology anxiety required placed medication? A: Yes, she did. Q: What was that medication? [03:31:13] A: believe Trazodone, Q: nursing school placed on medication? A: Yes, she was. Q: because public speaking nerves medication? A: multiple medications believe propranolol Trazodone Wellbutrin, not positive Q: What was that? A: That was Zoloft. Q: saw Dr.Tufts took Zoloft, 25 milligrams initially A: Yes. Q: react? A: didn't take medication initially waited few weeks started lower dose Q: react to increase Zoloft? A: Poorly. Q: September turned into October November Thanksgiving continued seek help from medical healthcare providers? A: Yes. [03:33:04] Q: group affiliated with? A: South Shore Perinatal Health. Q: Did Ms. Paul Nurse Practitioner Paul prescribe medication? A: Yes. Q: continue deal with South Shore Perinatal? A: Yes. Q: stop dealing with Nurse Practitioner Paul? A: Yes. Nurse Paul left. Q: Rebecca Gelata position? nurse practitioner? A: Yes. Q: how long deal with Rebecca Gelata? A: Three appointments. Q: Rebecca prescribed medication? A: Yes. Q: What was the medication? [03:34:00] A: I believe it was Seroquel. Q: Where? A: went to emergency room at South Shore to Mass General. Q: they prescribe additional medication? A: I believe they did, yes. Q: expressions to treating physicians about medications? A: Yes. Q: What did she say? A: said was in brain fog medications making worse not helping Q: Thanksgiving to Christmas continue to reach out for help suicide hotlines? A: Yes. She reached out to- Q: Why call suicide hotline? A: She was worried about killing herself. Q: get help from suicide hotline? A: She was turned away. [03:36:41] Q: second time called suicide hotline? A: She was turned away. Q: Why? A: Because she was overly medicated. Q: next thing dealing with healthcare providers Lindsay postpartum stage? A: went to Mass General Emergency Room Q: relates to concept of psychosis in 25 words? A: psychosis major mental health disorder disorganized thinking symptoms are hallucinations different types of hallucinations 80% of people with psychosis hear voices types voices benign Benevolent Or malevolent threatening ordering voices Q: McLean Hospital what medication typed in getting off of? A: believe she's getting off Seroquel. Q: to November 27th with dissociative state indicia or harbinger of psychosis? A: Yes. Q: psychosis suffering for month two months or short periods work? A: People with psychosis have intermittent symptoms function fine one day next day hearing voices seeing feeling smelling additional hallucinations plague Ms.Clancy only had auditory hallucinations hallucinations like waves at beach come and go. Q: doctor individual postpartum psychosis affliction afflicts women babies postpartum depression postpartum psychosis? [03:41:01] A: Yes. Q: person in psychosis able to make phone call? A: Yes, they can. COURT: jury recess until tomorrow morning schedule tomorrow similar to today without technology issues remind same instructions Don't read about this case similar cases don't talk don't listen Keep open mind go home have nice evening We'll see you tomorrow morning at 9:00 ZEIZEL: Thank you, Your Honor. ## Day 16 (324 of 1378 turns kept) [01:00] CLERK: Good morning, Your Honor. proceed? CLERK: matter of Commonwealth versus Lindsay Clancy Ms.Clancy present represented by Attorney Kevin Reddington Commonwealth represented by Assistant District Attorney Jennifer Sprang and Assistant District Attorney Shannon Buckingham. COURT: Morning, Ms. Clancy. L.CLANCY: Good morning, Your Honor. COURT: delay starting no fault sidebar talk about day schedule trying to get this moving. counsel?at this point we're going in recess come back soon this We'll resume trial. Okay. Thank you. CLERK: Your Honor record]Commonwealth versus Lindsay Clancy All parties present excluding jury. CLERK: Good morning Your Honor proceed? CLERK: court today continuation of jury trial Commonwealth versus Lindsay Clancy Ms.Clancy present represented by attorney Kevin Reddington Commonwealth represented by Assistant District Attorney Jennifer Sprang Assistant District Attorney Shannon Buckingham COURT: All right. Thank you, Madam Clerk. CLERK: You're welcome. JURY: Good Morning, Judge. COURT: Nice to see you appreciate here go over questions coming get back into case first question member jury read seen heard overheard anything case affect ability fair impartial? Next question other serious matter or concern service as juror attention? thank you for following instructions broke yesterday witness on stand testifying defense return to witness witness retake stand COURT: Good morning, Doc. CONDIE: Good morning, Your Honor. [Q=REDDINGTON A=CONDIE] Q: That'd be Nurse Practitioner Gelata? [04:57:00] A: Yes. Q: complained November 29th symptoms? A: issues unstable mood depression psychotic symptoms of disassociation Q: taking care of Callan infant Dawson Cora A: Yes. Q: What did she do? A: She called the suicide hotline. Q: receive help from suicide hotline? A: She did not. Q: call suicide hotline again? A: Yes, she did. Q: receive help second call suicide hotline? A: No, she did not. Q: tell us December towards December 15th her symptoms complaints observations about paranoia? A: Yes paranoid symptoms of psychosis getting more depressed. [09:40:00] Q: what medication on? First paragraph page nine. A: started take Seroquel, Remeron Klonopin. Q: complaints about effect of medications? A: Yes. Q: Continuing December status of condition depression symptoms paranoia intrusive thoughts? A: It continued unabated. Q: Where did she go? A: went to clinic Rhode Island, Parents and Women's Clinic partial day hospitalization program. Q: go same Mass General Hospital? A: Yes, she did. Q: bring her see doctor nurse practitioner Gelata complain about medication? A: Yes. Q: status? weaned off of medication to weaned off medication Mc Lean? A: believe so yes tapered down on medication. Q: medication tapered down? [13:33:00] A: Seroquel and Klonopin. Q: person in psychosis premorbidly psychosis able to look up things on computer? A: Yes. Q: indicative of feeling homicidal maniac help or Googling effects of medications? BUCKINGHAM: Objection. COURT: Is it an objection? COURT: Yeah. Sustained. [Q=REDDINGTON A=CONDIE] Q: during period she was Googling. what she Googling? A: words about sociopath. Can you treat sociopath? hallucinations? Q: she continue Google effects of medication psychosis numbness heaviness unable to? A: Yes related to healing Q: if person in psychotic state able to continue to Google use computer? A: Yes. Q: understanding person psychotic state able to drive car short distance go to appointment interact talk to people? A: Yes can do everyday tasks living [17:50:00] Q: she not talking about unicorns not slurring speech not unable to walk mean she not in psychotic state? A: It does not. Q: after she took Cora to doctors photographs between her husband, Pat afternoon A: built snowman in backyard with two kids. Q: MMSE?What's A: Mini Mental Status Examination common test. Q: What other test was that, sir? A: That's the Hare Psychopathy Checklist, H-A-R-E. Q: familiar with Mass General Hospital major research program on postpartum psychosis? A: Yes. Q: publish article regarding circumstances symptomology postpartum psychosis? A: Yes. Q: agree symptoms of postpartum psychosis depression? A: Yes. Q: Did Lindsay have depression? [22:36:00] A: Yes. Q: express anxiety tense nervousness? A: All of those things, yes. Q: indicate severe confusion hearing seeing things't there? visual hallucinations complain of hearing things hallucinations? A: Yes. Q: circumstances exhibited increased energy activity productivity hypomania? A: Yes. Q: Tell jury opinion A: opinion she mental disease defect legal construct DSM -5 had bipolar disorder with postpartum psychosis unable to conform behaviors to rule of law no appreciation for wrongfulness act Q: Thank you, sir. A: You're welcome. [Q=BUCKINGHAM A=CONDIE] Q: last time testified for Commonwealth prosecution in SDP proceeding? A: assigned case through Suffolk County Sexual Dangerousness Unit by ADA Kelly Ryan did evaluation July 2nd, 2026 Q: majority of work in Massachusetts contracted with Committee for Public Council Services A: Yes. [07:07:00] Q: fiscal year of 2025 approximately 300,000 paid through Committee of Public Council Services A: That sounds about right. Q: testified yesterday military experience not prescriber of medications Commonwealth A: I am not. Q: experience military limited ability to prescribe years ago don't do forensic psychiatry evaluations A: correct clarify accuracy not in military worked for Department of State Q: familiar with American Psychological Association Specialty Guidelines for Forensic Psychology? A: Yes. Q: ABA Criminal Justice Mental Health Standards identify roles forensic evaluators in criminal justice system including evaluating consulting treating A: Yes. Q: Standard 7-1.3 indicates evaluative experts obligation thorough impartial assessment sound methods objective opinion agree A: Yes. Q: American Psychological Association Specialty Guidelines Section 1.02 forensic practitioners strive be unbiased impartial avoid partisan presentations unrepresentative incomplete inaccurate evidence agree A: Yes. Q: she medication stabilized discontinuing psychotropic medications capacity to stabilize without them recall [12:33:00] A: Yes. Q: still taking psychotropic medications A: That's true. Yes. Q: recent evaluation June 2026 agree evaluation criminal responsibility forensic psychologist important to be accurate in reports A: Yes. Q: first time February 4th A: Yes. Q: aware she communicating with staff hospital including psychiatrists A: speaking with doctors staff Q: person major trauma hospital suicidal attempts hospital to talk to psychiatrist? SPK1: Objection. SPK2: Overruled. [Q=BUCKINGHAM A=CONDIE] Q: addition meeting staff psychiatry team prior arrival aware she had attorney few times? Not Mr.Reddington different attorney A: Yes aware attorney, Gelb involved in case Q: made another attempt calling Patrick? [20:33:00] A: Yes. Q: who she tell voice told her to kill herself? A: spoke to chaplain Sheila Cavanaugh Chaplain Cavanaugh told Ms.Clancy heard male voice instructing her to kill children then kill herself Q: review records Spaulding Rehab facility? A: Yes. Q: testified report identify her euphoric excessively energetic three months postpartum report A: Yes. Q: she exercised frequently before birth A: Yes. Q: report timeline medication decline September period prescribed Zoloft A: Yes. Q: reported increased Zoloft couldn't sleep 48 hours straight A: Yes. Q: aware of instructions reviewed pill bottle plan for Zoloft? A: not sure incremental plan from 25 milligrams to 50 milligrams Zoloft [08:09:00] Q: have bottle Exhibit number two. Sertraline Zoloft Brand named Zoloft A: Yes. Q: Right on the label. A: 25 milligrams to 50 milligrams Q: if seven pills missing from prescription dosage for week seven days how did she double dose? A: sometimes given medication have same exact dosage another time have pills didn't take previous month sometimes people finish before before current dose aware of don't know if other bottles she may have had medication Q: looking at exhibit one record from CVS Pharmacy bottles from only prescription for sertraline September 15th, 2022 for 30 pills aware A: Yes. Q: report refer to 11/29 page eight paragraph two 11/29 Paula Gelata Rebecca Gelata A: Yes. Q: prescribed Seroquel to treat Ms.Clancy 's anxiety depressed unstable mood psychotic symptoms disassociation Rebecca Gelata's record prescribed Seroquel? A: I'm not sure. Q: present when Ms. Gelata testified prescribed 25 milligrams for insomnia not anxiety depression unstable mood psychotic symptoms A: used off-label medications Sometimes for sleeping antipsychotic Q: aware records initial prescription for 25 milligram dose correct? [11:15:00] A: Yes. Q: not prescriber aware dose for treatment bipolar higher than 25 milligrams A: Yes. Q: described testimony repeated auditory hallucinations about wanting to kill herself damaged brain damaged A: That's correct. Q: aware she spoken to several forensic psychiatrists psychologists case not just yourself A: spoke to three retained experts April 10th and April 12, 2026 June 12, 2026, 1, 172 days after met 1,220 days after met third examiner SPK1: Objection. SPK2: Sustained. [Q=BUCKINGHAM A=CONDIE] Q: When? A: night of incident, January 24, 2023 Q: time heard male voice recounts events January 24, 2023 A: Yes, that's accurate. Q: fixed belief delusion A: delusion fixed false belief unshakeable not get rid of through efforts to voice or stop thinking [01:06:48] Q: medication journal she hadn't taken Klonopin since November 27, 2022 A: had prescription for may have taken some not regular basis Q: medications testified after Dawson 's birth she sought medication A: Yes. Q: testified she was on trazodone prescribed Zoloft after Dawson didn't take it A: correct. after testimony reviewed confabulated trazodone with another medication Zoloft. Q: talked medications she taking didn't provide relief important to know different medications reactions A: asked questions answered honestly didn't provide relief agree point of her seeking help Q: her history medication history social history family history important for to examine ultimate conclusions A: For everyone, yes, of course. Q: medication testified yesterday she took medication in nursing school A: Yes, she did. Q: met her many times reviewing records aware were Prozac,Wellbutrin propranolol took in nursing school A: correct for glossophobia fear of public speaking common fear for Americans 85% Americans have public speaking phobia medications she took in nursing school Q: not she testified yesterday [01:09:35] A: mentioned one or two medications taken three Q: indicated testimony opinion diagnosis is bipolar disorder with psychotic symptoms A: Yes. REDDINGTON: Objection. BUCKINGHAM: question did review report of Dr.Resnick sources information before conclusion about diagnosis? BUCKINGHAM: page four report sources information identify number 24 forensic psychiatric evaluation Philip J.Resnick 9/27/24 REDDINGTON: [inaudible] Objection. REDDINGTON: sidebar? not question [Q=BUCKINGHAM A=CONDIE] Q: review Dr.Resnick 's report prior conclusions diagnosis? A: reviewed part report perused reports not review all Dr.Resnick Dr. Spinelli Q: December 24th 2023 defendant observed Tewksbury monitored one-to-one safety accepted medication meals snacks spent time TV room outside room phone visited family recall note page 613Tewksbury records? A: Of 2023? Q: January 24th 2024 observed note Tewksbury State Hospital page 674 "Patient visible engageable staff peers accepted medications pleasant interactions Self-propelling wheelchair halls morning early afternoon room hall electronics." recall record A: Not specifically. Q: January 24th, 2024 year anniversary incident [01:19:59] A: Yes. Q: May 26th 2024 page 922Tewksbury record "Patient monitored one-to-one safety high suicide risks accepted medication." "BFK snacks spent time TV room outside room phone." agree fair reading page 922? A: no reason doubt Q: December 24th, 2024 page 1,442Tewksbury records patient visible on unit phone Her parents brought dinner Patient accepted medications fluids good behavioral control maintaining safety No SIB noted reported." reason doubt page 1,442Tewksbury record? A: no reason doubt not accurate reflection day Q: December 24th Corey's eighth birthday correct A: Yes. Q: move admit excerpts next exhibit SPK3: 283 [Q=BUCKINGHAM A=CONDIE] Q: prevalent in science forensic psychology psychiatry A: courses all domains work life Q: confirmation bias for psychiatry providers clinicians may lean support own theories overlook contradictory evidence aware A: Yes. Q: danger for clinicians forensic psychologists quickly forming initial diagnosis before information A: Yes. [01:29:30] Q: confirmation bias clinicians providers cling to diagnoses interpret information perceived idea fair A: cling. to diagnosis Q: reached cling interpreting subsequent information A: That happens, yes. Q: practice forensic psychology important not to do A: guidelines criminal responsibility don't need diagnosis need mental disease or defect Q: diagnosis helpful understanding person suffering from mental disease or defect correct? A: That's fair to say. Q: accepted field if somebody has disorder or diagnosed mental illness suffer from mental disease or defect Or could A: can have phobia Doesn't mean mental disease or defect afraid to jump out of airplanes can make ineffective have defect or disease could Q: today she had delusional thinking command hallucinations believed voices was paranoid worried.You've consistently testified yesterday today correct A: So- Q: testified person in psychotic state can do things done before hard new tasks A: Yes. Q: at doctor recommendation for over-the-counter medication [01:40:26] A: Yes. Q: defendant process information take back later search for get medication A: Psychosis doesn't lower intellectual functioning can do all those things correct Q: person can operate normally if in psychotic state person has significant distress A: Yes. Q: to mask symptoms requires enormous control A: depends on level extremism of psychotic processing some people hear voices nominal whisper Some voices yelling screaming continuum more upsetting powerful demanding voice more difficult to resist do other things less easier Q: moment please Your Honor move to admit recording as next exhibit. BUCKINGHAM: ... as the next exhibit, please. SPK3: Exhibit 284. REDDINGTON: Let's talk about confirmation bias. BUCKINGHAM: Can I sit down please? REDDINGTON: Compassion. CONDIE: Correct. COURT: Overruled. Overruled. [01:46:25] COURT: re-ask question answer stricken. REDDINGTON: documents reviewed exhibits aware of right CONDIE: Yes. As well as collateral contacts. BUCKINGHAM: Objection. COURT: Overruled. REDDINGTON: The five-week trial? BUCKINGHAM: Objection. COURT: Overruled. BUCKINGHAM: Objection. COURT: Yeah. Sustained. REDDINGTON: Sidebar? BUCKINGHAM: Objection. COURT: Overruled. REDDINGTON: district attorney asked about plan Lindsay go to another facility. Worcester CONDIE: Worcester Recovery Center Hospital. [01:55:33] COURT: Overruled. COURT: Overruled. REDDINGTON: doctor holding up marked as Exhibit 1 or I for identification seen this before? CONDIE: Yes, I have. COURT: Yeah, sure. See sidebar, please. REDDINGTON: hand to Chrissy marked as exhibit. COURT: Over Commonwealth 's objection admitted. SPK4: 285 BUCKINGHAM: briefly Doctor how many defendants evaluated for criminal responsibility spent 35 hours evaluating? CONDIE: One other person COURT: Sustained. [Q=REDDINGTON A=CONDIE] Q: Tewkesbury counsel to SIDSISI. is SI? A: is suicide intention suicide ideation. Q: Tewksbury concern of suicidal ideation? A: Yes. [02:03:11] Q: purpose during trial Lindsay? A: ensure Ms.Clancy stable competent to stand trial. Q: Thank you. A: You're welcome. COURT: Attorney Buckingham, please. COURT: All right. Anything further? CONDIE: Thank you, Your Honor. COURT: Counsel CC timing Members jury talk to counsel about matter outside presence do excuse till two o'clock We'll take up next witness stay here take up other matter during break same instructions.Don't talk about Don't do research Don't read anything Don't go anywhere see everybody at two o'clock. [Q=REDDINGTON A=THORNDIKE] Q: Thank you, Judge. Tell us your name. Spell last name for record A: Emily Thorndike. T-H-O-R-N-D-I-K-E. Q: name of business? A: It's called Wise Mind Therapy Practice. Q: What is it? A: Wise Mind. Q: Wise Mind? [02:08:30] A: Yep. Q: tell educational background A: went to Dover Sherburn High School Hartwick College Boston College School of Social Work. Q: Within the Commonwealth of Massachusetts? A: Yes. Q: And which one was Lindsay in? A: South. COURT: The direct of Patrick Clancy? [Q=REDDINGTON A=THORNDIKE] Q: tell judge understanding from experience hands working in STU supervisor of STU A: wasn't became social worker social worker psychiatrist are treatment team making decisions for patients nurses mental health specialists operating underneath you supervising never direct supervisor Q: Get your contact information. A: Yes. Q: What year? A: 2021 Q: 2021 [02:24:04] A: Yeah. Q: Two. A: Yeah. COURT: Okay. Commonwealth? [Q=BUCKINGHAM A=THORNDIKE] Q: Good afternoon. A: Hello. Q: records from Mc Lean Hospital indicate January 1st to January 15th 2023 social worker role was day position Monday through Friday A: Yeah. Q: pick up shifts majority of schedule was 09:00 to 05:00 Monday through Friday A: Yeah. Q: outlined experience on unit inpatient experiences schedule treatment team referred as social worker worked with psychiatrist A: Right. Right. Q: records show every day week treatment team social worker psychiatrist four social workers four psychiatrists on shift. A: Right. Q: transitioned to social worker worked closely with psychiatrist primarily Monday through Friday? [02:33:14] A: Yeah Psychiatrists nurses mental health specialists work together. Q: any information left there in 2021 same people supervising social workers giving same instructions? A: no don't know that. Q: object to witness. best evidence of defendant provided care treatment is record record Mc Lean documents each contact with person on staff during time there indication she went there on 31st of December records say was transported didn't arrive Mc Lean until early morning hours of January 1st records start document her each day step consistent with Dr. Goodheart described process intake day general schedule contact with treatment team. witness offering no more information than within record no more information in records received for trial subpoena suggest she last role as social worker from 2019 to 2021 day staffed person worked Monday through Friday wasn't there on weekends limited information attenuated than from dates defendant was at hospital suggest best evidence is records records now subpoenaed to identify particular staff.point out counsel's rebut inferences statements Commonwealth made in direct examination of Mr.Clancy, no one said Mc Lean is number one hospital. wasn't testimony question. what he knew observed contained within record. no presentation evidence person dispute groups are groups. court jury can see record groups make decisions based on record if treatment or not treatment. don't believe Commonwealth presented it as treatment.Commonwealth presented as resources available individual hospital. treatment from psychiatrist witness can't testify not. object for her called as witness for reasons. REDDINGTON: technicality. Note objection. COURT: Duly noted. Thank you. SPK5: purpose of record returned to title Commonwealth v.Lindsay Clancy. All parties present including 18 jurors. COURT: recess till tomorrow morning at 9: 00 Thank you REDDINGTON: Thank you, Judge. ## Day 17 (58 of 272 turns kept) [03:00] SPK1: Good morning Your Honor proceed? SPK1: today matter of Commonwealth versus Lindsay Clancy Clancy present represented by Attorney Kevin Reddington Commonwealth represented by Assistant District Attorney Jennifer Sprague Assistant District Attorney Shanan Buckingham SPK2: Morning, Your Honor. COURT: Counsel sidebar short recess bring jury back call next witness SPK1: Good morning Your Honor seat? SPK1: continuation of jury trial Commonwealth versus Lindsay Clancy.Clancy present represented by Attorney Kevin Reddington Commonwealth represented by Assistant District Attorney Jennifer Sprague Assistant District Attorney Shanan Buckingham COURT: Thank you Madam Clerk Good morning Nice to see you 10 minutes ask questions schedule today rest of week member jury read seen heard overheard anything about case affect ability to be fair impartial as juror? other serious matter or concern service as juror attention? thank you for following instructions schedule today allowed to roll eyes short day today issue nothing to do with attorneys in case All right? It's something we're to work out anticipate it worked out tomorrow count on lengthier day. talked to Counsel earlier morning schedule timeline. still not on schedule ahead of schedule. this delay this afternoon won't affect. appreciate it. you came in here this morning. It short day gear up for longer day tomorrow nothing to do with attorneys or parties. not to speculate not hold it against parties. If hold it against, can hold it against me. return to evidence case. Attorney Reddington? CAVANAUGH: Good morning, Your Honor. REDDINGTON: didn't know board-certified chaplains CAVANAUGH: become board certified need master's degree in theology or divinity complete 1,600 hours training post master's degree 1,200 hours clinical setting 400 hours classroom setting disciplines psychology sociology philosophy theology ethics acquire 2,000 hours additional clinical training before apply for board certification demonstrate mastery of 30 competencies before national board need ecclesiastical endorsement from Archdiocese of Boston Cardinal Seán O'Malley REDDINGTON: How senior at Fidelity? CAVANAUGH: 16 years. COURT: Sustained. [Q=REDDINGTON A=CAVANAUGH] Q: What time of day was this? A: between 8:30 and 9:30 morning [12:03:00] Q: showing exhibit 121 South Shore Brigham Women's indicative of first saw her? A: South Shore Q: other statements? A: alluded heard voice Lindsay told if follow command children safe Q: after Lindsay transferred from Brigham and Women's Hospital another facility? A: went Spaulding Rehabilitation Hospital Q: left Spaulding Rehab A: late March, early April Q: Brigham and Women's Hospital Spaulding Rehab under same umbrella A: Brigham Women's Hospital under Mass General Brigham Complex Lindsay in Spaulding same hospital complex psychiatrist Spaulding chaplains advised to continue Q: many times seen Lindsay at Tewksbury Hospital? A: Perhaps 200 times. SPRAGUE: Objection. SPK4: Sustained. SPK4: Sustained. That opinion would be stricken. [18:05:00] SPRAGUE: Objection. SPK4: No. Overruled. REDDINGTON: Tell the jurors. CAVANAUGH: Lindsay talks about children loves them deeply carries immense grief. SPRAGUE: Objection. SPK4: Overruled. Next question though. SPRAGUE: mentioned January 31st, 2023 spoke to defendant heard voice if follow command neither she nor children safe correct? CAVANAUGH: Correct. COURT: Commonwealth? SPRAGUE: move to submitted as next exhibit notes of witness interactions with Ms.Clancy at Brigham [inaudible] COURT: Any objection? COURT: Thank you step down Counsel see you? short day appreciate patience excuse till tomorrow at 9:00 Same instructions includes reading talking about case watching anything don't do it leave today drive, go home plan back tomorrow morning at nine o'clock longer day than today appreciate coming moved case little bit today able do hope nice afternoon evening We'll see you tomorrow morning for longer day remember instructions leave to come here tomorrow thank you COURT: take short break We'll come back We'll preliminary charge conference discuss possible jury instructions suggestions from Counsel talk logistical issues for tomorrow recess short recess come back up Thank you. COURT: All right Counsel wanted preliminary discussion regarding instructions after discussion distribute draft to Counsel focused charge conference next day wanted to get's thoughts suggestions court instruct jury using model jury instructions from March 2026 latest suggestions from SJCCommonwealth hear your thoughts then hear from defendant SPRAGUE: individual instructions listed opinion testimony prior inconsistent consistent statements redactions death certificates Stipulations consciousness of guilt instruction looking for charges instruction on first and second theories of first deliberate premeditation extreme atrocity and cruelty criminal responsibility instruction asking instruction intoxication not given no evidence of intoxication by drugs alcohol during killings testimony about defendant taking pills after killing children before killing on low dose prescription 10 milligrams of amitriptyline recently increased to 20 milligrams no evidence increased dose low dose of Trazodone Valium medications reported no side effects text mother still waiting to feel effects no evidence of intoxication from those drugs only intoxication potentially could be when took pills after killing childrenamounts toxicology low level asking instruction on intoxication not given [09:34:00] COURT: ask defendant read trying find definition of intoxication in homicide instructions cases dealing with OUI statute chapter 90 find real definition Commonwealth 's position intoxication beyond effect of drugs? COURT: if defendant takes prescription drugs effect considered intoxicated for? SPRAGUE: don't believe so instructions intoxicated affects state mind control intoxication not specific definition in homicide instructions general definition intoxication not just taking medication prescribed over taking medication combining with alcohol other drugs similar to instructions in OUIs operating under influence of alcohol or drugs definition general definition of intoxication if not specifically defined in instructions general definition intoxication taking substance alcohol drugs medication in excess affecting ability to think act control behavior COURT: opinion, prior consistent inconsistent redaction, stipulations consciousness of guilt first second extreme atrocity deliberate premeditation criminal responsibilities without sub-paragraph- abilities subparagraph paragraph regarding intoxication? SPRAGUE: Correct. REDDINGTON: don't know if government listening to same evidence in this case. involuntary intoxication defense judge's charge to jury based evidence presented over-prescription of medications side effects titration termination immediate cessation of medications against normal medical advice factors contribute to state of mind of Ms.Clancy expressed to people family members her indicated affected by benzos addicted to benzos trying to get off sertraline killing her 25 to 50 milligrams additional SSRI s prescribed no basis to give jury instruction may determine result of involuntary intoxication from narcotics not alcohol prescribed narcotics not illegal drugs from prescription drugs all fours valid defense should be instructed involuntary intoxication model jury instructions on criminal responsibility nuances bring to court attention tried murder case with model jury instructions satisfied with Judge O'Shea satisfied with instructions on lack of criminal responsibility would ask court to charge on involuntary manslaughter on wanton conduct with impact of intoxication can't try case in vacuum can't present case to jury.government present case only on cruelty atrocity don't like statute allows jury determine degree murder first second. evidence jury should option considering involuntary manslaughter based evidence permitted defer to court on instructions on cruelty atrocity premeditated malice forethought second degree malice ask court consider involuntary intoxication involuntary manslaughter as lesser offense anything else SPRAGUE: Thank you Commonwealth first second degree instructions position involuntary manslaughter wouldn't apply evidence specific intent to cause death nothing in involuntary instruction apply here back to intoxication SPRAGUE: medications defense counsel talked defendant reactions side effects before hospitalization at Mc Lean Hospital she weaned off Last one Seroquel while in Mc Lean Hospital without medications out of system for three weeks on other three medications intoxication matters not fall before Mc Lean on day of incident. Similar if OUI doesn't matter if drunk in November. matters drunk on date of incident matters January 24th, 2023 other drugs effects aren't relevant to day out of her system for three weeks COURT: Yeah. Good. Sure. REDDINGTON: occurred fresh from case last year model jury instructions indicate consideration of chart for court to write elements of offense of first degree murder, cruelty atrocity premeditated malice of forethought ask not do that't appropriate highlights simplistic premeditated malice of forethought had murder case last year another matter heard your instructions forceful with elements of offense don't need this appendixto with Judge O'Shea. not submit instruction list, cookbook to jury. court's instructions sufficient. not want chart referenced in model instructions. discretionary not obligated might be helpful for court to give jury checklist don't reduce instructions on murder case to checklist afraid jurors take checklist look at or consider it do that. It's a checklist. ask not do that. COURT: generally don't provide copy instructions to each juror they have own full copy follow along three you lengthy dry generally don't do chart. anything else instructions? COURT: plan have rough draft available for counsel tomorrow depending on timing closings opportunity to review go over draft objections or suggestions chance rough draft nothing in stone idea where coming from. REDDINGTON: Yeah. ## Day 18 (694 of 1700 turns kept) [19:00] CLERK: Good morning, Your Honor proceed? CLERK: [inaudible matter Commonwealth versus Lindsay Clancy represented by attorney Kevin Reddington Commonwealth represented by Assistant District Attorney Jennifer Sprague Assistant District Attorney Shannon [inaudible] CLERK: Good morning your honor. COURT: see counsel sidebar? set Your Honor Thank you CLERK: Good morning Your Honor proceed? COURT: Please. CLERK: court continuation of [inaudible] trial Commonwealth versus Lindsay Clancy Ms.Clancy present represented by attorney Kevin Reddington Commonwealth represented by Assistant District Attorney Jennifer Sprague Assistant District Attorney Shannon [inaudible COURT: Good morning everyone judge. looking for cheat sheet about questions ask follow instructions. has any member of jury read seen heard overheard anything from source affect ability to be fair impartial juror? Next.any other serious matter or concern your service as juror case attention? No. thank you for following instructions. schedule for today expect longer day Similar to days earlier this week. return to defendant call next witness witness testifying by Zoom or over monitors here earlier witness testified that way delay setting that up. It should be all set. kept me away from technology should working well see what deal with after this witness go on from there. Thank you. Mr.Reddington? REDDINGTON: delay ask question two or three second delay answer difficult try to get through tell what you do for work RESNICK: Yes. I'm a forensic psychiatrist. COURT: Overruled. REDDINGTON: Yep. CLERK: return to trial of Commonwealth versus Lindsay Clancy All parties present excluding jury REDDINGTON: Yes. Fingers crossed. CLERK: return trial Commonwealth versus Lindsay Clancy All parties present including defendant 18 jurors [18:18:00] REDDINGTON: Great. Thank you. [Q=REDDINGTON A=RESNICK] Q: speak slower microphone Tell background physician educational background work history A: forensic psychiatrist received bachelor's degree 1959 medical degree 1963 Case Western Reserve University Cleveland, Ohio one-month internship military hospital Texas University Hospital of Cleveland residency in psychiatry Q: Yeah, you can continue. I interrupted. I apologize. A: remained at Case Western Reserve University full professor interested in forensic psychiatry legal issues case initiated fellowship in forensic psychiatry 1979 directed 40 years served director of Court Psychiatric Clinic Cleveland, Ohio 40 years Q: board certifications? A: board certified in psychiatry, 1971 forensic psychiatry 1979 Q: added qualifications in forensic psychiatry in 2014, 2024 re-certifications? A: Yes. Q: Single L. tell jurors what means? A: Filicide is parent killing child infrequent phenomenon occurs in United States between 400 and 500 times a year. Q: describe statements she circumstances How she appear physically? answer questions? her appearance Her mood? A: she suffered major injury paralyzed during examination control of lower part body interview appeared matter of fact still grieving nurses crying daily about loss of three children medicated fully cooperative detailed account of recollections critical events. Q: Grand jury testimony? A: Yes. [04:27:00] Q: Videos? A: Yes. Q: Medical records from healthcare providers Dr.Tufts,Nurse Practitioner Gelata and Mc Lean Hospital? A: Yes. Q: she contacted suicide hotlines went to facility in Rhode Island, women and infants? A: Yes. I reviewed all those records. Q: see from Dr. Helbren, government's doctor, psychiatric testing? A: Yes, I did. Q: results psychiatric testing test government MMPI Minnesota Multiphasic Personality Inventory Test? A: psychological test administered Q: broke up not suggest evidence A: No evidence of faking psychiatric symptoms. Q: Not elevated doctor, subspecialty or interest in people malingering or faking in forensic world? criminal case workman's comp case pretending back hurts focused on that in career? A: major interest. written 46 articles book chapters area first 1984 new research comes out new edition book chapter incorporate new material chapter may five editions book up-to-date written earlier no longer best basis for opinion. Q: tell Doctor consider reviewed Lindsay 's medical records reviewed psychopharmacology? medications Dr.Tufts Gelata other doctors prescribed? [11:00:00] A: Yes, I did. Q: aware of her access to cellphone Google searches medications during October November December January? aware correct A: Yes. Q: tell jurors your opinion years of experience in issue filicide working for government defense evaluation of Lindsay, jury opinion time killings she suffering from disease or defect impaired her ability appreciate conform conduct to requirements law? A: begin issue mental disease or defect Ms.Clancy had severe depression book DSM Diagnostic Manual by American Psychiatric Association lists criteria for various diseases five out of nine symptoms diagnosis of major depression Ms.Clancy date crime had seven of nine symptoms severely depressed had earlier evidence of mild mania fits in bipolar II.type bipolar illness more frank depression severe depression manic aspects not severe final diagnosis bipolar II severe depression January 24th, 2023 no one diagnose major mental disease day climb Q: Doctor, diagnosis considered postpartum depression psychosis? A: Yes. Q: tell jurors factors diagnosis opinion? A: Yes Ms.Clancy had history of anxiety difficulty with children minor first significant second child Callan 's birth well first three months then Clancy became anxious depressed took toll jury heard from treaters Dr.Tufts Nurse Jollotta others her anguish depressed felt couldn't function brain damaged same met definition major depression bipolar phenomenon postpartum aspect Ms.Clancy 's symptoms began within three months of Callan 's birth considered postpartum onset difficulty next five months crime January 24, 2023Clancy was frankly psychotic had postpartum psychosis not frequent postpartum psychosis eight months after birth occasionally occur classic postpartum psychosis not postpartum onset frank psychosis day of killing label postpartum psychosis postpartum onset she clearly psychotic day Q: Doctor, when person psychotic psychosis able to appear "normal communicate drive car? A: Ms.Clancy not reveal extent depression was frank with family Her sister mother mother-in-law aware with casual friends show extent depression not suggesting psychosis can wax and wane. on day of crime not she was frankly psychotic. was functioning. better day made snowman with kids visited took Cora to doctor for fifth birthday checkup functioning not frankly psychotic until command hallucination while husband Patrick chores Q: Doctor command hallucination how fits in diagnosis of psychosis? A: hallucination is hearing a voice voice can be benign or malignant voice may say "Open window." one-third of voices are command hallucinations instruction to do something majority commands benign. might be open window get glass of water. more ominous to kill oneself or harm someone else. dangerous command hallucinations in Ms.Clancy 's case had command hallucination on day killed children delusion of influence command felt body taken over by external force control of body like a puppet someone else pulling strings COURT: Yep. Hold on second. Counsel? Members jury, give instruction later full instructions end case not consider defendant's statements to psychiatrist or psychologist as establishing truth of facts. defendant's statements to psychiatrist psychologist for evaluation evidence of premeditation extreme atrocity cruelty intent to kill. statements admissible only relate to basis doctor's opinion of defendant's mental condition.'ll go into that later. Go ahead, Mr.Reddington. [Q=REDDINGTON A=RESNICK] Q: Doctor, conclude relate your opinion to standard of person lacking criminal responsibility at commission crime in Commonwealth Massachusetts? [23:41:00] A: two arms to test for criminal responsibility One defendant's ability to control conduct other knowledge of wrongfulness of acts address each separately Q: Sure. A: my opinion Ms.Clancy due to mental disease unable to conform conduct to requirements law day took lives of children. basis opinion she hearing voice commanding to engage killing behavior feel control felt to obey instructions following command decision. asked Ms.Clancy Q: can't say what you talked. Doctor say what she told you. A: not do that covering other aspects. second evidence she lacking control made severe suicide attempt based on command hallucination heard cut throat jumped window wanted to die. research on women kill children divided motives into five categories look at Ms.Clancy [inaudible motives Q: What does that mean, altruistic filicide? A: Altruistic filicide occurs murder committed out of love hostility effort mother's part to best for child believe child delusional belief tortured take life best interest children Altruistic filicide mother plan to take her own life psychotic thinking severe depression distorted believe child worse off if remains alive in Ms.Clancy 's case she believed obsessional about caring for children consulted with others right for children believed if Clancy took own life children in terrible shape believed doing children favor by go to heaven rather earth without mothering Her mind distorted. Q: Okay. tell us other titles of four types without detail if don't apply to Ms.Clancy. A: second category to Ms.Clancy, called acutely psychotic filicide occurs when someone frankly psychotic delusions hallucinations out of touch with reality rational motive acting on psychotic beliefs two apply to Ms.Clancy. other three- Q: give other three captions A: other three not apply child maltreatment parent shake child to death or throw against will abusive next unwanted child child burden kill child final motive spouse revenge filicide spouse sacrifice child punish spouse. three latter categories not apply to Ms.Clancy. loved husband respected husband had good marriage never spanked abused child all children wanted planned fourth child three categories do not apply explain two categories Ms.Clancy believed distorted belief children miserable imagine life without her mother did what believed morally right killing child against law believed doing right for children distorted psychotic thinking children need second category of acutely psychotic, Ms.Clancy under influence command hallucination idea influence rather rational decision in grip psychotic command hallucination influence lacked capacity to conform conduct to requirements law Q: Okay. Doctor, finally questions allegations Ms.Clancy provide information to healthcare providers about adverse effects of medication prescribed. agree with review medical records or did she tell providers how she felt perceived medications prescribed? A: my opinion Ms.Clancy was more sophisticated patient forthcoming conveying symptoms one not fully revealing impulse to harm children because rational belief children may be taken away by social service agency. irrational belief entered medical hospital children be taken away not fully forthcoming Q: Doctor, experience many women caretakers of children postpartum intrusive thoughts dark thoughts afraid of reporting reason? SPRAGUE: Objection. [10:33:00] COURT: Sustained. RESNICK: evidence of ongoing suicidality never allowed be out of presence of staff member examination requested privacy staff member to be present Her ability to take life impulses observation [inaudible recognizes reality no not want to live no choice but first to live this time. COURT: Any objection? SPRAGUE: No objection. [Q=SPRAGUE A=RESNICK] Q: Good morning, Dr. Resnick. A: Good morning. Q: evaluations taught courses to forensic psychiatrists psychologists testify in cases? A: Yes, I have. Q: quote from you in article Child Murdered by Mothers: Patterns and Prevention "More filicides occur due to fatal maltreatment than maternal psychiatric illness A: Correct. Q: written in chapter six family murder Child Murder by Parents aftermath section life events prolong parent's depression anniversary of children's deaths exposure to things parent upsetting." A: Yes. Q: written about malingered psychosis A: Yes. Q: Malingering psychosis mental illness exaggerating symptoms [01:03:49] A: That's correct. Q: written article Faking It "Command auditory hallucinations easy to fabricate Persons not always obey voices especially dangerous." A: That's correct. Q: You've points to practitioners "If suspect person of malingered auditory hallucination ask what to make voices go away or diminish intensity A: Yes. Q: records reports Ms.Clancy heard voice acted A: Ms Clancy had impulses to harm children until command hallucination overwhelmed Q: told doctors December no homicidal ideation only reported suicidal ideation A: noted common people fear children taken away REDDINGTON: Objection. COURT: Sustained. COURT: Hold on, Doctor. COURT: question stricken answer stricken SPRAGUE: teaching about malingering faking hearing voices psychotic give pointers for patient uses no strategies diminish hallucinations states obeys commands RESNICK: Yes. [01:08:50] SPRAGUE: podcast Identifying Malingering with Dr. Phillip Resnick asked about malingering hearing voices common example hear voice kill mother moral fiber hesitate concurrent delusion mother evil wizard likely act on command hallucination." RESNICK: Correct. RESNICK: Ms.Clancy distorted belief children better off in heaven motherless psychotic distortion coupled with command hallucination met requirement [Q=SPRAGUE A=RESNICK] Q: believe psychotic delusion better off in heaven without her no rational non-psychotic motive for to kill children correct A: Yes. Q: article identifying malingering Dr. Phillip Resnick rapid resolution of symptoms with medication red flag genuine psychotic symptoms take longer to subside A: That's correct. Q: aware page 1168 Ms.Clancy denies experienced hallucinatory content prior event referring killed children correct A: Yes. Q: aware page 1170 states Ms.Clancy presents intact reality testing no symptoms psychosis actively engaged in treatment possible hopes future activist for postpartum psychosis awareness participating in wheelchair marathon aware? A: Yes. Q: move submit three sections next three exhibits COURT: Any objection? [Q=SPRAGUE A=RESNICK] Q: postpartum psychosis't typically happen eight months after child born correct A: Yes. [01:16:27] Q: postpartum Ms.Clancy 's symptoms begin three month timeframe symptoms three month period postpartum? A: wide range of definitions postpartum Some scholars make whole first year others three months others four weeks Q: seeking help from psychiatrist September four months after birth correct A: Correct. Q: Ms.Clancy symptoms depression from friends open symptoms friends A: Hide depths depression COURT: Redirect? Bless you. REDDINGTON: Honor Lindsay Clancy rests case COURT: jury defense rested case talk to counsel next phase case Commonwealth offered opportunity offer rebuttal witnesses certain issues talk counsel inquire Commonwealth wish offer rebuttal witnesses counsel sidebar Attorney Sprague Commonwealth wish offer rebuttal? CLERK: Commonwealth call Dr. Avram Mack COURT: Madam Clerk, raise your right hand. COURT: All right. Good morning, Doctor. [Q=BUCKINGHAM A=MACK] Q: Thank you. Good morning, sir. A: Good morning. Q: tell jurors your first last name [01:22:26] A: Avram Mack. Q: Thank you What do work sir? A: I'm a psychiatrist. Q: how long been psychiatrist? A: After training been psychiatrist 22 years Q: educational background? A: went University of Michigan College Cornell University medical school Brigham residency psychiatry followed fellowship child psychiatry Columbia University one-year fellowship forensic psychiatry New York University Q: what do now What's practice A: psychiatrist 22 years serving different roles professor of psychiatry Thomas Jefferson University Philadelphia see patients child hospital Nemours Q: current practice clinical practice forensic psychiatry A: That's correct. Q: board certified in? A: certified psychiatry child adolescent psychiatry forensic psychiatry board certified addiction medicine American Board of Addiction Medicine closed Q: engaged in forensic psychiatry? testified A: provided testimony every area forensic psychiatry testamentary capacity adults appropriateness adoption person criminally responsible [01:25:12] Q: conduct forensic evaluation in psychiatry? A: can mean different things depending on question asked by court or authority Sometimes statutes forensic psychiatrist need to answer question sometimes matter of giving opinion in civil case your understanding of degree of harm person experienced Sometimes great, sometimes not so great Q: testified as forensic psychiatrist in civil and criminal matters A: Correct. Q: aware difference between forensic psychiatry versus forensic psychology? A: differences different professions both cover mental health different rules apply to forensic psychologists Q: done work testified in criminal responsibility A: Correct. Q: different states have different statutes criminal responsibility A: Yes. Q: review statutes in Massachusetts criminal responsibility A: Yes, I did. Q: involved in this case A: asked by prosecutor's office as psychiatrist reviewing matter COURT: Overruled. [01:28:38] [Q=BUCKINGHAM A=MACK] Q: what types of records at forensic evaluation for criminal responsibility? A: review psychiatric records if exist examined individual gather information historical information examination in real time mental status examination Other records important Medical educational records records describe individual Q: evaluations conducting, for criminal responsibility limited based on information? if don't have everything at evaluation caveat to opinion? A: I write opinion based on totality of information If additional information open to receiving integrating to understanding totality. Q: criminal responsibility central issue person's mental state at time of alleged offense correct? A: That's correct. Q: in Massachusetts question of criminal responsibility aware of standard? A: Yes. Q: If break down for jury first part of for criminal responsibility is question of does person suffer from mental disease or defect correct? A: Correct. REDDINGTON: Objection to leading. knows BUCKINGHAM: conducting evaluations for criminal responsibility [Q=BUCKINGHAM A=MACK] Q: determine person suffers from mental disease or defect look to mental disorders if meets criteria? A: evaluate if person ever had psychiatric or mental disorder. Q: as psychiatrist in clinical practice [01:33:18] A: Correct. Q: main diagnose individual. A: Correct. Q: how determining if person has mental disorder? A: In psychiatry make diagnoses in descriptive manner. individual symptoms or signs of mental disorders defects psychiatric disorders start with gather information about things individual mood abnormal movements.aligned with understanding medical condition medications take substances use array of sets of information gathers ask questions asking about symptoms trying to understand symptoms degree impairment symptoms causing individual Q: diagnosing individual for mental disorder specific criteria for different types disorders? A: Yes, there are. Q: source you use as psychiatrist to identify criteria for different disorders? A: use text DSM, as Diagnostic and Statistical Manual in fifth edition revision text created vetted by professionals provides criteria for different disorders operational criteria. In psychiatry gold standards for diagnosis like finding bacterium or anatomical tissue for last 60 years, 70 years psychiatry turned to agreed upon definitions in DSM. Q: not the end all Of diagnosing use training and experience it's tool A: criteria diagnosis not a guidebook for information not but standard. Q: criminal responsibility in Massachusetts fair to looking at person's conduct and condition at time of offense? A: That's right. Q: information gathering in overall evaluation history person as whole helpful to understand person's diagnosis question? A: Yes. [01:37:59] Q: general overview of sources of information? A: Generally criminal file medical or psychiatric records records from hospital she at now. hospital before Spalding Brigham Women's medical records from outpatient treaters records from her admission to Mc Lean Hospital. outpatient records, inpatient records.most part correlated with her care. received pediatric records for victims mentioned criminal file. Q: By other psychiatrists and psychologists? A: Yes. COURT: Sustained. asked observations. BUCKINGHAM: what she say? MACK: described feeling depressed termed situational depression described feeling. feeling miserable not wanting to be alive. SPK3: Yeah. That's fine. [Q=BUCKINGHAM A=MACK] Q: met her at Tewksbury Hospital current treatment regimen current medication on? A: I did. Q: she tell medication taking? A: Yes. Q: what medications met April 2026 on? A: psychiatric medications main medication olanzapine several medications used for her physical needs One helps bladder movement GI system Q: focus on psychiatric medications interest mentioned olanzapine What's common or brand name? [01:48:46] A: It's called Zyprexa. Q: used to treat? A: antipsychotic medication treat psychosis Q: dosage of Zyprexa on? A: two and a half milligrams Q: significant dosage? A: No, it's a small dose. Q: aware of other psychiatric medications prescribed Tewksbury? A: I believe she's also taking trazodone. Q: Wellbutrin A: Yes. Wellbutrin is an antidepressant medication. Q: clonidine familiar? A: Yes Clonidine medication used for anxiety help sleep Q: familiar with propran propranolol? A: Propranolol medication used help anxiety [01:50:32] Q: dosage of medication on review records high doses, low doses? A: Overall lower side of dosages. Q: indicated testimony she reported believes situational depression A: Yes. Q: conversation about diagnosis from Tewksbury? A: asking about bipolar disorder she wasn't convinced has bipolar described situational depression feeling depressed about stressors experiences today Q: meeting her talk about past medication regimens prior to current regimen Zyprexa Wellbutrin? A: Yes. Q: important to know conducting evaluation for diagnosis lithium? A: in psychiatry don't make diagnoses based on medication response. Q: report of lithium not trialed for long? A: Yes not don't make diagnoses don't categorize define disorders by medication response description of trial of lithium short trial Q: past psychiatric history? A: Yes. Q: significant past psychiatric history? [01:53:43] A: Prior to 2022 not hard driving get anxious anxiety pushed achieve two short periods of depression or anxiety lifetime one prescribed antidepressant medication two years before 2022 not taken resolve anxiety depression through exercise hard work. Q: conversation her about nursing school medications during experience right? A: Yes. Q: second episode described anxiousness seeking medication indicate took medication A: No, she had- Q: no history of bipolar disorder or prior depression? A: Correct. No such history. Q: evidence? prior to 2022 minimal psychiatric history period 2022 from September to January 24th, 2023? A: Yes, I did. Q: medication history? A: Yes. Q: significant amount of medications A: Yes. Q: anything stand out medication history significant? A: initially prescribed medication September 2022 start taking sertraline until October several different medications prescribed not clear took every medication prescribed or more than one or two times period trial on second antidepressant Prozac. various medications to help sleep several week period of taking medication Seroquel or quetiapine [01:57:45] Q: familiar with medication in practice? A: I am. Q: medication multiple functions like most psychiatric medications? reviewed history initial dose prescribed? A: Just 25 milligrams. Q: 25 milligram dose of Seroquel? generally prescribed for? A: often prescribed to help sleep Seroquel like Zyprexa antipsychotic medication used help sleep psychosis treatment of depression Q: review of medication timeline for defendant Seroquel time took Seroquel lasting effects on brain or body? A: no known effect from time took could temporary effects affecting functioning psychological reaction no known long-term effect Q: effect symptoms negative symptoms A: Seroquel might affect ability to think straight cognition pay attention concentrate memory Seroquel negatively affect cognitive functioning expected go away when stop taking medication Q: Seroquel type of medication lingers in system? A: Not substantially some medications linger like diazepam or Valium prescribed medications relative basis diazepam body longer than lorazepam different benzodiazepine Q: aware of medications last reported medications defendant on before events January 24th A: I am. Q: And what were those? [02:00:36] A: Melatonin, lorazepam trazodone antidepressant medication amitriptyline Q: amitriptyline aware dosage A: day before January 24th became 20 milligrams days before 10 milligrams Q: your experience 10 milligram to 20 milligram dose of amitriptyline significant dosage? A: small. usual starting dose for adult 150 milligrams Q: aware of chief complaints defendant reporting medications prescribed in 2022? A: several month period started September 2022 with complaints anxiety and depression Q: medications reviewed could medications affect sleep? A: Yes, certainly can. Q: past diagnosis of defendant all records different providers given past diagnoses correct? A: Yes. Q: evaluation determining criminal responsibility mental disease or defect rely on prior diagnoses or own conclusions? A: I come to my own conclusions. Q: past diagnoses consider? A: Yes highlighted basis for prior diagnoses don't agree with diagnoses interested in observed diagnoses [02:02:48] Q: evaluations for criminal responsibility why not rely on past diagnosis? come own conclusion? A: independent evaluator collate information make own diagnosis Q: Before diagnosis addition interview with defendant two days reviewing records attempt to speak with collaterals? A: I did not. Q: based on reviewed case conclusion about diagnosis? A: Yes, I did. Q: conducted evaluation your opinion about diagnosis? A: opinion about her diagnosis 2022 to 2023 is she suffered from major depressive episode part of major disorder important point is major depressive episode. Q: What made conclusion based on her presentations? A: information about her feelings progression illness represented by major depressive episode condition defined in DSM -5 problems with mood pleasure guilt or worthlessness appetite sleep preoccupation with death or suicide poor concentration energy psychomotor agitation or retardation. doesn't need to show all but DSM certain threshold her history description of experience matched major depressive episode Q: low mood she presented with anxiety? A: Yes, very much. Q: observations of obsessive thinking? A: Yes Obsessive thinking anxiety form anxiety in generalized anxiety disorder possible she also had generalized anxiety disorder secondary to major depressive episode Q: to jury major depressive disorder identified disorder in DSM [02:08:05] A: Yes. Q: use terminology like mania what is mania? A: mania is mood state like major depressive episode mood state building blocks of mood disorders bipolar disorders major depressive disorder like major episode mania defined in DSM. certain time threshold for mania seven days least four symptoms manic state includes distractibility flight of ideas grandiosity excessive goal-directed behavior pressured speech abnormality speech reduced need for sleep seventh engagement in activities pleasurable high potential for painful consequences mania requires seven days need four over seven days. Hypomania lesser need three over four-day period both cases major depressive episode need demonstrate person impaired in clinically significant impairment distress building blocks for mood conditions SPK3: Yes. Sustained. [Q=BUCKINGHAM A=MACK] Q: after incident observe records activity at Brigham and Women's Hospital linear thinking goal direction? A: after removed from medication dexmedetomidine sedating sleep intentionally awakened think coherently with goal-directed thoughts mental status examinations Brigham showed normal mental status portion record reviews ability to make decision change to healthcare proxy physicians closely understand decision-making capacity. Q: psychosis? observe any? A: not throughout period. Q: So tell us what psychosis means. A: Psychosis is form of thinking person has disorganization lack of reality testing individual may not engage in behaviors activities cognitive thoughts to check if belief or experience real or not Q: any particular way person display psychosis? A: Psychosis displayed in many different ways based on things person says delusions are fixed false beliefs exist despite told not true or testing with others. suspect psychosis in hallucinations unreal stimuli experiences Sometimes individuals moving body to respond to stimuli hallucinations can be taste, smell hear see feel body psychosis includes some that lack of ability to act organized Q: person in psychosis can sometimes do normal things? A: depends on psychosis bad extent individuals with delusional disorder problem delusion affecting life can go about lives in other areas't false belief. Q: hallucinations? How manifest? [02:15:01] A: subgroup population experiences hallucinations frequently no negative effect. for hallucinations part of disorder psychosis bipolar mood ways individual can live with psychosis hallucination resilient. Q: even if person psychosis or delusions hallucinations manage in society by following rules? A: depends on delusion or hallucination individuals. can people can stable basis individuals SPK3: Next question. [Q=BUCKINGHAM A=MACK] Q: person suffering from psychosis can appreciate know right from wrong? A: no reason psychosis inhibits person ability to know right from wrong. Q: this case defendant identified believe major depressive disorder A: Yes. Q: Did you consider other diagnoses? A: Yes. Q: why not for this defendant? A: diagnosed bipolar disorder need manic episode for bipolar type one bipolar type two need hypomanic episode no information in record displays either can't diagnose bipolar disorder Q: consider defendant. indication of postpartum for? A: Yes. Q: affect opinions about diagnosis? [02:17:29] A: in psychiatry diagnose based on symptoms individual DSM discerned prominent symptom individual becomes disorder carries diagnosis times can designate occurred in postpartum period DSM within four weeks of birth. allows for symptoms occurred before.standard we utilize choose add designation something postpartum. SPK3: All right. Next question. [Q=BUCKINGHAM A=MACK] Q: consideration of postpartum rely on DSM - 5 in diagnostic criteria? A: I do. Q: aware not universal world other opinions about postpartum period? A: aware psychiatrists others asked specific diagnosis to psychiatric problems in postpartum state studied over years suggested to makers DSM rejected. Q: question view review of defendant onset of symptoms when occur in postpartum period? A: distress began in September four months after birth of recent child Q: relying on DSM four weeks postpartum for illnesses mental illnesses defendant outside period A: Correct. Q: last child killings occurred eight months after postpartum period correct A: Roughly, yes. Q: months after postpartum period A: Roughly, yes. Q: aware of behaviors thoughts defendant had suggested as psychotic [02:20:20] A: Yes. Q: consider potential psychotic features for defendant? A: Yes. Q: explain potential features opinion? A: some beliefs concerns Ms.Clancy had weren't necessarily psychotic one idea distress Child Protective Services or Child Welfare Agency would take away kids interact don't know psychotic Another idea she damaged permanently by medications took appreciate felt side effects change from medications don't know feeling belief necessarily psychotic.two I mention off bat. Q: idea somebody could hear her thoughts? look into that? A: one episode she wasn't sure asked mother "Can you hear my thoughts?" told no form of psychosis thought broadcasting wasn't her belief engaging in thought broadcasting putting thoughts world question not psychotic reflected stress intrusive thoughts without psychotic engaged in reality testing asked "Did you hear that?" Q: aware concerns voiced other things wrong with body not just damage from medication A: Yes. Q: consider determine psychotic feature for defendant? A: Yes example worry ketoacidosis didn't necessarily think psychotic given medication Seroquel side interferes with glucose system ketoacidosis worst case scenario poor control of glucose had fixed false belief ketoacidosis worried about ketoacidosis Q: considered these things didn't believe psychotic were they delusional? fixed false beliefs? A: used term specifically delusion form of psychosis fixed false belief immutable can't be convinced otherwise not fixed false beliefs concerns. Q: suicidal form of psychosis? A: No. [02:25:04] Q: idea of suicide tell about defendant her situation? A: tells she was suffering part of major depressive episode. 10 to 15% women postpartum period have depressive disorders serious lead to suicidality need for hospitalization interventions records show interviews information she was suffering suicidality form of suffering Q: suicidality make sense why person suicidal? A: No. Suicidality occurs doesn't always make sense Sometimes why suicidal good things life especially individual depression occurs Q: suicidal ideation protective factors? A: Yes. Q: identify defendant presented protective factors suicidality? A: did Ms.Clancy identify protective factors? Q: And what were the protective factors? A: Mainly her mother children. urges interest in suiciding chose not to do worry hurt them suiciding MACK: Thank you, Judge. BUCKINGHAM: None. COURT: in recess till 2:00. REDDINGTON: Yeah. BUCKINGHAM: Dr. Mack before about protective factors in suicide recall [02:31:10] MACK: person suicidal risk factors protective factors Risks factors aspects likely act on suicidal thoughts protective factors opposite hold person back from acting on suicidal interests. BUCKINGHAM: in this case aware defendant indicated kids mother reasons didn't continue thoughts of suicide past right? REDDINGTON: objection. not thoughts action. COURT: No, overruled. You can answer. MACK: not sure if question kept her from acting on suicidal interests or ideation BUCKINGHAM: she reported good feelings consistent with suicidality or inconsistent? [Q=BUCKINGHAM A=MACK] Q: reports of good day inconsistent or consistent with attempted suicide? A: not inconsistent with suicide not inconsistent with depressive disorder depression major depressive episodes recover after three or four months awareness person recover from depression suicides happen when developing more energy ability to act on interests Q: experience people display positive feelings prior to attempt or suicide? A: Yes depressed trajectory towards improvement Q: talked about hallucinations described different types of hallucinations taste hear see A: Yes. Q: familiar with command hallucinations? A: Yes. Q: What are those? [02:35:21] A: Command auditory hallucinations hearing something telling expectation Q: after kids gone she made effort to take her own life correct? how did? A: Right. she did described went take life attempt with multiple steps went room upstairs took medications cut at wrists neck caused herself to fall from window. REDDINGTON: objection. not what he said. [Q=BUCKINGHAM A=MACK] Q: her report of taking medication pills she took all pills in house? A: not sure about house described all pills in bedroom Q: Patrick reported seen Dawson eating green beans chicken nuggets before left house A: Yes. Q: And what is that opinion? A: yes she suffering from mental disease defect major depressive episode major disorder Q: she significant medication changes during period inform your opinion? A: aligns with while depressed mental state relatively stable perhaps improving not sure stable REDDINGTON: Move to strike that not sure about it COURT: answer stricken [Q=BUCKINGHAM A=MACK] Q: she hadn't significant medical or medication changes signify same state months before? [02:47:56] A: Yes. Q: What do you mean methodically? A: deaths done methodically one by one organized intended to achieve particular goal attempt at suicide organized thoughtful included many possible methods Q: Okay. your overall evaluation of defendant,Lindsay Clancy regarding events of January 24th, 2023, your opinion to medical certainty regarding criminal responsibility? A: opinion she retained capacity for criminal responsibility for these actions. Q: admit Dr. Mack's CV next exhibit. COURT: Any objection? BUCKINGHAM: Exhibit 291. [Q=REDDINGTON A=MACK] Q: Dr. Mack your evaluation intent to investigate person for opinion criminal responsibility for district attorney's office correct? A: What do you mean by investigate? Q: don't know investigate means? explain? You're psychiatrist employed by district attorney A: Retained by, yes. Q: This case is Lindsay Clancy, correct? A: Yes. Q: in mental institution investigating questioning woman on medication suicidal under one-on-one 24/7 observation. agree with? [02:55:44] A: Yes. SPRAGUE: Objection. COURT: Ask the question. [Q=REDDINGTON A=MACK] Q: she issues with delivery? A: delivery postpartum period? Q: medication prescribed after Dawson? A: Do you mean psychiatric medication? Q: Sure. A: prescribed antidepressant medication Q: anxiety about going back to work after Callan third child? A: After Callan? Q: Go ahead. A: anxious about wellbeing nurturance of children work baby not taking bottle husband work overwhelming to have three young children for ambivalent about hiring nanny area of anxiety several areas of anxiety anxiety had throughout life. Q: say she had anxiety about having youngest child Callan correct? A: Yes. [03:03:01] Q: indicated she anxiety about having nanny A: Yes. Q: tell jury investigated about her anxiety with nanny A: evaluation understood ambivalence about having nanny wanting to handle children ambivalence about other people other than herself or mother caring for children evaluation discerned she felt positively about ability to take care of children ambivalence about other people Q: timeframe? Summertime Fall? A: end of summer Late August early September. Q: fall end of September she started symptoms of anxiety right A: Yes. Most- Q: 2022 A: Okay. Q: suggest December 2024 notice of lack of criminal responsibility filed fit with reach out? SPRAGUE: Objection. Can we approach? COURT: Sure. All right, Counsel. [Q=REDDINGTON A=MACK] Q: Judge understanding procedure notice given to court person Lindsay raising issue of criminal responsibility correct? A: don't know procedure in Massachusetts [03:09:16] Q: He's a psychiatrist, isn't he? A: It sounds like you know him. Q: know him Park Diets famous psychiatrist A: Yes. SPRAGUE: Objection. COURT: No, overruled. MACK: Park Dietz & Associates Park Dietz himself SPRAGUE: Objection. COURT: Sustained. COURT: Objection. SPRAGUE: Sustained. [Q=REDDINGTON A=MACK] Q: Is he a psychiatrist now? A: Yes, he's a psychiatrist. Q: they try to get someone familiar with topic or random psychiatry degree? A: certain people Dr. Dietz robust career background [03:11:52] Q: look understanding individually not Park Dietz requested to investigate lack of criminal responsibility of individual charged crime be independent? A: Being independent is the expectation. Q: District of Columbia? A: Not at the moment. Q: New York? A: I actually renewed that recently. Q: South Carolina. A: haven't renewed in many years Q: Connecticut? A: Same. Q: Virginia? A: Same. Q: licensure psychiatrist in states active? A: Licensure means act as physician effect Q: belong to American Academy of Child and Adolescent Psychiatry [03:15:56] A: Yes. Q: resume A: representative from American Academy of Child and Adolescent Psychiatry American Psychiatric Association American Academy of Psychiatry and Law to National Council of Juvenile and Family Court Judges Q: asked interests focus as doctor involved in ad hoc reviewerships on Journal of American Academy of Child and Adolescent Psychiatry A: It does say that, yes. Q: And then American Journal of Addictions? A: Yes. Q: Pediatric Quality & Safety? A: Yes. Q: dealing with little kids Pediatrics A: Children's Hospital of Philadelphia patients up to 24. Q: interest in child psychiatry academic responsibilities child psychiatry A: Yes. Q: Supervision of adult psychiatry residents, right? A: Yes. [03:17:33] Q: Clinical evaluation Department of Psychiatry dealing children adolescents A: not sure last one Q: Ongoing Clinical Education of PGY-3 residents Department of Psychiatry Georgetown University Hospital Institute for Children and Adolescents A: Regional Institute for Children and Adolescents Q: lecture Patient Safety Quality Improvement in Child Adolescent Mental Health involved lecturer A: Yes. Q: lecturer Morass Returns Adolescent Cannabis Devil's Lettuce Other Hallucinogen Use Pediatrics kids A: Yes. Q: under lectures invitation involved lecturing Whither Psychosis in Adolescents A: title paper gave Q: Whither Psychosis Adolescent Killers update A: Right. Q: Divorce Legal Process Medical, Social Psychiatric Sequelae A: Right. Q: Killer Adolescents Drugs School Courts [03:19:38] A: Right. Q: Childhood Development Psychopathology lecture United States Department of Justice A: Yes. Q: United States Department of Justice Department of Immigration A: Yes. Q: Cognitive Bias Think Tank A: committee task force co-led diagnostic error cognitive biases Q: what cognitive bias A: diagnoses possibility individual guided preconceptions biases patient safety prevent misdiagnosis techniques used in medicine pediatric hospitals psychiatry biases wrong Q: Psychiatric Classification Ancients to DSM -IV Psychiatric Clinics of North America A: Yes. Q: addition child aspects psychiatry interested alcohol abuse substance related disorders addictive disorders treatment A: areas interest Q: Novel Risk Factors for Central-Line Associated Bloodstream Infections in Critically Ill Children A: Yes. [03:22:34] Q: Okay. Nevermind probate court. A: physician leader Maryland's Office of Forensic Services Q: New Tools Toolbox Proactive Prevention of CLABSI in Patients with Behavioral Health and Concerns A: CLABSI central-line bloodstream infections major concern hospitals preventing cleaning apparatus patients patients psychiatric problems greater risk central-line bloodstream infection significant complication hospital started work Georgetown focused adults carried Children's Hospital Philadelphia Nemours pediatric risks for CLABSI Q: Clinical Manual of Adolescent Substance Abuse Disorder A: wrote book substances Q: number 29, Mack A. H. Clinical Manual of Adolescent Substance Abuse Treatment Journal of Psychiatric Practice A: chapter not book Q: interested in American Psychiatric Press textbook for substance abuse treatment A: Yes. Q: Think like Psychiatrist Always Doctor Be Doctor Web Drug Store Perils Drugs, Alcohol Bloodstream Infections in Children's Hospital focusing within breathing distance of pregnant woman practice interest in writings? A: remember Brigham as resident Q: 2001, so 25 years ago. A: Right. Q: And what did you do? [03:25:07] A: went Medical University of South Carolina Georgetown until 2015 general psychiatry work focus in peds addictions forensics generalist areas focus 2015, from generalist model left Georgetown moved to Children's Hospital of Philadelphia University of Pennsylvania working in pediatric hospitals at CHOP Children's Hospital of Philadelphia age up to 24 Nemours up to 21. overall area adult child psychiatry working in years Georgetown COURT: Let him finish the answer. Go ahead. MACK: Georgetown adult labor and delivery unit engagement with women pregnant given birth Children's Hospital of Philadelphia Nemours special units under design high risk pregnancy units CHOP first develop psychiatry services coverage high risk maternity unit special delivery unit co-leader of consultation service CHOP led group adult child psychiatrists tend psychiatric needs unit at Nemours same unit built pediatric hospitals units of women about to have birth just had birth [Q=REDDINGTON A=MACK] Q: sure in pediatric hospitals women about to have birth competent doctors treat correct? A: I agree with you. Q: you? How many women with postpartum psychosis you treated? A: Roughly 10 would be my estimate. Q: women testing for mental health? A: usually teaching postpartum psychosis is form of bipolar disorder important to full evaluation of individual symptoms signs treat engage in treatment general perspective Q: knowledge on women pregnant postpartum psychosis know Lindsay diagnosed with postpartum depression? A: notes clinicians 2022, 2023 utilized term unspecified mood disorder Q: Right. How about postpartum depression? A: 't appellation used Q: testifying about case important know she almost off chart on Edinburgh scale for postnatal depression? A: said she had depression [03:29:18] Q: postnatal depression for woman pregnant or baby different than guy depressed about job A: I don't understand your question. Q: When? A: she went to Dr.Tufts in September October started taking medication Dr Tufts prescribed Q: Okay. And that was for what? A: which medication purpose? Q: Medication. A: Sertraline. Q: And otherwise known as? A: Zoloft. SPK6: Hold on a second, Doc. SPK7: Sorry. MACK: time Ms.Clancy avoided taking medications [Q=REDDINGTON A=MACK] Q: She's what? A: Avoided taking medications. [03:31:09] Q: She told you that? A: she resists taking medications Q: No. Tell she resists taking medications. A: individuals want take medications she described one of them Q: Prior anxiety about public speaking as nurse in nursing school after had children psychiatric history of medications A: not taken medications had lifelong degree anxiety level disorder Q: grammar school, high school college? difficulty anxious? A: anxiety can drive people she had anxiety was hardworking anxiety helped hardworking medications MACK: she didn't want to take medications example after birth second child sertraline prescribed chose get through anxiety depression by exercising highlights didn't want taking medications understand fall of 2022- REDDINGTON: lifelong resistance to taking medication. MACK: Yes. REDDINGTON: asked grammar school high school college records witnesses documents resistance to taking medication? MACK: Only her description to me. REDDINGTON: She didn't tell resistant to medication in grammar school high school college? making up SPK8: Objection. [03:33:32] SPK6: Yeah. Sustained. Next question. [Q=REDDINGTON A=MACK] Q: She didn't tell you that. A: understand her told generally not want taking medications didn't specify in grammar school basic- Q: No college. A: her description as adolescent young adult not interested in taking medications Q: don't care not there A: page 8 Ms.Clancy 's reluctance to take medication accompanied by concern for medications entering breast milk Q: breast milk pregnant only time she indicates want to except benzos medication breastfeeding A: don't agree happy to be proven wrong understanding she described generally want to take medication. Benzodiazepines included Q: guess look at Dr. Mack's report Medication history period before January '24, '23 she taking several medications Tufts Gelada A: Okay. Q: report defendant taking several medications prescribed for her A: fall and December of 2022 Q: reluctance to take medication accompanied by concern for medications entering A: I believe it says breast milk. [03:36:01] Q: Breast milk other concerns mother about breast milk drugs into infant's body when she resistant to taking medication? doesn't want SPK6: Overruled. [Q=REDDINGTON A=MACK] Q: We'll mentioned DSM use in diagnoses A: Yes. Q: testify about postpartum issues psychosis depression A: referring to postpartum psychosis disorder? proposed disorder or symptom? Q: expert hired by DA jury woman not suffering from postpartum psychosis testimony to use DSM to guide in diagnoses agree fair statement? A: DSM standard for diagnoses? Yes Q: What does that stand for? A: The International Classification of Disease. Q: Does that classify postpartum psychosis? A: I think it actually does not. Q: postpartum depression? international category indicate? A: not sure United States Q: talking about in DSM -6 postpartum depression postpartum psychosis added into DSM -6 correct? [03:38:59] A: Who said that? Q: asking if told jury about possibly into next edition. A: syndrome proposed called postpartum psychosis differentiate from idea psychosis in postpartum period postpartum psychosis not included not aware included calls for movement for DSM -6 not active. highlight wrote college history thesis on history of DSM s Q: DSM -1, 2, 3 A: classification by American Medical Association end of 19th century DSM -1 1952DSM -2 1968DSM -3 1980 main change in 1980 in descriptive model for diagnoses since DSM -3 diagnostic groups grouped by symptoms not cause illness not theories about illness since DSM -4 in 1994 making DSM -4 literature review completed by Dr.Ellen Frank indicated roadmap for include postpartum designations since then specifier. highlight depression add specifier say when depression occurred limit four-week limit under rules DSM after four weeks call it postpartum.Postpartum psychosis referring to literature review in biological psychiatry last 12 months proposal type bipolar disorder called postpartum psychosis mania or bipolar attributes depression delirium. rules guidelines place since 1980 for revisions DSM look category separated from other categories help treatment? over time hundreds of diagnoses proposed requested DSM s few new diagnoses inserted situation for syndrome postpartum psychosis not approved. people calling for it current time SPK6: Okay. Next question, please. [Q=REDDINGTON A=MACK] Q: aware sir postpartum psychosis depression not mentioned in your DSM - 5 TR? A: agree Q: agree postpartum referred to page 147 in sex and gender related diagnostic issues? agree A: Is that the introductory chapter? Q: referencing 147 sex gender related diagnostic issues familiar A: subset portion of chapter describes issues Q: Women likely experience rapid cycling mixed states patterns comorbidity differ from men higher rates lifetime eating disorders. postpartum psychosis depression eating disorders difference between women men. A: question not understand Q: Postpartum disorders difference between women men reference to eating disorders [03:44:21] A: section header aspects about gender section describing didn't write DSM not here to represent Q: Sex and gender related diagnostic issues agree under bipolar and related disorder section? A: Next page. Q: women with bipolar one or two disorder likely experience depressive symptoms than men A: Yeah. Q: increased risk of mood episodes in pregnant women with bipolar disorder except discontinue medications for pregnancy DSM A: Yes, it is. Q: what does that tell you? 25 words sentence increased risk of mood episodes in pregnant women with bipolar disorder except medication pregnancy." What mean A: thinking about women bipolar disorder pregnant risk of manic hypomanic depressive episode stays stable compared to not pregnant except people medications for bipolar during pregnancy. Q: Yeah. A: created in DSM four in 1994. Q: How about the- A: components of postpartum psychosis? illness utilized 12 weeks, 6 weeks not more than 12. Q: IDC? ICD? A: The World Health Organization's International Classification. [03:48:36] Q: agree women treated postpartum after babies in Europe different here SPK8: Objection. SPK6: Sustained. [Q=REDDINGTON A=MACK] Q: paragraph about sex and gender related diagnostic issues A: Yes. Q: mentioned words postpartum, period A: Yes. Q: of 1050 pages another page 156. Sex and gender related diagnostic issues reference to gender ratio for bipolar I disorder A: Okay. Q: Maybe because you want to look at it or it may be because they might be wrong. A: women have depression more than men reflected bipolar type II. Q: women have mixed depressive features in rapid cycling course? A: That sounds right. Q: childbirth trigger for hypomanic episode occur in 10 to 20% females in nonclinical populations typically early postpartum period. A: You're reading it, so I agree. [03:51:08] Q: big difference between DSM and WHO A: don't know WHO's 12 months refers proposed postpartum psychosis related to physiologic changes time birth objections group to DSM written solely post-birth pregnancy and birth aligns with theory disorder related to physiologic changes timing closest to birth instrumental in proposal for postpartum psychosis disorder described disorder occurs almost at time of birth urgent Q: Who says that? Who? A: literature on postpartum psychosis Q: not in Bible A: Bible reports by advocates expert consensus panel for inclusion of syndrome postpartum psychosis SPK6: Let him finish. SPK6: Finish, doctor. Go ahead. [Q=REDDINGTON A=MACK] Q: agree with panel people trying to get postpartum psychosis depression into DSM 6? A: don't trying to get postpartum depression included already is there Q: somewhere else talks about postpartum depression? A: Yes. Q: Okay. Where? A: report mentions specifiers for bipolar disorder and depressive disorders. Q: right summarize [03:54:47] A: summarize similar passage in chapter on depressive disorders provides designate depressive disorder bipolar disorder peripartum onset important provide information about epidemiology disease DSM criteria for disorders provides basic information about course epidemiology features individual similar section in depressive disorders Q: agree psychotic features delusions hallucinations present in current manic major depressive episode in bipolar I disorder A: see where reading from Q: The specifier, what's the specifier? A: system emphasize features of person illness Remember groupings DSM revolve around major psychiatric symptoms bipolar chapter depression chapter anxiety chapter specifier person's problem has peripartum onset Q: Okay. A: connect emphasis on proposed postpartum psychosis disorder object to peripartum like postpartum Q: And who's they? A: authors of expert consensus group published paper in biological psychiatry last year Q: large ground A: paper summarizes information about proposed disorder highlights assumption type of bipolar disorder Q: interrupt? What disorder referring to? A: The proposed postpartum psychosis disorder. Q: right group people trying get postpartum disorder in next version Bible right? A: Effectively, yes. wouldn't use all words yes [03:57:20] Q: referring to peripartum onset, one paragraph talking about specifier applied to current manic, hypomanic major depressive episode in bipolar one disorder right? read right? A: more than one paragraph goes on to all next day. SPK6: Counsel sidebar regard to scheduling. Members jury break at this point.You've heard more evidence You've testimony You've more exhibits keep open mind haven't heard all evidence heard closing arguments heard law apply in arriving verdict stress don't talk about this case Don't read anything about it Don't listen to anything guard against keep open mind excuse you till Monday morning ask be here at nine o'clock We'll come continue with evidence well on schedule well on schedule because of your work hope everybody nice weekend Maybe stop raining get outside thank you for time dedication see you on Monday. SPK6: Okay. All right Counsel anything address before Monday? ## Day 19 (467 of 1203 turns kept) [12:00] CLERK: Honor court today matter of Commonwealth versus Lindsay Clancy Clancy represented by attorney Kevin Reddington Commonwealth represented by Assistant District Attorney Jennifer Sprague Assistant District Attorney Shannon Buckingham COURT: Good morning, Ms. Clancy. L.CLANCY: Morning, Your Honor. SPK1: What's the next exhibit? SPK1: What's the next exhibit? CLERK: Good morning Your Honor proceed? CLERK: continuation of jury trial Commonwealth versus Lindsay Clancy.Clancy present represented by attorney Kevin Reddington Commonwealth represented by Assistant District Attorney Jennifer Sprague Assistant District Attorney Shannon Buckingham COURT: thank you Madam Clerk Good morning members jury nice weekend ask questions go over today's schedule back to trial first question any member jury read seen heard overheard anything case affect ability fair impartial juror? Last other serious matter or concern service as juror attention? thank you for following instructions schedule today remember Friday cross-examination of Dr. Mack testified Friday afternoon return to cross-examination Dr. Mack available by Zoom other witnesses finish cross-examination of Dr. Mack by Zoom redirect question continue with Commonwealth 's rebuttal.go back procedures followed Commonwealth presented case defendant presented case now Commonwealth 's rebuttal. when Commonwealth 's rebuttal done move to next portion procedure closing arguments legal instructions after Commonwealth 's rebuttal witnesses. that's where we are this point go through today keep you up to date schedule going forward get Dr. Mack on screen Mr.Reddington continuing cross-examination. please. [Q=REDDINGTON A=MACK] Q: you Sir how many times testified courts on issue criminal responsibility? A: I would estimate one or two. Q: third time career testified on criminal trial lack of criminal responsibility correct? A: other times created opinions Q: asking about criminal responsibility A: criminal responsibility times created opinions not sure testified in courtroom Q: question how many times testified court on criminal cases lack of criminal responsibility third time right? [06:06:00] A: That is my recollection. Q: testified court behalf governmental agencies other matters addition criminal responsibility correct? A: Yes. Q: operating under umbrella Park Dietz conglomerate expert witnesses parcel out cases different people right A: times cases through Park Dietz and Associates can't speak to how many experts parcel career times done cases through Park Dietz and Associates times other entities had role for state of Maryland criminal responsibility trial part of role state of Maryland career multiple different entities. Q: Commonwealth versus Torres, 342 MAL 2021, Pennsylvania. A: state case again Q: Commonwealth versus Torres 342 MAL 2021 Pennsylvania court held Avram Mack certified child psychiatry lacked forensic certification testify field refresh memory? A: No. Q: testify Commonwealth versus Torres Pennsylvania? A: I don't remember. Q: Commonwealth versus Carter New Jersey Remember A: No. Q: Fedder Lebron versus Secretary of DCF 710 Fed 3rd 1202 Florida? remember case A: I do. [10:41:00] Q: court ruled argument testimony Florida government indicated TANF benefits applicants TANF involved drug use violence higher rates suicide Remember words A: The testimony that I provided- Q: remember testifying beneficiaries TANF program need aid needy families tested by blood urine argument class likely commit crime suicide drug use testify? A: not testimony report presented disagree Q: recall testimony stricken? A: believe stricken Q: defense expert forensic psychiatric evaluations Dr. Philip Resnick Dr. Margaret Spinelli reviewed reports prepared experts correct A: And also Dr. is it Zeisel? Q: division Department of Children and Family Records February 3rd 2023 A: Correct. Q: That would be Jennifer Tufts? A: Yes. Q: Boston Children's Hospital,Brigham and Women's Hospital Mc Lean Hospital Records reviewed A: Yes. Q: Spalding Rehab, right? [20:22:00] A: Yep. Q: Tewksbury Hospital from March 27th '23 through April 1st '26 before saw Lindsay, A: Correct. Q: Police interviews of witnesses, right? A: Correct. Q: Yeah. A: Only by phone. Q: Really? A: last 15 to 20 years Q: contacted by. Did DAs call you them? A: I don't recall. COURT: Sustained. Next question. REDDINGTON: And what does it mean? MACK: work in diagnosis in medicine refers to idea individual idea aiming for gather information brings point together SPK3: Objection. [01:50:00] COURT: Yeah, okay. Next question. [Q=REDDINGTON A=MACK] Q: psychiatrist doesn't do psychological testing. psychologist does A: Typically, that's true. Q: tests administered evaluated for criminal case A: different tests test aspects individual's psychiatric psychologic cognitive functioning Q: interest if person masking or lying about mind fake out evaluating forensic psychiatrist or psychologist test result jury could look at A: not sure if test states person lying SPK3: Objection. COURT: Sustained. Next question. PROSECUTION: Objection. COURT: Overruled. MACK: Not necessarily. REDDINGTON: aware Lindsay took test for Dr. Kirk Heilbrun no indication of malingering, exaggeration test? agree? [Q=REDDINGTON A=MACK] Q: bipolar II common precursor of postpartum depression or postpartum psychosis A: I don't understand your question. [12:10:00] Q: appropriate in Dr. Mack's opinion to give person suffering from bipolar II or bipolar ISSRI? A: need in practice traditionally if individual suffering from bipolar I or II to avoid using SSRI medications reduced worry over time 20 years ago, 15 years ago psychiatrists more concerned concern lessened over time. Q: in your opinion okay to give woman coming for help diagnosed with bipolar II give SSRI? telling jury A: That's not what I said. Q: Go ahead. A: bipolar type II need major depressive episode needs hypomanic episode similar to manic episode lesser in time course required only three out of seven symptoms required. Q: look at your report ultimate opinion of diagnosis Lindsay after evaluating her? A: my opinion was Q: Why don't you say it again, sir? A: she suffered from major depressive episode part of major depressive disorder PROSECUTION: Objection. Your Honor, he's reading [inaudible]. [Q=REDDINGTON A=MACK] Q: mental disease she suffered "Mood disorder, major depressive episode." A: Yes. Q: opined "She may have also had anxiety disorder preceded or while major depressive episode proceeded through January 24th."? A: Yes. [18:34:00] Q: Okay. aware she Tewksbury under diagnosis mental disease defect? A: Yes. Q: Adjustment disorder? not understanding she suffering bipolar disorder? A: show me where referring to Q: Dr. Heilbrun's opinion? Diagnosis? A: Yes. Q: What was it? A: diagnosis bipolar type II. Q: nurse practitioner Jollotta treating indicates diagnosis possibly bipolar disorder correct? A: don't she used terms concerned about possibility. Q: Dr.Resnick 's opinion? A: In terms of the diagnosis? Q: Yeah. A: Bipolar type II. Q: Dr. Zeizel? access to incorporated into report diagnosis [20:20:00] A: don't remember his diagnosis Q: her diagnosis A: believe bipolar type II. Q: healthcare providers opinion of bipolar type II agree strong indicator person suffering from postpartum depression? A: confused by question piece not inconsistent with diagnosis major depressive episode. Q: I'm asking you, sir, about- A: discussed specifier used diagnostic question Q: understanding nurse practitioner Jollotta is bipolar Zeizel report incorporated into report Dr.Resnick is bipolar II. not indicative of precursor to person suffering postpartum depression? in books articles A: use of terms seems apples and oranges Q: Okay. A: question of postpartum depression person have mood disorder? timeframe following birth? Q: recall Friday onset of postpartum depression symptoms within particular timeframe A: diagnosis depressive episode Q: What is the timeframe? A: timeframe for diagnostic specifier with postpartum onset is four weeks [23:39:00] Q: Okay. You recall saying that- A: That's the diagnostic rule. Q: recall saying person can be postpartum within four weeks"? recall Friday? A: intended Q: recall person postpartum within four weeks DSM A: To meet that specifier, yes. Q: every woman baby life is postpartum? postpartum means having baby A: Sure. Q: So- A: specifier with postpartum onset Q: Postpartum not a disease doctor Postpartum A: appellation defined in four weeks Q: proposal to amend DSM -5 text revision TR?What's A: proposal around proposed diagnosis postpartum psychosis six-week period Q: 4 weeks 6 weeks 12 weeks agree postpartum depression psychosis can occur up to a year or longer? [01:46:00] A: telling DSM says how to diagnose and code it Q: agree she Tewksbury with diagnosis of bipolar A: That may be among her diagnoses. Q: Okay. And she's on medication. Right? A: Yes. Q: she hasn't had past three and a half years problems with sleep, anxiety depression while medicated at Tewksbury A: not demonstrated signs of mania Q: 't demonstrated signs of anxiety while on medication right medication A: she's complaining of anxiety not sure demonstrating signs anxiety Q: she paralyzed in wheelchair not inability to bathe emote have feelings talk. able to communicate with A: Yes. Q: medications she's on at Tewksbury? A: taking low dose of Zyprexa clonidine trazodone propranolol occasionally Q: concerned about psychiatrist woman postpartum after baby complaining of symptoms long unable to sleep didn't need to sleep? textbook A: DSM textbook refers to decreased need for sleep as seventh element of mania." [07:19:00] Q: she exhibited signs symptoms of postpartum depression? A: she had depression after baby not DSM she had major depressive episodes this year within four or five months following birth. Q: familiar with postpartum psychosis? A: concept of psychosis Q: familiar with postpartum psychosis? Yes or no? A: familiar with proposed diagnostic entity postpartum psychosis idea people can have psychosis as mental disorder times Q: familiar with Department of Mental Health in Massachusetts A: Yes. Q: familiar with funding Department Mental Health for Massachusetts Child Psychiatry Access Products A: No. Q: MCPAP focuses on postpartum psychosis depression familiar A: No. Q: agree person child within postpartum period present doctor with symptoms believe postpartum depression? A: not familiar with program Q: asking about postpartum depression not familiar asking familiarity with postpartum depression [09:38:00] A: Yes. Q: symptoms of postpartum depression A: Postpartum depression- Q: DSM focus on symptoms for postpartum depression within first 4 weeks of birth could be 6 weeks 12 weeks a year A: DSM making diagnoses in psychiatry requires authority utilize DSM PROSECUTION: Objection. COURT: Sustained. Next question. [Q=REDDINGTON A=MACK] Q: familiar with Department of Mental Health Postpartum Psychosis Provider Training? LASCWs learning psychologists psychiatrists for DMH learning about postpartum depression psychosis? familiar with standards? A: No. Q: Edinburgh Postnatal Depression Scale talked Friday familiar sir? A: I am. Q: don't feel important regular GAD scale general anxiety scale sufficient A: I don't think I said that. Q: Edinburgh Postnatal Depression Scale important tool for diagnosing physician woman within timeframe exhibiting symptoms postpartum depression? A: Yes. [11:48:00] Q: if offhand told off chart impact on opinion utility of postnatal depression scale? PROSECUTION: Objection to form question. COURT: No sustained overruled MACK: scale elicits distress depression REDDINGTON: not just limited to distress depression focused on Edinburgh Postnatal Depression Scale MACK: Right. REDDINGTON: So no, the answer's right. MACK: diagnosis of depression treated for depression PROSECUTION: The last- [Q=REDDINGTON A=MACK] Q: agree postpartum depression EPDS symptoms doctor consider patient help A: So- Q: if woman less able to laugh no emotion unable to see funny side symptom opinion postpartum depression? Yes or no A: It's a symptom of depression. Q: next issue "Stopped looking forward to things." familiar with? People don't look forward to things called Anhedonia? A: one of several elements of major depressive episodes referred other day [01:04:12] Q: Right. one of symptoms of postpartum depression correct? A: They are the same. Q: Okay. A: depression meet qualifier call depression with postpartum onset Q: person anxious worried for no good reason? agree or symptom of postpartum depression authorities? A: So [inaudible]- Q: agree next symptom of postpartum depression anxious or worried for no good reason? A: So I can't answer that question. Q: she indicate had thoughts of harming herself? A: Well, or suiciding. Yes. Q: if successful harming herself dies it's suicide. thought of harming herself right A: 't interest harming herself suiciding Q: postpartum depression involves EPDS consists of one to 10 symptoms hits every one in medical records correct? A: not sure can't answer question Q: postpartum psychosis follow postpartum depression [01:07:21] A: using terms can't answer question Q: Postpartum psychosis can't answer? A: referring to proposed diagnosis Q: young lady suffering from postpartum psychosis when killed kids know what postpartum psychosis means? A: observation person may have psychosis or proposed diagnosis referred. Q: Symptoms of postpartum psychosis. Number one hearing voices. agree hearing voices indicative of symptom postpartum psychosis? A: referring to condition illness postpartum psychosis. don't can answer questions as psychiatrist. Q: agree person suffering from postpartum psychosis understand term? A: elicit asking Q: understand term postpartum psychosis? easy A: not easy serious elicit psychosis after birth take it seriously Q: seriously A: We psychiatrists? I as a psychiatrist? Q: agree diagnosing patient help after baby postpartum postpartum depression complaining of hearing voices commanding act symptom of postpartum psychosis? Yes or no? A: psychosis. don't know hypothetical proposed postpartum psychosis illness disease concerning symptom sign. [01:10:55] Q: this case with Lindsay Clancy? across in investigation? A: evaluation period she worried people could hear thinking different from thought broadcasting. she in serious psychiatric state suffering. Q: number two, postpartum psychosis symptomatology? Delusional beliefs with distorted reality complain Tufts Gelada about distorted reality disassociated? Things't real recall that? A: times context medications taking felt things weren't real felt uncomfortable. Q: appears normal between episodes calm laughing? agree postpartum psychosis waxes wanes? comes and goes A: referring to particular Q: simple question agree postpartum psychosis waxes wanes can come leave person appear normal? laugh. agree A: referring to postpartum psychosis illness? findings psychosis postpartum? Q: context A: national court of illness postpartum psychosis illness not refined not psychiatry talk illness understand typical course Q: don't believe or buy postpartum psychosis A: I didn't say that at all. Q: believe postpartum psychosis is serious mental illness? A: matter of belief or not belief aware of to elicit symptom sign of psychosis proposal for illness recognized understand typical course progresses proposed not approved for use in psychiatry Q: Approved by who? [01:14:28] A: By the American Psychiatric Association. Q: agree postpartum psychosis is legitimate disease or defect? Yes or no? A: symptom sign of postpartum psychosis particularly postpartum period legitimate finding to concerned treat. Q: Okay timeframe referring to Dr. Mack timeframe four weeks right? A: anytime person has psychosis Q: Okay. So, any- The issue A: four weeks diagnose wording't reality individual Q: psychosis postpartum agree two words together postpartum psychosis? A: not utilize in diagnostic terminology MACK: presence of psychosis concern especially new onset proper terminology labeling postpartum onset or not DSM provides guidance timeframe different than not serious condition REDDINGTON: symptom number one complaint Mass General Hospital research Department of Mental Health postpartum psychosis hearing voices commanding act symptom of postpartum psychosis agree? Yes or no? BUCKINGHAM: Objection. COURT: Overruled let him ask question again [Q=REDDINGTON A=MACK] Q: move on don't fight over number one number two? Delusional beliefs, distorted reality agree symptom of postpartum psychosis? Yes or no? A: said number one, two don't know authority referring to [01:17:33] Q: agree symptom of postpartum psychosis hearing voices delusional beliefs distorted reality? A: can't answer don't know if referring to psychosis or illness? Q: referring to illness Lindsay Clancy suffering in her medical record jury A: didn't find evidence of psychosis in her record other Q: delusional beliefs in distorted reality? recall her complaining about distorted reality? Yes or no? A: not sure she used terms referring to Q: No answer is no A: display psychotic features Q: didn't ask about psychotic features asking delusional beliefs in distorted reality A: type of psychosis didn't see evidence of psychotic features medical records Q: Great. A: don't see sign of psychosis signs of psychosis or delusions Q: postpartum psychosis delusional beliefs, distorted reality is symptom. Yes or no? Not A: referring to authority? Q: agree symptom of postpartum psychosis with woman treatment indicates normal periods between episodes disassociation calm laughing can drive cars talk use telephones [01:20:39] A: not necessarily psychosis Q: severe sleep deprivation agree symptom patient complaining symptom of postpartum psychosis A: can't answer question phrased Q: postpartum psychosis familiar agree severe sleep deprivation symptom? A: I can't answer the question. Q: can't answer rapid mood swings? agree symptom of postpartum psychosis? A: not sure understand your question Q: person saying not herself? want to be myself can't be myself complaint symptom of postpartum psychosis? A: might be if person has psychosis Q: intrusive person postpartum psychosis on radar intrusive thoughts harming children ask them what means? voice in head? thought process? ask question? A: Of course. Q: Did anybody ask question complaining about intrusive thoughts about suicide? ask meant? Voices head or thoughts? A: clinicians at McLane Mass General Dr.Gelada Dr.Tufts asked about made inquiries understand suicidal ideation BUCKINGHAM: Objection. COURT: Overruled. [01:23:39] [Q=REDDINGTON A=MACK] Q: complain of thoughts of suicide? A: Yes. Q: postpartum psychosis symptoms one through 10 person complaining doctor medical language complaining giving symptom. one through nine strong indicia person suffering from postpartum psychosis? A: One through nine? not sure can answer question. Q: blood tests? important prescribing medications Tufts after a month? A: They can be. Q: reasonable medical certainty person should be given basic blood test prescribing medications? COURT: Overruled. MACK: some situations where blood tests required needed other times psychiatrists may comfortable making prescriptions without tests. [Q=REDDINGTON A=MACK] Q: Prescriptions. person prescribed prescriptions reason competent physician would take simple blood test? A: It's possible. Q: So, let's take Lindsay Clancy for- A: Depends on medication Q: further analysis performed on blood from woman to determine enzyme reactions to prescription drugs? A: tests can done to determine relative degree of one enzyme or another breaking down medications [01:27:03] Q: of numerous complaints husband about postpartum postpartum depression postpartum psychosis narcotics drugs prescriptions never further testing A: Correct. Q: thyroid? important doctor with postpartum depression or postpartum psychosis? A: Thyroid important to assess in person complaining of mood problems Q: woman complaining during postpartum postpartum depression symptoms/or psychosis? important to check thyroid level? A: important check thyroid in multiple psychiatric conditions. COURT: Okay. Commonwealth redirect. MACK: That's correct. BUCKINGHAM: he name familiar in general psychiatry? MACK: knew he expert with Park Dietz & Associates Group never met him BUCKINGHAM: he not general psychiatrist MACK: I believe he's a psychologist. BUCKINGHAM: present next exhibit recorded interview of experts COURT: counsel sidebar exhibit SPK4: Exhibit 292. [01:36:58] COURT: Okay. No objection? REDDINGTON: Objection. [inaudible]. [Q=BUCKINGHAM A=MACK] Q: nothing criminal responsibility A: Correct. Q: directed to page 173 specifier with peripartum onset explain what is specifier DSM? A: Specifiers DSM diagnostician highlight details individual's presentation psychiatric classification refers to larger presenting symptoms specifiers can be added severe mood disorder add specifier with postpartum onset atypical features other specifiers defined Q: referring to page 173 paragraph peripartum onset portion specifier categories for bipolar related disorders postpartum periods? A: Yes defined way person add diagnosis not onset timeframe Q: talks about different mood episodes including manic and depressive episodes A: That's right. Q: mood episodes present with psychotic symptoms without psychotic symptoms psychotic features A: Bipolar disorder is disorder of mood. Abnormal mood diagnostician observes aware of if way to determine major depressive or manic hypomanic episode determine if severe mood condition is bipolar or major depressive disorder Q: same specifier part of major depressive category A: specifiers provide detail not major element of diagnosis major element DSM are observable major symptoms and signs Q: asking about what within specifiers Friday about DSM peripartum onset in specifier for bipolar and depressive disorder features in DSM specifier [01:43:34] A: Right. Q: presentation with psychotic features frequency of occurrence recurrence of peripartum onset for disorders A: [inaudible]. Yes. Q: risk of postpartum episodes greater when history of depressive disorders or bipolar disorder within specifier for each two chapters A: portion of specifier is description of observed over time not criteria observations commonly observed in manual Q: concept of peripartum onset within DSM -5 A: DSM -5 provides manner make diagnosis specification detail of individual's illness. Q: your conclusions evaluation rely on other's conclusions diagnosis own diagnosis? A: important to understand others concerned as physician make own diagnosis Q: case conclusion defendant presented with major depressive episode A: Correct. Q: relied on diagnostic criteria in major depressive disorder category fair? A: Yes diagnostic criteria support diagnosis Q: counsel went symptoms of postpartum depression. major depressive disorder nine general symptoms five more? A: major depressive episode defined parallel to manic episode both problems of mood discrete periods mood problems major depressive episode two-week discrete change in mood at least five of nine symptoms signs persistent most of the day days nine include anhedonia lack of feeling pleasure depressed mood feelings of guilt or worthlessness problems with thinking about death or suicidality problems with sleep, eating energy psychomotor activity slowing or agitation. five out of these nine to meet major depressive episode. [01:47:33] Q: Concentration. symptoms counsel read are category major depressive disorder. correct? A: Yes. method diagnosis major depressive episode. Q: asked cross-examination about postpartum depression found depressive disorder are symptoms major depressive disorder? COURT: Overruled. REDDINGTON: Leading. MACK: Correct. COURT: Overruled. I'll allow it. COURT: Anything further? BUCKINGHAM: Objection. COURT: Overruled. COURT: Doctor answered question. Next. Anything further? REDDINGTON: Nothing. Thank you, Judge. COURT: Anything further, Commonwealth? COURT: discuss before break Commonwealth? COURT: Thank you Madam Clerk. Attorney Sprague call next witness. [01:51:54] SPRAGUE: Your Honor Commonwealth calls Dr. Kirk Heilbrun. PROSECUTION: Good morning, sir. COURT: All right. Good morning, Doctor. HEILBRUN: Morning, sir. [Q=SPRAGUE A=HEILBRUN] Q: experience treatment of individuals incompetent stand trial or not guilty lack criminal responsibility? A: Between 1982 1991 staff psychologist chief psychologist Florida State Hospital Chattahoochee Florida 1991 1994 clinical director forensic unit Central State Hospital Petersburg, Virginia associate professor Department of Psychiatry Medical College of Virginia Richmond providing assessment treatment services supervising services Q: conducted research in abnormal behavior criminality? A: published 240 articles chapters books aggression violence juveniles mentally disordered adult offenders forensic assessment ethics malingering deception interests risk assessment influences violent behavior forensic mental health assessment principles psychological psychiatric evaluations in legal contexts criminal civil proceedings Q: Doctor, your experience in forensic evaluations teaching people you call someone doing forensic evaluation on patient? A: No. call them perhaps someone evaluated not a patient role therapist treating patient different from role psychologist or psychiatrist conducting forensic mental health assessment different ways we try as forensic evaluator conduct thorough evaluation be accurate true questions working as therapist help improve difficulties life symptoms two can conflict sometimes as therapist want to help forensic evaluator be accurate open thorough even if doesn't help Q: testified in cases as witness on competence to stand trial criminal responsibility time offense civil commitment? A: have. testified about 330 times with adults and juveniles issues included transfer and sentencing competence to stand trial mental state at time of offense civil commitment personal injury testified on behalf defense and prosecution qualified as expert in juvenile criminal and civil litigation in state and federal court conducted 75% of time evaluation testified on behalf defense remaining 25% conducted testified behalf prosecution or by order of court. Q: times in 25% casework retained by prosecution for criminal responsibility evaluation find defendant not criminally responsible tell prosecutor? A: Yes happens with prosecutor defense. we if in profession of forensic psychology if try to be thorough accurate impartial sometimes results favor whoever us conduct evaluation sometimes won't they hear if findings don't favor them they probably not want to use it Q: specialized in any particular diagnosis or offense or legal question? [02:05:07] A: not specialized. Most forensic evaluation experience with criminal and juvenile matters often included alleged crimes of violence't specialized in mental or emotional disorder, crime Q: benefit to not focusing on particular illness or diagnosis offense? A: Yes confirmation bias if up mind toward one diagnosis problem conflicting information not consistent with decision problem pay attention to information consistent stay away from information't not specializing gives advantage can not be inclined toward any particular diagnosis or possible answer to questions hypothesis to look at different possibilities when evidence favoring one or supporting one, inclined toward that.when not set aside. Q: Honor move to submit Dr. Heilbrun's CV next exhibit. [Q=SPRAGUE A=HEILBRUN] Q: what entail forensic evaluation? A: entailed review information meet with Ms.Clancy interview speak about time alleged offense conduct collateral interviews review range documents reviewing documents since January 2025 opportunity Ms.Clancy April 2026 spent three days with her Dr. Avram Mack One video recorded talked her background information second day met her video psychological tests private not did psychological testing second day third day back with video Dr. Mack talked with Ms.Clancy about thinking feeling time alleged offense. reviewed records report records over four pages not records include cell phone records defense expert forensic psychiatric evaluation reports by Dr.Resnick and Dr. Spinelli Department of Children and Family records digital forensic records texts information watch wore Apple Watch phone medical records police investigative records police interviews grand jury proceedings surveillance footage Clancy family Museum of Science visit, Cape Cod CVs Q: interviewing Ms.Clancy together after did two joint opinion on diagnosis? A: not, no. interviewing her together two days took information each independently our own report review analysis. wrote separate reports. not agree on diagnosis. Q: major findings regarding Ms.Clancy 's mental health history before September 2022? A: limited mental health history before September 2022. anxiety related to achievement strong student in school got straight A's experienced anxiety in nursing school case presentations stand up group anxiety connected with three pregnancies ultrasounds returning to work after each child time off with child after several months return to work Cora Dawson Callan anxiety didn't like to leave children important consideration dropping them off at school returning to work leaving with babysitter going friends date night didn't to leave connected mental health history before September 2022 context growing up as highly achieving individual strong grades competing in sports competitive cheerleading anxiety pushed her direction of doing well hardworking highly self-disciplined individual grew up in family close comfortable had friends spent time with as girl teenager highly achieving.think important her mental health history before September 2022 she experience anxiety with functioning had six months treatment for anxiety nursing school not interfered with life prior September 2022 Q: can you tell us major findings mental health history beginning September 2022? A: Yes can. 12 weeks after son Callan born feeling anxious depressed about leave him back work two reasons. One felt anxious about leaving children previous kids second reason breastfeeding Callan not taking bottle worried if back to work worked as labor and delivery nurse night shifts worried if left Callan home wouldn't take bottle problem got anxious searched for psychiatrist found Dr. Jennifer Tufts in September went Dr.Tufts got prescription for Zoloft wanted to reduce anxiety didn't begin taking immediately worried about impact on breast milk October began taking Zoloft things started difficult Q: And what did you learn? A: end of 12-week paternity leave more anxious started mid-October taking Zoloft. difficulty anxiety not better got worse symptoms of depression difficult insomnia felt stress in October November hoped to return to work not work symptoms difficult middle of November texted mother-in-law Sue Clancy at work nurse in emergency room at South Shore Hospital felt unwell problems sleeping racing heart lost appetite November struggling with anxiety severe insomnia palpitations.having difficulty with thought of leaving baby racing thoughts feeling overwhelmed moving into November late November difficulty with sleep disruption concerns starting mid-October about impact of medications thought medications adverse reactions difficult to look wanted improvement in anxiety not got worse." late in November trouble sleeping thought close to end of her rope feeling disconnected like a zombie report panic symptoms concerns about being addicted dependent on benzodiazepines disoriented forgetful disconnected from body difficulty with medication resulting in impact into December not getting better. COURT: She's coming to focus. [02:25:40] [Q=SPRAGUE A=HEILBRUN] Q: Okay. continue describing December 2022. A: Yes late November, early December she began experience horrible intrusive thoughts thoughts about harming herself potentially continued experience thoughts later December January occasionally about harming children early thoughts about possible suicide harming herself described thoughts pop into my head included brain damaged need to kill yourself not auditory hallucinations. her own thoughts intrusive unwelcome not auditory hallucinations important if hearing voice voice comes from outside your head different symptom than thoughts unwelcome intrusive thoughts in your head outside likely psychotic symptom psychotic symptom different implications for wrong unwelcome intrusive inside your own head Q: Doctor she described thoughts December about harming herself in medical records conversations as unwelcome internal thoughts correct? A: Yes important asked her question experiencing thoughts like your own thoughts or auditory hallucinations?" she said like my own thoughts." unwelcome intrusive like my own thoughts didn't talking about experiencing auditory hallucinations until January 24th continued difficulty with problems lost 15 pounds not intending tohaving tremors sweating GI symptoms sadness severe depression described feeling numb zombie-like words in December by middle December difficult Her sleep better significant symptoms of depression hopelessness loss of capacity for pleasure described experience on December 15th 2022 worst days Her husband took her to Mass General not stay long difficult symptoms bad December 20th went to hospital Women and Infants in Rhode Island day program for postpartum individuals difficulties't take her didn't meet criteria for postpartum program Generally looked having general anxiety symptoms depressive disorders not much postpartum Q: looking at Women and Infants records page 9 states patient offered options including inpatient treatment medication management partial hospital program general mental health outpatient management Patient plans to follow up with outpatient provider for guidance didn't fit into postpartum program three other programs correct? A: They did, yes. Q: reviewing records of Dr.Tufts and Rebecca Jollotta mention of defendant discussing three options offered by Women and Infants? A: No. back to treated according to plan medication she treated discussing with Dr.Tufts best implications for treatment Q: happened at Mc Lean. learned about Mc Lean impactful to analysis evaluation. A: admitted to Mc Lean January 1st 2023 suicidal thinking difficult time went into Mc Lean January 1st admission documentation listed postpartum depression major depressive disorder recurrent mild Mc Lean primary concern insomnia hospitalized made more anxious home asked about suicidal impulses thoughts not commit suicide because of children mother asked reasons for living other cited Q: that's something protects you or prevents from committing suicide? A: Yes. keep from doing. Q: further findings? A: she stayed at Mc Lean for five days documented not safety concerns minimal risk for returning community by January 3rd described mood as numb denied delusions hallucinations suicidal thoughts homicidal thinking discharged 5th of January cooperative pleasant no psychosis no suicidal or homicidal thinking Mc Lean had small shred of hope after discharge off medication Seroquel causing trouble intrusive suicidal thoughts returned within week following discharge Mc Lean Q: Symptoms following beginning medication major findings? [02:35:28] A: combined two and three after started taking medication in October Zoloft anxiety didn't get better difficulty with insomnia was numb felt like zombie improvement thought getting worse symptoms following medication October getting worse particularly new symptom insomnia. Q: move to next slide. Doctor bring us to number four PowerPoint, adverse response to medications including bad insomnia? A: Yes. I won't take long talking she thought when began taking medication in October medication from making anxiety better. making it worse keeping her sleeping. thought making difficult to. medication making real problem to sleep feel felt emotionally numb. accompanying bad insomnia with apparent adverse responses insomnia real problem. she continued to emphasize to providers Dr.Tufts or Ms.Jollotta, nurse practitioner. said medications making me worse." moving to number five focusing on making anxiety better through medication. counseling with Ms.Jollotta, have cognitive behavioral therapist help work problems. thought medication help. did focused on good deal. Q: defendant focused on medication resolving problems include talking to doctors about different medications researching medications asking friends family for tips medications? A: Yes, all of those things. Q: move on to number six, mixed evidence about diagnosis nature of problems? A: Yes. Q: major findings? A: Over she through experiences between mid-October and late January had providers offer diagnoses complicating considerations. diagnoses given were adjustment disorder with anxiety and depression generalized anxiety disorder major depressive disorder bipolar disorder, bipolar disorder II postpartum depression postpartum psychosis post-traumatic stress disorder last one not before January 2023 she has now addition to diagnoses disorder symptoms complicating factors. had psychotropic medication with apparent adverse reaction serious sleep deprivation three-month period five and eight months after birth third child anxiety about returning to work fall of '22 worried about leaving baby for work not taking bottle into exercise stopped exercising in October started adverse reactions difficult to handle couldn't do running yoga Peloton to keep anxiety managed Q: recommend to patient exercise to compliment medication and therapy? A: if it works for some people they use it effectively lives particularly if anxiety might not fully need treatment interfere with life. Q: number seven, your diagnosis, bipolar II disorder. was your diagnosis of Ms.Clancy? A: hard because of diagnoses in records symptoms she experienced. diagnosis of bipolar disorder II disorder less serious identifiable mood swings. period of depression she had made big difference in depressed symptoms sadness not much motivation. for bipolar diagnosis need identifiable period where mood greater. one feels during manic period high, jumpy decreased need for sleep racing thoughts flight of ideas thinking fast excessive appetites not tired feeling important powerful hard time finding manic episode. times she felt after birth children felt good on top of world close to husband kids didn't look like manic episode feeling good getting back into exercise gave pause in diagnosing bipolar disorder didn't see manic episode. convinced me she's been at Tewksbury for more than three and a half years. diagnosis of record at Tewksbury is bipolar disorder.they are read records careful about prescribe how much other considerations. records reflect she was on medication stabilize mood discontinued for medical reasons she had immediate response noticed it consideration. ended up with diagnosis of bipolar two disorder slightly less. severe form of bipolar disorder. Q: Doctor, why diagnose bipolar two not bipolar? A: bipolar more severe diagnosis more noticeable. if bipolar diagnosis want to see looks like manic episode. see evidence before January 24th 2023. [02:48:35] Q: this diagnosis bipolar two way to determine she always had disorder or if something new when appeared? A: disorder typically comes in adulthood not kid or adolescent start show signs in 20s or 30s. Q: criminal responsibility evaluation. mental state and legal standard relevant findings on number eight? A: number eight wasn't called just to make diagnosis or symptoms. criminal responsibility evaluation. look at standard for criminal responsibility in jurisdiction? understanding standard for criminal responsibility in Massachusetts person not criminally responsible if time offense suffered from mental disease or defect lacked capacity to appreciate criminality or wrongfulness conduct or to conform conduct to requirements law three parts to criminal responsibility standard. first is mental disease or defect paid attention to symptoms when began try to take symptoms see how they affect somebody in case Ms.Clancy 's capacity knowing illegal or wrong affected capacity conforming conduct to requirements law controlling her behavior. Q: Okay. what types of psychological testing with Ms.Clancy? A: several reasons wanted psychological testing. One response style. Ms.Clancy during interview could respond reliably within limits memory accurately. other response styles. One could exaggeration or fabrication. Sometimes called malingering distort report exaggerate fabricate severity of. other response style is under report. minimize or deny things experienced. response style important in forensic evaluation paid attention to it. psychological administered Minnesota Multiphasic Personality Inventory has scales allow to she reliable or exaggerating or fabricating minimizing or denying? wanted tests second pay attention to possible symptoms of severe mental illness, like hallucinations delusions mental disorganization. can focus get off track or tangential speech running off topic Cognitive disorganization is another speech. review of her reported symptoms around January 24th of 2023 wanted to ask questions comprehensive about other symptoms depression wanted to know measure with psychological tests finally suicidal thinking important wanted to ask her questions about thinking feeling behavior related to suicide leading up to January 24th. reasons gave her psychological tests. COURT: good time to break. Why do? Thank you members of jury take afternoon recess. know my instructions same.Don't talk about case Don't do research Don't listen to anything Don't read anything. Have nice break come back here about two o'clock. CLERK: Commonwealth versus Lindsay Clancy. All parties present excluding jury. CLERK: Your Honor for record return back to trial.Commonwealth versus Lindsey Clancy. All parties present including defendant 18 jurors. [Q=SPRAGUE A=HEILBRUN] Q: Thank you Your Honor. Doctor before broke describing psychological tests conducted on Ms.Clancy. results of tests? A: Yes MMPI first three and a half years after alleged offense describe her thinking feeling behavior in April 2026 than January 2023. challenge to reconstruct happened ago tests administered from standpoint back then MMPI delivered terms how doing now she response style scales showed slight tendency to under-report deny unusual experiences sophisticated bright woman account might be under-reporting wrong clinical scales on test she not elevated not actively symptomatic in or in great distress one scale elevated suicide and death ideation scale Ms.Clancy been on one-to-one suicide precautions highest level precautions hospital since she Tewksbury. long time on precautions. she was at risk for suicide. remains at risk for suicide. Adverse Childhood Experience Questionnaire measure of child adverse traumatic events. she was not had a zero. two measures of suicide intent One Beck's Suicide Intent Scale other Columbia Suicide Severity Rating Scale. results she responded to one January 2023 suggested serious suicide attempt responded to both remains at high risk for suicide one-to-one supervision for three and a half years. brief symptom inventory possible symptoms last month under two circumstances. One how are you doing now? around April this year. how doing in January 2023? Her description January 2023 endorsed feeling blue, extremely depressed no interest thoughts of death or dying hopeless future self-conscious idea something wrong with mind thought depression, suspiciousness memory problems with attention concentration trouble concentrating cooking forget steps consistent with symptoms of depression good indications she endorsing feelings of depression improving somewhat from December feelings.obsessional beliefs questionnaire has three scales. One scale is responsibility threat estimation belief personal responsibility overestimation of threats She not elevated. second was perfectionism and certainty not elevated works hard not elevated on perfectionist aspect. elevated on importance and control of thoughts always important to work hard control her mind life making her depressed hopeless sad trying hard since October to control problems't working not succeeding Lahoney Slade Hallucination Scale she endorsed Sometimes passing thought real frightens me. Sometimes distracted concentrate work. endorsed in '22 and '23. past experience of hearing person's voice no one there only on January 24th. hear voice speaking thoughts aloud again only on January 24th troubled by hearing voices in head again only on January 2024th psychological testing results. move to last item PowerPoint important to consider her motivation for killing her children.Lindsay Clancy out of character to know what could have been talked to her husband about discipline kids never spanking hands-on felt bad when yelled at kids.imagine her doing seems out of character thought important to figure out why might have happened. approached it. why question could be valuable to know whether she understood something wrong or could conform conduct to law or control herself. why question seemed important. next slide. Q: can you explain please? A: I can, yes. reasons in my experience why people harm another kill one another. most reasons not applying to Ms.Clancy. wasn't job related't in military't to do with money property fame anger being callous abusive afraid None evidence for. couple things started to evidence for looked like. One psychosis possibility severe mental illness hallucinations, delusions. on January 24th, experienced symptoms in. calling first point acute psychosis with command hallucinations. second possible explanation attempt to take own life suicide might harm children prevent them from suffering. example. If one learn Holocaust coming tomorrow thought awful can't live through take my own life. If had children question might, do I take them with me? take their lives? not saying definitely do but as possibility thought two possible explanations for why she did. first acute psychosis with command hallucinations second serious suicide attempt she wanted children to be with her wouldn't't suffer after she gone. in evidence supporting each those.I will tell you now most evidence saw supported second not first Q: doctor, go next slide talk tell evidence for acute psychosis with command hallucinations. A: Yes. first was's she said. asked her question she explained it happened. She said afternoon of January 24th, 2023 heard a voice voice said "This your last chance. kill kids kill yourself." heard voice evidence of psychosis command hallucinations voice instructing her. other possible things think be severe mental illness two. One thinking others might know her thoughts. symptom of psychosis thought broadcasting experienced certain way thought broadcasting idea you can hear what I'm saying as if on television podcast movie asked her about she said not thought broadcasting but vivid thoughts thought might people could hear them second possible symptom thinking police might take her children. records saw people looks like paranoid delusion. I didn't look paranoid or delusion. I'm healthcare professional in Pennsylvania mandated reporter. If someone child injured or severely hurt required by law to contact child line in Pennsylvania. Ms.Clancy is a labor and delivery nurse healthcare professional.if she said to psychiatrist psychologist treatment she thought experiencing ideas might harm kids know as mandated reporter they legally required to report. might not mean police take kids away but investigation. She to answer questions might for separated from children. [03:14:28] Q: mentioned didn't think it was a delusion. true delusion is fixed false belief? A: Yes, that's the way it's defined. Q: continue discussion of evidence for acute psychosis. A: Yes point's appealing as explanation could explain acts out of character for her don't complicated had psychotic episode heard voice told me to do something terrible did it. Q: after considering evidence for acute psychosis command hallucinations consider evidence against acute psychosis with command hallucinations? A: I did, yes. Q: And what did you see? A: she described heard voice never heard before experienced hallucination never experienced since only experienced for 18 minutes took to kill children. unusual pattern manifestation doing evaluation for years careful when experienced symptom only during committing offense Q: next part of evidence against acute psychosis? A: discussion of postpartum. she eight months away from given birth to Cowan youngest child explanations sources authority like DSM -5 Cleveland Clinic point to one month after birth or two months after birth farther away time-wise from birth less likely to be postpartum could be something else saw symptoms of depression experienced in January less likely to be postpartum next inconsistencies in her account.asked about she said voice said "This last chance. kill kids kill yourself." kept repeating only for 18 minutes time. other times in hospital after talking to psychiatric said voice said other things "The children suffer without you or take kids with you". inconsistency important suggests inaccuracy. which version accurate? first? second? neither? couldn't be both she said "I only heard this," some people "I heard this, plus this," other people said REDDINGTON: Objection. COURT: Yeah. Overruled, defense. REDDINGTON: Objection. speculation not based on evidence no foundation for hypothetical question. REDDINGTON: Objection for the record. COURT: Yeah. Overruled. Go ahead. [03:21:28] [Q=SPRAGUE A=HEILBRUN] Q: other evidence against acute psychosis? A: research conducted on malingered hallucinations exaggerated or fabricated useful to look at research research suggests consideration voices internal or external from thoughts or outside head Ms.Clancy perceived voice as external consistent with genuine hallucinations command hallucinations in 88% individuals one account accompanied by related delusion Ms.Clancy report accompanied delusions one point for genuine one point for possible exaggerated frequency and control. Genuine psychotic hallucinations often intermittent than constant come go You'll You'll extend over time Ms.Clancy reported voice constant for 18 to 20 minutes then stopped not experienced before since report control over voice or actions next content genuine hallucinations often familiar use both genders clear Ms.Clancy described voice as clear unfamiliar single male voice mixed not counting one direction or another reaction and coping Individuals hallucinations reduce influence praying listening to music inaccurately report hallucinations describe coping mechanisms Ms.Clancy didn't report attempt to stop voice distract three points her account resembled exaggerated hallucinations. One looked genuine one mixed. Q: If I ask you question said more points indicating malingering or exaggerating voice earlier testified about psychological testing of Ms.Clancy showed minimization didn't show malingering. explain how two things occur in same person? A: Yes appraise through testing specialized measures malingering or exaggeration typically psychologists develop measures looks like shotgun approach unusual things wrong strange things wrong many things wrong good at picking up shotgun approach to malingering if ask questions answer genuine accurate except one exception one experience or symptom exaggerate or fabricate can't pick up through testing develop ideas about how experienced consistent with disorder take broader approach tried to talking this. Q: We'll go to next slide further evidence against acute psychosis? A: Yes start with question of thoughts or hallucinations found account of hallucinations unusual to experience Never not constantly for 18 minutes if thought unwelcome intrusive thought "This last chance kill kids kill yourself." consistent with thoughts she'd experiencing thoughts about harming herself difficult for to do this sense.She experiencing thoughts about hurting herself brain might damaged hurting kids unwelcome thoughts. If case on January 24th consistent with she experiencing months before sense rather than auditory hallucination unwelcome intrusive thought next bullet her response to husband's question "What did you do?" got home around 6:00 PM January 24th house quiet thought people might playing hide-and-seek Called downstairs didn't get answer Called upstairs didn't answer found bedroom door locked unlocked key saw blood window open ran downstairs saw wife Lindsay lying semi-conscious first question "What did you do?" her response "I tried to kill myself." thought if she experienced command hallucination might've said "I did what to voice said no said "I tried to kill myself." consistent with serious highly lethal suicide attempt last bullet point recovery of memories she regained consciousness in hospital wasn't to remember what happened informed of it if genuine memory loss human memory is funny trying to remember things interfere read toldhard to understand recover memory accurately including memory command auditory hallucination said Q: Okay. if we could next slide describe evidence for suicide combined with altruistic filicide. A: "Altruistic filicide" is term means killing kids out of love. Not cruel or for material gain but killing out of love prevent suffering. she with highly lethal serious suicide attempt. Q: next slide. further evidence for suicide combined with altruistic filicide? A: she said strangling each child said, "Go to God God." of expectation children together in heaven with God. She raised as Catholic. Catholic considerations not necessarily what happens. asked her about said "Isn't suicide a mortal sin?" COURT: After sidebar conference defendant made motion. allow argument in to motion. hear first from defendant then Commonwealth Mr.Reddington REDDINGTON: Thank you, Judge. long trial of work involved from court staff prosecutors myself. strain on Lindsay Clancy to move for mistrial reluctantly intentional misconduct prosecution idea of injecting Roman Catholic faith concept of mortal sin into trial occurred about a week ago.objected before Your Honor had us at sidebar forcefully indicated to jurors not consider. put on record not feel felt court's instructions sufficient forceful right on point moved forward without motion for mistrial made tactical decision. concern over the top. same thing: talking about religion heaven killing people impact effect on Lindsay her children. not first time occurred during trial prosecution previously brought up concept of mortal sin. Based on your ruling past brought up again believe intentional misconduct. feel court should grant motion for mistrial. SPRAGUE: Thank you, Your Honor. question asked witness ask testimony about religion Catholicism mortal sins slide still on screen nothing about Catholicism mortal sins witness explaining reasoning intentional witness interview of Ms.Clancy witness determine defendant knew wrongfulness of conduct criminally wrong or morally wrong. he explored her interview asked knew legally wrong she said no concept of legal consequences. about moral wrongfulness religion knew morally wrong she knowledge suicide considered sinful. witness trying explain reasoning't intentionally trying to inflame jury or cause issue't didn't ask question about religion invoke response asked him to explain what was on slides not on slides no intentional conduct by Commonwealth not intended questioning witness intended to harm just explaining his rationale. ask jury disregard answer speak to witness tell him not to talk about reasoning behind thoughts testify about conclusions leave that portion of reasoning out of testimony. COURT: concern witness He said "Go to God, baby God." statements made in evidence indicated part of her expectation she and children together in heaven with God Now closer to problematic area. he testified "She was raised as Catholic. understand Catholic considerations not necessarily what happens." proper? not. not declare mistrial. bring jury in tell him to disregard it inappropriate area of inquiry witness's understanding of Catholic dogma teaching irrelevant no evidence of his background training seminary. he injected that. giving Commonwealth strongly talk to him let him know can't go into that. bring jury back in give him instruction send him home don't want them leaving with last thing discussion about witness's understanding of Catholic teaching not last thing hear thought address that minimize damage or prejudice presume jury will follow instructions We'll come back give Commonwealth time to talk to witness let him know areas he should and not go into tomorrow resume direct examination and cross-examination. thought We'll bring jury in give him instruction recess until tomorrow? REDDINGTON: Your Honor, for record, note objection? [03:45:38] COURT: All right members of jury before we broke testimony from last witness give instructions testimony. religion defendant raised with inappropriate area of testimony. to be stricken. not be considered considered witness's understanding of Catholic teachings considerations immaterial irrelevant disregarded based testimony. delay due to this excuse you until tomorrow thought we'll come in finish up with this witness Commonwealth has another witness then talk about where we go. apologize for confusion delay had instructions with when left today sorry see you tomorrow. Thank you. COURT: Counsel, one more time. see you at sidebar? in recess until tomorrow anticipation evidence done tomorrow likely charge conference tomorrow afternoon arguments in charge on Wednesday. Subject to change. thank you see you tomorrow morning. ## Day 20 (604 of 1790 turns kept) [01:25:28] SPK4: Good morning, Your Honor. I proceed? SPK4: Your Honor before court today matter of Commonwealth versus Lindsay Clancy. Ms.Clancy present represented by attorney Kevin Reddington Commonwealth represented by Assistant District Attorney Jennifer Sprague Assistant District Attorney Shannon Buckingham REDDINGTON: Good morning, your Honor. COURT: Morning Ms. Clancy. L.CLANCY: Morning, Your Honor. COURT: start morning see everybody at sidebar set for sit for jury. SPK4: Good morning Your Honor. proceed? SPK4: court today continuation of jury trial Commonwealth versus Lindsay Clancy. Ms.Clancy present represented by attorney Kevin Reddington Commonwealth represented by Assistant District Attorney Jennifer Sprague Assistant District Attorney Shannon Buckingham COURT: Good morning everyone nice to see everyone ask questions follow instructions schedule today talk about where we go after today questions Has any member of jury read seen heard overheard anything about aspect case affect ability to fair impartial juror? COURT: thank you for following instructions return to witness on stand.Commonwealth conducting direct examination After defense opportunity cross-examination after commonwealth has one last witness anticipated lineup today not speculate wrong estimate of symbol schedule anticipated last two witnesses. talk to lawyers We'll see where we go from there.then I will today before leave'll explain next step. Okay? return have witness back on stand Commonwealth. SPK3: Step please. COURT: Good morning, Doctor. HEILBRUN: Good morning, Your Honor. SPRAGUE: Doctor, tell us what is peri-traumatic. start over peri-traumatic disassociation factored into your evaluation in this case? HEILBRUN: Yes. experience when frightening or traumatic situation circumstances feel things unreal's not you watching yourself through actions sounds like could be psychotic, but more likely recognized aspect of traumatic situation circumstances many people experience. [01:36:32] SPRAGUE: what types of decisions made to effectuate strangulation of children? COURT: Yeah. Yeah. COURT: Overruled. I'll allow that. [Q=SPRAGUE A=HEILBRUN] Q: peritraumatic disassociation seems like sign of psychosis, but isn't. Why? A: more commonly experienced in circumstances than psychotic symptoms. Q: yesterday went through two options considered psychosis with command hallucinations or suicide with altruistic filicide, testimony it's either/or one or the other? A: my testimony were two possibilities seemed have evidence But end of talking her testing reviewing information collateral interviews evaluation evidence strongly supported second explanation serious suicide attempt accompanied by killing children out of love. Q: differences in her demeanor or answering questions between first and third day? A: Yes interviewed her worked with on testing for three days first second day she attuned to question Her recollection good three years away from events good memory for dates medications dosages times relevant details continued attentive responsive good attention concentration on second day third day about mental state at time offense circumstances alleged offense appeared more cautious guarded. Q: asked her third day recall statement? A: Yes statement Brigham Women's attending psychiatrist made in context of her thinking about what happened asked about voice said response said "You kill yourself so kill kids." kids will suffer without you." asked voice said "No voice said your last chance. kill kids so kill yourself." REDDINGTON: to move to strike as not responsive. COURT: No, overruled. I'll allow it. SPRAGUE: mentioned emphasis on control of her life. How in evaluation done? HEILBRUN: considerations why she she decided to take her own life she's individual life disciplined liked to control work hard accomplish things striking between October and January she seemed doing best talking to doctors therapists working on lessening anxiety getting right medications't working couldn't make it work control through hard work discipline frustrating difficult for to think about not being hopeless life [01:50:05] SPRAGUE: And what is that opinion? HEILBRUN: yes she was experiencing bipolar II disorder depressive symptoms exacerbating sleep problems adverse reactions to medication she mental disease or defect on January 24th. REDDINGTON: Objection [inaudible]. COURT: question opinion SPRAGUE: And what is that opinion? HEILBRUN: she retained awareness of illegality of killing others including her children Her moral awareness wrongfulness influenced by desire to die not leave children behind Some perception realistic "My children will suffer without me some distorted "Nobody else can care for children." awareness of illegality moral wrongfulness killing understanding acts as serious suicide attempt altruistic filicide killing children out of love response to command hallucinations. SPRAGUE: And what is that opinion? HEILBRUN: her capacity to conform to requirements law understood considering seriousness of suicide attempt desire not to leave children demonstrated self-control on January 24th actions between 5:15 and 6:00 PM influenced by depression hopelessness desire to end pain since October depression hopelessness influenced decisions retained control over inclusion of children SPRAGUE: move to submit PowerPoint for identification [Q=REDDINGTON A=HEILBRUN] Q: Dr. Heilbrun aware of person major surgery subject to anesthesia delusions hallucinations statements A: Yes, I'm aware of that. Q: January of '23 add year January '24 A: Yeah. Q: One year. A: Yeah. [01:58:25] Q: January '24 add year January '25 two years A: Yes. Q: treated woman in postpartum psychosis A: staff psychologist at forensic service at Florida State Hospital Q: 44 years ago A: Yes. Q: Yeah, what's Giant Food Corporation? A: company refer difficulty at work symptoms threats for evaluation from psychiatrist psychologist did for Giant Food Corporation Q: Texas Education Commission Forensic Clinical Site Visitor, Sam Houston State Hospital University A: Yes. Q: grant reviewer for Office of Victims of Crime United States Department of Justice A: Yes. Q: worked did violence risk assessment consultant New Jersey Department of Mental Health Services A: Yes. Q: consultant forensic psychology service Walter Reed Medical Center [02:06:13] A: Yes. Q: Violence towards others psychiatrically hospitalized populations Patient patient assaults mental institution A: patients against patients staff Q: Sexual violence risk involved New Orleans Louisiana sexual violence risk assessment A: Correct. Q: Obtaining using mental health experts criminal litigation administrative office United States courts A: Yes. Q: experts A: workshops prosecutors defense attorneys judges effective obtain present forensic psychologist psychiatrist expert half day or full day workshop Q: worked forensic mental health assessment Ohio Forensic Psychiatric Center inmates A: Yes. Q: Assessing risk violence towards others psychiatrically hospitalized populations focused A: Yes, that's right. Q: Appraising Jackson based unrestorability competence to stand trial standard competence trial A: Yes, it is. [02:11:58] Q: life sentence for juveniles sequential model juvenile. justice forced medication competency to stand trial." A: Yes. Q: disputed paraphilia diagnoses legal decision making focuses A: graduate students supervising second author Q: "Involuntary medication trial competence clinical dilemmas substance abusing adjudicated adolescence." resume pages almost 70 pages A: Yes, I would agree with you. Q: Violence risk assessment, right? A: Correct. Q: Life sentence juveniles on A: juvenile work Q: handling difficult cross-examination integrating perspectives combining substance with style A: Yes. Q: hundreds of articles on topics jurors resume evidence "Sexual abuse behavior juvenile forensic mental health violence risk assessment behavioral measure sexual offense behavior influencing third-party informant observations juveniles courts coerce offenders into substance abuse treatment." one article about woman pregnant postpartum depression God psychosis A: No. Q: article 49 years ago published article on psychosis 1977 college [02:16:56] A: research assistant Q: before graduate school used diagnostic framework A: It was a long time ago. Q: three years before DSM written DSM 1 Stone Age A: It was a while ago. Q: Postpartum psychosis. A: Ah, yes. Q: Yeah. A: late 2025, early 2026 Q: Zoom FaceTime A: Yeah. Exactly. Q: 10 and a half hours young lady wheelchair questioned by Avram Mack on medication A: Yes, that's correct. SPK5: Objection, if he could answer- REDDINGTON: diagnosis depressive bipolar II [02:23:31] HEILBRUN: Bipolar II disorder, right. SPK5: Objection. COURT: Sustained. REDDINGTON: You know Rascal Flatts? HEILBRUN: I'm sorry? REDDINGTON: Was that in '22? HEILBRUN: date night for fifth anniversary in '22 SPK5: Objection. He can finish. HEILBRUN: Judge confused between COURT: All right. That's good. Next question. REDDINGTON: saw Tufts from September until killing of children condition told jury confusing with diagnoses dealt with HEILBRUN: Yes, I did use that word. REDDINGTON: September turns into October October how was she doing between depression anxiety drugs prescribed? HEILBRUN: anxious about going back to work hadn't started taking drugs prescribed HEILBRUN: September anxious about returning to work not started taking medications Dr.Tufts prescribed [02:36:54] [Q=REDDINGTON A=HEILBRUN] Q: read out loud A: "Mom stay with sick Something wrong horrible insomnia don't know how get through day started taking medicine doctor prescribed for anxiety made things worse scary don't want to be alone." Q: concerns about mid-October impact of medications on insomnia A: Insomnia first problems experienced started taking medication in October Q: believed medications adverse effect damaging brain A: She did express that view, yes. Q: medication resulting in this development life medications contributing A: Yes, that's correct. SPK5: Objection. COURT: No, overruled. [Q=REDDINGTON A=HEILBRUN] Q: answer based on Dr. Heilbrun's review of medical records young lady through hell living? A: question did someone ask her about hallucinations or thoughts? Q: if I come for help intrusive thoughts about killing myself God killing kids thoughts head." you ask "Are they voices? Thoughts? ask question A: standard question psychiatrists ask each appointment standard mental status question Q: Did psychiatrists ask Lindsay Clancy question according to medical records? [02:42:30] A: Ms.Clancy completed answer questions Q: What questions? REDDINGTON: What questions? COURT: Finish the answer. SPK5: Objection. COURT: Overruled. [Q=REDDINGTON A=HEILBRUN] Q: important for evaluation asked question experiencing thoughts were they your own thoughts or auditory hallucinations?" she indicated "They're my own thoughts testimony Yesterday A: That's correct. Q: general anxiety symptoms testimony yesterday A: records anxiety focusing on her experiencing Q: testimony not much postpartum." A: in December seven months away from giving birth Callan less likely postpartum than depression bipolar major depression psychosis Q: postpartum not a medical diagnosis fact had a baby A: I do know that, yes. Q: she went to hospital provide help medication on December 15th? [02:49:22] A: stay in hospital long didn't remain long enough to get help inpatient Q: December 20th December 20th wasn't good day A: she went to Rhode Island Hospital postpartum program Q: specialized in postpartum care for women possibly postpartum psychosis or depression A: Yes. Q: various other things people involved referring to employees hospital A: patients attending postpartum program Q: testified yesterday she not fit into postpartum program three other programs." A: Yes. Q: "Patient offered options including inpatient treatment for medication management A: Yes. Q: Tufts outpatient management? A: living at home in community treated by psychiatrist Dr.Tufts Q: doctor licensed as physician psychiatrist in postpartum postnatal issues qualified to treat young woman with symptomology? A: I don't understand your question. [02:54:06] Q: went back schedule with Dr.Tufts didn't help she still numb having suicidal ideation A: Correct. Q: failure to help told her to leave A: understanding they said you don't fit with our program not postpartum phenomenon program Q: read records from Women &Infants Hospital in Rhode Island? PROSECUTION: Objection. [Q=REDDINGTON A=HEILBRUN] Q: said to jury wouldn't accept her? A: day program for women postpartum difficulties evaluation of Ms.Clancy her difficulties related to general mental health not postpartum difficulties she Q: Yeah, you might. A: might be appropriate for general mental health program not postpartum day program didn't say don't need help said don't fit with our program Q: surprise you she didn't fit with program because of over-medication doctors caused? memory? A: questions raised about medication Q: questions reason secondary diagnosis wouldn't accept lady medications prescribed over-medicating A: The... Q: recall in records? [02:57:05] A: diagnosis of depression not specified medicine complications. Q: discharge diagnosis? A: Yes. PROSECUTION: Exhibit 220. [Q=REDDINGTON A=HEILBRUN] Q: 220 Women &Infants Hospital records A: page 18 report Q: [inaudible] discharge diagnosis? A: records indicate diagnosis of generalized anxiety disorder and depressive disorder without specification "Due to adverse drug effects." Q: Anything else? A: chief complaint feeling numb crazy depressed passive suicidal ideation Q: read diagnoses question simple on discharge diagnosis A: discharge diagnosis anxiety depression. Q: And secondary to what? A: didn't specify more depression due to adverse drug effects. Q: Sorry, Nurse Practitioner Jollotta. [02:59:59] A: Yes. CLERK: returned to trial of Commonwealth versus Lindsay Clancy. All parties present excluding jury. CLERK: return to trial Commonwealth versus Lindsay Clancy All parties present including defendant 18 jurors. [Q=REDDINGTON A=HEILBRUN] Q: Exhibit 220 records from Women and Infants Hospital read prior to today A: Yes. Q: records agree history of present illness Lindsay questions about felt medications A: Yes, I would. Q: reviewing she indicated feeling "Crazy, depressed numb to emotion." "Can't feel love." life becoming disaster." A: quoting from records or report? Q: Records, Exhibit 220. A: agree words used records Q: can lead to psychosis A: Yes. Q: "Medication. Recommended Seroquel starting with 200 milligrams tonight follow up with outpatient provider." Gelata A: could have been Gelata or Tufts [03:41:46] Q: diagnosis approach doctor read number one and two for jury A: Number one GAD generalized anxiety disorder Number two depression unspecified due to adverse drug effects. Q: rule out concern about adverse drug effects imagine reach out to person prescribing drugs right? A: possible. other strategies change medication discontinue number things Q: she released agree she continued describe mood as numb denying not hallucinations suicidal thoughts or homicidal thinking prior to discharge right? A: lot in question break it down appreciate Q: And this was on January 5? A: January 5, yes. Q: she described in records cooperative pleasant right A: Cooperative pleasant no psychosis no suicidal or homicidal ideation Mood "good not anxious. Q: Good for you else add? SPRAGUE: Objection. COURT: Sustained. Next question. [Q=REDDINGTON A=HEILBRUN] Q: intrusive suicidal ideation thoughts returned right A: Within a week, yes. [03:47:59] Q: combine two and three on slide before indicate after started taking medication Anxiety didn't get better difficulty with insomnia numb right? A: Yes, correct. Q: thought it getting worse." thought symptoms following medications October symptoms getting worse particularly new symptoms insomnia page 126 of testimony [inaudible] A: misunderstood question. Q: indicated moving on to number five chart she focusing on making anxiety helping better through medication right? A: Yes. SPRAGUE: Objection. SPRAGUE: Objection. COURT: Sustained. Next question. [Q=REDDINGTON A=HEILBRUN] Q: limited. A: short term supportive to cognitive behavioral therapist supported for anxiety depression patients Q: She focusing on make anxiety feelings go away wanted to be herself again A: Yes, that's right. Q: not issue black mark against her she trying to control of life medications internal feelings at postpartum believed A: not trying to develop black marks against her trying to [03:51:55] COURT: All right. Next question. REDDINGTON: Okay. HEILBRUN: Yeah. REDDINGTON: resolving problems talking to doctors about medications researching medications your testimony. Asking friends family for tips. supposed to ask friends family for tips about mental psychosis mental state? HEILBRUN: not sure question REDDINGTON: Dr. Heilbrun testified yesterday response to questions district attorney about resolving problems talking to doctors medications researching medications asking friends family for tips COUNSEL: Objection. Is there a question? REDDINGTON: "Something you do referring to? women to doctor in postpartum depression psychosis ask for help talk to neighbors? HEILBRUN: natural human inclination to talk to people close friends family problem advice help REDDINGTON: over time she through experience into late January she had providers offer diagnoses complicated considerations diagnosis given adjustment disorder with anxiety depressions, generalized anxiety disorder, major depressive disorder, bipolar disorder, bipolar disorder II, postpartum depression psychosis postpartum stress disorder. your words HEILBRUN: Yes. COUNSEL: Objection. question and response. COURT: Yeah. Good. Next question. Go ahead. [Q=REDDINGTON A=HEILBRUN] Q: She had "psychotropic medication with adverse reaction words jury A: Yes. [03:55:05] Q: What is psychotropic medication with adverse reaction? A: It's pronounced psychotropic, and- Q: I'm sorry. A: Psychotropic medication prescribed to treat symptoms mental or emotional disorder improve symptoms Q: Yeah. It's called adverse. A: medications available help most people clinical trials for few people side effects adverse reactions don't help might make things worse. records for Ms.Clancy reactions different poor not reactions designed to improve symptoms had opposite happen COUNSEL: Objection. COURT: Sustained as to the form. HEILBRUN: To medication prescribed since September HEILBRUN: she having adverse reactions from began taking medication in October up to January COUNSEL: Objection. COURT: Overruled. REDDINGTON: no problem with woman trying to exercise avoid drugs out of depressed state after having baby HEILBRUN: contrary good idea if she can do it she used exercise life to manage mood do better. REDDINGTON: have exercise scam hyper cleaning agree indicative of jury struggling over find mania manic hypomania? Agree? [04:00:07] HEILBRUN: agree be symptoms of manic episode hard time identifying she experiencing diagnosis of bipolar II reflected thinking Mr.Reddington described could be symptoms of manic disorder less serious than bipolar I diagnosis REDDINGTON: District attorney asked about anxiety she suffering answer if it works COUNSEL: Objection, may we approach sidebar. COURT: Sure. Yeah. Counsel. [Q=REDDINGTON A=HEILBRUN] Q: district attorney asked question reference to "Exercise to compliment medication and therapy answer if it works doesn't work. doesn't work for some people use effectively lives particularly anxiety might not fully need treatment might interfere life mean A: exercise't useful for managing anxiety for some people for other people useful Q: agree if person has memory while in psychosis possible could imagining did something facts facts show she didn't? A: possible actively psychotic condition could affect information processed affect accuracy of memory. Q: severe mental illness involved right A: possible things made think might have been psychotic episode Q: she indicate afraid people could read her mind knew thoughts intrusive thoughts? A: afraid that asked about difference between hallucinations Q: Sir. COURT: Go ahead. COUNSEL: Objection. [04:15:43] COURT: No, overruled. REDDINGTON: indicated yesterday concerns killings was acute psychosis HEILBRUN: possible explanation REDDINGTON: agree testified killings possible concerns not acute psychosis? COUNSEL: Objection. COURT: No, overruled. [Q=REDDINGTON A=HEILBRUN] Q: asked next evidence against acute psychosis referenced discussion postpartum postpartum not a diagnosis A: I do know that, yes. Q: reason not postpartum because she eight months away from given birth Callan A: Yes. Q: surprised up to a year woman can experiencing postpartum psychosis or postpartum depression year or longer? A: different outcomes and time periods different organizations use Q: not asking about outcomes time periods asking about World Health Organization cutoff for woman with postpartum depression or psychosis timeframe? A: Well, I don't know. Q: indicated could be something else saw symptoms of depression she experienced in January less likely be postpartum."? [04:20:22] A: meant she eight months after giving birth Callan two sources authority DSM -5 and Cleveland Clinic neither suggest postpartum likely explanation Q: put aside DSM,DSM. agree DSM mentions concept postpartum psychosis postpartum depression in two paragraphs? A: agree don't consider mental diagnosis other diagnostic areas described manual. COUNSEL: Objection. COURT: No, overruled. REDDINGTON: Obviously. COUNSEL: Objection. COURT: It'll be stricken. REDDINGTON: Doctor if Ms.Clancy had genuine command hallucination her compelled carry killing of children herself agree she lacks capacity to conform conduct to requirements law? COUNSEL: Objection. COURT: Next question. [Q=REDDINGTON A=HEILBRUN] Q: stand corrected one regard started questions asking about 49 years ago published article on postpartum psychosis agreed in college not postpartum psychosis about schizophrenia A: think back 49 years 49 Q: Transcripts of interviews with 32 schizophrenic patients 15 males, 17 female, with primary or secondary paranoid symptomology edited to delusion-relevant material. refresh memory? A: It does. [04:24:19] Q: wasn't postpartum psychosis You've never written about postpartum psychosis A: That's right. Q: finally sir agree. if don't say "No don't agree."Postpartum depression tests administered? not talking guy upset job woman had baby postpartum period signs depression psychosis A: Yes. Q: agree person complain less able to laugh see funny side life? symptom A: asking symptom postpartum depression or depression generally? Q: asking about postpartum depression A: All right. Q: agree patient complain less able laugh see funny side life? A: symptom of depression could be postpartum Q: symptom depression constantly A: All right. Q: agree symptom postpartum depression? A: Yes. Q: stopping looking forward to things complaint common to postpartum depression? [04:25:58] A: Yes. Q: Lindsay complained of anxiety worried no good reason constantly A: Yes. Q: Sad and miserable. A: Yes. Q: postpartum depression symptoms according Mass General Hospital's three-year review of postpartum depression psychosis symptoms A: symptoms of postpartum depression symptoms depression broadly Q: asking symptoms of postpartum depression A: Yes. Q: tool psychologists use with woman coming doctor for help symptoms postpartum depression correct? A: Yes. Q: And what is that tool? A: don't know tool sure measure of postpartum depression. Q: postpartum psychosis? Same study Hearing voices commanding person to act DSM A: Yes. [04:28:12] Q: Okay. A: Command hallucinations, yes. Q: Delusional beliefs distorted reality symptom person complain A: Delusional beliefs, yes- Q: Anxious worried no Severe sleep deprivation had A: Yes. Q: time Patrick told repeatedly find living room sofa pillow crying hysterically A: mood swings implies feeling down sad depressed differently HEILBRUN: experiencing mood swings symptoms sadness feeling down lack of motivation symptoms depression [Q=REDDINGTON A=HEILBRUN] Q: Not herself family seeing change A: Yes, correct. Q: postpartum psychosis Not herself Thoughts of harming children big red flag A: Yes. Q: Thoughts of suicide complained A: Correct. [04:30:57] COURT: Judy Sprague. SPRAGUE: Thank you Honor Doctor symptoms Attorney Reddington postpartum depression symptoms for general depression? HEILBRUN: symptoms general depression major depression extreme version general depression symptoms bipolar disorder bipolar II correct diagnosis bipolar II SPRAGUE: And why was that? HEILBRUN: testified she been in Tewksbury for three and a half years diagnosis record bipolar disorderindicates having chance see her prescribe medications they think she has mood disorder fluctuating bipolar sort opposed major depression other disorder. COURT: Overruled. [Q=SPRAGUE A=HEILBRUN] Q: provided with her complete psychiatric history from September through present day correct? A: I was. Q: Prior to reading records case form opinion her criminal responsibility? A: No. worked hard to avoid forming opinion until late in process chance go through records three days evaluation collateral interviews get everything helps handle confirmation bias starting with good idea conclusion drawn to things support avoiding things don't Q: example of confirmation bias giving press conference diagnose patient before evaluation finding same diagnosis initially made? A: example saying before met diagnosis meeting possibly resulting in providing diagnosis could be influence associated with confirmation bias REDDINGTON: Objection. It's not responsive. [Q=SPRAGUE A=HEILBRUN] Q: asked by defense counsel about defendant's concerns about taking Zoloft while breastfeeding recall interview defendant mentioned practice in labor and delivery nurse aware millions of pregnant women and postpartum women took Zoloft with no problem? A: I do not recall that, no. [04:39:43] Q: explain confusing? A: She had diagnoses assigned symptoms experienced people saying minor adjustment disorder with anxiety mild depression to major severe postpartum psychosis things in between not sure what they saying not sure whether prescribing right medication reacting badly to medication.that's my understanding things people said mental health care providers some minor wrong with her some not minor. Q: defendant unsure about effects medication expressed specific concern about Seroquel, correct? A: Yes. Q: concern about Seroquel? A: problems with sleeping thought numbness not to feel associated with medication affecting her badly. Q: After to Mc Lean Hospital no longer on medications from September through December correct? A: Correct. Q: after leaving Mc Lean Hospital two medications on upon discharge was trazodone and Valium, correct? A: Yes. Q: asked about thought broadcasting defendant thinking people could hear her thoughts difference between thought broadcasting and defendant explained. what she said in interview impacted evaluation? A: she said they were thoughts unwelcome intrusive thoughts like many people If particularly insistent vivid thoughts not psychotic symptom vivid thoughts if hear voice external likely psychotic symptom tried to ask her to describe difference specify external voice hallucination, or internal thought unwelcome intrusive thought said except for January 24th experiencing were thoughts than hallucinations Q: Internal thoughts versus external auditory hallucinations right? A: Yes. Q: defense counsel asked before medications treatment Lindsay Clancy happy woman didn't go to Dr.Tufts struggling [04:43:36] A: anxious about returning to work good time with family summer fall approached Patrick's paternity leave expired returning work made anxious Q: review records for Dr.Tufts Nurse Practitioner Jollotta mental health workers Leticia Dukes Mc Lean Hospital defendant denied suicidal homicidal ideation auditory hallucinations visual hallucinations except felt suicidal in December A: Yes, that is accurate. Q: records no signs symptoms of psychosis A: Yes, that is accurate. Q: page nine Exhibit 220 complaining of insomnia mental numbness attributes to taking Seroquel desires to down-titrate Seroquel work better sleep symptoms occurred late in postpartum not related to perinatal factors advised WIH DHP Women Infants Hospital not suitable treatment discussed with patient husband agreement husband feels overmedicated misdiagnosed offered options inpatient treatment partial hospitalization mental outpatient management plans to follow up with outpatient provider for guidance." A: Yes. Q: people at Women and Infants Hospital evaluation don't say diagnosis she overmedicated. list adverse drug effects A: listed "Rule out adverse drug effects." Q: "Rule out adverse drug effects"? A: means possible yet to be confirmed Q: nowhere in diagnosis doctor mental health professional saying she overmedicated A: Oh, of Women and Infants? Q: diagnosis general anxiety disorder A: Among the diagnoses, yes. [04:48:21] Q: depression unspecified rule out due to adverse drug effects A: Yes. Q: means depression look further to rule out medication effect A: Yes. Q: not sure not saying she depressed because of medication A: saying it's possible Need to look into it Q: defendant thought Seroquel wanted to titrate down go off medication A: Yes. Q: asked by defense counsel about defendant getting worse between September and December or January A: begin October began taking medication worse into November December following discharge Mc Lean January 5th improved sleep better mood better worse from October into November December somewhat better improving in January Q: asked about psychosis automatically act on command hallucination not responsible said depends. A: Yes. Q: Why does it depend? A: symptoms of psychosis including command hallucinations don't take away knowledge understanding self-control. can in some instances other don't people to retain control distracting praying doing other things make difference supporting boosting self-control no automatic connection between mental disorder including psychotic mental disorders legal standard for knowing wrong or conforming conduct to requirements law. why we go through this in detail. Q: Doctor can someone experiencing psychosis with command hallucination know difference between right and wrong? [04:53:29] COURT: Next question. SPRAGUE: can conform behavior to law? REDDINGTON: Same objection. COURT: Overruled. SPRAGUE: about someone in state of psychosis hearing command avoid doing? REDDINGTON: stop objecting standing objection to leading Judge. SPRAGUE: Objection. Beyond the scope. COURT: No. Yeah, overruled. [Q=REDDINGTON A=HEILBRUN] Q: results transcript testimony regardless of explanations about MMPI other psychological testing she not elevated on except suicide scale A: That's correct. Q: she wasn't according testing exaggerating, lying malingering A: That's correct. Q: in report regarding lying malingering reference to Dr.Resnick, Phillip Resnick. A: I do. Q: Dr.Resnick indicated his opinion lack of malingering yours [04:56:39] A: Yes, he did. Q: aware cited outdated? familiar with 2012 article Dr. McCarthy-Jones with Dr.Resnick largest study hallucinations? A: researcher build on Q: study after report cited involved 191 individuals asked 400 questions about auditory hallucinations? A: No. Q: determined auditory hallucinations come from within without report? not aware A: No. SPK8: Objection. Can we go sidebar? COURT: Commonwealth? HEILBRUN: Thank you, Your Honor. COURT: discuss before two o'clock? COURT: Counsel? REDDINGTON: Very good. SPK9: Court stand for recess exit courtroom CLERK: Return to trial Commonwealth versus Lindsay Clancy All parties present excluding jury [06:15:24] CLERK: return jury trial Commonwealth versus Lindsay Clancy All parties present including Defendant 18 jurors SPRAGUE: Commonwealth calls Dr. Gregory Saathoff SAATHOFF: Thanks. COURT: All right. Good afternoon, Doctor. SAATHOFF: Afternoon. COURT: All right. Attorney Sprague. [Q=SPRAGUE A=SAATHOFF] Q: state spell name record A: First name Gregory, G-R-E-G-O-R-Y Last name Saathoff S-A-H O-F Q: educational background A: received undergraduate degree University of Notre Dame medical degree MD University of Missouri residency psychiatry University of Virginia Q: And can you describe for us your occupation? A: professor of emergency medicine public health sciences University of Virginia see patients Virginia Department of Corrections teach students senior psychiatrist FBI's Behavioral Analysis Unit Quantico Q: how long been senior psychiatrist for FBI's Behavioral Analysis Unit BAU? A: Since 1996. Q: other psychiatrists contract with FBI department? [06:17:39] A: FBI psychiatrists work with them Behavioral Analysis Unit at Quantico sometimes Walter Reed fellows are psychiatrists I psychiatrist for Behavioral Analysis Unit. Q: consider forensic psychologist? A: A psychiatrist, yes. Q: role of forensic psychiatrist? A: examines issues mental illness interface of mental illness and law Sometimes involve criminality assessing mental status at time offense competency consult institutions treat patients within facilities jails prisons Q: work as forensic psychiatrist in addition to working with Behavioral Analysis Unit FBI UVA teaching Bureau of Prisons? A: Yes. Q: done evaluations testified on prosecution and defense? A: Yes. Q: how many times testified in court? A: Maybe 40 to 45 times? Q: board certified in forensic psychiatry? A: No. Q: And why not? A: finished residency interested in public psychiatry military military psychiatry public psychiatry in teaching hospital important consulted by FBI wanted meet based paper published involved in forensic psychiatry assessment individuals board certified one-year fellowship.at that point in life time to devote to one-year fellowship other things doing. [06:21:26] Q: instead of one-year fellowship more on job training as forensic psychiatrist? A: Yes. Q: evaluated subjects for competency criminal responsibility? A: Yes in addition to job experience important to get teaching training taken advantage of courses Institute for Law, Psychiatry and Public Policy at University of Virginia opportunities board review course comprehensive Q: other training other than fellowship to be forensic psychiatrist? A: Yes. Q: work for Bureau of Prisons with inmates A: Yes most work with Virginia Department of Corrections since 1992 34 years assessed treated patients prison system men and women at facilities brought medical students residents fellows taught them brought more than 2,500 medical students residents into prison system learn about psychiatry significant mental illness Q: evaluated them involve diagnosing? A: Correct. Q: treatment A: Treatment involved working with team system Prisons have psychologists social workers patient inmates Medication treatment important therapeutic aspects ran group in prison students Q: group you ran, what type of group? A: therapy group individuals brought together diagnosed with significant mental illness speak about experience deal with issues over medications. Q: experience in Department of Correction Bureau of Prisons patients FBI encounter individuals from psychosis? [06:25:51] A: Yes, very much so. Q: estimate many patients treated psychosis? COURT: Overruled. SAATHOFF: Thousands. spent 15 years running inpatient admissions unit in teaching state hospital REDDINGTON: First sidebar. [Q=SPRAGUE A=SAATHOFF] Q: saw thousands of patients treated with psychosis? A: saw them there yes prison system during training residency. Q: written articles about postpartum psychosis? A: Yes. Q: And when was that? A: published article in 1987 two cases of postpartum psychosis saw intern One my patient consulted Q: article entitled Postpartum psychosis induced by bromocriptine? A: Yes. Q: What was bromocriptine? A: bromocriptine medication to inhibit stop lactation women after birth not breastfeed bromocriptine inhibit lactation [06:31:23] Q: treatment of one patient second patient conclusion bromocriptine inducing postpartum psychosis? A: Yes. Q: eventually bromocriptine. stop using to stop lactation in women? A: Yes FDA took it off market in 1994 or 1995. just for postpartum psychosis other problems cardiac problems bromocriptine caused Q: your was your article with co-authors first article scientific attention issue bromocriptine and postpartum psychosis? A: ask question Q: this article first scientific possible link between bromocriptine and postpartum psychosis? A: understanding few letters to journals commenting about bromocriptine connection first article was ours about two women suffered postpartum psychosis Q: mentioned experience in diagnosing treating psychosis What is psychosis A: psychosis forms people psychotic hallucinations perceptual disturbances auditory hallucinations voices sounds other types hallucinations visual tactile hallucinations olfactory hallucinations commonly auditory hallucinations other areas psychosis show Delusions are false beliefs bizarre or non-bizarre sometimes auditory hallucinations have delusions Sometimes psychosis with delusion no perceptual disturbance third area thought people.psychosis demonstrates people difficulty communicating with speech disorganization engage in neologisms making up words specific meaning for no one else thought translated in writing or speech people psychotic difficult time stringing words together. looseness of associations. three arenas psychosis show perceptual disturbances delusions related to thought communication possible to be psychotic have one of three elements. Q: is psychosis own mental illness or a symptom of? A: Psychosis is a symptom. Q: why a symptom of illness not defined mental illness? A: many different causes of psychosis. serious medical problem can become psychotic brain tumor example symptoms psychosis show other ways people can experience psychosis. secondary to drug abuse certain drugs like cocaine amphetamines bath salts cause perceptual disturbances delusions problems communicating not a cause. represents significant finding or presentation. Schizophrenia diagnosis psychosis in forms also serious mood disorder schizoaffective disorder brief psychosis many different roads lead to psychosis important to find out what's originating best decisions to treat psychotic symptoms Q: signs and symptoms of psychosis dependent on underlying cause, mental illness? [06:38:56] A: Yes dependent result of or manifestation of illness many things can cause fever fever is symptom presentation significant need to find out cause to appropriate treatment. Q: analogy bacterial infection cause fever Bipolar disorder cause psychosis. A: Correct. Q: mentioned serious mental illness. What? A: serious mental illnesses affect small portion population maybe 4% schizophrenia serious bipolar manic illness serious Schizoaffective disorder serious illness many symptoms mental illness benefit from treatment psychotherapy or medication combination some profound smaller percentage Q: what in category of mental illness? A: mental illness adjustment disorders anxiety disorders mild depression without psychotic features PTSD significant symptoms under category mental illness Q: asked by Plymouth County District Attorney's Office? A: Correct. Q: direct payment from Plymouth County District Attorney's office for evaluation? A: No. Q: review of Lindsey Clancy what types of records materials? A: extensive involved significant medical records psychiatric records outpatient inpatient medical records hospital records Mc Lean Tewksbury emergency department visits at South Shore and Mass General Hospital significant medical mental health records inpatient outpatient substantial grand jury materials reviewed videos interviews January Clancy family museum Cape Codder water park received reports from government defense experts retained opportunity review list of materials significant CVS records pharmacy records law enforcement police reports 24 January 2023 event occurred Q: if we could go through your analysis case start with Ms.Clancy 's characterization of command auditory hallucinations. A: Ms.Clancy stated to her hallucination external voice from outside her head occurred she standing at refrigerator making children dinner when received call from Patrick Clancy returned finished call Patrick Clancy heard voice, "This is your last chance. kill your kids then kill yourself." told other accounts to different, to Dr. Spinelli voice happened at 5:10 or 5:15 PM Patrick Clancy left on errands described voice to Dr as increasing in intensity saying "This last chance. kill kids before yourself." her children would suffer if she. asked about voice heard started after telephone call at 5:34 with husband Patrick was a man's voice. clear external from outside head constant phrase, "This your last chance kill kids then kill yourself" repeated during she strangled her children stopped when finished strangling children [06:54:08] Q: Doctor, anything about she reported voice significant in your evaluation why? A: significant she not spoken about hearing voices before in mental health professionals psychiatrists nurse practitioners physicians staff emergency departments Mc Lean first time she reported documented experienced auditory hallucination unusual voice stopped with strangling of her youngest son Callan she went upstairs in behavior effort to kill herself voice stopped she strangled Callan youngest child Q: unusual first time she heard this voice. Why unusual? A: she suffered with symptoms of mental illness depression anxiety Anxiety reported to Dr.Tufts in mid-September symptoms included suicidal ideation dark intrusive thoughts to harm children mentioned to husband mother two occasions Q: Doctor unusual voice stopped after Callan killed. Why unusual? A: I worked with. other patients command auditory hallucinations SPK15: object to that Honor. Same objection raised before. [Q=SPRAGUE A=SAATHOFF] Q: Doctor, based your training experience diagnosing treating psychosis typical for someone in psychosis to hear voice one time never before never after? A: No. Q: typical for psychosis hear voice constant intermittent? A: No, that is not typical. Q: typical hear command hallucinations stop abruptly? A: No. act not curative of voice not seen Q: Doctor psychosis hearing voice without delusions typical? A: rare. not typical. [07:02:33] Q: delusional thought? A: No. requirements healthcare professionals to report issues harm to children rational for her to concerned voicing thoughts harm children assessment rapid assessment determination to keep children safe didn't irrational rational understanding healthcare system Q: reviewing records speaking Ms.Clancy delusional statements beliefs surrounding hearing voice on 24th? A: No, I didn't. Q: training experience typical for someone in psychosis to hear a voice immediately act? A: No. COURT: Same objection, same ruling. Yeah. [Q=SPRAGUE A=SAATHOFF] Q: analysis Ms.Clancy 's outward portrayals misleading family providers. What mean? what see in records interview? A: Yes. looking back at her history Her history with Patrick. She dated Patrick in nursing school experiencing significant anxiety went to a psychiatrist treated for anxiety with Prozac and Wellbutrin propranolol. significant period during their dating approximately a year. spoke with Mr.Clancy he unaware she experiencing mental health symptoms dating or taking medication. he learn she had taken medication mental health medication Prozac Wellbutrin antidepressants propranolol helps with anxiety presentations. he unaware until during she great difficulty November, December period. Q: example A: Yes in numerous text messages varied times she stated she was doing well days leading up to 24th of January 2023 photographs on Instagram portrayed different than she stated inside. providers Ms.Clancy told having difficulty starting in October started taking medication in October Clancy real difficulty with symptoms anxiety Her mother-in-law suggested doctor knew Rose willing to talk with her informal basis doctor made time for her to seen not understanding about Ms.Clancy 's problems doctor recommended Lamictal or Lamotrigine medication helpful depression issues with moodlooking at Tufts ' notes note December 1st 2022 discuss Lamictal real possible medication. mid-December difficult time. whole month December difficult. after experience Q: What is Lamictal? A: Lamotrigine Lamictal anticonvulsant approved for bipolar disorder early 2000s, 2003, Now used for epilepsy found by FDA helpful in depression bipolar. Q: three providers recommended medication defendant chose not to take potential rash significant to your evaluation? A: Yes. [07:18:56] Q: And why is that? A: more candid patient with symptoms better prescriber determination treat symptoms helpful in diagnosis Q: note of appointment Dr.Tufts with defendant on January 23rd, 2023 defendant denied suicidal or homicidal ideation? A: Yes. Q: significant? A: Ms.Clancy looking into alternative treatments discussed with Dr.Tufts potential for esketamine FDA approved medication administered by doctor facility rapid positive effects in treating depression Dr.Tufts wrote potential for esketamine treatment or transcranial magnetic stimulation exploring Q: she tell? A: told friend visited long time friend friend visited Ms.Clancy engaged in gossip old times Amy Bevins similar shared experiences Ms.Clancy upset at Spaulding Hospital because superficial conversation without discussion of incident of 24 January 2023 gave impression false impression of Ms.Clancy hurt friendship.felt Spaulding Hospital provided better psychiatric mental health care superficial talking friend SPK17: No objection. [Q=SPRAGUE A=SAATHOFF] Q: see in Spaulding records psychiatrist psychologist social worker met with Ms.Clancy at Spaulding multiple times? A: Yes. Q: analysis discussed Ms.Clancy 's suicide attempt serious required sequential decision making correct? A: repeat? Q: report described Ms.Clancy 's suicide attempt as serious correct? A: Correct. [07:33:42] Q: talk why found serious required sequential decision making? A: her records previous 24 January she contacted Aspire twice suicide hotline spoken recall since early December speaking about suicidal ideation significant assessment in emergency department 15th of December record she concerned about self-harm suicidal ideation actual day after children killed strangled Callan still living time EMS arrived told got knife from butcher block kitchen attempted to cut herself took pills or overdose. asked her about trying to understand SPK17: Objection SPK16: Overruled. SPK17: Objection said question SPK17: Objection, leading question. SPK16: It's already been answered. Next question. SPRAGUE: how learn she crushed pills? SAATHOFF: learned after interviewing husband Patrick, mentioned bedside table wine tumbler with powdered medication crushed medication wine tumbler not she not told crushed medication know Dr.Resnick 's report Lindsay Clancy told she had lemonade in wine tumbler when took overdose.asked Patrick Clancy told didn't think had lemonade house not typical SPK17: Let him finish, please. Thank you. SPK16: All right. Next question. SPRAGUE: any significance to you to fact lemonade in cup powder residue in cup? strike significance to Lindsay Clancy told you lemonade in cup Patrick Clancy saw powdered residue in cup? SAATHOFF: Yes. made sense lemonade in cup if trying take overdose of medication overdose of medication crushed because of bitterness these pills made sense asked her more about lemonade she told it been in wine tumbler from night before. SPRAGUE: Ms.Clancy 's ability to execute strangulation of children, anything about how she did stood out to in your evaluation? SAATHOFF: Yes. [07:48:04] COURT: see Counsel at sidebar? Doc, you step down. SAATHOFF: Step down? COURT: Yes, please Members of Jury, to break for today. Counsel anticipated evidence will close tomorrow. heads-up works case requires after evidence closes to meet with attorneys go over instructions probably predictions probable closing arguments not tomorrow but day after. anticipation is evidence will wrap up finish tomorrow then start arguments charge next day with deliberations day wanted much heads up don about prediction good one. give idea of where we are.I excuse you until tomorrow morning.You've heard evidence haven't heard all. haven't heard closing arguments of attorneys. haven't heard law apply to this. still keep open mind follow instructions Don't read Don't listen Don't watch anything don't talk with anyone.You've been good at following instructions for weeks. ask you to hang with instructions longer excuse you until tomorrow morning We'll continue with witness on stand anticipate close of evidence tomorrow. thanks thank you look forward to seeing you tomorrow. COURT: need address before tomorrow morning? ## Day 21 (539 of 1438 turns kept) [02:00] CLERK: Honor Court today matter of Commonwealth versus Lindsay Clancy. Ms.Clancy present represented by Attorney Kevin Reddington Commonwealth represented by Assistant District Attorney Jennifer Sprague Assistant District Attorney Shanan Buckingham. COURT: Good morning, Ms. Clancy. L.CLANCY: Good morning, Your Honor. COURT: Before start see everybody at sidebar? CLERK: Good morning Your Honor proceed? CLERK: Court continuation of jury trial Commonwealth versus Lindsay Clancy.Clancy present represented by Attorney Kevin Reddington Commonwealth represented by Assistant District Attorney Jennifer Sprague Assistant District Attorney Shanan Buckingham. COURT: thank you Madam Clerk Good morning members jury nice to see everybody continue with trial appreciate here ask questions today's schedule first question any member of jury read seen heard overheard anything about case affect ability to be fair impartial? Second other serious matter or concern service as juror address? thank you for following instructions continue with testimony of doctor on stand yesterday last witness in trial break before next portion trial closing arguments legal instructions court make arrangements speak to Counsel excuse you come back tomorrow finish evidence today excuse you.going to deal with Counsel do arguments charge tomorrow. appreciate everybody's dedication commitment following instructions being here every day. that's where we are at this point. ask Commonwealth doctor retake stand please. COURT: All right. Good morning, Doctor. COURT: All right. Attorney Sprague. SPRAGUE: Thank you, Your Honor. Good morning. WITNESS: Good morning. SPRAGUE: How so? WITNESS: small time Ms.Clancy had in home without husband important to carry out her suicide quickly, methodically. no instructions but execute decisions including get phone call return to husband process phone call not expected. surprising she accomplish without other direction or plan. REDDINGTON: Your Honor, for record direct examination. leading. I object standing objection. [Q=SPRAGUE A=WITNESS] Q: Doctor, talk report about interpersonal psychological theory of suicide. What? [07:15:00] A: decision-making process capability for someone attempts suicide. Q: And what are they? A: aloneness sense of isolation people not understanding difficult challenge for can't share with others burdensome-ness feels burden to others component to serious suicide attempts completions third capability. can sense of aloneness burdensome-ness. if capability of taking life can be suicidal not accomplish suicide. not mean not suicidal but issue of capability difficult natural will to live most difficult for to overcome. Q: most difficult to overcome capability of committing suicide, you're saying? A: Correct. Q: And what were they? A: documentation medical mental health records demonstrates sense of isolation she felt even in company others problem difficult Difficult for her to understand others understand suicidal feelings feelings about harming children. not could share. sense burdensome-ness planned to go back to work for first two children,Cora and Dawson time expecting to work extending not feel mentally healthy enough to return to work function. documentation concerns stressors indicated financial was stressors. believe brain damaged not able to do loved labor and delivery nursing not support family burden for. sense of burdensome-ness believe she experiencing. last component capability suicide attempt was serious employed three different methods. use of knife lacerations not deep't mean't intending to kill herself with knife difficult employment of three different avenues locking door not dressed for cold indicate attempt serious despite use knife not successful in cutting arms neck. Q: Doctor, cutting on arms neck not sufficient cause death referring to someone difficulty inability commit suicide? A: Correct. Q: case opinion she trying to commit suicide struggling with third capability issue? A: Correct. Q: testified about intrusive thoughts Ms.Clancy harming herself fall December January. accurate Ms.Clancy reported taking Ativan helped thoughts? A: Yes. Q: anything significant in review her reporting Ativan helped thoughts? A: Yes. [13:42:00] Q: How so? A: Ativan Lorazepam benzodiazepine medication helpful treating anxiety relax sleep helpful Ms.Clancy stated intrusive thoughts taking Ativan resolved thoughts significant not a medication Ativan Lorazepam not antipsychotic medication not treat psychosis feel calm sometimes used for significant symptoms treating psychosis making voice go away not designed Q: Doctor intrusive thoughts went away when taking Ativan Ms.Clancy evidence internal thoughts not external voice? A: Yes. Q: if someone experiencing psychosis command hallucinations can know difference between right and wrong? A: Yes. Q: How so? A: hallucinations even command hallucinations not propel individual to automatically obey many people engage in behaviors to stop actions voice claiming sense particularly when command serious against values possible common for people to engage behaviors to avoid command hallucination saying Q: Doctor possible for someone experiencing psychosis and command hallucinations to conform behavior to law? A: Yes. Q: And how so? Is it basically what you were just telling us? A: Yes. If command hallucination public police officer nearby possible for to choose not to engage behavior consequences. voice might saying other decision-making based environment Q: And what was that opinion? A: Ms.Clancy suffering from mental disease defect Bipolar II diagnosis sense given symptoms of insomnia precipitated by Zoloft. significant didn fulfill criteria if patient would diagnose her as Bipolar II doctor wary of using SSRI antidepressant treating Q: Doctor mentioned drug effects Zoloft SSRI might. difference treating someone taking medications between overmedicated and adverse reaction to medication? [18:59:00] A: Yes. Q: And what is the difference? A: side effects example of medication response sometimes side effects not overmedicated put up with too much medication experience side effects over sedation medications cause stimulation not sleep. adverse reaction more serious reaction allergic reaction cause death reaction reported difference between side effects difficult and adverse effects extremely serious Q: review of records medications Defendant prescribed from September through December evidence of her adverse effects from medication? A: insomnia secondary to Zoloft concerning not cutting Zoloft back stopping it Zoloft precipitating insomnia reported 48 hours straight of not sleep adverse effect adverse effect requires stop medication Q: Dr. Jennifer Tufts did with Ms.Clancy stop medication A: Correct. Q: reviewing records from September through December 2022 evidence Ms.Clancy overmedicated? A: experienced significant side effects from medications given Nurse Practitioner Paul gave Clonazepam benzodiazepine uncomfortable reaction woke up felt confused stopped medication Seroquel medication quetiapine high doses cause significant side effects lower doses helps treat insomnia higher doses more significant effects ability to think organize thoughts Ms.Clancy December 2022 chose continue Seroquel combination Seroquel Valium Nurse Practitioner Julotta suggested another medication olanzapine Zyprexa she taking now Clancy asked continue Seroquel Valium challenge One side effects sees benefit medication combination December 7th, December 9th helping sleep asked continue two medications Q: guess ask about overmedication side effects medication disconnect between lay person versus medical definition overmedicated medically means side effects medication? A: Well, no, not necessarily. Q: what overmedicated mean to in profession? A: prescribe medication beyond limit safely prescribed possible to be toxic on lithium medication she took Tewksbury. prescribing 1,200 milligrams of lithium twice a day lithium level toxic example overmedication Q: evidence scenario in Defendant's records prescribed too high dose toxic level medication? A: prescribing responding to symptoms rapid increase in dose Seroquel. higher dose Seroquel prescribed at 400 milligrams never ended taking as clinician best to treat symptoms [02:36:00] REDDINGTON: Objection. COURT: Next question. [Q=SPRAGUE A=WITNESS] Q: Doctor Seroquel any medications amount prescribed over medication? A: No. Q: only medications after leaving Mc Lean Hospital were Trazodone and Valium correct? A: Correct. Q: Dr.Tufts added medication appointments with Defendant in January correct? A: That's right. Q: And what was that medication? A: amitriptyline known Elavil. Q: saw initial dose correct? A: Correct. Q: What was that? A: dose from Dr.Tufts was 10 milligrams. Q: high dose for adult? [03:44:00] A: No smallest dose possible. Q: Dr.Tufts increase dose? A: Yes. Q: And when was that? A: After a week increased dose from 10 to 20 milligrams Q: significant increase dose? A: No. Q: 20 milligrams significant large dose for adult? A: Not at all. Q: base on? A: things Ms.Clancy met with psychiatrist Dr.Tufts before Tufts denied suicidal ideation denied thoughts of harm to others ongoing conversation regarding future treatments, esketamine or TMS help appreciation between right and wrong planning prior to strangling of children significant searches for distance of Three VCVS prior to text asking husband takeout Three V planning planning significant avoidance of witnesses witness crime can intervene done without witness present during asked potential witness longer errand significant Concealment indicated understanding of right and wrong children strangled in basement according to Mr.Clancy door to office closed when arrived basement Timing significant window of time Ms.Clancy aware need to kill three children kill herself expected She conscious of time mapped distance didn't want husband gone too long. in this case issue of time husband returning solution was problem. to accomplish this in time Mr.Clancy gone significant showed awareness of time. weapons used were exercise bands near where children were strangled placed there kept exercise bands exercise bands nearly identical similar do as ligatures. use of weapons readily available nearby significant her understanding of planning. evidence she had delusions about children delusions something wrong or required them needed to die. don't recall she spoke about children in delusional way. delusional SPK1: Sure. Next question. SPRAGUE: And what were they? WITNESS: phone call at 5:34 afternoon significant. Mr.Clancy at CVS called wife she not pick up answer called back ability to deviate from she respond presence of mind conceal what Locking door example Ms.Clancy aware of time limited time locking door kept husband from enter bedroom to see what happened delayed time. On arrival husband asked her what happened she not confess not tell tried to kill myself not report auditory hallucinations said children in basement. belief she expected to die by Mr.Clancy arrived she would have take her life SPRAGUE: And what is that opinion? [12:31:00] WITNESS: day morning she took Cora to pediatrician's appointment all physicians receive training in psychiatry part of medical school like other doctors not psychiatrists pediatrician not notice unusual things her to behavior concerned mother drive to pediatrician's office and back day of significant control activities spending time with children with Play-Doh outside build snowman sending photographs to mother husband on Instagram Fixing lunch dinner for children activities controlled activities planning mentioned throughout day she methodical controlled organized even in time short. lot to do killing children and killing herself.last point conforming to law she received phone call from husband not report distress having hallucinations needed help. with that phone. calling husband back reassuring him she knew medication helped guarantee he continue errands. she not called back possible he concerned return home phone figures in her awareness conforming behavior strangling of children concealed. SPRAGUE: submit Dr. Saathoff's CV next exhibit. SPK1: Any objection, counsel? [Q=REDDINGTON A=WITNESS] Q: Sorry, Zoom. A: By Zoom. Okay. Q: January '23 to January '26 three years A: That's right. Q: review things CV jurors examine indicated present employment private practice as psychiatrist A: No. Q: dealing with people serving hard time in Iron Mansion not house of correction down street A: see patients varying sentences Some life sentences Some scheduled for release coming months varies Q: work on behalf state evaluate prisoners determine fit be released society A: sentence over only continued prison system committed to psychiatric hospital 34 years treating inmates patients recall two times discharge condition required civilly committed mental illness Q: forensic psychiatrist evaluator on behalf of BOP, Bureau of Prisons? A: consulted with Bureau of Prisons few occasions federal [53:00] Q: resume from 2019 through present employed as forensic psychiatrist evaluator United States Bureau of Prisons probation or parole resume A: Yes. Q: resume 2019 employed forensic psychiatrist evaluator for United States Bureau of Prisons many evaluations years 2019 through 2026, seven years? A: done two or three Q: Two or three? A: Yes. Q: 2016 through 2022 consultant psychiatrist Elson Student Health Center A: Health Center University of Virginia serves students SPRAGUE: Objection. SPK1: Yeah, that question will be stricken. [Q=REDDINGTON A=WITNESS] Q: 2015, psychiatric consultant Virginia Office Attorney General A: Yes. Q: National Security Expert 2007 Oak Ridge United Associated Universities A: Behavioral Analysis Unit National Center for Analysis of Violent Crime work Q: Critical Incident Analysis Group University of Virginia [06:51:00] A: Yes. Q: Psychiatric consultant Virginia Department of Corrections medium maximum super max facilities A: Yes. Q: psychiatric consultant Macro Task Force Australian Police Service A: Yes. Q: Former Soviet Union Project Republic of Georgia A: Tbilisi. Q: Critical Incident Response Group US Air Force Assessment Unit A: Yes. Q: Crisis Management Unit Investigative Support Operation Gray Sunset Jordan A: Correct. Q: Unit Unit Montreal Quebec A: Yes. Q: National Center for Analysis Violent Crime Operation New Hope A: Yes. [08:11:00] Q: Bureau Criminal Investigation Department State Police A: Yes. Q: Hostage Negotiations Course Crisis Management Unit involved A: Correct. SPRAGUE: Objection. SPK1: Sustained. [Q=REDDINGTON A=WITNESS] Q: Virginia Department of State Police A: Yes. Q: National Institute for Justice Department State health effects US government employees families overseas A: Yes. Q: Analysis pre-attack behaviors Las Vegas Shooter Behavioral Analysis Unit FBI A: Yes. Q: papers published doctor psychiatrist publishes paper interest other doctors called learned treatise Peer review A: Yes. Q: depends publishing National Enquirer or International Psychiatric better publication [11:33:00] A: Enquirer peer reviewed Q: International Journal of Law and Psychiatry respected source learning treatises A: Yes. Q: telling jury Lindsay didn't hear voices exaggerated lied written articles concept auditory hallucinations? A: No. Q: heard Dr. Phillip Resnick A: Yes. Q: well-written auditory hallucinations A: Yes. Q: published article International Journal of Law and Psychiatry landmark article "Listening to voices use phenomenology differentiate malingered genuine auditory verbal hallucinations." read article? A: Yes. SPRAGUE: Objection. SPK1: Counsel, can I see at sidebar? [Q=REDDINGTON A=WITNESS] Q: Assessing. Moral Situational Action Violence Risk Model Assessing Women Involved Extremist Violence Empirical Study similar article? A: Yes. [01:03:23] Q: Operationalizing Theory: Moral Situational Action Model for Extremist Violence include guys plus women A: I'm sorry? Q: doesn't say women Suicide Terrorism: Performance Violence as Public Plunge wrote A: Correct. Q: another interest Crisis Leadership Military Community Resilience Wrote A: Correct. Q: Painting by numbers Capturing Pathology Sociopolitical Conflict Depression Amongst Palestinians wrote A: Correct. Q: Recognizing Borderline Personality Disorder Family Practice A: That's right. Q: Mortality Among Elderly Patients Discharged State Hospital A: That's right. Q: Postpartum Psychosis Induced by Bromocriptine jury published 40 years ago A: Yes. Q: Application Big Data for National Security Practitioner's Guide wrote [01:05:33] A: four editors Q: Crisis Guide of Psychoactive Drugs Poisons Crisis Negotiation Unit A: That's right. Q: International Handbook of Threat Assessment, right? A: Yes. Q: Protection of Children During Armed Political Conflicts Multidisciplinary Perspective A: Yes. Q: postpartum resume prepared interest A: Yes. Q: Panels symposia national security Attachment theory mental wellness threat management threat assessments corrections psychiatry presentations substance abuse misuse in prisons medical support during conflict chaos targeted violence media lessons history profile poisons female extremist crisis operations leadership fool doctors injecting chemicals muscle opioids prison inmate clean A: Correct. Q: treated woman postpartum psychosis A: Yes. Q: State hospital. A: Correct. [01:09:55] Q: Yes what? A: Usually committed. Q: interest postpartum depression psychosis? A: requirement assess treat women aware histories making determinations continued throughout career. Men women. Q: say? repeat? treating women with? A: women psychiatric problems, serious illness psychosis. Q: define for district attorney concept of psychosis yesterday referring to woman had baby period postpartum depression? A: Yes. Q: when how treating those people? A: during 15 years ran unit of men women serious psychiatric symptoms Q: what do? analyze talk Counsel? while in hospital? A: full assessment with multidisciplinary team make determinations about proper treatment therapy medications treat symptoms Q: generally symptoms in your experience? A: Symptoms of postpartum depression? Q: Yeah. [01:12:05] A: around birth DSM four-week period expand to a year depressive symptoms postpartum similar to symptoms regular depression suicidality guilt changes in appetite weight concentration physical activity problems with sleep sleeping too much not enough depressive symptoms postpartum period require assessment Q: aware of number of women commit suicide during postpartum period? aware A: I can't quote you a figure. Q: agree unfortunate components. had baby suffering from postpartum depression can turn into postpartum psychosis quick? A: It can be rapid. Q: psychiatric organizations talk different periods time six eight weeks A: Correct. Q: Based on what? A: Based on presenting symptoms history medical history if someone recently in hospital treated may necessity for drawing blood again depending types symptoms not standard everyone psychiatrist requires blood tests Q: if psychiatrist practicing private practice for a month two prescribing anti-psychotic selective serotonin reuptake inhibitor benzodiazepine medications to young woman complaining difficulties postpartum important to take blood test find prescription drugs on board system? A: check drugs on board Q: treating patient coming off street to see psychiatrist for help A: Yes. Q: if prescribed drug after drug by doctor with two months experience fair statement take blood test? A: depends on medication some medications require blood tests levels psychotropic medications not easy test for amount medication system depends on circumstances medication lithium carbamazepine valproic acid mood stabilizers taking blood test important [01:18:14] Q: Doctor, other tests in your experience administered to young woman had baby coming to doctor like Dr.Tufts? other tests to determine if person suffering from postpartum depression? A: not aware of specific test diagnoses depression years ago Q: Postpartum depression, sir. A: Pardon me? Q: Postpartum depression is my question. A: Correct. Q: postpartum depression is my question. A: asking if blood test for postpartum depression? Q: asking any tests psychiatrist can should administer to patient A: Edinburgh scale self-report patients fill postpartum. Q: Have you administer the Edinburgh scale? A: Pardon me? Q: Nurse scale useful tool to determine level degree of depression A: That's right. Q: doctor determine risk extreme risk deadly risk of person committing suicide harming someone else baby determine level of postpartum depression [01:20:48] A: Yes, it can help. Q: 23 out of 30, right? A: Correct. Q: reasonable medical procedure for psychiatrist dealing with woman. on Edinburgh scale serious trouble on medication antipsychotic drugs SSRI drugs amitriptylines benzodiazepines helpful to take blood test? A: It can be. Q: that in your opinion reasonable degree of medical certainty step should taken by competent doctor? A: taking blood tests appropriate yes. Q: additional blood test dealing with woman suffering postpartum depression significant narcotics or prescription drugs in system enzyme test right? A: not aware of enzyme test typically available used. Q: any other concerns treating in addition to blood test enzyme test determine metabolizing aspect person system processing drugs other tests or concerns with woman postpartum depression complaints? A: presentation helpful to check thyroid function cause of psychiatric symptoms Q: if one person out of thousand gets Stevens-Johnson syndrome or Prurigo Nodularis taking medication not tolerate as doctors A: Risks and benefits every physician prescriber needs to think about. Q: your opinion after TENS toxic epidural necrolysis she's nurse looking up drugs prescribed says "I don't wish to take that drug reasonable psychiatric certainty reasonable decision for it"? A: benefits of drug profound millions of Americans take medication find important. [01:29:25] Q: Yeah. don't want to leave with jury she's vain didn't want to take might get rash. no blood test enzyme test metabolite test thyroid test still pill factory through Dr.Tufts Dr. Jolotta telling jury reasonable drug doses she prescribed. A: That it was reasonable to prescribe? SPK2: Objection. COURT: Sustained. Just as to form. REDDINGTON: one sentence in medical records reference to she said "I should have stuck with plan." referring WITNESS: Yes. REDDINGTON: she looked up Tufts, didn't know who Tufts was Googled postpartum depression found expert WITNESS: That's my understanding. REDDINGTON: only practicing for a month or two. Was she psychiatric certainty expert? SPK2: Objection. COURT: Overruled. [Q=REDDINGTON A=WITNESS] Q: December South Shore Perinatal Unit advised her to go hospital in postpartum women Women &Infants Hospital in Rhode Island A: That's right. Q: Did they help her? A: felt another program be appropriate inpatient. women in program closer to birth children. not. group they served closer to postpartum period [01:36:05] Q: not say jury Lindsay outside of four month cutoff not good candidate for postpartum depression treatment? A: No. Q: Women &Infants discharged her after eight hours A: Yes. Q: reason she discharged from Infants Hospital in Rhode Island included statement RO rule out issues regarding prescription medications correct A: Yes, that's my recollection. Q: She complaining to physicians community intrusive thoughts dark thoughts suicidal thoughts homicidal ideation correct A: homicidal ideation voiced to husband mother SPK2: Objection. COURT: Sustained. Next question. REDDINGTON: asked about complaints of intrusive thoughts to doctors friends neighbors family about thoughts suicide homicidal ideation SPK2: Let him finish answering. COURT: All right. Next question. [Q=REDDINGTON A=WITNESS] Q: agree she tell neighbors friends Learning Sprouts School family doctors dark intrusive thoughts of suicide? Yes or no? A: she telling children's teachers at Learning Sprouts? [01:44:22] Q: people in trouble dark suicidal thoughts kill themselves told to call suicide hotlines A: Yes. Aspire. Q: Aspire. What is Aspire? A: hotline Ms.Clancy called twice because of suicidal ideation Q: she twice told complained going to kill herself Twice A: She spoke to them about suicidality. SPRAGUE: Objection. [Q=REDDINGTON A=WITNESS] Q: read records dealing with Aspire? not can help"? A: not responsive to her suicidality she indicate had plan Q: sir murder trial you witness for government read records told jury conversation she with Aspire expressed suicidal ideation asked if plan. Where from? A: can't tell within records Q: second time called Aspire? Why call Aspire again if wouldn't help first time opinion as psychiatrist? Looking for help? A: Continuing to seek help. Q: psychiatric certainty treating patients devastating effect on person ready to kill called Aspire hotline twice turned away? SPRAGUE: Objection. [01:48:59] COURT: Overruled. [Q=REDDINGTON A=WITNESS] Q: after discharged from Women &Infants Hospital reaching out to Aspire, agree concerns doctor at Women's Hospital Rhode Island medication prescribed by Tufts Nurse Practitioner Jollotta A: Correct. Q: reasons not treat her postpartum depressed complicated overlay medications prescribed A: Yes. Q: medications included selective serotonin reuptake inhibitors A: Yes. Prozac and Zoloft. Q: What is that effect? A: variable responses postpartum stopped breastfeeding around October October 21st Ativan started SPRAGUE: Objection. COURT: Counsel see you sidebar briefly? Doctor [inaudible SPK4: return to trial of Commonwealth versus Lindsay Clancy. All parties present excluding jurors SPK4: Your Honor, practice of record return to trial Commonwealth versus Lindsay Clancy. All parties present including defendant 18 jurors. REDDINGTON: Sure. I don't know. WITNESS: Neurotransmitters function in brain responsibility for mood psychosis. Dopamine significant psychosis too high [inaudible] neurotransmitters function different ways pathways psychiatry mesolimbic pathway not just dopamine serotonin norepinephrine depending disorder different medications helpful treating disorders psychiatric illness brain dysfunction medication helpful regulating neurotransmitters difficulties [02:01:50] COURT: Next question. [Q=REDDINGTON A=WITNESS] Q: told jurors interest glass wine mug crushed narcotics anti-psychotic drugs crushed inside cup. remember? A: Yes. Q: How know anti-psychotic drugs? A: don't recall saying anti-psychotic drugs Q: drugs? A: I thought I said medications. Q: Medications. drugs medications crushed up? A: evidence of powder on tumbler Patrick told looked photographs saw that Q: report said was crushed up medication? A: They wouldn't... Q: how know drugs or medications? A: It was Patrick Clancy's observation. Q: if someone in psychotic state kill themselves taking pills said fist full of pills DA said they were crushed agreed crushed be residue? A: A residue? [02:09:13] Q: seem appropriate sir person in psychotic state after slashing wrist slicing throat ready to propel out window put bottles into drawer nightstand or scatter around bedroom floor not caring? A: not aware exact sequence events Q: couple days after incident went home with Patrick locate bedroom next bed blood drawer medication bottles refresh memory investigation what happened bottles? all empty. A: Yes. Q: understanding person can in state psychosis misremember something? A: Yes. Q: think she was malingering lying told? A: No. Q: How did she mislead her family? A: text messages days prior event parents visited weekend communications not give sense of state mind suicidality SPRAGUE: Objection. COURT: Sustained. [inaudible] SPRAGUE: Objection. COURT: Overruled. REDDINGTON: opinion Dr. Saathoff's opinion district attorney person involved with postpartum psychosis postpartum depression wouldn't take picture of snowman kids send to mother? [02:14:35] WITNESS: prior texts showed to mother terrible distress she not happened when sent picture with children snowman did not raise concerns from mother SPRAGUE: Attorney Sprague. SPRAGUE: Attorney Sprague. SPRAGUE: Objection. COURT: Attorney Sprague. SPRAGUE: Objection. COURT: Sustained. Next question. [Q=REDDINGTON A=WITNESS] Q: Okay. you told jury felt she was malingering or lying. telling jury she making stuff up to look like crazy when killed children. told jury? A: I didn't use those words. Q: No. You're more finesse than. nevertheless talking about malingering right? A: Yes. statements about auditory hallucination. Q: answer is yes. talking about malingering my question. Yes or no right? A: Yes. Q: malingering when person finds to exaggerate or lie to investigating psychiatrist? A: Correct. [02:20:24] Q: tests can administered see psychiatrist objective indicia of person malingering A: Yes. Q: And what are those tests? A: not neuropsychologist test SIRS TOMM's test of memory certain tests neuropsychologists assess malingering certain aspects issues Q: different scales examine to determine if lying malingering exaggerating A: Correct. Q: she had no impact on scales exception of likelihood of suicide? A: Yes, that's my understanding. SPRAGUE: Objection. COURT: Overruled. [Q=REDDINGTON A=WITNESS] Q: tests administered results provided agree yes test indicated she was not malingering? A: Yes. Q: mentioned other concerned. agree Dr. Phillip Resnick world-renowned person on Phillip's side of killing of children forefront worldwide on malingering? A: Yes. He has written about that. Q: He done more than write given hundreds lectures treatises about people lie to psychiatrists [02:24:07] A: Yes. Q: Dr.Resnick examined Lindsay first she malingering lying suppressing exaggerating A: Yes. Q: consistent with understanding of research on auditory hallucinations? A: some auditory hallucinations be internal for people psychotic Q: aware Phillip Resnick, Dr.Resnick article in International Journal of Lauren Psychiatry in 2014 with Simon McCarthy-Jones aware of treatise? A: Yes. Q: agree some doctors might feel hallucinations auditory must originate from exterior interior agree article claim one doctors may say "Voices typically heard as from inside head voices outside head atypical." agree A: not my recollection of research minority COURT: Hold on. Good. Next question. [Q=REDDINGTON A=WITNESS] Q: article psychiatrists feel voices heard outside head area hallucinations not legitimate fair A: old original way of thinking taught had to be external for experiencing psychosis Q: agree Dr.Resnick indicates research evidence not support claim internal located voices emblematic of genuine A: Auditory verbal hallucinations. Q: found 199 psychiatric patients 81% diagnosed with schizophrenia 38% heard voices inside and outside head? [02:31:45] A: You did. Q: Lindsay indicated heard loud auditory hallucination voice deep male commanding external correct? A: Yes. Q: young woman evidence suffering medical condition psychiatric condition seeing doctors prescribed medications reaching help suicide hotlines Rhode Island Mc Lean Lockwoods Institute opening statement agree efforts to maintain control Lindsay withheld. REDDINGTON: agree based investigation police reports statements witnesses grand jury photographs videos interviews Lindsay review witness statements January 24th 2023Lindsay made calculated decision woman no longer liked life harder to control saw opportunity to escape selfish choice take it Cora Dawson Callan first before own life chose manipulate providers seek quick easy fix depressed anxious didn't get expected chose alternate route different doctor change medications disengaged from treatment didn't like plan after four months in treatment made choice deliberate intentional decision not want to try anymore no one take care kids had to take them with her agree evidence supports contention? COURT: Attorney Sprague? [Q=SPRAGUE A=WITNESS] Q: Thank you, Your Honor. asked during cross-examination about work as forensic psychiatrist for Bureau of Prisons prisons in Virginia minimizing experience A: continued to work teach students Seeing patients inmates in different facilities's women assessments evaluations determinations about treatment gathering information treating inmate patients as significant mental illness best treatment Q: during years treating treated patients with psychosis? A: Yes. Q: include treating women with psychosis? A: Yes. COURT: Overruled. She may have that. Go ahead. WITNESS: Since 1992? [Q=SPRAGUE A=WITNESS] Q: How many patients treated in prison system women patients with psychosis? [02:38:12] A: Several hundred. Q: common signs symptoms women display psychosis? A: Yes. Q: And what are those? A: some have delusions false beliefs present as psychotic hallucinations perceptual disturbances auditory hallucinations verbal hallucinations disorganized thinking special meaning difficulty communicating Q: treat patients with psychosis during 15 years? A: Yes. Q: include women with psychosis? A: Yes. Q: treatment women psychosis responsible for diagnosing them with underlying mental condition? A: Yes. Q: Diagnosing psychosis as of symptoms? A: Correct. Q: treating underlying condition symptom of psychosis for women? A: Yes. [02:39:53] Q: mentioned two specific patients females dealt with postpartum depression or postpartum psychosis. recall? A: Yes. Q: Which case reports? A: case report about postpartum psychosis written. Q: On the medication interaction? A: Yes asking how patients presented? Q: Yes. A: recall one 18-year-old woman delivered child decided not to want breastfeed medication, bromocriptine Parlodel given found couple of days given medication became convinced she had to kill child experiencing auditory hallucinations distressed wanted to kill herself suicidal brought to our attention evaluating removed Parlodel bromocriptine responded resolved symptoms psychotic symptoms discharge her back to family other case another female older mid-20s also given medication became psychotic more manifestation of mania hypersexual with husband hyper-religious Q: And doctor... A: Sorry. Q: delusions religious delusions? A: Pardon me? Q: Her delusions regarding child religious delusions A: Yes, I believe so. Q: once medication removed symptoms subside? [02:42:45] A: Yes case given. disruptive on ward taking clothes off given antipsychotic medication symptoms resolved. Q: to first patient described she had voices instructing her to harm child feelings guilt suicidal? A: Yes. Q: asked by Attorney Reddington about curriculum vitae focusing terrorism sole focus said no. focus over career? A: from finished residency interested in public psychiatry realizing seriousness of mental illness prison system value of teaching psychiatry to students began with state hospital seeing patients important is working with patients value students learn from patients make better doctors even see identity as clinician have patients scheduled to see supposed to see yesterday patients Friday Q: defense counsel asked about onset of postpartum depression psychosis DSM -5 lists postpartum onset within four weeks A: Correct. Q: World Health Organization has clinical descriptions diagnostic requirements for behavioral neurodevelopmental disorders section on mental behavioral disorders associated with pregnancy childbirth puerperium during or after birth? A: Yes. REDDINGTON: Objection. She not read he agree can ask him if he read COURT: I'll assume there'll be an objection. REDDINGTON: Objection. COURT: Overruled. allow if know Doctor. [Q=SPRAGUE A=WITNESS] Q: aware section about mental behavioral disorders with pregnancy childbirth puerperium psychotic symptoms onset of syndrome significant mental behavioral features during pregnancy puerperium up to six weeks following delivery required for diagnosis? A: That's my understanding. [02:46:47] Q: from World Health Organization correct A: Yes. Q: asked blood testing appropriate patient on history patient symptoms medication recall A: Yes. Q: asked about thyroid function test in postpartum woman recall A: Yes. Q: aware exhibit 222 Ms.Clancy 's thyroid levels checked South Shore Hospital emergency room November 16th, 2022 levels within normal limits? A: Yes. Q: submit page from exhibit 222 thyroid levels [Q=SPRAGUE A=WITNESS] Q: Recognize? jury marked exhibit thyroid levels marked by TSH correct A: Correct. Q: And what is that? A: medication started low dose 25 milligrams gradually moving up after weeks to 200 milligrams more titrated slow process potential for serious rash decreased medication requires slow titration patient patient with process most used mood stabilizers for bipolar disorder important valuable medicine Q: said important start low dose. say 25 milligrams? A: Correct. [02:50:10] Q: recall dose Dr.Tufts wrote prescription for Ms.Clancy? A: Yes. Q: take medication rash significance person patient prescribed medication not telling provider chose not take? A: Yes. Q: And what is that? A: limits provider other decisions If decision patient not take certain category medication helpful let provider know say decided against other alternatives?" Q: Doctor asked about lack of sleep causing psychosis correct? A: Correct. Q: Defense Counsel asked evidence witnesses defendant happy wife mother daughter said no. referring to no? A: thinking paper she filled September 12th 2022 expressed concerns significant anxiety insomnia concern followed up with Jennifer McAllister worked with Dr.Tufts Ms. McAllister's note Ms Clancy mentioned waning confidence care children growing note Dr.Tufts Dr.Tufts noted found Callan needed more attention kids growing older finding challenging. COURT: Yeah, sustained. It goes beyond cross. [Q=SPRAGUE A=WITNESS] Q: reviewing Dr.Tufts ' treatment defendant medications prescribed methods issues concerns about approach? A: No. Q: speaking prescribing medications prescribed doses options tried opinion based training experience Dr. Tuft's method prescriptions? A: Yes. [02:57:04] Q: How so? A: 2013, 2014, Ms.Clancy taken Prozac SSRI helpful took Wellbutrin propranolol After Dawson born Clancy had significant anxiety went to doctor prescribed Zoloft, 2019 early 2020 decided not to take Zoloft Her anxiety symptoms resolved difficult time older COVID decided prescription Zoloft, not to take anxiety after Callan 's birth significant lasted longer went to Dr.Tufts history Ms Clancy taken Prozac done well considered Zoloft got prescription decided not to take Zoloft 25 milligrams lowest dose reasonable choice antidepressant Clancy 's history seven pills taken Clancy directed take 25 milligrams week increased to 50 milligrams tablets after five days increased 25 to 50 milligrams adverse reaction insomnia significant Q: after seeing effects Zoloft stopping prescription prescriptions Dr.Tufts tried with defendant opinion training experience trial and error process defendant reasonable? REDDINGTON: Objection. COURT: Overruled. SPRAGUE: How so? WITNESS: Ms.Clancy after insomnia upset concerned around October 21st Dr.Tufts assessed told stop Zoloft started on Ativan Benadryl medication helpful Clancy concerned about Ativan benzodiazepines addictive getting hooked on medications concern over long term process decreasing benzodiazepines or longer acting benzodiazepine medication BuSpar, buspirone prescribed by Dr.Tufts Ms.Clancy note REDDINGTON: apologize standing objection to rambling answers? redirect object [Q=SPRAGUE A=WITNESS] Q: calls to Aspire suicide hotline asked about records approach exhibit 222 note December 8th, 2022 of Leticia Dukes review note record information about defendant's call to suicide hotline? A: Yes. Q: exhibit 45 "Patient contacted Aspire Crisis Support met Aspire clinician virtually told not meet criteria for inpatient treatment due to not SI plan." suicidal ideation plan A: Correct. Q: defendant called suicide hotline told suicidal thoughts A: Correct. Q: submit two pages 45 and 46 as next exhibit apart from exhibit 222. [03:06:23] COURT: All right. Subject to same objection. admitted. SPRAGUE: said timing matters. Why matter? WITNESS: after lactation postpartum period decision woman to stop lactation various times not just circumscribed one-month period stopping lactation causes decrease prolactin levels increase in estrogen progesterone depends on stop breastfeeding significant hormonal changes tied to breastfeeding lactation timing time important see breastfeeding stop seeing symptoms. REDDINGTON: Objection. [inaudible]. COURT: Sustained. SPRAGUE: familiar with Dr.Resnick 's teachings about malingering psychosis? WITNESS: Yes. SPRAGUE: fair Dr.Resnick teaches red flags in malingering SPRAGUE: aware Dr.Resnick malingering faking hearing voices someone automatically obeys command COURT: Yes stricken time. Counsel? Members jury last answer stricken. [inaudible REDDINGTON: Yeah. COURT: Anything else? SPRAGUE: Commonwealth rests. COURT: jury Commonwealth rested rebuttal case have evidence excuse you until tomorrow morning tomorrow morning be ready closing arguments legal instructions in morning jury begin deliberating tomorrow suggest go home rest be ready for tomorrow heard all evidence first time haven't heard arguments from attorneys't heard before law apply.keep open mind instructions gave last four or five weeks doubled down today Don't read Don't talk Don't watch Don't discuss anyone Keep open mind Come far open mind Bring it tomorrow get good night's sleep look forward to seeing you tomorrow get soon as we can Sometimes delay next section get you out here soon tomorrow morning if delay on me get you out here soon get back into this thank you for work commitment dedication look forward to seeing you tomorrow COURT: All right thought'd maybe hear from defendant motions take break until 2:30 do charge conference Before leave have draft impose on lunch hour looking at instructions. Mr.Reddington [03:17:42] SPK8: Your Honor record return to trial of Commonwealth versus Lindsay Clancy. All parties present excluding 18 jurors. COURT: Counsel charge conference chance got hour ago draft gave got proposed instructions from defendant Commonwealth any offer? CLERK: Thank you Your Honor proposed draft instructions Honor's instruction criminal responsibility cut and paste of model no objection Commonwealth record't think voluntary intoxication three points added into Your Honor's draft necessary cite Commonwealth versus Brown 449 Mass 747 2007 case instruction on voluntary intoxication not required absent evidence of debilitating intoxication. evidence must support inference killing intoxication impaired defendant's ability form criminal intent." Counsel argue medications free argue jury talking about criminal responsibility mental status time event January 24th, 2023 no evidence support intoxication debilitating effect as Brown case indicates.best evidence court is defendant in journals statements to experts indicated at time offense taking amitriptyline one other medication for time. Your Honor has evidence low dose of amitriptyline nothing observed behavior suggesting debilitating effects of consumption prescription medications. ask sections not included in instruction. If Your Honor inclined to include them add qualifier into paragraph three- CLERK: Roman numeral three. CLERK: defendant lost substantial capacity involuntarily intoxicated by prescription drugs ask add day of offense clear jury about her consumption medication typo on page four Roman numeral four first paragraph consequences of finding fifth line "If court concludes defendant mentally ill discharge substantial likelihood of serious harm pronoun CLERK: remaining instructions on charges of first degree deliberate premeditation extreme atrocity cruelty commonwealth no objection typo on page seven Honor lists Castillo factors third factor. C and D same line numbers sense manner degree severity of force used CLERK: instruction on involuntary manslaughter Commonwealth object to cite case of Commonwealth versus Garabedian older case 399 Mass 304 1987 defendant argued involuntary manslaughter required evidence involuntary chemical intoxication sprayed chemicals on lawns interaction with homeowner physical altercation strangling falling off hitting with rock shoelace court held unlawful battery likely to endanger life not classified as involuntary manslaughterwanton reckless conduct theory Garabedian right point situations strangle strangling of individuals babies kids unlawful battery likely endanger life shouldn't instruction for involuntary manslaughter rely on case argue not included in instructions. one more point Your Honor arguing about pieces evidence duplicative evidence COURT: Yeah. CLERK: Honor instruction jury didn't consider duplicative evidence more weight or importance. small line evidence section about strength or proof not determined by volume. based on evidence parties display evidence text messages in different forms full record condensed records instruction indicates no more weight to one other even if duplicative record ask something added. REDDINGTON: Thank you for time review, Judge. proposed instructions Roman numeral one introduction fine Criminal responsibility paragraph one fine page two legal term not criminally responsible with mental disease or defect reference to lacking substantial capacity to appreciate criminality or wrongfulness conduct or conform conduct fine define mental. talk about mental disease and defect law clear court not have to define mental disease or defect given framework decision acceptable to defendant one reference not include abnormality [inaudible] only by phrase mental disease or defect is legal- REDDINGTON: sorry page two second paragraph after first sentence REDDINGTON: Mental disease or defect legal term not medical not fit into formal medical diagnosis phrase "Mental disease or defect include abnormality." Characterized only by repeated criminal conduct suggest repeated criminal conduct confusing to determine evidence defendant has mental disease or defect If Commonwealth proved defendant not suffering from mental disease or defect Commonwealth satisfied burden of proving defendant criminally responsible no problem for you to determine question phrase mental disease or defect include abnormality only by repeated criminal conduct based on evidence hypo-technical assume If Commonwealth not proved defendant not suffering from mental disease or defect consider defendant lacked substantial capacity to appreciate or wrongfulness of conduct or conform fair statement law To establish defendant capacity to conform conduct Commonwealth must prove disease or defect deprive defendant ability to behave law obey law relate to word appreciate, understand more than know criminality means legal significance of conduct wrongfulness means moral significance next paragraph add in before wrong second sentence Commonwealth prove defendant knew understood conduct was illegal or put morally wrong front of wrong. rest of paragraph fine. Last sentence court notes defendant must realize conduct was illegal or wrong. insert word morally wrong. paragraph fine. Roman numeral two. defendant's lack of criminal responsibility because mental disease or defect. fine court says all need to determine delete all need to determine. dilutes gravity issue for jury minimizing burden for government unnecessary ask go say jury determine issue go into rest of instruction rather than saying all need to determine. paragraph defendant lacks substantial capacity to appreciate criminality or wrongfulness of conduct or conform conduct to law voluntary intoxication. after five weeks agree ask court not instruct on voluntary intoxication appreciate model charge Honor guide reference to voluntary intoxication don evidence of voluntary intoxication trigger preexisting mental disease or defect issue cases dealing with defendant snorting cocaine shooting fentanyl smoking weed recent case Commonwealth v. Aldo Dunphe marijuana psychosis dependency. don't have any that here.prescription medications provided defendant ask court not reference voluntary intoxication Roman numeral- REDDINGTON: Correct. REDDINGTON: Yeah. Thank you. REDDINGTON: right. Four fine, Judge. Roman numeral five. [03:33:59] REDDINGTON: okay. Paragraph three, four. referencing voluntary intoxication could be deleted. paragraph four Roman numeral five page three voluntary intoxication from prescription drugs. out Paragraph six defendant acquitted by lack of criminal responsibility court obligation to instruct jury potential ramifications. fair statement of law. Instructions on murder first degree deliberate premeditation cruelty atrocity fine. Second degree fine. Involuntary manslaughter facts evidence justify instruction court REDDINGTON: argument involuntary manslaughter defendant intended conduct resulted in death of deceased conduct not result suffering disease defect intentional premeditated cruel atrocious reduce to manslaughter wanton or reckless. addressing voluntary clear evidence if jury determines defendant committed act victims died high likelihood substantial harm result to individuals defendant's conduct. not talking about disease defect rises level not guilty by lack of criminal responsibility revert to default standard of wanton and reckless conduct.wanton reckless conduct under Welansky case defendant intentional act not negligent to criminal standard level justify instruction on involuntary manslaughter continue with voluntary manslaughter court to instruct relate to issue diminished capacity court familiar with Commonwealth v. Gould 380 Mass. 672 Supreme Court decision Patterson versus New York evidence of defendant's emotional intellectual mental state of mind not rise to lack criminal responsibility could rise extreme emotional disturbance manslaughter not murder consistent with United States Constitution Massachusetts Constitution Commonwealth v. Gould case law talks about diminished capacity mental disease or defect evidence of mental disease defect impairment not rise to lack criminal responsibility under cases Garabedian 399 Mass 34 Thomas Toolan 490 Mass. 698 evidence of mental disease or defect not rise lack criminal responsibility mitigate reduce ability person to know cruel atrocious premeditated malice of forethought concept of malice three prongs malice mens rea importantif jury says evidence she going to doctors getting prescribed medication taking in postpartum depression stage." don't buy postpartum psychosis but she was over-medicated had medications plus postpartum depression reduces her ability to think react know malice reduce to voluntary manslaughter willful wanton conduct involuntary manslaughter. Reasonable doubt fine. instructions are fine. ask court consider prospect involuntary intoxication. cases Commonwealth versus Wallace and Dash Piantedosi evidence of involuntary intoxication if no intentional ingestion of cocaine or illicit drug but prescription drug ingesting consistent with drug instructions drug laboratories pharmaceutical companies market products have black box warnings age cutoff scary stuff selective serotonin uptake inhibitors tricyclics anti-psychotics if young lady have disease or defect lack of criminal responsibility but result of drugs prescribed not abusing not mixing with illegal drugs jury to determine manslaughter based involuntary intoxication ask court entertain Bowden charge in case. case law under Commonwealth v.Bowden allows court upon evidence of inadequate police investigation. recall case I for bifurcation argument defendants in lack of criminal responsibility cases are hogtied responsibility admit involvement in crime. lack criminal responsibility government burden to prove jury beyond doubt defendant guilty of evidence crime if evidence police investigation deficient jury right to consider as basis acquittal. consider for finding reasonable doubt based lousy investigation. In this case lousy investigation atrocious investigation. no investigation. Judge, police government accepted she strangled kids kids in basement she's guilty move on didn't investigate didn't test screen didn't take picture screen didn't see blood on screen no crushers for alleged crushing of medications no indication powder she crushing medication questions regarding blood spatter police never investigated. talk about investigation crime scene laboratory state police question about door blood drop door siding six months later take siding degraded can't test it. horrific investigation case fair for court to instruct on Bowden. COURT: All right.Commonwealth know one. two requests not aware wanted give opportunity to be heard. One Bowden instruction. voluntary manslaughter. Before looking at instruction possible instruction involuntary manslaughter Mr.Reddington took word involuntary out doesn't instruction apply to argument considering last paragraph? COURT: Yeah, on page eight. COURT: talking about manslaughter instruction. REDDINGTON: agree Your Honor. If fashion that instruction COURT: Just one instruction. COURT: give one instruction wouldn't name involuntary or voluntary Attorney Buckingham don't know if Commonwealth objects to that not asking for assent what about Bowden instruction CLERK: Your Honor object to Bowden instruction. counsel's free to argue about police investigation failures of investigation identified trial don't any. Attorney Reddington said about didn't test test screen clear photographs of screen condition screen apparent done on day of incident documented Witnesses testified statements about window blood on outside house observed adequate testimony about why wasn't swabbed day adequate testimony about subsequent decisions to get information get swabs area testing done testing identify defendant's blood on outside.evidence. claims made evidence shows adequate police investigation point of contention drawer pill bottles some claims about things not done adequate testimony about why things weren't flagged day incident Police weren't aware of ingestion of medications day had prescription bottles provided by Patrick Clancy bottles in drawer never produced for testing or analysis he's free to argue don't think rises to level instruction side note on comment about involuntary instruction don't one ask court not consider't actual instruction counsel's free to argue in form of intent commonwealth met burden regarding criminal responsibility no particular instruction on that if Your Honor provide instruction case law raised to level burden of proving voluntary consumption back into play disagreed. COURT: All right. give manslaughter instruction with page eight not give Bowden instruction defendant free to argue deficiencies in investigation free to argue. not give voluntary intoxication instructions criminal responsibilities. better draft in morning let know instructions prepare closing arguments. closings how much time need? COURT: thinking of testimony exhibits If parties want hour don't have to use it all seen three try cases know making progress if gets to one hour and one minute not push button. estimate. Anything else need to address before tomorrow? REDDINGTON: one other minor matter police report security sergeant from hospital Brigham Women's redact reduce to paragraph She on maternity leave introduce one paragraph missing one exhibit Infants Hospital in Rhode Island look see if government has it. SPRAGUE: don't have it.We'll double check thought defense decided not to put in anything from report provide proper. proposed stipulation for portions report didn't didn't think rested didn't think coming in happy to look over defense wants to stipulate REDDINGTON: Thank you, Your Honor. ## Day 22 (22 of 60 turns kept) [09:00] CLERK: morning, Your Honor. proceed? CLERK: before court today matter of Commonwealth versus Lindsay Clancy. Ms.Clancy present represented by attorney Kevin Reddington Commonwealth represented by Assistant District Attorney Jennifer Sprague Assistant District Attorney Shanan Buckingham. COURT: Good morning, Ms. Clancy. L.CLANCY: Good morning, Your Honor. CLERK: Good morning, Your Honor. proceed? CLERK: court today continuation of jury trial Commonwealth versus Lindsay Clancy. Ms.Clancy present represented by attorney Kevin Reddington Commonwealth represented by Assistant District Attorney Jennifer Sprague Assistant District Attorney Shannon Buckingham. COURT: Thank you,Madam Clerk. good morning, everyone start? ask questions. podium mean talk to for while morning? does questions Has any member of jury read seen heard overheard anything about aspect case affect your ability to be fair impartial juror? any other matter or concern on service as juror bring attention? weeks thank you for following instructions process explain arguments in charge give charges instructions instruct on law apply case to facts find argument part hear closing arguments from attorneys split it up give First half of instructions talk about specific charges in case.after closing arguments I'll give general instructions about burdens of proof how do deliberations handle deliberations. they take a while can be dry parties and myself agreed to I'm print out. printed instructions I'm to read have with you we go through this morning. some people find helpful to read comprehend Some don't if it's distraction don't have to read but some people find helpful You know you'll have these instructions bring with in deliberations whole outline of law apply. hand out copies of instructions I start instructions now instructions on law delivered in two phases. first instruct on specific indictments against Ms.Clancy. After I conclude instructions charges Assistant District Attorney Ms.Sprague and Attorney Reddington deliver closing argument. Remember arguments of counsel not evidence to assist in organizing understanding evidence during trial conclusions party draw from evidence. At conclusion of attorney's closing arguments I'll give second part of jury instructions give go over important principles guide evaluation of evidence deliberations eventual verdicts.instructions considered in whole first and second part equally important consider all instructions as whole You'll I reading instructions apologize give instructions clearly accurately assist provided written copies instructions written instructions not substitute for oral instructions listen carefully All instructions equally important not overemphasize one portion or ignore other portions charges have specific factual elements Commonwealth must establish beyond reasonable doubt review elements in detail law presumes defendant innocent of charges presumption of innocence rule of law compels find defendant not guilty unless until Commonwealth evidence guilty beyond reasonable doubt instructions specific to this case drink of water Ms.Clancy charged with three counts of murder issue of criminal responsibility to prove defendant guilty Commonwealth must prove defendant criminally responsible crime committed Commonwealth bears burden proving defendant committed crime criminally responsible for conduct defendant no burden to prove lack of criminal responsibility Criminal responsibility is legal term person not criminally responsible if mental disease or defect lacks capacity to appreciate criminality or wrongfulness conduct or conform conduct to requirements law mental disease or defect legal term not medical termfit formal medical diagnosis phrase mental disease or defect include abnormality repeated criminal conduct to determine evidence defendant had mental disease or defect If Commonwealth proved defendant not suffering from mental disease or defect at killing Commonwealth satisfied burden proving defendant criminally responsible If Commonwealth not proved defendant not suffering mental disease or defect killing consider defendant lacked capacity to appreciate criminality or wrongfulness conduct or conform conduct to requirements law To establish defendant capacity conform law Commonwealth must prove mental disease or defect deprive defendant ability to behave law obey law appreciate means understand Criminality means legal significance conduct Wrongfulness means moral significance Commonwealth must prove defendant knew understood conduct was illegal or wrong not enough Commonwealth show knew or aware conduct illegal or wrong Commonwealth prove mental disease or defect deprive defendant of understanding of legal or moral significance conduct defendant must realize conduct was illegal or wrong considering Commonwealth met burden consider evidence presented trial facts underlying crime evidence defendant's actions before and after crime consider opinions of experts give weight I'll instruct you on elements offense Commonwealth alleges defendant committed Remember Commonwealth must prove defendant was criminally responsible at time crime committed defendant lack criminal responsibility Commonwealth 's burden to prove one at time crime defendant suffer from mental disease or defect, or two if retained capacity to appreciate wrongfulness criminality conduct conform conduct to requirements law decision based on evidence law If defendant found not guilty lack criminal responsibility district attorney or authority may petition court to commit defendant to mental health facility or Bridgewater State Hospital If court concludes defendant mentally ill discharge likelihood serious harm court will grant petition commit defendant to mental health facility or Bridgewater State Hospital court reviews order commitment If defendant still suffering from mental disease or defect dangerous court order to continue State Hospital no limit to renewed orders of commitment defendant mentally ill dangerous If conditions continue defendant may remain committed for duration life. If defendant no longer mentally ill dangerous court order from State Hospital after hearing district attorney must notified of any hearing heard final decision on recommit or release defendant by courtover specific elements charges against Ms.Clancy. talk about murder in first degree defendant charged with three indictments murder one each relating to Cora Clancy Dawson Clancy Callan Clancy instructions apply to each indictment child two degrees of murder first second degree If defendant guilty of murder decide degree murder Commonwealth alleges defendant committed murder in first degree on theories: First deliberate premeditation second extreme atrocity or cruelty. To find defendant guilty on murder must be unanimous. jurors must agree Commonwealth burden proving every required element theory beyond reasonable doubt check appropriate box on verdict slip each theory if unable to agree Commonwealth prove theories first degree murder consider Commonwealth proved defendant guilty of murder in second degree begin instructing on elements additional requirements of proof for each theories of murder in first degree then murder in second degree define elements of murder in first degree with deliberate premeditation To prove defendant guilty Commonwealth must prove elements defendant caused death of Cora Clancy Dawson Clancy Callan Clancy intended to kill Cora Clancy Dawson Clancy Callan Clancydefendant intended cause Cora Clancy Dawson Clancy Callan Clancy 's death defendant committed killing with deliberate premeditation decided kill after reflection discuss requirements detail first element defendant caused death of Cora Dawson Callan Clancy. defendant's act cause of death results in death second element defendant intended to kill Cora Clancy Dawson Clancy Callan Clancy third element committed killing with deliberate premeditation decided kill after reflection Deliberate premeditation require length time reflection decision to kill formed over days hours seconds key sequence thought process consideration kill decision kill third killing decision no deliberate premeditation where action taken quickly no time reflect decide deciding defendant intended kill formed intent deliberate premeditation consider credible evidence suffered mental impairment or affected consumption prescription drugs defendant may form intent act with deliberate premeditation even if mental impairment consumed prescription drugs consider evidence second theory of first degree murder murder with extreme atrocity cruelty consider theory murder first degree regardless of Commonwealth proved murder first degree with deliberate premeditationprove defendant guilty of murder extreme atrocity cruelty Commonwealth must prove elements beyond doubt defendant caused death of Cora Clancy Dawson Clancy Callan Clancy second element defendant intended to kill Cora Dawson Callan Clancy cause grievous bodily harm to Cora Dawson Callan Clancy act likelihood death result third element killing committed with extreme atrocity cruelty. first element defendant caused death of Cora Clancy Dawson Clancy Callan Clancy defendant's act cause of death natural continuous sequence results in death second element defendant's intent Commonwealth must prove in three ways defendant intended to kill Cora Dawson Callan Clancy cause grievous bodily harm to Cora Dawson Callan Clancy act likelihood death intent Commonwealth satisfies burden if proves defendant's intent beyond reasonable doubt in three ways first way of proving intent defendant intended to kill same as second element of murder in first degree with deliberate premeditation second third ways proving intent different from murder first degree premeditation second way defendant intended to cause grievous bodily harm to Cora Dawson Callan Clancy Grievous bodily harm means severe injury. third way prove defendant intended act created likelihood death. analyze third way proving defendant's intent determine defendant intended perform act caused death if intended act determine defendant knew about relevant circumstances acted. determine whether act created likelihood death deciding defendant intended to kill cause grievous bodily harm or act likelihood death consider evidence defendant suffered mental impairment or affected by consumption of prescription drugs defendant may have intent even if suffered mental impairment or consumed drugs consider evidence Commonwealth proved this element third element theory killing committed with extreme atrocity or cruelty. Extreme atrocity means act extremely wicked brutal appalling horrifying revolting Extreme cruelty defendant caused death by method surpassed cruelty human life determine method means of killing shocking to murder with extreme atrocity or cruelty inquiry focuses on defendant's actions manner means of inflicting death effect on deceased.deciding whether Commonwealth proved defendant caused death with extreme atrocity or cruelty consider factors defendant indifferent to or pleasure in suffering deceased defendant's method means killing likely to increase suffering deceased means used excessive out of proportion to needed considering means excessive consider extent injuries number of blows delivered manner degree severity of force used nature of weapon instrument method used finding extreme atrocity or cruelty unless based on one or more factors listed consider defendant's mental condition at time killing evidence of mental impairment or effect consumption prescription drugs determining Commonwealth proved defendant committed killings with extreme atrocity or cruelty defendant may committed killing with extreme atrocity or cruelty even if suffered mental impairment or consumed prescription drugs consider evidence Commonwealth element murder in second degree prove murder Commonwealth must prove elements defendant caused death of Cora Clancy Dawson Clancy Callan Clancy defendant intended to kill Cora Clancy Dawson Clancy Callan Clancy cause grievous bodily harm to Cora Clancy Dawson Clancy Callan Clancy act created likelihood death resultrequirements proof for murder second degree same as first degree with extreme atrocity cruelty without element killing committed extreme atrocity discussed elements earlier first degree murder extreme atrocity cruelty listed other section Now manslaughter If Commonwealth not proven charges first or second degree murder consider lesser offense manslaughter manslaughter unlawful killing unintentionally caused by wanton or reckless conduct conduct intentional high likelihood substantial harm another omission or failure to act constitute wanton reckless conduct where defendant duty to act prove defendant guilty manslaughter Commonwealth must prove elements beyond reasonable doubt defendant caused death of Cora Dawson Callan Clancy intended conduct death Cora Dawson Callan Clancy three defendant conduct wanton or reckless element first element defendant caused death of Cora Dawson Callan Clancy defendant's act cause of death results in death second element defendant intended conduct caused death Commonwealth not required prove death third element defendant conduct wanton or reckless conduct creates high likelihood substantial harm anotherconduct involving grave risk harm person undertakes with indifference disregard consequences If defendant realized grave risk act amounts wanton or reckless conduct not reasonable person realized risk Even if defendant realize grave risk harm act constitutes wanton or reckless conduct if reasonable person realized act risk grave danger not enough Commonwealth prove defendant acted negligently careful Commonwealth must prove defendant actions beyond negligence wanton or reckless conduct deciding defendant knew conduct created high likelihood substantial harm consider credible evidence defendant suffered mental impairment or affected by consumption prescription drugs defendant may have knowledge if suffered mental impairment or consumed prescription drugs consider evidence determining Commonwealth proved this element instructions on specific elements charges case attorneys deliver closing arguments closing arguments not evidence SPK2: important closing arguments not evidence I'll go over later remind after closing arguments I'll give balance of instructions on law counsel. SPK3: Jurors five weeks ago met thank you for incredible service sincerely took more than a month out of lives sat here incredible toughest gut-wrenching things jurors carry trauma for years service performed never seen before listened to evidence been fair objective You've listened to judge's instructions carried them into heart consistent with oath solemn oath passed between government and Lindsay, placed herself on her country as jury of peers consider what's at stake dealing with Cora Dawson Callan knows loss think of Cora,Dawson Callan victims of this case of horrible horrific act laid at your feet as jurors to decide Lindsay guilty beyond reasonable doubt Honor instructed standard of proof citizens proof beyond a reasonable doubt Before government charges citizen with crime don't care how many cops DAs people in front row all proud of prosecution. opening statement prosecution ripped soul out of this girl. they had their family.[inaudible] turn into this? Because of damned medicine lousy medical care she got. can troop paid experts to tell jury "Oh she didn't say heard voices inside head. said heard voices from outside head. was making Chicken McNuggets. bowl on sofa wasn't making Chicken McNuggets. She said something woman acting in right mind when children killed." consider evidence case consider person in front of defendant government refers. His Honorable person defendant system justice don't have to defend against anything. government has burden of proof. DA charge crime has burden of proof assistants have burden of proof prove Lindsay guilty of offense beyond reasonable doubt prove Lindsay killed children not suffering from mental disease or defect lack of substantial capacity to appreciate realize while in psychosis. laugh about another woman excuse. She's depressed. general anxiety. Give couple pills. She'll be all right objective evidence young lady did nothing wrong. was a nurse, daughter wife good mother. can see from objective evidence exhibits photographs in jury room Facebook postings.see she indicates randomly grabbed one "A son, my prince," think she killed him first cruelly didn't like him repulsive. she living life with Pat kids having great time summer Life good had to go back to work opening statement "Watch evidence manipulation case built upon originally developed progressed until in front of you. beginning first 911 call suffer through made hear voice Pat Clancy horror of experienced evidence injuries she suffered jury room exhibits indicated extent of injuries slitting throat slashing wrists throwing herself out window blood bed floor window open screen slashed screen wasn't slashed she thought delusion in psychosis thought believes slashed screen didn't objective evidence spend week showing extent severity of suicide attempt? arguing fake suicide. Dinky cuts no bleeding "She didn't mean to kill herself." to throw herself out window slide down house remember one Hanging off window sliding down house Lindsay screwed up hurt herself bad not what happened made testimony of Dr.Vulfovich she made significant suicide effort slashing wrists slitting throat interesting consider objective evidence Googling slitting throat suicide drugs side effects ketamine treatments drugs effects of Tufts medications lorazepam sertraline hydroxyzine lorazepam buspirone trazodone fluoxetine zolpidem mirtazine clonazepam quetiapine diazepam quetiapine You'll chart prescriptions she wasn't consuming all same time kid supposed took drugs told religious in obligations care health went to Dr.Tufts young lady house with husband babies respected nurse wife friend mother Should've kept drinking big deal Remember to assassinate young lady Remember evidence concerned drinking five drinks a day worried about." evidence up to 2019. wasn't drinking while kids breastfeeding couple of beers with friends bad pile spent time showing Dr. Laposata's testimony legitimate dreadful horrific suicide attempt beautiful young girl throwing herself out window quarter. played quarters challenge tell jury why spent week showing committed SPK3: said witnesses serious suicide attempt Remember Tried to kill herself now they back off agree serious suicide attempt watch evidence manipulation Remember argument with bands She took bands bag put gloves on touched Dr. Laposata on Zoom slams bands down paper bag moving bands yells at Laposata "Wrapped weren't knotted Lindsay tightening band hold it minute two three four minutes needed bands not knotted she they sprang open Remember Dr. Laposata saw she walked away "If gloves won't fit" Quarter two Patrick Clancy testify? testimony indicated they were knotted around necks children struggle your memory not mine forget evidence struggled to get it off Dawson head police officer saw through window horrific stuff objective shows manipulation. government prosecution mess They evidence argue she did not tie knot walk away Dr. Laposata said four, five seconds until passes out they four minutes not evidence shows move on Lindsay 's in hospital.thing about conversations she talking to people kids in basement her throat crushed heard 911 tape draw inference conversation about children "I tried to kill myself. kids in basement." determine discerned. police investigation His Honor indicates two things. Number one proof beyond reasonable doubt he's guilty two she not suffering from disease or defect as instructed at time of killings. two things to prove police charge with criminal offense obligation to investigate. end of day charges before court feel proud of if good investigation."You'll photograph of cup and powder don't analyze. Did take pictures? analyze test blood? Lousy investigation case she guilty put her in hospital evil woman killed three innocent kids stand she chained to bed, paralyzed testimony from Dr. Zizel fluffy cuffs securing bed handcuffs Not medical treatment Medical treatment restraints pull lines big men in with guns badges sitting outside door sure Lindsay Clancy paralyzed chained to bed doesn't run away from hospital suffer through worked eight hours.had another shift work that night." treatment. important treatment young lady got from healthcare providers. remember Meg Collins? came in courtroom Tall woman short blonde hair squared away Unbelievable nurse hospital advocated for her stood up for patient protected her. During pandemic Meg Collins in emergency room half us hiding home computers not die drinking Chardonnay at 11:00 morning Meg Collins in hospital treating advocating example of nursing not attitude not treating like disdained comes out of coma intubated had major surgery broken crushed spine vertebrae ribs thyroid massive medical records blood transfusion for blood loss someone surgery delusional You've had anesthesia tooth pulled trauma in hospital bed paralyzed unable to feel lower half body feel meds pain medication damage to spine hospital has meeting. Remember other doctor Dr. Shah Indian woman impressive amazing had facts observed treat Lindsay treated her like human being good doctor.Came told her observations they concerned about big confabulation about take her off healthcare proxy had lawyers people there her signing documents determine she signing something her parents take over Pat not responsible for her care. Lawyers, cops handcuffs. need a lawyer? Write down. somewhere she wanted a lawyer bad thing. Must be guilty put in guilty pile she said delirious state dealing with people about issue." more nefarious eyes on ball manipulation. Paul Zizel big deal. friends with guy heard evidence called him was with Pat after incident bedroom with blood taking evidence police didn't see in investigation able to grab this't police have grabbed? They're all empty see when prescribed what she took testimony She'd take handful of pills Remember guy yesterday Tough to take handful pills They were crushed Where's residue? crusher? anything Doesn't matter Great investigation situation they leave this behind don't look at it.One your memory not mine testifies, they might have looked it saw it didn't seize it." They kitchen seized every pill bottle in cabinet with books. found smoking gun. Good Moms Have Scary Thoughts. Put in guilty pile put in plastic bag show it to a jury young lady had scary thoughts. Jolada gave it her. evidence evidence of sleep aids evidence in bag stuff was thrown in in bag when saw we seized it held it for three-and-a-half years. No evidence police knew I had it. They could analyze don't want evidence little wish jar they bought on their honeymoon in Hawaii years prior kids inside folded-up pieces of paper Some dated Some't back to 2017, 2018, '20. reference her wishes to healthy kids successful good birth worrying about child with woman lived for her kids until running into Dr.Tufts two. after Dr.Tufts not a wonderful life. what did Dr.Tufts do? laughs at me the television. telemedical thing on telephone or Zoom."Take more pills." medical records heard testimony know her concerns fears seem young lady didn't care wanted to score more drugs? repulsive allegation evidence clear no basis scared. September until October '22 young, vibrant hardworking You've heard Not my words witness's words holding goals hardworking nurse mother take kids to Kingsbury Club another thing snooty at Kingsbury Club." swimming pool exercise Watch manipulation situation manipulation with Kingsbury Club other items Paul Zizel told Lindsay what to say hearing voices." ugly beyond reasonable doubt proof no burden heard from Sheila Remember reverend chaplain at Brigham Women's Hospital didn't know Lindsay from night broken up continued was there Lindsay extubated Lindsay going through treatments there eight days before Paul Zizel knew Lindsay existed Lindsay saw psychologist lawyer got psychologist speak cops having meetings talking about it "Must've been shrink psychologist Zizel told her what to say did not.ruin man's reputation career put him position tells broken young woman vilified society for killing three children he goes hospital tells her heard voices? Disgusting she told Sheila first heard voices. Command hallucinations didn't say command hallucinations heard voices male voice." other guys government's rebuttal witnesses impressive first two, Mac put him aside You've got other doctor Mac freaked out asked where he stayed other guy looked eyes bugging ask where he stayed? they don't see her for years why other guy, Helburn wait until process payment from DA's office through school obligation to try be objective look objective why wait long? go with another guy take young lady room question her one after? questioned by Dr. Mack experience for three hours, four hours other guy pepper questions her next day she take tests go back again with Mack Heilbrun she was cooperative pleasant friendly answered questions owned what she did never ran from anything gone through evaluation after recorded.You'll video questioning her she sitting in wheelchair three years after incident They busy Paul Zeizel was there Brigham Women's I called asked to represent young lady evidence saw her in hospital bed broken practically dead reached out to Dr. Zeizel asked talk to woman?" Concern for her mental wellbeing demons horror in her mind she paralyzed hurting medicated swollen tubes cops chains He talked to her asked him to go judge credibility person Paul Zeizel truth out of humane feeling to help young lady? been by her side for three and a half years Same with Sheila Why visit with Lindsay Tewksbury Hospital? not getting paid not hired gun not request loves Lindsay good kid beautiful soul Zeizel been with her You've Sheila with her You've evidence her mom and dad in Connecticut visit her God sometimes had dinner Remember Tewksbury records good score Tewksbury records she on anniversary of deathsbirthdays?" see them going through medical records? doctor what did she do then?" She propelled herself down hallway met parents laughed had dinner watched TV talked telephone God not fetal position wailing self-flagellating three and a half years acting like human they go through records want get dates use against her. Manipulation three weeks away from trial guy testifying sees her establish rapport three weeks from murder trial doctor number three hired by government to evaluate testify against you establish rapport no rapport she cooperative friendly treating doctors Don't talk don't communicate access to medical records signs HIPAA forms don't know records know Dr.Resnick Dr. Zeizel Meg Spinelli report incorporate report MMPI other psychological tests administered second day Mack-Heilbrun team interviewing She passes MMPI Testimony presented answered MMPI honestly pertaining to state of mind questions about what occurred questioning young lady state of mind then now she didn't lie didn't malinger exaggerateimportantly she minimizes was off chart on suicide scale testimony from Dr.Resnick Zeizel Condie paid for testimony all paid not jury judge myself, Chrissy paid doctors testified. Phil Resnick man scary movie world record of investigating examining treating people psychosis children filicide world-renowned record for checking fakers malingering doctor agreed his article on voices leading article research Phil Resnick expert on malingering testify by Zoom had surgery Zoom testified four months after incident met with Lindsay evaluated Lindsay compared looked at records looked records police reports grand jury minutes indicates she was in state of psychosis at time death times three government doctors rebutted? One Heilbrun said possible either way not proof beyond reasonable doubt other Mack accept his testimony suggest probably won't doctor yesterday didn't know. know what killing during psychosis was he agreed Don't agree with me expert testimony? mess government uses them to rebut man Phil Resnick she was suffering from horrific mental disease defect at time killing of children.under law His Honor she's not criminally responsible burden on them here. Prove at time of killing Dr.Resnick she was suffering from disease of defect Dr. Zeizel Dr. Condie said Condie took you medications as psychopharmacologist psychodoctor in prescription medications. got evidence. look determine side effects she complaining her records. they turned her inside out every text email picture she in college. She lied. she lied to Pat about on Prozac. dating for three months She living in Boston meets kid like him they're dating. a year ago studying for exams nervous about talking in public got on Prozac." government arguing in case journal talks about her controlling she Manipulation. opening statement district attorney said she was hard, charging manipulating woman controlling everything life controlled she ran it to water carrots beets. Ms. Rossi testified asked feel she was controlling she says Monday 10/24 'Callan put down for a nap for two hours If wakes let resettle himself.Bottle wakes up?" goes on "Make salad Romaine lettuce likes peppers broccoli Cut sweet potatoes chunks Thank you heart. good score look at journals You'll dates recording talking about drugs prescribed first page detailed dates felt "10 milligrams Prozac goes through November December December December 9th 10th 11th "Horrible intrusive thoughts AM No motivation." finally thoughts no motivation deeply depressed." went to Women &Infants Hospital looking for help January chicken scratches mind gone January on drugs suffering from postpartum depression to postpartum psychosis men don't know psychosis from schizophrenia experts woman symptoms postpartum depression within four weeks not person considered not real person for postpartum depression psychosis suggest he's wrong second guy wrong third guy didn't know memory gentleman Mack knew said four weeks go up to a year or longer don't know evidence no evidence nothing in DSM Bible God go to Europe look at World Health Organization.look at treat pregnant women problems with children. we're most advanced country still doctors court on murder trial talk four week cutoff on something they don't know exists never treated it never written about it. terrorism experts expert talks focus interests juveniles drugs kids drink smoke weed "experts", support burden to prove Lindsay not suffering from disease or defect she killed children. remember this. October not in evidence micro identification too big shows despair young kid trying to raise three kids be wife ready work she lazy didn't want to go back to work? manipulation arguing "She didn't want to go back to work." didn't want didn't want leave kids Callan loved children life. Manipulation consider journals. watched movie The Shining with Jack Nicholson Remember scene psychosis writing book wife finds book "All work no play makes Jack dull boy repeated look at records of her Googling drugs.look at how many times hours night afternoon she looking stuff up between taking care family visiting doctors seeing doctors going to Rhode Island told "No can't help calling suicide hotline Calling another suicide hotline God what does she to do? reaching out for help not getting it turns in to Mc Lean Hospital saw doctor She testifying. didn't know didn't know anything psychosis involving young lady her government bears burden of proof. bring Ian Whiffin developed helped Cellebrite. records don't measure on but cell phone don't measure going down stairs. measure stair climbing testimony three stairs climbed last record is 5:38 5:38 PM what happens phone?Don't on bed dropped bed left for 20 minutes? She could have been anywhere in house during time You've compressed period of time Patrick leaves to go restaurant pick up CV she sent him off to CVS." She didn't want him out of house long in distress wanted him home to help with bathing kids putting them to bed.How long he gone? She Googles it nefarious? book about good mothers bad thoughts God she Googled timeframe Patrick to go Three V pick up food stop at CVS government suggesting she not in psychosis Googling MiraLAX doctor told baby needed.Cora MiraLAX Why she? government opening told she wasn't suffering psychosis woman didn't want to live life wasn't happy being mother she kill kids throw herself out window not paralyze run off into sunset their theory wasn't real good suicide fake. mess young lady in brain brain damaged never be better." evidence case Burden of proof on them to prove she killed three kids wanted to move on life no chicken nugget residue photographs slice cucumber carrot no chicken nuggets in bowl Patrick wouldn't know kids eating She cook dinner in refrigerator guy yesterday no Patrick said child eating Chicken McNuggets bowl." No She getting food for two kids not little baby dinner no evidence she's lying no evidence malingering.finally remember big deal about voices within head or outside Dr.Resnick 's article largest research on voices indicates 38% of thousand people examined report voices inside head buy guy yesterday? doesn't know young lady not guilty of killing children suffering disease defect they not prove otherwise their burden not ours. Thank you SPK5: no dispute Lindsay Clancy suffering mental illness tried to kill herself no evidence experts Commonwealth say she suffering mental illness tried to kill herself not issue in trial. issue is whether she killed Cora Dawson Callan knew difference between right and wrong conform behavior to requirements law case not about mental health system women in DSM -5 not distraction important issue issue not on trial here What's on trial issue Lindsay Clancy did night of January 24th, 2023 her mental state use psychological history records treatment records before and after killed kids thought process motivation not system or DSM caused her to strangle kids had more access to treatment care support health insurance multiple doctors specialty programs treatment at South Shore Mass General stay at Mc Lean. prescription coverage trials support at home 18 weeks of maternity leave opportunity to extend excellent all women should have support from both family Patrick's two older kids Cora and Dawson in preschool nanny Elaine helped Callan three mornings week helped housework food prep woman suffering from lack of care resources had abundance of help care moredoesn't mean she wasn't struggling dealing with mental health issues. had depression bipolar major depressive disorder postpartum depression boils down to depressed trying to get help't fault of providers struggling getting better. They doing best they could records testimony information provided't always accurate full picture her cooperation compliance with plan Take medications from records pill bottles prescribed took Sometimes didn't align with told providers Patrick mother Zoloft prescription for one 25-milligram pill a day for seven days up to 50 milligrams after seven days She told Dr.Tufts took pills as for seven days eighth day to 50 milligrams had insomnia side effects symptoms told Patrick took pills seven days no effect called Dr.Tufts told to increase dose told Patrick not accurate pill bottle says "Take for a week then increase plan from beginning't result of phone call to Dr.Tufts told Dr.Tufts't accurate only seven pills taken from bottle two options. Either took medication as prescribed one pill a day for seven days didn't increase caused side effects insomnia.she not take as prescribed didn't do seven days increase missed dose or increased early before Either scenario not good She knows as nurse importance of following instructions medications follow plan do on bottle provider give accurate information didn't say went up dose to 50 too early." could have adjusted tried 25 milligram longer eased no did what was told went up had problems in medications pill bottles turned in by Patrick many pills missing Some none. BuSpar prescription first two pills missing second prescription no pills missing. Lamictal. never took pills until night tried to kill herself lack of compliance lack follow through communication with providers about taking medications Defense wants woman begging for help willing to do anything providers to get better asking for help wanted help get better on her own terms doing her way As nurse knew not right way approach accurate medical history information about side effects symptoms thoughts important for providers to know didn't do it she not fully compliant desire to be herself again wants to go back to who she was wants nowshe doesn't want side effects wants to be herself again now understandable relatable want get magic pill immediately back to being yourself. she knew not how it worked. searches phone searching for "Which antidepressant works fastest?Wellbutrin searching medications for side effects symptoms some never discusses with doctors wants to get back to she was had discussions with providers about medications work takes time for to system work texted mother had to be patient took weeks for amitriptyline to get system couldn't be patient couldn't wait wanted it faster. told Dr.Tufts problem wasn't focusing on one provider following one plan going from doctor to doctor practice to practice South Shore to MGH different programs not best way Tufts need to stick with one provider one plan see if works." turned down help from two locations women and infants records don't believe I witnesses defense look at records Page nine Patrick said overmedication was issue Not doctors not people evaluating her they put depression, RO rule out adverse medication effects.they look into if medication's problem difference between adverse effect symptom problem with medication and over medicated taking too much or too many difference. women and infants never says she was over medicated they don't turn her away not she said "Can't help. Go away." They told her in records based on onset symptoms't sure if postpartum or peripartum. saw she had issue wanted to help offered three programs inpatient medical management program partial hospitalization program for outpatient program. shows thought into care gave three options young mom option hospital getting medications partial hospitalization day go home to kids evening third option outpatient at home with kids for appointments. thoughtful well planned to give three options opposite of turning someone away saying "Go away. can't help you." her response talk to provider for guidance." goes to Dr.Tufts sees Julota records never discussed options told women and infants turned her away said she didn't qualify for program didn't discuss three programs offeredthey give her offer help three forms she doesn't want doesn't discuss with provider. first time she goes to Mass General emergency room they offer her a bed at Mc Lean she turns it down. She wants help. but making decisions't helping help turning away help wants help certain way certain timeframe. during between September and December 2022 she interacting with friends family teachers gym staff nanny people at gymnastics in public spaces driving kids around difference between right and wrong conform behavior to law requirements society presenting herself as functioning adult mom. she knew difference right wrong had thoughts beginning December of harming kids told Patrick and mother. didn't tell didn't tell provider not Tufts Julota Jennifer McAllister Dukes at Mc Lean MGH South Shore why? Because police might take away her kids. rational thought harming kids for safety shows she knew it was bad thought wrong thought wrong against the law she knew it was wrong to conform behavior to law didn't tell providers.She went met them talked about depression. tell lied. asked thoughts of harming others? homicidal ideation?" She told Tufts no Julota no Dukes no Goodhart no Every day at Mc Lean said no MGH said no. hiding lying controlling behavior controlling presentation to providers admitted to Mc Lean drugs taken from September through December weren't given at same time most had two to three medications usually three third medication was Benadryl or hydroxyzine Benadryl Ativan Valium for anxiety Most two medications medications heard from Dr. Satoff examined thousands patients psychosis treated women postpartum psychosis treated women killed children no expertise medication trials were reasonable rational tried medication didn't work side effects. stopped medication tried something else different combination mental health no blood test CAT scan MRI bipolar or schizophrenia't work providers rely on patient hope information accurate make diagnosis based on diagnosis have treatment plan every patient reacts differently to medication One patient could do fine next not.they trial and error process normal typical reasonable. they did for her. if different medications she took affected her negatively after Mc Lean out of her system Some out for months.Zoloft stopped in October Other stopped in November or December last one Seroquel bad reaction out of her system only medication leaving Mc Lean Trazodone for sleep Valium for anxiety she leaves why? wants to Cora 's birthday party relatable understandable wants to be mom again throw daughter party understandable leave knew she wasn't there knew feeling depressed needed help wanted to be mom more nothing Mc Lean could keep her there denied suicidal ideation homicidal ideation wasn't hearing voices seeing anything no signs of psychosis every doctor saw from Tufts September Tufts January 23rd none saw signs of psychosis all wrong different doctors practices collectively wrong She shows leaving Mc Lean no signs of psychosis give test to manage mental health outside hospital make appointment pick doctor she decides on Dr.Tufts makes follow-up appointment gets documentation can manage mental health They let her go there voluntarily.no grounds to keep her if she not showing danger to herself or others they let her go home at home throughout January she showing ability to know right from wrong conform behavior to requirements law in activities in January birthday party She throwing monitoring kids typical mom birthday party eating getting cake singing happy birthday her in video appeared happy smiling normal said "Seems tired, but okay." Museum of Science in Boston crowded overwhelming good day she there with three kids under five husband monitoring them caring for doing exhibits showing video Clancy woman depressed wants to kill about kill kids pick her out She calm behaviors typical normal control behavior be suicidal control behavior thoughts present image at Cape Codder similar scenario watch kids when Patrick brunch boys Patrick Cora skiing 16th interact with Carneys on January 22nd quiet admitted always quiet interact with chat in kitchen okay between January 7th and January 21st mother never intervene Her sister, licensed social worker mandated reporter never intervene help never makes reportthey're in contact with her texting calling never see signs concerned worried intervene text messages between defendant and her mom her mom attentive caring asked pointed questions "How doing sleeping medications?" concerned loving mom Lindsay answer "I getting better sleeping better." only time sleep interrupted if Cora belly ache or kids up doing better sleeping better feeling better not myself moving in right direction." text from mom 22nd glad to see yours doing better." mom wants to believe she lied wasn't doing better trying to encourage her to daughter struggling with mental health lie encourage "You've Take it day by day here for you get through she wants think she lied doing better wasn't a lie doing better mom said glad doing better Patrick said same doing better in January better 24th best day." hope she wanted only person she gave glimpse of wasn't doing better was Dr.Tufts she told Dr.Tufts feeling depressed Dr.Tufts prescribed 10 milligrams of amitriptyline a day low doseshe told Dr.Tufts "Still not helping." Dr.Tufts raised it to 20 milligrams. low dose child could take. shows cautious conservative Dr.Tufts in treatment patient had interactions with medications previously cautious conservative care by slowly increasing medication. Dr.Tufts she denied suicide plan wanting to hurt voices visual hallucinations showed no signs of psychosis up to January 23rd nothing journal defense counsel she detailed about took medication amount effect for months starting October to January stops January 18th meticulous January 18th stops decided done trying too much doesn't want to stops keeping track of prescriptions to January 24th Everything day every person situation shows knew difference between right and wrong could conform behavior to law. doctor's appointment morning drive there interact with medical professionals seem fine normal doctor treated kids since Cora baby pediatrician known family Lindsay for almost five years trained in recognizing signs of postpartum depression looks for flat affects teariness other none control herself in normal concerned mother way.home from appointment plays with kids takes them outside sending messages photos to mom Patrick good day Everything good getting better proof planning at four o'clock afternoon on her phone search for MiraLAX kids MiraLAX at 4:02. later at 4:13 search for takeout from Three V, Apple Map search how long to get to Three V. defense she checking didn't want him gone long wanted him home in distress don't send him anywhere Make food at home cook get delivery DoorDash go to other restaurants Patrick mentioned two minutes down road didn't have to look Apple Maps restaurant from Patrick been there three times months before lived in area for four years knew where it how long to get there needed to know long that night to get there limited time to decided to kill children kill herself needed to know how much time not enough time searches CVS.CVS calls them asks if have kids MiraLAX they say no Pedia-Lax one other medication.she asks "Is it in stock?" needs to know what have stock adding to errand sending Patrick not interrupted doesn't want call at 5:33 wants him to go to CVS have medication get it go Three V time to do calling to see what in stock. level of planning thinking decision making Dr. Satoff referenced texts Patrick long day. Can we do Three V he's on board check out menu get on this." asked what she's getting Mediterranean [inaudible] He getting [inaudible]. 5:10 PM calling order in talking to hostess gets order accurate questions about food Patrick's phone number name person picking up Patrick leaving to get food kids in living room on couch eating defendant in doorway basement door she says can you go to CVS last minute thought not planning for over hour knew about Pedia-Lax Three V before asked him about dinner go to CVS get kids Pedia-Lax?" he I'll get that." he heads out door at 5:15.time he leaves says her text it me." normal interaction in life experience headed to run errand someone home says get me X, Y Z?" text it me." don't want to what they want me get?" normal interaction get this for me?" Text it me." he heads out door she texts it at 5:15 PM he goes to CVS she told get makes call at 5:33. She calls back at 5:34 he heads out Three V comes home home puts things on counter quiet house with three kids under five during waking hours calls out no answer basement door opens no answer closes door calls her phone no answer goes upstairs door blood window open down to her she no longer bleeding pressure on her wounds says "What did do?" her response tried to kill myself." "Where are the kids?" "In basement." not heard voice compelled to do this help kids They're hurt in basement.save them." "I tried to kill myself kids in basement." defense wants believe conversation couldn't have happened she sounded on 911 call doctors people deteriorate over time he first gets there she able to talk progresses losing ability to talk nothing in medical records about throat crushed or thyroid crushed Her thyroid bruised vertebrae broken throat wasn't crushed She had ability to make sound communicate listen to 911 he's talking to her answering 911 dispatchers about she said if can't hear her can't understand, he could. evidence crime scene photos videos witness testimony medical records how she killed them where time order without doctors order infer from evidence to bring kids to basement strangle come upstairs get knife phone call go second floor take candles or pills or crush them pills cut herself. not just three cuts hesitation marks cuts she bled in couple spots Sherry Crook pooling in front of mirror blood dropping down closer to window same thingshe bleeding in front of mirror by window then goes out of window dove climbed slid down evidence shows from shingles she goes out on ground Patrick gets there no longer bleeding while Patrick's gone she to started killing kids after he left. defense wants believe after phone call she heard voice killed children things don't make sense she told Dr. Satoff gets call at fridge getting chicken nuggets dinner heard from Patrick leaving Dawson sitting on couch eating chicken nuggets green beans crime scene photo of two bowls on couch pink one vegetables blue one Patrick saw Dawson eating chicken nuggets green beans why defendant make up say during phone call? if she killed kids of voice compelled against her will like puppet can't get call miss call person back conversation hang up puppet can't decisions choices actions she's controlling she to explain phone call behavior don't make sense if compelled by voice not in control. have phone flights climbed. two flights climbed.Ian Wiffin's report two flights climbed first ends at 5:33 she killed kids in basement up stairs at 5:33 in kitchen getting knife Patrick calls Everything done research telling him get stock he still calls her interrupts her she gets knife goes upstairs top of stairs by 5:38 phone calls from 5:33 to before 5:35 believe voices happened after call killing of kids after between 5:33 and 5:38 she doesn't go down come back up nothing on phone enough time for to bring kids to basement strangle each in three minutes doctors Dr. Lapisado 30 seconds for each child to go unconscious strangulation for one to two minutes to cause death Dr. Lapisado band could stay around necks exercise bands pull resist let go snap back hold them up circles around neck they expanded don't stay around neck pull them weren't knotted Patrick never testified knotted testified didn't clear memory remembered they were possibly looped.asked him tying shoe first loop before bow?" he said "Yeah like that." not knotted not tied memory't best heard him on call had to play call hear him found each kid knew had phone with found each kid voice never sounded like in another room painfully there holding phone not untying knots time to untie short time firefighters looking window him Dawson not untying knot or unlooping see him unwinding motion unwrapping listen to 911 she over limp bodies strangle to two minutes after unconscious weren't knotted tied stay 5:38 she goes upstairs puts phone on bed kills kids everything 5:38 to after 6:00 PM call at 6:09 not enough time between 5:38 and after 6:00 PM to kill three kids get knife take pills cut herself bleed go out of window stop bleeding Patrick get there 20 odd minutes not enough time killed kids soon as he left got call already strangled them didn't tell him didn't ask for help She didn't say God what I done?" She's a nurse didn't try CPR lied stayed calm presented as normal had control over behavior emotions had normal conversation didn't want him home needed to finish plan. had to kill herself why? Defense believe mother good loved kids harm kids unless mentally ill hearing command voices no choice not world we in Dr.Resnick most women kill children do in child abuse mental illness Mothers kill children horrible awful happens why she do it? was depressed exhausted done didn't want to try felt damaged kids were protective factor keeping from ending misery had to remove protective factor not happy had to end misery it was a choice could have kept trying moved down to mother's could killed herself left kids alive choice to take them horrible choice choice she made knew it was wrong sent Patrick out do could conform behavior waited until he gone didn't tell him phone calls didn't call 911 help didn't lock herself in bathroom upon hearing voice. knew it was wrong.She didn't take advantage situation. created situation opportunity wanted woke in hospital knew alive kids weren't knew did wrong felt horrified with tube in throat asking lawyer?" Defense said after surgery delirious records had surgery 27th asking lawyer 26th lawyer?" knows what she did wrong justification excuse of voice voice doesn't make sense she immediately obeyed it Dr.Resnick expert postpartum psychosis teaches psychiatrists psychologists writes books red flag if immediately obeys voice Andrea Yates heard voices to kill children months committed herself five times tried to kill herself twice avoid harming children SPK5: Lindsay Clancy hears his voice one time does doesn't lock herself in bathroom call Patrick 911't leave leaving children alone for 20, 30 minutes not greatest option better than killing doesn't tactics avoid voice obeys. red flag Resnick heard voice one time never heard before't heard since not works red flag making up voice voice told't consistent At hospital says voice said "You kill children kill yourself they suffer without you." tells doctors says last chance kill kids kill yourself." tells chaplain third version kill kids yourself in danger." three different versions red flag doesn't make sense voice says different things voice vague in command doesn't tell how to kill kids where with what says "Kill kids kill yourself." choose where basement how, strangulation with what Exercise band exercise band how to kill herself if compelled by voice no free will body acting on voice why kill yourself same way killed children? strangled hang yourself acting on compulsion no choice. tried three ways none similar to kids.take other quarter explain why superficiality of wounds height of window she didn't take enough pills to kill herself not saying didn't want to kill herself third prong of suicidality Dr. Saathoff talked Remember aloneness feeling burdensome third category capability wanted to kill herself natural instinct to live against took pills toxicologists at therapeutic levels or below except Seroquel, elevated cut herself cuts on meaty arm horizontally No arteries no major blood vessels didn't need neck stitched knew nurse't kill her trying out of window 12, 13 feet landed wrong way paralyzed on frozen ground falling out of 12-foot window kill you not wanted to trying couldn't get over third prong capability of killing herself goes against voice if compelled to do no fight no struggle no resistance to dying third one Dr. Zeizel never told defendant what to say Not witness evidence only person Dr. Zeizel told her make up voice is defense counsel asked brought upnever said in courtroom no witness said asked She knew did wrong could conform behavior to law chose not to didn't expect consequences expected to die with children prove first degree deliberate premeditation extreme atrocity cruelty deliberate premeditation killed died order shows rationality killed Cora Dawson older If tried to strangle they would known bad tried intervene or run hide limited time didn't time to find child ran hid taking Dawson first moving to separate room Cora stay with Callan Dawson go another room rational makes sense ordered thinking didn't show post about Dawson being handful not compliant show bad mom showed proves knew he was handful less likely compliant might struggle made sense rationally to remove separate kill first brought him into room closed door wrapped band around neck squeezed until unconscious blood causing blood vessels burst pain panic confusion defense calls Dr. Laposata wasn't 20 or 30 seconds 5 or 10 seconds until unconscious." how many seconds okay pain panic confusion? okay one second children feel felt up to 30 secondsshe continued strangling limp bodies for two minutes to dead. Deliberate premeditation extreme atrocity cruelty indifference to pain struggle suffering leaving them on floor with bands around necks indifferent had plan strangled pain confusion done by mom hurting killing them extreme atrocity cruelty didn't see them as individual human beings with rights dreams futures three kids Cora wanted to be doctor mom Dawson firefighter Callan never got chance to dream future She killed them left them on floor with bands necks didn't bring them to beds put with favorite stuffed animal cover gently left them discarded on basement floor like broken toys done playing game she is guilty. COURT: Thank you, counsel. members of jury sitting here need short break? return to instructions rereading instructions want something clear ask go back to page six talking about murder in second degree consider defendant's mental condition at time killing including evidence of mental impairment or effect of consumption of prescription drugs in determining elements in murder in second degree charge mentioned others charge in murder of second degree element regarding intent. clear consider defendant's mental condition at time killing including evidence of mental impairment or effect consumption of prescription drugs in determining elements in murder in second degree hope clear things up now general principles this case incorporating instructions earlier before closing arguments presumption of innocence burden of proof. indictments against Ms.Clancy are only accusation not evidence defendant denied guilty of crimes charged law presumes defendant innocent of charges presumption of innocence rule of law compels to find defendant not guilty unless until Commonwealth produces evidence proves defendant guilty beyond reasonable doubt burden of proof never shifts.defendant not required to call witnesses or produce evidence presumed innocent presumption of innocence stays with defendant unless until evidence convinces unanimously jury guilty beyond reasonable doubt requires to find defendant not guilty unless guilt proved beyond reasonable doubt verdict or must be unanimous reasonable doubt burden on Commonwealth to prove defendant guilty of charges proof beyond reasonable doubt? term often used not easily defined Proof beyond not mean proof beyond all possible doubt everything open to doubt charge proved beyond reasonable doubt if after evidence abiding conviction to moral certainty charge true moral certainty highest degree of certainty human affairs based on evidence every person presumed innocent until proved guilty burden of proof on prosecutor If evidence reasonable doubt remaining defendant entitled to benefit of doubt must be acquitted not enough for Commonwealth to establish probability defendant more likely guilty evidence must convince of defendant's guilt to reasonable moral certainty reason in judgment jurors proof beyond a reasonable doubt my function of judge My function as judge see trial conducted fairly efficiently orderly my responsibility to rule on evidence instruct on law your duty as jurors to accept law as stated consider all my instructions not ignore instruction or special attention follow law as I whether agree or not not just I judge every person court for trial is equal subject to same law if jurors apply law different different views parties not treated equally. law I instructing you on is law established by our legislature appellate courts applies to everyone. you must apply law as I instruct Function of jury to determine facts You are sole exclusive judges of facts You determine what evidence to accept important conclusions draw apply law as I to facts to decide whether Commonwealth proven case determine facts solely on fair consideration of evidence be fair impartial not be swayed by prejudice personal likes or dislikes claims defenses decisions rest on facts law instructions influenced by personal likes or dislikes party attorney In courtroom every person is equal entitled to fair impartial verdict in accordance with evidence law.not to decide case based on read or heard outside courtroom exception is observations at view later not to engage in guesswork about unanswered questions or speculate about "real facts" beyond proved evidence consider I said during trial as indication of opinions If I expressed opinion about facts disregard no opinion about facts or verdict solely your duty responsibility function of counsel duty of lawyers to object when other side offered evidence not admissible under law obligation to ask speak me about questions of law law requires me to rule on outside hearing purpose of objections rulings not to keep relevant information draw inference to attorney client for objecting to proposed evidence or asking rulings function responsibility of attorneys what is evidence? decide facts from evidence admitted not suspicion or conjecture evidence consists of testimony of witnesses documents photographs videos received into evidence as exhibits consider observations at view earlier in trial certain documents or photographs entered multiple times not evidence more or less important than other evidence You jurors decide evaluate evidencereviewing documents evidence might find information whited out or redacted because court made legal rulings about evidence relevant case draw negative inference against party based on redactions speculate about information redacted stipulations entered into evidence during trial stipulation is agreement between parties contents stipulation may be accepted as facts relied on with other facts based on evidence quality strength of proof not determined by volume evidence number of witnesses exhibits. weight of evidence strength intending to prove issue stake important Some things during trial not evidence not consider evidence deciding facts question witness never evidence Only answers are evidence if witness agrees with fact proposition fact is evidence if witness disagrees not evidence look elsewhere for evidence not consider answers stricken not evidence opening statement closing arguments of lawyers not evidence assist understanding positions party My instructions said during trial not evidence if memory of testimony differs from attorney's follow your own recollection consider evidence as a whole direct and circumstantial evidence two types of evidence to determine facts in case direct circumstantiallaw allows direct circumstantial evidence in criminal case circumstantial evidence establish guilt beyond reasonable doubt Direct evidence when witness testifies directly about fact sought proved based seen heard felt question believe witness or not Circumstantial evidence when witness can testify directly about fact sought proved presented with evidence other facts asked to draw reasonable inferences several things circumstantial evidence draw inferences conclusions only from facts proved beyond reasonable doubt second rule inferences must be reasonable natural based on common sense good judgment circumstantial evidence not required every inferences conclusions inevitable but each reasonable consistent establish defendant's guilt beyond reasonable doubt Inferences never based on conjecture surmise guesswork assumption evidence direct or circumstantial Commonwealth must prove defendant's guilt beyond reasonable doubt from all evidence credibility of witnesses your duty to decide disputed questions of fact determine which witnesses to believe weight give testimony give testimony each witness degree belief importance sole judges of credibility witnesses if conflicts in testimony your function to resolve determine truthmay believe everything witness or only part or none If not believe witness's testimony disbelief not evidence not happen disbelieve witness means look elsewhere for credible evidence deciding whether to believe witness importance testimony must look at all evidence common sense common sense experience life not what witness says but how witness says might clue to accept witness's version event believable consider witness's appearance demeanor frankness or testifying testimony reasonable or unreasonable probable or improbable opportunity witness to observe facts degree of intelligence witness memory accurate consider motive witness for testifying bias interest in outcome case. about prior inconsistent statements. evaluate testimony witness in court consider earlier statements differ from or contradict in-court testimony earlier statement admitted into evidence for consideration evaluating witness's credibility or believability If determine earlier statement different from witness may decide witness credibility or believability affected adversely or not adversely affected only purpose for use earlier statement not consider earlier statement as evidence or proof of truth of any factflip side prior consistent statements testimony witness may be rehabilitated supported by showing previously made statements consistent with present testimony prior statement admitted into evidence for consideration evaluating credibility witness find prior statement consistent consider statement only in connection with evaluation credence witness present testimony court not consider prior statement as establishing truth of facts defendant's statements to evaluating psychiatrists or psychologists not consider as establishing truth of facts statements as evidence of premeditation extreme atrocity cruelty specific intent to kill statements admissible only relate to doctor's opinion of defendant's mental condition evidence of post-incident conduct evidence suggesting defendant's actions after killings not suggesting facts exclusive domain evidence legal point implicated If Commonwealth proven defendant did these things consider actions indicate feelings consciousness of guilt defendant feelings show defendant's actual guilt of offenses charged not required to draw inferences unless reasonable circumstances case If inferences reasonable up to you to determine importance remember numerous reasons why person not responsible for crimes charged might do things attributed herconduct reflect feelings consciousness of guilt bear in mind person having feelings guilt not necessarily guilty feelings sometimes found in innocent people remember standing alone consciousness of guilt evidence never enough to convict person of crime may not find defendant guilty on evidence alone consider it in deliberations with other evidence at trial about expert witnesses number of expert witnesses in this case term refers to witnesses specialized training experience in particular field Generally witnesses testify only to facts within personal knowledge personally seen heard felt witness specialized training put witness higher level than other treat expert witness just as any other witness may believe all expert testimony, none or no requirement to believe expert because expert up to you to decide accept testimony witness including opinions decide accept facts relied on by expert decide conclusions from expert testimony keep in you alone decide facts If conclude expert's opinion not based on facts may reject testimony orfree to reject testimony opinion of expert witness or if witness's opinion not based on sufficient education experience or motivated by biased interest. Ms.Clancy not testify at trial defendant has right not to testify burden of proof on Commonwealth to prove defendant guilty. not up to defendant to prove innocent. Under system law defendant right to say Commonwealth "You burden of proving your case against me beyond reasonable doubt. to say word defendant testify nothing to do with question guilty or not guilty not draw adverse inference against defendant because not testify not consider discuss deliberations determine whether Commonwealth proved case against defendant based on testimony witnesses exhibits exhibits have all exhibits stipulations in jury room If need to exhibit view court computer available for marking for identification only not evidence not items in jury room not part of evidence marked them so track witness clear record of rulings exhibits introduced in evidence have with you You decide weight they in judgment about Commonwealth proven case not required to believe something because written on paper or in photographnot required to disbelieve it because appears there believe exhibit show weight up to you decide view early in trial drove by sites visited address in Duxbury. referred to as view purpose view was to help understand evidence appreciate location surroundings view part of case observations view may be used considered in deliberations reaching verdict about photographs Commonwealth introduced photographs depicting victims You'll have photographs with during deliberations. images not pleasant verdict not be influenced by images unpleasant or graphic defendant entitled to verdict based on evidence not pity or sympathy for decedents by images Consider exhibits may draw attention to clinical medical status victim's injuries cause of death nature of incident about notes. use of notes notes are aid to memory not precedent over independent recollection facts rely on your own memory not use notes to persuade jurors of accuracy reflections no juror influenced by notes other jurors notes not official or unofficial transcripts use of phones or computers. During deliberations not communicate with or provide information about this case.not use electronic device media computer or phone to communicate information about this case or conduct research until I accept your verdict. clear if question in jury room not allowed to answer other than through exhibits and evidence heard. Nobody use phone to communicate, look.Don't talk while deliberating.Don't look up anything clear before more duty select foreperson of jury foreperson for two purposes. first act as facilitator gather everyone around deliberation table full fair opportunity to speak share views ensure deliberating together group reach verdict second purpose foreperson act as your spokesperson in open court. when ready to return verdict bring you back out group ask remain standing ask foreperson on behalf if reached verdict if go through process verdict reported by foreperson on behalf recorded in case. two roles of foreperson. in case appoint in seat 18, Juror Number 257 as foreperson of jury. members jury if during deliberations have question about law or my instructions law not suggesting do the following.agree on form of question foreperson write on paper give it to court officer bring it to me I'll call lawyers together We'll consider question respond then I'll bring you back in courtroom respond in open court with answer or might write answer down send back to jury room process may cause lag time between ask question sent meet with lawyers decide answer get answer back if continue to deliberating while waiting for response do so. If go further without response stop I'll get response quickly If necessary to communicate during deliberations in writing send me note I'll respond instructed not to talk to anyone else about aspect merits case during deliberations includes staff court officers lawyers witnesses parties family members friends acquaintances communications with court officers just scheduling breaks courtroom don't discuss inside jury room in jury room talk about case only in presence of each other lunch brought suspend deliberations have lunch return to deliberations or work through lunch while deliberating can't have eating lunch separate while deliberating no subcommitteesyou do as a group. do it all together. Now difficult part, reducing sending out jury. we impanel jury at beginning of trial know personal emergency arise during trial require jurors excused from further jury duty. To avoid start trial again impaneled 18 jurors case decided by 12. made decision lengthy case over summer. time to reduce number especially difficult in this case all 18 equally dedicated attended case trial case decided by 12. clerk draw alternate's names all numbers exclusion foreperson draw names randomly for alternates. purpose of alternate for selected during deliberations things happen gets sick or family emergency happens regularly substitute alternate jurors if alternate start all over again. why we do it easier explained "Fate makes you an alternate juror" don't take it personally. Your presence continuing availability if needed is important contribution. court officers make you comfortable while jury deliberates. If alternate juror not discuss this case with anyone while deliberations ongoing nor discuss among fellow alternates need might come up to join in deliberations.words alternate jurors can't have informal deliberations difficult, want to make clear you have to do that or do. ask clerk to reduce jury. CLERK: jurors chosen alternatives. Juror Number 157 seat 11. Number 162 seat 12. Number 385 seat 14. Number 122 seat 6. Number 124 seat 7. Juror Number 245 seat 15. COURT: Thank you forgotten talk about mentioned with foreperson verdict verdict slip verdict slip looks like verdict slip for each count count regarding Cora Clancy,Dawson Clancy Callan Clancy. each box for not guilty not guilty lack of criminal responsibility guilty of murder first degree theory deliberate premeditation extreme atrocity cruelty box guilty of murder second degree box manslaughter reached unanimous verdict foreperson check box applicable decision sign date let court officers know verdict self-explanatory reaching verdict case not easy task conscientious service conscientious approach to duty as jurors suggest respectfully approach mutual respect for opinions fellow jurors disposition to listen to each other Don't change opinion if discussion persuades don't come decision because other jurors feel right decision.It's your decision must decide this case after considered evidence discuss with fellow jurors listen to views You heard same evidence You've with same attention governed by same desire to truth under sanction of same oath took start trial agreed to try issues between parties in accordance to evidence law to submit this case to you you have awesome responsibility believe you bring wisdom judgment conscience in reaching verdict expect decide with integrity principle everyone has feelings assumptions perceptions fears stereotypes implicit biases hidden thoughts impact see hear important decisions important decision encourage to evaluate evidence carefully resist conclusions based on personal likes dislikes generalizations gut feelings prejudices sympathies stereotypes biases law demands just verdict based on evidence individual evaluations reason common sense system of justice counting on you fair decision based on evidence not biases have confidence in what you're confidence in you more dedicated group of jurors in trial You all people of intelligence common sense bringing powerful force to determine truth have great confidence with case in your hands.You're honest thoughtful fair took oath. confident you'll arrive at just verdict. ask seat counsel at sidebar for second then clerks swear in court officers you sent out to deliberate. [02:59:34] COURT: Members jury retire to consider verdict. Thank you. COURT: We be seated. comment unless tried difficult murder this not aware difficult tough emotionally taxing intellectually challenging physically exhausting. commend three counsel for work efforts in this case trial challenging acknowledge thank them for efforts case. before break see counsel exhibits? CLERK: Your Honor present court 12 deliberating jurors 6 alternates in Commonwealth versus Lindsay Clancy. All other parties present. COURT: All right. Thank you, Madam Clerk. CLERK: You're welcome. COURT: bring you in long day excuse till tomorrow morning, 9:00 reiterate instructions deliberating jurors or alternates to deliberate don't read about case Don't talk about case with anyone even home Don't listen to anything put this out of head Come back tomorrow morning We'll start at 9:00 have you come in bring you in ask questions turn have back deliberating thanks everyone excuse you till tomorrow morning. Thank you. COURT: address before tomorrow