Trial Day 11

Summary

Podcast Summary: Full Trial Audio – Lindsay Clancy Triple Murder

Episode: Trial Day 11
Date: August 11, 2026

---

Overview

This episode presents Day 11 of the Commonwealth vs. Lindsay Clancy trial, chronicling the detailed courtroom proceedings. The focus of the day’s testimony centers around the mental health care provided to Lindsay Clancy during the months leading up to her alleged crimes, including in-depth questioning of psychiatric nurse practitioner Rebecca Jollotta regarding her treatment, medication management, and communications with Ms. Clancy. The court also hears arguments about potential witnesses and the relevance of staff testimony from McLean Hospital. The exchange brings into focus the intersection of psychiatry, postpartum care, medication regimes, patient autonomy, and clinical protocols.

---

Key Discussion Points & Insights

1. Arguments Over Witness Admissibility and Relevance

[01:11 - 11:05]

• Defense Motion: The defense seeks to add Emily Thorndike, a former McLean Hospital social worker, to the witness list. Attorney Kevin Reddington argues her experience and recent social media comments could counter the prosecution’s positive portrayal of McLean Hospital.
• Judge’s Concerns: Judge Sullivan probes relevance, noting Thorndike left McLean a year before Clancy’s admission, questioning if her observations apply to the relevant time frame.
• Prosecution’s Objection: ADA Sprague objects, asserting Thorndike lacks direct, contemporaneous knowledge and has publicly commented on the trial, risking bias and violating sequestration expectations.
• Judge’s Guidance: Suggests a voir dire (preliminary examination) of the witness but is inclined to seek a current McLean staffer for accurate testimony on staffing and program availability.

Quote:

“If it was anything other than those kind of facts and this witness was not, had not worked there, I'm not sure we'd even be having this hearing.”
— Judge Sullivan [15:45]

---

2. Testimony from Psychiatric Nurse Practitioner Rebecca Jollotta

Background & Training

[29:27 - 30:31]

• Jollotta details her education (UConn, William James College), clinical background, and credentials in perinatal mental health.
• Specializes at South Shore Health’s Perinatal Behavioral Health Clinic serving postpartum women up to two years after childbirth.

Clinical Approach & Initial Assessment of Lindsay Clancy

[33:27 - 38:24]

• Clinic treats a spectrum from postpartum depression to psychosis. Clancy referred via family connections.
• On November 29, 2022, Rebecca’s first contact with Clancy, who reported severe insomnia, anxiety, and lack of response to medications (Mirtazapine/Remeron, Ativan, Trazodone).
• Jollotta’s method involves reviewing prior records, direct history-taking, and mental status assessments.

Medication Management & Patient Autonomy

[45:23 - 54:17]

• Discusses how Remeron works, anticipated delayed onset, and Clancy’s lack of improvement after a few days.
• Clancy is hesitant to take alternative sleep aids (Amiben, hydroxyzine) and expresses concern about benzodiazepine (Ativan) dependence.
• Jollotta emphasizes patients’ autonomy:

“They have autonomy in their decisions. I'm only making recommendations based on my education, experience, training...”
— Rebecca Jollotta [54:04]

Assessment of Psychiatric Symptoms

[56:15 - 61:19]

• Jollotta administers structured psychiatric screens (Edinburgh, GAD-7, etc).
• At initial visit: Moderate to severe postpartum depression and anxiety documented.
• Reports no findings of mania, psychosis, or homicidal ideation; only anxiety.

Ongoing Communication & Medication Changes

[62:32 - 104:55]

• Details ongoing communication via patient portal (MyChart) with repeated reports of insomnia, depressive symptoms, and medication side effects.
• Clancy’s reluctance or negative responses to various medications; frequent requests for alternative plans.
• Repeated efforts to balance Clancy’s medication desires and clinical recommendations, including mood tracking and sharing psychoeducational resources.
• Frequent support for non-pharmacological approaches (CBT, mindfulness, support groups).

Memorable Exchange:

“I'm really feeling as if I can't go on like this.”
— Lindsay Clancy to Jollotta [77:04]

• Jollotta carefully monitors for suicidal ideation, differentiating between nonspecific despair and acute intent/plan.

Monitoring for Mania/Bipolar and Mixed States

[109:05 - 130:12]

• With continued insomnia despite high benzodiazepine and antipsychotic use, Jollotta raises concern for bipolar spectrum, especially given Clancy’s unusual, “activating” response to antidepressant (Zoloft) and lack of sleepiness.
• Runs through the difference between major depression, postpartum depression, and bipolar disorder—notes potential risk of rapid cycling with SSRIs.
• Consults with Clancy and her husband about the diagnostic uncertainty; both initially resistant to the bipolar suggestion.

Tapering Benzodiazepines and Medication Adjustments

[127:51 - 147:56]

• As Clancy fears benzo dependence, Jollotta recommends a gradual taper with Valium, continuing alternatives for insomnia and mood stabilization (Seroquel, Prozac, later Lamotrigine).
• Reassesses treatment plans as Clancy’s symptoms and preferences change, involving her husband in clinical decisions.

Partial Hospitalization Referrals & Care Coordination Issues

[154:01 - 266:17]

• Multiple recommendations and attempts to refer Clancy to partial hospitalization (Women & Infants Hospital, McLean).
• Evidence of ineffective crisis response from local programs (Aspire Crisis Support); Clancy sometimes turned away or discharged after brief assessments, often for concerns about medication regimen or non-relevant diagnosis.
• Jollotta has limited ability to obtain records from outside providers due to absence of referral and formal record requests.

---

3. Cross-Examination and Clinical Documentation

[197:21 - 277:45]

• Prosecution and defense probe Jollotta on the accuracy and completeness of medical record reviews, timing/frequency of meetings, prescription records, and interdisciplinary coordination.
• Discuss patient reporting, requests for in-person visits, use of scoring (Edinburgh, GAD-7), changes in symptom severity, communication with Clancy’s prior psychiatrist (Dr. Tufts), and family involvement.
• Defense highlights that all benzodiazepines prescribed in January 2023 came from Dr. Tufts, not Jollotta.
• All providers agree Clancy was not “doctor shopping,” but instead trying to find relief or reduce medications.

---

Notable Quotes & Memorable Moments

• Judge William Sullivan on Social Media Witness:

  "I can't imagine that that witness would be allowed to give her, in a sense, review of McLean's. If it's five star and she may say it's two star, you know, this is not trip Advisor. I wouldn't allow that."
  [15:43]

• Rebecca Jollotta on Patient Autonomy:

  “They have autonomy in their decisions. I'm only making recommendations based on my education, experience, training, what I'm seeing in terms of symptoms, the patient has the autonomy.”
  [54:04]

• Jollotta on Clancy’s Self-Advocacy:

  “She advocated for herself, and you took that into consideration and created an alternative plan or suggested an alternative plan?”
  “Yes.”
  [97:02]

• On Intrusive Thoughts:

  “Intrusive thoughts are pretty common in postpartum depression… I wanted to reassure you that it's not uncommon and mean nothing about who you are as a mother.”
  [91:13-91:45]

• On Cross-Provider Communication:

  “You knew that she was a woman who had just given birth, like five months ago, right? ... You knew that she was obviously in trouble. She was sick, right?”
  “Yes.”
  — ADA Sprague & Jollotta [215:58-216:03]

---

Important Timestamps by Segment

• Witness Admissibility Arguments: [01:11 - 21:58]
• Direct Examination of Rebecca Jollotta: [29:17 - 194:23]
• Cross-Examination Highlights: [197:21 - 277:45]
• Redirect and Recap: [277:45 - 279:13]
• Discussion/Recap and End of Day: [279:20 - 279:30]

---

Key Takeaways

• Complex Clinical Picture: Clancy presented with severe postpartum depression and anxiety, complicated by insomnia, medication sensitivities, and self-advocacy around medication side effects and dependence.
• Patient-Centered, Iterative Care: Jollotta’s treatment plan was continuously adapted to patient feedback, test results, and collateral information from Clancy’s husband.
• Limits of Outpatient Care: Despite frequent professional contact and effort, Clancy’s reluctance to certain medicines, gaps in coordination between providers, and failures of crisis services hampered optimal intervention.
• Diagnostic Ambiguity: Mixed evidence pointed to possible bipolar disorder, but not enough to meet diagnostic criteria at time of care.
• System Challenges: The episode illustrates the difficulties in obtaining timely, consistent, and appropriate psychiatric services for severe postpartum illness within a fragmented system.

---

Tone & Language

• The court proceedings were highly formal, methodical, and at times emotionally charged—especially during witness testimony about Clancy’s mental decline and the health system’s struggles to meet her needs.
• Cross-examination became tense around the adequacy of communication, follow-up, and whether symptom progression was inevitable or potentially avoidable given the services accessed.

---

For those interested in the evidence, detailed testimony, and the complexities of postpartum psychiatric care in severe cases, this episode provides an exhaustive, real-time encounter with expert witnesses, clinical conundrum, and legal debate.

Transcript

[Rebecca Jollotta]

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

[Kevin Reddington]

Good morning, your honor. May I proceed?

[Judge William Sullivan]

Yes, please.

[Kevin Reddington]

Your honor, before the court today, we have the matter of Commonwealth versus Lindsay Clancy. Ms. Clancy is present. She is represented by attorney Kevin Reddington, and the Commonwealth is represented by Assistant district attorney Jennifer Sprague and Assistant District attorney Shannon Beckenham.

[Judge William Sullivan]

All right, well, good morning, everyone. Good morning, Council.

[Jennifer Sprague]

Good morning.

[Judge William Sullivan]

Good morning, Ms. Clancy. All right, what I want to do first, let me just talk to council just for a second. Well, before we get going, I just kind of wanted to remind everybody that there is a media order that has been issued on this case. And for some of the media and the individuals who've been here for the last couple of weeks, I'm sure familiar with it, but I know there's a constant people coming in and out. So just want to remind everyone that there is a specific media order that's been issued on this case, and everybody is presumed to have reviewed it and agreed on. So if there are any violations or problems with that, we'll have to deal with it. But I just kind of wanted to remind everybody, especially people who may have just come into the courtroom recently. So if you have any questions about what that order is, you can speak to any of the court officers. They have a copy of it. We get a copy of it to everybody who needs to see it and review it. All right? And with that, what we'll do is we're going to go. The defendant, excuse me, had filed a motion for addition to the witness list to add to the witness list regarding a Ms. Thorndike. So what I'm going to do, first, I'll hear from the defendant, then I'll hear from the Commonwealth.

[Bluff (Ad Speaker)]

Ms.

[Jennifer Sprague]

Brink, there is a woman, her name is Emily Thorndike, who's a LA CSW here in Massachusetts. She owns and is an independent operator of her own clinical social work establishment called Wise Mind Therapy. Your honor has her resume. She graduated from Dover Sherburne High School, received a bachelor of arts in sociology from Hartwood College, master's degree from B.C. 2019, is licensed in Massachusetts. And interestingly enough, she did work at the McLean Hospital in the very short term unit that the doctor was testifying that Lindsey was in for five days in January of 22 into 23. She worked for five years as a mental health specialist from May of 2014 to May of 2019. She was a clinical social worker, manager of that unit from 2019, 2021. So she's basically got about seven years and seven months of experience working in that unit for majority of that period of time, full time employee and then for one year as a supervisor. She left, as the court is aware from the motion. I vetted her out. I obviously would be concerned if there's any so called axe to grind, if you will, any lawsuits pending? Were you fired? Did you have any difficulties, any claims for harassment, hostile workplace? Absolutely nothing. She has friends that are still employees that still work at McLean. And I do not know this woman. I have literally never met her. Her involvement in this case came about after one of the prosecutors, I don't recall, which made it out on direct examination that McLean is some kind of a five star institution where the doctors, the psychiatrists, the psychotherapists, the counselors were all banging into each other in the hallway trying to interview Ms. Clancy, who was just blithely refusing care and treatment, which is not the case. Patrick testified as to his observations. The court is aware that Patrick's testimony clearly in all fours, landed on the fact that it was clear to him that there was no staff that was available other than kids behind plexiglass on their cell phones. She colored, she took walks, There was no therapy, she didn't speak to any therapists or counselors. So now the jury is left with that image that McLean is purportedly some kind of a five star hospital because they're affiliated, quote unquote, with Harvard. Which you from your practice, I'm sure, as I know from my practice, is as far from the truth as can be possible in my opinion. But it doesn't matter what my opinion is. I could cross examine somebody till the cows come home, it doesn't matter. This woman posted a video on TikTok which, much like yourself, I'm sure I hardly know what TikTok is, but I received an email from one of the very, very active people in the community of TikTok, saying, look, you got to check this video out. So I did. This is about a week ago, maybe longer now, when I saw her video saying that she could not stand for, and I quote, the lies and the misrepresentations from that witness stand about McLean Hospital. I then said to my private investigator, Bob Jones, I said, bob, I can't find this woman because she had a pseudonym, name or whatever. He went, we wrote, he called her, left messages. She never got back to us for like three days. He went to her house, he sat out in front of her driveway. She came home from work, they interacted, he waved, didn't want to scare her. And she said, I Thought, oh, by the way, I believe that actually my wife had written her a letter as well because she's a nurse and was trying to reach out to her to have her get in touch with me to no response. She then tells Bob, I thought you guys were all AI, I didn't know that you were real. I thought it was spam. He then gave me her number. I spoke to her. She told me exactly what I put in the affidavit or in the motion. And she is available, ready, willing and able to testify to an employee's observations over seven years, including as a supervisor, as to what woeful environment McLean Hospital offers, especially on holidays, such as major holidays like New Year's, which is fine, we all enjoy New Year's, but nevertheless, New Year's, the day after that weekend, Monday, nobody was there. And I think it's important to rebut the inference that was created through the examination by the DA.

[Judge William Sullivan]

Mr. Brink, let me ask you this, and I'm going to ask the Commonwealth kind of same thing. The, the. What's the relevance, what's the argument for the relevance of what McLean's was at least the. Because she wasn't there for about a year, if I looked at the, the motion, is that correct? That's right.

[Jennifer Sprague]

Yeah, that's true. She left. She, she has her own business now and she left, but it was just a year.

[Judge William Sullivan]

Yeah.

[Jennifer Sprague]

There's no change in the circumstances from Lindsey going into that hospital on New Year's of 2022-23 and this woman's work experience where she left a year before, and I agree with you, this would have been a non issue were it not for the flavor of the government's repeated argument that she was a person who was earning health care, didn't want health care, had the opportunity and she walked away from the opportunity, which as I say, is as far from the truth as possible. So I think it is now, because of their questioning squarely before the jury to leave that impression. And the woman that was the doctor from McLean was just a pleasure. She was just a lovely, lovely woman and testified as best she could on the case. But they're left with the impression that McLean is this wonderful place, that she just did not have any interest in utilizing what was available to her that was not available to her. And she's testifying through custom practice and her observations over seven and a half years.

[Judge William Sullivan]

Is there another alternative to get there, someone who actually works there or work, work there during this time period that it's the time period That a year, one of the things that. Yeah, but things can change in a

[Jennifer Sprague]

year, you know, I don't think so. At McLean, I don't know.

[Judge William Sullivan]

So I guess that's the question. I don't know. So that would be that. That's one of the things I'm going to. I may have to wrestle with. But that's kind of what I was asking, whether or not there is or. I understand the argument.

[Jennifer Sprague]

Okay.

[Judge William Sullivan]

And I understand that the argument regarding relevance. But if we're talking about staffing or the availability of programs and how that work, this witness is a gap there. I guess that's all. I'm wondering if there's another way to get there.

[Jennifer Sprague]

So you know the realities of trial practice. If you're the government, you send summonses, you have people come to your office, you're interviewing witnesses. If you're the defense, they run for the hills. For example. One motion I'm bringing with you is merely looking for pediatric records that I have had to have Bob Jones go and try to get them. HIPAA forms, everything. And they're avoiding us horribly. And I'm going to have a contempt hearing request very shortly. But the point I'm getting at is if they want to reach out to McLean, I'm sure that McLean administration would bend over backwards to give them every record that they would need as to how many employees they had, what their work records were, their doctors, their counsel, all available. I know I can't get it. So I'm suggesting to your honor that this is an opportunity for a person who worked there for all those years, who does not have any dog in the fight to testify to what her observations were clearly within her time frame. She left a year before Lindsey went in there on New Year's. So I certainly agree with that cross examination. They could get records if they wish, but I think it is relevant, I think it's material and I think it has to be used to rebut the inference that was raised.

[Judge William Sullivan]

All right, thank you.

[Jennifer Sprague]

Thank you.

[Judge William Sullivan]

Yeah. Come on.

[Bluff (Ad Speaker)]

Hanging out at the pool is great. Relaxing and playing Vegas style games on my phone at the same time. Drink in one hand and a blackjack in the other. It's all at stake. Spin Quest. Over a thousand games, including your favorite slots and table games. Be cool with this summer special. New players get 30 coin packs for

[Judge William Sullivan]

[e-mail] Spin Quest is a free to play social casino. Void where prohibited. Visit spinquest.com for more details.

[Grainger Ad Speaker]

Granger knows when you're a procurement manager for an office park. You're not managing one building. You're managing all of them. And to stay ahead, you need need to see through walls and around corners. Lights about to fail. Filters ready to clog H vac on its last leg. If you wait until something breaks, you're already behind. Count on Grainger for quality products, easy reordering and 24. 7 support. Call 1-800-GRAINGER click grainger.com or just stop by Grainger for the ones who get it done.

[Kevin Reddington]

Your honor, the commonwealth would object to the witness, the late disclose witness. In addition to the obvious Rule 14 issues, the fact that we didn't have notice of this individual, there's been no discovery other than what's contained in the affidavit and what we could identify from this woman's TikTok video. There's no report from the investigator who admittedly by counsel has spoken to this witness, this individual. Aside from that, we have a number of other wish issues with this witness. One is this isn't somebody that's proposed to be an expert, so they're not relieved. They wouldn't be relieved of a sequestration order. But this woman's TikTok, admittedly, she's been following the trial. She goes on for several minutes in a very long TikTok video where she identifies what she thinks are lies based on her observations of Patrick Clancy's testimony. We have no idea what her thoughts are or what her comments are on the rest of the trial that we assume she's watched based on her comments in this particular video that she outlines in this video, her experiences at McLean and her observations and how they are different from what was portrayed in that particular witness's testimony. But in the course of this trial, we not only have that particular witness's testimony, we have records from McLean, and the records speak from themselves about what she was offered, what she did, what she declined, what the contact was with each and every person who wrote a note in that record. But this witness admittedly wasn't there, had no contact, has no knowledge of the case in. Of itself. And in this case, your honor, we deal with facts. We're presenting facts to the jury. We're not presenting somebody's opinion about what kind of care the defendant got during her stay at McLean. That's not what this trial is about. That's not what it should be about. And if it wants to play out in the court of public opinion, that's fine, but not inside the walls of these courtroom. So this person who said that she cares about Lindsey in This video, whether other people do or don't. This person who said that the prosecution of this case is an abomination. This person who said that the health profession needs to be held responsible for their care of the defendant. That's not a witness that presents facts to this jury. And I would also agree that there is a problem with what relevant testimony that she could give. There is no indication that what her experiences were in those seven years up until December of 2021 are exactly the same as they would have been when the defendant was at that short term unit at McLean. And the defense had the opportunity to ask that of Dr. Goodhart and he didn't. So there is.

[Judge William Sullivan]

Wait a minute. I think she said, I don't know what the staffing was. Didn't she say, I don't know how many people were on. I don't know if it was a skeleton crew?

[Kevin Reddington]

She said on that particular weekend she didn't know what the staffing was, but she wasn't asking.

[Judge William Sullivan]

That's the only weekend we're talking about.

[Kevin Reddington]

Right. But now he wants to make this an issue about the practices and the common practice of the hospital. But that was not a question that was asked of her, nor would your honor necessarily have permitted it where he was trying to tailor the testimony to the exchanges with the defendant. So to then have the witness available to answer those questions that was at the facility during that time period and then not take that opportunity and offer this subsequent witness and call it a rebuttal witness, it's not a fair line of examination. It's not a fair line of rebuttal where she wasn't there during the time period. So we would object for all of those reasons.

[Judge William Sullivan]

I mean, just so everybody knows where I come, I can't imagine that that witness would be allowed to give her, in a sense, review of McLean's. If it's five star and she may say it's two star, you know, this is not trip Advisor. I wouldn't allow that.

[Kevin Reddington]

And no one.

[Judge William Sullivan]

But the question seems to be, for me, a closer call about what the standard staffing and programs may be available on a holiday weekend. Because the commonwealth witness said, I don't know that. And that seems to be something that maybe the parties could come to an agreement about establishing either, you know, there's got to be somebody who's still working there that says the weekend, two weeks, the weekend after this wasn't a holiday. We have X amount of people there. We have X amount of programs that are available on the holiday weekend. We do or we don't. That's, to me, that's where the battle on this motion is. I have, I do understand the commonwealth's objections regarding allowing people who watch the trial to then say, I disagree with it and I want to testify about what I disagree with. That's, that's troubling. But I'm talking about the facts on this thing and that, that's, that's. If it was anything other than those kind of facts and this witness was not, had not worked there, I'm not sure we'd even be having this hearing.

[Kevin Reddington]

And I would suggest that counsel indicated that in trial practice that people are reluctant to give information to the defense. But there are avenues, procedural avenues, that he could pursue to get that information involving the court or involving subpoenas in which there's been no indication that he's actually tried to do. And again, I would suggest to the court that we have the McLean records from that time period in evidence, and they are the best evidence of the contact that people there, staff that were there that day had or there that those four days had with the defendant on that day. So from the perspective of if there's missing information, there are avenues he could pursue if he wants to rebut it. I would suggest that this person's testimony is not relevant because they weren't there. And I would agree that the better option from, if defense wants to present this as a rebuttal would be from somebody that is there, but he doesn't have that. And so for those reasons, this motion should be denied

[Judge William Sullivan]

and you don't have to commit to this at all. But it seems to me that it would be a very simple solution to get the staffing records or somebody at McLean's who can testify to this. What was the program availability on mid December weekend if you went in there as opposed to the weekend of New Year's? And it may be no different whatsoever. And that kind of eliminates the argument. So I think the, probably the best way to deal with this is to maybe have a voir die of this witness. Regards to what? So then the record's clear, too. But it also allows the parties to consider, while this is, while we're setting this up, maybe there's another way to a lesser alternative, so to speak, that would reduce the prejudice to both parties,

[Kevin Reddington]

you know, so I don't, I would, I don't know how avoirdare of this particular witness who clearly wasn't there and didn't have contact with the facility during that time period, would answer your honor's questions.

[Judge William Sullivan]

But I do agree, maybe we can find out. I can ask the questions and she could, we could see, I'm, I understand the problem that I kind of had as the case was going. The individual that was probably he would anticipate could talk about the staffing, the difference of a holiday weekend and a non holiday weekend said she wasn't aware of that.

[Kevin Reddington]

So I don't know that she said she wasn't aware of the difference. She said she wasn't aware of who was there on that weekend because she wasn't working that weekend. So I think there's a slight distinction in that. But again, the witness was available. Counsel could have crossed around that subject to any sort of objection and we could have addressed it at that time when the witness was on the stand. But again, that witness is under summons and if counsel wants to recall her, he can. There are avenues that he could pursue if he wants to pursue this line of rebuttal that short of calling this particular witness that's been proposed is the point the commonwealth, which is to express.

[Judge William Sullivan]

So I'm going to, I take this under advisement. I want to review it. But I'm inclined just so everybody can kind of maybe make some idea where we may go with this. I'm inclined to have a dear, this witness or some other witness. So maybe the defendant can get somebody who hasn't watched the trial. Because I do understand there's an issue regarding sequestration, but that may be a function of a trial like this that's being broadcast. You know, how do we guard against that? But that's not going to affect really the relevance, the prejudice, the determinations I have to make, you know, and you know, really under all the rules, 401, 403, all of those considerations that I have to make. So I'm inclined to do that unless the parties can think of a, I won't say better alternative that's not fair to this witness. A different alternative that might address everybody

[Jennifer Sprague]

to agree on anything.

[Bluff (Ad Speaker)]

What's going on, everyone? It's bluff here. And you know what's more American than America's 250th birthday? Supporting American owned companies like Spinquest, America's number one social casino with over a thousand games like live dealer, blackjack and craps. They're offering new users a $30 coin package for just $10. Go to spinquest.com and sign up.

[Judge William Sullivan]

Today Spinquest is a free to play social casino. Void where prohibited. Visit spinquest.com for more details.

[Kevin Reddington]

I'm here on a job site with Tim who owns his own electrical contracting business.

[Judge William Sullivan]

Three employees and two work trucks.

[Kevin Reddington]

Tim traded up to Geico Commercial Auto Insurance. We're positively here where he needs us most.

[Jennifer Sprague]

They sure are.

[Rebecca Jollotta]

With step by step help on all his insurance needs.

[Kevin Reddington]

All for shockingly low rates.

[Bluff (Ad Speaker)]

Shockingly low, huh?

[Judge William Sullivan]

Just a little bit of electrician humor.

[Jennifer Sprague]

Do you get it?

[Kevin Reddington]

I got it. You know, it feels like we have a real connection. All right, I'll stop get a commercial

[Rebecca Jollotta]

auto insurance quote [e-mail] and see how

[Judge William Sullivan]

much you could save. It feels good to Geico. I know the referee that make it right is what I'm trying to do is put that out there. If the parties can agree. I think the three of you know me. If it. I don't have a problem making a decision. I really don't. But I just kind of wanted to give everybody that opportunity to maybe craft a solution and if I have to do it, that's. That's kind of what I'm saying by saying I'll take it under advisement. So I'll let the parties know.

[Kevin Reddington]

Can I just ask.

[Judge William Sullivan]

Sure.

[Kevin Reddington]

Your honor, do. If you're reviewing this taking under advice that you do look in more detail at those records. The McLean Hospital.

[Judge William Sullivan]

Sure, yeah.

[Kevin Reddington]

Current evidence so that your honor can see the extent of the contact, the extent of the notes of people who actually dealt with her. Because again, that is the issue. That is the factual issue here is the contact that they. That she actually had. Not what maybe she wasn't offered at other points but what she had while she was there. So ask that you just review.

[Judge William Sullivan]

All right, I'll review that. I'll review my notes regarding the doctor who testified from McLean's and then we can deal with this. This would be a witness that would be called later in the trial anyway. So give me a chance to do that, review that, get a decision to the three of you and then we can, depending what happens, either schedule a voir dire or go from there. All right. Thank you for everybody for kind of agreeing to argue this a little bit earlier so it gives me a chance to review the records and the arguments.

[Jennifer Sprague]

All right.

[Judge William Sullivan]

With that, now we ready for the. The jury?

[Jennifer Sprague]

Yes.

[Judge William Sullivan]

Come on.

[Jennifer Sprague]

All rise.

[Kevin Reddington]

George.

[Jennifer Sprague]

Entering

[Kevin Reddington]

anything to do before the honorable

[Jennifer Sprague]

William Sullivan, justice of the superior court now sitting in Plymouth.

[Bluff (Ad Speaker)]

Within the floor the Commonwealth draw on the air. Give your attendance and you shall be heard.

[Jennifer Sprague]

God saved. The Commonwealth of Massachusetts is Court is now in session. Please be seated.

[Kevin Reddington]

Good morning, your honor. May I Proceed.

[Judge William Sullivan]

Yes, please.

[Kevin Reddington]

Your Honor, before the court today, we have the continuation of the jury trial in 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. Thanks for your patience. I told you we got a little late start, but I appreciate you waiting for us. And so what I'm going to do is going to go through those questions, and then at that point, we'll talk a little bit about the schedule, and then we'll get right back into the trial. So, first question. As you all know, by this point, has any member of the jury read, seen, heard, or overheard anything from any source about any aspect in this case that would affect her ability to. To be a fair and impartial juror? Second question is, is there any other serious matter or concern bearing on your service as a juror in this case that anybody needs to bring to my attention? Again, thank you for following those instructions. And then in regards to today's schedule, I'll probably be wrong again, but the best aspect, I think, will probably be similar to yesterday. Okay, so we'll go. We'll go return to the case. We'll take a break, hopefully around 11, take a break from one to two, and then we'll go into the afternoon, depending on how the case testimony goes. And then at the end of the day, I'll try to remember, bring counsel over here. We'll talk about kind of where we are on the timeline of the case, where we are kind of scheduled for the week and going forward. So I'll try and give you that hopefully this afternoon before I send you home. All right, so with that, we're going to return. There was a witness. Ms. Paul was on the stand. The Commonwealth had finished their direct examination, and we're about to begin cross examination of that witness. So I would ask the witness if the witness could retake the stand, please. Good morning.

[Rebecca Jollotta]

Good morning.

[Judge William Sullivan]

All right, Mr. Reddington.

[Jennifer Sprague]

Thank you, Judge. Morning, Nurse Paul. Good morning. And if I understand, you now live and perhaps work in New Hampshire, is that right?

[Rebecca Jollotta]

That's correct.

[Jennifer Sprague]

And are you still doing the same type of work that you were doing with the social health?

[Rebecca Jollotta]

Yes, I am.

[Jennifer Sprague]

Excellent. Very good. You obviously are very, very dedicated person to this field, if you will, helping people that are pregnant women after they had birth and during that postpartum period, Right?

[Rebecca Jollotta]

Correct.

[Jennifer Sprague]

You worked with Lindsay, and the reason you were involved with Lindsay is because, if I understand it Correctly, her mother in law, Patrick's mother, Sue, worked with a friend of yours.

[Rebecca Jollotta]

Correct.

[Jennifer Sprague]

So basically, sue asked her friend if she could reach out and have you kind of step in and help out.

[Rebecca Jollotta]

That's correct.

[Jennifer Sprague]

And then that's what you did?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

And you stepped up and you treated this woman, obviously with. With care and professionalism. My opinion.

[Grainger Ad Speaker]

Thank you.

[Jennifer Sprague]

Your Honor, I would like to offer the records from South Shore Health if I could.

[Judge William Sullivan]

Objection.

[Kevin Reddington]

No objection.

[Judge William Sullivan]

Those records may be admitted 222

[Jennifer Sprague]

in the course of your treatment of Lindsey, actually, you went so far as to give her your cell phone, if I'm correct. Is that right?

[Rebecca Jollotta]

She did have my cell phone because I called her on my day off. Yes, sir.

[Jennifer Sprague]

Okay. I don't have any other questions. Judge, thank you very much for your care. All right.

[Judge William Sullivan]

Counsel, anything further?

[Rebecca Jollotta]

Oh, thank you.

[Jennifer Sprague]

All right.

[Judge William Sullivan]

Thank you. May step down, please?

[Kevin Reddington]

Thank you. The Commonwealth would call Rebecca D. Good morning.

[Jennifer Sprague]

Brown.

[Grainger Ad Speaker]

Stop right there.

[Jennifer Sprague]

Where's your right hand? Watch your step, please.

[Judge William Sullivan]

Hey, good morning. I'm going to ask you to keep your voice up and speak into that microphone. All right?

[Kevin Reddington]

Okay.

[Rebecca Jollotta]

Right here?

[Judge William Sullivan]

Yes. Attorney Bucky, please.

[Kevin Reddington]

Thank you. Good morning.

[Rebecca Jollotta]

Good morning.

[Kevin Reddington]

Could you please tell the jurors your first and last name?

[Rebecca Jollotta]

Rebecca Jalada.

[Kevin Reddington]

And how do you spell your last name for the record?

[Rebecca Jollotta]

J, O, L, L, O, T, T, A.

[Kevin Reddington]

And what do you do for work?

[Rebecca Jollotta]

I'm a psychiatric nurse practitioner.

[Kevin Reddington]

And what kind of training and education did you do in order to become a psychiatric nurse practitioner?

[Rebecca Jollotta]

Thank you. I have my bachelor's degree from the University of Connecticut in allied Health sciences. I then went on to get my master's actually in Counseling Psychology in 2013 from William James College in Newton. I worked in the mental health field as a clinician in various positions for a time. Then I went back to school. I've been an RN in Massachusetts since 2017. I got my MSN in 2019, at which time I became a licensed and credentialed psychiatric nurse practitioner.

[Kevin Reddington]

And where is that? Here in Massachusetts?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

Are you licensed anywhere else?

[Rebecca Jollotta]

No.

[Kevin Reddington]

And so can you tell us a little bit about your work history?

[Rebecca Jollotta]

Sure. I have worked in as a detox nurse at McLean. I have worked as a therapist in outpatient clinicians prior to becoming a nurse. I have worked in DMH respite facilities, and now I'm a nurse practitioner.

[Kevin Reddington]

And when you were a therapist doing outpatient therapists, was that something you were doing on your own as a social worker or were you associated with a practice?

[Rebecca Jollotta]

It was part of my training after I got my master's in counseling in 2013. So I had a panel of patients, but I was under the supervision of a licensed provider. It was up towards getting my licensure.

[Kevin Reddington]

And where do you currently work?

[Rebecca Jollotta]

South Shore Health.

[Kevin Reddington]

And how long have you worked for south shore Health?

[Rebecca Jollotta]

Since 2021.

[Kevin Reddington]

And how did you come to work at South Shore Health? What was the role that you started?

[Rebecca Jollotta]

I had been working sort of in general practice as a psychiatric nurse practitioner, but I was interested in working in women's mental health specifically. And at that point, I was getting training to become, you know, more specialized in it. And when a job opportunity became available, I applied for it.

[Kevin Reddington]

And what kind of training is that that you were doing to be more specialized in women's health?

[Rebecca Jollotta]

So Postpartum Support International is the certifying body so that somebody can become certified in perinatal mental health? I did the two day. Well, actually, it was a two day training plus a third day specifically for the psychopharmacology track of it. And then I took a examination and passed the examination.

[Kevin Reddington]

And so are you certified by the Postpartum Support International?

[Rebecca Jollotta]

I am.

[Kevin Reddington]

Now, as far as the South Shore Perinatal Behavioral Health Clinic, how did you become affiliated with that?

[Rebecca Jollotta]

That was the job I applied to in 2021.

[Kevin Reddington]

Okay, and so when you came to the clinic, who was running the clinic or who was the director?

[Rebecca Jollotta]

Julie Paul.

[Kevin Reddington]

And as far as the clinic itself, what. What is the clinic's. What's the patient base or who do the. Who does the clinic service?

[Rebecca Jollotta]

So we specialize in working with women who are pregnant and postpartum up to two years after the birth of their most recent baby. We offer medication management. We have a clinician on staff to do counseling. We have a few nurses that work in our program. We work with moms for any range of psychiatric disorders, including addiction.

[Kevin Reddington]

And when we talk about the range of psychiatric disorders in women who are postpartum, what are we talking about?

[Rebecca Jollotta]

Postpartum depression, anxiety, postpartum psychosis, bipolar disorder, panic disorder, obsessive compulsive disorder.

[Kevin Reddington]

And so you mentioned postpartum psychosis. Have you yourself had the experience of treating people, women with postpartum psychosis?

[Rebecca Jollotta]

I have, yes.

[Kevin Reddington]

And how many patients? Approximately, over the course of the last five years?

[Rebecca Jollotta]

Approximately five.

[Kevin Reddington]

And how about postpartum depression and postpartum anxiety?

[Rebecca Jollotta]

Hundreds.

[Kevin Reddington]

And in the range of services that the clinic offers and the work that you do, do you oftentimes collaborate with other community providers to offer additional referrals or services to patients if they need it?

[Rebecca Jollotta]

We do.

[Kevin Reddington]

And how about when somebody appears before you and you believe they need a higher level of care than what you can offer? Do you have relationships with hospitalization programs or are you able to make referrals for people for those services?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

Is that pretty common practice?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And you mentioned that one of the services or one of the things offered to patients at the clinic is medication management. Is that a big part of what you you do as a psychiatric nurse practitioner?

[Rebecca Jollotta]

It is.

[Kevin Reddington]

And what kind of training do you receive in order to be a prescriber?

[Bluff (Ad Speaker)]

What's going on everyone? It's bluff here and we're driving through the states in the Bluff Mobile and the best thing that we can do is play our favorite casino style games on Spin Quest. They have over a thousand games including live dealer blackjack and craps. With tons of slots and unlimited options. You can get a $30 coin pack for just $10 for new users. Sign up today. Go to spinquest.com right now.

[Judge William Sullivan]

Spinquest is a free to play social casino void where prohibited. Visit spinquest.com for more details.

[Nanit Ad Speaker]

This episode is brought to you by Nanit.

[Rebecca Jollotta]

If you're expecting or you know someone who is, sleep is a thing everyone worries about. Will the baby sleep? Will you sleep?

[Nanit Ad Speaker]

And then there are the devices. One for video, another for breathing, and you still end up googling at 2 in the morning.

[Rebecca Jollotta]

Nanit is all of it in one.

[Nanit Ad Speaker]

The Nanit Smart Baby Monitor system gives you crystal clear HD video, breathing, motion

[Grainger Ad Speaker]

monitoring, automatic sleep tracking, real time safety

[Rebecca Jollotta]

alerts and personalized sleep insights.

[Grainger Ad Speaker]

It's like the smartwatch you wear to track your own sleep, but for your baby.

[Nanit Ad Speaker]

The overhead view is unreal. The picture is so clear you can

[Rebecca Jollotta]

see spit up on the onesie and

[Nanit Ad Speaker]

you can check it from anywhere on

[Kevin Reddington]

your phone or the new 8 inch home display. Less wondering, more knowing.

[Nanit Ad Speaker]

Go to nanit.com that's N A N

[Rebecca Jollotta]

I T dot com.

[Grainger Ad Speaker]

If you're building a baby registry, Nanit

[Rebecca Jollotta]

goes on it first. So in order to be a prescriber, it's part of my master's in nursing. So you take courses like in Advanced pharmacology, Advanced Health Assessment, Pathophysiology. It's part of the coursework of my degree and then you actually have to take a certification exam and you have to pass the exam. You have to go on and get a DEA license, a Massachusetts Controlled Substance license. You have to go on and get your advanced practice registered nursing license. So it's education and certification and Licensure.

[Kevin Reddington]

And so you've done the education, you did the certification. And do you have all the licensures that you just described here in Massachusetts?

[Rebecca Jollotta]

I do.

[Kevin Reddington]

And you also mentioned part of the services of working with social workers in the clinic. And what do the social workers do?

[Rebecca Jollotta]

They provide short term counseling to patients. Again, because we specialize in up to two years postpartum, they could be available to provide counseling during that phase.

[Kevin Reddington]

And traditionally, postpartum period is a year after birth, right?

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

So why does the clinic offer support for women up to two years?

[Rebecca Jollotta]

We do acknowledge that while the highest risk period is the first three months postpartum, some women can struggle later on in the first year. They may have symptoms that emerge nine, ten months in. So we want to really be able to cover them and treat them if that happens, and get them stable.

[Kevin Reddington]

And does it sometimes take some time to get a person stable?

[Rebecca Jollotta]

Absolutely.

[Kevin Reddington]

And would that be why the program or your program goes up to two years?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

I want to draw your attention to a particular patient, Lindsey Clancy. You're familiar with that patient?

[Rebecca Jollotta]

I am.

[Kevin Reddington]

And how did you become involved with the care of Lindsay Clancy?

[Rebecca Jollotta]

I became involved. She had initially seen Julie, and Julie was going to be leaving the clinic in December, and she wanted somebody to take care of Lindsey, you know, again, longer term, since she would be leaving.

[Kevin Reddington]

And at that time, in 2022, when Julie was leaving, how many psychiatric nurse practitioners were at the clinic?

[Rebecca Jollotta]

3.

[Kevin Reddington]

And that includes Julie?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And so who was the other nurse practitioner?

[Rebecca Jollotta]

Andrea Warden.

[Kevin Reddington]

And fair to say you had a conversation with Julia about transferring care of this particular patient?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And did you have more experience than the other nurse practitioner in the field, if you know?

[Rebecca Jollotta]

Not necessarily.

[Kevin Reddington]

But as far as taking Lindsey on as a patient, you were agreeable to taking over for Julie?

[Rebecca Jollotta]

Yeah, in all likelihood. Andrea Warden only works two days at our clinic, so it could have been that I was working five days at that time, so I would have been more available.

[Kevin Reddington]

So do you recall when the first contact you had with Lindsey Clancy, what date it was?

[Rebecca Jollotta]

It was November 29, 2022.

[Kevin Reddington]

And so that was prior to Julie actually leaving, right?

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

And fair to say, on that November 29th date, you had an actual follow up with Lindsey?

[Rebecca Jollotta]

I did.

[Kevin Reddington]

Do you recall if it was virtual or was it in person?

[Rebecca Jollotta]

I recall that it was virtual.

[Kevin Reddington]

Okay. And in the practice of the clinic, is there an option for patients to do in person or face to face in person visits? And how. How does it come about that a person is either inpatient, excuse Me in person or virtual?

[Rebecca Jollotta]

Our model is that we do initial assessments in person because new motherhood is very busy, there's a lot going on. We would rather see you than not. And so sometimes it is just easier to log on to a screen. Sometimes. If we feel like someone would benefit from that face to face assessment, we'll say, please book your next appointment in person. And I know I did see Lindsay in person on at least one occasion, but my first was virtual.

[Kevin Reddington]

And as far as kind of that choice about whether a patient appears virtual or in person is part of the calculus, the patient's choice, what they want to have happen.

[Rebecca Jollotta]

Yeah.

[Kevin Reddington]

And if there were circumstances where you believed or insisted that an in person visit was required, would you articulate that to the patient?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And then have them scheduled for an in person?

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

And as far as your contact, your first contact with Lindsey Clancy, were you aware that Julie Paul had done that initial intake with her in person?

[Rebecca Jollotta]

I was.

[Kevin Reddington]

And you had the chance to. To speak with Julie and to also review the records prior to meeting with her?

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

And so were you aware that the day before, on November 28, that Julie had had some contact with Lindsey Clancy?

[Rebecca Jollotta]

I was.

[Kevin Reddington]

And that there was some phone interaction and there had been some messages sent to the clinic prior to you scheduling the meeting with her?

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

Yes. So would you agree that there was an issue that needed to be discussed and that led you to have this appointment with her prior to Julie actually leaving the program?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

When you met with Ms. Clancy, did you go through kind of a history of her present presentation or present illness and kind of things that had occurred in the past?

[Rebecca Jollotta]

I did.

[Kevin Reddington]

And do you do. Did you do kind of a nuts, nuts and bolts, start to finish, or did you rely on some of the previous information she had disclosed?

[Rebecca Jollotta]

I relied on some of the previous information she had disclosed. Things like where she grew up, where she went to school, past clinical history, medication trials, but otherwise I would add my own clinical assessment.

[Kevin Reddington]

Okay. And you were aware that in the history she presented to the clinic that she had previously been on some medications from another provider, correct?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And that she started with Zoloft and Ativan and Benadryl?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And that at some point she had visited the South Shore Hospital emergency room?

[Rebecca Jollotta]

I believe it was November 16th.

[Kevin Reddington]

And as a clinic that's associated with the South Shore Health System, do you have access to those records to review when you're dealing with a patient?

[Rebecca Jollotta]

I do. Yeah.

[Kevin Reddington]

And so you're aware that when she went to the ER on November 16 that they prescribed her trazodone?

[Rebecca Jollotta]

I am.

[Kevin Reddington]

And that she was reporting significant sleep issues at that time?

[Rebecca Jollotta]

I was aware.

[Kevin Reddington]

And then as far as the course of treatment at the clinic, were you able to review her course of treatment with Julie?

[Rebecca Jollotta]

I was.

[Kevin Reddington]

And fair to say that had been very recent, correct?

[Rebecca Jollotta]

Very recent, yes.

[Kevin Reddington]

Her first contact with the Clinic was actually November 20th, correct?

[Jennifer Sprague]

Correct.

[Kevin Reddington]

So you were aware that Julie had originally prescribed Prozac and had already changed the. The medication plan?

[Rebecca Jollotta]

Yes, I was aware.

[Kevin Reddington]

So in this meeting on November 29th, what was Lindsey reporting to you as the issues?

[Rebecca Jollotta]

Would I be able to refer to my note, your honor?

[Judge William Sullivan]

Sure.

[Rebecca Jollotta]

I know most of it by memory. So she had been taking Mirtazapine Rembron at that point for four nights. So I believe she started it on November 25th. I was then seeing her on November 29th. She wasn't yet appreciating much difference for mood, anxiety, or insomnia. She would say, you know, I'm able to fall asleep for two hours. Then I'm up for three hours in the middle of the night. And finding herself in those three hours needing to take an Ativan to help her fall back asleep.

[Kevin Reddington]

Now, when she said not appreciating much difference after taking it for four nights, in your training experience, is that something that you would normally see with that type of medication?

[Rebecca Jollotta]

Yes. I wasn't surprised by that.

[Kevin Reddington]

And for something like Mirtazapan, or it's referred to as Remeron.

[Rebecca Jollotta]

Right.

[Kevin Reddington]

What class of drug is that?

[Rebecca Jollotta]

It is a noradrenergic specific serotonin antidepressant. So it's slightly different than an ssri. It does work on serotonin. It also works on. The noradrenergic part is alpha receptors, which is what our body. Those are the receptors that our body responds to adrenaline. So it should help kind of calm you down. And it also works on histamine receptors, which is why it can make people sleepy.

[Kevin Reddington]

So for Remeron, the fact that it has a calming effect on somebody with anxiety, it's sometimes a good fit, right?

[Rebecca Jollotta]

Correct. Yep.

[Kevin Reddington]

And for somebody who might be complaining of sleep issues, it also has that secondary component that could help.

[Rebecca Jollotta]

Yeah, it is a good choice for somebody who's having depression with prominent anxiety, insomnia, decreased appetite, because it can also increase appetite, which sometimes we want to happen.

[Kevin Reddington]

And based on your view of her course of treatment with the clinic, those were issues that had arisen, Right?

[Rebecca Jollotta]

Yeah. I had noticed she had lost weight when she had gone to her PCP on October 20th. I believe she weighed like 130 pounds. On the 16th when she went to the Ed Sheer, she weighed 124 pounds. And they had done a pretty good medical workup on her with labs and everything. And she had reported decreased appetite, so that was part of the clinical picture. And of course, not sleeping and very anxious.

[Kevin Reddington]

Okay. And so with a medication like Remeron or Mirtazapine, does it take time to work or to see results?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And typically, what's the time frame for that drug?

[Bluff (Ad Speaker)]

Happy birthday, America. It's time to celebrate and play your favorite Las Vegas casino games by American owned spinquest.com what's better than fireworks and American Pie? Hitting a blackjack in the palm of your hand and you won't lose your fingers. Over a thousand games, including slots and live dealers and $30 coin packs are on sale for 10 spinquest.com buy American players.

[Judge William Sullivan]

For American players, Spin Quest is a free to play social casino void where prohibited. Visit spinquest.com for more details.

[Grainger Ad Speaker]

Grainger knows when you're a procurement manager for an office park, you're not managing one building, you're managing all of them. And to stay ahead, you need to see through walls and around corners. Lights about to fail, filters ready to clog H Vac on its last leg. If you wait until something breaks, you're already behind. Count on Grainger for quality products, easy reordering and 24. 7 support. Call 1-800-Grainger click granger.com or just stop by Granger for the ones who get it done.

[Rebecca Jollotta]

I usually tell patients four to six weeks at a given dose is really going to give us a good idea of what that dose is going to do. You may start to see improvements in the first two weeks, but full clinical benefit can take a month, sometimes eight weeks even.

[Kevin Reddington]

And you were aware prior to her coming to this follow up appointment with you that she had been reporting after taking the Remeron, feeling disoriented, forgetful, not feeling connected to the body, and anxious about whether she would actually sleep?

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

And so were you aware that on November 28th that one of the nurses actually advised her to increase the Remeron?

[Rebecca Jollotta]

I was.

[Kevin Reddington]

And in addition to the medication, there was also the recommendation that she add some cognitive behavioral therapy to her treatment plan?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And at that point on November 29, by November 29, were you aware of whether she had met with the social worker at the clinic?

[Rebecca Jollotta]

She had not.

[Kevin Reddington]

So did you have any indication that she had been engaging in some sort of cognitive, behavioral or psychotherapy?

[Rebecca Jollotta]

No.

[Kevin Reddington]

Now, in relation to the medication piece of this follow up, did you have any conversations with her about the concerns with the Remeron and what to do about that?

[Rebecca Jollotta]

Yes, I did. I explained to her that it takes time to work, that it has only been four days. So I did encourage her to give it some more time. I also made additional recommendations as well.

[Kevin Reddington]

Okay, and so what were the recommendations for?

[Rebecca Jollotta]

I had known that Julie had tried like 5 milligrams of Ambien, so I had suggested maybe we could try 10. Maybe we could try Ambien controlled release formulation. Because what? Because she was having these wake ups in the middle of the night. The controlled release, kind of like the outer layer, gives you 60% of the dose, helps you sleep, then throughout the night, the inner layer gives you 40% of the dose, keeps you asleep. I said that might be a good option while we're waiting for the Remron to work, because I was sort of thinking that maybe the underlying depression, anxiety was causing the poor sleep. So while we're treating that, you know, let's try these alternatives. Okay.

[Kevin Reddington]

And so was she receptive to the Ambien?

[Rebecca Jollotta]

No.

[Kevin Reddington]

And did she say why?

[Rebecca Jollotta]

No, I don't recall.

[Kevin Reddington]

Did she express to you that she had some other concerns about taking certain types of medications for sleep, like benzodiazepines?

[Rebecca Jollotta]

She did. What did she say about that? She was concerned about taking benzos. She had mentioned something called rebound anxiety. And what that is is once the dose sort of wears off, your anxiety goes like above your baseline. Once the dose of a benzodiazepine wears off, it usually typically has to do with half life of a medication. So for Ativan, that's usually between 8 and 24 hours. So if she's taking it in the middle of the night, the next morning she would feel more anxious. She was concerned about that. She also feels she was concerned about getting physically dependent on it because she had needed to take it for a number of nights.

[Kevin Reddington]

And when she used the term rebound anxiety, was that her terminology?

[Rebecca Jollotta]

Yes, it was.

[Kevin Reddington]

And is that a terminology that you generally use in psychiatric care to describe that, what you just told us about?

[Rebecca Jollotta]

Yes, it's a clinical term.

[Kevin Reddington]

And was that something that she mentioned first or did you mention?

[Rebecca Jollotta]

I put it in quotes in my notes. So she had. That's usually when a patient mentions it. I put it in quotes.

[Kevin Reddington]

Okay. And so as far as the plan to address the sleep and to help her with, with this complaint with Ambien, not a choice. What was your next recommendation?

[Rebecca Jollotta]

I Discussed hydroxyzine because it. It's an as needed medication for anxiety, but it's not a benzodiazepine. It doesn't really carry that risk of rebound anxiety or tolerance or dependence, and it could help her sleep. So I offered that as an alternative as well.

[Kevin Reddington]

Were you aware that she was offered hydroxyzine before?

[Rebecca Jollotta]

I was not aware of that.

[Kevin Reddington]

Was she willing to try the hydroxyzine?

[Rebecca Jollotta]

No.

[Kevin Reddington]

And so what was her preference?

[Rebecca Jollotta]

Her preference was to continue with the mercury, the mirtazapine, the Remron 15mg, and with the as needed lorazepam.

[Kevin Reddington]

And just so we kind of stay with the same terminology when you're talking lorazepam.

[Rebecca Jollotta]

Sorry, Ativan. Yeah.

[Kevin Reddington]

And that was something that she expressed to you?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

Now, when you're dealing with a patient, and obviously this is your first interaction with her, right? Mm. Do you take into account your contact and communication with them in assessing whether they have the ability to make these choices or make informed decisions?

[Rebecca Jollotta]

Absolutely.

[Kevin Reddington]

And so your conversation with her about her medication treatment that she had received and what you were proposing as a plan, was she able to engage with you in that conversation? Yep. And.

[Rebecca Jollotta]

Sorry, it was collaborative.

[Kevin Reddington]

And so when she declined the options that you first offered, did you then present her with alternatives?

[Rebecca Jollotta]

I did.

[Kevin Reddington]

And ultimately, at the end of the day, whose choice is it as to what medication regimen person would be on the patient, and why is that?

[Rebecca Jollotta]

Because they have autonomy in their decisions. I'm only making recommendations based on my education, experience, training, what I'm seeing in terms of symptoms, the patient has the autonomy.

[Kevin Reddington]

Are there instances where you're dealing with a patient where you have concerns that they shouldn't have autonomy or that maybe if I rephrase that question, are there instances where you're dealing with a patient where you're concerned that they don't have the ability to make the right choice for themselves?

[Rebecca Jollotta]

There would be, yeah.

[Kevin Reddington]

And what options do you have in those instances?

[Bluff (Ad Speaker)]

You know what? It sucks to be bored. But when I get on my phone and play real casino games on spinquest.com, the time flies by. That two hour wait at the DMV seems like 10 minutes. Play your favorite spots. Live blackjack, Live craps with a live dealer. New players. $30 coin packs are on sale for 10 bucks. Play spinquest.com and you'll never be bored again.

[Judge William Sullivan]

Spinquest is a free to play social casino void where prohibited. Visit spinquest.com for more details.

[Nanit Ad Speaker]

When you're a maintenance engineer in a beverage Manufacturing plant. You keep production lines moving and quality on track because there is no room for slowdowns. With Grainger's vast selection of high quality motors, sensors, belts and hard to find parts, you can get what you need fast and all in one place. So nothing gets in the way of getting the job done. Call 1-800-granger. Click granger.com or just stop by Granger for the ones who get it done.

[Rebecca Jollotta]

In those instances, I mean that, that sort of comes down to like competency, capacity to make decisions. Sometimes we might get our legal or ethics team, like involved to make a determination about whether this patient needs like a healthcare proxy to make their decisions, things like that.

[Kevin Reddington]

And what about if a person presents with a very serious risk to their own physical health or the health of others? What are your options then?

[Rebecca Jollotta]

I guess it would depend, you know, if they had capacity to make their decisions.

[Kevin Reddington]

In your interaction with her on November 29, did you also go through with her and perform a mental screening test or a mental status screening?

[Rebecca Jollotta]

I did.

[Kevin Reddington]

And why do you do that?

[Rebecca Jollotta]

It gives me some like, objective data of how the patient presents. Like how is their speech, how's their appearance, what is their thought process, what's their thought content, things of that nature.

[Kevin Reddington]

And in this meeting on November 29th of 2022, did you observe anything in which she displayed manic symptoms?

[Rebecca Jollotta]

No.

[Kevin Reddington]

And what traditionally are manic symptoms that you look for?

[Rebecca Jollotta]

So there's a new mnemonic called dig fast. Try to do this quick. D is distractibility. Patient is highly distracted to lots of extraneous stimuli. There is pressured speech, grandiosity. So like suddenly someone's like, I'm going to run for office, I'm going to be the president. And you're like, okay, you've never had an interest in that before. Sleep is really poor. So somebody might get like two hours of sleep but be like, go, go, go, go, go. Increased goal directed activity. So somebody might be like painting the exterior of their house. Painting the interior of their house. They might be, you know, doing a bunch of different projects with no, like decompression time or feeling tired. Those are the general symptoms of mania. Sometimes there can be psychosis associated with it as well.

[Kevin Reddington]

Okay, and so when you say mania and psychosis, are those two different things?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And so are you also looking in these screenings to identify signs of psychosis?

[Rebecca Jollotta]

Absolutely.

[Kevin Reddington]

And what would be signs of psychosis?

[Rebecca Jollotta]

Usually signs of psychosis, they can be sort of subtle. It might look like somebody's like responding to, you know, stimuli in their in their head, like basic, based on the way that their eyes are kind of tracking and they're not really paying attention, they may be quite guarded. They may have a delusional thought process. Like, for example, they might think that, like, somebody's out to get them when there's really no like basis.

[Kevin Reddington]

When you say responding to internal stimuli is that generally when a person hears things, auditory hallucinations, or sees things that aren't there, and in addition to kind of watching for these things, in your interaction, do you flat out ask somebody if they're experiencing those symptoms?

[Rebecca Jollotta]

I do.

[Kevin Reddington]

And in this first interaction that you had with Lindsey Clancy on 11 29, did she display any psychotic symptoms? No. What about assessing for suicidality, do you do that? And what do you do for that?

[Rebecca Jollotta]

I generally ask, you know, are you having any thoughts of wanting to hurt yourself or anybody else? And if the answer is yes, it sort of becomes a more in depth assessment.

[Kevin Reddington]

Do you go back and ask them about past thoughts, whether they've articulated that? And in this case with Ms. Clancy, did she ever indicate whether she had a history of having suicidal thoughts or suicidal ideation?

[Rebecca Jollotta]

She did not.

[Kevin Reddington]

And how about homicidal ideation? Do you ask about that?

[Rebecca Jollotta]

I do.

[Kevin Reddington]

And in this instance, did she indicate whether she had any homicidal ideation or thoughts of harming other people?

[Rebecca Jollotta]

No.

[Kevin Reddington]

And as far as your observations of her presentation, like her mood and physically, how she presented, did anything stand out to you as far as any of that,

[Rebecca Jollotta]

she appear. She seemed anxious.

[Kevin Reddington]

Okay.

[Rebecca Jollotta]

Can I remember?

[Kevin Reddington]

Okay. So as far as mood.

[Judge William Sullivan]

Sorry, I couldn't hear that.

[Jennifer Sprague]

If she can finish your answer? Sure.

[Judge William Sullivan]

Are you done with that? Okay.

[Jennifer Sprague]

All right.

[Kevin Reddington]

So as far as mood, you noted her to be anxious, right?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And you also look at a person's affect and did you have to answer yes or no?

[Rebecca Jollotta]

Yes. Sorry.

[Kevin Reddington]

You observed her. Her affect to be consistent with her mood, which you identified as anxious. Right. And you examined somebody. Yes. Sorry. That's okay. Thought process. Right?

[Rebecca Jollotta]

Right.

[Kevin Reddington]

And did you. What. What did you observe her thought process to be?

[Rebecca Jollotta]

I observed her thought process to be linear, meaning you could follow it, her train of thought easily and goal directed. She understood that she was there to be assessed for treatment, seemed to be her goal.

[Kevin Reddington]

And do you also perform other screenings like the Generalized Anxiety Depression Scale in the Edinburgh scale?

[Rebecca Jollotta]

I do.

[Kevin Reddington]

And did you do that for Lindsey Clancy on November 29th?

[Rebecca Jollotta]

I did.

[Kevin Reddington]

And what were the results of those screens?

[Rebecca Jollotta]

Her Edinburgh. So the Edinburgh scale is out of 30, she was 17.

[Kevin Reddington]

What does that mean?

[Rebecca Jollotta]

Moderate to severe symptoms, postpartum depression.

[Kevin Reddington]

Now, with that particular screening tool that you can use, is it fair to say that with postpartum women it often fluctuates?

[Rebecca Jollotta]

It can. The patient is asked about the previous seven days.

[Kevin Reddington]

And as far as the Generalized Anxiety Depression Scale, what were the results of that screen?

[Rebecca Jollotta]

14 out of a total of 21.

[Kevin Reddington]

And so what does that mean?

[Rebecca Jollotta]

That would mean moderately severe anxiety.

[Kevin Reddington]

And do you recall about how much or how long your interaction with her was on this telehealth visit?

[Rebecca Jollotta]

It would have been 30 minutes.

[Kevin Reddington]

And as a result of your interaction with her, did you come up a plan, come up with a plan moving forward as to what to do to address her issues or her concerns?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

What was the plan?

[Rebecca Jollotta]

Continue Rembron, 15mg, nightly Ativan as needed. Those medications had been prescribed to her already. I did not write her any prescriptions at that visit.

[Kevin Reddington]

And again, you indicated that you kind of encouraged her to stick with the Remeron and give it a chance to work.

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

Was she receptive to doing that?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And as far as, again, the sleep issue, based on your conversation with her and her request to continue with the Ativan, that's what you recommended?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

Did you also recommend other types of treatment that were not pharmacological?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And what were those?

[Rebecca Jollotta]

I recommended therapy, mindfulness, physical activity, meditation.

[Kevin Reddington]

And you're aware that in the past she had reported physical activity was something that had been helpful to her?

[Rebecca Jollotta]

Yes. I believe with her postpartum period with Dawson, her middle child, she had some anxiety, but it seemed to resolve with exercise in particular

[Kevin Reddington]

and fair to say, as it pertains to that experience, or postpartum with Dawson, she had reported at some point to the clinic that she had sought medication after having Dawson and that she didn't end up taking that medication, right?

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

Now, after this particular follow up, what's your practice when you're dealing with a patient to. To have them have an intervention if they need to get in touch with you or they have concerns before your next scheduled meeting?

[Rebecca Jollotta]

I generally advise for non emergencies, you can message me on the EPIC portal.

[Kevin Reddington]

Is that generally referred to as Mychart?

[Rebecca Jollotta]

Mychart, yeah.

[Kevin Reddington]

And so Mychart, you could kind of go back and forth with messages, right?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

Did you encourage Lindsey to utilize Mychart if she felt the need to reach out to you before your next scheduled appointment?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And at the end of that meeting, what was the plan for the next scheduled appointment? What was the track that you would ask her to Be on as far as regular visits, one week. And is that typical? One week?

[Rebecca Jollotta]

One to two weeks would be typical for a new patient.

[Kevin Reddington]

And based on her report of symptoms or potential symptoms, was it important to you to identify if there were any changes?

[Rebecca Jollotta]

Absolutely.

[Kevin Reddington]

Now, were you aware by the time that meeting was completed that she did have an appointment scheduled with a social worker at your clinic, letitia Dukes, for December 2nd?

[Rebecca Jollotta]

I was aware of that, yes.

[Kevin Reddington]

Now, after this meeting. So this is approximately 10:30 in the morning on 11:29, right?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

Did you have communication or contact with Lindsey Clancy on November 30th?

[Rebecca Jollotta]

I did.

[Kevin Reddington]

How did you have contact with her on that day?

[Rebecca Jollotta]

She messaged me on the My Chart portal.

[Kevin Reddington]

And you're aware that on that particular morning, Julie had informed her that she was leaving?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

Or were you aware? I should say yes. Now, when Lindsay messaged you, that was at 11am that was the first message? Correct.

[Rebecca Jollotta]

I would have to look at the note for the time.

[Kevin Reddington]

Okay. Do you have those?

[Rebecca Jollotta]

I do have the messages, I think I believe to be accurate. It was 11am Yep.

[Bluff (Ad Speaker)]

Forget whatever plans you have this weekend because you're staying at home and playing on Spin Quest. And there's never been a better time to sign up than right now. New users get 30 coin packs for just $10. All the table games you love with hundreds of slot games and real cash Prizes. That'[e-mail] Sports

[Judge William Sullivan]

Spinquest is a free to play social casino void where prohibited. Visit spinquest.com for more details.

[Grainger Ad Speaker]

Grainger knows. When you're a procurement manager for an office park, you're not managing one building, you're managing all of them. And to stay ahead, you need to see through walls and around corners. Lights about to fail, filters ready to clog H Vac on its last leg. If you wait until something breaks, you're already behind. Count on Grainger for quality products, easy reordering and 24. 7 support. Call 1-800-Grainger click granger.com or just stop by Grainger for the ones who get it done.

[Kevin Reddington]

And did she ask you something specific in that message?

[Rebecca Jollotta]

She did.

[Kevin Reddington]

What did she ask you?

[Rebecca Jollotta]

She asked me if it would be safe to stop taking Remron after five nights.

[Kevin Reddington]

So you had just met with her on November 29th?

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

And talked about stopping Remeron or talked about the concerns with Remeron?

[Rebecca Jollotta]

We talked about continuing it on the 29th. Yes.

[Kevin Reddington]

But as far as the starting of that meeting or you were talking with her about the medication, she had already reported concerns with that medication, right?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And so you encouraged her to stick with it, and then the next day she's asking to stop again?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

Do you recall that in that message she indicated that in the course of that night that the depression. She felt like the depression was much, much worse and not helping her sleep and that she only got two hours?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And she asked for a phone call from you, right?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And did you call her back or did you message her back?

[Rebecca Jollotta]

I messaged her back, but I also believe I had my nurse call her back because I was in between patients.

[Kevin Reddington]

Okay. And so when you messaged her back, what did you ask her about to address that concern about stopping the Remeron after five nights, I asked her what

[Rebecca Jollotta]

symptoms of depression did she notice was

[Kevin Reddington]

worsening, and why did you do that?

[Rebecca Jollotta]

Because she had mentioned that she felt that she was more depressed. She was attributing it to the medication.

[Kevin Reddington]

But in her original message, did she give you any detail about what was worse?

[Rebecca Jollotta]

Yeah. No, she did not. Sorry.

[Kevin Reddington]

Is it important to you to know what symptoms are worse so that you know how to advise the patient?

[Rebecca Jollotta]

Absolutely.

[Kevin Reddington]

And did you again express to her a concern with stopping that particular medication after the short period of time she had been on it?

[Rebecca Jollotta]

Yes. I shared with her that from what I understood, there had been really short medication trials since October, you know, a short course of the Zoloft, short course of Trazodone, and now what would be a short course of the Rembron. And I reiterated that sometimes it can take four to six weeks before these treatments start to work.

[Kevin Reddington]

And you also knew from Julie Paul that she had only taken Prozac for approximately four days?

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

So even though you gave her that information and encouraged her to stay with it, did you suggest an alternative?

[Rebecca Jollotta]

I did.

[Kevin Reddington]

And why did you suggest an alternative?

[Rebecca Jollotta]

At this point, I'm trying to establish a therapeutic relationship with her as a patient. So I had met with her on the 29th. She's concerned about the Mirtazapine. I'm kind of asking her to hang with me on it and give it a chance, but then the next day she's asking me again that she really doesn't like it. So at this point, I'm trying to kind of give her an alternative, to establish a collaborative therapeutic relationship.

[Kevin Reddington]

And at the end of the day, if you prescribe a medication and the patient doesn't want to take it, you don't know if they're going to take it, Right?

[Rebecca Jollotta]

Exactly.

[Kevin Reddington]

So what was the alternative you suggested?

[Rebecca Jollotta]

I had suggested Prozac. Again, just because I had known that she had taken it in, like, 2012, whenever she was in nursing school, and she was able to take it for a year, and she tolerated it. Okay. So I was kind of thinking, maybe we can try to get you to retrial it, and it would be helpful.

[Kevin Reddington]

And in making that recommendation to potentially restart it, had you reviewed the notes from Julie Paul in which the defendant, or Lindsey Clancy, indicated that when she took the Prozac, she felt disconnected and that she was concerned about that and that Julie had told her to stop it?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

But you still felt that it was worth giving it another try? And did you suggest anything else to pair with the Prozac to help sleep?

[Rebecca Jollotta]

I did.

[Kevin Reddington]

What did you suggest?

[Rebecca Jollotta]

I recommended Seroquel, 25 milligrams.

[Kevin Reddington]

And now Seroquel, is that a drug that you're familiar with?

[Rebecca Jollotta]

I am.

[Kevin Reddington]

And in your practice, especially dealing with women's health perinatal issues, what would a low dose of Seroquel accomplish for a woman postpartum to get them to sleep? And you are aware that Seroquel at higher doses could be used to treat other types of mental illnesses?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

But in this circumstance and with this recommendation, what was the purpose of the Seroquel?

[Rebecca Jollotta]

So at this stage, my awareness was that she had tried a first line option, which would be the benzodiazepine. The second line options are usually what we call the sedating antidepressants like Trazodone, Remeron. So this would be more like a third line option to try.

[Kevin Reddington]

And is that because Trazodone she reported, didn't help her? Didn't help, and she didn't like the feeling on Remeron?

[Rebecca Jollotta]

Right.

[Kevin Reddington]

And so ultimately, in that message, you kind of reiterated what your overall recommendations were, right?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And it was to continue with the remeron for another 10 days, and that the alternative would be to restart Prozac and add the 25 milligrams of Seroquel nightly for anxiety and insomnia.

[Rebecca Jollotta]

Is that correct?

[Kevin Reddington]

Yes.

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And so were you recommending that she be on all of those at the same time, that she do the Remeron, the Seroquel, the Prozac?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And in your experience in psychiatric care and prescribing medication, is it a common practice to pair low doses or doses of particular types of medications together to effectively manage a person's symptoms at this clinical juncture?

[Rebecca Jollotta]

My thought was the combination of Remeron with the Prozac to treat the depression with prominent anxiety, the Seroquel to Help alleviate the symptoms, sleep.

[Kevin Reddington]

And you're also addressing the concern of benzodiazepine dependency.

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

Did you encourage her to do something to help you to kind of manage her treatment track going forward?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

What did you encourage her to do?

[Rebecca Jollotta]

I had noticed that Lindsay was attributing a lot of her symptoms to her medication. And so I attached to the my chart message two different mood charts. And what those moods? One was daily, one is weekly. What it is, is it asks the patient each day to rate their mood from like zero to three. You know, good mood, bad mood, normal mood. It asks about like, did you take your medications? What doses, what were they? Check the box. How many hours a night did you sleep? Sleep? What's your anxiety level, what's irritability? And what I wanted from that was because it had all those parameters about mood and then also the medication, did you take it? We'd be able to track over time what the progression was. Was it getting worse since we started the medication, was it actually getting better? I just wanted more data.

[Kevin Reddington]

And were you aware that she was actually tracking those things herself?

[Rebecca Jollotta]

No.

[Kevin Reddington]

No. You continued to have some back and forth messages with her throughout the course of the day on November 30, correct?

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

So we have. She reached out to you at 11, you responded to her at 11:52.

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

There's another message from her at 12:15, right?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And just going back for a second, when you were asking her about worsening symptoms, did you ask specifically about suicidal symptoms?

[Rebecca Jollotta]

I did.

[Kevin Reddington]

And why those? If she was expressing some depression and sleep issues?

[Rebecca Jollotta]

Suicidal thoughts can, are a symptom of. Can be a symptom of depression. And I just wanted to make sure I assessed that one because it's. Because of its severity.

[Kevin Reddington]

And is that something that's important to do before you make a recommendation to change a medication?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

Now, when she responded at 12:15, did she tell you anything about the suicidal thoughts or if she was having any?

[Rebecca Jollotta]

She said she's not at the point of being suicidal.

[Kevin Reddington]

Okay. She also indicated, but I'm really feeling as if I can't go on like this. Right, right. And she asked you to call in the seroquel?

[Rebecca Jollotta]

She did ask me to call in the circle, yes.

[Kevin Reddington]

So based on her response, did you feel that she was taking the alternative that you were offering?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And then at 12:29pm you get another message from her where she asks for a phone call, right?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And again, at that point, did you have a phone call with her? Did you continue to interact with her on the my chart.

[Rebecca Jollotta]

I interacted with her on the my chart between patients and I had my nurse give her a call.

[Kevin Reddington]

And again, you said in between patients. So did you have the opportunity to pick up the phone and call?

[Rebecca Jollotta]

I did not.

[Kevin Reddington]

And is that one of the benefits of the messaging portal that you can get to somebody, get back to somebody quicker?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

So when, Before you were able to respond, did she send you some additional messages on my chart, if you remember, or if you could look at your notes.

[Jennifer Sprague]

Okay,

[Rebecca Jollotta]

I see.

[Jennifer Sprague]

Oh, I have had no luck lately.

[Grainger Ad Speaker]

Wait.

[Kevin Reddington]

Lady luck.

[Rebecca Jollotta]

Ritzki.

[Bluff (Ad Speaker)]

I got you.

[Rebecca Jollotta]

I've had so much luck on spinquest.com they have all of my favorite games, slot games, live blackjack, craps, and bubble craps. You can even get a 30 coin pack for just 10 bucks.

[Jennifer Sprague]

10 bucks for 30.

[Kevin Reddington]

I'm headed over to spinquest.com right now.

[Judge William Sullivan]

Spinquest is a free to play social casino void where prohibited. Visit spinquest.com for more details.

[Grainger Ad Speaker]

Granger knows when you're a procurement manager for an office park, you're not managing one building, you're managing all of them. And to stay ahead, you need to see through walls and around corners. Lights about to fail, filters ready to clog H Vac on its last leg. If you wait until something breaks, you're already behind. Count on Grainger for quality products, easy reordering and 24. 7 support. Call 1-800-GRAINGER click grainger.com or just stop by Grainger for the ones who get it done.

[Rebecca Jollotta]

The symptoms of depression that she reported?

[Kevin Reddington]

Yep. So just drawing your attention to 12:58pm yes. You get another message from her where she says the symptoms of depression that are much worse are just feeling completely hopeless and unmotivated to do anything at all. And that she says, I printed the daily mood chart and we'll start it. Now. You said that you did ask your nurse to give her a phone call at some point, and so you're aware that a nurse did call her on November 30, approximately 3:10pm yes. And that during that phone call that Lindsey agreed to the plan and that she was going to pick up the Seroquel?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

Now, at that point, you had another meeting scheduled with her for a week out. Right. But prior to that, did you also continue to communicate with her via MyChart?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

So moving into December 1st, again, were you able to send her a message?

[Rebecca Jollotta]

She sent me a message on December 1st and I did reply to it.

[Kevin Reddington]

Okay, so December 1st at 12:20pm we have a message From Lindsey Clancy. Hi, Rebecca. I really don't like the way I feel on the Remaron. And I know that I can't see. Stick with it or I can't stick with taking it. I started having very intrusive thoughts that I never had before. I didn't take it last night. I would really like to go back to Julie's original plan of Prozac in the morning and using Ativan and Benadryl at night as a band aid until I get to a therapeutic level of Prozac. Please let me know if you agree with this plan. I know that I need to give it a good couple of weeks to work. Is that the message that you first received on December 1st?

[Rebecca Jollotta]

It was.

[Kevin Reddington]

And were you aware that that same day that Lindsey had reached out to her primary care physician asking for an immediate appointment with her nurse practitioner?

[Rebecca Jollotta]

I was.

[Kevin Reddington]

And that she was looking to discuss medications?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

Do you know if she actually got an appointment or went to the appointment there?

[Rebecca Jollotta]

They had reached out to her and she did not respond to their voicemails or MyChart messages. So she did not see them that day, to my knowledge.

[Kevin Reddington]

So you're able to review the notes from the network of South Shore Health, correct?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

So you were able to review that she asked for an emergency appointment. They were able to find her an emergency appointment, but she didn't get the back in enough time to actually get there.

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

And so in the meantime, you're having a back and forth with her during the course of that day, December 1st?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

When she indicated to you in this message on December 1st first about having intrusive thoughts and not liking the Remeron and not taking it, what was your response?

[Rebecca Jollotta]

I sent her a detailed message of signs and symptoms of postpartum depression and anxiety, including factors like onset, risk factors, predictors, common symptoms. And it highlighted how intrusive thoughts are are quite common in postpartum depression, anxiety. And I asked her, you know, I'm wondering if that's what's going on here. I then asked her if she was able to take the Seroquel that night and if she noticed any improvement in terms of sleep or anxiety with the Seroquel.

[Kevin Reddington]

Now, by giving you this information about postpartum depression and postpartum anxiety, was that consistent with a diagnosis that either you or Julie had given her in coming into the clinic?

[Rebecca Jollotta]

Yes. We were thinking this could be some postpartum anxiety. And I wanted to familiarize her with the symptoms so that she had them written down and she could report them to me and understand that they are part of these disorders.

[Kevin Reddington]

And you also gave her some information about obsessions and compulsions, Right.

[Jennifer Sprague]

Mm.

[Kevin Reddington]

And you said you asked her about the Seroquel and asked about sleep, right?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And did you also reiterate that you were still encouraging to keep up with the Remaron for a period of time? Yes. And you further indicated to her that you wanted to kind of see if there was a correlation between the symptoms and the medication and that you just didn't have enough data.

[Rebecca Jollotta]

Right.

[Kevin Reddington]

In response to that message, she actually responded at 2:36 on December 1, correct?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And she indicated, thank you for the information. It was helpful that she says, I panicked last night and just took Ativan and Benadryl, but tonight I'll stick with the plan and try the 15 of Remeron and the 25 of Seroquel. Do you recall if you had ever had a conversation with her about kind of using Ativan and Benadryl as a backup or if she just felt like she wasn't getting any relief?

[Rebecca Jollotta]

I recall having a conversation about using the Ativan as a backup. I believe it was. Yeah. Well, yes, in my initial. I said, continue the Rembrandt and the Ativan as needed.

[Kevin Reddington]

Okay.

[Jennifer Sprague]

Yeah.

[Kevin Reddington]

And what about the Benadryl?

[Rebecca Jollotta]

The Benadryl I don't recall discussing.

[Kevin Reddington]

But you were aware that she had reported the combination of Ativan and Benadryl had worked for her before.

[Rebecca Jollotta]

Right.

[Kevin Reddington]

And in that message, she also says, I'm sorry for all the messages. It's just a scary, very scary, stressful time for me. And starting new meds with side effects is very scary to me. I'll check in in the morning and let you know how it went. Right, right. And again, you continued to have some contact with her on that same day after that?

[Rebecca Jollotta]

I. I believe I responded to that, reassuring her that it's understandable to have fears, concerns about starting medications. And I sent her a detailed description of common question and answers I get from patients about medications. Things like what to expect, how long does it take to work, what are common side effects, risks first, you know, is there any risk for suicide, homicide with medications?

[Kevin Reddington]

You know, so in providing all this information with her, what were you trying to do?

[Rebecca Jollotta]

Provide information because she had said it was so scary starting medication. So I wanted her to be equipped with understanding and, you know, what to expect, possibly.

[Kevin Reddington]

And based on your interactions with her and your review of Julie Paul's interactions with her, this was a person that was very receptive to taking information, right?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And as her role as a nurse, she was not afraid to ask questions. Is that fair? No.

[Rebecca Jollotta]

Yes, she was not afraid.

[Kevin Reddington]

And one of the things that you provided her or the information you provided her in this detailed response back to her on December 1 at 304 was that there are other sources or resources that she could utilize that are available at the clinic, right?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And.

[Rebecca Jollotta]

Oh, go ahead. Yep. Yes. Yes. I instructed her that we had copies of these books that we were giving out to patients and that she should come grab them when she was in clinic. And she informed me she would be seeing Leticia the next day for counseling, so she would grab them when she was there.

[Kevin Reddington]

Okay. And so that day, December 1st, fair to say, you went back and forth with her from about 12:30 to her last message, she was at 4:37 that day?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And you said that she indicated that she did have an appointment the next day with Letitia Dukes.

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And were you aware of whether that was an in person meeting?

[Rebecca Jollotta]

Yes, it was in. In person because she said, I'll be in clinic, I'll be able to get those resources. Okay.

[Bluff (Ad Speaker)]

You know what? It sucks to be bored. But when I get on my phone and play real casino games on spinquest.com the time flies by. That two hour wait at the DMV seems like 10 minutes. Play your favorite spots. Live blackjack, live craps with a live dealer. New players, 30 coin packs are on sale for 10 bucks. Play spinquest.com and you'll never be bored again.

[Judge William Sullivan]

Spinquest is a free to play social casino void where prohibited. Visit spinquest.com for more details.

[Nanit Ad Speaker]

When you're a maintenance engineer in a beverage manufacturing plant, you keep production lines moving and quality on track because there is no room for slowdowns. With Grainger's vast selection of high quality motors, sensors, belts and hard to find parts, you can get what you need fast and all in one place. So nothing gets in the way of getting the job done. Call 1-800-granger. Click granger.com or just stop by Granger for the ones who get it done.

[Kevin Reddington]

So moving to December 2nd, you didn't have a scheduled appointment with her, correct?

[Rebecca Jollotta]

I did not.

[Kevin Reddington]

And you knew she was going to see Leticia that morning in clinic, right?

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

And you received several messages from her that morning?

[Rebecca Jollotta]

I did.

[Kevin Reddington]

Again through the My Chart portal.

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

Beginning at 7:51am where she sends you a message saying, hi, Rebecca, I took the 15 Remeron and 25 Seroquel. I woke up at 12 with horribly intrusive thoughts of wanting it to be all over. I took 1mg Ativan and went back to sleep and the thoughts went away. Now that I have the Ativan on board, I really need to explore the option that I'm addicted to Ativan. I have a therapy appointment with Leticia in your office. I would really like to speak with someone in the substance use clinic to explore the option. Do you recall getting that message?

[Rebecca Jollotta]

I do.

[Kevin Reddington]

And did you respond to that message?

[Rebecca Jollotta]

I did. I am credentialed at Cell Health and Addiction Medicine, so I felt that I could be that person to discuss those concerns with her.

[Kevin Reddington]

Discuss the substance use concerns and so. And you're aware that the social workers can also screen for those as well?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

So at 8:51 on December 2nd, you respond to her, right?

[Rebecca Jollotta]

I did.

[Kevin Reddington]

And what do you tell her about the concern she just expressed in her 751 message?

[Rebecca Jollotta]

I fully appreciate and understand the concern for benzo tolerance. It's not something I want to happen to my patients ever. That being said, there's a place for benzodiazepines, especially at the beginning, an acute phase of treatment and getting someone stable. And then we would always pull back slowly. I think another thing to try tonight would be to take 50 milligrams of Seroquel, the two tablets, and see if that works better. The intrusive thoughts are part of postpartum depression, anxiety. Very painful to think and experience. But I want to reassure you that it's not uncommon and mean nothing about who you are as a mother. Let me know what you think.

[Kevin Reddington]

And so the recommendation from 25 to 50 milligrams of Seroquel, is that still within the range for treatments for insomnia?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

So would you characterize that as a low dose, a high dose, a low dose. And as far as her statement about intrusive thoughts, fair to say your response doesn't ask her more specifics about those thoughts, right?

[Rebecca Jollotta]

No.

[Kevin Reddington]

But you reiterate to her, just as you had in the lengthy messages where you provided information, that intrusive thoughts are pretty common.

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

Now, did she respond to that message?

[Rebecca Jollotta]

She did.

[Kevin Reddington]

And so at 9:04 on December 2, there's a response from Lindsey Clancy. I'm willing to try anything. I just keep coming back to the feeling that I'm dependent on Ativan. After my two and a half weeks of taking it daily with Benadryl following the bad reaction to Zoloft, I feel addicted to it and I feel like I'm not being heard that that is a possibility. I feel like we are throwing all these different meds at my insomnia. When the root cause is Ativan dependence, I don't feel any of the anxious thoughts I had before. I feel completely numb. So you got that message from her at 9:04, correct?

[Rebecca Jollotta]

I did.

[Kevin Reddington]

And what was your concern when you got that message? Or did you have any concern? I

[Rebecca Jollotta]

wouldn't say I had concern. I just wanted to again provide her some information about what I thought might be happening.

[Kevin Reddington]

Based on your training experience as a psychiatric nurse.

[Jennifer Sprague]

She didn't finish her answer. Please.

[Judge William Sullivan]

Okay, yeah, go ahead.

[Rebecca Jollotta]

I was finished.

[Judge William Sullivan]

Okay, well, she's finished. Next question.

[Kevin Reddington]

Based on your training and experience as a psychiatric nurse, and you said you had some experience with substance use, did you feel that there was a dependency issue or an addiction issue with Ativan?

[Rebecca Jollotta]

I did not.

[Kevin Reddington]

Is it fairly common that Ativan is going to make somebody feel better if they're feeling anxious?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

That's why you take it, right?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And that's why you take it as needed. Is that fair to say?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

So in your response to her at 9:37, do you make clear to her the difference between dependence and addiction?

[Rebecca Jollotta]

I do.

[Kevin Reddington]

Okay. And as far as benzodiazepines go, there is a real concern for dependence and addiction in the fields. Is that fair to say?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

But based on taking it for two and a half weeks, taking it to address actual symptoms of anxiety, did you have a concern of dependence?

[Rebecca Jollotta]

No.

[Kevin Reddington]

And so did you articulate to her that anything about that concept of dependence versus addiction. What did you say?

[Rebecca Jollotta]

I said, I wonder if you fear you're becoming dependent on the benzodiazepines. And there's a subtle difference between dependence and addiction. With addiction, there's a change in behavior caused by biochemical changes in the brain. After continued substance abuse, the substance use being becomes the main priority of the person with the substance use disorder, regardless of the harm it causes to themselves or others. With dependence, we're referring to physical dependence on a substance characterized by symptoms of tolerance. Oops, sorry. Characterized by symptoms of tolerance and withdrawal. Benzodiazepine withdrawal is similar to alcohol withdrawal symptoms. We would be seeing things like elevated vital signs, high blood pressure, tachycardia, diaphoresis, mild alteration of mental status initially with a possibility of perceptual disturbances, delirium, dysphoria and tremors. Did the insomnia predate the Ativan use? I hear your concerns about the benzos so my recommendation is do not take them every night. I recommend taking only every other night, and then we will not refill it.

[Kevin Reddington]

And so what's diaphoresis?

[Rebecca Jollotta]

Sweating.

[Grainger Ad Speaker]

Okay.

[Kevin Reddington]

And in the field of prescribing psychiatric medications, do you often have to deal with physical dependency and then addressing it later?

[Rebecca Jollotta]

I wouldn't say often.

[Kevin Reddington]

Is there a way to address that?

[Rebecca Jollotta]

Absolutely, yeah.

[Kevin Reddington]

And so that wasn't a concern of yours regarding Ativan, was it?

[Rebecca Jollotta]

Not at that time.

[Kevin Reddington]

And what about her statement about not being heard? Did you see that in her message where she says, I feel like I'm not being heard about addiction?

[Rebecca Jollotta]

That being a possibility.

[Kevin Reddington]

As a psychiatric nurse practitioner dealing in psychiatric medicine, is it important to you when a patient tells you that I don't feel I'm heard?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And do you take that in consideration when addressing them and continuing to build that relationship?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And so in this case, with the defendant, with Lindsey Clancy, did that change your approach with her at all? I.

[Rebecca Jollotta]

It's why I sent the message that I did, trying to explain what addiction versus dependence intolerance is. And I wanted to reassure her that we will try to have you take these less frequently and we don't need to continue them moving forward.

[Kevin Reddington]

So she advocated for herself, and you took that into consideration and created an alternative plan or suggested an alternative plan?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

Did your care of her change at all when she told you she wasn't being heard?

[Rebecca Jollotta]

I wouldn't say it changed.

[Kevin Reddington]

You treated her as you would any other patient, right?

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

Now, you continued to have messages with her throughout that day, is that fair to say?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And so at 10:02, you receive a message from her says the insomnia started from the Zoloft, but then after the two weeks of daily Ativan and Benadryl use, that's when the insomnia was at its worst. I've tried so many different sleeping aids at this point. Trazodone, Ambien, Remeron, Seroquel. And they all seem to barely touch the sleep until I take Ativin with them. So. So tonight I will try 15 of Remeron with 50 of Seroquel. I fear that if I wake up in the middle of the night with intrusive thoughts again, I will feel like I need Ativan. Do you recall her sending that message at 10:02?

[Rebecca Jollotta]

I do.

[Kevin Reddington]

And that she sent another message. It's kind of cut off, but it's still within the 10 o' clock hour, where she adds, I also just feel. I also just feel Concerningly numb right now, like I have no emotion whatsoever. I feel like I'm going to die and I don't care. What do I do about this?

[Rebecca Jollotta]

I do recall that message.

[Kevin Reddington]

Yes. And this is a message that she sent when she would have been or have seen Letitia Dukes already, right? If she had a 9 o' clock appointment, yes. When she sent that message to you, did you respond back to her at 11:35?

[Rebecca Jollotta]

I did.

[Kevin Reddington]

And with the fact that she talked about being numb and having no emotions, feel like I'm going to die and don't care. What did you do?

[Rebecca Jollotta]

I said this sounds like depression and anhedonia symptoms. I would say if you're feeling unsafe, particularly as we head into the weekend, it is important for you to have information for psych emergency services available to you. And I provided a list of the 24 hour emergency service programs like mobile crisis intervention.

[Kevin Reddington]

Okay, and when you say anhedonia, excuse me if I mispronounce that, what does that mean?

[Rebecca Jollotta]

Anhedonia is a symptom of depression where people are unable to feel pleasure. They might describe it as feeling numb. They're unable to look forward to things.

[Kevin Reddington]

And in her message where she says, I feel like I'm going to die and I don't care, did you take that as a suicidal thought or suicidal ideation?

[Rebecca Jollotta]

No.

[Kevin Reddington]

And so did you tell her to go to the ER right away?

[Rebecca Jollotta]

No.

[Kevin Reddington]

Did you have concerns that she needed to get a higher level of care at that moment when she sent that message?

[Rebecca Jollotta]

My concern about that statement was that I wanted her to have access to resources if it escalated or if she. If it worsened. So I made sure she had it okay.

[Kevin Reddington]

And

[Jennifer Sprague]

oh, I have had no luck lately.

[Grainger Ad Speaker]

Wait.

[Rebecca Jollotta]

Lady luck Bretzky.

[Bluff (Ad Speaker)]

I got you.

[Rebecca Jollotta]

I've had so much luck on spinquest.com they have all of my favorite games, slot games, live blackjack craps and bubble craps. You can even get a 30 coin pack for just 10 bucks.

[Jennifer Sprague]

10 bucks for 30.

[Kevin Reddington]

I'm headed over to spinquest.com right now.

[Judge William Sullivan]

Spinquest is a free to play social casino void where prohibited. Visit spinquest.com for more details.

[Grainger Ad Speaker]

Grainger knows. When you're a procurement manager for an office park, you're not managing one building, you're managing all of them. And to stay ahead, you need to see through walls and around corners. Lights about to fail, filters ready to clog. H Vac on its last leg. If you wait until something breaks, you're already behind. Count on Grainger for quality products. Easy reordering and 24. 7 support. Call 1-800-GRAINGER, click grainger.com or just stop by Grainger for the ones who get it done.

[Kevin Reddington]

Fair to say you also at the end of that message, indicate, are you able to get rest or reach out to your support system so that you can be helpful, so they can be helpful to you right now and that this is hugely important?

[Rebecca Jollotta]

I did say that, yes.

[Kevin Reddington]

And 11:41am she responds, yes, I have support. My parents are here to help. And Again, this is 12 2. Does this sound like side effects to Rembron or Seroquel? I have never felt like anything. Like I have never felt anything like this before. And then 11:57, she sends another message. Do you think over time these symptoms will go away over time? 1204, another message from her. Is there any chance you could give me a call to discuss when you have a minute at 12:10pm and just to confirm, your recommendation for tonight is 15 remeron, 50 seroquel, and avoid Ativan, even if I'm not sleeping. So you got those messages in succession, right?

[Rebecca Jollotta]

I did.

[Kevin Reddington]

And were you able to eventually respond to her with a phone call?

[Rebecca Jollotta]

I responded to the message at 12:12pm I wrote it down for her.

[Kevin Reddington]

And again, in your response to her, did you reiterate that these are pretty clear common signs of depression and that what she was expressing to you wasn't uncommon in women with postpartum depression?

[Rebecca Jollotta]

Correct. I said it sounds more like depression than side effects. It's not uncommon for me to hear, I've never felt anything like this before or I just don't feel like myself. All of this sounds like postpartum depression.

[Kevin Reddington]

And did you further try to give her some encouraging words?

[Rebecca Jollotta]

I shared a passage from book called this Isn't what I Expected.

[Kevin Reddington]

And is that book kind of centered around postpartum depression?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And did you also tell her, this is going to get better?

[Rebecca Jollotta]

I said, even though they feel terrible, remember that there are symptoms of an illness that is very real and very treatable. This is going to get better.

[Kevin Reddington]

And after that message on 12 12, did you in fact send her another message?

[Rebecca Jollotta]

I did.

[Kevin Reddington]

And fair to say that next message was to kind of address the concern about her question what to take.

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And you confirmed to take 15 milligrams Remeron, 10 milligrams Prozac and 50 milligrams Seroquel?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And that taking Ativan every other day might help?

[Rebecca Jollotta]

I said I would say taking Ativan every other day might help you to See, you are not addicted, as one cannot be addicted to something they don't take every day. But we can also decide to let me be concerned about whether you have a problem with the Ativan and simply take it nightly for now. And if I have concerns about your use of it, I will make them apparent to you. My primary concern at this time is that you sleep. And if that means taking the Ativan for middle of the night wake up, so that is what it means. I'm confident we can safely and successfully get you off Ativan in the near future. And then I also go on to make recommendations about if she does have trouble in the middle of the night, certain sleep hygiene techniques that she could do, like getting out of bed and doing something non stimulating, and then go back down to try to sleep again when you feel drowsy.

[Kevin Reddington]

So an alternative to medication, intervention.

[Rebecca Jollotta]

Yeah.

[Kevin Reddington]

And then at 1:40pm she responds, thank you, I'll stick with that plan. I really hope it works and to feel like myself soon, right?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And then at 2:35, you respond, we will follow you closely. We have lots of alternatives. If this for some reason isn't the combination, we'll find one that gets you back to feeling like yourself.

[Rebecca Jollotta]

I did say that, yes.

[Kevin Reddington]

In all your treatment of women, the women that you've treated with postpartum depression, is this common, that you have to kind of trial different plans in order to find the right one?

[Rebecca Jollotta]

Yes.

[Judge William Sullivan]

All right, Ms. Buckingham, it's 11 o'. Clock. Why don't we take the morning recess at this time?

[Jennifer Sprague]

All right, thank you.

[Judge William Sullivan]

So we'll take the break.

[Rebecca Jollotta]

Thank you.

[Jennifer Sprague]

Court, all rise, please.

[Judge William Sullivan]

All right, council, anything we need to discuss before the break? All right, so we'll be in recess for the morning recess at this time?

[Rebecca Jollotta]

Yes, thank you.

[Judge William Sullivan]

All right, we all sit for the jury.

[Kevin Reddington]

Yes, sir.

[Jennifer Sprague]

Bring in the jurors when you're ready. All right, jurors entering. This court's now in session. Please be seated.

[Kevin Reddington]

Your Honor, for the purpose of the record, we return back to the matter. Cornwall Press, Lindsay Clancy, all parties, including the 18 jurors.

[Judge William Sullivan]

All right, give me buggy in, please.

[Kevin Reddington]

Thank you. Nurse Gelato, when we broke, we were talking about your interaction via my chart with Lindsey Clancy on December 2nd of 2022, right?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And so the last one on December 2nd at 2:35pm was from you to her. And then on December 3rd, do you recall that a Mychart message was sent on that day at 7:24pm?

[Rebecca Jollotta]

I do.

[Kevin Reddington]

And you were able to Review that message some point after it was sent.

[Rebecca Jollotta]

I was.

[Kevin Reddington]

And she reports to you basically that she didn't want to wait till to let you know some things that were fresh in her mind. And it says, last night I didn't take Ativan. My dose had been the night before at 1am only slept about four hours at the beginning of the night, about 9:30 to 1:45. Then I dozed off or maybe another 45 minutes from 4:30 to 5. Today, all I had today, all day I had horrible intrusive thoughts and felt very. Excuse me, felt deeply depressed. I finally took a 0.5 of Ativan at 6pm and now the thoughts are gone and I feel good. You recall receiving that message?

[Rebecca Jollotta]

I do.

[Kevin Reddington]

Okay. And fair to say there were. There was no more communication between you and her until December 6th, correct.

[Rebecca Jollotta]

I believe December 3rd was a Saturday.

[Kevin Reddington]

And you actually were out of the office on the 5th with sickness?

[Rebecca Jollotta]

I was.

[Kevin Reddington]

But you are aware that Lindsey Clancy did reach out to the office on December 5th?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And that the nurse was able to respond to her to let her know that you were out sick, right?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And Lindsey Clancy responds at 8:30am that day that. That she would just reschedule. Excuse me. Lindsay reaches out to the nurse and says, that's fine, she'll reschedule. And that she in fact changed her appointment with Letitia Dukes to a virtual appointment for that day for December 5th?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

So on the 6th, when you return, did you have a scheduled meeting with Lindsey Clancy?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And on this particular meeting on December 6th of 2022, do you recall if that was an in person or virtual visit?

[Rebecca Jollotta]

It was an office visit.

[Kevin Reddington]

Okay.

[Rebecca Jollotta]

In person.

[Kevin Reddington]

And so just kind of looking at the note from that day from December 6, it says encounter date December 6. It says filed on December 7 in the under chief complaint history. Do you have it in front of you?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

The second paragraph says patient has verbally consented to this video visit. Is that just something that sometimes pre fills into the narrative?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

But your memory was that this was an in person visit?

[Rebecca Jollotta]

It was.

[Kevin Reddington]

Was the. Was Lindsay Clancy there by herself or with somebody else?

[Rebecca Jollotta]

She brought in her husband, Patrick.

[Kevin Reddington]

Had you met him before?

[Rebecca Jollotta]

I had not.

[Kevin Reddington]

Had you talked to him before?

[Rebecca Jollotta]

I had not.

[Kevin Reddington]

As part of your treatment plan or your course of treatment with Lindsey Clancy, was it your practice speak with collateral individuals?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And in this instance, did you feel a need to speak to collateral individuals up to this point?

[Rebecca Jollotta]

Not up to this point.

[Kevin Reddington]

If you did, would you have requested that of her yes. And do you need her express permission to do that?

[Rebecca Jollotta]

I do.

[Kevin Reddington]

So on this particular day, she presented with her husband, Patrick, correct?

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

And was there anything different about your approach to the meeting than your previous meetings with her?

[Rebecca Jollotta]

No.

[Kevin Reddington]

You still go through history. You go through how she's doing now you do your mental status exam, you do your screenings, right?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And so first, just let's talk quickly about the screenings. The Edinburgh screen. What was her score on this day when she came in? Do you remember?

[Rebecca Jollotta]

21.

[Kevin Reddington]

And the Gad 7, fair to say that screen was a 19?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

So would you say that it was pretty consistent with the last time that you saw her?

[Jennifer Sprague]

Objection. Which objection? My objection is that that's not right.

[Rebecca Jollotta]

Hey guys, lady luck here. Are you going on any road trips this summer? I know I'm going to be going on a bunch of road trips and being that I'm going to be passenger Princess, I Love playing on Spinquest.com Spinquest has all of my favorite slot games. Live blackjack, live craps. Head on over to Spinquest right now and get yourself a $30 coin pack for just 10 bucks.

[Judge William Sullivan]

Spinquest is a free to play social casino. Visit spinquest.com for more details.

[Nanit Ad Speaker]

When you're a maintenance engineer in a beverage manufacturing plant, you keep production lines moving and quality on track because there is no room for slowdowns. With Grainger's vast selection of high quality motors, sensors, belts and hard to find parts, you can get what you need fast and all in one place. So nothing gets in the way of getting the job done. Call 1-800-GRAINGER clickranger.com or just stop by Granger for the ones who get it done.

[Jennifer Sprague]

He's now got a 21 Edinburgh skill. Prior test testimony was not anywhere near 21. It's incredibly. It's deteriorated.

[Judge William Sullivan]

Well, I'm going to allow that question. On cross examination, you can certainly explore the basis of what her opinion was. So I'm going to allow that question. Go ahead. Come on.

[Kevin Reddington]

Well, let me ask you about that score of 21. It's 21 out of how much?

[Rebecca Jollotta]

30.

[Kevin Reddington]

So what? In what range is that?

[Rebecca Jollotta]

Moderate? Severe.

[Kevin Reddington]

Okay. And on your previous encounter with her, on your actual telehealth on November 29th, you reported that the score was 17 and that's moderate.

[Rebecca Jollotta]

Moderate, yep.

[Kevin Reddington]

And then on the GAD 7, on this particular day on December 6th, it was 19, right?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And on the previous visit it was 14.

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

Okay, so as far as your observations of her on December 6, did you notice anything different about her speech and language?

[Rebecca Jollotta]

No.

[Kevin Reddington]

How about her mood? What did you note her mood to be?

[Rebecca Jollotta]

Anxious.

[Kevin Reddington]

And the affect, fair to say, consistent with mood, meaning anxious, right?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And thought process?

[Rebecca Jollotta]

Thought process was linear and goal directed and thought content.

[Kevin Reddington]

Did she indicate to you whether she was experiencing any auditory or visual hallucinations?

[Rebecca Jollotta]

No.

[Kevin Reddington]

Any delusions?

[Rebecca Jollotta]

No.

[Kevin Reddington]

Any suicidal ideation, a plan or intent?

[Rebecca Jollotta]

No.

[Kevin Reddington]

And as far as your observations of her during this interaction, this in person visit, did you observe any signs of psychosis?

[Rebecca Jollotta]

No.

[Kevin Reddington]

Did you observe any signs of mania?

[Rebecca Jollotta]

No.

[Kevin Reddington]

Did you observe any signs of obsessive thoughts or compulsive behaviors?

[Rebecca Jollotta]

No.

[Kevin Reddington]

Now, when you met with Lindsey and Patrick on December 6, did she or did they report why Patrick was there?

[Rebecca Jollotta]

I don't recall if they indicated why he was there. I understood it to mean he was there to provide collateral and support for her.

[Kevin Reddington]

Were you aware that he was coming to the appointment?

[Rebecca Jollotta]

I don't recall if I was aware beforehand or not.

[Kevin Reddington]

And you had engaged in pretty significant my chart back and forth with her in the days preceding this, this meeting on December 6, right?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

Did she ever indicate to you, did she ever indicate to you in those messages that she wished to bring him along to one of the visits?

[Rebecca Jollotta]

No.

[Kevin Reddington]

And fair to say, when a person brings a collateral and is willing to have somebody speak, you're more than happy to get that information?

[Rebecca Jollotta]

Absolutely.

[Kevin Reddington]

This person, this collateral person, can they offer you a different perspective about the patient and what they're going through or what they're, how they're presenting?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

In this December 6th meeting or the visit, did she report to you some changes in her sleep or significant concern for sleep?

[Rebecca Jollotta]

I would have to review the note. What I remember is that the sleep really hadn't improved much beyond getting a few hours waking up in the middle of the night, maybe peaceing together. Okay, more time

[Kevin Reddington]

and fair to say there was some conversation to go back and talk about when symptoms started and try to get to kind of the root cause or what they believe the root cause of her symptoms were?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And did Lindsay and Patrick report to you the connection with the Zoloft medication in September as a concern?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And that at that they reported that or she reported that exact night I took went from 25 to 50 milligrams. I didn't sleep for 48 hours and I wasn't tired.

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

So that's in your note as a quote, meaning that's directly what she told you?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

Did you express to the Clancy on this particular meeting, did, did you express to Ms. Clancy, thoughts that you had about her diagnosis based on your interactions over the last few weeks?

[Rebecca Jollotta]

I did.

[Kevin Reddington]

And what was that?

[Rebecca Jollotta]

I discussed with her and her husband the possibility of potentially an underlying bipolar disorder. I based this on several factors, one of them being that she had such, what we call an activating response to the Zoloft. It's unusual for somebody to describe taking Zoloft and then going 48 hours without sleep and not being tired. So that raised my clinical suspicion a bit. And she had been, I would say, having difficulty tolerating other antidepressant medications that we had been trying to have her take since then. And so, again, I'm wondering if it's because potentially there might be an underlying, what we call mood disorder, bipolar disorder.

[Kevin Reddington]

And as far as. As far as the information that you had about her past psychiatric history, were there any indicators to you about manic episodes?

[Rebecca Jollotta]

No. So I do recall in reviewing Julie's note, prior to meeting with Lindsay, she filled out what we call a mood disorder questionnaire. It's like a screener somebody can do to assess history of mania and bipolar disorder. Lindsey had. It was a negative screen. So there's three questions. One question has 13 different symptoms. You have to score seven out of 13 on question one, but also on question two, it asks about, are the symptoms happening at the same period of time? And then it asks about any functional impairment from the symptoms. So she. I recall the three symptoms she did endorse were not sleeping for that period of time with the Zoloft and not feeling tired, having racing thoughts and trouble concentrating. None of the other symptoms did she endorse. They did occur at the same period of time. And I don't want to be inaccurate, so I can't remember what she said for functional impairment, but I believe it was minor impairment.

[Kevin Reddington]

Okay. And so the fact that those were reported, but ultimately the full screen revealed negative for potential mania.

[Rebecca Jollotta]

I did also consider, though, that the MDQ is less specific when it comes to bipolar 2 or bipolar not otherwise specified. There's bipolar I and bipolar 2. Both have mania symptoms as part of the diagnosis. Bipolar 1 is usually more severe in that it's typically, you know, patient might be hospitalized or it causes greater functional impairment. Bipolar two, it's a shorter duration and typically less functional impairment.

[Kevin Reddington]

And as far as determining diagnostically whether somebody might be presenting with bipolar disorder, is there a particular tool you use in your trade to try to assess that?

[Rebecca Jollotta]

Typically something like the mdq. And then you'll do more of an interview asking the patient about symptoms Specifically, and if they can ever recall a time where this may have happened in the past. Because sometimes patients can't always remember when they're manic. So I was glad to actually have Patrick in the visit because he could sort of help us look at Lindsay's history more longitudinally or at least since the time he knew her.

[Kevin Reddington]

Okay. And as far as. So those tools that you're talking about, the MDQ kind of screening tools that you use in practice, is there another tool that you use to assess whether a person meets particular criteria to be diagnosed with bipolar one or bipolar two?

[Rebecca Jollotta]

There are others. Not ones that I've used.

[Kevin Reddington]

So are you familiar with the DSM5?

[Rebecca Jollotta]

Oh, yes. Yes.

[Kevin Reddington]

Okay. So while that's not the end all be all, it is a guide that tells you specific criteria, how to determine if episodes are manic or depressive. Right. When it comes to bipolar.

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

The difference between mania and hypomania.

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And so while you noted that these there were some concerns reported, did what was reported to you rise to the level of diagnostic criteria for bipolar disorder?

[Rebecca Jollotta]

Not at that time.

[Kevin Reddington]

And when you explain this to them, your thoughts about her reactions to the medication and these reported prior symptoms, did Patrick and Lindsey seem receptive to your diagnosis?

[Rebecca Jollotta]

I recall Patrick saying, my wife is not bipolar. Lindsay looked at me. She did not. She did not say anything.

[Bluff (Ad Speaker)]

What's going on everyone? It's bluff here and we're driving through the states in the Bluff mobile and the best thing that we can do is play our favorite casino style games on Spin Quest. They have over a thousand games including live dealer blackjack and craps. With tons of slots and unlimited options, you can get a 30 coin pack for just $10. For new users. Sign up today. Go to spinquest.com right now Spinquest is

[Judge William Sullivan]

a free to play social casino void where prohibited. Visit spinquest.com for more details.

[Nanit Ad Speaker]

When you're a maintenance engineer in a beverage manufacturing plant, you keep production lines moving and quality on track because there is no room for slowdowns. With Grainger's vast selection of high quality motors, sensors, belts and hard to find parts, you can get what you need fast and all in one place. So nothing gets in the way of getting the job done. Call 1-800-GRAINGER clickranger.com or just stop by Granger for the ones who get it done.

[Kevin Reddington]

And was this the first time in this meeting on December 6th where you broached that issue or mentioned that?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

Did the conversation continue about symptoms and managing symptoms after that?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

Were you Able to get any more specific information from Patrick during that meeting? Not what the information, what he said particularly. But did you get additional specific information that kind of helped you assess whether you would change your diagnosis at that point?

[Rebecca Jollotta]

No.

[Kevin Reddington]

And were there still concerns in that particular meeting that the focus was trouble sleeping and the potential for addiction?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

As far as recommendations, did you talk about what's called tapering medication?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And what were your recommendations regarding tapering?

[Nanit Ad Speaker]

So

[Rebecca Jollotta]

we talked about her concerns about the benzos, and we decided to come up with a plan to taper off of them.

[Kevin Reddington]

And the last that had been reported to you via the MyChart messages was that she tried not taking it at all, ended up having horrible thoughts and felt deeply depressed, then took it and felt better. So was it realistic to recommend completely stopping?

[Rebecca Jollotta]

No.

[Kevin Reddington]

So what is a taper like? Why do we. Why do you recommend tapers?

[Rebecca Jollotta]

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

[Kevin Reddington]

When you say CIWA assessment, is that an acronym for something?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

So it's one of the letters. Just for the record.

[Rebecca Jollotta]

Ciwad. Cywa. Ciwa.

[Kevin Reddington]

Okay. And did you. When you do that assessment, does it give you some sort of score?

[Rebecca Jollotta]

It does.

[Kevin Reddington]

Ask the questions. And what was her score when you did that CIWA assessment One. And what does that mean?

[Rebecca Jollotta]

Minimal to no withdrawal. The only symptoms she reported was anxiety. Her blood pressure was normal, her pulse was normal. She had no nausea, no vomiting, no tremor, no tactile disturbances. People in withdrawal from benzos or alcohol will sometimes feel like there's bugs crawling or pins and needles. Auditory disturbances. So hearing things, seeing things. No sweats, no headache. She was oriented.

[Kevin Reddington]

So with that and knowing that she wasn't in withdrawals for Ativan, did you still recommend the taper and an alternative?

[Rebecca Jollotta]

I did.

[Kevin Reddington]

What was that?

[Rebecca Jollotta]

I recommended Valium. The reason I recommended this is she had discussed Rebound anxiety with me at our very first visit, feeling that rebound anxiety above her baseline once the benzo wears off. Valium has an extremely long half life. It can, as in like, 100 hours. It has a longer clinical duration of action. So I wanted to offset the chance that she would experience rebound anxiety. And I want, and it's often used when we're tapering somebody on shorter acting benzos. It's common practice to switch to longer acting benzos to do this.

[Kevin Reddington]

And did you also have conversations about the other medications that had been at issue, the Mirtazapine and the Seroquel?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

Did. What did the defendant, what did Lindsey Clancy express to you as far as Seroquel? Did she want to continue with that?

[Rebecca Jollotta]

No.

[Kevin Reddington]

Did she explain why?

[Rebecca Jollotta]

So she felt like when she took Remron and Seroquel together, she felt weighed down and exhausted, but her mind was still awake and alert, and she just didn't seem to think there was a benefit to being on it.

[Kevin Reddington]

And so did she express to you a desire to want to go back to trialing Prozac?

[Rebecca Jollotta]

Both Lindsey and her husband expressed that that was their preference.

[Kevin Reddington]

And was that something that you agreed with?

[Rebecca Jollotta]

I did. I had shared with them that I had concerns. Could be bipolar. It's in my differential diagnosis, which is just all the typical diagnoses we might be considering, and that typically SSRIs are contraindicated. But she did have that history of being able to tolerate Prozac at 20 milligrams and do okay with no mania. So I thought that's what they were wanting to do. So we could do it. We could try it.

[Kevin Reddington]

When you say contra. Contraindication.

[Rebecca Jollotta]

Okay, sorry.

[Kevin Reddington]

Does that mean.

[Rebecca Jollotta]

It means typically not something you would want to do if you were sure somebody had bipolar disorder.

[Judge William Sullivan]

Because

[Rebecca Jollotta]

if you put somebody on just an SSRI or like Prozac, like Zoloft, it can create a scenario where people are flipping back and forth between manic symptoms and depressed symptoms, or they're called rapid symptoms cycling. It's not that antidepressants or SSRIs are never prescribed in bipolar disorder, but you often would want to have a mood stabilizer on board at the same time.

[Kevin Reddington]

And so despite your suspicions, you listened to the patient and went along with her request?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

So at the conclusion of that meeting, did you indicate that she could discontinue the Seroquel at that point?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

With the plan that she was going to restart Prozac?

[Rebecca Jollotta]

Yes. Which I had been recommending the Prozac earlier, I believe, even on November 30, I had recommended it.

[Kevin Reddington]

And with that previous recommendation, it was in addition to the Seroquel and the Rembrandt.

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

So after this meeting on December 6th, did you have additional communications with Lindsey clancy via the MyChart messaging on December 7th?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And fair to say that those communications started as early as 9:48am when she sent the first message. Right.

[Rebecca Jollotta]

Let me just make sure. Oh, yes, yes.

[Kevin Reddington]

So on December 7th at 9:48am she sends a message saying, hi, Rebecca, last night did not go well at all. I took the Valium and melatonin and slept. Only, only slept from nine to one. Then around two I got desperate and took 25 milligrams of Benadryl and only slept about one more hour. What can I do? I really need help. So that was the message that you came into on December 7th, right?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And did you respond to her in the messaging app?

[Rebecca Jollotta]

I did.

[Kevin Reddington]

And what was the response? Trying to find the sequence at 10:19am

[Rebecca Jollotta]

So I discussed, I mentioned. So your husband made a good point yesterday, despite taking the Ativan in the evening, you were still only able to get a five hour stretch of sleep. Sleep, which, yes, is improvement, but does sort of dispel the notion that benzodiazepines are the only thing that are helping you sleep right now as you are still getting less than the target of six to eight hours with Ativan. And the Valium did not help for sleep much at all. My next step in this case is to try a higher dose of Seroquel on its own. Are you feeling any subsequent loss of energy, exhaustion, fatigue with lack of sleep?

[Kevin Reddington]

Why would it be the next step to to increase from 75 of Cerequil to 100?

[Jennifer Sprague]

What's up everybody? It's Bretzky and America is turning 250

[Kevin Reddington]

and I can't think of a better

[Jennifer Sprague]

way to celebrate that than playing on

[Bluff (Ad Speaker)]

an American owned social casino.

[Kevin Reddington]

Spinquest.com with all of your favorite games,

[Jennifer Sprague]

Live craps, bubble craps, live blackjack, there's no better place to play for free

[Kevin Reddington]

and win real cash prizes.

[Judge William Sullivan]

Spinquest.com Spinquest is a free to play social casino void where prohibited. Visit spinquest.com for more details.

[Grainger Ad Speaker]

Granger knows when you're a procurement manager for an office park, you're not managing one building, you're managing all of them. And to stay ahead, you need to see through walls and around corners. Lights about to fail, filters ready to clog H Vac on its last leg. If you want, wait until Something breaks, you're already behind. Count on Grainger for quality products, easy reordering and 24. 7 support. Call 1-800-GRAINGER, click grainger.com or just stop by Granger for the ones who get it done.

[Rebecca Jollotta]

So she had been taking 50, so I was suggesting 75 to 100 would be my next step because again, bipolar still on my differentials. And now I have the data that she only slept two hours. So I asked her the follow up question, are you feeling tired or, you know, are you feeling exhausted? Any subsequent loss of energy, it's still in the back of my mind that this could be bipolar.

[Kevin Reddington]

So as far as the Seroquel goes, at that point, creeping up the dosage, do you get now from the using it to treat insomnia to using it to treat something else like bipolar?

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

And so that piece of it about feeling subsequent loss of energy and exhaustion, fatigue. Why ask that?

[Rebecca Jollotta]

Patients can have insomnia because they're anxious or because they're depressed, but typically they're exhausted or they're tired the next day and it really does affect them. If a patient has an underlying bipolar, they could go on two hours of sleep and not feel tired at all. And that's unusual.

[Kevin Reddington]

And so that is one of the signs potentially of a manic episode.

[Rebecca Jollotta]

Potentially, yes.

[Kevin Reddington]

So on December 7th at 10:33, she responds, no, the weird thing is I don't feel tired at all. And she says, so just Seroquel tonight, question mark. I feel like I'm going to panic without a benzo with it. And then again at 11:44, another message. Would I be able to do the Valium with Seroquel? Is that a safe option? So again, in this exchange with her in MyChart, she's asking you questions to clarify what you've said and also alternatives to address the issue. Right, right. And as far as her questions go, and then her response about not feeling tired, how did you respond in the message?

[Rebecca Jollotta]

So she kind of sent those in succession. So the I don't feel tired. Would I be able to do the Valium with the Seroquel? So I respond by, if you're not sleeping well with the Valium alone, there's no need to continue it. And I will prescribe a short taper to get you off benzos altogether because you are not tired at all and had a significant reaction to Zoloft at 50mg. I'm concerned this is an underlying mood and bipolar disorder. I know you and your husband did not necessarily agree with that. But I feel that I'm going to. But I'm going to send along this information to review. So I sent her a list of symptoms of bipolar risk factors so that she could have it to refer to.

[Kevin Reddington]

And again, at this point, the only symptom she was reporting of mania was this not being able to sleep and not feeling tired. Right.

[Rebecca Jollotta]

And the. And yes. And the racing thoughts and the trouble concentrating.

[Kevin Reddington]

Okay. Is that things that she had reported to you in your visit on the 6th?

[Rebecca Jollotta]

No.

[Kevin Reddington]

Okay. In these messages that she was sending to you in her. On December 7, she didn't talk about racing thoughts, did she?

[Rebecca Jollotta]

No.

[Kevin Reddington]

Okay. She just talked about the sleep.

[Rebecca Jollotta]

Mm.

[Kevin Reddington]

Okay. But based on a review of her history, she had at one point indicated that she was feeling those in relation to a symptom she was describing. Is that correct? So at this point, what do you recommend her to do?

[Rebecca Jollotta]

I explained the importance of knowing if this is bipolar or significant because SSRIs, like so often, even Prozac would be contraindicated. My recommendation is to do 100 milligrams of Seroquel tonight, 200 milligrams of Seroquel tomorrow night, 300 milligrams on 12 9, 400 on 12 10, and we will hold there. I actually say hold the Prozac. As I'm concerned. This is a hypomanic mixed manic state.

[Kevin Reddington]

And what. What about the Rembron at that point? Where did this fall into the mix, if it fell in at all?

[Rebecca Jollotta]

I had recommended a very Short taper on December 6, I think I advised her to take half of a 7.5 milligram tablet for three nights. But in her message to me on December 7, she had not taken it that night. So I was. I had assumed she had just stopped that entirely.

[Kevin Reddington]

Okay, now, after you sent that message at 12:32, Did she respond at 2:53, indicating that she would stick with that plan and that she said she needed a refill on the Seroquel because she only had 3025 milligram tablets.

[Rebecca Jollotta]

There were actually. She did say that. There were actually a few earlier messages as well. That day I provided an alternative one as an option. It quickly came into my mind. Oh, we're thinking about Prozac. We could add Zyprexa on board because there's actually a combination pill of Prozac. Zyprexa. The brand name is Symbiox, and it's for bipolar. And I said, for our purposes, we can prescribe them separately and take them both for the same effect. And I asked her to let me know which one she would prefer. And she responded, I think I would like to do the Seroquel with the Valium taper.

[Kevin Reddington]

Okay. So that suggested alternative actually was on at 12:37.

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

And then at 1:00 clock she elects that she'd like to do the Seroquel with the Valium and asks for you to call in the Valium and the Seroquel.

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

So that's on December 7th, right?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

On December 8th at 6:35am she sends you a message saying did well last night, need Valium, feeling panicky, don't know if ready to taper as quickly as planned.

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

Kind of paraphrasing, but yeah.

[Rebecca Jollotta]

She exclaimed, I actually did really well last night with the volume and Sarequel. I mostly slept from nine to five with a few wake ups, but was able to go back to sleep. She was concerned that she felt like she needed to take the volume around 5pm because she was feeling panicky. I feel really dependent on it. Can I taper any slower?

[Kevin Reddington]

And what was your response to her request for a slower taper?

[Rebecca Jollotta]

I said I'm hesitant to taper any slower. Remember, Valium has a really long half life, 100 hours. So you will have some onboard in your surgery throughout the weekend.

[Kevin Reddington]

And why were you hesitant to taper any slower?

[Rebecca Jollotta]

I felt like she was anxious about being dependent on it and so I was trying to facilitate the process of tapering her off. And I was clinically thinking we could cover her symptoms of anxiety as we titrated the Seroquel because Seroquel actually has several clinical trials that show it has really good efficacy for anxiety.

[Kevin Reddington]

And this conversation about the request to taper that actually goes into February. Excuse me. December 9th of 2022, correct?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And in her response to your indicating you were hesitant to taper, she indicates that she took the 5 milligrams of Valium and that she didn't have any left and that she was afraid that she was going to take Ativan.

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

And had you recommended to take Ativan as an alternative or in lieu of Valium?

[Rebecca Jollotta]

No.

[Kevin Reddington]

Were there any more communications on that day, December 9th of 2022?

[Rebecca Jollotta]

Yes. What were they later that afternoon?

[Bluff (Ad Speaker)]

Hanging out at the pool is great. Relaxing and playing Vegas style games on my phone at the same time. Drink in one hand and a blackjack in the other. It's all at Spinquest. Over a thousand games including your favorite slots and table games. Be cool with this summer special new players get 30 coin packs for [e-mail]

[Judge William Sullivan]

SpinQuest is a free to play social casino void where prohibited. Visit spinquest.com for more details.

[Grainger Ad Speaker]

Grainger knows. When you're a procurement manager for an office park, you're not managing one building, you're managing all of them. And to stay ahead, you need to see through walls and around corners. Lights about to fail, filters ready to clog. H VAC on its last leg. If you wait until something breaks, you're already behind. Count all on Grainger for quality products, easy reordering and 24. 7 support. Call 1-800-GRAINGER click grainger.com or just stop by Grainger for the ones who get it done.

[Rebecca Jollotta]

Lindsay and her husband called. Okay.

[Kevin Reddington]

And so did you fair to say they called the clinic, leave a message and then you call them back?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And when you called them back, what was the nature of that conversation? Would you guys talk about?

[Rebecca Jollotta]

About her symptoms? We discussed that the plan was to taper the volume over the weekend, but they both agreed that Lindsay's symptoms were too acute. She's sleeping better, but still waking up with panic symptoms and intrusive thoughts. Feels numb, has thoughts of si. But no plan and no intent. I encouraged her to engage with Women and Infants in Rhode island to complete an intake for partial hospitalization program, but she was able to contract for safety over the phone with her, with the three of us on the phone that she didn't have a plan, no intent that she would reach out if needed. I did agree to continue the Valium until our next appointment, which was scheduled for 1213. I prescribed it as 5mg, but I advised her she could take a half tablet twice a day. So two and a half milligrams twice a day.

[Kevin Reddington]

So walk me through that. She had called, she had indicated to you that she wanted to slow the taper?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And then you said that wasn't a good idea.

[Rebecca Jollotta]

Right.

[Kevin Reddington]

And then on the 9th, they call you and say that she doesn't want a taper, she wants to stay where she is. Right.

[Rebecca Jollotta]

I think it was that same day. The messages were earlier in the day. And then later in the afternoon around it's noted at 16:10, so 4:10pm that she and her husband then called advocating to stay on.

[Kevin Reddington]

And in advocating to stay on the Valium that she reported she's still waking up with panic symptoms and having intrusive thoughts, feeling numb, Right?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

So in addition to agreeing to continue the Valium, did you make a recommendation

[Rebecca Jollotta]

about the seroquel, continue the titration so

[Kevin Reddington]

when you say titration, what does that mean?

[Rebecca Jollotta]

So I had recommended 100 on day one, 200 day two, 300, day three, 400, day four. This is the manufacturer recommended type of schedule to treat manic symptoms. Because again, I had shared with her, I think this is a mixed manic hypomanic state. So that's what I was targeting.

[Kevin Reddington]

Okay. And so as far as Seroquel goes, there's some guidance you get about Seroquel that's put out by the fda, right?

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

And it talks about dosage and administration for particular for every drug. Essentially, yes. And as far as Seroquel goes, there is different recommended dosages or ranges for different mental illnesses that you're treating.

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

So in this instance, where bipolar is in your differential diagnosis and you're recommending titrate up to 400, is that consistent with the thought that you believe she had bipolar diagnosis?

[Rebecca Jollotta]

Right. So I was thinking it was a mixed manic state or possible hypomanic state. A mixed manic state is when patient has symptoms of mania, like poor sleep, no loss of energy, but they also can feel depressed, numb, suicidal. It's sort of like a. It's a mixed state. It's. It's a mixture of symptoms that a mixed state presentation is clinically acute. It's unstable. So I really wanted to get the manic symptoms under control. I really wanted to get her to sleep.

[Kevin Reddington]

And so going up slowly to 400 milligrams. Is it? Is it. What's the recommended dosage range for somebody with bipolar disorder of Seroquel?

[Rebecca Jollotta]

For somebody, a manic presentation, you can titrate over days rather than weeks. You can actually go up to 800 milligrams.

[Kevin Reddington]

And so even though you had previously indicated to them in your December 6th meeting that you were agreeable to discontinuing the Seroquel based on our presentation in the days following, did you change your recommendation?

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

And with the increased Seroquel that you had requested as of December 9, she was reporting sleeping better, right?

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

And that had been something that had been a recurring concern in your interactions with her sleep?

[Rebecca Jollotta]

Yes. My understanding was that she had been sleeping poorly since October.

[Kevin Reddington]

And was there when you say you were recommending partial hospitalization during that phone call, did you give a particular place in which you would recommend her to try to seek treatment?

[Rebecca Jollotta]

Women and infants.

[Kevin Reddington]

And that's in Rhode Island.

[Rebecca Jollotta]

Rhode Island.

[Kevin Reddington]

And are you familiar with whether they have particular perinatal or postpartum programs there? They specialize after that call with The Clancy's on December 9th. When was the next time you had contact with Lindsey?

[Rebecca Jollotta]

December 9th was a Friday, so I believe it was Monday, December 12th.

[Kevin Reddington]

No. You're able to. People are able to send MyChart messages all hours a day, every day of the week, right?

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

But in this instance, you did not receive any messages over the weekend?

[Rebecca Jollotta]

No.

[Kevin Reddington]

So the next Mychart exchange was actually on December 12th of 2022, correct?

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

Now, on December 12th, do you recall who initiated the contact? Via my chart, Lindsay. And at 1:59pm she sent a message to you saying, I've been noticing on my Apple watch that my heart rate has been fluctuating more than usual. It has been going from 56 to 136 within a matter of minutes. I'm wondering if this is a side effect of the Seroquel and if there's anything I should do about it. Thanks, Lindsay. Do you remember getting that message?

[Rebecca Jollotta]

I do.

[Kevin Reddington]

And again, at that Point, as of December 12, you had recommended the titration plan going up to 400, right?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

So by that Monday, where should she have been if she was following your instructions?

[Rebecca Jollotta]

400 milligrams.

[Kevin Reddington]

And did she report to you whether she took 400 milligrams of Seroquel?

[Rebecca Jollotta]

She reported she was taking 200 milligrams.

[Kevin Reddington]

Did she say why?

[Rebecca Jollotta]

No.

[Kevin Reddington]

But your recommendation was that she should have been up to 400 at that point?

[Rebecca Jollotta]

At that point, yes.

[Kevin Reddington]

As far as the concerns about the fluctuating heart rate, were you able to address that with her in a response?

[Rebecca Jollotta]

Yes. I explained that medications like Seroquel can cause something called orthostatic hypotension, which is basically when you get up from sitting or standing, your blood pressure doesn't compensate in time, so it goes low and people can feel dizzy. I explained that the mechanism for that is alpha adrenergic blockades. So the alpha receptors that help us with, like adrenaline, they're also part of the picture here. With Seroquel, it's often accompanied by orthostatic tachycardia, meaning getting up from sitting to standing. Your heart rate. Heart rate can fluctuate. I said both can be common in the first days of medication exposure or when the dose is being increased. It's generally benign, meaning non harmful and self limiting, meaning it goes away on its own over time. I also advise it sometimes necessary necessitates slowing a dose, titration or dividing a dose into like two or three smaller doses.

[Kevin Reddington]

Okay. And so with this response, in trying to address these Concerns. You're aware that she had spoken to the nurse that morning?

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

And that she had expressed to the nurse a desire to get off the medication altogether?

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

And what was your response to that concern that she had in the call to the nurse, what did you tell her?

[Rebecca Jollotta]

I said, as long as you are aware of the risks, I don't think you've been on Seroquel long enough for it to have a positive benefit on your mood or anxiety, but if you've noticed benefit. If you have noticed benefit, the risk would be worsening of mood and anxiety upon stopping the medication. We also discussed tapering off the volume, which I'm fine with. If you would like to send like me to send along the taper schedule. Being off medication might help you see where you are at baseline, but I do think you are experiencing significant and severe symptoms of postpartum depression that needs to be treated. I acknowledge that medication alone is not always the best option for someone, but often it's part of the puzzle. Other treatments include counseling, support from others, ex exercise, healthy diet, yoga, and relaxation techniques. I know this has been brought to your attention several times, but I strongly, strongly recommend a partial hospitalization program so that you can get started on utilizing these treatment methods for relief.

[Kevin Reddington]

And you were aware at this point, as of Dec. 12, that she had met with Letitia Dukes at least once, right?

[Rebecca Jollotta]

At least once, yes.

[Kevin Reddington]

She had been given referrals for CBT or cognitive behavioral therapy programs out in the community and her community, right?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

There have been other recommendations for her to obtain a partial hospitalization program at that point?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

Now, anything about these exchanges that made you concerned that you had to kind of raise the level, meaning call her in for another meeting or make any sort of recommendations for inpatient hospitalization?

[Rebecca Jollotta]

Not at this junction.

[Kevin Reddington]

And why is that?

[Rebecca Jollotta]

I wasn't. She wasn't reporting any acute safety concerns in these messages at this point.

[Kevin Reddington]

It's just physical.

[Rebecca Jollotta]

Just physical side effects. Physical side effects.

[Kevin Reddington]

So the message is continued on December 12th, correct?

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

So at 2:44 Lindsey messages, you saying, thank you, Rebecca. It does say, seem to be orthostatic, and I'm glad to hear that it's benign and known side effect. And then she tells you a little bit more about the prior nights. Right. So she says. So the last three nights I've taken 2.5 milligrams of Valium and 200 of Seroquel. I have to say that I do like the way it makes me sleep very deeply and soundly for around seven to eight hours. But I don't like the way I feel in the morning and most of the day incredibly depressed and unmotivated to do anything at all. What would you recommend for tonight? Is that the next message after you explain to her the side effects?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

Okay, so for 10pm you respond to her, don't you?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And what did you recommend to address those concerns about incredibly depressed and unmotivated?

[Bluff (Ad Speaker)]

What's going on everyone? It's Bluff here and we're driving through the states in the Bluff Mobile and and the best thing that we can do is play our favorite casino style games on Spinquest. They have over 1000 games including live dealer, blackjack and craps. With tons of slots and unlimited options. You can get a $30 coin pack for just $10 for new users. Sign up today. Go to spinquest.com right now.

[Judge William Sullivan]

Spinquest is a free to play social casino void where prohibited. Visit spinquest.com for more details.

[Grainger Ad Speaker]

Grainger knows when you're a procurement manager for an office park, you're not managing one building, you're managing all of them. And to stay ahead, you need to see through walls and around corners. Lights about to fail, filters ready to clog H Vac on its last leg. If you wait until something breaks, you're already behind. Count on Grainger for quality products, easy reordering and 24. 7 support. Call 1-800-GRAINGER click grainger.com or just stop by Grainger for the ones who get it done.

[Rebecca Jollotta]

So at this juncture I recommended at least continuing the 200 of Seroquel because at least now she's sleeping. So I felt like although I had recommended getting up to 400, we had gotten sufficient like activation symptoms down, she was sleeping and the 2.5 of Valium. I think I advise that we need to give time for Seroquel to work for your mood. Let's continue to accumulate good nights of sleep as this can only be a good thing in terms of recovering and feeling better moving forward. I would say take them tonight and we will discuss further at our visit tomorrow.

[Kevin Reddington]

And you had a visit scheduled for December 13th, correct?

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

The message continues on that day at 7:17pm where she says, okay, thank you. I need to make our visit virtual tomorrow. I will not be able to make it to the office. Can you please change it to that? Is that right? So after having met in person with her on December 6, having had subsequent communications with her through the date of December 7th, and kind of again changing a little bit about the medication plan and having further communication with her on December 9 and now December 12. The plan was for her to again come in person on the 13th, correct?

[Rebecca Jollotta]

That was my recommendation, yes.

[Kevin Reddington]

Why did you recommend in person at that point?

[Rebecca Jollotta]

This was somebody who was communicating with me every day. And I did feel that she had significant symptoms of depression, some mixed symptoms with mania, anxiety. I felt that her symptoms were severe and significant enough that I wanted to touch base with her weekly and I wanted to see her in person. But again, I was okay with her doing virtual because I'd rather see her and lay eyes on her and try to treat her than not see her at all, if that would have made her just cancel the visit outright.

[Kevin Reddington]

Because generally you do the same thing whether you're in person or virtual. Right. As far as getting the history, going through symptoms, asking how they're feeling, doing the mental status exam.

[Rebecca Jollotta]

Right.

[Kevin Reddington]

So you meet with her on December 13th at 10:30, correct?

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

And now this is a virtual at her request?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And do you revisit with her kind of the recent events and the timeline of the changes that you've gone through through the MyChart messaging?

[Rebecca Jollotta]

Yes. I structured my note as, like, a recent treatment timeline. So I put, you know, 12, 6, what had happened, 12, 9, what had happened? And then I write update today, 12 13. That's sort of for me to, like, remember the treatment history that I've had with her so far.

[Kevin Reddington]

Okay. Because while the MyChart messages are available to you, they might be in a different place. Right. So they're not all contained within your same note.

[Rebecca Jollotta]

Right. So I made note of, again, our visit on 12, 6. I made note that her. She and her husband had called me on 12, 9, and then I made note on the 13th. So I wasn't documenting all the MyChart messages, but just sort of my visit history with her and phone calls.

[Grainger Ad Speaker]

Okay.

[Kevin Reddington]

And so when you saw her in this virtual visit on December 13, was she reporting a improvement in her sleep?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And how long. How was she sleeping during that time period?

[Rebecca Jollotta]

Seven to nine hours.

[Kevin Reddington]

Okay. And that was holding at 200 on the Seroquel.

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

And was she taking anything else daily?

[Rebecca Jollotta]

Valium 2.5. Just once daily at night.

[Kevin Reddington]

And while she reported sleeping better, she still had significant symptoms of depression, right?

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

What were the symptoms? She articulated hopelessness.

[Rebecca Jollotta]

And again, anhedonia. That feeling? No pleasure, Feeling numb.

[Kevin Reddington]

Okay. And she also kind of complained of that racing heartbeat. And that's tachycardia, right?

[Rebecca Jollotta]

Yep, the orthostatic tachycardia. So I recommended holding a bit longer at 200 milligrams. At this juncture, she had been on 200 milligrams for four nights. I wanted to continue it for a full seven nights. And then we were still discussing whether to taper benzos, and our plan was to kind of slowly phase them out at that point. So we were going to decrease from 2.5 milligrams daily to 2 milligrams for seven days, and then we were going to reassess at our next visit in a week. I also provided psychoeducation about behavioral activation, CBT techniques to utilize for depression. I also recommended postpartum.net for support, and I reiterated that she consider a partial hospitalization.

[Kevin Reddington]

And again, during this telehealth visit, you have these conversations with her, but you also do your mental status exam, you make observations of her, right?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

Did you observe any signs of mania?

[Rebecca Jollotta]

No.

[Kevin Reddington]

Did you observe any signs of psychosis?

[Rebecca Jollotta]

No.

[Kevin Reddington]

Did she articulate to you any suicidal ideation?

[Rebecca Jollotta]

She had endorsed that she had had thoughts of it on the Edinburgh over the previous weeks, that she sometimes had thoughts of harming herself, but not at that visit.

[Kevin Reddington]

Okay. And would that have been something you'd follow up on? Would that statement from the Edinburgh or.

[Jennifer Sprague]

Objection. Would that be something you'd follow up on?

[Rebecca Jollotta]

So, just to clarify, so again, the

[Jennifer Sprague]

Edinburgh after coming from the witness, Judge. I'm sorry.

[Judge William Sullivan]

Objection overruled. Next question.

[Rebecca Jollotta]

The Edinburgh is over the previous seven days. So she had that thought sometimes when I asked her, are you currently having si. It was no during the visit.

[Kevin Reddington]

Okay. And it just was the response? Sometimes?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And so did you ask further in your interaction with her on that day on the 13th, about whether she was experiencing suicidal ideation? Yes. Did she say she was?

[Rebecca Jollotta]

No.

[Kevin Reddington]

Did she indicate whether she had any plan or intent?

[Rebecca Jollotta]

No.

[Kevin Reddington]

And as far as intrusive thoughts, did she speak about intrusive thoughts during that meeting?

[Rebecca Jollotta]

No.

[Kevin Reddington]

Did she tell you she was having horrible thoughts?

[Rebecca Jollotta]

No.

[Kevin Reddington]

She had previously used that terminology in your MyChart exchanges. Correct. some point she's.

[Rebecca Jollotta]

I do remember the intrusive thoughts that she would mention. Intrusive thoughts? I don't recall horrible thoughts.

[Kevin Reddington]

Okay.

[Rebecca Jollotta]

In the My Jar messages, as far

[Kevin Reddington]

as the intrusive thoughts, were they things that you followed up on in your telehealth or in person visits? And was she able to articulate to you?

[Rebecca Jollotta]

Yes. Yes or no? Sorry.

[Kevin Reddington]

Was she able to articulate to you what types of thoughts she was having?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

What were they?

[Rebecca Jollotta]

Intrusive suicidal thoughts.

[Kevin Reddington]

So thoughts of harming herself or just wanting to die?

[Rebecca Jollotta]

Thoughts of wanting to die.

[Kevin Reddington]

At any point, did she ever indicate to you thoughts of wanting to harm her children?

[Rebecca Jollotta]

No.

[Kevin Reddington]

So at the conclusion of this visit on December 13th, what was the plan?

[Bluff (Ad Speaker)]

You know what? It sucks to be bored. But when I get on my phone and play real casino games on spinquest.com the time flies by. That two hour wait at the DMV seems like 10 minutes. Play your favorite slots, live blackjack, live preps with a live dealer. New players $30 coin packs are on sale for 10 bucks. Play spinquest.com and you'll never be bored again.

[Judge William Sullivan]

Spin Spinquest is a free to play social casino void where prohibited. Visit spinquest.com for more details.

[Nanit Ad Speaker]

When you're a maintenance engineer in a beverage manufacturing plant, you keep production lines moving and quality on track because there is no room for slowdowns. With Grainger's vast selection of high quality motors, sensors, belts and hard to find parts, you can get what you need fast and all in one place. So nothing gets in the way of getting the job done. Call 1-800-granger-cranger.com or just stop by Granger for the ones who get it done.

[Rebecca Jollotta]

The plan was to continue. Seroquel, 200 milligrams and Valium two milligrams.

[Kevin Reddington]

Okay. And again, in this December 13th meeting, did you also indicate to her that she should engage with other services like support groups or partial hospitalization programs or cbt?

[Rebecca Jollotta]

I did.

[Kevin Reddington]

Do you recall whether you received any Mychart messages from her after that visit on the 13th?

[Rebecca Jollotta]

I did. I actually sent her a message on the 13th.

[Kevin Reddington]

Okay, so on the 13th you meet with her at 10:30, at 2:27 you sent her a message. Why?

[Rebecca Jollotta]

I wanted to send along some more ideas and information on what she could do to help herself feel better.

[Kevin Reddington]

Because even though she was reporting sleeping better, she was still presenting with these depressed symptoms, correct?

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

And so in the message you sent her on December 13, it's actually a fairly lengthy message that talks a lot about cognitive behavioral therapy, right?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And the benefits of it and sends encouraging words.

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

Does she respond to you on the 13th?

[Rebecca Jollotta]

No.

[Kevin Reddington]

The next contact you have with her, is that in a mychart message on December 16th?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And December 16th, 12:50pm oh no, I apologize.

[Rebecca Jollotta]

The next contact with her there was a telephone call on December 15th.

[Kevin Reddington]

Was it with you or was it with a nurse?

[Rebecca Jollotta]

It was with me and her husband and Lindsay.

[Kevin Reddington]

Okay, sorry about that. So December 15th at 3:53pm you have a phone call with them. And what do they report to you in this phone call? What does Lindsay report?

[Rebecca Jollotta]

They inform. This has been the worst day for Lindsay is having persistent intrusive thoughts of suicide. No active plan, but both Lindsey and Patrick agree that higher level of care may be necessary at this time. Discussed options. They state they are likely to go to mghed as they have perinatal psychiatry as well as an inpatient psychiatric unit. Lindsay also deciding about McLean. This writer advised that they keep us posted and sign a ROI release of information so that we can communicate with treatment providers at higher level of care. Lindsey verbalized understanding and agreement.

[Kevin Reddington]

So on this phone call that you had with them on 12 15, what prompted the recommendation that they go to the emergency department again?

[Rebecca Jollotta]

They had described it as the worst day and was having persistent intrusive thoughts of suicide. And they were at the point where they were ready to get assessed for a higher level of care.

[Kevin Reddington]

And was this different than some of the other communications that you've had with or that you had had with Lindsey Clancy over the course of the weeks?

[Rebecca Jollotta]

I would say so.

[Kevin Reddington]

And so you talked to them about the process of going to the emergency department and the potential for going to McLean for inpatient?

[Rebecca Jollotta]

I recall advising them that if they were to go to their nearest er, which would either be bi, Plymouth or Celsure Health, the process would be that they would get evaluated. But if they were determined to need to go to a higher level of care or an inpatient psych, those facilities did not have inpatient psych units. So they may be sitting there waiting for a bed at any first opening in the state, which could be, you know, up in, you know, Amesbury or Newburyport, but that if they were to go somewhere like MGH, MGH has a unit called Blake 11, which is a psychiatry unit. And oftentimes they prioritize admissions from their own Emergency Department. MGH and McLean are also combined under the umbrella of what's now MGB. So sometimes if somebody presents to MGHED and there's no beds at Blake 11, they might reach out to McLean and try to get them in to McLean.

[Kevin Reddington]

So you communicated all of this information to them to kind of give them options on the best course might be to get inpatient?

[Rebecca Jollotta]

Yes, I summarized it in my note, but that's my recollection of the phone call.

[Kevin Reddington]

And you're aware that that Ms. Clincy had been employed at Mass General as a labor and delivery nurse?

[Rebecca Jollotta]

I was.

[Kevin Reddington]

So they were familiar with that facility.

[Rebecca Jollotta]

So I did ask, would you be comfortable with that. And they were.

[Kevin Reddington]

And so, to your knowledge, after this conversation, did they go to the Mass General emergency department on December 15th?

[Rebecca Jollotta]

They did.

[Kevin Reddington]

And so then you were able to communicate with Lindsey via MyChart that next day, on December 16th? Correct?

[Rebecca Jollotta]

She reached out to me on December 16th via MyChart.

[Jennifer Sprague]

Yes.

[Kevin Reddington]

And she indicated to you on December 16th at 12:50 that she, after visiting the ER yesterday, I opted to remain outpatient and pursue the partial program at Women and Infants. And Women and Infants. That had been the program that you had previously. Previously recommended in Rhode island, correct?

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

She indicates. I'm waiting on a call back for them to schedule. In the meantime, I want to know how to proceed with my meds. Do you still recommend the 2 milligrams of Valium and 200 of Seroquel nightly? Again, it's making me sleep well, but still not improving my mood, so I will need a refill on those meds. Please let me know. So in this particular message, she. She indicates to you that she was waiting to schedule women and infants, correct?

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

Were you aware that prior to, Letitia Dukes had already initiated the referral process for women and infants?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And so on this particular message, she's kind of updating you, but also asking you if she should stay on the same track for her medication?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And what was your response? So December 16th at 1:14, I said, hi, Lindsey.

[Rebecca Jollotta]

I know Leticia may have called you yesterday about information about women and infants, so I hope you were able to connect with her. Target dose for Seroquel treating depression is 300 milligrams. So we can increase it to 300 milligrams if you are willing. Yes. Continue the volume. Let me know what you think.

[Kevin Reddington]

And why, at this point, did you recommend increasing now to the 300 after having recommended staying at 200 for the

[Rebecca Jollotta]

Seroquel, the FDA recommended dose for treating depression, bipolar depression, Seroquel is 300 milligrams.

[Kevin Reddington]

So on December 16th, you continue to have messages with MyChart, messages with Lindsey Clancy, Correct?

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

In any of. Or do you know that she went to see her previous psychiatrist on that day, December 16th?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And so in her messages later in the day at approximately 2:11pm she indicates, I spoke with my original psychiatrist after my ER visit, and she recommended adding 25 milligrams of. Of Lamictal to stabilize my mood. Is that something you would agree with? Had you ever talked with her about Lamictal before?

[Rebecca Jollotta]

No.

[Kevin Reddington]

Is it a drug that you kind of commonly recommend for people?

[Rebecca Jollotta]

I do.

[Kevin Reddington]

And was it Something that you thought could be a good fit for this patient?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And so in your response to her at 226pm do you further talk about using it as a mood stabilizer?

[Rebecca Jollotta]

Yes, I state absolutely. Lamotrigine works well for mood stabilization and depression. I talked to her about the side effects of it.

[Kevin Reddington]

I'm fair to say those side effects are like rash and skin changes, fever.

[Jennifer Sprague]

Can we have planned out what the witness feels the side effects of rather than counsel?

[Judge William Sullivan]

Well, why don't we let the question be what was she told? All right. I think that's.

[Jennifer Sprague]

That's.

[Judge William Sullivan]

That's the proper question. So why don't you ask what was told or what was said or messaged to the defendant?

[Kevin Reddington]

Can you tell us what you message her the side effects were?

[Rebecca Jollotta]

So I recommended it needs to be a slow titration, meaning titration, you know, increasing the dose due to risk of sjs, which means Stevens Johnson syndrome, which can be a very serious rash that somebody can get. There's a higher risk of it if somebody takes lamictal, which is why the FDA recommends such a slow titration. 25 milligrams for two weeks, 50 milligrams for two weeks, 100 milligrams. You can't really go quick with it, but I also specified it can cause a benign rash with as a side effect. So any skin changes you notice, you want to be sure, are not accompanied by things like fever, malaise, pharyngitis, swollen lymph nodes. Also, watch for a rash that is purpuric or tender. Benign rash would be spotty, non confluent, non tender, and no systemic features like fever. Otherwise, I find this medication to be quite well tolerated. Take with food to minimize any risk of GI, such as nausea. I will send this to your pharm. I can send this to your pharmacy along with the dose change in Seroquel. Any luck with hearing back from women and infants?

[Kevin Reddington]

So the lamictal. Am I saying that correctly?

[Rebecca Jollotta]

Lamictal.

[Kevin Reddington]

Is that something that you would add to the Seroquel?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And why would you add it to Seroquel?

[Rebecca Jollotta]

They work differently. They have different mechanisms of action, and they can work well together.

[Kevin Reddington]

And so at that point, on December 16th, do you recall kind of what the last version of the medication recommendations were.

[Rebecca Jollotta]

From me?

[Kevin Reddington]

Yeah. So at this point, you added a medication. So what was on the prescribed or recommended list for you? For her, as of December 16th.

[Rebecca Jollotta]

So I asked her if she needed me to send along lilamotrigine, and she. She Said that she had had her psychiatrist send it along.

[Kevin Reddington]

Okay, but as far as now, what you know to be the medications that she's been advised to take, what are they at this point?

[Rebecca Jollotta]

December 16th, Lamotrigine, 25 milligrams, Seroquel, 300 milligrams and Valium, 2 milligrams.

[Kevin Reddington]

And the Valium, is that still a daily recommendation?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

At the end of that message that you just read, you asked her if there was any luck with hearing back from women and infants, correct?

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

Did she respond to you in a message about what was happening with the women and infants? The next message at 2:33.

[Rebecca Jollotta]

In 2:33, she said, unfortunately missed the call this morning from Women and infants, but I did request them to call back. I'm hoping they do so today.

[Kevin Reddington]

And you said that you'd also learned in this exchange that her other psychiatrist had already called in the Lamotrigine prescription.

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

And then did you have any further communication with her on 12 16?

[Bluff (Ad Speaker)]

What's going on, everyone? It's bluff here and we're driving through the states in the Bluff Mobile and. And the best thing that we can do is play our favorite casino style games on Spinquest. They have over 1,000 games, including live dealer blackjack and craps. With tons of slots and unlimited options. You can get a $30 coin pack for just $10 for new users. Sign up today. Go to spinquest.com right now.

[Judge William Sullivan]

Spinquest is a free to play social casino void where prohibited. Visit spinquest.com for more details.

[Grainger Ad Speaker]

Grainger knows when you're a procurement manager for an office park, you're not managing one building, you're managing them. And to stay ahead, you need to see through walls and around corners. Lights about to fail, filters ready to clog, H Vac on its last leg. If you wait until something breaks, you're already behind. Count on Grainger for quality products, easy reordering and 24. 7 support. Call 1-800-GRAINGER click grainger.com or just stop by Grainger for the ones who get it done.

[Rebecca Jollotta]

I see. Said, okay, sounds good. I hope so as well. And that was it.

[Kevin Reddington]

When's the next time you spoke with her?

[Rebecca Jollotta]

12:16 was a Friday. So I spoke to her on Monday, December 19th.

[Kevin Reddington]

And again, did you speak with her via the MyChart messaging or did you speak to her on the phone?

[Rebecca Jollotta]

MyChart messaging.

[Kevin Reddington]

And were you aware that on December 19th she had another appointment scheduled with Letitia Dukes for that morning?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And in your communications with her via MyChart. They started at 11:04am on December 19th?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And does she indicate to you in that message that she is starting with women and infants partial hospitalization tomorrow, meaning the 20th?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And that she's concerned because she has an appointment scheduled VR already and she's asking, asking what she should do about that. Correct?

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

And what was your response to her?

[Rebecca Jollotta]

So she has an appointment but should be in the program. Should I call and cancel or reschedule because she thought the program would be starting her medication? I said, I'm so glad you were able to get into the program this week. That's great. So feel free to call and reschedule. The only issue is that I am on vacation next week, so it might be two weeks out that we touch base again, if that's okay with you. Let me know what you think.

[Kevin Reddington]

Okay. And her response at 124 that says, I think since I'll be followed by women and infants, that two weeks out will be okay. My only concern is potentially needing more Valium before that. I'm trying my best not to take it at night, but have still been taking 2 milligrams every other night. Can we refill that just in case I continue to need it? Right, Right. So at that point, when she sends that message saying she needs the new prescription for Valium, was that in line with the recommendations you made for a taper of Valium?

[Rebecca Jollotta]

I had recommended that she take it daily.

[Kevin Reddington]

And so in this, she indicates to you that she's trying not to take it at night, but taking it every other night.

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

And on December 19, you respond, sure, no problem. When will you be out of Valium? And she responds, I'll run out tonight. And then you agree to send in the refill?

[Rebecca Jollotta]

Yes. I wanted to make sure she had an appointment rescheduled with me, and then I would refill enough of the volume to get to that next appointment.

[Kevin Reddington]

And so did you refill the prescription based on what she reported she was taking or what your recommendation was that she take of the Valium?

[Rebecca Jollotta]

What my recommendation was that she take.

[Kevin Reddington]

And so you recall receiving a message on December 20th via my chart from Lindsey?

[Rebecca Jollotta]

I do.

[Kevin Reddington]

And she reported to you that she had been discharged from Women and Infants that day? Correct?

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

And that they recommended she find help getting off the seroquel and that she was indicating that she'd like to taper the seroquels?

[Rebecca Jollotta]

Well, yes.

[Kevin Reddington]

Did you respond that day or the next day?

[Rebecca Jollotta]

The next day. Okay. Her message came in at 8:05pm So I responded the next morning.

[Kevin Reddington]

Okay. At 10:57?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And what were your thoughts about her report that she was discharged and the recommendation for tapering the Seroquel or getting off the cereal?

[Rebecca Jollotta]

I should say I said I'm not opposed to that. However, I'm concerned she discharged you, as I do feel you could benefit from the groups and added support, separate even from medication changes. In fact, if we're not going the medication route, I think groups and therapy are the treatment needed, as I feel the intrusive thoughts you've been having are nonetheless concerning, and I know they've caused you considerable distress. I'm also on vacation next week, so I'm hesitant to start a taper when I am not available to you for questions and concerns. Again, I'm open to starting a taper, but I want to be available to you as it happens. You mentioned you are connected to your previous psychiatrist. Would that be someone to consult as well?

[Kevin Reddington]

And so when you sent this message at 10:57, were you opposed to the idea of tapering the Seroquel?

[Rebecca Jollotta]

I understood that it was helping her to sleep, and I also understood that she felt as though she was still depressed and she wanted to. To come off of it.

[Kevin Reddington]

And in this correspondence back and forth on the 21st, was there any conversation about the lamotrigine and whether she took it as a mood stabilizer?

[Rebecca Jollotta]

No.

[Kevin Reddington]

As far as coming off medication, was that something that you thought might be a good option for her?

[Rebecca Jollotta]

As I had expressed to her, I was hesitant it could be done, but she would need a lot of what I would recommend to be group support, therapy, other types of treatment.

[Kevin Reddington]

At that point, based on your interactions with her through the clinic, through all the messages, through the meetings that you've had, did you. Were you aware of whether she was getting any other support like groups other than Letitia Dukes and yourself?

[Rebecca Jollotta]

No.

[Kevin Reddington]

And this partial.

[Jennifer Sprague]

Apologize. Is she aware or. No, she wasn't. She just said if you could just.

[Kevin Reddington]

Are you aware of whether she was.

[Rebecca Jollotta]

I was aware it was recommended. I was not aware that she was interacting with any groups.

[Kevin Reddington]

And the South Shore Perinatal Behavioral Program, you have groups that are offered through the clinic, correct?

[Rebecca Jollotta]

At that time? We did, yes.

[Kevin Reddington]

And if she was attending groups through the clinic, would that be something that you would have access to her or be noted in her records?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And as far as your communications with her, did she report to you that she was attending any sort of groups or therapy at other places in the community?

[Rebecca Jollotta]

No.

[Kevin Reddington]

The only person you were Aware of that she was communicating with was her previous psychiatrist, Correct?

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

And that's why you made that recommendation to consult with her?

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

And what's your concern, or what was your concern for not being available to her while you were on vacation with a taper?

[Rebecca Jollotta]

I wanted to be there to evaluate if the taper was going okay, if she was suddenly having a hard time sleeping again. So maybe I could recommend that we go back up or, you know, just to reassure her to be there for her while this was happening.

[Kevin Reddington]

In your prior communications with her, she was very communicative with you up about symptoms, about issues, about concerns, Correct?

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

And if you're on vacation, are you responding to my chart messages?

[Rebecca Jollotta]

No. There would be someone that would respond. It would. Would have been my nurse. And they would have consulted with the two other. And, well, Julie, I had believe her last day was the 22nd. But they would have consulted with the other NP there, but I would not be available. No.

[Kevin Reddington]

And you were invested in this patient's care, weren't you?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

So on December 21, after you made that recommendation that she not start the taper while you weren't available or consult with her psychiatrist. Other psychiatrists, did you get a response from her at 3:57?

[Rebecca Jollotta]

3i. On December 21st?

[Kevin Reddington]

Yes.

[Rebecca Jollotta]

I see. 347.

[Kevin Reddington]

Oh, I'm sorry. That's what I meant to say. Okay, so 347 she responds back to you. Correct. And gives you some more information about the Women and Infants recommendation.

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And it reads the psychiatrist at Women and Infants recommended a more general mental health phone. HP Partial hospitalization program, right?

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

Such as the one at McLean, which I'm open to. I'm also looking to schedule with a CBT therapist in Duxbury. My other therapist does have appointments this and next week, so I can follow up with her, too. How would you recommend starting the taper? I will need smaller pills, as the ones I have now are all 300 milligrams. Right? That's her response?

[Rebecca Jollotta]

Yes. She says her other psychiatrist does have appointments.

[Kevin Reddington]

Okay. And in the meantime, she had also sent an email to the clinic. You're aware?

[Rebecca Jollotta]

I'm not aware.

[Kevin Reddington]

Okay. Did. Do you know if she spoke with the nurse at some point on the 21st?

[Rebecca Jollotta]

Yes. I asked my nurse to call to again go over the risks and of tapering, which could include worsening of mood, worsening of sleep, verify that this was really something she wanted to move forward with, remind her that I wouldn't be there.

[Kevin Reddington]

Okay. And on 12-21-2022 at 4:26pm you respond to her in the MyChart message. Right.

[Rebecca Jollotta]

Right.

[Kevin Reddington]

And you had expressed reluctance for the taper. But ultimately did you provide her a plan for taper?

[Rebecca Jollotta]

Right. I said I know Nicole reached out to you and she relayed that you would like to proceed with the taper. I'm sending as 100 milligram tablets, 200 milligrams, two tablets for four nights, 100 milligrams one tablet for four nights, 50 milligram tabs, half tablets times four nights then off. Let me know if any issues.

[Kevin Reddington]

And is that standard or slow? T Slow taper off of Seroquel being at a 300 milligram dose.

[Rebecca Jollotta]

Considering the fact that she had only been taking it for a few weeks, yes. If she had been on it for months, I would have done a slower taper.

[Bluff (Ad Speaker)]

You know what? It sucks to be bored. But when I get on my phone and play real casino games on spinquest.com the time flies by. That two hour wait at the DMV seems like 10 minutes. Play your favorite slots, live blackjack, live craps with a live dealer. New players, $30 coin packs are on sale for 10 bucks. Play spinquest.com and you'll never be bored again.

[Judge William Sullivan]

Spinquest is a free to play social casino void where prohibited. Visit spinquest.com for more details.

[Nanit Ad Speaker]

When you're a maintenance engineer in a beverage manufacturing plant, you keep production lines moving and quality on track. Track because there is no room for slowdowns. With Grainger's vast selection of high quality motors, sensors, belts and hard to find parts, you can get what you need fast and all in one place. So nothing gets in the way of getting the job done. Call 1-800-GRAINGER click granger.com or just stop by Grainger for the ones who get it done.

[Kevin Reddington]

And in addition to giving her that plan, you also had the nurse provide her with some information about DBT groups, correct?

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

And what's dbt?

[Rebecca Jollotta]

Dialectical Behavioral Therapy.

[Kevin Reddington]

And how's that different from cognitive behavioral therapy?

[Rebecca Jollotta]

Dialectical behavioral therapy. There's certain tenets to it like emotion regulation, distress tolerance, interpersonal communication. There's a lot of skills to it. It's a very skills based treatment. So we had recommended that as an additional support.

[Kevin Reddington]

And the next time you had contact with the Clancy's, when was that? After December 21st, I believe.

[Rebecca Jollotta]

That was my last contact with Lindsey.

[Kevin Reddington]

Okay. As far as the Perinatal Behavioral Health clinic at South Shore, you're aware that on December 30th Patrick Clancy called in about his wife.

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

And that he spoke to a nurse, Katrina Melanson.

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And the record reflects that he reported that she was safe. Right. But she'd like to go to McLean.

[Rebecca Jollotta]

I do recall that.

[Kevin Reddington]

And he was advised to take her directly to the emergency department. You can't just go there to McLean.

[Rebecca Jollotta]

Right? Right.

[Kevin Reddington]

In your experience?

[Rebecca Jollotta]

In my experience.

[Kevin Reddington]

And that he said he didn't want to waste a day in the ed. Is that your recollection of the record?

[Rebecca Jollotta]

That is my recollection of the record.

[Kevin Reddington]

And that he was looking just to get the bed that was offered the last time on December 15th?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And fair to say that that's not how the process works.

[Rebecca Jollotta]

They do not hold beds for that length of time.

[Kevin Reddington]

Okay. And so then he was advised to take her to the emergency department or call 911.

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

And was that the last contact that the South Shore Perinatal Behavioral Health Clinic had with Lindsey Clancy?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

You were never advised or got any messages from her after she went to McLean, did you?

[Rebecca Jollotta]

No. We did check.

[Jennifer Sprague]

Okay.

[Judge William Sullivan]

The answer is no. Go ahead.

[Kevin Reddington]

Did you learn anything about her course of treatment at McLean after the fact?

[Rebecca Jollotta]

We had been wondering if she would come back to us. We did review the MASS pmp, which is sort of log of controlled scripts, and we saw that she had medications filled from her previous psychiatrist, Dr. Tufts,

[Kevin Reddington]

and that would have been objective.

[Jennifer Sprague]

Move to strike. It's not responsive to the question about McLean she's now talking about overall.

[Kevin Reddington]

So the mass PMP, what is that?

[Rebecca Jollotta]

It is a database that shows when patients fill controlled scripts such as benzodiazepines.

[Kevin Reddington]

Yes. And as a prescriber that has a DAA license, you're able to review that information for any patient?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And so after the 30th, when the call came in about going to McLean, you were able to identify that she was prescribed additional medicines by a different prescriber?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And she never came back to the clinic?

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

During all of your interactions with Lindsey Clancy, did she always present with clear, linear thinking?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

Was she able to express to you her concerns and ask appropriate questions when necessary?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And was she able to advocate for herself and express that she had some knowledge base about some of these medications?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And at no point during the time that she was your patient or that she was at the clinic did she ever indicate that she was had a plan to kill herself or harm her children, did she?

[Rebecca Jollotta]

No.

[Kevin Reddington]

Thank you. There's nothing further.

[Judge William Sullivan]

All right. Councillor Cassie Signbar. Excuse you. Till around 2 o'. Clock. Same. Same instructions. No research, no talking about this case. I hope everybody has a nice little break here. We'll see you back here right around 2:00'.

[Kevin Reddington]

Clock.

[Judge William Sullivan]

Okay.

[Jennifer Sprague]

All right. All right.

[Judge William Sullivan]

So we'll be in recess on this matter till around 2 o'.

[Jennifer Sprague]

Clock.

[Judge William Sullivan]

Okay. All right, we ready for the jury?

[Kevin Reddington]

Okay.

[Jennifer Sprague]

Court. All this court now session. Please be seated.

[Kevin Reddington]

Your honor, for the purpose of the record, we return back to the trial. Commonwealth versus Lindsay Clancy. All parties are present.

[Jennifer Sprague]

All right.

[Judge William Sullivan]

Thank you, ma'.

[Jennifer Sprague]

Am.

[Judge William Sullivan]

Mr. Reddington.

[Jennifer Sprague]

Thank you, judge. Good afternoon. Good afternoon, your honor. Just a couple of housekeeping matters. I have the medical records from women and infants hospital. I thought I offered that as an exhibit, but it's only marked for id so. Can I offer that now?

[Judge William Sullivan]

Come with any objection, I have to

[Kevin Reddington]

mark them as exhibit 220.

[Bluff (Ad Speaker)]

Yeah, I don't.

[Jennifer Sprague]

It just says exhibit F, though. That's why I just. I usually mess up on those things.

[Kevin Reddington]

There was another. There's another smaller packet that's not in a binder that council offered yesterday that's been marked as Exhibit 220. Here. It's up there.

[Jennifer Sprague]

Okay. All right.

[Judge William Sullivan]

Why don't we keep that mark for identification? If. If for some reason there's something different between Exhibit 220 and the identification, we could enter it. Okay. All right. If. If you need to offer anything additional, just let me know.

[Jennifer Sprague]

Great. Thank you. Thank you. The other thing, your honor, that. What I would ask is that there has been a lot of reference to the diagnostic statistical manual 5tr, especially as it relates to bipolar and related disorders. There's an awful. Not an awful lot, but there's like probably 15 pages of single space typing, and it's really hard for people to absorb it. I'd like to offer that section of the DSM just as an exhibit. So if somebody wanted to re. Look at it, they could.

[Kevin Reddington]

I would object. We have witnesses to testify about that.

[Jennifer Sprague]

All right.

[Judge William Sullivan]

All right. Why don't we just. Why don't we mark that for identification? I guess the.

[Jennifer Sprague]

That's my book, though. I need it.

[Judge William Sullivan]

Oh. Oh, I don't want to take away your book. Why we.

[Grainger Ad Speaker]

We.

[Judge William Sullivan]

We can readdress that. Okay, sure. In regards to that. And if we're to going to do it, it would just be portions of the.

[Jennifer Sprague]

Yes, it would only be that one section, but we'll see.

[Judge William Sullivan]

Well, I'll give the comma the opportunity to be hurried.

[Jennifer Sprague]

Okay. Thank you. So you, in the course of your employment at the South Shore health, is it?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

How Many times did Lindsay meet with you?

[Rebecca Jollotta]

Meet with me was three.

[Jennifer Sprague]

And how many times did she meet with. Does that include Tele. Tele. Medical?

[Rebecca Jollotta]

Yes, I saw her twice. Telehealth. Once in person.

[Jennifer Sprague]

And do you know how many times that you. You know that she had a psychiatrist that had been treating her since end of September, early October? Right.

[Rebecca Jollotta]

I knew that she had a psychiatrist that treated her in September.

[Jennifer Sprague]

And who was that?

[Rebecca Jollotta]

Dr. Tufts.

[Jennifer Sprague]

And did you know that she continued to see Dr. Tufts through October, November, December, the same time that she was reaching out to you guys for help, too?

[Rebecca Jollotta]

I was aware she took the Zoloft in October. I was not aware she was still seeing Dr. Tufts in November. And I knew she called her in December.

[Jennifer Sprague]

You would agree with me that young woman came to you people for help.

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

Okay. And she was very, very forthright. In other words, if you wanted her to sign a HIPAA form, she'd sign it, Right?

[Rebecca Jollotta]

Right.

[Jennifer Sprague]

And she would answer your questions to your perspective in an honest fashion?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

You didn't really hide anything.

[Rebecca Jollotta]

No.

[Jennifer Sprague]

She told you all about the medications that she had been on and her. Her fears and concerns about the medications, right?

[Rebecca Jollotta]

Correct.

[Jennifer Sprague]

She described, for you, as district attorney, brought out what she felt her symptomology was, including suicidal ideation, worrying about suicide, feeling heavy, lethargic, you can't get out of bed, all of that stuff, right?

[Judge William Sullivan]

Correct.

[Rebecca Jollotta]

Correct.

[Jennifer Sprague]

And one of the things that you had left us with towards the end of your testimony is the fact that that you were very willing, if you will, to work in tandem with other providers. In other words, you were concerned about being able to get information from other providers that had been dealing with her, treating her. Right.

[Rebecca Jollotta]

I'm not sure I understand the question.

[Jennifer Sprague]

Did you talk to Tufts?

[Rebecca Jollotta]

No.

[Jennifer Sprague]

Did you ever get access to Tufts medical records?

[Judge William Sullivan]

No.

[Jennifer Sprague]

Do you know how many times she saw Dr. Tufts?

[Rebecca Jollotta]

I do not.

[Jennifer Sprague]

Would it surprise you if I told you that she saw Dr. Tufts 14 times in the time frame of October or the end of September? October, November, December, and then January. Four months.

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

And that's 14 times plus the three that she saw you, is that right?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

So that's 17 times that this young lady had access to health care providers for her mental health issues, Correct?

[Rebecca Jollotta]

Correct.

[Jennifer Sprague]

And that would be within a compressed period of time? I know it's the last week, I believe, in September. But October, November, December and then January, right?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

And during that period of time, you're aware that she was provided many, many, many prescriptions for antipsychotics, selective serotonin reuptake inhibitors, benzodiazepines, all of that, Right? What's up, everybody? It's Bretzky. And America is turning 250.

[Kevin Reddington]

And I can't think of a better

[Jennifer Sprague]

way to celebrate that than playing on

[Bluff (Ad Speaker)]

an American owned social casino.

[Kevin Reddington]

Spinquest.com with all of your favorite games

[Jennifer Sprague]

live live craps, bubble craps, live blackjack, there's no better place to play for free and win real cash prizes.

[Judge William Sullivan]

Spinquest.com Spin Quest is a free to play social casino void where prohibited. Visit spinquest.com for more details.

[Grainger Ad Speaker]

Granger knows. When you're a procurement manager for an office park, you're not managing one building, you're managing all of them. And to stay ahead, you need to see through walls and and around corners. Lights about to fail, filters ready to clog. H Vac on its last leg. If you wait until something breaks, you're already behind. Count on Grainger for quality products, easy reordering and 24. 7 support. Call 1-800-GRAINGER click grainger.com or just stop by Grainger for the ones who get it done.

[Rebecca Jollotta]

I'm aware she was prescribed other medications.

[Jennifer Sprague]

She was what?

[Rebecca Jollotta]

Prescribed other medications.

[Jennifer Sprague]

Did you ask what other medications there were?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

And did she tell you?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

Did she tell you who prescribed them?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

It's pretty easy to get a list from cvs, right?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

And did you have any difficulty determining who was providing the prescriptions for all of these medications?

[Rebecca Jollotta]

No.

[Jennifer Sprague]

And did you know that in fact it was Jennifer Tufts that prescribed the sertraline? September 15th of 2022, 30 count, 25 milligrams. Was Jennifer Tufts. You knew that?

[Rebecca Jollotta]

I.

[Jennifer Sprague]

Did you know the Jennifer Tufts on October 21, seven count of lorazepam. You know that?

[Rebecca Jollotta]

I did.

[Jennifer Sprague]

And five days later, Jennifer Tufts described on October 26, hydroxyzine, 25 milligrams with a 30 count. Did you know that?

[Rebecca Jollotta]

I did not know that.

[Jennifer Sprague]

Did you know that on the Same day Tufts prescribed 30 count of lorazepam? Did you know that?

[Rebecca Jollotta]

I would have known that, yes. Checking the PMP for controlled substances? Yes.

[Jennifer Sprague]

When you download download that information and kind of put it in the file?

[Rebecca Jollotta]

No.

[Jennifer Sprague]

So is this your memory that you believe that you check the pmp?

[Rebecca Jollotta]

I do routinely check the pmp.

[Jennifer Sprague]

You might routinely check. But did you check?

[Rebecca Jollotta]

Yes. Yes, I did.

[Jennifer Sprague]

Don't download it. You don't keep it with the medical records. Right.

[Rebecca Jollotta]

It's a box you can click in the medical record and you can check that you reviewed it.

[Jennifer Sprague]

Okay. Is it in your Medical record that you reviewed it.

[Rebecca Jollotta]

I'm not sure how it would have gotten printed out. It doesn't, like, go into my note, but it's a box that I would have checked.

[Jennifer Sprague]

The box in the computer?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

Okay. October 26th, Buspirone, 5 milligrams, 30 count, same day by Tufts. You knew that

[Rebecca Jollotta]

buspirone? Yes, I had. I was not sure that it was Dr. Tufts that had recommended the buspirone.

[Jennifer Sprague]

Okay, so if I suggest to you that the prescriptions that we have in evidence on the chart indicates that on October 26, Dr. Tufts prescribed a 30 count of guisparone, would that either refresh your memory or would you accept that as being a medical history?

[Rebecca Jollotta]

I would accept that.

[Judge William Sullivan]

Okay.

[Jennifer Sprague]

And what is Guispiron?

[Rebecca Jollotta]

It is a medication used to treat anxiety.

[Jennifer Sprague]

Okay. And lorazepam. What is that? Benzodiazepine and hydroxyzine. What is that?

[Rebecca Jollotta]

It is an antihistamine medication.

[Jennifer Sprague]

And lorazepam, again prescribed on October 21, as well as 26 by Tufts. That's the same thing. You were just told us what lorazepam is, right?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

Sertraline, of course, is Prozac. Is that right?

[Rebecca Jollotta]

Zoloft.

[Jennifer Sprague]

They're both SSRIs, right?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

So from October 21 up through November 9, she was prescribed all of this group of drugs until she saw a Kavon Isa Depana, I Z, a D, P, A, N. Ah. Do you know who that person is?

[Rebecca Jollotta]

They work in the emergency department at Social Health.

[Jennifer Sprague]

All right. And that would have been on November 16th when she went into the emergency department, right?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

Prescribed Trazodone, 50 milligrams, right?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

And then you started to consult with your clinic around the 25th of November. That would be around Thanksgiving or so, correct? I. November 25th.

[Rebecca Jollotta]

I believe her first visit with Julia was November 21st.

[Jennifer Sprague]

Okay. What I'm saying is that it was around that time in November that she started to consult with your clinic, correct?

[Rebecca Jollotta]

Correct.

[Jennifer Sprague]

You know that she was referred to your clinic by her. Her mother in law, Pat's mother, who was a labor and delivery nurse.

[Rebecca Jollotta]

Yes, I am aware.

[Jennifer Sprague]

Referred her to Julie Paul, who kind of stepped in for very short period of time to try to help out, right?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

And then Julie left, went to New Hampshire to continue her work, and you picked up on November 30th of 22, is that right?

[Rebecca Jollotta]

November 29th.

[Jennifer Sprague]

On November 30th of 22, you wrote a script for Quetipine, 30 Count, is that right?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

And what is quetipine? Seroquel you also, a week later, wrote a script for diazepam, 5 milligrams, is that correct?

[Rebecca Jollotta]

Correct.

[Jennifer Sprague]

And then the next day you wrote a script for. I'm sorry, December 6th, you wrote a script for diazepam, 5 milligrams, right?

[Rebecca Jollotta]

Correct.

[Jennifer Sprague]

December 7th, you wrote a script for Diazepam, 5 milligrams, Right?

[Rebecca Jollotta]

Correct.

[Jennifer Sprague]

December 7th again, you wrote a script for creatipine. 30 count, right.

[Rebecca Jollotta]

I would need to check my.

[Jennifer Sprague]

You can look at anything you want if you have. You have your records. Feel free, please.

[Rebecca Jollotta]

Okay. You said December. I don't believe it was a 30 count of 100 milligrams.

[Jennifer Sprague]

Do you remember writing Quetipine's script for 100 milligrams?

[Rebecca Jollotta]

I do. I believe the quantity was 22.

[Jennifer Sprague]

22. Okay. So on December 7th of 22, you wrote a script for Quetipine and. Forgive me, I'm sorry, what is that again?

[Rebecca Jollotta]

Seroquel.

[Jennifer Sprague]

Seroquel for 100 milligrams, right?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

And why did you write the script on November 30th for Quetipine, 25mg, and then about a week later, increase it to 100mg

[Rebecca Jollotta]

on November 30th? I had anticipated utilizing it over a four week course of treatment for sleep and anxiety, but her clinical symptoms presentations changed and we opted to use it for mood stabilization.

[Jennifer Sprague]

And who's we?

[Rebecca Jollotta]

Me.

[Jennifer Sprague]

Okay. And were you working with anybody else? Any psychiatrists or anybody?

[Rebecca Jollotta]

No.

[Jennifer Sprague]

So when a person comes to your clinic as a woman who has recently had a baby or is within that postpartum range of time and presents with the symptomology that she presented, is that something that would give you cause for concern? Suicidal ideation?

[Rebecca Jollotta]

I in no way want to minimize what Lindsey experienced. But it's common for us to treat.

[Jennifer Sprague]

It's common to treat women in that fashion that are postpartum.

[Rebecca Jollotta]

Postpartum, who may have suicide, keeps cutting

[Kevin Reddington]

off the witness before she gives an answer. May she complete her answer?

[Jennifer Sprague]

Sure.

[Judge William Sullivan]

As I've said before, let's only talk one at a time. You finish your answer and then we'll go to the question.

[Jennifer Sprague]

Go ahead.

[Rebecca Jollotta]

Her symptoms were serious. And it's not uncommon for me to treat women with serious symptoms in the postpartum period.

[Jennifer Sprague]

Okay. Two days later, you prescribed eight count five milligrams of diazepam, is that right?

[Rebecca Jollotta]

Two days from December 7th?

[Jennifer Sprague]

Yeah, it was December 9th.

[Rebecca Jollotta]

December 9th, yes.

[Jennifer Sprague]

Four days later, you prescribed more diazepam, is that correct? December 13th.

[Rebecca Jollotta]

Correct. That would have been two milligrams, yes.

[Jennifer Sprague]

And then jump ahead to December 19th, you prescribed 14 count, two milligrams of Diazepam, is that correct?

[Rebecca Jollotta]

Correct.

[Jennifer Sprague]

And then December 19th, you prescribed 300 milligrams of Quetipine. 30 count, right?

[Rebecca Jollotta]

Correct.

[Jennifer Sprague]

And that was on December 19th. Three days later, on December 21st, you prescribed additional Quiadipine. 100 milligrams, 14 count, right?

[Rebecca Jollotta]

Correct.

[Jennifer Sprague]

And then one day later, you prescribed more Quetipine. 25 milligrams of 14 count, right?

[Rebecca Jollotta]

Correct.

[Jennifer Sprague]

As far as your prescriptions continued on, if we can jump ahead, you continue to to treat her and on January 13th you prescribed 2 milligrams of diazepam. Seven count, right. That would be on January 13th.

[Rebecca Jollotta]

I did not prescribe that on January 13th.

[Jennifer Sprague]

All right, if I suggest to you that Rebecca Gelada is a script for January 13th of diazepam that doesn't refresh your memory,

[Rebecca Jollotta]

would it have been a script that I had sent previously that hadn't been filled at the original date?

[Jennifer Sprague]

Well, I believe the records would indicate that. We'll make a note of it. January 13th, diazepam. How about January 16th? Do you recall prescribing diazepam to her? 2 milligrams 3 count, no. Diazepam on the 19th of January, 2 milligrams 14 count.

[Rebecca Jollotta]

No.

[Jennifer Sprague]

No. So are you, you're not able to prescribe medications somebody else can't use you name, Right?

[Rebecca Jollotta]

Right.

[Judge William Sullivan]

Okay.

[Jennifer Sprague]

And you have the DEA license to prescribe medications, correct?

[Rebecca Jollotta]

Correct.

[Jennifer Sprague]

Now, one of the things that you went through was a lot of, obviously it's a little confusing with the names of the various drugs. And the district attorney said to you blithely, she said, well, she's a nurse so she knows what those drug names mean. Do you recall that question?

[Rebecca Jollotta]

I do, yeah.

[Jennifer Sprague]

And you just said, yeah, right. So you're assuming that a woman who gets her RN at the age of 24 in a one year program and then works for seven years as a labor and delivery nurse is familiar with these names and what they are, what drugs they are.

[Rebecca Jollotta]

Hey guys, lady luck here. Are you going on any road trips this summer? I know I'm going to be going on a bunch of road trips. And being that I'm going to be passenger Princess, I Love playing on Spinquest.com Spinquest has all of my favorite slot games. Live blackjack, live craps. Head on over to Spinquest right now and get yourself a $30 coin pack for just 10 bucks.

[Judge William Sullivan]

Spinquest is a free to play social casino. Prohibited visit. Spinquest.com for more details.

[Nanit Ad Speaker]

When you're a maintenance engineer in a beverage manufacturing plant, you keep production lines moving and quality on track because there is no room for slowdowns. With Grainger's vast selection of high quality motors, sensors, belts, and hard to find parts, you can get what you need fast and all in one place. So nothing gets in the way of getting the job done. Call 1-800-GRAINGER clickranger.com or just stop by Grainger for the ones who get it done.

[Rebecca Jollotta]

She seemed to be familiar with them. Yes.

[Jennifer Sprague]

She understood what benzodiazepines are, what Seroquel is, what all of these medications are.

[Rebecca Jollotta]

I did not know that.

[Jennifer Sprague]

Did you ever ask her where she acquired what appeared to be, apparently to you, her ability to know what these medications are?

[Rebecca Jollotta]

I'm sorry, I don't understand the question.

[Jennifer Sprague]

Well, you wouldn't know the medications that a labor and delivery nurse uses when they're helping a woman who's giving birth, would you?

[Rebecca Jollotta]

Not necessarily.

[Jennifer Sprague]

Okay. In any event, one of the things that you left us with is the fact that you were very, I think the word was invested in Lindsey Clancy and were concerned about her treatment, right?

[Rebecca Jollotta]

Correct.

[Jennifer Sprague]

You knew that she had gone to the Rhode Island Program for Women and Infants Center, Behavioral Health Day Program in Providence, Rhode Island. You knew that, right?

[Rebecca Jollotta]

I did.

[Jennifer Sprague]

And you basically gave her the referral. You didn't make the referral. I think it was Latasha Dukes that might have done that.

[Rebecca Jollotta]

Correct.

[Jennifer Sprague]

So you were aware of the fact that a recommendation was made to Lindsey that she reach out to someone else for help, right?

[Rebecca Jollotta]

Lindsay made me aware of that, yes.

[Jennifer Sprague]

And she needed help, didn't she?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

And she went to Women's and infants hospital on December 20th, right?

[Rebecca Jollotta]

She did.

[Jennifer Sprague]

And was she treated at Women and Infants?

[Rebecca Jollotta]

I don't believe so.

[Jennifer Sprague]

Why not?

[Rebecca Jollotta]

I wouldn't want to speculate. I. Or assume. But it seemed to be her intake appointment.

[Jennifer Sprague]

Her what?

[Rebecca Jollotta]

Her intake appointment.

[Jennifer Sprague]

Okay, so without assuming a speculating, you referred her to this provider, right?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

So you have this woman who you know has been seeing. Doctor. Dr. Tufts. A psychiatrist, Right?

[Rebecca Jollotta]

Right.

[Jennifer Sprague]

You knew that. You didn't get access to Tufts records. You didn't know what Tufts was doing, but you knew that for a period of time before she saw you, she was dealing with a psychiatrist, right?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

You knew that she was a woman who had just given birth, like five months ago, right?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

You knew that she was obviously in trouble. She was sick, right?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

You told us that she was suffering from. And your words Were a mental health illness that was very real. And you told her that this will get better. And that was in December of 2022?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

So when you referred her needing help to this women's and infants program in Rhode island and she went. Because that's what she was told to do. What happened at women and infants program?

[Rebecca Jollotta]

I can't speak to what happened at women and infants.

[Jennifer Sprague]

Why not?

[Rebecca Jollotta]

Because I was not a part of that assessment.

[Jennifer Sprague]

What does that mean?

[Rebecca Jollotta]

I did not see the assessment and I did not speak with Dr. Diaz.

[Jennifer Sprague]

Why?

[Rebecca Jollotta]

Lindsay had informed me that she was going to be at the program for two weeks.

[Jennifer Sprague]

She was hoping to be at the program for two weeks? Right.

[Rebecca Jollotta]

She told me she was going to be at the program for two weeks.

[Jennifer Sprague]

But she was turned away after about eight hours of sitting there in an assessment and sitting in a group session. And she was turned away because of their concern that she was suffering from. Well, let me ask you, what was their diagnosis?

[Rebecca Jollotta]

I'm not sure.

[Jennifer Sprague]

Did you ever find out?

[Rebecca Jollotta]

I have not.

[Jennifer Sprague]

Does it matter to you as a treating person that I think your words were is invested in Lindsey Clancy's care at that time, did it matter to you why she didn't get accepted into the program?

[Rebecca Jollotta]

It did.

[Jennifer Sprague]

Why was it?

[Rebecca Jollotta]

I do not know their diagnosis.

[Jennifer Sprague]

Did you know that she had been diagnosed? You have different diagnosis disease, right? Like general anxiety disorder or general anxiety gad. And then you have. Is it a differential? Is that what it's called?

[Rebecca Jollotta]

Mm.

[Jennifer Sprague]

What does that mean?

[Rebecca Jollotta]

Yes, it means a differential in medicine could be patient comes in with a cough. What are your differentials? Differential might be bronchitis, pneumonia, strep throat. So it's different things, different diagnoses. You consider.

[Jennifer Sprague]

Did you know that in fact they wouldn't accept her into the postpartum program because of their concern that she had been over medicated by drugs and they wanted to find out.

[Rebecca Jollotta]

I can't speak to that.

[Jennifer Sprague]

Did you know that she was diagnosed as diagnosis depression due to adverse drug effects?

[Rebecca Jollotta]

I cannot speak to that.

[Jennifer Sprague]

Do you know invested as you were that on December. Strike that.

[Bluff (Ad Speaker)]

On

[Jennifer Sprague]

December 20th, the very same day that she had finished being evaluated? Woman you were invested in had been evaluated by Dr. Diaz that you recommended or you mentioned that in fact, looking at the exhibit that they recommended. Tapering Seroquel starting 200mg tonight, follow up with outpatient provider of note. We attempted to reach current outpatient provider Rebecca Gelada but did not receive a call back.

[Rebecca Jollotta]

I never received a call from women and infants.

[Jennifer Sprague]

So this medical record from Women and Infants saying that they called Rebecca Jalada and never got a call back. Your memory is that they never called you?

[Rebecca Jollotta]

They never called me. I absolutely would have called them back.

[Jennifer Sprague]

Uh huh. Okay. Well, regardless, you never talked to anybody from Women and Infants, did you? Whether they called you or whether you reached out to them being invested.

[Rebecca Jollotta]

I did not. I know our program re referred her a few days later.

[Jennifer Sprague]

I'm gonna offer this now, you, Honor. I think just.

[Kevin Reddington]

It's already in evidence.

[Judge William Sullivan]

Yeah, we. I'll allow. We'll keep it as an exhibit for identification. You can double check. Make sure the pages that have been referred here are contained within. Is it Exhibit 220?

[Jennifer Sprague]

Yep.

[Judge William Sullivan]

And if not, then we can admit the. The second.

[Jennifer Sprague]

Okay, thank you. One of the things that you. Is a takeaway from your treatment of Lindsey is that she was. I think your words were that she was scared and thought that starting these drugs, this. The drugs, it was scary. Were her words, right?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

And at no time did it occur to you that Lindsay was doctor shopping or trying to get drugs. She was trying to basically get off drugs, right?

[Rebecca Jollotta]

Correct.

[Jennifer Sprague]

One of the things that you had mentioned is that the Good Moms have Scary Thoughts book is something that you guys would give out to women when they would come into your program. No, this is something you guys provide people to just help them out, right?

[Rebecca Jollotta]

Yes. Yeah.

[Jennifer Sprague]

And just a couple of things. So on November 17, she had an office visit with you, is that correct?

[Rebecca Jollotta]

Not on November 17th.

[Jennifer Sprague]

Okay. And you were at South Shore Medical center, right?

[Rebecca Jollotta]

Yes. That may have been her pcp.

[Jennifer Sprague]

Okay. Is that her pcp? Is that person that would be under the umbrella of the South Shore Medical Center?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

Would that be Kimberly Toccio?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

Okay, so you must have read Kimberly Toccio's records, I would imagine, right?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

And you know that she was seen. Record indicates that she was seen by a psychiatrist. And this would be November 17th. Nope. Started Zoloft 25, which was then increased to 50 milligrams, right?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

And she took the Zoloft 50 milligrams for one night and was unable to sleep and was discontinued because of the effect that it had on her, right?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

Now, one of the things that you had mentioned is that it's important to determine and you did have thoughts of possibility that she was bipolar, is that correct?

[Rebecca Jollotta]

Correct.

[Jennifer Sprague]

And one of the things that is contraindicated to someone who does suffer from bipolar, whether it's one or bipolar two, is that you do not place them on a selective Serotonin reuptake inhibitor drug such as Prozac or Zoloft, right?

[Rebecca Jollotta]

Correct.

[Jennifer Sprague]

Because it can have an effect on them, isn't that right?

[Rebecca Jollotta]

Correct.

[Jennifer Sprague]

What's the effect it can have on them?

[Rebecca Jollotta]

It can cause what we consider rapid cycling, meaning you can swing from mania symptoms to depression symptoms relatively rapidly.

[Jennifer Sprague]

What's up everybody? It's Bretzky and America is turning 250.

[Kevin Reddington]

And I can't think of a better

[Jennifer Sprague]

way to celebrate that than playing on

[Bluff (Ad Speaker)]

an American owned social casino spin quest.

[Jennifer Sprague]

With all of your favorite games. Live craps, bubble craps, live blackjack. There's no better place to play for free and win real cash prizes.

[Judge William Sullivan]

Spinquest.com Spinquest is a free to play social casino void where prohibited. Visit spinquest.com for more details.

[Nanit Ad Speaker]

When you're a maintenance engineer in a beverage manufacturing plant, you keep production lines moving and quality and on track because there is no room for slowdowns. With Grainger's vast selection of high quality motors, sensors, belts and hard to find parts, you can get what you need fast and all in one place. So nothing gets in the way of getting the job done. Call 1-800-GRAINGER click granger.com or just stop by Grainger for the ones who get it done.

[Jennifer Sprague]

On November 21, did she have a, a meeting with you all, if you recall looking at the records, did she meet with Julie Paul, if you will?

[Rebecca Jollotta]

Yes. Yes.

[Jennifer Sprague]

And she gave Julie a history of what she had been going through, is that correct?

[Rebecca Jollotta]

Correct.

[Jennifer Sprague]

And in that history and in her talks with Julie, she had disclosed the fact that one of the things that she would that she did in November was took a marijuana gummy one gummy to try to sleep, right?

[Rebecca Jollotta]

Correct.

[Jennifer Sprague]

And again, her medical tests, blood tests, urine test, everything showed that she had no alcohol, no thc, nothing on board. But she still disclosed the fact that to try to get some sleep, she took one gummy in November, right?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

So again, she's reporting, you know what, trying to be honest with you people as a provider, correct?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

And the scales that counsel asked you about, you were talking about the G, the depression scale, you were talking about the Edinburgh scale. And I think we all know that now that the Edinburgh scale is geared for an evaluation of a person, of a woman who is in that postpartum period. And you evaluate whether or not they are, as a result of being postpartum, severely depressed, right?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

And you indicated that at some point her Edinburgh scale was initially, what was it? 15, 17.

[Rebecca Jollotta]

If you know initially at my visit, my first initial with her.

[Jennifer Sprague]

Yeah. What was her Edenburg scale the first time you saw her?

[Rebecca Jollotta]

17.

[Jennifer Sprague]

Okay. And that would be moderate.

[Rebecca Jollotta]

Moderate.

[Jennifer Sprague]

Okay. And then she had another Edinburgh scale after that. Correct, Correct. And when was that, if you know.

[Rebecca Jollotta]

December 6th.

[Jennifer Sprague]

And what is EPDs, what does that mean?

[Rebecca Jollotta]

Edinburgh Postpartum Depression Scale.

[Jennifer Sprague]

All right, so would you look at November 21, please? Which would be. So November 21, she was administered a Edinburgh test. Right.

[Rebecca Jollotta]

On the 21st. That would have been at Julie's appointment. I don't have that in front of me.

[Jennifer Sprague]

If I told you that. Well, on November 21st, it's a short period of time after November 17th. Did they admit the day? Whether it's Julie or somebody else admits Minister Edenberg tested her.

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

And what was the result?

[Rebecca Jollotta]

23.

[Jennifer Sprague]

That's severely depressed, isn't it?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

So in like six days she decompensated from Edinburgh scale 17 to Edinburgh scale 23. Right.

[Rebecca Jollotta]

So she was 23 on November 21 and 17 on November 29.

[Jennifer Sprague]

Okay. So when you see a patient that's come to you and has an Edinburgh scale of 23 and an Edinburgh scale a couple of days later, that would be. What was it?

[Rebecca Jollotta]

17.

[Jennifer Sprague]

And what was it when you first saw it? You referenced it before 17.

[Rebecca Jollotta]

17.

[Jennifer Sprague]

Yeah. That's still pretty high, isn't it?

[Rebecca Jollotta]

A tie? Yes.

[Jennifer Sprague]

Would that give you pause in conjunction with the symptomology that she's referring to and self reporting what she's feeling, I mean, the fact that she has a 23 on the Edinburgh scale, which is very high, and then followed up a couple of days later by a 17 taken in conjunction with what she was saying her symptoms were. That's of a concern, isn't it?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

So on November 20, which would be the day before that, Edinburgh scale of 23. And jury will have access to all these records. She was reporting struggling with postpartum anxiety. Right.

[Rebecca Jollotta]

I can't speak to that Enough.

[Jennifer Sprague]

That's fair enough. We'll go to when you treated her.

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

Did you have it. Did you have a chance to review Julie's notes?

[Rebecca Jollotta]

I did.

[Jennifer Sprague]

Okay.

[Rebecca Jollotta]

Yeah.

[Jennifer Sprague]

And when was the first time that you actually met with Lindsay?

[Rebecca Jollotta]

November 29th.

[Jennifer Sprague]

Okay. Which would have been after Thanksgiving, obviously, right?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

And you would have reviewed the records up to that point, right?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

So one of the things that you would have reviewed was what she had indicated or reported to Nicole Hardin Francis. Do you know her?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

And who is Nicole Harden, Francis?

[Rebecca Jollotta]

She's the nurse at our program.

[Jennifer Sprague]

All right. And this would be on November 28 that she was speaking with Nicole, the nurse. You read the report before you met with Lindsay on the 29th, right?

[Rebecca Jollotta]

Right.

[Jennifer Sprague]

So you knew that she had been reporting panic symptoms, that she was disoriented, that she was forgetful, that she was not connected to her body is what she told her, Right.

[Rebecca Jollotta]

I would have to review that just to be accurate. That's correct.

[Jennifer Sprague]

Okay. Do you agree with me that symptomology of mania, especially when incurred or encountered by a woman within the postpartum period, that's one of the symptoms, is being disoriented, right?

[Rebecca Jollotta]

Not necessarily.

[Jennifer Sprague]

How about maybe a little bit?

[Rebecca Jollotta]

Could be confused if you're manic.

[Jennifer Sprague]

Yeah. How about forgetful? That's. That's an issue, isn't it?

[Rebecca Jollotta]

Not necessarily a symptom of mania.

[Jennifer Sprague]

Okay. How about not connected to her body? What does that mean?

[Rebecca Jollotta]

I'm not sure what that means.

[Jennifer Sprague]

So if you have a patient who's coming to see you, who's indicated the day before that she has the panic symptoms, disoriented, forgetful, not connected to her body, wouldn't you ask her what she meant by that?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

Okay. So when you saw her on November 29, you diagnosed that she had postpartum anxiety, Right. Adjustment insomnia, right?

[Rebecca Jollotta]

Correct.

[Jennifer Sprague]

And when you met with her, you noted that over the last two weeks, you asked her about how she had been feeling, and she said she was feeling nervous, anxious and on edge. She said nearly every day. Right. That's November 29th. That would be under screenings.

[Rebecca Jollotta]

Yes. She was.

[Jennifer Sprague]

I would give you a page number, but they don't give us page numbers. She told you, and you can pull it up if you have it there, that she was not able to stop a. Control worrying. And that had been for several days at least, right?

[Rebecca Jollotta]

Correct.

[Jennifer Sprague]

And she was worrying and stressing about things. Worrying about different things every day, right?

[Rebecca Jollotta]

Nearly every day, yes.

[Jennifer Sprague]

Couldn't relax nearly every day. These are. This is a questionnaire form that you have, right?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

Being so restless nearly every day, correct?

[Rebecca Jollotta]

Correct.

[Jennifer Sprague]

Asked if she was annoyed or irritable, and she said not at all. Sure. Like she doesn't think. She didn't believe that she was a person that would be irritable or angry with people, right?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

And then feeling afraid, as if something awful might happen. And she got that Gad 7 score of 14. Is that correct?

[Rebecca Jollotta]

Correct.

[Jennifer Sprague]

So what does a Gad score of 14 tell you on November 29th?

[Rebecca Jollotta]

Moderate anxiety.

[Jennifer Sprague]

And then you ask about in the last seven days, trying to get a history. She denied definitely not so much now that she was able to laugh or see the funny side of things. Things.

[Rebecca Jollotta]

Right, right.

[Jennifer Sprague]

And that she was asked, is she looking forward with enjoyment to things? And she responded, hardly at all. Right.

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

Blaming herself when things go wrong? She says, yeah, some of the time. Yep.

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

Anxious and worried for no good reason. Yes. Correct.

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

Scared and panicky for no good reason. Yes. Correct.

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

Then they asked if she felt sad or miserable. She was a miserable person. And she said, no, not at all. Right, Right. Did she indicate that on that date, you gave her the EPDs Edinburgh Test and she had an Edinburgh score, as we said, of 17, right?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

All right. And then the medications that you prescribed to her. We've already got an evidence jury will be able to look at the actual scripts in the exhibit without going through every single day. The next time you saw her was November 30th, is that right?

[Rebecca Jollotta]

I messaged with her on November 30th, yes.

[Kevin Reddington]

Okay.

[Jennifer Sprague]

And you indicated that if you're not sleeping well with Valium, no need to continue it. I'll prescribe a short taper. And you went on about tapering and 5 milligrams of Valium to 2.5 milligrams and no benzos.

[Rebecca Jollotta]

And that was not on November 30th.

[Jennifer Sprague]

Okay. Does it say on the record. Are you looking where it says patient message in the Perinatal Behavioral Health Program of South Shore Health, November 30, 2022?

[Rebecca Jollotta]

Yes, I'm looking at the messages.

[Jennifer Sprague]

Okay, so is it a different date that you sent that message? It says November 30th on it. Right. I just don't know internally if you guys have different.

[Rebecca Jollotta]

Oh, I. I understand. Oh, at the top it says November 30th. More specific, it'll say the dates, but the header will say November 30th.

[Kevin Reddington]

So.

[Rebecca Jollotta]

I understand.

[Jennifer Sprague]

Okay. And basically, you indicated that you were going to send along information about bipartisan bipolar one or bipolar two, which. Which actually would be what's known as a bipolar spectrum disorder. Is that correct?

[Rebecca Jollotta]

Yes, that was on December 7th.

[Jennifer Sprague]

Okay. But it's. It's underneath November 30th, so forgive me for looking at it that way.

[Rebecca Jollotta]

Yeah, I don't know why that's.

[Jennifer Sprague]

All right. No problem. So one of the things with the mania that you. That you refer to and that you talk about is excessive activity. Is that it? Excessive cleaning? Sometimes. Right.

[Rebecca Jollotta]

Sometimes.

[Jennifer Sprague]

Excessive exercise sometimes. Did you know that after she had Callan that within a matter of a couple of weeks, that she. That she ran a 5k.

[Rebecca Jollotta]

No, I did not know that.

[Jennifer Sprague]

And that nobody wanted her to, including Pat, but she just had to get out there and run and did.

[Kevin Reddington]

Objection.

[Jennifer Sprague]

No, overall, you know that I did not. Is that something that would be important to know? I mean, as far as whether or not a person is in that manic stage where it's post delivery, and that's a significant artifact, if you will, of exercising. Right.

[Rebecca Jollotta]

It would have been something I would have considered. Okay.

[Jennifer Sprague]

And as I said, you were the. Pretty much the only one that actually considered bipolar spectrum disorder. Of all the doctors that she had seen, you know that, Right. Are you aware of that?

[Rebecca Jollotta]

I'm.

[Jennifer Sprague]

All right, never mind. That's right. She's going to object. That's okay.

[Rebecca Jollotta]

Okay.

[Jennifer Sprague]

So the symptoms that you noted were a mania. It says mania. Characterized by exaggerated excitement, hyperactivity, and racing, scattered thoughts. Right.

[Rebecca Jollotta]

Yeah.

[Jennifer Sprague]

So what is. Go ahead.

[Rebecca Jollotta]

Was that from my note?

[Jennifer Sprague]

I'm looking at the same thing that we've been looking at, which is.

[Rebecca Jollotta]

Oh, the information I sent her on by pulling.

[Jennifer Sprague]

Yeah. It says, hi, Lindsay. And then your note. Right.

[Kevin Reddington]

If I may suggest maybe showing the witness what he's referring to.

[Jennifer Sprague]

She has it in front of her.

[Rebecca Jollotta]

I think I understand what he's referencing, but. Thank you.

[Kevin Reddington]

If.

[Judge William Sullivan]

If the witness has a problem in regards to that and you need to look at some, just let. Let me know.

[Rebecca Jollotta]

Okay.

[Judge William Sullivan]

All right.

[Rebecca Jollotta]

Thank you.

[Jennifer Sprague]

Thank you. She. If you move ahead to, I think, the message portal or whatever it's called on November 30, it's captioned stopping Remeron.

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

Not sleeping. It was a huge problem for her, Right?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

And she told you in her message thing. No. The weird thing is I don't feel tired at all.

[Rebecca Jollotta]

Correct.

[Jennifer Sprague]

And that's one of the things that you had told us earlier, is a symptom, Correct?

[Rebecca Jollotta]

Correct.

[Jennifer Sprague]

A person that is not getting sleep but doesn't feel tired.

[Rebecca Jollotta]

Correct.

[Jennifer Sprague]

What is the symptom of?

[Rebecca Jollotta]

It's. It could. It's a symptom of mania that we look for.

[Jennifer Sprague]

Okay. And when we look for that mania, did you notice that, and did you factor that into your diagnosis?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

Okay. How many times, if you recall, did Pat come with his wife to meet with you? Was it three?

[Rebecca Jollotta]

He came to a visit once, I believe I said, spoke with him and Lindsey on the phone twice.

[Jennifer Sprague]

Would you agree with me that as counsel asked, did he get permission to be there, and you indicated no. That you would welcome the third party contact? Right.

[Rebecca Jollotta]

Correct.

[Jennifer Sprague]

And did it appear to you that he was very, very invested in her care and was very scared and worried.

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

And he was complaining about the fact that he believed that they believed that she was to going. Being overmedicated. Right.

[Rebecca Jollotta]

I believe he was concerned about her symptoms. He felt that they started once she started being medicated initially.

[Jennifer Sprague]

Right. Because she indicated that when she first started taking the SSRI back in October, I believe that she ended up having it increased and then had a period of almost two days where there was no sleep whatsoever. That was one of the instances, right?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

She also counsel had asked you and you did not recall her saying horrible intrusive thoughts. So if you would just look at November 30th patient message, it says, hi, Rebecca. And then it begins, I don't expect you to answer this until Monday.

[Rebecca Jollotta]

I see that.

[Jennifer Sprague]

Okay. And then she says how she basically only slept for about four hours at the beginning of the night, 9:30, and then dozed off for 45 minutes and said, today all day I had horrible intrusive thoughts and deeply depressed. Right?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

So when was the next time that you saw her after she sent that message? On November 30th?

[Rebecca Jollotta]

I would have seen her on December 6th.

[Judge William Sullivan]

She.

[Rebecca Jollotta]

She had sent this message, I believe, on December 3rd, and I saw her on the 6th.

[Jennifer Sprague]

So on December 3rd. And again, it would be the way that they print this thing out, it has a date of November 30, but then underneath it, it would be a different date of December 3rd, is that right?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

Okay. And when you as an invested nurse practitioner, receive a message from a woman who is postpartum, who has been through what she's been through, the symptomology that she explained and the doctors that she's

[Kevin Reddington]

seen,

[Jennifer Sprague]

not two very good results, you'd be concerned when you see a person saying, I have horrible intrusive thoughts, right?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

All right. So as a result of seeing on December 3rd that Lindsey Clancy, with her history, had been telling you that she had horrible intrusive thoughts, what did you do? Did you call her?

[Rebecca Jollotta]

She had told me that she took the Ativan and now the thoughts were gone and she had felt good.

[Jennifer Sprague]

So.

[Rebecca Jollotta]

But I did speak to her about it.

[Jennifer Sprague]

Yeah, but she told you, she told you that in her message, right. That she had today all day I had horrible intrusive thoughts, deeply depressed. I finally took 0.5 of Ataban, that Ativan at 6pm and the thoughts are gone is what she told you, right?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

Did you ever bother to ask. I don't know. I mean, would you ask the patient what the horrible intrusive thoughts?

[Judge William Sullivan]

Were

[Rebecca Jollotta]

I. I would have, yes.

[Jennifer Sprague]

Did you?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

What did she say?

[Rebecca Jollotta]

She described them as thoughts of not wanting to be here.

[Jennifer Sprague]

How about. Did she ever described to you that she was hearing voices?

[Rebecca Jollotta]

No.

[Jennifer Sprague]

How many people have you treated for postpartum psychosis?

[Rebecca Jollotta]

5.

[Jennifer Sprague]

And of those five people, did they hear voices?

[Rebecca Jollotta]

Not all of them.

[Jennifer Sprague]

How about some of them?

[Rebecca Jollotta]

Some of them.

[Jennifer Sprague]

And that's a real thing, isn't it?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

And visual hallucinations? Likewise.

[Kevin Reddington]

Not all.

[Jennifer Sprague]

So with the voices, that would be an auditory hallucination?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

Visual hallucination? Not all, but some.

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

And that's a real thing?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

So when she had horrible intrusive thoughts, did she say where these happened? Like, was she in the yard? Was she in her car? Did she. Did you ask her where and what? Or is it just that she just didn't want to be here anymore?

[Rebecca Jollotta]

It was more that she didn't want to be here anymore.

[Jennifer Sprague]

Okay. Did you ask her what that meant?

[Rebecca Jollotta]

I did ask her if she had any plans or intent for suicide, which changed at different times during our treatment.

[Jennifer Sprague]

So on December 2, you have received a. I'm sorry, you sent a note to Lindsey and said it, meaning what she was telling you in a prior communication. It sounds more like depression than side effects. That would be of drugs, right?

[Rebecca Jollotta]

Correct.

[Jennifer Sprague]

It is not uncommon for me to hear. And then you, quote, I have never felt anything like this before, end quote or quote, I just don't feel like myself. All of this sounds like postpartum depression, is that correct?

[Rebecca Jollotta]

Correct.

[Jennifer Sprague]

All right. So she was expressing all of the symptomology of the depression, what you believe would have been side effects. And you indicated that at this point, while you're working through it, this sounds like postpartum depression, right?

[Rebecca Jollotta]

Correct.

[Jennifer Sprague]

And what would the symptomology of what does postpartum depression mean and what is its effect on a patient?

[Rebecca Jollotta]

Postpartum depression is like depression at any time during a patient's life. However, there are some unique considerations. It typically occurs in the first three months after a person has a baby, but it can happen at any point in the first year. The considerations that are a little bit different than regular major depressive disorder are that there are significant hormone fluctuations that a person undergoes when they deliver a baby. Sometimes. Sometimes they breastfeed and they wean from breastfeeding, and that can set off additional hormone shifts. And it tends to be a very anxious presentation. And obsessive thoughts can occur with greater regularity in postpartum depression than they would with major depression outside of the postpartum period.

[Jennifer Sprague]

So as a result of this information, you prescribe medication to her

[Rebecca Jollotta]

after I sent her the information on the postpartum. Would this still be December 2nd?

[Jennifer Sprague]

Looking at the form that you have, it would be, yes. But I don't know if it's another date that there's a message underneath it. So let's look at the record where it says that on December 7th.

[Rebecca Jollotta]

Seventh, yes.

[Judge William Sullivan]

Okay.

[Jennifer Sprague]

Okay. And that's where you talked about bipolar spectrum disorder, right?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

And that's where you talked about how people would have these feelings of goal directed activity, overly talkative, racing thoughts, need to sleep, things of that nature, right?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

What was the end result of that? Did you prescribe medication for her?

[Rebecca Jollotta]

I did.

[Jennifer Sprague]

What was it?

[Rebecca Jollotta]

Seroquel.

[Jennifer Sprague]

One of the things that you had mentioned is that you provided a mood chart, I think. Is that what you said? A mood chart? Is this it? Is that an indication? Just so the jurors know that it's in the records. It's a horrible.

[Rebecca Jollotta]

That looks accurate. Yes.

[Jennifer Sprague]

Again. Yeah, there it is right there. See, on the very top it says mood chat.

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

All right. And on the top it says daily. And then you also provided another chart on that date.

[Judge William Sullivan]

What is that?

[Jennifer Sprague]

That's another variation of it.

[Rebecca Jollotta]

It's the weekly mood chart.

[Jennifer Sprague]

Okay, so did you tell her to fill this out?

[Rebecca Jollotta]

I suggested that she fill it out so we could keep track of her symptoms.

[Jennifer Sprague]

Okay. Do you remember if she filled it out when she spoke to you?

[Rebecca Jollotta]

She did not speak to me about filling it out after that. She did say she printed it out.

[Jennifer Sprague]

Okay. Did you ever ask to see it?

[Rebecca Jollotta]

I. I don't recall.

[Jennifer Sprague]

Okay. On December 1st, you. You met with her, is that right? Oh, no, wait a minute. Christine Zappi. Who's Christine Christina Zappi?

[Rebecca Jollotta]

I believe she's also someone that works at social center.

[Jennifer Sprague]

All right. Do you know that she saw Christine Zappi on December 1st? Christina. I'm sorry? It says Christina.

[Rebecca Jollotta]

I'm not sure if she saw her for a visit that day.

[Jennifer Sprague]

Okay, have you. Have you seen in the. In the pool of records that you have that she did see this individual and noted that she had been dealing with the problems, the insomnia symptomology for over a month and a half, and medications keep changing, and it doesn't seem like much is helping. Did you ever see that?

[Rebecca Jollotta]

That does sound familiar.

[Jennifer Sprague]

Okay, so she was somewhat in. This is almost hand in glove with saying, I'm not being heard. Right Idea. Did you see her on December 2nd?

[Rebecca Jollotta]

The next day, I spoke to her on December 2nd.

[Jennifer Sprague]

Okay. And again, the district attorney kept asking you about, you know, she had the opportunity to come in and see you if she wanted to, and things of that nature, right?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

And would you agree with me that it's sometimes better to have a face to face actual meeting with a patient rather than. Than just on the computer?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

Did you ever, if you recall, with all of the symptomology and deterioration going by week after week, say to her, I really think that we should get together in person?

[Rebecca Jollotta]

Yes. So we met in person on the 6th, and our plan had been to meet in person on the 13th.

[Jennifer Sprague]

Okay, so that would be December 6th, correct?

[Rebecca Jollotta]

Mm, yes.

[Jennifer Sprague]

Now, December 2nd, and you had a conversation with her on the phone, is that right?

[Rebecca Jollotta]

I believe it was just my chart messages.

[Jennifer Sprague]

Okay, so you see on where it says again, it's got the big black letters 12-2-22, and then underneath it, it says behavioral health history. Can you find that on your records? If you don't, that's fine. That would be the time that she indicated that she had been to the. The ER for anxiety symptoms as well as insomnia and heart palpitations. You remember that?

[Rebecca Jollotta]

I. I don't see that.

[Jennifer Sprague]

Okay, well, then let's get it. Do you have. You have access to other staff notes and records, right?

[Rebecca Jollotta]

I do. I. I only brought my own.

[Jennifer Sprague]

That answers that. So if I approach you, you.

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

Can I see what you're showing her first?

[Jennifer Sprague]

Yeah. Latasha Dukes. Who's Latasha Dukes?

[Rebecca Jollotta]

Leticia Dukes was. Was a clinician at our program at the time.

[Jennifer Sprague]

All right, so am I looking at Duke's msw? What does that mean?

[Rebecca Jollotta]

Master of social work.

[Jennifer Sprague]

And does that indicate a date that Ms. Dukes saw Lindsay?

[Rebecca Jollotta]

December 2nd.

[Jennifer Sprague]

And on December 2nd, again, she was complaining of symptomology. She meaning Lindsay having heart palpitations. Right.

[Rebecca Jollotta]

She's describing that she had heart palpitations and she went to the ER for anxiety symptoms.

[Jennifer Sprague]

Okay, so the answer is yes.

[Rebecca Jollotta]

Yes. Yes.

[Jennifer Sprague]

And that she then went to the ER and per patient's report, she has an addiction to Ativan and that's why she can't sleep. And she also noted that weight loss, right?

[Rebecca Jollotta]

Correct.

[Jennifer Sprague]

And panic attacks. Right?

[Rebecca Jollotta]

Correct.

[Jennifer Sprague]

So she's got a fear that she's on the benzodiazepines by script that she didn't want to be on, and she couldn't sleep and she was losing weight and all the other symptomology that we talked about, Right?

[Rebecca Jollotta]

Correct.

[Jennifer Sprague]

And that's in December.

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

December 5th, Nicole Hayden Francis had a chance to speak with Lindsay and at that point there was a recommendation that she might want to try inpatient in. In PT loc. What does that mean?

[Rebecca Jollotta]

Inpatient level of care.

[Jennifer Sprague]

Okay. And that would be Nicole Hayden Francis, who's a nurse, was telling her that on December 5th.

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

Now on. And again, I know you don't have the records from Leticia Dukes, so if I may approach you beg, on December 5, can you correct me if I'm reading correct. And on that occasion, Letitia Dunes notes that she called Aspire Crisis Support. She meaning Lindsay, right?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

What is Aspire Crisis Support?

[Rebecca Jollotta]

Aspire is the community mental health program that operates the local 24 hour emergency services program for psychiatric emergency services.

[Jennifer Sprague]

Okay. So when you, when I say you collectively, I mean psychiatrists, nurse practitioners, RNs from in the psychiatric world tell patients that are in crisis that if you feel that you're going to have suicidal ideation or anything, you should call these numbers is what your people will give them, Right?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

She called Aspire Crisis Report Support not once but twice. Right.

[Rebecca Jollotta]

If you know, I'm aware of that one time she called, but she was

[Jennifer Sprague]

not given any help at all by Aspire, whoever they are.

[Judge William Sullivan]

Right?

[Rebecca Jollotta]

I'm not aware of that.

[Jennifer Sprague]

Well, it says right in the records from Leticia that she met with an Aspire clinician virtually and was told that she did not meet the criteria for inpatient treatment due to not having an SI plan. What does that mean? They just told her, you're not laying on the ground with your throat cut, so we're not going to be able to help.

[Rebecca Jollotta]

You can't speak to what they told her.

[Jennifer Sprague]

So Aspire then recommended that she stat or go to a day program, is that correct?

[Rebecca Jollotta]

That's correct.

[Jennifer Sprague]

And the clinician said that he from aspiring would be sending the patient resources, right?

[Rebecca Jollotta]

Correct.

[Jennifer Sprague]

But they never did, did they?

[Rebecca Jollotta]

If you know, I don't know.

[Jennifer Sprague]

Further, Leticia notes that they review the sleep hygiene with the patient clinician provided patient suggestions for meditation, grounding, self soothing techniques. What's a self soothing technique?

[Rebecca Jollotta]

It might just be simple strategies to soothe yourself using any of your five senses,

[Jennifer Sprague]

she notes. And again, this is on December 5th. The Pap patient's husband joined the visit reporting that her anxiety had become significantly worse since starting the psychiatric medications. Did that say that?

[Rebecca Jollotta]

That is what that says. Okay.

[Jennifer Sprague]

And in fact, when you spoke to Pat, he had told you that in his quotation his words would be it was 10,000 times worse since she started this medication.

[Kevin Reddington]

Right.

[Jennifer Sprague]

If. If, you know, he.

[Rebecca Jollotta]

I don't recall him. Him using that phrase.

[Jennifer Sprague]

But he was upset about the medication, wasn't he?

[Rebecca Jollotta]

I would say he was concerned.

[Jennifer Sprague]

Do you recall that he said that? You're turning her into a zombie.

[Rebecca Jollotta]

I do not recall that he said that.

[Jennifer Sprague]

Would you say, the jury, that he was concerned or he was pissed off about the medication and what it was doing to his wife?

[Judge William Sullivan]

Now, overall,

[Rebecca Jollotta]

I. I would say he was concerned.

[Jennifer Sprague]

Concerned.

[Rebecca Jollotta]

Okay.

[Jennifer Sprague]

Did anybody address his concerns that day? Any day?

[Rebecca Jollotta]

I would say that day I collaborated with them to take her off certain medications.

[Jennifer Sprague]

Okay. December 6th, you had a meeting with. With her, is that correct?

[Rebecca Jollotta]

Correct again.

[Jennifer Sprague]

She's diagnosed postpartum anxiety, right?

[Rebecca Jollotta]

Correct.

[Jennifer Sprague]

Her EPDs score as a result of being administered the Edinburgh test was at that time a 21. Right. That would be underneath office visit and perinatal behavioral health above assessment and recommendations.

[Rebecca Jollotta]

Correct.

[Jennifer Sprague]

And 21. How would you grade that?

[Rebecca Jollotta]

Severe.

[Jennifer Sprague]

Severe what?

[Rebecca Jollotta]

Severe signs of postpartum depression to know

[Jennifer Sprague]

that she had lost over £15 by that point?

[Rebecca Jollotta]

I was aware she had lost some weight. I was not aware that it was 15 pounds.

[Jennifer Sprague]

Okay, so then there was another patient message on December 7th where she again was expressing concern about the drugs. And you indicated, either way, I continue to recommend the Valium taper, right?

[Rebecca Jollotta]

Correct.

[Jennifer Sprague]

There was a period of time that she indicated that she wanted to get off the medication and get off the drugs. And you indicated, as you told us, that you were on vacation that week, right?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

You basically told her to tough it out and just hit me up when. When I come back from vacation, right?

[Rebecca Jollotta]

No.

[Judge William Sullivan]

No.

[Jennifer Sprague]

Did you tell her to call you when you came back from vacation?

[Rebecca Jollotta]

No, I asked that she try to hold off and wait for me to come back from vacation for the taper. She had wanted to taper it sooner.

[Jennifer Sprague]

All right. Do you have somebody that covers for you if you're on vacation?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

Did somebody cover?

[Rebecca Jollotta]

She said that she was going to follow up with her other psychiatrist for the taper, but she did reach out to our program while I was on vacation.

[Jennifer Sprague]

I couldn't understand your words.

[Rebecca Jollotta]

I'm sorry. And I do know that she was in contact with other providers at our program, including Leticia Dukes, while I was on vacation.

[Jennifer Sprague]

And Leticia Dukes is a social worker, is that right?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

Okay. December 9th, there was another telephone encounter, it's called. Right?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

And. And yet again, her husband Pat was involved with this call, right?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

So does this put Patrick up to around four times, maybe five times that he had been involved either in person with your business or on the telephone or on the telemetry or whatever it is. Computer.

[Rebecca Jollotta]

I spoke with him on the phone twice. He was in one of our visits on December 6, and it appears he was in the visit with Letitia as well.

[Jennifer Sprague]

So this would be a Rebecca Gelada telephone.

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

Encounter on December 9th, right?

[Rebecca Jollotta]

Correct.

[Jennifer Sprague]

And on that occasion, Lindsay, and it says and her husband called this writer. That'd be you?

[Rebecca Jollotta]

Correct.

[Jennifer Sprague]

Regarding the plan to taper. Correct.

[Rebecca Jollotta]

Correct.

[Jennifer Sprague]

And they agree. They both agreed that Lindsay's symptoms remain too acute. What does that mean? What's acute mean?

[Rebecca Jollotta]

Severe.

[Jennifer Sprague]

Did they say that? She's sleeping but waking up? Let me back up. Was he telling you all this while she sat there? She wasn't saying much on that call conversation, was she?

[Rebecca Jollotta]

I don't recall who was saying more than the other person.

[Jennifer Sprague]

You recall that she indicated that she wanted her husband to be involved, to speak for her because she was really decompensating.

[Judge William Sullivan]

Right.

[Jennifer Sprague]

She wasn't self reporting and self advocating too well for herself at that point, was she?

[Rebecca Jollotta]

I just know she did have her husband on the call, and he did speak on the call.

[Jennifer Sprague]

They indicated that she was waking up with panic symptoms, right?

[Rebecca Jollotta]

Correct.

[Jennifer Sprague]

What panic symptoms? What does that mean?

[Rebecca Jollotta]

Panic symptoms can be this sudden rush of intense panic symptoms. Panic symptoms. What.

[Jennifer Sprague]

What were they?

[Rebecca Jollotta]

Panic symptoms are racing heart, intense fear. Those are panic symptoms. Sudden rushes of intense anxiety that seem to come out of nowhere.

[Jennifer Sprague]

Okay. Is that something that you learn in school or is that in a book? Is it in the DSM or what? We all have our own opinion as to what panic symptoms might be, but from a medical standpoint, those are panic.

[Rebecca Jollotta]

What panic symptoms are.

[Jennifer Sprague]

Would you agree that Patrick, in this conversation, also indicated that she was having intrusive thoughts yet again? Right?

[Rebecca Jollotta]

Correct.

[Jennifer Sprague]

What were the intrusive thoughts that she was having when she wakes up with panic symptoms?

[Rebecca Jollotta]

I don't recall the specific intrusive thoughts. I recall asking about safety and that she did identify having thoughts of suicide.

[Jennifer Sprague]

Well, Patrick told you that she has thoughts of suicide, Right.

[Rebecca Jollotta]

Lindsey as well.

[Jennifer Sprague]

Okay, so I'm asking you what you, as an invested health care provider, told this woman to advise her. What your investigation revealed. If you have a patient tell you I'm having intrusive thoughts, what were they?

[Rebecca Jollotta]

I recall that they were intrusive, suicidal thoughts.

[Jennifer Sprague]

And is this a frequent theme that you noted?

[Rebecca Jollotta]

I don't know if it was a frequent theme that I noted, but I know that it was documented several times throughout her course of treatment with providers in my program.

[Jennifer Sprague]

So at this point, with all the providers of your program and her indications, as well as her husband's, about the number of times that she had suicidal ideation, did you prescribe more drugs for her

[Rebecca Jollotta]

at this occasion? I prescribed Valium.

[Jennifer Sprague]

You bumped her up to Seroquel for 400 milligrams, didn't you?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

Did that help? How'd that work out?

[Rebecca Jollotta]

At 200 milligrams, she was able to sleep. So I felt that the mixed. The manic symptoms in her mixed presentation were alleviated at 200.

[Jennifer Sprague]

So on December 12, she sent you one of those messages. Thank you, Rebecca. She says, for the last three nights, I've taken 2.5 milligrams of Valium and 200 of Seroquel. I have to say, I do like the way it makes me sleep deeply and soundly for about seven or eight hours. I don't like the way I feel in the morning that you read that to the jury for the da, right? Yes, but then the rest of the sentence is incredibly depressed and unmotivated to do anything at all. Do you remember her saying that?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

You'd agree with me that that's one of the observations that you make, or symptomology of a person that's suffering significantly from postpartum anxiety depression. She's incredibly depressed and unmotivated to do anything. Right. What does that mean? What does she mean by that?

[Rebecca Jollotta]

I'm not sure I understand the question

[Jennifer Sprague]

when she says that she's unmotivated and is incredibly depressed. Was she able to go shopping? Could she get in the car and drive? Did you know that she stopped driving?

[Rebecca Jollotta]

I was not aware of that.

[Jennifer Sprague]

On December 12, She saw Letitia Dukes patients reporting thoughts of SI suicidal ideation, but no plan. She contacted Crisis over the weekend and will be starting a PHP in Norwell. What does that mean?

[Rebecca Jollotta]

Partial hospitalization program.

[Jennifer Sprague]

Okay. And that's because yet again, she's reporting the suicidal ideation, correct?

[Rebecca Jollotta]

Correct.

[Jennifer Sprague]

And there's a difference between suicidal ideation and having thoughts of suicide, Right. Under the dsm. Is there.

[Rebecca Jollotta]

There's a. Suicidal ideation can be a spectrum.

[Bluff (Ad Speaker)]

Okay.

[Jennifer Sprague]

On December 13, telemedicine in the perinatal behavioral unit. Again, there was a concern about suicidal ideation. And her book underneath Edinburgh Postnatal Depression Scale, if you have it was. Was now 20. It's still severe, right?

[Rebecca Jollotta]

Correct.

[Jennifer Sprague]

So what did you do on that date, if you know.

[Rebecca Jollotta]

December 13th, I recommended that she continue Seroquel, 200mg and Valium 2mg.

[Jennifer Sprague]

December 19th, telemedicine with Letitia Dukes. And this is when she indicated that she was going to can. She was going to contact Women and Infants. And Leticia helped her out to do that. So she went to Women and infants on the 20th, right?

[Rebecca Jollotta]

Correct.

[Jennifer Sprague]

Okay, so as time went on and she had gone to Women and Infants and was unable to be treated on December 20 and went home, picked up by her husband, what was her course of treatment after that? You didn't talk to anybody at Women and Infants, right?

[Rebecca Jollotta]

At that time? I did not talk to anybody at Women and Infants, but I do know that we re referred her in a few days.

[Jennifer Sprague]

I know. You already told us you re referred her. My question is real simple and I don't mean to be holy. I just want to ask you.

[Judge William Sullivan]

Yes.

[Jennifer Sprague]

Did you talk to anyone at Women and Infants?

[Rebecca Jollotta]

No.

[Jennifer Sprague]

So as I read the record, which is an exhibit, women and infants, December 20, differential diagnosis. Concern about medications. Concern reaches out to Rebecca Gelada. No return call from Gelada. You don't recall that you don't know what happened to her after that, do you? Other than going to McLean?

[Rebecca Jollotta]

I know that she went to McLean.

[Jennifer Sprague]

Right. Do you know when she went into McLean?

[Rebecca Jollotta]

At the end of December, early January.

[Jennifer Sprague]

Okay. Did you review the McLean records? Because you have access to them, right?

[Rebecca Jollotta]

I do not have access to them.

[Jennifer Sprague]

You don't?

[Rebecca Jollotta]

I don't.

[Jennifer Sprague]

So if you're treating a person for all of the stuff that we've talked about, and it's now apparent that things have decompensated so bad that they have voluntarily admitted her to a locked ward in a mental institution, is it important to Rebecca Gelada to find out what the diagnosis and treatment was of their patient?

[Rebecca Jollotta]

Yes.

[Jennifer Sprague]

Did you find out?

[Rebecca Jollotta]

I did not.

[Jennifer Sprague]

And anytime you called in an roi, anytime you needed a release of information, such as a HIPAA release, she would have signed it, right?

[Kevin Reddington]

Objection.

[Jennifer Sprague]

You have no reason.

[Kevin Reddington]

Speculation.

[Jennifer Sprague]

Well, not Hadley.

[Judge William Sullivan]

I'm gonna allow that. The jury can weigh that. You can explore that on cross examination. Redirect. I'm sorry.

[Jennifer Sprague]

From your treat. Thanks, Judge. From your treatment of Lindsay and her efforts to be a good patient and tell you all what her symptoms were and third party contacts and everything, she. To your opinion, she would have signed a release for you to get access to pretty much anything you wanted, right?

[Rebecca Jollotta]

I'm not sure if she signed a release for McLean to be able to speak with us.

[Jennifer Sprague]

Did anybody ask her? Did you ever ask her to sign a release?

[Rebecca Jollotta]

I did not.

[Jennifer Sprague]

Totally help Your Honor.

[Judge William Sullivan]

All right, tree Buckingham.

[Kevin Reddington]

Mr. Lata. Lindsay Clancy was only a patient at the South Shore Perry Perinatal Behavioral health clinic between November 20 and December 13, fair to say. Meaning November 20 is the first contact she had with Julie Paul. Right. And December 13th is the last time that you met with her.

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And she came to that clinic not from a referral from somebody like Jennifer Tufts, correct?

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

And so your information about her contact with that psychiatrist is limited to what she shared with you.

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

And she never offered to you that maybe you should talk to her, did she?

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

Now, you've also been asked about providing all the different medications. And if I may approach with exhibit one.

[Jennifer Sprague]

Yes, you may.

[Kevin Reddington]

I'm going to show you the second page there. I know it's kind of small, but take your time to take a look at it. Do you ever see on there that you prescribed any medications to Lindsey Clancy in January of 2023?

[Rebecca Jollotta]

None.

[Kevin Reddington]

And in fact, January 12th of 2023 is Jennifer Tufts correct?

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

January 5th of 2023. Aaliyah Goodhart. Correct.

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

January 16th, Jennifer Tufts.

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

Jennifer Tufts for Diazepam. Jennifer Tufts for Diazepam. Your last pursuit prescription filled is December 22, 2022.

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

So when Council asked you about this chart he was reading from.

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

You would agree with me. This record from CVS is what you would generally see when you pull a patient's prescription list.

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And as far as the going back through some of the medications and you were read by Counsel about on December 6th and 7th prescribing the same medication, is it common that you would change prescriptions to adjust for dosage?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And when you start some new medications, do you give somebody an automatic 30 day supply if you're not sure if that's going to be the course of medication?

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

So sometimes you're prescribing things at kind of odd dosages. Right. Or odd number of pills?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

So on December 6th, for the diazepam, you actually prescribed one pill.

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And then December 7th, two pills?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And then December 9th, different. A five milligram dose, eight pills?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And then on December 30th, I think it is two milligram dose, seven pills.

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And then the Seroquel as well on December or November 30th, when you first prescribed that at that low 25 milligram dose for insomnia, she was given 30 pills.

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And then when you changed the plan as of December 7, you had to give her a new prescription for a higher dose, didn't you?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

So that's the 100 milligrams at 22 pills.

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

Now, when you adjust the dosages or adjust the number of pills, do you give specific instructions on how to take the medication going forward?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

Do you expect the patient to follow those instructions and disregard the preference previous prescriptions?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

Now, at several points, you've indicated and council asked you about referrals or recommendations that Ms. Clancy go to a partial hospitalization program. Right. Do you recall that line of questioning?

[Rebecca Jollotta]

I do.

[Kevin Reddington]

And does South Shore Perinatal Behavioral Health have a partial hospitalization program?

[Rebecca Jollotta]

Not at this time.

[Kevin Reddington]

And so oftentimes you have to pair or recommend places outside in other communities, correct?

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

And you've talked about Women and Infants and that's one of the places that you've referred and that you did in fact refer this patient, correct?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

You don't have an affiliation with women and infants, do you?

[Rebecca Jollotta]

No.

[Kevin Reddington]

So any information that you receive would have to come from the patient or at the patient request, Is that fair to say?

[Rebecca Jollotta]

That's fair to say.

[Kevin Reddington]

In regards to her visit to Women and infants in December, December 20, you had contact with Lindsey Clancy the next day, didn't you?

[Rebecca Jollotta]

I did.

[Kevin Reddington]

And that was through the MyChart messaging?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And she explained to you what happened at Women and Infants?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

She gave you details about what they told her, that she wasn't going to benefit from the groups and that when she told them about her medication history or medication issues, that they believed that she should come off Seroquel?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

So while you don't have the records of the diagnosis, you had a report from the patient about what they were recommending, didn't you?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And as a result of that, you started a conversation with her about tapering Seroquel, didn't you?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

Were you talking to her about postpartum depression?

[Rebecca Jollotta]

Let me double check, please. I was.

[Kevin Reddington]

So that's when you sent the information in the mood chart, right?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

So that's November 30th, December 1st, and now by the time you get to December 7th, after having pretty significant back and forth communication with her, now you're talking with her and giving her some information about bipolar, correct?

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

So upon her presentation at the clinic and her initial focus of treatment, it was for postpartum depression and anxiety, was it not?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And as you began to have more contact with her, as you began to trial different medication regimens, is that when your differential diagnosis started to emerge?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And you responded to that appropriately with the medication you recommended, right?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

That's why the titrating of Seroquel became a conversation, is that fair to say?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And when you, after the Women and infants program on December 20, you didn't see Lindsay Clancy again in the clinic, did you either telehealth or in person?

[Rebecca Jollotta]

No.

[Kevin Reddington]

And the only contact you had with her was through the messages about the. The plan for tapering, correct?

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

And while you were going to be away and not available to her, you still gave her a plan and a prescription to assist with tapering, didn't you?

[Rebecca Jollotta]

I did.

[Kevin Reddington]

Was your. Was your st. Your clinic or your colleague still available for her if she needed it?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

Did she reach out?

[Rebecca Jollotta]

I believe that either she or Patrick did reach out on December 30th.

[Kevin Reddington]

And that was for a higher level of care recommendations, right?

[Rebecca Jollotta]

Correct.

[Kevin Reddington]

But as far as issues with the taper, did she reach out to you or your colleagues about issues with the taper?

[Rebecca Jollotta]

No.

[Kevin Reddington]

Now, counsel went through with you the call in which Patrick and Lindsay or Lindsay indicated to you that she was having panic symptoms and intrusive thoughts. Do you recall that?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

In that call, did you contract for safety?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

What does that mean?

[Rebecca Jollotta]

It means assessing immediate safety. For example, not to speak in hypothetical, but if somebody was saying, I have a plan to kill myself, I have a knife, I am calling 911, I am sectioning that person. If somebody is saying, I'm having thoughts of suicide, okay, what are they? Do you have a plan? Do you have intent? What I recall from Lindsay is she was having thoughts of suicide. She did not disclose a plan, no intent. And her husband was aware of this as well. He was on the call.

[Kevin Reddington]

In fact, in any of the times that you met with or had messages with Lindsey Clancy and she talked about intrusive thoughts or suicidal thoughts, did she ever articulate that she ever had a plan?

[Rebecca Jollotta]

No.

[Kevin Reddington]

Or that she ever actually had any intent of completing the act?

[Rebecca Jollotta]

No.

[Kevin Reddington]

And you're aware that she did have support in the way of her husband and her family, didn't you?

[Rebecca Jollotta]

I was aware of that.

[Kevin Reddington]

And again, intrusive thoughts. When a person tells you a postpartum mom tells you they're evident intrusive thoughts in your training experience, in the times that you've treated moms with postpartum depression or anxiety or even psychosis, that's a fairly common complaint, right?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And again, depressed and unmotivated, fairly common to hear those from new moms?

[Rebecca Jollotta]

Yes.

[Kevin Reddington]

And in your experience in treating individuals with postpartum psychosis, whether they hear voices or not, did you ever have any Concerns based on your contact with Lindsay Clancy that she was suffering from postpartum psychosis.

[Rebecca Jollotta]

I did not.

[Kevin Reddington]

I have nothing further.

[Jennifer Sprague]

It feels as though she was, doesn't it?

[Kevin Reddington]

Objection.

[Judge William Sullivan]

Hold on. Why don't we do this? Don't you get over there, Mr. Rank. And if you can, go ahead. Let me ask you a question.

[Rebecca Jollotta]

All right.

[Jennifer Sprague]

All right.

[Judge William Sullivan]

Anything further. All right, maybe you can step down. Thank you.

[Rebecca Jollotta]

Thank you.

[Judge William Sullivan]

Anything else? Could I see or sidebar like I finally got one prediction about how the day was going to go. Pretty close. So we're going to break for the day at this point. And so what I'm going to ask you to do is come back tomorrow at 9 o'. Clock. The hope would be kind of a similar schedule we could follow tomorrow as well. And then I'm told you we are well on schedule and perhaps somewhat ahead of schedule. So just for purposes, I don't want to jinx us, but that's kind of where we are. So I'm going to excuse you till tomorrow. Remember those instructions. Don't read anything about this case or any similar cases. Don't do any research. Don't talk about anything. Don't take any field trips. Those don't happen to be driving by any certain places. And put this out of your head till tomorrow. All right? It's been a long day. I appreciate it. So I hope you have a nice evening and come back here tomorrow morning. We'll pretty much follow the same type schedule. So again my thanks. I hope you have a great evening. We'll see you tomorrow.

[Nanit Ad Speaker]

Court.

[Jennifer Sprague]

All right, Exit of the quorum. This court's in session.

[Judge William Sullivan]

All right, council, anything we need to address before we recess till tomorrow?

[Jennifer Sprague]

Thank you.

[Judge William Sullivan]

All right, so this court will be in recess on this case until tomorrow. Nine o'.

[Bluff (Ad Speaker)]

Clock.

[Judge William Sullivan]

Thank you.

[Bluff (Ad Speaker)]

What's going on everyone? It's bluff here and we're driving through the states in the Bluff Mobile. And the best thing that we can do is play our favorite casino style games on Spin Quest. They have over a thousand games including live dealer blackjack and craps. With tons of slots and unlimited options, you can get a 30 coin pack for just $10. For new users sign up today. Go to spinquest.com right now.

[Judge William Sullivan]

Spin Quest is a free to play social casino void where prohibited. Visit spinquest.com for more details.

[Nanit Ad Speaker]

When you're a maintenance engineer in a beverage manufacturing plant, you keep production lines moving and quality on track because there is no room for slowdowns. With Grainger's vast selection of high quality motors, sensors, belts and hard to find parts. You can get what you need fast and all in one place so nothing gets in the way of getting the job done. Call 1-800-GRAINGER clickranger.com or just stop by Grainger for the ones who get it done.