Trial Day 10

Summary

Podcast Summary: Full Trial Audio – Lindsay Clancy Triple Murder

Episode: Trial Day 10 – August 10, 2026
Host: Full Trial Audio
Theme:
This episode continues the audio from the high-profile trial of Lindsay Clancy, a Massachusetts mother accused of murdering her three children. The focus of Day 10 centers on clinical and psychiatric testimony, particularly the cross-examination and redirect of Dr. Jennifer Tufts, Clancy’s outpatient psychiatrist, followed by direct examination of Psychiatric Nurse Practitioner Julie Paul from South Shore Perinatal Clinic. The proceedings aim to answer critical questions about Clancy’s mental state, the adequacy of her psychiatric care, and the interactions between her and multiple health care providers in the months leading up to the tragedy.

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Key Discussion Points & Insights

1. Dr. Jennifer Tufts: Background and Qualifications

• Dr. Tufts details her educational and professional background:
  • Medical school at University of Vermont (2014-2018), then psychiatric residency at Boston Medical Center/Boston VA (2018-2022). (03:19-05:04)
  • Specialized training in perinatal psychiatry during residency; treated at least 50 women in postpartum period during four years. (10:00-11:15)
  • Began practicing independently at Aster Mental Health in August 2022, board certified in general psychiatry as of September 2022. (07:38-08:24)
• Her first appointment with Lindsay Clancy took place on September 15, 2022. (12:17)

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2. Cross Examination: Approach and Treatment of Postpartum Patients

• Dr. Tufts is scrutinized for her experience level with postpartum psychosis and depression, particularly in the one month after starting independent practice. She estimates treating “maybe a couple” postpartum depression cases and “none” of postpartum psychosis in that time (15:36, 16:30).
• Questions over whether she represented herself as an expert in postpartum psychiatry on the Aster website vs. her actual experience. (17:55-18:27)
• Dr. Tufts clarifies: “That’s listed as one of my interests. Definitely.” (18:24)

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3. Intake and Telehealth Limitations

• Clancy’s psychiatric care was entirely via video appointments (telehealth), which Dr. Tufts affirms is now industry standard but can limit the observation of physical cues (e.g., hand-wringing, leg-bouncing) (30:55-32:36, 193:43).
• Dr. Tufts states she was never able to see or examine Clancy in person before the trial. (31:01)
• She emphasizes the importance of listening and supportive therapy: “It’s listening to the patient and providing emotional support and validation.” (49:28)

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4. Diagnosis, Treatment Plans, and Medication History

• Initial diagnosis (Sept 15, 2022): Generalized Anxiety Disorder (GAD), adjustment disorder with depressed mood; prescribed Zoloft (sertraline), an SSRI. (50:42-50:58)
• Side effects and discontinuation: Clancy was afraid to start Zoloft, waited about a month, then after increasing to 50mg experienced worsened symptoms—insomnia, diarrhea, and increased anxiety. Dr. Tufts told her to stop Zoloft immediately. (66:11-69:13, 118:24-119:04)
• After Zoloft was stopped, other medications including Ativan (lorazepam), Buspirone (Buspar), hydroxyzine, and later amitriptyline and trazodone were used. Each was titrated in response to Clancy’s reports of side effects and limited efficacy. (93:55, 129:04, 182:13, 184:23)
• Notable quote from Dr. Tufts:

  “Individuals have very varied responses to medications. Some have no side effects, some have one or two. It’s impossible to predict, but Zoloft is a top choice, a first-line medication.” (62:42–63:05)

• Therapeutic process: Supportive therapy offered, but main focus was on medication management. (41:32–41:54)

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5. Assessment of Suicide risk and Record-Keeping

• Dr. Tufts questioned on documentation: defense counsel probes why side effects and suicidal thoughts are not always detailed in records.
• Distinction made between “being worried about suicidal thoughts” and “actually having them.” Dr. Tufts:

  “If it’s a fear, then it means that they’re not actually having suicidal thoughts…It’s a level of concern that can be managed on an outpatient basis, not requiring hospitalization.” (205:28–205:53)

• Clancy did not report clear suicidal or homicidal ideation to Dr. Tufts. Multiple notes indicate “denies suicidal ideation,” but Clancy did express feeling “close to suicidal thoughts” or “hopeless,” especially as symptoms worsened in December and January. (85:02–85:50, 162:38)
• Counsel raises issue of lack of outreach to Clancy’s family, but Dr. Tufts cites HIPAA and Clancy’s ability to advocate for herself. (224:27–226:06)

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6. Criticisms Regarding Care Coordination and Medical Record Access

• Dr. Tufts did not obtain records from South Shore Perinatal Clinic, Women & Infants Hospital, or McLean beyond basic discharge summaries, unless Clancy signed specific releases. (115:07-115:41, 178:03)
• Defense suggests this limited her understanding of Clancy’s comprehensive medical picture.
• Prosecution and Dr. Tufts counter that Clancy was a “good historian,” able to report medication names, doses, and side effects clearly. (116:05-116:22, 196:00)

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7. Alternative Explanations and Considerations

• Scrutiny over whether Clancy’s psychiatric picture might have been due to undiagnosed bipolar disorder (“extreme reaction to SSRIs and insomnia”), but Dr. Tufts found no evidence of mania/hypomania in her history or presentation. (158:13–158:29, 214:46)
• Questions about use of tests like the Edinburgh Postnatal Depression Scale, thyroid function testing, and genetic tests for medication metabolism. Dr. Tufts states these are not standard or necessary in most outpatient psychiatry settings, and PHQ-9 is used as a depression screener instead. (35:27–37:13, 141:08)

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8. Redirect Examination by Prosecution

• Prosecution re-establishes Dr. Tufts’s relevant experience: Four years of residency, specialized elective in perinatal psychiatry, thousands of psychiatric patients seen, including dozens postpartum. (189:44–190:22)
• Telehealth is validated as standard care since COVID. (193:43, 193:50)
• Detailed review of medical forms shows Clancy repeatedly denied active suicidal or homicidal thoughts or intent, and therapy was recommended as a consistent part of her ongoing plan. (198:43–199:39)
• Prosecution confirms Clancy advocated for herself: scheduling own appointments, seeking ER care when needed, communicating details about medications and symptoms. (196:41–197:09)

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9. Testimony from Psychiatric NP Julie Paul (South Shore Perinatal Clinic)

• Background: Nurse, midwife, perinatal psych NP, director of South Shore’s perinatal mental health program. (235:00–238:29)
• Clinic details: Comprehensive team approach for pregnant/postpartum patients—psychiatric assessment, therapy, medication management, group therapy, care coordination. (239:04–242:22)
• Initial Contact with Lindsey Clancy (Nov 20–21, 2022):
  • Referral from family; Clancy reported increased anxiety, racing thoughts, insomnia, “overwhelmed,” but denied suicidal or homicidal ideation, psychosis, or hallucinations. (245:20–250:25)
  • Intake was in person; Clancy found to be an excellent historian, goal-directed, linear in thought, actively participated. (253:33–256:01)
  • Multiple standard screenings administered, including Edinburgh, GAD-7 (high anxiety), mood disorder questionnaire, and substance use scales; Clancy did not screen for suicidality at intake. (258:56–259:41)
• Treatment plan:
  • Started Prozac due to prior success, paired temporarily with Ativan for anxiety/sleep issues.
  • When Prozac caused increased discomfort after three days, switched to Mirtazapine (Remeron), Ambien, and Klonopin. (260:26–270:37)
  • Frequent MyChart follow-ups and medication adjustments based on Clancy’s self-reports.
  • Therapy with social worker scheduled.
  • Emphasis on team approach and patient’s active role in her own care. (239:41–242:22, 263:22)
• Paul observed no evidence of psychosis, hallucinations, or suicidal/homicidal ideation in her interviews. (250:10–250:29)

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Notable Quotes & Memorable Moments

• On evaluating psychosis:
  “You look at their appearance... their speech, whether they're speaking very fast, very loud... You look at what their thoughts are like... If someone is talking or making noises, or it seems like they're communicating with somebody that's not in the room, those are all behaviors that we assess for.”
  – Dr. Jennifer Tufts, (191:32–192:49)

• On telehealth:
  “Does looking at someone through a computer screen somehow inhibit how you hear the answers?”
  “No, it does not.”
  – Defense & Dr. Tufts, (194:06–194:12)

• On patient’s self-advocacy:
  “She demonstrated she could advocate for herself – scheduling own appointments, presenting to the emergency room, sharing detailed information about medications, doses… all of that.”
  – Dr. Tufts, (196:41–197:09)

• On supportive therapy:
  “It’s listening to the patient and providing emotional support and validation.”
  – Dr. Tufts, (49:28)

• On medication risk:
  “Individuals have very varied responses to medications… Zoloft is a first-line, safe medication for individuals, including postpartum women.”
  – Dr. Tufts, (63:16–63:33)

• On suicidal thoughts vs. plan:
  “A suicidal plan means they know exactly what they’re going to do to end their life... That is something that would require hospitalization.”
  – Dr. Tufts, (228:53)

• On screening results:
  “She [Clancy] was significantly high in the Gad 7… extreme anxiety. On the Edinburgh Postnatal Depression Scale, she scored a 23 out of 30… but negative for suicidality.”
  – Psychiatric NP Julie Paul, (259:19–259:41)

• On rapid medication changes:
  “It’s pretty common practice in psychiatry… trial different medications to find the right one.”
  – NP Julie Paul, (272:19)

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Timeline & Timestamps for Important Segments

• Dr. Tufts’s credentials and experience: 03:19–11:15
• First encounter with Lindsay Clancy: 12:17–13:25
• Telehealth limitations and standard: 30:55–32:36; 193:43–194:12
• First Zoloft prescription, adverse effects: 50:42–69:13, 118:24–119:04
• Therapeutic approach and supportive therapy: 41:32–49:28
• Assessing suicidality: 85:02–86:53, 162:38–163:02, 205:45–206:06
• Medication changes & polypharmacy issues: 93:55–105:43, 182:24–188:04
• Coordination of care and records: 115:07–116:22, 178:03
• Redirect on Dr. Tufts’s qualifications and Zoloft use: 189:02–200:05
• Testimony of NP Julie Paul (direct): 234:47–279:31
  • Intake and screenings for Clancy: 245:14–259:41
  • Medication changes in response to symptoms: 260:26–270:37

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Flow & Tone

• Professional, methodical legal proceedings, alternating between hostile cross-examination (defense), supportive redirect (prosecution), and collaborative/compassionate medical testimony (clinicians).
• Cross-examination is at times challenging and skeptical, particularly regarding Dr. Tufts’s experience, record-keeping, and the adequacy of psychiatric care.
• Re-direct and medical testimony refocus on patient engagement, careful risk assessment, team approach, and appropriate clinical standards.
• Emotional undercurrent: clinicians express empathy for the tragedy and concern for the patient’s suffering, but defend the process as standard and patient-centered.

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Conclusion

This day of testimony underscores the complexity of distinguishing between postpartum anxiety, depression, and potentially psychosis; the inherent limitations of outpatient and telehealth psychiatry; and the difficulty of intervening when patients do not disclose clear suicidal or homicidal intent. Both Dr. Tufts and NP Julie Paul stress that Lindsay Clancy, while severely symptomatic, did not display overt psychosis or actionable suicidal/homicidal ideation in their interactions. The defense pushes hard at the diligence of record-keeping and coordination of care, but the clinicians defend that their practices reflect industry standards and are responsive to the information provided by Clancy herself.

End of Summary

Transcript

[Courtroom Audio Technician]

Full trial audio. Everything hurting court. No silences to skip.

[Court Clerk]

Please be seated.

[Assistant District Attorney Jennifer Sprague]

Good morning, your honor. May I proceed?

[Judge William Sullivan]

Yes, please.

[Assistant District Attorney Jennifer Sprague]

Before the court today, we have the matter of Commonwealth versus Lindsay Clancy. Ms. Clancy is present. She is represented by attorney Kevin Reddington. The commonwealth is represented by assistant district attorney Jennifer Sprague and assistant district attorney Shannon Buckingham.

[Judge William Sullivan]

All right. Well, good morning, everyone. Good morning, council.

[Court Clerk]

Morning. Hi.

[Judge William Sullivan]

Good morning, Ms. Clancy. All right, before we begin and return to this witness, could I see council Seibart just briefly?

[Court Clerk]

Court. All rise. Jurors, enter. Hear ye, hear ye, hear ye. All persons having anything to do before the honorable William Sullivan, Justice Superior court now sitting in Plymouth within before the

[Judge William Sullivan]

Commonwealth, draw on the end, give you

[Court Clerk]

attendance, and you shall be heard. But save the Commonwealth of Massachusetts. This court is now in session. Please be seated.

[Assistant District Attorney Jennifer Sprague]

Good morning, your honor. May I proceed?

[Judge William Sullivan]

Yes, please.

[Assistant District Attorney Jennifer Sprague]

Your honor, before the court today, we have the continuation of the jury trial in the matter of Commonwealth versus Lindsey Clancy. Ms. Clancy is present. She is represented by attorney Kevin Reddington. The commonwealth is represented by assistant district attorney Jennifer Sprague and assistant district attorney Shannon Buckingham.

[Judge William Sullivan]

Thank you, madam clerk. Well, good morning, everyone. I hope everybody had a nice, cool weekend as best you could and were able to kind of recharge the batteries a little bit. So what I'm going to do is I'm going to ask you those questions, make sure everybody was able to follow my instructions, and then talk a little bit about today's schedule, and then we'll get right back into the case. So first, let me ask the questions. Has any member of the jury read, seen, heard or overheard anything, any source about any aspect of this case that would affect your ability to be a fair and impartial juror? Next, is there any other serious matter of concern bearing on your service as a juror in this case that anybody needs to bring to my attention? Thank you for following those instructions. And then in regards to today's schedule, we've got a number of witnesses. I'm not quite sure how long it may go, so we may break a little bit early today, just kind of depending on the way the case comes in. And in regards to where we are right now, we're going to. If you remember, when we broke on Friday, there was a witness at Dr. Tufts. Commonwealth had finished their direct examination. We're now going to have that witness return to the stand, and the cross examination by the defendant will begin. All right. And so with that, if we could recall that witness.

[Court Clerk]

All right.

[Judge William Sullivan]

Good morning, Doctor.

[Dr. Jennifer Tufts]

Good morning.

[Judge William Sullivan]

All right, Ms. Raington.

[Court Clerk]

Thank you. Good morning, Doctor.

[Dr. Jennifer Tufts]

Good Morning.

[Court Clerk]

Do you have your record in front of you, your notes?

[Courtroom Audio Technician]

I do.

[Court Clerk]

You can look at that anytime you want.

[Assistant District Attorney Jennifer Sprague]

Just.

[Dr. Jennifer Tufts]

Thank you.

[Court Clerk]

Dr. Tufts, you are presently a psychiatrist, correct?

[Dr. Jennifer Tufts]

Correct.

[Court Clerk]

And can you tell me where you went to med school?

[Dr. Jennifer Tufts]

University of Vermont.

[Court Clerk]

And what were the years that you were at University of Vermont?

[Dr. Jennifer Tufts]

2014-2018. It is. It's beautiful.

[Court Clerk]

And when you graduated from med school, you then did your residency?

[Dr. Jennifer Tufts]

Correct.

[Court Clerk]

And where was the residency?

[Dr. Jennifer Tufts]

Boston Medical Center.

[Court Clerk]

And can you tell me what is it exactly that you do as a psychiatric resident or a psychiatrist resident? What do you do?

[Dr. Jennifer Tufts]

You do a lot, a lot of different things. You rotate in all the different aspects of psychiatry as well as internal medicine, so that you have a foundational knowledge of broad medical topics. You admit patients into the inpatient hospital. You manage emergencies in the hospital and in the emergency room, decide whether patients need to be admitted psychiatrically or not, and also carry a panel of outpatients.

[Court Clerk]

Is this a hospital that you're working in or is it Boston University? Is it a medical center?

[Dr. Jennifer Tufts]

So, yes, it's the Boston University program located at the hospital Boston Medical center, with also a lot of time spent at the various Boston VA locations.

[Court Clerk]

And what were the years? I'm sorry,

[Dr. Jennifer Tufts]

2018 to 2022.

[Court Clerk]

So you basically were working as either a person studying to be a doctor, graduating and becoming a resident through the entire pandemic?

[Dr. Jennifer Tufts]

For the first part of the pandemic, yes.

[Court Clerk]

Pandemic ended when Joe Biden said it ended in July 2022. Right.

[Dr. Jennifer Tufts]

I'm not sure exactly when he said that.

[Court Clerk]

Would you agree with me that when the pandemic started, around 2019, when you began your residency, 202021 into 22, make sure you have 6 foot radius before you touch anybody. All of that, right? Yes. How did that impact your residency?

[Dr. Jennifer Tufts]

Well, I still went into the hospital most of the time wearing the proper protective equipment, but I absolutely still provided the necessary medical care that was needed. And some of the outpatient experiences were done via telemedicine.

[Court Clerk]

Telemedicine?

[Dr. Jennifer Tufts]

Yes. It's Zoom or something similar.

[Court Clerk]

Did you touch people, shake their hand, give them a hug, anything like that while you were working in your residency, during the pandemic?

[Dr. Jennifer Tufts]

Sometimes not. You know, I think everybody had to keep their distance at certain times. I began my program before the pandemic, so of course there was a lot more handshaking and things like that then.

[Court Clerk]

You can't really keep your distance, though, when you're working as a labor and delivery nurse with a woman who's having a baby directly in front of you. Can you?

[Dr. Jennifer Tufts]

I imagine not.

[Court Clerk]

So when you finished, do you graduate for residency or is it like you get a certificate or something?

[Dr. Jennifer Tufts]

Yes, there is a certificate for completing.

[Court Clerk]

You are now a licensed doctor.

[Dr. Jennifer Tufts]

Well, you're actually a licensed doctor the entire time that you're in residency. But upon the completion of that, you can obtain a full, unrestricted Massachusetts license and also become board certified.

[Court Clerk]

And the board certification, for example, you have a board certification in general psychiatry, Is that correct?

[Dr. Jennifer Tufts]

Yes, sir.

[Court Clerk]

And when was it that you got that certification?

[Dr. Jennifer Tufts]

When was. Was September 12, 2022.

[Court Clerk]

When was it that you actually started working as a physician? As a psychiatrist.

[Dr. Jennifer Tufts]

I started working as a physician and as a psychiatrist during the residency training program, But I started practicing completely independently at Astor mental health in August of 2022.

[Court Clerk]

August of 2022, yes. Now, prior to working with or at Aster, Is that Astr.

[Dr. Jennifer Tufts]

Aster, like the flower?

[Court Clerk]

What is Astro? Is it like a group of doctors? Is it a medical center?

[Dr. Jennifer Tufts]

It is a outpatient practice that is owned by a psychiatrist. It has a number of psychiatrists as well as therapists.

[Court Clerk]

And where is it located? Is it a brick and mortar type place where you have offices?

[Dr. Jennifer Tufts]

Yes, the original offices were in Braintree, Massachusetts, and now there is an office in Peabody as well. So at the time I saw the patient, I was working in the Braintree office. I currently work in Peabody, currently in Peabody, Massachusetts. It's a fairly lengthy process. A number of interviews with different staff at the practice and some recommendations, letters of reference, verification of credentials, all of that. But yes, it can be comparable to another profession in that process.

[Court Clerk]

Now, in August of 22, when you, congratulations, obviously you were hired by Astor, how many women have you treated in your residency that were postpartum with postpartum

[Dr. Jennifer Tufts]

depression or just in the postpartum period?

[Court Clerk]

How many women that were in the postpartum period did you treat prior to August of 22?

[Dr. Jennifer Tufts]

Many. It's. It's hard to give an exact number, but I did have specific training in that population.

[Court Clerk]

In that population. And where did you have the training in that population?

[Dr. Jennifer Tufts]

At Boston Medical Center.

[Court Clerk]

And can you tell us in that two year period approximately how many women that were in the postpartum period that you treated as a resident?

[Dr. Jennifer Tufts]

Okay, so it's really hard to give an exact number, but if I had to say at least 50.

[Court Clerk]

So in the two year period, you treated 50 people in the residency that had postpartum. And can you tell me what is postpartum?

[Judge William Sullivan]

What is that?

[Dr. Jennifer Tufts]

Well, I just want to address that. It was. It was a four year period, not a two year period.

[Court Clerk]

Oh, I'm sorry. Okay.

[Dr. Jennifer Tufts]

And sorry, what was. What was your question?

[Court Clerk]

Hold on. You saw 50 people in a four year period that had postpartum. In other words, they had done after having the baby, right?

[Dr. Jennifer Tufts]

Possibly, yeah, more or less. I. I saw a number of other patients. I saw much more than 50, but yes.

[Court Clerk]

So after you had your residency and after you were hired by Astor, is that when you began, In August of 22, your practice as a practicing psychiatrist?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And when was it that you actually got your DEA license that authorizes you to prescribe medication to citizens?

[Dr. Jennifer Tufts]

So during residency, I had a DEA license, but it was affiliated with the. With Boston Medical Center. And then when I started at Aster, I had a. My own DEA number. I don't know exactly when. Maybe sometime around August.

[Court Clerk]

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?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And it was when that you saw Lindsey Clancy?

[Dr. Jennifer Tufts]

I believe our first visit was September 15th of 2022.

[Defense Attorney Kevin Reddington]

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[Court Clerk]

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[Dr. Jennifer Tufts]

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[Assistant District Attorney Jennifer Sprague]

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[Court Clerk]

So you were practicing as a psychiatrist for. For a little more than a month.

[Dr. Jennifer Tufts]

I was practicing independently with my full credentials for about a month, but the training is just immense. That goes on before that?

[Court Clerk]

Absolutely, it must be. But that's a residency that you're talking about, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And, you know, in a residency, all I know is Grey's Anatomy. But I mean, you're working under a doctor. The doctors are supervising you, and they tell you what to do and they report to them. Correct.

[Dr. Jennifer Tufts]

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 available for any support I needed.

[Court Clerk]

So August of 22, when you started working at Astor, you actually filled out a form for your advertising, is that correct?

[Dr. Jennifer Tufts]

I believe that was handled by other people at the practice.

[Court Clerk]

Ah. And who would that be?

[Dr. Jennifer Tufts]

Well, we have non clinical staff that handle the administrative batters.

[Court Clerk]

Okay, but you can. 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 fair?

[Dr. Jennifer Tufts]

I believe, yes. I am not directing the marketing of our office, but yes.

[Court Clerk]

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?

[Dr. Jennifer Tufts]

Well, I don't think there was an ad. I think we have a website that had some information about myself.

[Court Clerk]

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?

[Dr. Jennifer Tufts]

How many patients in a month?

[Assistant District Attorney Jennifer Sprague]

Up until that month, I'm asking how

[Court Clerk]

many patients have you treated before you saw dense postpartum psychosis?

[Dr. Jennifer Tufts]

Well, in the span of one month, I would say none, because it's a very rare disorder.

[Court Clerk]

But it exists, doesn't it?

[Dr. Jennifer Tufts]

Absolutely.

[Court Clerk]

And one of the things would be the voices that people hear, right?

[Dr. Jennifer Tufts]

That is a symptom of psychosis. Absolutely. And that's legitimate, isn't is a legitimate diagnosis? Absolutely. Many do. The disorder can manifest differently in different people, but yes, many people do hear voices.

[Court Clerk]

How about postpartum depression? How many people in that month or so be. Before you met Lindsey, did you treat

[Dr. Jennifer Tufts]

for postpartum depression in the span of one month? It's really hard to pinpoint that. Maybe a couple.

[Court Clerk]

Maybe a couple. And do you recall how long you treated them for?

[Dr. Jennifer Tufts]

Again, it's hard to really pin down the individuals in a short span of time.

[Court Clerk]

Can you tell the jury what you put in your ad or in the aster website that you indicated that described you?

[Dr. Jennifer Tufts]

I don't recall.

[Court Clerk]

Well, one of the things you did is that you said that you basically were a specialist in postpartum people that have psychiatry. You indicated that on your website.

[Dr. Jennifer Tufts]

Are you able to. To read the actual document? I don't remember exactly the wording. Almost four. Yes.

[Court Clerk]

You haven't changed your ad on the website, have you?

[Dr. Jennifer Tufts]

I. I don't. I have. Not personally, no.

[Court Clerk]

And you've read it probably a bunch of times, right?

[Dr. Jennifer Tufts]

I read it a couple times, but I don't spend a lot of time on my website.

[Court Clerk]

Okay. Do you recall that you indicated that you were specializing in any particular aspect of psychiatry?

[Dr. Jennifer Tufts]

Yes. It probably includes a special interest in women's health, in perinatal psychiatry, in trauma related disorders, anxiety and, you know, there may be some other things that were mentioned.

[Court Clerk]

Yeah, like women that have babies and they're suffering from postpartum depression.

[Dr. Jennifer Tufts]

Absolutely.

[Court Clerk]

You advertise that after a month working for asta, right?

[Dr. Jennifer Tufts]

That's listed as one of my interests. Definitely.

[Court Clerk]

And again, forgive me, how many women did you treat for postpartum depression in that month and a half before you met Lindsay?

[Dr. Jennifer Tufts]

I don't know. Maybe a couple. But I've treated many of them in the residency, which was just immediately before.

[Court Clerk]

So when a person needs to see a psychiatrist, generally they're not well. Is that fair?

[Dr. Jennifer Tufts]

Some are not well. It really can vary.

[Court Clerk]

So when someone comes to see a psychiatrist like you, it's because they need help, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And when they come to you because they need help, for example, with Lindsey Clancy. She came to you because of your ad, right? Or your website for asta, what you said about yourself.

[Dr. Jennifer Tufts]

I don't know exactly how she found us.

[Court Clerk]

Well, do you know why she came to see you?

[Dr. Jennifer Tufts]

Yeah, I'm not sure exactly.

[Court Clerk]

Friday, we spent a long period of time going through your initial or the initial intake that she had to fill out. Is that correct? You recall that?

[Dr. Jennifer Tufts]

Yes, we do.

[Court Clerk]

And the district attorney kept asking you, and this is in Sept. Is it Sept. 12? Is that when that form was filled out?

[Dr. Jennifer Tufts]

I believe she completed the form on the 12th. The appointment was on the 15th.

[Court Clerk]

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?

[Dr. Jennifer Tufts]

Yes, our administration handles that.

[Court Clerk]

And what do they do? How does that happen?

[Dr. Jennifer Tufts]

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.

[Court Clerk]

Within the portal?

[Dr. Jennifer Tufts]

The patient portal? Yes.

[Court Clerk]

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.

[Dr. Jennifer Tufts]

Something like that.

[Court Clerk]

Are you aware of something like that or are you aware of what it does?

[Dr. Jennifer Tufts]

So, because I don't handle the scheduling and the sending of forms, I don't know exactly what it looks like.

[Court Clerk]

This is the form you're giving a person that needs help because they're possibly mentally ill, is that right?

[Dr. Jennifer Tufts]

Yes. And what's important is that I review the forms and we go through them in the appointment.

[Assistant District Attorney Jennifer Sprague]

Absolutely.

[Dr. Jennifer Tufts]

Oh, yes. Yes.

[Court Clerk]

Now understand that your record, exhibit 219, I believe the jury will have access to the tops records. Okay. You're aware of that, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

Because you have talked to the prosecution about what an exhibit is. And you know that your records are now in evidence before Ms. Jerry, right?

[Dr. Jennifer Tufts]

If that's what you say, yes.

[Court Clerk]

I wouldn't take what I said.

[Dr. Jennifer Tufts]

Well, I don't know.

[Court Clerk]

That's fine.

[Dr. Jennifer Tufts]

I don't know the details of how this works.

[Court Clerk]

But have you talked to them prior to your testimony?

[Dr. Jennifer Tufts]

No.

[Court Clerk]

You haven't Talked to the DA's office?

[Dr. Jennifer Tufts]

No. Not at all.

[Court Clerk]

You're a defendant in a very large lawsuit, are you not?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

You wouldn't happen to be represented by an attorney, would you?

[Dr. Jennifer Tufts]

I am.

[Court Clerk]

And the fact that you have an attorney is your right under the Constitution. It doesn't mean that you're guilty of anything. Right?

[Dr. Jennifer Tufts]

Right.

[Court Clerk]

Okay. And you know that the outcome of this case is very, very major to the outcome of your lawsuit?

[Dr. Jennifer Tufts]

I don't actually know that.

[Court Clerk]

So you understand that if in fact it's determined that you advertised as an expert in postpartum and in postpartum psychiatry and you've had a month experience plus a residency, would you consider that to be negligent or the service?

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[Dr. Jennifer Tufts]

I do not believe that I have been negligent.

[Court Clerk]

Do you understand what misrepresentation is?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

For the month having developed, plus your residency, you really wanted this jury complete if you were an expert. Can you advertise that?

[Dr. Jennifer Tufts]

I don't think that's exactly the wording that I used. I think I said that it was an interest of mine.

[Court Clerk]

No, go ahead.

[Judge William Sullivan]

Good answer.

[Court Clerk]

Are you an expert in postpartum?

[Dr. Jennifer Tufts]

I may be. I don't know. I think it depends on what you define an expert as.

[Court Clerk]

Well, when a patient comes to you and they fill out the form, do you agree with me that your records reflect that form that she filled out on September 12th of 2022? Right.

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And the form that the district attorney went through painstakingly with you is basically something like this. Right. That's just one of the forms that you've got to fill out. Right? Right.

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

See the little check mark?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

Who puts the check mark?

[Dr. Jennifer Tufts]

The patient.

[Court Clerk]

So how many pages? Because I don't want to go through all the pages yet. How many pages does a patient or how many pages did Lindsey go through to check the boxes for aspect?

[Dr. Jennifer Tufts]

There were a lot of patients.

[Court Clerk]

There's a lot. 10?

[Dr. Jennifer Tufts]

20? Yeah. Maybe between 10 and 20.

[Court Clerk]

Okay. And basically they're all legal checks and boxes, correct?

[Dr. Jennifer Tufts]

Not just checks?

[Court Clerk]

No. So does the person then answer questions by typing in an answer, such as, do you have any pending legal problems?

[Judge William Sullivan]

No.

[Court Clerk]

Have you been arrested? No. Things of that nature? Right.

[Dr. Jennifer Tufts]

Those are some of the questions.

[Court Clerk]

And the questions also, do they ask the patient what medications they were on?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

Before seeing you?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And Lindsey told you that she was on SSRIs in the past, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And SSRI means what?

[Dr. Jennifer Tufts]

A selective serotonin reuptake inhibitor.

[Court Clerk]

And that's pretty powerful stuff, isn't it?

[Dr. Jennifer Tufts]

It's an effective treatment for depression and anxiety.

[Court Clerk]

Well, it affects the serotonin levels in the brain, doesn't it?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

It rewires the brain, doesn't it?

[Dr. Jennifer Tufts]

It doesn't rewire the brain. It increases the serotonin. And many individuals with. With depression have low levels of serotonin.

[Court Clerk]

So Lindsay told you that she had been prescribed an SSRI when she was in nursing school, is that right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

What was the ssri?

[Dr. Jennifer Tufts]

Prozac.

[Court Clerk]

And how long was she on the Prozac?

[Dr. Jennifer Tufts]

I'm not sure. I probably asked.

[Court Clerk]

Isn't it true? Don't you guys have a saying that if it's not written, it didn't happen? You take copious notes, do you not?

[Dr. Jennifer Tufts]

It's impossible to write down every single thing that's said. So I write down what is clinically relevant, clinically necessary. But there's a lot that is discussed over an hour that is not able to be written down.

[Court Clerk]

Such as? The fact that a person was on an SSRI when they were in nursing school is not an important factor. Find out.

[Dr. Jennifer Tufts]

Oh, no. That's important. Sorry.

[Court Clerk]

No problem. I'm not. I'm not doing, you know, the Sophie Cunningham idea. I'm just asking a question, that's all. You can answer it. Okay. How about if she had a reaction to Prozac?

[Dr. Jennifer Tufts]

I asked her about the Prozac.

[Court Clerk]

Is that written in your notes?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And what did she say?

[Dr. Jennifer Tufts]

I mean, she said that she. She took it for a period of time. She didn't mention any side effects.

[Court Clerk]

So when a patient comes to see you with a month under your belt and they're sick and they're looking for help, you wait for them to volunteer, fax to you?

[Dr. Jennifer Tufts]

She volunteered a lot of information. She. She knew very well what her medical history was and was able to provide that for me.

[Court Clerk]

Such as what? That she was in nursing school and took Prozac.

[Dr. Jennifer Tufts]

That's part of it.

[Court Clerk]

And she told you that, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And she was pretty upfront and honest with you, wasn't she, in answering these questions, right?

[Dr. Jennifer Tufts]

I believe that she was.

[Court Clerk]

We all spent some time talking about the fact that she declared that she had consumed alcohol, that she felt guilty about it. Recall that on Friday? We dwelled on that for a while, didn't we?

[Dr. Jennifer Tufts]

Yes. That was a component. Yes.

[Court Clerk]

I mean, that's something that's important, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

What was her. What was her drink of choice?

[Dr. Jennifer Tufts]

I'm not sure.

[Court Clerk]

Did you ever ask her?

[Dr. Jennifer Tufts]

I'm not sure. We were not concerned that her level of alcohol use was a deduction.

[Judge William Sullivan]

Everybody knows, Doctor. Wait for the question. All right? And then. Same thing. I'll have Council wait until you finish your answer. All right. Go ahead, Ms. Remington.

[Court Clerk]

So is it important, Doctor, for you as a physician, to know your patient? In other words, know who they are?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And. And you know that Lindsay was a nurse, correct?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

You know that she graduated, obviously, from college, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

She good student?

[Dr. Jennifer Tufts]

I don't recall.

[Court Clerk]

Do you know when she got married?

[Dr. Jennifer Tufts]

I. I don't recall that specific detail. I don't know. I knew she was married.

[Court Clerk]

She had three kids, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And the reason that you knew that she was married is because you. You spoke to her husband, Patrick, Correct?

[Dr. Jennifer Tufts]

He. What?

[Court Clerk]

Did you.

[Dr. Jennifer Tufts]

Sorry.

[Court Clerk]

Or did you.

[Dr. Jennifer Tufts]

He attended one of the appointments and I spoke with him on that date.

[Court Clerk]

And did you say, hi, how are you? And you gave him a handshake when he came into your office?

[Dr. Jennifer Tufts]

It was telemedicine.

[Court Clerk]

It was what?

[Dr. Jennifer Tufts]

Telemedicine.

[Court Clerk]

Telemedicine. Is it fair to say that after, what is it? 14. When you said to the jury 14 appointments that you had with Lindsay during that period from September till January 14?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

Every single one of them were by television, Wendy?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

Until you came in this courtroom Friday, you never saw this woman in person, did you?

[Dr. Jennifer Tufts]

Correct.

[Court Clerk]

Were you ever concerned about her mental health as a person?

[Dr. Jennifer Tufts]

Absolutely.

[Court Clerk]

She was crying. She told you symptoms that she couldn't get out of bed, isn't that right?

[Dr. Jennifer Tufts]

At one time she said it was. It was difficult to get out of bed.

[Court Clerk]

Oh, difficult. Why was it difficult for Lindsey Clancy to get out of bed?

[Dr. Jennifer Tufts]

Because she was very depressed and.

[Court Clerk]

Did you give her a hug? Oh, no. You're on telemedicine, so you couldn't give her a hug, could you? You didn't have any chance to even look at her in person, did you?

[Dr. Jennifer Tufts]

I could look at her. It was. It was always a video appointment. I couldn't give her a hug. But that's not actually something that psychiatrists typically do with patients, I imagine.

[Court Clerk]

Now I'm looking at you, and you've got the witness stand cutting you off in half. Right. So I can't see from. From your waist down, your legs, your feet, your hands, anything. That's the same view that you have on the telemedicine bank.

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

Isn't it fair to say that you've studied and that you've learned that there are objective manifestations that patients may have that would be a tell. Like if you're playing poker, you have a tell. That would be an indicia of the fact that they're stressed or emotionally disturbed, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

Like hand wringing, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

Were you able to see the hands ringing when you were on telemedicine?

[Dr. Jennifer Tufts]

I don't believe. I don't recall seeing her hands.

[Court Clerk]

Recall. You know, how people sit there and they do this with their leg and the leg bounces because they're going through some type of emotional stress. You couldn't even see your legs, could you?

[Dr. Jennifer Tufts]

I couldn't see her legs, but I knew that she was under stress.

[Court Clerk]

So when she came to you, September 15th, I believe, is the first time that you all actually discussed their condition, Correct?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And looking at medical records, which the jury will be able to look at, it says visit date September 15, 2022. And you can look up. You can look along with me if you wish. Indicates why she came to see you, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

Right? Yes.

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

Okay. Why did she come to see you? According to the guessing and speculating. Never mind the tv. Just look at your notes. Tell me what brought Lindsey Clancy to your office.

[Dr. Jennifer Tufts]

Postpartum anxiety.

[Judge William Sullivan]

Is that it?

[Court Clerk]

Is that what you noted in the records?

[Dr. Jennifer Tufts]

Well, those were her words when asked, what are the problems for which you are seeking help?

[Court Clerk]

Ice. Postpartum anxiety. Now, as a psychiatrist, meeting with this young woman after a month or so of working as a psychiatrist, or aster, there are tests that you administer to a woman who's in postpartum to find out what type of anxiety they have. Right.

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[Dr. Jennifer Tufts]

Well, there are some screening tests, but the most important thing is what the patient tells you and what my assessment is in the session.

[Court Clerk]

I see. And that would carry through the Tufts evaluations for all 14 of those meetings is what the patient tells you, right?

[Dr. Jennifer Tufts]

Yes. And what I observe in the session,

[Court Clerk]

through the television, through the computer. What if you can tell me is the Edinburgh test?

[Dr. Jennifer Tufts]

It is a scale that looks at symptoms of postpartum depression.

[Court Clerk]

And when you administer. That's a major test, isn't it, for a doctor to evaluate a patient for ppd?

[Dr. Jennifer Tufts]

I wouldn't say It's a major test.

[Court Clerk]

It's a pretty big one, though, isn't it? It's the only one that measures the postpartum depression, right?

[Dr. Jennifer Tufts]

It's a common one.

[Court Clerk]

It's a what?

[Dr. Jennifer Tufts]

Common. Commonly used.

[Court Clerk]

So when you used it on Lindsay, when was that administered to her?

[Dr. Jennifer Tufts]

I did not use it on Lindsay. Why? We used the PHQ9, which is a.

[Court Clerk]

What's PHQ9?

[Dr. Jennifer Tufts]

It's depression screening Form.

[Court Clerk]

That's. That's like generalized anxiety disorder, general depression. It's got nothing to do with a woman suffering from postpartum depression, does it?

[Dr. Jennifer Tufts]

I disagree.

[Court Clerk]

Well, do you agree that people, perhaps that may know a little more than you, determine that the Edinburgh Scale is the appropriate scale to administer to a pregnant or postpartum woman?

[Judge William Sullivan]

Sustained as the form.

[Court Clerk]

You're familiar with the Edenburg Scale, right?

[Dr. Jennifer Tufts]

I've heard of it.

[Court Clerk]

Can you explain to me how it's graded?

[Dr. Jennifer Tufts]

No, I cannot.

[Court Clerk]

There are 30 questions in it, are there not?

[Dr. Jennifer Tufts]

I don't use this scale, so I don't know how many questions there are.

[Court Clerk]

So the Edinburgh Scale, do you even know that for someone that is depressed in their condition, condition of postpartum would be 15. Anything over that, they're in severe depression.

[Dr. Jennifer Tufts]

Okay.

[Court Clerk]

You know that her first Edenburg test that was administered to her put her at a 23?

[Assistant District Attorney Jennifer Sprague]

Objection.

[Court Clerk]

Overall, severe depression.

[Dr. Jennifer Tufts]

I. I was not aware of this test. I was not aware that this had been administered to her.

[Court Clerk]

Well, you know that except for the Prozac that she had when she was a nurse, what, 23, 24, 23 years old, she hadn't. Other than seeing her own doctor for having a baby, she hadn't seen any doctors. You knew that, right?

[Dr. Jennifer Tufts]

I didn't know exactly which doctor she seen. I think we, you know, we ask about your primary care doctor, but she did not report any other medical issues that she was under treatment for.

[Court Clerk]

So is it important for Dr. Jennifer Tufts to know whether or not a patient who is coming to you for help has a prior medical history other than what they might tell you?

[Dr. Jennifer Tufts]

Well, when patients are able to advocate for themselves and share their medical history, we rely on what they tell us.

[Court Clerk]

Was she able to advocate for herself, in your opinion, when she came to see you and you evaluated her in September?

[Dr. Jennifer Tufts]

Absolutely.

[Court Clerk]

About October?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

About November?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

About December, Yes. And your medical records, you would agree, show that during that period of time that she was deteriorating was a word that was used on Friday. Isn't that right?

[Dr. Jennifer Tufts]

So.

[Court Clerk]

No. No. So you used the word deteriorating on Friday. Did you not.

[Dr. Jennifer Tufts]

She was a little bit worse at certain appointments. And the deteriorating word, which is not my word choice, is what is in the note. Because I had to select that because.

[Court Clerk]

Why? You have some kind of a program that you have to check the box and you have to bring down the Dropbox. You can't take a pen and write something down about a patient.

[Dr. Jennifer Tufts]

There are certain parts of the note where I can write whatever I feel is necessary, but that specific aspect of the note is a button where you have to click one of three choices.

[Court Clerk]

So when the jury's going through your medical records, one of the things that they're going to see is that when you meet with a patient, you have a form that you fill out where it says, if you feel like you're going to harm yourself or somebody else, make sure you go to the emergency room, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

If you have any urges to harm yourself or others, go to the nearest emergency room. That's in every single time that you meet the patient, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And it indicates that if there's any. Call the Suicide Prevention and Crisis Hotline. If you feel that you're in crisis, you may text home to a particular number anytime. What's a suicide?

[Dr. Jennifer Tufts]

It's a phone number that patients in crisis can call and speak to a trained counselor.

[Court Clerk]

Now, a psychiatrist, you'd agree with me, is not a counselor. That's for sure. Right.

[Dr. Jennifer Tufts]

Well, a psychiatrist has training in therapy as well as in medicine.

[Court Clerk]

Did you give Lindsay Clancy any therapy?

[Dr. Jennifer Tufts]

There was some therapy incorporated in our sessions, but we did. Providing emotional support, listening to her.

[Court Clerk]

Anything else you want to say?

[Dr. Jennifer Tufts]

So her sessions were largely focused on the medication management, but there was an aspect of therapy. Include. Including those. Those items.

[Courtroom Audio Technician]

Okay.

[Court Clerk]

And the sessions were for what, 17 minutes?

[Assistant District Attorney Jennifer Sprague]

No.

[Court Clerk]

How long were they?

[Dr. Jennifer Tufts]

25 to 30 minutes.

[Court Clerk]

So 25 to 30 minutes on the television. And will you face the TV screen with her for the full 25 minutes?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And that's not noted in your records. It says 17 minutes in all your records.

[Dr. Jennifer Tufts]

So if. If you look closely, it says the therapy component was for 17 minutes. It doesn't say the entire duration is 17 minutes. It depends on the person.

[Court Clerk]

What did you do for therapy with her?

[Dr. Jennifer Tufts]

I listened to her. I listened to her concerns and provided support. I tried to provide her with hope that eventually things would improve.

[Court Clerk]

So you listen to her. You listen to her concerns, and you'd agree with me that her concerns were, for example, that she actually was unable to sleep. It's one of her concerns.

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[Dr. Jennifer Tufts]

She was having a lot of difficulty

[Court Clerk]

with sleep on the September 15th meeting. You indicate that her mood was okay, but her affect was anxious and you called it incongruent. What does that mean?

[Dr. Jennifer Tufts]

So she said she was feeling okay, she appeared anxious, and she also stated that she was anxious.

[Court Clerk]

So one of the things that you talked about Friday is when a patient presents with an incongruent something like that. I don't remember appearance, perhaps. That would mean that they're saying I'm okay, but they don't look like they're okay, right?

[Dr. Jennifer Tufts]

Well, it could. I don't think her affect and her mood were really that incongruent at that time. I think that she didn't appear terribly depressed. I didn't say she was terribly depressed in that initial visit, but she said she was anxious and she appeared anxious. That's pretty congruent.

[Court Clerk]

Okay, so did you put in the report that she was congruent or incongruent?

[Dr. Jennifer Tufts]

So that is not an option for me to indicate in that section. But it was congruent.

[Court Clerk]

You're like a robot. You can't take a pen and write something down. You have to do the Dropbox and the X's on the computer.

[Dr. Jennifer Tufts]

Well, it's. It's on the computer. I'm limited by the options that are up there.

[Court Clerk]

You're a doctor. Why are you limited?

[Dr. Jennifer Tufts]

Because of the technology.

[Court Clerk]

What technology? The fact that there's a form on a computer. You're trying to treat a human being who comes to you for help, and

[Dr. Jennifer Tufts]

that's what's Most important. What's most important was the treatment, not what is checked off on. On a box.

[Court Clerk]

Makes sense. So you were unable to make a note as to whether or not her affect and her mood appeared to be in conflict and that she would have been in con and that she had poor insight. You couldn't write that down, is that right? Because the box doesn't let you.

[Dr. Jennifer Tufts]

Correct.

[Court Clerk]

So basically she's telling you that I'm okay. Well, actually, when she came, do you know that she never saw other than when she was in nursing school. Would it surprise you, a psychiatrist? And that was only for like a week when she got the Prozac in nursing school because she was afraid of public speaking.

[Dr. Jennifer Tufts]

Did you know that I was aware that she did not have a significant past psychiatric history. I was. I was aware of that.

[Court Clerk]

Okay, so you were the first psychiatrist and she had the pleasure of meeting, is that correct?

[Psychiatric Nurse Practitioner Julie Paul]

Yeah,

[Dr. Jennifer Tufts]

I think it was.

[Court Clerk]

And isn't that important for you as a doctor to take a history?

[Dr. Jennifer Tufts]

I did take a history.

[Court Clerk]

So can you tell us, you testifying here for the God to tell us whether or not she had any past psychiatric history other than in nursing school for a week?

[Dr. Jennifer Tufts]

She did not report any other past psychiatric history other than the Prozac and Bobby trend.

[Court Clerk]

So when a patient comes to see you and you're treating to help that patient, if they don't report something to you, you don't know about it, apparently, Right?

[Dr. Jennifer Tufts]

Well, I. I think it depends. There are certainly things I can assess, but if it's related to their history, I. I do need them to tell me.

[Court Clerk]

Well, you can't assess it unless you ask, right?

[Dr. Jennifer Tufts]

Unless I. I ask or they volunteer it or they push out. Yes.

[Court Clerk]

You didn't ask for a prior history?

[Dr. Jennifer Tufts]

I did.

[Court Clerk]

What did she tell you?

[Dr. Jennifer Tufts]

She. She said that her prior history was. Was what we discussed. Discussed about the Prozac in the nursing school.

[Court Clerk]

So basically, other than hoping to give her hope is what you said for the therapy. How do you give someone hope for therapy? The other doctor

[Dr. Jennifer Tufts]

try to encourage them. And what did I encourage her? Yeah, I don't remember exactly the words it was. No, we don't. We don't write those, you know, details of every.

[Court Clerk]

That's the therapy you're talking about, right? Yes, yes. And you don't write down the therapy you give a patient in the records, right?

[Dr. Jennifer Tufts]

Well, I write something about it. I mentioned that.

[Court Clerk]

Excuse me. So yes or no.

[Judge William Sullivan]

Hold on, let her finish the question and listen to the question and answer just what they ask. Okay, go ahead. You can rephrase that question.

[Court Clerk]

No, I'll let her answer it. All right.

[Dr. Jennifer Tufts]

I mentioned that I provided supportive therapy.

[Court Clerk]

What is supportive therapy?

[Dr. Jennifer Tufts]

It's listening to the patient's concerns and providing emotional support and validation.

[Court Clerk]

So emotional support and validation all sounds good. Here's a young woman who was, what, 20, 29, 30 years old, came to see you.

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And came to see you for help, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

Told you she couldn't sleep and she was anxious, correct?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

You know that she was post. Postpartum. By the way, what is your opinion of the period of postpartum wherein one can have postpartum depression and more importantly, postpartum psychosis? What's the time frame?

[Dr. Jennifer Tufts]

It's typically one year.

[Court Clerk]

So she was well within that time frame, correct?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And you tried to provide therapy by giving her hope. And how long do you figure did that take? 5 minutes, 10 minutes, 2 minutes?

[Dr. Jennifer Tufts]

I'm not sure. I think it was different in each session.

[Court Clerk]

So the only thing that you diagnosed Lindsay with on September 15th was GAD. Generalized Anxiety Disorder. Correct.

[Dr. Jennifer Tufts]

It was Generalized anxiety disorder, as well as an adjustment disorder with depressed mood.

[Court Clerk]

And you prescribed medications to her, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And the medication that you provided to her was the Sertraline, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

The Sertraline would be Zoloft, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

Now, this is a little chart that shows the prescriptions that Lindsey was on. And you are the yellow colors. You can see that you agree with me that on September 15, you prescribe sertraline, Zoloft 30 count on September 15, 25 milligrams, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

Have you ever read the website of Sertraline?

[Dr. Jennifer Tufts]

The website for Sertraline?

[Court Clerk]

Yeah. Sertraline, Zof is a chemical that is marketed as a pharmaceutical, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

Right. It's a pill, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And as we said, it's an SSRI pill, correct?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

Do you know that Zoloft is not indicated for generalized anxiety? Why did you give it Zoloft?

[Dr. Jennifer Tufts]

It is a very effective medication for generalized anxiety anxiety disorder.

[Court Clerk]

So you're familiar with the drug labeling for Zoloft, is that correct?

[Dr. Jennifer Tufts]

Generally.

[Court Clerk]

Generally. Are you aware of what the manufacturer of Zoloft indicates it can be used for? To treat.

[Dr. Jennifer Tufts]

I'm aware that it's used to treat various forms of anxiety disorders as well as major depression.

[Court Clerk]

So when Lindsay came to see you, you know that she had stopped breastfeeding her son, right?

[Dr. Jennifer Tufts]

Not at the time of the first appointment.

[Court Clerk]

When did she stop breastfeeding? In October.

[Dr. Jennifer Tufts]

Something around then.

[Court Clerk]

You know that she had little or no psychiatric History other than seeing you? Correct.

[Dr. Jennifer Tufts]

And the proac. Yes.

[Court Clerk]

You know that in fact, that she had stopped drinking, whatever it was that she was drinking because you never asked, right?

[Dr. Jennifer Tufts]

I was not concerned about her level of drinking.

[Court Clerk]

Well, it's in your form, right?

[Dr. Jennifer Tufts]

That was at the intake, but I.

[Court Clerk]

Did you know that she wasn't drinking when you. When you were meeting with her, correct?

[Dr. Jennifer Tufts]

I. Yeah, that's what she told me.

[Court Clerk]

Okay. And you believe what she told me, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

So when she sees you, she's not on any psychiatric anti. Tropics or whatever they're called medications, correct? She wasn't on any medication, Correct. And she had stopped drinking anything, whatever it may have been? Right.

[Dr. Jennifer Tufts]

I'm not sure when she completely stopped drinking, but yes.

[Court Clerk]

You don't know when she started, when she stopped, what she drank, do you?

[Dr. Jennifer Tufts]

Well, I was not concerned that she was an alcoholic.

[Court Clerk]

That's a yes or no. Did you have any idea? Because we spent a long time on Friday talking about her guilt and having that she drank alcohol. You don't know what she drank, when she drank, when she started, when she stopped beating?

[Dr. Jennifer Tufts]

I know some details about her alcohol use, but it was overall minimal. So I.

[Court Clerk]

What other details were there that she

[Dr. Jennifer Tufts]

drank one to two times a week? Five. One to two servings, five times a week.

[Court Clerk]

And you don't know where. What, what it was? You have no idea, right?

[Dr. Jennifer Tufts]

I. I think she had mentioned at some point. Point that it was. It was calming. It was something that was calming. That's one way of saying it.

[Court Clerk]

I mean, you've treated, I imagine you've treated veterans that had post traumatic stress disorder, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And would you agree with me that many times when people have an anxiety disorder or ptsd, whatever the case may be, they try to numb

[Assistant District Attorney Jennifer Sprague]

there?

[Dr. Jennifer Tufts]

Sometimes they do.

[Court Clerk]

And sometimes they use alcohol.

[Dr. Jennifer Tufts]

Sometimes they do.

[Court Clerk]

We don't know what alcohol. We don't even know if it was a beer.

[Assistant District Attorney Jennifer Sprague]

Who.

[Dr. Jennifer Tufts]

I didn't think that was relevant for her.

[Court Clerk]

So with all of that, with that information, you then prescribed Zol to her, correct?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

You went over the side effects of Zoloft, Sertraline, I imagine, with her, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

Did you tell her that one of the known side effects is suicidal thoughts and actions in ideation?

[Dr. Jennifer Tufts]

Well, that's specifically in children, so I don't think I mentioned that because it wasn't relevant.

[Court Clerk]

Along with SSRIs, right.

[Dr. Jennifer Tufts]

Under age for children and adults younger

[Court Clerk]

than Latin, is there a black box warning on Zoloft?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And a black box warning is required or Prescribed by what, the fda?

[Dr. Jennifer Tufts]

Probably, probably.

[Court Clerk]

And it basically warns that especially with young people or young adults, that it may cause suicidal or God forbid, homicidal ideation. Yes,

[Dr. Jennifer Tufts]

yes. And.

[Court Clerk]

And you're aware that in fact the FDA has determined that that goes up possibly to a 23 or 24, 25 year old. You know that, right?

[Dr. Jennifer Tufts]

I think 24 is what they said.

[Court Clerk]

I'll give you 24. It's possible, is it not, that the SSRIs that get into a person's brain affect a person that's three or four years older than the fda? Cutoff with suicidal ideation or homicidal ideation possible.

[Dr. Jennifer Tufts]

There's a lot of development that happens in the brain between ages, like up to 24 and closer to 30. The brain is fully matured at past age 24, and so it's less vulnerable than in a younger individual.

[Court Clerk]

So with 24, you're suggesting as a cutoff, are you suggesting to the jury that a drug that increases the risk of suicide in a 24 year location cannot increase the risk of suicide? 29 or 30 year old patient just a little bit.

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[Dr. Jennifer Tufts]

There's. I don't believe there's evidence that it causes that at all in individuals over 24.

[Court Clerk]

So as a psychiatrist who had the ability to issue these types of medications to patients and citizens, what research did you do on Zoloi and suicidal ideation? Homicidal ideation?

[Dr. Jennifer Tufts]

I was taught extensively about SSRIs and suicidal ideation in my training in Vermont and Boston.

[Court Clerk]

Yes, okay, so in Vermont was when you get your medicine to zero, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And Boston would be when you were a resident, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And then you have board certification on general psychiatry, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

You can have a certification on the subspecialty, right?

[Dr. Jennifer Tufts]

There are certain subspecialties, yes.

[Court Clerk]

Right. And some of the subspecialties deal with postpartum or women that are pregnant and have be. Hezen. Have two Psychiatric symptomology.

[Dr. Jennifer Tufts]

There's no board certification for perinatal or reproductive psychiatry.

[Court Clerk]

Well, there are plenty of classes that are recognized. For example, at Harvard Medical School, there's an annual class or symposium, if you will, for postpartum. Have you ever been to that?

[Dr. Jennifer Tufts]

No, sir.

[Court Clerk]

What have you done? Done to research or to improve your education? I understand you went to med school and that you were a resident. What programs, continuing education symposiums have you attended since you got the ability to prescribe these medicines to people?

[Dr. Jennifer Tufts]

I have not attended a symposium.

[Court Clerk]

Have you attended anything?

[Dr. Jennifer Tufts]

I have not, but I have done a lot of reading on my own of research and guidelines about this area in psychiatry.

[Court Clerk]

Did you tell Lindsay when you were going. Because one of the things that you guys are always concerned about is what's called informed consent, right?

[Grainger Commercial Announcer]

Yes.

[Court Clerk]

What is informed consent? What does that mean in a medical sense? Not just like Oven street, it's

[Dr. Jennifer Tufts]

explaining to a patient the risks and benefits of treatment and possible alternatives and making sure that the patient understands what you're saying.

[Court Clerk]

Now, when you were going over the symptomology or when you were going over the side effects of Zoloft, one of the side effects of Zoloft is, and I quote, zole severe trouble sleeping, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

Did you tell her that?

[Dr. Jennifer Tufts]

Well, insomnia is listed as a side effect.

[Court Clerk]

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.

[Dr. Jennifer Tufts]

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, and that was true.

[Court Clerk]

Let's say trouble sleeping. You know that, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

Your answer is yes. Jury has to be able to hear you.

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And why would you prescribe Zoloft to a young woman who's postpartum, who's coming to you with anxiety, who's telling you she can't sleep, she's got all of these symptoms, and you prescribe a medication that would have a side effect of trouble Sleeping.

[Dr. Jennifer Tufts]

So individuals have very varied responses to medications. Some have no side effects, some have one or two. It's impossible to predict, but so often is a top choice a first line medication.

[Court Clerk]

Says who?

[Dr. Jennifer Tufts]

Says it's. It's the general consensus.

[Judge William Sullivan]

Her answer. And then I'll give you plenty of time to follow up any questions regarding her answer. So you finish your answer on that.

[Dr. Jennifer Tufts]

There's extensive research supporting the use of Sertraline in this instance. And the general consensus among psychiatrists is that it's a first line safe medication for individuals, including postpartum women.

[Court Clerk]

How about the kids that shoot other kids in high schools and the lawsuits that come out of that against Zola? Have you forget about them? Overruled.

[Dr. Jennifer Tufts]

Sorry, I wasn't sure what the question was.

[Court Clerk]

The question was in response to your observation about how all the psychiatrists or psychiatrists think it's a very, very safe, wonderful first line drug. You research it. How about the kids that kill other kids in schools with the lawsuits that arise out of the use of SSRIs. Have you ever researched that?

[Dr. Jennifer Tufts]

I don't know much about that.

[Court Clerk]

You know about the SSRIs messing with someone's brain. They go out and shoot people for no reason, right?

[Dr. Jennifer Tufts]

I'm not aware that that's linked to SSRIs.

[Court Clerk]

So you didn't really talk to her about increased risk of suicide and 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 can be a side effect, but describes other drugs that you could have given her that would be perfectly safe and common and allow someone with no psychiatric history to sleep better, right?

[Dr. Jennifer Tufts]

Not necessarily.

[Court Clerk]

Okay, so you prescribed her with the zoloft, it was 25 milligrams, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And when you prescribed her with the Zola of 25 milligrams, was that increased up to 0.05 milligrams or did you increase it at some point?

[Dr. Jennifer Tufts]

The instructions were to increase it to 50. After one week?

[Court Clerk]

After one week?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And you expected that she would listen to your instructions, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And she did, right?

[Dr. Jennifer Tufts]

She waited about a month, but then. Yes.

[Court Clerk]

Why did she wait a month?

[Dr. Jennifer Tufts]

I think it took her some time to decide whether that was truly what she wanted to do.

[Court Clerk]

Right. She was afraid of the drugs, wasn't she?

[Dr. Jennifer Tufts]

She was afraid of side effects.

[Court Clerk]

And she didn't want to take the pills, did she?

[Dr. Jennifer Tufts]

She eventually did want to take the pills because she wanted to feel better

[Court Clerk]

a month later, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

So you prescribe the Zola SSRI and then you tell her after a week to increase it and she doesn't take that medication for a month, correct?

[Dr. Jennifer Tufts]

Correct.

[Court Clerk]

And then she did take the medication, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And did you meet with her or talk to her before she actually started to implement that particular. Particular regimen?

[Dr. Jennifer Tufts]

I had met with her beforehand, but I was not aware of when she made the decision to go ahead and take it.

[Court Clerk]

So you met her on the 15th of September, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

When was the next time you met her?

[Dr. Jennifer Tufts]

Can I check?

[Court Clerk]

Sure, of course. Absolutely. You can look anything you want.

[Dr. Jennifer Tufts]

September 20th.

[Court Clerk]

And on September 28th, did you discuss with her the fact that she was afraid to take the Zola?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And did you recommend that she do that?

[Dr. Jennifer Tufts]

Well, she said that she was feeling better at that point and wasn't sure.

[Court Clerk]

Or take the Zola

[Dr. Jennifer Tufts]

at that visit? I don't think that I did.

[Court Clerk]

Okay, so when did she actually take the Zoloft?

[Dr. Jennifer Tufts]

She told me in her October 20th visit that she had taken it one week prior.

[Court Clerk]

And she told you that when she increased it in accordance with your instructions, she went off the rails, right?

[Dr. Jennifer Tufts]

I don't think she used those words, but she had to say about you as her doctor.

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[Dr. Jennifer Tufts]

She felt awful.

[Court Clerk]

Awful. Why did she feel awful? Did she have a stomach ache? Did she have a headache? Why she feel awful?

[Dr. Jennifer Tufts]

She did have some stomach aches. 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

[Court Clerk]

and what was your advice to her, as her doctor, on 28 October, after she told you about the effect that Zoloft had on her?

[Dr. Jennifer Tufts]

I told her to stop it. Stop the medication.

[Court Clerk]

Okay. Now, Zoloft being an SSRI and a patient that is taking the Zoloft, 0.05, we spent Friday afternoon going over the drugs, and 0.05 milligrams is the lowest dose and all that, that's the dose that is prescribed to people? Invariably. Correct.

[Dr. Jennifer Tufts]

It goes up to 200. But that is a starting dose.

[Court Clerk]

Pretty much all of you psychiatrists would agree with that, right? 0.05, right?

[Dr. Jennifer Tufts]

50.

[Court Clerk]

50. Okay. And you then told her to stop?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

What does it mean to titrate something

[Dr. Jennifer Tufts]

to slowly increase the amount?

[Court Clerk]

What do you tell patients with when they run an SSRI as to weaning them off the SSRIs?

[Dr. Jennifer Tufts]

Depends what the dose is. If it's a high dose, you need to slowly decrease the dose. So kind of the opposite of titration. But if it's a low dose to begin with, you can stop it.

[Court Clerk]

Are you supposed to tell a person that's on on an SSRI to stop immediately or to slowly withdraw from it?

[Dr. Jennifer Tufts]

At 50 milligrams, it is perfectly fine to stop it immediately.

[Court Clerk]

So you didn't have any concerns at all about telling her to immediately stop taking the Zoloft, and what did you do, put her on another drug?

[Dr. Jennifer Tufts]

Not immediately.

[Court Clerk]

Okay, so did she relate to you on that October 20th, 28th meeting that you had? Was it the 28th or the 26th?

[Dr. Jennifer Tufts]

I met with her the 21st and then the 26th.

[Court Clerk]

Okay. Now, on the 26th of October, what did she tell you her condition was?

[Dr. Jennifer Tufts]

So she was feeling back to how she was before the Zoloft, which is not great still, and that she was considering a new medication.

[Court Clerk]

So she was considering it. Did she do research on medication as to what medication she wanted to take? Is that what you were telling this jury?

[Dr. Jennifer Tufts]

She didn't specify exactly what medication she wanted to take, but that she wanted to try something else because she was still having significant anxiety.

[Court Clerk]

So when you say she wanted to try something else, I'm just asking, did you tell her what you recommended she try, or is that something that she decided to do on her own?

[Dr. Jennifer Tufts]

No, I gave her my recommendation.

[Court Clerk]

Okay. The only reason why I asked that is that, you know, a lot of times people might think that she's a psychopharmacologist, that she's a hat surgeon, that she's a vascular surgeon. If she knows everything about. About medicine. That's not true, is it?

[Dr. Jennifer Tufts]

No.

[Court Clerk]

Would you agree with me that prior to telling her to stop the Zoloft, that one of the concerns that you had is that Zoloft affects anxiety and affects sleep, and you hope that it treats the underlying anxiety by balancing brain chemistry and increasing serotonin, Right?

[Dr. Jennifer Tufts]

Yes.

[Judge William Sullivan]

Is that fair?

[Court Clerk]

And. And you'd agree with me that it does, as a side effect, have an impact on a person falling asleep or staying asleep as a common side effect? Right.

[Dr. Jennifer Tufts]

It can happen. It doesn't happen to everyone, but it certainly happens to some, but it is temporary. That's the important distinction, is that there are many side effects that disappear entirely.

[Grainger Commercial Announcer]

And.

[Dr. Jennifer Tufts]

And then the medicine is quite helpful for those certain conditions. Yes.

[Court Clerk]

She had problems sleeping, didn't she?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

Even after the Zola, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

So you, not her, you recommended a particular drug that she should take, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And again, as it relates to what one would expect a young woman who's a labor and delivery nurse to know about psychiatric medication. What is methadgine, do you know?

[Dr. Jennifer Tufts]

I'm sorry?

[Court Clerk]

Methazine?

[Dr. Jennifer Tufts]

I'm not sure.

[Court Clerk]

How about hermabite? B A T E, H E R, M A B, A T E. How about that? You ever heard of that?

[Dr. Jennifer Tufts]

I'm not familiar with that.

[Court Clerk]

That's what's used to. To administer to a woman who's going through birth. You don't have an obligation to know that, do you?

[Dr. Jennifer Tufts]

No.

[Court Clerk]

You have an obligation to know about psychiatric medications, though, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

There's a difference between what's known as mescience, which is not knowing what you have no duty to know, and ignorance, which is you don't know what you should know. Is that fair?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

So did you ever gauge Lindsey's knowledge or ability to judge what medication would be good for her?

[Dr. Jennifer Tufts]

So that was my role. That was my role. I didn't expect her to know significantly the details about different psychiatric medications.

[Court Clerk]

Is it important to know. Know that a woman that's coming to you because of postpartum issues, shall we say, had prior problems in prior deliveries?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And you agree with me that you're on the front line of healthcare for. For pregnant women when someone comes to see you either pregnant or after having a baby?

[Dr. Jennifer Tufts]

Yeah. They're usually referred by a therapist or an ob, but yes.

[Court Clerk]

Okay. So being on the front line dealing with these people, and you advertise that you deal with pregnant people before they have babies, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And after, correct?

[Defense Attorney Kevin Reddington]

Yes.

[Court Clerk]

Did she have any prior issues with her prior babies.

[Dr. Jennifer Tufts]

I knew that she had had some anxiety symptoms with her prior. After her prior child was.

[Assistant District Attorney Jennifer Sprague]

Sorry.

[Dr. Jennifer Tufts]

After her second child was born.

[Court Clerk]

That would be Dyson.

[Assistant District Attorney Jennifer Sprague]

Yes.

[Court Clerk]

And when she saw you after having Cowan, how old was gossip?

[Dr. Jennifer Tufts]

A few years old, maybe two or three.

[Court Clerk]

Did she tell you what the side effects were after she had Gossip?

[Dr. Jennifer Tufts]

She did. I did not list them because.

[Court Clerk]

Excuse me, that means you didn't write them down.

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

So what is it?

[Assistant District Attorney Jennifer Sprague]

Sorry.

[Court Clerk]

We'll go by your memory.

[Dr. Jennifer Tufts]

Go by my memory about what? I don't recall exactly which side effects she said, but I recall that they were some of the very common ones, the ones that are temporary.

[Court Clerk]

Hold on. You're telling this jury that you don't recall what the side effects were that she told you, but your memory is that they were general?

[Dr. Jennifer Tufts]

Yes. Because if they were anything else, I would have documented it.

[Court Clerk]

She took Zoloft. Did she take Zoloft SSRI after having Gossa?

[Dr. Jennifer Tufts]

I think she took it for about a week.

[Court Clerk]

You think or she did?

[Dr. Jennifer Tufts]

She did.

[Court Clerk]

So isn't that something that would be indicative of the fact that there was some psychiatric issues after she had her second child?

[Dr. Jennifer Tufts]

Yes, but she did not describe them as being severe.

[Court Clerk]

As a psychiatrist, can you ask her whether or not they're severe or you just wait for them to tell you?

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[Dr. Jennifer Tufts]

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[Court Clerk]

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[Dr. Jennifer Tufts]

based on her description, they did not sound severe.

[Court Clerk]

Tell me about bipolar. What's bipolar?

[Dr. Jennifer Tufts]

Bipolar is a mood disorder that has both depressive episodes as well as episodes of mania.

[Court Clerk]

Is it your understanding that if a person has a difficult birth and in fact has some psychiatric attributes as a result of that difficult birth, that you should not not prescribe SSRIs to that person because they could be bipolar?

[Dr. Jennifer Tufts]

Having a difficult birth does not. It's not a contraindication to an ssri.

[Court Clerk]

So after she had her second child, she took Zoloft and you did not detail any side effects and you don't remember any side effects? Do you agree that Lindsey had, at this point, a history of mental problems during postpartum?

[Dr. Jennifer Tufts]

She had a history of anxiety.

[Court Clerk]

Postpartum anxiety to the point that she was prescribed an ssri?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And she also had mental problems when she came to see you, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

So she had mental problems after she had the second child, mental problems after she had the third child, Correct?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And you'd agree with me that this is not easy stuff for somebody to be talking about? People get embarrassed in our society if they had mental problems, don't they?

[Dr. Jennifer Tufts]

Some do.

[Court Clerk]

She did, didn't she?

[Dr. Jennifer Tufts]

I'm not sure.

[Court Clerk]

So, not documenting any of the side effects, did you think it would be important to document the side effects of the drug before you prescribe Zoloft a second time? She's telling you that she had. You don't know, but she had side effects with Zoloft. Was it important for you to document the second time that you're giving us all of.

[Dr. Jennifer Tufts]

I did not feel that it was necessary to document the specific side effects.

[Court Clerk]

So if someone comes to you as a person who is in postpartum and all this symptomology that she had related to you, that if she told you that she was unzoloft after her second child and had had side effects, you don't think it's important to document the side effects? Number one, right?

[Dr. Jennifer Tufts]

It depends what the side effects are,

[Court Clerk]

which we don't know. Because you didn't write them down. You don't remember it?

[Dr. Jennifer Tufts]

I would have written them down if they.

[Court Clerk]

I don't think you would have done. What did you do?

[Judge William Sullivan]

No, overall. Go ahead.

[Dr. Jennifer Tufts]

I would have written them down.

[Court Clerk]

What did you do?

[Dr. Jennifer Tufts]

I wrote that she had side effects.

[Court Clerk]

Where are they?

[Dr. Jennifer Tufts]

I'm not sure.

[Court Clerk]

And then you prescribe Zoloft again in 2022.

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

Do you recall in the period of September of 22, October of 22, into November of 22, that she used the word overwhelmed, told you that she was overwhelmed, Is that correct?

[Dr. Jennifer Tufts]

Sorry. Which visit are we looking at?

[Court Clerk]

Well, the period of time September, October, November, she used the Terminology. That she was overwhelmed?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

Okay. And when you were treating her, you didn't think that she was just merely overwhelmed with three children, you knew she was really struggling, didn't you?

[Assistant District Attorney Jennifer Sprague]

I did.

[Court Clerk]

And it was at that point that you diagnosed her with a psychiatric condition and you prescribed psychiatric meds, isn't that right?

[Dr. Jennifer Tufts]

I prescribed psychiatric medications, yes.

[Court Clerk]

So when you prescribed the Zoloft and told her to increase it, she told you that she was having all these difficulties, you told her to stop. Did you give her things, therapy when you saw her?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

What did you do?

[Dr. Jennifer Tufts]

I think that. I

[Court Clerk]

apologize, but not what you think. I want to know what you did. That's why you write stuff down. So take your time and look at your notes. What did you do with this young woman for therapy?

[Dr. Jennifer Tufts]

On which day?

[Court Clerk]

On what?

[Dr. Jennifer Tufts]

Which. Which day are we talking about specifically

[Court Clerk]

came to you and told you that she was overwhelmed and you diagnosed her with a mental illness and prescribed a psychiatric condition? The psychiatric meds. What therapy did you give her? Because you told us that when you're on the television, you still give them therapy too, right?

[Dr. Jennifer Tufts]

I do.

[Court Clerk]

What did you do?

[Dr. Jennifer Tufts]

Well, I'm having trouble identifying exactly when she said the words overwhelmed, so it's hard to pinpoint exactly what I said. In a span of, you know, a

[Court Clerk]

number of different visits, did you indicate that there's information on the website that if a person has an emergency that they should. They should do something?

[Dr. Jennifer Tufts]

I did, and I advised her the same.

[Court Clerk]

So basically, if one of your patients become suicidal. And on that note, did she tell you at that point up to November of 22, that she was dwelling on suicidal thoughts?

[Dr. Jennifer Tufts]

It was a while before she mentioned anything about suicidal thoughts.

[Court Clerk]

Tell us when.

[Dr. Jennifer Tufts]

I might need to look through the records to see when she first did December 1st.

[Court Clerk]

So on December 1st, what did she tell you?

[Dr. Jennifer Tufts]

That she denied feeling suicidal, but that she was close to feeling suicidal.

[Court Clerk]

That's kind of like being a fisherman out in the ocean who's worried about the possibility of a storm and is thinking about the storm and is dwelling on the storm. Storm. Almost in fear of the storm, right? Objection.

[Judge William Sullivan]

No.

[Court Clerk]

Isn't it?

[Dr. Jennifer Tufts]

I guess.

[Court Clerk]

So when she tells you that she's. And I want to put words in your mouth, what did she say? She's having suicidal thoughts or what did she say, how close to it?

[Dr. Jennifer Tufts]

She denied having suicidal thoughts, but felt that she was getting close to it.

[Court Clerk]

Okay, so she was dwelling on it or thinking about it. Right. Is that fair?

[Dr. Jennifer Tufts]

She was fearful of eventually having those kinds of thoughts.

[Court Clerk]

To kill herself?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And how frequently were the thoughts?

[Dr. Jennifer Tufts]

I'm not sure exactly how frequent they were.

[Court Clerk]

If you ask her,

[Dr. Jennifer Tufts]

it's very likely that I did ask her the frequency.

[Court Clerk]

There be any medical records when you see some patients, you have some patients other than Lindsey Clancy at that point, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And you document when a patient. Thank God. When a patient comes in and tells you that she's in postpartum distress and she's close to having suicide thoughts to kill herself. That's important, we, isn't it?

[Dr. Jennifer Tufts]

It's important that, that I am aware that she's having these thoughts.

[Court Clerk]

What thoughts?

[Dr. Jennifer Tufts]

That she is fearful she could become suicidal.

[Court Clerk]

She told you, I imagine, or you asked how frequently these thoughts were.

[Dr. Jennifer Tufts]

I don't have it documented how frequently they were, but that is a question that I usually ask when we're talking about suicidal thoughts.

[Judge William Sullivan]

Sustained.

[Court Clerk]

Did she tell you. When did you ask about suicidal thoughts?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

What did she tell you? If you don't know, tell us.

[Dr. Jennifer Tufts]

No, I, I, I know. Sorry. But it's, it's what I said before that, that she denied having them and she wasn't having them. We were meeting, but she felt close to it. Close to having those thoughts.

[Court Clerk]

Okay. So she. Would you agree with me that many times patients, especially psychiatric patients, may minimize their symptomology?

[Dr. Jennifer Tufts]

Patients sometimes do.

[Court Clerk]

And sometimes when a woman has just had a child and has other little kids at home, that they're worried about the government taking kids away from them. Because you're a mandated reporter, aren't you? Overall, you're a mandated reporter, aren't you?

[Dr. Jennifer Tufts]

I am.

[Court Clerk]

And if she told you I'm having suicidal thoughts, I'm close to it. Homicidal thoughts, you'd report that, wouldn't you?

[Dr. Jennifer Tufts]

Not necessarily. I think it really depends on the context. But, but having suicidal thoughts alone is, is not a reportable condition.

[Court Clerk]

All right, so basically, we know that she was close to having suicidal thoughts to kill herself, whatever that means. We don't know how frequently she was having them. Yeah.

[Dr. Jennifer Tufts]

Today I don't know how frequently, but at that point, I believe believe I did know how frequently they were.

[Court Clerk]

Okay, so as a result of that, you then gave her therapy, I imagine, right through the television.

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And what therapy did you give her in November of 22?

[Dr. Jennifer Tufts]

I gave her supportive psychotherapy.

[Court Clerk]

And what, what does that mean? It sounds great. What is, what do you do?

[Dr. Jennifer Tufts]

It, it's listening to the patient and providing.

[Court Clerk]

Sorry, listening to the patient. Like when they say they're having.

[Judge William Sullivan]

Hold on. Sustained. Next question. Right next Question.

[Court Clerk]

Thank you.

[Judge William Sullivan]

Good

[Court Clerk]

listening to the patient.

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[Assistant District Attorney Jennifer Sprague]

Hey, it's your ceiling vent. So I'm dripping.

[Dr. Jennifer Tufts]

Could be the rain, could be the upstairs bathroom. Yikes. You could hire the guy your neighbor recommended, but I'm pretty sure that's just his cousin. Do we know if he's licensed or does he just own a ladder?

[Court Clerk]

Listen to your home. Go with thumbtack.

[Judge William Sullivan]

Upload a photo or voice note, and

[Court Clerk]

we'll diagnose your project and match you with the right pro for the job. Thumbtack. We know homes hire the right pro today. That would be one. For example, one of your patients tells me after all the treatment that you had provided prior to that, all the symptomology that she had anxiety and all of that, that she's close to having suicidal thoughts that would, I imagine, impact on you.

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

So what did you do with this psychotherapy?

[Dr. Jennifer Tufts]

So I provided emotional support and validation and encouragement.

[Court Clerk]

What does that mean?

[Dr. Jennifer Tufts]

Something like, I understand this is a very difficult time. It really, you know, it varies on the individual.

[Court Clerk]

Sure. How about lamb?

[Dr. Jennifer Tufts]

I don't remember the exact therapeutic words that I used.

[Court Clerk]

Okay. How long did you give the. How long? Therapy, validation and all that stuff?

[Dr. Jennifer Tufts]

I don't remember exactly the duration.

[Court Clerk]

About 10 minutes maybe. Through the television, Right through the computer. As we've pointed out, you tell the people that come to see you, when I say you, I mean collectively asker 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.

[Dr. Jennifer Tufts]

We advise them to call 911 or go to the emergency room as quickly as possible.

[Court Clerk]

How about suicide hotlines? Do you give them advice?

[Grainger Commercial Announcer]

That's.

[Dr. Jennifer Tufts]

That's an option as well? Yes.

[Court Clerk]

Did she call suicide hotlines?

[Dr. Jennifer Tufts]

I was not aware that she did.

[Court Clerk]

Did you ever ask her?

[Dr. Jennifer Tufts]

I don't think I specifically asked that question.

[Court Clerk]

Specifically. Did you ask her anything? Did you Beat around the bush, maybe ask her anything about suicide hotlines?

[Dr. Jennifer Tufts]

I don't think I asked her about suicide suicide hotlines.

[Court Clerk]

Would it surprise you to know that she called suicide hotline in that time frame not once but twice and was turned away? You guys are on the front line of this, aren't you?

[Dr. Jennifer Tufts]

No.

[Judge William Sullivan]

Overall,

[Dr. Jennifer Tufts]

it. It does surprise me.

[Court Clerk]

Yes, it does. What?

[Dr. Jennifer Tufts]

It surprises me that she called them

[Court Clerk]

twice and you never asked her if she had ever called the suicide hotline, did you?

[Dr. Jennifer Tufts]

I don't think that I did.

[Court Clerk]

I understand. You're a doctor. You were trying to do the right thing. You obviously. This is just horrible, isn't it?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

She continued on with her treatment with you, correct?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

What was the next medication that you put her in? Let's say we're up to, I guess would be the October 26th date. Is that right? Is that when you prescribe Ativan?

[Dr. Jennifer Tufts]

I prescribed that on the 21st.

[Court Clerk]

Sorry?

[Dr. Jennifer Tufts]

I prescribed the Ativan on the 21st.

[Court Clerk]

All right. Did you prescribe anything on the October 26th appointment?

[Judge William Sullivan]

Yes.

[Court Clerk]

And what was that?

[Dr. Jennifer Tufts]

Buspirone.

[Court Clerk]

Buspirone. And would you agree with me that is that also Vanspire?

[Dr. Jennifer Tufts]

Buspar or. Or Busperone are the common names for it.

[Court Clerk]

Okay. Ever heard of Vanspire? V A N V as in Victor A N S P A R. You ever heard of that?

[Dr. Jennifer Tufts]

No, I haven't.

[Court Clerk]

Okay. And would you agree with me that there are a number of side effects of buspirone?

[Dr. Jennifer Tufts]

Every medication has side effects.

[Court Clerk]

Okay, so my question is pretty simple. Buspirone. You mentioned it. I'm asking, any side effects?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

What are the side effects?

[Dr. Jennifer Tufts]

They could be tiredness or dizziness or rarely some upset stomach. But it's generally a very, very well tolerated mild medicine.

[Court Clerk]

And do you recall, was she taking any other medication at that point, if you know.

[Dr. Jennifer Tufts]

Yeah, she was taking some of the Ativan.

[Court Clerk]

Some Ativan, Right. Did you prescribe that to her?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

When did you prescribe the adivan to her?

[Dr. Jennifer Tufts]

The 21st.

[Court Clerk]

And she was compliant with your recommendations, right?

[Assistant District Attorney Jennifer Sprague]

Yes.

[Court Clerk]

Was she also reporting to you that she was taking Benadryl? It's like over the counter stuff.

[Dr. Jennifer Tufts]

It was being used as needed, yes.

[Court Clerk]

So that's PRN on the records? PRN or whatever. You take it as required, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And she reported to you that she was taking Benadryl, right?

[Dr. Jennifer Tufts]

She reported that, yes.

[Court Clerk]

And you didn't document how much she was taking? Right.

[Dr. Jennifer Tufts]

It's only available as one dose over the counter.

[Defense Attorney Kevin Reddington]

Okay.

[Court Clerk]

Did she re up the dose over the Counter.

[Dr. Jennifer Tufts]

Do you know, she didn't tell me that she did.

[Court Clerk]

Did you ask her?

[Dr. Jennifer Tufts]

I don't remember asking her about if she increased it. I think she was just taking one of them.

[Court Clerk]

You think? Did you know that Ativan and Benadryl are contraindicated, that they can have a serious impact to the central nervous system and depressant effects?

[Dr. Jennifer Tufts]

Yes, but can I explain that when they say depressant.

[Court Clerk]

Excuse me. The answer is yes, right? Is the answer yes?

[Judge William Sullivan]

Yeah, if the answer is yes. If that's the question. The Commonwealth may be able to ask you further questions if you'd like.

[Dr. Jennifer Tufts]

Well, I can't say yes to that entire statement.

[Judge William Sullivan]

All right, next.

[Court Clerk]

Did you discuss anything about Benadryl combined with Ativan on October 26th?

[Dr. Jennifer Tufts]

I don't recall.

[Court Clerk]

On October 26th, was she still worried about suicidal thoughts?

[Dr. Jennifer Tufts]

She denied that.

[Court Clerk]

And on October 26, how did she deny that? Is that. Do you have that noted in your record?

[Dr. Jennifer Tufts]

I do.

[Court Clerk]

And what does it say?

[Dr. Jennifer Tufts]

Patient denies suicidal ideation.

[Court Clerk]

Okay, so there's a. There's a huge difference between suicidal ideation and somebody having thoughts of suicide or being close to it, right?

[Dr. Jennifer Tufts]

Not exactly.

[Court Clerk]

Well, you knew that the last time you spoke to the woman, she told you that she was close to having thoughts of killing herself, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And you're her doctor, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

So what do you do? You just say, do you have. And check the box and say, do you have any suicidal ideation? And she says no. And you check the box?

[Dr. Jennifer Tufts]

No, it's not that simple.

[Court Clerk]

Do you ask her like, well, gee, the last time I spoke to you, you told me that you were close to having suicidal thoughts, thoughts of killing yourself. Did you pursue that on the 26th of October?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And what did she say?

[Dr. Jennifer Tufts]

That she wasn't.

[Court Clerk]

Now, how long was that appointment, if you recall? Would you agree? It was 17 minutes. And then there was some therapy.

[Dr. Jennifer Tufts]

The entire appointment was something between 25 and 30 minutes.

[Court Clerk]

And that was again through the television, right?

[Dr. Jennifer Tufts]

The computer, yes.

[Court Clerk]

Computer. Did you also add a drug called hydroxyzine?

[Defense Attorney Kevin Reddington]

Yes.

[Court Clerk]

When was that?

[Dr. Jennifer Tufts]

So that was the same visit as an alternative to the Benadryl.

[Court Clerk]

Okay, so on October 26, when she told you that she was taking over the count of Benadryl, I asked you what you prescribed to her, and you said Ativan, right? Right.

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And then I asked you about the contraindication of Ativan and Benadryl.

[Judge William Sullivan]

Right?

[Dr. Jennifer Tufts]

You asked me about that.

[Defense Attorney Kevin Reddington]

Yes.

[Court Clerk]

And then you, on October 26, statted her on Buspar, correct?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And what is the purpose of Buspar? That's for anxiety.

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And what kind of drug is Buspar?

[Dr. Jennifer Tufts]

It doesn't really fall into a class, but it does act on serotonin.

[Court Clerk]

So it's another. Similar to an ssri, Right?

[Dr. Jennifer Tufts]

It's kind of like a more mild version of an ssri.

[Court Clerk]

Okay, so she's on Benadryville, over the counter, Ativan, which is a benzodiazepine, Buspar, which is an ssri, and then you prescribe hydroxyzine on the same day.

[Judge William Sullivan]

Right.

[Dr. Jennifer Tufts]

They weren't all to be taken at the same time.

[Court Clerk]

What's hydroxyzine?

[Dr. Jennifer Tufts]

Hydroxyzine is an antihistamine.

[Court Clerk]

Okay, is that over the counter or is that. Can you just buy that over the counter? Do you have to go to the back where the pharmacist is?

[Dr. Jennifer Tufts]

You have to go to the pharmacist.

[Court Clerk]

Okay. And as far as you're concerned, she was taking the medications as she was required, right?

[Dr. Jennifer Tufts]

That's what I was told.

[Court Clerk]

I'm sorry.

[Dr. Jennifer Tufts]

Yes, that's what I was told.

[Court Clerk]

Did you by her?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And did you at any time tell her that she should keep a diary of her medications and keep. Keep a diary of any side effects that she has?

[Dr. Jennifer Tufts]

I didn't instruct her to do that.

[Court Clerk]

You don't have to instruct somebody to do anything. But did you recommend it? Like, say, hey, you're on all these meds. If you're having an effect, you should write it down when, time, date, anything like that?

[Dr. Jennifer Tufts]

I didn't tell her to do that.

[Court Clerk]

Would that be helpful?

[Dr. Jennifer Tufts]

Maybe. But usually we. We go through all of that in the appointments, and we met very frequently.

[Court Clerk]

Now, you'd agree with me that at this point, prior to the next appointment, which was November 2, she had gotten significantly worse even after all this medication that you had been prescribing?

[Judge William Sullivan]

Right.

[Court Clerk]

Did you make a note that she was telling you that she had depression and that she was crying, had more anxiety, insomnia had increased, brain fog and worrying about suicide.

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[Psychiatric Nurse Practitioner Julie Paul]

From Geico Subconscious News, I'm Tammy Racing

[Dr. Jennifer Tufts]

thoughts broadcasting from your brain. Tonight's top worry, if something happens to

[Courtroom Audio Technician]

your apartment and you need to, like, stay in a hotel and pay for it.

[Psychiatric Nurse Practitioner Julie Paul]

That would be crazy, right?

[Courtroom Audio Technician]

Art Palpitations has more.

[Court Clerk]

That would be crazy, Tammy, but you got surprisingly affordable renters insurance through Geico, so it could be covered, giving you peace of mind.

[Dr. Jennifer Tufts]

Aw, I love a story that ends well.

[Judge William Sullivan]

Next up, love stories.

[Court Clerk]

Are they all they're cracked up to be? It feels good to worry less.

[Dr. Jennifer Tufts]

It feels good to Geico. In the couple weeks after starting those medicines, I don't recall that the symptoms were significantly exacerbated.

[Court Clerk]

Okay, Friday afternoon, you answered the da and you said that you recall that she used the word brain fog, right?

[Dr. Jennifer Tufts]

She used that at some point. I don't recall when.

[Court Clerk]

What is brain fog?

[Dr. Jennifer Tufts]

It's a subjective. It's a very subjective feeling that someone might have where maybe it's, you know, hard to think of a word that you're trying to think of, or maybe it feels like, you know, maybe you're. You're thinking of things a little bit more slowly than you normally would.

[Court Clerk]

And. And how often was she dwelling on suicide?

[Dr. Jennifer Tufts]

At what point?

[Court Clerk]

At the point she told you that she had anxiety, insomnia, brain fog? Crying inconsolably Objection.

[Defense Attorney Kevin Reddington]

If we can have a date, I

[Judge William Sullivan]

think he's gonna get to that.

[Court Clerk]

October 26th, heading into November 2nd. Do you recall? I'll rephrase it. Do you recall going into the November month, meeting with her, and she told you that she had brain fog?

[Dr. Jennifer Tufts]

It was mentioned at some point. I don't see that on the 26th, specifically.

[Court Clerk]

All right, so let's talk about brain fog. Did you ask her what that meant? Because when you say subjective, that means that's her interpretation. That's in her head. She's telling me, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

As opposed to objective, which would be what people in general would think, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

So when she's telling you, in addition to the anxiety, in addition to the crying, in addition to the stress that she was undergoing, she was worrying about suicide, she talked about brain fog. So you must have asked her, what does that mean subjectively? What does that mean?

[Dr. Jennifer Tufts]

Subjectively means in. In the patient's, you know, own opinion, that's what their experience is.

[Court Clerk]

Okay, so she's the one that's inside her head, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

So what were the symptoms? What is it? When a patient tells you that they have brain fog, is that something you would consider as Being a potential side effect of the medications that you would put around

[Dr. Jennifer Tufts]

it depends on what? I mean, sometimes it could be, and sometimes it could be unrelated. It's a symptom of depression as well. So sometimes it's hard to tell what it's attributed to.

[Court Clerk]

So at this point, heading into November, your answer was to prescribe more medication, Three more drugs? Right. You prescribed Ativan or increased the Ativan. What was she. What was her load for Ativan at this point? Do you remember? Sorry, what was her milligrams, if that's right, nanograms. Whatever it is on the Ativan, on the script that you had provided her.

[Defense Attorney Kevin Reddington]

Objection. If we could just have a date.

[Judge William Sullivan]

I think she said don't. If you can answer that, go ahead.

[Dr. Jennifer Tufts]

Which. Which date are we referring to for the Adavan? Because there were.

[Court Clerk]

Did you increase her Ativan and to what level?

[Dr. Jennifer Tufts]

So she was prescribed Ativan 0.5 milligrams.

[Court Clerk]

Right.

[Dr. Jennifer Tufts]

And then when I next saw her, she said it was a little bit helpful. So I said you could increase it and see if 1 milligram is more helpful.

[Court Clerk]

Did she increase it?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And. And when was the next time you saw her? To talk to her on the television or on the computer?

[Dr. Jennifer Tufts]

Well, I saw her on the 26th, and then I saw her on the 31st.

[Court Clerk]

I'm sorry, how was she on the 31st? Halloween. How is she?

[Dr. Jennifer Tufts]

That's not my note. That's her therapy note.

[Court Clerk]

Okay, so how about this November 2nd? Was that the next time you saw her?

[Dr. Jennifer Tufts]

I saw her on November 2.

[Court Clerk]

And she told you that she was hesitant to use the medications, the buspar and the hydroxyzine. Right.

[Dr. Jennifer Tufts]

She said she was hesitant to try the buspar.

[Court Clerk]

She was scared of the drug. She was scared of the drugs? Right.

[Dr. Jennifer Tufts]

She was afraid to take a medication.

[Court Clerk]

She wasn't doctor shopping and asking you to. To give her drugs so she could get high. She was asking you for help, isn't that right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And she was afraid to take the drugs and told you that she was afraid to take the drugs? Right?

[Dr. Jennifer Tufts]

She told me she was afraid to take the buspirone.

[Court Clerk]

Did you advise her or counsel her or give her therapy about that? Validations?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And what did you tell her?

[Dr. Jennifer Tufts]

Well, I advised her of, you know, the risks.

[Court Clerk]

What were the risks?

[Dr. Jennifer Tufts]

Well, the risks of medicine, like we had said, sedation or dizziness.

[Court Clerk]

Okay, how about interfering with sleep?

[Dr. Jennifer Tufts]

Buspirone doesn't usually interfere with sleep.

[Court Clerk]

Not usually. Did you ask her about any thoughts of suicide or being Close to having thoughts of suicide?

[Assistant District Attorney Jennifer Sprague]

Yes.

[Court Clerk]

Did she indicate to you that she had any thoughts of suicide at all?

[Dr. Jennifer Tufts]

Not at that date.

[Court Clerk]

Did she use those words or is that a box that you checked off?

[Dr. Jennifer Tufts]

I don't remember her exact words, but we, we talked about suicide or, you know, thoughts of hurting yourself.

[Court Clerk]

Right. And there's a distinction between. And you records in the notation between suicidal ideation and I quote, worrying about thinking about suicide. Would you agree with that?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And what did she mean when she told you as her doctor that she was worrying about thinking about suicide?

[Dr. Jennifer Tufts]

You mean in the, in the prior appointment?

[Court Clerk]

I'm talking about a woman that's sitting in front of you on your television or your computer telling you that she was worried about thinking about suicide.

[Psychiatric Nurse Practitioner Julie Paul]

Well, on.

[Dr. Jennifer Tufts]

On the second, she didn't say that.

[Court Clerk]

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[Psychiatric Nurse Practitioner Julie Paul]

It feels good.

[Judge William Sullivan]

To Geico.

[Court Clerk]

Hey, it's Ryan Reynolds here from Mint Mobile. Now I was looking for fun ways

[Psychiatric Nurse Practitioner Julie Paul]

to tell you that Mint's offer of unlimited Premium Wireless for $15 a month is back. So I thought it would be fun if we made $15 bills, but it turns out that's very illegal.

[Court Clerk]

So there goes my big idea for the commercial.

[Psychiatric Nurse Practitioner Julie Paul]

Give it a [e-mail] Switch upfront payment

[Dr. Jennifer Tufts]

of $45 for 3 months, $90 for

[Court Clerk]

6 months or $180 for 12 month plan.

[Dr. Jennifer Tufts]

Required $15 per month equivalent taxes and fees.

[Court Clerk]

Extra initial plan term only greater than 50 gigabytes. Me slow when network is busy.

[Psychiatric Nurse Practitioner Julie Paul]

See terms.

[Court Clerk]

When was the next time that she told you that she was worried about or thinking about or suicidal ideation?

[Dr. Jennifer Tufts]

That was the December 1st visit.

[Court Clerk]

Okay, so go back to the November 2nd visit. Would you agree with me that she, after you talked with her for that period, however long it was, that you then brought up four medications to her recommending that they might be safer, and I quote, safer alternatives. Would you agree with that?

[Dr. Jennifer Tufts]

I see the word alternatives, not safer alternatives.

[Court Clerk]

Do you remember Talking to her about Remeron?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

Did you recommend that she take Remeron?

[Dr. Jennifer Tufts]

No.

[Court Clerk]

Did you ever prescribe Remeron?

[Dr. Jennifer Tufts]

No.

[Court Clerk]

And is that Mirtazapine? As far as its generic name, yes. And Remeron is an antidepressant, isn't that right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And you did not feel that that would be an appropriate medication for her to take at that time?

[Dr. Jennifer Tufts]

It was a very reasonable option, but we didn't decide to start it.

[Court Clerk]

So is this a collaboration, in other words, you and the patient, you would both make a decision as to when to start a drug, or is it your decision and advice to the patient?

[Dr. Jennifer Tufts]

Well, it's ultimately my decision, but the patient's thoughts about the matter are very important. At the end of the day, the patient has to go home and take it themselves. I'm not there to ensure that that is happening or not.

[Court Clerk]

So you had a November 22nd appointment, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And it was at that time that she told you that she had been to see South Shore Perinatal Clinic, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And did she tell you why she was seeing someone from the South Shore Perinatal Clinic?

[Dr. Jennifer Tufts]

I think she told me that it was because they were exclusively focused on treating perinatal conditions.

[Court Clerk]

Yeah, but so are you, right?

[Dr. Jennifer Tufts]

Not exclusively. I'm a general psychiatrist.

[Court Clerk]

I see. And did she mention the name of any doctor or nurse practitioner. Practitioner that she was seeing at the Social Perinatal Clinic?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

Who'd she mentioned?

[Dr. Jennifer Tufts]

I think she said something about Julie Paul. Yes.

[Court Clerk]

Okay. And a woman by the name of Nurse Gelada?

[Dr. Jennifer Tufts]

I. I heard her name a little bit later, but yes.

[Court Clerk]

Did she advise that, in fact, by script, she was using Ativan and Benadryl? And you told her to taper off the Ativan at that appointment?

[Judge William Sullivan]

Right.

[Court Clerk]

Had she tapered off the Ativan?

[Dr. Jennifer Tufts]

I think I had told her to. I gave her a prescribed taper prior to that appointment.

[Court Clerk]

What does that mean? What does that mean? You gave her a prescribed taper?

[Dr. Jennifer Tufts]

So I told her that she should reduce her dose by 0.25 milligrams every two weeks until the medication was stopped.

[Court Clerk]

Did she do that?

[Dr. Jennifer Tufts]

I mean, I don't believe that she completely stopped it, no.

[Court Clerk]

No, you don't believe or she didn't?

[Dr. Jennifer Tufts]

Well, trying to give the jury facts, yeah. She said she was taking Ativan. So. So, no, she didn't completely stop it.

[Court Clerk]

Had she tapered.

[Dr. Jennifer Tufts]

I'm not sure how much she had reduced the dose because I wasn't prescribing it again.

[Court Clerk]

Right. So did you Know that she had been or had she been to any emergency wards between that period of time that you last saw her and when you were seeing her on this meeting?

[Dr. Jennifer Tufts]

I know she went to the Army. Sorry, er. But I. I think it was after that.

[Court Clerk]

Okay. Which ER did she go to, do you know?

[Dr. Jennifer Tufts]

I think she went to Mass General.

[Court Clerk]

Do you know why she went to the er?

[Dr. Jennifer Tufts]

Because of depression.

[Court Clerk]

So was she treated at the er? Did they make any. To your knowledge, does her doctor make any recommendations?

[Dr. Jennifer Tufts]

I'm not sure what they told her, but they ultimately.

[Court Clerk]

Go ahead.

[Dr. Jennifer Tufts]

They ultimately discharged her. They didn't admit her.

[Court Clerk]

Go ahead.

[Dr. Jennifer Tufts]

Sorry.

[Court Clerk]

Sorry. Was she put on any medication?

[Dr. Jennifer Tufts]

Not from the er.

[Court Clerk]

When you looked at the records from South Shore Perinatal Clinic, what did they indicate about suicidal ideation, worrying about suicide, concern, close to suicide, anything?

[Dr. Jennifer Tufts]

I didn't have access to those records.

[Court Clerk]

You gotta keep your voice up so everybody can hear you. You what?

[Dr. Jennifer Tufts]

I did not have access to those records because we're a completely separate clinic.

[Court Clerk]

Seriously.

[Defense Attorney Kevin Reddington]

Objection.

[Court Clerk]

She's visiting with you as a patient and you can't access her medical records is what you're telling this jury.

[Dr. Jennifer Tufts]

I did not have access to them, no.

[Court Clerk]

Could you. Could. Could. Could she have signed a release, a HIPAA form?

[Dr. Jennifer Tufts]

Yes, she could have.

[Court Clerk]

And you could have got the records?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

But you didn't.

[Dr. Jennifer Tufts]

I did not feel like it was necessary because she provided all the relevant information about her treatment there.

[Court Clerk]

How do you know she's got mental disease and she's seeing you and she's. I love this cr. Cocktail of drugs. How do you know that? She is an accurate historian at this point in her life.

[Dr. Jennifer Tufts]

It felt very accurate when she was able to recall the names of the medicines, doses of the medicines, specific days. She provided a lot of incredibly detailed information, so it showed me she was capable of doing that.

[Court Clerk]

So when you talked to her husband, Pat. How many times did you talk to her husband Pat? I think I was living with her.

[Dr. Jennifer Tufts]

I think it was once.

[Court Clerk]

And he came to your office, right? No, he didn't. He got on the television or the computer screen, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And when was that?

[Dr. Jennifer Tufts]

I think it was the December 16th visit.

[Judge William Sullivan]

So what's reading to before we get to that?

[Dr. Jennifer Tufts]

Okay.

[Judge William Sullivan]

Probably a good spot to stop. Take the morning. We're gonna take the morning recess and then we'll come right back. Okay?

[Psychiatric Nurse Practitioner Julie Paul]

All right.

[Court Clerk]

Sir, please close your notebooks, facing on your chair.

[Judge William Sullivan]

Y' all sit for the jury.

[Assistant District Attorney Jennifer Sprague]

Court.

[Court Clerk]

All right, George, Andrew. This court's done session. Please be seated.

[Dr. Jennifer Tufts]

Your Honor, for The purpose of the

[Assistant District Attorney Jennifer Sprague]

record, we return back to the trial of Commonwealth vs Lindsay Clancy. All parties are present, including the defendant and the 18 jurors.

[Judge William Sullivan]

All right, thank you. Ms. Reagan,

[Court Clerk]

if you would just please look at your medical records that you have in front of you, I believe. And to just. Just go Back to the October20, where you have. I believe it's called interval history.

[Dr. Jennifer Tufts]

I had trouble hearing the date. Can you Repeat that?

[Court Clerk]

Sure. October 20th. Sorry. So, looking at the interview history, that's when that you decided to start Zolot? It says a week ago, right?

[Dr. Jennifer Tufts]

That's when the patient started it.

[Assistant District Attorney Jennifer Sprague]

Yes.

[Court Clerk]

Okay. And she then increased the dose, and it says last night, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And what was she telling you on the computer screen when you were talking to her? What did she say about increasing the dose of Ezoloft?

[Dr. Jennifer Tufts]

That she felt awful. She couldn't sleep, had insomnia, which became worse when she increased her dose. She didn't want to eat. She was having diarrhea. Food felt really unappealing. She was more depressed on it, crying all day yesterday, which is not normal for her. She had some mental fog and was terrified to start something new.

[Court Clerk]

Did she also tell you about her anxiety level?

[Dr. Jennifer Tufts]

Anxiety was really bad even before med. Now, hard to differentiate overnight. Racing thoughts, paranoid of getting suicidal thoughts, something bad happening, doesn't want to be alone.

[Court Clerk]

That must have given you concern that you had a pretty sick patient on your hands at that point, right?

[Dr. Jennifer Tufts]

I was concerned, yes.

[Court Clerk]

So you gave us some therapy, did you?

[Dr. Jennifer Tufts]

I gave her some therapy in conjunction with discussing all of her symptoms and assessing her and managing the medication. Okay.

[Court Clerk]

And again, I apologize. You have to keep your voice up so people can hear you way down here. So when you say that you were talking about the symptoms, and what did you do? You said talk about the same thing. That we had just gone over the symptoms.

[Dr. Jennifer Tufts]

There were a number of them to discuss in. In more detail. That's. That's the summary of them.

[Court Clerk]

Okay, so did she discuss it in detail?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

Did she tell you that her symptomology at this point on October 20th was. Was so bad that. That she had to have her mother come and stay with her?

[Dr. Jennifer Tufts]

Her mom was coming to provide support? Yes.

[Court Clerk]

She wasn't coming to provide support. She was coming to stay with them, to live with them, wasn't she?

[Dr. Jennifer Tufts]

Yes. I don't know for how long, but yes.

[Court Clerk]

Did you bother to ask her why is her mother having to stay with them?

[Dr. Jennifer Tufts]

Because she needed some help.

[Court Clerk]

Do you know how long the mother stayed with.

[Dr. Jennifer Tufts]

I Don't.

[Court Clerk]

Do you know that she ended up sleeping in the basement?

[Dr. Jennifer Tufts]

I don't.

[Court Clerk]

You know that she ended up sleeping with a mother?

[Dr. Jennifer Tufts]

I don't.

[Court Clerk]

So you decided that you'd stop the Zoloft and you would monitor closely, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

What does that mean, monitor closely?

[Dr. Jennifer Tufts]

Well, I saw her the next day, so that's. That's monitoring. An example of monitoring.

[Court Clerk]

So this would be on October 21st, that you saw her the next day, is that correct?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

Now, on the 20th, you made reference to the fact you also recommended that she try fish oil and things of that nature. Natural remedies.

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

You also wanted to look into what's called Zulreso. Z U L R E S S O.

[Assistant District Attorney Jennifer Sprague]

Yes.

[Court Clerk]

What's Zoriso?

[Dr. Jennifer Tufts]

It is a treatment for postpartum depression.

[Court Clerk]

And when you say that you were looking into it, what did you do? Did you find out if it was available and if she could participate in the program?

[Dr. Jennifer Tufts]

I did some digging online to see where it is done and how to do it. I hadn't officially recommended it, so I. I had not started that for her.

[Assistant District Attorney Jennifer Sprague]

It's.

[Dr. Jennifer Tufts]

It's not really an easy medicine that I can just start because. Sorry, it's. It's not a medication I can start on my own. It is. It's infused through an IV in a hospital, so it's a bit difficult to coordinate.

[Court Clerk]

It's a 60 hour infusion, right.

[Dr. Jennifer Tufts]

It's a long infusion. That. That sounds right.

[Court Clerk]

And it's about two and a half days of infusion. And it has to be under hospital circumstances. The only hospital around here is in Rhode island, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And did you ever recommend that you do that?

[Dr. Jennifer Tufts]

It was something to consider. I couldn't make the official recommendation because that's not something I prescribe.

[Court Clerk]

Why?

[Dr. Jennifer Tufts]

Because. Because you can't pick that up at the pharmacy?

[Court Clerk]

Well, no, obviously you have to go to a hospital setting and basically have an infusion through your veins for 60 hours or 2.5 days. But why didn't you look into it or recommend that she do that?

[Dr. Jennifer Tufts]

Well, I did look into it.

[Court Clerk]

So what happened?

[Dr. Jennifer Tufts]

She ended up actually going to a partial hospitalization program at the hospital that does it. I don't believe the program was completed, but she went and I advised her to discuss it with them because they have access to that medicine. I don't have access to it, of course.

[Court Clerk]

Is this Women in Infants Hospital in Rhode island that you're talking about?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

So when you looked at the medical records for Women at Infants Hospital, did They make reference to your inquiry for zo.

[Dr. Jennifer Tufts]

I never received records from Women and Infants.

[Court Clerk]

Did you ever look at them? Or even online?

[Dr. Jennifer Tufts]

Online?

[Court Clerk]

Yeah, like online, like you do when you talk to patients?

[Dr. Jennifer Tufts]

No, I. I never had access to them.

[Court Clerk]

Why?

[Dr. Jennifer Tufts]

You know what they say?

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[Dr. Jennifer Tufts]

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[Court Clerk]

Poetry, mate. But don't think my motorcycle or my

[Psychiatric Nurse Practitioner Julie Paul]

soul will be moving anytime soon. Got a flat tire.

[Dr. Jennifer Tufts]

Oh, that's all right.

[Court Clerk]

You ride with Geico motorcycle insurance and got their 247 emergency roadside service. They'll get you back on the road.

[Psychiatric Nurse Practitioner Julie Paul]

Ah, beautiful saying.

[Court Clerk]

You come up with that?

[Dr. Jennifer Tufts]

It's not a saying.

[Court Clerk]

It's a Geico motorcycle policy.

[Psychiatric Nurse Practitioner Julie Paul]

Tomato, tomato.

[Assistant District Attorney Jennifer Sprague]

It feels good to ride with help.

[Court Clerk]

It feels good to Geico. Emergency roadside service is optional coverage.

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[Defense Attorney Kevin Reddington]

The last thing you need is shopping.

[Courtroom Audio Technician]

That makes it hard.

[Dr. Jennifer Tufts]

Harder.

[Defense Attorney Kevin Reddington]

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[Courtroom Audio Technician]

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[Dr. Jennifer Tufts]

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[Defense Attorney Kevin Reddington]

Wayfair.

[Dr. Jennifer Tufts]

Every style, every home. Similar to to South Shore. It's a completely separate hospital that I don't have access to. I don't work there.

[Court Clerk]

Of course you don't work there, but you're a doctor and you're treating a patient who's got medical records that you could access through a hippo release, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

Why didn't you do that?

[Dr. Jennifer Tufts]

Well, she didn't ultimately end up having any treatment there, so it didn't seem necessary.

[Court Clerk]

She didn't end up having any treatment there, so it didn't seem necessary. You can't just walk into that place and say, hey, I'd like some Zorresa, can you?

[Dr. Jennifer Tufts]

I don't exactly know how it works.

[Court Clerk]

And then again, on that date, which would be October 20th, new jurors are looking at the records. You checked off the boxes again on objective findings. Mental status, exam, appearance, speech, things of that nature, correct?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

Excuse me for one minute. So when she was telling you on that date that she was paranoid in quoting your records, paranoid of getting suicidal thoughts and something bad happened, doesn't want to be alone, what did she mean by that?

[Dr. Jennifer Tufts]

Well, those were a lot of. A lot of her words, right?

[Court Clerk]

Isn't that a concern? If your patient is telling you she doesn't want to be alone, why didn't she want to be alone?

[Dr. Jennifer Tufts]

Because she was very anxious and had the feeling like something bad might happen.

[Court Clerk]

Okay. Did her mother ultimately and dad come to stay with them?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

How long did they stay with them?

[Dr. Jennifer Tufts]

I don't know.

[Court Clerk]

When you talk to the mother and the father, did you say to them, what is she doing? How does she appear? Is she in bed all day? What did they tell you?

[Dr. Jennifer Tufts]

They never called my office, so I never spoke with them.

[Court Clerk]

They never called your office?

[Dr. Jennifer Tufts]

They never called me or sent a message, so I did not have communication with them.

[Court Clerk]

So it's their fault, but they didn't call you, the doctor.

[Judge William Sullivan]

Sustained. Next question.

[Court Clerk]

So do you think maybe it would be reasonable if you had the doctor and you're investigating the patient's symptomology, that you might, when you know that the parents are staying with her, that you would make a phone call yourself?

[Dr. Jennifer Tufts]

It's not typical when you have an adult who is able to advocate for themselves, to speak with their parents.

[Court Clerk]

So while she is telling you about her symptomology and tearfulness and crying and unable to get up and anxiety and the medications and the mental illness that she had, you felt that she could advocate for herself?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

Okay. On the television, on the computer?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

The next time you saw her was on October 26, is that correct? And you can pull up your record.

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

Now, and if you look again at the interval history, where you put down what's going on in the patient's life that time, this is when she indicated that she's back to where she felt that she was before Zoloft, which was not great, and that you guys were considering a new medication, is that right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And then you started her on Ativan, as we talked about, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And then you started her on the buspirone, right?

[Dr. Jennifer Tufts]

Well, she had already been started on the Ativan, and then we added the buspirone.

[Court Clerk]

So my question was, you started her on buspirone, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

Okay. And also you added her hydroxyline as needed, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And you continued the Ativan, correct?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

Did you discuss side effects with her at that point?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

Did you also discuss starting Remeron or Pregabalin? Pregabalin, yes. What did you tell her about Remeron and pregabalin?

[Dr. Jennifer Tufts]

I don't think I went into any detail about those medicines, just that those might be things to consider in the future.

[Court Clerk]

And then you saw her on October 31, right?

[Dr. Jennifer Tufts]

That was her. I think that was just a therapy appointment with a different. Different provider.

[Court Clerk]

Would that be Jennifer McAllister?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

So it's a different provider in the sense that she works for asta, right?

[Dr. Jennifer Tufts]

Well, yes. It just wasn't myself.

[Court Clerk]

Right. So on October 31st, they did a suicide assessment or she did. Right. McAllister.

[Dr. Jennifer Tufts]

I wasn't there.

[Court Clerk]

Well, I know you weren't there, but these are medical records that have been introduced into evidence that the jury's going to have in the jury room.

[Defense Attorney Kevin Reddington]

Objection. Is that a question?

[Judge William Sullivan]

No. Good. Next question.

[Court Clerk]

McAllister did a suicide assessment, apparently. Right.

[Dr. Jennifer Tufts]

I'm sure she assessed suicide.

[Psychiatric Nurse Practitioner Julie Paul]

Please.

[Dr. Jennifer Tufts]

Where. Where do you see it? Sorry?

[Court Clerk]

Where it says suicide assessment. There's only four pages for October 31st. Yeah, well, actually there's. There would be eight because it's two sites.

[Dr. Jennifer Tufts]

So that. That is the assessment that you go through. If somebody reports any thoughts of suicide, then you ask those questions, which go into a lot more detail about them.

[Court Clerk]

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.

[Dr. Jennifer Tufts]

I wasn't there. You would have to ask her.

[Court Clerk]

Well, maybe I will if she comes in.

[Dr. Jennifer Tufts]

Okay.

[Court Clerk]

Why don't you tell me what the record shows? Did they do a suicide assessment? Did you check off the little boxes?

[Dr. Jennifer Tufts]

I'm looking for that section. It says that patient denies suicidal or homicidal ideation at this time.

[Court Clerk]

Okay. So again, this is on October 31st, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

The patient within a period of a couple of days and meetings with you that McAllister has access to because the records are within your business, right?

[Dr. Jennifer Tufts]

It's not my business, but yes.

[Court Clerk]

Has reported suicidal ideation and fear and dwelling about killing herself and afraid of those thoughts. Right.

[Dr. Jennifer Tufts]

She. I just want to be absolutely clear. So. So yes, you know, a little while earlier, she had. She had voiced those concerns.

[Court Clerk]

Right. So as a result of voicing those concerns, is it your understanding. Understanding that McAllister did not do any of the suicide assessment questions? Because Lindsey reported that she wasn't suicidal.

[Dr. Jennifer Tufts]

It appears that she asked about suicide acting.

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[Judge William Sullivan]

Ask the next question.

[Court Clerk]

Thank you. I'm not asking you. You've told us three times now that she said 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?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

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.

[Dr. Jennifer Tufts]

I don't see anything written here.

[Court Clerk]

So was there a suicide assessment?

[Dr. Jennifer Tufts]

I don't know. Because I wasn't there. I don't know what the conversation was.

[Court Clerk]

Looking at the records. Right.

[Dr. Jennifer Tufts]

From looking at the records, I don't see evidence of additional suicidal questions beyond asking if it was there or not.

[Court Clerk]

So suicidal assessment, doctor, is in the medical records, consumes almost four pages, does it not? Yes.

[Dr. Jennifer Tufts]

Yes.

[Judge William Sullivan]

Okay.

[Court Clerk]

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.

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And there is not one notation indicated that that test was ever administered to her on October 31st. Correct?

[Dr. Jennifer Tufts]

Correct. But it was. It looks like it was asked in other ways.

[Court Clerk]

November 2, it was asked in other ways. Is that what the little check box where it says deny suicidal ideation?

[Dr. Jennifer Tufts]

Can I read something that she.

[Assistant District Attorney Jennifer Sprague]

Yes.

[Court Clerk]

The suicidal assessment was not administered according to the record that's in front of you by McAllister. Yes.

[Dr. Jennifer Tufts]

The additional suicidal assessment. Yes.

[Court Clerk]

November 2nd. By the way, as a psychiatrist, not a psychologist, you have the ability to prescribed medication, obviously, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

We talked about the DEA number and all of that. Correct. Which you had for about a month. Other than when you were a resident, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

So you're prescribing these SSRIs and antipsychotics and antitropics or whatever they are, and it's important as to the metabolism of your patient with those drugs, isn't it?

[Judge William Sullivan]

Yes.

[Court Clerk]

Okay, wait a second. What does metabolism mean?

[Dr. Jennifer Tufts]

The body breaking down the medication.

[Court Clerk]

So how is it that you can determine how the body of your patient is breaking down the medication that is in their brain, and they're complaining about all of these symptoms. How, as a doctor, do you determine how the body's breaking it down?

[Dr. Jennifer Tufts]

We don't typically have any specific testing that we do to understand that.

[Court Clerk]

How about a blood test?

[Dr. Jennifer Tufts]

It's not done for that.

[Court Clerk]

It's not done for that meaning a blood test is not done to determine the metabolism of your patient, of your medications.

[Dr. Jennifer Tufts]

Are you referring to genetic testing?

[Court Clerk]

No, I'm asking about the metabolism. I'm not talking about genetics. I'm talking about the metabolism of the SSRIs in our body. Okay, you can tell that metabolism rate through blood testing, right?

[Dr. Jennifer Tufts]

Not in the way that you're describing.

[Court Clerk]

Okay, what way would it be?

[Dr. Jennifer Tufts]

There is genetic testing that can give information about metabolism.

[Court Clerk]

Like what?

[Dr. Jennifer Tufts]

It can talk about different enzymes that a person might have to suggest. It provides information about the enzymes that a person might have the genes for.

[Court Clerk]

Okay, so it provides the enzymes that a person might have the genes. Forgive me, I'm having difficulty with that. What does that mean?

[Dr. Jennifer Tufts]

It's a little complicated.

[Court Clerk]

You don't expect a patient that's going through what she was going through to understand that, would you?

[Dr. Jennifer Tufts]

No.

[Court Clerk]

Did. Did you guys do the enzyme test?

[Dr. Jennifer Tufts]

They are not typically done.

[Court Clerk]

Why?

[Dr. Jennifer Tufts]

Because, again, it's. It's genetics and insurance covering.

[Judge William Sullivan]

Finish that answer and I'll allow.

[Court Clerk]

Follow up.

[Judge William Sullivan]

Go ahead, Doc.

[Dr. Jennifer Tufts]

So it's not as simple as testing for an enzyme or not. You can test someone's genome like we have, have the ability to test the entire human genome now, but it's. Which is great. But the clinical, you know, use of that is not there yet. So while we can test these things, it does not yield meaningful clinical information. So it's not commonly done.

[Court Clerk]

What is the. Sorry, what is the Cytopro P4.15 system?

[Dr. Jennifer Tufts]

That's one of the enzymes that I'm talking about.

[Court Clerk]

So the Cytopro P450 system talks about and tests for the breakdown of psychiatric meds in the blood.

[Judge William Sullivan]

Right.

[Dr. Jennifer Tufts]

It's not in the way that you're describing. It doesn't tell you what medicines. It just. Yes, this is a test that is done, but it doesn't tell you what medications a patient will do better on. It's not useful in that way.

[Court Clerk]

So what's it useful for?

[Dr. Jennifer Tufts]

I mean, I don't find it terribly useful.

[Court Clerk]

How long has the Cytopro P450 system been in use in your field?

[Dr. Jennifer Tufts]

I'm sorry?

[Court Clerk]

How long has the Cytopro P450 system been in use in your field? Psychiatry.

[Dr. Jennifer Tufts]

Well, it's an enzyme in the body.

[Court Clerk]

Well, I know what it is. I'm asking you about the system. The testing. How long have they been using that?

[Dr. Jennifer Tufts]

The genetic testing. Maybe a few years. It's very new.

[Court Clerk]

Very new. Does insurance cover it?

[Dr. Jennifer Tufts]

Sometimes.

[Court Clerk]

Sometimes. So it is nevertheless a legitimate test to determine the break down of psychiatric meds in a patient's blood, correct?

[Dr. Jennifer Tufts]

It exists? Yes, it exists.

[Court Clerk]

Well, it exists, but you didn't use it, right?

[Dr. Jennifer Tufts]

It would not have made a difference.

[Court Clerk]

In what, in your opinion?

[Dr. Jennifer Tufts]

In her treatment.

[Court Clerk]

Because you go by the checks in the checkbox and what she self reports, right?

[Dr. Jennifer Tufts]

No, not. Not just the checks in the check box.

[Court Clerk]

In any event. Tell me about the thyroid.

[Dr. Jennifer Tufts]

The thyroid? It's an organ in the human body that regulates hormones.

[Court Clerk]

And what, if any, import and impact do thyroid levels have on your evaluation of a woman who is in the throes of postpartum depression?

[Dr. Jennifer Tufts]

They don't.

[Court Clerk]

What is the purpose of a test? To determine the thyroid levels?

[Dr. Jennifer Tufts]

Well, you can. You can test something like the tsh.

[Court Clerk]

Well, I don't know what a TSH is. I'm sorry, what is a tsh?

[Dr. Jennifer Tufts]

Thyroid stimulation hormone.

[Court Clerk]

Okay, thank you.

[Dr. Jennifer Tufts]

That's something that can be tested, typically by maybe a pcp, primary care or endocrinologist if they have concerns about someone's thyroid function.

[Court Clerk]

Were you aware of a study that was a major study that was peer reviewed? What does peer reviewed mean in your business?

[Dr. Jennifer Tufts]

That it was. Was reviewed by other researchers in a similar field.

[Court Clerk]

And the report or the. The article or whatever it may be has to be approved by the peers that are reviewing it before it can be published, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And you'd agree with me that in the medical field it's a big deal to have publishing articles on your resume, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And how many articles have you published about postpartum depression, postpartum psychosis, anything?

[Dr. Jennifer Tufts]

I have published something, but it's not a full article. It's just a small thing.

[Court Clerk]

Are you aware of the Psychiatry magazine article dealing with in 2021, thyroid function in postpartum psychosis. An exploratory study. Have you ever heard of anything about that, let alone read an article about it?

[Dr. Jennifer Tufts]

No.

[Court Clerk]

Are you aware that there are studies that have compared thyroid function between psychosis with postpartum onset PPO psychosis without postpartum onset PwPO and normal postpartum? You aware of that?

[Dr. Jennifer Tufts]

No.

[Court Clerk]

You're supposed to be an expert or you specialize or you have an interest in treating women that have suffered from postpartum, correct?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

Have you written any articles at all about postpartum depression, anxiety, psychosis?

[Dr. Jennifer Tufts]

No, I'm not a researcher. I'm a clinician.

[Court Clerk]

Have you read any of the articles, such as thyroid function and postpartum psychosis?

[Dr. Jennifer Tufts]

I've read many articles. There are thousands. I have not read that specific article.

[Court Clerk]

Thousands? Thousands of articles on postpartum psychosis and the thyroid?

[Dr. Jennifer Tufts]

No, not on that specific topic.

[Court Clerk]

So when the aster doctors are treating a person like Lindsay, it's your testimony to this jury that testing whether it's blood testing or whether it's the Cytopro P4 testing is not necessary. Because Jennifer Tufts doesn't think it's necessary. Right.

[Dr. Jennifer Tufts]

It does not yield information that would influence treatment.

[Court Clerk]

Really? So if there was elevation in the thyroid, that wouldn't impact on your treatment at all? Your evaluation, your investigation?

[Dr. Jennifer Tufts]

Sorry, I thought you had mentioned the cytochrome issue. Are we talking about that one or are we talking about the thyroid? Okay,

[Court Clerk]

so if. Can you repeat tests that reveal how they in the thyroid level? Is it your testimony that you wouldn't care?

[Courtroom Audio Technician]

What if the freshest thing you ate this summer didn't come from a store? Meet garden. Garden is the smart indoor home growing system that grows flavorful greens, herbs, fruit and vegetables right in your kitchen. No backyard, no experience, no grocery run required. Garden automatically balances water and light, so nutrient dense produce is always within reach. Heading out this summer, Kelby Garden's AI plant assistant keeps your garden thriving while you're away so you can come home to a harvest with garden. Your lettuce isn't days old from a truck. It's alive, crisp and inches from your plate. Fuel your summer from the inside out. Visit mygarden.com that's my G-A-R-Y-N.com

[Dr. Jennifer Tufts]

if I somehow found out that a patient had elevated thyroid levels, I would advise them to to talk to their primary care or maybe get an endocrinologist to discuss it.

[Court Clerk]

Did you ever recommend that Lindsey get an endocrinologist?

[Dr. Jennifer Tufts]

No, she did not.

[Court Clerk]

The Answer is no. And you basically did not have any information that you could use to even realize that there might have been a thyroid issue with. With this woman that was post pilot. Right. Because you didn't do any blood tests.

[Dr. Jennifer Tufts]

There was no clinical reason to obtain a blood test.

[Court Clerk]

All right, so you continue on with your meetings by the computer, correct?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

November 2nd. You can get November 2nd out. You got it.

[Dr. Jennifer Tufts]

November 22nd.

[Court Clerk]

No, it looks like November 2nd. I apologize. That's what I'm looking at. Tufts Jennifer MD Clancy Lindsey, follow up note, November 2nd.

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

Okay. And you're still diagnosing her with generalized anxiety disorder, gad, right? Yes. You add in there an adjustment disorder with depressed mood, I guess, because of what she had been telling you, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

Okay. Looking at the psychiatric condition, you note that it's improving, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And then you determine that you will decrease the Ativan to 0.75 milligrams for two weeks and then decrease it to 0.5 milligrams for two weeks and consider alternatives for sleep anxiety. Is that correct?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And then, you know, if she's having urges to harm herself or others, to go to the nearest emergency room and call 911 and things of that nature. Correct?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

So is that a form that you basically press a button? Because it seems to be kind of like a generic advice. Call 911 if you're feeling suicidal and things of that nature?

[Dr. Jennifer Tufts]

Well, that's advice that we provide for every single patient.

[Court Clerk]

Okay. And then you know that half the encounter was on counseling or coordination of care on November 2, right?

[Dr. Jennifer Tufts]

Yes. That's a typical statement. That's, that's. It's just a part of documentation that doctors use.

[Court Clerk]

All right. Now, on November 2nd, you were suggesting the four drugs that she would start would be Remeron, Trazodone, Pregabalin, and hydroxyzine. Right. Those were.

[Dr. Jennifer Tufts]

Those were just things we were considering. I wasn't starting all of those medicines

[Court Clerk]

on November 22nd. Now, that would be almost three weeks later. Right? You saw her. Right. And did you ask her about whether or not she was still having suicidal thoughts or worrying about suicidal thoughts, for example? Did you ask her that?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

How do you know that? Because the box is checked.

[Dr. Jennifer Tufts]

It's written in my note.

[Court Clerk]

What does it say?

[Dr. Jennifer Tufts]

Patient denies si.

[Court Clerk]

Okay. What did you ask her about that?

[Dr. Jennifer Tufts]

I don't remember the exact words, but I. I know that I asked about that.

[Court Clerk]

Did you ask her about how things are going at home with her mother and father staying there?

[Dr. Jennifer Tufts]

That I don't I don't remember. I didn't document how her parents were doing.

[Court Clerk]

Okay, well, I don't really care about how her parents are doing. I'm asking about whether or not you asked her how it was working out while her parents were there helping out. If you did, fine. If you didn't, that's fine, too.

[Dr. Jennifer Tufts]

Yeah, I don't think that I did. In this appointment, she.

[Court Clerk]

Okay. That's all. December 1st was the next appointment. Correct. And you can look at the interval history.

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

Now, on that December 1st appointment, this is after she had transferred to South Shore.

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

She disclosed to you that she had been seeing South Shore, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

We already talked about the fact that you never got the records from South Shore. So you don't know other than what Lindsey reported to you, what medications she was on? Right,

[Dr. Jennifer Tufts]

Right. I knew what she was. What she was telling me.

[Court Clerk]

Right. And she told you that she was doing the Ativan taper, right?

[Dr. Jennifer Tufts]

Well, she said she had. She had tried doing that, but that then she was having worse sleep.

[Court Clerk]

Having difficulty sleeping is what. What she indicated to you, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And she tried other meds that you had suggested, but stated that she was having difficulty with those meds, including Trazodone. Right.

[Dr. Jennifer Tufts]

Well, the Trazodone, she didn't have a problem with it just didn't seem like it was particularly helpful.

[Court Clerk]

Did you prescribe the trazodone or somebody else?

[Dr. Jennifer Tufts]

This was somebody else.

[Court Clerk]

So do you know what the milligrams were that she was on?

[Dr. Jennifer Tufts]

It says she tried between 50 and. And 150 milligrams.

[Court Clerk]

All right. Now, did she at some point try Remeron?

[Dr. Jennifer Tufts]

She said that she did.

[Court Clerk]

Did you suggest in your discussions that she try Remeron?

[Dr. Jennifer Tufts]

No, I did not.

[Court Clerk]

Did she indicate to you that she had rebound anxiety and intrusive thoughts, that she was going to die? Recall that?

[Dr. Jennifer Tufts]

Well, she said worse depression and intrusive thoughts.

[Judge William Sullivan]

Okay.

[Court Clerk]

Did she tell you what the intrusive thoughts were?

[Dr. Jennifer Tufts]

It was the feeling like I'm going to die.

[Court Clerk]

Did she then have a script for Prozac, 10 milligrams.

[Dr. Jennifer Tufts]

That's what she said.

[Court Clerk]

And she said that she couldn't sleep and had worse sleep, so that hadn't been stopped, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

Then she tried. She was on Klonopin, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And what is Klonopin?

[Dr. Jennifer Tufts]

It's a benzodiazepine.

[Court Clerk]

And on December 1st is when she told you again that she was close to having suicidal ideation, feeling hopeless, recall that?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

Now, on the interval history on that Date you indicated that she can't sleep. She's panicking. She had worse depression, intrusive thoughts. She was numb. Nothing mattered. I feel like I'm going to die. Denies suicidal ideation, but quote yesterday, close to it. Feeling hopeless. Did you give her therapy and validations after she told you that?

[Dr. Jennifer Tufts]

I believe that I did.

[Court Clerk]

What did you do? You got a woman that's telling you that she, she's hopeless. She doesn't care if she dies. Can't sleep. What did you do to validate on your therapy?

[Dr. Jennifer Tufts]

Well, I. I told her that this was. This was something that we would. We could address, that there was hope, that there were treatments and there are, you know, different types of treatment programs that are more specific, more supportive, like partial hospitalization programs. So she knew that she still had had options and, and the reason to hope.

[Court Clerk]

Did you ever suggest to her that maybe you ought to come in to see me rather than talk on the computer?

[Dr. Jennifer Tufts]

Discussing talking with her over the video did not seem like an issue. It didn't seem like there was anything that I was missing or that there was any need to see her in person.

[Court Clerk]

Now, you'd agree with me that In December of 2022, Covid was all done, right?

[Dr. Jennifer Tufts]

It wasn't completely all done.

[Court Clerk]

Were you still nervous about dealing with people and wearing masks and stuff, or were you able to sit down and talk to somebody face to face?

[Courtroom Audio Technician]

What if the freshest thing you ate this summer didn't come from a store? Meet garden. Garden is the smart indoor home growing system that grows flavorful greens, herbs, fruit and vegetables right in your kitchen. No backyard, no experience, no grocery run required. Garden automatically balances water and light, so nutrient dense produce is always within reach. Heading out this summer, Kelby Garden's AI plant assistant keeps your garden thriving while you're away so you can come home to a harvest with garden. Your lettuce isn't days old from a truck. It's alive, crisp and inches from your plate. Fuel your summer from the inside out. Visit mygarden.com that's my email. G-A-R--Y N.com we were definitely feeling more

[Dr. Jennifer Tufts]

comfortable about being face to face with people, but I think, you know, it was still something that we thought about.

[Court Clerk]

You discussed trying Seroquel with her at that point, right?

[Dr. Jennifer Tufts]

I didn't really discuss it. She. Well, she had told me that that was. That was something that she had discussed with her other provider.

[Court Clerk]

So looking at your notes, does it say also discussed trying Seroquel alone tonight?

[Dr. Jennifer Tufts]

Your notes say that it says? Yes, but I wasn't making a recommendation about the Seroquel. It was just a medicine I was providing her more information on,

[Judge William Sullivan]

so.

[Court Clerk]

So you were telling her about the Seroquel, you're providing information?

[Dr. Jennifer Tufts]

Yes, we were talking about the Seroquel.

[Court Clerk]

Right. Why?

[Dr. Jennifer Tufts]

Because her other provider had recommended that she started it.

[Court Clerk]

What is Seroquel?

[Dr. Jennifer Tufts]

An antipsychotic.

[Court Clerk]

You also discussed with her the possibility of undiagnosed bipolar disorder, did you not?

[Dr. Jennifer Tufts]

It was discussed.

[Court Clerk]

An undiagnosed bipolar disorder was, in your opinion, as a result of. Not a reaction, but extreme reaction to the SSRIs, right.

[Dr. Jennifer Tufts]

So not as a result of the SSRIs, but that react.

[Court Clerk]

Does your. Excuse me? Does your note say, and I quote, also discussed possibility of undiagnosed bipolar disorder given extreme reaction to SSRIs and insomnia, period? Does it say that?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

Those are your notes, right?

[Dr. Jennifer Tufts]

Yes. The way you were saying it made it sound a little bit different before. But that's exactly what I wrote.

[Court Clerk]

I read it directly from your note.

[Judge William Sullivan]

Right.

[Court Clerk]

How does it sound different?

[Dr. Jennifer Tufts]

I don't know. It sounded different the first time he said it than the second.

[Court Clerk]

So did she have bipolar?

[Dr. Jennifer Tufts]

No.

[Court Clerk]

Did you make that decision that night, that day?

[Dr. Jennifer Tufts]

I assessed that with her pretty much every. Every time that I saw her. And she never had mania?

[Court Clerk]

What about mood stabilizer, like lamictal? Did you discuss that with her?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

What is lamictal?

[Dr. Jennifer Tufts]

It's an anticonvulsant, but it's. It's used in treating mood disorders.

[Court Clerk]

So what was the end result of your meeting with her on December 1st? What did you guys do? Recommendations, advice, anything?

[Dr. Jennifer Tufts]

Yeah, well, so at this time, I was not prescribing her medications, but I was still concerned. Not concerned enough that she was at imminent risk of hurting herself or anybody else, given what she said. But we had a plan for her to pursue a partial hospitalization program.

[Court Clerk]

Where was that?

[Dr. Jennifer Tufts]

Well, the one that I had recommended was hri.

[Court Clerk]

What is that? Hri.

[Dr. Jennifer Tufts]

It's a hospital in Brookline.

[Court Clerk]

And did she ultimately go. Go to another hospital?

[Dr. Jennifer Tufts]

She ultimately went to the Women and Infants Hospital for one day.

[Court Clerk]

And those are the records that you didn't get, right?

[Dr. Jennifer Tufts]

Correct.

[Court Clerk]

Okay. And you decided that she did not have bipolar disorder because, in your opinion, she did not meet, and I quote, the criteria, Right. That would be the criteria in the dsm, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And the dsm, of course, is the Diagnostic Statistical Manual. Roman numeral text Revision, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

Is that what you were using back then, would be this thing here, DSM5TR. This is the DSM.

[Grainger Commercial Announcer]

Right.

[Court Clerk]

It's like a cookbook. Right.

[Dr. Jennifer Tufts]

It's more of a guideline that we use to, you know, to help us in our. In our treatment. But it's not. It's not the psychiatry bible that people sometimes think that it is.

[Court Clerk]

Right. Hypomanic bipolar disorder. How many days does that require?

[Dr. Jennifer Tufts]

Under the dsm, a hypomanic episode lasts for at least four days.

[Court Clerk]

Dsm.

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

Remember on Friday you said that the most important criteria is seven days with continued high energy levels.

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

So is it. Is it seven days or is it four days? And who says.

[Dr. Jennifer Tufts]

Well, mania is. Is seven days. Hypomania is four.

[Court Clerk]

Yeah. Severe mental disturbance. At that point that was manifesting itself,

[Dr. Jennifer Tufts]

she had a maybe moderate and. Moderate heading towards severe.

[Court Clerk]

Moderate heading towards severe mental issue. Okay, you agree with me that she had increased anxiety, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

She had very, very increased depression. Right.

[Dr. Jennifer Tufts]

Well, she. She.

[Assistant District Attorney Jennifer Sprague]

She did.

[Dr. Jennifer Tufts]

She said since the run.

[Court Clerk]

Just answered yes or no.

[Dr. Jennifer Tufts]

I'm sorry, I was just trying to check the record.

[Court Clerk]

Okay, you can check the record all you want, but if I ask you a question, respectfully, can you just not go on and gamble? Answer yes and no. That's all.

[Dr. Jennifer Tufts]

It's sometimes impossible to do that.

[Judge William Sullivan]

That.

[Dr. Jennifer Tufts]

Okay, go on.

[Assistant District Attorney Jennifer Sprague]

Thank you.

[Court Clerk]

Now, mental issues like anxiety that was diagnosed, or depression that was diagnosed, and the fact that she indicated yet again that she was close to suicidal ideation, quote, worried about suicidal thoughts, but you indicated that she wasn't suffering from suicidal ideation on that day. Is that fair?

[Dr. Jennifer Tufts]

She denied it.

[Court Clerk]

But she told you that she was worried about suicidal ideation and having suicidal thoughts, right?

[Dr. Jennifer Tufts]

Well, this. Yes. This was the time she said she was worried that she was close to having suicidal thoughts.

[Court Clerk]

So did you ask her what does that mean? Does that mean she's standing at the edge of the stairs and she's thinking about falling down the stairs or what. What does that mean, a close to suicidal ideation?

[Dr. Jennifer Tufts]

So I asked about that, and that's. That's when she said. She described it further as using the word hopeless.

[Court Clerk]

So did you prescribe the lamotrigine on that occasion or. No.

[Assistant District Attorney Jennifer Sprague]

No.

[Court Clerk]

On December 16th, that's the next appointment she had, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

That'd be two weeks later, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

She was still not well. Correct. She told you she was having a really rough time.

[Dr. Jennifer Tufts]

She was sleeping, but she was still feeling very poorly.

[Court Clerk]

In your notes, does it say that she was having a really rough time?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

So when I asked you your notes Reflected that she said she was having a really rough time. Why do you feel compelled to say she was sleeping? Overall,

[Dr. Jennifer Tufts]

it's an important detail.

[Court Clerk]

Yeah, I guess. How about the rough hand? What did that mean? What were the symptoms of having a really rough tan in the skin?

[Dr. Jennifer Tufts]

Do you want me to.

[Court Clerk]

Yeah, I might get the answer to that.

[Dr. Jennifer Tufts]

So finally works. Referring to the thalium and quetiapine. But very depressed during the day, no motivation, some si. Do you want me to continue?

[Court Clerk]

Sure.

[Dr. Jennifer Tufts]

Went to MGH emergency room for si. Declined inpatient. Feeling hopeless, no intent or plan and feels like depression related to seroquel.

[Court Clerk]

Okay, that's the question on Friday that I'll strike that. So what was the si? Suicidal ideation?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And can you read that back to me?

[Dr. Jennifer Tufts]

Me again.

[Court Clerk]

What did she say about si?

[Dr. Jennifer Tufts]

So that when, when she went to the hospital, she went because she had no motivation.

[Court Clerk]

Some si, Some si. Meaning that she had some suicidal ideation, right?

[Dr. Jennifer Tufts]

Yes. In her words. Yes.

[Psychiatric Nurse Practitioner Julie Paul]

Yeah.

[Court Clerk]

In her words, as opposed to thinking about having suicidal ideation or worse, worrying about suicidal ideation, she actually indicated that she had suicidal ideation, Right.

[Dr. Jennifer Tufts]

I can't answer that as a yes or no.

[Court Clerk]

Well, it's in your notes that she said that, right? Yes.

[Dr. Jennifer Tufts]

What is in my note?

[Court Clerk]

Do you understand my question?

[Dr. Jennifer Tufts]

I'm a little bit confused right now. Can you repeat what your question?

[Court Clerk]

Sure, of course. We spent some time talking about thinking about suicidal ideation, worrying about suicidal ideation. Now saying she had suicidal ideation, right?

[Dr. Jennifer Tufts]

She said it. Yes.

[Court Clerk]

Well, this is the only source of information that you're getting apparently, is what she's telling you, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

So what suicidal ideation did she have? She thinking of cutting the throat? Was she thinking of throwing herself off a building? Running out in front of a car? What?

[Dr. Jennifer Tufts]

No.

[Court Clerk]

What was she thinking of?

[Dr. Jennifer Tufts]

So I asked her those important follow up questions and that's. So what do you mean when you say I'm feeling suicidal? And that's when she, she said it means I'm feeling hopeless. And then I asked you, do you have intention of hurting yourself? Do you have a plan for hurting yourself? And she denied those.

[Court Clerk]

And that's where you left it.

[Dr. Jennifer Tufts]

I'm sure more was said, but that's the most important point of that clinical encounter.

[Court Clerk]

And, and did you give a therapy by the computer on that day too?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

What did you, what did you do for therapy about her suicidal ideation and saying she wanted to kill us?

[Dr. Jennifer Tufts]

Well, we, you know, we explored what that, what that meant and you know, what, what to do If. If you're feeling that way.

[Court Clerk]

To do what?

[Dr. Jennifer Tufts]

Call 911 to go to the emergency room.

[Court Clerk]

Did you discuss prescribing Seroquel to her? Was she getting Seroquel? Did Seroquel enter into your discussion at all?

[Dr. Jennifer Tufts]

We talked about it. I was not prescribing it for her.

[Court Clerk]

What is cerequal?

[Dr. Jennifer Tufts]

That's an antipsychotic.

[Court Clerk]

So at the conclusion of your meeting on December 16, basically what you took away is that she had now increased to suicidal ideation, is feeling hopeless, all the rest of the things that we've talked about. And then she, what, just moved on, went home?

[Dr. Jennifer Tufts]

Well, she was assessed in the emergency room and was not admitted. And I assessed her on that day again. And while she was certainly struggling, she did not require hospitalization at that moment. So she was. She was planning on going to the Women Infants Program, and I supported that.

[Court Clerk]

Did you know that around that time she confessed to her husband that she was having now thoughts of harming children?

[Dr. Jennifer Tufts]

No.

[Court Clerk]

Would that have been something you were concerned about?

[Dr. Jennifer Tufts]

If I heard that, I would have been very concerned.

[Court Clerk]

You would have called dcf, right?

[Dr. Jennifer Tufts]

I might have.

[Court Clerk]

And when you spoke to Pat, did you ever ask him what his observations were of her spiraling into November and December? Not that one time that he stuck his face on the computer and talked to you. Did you ever talk to him?

[Dr. Jennifer Tufts]

He never called me again or he never called at all. I never spoke with him again.

[Court Clerk]

So he is a husband of a woman. Woman. Just had a baby. She was postpartum with all of these symptoms that we talked about, all of the drugs that you were prescribing, she was dealing with, trying to get help. You never talked to her husband about what he observed because he didn't call you?

[Dr. Jennifer Tufts]

Well, we did speak on that visit.

[Court Clerk]

Which visit?

[Dr. Jennifer Tufts]

The 16th or. I. I think that that's the one that he was at.

[Court Clerk]

Think of what.

[Dr. Jennifer Tufts]

It's not noted, but I remember some of what we talked about. And so in reading that record, it seems like that's the likely one that he was at.

[Court Clerk]

December 16th. On your objective findings, you note that her mood was depressed, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

What does that mean? Does she just say, I'm depressed, or did she give you the symptoms? I mean, you check the little box? Yeah.

[Dr. Jennifer Tufts]

Yeah. It means she's saying that she's depressed.

[Court Clerk]

Okay, so you're the doctor. You check the little box. What did your patient tell you about her symptoms? That she was depressed on that day? Was she crying? Was she able to get out of bed? Was she Worshiping at the portal. What was going on in her life?

[Dr. Jennifer Tufts]

She was, she said she was having a really tough time.

[Court Clerk]

Her affect was flat, right?

[Grainger Commercial Announcer]

Yes.

[Court Clerk]

And again, depressed. You check it off twice. One under mood and one under affect, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And then next page it says recent lab work. That wouldn't be blood testing, would it? With asta. It's ASTA do blood testing.

[Dr. Jennifer Tufts]

We don't have a phlebotomist for a lab. No.

[Court Clerk]

Well, why does it say recent lab work typed into your form when you check off the little boxes?

[Dr. Jennifer Tufts]

That's something that auto populates. It's a template that, you know, many different. It's a template, the whole node is, is something that psychiatrists or at, you know, probably all across the country use.

[Court Clerk]

Probably. You can't diagnose someone's illness by a template though, can you?

[Dr. Jennifer Tufts]

No.

[Court Clerk]

You filled in, no lab results were found, right?

[Dr. Jennifer Tufts]

There were none in the computer? Yes. I didn't type that in though. It just auto populate. It was auto populated.

[Court Clerk]

So on the next page, where it talks about symptom goals, treatment goals. I'm sorry, symptom reduction and improve functioning. What does that mean?

[Dr. Jennifer Tufts]

Symptom reduction is to have fewer, fewer mental health symptoms and improve functioning means, you know, improved, you know, day to day life functioning. You know, things that. Things that she's doing in her daily life.

[Court Clerk]

Really? Did you tell her all that?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

A young woman that's obviously mentally ill, very sick, she's deteriorating. Whether you like that word or it's automatically imported. What on that date did you do? Never mind all those words you just said. What did you tell her on the television or the computer?

[Dr. Jennifer Tufts]

I told her to go to the partial hospitalization program and if she was having more suicidal thoughts again or felt like she was at risk of hurting herself or anybody else, that she should go immediately to the emergency room.

[Court Clerk]

How long did that meeting take?

[Dr. Jennifer Tufts]

Probably about 30 minutes.

[Court Clerk]

And was there any. Was that the therapy that you provided, telling her to go to the emergency room?

[Dr. Jennifer Tufts]

I mean, that was probably a component.

[Court Clerk]

So the plan, excuse me, on December 16, was to follow up with Women and Infants, right?

[Assistant District Attorney Jennifer Sprague]

Yes.

[Court Clerk]

Did she?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

Do you know when?

[Dr. Jennifer Tufts]

I don't know exactly. The day. Shortly after.

[Court Clerk]

You were considering a brexanoline or brexanolone infusion, right?

[Dr. Jennifer Tufts]

That's the Zilrasso.

[Court Clerk]

That's the same thing wrote out?

[Dr. Jennifer Tufts]

Yeah.

[Court Clerk]

And that didn't go anywhere, right?

[Dr. Jennifer Tufts]

No.

[Court Clerk]

Says stat lamictal 25 milligrams daily, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

Continue Seroquel. Right. What was the Milligram from Cerequil up to. At this point?

[Dr. Jennifer Tufts]

Well, she had told me it was 200. That was. That. I. I did not write the. That prescription. So that's what her provider had prescribed her.

[Court Clerk]

Okay. So you can ask somebody to show me the bottle. Pill bottle. You can ask somebody to show me the CVS receipt. You can ask somebody. You can call to verify, right? I could, but you. Anyway, she said that she was on Seroquel, 200 milligrams, right. And had stopped with the value, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And then you go on with that form thing saying if you have urges to harm yourself or others, you got to call 911 Crisis Hotlines and everything else. Right. That's the next two paragraphs. They've done that before, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

Was her mother and father still staying with her on December 16, if, you know, with Pat and the kids?

[Dr. Jennifer Tufts]

I'm not sure.

[Court Clerk]

Did you ever ask. Ask anybody other than her how she was doing?

[Dr. Jennifer Tufts]

I. I asked her husband when he was at the appointment.

[Court Clerk]

Yeah, that's the other appointment. How about. Now we're talking December 16th into. Into the month of December. Did you ever ask anyone how she was doing?

[Dr. Jennifer Tufts]

Well, I think he was at that visit.

[Court Clerk]

You think he was at the visit. How did. How did he tell. What did he say to you about how she.

[Dr. Jennifer Tufts]

You said she wasn't doing well.

[Court Clerk]

She's done,

[Judge William Sullivan]

right?

[Dr. Jennifer Tufts]

Objection.

[Judge William Sullivan]

Overall.

[Court Clerk]

Go ahead.

[Dr. Jennifer Tufts]

He said she wasn't doing well.

[Court Clerk]

Anything else?

[Dr. Jennifer Tufts]

Yeah, he felt that might have been. His opinion was that it was related to when she started the Seroquel.

[Court Clerk]

You basically say you guys are turning her into a zombie, right?

[Assistant District Attorney Jennifer Sprague]

Objection.

[Court Clerk]

Overruled.

[Dr. Jennifer Tufts]

I don't have that written. He may have said that.

[Court Clerk]

Does that kind of hit you, though? You might remember that you might have been, as some people, worried about suicide. You might be thinking in your brain that he did say you're turning her into a zombie. Possible.

[Dr. Jennifer Tufts]

It's very possible.

[Court Clerk]

Next meeting after the December 16th. Was it December 16th? Is that what we were just on?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

Okay. The next meeting was January 6th?

[Dr. Jennifer Tufts]

Yes. Okay.

[Court Clerk]

And how does this happen? Does the patient call? I know you don't set up these appointments. Somebody has to deal with somebody in administration or whatever. But. But do you, like, on December 16, say to Lindsey, call me, or set up an appointment for January 6, or do they have to do it themselves?

[Dr. Jennifer Tufts]

So at the end of an appointment, I typically will schedule their next appointment.

[Court Clerk]

So did you schedule January 6th?

[Dr. Jennifer Tufts]

I think that one she scheduled herself.

[Court Clerk]

That was the day after she got out of McLean.

[Judge William Sullivan]

Right.

[Dr. Jennifer Tufts]

Yeah. Usually the hospital coordinates the discharge appointment.

[Court Clerk]

Well, if I tell you that in fact the hospital told her to set up the appointment, that within an hour she set up the appointment. Is that in your notes?

[Dr. Jennifer Tufts]

It's not in my notes, no.

[Court Clerk]

Do you remember that? That was pretty a pretty big deal. She was in McLean, locked wards for four and a half days, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

She's your patient and she's really gone downhill bad, right?

[Dr. Jennifer Tufts]

No. She wasn't doing well.

[Court Clerk]

And she admitted herself to the lock wards at mlan, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

What was the diagnosis at mlan?

[Dr. Jennifer Tufts]

I. I believe they diagnosed her with major depression.

[Court Clerk]

Did they recommend any medication?

[Dr. Jennifer Tufts]

They took her off of the Seroquel.

[Court Clerk]

They took her off of it.

[Judge William Sullivan]

Off.

[Court Clerk]

So did you look at the McLean records?

[Dr. Jennifer Tufts]

Yes, definitely.

[Court Clerk]

And those were imported easily because you're part of the same structural.

[Dr. Jennifer Tufts]

No, but after someone is hospitalized, the hospital usually faxes it to their doctor.

[Court Clerk]

Right. So if I tell you that the MLAN records are really pretty voluminous. That's not what they fax. They fax you like a two page dispatch summary, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

You didn't get that by fax, right?

[Dr. Jennifer Tufts]

No.

[Court Clerk]

So what does the claim tell you? Look at the notes.

[Dr. Jennifer Tufts]

Which part do you want me to read?

[Court Clerk]

Did you ever have her assign a release from McLean? Did you ever get access to the McLean records?

[Dr. Jennifer Tufts]

I had access to the discharge summary.

[Court Clerk]

Okay, so put the discharge summary aside, because that's what they fetched you, a couple of pages. What about the records?

[Dr. Jennifer Tufts]

No, but that's typically not done. A discharge summary is a record.

[Court Clerk]

Did you talk to the doctor that discharged her?

[Dr. Jennifer Tufts]

No, no one called me.

[Court Clerk]

No. What?

[Dr. Jennifer Tufts]

No, no one called me. I wasn't notified about the hospitalization until she was discharged.

[Court Clerk]

So you just sit there behind your computer and wait for people, Patrick, wait for the doctor from McLean, wait for the sick person who's the patient to call you. And if these people don't call you, it doesn't exist apparently, right?

[Dr. Jennifer Tufts]

No, not exactly. I had no way of knowing she was even at McLean.

[Court Clerk]

Well, you did once she got discharged, right?

[Dr. Jennifer Tufts]

Yeah, but that was after the fact, Right.

[Court Clerk]

So did you care why she was in McLean?

[Dr. Jennifer Tufts]

Of course.

[Court Clerk]

And why was she in McLean?

[Dr. Jennifer Tufts]

Because she was depressed.

[Court Clerk]

And what was the. Does your record indicate that she was discharged yesterday under interval history?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And discharged from where?

[Dr. Jennifer Tufts]

Well, I said mgh.

[Court Clerk]

Is that Mass General Hospital?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And she was currently on Trazodone?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

She indicated that the goal was to come off Seroquel?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And she described as herself as still being very Numb?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

She couldn't sleep. Right.

[Dr. Jennifer Tufts]

That's not entirely true.

[Court Clerk]

Am I lying? I'm reading the medical records here. Sleep. Taking Ativan and Trazodone, slept five hours. Broken. Wondering about increasing Trazodone and switching to Valentine. What does that mean?

[Dr. Jennifer Tufts]

Well, it means she was having trouble sleeping. It wasn't that she wasn't sleeping at all.

[Court Clerk]

I see. So was the Trazodone increased at that point?

[Dr. Jennifer Tufts]

Yes.

[Assistant District Attorney Jennifer Sprague]

Yes.

[Court Clerk]

How about on January 9th? Did you see her through the computer or whatever then?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And did she. Did you prescribe medication to her on that date?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And was that diazepam?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

Fourteen count one milligram. No, I'm sorry. Fourteen count five milligrams.

[Dr. Jennifer Tufts]

That sounds right.

[Court Clerk]

Okay. Did you also, on January 12th, three days after January 9th meeting, prescribe additional medication to her?

[Dr. Jennifer Tufts]

I'm not sure. I don't have a record from January 12th.

[Court Clerk]

Do you recall on January 12th that in fact you prescribed Trazodone? 150 milligrams, 30 cup?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

Three days later or a couple of days later, January 16, you recall prescribed amitriptyline?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

What is amitriptyline?

[Dr. Jennifer Tufts]

It's a tricyclic antidepressant.

[Court Clerk]

What does a tricyclic antidepressant mean?

[Dr. Jennifer Tufts]

Well, it's an older antidepressant. It's called a tricyclic because it has three rings. If you look at the chemical itself, like a tricycle. But it's an older but efficacious medicine for depression and anxiety as well as insomnia.

[Court Clerk]

On January 16, look at your interval history. She indicated to you that her mood was very low. No motivation?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

Numb?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

Able to force herself out of bed. Taking care of basics. Eating, concentration, fine. Caring for baby. Bonding. Feels forced. Is that what you told her?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

Through the computer, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

Would have been. Were you concerned about this woman? Postpartum? Well, within a year. From the cdc. At that point, with these symptoms that she's telling you about?

[Dr. Jennifer Tufts]

I was concerned that she was depressed.

[Court Clerk]

And in all of the times that you spoke to her, you'd agree with me that she appeared to be honest and forthright, telling you what she felt? Right.

[Dr. Jennifer Tufts]

That's what I thought she was. Yes.

[Court Clerk]

Do you have any reason to think that she was lying to you? Because.

[Dr. Jennifer Tufts]

No.

[Court Clerk]

Diazepam taper on January 16th. 5 milligrams, last two nights. Slept for four hours and then a light sleep, maybe two hours, stretches. Did she express that she was still having concerns about side effects from medications?

[Dr. Jennifer Tufts]

Not at that point.

[Court Clerk]

So what does ROS mean under interval history that we're looking at?

[Dr. Jennifer Tufts]

Review of symptoms.

[Court Clerk]

Okay, and then it says patient denies sihi. That'd be suicidal ideation. Homicidal ideation, correct?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

Denies are the questions that concerns. And you recommend a low dose of amitriptyline for depression, correct?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

Patient depression agrees with the treatment. And, guys, we're also going to explore ketamine treatment. Ketamine treatment, escape.

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

Now, did you know that she was on her computer looking up medication after medication after medication after medication, treatments, ketamine treatments and all that? Do you know that?

[Dr. Jennifer Tufts]

No.

[Court Clerk]

Did you ever ask her whether or not she was looking up the symptomology of pharmacology and having interactions between drugs?

[Dr. Jennifer Tufts]

No.

[Court Clerk]

January 23rd, you had that meeting, correct? With her?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And this is after, obviously. Excuse me. The January 16th appointment. And in the January 16th appointment, she told you that her mood was very low and that's the worst that she ever reported her mood to you, isn't that right?

[Dr. Jennifer Tufts]

On the 16th?

[Court Clerk]

Yeah.

[Dr. Jennifer Tufts]

I don't know if that was the worst it was ever reported, but it was certainly bad.

[Court Clerk]

You didn't recommend that she had a hospital evaluation, did you? This is the day before she killed the kids, right?

[Dr. Jennifer Tufts]

The 23rd? Yeah, it was the day before.

[Court Clerk]

You didn't recommend a hospital evaluation, did you?

[Dr. Jennifer Tufts]

No. There were.

[Judge William Sullivan]

No.

[Court Clerk]

The answer is no.

[Dr. Jennifer Tufts]

No.

[Court Clerk]

They'll ask you all the questions they want.

[Dr. Jennifer Tufts]

Okay.

[Court Clerk]

Your answer's no. January 23, Brandon testified, and she said her mood was depressed. And you noted that her affect was depressed and flat, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

She also reported that her heart was racing, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

She had no motivation, is what she told you, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

She told you that she had been feeling numb and no emotion for 17 days straight, is what she told you, right?

[Dr. Jennifer Tufts]

I'm not sure about 17 days straight, but that's how she was feeling.

[Court Clerk]

You didn't reach out to her mother and father at that point? They didn't call you, I guess, right?

[Dr. Jennifer Tufts]

No.

[Court Clerk]

And Patrick couldn't call you at that point, right?

[Dr. Jennifer Tufts]

No.

[Court Clerk]

So she's sitting in front of her computer getting help from her doctor on January 23rd, and what did you do?

[Dr. Jennifer Tufts]

Well, I thought about how I could best help her. The medicines that she'd tried and what her current symptoms were. And it made sense to slowly titrate the amitriptyline so that we could get her to a dose that reduced her depression so that she would feel better.

[Court Clerk]

Increased the amitriptyline?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

That pushed her over the edge, didn't it?

[Dr. Jennifer Tufts]

I don't think so.

[Judge William Sullivan]

All right, mention the jury. We're going to take the afternoon recess at this time. All right. Court.

[Assistant District Attorney Jennifer Sprague]

All right,

[Judge William Sullivan]

Council, anything we need to discuss before the break?

[Court Clerk]

No, you, Honor. Thank you.

[Judge William Sullivan]

All right, so we'll be recessed on this matter.

[Court Clerk]

This court's now in session. Please be seated.

[Assistant District Attorney Jennifer Sprague]

Your Honor, for the purpose of the record, we return back to the trial. Commonwealth versus Lindsay Clancy. All parties are present, including the defendant, and including the 18 jurors.

[Judge William Sullivan]

All right, thank you, Madam Clerk. Commonwealth redirect.

[Defense Attorney Kevin Reddington]

Thank you. Good afternoon, Doctor. I apologize for my voice. If you can't hear me, just let me know.

[Dr. Jennifer Tufts]

Okay.

[Defense Attorney Kevin Reddington]

You were asked on cross examination about your residency. At that point, you were already a doctor, correct?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

And during your residency, that was a four year period, correct?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

And you were saying that you treated patients during that time, Is that correct?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

Was there someone with you while you treated these patients, telling you what to do and how to handle them?

[Dr. Jennifer Tufts]

No.

[Defense Attorney Kevin Reddington]

Were you alone responsible for the evaluation, diagnosis and treatment of your patients?

[Dr. Jennifer Tufts]

For the most part. But if I had questions or. Or, you know, needed to talk it through, I had help.

[Defense Attorney Kevin Reddington]

And approximately how many patients did you treat during those four years?

[Dr. Jennifer Tufts]

Thousands.

[Defense Attorney Kevin Reddington]

And those were all psychiatric patients, correct?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

You said approximately 50 of those patients were patients dealing with postpartum depression or some postpartum issues. Is that correct?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

You also said you had some specialized or specific training in that area. Can you describe. Describe that for us?

[Dr. Jennifer Tufts]

Yes. I did a specialized elective with a specifically perinatal psychiatrist where I worked in an obstetric clinic, and I saw patients who were pregnant in postpartum.

[Defense Attorney Kevin Reddington]

And how long was that clinic for?

[Dr. Jennifer Tufts]

It was for about a year.

[Defense Attorney Kevin Reddington]

And so for a year, you were evaluating and diagnosing and treating women with postpartum issues?

[Judge William Sullivan]

Yes.

[Defense Attorney Kevin Reddington]

And that's separate and apart from your residency?

[Dr. Jennifer Tufts]

It's a part of the residency. It's an elective.

[Defense Attorney Kevin Reddington]

So for one year out of the four that was specifically designated to postpartum issues?

[Dr. Jennifer Tufts]

Yes. It wasn't every single day, but it was continuing the same patients for about a year.

[Defense Attorney Kevin Reddington]

So you would follow those same patients throughout the year, is that what you're saying?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

And you were asked about postpartum psychosis and you said it was rare. How rare is it?

[Dr. Jennifer Tufts]

I'm not sure the statistic, but Low?

[Grainger Commercial Announcer]

Low.

[Defense Attorney Kevin Reddington]

Have you dealt with patients in your four years of residency that had other types of psychosis?

[Dr. Jennifer Tufts]

Yes, many.

[Defense Attorney Kevin Reddington]

And psychosis, whether it's from postpartum or some other mental illness, does it Present the same, or does it matter what the underlying illness is?

[Dr. Jennifer Tufts]

I mean, it can present different based on the individual, but it's the same general disorder.

[Defense Attorney Kevin Reddington]

And so what are the symptoms or signs that you look for to determine whether someone has psychosis?

[Dr. Jennifer Tufts]

So you look at them, you assess their appearance. Are they disheveled? And then you look at how cooperative they are, how they're engaging in your interview. Are they answering your questions? Or maybe refusing to answer your questions, maybe being very aggressive. You look at their speech, whether they're speaking very fast, very loud, or the opposite, like maybe not really even speaking much at all. You look at what their thoughts are like, and we assess thoughts by what they're saying. That's how we know what people are thinking and whether what they say makes sense linearly, or whether someone's jumping around and you can't follow them. We also assess the thoughts for their content. If someone is speaking about things that are very bizarre, things that are very paranoid, if someone is talking or making noises, or it seems like they're communicating with somebody that's not in the room, those are all things behaviors that we assess for.

[Defense Attorney Kevin Reddington]

So although you'd never treated someone with postpartum psychosis, you had evaluated, diagnosed, and treated people with other types of psychosis, is that correct?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

Did you see any signs of psychosis in any of your interactions with Lindsey Clancy?

[Dr. Jennifer Tufts]

No.

[Defense Attorney Kevin Reddington]

Defense counsel mentioned that part of your residency was during COVID Did mental health issues just stop during COVID Of course not.

[Dr. Jennifer Tufts]

They often got worse.

[Defense Attorney Kevin Reddington]

And so it's fair to say you still kept busy seeing patients on a daily basis?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

You also mentioned that some of the patients you saw in your residency, it was outpatient care, is that correct?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

Is that similar to the care you were providing to Lindsey Clancy?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

And was that all four years, you were providing outpatient care to psychiatric patients?

[Dr. Jennifer Tufts]

For three of the four.

[Defense Attorney Kevin Reddington]

You were also asked about telehealth. Is telehealth appointments in psychiatric care standard in the industry?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

And how long has that been standard? Since COVID And is it a fairly common and accepted practice at this point?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

Most of the session for a psychiatric session, you're talking to someone, right?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

Does looking at someone through a computer screen somehow inhibit how you hear the answers?

[Dr. Jennifer Tufts]

No, it does not.

[Defense Attorney Kevin Reddington]

Or inhibit the way you ask your questions?

[Dr. Jennifer Tufts]

No.

[Defense Attorney Kevin Reddington]

And defense counsel asked you about not being able to see below the waist, Someone's shaking or moving. But if someone's sitting and they're. They're bouncing, can you see it elsewhere? Can you See other movement?

[Dr. Jennifer Tufts]

Yeah. Sometimes it can reverberate in different parts of the body.

[Defense Attorney Kevin Reddington]

You were also asked about the Edinburgh scale. You said you don't use it, right?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

You said you use the phq9. Why do you use that instead of the Edinburgh scale?

[Dr. Jennifer Tufts]

It's not my choice. That's the practice at Aster.

[Defense Attorney Kevin Reddington]

Of what we use the phq9. What does that look for?

[Dr. Jennifer Tufts]

It assesses various symptoms of depression and postpartum depression.

[Defense Attorney Kevin Reddington]

Are there questions on the PHQ9 that look for the signs and symptoms of postpartum depression?

[Dr. Jennifer Tufts]

Not specifically postpartum depression, but the symptoms of postpartum depression are symptoms of depression that occur during postpartum. It's the same symptoms.

[Defense Attorney Kevin Reddington]

So the PHQ9 is asking the patient questions that would reveal whether or not they might be depressed, but not whether or not they just had a baby?

[Dr. Jennifer Tufts]

Correct.

[Defense Attorney Kevin Reddington]

And then with your interaction with the patient, you're able to know whether or not they are in the postpartum phase?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

And so would it be fair to say that you take the PHQ9 plus the information you learn from the patient, put it together, and come up with a diagnosis?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

When you take a history from a patient, you were asked about taking history from Ms. Clancy, how important is it that the patient give you accurate information?

[Dr. Jennifer Tufts]

That's very important.

[Defense Attorney Kevin Reddington]

And why is that?

[Dr. Jennifer Tufts]

Well, that information is being used to make treatment decisions, and a lot of things can. Can be assessed. You know, the things that I described before. That's very helpful. But we can't see what someone else's thoughts exactly are, so the person does have to tell them to us.

[Defense Attorney Kevin Reddington]

And would you agree that people in the medical field, such as nurses, are acutely aware of the necessity of an accurate medical history and symptom presentation?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

You mentioned that the defendant was able to advocate for herself. In what ways did she show you that?

[Dr. Jennifer Tufts]

In scheduling her own appointments, in presenting herself to the emergency room when things were really not going well, in communicating her concerns to myself and sharing about a lot of detailed information about all of the different medications, doses, times they were tried, what the reactions were, all of that information.

[Defense Attorney Kevin Reddington]

If a patient is clearly advocating for themselves and can communicate in that way, would you typically reach out to family and friends to let them know, hi, I'm her psychiatrist, and I'd like to talk to you about her treatment.

[Dr. Jennifer Tufts]

No. In fact, we don't have HIPAA permission to do that.

[Defense Attorney Kevin Reddington]

Now, you mentioned, or you were asked about therapy. Therapy. In your sessions, do you keep a recording or a transcript of everything you Say, in your therapy sessions?

[Dr. Jennifer Tufts]

No.

[Defense Attorney Kevin Reddington]

Is your therapy conversation or what you say to a patient the same for every patient?

[Dr. Jennifer Tufts]

No.

[Defense Attorney Kevin Reddington]

Is it a script or a conversation?

[Dr. Jennifer Tufts]

It's a conversation.

[Defense Attorney Kevin Reddington]

So depending if I'm your patient and I'm telling you certain things, is your response dependent on what I'm telling you?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

And so when you're providing therapy to someone like Ms. Clancy, is that dependent on what she's telling you and then how she's responding to what you're saying? Basically a conversation?

[Dr. Jennifer Tufts]

Yes. Therapy is a lot of listening.

[Defense Attorney Kevin Reddington]

Would you say it's more important in therapy for the psychiatrist or therapist to talk or listen?

[Dr. Jennifer Tufts]

Listen.

[Defense Attorney Kevin Reddington]

And why is that?

[Dr. Jennifer Tufts]

Because that's how you really understand what a person is feeling.

[Defense Attorney Kevin Reddington]

Now, is it accurate to state that in every one of your sessions with Ms. Clancy, you told her about individual therapy and encouraged her to attend individual therapy.

[Dr. Jennifer Tufts]

That was the treatment recommendation each time? I'm not sure if I explicitly mentioned it each time. Time, but I did, many times.

[Defense Attorney Kevin Reddington]

And you, in fact, wrote it on the work form that we talked about previously on page 104 of the records. It lists, was the patient referred to other healthcare providers for evaluation or treatment? Says yes. If yes, state the nature of such treatments and expected duration of treatment. And it says individual weekly therapy, correct?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

And this is the form that the defendant asked you to fill out, correct?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

And you sent it back to her and the first version she wanted you to make some corrections on, correct?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

But she didn't ask you to change that portion, correct?

[Dr. Jennifer Tufts]

No.

[Defense Attorney Kevin Reddington]

And in fact, on the second version on page 107 of the record, it still says individual weekly therapy recommended. Correct. For follow up?

[Psychiatric Nurse Practitioner Julie Paul]

Yes.

[Defense Attorney Kevin Reddington]

Would it be accurate to state that the defendant only saw Jennifer McAllister twice the entire time that she was with your practice for therapy?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

You were asked about Zoloft being used for general anxiety disorder. Is that a common drug used for general anxiety disorder?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

And why is that?

[Dr. Jennifer Tufts]

Because it's effective and it's safe.

[Defense Attorney Kevin Reddington]

You were also asked about the suicide warning on it, that there is a suicide warning. Is that for all ages?

[Dr. Jennifer Tufts]

No.

[Defense Attorney Kevin Reddington]

What ages or groups is that suicide warning for?

[Dr. Jennifer Tufts]

It's really for children and adolescents. They do say up to 24 years, but it's really children and adolescents.

[Defense Attorney Kevin Reddington]

Would it be accurate to state that the defendant was 32 years old when she saw you?

[Dr. Jennifer Tufts]

That sounds right.

[Defense Attorney Kevin Reddington]

Well, if you want to check the right,

[Dr. Jennifer Tufts]

yes.

[Defense Attorney Kevin Reddington]

Is that correct?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

Okay, so 32 years old is not three to four years older than 24, correct?

[Dr. Jennifer Tufts]

No.

[Defense Attorney Kevin Reddington]

Why didn't you have to titrate the 50 milligrams of Zoloft?

[Dr. Jennifer Tufts]

You mean to stop it?

[Defense Attorney Kevin Reddington]

Yes.

[Dr. Jennifer Tufts]

Because it's still a very low dose, so it can be stopped right away.

[Defense Attorney Kevin Reddington]

So it wasn't necessary?

[Dr. Jennifer Tufts]

Not necessary.

[Defense Attorney Kevin Reddington]

The defendant waited about a month after receiving the prescription before taking the medication, correct?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

And she only took the medication when she decided she was ready to take it, correct?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

So she was taking in the information you gave her, correct?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

She was making her own decisions, correct?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

She was not forced to. Correct?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

She actually had an appointment in between when you first prescribed it and when she started taking it, where she was still discussing with you whether or not she wanted to take it.

[Dr. Jennifer Tufts]

Is that correct? Yes.

[Defense Attorney Kevin Reddington]

Is that part of the advocating for herself that you were talking about?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

Is that part of the medical sophistication that she possessed that you were talking about?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

Your Honor, at some point, in light of the fact this is direct, I have to object.

[Judge William Sullivan]

Sure, yeah. If you could just not ask the leading question.

[Dr. Jennifer Tufts]

Sure.

[Defense Attorney Kevin Reddington]

I want to direct your attention to the September 12, 2022, form that the defendant filled out on page 16 of the record. We have different page numbers.

[Dr. Jennifer Tufts]

We do, but if you just tell me what you're looking at, I can find out it.

[Defense Attorney Kevin Reddington]

The past psychiatric history.

[Dr. Jennifer Tufts]

Okay.

[Defense Attorney Kevin Reddington]

What did she tell you? Ms. Clancy, tell you about the. Where it says if? Yes. List the reason and dates. What did she tell you?

[Dr. Jennifer Tufts]

She said anxiety, September 2013 to September 2014. Postpartum, anxiety, May 2020.

[Defense Attorney Kevin Reddington]

And on the phone following page, under the past or current psychiatric medications, which ones did she list?

[Dr. Jennifer Tufts]

Prozac, 50 milligrams and Wellbutrin, 100 milligrams.

[Defense Attorney Kevin Reddington]

Is there a column there that says effective yes or no?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

What was the defendant's answer with whether or not Prozac was effective?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

What was her answer as to whether or not Wellbutrin was effective?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

Is there another column there that said experience side effects?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

Did she check off any side effects experienced for Prozac?

[Dr. Jennifer Tufts]

No.

[Defense Attorney Kevin Reddington]

Did she check off any side effects experienced for Wellbutrin?

[Dr. Jennifer Tufts]

No.

[Defense Attorney Kevin Reddington]

Going to the October 20, 2022 appointment, you were asked about this on cross examination about documenting side effects. In your notes, did you document the side effects that the defendant reported from the Zoloft on October 20, 2022?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

And what did you document?

[Dr. Jennifer Tufts]

Well, I checked the box for gi, but I also talked about the side effects in the interval history.

[Defense Attorney Kevin Reddington]

And so what does GI mean?

[Dr. Jennifer Tufts]

Gastrointestinal.

[Defense Attorney Kevin Reddington]

So that means stomach issues.

[Dr. Jennifer Tufts]

Yeah.

[Defense Attorney Kevin Reddington]

And what did you put in your notes?

[Dr. Jennifer Tufts]

Couldn't sleep. Insomnia. Worse on increased dose. Doesn't want to eat. Diarrhea. Food really unappealing. Was more depressed on it. Crying all day yesterday. Not normal mental fog. Terrified to start something new.

[Defense Attorney Kevin Reddington]

And so you did document the side effects that she reported to you, correct?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

You also documented in the interval history, paranoid of getting suicidal thoughts. Was that the defendant's phrasing?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

And is there a difference between someone being worried about having suicidal thoughts and someone actually having suicidal thoughts?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

And what's the difference in terms of. Of how a psychiatrist sees it?

[Dr. Jennifer Tufts]

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

[Defense Attorney Kevin Reddington]

What's the difference in your training and experience between someone having fears of suicidal thoughts and actually having suicidal thoughts?

[Dr. Jennifer Tufts]

Well, so if it's. If it's a fear, then it means that they're not actually having suicidal thoughts. It's a negative.

[Defense Attorney Kevin Reddington]

And does that affect the way you proceed with treatment?

[Dr. Jennifer Tufts]

Yes, in some ways, yes.

[Judge William Sullivan]

How?

[Dr. Jennifer Tufts]

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.

[Defense Attorney Kevin Reddington]

And so, according to the defendant, she was not yet having suicidal thoughts at that time?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

So when defense counsel asked you repeatedly why you didn't document how many times she had those thoughts, she hadn't had those actual thoughts yet, correct?

[Dr. Jennifer Tufts]

Correct.

[Defense Attorney Kevin Reddington]

That was later in December, is that right?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

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?

[Dr. Jennifer Tufts]

Well, she arranged for her mother to stay day. I'm not sure if that was because she was afraid something bad was happening or it just seemed like they needed more help.

[Defense Attorney Kevin Reddington]

Okay, so you. You don't recall the two being together as a thought.

[Dr. Jennifer Tufts]

Correct.

[Defense Attorney Kevin Reddington]

And the fact that she was struggling and arranged to have her mother stay, got support, advocated for herself, would those be protective factors?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

How so?

[Dr. Jennifer Tufts]

So if someone demonstrates 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 serious safety concerns were to arise.

[Defense Attorney Kevin Reddington]

So based on your training experience with Ms. Clancy, where she says she's worried about getting suicidal thoughts and she has her mom come stay with her. Do you see that as a positive decision?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

You were asked about not asking the defendant if she had called the suicide hotline. If a patient denies suicide, suicidal ideation, would you typically ask them if they had called a suicide hotline?

[Dr. Jennifer Tufts]

No.

[Defense Attorney Kevin Reddington]

And why not?

[Dr. Jennifer Tufts]

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.

[Defense Attorney Kevin Reddington]

You were asked about prescribing hydroxyzine, Ativan, and bus bar. Did you tell the defendant how to take those medications?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

What were your instructions?

[Dr. Jennifer Tufts]

So the Ativan was to take as needed for severe anxiety. The buspar was to be an everyday medicine. And the hydroxyzine? We had started that to see if she could use that as an alternative to the Ativan. So to take it instead of the Ativan. But if the Ativan wasn't. Or, sorry, if the hydroxyzine wasn't working, she still had the Ativan to use, which is. It's stronger.

[Defense Attorney Kevin Reddington]

So there was never. Was there ever an instruction for her to take all three at the same time?

[Dr. Jennifer Tufts]

No.

[Defense Attorney Kevin Reddington]

And you were asked about the contraindications of Ativan and Benadryl. Do you recall that?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

What are there contraindications for taking the two together?

[Dr. Jennifer Tufts]

It's not an absolute contraindication. You have to be careful that the person is not excessively sedated, meaning they're so sleepy that it's hard for them to engage in normal activities because they're so sleepy. Or maybe they might feel a little bit dizzy. But it's not an absolute contraindication. You just have to monitor them.

[Defense Attorney Kevin Reddington]

And is that one of the reasons that you prescribe the hydroxyzine?

[Dr. Jennifer Tufts]

Sorry, is what? One of the reasons is the.

[Defense Attorney Kevin Reddington]

The fact that the two of them together, Ativan and Benadryl. Well, let me strike that question. Why did you prescribe the hydroxyzine?

[Dr. Jennifer Tufts]

So she had been taking Benadryl, which is not a prescription medication. It's not. Not classically within the scope of psychiatry, but it's very similar to hydroxyzine. So I thought that hydroxyzine might be a better alternative than the Benadryl.

[Defense Attorney Kevin Reddington]

Okay. And I'm just going to direct you to your November 2, 2022, interval history. Now, would it be fair to say that on the November 2nd date, the defendant reported she was fine all day? Evenings, bedtime, get anxious. Ativan helps. Sleeping great on it. Afraid to try something else, but knows it's not a long term solution, is that correct?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

And what part of that did the defendant tell you was not a long term solution?

[Dr. Jennifer Tufts]

Taking the Ativan.

[Defense Attorney Kevin Reddington]

And why is that?

[Dr. Jennifer Tufts]

Because it was indicated for short term use only. The people can struggle more with dependence if they're taking it for a very long period. Period of time.

[Defense Attorney Kevin Reddington]

And was there a plan developed based on that concern?

[Dr. Jennifer Tufts]

Yes, there was.

[Defense Attorney Kevin Reddington]

What was the plan?

[Dr. Jennifer Tufts]

To reduce the dose by 0.25 milligrams every two weeks until she was off it.

[Defense Attorney Kevin Reddington]

So the defendant was able to express to you a concern she had about the medication. You had a conversation about it and you addressed that with her and came up with a plan, is that right?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

She also told you that day that she was in therapy and exercising daily, correct?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

Did the defendant ever tell you that she went to the South Shore Hospital emergency department on November 16, 2022?

[Dr. Jennifer Tufts]

I don't recall that.

[Defense Attorney Kevin Reddington]

Did she tell you that they had prescribed Trazodone to her at that time?

[Dr. Jennifer Tufts]

I don't recall that.

[Defense Attorney Kevin Reddington]

Did she ever tell you that she was trying some alternative methods, like weed gummies?

[Dr. Jennifer Tufts]

No.

[Defense Attorney Kevin Reddington]

Do you have any way of knowing these things if the patient doesn't tell you?

[Dr. Jennifer Tufts]

No.

[Defense Attorney Kevin Reddington]

Now, on December 1, 2022, 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?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

Up until that point, had she consistently denied suicidal ideation or intent or a plan?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

Had she consistently denied homicidal ideation, intent or a plan?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

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?

[Dr. Jennifer Tufts]

Not usually. Not in that way.

[Defense Attorney Kevin Reddington]

How do you get that information from them? What types of questions do you ask?

[Dr. Jennifer Tufts]

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.

[Defense Attorney Kevin Reddington]

And is there a difference between having thoughts of suicide versus having the intent and a plan to do it?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

And are there different types of. Of treatment or things that you would do? If. So if someone has intent or plan to do it?

[Dr. Jennifer Tufts]

Yes. That would generally require hospitalization.

[Defense Attorney Kevin Reddington]

And so if Ms. Clancy had told you she had thoughts of hurting herself or actually straight that if she told you that she had A plan to hurt herself or a plan to hurt her children. Would you have moved to commit her?

[Assistant District Attorney Jennifer Sprague]

Yes.

[Defense Attorney Kevin Reddington]

And that would be a Section 12?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

You were asked about the October 31st therapy session with Jennifer McAllister. And I know you weren't present from that. You're just going from the records, but you did say that in that session the defendant denied suicidal ideation and homicidal ideation, correct?

[Dr. Jennifer Tufts]

Yeah, that's what's documented.

[Defense Attorney Kevin Reddington]

Would there be any reason, based on your training experience, to do that, further suicidal ideation, intent assessment?

[Dr. Jennifer Tufts]

No.

[Defense Attorney Kevin Reddington]

Why not?

[Dr. Jennifer Tufts]

Because if someone is denying suicidal ideation, they're just going to deny the every other detail about suicide.

[Defense Attorney Kevin Reddington]

That further evaluation is that very specific questions about planning for suicide, how you do it, all of those things?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

You were also asked about evaluating the defendant for bipolar, and you said that she, based on your conversations with her, there were no signs of mania, correct?

[Dr. Jennifer Tufts]

Correct.

[Defense Attorney Kevin Reddington]

What are the types of questions you ask a patient to determine if they've experienced an episode of mania?

[Dr. Jennifer Tufts]

Well, a lot of it is what I can see in the session. I might also ask about some of those symptoms, like decreased need for sleep or racing thoughts or increased risk taking activities. But even if they're reporting those things, I would. I would have to really see it for myself to diagnose that.

[Defense Attorney Kevin Reddington]

And what, what would you see physically?

[Dr. Jennifer Tufts]

So I might see that the person is talking very fast and it's almost impossible to interrupt their rate of speech. And it might also be very loud. They might be hyperactive, not able to sit still. They might be yelling and jumping from one thought to another without any linear connection between the thoughts. They might. Yeah, I guess that's probably what I would. What I would observe in terms of behaviors.

[Defense Attorney Kevin Reddington]

Did you observe any of those behaviors with Lindsey Clancy?

[Dr. Jennifer Tufts]

No, it was the opposite.

[Defense Attorney Kevin Reddington]

What do you mean, it was the opposite?

[Dr. Jennifer Tufts]

So you know, the opposite of euphoria is dysphoria or depression. The opposite of hyperactivity is tiredness and fatigue. So, you know, in a way, it was the opposite of mania that I observed.

[Defense Attorney Kevin Reddington]

And in terms of the questions you asked about her past behavior, were any of the answers that she gave indicative of mania?

[Dr. Jennifer Tufts]

No.

[Defense Attorney Kevin Reddington]

You were asked about discussing seroquel with the defendant, even though you weren't the prescriber. Why did you discuss that medication with her?

[Dr. Jennifer Tufts]

Because the patient was asking about it and her husband was also asking me about it. They really wanted my opinions about. Wasn't necessarily that I was prompting this line of conversation.

[Defense Attorney Kevin Reddington]

And what did you tell them about it?

[Dr. Jennifer Tufts]

Well, I shared that it has very good evidence for treating depression. And I may have shared that Seroquel does different things at different doses. Right. So sometimes people are concerned that it is called an antipsychotic, but it actually doesn't function as an antipsychotic until you get up to really high doses, like 800 milligrams. So in low doses, it's more of a sleep medicine or an antidepressant. So I. I think that I explained that to them, and it's obviously a very important part of it, but they were also concerned about that causing the depression that she was experiencing. So we talked a bit about how you would tell. You know, it kind of can be. It can be hard to tell whether a medicine is causing that or it's just occurring because of depression.

[Defense Attorney Kevin Reddington]

What did you tell them in terms of how to tell that?

[Dr. Jennifer Tufts]

It's really based on the timing. If you were to notice a significant decline after starting or increasing the medication

[Defense Attorney Kevin Reddington]

and prior to Ms. Clancy taking the Seroquel, had you noticed signs of depression in her?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

And after she was off of the Seroquel in January, did you see signs of depression in her?

[Judge William Sullivan]

Yes.

[Defense Attorney Kevin Reddington]

So that was completely off, hysterical, both before and after, still showing signs of depression?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

During January, the defendant told you she. She had trouble getting out of bed.

[Dr. Jennifer Tufts]

Is there a specific visit?

[Defense Attorney Kevin Reddington]

I think it was right after the. She got out of the hospital. Maybe your first or second visit with her.

[Dr. Jennifer Tufts]

I see that on the 16th, she did say that she was able to force herself out of bed and take care of basics, so on and so forth.

[Defense Attorney Kevin Reddington]

Were you aware that she had gone to the Museum of Science with her family on January 8th and spent a few hours there interacting with the exhibits and the children?

[Dr. Jennifer Tufts]

No.

[Defense Attorney Kevin Reddington]

Were you aware on January 15, the day before that session, she had been to the Cape Codder down in Hyannis with the family, interacting with the kids and going down little water slides and all of that?

[Dr. Jennifer Tufts]

No.

[Defense Attorney Kevin Reddington]

Were you aware that on January 14th she watched all three kids while Pat went to a brunch and was fine?

[Dr. Jennifer Tufts]

No.

[Defense Attorney Kevin Reddington]

Were you aware that on January 16th her husband took Cora skiing and she was alone with the boys all day and had no issues?

[Dr. Jennifer Tufts]

No.

[Defense Attorney Kevin Reddington]

You were asked about the thyroid and how that can affect mental health and postpartum. Were you aware that at both South Shore Hospital and Brigham and Women's Hospital, her thyroid limits were in normal range?

[Dr. Jennifer Tufts]

No, I was not.

[Defense Attorney Kevin Reddington]

You received a discharge from summary from McLean Hospital?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

What's contained in the discharge summary?

[Dr. Jennifer Tufts]

So it includes information about how the patient initially presented, what they said when they first came to the hospital, and their initial assessment from the psychiatrist that they spoke with. It talks a bit about their course, their treatment course, how things progressed, any changes that were made. And then it talks about how the patient appears on the day of distress.

[Defense Attorney Kevin Reddington]

Does it also include what medications they were prescribed and what the diagnosis might have been?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

And was that sufficient in terms of your review of the information that you needed to know about your patient at that time?

[Dr. Jennifer Tufts]

Yes, that was a very helpful amount of information that I would typically review that amount of information for a patient after the hospital.

[Defense Attorney Kevin Reddington]

Now, you were asked about your January 23, 2023, session with the defendant. Defense counsel asked if you had, you know, recommended a hospital evaluation for her on that day, and you said no. Why not?

[Dr. Jennifer Tufts]

Because she was completely denying any suicidal ideation or homicidal ideation. There were no signs of psychosis or mania. So there were no serious signs that her safety or that anyone else's safety was at risk.

[Defense Attorney Kevin Reddington]

And during that session, did she ever tell you that she planned to harm herself or the children?

[Dr. Jennifer Tufts]

No.

[Defense Attorney Kevin Reddington]

If she had done that, what would you have done?

[Dr. Jennifer Tufts]

I would have. It depends exactly how it would have played out. You know, it would definitely include hospitalization if the children were in immediate harm. It might include enlisting help from my staff so that they could call the police while I'm on the phone with her. You know, I think it. It depends, but I would. I would address it promptly.

[Defense Attorney Kevin Reddington]

You were asked by defense counsel about the amitriptyline that you prescribed on January 16, 2023. That initial prescription was for 10 milligrams, correct?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

Would you agree with me that this shows that the prescription was filled on that same day, January 16, 2023?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

And out of this pill bottle here, there were 30 pills in this prescription, correct?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

And there are only eight. There are eight pills missing from this bottle. So filled on January 16th, 16th, 17th, 18th, 19th, 20th, 21st, 22nd, 23rd would be eight days. Correct. And on the 23rd is when you said she could raise it to 20 milligrams?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

So if there are only eight pills missing, she never took that additional dose. Correct?

[Dr. Jennifer Tufts]

That's what I would think based on what you just said.

[Defense Attorney Kevin Reddington]

So the amitriptyline, increasing it from 10 milligrams to 20 milligrams wouldn't have pushed her over the edge. Correct.

[Dr. Jennifer Tufts]

Well, if she didn't take 20 milligrams, then that's correct.

[Defense Attorney Kevin Reddington]

I have nothing further. Thank you.

[Judge William Sullivan]

Can we cross Briefly.

[Court Clerk]

So one of the questions that prosecutor asked you pertained to whether or not you could reach out to a third party. You recall that question? Like mother, father, husband?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And we already on cross talked about that. You didn't, and they didn't call you, but then the DA also raised that, and you said you didn't have HIPAA permission. Recall just telling that to the jury?

[Dr. Jennifer Tufts]

Yes, that was an additional detail.

[Court Clerk]

All right, what does that mean?

[Dr. Jennifer Tufts]

Well, hipaa, you is the privacy law for patients, which we have to respect and honor very diligently. So we are not allowed to talk about a patient's treatment to anyone. We're not even allowed to say that they are a patient at our clinic unless they were to waive those HIPAA rights.

[Court Clerk]

And she was. Was very cooperative, would have been more than willing to have you talk to her mother, father, and her husband, right?

[Defense Attorney Kevin Reddington]

Objection.

[Judge William Sullivan]

Sustained.

[Court Clerk]

Well, did you ever tell her, ask her to sign a HIPAA form?

[Dr. Jennifer Tufts]

So that was not the main reason why it wasn't done. It wasn't. A release, you mean? Yes. No, I did not ask her to sign a release.

[Court Clerk]

And if she did sign the release, even though her mother, her father, her husband didn't call you, you could have then reached out to them, right?

[Dr. Jennifer Tufts]

I could have, but it is not typically something that is done when you have an adult patient who's able to speak for themselves.

[Court Clerk]

What is that? It's not typically done when.

[Dr. Jennifer Tufts]

When you have an adult patient who is able to speak for themselves.

[Court Clerk]

My God. You don't call the parents that she's living with because they're helping her or her husband?

[Dr. Jennifer Tufts]

No.

[Court Clerk]

Because why she's able to advocate for herself.

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

Prosecutor, yet again raises the issue of the. The marijuana. You recall that question?

[Assistant District Attorney Jennifer Sprague]

Yes.

[Court Clerk]

She wasn't smoking marijuana, was she?

[Dr. Jennifer Tufts]

She did not tell me she was smoking marijuana.

[Court Clerk]

Did she tell you that she was using marijuana?

[Dr. Jennifer Tufts]

No.

[Court Clerk]

Did she tell you that she was using gummies?

[Dr. Jennifer Tufts]

No.

[Court Clerk]

Did she? Because gummies in plural is what the DA asked you, right? That she was using gummies?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

Now, I asked you about getting access to the Woman and Infants hospital records. Which you did not. Which you did not, right?

[Dr. Jennifer Tufts]

I did not.

[Court Clerk]

And we already went over that. You could have if you. If you asked for them with a hippophone, right?

[Defense Attorney Kevin Reddington]

Objection. Didn't ask about those records.

[Court Clerk]

I don't care if she asked about the record.

[Judge William Sullivan]

Overruled. You can ask that question.

[Court Clerk]

Yeah. She asked you about marijuana gummies, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

Okay. Your Honor, I would offer the Women and Infants hospital records from Rhode island dealing with Lindsey Clancy.

[Defense Attorney Kevin Reddington]

No objection.

[Judge William Sullivan]

Okay. They may be admitted.

[Defense Attorney Kevin Reddington]

I just want to look at them at some point to make sure it's a clean copy.

[Court Clerk]

And it's important for a. It's important for a patient to be forthright when asked questions by their provider, right?

[Grainger Commercial Announcer]

Yes.

[Court Clerk]

And you always. Your opinion found her to be forthright, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

If you. If I could approach you with exhibit 220. Excuse me. And see the second paragraph. It begins in the middle of November. Could you read that?

[Dr. Jennifer Tufts]

In the middle of November, she tried taking a marijuana edible to help her sleep, which caused her to have increased anxiety and palpitations.

[Court Clerk]

So the records, if you had obtained them, you would have seen that it was not marijuana. It was not gummies, plural. It was one gummy that. That she tried and it didn't work out, Right?

[Dr. Jennifer Tufts]

Based on what I just read, yes.

[Court Clerk]

Then you told us that there's a difference between a thought of suicide versus a plan of suicide, one of which would result, in your words, were a commit a commitment, right?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

What does that mean? Thought versus plan equals commitment.

[Dr. Jennifer Tufts]

A suicidal plan means that they are, you know, they know exactly what they're going to do to end their life. You know, what they're going to use, maybe when they're going to do it, they've researched it, and that presents an immediate threat. And that is something that would require hospitalization.

[Court Clerk]

District attorney had asked you also about the thyroid levels, and you indicated or she indicated that they were in the low range at Mass General Hospital. Reid, is that correct?

[Dr. Jennifer Tufts]

I thought she said they were normal.

[Court Clerk]

Oh, I thought she said low, but normal or low mgh, Mass General Hospital. Right.

[Dr. Jennifer Tufts]

Sorry. What's the question?

[Court Clerk]

District attorney asked you whether or not they were thyroid read. Do you remember that question?

[Dr. Jennifer Tufts]

She said her thyroid had been tested. Yes.

[Court Clerk]

Okay. And your response was that my memory juror's accounts that it was low reads MGH and South Shore Hospital, is that right?

[Dr. Jennifer Tufts]

I. I thought she said that it was normal or within normal limits?

[Defense Attorney Kevin Reddington]

Almost.

[Court Clerk]

Fine, we'll go with normal. So your memory is that there were thyroid blood level reads of Lindsey Clancy from two healthcare providers, is that correct?

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

One would be Mass General Hospital, right?

[Dr. Jennifer Tufts]

I don't remember exactly. I think she said. Yes, I think she said Mass General.

[Court Clerk]

Okay. Do you remember where the other hospital healthcare provider was?

[Dr. Jennifer Tufts]

It might have been South Shore.

[Court Clerk]

Do you know what date those were?

[Dr. Jennifer Tufts]

No.

[Court Clerk]

Those are old reads, weren't they?

[Dr. Jennifer Tufts]

I don't know.

[Court Clerk]

One of the things that the district attorney asked you about on a number of occasions that seems to be important is if the person that you're treating has, I guess, what do they call it? Pressured speech.

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And you've told us repeatedly that you never detected that Lindsey had pressured speech. Right.

[Dr. Jennifer Tufts]

Correct.

[Court Clerk]

I'm sorry.

[Dr. Jennifer Tufts]

Correct.

[Court Clerk]

Looking at the record from October 21st, would you.

[Defense Attorney Kevin Reddington]

Objection. Is writing on this.

[Judge William Sullivan]

I'll ask you to take a look at. And if you want to get the actual exhibit, we could do that.

[Court Clerk]

All right. So forget all about my sloppy writing. I'm looking here on October 21st of 22. Is that correct? Right up there?

[Judge William Sullivan]

Yes.

[Court Clerk]

Okay.

[Dr. Jennifer Tufts]

Yes.

[Court Clerk]

And can you just read this paragraph here for us?

[Dr. Jennifer Tufts]

No.

[Court Clerk]

Sorry.

[Dr. Jennifer Tufts]

No sleep last night. Falls asleep after 40 minutes. Heart racing, severe anxiety, worrying about kids, baby sleep, sleep, yawns, but not drowsy. Not hyper. Pressured speech.

[Court Clerk]

What was that?

[Dr. Jennifer Tufts]

Not hyper, not pressured speech is what I meant. I know it doesn't say not, but that is exactly what I meant. I don't care what it says. I know what I meant.

[Court Clerk]

Well, when you wrote this, you did not say not pressured speech. You said in the medical record, pressured speech speech, Right?

[Dr. Jennifer Tufts]

No.

[Court Clerk]

Does it say that?

[Dr. Jennifer Tufts]

Yeah. The word is. The word not is right before. Not hyper, comma, pressured speech. The two are following the knot to

[Court Clerk]

you when you put down in a medical record, heart racing, comma, severe anxiety, comma, worried about kids, comma, baby, comma, sleep, comma, yawns, but not drowsy, period. Not hyper, comma, pressured speech. That's what you wrote, right?

[Dr. Jennifer Tufts]

She did not have pressured speech. Doctor, I wrote that. But you're misinterpreting my note.

[Court Clerk]

Am I reading this correctly? And the jury will be able to look at it that you put not hyper, comma, pressured speech. Did you. Did I read that right?

[Dr. Jennifer Tufts]

Yes, but your interpretation is incorrect.

[Court Clerk]

As opposed to yours, all they have

[Judge William Sullivan]

just in regards to what was raised there.

[Defense Attorney Kevin Reddington]

Yes. Just two brief issues approaching you with your records from October 21, 2022. The section labeled speech, where there are all the boxes where you can put pressured word salad, all of the different things. What do you check off for speech on October 21, 2022?

[Dr. Jennifer Tufts]

Appropriate.

[Defense Attorney Kevin Reddington]

And defense asked you about the thyroid levels. Was it. Would it be accurate to state that? I asked you if you were aware that her levels were normal at Selchill Hospital and Brigham and Women's Hospital?

[Dr. Jennifer Tufts]

Yes.

[Defense Attorney Kevin Reddington]

And your answer was no, correct?

[Dr. Jennifer Tufts]

No, I was not aware.

[Defense Attorney Kevin Reddington]

Because you don't have those records, Correct?

[Dr. Jennifer Tufts]

Correct.

[Defense Attorney Kevin Reddington]

Thank you.

[Judge William Sullivan]

All right.

[Court Clerk]

Do we have any clue as to how old they were?

[Dr. Jennifer Tufts]

I don't know. You're asking me about something I never saw.

[Court Clerk]

All right. Nothing further.

[Judge William Sullivan]

All right. Anything further.

[Assistant District Attorney Jennifer Sprague]

All right.

[Judge William Sullivan]

Thank you, doctor. Let me step down.

[Assistant District Attorney Jennifer Sprague]

Thank you.

[Defense Attorney Kevin Reddington]

The commonwealth would move to submit the certified copy of the Spalding Rehabilitation records for.

[Court Clerk]

No objection. That's by agreement.

[Judge William Sullivan]

Okay. Agreement of council. The Spalding records will be introduced. Please. Council.

[Assistant District Attorney Jennifer Sprague]

Julie Paul.

[Court Clerk]

All right.

[Judge William Sullivan]

Good afternoon.

[Psychiatric Nurse Practitioner Julie Paul]

Good afternoon. All right.

[Court Clerk]

Yes.

[Judge William Sullivan]

Attorney Buckham, please.

[Assistant District Attorney Jennifer Sprague]

Thank you. Good afternoon.

[Psychiatric Nurse Practitioner Julie Paul]

Good afternoon.

[Assistant District Attorney Jennifer Sprague]

Could you please tell the jury your first and last name?

[Psychiatric Nurse Practitioner Julie Paul]

Julie Paul.

[Assistant District Attorney Jennifer Sprague]

And what do you do for work?

[Psychiatric Nurse Practitioner Julie Paul]

I am a psychiatric mental health nurse practitioner. Board certified.

[Assistant District Attorney Jennifer Sprague]

And can you tell us a little bit about your educational background?

[Psychiatric Nurse Practitioner Julie Paul]

Sure. I graduated in 1991 from St. Anselm College with my nursing degree. Worked as a labor delivery nurse for 17 years and then graduated in 2006 from Frontier Nursing University with my midwifery degree. And then in 2018, I graduated from Frontier Nursing University with my psychiatric nurse practitioner degree. I also have a perinatal mental health certification from Postpartum Support International from 2018.

[Assistant District Attorney Jennifer Sprague]

Okay. Are you also a certified midwife?

[Psychiatric Nurse Practitioner Julie Paul]

Yes, I am.

[Assistant District Attorney Jennifer Sprague]

And are you licensed in the state of Massachusetts to be a psychiatric nurse practitioner?

[Psychiatric Nurse Practitioner Julie Paul]

Yes, I am.

[Assistant District Attorney Jennifer Sprague]

And what is required in order for you to become certified to. To be a psychiatric nurse practitioner in Massachusetts?

[Psychiatric Nurse Practitioner Julie Paul]

I attended a certified program, did two years additional training, and then took the certification exam through the ancc.

[Assistant District Attorney Jennifer Sprague]

And can you tell us a little bit about your work history, your work background?

[Psychiatric Nurse Practitioner Julie Paul]

Sure. Like I said, in New Hampshire, I worked as a labor and delivery nurse before transferring to Massachusetts in 2006 to work as a certified nurse midwife. And then in 2018, I started the perinatal behavioral health program at Selshire Hospital as a psychiatric nurse practitioner.

[Assistant District Attorney Jennifer Sprague]

And so the perinatal behavioral health clinic. Explain to us a little bit about how that came about.

[Psychiatric Nurse Practitioner Julie Paul]

Sure. There's a lack of resources on the South Shore for perinatal for pregnant postpartum people with mood disorders. So I really felt compelled because I had a couple clients that really struggled with mental health issues as a nurse midwife and really wanted additional education and being able to prescribe for them. So. And take care of them in a proper way. So I went back, got my psyc NP and then worked with South Shore Hospital to establish the program.

[Assistant District Attorney Jennifer Sprague]

And where was the program actually located?

[Psychiatric Nurse Practitioner Julie Paul]

It was located right in Weymouth, Massachusetts.

[Assistant District Attorney Jennifer Sprague]

And you said you worked with the South Shore Hospital?

[Psychiatric Nurse Practitioner Julie Paul]

Correct.

[Assistant District Attorney Jennifer Sprague]

So the clinic is tied to South Shore Hospital in the South Shore, our health system?

[Psychiatric Nurse Practitioner Julie Paul]

Yes, it is.

[Assistant District Attorney Jennifer Sprague]

Now, when did you start that program? Specifically, when was it up and running?

[Psychiatric Nurse Practitioner Julie Paul]

2018 is when I started in October of 2018.

[Assistant District Attorney Jennifer Sprague]

And what, did you do that by yourself, or did you have other practitioners that were doing that with you?

[Psychiatric Nurse Practitioner Julie Paul]

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.

[Assistant District Attorney Jennifer Sprague]

And what makes up this program? Program other than you?

[Psychiatric Nurse Practitioner Julie Paul]

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 in the team, two additional 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.

[Assistant District Attorney Jennifer Sprague]

And what's the Bridge Clinic?

[Psychiatric Nurse Practitioner Julie Paul]

The Bridge Clinic works with people with substance use disorders.

[Assistant District Attorney Jennifer Sprague]

And all of this is kind of under that umbrella of what's classified as South Shore Behavioral Health, correct?

[Psychiatric Nurse Practitioner Julie Paul]

That's correct.

[Assistant District Attorney Jennifer Sprague]

Now, as the clinic grew, did your role there change?

[Psychiatric Nurse Practitioner Julie Paul]

I'm sorry, can you repeat that?

[Assistant District Attorney Jennifer Sprague]

As the clinic grew to what you described as having additional therapists and other prescribers on staff, did your role there change at all?

[Psychiatric Nurse Practitioner Julie Paul]

I became the director of the program.

[Assistant District Attorney Jennifer Sprague]

And as director of the program, did you still see patients?

[Psychiatric Nurse Practitioner Julie Paul]

Yes, I did.

[Assistant District Attorney Jennifer Sprague]

And was that at the same level as it had before, or did it decrease because of your administrative roles?

[Psychiatric Nurse Practitioner Julie Paul]

It actually increased because I increased my hours to five days a week. I did have a little bit of administrative time.

[Assistant District Attorney Jennifer Sprague]

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?

[Psychiatric Nurse Practitioner Julie Paul]

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. 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 Aspire, but part of our program, embedded within our program. And I brought in two additional prescribers as well as nursing staff.

[Assistant District Attorney Jennifer Sprague]

And when you talk about people as prescribers and your role as a psychiatric nurse practitioner who could prescribe, what were you offering to patients as part of this clinical clinic?

[Psychiatric Nurse Practitioner Julie Paul]

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.

[Assistant District Attorney Jennifer Sprague]

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 to address all these resources for patients?

[Psychiatric Nurse Practitioner Julie Paul]

That's correct.

[Assistant District Attorney Jennifer Sprague]

So while you, as the psychiatric nurse practitioner, might have been a prescriber, were you also engaged in the therapy or psychotherapy?

[Psychiatric Nurse Practitioner Julie Paul]

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.

[Assistant District Attorney Jennifer Sprague]

And so being that you had a history of working as a midwife and working as a nurse in labor and delivery, do you have a lot of experience with moms or women who are in that postpartum period?

[Psychiatric Nurse Practitioner Julie Paul]

Yes.

[Assistant District Attorney Jennifer Sprague]

And how about your experiences with diagnosing and prescribing for women in that period? Do you have experience in that, in

[Psychiatric Nurse Practitioner Julie Paul]

the labor and delivery realm as a nurse, midwife? Yes. I diagnosed, like, labor and that sort of thing, and even depression, anxiety, not to the extent of higher acuity psychiatric conditions, but as a psychiatric nurse practitioner, I did.

[Assistant District Attorney Jennifer Sprague]

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?

[Psychiatric Nurse Practitioner Julie Paul]

Correct.

[Assistant District Attorney Jennifer Sprague]

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?

[Psychiatric Nurse Practitioner Julie Paul]

Correct.

[Assistant District Attorney Jennifer Sprague]

And so what encompasses a treatment plan generally?

[Psychiatric Nurse Practitioner Julie Paul]

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 major in our own disciplines.

[Assistant District Attorney Jennifer Sprague]

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 encompassing with the social workers that you work with at the clinic?

[Psychiatric Nurse Practitioner Julie Paul]

Our social workers primarily did cognitive behavioral therapy. We did group therapy for more social support. What I did mainly was just supportive therapy.

[Assistant District Attorney Jennifer Sprague]

Okay. And would you oftentimes, through the clinic, refer clients out to other local community providers?

[Psychiatric Nurse Practitioner Julie Paul]

Yes, we would.

[Assistant District Attorney Jennifer Sprague]

Now, as the psychiatric nurse practitioner, does medication play an important role when you are dealing with a particular patient that came into the. The clinic?

[Psychiatric Nurse Practitioner Julie Paul]

Yes, it does play a role.

[Assistant District Attorney Jennifer Sprague]

And how is it that you determine what's the appropriate medication track for any given patient?

[Psychiatric Nurse Practitioner Julie Paul]

We do proper screening, and then we do 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.

[Assistant District Attorney Jennifer Sprague]

When you say work as a team, does that include the patient themselves?

[Psychiatric Nurse Practitioner Julie Paul]

Absolutely. The patient is the most important part of the team Team.

[Assistant District Attorney Jennifer Sprague]

And in your training and experience working with postpartum women, what is the acceptable period for to determine postpartum?

[Psychiatric Nurse Practitioner Julie Paul]

Anywhere within the first year.

[Assistant District Attorney Jennifer Sprague]

Did you know a nurse or do you know a nurse named Susan Clancy?

[Psychiatric Nurse Practitioner Julie Paul]

I do.

[Assistant District Attorney Jennifer Sprague]

How do you know her?

[Psychiatric Nurse Practitioner Julie Paul]

I worked with her off and on throughout my years as a nurse midwife.

[Assistant District Attorney Jennifer Sprague]

And what's the nature of your relationship with her other than the working with her?

[Psychiatric Nurse Practitioner Julie Paul]

Essentially, we just worked together. We worked when we did births together, we worked well as a team.

[Assistant District Attorney Jennifer Sprague]

And do you know where she worked?

[Psychiatric Nurse Practitioner Julie Paul]

She worked at Telshire Hospital.

[Assistant District Attorney Jennifer Sprague]

On November 20th of 2022, did you have a conversation or did you get a call from Sue Clancy?

[Psychiatric Nurse Practitioner Julie Paul]

I did. She was received. She was referred to me through Nanette Landry, another midwife that I work with.

[Assistant District Attorney Jennifer Sprague]

Okay. And so as a result of the phone call that you had with her, did you get in contact with a woman by the name of Lindsay Clancy?

[Psychiatric Nurse Practitioner Julie Paul]

Yes, I did.

[Assistant District Attorney Jennifer Sprague]

Was that the same day or a different day?

[Psychiatric Nurse Practitioner Julie Paul]

It was the same day.

[Assistant District Attorney Jennifer Sprague]

And your contact with Lindsey Clancy, was it by phone or virtual or in person?

[Psychiatric Nurse Practitioner Julie Paul]

It was by phone.

[Assistant District Attorney Jennifer Sprague]

And so what was the purpose of calling Lindsay Clancy?

[Psychiatric Nurse Practitioner Julie Paul]

I just wanted to get her side of what had been going on with her history. Sue had alluded that she was struggling in the postpartum period, so I wanted to know exactly what she was struggling with to see if she'd be a good candidate for our program.

[Assistant District Attorney Jennifer Sprague]

So did you initiate the call to

[Psychiatric Nurse Practitioner Julie Paul]

Lindsey Clancy with the permission? I asked Sue Clancy if Lindsay had given permission, and she said she had.

[Assistant District Attorney Jennifer Sprague]

And in the conversation that you had with her, do you know approximately how long that phone conversation lasted?

[Psychiatric Nurse Practitioner Julie Paul]

I don't recall.

[Assistant District Attorney Jennifer Sprague]

Okay, but were you able to get all the pertinent information from her during the that phone call?

[Psychiatric Nurse Practitioner Julie Paul]

I got enough data to determine that she would be a good candidate for the program.

[Assistant District Attorney Jennifer Sprague]

So she would have met criteria for a referral from any other resource?

[Psychiatric Nurse Practitioner Julie Paul]

Correct.

[Assistant District Attorney Jennifer Sprague]

Now, is it fair to say that in this conversation, in order to determine whether she qualified, you had to ask her some background questions?

[Psychiatric Nurse Practitioner Julie Paul]

I did.

[Assistant District Attorney Jennifer Sprague]

And so were you able to identify whether she was in that postpartum period?

[Psychiatric Nurse Practitioner Julie Paul]

Yes. I asked when the birth of and she said it was May 26, 2022.

[Assistant District Attorney Jennifer Sprague]

And so after determining that she was in fact postpartum with a baby at home, did you ask any questions or did you learn any information about how the experience was earlier in the postpartum, right after birth?

[Psychiatric Nurse Practitioner Julie Paul]

I did. She said she did really well for the first 12 weeks. She was excited, really happy. And then when Patrick went back to work, she said she started to struggle with some anxiety.

[Assistant District Attorney Jennifer Sprague]

And you knew Patrick to be her husband, Patrick Clancy?

[Psychiatric Nurse Practitioner Julie Paul]

Correct.

[Assistant District Attorney Jennifer Sprague]

And do you recall her indicating that she was having difficulty leaving the baby, that she was feeling overwhelmed and having racing thoughts?

[Psychiatric Nurse Practitioner Julie Paul]

Yes.

[Assistant District Attorney Jennifer Sprague]

And so in your training and experience is that thing, are those things that you would hear from new moms?

[Psychiatric Nurse Practitioner Julie Paul]

It's very typical of what I hear.

[Assistant District Attorney Jennifer Sprague]

Did you learn from her whether she had engaged with any other treatment prior to contacting or prior to you having this conversation with her?

[Psychiatric Nurse Practitioner Julie Paul]

She did say that she had met with a psychiatrist. She didn't give the name. And then she'd also said that she had been in the emergency room a few days prior to.

[Assistant District Attorney Jennifer Sprague]

Okay. And were you able to determine that was actually the South Shore emergency room?

[Psychiatric Nurse Practitioner Julie Paul]

Yes, it was.

[Assistant District Attorney Jennifer Sprague]

And that would have been on November 16th of 2022?

[Psychiatric Nurse Practitioner Julie Paul]

Correct.

[Assistant District Attorney Jennifer Sprague]

Now, in addition to seeing a psychiatrist, did she identify to you some medications that she had been taking up to that point?

[Psychiatric Nurse Practitioner Julie Paul]

She did. She said she had trialed Zoloft for one week. She also said that she'd been trialing Ativan and Benadryl, which worked the best to help her sleep. She identified, she had questions about Buspar. Didn't say specifically whether she had been prescribed that or not, but that she had any questions about Buspar.

[Assistant District Attorney Jennifer Sprague]

Okay. And did she mention anything about that combination of Ativan and Benadryl in her treatment history that was of concern to her?

[Psychiatric Nurse Practitioner Julie Paul]

Just that she had been taking it for two weeks. It worked really well. But then she was getting concerned about dependence, so she self weaned herself off of that.

[Assistant District Attorney Jennifer Sprague]

And were you aware, did she tell you that she had been prescribed Trazodone after that?

[Psychiatric Nurse Practitioner Julie Paul]

Yes. After she went to the emergency room, she was prescribed Trazodone.

[Assistant District Attorney Jennifer Sprague]

Did she indicate whether the Trazodone gave her any relief to her sleep issues?

[Psychiatric Nurse Practitioner Julie Paul]

She said she was able to fall asleep but was having difficulty staying asleep.

[Assistant District Attorney Jennifer Sprague]

Did she also indicate to you that one of her goals was not to be on long term medications?

[Psychiatric Nurse Practitioner Julie Paul]

Yes, she did.

[Assistant District Attorney Jennifer Sprague]

And based on this initial phone conversation, did you recommend that she come in for an intake appointment? Appointment?

[Psychiatric Nurse Practitioner Julie Paul]

I did.

[Assistant District Attorney Jennifer Sprague]

How about the immediate need for sleep? Did you address that with her?

[Psychiatric Nurse Practitioner Julie Paul]

I just encouraged her to take the medication that she already had on hand that if the Benadryl and the Ativan were working, she should take that to help her sleep that night. And we talked the next morning about different options.

[Assistant District Attorney Jennifer Sprague]

And also in this initial phone call, did you have a conversation with her about options and risks of various types of SSRIs or continued use of benzodiazepines?

[Psychiatric Nurse Practitioner Julie Paul]

Yes, we reviewed that. Being on SSRI most of the time is preferable than being on benzodiazepines for long periods of time, especially to address our concern about addiction or dependency on the medication.

[Assistant District Attorney Jennifer Sprague]

And is this kind of a normal conversation you would have with somebody to screen them and determine whether the clinic. The self. Sure. Perinatal clinic, was an appropriate fit?

[Psychiatric Nurse Practitioner Julie Paul]

Yes. It's more to establish rapport and get a basic understanding and make sure that she was safe. And she didn't indicate that she was safe.

[Assistant District Attorney Jennifer Sprague]

And so that's kind of my follow up to that. So in the course of that phone call, you were able to communicate with her, correct?

[Psychiatric Nurse Practitioner Julie Paul]

Correct.

[Assistant District Attorney Jennifer Sprague]

And what she was telling you about her reported history, did that seem to make sense to you?

[Psychiatric Nurse Practitioner Julie Paul]

Yes, it did.

[Assistant District Attorney Jennifer Sprague]

And did you identify, or were you addressing or assessing during the whole course of this conversation whether there was any immediate safety, risk or need for her?

[Psychiatric Nurse Practitioner Julie Paul]

Yes, I was.

[Assistant District Attorney Jennifer Sprague]

And did you find that there was any.

[Psychiatric Nurse Practitioner Julie Paul]

There was no immediate need.

[Assistant District Attorney Jennifer Sprague]

Now, as a result of this conversation, you did you determine whether she was having any suicidal ideations?

[Psychiatric Nurse Practitioner Julie Paul]

Yes, I asked her specifically. She felt like she wanted to harm yourself or her channel. And she said no.

[Assistant District Attorney Jennifer Sprague]

And how about asking her about homicidal ideations?

[Psychiatric Nurse Practitioner Julie Paul]

Yes.

[Assistant District Attorney Jennifer Sprague]

And did she indicate whether she had any?

[Psychiatric Nurse Practitioner Julie Paul]

She did not.

[Assistant District Attorney Jennifer Sprague]

Did you also ask her whether she had experienced any auditory hallucinations?

[Psychiatric Nurse Practitioner Julie Paul]

I did.

[Assistant District Attorney Jennifer Sprague]

And did she experience any?

[Psychiatric Nurse Practitioner Julie Paul]

Not at the time, no.

[Assistant District Attorney Jennifer Sprague]

And did she indicate to you whether she'd ever experienced any?

[Psychiatric Nurse Practitioner Julie Paul]

No.

[Assistant District Attorney Jennifer Sprague]

How about visual hallucinations? Did you ask her about those?

[Psychiatric Nurse Practitioner Julie Paul]

I did.

[Assistant District Attorney Jennifer Sprague]

And did she indicate that she had experienced any?

[Psychiatric Nurse Practitioner Julie Paul]

No.

[Assistant District Attorney Jennifer Sprague]

And delusions? Did you ask her whether she had any delusions?

[Psychiatric Nurse Practitioner Julie Paul]

I didn't ask specifically about delusions. I believe.

[Assistant District Attorney Jennifer Sprague]

Okay. And in the course of talking with an individual, do you kind of constantly keep that in mind with what they're telling you, whether they're having any ideas of delusion?

[Psychiatric Nurse Practitioner Julie Paul]

Yes, I do.

[Assistant District Attorney Jennifer Sprague]

In the conversation you had with her on November 20, did you identify based on your conversation with her whether she was experiencing. Experiencing delusions?

[Psychiatric Nurse Practitioner Julie Paul]

No, I did not.

[Assistant District Attorney Jennifer Sprague]

And fair to say, a standard set of questions that you also ask have to do with drug use or tobacco or alcohol. Did you ask those questions as well?

[Psychiatric Nurse Practitioner Julie Paul]

I don't recall.

[Assistant District Attorney Jennifer Sprague]

If I were to show you your note, would that refresh your memory?

[Psychiatric Nurse Practitioner Julie Paul]

I have my notes right here. I could look at it.

[Assistant District Attorney Jennifer Sprague]

Okay. Draw your attention to the note from November 20th of 2022.

[Psychiatric Nurse Practitioner Julie Paul]

Yes, I did ask her, apparently. And she said no to illicit drug use, tobacco or marijuana or alcohol at that time.

[Dr. Jennifer Tufts]

Okay.

[Assistant District Attorney Jennifer Sprague]

And she also indicated to you that at this time on November 20, that she had stopped breastfeeding?

[Psychiatric Nurse Practitioner Julie Paul]

That's correct.

[Assistant District Attorney Jennifer Sprague]

Now, did. Did she schedule or did you schedule with her an intake for the next day, November 21st?

[Psychiatric Nurse Practitioner Julie Paul]

We did.

[Assistant District Attorney Jennifer Sprague]

And at the clinic, what generally is the practice for whether a person appears in person or on a telehealth visit or virtually?

[Psychiatric Nurse Practitioner Julie Paul]

Generally speaking, we like to do the intake in person as long as it's feasible. And for her it was okay.

[Assistant District Attorney Jennifer Sprague]

And just kind of, while we're on that topic, going forward with a patient who's being seen at the clinic, what are the criteria to determine an in person visit or a telehealth visit?

[Psychiatric Nurse Practitioner Julie Paul]

They're given the option about what works best for them.

[Assistant District Attorney Jennifer Sprague]

And are there instances where you as a provider might insist a person comes in in person?

[Psychiatric Nurse Practitioner Julie Paul]

If somebody needs to do like a urine drug screen or laboratory work, we'll have them come in. Or if they seem to be not making sense or having more difficulties, we'll have them come in in person.

[Assistant District Attorney Jennifer Sprague]

And if a person is scheduled for an in person visit and there are no observed issues on your end, can they opt to change it to a virtual appointment at any point?

[Psychiatric Nurse Practitioner Julie Paul]

Yes.

[Assistant District Attorney Jennifer Sprague]

And that's just the normal course of business at the clinic?

[Psychiatric Nurse Practitioner Julie Paul]

Correct.

[Assistant District Attorney Jennifer Sprague]

Now, in this particular instance, you said the intake was in person, right?

[Psychiatric Nurse Practitioner Julie Paul]

Yes.

[Assistant District Attorney Jennifer Sprague]

And during the course of the intake, are there particular types of questions that are asked of the person to get to know them and get to know their situation?

[Psychiatric Nurse Practitioner Julie Paul]

Yes, generally we do a full intake. She the first thing they do is meet with the nurse who does all the screenings.

[Assistant District Attorney Jennifer Sprague]

And one of the things that is asked of an individual when they come in is to tell you why they are there, right?

[Psychiatric Nurse Practitioner Julie Paul]

Correct.

[Assistant District Attorney Jennifer Sprague]

Their complaint is yes.

[Psychiatric Nurse Practitioner Julie Paul]

Would it be okay if I refer to my note?

[Assistant District Attorney Jennifer Sprague]

Sure.

[Psychiatric Nurse Practitioner Julie Paul]

So she said pretty much I cannot sleep was her major concern.

[Assistant District Attorney Jennifer Sprague]

And is that something that you've seen in your experience with new moms that come through the clinic and are Postpartum, it's very typical. Now, even with that report or that reason, do you do a full history to try to identify kind of what's going on in the present and what has happened in the past?

[Psychiatric Nurse Practitioner Julie Paul]

Yes, I do.

[Assistant District Attorney Jennifer Sprague]

And generally, is it fair to say that that's kind of the goal of an intake? Right.

[Psychiatric Nurse Practitioner Julie Paul]

I do that with every client. I have a standard set of questions.

[Assistant District Attorney Jennifer Sprague]

Is that just for the intake or any follow up?

[Psychiatric Nurse Practitioner Julie Paul]

Any follow up. I have a basic kind of script, but I always adjust it based on what they're saying.

[Assistant District Attorney Jennifer Sprague]

But fair to say, once a person gives kind of that history of their background, especially if they've had prior births before, prior experience, experiences with mental health professionals or psychiatric history, that that kind of follows the patient as they go through with their subsequent visits?

[Psychiatric Nurse Practitioner Julie Paul]

Yes.

[Assistant District Attorney Jennifer Sprague]

So in this instance, you had some background information from the phone call you had with her, but did you go back through those standard questions that you'd ask in an intake?

[Psychiatric Nurse Practitioner Julie Paul]

I did.

[Assistant District Attorney Jennifer Sprague]

And did you learn a little bit more about. About her current mental status? Did you ask her some questions about currently, how she was in this November 21st meeting?

[Psychiatric Nurse Practitioner Julie Paul]

I did.

[Assistant District Attorney Jennifer Sprague]

And so, again, do you kind of go through in each and every instance whether the person has any thoughts of suicide or harming themselves or others at every visit?

[Psychiatric Nurse Practitioner Julie Paul]

Those are standard questions that I ask. If they have any type of suicidal homicidal ideation or auditory or visual hallucinations.

[Assistant District Attorney Jennifer Sprague]

Do you ask the same questions each time or is it kind of fluid based on your rapport and conversations with the patient?

[Psychiatric Nurse Practitioner Julie Paul]

Generally, I try and touch upon the topic. Sometimes we get to that answer indirectly just by the line of questioning that we're using.

[Assistant District Attorney Jennifer Sprague]

Okay. And where it had been reported to you that she had been on the Zoloft and stopped due insomnia, that she was overwhelmed and her mind was racing, did you talk with her about intrusive thoughts?

[Psychiatric Nurse Practitioner Julie Paul]

I did.

[Assistant District Attorney Jennifer Sprague]

And did she indicate whether at that point she was having any intrusive thoughts, thoughts of harming herself or her babies?

[Psychiatric Nurse Practitioner Julie Paul]

She was not.

[Assistant District Attorney Jennifer Sprague]

Did she report to you how she was feeling at home with having now three children to take care of?

[Psychiatric Nurse Practitioner Julie Paul]

She was feeling overwhelmed.

[Assistant District Attorney Jennifer Sprague]

And that, again, reiterating that around 12 weeks when Patrick went back to work, that she was having increased anxiety?

[Psychiatric Nurse Practitioner Julie Paul]

Correct.

[Assistant District Attorney Jennifer Sprague]

And did she indicate to you that that was something that she had experienced to some extent with her other two

[Psychiatric Nurse Practitioner Julie Paul]

children, at least with her second pregnancy.

[Assistant District Attorney Jennifer Sprague]

And was she able to manage that with her second pregnancy without medication?

[Psychiatric Nurse Practitioner Julie Paul]

As far as what I was told, yes.

[Assistant District Attorney Jennifer Sprague]

And fair to say, she indicated that she would use breathing, meditation and yoga to work through it.

[Psychiatric Nurse Practitioner Julie Paul]

Correct.

[Assistant District Attorney Jennifer Sprague]

And so on this November 21st intake date, you again ask about drug use. Right.

[Psychiatric Nurse Practitioner Julie Paul]

Correct.

[Assistant District Attorney Jennifer Sprague]

And at this point she had told you that she had did trial one cbd, gummy at some point, but that did not help.

[Psychiatric Nurse Practitioner Julie Paul]

Correct.

[Assistant District Attorney Jennifer Sprague]

And you also learn about any prior psychiatric medications she had been on?

[Psychiatric Nurse Practitioner Julie Paul]

Yes. She had been on the Zoloft, the Ativan. She had been prescribed Buspar, but she hadn't. She didn't indicate whether she had taken that or not.

[Assistant District Attorney Jennifer Sprague]

Okay, and so that was her report of her most recent course of treatment. But did she talk about having anxiety issues further back in her history?

[Psychiatric Nurse Practitioner Julie Paul]

Yes, in college she had trialed Prozac, Propranolol and Wellbutrin.

[Assistant District Attorney Jennifer Sprague]

And fair to say she indicated that to you that she did well on those medications in nursing school.

[Court Clerk]

Correct.

[Psychiatric Nurse Practitioner Julie Paul]

With the only side effect being sexual side effects.

[Assistant District Attorney Jennifer Sprague]

Did you talk to her at this point in November20, on November 21, excuse me, 2022, about whether she had a plan to go back to work?

[Psychiatric Nurse Practitioner Julie Paul]

I don't know if that was a specific day. I know that we talked about work at a different date.

[Assistant District Attorney Jennifer Sprague]

Okay, if you have your note in front of you, I just draw your attention to maybe the last paragraph of the history of present illness.

[Psychiatric Nurse Practitioner Julie Paul]

Oh, I'm sorry, And you're talking about the day of the intake? Yes, Sorry, I thought you said the 22nd. So, yes, she had planned to go back to work in October, but it got delayed. She pushed it forward to November because she was having anxiety.

[Dr. Jennifer Tufts]

Okay.

[Assistant District Attorney Jennifer Sprague]

And during the course of this intake, again, you did those same mental status screens for any concerns, right?

[Psychiatric Nurse Practitioner Julie Paul]

Correct.

[Assistant District Attorney Jennifer Sprague]

Did you know any in this face to face, in person meeting with her?

[Court Clerk]

No.

[Psychiatric Nurse Practitioner Julie Paul]

She was goal directed, linear. She was a great historian, actively participated in the care plan.

[Assistant District Attorney Jennifer Sprague]

And as far as some of the screenings that you do during these visits for a person who is in that postpartum period, are there any specific screenings that you do?

[Psychiatric Nurse Practitioner Julie Paul]

Yes, we do the Edinburgh Postnatal Depression Scale. We did the gad, which is the Generalized Anxiety Depression Scale Scale. We did the Mood Disorders Questionnaire Scale, the Colombian Suicidal Scale, as well as the five Ps, which assesses for substance use disorders in pregnancy and postpartum.

[Assistant District Attorney Jennifer Sprague]

And so as far as in each one of those screens, what did you find as it pertained to this particular patient?

[Psychiatric Nurse Practitioner Julie Paul]

She was significantly high in the Gad 7, which is for generalized anxiety. She scored 21 out of 21, which is. They're just screening, so it's not Diagnostic, but it did indicate that she was experiencing extreme anxiety. And then with the Edinburgh Postnatal Depression Scale, she scored a 23 out of 30. But the one that I look for the most in that scale is number 10, and she was negative. And that's for suicidality.

[Assistant District Attorney Jennifer Sprague]

Okay, and so why is it that you look at that one in particular, or why do you consider that most?

[Psychiatric Nurse Practitioner Julie Paul]

Because that shows significant depression, especially if they have thoughts of harming themselves.

[Assistant District Attorney Jennifer Sprague]

Is it fair to say that that Edinburgh scale also confused fluctuate with postpartum mom depending on their situation?

[Psychiatric Nurse Practitioner Julie Paul]

Yes.

[Assistant District Attorney Jennifer Sprague]

And the other screens that you performed, did you identify whether there was any substance use issues?

[Psychiatric Nurse Practitioner Julie Paul]

No, there wasn't.

[Assistant District Attorney Jennifer Sprague]

Now, once you were able to kind of gather all this information from her and do these screenings, were you able to come up with an assessment and a plan for how to help her?

[Psychiatric Nurse Practitioner Julie Paul]

Yes, she.

[Defense Attorney Kevin Reddington]

She.

[Assistant District Attorney Jennifer Sprague]

And what was going to be the plan with Ms. Clancy?

[Psychiatric Nurse Practitioner Julie Paul]

So we had discussed starting Prozac.

[Judge William Sullivan]

Okay.

[Assistant District Attorney Jennifer Sprague]

And is that or why. Why Prozac? Why start there?

[Psychiatric Nurse Practitioner Julie Paul]

Because she'd had a history of being successful on it in the past, and that's a good indicator that instead of trying multiple medications to start with the ones that actually work. So I gave her 10 milligrams for the first four days to make sure there were no adverse reactions. And then I gave. Gave her. I was going to increase her to 20 milligrams if she tolerated that well.

[Assistant District Attorney Jennifer Sprague]

Okay, and what about some of the medications that she had already, that she was already on? The Ativan and Benadryl and the Trazodone. Did you have a plan for those?

[Psychiatric Nurse Practitioner Julie Paul]

I did. So I encouraged her to take the Ativan. So when Prozac can sometimes be very activating, it can make the anxiety worse before it gets better when you first start it. So I wanted to pair it with the Ativan just in the beginning, just to help her be more comfortable with the anxiety and to make sure that it didn't interfere with her sleep.

[Assistant District Attorney Jennifer Sprague]

And as far as Prozac goes, what class of medication is it?

[Psychiatric Nurse Practitioner Julie Paul]

It's an ssri, a selective serotonin reuptake in timber.

[Assistant District Attorney Jennifer Sprague]

Is it commonly prescribed to treat people with depression?

[Psychiatric Nurse Practitioner Julie Paul]

Yes, it is a first line treatment.

[Assistant District Attorney Jennifer Sprague]

You said first line treatment.

[Psychiatric Nurse Practitioner Julie Paul]

Correct.

[Assistant District Attorney Jennifer Sprague]

And the idea of pairing a particular medication like an SSRI with another medication, is that a fairly common practice with psychiatric medications? Yes, as far as the. You mentioned that sometimes symptoms could get worse before they get better. Is that also common with SSRIs?

[Psychiatric Nurse Practitioner Julie Paul]

Yes, it is.

[Assistant District Attorney Jennifer Sprague]

Does it take a While for a medication to get into a person's system and stabilize them, generally side effects are

[Psychiatric Nurse Practitioner Julie Paul]

the first week or two, but to get to a therapeutic level, it's about four to six weeks.

[Court Clerk]

Weeks.

[Assistant District Attorney Jennifer Sprague]

And was this something that you discussed with her about the timetable it would take to reach a therapeutic level?

[Psychiatric Nurse Practitioner Julie Paul]

Yes.

[Assistant District Attorney Jennifer Sprague]

And when we say therapeutic level, what's the goal of reaching therapeutic level is remission in symptoms. People start to feel better then, right?

[Psychiatric Nurse Practitioner Julie Paul]

Correct.

[Assistant District Attorney Jennifer Sprague]

Now, even though you were advising that she continue with the Ativan and she had told you that there she had concerns about continuing with the benzodiazepine, did you indicate that there would be a plan to taper that or reduce that?

[Psychiatric Nurse Practitioner Julie Paul]

Yes. Once the activating symptoms went away, then we would look at reducing that and moving away from the Ativan and moving more towards, like, abuse bar.

[Assistant District Attorney Jennifer Sprague]

Okay. And as far as talking about that plan and what the risks and benefits of that plan were, did she appear to understand and engage in conversation with you about the.

[Psychiatric Nurse Practitioner Julie Paul]

Yes, she verbally understood and said that she understood the instructions.

[Assistant District Attorney Jennifer Sprague]

Did she ask the appropriate questions or follow up?

[Psychiatric Nurse Practitioner Julie Paul]

Yes, she did.

[Assistant District Attorney Jennifer Sprague]

And as far as kind of overall, what the plan was moving forward, was medication the only recommendation that you were making, or did you have other recommendations for her?

[Psychiatric Nurse Practitioner Julie Paul]

No, I set her up with talk therapy with Letitia Dukes as well.

[Assistant District Attorney Jennifer Sprague]

Sorry, when you say talk therapy, what do you mean by that?

[Psychiatric Nurse Practitioner Julie Paul]

So coming in and actually doing cognitive behavioral therapy with a clinician, someone who can act, who is trained in this.

[Assistant District Attorney Jennifer Sprague]

And so you mentioned Leticia Dukes.

[Psychiatric Nurse Practitioner Julie Paul]

Correct. She was the clinician in our program at the time.

[Assistant District Attorney Jennifer Sprague]

And when you make this recommendation and this intake visit, do you work with the patient to schedule something before they leave, or is it up to them to schedule the time with the social worker?

[Psychiatric Nurse Practitioner Julie Paul]

It was set up with her before she left, I believe.

[Assistant District Attorney Jennifer Sprague]

And you're aware that the first appointment, scheduled appointment with Leticia was for December 2nd, correct?

[Psychiatric Nurse Practitioner Julie Paul]

I believe, because it was a holiday week, that week.

[Assistant District Attorney Jennifer Sprague]

Okay. Now, this time that you were with Ms. Clancy during this initial intake, fair to say, is approximately 60 minutes?

[Psychiatric Nurse Practitioner Julie Paul]

Yeah, she spent 30 minutes with my nurse and 60 minutes with myself.

[Assistant District Attorney Jennifer Sprague]

So she was there for an hour and a half. And is that normal time period that you allot for people coming in for intakes?

[Psychiatric Nurse Practitioner Julie Paul]

Yes.

[Assistant District Attorney Jennifer Sprague]

And as far as follow up with you as a clinic, as the clinician and prescriber, was there a plan set for when she was going to return?

[Psychiatric Nurse Practitioner Julie Paul]

Yes, we had established a return in two weeks.

[Assistant District Attorney Jennifer Sprague]

Now, at this point, because you had made that initial contact with her. And you had done this intake, was she going to be assigned to you as a patient?

[Psychiatric Nurse Practitioner Julie Paul]

This was going to be a short term arrangement. I was already in the process of leaving the program at the time.

[Assistant District Attorney Jennifer Sprague]

Had that been communicated to her?

[Psychiatric Nurse Practitioner Julie Paul]

I don't recall.

[Assistant District Attorney Jennifer Sprague]

Okay, and as far as what your plan was, how long were you remaining at the practice?

[Psychiatric Nurse Practitioner Julie Paul]

I was at the practice until mid December.

[Assistant District Attorney Jennifer Sprague]

So this was like a preplanned?

[Psychiatric Nurse Practitioner Julie Paul]

I was moving back to New Hampshire. Yes.

[Assistant District Attorney Jennifer Sprague]

But as far as the preliminary care, did you continue on with Lindsey as a patient?

[Psychiatric Nurse Practitioner Julie Paul]

No, I transferred her care on November 30, and I communicated with that to Lindsay.

[Assistant District Attorney Jennifer Sprague]

Okay, so as far as after the intake, she was provided with that December 2nd video. Excuse me, Intake or meeting with Leticia Dukes, the social worker. And then the next scheduled event would have been December 7th. Right. For a followup.

[Psychiatric Nurse Practitioner Julie Paul]

She had a. I believe. I don't recall the actual. What her next follow up with me was. I don't recall that date. But she did have a follow up with Rebecca Gelada.

[Assistant District Attorney Jennifer Sprague]

Okay. Prior to you communicating on November 30th that you were transferring her care, did you have further contact with Lindsey Clancy?

[Psychiatric Nurse Practitioner Julie Paul]

Yeah, we had a few phone calls and Mychart messages going back and forth.

[Assistant District Attorney Jennifer Sprague]

Can you just explain to the jury what the Mychart message is messaging system is in your practice?

[Psychiatric Nurse Practitioner Julie Paul]

It's kind of a chat feature between the client. They can reach out directly to the provider. It goes right to our inbox, and we can talk back and forth between visits.

[Assistant District Attorney Jennifer Sprague]

And do you encourage patients, when they come in at that first meeting to utilize the Mychart messaging system?

[Psychiatric Nurse Practitioner Julie Paul]

I do, often. It's the quickest way to get a hold of me if they're experiencing any major issues.

[Assistant District Attorney Jennifer Sprague]

And fair to say it's just an easy way in between visits to communicate particular points of information or concerns or symptoms?

[Psychiatric Nurse Practitioner Julie Paul]

Yes.

[Assistant District Attorney Jennifer Sprague]

Do you in your practice often use Mychart messages if you're not available, to meet with the patient to make changes to their treatment plan?

[Psychiatric Nurse Practitioner Julie Paul]

Occasionally, yes.

[Assistant District Attorney Jennifer Sprague]

Now, prior to your first Mychart message with Lindsey Clancy, did you get a text message from her on your personal phone? I do.

[Psychiatric Nurse Practitioner Julie Paul]

I don't recall.

[Court Clerk]

Okay.

[Assistant District Attorney Jennifer Sprague]

Do you recall whether Sue Clancy provided your number to Lindsey?

[Psychiatric Nurse Practitioner Julie Paul]

I know I did. So she must have. She had my number because I called her from my direct. My personal phone call because it was on a Sunday when I reached out to her initially.

[Assistant District Attorney Jennifer Sprague]

So that November 20th phone conversation was a communication between you and her on your personal phone?

[Psychiatric Nurse Practitioner Julie Paul]

Correct.

[Assistant District Attorney Jennifer Sprague]

And so do you recall on November 22, getting a message from her saying, hi, Julie, this is Lindsey Clancy. I'm sorry to contact you like this, but when you have a minute, can you please call?

[Psychiatric Nurse Practitioner Julie Paul]

I can't recall whether that was in my chart message or if that was on my personal phone. I apologize.

[Assistant District Attorney Jennifer Sprague]

That's okay. As a result of some way her contacting you, did you then have or send her a message or have a conversation with her on November 23rd?

[Psychiatric Nurse Practitioner Julie Paul]

I. I know we communicated on the 22nd. I sent a message saying that was the day she was getting nervous about starting the Prozac, so we encouraged her to go ahead and start the Prozac. I know we communicated on the 23rd, either by phone or by my chart message that indicated that she had taken the medication, she had started it on the 23rd.

[Grainger Commercial Announcer]

Second.

[Dr. Jennifer Tufts]

Okay.

[Assistant District Attorney Jennifer Sprague]

And were you aware at this time period that she was currently already a patient in the South Shore Health System Network with a primary care physician named Margaret Anastasia?

[Psychiatric Nurse Practitioner Julie Paul]

Yes.

[Assistant District Attorney Jennifer Sprague]

And she's a nurse practitioner, right?

[Psychiatric Nurse Practitioner Julie Paul]

Correct.

[Assistant District Attorney Jennifer Sprague]

Now, as far as these concerns that she relayed to you about starting the Prozac, do you know whether she did start the Prozac?

[Psychiatric Nurse Practitioner Julie Paul]

Yes, she stated that she started the Prozac on the 22nd of November.

[Dr. Jennifer Tufts]

Okay.

[Assistant District Attorney Jennifer Sprague]

And by November 25th of 2022, did you start having some Mychart communications with Lindsey Clancy?

[Psychiatric Nurse Practitioner Julie Paul]

I did.

[Assistant District Attorney Jennifer Sprague]

And so just referring first to November 25th of 2022, fair to say that you gave her or sent her a Mychart message encouraging to kind of stick with the plan, right?

[Psychiatric Nurse Practitioner Julie Paul]

Correct. Prior to that?

[Assistant District Attorney Jennifer Sprague]

Yes.

[Psychiatric Nurse Practitioner Julie Paul]

I did not.

[Assistant District Attorney Jennifer Sprague]

Okay. So on November 25, did you prescribe her some additional medications?

[Psychiatric Nurse Practitioner Julie Paul]

I did. So she wasn't tolerating the Prozac, so we had a conversation about stopping the Prozac I gave her. She was really having a hard time sleeping, so I gave her a one time dose of Ambien. And then I also prescribed Mirtazapine, which is another antidepressant, but it works really good for sedation and anxiety. So it started that at 7.5 milligrams, told her to stop the Prozac. And I also paired it with Klonopin, but I told her explicitly not to take the Ativan, just to take the Klonopin to help. It's longer acting benzodiazepine to help her with sleep and longer acting anxiety support while we got this new medication up and running.

[Assistant District Attorney Jennifer Sprague]

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?

[Psychiatric Nurse Practitioner Julie Paul]

Yes, that's correct.

[Assistant District Attorney Jennifer Sprague]

And so you said your recommendation at that point was to discontinue the Prozac.

[Psychiatric Nurse Practitioner Julie Paul]

Correct.

[Assistant District Attorney Jennifer Sprague]

And as far as the Prozac went, she hadn't taken it for very long, had she?

[Psychiatric Nurse Practitioner Julie Paul]

She took her for three days.

[Assistant District Attorney Jennifer Sprague]

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?

[Psychiatric Nurse Practitioner Julie Paul]

When a client doesn't have buy into the medication, it's awful. It doesn't work as well. So I was working with Lindsay to try and find a medication that would make her feel more comfortable. She was feeling very uncomfortable, very anxious. And the Prozac, she just wasn't tolerating the activation from the Prozac. So Mirtazapine is a little bit more calming, which I thought she would resonate with better.

[Judge William Sullivan]

Okay.

[Assistant District Attorney Jennifer Sprague]

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?

[Psychiatric Nurse Practitioner Julie Paul]

Yes.

[Assistant District Attorney Jennifer Sprague]

And again, in that Mychart message, you did indicate to stop the Prozac, Benadryl and Atifan and don't take while taking Klonopin, right?

[Psychiatric Nurse Practitioner Julie Paul]

Correct.

[Assistant District Attorney Jennifer Sprague]

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?

[Psychiatric Nurse Practitioner Julie Paul]

Yes, it's pretty common practice in psychiatry.

[Assistant District Attorney Jennifer Sprague]

And fair to say there's no way to anticipate how a particular patient is going to respond to any particular treatment. Medication treatment.

[Psychiatric Nurse Practitioner Julie Paul]

Correct.

[Assistant District Attorney Jennifer Sprague]

So after prescribing the Klonopin, the Mirtazapine 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?

[Psychiatric Nurse Practitioner Julie Paul]

I just told her to keep she can Mychart message me over the weekend. It was the holiday weekend, so I made sure she knew I was available to answer her questions.

[Assistant District Attorney Jennifer Sprague]

And fair to say she did in fact MyChart sending you MyChart messages over the course of that weekend, correct?

[Psychiatric Nurse Practitioner Julie Paul]

She did, yes.

[Assistant District Attorney Jennifer Sprague]

And so starting at 7:51 on November 26, she reported to you kind of how that night went, didn't she?

[Psychiatric Nurse Practitioner Julie Paul]

Yes.

[Assistant District Attorney Jennifer Sprague]

Where she said I did better last night. I took 7.5 mirtazapine and 0.5 klonopin at bedtime. Slept fairly well on and off until 3:45. And then she asked, do you think increasing the Mirtazapine will help me stay asleep longer? I can survive like this, but would be helpful to get to sleep until at least five thoughts. Thank you. Lindsay.

[Psychiatric Nurse Practitioner Julie Paul]

Yes.

[Assistant District Attorney Jennifer Sprague]

Did you respond to that message?

[Psychiatric Nurse Practitioner Julie Paul]

I did.

[Assistant District Attorney Jennifer Sprague]

And what did you advise her to do when she asked about increasing the Mirtazapan and wanting to stay asleep longer?

[Psychiatric Nurse Practitioner Julie Paul]

I said she could trial the flu 15 milligrams.

[Assistant District Attorney Jennifer Sprague]

And again, is that something that is common for you to do in prescribing, that maybe you have to adjust the dosage?

[Psychiatric Nurse Practitioner Julie Paul]

Yes.

[Assistant District Attorney Jennifer Sprague]

Did you have any concerns that increasing the mirtazapam up to 15 would have had any issues or problems?

[Psychiatric Nurse Practitioner Julie Paul]

No.

[Assistant District Attorney Jennifer Sprague]

And then again on November 27, you had a correspondence with her starting at 9:59am where she again reports to 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?

[Psychiatric Nurse Practitioner Julie Paul]

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.

[Assistant District Attorney Jennifer Sprague]

Okay. So this wasn't kind of unexpected.

[Psychiatric Nurse Practitioner Julie Paul]

It wasn't out of the ordinary for me.

[Assistant District Attorney Jennifer Sprague]

And so on the 27th she indicated she slept with. Well, taking the 15amtazepam and the 0.5 klonopin. Feel rested but super disconnected with myself in reality. And describes it was a scary feeling thinking of stopping Klonopin tonight and just taking the Mirtazapine. Do you recall that 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?

[Psychiatric Nurse Practitioner Julie Paul]

She's referring to the Klonopin and yes she did. She was really anxious about being dependent on benzodiazepines. So I think her goal was to not be on them. And if she was gonna she the disorientation might have been because of all the sedation from the Mirtazapine, which is a common side effect, which is why we chose that. And she knew that. And adding the Klonopin, maybe removing that might have helped with some of the sedative factors for it.

[Assistant District Attorney Jennifer Sprague]

So did you find there to be any issues with stopping the Klonopin or her deciding not to take it after two days?

[Psychiatric Nurse Practitioner Julie Paul]

No, I did not.

[Assistant District Attorney Jennifer Sprague]

And in Fact you indicated and told her that should help with the disorientation, right?

[Psychiatric Nurse Practitioner Julie Paul]

Yes, it might.

[Dr. Jennifer Tufts]

Okay.

[Assistant District Attorney Jennifer Sprague]

And so that was on November 27th. And fair to say that there was another communication via MyChart on November 28th with Lindsey Clancy?

[Psychiatric Nurse Practitioner Julie Paul]

Yes, there was.

[Assistant District Attorney Jennifer Sprague]

And at this point she was asking for, or there was some back and forth about needing a note for work, Correct?

[Psychiatric Nurse Practitioner Julie Paul]

Correct.

[Assistant District Attorney Jennifer Sprague]

And is that something that you had talked about with her, about getting another note for work?

[Psychiatric Nurse Practitioner Julie Paul]

Yes, that's what I do that often.

[Assistant District Attorney Jennifer Sprague]

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 term disability anymore and she's just going to be on personal leave.

[Psychiatric Nurse Practitioner Julie Paul]

Correct.

[Assistant District Attorney Jennifer Sprague]

So on the 28th, there was no back and forth about her taking the medicine and the effects or how she was feeling.

[Psychiatric Nurse Practitioner Julie Paul]

She actually had a panic attack earlier in the day before there was communications about work. And I recommended she take 0.5 of Ativan and go for a run. And I also recommended that she consider doing the partial hospitalization program at Women and Infants.

[Assistant District Attorney Jennifer Sprague]

And what was her response to. To the recommendation for the partial hospitalizational program?

[Psychiatric Nurse Practitioner Julie Paul]

At that time, she felt it wasn't going to work logistically for her or her family.

[Assistant District Attorney Jennifer Sprague]

And why did you recommend maybe going for a run?

[Psychiatric Nurse Practitioner Julie Paul]

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 down.

[Assistant District Attorney Jennifer Sprague]

Now, on November 29th of 2022, that was the first day that she actually met with Rebecca Gelada. But you had some conversation with her or she, she sent you a message, I should say earlier in the day. Correct.

[Psychiatric Nurse Practitioner Julie Paul]

She sent me a message earlier in the day. And at that time I wasn't working that day and Rebecca had an opening. So I offered the appointment with Rebecca for her. So I didn't actually communicate with her that day.

[Assistant District Attorney Jennifer Sprague]

Okay, but you did receive her message at 6:05am where she reported that at that point she took 15 remeron and CBD and it only worked slightly.

[Psychiatric Nurse Practitioner Julie Paul]

Correct.

[Assistant District Attorney Jennifer Sprague]

So how did you get from what you have told us now was the Mirtazapine or is that. That's Remeron, right?

[Psychiatric Nurse Practitioner Julie Paul]

Correct.

[Assistant District Attorney Jennifer Sprague]

How do we get from just the Mirtazapine with not the other, without the Klonopin or without some other?

[Psychiatric Nurse Practitioner Julie Paul]

The Klonopin was an as needed medication, so I honored her choice to be able to decide whether she wanted to take that or not.

[Assistant District Attorney Jennifer Sprague]

Okay, so after this panic attack, after the communication about the work form she reports the next morning that she took the 15 of the Mirtazapine or Remeron, and then she was having some sleep issues. Right?

[Psychiatric Nurse Practitioner Julie Paul]

Correct.

[Assistant District Attorney Jennifer Sprague]

And that she tried breathing, meditation and muscle relaxation, but then she ended up having to take the Ativan. Now, had you had any conversation with her in this back and forth, in these MyChart messages about whether Ativan was something that she should continue to take?

[Psychiatric Nurse Practitioner Julie Paul]

It was understood that she wouldn't take it unless. Until I had that conversation with her, I was under the understanding that she wouldn't be taking it while taking the Klonopin.

[Assistant District Attorney Jennifer Sprague]

But she had told you she wanted to discontinue the Klonopin.

[Psychiatric Nurse Practitioner Julie Paul]

Correct.

[Assistant District Attorney Jennifer Sprague]

And so you said as of November 30 that you had then fully transferred care.

[Psychiatric Nurse Practitioner Julie Paul]

I let her know that I would be leaving the clinic, and I thought it would be best if she saw a clinician that was working five days a week.

[Court Clerk]

Week.

[Assistant District Attorney Jennifer Sprague]

And Rebecca Gelada, is she a clinician that works at the clinic?

[Psychiatric Nurse Practitioner Julie Paul]

Correct.

[Assistant District Attorney Jennifer Sprague]

And had you worked with her for quite some time?

[Psychiatric Nurse Practitioner Julie Paul]

She had been in the clinic, I think, for two years, I believe, at the time.

[Assistant District Attorney Jennifer Sprague]

And you said that you had recommended on the day before, on the 29th, that she set up that meeting with Rebecca because she was available.

[Psychiatric Nurse Practitioner Julie Paul]

Correct.

[Assistant District Attorney Jennifer Sprague]

So it just was kind of happenstance that she ended up with Rebecca or.

[Psychiatric Nurse Practitioner Julie Paul]

I was in the process of transferring all of my patients between Rebecca and our new hire. And Rebecca was an experienced clinician, so I felt she would be a better match for Lindsey.

[Dr. Jennifer Tufts]

Okay.

[Assistant District Attorney Jennifer Sprague]

And as far as when you sent or communicated to Ms. Clancy that you were transferring her care, that was via MyChart message, right?

[Psychiatric Nurse Practitioner Julie Paul]

Correct.

[Assistant District Attorney Jennifer Sprague]

And Lindsey then responded to you, or do you recall if she responded to you?

[Psychiatric Nurse Practitioner Julie Paul]

He did respond to me saying, thank you for the care that I provided. She appreciated it and wished me luck.

[Assistant District Attorney Jennifer Sprague]

Did you have any other contact with Lindsey Clancy after that point?

[Psychiatric Nurse Practitioner Julie Paul]

No, I did not.

[Assistant District Attorney Jennifer Sprague]

And just to be clear, so when we were talking about moving from November 28th to the 29th in time, did you have a phone call with her outside the MyChart messages about that panic attack, or do you recall having entering a progress note about that?

[Psychiatric Nurse Practitioner Julie Paul]

I do remember entering a progress note about that, and that's when I told her to go for the run. I made the recommendation for the php.

[Assistant District Attorney Jennifer Sprague]

Did you ever have any further contact with Sue Clancy about Lindsay Clancy's care after that first contact on November 20, 2022?

[Psychiatric Nurse Practitioner Julie Paul]

I don't recall that.

[Assistant District Attorney Jennifer Sprague]

I have no further questions at this time.

[Judge William Sullivan]

Councillor Can I see it Saturday? All right, ma', am, you may step down. All right, well, members of the jury, just a couple minutes. So we're going to break. The commonwealth is finished on the direct. We're going to start with the crossing examination of this witness, but we're going to start that tomorrow. All right? So we're going to break till tomorrow. Remember my instructions. Don't talk about this case. Don't read about this case, even similar cases in regards to this. Don't read anything. Don't take any field trips. Don't do any research. You kind of know what the instructions are. I'm going to ask you those questions. We'll come in. We might start. I'd ask you to be here, ready to go at night. There may be an issue. I have to talk to council. Might cause a little bit of a delay, but we'll try and keep that minimized. We'll get you in here tomorrow. Okay, great. Thank you for all your work, and I hope you. Nice. Have a nice evening. We'll see you tomorrow.

[Court Clerk]

All right. This court session. Please be seated.

[Judge William Sullivan]

All right. Anything else? We need to address the court. Thank you. So the plan will be to start. Start tomorrow before we bring the jury back in. My. My plan would be to address the defendant's motion for that additional witness. We could. We could maybe do that first thing. And then after I do that, go right back into the presentation evidence. All right. Thank you, everyone. Thank you. Board arrives.