Trial Day 9

This court is now in session. Please be seated.

Good morning, Your Honor. May I proceed?

Yes, please.

Your Honor, before the court today, we have the matter of Commonwealth v. 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 Shanan Buckingham.

All right. Well, good morning, counsel.

Morning.

Hi, good morning, Ms. Clancy. All right. Counsel, can I see you sidebar?

Court. All rise. [inaudible 00:00:36].

Oyez, oyez, oyez! All persons having anything to do before the Honorable William Sullivan, Justice. The Superior Court now sits in Plymouth within before the Commonwealth. Drawing any of 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?

Yes, please.

Your Honor, before the court today, we have a continuation of the jury trial in the matter of Commonwealth v. Lindsay Clancy. Ms. Clancy is present. She is represented by attorney Kevin Reddington, but Commonwealth is represented by Assistant District Attorney Jennifer Sprague and Assistant District Attorney Shanan Buckingham.

All right. Thank you, Madam Clerk. Good morning, everyone.

Good morning.

So what I'm going to do, as you probably expect, I'm going to ask you those questions to make sure everybody's able to follow my instructions. Go a little bit into our schedule and then we'll return to the evidence on this case. So first question, 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 in this case?

None.

Last question is, is there any other serious matter or concern bearing on your service as a juror in this case that anybody needs to bring to my attention at this time?

No.

Again, thank you so much for following those instructions. Again, as I always say, I hesitate to give you the schedule because I'm probably 50% right, 50% wrong. But the intention today, the thought is we'll probably go most of today. All right? And then at the end of the day before I send you home, I'm going to talk to the lawyers, kind of see what the schedule is for next week so you can plan as best you can and also kind of see where we are in regards to the timeline and the estimate of the case. So I'll try and give you as much of that information today before I send you home. All right? So with that, I will return to the case on trial. Commonwealth, call your next witness please.

Commonwealth would call Kimberley Hardy as witness today.

Good morning. Stop right there and raise your right hand for the clerk.

Good morning. 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 shall be the truth, the whole truth, and nothing but the truth so help you God? Thank you. You may have a seat.

Watch your step, please.

Hi, good morning.

Good morning.

I'm going to ask you to keep your voice up as best you can and speak into that microphone. Okay?

Okay.

That's good. All right. Commonwealth.

Thank you. Good morning.

Good morning.

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

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

And what city or state do you currently live in?

Cypress, Texas.

And back in 2023, where did you live?

Brockton, Massachusetts.

And in 2023, where did you work?

Kingsbury Club.

Where is the Kingsbury Club?

In Kingston.

And how long did you work for that club?

Four years.

What is the Kingsbury Club?

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

Okay. Is it a private facility?

Yes.

So members only?

Yes.

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

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

So what is the playroom at the Kingsbury Club?

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

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

We have our system where we sign them in.

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

Yes.

And it also logs when the child leaves, correct?

Yes.

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

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

And as far as that system geared towards the guardian who drops off and picks up?

Correct.

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

Yes.

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

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

Are you familiar with some members using a scan app to sign in?

Yes.

And as far as where the playroom is in the club, where is it in relation to when you come in the front doors?

It is right to the right. There is a long hallway and at the end of the hallway, that's the playroom.

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

Yes.

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

We have a pool and a spa.

I'm going to draw your attention to ... Sorry, one more background question.

Mm-hmm.

You mentioned that there's other programs that the Kingsbury Club runs for children, right?

Mm-hmm.

And you as the child service director were involved in that?

Yes.

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

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

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

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

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

Yes.

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

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

And it was a first come, first serve?

Yes.

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

Yes.

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

Yes.

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

Mainly Patrick.

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

Yes.

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

Yes.

And how would you describe her demeanor during those interactions?

She just seemed very shy.

Maybe just to focus on the timeframe.

Well, that's fair. I'm going to draw your attention to maybe the September of 2022 to January of 2023, that fall into the winter. Did you see Lindsay Clancy drop the kids off at the playroom during that time period?

Yes.

And you had the occasion to interact with her?

Mm-hmm.

And during that time period in the fall to winter, what were your observations of her demeanor?

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

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

Correct.

Were you aware that there was a third child?

Yes.

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

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

[inaudible 00:09:50].

I'm sorry, what's the objection?

Who. The answer was from who.

If you could just find out.

So this conversation that you had when you said that you asked about Callan, was that with Lindsay, or Patrick?

Lindsay.

Okay. And so what did she tell you about Callan?

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

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

Yes.

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

No.

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

Yeah, she had workout outfits on.

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

Yes.

Did you notice anything different about her when she came back to pick the kids up during this timeframe?

No.

Was she ever late picking them up?

No.

Did you ever learn that she had left the property after bringing them to the playroom?

No.

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

Yes.

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

Yes.

Do you recall approximately when that was?

In January.

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

I think it was a few weeks in.

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

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

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

Mm-hmm.

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

Mm-hmm. Yeah.

Did Cora and Dawson usually come in the mornings?

Yes.

Around that time? And what time does the playroom open?

We open at 8:00.

And what time does it close?

It closes at 2:00.

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

Sometimes. Not usual.

Is it fair to say that generally when Lindsay dropped them off, they came in the morning?

Yeah.

And is there anything about that day with Cora, that last day that you saw her that sticks out in your mind?

Not that I recall.

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

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

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

Yes.

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

She left it.

Your Honor, at this time, I would move to admit the Kingsbury Club records as the next exhibit.

All right. They may be admitted.

Exhibit 218.

Thank you. Nothing further. Thank you.

All right, counsel.

Morning.

Good morning.

So you saw Lindsay with her children dropping them off, picking them up on a fairly regular basis, is that correct?

Yes.

And Patrick, of course, right?

Yes.

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

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

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

No.

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

Yes.

Thank you. That's all I have.

Thank you.

Any redirect?

No, thank you.

Thank you. You may step down.

Thank you.

Thank you.

Assist her please.

All right. Commonwealth.

The Commonwealth would call Sarah Carney, please.

Good morning, ma'am. Stop right there. Raise your right hand to the clerk.

Good morning. 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 shall be the truth, the whole truth, and nothing but the truth so help you God? Thank you. You may have a seat, ma'am.

Watch your step, please.

All right. Good morning.

Good morning.

All right, counsel.

Thank you. Good morning.

Good morning.

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

Sure. Sarah Carney.

And how do you spell your first name?

S-A-R-A-H.

And the last name?

C-A-R-N-E-Y.

And what city or town do you live in?

Duxbury, Massachusetts.

And are you married?

Yes.

And who's your husband?

Kyle Carney.

And do you have children?

Yes.

How old are your children?

Five and two.

Do you know the Clancy family?

Yes.

And how do you know them?

Went to school with Pat and then met Lindsay later.

And so when you say you went to school with Pat, fair to say you went to Salve?

Yes.

And did you know Pat before school?

No.

And did you become friends with him in school?

Yes.

When you graduated from college, did you remain friends with Patrick?

Yes.

And is your husband also a friend of Patrick's?

Yes.

Did they meet at college or just someplace else?

In college.

At some point, did you come to know Lindsay Clancy?

Yes.

And do you remember approximately when you were introduced to her?

A few years after college, maybe 12, 13 years ago.

And where were you living then when you first met her?

Boston.

Okay. How about Pat? Was he living in Boston as well?

I believe so.

And what was your relationship like with Patrick after college? Were you close?

Yes, friends. Close.

And as he began a relationship with Lindsay, did you become friendly with her?

Yeah.

Did you have that same relationship with Lindsay that you had with Pat?

No.

As time passed on, did your families remain friendly?

Yes.

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

Yes.

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

Close, friendly, went to the beach together, had them over at our house, went to their house, that kind of thing.

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

Yeah, probably fewer times just because we're all busy, but yep.

And were you around after each of the Clancy children were born? Meaning after Cora was born, you were still part of Patrick's life?

Yeah.

Did you notice any changes in Lindsay after Cora was born?

No.

And how about Dawson when Dawson came along? Did you notice any changes in Lindsay after Dawson was born?

No.

And then Callan, who was born in May of 2022, were you still friendly with them and still doing those trips and going to each other's houses, beach trips?

Yep.

So did you notice anything different about Lindsay after Callan was born?

No.

Do you recall observing Lindsay or seeing Lindsay when she was pregnant with Callan?

Yes.

Fair to say she was a pretty active person?

Yes.

And even in pregnancy, being very pregnant, she was physically active?

Yes.

Do you recall what kind of exercise she did or seeing her exercise?

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

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

I'm not sure.

Have you been inside their house before?

Yes.

So you know that they had the living room area on the first floor and basement area was finished?

After a few moves in the living room, I've never been to the basement.

Okay. So in that video, what did you observe the kids doing in the background?

Playing on the couch, playing with toys.

And when you observed this video, fair to say it was kind of like a beach body type exercise?

Sure. I'm not sure what that means.

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

I don't recall.

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

Sure, if that's what I said. I don't recall.

Now, I'm drawing your attention to the summer of 2022 and the fall of 2022. Were you still going to the beach and getting together with the Clancys?

I believe so, yes.

Other than going to the beach, what other kinds of activities would you invite them to do with your family?

They probably came over to our house once or twice.

Throughout the course of the fall of 2022, did you notice any changes in Lindsay's physical health?

I think I saw her one time at drop-off and she just seemed thinner. More frail.

I'm sorry?

Thinner.

Okay. Did you ever have a conversation with her at drop-off about your observations?

No.

How about just observing her overall demeanor? Did you notice anything change about her in the fall into the winter of 2022?

No.

Did you ever have any conversations with her about postpartum depression or sleep issues?

No.

And I'm going to draw your attention to January 22nd, 2023. That was a weekend. Do you recall that weekend?

Yes.

And did you have something happening at your house that your family invited the Clancys to?

Yes, we had a bonfire.

And who came from the Clancy family to the bonfire?

Pat, Lindsay, Cora, and Dawson.

Where was Caroline, if you know?

At home with Lindsay's parents.

Did you have the occasion to speak with Lindsay on that day?

Yes.

And fair to say, prior to that day, you hadn't really seen her much that winter?

Correct.

Were you happy to see her that day?

Yeah.

And what were your observations of her that day, her demeanor? Did she seem normal, or off?

Just quiet, but fairly normal.

Did you have the occasion to speak with her, just you and her?

Yes.

And was that outside of the bonfire, or somewhere else in your house?

In the kitchen.

And did you ask her anything?

I was talking to her about my children, my daughter's allergies, and then the conversation mulled and I asked her how she was doing.

And what did she tell you?

Good.

And did you have any further conversation or ask any follow-up questions?

No.

Why didn't you follow up?

Because I figured if she wanted to explain or deep dive into it, she would. I wasn't going to press her.

But on this occasion, she just said fine, and you kind of moved on to the next topic?

Yes.

And throughout the course of that day or that afternoon that you were with her, did you notice anything change about how she was communicating with you? Did she start to talk faster or seem confused in any way?

No.

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

No? I think it was nap time for the kids.

Okay. And was that the last time you saw or talked to Lindsay?

Yes.

Nothing further. Thank you.

All right. Mr. Reddington?

Good morning. So what was the timeframe that you knew Lindsay, not Patrick? I know you were very friendly with Patrick.

Yep.

What was the timeframe that you knew Lindsay?

12 years.

And would you say that you were close to her or were you social? Or how-

Social.

Social?

Yep.

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

Right. Just the kitchen level.

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

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

One time at drop off. Okay. You had occasion to ask her advice about the babies and things of that nature on occasion, did you not?

Yep.

She was always helpful to you or forthcoming?

Yes. Yes.

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

Yep.

And that was where, in your backyard?

In our backyard.

Was it in the daytime or the nighttime?

Around lunchtime.

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

A few hours.

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

Yes.

And she appeared to be quiet to you?

Yes.

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

Yes.

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

Correct.

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

All right. Any redirect?

As far as your observations of Lindsay over the course of 12 years, fair to say she was always quiet with you?

Yes.

Thank you. Nothing further.

Right, thank you, ma'am. You may step down. Thank you.

Thank you.

Commonwealth.

The Commonwealth would call Alia Goodheart.

Right there. Stop right there. Raise your right hand for the clerk please.

Good afternoon. 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 Commonwealth and the defendant shall be the truth, the whole truth, and nothing but the truth so help you God? Thank you. You may have a seat.

Watch your step, please.

All right. Good morning, Doctor.

Good morning.

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

Thank you.

All right. Thank you. Counsel.

Thank you. Good morning.

Good morning.

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

My first name is Alia. Last name is Goodheart.

Can you spell your first name for the record?

A-L-I-A.

And your last name, please?

G-O-O-D-H-E-A-R-T.

And what do you do for work?

I'm a psychiatrist.

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

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

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

I am.

Are you licensed in any other states?

No.

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

Correct.

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

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

Okay. And what is McLean Hospital?

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

What kind of services does that facility offer to patients?

They have lots of services, including inpatient, outpatient, substance abuse, trauma focused. There are lots of specializations, eating disorder programs. They have residential programs, they have partial programs. So there's a really broad bit of.

And what is your role at McLean?

I work on one of the inpatient psychiatric units.

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

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

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

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

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

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

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

Correct.

And are they trained to do that?

Absolutely.

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

‍ Yes.

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

Yes.

So you can't just walk in?

Not at McLean.

For the inpatient in any-

Right. Correct.

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

They have to be sent on a Section 12. Most of-

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

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

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

And the Section 12 could be something that the patient voluntarily elects to do, right?

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

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

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

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

Correct.

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

It's called the Acute Psychiatric Consultation APS. So the service is Acute Psychiatric Services and it's an evaluation. So it's a complete evaluation by either a nurse practitioner or a psychiatrist. And they go over things like, why are you coming now? What is your history? Have you ever had problems before? What's your family history? They document how you're presenting. They inquire about symptoms. And that's how they find out what medications you're on. And then based on that, they decide whether you need... There could be several options. They can recommend inpatient treatment. They can recommend partial hospital program, but the patient doesn't have to do either. If they're not unsafe, they can choose to leave. But most of the time people take the recommendation and they've presented because they are seeking help.

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

Correct.

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

It's a Clinical Evaluation Center.

What happens at that stage at McLean?

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

And you said this evaluation is done by a psychiatrist?

Correct.

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

Correct.

And when they first make it to the Clinical Evaluation Center, they're always seen by a psychiatrist?

Yes.

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

Yes.

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

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

Oh, sure. [inaudible 00:37:43]. Sorry.

No worries.

Up [inaudible 00:37:46] my fault.

Can you repeat the question?

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

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

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

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

And what does one-to-one mean?

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

And again, this determination of which unit to be on and what level of security or what level of check is done by the psychiatrist that performs that first evaluation, correct?

Correct.

Now, when a person who comes through the CEC then gets sent to the unit, do they walk to the unit on their own or how do they get to the unit?

They're escorted to the unit.

And you said there's four inpatient psych units, is that-

Correct.

Now, when the person arrives at the unit, what happens?

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

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

Yes.

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

Yes.

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

Yes.

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

No.

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

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

Now, what if they're there on a Section 12? Is there a time limit or a minimum amount of time they have to be there?

We're going to object, Your Honor. She wasn't there on Section 12. She was on a voluntary.

We haven't gotten there yet. I'm just asking background questions about the facility.

I'll allow some background questions, but let's kind of move it along.

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

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

Yes.

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

She wasn't discharged AMA.

We'll allow them to set the terms and where we are. So you can go into that.

AMA is not applicable.

If we can approach.

Yeah. You know, I don't think you heard me.

I did hear you.

All right? Well then I'm going to allow that question. Your rights are safe.

[inaudible 00:42:27] my objection.

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

Thank you.

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

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

Yes.

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

Correct.

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

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

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

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

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

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

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

I think they're still seen by a psychiatrist.

She's thinking. If she knows, I have no objection. I'm going to object to the way she's answering that.

All right. Why don't you rephrase the question?

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

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

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

Other than the social worker.

Okay. And when I say stay the same, it could be different individuals-

Correct.

... but it's somebody from that group, correct?

Yes.

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

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

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

No.

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

Yes.

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

Yes.

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

Yes.

And do you know where she came from?

The emergency department at MGH.

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

Again, for transportation, it's always a section, but then she signed in voluntarily, which is the Section 10.

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

Correct.

And did she go through that process of the Clinical Evaluation Center in the early morning hours, approximately 4:00 AM on the 1st?

Yes.

And who saw her there?

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

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

I've never met her.

Okay. But she is a psychiatrist on staff?

Correct. I did-

And-

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

Well, she works at McLean.

Correct.

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

Yes.

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

Correct.

And she was screened on the suicide screening?

Correct.

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

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

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

Yes.

And that she was having some issues managing medication?

I don't know what you mean by that.

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

Yes.

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

Yes.

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

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

Your Honor, I'm sorry. Assumptions. I'd like-

I mean, she would have had-

I can ask it a different way.

If she doesn't know, she doesn't know, all right?

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

Yes.

And you indicated a little while ago in your testimony that McLean is affiliated with the Brigham Hospital-

Correct.

... and Mass General. So is it fair to say that those records from Mass General are available to you at McLean?

Yes.

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

Yes.

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

Objection.

I don't know.

Good. Just if you could answer that. You don't know?

I don't know.

Okay. All right. Next question.

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

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

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

Correct.

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

Yes.

And that there was no violent or homicidal ideation, right?

Yes.

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

Correct.

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

Yes.

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

Yes.

That she attributed that to medication?

Yes.

Okay. And so what was the plan, the first plan that came out of that Clinical Evaluation Center evaluation of Ms. Clancy?

She was continued on the medications she was admitted on. The plan, they do the checks. They decide what medical monitoring you need, but she basically was admitted and the medications were the same.

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

15 minutes.

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

Low. Minimal. Yeah.

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

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

Just referring to what's already been marked as Exhibit 79. I'm going to draw your attention to page 24.

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

Okay. Does that refresh your memory as to the provisional diagnosis?

Yes.

And what was it?

Major depressive disorder, severe without psychotic features.

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

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

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

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

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

Yes.

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

It was a different psychiatrist.

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

It was Dr. Madva.

And that would be Dr. Elizabeth Madva?

Correct.

Again, is she a psychiatrist as well?

Yes.

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

Yes.

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

Yes.

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

I'm sorry, could you repeat the question?

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

Yes.

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

It's a conversation and also you gather information.

Okay. And so do you rely on things that were reported before?

Yes.

Okay. But you also ask follow up questions, right?

Correct.

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

Yes.

Reviewed her history with her and spoke with her about how she was feeling?

Yes.

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

Yes.

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

Yes.

Okay. After Ms. Clancy was seen by Dr. Madva, were you aware of what the plan was regarding her medication?

Yes.

And what was the plan?

Ms. Clancy complained there were several symptoms. One of the things that she did complain about was the numbness. And Dr. Madva did hear that and hear her concern and that she had been sensitive to many different medications. So she-

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

Were you finished with your answer?

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

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

Yes.

And what medications were those?

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

Your Honor, [inaudible 00:57:52]-

Again, we're going to let her finish.

Yeah. I'm just saying [inaudible 00:57:54] she looks at the records.

Yeah.

So Seroquel, Valium, and Benadryl.

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

In the past, yes.

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

Yes.

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

Did who appear to agree?

Ms. Clancy.

Rephrase that question, please.

Ms. Clancy?

Yes.

She disagreed with the diagnosis.

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

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

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

Yes.

Is Seroquel sometime used in low doses to address insomnia?

Yes.

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

Yes.

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

Yes.

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

Yes.

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

Yes.

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

No.

Okay. And as far as after the check-in with Dr. Madva on the 2nd, was the plan to continue to decrease the Seroquel?

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

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

Yes.

From nurse January 1st at 6:28 AM?

Yes.

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

Yes.

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

Yes.

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

Yes.

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

Yes.

And in relation to January 2nd, a nurse made note of interaction with her on 9:46 on the 2nd, right?

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

Okay. But fair to say on the 2nd, she interacted with nurses and Dr. Madva?