Trial Day 18

This court is now in session. Please be seated.

Good morning, Your Honor. May I proceed?

Yes, please.

Your honor [inaudible 00:00:20] we got the matter of Commonwealth versus Lindsay Clancy. She is represented by attorney Kevin Reddington, The Commonwealth is represented by Assistant District Attorney Jennifer Sprague and Assistant District Attorney Shannon [inaudible 00:00:20].

All right. Well, good morning everyone. Good morning, counsel. Good morning, Ms. Clancy.

Good morning your honor.

All right. So can I see counsel sidebar, please?

All set, Your Honor. Thank you.

Okay.

Your honor, [inaudible 00:04:35] before the jurors come out.

[inaudible 00:04:37]. All right.

Court all rise, please. Hear ye, hear ye, hear ye. All persons having anything to do before the honorable William Sullivan, Justice of the Superior Court now sitting [inaudible 00:06:10] within the Florida Commonwealth. Drawn in, give your attendance, and you shall be heard. God save the Commonwealth of Massachusetts. This court is now in session. Please be seated.

Good morning, Your Honor. May I proceed?

Please.

Your Honor, before the court today, we have a continuation of the [inaudible 00:06:28] trial in the matter of Commonwealth versus Lindsay Clancy. Ms. Clancy is present. She is represented by attorney Kevin Reddington. The Commonwealth is represented by Assistant District Attorney Jennifer Sprague and Assistant District Attorney Shannon [inaudible 00:06:41].

All right. Good morning, everyone.

Good morning, judge.

What I'm going to do is I was looking for my little cheat sheet about the questions that I thought you could probably say along with me at this point. But let me ask them just to make sure everybody's able to follow those instructions. So has any member of the jury read, seen, heard, or overheard anything from any source that would affect your ability to be a fair and impartial juror?

[inaudible 00:07:08].

Next question. Is there any other serious matter or concern bearing on your service as a juror in this case anybody needs to bring to my attention?

No.

All right. Again, as always, thank you for following those instructions. Now, what the schedule for today is that I would expect a longer day. All right? Similar to some of the days we had earlier this week. So what we're going to do is we're going to return to the defendant who's going to call their next witness. And that witness is going to be testifying by Zoom or over the monitors that you're going to have here. There was an earlier witness, I think, who had also testified that way. And so the delay we had coming in here was just setting that up. It should be all set. They kept me away from all the technology, so I think it should be working pretty well. And then at that point, we'll see what we'll deal with after this witness and then we'll go on from there. Okay. All right. Thank you. Mr. Reddington?

Judge. I don't know who's going to turn it on.

[inaudible 00:08:27].

Okay. Thank you.

Could you please raise your right hand, sir? Would you please raise your right hand, sir? Do 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 Commonwealth and the defendant [inaudible 00:09:20], shall be the truth, the whole truth, and nothing but the truth, so help you God?

I don't think there's volume.

Could you turn on your volume? You're muted.

Okay. I think I've got it. But it's a little hard for me to hear you on your end. If you could keep your voices up, please.

Do you want me to swear him in again?

Yes, please.

Please raise your right-hand one more time. Do 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 Commonwealth and the defendant [inaudible 00:09:45], shall be the truth, the whole truth, and nothing but the truth, so help you God?

He froze.

Yes, I do.

Thank you.

Thank you. I am going to be able to hear you now.

All right. Give it a try.

All right, counsel.

Good morning, doctor. Will you tell us your name in a loud voice so that we can all hear you and spell it for the record?

Phillip Resnick. P-H-I-L-L-I-P, R-E-S-N-I-C-K.

And where do you live, sir? Where do you live? Can you hear me?

I'm in... You froze up. I can hear you now.

Okay. Where do you live?

I live in the Cleveland, Ohio area.

So this is a delay. If I ask a question, there's like a two or three second delay for your answer. So that's a little difficult, but we'll try to get through it. Can you tell us what you do for work, sir?

Yes. I'm a forensic psychiatrist.

And first off, the reason that you are not appearing here today in court, is that because you have had recent unexpected major surgery regarding an illness. And as of last week, you've now been released from the hospital and you're at home?

Overruled.

I was discharged from the hospital Tuesday night and there was a recommendation that I not fly for the next few days.

Okay. So you did intend and had tickets to come here and testify, but obviously the court has accommodated us with a Zoom.

Yes.

Okay. Have you worked on this case with Lindsay Clancy at my request, sir?

Yes, I have.

Okay. Can you tell the jurors your educational and professional background, please?

Yes. I have a bachelor's degree in psychology from [inaudible 00:12:12] Western Reserve University. [inaudible 00:12:18].

Yeah, it's really low in [inaudible 00:12:19].

I graduated high school in 19-

Hold up for a second. We're having technical difficulties.

All right. Can I see counsel here at the side, please? Well, members of the jury, just like in the old days when you're watching TV, the little sign used to come up and say technical difficulties. That's where we are. So what we're going to do is we're going to take a short break and have people who know more about this than I do to kind of readdress this. All right. To see if we can have a smoother presentation so you're able to follow and listen to the testimony without kind of being broken up and choppy. All right. So I'm going to ask you... Well, I hope it's a short break, but the goal is to get this in a manner that is easier for you to hear and absorb this information. So we're going to take a short break, I hope. And we'll see you in a couple of minutes. All right. Thank

You. All rise please. Jurors exiting.

[inaudible 00:15:37].

All right.

No, it's [inaudible 00:15:45].

All right. So we'll be in a short recess.

Yep.

We'll kind of see if we can get this working again and we'll be out as soon as that's done.

Court all rise. This 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 are present excluding the jury.

Are we ready for the jury?

Yes. Fingers crossed.

All right.

[inaudible 00:17:13].

All rise, please. Jurors entering. 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 are present, including the defendant and including the 18 jurors.

Thank you, Madam Clerk. Members of the jury, we're going to give it another go. All right. All right. Go ahead.

Great. Thank you.

Mr. Reddington.

[inaudible 00:18:21]. All right, doctor, can you hear me?

Yes. Yes.

Excellent. Tell us again your name for the record and spell the last name.

Okay. Phillip, last name Resnick. P-H-I-L-L--I-P, R-E-S-N-I-C-K.

All right. And you're going to have to speak a little slower only because of the microphone. Okay. Tell us your background, sir. I know you're a physician. Tell us your educational background and your work history.

I am a forensic psychiatrist and I received a bachelor's degree [inaudible 00:19:12] in 1959 and a medical degree in 1963. Both from Case Western Reserve University in Cleveland, Ohio. I then had a one-month internship in a military hospital in Texas. And then I came back to University Hospital of Cleveland where I completed my residency in psychiatry.

And do you have-

[inaudible 00:19:42].

I'm sorry, go ahead.

Yeah. Would you like me to continue?

Yeah, you can continue. I interrupted. I apologize.

Yeah. I have remained at Case Western Reserve University as now a full professor. And I've also become interested in forensic psychiatry. That is that aspect of psychiatry, which relates to legal issues such as this case. And I initiated a fellowship in forensic psychiatry in 1979 and directed that for 40 years. I also served as director of the Court Psychiatric Clinic in Cleveland, Ohio for over 40 years.

Doctor, do you have board certifications as well?

Yes. I'm board certified in psychiatry, 1971. And board certified in forensic psychiatry, 1979.

Did you also have added qualifications in forensic psychiatry in 2014, 2024 and re-certifications?

Yes.

And have you, without going through them, also had a number of visiting professorships?

Yes. I've had about 14 visiting professorships.

Now, doctor, this case involves what I guess is referred to as filicide, F-I-L-L-I-C-I-D-E, I believe. Did I spell that right?

Single L.

Single L. Okay. Can you tell the jurors what that means?

Yeah. Filicide is a parent killing a child and it is a relatively infrequent phenomenon that occurs in the United States somewhere between 400 and 500 times a year.

And doctor, is it fair to say that you have, at least in the country, if not outside the country, the most experience in working on filicide cases?

I believe that's true. I have been personally involved in, I'd estimate about 80 cases where I was asked to evaluate mothers and fathers who had killed their children.

And question that I have, doctor, is have you had occasion to work on cases that found themselves in court where you gave testimony either for the government or for the defense?

Yes, I have. [inaudible 00:22:42].

Let me just go through if I can... So let me just go through so we can cut to the chase. Did you work as an expert on the case of Jeffrey Dahmer?

Yes. I consulted with the prosecution in that case.

Did you also work on the case of what is referred to as the Unabomber. A fellow by the name of Kaczynski?

Yes. I was also a consultant to the government on that case.

Did you also find yourself consulting on the matter of, in Florida, the Commonwealth versus or the State versus Casey Anthony?

I was a consultant to the defense in that case, but I could not be held [inaudible 00:23:27].

Did you also work on the matter of Andrea Yates?

Yes. I testified for the defense in both of her trials.

Did you also work on the case of what is known as the Aurora Movie Theater shooting?

Yes. I was a consultant to the prosecutor in that case.

Did you also work on the case involving the Oklahoma City Bombing, courthouse?

Yes. Again, I was employed by the government in that case.

And in addition to those cases, did you also, in your practice, consult with the defense as well as the prosecution on a number of homicide cases, many of which involve filicide?

Yes, I have.

All right. In the course of this case, sir, did I reach out to you and ask if you would assist me in evaluating Lindsay Clancy?

Yes, you did.

And can you tell the jurors when and for how long you would actually interview? Whether it would be Lindsay, whether it would be third party contacts. Just give us an idea as to how you evaluated her.

Yes. About four months after the crime, I did a personal evaluation of Lindsay and her parents to gain information. And I spent three hours interviewing her on that date.

And how long did you spend interviewing third party contacts of her parents?

An hour and 15 minutes.

And this would be in May of 2023?

That's right.

Where did the interview take place?

The interview took place at Duxbury Hospital.

Is that a hospital facility that's a mental institution in the town or city of Tewksbury?

Tewksbury, yes.

And Lindsay actually came and was living in Duxbury at the time of the incident. Is that correct?

That's correct.

All right. So can you describe for us, without getting into any statements that she made to you, tell us about the circumstances. How did she appear to you physically? And how was she able to answer your questions? Just tell us what her appearance was. Her mood?

Yes. Well, first of all, at the time, of course, she had suffered a major injury and was paralyzed. So that was the setting. So during the examination, she did not have control of the lower part of her body. During the interview, she appeared somewhat matter of fact, but at the time she was still grieving. The nurses told me that she was crying daily about the loss of her three children. And she was also medicated at that time. She was fully cooperative and gave me a detailed account of her recollections of the critical events.

Did you make an observation of her affect? Did she appear to have what you refer to as a flat affect?

Yes. She did have, where I would call it a blunted affect. That is, her emotions were not as you would expect. Her feeling tone was muted.

Muted? Is that what you said, muted?

Muted, yes.

Okay. Now, doctor, in the course of evaluating this case, and again, in the interest of time, would you agree that you had a chance to review a number of items to assist you in your evaluation?

I reviewed extensive records in this case, both records referring to Ms. Clancy's mental illness, how it developed, who her treaters were, and then also I was able to evaluate records after her conduct.

And that would include police reports?

Extensive police reports, yes.

Grand jury testimony?

Yes.

Photographs?

Yes.

Videos?

Yes.

Medical records from healthcare providers such as Dr. Tufts, Nurse Practitioner Gelata and McLean Hospital?

Yes.

Were you aware that she had also contacted suicide hotlines and went to a facility in Rhode Island, women and infants?

Yes. I reviewed all those records.

So with all of that information, Doctor, that you had access to, did you also have the opportunity to review any records from, let's say, the government's doctors? Dr. Helbren, Dr. Mack, Dr. Satoff.

Yes. After I prepared my report, I was aware that there are three experts employed by the prosecution. And I was able to review their reports in detail [inaudible 00:29:29].

Okay. And your report is actually dated. You saw her in 2023, and you prepared your report ultimately after your evaluation in September. Do you know when the government's doctor's reports were available to you? Was that recently?

My recollection is that they did their evaluation about two years after the crime, and I had the opportunity to see her four months after the crime.

Now, did you also have occasion, sir, to see from Dr. Helbren, government's doctor, psychiatric testing?

Yes, I did.

Can you tell us, for example, was one of the results on the psychiatric testing a test that he administered for the government called the MMPI, or Minnesota Multiphasic Personality Inventory Test?

That was a psychological test that he administered, yes.

And do you recall from reviewing the records what the results were? Was she faking? Was she lying or was she telling the truth and-

[inaudible 00:30:46].

The results showed no evidence of faking.

Hold on. Okay, Doctor, I had asked you if you were aware that government's Dr. Helbren had administered the MMPI test. And came to a conclusion as to whether or not Lindsay was telling the truth, faking, or exaggerating symptoms. And you relied on that test as a portion of your opinion. Is that right?

Yes, I did.

Can you tell the jurors what the results of that test were, to your knowledge?

In summary, the results were that Lindsay Clancy had a tendency to minimize. And did not have a tendency to exaggerate what she was saying in her own symptoms.

Did it also indicate that she was not, I think the terminology is faking or lying in her answers, but in fact was being truthful as best she could be?

Yes. Although the test is a little more specific about symptoms rather than lying or not lying. But it did not suggest any evidence of faking symptoms.

Okay. And I'm sorry, that broke up. It did not suggest any evidence of what?

No evidence of faking psychiatric symptoms.

Okay. And then finally, one of the scales in that test is referred to as the K... I think from the books, the K scale or the lie scale. Is that correct?

Yes, that was not elevated.

Not elevated. Okay. Now, doctor, in your experience, do you have any particular subspecialty or interest in the concept of people that are malingering or faking in the forensic world? In other words, if it's a criminal case, if it's a workman's comp case where somebody's pretending their back hurts, things of that nature, have you focused on that as a subspecialty or interest in your career?

That has been a major interest. I've actually written 46 articles or book chapters in this area. The first was 1984. And over the course of that, of course, new research comes out. So when you write a new edition of a book chapter, it would incorporate new material. So even though the chapter may go through five editions in a particular book, they're up-to-date. And the ones which were written earlier would no longer be the best basis for forming an opinion.

Now, for example, when you reviewed Dr. Helbren's report for the government, did he refer to your articles?

He did refer to my research, yes.

And was that updated research or was it old research that he referenced?

He referenced older research.

So can you tell us, Doctor, when you consider the... Let me start over again. When you reviewed Lindsay's medical records, you also reviewed the psychopharmacology? In other words, the medications that Dr. Tufts and Gelata and all of these other doctors had prescribed to her during that period of time?

Yes, I did.

And have in mind your...

Yes, I did.

And have in mind your interview, the time that you spent with her directly reviewing all of the documents, all of the medical records, everything that we've talked about, and you're also aware from her, not specifically what she said to you, but you're aware of the circumstances from her recollection as to the killings that she told you. Is that correct?

Yes, as well as the journal she kept and other evidence of her thinking and symptoms as the time approached for the crime on January 24th, 2023.

Okay. You were also aware of her access to her cellphone doing Google searches and looking up medications during that period of October, November, December and January? You're aware of that, correct?

Yes.

Okay. Can you tell the jurors, in your opinion, sir, with your years of experience in the issue of filicide, working for just the government on a number of cases and the defense and your evaluation of Lindsay, can you tell this jury your opinion as to whether or not at the time of the killings that she was suffering from a disease or defect that impaired her ability to substantially appreciate and/or conform her conduct to the requirements of the law?

Well, sure. Let me begin with the issue of whether she had a mental disease or a defect. Ms. Clancy had a severe depression. There is a book called the DSM, or Diagnostic Manual, prepared by the American Psychiatric Association, which lists criteria for various diseases. In the Diagnostic Manual, for example, one needs to have five out of nine symptoms to make a diagnosis of major depression. Ms. Clancy, as she approached the date of the crime, actually had seven of the nine symptoms and was severely depressed. In addition to that, she had some earlier evidence of what's called a mild mania, and that fits together in what's called bipolar II. In other words, it's a type of bipolar illness where there is more frank depression, severe depression, but the manic aspects are not as severe. So my final diagnosis of her was called bipolar II with a severe depression on January 24th, 2023, and from reading the reports of all of the experts that will be testifying, no one failed to diagnose a major mental disease on the day of the climb.

Now Doctor, in the course of that diagnosis, have you considered the concept of postpartum depression and/or postpartum psychosis?

Yes.

Can you tell the jurors how that-

First of all-

I'm sorry. Can you tell the jurors how that factors into your diagnosis and opinion?

Yes. Ms. Clancy had a history of anxiety and difficulty with each of her children. It was minor with her first child, more significant with her second child. On the occasion of Callan's birth, things went well for the first three months, but then Ms. Clancy became very anxious and depressed, and it took quite a toll on her. I believe the jury has heard from various treaters such as Dr. Tufts and Nurse Jollotta and others and her own anguish about how depressed she was, where she actually felt she couldn't function, her brain was damaged. She would never be the same. So she definitely met the definition of a major depression as well as this bipolar phenomenon. Now with respect to the postpartum aspect, since Ms. Clancy's symptoms began within three months of Callan's birth, that would be considered a postpartum onset. Then of course she had considerable difficulty over the next five months, and at the time of the crime itself on January 24, 2023, Ms. Clancy was frankly psychotic. So in that sense, she had a postpartum psychosis. It's actually not frequent to have a postpartum psychosis eight months after a birth, but it does occasionally occur. What I can say is whether it is a classic postpartum psychosis or not, with a postpartum onset and frank psychosis on the day of the killing, I would label that a postpartum psychosis in the sense that it was a postpartum onset and she was clearly psychotic on that day.

Doctor, when a person is psychotic or involved in having a psychosis, in your opinion, are they able to appear "normal," quote, unquote, communicate with people, drive a car, things of that nature?

Well, let me say there that Ms. Clancy herself did her best to not reveal the extent of her depression. She was frank with members of her own family. Her sister, her mother, her mother-in-law were aware of how anguished and depressed she was, but with more casual friends, she tended not to show the extent of her depression. I'm not suggesting that she was, although psychosis can indeed wax and wane. For example, on the day of her crime, I'm not suggesting that she was frankly psychotic every minute. She was functioning. In fact, she said she was having a better day than other days. She actually went out and made a snowman with the kids, visited with, took Cora to a doctor for the fifth birthday checkup, and was functioning at a level that was not frankly psychotic until she had a command hallucination while her husband Patrick was out doing a couple of chores.

Can you tell us, Doctor, in your opinion, what a command hallucination is and how it fits, if you will, in a diagnosis of psychosis?

Yes. If we take, first of all, a hallucination is simply hearing a voice, and the voice can be benign or it can be more malignant. A voice may just simply say, "Open the window." About one-third of voices are called command hallucinations. That is, an instruction to do something. The majority of those commands are benign. It might be open a window, get a glass of water. It might be something much more ominous, such as to kill oneself or harm someone else. Those are dangerous command hallucinations. Now, in Ms. Clancy's case, she had not only a command hallucination on the day that she killed her children, she had what is known as a delusion of influence. That is, not only did she hear a command, but she felt that her body was taken over by an external force where she was in a green space and did not have control of her own body. It was almost like she was a puppet and someone else was pulling the strings.

Yep. Hold on a second. Counsel? Members of the jury, I want to give you an instruction at this point. I'm going to go into this also a little bit later when I give you the full instructions at the end of the case, but you are not to consider the defendant's statements to any psychiatrist or psychologist as establishing the truth of any facts that are contained in those statements. All right? The defendant's statements to any psychiatrist or psychologist for purposes of evaluation cannot be considered by you as evidence of premeditation, extreme atrocity or cruelty or specific intent to kill. Such statements are admissible only as they relate to the basis for the doctor's opinion of the defendant's mental condition. All right? I'll go into that a little bit later. Okay. Go ahead, Mr. Reddington.

So Doctor, to conclude, would you relate your opinion as it relates to the standard of a person lacking criminal responsibility at the time of the commission of a crime in the Commonwealth of Massachusetts?

Well, there are two arms to the test for criminal responsibility. One has to do with the defendant's ability to control their conduct and the other has to do with their knowledge of the wrongfulness of their acts. I'd like to address each of those separately, if I may.

Sure.

With regard to my opinion, my opinion is that Ms. Clancy was, due to her mental disease, unable to conform her conduct was to the requirements of the law on the day that she took the lives of her children. Let me give you the basis of that opinion. First of all, she was hearing a voice which was commanding her to engage in the killing behavior and she did not feel any sense of control. She felt that she had to obey the instructions she was receiving. It was a matter where she was just following the command rather than being able to make any decision to do it or not. For example, I asked Ms. Clancy-

No, you can't say what you talked... Doctor, you cannot say what she told you. All right?

Okay. All right. I will not do that. Let me just make sure I'm covering other aspects of this. The second evidence that she was lacking control is the fact that she made a severe suicide attempt also based on the command hallucination that she heard that day, so that she not only cut her throat and jumped out of the window, she very much wanted to die. Now, in my research on women who kill their children, I've divided the motives into five categories, and I want to look at how Ms. Clancy [inaudible 00:50:36] to those motives.

Tell us the five categories.

Yeah. The five categories are, first, altruistic filicide.

What does that mean?

Secondly-

What does that mean, altruistic filicide?

Altruistic filicide occurs when a murder is committed out of love rather than hostility. It is an effort on a mother's part to do what is best for the child. They may believe that the child is... they may have a delusional belief the child is about to be tortured in their delusional mind and they take their life in doing what they believe is in the best interest of the children based on their delusional idea. Altruistic filicide also occurs when a mother may plan to take her own life, and in her psychotic thinking and severe depression, it is distorted, and she may believe that the child will be worse off if she remains alive. For example, in Ms. Clancy's case, she believed that, as the jury has already heard, she was obsessional about caring for her children. She consulted with others at work to try and do exactly what was right for her children, and she believed that if Ms. Clancy took her own life, her children would be in terrible shape. In her mind, she believed that she would be doing her children a favor by having them go to heaven with her rather than remain on earth without her doing the mothering. Her mind was very distorted like that.

Okay. If you could just tell us the other titles of the other four types that you will refer to. Just tell it without getting into detail if they don't apply to Ms. Clancy.

All right. The second category does apply to Ms. Clancy, and that is it's called acutely psychotic filicide. This occurs when someone is frankly psychotic. They may have delusions or hallucinations, they're out of touch with reality, and rather than having any rational motive, they're simply acting on their psychotic beliefs. Those two both apply to Ms. Clancy. The other three-

Okay, go ahead.

I'm sorry?

Go ahead. No, that's all right. Just give us the other three, the captions of them.

The other three, which do not apply, one is called child maltreatment, in which a parent may shake the child to death or throw a child against a will in an abusive manner. The next category is unwanted child, where someone, just for their convenience, the child is a burden and they kill the child for that motive. The final motive is spouse revenge filicide. That is, someone hates their spouse so much that they're willing to sacrifice the child as a way to punish the spouse. The three latter categories clearly do not apply to Ms. Clancy. She loved her husband, respected her husband, had a good marriage. She never spanked or ever abused her child, and all of her children were wanted. In fact, she planned to have a fourth child. So those three categories clearly do not apply. If I can explain how the two categories did apply, I've already mentioned that Ms. Clancy believed a distorted belief that her children would just be miserable and she could not imagine them continuing to exist and have a decent life without her being there as a mother. So in that sense, she did what she believed was morally right. Even though she understood that ordinarily killing a child is against the law, she believed that she was doing what was right for her children with her distorted psychotic thinking about the children's need for her. Then with respect to the second category of acutely psychotic, Ms. Clancy was under the influence of a command hallucination and idea of influence, so that at that time, rather than the ability to make a rational decision, she was so in the grip of her psychotic command hallucination and idea of influence that she lacked the capacity to conform her conduct to the requirements of the law.

Okay. Doctor, pretty much finally, there've been some questions or allegations that Ms. Clancy did not provide information to her healthcare providers about her adverse effects of medication that she had been prescribed. Do you agree with that from your review of the medical records or did she in fact tell her healthcare providers how she felt as a result of what she perceived to be the medications that were prescribed?

It's my opinion with reasonable medical certainty that Ms. Clancy was actually a more sophisticated patient than most and she was forthcoming in conveying her symptoms. The one area in which she was not fully revealing was the area of when she had an impulse to harm her children, and that was because she had a rational belief that her children may be taken away ‍ from her by a social service agency. She had an irrational belief that if she even entered a medical hospital, that her children will be taken away. So that is the one area in which she was not fully forthcoming.

Now, Doctor, in your experience, do you find that many women that are caretakers of children, postpartum after the child is born, that are having these intrusive thoughts and having these dark thoughts are in fact afraid of reporting them because of that very reason that you're talking about?

Objection.

Sustained.

Yes, as a matter of fact-

Yeah, you can't answer that.

[inaudible 00:58:38] rephrase that.

Okay. It's also been mentioned here a couple of times that she hasn't killed herself yet, even though she's in the Tewksbury Hospital. Can you tell the jurors briefly, while she's in the Tewksbury Hospital, what are the circumstances of her confinement and what type of care is being provided to her as it relates to why she hasn't killed herself yet?

Well, let's see. Indeed, there is evidence of her ongoing suicidality to such an extent that she is never allowed to be out of the presence of a staff member. Even when I conduct an examination of her and requested privacy, a staff member had to be present. Her ability to take her life in view of her impulses and observation is [inaudible 00:59:41] and she recognizes that, so that the reality is no matter she does not want to live at any point, she has no choice but first to live at this time.

Thank you very much, Doctor. You have to answer some questions from the DA. Your Honor, at this point, I would like to, because I'm looking at 40-page resumes, so I just offer that if I could.

Any objection?

No objection.

Okay. That may be marked.

Thank you.

[inaudible 01:00:30]. If I may?

Yes, please. [inaudible 01:00:38].

Good morning, Dr. Resnick.

Good morning.

In addition to the evaluations that you do, is it true that you've also taught some courses to other forensic psychiatrists and psychologists about how to testify in cases like these?

Yes, I have.

And you teach them how to answer questions and how to dress and how to appear believable and trustworthy, correct?

That's correct.

In one of your trainings, excuse me, Do's and Don'ts of Depositions by Dr. Philip Resnick, in your course description, you state information beyond the question should not be volunteered because it will open up new areas for questioning, provide ammunition for attacks, eliminate the opportunity for surprise, and information fails to get to the jury. Correct?

That's correct.

So you teach other psychologists how to hold back information in the discovery process to surprise the other side?

No, that's not [inaudible 01:01:49], and I'm not a [inaudible 01:01:51].

Now, a woman who kills her child can have more than one motive, correct?

Yes.

Actually, the most common motive for women who kill their children is fatal maltreatment or child abuse, correct?

That's correct.

And in fact, most women who kill their kids don't do it due to mental illness, correct?

That's correct.

And in fact, there's a quote from you in an article, Child Murdered by Mothers: Patterns and Prevention, where you say, quote, "More filicides occur due to fatal maltreatment than because of maternal psychiatric illness," correct?

Correct.

You also have written about parents having significant emotional devastation after killing their children, correct?

Yes.

And in fact, you've written in chapter six of family murder, Child Murder by Parents, n the aftermath section, you've written, quote, "These life events are likely to prolong the parent's depression. The anniversary of the children's deaths and exposure to things that remind the parent of it are likely to be upsetting." Correct?

Yes.

Things like birthdays and holidays and the anniversary of the killings would all be something that would be upsetting, correct?

They sometimes are, yes.

Now, you've written a lot about malingered psychosis, correct?

Yes.

Malingering psychosis, you can have a mental illness and your malingering could be exaggerating those symptoms or saying you have psychosis symptoms when you don't, correct?

That's correct.

One of the things that you have written, and there's an article that you wrote called Faking It, you've written in here, quote, "Command auditory hallucinations are easy to fabricate. Persons experiencing genuine command hallucinations do not always obey the voices, especially if doing so would be dangerous." Correct?

That's correct.

You've also given some points to other practitioners, quote, "If you suspect a person of malingered auditory hallucination, ask what he or she does to make the voices go away or diminish an intensity," correct?

Yes.

Because typically someone who hears a voice telling them to do something horrible like kill their child will try to resist that voice initially, correct?

There's variability. Some do and some don't.

And in fact, the case you mentioned earlier, Andrea Yates, Ms. Yates, in fact, committed herself to a hospital five times and tried to kill herself twice, all while trying to not kill her children, correct?

Yes.

She had heard voices for months telling her to kill her children, and to resist those voices, she actually tried to kill herself, correct?

Until she could no longer resist the voices, yes.

Right. But she tried.

Right, as did Ms. Clancy.

Well, according to the records and reports that we have that are in evidence, Ms. Clancy heard the voice and immediately acted, correct? According to those records? Is that correct?

Well, Ms. Clancy had impulses to harm her children, which she did resist until the command hallucination when she was overwhelmed, yes.

But according to the records and the testimony that you've had, she had an impulse in December one time to harm her children, correct?

I believe it was on two occasions that she mentioned it to her husband.

And then never again after that, until her kids were killed, correct?

There were only two occasions she mentioned it, but she referred to having these horrible impulses, so that suggests to me she was dealing with it on an ongoing basis, although she mentioned it only twice to her husband.

But she never said she had thoughts to kill her children. She said she had thoughts to harm her children, correct?

Yes, but actually, I think it's clear that to harm her children was to kill her children.

Well, in the records where you say that she was so clear in presenting her symptoms to her doctors, she repeatedly was asked if she had any homicidal ideations and she repeatedly said no, correct?

That's right, and she didn't in the initial parts of her treatment, but by late December and January is when she did have those impulses, and she did not acknowledge them.

But what she told her doctors-

She did now acknowledge them to her doctors.

What she told her doctors in December is that she had no homicidal ideation. She only reported suicidal ideation, correct?

Yes, and as noted, that's very common, because people fear their children will be taken away.

So it's better to kill them than to have them taken away?

Objection.

Sustained.

No, it's not better to kill them-

Hold on, Doctor.

... than have them taken away.

That question is stricken, that answer is stricken. Okay.

You say that she was very forthcoming in her symptoms to her medical providers, but she never told those medical providers that she had an impulse to harm her children, correct?

That's correct.

You also, in teaching people about malingering, about faking hearing voices or being psychotic, you give pointers of what people should look for, such as patient uses no strategies to diminish hallucinations, patient states he obeys all commands. Correct?

Yes.

You also, in a podcast, evidence entitled Identifying Malingering with Dr. Phillip Resnick, you were asked about malingering and asked about hearing voices and you said, quote, "So a common example I'll use in teaching is if you hear a voice out of the blue that says kill your mother, your moral fiber would cause you to hesitate. But if you have concurrent delusion that your mother is an evil wizard, you're more likely to act on that command hallucination." Correct?

Correct.

And there's no evidence in the records or in the testimony that we've had thus far that Ms. Clancy believed that her children were evil or that they were possessed or that there was any danger posed by them or to them by such forces, correct?

Instead, Ms. Clancy-

Well, it's a yes-or-no question, Doctor.

No, go ahead. You can answer that.

Instead, Ms. Clancy had the dichotic distorted belief that her children would be better off in heaven rather than being motherless, but that...

They're off in heaven rather than being motherless. So that was her psychotic distortion coupled with the command hallucination. So she met the exact requirement you're referring to.

And you believe that that was her psychotic delusion that they would be better off in heaven without her because according to your report, you could figure out no rational non-psychotic motive for her to kill her children, correct?

Yes.

And so just because you can't figure out a motive or you don't know a motive or the person doesn't tell you a motive, doesn't mean that there actually isn't a motive, correct?

There was a motive.

But that's not what I asked you. I did not ask you about Ms. Clancy. I said just because someone tells you that they don't have a motive or you can't figure out a motive doesn't mean they didn't actually have a motive, correct?

That's possible, yes.

You also state in another article identifying malingering with Dr. Phillip Resnick, you point out that the rapid resolution of symptoms with medication can be a red flag as genuine psychotic symptoms usually take longer to subside, correct?

That's correct.

Were you aware from the Tewksbury records that on page 1136, it says Ms. Clancy has been clinically stable since her admission. There have been no events of effective cognitive or behavioral instability since her admission. And that Ms. Clancy has not evidenced any challenges in accepting and conforming to the rules and standards. Did you review that note?

Yes, I'm aware of that.

Okay. Were you also aware on page 1168 that it says Ms. Clancy denies that she has ever experienced hallucinatory content prior to or since that event, referring to when she killed her children, correct?

Yes.

And you're aware on page 1170, it states Ms. Clancy presents with intact reality testing and no observable symptoms of psychosis. She's actively engaged in treatment. She's able to identify possible hopes for her future, including serving as an activist for postpartum psychosis awareness and participating in a wheelchair marathon. Were you aware of that?

Yes.

I move to submit these three sections as the next three exhibits.

Any objection?

No.

All right. Are those part of the Tewksbury records they're already in?

Yes.

Okay. Those may be admitted.

[inaudible 01:13:06].

Doctor, you mentioned that when you interviewed Ms. Clancy, you spoke to some nurses who told you she had been crying every day, correct?

Yes.

Are you aware that in the Tewksbury records, in the one-to-one notes of people who watched her every minute of every day, there's no record of her crying every day?

Well, when I saw her at four months, I'm not sure, was she already... How long had she been at Tewksbury. Well, I'm not aware of that note, but my recollection is that she was observed crying.

But there's no record of her crying at Tewksbury every day, correct?

I have no knowledge of it.

And you mentioned that during the interview, not getting into anything that she said, but her affect, her expressions, her emotions, you said that they were flat and blunted, correct?

Yes.

Do you remember the portions of the video where she smiled and laughed?

Are you talking about the video of my interview?

What was that?

Are you talking about the videotape of my interview with her?

Yes. Yes. At the end of the video, do you recall her smiling and laughing?

Does that open up the video?

This is affect and behavior.

That's an issue we could talk about over here and probably something best raised on cross.

Okay.

I mean, on redirect. I'm sorry.

And just getting into her affect and behavior, doctor.

Yes. Yeah. That's not inconsistent with her affect throughout the interview. Especially for example, in talking about-

Well, not getting into what she talked about, Doctor. I'm not asking anything about what she talked about. Just her expressions and her affect. Now, you mentioned that the Commonwealth experts saw Ms. Clancy three years after you examined her, correct?

I said it was three years after the crime.

Okay. And you're aware that the Commonwealth was not permitted to interview Ms. Clancy until after defense had filed a notice of their defense and we'd been given permission by the court to have our experts interview her, correct?

Yes.

And you're aware that did not occur until approximately two and a half years after the incident, correct?

Yes.

Now you mentioned that postpartum psychosis doesn't typically happen eight months after a child's born, correct?

Yes.

In fact, typically it's within four weeks of a child being born, correct?

Most often, yes.

And you mentioned that her postpartum, Ms. Clancy's postpartum symptoms begin within that three month timeframe of postpartum. Do symptoms have to occur within that three month period to be postpartum?

Well, there's a wide range of definitions of postpartum. Some scholars in the area make it the whole first year, others three months, others four weeks.

And in fact, her seeking help from a psychiatrist happened in September, which would have been four months after she gave birth, correct?

Correct.

You mentioned that Ms. Clancy was able to hide her symptoms of depression from her friends, that she was open with some people, but she was able to hide those symptoms from friends and other people she interacted with, correct?

Yes. Hide the depths of her depression.

And so she was able to control and conform her behavior to situations in which she did not want to show people how she was feeling, correct?

Sure. Very common.

Now you wrote in your report on page 24 that Ms. Clancy had paranoid beliefs that her children would be taken away from her if anyone knew what she was going through, correct?

Yes.

But that's actually a rational belief, is it not, that if someone knows you want to harm your children, they might be taken away?

It can be rational that it was more approached irrational in her case rather than rational.

I have nothing further.

Redirect? Bless you.

No. Thank you, doctor.

All right. So if we could turn off that. Thank you, Doctor.

Thank you.

All right. Reddington.

Your Honor, Lindsay Clancy rests her case.

All right. So members of the jury, the defense has now rested its case. All right. So I'm going to talk to counsel for a minute or so over here. And we're about to go into the next phase of this case. The Commonwealth has offered, given the opportunity to offer rebuttal witnesses on certain issues. And so I'm going to talk to counsel first and I'll inquire of the Commonwealth if they wish to offer these rebuttal witnesses. Okay? So counsel, can I see you at sidebar? All right. Attorney Sprague, the Commonwealth wish to offer any rebuttal?

Yes, Your Honor.

All right. If you call your next witness, please.

The Commonwealth would call Dr. Avram Mack.

Madam Clerk, raise your right hand.

Good morning. Do you solemnly swear the testimony of the evidence you shall give to the court [inaudible 01:22:00] shall be the truth, the whole truth and nothing but the truth?

I do.

Thank you. You may proceed, sir.

All right. Good morning, Doctor.

Morning.

All right. I just ask you to keep your voice up so the jury can hear you. And with that, Attorney Buckingham, please.

Thank you. Good morning, sir.

Good morning.

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

Avram Mack.

And would you spell your name for the record, please?

Avram is spelled A-V like Victor, R like Robert, A like apple, M like Mary.

And I'm just going to ask you to speak in a loud, clear voice. And if you need to push closer to the microphone, that might help.

I will.

Thank you. What do you do for work, sir?

I'm a psychiatrist.

And how long have you been a psychiatrist?

After training, I've been a psychiatrist for 22 years now.

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

Sure. I went to the University of Michigan College, Cornell University for medical school. I was here at the Brigham for residency in psychiatry. And then that was followed by a fellowship in child psychiatry at Columbia University and a one-year fellowship in forensic psychiatry at New York University.

And what do you do now? What's your area of practice now?

I'm a psychiatrist. For all these 22 years, I've been serving in a lot of different roles. Currently, I'm a professor of psychiatry at Thomas Jefferson University in Philadelphia, and I see patients at a child hospital called Nemours.

And so you, in your current practice, have a clinical practice and you also do forensic psychiatry. Is that correct?

That's correct.

And do you have any board certifications?

I do.

And what are you board certified in?

I'm board certified in psychiatry, child and adolescent psychiatry, and also forensic psychiatry. I had been board certified in addiction medicine by the American Board of Addiction Medicine, but they closed. So I don't know if I can still say that I'm board certified by them.

Okay. And to what extent are you engaged in the forensic psychiatry? What areas of forensic psychiatry have you testified in?

I've provided testimony in perhaps almost every area of forensic psychiatry, ranging from testamentary capacity of adults who engage in contracts or appropriateness for adoption, or whether or not a person is competent, or if a person is criminally responsible.

Now, in what areas of the country have you testified on those topics?

Around the country. I'm not sure how many states I've testified in, but I've been engaged in reviews or investigations of cases in I think more than half the states.

And what does it mean to conduct a forensic evaluation in psychiatry?

Well, it can mean a lot of different things depending on the question that's being asked by a court or other authority. Sometimes there are statutes that you as the forensic psychiatrist need to try to answer a particular question that a statute requires. Or sometimes it is a matter of giving an opinion, say in a civil case, where it's your understanding of say the degree of harm that the person has experienced. Sometimes great, sometimes not so great.

And you, in your experience, have testified as a forensic psychiatrist in both civil and criminal matters, correct?

Correct.

And are you aware of a difference between forensic psychiatry versus forensic psychology?

There are differences aside from the fact that they're different professions, but they both cover mental health. There are different rules that apply to forensic psychologists in their carrying out their roles as psychologists.

Now, you mentioned that you have done some work and testified in matters regarding criminal responsibility, right?

Correct.

And you're aware that different states have slightly different statutes when it comes to criminal responsibility?

Yes.

And so in this case, you were asked to review the matter of the Commonwealth versus Lindsay Clancy, correct?

Yes.

And so in order to do that, did you review the statutes here in Massachusetts regarding criminal responsibility?

Yes, I did.

And can you tell us how it came that you were involved in this case?

I was asked by the prosecutor's office to be involved as a psychiatrist reviewing the matter.

And when you're asked or you're retained by either side in a case, a defense or a prosecution, what is the goal of the evaluation? Are you just trying to advocate for the side who hired you or are you conducting an independent evaluation of the evidence?

Overruled.

You can answer.

Well, to answer your question, certainly the goal is to provide an independent evaluation. Or one would also add to provide clarity and to say what can be said. In criminal matters, sometimes it's a very certain question. It's either a yes or a no. In other matters, it's not always necessarily a strict yes or a no.

Now, in criminal matters where you were asked to conduct these independent evaluations, how do you approach it? What kind of information do you seek or would you prefer to have in order to conduct the evaluation?

Well, generally, one starts with the statute and then tries to gather or review what information exists to understand the mental state of the person, if that's pertaining to the particular statutory question, and to understand the mental history and the mental state of the individual and to see if that can be applied to the questions at hand.

And so what types of records are you generally looking at when conducting a forensic evaluation for something like criminal responsibility?

Well, one would certainly want to review psychiatric records if they exist. Ideally also to have examined the individual and to gather information, not only historical information from the individual, but to do in that sense, an examination in real time. And that provides you the information, what we call a mental status examination. Other records are also important. Medical records, educational records, and other records that describe the individual.

And when we're talking about a criminal case, fair to say you review the entire criminal file too, right?

Yes.

And when you're doing these evaluations and creating a database of this particular information, are there any limitations to your opinion or evaluation?

Not sure how you mean that.

Well, when you have these evaluations that you're conducting, namely for criminal responsibility, do those evaluations... Are they limited based on the information that you have? Meaning if you don't have everything at the time you do your evaluation, is there a caveat to your opinion?

Well, when I write an opinion or state an opinion, it is based on the totality of the information that I have. If additional information comes along, I am open to receiving that and integrating them to my understanding of the totality.

Now, when you interview the individual in these evaluations, the purpose of the interview or purpose of your contact with them is not to provide treatment, correct?

Correct.

And the opinion that you reach ultimately is based on the defendant's mental state, correct?

To the extent that impacts the question, yes.

Okay. Well, when we're talking about criminal responsibility, you'd agree that's the central issue, is the person's mental state at the time of the alleged offense, correct?

That's correct.

Okay. So in Massachusetts here with the question of criminal responsibility, are you aware of what the standard is?

Yes.

And what is it?

Well, it uses particular language based on a common concept throughout the country called the M'Naghten standard. And I could read to you the specifics of the language, but effectively it refers to two pieces. Well, actually it starts with three. One is, did the person have a mental disorder at the time of the event? And then secondly, the two prongs speak to specifics about the mental state at the time. One being... And I would want to refer to the actual statute.

If we can, maybe we break that down for the jury. So the first part of this for criminal responsibility is the question of, does the person suffer from a mental disease or defect, correct?

Correct.

Objection to the leading. Let's see if he knows.

Yeah, if you just ask him.

I can rephrase it.

And if you want to refresh his memory, you can.

Well, you've already testified the first part of the analysis, and I think you used the terminology mental disorder, right?

Yes. I did.

And you're aware that a mental disorder is a clinical term?

Yes.

I'm sorry, I didn't hear that. I apologize. What was that?

A mental disorder is a clinical term. The terminology mental disease or defect, are you aware that's a legal term?

Okay.

Okay. Well, so when you are conducting evaluations for criminal responsibility-

Is that an answer?

Yes. I'm sorry. Yes.

Yeah. All right.

When you're conducting an evaluation for criminal responsibility and you're trying to determine whether a person suffers from a mental disease or defect, do you look to mental disorders to see if that meets criteria?

I would evaluate if the person has ever had a psychiatric or a mental disorder.

And what kinds of tools do you have available to you to do that?

Well, there are two tools. One is gathering of historical information, and the other is the information you gather from actually seeing the person face to face.

And as a psychiatrist, that's something you do in your clinical practice all the time, right?

Correct.

Because one of the main things you're going to do is look to try to diagnose an individual.

Correct.

And so how do you go about determining that if a person has a mental disorder?

In psychiatry, we make diagnoses in a descriptive manner. We look to see ways in which the individual has symptoms or signs of mental disorders or mental defects or psychiatric disorders. So in particular, one will start with trying to gather as much information as possible about what are the things that bother the individual. That may be their mood, that might be things that they get anxious about, that may be abnormal movements that they make. And that will also be aligned with understanding their medical condition, any medications that they take, any substances that they use. There's an array of sets of information that one gathers in that portion where you ask questions, but effectively you're asking questions about symptoms. And one is trying to understand not just symptoms, but the degree of impairment that symptoms might be causing an individual.

Okay. And do you work with any sort of tools that help you identify particular characteristics of symptoms associated with disorders in your field?

Well, at times, individuals use scales or tests, which can be psychological tests or scales that ask particular questions. Or other times you might use tests that are biological tests like the person brainwaves called an EEG or laboratory tests.

When you're talking about diagnosing an individual for any particular mental disorder, are there specific criteria for different types of disorders?

Yes, there are.

And is there a source that you use as a psychiatrist in order to identify the criteria for different disorders?

We use a text called the DSM, otherwise known as the Diagnostic and Statistical Manual. It's currently in its fifth edition, or actually a revision was made of its fifth edition. And so that text, which is created and vetted by a large number of professionals, provides criteria for the different disorders. And these are known as operational criteria. In psychiatry, there aren't necessarily gold standards that you can use for diagnosis like finding a bacterium or finding an anatomical tissue. So for the last 60 years, 70 years, psychiatry has turned to agreed upon definitions that are listed in the DSM.

Okay. And you said it's not the end all be all, right? Of diagnosing. You use your training and experience as well, but it's a tool that you use.

Well, they are the criteria that one uses to make the diagnosis. It is not a guidebook for how to gather that information. It's not a how to, but it is the standard.

Okay. So now going back to the legal standard here in Massachusetts. So one part is the disorder, right? And you said there's a second part.

Right. So the second part are particular criteria about the person's state at the time of the event. So one of them is they both utilize to have retained, retained substantial capacity to know that the act was wrong or against the law. And the other being retained substantial capacity to control or conform one's behaviors to the law. Okay.

And so when you're talking about criminal responsibility here in Massachusetts, is it fair to say you're looking at the person's conduct and their condition at the time of the offense?

That's right.

And the information that you're gathering in this overall evaluation, getting history and looking at the person as a whole, is that helpful to understand the person's diagnosis when you're being asked this particular question?

Yes.

Okay. But ultimately, you're rendering an opinion of the person at the time of the offense?

That's correct.

So in this particular case, you were provided a series of records and information regarding the defendant, Lindsay Clancy, correct?

Yes.

And can you just give us a general overview of the sources of information you had available to you?

Generally speaking, there was the criminal file, as you mentioned before. And then in terms of medical or psychiatric records, there was the records from the hospital that she's at right now. The hospital that she was at right before called Spalding. The hospital that she was at before that, which was Brigham and Women's. In addition, there was the medical records from outpatient treaters, and there was also the records from her admission to McLean Hospital. So overall, there were outpatient records, there were inpatient records. For the most part, those all correlated with her own care. Additionally, we received the pediatric records for some of the victims in this matter. And as I mentioned before, the criminal file.

Okay. And in addition to the records related to the defendant herself, were you also provided some other reports to review?

I was.

By other psychiatrists and psychologists?

Yes.

Now, you mentioned that one of the things that's useful in these evaluations is an interview with the person themselves, right?

Yes.

And did you engage in an interview with the defendant?

I did.

And when did that occur?

I interviewed her on April 10th and April 12th of this year.

And that's of this year in 2026?

Correct.

And what were your observations of her when you first met with her on April 10th? Can you describe her demeanor?

Generally, she was friendly and cooperative.

When you begin an interview with an individual that you're evaluating, do you conduct what's referred to as a mental status exam?

Well, the mental status exam happens all the while that you're interacting with somebody. You're always observing for aspects of their emotions, how they speak, their mood, and so forth. Sometimes there are directed aspects of the mental status examination where you are asking about particular cognitive capacities like executive functioning and attention and concentration. But the gathering of information about the person's mood, for example, or their thought process, that happens throughout the entire portion.

Okay. And so over the course of the time that you met with the defendant, were you able to make observations of, for instance, whether she maintained eye contact with you when speaking?

Right. So she did maintain eye contact.

Okay. What about her emotional state?

So overall, if we go through the various components, like what's called her affect, which is her emotional expression or her mood, generally speaking, there were not many abnormalities in her presentation. And I can go through them. They include the way in which she speaks. That is to say the rapidity of speech, if the speech is made in sort of regular intervals between words. In terms of though, does the person, and in this case, did Ms. Clancy make goal directed ideas? Was there a particular content of the ideas? So generally speaking, for all the components of the mental status examination, excuse me, there were not really abnormalities. I would say at some point she seemed distressed by some topics. I believe tearful at one point, but otherwise nothing remarkable on mental status examination.

Okay. And in these evaluations, when you're interviewing the individuals, are you also taking account of their physical presentation?

Yes.

And obviously when you met with her in April of 2026, you were able to observe her physical condition, right?

Yes.

And what were your observations of her physical condition?

Well, she's utilizing a wheelchair. Generally speaking, there were not necessarily abnormal movements that I observed. She seemed comfortable physically-

Did you find that she was able to kind of navigate her situation herself? Meaning you were in a room with her with other individuals, right?

Yes.

And she was able to kind of take care of her own-

I'm going to object, leading at this point, just as they object.

Sustained. If you just asked the observations.

What did you observe her do as far as moving herself around the room? Was she able to do that?

Yes. At the moments when there were transitions, when we took a break and she went out to the hall, she was able to navigate her wheelchair one place or another.

And when you spoke with her on April 10th and April 12th, were you able to have a conversation with her about her level of functioning at the Tewksbury?

Yes.

And did she tell you anything about what her general day looked like?

She described her general day. She described basically her existence there at Tewksbury.

Okay. And did she indicate to you whether she engaged with other patients or did she spend her day mostly in bed or what did she say about that?

Mostly she described she stays in bed or on her own. I don't think she described interacting with patients very much. There were a couple of ways in which she did interact with staff, at least. There was a therapist that she described working with. She did describe having had a physical therapist at a certain point. I'm not sure if I remember if she still was getting physical therapy. She stated she wasn't very interested in the physical therapy that she was getting there. She wasn't interested in the food there. She described having visitors at a not infrequent basis and that sometimes she was able to eat food or drinks that were brought in by them.

And who were her visitors, if you recall?

Family members mostly, as well as I believe both... And I'm not sure if they were specifically from the Brigham or Mass General, or any place in particular, but I believe religious...

... or any place in particular, but I believe religious figures, chaplain or priest from some organizations.

And her having told you that, that she has visitors, were you able to corroborate that in reviewing records that she had visitors?

Yes.

And were you able to corroborate or were you able to identify in the records that she did interact with staff and patients at the hospital according to the records?

To some degree, yes.

And you said that she had indicated to you that the food wasn't appealing at the hospital. And did you have a chance to observe her consuming her own snacks or beverages?

Beverages, yes.

Now, did she indicate to you her level of attention to hygiene and grooming while at Tewksbury?

She did. She described that she wasn't very interested in her own hygiene or grooming.

And were you able to later, in the conversation, speak with her about her ability to take care of her own daily activities like grooming? For instance, showering. Was she able to do that on her own?

Showering is embarrassing. It requires staff to help her. And that's one way in which she would rather not. It may also be that she described a lack of interest, so it's both components.

When you observed her, did she appear to be disheveled or not properly groomed in your meetings on April 10th and 12th?

No, she appeared groomed sufficiently, and I believe her hair was combed and she was wearing neat clothing.

Now, did she describe to you her thoughts or feelings about her current situation?

Yes.

And what did she say about that?

Well, she described feeling depressed, which she termed situational depression. She described feeling... I'm not sure the exact term she used, but feeling miserable, not wanting to be alive.

And-

Let him finish, please. If he's finished, that's fine, but don't cut him off.

Yeah. That's fine.

I'm sorry, Doctor, were you done?

Yes.

Thank you. So when you were meeting with her, do you recall her indicating that she reported being devastated?

Yes.

That she was devastated and grieving by her current situation?

Yes.

When you met with her at the Tewksbury Hospital, did you go over with her what her current treatment regimen is, what current medication she was on?

I did.

Was she able to tell you what medication she was taking?

Yes.

And were you able to confirm that with the records, that that was an accurate report?

Yes.

So what medications, when you met with her in April of 2026, was she currently on?

Well, in terms of psychiatric medications, the main medication of note is olanzapine. I believe that there were several medications being used for her physical needs. One that helps with her bladder, one that helps with movement of the GI system.

Well, let's just focus on the psychiatric medications, right? 'Cause that's of your interest here. You mentioned olanzapine. What's the common or the brand name for that?

It's called Zyprexa.

And what is it used to treat?

Originally it was created to be an antipsychotic medication, so to treat psychosis.

Okay. And are you aware that it's prescribed to Ms. Clancy for bipolar?

Yes. It is also used for mania. It is also sometimes used-

The question was bipolar.

Yeah. Yeah. If you could just listen to the question. Answer the question, and then if the Commonwealth or the other side wants to add to the answer, they'll ask you, okay? Go ahead.

So I think my question was, are you aware that the Zyprexa is prescribed for bipolar?

Yes. Bipolar is a disorder of mania, which is, I'm sorry, why I was mentioning at that point.

And what was the dosage of the Zyprexa that she was on, if you recall?

I believe it was two and a half milligrams.

And in your experience, is that a significant dosage?

No, it's a small dose.

Are you aware of any other psychiatric medications that she's prescribed at Tewksbury?

I believe she's also taking trazodone.

Okay. How about Wellbutrin? Does that ring a bell?

Yes. Wellbutrin is an antidepressant medication.

Okay. And clonidine, does that sound familiar?

Yes. Clonidine is a medication that's sometimes used for anxiety or to help people go to sleep.

And are you familiar with the propran- excuse me, propranolol?

Propranolol is also a medication. It also is sometimes used to help with anxiety.

Okay. And as far as the dosage of medication that she's on, based on your review of the records, are those high doses, low doses?

Overall, they're on the lower side of dosages.

And you indicated briefly in your testimony that she had reported to you that she believes to have situational depression?

Yes.

Did you have a conversation with her about the diagnosis from Tewksbury?

If you're asking about bipolar disorder, at one point, she made the statement that she wasn't convinced that she has bipolar or has had bipolar disorder. She described situational depression in terms of feeling depressed about the several stressors that she experiences today.

And what are those stressors?

Well, the remorse and sadness about the events that this case is about. Her separation or estrangement from her then husband, her being separated from the world, her physical injury.

Do you recall her actually using the term, remorse, or is that just your description of the conversation you had?

That's my summarization right here.

Okay. Now, when you were meeting with her, did you talk to her about past medication regimens that she had been on prior to the current regimen of the Zyprexa and Wellbutrin?

Yes.

And so are you aware that she had previously been prescribed, at some point, lithium?

Yes.

And is that something that would be important to you to know when you were conducting your own evaluation for diagnosis of whether somebody was on lithium?

It might help, but in psychiatry, we don't make diagnoses based on medication response.

Okay. And when it came to the report of the lithium, fair to say it was not something that was trialed for a very long period of time?

Yes. And let me correct that. It's not that we don't make diagnoses. We don't categorize or define disorders by medication response. So I heard the description of the trial of lithium, and that was a short trial.

Okay. And about her physical injuries, did you have a conversation with her about her understanding of her physical injuries?

Yes.

Do you recall whether she reported that she had any head injuries after January 24th?

She denied that she had had a head injury.

And was she familiar with the extent of her spinal injury?

Yes.

Meaning she was able to explain to you where the injuries occurred in?

That's correct.

Were you able to review, in your interview with her, past psychiatric history?

Yes.

And did she have a significant past psychiatric history?

Prior to the year 2022, she had not. She had been, over time, very hard driving. Someone who tended to get anxious, and anxiety sometimes pushed her to achieve or to do things. There had been two short periods of depression or anxiety throughout her lifetime. In one, she had been prescribed antidepressant medication around two years before 2022, which she had not actually taken. She had tended to resolve her anxiety or depression through exercise and hard work.

And when you say the two short periods, are you speaking of periods after childbirth?

One was while she was in nursing school. And the other was after the birth of her second child.

So you were able to have a conversation with her about nursing school and going on medications during that experience, right?

Yes.

And as far as the second episode where she described anxiousness and seeking medication, did she indicate to you whether she actually took medication-

‍ No, she had-

... after the birth-

Sorry.

After the birth of her second child?

She had been prescribed it, but she hadn't taken it.

Now, based on your review of records and your interview with her, were you able to identify and learn some general information about her family history?

Yes.

Did she report anyone in her family suffering from any other mental illness in the past?

No.

So no history of bipolar disorder or prior depression?

Correct. No such history.

Did you also review with her her work history?

Yes.

And did you talk to her about whether there were any adverse events in her past that affected her?

That is something I asked about. And also, I was able to look at her records to try to elicit if there were any particular adverse events in her life.

So did you find any-

No.

... evidence of any? And you said that prior to 2022, there hadn't been... Or there was minimal psychiatric history. Did you look at and talk to her about the period of 2022 from approximately September leading up to the events of January 24th, 2023?

Yes, I did.

So as far as going through that time period, were you able to review her medication history during that time?

Yes.

And fair to say there was a significant amount of medications that you looked at as far as-

Yes.

... what she was taking and what it was prescribed for?

Correct.

Did anything stand out to you in the timeline of her medication history that was significant in this case?

Well, she was initially prescribed medication in September of 2022. She didn't actually start taking that medication, sertraline, until October. There were several different medications that were prescribed. It is not clear that she actually took every medication that was ever prescribed or that she necessarily took it more than one or two times. There was a period of trial on a second antidepressant called Prozac. There were various medications used to help her to sleep. And then there was a several week period of taking a medication called Seroquel or quetiapine.

Are you familiar with that medication in your practice?

I am.

And is it fair to say that that medication has multiple functions like most psychiatric medications? When you reviewed her history, what was the initial dose that she was prescribed for it?

Just 25 milligrams.

And what is a 25 milligram dose of Seroquel? What is that generally prescribed for?

Well, it's often prescribed these days to help individuals to sleep, but Seroquel is also like Zyprexa, a antipsychotic medication. It can be used to help people to sleep. It can be used to help psychosis. It can be used to help the treatment of depression.

Okay. And as far as your review of the medication timeline for this defendant with the Seroquel, would the amount of time that she took the Seroquel have had any lasting effects biologically on her brain or her body?

There's no known effect that one would have from the amount of time that she took it. There could have been temporary effects, which could have been affecting her functioning or her psychological reaction to her functioning, but there's no known biological long-term effect.

So when you say that they could have somewhat effect, are we talking about symptoms or negative symptoms maybe?

So Seroquel might affect a person's ability to think straight. We talked earlier about cognition, the ability to pay attention, to concentrate, to have memory. And Seroquel can negatively affect your cognitive functioning, although it is expected that that will eventually go away when you stop taking the medication.

Okay. And is Seroquel a type of medication that lingers in a person's system?

Not substantially. There are some medications that do linger, like diazepam or Valium, which is another medication that she was later prescribed. All medications are on a relative basis. So diazepam will stay in your body much longer than, say, lorazepam, a different benzodiazepine.

Okay. But as far as the Seroquel goes, once a person stops taking it, is it fair to say that the symptoms or any negative symptoms that they have would eventually resolve themselves?

Yes.

And you're aware of the medications, the last reported medications that the defendant was on right before the events of January 24th?

I am.

And what were those?

Melatonin, lorazepam, trazodone, and an antidepressant medication called amitriptyline.

And as far as the amitriptyline, you're aware of what the dosage was?

Well, on the day before January 24th, it became 20 milligrams, but for several days before that, it was 10 milligrams.

Now in your experience, a 10 milligram to 20 milligram dose of amitriptyline, is that a significant dosage?

It's small. The usual starting dose for an adult is 150 milligrams.

Are you aware of what the chief complaints or problems that the defendant had been reporting at the time when these medications were all being prescribed to her in 2022?

Well, it's a several month period, but it started in September of 2022 with complaints of anxiety and depression.

And fair to say in reviewing all the records and with your conversation, that sleep also was a main issue or a complaint?

Yes, that's right.

And in some of the medications that you reviewed, could the medications themselves affect a person's sleep?

Yes, certainly can.

Now, as far as past diagnosis of this defendant, you were able to review overall in all the records that were available to you, what different providers had given as far as past diagnoses, correct?

Yes.

And as far as your overall evaluation in determining criminal responsibility where you have to answer first that question of mental disease or defect, do you rely on those prior diagnoses or do you come to your own conclusions?

I come to my own conclusions.

Are the fact that there were past diagnoses something that you consider?

Yes, especially to the extent that they highlighted the basis for those prior diagnoses. I don't necessarily have to agree with the diagnoses, but I'm interested in what was observed in terms of coming to those diagnoses.

And when you're doing these types of evaluations for criminal responsibility, why do you not rely on a past diagnosis? Why do you come to your own conclusion?

Well, that's part of being an independent evaluator, where in your mind, you're able to collate the information and make your own diagnosis.

Before we move on to your actual diagnosis, in addition to the interview that you had with the defendant over those two days, reviewing all the records, did you attempt to speak with what are called collaterals?

I did not.

Okay. Is that something that you sometimes do in these evaluations?

Sometimes.

Fair to say, in this particular case, you did have a significant amount of information from people that were close to the defendant, right?

That was my view, yes.

And after speaking with the defendant, did she identify to you some people that maybe you could talk to?

I don't remember who she said, but I think she suggested perhaps her husband, or then husband.

But you, yourself didn't have an interview with Patrick Clancy, did you?

No.

But you were able to review his grand jury testimony and interviews he's given with the police in the past, right?

Yes, I did.

Okay.

And CPS.

And as far as speaking with the defendant's parents or her sister, are you aware that attempts were made or requests were made to speak with them, but they didn't respond?

I wasn't aware of that.

Okay.

[inaudible 02:04:36]

I was not.

So based on everything that you reviewed in this case, were you able to come to a conclusion about diagnosis?

Yes, I did.

And at the time that you conducted this evaluation, what is your opinion about diagnosis?

My opinion about her diagnosis in the span from 2022 to 2023 is that she suffered from what's called a major depressive episode. That probably is a part of what's called a major depressive disorder, but the important point about it is a major depressive episode.

What made you come to that conclusion, based on her presentations?

The information about her feelings and the progression of her illness highlighted that it was best represented by a major depressive episode. It's a condition defined in DSM-5 where an individual displays problems with mood, problems with feeling pleasure, feelings of guilt or worthlessness, problems with appetite, problems with sleep, of preoccupation with death or suicide, poor concentration, poor energy, perhaps also what's called psychomotor agitation or retardation. So one doesn't necessarily need to show all of those, but as it is in the DSM criteria sets, one needs to have a certain threshold. And her history and her description of her experience, in my view, that, sorry, matched a major depressive episode.

Okay. And you indicated that it was a progressive thing from the fall into January of 2023, right?

Yes.

And in addition to the low mood, were you able to identify that she presented with anxiety at various points?