Transcript of Trial Day 15

Full trial audio.

Everything heard in court.

No silences to skip.

Jennifer Sprague and Assistant District Attorney Shannon Buckingham.

All right, well, good morning everyone. Good morning, counsel. Good morning, Miss Clancy. All right, um, before we start, could I see everybody talk about today's schedule? Ready for the jury?

Yes.

Yes.

Hey, hey, hey!

All persons having anything to do before the Honorable William Sullivan, Justice of the Superior Court, now sitting in Plymouth within the Commonwealth, draw near, give your attendance, and you shall be heard. God save the Commonwealth of Massachusetts. This court is now in session.

Please be seated.

Yes, please.

Your Honor, before the court today we have a continuation of a jury trial in the matter of Commonwealth v. Susan P. Kennedy.

Miss Clancy is present.

She is represented by Attorney Thank you, Madam Clerk. Good morning, everyone. All right, uh, nice to see everyone. You know I'm going to ask you those questions, then we'll talk a little bit about, uh, today's schedule. Uh, so first question is, any member of the jury read, seen, heard, or overheard anything from any source about any aspect of this case, uh, that would affect your ability to be fair and impartial as a juror? Next question: 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? All right, again, thank you for following those instructions. Uh, and what I wanted— we'll talk a little bit about today's schedule. Um, we're at the, the point in the trial where I think, as you saw a little bit yesterday, there's kind of some stop and starts that go through, and I think we're going to have a similar day today. All right, so I appreciate your, uh, patience with this as I deal with, uh, counsel about some things that I have to speak to outside of your presence. Uh, but as you see, the case is moving forward, and those kind of gaps or the stops that you see are part of the reason it keeps the case moving.

So, uh, I think the schedule today will be similar, uh, in some ways to what we had yesterday. All right, uh, and so with that, uh, we're going to now return to the defendant who's presenting, uh, her case at this time. Uh, Attorney Reddington, thank you.

Uh, call Sue Lancy, please. Yeah, she should be in the hallway.

Good morning.

Good morning.

I'm just going to ask you to speak into that microphone, keep your voice up if you could. Hi, Counselor.

Good morning.

Good morning.

And just tell us your name and spell it, please.

Susan Clancy. S-U-S-A-N C-L-A-N-C-Y. Situate. Yes.

And both you and Chris are mother and father of Patrick?

Correct.

Yes. Relationship was with Lindsay, how you know her.

Yeah, Lindsay married my son Patrick, and we had a very good relationship.

And did you have occasion to go to their home? Yes, Weymouth.

Yes, I did.

And then in Duxbury as well?

Correct.

And obviously you and your husband were the grandparents of the 3 little kids?

Yes.

And, uh, how was your relationship with, with the babies?

Beautiful.

And, um, tell us how frequently, to your memory, you were able to visit with your son Lindsay and of course your grandchildren.

At least a couple times a month we would see them.

At some point—

oh, by the way, what do you do for work?

Um, I'm an RN.

I'm sorry, an RN?

An RN.

And what type of, uh, any—

I worked in the labor and delivery room for About 38 years.

38 years in labor and delivery?

Correct.

Helping women that were having babies? Correct. And obviously you kept up with the studies and continuing education and things?

Yes, I did.

To that extent, in your capacity as an RN with 38— well, back then it would have been 35 years of experience, I think.

Yes.

Is it fair to say that you, as I said, you would keep up with all of recent developments developments in postpartum psychosis, postpartum depression, all of that?

Somewhat, but I mainly just was in the delivery room itself.

Were you aware of the various physicians that were in the forefront, if you will, of postpartum studies as it relates to medicine?

Yes.

Would one of the people that you were interested in be a person by the name of Dr. Meg Spinelli?

Yes.

Can you tell us who Meg Spinelli is?

I don't really know Meg Spinelli well. We've spoken a couple of times. I believe she specializes in postpartum mental health.

And have you met with her before?

Not in person.

Okay.

Did you at some point ask Dr. Spinelli to help out at your hospital? And I guess they call it a wounds lecture.

I asked her to, um, bring on her experience and education in that area and share it with my colleagues.

Did she do that?

She did.

And as time went by, dealing with your job, your family, your son daughter-in-law, grandchildren. Um, did you notice in 2022, after Callan was born, any change in the personality, if you will, of Lindsay?

Uh, several months after that I did.

Would that be sometime in the fall?

Yes.

And can you tell the jurors, being as close as you were with the family— well, let me back up. As a mother-in-law, Did you have any observation to observe Lindsay with her kids?

Yes.

Can you tell the jurors about how you saw her acting with her children as a mother?

She was very nurturing, very loving. She was a wonderful mother. Wonderful.

Did you ever see her treat her middle son Dawson bad because you didn't like him?

No.

Did she love Dawson, in your opinion?

She loved her children, all of them. Very, very much.

And during that period of time, let's say October, November of 2022, what did you observe about Lindsay?

She reached out to me in November and told me that she felt unwell.

Did she describe any symptoms? She did.

She felt, um, mostly she had insomnia. She was losing her appetite. She was very anxious and sad.

Did she tell you that she was seeing doctors?

Yes.

And at some point, did you recommend— did she come to you and ask you for help regarding seeing a doctor?

Yes, she asked for my support.

And did you— you obviously gave it to her?

Yes.

And what did you do to make any recommendations for her?

I reached out to my colleagues. Who were running a clinic for women that were struggling postpartum.

Would that be the South Shore?

Yes, correct.

And at some point, as a result of your intervention, was a nurse practitioner, Julie Hall, uh, agreeing to step in and help out?

Yes.

Did Lindsay see Julie?

I believe she did.

And you really pretty much were out of the mix at that point? You basically made the connection, knew that she was going there, right?

Correct.

Did you find that, that Lindsay was interested at all times trying to get better and see doctors?

Very much so.

Did you find at all— you have an opinion with your observations of Lindsay as to whether or not she was offered help and would just spurn it and not see doctors?

She was begging for help.

And during that period of time, um, you were there for her by text and by telephone and in person?

Correct.

Now During that time that you were, let's say, November and into December, the holiday season, do you recall the holidays for 2022?

Yes.

Tell us, was that a fun time for the Clancy's?

Lindsay was struggling. We were all very concerned.

Um, you knew in January, uh, New Year's actually, that she ended up going—

Yes.

Yes. You know that she'd eventually get out of the hospital?

Yes.

Um, fair to say that you and Lindsay, as I said, communicated a lot by text messaging?

Yes, correct.

So I'm going to approach you with, uh, extraction report. This is a report that is done by—

no, I think so.

And just take a look. And see if your telephone number is on there, just for foundation purposes. Or if you— it is. Okay. And just quickly flip through and see if you recognize those texts. You don't have to look at all of them, that's for sure. They appear to be texts between you and Lindsay.

Okay.

Um, Your Honor, I'm not going to go through each and every text. What I'm going to suggest is I would offer this, and then the jurors would be able to look at what they wish.

Any objection?

All right, over the, uh, common objection, that may be admitted.

Thank you very much.

Good morning.

Good morning.

So you, um, indicated that you've Um, were a labor and delivery nurse for 38 years. And what hospital was that?

South Shore Hospital.

And early on in, in the defendant's career, you, uh, did you work with her?

Briefly.

And, um, she then went to Mass General, correct?

Yeah, she was a student at the time.

Okay.

Um, and you stated that you are aware of a doctor named Meg Spinelli, correct?

Yes.

Did you reach out to her in this case?

I don't remember exactly how she and I connected. I, I don't recall.

Well, you indicated that, um, you connected with her in a professional capacity to have her come to your hospital, right?

Yes.

But as far as her role in this case with the defendant, did you reach out to her for that?

I don't think I did. I don't recall.

Um, now you said that you began to notice some issues in, um, well, defense counsel said October, November. But fair to say you weren't aware of what was going on until she texted you on November 16th when she was at the emergency room?

Yes.

And that was at South Shore Hospital?

Yes.

And you actually met her there at the emergency room?

Yes.

Was she by herself or with Patrick?

She was by herself.

Um, did you know how she got there?

She drove.

She drove herself to the hospital?

Correct.

And she was in the emergency room for a while, correct?

I don't know how long, probably an hour, maybe 2 hours.

Well, you went down when you knew she was there, sat with her for a little bit, went back upstairs to your— because you were working that day, right?

Correct. I wasn't able to go down immediately. I had to wait about an hour and a half and then I went down.

Okay. And then you sat with her for a little bit, went back up to work, right?

Yes.

And then you came back down at some point before she was discharged? Yes, Council.

Can I see it, Sabra, just very briefly?

So, Mrs. Clancy, um, you, you came down to the emergency room and you sat with her for a while, correct? Yes. And did she tell you, um, why she was there?

Yes.

And fair to say she indicated to you that she was having trouble sleeping and she had some heart palpitations?

Correct.

And that's what brought her to the emergency room to get checked out?

Yes.

Did she tell you that she had consumed a weed gummy before going to the ER that day?

Sure.

She did not.

Okay. And, um, in your experience as a nurse, is that sometimes a reaction to THC or CBD or some sort of weed that somebody might have a faster heartbeat?

I don't know.

Um, now when she was in the emergency room, uh, she was seen by a doctor and provided some medication. Were you there when the doctor was there?

Yes.

And you're aware that the doctor, the ER doctor, gave her some Trazodone to help her sleep? Yes, because that's what she was really concerned about, right? To sleep. Yes. And, um, when she left the emergency room, did you call her an Uber or have Pat come and get her or call your husband to come get her? No, she left in her own car, right?

Correct.

Um, and so fair to say, after that ER visit, you, you remained in pretty constant contact with her, at least via text message, right? And that you would check in with her pretty much daily. And that's all in these texts?

Yes.

Now, you were familiar with the Perinatal Behavioral Health Clinic because of your work at South Shore Hospital, correct?

Yes, correct.

And so the person actually that you connected with first was not Julie Paul, was it?

No, it was one of the midwives that I was working with.

And her name is Nanette?

I think so.

And so did she provide you with Julie Paul's contact information?

She suggested Julie.

Okay. And as a result of these— the suggestion, you reached out to Julie with Lindsay's permission, right?

Yes.

And, um, you said that at that point you made the contact, knew she had spoken to Julie, and you kind of stepped back from the clinic.

Yes.

You're aware Julie Paul is one of the only prescribers that the defendant encountered that's not personally named in a civil lawsuit that's pending, don't you?

I'm not sure.

Now, um, so the ER visits on the 16th, uh, contact is made with Julie Paul on November 20th, right?

It sounds right.

Okay, um, and that would have been your phone call to her first?

I don't remember exactly.

Um, in the time period, well, you know, she was going and getting, uh, going to see providers and meeting with Julie and going to the clinic. Um, did you offer to help out more with the kids?

Yes.

Um, you were still working full-time at that time, weren't you?

Yes.

So fair to say it was kind of limited based on your schedule?

Correct.

Did you have a normal schedule that you worked at that time period?

I don't know what you mean.

Well, um, as a nurse, did you, did you work day shifts? Did you work?

I work the day shift.

Um, so did you offer to watch the kids at nighttime?

I don't remember exactly.

Did the kids come to stay at your house overnight so that she could get some sleep?

No, they didn't.

Fair to say you offered and she didn't want the kids to come to your house, right?

No, that's not right.

Well, were they, um, did they ever sleep over your house?

No, they didn't.

And Cora was 5, right?

Yes, correct. She turned 5 that December.

So at any point they never stayed over?

We decided together it was best for them to be in their own beds at their own house with all the belongings weddings, and Lindsay's parents were very actively involved in staying over and helping out. So it was the best decision that they stay home in their own beds.

So prior to the, um, November of 2022, did you and your husband ever come and stay over the night so that Patrick and Lindsay could go off?

We never did stay at their house.

And as far as kind of watching the kids or taking the kids outside of the house during the daytime, did you often take Cora on kind of day trips out to lunch?

Yeah, we used to go to lunch together.

How about Dawson? Did you take him one-on-one out to—

not as much, he was younger.

And how about Kallen? Did you ever take him out of the house without Lindsay?

No.

And are you aware that, um, Lindsay told one of the therapists that she wasn't close with you as in-laws, and that she—

I didn't know that.

No, that she said she doesn't generally allow the in-laws to watch her children.

I did watch the kids.

Okay, but are you aware that she told the therapist that?

No.

Are you aware she told the therapist that she didn't have any particular reason why and that they don't bug me about it either?

I don't— I didn't know any of that.

Now, um, Lindsay, uh, the defendant, she communicated with you via text about her issues with sleep and the medication she was taking, right?

Yes.

And as far as the ER visit where the Trazodone was prescribed, do you recall having a back and forth conversation with her about that it's okay to increase it, um, if you weren't getting any relief?

The doctor told her that, so I repeated that.

Okay. Um, and so you're aware that she was in fact increasing the dose?

I did not know that.

Now, um, once the defendant— once she was seeing Julie Paul, did you continue to have conversations with her about how she was feeling?

Yes.

And, um, you knew that she was taking some new medications after she saw Julie, right?

Yes.

And so these pages are different. At some point, um, after being prescribed some medication, um, you recall that, um, Lindsay told you that she thought she developed a benzo dependency, correct?

I vaguely remember that.

That would be on November 29th, where she says, I just deep down inside of me feel that I've developed a benzo dependence after just 2 weeks of using it, and I feel like no one is hearing that and addressing it, and we keep throwing different meds in the mix that aren't really addressing the real issue. Do you recall that message?

Sounds familiar.

And she asks you, or are you— you respond so hard, I don't know what to do, so should you not use it? And she responds, I guess not, but then I don't sleep, right? Do you recall that?

I, I can't say for certain. It sounds right.

Okay.

I don't remember a lot of specifics.

And November 30th November 30th, she says— and I'm just gonna— she says, I'm not okay and I'm terrified of taking meds tonight. Do you see that in the green?

Yes.

And then your response is, why are you scared? What happens if you don't take them? What are you afraid of? What about Ambien? Right, you're actively trying to help her kind of figure out the medication.

Yes, there were a lot of medications.

Okay, um, you're aware she wasn't prescribed all the medications at one time, but just a lot of different combinations were kind of thrown around as options, right?

It seemed confusing.

Um, that she also— she's very clear and she tells you which medications she's taking, right? Ativan and Remeron, probably.

Okay.

And then she also tells you on November 30th, when you're talking about it, she says, I know they take time to reach a therapeutic level to have the desired effect, right? Do you remember that?

Yes.

And then you respond, exactly. And she tells you that she's just, um, depressed and she thinks it was brought on by the medication, right?

I don't remember that.

Okay, well, on November 30th at 7:52, I was never ever this depressed. It was brought on by the medication. Did you say that or did she say that?

She probably said that.

Now, you were asked about, um, the holidays and Thanksgiving. You remember Thanksgiving? Where did you guys go for Thanksgiving?

To my daughter's house.

And, um, do you remember telling the grand jury that during Thanksgiving things were better?

I don't recall.

Well, do you remember saying that she, she said things were better? Do you remember that?

Vaguely.

Okay. Um, you were asked, what was Lindsay like during the big Thanksgiving gathering? What observations did you make? Answer: She smiled. The girls all had Thanksgiving t-shirts on that sort of matched. We took a picture. She mostly focused on the kids and interacting with the cousins and the aunts and uncles. At one point she went off a little into the distance and I approached and asked her how she was doing and she said, "I'm trying hard to get better. I'm still working at it." I asked about her sleep. I thought that was important. And also the fact that she lost some weight. She didn't have an appetite. And she said things were getting better.

Okay.

Now, during the holidays, you in fact took some time off of work so that you were around a little bit more, correct?

Correct.

And so when you were around a little bit more, did you spend all day every day at their house?

No.

Um, fair to say you would come sometimes play with the kids, right?

Yes.

Do shopping for her?

Correct.

And then you actually went on vacation?

Yes.

You and your husband went to Aruba?

Yes.

How long were you in Aruba?

5 or 6 days, I think.

And, um, now moving towards Christmas, you had dinner with them at their house on the 23rd, right?

I don't remember.

Okay. Um, do you remember breakfast on Christmas Day?

Yes.

Was that at their house or someplace else?

Their house.

Okay. And then what did you guys do after breakfast?

We went to church.

And, um, fair to say you've previously testified that breakfast was great?

Yes.

And that church was beautiful?

Yes.

And in fact, um, the defendant, she told you that it was great and that she was glad she went to church that day on Christmas?

Yes, she did.

And then after that, you're aware they went down to Connecticut to see her family, right? Um, now, are you an active member in the Catholic Church?

Yes.

So you're, um, aware that murder is considered a mortal sin? Yeah.

Counsel, could I see you over here?

All right.

And what that means is you are not to consider it for any reason or any purpose. Okay.

All right. Counsel, so you were aware, Mrs. Clancy, about the stay at McLean Hospital from January 1st to January 5th, correct? Yes. And, um, did you come to the house to help with the kids during that time period?

Yes.

Um, and fair to say when she came home on the 5th, there was a party for Cora on the 7th?

Yes.

Did you go to the birthday party?

No.

Um, were you at the house much between January 7th and January 24th?

I don't remember.

Do you recall previously, um, reporting that you hadn't been at the house?

I don't remember.

And during that time period, you never took the kids on a day trip or for a visit?

I don't recall.

And were you aware that between January 7th and January 24th that Pat and Lindsay went to the Cape Codder with the kids?

I'm aware of that.

And that they went to the Museum of Science with the kids?

Yes.

And that Pat left, um, Dawson and Callan home— or excuse me, left, um, yeah, Dawson and Callan home to go take Tori skiing. Were you aware of that?

It sounds accurate to me.

On the ski trip, did they ask you to come over and stay with Lindsay while she was with the other kids?

I don't remember.

And, um, you were asked on direct examination about Lindsay going to see providers, and you said, I think, she was begging for help, right?

She was.

Um, you— did you attend any of those meetings with her therapist or doctors?

No.

So you don't know what she told the providers, right?

I don't know.

And you don't know what kind of help she asked for other than medication, do you?

No.

And do you know whether there was any option, other options offered to her other than McLean, like a partial hospitalization program or intensive outpatient? Were you aware of those options?

Yeah.

And do you know she went?

She went to Women and Infants.

So that's the one day where Pat dropped her off and went skiing and then came back, right?

I believe so.

And nothing further.

All right, Mr. Springsteen, redirect.

So you She asked you about options that were available to Lindsay, correct?

Yes.

You mentioned one of them was that she could go to the Women and Infants Program in Rhode Island that specializes in perinatal and postpartum, right?

Yes. Yes.

You also know that they gave her numbers to call suicide hotlines, right?

Yes.

She called twice, not once but twice, and again was turned away. Isn't that right?

Yes.

Thank you, ma'am.

Come on.

So you're aware she was turned away because she told you she was turned away, right?

I don't remember the details of that visit or that day.

You didn't review the records, did you?

No.

So you're not aware that they actually, um, deferred to Pat and Lindsay reporting over medication?

I remember something being said that she wasn't a candidate for that program. That's what I recall being told by Patrick and Lindsay.

Okay, and that's because she— everything she described was reported connected to medication and occurred well after what's considered the postpartum period, right?

I don't know.

Well, you're a labor and delivery nurse, you know the postpartum period could be up to a year, right?

I've heard it could be longer.

Um, but generally it's within the first 12 weeks that you start to see some symptoms.

I don't know.

You're aware that, um, she was sent from Women and Infants with actually several options where it included inpatient treatment for medication management, a partial hospitalization program focused on general mental health, or continued outpatient management. That's, that's what she was sent away with. Okay, nothing further.

May I?

One more.

Good.

One.

So outpatient management, that would include somebody like Gelada, right?

Yes.

You know that Women and Infants called Gelada and she never called them back?

I didn't know that.

Come up. Anything on that?

No.

All right, thank you, ma'am. Let me step down. Thank you.

All right, all right.

Well, members of the jury, this is one of those stops I told you about. We're going to have kind of throughout today. So I'm going to ask you to go back to the jury room, uh, hopefully just for a short amount of time, and we'll bring you right back in and we'll continue, uh, with the evidence.

Okay.

All right.

All right, counsel, I know that the, uh, the next, uh, witness, uh, is scheduled to be Dr. Lopesada.

Yes.

Um, and she will be testifying, uh, by Zoom.

That's correct.

Um, and I think at some point after we talk a little bit, we're gonna take a short break just to make sure that, uh, logistically everything's all set up with the doctor and the system here. And I appreciate everybody's help technically in setting that up. And I know that the defendant has provided, I don't know, maybe 5 or 6 exhibits that counsel wanted to introduce through Dr. La Pasada. And so I guess Commonwealth, have you had an opportunity to take a look at these?

Yes.

And we are objecting to these items.

No.

All right.

And so why don't we discuss those here in open court and go through it? And so I've had the opportunity to see these this morning as well. And so, Commonwealth, why don't I hear the objections and then I'll hear from, um, the defendant.

The main objection is that the drawing is inaccurate. The window well is in the wrong place, and where they have her falling and landing in slide 4 would be where the window well is actually placed in the photograph. I can pass up the photograph to the court. This is in evidence, I believe, um, maybe a couple times. But chalks are discretionary, but what they should not do is mislead a jury and present information that's not accurate. And so the drawing itself is inaccurate, and so we're objecting to these slides.

Is that the Commonwealth's objections, that the window well is in the wrong place on the drawing?

Putting aside the late disclosure and the fact that I don't know if anyone who created this is going to come in and testify that they created it and whether it's to scale or not, but the main objection is that it's inaccurate.

All right, Mr. Rankin.

Thank you, Your Honor. Obviously, um, the window well, um, you've got— this thing is ridiculous— here's the diagram we're talking about. The, um, window well— I'm just gonna— you already have a copy, right?

I do, yeah.

The window well is depicted on the diagram, I suggest, accurately, and in fact measurements were taken by the gentleman who did the computer animation in conjunction with information by way of medical provided by Dr. Laposata, and it shows clearly that, as Your Honor can see, that We're talking about the x-rays that are included. There are exhibits that she attaches that shows the way that she falls, how she hits her head. The Klemelovs has been suggesting that, I guess, that they are confused as to how she would have ended up the way she did. This shows the way that she landed on her head, gets the Jefferson fracture, falls back, legs are facing out from the house, she's laying in the snow. They're all depicted there. If there's an issue with the window well that's off according to the government, they could raise that on cross. They could say, well, the window well was really 6 inches to the left instead of to the right. That never struck her anyway. It's totally irrelevant. Um, I think that they are useful for a jury to be able to review. I did have copies made for the jurors and the court as well as the DAs, um, and Dr. Laposata has it.

And then I could go, you know, I could go through, but you can see that we've taken the, the diagram, the window where the body lands, and then to the right of it would be the actual X-ray. Dr. Laposata can compare the injuries, talk about the, the Jefferson fracture. There's a photograph that shows the blood in the snow shows the area in the photograph actually shows the, shows the window well. And I suggest the window well on page 6 is exactly the way we have it depicted. So I don't know what the objection is. I would ask that the court would allow this to be in.

All right, well, I, I guess it appears to be slides 4 5 and 6 certainly, um, go towards the, the doctor's opinion as we said, the mechanism of the injury that shows the, um, the head striking of the ground. And then on the other part of the slide has the X-rays, and there's also a slide regarding the Jefferson fracture diagram, um, and then 5 is a diagram showing how the thoracic spine injury could, could have occurred, uh, and there's a diagram regarding the thoracic spine, specifically T6 Um, and then, uh, slide 6 shows the— and I think there has been testimony as that's— that is where the defendant was found. And also then there's a thoracic spine. I think it's either an x-ray or some type of scan, as well as some of the additional medical devices that were found in that area. Um, I, I'm not quite sure about 1, 2, and 3. Um, that's, that's fine.

I, I can remove 1, I can remove 2, and we'll just, uh, focus if you want on 3.

I think that goes more towards the doctor's, um, background and kind of what had been offered in regards to the, uh, her opinion.

Your Honor, I think you said you were unsure of 1, 2 and 3.

Yeah.

And defense said he could go with 3, 4, and 6— 3, 4, 5, and 6. So 3 was an issue, was it not?

Well, I, I, I think again, I think 4, 4 kind of would cover what's— let's deal with that. All right, so, uh, so I would allow in slide 4, Slide 5 and Slide 6.

Okay, thank you.

Okay, and so what we'll do is— yeah, objection noted. And then what we'll do is take a short break at this point, set up the Zoom call. Also, I know we're going to have to probably make certain changes to the jury book that was going to be presented. So the only slides that will be in that book will be, like I said, just so we know. Yeah, just so we know which ones you're talking about.

Okay, there's a book. Well, no, it's just— it's not a book, it's just borrowed, stapled together, the— all of the exhibits.

All right, so just so we know what we're talking about, right? 4 and 5 is the thoracic spine.

Yeah, so like I say, I I've got enough for the jurors plus you and the DAs.

Okay. And then 6. I just kind of want to make sure that we're all talking the same.

Okay.

Thank you.

All right, so why don't we do that? We'll take a short break so that those changes can be made and we can set up for the Zoom, and then we'll come back out and we'll proceed with Dr. Lopes.

Thank you.

Okay. All right, thank you.

All rise. This court is back in session.

You may be seated.

All right, are we ready for the jury?

Yes, we have some kind of background noise. I don't know if there's anything that can be done with it.

I know, I'm not sure. I'm probably the wrong person to ask in regards to that.

I'm right behind you.

Hello?

Wait a minute, hold on.

Have a nice day. Is anyone there?

Hold on, Doc.

I'm not sure this is going to work at this point, so why don't we see if we can get somebody to address this? Because we will get it done. —but we can toss them at FDR or somebody. So why don't we take a further break? We'll figure this out. I'll ask Krug. Yeah. All right.

All right.

Thanks.

All right. So I think probably it makes more sense to address the whatever the technological issues were in the Zoom. Maybe that could be done during the lunch period, um, and then we can go forward. I know the defense next witness would be— is it Dr. Condi? And I know that we had talked about, um, a possible voir dire in regards to Dr. Condi. Um, do the, do the parties see the need for, um, the doctor testify that, or maybe we could just hear the offer of proof for what the expectations of the testimony is, and then we can—

Hi.

Yeah, so the objection is that we were provided with an affidavit, the original affidavit that was provided, um, counsel agreed that it referred to standard of care, which is not the issue in this case, really reflects his opinions in a civil case. So we were provided another affidavit which appears to factually have the same number of paragraphs and just deletes the ultimate opinion section and adds that Dr. Tufts and Nurse Gelato were aware that Lindsay was experiencing symptoms of suicidal ideation and a critically deteriorating condition while under their care and failed to take reasonable steps. So it's unclear from his affidavit what exactly he's going to testify to. Is he going to just reiterate everything that has been presented in the records, everything that we would expect defense counsel to offer through expert testimony in the criminal responsibility error about the medication regimens that the defendant was on over the course of several months? Because if that's the case, then I would suggest that the that this is cumulative testimony and that it didn't— it doesn't need to be presented in this manner to the jury.

But let me ask this, similar to the question I asked earlier, um, to a similar objection regarding cumulative. The defense hasn't put it— this isn't the— this is their first witness in regards to that. Wouldn't the cumulative analysis be done if there's a follow-up expert that would be addressing these areas?

Potentially, but that then becomes the defense's strategic choice about whether— if he's— if they're going to call Dr. Condi for this piece of it and the other experts for another piece of it, it's unclear, especially where the reports we've been provided by Dr. Spinelli, um, and Dr. Zyzel talk about polypharmacology as part of the basis of their opinions in this case. So it's, it's difficult to assess that, and obviously flagging it and objecting at this point based on what we know the anticipated evidence to be. So I don't know if a proffer is necessary at this point to outline what exactly he expects Dr. Condi to say and how that differs from the opinions of the other experts.

It seems to me that the main objection may lay in regards to Dr. Spinelli then, whether or not— it depends on what her testimony is and how that overlaps with whatever Dr. Condi's is at this point.

Yeah, and I appreciate the fact that you recognize that we have not yet put on a doctor yet. I don't have to accept their evidence. I don't have to accept their doctors. Our doctors— this is our first doctor who is a very qualified psychopharmacologist. I expect to elicit from him the treatment very briefly that she received and the medications that she was on and the the effect of these medications as it relates to her condition when she was seeking medical help. That's it. I'm not going to get into criminal responsibility with him. I'm not going to get into lack of criminal responsibility with him. Basically, psychopharmacology and the treatment that she received. He's not going to, you know, be criticizing what Jalada did, what Tufts did. He's just going to detail her condition according to the medical records and the medications that were provided. I am well aware and very experienced in trying jury cases and know when you lose the jury. I know when you— I'm not going to have Dr. Zisel and Dr., uh, I'm not going to have Meg Spinelli wax eloquently for hours and bore the jury to death. I'm going to get right to the chase.

Dr. Spinelli is a well-qualified doctor on, on the issues of postpartum psychosis and postpartum depression and treating a pregnant woman and/or postpartum, uh, perinatal, uh, client or patient. Dr. Zisel is a general psychologist and will be discussing a number of issues, as you're well aware, because he's been involved with Lindsay for literally 3 years. 46 times he's seen her or something like that. So I'm going to focus their testimony on those fields. I don't think it's necessary for us to have Dr. Condi get up here on a voie dire so that they can hear what he's going to testify to. I'm not going to have him rambling or going off the script. He signed an affidavit, which is even, I think, better than a medical report, you know, that you usually get. So they, they have plenty to cross-examine him from. All right.

And the intention is not to ask the question regarding standard of care. That's correct.

All right, all right.

So, uh, over the Commonwealth's objection, I'm going to allow at this point Dr. Condi's testimony, um, in line with the affidavit, basically in line with that affidavit, with the, uh, with the holding he's not to testify as to the standard of care. Opinion as he had the original statement.

Can I just tell him that to make sure?

Sure. Right. So with that, counsel, we ready for the jury?

Yes, we are. God bless you. Can we approach? Sure.

Yeah. Uh, and basically the real problem was, uh, a technological issue. It was going to be a Zoom call. There's been some problems. We're going to try and work on that. Instead of going with that witness, we're going to go on to the next witness, and then we'll put the, the technological problems for later. All right, so with that, uh, Attorney Reddington.

Yes, thank you, Judge. Um, all right, good morning, Doctor.

Morning, Your Honor.

Hi, Judy Rankin. Thank you, Judge. Um, Doctor, could you, uh, keep your voice up so all the jurors and counsel can hear you and tell us your name and spell your last name?

My name is Donald Condie, C-O-N-D-I-E.

And tell us, uh, what do you do for work, sir?

I'm a child, adolescent, and adult, uh, clinical and forensic psychiatrist.

And can you tell us your, your background as to where you went to school and when you get your medical degree and things of that nature?

I graduated from Tulane University, then spent some time at, uh, in graduate school at the University of New Orleans, then went to medical school at Louisiana State University in New Orleans, and then I came to Boston to the Massachusetts Mental Health Center, uh, to train in psychiatry. And where is that? Uh, the Massachusetts Mental Health Center was at 74 Fenwood Road. That building has been demolished, and now they're at 75 Fenwood Road in Boston.

I was referring to more like, is that affiliated with any particular medical schools? Uh, yes. What is it? Uh, Harvard. And what years were you working at the Mass Mental Health Center affiliated with Harvard?

I started, uh, there after medical school. I graduated in 1982 from medical school, was an intern in 1982 to '83, um, and that was a Harvard-affiliated internship, and then residency was, uh 83 to 85 for adult training, 2 years. Then '85 to '87, which is 2 years of training for child and adolescent. Then I did a forensic fellowship also at the Mass Mental Health Center. And during that year, I spent some time at Harvard Law School as a visiting fellow.

And do you have, or did you have, any board certifications that you can tell us about?

I'm board certified in adult and child and adolescent psychiatry.

Do you have a particular focus also on medications that are utilized in the course of psychiatry?

Yes, I've spent a great deal of my career treating people in the state system with psychotic disorders and mood disorders. Disorders.

Tell us a little bit about that. Was there one particular period of time that you worked with literally more than 100 people that had serious psychotic disorders?

Well, the Massachusetts Mental Health Center was a state inpatient facility, so we had many people with either no insurance or MassHealth insurance. Probably at least half of the patients at any given time would have had psychosis or a major depressive disorder.

Have you, in the course of your career, following through on psychosis or major depressive disorder, had any focus or treatment on, on women that are either pregnant or have had little babies and they looking for help in the postpartum period. Yes. Tell us about that.

Well, starting in my residency, so in 1983, we had several patients at the Massachusetts Mental Health Center who were pregnant and were also sometimes afflicted with psychosis. We also had people people who had delivered a child but were then hospitalized, sometimes with a psychotic depression or sometimes with simply suicidal ideation. And I've encountered that very frequently since then. I was for 14 years the Chief Medical Officer of VinFen, which is a very large agency with contracts from the Department of Mental Health and the Department of Mental Retardation in Massachusetts and in Connecticut. We ran about 350 group homes, about 10 people per home, so maybe 3,500 patients. We frequently had people who were pregnant and were taking medications for psychosis. Sometimes after delivery, the severity of their psychosis would increase. So I'm fairly familiar with that phenomenon.

Uh, Doctor, how many years have you actually been practicing now as a physician?

I've been a licensed physician in Massachusetts since 1983.

So what's that, uh, '83, '90, 2000, 2026?

Okay, about 40 years. A little more than 40 years.

Okay. From 1990 through 2012, were you affiliated with, um, forensic child psychiatry with Mass General Hospital? Yes. And were you also affiliated, uh, through 2013 with Mass General on, uh, forensic case consults? In this field? Yes. All right. I'm asking, have you had occasion to make a number of presentations? We have to go through them, but did you make a number of presentations and working as a lecturer for various medical schools, law schools, things like that?

Yes. My— well, during the time that I was At Mass General Health Center, I was, uh, a fellow at Harvard Medical School.

What does that mean, to be a fellow?

Uh, it means you're a resident in a training program and you're teaching Harvard Medical students, uh, things about the specialty in which you happen to be practicing.

And what was the specialty that you were a fellow lecturing Harvard Medical students about?

First it was general psychiatry, then it was child and adolescent psychiatry. Uh, and then it was forensic psychiatry.

Um, you also have had, uh, various scientific and medical publications, um, that you have, um, been authored on a number of occasions, articles. Is that correct? Yes. All right. Your Honor, um, I don't have to— his CV, if I could, just if, uh, as an exhibit, if that's accepted. Come on.

Objection. Okay, that may be admitted.

Thank you. Now, Doctor, if you can tell me, um, do you know— not necessarily personally, but do you know of Lindsay Clancy?

I know about the case, uh, in general, but I don't know anyone personally.

Now, you have never met her? Is that correct? That's correct. You've never talked to her, right?

Never have. That's correct.

I have not. I consulted with you for purposes of psychopharmacology and issues like that in this case. Is that right? Yes. Fair to say that we've had a number of conversations in the evening, off hours, about various medications administered to women that are pregnant or postpartum. Is that right? Yes. Excuse me. Can you tell the jury, um, in a summary, what documentation, uh, medical records, police reports, things of that nature on this case that you've had a chance to review?

Well, I've, uh, reviewed the records of, um, Rebecca Gelada, the nurse practitioner, um, Dr. Jennifer Tufts, the psychiatrist that saw Miss Clancy. I've reviewed the Brigham and Women's Hospital records, um, and the, uh, Women and Infants records. I've reviewed the McLean records, uh, and I might be leaving something out.

You know about her background as far as her employment as a labor and delivery nurse and her family, her 3 children, and her husband that she was married, right?

Yes, I'm familiar with that.

Okay, so if I could, Doctor, direct your attention to, um, let's say the fall of 2022, end of September. Um, can you tell us what Lindsay's status was as far as maternity leave with work and any complaints that she had at that time regarding her mental state. From my— excuse me, could I get some water?

We've got some on the way.

Thank you. Thank you. Appreciate it.

Sorry, my allergies are kicking up. So from my review of the records, which would start with Dr. Tufts, records. My understanding is that, uh, Ms. Clancy was planning to go back to work as a labor and delivery nurse at Mass General. She worked, I believe, the, um, 12 midnight to 12 AM shift, um, and she began to experience As she had to some extent after her first two deliveries, some postpartum anxiety, and consulted Dr. Tufts at that time.

Now, after she had her third child, Kellen, was she in— would you strike that? It's fair to say she was in treatment with Dr. Tufts as a treating physician. Yes. Okay. Um, and looking at your, your affidavit, I believe in paragraph 9, did you determine from looking at the medical records as to the time frame that Lindsay treated with Dr. Tufts? Yes. And what was that?

She started in the middle of September 2022, and I'm sure that her last appointment was January 23rd, 2023.

Now, did you have a chance to review Dr. Tufts' medical records? Yes, I did. Can you describe them for us, please?

Uh, they are somewhat sparse, and there are many checkboxes in the records but not a great deal of sentences that describe what was done during sessions.

Were you aware that the sessions that Dr. Tufts conducted with Lindsey from September, the end of September, up through January 23rd, were all tele—

televised on a computer? Yes, they were all video.

Um, do you recall the medications that Dr. Tufts prescribed, prescribed Lindsay?

I believe the first medication she started was Zoloft, 25 milligrams.

And what does that— tell us what Zoloft is. What effect does it have on a person? I'm sorry, what effect does that have on a person?

Well, Zoloft is a selective serotonin reuptake inhibitor. Which is a type of antidepressant that started being used around 1988, I believe. Prozac was the first one, Zoloft was the second. When it works to be helpful, it combats both anxiety and depressive symptoms that people might have. It also has in some people an effect of causing a feeling of jitteriness and increasing anxiety. So it's something that does have some potential side effects as well as beneficial effects.

And when she was prescribed the original 25 milligrams of Zoloft, did she in fact take that, or did she defer on taking that?

My recollection of the records is that she had it prescribed, picked it up, but did not take it for at least a couple of weeks because she did not wish to take medication. She was, I believe, still breastfeeding at that time. Um, there are medications, and Zoloft would be one, that would likely appear to some extent in the breast milk.

Okay, so because she was worried about that, she held off on that but ultimately did take the prescription from Dr.

Tufts, is that right? The records indicate that she did eventually start taking— does it indicate—

25 milligrams. Sorry, does it indicate when she started taking them after that little hiatus?

To be exact, I'd have to look, uh, at the records, but I believe it was at the end of September.

And was that dosage increased at some point?

It increased from 25 milligrams to 50 milligrams.

And what happened when Lindsay took the 50 milligrams of Zoloft prescribed by Dr. Tufts?

The records indicate that, um, she had a rather rapid, uh, series of difficulties, that she had insomnia for, uh, I believe the records say 48 hours. Couldn't sleep. Um, it's something that would be called activation that these medications can cause in some people who are more susceptible.

By mid-October, um, after she began taking the Zoloft, was it— would you agree that the records indicate a week after starting the medication and increasing the dose, she reported in October to Dr. Tufts what you're relating, is that she felt How did she describe it to Dr. Topps? If you could— I don't want to put words in your mouth.

Well, she felt that she was— she talked about being numb. She talked about not being herself. She talked about feeling worse, not better. Antidepressants usually take at least 2 to 3 and frequently 4 to 6 weeks to have useful effects, but sometimes, uh, side effects can happen very quickly.

Did she also indicate, looking at your affidavit, that she was crying all day, she was experiencing mental fog, terrified to start something new, anxiety had gotten much worse? Did she tell that to Dr. Tufts at that time, in the end of October?

Yes, I do recall those things being in the record.

All right, and following through again on your affidavit, was there further explanation from Lindsay's recitation of symptomology to Dr. Tuffs? Did she further state about racing thoughts, paranoia? What did she say? She's gonna get your report. Look at your affidavit if that helps you refresh your memory.

I actually don't have the affidavit with me at the moment.

Um, I do have some of the records, but, um, well, let me just approach you then and hand you your affidavit, paragraph 13, and see if that refreshes your memory.

Thank you. Yes.

What did she say to Dr. Tufts?

She reported— uh, Dr. Tufts reported that Lindsay's psychiatric condition was generally deteriorating. That's a check box on one of the forms that her records—

what did Lindsay say her symptoms were at that point?

That she was having, um, the racing thoughts and that she was also, uh, feeling, as I said, not like herself. Um, that her depression was worse than it had been. I believe that's also around the time that Dr. Tufts thought of trying a medication called Zolresso. Zolresso? Yes. And what is that?

Is that— you need that by way of injection? Uh, yes.

Zolresso is no longer marketed. Um, it Wasn't a particularly successful medication.

It requires a 60-hour continuous IV infusion in a hospital setting or in a medical setting. So she didn't do the Zolresso though, right?

She did not. It also costs $34,000 just for the medication, not for the monitoring.

Okay, um, what's the next thing that happened with Dr. Tufts and Lindsay Clancy, sir?

Well, if I look at my affidavit, the, um, when she stopped taking the, uh, medication, the Zoloft, um, she now felt better as she had felt before she took the Zoloft. But she was less anxious. What was the next medication? She was put on Benadryl and had some difficulty sleeping, but also was worried that night because her son was coughing. And she worried a great deal about the children's health.

And that would be something that would also intrude on her, her sleep, worrying about her children? Yes. Okay. What other symptomology traveling through November into December did she relate to Dr. Tufts according to your review of the medical records?

Well, she talked about things like dizziness, um, feeling sedated in the morning when she woke up if she got any sleep at all. But, and I think she used the term brain fog at times. These are sometimes symptoms that people who are experiencing postpartum depression frequently complain about. She continued to complain about anxiety.

Well, it's not what they're complaining about, it's what they're living, right?

It is a very unpleasant experience, yes.

And, and continuing on through November, uh, at some point did she leave or stop with Tufts and go to another healthcare provider by way of either emergency room initially and then another healthcare provider? Yes. Who was that?

She started, uh, treatment with Rebecca Gelada, a nurse practitioner at South Shore perinatal program.

Now, one of the things that was apparent that we— if you recall, I believe that she also had initially been referred there by a friend of the family.

Is that right? To that perinatal clinic? Yes. My understanding from the records is that, um, uh, Miss Clancy's mother-in-law was friendly with a nurse practitioner who practiced in the perinatal program, and I believe it actually started the perinatal program.

Yes. And ultimately, or in the beginning, she was treated by a Julie Paul, is that correct? Yes. Do you remember looking at the medical records, uh, and that on November 27th, 2022, nurse practitioner Julie Paul reported that Lindsay stated that she was, was disassociated she was not in touch with reality. Do you remember that? Yes. And what— is that a symptomology? Is that a symptom of psychosis, to be disassociated and not in touch with reality?

It certainly can be. Dissociation, um, can mean that people feel like things around them are not real, right?

And that's pretty serious. Feeling to have, right? It is. And that's pretty common, unfortunately, with, with women that have postpartum psychosis, right?

It certainly can be, yes.

And what are the other symptomologies of postpartum psychosis, sir?

Well, psychosis in general just means a lack of understanding of what's real as opposed to what is not. So a person with psychosis can have delusions, which are fixed false beliefs. They could believe that, for example, they have been told by God to do something. They can also have hallucinations at times. What kind of hallucinations? Most people have auditory hallucinations, not visual hallucinations. Is that correct?

Auditory is hearing, right? Yes. Okay. As opposed to what?

As opposed to visual hallucinations.

Visual. And in the course of reviewing the medical records, did you see that in fact that Lindsay had auditory— no, no visual hallucinations, but auditory voices?

At times she reported that she had heard a voice, yes.

Okay. Do you recall that as the time went by, that she— in December, do you remember seeing in the medical records that she was relating, that she was heavy, that she couldn't get out of bed, that she couldn't bathe, that she couldn't react, she couldn't love, she couldn't feel? Do you remember any of that from looking at the medical records?

Yes, those are all phrases that I recall from the medical records.

They were all coming from her, right? Yes. To the doctors? Yes. That would be Dr. Tufts and then Dr. Jalada, is that right? Nurse Jalada. Sorry, Nurse Practitioner Jalada. You recall, sir, that Nurse Practitioner Jalada prescribed additional medications to Lindsay during that period of time from November through December?

Yes.

Tell us what they were.

I'd have to look to be sure, but, um, I believe she continued the Benadryl at times, and there was some talk about the use of Buspar, but I believe that was Dr. Tufts.

About the what? I'm sorry, I said it. I'm sorry, what was the word you just used?

Oh, uh, sorry, Buspar, which is the brand name for buspirone, which is an anti-anxiety medication.

All right, how about Remeron? Was there ever a prescription for Remeron?

Remeron is a different kind of antidepressant, uh, which helps people sleep a little bit and also sometimes helps their appetite. Yes, that was another—

the answer is yes, she was prescribed Remeron. Yes, she was. And that's an antidepressant? It is. Is that mocking or similar to, but not exactly the same as, the selective serotonin reuptake inhibitors, Zoloft, Prozac, things of that nature, right?

It's similar in the sense that it has an antidepressant effect, uh, it has some effect on serotonin It has some effect on the adrenal— adrenergic system as well. What? The adrenergic system. Adrenaline is a neurotransmitter. It's also a hormone that circulates. If you are suddenly scared or something like that, you get a surge of adrenaline. So if you were in a near-miss car accident, you might find yourself shaking. Because adrenaline will flood into your system from the adrenal glands, but it's also a neurotransmitter, and mirtazapine has some effect on that.

Mirtazapine, is that the same as Remeron?

Yes, sorry. So it's two different names, generic and not generic. Mirtazapine is the generic name, and I was taught to use generic names, but yes, Remeron is.

Around this time, Lindsay has been prescribed the Prozac, she had been prescribed Remeron, she had been prescribed Benadryl, she had been prescribed other medications very similar to the SSRIs. Is that correct? Yes. All right, and does the selective serotonin reuptake inhibitor— that's fancy word, what does it mean? Isn't that serotonin in your brain? Doesn't it block or in some fashion affect your brain?

It's a little complicated to explain, but serotonin Okay, serotonin in this sense is a neurotransmitter. Uh, the brain is a relatively complicated place. It has about 86 billion nerve cells. They've got thousands of connections to each other, but they're not like the wires in your house where you put two pieces of wire together, twist the copper, and then put a nut on that. Uh, Nerves don't touch, they go close to each other, but there's a space between them, and that's called the synaptic cleft. One nerve secretes a neurotransmitter into the synaptic cleft, and it moves over to the next nerve in line where there's a receptor. Serotonin does that in the synaptic cleft, but it's also taken back up by the nerve that secreted it as a— so it's reuptake. So a selective serotonin reuptake inhibitor slows down the reuptake of serotonin, prolonging its activity in the synaptic cleft, which causes the next nerve in line to be activated. I'm sorry that it's so complicated. So that's what serotonin is doing, and that's what a reuptake inhibitor does.

Or has just had a baby. Can you tell me what effect, for example, hormones have when a person has a baby? I know two guys, but I mean, do you know what happens when a woman has a baby?

I've been at quite a few deliveries, yes. Okay. The The fact is that many hormones increase. So progesterone is a hormone that many people have heard of. It's a component of birth control pills because it promotes gestation. So progesterone in a birth control pill fools the body into thinking it's pregnant, which means it doesn't— the womb doesn't produce eggs that could be fertilized. And that's the way the birth control pill works. Or some of them do. Progesterone goes down very quickly after birth, as do many other hormones that are, that are going up and then down after birth.

So if the hormones go up and if there's an overload, if you will— might be the wrong word— of hormones, what effect does that have on the human body? What effect does that have on a woman who's just had a baby?

Well, it's quite complicated.

Just tell us basically what your feeling is that they want to get into it, they can ask. But what, what effect does it have on a woman that has a baby?

Well, uh, one of the other hormones that goes up is prolactin. So after the woman gives birth, prolactin promotes lactation, and it's a hormone that increases so that the mother can then breastfeed. These hormones are also seen in all mammals that feed their young through producing milk. So it's a very common mammalian thing to do, but other kinds of things can happen to—

did you say males or mammals? Mammals. Okay, because males don't breastfeed, right?

I'm sure they don't, yes.

Okay, so as far as the hormone, again, I would ask when When a woman has a baby and the placenta, I think I pronounced that right, is through the birth, all of a sudden what happens? It stops that massive influx of hormones or it increases that influx of hormones?

Well, some hormones go up like prolactin and some hormones go down very quickly.

What effect does that have in your experience and your education and your research on women that have a baby? What effect does that have on them?

Well, many women experience postpartum blues. What is postpartum blues? It's a feeling of—

I'm sorry, sounds like a '50s thing. What's postpartum blues?

It's a feeling of low energy and being sad. Not as serious or usually as long as postpartum depression.

What is postpartum depression? Is that the next level?

It's a more serious condition where the woman may feel that she can't connect to the baby, that she feels isolated, she has no energy, she may also have insomnia.

So for example, if a woman is, is unable to sleep, feels as though she's losing a contact or connection with her infant, is stressing about not having that contact with her infant, feels that she's unable to emote or feel love or any emotions and can't relate to people, and also is out of reality— is those a dissociative state? Are those, in your opinion, symptoms of postpartum depression and/or leading to postpartum psychosis? Yes, they are. And Lindsay had those symptoms, didn't she?

She reported all those symptoms, yes.

Um, doctor, when a doctor like Tufts is, is meeting with a person and checking the boxes, can that doctor give a blood test to, to the patient? Certainly. Is that important in your opinion, that a doctor give a patient, especially a woman who's coming to them for help with these symptoms, give them a blood test? Yes. And, and again, we all know what blood tests are, but just tell me, I mean, is that a simple test? Is Is it complicated?

It's fairly simple to have blood drawn, and there are many tests that are relevant, particularly after a woman has given birth. Why? Well, some women become anemic. Depends on how much blood loss might have occurred during birth, but there's usually some blood loss, so checking hemoglobin levels is important. The thyroid can be affected by delivery of the baby, and some women in the postpartum period develop inflammation of the thyroid. The thyroid is a very important gland that regulates many parts of the body.

Is that why many times when a, when a competent psychiatrist is treating a patient that is postpartum after having a baby, that they might run— and I may be wrong saying it—

but a thyroid test? They would do most commonly two different kinds of thyroid tests. They would test for thyroid stimulating hormone, which goes up when the thyroid hormones that also can be tested for actually go down. So thyroid stimulating hormone is telling the body make more thyroid hormone because it's not enough in the circulation.

Did Tufts ever use a blood test at all in her treatment?

No, she did not.

Did Tufts ever check the thyroid levels of Lindsay Clancy at all during her treatment? No, she did not. Gelada, did they test any of those things?

No, uh, Nurse Gelada did not do blood testing either.

Now, you've made reference, sir, to postpartum, uh, postpartum depression, postpartum psychosis. You're familiar with the DSM, what is referred to as DSM-5-TR, Diagnostic Statistical Manual of Mental Disorders, uh, 5, you said TR, that would be right there. I mean any text revision? Correct. All right. Um, and I'm approaching you with this and asking, you see that section there? Yes. And what is that section?

The bipolar and related disorder section.

What is bipolar disorder? What does that mean?

Bipolar is the a newer name for what used to be called manic depressive illness. Uh, it describes an illness where people's moods go up, which is the manic phase, and then go down, which is the depressed phase. Uh, there are different categories of bipolar disorder. Bipolar I is the most serious. Bipolar II disorder uh, also has similar fluctuations of mood. But in both cases of bipolar disorder, most people spend more time being depressed than they do being manic.

Now just tell me, what does manic mean? What does that actually mean?

Uh, they feel usually euphoric, that they don't have— they're up. You're really up. You're extremely optimistic. You might spend a lot of money foolishly, but you wouldn't worry about that because certainly you're going to win the lottery. You can just feel it. So there can be psychotic thoughts along with bipolar mania, unreasonable expectations. Like I said, that you are destined to win the lottery or In serious cases, you can believe that God is speaking to you and has appointed you to do some special thing in life.

Um, let's say divesting oneself of personal property, cleaning garages, things like that.

Uh, there was talk in the records of an episode where Miss Clancy and her husband cleaned out the garage, but it It was difficult to tell from the records whether or not that represented what we would call a hypomanic episode.

Was there a lot of references to exercise?

There were a lot of records, uh, references to exercise, um, and exercise can be a very useful thing.

Um, yeah, that's one of the things that a woman postpartum may very well be prescribed to do by a doctor, like, or practitioner likes a lot, right?

I believe that nurse practitioner Julie Paul recommended a long run at one point.

So there's nothing wrong with a woman going to, let's say, Kingsbury or whatever it is, or taking her kids to the local gym with a swimming pool and trying to get some exercise in the postpartum stage? That doesn't— that's something you wouldn't hold against her? No. Okay, now how about, uh, are you aware that, uh, within a very short period of time after she had baby Callan, that she actually ran, uh, a road race? Yes. That is that indicative of a person that's, that's kind of ramped up and doing these things you're talking about?

It's unusual to, uh, decide to run so soon after delivering a baby. I believe that she ran on the day that she, uh, might have delivered her last child, Kallen. That's correct.

So during the month of December, um, in your review of the records, would you agree that her symptoms that she has related to the doctors that were there to help her, um, they basically increased, did they not? I'm sorry, I couldn't— increased that. Yes. And, and are you aware that then she went somewhere voluntarily in December?

Yes. Where? She went to the Mass General emergency room on, uh, I believe that was in December. She had gone to the South Shore emergency room previously.

And, um, did you in the record see that in fact she had good had gone to, uh, Women and Infants Program in Rhode Island for a day? Yes. And, and are you familiar with that particular establishment? Is that a— supposedly helps pregnant women? Yes, I reviewed those records as well. And, um, do you know why she was discharged after a day?

The records stated that they thought that uh, she was having complications from medications more than she was suffering from postpartum issues, and therefore was not a good candidate for their program.

And this was after getting there at 8 in the morning and leaving there around 4 o'clock in the afternoon, right?

That's my understanding, yes.

The records indicate, if you read them, that, uh, during that period of time there were little group sessions and coloring sessions and things like that. Is that correct? Yes. You know that there are suicide hotlines that people are told to call, right? Yes. Especially if a woman is, is in postpartum and is experiencing these difficulties and is describing the symptomology and on all these medications, that if you feel like you're going to kill yourself, you're supposed to call a telephone number, right?

Well, it wouldn't be the advice I would give, but that was some advice that was given, yes.

And did she call, to your knowledge from reviewing the records, the telephone?

She called, uh, the Aspire hotline, I believe, on two occasions. And, uh, was she given any help by the Aspire hotline? I believe the records say that she was told by Aspire that since she did not have a suicide plan, she did not require what's called a higher level of care, meaning an inpatient admission.

So she basically had been to Nurse Gelada, she had contacted Aspire on two occasions, she went to Rhode Island Hospital on a recommendation the day after she was recommended to go there, uh, and left after not being accepted. After calling the suicide hotlines, things got to the point where she and her husband went to an emergency room. Is that right? Yes. And did they get treatment at the— did she get treatment at the emergency room?

I believe the first time that she went to the Mass General emergency room, they recommended that she consider an admission at McLean, but she and her husband decided that they did not want her to go inpatient at that time.

How about the next time she went to the emergency room?

The next time she went to the emergency room, which was not very long after, she was admitted to McLean.

McLean Hospital. And that would be— that would be the locked wards for a period of about 4 days, correct?

Yes.

Um, in reference to the bipolar disorder that we touched upon, sir, is that something that's a consideration when you're treating, as a psychiatrist, a woman who's coming to you for help and expressing concerns about the symptoms that we've talked about?

Yes. Why? Well, some people with bipolar disorder, especially given the fact that depression is a prominent symptom in bipolar disorder, become suicidal, uh, and can even, uh, commit suicide. So that's a very serious possibility that has to be considered.

Did any of the nurse practitioners consider that as a possible diagnosis?

The records indicate that Ms. Clancy was frequently asked if she had a plan to kill herself, even after she reported having what was called passive suicidal ideation, but it was reported very, very frequently in the records.

And in reference to her treatment with Nurse Practitioner Gelada, did your knowledge— Nurse Practitioner Gelada consider as a secondary diagnosis or a working diagnosis the possibility of bipolar disorder? Yes. Was anything followed through on that?

I believe she discussed the possibility of a mood stabilizer, um, but I believe that she then ended up using, uh, Seroquel or quetiapine, which is, uh, that's Seroquel and quetiapine with a Q, right?

I'm sorry, Seroquel and quetiapine with a Q. Q—

quetiapine with a Q. Yes, using the two words again.

I just want to make sure it's clear.

Seroquel is the brand name, quetiapine is the generic name. All right.

And did she, meaning Lindsay, to your knowledge in the medical records dealing with these providers, complain about the effect that Seroquel had on her? Yes. And what did she say? What were the symptoms, or what did she feel?

Well, she often felt, um, spacey, uh, as if she was not, uh, her normal self. She felt— it's fairly commonly reported that she felt hungover, um, in the morning because these medicines, that particular medicine, does make people, uh, somewhat sleepy. I believe the Beginning doses were described as a sleeping dose, which is a very low dose of the medication that does in fact help sleep to some extent.

Was the Seroquel ultimately increased to 400 milligrams a day, 200 milligrams a day? Do you recall that?

Yes, it started at 25 and—

It was bumped up pretty significantly, wasn't it?

Yes, 400 is a lot more than 25.

And she was complaining about the effect of the is that correct? She was. And she was complaining about the fact that she couldn't sleep. All those symptoms that we went through continued on through the month of December after McLean. She went there for the New Year's period. I know, I'm almost there. Um, she went to the McLean for treatment, um, and still complained of these symptoms. Is that correct? Yes. Did the symptoms ever resolve themselves? For Lindsay in January, if you know?

There were times when she appeared to be a little less distressed, but the symptoms were never completely resolved. No.

And did you know that she went to see Dr. Jennifer Tufts on January 9th and that she was prescribed diazepam? Yes. And then on the 12th, she was prescribed Trazodone, 150 milligrams. By Dr. Tufts. Yes. January 16th, 2 milligrams of diazepam by Dr. Tufts. January 16th, the same day, 10 milligrams of amitriptyline by Dr. Tufts. Yes. What is, what is amitriptyline?

Amitriptyline is one of the older types of antidepressants. It's what's called a tricyclic. Antidepressant. It has more side effects, but one of the useful side effects in some cases is that it makes people sleepy.

Did it help her sleep? Not really. Now, in reference to the DSM, out of that revision, you agree with me that they have DSM-1, DSM-2 revised, rebooted, reconsidered, DSM-3, all the way up to DSM-5 text revision, right? Correct. And consisting of over 1,000 pages, right? Yes. Is this like considered— some people say the Bible of psychiatry, or is it like a cookbook?

I would call it a dictionary. Um, it's a list of definitions.

If I looked under P in this dictionary, would it contain anything about postpartum psychosis for a woman?

There is one mention on page 148. That's it.

That's it. The rest of the world, they don't care about the DSM. They have some other— yes— information, right?

What is that called? The World Health Organization publishes something called the International, uh, Classification of Disease, which is now in its 11th edition. It lists postpartum psychosis as a separate entity, and that's the one that insurance companies use for billing purposes, right?

Not this, correct? Are you familiar, sir, with the way other countries treat pregnant women in postpartum condition when they see the— let me finish— when they see a doctor for medical treatment? Yes or no? Objection.

Right, just allow that question. They will.

Yes.

And how, how does that differ from the United States of America? Sustained.

Good afternoon. Afternoon. Um, you spent some time when you first got to the stand going over your, um, your qualifications, and I think counsel now has admitted your curriculum vitae into evidence, right?

I'm sorry, did hear the last part.

The— your curriculum vitae? Yes. Is— you, you went through that with counsel, you recall that? Yes. Um, and fair to say the majority of the entries in your experience and your presentations and your teaching and fellowships, most of which revolve around child and adolescent psychiatry, correct?

I wouldn't I would say the majority.

Well, where in your CV does it say that you worked with postpartum women? It doesn't say that specifically. Okay, so your testimony is that back in 1983 when you were at the— was it the Massachusetts— sorry, Mental Health Center— you worked with the postpartum women, is that correct?

There were patients who had either were pregnant while they were there or delivered and were hospitalized after that, yes.

Okay. And, um, your involvement in this case, um, with counsel, with defense counsel, wasn't, um, directly that he reached out to you, was it? It was that you had provided some information as it pertains to a civil lawsuit that's pending? That's correct. And so this affidavit that counsel's been referring to that you drafted, you've revised it for these proceedings, but, um, fair to say you went through a series of records that didn't include anything related to this criminal case, meaning no police reports, interviews, photos from the scene? Is that fair to say?

No police reports, no photos from the scene.

So the majority of what you reviewed pertained to medical records, right? Yes. And in fact, you cite to in your affidavit a New Yorker article for facts. Yes. That's where you got most of your facts, is from a New Yorker article?

No, I also spoke to Mr. Clancy. You spoke to Mr.

Clancy? Is that in your affidavit? Uh, well, you have it before you. Can you point to a paragraph where you indicate that you got a report directly from Mr. Clancy?

Uh, I don't know if it's in the affidavit. Okay. But I did interview Mr. Clancy for 90 to 100 minutes.

Now, um, in relation to kind of going through the medical treatment, um, you indicate that, um, the defendant reported that she was hesitant about taking medications. Do you recall that in paragraph 11? Yes. But you're aware that she sought out a psychiatrist, not a therapist, not a psychotherapist or a psychologist. She sought a psychiatrist as her first contact in the postpartum period, correct? Correct. And psychiatrists presumably prescribe medications and don't necessarily offer psychotherapy, do they?

Well, all psychiatrists are trained to do psychotherapy to some extent at least, um, but yes, they, they can also prescribe medication.

And, um, through the records you learned that the defendant did have reactions to low dose of of Zoloft, um, and you— and your testimony is that, um, a blood test would have helped. Is that your testimony? Yes. So a blood test that's about 4 or 5 months postpartum, how is that going to help prescribers?

Well, the blood test I was thinking of was you could do a level of the antidepressant in her blood And that would tell you whether it was average, expected given the dose, or too high or too low.

And that would, um, that would yield results if a person's only been taking medication for less than a week? Yes. But you indicate that over a period of 4 to 6 weeks is when you would expect to see a medication start to take effect, correct?

It sometimes takes that long, yes.

Now, um, you also spoke a little bit about Zulresso. You're aware from reviewing the records of Jennifer Tufts that she researched Zulresso and spoke about Zulresso but never made a recommendation to the defendant that she do that injection?

Yes.

You also describe that by November 21st, um, that the defendant was experiencing, um, suggesting symptoms of mania like racing thoughts. But in fact, the criteria is not just racing thoughts, it's racing thoughts, pressured speech, correct?

There are a number of criteria that are listed, but racing thoughts is one of them, yes. Okay.

And, and you also list, or you identify in your affidavit, extreme insomnia, but For mania, it's not just insomnia, it's that there's insomnia with a decreased need for sleep, correct?

It can be a decreased feeling that you need to sleep even if you didn't sleep for several days, but it's also true that some people feel very tired. It's not just one or the other. From the records, aren't you? In that period, yes.

Okay. Um, you also You also indicated that in reviewing records pertaining to— I think you noted Jennifer Tufts— that her notes were a series of check— or the record was a series of checkboxes, right? That was your testimony?

There are a few sentences, but they're mostly checkboxes, yes.

And fair to say, the way in which those notes are created, there are several areas in which notes are placed at different points in those records?

There are notes at certain places, yes.

And those notes are reflective of statements that the defendant was making about her mood and how she was feeling and symptoms, correct? Yes. Those are all important things for a treating psychiatrist to consider when they're considering a patient's overall presentation. Is that fair to say? Yes, fair to say. Now, um, you also reference in your affidavit that the defendant, um, had reported that she had these increased symptoms with Zoloft and didn't sleep for 48 hours after increasing the dose.

Remember that in the record? Yes, from 25 to 50.

And you didn't review any police reports to identify that there were only 7 pills missing from that bottle of Sertaline, did you?

I did not review a police report, no.

So if a person takes 7 pills over 1 week period at 25 milligrams, how do they increase the dose without more pills missing from the bottle?

Well, I believe, um, if you took 3 or 4 pills for a few days of 25, then still would have enough pills to take 2 25s and increase the dose to 50.

Right, but if a prescription reads that if 30 are filled and only 7 are missing from the pill bottle when it's located months later, then if you've taken 7 pills, you've taken 1 pill each day, correct?

Not necessarily. I believe that she stopped taking the medication rather quickly, and I'm not sure which pill bottle you're discussing because, as you said, I didn't review a police report. Okay.

Now, you're aware that on December 15th, that the defendant and her husband reported that she was having persistent intrusive thoughts that day, correct? Yes. And that that's the day she first presented to Mass General Hospital. Yes. And you're aware that Mass General Hospital is directly affiliated with McLean Hospital, right?

They are affiliated, yes.

And that, um, she was advised to go to the inpatient program and she chose not to go? Yes. From reviewing the records, did you see how, um, Latisha Dukes, a social worker— or a mental health worker, excuse me— from the South Shore Perinatal Behavioral Health Clinic had previously had discussions with the defendant about going to Women and Infants before her presentation to the Mass General ER on December 15th? Yes. And she didn't in fact go to that program until December 20th, is that fair to say? Yes. Now, you also mentioned in your review of the medications um, lamotrigine. You recall that?

Yes.

And that was a medication that was prescribed to the defendant in December of 20— of 2022, correct? Correct. Um, you're aware that she never took lamotrigine?

I believe that's, uh, what she said, yes.

Now, you also were asked, or you spoke about Seroquel. So you're familiar with the prescriptions, or the what was prescribed of the Seroquel over the period of time, um, from November 30th through early December, correct? You reviewed that? And so I think you testified on direct examination that the initial dose was a low dose, 25 milligrams, correct? And you're familiar that is a fairly common dosage, a low dose, to prescribe to address some sleep issues? It is, yes. And you're aware that for per— people who are suspected or have bipolar disorder, that the levels of prescribed, um, are generally much higher than 25 milligrams, right? Yes, they would be. They could range anywhere from 100 milligrams to up to, um, well, what is the range, if you know? It would go up to 800 milligrams. And so in this circumstance, you're aware that Rebecca Gelada had um, suspicions about bipolar disorder, right?

She mentions it as a distinct possibility, yes.

And, um, without relief, she recommends titrating or going up on the Seroquel over a period of time, right? Yes. And you settled on a number of 400, but you know from the records that that was the goal, to titrate up to 400 milligrams. Do you know if the defendant ever 400 milligrams? I do not. Um, and you're also aware that once the defendant started reporting having symptoms and concerns about the Seroquel, that she had requested, um, to taper off the Seroquel, correct? Yes. And you're aware that prior to her presentation at McLean Hospital, that Rebecca Gelotta actually did um, send in a prescription that would allow for her to taper down? Yes. And when the defendant was admitted to McLean Hospital on January 1st, she was already on a taper plan, meaning she had gone back down to approximately 100 milligrams per night?

I believe she was, yes.

And that at McLean, they further immediately started to reduce the dosage with each night?

I believe that was the plan at McLean, yes.

So the first night she was there, she went down to 75 milligrams, correct?

I believe that's correct, yes.

And then by the time she was discharged, she was at zero?

Yes. And they were talking about the amitriptyline.

Well, did she leave McLean Hospital with a prescription for amitriptyline?

I don't know if she left with a prescription, but it was discussed. Uh, in the records that they recommended that.

And, um, as of January 12th, 2023, you're aware that the only active prescriptions for the defendant were for amitriptyline, right? Yes. And, um, Valium as needed and Trazodone.

That sounds correct, yes.

So throughout the course of your review of the records and all of the different medications that she was on, um, from October through January, um, she wasn't on all the medications at the same time, correct?

No, not at the same time.

And it's fair to say she was only on maybe 3 medications at one time?

3, there might have been 4 at one point, but yes.

And she had expressed, um, particular medications that she wished to return to, like Ativan at some point, correct?

She was quite ambivalent about Ativan and talked a great deal in the records about being worried that she was addicted to it.

But Ativan tended to work for her, correct?

It made her feel less anxious.

And she actually described that at certain points to the providers that when she felt intrusive thoughts or she had a bad experience that she took the Ativan and the thoughts were gone, didn't she not?

I'm not sure that she said the intrusive thoughts were gone, but she would feel less anxious when she took it.

And as far as, um, your conversations about hallucinations and auditory hallucinations, you indicated that at some point, or at points, I think was your testimony, that, um, the defendant did hear a voice. But you're aware that she never reported to Jennifer Tufts that she heard a voice? She did not. She never reported to Rebecca Gelada that she heard a voice, did she? She did not. She never reported to Leticia Dukes that she heard a voice? She did not. And the only time she's ever said that she heard this voice was on January 24th, 2023. Is that fair to say? Correct.

Thank you, nothing further. So when the district attorney asks you whether or not Lindsay, after all the symptoms that we've already gone through, told, uh, Rebecca Gelada that she heard a voice, told Dr. Tufts that she heard a voice, and denied that she heard a voice, would you agree that there are reasons that a woman would not tell the doctor or minimize their symptoms out of fear? Yes. What kind of fear? Fear of what?

Well, in the records it stated that, uh, Ms. Clancy reported she was worried that her children would be taken away from her, uh, perhaps by the Department of Children and Families if she reported very severe symptoms. The other thing is, as a healthcare professional, Boards of registration sometimes take a dim view of people who have been in treatment for certain psychiatric illnesses, and so she might have been concerned about her nursing license, but that's speculation.

So there are other reasons why a person may be concerned about telling healthcare providers, mandated reporters, that they're hearing voices, correct? Yes. Would you agree with me that you don't have to see the proverbial unicorn in the corner to your health provider to be suffering from psychosis? Yes, that's true. And, and can you tell us, uh, counsel was asking about the, uh, symptomology, uh, psychosis. Does— is that something that just grinds on for day after week after month, or is that something that comes on out of nowhere very quickly?

No, overall it can be quite episodic. What does that mean? It means that an episode can start and stop, and then an interval of time goes by— it could be days, weeks, or months— and then another episode occurs.

Counsel asked you about bipolar disorder, uh, the suspicions of bipolar disorder from Dr. Jalada. And then talked about the prescriptions that were prescribed. Is it, in your opinion, appropriate to prescribe a selective serotonin reuptake inhibitor to a person that is bipolar? Objection, non-essential.

No, overruled.

It would be considered something to be done cautiously and usually with a mood stabilizer begun at the same time to to prevent the possibility of making manic symptoms worse. Thank you, sir.

Just briefly, you didn't interview the defendant, did you?

I did not.

You don't know what she was concerned about. You're speculating. Yes. And, um, for a person who's begging for help, wouldn't it be important to be honest with their providers about what you're feeling, seeing and hearing.

It should be, but that's not always what doctors find. Nothing further.

All right, anything further? Perfect. All right, thank you, Doc. Let me step down. Thank you. Can I see a sidebar again? Scheduling. All right, so members of the jury, what we're going to do is we're going to, uh, break at this point till 2:00. All right, and much of the next longer break, we'll be trying to resolve the technology issue that we had. And so if it's resolved, we may call one witness. If it's not, we'll call another witness. So, but, uh, so we're going to try and get that all done during the break. So with my skills and technology, that's why we probably need a little bit longer, uh, than than just the hours. So, uh, so, uh, be— we'll in recess till 2 o'clock. We'll come back in for the next witness. Okay, thank you. All rise, please. All right, so, Council, anything we need to discuss, uh, before the break? All right, so we'll come back in two— we'll be in recess till 2 o'clock, uh, and we have one of two different witnesses depending on how things work out over the break.

Yup, we can go all day, no problem.

All right, thank you. Thank you. All right, counsel, we, uh, all set? Yes.

All right, ready for the jury? Yes. All rise, please, jurors. The court is back in session.

You may be seated.

Your Honor, for the purpose of the record, we return back to the trial of Commonwealth versus Lindsay Clancy. All parties All right, thank you.

And you can consider her testimony the same as if she was testifying here live. Okay. All right, Mr. Rankin.

Yes, thank you.

Yes, Dr.

Lopesado, please raise your right hand. Do you solemnly swear that you shall make— you solemnly swear that the testimony and the evidence you shall give to the court and the jury in the matter now pending between the swear and help the defendant at the bar shall be the truth, the whole truth, and nothing but the truth, so help you God. I do. Thank you.

Good afternoon, Director. Can you hear me?

Um, you're a little echoey, but I can hear you.

Okay, I'm just standing in the corner here so that everybody can hear you. Uh, tell us your name and spell your last name.

Um, Dr. Elizabeth Lopesada.

L-A-P-O-S-A-T-A. And, uh, fair to say that you have some issues that require you to speak to us today by Zoom rather than appearing in person as you intended to do, is that correct? Yes, that's correct. Okay, uh, tell us what you do for work, doctor.

Uh, well, I'm a medical doctor, board certified in anatomic in forensic pathology. So I have an active practice in forensic pathology where I review, um, cases to understand how people get injured or how people die.

And how can you tell us your educational background? Um, certainly.

I graduated from Bucknell University in 1975, um, cum laude, with honors in in biology. I went to University of Maryland School of Medicine where I graduated with an MD degree in 1979. I did my 2 years internship at Johns Hopkins Hospital in anatomic pathology, which is the study of diseases of the body. Then I trained in St. Louis, Missouri with a fellowship in forensic pathology, which is understanding causes of death and how trauma affects the body.

Um, do you hold any board certifications or any licensures in that field?

Um, yes, in 1983— excuse me— I sat for my board exams and became board-certified diplomat of of the American Board of Pathology in anatomic and forensic pathology. And tell us your, uh, your work history, if you would, please. Certainly. Since I became board certified in 1983, I've had faculty positions in St. Louis University School of Medicine, and where I also was the assistant medical examiner for the city of St. Louis. I then moved to Pennsylvania, Philadelphia, where I ran the autopsy service at the Hospital of the University of Pennsylvania, had a faculty appointment there, a research lab, and I taught forensic pathology to medical students.

I then—

and I was also a city of Philadelphia Philadelphia Medical Examiner. Um, after that I was an Assistant Medical Examiner for the State of Delaware, and in 1993 I was selected to be Chief Medical Examiner for the State of Rhode Island, which was a position I held until 2005 when I started my independent consulting practice.

So you've been an independent consultant testifying in courts and working on cases since 2005?

Um, at my own business, yes. And certainly testifying on cases before that as medical examiners employed for the city of St. Louis, uh, the city of Philadelphia, and the state of Delaware, and the state of Rhode Island.

Okay. And now you're independent, on your own, as it were? Correct.

I am, as it were. Yeah.

Now, did I reach out to you on the case of the Commonwealth versus Lindsay Clancy and ask if you would help us out by looking at the discovery of the case? Yes, you did. And you're here to testify today. Can you tell the jurors what you actually reviewed as a basis of your opinion for your testimony?

Um, certainly. I reviewed, um, medical records, and I have a list here on Dawson Clancy. I reviewed the Office of the Medical Examiner entire file. I reviewed his EMS reports, his terminal hospitalization, the Duxbury Police supplemental narrative, Duxbury Police narrative, and his pediatric South Shore Healthcare medical records.

Could I just interrupt you for a minute? I apologize. Um, just in the interest of time, rather than going through every single— let me ask it this way. Did you look at this? Did you look at police reports? Yeah. Did you look at grand jury minutes? Yes. Did you look at medical records for Lindsay Clancy? Yes, I— yes, I did. Can you tell the jurors what medical records you looked at?

Um, for Dawson Clancy? No, no, no, not Dawson, for Lindsay Clancy. Oh yes, I looked at, um, her South Shore Medical records when she was admitted on the evening of January February 24th. I looked at her Brigham and Women's Hospital records, photographs that were taken of her and published in her hospital records. I looked at the Department of State Police Crime Laboratory toxicology report, crime scene photos of the bedroom, the outside of the house, um, you know, crime scene photos approximately 500 of them, grand jury proceedings, um, and photographs of the round exercise bands.

How about medical records? Did you review medical records, uh, pertinent to Lindsay and her treatment by healthcare providers in 2022 into 2023?

Yes.

Can you tell us what records you looked at?

Uh, well, I looked at her records from, um, the post-injury records from South Shore Hospital where she was first transported after she was found in the backyard of her house. And then I looked at her hospital records where she was transferred from South Shore Hospital to Bergamon Women's Hospital. Excellent.

Doctor, in the course of preparing for your testimony here, did I direct you to a gentleman, a Mr. Drake, and ask him for help putting together a little diagram to illustrate your testimony? Um, yes, you did.

I, uh, Mr. Jeffrey Drake Graphics. Yes, under my direction. And we put together some illustrations.

And Your Honor, could I— we all know what they did. Could I argue this now? If you want to.

Is there any objection? Disregard. Yeah, so same ruling. That may be admitted. Do you want to pass out those?

Yes, that would be great.

Yeah. To the jury, if you could pass out copies of what was just introduced as the exhibit. We just did it just so you can kind of follow along with the testimony. Uh, and at the end, you're going to ask to pass it back for us. Thank you.

All set? Yes, I think so. Thank you. Now, Doctor, uh, first of all, you made reference to Dawson Flancy, that you've had a chance to review medical records and photographs and autopsy reports on Dawson Clancy?

Yes, on Dawson, Cora, and Callan. All three.

Okay, three of the children. Um, one of the— one of the questions that I have is that of the photographs, the autopsy photographs that you were—

do you want to take that? It might be just kind of confusing that this— that's better. Then we can go back, we get back to the charts. We can do that. Okay, thanks. Thank you.

Um, the autopsy photographs, did you have a chance to review those, Doctor?

Yes, I did.

And in your extensive experience, have you had a chance to see autopsy photographs of young children, infants, adults, people being examined prior to an autopsy? And of course, during that time—

oh yes, many, many, many.

Now my question simply is, did you notice on the autopsy photographs of the children what, uh, let's say, have been referred to as bruises to this jury? Have you seen— are you aware of that testimony?

Yes, there were bruises consistent with, um, active children jumping and running.

And how about medical treatment and procedure? Did you make make any observations, in your opinion, to a reasonable degree of medical certainty as to the cause? For example, on the infant, on the infant's head, bruising on the head, what appears to be bruising.

Um, yes, on Callan when he was in the hospital, and there are even photographs of him in the hospital, he had EKG or EEG, electroencephalogram monitoring devices attached to his head so the doctors could follow his brain waves. And they are little round cup-like things. And so where they were attached, actually on both sides of his head, they did leave a small little brown kind of parallel mark, little lines there that were from medical treatment for monitoring his brain waves. He also had many puncture wounds and evidence of medical treatment in that way.

And did you also notice that there would be— appear to be on occasion fluid that might be mistaken for a bruise?

Um, that's possible, yes. If there is some, um, liquid fluid that's a little blood-tinged, you can see it on the surface of the skin, and there would be something you could wipe off.

So for example, Doctor, to a reasonable degree of medical certainty, on the photographs of, of the infant that show what you say were the couplet marks on the area of the skull, they don't come from anybody squeezing, beating, pushing, or causing any injury to that child, in your opinion?

Is that correct? No, absolutely not. No.

Doctor, you also had a chance to review the medical records of Lindsay Clancy when she went to the South Shore Hospital and then subsequently went to the Brigham and Women's Hospital. Is that correct? Yes, that's correct. Um, and you don't have to get into detail, we've heard it a number of times, but there were injuries to her left wrist, her right wrist, her neck. Is that correct?

Yes, there were sharp force injuries to those areas.

And in your practice As a pathologist, have you had occasion over the years and over the many cases that you have had involvement with to observe self-inflicted wounds to a person's wrist or their neck in the course of a suicide attempt? Oh, many times. And can you tell the jury, to your opinion, to a reasonable degree of medical certainty, as to the nature of these injuries, and are they consistent with somebody trying, in your opinion— wait a minute— trying to kill themselves? Sustained. So you would agree that there's an injury to the left wrist, injury to the right wrist, that's a sharp incised wound, is that correct?

Yes, they're, they're cutting type wounds made by a sharp object such as a knife. Okay.

And how about the neck? Did that penetrate the fascia, or did that penetrate the skin? To what degree?

Um, yes, there were also, um, linear superficial incised wounds to her neck, and there were several, several of them, and one or two of them went deeper. There was bleeding also from the wounds on her wrists, and there were numerous attempts marks at cutting the skin, which we call hesitation marks, which are a classic finding in suicide attempts. And they did— those incisions did cut in through the skin and cut blood vessels that were under the skin. And you can also tell from looking at the photos of Lindsay taken in the hospital when she was first admitted. Um, and also, uh, when the photograph of the bedroom— her bedroom— you could see there was significant bloodshed event from those cutting injuries. No.

Um, did she also sustain an injury to her neck from your review of the medical records? Yes. Can you tell us what type of injury. And if we could, and if it assists the jury with you, you can make reference to the pages of the little report in the diagrams, page 4, 5, and 6, and tell us what we're looking at.

Um, okay, um, let's see. So are we ready to look at number 4?

Sure, yep, start off with 4.

Okay. Um, so that's the first page you have.

So just—

yes, that's right. Yes, page 4 is actually page 1. Yeah. So, um, what we have here is, um, to show you how Lindsay was injured. And I got this from the scene photographs, from all her medical history, and my knowledge and understanding how injuries happen to the body. So if we look at the left-hand side of this panel, we see a depiction of the backside of the house, and the top window on the second floor is open. That's where she would have put her palms down on the windowsill and put her head out and precipitated precipitated down to fall on the hard frozen ground. During her fall headfirst, she had cuts on her wrists which were bleeding, and her coming head down on the side of that building would then transfer some of that blood onto the side of the building, which was found in the scene photographs. She then hits really head first, um, and as her body descends that 13 or 14 feet. And if you look at the, uh, so she really did a free fall dive head first. Then if you look on the right upper two diagrams that just show a skull, this illustrates the forces then that were applied to Lindsay's head from hitting the ground and then her head bending a little bit.

And what she got from that is what we call a characteristic burst fracture or a Jefferson fracture. And this is a fracture that we see with people who hit their head head-on, like if they've taken a dive into a swimming pool and they hit their head on the bottom. It's a classic finding in people who have energy applied to the falling head. And what it does is that it takes the first cervical vertebrae, which kind of looks like a donut as you see up there in the middle, and it squashes it. The base of the skull then squashes that, and then like a donut it kind of spreads it out. And she He had— 1, 2, 3, 4, 5, 6, or 7 fractures of that cervical vertebrae, number 1, the ring of that. And the fractures I have pointed to there with arrows, so that is called the characteristic Jefferson fracture from hitting your head, the top of your head, in a dive-first position. So it's— you could also describe it as a burst fracture. Bursting type fracture. But you don't get any spinal cord injury from that because the area— the hole in the middle is pretty big, so it just crushes down on the sides and fractures the ring around the spinal cord.

So that, that tells me immediately that she landed head first and went down the window, went down head first. Um, then the energy is transmitted then from her head down her vertebral body, down the bony spine, and that then fractured and compressed C1. The lower right-hand panel there puts that cervical vertebral body in the context of the rest of her skeleton. The left, the left upper hand. We see her jaw, and then the C1 is pointed out there, and other little springs there to indicate they were squished and compressed together and fractured.

Now, looking at the next page, which would be 5, does that assist us in looking at the illustration of the injury to the spine?

Yeah, so this is, um, after her head hits. So she hits her head first, then there is, um, some flexion of her body, and the, the energy from the impact is transmitted down her vertebral column. And what that did was it crushed the number of her thoracic vertebrae, or vertebrae in the chest area, and actually made thoracic, uh, vertebral body T5 go— be compressed and move over the top of the lower vertebrae, and that is what, um, injured her spinal cord. In the right-hand panel there, the yellow 2 coming down is the spinal cord, and the T— thoracic vertebra 5 and 6 is pictured there. And you can see that her whole spinal column was compressed and it moved forward and out of place, causing her spinal cord injury. There were also injuries that are indicated by those red stars there, and those are fractures of the transverse processes of the cervical vertebrae. So when they were compressed, the areas where the joints are between the, between the vertebrae were compressed and fractured those transverse processes. So she had a bending injury injury, and she also had a right posterior rib injury. You can see on the left-hand panel, her shoulders are also hitting the ground, and that caused a fracture of the right first rib in the back.

And the flexion of her neck also damaged her thyroid gland and some of her, uh, voice box cartilages.

And if we look at panel, uh, page 6, can you tell us what we're looking at there?

Yeah, this is the final resting position of Lindsay's body. It's documenting all the materials I reviewed. That was on the left-hand side. So she is lying down on hard frozen ground. Um, her clothing is wet that she has on indoor clothing. The time that this occurred, it was dark and no sun. The temperature was in the low 30s, so she is going to be at risk of her body temperature going down lying on that cold ground. In addition to— now that her cervical— her thoracic chest spine is fractured, that That has totally disrupted the thermal regulation of the bottom half of her body. So she is going to lose heat from the lower half of her body and as it— to approach ambient temperature. So there she is lying there on the ground. Then if we go to the right side of that, this is a scene photograph showing the area where where Lindsay's body landed. You can see on the right at the base area there is some medical debris from the EMS emergency treatment. Then circled in, or put in a red square, it's a little bit of snow that has some blood on it, which would correspond to her position lying down as we see it in the left-hand side there.

And sorry, go ahead.

Okay, then the, the last bit here is an X-ray of Lindsay, which was taken in early February after she had, um, surgical stabilization of her fractured spine. So this is looking at the side of her, and you can see the hardware, which they look like little golf tees going to the left side. So this is the surgical metal hardware that was placed in her spine to open up and align her spine to try to preserve any function that was still available.

Now, Doctor, when she went to the, uh, Brigham and Women's Hospital, were you reviewing the medical records been able to discern that she actually coded as a result of her injuries?

Yes, she did. She was in, um, spinal shock and hypothermia, and her heart did stop.

And did you observe that there were, and I quote, massive blood transfusions to, to treat her at Brigham and Women's?

Yeah, she lost a a lot of blood around the muscles that hold the spine up because that was so damaged. So her hemoglobin and hematocrit and her red blood cell level was very low on admission.

And the final question I had, Doctor, is as it relates to the records, it showed that she had a core body temperature of 82 degrees as opposed to 98.6, which we're accustomed to. Can you tell the jury, in your opinion, to a reasonable degree of medical certainty, what does that mean and how did that happen? I mean, that's pretty low.

Um, yes, that is low. That's like, you know, 16 degrees below normal. And so her low body temperature came from lying on the hard frozen ground, which would be 32 degrees frozen ground. She had wet clothing on, so wet clothing is going to transmit the body heat into the atmosphere quicker than dry clothing. She had— it was indoor clothes. She didn't have a big parka on. There was no sun at that time to keep her body temperature up. The ambient, or the air temperature, was around 30°. She has a thin body, and also most importantly, because of that thoracic spinal cord transection, she lost the ability to control her body temperature below that level. So that means all her blood vessels just dilate and they just lose heat to the atmosphere.

Thank you very much, Doc.

You were head of the Rhode Island Office of the Chief Medical Examiner when it was cited for 10 violations and unsafe conditions, correct?

Um, yes, the unsafe condition was a light bulb out in a hallway, a computer in a hallway, and a few other minor things. I was very happy to have the safety inspection, right?

Those were the unsafe conditions, but there are also 10 other violations, correct?

They were minimal. I don't recall now, it was 20 years ago.

You didn't treat Miss Clancy, correct? Correct. And you didn't examine her yourself, correct? Correct. Now, you talked about a Jefferson fracture and, um, or a C1 burst fracture and how it can be from hitting the top of your head, correct? Yes. Isn't it also true that you can sustain a burst fracture by hitting the back of your head or the top of your shoulders as well? No. You say that she fell from 13 feet from the window sill onto her head, the top of her head, correct? Onto the frozen ground? Yes. And you're saying that she fell with such force that she burst her C1 vertebrae and then broke other vertebrae in her back and broke ribs, correct?

Yes, just the force of a free-falling body. Yes.

Okay, but she had no injuries to her head, correct?

Um, she— I'm sure she had bruising to her scalp under her hair. You're sure? She did not— she did— she did not have a skull fracture, right?

She didn't have a skull fracture, correct? Yes. She didn't have any cuts or things that needed sutures, correct?

Um, well, her She needed sutures in the cutting wounds on her wrist.

Well, we're talking about her head right now. She didn't need any sutures on her head, correct? Correct. She didn't have any large dents in her head, correct?

Large dents? What do you mean?

I'm hitting the frozen ground head first. There were no dents or bumps or sutures required on her head, correct?

Uh, her scalp was intact. The forces were transmitted to C1.

So through her head, so hitting the frozen ground, the icy frozen ground, not a bump or scratch or scrape on her top of her head. And then within her head, there was no brain bleed, there was no hemorrhaging, there was no injury into her brain itself. Nothing showed up on the CT scans, correct?

Correct. Her brain was fine, her skull was fine. I'm sure she probably had some scalp bruising under her hair.

You say you're sure, but you didn't see her head?

I saw, I saw the medical records and I examined all of those. I'm sure she had some bruise on the top of her head to the back side, as I showed in my diagram number 4. I'm sure there was some bruising on her scalp under her hair, but that was not a major concern at the time she was taken into the hospital.

You keep saying you're sure there were bruises, that you're sure that there was this or that. That's not shown in any photographs or medical evidence, so you're not sure, are you? You're assuming?

No, I'm sure.

Okay, let me show you some photographs here. Excuse me. No, I've— no, let me show I'm asking the questions. Let me show you some photographs. Let me show you some photographs of the defendant that were taken at the hospital of her head.

Do we have sharing privileges on the computer?

Showing you here a photo of the on the top of the defendant's head?

Yes, I see them. No swelling, correct? Oh, we just see her hair.

There's no blood on the white sheet, correct?

I'm sorry, I couldn't hear what you just asked me.

There's no blood on that very white sheet, correct?

Um, well, I don't see what's under her head, but that's not relevant to understanding that she did fall head first.

Okay, so you're saying she fell head first from 13 feet onto hard frozen ground and had no visible injuries to the exterior of her head?

Yes. And you're saying that she— excuse me, I'm, I'm—

it was a yes or no question, Doctor.

Listen, Hold on, doctor. Listen to the question, answer the question, and then we'll just go from there. Go ahead. You want to re-ask that question, doctor?

Yes or no, she fell to the ground, frozen ground, and that had no apparent injury to the exterior of her head, correct?

Correct.

She fell headfirst to the frozen ground and not with enough force to break several vertebrae and her ribs, but did not have a skull fracture, a brain bleed, or anything else, any other type of injury to her head, correct? That's absolutely correct. Move to put the photographs we're just showing into evidence. Any objection?

All right, they may be admitted.

282.

Doctor, in your report that you provided to defense counsel, you also talked about the strangulation of the children, correct?

I did.

And in your report, you wrote that it would take— would have taken 5 to 10 seconds for unconsciousness to occur, correct?

Yes. Okay.

Now, do you recall testifying previously in State of Rhode Island versus Kimberly Frye, case number W1- /2010-0413A.

Do you recall testifying previously in that case? No, I don't.

Let me refresh your memory. It was a woman who had killed her 8-year-old daughter by asphyxia, and you testified manual strangulation.

Yes. Yeah.

So ring a bell? Yes. Okay. And so you testified back in 2011 in that case, and you were asked, if you have to— if you have a very complete compression— strike that. You were asked, unconsciousness due to oxygenation can occur within 10 to 20 seconds. And you said, if you have a very complete compression of the blood vessels of the neck, you can become unconscious within 10 to 20 seconds. And then you were asked— I'm just saying hypothetically, just strangulation alone is 10 to 20 seconds— and you said if it is effectively and continuously applied, like in a lateral vascular neck restraint, most times there is a struggle going on, so you can't quite get that. So in that case there, you didn't testify that it was 5 to 10 seconds, you testified that it was 10 to 20 seconds, and that if there's any struggling, it could be correct?

Um, yes, but that, that case was—

well, that was a yes or no question.

Defense can follow up. Hold on, hold on. She's answered the question, and then we'll have a redirect if, if counsel would like to.

Well, I don't remember.

Why don't you—

doctor, wait for a question. You were also asked in that same trial, doctor. The question put to you in that trial was But once that unconsciousness set in, you agree with me that there had to have been a consistent application of pressure, either suffocation, strangulation, or compressions of the chest, for 2 to 3 more minutes continuously while the child was unconscious, correct? And you answered, I think that's a fair statement. And the question was, you said that before yourself, correct? And you answered yes. And then the question was, I'm asking your opinion, And you said— the question was, after Kandyn became unconscious, after 2 to 3 minutes of continuous application of one of those 3, and you answered correct. Is that right?

I have no memory of that. I'm sure if you're reading it correctly—

well, you, you have memory of your medical knowledge, correct?

Sure, I have memory of my medical knowledge.

And so at that point in time, in 2011, you testified that you would have to strangle someone 10 to 20 seconds at least to unconsciousness, and then you would have to continue to strangle them for 2 to 3 minutes for, for death to occur. And you said correct. Is that still your medical knowledge?

Um, that's a different case. That was not ligature, that was a manual.

So either way, you're talking about the compression of the neck causing a loss of oxygen and blood, correct?

Um, yeah, there are many ways that can occur, and the, the way the pressure is applied, um, is, is very important in understanding how long it takes to become unconscious. These are, um, the, the children here, um, were the victims of what we call ligature strangulation. Um, the Fry case— that's coming back to me a little now— that was a manual strangulation and also a body compression, which is a totally different type of asphyxia.

I mean, you were asked about that in that case, and you were asked, but once unconsciousness has set in, you agree with me that there has to be consistent application of pressure either suffocation, strangulation, or compressions for 2 to 3 minutes more. And you answered correct. So not all three. You said either one of those could cause death after 3 minutes, correct? Yeah, just if you could rephrase that question. You were asked, but once unconsciousness set in, you agree with me that there had to have been consistent application of pressure, either suffocation, strangulation, or compressions of the chest for 2 to 3 minutes more continuously while they're unconscious. And you said, I think that's a fair statement. So that's what you said, correct?

Yes, in order to become dead, brain dead, you need— you— the physiology is that the— you become unconscious within 5 to 10 seconds, and then you need—

then you're unconscious.

But that's not dead, then that continued constriction of the blood flow has to be still continuously applied for the brain to die. Correct. So that's— yeah, so that's the— that is what happens, and that's what happened to the Clancy children. The ligatures were wrapped around, they went unconscious in 5 to 10, maybe 20 seconds, probably less than 20 seconds because it was a, um, a ligature, not a manual strangulation. So it was immediately compressed, unconsciousness within 10 seconds, and then death within 5 to 10 minutes after that, with continuous pressure, with continuous pressure around the neck. Yes, because this is a ligature strangulation. Thank you.

Okay, so when you're talking about ligature strangulation as opposed to manual strangulation, tell us in your mind what that means.

Oh, well, they're, they're very, very different. Um, manual strangulation means that you had— somebody has used their hand and they've pressed either side of the neck. Okay? That the hand is manual strangulation. Strangulation means that you have stopped the blood flow that comes out of your brain and the carotid artery continues to pump oxygenated blood into your brain, but it can't drain out through the jugular veins. So with then you, with continuous pressure, then you, the blood can't get in because it can't flow out. It's kind of like stopping up a pipe. And then so you go unconscious within 5 to 10 seconds, but then with continued pressure, your brain dies. So the difference between manual and ligature is that manual can be kind of an off and on thing. You may put— you have a jugular vein on either side of your neck. So if you're using a hand, you might compress one greater than the other. You might let go. The person that you're trying to strangle may struggle and remove your hand a little bit. So it's a very different sequence of events to end up with brain death and asphyxia. Whereas wrapping a Round Loop Resistance Band, which is a ligature, immediately compresses those vessels.

There's no, there's no coming off, there's no putting back on. So it's a very complete, one-time, immediate, non-varying compression with those exercise bands ligature, which causes unconsciousness, effectively within 4 to 10 seconds.

And in reference to the manual strangulation, where generally somebody would use their hands and perhaps press with their thumbs, that, that has a very, um, common— that you see many times, fracture of what's called the hyoid bone, correct?

Yes, that can happen. Absolutely. A little U-shaped bone up underneath the jaw. So they're— they both cause, you know, brain death from lack of oxygen to the brain, but the way they get there, it's leading up to that, is a totally different pathophysiologic process.

So when counsel went through the Rhode Island case, whatever that name was, and was reading from a transcript and asking you questions about the time that a person through manual strangulation, and then she made reference to suffocation. She made reference to strangulation. She made reference to compression of the chest. That has nothing to do, in your opinion, with the ligature strangulation. Is that correct?

Uh, it's a totally different mechanism of injury.

Thank you.

Great. Doctor, as you said a few moments ago, the, uh, the ligature causes unconsciousness, and then the pressure has to continuously be applied for several minutes to cause death, correct?

Yes.

Thank you. All right, anything further?

One other question on the ligature, Doctor, and we discussed this, is the ligature— does that require a person to stand over the body and continuously continuously apply pressure to the ligature or walk away leaving the ligature?

No, in this case, these were elastic round loops that were put around somewhat tightly, pinching the skin. You could see little lines where the skin was pinched, and it just stays there. So it's an immediate compression of those belly veins, staying there, and then death occurs minutes later. Thank you.

Doctor, did you see these exercise bands? Yes. And you know that they're one long line with a handle on each end, correct?

Right. And they're, they're, they're round. They're a cylinder, right? They're not like a flat band.

And you know they were wrapped around each child's neck and pulled to strangle them, correct?

Well, they were, they were wrapped several times firmly enough around the neck to close off the jugular veins.

And, and you're not aware— there's been no testimony, no evidence, nothing showing that they were knotted and left there, correct? They weren't tied in a knot and left around their necks according to any of the evidence, correct?

Um, the important part to me was they were wrapped several times, and then whether it had a bow or not would not really be important. It was secure and wrapped around the neck several times. Yeah, I can tell that from the appearance of the skin on the neck.

It almost looks like a band, doctor, wrapped around the child's neck several times. And then left there. I guess you can't see it from where you are, but it just fell apart. It didn't stay in a circle.

Yeah, I sort of saw what you did. So what was that? I said I saw that. You saw it.

So it was left there and it fell apart, correct? Yeah, what you just did.

Sure. Yeah, thank you. All right.

All right. Thank you, Doctor. All right.

Thank you, Your Honor.

I see you just for a second. Take the equipment down. Took us hours to get it up. Hopefully it'll take us about 5 minutes to take it down. So I'm just going to ask you a very quick break and we'll bring you right back in. We'll call the next witness. Okay.

All right. Thank you.

Next call from this court's recession.

Please be seated. All right. So we'll be in— I know we always say it, but we'll be in a short recess. Uh, come soon as we can get the equipment down, we'll bring— we'll come right back out, we'll take the next witness. Okay, thank you.

Goodbye.

Director, we return back to the matter of Commonwealth v. Lindsay.

Council, all parties are present excluding the jury. All right, counsel, we ready for the jury? Yes. Okay, thank you. All right, jury, ready? Thank you.

Call Dr. Paul Ziesel, please. All right. Good afternoon, Doctor. Good afternoon, Your Honor. Hi, Mr. Brinkton. Thank you, Judge. Afternoon. Tell us your name and spell your last name for the record, please. Good afternoon.

Paul Ziesel.

Z-E-I-C-E-L. And, um, what do you do for work, sir?

I'm a clinical and forensic psychologist.

And briefly, what's the difference between a psychiatrist and a psychologist?

A psychiatrist goes to 4 years of medical school and does a residency in a specific field in medicine. A psychologist goes to graduate school, generally 4 years, and gets a PhD or a PsyD, Doctor of Psychology, in psychology. The difference in terms of clinical practice— psychologists are trained very extensively in counseling, testing, interpretation of testing, and that then continues to various treatment modalities working with children, adolescents, couples, families, and it can extend beyond that neuropsych testing issues of guardianship, child custody cases, and there are many variants in that. So psychologists are in the domain of treatment, testing, and evaluation of mental health conditions.

Can psychologists prescribe medication?

Generally, no, but the Department of Defense will allow psychologists in the military and overseas to sometimes prescribe medication, but 99% of psychologists do not have prescription privileges.

As far as the testing that you referenced, what is it you referring to regarding testing?

So this testing across various domains— if a person comes in with, let's say, concerns about intellectual functioning for a child They would have a, perhaps, school psychologist or educational psychologist who would do testing on cognitive levels of functioning or neuropsych testing or testing that deals with issues of ADD, attention deficit disorder, or attention ADHD, attention deficit hyperactivity disorder. There's other testing that would include, for example, forensic testing. That's the integration of mental health and the law. That requires a psychologist to know about the different types of forensic testing issues that might be there. So this would often be things that would be pertaining to deception, malingering, personality, personality assessment, and sometimes sociopathy or what's known in the DSM-5-TR, which you've heard about, antisocial personality disorder. In addition, as I briefly mentioned, guardianship, conservatorship, uh, custody issues with parenting, risk assessments for certain jobs that individuals might have, working for government in top secret positions, police officers, military as well.

So for example, some of the testing— what is the MMPI?

So yes, it's called the Minnesota Multiphasic Personality Inventory, and there are various iterations. There's MMPI-3, there's the RF. Some are focused on forensic assessment. It is a test that has been around since the 1940s that was originally used to determine a sample size of white men going into the military who would be good leaders. Today, the sample is based on a much more diversified population. Including women and different racial ethnicities, and it's divided into two parts. One part has what we call a validity and reliability scale and a lie scale. Validity—

the lie scale, is that also referred to as the K scale?

Yes, it could be considered part of the K scale, and it's whether someone is being dishonest with the test. But it will change slightly because people on some tests, psychological tests, will want to come across as faking good. Some people will want to come across as faking bad. Faking good would be a mother whose children were taken away. She would like to get them back, so she wants to come across as the healthiest person there is. Conversely, faking bad is someone seeking a let's say, workman's compensation claim, and they may have a tendency to exaggerate the nature of their injuries.

So in this case, for example, forget about workman's comp, let's talk about a murder charge. If a defendant submits to a psychological test such as the MMPI and the interpretation by a psychologist of the results of that test, if the person wanted to pretend pretend that they were suffering from a disease or defect, would that test ostensibly be able to, to tell the psychologist that? Yes. Was it MMPI administered by the government's doctors on this case to Lindsay? Yes. Did that have a case scale as to whether or not she was lying or exaggerating, malingering, or trying to fake, uh, that she had some disease or defect?

Yes, it had a case—

yeah, can I see counsel over here?

So, Doctor, um, let me just, as we say, lead you a little bit. Um, yes or no answers would be fine. Um, were you aware that a test was administered by the government's doctor— I think it was Dr. Helbrun— uh, to Lindsay Clancy in the course of the government's evaluation? Yes. And did you consider the, uh, results, uh, of— in the interpretation of that test as part of your opinion for this jury? Yes. And to that extent, as you discuss whether or not somebody is faking or somebody is exaggerating, um, do you have an opinion based upon your review of the discovery in the case to a reasonable degree of medical certainty as to whether or not Lindsay Clancy, in the course of that evaluation, was malingering or lying or exaggerating? Yes, I do.

Tell the jury my opinion in the testing of Ms. Clancy regarding the MMPI. Was that—

Objection. Just, just that, just the doctor, your opinion, doctor.

She was not faking. There was no evidence of any malingering. She presented as an honest citizen.

Okay. Now, regarding your, your background, I may have jumped the gun. Tell briefly what your educational background is?

I have a bachelor's degree from Queens College. I have a master's degree from Harvard University and a doctorate in clinical psychology from William James College.

And your, your career spans how many years, sir?

Uh, I've been licensed for 37 years.

And would you consider yourself to be a forensic psychologist? Yes, I do. And as you indicated, that's the interface between medicine and law, is that correct?

Forensic and mental health and law. Yes, mental health and law.

Okay. Um, in this case, uh, your, your experience obviously is something somebody has to evaluate. Can you tell us your, your history as a psychologist? In other words, your experience that you've had in the field?

Yes. Well, in the field, I have, as a forensic psychologist, been involved in over 1,000 cases, uh, testifying for both the Commonwealth as well as for respondents' counsel. I testify more for respondents or defendants, uh, these days. I've been qualified in every court in the Commonwealth with the exception of Nantucket. Because I've not done any cases in Nantucket County. I have a small private practice. I have done work with governmental agencies, a psychologist for the DEA, Drug Enforcement Administration, and I've worked as a federal contractor, as a vendor overseas for the State Department in Afghanistan. How long were you in Afghanistan? I was in Afghanistan from November 2007 to roughly mid-February 2011.

So for that 4-year period while you were in Afghanistan, what was the nature of your work?

The nature of my work was basically the equivalent through the military— the analogies with the military— it's a combat psychologist. I was embedded in the field I would do evaluations, what we call critical incident debriefings. And when there would be multinational forces, and in Afghanistan it was the ISAF coalition, International Security Assistance Forces, that would be countries that were deployed over there: England, Germany, France, Spain, Italy, Portugal, Romania, Bulgaria, Australia, New Zealand, a total of 38 countries. I could go on, but I'm not going to. And I had to be loaned to various countries in different parts of the country to do debriefings after a critical incident, which would be what's called a TIC, T-I-C, troops in combat. I'd fly out usually on a helicopter, do the debriefings of the people who survived those attacks, engaged in those attacks, and ensure that they were stable enough to continue, and if you will, fit for duty. I would also do evaluations on violence assessments, individuals who had problems maintaining their ability to function safely in a war zone where everyone carries at least one weapon, usually two, to ensure that they were able to be healthy for their work, and I would do various types of training and debriefing.

I was also loaned out to other governmental agencies— the U.S. Marshals, the FBI, the CIA— and with each of those agencies, there would be various issues that were necessary— people getting hurt, uh, people killing, uh, individuals who attack them. And when that occurs, as one would imagine, there's great trauma that goes with that. And these people were not necessarily negatively impacted in the moment, but we would make sure that they were healthy enough to continue their work if need be. If they were psychologically impaired, I would be involved in helping get them sent over back to Europe, to Landstuhl, Germany, sometimes to Dubai, and help with individuals who suffered themselves with issues back from the United States. So I would have to do death notifications with the military. I would help up with issues of conflict with other soldiers and contractors and agencies, dealing with all the issues that one might expect could come up in, in various parts of the war zone. I was often sent to what are called FOBs, those are Forward Observation Bases, generally about 100 people more or less in those bases, multi-international. And I was also sent to COPs, C-O-Ps, combat outpost, very remote in the middle of nowhere on mountainsides where you'd walk up goat trails just to get to where your small base is.

And the billets were often cots and tents that were erected on rocks and no electricity, quite remote. And I was on many, many dismounted patrols with the belief that having a psychologist or someone psychologically trained to deal with what it's like to be in a war zone would be therapeutic. If not therapeutic, explainable and helpful. I did many of those events.

At some point, did I ask you to become, uh, involved to some degree in this case? Yes. Can you tell the jury when that was?

I received a phone call from Attorney Reddington late in the evening on February 3rd, 2023. It was late because I was already in bed sleeping. The phone rang. It was about 11:30.

And without getting into the details, did I advise you that I was representing a young woman by the name of Lindsay Clancy and that she was severely injured and she was in a hospital? Yes. As a result of that, um, what did you do?

That next morning, I went to Brigham and Women's Hospital, went to the front desk where one would normally check in, and there was a woman there who I felt was a volunteer. I explained who I was. I explained that I was asked by Attorney Reddington to evaluate Miss Clancy on the surgical ICU unit.

Were you able to access her to speak to her?

Eventually, yes.

And when you say eventually, what's the time frame?

I was Initially told I couldn't go. I had to wait 30 minutes. Attorney Reddington called the chief counsel of the hospital to enable me to have access to the unit where Ms. Clancy was staying. When was it that you were able to get into the unit to see her? 12:30 in the afternoon, February 4th. So it would be January 24th, 7—

so this is almost 11 days later, right? Yes. You're also aware that I needed a court order to get you into the hospital? That's correct. And were you able to ultimately get in the hospital, go to the surgical unit, and meet with Lindsay? Yes. Um, jurors have had a chance to look at photographs of her laying in the, in the, in the bed with tubes and wires and all of that. Is that what she looked like when you first saw her?

Yes. However, she was also with her right arm, as I recall, shackled to the bed with handcuffs.

So did that little soft little things that tie her hands to the side of the bed with the handcuffs—

they weren't soft, they were regular but appeared to be metal handcuffs that police officers and preps officers in this court used for detaining people and arresting people. They were not soft.

While she's laying in the bed, did she have the tubes and the wires for treatment in the emergency— the intensive care unit, I should say? Yes. Was she intubated at that point, if you recall? She was not. So she was able to speak? Yes. Was she able to move other— obviously she's chain to the bed so she couldn't get up?

She could not get up. She couldn't move below her sternum, the chest bone.

At that point, had you and I met and talked about this case at all? No. What was the reason I asked you to go to the hospital?

You are worried about her mental health, given the significant event that had just taken place a few days earlier. You were concerned that she had absolutely no ability to have visitors. Visitors were not permitted to meet with her, from family members to friends to priests. No one was able to see her.

So as a result of that, um, conversation we had, you went to the hospital, went into her room, and you were able to speak to her. Is that correct? Yes. Can you Can you tell the jurors if you recall what type of law enforcement presence, uniformed cops, guns, stuff like that, what did you notice?

I noticed literally outside of her hospital room were two state troopers in their blue uniforms sitting each in a chair on either side of the doorway to Ms. Clancy's room. With a nurse sitting in the corner of her room.

When you went in to see her on that date, was it your understanding she had recently been extubated? In other words, they removed the tube from her mouth? Yes. And do you recall the conversation that you had with Lindsay at that time?

Yes, I did.

Tell the jurors what your memory is.

The conversation I had with Ms. Klansky at that time was one where I asked if she knew where she was. So I did what's called a mental status exam, a brief mental status exam. It's orientation to time, place, location. She didn't know where she was, wasn't quite sure what time it was. She knew who she was, and she told me that she remembers what happened. But it was very fuzzy and foggy at the time. She had been on medication for the significant pain post-surgery, uh, while in that hospital room.

And during the course of that interview with her, did she express any concern to you about her husband Patrick? Yes, she did. Tell the jurors what she indicated to you.

She said, since 11 days prior to my meeting with her, which would have been January 24th, 2023, she had no contact with Patrick. She wanted to know how he was doing. She wanted to know if she could call him and find out where things are with her and with him and how he was faring and to just speak with him.

She expressed concern about her family. Yes, she did. Did she express concern about what had happened? Yes. Did she ask you, or did you offer to her, the ability to speak to her husband Patrick?

She asked me if she could use my cell phone to call her husband. Did she do that?

Yes, she did. Did you hear the conversation?

Yes, I told her we'd call. It would have to be on speakerphone.

And tell us about that conversation.

So that first phone call, I believe on the 24th, he did not pick up. We left— she left a message. I did not leave a message. We then called back 2 days later on the 6th.

And after the 2 days had transpired and the call was made on the 6th, did she have a chance to talk to Patrick? Yes. Were you there? Yes. Was she still chained to the bed? Yes. Were the cops still outside the room?

Yes. Not in blues, they were in civilian clothing, jeans, flannel shirts.

And tell us what she said to Patrick in your presence on the speakerphone at that point.

She had told Patrick that she loved him very much. She was unable to express a lot of emotion, but she expressed love for him, and she had said that she heard a male voice ordering her, telling her that she didn't have any choice, but she had to kill her children and then kill herself.

Now, Doctor, have in mind your, your background, your career, your— did you tell Lindsay Clancy to lie or make that up and pretend that she was hearing voices? No. Do you have any conversation or any suggestions to her at all that she should say she heard voices? Or anything like that?

Absolutely not.

Why did you let her call her husband on your cell phone?

I let her call her husband out of human compassion.

As time went by, did I then— oh, by the way, you've testified for, for me on other matters, have you not? Yes. We go back about 20 years. Yes. And we socialized together? Yes. So we're friends? Yes. And, uh, as you worked on the case, can you tell the jurors what information you had access to that would allow you to continue with your investigation as a psychologist?

I had access to her clinical records. Many of that were discussed here. Emergency records, sorry, grand jury minutes. Uh, with the longitudinal nature of my evaluation, I had records from Brigham and Women's, South Shore, Spaulding Hospital, and most recently Tewksbury Hospital, which go back to, I believe, March 27th or so, 2023, till today.

How many times have you seen Lindsay since that day in January of '24? So I've met with—

2023. I've met with Ms. Clancy over 45 times since then, and that was at the writing and the issuance of my report to Attorney Reddington. That was in middle of June, and I've seen Ms. Clancy since then 20 times probably, or 15, inclusive of being in this courtroom and sometimes meeting with her in the holding unit.

And we've had occasion to visit with her in Tewksbury Hospital many, many of those times, right? Yes. Um, and you've had occasion to visit with her in, in the lockup to this courthouse? Correct? Yes. Um, and, and she's been treated very well by everybody, the court officers, everybody. Is that correct? Objection.

Yeah, that's sustained.

Well, you've had a chance to see her in the lockup, right? Yes. Why would—

No, overruled. Why would you—

Why would you see her in the lockup?

I would see Lindsay Clancy in lockup Because the nature of presentation in this court has been gut-wrenching for anyone who would be exposed to such horrific—

Objection and move to strike. It's not responsive to the question.

Can I see counsel over here?

I'll withdraw it.

All right, so that answer, please, Jill, that answer is stricken. Okay.

Tewksbury Hospital. Have you had to see her to evaluate her in addition to your testimony for a jury?

Yes. Why? Because the nature of mental health is something that's not a static or what we consider historical piece of information. Static information means a date of birth. That's never going to change. Dynamic issues are things that are subject to change, like the weather, like your health, like your mood. So to do an evaluation for a case that Ms. Clancy is involved in, which is a triple homicide case, requires an examiner to ensure that she's competent to stand trial and that her mental health is stable enough to be able to go forward with court proceedings.

Is there an additional component And has there been an additional component of her suicidal ideation while she's been— since she's been in custody at Brigham and Women's, and then of course transferred years ago to Tewksbury? Objection. Please approach. Can I see counsel? So, Doctor, while you're evaluating her, whether it be in Tewksbury or you're visiting with her here, her present state of mind is always an interest to you, is that correct? Yes. Um, and in addition to all of the police reports, grand jury minutes, photographs, and things that you've described for us, sir, have you also had occasion to review all of the medical records without going through every one of them dealing with Jennifer Tufts, gelada, drugs that were prescribed to her, etc.? Yes. Were you able to take a family history and school history from Lindsay? Yes. Um, were you able to take a medical history from Lindsay? Yes. Were you concerned about her status as a woman who had recently had a child, Kallen, in the spring of 2022? Yes. And what time frame was it that you were focused focusing on for purposes of your evaluation as to her mental state after having Kelly, when she was postpartum?

The time frame started in roughly September 2022 through January 2023.

And during that period of time, you were aware that she had certain symptomology. Again, we go through every single one of them, or we can just say yes, she did express that she had symptoms. All the juries heard the evidence up to this point.

Yes, many times, to many—

to other people. Did she see doctors? Yes. Dr. Tufts? Yes. Was that the first time that she was expressing anxiety and her concerns about insomnia, and that she went to see Dr. Tufts and she was prescribed prescribed the SSRI? Yes. Okay. July, June, August of 2022, what was her mood at that point?

Her mood was waxing and waning at times, but struggling as well, uh, in common sense ways. Having 3 children, ages 5 and under, not an easy task.

So in the fall of 2022, when she went to see Dr. Tufts, that's when she was prescribed the first SSRI, Zoloft? Yes. And that would— and again, when she had the second baby, that would be Dawson? Yes. Did she have also, uh, indicia, uh, symptomology of anxiety and the symptoms that she had described that required that she had to be placed on some medication?

Yes, she did. What was that medication? I believe that was, uh, Trazodone, if I'm not mistaken.

When she was in nursing school, prior to that, was she placed on medication? Yes, she was. And that was because of public speaking nerves? Uh, what was the medication?

Uh, there were multiple medications. I believe it was, uh, propranolol, and I believe it may have been, uh, trazodone and Wellbutrin, but I'm not totally positive of that.

Do you recall that she was prescribed an SSRI when she was in nursing school?

Yes. What was that? That was Zoloft.

Um, when she saw Dr. Taftson, she took the Zoloft. It was 25 milligrams initially, is that correct?

Yes. Was it increased? It was increased to 50 milligrams sometime later.

And how did she react to that?

She didn't take the medication initially. She waited a few weeks to— until she started on the lower dose.

So my question was, how did she react to the increase in the Zoloft? Poorly. What does that mean?

It was not a therapeutic uplift for her. She didn't do well. She didn't feel better by all reports from Miss Clancy. She did not get better.

How about sleeping? Did she have any complaints about sleeping?

Yes. What was that? Her insomnia got worse with the passage of time.

As September turned into October, it turns into November around the time of Thanksgiving. Had she continued to seek help from medical healthcare providers? Yes. Answer is yes. Yes. Who did she seek to get help from?

Well, the initial person I believe was her mother-in-law, Sue Clancy, and who was a labor and delivery nurse in New Jersey.

Who did she see as a result of Sue Clancy?

I believe it was, uh, Julie Paul initially.

What group was she affiliated with?

South Shore Perinatal Health. Did Ms.

Paul, Nurse Practitioner Paul, prescribe medication for her? Yes. And did she continue to deal with South Shore, uh, perinatal. Yes. When at some point did she start dealing— shortly, a short period of time—

with Nurse Practitioner Paul? Yes, Nurse Paul left.

And why was that?

She got a transfer position. It had nothing to do with her patient load, or—

so that's— she was transferred? She was transferred. Okay. So as a short period of time, she was transferred. Who was the next person that she dealt with? Rebecca Gelada. Did Rebecca Gelada have a particular position? Was she a nurse practitioner? Yes. And how long did she deal with Rebecca Gelada? 3 appointments. And during that period of time with Rebecca Gelada, was she prescribed medication? Yes. What was the medication?

I believe it was Seroquel.

How did she react to that? Poorly. And as time went by, going into the holiday season, Thanksgiving, do you recall what her what her symptomology and complaints were to the healthcare providers at that point, whether it be Tufts or Gelada, anybody?

Yes. What were they? She had many concerns about her health. She wasn't feeling well. She felt out of touch with herself. She felt numb. She experienced disassociation.

All right, stop right there.

What is disassociation? Disassociation is a psychological construct That means you feel removed from your body. You don't feel in touch with your body. You feel different than the way you normally do. You look back at your life and you say, something is wrong with me. I'm not feeling the way I normally do.

Did she express, for example, when the jurors look at the medical records on November 27th, 2022, to a nurse practitioner Wada that she felt that she was out of her body and that she had a dissociated state.

Body, you feel removed, you feel as if you are not in your full body.

Now, at that time, was she also complaining of other symptoms? And, and to cut to the chase, was she saying that she could not emote, she couldn't feel love, she couldn't feel happiness, she felt heavy? She couldn't walk, She couldn't bathe. She had difficulty relating to people. Is that fair to say?

Absolutely. She couldn't get out of the bed. She had total flattened affect.

Did she then seek additional help? Yes. Where?

She went to the, uh, I believe the emergency room initially at South Shore to go to Mass General.

And did they prescribe additional medication for her?

I believe they did, yes.

Did she make any expressions to her treating physicians up to this point about what the medic— in her opinion, what the medications were doing to her? Yes.

What did she say? She said she was in a brain fog. They were— the medications were making things worse. They were not helping. They were not helping her.

Now, as that time went on into the period of Thanksgiving up to around Christmas, did she continue to reach out to people for help, such as suicide hotlines?

Yes, she reached out to— the answer is yes.

Yes. Did she call a suicide hotline? She was worried about killing herself. And did she get any help from the suicide hotline?

She was turned away.

How about the second time she called the suicide hotline? She was turned away. How about when she went to the Women and Infants Program in Rhode Island?

They told her she was not a good fit for the program. She was— because she was overly medicated.

And did she continue to seek help from healthcare providers? Yes. And what was the next thing that happened as far as dealing with healthcare providers for Lindsay in her postpartum stage?

She went to the Mass General emergency room.

What happened there?

On 12:30, she said she needed to go to the hospital. She left the emergency room. She was sent to McLean Hospital in Belmont. It's a Harvard-affiliated hospital.

Now, that McLean Hospital, when you say was sent to, they had to say that even though they had to transport her, it was a voluntary commitment? Yes. And what was her state of mind that caused her to have a voluntary commitment to the locked wards of McLean Hospital?

She was worried about killing herself and she uttered concerns about killing her children.

How about, did she relate any intrusive thoughts and dark thoughts, things of that nature, during this period of time, October, November, December? Yes. Tell me about that.

She said she had, quote, horrible thoughts, unquote. She felt that people could actually hear her thoughts. The thoughts were so loud that strangers could hear them sometimes.

With the Little Sprouts, uh, school with the kids, that they could read her thoughts and that she would lose custody.

Yes, it's called ideas of reference. You believe other people can hear what you're thinking, and that can have a very negative interpretation for the person believing that, feeling that, and thinking that the outcome is going to be a negative one, that their children may be relieved from their care.

Now, as it relates to the concept of psychosis, can you tell me in 25 words or less what is psychosis?

A psychosis is what's considered a major mental health disorder. It's when people have disorganized thinking, and the symptoms most typically are hallucinations. There are different types of hallucinations. 80% of people with psychosis hear voices. There are different types of voices that one can hear. Benign: get a glass of water. Benevolent: you're a good person, keep it up. Or malevolent: threatening them, telling them, ordering them to do something horrible. And you believe those voices.

During that period of time, uh, when she got out of the McLean Hospital, what medication— what medication was she titrating or getting off of?

I believe she's getting off the Seroquel.

Was she able to do that? Yes. Um, relating back to November 27th with the dissociative state, is that an indicia— is that an indication or harbinger of psychosis? Yes. And Is a psychosis, is that something that would be, somebody would be suffering from a psychosis for a month at a time, 2 months at a time, or is that short periods, or how does that work?

People with psychosis have intermittent symptoms. They can function fine one day, and the next day they can be hearing voices, they could be seeing things, feeling things, smelling things, To be clear, those additional types of hallucinations did not plague Ms. Clancy. She only had auditory hallucinations. But hallucinations are like the waves at the beach. They come, go, they come and go. They're called waxing and waning.

Yes. And, and would you tell me, uh, doctor, in your opinion, is an individual, and we refer to postpartum psychosis and ultimately postpartum psychosis. Yes. Can you tell us, uh, is a person, even if they are in the throes of psychosis, are they able to make a phone call? Yes, they can. Are they able to drive a car? Yes. Are they able to say, "Hi, Hawaii, I'd like to have a hot dog"? Yes. They don't, they don't have to look at the unicorn in the corner, right? That's correct.

Mr. Rankin, it's 4 o'clock. Is this a good time to— Sure. All right, so members of the jury, we're going to, uh, recess until tomorrow morning. Um, I would expect our schedule tomorrow will be similar, uh, to the schedule we had today, hopefully without the technology issues. Um, and I'm just going to remind everybody the same instructions: don't read anything about this case or similar cases. Don't talk about it. I don't listen to anything. Uh, and keep an open mind. Go home. Uh, have a nice evening. We'll see you tomorrow morning, uh, 9 o'clock.

Okay. All rise, please. Jurors exit.

Doctor, if you want, you may step down.

Thank you. I hesitate to ask you to approach. All right.