Trial Day 9

Summary

Full Trial Audio: Lindsay Clancy Triple Murder

Day 9 – August 7, 2026

Summary of Episode

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Overview

This episode covers Day 9 of the Lindsay Clancy triple murder trial, focusing on key witness testimony and in-depth examination of Lindsay Clancy’s medical and psychiatric history. The day’s theme centers on Clancy’s mental health before and after the deaths of her children, the protocols and challenges of psychiatric evaluation and inpatient care, and the medical decision-making around her diagnosis and treatment. Testimony from club staff, friends, and several psychiatrists provides a layered view of Clancy’s behavior, symptoms, and treatment in the months leading to the tragedy, as well as insights into the standard practices and limitations of psychiatric care.

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Key Sections and Testimony

1. Court Proceedings Overview

[00:08-01:11]

• The session is formally opened, with all counsel and parties present.
• Judge Sullivan reviews juror instructions and outlines the day's schedule.
• The jury is asked if anyone has concerns affecting their impartiality.

2. Testimony: Kimberly Hardy, Kingsbury Club (Child Services Director)

[02:40-13:39]

Background & Processes at the Club

• Hardy describes Kingsbury Club’s playroom operations, child drop-off procedures, and security measures.
• She supervised children aged 3 months to 10 years. Parents had to remain on the property when children were in the playroom.

Observations of the Clancy Family

• Cora and Dawson Clancy regularly attended; usually dropped off by Patrick, sometimes by Lindsay Clancy.
• Hardy: “She just seemed very shy. She was just...I would usually try to start a conversation with her. But nothing else—yeah, just shy.” [07:38]
• Lindsay did not bring her youngest child due to concerns about colds during flu season.
• Lindsay appeared in workout clothes, dropped off and picked up the children punctually, never left the premises.
• “She always picked up on time, and they were always excited to see her.” [12:10]

Club Records as Evidence

• Children’s playroom attendance, including dates near the time of the incident, were confirmed.
• Cora once left a drawing behind for Hardy.
• No behavioral red flags were noted; interaction and demeanor remained consistent.

3. Testimony: Sarah Carney, Family Friend

[13:45-23:41]

Relationship and Observations

• Carney is a close friend to Patrick Clancy since college, social with Lindsay since the start of their relationship.
• The families spent time together, but Carney described her relationship with Lindsay as “social,” not intimate.
• "She was always quiet with you?" "Yes." [23:39]

Notable Encounters

• No observations of marked changes in Lindsay after the birth of any of the children.
• Carney described Lindsay as “just quiet, but fairly normal” at a bonfire in January 2023.
• Lindsay reported doing “good” when asked about her wellbeing.
• No abrupt departures or behavioral changes noticed during their last interaction.

4. Testimony: Dr. Aaliyah Goodheart, McLean Hospital Psychiatrist

[23:44-151:22]

Professional Background & Inpatient Psychiatric Care [24:11-41:18]

• Dr. Goodheart explains her training, her role at McLean, and typical protocols for inpatient psychiatric units.
• Emphasizes team-based observation and care, with patients observed around the clock via nurses and mental health staff.
• Detailing of assessment processes, “section 12” involuntary admissions, and levels of supervision for patient safety.

Clancy's Admission & Evaluation at McLean [44:20-151:22]

• Clancy was admitted at 4:00 am on Jan 1, 2023 from MGH; signed in voluntarily.
• She reported insomnia, numbness, and some medication side effects.
• Dr. Outlaw and Dr. Madva performed initial evaluations; major depressive disorder as provisional diagnosis.

Key Findings & Medical Records:

• Clancy reported suicidal thoughts but no plans, no homicidal ideation, and no psychosis or mania observed.
• Treated with Seroquel, Valium, and Benadryl upon admission; plan was to taper Seroquel due to numbness.
• Protective factors: Clancy cited her children and mother as reasons not to commit suicide.
• Clancy wanted to be home for her daughter’s birthday, requested discharge earlier than originally planned.
• “She was future-oriented, she was dearly invested in her children. She was a caring mother, just like a caring mother. She had her parents around to help her. She had family and supports. We ensured that she would have outpatient psychiatric care for follow up.” [79:42]

Discharge Planning:

• Discharged on Ativan and Trazodone, instructed to follow up with outpatient providers.
• Provided a resource packet with crisis hotline numbers and further psychiatric care contacts.

Cross-examination Highlights

• DA pressed Dr. Goodheart about lack of collateral records from outside providers, psychiatric testing, and whether Edinburgh scale or blood work was done.
• Questions about the usefulness and limitations of self-reported symptoms and collateral histories from family.
• Debate about whether postpartum depression/psychosis is included in DSM criteria.
• Dr. Goodheart: “You take the history into consideration, but you’re treating the patient in front of you, because that’s the presentation.” [151:13]

5. Testimony: Dr. Jennifer Tufts, Psychiatrist (Aster Mental Health)

[151:35-276:57]

Treatment History & Diagnostic Practices

• Tufts saw Clancy beginning in September 2022; initial patient forms indicated prior Prozac and Wellbutrin use with no side effects.
• Clancy reported anxiety, sleep disturbances, but denied suicidal or homicidal ideation.
• Zoloft (Sertraline) prescribed in September but initially not taken due to fear of side effects; when started in October, precipitated worsening sleep and increased anxiety, leading to discontinuation.
• Tufts and Clancy discussed alternative medications including Ativan, Buspar, Remeron, Trazodone, Benadryl, and later Lamictal; generally started at the lowest effective dose.

Therapy and Coordination of Care

• Therapy with LMHC Jennifer McAllister recommended and begun in October 2022.
• Clancy sometimes struggled to stick with a treatment plan, rotated through various medications and providers.
• Tufts: “I keep reaching out to different people and not sticking with the plan.” [242:46]
• Tufts did not observe evidence of mania or psychosis in any encounters.
• Regularly inquired about suicidal/homicidal ideation; Clancy repeatedly denied active intent or plan.

Lead-up to McLean Admission & After

• In December 2022 and January 2023, Clancy reported persistent depression, numbness, anhedonia, and sleep disruption.
• She was aware of and discussed crisis resources, including Suicide Prevention Lifeline.
• After McLean discharge, continued with Trazodone, Ativan, and melatonin; persistently felt “numb” but denied active suicidal or homicidal ideation. Tufts considered her “deteriorating” but not at imminent risk.

Medical Decision-Making

• Tufts explained rationale for medication choices, side effect management, and diagnostic criteria (esp. for bipolar disorder).
• Clear that at no point did Clancy meet the criteria for involuntary commitment or psychosis per DSM standards.
• “Throughout your time treating Ms. Clancy, did you continue to recommend that she attend individual therapy?” “Yes.” [276:26]

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Notable Quotes & Witness Insights

“She [Lindsay Clancy] just seemed very shy...I would usually try to start a conversation with her. But nothing else—yeah, just shy.”
— Kimberly Hardy, [07:38]

“She was future oriented, she was dearly invested in her children. She was a caring mother, just like a caring mother. She had her parents around to help her. She had family and supports.”
— Dr. Aaliyah Goodheart, [79:42]

“You take the history into consideration, but you’re treating the patient in front of you, because that’s the presentation.”
— Dr. Aaliyah Goodheart, [151:13]

“I keep reaching out to different people and not sticking with the plan.”
— (Clancy, as quoted by Dr. Jennifer Tufts), [242:46]

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Important Timestamps

• Kimberly Hardy Testimony (Kingsbury Club): [02:40-13:39]
• Sarah Carney Testimony (Family Friend): [13:45-23:41]
• Dr. Aaliyah Goodheart (McLean Psychiatrist):
  • Psychiatric background, hospital procedures: [24:11-41:18]
  • Clancy’s evaluation, hospital course: [44:20-151:22]
• Dr. Jennifer Tufts (Aster Mental Health): [151:35-276:57]

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Memorable Moments

• Thorough look into psychiatric inpatient procedure and how real-life diagnostic uncertainty can shape care.
• Lengthy courtroom exchanges about the limitations and debated areas of psychiatric diagnosis, especially for postpartum mental health.
• Detailed medical review of Lindsay Clancy’s symptoms and treatment, with repeated denials (by patient and witnesses) of active violence or severe psychosis leading up to the deaths.

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Conclusion

Day 9 of Lindsay Clancy’s trial paints a complex picture of her mental health journey through witness testimony and psychiatric documentation. The evidence suggests multiple attempts to address her anxiety, insomnia, and depression via both medication and therapy, but persistent symptoms and skepticism about medication’s side effects complicated her care. There is consistent testimony refuting any overt signs of psychosis or imminent dangerousness, as seen by professionals and lay observers alike. Questions raised about best psychiatric practice, the limits of short-term inpatient care, and collaboration among treating professionals provide insight into the broader difficulties of mental health management in tragic cases like these.

Transcript

[Kimberly Hardy]

Full trial.

[Dr. Aaliyah Goodheart]

Audio.

[Dr. Jennifer Tufts]

Everything hurt in court. No silences to skip

[Attorney Kevin Reddington]

session. Please be seated. Good morning, your honor. May I proceed?

[Judge William Sullivan]

Yes, please.

[Attorney 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. The commonwealth is represented by assistant district attorney Jennifer sprague and assistant district attorney Shannon Buckingham.

[Assistant District Attorney Jennifer Sprague]

All right.

[Judge William Sullivan]

Well, good morning, council.

[Assistant District Attorney Shannon Buckingham]

Morning.

[Judge William Sullivan]

Hi. Good morning, Ms. Clancy. All right, council, can I see it? Sidebar. All right, I'll step for the jury. All persons having anything to do before the honorable William Sullivan, justice, the superior

[Assistant District Attorney Jennifer Sprague]

court now sitting in pl the commo drawing the anger of your attendance, and

[Judge William Sullivan]

you shall be heard.

[Assistant District Attorney Jennifer Sprague]

Commonwealth of Massachusetts, this court is now in session.

[Dr. Jennifer Tufts]

Please be seated.

[Attorney Kevin Reddington]

Good morning, your honor. May I see?

[Judge William Sullivan]

Yes, please.

[Attorney Kevin Reddington]

Before the court today, we have a continuation of the jury trial in the matter of Commonwealth versus Lindsay Clancy. Ms. Clancy is present. She is represented by attorney Kevin Redington. But commonwealth is represented by assistant district attorney Jennifer Sprague and assistant district attorney Shannon Buckingham.

[Judge William Sullivan]

All right, thank you, madam clerk. Good morning, everyone. So what I'm going to do is you probably expect. I'm going to ask you those questions to make sure everybody's able to follow my instructions. I'll go a little bit into our schedule, and then we'll return to the evidence on this case. So, first question is any member of the jury red seen, hurt, or over anything from any source that would affect your ability to be in fear, an impartial juror in this case? Last 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 at this time? Again, thank you so much for following those instructions. The again, as I always say, I hesitate to give you the schedule because I'm probably 50% right, 50% wrong. But the intention today, the thought is we'll probably go most of today, and then at the end of the day, before I send you home, I'm going to talk to the lawyers, kind of see what the schedule is for next week so you can plan as best you can, and also kind of see where we are in regards to the timeline and the estimate of the case. So I'll try and give you as much of that information today before I send you home. All right? So with that, I'm going to. We'll return to the case on trial. Commonwealth, call your next witness, please.

[Attorney Kevin Reddington]

Commonwealth with Kobe. I'm really hardy.

[Assistant District Attorney Jennifer Sprague]

Please.

[Dr. Aaliyah Goodheart]

Hey, good morning.

[Kimberly Hardy]

Good morning.

[Judge William Sullivan]

I'm going to ask you to keep Your voice up as best you can and speak into that microphone. Okay? Okay, that's good. All right, come on.

[Attorney Kevin Reddington]

Good morning.

[Kimberly Hardy]

Good morning.

[Attorney Kevin Reddington]

Could you please introduce yourself to the jury? Spelling your first and last name for the record.

[Kimberly Hardy]

It is Kimberly Hardy. K I M B E R L E E H A R D Y.

[Attorney Kevin Reddington]

And what city or state do you currently live in?

[Kimberly Hardy]

Cypress, Texas.

[Attorney Kevin Reddington]

And back in 2023, where did you live?

[Kimberly Hardy]

Brockton, Massachusetts.

[Attorney Kevin Reddington]

And in 2023, where did you work?

[Kimberly Hardy]

Kingsbury Club.

[Attorney Kevin Reddington]

Where is the Kingsbury Club?

[Kimberly Hardy]

In Kingston.

[Attorney Kevin Reddington]

And how long did you work for that club?

[Kimberly Hardy]

Four years.

[Attorney Kevin Reddington]

What is the Kingsbury Club?

[Kimberly Hardy]

It is a tennis club, but it also has, like a gym. It's kind of like a Y where people. People can come and drop their kids off in the playroom and stuff like that.

[Attorney Kevin Reddington]

Is it a private facility?

[Kimberly Hardy]

Yes.

[Attorney Kevin Reddington]

So members only?

[Kimberly Hardy]

Yes.

[Attorney Kevin Reddington]

And you mentioned dropping kids off. What was your role at the Kingsbury Club?

[Kimberly Hardy]

So I was the child service director. So I ran all the kids programming and the playroom.

[Attorney Kevin Reddington]

So what was or what is the playroom at the Kingsbury Club?

[Kimberly Hardy]

So the playroom is a room where parents can drop their kids off for two hours a day so that they can work out.

[Attorney Kevin Reddington]

And what's the procedure when a parent or a guardian drops a child off at the playroom?

[Kimberly Hardy]

We have our system where we sign them in.

[Attorney Kevin Reddington]

And that's something on the computer that logs when the child comes in?

[Kimberly Hardy]

Yes.

[Attorney Kevin Reddington]

And it also logs when the child leaves, correct?

[Kimberly Hardy]

Yes.

[Attorney Kevin Reddington]

Now, what's the protocol for who can drop off and pick up a child at the playroom?

[Kimberly Hardy]

So parents, usually we say whoever drops off should be the one picking up as well, unless the parent notifies us that another parent will be picking up.

[Attorney Kevin Reddington]

And as far as that system that you have to log the drop off and pick up. If I had to say, that system is geared to towards the guardian who drops off and picks up.

[Dr. Aaliyah Goodheart]

Correct.

[Attorney Kevin Reddington]

So it's a separate log for each child based on who the guardian is?

[Kimberly Hardy]

Yes.

[Attorney Kevin Reddington]

Now, what is the security like at the Kingsbury Club? How do you get into the club?

[Kimberly Hardy]

Oh, you sign in, you have a key fob, and you go to the front desk and you'll sign in.

[Attorney Kevin Reddington]

Are you familiar with some members using like a scan app to sign in? And as far as where the playroom is in the club, where is it in relation to kind of when you come in the front doors, it is

[Kimberly Hardy]

right to the right there is a long hallway. And at the end of the hallway, that's the playroom.

[Attorney Kevin Reddington]

Now, is there Kind of a rule there at the Kingsbury Club when you drop your child at the playroom that you have to remain on property?

[Kimberly Hardy]

Yes.

[Attorney Kevin Reddington]

And other than the gym and the tennis courts, what other facilities are on property?

[Kimberly Hardy]

We have a pool and a spa.

[Attorney Kevin Reddington]

I'm going to draw your attention to or. Sorry, one more background question. You mentioned that there's other programs that the Kingsbury Club runs for children. Right. And you, as the child service director, were involved in that?

[Kimberly Hardy]

Yes.

[Attorney Kevin Reddington]

Is there a particular age that the children can start participating in the other group activities?

[Kimberly Hardy]

Camp starts at five. And at that point too, we had tennis that started at 5, but swim lessons can start from babies.

[Attorney Kevin Reddington]

Okay. And so is there an age limit to the kids that could be in the playroom at any given point?

[Kimberly Hardy]

Typically we only take 3 months old up up to like age 10. Normally they don't want to be in there.

[Attorney Kevin Reddington]

And then you said that the time limit is two hours per day.

[Kimberly Hardy]

Yes.

[Attorney Kevin Reddington]

Is there a schedule or sign up in advance or was there 1 in 2023 if a member wanted to bring their kid into the playroom?

[Kimberly Hardy]

Yes. But in 2023, parents normally didn't sign up in advance because we were just getting back from COVID and we had low numbers. So we just took walk ins.

[Attorney Kevin Reddington]

And it was a first come, first serve?

[Kimberly Hardy]

Yes.

[Attorney Kevin Reddington]

Are you familiar or were you familiar with Cora and Dawson Clancy?

[Kimberly Hardy]

Yes.

[Attorney Kevin Reddington]

Did you often see them in the playroom at the Kingsbury Club?

[Kimberly Hardy]

Yes.

[Attorney Kevin Reddington]

And who would be the party that would drop them off and pick them up?

[Kimberly Hardy]

Mainly Patrick.

[Attorney Kevin Reddington]

Did you or were you present in the playroom when Lindsay Clancy at times dropped them off and picked them up?

[Kimberly Hardy]

Yes.

[Attorney Kevin Reddington]

And when Lindsay Clancy came to drop off and pick up the children, did you interact with her?

[Kimberly Hardy]

Yes.

[Attorney Kevin Reddington]

And how would you describe her demeanor during those interactions?

[Kimberly Hardy]

She just seemed very shy.

[Attorney Kevin Reddington]

That fall into the winter, did you. And during that time period in the fall to winter, what were your observations of her demeanor?

[Kimberly Hardy]

She just seemed shy. She was just. We'd come in and pick up. I would usually try to start a conversation with her. But nothing else? Yeah, just shy.

[Attorney Kevin Reddington]

Okay. And it was only Cora and Dawson that came to the playroom?

[Kimberly Hardy]

Correct.

[Attorney Kevin Reddington]

Were you aware that there was a third child?

[Kimberly Hardy]

Yes.

[Attorney Kevin Reddington]

And do you know of any reason why that child didn't come with the other two?

[Kimberly Hardy]

I asked a couple times because I said that he can come in because he's over three months. And the answer was because they were scared of sickness.

[Judge William Sullivan]

I'm sorry, what was the objection?

[Assistant District Attorney Jennifer Sprague]

The answer was you could just find

[Attorney Kevin Reddington]

out so this conversation that you had when you said that you asked about Catalan, was that with Lindsey or Patrick? Lindsey. Okay. And so what did she tell you about Catlin?

[Kimberly Hardy]

She was nervous about colds because it was cold and flu season.

[Attorney Kevin Reddington]

Okay. And so obviously, when Cora and Dawson came, there would be other children in the playroom as well, right?

[Kimberly Hardy]

Yes.

[Attorney Kevin Reddington]

When Lindsey would drop the kids off during this time period, between September of 2022 and January of 2023, did she ever tell you what her plans were at the club?

[Assistant District Attorney Jennifer Sprague]

No.

[Attorney Kevin Reddington]

Did you see or make observations of how she was dressed when she dropped them off?

[Kimberly Hardy]

Yeah. She had workout outfits on.

[Attorney Kevin Reddington]

And would she come back before the end of that two hours to pick the kids up?

[Kimberly Hardy]

Yes.

[Attorney Kevin Reddington]

Did you notice anything different about her when she came back to pick the kids up during this time frame? No. Was she ever late picking them up? No. Did you ever learn that she had left the property after bringing them to the playroom?

[Kimberly Hardy]

No.

[Attorney Kevin Reddington]

And that is a very strict rule at the club, correct?

[Kimberly Hardy]

Yes.

[Attorney Kevin Reddington]

Do you recall the last time that you saw Lindsey Clancy and Cora and Dawson at the Kingsbury Club?

[Kimberly Hardy]

Yes.

[Attorney Kevin Reddington]

Do you recall approximately when that was?

[Kimberly Hardy]

In January.

[Attorney Kevin Reddington]

Would it have been closer to New Year's or a few weeks into the month?

[Kimberly Hardy]

I think it was a few weeks in.

[Attorney Kevin Reddington]

And how is it that you remember them on that particular day?

[Kimberly Hardy]

Just their usual selves. They came in, played nothing.

[Attorney Kevin Reddington]

If I tell you that Cora and Dawson were dropped off by Lindsey on January 13 at 9:07, does that sound right to you?

[Dr. Aaliyah Goodheart]

Mm.

[Attorney Kevin Reddington]

And that they were also dropped off on January 17th at 9:30am does that sound right?

[Kimberly Hardy]

Yeah.

[Attorney Kevin Reddington]

Did Cora and Dawson usually come in the mornings? Yes, around that time. And what time does the playroom open?

[Kimberly Hardy]

We open at 8.

[Attorney Kevin Reddington]

And what time does it close?

[Kimberly Hardy]

It closes at 2.

[Attorney Kevin Reddington]

Did you ever have occasion to see Cora and Dawson in the playroom during that time, September to January, later in the afternoon?

[Kimberly Hardy]

Sometimes. Not usual.

[Attorney Kevin Reddington]

Is it fair to say that generally when Lindsey dropped them off, they came in the morning? Yeah. And is there anything about that day with Cora, that last day that you saw her, that sticks out in your mind?

[Kimberly Hardy]

Not that I recall.

[Attorney Kevin Reddington]

What kinds of things would the kids do in the playroom?

[Kimberly Hardy]

They like to color. They would play with the dolls, dress up toys, the cars, the train set.

[Attorney Kevin Reddington]

And one. On one of those last days that you saw Cora, did she draw a picture?

[Kimberly Hardy]

Yes.

[Attorney Kevin Reddington]

Did she take it with her or did she give it to you?

[Kimberly Hardy]

She left it.

[Attorney Kevin Reddington]

Your Honor, at this time, I would move to admit the Kingsbury Club records

[Judge William Sullivan]

as the next exhibit, they may be admitted.

[Attorney Kevin Reddington]

Thank you. Nothing further.

[Judge William Sullivan]

Thank you.

[Assistant District Attorney Jennifer Sprague]

All right, Counsel. Morning.

[Kimberly Hardy]

Good morning.

[Assistant District Attorney Jennifer Sprague]

So you saw Lindsay with her children, dropping them off, picking them up on a fairly regular basis.

[Judge William Sullivan]

Is that correct?

[Assistant District Attorney Jennifer Sprague]

And Patrick, of course, right?

[Kimberly Hardy]

Yes.

[Assistant District Attorney Jennifer Sprague]

Did you ever see how she acted around them? Did she appear to be, you know, happy to be with them and take care of them, or did she appear to be angry with them at all?

[Kimberly Hardy]

No, never angry. She seemed happy to be with them. She always picked up on time, and they were always excited to see her.

[Assistant District Attorney Shannon Buckingham]

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[Kimberly Hardy]

Game night's fun until someone spends five

[Assistant District Attorney Shannon Buckingham]

minutes lining up one shot.

[Judge William Sullivan]

Chalk. Breathe.

[Assistant District Attorney Shannon Buckingham]

Rechock.

[Assistant District Attorney Jennifer Sprague]

Still aiming.

[Assistant District Attorney Shannon Buckingham]

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[Kimberly Hardy]

I can spin anywhere, anytime.

[Assistant District Attorney Shannon Buckingham]

And there's always a new social casino game every week.

[Kimberly Hardy]

Spins happen way faster than that shot.

[Assistant District Attorney Shannon Buckingham]

Play [e-mail].

[Attorney Kevin Reddington]

let's Chumba.

[Assistant District Attorney Shannon Buckingham]

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[Attorney Kevin Reddington]

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[Assistant District Attorney Jennifer Sprague]

And you certainly weren't close enough to her to know if she had any personal issues in her life as. As far as psych. You know, her mind or her body or anything like that. Right.

[Attorney Kevin Reddington]

No.

[Assistant District Attorney Jennifer Sprague]

You would be aware, though, that on occasion, people are advised by their doctors or psychiatrists to exercise. It might be a good thing for them to do. Is that.

[Attorney Kevin Reddington]

Yes.

[Assistant District Attorney Jennifer Sprague]

Thank you. That's all I have.

[Kimberly Hardy]

Thank you.

[Assistant District Attorney Jennifer Sprague]

Any redirect?

[Attorney Kevin Reddington]

No, thank you.

[Judge William Sullivan]

Thank you. You may step down. Thank

[Assistant District Attorney Jennifer Sprague]

you. All right, come off.

[Attorney Kevin Reddington]

Come on off. Would call Sarah Carney, please?

[Assistant District Attorney Jennifer Sprague]

Good morning, ma'.

[Attorney Kevin Reddington]

Am.

[Assistant District Attorney Jennifer Sprague]

Stop right there. Raise your right hand. Watch your step, please.

[Judge William Sullivan]

All right. Good morning.

[Attorney Kevin Reddington]

Good morning.

[Assistant District Attorney Jennifer Sprague]

All right.

[Judge William Sullivan]

All right, Council.

[Attorney Kevin Reddington]

Thank you. Good morning. Could you please tell the jurors your first and last name?

[Dr. Jennifer Tufts]

Sure.

[Kimberly Hardy]

Sarah Carney.

[Attorney Kevin Reddington]

And how do you spell your first name? S, A, R, A, H. And the last name?

[Kimberly Hardy]

C A, R, N, E, Y.

[Attorney Kevin Reddington]

And what city or town do you live in?

[Kimberly Hardy]

Duxbury. Massachusetts.

[Attorney Kevin Reddington]

And are you married? Yes. And who's your husband?

[Dr. Jennifer Tufts]

Kyle Kearney.

[Attorney Kevin Reddington]

And do you have children? Yes. How old are your children?

[Dr. Jennifer Tufts]

5 and 2.

[Attorney Kevin Reddington]

Do you know the Clancy family? Yes. And how do you know them?

[Kimberly Hardy]

Went to school with Pat and then met Lindsey later.

[Attorney Kevin Reddington]

And so when you say you went to school with Pat, fair to say you went to Salve? Yes. And did you know Pat before school?

[Dr. Aaliyah Goodheart]

No.

[Attorney Kevin Reddington]

And did you become friends with him in school? Yes. When you graduated from college, did you remain friends with Patrick? Yes. And is your husband also a friend of Patrick's? Yes. Did they meet at college or just someplace else in college at some point, did you come to know Lindsey Clancy?

[Kimberly Hardy]

Yes.

[Attorney Kevin Reddington]

And do you remember approximately when you were introduced to her? A few years after college, maybe 12, 13 years ago. And where were you living then when you first met her?

[Dr. Jennifer Tufts]

Boston.

[Attorney Kevin Reddington]

Okay. How about Pat? Was he living in Boston as well? I believe so. And what was your relationship like with Patrick after college? Were you close? Yes. Friends?

[Dr. Aaliyah Goodheart]

Close.

[Attorney Kevin Reddington]

And as he began a relationship with Lindsay, did you become friendly with her? Yeah. Did you have that same relationship with Lindsay that you had with Pat? No. As time passed on, did your families remain friendly?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And eventually both your families ended up living in the same town in Duxbury, correct?

[Dr. Jennifer Tufts]

Yes.

[Attorney Kevin Reddington]

What was the relationship like between your families starting in 2019?

[Kimberly Hardy]

Close, friendly, went to the beach together, you know, had them over at our

[Dr. Aaliyah Goodheart]

house, went to their house, that kind of thing.

[Attorney Kevin Reddington]

And as the Clancy start having children and you started having children, did that remain throughout?

[Kimberly Hardy]

Yeah, probably fewer times just because we're

[Dr. Aaliyah Goodheart]

all busy, but yep.

[Attorney Kevin Reddington]

And were you around after each of the Clancy children were born, meaning after Cora was born, you were still part of Patrick's life? Yeah. Did you notice any changes in Lindsay after Cora was born? No. And how about Dawson? When Dawson came along, did you notice any changes in Lindsay after Dawson was born?

[Kimberly Hardy]

No.

[Attorney Kevin Reddington]

And then Callan, who was born in May of 2022, were you still friendly with them and still doing those trips and going to each other's houses, beach trips. So did you notice anything different about Lindsay after Callan was born?

[Dr. Aaliyah Goodheart]

No.

[Attorney Kevin Reddington]

Do you recall observing Lindsay or seeing Lindsey when she was pregnant with Callan? Yes. Fair to say she was a pretty active person. Yes. And even in pregnancy, being very pregnant, she was physically active? Yes.

[Kimberly Hardy]

I remember her posting videos of her exercising, and the kids were in the background.

[Attorney Kevin Reddington]

And where would the exercising happen? Could you tell where it was in their house?

[Kimberly Hardy]

I'm not sure.

[Attorney Kevin Reddington]

Have you been inside their house before? Yes. So you know that they had the living room area on the first floor and basement area was finished. Who moves the living room? I've never been to the basement. Okay, so what did in that video, what did you observe the kids doing in the background? Playing on the couch, playing with toys. And when you observed this video, fair to say it was kind of like a beach body type exercise? Sure.

[Kimberly Hardy]

I'm not sure what that means.

[Attorney Kevin Reddington]

Did you see any equipment in the video, like workout equipment?

[Kimberly Hardy]

I don't recall.

[Attorney Kevin Reddington]

Do you recall previously indicating that you saw the kids playing with exercise bands in the videos? Sure.

[Kimberly Hardy]

If that's what I said, I don't recall.

[Attorney Kevin Reddington]

Now I'm drawing your attention to the summer of 2022 and the fall of 2022. Were you still going to the beach and getting together with the Clancy's? I believe so, yes. Other than going to the beach, what other kinds of activities would you invite them to do with your family?

[Kimberly Hardy]

They probably came over to our house

[Dr. Aaliyah Goodheart]

once or twice

[Attorney Kevin Reddington]

throughout the course of the fall of 2022. Did you notice any changes in Lindsay's physical health?

[Kimberly Hardy]

I think I saw her one time at drop off and she just seemed thinner, more.

[Attorney Kevin Reddington]

I'm sorry, no. Did you ever have any conversations with her about postpartum depression or sleep issues?

[Assistant District Attorney Jennifer Sprague]

No.

[Attorney Kevin Reddington]

And I'm going to draw your attention to January 22, 2023. That was a weekend. Do you recall that weekend? Yes. And did you have something happening at your house that your family invited the Clancy's to?

[Kimberly Hardy]

Yes, we had a bonfire.

[Attorney Kevin Reddington]

And who. Who came from the Clancy family to the bonfire?

[Kimberly Hardy]

Pat, Lindsay, Cora and Dawson.

[Attorney Kevin Reddington]

Where was Callan, if you know? At home with Lindsay's parents. Did you have the occasion to speak with Lindsey on that day? Yes. And fair to say, prior to that day, you hadn't really seen her much that winter?

[Assistant District Attorney Jennifer Sprague]

Correct.

[Attorney Kevin Reddington]

Were you happy to see her that day? Yeah. And what were your observations of her that day? Her demeanor? Did she seem normal or off or. Just quiet, but fairly normal. Did you have the occasion to speak with her, just you and her? Yes. And was that outside at the bonfire or somewhere else in your house?

[Kimberly Hardy]

In the kitchen.

[Attorney Kevin Reddington]

And did you ask her anything? I was talking to her about my

[Kimberly Hardy]

children, my daughter's allergies, and then I. The conversation lulled and I asked her how she was doing.

[Attorney Kevin Reddington]

And what did she tell you? Good. And did you have any further conversation or ask any follow up questions?

[Dr. Aaliyah Goodheart]

No.

[Attorney Kevin Reddington]

Why didn't you follow up?

[Kimberly Hardy]

Because I figured if she wanted to explain or deep dive into it, she

[Attorney Kevin Reddington]

would Wasn't going to press her, but on this occasion she just said, fine. And you kind of moved on to the next topic. Yes. And throughout the course of that day or that afternoon that you were with her, did you notice anything change about how she was communicating with you? Like, did she start to talk faster or seem confused in any way?

[Judge William Sullivan]

No.

[Attorney Kevin Reddington]

Was there anything that happened at that interaction that made them abruptly leave?

[Assistant District Attorney Shannon Buckingham]

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[Dr. Aaliyah Goodheart]

no, I

[Attorney Kevin Reddington]

think it was like nap time for the kids.

[Dr. Aaliyah Goodheart]

Okay.

[Attorney Kevin Reddington]

And was that the last time you saw or talked to Lindsay? Yes. Nothing further than

[Assistant District Attorney Jennifer Sprague]

morning. So what was the time frame that you knew Lindsay, Not Patrick? I know you were very friendly with Patrick.

[Dr. Aaliyah Goodheart]

Yep.

[Assistant District Attorney Jennifer Sprague]

What was the time frame that you knew Lindsay?

[Kimberly Hardy]

12 ish.

[Attorney Kevin Reddington]

12 years.

[Assistant District Attorney Jennifer Sprague]

And would you say that you were close to her or were you social or how.

[Attorney Kevin Reddington]

Social?

[Assistant District Attorney Jennifer Sprague]

Social. And on occasion you had the opportunity to be in their house, the upstairs portion of it that you indicated, never in the basement of the office area, Right?

[Dr. Aaliyah Goodheart]

Right.

[Attorney Kevin Reddington]

Just the kitchen level.

[Assistant District Attorney Jennifer Sprague]

Okay. Can you tell us, like, in the fall of 22, approximately how many times you and your husband Kyle saw Lindsey and her husband Pat together? Not Kyle with Pat or you with Pat?

[Kimberly Hardy]

I think it was just the one time at drop off.

[Assistant District Attorney Jennifer Sprague]

One time at drop off.

[Dr. Aaliyah Goodheart]

Okay.

[Assistant District Attorney Jennifer Sprague]

You had occasion to ask her advice about the babies and things of that nature on occasion, did you not?

[Attorney Kevin Reddington]

Yep.

[Assistant District Attorney Jennifer Sprague]

She was always helpful to you or forthcoming?

[Dr. Aaliyah Goodheart]

Yes. Yes.

[Assistant District Attorney Jennifer Sprague]

And this the last time you saw her? On January 22, this was a bonfire. Is that what it was?

[Dr. Aaliyah Goodheart]

Yep.

[Assistant District Attorney Jennifer Sprague]

And that was where? In your backyard?

[Kimberly Hardy]

In our backyard.

[Assistant District Attorney Jennifer Sprague]

Was it in the daytime or the nighttime?

[Attorney Kevin Reddington]

Around lunchtime?

[Assistant District Attorney Jennifer Sprague]

Lunchtime. And do you recall how long they were there for the bonfire?

[Kimberly Hardy]

A few hours.

[Assistant District Attorney Jennifer Sprague]

And they were there with the two older kids and Callan was home with her parents, right?

[Attorney Kevin Reddington]

Yes.

[Assistant District Attorney Jennifer Sprague]

And she appeared to be quiet to you?

[Attorney Kevin Reddington]

Yes.

[Assistant District Attorney Jennifer Sprague]

And she appeared to your observation around that time frame to be thinner than what you had seen before?

[Attorney Kevin Reddington]

Yes.

[Assistant District Attorney Jennifer Sprague]

But you'd agree with me that you guys weren't that close that she would confide in you, correct?

[Kimberly Hardy]

Correct.

[Assistant District Attorney Jennifer Sprague]

That's all we have. Thank you, ma'.

[Judge William Sullivan]

Am.

[Attorney Kevin Reddington]

Any regret as far as your observations of Lindsay over the course of 12 years. Fair to say she was always quiet with you?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

Thank you.

[Dr. Aaliyah Goodheart]

All right.

[Judge William Sullivan]

Thank you, ma'.

[Attorney Kevin Reddington]

Am.

[Judge William Sullivan]

May step down. Thank you.

[Kimberly Hardy]

Thank you.

[Judge William Sullivan]

Commonwealth.

[Attorney Kevin Reddington]

The Commonwealth would call Aaliyah Goodheart.

[Judge William Sullivan]

Good morning, Doctor.

[Dr. Aaliyah Goodheart]

Good morning.

[Judge William Sullivan]

All right, I'm going to ask you, when you sit down, if you speak loudly so jury can hear you and speak into that microphone. Okay?

[Dr. Aaliyah Goodheart]

Thank you.

[Judge William Sullivan]

All right. Thank you, Council.

[Attorney Kevin Reddington]

Thank you. Good morning.

[Dr. Aaliyah Goodheart]

Good morning.

[Attorney Kevin Reddington]

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

[Dr. Aaliyah Goodheart]

My first name is Alia. Last name is Good Heart.

[Attorney Kevin Reddington]

Can you spell your first name for the record?

[Dr. Aaliyah Goodheart]

A L, I A.

[Attorney Kevin Reddington]

And your last name, please?

[Dr. Aaliyah Goodheart]

G O, O D H E A

[Attorney Kevin Reddington]

R T. And what do you do for work?

[Dr. Aaliyah Goodheart]

I'm a psychiatrist.

[Attorney Kevin Reddington]

And can you tell us a little bit about your educational background to be a psychiatrist?

[Dr. Aaliyah Goodheart]

I got my medical degree from the State University of New York in Brooklyn, the Health Sciences Center. And I came to Boston to do my four year residency at the Harvard Longwood Psychiatry Residency Program. I also trained for an additional three years at the Boston Psychoanalytic Institute and got my advanced training in advanced training. I attended the advanced training program and. Yeah.

[Attorney Kevin Reddington]

Are you licensed here in Massachusetts to practice as a psychiatrist?

[Dr. Aaliyah Goodheart]

I am.

[Attorney Kevin Reddington]

Are you licensed in any other states?

[Dr. Aaliyah Goodheart]

No.

[Attorney Kevin Reddington]

So you said that you're a medical doctor with a specialization in psychiatry, correct?

[Dr. Aaliyah Goodheart]

Correct.

[Attorney Kevin Reddington]

Can you tell us a little bit about your work history in that field?

[Dr. Aaliyah Goodheart]

Yes, I've worked in several different settings. When I first started out, I was working at Beth Israel in integrated care, which means essentially that you work with primary care physicians. And if they have patients that they have questions about, they can consult you. And if there's a need, you can continue to manage the patient's psychopharm medications. And if it's simple, they can continue to do it. But you're available for them to consult with and to discuss cases. After that, I went to Emerson Hospital, where I worked on the inpatient psychiatric unit for a total of nine years. I left for one year to be the medical director at another freestanding hospital. After that, I worked at the women's prison in Framingham for a year and a half. And after that, an outpatient clinic affiliated with Tufts. I had a private practice for two years, and then I've been working at McLean for the last five years.

[Attorney Kevin Reddington]

Okay, and what is McLean Hospital?

[Dr. Aaliyah Goodheart]

It's a freestanding psychiatric hospital that is part of the Mass General Brigham system.

[Attorney Kevin Reddington]

What kind of services does that facility offer to patients?

[Dr. Aaliyah Goodheart]

They have, you know, lots of services, including inpatient, outpatient, substance abuse Trauma focused. There are lots of specializations. Eating disorder programs, they have residential programs, they have partial programs. So there's a really broad width of.

[Attorney Kevin Reddington]

And what is your role at McLean?

[Dr. Aaliyah Goodheart]

I work on one of the inpatient

[Attorney Kevin Reddington]

psychiatric units and tell us a little bit about what an inpatient psychiatric unit is.

[Dr. Aaliyah Goodheart]

Patients who come to our unit are. You are referred to us by the emergency department because it's been determined that they need inpatient level of care. You can come voluntarily or you can be sent involuntarily. And once you arrive, we work with the patient until you know their. For a certain period of time, which isn't predetermined, it is flexible. So it depends on what's going on. And when you're on an inpatient unit, it's not just that you're seeing the psychiatrist, you're working as a team. So there are nurses, there are mental health workers, there are social workers. And the way it works at McLean is that every day you have a meeting where people discuss what's been going on and you share any information that you have. And you, you know that that kind of guides treatment. It's if I'm on the unit while I see the patient, I'm not there 24, 24 7. But the mental health staff and the nursing staff are there and they contribute to the assessment of the patient.

[Attorney Kevin Reddington]

So in that team approach, when you have mental health workers, nurses, social workers that work with you, there's fair to say, some combination of that team present all the time?

[Dr. Aaliyah Goodheart]

Yes. There are three shifts, and each shift has mental health workers and nurses.

[Attorney Kevin Reddington]

And in that team approach, sometimes particular members of that team may have direct contact with the patient, correct?

[Dr. Aaliyah Goodheart]

Absolutely. Each shift, each patient is assigned a mental health worker and a nurse. They have. They're offered a check in, which is basically time to sit and talk about how they're doing and what's going on and if they're upset or distressed. And so, you know, there is documentation of that and that happens on a regular basis.

[Attorney Kevin Reddington]

And even when members of the particular treatment team don't have direct contact with a patient, they are still there and observing what's going on, right?

[Dr. Aaliyah Goodheart]

Correct.

[Attorney Kevin Reddington]

And are they trained to do that?

[Dr. Aaliyah Goodheart]

Absolutely.

[Attorney Kevin Reddington]

And so even if they don't have a conversation with somebody that's documented, they're still observing to be able to report back if there's any concerns that they observe during any given shift. Is that fair to say?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

Now, you mentioned that the inpatient unit at McLean that most they come from the ER departments of the Surrounding hospitals?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

So you can't just walk in. Not at McLean for the inpatient, right?

[Dr. Aaliyah Goodheart]

Correct.

[Attorney Kevin Reddington]

Okay. And so oftentimes when a patient comes from the emergency department or is referred over there, how do they get there?

[Dr. Aaliyah Goodheart]

They have to be sent on a section 12 most of the time. Well, then it doesn't make sense. So they're usually sent on a section 12, especially if they're going to be sent in an ambulance. And then when they arrive at McLean, they are seen at the CEC, which is the Clinical Evaluation Center.

[Attorney Kevin Reddington]

If I could just stop for you for one second. Can you tell us what a section 12 is?

[Dr. Aaliyah Goodheart]

Section 12 is basically a doctor or social worker or psychologist states that you are being referred to a hospital for admission because you have a mental health condition.

[Attorney Kevin Reddington]

And the section 12 could be something that the patient voluntarily elects to do. Right.

[Dr. Aaliyah Goodheart]

That's section 10. The section 12 is. It means that you have to go there. If you go there and they evaluate that you're fine, and you decide you don't want to be at the hospital, you can choose to leave and they'll have to let you go.

[Attorney Kevin Reddington]

So when you say that a person comes Transported from an ER on a Section 12, they also can come transported on a 10 as well. A voluntary.

[Dr. Aaliyah Goodheart]

A Section 12 is required for transportation because in the time between when they leave the hospital and they're supposed to get to you, you want to make sure that something could happen and then they could leave. So you want to make sure that the physician sees them at that end and then somebody sees them at the other end to ensure that something hasn't changed. So it's evaluation.

[Attorney Kevin Reddington]

Okay. And at the emergency department, there is a particular type of evaluation that's done before somebody is sent over to McLean. Correct?

[Dr. Aaliyah Goodheart]

Correct.

[Attorney Kevin Reddington]

From the Mass General, what is that usually referred to?

[Dr. Aaliyah Goodheart]

It's called the Acute Psychiatric Consultation. Aps. No, so the service is Acute Psychiatric Services, and it's an evaluation. So it's a complete evaluation by either a nurse practitioner or a psychiatrist. And they go over things like, why are you coming now? What is your history? Have you ever had problems before? What's your family history? They document how you're presenting, they inquire about symptoms, and that's how they. They find out what medications you're on. And then they. Based on that, they decide whether you need, you know, the. There could be several options. They can recommend inpatient treatment, they can recommend partial hospital program, but the patient doesn't have to do either. If they're not unsafe, they can choose to leave. But most of the time people take the recommendation and they've presented because they are seeking help.

[Attorney Kevin Reddington]

And unless the patient is deemed unsafe in that involuntary realm, it's their choice.

[Dr. Aaliyah Goodheart]

Correct.

[Attorney Kevin Reddington]

Now, you mentioned that when they come to McLean that they first come through and have a CEC. What is that?

[Assistant District Attorney Shannon Buckingham]

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[Dr. Aaliyah Goodheart]

Casino It's a clinical evaluation center.

[Attorney Kevin Reddington]

What happens at that stage at McLean?

[Dr. Aaliyah Goodheart]

They're seen by a psychiatrist and there's a nurse as well. They review the history that was obtained at the emergency department and they inquire about any. They actually do another evaluation, just like at the aps, basically reviewing all the history, but also asking their own questions. And if they have any concerns, they document them there.

[Attorney Kevin Reddington]

And you said this evaluation is done by a psychiatrist?

[Dr. Aaliyah Goodheart]

Correct.

[Attorney Kevin Reddington]

And when a person comes into McLean, can they come at any hour of the day or night?

[Dr. Aaliyah Goodheart]

Correct.

[Attorney Kevin Reddington]

And when they first make it to the clinical evaluation center, they're always seen by a psychiatrist?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

Now, once they do this evaluation, gather all the information, do they also do kind of a physical exam to make sure that there's no medical issues to address?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And after all the information is gathered, what is done at the evaluation center?

[Dr. Aaliyah Goodheart]

So they basically entered the order. May I have some water, please?

[Judge William Sullivan]

Oh, sure. Sorry.

[Dr. Aaliyah Goodheart]

No worries.

[Judge William Sullivan]

My fault.

[Dr. Aaliyah Goodheart]

Can you repeat the question?

[Attorney Kevin Reddington]

Sure. When a patient is evaluated or seen in the clinical evaluation center, what happens after the evaluation's done?

[Dr. Aaliyah Goodheart]

So they determine the level of checks that the patient should be on once they get to the unit. Because there are several units, there are at least four inpatient units. They decide what medications the patient is going to be able to get. Thank you. Until they are seen by a psychiatrist on the unit.

[Attorney Kevin Reddington]

And when you say level of check, what does that mean?

[Dr. Aaliyah Goodheart]

Everybody who is on the unit. There's a mental health worker assigned the task of ensuring that all the patients who are supposed to be on the unit are present and that they're safe. And the lowest level is 15 minute checks. If there's concern about somebody, it goes up to five minute checks. And if they're extremely unsafe, it goes to a one to one.

[Attorney Kevin Reddington]

And what does one to one mean?

[Dr. Aaliyah Goodheart]

There would be a staff person with the patient at all times.

[Attorney Kevin Reddington]

And again, this determination of which unit to be on and what level of security or what level of check is done by the psychiatrist that performs that first evaluation. Correct. Now, when a person who comes through the CEC then gets sent to the unit, do they walk to the unit on their own or how do they get to the unit?

[Dr. Aaliyah Goodheart]

They're escorted to the unit.

[Attorney Kevin Reddington]

And you said there's four inpatient psych units, is that correct? Now, when the person arrives at the unit, what happens?

[Dr. Aaliyah Goodheart]

They're seen by a nurse and a mental health worker. Their belongings are. They go through the belongings to ensure that there's nothing unsafe. There's certain things that are not allowed on a psych unit. The nurse reviews their history and takes some vital signs, sees if they need any medication, and then they show them to their room and the unit.

[Attorney Kevin Reddington]

And again, people come through the CEC at all hours of the day and night, correct?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

So this whole process is pretty seamless and could happen at any point?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

Now, you mentioned previously that the length of stay or how long a person is on the unit or inpatient varies, right?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

Is there any sort of minimum that's required when a person comes in for an inpatient stay at McLean?

[Dr. Aaliyah Goodheart]

No.

[Attorney Kevin Reddington]

And if they are voluntarily there, can they leave at any time?

[Dr. Aaliyah Goodheart]

As long as the psychiatrist and the team assesses them and determines that they don't pose an imminent risk to themselves or anybody else.

[Attorney Kevin Reddington]

Now, what if they're there on a section 12? Is there a time limit or a minimum amount of time they have to be there? We haven't gotten there yet. I'm just asking background questions about the facility.

[Dr. Aaliyah Goodheart]

So section 12 entails that you. That the team and the psychiatrist have. Has three days to evaluate the patient, to determine whether they pose a danger to themselves or others. And if at the end of that time, they do determine that the person poses a risk, then they have to apply for commitment, which would mean going in front of a judge who would decide if the patient should remain hospitalized or be discharged.

[Attorney Kevin Reddington]

And if, at the end of the 3 days you deem them to be safe, are they allowed to leave?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And is there something in the field of psychiatry or in your training and experience in your time at McLean about being discharged against medical advice?

[Assistant District Attorney Jennifer Sprague]

He wasn't discharged.

[Judge William Sullivan]

AMA, we'll allow the set the. Really the terms and where we are so you can go into that.

[Assistant District Attorney Jennifer Sprague]

AMA is not applicable.

[Attorney Kevin Reddington]

If we can approach,

[Judge William Sullivan]

your rights are safe.

[Assistant District Attorney Jennifer Sprague]

My objection.

[Judge William Sullivan]

Yeah, I've noted it. Go ahead, Council.

[Attorney Kevin Reddington]

Thank you.

[Dr. Aaliyah Goodheart]

I think we Tend not to do against medical advice because if the are concerned about somebody's safety, we would not discharge them.

[Attorney Kevin Reddington]

So you have another procedure available to you if you were concerned for somebody's safety?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And that's the procedure you described about seeking order for further commitment?

[Dr. Aaliyah Goodheart]

Correct.

[Attorney Kevin Reddington]

Okay, thank you. Now, when a person comes and goes through that process and is placed on their unit and settled in, what is the plan after that? How often do they see providers?

[Dr. Aaliyah Goodheart]

They're assessed by a psychiatrist every single day that they're there, they have nurses who are checking in with them, mental health workers. They're offered group programming and medical monitoring. Vital signs? Yeah.

[Attorney Kevin Reddington]

What types of group programming are offered to people while they're inpatient?

[Dr. Aaliyah Goodheart]

At McLean we offer skills groups which are things like they're meant to teach patients skills so that they can tolerate distress, they can kind of observe their thoughts. It's meant to shore up their skills. Then there are some groups which are more just relaxed, I guess. Such as going for fresh air, walks or going to the recreation center, just, you know, drawing or coloring and. Yeah.

[Attorney Kevin Reddington]

And are there other things offered to patients once they're on a unit to assist them in their career, like counseling?

[Dr. Aaliyah Goodheart]

Yeah, those are the check ins. And when they meet with the psychiatrist and the social worker, the counseling happens in those sessions as well. And also by the nurses and the mental health staff.

[Attorney Kevin Reddington]

Okay. Now does this procedure or does how this how it operates for any given patient, does it change if there's a holiday or a weekend?

[Dr. Aaliyah Goodheart]

I think they are still seen. They're still seen by a psychiatrist.

[Judge William Sullivan]

Why don't you rephrase the question?

[Attorney Kevin Reddington]

I will, thank you. As far as your experience at McLean Hospital, does the schedule change when there's a weekend or a holiday?

[Assistant District Attorney Shannon Buckingham]

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[Dr. Aaliyah Goodheart]

The group schedule might change, but the staffing schedule doesn't change.

[Attorney Kevin Reddington]

So the availability and the mental health worker that sees the patient, the social worker that checks in, and the psychiatrist and nurse, the team all stays the same even on a weekend or a

[Dr. Aaliyah Goodheart]

holiday, other than the social worker.

[Attorney Kevin Reddington]

Okay, and, and when I say stay the same, it could be different individuals, but it's somebody from that group, correct?

[Dr. Aaliyah Goodheart]

Yes. Okay.

[Attorney Kevin Reddington]

So as far as your role as a psychiatrist, how do you get assigned patients when they are admitted to McLean inpatient.

[Dr. Aaliyah Goodheart]

It's random. Their beds that are open and I carry a certain number of patients, and other psychiatrists have a certain number of patients, and whoever has an opening gets the admission.

[Attorney Kevin Reddington]

Do you have to be there when the patient is admitted to have the patient assigned to you?

[Dr. Aaliyah Goodheart]

No.

[Attorney Kevin Reddington]

And so do you rely on other psychiatrists to perform those tasks before you meet a patient?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

I'm going to draw your attention to a particular patient by the name of Lindsey Clancy that arrived at McLean in the early morning hours of January 1st of 2023. Do you recall that patient?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

Have you had the ability to review the records related to that patient prior to coming in today?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And do you know where she came from?

[Dr. Aaliyah Goodheart]

The emergency department at mgh.

[Attorney Kevin Reddington]

Okay. And did she come voluntarily or did she come on some sort of section again for transportation?

[Dr. Aaliyah Goodheart]

It's always a section. But then she signed in voluntarily, which is the section 10.

[Attorney Kevin Reddington]

Okay. So your, to your knowledge, she was brought in the early morning hours via ambulance?

[Dr. Aaliyah Goodheart]

Correct.

[Attorney Kevin Reddington]

And did she go through that process of the Clinical Evaluation center in the early morning hours, approximately 4am on the 1st?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And who saw her there?

[Dr. Aaliyah Goodheart]

I think the psychiatrist's name was Dr. Outlaw.

[Attorney Kevin Reddington]

Okay. And you're familiar with Dr. Jasmine Outlaw?

[Dr. Aaliyah Goodheart]

I've never met her.

[Attorney Kevin Reddington]

Okay. But she is a psychiatrist on staff,

[Dr. Aaliyah Goodheart]

and I don't know what. On staff? What you mean by on staff?

[Attorney Kevin Reddington]

Well, she works at McLean.

[Dr. Aaliyah Goodheart]

Correct.

[Attorney Kevin Reddington]

And so you were able to review the information she gathered in that first evaluation?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And in reviewing that information, did you identify that the patient was identified as medically stable? Right. Meaning she didn't have any acute medical issues that you had to worry about.

[Dr. Aaliyah Goodheart]

Correct.

[Attorney Kevin Reddington]

And she was screened on the suicide screening?

[Dr. Aaliyah Goodheart]

Correct.

[Attorney Kevin Reddington]

What was the chief complaint of the patient when she arrived at McLean?

[Dr. Aaliyah Goodheart]

She was unhappy. She was finding it hard to sleep if she didn't take medications.

[Attorney Kevin Reddington]

Okay. And do you recall reviewing in the records that it was noted that she reported that she felt numb?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And that she was having some issues managing medication?

[Dr. Aaliyah Goodheart]

I don't know what you mean by that.

[Attorney Kevin Reddington]

Well, she had some complaints about side effects or symptoms of medication?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

Now, when the psychiatrist and the Clinical evaluation Center gather the information, fair to say that it's primarily based on what's reported to the doctor by the patient?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

At McLean, do you have access to a patient's full psychiatric history or all of their records from other places?

[Dr. Aaliyah Goodheart]

It depends where the patient is coming from. I think that Dr. Outlaw did take an excerpt of the APS evaluation that was done at MGH. So I assume that she had access to that.

[Assistant District Attorney Jennifer Sprague]

Assumptions.

[Dr. Aaliyah Goodheart]

I mean, I should have said a

[Judge William Sullivan]

different way to know. She doesn't know. Yeah.

[Attorney Kevin Reddington]

As far as the full record of this particular patient that you were assigned to and responsible for, you reviewed all of the notes and information gathered by Dr. Outlaw on that first interaction with the patient, correct?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And you indicated a little while ago in your testimony that McLean is affiliated with the Brigham Hospital and Mass General. So is it fair to say that those records from Mass General are available to you at McLean?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And again, you indicated that that APS evaluation is something that's done at the emergency room, right?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And is it common that that information come along with the patient?

[Dr. Aaliyah Goodheart]

I don't know.

[Assistant District Attorney Jennifer Sprague]

Good.

[Judge William Sullivan]

Just if you can answer that. You don't know.

[Dr. Aaliyah Goodheart]

I don't know.

[Judge William Sullivan]

Okay. All right, next question.

[Attorney Kevin Reddington]

In this instance, when you reviewed the records, were you aware or did you see that there was some Note to the APS evaluation from the Mass General ER?

[Dr. Aaliyah Goodheart]

I saw the excerpt of the APS evaluation in Dr. Outlaw's note.

[Attorney Kevin Reddington]

Okay. And that excerpt from the APS evaluation was conducted by somebody by the name of Dr. Hogan, correct?

[Dr. Aaliyah Goodheart]

Correct.

[Attorney Kevin Reddington]

And did you review a portion of the record indicating that the patient said to Dr. Hogan or reported thoughts of wishing to be dead, but no plan?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And that there was no violent or homicidal ideation? Right?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And that was observed at Mass General to have no evidence of psychosis, mania, obsessions, or current anxiety symptoms?

[Dr. Aaliyah Goodheart]

Correct.

[Attorney Kevin Reddington]

So. So that's information that you knew before you met with the patient?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And as far as what's reported when the patient comes to McLean and in this instance, when Lindsey Clancy came, are you aware she reported during that clinical evaluation, center evaluation, that at the beginning of December, she had started Seroquel and Remeron and started to have intrusive and suicidal thoughts?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

That she attributed that to medication?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

Okay. And so what was the plan, the first plan that came out of that clinical evaluation center evaluation of Ms. Clancy?

[Dr. Aaliyah Goodheart]

She was continued on the medications she was admitted on? You know the plan. They do the checks. They decide what medical monitoring you need. But she basically was admitted and the medications were the same.

[Attorney Kevin Reddington]

And what was the security level or how long were the checks assigned to her after this evaluation?

[Dr. Aaliyah Goodheart]

15 minutes.

[Attorney Kevin Reddington]

And was she considered to be a high risk upon coming into the inpatient unit, or was she minimal risk?

[Judge William Sullivan]

Low.

[Dr. Aaliyah Goodheart]

Minimal. Yeah.

[Attorney Kevin Reddington]

And were you aware of what's called the provisional diagnosis that was assigned to this patient when she arrived?

[Dr. Aaliyah Goodheart]

I don't recall what the provisional diagnosis was. But I do know that they do assign a diagnosis. I don't recall it. I must have seen it in the records. But I think there are like five different diagnoses. In

[Attorney Kevin Reddington]

just referring to what's already been marked as exhibit 79, I'm going to draw your attention to page 24.

[Dr. Aaliyah Goodheart]

Thank you. Okay. I think I remember. Yes.

[Assistant District Attorney Jennifer Sprague]

Okay.

[Attorney Kevin Reddington]

Does that refresh your memory as to the provisional diagnosis?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

What was it?

[Dr. Aaliyah Goodheart]

Major depressive disorder. Severe without. Without psychotic features.

[Attorney Kevin Reddington]

Now, what. What does the provisional diagnosis mean to you when you're assigned a patient?

[Dr. Aaliyah Goodheart]

That this is the assessment of the psychiatrist who saw her at that time.

[Attorney Kevin Reddington]

Do you have to stick with that diagnosis or are you free to change that based on your experiences with the patient?

[Dr. Aaliyah Goodheart]

I did. The diagnosis I give the patient is dependent on what my interactions are and the observations of the team.

[Attorney Kevin Reddington]

Now, for this particular patient, Ms. Clancy, on January 1st, when she got situated onto the unit after that first evaluation by Dr. Outlaw, are you aware that she was then seen later in that day on January 1st?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And were you the doctor who saw her or was there somebody else?

[Dr. Aaliyah Goodheart]

It was a different psychiatrist.

[Attorney Kevin Reddington]

Okay. And who was the psychiatrist that saw her on January 1st?

[Dr. Aaliyah Goodheart]

It was Dr. Madva.

[Attorney Kevin Reddington]

And that would be Dr. Elizabeth Madva.

[Dr. Aaliyah Goodheart]

Correct again.

[Attorney Kevin Reddington]

Is she a psychiatrist as well?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And so this occurred while you were not in the hospital, right?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And were you able to review the notes, the admission notes of Dr. Madhva regarding her interactions with this patient on January 1st at approximately 12:47pm?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And again, as far as these interactions go with the patient and the psychiatrist, it's more of a conversation. Right.

[Dr. Aaliyah Goodheart]

I'm sorry, could you repeat the question?

[Attorney Kevin Reddington]

Yeah. It's a conversation. When you meet with a patient.

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

You ask them how they're feeling, get information that you think is necessary, Is that fair to say?

[Dr. Aaliyah Goodheart]

It's a conversation. And also you gather information and so

[Attorney Kevin Reddington]

do you rely on things that were reported before?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

But you also ask follow up questions, right?

[Dr. Aaliyah Goodheart]

Correct.

[Attorney Kevin Reddington]

And as far as your review of Dr. Madhva's interaction with Ms. Clancy on January 1, is it clear to you that she did that?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

She reviewed her history with her and spoke with her about how she was feeling?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

At the time she spoke with Dr. Madva, you where she said that she denied feeling depressed and denied any passive death wishes or suicidal thoughts, but reports feeling numb.

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

She reports she can't feel any emotion other than mild anxiety at now being in a hospital setting?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

After Ms. Clancy was seen by Dr. Madhva. Were you aware of what the plan was regarding her medication?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

What was the plan?

[Assistant District Attorney Shannon Buckingham]

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[Dr. Aaliyah Goodheart]

Ms. Clancy complained one of the. There were several symptoms. One of the things that she did complain about was the numbness. And Dr. Madhwa did, you know, hear that and hear her concern and that she had been sensitive to many different medications. So she.

[Attorney Kevin Reddington]

Well, let me ask if I can ask a question.

[Judge William Sullivan]

Finish with your answer.

[Dr. Aaliyah Goodheart]

So she, she determined that it was possible that the numbness the patient was completely complaining of was a side effect of the medication she was on. And the plan was to taper that medication and observe the patient to see whether the numbness went away and also if any other symptoms became evident.

[Attorney Kevin Reddington]

So the medications, you were aware of the medications that. That Ms. Clancy came into MLAN on, right?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And what medications were Those?

[Dr. Aaliyah Goodheart]

Seroquel at 100 milligrams a day, at Valium, 2 milligrams. I don't remember the frequency. I think it was per day.

[Judge William Sullivan]

And again, we're going to let her finish.

[Assistant District Attorney Jennifer Sprague]

Yeah, I'm just saying I have no problem. She looks at the record.

[Judge William Sullivan]

Yeah.

[Dr. Aaliyah Goodheart]

So Seroquel, Valium and Benadryl, do you

[Attorney Kevin Reddington]

remember or do you recall Remron being one of the drugs that were described or reported by Ms. Clancy when she came in, that she reported taking?

[Dr. Aaliyah Goodheart]

In the past? Yes.

[Attorney Kevin Reddington]

Okay. And again, in that report from the patient about past history, do you recall her indicating that one of the providers had suspected a bipolar disorder?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

In your interactions with Ms. Clancy and your review of the interaction she had with other psychiatrists, did she appear to agree with that diagnosis?

[Dr. Aaliyah Goodheart]

Did you appear to agree, Ms. Clancy,

[Judge William Sullivan]

please raise that question, please.

[Dr. Aaliyah Goodheart]

Ms. Clancy? She disagreed with the diagnosis.

[Attorney Kevin Reddington]

Okay. The fact that she came in and she was on 100 milligrams of Seroquel or more, would that have been something that was significant to you in considering a bipolar diagnosis?

[Dr. Aaliyah Goodheart]

Sercal is used for several purposes. It is not just used for bipolar illness.

[Attorney Kevin Reddington]

Okay. And Ms. Clancy also reported coming to McLean, issues with insomnia, correct?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

Is Seroquel sometime used in low doses to address insomnia?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

Now, as far as the plan from January 1, 1st, you indicated that Dr. Madva recommended reducing the Seroquel and then monitoring symptoms, correct?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

Were you aware that Ms. Clancy saw Dr. Madva again on January 2nd?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And again, that was prior to your first point of contact with her?

[Dr. Jennifer Tufts]

Yes.

[Attorney Kevin Reddington]

As far as what you know from reviewing the record, you aware that Ms. Clancy reported that she slept well on lesser dose of Seroquel?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

Did she report any delusions, hallucinations, or suicidal or homicidal ideation?

[Dr. Aaliyah Goodheart]

No.

[Judge William Sullivan]

Okay.

[Attorney Kevin Reddington]

And as far as after the check in with Dr. Madhva on the second, was the plan to continue to decrease the Seroquel?

[Dr. Aaliyah Goodheart]

Dr. Madhava was going to continue her on 75 milligrams, and then the next day she would have gone down to 50 milligrams.

[Attorney Kevin Reddington]

And on these first few days that Lindsey Clancy was at McLean Hospital from January 1st until you actually saw her on January 3rd, you're aware that in addition to seeing Dr. Outlaw at the intake and Dr. Madhva on two occasions on the 1st and the 2nd, that there were also notes in the record for you to review from nurses who interacted with her on January 1st at 5:20am, right?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

From nurse January 1st at 6:28am?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

A nurse interacting with her on January 1st at 10:34am?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And that she actually participated in a group activity with a social worker at 12:03pm on the 1st?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And that a nurse interacted with her and note made notes at 2:07pm on the 1st?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And that she saw a mental health worker at 9:33pm on the 1st?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And in relation to January 2nd, she A nurse made note of interaction with her on 9:46 on the second. Right.

[Dr. Aaliyah Goodheart]

I remember there were interactions. I don't remember the exact time, but

[Attorney Kevin Reddington]

fair to say, on the second she interacted with nurses and most in Dr. Madhva?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

Based on your review now going to January 3rd, that was the first face to face contact you had with the patient, correct?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

Prior to meeting with her, had you reviewed all of these notes and all of the information up to that date?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And did you go through again a report of history with her?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

Were you able to make an assessment of her mental status during that interaction with her?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And what were your observations of her mental status?

[Dr. Aaliyah Goodheart]

I can't. I Mean, I can remember certain elements, but I don't remember. I mean, she was dressed in, you know, she was appropriately dressed. Her speech was of normal rate and volume. Behaviorally, she was polite and cooperative. Her mood, I don't remember exactly. It's a quote. So I don't remember exactly what she quoted her mood as being. Can you. It would be in the medical record.

[Attorney Kevin Reddington]

Yeah, one moment. I'm just gonna approach, if that's okay.

[Judge William Sullivan]

Yeah. And just so the records are exhibit 79.

[Attorney Kevin Reddington]

Yes.

[Judge William Sullivan]

All right, so those records, you'll have those with you.

[Attorney Kevin Reddington]

Okay, So I have six pages, 61 through 66. That's your note. If you can just take a look

[Dr. Jennifer Tufts]

at that and let me know.

[Attorney Kevin Reddington]

Does that refresh your memory as to what your observations were of her mood?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

What was her anxious and did you observe signs of anxiety or did she tell you that she felt anxious?

[Dr. Aaliyah Goodheart]

She appeared anxious.

[Attorney Kevin Reddington]

And her affect, did you observe it to be congruent to her mood?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And you exert exam, you examined her and found her to have linear thinking and appear goal directed, Right?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And as far as addressing kind of why she was there and what your recommendations were ultimately, what were you trying to address or accomplish in the treatment plan with Ms. Clancy?

[Dr. Aaliyah Goodheart]

That's a very broad question.

[Attorney Kevin Reddington]

Okay. I could break it down if that's okay. Yes. So as far as, once you had a chance to sit and talk with her, what did she identify to you to be her main concerns that she wanted to address during her stay at McLean?

[Dr. Aaliyah Goodheart]

She did not want to be dependent on an antipsychotic medication, which is what Cerequel class is, even though it's used for insomnia and other indications, depression. She didn't want to be dependent on Seroquel to be able to fall asleep.

[Attorney Kevin Reddington]

Okay. And so fair to say she was very concerned about wanting to sleep at night?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And she was very concerned about her symptomology or what she was experiencing by way of symptoms from various medications, right?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And that concept or the phrase numbness, did she use that a few times?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And again, you mentioned Dr. Madhva was concerned about the numbness with the medication. In your experience with Seroquel, is that also a common side effect for people to feel numb?

[Dr. Aaliyah Goodheart]

It can be one of the side effects that people can have.

[Attorney Kevin Reddington]

And as far as the suicidal statements that you are aware of for from the prior reports, did you go through that with her about whether she presented to you with suicidal ideation?

[Dr. Aaliyah Goodheart]

Can you ask me that again?

[Attorney Kevin Reddington]

Sure. Did you talk to her about her thoughts of suicide?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And did you talk to her about whether she had any specific plan?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

Did she have any plan?

[Dr. Aaliyah Goodheart]

No.

[Attorney Kevin Reddington]

Had she reported that she had ever had a plan for suicide?

[Judge William Sullivan]

No.

[Attorney Kevin Reddington]

And did she tell you there were reasons why she thought she wouldn't commit suicide?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

What were those reasons?

[Dr. Aaliyah Goodheart]

Her children and her family. Her mother.

[Assistant District Attorney Shannon Buckingham]

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[Attorney Kevin Reddington]

So after this face to face interaction with her and kind of going through her history and having reviewed what you had, the information you had about her, what did you develop as a plan for her while she was at McLean?

[Dr. Aaliyah Goodheart]

I continued with the plan to taper her off Seroquel and to monitor whether her symptoms improved, but also to see if she could sleep while she was off of Seroquel. And to really observe symptoms and mood.

[Attorney Kevin Reddington]

During this first interaction with her, was there any conversation about how long she would stay or what her plan might be after she left McLean?

[Dr. Aaliyah Goodheart]

When we met the first time, Lindsay said that she had her daughter's birthday coming up on the weekend and that it had been planned months ahead of that date and she was hoping that she could be there that weekend so she could be with the kids and family who was going to come for the birthday party.

[Attorney Kevin Reddington]

Now, the concept of kind of tapering her off the seroqueline, monitoring her symptoms, did that seem like a realistic goal to you?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And now after having spoken to her and developing this plan, were you also cognizant or thinking about the potential for a bipolar disorder diagnosis? And so how does that, how did that affect how you approached this plan to taper?

[Dr. Aaliyah Goodheart]

Again, We were observing for any symptoms that would indicate that she might have bipolar disorder.

[Attorney Kevin Reddington]

And where she had reported that she had issues with sleep, was that also something of concern to you if there was the potential for a bipolar disorder?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And reduction of medication, what was the concern for the sleep?

[Dr. Aaliyah Goodheart]

I think people's mental health is negatively affected if they cannot sleep. Whether it's bipolar disorder or Depression. And so sleep is important.

[Attorney Kevin Reddington]

Okay. And so a person that might. You might be considering for a bipolar diagnosis, would lack of sleep make you watch for symptoms of hypomania?

[Dr. Aaliyah Goodheart]

Yes. Sleep is one of sleep deprivation can lead to a bipolar episode, a hypomanic manic episode.

[Attorney Kevin Reddington]

So you wanted to monitor her patterns in her sleep and her mood to see if there was any evidence of that, Correct?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

In this first interaction where you identified a plan, did you also make a suggestion about a particular medication that she might consider after the Seroquel has been. Had been discontinued?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

What was. What was the alternative medication, if you will?

[Dr. Aaliyah Goodheart]

It was Cymbalta, which is an antidepressant.

[Attorney Kevin Reddington]

And that was that something that you intended to prescribe for her while she was there, or was it something that you suggested that she could consider as an outpatient?

[Dr. Aaliyah Goodheart]

It was just a consideration. It would depend on how she was doing after she was off of the cercle.

[Attorney Kevin Reddington]

Okay. Now what about the other, the Valium? Was there a plan to address tapering or weeding or off Valium or an alternative to Valium?

[Dr. Aaliyah Goodheart]

Yes, I switched her from Valium to Ativan. Because it has a shorter half life and, you know, in my experience, it manages anxiety well.

[Attorney Kevin Reddington]

And were you aware that she had taken Ativan before?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And did she report any concerns about Ativan or benzodiazepines in general?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

What was the concern she reported to you?

[Dr. Aaliyah Goodheart]

She stated that her husband had concerns about her being on a benzodiazepine.

[Attorney Kevin Reddington]

During this interaction with her on January 3, did you observe any signs of psychosis?

[Dr. Aaliyah Goodheart]

No.

[Attorney Kevin Reddington]

And in the notes and the interactions with the providers prior to your meeting between January 1 and January 3, did anyone ever know any symptoms or concerns for psychosis?

[Dr. Aaliyah Goodheart]

No.

[Attorney Kevin Reddington]

And you're aware that Ms. Clincy was also still in that. What was considered the postpartum period? Right. She had had a child in May of 2022.

[Dr. Aaliyah Goodheart]

That's a tricky question to answer because different organizations or agencies assign postpartum a different length of time.

[Attorney Kevin Reddington]

Okay. And so in your training experience, in your experience as a person who diagnosis.

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

Really not a consideration?

[Dr. Aaliyah Goodheart]

It was.

[Attorney Kevin Reddington]

Okay. And why was it for you?

[Dr. Aaliyah Goodheart]

I mean, she had a child and their risk of postpartum depression. Postpartum psychosis is a serious consideration.

[Attorney Kevin Reddington]

Now, after this first meeting with Ms. Clancy on the third, were you able to give her, in your own opinion, a diagnosis?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

What was that?

[Dr. Aaliyah Goodheart]

You said after the third?

[Attorney Kevin Reddington]

Right.

[Dr. Aaliyah Goodheart]

Okay. So that would mean one meeting. Yes, I gave her a diagnosis of Insomnia. Second, with a mental health condition. Because one day of observation wasn't sufficient me. Sufficient for me to figure out if she truly, you know, to give a solid diagnosis. Because it sticks with the patient.

[Attorney Kevin Reddington]

Right. Fair to say you just didn't have enough information at that point.

[Dr. Aaliyah Goodheart]

Correct.

[Attorney Kevin Reddington]

Okay, so again, you saw her on January 3rd. And I was approximately 9:15aM Right.

[Assistant District Attorney Jennifer Sprague]

Right.

[Dr. Aaliyah Goodheart]

If that's what it says. Yeah.

[Attorney Kevin Reddington]

Well, if I.

[Assistant District Attorney Shannon Buckingham]

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[Attorney Kevin Reddington]

At the top of your in inpatient progress Note on page 61 of the exhibit. If I say the Data Service reads 1323 at 9:15, would that be where you would note the time you were scheduled to speak with the patient?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

Okay. And you're aware that on that same day on January 3rd, that in addition to meeting with you, that she met with a social worker at 10:07am? Right?

[Dr. Aaliyah Goodheart]

Yes, the social worker and I would have met with her together.

[Attorney Kevin Reddington]

Okay. But then the social worker would have their own note if there was any interaction that they were noting. And also a nurse as well?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And that on the third, that Ms. Clancy participated in a group at 12:02pm, correct?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And engaged with a mental health worker at 12:22pm Right.

[Dr. Aaliyah Goodheart]

I do know that she engaged with the mental health worker. The times are. Okay, not something I recall.

[Attorney Kevin Reddington]

If I indicate that the records show she did another group at 2:36pm, would that sound right?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

That she then declined a group at 3:50pm?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And then saw another mental health worker in the evening before presumably she went to bed 8:52pm?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

Did you see her on January 4th?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And so again, is this the same. Same protocol? You meet, you talk, you discuss. Did you talk to her about how the previous night sleep went?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And how was that night's sleep?

[Dr. Aaliyah Goodheart]

She reported sleeping well. Well, I don't remember the exact words, but she said she slept okay? Yeah.

[Attorney Kevin Reddington]

And do you remember having a conversation with her again on that day, January 4th, about going home?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And what did she say about that?

[Dr. Aaliyah Goodheart]

Originally, I think we were thinking. We had talked about discharge on Friday and she was. She stated that she was anxious being in the hospital and that she wanted to be discharged so she could be home with her family and her children.

[Attorney Kevin Reddington]

And so did she ask to leave earlier than Friday?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And when she asked to leave earlier than Friday, what was your response to that?

[Dr. Aaliyah Goodheart]

Whenever we. I said she could leave provided she had psychiatric follow up the next day.

[Attorney Kevin Reddington]

And why did you do that?

[Dr. Aaliyah Goodheart]

I wanted to ensure that if she wasn't able to sleep that night after discharge, that she could speak with somebody about it so that they could come up with a plan to ensure she could sleep and to monitor how she was doing off of the medication.

[Attorney Kevin Reddington]

And was there kind of a secondary reason that you had asked that she make sure she make an appointment before discharge?

[Dr. Aaliyah Goodheart]

Yes. It was also to assess whether she could think clearly and follow directions and get it together. We asked her to set up the appointment herself. And she was able to do that. She responded within an hour. She told the. The social worker that she had gotten an appointment and she went. The social worker had asked her for a fax number so that we could discharge the sum. We could send the discharge summary, and she provided the fax number as well.

[Attorney Kevin Reddington]

And now, on this day that you had met her on January 4, or. Yes, January 4, she reported that she slept well. Do you recall what dose of Seroquel she was down to at that point? Had she reached zero

[Dr. Aaliyah Goodheart]

on which day?

[Attorney Kevin Reddington]

On the 4th when you saw her?

[Dr. Aaliyah Goodheart]

I'd have to walk myself through this. So I know she was on 75 milligrams the night of the 1st, 75 milligrams the night of the 2nd. On the night of the 3rd, we decreased it to 50 milligrams. On the night of the fold, she would have been on 25 milligrams.

[Attorney Kevin Reddington]

Okay. And fair to say that on the 4th, your plan was to continue to taper her so that she wouldn't. She would be at zero for Seroquel. Take no Seroquel on Thursday night, right?

[Dr. Aaliyah Goodheart]

Correct.

[Attorney Kevin Reddington]

And that she would be restarted on Ativan and that she'd have the Trazodone available if she needed it.

[Dr. Aaliyah Goodheart]

She was already on Ativan during her admission and was taking it at night. She also had Trazodone, Which is a sleep medication. It has sedating properties, so it can be used for sleep. So, yes, she had the option to take that as well.

[Attorney Kevin Reddington]

And so did you have a concern about her leaving on Thursday the 5th without having monitored her at. No Seroquel,

[Dr. Aaliyah Goodheart]

I did not have any concerns about her safety or a risk for anybody else.

[Attorney Kevin Reddington]

Okay. But as far as, from a diagnostic perspective, would you have preferred to have more information about her sleep patterns? And her mood?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

Now, you said that you didn't have a concern for her safety. So what in your time that you were with her, that you met with her, and all the information that we reviewed, what were identified as maybe protective factors that made you feel comfortable that she was safe?

[Dr. Aaliyah Goodheart]

She was. There are several things. She was future oriented, she was dearly invested in her children. She was a caring mother, just like a caring mother. She had her parents around to help her. She had family and supports. We ensured that she would have outpatient psychiatric care for follow up. She didn't have a history of suicide, she had no history of psychosis, postpartum psychosis. You know, she had a stable place to live.

[Attorney Kevin Reddington]

So the statement that she made to you that she wouldn't have completed the act of suicide because of her kids or her mom, was that something that you considered?

[Dr. Aaliyah Goodheart]

Absolutely.

[Attorney Kevin Reddington]

And the fact that during the time she from admission on January 1st to the time she was discharged on January 5th, that she didn't make statements supporting suicidal ideation, was that a factor that you considered?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And at no time during the time she was at McLean did she ever indicate that she had a, ever reported or had thoughts of harming anyone else, did she?

[Dr. Aaliyah Goodheart]

She had never stated that she had any thoughts of harming anybody else.

[Attorney Kevin Reddington]

And ultimately, at the end of that conversation with her or the hour later, she was able to secure that appointment that you asked her to on her own.

[Dr. Aaliyah Goodheart]

Correct.

[Attorney Kevin Reddington]

And so what? Knowing that now the discharge has moved up a day, what was your plan for medication for her upon discharge?

[Dr. Aaliyah Goodheart]

She would have continued on the advan to help her sleep at night. That was a short term plan. Once she was feeling better or was able to sleep or her mood came back to baseline, she could taper off of it. She had trazodone to use as needed, melatonin.

[Attorney Kevin Reddington]

And as far as your recommendations for medication, it would be no more Seroquel? I guess. Let me ask that question a different way.

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

You didn't give her a new prescription for a different doses of Seroquel, did you?

[Dr. Aaliyah Goodheart]

No.

[Attorney Kevin Reddington]

And did you advise her to take Seroquel when she was home if she felt that she needed it?

[Dr. Aaliyah Goodheart]

I would assume she would take what I had prescribed.

[Attorney Kevin Reddington]

Just to back up one second. As part of this treatment team plan for patients at McLean Hospital, is it fair to say that either you or other members of the team, either a mental health worker, social worker, nurse, sometimes reach out to collaterals in order to try to gather information and assess a patient?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And in this instance are you aware that somebody reached out to Patrick Clancy to speak with him about his wife and her care?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And were you aware that he reported that she hadn't ever had suicidal thoughts?

[Judge William Sullivan]

Yes.

[Attorney Kevin Reddington]

And that he actually reported to the social worker that she was concerned about dependency?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

But she had told you that her husband was concerned, is that correct?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And that he felt that she had succumbed to social pressure to take psychiatric medications because her friends were taking them?

[Dr. Aaliyah Goodheart]

That's what he told the social worker.

[Attorney Kevin Reddington]

And you're aware that he had made statements that he was unhappy with the medical care she was receiving at McLean?

[Dr. Aaliyah Goodheart]

He said. I don't think.

[Attorney Kevin Reddington]

Were you aware that he said he was very unhappy with the medical care she received?

[Dr. Aaliyah Goodheart]

She received? Yes. She didn't specify. He didn't specify. McLean.

[Attorney Kevin Reddington]

Okay, thank you. And as far as you're aware, the patient themselves, Ms. Clancy, she never complained that she wasn't getting seen by someone, staff or doctors, was she?

[Dr. Aaliyah Goodheart]

She never complained of that.

[Attorney Kevin Reddington]

Did she ever file any sort of complaint with the hospital?

[Dr. Aaliyah Goodheart]

No.

[Attorney Kevin Reddington]

And is there a mechanism for a person to file a complaint if they feel like they're not being treated?

[Dr. Aaliyah Goodheart]

Absolutely.

[Attorney Kevin Reddington]

And is that information posted all over the units?

[Dr. Aaliyah Goodheart]

It is posted on the unit and the forms are available.

[Attorney Kevin Reddington]

And a person, even if they're not on a one to one or directly interacting with a mental health worker or social worker, do they always have the ability to request to speak to somebody?

[Dr. Aaliyah Goodheart]

Absolutely.

[Attorney Kevin Reddington]

And so even when maybe somebody from their team is not there or working, is there somebody always on call, a mental health worker, a social worker, a psychiatrist, a nurse for a person to speak to if they felt they needed to?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And in addition to your meeting with her on January 4, and after coming up with that plan for discharge on the 5th, are you aware that she then continued to engage in groups on the 5th and that she continued to engage with mental health workers and social workers?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And do you recall when she was discharged on the 5th? Was it in the morning or in the evening?

[Dr. Aaliyah Goodheart]

Afternoon, probably around 3ish, is my recall.

[Attorney Kevin Reddington]

Okay.

[Assistant District Attorney Shannon Buckingham]

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[Attorney Kevin Reddington]

And upon discharge, was she provided with information that she could use when she was home, like resources?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And do you recall that she had asked about resources to find a new doctor at some point?

[Dr. Aaliyah Goodheart]

She. She. Yes.

[Attorney Kevin Reddington]

And that she ultimately reported to the social worker that she felt comfortable managing at home?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

I may have one moment.

[Judge William Sullivan]

Sure.

[Attorney Kevin Reddington]

So upon discharge, what did you actually Prescribe her?

[Dr. Aaliyah Goodheart]

A 14 day supply of Ativan and a 14 day supply of Trazodone. Okay.

[Attorney Kevin Reddington]

And when you were having conversations with her about her thoughts of suicide or her thoughts of wanting to die, was she expressly asked if she wanted to kill herself?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And what was her answer? If you recall, she denied that. She denied that?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And where she specifically asked if she had a plan to kill herself?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And did she. What was her answer to that?

[Dr. Aaliyah Goodheart]

She denied it.

[Attorney Kevin Reddington]

And was she specifically asked if she wanted to harm anyone else?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And did she provide an answer for that?

[Dr. Aaliyah Goodheart]

She denied it.

[Attorney Kevin Reddington]

And those are standard questions you would ask at every interaction with her, correct?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And prior to discharge, she would also be asked those questions again, correct?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

Because if her answers changed at any point, it would have changed your plan, right?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

Thank you. Nothing further. Thank you.

[Assistant District Attorney Jennifer Sprague]

Like to start off just by asking. District attorney asked you about resources that were provided to her. What were the resources?

[Dr. Aaliyah Goodheart]

We had just. We had discussed going on Psychology Today where. I'm sorry, she was aware of the website. Psychology Today website. Yes. She was given the name of case manager through her insurance who she could contact for assistance in finding new providers.

[Assistant District Attorney Jennifer Sprague]

So other than telling her about the website for Psychology Today and talking about her insurance company and what they would allow for her to reach out for what other providers? Is that what it was?

[Dr. Aaliyah Goodheart]

Can you restate that?

[Assistant District Attorney Jennifer Sprague]

Sure. Of course. You referenced her insurance company.

[Dr. Aaliyah Goodheart]

Yes.

[Assistant District Attorney Jennifer Sprague]

That's a major consideration in medical treatment, is it not, What a person has for insurance?

[Dr. Aaliyah Goodheart]

No, no. I don't understand what you mean by that.

[Assistant District Attorney Jennifer Sprague]

You know what insurance is. I mean, as far as, like a person paying their bills for medical treatment or psychiatric treatment.

[Dr. Aaliyah Goodheart]

Insurance is important because who you can see is limited by what insurance you have.

[Assistant District Attorney Jennifer Sprague]

So that's what I was asking. As far as the insurance. You referenced that on the resources when the DA asked you about resources, and I asked you what were the resources, and you said, going on the website for Psychology Today, right?

[Dr. Aaliyah Goodheart]

Yes.

[Assistant District Attorney Jennifer Sprague]

And that you spoke to her about her insurance. Right?

[Dr. Aaliyah Goodheart]

We gave her the name of a case manager who she could contact and her telephone number in case she wanted to find other providers, they would be able to look at their database and figure out what providers would be within the distance she was comfortable with, whether they were male or female, if she had a preference, and if she had any preference about any specialization.

[Assistant District Attorney Jennifer Sprague]

Okay. And in reference to the insurance, what is the insurance? You answered the question about insurance. I'm just asking what is the involvement of insurance in that offer of resources?

[Dr. Aaliyah Goodheart]

I don't understand your question.

[Assistant District Attorney Jennifer Sprague]

Maybe I didn't understand your answer. That's why I apologize. You had indicated that in addition to telling her to go on the website for Psychology Today, that you spoke about her insurance and other providers that would be permitted, I guess, under her insurance.

[Dr. Aaliyah Goodheart]

Not every patient. The fact that she had a case manager at Blue Cross Blue Shield was an added benefit because they could assist her in finding providers. That's what I meant.

[Assistant District Attorney Jennifer Sprague]

All right, other than the case manager from Blue Cross Blue Shield and to do research off of the website for Psychology Today, what resources were provided to this woman?

[Dr. Aaliyah Goodheart]

There are numerous resources that are printed on the after visit summary. I don't know each and every one of them, but I think they would be in the medical record.

[Assistant District Attorney Jennifer Sprague]

Okay, and that's something that is provided to a patient when they leave?

[Dr. Aaliyah Goodheart]

Yes.

[Assistant District Attorney Jennifer Sprague]

She came in on a voluntary, is that correct? In other words, I know she was transported by an ambulance, but nevertheless it was that she and her husband Patrick wanted her to be treated at McLean. Correct.

[Dr. Aaliyah Goodheart]

She came in and signed in on a voluntary.

[Assistant District Attorney Jennifer Sprague]

In other words, there were no orders of a court, no judge ordering that she be committed or anything like that, is that correct?

[Dr. Aaliyah Goodheart]

Yes.

[Assistant District Attorney Jennifer Sprague]

All right. And she came in on, was it New Year's Eve, January 1st?

[Dr. Aaliyah Goodheart]

Yes.

[Assistant District Attorney Jennifer Sprague]

And do you remember what time she came in?

[Dr. Aaliyah Goodheart]

I think she arrived at the CEC around 4.

[Assistant District Attorney Jennifer Sprague]

Now, would you agree that on New year's Eve in McLean Hospital that that ward is present, pretty much running on a skeleton crew?

[Dr. Aaliyah Goodheart]

You're. I. I can't speak to something I'm not there.

[Assistant District Attorney Jennifer Sprague]

Well, it's obviously you're not there, but what about other people was skeleton crew New Year's Eve?

[Dr. Aaliyah Goodheart]

You would have to ask somebody who was there.

[Assistant District Attorney Jennifer Sprague]

Well, you've worked there for what, seven years?

[Dr. Aaliyah Goodheart]

Five.

[Assistant District Attorney Jennifer Sprague]

Five years. And, and what is the ward? The.

[Dr. Aaliyah Goodheart]

She was on AB1 South.

[Assistant District Attorney Jennifer Sprague]

81 South.

[Dr. Aaliyah Goodheart]

A as in Apple, B as in Boy 1 South.

[Assistant District Attorney Jennifer Sprague]

South. And how many doctors work at AB south or whatever shifts that you may have?

[Dr. Aaliyah Goodheart]

There are four psychiatrists at assigned who work on AV1 south now, sorry, go ahead. That. Yes, that's it.

[Assistant District Attorney Jennifer Sprague]

And does that include you?

[Dr. Aaliyah Goodheart]

Yes.

[Assistant District Attorney Jennifer Sprague]

And how many, approximately how many nurses work on AB South?

[Dr. Aaliyah Goodheart]

I wouldn't know, but I know that there is a nurse assigned to each team and that there are four teams sometimes. Yeah, in general.

[Assistant District Attorney Jennifer Sprague]

Four teams on AB south, right?

[Dr. Aaliyah Goodheart]

Yes.

[Assistant District Attorney Jennifer Sprague]

Okay, and when you say a team that consists of what, a psychiatrist, a nurse perhaps, or what a psychiatrist, a

[Dr. Aaliyah Goodheart]

nurse, a social worker and an assigned mental health worker.

[Assistant District Attorney Jennifer Sprague]

And what are the shifts that this team would work?

[Dr. Aaliyah Goodheart]

There are three shifts.

[Assistant District Attorney Jennifer Sprague]

Okay, and would that be like, you know, seven or eleven. Eleven or four, that type of thing?

[Dr. Aaliyah Goodheart]

I think there's seven hour shifts or eight hour shifts. I don't know the exact times.

[Assistant District Attorney Jennifer Sprague]

Right. And are you assigned a shift or do you just go whenever you want?

[Dr. Aaliyah Goodheart]

We are not assigned shifts.

[Assistant District Attorney Jennifer Sprague]

And when she was brought, when she was presented to the hospital, she went through that initial evaluation that you told us about the cec, Is that correct?

[Dr. Aaliyah Goodheart]

I'm sorry, cec?

[Assistant District Attorney Jennifer Sprague]

Maybe you were talking about the.

[Dr. Aaliyah Goodheart]

Yeah. Can you repeat the question?

[Assistant District Attorney Jennifer Sprague]

Sure. When she admitted herself and was escorted onto AB south, that's where she was evaluated.

[Dr. Aaliyah Goodheart]

She was evaluated in the CEC by the psychiatrist. Then she came to the unit and was seen by Dr. Madwa later the same day. So she met two psychiatrists on January 1st.

[Assistant District Attorney Jennifer Sprague]

Okay, so you have a woman that has admitted herself to McLean on New Year's for help, right?

[Dr. Aaliyah Goodheart]

Yes.

[Assistant District Attorney Jennifer Sprague]

And she was evaluated at the cec. Is that on that ward or is that a different part of the hospital?

[Dr. Aaliyah Goodheart]

It's a different part.

[Assistant District Attorney Jennifer Sprague]

Okay. And how long does that evaluation typically take?

[Dr. Aaliyah Goodheart]

I have. I can't speak to that. I don't work in the cec.

[Assistant District Attorney Jennifer Sprague]

What do you do in the ce? What happens in the cec? Does prison sit down and they get interviewed or what do they do?

[Dr. Aaliyah Goodheart]

There's a full psychiatric evaluation.

[Assistant District Attorney Jennifer Sprague]

And a full psychiatric evaluation consists of what

[Dr. Aaliyah Goodheart]

the his achieve complaint or history of. So basically a history of present illness, which would be what brings the person into the hospital?

[Assistant District Attorney Jennifer Sprague]

Okay.

[Dr. Aaliyah Goodheart]

They review past psychiatric history, substance use history, social history, family history. They do a mental status exam and then they make an assessment.

[Assistant District Attorney Jennifer Sprague]

And they would be the CEC psychiatrist. And that would be the psychiatrist that you were referring to, Dr.

[Dr. Aaliyah Goodheart]

Outlaw.

[Assistant District Attorney Jennifer Sprague]

Dr. Outlaw. Now how long does the CEC typically take?

[Dr. Aaliyah Goodheart]

I do not know. It depends on the speed of the person seeing the patient.

[Assistant District Attorney Jennifer Sprague]

I imagine that at some point a psychiatrist or a social worker or somebody must get into the prior history that the patient had prior to coming to your doorstep.

[Dr. Aaliyah Goodheart]

Right.

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[Dr. Aaliyah Goodheart]

That is a part of the evaluation? Yes.

[Assistant District Attorney Jennifer Sprague]

Okay. And you had a chance, as the district attorney asked you, as to whether or not you were able to review the medical records that involved Lindsey Clancy's treatment at McLean Hospital for the four and a half days, right?

[Dr. Aaliyah Goodheart]

I was able to review the CEC note, which had an excerpt of the MGH evaluation and notes that were available to me since January 1st at McLean.

[Assistant District Attorney Jennifer Sprague]

Now, as a psychiatrist, I mean, she's. When she goes to the hospital, she's your patient, right? She's your patient.

[Dr. Aaliyah Goodheart]

Yes.

[Assistant District Attorney Jennifer Sprague]

Yes. And as a doctor, what you want to do is get all the information that's available on why this person is in your locked ward, right?

[Dr. Aaliyah Goodheart]

Yes.

[Assistant District Attorney Jennifer Sprague]

So did you do inquiry into her prior history or was that left to the CEC person or the social worker?

[Dr. Aaliyah Goodheart]

That is part of the evaluation, and

[Assistant District Attorney Jennifer Sprague]

the evaluation is cec and when I

[Dr. Aaliyah Goodheart]

see her as well.

[Assistant District Attorney Jennifer Sprague]

All right, so do you. Sometimes. When I say you, I mean you or the social worker or the CEC person. Do you talk to people like third party. I think you said third party contacts.

[Dr. Aaliyah Goodheart]

Yes.

[Assistant District Attorney Jennifer Sprague]

All right.

[Dr. Aaliyah Goodheart]

The social worker does.

[Assistant District Attorney Jennifer Sprague]

Okay, so. And you reviewed the records. When did the social worker talk to the first psychiatrist that she went to see?

[Dr. Aaliyah Goodheart]

The social worker contacted Patrick.

[Assistant District Attorney Jennifer Sprague]

Well, I know you told us that he contacted Patrick and that Patrick gave some history about the benzodiazepines that he was contacting, concerned about, and thought she wasn't getting good medical care. Is that correct?

[Dr. Aaliyah Goodheart]

Yes.

[Assistant District Attorney Jennifer Sprague]

All right. You know that she had medical treatment before she came to McLean?

[Dr. Aaliyah Goodheart]

Yes.

[Assistant District Attorney Jennifer Sprague]

Okay. Who was. Who was her psychiatrist?

[Dr. Aaliyah Goodheart]

The nurse practitioner she was seeing prior to coming to McLean. I was aware of that person.

[Assistant District Attorney Jennifer Sprague]

Would that be nurse practitioner Gelada?

[Dr. Aaliyah Goodheart]

Yes.

[Assistant District Attorney Jennifer Sprague]

Did you speak to her?

[Dr. Aaliyah Goodheart]

No.

[Assistant District Attorney Jennifer Sprague]

Did you look at her records?

[Dr. Aaliyah Goodheart]

I did not have access to them.

[Assistant District Attorney Jennifer Sprague]

Why not?

[Dr. Aaliyah Goodheart]

They aren't in the same medical record system.

[Assistant District Attorney Jennifer Sprague]

Well, the same medical record system is just so that you have access to mgh. You have access to Brigham and Women's Hospital because it's all part of some big computer information access you have? What about other health care providers? Can you get access to their records?

[Dr. Aaliyah Goodheart]

Not immediately.

[Assistant District Attorney Jennifer Sprague]

Well, how about if you have a release signed by a patient under the HIPAA law? You know what the HIPAA law is, obviously, right?

[Dr. Aaliyah Goodheart]

Yes.

[Assistant District Attorney Jennifer Sprague]

And just tell me, what does that actually mean? That a patient allows someone to look at their medical records?

[Dr. Aaliyah Goodheart]

Yes.

[Assistant District Attorney Jennifer Sprague]

And Glynzie was very, very cooperative with you guys, wasn't she?

[Dr. Aaliyah Goodheart]

Yes.

[Assistant District Attorney Jennifer Sprague]

Did anyone ever ask her to sign a HIPAA release for anyone to get access to nurse practitioner Gelada's records?

[Dr. Aaliyah Goodheart]

No.

[Assistant District Attorney Jennifer Sprague]

About psychiatrist Tuft's records?

[Dr. Aaliyah Goodheart]

No.

[Assistant District Attorney Jennifer Sprague]

How about Nurse Practitioner Paul's records?

[Dr. Aaliyah Goodheart]

No.

[Assistant District Attorney Jennifer Sprague]

Who's Letitia Dukes?

[Dr. Aaliyah Goodheart]

She was a social worker, I think, that Lindsay saw at South Shore at the perinatal program.

[Assistant District Attorney Jennifer Sprague]

Okay. And do you know when she went to the South Shore, Rhode island perinatal program?

[Dr. Aaliyah Goodheart]

I know it was prior to admission. I don't remember the exact dates.

[Assistant District Attorney Jennifer Sprague]

Do you know what recommendations that she had received at that point?

[Dr. Aaliyah Goodheart]

No. Other than the medication, do you know

[Assistant District Attorney Jennifer Sprague]

what medication she was actually on when she presented to McCarthy? McLean Hospital?

[Dr. Aaliyah Goodheart]

Seril and Valium.

[Assistant District Attorney Jennifer Sprague]

What is it?

[Dr. Aaliyah Goodheart]

Seril and Valium.

[Assistant District Attorney Jennifer Sprague]

You knew that Dr. Tufts was the first psychiatrist that she actually consulted, correct?

[Dr. Aaliyah Goodheart]

I believe so.

[Assistant District Attorney Jennifer Sprague]

And when I. Again, if you don't know, just say you don't know it.

[Dr. Aaliyah Goodheart]

Yes.

[Assistant District Attorney Jennifer Sprague]

Okay. And. And I think you made reference to the fact. And maybe the DA made reference in questioning you about the fact that she was looking for doctors for some type of medication or something. Is that fair?

[Dr. Aaliyah Goodheart]

That's a very vague statement. I don't know what you mean.

[Assistant District Attorney Jennifer Sprague]

Okay, well, actually, she saw Dr. Tufts because Dr. Tufts advertised that she was an expert in perinatal care.

[Attorney Kevin Reddington]

Right direction.

[Judge William Sullivan]

Nova rule.

[Dr. Aaliyah Goodheart]

Oh, sorry. I wouldn't know why she saw Dr. Tufts.

[Assistant District Attorney Jennifer Sprague]

Do you know what medication Dr. Tufts prescribed to her?

[Dr. Aaliyah Goodheart]

From what Lindsay told me, yes.

[Assistant District Attorney Jennifer Sprague]

What?

[Dr. Aaliyah Goodheart]

Zoloft was the first.

[Assistant District Attorney Jennifer Sprague]

All right, so Dr. Tufts, according to Lindsay, provided her Lindsay with Zoloft, which is an ssri, correct?

[Dr. Aaliyah Goodheart]

It's an antidepressant in that class, yes.

[Assistant District Attorney Jennifer Sprague]

Okay, so when you say an antidepressant in that class, the class would be Selective serotonin reuptake inhibitor, right?

[Dr. Aaliyah Goodheart]

Yes.

[Assistant District Attorney Jennifer Sprague]

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

[Dr. Aaliyah Goodheart]

I don't know what you mean by powerful, no.

[Assistant District Attorney Jennifer Sprague]

Well, are you supposed to prescribe Zoloft or Sertraline to a person that has bipolar?

[Dr. Aaliyah Goodheart]

I think it all depends on what you're seeing when you see the patient in gym.

[Assistant District Attorney Jennifer Sprague]

So it's important, I would imagine, then, to be fair in your evaluation of this young woman that came to your hospital for help on New Year's, to find out what any evaluations were of her condition, her presentation, her symptomology, when she saw that first psychiatrist, Dr. Tufts.

[Dr. Aaliyah Goodheart]

Right. Lindsay was cooperative and she was forthcoming. I had no reason to think that she would not provide us with what other providers thought. Just like she told us that Tufts said she was worried about bipolar disorder, and I apologize.

[Assistant District Attorney Jennifer Sprague]

Tufts advised her that she was worried.

[Dr. Aaliyah Goodheart]

Oh, Sorry. It was gelada. Yes.

[Assistant District Attorney Jennifer Sprague]

Okay.

[Dr. Aaliyah Goodheart]

Sorry. Thank you.

[Assistant District Attorney Jennifer Sprague]

That's all right. No problem. And again, if you. If you have records, you want to look at them, that's fine, because I know it's tough to have all the stuff in your head.

[Dr. Aaliyah Goodheart]

Yes. Thank you.

[Assistant District Attorney Jennifer Sprague]

And so Dr. Tufts prescribed the Zoloft to her, and you knew that, right? After the initial prescription of Zoloft, do you know how many milligrams per. How many milligrams she was prescribed initially by Dr. Tufts?

[Dr. Aaliyah Goodheart]

Lindsay, I think, stated it was 25.

[Assistant District Attorney Jennifer Sprague]

Okay. And then Dr. Tufts increased it to, what, 100?

[Assistant District Attorney Shannon Buckingham]

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[Dr. Aaliyah Goodheart]

See terms and conditions 21/ Lindsey said it was increased to 50.

[Assistant District Attorney Jennifer Sprague]

50. All right, so, and again, you're in a. I don't know if it's appropriate to say, but you're in a mental institution, right? That's where you work at McLean Hospital. Okay. And it's a locked ward, right?

[Dr. Aaliyah Goodheart]

Yes.

[Assistant District Attorney Jennifer Sprague]

And she's a patient that's coming to you for help, right?

[Dr. Aaliyah Goodheart]

Yes.

[Assistant District Attorney Jennifer Sprague]

Is it appropriate for a doctor to take what that patient is telling you as a history, or do you have to verify it or talk to other healthcare providers to make sure that they're not just running off and making something up?

[Dr. Aaliyah Goodheart]

I had no reason to believe that she was not a reliable reporter.

[Assistant District Attorney Jennifer Sprague]

Because she seemed very forthright, right?

[Dr. Aaliyah Goodheart]

Yes.

[Assistant District Attorney Jennifer Sprague]

She seemed very honest in her disclosure of her symptomology, right?

[Dr. Aaliyah Goodheart]

Yes.

[Assistant District Attorney Jennifer Sprague]

One of the things. One of the tools that you and the mental health field have access to is psychiatric testing, right?

[Dr. Aaliyah Goodheart]

Yes.

[Assistant District Attorney Jennifer Sprague]

Okay. You have, for example, one tool, and I think psychologists. And there are psychologists that are on staff, I would imagine, at McLean as well.

[Dr. Aaliyah Goodheart]

No, not on that unit.

[Assistant District Attorney Jennifer Sprague]

As a psychiatrist, you don't administer psychiatric or psychological testing, do you?

[Dr. Aaliyah Goodheart]

No.

[Judge William Sullivan]

All right.

[Assistant District Attorney Jennifer Sprague]

But, for example, you know, you've got the Beck Inventory Test, or what's called the MMPI test. You're familiar with those, right?

[Dr. Aaliyah Goodheart]

These are forms and. Yeah, forms that the patient can fill out.

[Attorney Kevin Reddington]

Right.

[Assistant District Attorney Jennifer Sprague]

And one of the tests is the mmpi, which is Minnesota Multiphasic Personality Inventory Test. Right.

[Dr. Aaliyah Goodheart]

I have heard of that.

[Assistant District Attorney Jennifer Sprague]

Okay. And you know that one of the things that it determines is if they call it the K scale, whether or not somebody is lying or minimizing or. Not minimizing, but lying about their symptomology. Right.

[Dr. Aaliyah Goodheart]

I don't know much about the scale.

[Assistant District Attorney Jennifer Sprague]

Well, that's a tool that can give someone information as to the person's presentation of their symptomology. That would be important. As to their honesty of whether or not they're trying to minimize or whether or not they're trying to falsely project their symptomology. Right.

[Dr. Aaliyah Goodheart]

I don't know what you're asking me.

[Assistant District Attorney Jennifer Sprague]

Okay. Were you aware that there were ever any psychological testing administered to Lindsay or MMPI or Beck or anything?

[Dr. Aaliyah Goodheart]

I. No.

[Assistant District Attorney Jennifer Sprague]

Okay. How many times did she call or reach out to help for a suicide hotline?

[Dr. Aaliyah Goodheart]

I wouldn't. I don't know.

[Assistant District Attorney Jennifer Sprague]

Wouldn't that be something important to find out if the person who you're suggesting was denying suicidality or suicidal ideation upon your evaluation that she called out to

[Dr. Aaliyah Goodheart]

suicide hotlines, she was telling. She told us that she was having suicidal thoughts but had no intent or plan. So I do know that she was struggling with suicidal ideation.

[Assistant District Attorney Jennifer Sprague]

Right. Anybody else that you talk to, or did you talk to anybody else?

[Dr. Aaliyah Goodheart]

I know the social worker, Dr. Patrick, and he did give the information. He gave.

[Assistant District Attorney Jennifer Sprague]

Okay. So what I'm asking is, as you're investigating the history of this patient, you're not aware, no idea, that she had reached out on not one, but two occasions to a suicide hotline. Is that correct?

[Dr. Aaliyah Goodheart]

Yes.

[Assistant District Attorney Jennifer Sprague]

All right. Did you know that when she was first prescribed the Zoloft by Dr. Tufts at 25 milligrams, then increased to 50 milligrams, that she then reported that she was unable to sleep?

[Dr. Aaliyah Goodheart]

She shared with us. Sorry. I'm sorry. I didn't.

[Attorney Kevin Reddington]

Oh, my head. No problem.

[Assistant District Attorney Jennifer Sprague]

What is it?

[Dr. Aaliyah Goodheart]

I'm going to let you finish the question.

[Assistant District Attorney Jennifer Sprague]

Okay. Thank you. No big deal. It's just that she reported that she went for 48 hours without sleep.

[Dr. Aaliyah Goodheart]

I don't remember that time quoted. I know she had difficulty sleeping.

[Assistant District Attorney Jennifer Sprague]

You indicated in your testimony that. And I quote, I would have preferred to have more information about her Sleep patterns. Right. Do you remember saying that?

[Dr. Aaliyah Goodheart]

Following the changes in the medications that we were making.

[Assistant District Attorney Jennifer Sprague]

So sleep pattern would be just what it says, sleep pattern. Like you sleep from 9 at night till 7 in the morning or 12 at night, whatever your patent would be, right?

[Dr. Aaliyah Goodheart]

Yes.

[Assistant District Attorney Jennifer Sprague]

And why is a sleep pattern important for you as a psychiatrist trying to evaluate your patient?

[Dr. Aaliyah Goodheart]

Because difficulty sleeping is a symptom of several different conditions and it can worsen several different conditions.

[Assistant District Attorney Jennifer Sprague]

And you know that she had reported severe anxiety, right?

[Dr. Aaliyah Goodheart]

She was struggling with anxiety.

[Assistant District Attorney Jennifer Sprague]

Yes, struggling with anxiety. And she was having not just insomnia, but she had very, very severe insomnia, didn't she?

[Dr. Aaliyah Goodheart]

She wasn't able to sleep.

[Assistant District Attorney Jennifer Sprague]

And you would prefer to have more information about sleep patterns, is what you said. I'm not putting words in your mouth. That's what you said.

[Dr. Aaliyah Goodheart]

I know that we were able to observe her sleep while she was on the unit. Once she left the unit, I would not know how she was sleeping, which is why we referred her to somebody else so that they could continue to monitor her symptoms, obviously.

[Assistant District Attorney Jennifer Sprague]

So let's put the time that you are observing her or that your social workers are investigating, to whatever extent they did, her background, what were her sleep patterns that were important to you prior to New Year's 2023?

[Dr. Aaliyah Goodheart]

The amount of sleep is important.

[Assistant District Attorney Jennifer Sprague]

Yeah. And you said that, you already said. I would have preferred to have more information about her sleep patterns after she was in.

[Dr. Aaliyah Goodheart]

If I was going to continue to evaluate her, I would want to observe her sleep is what I meant.

[Assistant District Attorney Jennifer Sprague]

Oh, so you didn't mean that as an evaluator of her prior medical history, trying to get a history of your patient for purposes of diagnosis and treatment, that you wanted to know what her sleep patterns were. You didn't mean that. You meant prior.

[Dr. Aaliyah Goodheart]

The history of whether somebody's struggling with insomnia is important, and the patient can relay that to me.

[Assistant District Attorney Jennifer Sprague]

Okay. You ever heard of patients that minimize their symptoms and lie about their symptoms?

[Dr. Aaliyah Goodheart]

Sometimes, yes.

[Assistant District Attorney Jennifer Sprague]

Okay, so it's important to corroborate what the person is telling you, right? I mean, you know, you want to talk to somebody else. Objective to find out what, if any, evidence there is of symptomology.

[Dr. Aaliyah Goodheart]

And we did that with.

[Assistant District Attorney Jennifer Sprague]

I'm sorry, we.

[Dr. Aaliyah Goodheart]

So when a patient presents and they're talking to us, it is not just about what they are saying. It's about their body language, their eye contact. You can get a sense of whether a person is being honest or whether they're lying. And we are not, you know, we Are providers. The patient is there to get help. They are going to tell us what is bothering them and what they're concerned about. That's why they're in the hospital.

[Assistant District Attorney Jennifer Sprague]

This woman was in a locked ward. She couldn't walk off your unit, could she?

[Dr. Aaliyah Goodheart]

That is what a psychiatric unit is, Right.

[Assistant District Attorney Jennifer Sprague]

And she was very sick, wasn't she?

[Dr. Aaliyah Goodheart]

I don't know what you mean by very sick.

[Assistant District Attorney Jennifer Sprague]

Really? You indicated that you would assume that she would take what I prescribed. Do you do that with all of your patients? Assume that when they have mental disease or a defect, that they would do what they're told?

[Dr. Aaliyah Goodheart]

If they are cooperative and they have been cooperative and reliable? Yes.

[Assistant District Attorney Jennifer Sprague]

One of the things that's referenced would be she stated that she had intrusive thoughts.

[Judge William Sullivan]

Remember that?

[Dr. Aaliyah Goodheart]

Yes.

[Assistant District Attorney Jennifer Sprague]

What were the intrusive thoughts?

[Dr. Aaliyah Goodheart]

From what I. From what's stated in the medical record? Thoughts of suicide.

[Assistant District Attorney Jennifer Sprague]

Okay. And how often would she have the intrusive thoughts?

[Dr. Aaliyah Goodheart]

I don't recall if the frequency.

[Assistant District Attorney Jennifer Sprague]

Would you agree with me that in addition to anxiety and in addition to inability to sleep, that she was in what was self described as a brain fog?

[Dr. Aaliyah Goodheart]

Right. She complained of feeling. Yeah, you can complain of feeling foggy.

[Assistant District Attorney Jennifer Sprague]

She also complained about that she felt as if she was a zombie. Right?

[Dr. Aaliyah Goodheart]

She did not use those words.

[Assistant District Attorney Jennifer Sprague]

Did anybody else use that word describing her in your investigation?

[Dr. Aaliyah Goodheart]

No.

[Assistant District Attorney Jennifer Sprague]

Did Patrick tell you that he was concerned about the medications that she had been prescribed over the past two or three months?

[Dr. Aaliyah Goodheart]

Yes.

[Assistant District Attorney Jennifer Sprague]

And you knew what the medications were that she was prescribed? Correct? She told us she told you. Okay. And she told you that she was prescribed in addition to the SSRI Zoloft that was increased from 25 to 100. That she was then told.

[Dr. Aaliyah Goodheart]

I was aware.

[Assistant District Attorney Jennifer Sprague]

I'm sorry. 50.

[Dr. Aaliyah Goodheart]

Correct.

[Assistant District Attorney Jennifer Sprague]

She was then told to stop taking the Zoloft by Dr. Tuts. Right.

[Dr. Aaliyah Goodheart]

She reported not being able to sleep and they agreed that she would not take this all off.

[Assistant District Attorney Jennifer Sprague]

Okay, so. So the answer is yes. She was told to stop taking the Zoloft by Dr. Tufts. Right?

[Dr. Aaliyah Goodheart]

I. I think you would have to ask Dr. Tufts that.

[Assistant District Attorney Jennifer Sprague]

Well, I will, but I'm asking you as investigating.

[Dr. Aaliyah Goodheart]

I know that she stopped taking the Zoloft and that she saw Dr. Tuft. So I assume that.

[Assistant District Attorney Shannon Buckingham]

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[Dr. Aaliyah Goodheart]

They would have come to that agreement.

[Assistant District Attorney Jennifer Sprague]

All right, so as you're evaluating this patient, you're assuming that she voluntarily stopped

[Dr. Aaliyah Goodheart]

taking the Zoloft because she wasn't able to sleep and she discussed it with Dr. Tufts.

[Assistant District Attorney Jennifer Sprague]

She did. You knew that?

[Dr. Aaliyah Goodheart]

She told us she did.

[Assistant District Attorney Jennifer Sprague]

Okay. How many patients have you treated. How many women have you treated that were suffering from postpartum psychosis?

[Dr. Aaliyah Goodheart]

I don't recall. I don't remember. But I think it would stick in my memory, so I don't think that I probably have.

[Assistant District Attorney Jennifer Sprague]

You don't think you probably have?

[Dr. Aaliyah Goodheart]

I don't. I don't think I have. I haven't seen any.

[Assistant District Attorney Jennifer Sprague]

How about postpartum depression?

[Dr. Aaliyah Goodheart]

Yes.

[Assistant District Attorney Jennifer Sprague]

And how many patients have you treated with postpartum depression over the last

[Dr. Aaliyah Goodheart]

20 years? I wouldn't remember. There are lots of patients I have seen. I don't keep a record of what diagnoses and what people. I see.

[Assistant District Attorney Jennifer Sprague]

Now, one of the things that you. When I say you collectively, I mean psychiatrists, psychologists, use in your evaluations and diagnoses of patients would be what's referred to as the dsm, correct?

[Dr. Aaliyah Goodheart]

Yes.

[Assistant District Attorney Jennifer Sprague]

And that would be dsm. It means Diagnostic Statistical Manual, right?

[Dr. Aaliyah Goodheart]

Yes.

[Assistant District Attorney Jennifer Sprague]

And it started out with DSM 1, then it went to 2, then it went to 2R, meaning revised. And then there were a number of revisions, and now we're all the way up to DSM 5, correct?

[Dr. Aaliyah Goodheart]

Yes.

[Assistant District Attorney Jennifer Sprague]

And DSM 5, also, the most recent would be TR. What does TR mean?

[Dr. Aaliyah Goodheart]

I don't actually know.

[Assistant District Attorney Jennifer Sprague]

So the DSM, the Diagnostic Statistical Manual, is really. It's about this thick, right? If you have a regular sized book.

[Dr. Aaliyah Goodheart]

I just have a little one, but I think so.

[Judge William Sullivan]

Okay.

[Assistant District Attorney Jennifer Sprague]

Do you rely on, or do you use in your evaluation of patients, the Diagnostic Statistical Manual?

[Dr. Aaliyah Goodheart]

The diagnoses are based on the criteria that are stated in there.

[Assistant District Attorney Jennifer Sprague]

Okay. So you do use for diagnosis purposes what is stated in the dsm, correct?

[Dr. Aaliyah Goodheart]

Yes.

[Assistant District Attorney Jennifer Sprague]

And it's kind of like a cookbook. I mean, it basically tells you what the ingredients of a particular mental disease or defect would be, right?

[Dr. Aaliyah Goodheart]

Yes.

[Assistant District Attorney Jennifer Sprague]

And you know that it's basically a group of people that get together and they discuss what should or should not be included in the manual that psychiatrists and psychologists use to diagnose patients, right?

[Dr. Aaliyah Goodheart]

Yes.

[Assistant District Attorney Jennifer Sprague]

And they try to keep up to date and stay on top of any recent developments. Right.

[Dr. Aaliyah Goodheart]

I would assume. I don't know. Okay. I can't Speak to.

[Assistant District Attorney Jennifer Sprague]

That's all right. So here we are in 2026, not 1928. Is postpartum depression in the DSM?

[Dr. Aaliyah Goodheart]

I think it's a subcategory.

[Assistant District Attorney Jennifer Sprague]

You think it's a subcategory of what?

[Dr. Aaliyah Goodheart]

Depression.

[Assistant District Attorney Jennifer Sprague]

Depression. How about psychosis? Postpartum psychosis in 2026. Is that in this manual?

[Dr. Aaliyah Goodheart]

I don't exactly know where it is.

[Assistant District Attorney Jennifer Sprague]

Have you ever seen it on screen?

[Dr. Aaliyah Goodheart]

I don't recall paying attention to where it's categorized.

[Assistant District Attorney Jennifer Sprague]

So if you're treating a woman who is, as you put it, postpartum because she had the child, and then you told the jury, well, there's a time frame, a cutoff as to whether or not a person is still postpartum, still subject to mood swings and still subject to hormone imbalance. And is a cutoff is what you said, right?

[Dr. Aaliyah Goodheart]

Different organizations use different definitions.

[Assistant District Attorney Jennifer Sprague]

How about you? You're here for the government testifying in this case. What's your understanding of a cutoff? A postpartum is if there is one.

[Dr. Aaliyah Goodheart]

For the DSM 5, it is four weeks. For ACOG, which is the American Academy of Obstetrics or something. I don't remember what that stands for. It's 12 weeks. For the CDC, it's 12. 12 months. For the CDC, it's twelve months.

[Assistant District Attorney Jennifer Sprague]

Okay, so CDC would be center for Disease Control, right?

[Dr. Aaliyah Goodheart]

Yes.

[Assistant District Attorney Jennifer Sprague]

So they're pretty much all over the place as far as the time frame that a woman can still be involved with postpartum symptomology, right?

[Dr. Aaliyah Goodheart]

Yes.

[Assistant District Attorney Jennifer Sprague]

Have you ever heard of a doctor by the name of Meg Spinelli?

[Dr. Aaliyah Goodheart]

No.

[Assistant District Attorney Jennifer Sprague]

Have you read anything about the efforts being made to have the DSM 6 coming out? Include.

[Attorney Kevin Reddington]

Objection.

[Judge William Sullivan]

No. Overruled.

[Assistant District Attorney Jennifer Sprague]

Postpartum psychosis.

[Dr. Aaliyah Goodheart]

I'm sorry, what's the question?

[Assistant District Attorney Jennifer Sprague]

Have you read or are you aware of efforts being made to include postpartum psychosis in the DSM 6 that will be coming out within a couple of months?

[Dr. Aaliyah Goodheart]

I think. I haven't. I think it's clear that there is question about where it should be placed or categorized.

[Assistant District Attorney Jennifer Sprague]

Okay. So are you aware of any efforts being made to include postpartum psychosis in the DSM 6 when it comes out?

[Dr. Aaliyah Goodheart]

Vaguely.

[Assistant District Attorney Jennifer Sprague]

Vaguely? How vague?

[Dr. Aaliyah Goodheart]

I don't know.

[Assistant District Attorney Jennifer Sprague]

You don't know?

[Dr. Aaliyah Goodheart]

The DSM is reviewed every time and they try to move things around Based on what clinicians and researchers think.

[Assistant District Attorney Jennifer Sprague]

What, if any, impact does the thyroid have on a woman who has just had a baby and is in the postpartum period? Whatever they decided in six months, four Months, A year? What impact does the thyroid have?

[Dr. Aaliyah Goodheart]

I am not internal medicine physician. I am a doctor. What I do know about the thyroid is that the thyroid can affect one's mood and anxiety whether one is pregnant or not.

[Assistant District Attorney Jennifer Sprague]

So is it fair to say that thyroid levels are important in evaluating a woman who is in postpartum?

[Dr. Aaliyah Goodheart]

It's. It's one tiny component of the entire. It is one component. I.

[Assistant District Attorney Jennifer Sprague]

Okay, so what does that mean?

[Dr. Aaliyah Goodheart]

It's one of the 10.

[Assistant District Attorney Jennifer Sprague]

It's a tiny component. What does that mean?

[Judge William Sullivan]

Sure you'll let her finish?

[Assistant District Attorney Jennifer Sprague]

Go ahead.

[Dr. Aaliyah Goodheart]

It's one of the tests that can be done when a patient is admitted.

[Assistant District Attorney Jennifer Sprague]

Okay. Was it done by McLean Hospital?

[Dr. Aaliyah Goodheart]

I. No.

[Assistant District Attorney Jennifer Sprague]

What?

[Dr. Aaliyah Goodheart]

No.

[Assistant District Attorney Jennifer Sprague]

Are you aware that. That your records indicate that she had a thyroid read that are part of the records?

[Dr. Aaliyah Goodheart]

I. My recall is that the TSH was not from 2022 or 2023.

[Assistant District Attorney Jennifer Sprague]

Right. It was from 2000. And what?

[Dr. Aaliyah Goodheart]

I wouldn't know. You'd have to refer to the record.

[Assistant District Attorney Jennifer Sprague]

So in other words, it was imported into McLean Records by, I guess, computer access or something from MGH years before.

[Dr. Aaliyah Goodheart]

Right. Things move forward. Yes.

[Assistant District Attorney Jennifer Sprague]

I'm sorry.

[Dr. Aaliyah Goodheart]

Labs do populate from the past.

[Assistant District Attorney Jennifer Sprague]

Okay, so in the past, as a psychiatrist, as her treating psychiatrist at McLean Hospital, trying to do an investigation, evaluate this woman to tell her what your diagnosis was and what you guys can do to help her out, did you look at the thyroid reads?

[Dr. Aaliyah Goodheart]

It was one of the labs that I would have reviewed.

[Assistant District Attorney Jennifer Sprague]

You would have reviewed. Okay. As you're sitting here today, do you have any memory about what the thyroid

[Dr. Aaliyah Goodheart]

reads were it was within normal limits?

[Assistant District Attorney Jennifer Sprague]

And that would be coming from how long before? A year, two, three?

[Dr. Aaliyah Goodheart]

I don't remember.

[Assistant District Attorney Jennifer Sprague]

So there were no actual thyroid tests done, done while she was at the hospital at McLean, right?

[Dr. Aaliyah Goodheart]

No.

[Assistant District Attorney Jennifer Sprague]

What is the Edinburgh, the EPDs or something like that?

[Judge William Sullivan]

What is that?

[Dr. Aaliyah Goodheart]

It's a scale.

[Assistant District Attorney Jennifer Sprague]

A scale? What kind of a scale?

[Dr. Aaliyah Goodheart]

It's a postpartum scale for depression.

[Assistant District Attorney Jennifer Sprague]

And it's used by psychiatrists and psychologists to evaluate the risk factor of a woman who is involved with postpartum.

[Judge William Sullivan]

Right.

[Dr. Aaliyah Goodheart]

I think it's to assess the level

[Assistant District Attorney Jennifer Sprague]

of depression in a woman who's involved with postpartum, not some guy that got injured on a soccer field, right?

[Dr. Aaliyah Goodheart]

Yes.

[Assistant District Attorney Jennifer Sprague]

So what does the EPDs mean? I'm probably butchering that. What is that an acronym for Edinburgh's

[Dr. Aaliyah Goodheart]

Postpartum Depression Scale or something?

[Assistant District Attorney Jennifer Sprague]

Okay, the Edinburgh Postpartum Depression Scale. Was that administered to Lindsey when she was in for the four days and A half that she was in your hospital?

[Dr. Aaliyah Goodheart]

No.

[Assistant District Attorney Jennifer Sprague]

Why not?

[Dr. Aaliyah Goodheart]

Because we don't necessarily administer skills.

[Assistant District Attorney Jennifer Sprague]

You don't necessarily what?

[Dr. Aaliyah Goodheart]

We don't administer skills.

[Assistant District Attorney Jennifer Sprague]

What? That's. That's an accepted

[Assistant District Attorney Shannon Buckingham]

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[Assistant District Attorney Jennifer Sprague]

That's an accepted tool to evaluate a patient as a psychiatrist or a psychologist isn't.

[Dr. Aaliyah Goodheart]

Is a tool, but it doesn't, in the end determine the diagnosis.

[Assistant District Attorney Jennifer Sprague]

Oh, no, of course not. Because the doctor who supposedly has accident as to the person's medical history and all of the other aspects of your evaluation is the one that gives the diagnosis. Right.

[Dr. Aaliyah Goodheart]

Does the psychiatrist makes the diagnosis based on the presentation, the history of the patient.

[Kimberly Hardy]

Right.

[Assistant District Attorney Jennifer Sprague]

So so far what we've got is a presentation of the patient who was in the locked wards at McLean Hospital. And the presentation was from her.

[Judge William Sullivan]

Right.

[Dr. Aaliyah Goodheart]

Her presentation is how she presents, how she is observed. It's not what she's telling us.

[Assistant District Attorney Jennifer Sprague]

Well, isn't what she's telling you part of what you consider?

[Dr. Aaliyah Goodheart]

Yes.

[Assistant District Attorney Jennifer Sprague]

Okay. And what Patrick's telling you is part of what you consider?

[Dr. Aaliyah Goodheart]

Yes.

[Assistant District Attorney Jennifer Sprague]

So other than what Lindsay, who was in the locked ward, tells you and her husband who tells. Tells you what if any investigation did you do.

[Dr. Aaliyah Goodheart]

We did not do any additional collateral contact.

[Assistant District Attorney Jennifer Sprague]

And you didn't do any tests either. Right. You didn't do any. Did you do a blood test?

[Dr. Aaliyah Goodheart]

Psychiatry as a field is not dependent on blood tests. If it was that simple, it would be much better for everybody. It's based on the evaluation of the patient who's sitting in front of you.

[Assistant District Attorney Jennifer Sprague]

So you're suggesting to this jury that it's not a valid medical step for one to take to take blood from a person who is on a cocktail of drug medications to find out what their levels are?

[Dr. Aaliyah Goodheart]

No. Not a regular procedure at all.

[Assistant District Attorney Jennifer Sprague]

Okay. Now, McLean did not take any blood. McLean did not do the Edinburgh scale. But that would be something that you would be interested in, right? As to whether or not anyone else gave her the Edinburgh depression scale.

[Dr. Aaliyah Goodheart]

Let me clarify one thing. McLean did draw blood. They did do testing.

[Assistant District Attorney Jennifer Sprague]

I.

[Dr. Aaliyah Goodheart]

Whether there was no testing for levels of drugs.

[Assistant District Attorney Jennifer Sprague]

Drugs.

[Dr. Aaliyah Goodheart]

Just let me clarify that. So that's fine. Okay.

[Assistant District Attorney Jennifer Sprague]

So they took a CBC or maybe a blood count evaluation, but it had nothing to do with what was on board. As they say, as far as tricyclics, antipsychotics, SSRIs, anything. Right.

[Dr. Aaliyah Goodheart]

They check for substances of abuse, but nothing else.

[Assistant District Attorney Jennifer Sprague]

Well, there were no substances of abuse in her blood, were there?

[Dr. Aaliyah Goodheart]

No.

[Assistant District Attorney Jennifer Sprague]

The tricyclics, the antipsychotics, the SSRIs, the benzodiazepines, the Z drugs that they call some of their categories. They didn't test for that, did they?

[Dr. Aaliyah Goodheart]

Those are not tested on a regular basis.

[Assistant District Attorney Jennifer Sprague]

How about on her basis?

[Dr. Aaliyah Goodheart]

I don't know why I would have tested for those. What would have been the indication?

[Assistant District Attorney Jennifer Sprague]

How about if she presents. And the history that she's giving you is that she was on a number of drugs for that three month period or three and a half month period. Would it be of interest to you as to what was on board in her blood?

[Dr. Aaliyah Goodheart]

Medications have different half lives. So if she had taken something, it would depend on what the half life was. If it was a day, it would be out of her system. I would not be. We would not be able to catch it at that time. It would depend on what she'd been taking and, you know, what was in her bloodstream at that point.

[Assistant District Attorney Jennifer Sprague]

So the admission note that was noted in the medical records would be on page 64 of the Medical records that were. You were presented by the district attorney.

[Dr. Aaliyah Goodheart]

I don't remember what page it's on, but that's understandable. Thank you.

[Assistant District Attorney Jennifer Sprague]

Tell me what I'm looking at. Tell me what this means. When it says clinical summary, that says

[Dr. Aaliyah Goodheart]

the social workers note.

[Assistant District Attorney Jennifer Sprague]

Okay.

[Judge William Sullivan]

Can you. Doctor, can you maybe move that microphone just so the caller.

[Assistant District Attorney Jennifer Sprague]

That's the social worker's note.

[Dr. Aaliyah Goodheart]

Correct.

[Assistant District Attorney Jennifer Sprague]

And that's what the district attorney was questioning you on when she referred you to symptomology.

[Dr. Aaliyah Goodheart]

It was just a conversation with Patrick. I'm not sure what. I don't recall what you're talking about.

[Assistant District Attorney Jennifer Sprague]

All right, you can read along with me.

[Judge William Sullivan]

All right.

[Dr. Aaliyah Goodheart]

Okay.

[Assistant District Attorney Jennifer Sprague]

Clinical summary says the case was discussed in rounds. And would that be like on Grey's Anatomy, you have rounds and they. And they see patients in the. In the rooms and that type of thing? No. What does it mean when it says in rounds?

[Dr. Aaliyah Goodheart]

It's when we meet in the morning, the social worker, the psychiatrist, the nurse and the charged Nurse, the utilization reviewer.

[Assistant District Attorney Jennifer Sprague]

Okay, so that's why it says on page 63, discussed in rounds, SW&PIC met with Lindsay as part of the intake interview, right?

[Dr. Aaliyah Goodheart]

Yes.

[Assistant District Attorney Jennifer Sprague]

Okay, Presenting problem. Then it says hx. That's history, Right. And psychosocial HX history was discussed, correct?

[Dr. Aaliyah Goodheart]

Yes.

[Assistant District Attorney Jennifer Sprague]

At that point, she stated that she was hoping to be home by next weekend for her daughter's birthday. Right. And that then she relates her history as far as having a third baby on May 26th. That would be Callan, right?

[Dr. Aaliyah Goodheart]

Yes.

[Assistant District Attorney Jennifer Sprague]

Her youngest baby. And she then told you all that 12 weeks after she delivered the baby, wasn't taking the box bottle was around the time that she was supposed to go back to work. Husband also went back to work, and she was experiencing a lot of. And then someone puts in, quote, situational anxiety. Is that correct?

[Dr. Aaliyah Goodheart]

That's what it states.

[Assistant District Attorney Jennifer Sprague]

All right, so as a result, is that coming from her or that word, situational anxiety? Was that her words because it's in quotes, or was that. You guys put that in there?

[Dr. Aaliyah Goodheart]

I didn't write that note.

[Assistant District Attorney Jennifer Sprague]

Okay, but you factored that in in your investigation, right?

[Dr. Aaliyah Goodheart]

I read it.

[Assistant District Attorney Jennifer Sprague]

Okay. And as a result of this, she subsequently saw a psychiatrist that prescribed her Zoloft, right?

[Dr. Aaliyah Goodheart]

Yes.

[Assistant District Attorney Jennifer Sprague]

And that would be Dr. Tufts, right?

[Dr. Aaliyah Goodheart]

Yes.

[Assistant District Attorney Jennifer Sprague]

And one week after prescribing that, it says after one week of taking it that she developed insomnia, correct?

[Dr. Aaliyah Goodheart]

Yes.

[Assistant District Attorney Jennifer Sprague]

Okay, so that's an indication of a reaction that the patient had to the medication that was prescribed to her being the ssri. Zoloft, Right.

[Dr. Aaliyah Goodheart]

It could be a side effect. Yes, could be.

[Assistant District Attorney Jennifer Sprague]

Okay, and the psychiatrist told her to stop taking Zoloft, right?

[Dr. Aaliyah Goodheart]

That's what it states.

[Assistant District Attorney Jennifer Sprague]

And do you know from your investigation and your evaluation of Lindsey Clancy, when the doctor told her to stop taking Zoloft, it was like. I mean, you can guess. It was like a week later, a

[Dr. Aaliyah Goodheart]

couple of days later, it would be if that. If I don't recall off the top of my head, but if that information was available, it would be in my note.

[Assistant District Attorney Jennifer Sprague]

Do you know, can you find your note in here? I just don't know how to navigate that. Would it help you if you had a break or a little recess just to look at this?

[Dr. Aaliyah Goodheart]

No, I can find it right now.

[Assistant District Attorney Jennifer Sprague]

You know, Mr.

[Judge William Sullivan]

Rating, that's probably not a bad idea. We've been sitting here, kind of missed that morning recess. So we're going to take that at this point. Just a short, short morning recess. Let all of you kind of stretch your legs a little bit. And then we'll come right back. Back. Okay.

[Dr. Aaliyah Goodheart]

Court. All right, jurors, close your notebooks.

[Assistant District Attorney Jennifer Sprague]

Place them on your chairs, please.

[Dr. Aaliyah Goodheart]

This way. Said I can. I should.

[Assistant District Attorney Jennifer Sprague]

Your Honor, can she have permission to take that and look at it, the exhibit out of the courtroom?

[Judge William Sullivan]

I think it's probably best if. If you want to look at it, keep that in the courtroom.

[Assistant District Attorney Jennifer Sprague]

Yeah.

[Attorney Kevin Reddington]

Okay.

[Assistant District Attorney Jennifer Sprague]

Yeah, so you can look at it, but just. You have to stay in the courtroom. Okay. She wants to take a break, as. Do as we all do.

[Judge William Sullivan]

Leave it here. All right, so we'll be in a short recess. Thank you. All right.

[Assistant District Attorney Jennifer Sprague]

And I think it's. I don't want to go to the sidebar. I really don't want to go to the sidebar.

[Judge William Sullivan]

I need to know what you're going to talk about before I want to

[Assistant District Attorney Jennifer Sprague]

tell you that I. They got picked up on a hot mic saying shut her up during the playing of that autopsy. All right. This is not. This is not like Man's Tales where you put a tape.

[Judge William Sullivan]

Yes. Get sidetracked by that. All right.

[Assistant District Attorney Jennifer Sprague]

All right.

[Judge William Sullivan]

Ready for the jury? Yeah.

[Dr. Aaliyah Goodheart]

Wait a minute. Can I keep

[Assistant District Attorney Jennifer Sprague]

court?

[Dr. Aaliyah Goodheart]

All rise.

[Assistant District Attorney Jennifer Sprague]

Jurors, enter. This court's now in session. Please be seated.

[Attorney Kevin Reddington]

Your Honor, for the purpose of the record, we return back to the trial. A commonwealth for us is Lindsay Clancy.

[Dr. Aaliyah Goodheart]

All parties are present, including the defendant,

[Attorney Kevin Reddington]

and including the 18 jurors.

[Assistant District Attorney Jennifer Sprague]

All right, Ms. Briggton. I think it's page 63. Pretty sure.

[Dr. Aaliyah Goodheart]

My note.

[Assistant District Attorney Jennifer Sprague]

Yes, I believe.

[Judge William Sullivan]

It is.

[Assistant District Attorney Shannon Buckingham]

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[Assistant District Attorney Jennifer Sprague]

Doctor, you'd agree with me that your notes are contained in exhibit 79, correct?

[Dr. Aaliyah Goodheart]

Yes.

[Assistant District Attorney Jennifer Sprague]

Okay. And one of the things that you had. Correct.

[Dr. Aaliyah Goodheart]

Yes.

[Assistant District Attorney Jennifer Sprague]

And that was not against medical advice, was it?

[Dr. Aaliyah Goodheart]

No.

[Assistant District Attorney Jennifer Sprague]

And finally, you had made reference to the fact that postpartum psychosis is a serious consideration for you or your staff when you're evaluating a patient in McLean. Correct. And one of the recommendations that you made was that she should follow up with other healthcare providers. And if I understand correctly, she actually sent a text or an email or something and confirmed that she did within the hour. Right.

[Dr. Aaliyah Goodheart]

She made an appointment with Dr. Tufts for the next morning.

[Assistant District Attorney Jennifer Sprague]

Right. And she told you, you guys that. Right?

[Dr. Aaliyah Goodheart]

She told the social worker that.

[Assistant District Attorney Jennifer Sprague]

So she was very responsive to your advice about you should reach out to your. Your provider, and she did that, right? Yes, that's all he had. Thank you.

[Judge William Sullivan]

All right. All right, council redirect.

[Attorney Kevin Reddington]

Dr. Goodheart, good care. You're familiar with the discharge before that a patient gets, right?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

I'm going to show you what's been marked as Exhibit 146. Is that familiar to you?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And you know that to be discharge paperwork for, or what's called the after visit summary for Lindsay Clancy at our state from McLean, correct?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And in this discharge paperwork, there's actually two packets, so it's pages one of six, and then there's another one, one of seven. You see that?

[Judge William Sullivan]

Yes.

[Attorney Kevin Reddington]

And it gives instructions on if you need immediate help. It gives phone numbers, right?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

It gives a crisis plan and where to call for the suicide prevention lifeline, right?

[Assistant District Attorney Jennifer Sprague]

Yes.

[Attorney Kevin Reddington]

It gives instructions on what the patient's supposed to do or what you've talked about as far as what to do as follow up, right?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And in this instance, it says, what's next? Call Cassandra Wolfson. Give her a call for assistance with finding community behavioral health providers. And that's identified as the Blue Cross Blue Shield case manager, right?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And was that based on a conversation that you had with Ms. Clancy about the fact that she wanted a new provider?

[Dr. Aaliyah Goodheart]

She had a psychiatrist or a prescriber. She stated that she was going to be assigned a therapist by the individuals at the South Shore. And if she wanted to have more options or more choices, she could always call that person to get more choices.

[Attorney Kevin Reddington]

So she was looking for an additional provider.

[Dr. Aaliyah Goodheart]

Yeah.

[Attorney Kevin Reddington]

Okay. And also part of this discharge package, you see that there's a section that's labeled community services, right?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And there are a number of online resources as well as the direction to contact your primary care physician and insurance company, right?

[Dr. Aaliyah Goodheart]

Yes.

[Assistant District Attorney Jennifer Sprague]

Okay.

[Attorney Kevin Reddington]

And so these are resources that were discussed and told and available to her when she was discharged from the claim?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

Now, in addition to the resources that were given at discharge, you're aware she did participate in particular groups that would have given her some information and skills while she was there, right?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And those skills were about illness and symptom management, correct?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

Self compassion was another one, right?

[Dr. Aaliyah Goodheart]

Yes.

[Assistant District Attorney Jennifer Sprague]

I'm going to object this is beyond the scope of cross, which is, I think, a legitimate objection, so.

[Judge William Sullivan]

All right.

[Assistant District Attorney Jennifer Sprague]

Sustained.

[Attorney Kevin Reddington]

Counsel, on cross examination, kept referring to this, the unit at McLean, as the locked unit. Right. You remember that line of questioning, and fair to say it is locked for the safety of the patients, right?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And in this circumstance, with Ms. Clancy, when she arrived from Mass General via ambulance, she voluntarily agreed to be at this locked facility until it was safe for her to leave?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

Now, when she came in, she was identified, I think you said, as low risk.

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And at the lowest level of checks, correct?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And she was very vocal with you about how long she wanted to stay and when she wanted to leave?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And you respected that and you worked with her to come up with a plan, correct?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And when counsel says she wasn't discharged against medical advice, would you have preferred more time with this patient to assess her symptomology?

[Assistant District Attorney Jennifer Sprague]

Overall,

[Dr. Aaliyah Goodheart]

I think you're asking me to go back and do something at the time.

[Attorney Kevin Reddington]

Let's talk about the time that you had the conversation with her about leaving early.

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

You said her original plan was to stay till at least Friday, right?

[Dr. Aaliyah Goodheart]

I think I didn't have a set time on when she would leave. I take it a day at a time based on how the patient is doing.

[Attorney Kevin Reddington]

And at the time that she indicated that she wanted to bump up her discharge to Thursday?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

Had you had the opportunity to observe her symptoms for more than a day or two?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

Had you been able to identify if any of the issues that she came in with were resolved?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And so she was sleeping better, right?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

Was there any indication that her mood had vastly improved?

[Dr. Aaliyah Goodheart]

Her mood had improved. I don't know what you mean by vastly.

[Attorney Kevin Reddington]

Well, did you have enough time to get to the root causes of why she was having the insomnia or why she was feeling numb?

[Dr. Aaliyah Goodheart]

No.

[Attorney Kevin Reddington]

Okay. And so with more time, would that have been something that you could have explored more, at least?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And you were asked on cross examination about asking Lindsey Clancy to sign releases, and you said that you did not do that in this case, correct?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

With more time with a particular patient, is it possible that you could have determined that you needed that more information and then asked her to sign releases?

[Judge William Sullivan]

Sustained.

[Attorney Kevin Reddington]

Well, as far as your protocol for asking for releases, is it something that you do with every patient?

[Dr. Aaliyah Goodheart]

No.

[Attorney Kevin Reddington]

What are the circumstances that would lead you to ask for releases to be signed?

[Judge William Sullivan]

Overall,

[Dr. Aaliyah Goodheart]

it depends on how the patient is presenting, whether they appear like they appear reliable, whether their history that they're giving is consistent across different times when they were evaluated. For example, she was evaluated in the emergency department in the CEC than on the unit by Dr. Madhua and myself. And also we had obtained collateral information from Patrick. And so I didn't feel like there was any urgent need to obtain the collateral from the other providers. And she was telling us what she liked and what she disliked about what the providers were doing.

[Attorney Kevin Reddington]

Okay. And so you were responding to those conversations in coming up with a plan?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And again, the team is not just you and your team, but also the patient as well?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And in these, during this time period that she was was there, in addition to what she was reporting, you were also making observations of her?

[Dr. Aaliyah Goodheart]

Absolutely.

[Attorney Kevin Reddington]

And was there anything inconsistent about what she was reporting to what your observations of her were?

[Dr. Aaliyah Goodheart]

No.

[Attorney Kevin Reddington]

When she arrived at the at McLean, you were advised of what medication she had been on, correct?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And any of the treatment plans that you or any of your colleagues recommended, did they require different medications?

[Assistant District Attorney Shannon Buckingham]

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[Dr. Aaliyah Goodheart]

I'm not sure I understand your question.

[Attorney Kevin Reddington]

Well, you were asked about. We're asked about the blood work.

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And so you indicated that McLean does draw blood upon admission, right?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

But that you did not look at the blood work or ask or evaluate it for levels of medications.

[Dr. Aaliyah Goodheart]

Correct.

[Attorney Kevin Reddington]

Was there any reason to do that based on the medication regimen that you were advised that she had been on?

[Dr. Aaliyah Goodheart]

No.

[Attorney Kevin Reddington]

And with your treatment plan as far as medication, would there have been a reason to do that, to either verify or not verify that she already had things in her system?

[Dr. Aaliyah Goodheart]

No.

[Attorney Kevin Reddington]

You were asked on cross examination about the defendant reporting that she complained of brief brain fog or being foggy. Do you recall that?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

Do you also recall that she was observed by nurses to have improved mention improved memory and improved convers. Concentration. Excuse me. Over the time that she had been at McLean?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

You were asked on cross examination about suicide hotline. And are you familiar with suicide hotlines?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And what do they assess for when you call one

[Dr. Aaliyah Goodheart]

imminent? I mean like risk. And if somebody's calling and they're feeling suicidal, I think the point is for them to send somebody or to help them through it.

[Attorney Kevin Reddington]

So it's a point of intervention, correct?

[Dr. Aaliyah Goodheart]

Correct.

[Attorney Kevin Reddington]

But in order for A person to receive intervention, they have to identify that they have an intent or a plan?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And to your knowledge, based on your experience and your conversations with this particular patient, did she ever indicate that she ever said she had a plan?

[Dr. Aaliyah Goodheart]

No.

[Attorney Kevin Reddington]

You were asked some questions about the DSM 5, and I actually have a big version of the most recent version, the DSM 5TR, meaning text revision. You're familiar with this book?

[Dr. Aaliyah Goodheart]

Thank you for clarifying that. Yes.

[Attorney Kevin Reddington]

And Council asked you some questions about postpartum depression and postpartum psychosis and whether they appear here in the DSM 5?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

Recall that line of questioning and fair to say they do appear. They're not their own category, correct?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

But they do appear in conversation of bipolar disorder. Bipolar disorder 1 having major depressive symptoms or episodes as well as psychosis?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And it's very brief mention, but it's in here, is that correct?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And as a psychiatrist, this is just a tool that you could use?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

What other things do you rely upon when making a diagnosis, other than a tool like this

[Dr. Aaliyah Goodheart]

observation of the patient, the history that they're relating, the information from family and other. You know, that's essentially it. And other records, if available.

[Attorney Kevin Reddington]

Okay. And you use that information based on your own training and experience to come up with a diagnosis?

[Dr. Aaliyah Goodheart]

Yes.

[Attorney Kevin Reddington]

And your diagnosis, does that have to agree with anyone else?

[Dr. Aaliyah Goodheart]

No.

[Attorney Kevin Reddington]

And when you're treating a patient that comes before you for help at McLean, you're treating the patient in front of you, or you're treating the patient from several months ago, you take the history

[Dr. Aaliyah Goodheart]

into consideration, but you're treating the patient in front of you, because that's the presentation.

[Attorney Kevin Reddington]

Thank you. No further question.

[Judge William Sullivan]

Ms. Rankin?

[Assistant District Attorney Shannon Buckingham]

No.

[Assistant District Attorney Jennifer Sprague]

Thank you. Thank you.

[Dr. Aaliyah Goodheart]

Thank you. Thank you,

[Dr. Jennifer Tufts]

Dr. Jennifer Tufts.

[Assistant District Attorney Jennifer Sprague]

All right.

[Judge William Sullivan]

Good afternoon, Doctor.

[Dr. Aaliyah Goodheart]

Good afternoon.

[Judge William Sullivan]

I've asked you to keep your voice up and speak into that microphone. All right?

[Assistant District Attorney Jennifer Sprague]

Okay.

[Judge William Sullivan]

Council.

[Dr. Jennifer Tufts]

Thank you, Honor. Good afternoon. Can you please state and spell your name for the record?

[Kimberly Hardy]

Jennifer Tufts. J E, N N I F E R T U F T S. Your date of birth? December 31, 1989.

[Dr. Jennifer Tufts]

Where do you work?

[Kimberly Hardy]

Astor Mental Health.

[Dr. Jennifer Tufts]

And how long have you worked there for?

[Kimberly Hardy]

3 and a half years.

[Dr. Jennifer Tufts]

What is your role there?

[Kimberly Hardy]

I'm a psychiatrist.

[Dr. Jennifer Tufts]

And how long have you been a psychiatrist?

[Kimberly Hardy]

I've been efficiently, fully licensed psychiatrist for close to four years.

[Dr. Jennifer Tufts]

I want to ask you, if you could just explain to us your educational background and your training background that qualifies you to be a psychiatrist?

[Kimberly Hardy]

Absolutely. So I went to medical school at University of Vermont, graduated in 2018 with an M.D. i did a postgraduate training in psychology psychiatry at Boston Medical center. That was four years going into 2022. And then I began working at Astor mental health in 2022.

[Dr. Jennifer Tufts]

And are you a licensed psychiatrist in Massachusetts?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

While you were working at Astor Mental Health, did you have a patient named Lindsey Clancy?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And at this time, you, Honor, I'd move to submit the records of Lindsey Clancy for her Astro Mental Health exhibit.

[Judge William Sullivan]

They may be admitted.

[Dr. Jennifer Tufts]

Do you recall when you first saw Lindsey Clancy as a patient?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

When was that?

[Kimberly Hardy]

It was in September of 2022.

[Dr. Jennifer Tufts]

And was that first appointment on September 15, 2022?

[Kimberly Hardy]

I believe that it was.

[Dr. Jennifer Tufts]

And prior to a patient coming in for their first appointment, is there paperwork that they fill out, either online or that's provided to them to fill out?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And what type of paperwork is that?

[Kimberly Hardy]

It's fairly extensive. It includes past health history, past psychiatric history, medications they have taken in the past. It includes names of any therapists or other doctors they work with, usually primary care. It includes any report of substances that they may use or may have used in the past. It includes a number of scales. So scales assessing things like anxiety, depression, adhd. So it's a fairly lengthy document.

[Dr. Jennifer Tufts]

Are you aware that Lindsey Clancy filled out those documents on September 12, 2022, three days prior to her first appointment?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And did you have an opportunity to review what Lindsey filled out prior to meeting with her for that first appointment?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And do you recall what you learned from those documents about her prior mental health treatment?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

What was that?

[Kimberly Hardy]

That she had previously taken some medication. I believe it was in nursing school. It may have been fairly brief, but she had tried the medication, Prozac.

[Dr. Jennifer Tufts]

Do you recall that? She also listed that she had tried Wellbutrin as well, while she was on the Prozac?

[Kimberly Hardy]

That was listed as well.

[Attorney Kevin Reddington]

Okay.

[Dr. Jennifer Tufts]

And do you recall that when she listed that she took the Prozac and the Wellbutrin while in nursing school, she listed that she had no side effects from those medications?

[Kimberly Hardy]

That is correct.

[Dr. Jennifer Tufts]

Prozac. Is that an ssri?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

So she reported. Lindsey reported that she had previously taken an SSRI while in nursing school with no side effects, correct?

[Kimberly Hardy]

Correct.

[Dr. Jennifer Tufts]

Did she also report that she had no history of any kind of abuse that had occurred to her at any point in her life?

[Kimberly Hardy]

Correct.

[Dr. Jennifer Tufts]

What did she report in regards to alcohol consumption?

[Kimberly Hardy]

I believe she reported one to two drinks at a time and possibly up to five times a week.

[Dr. Jennifer Tufts]

And was. Is there a portion when the patient fills that in how much they drink. Is there a question there about whether they feel guilty about that?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And what was her response?

[Kimberly Hardy]

Am I allowed to go check that just to make sure?

[Dr. Jennifer Tufts]

Is there an objection to her reviewing

[Kimberly Hardy]

the records she indicated? Yes.

[Dr. Jennifer Tufts]

And so in that section, is it correct that she listed that she was drinking five times per week and feeling guilty at that time about it?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And did she list her height as 5 foot 6 in those documents? I believe on the Same page, page 20?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

Now, did those that initial survey or questionnaire that she filled out get into what symptoms she was experiencing at the time?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And what symptoms did she report experiencing at that time?

[Kimberly Hardy]

Anxiety attacks, decreased appetite, depressed food, easily distracted, excessive worry, guilt, unable to feel pleasure, unable to fall asleep, and racing thoughts.

[Dr. Jennifer Tufts]

And would it be fair to say that there's a checklist of symptoms and the patient checks off which ones they're expecting experiencing? Correct.

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And so on that list, engage in risky behaviors that was not checked off, Correct?

[Kimberly Hardy]

Correct.

[Dr. Jennifer Tufts]

And excessive energy wasn't checked off. Correct.

[Kimberly Hardy]

Correct.

[Dr. Jennifer Tufts]

Feelings of hopelessness, feelings of abandonment, feelings of emptiness, none of those were checked off. Correct.

[Kimberly Hardy]

Correct.

[Dr. Jennifer Tufts]

Impulsive behavior that was not checked off, Correct?

[Kimberly Hardy]

Correct.

[Dr. Jennifer Tufts]

Now, was there also a suicide risk assessment form that Ms. Clancy filled out?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And, and what is a suicide risk assessment?

[Assistant District Attorney Shannon Buckingham]

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[Kimberly Hardy]

Well, it. It assesses various factors that may increase a person's risk of committing suicide.

[Dr. Jennifer Tufts]

And the form that Ms. Clancy filled out, one of the first question is, have you been so distressed you seriously wish to end your life? And her response was no. Correct.

[Kimberly Hardy]

I'm just looking.

[Dr. Jennifer Tufts]

Page 23.

[Kimberly Hardy]

Correct.

[Dr. Jennifer Tufts]

And the second question is, has anything happened recently to make you feel you don't want to live? And her answer was no. Correct.

[Kimberly Hardy]

Correct.

[Dr. Jennifer Tufts]

There's question three, a specific plan. Do you have a specific plan of how you would kill yourself? And her answer was no. Correct.

[Kimberly Hardy]

Correct.

[Dr. Jennifer Tufts]

Fourth question is access to weapons or means of hurting yourself? And the answer is no. Correct.

[Kimberly Hardy]

Correct.

[Dr. Jennifer Tufts]

The fifth question is, made a serious suicide attempt. And the answer was no. Correct.

[Kimberly Hardy]

Correct.

[Dr. Jennifer Tufts]

The sixth question, purposely done something to hurt yourself. Again, no. Correct.

[Kimberly Hardy]

Correct.

[Dr. Jennifer Tufts]

Seventh question. Heard voices telling you to hurt yourself? Her answer was no. Correct.

[Kimberly Hardy]

Correct.

[Dr. Jennifer Tufts]

Number nine, having thoughts of killing or seriously hurting Someone else? The answer was no, correct?

[Kimberly Hardy]

Correct.

[Dr. Jennifer Tufts]

Number 10 heard voices telling you to hurt others. The answer was no, correct?

[Kimberly Hardy]

Correct.

[Dr. Jennifer Tufts]

Hurt someone or destroyed property on purpose? The answer was no, Correct?

[Kimberly Hardy]

Correct.

[Dr. Jennifer Tufts]

In fact, the answers to every question on this suicide checklist was no, correct?

[Kimberly Hardy]

Correct.

[Dr. Jennifer Tufts]

Did you. Was there also a substance use assessment form that was filled out on page 24?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And there were no issues with substance use, correct?

[Kimberly Hardy]

Correct.

[Dr. Jennifer Tufts]

Is there also an ADHD self report scale that's filled out?

[Kimberly Hardy]

There usually is.

[Dr. Jennifer Tufts]

Direct you to page 25.

[Kimberly Hardy]

Okay.

[Dr. Jennifer Tufts]

And ADHD, is that attention deficit hyperactive disorder?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And given the answers that Ms. Clancy gave on that self reporting form, were there any concerns about Attention Deficit hyperactive disorder?

[Kimberly Hardy]

Not significantly.

[Dr. Jennifer Tufts]

Were there any concerns at all?

[Kimberly Hardy]

Well, she reported often to some of the questions. Yes.

[Dr. Jennifer Tufts]

And Would that. Is that significant to you? Based on your training and experience, you

[Kimberly Hardy]

have to look at this form within the entire picture of the patient. So, no, I didn't suspect that Lindsey had adhd.

[Dr. Jennifer Tufts]

So these forms are a tool, and you use them together, along with your observations of the patient to come to conclusions. Is that correct?

[Judge William Sullivan]

Yes.

[Dr. Jennifer Tufts]

There was also a. I believe it's entitled a GAD screening. Is that Generalized Anxiety Disorder?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

Okay. And did Ms. Clancy fill that out as well? Page 27.

[Kimberly Hardy]

Sorry, my pages are a little bit different than yours.

[Dr. Jennifer Tufts]

Oh, I apologize.

[Kimberly Hardy]

I'll find it.

[Dr. Jennifer Tufts]

Ms. Clancy's answers to these questions, did they give you cause for concern based on your training and experience?

[Kimberly Hardy]

They were highly suggestive of anxiety and anxiety disorder.

[Dr. Jennifer Tufts]

And for example, number one, feeling nervous, anxious, or on edge, she responded nearly every day, correct?

[Kimberly Hardy]

Correct.

[Dr. Jennifer Tufts]

Not being able to stop or control worrying, she answered nearly every day, correct?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And so several of these questions were either nearly every day or several days, correct?

[Kimberly Hardy]

Yes.

[Assistant District Attorney Jennifer Sprague]

Can I just ask what page that is?

[Dr. Jennifer Tufts]

And then is there also a patient questionnaire that the patient fills out?

[Kimberly Hardy]

Yes, I believe so.

[Attorney Kevin Reddington]

Yes.

[Dr. Jennifer Tufts]

And what is the purpose of this patient questionnaire?

[Kimberly Hardy]

I'm not sure exactly which one you're referring to. It might be the one that asks about things like whether the symptoms affect their daily living, what their history is. Is that what you're looking at?

[Dr. Jennifer Tufts]

It's entitled Tools PHQ9 Patient Questionnaire, and the date is 9:3, if you want

[Judge William Sullivan]

to go over shore.

[Kimberly Hardy]

Are you able to. Thank you.

[Attorney Kevin Reddington]

Yes.

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

So this form that's entitled PHQ9 patient questionnaire, what is the purpose of that form?

[Kimberly Hardy]

It's a screening tool for depression.

[Dr. Jennifer Tufts]

And can you talk about the defendant's answers to those questions and what they told you, based on your training and experience?

[Kimberly Hardy]

Well, some of the answers were positive. So that really indicates that she should be assessed for depression. She might have it.

[Dr. Jennifer Tufts]

And when you say positive, what do you mean by positive?

[Kimberly Hardy]

So, for example, she said, for number two, feeling down, depressed and hopeless more than half of the days, a positive response means indicating. Yes.

[Dr. Jennifer Tufts]

So it's not a positive happy response. It's a positive. This might be an issue response.

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And on the next form, a 1 initial diagnosis diagnostic assessment.

[Judge William Sullivan]

Yes.

[Dr. Jennifer Tufts]

There is a place there again. Well, this is for September 15th, the day you actually met her, correct?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

So the patient fills out the forms in advance of meeting with you. Do they then again fill out the forms when they meet with you?

[Kimberly Hardy]

No. These are the same forms?

[Dr. Jennifer Tufts]

Same forms, just the different date on them?

[Kimberly Hardy]

Yes. Because they're. Yeah, they're included in the intake note, which is what I write. But some of the information is from the patient's self report.

[Dr. Jennifer Tufts]

So would it be a combination of the forms they fill out and then what you observe and ask about during your initial meeting?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And that initial meeting with Ms. Clancy, was that in person or was that a telehealth?

[Kimberly Hardy]

Telehealth.

[Dr. Jennifer Tufts]

Does the. WHO controls whether it's an in person meeting or telehealth, you or the patient?

[Attorney Kevin Reddington]

Both.

[Dr. Jennifer Tufts]

Both. And if a patient told you, I don't want to do telehealth, I only want to do in person, is that an option?

[Kimberly Hardy]

Yes.

[Judge William Sullivan]

Good.

[Kimberly Hardy]

Sorry.

[Judge William Sullivan]

I'll let that stand.

[Dr. Jennifer Tufts]

And can you just tell us when you met with Ms. Clancy on that first day, did you ask her questions, such as, do you have suicidal intent?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

What was her response?

[Kimberly Hardy]

That she did not.

[Dr. Jennifer Tufts]

Did you ask her if she had homicidal intent?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

What was her response?

[Kimberly Hardy]

She did not.

[Dr. Jennifer Tufts]

Did you ask her if she was experiencing any auditory hallucinations or visual hallucinations?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

What was her response?

[Kimberly Hardy]

She did not.

[Dr. Jennifer Tufts]

Did you ask her questions to determine if she was experiencing any symptoms of mania?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

What types of questions you ask to determine that?

[Kimberly Hardy]

Well, a lot of it can be assessed without asking, but questions may look like. Have you ever had a period of time in your life where you were excessively energetic and euphoric? I might leave it there and then follow up with some of the other symptoms.

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[Dr. Jennifer Tufts]

Did any of the questions you asked Ms. Clancy related to mania or manic episodes? Did any of her answers to those questions indicate that she had experienced mania or manic episodes?

[Kimberly Hardy]

No.

[Dr. Jennifer Tufts]

Now, in that first meeting, do you. What's your exam process, how do you start the meeting and how does it flow?

[Kimberly Hardy]

Sure. So I start the meeting by introducing myself, explaining what we're going to be doing for the day. Then I ask the patient why they're there. We talk about why they're there. I assess for different mood symptoms, anxiety symptoms, psychosis symptoms, mania symptoms, safety concerns. Then we start talking about the history. We start talking about the. The past psychiatric history, the past medical history, substance use. We start talking about other medicines that they have tried in the past or may still be taking. And it's not always in that order, but that's the general order. Sometimes things come up sooner and

[Attorney Kevin Reddington]

we

[Kimberly Hardy]

talk a bit about what the patient's goals are, what they're looking for in this time period, and then I may give some of my recommendations.

[Dr. Jennifer Tufts]

And did you follow that process for that initial meeting with Lindsey Clancy?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

Now, you mentioned that part of the initial evaluation is looking for signs of psychosis. Is that correct?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

What types of things are you looking for to see if someone's experiencing psychosis?

[Kimberly Hardy]

So there are a number of things. They start with how the patient appears. So some signs of psychosis might be that they appear disheveled. I assess what their attitude is. If they might be agitated or very uncooperative, that's a red flag. I will assess what their speech. Speech is like. Is it very loud? Is it very fast? Or sometimes it could be the opposite, where they're not really even speaking at all. I assess what their mood is like, what they're saying that they're feeling and how they appear visually. I assess what their thoughts are like. So. So are their thoughts disorganized, where it's really hard to understand they're jumping around and you can't follow their line of thought? I assess what the thought content is. If it's particularly about anything very bizarre or very paranoid, that would be potentially indicative of psychosis.

[Dr. Jennifer Tufts]

And you conducted that type of evaluation on Lindsay Clancy in that first meeting, is that correct?

[Kimberly Hardy]

Yes. That assessment is done with every patient.

[Dr. Jennifer Tufts]

And did you note any signs or symptoms of psychosis with Ms. Clancy that day?

[Kimberly Hardy]

No.

[Dr. Jennifer Tufts]

Do you also, in addition to the observations you're making of the patient that day, are you also asking questions about their past behavior? And things that have happened to them in the past that might indicate whether psychosis is an issue?

[Attorney Kevin Reddington]

Yes.

[Dr. Jennifer Tufts]

And what types of things are you asking them about their past?

[Kimberly Hardy]

Well, I may ask, have you ever heard voices? Have you ever seen something that other people didn't see?

[Dr. Jennifer Tufts]

And did you ask those questions of Ms. Clancy?

[Kimberly Hardy]

I believe I did.

[Dr. Jennifer Tufts]

And what was her response?

[Kimberly Hardy]

No.

[Dr. Jennifer Tufts]

Do you, as part of this evaluation, are you making an assessment about the patient's judgment and insight?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And when we talk about psychiatry, what are we talking about when we say judgment?

[Kimberly Hardy]

So judgment indicates their decision making process and whether it is a logical decision making process or perhaps not.

[Dr. Jennifer Tufts]

And same question. In terms of insight, what does that mean in psychiatry when you're assessing their insight?

[Kimberly Hardy]

So that's more about a patient's awareness, both of their inner feelings as well as mental health, a bit more broadly.

[Dr. Jennifer Tufts]

And in terms of orientation, when you're assessing a patient, what does that mean?

[Kimberly Hardy]

Orientation is awareness of where someone is, who someone is, what day it is, what's going on.

[Dr. Jennifer Tufts]

And based on your evaluation of Lindsey Clancy that first day, September 15, 2022, did she appear to have any issues with judgment, insight, or orientation?

[Kimberly Hardy]

No.

[Dr. Jennifer Tufts]

Do you also assess the patient's memory?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And how do you do that?

[Kimberly Hardy]

Well, it depends. Often, unless there is a specific concern about memory or dementia, it's based off of my conversation with them. Are they able to recall medications that they have taken? Are they able to recall, you know, things that they have done with a lot of detail and specificity.

[Dr. Jennifer Tufts]

And did there appear to be any issues with Lindsay Clancy's memory in your evaluation of her?

[Kimberly Hardy]

No.

[Dr. Jennifer Tufts]

And what about attention and concentration? What are you looking for as a psychiatrist when evaluating attention and concentration?

[Kimberly Hardy]

I'm looking for whether they're paying attention to the conversation, if they can follow it, or maybe if they get distracted, it seems like they're not listening. Something like that.

[Dr. Jennifer Tufts]

Did Lindsey Clancy appear to have any issues with attention or concentration?

[Kimberly Hardy]

No.

[Dr. Jennifer Tufts]

There's. There was something in the records called fund of knowledge. What does that mean?

[Kimberly Hardy]

So fund, basis of knowledge, what someone understands about the world. So maybe if somebody has a very low education, they might have a low fund of knowledge.

[Dr. Jennifer Tufts]

And was there any issue with Lindsey Clancy's fund of knowledge?

[Kimberly Hardy]

No.

[Dr. Jennifer Tufts]

Are you also assessing mood?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And how do you assess the mood of a patient? And why do you assess it?

[Kimberly Hardy]

Well, it's very important. The mood is based on what the patient says, what they say about how they're feeling.

[Dr. Aaliyah Goodheart]

Okay.

[Dr. Jennifer Tufts]

And so are there circumstances where a patient might say they're feeling happy. But you make observations that they appear depressed?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

Okay. And so when we see mood in the records, that refers to how the patient is reporting their mood is?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

So if it says appropriate mood and affect, or actually if it says patient description of their emotional state, it says okay. Does that mean the patient said okay?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

Is there a place in the record where you describe what your observations of the mood are?

[Kimberly Hardy]

That's the affect.

[Dr. Aaliyah Goodheart]

Affect.

[Dr. Jennifer Tufts]

Okay. And so affect is how the patient presents.

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

This first meeting with Lindsey, what was her mood?

[Kimberly Hardy]

It was okay.

[Dr. Jennifer Tufts]

And what was her affect?

[Kimberly Hardy]

Anxious.

[Dr. Jennifer Tufts]

So she was reporting to you she felt okay, you were seeing she looked a little anxious?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

How do you. Or what is it about a person that tells you they look anxious? Like, what were you seeing with Lindsey Clancy that told you she looked anxious?

[Kimberly Hardy]

It's hard to recall exactly what she seemed like sometimes, you know, a person might look anxious.

[Dr. Jennifer Tufts]

Sustain in your general observations of patients, what things we do look for in a patient to determine whether their affect is anxious?

[Kimberly Hardy]

Is their voice quivering? Are they shaking a little bit? Do they appear very nervous?

[Dr. Jennifer Tufts]

And what is psychomotor behavior?

[Kimberly Hardy]

So psychomotor behavior refers to someone's body and their movements. So sometimes that can be abnormal.

[Dr. Jennifer Tufts]

And did you notice anything abnormal about Lindsey Clancy's psychomotor behavior?

[Kimberly Hardy]

No.

[Dr. Jennifer Tufts]

This first meeting, Was that approximately 40 minutes?

[Kimberly Hardy]

It was a little bit longer than that, maybe 50 to 60 minutes.

[Dr. Jennifer Tufts]

Is that typical for that first meeting where you're doing this initial assessment?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And was she. Did she appear alone in that virtual meeting, or was she with anyone Alone? And what are treatment modality and interventions in general?

[Kimberly Hardy]

So that section is referring to therapy, treatment modalities. It's not asking about medications. So different forms of therapy that might be done in a session.

[Dr. Jennifer Tufts]

And what would be treatment goals?

[Kimberly Hardy]

Goals that we are working on or will plan to work on, since this is only the first visit.

[Dr. Jennifer Tufts]

So how do you determine for an individual patient the treatment modality or interventions that are needed?

[Kimberly Hardy]

It depends on the patient.

[Dr. Jennifer Tufts]

So basically on what you're seeing, what you're hearing, and the history they provide.

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And how do you determine treatment goals?

[Kimberly Hardy]

So a lot of that is driven by what the patient's goals are.

[Dr. Jennifer Tufts]

And you mentioned earlier that as part of your evaluation, you asked the patient why they've come to you, what they're concerned about. Do you recall Lindsey's response to that question, why she was there, what she was concerned about?

[Kimberly Hardy]

I believe her biggest concern was about anxiety.

[Dr. Jennifer Tufts]

And what were the. What was the treatment modality or interventions that you determined would be needed for Lindsey Clancy based on this initial evaluation.

[Kimberly Hardy]

So I recommended a medication, Sertraline, as well as individual therapy.

[Dr. Jennifer Tufts]

And the medication, Sertraline, is that Zoloft?

[Attorney Kevin Reddington]

Yes.

[Dr. Jennifer Tufts]

And when you say you recommended the Zoloft to her, was that you telling her you have to take this medication or did you have a discussion about it?

[Kimberly Hardy]

A discussion.

[Dr. Jennifer Tufts]

And during that discussion, did you get the patient, Ms. Clancy's input on whether she wanted to take the medication or what her thoughts were about the medication?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And do you recall the details of that conversation with her?

[Judge William Sullivan]

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[Kimberly Hardy]

I recall that she was generally reluctant to take medications, but at this point she was considering it and was was interested in learning about what medications might be helpful for her.

[Dr. Jennifer Tufts]

And as of part, as part of that discussion, did you explain what the medication was and the side effects and all of that?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And did she have any questions for you based on your explanation of what the medication was for and what the side effects could be?

[Kimberly Hardy]

I'm not sure.

[Dr. Jennifer Tufts]

And why did you recommend that particular medication?

[Kimberly Hardy]

So it's a first line medication used for treating anxiety disorders. It also is first line treatment when women are breastfeeding. It's the safest SSRI for babies.

[Dr. Jennifer Tufts]

And when you say a first line medication, what does that mean?

[Kimberly Hardy]

It just means it's one of the medications that is recommended first. Sometimes you have to try a number of different medications, but that is often a first choice.

[Dr. Jennifer Tufts]

And is that based on studies and the experience of the psychiatric profession?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

What was the dosage that you recommended or prescribed for her for the Zoloft?

[Kimberly Hardy]

25mg.

[Dr. Jennifer Tufts]

And were there instructions on the prescription in terms of how many milligrams to take the first week and then how many to take the second week?

[Kimberly Hardy]

Yes, it was 25 milligrams for one week and then increasing to 50 milligrams.

[Dr. Jennifer Tufts]

And that was your initial prescription and what should have been on the pill bottle? Correct.

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

Was there ever a call from the defendant where she called you and said that she was having trouble with the 25 milligrams and you recommended her go to the 50 milligrams?

[Assistant District Attorney Jennifer Sprague]

No.

[Attorney Kevin Reddington]

You.

[Dr. Jennifer Tufts]

You said you also recommended therapy, is that correct?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And Astro Mental Health, did they have therapists on staff that you referred Ms. Clancy to?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And do you know if she took advantage of that, that resource?

[Kimberly Hardy]

She did.

[Dr. Jennifer Tufts]

Do you know which therapist she saw?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

Who was that?

[Kimberly Hardy]

Jennifer McAllister.

[Dr. Jennifer Tufts]

And how does it work when a patient is at Astro Mental Health? They're being seen by a psychiatrist, they're being seen by a therapist. Is there someone that's kind of in charge of the treatment of the patient, that oversees everything, or is it all just individual?

[Kimberly Hardy]

The psychiatrist is in charge.

[Dr. Aaliyah Goodheart]

Okay.

[Dr. Jennifer Tufts]

So you would have been in charge of Ms. Clancy's treatment?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And as part of being in charge of her treatment, would you review the records from her therapy sessions to inform and guide your treatment of her?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

What were the treatment goals for the defendant?

[Kimberly Hardy]

I don't recall exactly what her words were.

[Dr. Jennifer Tufts]

Would the goals be what your patient tells you?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

That you look at page 41 of the records for exhibit 219 to the treatment goals section. Does that refresh your memory?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And what were the treatment goals, according to Ms. Clancy?

[Kimberly Hardy]

So these are not her words? They are. There's a list in the electronic medical record where I can indicate which ones might apply or I can type out my own. So the treatment goals, based on what we had decided on together, were symptom reduction and improved functioning.

[Dr. Jennifer Tufts]

And you said that Ms. Clancy had been a little reluctant about starting medication. Did she tell you why she was reluctant?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And why was that?

[Kimberly Hardy]

She was worried about having side effects.

[Dr. Jennifer Tufts]

And did she mention which specific side effects or just side effects in general?

[Kimberly Hardy]

I thought it was in general.

[Dr. Jennifer Tufts]

And as a result of that concern, is that when you went over the potential side effects of Zoloft?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And after having that discussion and you explaining the side effects of Zoloft, how did the two of you leave it in terms of whether she was going to take the medication or not?

[Kimberly Hardy]

I told her what my recommendation was, that she should start the Searcher lean. I'm not sure if she told me definitively if she was going to take it or not. She might have needed some time to think about it.

[Dr. Jennifer Tufts]

And based on your evaluation with Ms. Clancy, everything you learned about her history and how she presented that day, did you have an initial diagnosis?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And what was that?

[Kimberly Hardy]

It was A generalized anxiety disorder. And it was an adjustment disorder with depressed mood.

[Dr. Jennifer Tufts]

What is generalized anxiety disorder?

[Kimberly Hardy]

It's an anxiety disorder where an individual may have a lot of different worries. They may also have physical feelings of anxiety, but they're worried about a lot of things. Not really just one thing specifically.

[Dr. Jennifer Tufts]

And what is adjustment disorder with depressed mood?

[Kimberly Hardy]

So adjustment disorder refers to a fact that there may be symptoms, but they are kind of secondary to the situation. So they don't meet the full criteria, say, of a major depressive disorder, but there were some symptoms of depression.

[Judge William Sullivan]

Is this a good place to start? All right, members of the jury, this is. It's one o'. Clock. We're going to take the afternoon recess. I'm going to ask you to be ready for back at 2 o'.

[Assistant District Attorney Jennifer Sprague]

Clock.

[Judge William Sullivan]

And again, same instructions and orders. Don't during the break, don't read anything about this case or similar cases. Don't do any research. Don't talk about this. Just kind of relax as best you can for the next hour. We'll have bring it back in. We'll continue with the evidence this afternoon. Okay? Please. All right, doctor, you may step down. All right, before we recess, I just want to make a. I guess a comment. I just want to make it real clear that there is to be no inappropriate comments or disruptive comments to be made inside of this courtroom. If anybody is found to make those, they will be immediately escorted out and barred for the balance of this.

[Assistant District Attorney Jennifer Sprague]

All right?

[Judge William Sullivan]

I just want to make that real clear. And just in case you're wondering, there are microphones all around. And so if we hear. If I get a report of that, there's going to be some serious issues and serious problems. So I just kind of wanted to put that out for everybody. So it's crystal clear there's going to be no warnings, no yellow cards. You're out. All right? So I just kind of want to make that real clear. And so with that, we'll be in recess on this matter till 2 o'. Clock. Court, all rise. Court stands in recess.

[Assistant District Attorney Jennifer Sprague]

Please exit the table.

[Judge William Sullivan]

Thank you, session.

[Dr. Jennifer Tufts]

You may be seated.

[Attorney Kevin Reddington]

So for the purpose of the record, we return back to the matter of Commonwealth versus Lindsay Clancy. All parties are present, including the defendant, excluding the jury.

[Judge William Sullivan]

All right, counsel, we ready for the. For the jury.

[Dr. Jennifer Tufts]

Can we be seen briefly at sidebar?

[Dr. Aaliyah Goodheart]

Sure.

[Judge William Sullivan]

We have the. The witness on the stand. All right, we all set?

[Assistant District Attorney Jennifer Sprague]

George, Andrew. This court's now assessed. Please be seated.

[Attorney Kevin Reddington]

Your honor, for the purpose of the record, we return back to the trial of Commonwealth vs Lindsay Clancy.

[Dr. Aaliyah Goodheart]

All parties present, including the dependent and

[Attorney Kevin Reddington]

including the 18J break.

[Dr. Jennifer Tufts]

Thank you, Honor.

[Assistant District Attorney Shannon Buckingham]

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[Dr. Jennifer Tufts]

Dr. Tufts, back on that first appointment with Ms. Clancy on September 15, 2022. As part of the record, did you detail a section history of present illness?

[Dr. Aaliyah Goodheart]

Yes.

[Dr. Jennifer Tufts]

And in that section, you put in here initial presentation, nursing school, Prozac helped got treatment after second baby two for anxiety. Zoloft, one week was nervous about breastfeeding. Initial side effects. Can you just tell us where that information came from?

[Kimberly Hardy]

My conversation with the patient.

[Dr. Jennifer Tufts]

And where it says Zoloft, one week was nervous about breastfeeding. What does that mean?

[Kimberly Hardy]

So she had tried Zoloft before, During the postpartum period after her second baby.

[Dr. Jennifer Tufts]

And did she tell you whether she had any side effects when she took Zoloft after her second baby?

[Kimberly Hardy]

She mentioned something about initial side effects, which are pretty common for many people. I didn't detail what those side effects were, but they sounded like the very normal ones that people might experience that are transient in the beginning of the treatment.

[Dr. Jennifer Tufts]

And what would those side effects be?

[Kimberly Hardy]

Possibly upset stomach, appetite issues.

[Assistant District Attorney Jennifer Sprague]

Can we know what related to this patient rather than somebody?

[Judge William Sullivan]

All right, so why don't you ask if she remembers what the defendant said the side effects were?

[Dr. Jennifer Tufts]

Do you remember what the defendant said the side effects were?

[Kimberly Hardy]

I don't remember them exactly, but they were ones that did not seem concerning.

[Dr. Jennifer Tufts]

And in your experience, in your training and experience as a psychiatrist who prescribes Zoloft, what are the common side effects that you deal with that patients deal with from this medication?

[Kimberly Hardy]

So in the first couple weeks of treatment, we described that there's a lot of serotonin in the gut as well as the brain. So the medicine often affects the gut first. So you might have diarrhea, constipation, difficulties with appetite, nausea, things like that.

[Dr. Jennifer Tufts]

And you also wrote in the note about history of present illness, 3 months postpartum, also 4 and 2 year olds feeling overwhelmed. Is that correct?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And that came from the patient, Ms. Clancy?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And furthermore, you wrote that the baby needing more attention, other kids more challenging too. Is that coming from the patient?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And does she also describe she's having Trouble, leaving the baby too anxious to do anything. When she leaves, physical tension, heart racing, worries he won't eat or sleep because he's refusing the bottle?

[Dr. Aaliyah Goodheart]

Yes.

[Dr. Jennifer Tufts]

And did she say that makes her irritable?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And in that same note is where you detail that she denied audio hallucinations, visual hallucinations, you also. Correct.

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And you also detail suicidal ideation, homicidal ideation, denies no concern about hurting baby. Is the no concern about hurting baby. Is that a note, an observation you're making, or something that came from miss Clancy?

[Kimberly Hardy]

It came from our conversation.

[Dr. Jennifer Tufts]

So at some point in time, she told you she had no concerns about harming the baby?

[Kimberly Hardy]

Yes, it was

[Judge William Sullivan]

an objection. If you could rephrase that question.

[Dr. Jennifer Tufts]

What did she tell you about her thoughts about the baby?

[Kimberly Hardy]

I asked if there were those thoughts and she denied them.

[Dr. Jennifer Tufts]

And did you also provide information to her about what to do if in between appointments, there were emergencies or issues?

[Kimberly Hardy]

Yes, I believe that I did. I usually do when I meet a patient.

[Dr. Jennifer Tufts]

And in the page describing treatment follow up plan, which would be in the initial diagnostic assessment from September 15, in that treatment follow up plan section, is there a part. There's a part there that says if having urges to harm self or others, go to the nearest emergency room, call 911 or call the National Suicide Prevention and Crisis Hotline, Correct?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

Is this page given to the. To the patient?

[Kimberly Hardy]

They can access it online on the portal.

[Dr. Jennifer Tufts]

So Ms. Clancy would have the ability to go on here, look at the portal and see what to do if she was having a crisis?

[Kimberly Hardy]

Yeah. Just this plan section? Yes.

[Dr. Jennifer Tufts]

Just the treatment plan section? Yes. So is it that she would have to search through the records, or is that something you can click on to see the treatment plan?

[Kimberly Hardy]

I'm not sure exactly what it looks like for a patient.

[Dr. Jennifer Tufts]

Okay. But that's one of the sections that's available to the patient, Lindsey Clancy, if she goes onto the portal? Yes. There's also in here, if you feel you're in crisis, you may text home. Home to a certain text number from anywhere in the United States. Is that correct?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And what does that do? When you text that text number to the. You text home to that text number.

[Kimberly Hardy]

It connects you to a counselor.

[Dr. Jennifer Tufts]

Now, what was the treatment or follow up plan for Ms. Clancy?

[Kimberly Hardy]

To start the search relien. To start individual therapy and to follow up with myself.

[Dr. Jennifer Tufts]

So your recommendation wasn't just that she take pills, you recommended that she attend therapy, correct?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And when you recommended the therapy, did you. And the medication, did you Also go over with Ms. Clancy alternatives to the medication that you were recommending?

[Kimberly Hardy]

I believe she was aware that the alternative was that she could not take a medication, which is what she had been doing before.

[Dr. Jennifer Tufts]

And after you went over all of this information with Ms. Clancy, did she convey to you that she understood the plan and was agreeable to the plan?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

What is informed consent?

[Kimberly Hardy]

Informed consent means you communicate with a patient what the risks and benefits are of treatment, and they understand that, and they agree to the treatment.

[Dr. Jennifer Tufts]

And did Ms. Clancy show that she had informed consent to everything you discussed?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

Now, was your next appointment with Ms. Clancy on September 28, 2022?

[Kimberly Hardy]

Yes, it was.

[Dr. Jennifer Tufts]

And so during that appointment, did you discuss the medication, the Zoloft, that you had prescribed to her?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And what did you learn from Ms. Clancy about whether or not she had taken that medication?

[Kimberly Hardy]

I decided. She shared that she decided not to take it.

[Dr. Jennifer Tufts]

Did she tell you that she had picked it up but had decided not to take it?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

Did she tell you how she was feeling?

[Kimberly Hardy]

She said a little bit better.

[Dr. Jennifer Tufts]

And did she elaborate on that?

[Kimberly Hardy]

The baby was getting some more sleep, so she was also able to get some more sleep, and that helped her feel better.

[Dr. Jennifer Tufts]

And at this appointment, did you go through a mental status examination of Ms. Clancy?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And what is a mental status exam?

[Kimberly Hardy]

So, mental status exam is an assessment of the patient at the point of meeting. It can change at different times, but it's comprehensive, referring to how the patient appears, how they cooperate, how they speak, how they describe their thoughts, how they're able to communicate with you and what their mood is like.

[Dr. Jennifer Tufts]

And do you do that at every appointment with every patient?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And so, on September 28, 2022, when you met with Lindsey Clancy for that second meeting, did you do a mental status examination?

[Kimberly Hardy]

Yes, I did.

[Dr. Jennifer Tufts]

And what was the result of that?

[Kimberly Hardy]

So I can. Is it okay if I read it from the. From the note, or do you just want me to.

[Dr. Aaliyah Goodheart]

No. Objection.

[Judge William Sullivan]

Go ahead. You may.

[Kimberly Hardy]

She was alert, she was oriented. She was appropriate. Her rapport, meaning how she worked with me was appropriate. Dressed appropriately, euthymic, meaning not. Not depressed, not angry, kind of a normal mood. Her affect was full. Her speech was appropriate. Her thought, content and a process were appropriate. She did not mention any hallucinations. At this point, I mentioned her insight was poor, her judgment was excellent, her cognition did not show any deficits, and there was normal sex, psychomotor activity.

[Dr. Jennifer Tufts]

And why did you list that? Her insight was poor.

[Kimberly Hardy]

So I. I think that that must have been related to the fact that at this point she did have some very clinically significant anxiety. Usually when people come to a psychiatrist, they believe that their, their symptoms are significant and that a medication is something that might be prescribed. But despite these symptoms, she still didn't want to try the medicine.

[Dr. Jennifer Tufts]

And what is the difference between a psychiatrist and a psychologist?

[Kimberly Hardy]

So a psychiatrist is a medical doctor. We go to medical school and then we specialize in psychiatry. A psychologist. Psychologist does not go to medical school. They may do a lot of research in their training, they may learn a lot about psychotherapy, but they don't learn about the human body, about how we metabolize medications and things like that.

[Dr. Jennifer Tufts]

And so a psychiatrist. Can a psychiatrist prescribe medication?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

Can a psychologist prescribe medication?

[Kimberly Hardy]

No.

[Dr. Jennifer Tufts]

Now, in the medical records, exhibit 219, page 47, it lists here recent lab work. No lab results were found. Is it that you had ordered lab work and you couldn't find the results or that none were ordered?

[Kimberly Hardy]

None were ordered.

[Dr. Jennifer Tufts]

And why is that?

[Kimberly Hardy]

It was not necessary.

[Dr. Jennifer Tufts]

And why isn't it necessary at that point for Ms. Clancy to order blood work?

[Kimberly Hardy]

There's, there's no blood work that is commonly done when a patient presents with generalized anxiety disorder and no other medical complications.

[Dr. Jennifer Tufts]

What types of situations would you order blood work for?

[Assistant District Attorney Shannon Buckingham]

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[Kimberly Hardy]

I mean there, there could be a lot. You know, certain medications require laboratory monitoring. Maybe something that could affect the kidneys or could affect the thyroid, could affect the cholesterol. These are things that we monitor to make sure that the medicine is prescribed safely.

[Dr. Jennifer Tufts]

And so Zoloft is that not one of the ones that would need to be monitored because of its potential effects on the body?

[Kimberly Hardy]

Correct.

[Dr. Jennifer Tufts]

And at that time she reported to you she wasn't even taking it yet? Correct?

[Kimberly Hardy]

Correct.

[Dr. Jennifer Tufts]

And your appointment that day? I think according to the records it was approximately 17 minutes long. Is that correct?

[Kimberly Hardy]

So can I explain that?

[Dr. Jennifer Tufts]

Absolutely.

[Kimberly Hardy]

Because I think there's a bit of a misunderstanding. So the 17 minutes I think people are looking at the note where it says a therapy start time of 10am, a therapy end time of 10:17. So they're calculating 17 minutes. But those timestamps are specifically related to the therapy portion of the exam. They're not reflective of the complete duration of time when I met with her.

[Dr. Jennifer Tufts]

So what would be the complete time that you met with her on that day?

[Kimberly Hardy]

So I don't know the exact amount of minutes, but the appointments are 25 minute appointments. So it would be more or less a few minutes. About 25.

[Dr. Jennifer Tufts]

And so the 17 minutes that are for the therapy portion of the appointment, what comprises therapy, what does that involve?

[Kimberly Hardy]

It really varies based on the person, based on the situation. It can involve providing some emotional.

[Assistant District Attorney Jennifer Sprague]

I apologize. Can we talk about Lindsey Clancy rather than in general? That's all.

[Judge William Sullivan]

I'm going to allow a little bit of the background to. Then we'll move into the defendant.

[Dr. Jennifer Tufts]

Thank you. So you were saying that the therapy portion is kind of talking to the patient, seeing how they are and getting an assessment of their current mental state?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And the other eight minutes, typically what happens in those eight minutes that's more

[Kimberly Hardy]

focused on specifically medications and medication management.

[Dr. Jennifer Tufts]

So these appointments that you had with Lindsay Clancy, when it says 17 minutes, that's the therapy, the talk portion of the appointment, and then there was a separate portion where medication was discussed?

[Kimberly Hardy]

Yes. In the real world, those two segments are intertwined. So it's not necessarily that we say this is the end of your therapy component. It's a bit more seamless than that.

[Dr. Jennifer Tufts]

Now, in your training experience, in the way you conduct your practice, if you're having a therapy portion or you're conducting therapy with a client and that 25 minutes has run out, is it a hard stop or is there an option to continue?

[Kimberly Hardy]

It's not a hard stop. I do have limitations because I have other patients that are waiting. But if there's something urgent, I can go a little bit over. If there's an emergency, I can cancel the next patient if I have to.

[Dr. Jennifer Tufts]

And these 25 minute appointments that you have, if a patient were to request a longer appointment with you, is that available?

[Kimberly Hardy]

It's an option.

[Dr. Jennifer Tufts]

Did Lindsey Clancy ever request a longer appointment time with you?

[Dr. Aaliyah Goodheart]

No.

[Dr. Jennifer Tufts]

Now that that appointment on September 28, 2022, was that also a virtual appointment?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And did Ms. Clancy appear to be alone in that virtual appointment?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And based on your conversations and assessment of her on that day, what was the plan going forward?

[Kimberly Hardy]

So at this point she was improving and we decided to pause on the medication question and have her meet with one of our therapists.

[Dr. Jennifer Tufts]

So that first appointment was on September 15th. You recommended therapy. The next appointment was September 28th. So had Lindsay not scheduled a therapy appointment yet with Jennifer McAllister at that point?

[Kimberly Hardy]

I'm not sure when she called to schedule that.

[Dr. Jennifer Tufts]

But that was the plan going forward that your recommendation was that she attend therapy with Jennifer McAllister?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And did Ms. Clancy seem receptive to that plan?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

Did she tell you she was going to make an appointment with Ms. McAllister?

[Judge William Sullivan]

Yes.

[Dr. Jennifer Tufts]

Now, according to the records, the next appointment was October 3, 2022, just five days later. Was there a reason that you had such a short time span between that September 28th appointment and the October 3rd appointment with Ms. Clancy?

[Kimberly Hardy]

I believe that the patient must have scheduled the appointment on her own, and that's why the span time was rather short.

[Dr. Jennifer Tufts]

Do you recall miss Clancy reaching out to you about getting paperwork for a maternity leave extension?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And did she reach out to you through the portal for Astron Health?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And did you respond to her on that portal?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And did you fill out paperwork for her for her to extend her maternity leave?

[Kimberly Hardy]

I think that I did.

[Dr. Aaliyah Goodheart]

And

[Dr. Jennifer Tufts]

there is a message from Ms. Clancy to you on September 30, 2022, in the portal that states, hi, Dr. Tufts. Thanks again for all your help at our last two appointments. While I am feeling just better enough to function without medication, I did reach out to my employer about extending my leave for reasons of postpartum anxiety, depression. I don't feel mentally well enough to return to taking care of patients with a baby at home that still won't take the bottle. I know this will trigger my anxiety too much and also having to stay up all night as a nurse, I don't feel it's possible right now. They asked that my provider could fill out a form so they could process this report request. Can I please send you the form to fill out? And you responded on September 30, 2022 at 2:41pm this type of paperwork often requires a lot of information, so it's best if we go through it together in an appointment. Do you recall that?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

So would that have been why the October 3rd appointment was set up?

[Kimberly Hardy]

That may have been, yes.

[Dr. Jennifer Tufts]

And then do you recall receiving a message from Ms. Clancy on October 10, 2022, stating, hi, Dr. Tufts, there is a part on the Serious Health Condition form that you filled out for me that needs to be changed. On the second page, you put, I could Work a reduced schedule of 8 hours per day, 2 days per week. However, we discussed not working at all until January 1st. I think we talked about when I returned to work, that is what I could do, but that the way it appears on the form makes it seem like I can do that. Now, do you still have the form to make the adjustment, or do I need to send it back to you? And then you responded that you would send back an updated version, Is that correct?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

So do you recall having a conversation with Ms. Clancy on. At the October 3rd appointment about not returning to work and how long she should be out of work for?

[Kimberly Hardy]

I recall having a conversation.

[Dr. Jennifer Tufts]

And that January 1st date, was that something you decided or something Ms. Clancy requested?

[Kimberly Hardy]

I think it was something that we decided together.

[Dr. Jennifer Tufts]

And in that appointment on October 3rd, did Ms. Clancy tell you that she was on the verge of taking the medication?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And did you discuss that with her?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And what was that discussion?

[Kimberly Hardy]

Well, she was having more anxiety again. It seemed like maybe it had started getting better, and then it was kind of where it had been when she initially reached out. And so she was feeling like a medication might be helpful.

[Dr. Jennifer Tufts]

And did Ms. Clancy tell you at that appointment that she wanted to try therapy before taking the medication?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

But she had not had a. An appointment with Jennifer McAllister yet. Correct.

[Kimberly Hardy]

I'm not sure what date her first appointment was with Jennifer McAllister.

[Dr. Jennifer Tufts]

Showing you page 57 of exhibit 219, an initial therapy assessment by Jennifer McAllister, on October 3, 2022, would that have been the first time she saw Ms. McAllister?

[Judge William Sullivan]

Yes.

[Dr. Jennifer Tufts]

So that's on that same day that you saw her, it looks like from the records, you saw her at 11:30, is that correct?

[Kimberly Hardy]

I don't have the time on my paper, but I'm sure that's correct.

[Dr. Jennifer Tufts]

Okay, so apparently she saw you about the work form, and then she had an appointment with Ms. McAllister, is that correct?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And it says here in the records that Jennifer McAllister is an LMHC. What is that?

[Kimberly Hardy]

A licensed mental health counselor.

[Dr. Jennifer Tufts]

And so is a counselor. A licensed mental health counselor, someone who can conduct therapy sessions?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And why is it in your practice that you have a psychiatrist who does therapy and prescribes medication, but in addition, you would have a therapist doing counseling.

[Kimberly Hardy]

So today, a lot of psychiatry is. Is practiced as a team. At least that's how we practice at my office. So oftentimes the therapist is able to see the patient every single week. They're able to focus in more depth on certain aspects of, you know, the patient's well being. And so it's helpful to have one person paying extra attention to the therapy component, especially when the psychiatrist does have to spend a lot of time discussing the medications and thinking about the medications.

[Dr. Jennifer Tufts]

And so is that the teamwork approach that Lindsey Clancy received in her treatment at Aster Mental Health?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And in that October 3rd assessment with Ms. McAllister, you reviewed those notes and records so that you could properly treat Ms. Clancy, correct?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And in that first. That first meeting with Ms. McAllister, the defendant described her relationship with her parents as very supportive and stable? Correct.

[Kimberly Hardy]

I don't have Jennifer's notes in front of me.

[Dr. Jennifer Tufts]

Sonia, page 60.

[Dr. Aaliyah Goodheart]

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[Assistant District Attorney Jennifer Sprague]

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[Dr. Jennifer Tufts]

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[Dr. Jennifer Tufts]

You want to just review the notes?

[Dr. Aaliyah Goodheart]

Sure.

[Attorney Kevin Reddington]

Look up.

[Dr. Jennifer Tufts]

Does that refresh your memory as to the notes that you reviewed from her from Lindsay's session with McAllister?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And so in that session Ms. Clancy stated that her parents were very supportive and stable.

[Attorney Kevin Reddington]

Yes.

[Dr. Jennifer Tufts]

And she also mentioned having the support of an older sister who only lived two and a half hours away, is that correct?

[Kimberly Hardy]

That's what she stated in the note to John.

[Dr. Jennifer Tufts]

Did she also say that she was not close with her in laws who lived in Scituate? She would see them often as they were her husband's parents, but they don't. She didn't generally allow them to watch the children. Is that correct?

[Kimberly Hardy]

That's what I read.

[Dr. Jennifer Tufts]

And she. There's a quote in here. Don't have a particular reason why they don't bug me about it either. Is that correct?

[Kimberly Hardy]

That's what I read.

[Dr. Jennifer Tufts]

And October 3, 2022, when you met with her that day, did you again do a mental status exam?

[Dr. Aaliyah Goodheart]

Yes.

[Dr. Jennifer Tufts]

Had anything changed in that mental status exam from the September 28th meeting that you had with her?

[Kimberly Hardy]

Can I review it?

[Dr. Jennifer Tufts]

Yes.

[Kimberly Hardy]

I mean there isn't anything that stands out to me right now.

[Dr. Jennifer Tufts]

And I think that what you put on the October 3rd date was that her insight was still poor?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

Was that for the same reasons you described earlier?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

The next time that you saw Ms. Clancy was that on October 20, 2022?

[Dr. Aaliyah Goodheart]

Yes.

[Dr. Jennifer Tufts]

And what information did you learn on that date about whether or not she was taking the Zoloft you had prescribed?

[Kimberly Hardy]

So she told me that she decided to start the Zoloft.

[Dr. Jennifer Tufts]

And did she tell you how long she had been taking it?

[Kimberly Hardy]

For one week.

[Dr. Jennifer Tufts]

And did she tell you that the previous night she had increased the dose?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And that's what was in the original prescription? Correct. To take the pills at 25 milligrams for one week and then increase to 50?

[Attorney Kevin Reddington]

Yes.

[Dr. Jennifer Tufts]

So if that had been done, taking the seven pills? Taking the pills for one week would be seven pills and then increasing the dosage the next night would be two pills?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And so that would be nine pills?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

When she told you she increased the dose, she told you she now feels awful. Is that correct?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And what was it that was bothering her?

[Kimberly Hardy]

She was having increased difficulty sleeping. She had loss of appetite, diarrhea. She was feeling. Her mood was down. She was tearful and feeling very foggy and feeling very anxious.

[Dr. Jennifer Tufts]

Now, what is the lowest dose of Zoloft that you would prescribe a patient or could prescribe?

[Kimberly Hardy]

The smallest pill is 25.

[Dr. Jennifer Tufts]

And what's the highest dose of Zoloft?

[Kimberly Hardy]

200.

[Dr. Jennifer Tufts]

So she was on the lowest dose of 25, is that correct?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And then according to what she told you, she had increased for one night to 50 milligrams, is that correct?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

Did she also tell you she was scared to start something new?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

Is that in terms of another medication?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

So what was your discussion with Ms. Clancy when she's telling you that she having these issues with Zoloft, but she's afraid to try something new?

[Kimberly Hardy]

So we discussed what to do moving forward. So we discussed whether whether it would make sense to switch to a different medication at that point and at that moment, because of her negative experience with the Zoloft, she did not want to start a new medication at that point.

[Dr. Jennifer Tufts]

At this meeting with her, did you ask her if she had any suicidal thoughts?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

What was her response?

[Kimberly Hardy]

No.

[Dr. Jennifer Tufts]

Did you ask her if she had any homicidal ideation or thoughts?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

What was her response?

[Kimberly Hardy]

No.

[Dr. Jennifer Tufts]

Did you ask her if she was hearing any voices or seeing any visual hallucinations?

[Kimberly Hardy]

I'm not sure if I asked that in that appointment, but she was very clearly not psychotic.

[Dr. Jennifer Tufts]

And why do you say that?

[Kimberly Hardy]

Because of how I described some of the signs of psychosis that are on the mental status exam. None of those were present.

[Dr. Jennifer Tufts]

What was her affect during this meeting?

[Kimberly Hardy]

It was depressed.

[Dr. Jennifer Tufts]

And did you write that she. Strike that. What was it about her affect that made you write that she was depressed?

[Kimberly Hardy]

She visually appeared like she was feeling sad.

[Dr. Jennifer Tufts]

And her mood, how did she report that to you?

[Kimberly Hardy]

That was depressed as well. And anxious.

[Dr. Jennifer Tufts]

What about her thought content and process that day?

[Kimberly Hardy]

That was appropriate.

[Dr. Jennifer Tufts]

And her speech?

[Kimberly Hardy]

It was appropriate.

[Dr. Jennifer Tufts]

And her judgment and cognitive skills?

[Kimberly Hardy]

Her judgment was excellent. And her cognition didn't have any deficits.

[Dr. Jennifer Tufts]

And her psychomotor activity?

[Kimberly Hardy]

Normal.

[Dr. Jennifer Tufts]

So the main change here from previous visits was that she appeared depressed and anxious?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

Although she had appeared anxious that first visit, correct?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

So to make sure we have the timeline correct, the first visit she appeared anxious. The second visit she appeared to be doing better. The third visit, she still had that poor insight. When you met about the paperwork, and then this fourth visit, she appears depressed, is that correct?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

Did she also tell you that she was worried about getting suicidal thoughts?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

So that would have come directly from her, correct?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And what was that? What were the details of that conversation?

[Kimberly Hardy]

So it was one of the things that she was anxious about. It was a fear of one day having suicidal thoughts if she were to continue to feel poorly.

[Dr. Aaliyah Goodheart]

Okay.

[Dr. Jennifer Tufts]

And showing you page 77 of Exhibit 219, I know you said earlier you weren't sure if you asked her about audio or visual hallucinations, but just directing your attention to the. To the interval history, if that refreshes your memory, yes. So did you ask her about Claudia,

[Kimberly Hardy]

who was the nation's individual hallucinations on the 21st? I did.

[Dr. Jennifer Tufts]

Okay, so then there was an appointment the following day on October 21st?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

So why did she have an appointment that following day?

[Kimberly Hardy]

Because she was feeling pretty poorly after starting the Zoloft, so we were following her closely.

[Dr. Jennifer Tufts]

And at that point, you knew that she had had an appointment on the third with Ms. McAllister, correct?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And do you know whether or not she had followed up making another appointment or was struggling with that?

[Kimberly Hardy]

I. She was planning on making another appointment. I don't know when that second appointment was scheduled.

[Dr. Jennifer Tufts]

When you. That first appointment where she was seeming depressed and having issues with Zoloft on October 20th, did you tell her to stop taking the medication at that point?

[Kimberly Hardy]

Yes, I did.

[Dr. Jennifer Tufts]

Okay. And did you discuss other options with her other than medication, like natural remedies?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And what type of natural remedies did you discuss with Ms. Clancy.

[Kimberly Hardy]

So I mentioned things like fish oils, something called L methylfolate or C. These are supplements.

[Dr. Jennifer Tufts]

And is that why would you offer alternative remedies to a patient?

[Kimberly Hardy]

So it was because she seemed reluctant to start a prescribed medication? I thought she might be more open to something that was natural.

[Dr. Jennifer Tufts]

So you weren't pushing her to take a prescription medication, correct?

[Kimberly Hardy]

No.

[Dr. Jennifer Tufts]

Now, on October 21st, when you saw her, did she tell you that she hadn't been able to get any sleep the night before?

[Attorney Kevin Reddington]

Yes.

[Dr. Jennifer Tufts]

You've already said she told you she wasn't having audio or visual hallucinations, correct?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

Did you ask her if she was having suicidal ideation or homicidal ideation?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And what was her response?

[Kimberly Hardy]

No.

[Dr. Jennifer Tufts]

What was her affect that day?

[Kimberly Hardy]

It was depressed.

[Dr. Jennifer Tufts]

And did she tell you during your conversation that day that she had been anxious all day, not depressed or irritable, getting better?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

Okay, so she's telling you she's not depressed, but her affect to you appeared depressed, Is that correct?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And is that for the same reasons you stated earlier, those visual cues that you saw?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

Did she appear hyper or manic in any way?

[Dr. Aaliyah Goodheart]

No.

[Dr. Jennifer Tufts]

Was there any changes in her rate of speech or pattern of speech?

[Kimberly Hardy]

No.

[Dr. Jennifer Tufts]

Was there any difference in her mental status exam?

[Kimberly Hardy]

No.

[Dr. Jennifer Tufts]

And this, this appointment, was this. This appointment virtual as well?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

Had all your appointments up to this point point been virtual?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

Was she alone in that virtual meeting?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

What was the plan that was formulated on October 21?

[Kimberly Hardy]

So the plan was that she start a medication called Ativan to be taken as needed, which means not necessarily every day, but in the instance of severe anxiety.

[Dr. Jennifer Tufts]

And how did you explain to Ms. Clancy when to take the medication?

[Kimberly Hardy]

I don't remember exactly how I explained that.

[Dr. Jennifer Tufts]

So in general, as a psychiatrist, when you're prescribing a medication like Ativan and you're telling a patient to take as needed, what does that mean?

[Kimberly Hardy]

So it means when the symptoms are present, and in this case, in particular, when the symptoms are severe.

[Dr. Jennifer Tufts]

So with Ms. Clancy, what were the symptoms that she was experiencing that made you decide that Ativan would be an appropriate medication?

[Kimberly Hardy]

Anxiety.

[Dr. Jennifer Tufts]

So would it be when she was feeling anxious, feeling those symptoms of anxiety, that she should take the medication?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And what was the dose again?

[Kimberly Hardy]

0.5.

[Dr. Jennifer Tufts]

What's the lowest dose of Ativan you can give?

[Kimberly Hardy]

0.5.

[Dr. Jennifer Tufts]

What's THE highest dose?

[Kimberly Hardy]

Maybe two.

[Dr. Jennifer Tufts]

So you started her at the lowest dose, the 0.5?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And was there a specific time frame that you wanted her to try this in?

[Kimberly Hardy]

Yes. This was for one week.

[Dr. Jennifer Tufts]

And was the prescription for a one week amount or is it hard to tell that because. Because it's as needed.

[Kimberly Hardy]

It's hard to tell that without seeing exactly how many pills were prescribed.

[Dr. Jennifer Tufts]

And was there also, again, a recommendation to go to Ms. McAllister for therapy?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And when were you recommending follow up with Ms. Clancy?

[Kimberly Hardy]

One week.

[Dr. Jennifer Tufts]

And why a short turnaround at this point?

[Kimberly Hardy]

Because she was still having very significant symptoms.

[Dr. Jennifer Tufts]

And did you in fact see her on October 26, 2022?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And at that appointment, what was Ms. Clancy's affect?

[Kimberly Hardy]

Depressed.

[Dr. Jennifer Tufts]

What was her mood?

[Kimberly Hardy]

According to her, it was anxious and depressed.

[Dr. Jennifer Tufts]

And did you discuss with her whether the Ativan, whether she was taking the Ativan and whether it was working?

[Kimberly Hardy]

She said that it was not helpful for her sleep, but it made her feel less anxious.

[Dr. Jennifer Tufts]

And in this appointment there was a discussion of Benadryl, is that correct?

[Kimberly Hardy]

So she reported that Benadryl was something she had tried and it was helpful. It was teaching, taken over the counter.

[Dr. Jennifer Tufts]

Had you recommended or told her to take the Benadryl at that point?

[Kimberly Hardy]

I don't think so.

[Dr. Jennifer Tufts]

And so when you met with her and she told you that she had taken the Benadryl and it had helped, what was your reaction to that?

[Kimberly Hardy]

I was glad that something was helping.

[Dr. Jennifer Tufts]

And did she tell you how often she was taking it or how much of it she was taking?

[Kimberly Hardy]

I don't recall.

[Dr. Jennifer Tufts]

Did you ask her that day if she had any suicidal or homicidal ideation?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And what was the response?

[Kimberly Hardy]

No.

[Dr. Jennifer Tufts]

Did you see any signs of psychosis that day?

[Kimberly Hardy]

No.

[Dr. Jennifer Tufts]

Up to that point on August. Sorry, October 26, 2022, had you ever had any difficulties in communicating with Ms. Clancy?

[Kimberly Hardy]

No.

[Dr. Jennifer Tufts]

Ever any difficulties understanding her or thinking she wasn't understanding what you were saying?

[Judge William Sullivan]

No.

[Dr. Jennifer Tufts]

At this appointment on October 26, 2022, did she tell you that she had scheduled an appointment for therapy with Ms. McAllister?

[Kimberly Hardy]

I don't remember. Oh, yes, she did. She said she has an upcoming appointment.

[Dr. Jennifer Tufts]

And what was the plan after meeting with Ms. Clancy on the 26th?

[Kimberly Hardy]

So at that point we discussed trying a new medication because she felt that whatever side effects were caused by the Zoloft had resolved, but she still had the same anxiety that she had had beforehand. So we discussed starting the medication Buspar, at 5 milligrams twice a day.

[Dr. Jennifer Tufts]

And what is the lowest dose of Buspar?

[Kimberly Hardy]

5mg.

[Dr. Jennifer Tufts]

And what is the highest dose?

[Kimberly Hardy]

You can prescribe the pills probably come up to 30 and multiple. 30 pills, 10 taken per day.

[Dr. Jennifer Tufts]

So you could prescribe someone more than 30 milligrams per day, like a total dose of 60.

[Dr. Aaliyah Goodheart]

Okay.

[Dr. Jennifer Tufts]

So you started her again at the lowest dose?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And why did you choose Buspar?

[Kimberly Hardy]

So Buspar is very well tolerated. It's a very mild medicine, especially for someone who is experiencing side effects from another medication.

[Dr. Jennifer Tufts]

And what does Buspar do?

[Kimberly Hardy]

It lowers anxiety.

[Dr. Jennifer Tufts]

And was she to continue taking the Ativan with the Buspar?

[Kimberly Hardy]

She could continue taking it as needed if she were to have those extreme moments of anxiety.

[Dr. Jennifer Tufts]

So would it be that the bus bar was twice a day, and then if things. If she felt really anxious, she could take an Ativan if you.

[Attorney Kevin Reddington]

Yes.

[Kimberly Hardy]

Because given that low dose of the buspirone, it might not have been enough of a dose to be effective right away.

[Dr. Jennifer Tufts]

And Buspar and Buspirone are the same thing?

[Kimberly Hardy]

Yes. Sorry.

[Dr. Jennifer Tufts]

There's also a note in here prescribing hydroxyzine 25mg daily as needed for anxiety. What is that?

[Kimberly Hardy]

Hydroxyzine is an antihistamine. It's similar to the Benadryl that she had been taking for sleep. So I recommended that she try the hydroxyzine. It is a safer medicine to take compared to the Ativan. So if someone is feeling very anxious and they can take a hydroxyzine and that prevents them from needing to take the Ativan, that's good. So I wanted her to at least try that option instead.

[Dr. Jennifer Tufts]

So you gave her several options on how to deal with the anxiety as it appears, period, each day, is that correct?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And why take hydroxyzine, which is an antihistamine, instead of just taking the Benadryl?

[Kimberly Hardy]

So they're very similar, but hydroxyzine is indicated for anxiety, whereas Benadryl is really indicated for allergies.

[Dr. Jennifer Tufts]

And you discussed this plan with Ms. Clancy, and did she agree to that plan?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And in discussing it with her, did you go over all the possible side effects and the interactions of the medications that you had prescribed?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And did she voice any concerns about any of that?

[Kimberly Hardy]

No. I mean, I think she was still apprehensive about starting a new medicine and about potential side effects, but nothing specific.

[Dr. Jennifer Tufts]

So it was a general concern about medication? In general, yes. But after you had the conversation and explained what you were recommending and prescribing, did she agree to that plan?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And was there any change in her mental status that day?

[Kimberly Hardy]

No.

[Dr. Jennifer Tufts]

Now, going to the next time that you saw Ms. Clancy was that October 30th? I'm sorry, was her next appointment on October 31st with Jennifer McAllister?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

So you were able to review in the records in preparation for your next appointment that she had in fact went to a therapy appointment?

[Kimberly Hardy]

Correct.

[Dr. Jennifer Tufts]

And the therapy appointment, was that approximately an hour long appointment with Ms. McAllister?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

When was your next appointment with Ms. Clancy?

[Kimberly Hardy]

November 2nd.

[Dr. Jennifer Tufts]

And on that date, was that also a virtual appointment?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

Do you know whether the therapy appointment with Ms. McAllister was in person or virtual?

[Kimberly Hardy]

I'm not 100% sure, but I think it was virtual.

[Dr. Jennifer Tufts]

And up to this point, had Ms. Clancy ever told you that she didn't want to do virtual, that she wanted to come in in person?

[Attorney Kevin Reddington]

No.

[Dr. Jennifer Tufts]

Now, on this November 2nd appointment, did you have a discussion about the bus bar?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And what was that discussion?

[Kimberly Hardy]

So she did not start it. She was too afraid to start a new medication.

[Dr. Jennifer Tufts]

Did she tell you that she had continued with the Ativan and the Benadryl?

[Kimberly Hardy]

She said she continued with the Ativan, Ativin.

[Dr. Jennifer Tufts]

Was there any further discussion about the Benadryl or the other antihistamine that you had prescribed, the hydroxyzine? Hope I'm saying that correctly.

[Kimberly Hardy]

You are, and I'm not sure. I don't think there was much conversation about the Benadryl or the hydroxyzine.

[Dr. Jennifer Tufts]

And what was her affect that day?

[Kimberly Hardy]

It appeared appropriate.

[Dr. Jennifer Tufts]

And what was her mood? How did she report feeling?

[Kimberly Hardy]

Euthymic.

[Dr. Jennifer Tufts]

What does that mean?

[Kimberly Hardy]

Euthymic means a normal mood, not necessarily sad or angry or euphoric. It's just kind of neutral in the middle.

[Dr. Jennifer Tufts]

And would that have been a word coming from Ms. Clancy or just how you describe the word you used?

[Kimberly Hardy]

It's a clinical word.

[Dr. Jennifer Tufts]

And did you ask her if she had any suicidal or homicidal ideation?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

What was her response?

[Kimberly Hardy]

No.

[Dr. Jennifer Tufts]

Did you see any signs of psychosis present in her that day?

[Kimberly Hardy]

No.

[Dr. Jennifer Tufts]

That day, did you discuss alternatives to Ativan?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And why were you discussing alternatives to the Ativan?

[Kimberly Hardy]

Because Ativan was not a medication I intended for her to be taking for a long period of time. It was a short term medication.

[Dr. Jennifer Tufts]

Why is that?

[Kimberly Hardy]

Because people. It does have a risk of dependency when people take it for a long period of time, and especially at high doses.

[Dr. Jennifer Tufts]

So did you bring up this discussion about alternatives to ATIVAN or did Ms. Clancy ask about it?

[Kimberly Hardy]

I think that was something I brought up.

[Dr. Jennifer Tufts]

And what were the alternatives that you discussed with her?

[Kimberly Hardy]

Remeron, Trazodone, Pregabalin and hydroxyzine.

[Dr. Jennifer Tufts]

And what was it about those medications that you thought they would be appropriate for Ms. Clancy?

[Kimberly Hardy]

That they might be safer medications that could also help her with sleep, also help her with some of the anxiety.

[Dr. Jennifer Tufts]

And how are they safer so they

[Kimberly Hardy]

don't have that risk of the dependency?

[Dr. Jennifer Tufts]

And while you're interacting with her and discussing the alternatives to Ativan, what was her mental status that day? Was there any change in it?

[Kimberly Hardy]

No.

[Dr. Jennifer Tufts]

And so after this discussion with her about the alternatives, was there a decision made on how to proceed?

[Kimberly Hardy]

Yes. So we discussed tapering the Ativan by 0.25 milligrams every two weeks.

[Dr. Jennifer Tufts]

And what does tapering mean?

[Kimberly Hardy]

It means slowly reducing.

[Dr. Jennifer Tufts]

And why do you slowly reduce the medication?

[Kimberly Hardy]

So when you are taking Ativan, like I mentioned, the risks of dependency, there's also risks of withdrawal symptoms if a medication like that is abruptly stopped. So. So that's why we gradually decrease it.

[Dr. Jennifer Tufts]

And so if the plan was to decrease it by 0.25 milligrams a week, what amount was she taking per week?

[Kimberly Hardy]

So it was by 0.25 milligrams every two weeks?

[Dr. Jennifer Tufts]

Two weeks. Okay.

[Kimberly Hardy]

So at first we were decreasing it from 1 to 0.75.

[Attorney Kevin Reddington]

Okay.

[Dr. Jennifer Tufts]

So it was a 1 milligram pill that she was taking, and then she would just take less and less and less until she wasn't taking it any longer?

[Kimberly Hardy]

Yes.

[Assistant District Attorney Jennifer Sprague]

Okay.

[Dr. Jennifer Tufts]

And then had you, with Ms. Clancy, decided on a replacement for the ativan?

[Kimberly Hardy]

At this point, I don't think there was a medicine that we had decided on.

[Dr. Jennifer Tufts]

So the plan at that point was just to taper off the ativan, but nothing was added at that point?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

Did you next see Ms. Clancy on November 22, 2022?

[Attorney Kevin Reddington]

Yes.

[Dr. Jennifer Tufts]

And do you recall why there was a 20 day gap between seeing her on the 2nd and then seeing her on the 22nd?

[Kimberly Hardy]

Well, I'm not sure. I would really be guessing if I said okay.

[Dr. Jennifer Tufts]

Did you learn at that appointment on November 22nd of 2022 that Ms. Clancy had started another program?

[Judge William Sullivan]

Yes.

[Dr. Jennifer Tufts]

And what program was that?

[Kimberly Hardy]

It was a south shore perinatal mental health clinic.

[Dr. Jennifer Tufts]

And was that the first that you learned of miss Clancy being involved in that program?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

Did she tell you she was thinking about doing it or that she was already enrolled in that program?

[Kimberly Hardy]

That she was enrolled in it and that it sounded like she was going to be transferring her care there?

[Dr. Aaliyah Goodheart]

Okay.

[Dr. Jennifer Tufts]

And did she tell you that she was starting a new medication?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

What did she tell you she was starting?

[Kimberly Hardy]

She said she was going to start Prozac.

[Dr. Jennifer Tufts]

And did she also tell you what she was currently using for medication?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And what was that?

[Kimberly Hardy]

The Ativan and the Benadryl.

[Dr. Jennifer Tufts]

And did she tell you that was for sleep as needed?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And so you had put in place a plan on November 2 to taper off the Ativan, but on November 22, she was still on the Ativan, is that correct?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And had she tapered off or reduced the dose, to your knowledge?

[Kimberly Hardy]

I don't have it documented exactly what dose she was taking on that date. She was just taking. Still taking the medicine?

[Dr. Jennifer Tufts]

Still taking it. Okay. On that date, did Ms. Clancy deny suicidal and homicidal ideation?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

Did she show any signs of psychosis?

[Kimberly Hardy]

No.

[Dr. Jennifer Tufts]

Did she also tell you that she was going to be transferring her therapy care to that South Shore Perinatal Health Clinic?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

So, basically, at that point, the plan was for her to receive her mental health care at the Celsius Perinatal Clinic and no longer see you. Was that the plan?

[Judge William Sullivan]

Okay.

[Dr. Jennifer Tufts]

Was there also discussion of a return to work letter that day?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And did she request that from you?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And did you give her a return to work letter?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And was that authorizing her to return to work immediately or on January 1st, as the previous form had said?

[Kimberly Hardy]

I don't remember what date it was for her to return to work. I. I don't think it was immediate.

[Dr. Jennifer Tufts]

Did you then have a further appointment with Ms. Clancy on December 1, 2022?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And how is it that she was planning on transferring care to the South Shore perinatal clinic on November 22, but then on December 1, she has an appointment with you?

[Kimberly Hardy]

So patients can schedule their own appointments. I'm not involved in the scheduling. I can schedule a patient an appointment if someone asks me to, but they can schedule it without my awareness. So she had scheduled it.

[Dr. Aaliyah Goodheart]

Okay.

[Dr. Jennifer Tufts]

So she hadn't reached out to you in advance to ask about it. She just scheduled an appointment with you for December 1st, 2022, is that correct?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

Okay. And in that appointment, did she tell you that she ended up not returning to work?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And what was discussed at that appointment?

[Kimberly Hardy]

That she wasn't getting better.

[Dr. Jennifer Tufts]

And in what ways wasn't she getting better?

[Kimberly Hardy]

She had tried the Ativan taper, but without the Ativan, she was having a lot of difficulty sleeping. So she tried a few different medications, a few different medication combinations, but she was having trouble with them.

[Dr. Jennifer Tufts]

And did she tell you what types of medication she had tried, yes. And what were those tried?

[Kimberly Hardy]

Trazodone, 50 to 150 milligrams, was minimal effect. Ativan and Benadryl combination was helpful. Then she added the Prozac, 10 milligrams with the Ativan and Benadryl to help with the sleep. But she still had worse sleep, so that was stopped. Then she tried a combination of Remeron with. With Klonopin, but she felt disoriented, had rebound anxiety, and it was of minimal help. Then she tried Remeron and Seroquel, and actually that was prescribed, but she didn't take it.

[Dr. Jennifer Tufts]

And these medications that she was talking to you about, those weren't prescribed by you, correct?

[Kimberly Hardy]

Correct.

[Dr. Jennifer Tufts]

Did she tell you that those had been prescribed by her provider at South Shore Perinatal Clinic?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And what is Trazodone?

[Assistant District Attorney Jennifer Sprague]

It is.

[Kimberly Hardy]

The category is an antidepressant, but the doses that we use are low, so it's really a sleep medicine.

[Dr. Jennifer Tufts]

And what is the lowest dose of trazodone?

[Kimberly Hardy]

50.

[Dr. Jennifer Tufts]

And what is the highest?

[Kimberly Hardy]

It can go very high, up to maybe 600.

[Dr. Jennifer Tufts]

Okay, so the 50 to 150 milligrams that Ms. Clincy told you she had taken, is that on the lower end of the dosage?

[Kimberly Hardy]

Yes, it's the commonly prescribed dose, again, because it's mostly used as a sleep medicine. So those are the normal ranges.

[Dr. Jennifer Tufts]

And Prozac, I think you had said earlier, was an SSRI?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And that was a medication Ms. Clancy had told you she had taken in nursing school, correct?

[Attorney Kevin Reddington]

Yes.

[Dr. Jennifer Tufts]

With no side effects then?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And she told you on December 1, 2022 that the Prozac had worsened her sleep?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And then what is Remeron?

[Kimberly Hardy]

Remeron is Mirtazapine.

[Dr. Jennifer Tufts]

And what's that?

[Kimberly Hardy]

It's another antidepressant.

[Dr. Jennifer Tufts]

And what is Klonopin?

[Kimberly Hardy]

It is a benzodiazepine, like the Ativan.

[Dr. Jennifer Tufts]

So prescribing Remeron as an antidepressant and Klonopin as an anxiety medication, is that an unusual combination?

[Kimberly Hardy]

No.

[Dr. Jennifer Tufts]

And then she told you she had been prescribed Remeron and Seroquel but hadn't started that? Correct.

[Kimberly Hardy]

So I think she had started the Remeron, but maybe hadn't started the Seroquel yet.

[Dr. Jennifer Tufts]

And did she also tell you that she was having some intrusive thoughts on the Remeron, so she was planning on starting?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

Did she tell you what those intrusive thoughts were?

[Kimberly Hardy]

She said it was a feeling like, I'm Going to die.

[Dr. Jennifer Tufts]

Not a feeling that she wanted to kill herself, but a feeling like she was going to die?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

Did you ask her if she had suicidal ideation?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

What was her response?

[Kimberly Hardy]

So she denied having suicidal ideation, but she was feeling pretty badly. She. She said she was close to it, meaning close to having some suicidal thoughts, and that she was feeling very hopeless, but she didn't have any active thoughts of hurting herself, didn't have any intention of doing anything, didn't have any plans.

[Dr. Jennifer Tufts]

Did she also tell you, and this is a quote in the records on page 144. I think it's my problem. I keep reaching out to the different people and not sticking with the plan.

[Kimberly Hardy]

That's what I documented.

[Dr. Jennifer Tufts]

And did you discuss that with her, that concern that she kept reaching out to different people and wouldn't stick with the plan?

[Kimberly Hardy]

Yes, I advised that she have one person who is managing the medications.

[Dr. Jennifer Tufts]

And why is that important?

[Kimberly Hardy]

So that it's very clear what's happening

[Dr. Jennifer Tufts]

and what is the importance, if any, of sticking with a plan, a mental health plan?

[Kimberly Hardy]

Well, the importance of sticking with a plan. You know, obviously the psychiatrist comes up with a plan for very particular reasons. And so, you know, sticking with the plan is advisable.

[Dr. Jennifer Tufts]

When you prescribe psychiatric medications, do those medications take effect immediately?

[Kimberly Hardy]

No.

[Dr. Jennifer Tufts]

How do they. How does that effect start to happen in a person?

[Kimberly Hardy]

Well, it depends which medicine. Some medicines do work very quickly, like the benzodiazepines, Ativan and Klonopin. But the medicines that prevent anxiety, the medicines that prevent depression, those do take a long time to actually kick in.

[Dr. Jennifer Tufts]

And why is that?

[Kimberly Hardy]

So the way that the medications interact with the brain, the serotonin receptors, the way that they change the neurotransmitters, it takes time for those changes to happen.

[Dr. Jennifer Tufts]

Now, did you also talk to Ms. Clancy about bipolar disorder that day?

[Attorney Kevin Reddington]

Yes.

[Dr. Jennifer Tufts]

And why did you do that?

[Kimberly Hardy]

So it was mentioned because of the poor reaction she had had to some of her medications, the insomnia. So we discussed whether these side effects she was experiencing indicated she had bipolar disorder. But when that was assessed, it was not deemed that she had bipolar disorder.

[Dr. Jennifer Tufts]

And why was that?

[Kimberly Hardy]

Because she. She really didn't meet the criteria.

[Attorney Kevin Reddington]

And which.

[Dr. Jennifer Tufts]

What criteria didn't she meet?

[Kimberly Hardy]

So there's a number of different criteria for bipolar disorder. Or, you know, specifically looking at mania, because she did. She did have some symptoms of depression. But the other side is me. So the most important one is euphoria. So actually, seven days of continued euphoria with very High energy levels. That's the most important one. But then in addition to that, you need some other things, like potentially pressured speech, grandiosity, which is like a person feeling superhuman or godlike. You might see increased risk taking behaviors. Usually those are significant risks, like somebody having affairs or using drugs. Things that really negatively impact their life. The person might have a decreased need for sleep, which is not just insomnia, but it's truly not needing the sleep and having enormous amounts of energy.

[Dr. Jennifer Tufts]

Otherwise, what is pressured sleep?

[Judge William Sullivan]

Speech.

[Kimberly Hardy]

It means talking very fast, so fast that it's really hard to interrupt them.

[Dr. Jennifer Tufts]

And did you ask Ms. Clancy on December 1st questions that would potentially elicit whether or not she met that criteria?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And did any of her responses to your questions indicate any instances of mania in her past or present?

[Kimberly Hardy]

No.

[Dr. Jennifer Tufts]

What was the plan going forward from that day?

[Kimberly Hardy]

So at this point she was still seeing the doctors or the providers at South Shore, and so they were still managing her medications. So the plan was that she had an appointment with them tomorrow. She was considering taking the Remeron with or, sorry, considering taking the Seroquel without the Remeron because she had had side effects with that. But that wasn't decided on. That was something to consider. And we also talked about starting a medicine called lamotrigine. I just gave her some information about the medicine. And we also talked about her going to a partial hospitalization program which provides extra support for people who are really struggling.

[Dr. Jennifer Tufts]

Lamotrigine. Is that lamictal?

[Attorney Kevin Reddington]

Yes.

[Dr. Jennifer Tufts]

And did you prescribe it to her that day or just discuss that option with her?

[Kimberly Hardy]

Just discussed on that day.

[Dr. Jennifer Tufts]

Why did you discuss that option with her?

[Kimberly Hardy]

Because it was clear that she had depressive symptoms and she was not tolerating some of the other antidepressants. So thought that that might be another option to explore.

[Dr. Jennifer Tufts]

And you also discussed with her a partial hospitalization program?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And why did you do that?

[Kimberly Hardy]

Because she was really having a hard time. She had mentioned those thoughts of feeling hopeless and the intrusive thoughts. So I referred her to a program that would provide extra support. It would be a program that she went to every single day, not hospitalized. She could still stay at home and be with her family, but that she would have all day care every day for, you know, as long as that was needed.

[Dr. Jennifer Tufts]

And what program was that that you referred her to?

[Kimberly Hardy]

The HRI program.

[Dr. Jennifer Tufts]

What does HRI stand for?

[Kimberly Hardy]

It's a hospital. I'm not sure what it stands for.

[Dr. Jennifer Tufts]

And where is that program located?

[Kimberly Hardy]

It's in Massachusetts. I think Brookline.

[Dr. Jennifer Tufts]

And when you referred her, when you talked about that program with Ms. Clancy and referred her to that program, what was her response?

[Kimberly Hardy]

Well, I gave her the information for it. It's a program where the patient can call and schedule their intake appointment, so I gave her that information.

[Dr. Jennifer Tufts]

And was there any concern at that point, you had mentioned earlier that it's important to have, you know, one provider prescribing medication, knowing what you're taking. You knew she was going to the South Shore perinatal program. Was there any concern about discussing medications with her, like lamictal on the 1st, when you knew she was seeing these other providers?

[Kimberly Hardy]

Well, she continued to see me in more of a supportive role, and I was just trying to help her, give her as much information that could potentially be helpful. So it was something for her to discuss with the other providers.

[Dr. Jennifer Tufts]

Did you ever reach out to South Shore to get those records or ask Lindsey for some type of waiver to get the South Shore records?

[Kimberly Hardy]

No, I didn't. And the reason why is because she was very aware of what the medication. She was very, very able to communicate what the different treatment decisions were. She was very medically sophisticated, so I didn't think it was necessary.

[Dr. Jennifer Tufts]

And you were aware she was a labor and delivery nurse, correct?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

So you were aware she was familiar with medications and she was able to communicate with you on a level that's not a typical patient, correct?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

Did you next see her on December 16, 2022?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And did you make that appointment for her with her, or did she reach out as she did on the December 1st and make her own appointment?

[Kimberly Hardy]

I'm not sure.

[Dr. Aaliyah Goodheart]

Okay.

[Dr. Jennifer Tufts]

And that appointment on December 16, 2022, what did you discuss with her that day?

[Kimberly Hardy]

So she was still not feeling well. She said, I'm having a really rough time, though. She said she found something that was helpful for her sleep, Valium and quetiapine, which is Seroquel. She said it finally works. But feeling very depressed during the day, no motivation, had some si. Suicidal ideation. So she went to Mass General emergency room, declined in patients. She was feeling hopeless, but didn't have any intent or suicidal plans.

[Dr. Jennifer Tufts]

So when she told you that she had had some suicidal ideation, did you ask her specifics about that?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And what was her response?

[Kimberly Hardy]

So she described it as this hopelessness, like a fear of not getting better.

[Dr. Jennifer Tufts]

Did she have a plan on, a plan to kill herself or a plan of how to kill herself?

[Kimberly Hardy]

No.

[Dr. Jennifer Tufts]

And you mentioned she told you she went to Mass General Hospital emergency department. Because of these feelings, is that correct?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And did she tell you that they had offered her an inpatient program at McLean and she had turned them down?

[Dr. Aaliyah Goodheart]

Yes.

[Dr. Jennifer Tufts]

Did she tell you why she turned them down?

[Kimberly Hardy]

I don't remember.

[Dr. Jennifer Tufts]

Did she tell you about plans? Well, did she tell you what she was taking for medication? At that point in the plans for

[Kimberly Hardy]

medication, she said she was taking a mixture of the Valium and the quetiapine, and there was a plan to increase the quetiapine, but. But currently she was taking 200 milligrams.

[Dr. Jennifer Tufts]

And did she also talk to you about the Women and Infants program in Rhode Island?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And what did she tell you about that?

[Kimberly Hardy]

She said that she was referred and appointments were being scheduled.

[Dr. Jennifer Tufts]

And were you familiar with that program?

[Kimberly Hardy]

I've heard about it.

[Dr. Jennifer Tufts]

What type of program is it?

[Kimberly Hardy]

It's one of those partial hospital programs that I had mentioned, but it is focused on postpartum, so I thought that that was a good fit.

[Dr. Jennifer Tufts]

Did she tell you during this appointment that she thought that her depression was related to the Seroquel?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And did she tell you why she thought that?

[Kimberly Hardy]

She thought there was some coinciding of. Of the timing in which she started the Seroquel and started feeling more depressed.

[Dr. Jennifer Tufts]

And did you note in the records that it was unclear if Seroquel was causing the depression as reported, she was more depressed the last visit before taking it?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

Can you just explain that, what your observations were?

[Kimberly Hardy]

Yeah, I wasn't sure if the Seroquel was making her worse because she did already seem depressed before she had started the Seroquel. So I just. I wasn't sure. I thought it.

[Dr. Jennifer Tufts]

It was possible, but what was the plan going forward from that appointment?

[Kimberly Hardy]

So the plan was for her to go to this Women in Inference program, and if she was having more suicidal thoughts, to go back to the emergency room.

[Dr. Jennifer Tufts]

And was she also planning to start Lamictal 25 milligrams daily?

[Kimberly Hardy]

Yes. that moment, given how the depression was continuing and worsening, I did feel like after we had discussed the lamictal numerous times, that I did need to step in and prescribe that for her.

[Dr. Jennifer Tufts]

And you prescribed the 25 milligram daily dose for her?

[Judge William Sullivan]

Yes.

[Dr. Jennifer Tufts]

What's the lowest level of Mictal that you would prescribe?

[Kimberly Hardy]

25.

[Dr. Jennifer Tufts]

And what's the highest?

[Kimberly Hardy]

So in psychiatry, typically, 200, but I mean, it really can go up to 400 or 500.

[Dr. Jennifer Tufts]

And so again, you prescribed the lowest dose to start with, correct?

[Dr. Aaliyah Goodheart]

Yes.

[Dr. Jennifer Tufts]

And was she to continue with the Seroquel that she had been prescribed by the South Shore Perinatal Program?

[Attorney Kevin Reddington]

Yes.

[Dr. Jennifer Tufts]

And what about Valium?

[Attorney Kevin Reddington]

So

[Kimberly Hardy]

I didn't make a recommendation on the Valium. I think there was a plan already in place on tapering it that I supported.

[Dr. Jennifer Tufts]

And did you do anything in terms of reaching out to her providers at South Shore Perinatal to let them know you were adding a provider prescription, or did you communicate with Ms. Clancy about letting her providers know?

[Kimberly Hardy]

I communicated with. With Lindsay about that. And. And she was so good at giving me all of these updates about what she did with them. I. I figured she would. She would tell them when she next saw them.

[Dr. Jennifer Tufts]

And did she tell you that she would update them?

[Kimberly Hardy]

I

[Attorney Kevin Reddington]

was.

[Dr. Jennifer Tufts]

The next time you saw Ms. Clancy on January 6, 2023?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And how did that appointment come about?

[Kimberly Hardy]

So, again, I don't often do the scheduling. I'm not sure exactly whether I had scheduled that or she had.

[Dr. Jennifer Tufts]

Did you learn during that appointment that Ms. Clancy had just been discharged from McLean Hospital?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And what, if anything, did Ms. Clancy tell you about her current mental state and what had happened between your last appointment on December 16th and now this appointment on January 6th?

[Kimberly Hardy]

So she was continuing to feel depressed and attributing it to the Seroquel that she had been taking. So the idea was going to McLean so that she could be safely taken off of the Seroquel.

[Dr. Jennifer Tufts]

And was it at McLean, according to Ms. Clancy, that she had tapered off the Seroquel?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And so on January 6, did she tell you what she was prescribed at that time?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And what Was that?

[Kimberly Hardy]

Trazodone, 100 milligrams, Ativan, 1 milligram, and Melatonin, 5 milligrams.

[Dr. Jennifer Tufts]

And are these all low doses of these medications?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

Did you ask her if she had current suicidal ideation?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And what did she say?

[Kimberly Hardy]

No.

[Dr. Jennifer Tufts]

Did you ask her if she had homicidal ideation?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And what was her response?

[Kimberly Hardy]

No.

[Dr. Jennifer Tufts]

Did you observe any signs or symptoms of psychosis in her presentation? Answer. Or behavior?

[Kimberly Hardy]

No, I did not.

[Dr. Jennifer Tufts]

Did you ask her about whether she was having side effects from these medications, the Trazodone and the Ativan and the Melatonin?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

What was her response?

[Kimberly Hardy]

So the only side effect she felt was that potentially when the Ativan would wear off, she would take it at night, and then in the morning it would wear off and she would feel more anxious after it wore off.

[Dr. Jennifer Tufts]

And in terms of the Trazodone, did she say she had any side effects from the Trazodone?

[Kimberly Hardy]

No.

[Dr. Jennifer Tufts]

And melatonin. What is melatonin?

[Kimberly Hardy]

Melatonin is a chemical that the brain makes that tells us it's time to go to sleep. It's associated with the circadian rhythm. It's not a prescription, actually. It's a medicine that you can pick up over the counter at the pharmacy.

[Dr. Jennifer Tufts]

And is it just to help regulate sleep?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

What was the. What was her mood? According to Ms. Clancy, on that date

[Kimberly Hardy]

she was feeling numb.

[Dr. Jennifer Tufts]

Numb.

[Kimberly Hardy]

Numb.

[Dr. Jennifer Tufts]

Did that cause you any concern?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And why is that?

[Kimberly Hardy]

Well, she still appeared quite depressed.

[Dr. Jennifer Tufts]

And in what way was that her affect?

[Kimberly Hardy]

It was. Yes. Her affect was congruent, meaning it was the same as her mood.

[Dr. Jennifer Tufts]

So just so we can understand. So if I tell you I'm happy and I appear happy, is that congruent?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And if I tell you I'm happy but I appear sad, is that incongruent?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And is that important when evaluating a patient?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And why is that?

[Kimberly Hardy]

Sometimes it's not congruent and there could be all sorts of reasons why, but it's just something to pay attention to.

[Dr. Jennifer Tufts]

And so on this day, though, her mood and her affect were congruent?

[Kimberly Hardy]

Yes.

[Dr. Aaliyah Goodheart]

Okay.

[Dr. Jennifer Tufts]

And was there a plan formulated for that day? On that day?

[Kimberly Hardy]

Yes. So the plan on that day was to increase the trazodone to 150 milligrams. She had previously taken that dose and tolerated it well. And she had just come off of the seroquel at Mass General or sorry, at McLean. So we were still in the phase where we were monitoring to see if the depression might get better off of that medicine.

[Dr. Jennifer Tufts]

And is that why you didn't immediately prescribe a new antidepressant? Yes. And was she to continue the Ativan at 1 milligram per night and the melatonin at 5 milligrams per night?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And I believe in this note for under condition, you wrote deteriorating.

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And why is that?

[Assistant District Attorney Jennifer Sprague]

So?

[Kimberly Hardy]

It sounds like a very strong word. I will give some context that it's not my choice of a word. I have three options when I'm filling that out. I can say a patient is improving, unchanged or deteriorating. So she wasn't improving and she wasn't really unchanged. She appeared a little bit worse than the last time I had seen her. So the best word is to say deteriorating.

[Dr. Jennifer Tufts]

Was there anything about her presentation or affect, things that she told you that led you to believe that she was in imminent danger of harming herself or someone else?

[Kimberly Hardy]

No, there wasn't. And we had, you know, she was feeling Depressed. And we had a plan to address that.

[Dr. Jennifer Tufts]

Is there something you can do if you have a patient who you think is at risk of harming themselves or others?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And what is that?

[Kimberly Hardy]

I could issue a Section 20, which would mandate that they be brought to a hospital for treatment or at least for evaluation and then possible treatment.

[Dr. Jennifer Tufts]

And did you feel that was necessary at that time with Ms. Clancy?

[Kimberly Hardy]

No.

[Dr. Jennifer Tufts]

And when you're evaluating a patient, taking the history, looking at their current state, looking at what they. The answers they give you to the questions, are you reliant on the information that they give you?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

So if a patient withholds important information, is it hard to make a diagnosis or plan?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

Was your next appointment with Ms. Clancy on January 9, 2023?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And what was discussed at that appointment?

[Kimberly Hardy]

So she said that the trazodone increase was helpful. She was still getting that rebound anxiety the day after she took the Ativan. The mood was okay, but she was feeling like she was still flat. She wasn't able to cry, but she said she was able to laugh a little bit and hadn't been having recent thoughts of suicidal ideation.

[Dr. Jennifer Tufts]

Had not been?

[Kimberly Hardy]

Had not been.

[Dr. Jennifer Tufts]

And did you also ask her if she had any homicidal ideation?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And what was her response?

[Attorney Kevin Reddington]

No.

[Dr. Jennifer Tufts]

Did you notice any signs or symptoms of psychosis?

[Kimberly Hardy]

No, I did not.

[Dr. Jennifer Tufts]

Did you have a discussion with her about trying an antidepressant?

[Kimberly Hardy]

Yes, I did.

[Dr. Jennifer Tufts]

And what was that discussion?

[Kimberly Hardy]

So at this point, she had been on off of the Seroquel for a couple weeks and she wasn't getting better. So I thought that suggested the Seroquel might not have been what was causing depression. And it was depression, so that was what we needed to treat.

[Dr. Jennifer Tufts]

And what were your suggestions for treatment of the depression?

[Kimberly Hardy]

We considered some different options. We didn't pick a medicine on that date, but we considered Amitriptyline and Wellbutrin.

[Dr. Jennifer Tufts]

And Wellbutrin was one of the medications she had taken when she was in nursing school, correct?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And you discussed those medications on the 9th. Why wasn't a decision made that day?

[Kimberly Hardy]

Because we had made a different medication change because of that rebound anxiety with the Ativan. We decided to switch that to Diazepam, which is Valium, and it has a longer half life, meaning it's broken down by the body much more slowly, so you're less likely to get that rebound anxiety. And also the nice thing about the Diazepam is it's easier to stop gradually. You can every week or every couple weeks. You can increase the dose by just one or two milligrams, so it's a lot easier to stop. So I felt that that was a better alternative. And she also wanted to be off of the Ativan and be able to sleep without that kind of medicine.

[Dr. Jennifer Tufts]

And I don't think I asked you this before, but what is rebound anxiety?

[Kimberly Hardy]

It just means that when the medication that treats the anxiety gets out of the system, the anxiety comes back and it comes back even worse.

[Dr. Jennifer Tufts]

And you explained it a little bit. But what is a half life of a medication and what does that mean in terms of the body processing and how it affects you?

[Kimberly Hardy]

Yeah, so it's a little bit complicated, but it's basically the time it takes for half of the medicine to be broken down by the body.

[Dr. Jennifer Tufts]

And that tells you or indicates to you how long it lasts in the system?

[Judge William Sullivan]

Yes.

[Dr. Jennifer Tufts]

And so you were saying that Valium, the Diazepam, the Valium, might avoid the rebound anxiety because it's slower to leave the body, is that right?

[Attorney Kevin Reddington]

Yes.

[Dr. Jennifer Tufts]

Did Ms. Clancy send you after this appointment on the 9th, January 9th, did she send you emails on January 11th, 2023, asking you about your knowledge and thoughts on ketamine therapy and whether that would be a good option for her?

[Kimberly Hardy]

Yes, she did.

[Dr. Jennifer Tufts]

And what was your response to that? If you can't find it, I can bring it up to you.

[Kimberly Hardy]

I think I have it. So I mentioned that it's a great option, but it can be hard to get the insurance coverage for it. Usually you need to have demonstrated that you've tried four different antidepressants first and so that it might be necessary to try another medicine first.

[Dr. Jennifer Tufts]

In that email where she was asking you about ketamine therapy, did she tell you that she was. Did she say, I'm still feeling a very low mood, no motivation, just very depressed. This has been going on for months now, and I'm getting desperate for something that would work quickly to get me out of this depressed state. Do you remember that being part of the email?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

Had she indicated thoughts like that to you before wanting something that would work quickly to help her feel better quickly?

[Kimberly Hardy]

I mean, she may have said that once or twice.

[Dr. Jennifer Tufts]

Do you know where?

[Attorney Kevin Reddington]

Strike that.

[Dr. Jennifer Tufts]

Did you ever recommend ketamine therapy to you or is this something she broached to you in this email for the first time?

[Kimberly Hardy]

It was something I had considered because at this point she was starting to be a bit treatment resistant. And ketamine is a treatment for treatment resistant depression. So it's a reasonable thought. But I didn't think we were at that point yet.

[Dr. Jennifer Tufts]

And you mentioned that insurance companies usually require you to try four antidepressants, is that correct?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And when you say treatment resistant, is that someone who is in depression but the typical medications aren't working for them?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And did you have an appointment with Ms. Clancy on January 16, 2023?

[Kimberly Hardy]

Yes, I did.

[Dr. Jennifer Tufts]

And what was your interaction with Ms. Clancy on January 16?

[Kimberly Hardy]

Her mood was still very low. She was still depressed. She was able to get out of bed and take care of her basics like hygiene and eating. Her concentration was fine and she was doing what she needed to do to take care of her baby. Though she subjectively felt like the bonding was forced with the baby.

[Dr. Jennifer Tufts]

She told you that? That the bonding felt forced with the baby?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

Did you ask her if she had suicidal or homicidal ideation?

[Kimberly Hardy]

I did.

[Dr. Jennifer Tufts]

And what was her response?

[Kimberly Hardy]

No.

[Dr. Jennifer Tufts]

Did she show any of the signs or symptoms of psychosis on that day?

[Kimberly Hardy]

No, she did not.

[Attorney Kevin Reddington]

What?

[Dr. Jennifer Tufts]

Well, did you have a discussion about a Valium table?

[Judge William Sullivan]

Yes.

[Dr. Jennifer Tufts]

And why did you have that discussion? Who brought that up?

[Kimberly Hardy]

That was because she really did not want to have to take a benzodiazepine medication every day for sleep. So we discussed how to come off of that medication safely.

[Dr. Jennifer Tufts]

And that again, does that like, taper off to take a little bit less each time?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And did she agree with that plan?

[Attorney Kevin Reddington]

Yes.

[Dr. Jennifer Tufts]

Was a decision made at that point on which, if any, antidepressant to take?

[Kimberly Hardy]

No, we had not made a decision. Oh, sorry, sorry. At this point, we did. We did go ahead and decide to try the amitriptyline.

[Dr. Jennifer Tufts]

And what is amitriptyline?

[Kimberly Hardy]

So it is a tricyclic antidepressant.

[Dr. Jennifer Tufts]

What does that mean?

[Kimberly Hardy]

It's an older antidepressant. It's been around for very many years. It helps treat insomnia and some pain, headache conditions as well.

[Dr. Jennifer Tufts]

And the dose that you prescribed, did you say it was 10 milligrams?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

Is that the lowest dose?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

What's the highest dose?

[Kimberly Hardy]

Can get quite high, maybe 150.

[Dr. Jennifer Tufts]

And so again, you started her at the lowest dose. Why was it that throughout this time you're treating her and trying these different medications that you always start at the lowest dose with her?

[Kimberly Hardy]

That's standard practice because the medications, they have side effects and the lower the dose, the more mild the side effects are. And it gives the patient time to acclimate to the medicine and then you gradually increase it depending on how they're tolerating it.

[Dr. Jennifer Tufts]

And what was the plan going strike that. What was her mood in affect that day?

[Kimberly Hardy]

It was depressed. Mood was depressed, affect was depressed and flat.

[Dr. Jennifer Tufts]

And at that point in time where she's denying suicidal ideation, denying homicidal ideation, showing no signs of psychosis, were there any grounds for you or any reason for you to seek a section 12?

[Kimberly Hardy]

No.

[Dr. Jennifer Tufts]

Your next appointment with her was January 23, 2023, is that correct?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And again, all of these appointments were virtual appointments, correct?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

During this appointment, what was her mood and affect?

[Kimberly Hardy]

Mood was depressed, affect was depressed and flat.

[Dr. Jennifer Tufts]

Did she tell you she had started the amitriptyline?

[Attorney Kevin Reddington]

She did.

[Dr. Jennifer Tufts]

And did she tell you if there were any side effects to that?

[Kimberly Hardy]

It didn't appear that there were side effects.

[Dr. Jennifer Tufts]

What was the conversation or interaction with her that day on the 23rd?

[Kimberly Hardy]

So she said she was doing all right, a little more anxious, and the anxiety was described as the feeling of her heart racing. She had a decreased appetite as well. She was on only 2mg of Valium at this point and feeling more anxious in the morning, mood was the same. Flat, anxious, no motivation, numb. She has to force herself to get out of bed and out of the house, but is able to do that and she is sleeping. Okay.

[Dr. Jennifer Tufts]

And did you ask her if she had suicidal ideation or homicidal ideation on the 23rd?

[Kimberly Hardy]

Yes, I did.

[Dr. Jennifer Tufts]

What was her response?

[Kimberly Hardy]

No.

[Dr. Jennifer Tufts]

And did you notice any symptoms or signs of psychosis that day?

[Kimberly Hardy]

No.

[Dr. Jennifer Tufts]

Was her. Was her. Was there any difference in her rate of speech or speech pattern?

[Kimberly Hardy]

No.

[Dr. Jennifer Tufts]

Was there any difference in her ability to think or communicate in any way?

[Kimberly Hardy]

No.

[Dr. Jennifer Tufts]

Was there any change in your evaluation of her judgment or insight?

[Dr. Aaliyah Goodheart]

No.

[Dr. Jennifer Tufts]

Did you still consider her insight poor at that point?

[Kimberly Hardy]

I did.

[Dr. Jennifer Tufts]

And why were you still considering her insight poor?

[Kimberly Hardy]

So I think there were just a couple of things that came up throughout our 14 visits that suggested that to me. Like I explained earlier, but later on, it was it had to do with her over attribution. It seemed to the medications about certain symptoms that she was feeling, meaning, like how she felt about the seroquel, how she felt that that was making her depressed, when in reality I think she was just depressed. So it was related to her thoughts about medications and how she was feeling.

[Dr. Jennifer Tufts]

So would it be accurate to state that instead of accepting that she was depressed, she was placing the blame on the medication sustained. In your mental status exam of her on the 23rd, how was her appearance?

[Kimberly Hardy]

She was appropriately dressed.

[Dr. Jennifer Tufts]

How was your rapport with her? It was appropriate how was her speech?

[Kimberly Hardy]

It was appropriate.

[Dr. Jennifer Tufts]

How was her thought content and process appropriate? How was her cognitive abilities?

[Kimberly Hardy]

They. There were no deficits.

[Dr. Jennifer Tufts]

And her psychomotor motor activity?

[Kimberly Hardy]

Normal.

[Dr. Jennifer Tufts]

What was the plan going forward on that day?

[Kimberly Hardy]

So we were going to continue the same dose of the diazepam because she was feeling a bit more of the anxiety. So we said to slow down the taper and we increased the amitriptyline to 20 milligrams, thinking that that would also help with the sleep.

[Dr. Jennifer Tufts]

And. At any point in time, did she tell you she was planning to kill herself?

[Kimberly Hardy]

No.

[Dr. Jennifer Tufts]

At any point in time on the 23rd, did she say she was planning to kill her children?

[Kimberly Hardy]

No, absolutely not.

[Dr. Jennifer Tufts]

At any point in time during your interaction with her in that session, was there anything about her affect or demeanor, her behavior, that indicated to you that she was a danger to herself or others?

[Kimberly Hardy]

No.

[Dr. Jennifer Tufts]

Was there any reason, based on your evaluation of her in that session, that would give you grounds to file a section 12 on her that day?

[Kimberly Hardy]

No.

[Dr. Jennifer Tufts]

Throughout your time treating Ms. Clancy, did you continue to recommend that she attend individual therapy?

[Kimberly Hardy]

Yes.

[Dr. Jennifer Tufts]

And why is that?

[Kimberly Hardy]

It's very important.

[Dr. Jennifer Tufts]

And is there a reason it's important or, like, what are the benefits?

[Kimberly Hardy]

Many studies have been done to show the efficacy of therapy as a component of treatment for depression and anxiety. So, you know, some people may only do medicine, some people may only do therapy, but the best response is a combination.

[Dr. Jennifer Tufts]

Thank you, Doctor. I have nothing further.

[Judge William Sullivan]

Counselor, can I see a great sidebar? All right, so members of the jury, I'm gonna. I'm gonna break at this point. I'm going to excuse you till Monday morning at 9 o'. Clock. The schedule I'm going to suggest to be similar to today. It should be pretty much a full day. We are still, if not on schedule, ahead of schedule. I just kind of want to let you know that. So now you're going to have the weekend. And so I just kind of want to reiterate those instructions I've been giving you every day. Because you know the questions I'm going to ask you on Monday. Right. And so I'm going to instruct you and remind you I don't talk about this case with anyone. I don't do any research on this case, don't take any field trips and happen to drive by any place that you have questions about. It's also very important you don't read anything about this case or similar cases that might come up, all right? And don't listen to anything, don't watch anything. You've gotten a fair amount of evidence so far. We've been here for a couple of weeks. You don't have all the evidence, all right? And so it's important for you, you to keep an open mind. And the best way to do that is basically shut your mind off until Monday. All right? I know it's been a long couple of weeks for you, so I hope you have a nice weekend, get rested. We'll see you everybody on Monday. And again, thank you so much for all your time and your work on this. And I really do hope you have a nice weekend and we'll see you Monday. Okay?

[Assistant District Attorney Jennifer Sprague]

All right,

[Judge William Sullivan]

Council, if I could ask you to come one more time, basically just talk about kind of the schedule for Monday. All right? So we'll be in recess on this matter until 9 o' clock on Monday. Thank you.

[Assistant District Attorney Shannon Buckingham]

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[Attorney Kevin Reddington]

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[Assistant District Attorney Shannon Buckingham]

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