Hidden True Crime - “I Feel Like I'm Going to Die” | Lindsay Clancy’s DISTURBING Messages Revealed | Trial Day 11

Episode Date: August 12, 2026

* This episode was recorded live and we are working out some audio issues in a newly redone studio :) Lauren Matthias is here to break down Day 11 of the Lindsay Clancy trial, where jurors heard some of the most alarming evidence yet about Clancy’s deteriorating mental health in the weeks before the deaths of her three children. Psychiatric nurse practitioner Rebecca Jollotta walked jurors through Lindsay’s private messages describing severe insomnia, depression, intrusive thoughts and desperate pleas for help, while detailing a rapidly changing treatment plan involving Ativan, Valium, Seroquel, Prozac and other medications. Jurors also heard when Jollotta began questioning whether Lindsay could be experiencing an underlying bipolar disorder or mixed manic state, when suicidal thoughts escalated, and why a higher level of psychiatric care was ultimately recommended. About Hidden True Crime What started as a simple conversation at their dinner table became a captivating podcast. Join the dynamic duo of Dr. John Matthias, a criminal psychologist, and Lauren Matthias, an investigative journalist, as they delve into the psychological facets of unthinkable crimes every week. Their unique perspectives and in-depth analysis offer a fresh take on true crime storytelling. Thank you for your support through sponsorships, subscribing, listening, and becoming a Patreon member at⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Patreon.com/HiddenTrueCrime⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Learn more about your ad choices. Visit podcastchoices.com/adchoices

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diagonal screen. Don't miss Buick's employee pricing for you event. Visit buick.ca for more details. Hello, hidden gems. Thanks so much for joining us for day 11 of the Lindsay Clancy trial. We're going to go through everything. Today was actually Lindsay's birthday. She turned 36 today. And she sat in court and, you know, interestingly, want to know what is shaping this trial on day 11 more than anything? Take a listen to this. I'm a Massachusetts social worker and I also worked on the exact inpatient unit at McLean for nearly eight years that Lindsay Clancy was a patient at. Very important. I was not there when she was there, but I literally worked there for eight years. We need to correct the misinformation that this prosecutor is saying about McLean and what.

what the stay there is like. Okay. So, yeah, that's a TikTok. That's a TikTok. So let me explain. Because it was before the jury even came in. This morning started with emotions hearing, okay? And in my opinion, this kind of shows how these modern cases are truly,

sincerely being shaped and influenced by social media, more specifically, TikTok. The defense claimed it has spotted a TikTok from a woman who used to work at McLean Hospital. And I should say, I suspect that the TikTok was sent to the defense, which is how they spotted it. I mean, unless Kevin Reddington is scrolling TikTok as he lays down at night, I guess anything's possible. We all need to wind down somehow. You know, we all have different ways to unwind after a stressful day. So who knows?

Maybe he was just scrolling TikTok and it hit his algorithms. Nonetheless, the defense had seen this TikTok. The same one had also been sent to us last week. It was making its rounds where this woman, as you just heard, worked at McLean in the same short-term unit where Lindsay stayed for five days. So Redington wanted to add her all of a sudden to the witness list, this TikToker, as basically a rebuttal witness. who could speak to how that unit actually operated.

So take a listen to this. Your Honor, basically, as the motion speaks for itself, there is a woman, her name is Emily Thorndyke, who's a L.A. CSW here in Massachusetts. She owns and is an independent operator of her own clinical social work establishment called Wise Mind Therapy. Your Honor has her resume. She graduated from Dover Shurban High School,

received the Bachelor of Arts in Sociology from Hartwork College. Master's degree from BC, 2019, is licensed in Massachusetts. And interestingly enough, she did work at the McLean Hospital in the very short-term unit that the doctor was testifying that Lindsay was in for five days in January. of 22 into 23. She worked for five years as a mental health specialist from May of 2014 to May of 2019. She was a clinical social worker manager of that unit

from 2019, 2021. So she's basically got about seven years and seven months of experience working in that unit for a majority of that period of time, full-time employee. and then for one year as a supervisor. She left, as the court is aware from the motion. I vetted her out.

I obviously would be concerned if there's any so-called acts to grind, if you will. Any lawsuits pending? Were you fired? Did you have any difficulties? Any claims for harassment? Hostel workplace? Absolutely nothing. She has friends that are still employees that still work.

at McLean. And I do not know this woman. I have literally never met her. Her involvement in this case came about after one of the prosecutors, I don't recall, which made it out on direct examination that McLean is some kind of a five-star institution where the doctors, the psychiatrist, the psychotherapist, the counselors were all banging into each other in the hallway trying to interview Ms. Clain. who was just blithely refusing care and treatment, which is not the case. Patrick testified as to his observations. The court is aware that Patrick's testimony clearly, in all fours, landed on the fact that it was clear to him that there was no staff that was available other than kids behind

plexiglass on their cell phones. She colored. she took walks. There was no therapy. She didn't speak to any therapists or counselors. So now the jury is left with that image that McLean is

purportedly some kind of a five-star hospital because they're affiliated, quote-unquote, with Harvard, which you from your practice, I'm sure, as I know from my practice, as far from the truth as can be possible, in my opinion. But it doesn't matter what my opinion is.

I could cross-examine. and somebody to the cows come home. It doesn't matter. This woman posted a video on TikTok, which, much like yourself, I'm sure. I hardly know what TikTok is, but I received an email from one of the very, very active people in the community of TikTok saying, look, you've got to check this video out. So I did. This is about a week ago, maybe longer now. When I saw her video saying that she could not stand for, and I quote, the lies and the misrepresentations from that witness stand about McLean Hospital, I then said to my private investigator, Bob Jones, I said, Bob, I can't find this woman because she had a pseudonym name or whatever. He went, we wrote, he called her, left messages, she never got back to us for like three days. He went to her house. He sat out in front of her driveway. She came home from work. they interacted, he waved, didn't want to scare her. And she said, I thought, oh, by the way, I believe that my, actually, my wife had written her a letter as well

because she's a nurse and was trying to reach out to her to have her get in touch with me to no response. She then tells Bob, I thought you guys were all AI. I didn't know that you were real. I thought it was, Am. He then gave me her number. I spoke to her. She told me exactly what I put in the affidavit or in the motion. And she is available, ready, willing, and able to testify to an employee's observations over seven years, including as a supervisor, as to what woeful environment McLean Hospital offers, especially on holidays, such as major holidays like New Year's, which is fine.

We all enjoy New Year's. But nevertheless, New Year's, the day after, that weekend, Monday, nobody was there. And I think it's important to rebut the inference that was created through the examination by the DA. All right, Ms. Brake, let me ask you this. And I'm going to ask the Commonwealth kind of the same thing. What's the relevance? What's the argument for the relevance of what McLean's was at least the – because she wasn't there for about a year. if I looked at the motion.

Is that correct? That's right. Yeah, that's true. She left. She has her own business now, and she left, but it was just a year. Yeah. There's no change in the circumstances from Lindsay going into that hospital on New Year's of 2022 to 23, and this woman's work experience where she left a year before.

And I agree with you. This would have been a non-issue. were it not for the flavor of the government's repeated argument that she was a person who was spurning health care, didn't want health care, had the opportunity and she walked away from the opportunity, which, as I say, is as far from the truth as possible. So I think it is now because of their questioning squarely before the jury to leave that impression. And the woman that was the doctor from McLean was just a pleasure. She was just a lovely, lovely woman and testified as best she could in the case.

But they're left with the impression that McLean is this wonderful place that she just did not have any interest in utilizing what was available to her. That was not available to her. And she's testifying to custom practice and her observations over seven and a half years. Is there another alternative to get there, someone who actually works there? or work there during this time period. It's the time period that a year. One of the things that may, yeah,

but things can change in a year, you know? I don't think so at McLean. I don't know so. I guess that's the question. I don't know so. That would be, that's one of the things I may have to wrestle with, but that's kind of what I was asking whether or not there is, or I understand

the argument. Okay. And I understand the argument regarding relevance. but if we're talking about staffing or the availability of programs and how that work, this witness is a gap there. I guess that's all. I'm wondering if there's another way to get there. So, you know, the realities of trial practice, if you're the government, you send summonses, you have people come to your office, you're interviewing witnesses.

If you're the defense, they run for the hills. For example, one motion I'm bringing with you is merely looking for pediatric records that I have had to have Bob Jones go and try to get them hip-oforms, everything, and they're avoiding us horribly. And I'm going to have a contempt hearing request very shortly. But the point I'm getting at is if they want to reach out to McLean, I'm sure that McLean, administration, would bend over backwards to give them every record that they would need as to how many employees they had what they're working. records were their doctors, their counselors, all available. I know I can't get it. So I'm suggesting to your honor that this is an opportunity for a person who worked there for all those years who does not have any dog in the fight to testify to what her observations were

clearly within her time frame. She left a year before Lindsay went in there on New Year's. So I certainly agree with that. Cross examination. They could get records if they wish, but I think it is relevant. I think it's material, and I think it has to be used to rebut the inference that was raised. All right. Thank you.

Thank you. Yeah. Comel? Your Honor, the Carmel would object to the witness, the late disclosed witness. In addition to the obvious Rule 14 issues, the fact that we didn't have notice of this individual, there's been no discovery other than what's contained in the affidavit and what we could, identify from this woman's TikTok video. There's no report from the investigator who admittedly by counsel has spoken to this witness, this individual. Aside from that, we have a number of other

issues with this witness. One is this isn't somebody that's proposed to be an expert, so they're not relieved, they wouldn't be relieved of a sequestration order, but this woman's TikTok, admittedly, she's been following the trial. She goes on for several minutes in a very long TikTok video where she identifies what she thinks are lies based on her observations of Patrick Clancy's testimony. We have no idea what her thoughts are or what her comments are on the rest of the trial that we assume she's watched based on her comments in this particular video, that she outlines in this video her experiences at McLean and her observations and how they are different from what was portrayed in that particular witness's testimony.

But in the course of this trial, we not only have that particular witness's testimony, we have records from McLean, and the records speak from themselves about what she was offered, what she did, what she declined, what the contact was with each and every person who wrote a note in that record. But this witness, admittedly, wasn't there, had no contact, has no knowledge of the case and of itself. And in this case, Your Honor, we deal with facts. We're presenting facts to the jury. We're not presenting somebody's opinion about what kind of care the defendant's. got during her to stay at McLean. That's not what this trial is about. That's not what it should be

about. And if it wants to play out in the court of public opinion, that's fine, but not inside the walls of these court room. So this person who said that she cares about Lindsay in this video, whether other people do or don't, this person who said that the prosecution of this case is an abomination, this person who said that the health profession needs to be held responsible for their care of the defendant, that's not a witness that presents facts to this jury. And I would also agree that there is a problem with what relevant testimony that she could give. There is no indication that what her experiences were in those seven years up until December of 2021 are exactly the same as they would have been when the defendant was at that short-term unit

at McLean. And the defense had the opportunity to ask that of Dr. Goodhart, and he didn't. Wait a minute. I think she said, I don't know what the staffing was. didn't she say I don't know how many people were on I don't know if it was a skeleton crew she said on that particular

weekend she didn't know what the staffing was but she wasn't asked any... That's the only weekend we're talking about. Right but now he wants to make this an issue about the practices and the common practice of the hospital but that was not a question that was asked of her nor would Your Honor necessarily have

permitted it where he was trying to tailor the testimony to the exchanges with the defendant. So to then have the witness available to answer those questions that was at the facility during that time period and then not to take that opportunity and offer this subsequent witness and call it a rebuttal witness. It's not a fair line of examination. It's not a fair line of rebuttal where she wasn't there during the time period. So we would object for all of those reasons.

I mean, just so everybody knows where it's going. I can't imagine that that witness would be allowed to give her, in a sense, review of McLean's. If it's five-star and she may say it's two-star, you know, this is not TripAdvisor. I wouldn't allow that. And no one in the- But the question seems to be, for me, a closer call about what the- standard staffing and programs may be available on a holiday weekend. Because the Commonwealth's witness said, I don't know that.

And that seems to be something that maybe the parties could come to an agreement about... You know, it's interesting. The judge seems to be leaning towards it, right? Buckingham, who I know that her bow is, of conversation. It was more of a ribbon today, I think, than a bow. Nonetheless, however you feel about it, she pushed back saying that Thorndyke, Emily Thorndyke, still wouldn't be able to answer those questions because she wasn't working there at the time, as many of you pointed out in chat. She wasn't even there at the same time Lindsay was there. She also pointed out that the defense

could have asked Dr. Goodhart more about staffing when she was on the stand or even recall her, right? Dunmore cross-exam. The judge though, as you just saw there, was leaning towards the voir dire of Thorndyke or possibly another witness just to see what information they could actually provide. He encouraged both sides

to think about alternatives, maybe even get staffing records directly from McLean. He made it clear that if he needed to be, if he needed, he would make a ruling, but would rather give everyone a chance to have a solution on their

own. In other words, hey, defense and prosecution, get together and sing kumbaya and you guys figure it out, right? You know, hold hands and come up with a decision. But Redington said that he doesn't think that he and the Commonwealth can agree on anything. So there probably will be no kumbaya, in other words, and he has a point. I don't think that's going to happen, but, you know, nice try judge. He'll probably have to make a ruling. So Buckingham asked the judge to review the McLean Hospital records closely. And maybe I should say for those that are trying to remember, the McLean Hospital, what we're talking about is the inpatient stay Lindsay had.

There are all these questions about how much help she did or didn't receive, whether it was normal protocol or not normal protocol. That's what this TikTok witness rebuttal would be. So they actually showed contact Lindsay had with. the staff and the judge agreed and said he'd review the notes from Dr. Goodhart's testimony, told everyone he'd get them a decision because it's probably not going to happen without the judge making the decision. So they decided to move forward and they scheduled a voir dire and they will go from there. So that wrapped up the motions hearing, TikTok. Yes, TikTok has entered the chat

or the courtroom. And then the jury was brought in. But before we go there, I actually do want to play Emily's TikTok for everyone. It's long. And maybe we won't play the whole thing. But it is really interesting, though, I think. So maybe we will. I wanted to show this TikTok to you last week when we were sent it by a hidden jam. Thank you to the person that sent it. You know who you are. It was really interesting to us. But I felt it was a bit off topic. It wasn't part of the trial. Right. So I was like, I don't know if we should share that. Let's just stick to the trial. Well, now it's literally on the court record. And while they're, the jury may or may not not hear it or hear from Emily. I want to know your guys' thoughts,

whether or not you think this should be allowed in. So welcome to social media in a modern day courtroom, how it is changing things. You do a TikTok and all of a sudden you might be a witness at a murder trial. Take a listen. I'm a Massachusetts social worker and I also worked on the exact inpatient unit at McLean for nearly eight years that Lindsay Clan. was a patient at. Very important. I was not there when she was there, but I literally worked there for eight years. We need to correct the misinformation that this prosecutor is saying about McLean and what the stay there is like. So I'm going to break down everything for you and tell you the truth. Let's preface this with identifying what the prosecutor's approach is with the McLean stay

in particular. The prosecution is trying to say that if Lindsay really wanted to get better, why didn't she engage in treatment more? And then the prosecutor specifically talks about McLean what's offered there and identifies things that Lindsay did not participate in. And we need to correct that. Let me tell you how it actually works. So the first thing the prosecution brings up with Patrick Clancy is that he has stated that he felt like she didn't really get any treatment while she was at McLean. Didn't really see a doctor while she was there.

Now, the prosecutor then says to him, well, are you aware she actually saw a doctor each day and she saw a resident? Are you aware of that? And he says, no, I wasn't under that impression. Let me tell you exactly why that is. In general, there are around 23 patients on the unit at a time. And because of that, there are usually around four to five physicians in charge, we call them, four to five psychiatrists who split up the patients so that there's not just one doctor seeing 23 patients. Each doctor has usually around five to six. They vary a little bit.

But they are limited and that 23 patient population is divided up and it's split amongst doctors. When a patient is admitted to the unit, they are specifically assigned to clinicians. One is a psychiatrist, and the second is the social worker. You are literally told as a patient, this is your treatment team. This is your doctor. This is your social worker. With that being said, legally, every patient needs to be seen at least once a day by a doctor. So on the weekends and on the holidays, when the physicians in charge, the regular physicians

who are working there are off because they work weekday hours. the weekends and on holidays, the patients still need to be seen by a doctor. How that works is that there is one doctor who comes on the weekend in holidays and he or she sees every single patient on the unit. Okay? And if you think about it, there's a reason that the doctors who are there during the week are only assigned four to five patients because you cannot spend a long amount of time as a doctor with 23 different patients. So the job of the weekend doctor, as we call them, the holiday doctor, is literally to just go quickly check in with every patient. It is not a lengthy meeting by any means. So this idea of the prosecution saying, well, she actually did see a

doctor. So that was kind of a lie. She saw a doctor. She didn't see her doctor. Now, moving on to the next part. The prosecutor also says to Patrick Clancy, well, are you aware that there is actually one-on-one therapy offered on the unit every day? This is what really pissed me off. There is absolutely no one-on-one therapy offered on that unit. What this prosecutor is referring to is what we literally call check-ins. And you know who does those check-ins? It is unlicensed individuals. This is a job where you only have to have a high school degree to get it.

And I can say this because I did that job for five years. I was the clinician who was performing one-on-one therapy in her mind. No, I was doing check-ins. I did that job. So I promise you, this was not one-on-one therapy. I love my coworkers, and this is no disrespect to them. We were not people who were licensed or qualified in any way to give therapy, and we did not. And within these check-ins, I'm going to tell you what the conversations are. How's your day? How do you sleep? Have you been able to eat today? Have you been able to go to groups? What's your treatment plan? Have you talked to your family? What's your doctor saying?

There are brief questions at the end where we say, are you feeling safe? They aren't safety assessments. Let's be honest. You do check that little box, but I'm telling you, that's the line of questioning. It is not one-on-one therapy. Now, let's talk about something the prosecutor brought up today. She brings up and tells Patrick Clancy, you know, are you aware that, you know, Lindsay was also checked on every 15 minutes by staff? Let me tell you what she's referring to. We literally call this checks, okay? And it's when we would go around on the unit, every 15 minutes, staff has to go around and go around the unit. And you know what your job is on 15-minute checks? You make sure everybody's alive. You make sure everybody's not, you know, people try to commit suicide on the unit. And the 15-minute checks is not

conversations. We're going around and we're literally checking off on a board we saw this person. You put a check, you put an A if they're in bed, awake, and you put an S if they're asleep. And you put an O if they're off the unit. That's it. You're just going around. This isn't like check-ins. You're just visually putting eyes on them to legally indicate that they are okay. But this is not a check-in. It's just, hello, I see you. So another thing the prosecutor brings up today. And again, I think this is from the idea of like, clearly Lindsay was well enough. Um, she brings up how, you know, are you aware that Lindsay was granted permission to, you know, go off the unit, like go outside, right? And Patrick's like, well, yeah, I was aware like she went for a

walk and the prosecutor is kind of like, so she was allowed to go out. And again, I think she's trying to be like, if she was allowed to go outside, clearly she was okay. And I'm going to tell you guys something. 75% of the patients who are admitted to the unit, um, within two days, get granted that. permission. Sometimes it's the day they get there. Um, the only patients who don't get granted that permission and especially quickly are the ones who are acute safety concerns. Those are patients who can't, um, be trusted in a sense to not try to harm themselves if they leave the unit. There are patients who are flight risks and they can't be granted the permission to go off the unit. So this idea of like, well, Lindsay was granted that permission. It really doesn't have much meaning because if I'm being

honest, everybody is granted that position unless you are really active. doing something to yourself. So like this isn't that deep. Now the prosecution starts talking about the discharge piece at McLean. And it does sound like Lindsay asked to be discharged. And the obvious thing to like think about is like, why would she want to stay on the unit any longer when she's not getting any help? It, it is logical to ask to be discharged. And she was discharged, you know, she wanted to go to one of her children's birthday parties. And her asking to discharge to be able to go to her kid's birthday is a completely normal thing that people get discharged for. birthdays, graduations, funerals, bigger events that people want to be a part of that is good for them to be a part of.

If the person is deemed safe, which I'll get back to, the team is usually happy to allow that. So her asking to be discharged for her kid's birthday is not abnormal. It's very normal. And I also think it is indicative of her wanting to be a mom, which, you know, is the opposite of what this prosecution is trying to say. All right. Now, my last and most important part, Even though Lindsay asked for discharge, and it was granted, McLean failed her. These outpatient, I'm sorry, Dr. Jennifer Tufts. I mean, I'll say, we know the name, but I think that woman needs to lose her license. I'm going to be straight up.

McLean needs to be held accountable. They did clearly not do their proper assessment when they granted her discharge. I'm going to be straight up, okay? And I'm going to say that as somebody who's worked on that unit and had to approve discharge. You are a well-trained mental health professional. You know when you are assessing a woman with postpartum mental health, you need to be doing a damn good job of making sure that she's not going to go hurt her kids because of where she's at and her mental health. And I don't think McLean did a proper assessment. I don't think they asked

any questions about the kids. A lot of times when you're discharging from this unit, it's about are you going to go hurt yourself? And she was suicidal. So she should have had a suicide assessment. But knowing that this is postpartum, I do believe that McLean failed her by not doing a better assessment about where she was at with her kids. I don't care that I worked there. I don't care that I respect the hospital. I respect a lot of the clinicians there, but no, no program is immune from clinicians who aren't doing their job properly. And her asking to discharge, it's on the clinicians. They let her go. We are held to a specific criteria to let patients go. They failed her. I know this is a long-ass video, but I felt it important to give like literally firsthand perspective. I'm watching

this case, listening to this prosecutor just lie and gaslight. And I'm like, I'm enraged at the lies that you're telling. I mean, in general, but specifically at McLean, I'm like, I know that what you're saying isn't fucking true because I did it. I was there for eight years on that exact unit. Like I said, how are there two female prosecutors prosecuting this case? It's beyond me. It's sickening. It's traumatizing. This woman doesn't want to be alive. And all that this case is doing is further traumatizing. If you guys don't care about Lindsay, fine. I do, but let's look at the other people. This is traumatizing Patrick Clancy further. This is traumatizing an entire jury.

Can you imagine? These are just civilians doing their, you know, civilian duties and doing jury duty. And there's such a thing as vicarious trauma. And that's when you're traumatized by somebody else's trauma. And this shit is dark. The prosecutors need to show these onesies and we know the kids are not here anymore. All it is is like torturing, you know, this family over and over again. And I think it's abomination.

I think it is awful. And I don't know how these prosecutors sleep at night, if I'm honest. The only positive reframe I can think is that this better be a marker in history. Shit needs to change with women's mental health. And I think everybody's waking up with this. I know there's a lot of people who are just kind of assholes and they're just like, she's a monster. But I've seen a lot of a switch of people being like, what the fuck? So these health care, you know,

clinicians need to be held responsible. It's them at the end of the day. And this is a fucking tragedy. So, by the way, hopefully our mic, we tried cords, we tried routers. We don't know what's going on. So we hope that we get through this today with our mic. Well, as, as Emily put it, she made a long ass TikTok, her words, not mine. So everybody remember when you do a long ass TikTok, it could show up. I don't, a murder trial. That's real. That's real. So she certainly is opinionated and you guys can probably also see after listening to that entire

TikTok why the prosecution and the defense are not going to get together and seeing kumbaya and make a decision. The first witness was the continuation of yesterday. It was it was Julie Paul. Remember Julie Paul treated Lindsay and was referred by Lindsay's mother-in-law. So this time, though, she's up for cross-examination with Reddington. And Reddington, so we're wondering, right, he almost cross-examined Dr. Toffs for an entire day. It was brutal, right?

So I'm holding my breath, like, what's he going to do? Cross-examination's up with Julie. Julie is now working and living in New Hampshire and walked through the basics of her job. She explained that she still worked in the same field, supporting pregnant and postpartum women. So Reddington made a point of acknowledging how dedicated she was to that work. And she agreed. He asked her how she first became involved with Lindsay. And Julie explained again that it started through a personal connection.

That would be Patrick's mother, Lindsay's mother-in-law, ex-mother-in-law. Patrick's mother, Sue, had a friend who knew Julie. And Sue asked that friend to reach out. Julie stepped in from there. So we're all holding our breath, right? What's Redington going to do to Julie? Well, Redington noted that she treated Lindsay with care and professionalism. And then, and Julie thanked him.

And then he moved quickly after that. He offered the South Shore health records into evidence, which the judge admitted. He thanked her for her care. She said thank you. And then after that, he offered the South Shore health records. Put those in evidence, right? The judge admitted. And then there was this one last detail.

Julie had even given Lindsay her cell phone number. So it was very personal. Reddington ended the cross right there telling her again, thank you very much for your care, end quote. And there was no redirect. That was it. That was it. Yeah.

So like compare that to Dr. Tufts to Julie this morning, very different. So there you go. That was it. And it was the next witness. Next witness. So then the Commonwealth called their next witness, and it was Rebecca Jalada. Rebecca introduced herself as a psychiatric nurse practitioner. Buckingham went through her education, a bachelor's degree from Yukon, a master's in counseling

psychology from William James College, then nursing school, followed by her MSN in 2019. She explained that she had worked in the range of mental health settings, detail. talks at patient therapy, DMH respite programs before becoming a psychiatric nurse practitioner. She said she had been working at South Shore Health since 2021. And when Buckingham asked how she ended up in the perinatal clinic, Rebecca explained that she had been interested in women's mental health and had been pursuing specialized training. She completed the postpartum support international certification, including a two-day training and a third day focused on psychopharmacology,

and then passed the exam and became fully certified. So Shannon Buckingham had described the clinic itself, and Rebecca said that the program served women who were pregnant or up to two years postpartum. They offered medication management, counseling, and support for a wide range of psychiatric conditions, postpartum depression, anxiety, psychosis, bipolar. panic disorder, OCD. She mentioned that she had treated about five women with postpartum psychosis

over the past five years and hundreds, hundreds with postpartum depression and anxiety. She explained that the clinic often collaborated with community providers and regularly referred patients to higher levels of care when needed. Medication management was a major part of her and she walked through the training required to prescribe, advanced pharmacology, health assessment, certification exams, DEA licensure, controlled substance licensure, advanced practice, nursing, licensing. She confirmed that she held all of those credentials. So then Shannon Buckingham then wanted to talk about the social workers in the clinic.

And Rebecca said they provided short-term counseling during the postpartum period. She explained why the clinic treated women up to two years postpartum. Symptoms sometimes emerged later and it could take time to stabilize someone. So then Buckingham brought the focus to Lindsay specifically. Rebecca said she became involved because Julie Paul was leaving clinic in December 2020 and wanted someone to take over Lindsay's care. So at that time, there were three nurse practitioners in the clinic, including Julie. The other was Andrea Warden, who had only worked to take over Lindsay's care.

two days a week. So Rebecca was the most available to take Lindsay on. Rebecca recalled her first contact with Lindsay that was November 29th, 2022. It was a virtual visit. She explained that the clinic usually did initial assessments in person, but follow-ups could be virtual or in person depending on the patient's needs and preferences. She had seen Lindsay in person at least once, but that first meeting was online. She already knew that Julie had done the intake and had reviewed the records. She was aware that Lindsay had been in the South Shore ER on November 16th, had been prescribed tracodone, and was reporting significant, significant sleep issues. She also knew Julie had started Lindsay on Prozac and then changed the medication plan.

So when Buckingham asked what Lindsay reported during that November 29th appointment, Rebecca asked to refer to her notes. She explained that Lindsay had been taking Mertazepine or Remmeron for four nights. Lindsay wasn't noticing much improvement yet in mood, in anxiety, or sleep. She described sleeping for two hours, then being awake for three and needing at a van to fall back asleep. Rebecca said she wasn't surprised that Lindsay hadn't felt much change yet because Remeron does often take time.

She went on to describe the medication. Remeron was a norogeneric and specific seroton, I don't know, it's a specific antidepressant. It works on serotonin, alpha receptors related to adrenaline, and histamine receptors, which made it sort of sedating, he gave it a sedating quality. She said it was a good fit for someone dealing with depression, anxiety, insomnia, and decreased appetite. rebecca noted lindsay's weight loss we keep hearing about lindsay's weight loss so allegedly she went from around 130 pounds at her PCP visit in october to 124 pounds when she went to the er on november 16th that's a lot of weight to drop by the way she's five six five six so she went from

one 30 to 124 in less than a month Lindsay had reported decreased appetite wasn't sleeping was very anxious. Then they went through the details of the November 29th appointment. The focus stayed on Remmeron and how it worked, how long it usually took to show results and what Lindsay had been reporting in those early days. So Rebecca explained that it was not a quick fix. She usually told patients it could take four to six weeks at a stable dose before you really understood its full effect. Sometimes people notice small improvements in the first couple of weeks, but the real benefit often took a month or more. She already knew Lindsay had been described feeling disoriented, feeling forgetful, disconnected from her body, and anxious about whether she'd sleep at all.

Those concerns had come in before the appointment. She also knew that one of the nurses had advised Lindsay on November 28th to increase the Remmeron, and alongside that, the clinic had recommended adding cognitive behavioral therapy, and by the time Rebecca met with her on the 29th, she still hadn't met with the clinic social worker, wasn't engaged in any therapy or cognitive behavioral therapy. Rebecca talked about how she addressed the medication concerns. She reminded Lindsay that this medication needed time. Four days wasn't enough to judge it. She encouraged her to keep going with it. But she also offered other options. So while she said keep going with it, she threw out some other options. Julie had already tried a low dose of Ambien. So Rebecca suggested

trying 10 milligrams or even the controlled release version. She explained how that formulation worked. The outer layer helped you fall asleep and the inner layer kept you asleep through the night. She thought it might help while they waited for the Remeron to kick in, right? Again, it takes time. Lindsay did not want Ambien, but Rebecca couldn't recall her reasoning for not wanting Ambien. This is a sleep aid. So then they moved on to benzodiazepines. Lindsay had concerns, about those two, she brought up rebound anxiety. And Rebecca confirmed that was a very real clinical term, rebound anxiety. So Lindsay worried that once Ativan wore off her anxiety would spike above baseline. She also feared becoming physically dependent because she needed it several nights in a

row. Rebecca tried another option, hydroxazine. It was not a benz-o. It did not carry the same risks, and it could help with sleep. Lindsay didn't want that either. Her preference was to stay with Remmeron at 15 milligrams and continue using Atavanas needed. Rebecca said the conversation was collaborative. They worked together. She assessed Lindsay's ability to make informed decisions and felt she was capable of engaging in that process. So when a patient declined one option, Rebecca offered alternatives. Ultimately, the patient chose the regimen.

So then Shannon Buckingham, Commonwealth, asked her about situation. where a patient might not have the capacity to make decisions. Rebecca explained that in those cases, they might involve legal or ethic teams consider a health care proxy or evaluate competency. So if someone presented a serious risk to themselves or others, the response depended on whether they had decision-making capacity. She also described the mental status screening she performed. but gave her objective data on speech, appearance, thought process, thought content. So then on November 29th, she didn't see any manic symptoms. She ran through the dig fast, which went over distractibility, pressured speech, grandiosity,

decreased need for sleep, increased goal-directed activity. None of that appeared. She also looked for psychosis. Sometimes it showed up subtly. Sometimes someone was responding to like an internal stimuli, guarded behavior, delusional thinking. She asked directly, very specifically about hallucinations. Hallucinations. This is important.

Lindsay didn't display, according to her, any psychotic symptoms. So Rebecca screened for suicidal and homoic homoic. Homicidality, suicidality, homicidality, and Lindsay denied both. She did not report any issue, suicidal or homicidal thoughts. Her mood appeared anxious, and her affect matched that. Her thought process was linear and goal directed. She understood why she was there. Rebecca also used the Edingberg scale that was brought up with Dr. Tufts.

Dr. Tufts didn't use it. Rebecca did the Eatingberg scale and the generalized anxiety scale. Lindsay scored a 17 out of 30 on the eating berg, which meant moderate to severe postpartum depression. So it did not mean severe, moderate to severe. On the anxiety scale, she scored 14 out of 21, which is moderately severe anxiety. The appointment lasted about 30 minutes. Rebecca's plan was to continue.

The Remron at 15 milligrams nightly, continue atavana's needed, and add non-medication strategies again, mindfulness, therapy, physical activity, meditation. She knew exercise had helped Lindsay after Dawson's birth. Rebecca encouraged her to use my chart for non-emergency communication. She scheduled Lindsay for another visit in one week, which is typically for a new patient with active symptoms. she also knew Lindsay had an appointment with the clinic's social worker Letitia Dukes on December 2nd. And the next day, November 30th, Lindsay messaged her.

Rebecca confirmed that she received the message at 11 a.m. Lindsay asked if it would be safe to stop Remmeron after five nights. She said her depression felt much, much worse. She wasn't sleeping and she'd only gotten two hours of sleep. She asked Rebecca to call her. So Rebecca messaged back because she was between patients. and she also had a nurse call Lindsay. She asked Lindsay what symptoms had worsened.

And since Lindsay had not given specific, she definitely wanted to ask and she was clearly very concerned. Rebecca explained that she was concerned about stopping Remmeron so quickly. She pointed out that Lindsay had already had short trials of Zoloft, Trazadone, and now Remmeron. She reminded her that antidepressants often needed four to six weeks to work. So even so, Rebecca offered an alternative. wanted to build a therapeutic relationship and Lindsay clearly dislikes this medication. So if a patient didn't want to take a medication, there was no guarantee they'd actually take it.

So Rebecca suggested retrying Prozac. Lindsay had taken it years earlier in nursing school and tolerated it for a year. Rebecca thought it might be worth revisiting even though Lindsay had recently reported feeling disconnected on it and Julie had told her to stop. Rebecca also suggested pairing Prozac with Syriquil at 25 milligrams. She explained that at low doses, Syracquil helped postpartum women's sleep. It wasn't being used as an antipsychotic here, even though it is wrong, just as a third-line sleep option after Trasadone and Remmeron had not worked. So by the end of the message exchange, Rebecca laid out two paths, which were, continue, Remmeron for another 10 days or restart Prozac,

and adds Syracool nightly for anxiety and insomnia. So at that point, at this point, the testimony turns into a detailed walkthrough of how Rebecca tried to manage Lindsay's symptoms while balancing Lindsay's fears about certain drugs. So Buckingham asks whether Rebecca was recommending all three medications at once, Remmeron, Prozac, and Cyracil. She said, yes, she was, all of them. She explained that paring medications was common in psychiatric. psychiatric care. Her thinking at that moment was that Rimron and Prozac together could target the depression and anxiety while Syracquil could help with sleep. She also wanted to address Lindsay's fear of becoming dependent on benzodiazepines. Rebecca talked about how she encouraged

Lindsay to help track her symptoms. She had noticed Lindsay was attributing everything, almost everything, almost everything, that she felt to whatever medication she happened to be taken that day. I felt that was a really important part of this testimony, that Lindsay was attributing almost everything she felt to whatever medication she happened to be taking that day. So she sent her two mood charts through my chart, one daily, one weekly. They asked the patients to rate their mood, to note medication doses, track sleep hours, anxiety levels, irritability. Rebecca wanted data, right? Something concrete to compare over time. She didn't know Lindsay had already been tracking things on her own. So messages kept coming in

throughout November 30th. Lindsay had reached out at 11 a.m. Rebecca responded at 11.52. And another message came in at 1215. I mean, she's really reaching out. Rebecca had asked specifically about suicidal symptoms because Lindsay had mentioned worsening depression, right? And now she's messaging and calling. She explained. that these sort of self-harm thoughts could be part of depression and that she needed to assess that before advising any medication changes. So in that 1215 message, Lindsay told her, I'm not at the point of being suicidal. That's a quote. I'm not at the point. But she added, quote, I'm really feeling as if I can't go on like this, end quote. Those are really contradictory, right?

I am not at the point of being suicidal, but then she adds, I'm really feeling as if I can't go on like this, what certainly implies, you know, what she just said she wasn't feeling yet. She asked Rebecca to call in the Syracille. Rebecca took that as a sign that she was willing to try the alternative. So more messages followed. At 1229, Lindsay asked again for a phone call, right? I mean, she's really reaching out. Rebecca could not call because she was between patients, so she continued messaging and had her nurse reach out.

Lindsay sent another message at 1258 describing the worsening depression. This is what she said, quote, feeling completely hopeless and unmotivated to do anything at all. She also said she printed the daily mood chart and would start using it. Rebecca confirmed that the nurse called Lindsay around 3.10 p.m. Lindsay agreed to the plan and said she would pick up the Syracul. The next scheduled appointment was still a week away, but the MyChart messages continued into December 1st. At 12.20 p.m., Lindsay wrote a long message saying she didn't like how she felt on the Remmeron and she could not stick with it. It just was impossible.

She's feeling really clearly not good. She just cannot stick with this, no matter how much Rebecca encouraged her. She said she started having intrusive thoughts that she had never had before. Boom. So at that moment, she's clearly scared. She cannot continue with this remerone. She's having intrusive thoughts that she had never had before. She told Rebecca, she didn't take Remmeron the night before and wanted to go back to Julie's original plan, Prozac in the morning, Ativan, and Benadryl at night. And she asked, quote, please let me know if you agree with this plan.

Rebecca also knew Lindsay had reached out to her primary care office that same day asking for an immediate appointment to discuss medications. The office found her in emergency slot, but Lindsay didn't respond to their messages in time to actually go to this emergency slot. Rebecca replied with a detailed message explaining postpartum depression and anxiety, onset, risk factors. predictors, common symptoms. She highlighted that intrusive thoughts were common in postpartum depression and anxiety. She asked whether Lindsay had taken the syracill and whether it helped with sleep or anxiety. She also reiterated that she still wanted Lindsay to give Remmeron more time. So she's still encouraging, like, don't give up. She explained that she didn't yet have enough data to know whether the symptoms were tied to the medication, right? She's saying that Lindsay is tying

everything to the medication. While Rebecca is looking for more data to really find out, is it the medication or is it Lindsay? Lindsay responded at 2.36 p.m. She thanked Rebecca for the information and said it was helpful. She admitted that she had panicked the night before and taken Ativan and Penadryl instead, but she promised, quote, tonight I'll stick with the plan and try the 15 of Remeron and the 25 of Syracul. And quote, Rebecca reassured her again and sent a long message with common questions and answers about medications. How long they take to work, typical side effects, risks, what to expect. She wanted Lindsay to feel informed rather than scared. Lindsay had always been someone who asked questions and absorbed information, so Rebecca leaned

into that. Rebecca also told her about two books the clinic offered. We've seen one of these books in evidence. Remember this book? Good moms have scary thoughts. That book was in her bookshelf, as well as the pregnancy and postpartum anxiety workbook. She said Lindsay could pick them up when she came in for her canceling appointment with Letitia the next day. So messages continued until about 4.37 p.m. Lindsay confirmed that she'd be in the clinic on December 2nd and would grab the books then. December 2nd arrived. Rebecca did not have an appointment with Lindsay that day, but she knew Lindsay was seeing Letitius in person, even so the MyChart messages started early at 7.51 a.m., Lindsay wrote, I took the 15 Remmeron and 25th Cyracul.

I woke up at 12 with horribly intrusive thoughts of wanting it to all be over. I woke up at 12 with horribly intrusive thoughts of wanting it to be all over, end quote. She said that she took one milligram of Ativan, went back to sleep, and the thoughts went away. So the Ativan helped. She told Rebecca that she needed to explore whether she was addicted to Ativan and asked to speak with someone in the substance use clinic. Rebecca responded at 8.51. She told Lindsay that she understood the concern about benzodiazepine tolerance and she

didn't want that for her patients. She explained, though, that Benzos had a place in the acute. phase of treatment and could be tapered later. She suggested trying 50 milligrams of syracoyle that night instead of 25. She reassured her again about intrusive thoughts. Quote, very painful to think and experience. That's an end quote, but common in postpartum depression and anxiety. Lindsay wrote back at 904, and let's listen to this. And so at 904 on December 14, on December, second. There's a response from Lindsay Clancy. I'm willing to try anything. I just keep coming back to the feeling that I'm dependent on Ativan after my two and a half weeks of taking it daily with Benadryl,

following the bad reaction to Zoloft. I feel addicted to it and I feel like I'm not being heard that that is a possibility. I feel like we are throwing all these different meds at my insomnia. When the root cause is Ativan dependence, I don't feel any of the anxious thoughts I had before. I feel completely numb. So you got that message from her at 904, correct? I did. And what was your concern when you got that message, or did you have any concern? I wouldn't say had concern.

I just wanted to, again, provide her some information about what I thought might be happening. Based on your training experience, is a psychiatric nurse. She didn't finish her answer. please okay yeah i was finished okay well she's finished next question based on your training and experience as a psychiatric nurse um and you said you had some experience with substance use um did you feel that there was a dependency issue or an addiction issue with adivan i did not um is it fairly common that adivan is going to make somebody feel better if they're feeling anxious yes that's why you take it right yes um and that's why you take it as needed

Is that fair to say? Yes. So in your response to her at 937, do you make clear to her the difference between dependence and addiction? I do. Okay. And as far as benzodiazepines go, there is a real concern for dependence and addiction in the fields.

Is that fair to say? Yes. But based on taking it for two and a half weeks, taking it to address actual. symptoms of anxiety, did you have a concern of dependence? No. And so did you articulate to her that anything about that concept of dependence versus addiction? What did you say?

I said, I wonder if you fear you're becoming dependent on the benzodiazepines and there's a subtle difference between dependence and addiction. With addiction, there's a change in behavior caused by biochemical changes in the brain after continued substance abuse. The substance use becomes the main priority of the. person with a substance use disorder, regardless of the harm it causes to themselves or others. With dependence, we're referring to physical dependence on a substance characterized by symptoms of tolerance. I'm sorry, characterized by symptoms of tolerance and withdrawal.

Benzodiazepine withdrawal is similar to alcohol withdrawal symptoms. We would be seeing things like elevated vital signs, high blood pressure, tachycardia, diapheresis, mild alteration of mental status, initially with a possibility. of perceptual disturbances, delirium, dysphoria, and tremors. Did the insomnia predate the Ativan use? I hear your concerns about the benzos. So my recommendation is do not take them every night. I recommend taking only every other night and then we will not refill it.

And so what's diaphoresis? Sweating. Okay. And in the fields of the field of, fields of prescribing psychiatric medications. Do you often have to deal with physical dependency and then addressing it later? I wouldn't say often. Is there a way to address that as far? Absolutely, yeah. And so that wasn't a concern of yours regarding at a van, was it? Not at that time. And what about her statement about not being?

heard. Did you see that in her message where she says, I feel like I'm not being heard about addiction? That being a possibility. As a psychiatric nurse practitioner dealing in psychiatric medicine, is it important to you when a patient tells you that I don't feel I'm heard? Yes. And do you take that in consideration when addressing them and continuing to build that relationship? Yes. And so in this case with the defendant, with Lindsay Clancy, did that change your approach with her at all? It's why I sent the message that I did try and explain what addiction versus dependence intolerance is.

And I wanted to reassure her that we will try to have you take these less frequently and we don't need to continue them moving forward. So she advocated for herself and you took that into consideration. and created an alternative plan or suggested an alternative plan. Yes. Did your care of her change at all when she told you she wasn't being heard? I wouldn't say it changed. You treated her as you would any other patient, right? Correct.

Now, you continue to have messages with her throughout that day. Is that fair to say? Yes. And so at 1002, you receive a message. message from her. She says the insomnia started from the Zoloft, but then after the two weeks of daily Adavan and Benadryl use, that's when the insomnia was at its worst. I've tried so many different sleeping aids at this point, Trazidone, Ambien, Remmeron, Seraquil, and they all seem to barely touch the sleep until I take Ativan with them. So tonight I will try 15 of Remmeron with 50

of Seraquil. I fear that if I wake up in the middle of the night with intrusive thoughts again, I will feel like I need Ataban. Do you recall her sending that message at 1002? I do. And that she sent another message, she's kind of cut off, but it's still within the 10 o'clock hour, where she adds, I also just feel, I also just feel concerningly numb right now. Like I have no emotion whatsoever. I feel like I'm going to die and I don't care. What do I do about this?

I do recall that message, yes. And this is a message that she sent when she would have been or have seen. Leticia Dukes already, right? If she had a 9 o'clock appointment? Yes. When she sent that message to you, did you respond back to her at 1135? I did. And with the fact that she talked about being numb and having no emotions,

feel like I'm going to die and don't care, what did you do? I said this sounds like depression and an hedonia symptoms. I would say if you're feeling unsafe, particularly as we head into the weekend, It is important for you to have information for psych emergency services available to you. And I provided a list of the 24-hour emergency service programs like mobile crisis intervention. Okay. And when you say an hedonia, excuse me, if I mispronounced that, what does that mean? Anhedonia is a symptom of depression where people are unable to feel pleasure. They might describe it as feeling numb. They're unable to look forward to things.

things. And in her message where she says, I feel like I'm going to die and I don't care, did you take that as a suicidal thought or suicidal ideation? No. And so did you tell her to go to the ER right away? No. Did you have concerns that she needed to get a higher level of care at that moment when she sent that message? My concern about that statement was that I wanted her to have access to resources if it escalated or if she, if it were so. So I made sure she had it. Okay. And fair to say you also, at the end of that message indicates,

are you able to get rest or reach out to your support system so that you can be helpful, so they can be helpful to you right now and that this is hugely important? I did say that, yes. And 1141 a.m. She responds, yes, I have support. My parents are here to help. And again, this is 12.2. Does this sound like side effects to Remmeran or Sarahquil?

I have never felt like anything like, I have never felt anything like, I have never felt anything like this before. And then 1157, she sends another message. Do you think over time these symptoms will go away over time? 12.4. Another message from her is that there any chance you could give me a call to discuss when you have a minute at 12.10 p.m. And just to confirm, your recommendation for tonight is 15 Remmeron, 50 Syracul, and avoid at a van, even if I'm not sleeping.

So you got those messages in succession, right? I did. And were you able to eventually respond to her with a phone call? I responded to the message at 12, 12 p.m. I wrote it down for her. And again, in your response to her, did you reiterate that these are pretty common signs of depression and that what she was expressing to you wasn't uncommon in women with postpartum depression? Correct.

I said it sounds more like depression than side effects. It's not uncommon for me to hear. I've never felt anything like this before or I just don't feel like myself. All of this sounds like postpartum depression. And did you further try to give her some encouraging words? I shared a passage from a book called This Isn't What I Expected. And is that book kind of centered around postpartum depression? Yes.

And did you also tell her this is going to get better? I said even though they feel terrible, remember that there are symptoms of an illness that is very real and very treatable. This is going to get better. And after that message on 1212, did you in fact send her another message? I did. And fair to say that next message was to kind of address the concern about her question, what to take. Yes. And you confirmed to take 15 milligrams, Remeron, 10 milligrams, Prozac, and 3.5.

50 milligram serriquil. Yes. And that taking Ativan every other day might help. I said, I would say taking Ativan every other day might help you to see you are not addicted, as one cannot be addicted to something they don't take every day. But we can also decide to let me be concerned about whether you have a problem with the Ativan and simply take it nightly for now. And if I have concerns about your use of it, I will make them apparent to you. My primary concern at this time is that you sleep. And if that means taking the ad-of-van for middle-of-the-night wake-ups, that is what it means. I'm confident we can safely and successfully get you off at-a-van in the near future. And then I also go on to make recommendations about if she does have trouble in the middle of the night,

certain sleep hygiene techniques that she could do, like getting out of bed and doing something non-stimulating, and then go back down to try to sleep again when you feel drowsy. So an alternative to medication intervention. Yeah. And then at 1.40 p.m., she responds, thank you. I'll stick with that plan. I really hope it works and to feel like myself soon, right? Yes.

And then at 2.35, you respond. We will follow you closely. We have lots of alternatives. If this for some reason isn't the combination, we'll find one that gets you back to feeling like yourself. I did say that, yes. In all your treatment of women, the women that you've treated with postpartum depression, is this common that you have to kind of trial different plans in order to find the right one?

Yes. The judge then called for the morning break. Yeah, we're only to the morning break. A lot happened today. So I hope you guys are getting comfortable and have your snacks. After the break, Buckingham continued going into. to the MyChart exchanges, starting back with December 2nd, the last message Rebecca had sent to Lindsay that afternoon. And then she moved to December 3rd. Rebecca remembered that message very

clearly. Lindsay had written at 7.24 p.m. saying she didn't want to wait to tell Rebecca what was fresh in her mind. She explained that she hadn't taken out of Ann the night before. Her last dose had been at 1 a.m. the previous night. She slept for about four hours and then dozed. for another 45 minutes. She said, quote, today all day I had horrible, intrusive thoughts and felt deeply depressed. I finally took a 0.5 of Ativan at 6 p.m. And now the thoughts are gone and I feel good.

End quote. So Rebecca confirmed that she'd seen that message. And after that, there was silence between them until December 6th. December 3rd had been a Saturday and Rebecca was out sick for the 5th. So she knew that Lindsay had reached out to the office that day. and the nurse had told her Rebecca was out. Lindsay said that she'd just reschedule and switch her appointment with the clinic's social worker, Letitia Dukes, to virtual.

So when Rebecca returned on December 6th, she had an in-person appointment scheduled with Lindsay. Even though the note had a line about verbal consent for a video visit, she explained that those lines sometimes auto-populate. The visit was definitely in-person, she states. Lindsay did not come alone either. Patrick came with her. Okay. So Rebecca had not met him before and had not spoken to him. She explained that she did sometimes speak with collateral sources. That means people that know the patient, but only with the patient's permission. So up until this point, she had not felt the need to ask for that. Lindsay hadn't mentioned wanting to bring him,

but Rebecca welcomed the additional perspective, her husband. They went, through the usual structure, history, current symptoms, mental status exam screenings. Lindsay's Eidenberg score. They tested it again, 10 questions. Remember how it was moderate to severe? Well, now it was 21 out of 30, also moderate to severe, but it is going higher now. Her GAD-GAD-7 score was 19. Both were higher than the scores from November 29th. So Rebecca described Lindsay's presentation. In other words, her nonverbals, what she's doing. Her speech was normal. Her mood was anxious.

Her affect matched that. Her thought process was linear and goal directed. She denied hallucinations, delusions, suicidal thoughts, homicidal thoughts. Rebecca did not see signs of psychosis, did not see signs of mania, obsessive thoughts, or compulsive behaviors. Buckingham asked whether Lindsay or Patrick explained why he came. Rebecca did not recall a specific reason. she assumed he was there to offer support and collateral information, meaning sharing anything he noticed. She also confirmed that Lindsay had never mentioned wanting him at a visit in their earlier messages.

During the visit, they'd talked about sleep. Rebecca remembered that Lindsay still wasn't sleeping well. A few hours at the start of the night, then waking up, then maybe piecing together a little more. They also revisited when symptoms began. Lindsay and Patrick brought up the Zoloff from September. Lindsay told her, quote, that exact night I went from 25 to 50 milligrams. I didn't sleep for 48 hours and I wasn't tired, end quote. Rebecca had written that as a quote in her notes that led into the part of the appointment that stood out the most. Rebecca told them that she was considering the possibility of an underlying bipolar disorder. She explained why. The activating response to Zoloft, that was unusual. Going 48 hours without sleep and not feeling tired, that raised her suspicion. Lindsay had also struggled to tolerate other antidepressants since then. Rebecca was starting to wonder whether there might be a mood disorder underneath all of this.

She reviewed the screening, Julia had done earlier. The mood disorder questionnaire, Lindsay's screen, had been negative. She endorsed three symptoms, not sleeping and not feeling tired, raising thoughts, trouble concentrating. They occurred at the same time, but the functional impairment was minor. Rebecca explained that MDQ wasn't always sensitive for bipolar 2 or bipolar NOS. She talked about the difference between bipolar 1 and bipolar 2, severity, duration, the impairment. She said she was glad Patrick was there because sometimes partners could help fill in patient history and history that patients did not remember. So take a listen to this.

So are you familiar with the DSM-5? Oh, yes, yes. Okay, so while that's not the end-all, be-all, it is a guide that tells you specific criteria, how to determine if episodes are manic or depressive, right, when it comes to bipolar? Yes. The difference between mania and hypomania.

Yes. And so while you noted that these, there were some concerns reported, did what was reported to you rise to the level of diagnostic criteria for bipolar disorder? Not at that time. And when you explain this to them, your thoughts about her reactions to the medication and these reported prior symptoms, did Patrick and Lindsay seem receptive to your diagnosis? I recall Patrick saying my wife is not bipolar.

Lindsay looked at me. She did not say anything. Okay. And was this the first time in this meeting on December 6th where you broached that issue or mentioned that? Yes. Did the conversation continue about symptoms and managing symptoms after that? Yes. Were you able to get any more specific information from Patrick during that meeting?

Not what the information, what he said particularly, but did you get additional specific information that kind of helped you assess whether you would change your diagnosis at that point? No. And were there still concerns in that particular meeting that the focus was trouble sleeping and the potential for addiction? Yes. As far as recommendations, did you talk about what's called tapering medication? Yes. And what were your recommendations regarding tapering?

So we talked about her concerns about the benzos. And we decided to come up with a plan to taper off of them. And the last that had been reported to you via the MyChart messages was that she tried not taking it at all, ended up having horrible thoughts and felt deeply depressed, then took it and felt better. So was it realistic to stopping? No. So what is a taper? Why do you recommend tapers?

I recommend tapers to slowly get somebody off. of something. And tapers can be useful because we might have somebody at a dose and they might say, oh, I'm too anxious to stop this or I'm not ready to step down to another level and we can kind of keep them on it longer. But at this point, since I had met her on November 29th and throughout the my chart messages, there was multiple concerns voiced about benzodiazepines. And again, in this visit, so I even did what's called a CWA assessment. which is something we use to determine if somebody's having actual withdrawal from benzodiazepines or alcohol. Again, I really wanted to show her I was assessing this and taking this seriously.

When you say C-W assessment, is that an acronym for something? Yes. What are the letters, just for the record? C-I-W-A. C-I-W-A. C-I-W. Okay. And did you, when you do that assessment, does it give you some sort of score? It does. Ask the questions. And what was her score when you did that C-I-W-A assessment? One. And what does that mean? Minimal to no withdrawal. The only symptoms she reported was anxiety. Her blood pressure was normal. Her pulse was normal.

should no nausea, no vomiting, no tremor, no tactile disturbances. People in withdrawal from benzos or alcohol will sometimes feel like there's bugs calling or pins and needles, auditory disturbances. So hearing things, seeing things, no sweats, no headache. She was oriented. So with that, and knowing that she wasn't in withdrawals for Ativan, Did you still recommend the taper in an alternative? I did.

What was that? I recommended Valium. The reason I recommended this is she had discussed rebound anxiety with me at our very first visit, feeling that rebound anxiety above her baseline once the Benzo wears off. Valium has an extremely long half-life. It can, as in like 100 hours. It has a longer clinical duration of action. So I wanted to offset the chance that she would experience rebound anxiety.

And it's often used when we're tapering somebody on shorter acting benzos. It's common practice to switch to longer acting benzos to do this. And did you also have conversations about the other medications that had been at issue, than metazepine and the serakil? Yes. What did the defendant, what did Lindsay Clancy express to you as far as Saraquil? Did she want to continue with that? No.

By the way, guys, I think we've like done process of elimination now with the microphone. Yeah, you heard me. I was a little, I was unmuted there for a little bit. But we have tried everything. We brought in the wireless box. We do think it's a wireless issue. And a lot of you have noticed our new. wallpaper behind us in our new studio set, we are starting to think, here's our final

consensus, that the new, the wallpaper is actually extra fancy. It's actually audio wallpaper. It's very thick to improve the audio. And now we're starting to realize that maybe it's affecting the Wi-Fi to this room because it's everywhere. So we're going to figure that out before next time. So process of elimination. Thanks for being with us tonight, though. We'll get it figured out. Anyway, back to Remmeron. It's so sad. Okay, Lindsay did not want to continue taking Syracquil. She said that when she took Remeron and Syracquil together, that she felt way down and exhausted. But her mind stayed awake. She didn't feel it helped. Both Lindsay and Patrick said they wanted to go back to Prozac and Rebecca agreed. She told them that she had concerns about

bipolar disorder, but Prozac had worked for Lindsay in the past without causing mania. She said that they could try it. By the end of the visit, Rebecca told her she could discontinue Syracille and restart Prozac. She had already recommended Prozac earlier in the week and the next morning, December 7th, Lindsay messaged her again at 9.48 a.m. Quote, last night did not go well at all, she wrote. She said that she took Valium and melatonin and slept from 9 to 1. So 9 p.m. to 1 a.m. and then around or 2 a.m. She got desperate. So she took 25 milligrams of Benadryl and slept one more hour.

And then she said, quote, what can I do? I really need help. That's heartbreaking. What can I do? I really need help. Rebecca responded at 1019. She reminded Lindsay that, Patrick had made a good point the day before.

Even with Ativan, she was only getting about five hours of sleep. That showed, Ativan wasn't the only thing helping her sleep. She pointed out that Valium hadn't helped much either. Her next step was to try a higher dose of Syracquil. Syracquil on its own, she asked Lindsay whether she was feeling any exhaustion or fatigue from the lack of sleep. So one Shannon Buckingham moved into the December 7th messages. They discussed how Rebecca was trying to sort out.

Whether Lindsay's symptoms were tied to insomnia, depression, or something more complicated. Rebecca explained that her next step was to increase Syracquil. Lindsay had been taking 50 milligrams, so Rebecca suggested moving up to 75 or even 100. She said she was still keeping bipolar disorder in her differential diagnosis, and now she had fresh data. Lindsay had only slept two hours and didn't feel tired the next day. That detail mattered. Rebecca told the court that patients who are anxious or depressed might sleep poorly, but they're exhausted afterward,

that someone with an underlying bipolar condition could run on two hours of sleep and feel fine. That was unusual enough to make her pay attention. Lindsay's message at 1033 that morning confirmed it. She wrote, quote, no, the weird thing is I don't feel tired at all. And then she asked whether she should take only Syracurquil that night, and she admitted that she felt like she'd panic without a benzo. A little later, she asked, quote, would I be able to do the Valium with Syracquil? Is that a safe option? Rebecca responded by telling her that if Valium wasn't helping her sleep, there was no need to continue it.

She said that she would prescribe a short taper to get her off of benzodiazepines altogether. She also told her, because you are not tired at all and had a significant reaction to Zoloft at 15. milligrams. I'm concerned this is an underlying mood and bipolar disorder. End quote. She said that. She sent Lindsay a list of bipolar symptoms and risk factors so that she could review them. And then Shannon Buckingham pointed out that the only manic type symptom that Lindsay was reporting in those messages was the lack of fatigue. Rebecca agreed the racing thoughts and trouble concentrating had come up earlier in her history, but not in the December 7th messages. Rebecca then laid out the plan that she recommended.

She explained to Lindsay that if bipolar was in the pitcher, SSRIs like Zoloft or Prozac could be contraindicated. So she told her to take 100 milligrams of Syracquel that night, then 200 the next night, 300 the night after, and 400 the night after that. She said she wanted to hold Prozac because she was concerned Lindsay was in a hypomanic, mixed manic state. She also noted that Lindsay hadn't taken Remmeron the night before, so she assumed that she had stopped it entirely.

And after that message, Lindsay responded at 253 saying that she'd stick with the plan and needed a refill because she only had 30, 25 milligram tablets. Rebecca explained that she had also offered an alternative earlier that day, adding ZyPrexia alongside Prozac, since there was a combination pill used for bipolar called Simpsiorex. by axe and she told Lindsay that they could prescribe the two separately for the same effect. Lindsay chose the Syracule with the Valium taper and the next morning, December 8th. At 6.35 a.m., Lindsay wrote again. She said that she'd slept mostly from nine to five with a few wakeups and was able to fall back asleep, but she also said that she felt panicky and didn't know if she was ready to taper as quickly as planned. She asked if she could taper slower. Rebecca told her she was hesitant to slow down and I reminded her that Valium had a very long half-life around a hundred hours,

so she'd still have some in her system through the weekend. She explained that she was trying to help Lindsay move off the benzo because Lindsay herself had been anxious about dependence. That was upset concerning Lindsay. Rebecca also said that she believed they could cover her anxiety symptoms with Syracille as they increased the dose since clinical trials showed it helped with anxiety. And that conversation carried into December 9th. Lindsay wrote that she had taken the five milligrams of Valium and did not have any left.

She said that she was afraid that she had end up taking Ativan. Rebecca confirmed that she had not recommended Ativan as a substitute. Later that afternoon, Lindsay and Patrick called the clinic together. They left a message and Rebecca called them back. She said she talked about Lindsay's symptoms. The plan had been to taper vans. volume over the weekend, but both Lindsay and Patrick felt her symptoms were too acute. Lindsay was sleeping better, but still waking up with panic and intrusive thoughts.

Intrusive thoughts. She felt numb. She had thoughts of suicidal ideation, but no plan or intent. Rebecca encouraged her to reach out to women and infants hospital in Rhode Island for a partial hospitalization program. Lindsay was able to contract for safety over the phone. She said she had no plan, no intent, and would reach out of things worsened. Rebecca agreed to continue the volume until their next appointment on December 13th.

She prescribed five milligrams but told Lindsay she could take half a dehablet twice a day. She also told her to continue the Syracille 100, then 200, then 300, then 400, she explained that this was the manufacturer's recommended schedule for treating manic symptoms. She said that she believed Lindsay was in a mixed manic or hypomanic state and wanted to get those symptoms under control and get her sleeping. Buckingham asked about dosage ranges. Rebecca said that for bipolar manias, Syriquil could be quickly,

they could go up to 800 milligrams. She acknowledged that she had previously agreed to discontinue. continues Syracurquil on December 6th, but Lindsay's presentation in the days that followed changed her recommendation. By December 9th, Lindsay was reporting better sleep with the increased dose. Rebecca confirmed that women and infants had specialized perinatal programs and that she recommended it because of Lindsay's acute symptoms. So after that phone call on December 9th, the next contact came in Monday, December 12th. Lindsay had it messaged over the weekend. At 1.59 p.m. she wrote, quote, I've been noticing on my Apple Watch that my heart rate has been fluctuating more than usual, going from 56 to 136 within minutes. That is incredible. I'm wondering if this is a side effect of the Syracule. By December 12th, Lindsay should have been at 400 milligrams if she had followed the schedule. This schedule is a step-by-step plan for changing the dose over the medicine over time. Lindsay reported that she was only taking 200 but did not say why. Rebecca can't.

that her recommendation had been 400 by that point. The December 12th messages were about the physical side effects Lindsay was reporting while on Sierraquil. Rebecca explained how she responded when Lindsay wrote about her heart rate jumping from the mid-50s to 130th within minutes. And she told her that medications like the Syracquil could cause hypotension, orthostatic hypotension.

Basically, when someone stands up, their blood pressure doesn't adjust quickly enough, so it drops and they feel dizzy. She also explained orthostatic tachycardia, the heart rate spiking when someone goes from sitting to standing. She said both were common early in treatment or during dose increases. She told Lindsay that they were generally benign and self-limiting. Sometimes she said they required slowing or splitting the dose into smaller amounts. Rebecca also knew Lindsay had spoken to the clinic nurse that morning and had told she wanted to get off all medications. Rebecca addressed that directly.

She told Lindsay, quote, as long as you are aware of the risks, I don't think you've been on Syracquil, long enough for it to have a positive benefit on your mood or anxiety, end quote. She warned Lindsay. That stopping it, though, could worsen her symptoms. She said she was fine with tapering off Valium

if Lindsay wanted that, and she could send a taper schedule. She also told her that being off medication might help her see her baseline. but she believed Lindsay was experiencing significant and severe symptoms of postpartum depression that needed to be treated. End quote. She reminded her that medication was only one part of the puzzle, counseling, support,

exercise, diet, yoga, relaxation techniques, and she strongly recommended partial hospitalization again. So by this point, Rebecca New Lindsay had met with the clinic social worker, at least one, and had been given referrals to CBT programs. She also knew Lindsay had already been encouraged to pursue partial hospitalization. Buckingham asked whether anything in these exchanges made Rebecca feel she needed to escalate care, bring Lindsay in urgently or recommend inpatient hospitalization. Rebecca said no.

Lindsay was not reporting acute safety concerns. These were physical side effects. So the messages continue that afternoon. At 244, Lindsay wrote back, seeing she was relieved to hear the heart rate issue was benign. She told Rebecca that she had been taking 2.5 milligrams of Valium and 200 milligrams of Syracoyle for the past three nights. She said she liked how deeply she slept, seven to eight hours. But she didn't like how she felt during the day.

She said that she felt, quote, incredibly depressed and unmotivated to do anything at all. She asked what Rebecca recommended for that night. And Rebecca responded at 410. She told her to continue the 200 milligrams of Syracool because at least she was sleeping. Even though she had originally recommended going up to 400, she felt that they had already calmed the activating symptoms and wanted to give Syracool time to work on mood. She told her to keep taking the 2.5 milligrams of Valium and said they would discuss everything at their visit the next day.

but later that evening at 717 lindsay wrote again she said she needed to make the next day's visit virtual because she couldn't make it into the office rebecca agreed she did prefer in person because lindsay's symptoms were significant depression anxiety mixed features and she wanted to see her weekly but she'd rather see her virtually than not see her at all so on december 13th at 10 30 a.m. they met virtually. Rebecca structured her note as a timeline, the December 6 visit the December 9th phone call, and then the update for December 13th. She did not document every my chart message. She captured the major treatment points. Lindsay reported that she was sleeping seven to nine hours. She was holding at 200 milligrams of cyrical and taking 2.5 milligrams of volume at night.

Even with better sleep, she still felt significant depression, hopelessness, she also mentioned the racing heartbeat again. Rebecca recommended stain at 200 milligrams for a full seven nights before increasing. She said they were still planning to taper the benzop, decreasing from 2.5 milligrams to 2 milligrams for seven days. Then reassessing, she gave her psychoeducation about behavioral activism and CBT techniques. She recommended postpartum.net for support groups and reiterated partial hospitalization. clearly she felt she needed to be hospitalized. She also performed her mental status exam. Lindsay showed

no signs of mania, no signs of psychosis. When Rebecca asked about suicidal ideation, Lindsay said she wasn't experiencing it at that moment. She had endorsed sometimes, though, on the Inberg scale over the previous week, but she denied any current thoughts, plan, or intent. Rebecca asked about intrusive thoughts. Lindsay said she wasn't having them during that visit. She had previously described intrusive self-harming thoughts, thoughts of wanting to die, but she had never indicated thoughts of harming her children. Okay. By the end of the visit, the plan was to continue Syracquil at 200 milligrams, continue Valium at 200 milligrams, and keep engaging with therapy, support groups and partial hospitalization options.

After the December 13th virtual visit, Rebecca didn't hear from Lindsay right away. She actually reached out herself later that afternoon. At 227, she sent Lindsay a long message with more ideas about how to help herself feel better, mostly cognitive behavioral therapy techniques, encouragement, and reminders that even though sleep had improved, the depression was still very present. Lindsay did not respond that day. The next contact came on December 15th. and this time it wasn't a message.

It was a phone call. Rebecca explained that she spoke with both Lindsay and Patrick at 353 p.m. Lindsay told her it had been the worst day. She was having persistent, intrusive thoughts of self-harm. No plan, but the thoughts were constant. So she was in suicidal ideation. Both she and Patrick agreed she probably needed a higher level of care. Rebecca walked them through their options.

She explained how emergency departments worked that if they went to the closest ER, like Plymouth or South Shore, those hospitals didn't have inpatient psych units. They might end up waiting for a bed somewhere else in the state. She told them that Mass General had Blake 11, a dedicated psychiatry unit, and that MGH, often prioritized admissions from its own ER. She also explained that MGH and McLean were under the same umbrella, so presenting at MGH, could help them get into McLean if needed. She asked that they'd be comfortable going to Mass General, knowing that Lindsay had worked there as a labor and delivery nurse. They said yes. Rebecca told them to keep her updated and to

sign a release so she could communicate with whichever team evaluated her. Lindsay agreed. They did go to the Mass General emergency department that night. The next day, December 16th, Lindsay messaged her. At 12.50 p.m. She said that she had opted to remain outpatient and pursue the partial hospitalization program at women and infants in Rhode Island. The same program that Rebecca had been recommending. She said she was waiting for a call back to schedule. She also asked how to proceed with her medications, whether she should stay on two milligrams of volume and 200 milligrams of circle. She said that she was sleeping well, but her mood still wasn't improving and she asked for

refills. Rebecca responded at 1.14. She told her the target dose for Syracille when treating bipolar depression was 300 milligrams so they could increase it if she was willing. She told her to continue the volume and ask what she thought. Later that afternoon, Lindsay wrote again. She said that she had spoken with her original psychiatrist after the ER visit and that psychiatrist recommended adding 25 milligrams of Lamictal to stabilize her mood. She asked Rebecca if she agreed. Rebecca said yes. She told her,

Lamotrogen worked well for mood stabilization and depression. She explained the slow schedule 25 milligrams for two weeks, then 50 for two weeks, then 100, and because of the risk of Stevens Johnson syndrome, she told her what to watch for, which was a fever or swollen lymph nodes, tender rash. She also explained that benign rashes could happen to. She said the medication was usually well tolerated and suggested taking it with food. She told Lindsay that she could send the prescription, but Lindsay said her psychiatrist had already done that.

Rebecca then asked whether she had heard back from women and infants. At 233, Lindsay replied that she had missed their call, but had asked them to call back. She had hoped that reached her that day. Rebecca replied, okay, sounds good, I hope so as well. The next contact came on Monday, December 19th. Lindsay had an appointment with Letitia that morning, and then she messaged Rebecca at 11.04 a.m. She said she was starting with the women and infants partial program the next day, December 20th. She was concerned because she had already had an appointment scheduled with Rebecca and asked what she should do. Rebecca told her that she was glad she got into the program. She said, Lindsay could reschedule her appointment. She also let her know that she'd be on vacation the next week, so their next check-in might be two weeks out. Lindsay wrote back at 124. She said that was fine since she'd be followed by women and infants, but she was worried about needing more value.

She said she was trying not to take it at night, but was still taking two milligrams every other night. She asked if they could refill it. Rebecca asked when she'd run out. Lindsay said she'd run out that night. Rebecca agreed to send a refill, but only enough to get her to the next appointment. She refilled it based on her recommendation, not based on Lindsay's every other night use. And then came December 20th.

Rebecca confirmed that she received another message from Lindsay that day. Lindsay told her she had been discharged from women and infants that same day. The program recommended she find help tapering off Syracquil, and Lindsay says she wanted to start that taper. Rebecca did not respond that night. She waited until the next morning, December 21st at 1057 a.m. she told Lindsay she was not opposed to tapering, but she was concerned that she'd been discharged because she believed Lindsay could benefit from the groups and added support that the program offered. She wrote, quote, if we're not going the medication route, I think groups and therapy

are the treatment needed, as I feel the intrusive thoughts you've been having are nonetheless concerning, end quote. She also reminded her that she was going on vacation the next week and was hesitant to start a taper when she would not be available for questions. She said she was open to it, but wanted to be present while it happened. She asked whether Lindsay's previous psychiatrist might be someone that she could consult. Buckingham asked whether Rebecca was opposed to tapering. Rebecca said, no. She understood Lindsay felt Syrac well helped her sleep, but didn't help her mood. And she also said that Lindsay would need a lot of support as she came off medication. They talked about whether Lindsay was getting any other support besides Letitia and her psychiatrist, Rebecca said she wasn't

aware of Lindsay attending any groups. The clinic offered perinatal support groups, and if Lindsay had been attending, it would have shown up in her records. Lindsay hadn't mentioned any outside groups either. Rebecca explained why she didn't want to start the taper while she was away. Lindsay had been extremely communicative. Yeah, we're seeing this, messaging constantly, right, about symptoms, about fears, about side effects. Rebecca wanted to be available in case Lindsay's sleep collapsed or her mood worsened. And if she was gone, the nurse would respond and the other nurse practitioner could be consulted, but Rebecca herself would not be there.

So later that afternoon, at 3.47 p.m., Lindsay responded. She said the psychiatrist at women and infants recommended a more general mental health partial program, like the one at McLean. She said she was open to that. She also said she was trying to schedule with the CBT therapist in Danvers and that her other therapists had openings that week and the next. And she asked how Rebecca recommended starting the taper and noted that she'd seen smaller pills because hers were at 300 milligrams. Rebecca learned that Lindsay had also emailed the clinic that day and she asked her nurse to

call Lindsay to go over the risks, worsening mood, worsening sleep, making sure Lindsay truly wanted to move forward and reminding her that Rebecca wouldn't be available during the taper. So then at 4.26 p.m. Rebecca sent the taper plan. She wrote, quote, I know Nicole reached out to you and she relayed that you would like to proceed with the taper. I'm sending 100 milligram tablets, 200 milligram, 200 milligram, two tablets for four nights, 100 milligrams, one tablet for four nights, 50 milligram, half tablets for four nights, then off. Let me know if any issues. She explained that this was a reasonable taper given Lindsay had only been on Syracquil for a few weeks. If she'd been on it for months, she would have tapered more slowly. She also had the nurse send Lindsay information about DBT groups,

which are dialectical behavioral therapy. She explained that DBT focused on emotion regulation, distress tolerance, interpersonal skills, a very structured skill-based treatment. So Rebecca said that December 21st was her last contact with Lindsay. The clinic's next interaction came on December 30th when Patrick called. He spoke to Nurse Katrina. He said Lindsay was safe, but wanted to go to McLean. Katrina told him she couldn't just show up there. She needed to go through an emergency department. So Patrick said he didn't want to waste a day in the ER and he was hoping to get the same bed that had been offered on December 15th. Katrina explained that beds, aren't held like that. She advised him to take Lindsay to the ER or call 911. And that was the last

contact the clinic had with her. Rebecca said she never received any messages from Lindsay after she went to McLean. She later saw through the state's prescription monitoring program that Lindsay's previous psychiatrist had prescribed additional medications. Lindsay never returned to the clinic. So Shannon Buckingham, closed by asking about Lindsay's presentation throughout all of this. Take a listen. During all of your interactions with Lindsay Clancy, did she always present with clear linear thinking? Yes. Was she able to express to you her concerns and ask appropriate questions when necessary?

Yes. And was she able to advocate for herself and express that she had some knowledge base about some of these medications? Yes. And at no point during the time that you, she was your patient or that she was at the clinic, did she ever indicate that she was, um, had a plan to kill herself or harm her children. Did she? No. Thank you.

There's nothing further. Well, that ended the direct examination and the judge broke for lunch. Yeah. We're just on lunch, guys. Do you have your snacks? Do you have your snacks? No, we are getting closer to the end of the day, but it's lunch time. It's lunch.

So after lunch, Reddington gets up for cross-examination. Yeah. You know, when Reddington gets up, we're like, okay, and what's he going to do now? Well, he started by confirming how many times Lindsay had met with Rebecca, and she told him three visits, two virtual, one in person. And then he moved to the psychiatrist Lindsay had been seen before she came to South Shore. And that was Dr. Tufts. We know about Dr. Tufts.

Rebecca knew that Lindsay had seen her in September, but she didn't realize that Lindsay had continued to see her through October, November, and December. Redington told her that Lindsay had actually seen Tufts 14 times in those four months. Rebecca said that would surprise her. He pointed out that when you added Rebecca's three visits, Lindsay had met with mental health providers 17 times in that short window. He walked her through the long list of prescriptions. Zee had received from Tuft,

xylopam, hydroxazine, and buzbrone. He asked whether she knew about each one. Some she did, some she did not. Rebecca explained that she routinely checked the state's prescription monitoring program, but the PMP didn't automatically print into her notes. It was just a box, right, that she clicked in the electronic chart.

Reddington then kept going through the timeline. October 21st, Larazepan, October 26, hydroxazine, another lorazepan that same day, buzperone, trazodone from the ER on November 16th. Then he moved into the period where Lindsay started with the South Shore Clinic. Julie Paul saw her first in November 21st, and then Rebecca picked up on November 29th. He walked through every prescription, Rebecca wrote, Syracille on November 30th, Valium on December 6th, more Valium on December 7th, Syracul again on December 7th, more Valium on December 9th, another Valium on December 13th, and Valium and 300 milligrams of Syracquil on December 19th,

and additional Syracquil on December 21st. He asked her to check her records as he went. He asked her why she had started with 25 milligrams of Syracool and then increased it to 100 a week later. Well, Rebecca explained that she had originally planned to use it for sleep and anxiety, but Lindsay's presentation changed, and she shifted to using it for mood stabilization. Redding impressed her on whether she was working with any psychiatrist.

She said, no. She was managing Lindsay's care herself. He asked whether Lindsay's symptoms were concerning. Rebecca said they were serious, but not uncommon in postpartum patients. She explained that she treated women with severe postpartum symptoms regularly. He continued walking through the December prescriptions and then jumped ahead to January. He suggested she had written more volume scripts in mid-January, but Rebecca said she had not. He asked whether anyone else could prescribe under her name.

She said no. And then he turned to Lindsay's familiarity with medication names. He reminded her that the prosecutor had said Lindsay was a nurse and therefore understood the drug names, right? Rebecca agreed that Lindsay seemed familiar with them. Reddington asked whether she knew Lindsay had been Googling medication. 60, 70, 100 times a night. Wow. Rebecca said she didn't know that. He asked whether she ever asked Lindsay how she learned all of this information. Rebecca said she didn't. He circled back to how invested Rebecca had been in Lindsay's care. She agreed she was. He reminded her that she

had referred Lindsay to the women and infants perinatal program in Rhode Island. Rebecca confirmed that Leticia Dukes had made the actual referral, but she had recommended it. it. He pointed out that Lindsay had gone there because that's what she was told to do and then asked whether she had been treated there. Rebecca said she didn't believe so. It seemed to be an intake appointment. Reddington then laid out the bigger picture. Lindsay had been seen a psychiatrist for months. She had just had a baby months earlier. She was clearly, clearly struggling. Rebecca had told her she was suffering from a mental health illness that was very real and had reassured her, this will get better. That was December 2022. And when Lindsay was told to go to the women and infants

for help, she went. Then he asked Rebecca, what happened at women and infants? When you referred to her needing help to this women's and infants program in Rhode Island, and she went because that's what she was told to do. What happened at Women and Infants Program? I can't speak to what happened at women and infants. Why not? Because I was not a part of that assessment. What does that mean?

I did not see the assessment and I did not speak with Dr. Diaz. Why? Lindsay had informed me that she was going to. to be at the program for two weeks. She was hoping to be at the program for two weeks, right? She told me she was going to be at the program for two weeks. But she was turned away after about eight hours of sitting there in an assessment and sitting in a group session.

And she was turned away because of their concern that she was suffering from, well, let me ask you, what was their diagnosis? I'm not sure. Did you ever find out? I have not. Does it matter to you as a treating person that I think your words were is invested in Lindsay Clancy's care at that time? Did it matter to you? Why she didn't get accepted into the program?

It did. Why was it? I do not know their diagnosis. Did you know that she had been diagnosed? You have different diagnoses, right? Like general anxiety disorder or general anxiety, GAD. and then you have, is it a differential? Is that what it's called?

What is that? Yes. It means a differential in medicine could be, patient comes in with a cough. What are your differentials? Differential might be bronchitis, pneumonia, strep throat. So it's different things, different diagnoses you consider. Did you know that in fact they wouldn't accept her into the post-pattern program

because of their concern that she had been over-medicated by drugs and they wanted to find out. I can't speak to that. Did you know that she was diagnosed as diagnosis depression due to adverse drug effects? I cannot speak to that. Do you know, invested as you were, that on December, strike that,

on December 20th, the very same day that she had finished being evaluated, woman you were invested in, had been evaluated by Dr. Diaz that you recommended or you mentioned, that in fact, looking at the exhibit, that they recommended tapering Syracool, starting 200 milligrams tonight, follow up with outpatient provider of note. We attempted to reach current outpatient provider, Rebecca Jalada, but did not receive a call back. I never received a call from women and infants. So this medical record from women and infants saying that they called Rebecca Gillada and never got a call back, your memory is that they never called you? They never called me.

I absolutely would have called them back. Uh-huh. Okay. Well, regardless, you never talked to anybody from women and infants, did you? Whether they called you or whether you reached out to them being invested. I did not. I know our program re-refered her a few days later. Reddington then moved on to Lindsay's fear of medications. He reminded Rebecca that Lindsay had described starting new drugs as scary. Rebecca agreed. He said at no time did it seem like

Lindsay was doctor shopping or trying to get more drugs. She was trying to get off of them. Rebecca said correct. He brought up the book Good Moms Have Scary Thoughts, which the clinic gave out to patients. Rebecca confirmed that. And then he went back to the, you know, the kind of the timeline. He asked whether she had reviewed the PCPs records from November 17th. She had. He walked through the Zoloft trial, 25 milligrams, increased to 50, one night of no sleep, discontinued immediately. Rebecca agreed. He returned to the bipolar concern. She confirmed that SSRIs like Prozac or Zolov were contraindicated. in bipolar disorder because they could cause rapid swings between mania and depression.

He asked whether she had reviewed Julie Paul's notes. She had. He went through Lindsay's disclosure that she had taken a marijuana gummy once in November to try to sleep. Rebecca confirmed that Lindsay had been honest about that. He then went through the Edenberg scores. Make a listen. The scales that counsel asked you about, you were talking about the G, the depression scale.

You were talking about the Edenberg scale. And I think we all know that now that the Edenberg scale is geared for an evaluation of a person, of a woman who is in that postpartum period. And you evaluate whether or not they are as a result of being postpartum severely depressed, right? Yes. And you indicated that at some point her Edenberg scale, was initially, what was it, 15, 17, if you know?

Initially at my visit, my first initial with her. Yeah, what was her Edenberg scale the first time you saw it? 17. Okay. And that would be moderate? Moderate. Okay. And then she had another Edenberg scale after that, correct?

Correct. And when was that, if you know? December 6th. And what is EPDS? What does that mean? Edenberg post-thartan depression scale. All right. So would you look at November 21st, please, which would be,

so November 21st, she was administered a Edenberg test, right? On the 21st, that would have been at Julie's appointment. I don't have that in front of me. If I told you that, well, on November 21st, it's a short period of time after November 17th. Did they admit they, whether it's Julie or somebody else, administer, Edenberg, passed to her? Yes.

And what was the result? 23. That's severely depressed, isn't it? Yes. So in like six days, she decompensated from Edenberg scale 17 to Edenberg scale 23, right? So she was 23 on November 21st. Right. And 17 on November 29th.

Okay. So when you see a patient that's come to you and has an Edenberg scale of 23 and an Edenberg scale a couple of days later, that would be, what was it? 17. And what was it when you first saw it, you referenced it before? 17? 17. Yeah.

That's still pretty high, isn't it? It's high, yes. Would that give you pause in conjunction with the symptomology that she's referring to and self-reporting, what she's feeling? I mean, the fact that she has a 23 on the Edenberg scale, which is very high, and then followed up a couple of days later by a 17, taken in conjunction with what she was saying her symptoms were. That's of a concern, isn't it? Yes. So on November 20th, which would be the day before, that Edenberg scale of 23, and the jury will have access to all these records, she was reporting, struggling with postpartum anxiety, right?

I can't speak to them. Okay, that's fair enough. We'll go to when you treated her. Yes. Did you have a chance to review Julie's notes at all? I did. Okay. Okay.

Yeah. And when was the first time that you actually met with Lindsay? November 29th. Okay. Which would have been after Thanksgiving, obviously, right? Yes. And you would have reviewed the records up to that point, right? Yes.

So one of the things that you would have reviewed was what she had indicated or reported to Nicole Hardin-Francis. Do you know her? Yes. And who is Nicole Hardin? Frances. She's the nurse at our program. All right. And this would be on November 28th that she was speaking with Nicole, the nurse. You read the report before you met with Lindsay on the 29th, right? Right. So you know that she had been reporting panic symptoms, that she was disoriented, that she was forgetful, that she was not connected to her body. That's what she told her, right?

review that just to be accurate. That's correct. Okay. And you agree with me that symptomology of mania, especially when incurred or encountered by a woman within the postpartum period, that's one of the symptoms is being disoriented, right? Not necessarily.

How about maybe a little bit? Could be confused if you're manic. Yeah. How about forgetful? That's an issue, isn't it? Not necessarily a symptom of mania. Okay. How about not connected to her body? What does that mean? I'm not sure what that means. So if you have a patient who's coming to see you, who's indicated the day before

that she has panic symptoms, disoriented, forgetful, not connected to her body, wouldn't you ask her what she meant by that? Yes. Okay. So when you saw her on November 29th, you diagnosed that she had post-partum anxiety, right? Adjustment, insomnia, right? Correct. And when you met with her, you noted that over the last two weeks, you asked her about how she had been feeling, and she said she was feeling nervous, anxious, and on edge.

She said nearly every day, right? That's November 29th. That would be under screenings. Yes, she was. I would give you a page number, but they don't give us page numbers. She told you, and you can pull it up if you have it there, that she was not able to stop a control worrying, and that had been for several days at least, right?

Correct. And she was worrying and stressing about things, worrying about different things every day, right? Nearly every day, yes. Couldn't relax nearly every day. This is a questionnaire form that you have, right? Yes. Being so restless nearly every day, correct?

Correct. Asked if she was annoyed or irritable, and she said, not at all, sure. Like she doesn't think, she didn't believe that she was a person that would be irritable or angry with people, right? Yes. And then feeling afraid as if something awful might happen and she got that GAD 7th score of 14. Is that correct? Correct. So what does a GAD score of 14 tell you on November?

the 29th. Moderate anxiety. And then you ask about in the last seven days trying to get a history, she denied definitely not so much now that she was able to laugh or see the funny side of things, right? Right. And that she was asked, is she looking forward with enjoyment to things? And she responded hardly at all, right? Yes. Blaming herself. When things go wrong, she says, yeah, some of the time. Yep. Yes. anxious and worried for no good reason, yes, correct? Yes. Scared and panicky for no good reason, yes, correct?

Yes. Then asked if she felt sad or miserable, if she was a miserable person, and she said, no, not at all, right? Right. Did she indicate that on that day, you gave her the EPDS-Edenberg test, and she had an Edenberg score, as we said, of 17, right? Yes. All right.

And then the medications that you prescribed to her, we've already got an evidence. The jury would be able to look at the actual scripts in the exhibit without going through every single day. The next time you saw her was November 30th, is that right? I messaged with her on November 30th, yes. Okay. And you indicated that if you're not sleeping well with Valium, no need to continue it, I'll prescribe a short taper. And you went on about taper and 5 milligrams of Valium to 2.5 milligrams and no benzos and that was not on November 30th okay does it say on the record are you looking where it says patient message in the

perinatal behavioral health program of South Shore health November 30 2022 yes I'm looking at the messages okay so is it a different date that you sent that message it says November 30th on it right? I just don't know internally if you guys have different. Oh, I understand. At the top it says November 30th. More specific, it'll say the dates, but the header will say November 30th. So I understand. Okay. And basically you indicated that you were going to send along information about bipolar 1 or bipolar 2, which actually would be what's known as a bipolar spectrum disorder.

Is that correct? Yes, that was on December 7th. Okay, but it's underneath November 30th, so forgive me for looking at it that way. Yeah, I don't know why. That's all right, no problem. So one of the things with the mania that you refer to and that you talk about is excessive activity. Is that it? Access of cleaning sometimes, right?

Sometimes. Excessive exercise? Sometimes. Did you know that after she had Callin that within a matter of a couple of weeks that she that she ran a 5K? No, I did not know that. And that nobody wanted her to, including Pat, but she just had to get out there and run and did. Objection. No, overall.

You know that? I did not. Is that something that would be important to know? I mean, as far as whether or not a person is in that manic stage where it's post-delivery and that's a significant. and out of fact, if you will, of exercising, right? It would have been something I would have considered. Okay. And as I said, you were pretty much the only one that actually considered bipolar spectrum disorder

of all the doctors that she had seen. You know that, right? Are you aware of that? All right, no mind. That's right. She's going to object. That's okay. So the symptoms that you noted were a mania.

It says mania characterized by exaggerated excitement, hyperactivity. and racing scattered thoughts, right? Yeah. So what is... Go ahead. Was that from my note? I'm looking at the same thing that we've been looking at, which is...

Oh, the information I sent her on my polls. Yes. Hi, Lindsay, and then your note, right? Mm-hmm. If I may suggest maybe showing the witness what he's referring to you? She has it in front of her. I think I understand what he's referencing, but thank you.

If the witness has a problem in regards to that, and you need to look at some just let me know. Okay. All right. Thank you. Thank you. If you move ahead to, I think, the message portal or whatever it's called on November 30th, it's captioned, Stopping Remeron.

Yes. Okay, you're with me. And it says, no, this would go to the fact that she was still not sleeping. It was a huge problem for her, right? Yes. And she told you in her message thing, no, the weird thing is I don't feel tired at all. Correct. And that's one of the things that you had told us earlier is a symptom, correct?

Correct. A person that is not getting sleep, but doesn't feel tired. Correct. What is the symptom of? It's a symptom of mania that we look for. Okay. And when we looked for that mania, did you notice that? Did you factor that into your diagnoses?

Yes. Okay. How many times, if you recall, did Pat come with his wife to meet with you? Was it three? He came to a visit once, I believe I spoke with him and Lindsay on the phone twice. Would you agree with me that, as counsel asked, did he get permission to be there? And you indicated, no, that you would welcome the third party contact, right? Correct.

And did it appear to you that he was very, very invested in her care and was very scared and worried? Yes. And he was complaining about the fact that he believed, that they believe, that she was being over-medicated, right? I believe he was concerned about her symptoms. He felt that they started once she started being medicated initially. Right, because she indicated that when she first had taken the SSRI back in October, I believe, that she ended up having it increased and then had a period of almost two days

where there was no sleep whatsoever. That was one of the instances, right? Yes. So the Zoloft episode came up again the night Lindsay increased her dose and then stayed awake for nearly two days. Rebecca confirmed that was one of the events she considered significant. Next, he revisited Lindsay's message about, in quote, horrible, intrusive thoughts. So Rebecca confirmed the message and noted that she saw Lindsay in person on December 6th after that. She said she was concerned and had spoken with Lindsay about it.

When she asked Lindsay what the intrusive thoughts were, Lindsay described them as thoughts of not wanting to be here. Redington asked whether Lindsay ever mentioned hearing voices. Rebecca said no. She explained she had treated five postpartum psychosis patients, and some had auditory hallucinations, some had visual hallucinations, but Lindsay never reported anything like that. Lindsay also never described a specific setting for those intrusive thoughts. She explained them more generally as not wanting to exist. He moved to another message where Rebecca had written, quote,

it sounds more like depression than side effects, end quote. She agreed that was her assessment. She explained postpartum depression how it can appear any time in the first year, often with anxious features, obsessive thoughts, and hormones shifts after birth or during breastfeeding. reading. And then medications came up again. Rebecca confirmed she prescribed syracurquil after that exchange. He brought up the mood charts. She had sent to Lindsay. Rebecca said she had encouraged Lindsay to use them and Lindsay told her she printed them, though Rebecca did not recall ever seen the completed charts. Another provider entered the discussion, Christina Zappi. Rebecca

wasn't sure of the details, so Reddington actually read from the record. So Lindsay had told Zappi that she had been dealing with insomnia for a month and a half. Medications kept changing and nothing seemed to help. Rebecca said that lined up with Lindsay telling her that she didn't feel heard. He asked about the December 2nd communication and Rebecca said she spoke with Lindsay through my chart that day. She agreed that face-to-face visits are better and noted that she did bring Lindsay in on December 6th and had planned another in-person visit for December 13th. And then he moved to Letitia Duke's December 6th. December 2nd note, Lindsay had gone to the ER for anxiety, insomnia, and heart palpitations.

Rebecca agreed. Lindsay had told Letitia, she feared that she was addicted to Ativan and couldn't sleep without it. She had also reported weight loss and panic attacks. Rebecca confirmed all of that. He continued into December 5th, and Lindsay had been recommended inpatient level of care. He brought up Aspire crisis support and Rebecca explained Aspire was the local emergency services program. According to the record, Aspire told Lindsay that she didn't meet impatient criteria because she didn't have a suicidal plan. Rebecca said she could not speak to what Aspire told her directly, but they recommended a day program. As for whether Aspire ever sent the resources, they promised, Rebecca said she did not know. And once Redington reached

the December 5th note from Letitia Dukes, he used it to highlight how much Patrick had been involved. Letitia had documented that she reviewed sleep hygiene with Lindsay and gave her medication, grounding, and self-soothing techniques. When he asked Rebecca what self-soothing meant, she explained that it was simple strategies using the five senses to calm yourself. He pointed out that Leticia had written, quote, the patient's husband joined the visit reporting that her anxiety had become significantly worse, starting with psychiatric medications. Take a listen. And she notes, and again, this is on December 5th, that Pat, patient's husband, joined the visit reporting that her anxiety had become significantly worse since starting the psychiatric medications.

Does that say that? That is what that says. Okay. And in fact, when you spoke to Pat, he had told you that, in his quotation, his words would be it was 10,000. thousand times worse since she started this medication, right? If you know. I don't recall him using that phrase. But he was upset about the medication, wasn't he?

I would say he was concerned. Do you recall that he said that you're turning her into a zombie? I do not recall that he said that. Would you say to the jury that he was concerned or he was pissed off about the medication and what it was doing to his wife. Checkion, how's an answer? No, overall. I would say he was concerned.

Concerned? Okay. Did anybody address his concerns? That day. Any day? I would say that day I collaborated with them to take her off certain medications. Okay. December 6th you had a meeting with her. Is that correct?

Correct. Again, she's diagnosed post-bitam anxiety, right? Correct. Her EPDS score as a result of being administered, the Edinburgh test was at that time a 21, right? That would be underneath office visit and perinatal behavioral health above assessment and recommendations.

Correct. And 21, how would you grade that? Severe. Severe what? severe signs of postpartum depression. So know that she had lost over 15 pounds by that point? I was aware she had lost some weight. I was not aware that it was 15 pounds.

Okay. So then there was another patient message on December 7th, where she again was expressing concern about the drugs, and you indicated, either way, I continue to recommend the Valium Taper. right? Correct. There was a period of time that she indicated that she wanted to get off the medication and get off the drugs and you indicated, as you told us, that you were on vacation that week, right?

Yes. You basically told her to tough it out and just hit me up when I come back from vacation, right? No. Did you tell her to call you when you came back from vacation? No, I asked that she tried to hold off and wait for me to come back from vacation. for the taper. She had wanted to taper it sooner. All right. Do you have somebody that covers for you if you're on vacation? Yes.

Does somebody cover? She said that she was going to follow up with her other psychiatrist for the taper, but she did reach out to our program while I was on vacation. I couldn't understand you work. I'm sorry. I know that she said that she had an appointment with her psychiatrist who would do work on the taper with her. And I do know that she was in contact with other providers at our program, including Letitia Dukes while I was on vacation.

And Latisha Dukes is social workers? Is that right? Yes. Okay. December 9th, it was another telephone encounter, it's called, right? Yes. And yet again, her husband, Pat, was involved with this call, right? Yes.

So does this put Patrick up? to around four times, maybe five times, that he had been involved either in person with your business or on the telephone or on the telemetry or whatever it is, computer? I spoke with him on the phone twice. He was in one of our visits on December 6th, and it appears he was in the visit with Letitia as well. So this would be a Rebecca Gelada telephone encounter on December 9th, right? Correct. And on that occasion, Lindsay, and it says, and her husband,

called this writer, that it be you. Correct. Regarding the plan to taper, correct? Correct. And they both agreed that Lindsay's symptoms remain too acute. What does that mean? What's acute mean? Severe.

Did they say that she's sleeping but waking up with, let me back up. Was he telling you all this while she sat there? She wasn't saying much on that conversation. What she? I don't recall who was saying more than the other person. You recall that she indicated that she wanted her husband to be involved to speak for her because she was really decompensating, right? She wasn't self-reporting and self-advocating too well for herself at that point, was she?

I just know she did have her husband on the call and he did speak on the call. The conversation moved into the panic symptoms Lindsay had been experiencing raising heart, Southern waves of fear, the jolt of anxiety, the comes out of nowhere. Rebecca described those as classic panic features based on her clinical training. And then the intrusive thoughts came up again. Patrick had mentioned them and Lindsay had too. Rebecca said she didn't remember every detail of the content, but she did remember assessing safely and hearing Lindsay acknowledged suicidal thoughts.

Patrick had echoed that concern, but Lindsay herself had told Rebecca the same thing. Reddington wanted to know whether these intrusive suicidal thoughts were a recurring theme. Rebecca said they appeared in the documentation several times, though she didn't label them as frequent. He pushed on the medication decisions. Rebecca confirmed she prescribed volume during that period. He pointed out that she also increased airquil to 400 milligrams. She explained that Lindsay actually slept at 200 milligrams, and that dose seemed too calm the manic type symptoms that she had been watching for. And then came the December 12th message,

the one where Lindsay said she slept deeply, but woke up feeling incredibly depressed and unmotivated to do anything at all. Rebecca remembered it was, uh, and agreed that those feelings lined up with severe, severe postpartum depression. Redington also asked if Rebecca knew that Lindsay had stopped driving during this time, but she said no. She wasn't aware of that. December 12th appeared again in Letitia's notes. Lindsay reporting ideation without a plan, contacting crisis services over the weekend, and preparing to start a partial program. Rebecca agreed that this was tied to the ongoing self-harming thoughts. Reddington asked about the difference between the ideation and thoughts of self-harm.

So what's the difference between suicidal ideation and thoughts of suicide? And Rebecca explained that ideation exists on the same. the spectrum. And then came December 13th, the virtual visit, where Lindsay's, I didn't, Bur, by the way, Sterling, thank you, you corrected my pronunciation. I didn't, I didn't brough score. Is that it? Burr was still high at 20. Rebecca said she kept her on 200 milligrams of syroquil and two milligrams of Valium. By December 19th, Lindsay was telling Letitia she had planned to contact women and infants, and Letitia helped her do that. Once Lindsay went to women and infants on December 20th,

Reddington walked through what happened afterward. Rebecca said she did not speak with anyone at the program at that time, though the clinic re referred her a few days later. He read from the women and infants record noting, quote, reaches out to Rebecca Gelada, no return call. So Rebecca said she didn't receive, recall receiving any call and would have absolutely returned it if she had. I mean, I agree with that.

We see her being very responsible. to her. He asked about what she knew about Lindsay's next steps. Rebecca said she knew Lindsay went to McLean. She believed it was late December or early January. She didn't have access to McLean's records. Reddington asked whether it was important for her as Lindsay's provider to know the diagnosis and treatment once Lindsay was admitted to a locked psychiatric unit. Rebecca said yes, but when he asked whether she ever found out, she said no. He finished by asking whether Lindsay would have signed a release if Rebecca had requested one. Rebecca said she wasn't sure whether Lindsay had signed anything from McLean and confirmed she herself had not asked for a release.

And that's where Reddington ended his cross-examination. And after that, Buckingham stood up for redirect and went back over the actual timeline of Lindsay's care at South Shore. She reminded everyone that Lindsay was only a patient there from November 20th through December 13th, starting with Julie Paul and ending with Rebecca's final virtual visit. That was the entire window. That was the entire timeline, November 20th through December 13th, not even a month. Buckingham pointed out that Lindsay did not come to the clinic because a psychiatrist referred her. She came because her mother-in-law connected her to Julie. So everything Rebecca knew about Lindsay's earlier psychiatric care came from what Lindsay herself shared. Lindsay never asked Rebecca to reach out to Dr. Tufts and never suggested

she should coordinate with her. And then Buckingham pulled out the prescription log. She walked Rebecca through it, showing the jury that none of the January 2023 prescriptions were written by Rebecca. Every January script came from other providers, mostly Dr. Tufts and Dr. Goodhart. Rebecca's last prescription was filled on December 22nd, 2022, so two days. three days before Christmas, two days before Kora's fifth birthday. That was it. Buckingham used fifth birthday, and that was it Buckingham used that to explain why some of the December prescriptions looked repetitive or oddly sized. Rebecca confirmed that when she adjusted dosages, she issued new prescriptions, sometimes one pill, sometimes two, sometimes eight. She didn't

automatically give 30-day supplies when she wasn't sure a medication would be continued. And when she changed a dose, she expected the patient to follow the new instructions and disregard the old script. Buckingham then circled back to the partial hospitalization referrals. South Shore did not have its own pHP, so they routinely sent patients to outside programs. Women and infants was one of those places. Rebecca had no affiliation with them, so any information she received had to come directly from Lindsay, and Lindsay did tell her what happened there, that the program didn't think she'd benefit from groups and that they recommended tapering Syracquil. That's why Rebecca started the taper conversation. She also clarified the diagnostic timeline. In late November,

Rebecca was treating Lindsay for postpartum depression and anxiety as the days went on as the messages piled up as medications were trialed and symptoms evolved. Her differential diagnosis expanded. And that is when bipolar spectrum entered the picture. And that's where, you're, why the Syracill became part of the plan. Buckingham reminded the jury that after December 20th, Rebecca never saw Lindsay again. No telehealth, no in-person visits. The only contact was through my chart about tapering. Even though she was about to leave for vacation, she still gave Lindsay a taper plan and a prescription. And the clinic remained available if Lindsay needed help. Lindsay did not reach out about any tapering problems.

The only contact was Patrick's call on December 30th, asking about higher-level care. Buckingham finished by addressing the safety concerns. She asked Rebecca to explain contracting for safety. Rebecca said she always assessed whether Lindsay had a plan or intent. Lindsay never articulated a plan, never expressed intent. And she had support her husband and her parents. Buckingham also. also asked whether intrusive thoughts were common in postpartum depression and anxiety.

Rebecca said yes. She said depressed and unmotivated was common to. And she told the jury that she never had concerns that Lindsay was experiencing postpartum psychosis. And that is when Reddington stood up and tried to slip in one last. Now, counsel went through with you a call and, which Patrick and Lindsay or Lindsay indicated to you that she was having panic symptoms and intrusive thoughts. Do you recall that? Yes.

In that call, did you contract for safety? Yes. What does that mean? It means assessing immediate safety. For example, not to speak in hypothetical, but if somebody was saying, I have a plan to kill myself, I have a knife, I am calling 911. I'm sectioning that person. If somebody's saying I'm having thoughts of suicide, okay, what are they? Do you have a plan?

Do you have intent? What I recall from Lindsay is she was having thoughts of suicide. She did not disclose a plan, no intent. And her husband was aware of this as well. He was on the call. In fact, in any of the times that you met with or had messages with Lindsay Clancy and she talked about intrusive thoughts or suicidal thoughts, did she ever articulate that she ever had a plan?

No. Or that she ever actually had any intent of completing the act? No. And you're aware that she did have support in the way of her husband and her family, didn't you? I was aware of that. And again, intrusive thoughts, when a person tells you, a postpartum mom tells you they're having intrusive thoughts in your training experience in the times that you've treated moms with postpartum

depression or anxiety or even psychosis. That's a fairly common complaint, right? Yes. And again, depressed and unmotivated, fairly common to hear those from new moms. Yes. And in your experience in treating individuals with postpartum psychosis, whether they hear voices or not, did you ever have any concerns based on your contact with Lindsay Clancy that she was suffering from postpartum psychosis? I did not. I have nothing further. It feels as though she was, doesn't it? Objection.

Hold on. When we do this? Let you get over there, Ms. Rankin, if you can, go ahead. Let me answer your question. I'll answer your question. All right, all right. So did you hear that? Did you hear that question that Reddington slipped in?

It was about, you know, she said she'd never had concerns about Lindsay experiencing postpartum psychosis, but then Redington stands up that you just heard there. tries to slip in that one last question, quote, well, it appears as though she was, doesn't it? Buckingham ejected as you saw that and then Reddington withdrew that question. It was interesting. After that, the judge called court into recess until tomorrow morning. Yeah, it was a big day. We've been hanging out for two and a half hours. A few mic issues.

We've gone through that. Maybe some mispronunciation for me about some testing and drug. that I don't know about doing my best. Thanks everybody for your patience. I am not a care provider, but I'm grateful for those that are in this industry, caring for people. Thank you.

How's everybody snacks, by the way, too? Because I am starving. Did not have dinner before I started this. So let me see, though, a few things that you guys are saying. I want to talk about Patrick. A lot of rumors and thoughts about Patrick out there, like to the point where I'm getting like texts from friends being like, is it true about Patrick?

And there's like extreme things. There's people judging how quickly he got married, one month he met his wife when they moved in together, when they actually got married. Then there are questions about, then there are more kind of odd conspiracy theories that he plotted and planned this, that he has different shoes on and the different surveillance video, that, you know, he was involved. And all I can say is I sat in court the first two full weeks.

I heard the 911 call. I saw the surveillance where he was in going out. But that 911 call, let me. let me just say this. Patrick had no idea. Not only did you not have any idea what Lindsay had done to the children. It was clear it wasn't even crossing his mind. As Lindsay was laying there on the ground, he was so focused on her and her needs. You can tell he just knew his kids were probably okay. He wasn't thinking, are they okay? Are they not okay? Like it's like, I was like anxious. Everybody's like anxious listening to the 911 call because I had no idea how long he stayed

with Lindsay. You don't realize that until you're hearing the call. We know what he's about to find inside the house. It's clear he doesn't. So we're all panicking, listening. I'm actually, I shouldn't have put my feelings on somebody else. I'm panicking, listening to the 911. want to call thinking, oh my gosh, go downstairs, go downstairs, go help the children. He just waits with Lindsay. He's worried about Lindsay. He's not even thinking that the children aren't okay. It doesn't cross his mind even that Lindsay would have done something to them. He's not even thinking, oh, she had bad thoughts. Are they okay? It's just clear. And then, of course, the screams the moment he finally says, I'm going to go check on the kids. Where are they?

Lindsay says they're in the basement. He's like, thanks for being with the wife. I'm going to go check on my kids. Had no idea what he was going to find. Yeah, I believe his life was completely destroyed. He is such a victim in this case, such a victim. And I understand him needing to move on. I mean, I can't imagine the grief and the torment and the pain.

So I just want to share that. I mean, it's one thing to question and speculate about when he should or shouldn't have gotten to a relation. I mean, I don't think it is, but like, go for it if that's what you want to do. But he did not participate in this. I actually find those conspiracy theories just so sad for him. Anyway, I think for me, where I am right now, I thank you again for your varying opinions. it's so clear to me that Lindsay was having severe mental health issues, that she was seeking help desperately.

And it seems like Patrick was trying to help her too. So I guess ultimately the question is, was there psychosis? Was it intrusive thoughts? Was it simply her just wanting to take her kids? with her as she consciously made the choice to self-harm. But I don't think anybody here is questioning, not even the jury, that there were severe, severe mental health issues and that she was absolutely seeking help.

Hearing the messages today between her and Rebecca Gillotta was really interesting, the amount of time she reached out, the amount of contact, the desperation. This case is exhausting. It is. All right. Thank you, Susan, for your super chat. You said, who was the most best, most credible witness?

Will her current treatment come in? Who's coming up to testify? You know, I think ultimately, right now the best witness has been Patrick and then Gelada and Tufts. I mean, Patrick experienced what he experienced. And Tuffs and Jalota explaining the depth of. her kind of mental health crisis. I also think the nanny was an exceptional witness showing how she was separate, you know, someone that wasn't in love with her like Patrick, just someone that

saw her parenting day to day, saw the family dynamics. And she stated she was a wonderful mother sharing who Lindsay was. It was a prosecution witness. We've hardly heard from, I think, a lot of people, I mean, these are the prosecution witnesses that I have been really good and not necessarily for the prosecution, maybe for the defense. But I think the defense witnesses are going to be pretty powerful. And I think Patrick's going to probably have a completely different testimony for the defense that he did for the prosecution. Do I think that the medical system failed her? You know, I'm not a medical care provider. So I don't want to judge. It doesn't. It doesn't. feel like medical providers cared for her, and we're trying to figure it out.

I think one issue that's coming up in this is maybe the way Lindsay Clancy presented. I think that Lindsay Clancy was unique in being a perfectionist, someone that had a lot of knowledge about the medical field being a nurse, and someone that presented calm and steady and stable. Remember how I've always talked about being in that courtroom, just sort of the stoic nature of Patrick of the jury, the flat affect that Lindsay has? And look, like, Lindsay's in a wheelchair. Lindsay's a defendant, and she still looks decently put together, right? I wonder if it was difficult to try to process and understand the depth of her mental collapse due to presentation, you know, what she looked like, how she acted, her flat affect, her knowledge of the medical

system, and how brilliant and smart and knowledgeable she is and how put together she tried to make herself. So I don't know. I don't. I don't. know whether the medical teams or doctors or practitioners failed her. I think that mental health is very scary. I wish that she had been able to stay in a hospital inpatient longer, and I wish that she had been able to get into some postpartum inpatient help. I think that was the biggest thing that was lacking that maybe she could have gotten into that Rhode Island hospital

that they kept recommending because she clearly needed probably more help than doctor appointments provided to probably needed severe inpatient. Joe asks, I do think, or she's, you state this, Joe, you do think Patrick will be called back by the defense? Absolutely. Think about it.

like the prosecution, I mean, this is my issue with the prosecution right now. They've had a lot of witnesses that I think have helped the defense. And they have not given a really solid motive. Like I said, if there was some affair going on, if there was some really solid journal entry from Lindsay or some Google searches that really kind of showed some plotting and planning, like they haven't showed that. And so then the defense is going to pull Patrick Clancy back up. And Patrick is going to give a completely different testimony with Reddington. You know, I wonder who else he'll call back up, but I could see a hung jury too. People aren't ready to accept.

Yeah, mental illness. It's so serious. It's frightening. I agree. And, you know, keep in mind, Andrea Yates, the most well-known case of postpartum psychosis. she killed her five children one by one because she was left alone for an hour. She had two trials. And the first trial, she was found guilty.

So it was only overturned because they were able to show that one of the witnesses made up some lawn order episode or was a law and order. Was that back then, law and order? I think so, yeah. That, yeah, a law and order. episode about postpartum psychosis that the witness had claimed that Andrea Yates had watched us putting in the jurors minds that she had planned this and plotted this and said, oh, I'm going to pull off postpartum psychosis. They proved that that was false testimony,

got a retrial. And then she was found not guilty by reasons of insanity. So Andrea Yates, a woman found that most people accept had post- part of psychosis was originally found guilty. I mean, wow, right? Jesse asks, hidden you crime, how much longer do you think before the prosecution arrest? I don't know. You know, when I spoke to Redington outside the courthouse, like two weeks ago now, he suspected that the prosecution would be winding up last week or this week. It hasn't happened yet. So I don't know. I don't know. You know? I don't know.

Someone says, I'm 32 and vote guilty. She knew what she did was wrong. Someone else says it's infuriating that these doctors keep saying they weren't concerned. Yet Lindsay Clancy was clearly voicing very concerning statements. Why did it take something like this to take her seriously? Yeah, I would say some of the most interesting compelling testimony for the defense today is the repeated intrusive thoughts, Lindsay is claiming she has. And could that have been psychosis and Lindsay was downplaying it?

Could she have been feeling psychosis? What were these intrusive thoughts saying? Did she dare to share what they were really saying? Could she have been avoiding saying that she had these very serious thoughts about harming her children, but not dare saying them because would they take her kids away? You know? But that was compelling to hear the repeated messaging she made to Rebecca Jalada and the repeated worries about, you know,

intrusive thoughts and to the point where even Rebecca Jelot of thought she should be impatient. Many of you are asking about Dr. John. Yes, Dr. John is preparing. Yes, I know that many psychiatrists and psychologists have discussed what they're seeing in the trial. So helpful, all of those mental health experts weighing in their perspective, John is preparing his perspective and he will be sharing soon. I am going to to go eat. I'm hungry. Joe, go eat something more than cinnamon life. Thank you, everyone, for your patience with the mic issues. Like I said, we actually have concluded. It's our beautiful new set, which many of you have said you've enjoyed. Thank you. It's a work in progress. We're

going to be working with the lighting with some decor. There's more coming. But we do suspect this is padded wallpaper. It is audio wallpaper. Thus, we think that in might be affecting the wireless. So we're going to work on that. So thank you, everyone. This case is very traumatizing, by the way, no matter what side you're on. I have a lot of empathy for both of you on both sides, too, and I get it, three children lost their lives. We want them to have justice, a lot of varying opinions on what justice looks like. This is so sad. All right. I see a few more questions, but I'm going to stop here. And I'll see you all tomorrow and we'll talk.

And thank you to our moderators. Thank you, thank you. I know that this case is one of those cases with those sort of strong opinions. I just want to say thank you for those in chat that are being so respectful to one another and the varying opinions. And thank you to our moderators who are managing some strong feelings and emotions in the chat. So, all right. Thank you, gems. We'll see you.

Bye.