Speaker 1: Full trial audio. Everything hurt in court, no silences to skip.
Speaker 2: May I proceed yourana, yes, please, Diana before the court
Speaker 2: today we have the matter of Commonwealth for USUS. Lindsay Clancy,
Speaker 2: MISSUS Clancy is present. She is represented by Attorney Kevin
Speaker 2: running Down.
Speaker 3: The Commonwealth is.
Speaker 2: Represented by Assistant District Attorney Jennifer Sprague and assistant District
Speaker 2: attorney she had in Buckingham.
Speaker 4: All right, good morning, council, right, good morning, miss Clancy.
Speaker 4: Council you see it briefly just for a second and
Speaker 4: then I think we'll be ready to bring the jury in.
Speaker 5: A morning.
Speaker 6: Yes, please, you want to.
Speaker 2: Be more the court today we have the continuation of
Speaker 2: the jury trial on the matter Commonwealth for US as
Speaker 2: Lindsay Clancy, MS Clancy is present. She is represented by
Speaker 2: Attorney Kevin Runnington. The Commonwealth is represented by Assistant District
Speaker 2: Attorney Jennifer Spray and Assistant District Attorney Shannon Buckingham.
Speaker 4: All right, thank you, madam clerkcom Good morning everyone. Everybody
Speaker 4: had a RESTful weekend. So what I want to do
Speaker 4: is just kind of tell you first, I'm going to
Speaker 4: go through those questions, make sure everybody was able to.
Speaker 6: Follow my instructions.
Speaker 4: Then I'm going to go over what today's schedule is,
Speaker 4: and then we'll return to the comwell's presentation of evidence,
Speaker 4: all right, And so so let me ask those questions.
Speaker 4: First question, has any member of the jury red scene
Speaker 4: or over heard anything from any source about any aspect
Speaker 4: of this case that would affect your ability to be
Speaker 4: fair and impartial?
Speaker 7: All right?
Speaker 4: Next question, is there any other serious matter or concern
Speaker 4: bearing on your service as a juror in this case
Speaker 4: that anybody needs to bring to my attention? Again, thank
Speaker 4: you for following those instructions. Now, today's schedule. Let me
Speaker 4: say the first thing about schedule. I know I haven't
Speaker 4: always been completely correct on some of the schedules we followed,
Speaker 4: but I want to just let you know those decisions
Speaker 4: about the scheduling is on me, all right, and sometimes
Speaker 4: I have to take into consideration other factors or things
Speaker 4: that are going on. So what I really wanted to
Speaker 4: tell you is that don't speculate why we might go
Speaker 4: a little late or a little early on any certain days,
Speaker 4: but certainly don't hold it against either side in regards
Speaker 4: to that the person who's making those decisions or that
Speaker 4: decision is me, all right, so you should be aware
Speaker 4: of that. So that being said, the thought is today
Speaker 4: we should go into the afternoon, all right, and if
Speaker 4: that changes, I'll let you know. So and what we're
Speaker 4: going to do at this point, we're going to return to.
Speaker 8: The commonwealths uh.
Speaker 6: And with that call off, call your next witness please.
Speaker 9: Called Michael Snyder for doctor Snyder.
Speaker 8: We just approached.
Speaker 6: Oh shoot, yeah, good morning.
Speaker 9: Done, Good morning, all right.
Speaker 10: Inquire Tony Buckye please thank you, Good.
Speaker 7: Morning, sir. Could you please tell the jurors.
Speaker 11: Your first and last name, Michael Snyder.
Speaker 7: Do you mind spelling your last name for the record,
Speaker 7: please s n Y d e Er. And how are
Speaker 7: you employed.
Speaker 11: I'm a physician at Beth Israel.
Speaker 7: And how long have you been a physician.
Speaker 11: Since nineteen ninety eight?
Speaker 7: Can you tell us a little bit about your educational background?
Speaker 12: So undergrad at UMass Amherst, I did medical school at
Speaker 12: Tufts University, and then I did my residency and emergency
Speaker 12: medicine at Boston University.
Speaker 7: And how long have you worked at Beth Israel.
Speaker 11: Since twenty fourteen, twelve years?
Speaker 7: And do you primarily work in the emergency department. Yes,
Speaker 7: I'm going to draw your attention to January twenty fourth
Speaker 7: of the year twenty twenty three. Do you recall working
Speaker 7: in the emergency department on that day, Yes, and in
Speaker 7: the evening where you made aware of multiple pediatric traumas
Speaker 7: that were coming into the emergency department.
Speaker 8: Yes.
Speaker 7: And when you are made aware of things people coming in,
Speaker 7: how does that occur?
Speaker 12: So we'll typically get a call on the MS phone
Speaker 12: that something's coming in that they want us to know
Speaker 12: about upfront, and do.
Speaker 7: They provide you with some basic background information about what's
Speaker 7: occurring or what occurred on scene and what's occurring during
Speaker 7: the transport.
Speaker 11: When possible, Yeah?
Speaker 7: And when the emergency personnel the mts or paramedics survived
Speaker 7: at Beth Israel, there were three patients correct, correct, and
Speaker 7: you were assigned to treat one patient.
Speaker 11: Correct.
Speaker 7: Do you recall which patient that was Core? And prior
Speaker 7: to EMS arriving, did you learn more about Korra's presentation
Speaker 7: and what was occurring.
Speaker 11: Yeah, So we had heard that.
Speaker 12: All three were in cardiac arrest, and the Core particular,
Speaker 12: they were still working on doing CPR and doing what
Speaker 12: we call pediatric events advanced life support, so medications to
Speaker 12: try and restart the heart.
Speaker 11: And they also mentioned that they had used what we.
Speaker 12: Call a defibrillator to shock the heart to try to
Speaker 12: restart it, and they were still doing CPR when they
Speaker 12: were arriving.
Speaker 7: And is this information important to you as you're assessing
Speaker 7: a patient coming into the emergency department.
Speaker 11: Yeah, yeah, it's important to know.
Speaker 12: You know what things look like in the field, how
Speaker 12: long the patient might have been without a pulse or
Speaker 12: how long they may not have been breathing for, so
Speaker 12: we can kind of expect or know what injuries to
Speaker 12: look out for what we can potentially reverse.
Speaker 7: And were you aware of the age of Korra, Yes,
Speaker 7: and she was five correct, Yes, And as far as
Speaker 7: the medications that you were aware of what medications had
Speaker 7: been provided.
Speaker 12: So prior to coming to us, she had been given epernephrine,
Speaker 12: which is the primary medication we use in a cardiac arrest.
Speaker 7: And do you know how they had administered that medicine
Speaker 7: to her?
Speaker 9: Yeah.
Speaker 12: So she had what we call an intra osseous device
Speaker 12: in her right tibia. Sometimes it's very difficult to get
Speaker 12: an IV in so we can go directly into the
Speaker 12: bone or the bone marrow.
Speaker 7: And were you aware of whether she had been intubated in.
Speaker 11: Route, so she was not intubated in route.
Speaker 7: When she arrived at the emergency department. Were you there
Speaker 7: to greet the ambulance.
Speaker 9: Yes?
Speaker 7: And what happens when a patient comes in through the
Speaker 7: emergency department via ambulance.
Speaker 12: So when the patient first comes in, you know, we
Speaker 12: immediately have our team you know, start to sort of
Speaker 12: take over care so there's no gap. And then we
Speaker 12: also get a sign out from the paramedics and amts
Speaker 12: and any other staff that had been involved in the case.
Speaker 7: And do you and your emergency room staff then perform
Speaker 7: your own initial assessment of the patient? Yes, but what
Speaker 7: do you do for that?
Speaker 12: So initially we sort of go through our ABC's airway
Speaker 12: breathing circulation. So initially, you know, focusing on the primary
Speaker 12: things such as making sure we're getting air and oxygen
Speaker 12: into the patient, keeping the heart going, so continuing CPR
Speaker 12: at that point.
Speaker 7: And as far as Cora went, did you observe that
Speaker 7: she was breathing, so she was not breathing on her own?
Speaker 7: How about the heart? Did you observe that her heart
Speaker 7: was beating?
Speaker 10: There was no heartbreat.
Speaker 7: How about her physical appearance? What observations did you make
Speaker 7: of her physical appearance?
Speaker 12: So initially when she had come in, you know, some
Speaker 12: of the things we notice is sort of a blue
Speaker 12: tint to the skin, which typically you know, we can
Speaker 12: see when there's less oxygen or lack of oxygen. And
Speaker 12: then the other things on a quick survey is there
Speaker 12: was some areas of bruising on the neck and around
Speaker 12: the eyes called patkiah kind of little bleeding, episodes of
Speaker 12: bleeding under the skin, and I believe a small amount
Speaker 12: of blood coming from the nose.
Speaker 7: Were you able to make observations of her hands or
Speaker 7: other parts of her body?
Speaker 12: So the hands definitely had that what we call sinosis
Speaker 12: or blue.
Speaker 7: Que Now as far as the eyes, you mentioned patigi
Speaker 7: are around the face and the eyes as well as
Speaker 7: the neck. Did you notice anything else about her eyes?
Speaker 11: So the pupils were fixed and enlarged.
Speaker 7: Is why is that significant to you?
Speaker 12: So oftentimes it can when we see it coming in,
Speaker 12: it can indicate two different things. Some of the medications
Speaker 12: like epinephyrine can cause the pupils to dilate, but also
Speaker 12: if the brain is starting to become damaged or not functioning,
Speaker 12: then you start to lose initially some of the signals
Speaker 12: that would make the pupil smaller, so they tend to
Speaker 12: start to get enlarged or dilated if there's brain injury
Speaker 12: starting or has occurred.
Speaker 7: Now, you indicated that when Core arrived, she did not
Speaker 7: she was not intubated, meaning she did not have a
Speaker 7: breathing tubein. Did you and your team attempt to intubate her, yes.
Speaker 13: And.
Speaker 7: Did you do that on your own or with the
Speaker 7: assistance of other parts of the emergency department or the hospital.
Speaker 12: So we had anesthesia there after we got the phone
Speaker 12: calls or multiple patients coming in. Typically will have all
Speaker 12: the help that we could possibly need there to be
Speaker 12: able to take care of all the patients. So I
Speaker 12: had an anesthesiologist in the room with me who put
Speaker 12: the breathing tubein.
Speaker 7: In instances where an individual might have suffered sort of
Speaker 7: injury to their neck, does that complicate the insertion of
Speaker 7: a breathing tube.
Speaker 12: It can, yeah, because normally you might need to move
Speaker 12: or tilt the head to get a direct view where
Speaker 12: you can put a breathing tube in. But when there's
Speaker 12: a concern for neck injury, we stabilize it, typically with
Speaker 12: a collar or manually, so there's you don't have the
Speaker 12: ability to move the head and the neck around to
Speaker 12: try and get a better view.
Speaker 7: Once a breathing tube was put in, were you and
Speaker 7: your team able to manually give breath to Cora?
Speaker 8: Yes?
Speaker 7: Now, did you then perform an assessment, a cardiac assessment
Speaker 7: of her.
Speaker 12: Yeah, So, in addition to listening to the hard feeling
Speaker 12: for a pulse, we'll also tend to use an ultrasound
Speaker 12: machine in the room where we can kind of get
Speaker 12: a direct view of heart function.
Speaker 7: And you were aware that they had defibrillated her twice
Speaker 7: in the ambulance. Why is that significant when you're treating
Speaker 7: a patient that's in cardiac.
Speaker 12: Or ass So, when they defibrillate a patient, it's typically
Speaker 12: the hearts or might be in a rhythm where it
Speaker 12: can't pump blood, so it might be sort of out
Speaker 12: of sink or quivering, where we may attempt to use
Speaker 12: electricity to kind of shock it back into a rhythm.
Speaker 7: Once you performed the ultrasound, the cardiac ultrasound, were there
Speaker 7: any attempts made further to use a defibrillator or throughout
Speaker 7: your course of treatment with her, did you continue with
Speaker 7: various medications, Yes, and with cpr on going throughout your
Speaker 7: entire time with her.
Speaker 8: Yes.
Speaker 7: Were you consulting with any other colleagues or any other
Speaker 7: hospitals in regards to the care of Korra?
Speaker 11: Yeah, so we absolutely had.
Speaker 12: In addition to all my colleagues in the emergency room,
Speaker 12: we had intensive care physicians from Children's that were on
Speaker 12: the phone with us, kind of working through any things
Speaker 12: that may have come up in the case, also expecting
Speaker 12: that they would be received the patients from us.
Speaker 7: Is your hospital at the Beth Israel equipped to handle
Speaker 7: this type of pediatric trauma.
Speaker 12: So we can do the initial stabilization, but then we
Speaker 12: need to ship the patients out to either get our
Speaker 12: specialty care or continued in patient care.
Speaker 7: And how long did efforts in treating Kora continue So.
Speaker 12: In the emergency room roughly thirty minutes and.
Speaker 7: Fair to say that all of the efforts that you
Speaker 7: made were not successful.
Speaker 8: Correct?
Speaker 7: And at approximately seven excuse me, nineteen twenty eight or
Speaker 7: seven twenty eight, did you finally declare Cora deceased?
Speaker 9: Yes?
Speaker 7: Thank you, I have nothing.
Speaker 6: Further I hope questions, Thank you, Thanks, Thanks someholl calls.
Speaker 14: Doctor Andrews caparro.
Speaker 6: A right, good believe dodme?
Speaker 14: Yes, please, thank you, good morning. Can you please stay
Speaker 14: and spell your name for the record.
Speaker 15: My name's doctor Andrew Caprarro, last name CP.
Speaker 10: Rro and your date of birth please July.
Speaker 8: Ninth, nineteen seventy.
Speaker 14: What do you do for a living.
Speaker 15: I'm an attending physician in the emergency department at Boston
Speaker 15: Children's Hospital.
Speaker 14: And how long have you done that?
Speaker 13: For the last twenty six years?
Speaker 14: Can you just briefly describe for us the training and
Speaker 14: education you had to qualify for that role.
Speaker 15: I went to Providence College undergrad and then went to
Speaker 15: Brown Medical School. Subsequently, I went to Connecticut Children's Medical
Speaker 15: Center for my pediatric residency and then did fellowship training
Speaker 15: in pediatric emergency medicine at Boston Children's Hospital from two
Speaker 15: thousand to two thousand and three and have been in
Speaker 15: attending there ever since.
Speaker 14: And what's involved with being an attending at Boston Children's Hospital.
Speaker 15: It means that I am guiding the care and treatment
Speaker 15: for the patients that I am seeing during my particular shift.
Speaker 14: And are you assigned to a specific life location or
Speaker 14: area of the hospital.
Speaker 15: I'm always in the emergency department and the emergency department
Speaker 15: is broken up into different zones, of which I am
Speaker 15: sort of the primary attending for one set of rooms.
Speaker 14: I want to direct your attention to January twenty fourth,
Speaker 14: twenty twenty three. Were you working that evening?
Speaker 8: I was.
Speaker 14: And at some point in time, did you learn that
Speaker 14: a patient named Callum Clancy was going to be transported
Speaker 14: to your hospital?
Speaker 15: I did?
Speaker 14: And did you recall where he was being brought from.
Speaker 13: From Bethelville, Plymouth?
Speaker 8: I believe.
Speaker 14: And was he being med flighted to your facility?
Speaker 10: Correct?
Speaker 14: And were you provided with some information about the patient
Speaker 14: in order to prepare for his arrival?
Speaker 10: I was?
Speaker 14: And what did you learn?
Speaker 8: We have a communication that's exactly correct.
Speaker 14: Yes, at that point in time, did you work with
Speaker 14: another doctor to do more in depth testing regarding his
Speaker 14: neurological status?
Speaker 8: Yes?
Speaker 16: So at Children's we have multiple teams that come together
Speaker 16: for a patient for many patients, but for Callen.
Speaker 8: The neurology team was there from the beginning.
Speaker 16: And when in a case like this, when we see
Speaker 16: no response in an unresponsive patient, we start to have
Speaker 16: the get our neurology team, and one of the things
Speaker 16: we start to do is brain death.
Speaker 8: Testing to see if they could be what would we.
Speaker 16: Called brain dead, meaning that the brain itself is not functioning,
Speaker 16: and that even though their heart.
Speaker 14: Is still beating, How is it that someone's heart can
Speaker 14: be beating if their brain is dead.
Speaker 8: It's a really good question.
Speaker 16: So there's actually two parts to the nervous system.
Speaker 8: The one is the part that we see.
Speaker 16: The most in people when they react and they react
Speaker 16: to us and they speak and they do things.
Speaker 8: The other one is the autonomic or automatic system.
Speaker 16: And the automatic system is largely in charge of the
Speaker 16: things like the heart if the heart has not been injured.
Speaker 8: And so it was sort of continuing on.
Speaker 14: And does that give you any indication, the fact that
Speaker 14: the heart was still continuing on about where the injuries
Speaker 14: were in the brain?
Speaker 8: Yes, it does, actually, yeah, that where would that be?
Speaker 16: It seemed the cerebellum, which is that part that makes
Speaker 16: us sort of the human side of what we do,
Speaker 16: that's much more sensitive to a lack of oxygen, to
Speaker 16: an anoxic injury. And it told me that that was
Speaker 16: really where that injury was, was in that part of
Speaker 16: the brain, much less so in the.
Speaker 8: Brain stem itself.
Speaker 14: So would it be fair to say that the brain
Speaker 14: stem itself that controls those automatic responses was still functioning somewhat,
Speaker 14: but the part of the brain that made Callen Kalen
Speaker 14: was not functioning.
Speaker 8: That's exactly correct.
Speaker 14: Yeah, And what could you describe for us the brain
Speaker 14: death testing?
Speaker 16: Sure, So the brain death testing at Boston Children's is
Speaker 16: a it's a very strict testing that includes some of
Speaker 16: the things that I just mentioned.
Speaker 8: But we work with our UH it's there's a checklist that.
Speaker 16: We work on with our neurologic colleagues, and we sort of.
Speaker 8: Go through each of the what we would expect.
Speaker 16: For responses from someone and we actually then work through
Speaker 16: different of the of the nerve sets that we would
Speaker 16: expect them to respond to.
Speaker 8: We have it set up so.
Speaker 16: That there's a an ICU physician is there, and then
Speaker 16: a neurologist is there, and the neurologist and the neurology
Speaker 16: team they're the ones who perform the brain death testing.
Speaker 8: It's and then that.
Speaker 16: The test is then repeated again twenty four hours later
Speaker 16: just to make sure that there's no there's no piece
Speaker 16: of that that is different or incongruous with a diagnosis
Speaker 16: of brain death.
Speaker 14: And while the neurologist is doing this testing, are there
Speaker 14: present watching the testing and seeing the results as it happens.
Speaker 14: Is one of those breathing components.
Speaker 1: In apnea tests?
Speaker 8: Yes, it is?
Speaker 14: Yeah, And what is an apnea test?
Speaker 16: So apanea is as a word that just describes uh,
Speaker 16: not describes a lack of breathing.
Speaker 1: And how do you test that?
Speaker 16: So in a patient such as callen, what what we
Speaker 16: do and in any patient when we're doing brain death testing,
Speaker 16: what we're we we actually disconnect them from the ventilator.
Speaker 8: And the reason that we do that is we.
Speaker 16: Want to see if that autonomic system in the brain
Speaker 16: will start.
Speaker 11: To react as as as the.
Speaker 8: Carbon dioxide starts to increase.
Speaker 16: So our body makes carbon dioxide all the time, and
Speaker 16: the way we get rid of it is by exhaling,
Speaker 16: and where we breathe in oxy fresh oxygen and then
Speaker 16: we breathe out CO two. And what we what we
Speaker 16: do is we disconnect from the ventilator to see if
Speaker 16: knowing that their carbon dioxide will start to rise, and
Speaker 16: the normal response for that autonomic part of the brain
Speaker 16: would be to sort of increase breathing. That's why we
Speaker 16: breathe when we sleep, because as we go to sleep,
Speaker 16: the conscious part of our brain stops, but the autonomic
Speaker 16: part kicks in and then we breathe right through our
Speaker 16: sleep because that carbon dioxide rises.
Speaker 10: So in a.
Speaker 14: Patient who has brain death, would it be accurate to
Speaker 14: state that as the carbon dioxide level increases, the automatic
Speaker 14: response would be to take a breath to get more oxygen.
Speaker 14: But a patient who's brain dead won't do that.
Speaker 8: That's correct?
Speaker 14: And did you do all of these tests or do
Speaker 14: the neurologists do all these tests on Kalin while you observed?
Speaker 8: Yes?
Speaker 17: They did.
Speaker 8: Yeah.
Speaker 14: And did he have any response to any of the
Speaker 14: physical tests where you were looking for a reflex or reaction?
Speaker 8: No, he did not, no response to any And what.
Speaker 14: Was his reaction or results on the apnea test?
Speaker 8: So the apnea a test?
Speaker 16: Again, we do one, We do all the brain testing
Speaker 16: one day, and then we wait at least twenty four.
Speaker 8: Hours for the second one.
Speaker 16: The first and what we expect with the carbon dioxide
Speaker 16: is that it will increase.
Speaker 8: We have it written in our it'll.
Speaker 16: It did all in writing for our protocol that it
Speaker 16: will increase by twenty or get to.
Speaker 8: A level of sixty. A normal CO two would be.
Speaker 16: Around forty And the first time we did that on
Speaker 16: the first day, it actually.
Speaker 8: Went to fifty nine point seven, not sixty.
Speaker 16: And again it was in our protocol as has to
Speaker 16: get to sixty or increase by twenty And I actually
Speaker 16: talked to my colleagues, including neurology. I said, I know
Speaker 16: this is very close. It's fifty nine point seven, but
Speaker 16: it's not sixty. I repeated that piece of the test
Speaker 16: later on that day to make sure that it was valid.
Speaker 8: And as I say, I.
Speaker 16: Checked with everyone to make sure that that that I
Speaker 16: was doing the right thing, and they all agreed that
Speaker 16: we should just and the second time it went to
Speaker 16: eighty seven. So that was Everything else was the same,
Speaker 16: and we made sure that there's things that we look
Speaker 16: at to to make sure that there's not on any
Speaker 16: medications that there's no changes in this temperature, there's no
Speaker 16: abnormalities of the salts and the blood what we call
Speaker 16: the electrolytes.
Speaker 8: So those all those conditions were the exact same, and
Speaker 8: I did.
Speaker 16: I repeated that later on the day and it did
Speaker 16: come back positive.
Speaker 14: Why is it so important that you meet that.
Speaker 7: Specific criteria what the emergency room protocols. You also draw
Speaker 7: blood for patients that come in Yes, and how is
Speaker 7: that usually done?
Speaker 17: It's usually done on arrival by the nursing staff.
Speaker 7: And do they draw blood according to a medical physicians
Speaker 7: orders or do they draw blood for various purposes? Explain
Speaker 7: to us how that works.
Speaker 17: So it's usually like what we call a rainbow. So
Speaker 17: they just draw all the twobes of blood as soon
Speaker 17: as the patient arrives and anticipation for orders.
Speaker 7: Okay, And so what happens to the blood after somebody
Speaker 7: in the emergency department takes it from the patient? Where
Speaker 7: does it go? It gets tubed to the lab and
Speaker 7: fair to say that at Sousha Hospital they have a
Speaker 7: pneumatic tube system correct. Correct, and then it goes to
Speaker 7: a separate laboratory.
Speaker 17: Correct.
Speaker 7: And once a physician then assesses a patient and determines
Speaker 7: what kinds of testing needs to be done on those samples.
Speaker 7: How do you communicate that to the laboratory?
Speaker 17: So orders are put into a computer and they go
Speaker 17: through the computer.
Speaker 8: To the lab.
Speaker 7: And as you're treating a patient, is it oftentimes necessary
Speaker 7: to change the orders or order additional tests?
Speaker 17: Yes?
Speaker 7: And so in this particular case, blood in urine was
Speaker 7: collected from Lindsay Clancy upon her arrival correct correct, and
Speaker 7: then sent to the lab.
Speaker 17: Yes.
Speaker 7: Now, going back to the imaging tests, you said that
Speaker 7: there were some CT scans that were ordered correct. What
Speaker 7: areas of the body were the CT scans for?
Speaker 17: It was our entire body, her head, her neck, her chest,
Speaker 17: her abdomen, and her pelvis.
Speaker 7: Now as far as the the cts for her head,
Speaker 7: were there more than one tat CT test for the head?
Speaker 17: I don't remember. I'd have to look at my record.
Speaker 7: Well, what are the normal or what are the options
Speaker 7: for CT head stands?
Speaker 17: Usually just a CT head plane, but you could also
Speaker 17: do a CT angiogram depending on your concern for injury.
Speaker 7: And do you do you recall which one you ordered here?
Speaker 17: For a trauma one, it would be a plane CT head.
Speaker 7: And why do you order that particular test?
Speaker 17: Well, we're trying to assess for skull fractures and crannial bleeding,
Speaker 17: things like that.
Speaker 7: And when you say a plane CT what's the exact
Speaker 7: order that's put in for that type of a CT
Speaker 7: CT head?
Speaker 17: Okay?
Speaker 7: And are there CT heads with contrast?
Speaker 3: There are?
Speaker 7: And are there CT head skins without contrast? Yes? Ay,
Speaker 7: approach to itness. I'll show you those documents. If that's okay? Sure,
Speaker 7: I apologize. There's a little series of imagination. So I'm
Speaker 7: just gonna dry your attention to this page that's black
Speaker 7: and you can just take a look at it. Sure,
Speaker 7: m hm, okay, And I'm just gonna flip to the
Speaker 7: next page. The next page is blank.
Speaker 9: But is this the extent of.
Speaker 7: What you would have received as far as information regarding
Speaker 7: a head CT that was done without contrast?
Speaker 17: Yes, And I'm going just try your.
Speaker 7: Attention again to another page here towards the end, two
Speaker 7: pages from the end of the document, and you could
Speaker 7: take a look at that. Does that reflect the report
Speaker 7: you would have received for the head CT ordered with contrast.
Speaker 8: Yes.
Speaker 7: And in addition to your getting a report from imaging,
Speaker 7: you also receive some actual images correct, Yes? And do
Speaker 7: you review those Yes? In this particular circumstance when it
Speaker 7: came to the patient of Lindsay Clancy, was there anything
Speaker 7: remarkable in either of those head cts, Not that I recall,
Speaker 7: And in fact, the head CT with contrast indicated the
Speaker 7: impression was unremarkable. CTA have had no evidence into cranial
Speaker 7: aneurysm our, travinous malformation or brupt occlusion correct?
Speaker 17: Correct?
Speaker 7: What does that mean?
Speaker 17: Means it's a normal study.
Speaker 7: Now, as far as the other CT scans that were conducted,
Speaker 7: there were findings, remarkable findings on some of the others correct, correct,
Speaker 7: And what did they reflect in your experience? As far
Speaker 7: as her injury goes?
Speaker 17: From what I can recall, I know she had a
Speaker 17: thoracic spine injury.
Speaker 7: And how about the CT that was done of the
Speaker 7: chest area.
Speaker 17: I don't recall.
Speaker 7: It may approach that refresh your memory?
Speaker 17: Yes?
Speaker 7: And what was.
Speaker 17: So it talks about her thoracic spine injuries?
Speaker 7: Now, after reviewing all of the images, all of the
Speaker 7: CT scans that were done here, the cervical spine, the
Speaker 7: head cts, the thoracic spine, what was the plan for
Speaker 7: this particular patient? Was she able to be treated further
Speaker 7: at Selfshare Hospital?
Speaker 17: The decision was made by the team that her injuries
Speaker 17: were too severe to stay at Selfshur Hospital and the
Speaker 17: decision was made to transfer him to her to a
Speaker 17: tertiary care center.
Speaker 7: Were you able to stabilize her before transporting yes? Is
Speaker 7: that something that's important to make sure our patient is
Speaker 7: stable before sending them off in the ambulance or a helicopter. Yes,
Speaker 7: And so as far as this particular patient goes, are
Speaker 7: you aware of when whether any surgical intervention had to
Speaker 7: be done before she was stabilized and transported.
Speaker 17: I was not aware of any intervention.
Speaker 7: Being done, and again you had doctor Carpio who was
Speaker 7: also there to assess that.
Speaker 8: Correct.
Speaker 17: We work as a team.
Speaker 7: Kind of going back to those injuries on her neck
Speaker 7: and her wrist, very briefly, can you explain to us
Speaker 7: the difference between leading in be an artery or a
Speaker 7: vein and how that might present itself in an emergency situation.
Speaker 17: Venus bleed would be a little bit slower, darker blood,
Speaker 17: and arterial bleed would be pulsatile and bright red.
Speaker 7: And is it fair to say that when you strike
Speaker 7: either an artery or a vein that they're of different
Speaker 7: pressure systems and so the manner in which the blood
Speaker 7: comes out is different. Yes, in either circumstance where an
Speaker 7: artery or a vein is struck or nicked or cut,
Speaker 7: would that be something that you'd have to stabilize for
Speaker 7: a patient in order to make sure that they don't
Speaker 7: bleed out?
Speaker 9: Yes?
Speaker 7: Was that done here?
Speaker 17: It wasn't necessary.
Speaker 7: Now, this particular patient at some point was noted to
Speaker 7: be I think it's was referred to as hypothermic. Do
Speaker 7: you recall that yes? Do you recall at what point
Speaker 7: in your treatment of her was that noted? Was it
Speaker 7: as she was coming into the emergency department or did
Speaker 7: that develop while she was in the emergency department?
Speaker 17: I don't recall.
Speaker 7: What was the course of treatment for a low body temperature.
Speaker 17: We placed something called a bear hugger on them, which
Speaker 17: is a warming blanket.
Speaker 7: And can you explain to us what could cause a
Speaker 7: person's body temperature to drop to I think it was
Speaker 7: eighty two point one.
Speaker 17: There are many reasons, but it could be a metabolic
Speaker 17: disarray or exposure.
Speaker 7: In this circumstance, did you know what the source of
Speaker 7: the drop in the body temperature was for Mss Clancy?
Speaker 17: No?
Speaker 7: And do you recall how long she was in the
Speaker 7: emergency department before she was transported approximately to the Brigham.
Speaker 17: I think it was about four hours.
Speaker 7: At this time, you're honor, I would move to enter
Speaker 7: into evidence. A copy of the Selfshore Hospital medical records
Speaker 7: for Lindsay Clancy from January twenty fourth, twenty three is
Speaker 7: the next exhibit.
Speaker 6: That may be admitted.
Speaker 8: Well, they may be admitted, and.
Speaker 7: I would also move to enter as the next exhibit
Speaker 7: a certified copy of imaging records from the Selfshore Hospital
Speaker 7: for Lindsay Clans from January.
Speaker 6: Twenty four, it may be admitted.
Speaker 7: So, finally, doctor McDonough, did this defendant received surgery at
Speaker 7: Health Self Store Hospital?
Speaker 17: Not that I'm aware.
Speaker 7: Did you observe any cuts, abrasions or blood on the
Speaker 7: area of her head?
Speaker 9: No?
Speaker 7: And based on your review of those findings on the
Speaker 7: CT scans, was there any noted injury from the head
Speaker 7: cts that you could tell?
Speaker 8: No?
Speaker 7: And were you able after using that bear hugger device
Speaker 7: able to get her blood or excuse me, her body
Speaker 7: her core body temperature back up to normal.
Speaker 17: I don't recall.
Speaker 7: Did you ever observe those wounds that you observed on
Speaker 7: her neck or her wrists ever start bleeding actively? Again? No,
Speaker 7: I have nothing for there, just ready.
Speaker 18: So would you agree with me that when Lindsay was
Speaker 18: brought into the Soshua Hospital that she was unconscious.
Speaker 17: I recall her eyes being opened, but she was nonverbal.
Speaker 18: Okay, So, as an experienced emergency room doctor, can you
Speaker 18: tell me when someone's unconscious? What is that? What are
Speaker 18: the syentomology of it? What does that mean?
Speaker 17: Usually means they're completely unresponsive with eyes closed?
Speaker 8: Okay?
Speaker 9: Was she responsive?
Speaker 17: Not verbally?
Speaker 9: Was she responsive at all?
Speaker 17: She was responsive to pain?
Speaker 18: So that means that you would do something to cause pain,
Speaker 18: perhaps the bottom of the foot or whatever it is,
Speaker 18: to see if they have a reaction. Correct, And would
Speaker 18: you agree with me that when people even have very
Speaker 18: very serious brain injuries, that they can respond to pain stimuli.
Speaker 17: Sometimes sometimes so her eyes were open?
Speaker 9: Was were her pupils equal and reactive to light?
Speaker 17: I don't recall.
Speaker 9: You don't recall.
Speaker 18: What does it mean with pe r L pupils equal
Speaker 18: reactive to light?
Speaker 9: What does that mean?
Speaker 17: Exactly what you just said. It means her pupils are
Speaker 17: equal and reactive to light.
Speaker 9: And as a doctor, what does that tell you?
Speaker 17: It tells me that there's no significant neurologic injury.
Speaker 18: And in this case, you don't recall if her pupils
Speaker 18: were equal or reactive to light?
Speaker 17: I don't, okay.
Speaker 18: And that's when you take the little flash light sometimes
Speaker 18: and you put it over the eye and see if
Speaker 18: it is.
Speaker 9: Constriction of the pupil.
Speaker 17: Correct?
Speaker 18: Did you do additional evaluations of her to see what
Speaker 18: her neurological function was.
Speaker 17: She was pretty quickly intubated from what I recall, so
Speaker 17: after that it would be difficult to assess her neurologically.
Speaker 9: Sure, was she on any pain medication?
Speaker 17: If you remember, I don't remember.
Speaker 18: You recall did she have difficulty being intubated? I mean,
Speaker 18: would you agree with me that if you're not under
Speaker 18: some type of medication or sedation or unconscious, it hurts
Speaker 18: to be intubated, doesn't it.
Speaker 17: We wouldn't intubate somebody without first giving them some induction medicines.
Speaker 9: Okay, so what would the induction medicines be?
Speaker 17: They're not universal.
Speaker 9: Well, depend on what are the induction in the sense
Speaker 9: that you used on Lindsay Clancy.
Speaker 17: I don't know. I'd have to refer to my record.
Speaker 17: And also I wasn't the one who did the intubation,
Speaker 17: So she.
Speaker 18: Was intubated, had the tube coming out of her mouth,
Speaker 18: She's laying on the table, and you are continuing an assessment.
Speaker 18: You were the lead doctor in the emergency room for
Speaker 18: Lindsay Clancy, right.
Speaker 17: I wouldn't say I was the lead I think the
Speaker 17: trauma surgeon and I worked together.
Speaker 9: Right, her temperature, her core body temperature was eighty two
Speaker 9: degrees Is that right?
Speaker 17: If that's what the record states, then yes, I'm sorry.
Speaker 17: If that's what her medical record states.
Speaker 9: Then, as you said here, you don't know what her
Speaker 9: core body temperature was.
Speaker 17: I saw her three years ago. I see about two
Speaker 17: hundred patients.
Speaker 9: I'm sure.
Speaker 17: I'm happy to look at my record if you bring it. Sorry,
Speaker 17: I did, but I don't have a photographic memory.
Speaker 18: Did she regain consciousness at all while she was in
Speaker 18: your emergency room?
Speaker 8: No?
Speaker 9: Can you tell me what cf CSF.
Speaker 17: Is real spinal fluid?
Speaker 9: Yeah?
Speaker 17: So what that is it would be I'm not sure
Speaker 17: in what context you're referring to it.
Speaker 18: Well, how about if there's a massive leakage of CSF
Speaker 18: from her nose?
Speaker 9: What does that tell you as a doctor.
Speaker 17: It could mean that there's a skull fracture.
Speaker 9: Did you notice any clear fluid coming from her nose?
Speaker 17: I did not.
Speaker 9: Is that something you would look for?
Speaker 10: Yes?
Speaker 18: How quickly do you get the results of the X
Speaker 18: rays when you're in the emergency room?
Speaker 17: Well, these were CT scans.
Speaker 7: But oftentimes is it the case that when you're responding
Speaker 7: to crime, serious crime scenes like this one that you're
Speaker 7: working in tandem with a forensic scientist from that unit. Yes,
Speaker 7: that's correct, okay, And so in this circumstance you indicated
Speaker 7: that more enheartment also was at the Celtier hospital with you. Yes,
Speaker 7: when you got to the Ceutra hospital, what was the
Speaker 7: purpose for you being called out there? What were you
Speaker 7: asked to do?
Speaker 19: So my instructions were to document the defendant any injuries
Speaker 19: that she had. Forensic scientists heart Innett was going to
Speaker 19: be taking swabs, and anytime they take swabs, we have
Speaker 19: to document the areas in which they swab.
Speaker 7: So when you got to the Soltial Hospital, do you
Speaker 7: remember where you went in the hospital?
Speaker 20: Yeah?
Speaker 19: I went to one of the trauma rooms in the
Speaker 19: emergency department.
Speaker 7: And so were you able to make observations of Lindsay Clancy?
Speaker 21: Yes?
Speaker 7: And do you see Lindsay Clancy in the courtroom?
Speaker 8: Yes?
Speaker 6: All right, record may reflect the identification.
Speaker 17: Thank you.
Speaker 7: What were your observations of her when you saw her?
Speaker 19: She was covered in like blankets and like heating devices
Speaker 19: and she had a neck collar on. So when I
Speaker 19: first walked in the room, I couldn't see anything on
Speaker 19: her body. Because she was under the blanket than like
Speaker 19: the neck brace.
Speaker 3: In her face?
Speaker 7: May I approach got a fair and at your representation
Speaker 7: of how you observed Lindsay Clint, Yes, an objection.
Speaker 9: I have no objection to any of the photographs.
Speaker 8: All right, that maybe addited.
Speaker 7: Beers. I'm just showing you now. Can you see that
Speaker 7: from where you're sitting. Yes, And so this blanket that's
Speaker 7: how you observed her in the trauma room. Yes, at
Speaker 7: some points, did you and other medical stat remove the
Speaker 7: blankets to document injuries?
Speaker 19: We didn't remove the blanket, but we did remove her
Speaker 19: arms out from underneath the blanket.
Speaker 7: Okay, And so were you able to do that on
Speaker 7: your own? Did you need assistance?
Speaker 17: I need assistance?
Speaker 7: And why did you need assistance?
Speaker 19: When I first attempted to pull out her right arm,
Speaker 19: she was incoperative and pulling it back and fighting against
Speaker 19: us a little.
Speaker 7: So did you enless the help of the nurses to
Speaker 7: help you to remove her arm from the blanket? Yes,
Speaker 7: we're able to make any observations of kind of the
Speaker 7: temperature in the room at the time that you got
Speaker 7: in there. Yes, it was very hot in the room, okay,
Speaker 7: in that blanket that you observed. Were you ware that
Speaker 7: blanket was to kind of bring her body temperature up? Yes.
Speaker 7: When you were able to view her arms when you
Speaker 7: first saw them, did they have anything on them?
Speaker 19: There was a red brown stain on her hands and
Speaker 19: there was gauze on like her wrist area.
Speaker 7: Did you enlist the help of the medical staff to
Speaker 7: remove the gauze? Yes?
Speaker 19: And why was that to document any injuries that might
Speaker 19: have been underneath? And were you able to observe injuries?
Speaker 21: Yes?
Speaker 7: In addition to well strict that the injuries that you
Speaker 7: observed are the areas of the body that you documented.
Speaker 7: What were they I documented?
Speaker 19: I took that first overall photo of her. I took
Speaker 19: a close up of her face and the neck area
Speaker 19: that I could see. I documented both her hands, both
Speaker 19: sides of them, her wrist area underneath where the gauze was,
Speaker 19: and then the nurses assisted in opening up the neck brace,
Speaker 19: and I took photos of her neck as well.
Speaker 7: And in addition to documenting the defendant herself, did you
Speaker 7: document any other items that were at the Celsher hospital
Speaker 7: that evening? Yes?
Speaker 19: I documented any personal belongings that were brought in with her.
Speaker 7: And so you're aware that they removed clothing from her. Yes,
Speaker 7: and so you documented the clothing correct, and that she
Speaker 7: had two rings, yes, and that you photograph those rings.
Speaker 9: Yes.
Speaker 7: And you're where Trooper Lawler had retained those items.
Speaker 19: I'm not sure who retained them from there, okay, but
Speaker 19: your role was just to document them, correct.
Speaker 17: I didn't take anything.
Speaker 9: Okay.
Speaker 7: In really regards to this particular well, go back for
Speaker 7: one second. In the crime lab, how do your unit
Speaker 7: or how do you identify particular cases that you work.
Speaker 19: On, as in like being called out to something?
Speaker 7: Well, is there a way that you once you get
Speaker 7: called out to a case and do work on a case,
Speaker 7: is there a way to track what you did with
Speaker 7: each case by some sort of case number or lab number.
Speaker 19: Yes, we have a case number associated with it.
Speaker 7: And as far as lab numbers go, you're aware that
Speaker 7: the crime lab follows pieces of evidence using the same
Speaker 7: lab number.
Speaker 3: Yes, that's correct.
Speaker 7: And does that track items that go through your system?
Speaker 19: Yes, So our lab number goes into a computer system
Speaker 19: and it tracks everything. It keeps every report written on
Speaker 19: that case, it tracks the custody logs, it tracks every
Speaker 19: piece of evidence that's been involved in the case.
Speaker 9: If it helps you.
Speaker 18: There's no issue is to change a custody or foundation
Speaker 18: or anything like that.
Speaker 6: All right, thank you, thank you.
Speaker 7: Other than going out to the Sostra Hospital on January
Speaker 7: twenty fourth, do your call being called out to another
Speaker 7: location later in relation to the same lab number. Yes,
Speaker 7: and that would have been on January sixth, twenty twenty three.
Speaker 7: February sixth, excuse me, February sixth, thank you? So where
Speaker 7: did you go?
Speaker 19: I was called to the Plymouth Detective Unit's office in Brockton.
Speaker 7: And did you me or speak with one of the
Speaker 7: troopers from that office?
Speaker 17: Yes?
Speaker 14: I did, Trooper Rabbit.
Speaker 7: Trooper Rabbit, And what did he ask you to do
Speaker 7: on that day?
Speaker 19: He asked me to photograph a bag of medication and
Speaker 19: some documents that were inside that bag that had been.
Speaker 21: Brought to their office.
Speaker 7: And did you do anything else with the items that
Speaker 7: Trooper Rabbit had in his possession on January excuse me, February.
Speaker 19: Sixth, No, I just photographed them and left them with them.
Speaker 7: And again, is that something that your unit sometimes is
Speaker 7: called out to do? Yes? I think further?
Speaker 8: Could you raising?
Speaker 4: So?
Speaker 9: Is it trooper or you a chemist or sergeant? Sorry Tragian?
Speaker 9: You had a search warrant. Apparently when you went into
Speaker 9: the house. I guess with Trooper Rabbit.
Speaker 7: I didn't go into the house.
Speaker 18: Oh so he just gave you the bag. In other words,
Speaker 18: you didn't go in the house and take pictures of
Speaker 18: any of the rooms or anything like that.
Speaker 19: No, the bag was at their office when I went
Speaker 19: to the Oh.
Speaker 9: Okay, all right, it's all we have.
Speaker 6: Thank you, anything anything further turning buck?
Speaker 7: Yeah?
Speaker 6: No, thanks, all right, thank you, sir, thank you.
Speaker 9: Yeah.
Speaker 6: Please, And so I'm going to ask you go back.
Speaker 6: We'll get you back in here in a short while. Okay,
Speaker 6: thank you.
Speaker 8: All right, all.
Speaker 4: Right, so we'll be in recess on this matter as time.
Speaker 6: Thank you. All right.
Speaker 7: Going back to January of twenty twenty three, were you
Speaker 7: working in that same unity and what was the shift
Speaker 7: that you normally worked?
Speaker 10: I worked the night shift, which is seven pm seven am.
Speaker 7: And do you what was your schedule like for any
Speaker 7: given week. Did you work back to back shifts.
Speaker 10: Or I can sometimes work back to back shifts.
Speaker 7: Okay, but you always worked the night shift, the night shift.
Speaker 11: Okay.
Speaker 7: I'm going to draw your attention to a particular patient
Speaker 7: that you had some interaction with in January of twenty
Speaker 7: twenty three, and that was Lindsay Clancy. Do you recall
Speaker 7: treating her?
Speaker 8: Yes?
Speaker 7: And was she in that traumasurgical intensive care unit?
Speaker 8: Yes?
Speaker 7: Do you remember the first time you interacted with her?
Speaker 10: Yes? I got her.
Speaker 7: And would that have been on the first night she
Speaker 7: was there on January twenty fourth?
Speaker 10: Yes?
Speaker 7: How did she come to your unit at the Brigham She.
Speaker 10: Came from the emergency room, went to MRI, then came
Speaker 10: to th THEEO to.
Speaker 7: Me and were you aware that she had been seen
Speaker 7: at a local hospital in Weymouth, the South Shore Hospital
Speaker 7: Shore while you were treating her on that first night?
Speaker 7: Were you the main nurse assigned to her care?
Speaker 10: Yes?
Speaker 7: And what were your responsibilities as the nurse assigned to
Speaker 7: her care on that first night?
Speaker 10: First night she was intubated, came to be intubated, We
Speaker 10: had to maintain our book pressure at a certain number.
Speaker 10: Just care, regular nursing care, okay.
Speaker 7: And were you aware that she was on what's called
Speaker 7: the one to one Yes? What does that mean?
Speaker 10: That means patient usually can't be left alone and also
Speaker 10: depending you always have to have somebody outside the room
Speaker 10: with a certain monitor of the patient and.
Speaker 7: Is that because that patient has been identified as a
Speaker 7: potential suicide risk. Yes, Now, on that the twenty fourth
Speaker 7: into the early morning, I was at the twenty fifth.
Speaker 7: Was there a particular event that you were witnessed to
Speaker 7: for this particular patient?
Speaker 10: She coded?
Speaker 7: What does that mean?
Speaker 10: Means her blood pressure dropped? For her, it meant her
Speaker 10: blood pressure dropped and it wasn't sustainable work life.
Speaker 7: So what did you do when her blood pressure fell
Speaker 7: and she coded?
Speaker 10: We started CPR, We did compressions.
Speaker 7: And this event occurred approximately at three thirty in the morning.
Speaker 1: Correct.
Speaker 9: Yes?
Speaker 7: Was she eventually stabilized after that code?
Speaker 8: She was?
Speaker 7: And did they do something as far as intervention to
Speaker 7: try to maintain her blood pressure?
Speaker 10: We increased her pressers. We added two more presses, she
Speaker 10: was already on two. They placed chest tubes and started
Speaker 10: what we call a mass of blood transfusion.
Speaker 8: Protocol.
Speaker 14: And did this.
Speaker 7: All occur in the trauma surgical intensive care unit or
Speaker 7: did she have to be taken to a different unit?
Speaker 10: It all occurred in her.
Speaker 7: And other than medical staff that was treating her that
Speaker 7: particular night, did you observe anybody else present?
Speaker 10: She had two police officers outside.
Speaker 7: The room, okay, And so did they remain outside the
Speaker 7: room for the duration?
Speaker 9: Oh?
Speaker 10: Is that side the room? Yes?
Speaker 7: As far as your interaction with the patient of that
Speaker 7: particular night shift, was she responsive at all during the
Speaker 7: time that you saw her? And with intubation you mentioned
Speaker 7: she was intubated. Is a patient often sedated in order
Speaker 7: to maintain intubation? Why is that.
Speaker 10: Helps them not fight the vent and breathe better and
Speaker 10: make sure that they're comfortable?
Speaker 7: And what does sedation do to an individual.
Speaker 10: Your calmer, you're sleeping.
Speaker 7: Make them more relaxed. Other than that night, that first night,
Speaker 7: the twenty fourth into the twenty fifth, did you have
Speaker 7: the occasion to treat this patient at other points within
Speaker 7: that week?
Speaker 10: Yes?
Speaker 9: I have.
Speaker 7: And I'm gonna draw your attention to January twenty sixth
Speaker 7: of twenty twenty three. Do you recall interacting with her
Speaker 7: on that day?
Speaker 9: Yes?
Speaker 7: And is it fair to say that on the twenty
Speaker 7: six she was still intubated and under sedation. Yes, Well,
Speaker 7: during this time period on the twenty sixth, was she arousable,
Speaker 7: meaning could you initiate some communication with her some yes?
Speaker 7: And were you able to kind of give her commands
Speaker 7: in order to care for her that she was able
Speaker 7: to follow. Yes, And when I say able.
Speaker 14: To follow obviously simple commands.
Speaker 7: What kinds of.
Speaker 10: A neuro check to just make sure she's alert and
Speaker 10: she's able to follow, understand what you're saying to her.
Speaker 7: And for this particular patient, you're aware that she presented
Speaker 7: with a spinal injury. Correct. Correct, And so movement of
Speaker 7: the explower extremities was not something that she did.
Speaker 11: Correct.
Speaker 7: But did you observe her to move her head around
Speaker 7: and move her arms around?
Speaker 10: Yes?
Speaker 7: Now, you also had the occasion to treat her in
Speaker 7: the overnight shift of January twenty eighth of twenty twenty three, correct, Yes,
Speaker 7: And during that time she was also still intubated.
Speaker 10: I believe, so, I'm not sure I've had her both
Speaker 10: intubated and.
Speaker 7: Okay, while she was still intubated, did you have a
Speaker 7: system that you could use to communicate with her.
Speaker 10: Yes. Board. We have a whiteboard or clear board that
Speaker 10: sometimes patients can right on.
Speaker 7: Did you observe her to utilize that whiteboard to write
Speaker 7: on it?
Speaker 10: Yes?
Speaker 7: And at this point when she's writing on the board,
Speaker 7: she's now her eyes are open and she's responsive. Yes,
Speaker 7: and she's able to tell you how she's feeling. Correct
Speaker 7: and fair to say she used that whiteboard to tell
Speaker 7: you she was confused and that she couldn't fail her
Speaker 7: lower extremities. And do you recall her complaining of having pain?
Speaker 10: I don't recall.
Speaker 7: During this time period of the twenty eighth. Do you
Speaker 7: recall whether the patient was placed into restraints?
Speaker 8: Yes?
Speaker 7: And why was that?
Speaker 10: Well, we restrain all patients that are intubated, So.
Speaker 7: On this particular night, the second she made a request
Speaker 7: of you for her lawyer. Correct?
Speaker 8: Yes?
Speaker 7: Was that something she had asked you before?
Speaker 10: No?
Speaker 7: And so did you think it was something worth noting?
Speaker 10: Yes?
Speaker 7: Why would you note something like that because.
Speaker 10: That was the first time she referred to anything going
Speaker 10: on with the case.
Speaker 7: And this was not a conversation you'd had before. What
Speaker 7: did you do when she made that request? What was
Speaker 7: your response?
Speaker 10: I sent what we call a consult to the social
Speaker 10: worker in order to coordinate reaching out to her lawyer.
Speaker 7: In any of the shifts that you had been caring
Speaker 7: for this particular patient, did you see anyone besides medical
Speaker 7: staff and the law enforcement that were outside of the
Speaker 7: room come in and speak with her.
Speaker 12: No?
Speaker 7: Were you aware that she was not to have visitors
Speaker 7: to the first night and is that something that you've
Speaker 7: seen before in your work as a nurse one there
Speaker 7: are police on site?
Speaker 9: Yes?
Speaker 7: Were you present at one point when some troopers came
Speaker 7: in to take photographs of her?
Speaker 10: Yes?
Speaker 7: And were you in the room when they took the photographs?
Speaker 7: Do you recall assisting them in viewing the injuries to
Speaker 7: her wrists in her neck?
Speaker 10: I don't know if I I don't remember.
Speaker 14: Assisting, okay, but you were present with.
Speaker 7: Her and fair to say your contact ended with this
Speaker 7: patient on February third, when she was transferred off of
Speaker 7: the Trauma Surgical ic US unit. Yes, so one moment. Now,
Speaker 7: you were not the only nurse to treat her on
Speaker 7: the night shift, correct, So on days that you didn't work,
Speaker 7: another nurse treated her. And were you familiar with the
Speaker 7: nurse who was generally assigned to treat her during the
Speaker 7: day and who was that?
Speaker 10: Megan Colin?
Speaker 7: Megan Collins? And is it fair to say that with
Speaker 7: the law enforcement presence and this patient's particular situation, the
Speaker 7: amount of medical staff that we're treating her on a
Speaker 7: regular basis was fairly limited, meaning it was the same
Speaker 7: people of the time.
Speaker 10: Thank you, pretty ready morning.
Speaker 6: First of all, calm all thing objection, Hm.
Speaker 14: I actually have those on a disc. I was going
Speaker 14: to put the disc in instead of all the paper.
Speaker 6: Well we put both. What we put both in, we
Speaker 6: could do A and B.
Speaker 18: Thank you, Yes, lawyer first, since that was the last
Speaker 18: that they asked you about. And correctly, if I'm wrong
Speaker 18: on any of these dates are acts. She was admitted
Speaker 18: on the twenty fourth of January. Is that correct?
Speaker 9: Yes?
Speaker 18: And do you have do you have a memory of so?
Speaker 18: Approximately what time was it in the evening?
Speaker 10: Well she got to the ICO was around three.
Speaker 9: Okay, you're very soft spoken. Sorry, you can just keep
Speaker 9: your voice up as.
Speaker 10: She got to the ICO around three am.
Speaker 9: Thank you. And she came by midflight.
Speaker 22: She came to me from MRI, and MRI obviously would
Speaker 22: be when you're taking the pictures, and that would be
Speaker 22: on the twenty fourth of January in the early morning hours, correct.
Speaker 10: I think it went into the twenty fifth.
Speaker 9: Into the twenty fifth, I think so. Console asked you
Speaker 9: about the whiteboard that she would write on, and I
Speaker 9: think it was again if I'm wrong, correctly, it was
Speaker 9: the January twenty eighth that she used for the first time.
Speaker 9: The white board to communicate.
Speaker 18: Yes, and the white board basically is just a white board,
Speaker 18: and you're right on it.
Speaker 9: And she was not able to speak because she was intubated.
Speaker 18: Right, yes, And she was in the restraints that you've
Speaker 18: described as well, right right. Moving forward January twenty eighth,
Speaker 18: twenty nine thirty into February first, February second. It was
Speaker 18: on February second the council asked you about her asking
Speaker 18: to reach out to her lawyer. Correct, yes, And do
Speaker 18: you know who her lawyer was at that time? Now
Speaker 18: had you seen him before?
Speaker 17: No?
Speaker 18: Did you know as the name Attorney Gelb? Now make
Speaker 18: any reference to you. Do you know that whether or
Speaker 18: not she had conversation with Attorney Gelb regarding her status
Speaker 18: as being under arrest by the numerous police that were.
Speaker 9: Guiding the Roman.
Speaker 10: I don't.
Speaker 18: Do you know whether or not she was ever able
Speaker 18: to talk to attorney Galbo or did you refer her
Speaker 18: to the social worker people.
Speaker 10: I've put in a concept for the social worker.
Speaker 9: Okay, thank you.
Speaker 18: When she was admitted on the twenty fourth, would you
Speaker 18: agree that she was in the state of cardiac arrest shortly.
Speaker 10: Thereafter, shortly after arriving to me.
Speaker 18: So I'm looking at the medical records that have been
Speaker 18: introduced for the jurors, and I'm referencing on page.
Speaker 9: Eighteen if I may.
Speaker 18: Now there's one page of four hundred pages of medical records.
Speaker 6: Can you see them?
Speaker 8: But I.
Speaker 9: Looking at this came the SICU.
Speaker 8: Of course.
Speaker 10: I see you, serrical Ice, and that makes reference.
Speaker 18: To the fact that shortly after arriving in the ICU,
Speaker 18: the patient had.
Speaker 9: A cardiac arrest.
Speaker 10: Yes you there, then I was.
Speaker 18: And when it says the ideology of the arrest, she
Speaker 18: got two rounds of CPR before obtaining r O s C.
Speaker 9: Can you tell me please what a CPR? Two rounds
Speaker 9: of what is RROS?
Speaker 10: Meaning? We did chest compression. She was already intubated, so
Speaker 10: she was getting oxygen.
Speaker 18: Okay, And then bilateral chest tubes were placed in her body.
Speaker 10: Yes, does that mean from both both sides?
Speaker 9: Okay?
Speaker 18: And they punctures through the chest into what the lungs,
Speaker 18: the ones and when they placed the chest tubes at
Speaker 18: this point shortly after admission, there was one hundred to
Speaker 18: three hundreds of blood from each chest to.
Speaker 9: What does that mean?
Speaker 10: That's the output they got once they put the chest again?
Speaker 10: Can you that's the output they got once they put
Speaker 10: the chest to bin.
Speaker 9: Okay, So when they put the chest to again, a
Speaker 9: drained one hundred to three hundred c seeds of blood?
Speaker 9: Is that correct?
Speaker 10: Correct?
Speaker 9: And then after that again shortly after admission to the hospital,
Speaker 9: coming from south Shore Hospital, she then got a massive
Speaker 9: transfusion protocol which you told us about, right, Yes? What
Speaker 9: does that mean?
Speaker 10: Means she gets we have a protocol that but blood
Speaker 10: depending blood products?
Speaker 9: Okay?
Speaker 10: She had some piers rapidly.
Speaker 18: And was there a notice shortly after arrival to the
Speaker 18: ICU she was being turned and had thirty c seeds
Speaker 18: of clear fluid that came out.
Speaker 8: Of her nose?
Speaker 7: Is that right?
Speaker 8: Yes?
Speaker 19: And what is that is that?
Speaker 9: Was there a suspicion that that was see it? What's
Speaker 9: called CSF?
Speaker 10: Yes?
Speaker 9: And what is CSF?
Speaker 10: It's final fluid?
Speaker 9: Okay. Going to the next.
Speaker 18: Page, which would be nineteen, does it indicate again on there?
Speaker 9: If I can just bring this up a little bit better.
Speaker 9: So she now has noted acute blood loss anemia?
Speaker 4: Right?
Speaker 9: What does that mean?
Speaker 10: She has a low blood count?
Speaker 9: And you know what happened to the blood or any idea?
Speaker 8: I did not?
Speaker 9: So she had very low, lost a lot of blood, right, yes,
Speaker 9: And she had anemia that would be what low blood
Speaker 9: or something?
Speaker 10: Yes?
Speaker 9: And she required multiple transfusions immediately.
Speaker 10: Following her arrest, right yes.
Speaker 9: And when it says arrest, does that mean arrest by
Speaker 9: the police, that does that mean the kid? I want
Speaker 9: to make sure that's clear.
Speaker 18: It's kydiac arrests nothing to do with the police. And
Speaker 18: she had massively required multiple transfusions that yes. Were you
Speaker 18: aware of the extent of the after you have the
Speaker 18: X ray not X rays, after you have the MRIs
Speaker 18: and the catskins. Were you aware as her the lead
Speaker 18: nurse or treating nurses to what the extent of her injuries.
Speaker 10: Were at that point? I don't believe.
Speaker 9: So at some point did you become aware of that?
Speaker 8: Yes?
Speaker 18: Okay, so again I've got the records. You don't, so
Speaker 18: let me do it this way, just to make it easy.
Speaker 18: Do you remember that she had a burst fracture of
Speaker 18: C one?
Speaker 10: Yes?
Speaker 9: What does that mean?
Speaker 10: Means a cerebral fracture up here?
Speaker 9: This is the cervical pere and then T five and
Speaker 9: T six it was a transsection. What does that mean?
Speaker 10: Thorassic?
Speaker 9: Okay?
Speaker 19: Fine?
Speaker 9: Down here and when it says transaction, what does that mean?
Speaker 10: It's severed?
Speaker 9: And then T.
Speaker 18: One two, three four, Also we're injured as well, right,
Speaker 18: what is neurogenic shock?
Speaker 9: What does that mean? If you know?
Speaker 10: Neurogenic shock?
Speaker 9: Sorry, yeah, neurogenic shock.
Speaker 10: It just makes reference on these are not my notes,
Speaker 10: so I can't really that's.
Speaker 18: Fine, I understand, And this would be on page sixty five.
Speaker 18: Do you recall reviewing the documentation as to the what's
Speaker 18: captioned present illness in the records? Did you know that
Speaker 18: she was presenting as a transfer from Socio Hospital?
Speaker 8: Yes?
Speaker 18: Did you know that she was that under present illness?
Speaker 18: And the history would be that she's a thirty thirty
Speaker 18: two year old female with history significant for post partum depression.
Speaker 10: Did you know that? Yes?
Speaker 9: And did you know that after the fall with the C.
Speaker 18: One burst fracture and the complex transaction of T five
Speaker 18: and T six she also had rib fraction correct yes,
Speaker 18: on page sixty six. That would make reference to the
Speaker 18: time frame going into the twenty fifth. On the twenty fifth,
Speaker 18: that she was reacting to painful stimuli, right, yes, And
Speaker 18: that basically means that she's not conscious if you will,
Speaker 18: but she's able to react.
Speaker 10: To if you cause pain, yeah, okay.
Speaker 18: There's a notation of a contusion, laceration and crushing of
Speaker 18: the thyroid with thyroidal edema.
Speaker 9: What does that mean.
Speaker 10: She has swelling I'm assuming around her thyroid, okay, and
Speaker 10: that again this is not my scope.
Speaker 9: Okay, okay.
Speaker 18: On page seventy the same evening, making reference to the
Speaker 18: fact that in addition to the injuries to the spine,
Speaker 18: that she also had the rib fractions and was currently
Speaker 18: in shock.
Speaker 9: Do you remember that that she was in shock? Yes?
Speaker 10: No, yes, okay?
Speaker 18: Would you agree or do you recall that there's a
Speaker 18: notation that this patient is critically ill and noting that
Speaker 18: she has postpartum psychosis. On page seventy two.
Speaker 6: They see counseling.
Speaker 9: When you're treating a patient, one.
Speaker 18: Of the things you try to do is to know
Speaker 18: what their total body and emotional condition is, what they've
Speaker 18: been dealing with, and what injuries they have.
Speaker 10: Right, we got a run down history of the patient.
Speaker 18: Sure, and as it goes into the end of January,
Speaker 18: and she had been communicating on the whiteboard, you were
Speaker 18: aware at that point why she was in the hospital, right, Yes,
Speaker 18: you know where she came from social hospital, right?
Speaker 9: Yes, and you knew that there had been there had
Speaker 9: been discussion about postpatum psychosis. Isn't that right? Yes?
Speaker 8: Okay?
Speaker 9: And do you recall that? And this would be on
Speaker 9: and I approach you under the witness.
Speaker 6: Maybe if you could show counsole what I want?
Speaker 9: The date in the time.
Speaker 18: Oh yeah, legal team, So I'll just showing you one
Speaker 18: page for the medical record.
Speaker 9: Can you tell what date is this?
Speaker 1: Page?
Speaker 2: Five?
Speaker 9: January twenty five?
Speaker 6: Yeah, if I ask you, if you keep your voice
Speaker 6: at least speaking out?
Speaker 10: Sorry, yeah, thank you, January twenty fath Okay, say what time?
Speaker 10: Nine am? Nine or three am?
Speaker 9: And looking at that, do you recall on that day
Speaker 9: you have been working with her the night before?
Speaker 8: Correctly?
Speaker 9: Correct where it indicates that patient is under arrest, right, yes,
Speaker 9: A police officers.
Speaker 10: At her bedside outside the rum.
Speaker 9: Well it says at a bedside of the record, isn't.
Speaker 10: It in the record? But I'm saying they are in
Speaker 10: the night.
Speaker 9: Before, they were outside her un outside you were not
Speaker 9: there during the day apparently, right cracked. Okay, And this
Speaker 9: difference from you guys as far as your medical records.
Speaker 9: If the police officer is at the bedside as opposed
Speaker 9: to in the chair in the hallway outside of the room. Yes,
Speaker 9: so indicated police officer ed her bedside. We will involve
Speaker 9: the social work and legal teams, right, yes, And again
Speaker 9: on page seventy two there's a reference to CSF leak
Speaker 9: and that's significant. It's a significant amount of fluid coming
Speaker 9: from her nose. Do you have any memory of observing
Speaker 9: that in your treatment ident? Okay?
Speaker 18: And then of course there was the code event that
Speaker 18: you've already described for us. There's one hundred to three
Speaker 18: hundred c seeds of blood coming from the tubes. And
Speaker 18: then it makes reference to on page seventy four it's
Speaker 18: a massive transfusion protocol. Is that like a medical term
Speaker 18: or is that somebody describing it or.
Speaker 10: It's a medical it's a protocol that we have at
Speaker 10: the hospital. Okay.
Speaker 9: And on page seventy five, did you make reference two
Speaker 9: or did you observe the injuries for example to her wrist?
Speaker 8: I observed, yes, And would you agree with me?
Speaker 9: At page seventy five the medical record indicating if it says,
Speaker 9: are you e.
Speaker 8: What is RUI means?
Speaker 18: You know, write upper extremity, Write upper extremity three point
Speaker 18: five centimeter deep laceration bolar aspect of wrist. Tell me
Speaker 18: what is the bolar aspect of the wrist?
Speaker 9: I just don't know.
Speaker 10: I'm not sure that's fine.
Speaker 18: Would you agree that there was noted a three point
Speaker 18: five centimeter deep.
Speaker 9: Laceration after wrist?
Speaker 10: I can't say if I adn't measure. This is somebody
Speaker 10: else's note.
Speaker 18: Well, when you looked at her, did you observe with
Speaker 18: your own eyes and your own experience that she had
Speaker 18: a deep laceration.
Speaker 10: On the she had her laceration.
Speaker 8: Yes, you can't say it's deep in it.
Speaker 10: I can't say I didn't.
Speaker 9: You want to say it was superficial.
Speaker 10: I can't say that either.
Speaker 9: So when you looked at the laceration on her wrist,
Speaker 9: you can't tell us if you would agree that it
Speaker 9: was a deep laceration.
Speaker 10: I really didn't get to it at the time when
Speaker 10: she arrived.
Speaker 18: Lue underneath that left upper extremity apparently right, Yes, two
Speaker 18: sent to me to deep laceration again on the volar
Speaker 18: aspect of the wrist, you did see laceration.
Speaker 8: Of the risk.
Speaker 10: Yeah, she had dressings, okay.
Speaker 9: And when she was admitted she had the core temperature
Speaker 9: of eighty two degrees? Is that correct?
Speaker 10: If that's what's noted?
Speaker 13: Right?
Speaker 9: Do you remember did they use a bear claw or
Speaker 9: something like that? What is it they call it?
Speaker 10: They put the bear hugger, bear hugger.
Speaker 9: They put a bear hugger blanket on them.
Speaker 10: And when I say them, I mean people that have
Speaker 10: a low, long timetur to warm them up.
Speaker 18: It hopefully raises the tech and then if it has
Speaker 18: warm intervened, I intervened IVF.
Speaker 8: That would be putting warm saline in the.
Speaker 10: Body, yes, through an iv all.
Speaker 9: Right, all with an effort to try to get the
Speaker 9: temperature up. And her core temperature was eighty two degrees,
Speaker 9: even after she was at the South Shore Hospital and
Speaker 9: underneath the bear thing and all that.
Speaker 10: And still I think that's what's noted. Again, that's time.
Speaker 9: I know it's pretty low, isn't it?
Speaker 6: It is?
Speaker 9: And you made reference to pressors.
Speaker 10: I'm sorry, Can you pressors without pressure medication to bring
Speaker 10: up the boot pressure?
Speaker 9: Okay? On January twenty sixth, she was still intubated, is
Speaker 9: that right?
Speaker 10: Yes?
Speaker 9: And she was under sedation right, yes? And then you
Speaker 9: referenced January twenty night, twenty nights January twenty eighth overnight shift.
Speaker 9: She was still intubated, right, yes.
Speaker 18: And January twenty eighth is when she first started utilizing
Speaker 18: the whiteboard.
Speaker 8: Is that correct?
Speaker 9: Yes, but she was intubated, yes, Yes, she was restrained.
Speaker 18: To the bed, yes, and had the tube was still
Speaker 18: in her mouth and she was writing on a whiteboard
Speaker 18: on the.
Speaker 9: Twenty eighth of January.
Speaker 18: Correct, she was able to yes, January thirtieth, she was extubated,
Speaker 18: as the district attorney asked, you rang.
Speaker 9: Yes, So at that point was she able to talk
Speaker 9: like you know, talk talk okay?
Speaker 18: And then on February second is when she used the
Speaker 18: she asked about wanting to reach out to her attorney.
Speaker 8: Is that correct?
Speaker 9: Yes, you had no knowledge as to her mother and
Speaker 9: father getting an attorney for her while she was in
Speaker 9: custody with the police.
Speaker 8: All around her.
Speaker 9: Nope, okay, And you try to help her out as
Speaker 9: best you can.
Speaker 10: To coordinate's harder at night, you know, so to pass
Speaker 10: it on.
Speaker 9: And finally she was not able to have visitors per
Speaker 9: order of the police. Is that correct?
Speaker 10: Correct?
Speaker 9: Thank you very much, man, Thank cam.
Speaker 7: I'most redirect miss sanity the first time that it's going
Speaker 7: to say the defendant, the patient used whiteboard with you
Speaker 7: was on January twenty eighth. Correct. Yes, you're not aware
Speaker 7: of if she used that tool with other nurses on
Speaker 7: other shifts, are you. And the first time that she
Speaker 7: mentioned a lawyer on the February second, that's the first
Speaker 7: time she mentioned a lawyer to you. Correct.
Speaker 8: Correct.
Speaker 7: You were asked about the trauma and the chest tube
Speaker 7: and that she lost one hundred to three hundred c
Speaker 7: seas of blood. Yes, the transfusion came after that, correct.
Speaker 10: Yes, and.
Speaker 7: Fair to say. The course of her treatment coming to
Speaker 7: Brigham was that she first came in through the emergency department, correct,
Speaker 7: Then she was sent for an MRI, and then she
Speaker 7: came to the trauma surgery. Correct. And you're aware that
Speaker 7: she had other imaging like CT scans, correct, And that,
Speaker 7: especially when it came to the head cts, she didn't
Speaker 7: have any intercranial imagery, intercranial injuries, or anything that required
Speaker 7: that you be focused on her head injury correct. Correct,
Speaker 7: So it was more cardiac issue and keeping her stable
Speaker 7: and internal bleeding in the chest area.
Speaker 14: Yes.
Speaker 7: As far as what you're aware of from other treating physicians,
Speaker 7: You're aware doctor Anderson was one of the trauma surgeons
Speaker 7: that were treating was treating the patient. Yes, and he
Speaker 7: was making assessments and giving orders to you and other nurses. Yes.
Speaker 7: And are you aware that he identified in the history
Speaker 7: that this patient actually had a history of postpartum mood SIMPT,
Speaker 7: it's not psychosis.
Speaker 10: I would have to look at the note. I don't remember.
Speaker 7: Those aren't notes that you would have written, and you
Speaker 7: weren't taking a full history of.
Speaker 10: The patient at the time.
Speaker 7: Were you aware that she then subsequently was fully evaluated
Speaker 7: by the psychiatric.
Speaker 10: Team I knew she is so psyched.
Speaker 8: Yes.
Speaker 7: And were you aware that they ultimately identified that there's
Speaker 7: an inherent uncertainty in her diagnosis?
Speaker 10: I do not remember.
Speaker 7: As far as the last lacerations went. In your treatment
Speaker 7: of her, again, you treated her overnight shifts for various days. Correct.
Speaker 7: Did you ever have a situation where you had to
Speaker 7: change her bandages because they were seeping?
Speaker 4: No?
Speaker 7: And are you aware that.
Speaker 10: Except for the first night, but we didn't get to
Speaker 10: that because she coded, because she.
Speaker 7: Coded, And then you're aware that the next day after
Speaker 7: another individual of physicians assistant physician's assistant excuse me, actually
Speaker 7: came in and those lasseres and as far as doctor
Speaker 7: Anderson goes, were you aware that on January twenty fifth,
Speaker 7: he noted that the lacerations to her neck and wrists
Speaker 7: were very superficial and didn't require treatment at.
Speaker 10: That time, I was not aware. I don't remember that note.
Speaker 1: Would you.
Speaker 7: If I showed you the record that that's in his note,
Speaker 7: would you agree that that's an assessment that he made. Yes,
Speaker 7: and he didn't instruct you to do anything further with
Speaker 7: those injuries?
Speaker 10: Yes, right, thank you.
Speaker 9: Very briefully true. Disic attorney asked you about the evaluation
Speaker 9: by the psych as she put at psychiatric teams with
Speaker 9: a determination that there was inherent uncertainty according to the
Speaker 9: psychiatric teams. Do you know when the psychiatric teams were
Speaker 9: evaluating her?
Speaker 10: I don't know. I was after and during the day.
Speaker 10: I don't know what day, But.
Speaker 18: In any event, I did show you and the the
Speaker 18: thing over there, the where the reference was made to
Speaker 18: postpatum depression, post patum psychosis.
Speaker 9: Correct.
Speaker 23: Yes, and.
Speaker 9: It's all heah, thank you man.
Speaker 6: Anything further alright, thank you man, Let me sit down,
Speaker 6: Thank you. Hi. Comma would call Meghan Collins please, Hi,
Speaker 6: good afternoon. Ask you speaking to that microphone, keep your
Speaker 6: voice up. Okay, all right, pre Bucky please.
Speaker 7: Thank you, good afternoon. Hi. Can you please tell the
Speaker 7: juror your first and last name, Meghan Collins? Would you
Speaker 7: mind spollowing your first name for the record?
Speaker 4: M E.
Speaker 8: G H A N.
Speaker 3: Collins C O L L I N S.
Speaker 7: Thank you? And what do you do for work?
Speaker 3: I'm an? I see you nurse?
Speaker 7: And how long have you been a nurse?
Speaker 3: Eleven years?
Speaker 7: And did you go to school for that?
Speaker 10: Yes?
Speaker 7: Where'd you go?
Speaker 3: Sacred Heart?
Speaker 7: What hospital do you currently work at?
Speaker 3: Brigham and Women's and how long have you worked there?
Speaker 3: Eight years?
Speaker 7: In January of twenty twenty three? What unit were you
Speaker 7: working on at the Brigham the trauma Surgical?
Speaker 10: I see you?
Speaker 7: Did you work a particular shift?
Speaker 23: I did?
Speaker 7: And what shift was that? Seven A to seven p?
Speaker 7: So seven am to seven pm? And you just have
Speaker 7: to answer out loud? Sorry, okay, Yes, I'm going to
Speaker 7: draw your attention to a particular patient that was treated
Speaker 7: there beginning on January twenty fourth. Lindsay Clancy, are you
Speaker 7: familiar with that patient?
Speaker 9: Yes?
Speaker 7: Were you a nurse that was treating her during the
Speaker 7: day shift while she was in the ICU?
Speaker 3: I was.
Speaker 7: Are you aware that she arrived at the Brigham Hospital
Speaker 7: on January twenty fourth of twenty twenty three.
Speaker 3: When she was admitted to URICU, it was overnight.
Speaker 23: So as far as the hospital, do you know when
Speaker 23: she arrived at the hospital, I believe the day evening prior.
Speaker 10: And you.
Speaker 7: A patient who comes to your hospital doesn't automatically come
Speaker 7: to the ICU, correct, that's correct? Where did they go first?
Speaker 3: Usually the emergency room?
Speaker 7: And you're aware this particular patient actually went through a
Speaker 7: local hospital before being transferred to the emergency department at
Speaker 7: Brigham and then to the ICU. Correct.
Speaker 3: Correct?
Speaker 7: And so when you interacted whether she had already been
Speaker 7: at the ICU unit for that night shift? Is that
Speaker 7: fair to say?
Speaker 3: Correct? Interacted? She was intubated when she arrived.
Speaker 7: And were you with her the entire day of the
Speaker 7: twenty fifth, from that seven am to seven pm shift?
Speaker 17: Yes?
Speaker 7: And was she on what's called the one to one
Speaker 7: during that day?
Speaker 3: Yes?
Speaker 7: And what does that mean for you as the nurse
Speaker 7: if she's on the one to one?
Speaker 23: She was one to one nursing perra ratios because of
Speaker 23: how critically.
Speaker 7: Ill she was, And so you were there pretty much
Speaker 7: the entire time.
Speaker 17: Correct?
Speaker 7: Were there any other people there other than the medical
Speaker 7: staff in yourself treating her? Were there any other people there?
Speaker 3: There were officers, police officers, and.
Speaker 7: They were outside the room.
Speaker 3: Correct.
Speaker 7: Had you taken overcare of this patient from another nurse
Speaker 7: on the night shift?
Speaker 10: Yes?
Speaker 3: And who was that Rachelle?
Speaker 7: And you are familiar with Rachelle you worked there before, Yes,
Speaker 7: I have. And you advised that over the course of
Speaker 7: the night shift that this patient had coded.
Speaker 9: I was.
Speaker 7: And when you came on shift in the morning because
Speaker 7: of what had happened overnight, were you aware that she
Speaker 7: was sent for an additional CT scan.
Speaker 23: We went for CT imaging in the morning when I
Speaker 23: got there because she was not stable overnight, And you
Speaker 23: said she was intubated correct, Correct? How was she responsive
Speaker 23: during that first day that you encountered her? The first
Speaker 23: shift that I had her, we were focused on her
Speaker 23: injuries and keeping her sedated, so the interactions responses were minimal,
Speaker 23: But that was intentional as she was again, like I said,
Speaker 23: so critically ill.
Speaker 7: And so you also said that she was sedated for
Speaker 7: the majority of that day, correct, Yes? And is that
Speaker 7: something that often happens when a person is intubated, that
Speaker 7: they're sedated, it is, if right? And did you treat
Speaker 7: her on the twenty sixth to your best ever memory, I.
Speaker 3: Would have to go back and look.
Speaker 9: I don't have a problem records.
Speaker 7: As far as January twenty sixth, on that seven am
Speaker 7: to seven pm shift, do you recall making notes that
Speaker 7: the patient required additional sedation due to the tube intolerance, Yes, okay,
Speaker 7: and that she was started on low dose of propofol.
Speaker 7: That is correct, and that in the afternoon that she
Speaker 7: had the chest tubes and you kind of check those
Speaker 7: chest tubes to it, says interval c x R. Looked
Speaker 7: okay with chest tubes to water seal. Yes, that's correct,
Speaker 7: and so she had previously been given chest tubes and
Speaker 7: your role was just to kind of make sure that
Speaker 7: everything was fine.
Speaker 23: They placed bilateral chest tubes and monitoring those is a
Speaker 23: part of my responsibilities in the ICU, and we you
Speaker 23: were concerned for her respiratory status, so that is why
Speaker 23: I made a note of it, okay.
Speaker 7: And as far as the injuries that were a part
Speaker 7: of your assessment of her, fair to say, on January
Speaker 7: twenty ninth, you also were treating her that day from
Speaker 7: seven am to seven pm, and you made a note
Speaker 7: where you identified injuries, right, correct, And those injuries would
Speaker 7: have been things that were reported to you based on
Speaker 7: a doctor's review of labs and images and that kind
Speaker 7: of thing.
Speaker 10: Correct.
Speaker 7: Yes, you don't make your own assessment about thorcic injuries
Speaker 7: or cervical injuries.
Speaker 3: I do not diagnose.
Speaker 7: Also on the twenty ninth or the twenty eighth into
Speaker 7: the twenty ninth, that is, at that point when the
Speaker 7: patient was extubated. Correct.
Speaker 3: Correct.
Speaker 7: Do you recall making observations of the patient when she
Speaker 7: was at or she was extubated.
Speaker 3: She was not exturbated on my shift. I was there
Speaker 3: the following day.
Speaker 7: Okay. Did you note how her demeanor her presentation the
Speaker 7: next day?
Speaker 8: I did?
Speaker 7: And fair to say you noted increased confusion, agitation, and
Speaker 7: picking at lane lines and drains. Correct, that's correct, And
Speaker 7: fair to say the patient had to be restrained because
Speaker 7: of the activity, that is correct. Is that something that
Speaker 7: you often see when patients come out of intubation, that
Speaker 7: when they're extubated, that they exhibit signs of confusion or delirium.
Speaker 3: Yes, it's called ICU delirium.
Speaker 7: And over the course of the next few days in
Speaker 7: your interactions with her, did you see that delirium decline
Speaker 7: or decrease.
Speaker 23: Yes, it was a multi modal approach to manage the
Speaker 23: delirium agitation and it did get better and it did improve.
Speaker 7: And fair to say, during the time that you were
Speaker 7: treating this particular patient there was also sleep issues that
Speaker 7: were part of the treatment plan.
Speaker 8: That is correct.
Speaker 7: And on January twenty ninth and January thirtieth of twenty
Speaker 7: twenty three, were you present when the psych consult team
Speaker 7: came in to speak with the defendant?
Speaker 3: Yes, I was.
Speaker 7: What was the purpose of you being present?
Speaker 3: The purpose is.
Speaker 23: We had consulted the psychiatry team to evaluate and determine capacity.
Speaker 23: And my role is the as the ICU nurse is
Speaker 23: advocacy on behalf of the patient and to alert the
Speaker 23: providers if there's any changes in the mental status.
Speaker 7: Now, when they came in and you said advocate for
Speaker 7: their position, you're aware that the patient was looking to
Speaker 7: change her health care proxy.
Speaker 23: Correct, the patient was changing her health care proxy. That
Speaker 23: is correct, and that there has to.
Speaker 7: Be an evaluation to determine whether she's of a particular
Speaker 7: mental status and medically able to make that decision on
Speaker 7: her own. Is that fair to say?
Speaker 3: Yes?
Speaker 7: And do you recall who was present other than yourself
Speaker 7: and the psych doctors and doctors from the psychiatric unit.
Speaker 9: There was the.
Speaker 3: Social worker, myself, and her lawyer was present.
Speaker 7: Had you been present when a lawyer or somebody else
Speaker 7: was with her prior to this consult.
Speaker 8: No?
Speaker 7: And fair to say you were made aware.
Speaker 17: Very early on that.
Speaker 7: There was a particular group of people that would be
Speaker 7: having access to this individual. Correct.
Speaker 3: Can you clarify, well, is it fair.
Speaker 8: To say that.
Speaker 7: The treatment team was kept small on purpose? I mean,
Speaker 7: the same people were coming in and being the nurse,
Speaker 7: day and night staff. There was limited access.
Speaker 23: Is that fair to say it was kept to a Yes,
Speaker 23: it was kept to a smaller team, but that was
Speaker 23: also protection of privacy for the patient.
Speaker 7: And during the course of time when she's on the ICU,
Speaker 7: which is between the twenty fourth to February third, there's
Speaker 7: always law enforcement posted outside the room. Correct, Yes, and
Speaker 7: it was because she was well I'm just asking you
Speaker 7: if there were law enforcement there was. Do you recall
Speaker 7: having to check with the nursing director and the legal
Speaker 7: team at the hospital to make sure that it was
Speaker 7: permissive to allow anyone in besides medical staff.
Speaker 3: Yes, that's standard protocol.
Speaker 7: And when she was transferred off of your unit on
Speaker 7: February third, did you have any further contact with her?
Speaker 7: I did not and nothing further. Thank you?
Speaker 9: Pretty ready to absinutely.
Speaker 8: I think.
Speaker 18: How many years you've been a nurse eleven and you
Speaker 18: obviously take that position and as very serious and your
Speaker 18: concern is to protect your patient.
Speaker 9: Is that right?
Speaker 8: That is.
Speaker 18: You made reference to the fact that she was changing
Speaker 18: her her documents as far as health care proxy, Yes, did.
Speaker 8: You know anything?
Speaker 18: Did you know who she was changing it from her
Speaker 18: husband to her mother and father, or did you know
Speaker 18: anything about the specifics she was changing.
Speaker 3: It from her from Patrick to her parents?
Speaker 9: And what is a d n R.
Speaker 3: D n R means do not resuscitate.
Speaker 9: Do you know what her DNR was?
Speaker 3: Her code status was full at the time that I
Speaker 3: took care of her.
Speaker 18: Do you recall that she had indicated repeatedly that she
Speaker 18: wanted a d NR, that she did not want to
Speaker 18: be resuscitated if emergency arose.
Speaker 3: I was not privy to that knowledge, okay.
Speaker 9: But that's noted in the medical record. It would be
Speaker 9: noted in the records, right, it would be yes, thank
Speaker 9: you very much, Thank you, pretty.
Speaker 6: Thank you, thank you, thank you.
Speaker 3: Comald calls doctor Shah.
Speaker 6: All right, good afternoon, doctor.
Speaker 4: I'm going to ask you keep your voice up and
Speaker 4: speak into that microphone, right, thanks, thank you, thank.
Speaker 14: You, Anna, good afternoon. Can you please stay and spell
Speaker 14: your name for the record.
Speaker 8: Sure.
Speaker 20: My first name is Stagel s E j a L.
Speaker 20: Last name of Shaw s h A H. What's your
Speaker 20: day of birth five eight eighty one.
Speaker 14: What do you do for a living.
Speaker 1: I'm a psychiatrist.
Speaker 14: And can you briefly describe your education and training background
Speaker 14: that qualifies you to be a psychiatrist?
Speaker 17: Yeah?
Speaker 1: Absolutely so.
Speaker 20: I did my undergraduate in Philadelphia at the University of Pennsylvania,
Speaker 20: followed by medical school at Jefferson Medical College, also in Philadelphia.
Speaker 20: I moved, Oh sure, I moved up to Boston to
Speaker 20: do my residency in psychiatry at Brighaman and Women's Hospital
Speaker 20: and Beth Israel Deaconess, followed by a fellowship in Consultation
Speaker 20: Liaison psychiatry at Brigham and Women's Hospital and then stayed
Speaker 20: on as a faculty member.
Speaker 14: And where do you work currently?
Speaker 1: I work at Brighaman and Women's Hospital And what is
Speaker 1: your role there. I'm Associate Chief of the Division.
Speaker 20: Of Psychiatry and Medicine, leading the Consultation Liaison psychiatry service
Speaker 20: at Brigham.
Speaker 14: And what is the consultation in liaison service.
Speaker 20: Yeah, so, consultation liaison psychiatry is a subspecialty of psychia
Speaker 20: treat that works at the interface of psychiatry and medicine.
Speaker 20: So we work both in the inpatient and outpatient settings.
Speaker 20: In this particular instance, we get called by other healthcare
Speaker 20: providers that may need help with their patients or have
Speaker 20: a question related in the psychiatric realm. And so I
Speaker 20: would see a patient that's admitted to the hospital and
Speaker 20: help provide recommendations to the physicians and the rest of
Speaker 20: the care team that's caring for that patient.
Speaker 14: So basically, say, at the Brigham, if a patient's being
Speaker 14: treated there and a medical doctor is treating them and
Speaker 14: thinks that they need a consultation with a psychiatrist, your
Speaker 14: department would be called.
Speaker 1: That's correct. And how long have you been with the
Speaker 1: Brigham nineteen years now?
Speaker 14: I want to direct your attention to January of twenty
Speaker 14: twenty three. Did you interact with the patient named Lindsay Clancy.
Speaker 14: I did, and was that on January twenty ninth, twenty
Speaker 14: twenty three.
Speaker 1: Yes, that was the first of a handful of times
Speaker 1: that I saw her.
Speaker 14: And why did you meet with Lindsay Clancy on January
Speaker 14: twenty ninth, twenty twenty three.
Speaker 20: So my team was seeing Ms Clancy for a number
Speaker 20: of reasons, including for psychiatric safety risk assessment. She had
Speaker 20: come in reporting aice reporting a suicide attempt, which is
Speaker 20: a common reason why my team would be called is
Speaker 20: to continue to ensure that patients are safe when they're
Speaker 20: in the hospital. So we make recommendations about kind of
Speaker 20: safety status, you know, what can we.
Speaker 1: Do to help keep a patient safe.
Speaker 20: But then we also make recommendations related to medications. So
Speaker 20: that's why my team was following her. So that was
Speaker 20: one of the reasons why I saw her.
Speaker 1: On the twenty ninth, is to continue that assessment.
Speaker 20: I was also called to ask a new I was
Speaker 20: asked a new question that day, a consult question on
Speaker 20: whether she was able to make the decision to change
Speaker 20: her health care proxy from her at the time husband
Speaker 20: to her parents.
Speaker 14: And when you consult to help determine whether someone's capable
Speaker 14: of making a decision like that, changing their health care proxy.
Speaker 14: Are you evaluating their medical decision making capacity?
Speaker 1: That's correct?
Speaker 14: How do you go about doing correct? And she's speaking
Speaker 14: to and were you aware that Patrick Clancy was her
Speaker 14: health care proxy?
Speaker 1: I was told that by her primary medical team.
Speaker 14: And when you talked to Ms Clancy, did she tell
Speaker 14: you who she wanted to take over that role?
Speaker 1: She did and who was both her parents.
Speaker 14: And you talked about that needing to be a consistent choice.
Speaker 14: How did you ensure that was a consistent choice with her?
Speaker 20: Yeah, so we waited to make that make the change
Speaker 20: from Patrick Clancy to her parents until the next day
Speaker 20: for a variety of reasons. We wanted to ensure that
Speaker 20: that choice was consistent over time, and especially because the
Speaker 20: day that I saw her, she had just gone through
Speaker 20: some pretty major medical events, including she had a major
Speaker 20: sign surgery, a decompression, and effusion. She had gone through
Speaker 20: some oxygen desaturation overnight so was not breathing as well,
Speaker 20: her heart rate was up, all of which then led
Speaker 20: to her being what we call delirious. She was quite
Speaker 20: she was confused overnight to the point where she asked
Speaker 20: her nurse, am I delirious? And she was also experiencing
Speaker 20: some visual hallucinations, so that was one of the reasons
Speaker 20: why I was called in to make sure that she
Speaker 20: was she was able to make that decision to change
Speaker 20: her health care proxy. And then in addition, the team
Speaker 20: had also voiced, you know, concerns that she had come
Speaker 20: in after a reported suicide attempt, and so making sure
Speaker 20: that she was able to make that decision.
Speaker 1: Of sound mind.
Speaker 20: And so we actually waited until the next day when
Speaker 20: she could be reassessed. At that point, her delirium had
Speaker 20: cleared and she was continuing to make that consistent choice
Speaker 20: to change her health care proxy to her parents.
Speaker 14: And and in fact, you noted in the medical records
Speaker 14: that the the the hallucinations were part of of an
Speaker 14: issue with oxygen.
Speaker 1: It could be that could be one of the reasons.
Speaker 20: Delirium is usually due to a variety of different medical reasons,
Speaker 20: and oxygen desaturation could be one of them. She had
Speaker 20: also just recently had anesthesia related to surgery that she
Speaker 20: had on her spine, so that could be another reason.
Speaker 20: And then her heart rate was also actually quite elevated,
Speaker 20: so that could be another reason.
Speaker 14: Is it common for patients who are just coming off
Speaker 14: of anesthesia from surgery, who have an issue with oxygen
Speaker 14: and other medical issues that you described to have visual hallucinations,
Speaker 14: they can.
Speaker 20: It's it's not it's not that everybody does, but they can.
Speaker 20: And delirium can be quite common after after surgery and
Speaker 20: particularly anesthesia, and.
Speaker 14: Those hallucinations that she was having, those were resolved by
Speaker 14: the next day. They were over by the next day. Correct,
Speaker 14: that's correct, And her choice to change her health care
Speaker 14: proxy to her parents was consistent the following day. Correct,
Speaker 14: that's right. You also about the patient has to understand
Speaker 14: the risks and benefits of the decision.
Speaker 3: Correct, that's correct.
Speaker 14: How do you make sure the patient understands that?
Speaker 20: Yeah, So one of the things we do is really
Speaker 20: ask patients to take us through their thought process of
Speaker 20: why they're making that decision and what led to them
Speaker 20: making that decision at that moment in time. So we're
Speaker 20: able to kind of see their thought process and ensure
Speaker 20: that they're understanding, you know, what it means to remove
Speaker 20: one person and add another, and what.
Speaker 14: Was missus Clancy's thought process in explaining that to you.
Speaker 20: Yeah, she was saying that her parents are quite supportive
Speaker 20: to her and that she was thinking that she would
Speaker 20: have to change her health care proxy from her husband
Speaker 20: to somebody else, And we didn't necessarily go into the
Speaker 20: reasons as to, you know, why she would have to
Speaker 20: change it, but she explained that she was very close
Speaker 20: with her parents. They would see each other frequently given
Speaker 20: that they lived in close geographic proximity, and that she
Speaker 20: felt that they were very supportive to her and would
Speaker 20: have her best interests in mind should we need to
Speaker 20: invoke the health care proxy, or that she couldn't be
Speaker 20: if she couldn't make her own medical decisions.
Speaker 14: So was there a concern on her part that her
Speaker 14: husband wouldn't have her best interests in mind at that
Speaker 14: point in time? Sustain You also talked about the patient.
Speaker 14: You have to make sure the patients thinking about the
Speaker 14: information rationally. How do you how do you go about
Speaker 14: doing that?
Speaker 20: Yeah, so one of the things we do is really
Speaker 20: ensure that the patient understands the situation and you know,
Speaker 20: all of the kind of parts around it. So this
Speaker 20: comes into play much more when when it's about a
Speaker 20: specific medical intervention like an invasive medical procedure or something
Speaker 20: like an amputation or a surgery with a health care proxy.
Speaker 20: One of the things you want to make sure is
Speaker 20: that the person that they want to change their health
Speaker 20: care proxy to or a point does their health care
Speaker 20: proxy make.
Speaker 1: Sense in the context of their life?
Speaker 20: And you know, ms Clancy was able to talk about
Speaker 20: how her parents were quite involved in her life, and
Speaker 20: so that's one of the things that we would assess.
Speaker 14: And then the last thing was making sure the patient
Speaker 14: understands the risk if the change doesn't happen. Did you
Speaker 14: go over that with mss Clancy and how did you
Speaker 14: do that?
Speaker 10: Yeah?
Speaker 1: I did go over that with her.
Speaker 20: We talked a little bit about how it could mean
Speaker 20: that she would not have a health care proxy were
Speaker 20: she not to appoint her parents, and so we went
Speaker 20: through that. You know, it's always in healthcare we always
Speaker 20: talk about how it's great to have a health care
Speaker 20: proxy just in case you become unable to make medical
Speaker 20: decisions and who would you want that to be.
Speaker 14: And during this conversation with the defendant going over all
Speaker 14: these points, did you ever have difficulty understanding her?
Speaker 17: I did not.
Speaker 14: Did she ever appear to have difficulty understanding you?
Speaker 20: So the first day when I saw her on January
Speaker 20: twenty ninth, she described herself as feeling confused, and I
Speaker 20: definitely witnessed that as well. We went through a bedside
Speaker 20: cognitive evaluation and she definitely made some mistakes on some
Speaker 20: of the cognitive evaluation.
Speaker 1: Therefore, I did.
Speaker 20: Diagnose her at that time with delirium and then.
Speaker 14: She was reevaluated the following day and there were no
Speaker 14: issues with her understanding and the delirium was gone correct.
Speaker 8: That's correct.
Speaker 14: And were you aware during this evaluation that Miss Clansley
Speaker 14: did not have a brain injury?
Speaker 1: I'm sorry, I can you repeat the question?
Speaker 14: Were you aware that Ms Clancy did not have a
Speaker 14: brain injury at that time?
Speaker 20: So one of the things that we look at is
Speaker 20: any kind of relevant medical information that might be available
Speaker 20: to us. And I noticed that her Glasgow COMA scale
Speaker 20: when she was transferred to Bringham a Women's Hospital was
Speaker 20: a ten, which would indicate that she potentially have had
Speaker 20: a moderate brain injury.
Speaker 1: But I don't recall thinking.
Speaker 20: About whether you know specifically whether she had a brain injury.
Speaker 14: Were you aware that a cat scan was done Page
Speaker 14: one and ten of the records, and on the cat
Speaker 14: scan the impression was no acute entracranial findings, so no
Speaker 14: brain injury.
Speaker 20: So you can essay, I did review the head imaging
Speaker 20: that was available at the time.
Speaker 1: You can have a normal cat scan and still have
Speaker 1: a brain injury.
Speaker 14: Were you aware that she had multiple cat scans that
Speaker 14: showed no bleeding in the brain, no skull fractures, no injuries,
Speaker 14: visible injuries whatsoever.
Speaker 1: I'm sorry, but can you repeat the question?
Speaker 14: Were you aware that she had multiple cat scans at
Speaker 14: Self Shore Hospital and at Brigham and Woman's that showed
Speaker 14: no skull fractures, no into cranial bleeding, no hemorrhaging, no
Speaker 14: visible damage whatsoever.
Speaker 1: Yes?
Speaker 14: And were you aware that she was valued at Self
Speaker 14: Shore Hospital and at the Brigham and she had no
Speaker 14: external injuries on her head either.
Speaker 1: Yes.
Speaker 14: Now she was allowed to change your health care proxy
Speaker 14: to her parents.
Speaker 8: Correct.
Speaker 1: That's correct.
Speaker 14: So if someone had an injury, a brain injury to
Speaker 14: the point where they didn't know what was going on,
Speaker 14: or they were having trouble processing or thinking, they wouldn't
Speaker 14: be allowed to change their healthcare.
Speaker 3: Correct.
Speaker 1: It depends to what extent.
Speaker 20: Most patients that have either a head injury or severe
Speaker 20: mental illness, let's say, just anything going on with the brain,
Speaker 20: retain the ability to make most medical decisions, and we
Speaker 20: think about changing health care proxies as a pretty low
Speaker 20: risk decision. As I mentioned before, something like an amputation
Speaker 20: or a major surgery invasive procedure is something that we
Speaker 20: would hold somebody to a higher bar, But a health
Speaker 20: care proxy is a pretty low risk, especially if it
Speaker 20: makes sense in terms of who they want to change
Speaker 20: it to.
Speaker 14: And when was her Glasgow score?
Speaker 8: Ten?
Speaker 20: I believe it was as she was being transferred from
Speaker 20: the outside hospital to Brigham and Women's.
Speaker 14: And you're seeing her several days later, correct, correct? And
Speaker 14: so when she was transferred from the outside hospital to Brigham,
Speaker 14: she was unconscious, correct, I believe? So, Okay, so now
Speaker 14: she's conscious, correct, that's correct. And when she was transferred
Speaker 14: from the outside hospital to Brigham, she wasn't communicating or
Speaker 14: speaking or opening her eyes on her own.
Speaker 10: Correct.
Speaker 20: That's what the reports that I was not there at
Speaker 20: that time, but the notes that I read that's correct.
Speaker 14: So when you're speaking to her a couple days later,
Speaker 14: she's opening her eyes, she's communicating, she's responsive, she's interacting. Correct. Yes,
Speaker 14: So it's fair to say that our Glasgow score would
Speaker 14: be higher than the ten when you were speaking to her.
Speaker 17: Correct.
Speaker 3: Yes, Now.
Speaker 14: You did a mental status examination of her while you
Speaker 14: were doing this evaluation about her decision making capacity correct. Yes,
Speaker 14: And it's fair to say under mood you listed okay, yes,
Speaker 14: that you listed her thought processes organized, goal directed. Is
Speaker 14: that correct?
Speaker 1: Yes?
Speaker 14: You asked her if she was having hallucinations or delusions
Speaker 14: and she other than those initial ones the first day,
Speaker 14: she denied those during my evaluation, yes, And she also
Speaker 14: denied suicidal intent and homicidal intent correct.
Speaker 8: Yes.
Speaker 14: And you listed her insight and judgment as fair correct.
Speaker 8: Yes.
Speaker 14: Her behavior was calm and cooperative.
Speaker 1: Yes.
Speaker 14: And you didn't see anything about her behavior that would
Speaker 14: indicate to you that she was responding to some type
Speaker 14: of voices or hallucination that you couldn't.
Speaker 1: See at that moment.
Speaker 20: No, But as I mentioned, I did speak with the
Speaker 20: nurse beforehand, and Mss Clancy was able to report to
Speaker 20: me that she reported visual whose nations.
Speaker 14: Overnight overnight after surgery.
Speaker 1: That's right, okay, And then never again, not during my evaluation.
Speaker 14: And did you speak to Mss Clancy again on February nineteenth,
Speaker 14: twenty twenty three. Yes, And was the purpose for that
Speaker 14: to prepare her for a transition from Brigham and Women's
Speaker 14: to Spalding rehabilitation.
Speaker 1: That was one of the reasons, and what were the
Speaker 1: other reasons?
Speaker 20: So it was an ongoing safety evaluation, ongoing evaluation of
Speaker 20: psychiatric safety risk as well as medication evaluation to determine
Speaker 20: if her medications were at the right level, the right dosage,
Speaker 20: and that she was on the right medications, and then
Speaker 20: just ongoing evaluation in terms of kind of her mental status.
Speaker 14: And during that meeting, she denied suicidal intent, correct, that's correct,
Speaker 14: She denied homicidal intent, correct. She denied having auditory or
Speaker 14: visual hallucinations correct.
Speaker 9: Yes.
Speaker 14: She reported her mood as okay. Is that correct? Yes,
Speaker 14: And she told you she was looking forward to moving
Speaker 14: to Spalding correct.
Speaker 8: Yes.
Speaker 14: She also denied any confusion or disorientation.
Speaker 3: Is that correct?
Speaker 1: Yes?
Speaker 14: And again you described her mood as okay on that day, yes.
Speaker 14: And you described her as future oriented on that day.
Speaker 1: Yes.
Speaker 14: And then you spoke to her again on February twenty first,
Speaker 14: twenty twenty three.
Speaker 3: Is that correct?
Speaker 14: Yes? And on that day this is the same purpose
Speaker 14: that you just described, getting her ready, assessing her mental status,
Speaker 14: and getting her ready to transfer to Falding. Yes, okay.
Speaker 14: And during that time you wrote that the patient reported
Speaker 14: feeling down about her current situation, her paralysis, and the
Speaker 14: events leading up to her hospitalization.
Speaker 3: Is that correct?
Speaker 10: Yes?
Speaker 14: And you also noted that she said her thoughts about
Speaker 14: what she had done were not constant throughout the day.
Speaker 3: Correct.
Speaker 14: Correct, So she wasn't thinking about killing her children throughout.
Speaker 1: The day every day correct? Correct.
Speaker 14: And she said she had no suicidal intent, no homicidal intent. Correct,
Speaker 14: But full about treatment at Spaulding. Yes, she was future oriented, yes,
Speaker 14: and she denied suicidal ideation, homicidal ideation. Yes, she denied
Speaker 14: audio hallucination, visual hallucination, and anything else of that nature.
Speaker 1: Yes, thank you.
Speaker 18: So doctor from your testimony and correct me if I'm wrong.
Speaker 18: Was she, to your opinion and your experience, an honest
Speaker 18: patient telling you what her symptoms were?
Speaker 9: Finish, that's an evaluation and a psychiatric I allow that question. Yes.
Speaker 18: In other words, she didn't go off and try to
Speaker 18: exaggerate to you and say I'm seeing visions and I'm
Speaker 18: hearing voices, and I'm suicidally ideated, and I'm homicidally ideated.
Speaker 9: She didn't say any of those things to you, did
Speaker 9: she She actually denied them? Right?
Speaker 8: Correct?
Speaker 18: So This is not, in your opinion, someone who was
Speaker 18: trying to exaggerate her conditions for some legal reason.
Speaker 9: Correct.
Speaker 18: No, And you obviously were in close contact with her
Speaker 18: for for about a month, right, just a couple of questions.
Speaker 9: The council'll ask you whether or not.
Speaker 18: And I think it may have been in the beginning
Speaker 18: in January that you had difficulty understanding her. Obviously, after
Speaker 18: removing the tools and everything else, you're able to talk
Speaker 18: with her.
Speaker 9: Correct Correct.
Speaker 18: And you knew that one of the concerns, if you will,
Speaker 18: was postpartum issues. You knew that, right, yes, And your
Speaker 18: experience as a psychiatrist, you're familiar with the concept of
Speaker 18: postpartum psychosis.
Speaker 9: Correct.
Speaker 8: Yes.
Speaker 18: And you know that people can communicate and plan and
Speaker 18: act on plans even if they're in the middle of
Speaker 18: a psychosis.
Speaker 9: Right.
Speaker 7: Yes.
Speaker 18: You don't have to be drooling and stumbling and unable
Speaker 18: to walk and talk to be in a psychosis, do
Speaker 18: you so? In other words, a person can be in
Speaker 18: a psychosis and can communicate to friends, family, people talk.
Speaker 9: Correct.
Speaker 18: Yes, So you didn't, as console asked, you didn't have
Speaker 18: any difficulty understanding her. She wasn't slurring her words or
Speaker 18: anything like that when she was able to talk, right, Okay.
Speaker 9: One of the things that.
Speaker 18: When she was admitted and then without going through I'm
Speaker 18: not going to go through all the stuff we've already
Speaker 18: talked about with the medical condition and everything else, you indicated.
Speaker 9: That she was very very ill. Correct.
Speaker 8: Correct?
Speaker 9: Did she appear to be cooperative to you when you
Speaker 9: would interact with her?
Speaker 2: Yes?
Speaker 9: As a doctor.
Speaker 18: As a psychiatrist, you're familiar with bipolar, the concept of
Speaker 18: a bipolar diagnosis.
Speaker 9: Correct.
Speaker 1: Correct?
Speaker 9: Can you tell me what bipolar means?
Speaker 20: Yeah, So, bipolar disorder is a mood disorder categorized as
Speaker 20: a mood disorder where patients have distinct depressive episodes as
Speaker 20: well as, depending on the type of bipolar disorder, either
Speaker 20: hypomanic episodes or manic episodes to the point where they
Speaker 20: don't sleep for days. They still have lots of energy,
Speaker 20: there's this decreased need for sleep. There could be irritability,
Speaker 20: there can be impulsiveness, racing thoughts. A lot of patients
Speaker 20: describe that they're out of control of their behavior, and
Speaker 20: then severe episodes can also include psychosis.
Speaker 18: In reference to bipolar, as you were referring to when
Speaker 18: somebody is hypomanic, what does hypomanic mean.
Speaker 1: Yeah, it's a lesser degree of mania.
Speaker 20: So when patients are hypomanic, they don't always experience things
Speaker 20: like psychosis, but they might experience some of the other
Speaker 20: symptoms that I described, including racing thoughts, kind of moving
Speaker 20: too quickly, talking too quickly, being irritable, And as.
Speaker 18: It relates to the hypomania, would that include things such
Speaker 18: as somebody who is getting up early in the morning
Speaker 18: and exercising or cleaning out their house or selling their
Speaker 18: property out of a garage and having difficulties.
Speaker 9: Sleeping and they're awake all night.
Speaker 1: Yeah.
Speaker 9: Yes.
Speaker 18: As a psychiatrist, one of the things you were concerned
Speaker 18: about when you were first started to deal with her,
Speaker 18: as well as when you were releasing her, if you will,
Speaker 18: is the medication that she had on board, so to speak,
Speaker 18: when she came into the hospital, right, Yes, do you remember,
Speaker 18: and I know it's difficult to recall off hand, but
Speaker 18: do you recall the medications that she was actually under
Speaker 18: from purposes of taking her blood.
Speaker 1: When it was tested when she first came to the hospital.
Speaker 20: Yeah, if you know, I believe her medication list for
Speaker 20: previous to the incident, she was on amatripolene, diazepam. I
Speaker 20: believe she was also on prescribed laurazapam, and there may
Speaker 20: have been one other.
Speaker 18: Okay, So looking at that, if I tell you that
Speaker 18: there was a toxicology report done on her as of
Speaker 18: January twenty fourth, by way of taking her blood, you
Speaker 18: familiar with that, right when they analyzed for toxicology, and
Speaker 18: toxicology obviously would tell us what the medications, if any,
Speaker 18: what type of drugs she had on board, booze, cocaine, anything, right, Yes,
Speaker 18: And you're aware that the toxicology report as well as
Speaker 18: the report from the Department of State Police, as well
Speaker 18: as the NMS laboratory, which would be in Pennsylvania. So
Speaker 18: that's an international or a national respected laboratory, isn't it
Speaker 18: the NMS lab If you know, I don't know, okay,
Speaker 18: but you know that they did take her blood, They
Speaker 18: did test her blood, and it was at the State
Speaker 18: Police laboratory as well as any other labs attested it.
Speaker 9: Right.
Speaker 1: Yes, I believe I found that out later.
Speaker 20: I did not know that the first time I saw her,
Speaker 20: because those labs take a little bit.
Speaker 18: Of time to sh sure and you treated it for
Speaker 18: about a month. So you were pretty close to her
Speaker 18: and got to know her quite well.
Speaker 14: Yes.
Speaker 9: Would you agree with.
Speaker 18: Me that one of the things that her blood reflected
Speaker 18: or that she was on, was trasodote.
Speaker 9: Yes, tell me what trazodone is.
Speaker 1: Trasidone is an antidepressant medication.
Speaker 20: It's more often utilized as a sleep aid because of
Speaker 20: one of the side effects is sedation, and so patients
Speaker 20: that are often having difficulty sleeping are placed on trasidone.
Speaker 18: And is trasidone does that share some of the qualities
Speaker 18: of what I referred to as SSRIs, even though or SSRA,
Speaker 18: even though it's not an SSRI, shares similar qualities.
Speaker 10: Yes.
Speaker 9: Can you tell me what SSIRI means?
Speaker 20: Yeah, So that's a selective serotonin reuptake inhibitor, and it's
Speaker 20: a class of medications that are antidepressants.
Speaker 18: And the ssiris that would also include zoloft for example,
Speaker 18: correct would also include prozac for example. Yes, Are you,
Speaker 18: as a psychiatrist aware that zoloft and or ssri prozac
Speaker 18: should not be prescribed to a patient who has by.
Speaker 1: Polar It can be prescribed.
Speaker 20: Oftentimes it's prescribed together with another medication that can be
Speaker 20: protective because patients with bipolar disorder may be experiencing depression,
Speaker 20: and so they may be prescribed in antidepressant but along
Speaker 20: with another medication that what we call protective.
Speaker 18: And in reference to the SSIRI is a selective serotonin
Speaker 18: reuptake inhibitor.
Speaker 9: What does that mean? Selective serotonin reuptake inhibitor. What does
Speaker 9: that mean?
Speaker 20: Yeah, so oftentimes in depression, patients are kind of lacking
Speaker 20: serotonin in.
Speaker 1: The spaces in their brain that helps.
Speaker 9: What is serotonin?
Speaker 20: Yeah, serotonin is a neurotransmitter, So it's a hormone in
Speaker 20: the brain that works on the brain. It works in
Speaker 20: other areas in the body as well, but for these purposes,
Speaker 20: it works in the brain at nerve endings throughout the body,
Speaker 20: and that neurotransmitter helps with things like mood regulation.
Speaker 1: For patients with.
Speaker 20: Depression, they're often lacking kind of that ability to have
Speaker 20: another serotonin in those spaces, and so a selective serotonin
Speaker 20: reuptake inhibitor prevents serotonin being kind of sucked back into
Speaker 20: the cell, so it allows for serotonin to be more available.
Speaker 18: And what is an SSA I What does that mean?
Speaker 18: An antagonist? Selective serotonin antagonist.
Speaker 1: So those are medications that kind of do the opposite, okay, And.
Speaker 18: You knew as a psychiatrist, at least looking at her history,
Speaker 18: you knew that she had been seeing psychiatrists immediately prior
Speaker 18: to her suicide attime, correct?
Speaker 17: Correct?
Speaker 18: And you knew that she had been prescribed a number
Speaker 18: of drugs by these various psychiatrists.
Speaker 9: Correct.
Speaker 1: Correct?
Speaker 9: And to your knowledge, was she prescribed diazepam yes? Rellion?
Speaker 18: Was she prescribed busperone otherwise known as van spar Yes?
Speaker 9: About wellbutrin?
Speaker 19: Yes?
Speaker 9: And what is albutrin? Is that an antidepressant?
Speaker 1: It is an antidepressant.
Speaker 9: Hydroxyzine?
Speaker 11: What is hydro It can be used.
Speaker 20: For a number of reasons, but for psychiatric purposes, it's
Speaker 20: often used as an anti anxiety medication.
Speaker 18: And clonopin, Yes, is hydroxyzine? Is that a strike that clonopin?
Speaker 18: That's a benzo diazepin.
Speaker 1: Right, that's correct.
Speaker 9: And then la matrigene, Yeah, lomotrigene, lamotrigene. Sorry, yes, what
Speaker 9: type of type of medication is that? Is that a
Speaker 9: mood stabilizer?
Speaker 7: It is?
Speaker 20: Yeah, it's also an anti seizure medication, but in the
Speaker 20: psychiatric realm it's used as a mood stabilizer, and.
Speaker 18: Then we talked about prozac. That's an SSRI correct correct,
Speaker 18: and what's remarn.
Speaker 1: Also an antidepressant.
Speaker 9: So in addition to all.
Speaker 18: Of the drugs that I had mentioned, she was also
Speaker 18: prescribed memarn correct correct.
Speaker 9: She was also prescribed sarah quill or.
Speaker 1: Weetipen ye critiopene yes with tytopine okay?
Speaker 20: And what is sarahqual So, sarahquill is an antipsychotic medication,
Speaker 20: and she.
Speaker 18: Was prescribed, as we already talked, trazodone. She also prescribed amitryptlene. Yes,
Speaker 18: what is amitriptlene.
Speaker 20: Amatriptlen is one of the older antidepressants. It's a tricyclic
Speaker 20: antidepressant that can often be used to.
Speaker 1: Help with sleep, but also mood.
Speaker 9: And and ambient correct correct in.
Speaker 20: Zopidine zopidine Yeah, Zolpidem is the generic name of ambient.
Speaker 9: Oh. Okay.
Speaker 18: Some of these drugs they also have what's called a
Speaker 18: suicide warning or a black box warning.
Speaker 9: Isn't that right?
Speaker 8: Yes? Can you tell me what that means?
Speaker 16: Yeah?
Speaker 20: So, in studies that have been that have been done,
Speaker 20: some of them show that they, especially after starting an antidepressant,
Speaker 20: it can increase someone's risk of suicidality. Many of those
Speaker 20: studies showed that it was mostly in adolescence and young adults,
Speaker 20: but it can happen in adults as well.
Speaker 9: And Selexa was also a drug. Is that an s
Speaker 9: s R too? And all of these drugs that we
Speaker 9: just went through were all prescribed from September end of
Speaker 9: September till January.
Speaker 1: Yes, September twenty twenty two sustained.
Speaker 9: Thank you, thank you.
Speaker 14: Almost redirect Yes, doctor, all those drugs that defense Counsul
Speaker 14: just listed, you're aware she wasn't on all of those
Speaker 14: drugs at the same time, correct, Correct? And did you
Speaker 14: know that many of those drugs she took very a
Speaker 14: very small amount of some she didn't take any pills
Speaker 14: at all.
Speaker 1: I was not aware of that.
Speaker 14: For abuse bar, which is one of the ones he mentioned.
Speaker 14: Were you aware the first prescription she only took two
Speaker 14: pills out of that bottle.
Speaker 3: I was not aware.
Speaker 14: Were you aware the second prescription a month or so
Speaker 14: later form abuse bar she took zero pills.
Speaker 1: Out of that bottle. I was not aware.
Speaker 14: So you're just where you're getting this information about what
Speaker 14: she was on and when. Yeah.
Speaker 20: So one of the things that we do is try
Speaker 20: to collect as much information as we can during our assessments,
Speaker 20: and so we look through the record in terms of
Speaker 20: what was prescribed. We also talk with other providers as
Speaker 20: to what they prescribe. But in the context of the
Speaker 20: assessments that we were doing, it did not require us
Speaker 20: to determine, you know, what exactly she had been on before,
Speaker 20: because we were using a different set of medications to
Speaker 20: treat something different symptoms that she was experiencing.
Speaker 14: So you really have no idea what she was taking
Speaker 14: or when you just know what was prescribed.
Speaker 20: I know what was prescribed, and then we were also
Speaker 20: getting reports of what was being taken what wasn't being taken, but.
Speaker 14: From the defendant, correct, Okay, So she's reporting to you
Speaker 14: that she took those medications, but you'd be surprised to
Speaker 14: know that at least one of them zero pills were taken.
Speaker 1: I don't think I'm surprised, No, okay.
Speaker 14: And you talked about, well talked about prescription and what
Speaker 14: she was taking. Were you aware that in the timeframe
Speaker 14: just prior to her being admitted to the hospital, she
Speaker 14: was only prescribed trasitone valume and immatriptolene just three medications. Yes,
Speaker 14: and you were asked about you know mania, and you
Speaker 14: know exercising and cleaning out your garage and selling your
Speaker 14: belongings could be signs of mania correct.
Speaker 1: Correct.
Speaker 14: But there are people who just exercise every day and
Speaker 14: they're not manic correct correct. And there are people who
Speaker 14: have a messy garage and have accumulated a lot of
Speaker 14: junk and decide to clean out the garage that aren't
Speaker 14: manic correct correct. And in fact, if someone is manic
Speaker 14: and attempts to do one of those tasks like cleaning
Speaker 14: out a garage, it's usually in a disorganized way, and
Speaker 14: oftentimes they don't finish the task correct sometimes. So if
Speaker 14: someone approaches a task by cleaning out the garage by
Speaker 14: organizing with another party, organizing the belonging, separating them into keep, sell, throwout,
Speaker 14: but that's pretty organized behavior correct correct. And if someone
Speaker 14: sells belongings that they no longer need, that's not necessarily
Speaker 14: a sign of mania correct correct. That's more if they're
Speaker 14: selling their stove and then they have nothing to cook
Speaker 14: with correct correct. So if they're selling junk in their
Speaker 14: garage that they no longer need, that's not necessarily manic
Speaker 14: correct not necessarily thank you.
Speaker 8: It's drinking.
Speaker 9: As Consols said, they're exercising every day, and they have
Speaker 9: a messy garage that obviously would not be indicative of
Speaker 9: hypermania warning. Probably sure, normal person could have, as Console
Speaker 9: said it. How about a person that, at the same
Speaker 9: time can't sleep because the insignia is so bad they
Speaker 9: go forty eight hours without sleep. Is that something to
Speaker 9: be considered in the whole evaluation.
Speaker 8: Yes.
Speaker 18: How about the fact that a person's saying that my
Speaker 18: brain is broken and that they can't concentrate, they can't think.
Speaker 18: Is that something that the person you would consider in
Speaker 18: conjunction with the messy garage and the exercise. Yes, thoughts
Speaker 18: of hurting themselves, sidal adeation, that's something that's important to evaluate. Yes,
Speaker 18: homicidal ideation. Telling your husband that you're having thoughts about
Speaker 18: hurting your children, that's something you consider, isn't it.
Speaker 3: Yes.
Speaker 18: In reference to Consul's comiment about just three medications that
Speaker 18: she was on prior to coming trying to commit suicide,
Speaker 18: you're not aware of the doctors telling her to discontinue
Speaker 18: this medication. Stat a new medication, go on to a
Speaker 18: different medication depending on the doctor you're not aware of
Speaker 18: that right now. And finally, if you know, did she
Speaker 18: sign a DNR do not res ascitate?
Speaker 20: She asked to the day after the first evaluation that
Speaker 20: I did of her, which was the capacity assessment to
Speaker 20: change her health care proxy.
Speaker 1: But in the context of her reporting a.
Speaker 20: Serious suicide attempt, we did not change her code status.
Speaker 20: We continued to chat with her about that, and she
Speaker 20: ultimately came to the conclusion that it made sense to
Speaker 20: make sure that her mental health was stable before she
Speaker 20: considered her code status.
Speaker 18: Okay, but her initial reaction or her conversations with you,
Speaker 18: always that she wanted.
Speaker 9: To have a do not Resuscitate status?
Speaker 8: Correct, Thank you? Come up?
Speaker 6: All right, Thank you doctor, Thank you your honor.
Speaker 4: All right, the Jew, we can think the afternoon resiss
Speaker 4: at this point, So I'm going to ask you to
Speaker 4: go back to your room and then we'll come back here.
Speaker 10: Approximate tour.
Speaker 9: Okay, all right, excellently, cool.
Speaker 8: Counsel.
Speaker 4: I think we need to address before the break. All right,
Speaker 4: so we'll be in resiss till about two o'clock.
Speaker 7: Thank you.
Speaker 1: Date of birth is nine twelve, nineteen eighty two.
Speaker 14: What do you do for a living?
Speaker 1: I am a forensic psychiatrist, and I work on at
Speaker 1: Brigham and Women's Hospital.
Speaker 14: And what is a forensic psychologist or psychiatrist.
Speaker 1: Well, I'm a forensic psychiatrist by specialty training, and we
Speaker 1: work in the courts, often doing forensic evaluations of individuals.
Speaker 1: But I'm also an adult psychiatrist and I work at
Speaker 1: Brigham and Women's Hospital as an adult psychiatrist on the
Speaker 1: consult liaison unit.
Speaker 14: And can you just briefly describe your education and training
Speaker 14: background that qualifies.
Speaker 3: You for this work.
Speaker 1: Sure. I grew up in the South Shore. I went
Speaker 1: to Dartmouth College and then I went to medical school
Speaker 1: at UMass Chan Medical School. I then did my psychiatry
Speaker 1: residency at Harvard Longwood, which consists of Brigaman Women's, Beth Israel,
Speaker 1: Boston Children's at the time, and after that I did
Speaker 1: sub specialty training after my psychiatry residency in forensic psychiatry
Speaker 1: again at UMass Chan Medical School.
Speaker 14: And focusing in on January of twenty twenty three, were
Speaker 14: you working at the Brigham and Women's Hospital. I was,
Speaker 14: And specifically on January twenty fifth, twenty twenty three, did
Speaker 14: you interact with a woman a patient there named Lindsay Clancy.
Speaker 1: I did on January twenty sixth, twenty sixth.
Speaker 14: Okay, in what capacity did you interact with her as
Speaker 14: a forensic psychiatrist or as a member of the staff
Speaker 14: at Brigham.
Speaker 1: And Women's I interacted with her as a member of
Speaker 1: the staff, the psychiatry staff at Brigham and Women's Hospital.
Speaker 14: And did you have a particular role that day on
Speaker 14: January twenty sixth, twenty twenty three.
Speaker 1: Yes, I was on the Consulate leaves On service, which
Speaker 1: is the psychiatry service that's called by medical and surgical
Speaker 1: specialties to help evaluate and provide psychiatric recommendations.
Speaker 14: And when you did you meet with Mss Clancy on
Speaker 14: that day on the twenty sixth, I did? And was
Speaker 14: that around fourteen pm that you had that interaction. I
Speaker 14: think it was somewhere between two and three o'clock, yes,
Speaker 14: And when you met with Lindsay Clancy, was that in
Speaker 14: her hospital room in the ICU?
Speaker 7: It was?
Speaker 14: And was she indbated at the time she was? And
Speaker 14: was she awake?
Speaker 1: She was awake?
Speaker 14: And what was she oriented?
Speaker 1: So she was intubated, so it was difficult for her
Speaker 1: to really answer a lot a range of questions and
Speaker 1: so she she gestured to me to be able to write,
Speaker 1: and so we knew that she was really exhausted and
Speaker 1: anxious from the entire experience and the evaluation, and so
Speaker 1: we didn't ask her all of the questions around orientation.
Speaker 14: When she gestured that she wanted to write, did you
Speaker 14: give her something to write with or something to write on?
Speaker 7: I did?
Speaker 1: And what did you give her paper?
Speaker 14: And did you also give her a pen or something
Speaker 14: like that?
Speaker 17: I did?
Speaker 14: Was she able to when you asked her certain questions?
Speaker 14: Was she able to answer those questions by writing the
Speaker 14: answers on the paper?
Speaker 8: She was?
Speaker 14: And did you ask her about her mood that day?
Speaker 1: I did ask her her mood?
Speaker 14: And what did she write?
Speaker 1: She wrote horrified?
Speaker 14: And what was her affect during this interaction?
Speaker 1: At the time that I saw her, she was intubated,
Speaker 1: and that in and of itself is very uncomfortable, and
Speaker 1: so she seemed very anxious.
Speaker 14: And did she write anything else on that paper that
Speaker 14: you saw?
Speaker 1: Yes, the entire evaluation was done through writing because she
Speaker 1: couldn't speak.
Speaker 14: So what types of questions were you asking her? And
Speaker 14: what was she repronging with?
Speaker 1: So we asked her, you know, how are you feeling
Speaker 1: horrified and then she wrote down do I have an attorney?
Speaker 1: And I said with my team that at this time,
Speaker 1: we're just getting to know you and getting to know
Speaker 1: the case, and we're not sure exactly you know, what
Speaker 1: is happening. And we asked her do you have questions
Speaker 1: for us? And she asked, is my body broken? Are
Speaker 1: my legs straight? And she then asked about can she
Speaker 1: have visitors? And you know where her family is?
Speaker 14: And when you are asking her questions, what is the
Speaker 14: goal of the questions that you're asking her? What are
Speaker 14: you trying to address or assess?
Speaker 1: It depends. Psychiatrists are call for all kinds of issues
Speaker 1: that happen in the hospital. In this situation, we were
Speaker 1: asked around you know, diagnosed clarity that there was a
Speaker 1: likely suicide event that occurred. Can you evaluate her for
Speaker 1: safety at this time before she goes into.
Speaker 14: Surgery and I know that she was intubated, so she's
Speaker 14: writing her answers. But based on the answers she wrote
Speaker 14: on the paper, did she seem to understand the questions
Speaker 14: you were asking?
Speaker 7: Yes?
Speaker 14: And her response is did you understand those?
Speaker 7: Yes?
Speaker 1: She was anxious and she needed breaks. And I said
Speaker 1: anytime you need a break, we can leave. But she
Speaker 1: did write to us those particular answers.
Speaker 14: So what she was writing, even when she asked if
Speaker 14: she had a lawyer, those were things. What she was
Speaker 14: writing made sense given the situation. She wasn't writing, is
Speaker 14: there a unicorn in the corner?
Speaker 8: Right?
Speaker 1: Correct? That if there was a unicorn in the corner.
Speaker 14: So what she's asking, do I have an a turn?
Speaker 14: Are my legs straight? Is my body broken? Those all
Speaker 14: made sense given the situation she was in. Correct, they
Speaker 14: were relevant answers and questions she was asking. And are
Speaker 14: you familiar with the characteristics of psychosis?
Speaker 11: Yes?
Speaker 8: Okay?
Speaker 14: And what are the typical signs or symptoms of someone
Speaker 14: who is in psychosis?
Speaker 1: It really depends and it ranges across a spectrum of symptoms.
Speaker 1: So we have a whole category of different types of
Speaker 1: symptoms that we look at for psychosis, and they are
Speaker 1: different for everyone. But you know, they can be what
Speaker 1: we call negative symptoms, which are more internal isolating, not responding,
Speaker 1: not reacting very much. And then we have symptoms like
Speaker 1: positive symptoms, that's what we call them in psychiatry, but
Speaker 1: they're a little bit more outward focused, where objectively, you
Speaker 1: can see what those symptoms are, like being paranoid, darting
Speaker 1: your eyes around, responding to internal stimuli, which means you're
Speaker 1: responding to voices, and you know, being within a delusion.
Speaker 1: So there's all kinds of symptoms and they look different
Speaker 1: for each and every person.
Speaker 14: In your conversation with Ms Clancy, did you notice any
Speaker 14: internal or external signs of psychosis.
Speaker 1: At the time, I documented that I did not note those.
Speaker 14: And did you also note that you know she was
Speaker 14: her thinking was linear, goal oriented, thoughtful, and she didn't
Speaker 14: appear to be responding to internal stimuli.
Speaker 1: Yes, that is typical language and psychiatric mental statuses, and
Speaker 1: I did document that what is internal stimuli. Oftentimes it's
Speaker 1: very difficult for our patients to be able to articulate
Speaker 1: what they're hearing. They may have perceptual disturbances like hallucinations
Speaker 1: or auditory hallucinations, and maybe hearing voices. When it's really active,
Speaker 1: we often see those individuals interacting with those voices. I
Speaker 1: didn't see that in that particular moment.
Speaker 14: So, for example, you could see someone engaging in a conversation,
Speaker 14: looks like they're engaging in a conversation with someone or
Speaker 14: looks like they're looking over at something, thinking something or
Speaker 14: someone is there when they're not.
Speaker 1: Correct, that's what responding to internal stimuli is.
Speaker 14: And you didn't see any of that present with miss Clancy.
Speaker 1: Correct?
Speaker 14: And would it be fair that some of the obvious
Speaker 14: signs of psychosis would be someone whose thoughts are disorganized,
Speaker 14: that they're thinking isn't linear, that they're not making sense
Speaker 14: things like words salad, where they're just throwing in words,
Speaker 14: making sentences that don't make sense.
Speaker 1: So you describe symptoms that we can see in people
Speaker 1: with serious mental illness, who have a psychotic disorder with
Speaker 1: active symptoms, and.
Speaker 14: You didn't see any of that with Ms Clancy.
Speaker 3: Is that correct?
Speaker 1: Not in that snapshot moment of time.
Speaker 14: And to be clear, you only saw for a limited
Speaker 14: amount of time on that one day. Correct.
Speaker 3: That is correct?
Speaker 14: And this is January twenty sixth, twenty twenty three, about
Speaker 14: a day and a half or so after she's admitted
Speaker 14: to Brigham in woman's that is correct. Yes, and she's
Speaker 14: still intubated. And one of the first questions she ask
Speaker 14: is do I.
Speaker 3: Have a lawyer?
Speaker 8: Yes?
Speaker 14: And did you have any based on your training experience,
Speaker 14: did you have any thoughts about her awareness or thoughtfulness
Speaker 14: about the questions she asked or the answer she gave.
Speaker 17: It.
Speaker 14: Did you have any assessment professionally of the responses and awareness.
Speaker 8: That she had.
Speaker 1: Yes. At that time, I was trying to assess, you know,
Speaker 1: is she confused or oriented? Is she completely disorganized? Is
Speaker 1: she so anxious that she won't be able to sleep?
Speaker 1: I was assessing suicidality mostly. I was being called into
Speaker 1: the room for that, and so there were a lot
Speaker 1: of things that I was assessing all at the same
Speaker 1: time before the surgical intervention that was going to happen.
Speaker 1: And did I answer your question, yes, okay.
Speaker 14: And so in doing that and evaluating all of those things,
Speaker 14: did you have any concerns at that point in time
Speaker 14: that she couldn't make a decision to have the surgery,
Speaker 14: or that there was some cause for concern there in
Speaker 14: her behavior.
Speaker 1: I felt she had the capability to make the decision
Speaker 1: for surgery at that time.
Speaker 14: Another the questions, thank you, thank you, it's strength.
Speaker 1: Definitely good afternoon.
Speaker 18: So just a couple of questions. The council was asking
Speaker 18: you about psychosis. Apparently you've dealt with people, some of
Speaker 18: your patients while you're working in the hospital that in
Speaker 18: fact were florid, they had psychosis and symptoms of the psychosis.
Speaker 9: Yes, so you've dealt with people. Is it a fair
Speaker 9: amount of people that would actually hear voices?
Speaker 1: Yes, I've seen many patients that are hearing voices.
Speaker 18: And would they to your knowledge, were they involved with
Speaker 18: command hallucinations.
Speaker 9: Things of that nature.
Speaker 1: My patients in the past.
Speaker 9: Yes, Yeah, large.
Speaker 18: Amount of people that you've treated over the years that
Speaker 18: have suffered from command hallucinations, hearing voices, delusions.
Speaker 9: Things of that nature right in my career.
Speaker 7: Yes.
Speaker 18: And do you know whether or not there had been
Speaker 18: any indication from lindsay as to well in the hospital
Speaker 18: having any delusions or psychosis symptoms of that nature, if
Speaker 18: you know.
Speaker 1: So I saw her, she had only been in the
Speaker 1: hospital for a day and a half and I hadn't
Speaker 1: heard about any psychotic delusions from anything I see.
Speaker 14: I saw her one time once.
Speaker 9: Okay, how long did how long were you evaluating her?
Speaker 1: Probably because she was intubated, it was very excasting. How
Speaker 1: long about twenty to thirty minutes?
Speaker 9: Twenty minutes, thirty minutes?
Speaker 18: And a psychosis is a psychosis to you knowledge, something
Speaker 18: that has to continue or does it stop.
Speaker 1: It absolutely depends on the patient. It depends on their age,
Speaker 1: how many episodes of psychosis they have had, It depends
Speaker 1: on the type of psychosis we're seeing. For some people
Speaker 1: they can have moments of clarity, absolutely, and for some
Speaker 1: it can be more continuous. It really depends on the
Speaker 1: patient and their illness.
Speaker 18: Okay, So basically you're saying that it would be case specific, Yes,
Speaker 18: all right, And in the twenty minutes or so that
Speaker 18: you had when you're dealing with Lindsey, were you aware
Speaker 18: of her prior medical and psychiatric.
Speaker 1: History when we get consulted on a case we I'm sorry,
Speaker 1: I mean interrupt you.
Speaker 9: I'm asking were you aware of her medical and psychiatric history?
Speaker 1: I was aware of the portion that was in the
Speaker 1: medical record before I saw her.
Speaker 9: Okay, so that would deal with as far as postpartum psychosis.
Speaker 1: I could you ask that question man, when you looked.
Speaker 18: At the medical record and when you were involved evaluating
Speaker 18: her on behalf of the hospital, because you weren't. You
Speaker 18: weren't a psychiatrist that her mother or father had.
Speaker 9: Retained and asked to go see her, right, correct. You
Speaker 9: were working for the hospital.
Speaker 1: I was working for Brigham and Women's Hospital, and you had.
Speaker 18: Spoken to a number of people before you interacted with
Speaker 18: her for the twenty minutes that you saw her while
Speaker 18: she was.
Speaker 9: There for a month, right, No? Okay? Now, were you
Speaker 9: aware of her history of docum documented postpartum depression.
Speaker 1: I was aware of mostly the postpartum anxiety that was
Speaker 1: in the record.
Speaker 18: Yes, and postpartum anxiety. The symptomology would be insomnia.
Speaker 9: Yes. Did she have insomnia prior to seeing you for
Speaker 9: twenty minutes?
Speaker 14: Yes?
Speaker 9: And do you recall the length of time that she
Speaker 9: would be suffering from insomnia? Was it like a week,
Speaker 9: a day, a month or what.
Speaker 1: I don't recall the timing exactly.
Speaker 9: Do you recall that at.
Speaker 18: One point that she was on medication and actually went
Speaker 18: for forty eight hours without sleep.
Speaker 1: I don't recall that exactly from the record that number.
Speaker 9: Do you recall, in addition to the insomnia, that she
Speaker 9: was concerned as asking you if in fact her brain
Speaker 9: was broken?
Speaker 1: She asked me, is my body broken?
Speaker 9: Okay? Did you see in the records that she was
Speaker 9: concerned about the effect of the drugs and whether or
Speaker 9: not her brain was broken quote unquote.
Speaker 1: I did not see that language in the records.
Speaker 18: How about acting on command, hallucinations, conversations, just statements to
Speaker 18: the effect that she was having thoughts of suicidal ideation?
Speaker 1: You know that, right, I did know about the suicidal ideation.
Speaker 18: Yes, How many times did she express to people that
Speaker 18: she would tell people that she had been concentrating on
Speaker 18: committing suicide.
Speaker 1: If you know, I don't recall the number of times.
Speaker 9: So, in any event, you know that she was insomnia.
Speaker 9: You know that there was a significant period of time
Speaker 9: that she was suffering from insomnia. Knew that she was
Speaker 9: expressing suicidal ideation. How about homicidal ideation? Did she express that?
Speaker 8: Not?
Speaker 1: From my review of the records?
Speaker 9: Okay?
Speaker 18: Would that be indicative of a person that could be
Speaker 18: in psychosis expressing concerns about homicidal ideation.
Speaker 6: Overall alone?
Speaker 1: Sorry, I don't know that question. Could you repeat that question?
Speaker 9: Is that one of the factors that one would be
Speaker 9: concerned about as a psychiatrist if a person was expressing
Speaker 9: homicidal ideation, I would.
Speaker 1: Be concerned about that as a psychiatrist.
Speaker 18: And in fact, in this case, you knew at least
Speaker 18: about the suicidal ideation that she had been expressing. Right, Yes,
Speaker 18: But you didn't know about any homicidal ideation.
Speaker 9: She was expressing.
Speaker 1: Right from the records. I knew that there was an
Speaker 1: event that had occurred and that.
Speaker 9: The children died.
Speaker 18: That's the event you're referring to, right, Yes, Okay, next question, now,
Speaker 18: as far as the period of time that she.
Speaker 9: Was involved with. By the way, what's hypomania.
Speaker 1: Hypomania is sort of the gradual increase towards mania, the
Speaker 1: symptoms that we see in somebody who might have bipolar disorder.
Speaker 1: And with bipolar disorder, we see mixed depression and we
Speaker 1: see mania, and we see symptoms that kind of gradually
Speaker 1: increase to mania, and we call that period hypomania.
Speaker 9: Did she exhibit, to your knowledge from the medical records,
Speaker 9: any periods of hypermania, excessive cleaning, exercise, or activities, being
Speaker 9: awake at night, things of that nature.
Speaker 1: At that moment on January twenty sixth, I don't remember
Speaker 1: reading about that, Okay.
Speaker 18: Do you have any memory of reading about it at
Speaker 18: all other than that moment. As a treating physician, a doctor.
Speaker 10: Psychiatrist, I don't remember.
Speaker 9: So what is your purpose at the hospital.
Speaker 18: I mean, you're not treating the person for any illness
Speaker 18: that they have as far as their mental condition, right,
Speaker 18: you're not treating them.
Speaker 1: We are, Oh, you are, yes, So you're.
Speaker 18: Concerned about obviously their symptomology of any that they present
Speaker 18: at the time that you're looking at them and talking
Speaker 18: to them.
Speaker 9: Or in this case, she couldn't talk.
Speaker 1: But she couldn't talk, and she was going into surgery,
Speaker 1: and we had recommended suicidal precautions, We had recommended trauma
Speaker 1: informed care so that she was getting the care that
Speaker 1: she needed. She was going to go into surgery, and
Speaker 1: then after that we were going to continue to follow
Speaker 1: her and assess her and make sure that we were
Speaker 1: evaluating her appropriately and making recommendations to the surgical team
Speaker 1: for the care that she needed.
Speaker 8: Go said objection.
Speaker 9: So, when you're dealing with this person that's going into surgery,
Speaker 9: did you know what type of surgery she was going
Speaker 9: in for?
Speaker 1: At the time, we knew that she was going into
Speaker 1: surgery for her spine?
Speaker 8: Did you know what happened with spaine?
Speaker 1: I knew that she had injuries to her spine.
Speaker 18: Did you know that there was a transaction injury that
Speaker 18: her spine was basically exploded and five six other thoracic
Speaker 18: vertebrae fractioned, including the cervical vertebrae up by her throat.
Speaker 1: You knew all that we were reading about. It was
Speaker 1: all actively happening at that time. Was she in pain, Yes,
Speaker 1: I'm sure she was.
Speaker 9: Was she on medication?
Speaker 8: She was on.
Speaker 1: She was on a few medications related to pain and
Speaker 1: blood pressure.
Speaker 9: So she's brought into the hospital. You knew from reviewing
Speaker 9: her records as a psychiatrist that, in fact, she coded
Speaker 9: the day before, right.
Speaker 1: I don't recall her coding the day before I saw her.
Speaker 1: I do recall from the records that she had a
Speaker 1: coding event after, I think on the twenty seventh or
Speaker 1: twenty eighth.
Speaker 9: Okay, So you were not involved with her when she coded.
Speaker 9: Did you know that she had any events of that
Speaker 9: nature right after she was brought from the South Shore Hospital?
Speaker 1: I don't know what you're referring to.
Speaker 9: You know what a code is, right, Yes, you almost
Speaker 9: die before you saw her.
Speaker 1: I think it was after.
Speaker 9: Okay. How about profusion blood in the body and tubes
Speaker 9: being inserted into a chest?
Speaker 1: Did you know that from looking at the records, I
Speaker 1: think that happened after, But I don't recall because I
Speaker 1: don't have the records on me.
Speaker 9: Okay, so did you know that she had massive transfusions?
Speaker 9: Not at on this jury that it was after she
Speaker 9: saw you that she coded, had transfusions, had double tubes
Speaker 9: put into her both sides of her lungs. It's you
Speaker 9: had testimlonity that it was after she saw you.
Speaker 10: You don't know, do you.
Speaker 1: My understanding is the surgery happened after I saw her?
Speaker 8: Oh, the surgery did.
Speaker 9: I'm asking you about the massive transfusions. I'm asking you
Speaker 9: about the toobs being inserted so that the three hundred
Speaker 9: milligrams and whatever it is of blood can be perfused
Speaker 9: to take them out of her chest.
Speaker 8: Cat.
Speaker 18: I'm asking about whether or not you knew that she
Speaker 18: had coded. I'm not asking about the surgery, obviously, that
Speaker 18: took place after you saw her, right.
Speaker 9: Asked, An answered, because that's why you were talking to her,
Speaker 9: right to see if she could make an informed consent
Speaker 9: to a surgery. I guess no.
Speaker 1: I was called for the for the suicidal ideation.
Speaker 9: The suicidal ideation continues to this day?
Speaker 8: Is it not objectionally sustained?
Speaker 18: Did the suicidal ideation that you were concerned about continue
Speaker 18: the time that she was in bringing the woman's hospital.
Speaker 7: For a month.
Speaker 1: I saw her one time, right, Yes, so you.
Speaker 9: Know nothing about suicidal ideation after you saw her intubated
Speaker 9: and then laying in the bed, and then you talk
Speaker 9: to her as you've discussed with the jury.
Speaker 1: Right, that's correct, that's it, that's correct.
Speaker 9: How about the so many cops were there? I don't
Speaker 9: recall there were some, right, there were armed men in
Speaker 9: that room, were they not?
Speaker 1: I don't recall. I think they were outside the room
Speaker 1: if I remember correctly from three years ago.
Speaker 9: Okay, I know it's been a while. Do you recall
Speaker 9: armed police officers being outside the room?
Speaker 10: I think I.
Speaker 1: Don't recall.
Speaker 18: Do you have any memory of any police officers being
Speaker 18: outside the room where she was laying in that bed?
Speaker 1: I knew she was in custody, and generally in custody.
Speaker 9: No, no, not generally. Let's talk about Lindsay Clanton.
Speaker 1: I can't recall.
Speaker 18: Okay, did you know that she couldn't even have visitors
Speaker 18: in the sense that the police would not even let
Speaker 18: her mother or father visit with her.
Speaker 1: I can't recall.
Speaker 9: Did you know that when you were dealing with her,
Speaker 9: was she handcuffed to the side of the granny of stretch.
Speaker 1: She had a soft restraint according to my documentation restraints.
Speaker 9: Okay, yes, did you have any conversation with the police
Speaker 9: at all? No, And after you spoke to her for
Speaker 9: twenty minutes, that really ended your involvement with Lindsay Clancy
Speaker 9: until today.
Speaker 16: Right, That is correct?
Speaker 9: Thank you, Thank you.
Speaker 14: Doctor. When you were being asked about these records that
Speaker 14: you reviewed, what records did you review?
Speaker 1: I reviewed the records in EPIC, which is our medical
Speaker 1: record at Brigham and Women's Hospital, And.
Speaker 14: So you didn't do a deep dive into mss Clancy's
Speaker 14: entire psychiatric history prior to coming to Brigham and Woman's. Correct.
Speaker 1: I did as you do, as is protocol for a
Speaker 1: consult You look at the records and you make sure
Speaker 1: you have an understanding of what's been happening with the patient.
Speaker 14: But did you have access at that time to all
Speaker 14: all the records for all the treatment providers Ms Clancy
Speaker 14: had seen regarding her mental health for the last six months?
Speaker 1: You know, I don't even know you get I had
Speaker 1: some of the records. I don't know if I had
Speaker 1: all of the records.
Speaker 14: And so you reviewed what you had correct, correct, and
Speaker 14: then you met with the patient.
Speaker 1: Correct.
Speaker 14: Correct, And in meeting with her, where she's you know,
Speaker 14: she's she's she's had these events happen, she's had the
Speaker 14: tubes in her chest. She she's about to go into surgery.
Speaker 14: One of the first things on her mind is do
Speaker 14: I have a lawyer? Correct?
Speaker 9: Secondly, this is the fourth time the counsul has tried
Speaker 9: to accentuate that.
Speaker 6: Well, I love that question.
Speaker 14: Well, that was one of her first thoughts was do
Speaker 14: I have a lawyer?
Speaker 3: Correct?
Speaker 1: She wasn't able, she was exhausted, she was intbated, she
Speaker 1: could barely talk, she was writing, and she was getting
Speaker 1: ready for surgery. And so those were the few questions
Speaker 1: that came up.
Speaker 14: Right, She's exhausted, she's anxious, she's in pain, she's about
Speaker 14: to go in for surgery, and she wants to know
Speaker 14: do I have a lawyer?
Speaker 8: Sustained.
Speaker 14: So, given the condition she was in at that time,
Speaker 14: you know, the defense counsel asked you about the pain
Speaker 14: she was in. Defense counsel asked you about the surgery
Speaker 14: she was about to go into. Those are the issues
Speaker 14: that she was focused on in your conversation with her.
Speaker 14: And I broken, are my legs straight?
Speaker 1: Do I have a lawyer.
Speaker 10: Yes, thank you.
Speaker 18: She wasn't focused on much well, she was exhausted, in pain,
Speaker 18: anxious and concerned about the future surgery that she was imminent.
Speaker 4: Was she.
Speaker 9: If you could speak up?
Speaker 6: Asked that question.
Speaker 18: She wasn't focused on much of anything while she was exhausted,
Speaker 18: in pain, unable to talk, and anticipating imminent surgery.
Speaker 8: Right, that's correct, thank you, that's all.
Speaker 6: Yeah, anything, come hi, thank you doctor, Thank you, thank you.
Speaker 6: Hye camel.
Speaker 7: Common would called Robert Flynn as its next witness.
Speaker 4: Please, thanks stuff please a rkay afternoon, sir, Yeah, twenty
Speaker 4: bucky and please thank you.
Speaker 7: Good afternoon. Could you please tell the jurors your.
Speaker 21: First and last name, Robert Flynn f l Y And
Speaker 21: then and how are you employed, sir?
Speaker 13: For the Duxbury Please Apartment.
Speaker 7: What is your current ranker assignment there?
Speaker 13: Currently? I am a patrol sergeant.
Speaker 21: How long have you been with the Duxbury Police About
Speaker 21: seven and a half years, going back.
Speaker 7: To January of twenty twenty three. What was your assignment then?
Speaker 13: I was assigned to the detective Bureau.
Speaker 7: So if I draw your attention to January twenty fourth
Speaker 7: of twenty twenty three, were you working that day or
Speaker 7: were you called in both?
Speaker 13: I worked at the eight am to four pm shift
Speaker 13: and I was called in and later after my shift.
Speaker 7: Okay, So you became aware of an incident that occurred
Speaker 7: in the town of Duxbury approximately six pm that evening, yes, ma'am.
Speaker 7: And so when you come back in after working that
Speaker 7: day shift, where do you go or where are you
Speaker 7: directed to go?
Speaker 13: I was contacted by a sergeant Detective Jamali, who informed
Speaker 13: me to respond to forty seven Summer Street.
Speaker 7: And so while you're en route to that location, are
Speaker 7: you monitoring the radio, yes, ma'am. And are you monitoring
Speaker 7: communications with other Duxbury officers?
Speaker 13: Yes, ma'am. I had a department issued vehicle that I
Speaker 13: took home and I responded to it in that vehicle,
Speaker 13: and I had scan on, which is getting all surrounding agencies,
Speaker 13: including fire, Pembrooke, Kingston, Marshfield.
Speaker 7: And while you were en route and had that radio on,
Speaker 7: could you hear officers screaming and being chaotic?
Speaker 9: Yes, ma'am.
Speaker 7: When you arrived at forty seven Summers were there already
Speaker 7: other first responders there?
Speaker 13: Yes'm?
Speaker 7: And is it fair to say that when you actually
Speaker 7: arrived at that location, you were made aware that the
Speaker 7: children that were on scene had already been transported. No, okay,
Speaker 7: So what did you know when you arrived?
Speaker 13: What did you did appear that a mother had killed
Speaker 13: her three kids?
Speaker 7: Okay when you got there on the scene, were the
Speaker 7: children still in the house?
Speaker 13: So I was under the impression that they were still
Speaker 13: in the house, because most incidents I've had involving a
Speaker 13: sudden death at a house, the fire department declares them
Speaker 13: on scene and it becomes a police matter and we.
Speaker 8: Help the investigation.
Speaker 7: Okay, that was your understanding based on the information that
Speaker 7: you had. Correct. But did you come to learn that
Speaker 7: the children had been transported? And how about the individual
Speaker 7: the person the fourth person if you will, on scene
Speaker 7: where you would vi that there was a woman who
Speaker 7: had been transported from the scene as well. Yes, And
Speaker 7: as a result of kind of the nature of what
Speaker 7: you believed you were coming into, did you call for
Speaker 7: extra help.
Speaker 21: With that are own department or with an outside department.
Speaker 13: Death investigation in town of Duxbury and other communities. So
Speaker 13: we are to notify investigators of the state police, and as.
Speaker 7: A detective of the Dexbury Police, you're familiar with that
Speaker 7: relationship with the state police that oftentimes when a death
Speaker 7: investigation occurs, that you work in connection with the state
Speaker 7: police detective unit of that jurisdiction to conduct an investigation. Correct.
Speaker 7: And so in this instance, when you went there, you
Speaker 7: believed that the children had already passed, so you made
Speaker 7: that phone call to the detective's unit.
Speaker 13: Correct, that's correct.
Speaker 7: And certainly well sometime thereafter you wore advice of the
Speaker 7: children's passing and that this was a death invest stigation. Correct,
Speaker 7: that's correct. Once the children had been removed from the
Speaker 7: scene and the defendant had been removed to the scene,
Speaker 7: did you and your other officers from the Duxbury Police
Speaker 7: Department do anything to secure the scene?
Speaker 9: Yeah, so I was.
Speaker 13: Once we gathered more information and I notified the Master's
Speaker 13: State Police, we decided to conduct a security sweep of
Speaker 13: the house. This is to make sure that there was
Speaker 13: no further suspects or for their victims or any other
Speaker 13: people in the house that we may have missed.
Speaker 7: In regards to the security sweep, what is the goal
Speaker 7: you just described Its to kind of identify their other people.
Speaker 7: But as far as your observations and your contact within
Speaker 7: the house. You try to minimize your contact within the
Speaker 7: house in those instances.
Speaker 13: Yes, I'm not searching for any type of evidence and
Speaker 13: just have different observations that I obviously noticed.
Speaker 7: And what areas of the house did you go into
Speaker 7: prior to their arrival of the state police?
Speaker 13: I first entered. I entered with three three of us,
Speaker 13: Sagan Patricus who's from the king Sipolice apartment, and it
Speaker 13: was the Lieutenant Wiler at the time. So we all
Speaker 13: kind of went into our own separate rooms and separate
Speaker 13: ways throughout the house. But I think ultimately all three
Speaker 13: of us went to all three floors of the.
Speaker 10: Home, okay.
Speaker 7: And so talking first about the main floor of the house,
Speaker 7: did you go into the kitchen area? Yes, I did,
Speaker 7: And did you make any observations in that kitchen area?
Speaker 10: I observed it.
Speaker 13: Was clear to me that there was young children living there.
Speaker 13: There was some paintings on the wall. I noticed a.
Speaker 9: Takeout food bag.
Speaker 13: The only word I remember from that is it being
Speaker 13: Mediterranean written on the receipt.
Speaker 7: Okay, And if I may approach with a picture showing
Speaker 7: you the picture is just accurately depicted the kitchen area
Speaker 7: that you observed.
Speaker 10: May be admitted.
Speaker 7: Showing you on the screen what's snow ben marked at four?
Speaker 7: This is the kitchen at forty seven Summer Street. And
Speaker 7: in the middle of the photograph is a takeout bide correct.
Speaker 13: Yes, Pam.
Speaker 7: And you're aware that in the background here of the
Speaker 7: photograph where there's a kitchen table, there's kind of a door.
Speaker 13: Next to it, yes, ma'am.
Speaker 5: And then there's on the other opposite side there's a.
Speaker 7: Slider door correct.
Speaker 9: Correct.
Speaker 7: And in addition to making those general observations about the
Speaker 7: kitchen area, did you go in other areas of the
Speaker 7: main floor.
Speaker 10: Of the house?
Speaker 13: Yes?
Speaker 17: I did.
Speaker 7: And in the living room area, I'm sure you what's
Speaker 7: been marked already is a bit twenty five. Is that
Speaker 7: familiar to you as well?
Speaker 9: Yes, ma'am.
Speaker 7: And again, upon your kind of sweep of this house,
Speaker 7: what stood out to you about the living room.
Speaker 13: Area that appeared a young child lived there and there
Speaker 13: was food on the couch, the snack and then this.
Speaker 24: Photograph can you see a couple of holes of here
Speaker 24: on the bottom of the photo and the further up
Speaker 24: on the couch, yes, ma'am.
Speaker 7: Now in that main area of the house, you didn't
Speaker 7: find any other individuals correct?
Speaker 13: Negative?
Speaker 7: And had you been made aware that the husband, Patrick
Speaker 7: Clancy had been a here to say? This was still
Speaker 7: upon your arrival, a pretty chaotic scene.
Speaker 13: Correct.
Speaker 7: There was a lot of firefighters around, a lot of
Speaker 7: equipment going around.
Speaker 13: Correct.
Speaker 7: Okay, in that basement, did you do a full sweep
Speaker 7: of every room in the basement, Like.
Speaker 13: I said, three of us too, combined and made sure
Speaker 13: that we at least hit every part that a human
Speaker 13: or something could be in. So yes, okay, But.
Speaker 7: As far as you yourself, fair to say you just
Speaker 7: kind of went in on the left side.
Speaker 21: Yes, I went into the left And did you see.
Speaker 7: A lot of the firefighters equipment still left behind? Yes,
Speaker 7: a lot of medical supplies. Now going up to now
Speaker 7: the second floor. Did you go to the second.
Speaker 8: Floor of the home the Florida Yes, yes.
Speaker 7: And did you enter into the master bedroom?
Speaker 9: Yes?
Speaker 7: And is there anything that kind of struck you about
Speaker 7: walking into that master bedroom as far as the temperature.
Speaker 13: Of the room, it was colder than the rest of
Speaker 13: the house.
Speaker 7: And did you notice that there was in fact a
Speaker 7: window open, yes, ma'am. So I'm just going to show
Speaker 7: you what's been market. Is that familiar to you as
Speaker 7: the window that you observed open.
Speaker 9: Yes, ma'am.
Speaker 7: And as far as the furniture in that bedroom, did
Speaker 7: you make any observations of a bed in the room?
Speaker 13: Yes, ma'am.
Speaker 7: Was there anything that stood out to you on the
Speaker 7: bedding or in the area of the.
Speaker 21: Bed, the bedding itself, if it stood out to you,
Speaker 21: not necessarily?
Speaker 7: No, how about items on the bed, yeah, so.
Speaker 13: Sorry Triguez point out that there was a cell phone
Speaker 13: on the bed.
Speaker 7: Okay, I'm just going.
Speaker 10: To show you.
Speaker 7: See an object. Is that how it appeared when you
Speaker 7: first entered into the bedroom, yes, ma'am. At some point,
Speaker 7: were you able to go out to the backyard of.
Speaker 13: The home, yes, ma'am. So after leaving the upstairs, we
Speaker 13: went back through the kitchen and that's we talked about earlier,
Speaker 13: and went up through the backslider.
Speaker 7: And were you able to make observations of the backyard area.
Speaker 9: Yes.
Speaker 13: We came out to a porch and took a left
Speaker 13: which would have been the back right side of the house,
Speaker 13: and there was some matted doow snow and some other
Speaker 13: medical equipment, which we believed was the window that Lindsay
Speaker 13: Clancy came out of.
Speaker 7: And from that area that vantage point in the backyard
Speaker 7: where you were, could you see into other areas of
Speaker 7: the house?
Speaker 9: Yes?
Speaker 7: In what areas of the house? Could you see into
Speaker 7: Near where that area was?
Speaker 13: There was a basement window that kind of went into
Speaker 13: but I later learned what it was, but a basement
Speaker 13: window to like an office or gym area.
Speaker 7: Shay Exhibit thirty eight. Is that unfamiliar as the backyard view?
Speaker 10: Yes, ma'am and fair to say.
Speaker 7: There's an area here of.
Speaker 24: The photo that I'm pointing to you with my pen,
Speaker 24: which is kind of on my right that is a window. Well,
Speaker 24: is that the window you could see into? And then
Speaker 24: again in this photograph, do you see the open window
Speaker 24: that you observed when you went into the bed.
Speaker 7: Yes, As far as that open window when you were
Speaker 7: in the backyard, did you see any screens or anything
Speaker 7: around the property that would give you any indication of
Speaker 7: how that window was open or the condition of the window.
Speaker 13: No, to me, appeal that the scream was just pushed out.
Speaker 7: Now again, as you and and did three other investigators
Speaker 7: did that sweep at the house? You didn't touch or
Speaker 7: move anything? Correct?
Speaker 9: Negative?
Speaker 7: And once you were did that security sweep? Is there
Speaker 7: a protocol in place to make sure that the scene
Speaker 7: remains as it is until the state police arrived.
Speaker 13: Yeah, so there was. One of the officers was logging
Speaker 13: individuals that were in and out of the house. Crime
Speaker 13: scene tape was put up around the property, though doors
Speaker 13: were secured, And around this time is when I received
Speaker 13: a phone call from.
Speaker 7: Trooper mckellokan and did you remain on scene.
Speaker 13: We remained on scene until some troopers showed up to
Speaker 13: the area.
Speaker 7: And while you were on scene, did you attempt to
Speaker 7: help coordinate other members of the Duxbury Police Department to
Speaker 7: take care of other things like going to the hospitals
Speaker 7: and securing coverage.
Speaker 13: The decision for who was going to the hospital was
Speaker 13: made by our command staff, but I met some of
Speaker 13: the troopers out back at the station to coordinate further.
Speaker 10: Okay.
Speaker 7: And when you were back at the station, were you
Speaker 7: aware or advised that a search point was sought for
Speaker 7: the residents. Did you go back to forty seven Summers
Speaker 7: Street with the team when the search warrant was received
Speaker 7: and did you participate in the execution of that warrant?
Speaker 13: I was present during it.
Speaker 7: Okay, fair to say that you didn't. You weren't responsible
Speaker 7: for searching any particular location or collecting any evidence, No, ma'am.
Speaker 7: That was reserved for the state police.
Speaker 13: For the most part.
Speaker 8: Yes.
Speaker 7: At the conclusion of that search warrant, were you asked
Speaker 7: to go back into the house, yes, ma'am. And what
Speaker 7: were you asked to go back in the house to
Speaker 7: do once the.
Speaker 13: Search warm was completed. My lieutenant told me to go
Speaker 13: back up into the house and close the window in
Speaker 13: the upstairs bedroom.
Speaker 7: And when you went back in and got closer to
Speaker 7: that window, did you make any observations of damage to
Speaker 7: the window or the window screen. No, and were able
Speaker 7: to close it and secure the window eventually. Yes, fair
Speaker 7: to say there was blood in that area that kind
Speaker 7: of was in the way.
Speaker 13: Yes, in the bed was kind of pushed in front
Speaker 13: of it, So did you have.
Speaker 7: To move the bed in order to get to the window.
Speaker 7: As far as anything removed from the home, did you
Speaker 7: go back into the basement at somebody's direction at some point?
Speaker 7: Had you helped to remove some medical equipment that the
Speaker 7: fire department.
Speaker 21: Had left behind during the search part?
Speaker 10: Okay?
Speaker 7: And is that the only items that you yourself removed
Speaker 7: from the home?
Speaker 9: Correct?
Speaker 7: As part of the follow up investigation, did you work
Speaker 7: with Trooper mc gallaghan and some of the other troopers
Speaker 7: from the State Police Detective Unit to conduct follow up
Speaker 7: interviews and gather more information? Is it fair to say
Speaker 7: that the state Police were the primary investigators and they
Speaker 7: took over pretty much everything from that point on.
Speaker 13: That's correct.
Speaker 7: Thank you, I'm miss ray.
Speaker 9: I have no questions. Thank you, sir.
Speaker 8: All right, thank you, sir, thank you.
Speaker 14: I'm well called Mark Ferrioli.
Speaker 4: A right, good athnute sir, an, thank.
Speaker 14: You, good afternoon. Can you please stay and spell your
Speaker 14: name for the record.
Speaker 10: I'm Detective Mark Ferrioly far iol I. Where do you
Speaker 10: work the Massachusetts State Police?
Speaker 14: How long have you been a state tripper?
Speaker 10: Since two thousand and five?
Speaker 14: And back in January of twenty twenty three, where were
Speaker 14: you assigned within the State Police?
Speaker 10: I was assigned to the Plymouth County State Police Detective Unit.
Speaker 10: And were you.
Speaker 14: Involved in a limited way in the investigation regarding Lindsay Clancy.
Speaker 1: Yes, I was, and specifically.
Speaker 14: Directing your attention to January twenty seventh, twenty twenty three,
Speaker 14: were you aware that a search warrant was obtained on
Speaker 14: that date to collect the blood in urine of Lindsay
Speaker 14: Clancy from Selfshare Hospital, Yes.
Speaker 6: It was.
Speaker 14: And then directing your attention to January thirty first, twenty
Speaker 14: twenty three, at ten twenty five in the morning, did
Speaker 14: you go to the Selfshore Hospital to collect the blood
Speaker 14: and urine of Lindsay Clancy?
Speaker 9: Yes?
Speaker 8: I did?
Speaker 14: And where did you collect that?
Speaker 10: From the lab at Social Hospital?
Speaker 14: And was that from the specimen process supervisor Melissa ker Dupain,
Speaker 14: Yes it was. And if you recall how many vials
Speaker 14: you collected in total?
Speaker 10: I collected seven vials and was that all blood or
Speaker 10: urine or both? Six were blood vials and one was urine.
Speaker 14: And once you collected those vials, where did you bring them?
Speaker 10: I brought them directly to the Massachusetts State Lab in Lakeville.
Speaker 14: And did you drop those off at the State Lab
Speaker 14: at approximately eleven fifteen am on January thirty first, twenty
Speaker 14: twenty three, Yes, I did. Do you recall who you
Speaker 14: gave the vials of blood and urine belonging to Lindsay
Speaker 14: Clancy too at the lab?
Speaker 10: Leah O'Connell, Thank.
Speaker 8: You, it's Randon right.
Speaker 9: We have stipulated to the train of custody. Any questions right,
Speaker 9: all right, thank you, suirre having no time. Hi, thank you,
Speaker 9: thank you.
Speaker 14: Aliah O'Connell, Hey, good afternoon, Good afternon sa Hi council,
Speaker 14: thank you, good afternoon. Can you please stay and spell
Speaker 14: your name for the record.
Speaker 3: My name is Leah O'Connell L E A H O
Speaker 3: C O N N E L L.
Speaker 1: Where do you work currently?
Speaker 7: I'm employed with the Massachusetts State Police as a trooper.
Speaker 14: Back in January of twenty twenty three, were you also
Speaker 14: employed with the State Police?
Speaker 7: I was at the crime lab and what were your.
Speaker 14: Responsibilities at the crime lab at that time?
Speaker 17: So?
Speaker 7: I was a forensic evidence technician, So we were evidence
Speaker 7: submitted to the lab for testing.
Speaker 14: And once you receive that evidence, while we had some
Speaker 14: local offices there with us as well.
Speaker 9: Yeah.
Speaker 18: So it was law enforcement that found the pill bottles
Speaker 18: in the kitchen, right I believe so, and seized.
Speaker 9: Them, is that correct? Correct? And documented that they had
Speaker 9: seized them in the kitchen, feeling someone whoever it was,
Speaker 9: that it was relevant material to this investigation, right correct?
Speaker 9: And the books that we've just gone through, Patrick.
Speaker 18: Plans would be relevant material to this investigation, right correct?
Speaker 10: Yes, anxiety work right correct?
Speaker 6: Yes.
Speaker 18: One of the documents pregnant, right, yes, one or another
Speaker 18: notebook that had post ittum depression of anxiety.
Speaker 7: Correct.
Speaker 9: Yes, there were also whether.
Speaker 18: Documents that were said in the house and introduced the
Speaker 18: record civity one.
Speaker 9: Uh yeah, it looks like a diary three of sweat.
Speaker 8: Blow last night, I believe so. Yes.
Speaker 9: Do you know why all these were se.
Speaker 10: Why the books that I.
Speaker 13: Seized was seized?
Speaker 9: You investigate lieutenant.
Speaker 25: Decided I'm a captain, sir. Yes, sir, And back then,
Speaker 25: what was your new captain? I was a lieutenant at
Speaker 25: that time?
Speaker 8: Search.
Speaker 25: No, there was also a detective lieutenant assigned unit commander
Speaker 25: at that time.
Speaker 5: So, but your enough and you knew the investigation.
Speaker 9: What was relevant in material in the investigation?
Speaker 7: Right?
Speaker 9: Yes?
Speaker 18: And and I obviously you or somebody else working with
Speaker 18: you determined that all of these items, the pills that
Speaker 18: were sees, the books that were seized from the kitchen,
Speaker 18: et cetera, were relevant and material correct.
Speaker 9: Yes. Do you know who searched the bedroom? I know
Speaker 9: you said you were in there. Did you search the bedroom?
Speaker 25: I was part of the team that searched the bedroom.
Speaker 25: There were a number of other offices that searched the
Speaker 25: bedroom as well. I believe in the report it documents
Speaker 25: who sees what from the bedroom? Okay, So I don't
Speaker 25: know off the top of my head who that was, sir,
Speaker 25: but I know it's.
Speaker 10: Clearly labeled in the report.
Speaker 9: Okay, do you have the report?
Speaker 23: I do not know.
Speaker 9: Do you recall how many.
Speaker 18: Law officers were actually involved in that little bedroom searching?
Speaker 10: I would have to guess the approximately five.
Speaker 18: Vibe And as Consul asked, when somebody discovered something that
Speaker 18: appeared to be relevant to the material, they would log
Speaker 18: it in. Somebody would kind of be the record keeper,
Speaker 18: would log it in.
Speaker 9: Correct. Yes, is one of the things that you would also, you, yourself,
Speaker 9: I believe sees would be the laptop computers that were
Speaker 9: downstairs in the office, right, Yes, and you seized also
Speaker 9: collectively you, I mean you or the other five people
Speaker 9: seized the cell phone that was on the bed.
Speaker 10: Yes, I believe there was a cell phone seize from
Speaker 10: the bedroom.
Speaker 18: So it made sense as an investigator that electronic media
Speaker 18: and things of that nature would be important.
Speaker 9: Correct. Yes, was there an Apple Watch involved in this investigation?
Speaker 25: If you know, I believe there was an Apple Watch
Speaker 25: recovered after the fact, that was.
Speaker 10: We didn't recover at the search warrant, if I recall correctly, do.
Speaker 9: You know when it was recovered?
Speaker 10: I don't know exactly off the top of my head.
Speaker 9: No Apple watch that I recovered with Pat Clancy, I
Speaker 9: believe Selsa.
Speaker 25: Yeah, I believe there was a watch that was turned
Speaker 25: into us after the fact that wasn't recovered during the
Speaker 25: search warrant.
Speaker 9: Looking at.
Speaker 18: Raw, do you recall it next to the mad in
Speaker 18: the bedroom there was a night stand. There was a draw,
Speaker 18: and inside the draw, we're a bunch of pill bottles,
Speaker 18: an Apple watch, sleeping.
Speaker 9: Aids that nature.
Speaker 10: I didn't search that draw, sir.
Speaker 9: Okay. I don't even know about just asking why nobody's search.
Speaker 10: I don't know that it wasn't searched. I just know
Speaker 10: that I didn't search it, sir. So it may have
Speaker 10: been searched, and maybe who ever searched it didn't feel.
Speaker 25: That that information was pertinent to seize. I can't speak
Speaker 25: for them, but I can tell you that I didn't
Speaker 25: search at draw.
Speaker 6: We directed all right, thank you, sir?
Speaker 5: As his next witness.
Speaker 6: Okay, afternoon, sir.
Speaker 7: Be Bucky, please thank you, good afternoon. Could you please tell.
Speaker 21: The Jursey your first and last name Corey Mellow And.
Speaker 7: Can you spell your first name for the Recordy.
Speaker 10: And your last name am Mel?
Speaker 7: And how are you employed work for the State Police
Speaker 7: in what unit or what's your current assignment with the
Speaker 7: state Police Currently?
Speaker 13: I work for the Commercial Vehicle Enforcement Section.
Speaker 7: Going back to January of twenty twenty three, what was
Speaker 7: your assignment then?
Speaker 13: I worked for the Plens Colony District Attorney's Office at
Speaker 13: that time.
Speaker 7: With the State Police Detective Unit. Correct, Yes, And I'm
Speaker 7: going to draw your attention to January twenty fourth, twenty
Speaker 7: twenty three. Were you involved in the investigation into the
Speaker 7: incident that occurred at forty seven Summer Street in Duxbury
Speaker 7: on January twenty fourth? Yes, I was, and fair to
Speaker 7: say that when State Police got involved in that investigation,
Speaker 7: a large group of the State Police Detective Unit went
Speaker 7: out to Duxbury to work that investigation.
Speaker 13: Correct.
Speaker 7: Were you the case officer in that case? I was
Speaker 7: not the case Your role in that case was that
Speaker 7: to assist in things like search warrants, neighborhood canvases, interviewing
Speaker 7: of witnesses.
Speaker 9: Correct.
Speaker 7: Yes, And in this particular investigation, you're aware that there
Speaker 7: was a search warrant executed at forty seven Summer Street
Speaker 7: after the incident occurred.
Speaker 1: Correct.
Speaker 7: Correct, And as part of the search weren't execution? Were
Speaker 7: you involved in searching the home?
Speaker 9: Yes?
Speaker 7: I was. And did you search the various floors of
Speaker 7: the home, meaning the basement, that first floor, and the
Speaker 7: second floor.
Speaker 9: Yes.
Speaker 7: In searching that home there were a number of other
Speaker 7: detectives and troopers also searching correct.
Speaker 13: Correct.
Speaker 7: Do you recall locating a phone in the upstairs bedroom,
Speaker 7: a laptop, some workout bands in the basement that were
Speaker 7: hanging on the door.
Speaker 9: Yes, I do.
Speaker 7: And when you recovered these particular items are relocated these items,
Speaker 7: did you then turn them into an evidence officer, direct
Speaker 7: an evidence officer to things that you thought might have
Speaker 7: some evidentiary value.
Speaker 9: Yes.
Speaker 7: At some point after the search warrant was over, You're
Speaker 7: aware a lot of items were brought back for exam
Speaker 7: fur their examination correct.
Speaker 9: Correct.
Speaker 7: Is that common that when you're working on a search
Speaker 7: warrant but things are kind of.
Speaker 14: All right?
Speaker 7: Is it common that a lot of times search warrant
Speaker 7: things are collected and brought back for further examination.
Speaker 9: Yes?
Speaker 7: Is that because it's kind of chaotic there and can't
Speaker 7: really examine things thoroughly on scene.
Speaker 13: That's correct.
Speaker 7: Yes, So in this particular circumstance, were you asked to
Speaker 7: review some books and journals?
Speaker 9: Yes? I was, and Goma it's a sleeping grate foot
Speaker 9: Pat Pat is handling nighttime stuff, Julie for making a
Speaker 9: plan for me. A big thing is I feel disconnected
Speaker 9: with myself time reality. I think going back to work
Speaker 9: will help with that. If you wrote that right, correct?
Speaker 9: And then there are numbers of pages twenty two of
Speaker 9: sixty three, twenty four, twenty five, twenty six, twenty seven,
Speaker 9: twenty eight, all reproducing what council asked you about and
Speaker 9: what I just went through that were from those journals,
Speaker 9: right correct. Do you have anything to do with the
Speaker 9: search of the house yes? Did you search in the bedroom? Yes?
Speaker 9: How many other people were with you searching in the bedroom?
Speaker 10: I don't call how many other people of the me
Speaker 10: at that time? I'm not aware.
Speaker 9: Did you see the draw?
Speaker 13: I don't recall what I don't recall?
Speaker 9: Okay, so yeah, redirect, thank you?
Speaker 10: All right, thank you sir.
Speaker 6: Now I see it, Cybar all right, So bim's the jury.
Speaker 6: We're going to break at this point until tomorrow.
Speaker 4: Talk talking to console my expectation is we have a
Speaker 4: similar schedule tomorrow.
Speaker 9: The hope would be I will go in the morning.
Speaker 8: And should go into the afternoon.
Speaker 4: But just to give you the that's the best estimate
Speaker 4: that we have, all right, and so I'm gonna excuse.
Speaker 6: You till tomorrow. We're gonna ask you those questions. I
Speaker 6: don't listen to anything, don't.
Speaker 4: Talk about this, don't take any road trips or do
Speaker 4: any research on this. Put this out of your head
Speaker 4: as best you can go tomorrow morning. Hopefully the rate
Speaker 4: is stop and we'll see everybody tomorrow. Thank you so
Speaker 4: much for all your work here today.
Speaker 13: Thank you.
Speaker 5: All right. Sure notebooks are basing on the trais follow.
Speaker 4: All right, So we'll be in recess on this until
Speaker 4: tomorrow morning at nine.
Speaker 13: Thank you, Thank you.
Speaker 23: All right.
Speaker 8: Place