Hidden True Crime - Psychiatrist GRILLED in BRUTAL Cross-Examination | Lindsay Clancy Trial Day 10

Episode Date: August 11, 2026

Day 10 of the Lindsay Clancy trial brought an intense cross-examination of psychiatrist Dr. Jennifer Tufts, who treated Lindsay in the months leading up to the deaths of her three children. Defense attorney Kevin Reddington questioned Tufts about all 14 appointments being conducted virtually, her experience treating postpartum mental health conditions, Lindsay’s worsening depression and suicidal thoughts, numerous psychiatric medications and side effects, and information Tufts says she never knew—including alleged thoughts of harming the children. The testimony moved through Lindsay’s hospitalization at McLean, medication changes and her final appointments leading up to January 23, 2023—just one day before the killings. 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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the majority of the day, getting grilled. It was brutal, honestly. Take a listen to this clip. Can you just read this paragraph here for us? No. No sleep last night, falls asleep after 40 minutes, heart racing, severe anxiety, worrying about kids, baby, sleep, yons, but not drowsy, not hyper-pressured speech. What was that? Not hyper, not-p pressured speech is what I meant.

I know it doesn't say not, but that is exactly what I meant. When did you see this that you notice that it did not say not? I don't care what it says. I know what I meant. Yeah. care what it says, I know what I meant. Things got tense in that courtroom between Dr. Tuffs and Kevin Reddington. I have thoughts about today. We're headed into week three of Lindsay Clancy trial. It's Monday. And I'm going to save those thoughts for a little bit later because we

have a lot to go through. Because Monday opened with the defense, starting their cross-examination of Dr. Jennifer Tufts. We knew that was going to happen. Reddington first went over her background, typical. She confirmed that she is a psychiatrist and trained at the University of Vermont from 2014 to 2018. And then she had a residency at Boston Medical Center. Four years, she clarified not to as he tried to claim at first,

rotating through psychiatry, internal medicine, inpatient emissions, emergency evalysis, evals. She said that residents rotate all different aspects of psychiatry as well as internal medicine, so they have a foundational knowledge, right, of all those medical topics. She's also board certified. It's a big deal for doctors. Reddington lingered, though, on the pandemic years, pointing out that much of her residency happened under masks and social distancing. He pushed her on whether she ever touched patients, like shook hands, hugged anyone. She explained that she still worked in person, but some outpatient visits switched to telemedicine after the pandemic,

right? From there, he walked through the transition from residency to becoming fully licensed, pointing out that she received her unrestricted Massachusetts license and board certification in September of 2022. Again, remember, Lindsay Clancy killed her three children January, 20, 23, so shortly after. She told him that she began practicing independently at Aster Mental Health the month before, though, August 22. He kept circling back to how new she was in independent practice, right? Which makes sense. Take a listen to this and then I have thoughts. We'll talk.

So August of 22, you start working at Aster. August of 22, you got your DEA license individually that authorized you to prescribe medication, correct? Yes. And it was when that you saw Lindsay Clancy? I believe our first visit was September 15th. Of? 2022. So you were practicing as a psychiatrist

for a little more than a month? I was practicing independently with my full credentials for about a month, but the training is just immense that goes on before that. Absolutely. Absolutely. It must be. But that's a residency that you're talking about, right? Yes. And you know what a residency, all I know is great is anatomy, but I mean you're working under a doctor, the doctors are supervising you and they tell you what to do and then you report to them, correct?

They don't really tell you what to do. They're there as a resource if you need additional support. But I followed many of my own patients. I was the only person in the room with them. And, you know, my notes were signed off by. an attending physician and that attending was was available for any support it needed. So in August of 22 when you started working at Astor, you actually filled out a form for your advertising. Is that correct? I believe that was handled by other people at the practice. Ah, and who would that be? Well, we have non-clinical staff that hand. the administrative matters. Okay, but you're a doctor and you're out there to the public. You're advertising yourself and your services to the public.

Is that there? I believe, yes. I am not directing the marketing of our office, but yes. Okay, never mind your office. I'm talking about you. You had an ad that was in on the computer, that if somebody wanted to reach out to a doctor, they could see your ad amongst many others, right?

Well, I don't think there was an ad. I think we have a website that had some information about myself. Okay. Now, in August of 22, up until when you saw Lindsay, how many patients in that month or so had you treated for postpartum psychosis? How many patients in a month? Up until that month, please? I'm asking you about Wings, that month.

working in August of 22 or after you are on your own as an employee how many patients have you treated before we've seen as a classic post-a-psychologist well in the span of one month I would say none because it's a very rare disorder okay but it exists doesn't it absolutely and one of the things would be the questions that people hear right symptom of psychosis, absolutely. And that's legitimate, isn't it? It is a legitimate diagnosis, absolutely. Not the diagnosis.

People that have postpartum psychosis hear voices, really not? Many do. The disorder can manifest differently in different people, but yes, many people do hear voices. How about postpartum depression? How many people in that month or so before you, met Wimsy did you treat for post-pattern depression? In the span of one month, it's really hard to pinpoint that. Maybe a couple.

Maybe a couple? Do you recall how long you treated them for? Again, it's hard to really pin down the individuals in a short span of time. Can you tell the jury what you put in your ad or in the Astor website that you indicated that described you? I don't recall. Well, one of the things you did is that you said that you basically were a specialist in the postpartum, people that have them, psychiatry, you indicated that on in the website, yeah.

Are you able to read the actual document? I don't remember example the wording. You've been working now. How many years now? Three since you sold this? Almost four, yes. You haven't changed your ad on the website, have you? I have not personally now. And you've read it probably a bunch of times, right?

I read it a couple times, but I don't spend a lot of time on my website. Okay. Do you recall that you indicated that you were specializing in any particular aspect of psychiaty? Yes. It probably includes a special interest in women's health, in paramedal psychiatry, in trauma-related disorders, anxiety, and, you know, there may be some other things that are mentioned. Yeah, like women that have babies and they're suffering from post-padom depression, right? Absolutely. You empathize that after a month working for Rasta, right? that's listed as one of my interests definitely and again forgive me how many women did you treat for post-partum depression in that month and a half before you met lindsay i don't know maybe a couple

but i've treated i treated many of them in the residency which was just immediately before so when a person needs to see a psychiatrist generally they're not well is that fair Some are not well. It really vary. So when someone comes to see a psychiatrist like you, it's because they need help, right? Yes. And when they come to you because they need help, for example, with Lindsay Clancy, she came to you because of your ad, right? Or your website for Ashton, what you said about yourself.

I don't know exactly how she found us. Well, do you know why she came to see you? I'm not sure exactly. Friday, we spent a long period of time going through your initial or the initial intake that she had to fill up. Is that correct? Do you recall that? Yes, we did. And the district attorney kept asking you, and this is in September 12th.

Is that when that form was filled out? I wonder if she completed the form on the 12th. the agreement was on the 15th. So what does a person do? Do they call you or do they talk to somebody in administration? How do you get the form to fill out? Yes, our administration handles that. And what do they do?

How does that happen? They send them the documents, probably by email, and the patient fills them out. Actually, it might be all within the portal that we use. Within the portal? The patient portal, yes. Okay, and that means that you go online and you can access Astor Mental Health

and then all these little drop-down boxes would come up? Something like that. Are you aware or something like that or are you aware of what it does? So because I don't handle the scheduling and send you a form, I don't know exactly what it looks like. This is the form of giving a person that needs help because they're possibly mentally ill.

Is that right? Yes. And what's important is that I review the forms and we go through in the appointment. Absolutely. Oh, yes. Now, understand that the records, the 219, I believe, the jury will have access to the Tufts records. Okay? You're aware of that, right?

Yes. Yes. Because you have talked to the prosecution about what an exhibit is and you know that your records are now in evidence before this jury, right? Um, if that's what you say, yes. I wouldn't take what I say. Well, I don't know. That's fine.

I don't know the details of how this works. All right. Have you talked to them prior to your testimony? No. You haven't talked to the VA's office? No, not at all. You're a defendant in a very large lawsuit. Are you not?

Yes. You wouldn't happen to be represented by an attorney, would you? I am. And the fact that you have an attorney is you're right under the Constitution. It doesn't mean you're guilty of anything, right? Right. Okay. And you know that the outcome of this case is,

very, very major to the outcome of your loss. I actually know that. Really interesting. Loved hearing a lot of your voices there in chat, a lot of varying opinions. You know, I think this probably is one of Dr. Tuft's most stressful days of her life, thousands of people watching her and judging her on the stand. Did she do everything right?

We'll talk about that in a little bit. But let's talk about Reddington for a little bit. I'm interested to know what the jury's thinking. A lot of you thinking that he was rude, that he was condescending towards or other people thinking he was doing an excellent job for the defense. One thing I also thought was interesting. In fact, I'm going to find this comment. It was a great comment.

Yeah, I want to talk about this. Not sure how I feel about it, but I feel the blame is being put on the doctor. But there's only so much they can do when you go home and your, alone. One thing that I think that Reddington is doing a great job on, and that is from a defense perspective, is you're right, he is placing the blame really on somebody else. It's extra interesting to me because this is a, I always talk about this being a why don't it trial, right? It's not a who done it trial. It's a why done it trial. And yet he's kind of like figuring out a way to make it a whodont.

There's something called Saudi in law, S-O-D-D-I. Some other dude did it, Saudi. And in Lindsay Clancy's case, it's pretty clear who the responsible party is. Everybody's agreed to it. Lindsay killed her children. Yet he is finding someone else to blame, which is typically a good defense strategy.

He's not outwardly saying that, that Dr. Tufts killed the children, but he is certainly implying negligence and care that wasn't appropriate for Lindsay Clancy. Now, the varying opinions here, whether the care was negligent or not is varying, but certainly interesting to see your opinions on this matter. There were some things that I disagreed with that Reddington was saying about her and her expertise and other things. I thought, oh, dear, my goodness. But you're right, four years of residency and four years of medical school.

She's certainly more experienced than most of us in psychiatry, except for the psychiatrist in chat. Anyway, I think other things that Reddington does that are interesting is how he frames things. get into that a little bit later because first, you know, the expert, being an expert, really focusing on her lack of experience. You're right. Everyone has to start somewhere, but she was a new psychiatrist compared to others with years of experience. Anyway, he moved to the intake form. Lindsay filled out on September 12th, the one that the DA had gone through page by page on Friday. He asked how many pages it was. She estimated 10 to 20. He asked who checked the boxes, she said the patient, He asked whether Lindsay disclosed past SSRI use.

She said yes, Prozac in nursing school. He asked whether Lindsay reported side effects. She said no. He tried to suggest that she waited for Lindsay to volunteer information. She pushed back, St. Lindsay offered a lot of information on her own and understood her medical history well. And, you know, she knew that she was talking to a nurse. She is well spoken when it comes to.

medical care, I'm sure. He brought up the alcohol disclosure, the guilt Lindsay wrote about, and reminded her how long the DA had spent on that Friday. She agreed it was part of the pitcher, but not a major concern. And then he dug right into Lindsay's life, her education, her marriage, her three children. He asked whether she knew those details. She said, yes, she did. He asked whether she'd ever met Patrick in person. And she said, no, their one interaction was through telemedicine, which Reddington kept referring to as the TV. That was another great thing that he framed.

It wasn't telemedicine or Zoom. It was the TV. You saw her through the TV. And that became his next theme, telemedicine, aka TV. He pointed out that every single appointment, 14 in total, was virtual. He referred to it as the television. He emphasized the fact that she never saw Lindsay's full body, right? Which means her nonverbal.

She never saw her hands, her legs, any physical tells of distress. She acknowledged that she could not see those things. And I will say this, that is important. You know, I watch trials from home and I watch them in the courtroom. There are things you see in person that you do not see when you're on the television. But she still knew Lindsay was under significant stress. despite not being able to see her. He asked if she could hug her,

and she explained that wouldn't happen in a regular setting in person either. Psychiatrists usually don't hug their patients. And then he asked why Lindsay came to her in the first place. She looked at her notes and she told him that the reason documented in the record was postpartum anxiety. That's interesting. So not postpartum depression, postpartum anxiety.

And then Redington brought in testing. Take a listen. Ice. Post-party anxiety. Now, as a psychiatrist, meeting with this young woman, after a month of so, was working as a psychiatrist or pastor,

there are tests that you administer to a woman who's in post-paround find out what type of anxiety they have, right? There are some screening tests, but the most important thing is what the patient tells you and what my assessment is in the session. I see. And that would carry through the Tufts evaluations for all 14 of those meetings.

What the patient tells you, right? Yes, and what I observe in the session. Through the telephone? Through the computer. What, if you can tell me, is the Heedenberg test? It is a scale that, that looks at symptoms of postpartum depression. And when you administer, that's a major test, isn't it for a doctor to evaluate a patient for

PPD? I wouldn't say it's a major test. It's a pretty big one though, isn't it? It's really one that measures the post-partum depression, right? It's a common one. It's a what? Common. Commonly used. Commonly.

So when you used it on Lindsay, when was that administered to her? I did not use it on Lindsay. Why? We used the PHQ9, which is a depression screening form. That's like generalized anxiety disorder, general depression. It's got nothing to do with a woman suffering from post-tile depression. I disagree. Well, do you agree that people perhaps that may know a little more than you determine that the

Edenberg scale is the appropriate scale to administer it? to a pregnant or post-pirate woman. Yes. You're familiar with the Edinburgh scale, right? I've heard it. And can you explain to me how it's great? No, I cannot. There are 30 questions in it.

Are they not? I don't use this scale, so I don't know how many questions there are. So the Edenberg scale, do you even know that, how about for someone that is depressed in their condition, post pattern would be 15. Anything over that? You're in severe depression. Okay.

You know that her first Edenberg test that was administered to her put her at a 23. Objection. No rule. Severe depression. I was not aware of this test. I was not aware

that this had been administered to her. You know, the testing thing is interesting to me. The Edinburgh scale, I think that not every psychiatrist uses the same testing. That is true, actually. Not every psychiatrist needs to use the same testing, but to not know about it was surprising to me to say she didn't know about that testing because she uses other testing. And I don't think it was a good look. Just my personal, that was personal thoughts. But that was one thing. Anyway, from there,

Reddington tried to paint her as someone who relied too heavily. on what information Lindsay volunteered, although I will say that is oftentimes how psychiatrists learn information is what the patient volunteers. But he asked, but he went for it. He went for it, and he asked whether it was important for a psychiatrist to know a patient's medical history beyond what they say. And she explained that when patients can advocate for themselves, doctors rely on their reports. He asked whether Lindsay was able to advocate for herself. she said yes across every month she treated her he then brought up that word deteriorating which had come up on Friday she classified that it wasn't her personal word choice it was it was a

multiple choice word right it was one of the preset options in the electronic chart she explained that she had to select from a drop down and that specific aspect of the note is a button where you have to click on one of three choices. That opened the door for him to attack the technology, which, yeah, attack the technology, you know. Sometimes I wonder if we're relying too much on technology. He pushed the idea that she couldn't freely write what she observed, that she was boxed in by forms and check marks.

She kept reminding him that the treatment itself mattered more than the formatting, and she also highlighted the standard safety language in her notes, the part that tells patients to go to the emergency room if they feel they might harm themselves and others. And she confirmed that it appears in every visit. He asked about the self-harm hotline, what it was. She explained it was a number for patients in crisis to reach a trained counselor. And then he asked about the therapy component of their sessions. He asked about whether she gave Lindsay therapy and she said, yes, supportive therapy. In other words, listening, validating, offering hope. But he pointed out that this therapy was usually just a few minutes and she told

him it varied. But he pointed out that the records listed 17 minutes. She explained that the 17 minutes referred only to the therapy portion, not the full session. He kept pushing, asking what supportive therapy even meant. She described it as listening to concerns, providing emotional support, validating feelings. She said, in other words, quote, I listened to her concerns and provided support. I tried to provide her hope that eventually things would improve, end quote. Next, he walked through the symptoms, Lindsay reported early on, the anxiety, the trouble sleeping, the postpartum sort of decline, the timeline, the time frame. He asked how long postpartum depression or psychosis could occur. She told them typically within a year, meaning Lindsay was well within that window,

right? Right. Callan was only eight months old. He asked what she diagnosed from September 18th. And she told him that she had diagnosed her with generalized anxiety disorder and in adjustment disorder with depressed mood. And then he moved straight into medication, specifically Zoloft. She confirmed that she prescribed 25 milligrams, 30 tablets. He tried to argue that Zoloft wasn't indicated for generalized anxiety, but she disagreed saying it was effective for generalized anxiety disorder. He asked whether she knew what the manufacturer listed it for, and she said that she was aware it treated various anxiety disorders and major depression, both.

He kept circling back to alcohol, asking whether she was aware. knew what Lindsay drank, when she drank, how much she drank. She told him she wasn't concerned about alcohol misuse and that Lindsay's intake was minimal. She described it as calming for Lindsay. Then came the black box warning. He asked whether she told Lindsay that Zoloft carried a risk for ideation, both suicidal and homicidal. She explained that the warning applied to children and young adults under 24, so she did not emphasize that because Lindsay was older. So he pushed the idea that the risk could extend beyond 24, but she told him she didn't believe there was evidence of that.

He asked what research she had done on Zoloft and ideation, and she said that her training covered SSRIs extensively. He asked whether she had attended postpartum symposiums or continuing education programs, meaning CEs. That's where you get your CEs. She said that she hadn't, but she had done a lot of reading on her own. And then he returned to informed consent. Take a listen to this.

And what is informed consent? What is that in a medical sense, not just like out of the street or something? Exceeding to a patient the risks and benefits of treatment and possible alternatives and making sure that the patient understands what you're saying. Now, when you were going over in the symptomology or when you were going over, with the side effects of Zolov, one of the side effects of Zoloft is, and I quote, severe trouble sleeping, right? Yes. Did you tell her that?

Well, insomnia is listed as a side effect. No, no, no, no, no. You already said yes, you know it. Just did you tell her that Zoloft has a side effect of giving the patient severe trouble sleeping? That's all. So I didn't use the word severe because it typically doesn't cause severe trouble sleeping, but I thought you were referring to when she told me that she did have severe trouble sleeping. Well, that's what she told him, right?

She had trouble sleeping, right? She told me. Yes. And you know that one of the side effects of Zolaf is, let's say, trouble sleeping. You know that, right? Yes. Your answer is yes. The jury has to be able to hear.

Yes. Yes. And why would you prescribe Zoloft to a young woman who's postparticle, who's coming to you with anxiety? We tell her you we can't, she can't sleep. She's got all of these symptoms, and you prescribe a medication that would have any side effect of trouble to see you? So individuals have very varied responses to medications. Some have no side effects. Some have one or two.

it's impossible to predict that Zoloft is a top choice, a first-line medication. It says it's the general consensus. We can't have both of you talk at the same time. So let me finish, could answer, and then I'll give you there plenty of time to follow up any questions regarding the answer. So you finish your answer on that? There's extensive research supporting the use of searcherling in this instance, and the general consensus among psychiatrists is that it's a first line safe medication

for individuals, including postpartum women. How about the kids that shoot other kids in high schools in the lawsuits that come out of that and so a lot? You know about them? No rule. Sorry? You in the answer? I put the sure of the question once. The question was, in response to your observation about all psychiatrists,

a psychiatrist, it's a very, very safe, wonderful first-line drug, and you researched it. How about the kids that kill other kids in schools with the lawsuits that arise out in the use of SSRI? So have you ever researched that? I don't know much about that. You know about the SSRI? and messing with some of the brain they go out and they shoot people for no reason, right?

I'm not aware that that's linked to SSRIs. So you didn't really talk to her about increased risk of suicide. The 24-year-olds are down because she's four or five years older than that. You didn't talk to her about the trouble sleeping that could be a side effect, but describes that there's other drugs that you could have given her that would be perfectly safe in common. and allow someone who knows psychiatric history to sleep better, right? Not necessarily. Okay, so he prescribed her with the Zola.

It was 25 milligrams, right? Yes. And when you prescribed her with the Zola of 25 milligrams, was that increased up to 0.05 milligrams? Did you increase it at some point? The instructions were to increase it to 50 after one week. after one week? Yes.

And you expected that she would listen to your instructions, right? Yes. And she did, right? She waited about a month, but then yes, she did. Why did she wait a month? I think it took her some time to decide whether that was truly what she wanted to do. Right, she was afraid of the drugs, wasn't she? She was afraid of side effects.

And she didn't want to take the pills, did she? She eventually did want to take the pills because she wanted to feel better. A month later, right? Right? Yes. So you prescribe the Zolov, SSRI, and then you tell her after a week to increase it, and she doesn't take that medication for a month, correct? Correct. And then she did take the medication, right?

Yes. And did you meet with her or talk to her before she actually started to end. implement that particular regimen? I had met with her beforehand, but I was not aware of when she made the decision to go ahead

and take it. So, you met her on the 15th of September, right? Yes. When was the next time you met it? Can I check? Actually, you can look at anything you want. September 28th? And on September 28th,

did you discuss with her the fact that she was afraid to take the Zola? Yes. And did you recommend that she'd do that? Well, she said that she was feeling better at that point. So it's a real easy question. When you talked with her, did you recommend that she'd increase or take the Zola? At that visit, I don't think that I did.

Okay. So when did she actually take the Zola? The Zola. She told me in her October 20th visit that she had taken it one week prior. And she told you that when she increased it in accordance with your instructions, she went off the rails, right? I don't think she used those words, but she had. What words did she use for you as her doctor?

She felt awful. Awful. Why did she feel awful? Did she have a stomachache? Did she have a headache? Why does she feel awful? She did have some stomach gigs. She had some diarrhea and had a difficult time eating. She also had increased anxiety. She had some more depressed feelings. She had more difficulty sleeping. And what was your advice to her as her doctor on the 28th of October after she told you about the effect of Zolov's head on it?

I told her to stop the medication. Well, Reddington pushed her on whether stopping an SSRI abruptly was safe. And she explained that at 50 milligrams, it was fine to stop immediately. He asked what happened next. And she said that Lindsay fell back to her baseline, still not great, and was considering it new medication. He asked whether Lindsay had researched medications herself. Tuff said no. And she gave a recommendation.

So he keeps circling back to sleep, right? because we know that Lindsay was not sleeping. And he kept pointing out that Zoloft can affect sleep and that Lindsay already struggled with insomnia. She explained that that side effects are temporary for many people and that Zoloft is still a first line choice. And then he tried to test her knowledge of these medications, throwing out drug names using labor and delivery.

She did not recognize them. And he used that to draw a line between what she used. wasn't expected to know and what she should know as a psychiatrist. She told him she didn't expect Lindsay to understand a lot about psychiatric medications and that it was her job to guide her. He asked whether she knew Lindsay had postpartum anxiety after her second child. She said yes. He asked whether she documented the side effects Lindsay had back then and she said she didn't write them down because they were common. They were temporary. So he kind of explains this though.

another failure saying she didn't remember them because she didn't document them. Yet she prescribed Zoloft again in 2022. Then he moved into the emotional side of Lindsay's symptoms. He asked whether Lindsay used the word overwhelmed during September, October, November. She said yes. He asked whether she believed Lindsay was simply overwhelmed by having three kids. Tuff said no. She knew Lindsay was genuinely struggling. He asked what therapy she gave Lindsay during those months. She said supportive psychotherapy, listening, validating, encouraging. He pushed her to be specific. And she told him, she didn't remember the exact words because they varied by session. And then came December 1st, the first time suicidal thoughts entered the picture.

Tough said Lindsay denied being suicidal. She described it saying, that, quote, she denied feeling suicidal, but felt that she was getting close to feeling that way, end quote. So that she wasn't but getting close to feeling that way. She explained that Lindsay was afraid she might eventually develop those self-harming thoughts. He asked how frequently those thoughts occurred and she said she didn't have the frequency documented, but she usually asked that question. Would you agree with me that many times patients, especially in psychiatric patients, may minimize this entomology.

Patients sometimes do. And sometimes when a woman has just had a child and has other little kids at home, you're worried about the government, taking kids away from them, because you're a mandated reporter, right? You're a mandated reporter, right? I am.

And if she called you, I'm having a suicidal process. close to it and homicide. You'd be quite that, wouldn't you? Not necessarily. I think it really depends on the context, but having suicidal thoughts alone is not a reportable condition. So basically, we know that she was close to having

suicidal thoughts to kill itself, whatever that means. We don't know how frequently she was having them. Yeah? Today, I don't know how frequently. But at that point, I believe I did know how frequently they were. So as a result of that, you then gave a therapy, I imagine, right? You can tell them. Yes.

And what therapy did you give her in November of 22? I gave her supportive psychotherapy. And what does that mean? It sounds great. What do you do? It's listening to the patient and providing... Sorry, listening to the patient. Yes.

when they say they're having oh hold on because sustained next question so you can finish the answer right next question thank you very listening to the patient that would be when for example one of the patients tells you after all the treatment that you have provided prior to that all the symptomology that she had and the son do anxiety and all of that that she's close to having suicidal thoughts. That would I imagine impacted me? Yes. So what did you do

with this psychotherapy? So I provided emotional support and validation and encouragement. What was that me? Something like

I understand this is a very difficult time and it really, you know, it varies on the individual. Sure. How about my answer? I don't remember the exact therapeutic words that I used. Okay. How long did you give the third?

How long did you give the therapy? Validation and all that stuff. I don't remember exactly the duration. Be about ten minutes? Maybe. Through the television, right? Good. So, as we pointed out, you tell the people,

they come to see you, when I say you, I mean collectively asked their medical, that you would expect that if a person is in crisis, as you guys say, or is suicidal, that they would have to go to a computer or their cell phone, right? They would have to punch in your office, right? Look up the number. We advise them to call 911 or go to the emergency room as quickly as possible. How about suicide hot ones? You give them advice to call them? That's an option as well. Sure. Did she call suicide hotlines? I was not aware that she did. Did you ever ask her?

I don't think I specifically asked that question. Call her specifically. Did you ask her anything to be around the bush? Maybe you asked her anything about suicide hotlines? I don't think I asked her about suicide hotlines. Would it surprise you to know that she called suicide hotline in that time frame, not once but twice when he was turned away? You guys were in the front lines, aren't you?

It does surprise me, yes. It does what? It surprised me that she called them twice. And you never asked her if she had ever called a suicide by the way, you did you? I don't think that I did. You're a doctor. You were trying to do it like that. You obviously, this is just horrible, is it?

Yes. She continued on with her treatment. with you, correct? Yes. Well, after that, he moved into medication changes. On October 21st, she prescribed Ativan. On October 26th, she had abuse boron. And then he asked about side effects.

And she said, Buesprone was generally mild, maybe tiredness, dizziness, or an upset stomach. He asked whether Lindsay was taking Atavann at the same time. And she said, yes, and that Lindsay was compliant. Tuff's also agree. that Lindsay had been taking Benadryl as needed over the counter one dose at a time. Reddington pushed her on whether she asked if Lindsay ever increased it. She said she didn't remember asking.

Then he went into the interaction between Benadryl and Ativan, pointing out that the combination can depress the central nervous system. She tried to explain the nuance, but he cut her off, insisting on a yes or no answer. He asked whether she discussed that interaction with Lindsay on October 26th. She said that she did not recall. And from there, he circled back to those thoughts of self-harm. On October 26th, Lindsay denied ideation. And Tufts had it documented exactly that way.

Patient denies ideation, self-harm ideation. He tried to draw a sharp line between ideation and being close to those self-harming thoughts and reminding her that Lindsay had told her she was close to feeling, self-harming things, feeling suicidal at the previous visit. He asked whether she followed up on that, and she said yes. And Lindsay told her that she wasn't feeling that way anymore. And then he asked about how long that appointment lasted. She said that the full visit was 25 to 30 minutes, even though the therapy portion was shorter.

Then he moved into hydroxazine. She prescribed that on October 26th as an alternative to Benadryl. He walked through the list Benadryl, Ativan, Bustboron, hydroxazine, basically a cocktail of interacting drugs. She explained that they weren't meant to all be taken at once. He asked whether she ever told Lindsay to keep a diary of her medications or side effects. She said that she didn't instruct her to do that. He asked whether she recommended it.

She said, no, remember Lindsay did it, though, for her. herself. She explained that they met frequently and went through everything during their appointments. He painted the picture that Lindsay was getting worse heading into November, crying more, more anxiety, more insomnia, brain fog, and worrying about self-harm. Tuss didn't recall those symptoms being significantly exacerbated in that exact window. He asked about brain fog, and she described it as a subjective feeling, something like slowed thinking or trouble-finding words. He asked whether she considered brain fog a potential medication side effect, and she said it depended, because brain fog can also be a symptom of depression. But that note belonged to

Lindsay's therapist, not Tufts. So the next time Tufts saw her was November 2nd. And on November 2nd, Lindsay told her she was hesitant and scared to take buzprone and hydroxazine. He asked whether she counseled her about that fear. She said, yes, explaining the risks like sedation or dizziness. And then Redington asked whether she asked about suicidal thoughts at that visit. And she said, yes. And she denied. She didn't remember the exact phrasing, oh, more feedback issues.

But they discussed self-harm directly at that moment. He asked when those thoughts came up again and she told them it was December 1st, the same date that she had mentioned earlier. and then he moved into Remmeron. She had discussed it with Lindsay as an alternative, but did not prescribe it. He asked whether she recommended it. She said no, explaining that medication decisions were collaborative, right? But ultimately, Lindsay's decision.

And next came the November 22nd appointment. Lindsay told her that she'd gone to South Shore perinatal clinic. Tuths said that Lindsay explained that the clinic specialized in perinatal conditions. He asked whether she knew the name. of the provider. She said Lindsay mentioned Julie Paul. And then later, she heard the name Nurse Jalotta. He asked whether Lindsay was still using Atavann and Benadryl. She said yes. He asked whether she told Lindsay to taper off Ativan. She said that she had asked her to taper off the Ativan, reducing it by 0.25 milligrams every two weeks. He asked whether Lindsay followed that

taper. She said Lindsay had not fully stopped. He asked whether Lindsay had gone to any emergency rooms. She said that she knew Lindsay went to Mass General for depression and was discharged without being admitted. He asked whether she had access to South Shore's records. She said no, because they were a separate clinic. And so then he asked whether Lindsay could have signed a release. She said yes. He asked why she didn't request the records. She said that she didn't feel it was necessary because Lindsay provided detailed information about her treatment there. So he challenged whether Lindsay was an accurate historian given her mental state. And Tuft said, Lindsay recalled medication names, doses, and dates with precision, which

showed that she was capable of providing accurate information. And then he asked how many times she spoke with Lindsay's husband. She said, only once during a telemedicine appointment on December 16th, or as Kevin Reddington says, the television. And that's where the judge paused things for the morning recess. and then when court came back from recess, Redington picked up right where he had left off drilling into the October 20th appointment the day Lindsay told Dr. Tufts that increasing her Zolop dose had sent her spirally. Tuffs looked at her notes and walked through what

Lindsay had reported. She said, quote, she felt awful, couldn't sleep, had insomnia, didn't want to eat, was having diarrhea, more depressed, crying all day yesterday, mental fog, terrified to start something new, was all in quotes. Her anxiety had spiked too. Lindsay told her that racing thoughts kept her up overnight, that she felt paranoid she might get self-harming thoughts, that she don't want to be alone because she feared something bad might happen. Tofs agreed she was concerned. She said that she gave Lindsay therapy alongside the medication discussion, listening, validating, trying to help her process everything she was feeling. Lindsay also told her that her mother was coming to stay with them. Tuff said she knew the mother was coming to provide support, but she didn't know

how long she stayed. She said Lindsay would still able to advocate for herself, so she did not typically reach out to parents of adult patients. So after hearing how badly Lindsay reacted to Zoloft, Tuft stopped the medication and planned to monitor her closely. She saw her again the very next day, October 21st. She also recommended fish oil and other natural supplements. And she started looking into other options like IV infusion treatment for postpartum depression. She explained that Zolresso required a 60-hour hospital stay and wasn't something that she could prescribe herself. She said that she researched where it was offered, women in infants hospital in Rhode Island, but she never accessed their records and never formally recommended the treatment. She said,

Lindsay later attended a partial hospitalization program at the same hospital, and she advised her to discuss this infusion therapy with them. Reddington pushed her on why. She didn't request records from women and infants. She said Lindsay didn't receive treatment there, so she didn't think it was necessary. He pushed again, asking why she did not request records from South Shore perinatal either. She said Lindsay gave detailed information about her treatment, so she felt she had what she needed. Then he moved to October 26th. Lindsay told her she felt back to where she'd been before Zoloft, still not great, and wanted to consider a new medication. Tuffs, that's when Tuffs added abuse prone, continued ativan and added hydroxazine as needed. She said that she discussed

side effects. She also mentioned Remmeron. And as a future possibility but to not go into detail. And then, again, came Halloween, October 31st. So here you have a patient who's already reported to you as a psychiatrist that she's got suicidal ideation, worried about suicide, worried about killing herself days before October 31st. And a suicide assessment was done by McAllister, right? I wasn't there. You would have to ask her. Oh, maybe I will. If she comes in, why don't you tell me what the record shows?

Did they do a suicide assessment? Did she check off the little boxes? I'm looking for that section. It says that patient denies suicidal or homicidal ideation at this time. Okay, so again, this is on October 31st, right? Yes. within a period of a couple of days in meetings with you that McAllister has access to because the

records are within your business, right? It's not my business, but yes. Has reported suicidal ideation and fear and dwelling about killing herself and afraid of those thoughts, right? I just want to be absolutely clear. So yes, you know, a little while earlier she had voiced those concerns. Right. So as a result of voicing those concerns, is it your understanding that McAllister did not do any of the suicide assessment questions

because Lindsay reported that she wasn't suicidal? it appears that she asked about suicide. You already told us that. I'm asking you about, excuse me, she said, hold on. Asked this question, good. Thank you. I'm not asking you, you've told us three times now, that she says she was not suicidal when she spoke to McAllister.

I'm asking you about the suicide assessment for the third time. You see it in front of you? Yes. Okay. Can you tell me, did Lindsay answer any of the, questions that were asked over the two pages, possibly three of the suicide assessment. Yeah, three. Done by McAllister.

I don't see anything written here. So was there a suicide assessment? I don't know because I wasn't there. I don't know what the conversation was. And you don't know from looking at the records, right? From looking at the records, I don't see evidence of additional suicidal questions beyond asking if it was there or not. So a suicidal assessment doctor is in the medical records.

It consumes almost four pages, does it not? Yes. Okay. And all of the questions, like asking, have you felt life is not worth living? Is death something you thought about recently? Are you dwelling on that? What leads up to the thoughts? What are the thoughts?

All those questions, right? For four pages, right? Yes. And there is not one notation indicated that that test was ever administered to her on October 31st, correct? Correct.

But it looks like it was asked in other way. From there, he shifted into metabolism asking how she determined how Lindsay's body was breaking down psychiatric medications. And she explained that psychiatrists don't typically test metabolism directly and that blood tests

aren't used for that purpose. He asked about genetic testing. Specifically, the CYP 450 system, she said that the testing existed, but wasn't clinically useful enough to guide medication choices, and he asked whether insurance covered it. She said sometimes.

He asked whether she used it. She said no, because it wouldn't have changed Lindsay's treatment. He then moved into thyroid function. She explained that thyroid levels don't impact her evaluation of postpartum depression. He asked whether

she knew about the peer-reviewed study on thyroid function and postpartum psychosis. She said no. He asked whether she'd written any articles on postpartum depression, anxiety, or psychosis. She said no, explaining she was a clinician, not a researcher. Reddington kept pressing on what he saw as gaps in Dr. Tubbs' medical investigation. He asked whether she'd read specific articles about thyroid function and postpartum psychosis. She told him that she had read many articles over the years, but not that particular one. Then he went back to the idea that she had not ordered blood tests or the P450 testing.

She told them again that those tests would not have changed treatment because they don't yield clinically useful information for psychiatric medication choices. Well, then he pivoted and he pivoted to thyroid levels. Asked whether elevated thyroid numbers would matter. She said, if she learned a patient had abnormal thyroid levels, She advised them to speak with their primary care doctor or an endocrinologist. He asked whether she ever recommended that Lindsay see an endocrinologist. She said no.

He pointed out she wouldn't have known whether there was a thyroid issue because she didn't order blood test. She told him there was no clinical reason to order them. And from there, he moved into the November 2nd appointment. She confirmed that she still diagnosed Lindsay with generalized anxiety disorder and adjustment disorder with depressed mood. She noted that Lindsay's condition appeared to be improving. She documented a taper plan for Ativan, decreasing to 0.75 milligrams for two weeks and then

0.5 milligrams for two weeks. She also noted the standard emergency instructions. Go to the ER. Call 911. Call the hotline if she felt at risk. In other words, she had options. He asked whether that emergency language was just a button she pressed, but she said it was advice given to every patient.

He pointed out that she had discussed four possible medications on November 2nd, Remmeron, thrasidone, hydroxazine, and I'll work my best on this one, pregabble. Pragabolin, pregabalin, hydroxazzoidone, remerom, and pregabalin. And she said that those were just options that they were considering, not medications that she was starting, just they were talking about them. then we get to November 22nd. She confirmed she asked about self-harming thoughts and that Lindsay denied them.

He asked about whether she asked about how things were going at home with her parents staying there. She said that she didn't think she asked. September 1st was the next appointment. And by then, Lindsay had transferred to South Shore perinatal. Tufts reminded him she did not have access to those records. She only knew what Lindsay reported. Lindsay told her that she had tried tapering Ativan, but that's when her sleep worsened, which means adivant was helping her sleep. She had tried Trazadone between 50 and 150 milligrams, another

medication that's supposed to help you be able to sleep. It didn't help. She tried Remmeron. She tried Prozac 10 milligrams, but couldn't sleep and had worse sleep. So that was stopped. She was also on Clonopin, and then came the intrusive thoughts. Those intrusive thoughts. Tufts describe them as worse depression and intrusive thoughts feeling like I'm going to die. Lindsay told her she was close to self-harm ideation and feeling hopeless. Hopeless is frightening. Tufts documented it exactly that way too, writing, quote, denies ideation, but yesterday close to it,

feeling hopeless, end quote. That's what she wrote. She said she gave therapy, validation, reassurance, reminding Lindsay that there were treatment options like partial hospitalization programs. He asked whether she ever suggested Lindsay come in person instead of telemedicine, aka the television. She said no. She didn't feel like she was missing anything by seeing her on video.

He asked whether COVID was over by then. She said people were more comfortable than, yeah, meeting and person, but it was still something that they thought about. He pointed out that her notes said they discussed Syriquil. She said they talked about it because Lindsay's other providers had recommended it. Siriquil is, again, it's an antipsychotic. He asked whether she discussed undiagnosed bipolar disorder. She said yes, actually, to that, because Lindsay had extreme reactions to the SSRIs and severe insomnia, which would maybe point, right, to undiagnosed bipolar disorder. Her note said, quote, also discussed the possibility of undiagnosed bipolar disorder given extreme reaction

to SSRIs and insomnia. She wrote that. He asked whether she diagnosed bipolar disorder. She said, she said no. Lindsay never had mania, she said. He asked whether she discussed a drug called Limitl. Lemictal, thanks guys, limitle. She said, yes.

explaining that it was used for mood disorders. He asked what the plan was after that December 1st appointment, and she said she wasn't prescribing medications at that point. But she recommended a partial hospitalization program at HRI in Brookline. Lindsay ultimately went to the women in infants hospital for one day. We know that. Those were the records tough, though, did not have because she never got those records. he asked whether she used the DSM-5 criteria.

She said yes, that's for psychologists and psychiatrists. He asked about the difference between mania and hypomania. And she explained that mania requires seven days, hypomania, four. And then we're to December 16th, almost a month away from the horrific day. A little bit over. Lindsay told her then, just a little over a month before that day, that she was having a really rough time. Tufts added that she was sleeping but still feeling poorly.

He asked why she mentioned sleep and she said it was an important detail. She read from her notes again. Quote, very depressed during the day. No motivation. Some SI, meaning self-harming ideation, went to MGH emergency room or SI. So she goes in the ER for that. declined inpatient, feeling hopeless, feels like depression related to Syriquil, end quote. That's fascinating.

He asked whether some SI meant, right, that ideation. She said yes. So in other words, she went to the ER for that because that's how bad it was. He asked what this ideation meant in this context. And she said she asked Lindsay follow-up questions, whether she had intent, or a plan to follow through. Lindsay denied both, no intent, no plan. He asked what therapy she gave.

She said she explored what those feelings meant and discussed what to do if they worsened, like going to the ER. He asked whether Syracwell came up. She said, yes, they talked about it, but she wasn't prescribing it. He asked whether she knew Lindsay had confessed to her husband that she was thought of harming the children.

And she said no, she did not share that with her. He asked whether she would have been concerned about that. She said, yes. He asked whether she would have called DCF, you know, Department of Children and Family Services. She said that she might have, which I'm going to pause and point out. That's one reason some people don't fully share everything going on in their lives

because if Lindsay's feeling like a terrible mother and she has thought of harming her children, and the last thing she's probably going to want is DCF showing up at her house, right? Anyway, I'm not saying that's why she didn't mention it. I don't know why she didn't mention it. I'm just saying that sometimes that is why people don't mention it sadly when they are there to help, right? And DCF could have helped.

Anyway, then Kevin Reddington asked whether she had ever talked to Patrick Clancy again. And she said, no, he never called her. and she only spoke with him once during that telemedicine visit that she believed was December 16th. He asked what Lindsay told her about being depressed that day, and she said that Lindsay told her she was having a really rough time. Her affect was flat. It's almost what she's like every day in the courtroom. Her mood was depressed. He pointed out that her template included a section for recent lab work. She explained that Astor didn't have a lab. The template auto-populated with, quote, no lab results found.

He asked what, quote, symptom reduction and improved functioning meant. So she explained it meant fewer mental health symptoms and better day-to-day functioning. Then he asked whether she told Lindsay that. She said yes. Then he asked what she actually told Lindsay that day and she said, she told her to go to the partial hospitalization program, like go there. And if she felt at risk of hurting herself or anyone else, she should go immediately to the emergency room. So by the time the questions got to the December 16th appointment,

the pattern was familiar. Lindsay sat in front of her computer, exhausted and overwhelmed, and Tufts tried to figure out how to help her through a screen. That visit lasted about 30 minutes. Tuff said the therapy she offered was in the conversation, which included reassurance, validation, guidance, the same recommended emergency instructions that she always gave when someone was struggling. The plan that day was for Lindsay to follow up with women in infants hospital. Tuff said that she believed Lindsay did go, but she didn't know the exact date.

she also noted that they were considering another drug, bruxanelone, the infusion in Rhode Island, but that never materialized. Her notes from that day showed a few medication changes that LeMictal was started at 25 milligrams. Syracool continued, and Lindsay told her that she was on 200 milligrams prescribed by another provider. Tufts didn't verify the bottle or even call the pharmacy.

She simply went by what Lindsay reported. The standard emergency language appeared again in the note. The part that says if she has urges to harm herself or if she has urges to harm others, she should call 911 or the crisis hotline. That template showed up in every visit. When Reddington asked whether Lindsay's parents were still staying with her, Tuft said that she was not sure. He asked whether she ever reached out to anyone besides Lindsay to understand how she was doing.

again she said she only spoke to Patrick Clancy once. She remembered him saying Lindsay wasn't doing well and that he believed Syracool was making things worse. She said that he may have said she looked like a zombie. After December 16th, the next appointment was January 6th. Tufts explained that Lindsay likely scheduled that one herself, usually the hospital coordinates discharge appointments, but she wasn't certain.

Lindsay had just spent four and a half days in the locked unit and McLean. She admitted herself because she was not doing well. So in other words, she took her advice. She went herself to inpatient. And Tufts had McLean diagnosed her with major depression, major, which was different than what Tufts had diagnosed her with. They discontinued the serial. She received a discharge summary, just a couple of pages, not the full records. She didn't speak to the doctor who discharged Lindsay.

She said she didn't know Lindsay was hospitalized until after she was released. And then on January 6th, getting near to this day, it's heartbreaking day, January 6th, Lindsay told her she was still numb, still struggling after being hospitalized, still unable to sleep consistently. She was taking adivant and tracidone. The tracidone was increased. And then three days later on January 9th, Tufts prescribed diazepam. On January 12th, she prescribed transidone. and 150 milligrams. On January 16th, she prescribed amytryptylene and antidepressant. She explained

that it was older, but effective for depression, anxiety, and insomnia. During that January 16th visit, now we're getting to that week, terrific week. The January 16th, Lindsay tells her that her mood was very low. She had no motivation. She felt numb. She could force herself out of bed, but only for basic tasks. Remember, Patrick referred to her as a zombie. That's so telling. I want to talk about that in a little bit. She said caring for the baby felt forced. Tuff said she believed that Lindsay was honest and forthright throughout their treatment. She didn't think Lindsay was lying to her. January 16th note showed a diazepam taper, five milligrams for the last two nights, four hours of sleep, followed by light sleep.

Lindsay denied either ideation that day, and Tufts recommended a low dose of amatryptylene for depression. They also discussed exploring ketamine treatment. So then Reddington asked whether Tufts knew that Lindsay was researching medications constantly, looking at drug interactions, ketamine and other treatments. And she said no. She had not asked. January 23rd, the day before. the day before.

January 23rd, Friday you testified that she said her mood was depressed and you noticed that her effect was depressed and flat, right? Yes. She also reported that her heart was racing, right? Yes. She had no motivation, is what she told you, right? Yes. She told you that she had been feeling numb and no emotion for 17 days straight is what she

told you, right? I'm not sure about 17 days straight, but that's how she was feeling. You didn't reach out to her mother and father at that point. They didn't call you, I guess, right? No. And Patrick couldn't call you at that point, right? No. So she's sitting in front of her computer getting help from her doctor on January 23rd. And what did you do? Well, I thought about how I could best help her the medicines that she tried and what her current symptoms were. And it made sense to slowly titrate the amyptylene so that we could get her to a dose that reduced her depression so that she would feel better. It increased the amyptorylid. Yes.

That pushed you over the eggs, isn't it? I don't think so. And that's where the court broke for the afternoon recess. Don't worry, broke for the afternoon recess. We're still going. I mean, it was the longest cross-exam. Like, clearly, Kevin Reddington is showing his hand at what his defense is going to be by cross-examining this witness for so long,

but a very, very important witness. Because if she's going to be not guilty by insanity, her mental health doctor is everything, right? So after lunch, though, ADA spray gets up for redirect because we just spent the whole morning with Kevin Redington really pushing Dr. Tufts. So Sprague stood up for redirect. And she started by going back over Tufts training. It was kind of like deja vu of Friday for a little bit. She starts pointing out that even during residency, Tufts was already a doctor.

That is true. responsible for evaluating, diagnosing, and treating patients on her own. That is a fact. She explained that she wasn't sitting in a room with someone telling her what to do. She handled her own cases. And if she needed guidance, she could consult an attending physician. She told Sprague that she had treated thousands of psychiatric patients over those four years. Sprig walked her back through the postpartum experience she had during residency.

The elective she did with a perinatal psychiatrist. the year that she spent in the clinic seeing pregnant and postpartum women. Tufts explained that she followed those same patients over time, evaluating diagnosing and treating them throughout their pregnancies and postpartum periods. Sprague asked about postpartum psychosis, how rare it was. Tough said she didn't know the exact statistic, but it was low. She said that she had treated many patients with other forms of psychosis, and that psychosis presents in similar ways,

regardless of the underlying cause. She described what she looks for, appearance, engagement, speech, thought patterns, bizarre or paranoid content, signs someone may be responding to things that aren't there. She told Sprague that she never saw any signs of psychosis in Lindsay, and Sprague also addressed the COVID questions from cross-exam. So she asked, whether mental health issues stopped during the pandemic. It's toughs that, of course not. In fact, they probably worsened during the pandemic, right? They, you know, they were definitely getting worse for many. She confirmed she still set patients daily during the pandemic,

including outpatient care for three of her four residency years. And she explained that telehealth became a standard since COVID, widely accepted in psychiatry. She said that talking through a screen did not change how she asked questions or how she heard the answers. Sprague pushed back on the idea that Tufts couldn't see movement below the waist. Tuff said that she could still see signs of agitation elsewhere, bouncing, fidgeting, movements that reverberates through the body. Then Sprague moved through the Edingberg scale,

right? The Edenberg scale is important. It's a testing for postpartum depression, 10 questions. Tufts not only doesn't use it. She implied she didn't know what it was. So Tufx explains that Aster use the PHQ 9 instead. That can be a replacement for generalized depression, not postpartum, but generalized. And she used that instead because she chose it, but because also that it was standard practice. The PHQ 9 screens for depression. It can screen for postpartum depression too. And postpartum depression is still depression.

the symptoms do overlap. She said that she combined the pH Q9 with the patient's history to make her diagnosis. I will just throw out that that is true, it can be in replacement. But the Edenberg scale is only 10 questions. It could have easily been added. But anyway, we'll keep going. Brigg asked about the importance of accurate history. Tuf said it was critical because treatment decisions depend on what the patient reports.

She explained that nurses like Lindsay tend to understand how important accurate reporting is. She also pointed out that Lindsay advocated for herself. Lindsay was scheduling appointments, right? Lindsay was going to the ER when she felt she needed help. That was a sign that Lindsay was capable of getting help and knowing what she needed. So Sprague then asked about therapy. Tuff said therapy is mostly listening, right? It's understanding what the patient is feeling.

She said that she encouraged Lindsay to attend individual therapy throughout their time together. She pointed out that Lindsay only saw the therapist. twice. Sprague then addressed Zoloft. She asked whether it was commonly used in generalized anxiety disorder. Tuf said yes, because it's effective, because it's safe. She clarified that the warnings of self-harm applied to children and adolescents up to age 24, Lindsay was 32. She explained that stopping Zoloft at 50 milligrams did not require tapering because it was still a low dose. Sprague highlighted that Lindsay waited a month before taking Zoloft and only took it when she decided she was ready. She said Lindsay made her own decisions and that was part of her ability to advocate for herself.

Sprague then decided to get into the intake form. Lindsay had filled out on September 12th. Lindsay had listed past anxiety. She listed postpartum anxiety. She listed Prozac and Welbutrin and marked both medications as effective. with no side effects. The Sprigg used that to counter the idea that Tufts failed to document history. And then we're to October 20th again, the October 20th appointment.

And on this redirect, the one where Lindsay describes her reaction to Zoloff, Sprague asked whether Tufts documented the side effects. And Tuft said yes, and then she read them out loud. Quote, couldn't sleep, insomnia, doesn't want to eat, diarrhea, more depressed, crying all day, mental fog terrified to start something new. End quote. She also documented Lindsay's fear of getting suicidal thoughts. Take a listen.

Start something new. And so you did document the side effects that she reported to you, correct? Yes. You also documented in the interval history paranoid of getting suicidal thoughts. Was that the defendant's phrasing? Yes. And is there a difference between someone being warm, worried about having suicidal thoughts and someone actually having suicidal thoughts?

Yes. And what's the difference in terms of how a psychiatrist sees it? So that's the difference between what a patient might answer and then what the psychiatrist actually assesses. So a patient might say they're having suicidal thoughts, but when they describe them, they're not actual suicidal thoughts. their fears of suicidal thoughts. So that's the difference there. I'm sorry, I think I forgot exactly what your question was.

What's the difference in your training and experience between someone having fears of suicidal thoughts and actually having suicidal thoughts? Well, so if it's a fear, then it means that they're not actually having suicidal thoughts. It's a negative. And does that affect the way you proceed with? treatment? Yes, in some ways, yes. How? Well, you still proceed with treatment. It's still concerning, but it is a level of concern that can be managed on an outpatient basis, not requiring hospitalization. And so, according to the defendant, she was not yet having suicidal thoughts

at that time. Yes. So when defense counsel asked you repeatedly why you didn't document how many time she had those thoughts, she hadn't had those actual thoughts yet, correct? Correct. That was later in December. Is that right? Yes. Now, she also told you that she was worried about something, that something bad might happen, so she arranged for her mother to stay. Is that correct? Well, she arranged for her mother to stay. I'm not sure if that was because she was afraid something bad was happening, or it just seemed like they needed more help. Okay. So you don't recall the two being together as a thought? Correct. And the fact that she was struggling and arranged to have her mother stay, got support, advocated for herself. Would

those be protective factors? Yes. How so? So if someone demonstrates that, that they can advocate for themselves, that they can seek help if symptoms worsen, then that shows that they have good judgment. They can be trusted to present for care if, you know, serious safety concerns were to arise. So based on your training experience with Ms. Clancy, where she says she's having, she's worried about getting suicidal thoughts and she has her mom, come stay with her. Do you see that as a positive decision? Yes. You were asked about not asking the defendant if she had called a suicide hotline.

If a patient denies suicidal ideation, would you typically ask them if they had called a suicide hotline? No. And why not? Because I, you know, I wouldn't think that they would have, you know, if a patient were to call a suicide hotline. I would think that they would be telling me they're having suicidal thoughts as well. So Sprague clarified the medication instructions. Ativan is needed. Use prone daily.

Hydroxazine is an alternative to Ativan. She asked whether Tufts ever instructed Lindsay to take all three at once and Tuff said no. She asked about the Ativan taper. Tufts explained that Lindsay expressed concern about long-term use. They discussed it and they created a taper plan together. Sprague used that to show Lindsay was engaged and thoughtful about her treatment. Sprig asked whether Lindsay ever told her about the ER visit on November 16th, the Trazidone prescription or we're trying weed gummies. Note that weed gummies.

Tuff said no. She said she had no way of knowing things the patient didn't report. But then we get to December 1st. So take a listen to this. Now on December 1st, 22, defense asked you about that date. That's the date that she again said she had the fear of thoughts of suicide. Is that correct? Yes. Up until that point, had she consistently denied suicidal ideation or intent or a plan? Yes.

Had she consistently denied homicidal ideation intent or a plan? Yes. What's the difference? Well, let me ask you this. When you talk to a patient, do you ask them, do you have suicidal ideation? Not usually. Not in that way. How do you get that information from them?

What types of questions do you ask? It depends how the course of the conversation is going. I might ask if they're having thoughts of hurting themselves, if they sometimes wish that they weren't alive. It can be a lot of different words. And sometimes I use the patient's own words. but things like that. And is there a difference between having thoughts of a suicide versus having the intent and a plan to do it? Yes.

And are there different types of treatment or things that you would do if someone has intent or plan to do it? Yes, that would generally require hospitalization. And so if Ms. Clancy had told you she had thoughts of hurting herself, or actually, straight that, if she told her, you that she had a plan to hurt herself or a plan to hurt her children, would you have moved to commit her? Yes. So Sprague addressed the October 31st therapy session. She asked whether there was any reason to administer the full ideation assessment if Lindsay denied ideation and Tuff said no, because someone denying ideation would deny every detail in the assessment. And then Sprague asked about bipolar disorder. Tuf's explained how she evaluates mania. And mania is,

described she assesses it as fast speech, loud speech, hyperactivity, inability to sit still, jumping from thought to thought. She said she never saw any signs of mania with Lindsay. Once redirect finished, Reddington, right back up in, right back in. He started with the HIPAA issue. Spragut asked why Tufts didn't reach out to Lindsay's parents or Patrick, right? And Tufts explained that she didn't have a release. Well, then Reddington seized on that. Like, we knew that. Like, when you say you'd have a release, why not?

He asks whether she even asked Lindsay to sign one. And she said no. So he really pushed this idea that even without the family calling her, she could have reached out if she had had permission. Tufts repeated that wasn't typical to contact family when an adult patient could advocate for themselves. Okay. He pressed again, though, asking why she wouldn't call the parents who were living with her and helping her. She stayed with her answer. Lindsay was able to speak for herself and she was forthcoming, an adult patient. So she wouldn't typically call the parents. And then Reddington brings up that marijuana. Remember when I said, remember weed gummies? Well, Sprague had asked whether Lindsay had ever told her she used gummies, weed gummies. Plural. And Tufts had said no. Well, Reddington pointed out the spray could use the word again,

gummies, plural. He asked whether Lindsay, he asked whether Lindsay had ever told her she used marijuana at all. She said no. And he reminded her, though, that she didn't have the women in infants records. And then he introduced them. Here they are. Here's the records of the marijuana, the weed gummies. And it states, are you ready for this? It states in the record. Quote, in the middle of November, she tried taking a marijuana edible, a marijuana edible, to help her sleep, which costs her to have increased anxiety and palpitations, end quote. So he used that to show that it was not multiple gummies. There was no plural.

It was one. And Lindsay had not told her about it. So then from there, he went back to ideation, self-harm thoughts, versus having self-harm plans and he explained to her again what commitment the difference between a thought and a plan right she told them a plan meant knowing exactly how one intended to follow through with the ideation their method the timing something researched and imminent that would require hospitalization then he revisited the thyroid questions break had said lindsay's thyroid levels were normal at South Shore and Brigham.

Reddington asked whether she remembered that. She said yes. He asked whether those were old readings. She said she didn't know. Then he got into pressured speech. Remember how we started this episode? It's live about the pressured speech. So he reminded her that she had testified repeatedly

that Lindsay never showed pressured speech. He pulled up the October 21st record and had her read it. Take a listen and I'll talk about it. So forget all about my sloppy writing. I'm looking here on October 21st of 22. Is that correct? Right up there? Yes.

Yes. And can you just read this paragraph here for us? No. No sleep last night, falls asleep after 40 minutes, heart racing, severe anxiety, worrying about kids, baby, sleep, yawns, but not drowsy,

not hyper-pressured speech. What was that? Not hyper, not-pressured speech is what I meant. I know it doesn't say not, but that is exactly what I meant. When did you see this that you noticed that it did not say not? I don't care what it says. I know what I meant. Well, when you wrote this, you did not say not pressured speech.

You said in the medical record pressured speech, right? No. Just say that. Yeah, the word is, the word not is right before, not hyper, comma, pressured speech. The two are following the knot. When you put down in a medical record, heart racing, comma, severe anxiety, comma, worried about kids, comma, baby, comma, sleep, comma, yawns, but not drowsy, period. Not hyper, comma, pressured speech.

That's what you wrote, right? She did not have pressure speech. I wrote that, but you're misinterpreting my note. Am I reading this correctly and the jury will be able to look at it, that you put not hyper, pressure in speech. Did I read that right? Yes, but your interpretation is incorrect. As opposed to you.

Go ahead. Just in regards to what was raised in. Yes, just two brief. Approaching you with your records from October 21st, 2022, the section labeled speech, where there are all the boxes where you can put pressure, word salad, all of the different things. What do you check off for speech on October 21st, 2022?

Appropriate. And defense asked you about the byword levels. Was it, would it be accurate to state that I asked you if you were aware that her levels were not? normal of Seltzer Hospital and Brigham and Women's Hospital? Yes. And your answer was no, correct? No, I was not aware.

Because you don't have those records, correct? Correct. Thank you. We have any clue as to how old they were? I don't know. You're asking me about something I never saw. All right. Nothing further.

All right. Thank you, Doc. I want to know your thoughts on that. I mean, I get what Dr. Tufts. saying what she meant not hyper-pressured speech. Because somebody actually asked what is pressured speech anyway. It would be probably kind of like a hyper-speech. A pressured speech would be when you have a lot of anxiety and you can feel someone's tone, right? Like, think about it. I have to hurry. I have this and this and this. You're not yelling necessarily. You can yell with

pressured speech, pressurized speech. But you're like, I don't know what to do and I have to do this and I have to do this and I'm running around and you can like feel the anxiety in somebody. It's kind of hyper. It's kind of pressurized. So I do kind of believe Dr. Tufts that she meant not hyper-pressured speech. Not only that, but she talks about Lindsay in the same notes, yawning, and she talks about a flat affect. So those would be the opposite of pressurized hyper speech. Hyper and pressurized could be combined. So I do believe Dr. Tufts and I do believe what she meant. I think it's an interesting thing for Kevin Reddington to grab hold of. You said that she had pressurized speech.

Look here, which I don't know how that would, you know, come into play. But yeah, you clearly told you she was just done. And she was like, that is not what I meant. Not hyper-pressurized speech. But I saw varying opinions there. I was talking to Grayson earlier about it. And I think we had some varying opinions on it. I want to know what you guys think about this. That's why I started with this because different people are seeing this differently. And was she a feisty witness or was she finally just done with Cross and standing up for herself? I'd love to know what you guys think in comments in chat right now, but also in comments later. Anyway, and what would it mean if she did have pressurized speech that day? Would that change her treatment? I don't know. The

final witness of the day was Julie Paul, a psychiatric mental health nurse practitioner. She spent 17 years as a labor delivery nurse. So yeah, I thought that was going to be just Dr. Tuft on the stand the entire day, but no, we get to Julie Paul, another very important witness. And she spent 17 years as a labor and delivery nurse, earned her midwifery degree in 2006, and completed her psychiatric nurse practitioner degree in 2018. She also held a perinatal mental health certification from postpartum support international. In 2018, she created the perinatal behavioral health program at South Shore Hospital. Take a listen. Sure. And so the perinatal behavioral health clinic, explain to us a little bit about how that came about. Sure, there's a lack of resources

on the South Shore for parinatal, for pregnant postpartum people with mood disorders. So I really felt compelled because I had a couple clients that really struggled with mental health issues as a nurse midwife and really wanted additional education and be able to prescribe for them and take care of them in a proper way. So I went back up my psych NP and then worked with Selture Hospital to establish the program. And where was the program actually located? It was located right in Wymouth, Massachusetts. And you said you worked with the South Shore Hospital? Correct. So the clinic is tied to South Shore Hospital in the South Shore Health System. Yes, it is.

Now, when did you start that program specifically? When was it up and running? 2018 is when I started in October of 2018. And what, did you do that by yourself or did you have other practitioners that were doing that with you? Initially, it was just me. I started doing it two days a week and then grew the program gradually over the next year or two. And what makes up this program other than you? So at the time, when it was just me, I just saw patients two days a week and then gradually built up to five days a week.

And we included a therapist and the team two different prescribers. We also worked with women with substance use disorders as well. So we had additional support that way. And then when the building grew, we also had substance the bridge clinic on the other side. And then we were on the other side of that program. And what's the bridge clinic? The bridge clinic works with people with substance use disorders. And all of this is kind of under that umbrella of what's classified as South Shore behavioral health, correct?

That's correct. Now, as the clinic grew, did your role there change? I'm sorry, can you repeat that? As the clinic grew to what you described as having additional therapists and other prescribers on staff, did your role there change at all? I became the director of the program. And as director of the program, did you still see patients? Yes, I did. And was that at the same level as it had before, or did it decrease because of your administrative rules? It actually increased because I increased my hours to five days a week. I did have a little bit of administrative time.

Okay. And can you tell us a little bit about how the clinic would work for a woman who is coming in either during the birth period or prior to birth and after birth? What kinds of things would they be offered at the clinic? So I'd receive a referral and then the client would come in. We would do a 90-minute intake when they left. When it was just me, I was using outside therapists, that sort of thing. But as the program grew, we had moms groups run by doulas. We had therapists that we brought in that was brought in from a spire, but part of our program embedded within our program. And I brought in two additional prescribers as well as nursing staff. And when you talk about people as prescribers in your role as a psychiatric nurse practitioner who could prescribe, what were you offering to patients as part of this clinic as a prescriber?

We were offering the proper medication for anxiety, depression, mood disorders, really any psychiatric disorder that came in. Mostly for pregnant and postpartum, people up to two years postpartum. We also offered like therapy focused on sleep hygiene, really looked at the whole person, not just medication management. And fair to say that the medication is one piece and the therapy is another piece and this is part of a team approach that you had at the clinic. That's correct. That's correct. That's correct. So while you as the psychiatric nurse practitioner might have been a prescriber, were you also engaged in the therapy or psychotherapy?

I would do supportive therapy, but I'm not a therapist. I mainly am responsible for assessing, diagnosing, prescribing, but I also really understand the importance of sleep, nutrition, and exercise. And so being that you had a history of working as a midwife and working as a nurse and labor and delivery, do you have a lot of experience with moms or women who are in that postpartum period? Yes. And how about your experiences with diagnosing and prescribing for women in that period? Do you have experience in that?

In the labor and delivery room, as a nurse midwife, yes, I diagnosed like labor and that sort of thing, and even depression and anxiety, not to the extent of higher acuity psychiatric conditions, but as a psychiatric nurse practitioner, I did. Okay. And as far as your role at the perinatal behavioral health clinic, fair to say that your primary patient base was all going to be women who are either pregnant or after birth? Correct. And a part of this team approach at the clinic is it also to work on developing a treatment plan for patients when they come in. Correct. And so what encompasses a treatment plan generally? Generally, if it were a situation where we were referring them for therapy, then we would work with the therapist to kind of work, bring in the client to figure out what their needs are and then really stress whatever. The therapist works on certain aspects of the therapy that we kind of work together, but in,

not in tandem kind of we talk, but not to the extent we each are in our own disciplines. Okay. And as far as the resources that the clinic had available to you, is it fair to say that there are certain types of therapy, for instance, cognitive behavioral therapy or dialectic behavioral therapy that are not necessarily encompassed with the social workers that you work with at the clinic? Our social workers primarily did cognitive behavioral therapy. We did group therapy for more social support. What I did mainly was just supportive therapy. Okay.

And would you oftentimes, through the clinic, refer clients out to other local community providers? Yes, we would. Now, as the psychiatric nurse practitioner, does medication play an important role when you are dealing with a particular patient that came into the clinic? Yes, it does play a role.

And how is it that you determine and what's the appropriate medication track for any given patient? We do proper screening and then we do it a complete interview with the client. And then based on what their responses are, together we work as a team to develop the best medication options or treatment options for that client. When you say work as a team, does that include the patient themselves? Absolutely. The patient is the most important part of the team.

So Paul, as many of you mentioned in that in the chat, yes. She knew Susan Clancy or knows her Patrick's mother since she worked with her as a midwife because Patrick's mother is also in care and nursing. So on November 20, 22, Susan Clancy contacted her saying that her daughter-in-law, Lindsay was struggling postpartum. So after confirming Lindsay had given permission, Paul called her that same day. so her mother-in-law stepping in, you know, to help. Paul calls her that same day, and the purpose was to hear Lindsay's own account, her history, symptoms, and whether she'd be a good fit for the clinic. Lindsay said that she had done well for the first 12 weeks after Callan's birth,

but then when Patrick returned to work, she began struggling with anxiety. She felt overwhelmed and had racing thoughts. All things Paul said were typical postpartum experiences. Lindsay said that she had seen a psychiatrist and had gone to the South Shore ER in November, November, November 2006, it was November 16th, to be exact, 2023. She reported trying Zoloft for one week using Ativan and Benadryl for sleep, having questions about Busepar and being prescribed Trazadone after the ER visit. And she said, Adavan and Benadryl helped.

She worried about dependence and had weaned herself off. Trasidon helped her fall asleep, but not stay asleep. She also said that she didn't want to be on long-term medication. Paul encouraged her to use what she already had, which was Adavan and Benadryl, just for that night, and said that they would discuss other options the next morning. They talked about SSRIs versus benzodiazepines, and Paul explained that SSRIs were preferable long term. And throughout the call, Paul assessed safety. Lindsay denied suicidal ideation, denied thoughts of harming herself or harming her little ones, denied hallucinations and showed no signs of delusion. She also denied drug, tobacco, marijuana, and alcohol use and said that she had stopped

breastfeeding. Paul scheduled an in-person intake for November 21st. Intakes are typically face-to-face unless there was a barrier and you couldn't make it in. Follow-ups could be virtual. She only insisted on in-person visits if someone seemed confused, disorganized, or needed labs or drug screens. At the intake, Lindsay met with a nurse for screenings and then spent an hour with Paul and her main complaint was simple. She could not sleep. Paul said that was extremely common postpartum. So she has a typical symptoms that she is displaying. Lindsay said she felt overwhelmed at home with three children and that her anxiety had increased around 12 weeks postpartum. She had similar anxiety after her second child. She had managed it with breathing,

meditation and yoga. So she was practicing some mindfulness. She said that she had tried one one CBD gummy, but it did not help. They reviewed her psychiatric history, Zoloft, Ativan, use bar, an earlier use of Prozac, propranolol, and well-b uterine in college, which she said had worked aside from some sexual side effects. She said that she'd planned to return to work in October, but delayed it due to this anxiety. So Paul performed multiple screenings. She did perform the Idenberg Postnatal Depression Scale, the GAD 7. the mood disorders questionnaire, Columbia, suicide severity rating scale,

and the 5PS for substance use. Lindsay scored 21 out of 21 on the G.87, extreme anxiety. And 23 out of 30 on the Itenberg scale, 23 out of 30. So in other words, the self-harm question was the only negative question. There were no substance abuse use concerns. Paul recommended starting Prozac since Lindsay had responded well to it in the past. She prescribed 10 milligrams for four days and then planned to increase to 20 milligrams. She paired it with Atavant temporarily to offset early SSRI activation and explained the SSRIs

take four to six weeks to reach therapeutic levels. They discussed tapering Ativan once Prozac settled. So Lindsay understood the plan and asked appropriate questions, according to Paul. Paul also set her up with cognitive behavioral therapy or CBT throughout the clinic with Letitia Duke, scheduling the first appointment for December 2nd. The intake lasted 90 minutes total. Paul told Lindsay she would soon be leaving the clinic because she was moving back to New Hampshire. So her care with Paul would be short term.

She transferred Lindsay's care on November 30th and communicated that through MyChart. And before the transfer, they exchanged several my chart messages and a few phone calls. And from there, Buckingham moved into the medication change period. The part where Lindsay began struggling with Prozac and Paul had to adjust her treatment in real time.

Okay. So on November 25th, did you prescribe her some additional medications? I did. So she wasn't tolerating the Prozac. So we had a conversation about stopping the Prozac. I gave her, she was really having a hard time sleeping, so I gave her a one-time dose of Ambien. And then I also prescribed mertazapine, which is another antidepressant, but it works really good for sedation and anxiety. So it started that at 7.5 milligrams, told her to stop the Prozac. And I also paired it with clonopin, but I told her explicitly not to take the adaband, just to take the clonopin to help its longer acting benzodiazepine, to help her with sleep and long.

acting anxiety support when well we got this new medication up and running. And so in your conversations with her about her concerns about the Prozac, for her to say she reported to you that she was feeling disconnected out of it a little bit spacey. Does that sound right? Yes, that's correct. And so you said your recommendation at that point was to discontinue the Prozac. Correct.

And as far as the Prozac went, she hadn't taken it for very long, had she? She took her for three days. three days? Correct. And again, you had that conversation with her about kind of waiting it out for the four to six weeks. But based on what she was reporting to you, did you have any concerns about her stopping the Prozac after only three days? When a client doesn't have buy-in to the medication, it's awful. It doesn't work as well. So I was working with Lindsay to try and find a medication that would make her feel more comfortable. She was feeling very uncomfortable, very anxious, and the Prozac, she just wasn't tolerating the activation from the Prozac.

Somertazepine is a little bit more calming, which I thought she would resonate with better. Okay. And so, again, this is not one of those follow-up visits on a telehealth or a face-to-face. So were you relying heavily on what she was reporting to you? Yes. And again, in that my chart message, you did indicate to stop the Prozac, Benadryl, and Adipan, and don't take while taking Clonopin, right? Correct. And in your practice as a psychiatric nurse practitioner who prescribes medication,

is it common that you have to kind of trial different medications to find the right one to work for any given patient? Yes, it's pretty common practice in psychiatry. And fair to say, there's no way to anticipate how a particular patient is going to respond to any particular treatment, medication treatment. Correct. So after prescribing the clonopin, the metazapine, and giving her that single dose of Ambien, did you do anything or set anything up to follow up with her after changing those prescriptions? I just told her to keep, she can my chart message me over the weekend. It was the holiday weekend.

So I made sure she knew I was available to answer her questions. And fair to say she did, in fact, my chart, you send you my chart messages over the course of that weekend, correct? Yes. And so starting at 751 on November 26, she reported to you kind of how that night went, didn't she? Yes. Where she said I did better last night. I took 7.5 metazepine and 0.5 clonopin at bedtime, slept fairly well on and off until 345. And then she asked, do you think increasing the metazepin will help me stay asleep longer? I can survive like this, but would be helpful to get to sleep until at least five thoughts. Thank you, Lindsay.

Yes. Did you respond to that message? I did. And what did you advise her to do when she asked about increasing the metazepan and wanting to stay asleep longer? I said she could try all the 15 milligrams. And again, is that something that is common for you to do in prescribing that maybe you have to adjust the dosage? Yes. Did you have any concerns that increasing the metazepan up to 15 would have had any issues or problems?

No. And then again, on November 27th, you had a correspondence with her starting at 9.59 a.m., where she again reports to you how she did that night. Is that something you encouraged her to do to just give you a nightly or like a follow up the next day, check in to let you know how she was or what she was experiencing by way of symptoms? I do that with a lot of clients that are really anxious. I like to make myself available to them so that they have that reassurance. Okay. So this wasn't kind of unexpected. It wasn't out of the ordinary for me.

And so on the 27th, she indicated she slept well, taking the 15 of mytazepin and a 0.5 clonipin, feel rested but super disconnected with myself in reality and describes it was a scary feeling, thinking of stopping clonepin tonight and just taking the mertazepin. Do you recall that? I do. I do. Communication. And she acknowledges that I've only taken it two nights so that it should,

so that should be right, okay? Or, sorry, I've only taken it two nights, so that should be okay, right. Do you recall her asking that? He's referring to the clonopin, and yes, she did. She was really anxious about being dependent on benzodiazepines. So I think her goal was to not be on them. And if she was going to, the disorientation might have been because of all the sedation from the metasping, which is a common side effect, which is why we chose that and she knew that.

And adding the clonopin, maybe removing that might have helped with some of the sedative factors for it. So did you find there to be any issues with stopping the clonopin or her deciding not to take it after two days? No, I did not. And in fact, you indicated and told her that should help with the disorientation, right? Yes, it might. Okay. And so that was on November 26. seventh and I'm fair to say that there was another communication via my chart on November 28th with Lindsay Clancy. Yes, there was.

And at this point, she was asking for, or there was some back and forth about needing a note for work, correct? Correct. And is that something that you had talked about with her about getting another note for work? Yes, that's what I do that often. And in fact, you kind of went back and forth with her and ultimately she said, never mind that she didn't qualify for short from disability anymore, and she's just going to be on personal leave. So on the 28th, there was no back and forth about her taking the medicine and the effects

or how she was feeling. She actually had a panic attack earlier in the day before those communications about work, and I recommended she take point five of Adavan and go for a run. and I also recommended that she considered doing the partial hospitalization program at women and infants. And what was her response to the recommendation for the partial hospitalization of program? At that time, she felt it wasn't going to work logistically for her or her family. And why did you recommend maybe going for a run? To get rid of some of the adrenaline from the anxiety.

And running has been a really good thing for her in the past, and I thought it would help calm her. Yeah, fascinating. So on November 29th, Lindsay messages at 605 a.m. saying that she had taken 15 milligrams of Memoron and CBD and slept only slightly better. Well, Paul wasn't working that day, but Rebecca Jalada had an opening, so she offered the appointment, right? She said that she was already in the process of transferring her patients to Rebecca and another new hire. and Rebecca's experience made her a good fit. So by November 30th,

Paul formally transferred Lindsay's care. Lindsay thanked her and wished her luck. Paul said she had no further contact with Lindsay after that and no additional communication with Susan Clancy beyond the initial referral. And that is where the judge ended for the day, telling the jury that they'd pick up with cross-examination of Nurse Paul in the morning,

which I suspect will also be fire because we've been hearing, we've been hearing a lot. I think about the defense's defense, right? If this is not guilty by reasons of insanity, her mental health is everything. And so I'm sure that cross tomorrow will also be fire. And we will be here to follow it all. Follow it all. I pinned a few things that I want to talk about. Thank you for your thoughts.

I see some people that said that their opinions have changed about this case. That's fascinating. I think one thing that I'm learning, I'm just going to talk about me. All I can do is talk about me. And I'll share some of your thoughts is it's very clear to me that Lindsay Clancy was suffering with mental health. Now, that's not an excuse. there are a lot of people who commit crimes with mental health that are not excused for that. But it is clear that she was suffering something unique to me and very severe,

that there was a lack of communication between doctors that perhaps Lindsay didn't fully understand the depth of her mental health. I think that's common. Or perhaps she didn't want to share everything because of shame, you know, I don't know. This comment I want to read, because I think it's interesting. Nurses are taught to compartmentalize to do their job. Lindsay probably compartmentalize for emotions and moods for as long as she could socially

end at home. I think that it was in Lindsay's nature to just try to stay calm, right? To just kind of be calm. I watch her parents in the courtroom. And of course, it's very, very sad for them to be there. I can't imagine them ever showing any emotion that isn't, you know, sadness or disparate. So sad why they're there. But it's a very flat affect from them as well.

And Lindsay is either in tears or has a flat affect. I think that when we watch old videos of her, I think that you're right. I think she is a stable, steady person. She likely was not fully grasping what she was experiencing, right? There's also the fear of people taking your children. away or of being a bad mother if you say I want to harm my children. I don't know. But I think what I do know or feel confident in right now with me looking at the evidence is that she was suffering deeply from mental illness and she was desperately trying to get help. That's where I am.

Anyway, a lot of people that are in the, in this, you know, just because a test exists does not mean you need to use it. Some people thinking this doctor is severely responsible, other people thinking that she was doing her job. A lot of varying comments. Will she testify or should Lindsay Clancy testify? I don't think she should personally. No, I don't think she should. One thing that I thought was interesting too was Patrick Clancy's description. of Lindsay being a zombie.

That is, that is something other than herself, right? That is somebody that gets up without feeling and goes to the emotions of what she's supposed to do when she wakes up and is not her, right? It's like saying, like, my wife is not in there. That is a description that catches me. Him saying that she's a zombie, a zombie. What are your thoughts? Reddington.

I'm very interested, varying opinions in whether he's going to make the jury angry or whether he's simply defending his client or if he's rubbing the jury the wrong way, varying opinions here. He fiercely defends Lindsay. That's for sure, fiercely. Even, you know, touching her on the back, comforting her. I think he does a really great job, like I said, framing things. You know, the TV is the telehealth.

He kept saying that she said that she was an expert in postpartum. I went to the website and she does list expertise areas with bullet points. And then in the specific sentence, she says she has an interest in postpartum. Yes, expertise can be expert if you even are an expertise in something. usually an expert. But I do think it's a little bit more abstract than stating on a website. I am an expert. So I'm not saying that it doesn't mean expert, but it's certainly a little bit more abstract at the website than Redington explains it. And another way he framed something that was really interesting was kept saying it's an ad. You're advertising your services. And she said,

well, this is, I don't know. This is my bio that is on our company's website, you know, a bio, but it's an advertisement. So he does have a way of using these sort of words and framing things in a way that kind of, I think, confuses people or the jury. I also, people have mentioned his age 74. He is still, he seems sharp and he seems ready to defend Lindsay. I'm certainly curious what the jury is thinking. I also want to address, I did an interview this weekend with Susan Smith.

prosecutor. You everyone remembers Susan Smith, a woman who killed her two children, and she did not get the death penalty, and she was even up for parole. She's in her 50s, and she was up for parole two years ago. So the same prosecutor had a stand before a parole board 30 years later and state why she should stay behind bars, and she was not given parole, and he'll have to do that every two years now from now on. Susan Smith. A woman who lied on public television saying that a black man had hijacked her and taken her children. And ultimately, she let them drive into John D. Long Lake. And they drowned.

Her two little boys, Michael and Alexander. And before that, I had interviewed Andrea Yates' defense attorney. And I got more pushback by interviewing Susan Smith prosecutor and saying that there were some similarities in this case. Ultimately, the similarity is that these two women killed their children and have confessed to that and have admitted that. There's no other person to blame. Susan Smith confessed. So Susan Smith's trial was also a Y done at trial with a very different circumstances. And I pointed out the very different circumstances. I'm just wanting to explore things during this trial. A lot of people comparing this case to Susan Smith. A lot of people comparing this case to Andrea

Yates. So I found attorneys on both cases to discuss so we can learn the differences and see how we feel about the evidence presented so far. And none of them have the very specific evidence that we've seen so far in Lindsay Clancy's case. It's unique. But Susan Smith was not found to be suffering from postpartum. She did have a 14-month-old. It was one of the victims. And the defense argued fiercely Susan Smith's mental health. And that, I think, is what saved her from the death penalty. But Susan Smith also did some things. I want to point out that Lindsay Clancy, we have not seen in the evidence at all.

Susan Smith lied to the public, tried to blame somebody else for doing this, had an elaborate story, sort of like Emmanuel Harrow, for those that followed that case. She manipulated the public. She stayed and kept that story for nine days, nine days. nine days. She was a very, very manipulative person. She talked about her children crying for their mother and ultimately the prosecutor believes, as do I, that she probably did experience that because it took the car a long time to drown in the lake, that it wasn't sudden, that it floated for a little bit. So I do not believe, after that interview, I do not believe that Lindsay Clancy

is another Susan Smith. I don't at all. Andrea Yates, on the other hand, a woman who was actually found guilty at her first trial and then at a second trial found not guilty

by reasons of insanity. I don't know if Lindsay Clancy fits her exactly either, that there was, she had a bald spot in her hair that she was trying to rub out 666, there was a massive religious component that her eyes had no pupils,

her attorney explains that she was completely glazed over. She too had been getting a lot of mental health, five children, five lost. So I shared these interviews for people to just explore, not for a point, not for an agenda, but because these are the cases that people have been discussing. I see right now from what I've seen so far, and we've only heard from the prosecution, I'm seeing more similarities with Andrew Yates

and Susan Smith, but Lindsay Clancy is her very own unique case. And the defense strongly, strongly believing, not just the defense, but her family and Patrick with his nonprofit, believing that this was a psychosis of sorts,

that she was a wonderful mother, and she was mentally ill. And this was horrific. That is interesting. You're right. Andrea Yates did wait until an hour where she was, she was left alone with her children, right? Because she was having her mother-in-law coming over and helping with the children because she was not doing well.

And in the one hour, she was waiting for her mother-in-law, that's when she did it, you know. Also, Andrea Yates' defense attorney saying that he still considers her a daughter, talks to her often, visits her, and even let her know about the interview where she was supportive so that we could talk about these issues of postpartum mental health. So if there's any other interviews or cases that you'd like us to explore while we are following Lindsay Clancy, let me know. Let me know because I think that the more we understand this case, the better. And I'd love to do some more interviews. So let me know. Yeah, I think so.

Learning the differences in these cases is incredibly important. Yeah, I don't know where you guys are, but as far as the prosecution goes, they haven't shown me much more of a motive. Oh, the other big thing with the Susan Smith case is the motive, right? That she was in love with somebody having an affair and this person didn't want children. So he was ending this affair. So there's another motive there. In Lindsay Clancy case, the prosecution's brought no other motive here except for that. She was mentally ill.

I'm waiting for the prosecution to show more. And I haven't seen anything yet. Even her journal says she wants to connect more with Patrick. that he deserves that. And she's feeling sorry for him and wants to connect to him. But I am waiting. Right. Motive is not required.

It's intent that matters in this case. This is, again, a why-done-it-case? Motive, you don't have to prove motive. But yes, it would certainly help in this case, right? If the prosecution, at least, I think. No hairball today. I do wonder if maybe the pushback. is perhaps why. I'd be very curious as to why no hair bow. It's not the only day she hasn't worn a

hair bow. There have been other days that the prosecution of Buckingham has not worn a hair bow. So this isn't her first day not wearing a hair bow, but it is interesting to know that she's not wearing one. Oh yeah, a lot of conspiracy theories about Patrick, so many that I've had friends reach out that have been following this case asking, are the things about Patrick? true? You know, what are they saying about Patrick in court? And the bottom line is nothing. And the one thing that I heard while I was in court, as you know, that I'll never unhear, is this 911 call. And let me just explain Patrick in it because we have the knowledge of what's going on in the house. And Patrick is seeing with Lindsay, you feel yourself getting very anxious or I got very anxious because I did not

realize how long he stays with Lindsay before checking on the children. It was actually a very large amount of time. And you're anxious because you're like, go check the kids, go check the kids. You want him to do that. And you know what he's about to find. But I can say this, he had no inkling. He had no clue. It didn't even cross his mind that she might have done something to the kids. That much I'll say. And that 911 call made it clear. He had no idea. It had not even been a thought.

What if she did something to the kids? He thought he was going to run down and find the kids after helping his wife. He had no idea. And right, if Patrick had been having an affair, they would have been using that as a motive. Right? There's no affair. Also, people surprised he's remarried by now. It's been three years.

So much can happen in three years, you know. That doesn't seem fast to me if it had been six months or one year. I don't understand that, oh, it's so fast that he's been remarried. I don't. He's a family man. He suffered the loss of his entire family. It seems like he has found love again with a doctor. And I'm happy for him.

Thank you for sharing the studies have shown that severe psychosis is entirely absent. in the vast majority of the right, right, in school. You know what, Dr. John has discussed the difference, the differences, and we'll certainly ask them. Many of you are asking for Dr. John's opinion. Yes, he is catching up. Yes, he has things to say, yes, we're going to be doing a few shows. So stay tuned this week because we will be hearing from Dr. John,

criminal psychologist on this channel. So thank you. Thank you to those who like this video. Thank you for those who subscribe, who support us. It means so much. We couldn't do this without all of you. Thank you to our moderators. They're amazing.

These trials are crazy, aren't they? Like the going live and the moderating and the following, our moderators are just incredible. And thank you to everyone for the really profound comments that I'm seeing and pasting and sharing. what you feel. I agree with this. Defense is setting the stage for the defense case.

I bet we see Tufts again. So do I. I think she'll be back on for the defense. But maybe not. Maybe he is satisfied with what she shared today. Who knows? Defense prosecution is quite the game of cat and mouse, right? If he brings in Tufts again,

they get to cross-examine her again. So maybe he'll be content with what they did today. Right. Patrick was clearly in utter shock. Never suspected it. I'll just share that. All right. You guys are telling me to go rest.

Thanks. I will. I will go rest. I appreciate it. Thank you, everyone, for being here. Until tomorrow, we'll continue following every bit of this trial. And check out our, like I said, our episode on both Susan Smith's prosecutor and then Andrea Gates. defense attorney, I think both really interesting points, shows how they differ and how they're

similar in these cases. All right. We'll see everyone. Bye-bye.