WEBVTT 1 00:00:01.520 --> 00:00:06.120 Full trial audio. Everything hurt in court, no silences to skip. 2 00:00:08.839 --> 00:00:11.359 May I proceed yourana, yes, please, Diana before the court 3 00:00:11.400 --> 00:00:13.919 today we have the matter of Commonwealth for USUS. Lindsay Clancy, 4 00:00:13.960 --> 00:00:16.519 MISSUS Clancy is present. She is represented by Attorney Kevin 5 00:00:16.600 --> 00:00:17.039 running Down. 6 00:00:17.079 --> 00:00:18.000 The Commonwealth is. 7 00:00:17.960 --> 00:00:21.760 Represented by Assistant District Attorney Jennifer Sprague and assistant District 8 00:00:21.800 --> 00:00:23.320 attorney she had in Buckingham. 9 00:00:23.440 --> 00:00:26.800 All right, good morning, council, right, good morning, miss Clancy. 10 00:00:28.120 --> 00:00:30.480 Council you see it briefly just for a second and 11 00:00:30.519 --> 00:00:32.280 then I think we'll be ready to bring the jury in. 12 00:00:33.840 --> 00:00:55.200 A morning. 13 00:00:56.439 --> 00:00:57.439 Yes, please, you want to. 14 00:00:57.439 --> 00:00:59.359 Be more the court today we have the continuation of 15 00:00:59.359 --> 00:01:01.640 the jury trial on the matter Commonwealth for US as 16 00:01:01.640 --> 00:01:04.719 Lindsay Clancy, MS Clancy is present. She is represented by 17 00:01:04.760 --> 00:01:08.799 Attorney Kevin Runnington. The Commonwealth is represented by Assistant District 18 00:01:08.840 --> 00:01:12.719 Attorney Jennifer Spray and Assistant District Attorney Shannon Buckingham. 19 00:01:13.319 --> 00:01:18.480 All right, thank you, madam clerkcom Good morning everyone. Everybody 20 00:01:18.519 --> 00:01:21.599 had a RESTful weekend. So what I want to do 21 00:01:21.719 --> 00:01:23.480 is just kind of tell you first, I'm going to 22 00:01:23.519 --> 00:01:26.879 go through those questions, make sure everybody was able to. 23 00:01:26.840 --> 00:01:28.319 Follow my instructions. 24 00:01:28.799 --> 00:01:31.400 Then I'm going to go over what today's schedule is, 25 00:01:32.239 --> 00:01:36.439 and then we'll return to the comwell's presentation of evidence, 26 00:01:36.519 --> 00:01:39.239 all right, And so so let me ask those questions. 27 00:01:39.400 --> 00:01:42.519 First question, has any member of the jury red scene 28 00:01:42.599 --> 00:01:45.840 or over heard anything from any source about any aspect 29 00:01:45.879 --> 00:01:48.480 of this case that would affect your ability to be 30 00:01:48.599 --> 00:01:49.519 fair and impartial? 31 00:01:50.599 --> 00:01:51.519 All right? 32 00:01:51.840 --> 00:01:55.400 Next question, is there any other serious matter or concern 33 00:01:55.680 --> 00:01:58.079 bearing on your service as a juror in this case 34 00:01:58.239 --> 00:02:02.280 that anybody needs to bring to my attention? Again, thank 35 00:02:02.319 --> 00:02:05.599 you for following those instructions. Now, today's schedule. Let me 36 00:02:05.680 --> 00:02:09.479 say the first thing about schedule. I know I haven't 37 00:02:09.479 --> 00:02:14.159 always been completely correct on some of the schedules we followed, 38 00:02:14.280 --> 00:02:17.360 but I want to just let you know those decisions 39 00:02:17.400 --> 00:02:21.159 about the scheduling is on me, all right, and sometimes 40 00:02:21.159 --> 00:02:24.159 I have to take into consideration other factors or things 41 00:02:24.159 --> 00:02:27.360 that are going on. So what I really wanted to 42 00:02:27.400 --> 00:02:29.840 tell you is that don't speculate why we might go 43 00:02:29.879 --> 00:02:33.199 a little late or a little early on any certain days, 44 00:02:33.439 --> 00:02:37.960 but certainly don't hold it against either side in regards 45 00:02:37.960 --> 00:02:40.599 to that the person who's making those decisions or that 46 00:02:40.639 --> 00:02:44.039 decision is me, all right, so you should be aware 47 00:02:44.039 --> 00:02:48.759 of that. So that being said, the thought is today 48 00:02:49.439 --> 00:02:52.879 we should go into the afternoon, all right, and if 49 00:02:52.879 --> 00:02:55.879 that changes, I'll let you know. So and what we're 50 00:02:55.879 --> 00:02:58.520 going to do at this point, we're going to return to. 51 00:02:58.479 --> 00:03:01.039 The commonwealths uh. 52 00:03:01.120 --> 00:03:04.000 And with that call off, call your next witness please. 53 00:03:05.919 --> 00:03:09.000 Called Michael Snyder for doctor Snyder. 54 00:03:09.120 --> 00:03:09.840 We just approached. 55 00:03:09.879 --> 00:03:13.240 Oh shoot, yeah, good morning. 56 00:03:13.000 --> 00:03:15.639 Done, Good morning, all right. 57 00:03:16.159 --> 00:03:19.000 Inquire Tony Buckye please thank you, Good. 58 00:03:18.800 --> 00:03:21.120 Morning, sir. Could you please tell the jurors. 59 00:03:20.919 --> 00:03:23.400 Your first and last name, Michael Snyder. 60 00:03:23.719 --> 00:03:25.360 Do you mind spelling your last name for the record, 61 00:03:25.400 --> 00:03:28.719 please s n Y d e Er. And how are 62 00:03:28.719 --> 00:03:29.280 you employed. 63 00:03:29.759 --> 00:03:31.879 I'm a physician at Beth Israel. 64 00:03:32.800 --> 00:03:35.240 And how long have you been a physician. 65 00:03:35.960 --> 00:03:37.360 Since nineteen ninety eight? 66 00:03:37.759 --> 00:03:40.080 Can you tell us a little bit about your educational background? 67 00:03:40.639 --> 00:03:44.719 So undergrad at UMass Amherst, I did medical school at 68 00:03:44.800 --> 00:03:48.159 Tufts University, and then I did my residency and emergency 69 00:03:48.199 --> 00:03:51.159 medicine at Boston University. 70 00:03:51.280 --> 00:03:53.800 And how long have you worked at Beth Israel. 71 00:03:54.479 --> 00:03:56.759 Since twenty fourteen, twelve years? 72 00:03:58.759 --> 00:04:01.919 And do you primarily work in the emergency department. Yes, 73 00:04:02.759 --> 00:04:05.039 I'm going to draw your attention to January twenty fourth 74 00:04:05.039 --> 00:04:06.960 of the year twenty twenty three. Do you recall working 75 00:04:06.960 --> 00:04:10.280 in the emergency department on that day, Yes, and in 76 00:04:10.319 --> 00:04:14.280 the evening where you made aware of multiple pediatric traumas 77 00:04:14.319 --> 00:04:16.839 that were coming into the emergency department. 78 00:04:17.120 --> 00:04:17.439 Yes. 79 00:04:17.879 --> 00:04:22.639 And when you are made aware of things people coming in, 80 00:04:22.759 --> 00:04:23.839 how does that occur? 81 00:04:24.639 --> 00:04:28.720 So we'll typically get a call on the MS phone 82 00:04:29.040 --> 00:04:31.600 that something's coming in that they want us to know 83 00:04:31.639 --> 00:04:33.639 about upfront, and do. 84 00:04:33.639 --> 00:04:36.720 They provide you with some basic background information about what's 85 00:04:36.879 --> 00:04:39.439 occurring or what occurred on scene and what's occurring during 86 00:04:39.480 --> 00:04:40.639 the transport. 87 00:04:41.000 --> 00:04:43.279 When possible, Yeah? 88 00:04:43.360 --> 00:04:49.000 And when the emergency personnel the mts or paramedics survived 89 00:04:49.040 --> 00:04:52.959 at Beth Israel, there were three patients correct, correct, and 90 00:04:53.639 --> 00:04:55.519 you were assigned to treat one patient. 91 00:04:56.160 --> 00:04:56.519 Correct. 92 00:04:56.600 --> 00:05:02.120 Do you recall which patient that was Core? And prior 93 00:05:02.160 --> 00:05:06.959 to EMS arriving, did you learn more about Korra's presentation 94 00:05:07.319 --> 00:05:08.560 and what was occurring. 95 00:05:09.000 --> 00:05:11.000 Yeah, So we had heard that. 96 00:05:12.639 --> 00:05:17.120 All three were in cardiac arrest, and the Core particular, 97 00:05:17.240 --> 00:05:20.639 they were still working on doing CPR and doing what 98 00:05:20.680 --> 00:05:24.600 we call pediatric events advanced life support, so medications to 99 00:05:24.639 --> 00:05:25.920 try and restart the heart. 100 00:05:27.120 --> 00:05:29.879 And they also mentioned that they had used what we. 101 00:05:29.839 --> 00:05:32.199 Call a defibrillator to shock the heart to try to 102 00:05:32.240 --> 00:05:35.120 restart it, and they were still doing CPR when they 103 00:05:35.120 --> 00:05:35.879 were arriving. 104 00:05:37.319 --> 00:05:42.240 And is this information important to you as you're assessing 105 00:05:42.240 --> 00:05:44.079 a patient coming into the emergency department. 106 00:05:44.800 --> 00:05:46.720 Yeah, yeah, it's important to know. 107 00:05:46.600 --> 00:05:49.399 You know what things look like in the field, how 108 00:05:49.439 --> 00:05:52.000 long the patient might have been without a pulse or 109 00:05:52.360 --> 00:05:54.360 how long they may not have been breathing for, so 110 00:05:54.399 --> 00:05:57.920 we can kind of expect or know what injuries to 111 00:05:57.959 --> 00:06:00.000 look out for what we can potentially reverse. 112 00:06:01.000 --> 00:06:04.759 And were you aware of the age of Korra, Yes, 113 00:06:05.120 --> 00:06:08.360 and she was five correct, Yes, And as far as 114 00:06:08.439 --> 00:06:12.759 the medications that you were aware of what medications had 115 00:06:12.800 --> 00:06:13.959 been provided. 116 00:06:13.959 --> 00:06:18.279 So prior to coming to us, she had been given epernephrine, 117 00:06:18.279 --> 00:06:21.480 which is the primary medication we use in a cardiac arrest. 118 00:06:22.639 --> 00:06:25.639 And do you know how they had administered that medicine 119 00:06:25.639 --> 00:06:25.920 to her? 120 00:06:26.199 --> 00:06:26.399 Yeah. 121 00:06:26.480 --> 00:06:29.079 So she had what we call an intra osseous device 122 00:06:29.199 --> 00:06:33.319 in her right tibia. Sometimes it's very difficult to get 123 00:06:33.360 --> 00:06:35.240 an IV in so we can go directly into the 124 00:06:35.240 --> 00:06:36.279 bone or the bone marrow. 125 00:06:38.959 --> 00:06:41.720 And were you aware of whether she had been intubated in. 126 00:06:41.839 --> 00:06:44.800 Route, so she was not intubated in route. 127 00:06:45.879 --> 00:06:48.120 When she arrived at the emergency department. Were you there 128 00:06:48.160 --> 00:06:49.399 to greet the ambulance. 129 00:06:49.519 --> 00:06:49.839 Yes? 130 00:06:50.319 --> 00:06:53.879 And what happens when a patient comes in through the 131 00:06:53.920 --> 00:06:56.000 emergency department via ambulance. 132 00:06:56.560 --> 00:06:58.959 So when the patient first comes in, you know, we 133 00:06:59.199 --> 00:07:01.720 immediately have our team you know, start to sort of 134 00:07:01.759 --> 00:07:04.240 take over care so there's no gap. And then we 135 00:07:04.319 --> 00:07:08.079 also get a sign out from the paramedics and amts 136 00:07:08.160 --> 00:07:10.519 and any other staff that had been involved in the case. 137 00:07:11.319 --> 00:07:14.959 And do you and your emergency room staff then perform 138 00:07:15.079 --> 00:07:17.639 your own initial assessment of the patient? Yes, but what 139 00:07:17.680 --> 00:07:18.279 do you do for that? 140 00:07:18.839 --> 00:07:23.000 So initially we sort of go through our ABC's airway 141 00:07:23.000 --> 00:07:27.959 breathing circulation. So initially, you know, focusing on the primary 142 00:07:28.000 --> 00:07:30.399 things such as making sure we're getting air and oxygen 143 00:07:30.399 --> 00:07:34.120 into the patient, keeping the heart going, so continuing CPR 144 00:07:34.160 --> 00:07:34.800 at that point. 145 00:07:36.160 --> 00:07:38.959 And as far as Cora went, did you observe that 146 00:07:39.040 --> 00:07:41.639 she was breathing, so she was not breathing on her own? 147 00:07:41.920 --> 00:07:44.759 How about the heart? Did you observe that her heart 148 00:07:44.800 --> 00:07:45.240 was beating? 149 00:07:45.519 --> 00:07:46.800 There was no heartbreat. 150 00:07:48.279 --> 00:07:50.879 How about her physical appearance? What observations did you make 151 00:07:50.959 --> 00:07:52.160 of her physical appearance? 152 00:07:52.639 --> 00:07:55.160 So initially when she had come in, you know, some 153 00:07:55.199 --> 00:07:58.079 of the things we notice is sort of a blue 154 00:07:58.279 --> 00:08:01.199 tint to the skin, which typically you know, we can 155 00:08:01.240 --> 00:08:05.279 see when there's less oxygen or lack of oxygen. And 156 00:08:05.319 --> 00:08:07.879 then the other things on a quick survey is there 157 00:08:08.000 --> 00:08:13.120 was some areas of bruising on the neck and around 158 00:08:13.160 --> 00:08:17.519 the eyes called patkiah kind of little bleeding, episodes of 159 00:08:17.560 --> 00:08:20.279 bleeding under the skin, and I believe a small amount 160 00:08:20.279 --> 00:08:21.560 of blood coming from the nose. 161 00:08:23.600 --> 00:08:26.279 Were you able to make observations of her hands or 162 00:08:26.319 --> 00:08:28.560 other parts of her body? 163 00:08:28.319 --> 00:08:32.159 So the hands definitely had that what we call sinosis 164 00:08:32.679 --> 00:08:33.720 or blue. 165 00:08:33.519 --> 00:08:39.440 Que Now as far as the eyes, you mentioned patigi 166 00:08:39.759 --> 00:08:42.080 are around the face and the eyes as well as 167 00:08:42.080 --> 00:08:44.279 the neck. Did you notice anything else about her eyes? 168 00:08:44.840 --> 00:08:48.440 So the pupils were fixed and enlarged. 169 00:08:49.240 --> 00:08:50.759 Is why is that significant to you? 170 00:08:51.159 --> 00:08:54.159 So oftentimes it can when we see it coming in, 171 00:08:54.279 --> 00:08:56.919 it can indicate two different things. Some of the medications 172 00:08:56.919 --> 00:09:00.639 like epinephyrine can cause the pupils to dilate, but also 173 00:09:00.759 --> 00:09:04.600 if the brain is starting to become damaged or not functioning, 174 00:09:05.159 --> 00:09:11.360 then you start to lose initially some of the signals 175 00:09:11.399 --> 00:09:14.080 that would make the pupil smaller, so they tend to 176 00:09:14.120 --> 00:09:17.960 start to get enlarged or dilated if there's brain injury 177 00:09:18.000 --> 00:09:19.639 starting or has occurred. 178 00:09:20.720 --> 00:09:24.000 Now, you indicated that when Core arrived, she did not 179 00:09:24.240 --> 00:09:26.159 she was not intubated, meaning she did not have a 180 00:09:26.200 --> 00:09:29.960 breathing tubein. Did you and your team attempt to intubate her, yes. 181 00:09:30.039 --> 00:09:30.440 And. 182 00:09:32.279 --> 00:09:34.519 Did you do that on your own or with the 183 00:09:34.519 --> 00:09:38.320 assistance of other parts of the emergency department or the hospital. 184 00:09:38.600 --> 00:09:41.759 So we had anesthesia there after we got the phone 185 00:09:41.799 --> 00:09:46.440 calls or multiple patients coming in. Typically will have all 186 00:09:46.519 --> 00:09:50.320 the help that we could possibly need there to be 187 00:09:50.360 --> 00:09:51.960 able to take care of all the patients. So I 188 00:09:52.039 --> 00:09:55.120 had an anesthesiologist in the room with me who put 189 00:09:55.120 --> 00:09:55.919 the breathing tubein. 190 00:09:56.960 --> 00:10:00.440 In instances where an individual might have suffered sort of 191 00:10:00.480 --> 00:10:03.759 injury to their neck, does that complicate the insertion of 192 00:10:03.759 --> 00:10:04.559 a breathing tube. 193 00:10:04.759 --> 00:10:08.159 It can, yeah, because normally you might need to move 194 00:10:08.320 --> 00:10:11.000 or tilt the head to get a direct view where 195 00:10:11.000 --> 00:10:12.840 you can put a breathing tube in. But when there's 196 00:10:12.879 --> 00:10:16.120 a concern for neck injury, we stabilize it, typically with 197 00:10:16.159 --> 00:10:19.600 a collar or manually, so there's you don't have the 198 00:10:19.639 --> 00:10:21.600 ability to move the head and the neck around to 199 00:10:21.600 --> 00:10:22.600 try and get a better view. 200 00:10:25.440 --> 00:10:28.120 Once a breathing tube was put in, were you and 201 00:10:28.159 --> 00:10:31.320 your team able to manually give breath to Cora? 202 00:10:31.600 --> 00:10:31.919 Yes? 203 00:10:32.360 --> 00:10:35.879 Now, did you then perform an assessment, a cardiac assessment 204 00:10:35.919 --> 00:10:36.159 of her. 205 00:10:36.879 --> 00:10:40.279 Yeah, So, in addition to listening to the hard feeling 206 00:10:40.360 --> 00:10:43.559 for a pulse, we'll also tend to use an ultrasound 207 00:10:43.600 --> 00:10:46.279 machine in the room where we can kind of get 208 00:10:46.279 --> 00:10:48.360 a direct view of heart function. 209 00:10:49.960 --> 00:10:53.919 And you were aware that they had defibrillated her twice 210 00:10:53.919 --> 00:10:56.639 in the ambulance. Why is that significant when you're treating 211 00:10:56.679 --> 00:10:58.159 a patient that's in cardiac. 212 00:10:57.840 --> 00:11:01.840 Or ass So, when they defibrillate a patient, it's typically 213 00:11:01.879 --> 00:11:04.759 the hearts or might be in a rhythm where it 214 00:11:05.159 --> 00:11:08.440 can't pump blood, so it might be sort of out 215 00:11:08.440 --> 00:11:12.240 of sink or quivering, where we may attempt to use 216 00:11:12.240 --> 00:11:15.039 electricity to kind of shock it back into a rhythm. 217 00:11:15.639 --> 00:11:19.279 Once you performed the ultrasound, the cardiac ultrasound, were there 218 00:11:19.320 --> 00:11:27.720 any attempts made further to use a defibrillator or throughout 219 00:11:27.759 --> 00:11:29.639 your course of treatment with her, did you continue with 220 00:11:29.720 --> 00:11:33.759 various medications, Yes, and with cpr on going throughout your 221 00:11:33.919 --> 00:11:35.440 entire time with her. 222 00:11:35.600 --> 00:11:35.919 Yes. 223 00:11:36.759 --> 00:11:39.759 Were you consulting with any other colleagues or any other 224 00:11:39.799 --> 00:11:41.759 hospitals in regards to the care of Korra? 225 00:11:42.399 --> 00:11:43.759 Yeah, so we absolutely had. 226 00:11:44.000 --> 00:11:47.720 In addition to all my colleagues in the emergency room, 227 00:11:48.039 --> 00:11:53.360 we had intensive care physicians from Children's that were on 228 00:11:53.399 --> 00:11:56.600 the phone with us, kind of working through any things 229 00:11:56.639 --> 00:11:58.960 that may have come up in the case, also expecting 230 00:11:59.000 --> 00:12:01.080 that they would be received the patients from us. 231 00:12:02.120 --> 00:12:05.399 Is your hospital at the Beth Israel equipped to handle 232 00:12:05.480 --> 00:12:07.279 this type of pediatric trauma. 233 00:12:07.600 --> 00:12:10.600 So we can do the initial stabilization, but then we 234 00:12:10.639 --> 00:12:13.200 need to ship the patients out to either get our 235 00:12:13.559 --> 00:12:16.320 specialty care or continued in patient care. 236 00:12:17.320 --> 00:12:22.440 And how long did efforts in treating Kora continue So. 237 00:12:22.600 --> 00:12:27.480 In the emergency room roughly thirty minutes and. 238 00:12:28.080 --> 00:12:32.919 Fair to say that all of the efforts that you 239 00:12:33.039 --> 00:12:34.399 made were not successful. 240 00:12:35.200 --> 00:12:35.600 Correct? 241 00:12:35.960 --> 00:12:39.480 And at approximately seven excuse me, nineteen twenty eight or 242 00:12:39.519 --> 00:12:43.399 seven twenty eight, did you finally declare Cora deceased? 243 00:12:43.639 --> 00:12:43.879 Yes? 244 00:12:44.639 --> 00:12:45.919 Thank you, I have nothing. 245 00:12:45.720 --> 00:12:52.360 Further I hope questions, Thank you, Thanks, Thanks someholl calls. 246 00:12:52.399 --> 00:12:54.039 Doctor Andrews caparro. 247 00:12:57.120 --> 00:13:00.759 A right, good believe dodme? 248 00:13:01.120 --> 00:13:03.440 Yes, please, thank you, good morning. Can you please stay 249 00:13:03.440 --> 00:13:04.679 and spell your name for the record. 250 00:13:05.159 --> 00:13:08.840 My name's doctor Andrew Caprarro, last name CP. 251 00:13:09.039 --> 00:13:12.360 Rro and your date of birth please July. 252 00:13:12.240 --> 00:13:13.360 Ninth, nineteen seventy. 253 00:13:13.919 --> 00:13:14.879 What do you do for a living. 254 00:13:15.399 --> 00:13:17.919 I'm an attending physician in the emergency department at Boston 255 00:13:17.960 --> 00:13:18.759 Children's Hospital. 256 00:13:19.120 --> 00:13:20.159 And how long have you done that? 257 00:13:20.879 --> 00:13:22.399 For the last twenty six years? 258 00:13:22.639 --> 00:13:25.159 Can you just briefly describe for us the training and 259 00:13:25.320 --> 00:13:27.480 education you had to qualify for that role. 260 00:13:28.600 --> 00:13:30.840 I went to Providence College undergrad and then went to 261 00:13:30.879 --> 00:13:34.919 Brown Medical School. Subsequently, I went to Connecticut Children's Medical 262 00:13:34.919 --> 00:13:39.159 Center for my pediatric residency and then did fellowship training 263 00:13:39.200 --> 00:13:42.320 in pediatric emergency medicine at Boston Children's Hospital from two 264 00:13:42.360 --> 00:13:44.639 thousand to two thousand and three and have been in 265 00:13:44.639 --> 00:13:45.679 attending there ever since. 266 00:13:46.559 --> 00:13:49.759 And what's involved with being an attending at Boston Children's Hospital. 267 00:13:50.480 --> 00:13:54.600 It means that I am guiding the care and treatment 268 00:13:54.679 --> 00:13:57.600 for the patients that I am seeing during my particular shift. 269 00:13:58.240 --> 00:14:00.759 And are you assigned to a specific life location or 270 00:14:00.799 --> 00:14:01.840 area of the hospital. 271 00:14:02.519 --> 00:14:05.120 I'm always in the emergency department and the emergency department 272 00:14:05.200 --> 00:14:07.320 is broken up into different zones, of which I am 273 00:14:07.360 --> 00:14:10.399 sort of the primary attending for one set of rooms. 274 00:14:11.559 --> 00:14:13.960 I want to direct your attention to January twenty fourth, 275 00:14:14.039 --> 00:14:16.639 twenty twenty three. Were you working that evening? 276 00:14:16.919 --> 00:14:17.320 I was. 277 00:14:17.879 --> 00:14:19.600 And at some point in time, did you learn that 278 00:14:19.639 --> 00:14:23.200 a patient named Callum Clancy was going to be transported 279 00:14:23.240 --> 00:14:24.080 to your hospital? 280 00:14:24.240 --> 00:14:24.600 I did? 281 00:14:25.039 --> 00:14:28.720 And did you recall where he was being brought from. 282 00:14:29.080 --> 00:14:30.200 From Bethelville, Plymouth? 283 00:14:30.240 --> 00:14:30.639 I believe. 284 00:14:31.039 --> 00:14:33.039 And was he being med flighted to your facility? 285 00:14:33.200 --> 00:14:33.639 Correct? 286 00:14:34.159 --> 00:14:37.240 And were you provided with some information about the patient 287 00:14:37.320 --> 00:14:39.120 in order to prepare for his arrival? 288 00:14:39.440 --> 00:14:39.840 I was? 289 00:14:40.039 --> 00:14:40.960 And what did you learn? 290 00:14:41.879 --> 00:14:43.840 We have a communication that's exactly correct. 291 00:14:43.919 --> 00:14:48.480 Yes, at that point in time, did you work with 292 00:14:48.559 --> 00:14:52.919 another doctor to do more in depth testing regarding his 293 00:14:53.000 --> 00:14:54.120 neurological status? 294 00:14:54.559 --> 00:14:54.919 Yes? 295 00:14:55.039 --> 00:14:58.679 So at Children's we have multiple teams that come together 296 00:14:59.039 --> 00:15:02.399 for a patient for many patients, but for Callen. 297 00:15:02.639 --> 00:15:05.279 The neurology team was there from the beginning. 298 00:15:05.399 --> 00:15:08.480 And when in a case like this, when we see 299 00:15:08.480 --> 00:15:12.399 no response in an unresponsive patient, we start to have 300 00:15:12.559 --> 00:15:15.120 the get our neurology team, and one of the things 301 00:15:15.120 --> 00:15:17.200 we start to do is brain death. 302 00:15:17.039 --> 00:15:19.440 Testing to see if they could be what would we. 303 00:15:19.679 --> 00:15:23.279 Called brain dead, meaning that the brain itself is not functioning, 304 00:15:24.399 --> 00:15:26.559 and that even though their heart. 305 00:15:26.399 --> 00:15:29.639 Is still beating, How is it that someone's heart can 306 00:15:29.679 --> 00:15:32.720 be beating if their brain is dead. 307 00:15:33.080 --> 00:15:34.039 It's a really good question. 308 00:15:34.120 --> 00:15:38.840 So there's actually two parts to the nervous system. 309 00:15:39.000 --> 00:15:42.440 The one is the part that we see. 310 00:15:42.200 --> 00:15:44.480 The most in people when they react and they react 311 00:15:44.519 --> 00:15:46.200 to us and they speak and they do things. 312 00:15:46.440 --> 00:15:50.159 The other one is the autonomic or automatic system. 313 00:15:50.519 --> 00:15:54.720 And the automatic system is largely in charge of the 314 00:15:54.799 --> 00:15:57.159 things like the heart if the heart has not been injured. 315 00:15:57.399 --> 00:15:59.559 And so it was sort of continuing on. 316 00:16:00.399 --> 00:16:03.440 And does that give you any indication, the fact that 317 00:16:03.480 --> 00:16:07.000 the heart was still continuing on about where the injuries 318 00:16:07.000 --> 00:16:07.720 were in the brain? 319 00:16:08.879 --> 00:16:11.240 Yes, it does, actually, yeah, that where would that be? 320 00:16:12.559 --> 00:16:15.799 It seemed the cerebellum, which is that part that makes 321 00:16:15.840 --> 00:16:17.840 us sort of the human side of what we do, 322 00:16:19.120 --> 00:16:22.960 that's much more sensitive to a lack of oxygen, to 323 00:16:23.039 --> 00:16:25.559 an anoxic injury. And it told me that that was 324 00:16:25.639 --> 00:16:27.720 really where that injury was, was in that part of 325 00:16:27.759 --> 00:16:30.360 the brain, much less so in the. 326 00:16:32.039 --> 00:16:33.159 Brain stem itself. 327 00:16:33.840 --> 00:16:36.519 So would it be fair to say that the brain 328 00:16:36.559 --> 00:16:41.279 stem itself that controls those automatic responses was still functioning somewhat, 329 00:16:41.440 --> 00:16:43.840 but the part of the brain that made Callen Kalen 330 00:16:44.440 --> 00:16:45.240 was not functioning. 331 00:16:45.360 --> 00:16:46.240 That's exactly correct. 332 00:16:46.320 --> 00:16:51.639 Yeah, And what could you describe for us the brain 333 00:16:51.720 --> 00:16:52.399 death testing? 334 00:16:52.879 --> 00:16:57.759 Sure, So the brain death testing at Boston Children's is 335 00:16:57.759 --> 00:17:01.799 a it's a very strict testing that includes some of 336 00:17:01.840 --> 00:17:03.000 the things that I just mentioned. 337 00:17:03.039 --> 00:17:08.079 But we work with our UH it's there's a checklist that. 338 00:17:08.000 --> 00:17:12.240 We work on with our neurologic colleagues, and we sort of. 339 00:17:12.160 --> 00:17:14.559 Go through each of the what we would expect. 340 00:17:14.160 --> 00:17:18.240 For responses from someone and we actually then work through 341 00:17:18.319 --> 00:17:21.960 different of the of the nerve sets that we would 342 00:17:22.039 --> 00:17:23.359 expect them to respond to. 343 00:17:24.319 --> 00:17:26.559 We have it set up so. 344 00:17:26.440 --> 00:17:30.279 That there's a an ICU physician is there, and then 345 00:17:30.519 --> 00:17:33.519 a neurologist is there, and the neurologist and the neurology 346 00:17:33.559 --> 00:17:36.880 team they're the ones who perform the brain death testing. 347 00:17:37.559 --> 00:17:39.720 It's and then that. 348 00:17:39.880 --> 00:17:43.680 The test is then repeated again twenty four hours later 349 00:17:44.079 --> 00:17:46.400 just to make sure that there's no there's no piece 350 00:17:46.440 --> 00:17:50.880 of that that is different or incongruous with a diagnosis 351 00:17:50.920 --> 00:17:52.039 of brain death. 352 00:17:52.799 --> 00:17:55.599 And while the neurologist is doing this testing, are there 353 00:17:55.680 --> 00:17:58.920 present watching the testing and seeing the results as it happens. 354 00:18:00.119 --> 00:18:02.119 Is one of those breathing components. 355 00:18:01.599 --> 00:18:02.599 In apnea tests? 356 00:18:02.680 --> 00:18:03.240 Yes, it is? 357 00:18:03.319 --> 00:18:05.039 Yeah, And what is an apnea test? 358 00:18:05.359 --> 00:18:09.519 So apanea is as a word that just describes uh, 359 00:18:09.759 --> 00:18:12.839 not describes a lack of breathing. 360 00:18:14.400 --> 00:18:15.960 And how do you test that? 361 00:18:16.759 --> 00:18:20.599 So in a patient such as callen, what what we 362 00:18:20.720 --> 00:18:23.319 do and in any patient when we're doing brain death testing, 363 00:18:25.079 --> 00:18:29.960 what we're we we actually disconnect them from the ventilator. 364 00:18:30.400 --> 00:18:32.279 And the reason that we do that is we. 365 00:18:32.240 --> 00:18:35.480 Want to see if that autonomic system in the brain 366 00:18:35.960 --> 00:18:36.839 will start. 367 00:18:36.599 --> 00:18:39.400 To react as as as the. 368 00:18:39.319 --> 00:18:41.440 Carbon dioxide starts to increase. 369 00:18:41.599 --> 00:18:45.759 So our body makes carbon dioxide all the time, and 370 00:18:45.839 --> 00:18:48.039 the way we get rid of it is by exhaling, 371 00:18:48.519 --> 00:18:52.200 and where we breathe in oxy fresh oxygen and then 372 00:18:52.200 --> 00:18:56.359 we breathe out CO two. And what we what we 373 00:18:56.400 --> 00:18:59.640 do is we disconnect from the ventilator to see if 374 00:19:00.079 --> 00:19:02.599 knowing that their carbon dioxide will start to rise, and 375 00:19:02.680 --> 00:19:05.880 the normal response for that autonomic part of the brain 376 00:19:05.960 --> 00:19:09.240 would be to sort of increase breathing. That's why we 377 00:19:09.359 --> 00:19:12.799 breathe when we sleep, because as we go to sleep, 378 00:19:12.880 --> 00:19:16.839 the conscious part of our brain stops, but the autonomic 379 00:19:16.920 --> 00:19:19.119 part kicks in and then we breathe right through our 380 00:19:19.160 --> 00:19:22.640 sleep because that carbon dioxide rises. 381 00:19:23.599 --> 00:19:24.119 So in a. 382 00:19:24.079 --> 00:19:26.799 Patient who has brain death, would it be accurate to 383 00:19:26.880 --> 00:19:32.640 state that as the carbon dioxide level increases, the automatic 384 00:19:32.720 --> 00:19:35.039 response would be to take a breath to get more oxygen. 385 00:19:35.319 --> 00:19:37.759 But a patient who's brain dead won't do that. 386 00:19:37.759 --> 00:19:38.359 That's correct? 387 00:19:39.079 --> 00:19:42.480 And did you do all of these tests or do 388 00:19:42.559 --> 00:19:46.000 the neurologists do all these tests on Kalin while you observed? 389 00:19:46.079 --> 00:19:46.240 Yes? 390 00:19:46.279 --> 00:19:46.559 They did. 391 00:19:46.640 --> 00:19:46.880 Yeah. 392 00:19:47.000 --> 00:19:49.720 And did he have any response to any of the 393 00:19:49.720 --> 00:19:52.400 physical tests where you were looking for a reflex or reaction? 394 00:19:52.880 --> 00:19:55.359 No, he did not, no response to any And what. 395 00:19:55.279 --> 00:19:58.359 Was his reaction or results on the apnea test? 396 00:19:58.839 --> 00:20:00.200 So the apnea a test? 397 00:20:00.839 --> 00:20:03.920 Again, we do one, We do all the brain testing 398 00:20:03.920 --> 00:20:05.720 one day, and then we wait at least twenty four. 399 00:20:05.519 --> 00:20:06.519 Hours for the second one. 400 00:20:07.079 --> 00:20:10.519 The first and what we expect with the carbon dioxide 401 00:20:10.559 --> 00:20:11.799 is that it will increase. 402 00:20:12.519 --> 00:20:14.759 We have it written in our it'll. 403 00:20:16.160 --> 00:20:18.559 It did all in writing for our protocol that it 404 00:20:18.559 --> 00:20:21.599 will increase by twenty or get to. 405 00:20:21.640 --> 00:20:24.759 A level of sixty. A normal CO two would be. 406 00:20:24.759 --> 00:20:28.160 Around forty And the first time we did that on 407 00:20:28.200 --> 00:20:31.240 the first day, it actually. 408 00:20:31.000 --> 00:20:34.720 Went to fifty nine point seven, not sixty. 409 00:20:35.200 --> 00:20:37.359 And again it was in our protocol as has to 410 00:20:37.359 --> 00:20:43.440 get to sixty or increase by twenty And I actually 411 00:20:44.079 --> 00:20:47.279 talked to my colleagues, including neurology. I said, I know 412 00:20:47.759 --> 00:20:50.200 this is very close. It's fifty nine point seven, but 413 00:20:50.599 --> 00:20:54.160 it's not sixty. I repeated that piece of the test 414 00:20:54.359 --> 00:20:57.279 later on that day to make sure that it was valid. 415 00:20:57.319 --> 00:20:58.480 And as I say, I. 416 00:20:58.519 --> 00:21:00.720 Checked with everyone to make sure that that that I 417 00:21:00.799 --> 00:21:05.880 was doing the right thing, and they all agreed that 418 00:21:05.880 --> 00:21:08.160 we should just and the second time it went to 419 00:21:08.200 --> 00:21:11.359 eighty seven. So that was Everything else was the same, 420 00:21:12.079 --> 00:21:14.240 and we made sure that there's things that we look 421 00:21:14.279 --> 00:21:15.960 at to to make sure that there's not on any 422 00:21:16.000 --> 00:21:18.599 medications that there's no changes in this temperature, there's no 423 00:21:19.440 --> 00:21:21.559 abnormalities of the salts and the blood what we call 424 00:21:21.599 --> 00:21:22.359 the electrolytes. 425 00:21:22.559 --> 00:21:26.119 So those all those conditions were the exact same, and 426 00:21:26.200 --> 00:21:26.440 I did. 427 00:21:26.559 --> 00:21:28.240 I repeated that later on the day and it did 428 00:21:28.240 --> 00:21:29.039 come back positive. 429 00:21:29.440 --> 00:21:32.279 Why is it so important that you meet that. 430 00:21:32.359 --> 00:21:36.200 Specific criteria what the emergency room protocols. You also draw 431 00:21:36.279 --> 00:21:41.119 blood for patients that come in Yes, and how is 432 00:21:41.160 --> 00:21:42.160 that usually done? 433 00:21:42.680 --> 00:21:45.000 It's usually done on arrival by the nursing staff. 434 00:21:45.960 --> 00:21:50.960 And do they draw blood according to a medical physicians 435 00:21:51.079 --> 00:21:55.880 orders or do they draw blood for various purposes? Explain 436 00:21:55.960 --> 00:21:56.839 to us how that works. 437 00:21:57.119 --> 00:21:59.079 So it's usually like what we call a rainbow. So 438 00:21:59.079 --> 00:22:00.759 they just draw all the twobes of blood as soon 439 00:22:00.799 --> 00:22:03.400 as the patient arrives and anticipation for orders. 440 00:22:03.599 --> 00:22:06.400 Okay, And so what happens to the blood after somebody 441 00:22:06.400 --> 00:22:08.640 in the emergency department takes it from the patient? Where 442 00:22:08.640 --> 00:22:11.359 does it go? It gets tubed to the lab and 443 00:22:11.839 --> 00:22:14.480 fair to say that at Sousha Hospital they have a 444 00:22:14.519 --> 00:22:17.880 pneumatic tube system correct. Correct, and then it goes to 445 00:22:18.359 --> 00:22:20.000 a separate laboratory. 446 00:22:20.799 --> 00:22:21.200 Correct. 447 00:22:21.480 --> 00:22:25.599 And once a physician then assesses a patient and determines 448 00:22:25.680 --> 00:22:29.799 what kinds of testing needs to be done on those samples. 449 00:22:30.119 --> 00:22:32.279 How do you communicate that to the laboratory? 450 00:22:32.680 --> 00:22:34.640 So orders are put into a computer and they go 451 00:22:34.720 --> 00:22:35.599 through the computer. 452 00:22:35.359 --> 00:22:35.799 To the lab. 453 00:22:36.640 --> 00:22:41.000 And as you're treating a patient, is it oftentimes necessary 454 00:22:41.039 --> 00:22:43.400 to change the orders or order additional tests? 455 00:22:43.680 --> 00:22:44.000 Yes? 456 00:22:45.319 --> 00:22:49.240 And so in this particular case, blood in urine was 457 00:22:49.279 --> 00:22:52.559 collected from Lindsay Clancy upon her arrival correct correct, and 458 00:22:52.599 --> 00:22:53.559 then sent to the lab. 459 00:22:53.759 --> 00:22:54.039 Yes. 460 00:22:55.920 --> 00:23:00.319 Now, going back to the imaging tests, you said that 461 00:23:00.519 --> 00:23:03.720 there were some CT scans that were ordered correct. What 462 00:23:03.920 --> 00:23:06.759 areas of the body were the CT scans for? 463 00:23:07.720 --> 00:23:10.880 It was our entire body, her head, her neck, her chest, 464 00:23:10.880 --> 00:23:12.480 her abdomen, and her pelvis. 465 00:23:13.440 --> 00:23:21.599 Now as far as the the cts for her head, 466 00:23:22.799 --> 00:23:26.839 were there more than one tat CT test for the head? 467 00:23:27.200 --> 00:23:28.920 I don't remember. I'd have to look at my record. 468 00:23:29.960 --> 00:23:32.279 Well, what are the normal or what are the options 469 00:23:32.359 --> 00:23:34.640 for CT head stands? 470 00:23:34.799 --> 00:23:37.279 Usually just a CT head plane, but you could also 471 00:23:37.319 --> 00:23:42.119 do a CT angiogram depending on your concern for injury. 472 00:23:44.200 --> 00:23:48.039 And do you do you recall which one you ordered here? 473 00:23:49.079 --> 00:23:52.200 For a trauma one, it would be a plane CT head. 474 00:23:54.319 --> 00:23:56.279 And why do you order that particular test? 475 00:23:56.640 --> 00:24:00.880 Well, we're trying to assess for skull fractures and crannial bleeding, 476 00:24:01.240 --> 00:24:01.880 things like that. 477 00:24:03.000 --> 00:24:07.240 And when you say a plane CT what's the exact 478 00:24:07.640 --> 00:24:10.079 order that's put in for that type of a CT 479 00:24:10.680 --> 00:24:11.359 CT head? 480 00:24:11.799 --> 00:24:12.119 Okay? 481 00:24:12.200 --> 00:24:16.640 And are there CT heads with contrast? 482 00:24:17.000 --> 00:24:17.400 There are? 483 00:24:17.799 --> 00:24:22.440 And are there CT head skins without contrast? Yes? Ay, 484 00:24:22.480 --> 00:24:30.359 approach to itness. I'll show you those documents. If that's okay? Sure, 485 00:24:31.880 --> 00:24:35.359 I apologize. There's a little series of imagination. So I'm 486 00:24:35.359 --> 00:24:38.680 just gonna dry your attention to this page that's black 487 00:24:38.720 --> 00:24:40.440 and you can just take a look at it. Sure, 488 00:24:41.480 --> 00:24:45.480 m hm, okay, And I'm just gonna flip to the 489 00:24:45.519 --> 00:24:48.480 next page. The next page is blank. 490 00:24:48.559 --> 00:24:50.359 But is this the extent of. 491 00:24:51.920 --> 00:24:54.720 What you would have received as far as information regarding 492 00:24:55.079 --> 00:24:57.920 a head CT that was done without contrast? 493 00:24:58.160 --> 00:25:00.799 Yes, And I'm going just try your. 494 00:25:00.720 --> 00:25:06.480 Attention again to another page here towards the end, two 495 00:25:06.519 --> 00:25:08.200 pages from the end of the document, and you could 496 00:25:08.200 --> 00:25:15.079 take a look at that. Does that reflect the report 497 00:25:15.119 --> 00:25:17.799 you would have received for the head CT ordered with contrast. 498 00:25:17.920 --> 00:25:18.240 Yes. 499 00:25:19.000 --> 00:25:21.839 And in addition to your getting a report from imaging, 500 00:25:21.920 --> 00:25:27.599 you also receive some actual images correct, Yes? And do 501 00:25:27.640 --> 00:25:32.720 you review those Yes? In this particular circumstance when it 502 00:25:32.720 --> 00:25:34.920 came to the patient of Lindsay Clancy, was there anything 503 00:25:35.000 --> 00:25:40.279 remarkable in either of those head cts, Not that I recall, 504 00:25:42.799 --> 00:25:48.359 And in fact, the head CT with contrast indicated the 505 00:25:48.359 --> 00:25:52.200 impression was unremarkable. CTA have had no evidence into cranial 506 00:25:52.240 --> 00:25:57.559 aneurysm our, travinous malformation or brupt occlusion correct? 507 00:25:57.680 --> 00:25:57.960 Correct? 508 00:25:58.039 --> 00:25:58.839 What does that mean? 509 00:26:00.200 --> 00:26:03.799 Means it's a normal study. 510 00:26:04.240 --> 00:26:07.559 Now, as far as the other CT scans that were conducted, 511 00:26:08.079 --> 00:26:12.319 there were findings, remarkable findings on some of the others correct, correct, 512 00:26:12.519 --> 00:26:15.839 And what did they reflect in your experience? As far 513 00:26:15.839 --> 00:26:16.839 as her injury goes? 514 00:26:17.960 --> 00:26:19.519 From what I can recall, I know she had a 515 00:26:19.559 --> 00:26:22.920 thoracic spine injury. 516 00:26:24.720 --> 00:26:27.720 And how about the CT that was done of the 517 00:26:27.839 --> 00:26:28.559 chest area. 518 00:26:29.039 --> 00:26:30.039 I don't recall. 519 00:26:31.920 --> 00:26:37.000 It may approach that refresh your memory? 520 00:26:37.119 --> 00:26:37.400 Yes? 521 00:26:37.440 --> 00:26:38.000 And what was. 522 00:26:41.160 --> 00:26:43.319 So it talks about her thoracic spine injuries? 523 00:26:44.519 --> 00:26:48.039 Now, after reviewing all of the images, all of the 524 00:26:48.079 --> 00:26:51.759 CT scans that were done here, the cervical spine, the 525 00:26:51.839 --> 00:26:57.759 head cts, the thoracic spine, what was the plan for 526 00:26:57.799 --> 00:27:00.480 this particular patient? Was she able to be treated further 527 00:27:00.519 --> 00:27:01.519 at Selfshare Hospital? 528 00:27:02.559 --> 00:27:05.839 The decision was made by the team that her injuries 529 00:27:05.839 --> 00:27:08.039 were too severe to stay at Selfshur Hospital and the 530 00:27:08.079 --> 00:27:10.279 decision was made to transfer him to her to a 531 00:27:10.359 --> 00:27:11.359 tertiary care center. 532 00:27:12.680 --> 00:27:16.119 Were you able to stabilize her before transporting yes? Is 533 00:27:16.119 --> 00:27:18.359 that something that's important to make sure our patient is 534 00:27:18.359 --> 00:27:22.279 stable before sending them off in the ambulance or a helicopter. Yes, 535 00:27:23.079 --> 00:27:27.400 And so as far as this particular patient goes, are 536 00:27:27.440 --> 00:27:30.240 you aware of when whether any surgical intervention had to 537 00:27:30.279 --> 00:27:33.359 be done before she was stabilized and transported. 538 00:27:33.880 --> 00:27:35.799 I was not aware of any intervention. 539 00:27:35.400 --> 00:27:39.759 Being done, and again you had doctor Carpio who was 540 00:27:39.799 --> 00:27:41.200 also there to assess that. 541 00:27:42.000 --> 00:27:42.319 Correct. 542 00:27:42.359 --> 00:27:46.279 We work as a team. 543 00:27:46.359 --> 00:27:51.799 Kind of going back to those injuries on her neck 544 00:27:51.880 --> 00:27:57.400 and her wrist, very briefly, can you explain to us 545 00:27:57.440 --> 00:28:00.839 the difference between leading in be an artery or a 546 00:28:00.920 --> 00:28:03.920 vein and how that might present itself in an emergency situation. 547 00:28:05.559 --> 00:28:08.920 Venus bleed would be a little bit slower, darker blood, 548 00:28:08.920 --> 00:28:11.960 and arterial bleed would be pulsatile and bright red. 549 00:28:13.200 --> 00:28:16.759 And is it fair to say that when you strike 550 00:28:16.920 --> 00:28:19.920 either an artery or a vein that they're of different 551 00:28:19.920 --> 00:28:22.480 pressure systems and so the manner in which the blood 552 00:28:22.519 --> 00:28:27.119 comes out is different. Yes, in either circumstance where an 553 00:28:27.200 --> 00:28:30.640 artery or a vein is struck or nicked or cut, 554 00:28:31.519 --> 00:28:34.119 would that be something that you'd have to stabilize for 555 00:28:34.200 --> 00:28:36.279 a patient in order to make sure that they don't 556 00:28:36.319 --> 00:28:36.720 bleed out? 557 00:28:36.960 --> 00:28:37.200 Yes? 558 00:28:38.359 --> 00:28:39.119 Was that done here? 559 00:28:39.599 --> 00:28:45.880 It wasn't necessary. 560 00:28:43.119 --> 00:28:47.160 Now, this particular patient at some point was noted to 561 00:28:47.319 --> 00:28:53.680 be I think it's was referred to as hypothermic. Do 562 00:28:53.720 --> 00:28:57.960 you recall that yes? Do you recall at what point 563 00:28:58.000 --> 00:29:01.480 in your treatment of her was that noted? Was it 564 00:29:01.640 --> 00:29:04.920 as she was coming into the emergency department or did 565 00:29:04.920 --> 00:29:08.720 that develop while she was in the emergency department? 566 00:29:09.000 --> 00:29:09.720 I don't recall. 567 00:29:12.759 --> 00:29:16.680 What was the course of treatment for a low body temperature. 568 00:29:17.400 --> 00:29:19.440 We placed something called a bear hugger on them, which 569 00:29:19.480 --> 00:29:20.359 is a warming blanket. 570 00:29:21.680 --> 00:29:24.680 And can you explain to us what could cause a 571 00:29:24.720 --> 00:29:28.920 person's body temperature to drop to I think it was 572 00:29:28.960 --> 00:29:30.640 eighty two point one. 573 00:29:31.000 --> 00:29:33.599 There are many reasons, but it could be a metabolic 574 00:29:33.720 --> 00:29:35.400 disarray or exposure. 575 00:29:36.440 --> 00:29:39.960 In this circumstance, did you know what the source of 576 00:29:40.279 --> 00:29:42.759 the drop in the body temperature was for Mss Clancy? 577 00:29:43.079 --> 00:29:43.200 No? 578 00:29:46.799 --> 00:29:50.559 And do you recall how long she was in the 579 00:29:50.559 --> 00:29:55.599 emergency department before she was transported approximately to the Brigham. 580 00:29:55.400 --> 00:29:57.039 I think it was about four hours. 581 00:30:00.279 --> 00:30:02.160 At this time, you're honor, I would move to enter 582 00:30:02.839 --> 00:30:06.519 into evidence. A copy of the Selfshore Hospital medical records 583 00:30:06.519 --> 00:30:09.079 for Lindsay Clancy from January twenty fourth, twenty three is 584 00:30:09.119 --> 00:30:09.799 the next exhibit. 585 00:30:12.039 --> 00:30:12.920 That may be admitted. 586 00:30:14.559 --> 00:30:19.119 Well, they may be admitted, and. 587 00:30:19.160 --> 00:30:22.039 I would also move to enter as the next exhibit 588 00:30:23.200 --> 00:30:27.599 a certified copy of imaging records from the Selfshore Hospital 589 00:30:27.640 --> 00:30:34.160 for Lindsay Clans from January. 590 00:30:29.319 --> 00:30:32.480 Twenty four, it may be admitted. 591 00:30:33.559 --> 00:30:38.160 So, finally, doctor McDonough, did this defendant received surgery at 592 00:30:38.160 --> 00:30:39.440 Health Self Store Hospital? 593 00:30:40.079 --> 00:30:40.920 Not that I'm aware. 594 00:30:43.000 --> 00:30:45.759 Did you observe any cuts, abrasions or blood on the 595 00:30:45.759 --> 00:30:46.920 area of her head? 596 00:30:47.440 --> 00:30:47.519 No? 597 00:30:49.440 --> 00:30:53.160 And based on your review of those findings on the 598 00:30:53.200 --> 00:30:56.960 CT scans, was there any noted injury from the head 599 00:30:56.960 --> 00:30:58.079 cts that you could tell? 600 00:30:58.519 --> 00:30:58.599 No? 601 00:31:00.440 --> 00:31:04.279 And were you able after using that bear hugger device 602 00:31:04.799 --> 00:31:07.039 able to get her blood or excuse me, her body 603 00:31:07.079 --> 00:31:08.839 her core body temperature back up to normal. 604 00:31:09.079 --> 00:31:10.039 I don't recall. 605 00:31:13.119 --> 00:31:16.119 Did you ever observe those wounds that you observed on 606 00:31:16.160 --> 00:31:21.480 her neck or her wrists ever start bleeding actively? Again? No, 607 00:31:23.839 --> 00:31:28.279 I have nothing for there, just ready. 608 00:31:31.920 --> 00:31:35.279 So would you agree with me that when Lindsay was 609 00:31:35.279 --> 00:31:39.200 brought into the Soshua Hospital that she was unconscious. 610 00:31:42.319 --> 00:31:44.880 I recall her eyes being opened, but she was nonverbal. 611 00:31:45.720 --> 00:31:51.000 Okay, So, as an experienced emergency room doctor, can you 612 00:31:51.039 --> 00:31:53.920 tell me when someone's unconscious? What is that? What are 613 00:31:53.960 --> 00:31:56.200 the syentomology of it? What does that mean? 614 00:31:57.359 --> 00:31:59.920 Usually means they're completely unresponsive with eyes closed? 615 00:32:00.160 --> 00:32:00.480 Okay? 616 00:32:01.680 --> 00:32:02.640 Was she responsive? 617 00:32:03.279 --> 00:32:03.880 Not verbally? 618 00:32:05.319 --> 00:32:07.079 Was she responsive at all? 619 00:32:07.440 --> 00:32:08.640 She was responsive to pain? 620 00:32:09.319 --> 00:32:12.680 So that means that you would do something to cause pain, 621 00:32:12.799 --> 00:32:14.799 perhaps the bottom of the foot or whatever it is, 622 00:32:14.839 --> 00:32:18.960 to see if they have a reaction. Correct, And would 623 00:32:19.000 --> 00:32:21.759 you agree with me that when people even have very 624 00:32:21.880 --> 00:32:29.079 very serious brain injuries, that they can respond to pain stimuli. 625 00:32:29.519 --> 00:32:33.079 Sometimes sometimes so her eyes were open? 626 00:32:34.519 --> 00:32:37.759 Was were her pupils equal and reactive to light? 627 00:32:38.279 --> 00:32:39.079 I don't recall. 628 00:32:39.359 --> 00:32:40.039 You don't recall. 629 00:32:40.519 --> 00:32:43.480 What does it mean with pe r L pupils equal 630 00:32:43.519 --> 00:32:44.400 reactive to light? 631 00:32:44.440 --> 00:32:45.079 What does that mean? 632 00:32:46.480 --> 00:32:48.400 Exactly what you just said. It means her pupils are 633 00:32:48.440 --> 00:32:49.680 equal and reactive to light. 634 00:32:49.799 --> 00:32:51.440 And as a doctor, what does that tell you? 635 00:32:52.680 --> 00:32:55.359 It tells me that there's no significant neurologic injury. 636 00:32:55.720 --> 00:32:58.839 And in this case, you don't recall if her pupils 637 00:32:58.839 --> 00:33:00.839 were equal or reactive to light? 638 00:33:01.440 --> 00:33:02.759 I don't, okay. 639 00:33:03.279 --> 00:33:05.400 And that's when you take the little flash light sometimes 640 00:33:05.440 --> 00:33:07.160 and you put it over the eye and see if 641 00:33:08.240 --> 00:33:08.640 it is. 642 00:33:08.640 --> 00:33:09.960 Constriction of the pupil. 643 00:33:10.440 --> 00:33:10.839 Correct? 644 00:33:12.599 --> 00:33:15.279 Did you do additional evaluations of her to see what 645 00:33:15.440 --> 00:33:18.960 her neurological function was. 646 00:33:21.319 --> 00:33:24.119 She was pretty quickly intubated from what I recall, so 647 00:33:24.160 --> 00:33:26.599 after that it would be difficult to assess her neurologically. 648 00:33:27.000 --> 00:33:30.319 Sure, was she on any pain medication? 649 00:33:30.440 --> 00:33:32.480 If you remember, I don't remember. 650 00:33:33.240 --> 00:33:36.960 You recall did she have difficulty being intubated? I mean, 651 00:33:37.319 --> 00:33:40.599 would you agree with me that if you're not under 652 00:33:40.640 --> 00:33:46.200 some type of medication or sedation or unconscious, it hurts 653 00:33:46.279 --> 00:33:47.759 to be intubated, doesn't it. 654 00:33:48.400 --> 00:33:51.880 We wouldn't intubate somebody without first giving them some induction medicines. 655 00:33:52.279 --> 00:33:55.519 Okay, so what would the induction medicines be? 656 00:33:56.599 --> 00:33:57.680 They're not universal. 657 00:33:58.079 --> 00:34:00.400 Well, depend on what are the induction in the sense 658 00:34:00.440 --> 00:34:01.839 that you used on Lindsay Clancy. 659 00:34:02.079 --> 00:34:04.119 I don't know. I'd have to refer to my record. 660 00:34:04.119 --> 00:34:06.000 And also I wasn't the one who did the intubation, 661 00:34:06.799 --> 00:34:07.759 So she. 662 00:34:07.920 --> 00:34:10.840 Was intubated, had the tube coming out of her mouth, 663 00:34:10.920 --> 00:34:14.360 She's laying on the table, and you are continuing an assessment. 664 00:34:14.400 --> 00:34:16.400 You were the lead doctor in the emergency room for 665 00:34:16.480 --> 00:34:17.360 Lindsay Clancy, right. 666 00:34:18.280 --> 00:34:19.920 I wouldn't say I was the lead I think the 667 00:34:19.920 --> 00:34:21.360 trauma surgeon and I worked together. 668 00:34:22.000 --> 00:34:25.880 Right, her temperature, her core body temperature was eighty two 669 00:34:25.920 --> 00:34:26.880 degrees Is that right? 670 00:34:27.480 --> 00:34:30.079 If that's what the record states, then yes, I'm sorry. 671 00:34:30.199 --> 00:34:32.280 If that's what her medical record states. 672 00:34:31.960 --> 00:34:33.639 Then, as you said here, you don't know what her 673 00:34:33.679 --> 00:34:34.840 core body temperature was. 674 00:34:35.480 --> 00:34:37.400 I saw her three years ago. I see about two 675 00:34:37.440 --> 00:34:38.039 hundred patients. 676 00:34:38.440 --> 00:34:38.840 I'm sure. 677 00:34:39.840 --> 00:34:43.079 I'm happy to look at my record if you bring it. Sorry, 678 00:34:43.079 --> 00:34:47.679 I did, but I don't have a photographic memory. 679 00:34:47.679 --> 00:34:51.559 Did she regain consciousness at all while she was in 680 00:34:51.679 --> 00:34:52.920 your emergency room? 681 00:34:53.400 --> 00:34:53.480 No? 682 00:34:54.960 --> 00:34:59.119 Can you tell me what cf CSF. 683 00:34:58.239 --> 00:35:01.119 Is real spinal fluid? 684 00:35:01.320 --> 00:35:02.559 Yeah? 685 00:35:02.800 --> 00:35:05.440 So what that is it would be I'm not sure 686 00:35:05.440 --> 00:35:06.920 in what context you're referring to it. 687 00:35:07.079 --> 00:35:11.320 Well, how about if there's a massive leakage of CSF 688 00:35:11.440 --> 00:35:12.199 from her nose? 689 00:35:12.239 --> 00:35:13.760 What does that tell you as a doctor. 690 00:35:14.199 --> 00:35:16.239 It could mean that there's a skull fracture. 691 00:35:17.039 --> 00:35:20.159 Did you notice any clear fluid coming from her nose? 692 00:35:20.360 --> 00:35:20.760 I did not. 693 00:35:21.960 --> 00:35:23.280 Is that something you would look for? 694 00:35:23.800 --> 00:35:24.119 Yes? 695 00:35:25.599 --> 00:35:28.400 How quickly do you get the results of the X 696 00:35:28.519 --> 00:35:30.760 rays when you're in the emergency room? 697 00:35:32.159 --> 00:35:33.480 Well, these were CT scans. 698 00:35:33.480 --> 00:35:37.239 But oftentimes is it the case that when you're responding 699 00:35:37.239 --> 00:35:41.000 to crime, serious crime scenes like this one that you're 700 00:35:41.199 --> 00:35:43.960 working in tandem with a forensic scientist from that unit. Yes, 701 00:35:44.039 --> 00:35:47.199 that's correct, okay, And so in this circumstance you indicated 702 00:35:47.239 --> 00:35:50.800 that more enheartment also was at the Celtier hospital with you. Yes, 703 00:35:51.679 --> 00:35:54.360 when you got to the Ceutra hospital, what was the 704 00:35:54.360 --> 00:35:56.239 purpose for you being called out there? What were you 705 00:35:56.280 --> 00:35:56.800 asked to do? 706 00:35:57.400 --> 00:36:02.239 So my instructions were to document the defendant any injuries 707 00:36:02.280 --> 00:36:05.559 that she had. Forensic scientists heart Innett was going to 708 00:36:05.599 --> 00:36:09.079 be taking swabs, and anytime they take swabs, we have 709 00:36:09.199 --> 00:36:11.639 to document the areas in which they swab. 710 00:36:12.559 --> 00:36:15.039 So when you got to the Soltial Hospital, do you 711 00:36:15.079 --> 00:36:16.960 remember where you went in the hospital? 712 00:36:17.480 --> 00:36:17.679 Yeah? 713 00:36:17.679 --> 00:36:19.480 I went to one of the trauma rooms in the 714 00:36:19.559 --> 00:36:20.559 emergency department. 715 00:36:21.039 --> 00:36:25.480 And so were you able to make observations of Lindsay Clancy? 716 00:36:25.719 --> 00:36:26.039 Yes? 717 00:36:26.519 --> 00:36:28.199 And do you see Lindsay Clancy in the courtroom? 718 00:36:28.320 --> 00:36:28.599 Yes? 719 00:36:29.280 --> 00:36:32.079 All right, record may reflect the identification. 720 00:36:32.760 --> 00:36:33.119 Thank you. 721 00:36:34.480 --> 00:36:37.079 What were your observations of her when you saw her? 722 00:36:38.239 --> 00:36:42.920 She was covered in like blankets and like heating devices 723 00:36:43.360 --> 00:36:45.400 and she had a neck collar on. So when I 724 00:36:45.440 --> 00:36:48.159 first walked in the room, I couldn't see anything on 725 00:36:48.199 --> 00:36:50.199 her body. Because she was under the blanket than like 726 00:36:50.239 --> 00:36:51.159 the neck brace. 727 00:36:50.920 --> 00:36:51.480 In her face? 728 00:36:51.639 --> 00:36:57.639 May I approach got a fair and at your representation 729 00:36:57.840 --> 00:37:04.440 of how you observed Lindsay Clint, Yes, an objection. 730 00:37:05.199 --> 00:37:07.079 I have no objection to any of the photographs. 731 00:37:07.119 --> 00:37:09.079 All right, that maybe addited. 732 00:37:10.599 --> 00:37:14.880 Beers. I'm just showing you now. Can you see that 733 00:37:14.880 --> 00:37:18.760 from where you're sitting. Yes, And so this blanket that's 734 00:37:18.800 --> 00:37:22.840 how you observed her in the trauma room. Yes, at 735 00:37:22.880 --> 00:37:27.280 some points, did you and other medical stat remove the 736 00:37:27.320 --> 00:37:30.280 blankets to document injuries? 737 00:37:30.480 --> 00:37:33.119 We didn't remove the blanket, but we did remove her 738 00:37:33.239 --> 00:37:35.079 arms out from underneath the blanket. 739 00:37:34.840 --> 00:37:37.519 Okay, And so were you able to do that on 740 00:37:37.559 --> 00:37:39.320 your own? Did you need assistance? 741 00:37:39.400 --> 00:37:40.280 I need assistance? 742 00:37:40.320 --> 00:37:41.679 And why did you need assistance? 743 00:37:42.960 --> 00:37:45.599 When I first attempted to pull out her right arm, 744 00:37:45.880 --> 00:37:50.119 she was incoperative and pulling it back and fighting against 745 00:37:50.199 --> 00:37:50.679 us a little. 746 00:37:51.039 --> 00:37:53.800 So did you enless the help of the nurses to 747 00:37:53.920 --> 00:37:56.800 help you to remove her arm from the blanket? Yes, 748 00:37:57.239 --> 00:37:59.480 we're able to make any observations of kind of the 749 00:37:59.519 --> 00:38:01.760 temperature in the room at the time that you got 750 00:38:01.800 --> 00:38:04.480 in there. Yes, it was very hot in the room, okay, 751 00:38:04.559 --> 00:38:07.639 in that blanket that you observed. Were you ware that 752 00:38:07.679 --> 00:38:10.760 blanket was to kind of bring her body temperature up? Yes. 753 00:38:14.360 --> 00:38:18.400 When you were able to view her arms when you 754 00:38:18.480 --> 00:38:20.599 first saw them, did they have anything on them? 755 00:38:21.440 --> 00:38:25.960 There was a red brown stain on her hands and 756 00:38:26.000 --> 00:38:28.599 there was gauze on like her wrist area. 757 00:38:29.239 --> 00:38:31.159 Did you enlist the help of the medical staff to 758 00:38:31.199 --> 00:38:32.440 remove the gauze? Yes? 759 00:38:32.519 --> 00:38:35.320 And why was that to document any injuries that might 760 00:38:35.360 --> 00:38:38.280 have been underneath? And were you able to observe injuries? 761 00:38:38.440 --> 00:38:38.719 Yes? 762 00:38:42.360 --> 00:38:46.760 In addition to well strict that the injuries that you 763 00:38:46.800 --> 00:38:49.719 observed are the areas of the body that you documented. 764 00:38:49.719 --> 00:38:52.000 What were they I documented? 765 00:38:52.920 --> 00:38:55.079 I took that first overall photo of her. I took 766 00:38:55.119 --> 00:38:58.000 a close up of her face and the neck area 767 00:38:58.000 --> 00:39:01.559 that I could see. I documented both her hands, both 768 00:39:01.599 --> 00:39:05.400 sides of them, her wrist area underneath where the gauze was, 769 00:39:05.840 --> 00:39:09.119 and then the nurses assisted in opening up the neck brace, 770 00:39:09.159 --> 00:39:10.920 and I took photos of her neck as well. 771 00:39:12.199 --> 00:39:16.320 And in addition to documenting the defendant herself, did you 772 00:39:16.440 --> 00:39:20.000 document any other items that were at the Celsher hospital 773 00:39:20.039 --> 00:39:20.880 that evening? Yes? 774 00:39:20.920 --> 00:39:23.800 I documented any personal belongings that were brought in with her. 775 00:39:24.280 --> 00:39:28.920 And so you're aware that they removed clothing from her. Yes, 776 00:39:29.159 --> 00:39:32.119 and so you documented the clothing correct, and that she 777 00:39:32.199 --> 00:39:35.400 had two rings, yes, and that you photograph those rings. 778 00:39:35.440 --> 00:39:35.679 Yes. 779 00:39:35.880 --> 00:39:39.679 And you're where Trooper Lawler had retained those items. 780 00:39:40.440 --> 00:39:42.679 I'm not sure who retained them from there, okay, but 781 00:39:42.800 --> 00:39:45.559 your role was just to document them, correct. 782 00:39:45.599 --> 00:39:46.519 I didn't take anything. 783 00:39:46.719 --> 00:39:47.039 Okay. 784 00:39:48.320 --> 00:39:51.360 In really regards to this particular well, go back for 785 00:39:51.400 --> 00:39:56.440 one second. In the crime lab, how do your unit 786 00:39:56.559 --> 00:39:59.360 or how do you identify particular cases that you work. 787 00:39:59.239 --> 00:40:03.599 On, as in like being called out to something? 788 00:40:03.760 --> 00:40:06.000 Well, is there a way that you once you get 789 00:40:06.039 --> 00:40:09.039 called out to a case and do work on a case, 790 00:40:09.400 --> 00:40:11.320 is there a way to track what you did with 791 00:40:11.360 --> 00:40:14.599 each case by some sort of case number or lab number. 792 00:40:14.679 --> 00:40:16.480 Yes, we have a case number associated with it. 793 00:40:16.639 --> 00:40:19.800 And as far as lab numbers go, you're aware that 794 00:40:20.440 --> 00:40:24.880 the crime lab follows pieces of evidence using the same 795 00:40:25.800 --> 00:40:26.320 lab number. 796 00:40:26.400 --> 00:40:27.079 Yes, that's correct. 797 00:40:27.199 --> 00:40:31.400 And does that track items that go through your system? 798 00:40:31.480 --> 00:40:36.000 Yes, So our lab number goes into a computer system 799 00:40:36.000 --> 00:40:38.800 and it tracks everything. It keeps every report written on 800 00:40:38.840 --> 00:40:42.159 that case, it tracks the custody logs, it tracks every 801 00:40:42.159 --> 00:40:44.119 piece of evidence that's been involved in the case. 802 00:40:44.400 --> 00:40:45.119 If it helps you. 803 00:40:45.400 --> 00:40:48.079 There's no issue is to change a custody or foundation 804 00:40:48.199 --> 00:40:48.960 or anything like that. 805 00:40:49.199 --> 00:40:50.360 All right, thank you, thank you. 806 00:40:52.840 --> 00:40:55.679 Other than going out to the Sostra Hospital on January 807 00:40:55.719 --> 00:40:58.880 twenty fourth, do your call being called out to another 808 00:40:58.960 --> 00:41:02.599 location later in relation to the same lab number. Yes, 809 00:41:02.920 --> 00:41:05.199 and that would have been on January sixth, twenty twenty three. 810 00:41:05.239 --> 00:41:08.679 February sixth, excuse me, February sixth, thank you? So where 811 00:41:08.679 --> 00:41:09.239 did you go? 812 00:41:09.960 --> 00:41:14.320 I was called to the Plymouth Detective Unit's office in Brockton. 813 00:41:15.199 --> 00:41:19.719 And did you me or speak with one of the 814 00:41:19.840 --> 00:41:21.119 troopers from that office? 815 00:41:21.239 --> 00:41:21.400 Yes? 816 00:41:21.440 --> 00:41:22.400 I did, Trooper Rabbit. 817 00:41:22.559 --> 00:41:25.760 Trooper Rabbit, And what did he ask you to do 818 00:41:26.119 --> 00:41:26.679 on that day? 819 00:41:27.559 --> 00:41:31.760 He asked me to photograph a bag of medication and 820 00:41:31.800 --> 00:41:34.280 some documents that were inside that bag that had been. 821 00:41:34.119 --> 00:41:35.000 Brought to their office. 822 00:41:36.039 --> 00:41:38.880 And did you do anything else with the items that 823 00:41:38.920 --> 00:41:44.559 Trooper Rabbit had in his possession on January excuse me, February. 824 00:41:43.920 --> 00:41:47.360 Sixth, No, I just photographed them and left them with them. 825 00:41:47.760 --> 00:41:51.239 And again, is that something that your unit sometimes is 826 00:41:51.280 --> 00:41:55.079 called out to do? Yes? I think further? 827 00:41:56.079 --> 00:41:56.719 Could you raising? 828 00:42:00.159 --> 00:42:00.239 So? 829 00:42:02.320 --> 00:42:06.639 Is it trooper or you a chemist or sergeant? Sorry Tragian? 830 00:42:06.800 --> 00:42:08.960 You had a search warrant. Apparently when you went into 831 00:42:09.000 --> 00:42:11.000 the house. I guess with Trooper Rabbit. 832 00:42:11.159 --> 00:42:12.159 I didn't go into the house. 833 00:42:12.360 --> 00:42:14.559 Oh so he just gave you the bag. In other words, 834 00:42:14.599 --> 00:42:16.239 you didn't go in the house and take pictures of 835 00:42:16.239 --> 00:42:17.719 any of the rooms or anything like that. 836 00:42:17.840 --> 00:42:20.039 No, the bag was at their office when I went 837 00:42:20.159 --> 00:42:20.840 to the Oh. 838 00:42:20.960 --> 00:42:23.320 Okay, all right, it's all we have. 839 00:42:23.400 --> 00:42:25.800 Thank you, anything anything further turning buck? 840 00:42:25.880 --> 00:42:26.039 Yeah? 841 00:42:26.440 --> 00:42:31.719 No, thanks, all right, thank you, sir, thank you. 842 00:42:32.079 --> 00:42:32.280 Yeah. 843 00:42:32.320 --> 00:42:35.679 Please, And so I'm going to ask you go back. 844 00:42:35.679 --> 00:42:38.559 We'll get you back in here in a short while. Okay, 845 00:42:38.599 --> 00:42:40.440 thank you. 846 00:42:40.480 --> 00:42:46.639 All right, all. 847 00:42:46.559 --> 00:42:49.440 Right, so we'll be in recess on this matter as time. 848 00:42:49.519 --> 00:42:54.159 Thank you. All right. 849 00:42:55.719 --> 00:42:58.480 Going back to January of twenty twenty three, were you 850 00:42:58.519 --> 00:43:02.079 working in that same unity and what was the shift 851 00:43:02.079 --> 00:43:03.039 that you normally worked? 852 00:43:03.199 --> 00:43:06.199 I worked the night shift, which is seven pm seven am. 853 00:43:06.920 --> 00:43:09.400 And do you what was your schedule like for any 854 00:43:09.400 --> 00:43:12.119 given week. Did you work back to back shifts. 855 00:43:11.760 --> 00:43:15.880 Or I can sometimes work back to back shifts. 856 00:43:15.599 --> 00:43:20.000 Okay, but you always worked the night shift, the night shift. 857 00:43:20.039 --> 00:43:20.480 Okay. 858 00:43:20.920 --> 00:43:24.360 I'm going to draw your attention to a particular patient 859 00:43:24.760 --> 00:43:28.599 that you had some interaction with in January of twenty 860 00:43:28.599 --> 00:43:31.360 twenty three, and that was Lindsay Clancy. Do you recall 861 00:43:31.400 --> 00:43:31.920 treating her? 862 00:43:32.159 --> 00:43:32.440 Yes? 863 00:43:32.880 --> 00:43:37.880 And was she in that traumasurgical intensive care unit? 864 00:43:38.159 --> 00:43:38.400 Yes? 865 00:43:39.559 --> 00:43:43.199 Do you remember the first time you interacted with her? 866 00:43:43.880 --> 00:43:44.920 Yes? I got her. 867 00:43:45.159 --> 00:43:47.079 And would that have been on the first night she 868 00:43:47.119 --> 00:43:48.559 was there on January twenty fourth? 869 00:43:48.679 --> 00:43:48.920 Yes? 870 00:43:50.239 --> 00:43:54.000 How did she come to your unit at the Brigham She. 871 00:43:53.960 --> 00:43:59.000 Came from the emergency room, went to MRI, then came 872 00:43:59.039 --> 00:43:59.880 to th THEEO to. 873 00:43:59.840 --> 00:44:03.440 Me and were you aware that she had been seen 874 00:44:03.480 --> 00:44:07.360 at a local hospital in Weymouth, the South Shore Hospital 875 00:44:07.400 --> 00:44:15.639 Shore while you were treating her on that first night? 876 00:44:16.280 --> 00:44:19.280 Were you the main nurse assigned to her care? 877 00:44:19.519 --> 00:44:19.840 Yes? 878 00:44:20.280 --> 00:44:24.159 And what were your responsibilities as the nurse assigned to 879 00:44:24.199 --> 00:44:25.440 her care on that first night? 880 00:44:26.079 --> 00:44:30.280 First night she was intubated, came to be intubated, We 881 00:44:30.360 --> 00:44:33.320 had to maintain our book pressure at a certain number. 882 00:44:34.760 --> 00:44:37.480 Just care, regular nursing care, okay. 883 00:44:37.519 --> 00:44:39.360 And were you aware that she was on what's called 884 00:44:39.360 --> 00:44:42.880 the one to one Yes? What does that mean? 885 00:44:43.519 --> 00:44:48.159 That means patient usually can't be left alone and also 886 00:44:48.519 --> 00:44:52.880 depending you always have to have somebody outside the room 887 00:44:52.960 --> 00:44:55.559 with a certain monitor of the patient and. 888 00:44:55.599 --> 00:44:57.920 Is that because that patient has been identified as a 889 00:44:57.920 --> 00:45:05.400 potential suicide risk. Yes, Now, on that the twenty fourth 890 00:45:05.440 --> 00:45:07.480 into the early morning, I was at the twenty fifth. 891 00:45:07.880 --> 00:45:10.400 Was there a particular event that you were witnessed to 892 00:45:10.480 --> 00:45:11.599 for this particular patient? 893 00:45:12.360 --> 00:45:13.199 She coded? 894 00:45:13.679 --> 00:45:14.440 What does that mean? 895 00:45:14.880 --> 00:45:19.000 Means her blood pressure dropped? For her, it meant her 896 00:45:19.039 --> 00:45:22.440 blood pressure dropped and it wasn't sustainable work life. 897 00:45:22.559 --> 00:45:25.400 So what did you do when her blood pressure fell 898 00:45:25.679 --> 00:45:26.360 and she coded? 899 00:45:26.719 --> 00:45:31.320 We started CPR, We did compressions. 900 00:45:31.079 --> 00:45:34.320 And this event occurred approximately at three thirty in the morning. 901 00:45:34.360 --> 00:45:34.719 Correct. 902 00:45:34.800 --> 00:45:35.119 Yes? 903 00:45:36.159 --> 00:45:38.519 Was she eventually stabilized after that code? 904 00:45:38.719 --> 00:45:39.119 She was? 905 00:45:39.559 --> 00:45:42.360 And did they do something as far as intervention to 906 00:45:42.360 --> 00:45:44.000 try to maintain her blood pressure? 907 00:45:44.400 --> 00:45:51.440 We increased her pressers. We added two more presses, she 908 00:45:51.480 --> 00:45:56.280 was already on two. They placed chest tubes and started 909 00:45:56.679 --> 00:45:59.440 what we call a mass of blood transfusion. 910 00:46:00.440 --> 00:46:00.960 Protocol. 911 00:46:01.800 --> 00:46:02.320 And did this. 912 00:46:02.360 --> 00:46:05.719 All occur in the trauma surgical intensive care unit or 913 00:46:05.719 --> 00:46:07.599 did she have to be taken to a different unit? 914 00:46:07.679 --> 00:46:08.679 It all occurred in her. 915 00:46:11.119 --> 00:46:14.079 And other than medical staff that was treating her that 916 00:46:14.119 --> 00:46:17.000 particular night, did you observe anybody else present? 917 00:46:18.880 --> 00:46:22.159 She had two police officers outside. 918 00:46:21.800 --> 00:46:24.039 The room, okay, And so did they remain outside the 919 00:46:24.119 --> 00:46:24.840 room for the duration? 920 00:46:25.079 --> 00:46:25.239 Oh? 921 00:46:25.360 --> 00:46:26.400 Is that side the room? Yes? 922 00:46:27.440 --> 00:46:31.360 As far as your interaction with the patient of that 923 00:46:31.400 --> 00:46:35.519 particular night shift, was she responsive at all during the 924 00:46:35.559 --> 00:46:39.880 time that you saw her? And with intubation you mentioned 925 00:46:39.880 --> 00:46:43.760 she was intubated. Is a patient often sedated in order 926 00:46:43.880 --> 00:46:46.320 to maintain intubation? Why is that. 927 00:46:47.920 --> 00:46:52.039 Helps them not fight the vent and breathe better and 928 00:46:52.079 --> 00:46:54.000 make sure that they're comfortable? 929 00:46:54.639 --> 00:46:57.599 And what does sedation do to an individual. 930 00:46:58.039 --> 00:47:00.199 Your calmer, you're sleeping. 931 00:47:01.239 --> 00:47:09.840 Make them more relaxed. Other than that night, that first night, 932 00:47:09.880 --> 00:47:12.119 the twenty fourth into the twenty fifth, did you have 933 00:47:12.159 --> 00:47:15.800 the occasion to treat this patient at other points within 934 00:47:15.840 --> 00:47:16.159 that week? 935 00:47:16.760 --> 00:47:16.960 Yes? 936 00:47:17.480 --> 00:47:17.679 I have. 937 00:47:17.840 --> 00:47:23.079 And I'm gonna draw your attention to January twenty sixth 938 00:47:23.320 --> 00:47:28.000 of twenty twenty three. Do you recall interacting with her 939 00:47:28.039 --> 00:47:28.559 on that day? 940 00:47:29.320 --> 00:47:29.679 Yes? 941 00:47:30.480 --> 00:47:33.119 And is it fair to say that on the twenty 942 00:47:33.159 --> 00:47:38.760 six she was still intubated and under sedation. Yes, Well, 943 00:47:39.360 --> 00:47:44.000 during this time period on the twenty sixth, was she arousable, 944 00:47:44.119 --> 00:47:48.639 meaning could you initiate some communication with her some yes? 945 00:47:48.920 --> 00:47:51.440 And were you able to kind of give her commands 946 00:47:51.559 --> 00:47:53.840 in order to care for her that she was able 947 00:47:53.880 --> 00:47:56.880 to follow. Yes, And when I say able. 948 00:47:56.679 --> 00:47:59.760 To follow obviously simple commands. 949 00:48:00.199 --> 00:48:01.000 What kinds of. 950 00:48:02.840 --> 00:48:05.800 A neuro check to just make sure she's alert and 951 00:48:05.800 --> 00:48:08.480 she's able to follow, understand what you're saying to her. 952 00:48:08.960 --> 00:48:12.079 And for this particular patient, you're aware that she presented 953 00:48:12.119 --> 00:48:15.039 with a spinal injury. Correct. Correct, And so movement of 954 00:48:15.079 --> 00:48:18.440 the explower extremities was not something that she did. 955 00:48:18.599 --> 00:48:18.960 Correct. 956 00:48:19.000 --> 00:48:21.519 But did you observe her to move her head around 957 00:48:21.599 --> 00:48:22.679 and move her arms around? 958 00:48:23.000 --> 00:48:23.320 Yes? 959 00:48:26.239 --> 00:48:28.920 Now, you also had the occasion to treat her in 960 00:48:28.960 --> 00:48:32.840 the overnight shift of January twenty eighth of twenty twenty three, correct, Yes, 961 00:48:33.440 --> 00:48:37.840 And during that time she was also still intubated. 962 00:48:38.599 --> 00:48:41.280 I believe, so, I'm not sure I've had her both 963 00:48:41.280 --> 00:48:42.000 intubated and. 964 00:48:42.800 --> 00:48:48.559 Okay, while she was still intubated, did you have a 965 00:48:48.599 --> 00:48:51.719 system that you could use to communicate with her. 966 00:48:54.239 --> 00:48:58.079 Yes. Board. We have a whiteboard or clear board that 967 00:48:58.320 --> 00:49:00.639 sometimes patients can right on. 968 00:49:01.280 --> 00:49:04.360 Did you observe her to utilize that whiteboard to write 969 00:49:04.360 --> 00:49:04.639 on it? 970 00:49:04.800 --> 00:49:05.079 Yes? 971 00:49:05.719 --> 00:49:11.440 And at this point when she's writing on the board, 972 00:49:11.480 --> 00:49:14.199 she's now her eyes are open and she's responsive. Yes, 973 00:49:15.039 --> 00:49:18.280 and she's able to tell you how she's feeling. Correct 974 00:49:19.039 --> 00:49:21.599 and fair to say she used that whiteboard to tell 975 00:49:21.599 --> 00:49:24.079 you she was confused and that she couldn't fail her 976 00:49:24.119 --> 00:49:27.760 lower extremities. And do you recall her complaining of having pain? 977 00:49:28.880 --> 00:49:30.000 I don't recall. 978 00:49:35.039 --> 00:49:38.320 During this time period of the twenty eighth. Do you 979 00:49:38.440 --> 00:49:42.320 recall whether the patient was placed into restraints? 980 00:49:42.840 --> 00:49:43.079 Yes? 981 00:49:43.280 --> 00:49:43.960 And why was that? 982 00:49:45.039 --> 00:49:48.519 Well, we restrain all patients that are intubated, So. 983 00:49:49.880 --> 00:49:53.880 On this particular night, the second she made a request 984 00:49:53.920 --> 00:49:55.800 of you for her lawyer. Correct? 985 00:49:55.960 --> 00:49:56.119 Yes? 986 00:49:56.440 --> 00:49:58.039 Was that something she had asked you before? 987 00:49:58.440 --> 00:49:58.559 No? 988 00:49:59.119 --> 00:50:03.639 And so did you think it was something worth noting? 989 00:50:03.840 --> 00:50:04.199 Yes? 990 00:50:04.440 --> 00:50:07.239 Why would you note something like that because. 991 00:50:06.960 --> 00:50:10.079 That was the first time she referred to anything going 992 00:50:10.119 --> 00:50:11.599 on with the case. 993 00:50:12.679 --> 00:50:18.159 And this was not a conversation you'd had before. What 994 00:50:18.239 --> 00:50:20.119 did you do when she made that request? What was 995 00:50:20.159 --> 00:50:20.840 your response? 996 00:50:22.079 --> 00:50:25.119 I sent what we call a consult to the social 997 00:50:25.119 --> 00:50:28.400 worker in order to coordinate reaching out to her lawyer. 998 00:50:29.480 --> 00:50:32.360 In any of the shifts that you had been caring 999 00:50:32.519 --> 00:50:37.880 for this particular patient, did you see anyone besides medical 1000 00:50:37.920 --> 00:50:40.360 staff and the law enforcement that were outside of the 1001 00:50:40.440 --> 00:50:42.480 room come in and speak with her. 1002 00:50:42.880 --> 00:50:42.960 No? 1003 00:50:46.400 --> 00:50:50.079 Were you aware that she was not to have visitors 1004 00:50:51.039 --> 00:50:53.880 to the first night and is that something that you've 1005 00:50:53.920 --> 00:50:55.880 seen before in your work as a nurse one there 1006 00:50:55.920 --> 00:50:57.480 are police on site? 1007 00:50:57.679 --> 00:50:58.000 Yes? 1008 00:51:00.639 --> 00:51:07.039 Were you present at one point when some troopers came 1009 00:51:07.079 --> 00:51:08.360 in to take photographs of her? 1010 00:51:08.599 --> 00:51:08.960 Yes? 1011 00:51:11.079 --> 00:51:14.400 And were you in the room when they took the photographs? 1012 00:51:14.840 --> 00:51:19.119 Do you recall assisting them in viewing the injuries to 1013 00:51:19.199 --> 00:51:20.199 her wrists in her neck? 1014 00:51:22.119 --> 00:51:25.079 I don't know if I I don't remember. 1015 00:51:24.760 --> 00:51:29.159 Assisting, okay, but you were present with. 1016 00:51:29.079 --> 00:51:35.000 Her and fair to say your contact ended with this 1017 00:51:35.079 --> 00:51:38.639 patient on February third, when she was transferred off of 1018 00:51:38.679 --> 00:51:45.119 the Trauma Surgical ic US unit. Yes, so one moment. Now, 1019 00:51:45.480 --> 00:51:47.960 you were not the only nurse to treat her on 1020 00:51:48.000 --> 00:51:50.960 the night shift, correct, So on days that you didn't work, 1021 00:51:51.000 --> 00:51:54.519 another nurse treated her. And were you familiar with the 1022 00:51:54.639 --> 00:51:56.880 nurse who was generally assigned to treat her during the 1023 00:51:56.960 --> 00:51:58.440 day and who was that? 1024 00:51:58.960 --> 00:51:59.880 Megan Colin? 1025 00:52:00.199 --> 00:52:03.360 Megan Collins? And is it fair to say that with 1026 00:52:03.639 --> 00:52:08.559 the law enforcement presence and this patient's particular situation, the 1027 00:52:08.599 --> 00:52:11.360 amount of medical staff that we're treating her on a 1028 00:52:11.400 --> 00:52:14.360 regular basis was fairly limited, meaning it was the same 1029 00:52:14.360 --> 00:52:15.119 people of the time. 1030 00:52:15.960 --> 00:52:20.440 Thank you, pretty ready morning. 1031 00:52:23.360 --> 00:52:34.320 First of all, calm all thing objection, Hm. 1032 00:52:37.639 --> 00:52:39.280 I actually have those on a disc. I was going 1033 00:52:39.360 --> 00:52:41.880 to put the disc in instead of all the paper. 1034 00:52:42.280 --> 00:52:45.760 Well we put both. What we put both in, we 1035 00:52:45.800 --> 00:52:46.519 could do A and B. 1036 00:52:47.719 --> 00:52:54.480 Thank you, Yes, lawyer first, since that was the last 1037 00:52:54.960 --> 00:52:58.159 that they asked you about. And correctly, if I'm wrong 1038 00:52:58.199 --> 00:53:03.559 on any of these dates are acts. She was admitted 1039 00:53:03.599 --> 00:53:06.000 on the twenty fourth of January. Is that correct? 1040 00:53:06.400 --> 00:53:06.760 Yes? 1041 00:53:07.440 --> 00:53:09.679 And do you have do you have a memory of so? 1042 00:53:09.760 --> 00:53:11.960 Approximately what time was it in the evening? 1043 00:53:13.599 --> 00:53:16.320 Well she got to the ICO was around three. 1044 00:53:16.480 --> 00:53:20.920 Okay, you're very soft spoken. Sorry, you can just keep 1045 00:53:20.920 --> 00:53:22.880 your voice up as. 1046 00:53:22.719 --> 00:53:25.079 She got to the ICO around three am. 1047 00:53:25.239 --> 00:53:27.119 Thank you. And she came by midflight. 1048 00:53:28.199 --> 00:53:31.960 She came to me from MRI, and MRI obviously would 1049 00:53:31.960 --> 00:53:36.119 be when you're taking the pictures, and that would be 1050 00:53:36.159 --> 00:53:39.400 on the twenty fourth of January in the early morning hours, correct. 1051 00:53:39.920 --> 00:53:41.920 I think it went into the twenty fifth. 1052 00:53:41.639 --> 00:53:46.639 Into the twenty fifth, I think so. Console asked you 1053 00:53:46.760 --> 00:53:52.639 about the whiteboard that she would write on, and I 1054 00:53:52.679 --> 00:53:54.920 think it was again if I'm wrong, correctly, it was 1055 00:53:54.960 --> 00:53:59.519 the January twenty eighth that she used for the first time. 1056 00:53:59.599 --> 00:54:01.400 The white board to communicate. 1057 00:54:02.320 --> 00:54:06.039 Yes, and the white board basically is just a white board, 1058 00:54:06.400 --> 00:54:07.079 and you're right on it. 1059 00:54:08.599 --> 00:54:11.920 And she was not able to speak because she was intubated. 1060 00:54:11.360 --> 00:54:13.679 Right, yes, And she was in the restraints that you've 1061 00:54:13.719 --> 00:54:19.880 described as well, right right. Moving forward January twenty eighth, 1062 00:54:20.239 --> 00:54:26.800 twenty nine thirty into February first, February second. It was 1063 00:54:26.840 --> 00:54:31.199 on February second the council asked you about her asking 1064 00:54:31.280 --> 00:54:35.559 to reach out to her lawyer. Correct, yes, And do 1065 00:54:35.679 --> 00:54:38.440 you know who her lawyer was at that time? Now 1066 00:54:39.280 --> 00:54:40.559 had you seen him before? 1067 00:54:40.880 --> 00:54:40.920 No? 1068 00:54:41.840 --> 00:54:45.840 Did you know as the name Attorney Gelb? Now make 1069 00:54:45.880 --> 00:54:50.440 any reference to you. Do you know that whether or 1070 00:54:50.480 --> 00:54:55.199 not she had conversation with Attorney Gelb regarding her status 1071 00:54:55.199 --> 00:54:58.000 as being under arrest by the numerous police that were. 1072 00:54:57.920 --> 00:54:58.679 Guiding the Roman. 1073 00:54:59.000 --> 00:54:59.400 I don't. 1074 00:55:00.639 --> 00:55:03.239 Do you know whether or not she was ever able 1075 00:55:03.280 --> 00:55:05.960 to talk to attorney Galbo or did you refer her 1076 00:55:06.000 --> 00:55:07.840 to the social worker people. 1077 00:55:08.280 --> 00:55:11.159 I've put in a concept for the social worker. 1078 00:55:11.039 --> 00:55:11.880 Okay, thank you. 1079 00:55:14.960 --> 00:55:20.519 When she was admitted on the twenty fourth, would you 1080 00:55:20.599 --> 00:55:26.440 agree that she was in the state of cardiac arrest shortly. 1081 00:55:26.079 --> 00:55:28.880 Thereafter, shortly after arriving to me. 1082 00:55:30.039 --> 00:55:32.920 So I'm looking at the medical records that have been 1083 00:55:32.920 --> 00:55:40.159 introduced for the jurors, and I'm referencing on page. 1084 00:55:40.360 --> 00:55:41.840 Eighteen if I may. 1085 00:55:43.079 --> 00:55:51.719 Now there's one page of four hundred pages of medical records. 1086 00:55:51.840 --> 00:55:52.639 Can you see them? 1087 00:55:53.239 --> 00:55:54.039 But I. 1088 00:55:56.039 --> 00:56:03.920 Looking at this came the SICU. 1089 00:56:04.159 --> 00:56:04.840 Of course. 1090 00:56:06.840 --> 00:56:11.719 I see you, serrical Ice, and that makes reference. 1091 00:56:11.440 --> 00:56:16.119 To the fact that shortly after arriving in the ICU, 1092 00:56:16.639 --> 00:56:17.559 the patient had. 1093 00:56:17.440 --> 00:56:18.400 A cardiac arrest. 1094 00:56:19.440 --> 00:56:22.159 Yes you there, then I was. 1095 00:56:22.840 --> 00:56:26.159 And when it says the ideology of the arrest, she 1096 00:56:26.280 --> 00:56:29.760 got two rounds of CPR before obtaining r O s C. 1097 00:56:29.960 --> 00:56:32.719 Can you tell me please what a CPR? Two rounds 1098 00:56:32.760 --> 00:56:33.559 of what is RROS? 1099 00:56:33.960 --> 00:56:37.159 Meaning? We did chest compression. She was already intubated, so 1100 00:56:37.280 --> 00:56:38.760 she was getting oxygen. 1101 00:56:38.599 --> 00:56:44.400 Okay, And then bilateral chest tubes were placed in her body. 1102 00:56:45.239 --> 00:56:47.440 Yes, does that mean from both both sides? 1103 00:56:47.639 --> 00:56:47.960 Okay? 1104 00:56:48.119 --> 00:56:50.559 And they punctures through the chest into what the lungs, 1105 00:56:50.679 --> 00:56:56.119 the ones and when they placed the chest tubes at 1106 00:56:56.159 --> 00:56:58.719 this point shortly after admission, there was one hundred to 1107 00:56:58.920 --> 00:57:03.119 three hundreds of blood from each chest to. 1108 00:57:04.719 --> 00:57:05.360 What does that mean? 1109 00:57:06.440 --> 00:57:08.800 That's the output they got once they put the chest again? 1110 00:57:09.119 --> 00:57:11.360 Can you that's the output they got once they put 1111 00:57:11.400 --> 00:57:12.000 the chest to bin. 1112 00:57:12.719 --> 00:57:15.440 Okay, So when they put the chest to again, a 1113 00:57:15.559 --> 00:57:18.679 drained one hundred to three hundred c seeds of blood? 1114 00:57:18.719 --> 00:57:19.239 Is that correct? 1115 00:57:19.800 --> 00:57:20.159 Correct? 1116 00:57:20.719 --> 00:57:24.320 And then after that again shortly after admission to the hospital, 1117 00:57:24.440 --> 00:57:28.239 coming from south Shore Hospital, she then got a massive 1118 00:57:28.440 --> 00:57:32.639 transfusion protocol which you told us about, right, Yes? What 1119 00:57:32.719 --> 00:57:33.239 does that mean? 1120 00:57:34.519 --> 00:57:38.519 Means she gets we have a protocol that but blood 1121 00:57:39.320 --> 00:57:40.559 depending blood products? 1122 00:57:40.880 --> 00:57:41.199 Okay? 1123 00:57:41.760 --> 00:57:43.519 She had some piers rapidly. 1124 00:57:44.679 --> 00:57:49.800 And was there a notice shortly after arrival to the 1125 00:57:50.079 --> 00:57:54.079 ICU she was being turned and had thirty c seeds 1126 00:57:54.159 --> 00:57:55.840 of clear fluid that came out. 1127 00:57:55.719 --> 00:57:56.360 Of her nose? 1128 00:57:56.519 --> 00:57:56.960 Is that right? 1129 00:57:57.199 --> 00:57:57.360 Yes? 1130 00:57:58.079 --> 00:57:59.480 And what is that is that? 1131 00:58:00.079 --> 00:58:02.679 Was there a suspicion that that was see it? What's 1132 00:58:02.719 --> 00:58:03.480 called CSF? 1133 00:58:04.320 --> 00:58:04.519 Yes? 1134 00:58:04.840 --> 00:58:05.880 And what is CSF? 1135 00:58:07.320 --> 00:58:08.280 It's final fluid? 1136 00:58:08.679 --> 00:58:12.000 Okay. Going to the next. 1137 00:58:11.920 --> 00:58:17.480 Page, which would be nineteen, does it indicate again on there? 1138 00:58:18.760 --> 00:58:20.880 If I can just bring this up a little bit better. 1139 00:58:22.039 --> 00:58:27.039 So she now has noted acute blood loss anemia? 1140 00:58:27.320 --> 00:58:27.480 Right? 1141 00:58:28.360 --> 00:58:28.960 What does that mean? 1142 00:58:29.800 --> 00:58:30.960 She has a low blood count? 1143 00:58:31.760 --> 00:58:34.480 And you know what happened to the blood or any idea? 1144 00:58:34.800 --> 00:58:35.159 I did not? 1145 00:58:36.239 --> 00:58:40.079 So she had very low, lost a lot of blood, right, yes, 1146 00:58:42.960 --> 00:58:45.360 And she had anemia that would be what low blood 1147 00:58:45.400 --> 00:58:45.719 or something? 1148 00:58:46.119 --> 00:58:46.280 Yes? 1149 00:58:47.159 --> 00:58:51.239 And she required multiple transfusions immediately. 1150 00:58:50.719 --> 00:58:52.880 Following her arrest, right yes. 1151 00:58:53.599 --> 00:58:55.920 And when it says arrest, does that mean arrest by 1152 00:58:55.960 --> 00:58:58.239 the police, that does that mean the kid? I want 1153 00:58:58.280 --> 00:58:59.079 to make sure that's clear. 1154 00:58:59.079 --> 00:59:02.960 It's kydiac arrests nothing to do with the police. And 1155 00:59:03.159 --> 00:59:11.280 she had massively required multiple transfusions that yes. Were you 1156 00:59:11.480 --> 00:59:14.840 aware of the extent of the after you have the 1157 00:59:15.039 --> 00:59:17.480 X ray not X rays, after you have the MRIs 1158 00:59:18.360 --> 00:59:21.880 and the catskins. Were you aware as her the lead 1159 00:59:22.000 --> 00:59:25.039 nurse or treating nurses to what the extent of her injuries. 1160 00:59:24.639 --> 00:59:29.039 Were at that point? I don't believe. 1161 00:59:29.119 --> 00:59:31.559 So at some point did you become aware of that? 1162 00:59:31.760 --> 00:59:31.920 Yes? 1163 00:59:32.079 --> 00:59:34.840 Okay, so again I've got the records. You don't, so 1164 00:59:35.000 --> 00:59:36.760 let me do it this way, just to make it easy. 1165 00:59:37.239 --> 00:59:39.599 Do you remember that she had a burst fracture of 1166 00:59:39.719 --> 00:59:40.119 C one? 1167 00:59:40.599 --> 00:59:40.800 Yes? 1168 00:59:41.119 --> 00:59:41.760 What does that mean? 1169 00:59:42.599 --> 00:59:45.159 Means a cerebral fracture up here? 1170 00:59:46.360 --> 00:59:50.519 This is the cervical pere and then T five and 1171 00:59:50.639 --> 00:59:53.679 T six it was a transsection. What does that mean? 1172 00:59:53.800 --> 00:59:54.239 Thorassic? 1173 00:59:54.800 --> 00:59:55.079 Okay? 1174 00:59:55.519 --> 00:59:55.800 Fine? 1175 00:59:55.960 --> 00:59:59.280 Down here and when it says transaction, what does that mean? 1176 01:00:00.760 --> 01:00:01.800 It's severed? 1177 01:00:03.519 --> 01:00:04.000 And then T. 1178 01:00:05.639 --> 01:00:09.320 One two, three four, Also we're injured as well, right, 1179 01:00:10.599 --> 01:00:12.880 what is neurogenic shock? 1180 01:00:13.039 --> 01:00:16.679 What does that mean? If you know? 1181 01:00:17.159 --> 01:00:18.480 Neurogenic shock? 1182 01:00:18.679 --> 01:00:20.199 Sorry, yeah, neurogenic shock. 1183 01:00:21.760 --> 01:00:24.679 It just makes reference on these are not my notes, 1184 01:00:24.800 --> 01:00:26.239 so I can't really that's. 1185 01:00:26.400 --> 01:00:32.800 Fine, I understand, And this would be on page sixty five. 1186 01:00:36.800 --> 01:00:41.199 Do you recall reviewing the documentation as to the what's 1187 01:00:41.480 --> 01:00:47.719 captioned present illness in the records? Did you know that 1188 01:00:47.840 --> 01:00:50.679 she was presenting as a transfer from Socio Hospital? 1189 01:00:52.400 --> 01:00:52.599 Yes? 1190 01:00:52.880 --> 01:00:55.880 Did you know that she was that under present illness? 1191 01:00:55.960 --> 01:00:58.280 And the history would be that she's a thirty thirty 1192 01:00:58.280 --> 01:01:03.119 two year old female with history significant for post partum depression. 1193 01:01:03.239 --> 01:01:04.559 Did you know that? Yes? 1194 01:01:05.280 --> 01:01:07.920 And did you know that after the fall with the C. 1195 01:01:08.159 --> 01:01:11.960 One burst fracture and the complex transaction of T five 1196 01:01:12.039 --> 01:01:16.519 and T six she also had rib fraction correct yes, 1197 01:01:19.280 --> 01:01:23.480 on page sixty six. That would make reference to the 1198 01:01:23.639 --> 01:01:28.760 time frame going into the twenty fifth. On the twenty fifth, 1199 01:01:29.159 --> 01:01:33.400 that she was reacting to painful stimuli, right, yes, And 1200 01:01:33.480 --> 01:01:35.920 that basically means that she's not conscious if you will, 1201 01:01:35.960 --> 01:01:37.360 but she's able to react. 1202 01:01:37.079 --> 01:01:39.840 To if you cause pain, yeah, okay. 1203 01:01:43.559 --> 01:01:47.519 There's a notation of a contusion, laceration and crushing of 1204 01:01:47.679 --> 01:01:51.519 the thyroid with thyroidal edema. 1205 01:01:51.840 --> 01:01:52.639 What does that mean. 1206 01:01:54.159 --> 01:01:57.960 She has swelling I'm assuming around her thyroid, okay, and 1207 01:01:58.079 --> 01:02:01.000 that again this is not my scope. 1208 01:02:01.599 --> 01:02:03.079 Okay, okay. 1209 01:02:05.679 --> 01:02:09.840 On page seventy the same evening, making reference to the 1210 01:02:09.920 --> 01:02:14.000 fact that in addition to the injuries to the spine, 1211 01:02:14.039 --> 01:02:16.440 that she also had the rib fractions and was currently 1212 01:02:16.599 --> 01:02:17.159 in shock. 1213 01:02:18.440 --> 01:02:24.320 Do you remember that that she was in shock? Yes? 1214 01:02:24.440 --> 01:02:26.119 No, yes, okay? 1215 01:02:27.159 --> 01:02:29.280 Would you agree or do you recall that there's a 1216 01:02:29.360 --> 01:02:36.440 notation that this patient is critically ill and noting that 1217 01:02:36.599 --> 01:02:40.519 she has postpartum psychosis. On page seventy two. 1218 01:02:43.920 --> 01:02:44.760 They see counseling. 1219 01:02:46.960 --> 01:02:48.800 When you're treating a patient, one. 1220 01:02:48.679 --> 01:02:50.199 Of the things you try to do is to know 1221 01:02:50.360 --> 01:02:55.159 what their total body and emotional condition is, what they've 1222 01:02:55.159 --> 01:02:56.840 been dealing with, and what injuries they have. 1223 01:02:57.199 --> 01:03:01.960 Right, we got a run down history of the patient. 1224 01:03:02.400 --> 01:03:07.039 Sure, and as it goes into the end of January, 1225 01:03:08.559 --> 01:03:11.639 and she had been communicating on the whiteboard, you were 1226 01:03:11.639 --> 01:03:15.920 aware at that point why she was in the hospital, right, Yes, 1227 01:03:16.239 --> 01:03:18.480 you know where she came from social hospital, right? 1228 01:03:18.679 --> 01:03:23.559 Yes, and you knew that there had been there had 1229 01:03:23.599 --> 01:03:28.199 been discussion about postpatum psychosis. Isn't that right? Yes? 1230 01:03:28.639 --> 01:03:28.920 Okay? 1231 01:03:31.760 --> 01:03:34.239 And do you recall that? And this would be on 1232 01:03:37.280 --> 01:03:39.079 and I approach you under the witness. 1233 01:03:40.079 --> 01:03:44.239 Maybe if you could show counsole what I want? 1234 01:03:44.320 --> 01:03:46.440 The date in the time. 1235 01:03:50.280 --> 01:03:54.159 Oh yeah, legal team, So I'll just showing you one 1236 01:03:54.239 --> 01:03:55.519 page for the medical record. 1237 01:03:56.800 --> 01:03:59.280 Can you tell what date is this? 1238 01:03:59.519 --> 01:03:59.800 Page? 1239 01:04:04.159 --> 01:04:04.360 Five? 1240 01:04:05.039 --> 01:04:06.039 January twenty five? 1241 01:04:06.159 --> 01:04:07.679 Yeah, if I ask you, if you keep your voice 1242 01:04:07.719 --> 01:04:08.559 at least speaking out? 1243 01:04:08.679 --> 01:04:13.000 Sorry, yeah, thank you, January twenty fath Okay, say what time? 1244 01:04:13.599 --> 01:04:15.280 Nine am? Nine or three am? 1245 01:04:18.599 --> 01:04:24.320 And looking at that, do you recall on that day 1246 01:04:25.519 --> 01:04:27.199 you have been working with her the night before? 1247 01:04:27.320 --> 01:04:27.679 Correctly? 1248 01:04:27.800 --> 01:04:33.039 Correct where it indicates that patient is under arrest, right, yes, 1249 01:04:34.559 --> 01:04:36.119 A police officers. 1250 01:04:35.719 --> 01:04:37.920 At her bedside outside the rum. 1251 01:04:38.519 --> 01:04:40.679 Well it says at a bedside of the record, isn't. 1252 01:04:40.440 --> 01:04:44.639 It in the record? But I'm saying they are in 1253 01:04:44.760 --> 01:04:45.199 the night. 1254 01:04:45.079 --> 01:04:48.079 Before, they were outside her un outside you were not 1255 01:04:48.320 --> 01:04:52.360 there during the day apparently, right cracked. Okay, And this 1256 01:04:52.599 --> 01:04:55.840 difference from you guys as far as your medical records. 1257 01:04:55.880 --> 01:04:59.599 If the police officer is at the bedside as opposed 1258 01:04:59.639 --> 01:05:02.519 to in the chair in the hallway outside of the room. Yes, 1259 01:05:03.760 --> 01:05:07.760 so indicated police officer ed her bedside. We will involve 1260 01:05:08.039 --> 01:05:13.840 the social work and legal teams, right, yes, And again 1261 01:05:14.239 --> 01:05:18.679 on page seventy two there's a reference to CSF leak 1262 01:05:19.480 --> 01:05:23.480 and that's significant. It's a significant amount of fluid coming 1263 01:05:23.519 --> 01:05:26.440 from her nose. Do you have any memory of observing 1264 01:05:26.519 --> 01:05:28.400 that in your treatment ident? Okay? 1265 01:05:30.360 --> 01:05:32.559 And then of course there was the code event that 1266 01:05:32.679 --> 01:05:36.480 you've already described for us. There's one hundred to three 1267 01:05:36.559 --> 01:05:38.920 hundred c seeds of blood coming from the tubes. And 1268 01:05:38.960 --> 01:05:41.679 then it makes reference to on page seventy four it's 1269 01:05:41.679 --> 01:05:46.360 a massive transfusion protocol. Is that like a medical term 1270 01:05:46.480 --> 01:05:48.400 or is that somebody describing it or. 1271 01:05:48.519 --> 01:05:51.079 It's a medical it's a protocol that we have at 1272 01:05:51.119 --> 01:05:51.960 the hospital. Okay. 1273 01:05:55.480 --> 01:06:00.199 And on page seventy five, did you make reference two 1274 01:06:00.400 --> 01:06:04.719 or did you observe the injuries for example to her wrist? 1275 01:06:06.599 --> 01:06:09.840 I observed, yes, And would you agree with me? 1276 01:06:10.199 --> 01:06:14.440 At page seventy five the medical record indicating if it says, 1277 01:06:14.639 --> 01:06:15.320 are you e. 1278 01:06:15.559 --> 01:06:16.719 What is RUI means? 1279 01:06:16.760 --> 01:06:22.559 You know, write upper extremity, Write upper extremity three point 1280 01:06:22.719 --> 01:06:29.920 five centimeter deep laceration bolar aspect of wrist. Tell me 1281 01:06:30.239 --> 01:06:32.639 what is the bolar aspect of the wrist? 1282 01:06:35.960 --> 01:06:36.480 I just don't know. 1283 01:06:36.599 --> 01:06:39.440 I'm not sure that's fine. 1284 01:06:39.679 --> 01:06:42.119 Would you agree that there was noted a three point 1285 01:06:42.320 --> 01:06:43.800 five centimeter deep. 1286 01:06:43.719 --> 01:06:45.519 Laceration after wrist? 1287 01:06:45.840 --> 01:06:48.320 I can't say if I adn't measure. This is somebody 1288 01:06:48.360 --> 01:06:48.960 else's note. 1289 01:06:50.119 --> 01:06:52.400 Well, when you looked at her, did you observe with 1290 01:06:52.519 --> 01:06:55.239 your own eyes and your own experience that she had 1291 01:06:55.280 --> 01:06:56.760 a deep laceration. 1292 01:06:56.360 --> 01:06:58.519 On the she had her laceration. 1293 01:06:58.800 --> 01:07:00.719 Yes, you can't say it's deep in it. 1294 01:07:01.280 --> 01:07:02.559 I can't say I didn't. 1295 01:07:02.920 --> 01:07:04.400 You want to say it was superficial. 1296 01:07:05.199 --> 01:07:06.159 I can't say that either. 1297 01:07:06.639 --> 01:07:09.559 So when you looked at the laceration on her wrist, 1298 01:07:09.920 --> 01:07:11.679 you can't tell us if you would agree that it 1299 01:07:11.800 --> 01:07:12.840 was a deep laceration. 1300 01:07:15.440 --> 01:07:19.000 I really didn't get to it at the time when 1301 01:07:19.039 --> 01:07:19.559 she arrived. 1302 01:07:20.440 --> 01:07:25.880 Lue underneath that left upper extremity apparently right, Yes, two 1303 01:07:26.000 --> 01:07:29.119 sent to me to deep laceration again on the volar 1304 01:07:29.239 --> 01:07:32.239 aspect of the wrist, you did see laceration. 1305 01:07:31.800 --> 01:07:32.599 Of the risk. 1306 01:07:32.800 --> 01:07:35.440 Yeah, she had dressings, okay. 1307 01:07:39.119 --> 01:07:41.559 And when she was admitted she had the core temperature 1308 01:07:41.559 --> 01:07:43.199 of eighty two degrees? Is that correct? 1309 01:07:44.519 --> 01:07:45.480 If that's what's noted? 1310 01:07:45.800 --> 01:07:45.960 Right? 1311 01:07:46.280 --> 01:07:48.159 Do you remember did they use a bear claw or 1312 01:07:48.239 --> 01:07:49.679 something like that? What is it they call it? 1313 01:07:49.760 --> 01:07:51.480 They put the bear hugger, bear hugger. 1314 01:07:51.519 --> 01:07:53.559 They put a bear hugger blanket on them. 1315 01:07:54.760 --> 01:07:56.440 And when I say them, I mean people that have 1316 01:07:56.559 --> 01:07:58.519 a low, long timetur to warm them up. 1317 01:07:58.559 --> 01:08:01.440 It hopefully raises the tech and then if it has 1318 01:08:01.599 --> 01:08:04.960 warm intervened, I intervened IVF. 1319 01:08:05.320 --> 01:08:08.360 That would be putting warm saline in the. 1320 01:08:08.360 --> 01:08:10.679 Body, yes, through an iv all. 1321 01:08:10.559 --> 01:08:12.360 Right, all with an effort to try to get the 1322 01:08:12.440 --> 01:08:16.159 temperature up. And her core temperature was eighty two degrees, 1323 01:08:16.279 --> 01:08:19.159 even after she was at the South Shore Hospital and 1324 01:08:19.520 --> 01:08:20.960 underneath the bear thing and all that. 1325 01:08:21.159 --> 01:08:24.239 And still I think that's what's noted. Again, that's time. 1326 01:08:24.279 --> 01:08:25.479 I know it's pretty low, isn't it? 1327 01:08:25.600 --> 01:08:25.800 It is? 1328 01:08:31.720 --> 01:08:33.680 And you made reference to pressors. 1329 01:08:33.760 --> 01:08:37.119 I'm sorry, Can you pressors without pressure medication to bring 1330 01:08:37.199 --> 01:08:37.960 up the boot pressure? 1331 01:08:38.079 --> 01:08:47.800 Okay? On January twenty sixth, she was still intubated, is 1332 01:08:47.840 --> 01:08:48.199 that right? 1333 01:08:48.880 --> 01:08:49.079 Yes? 1334 01:08:49.279 --> 01:08:52.520 And she was under sedation right, yes? And then you 1335 01:08:52.640 --> 01:08:58.159 referenced January twenty night, twenty nights January twenty eighth overnight shift. 1336 01:08:58.520 --> 01:09:01.159 She was still intubated, right, yes. 1337 01:09:01.960 --> 01:09:06.239 And January twenty eighth is when she first started utilizing 1338 01:09:06.359 --> 01:09:07.000 the whiteboard. 1339 01:09:07.119 --> 01:09:07.720 Is that correct? 1340 01:09:08.239 --> 01:09:14.399 Yes, but she was intubated, yes, Yes, she was restrained. 1341 01:09:13.880 --> 01:09:19.199 To the bed, yes, and had the tube was still 1342 01:09:19.239 --> 01:09:21.800 in her mouth and she was writing on a whiteboard 1343 01:09:21.920 --> 01:09:22.119 on the. 1344 01:09:22.159 --> 01:09:23.600 Twenty eighth of January. 1345 01:09:23.720 --> 01:09:28.039 Correct, she was able to yes, January thirtieth, she was extubated, 1346 01:09:28.119 --> 01:09:29.920 as the district attorney asked, you rang. 1347 01:09:30.600 --> 01:09:34.119 Yes, So at that point was she able to talk 1348 01:09:34.359 --> 01:09:36.119 like you know, talk talk okay? 1349 01:09:37.479 --> 01:09:41.399 And then on February second is when she used the 1350 01:09:42.439 --> 01:09:45.239 she asked about wanting to reach out to her attorney. 1351 01:09:45.399 --> 01:09:46.000 Is that correct? 1352 01:09:46.199 --> 01:09:48.840 Yes, you had no knowledge as to her mother and 1353 01:09:48.960 --> 01:09:51.119 father getting an attorney for her while she was in 1354 01:09:51.199 --> 01:09:52.520 custody with the police. 1355 01:09:52.239 --> 01:09:52.840 All around her. 1356 01:09:53.439 --> 01:09:56.520 Nope, okay, And you try to help her out as 1357 01:09:56.520 --> 01:09:57.079 best you can. 1358 01:09:57.319 --> 01:10:00.479 To coordinate's harder at night, you know, so to pass 1359 01:10:00.520 --> 01:10:00.720 it on. 1360 01:10:01.600 --> 01:10:05.159 And finally she was not able to have visitors per 1361 01:10:05.239 --> 01:10:06.960 order of the police. Is that correct? 1362 01:10:07.279 --> 01:10:07.600 Correct? 1363 01:10:08.319 --> 01:10:09.920 Thank you very much, man, Thank cam. 1364 01:10:10.640 --> 01:10:20.680 I'most redirect miss sanity the first time that it's going 1365 01:10:20.720 --> 01:10:23.359 to say the defendant, the patient used whiteboard with you 1366 01:10:24.119 --> 01:10:26.920 was on January twenty eighth. Correct. Yes, you're not aware 1367 01:10:27.000 --> 01:10:29.199 of if she used that tool with other nurses on 1368 01:10:29.279 --> 01:10:32.319 other shifts, are you. And the first time that she 1369 01:10:32.520 --> 01:10:35.479 mentioned a lawyer on the February second, that's the first 1370 01:10:35.520 --> 01:10:37.159 time she mentioned a lawyer to you. Correct. 1371 01:10:37.319 --> 01:10:37.640 Correct. 1372 01:10:39.560 --> 01:10:44.039 You were asked about the trauma and the chest tube 1373 01:10:44.079 --> 01:10:47.560 and that she lost one hundred to three hundred c 1374 01:10:47.680 --> 01:10:51.079 seas of blood. Yes, the transfusion came after that, correct. 1375 01:10:51.359 --> 01:10:52.520 Yes, and. 1376 01:10:54.199 --> 01:10:57.399 Fair to say. The course of her treatment coming to 1377 01:10:57.479 --> 01:11:00.359 Brigham was that she first came in through the emergency department, correct, 1378 01:11:01.239 --> 01:11:03.840 Then she was sent for an MRI, and then she 1379 01:11:03.960 --> 01:11:09.960 came to the trauma surgery. Correct. And you're aware that 1380 01:11:10.920 --> 01:11:14.680 she had other imaging like CT scans, correct, And that, 1381 01:11:15.359 --> 01:11:17.520 especially when it came to the head cts, she didn't 1382 01:11:17.560 --> 01:11:23.079 have any intercranial imagery, intercranial injuries, or anything that required 1383 01:11:23.159 --> 01:11:27.359 that you be focused on her head injury correct. Correct, 1384 01:11:27.560 --> 01:11:30.000 So it was more cardiac issue and keeping her stable 1385 01:11:30.720 --> 01:11:32.399 and internal bleeding in the chest area. 1386 01:11:32.640 --> 01:11:32.840 Yes. 1387 01:11:34.680 --> 01:11:39.760 As far as what you're aware of from other treating physicians, 1388 01:11:39.840 --> 01:11:43.359 You're aware doctor Anderson was one of the trauma surgeons 1389 01:11:43.439 --> 01:11:47.640 that were treating was treating the patient. Yes, and he 1390 01:11:47.920 --> 01:11:52.119 was making assessments and giving orders to you and other nurses. Yes. 1391 01:11:52.840 --> 01:11:56.479 And are you aware that he identified in the history 1392 01:11:56.880 --> 01:11:59.920 that this patient actually had a history of postpartum mood SIMPT, 1393 01:12:00.039 --> 01:12:00.880 it's not psychosis. 1394 01:12:01.680 --> 01:12:03.760 I would have to look at the note. I don't remember. 1395 01:12:03.800 --> 01:12:06.600 Those aren't notes that you would have written, and you 1396 01:12:06.760 --> 01:12:08.800 weren't taking a full history of. 1397 01:12:08.840 --> 01:12:09.920 The patient at the time. 1398 01:12:12.920 --> 01:12:16.359 Were you aware that she then subsequently was fully evaluated 1399 01:12:16.479 --> 01:12:18.079 by the psychiatric. 1400 01:12:17.840 --> 01:12:19.840 Team I knew she is so psyched. 1401 01:12:19.920 --> 01:12:20.079 Yes. 1402 01:12:20.359 --> 01:12:24.079 And were you aware that they ultimately identified that there's 1403 01:12:24.079 --> 01:12:26.279 an inherent uncertainty in her diagnosis? 1404 01:12:26.800 --> 01:12:28.279 I do not remember. 1405 01:12:30.199 --> 01:12:33.880 As far as the last lacerations went. In your treatment 1406 01:12:33.960 --> 01:12:37.800 of her, again, you treated her overnight shifts for various days. Correct. 1407 01:12:38.520 --> 01:12:41.079 Did you ever have a situation where you had to 1408 01:12:41.159 --> 01:12:42.840 change her bandages because they were seeping? 1409 01:12:43.600 --> 01:12:43.640 No? 1410 01:12:44.279 --> 01:12:45.199 And are you aware that. 1411 01:12:45.840 --> 01:12:47.840 Except for the first night, but we didn't get to 1412 01:12:47.920 --> 01:12:49.399 that because she coded, because she. 1413 01:12:49.479 --> 01:12:52.479 Coded, And then you're aware that the next day after 1414 01:12:53.079 --> 01:12:58.119 another individual of physicians assistant physician's assistant excuse me, actually 1415 01:12:58.199 --> 01:13:04.840 came in and those lasseres and as far as doctor 1416 01:13:04.920 --> 01:13:07.560 Anderson goes, were you aware that on January twenty fifth, 1417 01:13:07.640 --> 01:13:10.479 he noted that the lacerations to her neck and wrists 1418 01:13:10.520 --> 01:13:12.840 were very superficial and didn't require treatment at. 1419 01:13:12.800 --> 01:13:16.119 That time, I was not aware. I don't remember that note. 1420 01:13:16.840 --> 01:13:17.239 Would you. 1421 01:13:20.000 --> 01:13:22.439 If I showed you the record that that's in his note, 1422 01:13:22.479 --> 01:13:25.319 would you agree that that's an assessment that he made. Yes, 1423 01:13:25.800 --> 01:13:29.079 and he didn't instruct you to do anything further with 1424 01:13:29.159 --> 01:13:29.720 those injuries? 1425 01:13:29.840 --> 01:13:33.079 Yes, right, thank you. 1426 01:13:34.479 --> 01:13:38.600 Very briefully true. Disic attorney asked you about the evaluation 1427 01:13:38.760 --> 01:13:42.399 by the psych as she put at psychiatric teams with 1428 01:13:42.520 --> 01:13:47.600 a determination that there was inherent uncertainty according to the 1429 01:13:47.720 --> 01:13:53.039 psychiatric teams. Do you know when the psychiatric teams were 1430 01:13:53.079 --> 01:13:53.880 evaluating her? 1431 01:13:54.359 --> 01:13:57.000 I don't know. I was after and during the day. 1432 01:13:57.159 --> 01:13:58.159 I don't know what day, But. 1433 01:13:59.079 --> 01:14:01.279 In any event, I did show you and the the 1434 01:14:01.439 --> 01:14:04.199 thing over there, the where the reference was made to 1435 01:14:04.239 --> 01:14:06.520 postpatum depression, post patum psychosis. 1436 01:14:06.640 --> 01:14:06.960 Correct. 1437 01:14:07.880 --> 01:14:08.520 Yes, and. 1438 01:14:12.359 --> 01:14:13.319 It's all heah, thank you man. 1439 01:14:13.880 --> 01:14:16.399 Anything further alright, thank you man, Let me sit down, 1440 01:14:16.439 --> 01:14:25.880 Thank you. Hi. Comma would call Meghan Collins please, Hi, 1441 01:14:26.000 --> 01:14:31.119 good afternoon. Ask you speaking to that microphone, keep your 1442 01:14:31.199 --> 01:14:34.680 voice up. Okay, all right, pre Bucky please. 1443 01:14:34.479 --> 01:14:38.439 Thank you, good afternoon. Hi. Can you please tell the 1444 01:14:38.520 --> 01:14:41.800 juror your first and last name, Meghan Collins? Would you 1445 01:14:41.840 --> 01:14:43.399 mind spollowing your first name for the record? 1446 01:14:43.840 --> 01:14:44.000 M E. 1447 01:14:44.279 --> 01:14:45.239 G H A N. 1448 01:14:46.079 --> 01:14:48.680 Collins C O L L I N S. 1449 01:14:49.039 --> 01:14:50.720 Thank you? And what do you do for work? 1450 01:14:51.159 --> 01:14:52.239 I'm an? I see you nurse? 1451 01:14:52.600 --> 01:14:53.760 And how long have you been a nurse? 1452 01:14:54.159 --> 01:14:55.000 Eleven years? 1453 01:14:55.600 --> 01:14:56.720 And did you go to school for that? 1454 01:14:57.279 --> 01:14:57.439 Yes? 1455 01:14:57.560 --> 01:14:58.039 Where'd you go? 1456 01:14:58.680 --> 01:14:59.279 Sacred Heart? 1457 01:15:01.840 --> 01:15:03.560 What hospital do you currently work at? 1458 01:15:03.880 --> 01:15:06.079 Brigham and Women's and how long have you worked there? 1459 01:15:07.199 --> 01:15:07.800 Eight years? 1460 01:15:10.039 --> 01:15:13.279 In January of twenty twenty three? What unit were you 1461 01:15:13.359 --> 01:15:16.199 working on at the Brigham the trauma Surgical? 1462 01:15:16.239 --> 01:15:16.640 I see you? 1463 01:15:17.600 --> 01:15:18.960 Did you work a particular shift? 1464 01:15:19.640 --> 01:15:19.960 I did? 1465 01:15:20.640 --> 01:15:23.960 And what shift was that? Seven A to seven p? 1466 01:15:24.960 --> 01:15:28.880 So seven am to seven pm? And you just have 1467 01:15:28.960 --> 01:15:32.920 to answer out loud? Sorry, okay, Yes, I'm going to 1468 01:15:33.000 --> 01:15:36.000 draw your attention to a particular patient that was treated 1469 01:15:36.039 --> 01:15:39.119 there beginning on January twenty fourth. Lindsay Clancy, are you 1470 01:15:39.199 --> 01:15:40.199 familiar with that patient? 1471 01:15:40.520 --> 01:15:40.720 Yes? 1472 01:15:41.039 --> 01:15:43.760 Were you a nurse that was treating her during the 1473 01:15:43.920 --> 01:15:45.960 day shift while she was in the ICU? 1474 01:15:46.479 --> 01:15:46.840 I was. 1475 01:15:48.359 --> 01:15:51.640 Are you aware that she arrived at the Brigham Hospital 1476 01:15:51.760 --> 01:15:55.640 on January twenty fourth of twenty twenty three. 1477 01:15:56.399 --> 01:15:59.920 When she was admitted to URICU, it was overnight. 1478 01:16:01.000 --> 01:16:03.520 So as far as the hospital, do you know when 1479 01:16:03.560 --> 01:16:06.600 she arrived at the hospital, I believe the day evening prior. 1480 01:16:07.279 --> 01:16:07.560 And you. 1481 01:16:09.439 --> 01:16:12.600 A patient who comes to your hospital doesn't automatically come 1482 01:16:12.720 --> 01:16:15.800 to the ICU, correct, that's correct? Where did they go first? 1483 01:16:16.399 --> 01:16:18.520 Usually the emergency room? 1484 01:16:19.319 --> 01:16:22.319 And you're aware this particular patient actually went through a 1485 01:16:22.359 --> 01:16:25.760 local hospital before being transferred to the emergency department at 1486 01:16:25.800 --> 01:16:27.920 Brigham and then to the ICU. Correct. 1487 01:16:28.119 --> 01:16:28.479 Correct? 1488 01:16:29.199 --> 01:16:31.960 And so when you interacted whether she had already been 1489 01:16:32.560 --> 01:16:37.840 at the ICU unit for that night shift? Is that 1490 01:16:37.960 --> 01:16:38.520 fair to say? 1491 01:16:39.039 --> 01:16:44.760 Correct? Interacted? She was intubated when she arrived. 1492 01:16:47.079 --> 01:16:51.399 And were you with her the entire day of the 1493 01:16:51.479 --> 01:16:53.920 twenty fifth, from that seven am to seven pm shift? 1494 01:16:54.439 --> 01:16:54.640 Yes? 1495 01:16:55.279 --> 01:16:58.359 And was she on what's called the one to one 1496 01:17:00.079 --> 01:17:00.600 during that day? 1497 01:17:01.039 --> 01:17:01.239 Yes? 1498 01:17:01.800 --> 01:17:04.359 And what does that mean for you as the nurse 1499 01:17:04.760 --> 01:17:05.800 if she's on the one to one? 1500 01:17:06.720 --> 01:17:10.239 She was one to one nursing perra ratios because of 1501 01:17:10.319 --> 01:17:11.279 how critically. 1502 01:17:10.920 --> 01:17:14.359 Ill she was, And so you were there pretty much 1503 01:17:14.399 --> 01:17:15.079 the entire time. 1504 01:17:15.720 --> 01:17:16.079 Correct? 1505 01:17:16.720 --> 01:17:19.560 Were there any other people there other than the medical 1506 01:17:19.640 --> 01:17:23.359 staff in yourself treating her? Were there any other people there? 1507 01:17:25.079 --> 01:17:27.479 There were officers, police officers, and. 1508 01:17:29.399 --> 01:17:30.520 They were outside the room. 1509 01:17:30.960 --> 01:17:31.319 Correct. 1510 01:17:33.840 --> 01:17:36.640 Had you taken overcare of this patient from another nurse 1511 01:17:36.680 --> 01:17:37.359 on the night shift? 1512 01:17:38.199 --> 01:17:38.399 Yes? 1513 01:17:38.600 --> 01:17:40.239 And who was that Rachelle? 1514 01:17:40.920 --> 01:17:44.479 And you are familiar with Rachelle you worked there before, Yes, 1515 01:17:44.560 --> 01:17:48.159 I have. And you advised that over the course of 1516 01:17:48.279 --> 01:17:50.880 the night shift that this patient had coded. 1517 01:17:51.600 --> 01:17:51.960 I was. 1518 01:17:52.640 --> 01:17:55.520 And when you came on shift in the morning because 1519 01:17:55.560 --> 01:17:57.640 of what had happened overnight, were you aware that she 1520 01:17:58.279 --> 01:17:59.920 was sent for an additional CT scan. 1521 01:18:01.560 --> 01:18:04.000 We went for CT imaging in the morning when I 1522 01:18:04.079 --> 01:18:08.079 got there because she was not stable overnight, And you 1523 01:18:08.119 --> 01:18:12.600 said she was intubated correct, Correct? How was she responsive 1524 01:18:12.680 --> 01:18:15.960 during that first day that you encountered her? The first 1525 01:18:16.039 --> 01:18:19.720 shift that I had her, we were focused on her 1526 01:18:19.880 --> 01:18:27.039 injuries and keeping her sedated, so the interactions responses were minimal, 1527 01:18:27.319 --> 01:18:31.239 But that was intentional as she was again, like I said, 1528 01:18:31.319 --> 01:18:32.159 so critically ill. 1529 01:18:32.760 --> 01:18:35.800 And so you also said that she was sedated for 1530 01:18:36.159 --> 01:18:41.239 the majority of that day, correct, Yes? And is that 1531 01:18:41.600 --> 01:18:45.000 something that often happens when a person is intubated, that 1532 01:18:45.039 --> 01:18:52.880 they're sedated, it is, if right? And did you treat 1533 01:18:52.920 --> 01:18:59.039 her on the twenty sixth to your best ever memory, I. 1534 01:18:59.039 --> 01:19:00.479 Would have to go back and look. 1535 01:19:01.439 --> 01:19:03.960 I don't have a problem records. 1536 01:19:07.279 --> 01:19:10.560 As far as January twenty sixth, on that seven am 1537 01:19:10.680 --> 01:19:15.239 to seven pm shift, do you recall making notes that 1538 01:19:15.399 --> 01:19:20.479 the patient required additional sedation due to the tube intolerance, Yes, okay, 1539 01:19:21.319 --> 01:19:23.760 and that she was started on low dose of propofol. 1540 01:19:24.560 --> 01:19:28.439 That is correct, and that in the afternoon that she 1541 01:19:28.640 --> 01:19:32.239 had the chest tubes and you kind of check those 1542 01:19:32.359 --> 01:19:37.640 chest tubes to it, says interval c x R. Looked 1543 01:19:37.680 --> 01:19:41.840 okay with chest tubes to water seal. Yes, that's correct, 1544 01:19:42.079 --> 01:19:46.159 and so she had previously been given chest tubes and 1545 01:19:46.560 --> 01:19:48.359 your role was just to kind of make sure that 1546 01:19:48.479 --> 01:19:49.239 everything was fine. 1547 01:19:50.279 --> 01:19:55.159 They placed bilateral chest tubes and monitoring those is a 1548 01:19:55.199 --> 01:20:00.119 part of my responsibilities in the ICU, and we you 1549 01:20:00.199 --> 01:20:04.079 were concerned for her respiratory status, so that is why 1550 01:20:04.159 --> 01:20:05.600 I made a note of it, okay. 1551 01:20:09.000 --> 01:20:13.000 And as far as the injuries that were a part 1552 01:20:13.079 --> 01:20:17.680 of your assessment of her, fair to say, on January 1553 01:20:17.760 --> 01:20:21.640 twenty ninth, you also were treating her that day from 1554 01:20:21.720 --> 01:20:24.399 seven am to seven pm, and you made a note 1555 01:20:24.479 --> 01:20:29.880 where you identified injuries, right, correct, And those injuries would 1556 01:20:29.920 --> 01:20:32.119 have been things that were reported to you based on 1557 01:20:32.359 --> 01:20:36.720 a doctor's review of labs and images and that kind 1558 01:20:36.760 --> 01:20:36.920 of thing. 1559 01:20:37.000 --> 01:20:37.279 Correct. 1560 01:20:37.640 --> 01:20:41.640 Yes, you don't make your own assessment about thorcic injuries 1561 01:20:41.840 --> 01:20:43.000 or cervical injuries. 1562 01:20:43.800 --> 01:20:44.840 I do not diagnose. 1563 01:20:47.079 --> 01:20:50.039 Also on the twenty ninth or the twenty eighth into 1564 01:20:50.119 --> 01:20:52.760 the twenty ninth, that is, at that point when the 1565 01:20:53.039 --> 01:20:54.720 patient was extubated. Correct. 1566 01:20:55.560 --> 01:20:55.920 Correct. 1567 01:20:56.039 --> 01:20:59.119 Do you recall making observations of the patient when she 1568 01:20:59.359 --> 01:21:01.079 was at or she was extubated. 1569 01:21:02.079 --> 01:21:05.720 She was not exturbated on my shift. I was there 1570 01:21:05.880 --> 01:21:06.800 the following day. 1571 01:21:07.359 --> 01:21:11.479 Okay. Did you note how her demeanor her presentation the 1572 01:21:11.560 --> 01:21:12.000 next day? 1573 01:21:12.720 --> 01:21:13.039 I did? 1574 01:21:13.720 --> 01:21:17.159 And fair to say you noted increased confusion, agitation, and 1575 01:21:17.279 --> 01:21:20.920 picking at lane lines and drains. Correct, that's correct, And 1576 01:21:21.000 --> 01:21:23.800 fair to say the patient had to be restrained because 1577 01:21:23.880 --> 01:21:28.239 of the activity, that is correct. Is that something that 1578 01:21:28.760 --> 01:21:32.840 you often see when patients come out of intubation, that 1579 01:21:32.920 --> 01:21:36.680 when they're extubated, that they exhibit signs of confusion or delirium. 1580 01:21:37.520 --> 01:21:39.319 Yes, it's called ICU delirium. 1581 01:21:41.960 --> 01:21:44.520 And over the course of the next few days in 1582 01:21:44.920 --> 01:21:48.640 your interactions with her, did you see that delirium decline 1583 01:21:48.720 --> 01:21:49.720 or decrease. 1584 01:21:51.000 --> 01:21:55.960 Yes, it was a multi modal approach to manage the 1585 01:21:57.600 --> 01:22:04.000 delirium agitation and it did get better and it did improve. 1586 01:22:05.319 --> 01:22:06.960 And fair to say, during the time that you were 1587 01:22:07.039 --> 01:22:11.239 treating this particular patient there was also sleep issues that 1588 01:22:11.439 --> 01:22:13.279 were part of the treatment plan. 1589 01:22:14.000 --> 01:22:14.720 That is correct. 1590 01:22:16.199 --> 01:22:20.039 And on January twenty ninth and January thirtieth of twenty 1591 01:22:20.119 --> 01:22:24.119 twenty three, were you present when the psych consult team 1592 01:22:24.199 --> 01:22:25.800 came in to speak with the defendant? 1593 01:22:26.800 --> 01:22:27.560 Yes, I was. 1594 01:22:28.479 --> 01:22:30.199 What was the purpose of you being present? 1595 01:22:31.359 --> 01:22:32.319 The purpose is. 1596 01:22:33.920 --> 01:22:40.720 We had consulted the psychiatry team to evaluate and determine capacity. 1597 01:22:41.319 --> 01:22:45.840 And my role is the as the ICU nurse is 1598 01:22:46.479 --> 01:22:51.039 advocacy on behalf of the patient and to alert the 1599 01:22:51.079 --> 01:22:53.760 providers if there's any changes in the mental status. 1600 01:22:54.680 --> 01:22:57.760 Now, when they came in and you said advocate for 1601 01:22:57.920 --> 01:23:01.439 their position, you're aware that the patient was looking to 1602 01:23:01.600 --> 01:23:03.079 change her health care proxy. 1603 01:23:03.119 --> 01:23:07.479 Correct, the patient was changing her health care proxy. That 1604 01:23:07.680 --> 01:23:10.079 is correct, and that there has to. 1605 01:23:10.119 --> 01:23:15.000 Be an evaluation to determine whether she's of a particular 1606 01:23:15.039 --> 01:23:17.439 mental status and medically able to make that decision on 1607 01:23:17.560 --> 01:23:18.720 her own. Is that fair to say? 1608 01:23:19.000 --> 01:23:19.159 Yes? 1609 01:23:20.359 --> 01:23:24.039 And do you recall who was present other than yourself 1610 01:23:24.199 --> 01:23:28.239 and the psych doctors and doctors from the psychiatric unit. 1611 01:23:29.119 --> 01:23:29.800 There was the. 1612 01:23:29.840 --> 01:23:36.960 Social worker, myself, and her lawyer was present. 1613 01:23:38.159 --> 01:23:41.760 Had you been present when a lawyer or somebody else 1614 01:23:42.039 --> 01:23:45.920 was with her prior to this consult. 1615 01:23:48.119 --> 01:23:48.159 No? 1616 01:23:49.399 --> 01:23:52.359 And fair to say you were made aware. 1617 01:23:52.239 --> 01:23:53.680 Very early on that. 1618 01:23:55.760 --> 01:23:58.640 There was a particular group of people that would be 1619 01:23:59.399 --> 01:24:01.359 having access to this individual. Correct. 1620 01:24:02.640 --> 01:24:05.000 Can you clarify, well, is it fair. 1621 01:24:04.880 --> 01:24:05.359 To say that. 1622 01:24:06.960 --> 01:24:10.199 The treatment team was kept small on purpose? I mean, 1623 01:24:10.239 --> 01:24:13.319 the same people were coming in and being the nurse, 1624 01:24:13.439 --> 01:24:15.800 day and night staff. There was limited access. 1625 01:24:16.279 --> 01:24:20.239 Is that fair to say it was kept to a Yes, 1626 01:24:20.319 --> 01:24:22.640 it was kept to a smaller team, but that was 1627 01:24:22.720 --> 01:24:25.279 also protection of privacy for the patient. 1628 01:24:26.239 --> 01:24:29.800 And during the course of time when she's on the ICU, 1629 01:24:30.039 --> 01:24:34.720 which is between the twenty fourth to February third, there's 1630 01:24:34.760 --> 01:24:39.479 always law enforcement posted outside the room. Correct, Yes, and 1631 01:24:39.640 --> 01:24:42.479 it was because she was well I'm just asking you 1632 01:24:42.560 --> 01:24:49.239 if there were law enforcement there was. Do you recall 1633 01:24:49.359 --> 01:24:51.760 having to check with the nursing director and the legal 1634 01:24:51.800 --> 01:24:53.720 team at the hospital to make sure that it was 1635 01:24:53.760 --> 01:24:56.319 permissive to allow anyone in besides medical staff. 1636 01:24:57.760 --> 01:24:59.199 Yes, that's standard protocol. 1637 01:25:00.399 --> 01:25:04.039 And when she was transferred off of your unit on 1638 01:25:04.239 --> 01:25:06.840 February third, did you have any further contact with her? 1639 01:25:08.600 --> 01:25:13.439 I did not and nothing further. Thank you? 1640 01:25:14.520 --> 01:25:19.439 Pretty ready to absinutely. 1641 01:25:19.600 --> 01:25:20.119 I think. 1642 01:25:23.239 --> 01:25:26.600 How many years you've been a nurse eleven and you 1643 01:25:26.960 --> 01:25:33.119 obviously take that position and as very serious and your 1644 01:25:33.239 --> 01:25:34.960 concern is to protect your patient. 1645 01:25:35.039 --> 01:25:35.439 Is that right? 1646 01:25:36.199 --> 01:25:36.560 That is. 1647 01:25:39.279 --> 01:25:41.680 You made reference to the fact that she was changing 1648 01:25:41.800 --> 01:25:48.039 her her documents as far as health care proxy, Yes, did. 1649 01:25:47.960 --> 01:25:48.479 You know anything? 1650 01:25:48.640 --> 01:25:50.560 Did you know who she was changing it from her 1651 01:25:50.680 --> 01:25:52.479 husband to her mother and father, or did you know 1652 01:25:52.560 --> 01:25:55.399 anything about the specifics she was changing. 1653 01:25:55.119 --> 01:25:57.720 It from her from Patrick to her parents? 1654 01:25:59.560 --> 01:26:02.399 And what is a d n R. 1655 01:26:03.960 --> 01:26:05.920 D n R means do not resuscitate. 1656 01:26:06.399 --> 01:26:07.680 Do you know what her DNR was? 1657 01:26:09.119 --> 01:26:11.279 Her code status was full at the time that I 1658 01:26:11.359 --> 01:26:12.000 took care of her. 1659 01:26:12.680 --> 01:26:16.000 Do you recall that she had indicated repeatedly that she 1660 01:26:16.159 --> 01:26:18.279 wanted a d NR, that she did not want to 1661 01:26:18.319 --> 01:26:21.479 be resuscitated if emergency arose. 1662 01:26:23.000 --> 01:26:26.039 I was not privy to that knowledge, okay. 1663 01:26:25.800 --> 01:26:27.720 But that's noted in the medical record. It would be 1664 01:26:27.760 --> 01:26:30.600 noted in the records, right, it would be yes, thank 1665 01:26:30.640 --> 01:26:34.000 you very much, Thank you, pretty. 1666 01:26:35.680 --> 01:26:36.920 Thank you, thank you, thank you. 1667 01:26:41.439 --> 01:26:43.039 Comald calls doctor Shah. 1668 01:26:43.760 --> 01:26:45.000 All right, good afternoon, doctor. 1669 01:26:45.640 --> 01:26:47.479 I'm going to ask you keep your voice up and 1670 01:26:47.600 --> 01:26:51.079 speak into that microphone, right, thanks, thank you, thank. 1671 01:26:50.960 --> 01:26:53.239 You, Anna, good afternoon. Can you please stay and spell 1672 01:26:53.279 --> 01:26:54.119 your name for the record. 1673 01:26:54.399 --> 01:26:54.600 Sure. 1674 01:26:55.119 --> 01:26:57.560 My first name is Stagel s E j a L. 1675 01:26:57.800 --> 01:27:00.880 Last name of Shaw s h A H. What's your 1676 01:27:00.960 --> 01:27:02.920 day of birth five eight eighty one. 1677 01:27:04.079 --> 01:27:05.000 What do you do for a living. 1678 01:27:05.199 --> 01:27:06.159 I'm a psychiatrist. 1679 01:27:06.840 --> 01:27:11.359 And can you briefly describe your education and training background 1680 01:27:11.399 --> 01:27:12.920 that qualifies you to be a psychiatrist? 1681 01:27:13.079 --> 01:27:13.279 Yeah? 1682 01:27:13.279 --> 01:27:14.319 Absolutely so. 1683 01:27:14.560 --> 01:27:18.000 I did my undergraduate in Philadelphia at the University of Pennsylvania, 1684 01:27:18.119 --> 01:27:21.680 followed by medical school at Jefferson Medical College, also in Philadelphia. 1685 01:27:22.079 --> 01:27:26.680 I moved, Oh sure, I moved up to Boston to 1686 01:27:26.800 --> 01:27:30.479 do my residency in psychiatry at Brighaman and Women's Hospital 1687 01:27:30.600 --> 01:27:34.119 and Beth Israel Deaconess, followed by a fellowship in Consultation 1688 01:27:34.199 --> 01:27:37.479 Liaison psychiatry at Brigham and Women's Hospital and then stayed 1689 01:27:37.520 --> 01:27:38.920 on as a faculty member. 1690 01:27:39.880 --> 01:27:41.640 And where do you work currently? 1691 01:27:41.840 --> 01:27:44.399 I work at Brighaman and Women's Hospital And what is 1692 01:27:44.479 --> 01:27:48.000 your role there. I'm Associate Chief of the Division. 1693 01:27:47.720 --> 01:27:51.760 Of Psychiatry and Medicine, leading the Consultation Liaison psychiatry service 1694 01:27:51.880 --> 01:27:52.520 at Brigham. 1695 01:27:53.039 --> 01:27:55.800 And what is the consultation in liaison service. 1696 01:27:56.079 --> 01:27:59.920 Yeah, so, consultation liaison psychiatry is a subspecialty of psychia 1697 01:28:00.079 --> 01:28:03.760 treat that works at the interface of psychiatry and medicine. 1698 01:28:04.479 --> 01:28:07.800 So we work both in the inpatient and outpatient settings. 1699 01:28:08.520 --> 01:28:12.479 In this particular instance, we get called by other healthcare 1700 01:28:12.520 --> 01:28:15.279 providers that may need help with their patients or have 1701 01:28:15.359 --> 01:28:19.079 a question related in the psychiatric realm. And so I 1702 01:28:19.119 --> 01:28:21.880 would see a patient that's admitted to the hospital and 1703 01:28:22.039 --> 01:28:25.199 help provide recommendations to the physicians and the rest of 1704 01:28:25.239 --> 01:28:26.960 the care team that's caring for that patient. 1705 01:28:27.520 --> 01:28:30.119 So basically, say, at the Brigham, if a patient's being 1706 01:28:30.159 --> 01:28:33.680 treated there and a medical doctor is treating them and 1707 01:28:33.920 --> 01:28:37.399 thinks that they need a consultation with a psychiatrist, your 1708 01:28:37.439 --> 01:28:38.359 department would be called. 1709 01:28:38.560 --> 01:28:41.840 That's correct. And how long have you been with the 1710 01:28:41.880 --> 01:28:44.199 Brigham nineteen years now? 1711 01:28:44.239 --> 01:28:46.560 I want to direct your attention to January of twenty 1712 01:28:46.640 --> 01:28:50.000 twenty three. Did you interact with the patient named Lindsay Clancy. 1713 01:28:50.199 --> 01:28:54.720 I did, and was that on January twenty ninth, twenty 1714 01:28:54.800 --> 01:28:55.319 twenty three. 1715 01:28:55.800 --> 01:28:58.079 Yes, that was the first of a handful of times 1716 01:28:58.119 --> 01:28:58.680 that I saw her. 1717 01:28:59.239 --> 01:29:02.359 And why did you meet with Lindsay Clancy on January 1718 01:29:02.399 --> 01:29:03.920 twenty ninth, twenty twenty three. 1719 01:29:04.319 --> 01:29:09.079 So my team was seeing Ms Clancy for a number 1720 01:29:09.079 --> 01:29:13.600 of reasons, including for psychiatric safety risk assessment. She had 1721 01:29:13.680 --> 01:29:17.199 come in reporting aice reporting a suicide attempt, which is 1722 01:29:17.239 --> 01:29:20.279 a common reason why my team would be called is 1723 01:29:20.399 --> 01:29:23.880 to continue to ensure that patients are safe when they're 1724 01:29:23.920 --> 01:29:28.079 in the hospital. So we make recommendations about kind of 1725 01:29:28.119 --> 01:29:29.800 safety status, you know, what can we. 1726 01:29:29.800 --> 01:29:31.199 Do to help keep a patient safe. 1727 01:29:31.439 --> 01:29:35.560 But then we also make recommendations related to medications. So 1728 01:29:35.680 --> 01:29:37.560 that's why my team was following her. So that was 1729 01:29:37.600 --> 01:29:39.039 one of the reasons why I saw her. 1730 01:29:39.039 --> 01:29:41.319 On the twenty ninth, is to continue that assessment. 1731 01:29:42.159 --> 01:29:44.640 I was also called to ask a new I was 1732 01:29:44.680 --> 01:29:48.039 asked a new question that day, a consult question on 1733 01:29:48.680 --> 01:29:51.760 whether she was able to make the decision to change 1734 01:29:51.800 --> 01:29:54.640 her health care proxy from her at the time husband 1735 01:29:54.840 --> 01:29:55.640 to her parents. 1736 01:29:56.479 --> 01:30:02.560 And when you consult to help determine whether someone's capable 1737 01:30:03.000 --> 01:30:05.880 of making a decision like that, changing their health care proxy. 1738 01:30:06.560 --> 01:30:10.039 Are you evaluating their medical decision making capacity? 1739 01:30:10.359 --> 01:30:10.920 That's correct? 1740 01:30:11.319 --> 01:30:13.640 How do you go about doing correct? And she's speaking 1741 01:30:13.720 --> 01:30:16.840 to and were you aware that Patrick Clancy was her 1742 01:30:17.119 --> 01:30:17.880 health care proxy? 1743 01:30:18.079 --> 01:30:20.079 I was told that by her primary medical team. 1744 01:30:20.720 --> 01:30:23.479 And when you talked to Ms Clancy, did she tell 1745 01:30:23.520 --> 01:30:25.560 you who she wanted to take over that role? 1746 01:30:25.800 --> 01:30:28.399 She did and who was both her parents. 1747 01:30:28.560 --> 01:30:32.720 And you talked about that needing to be a consistent choice. 1748 01:30:32.920 --> 01:30:35.159 How did you ensure that was a consistent choice with her? 1749 01:30:35.359 --> 01:30:38.119 Yeah, so we waited to make that make the change 1750 01:30:38.680 --> 01:30:41.319 from Patrick Clancy to her parents until the next day 1751 01:30:42.119 --> 01:30:44.279 for a variety of reasons. We wanted to ensure that 1752 01:30:44.439 --> 01:30:47.880 that choice was consistent over time, and especially because the 1753 01:30:47.960 --> 01:30:50.119 day that I saw her, she had just gone through 1754 01:30:50.600 --> 01:30:54.039 some pretty major medical events, including she had a major 1755 01:30:54.119 --> 01:30:58.199 sign surgery, a decompression, and effusion. She had gone through 1756 01:30:58.239 --> 01:31:02.079 some oxygen desaturation overnight so was not breathing as well, 1757 01:31:02.479 --> 01:31:05.119 her heart rate was up, all of which then led 1758 01:31:05.159 --> 01:31:07.880 to her being what we call delirious. She was quite 1759 01:31:08.119 --> 01:31:11.159 she was confused overnight to the point where she asked 1760 01:31:11.159 --> 01:31:14.479 her nurse, am I delirious? And she was also experiencing 1761 01:31:14.560 --> 01:31:18.039 some visual hallucinations, so that was one of the reasons 1762 01:31:18.079 --> 01:31:20.239 why I was called in to make sure that she 1763 01:31:20.479 --> 01:31:23.039 was she was able to make that decision to change 1764 01:31:23.079 --> 01:31:26.840 her health care proxy. And then in addition, the team 1765 01:31:27.000 --> 01:31:30.600 had also voiced, you know, concerns that she had come 1766 01:31:30.640 --> 01:31:33.720 in after a reported suicide attempt, and so making sure 1767 01:31:34.359 --> 01:31:36.319 that she was able to make that decision. 1768 01:31:36.359 --> 01:31:37.159 Of sound mind. 1769 01:31:37.479 --> 01:31:39.760 And so we actually waited until the next day when 1770 01:31:39.800 --> 01:31:42.880 she could be reassessed. At that point, her delirium had 1771 01:31:42.960 --> 01:31:47.199 cleared and she was continuing to make that consistent choice 1772 01:31:47.479 --> 01:31:49.600 to change her health care proxy to her parents. 1773 01:31:50.159 --> 01:31:53.560 And and in fact, you noted in the medical records 1774 01:31:53.680 --> 01:32:01.079 that the the the hallucinations were part of of an 1775 01:32:01.119 --> 01:32:02.039 issue with oxygen. 1776 01:32:02.720 --> 01:32:04.359 It could be that could be one of the reasons. 1777 01:32:04.479 --> 01:32:08.119 Delirium is usually due to a variety of different medical reasons, 1778 01:32:08.840 --> 01:32:11.520 and oxygen desaturation could be one of them. She had 1779 01:32:11.520 --> 01:32:15.960 also just recently had anesthesia related to surgery that she 1780 01:32:16.079 --> 01:32:18.479 had on her spine, so that could be another reason. 1781 01:32:19.159 --> 01:32:21.920 And then her heart rate was also actually quite elevated, 1782 01:32:22.800 --> 01:32:23.840 so that could be another reason. 1783 01:32:24.479 --> 01:32:27.079 Is it common for patients who are just coming off 1784 01:32:27.119 --> 01:32:31.199 of anesthesia from surgery, who have an issue with oxygen 1785 01:32:31.560 --> 01:32:35.439 and other medical issues that you described to have visual hallucinations, 1786 01:32:35.640 --> 01:32:36.079 they can. 1787 01:32:37.079 --> 01:32:40.279 It's it's not it's not that everybody does, but they can. 1788 01:32:41.079 --> 01:32:43.800 And delirium can be quite common after after surgery and 1789 01:32:43.840 --> 01:32:45.359 particularly anesthesia, and. 1790 01:32:45.399 --> 01:32:49.600 Those hallucinations that she was having, those were resolved by 1791 01:32:49.600 --> 01:32:51.520 the next day. They were over by the next day. Correct, 1792 01:32:51.640 --> 01:32:54.359 that's correct, And her choice to change her health care 1793 01:32:54.399 --> 01:32:57.520 proxy to her parents was consistent the following day. Correct, 1794 01:32:57.640 --> 01:33:01.920 that's right. You also about the patient has to understand 1795 01:33:01.960 --> 01:33:03.720 the risks and benefits of the decision. 1796 01:33:03.800 --> 01:33:04.920 Correct, that's correct. 1797 01:33:04.960 --> 01:33:06.760 How do you make sure the patient understands that? 1798 01:33:07.359 --> 01:33:09.319 Yeah, So one of the things we do is really 1799 01:33:09.560 --> 01:33:13.640 ask patients to take us through their thought process of 1800 01:33:13.800 --> 01:33:16.239 why they're making that decision and what led to them 1801 01:33:16.279 --> 01:33:18.800 making that decision at that moment in time. So we're 1802 01:33:18.800 --> 01:33:21.680 able to kind of see their thought process and ensure 1803 01:33:21.840 --> 01:33:24.439 that they're understanding, you know, what it means to remove 1804 01:33:24.520 --> 01:33:26.920 one person and add another, and what. 1805 01:33:27.039 --> 01:33:29.359 Was missus Clancy's thought process in explaining that to you. 1806 01:33:29.720 --> 01:33:31.880 Yeah, she was saying that her parents are quite supportive 1807 01:33:31.960 --> 01:33:35.640 to her and that she was thinking that she would 1808 01:33:35.680 --> 01:33:38.159 have to change her health care proxy from her husband 1809 01:33:38.239 --> 01:33:41.880 to somebody else, And we didn't necessarily go into the 1810 01:33:41.960 --> 01:33:44.680 reasons as to, you know, why she would have to 1811 01:33:44.760 --> 01:33:47.640 change it, but she explained that she was very close 1812 01:33:47.680 --> 01:33:50.600 with her parents. They would see each other frequently given 1813 01:33:50.640 --> 01:33:54.159 that they lived in close geographic proximity, and that she 1814 01:33:54.239 --> 01:33:56.079 felt that they were very supportive to her and would 1815 01:33:56.079 --> 01:33:58.560 have her best interests in mind should we need to 1816 01:33:58.600 --> 01:34:00.560 invoke the health care proxy, or that she couldn't be 1817 01:34:00.680 --> 01:34:02.640 if she couldn't make her own medical decisions. 1818 01:34:03.000 --> 01:34:04.800 So was there a concern on her part that her 1819 01:34:04.880 --> 01:34:06.840 husband wouldn't have her best interests in mind at that 1820 01:34:06.920 --> 01:34:14.239 point in time? Sustain You also talked about the patient. 1821 01:34:14.560 --> 01:34:17.359 You have to make sure the patients thinking about the 1822 01:34:17.399 --> 01:34:19.439 information rationally. How do you how do you go about 1823 01:34:19.479 --> 01:34:19.720 doing that? 1824 01:34:20.039 --> 01:34:22.560 Yeah, so one of the things we do is really 1825 01:34:22.720 --> 01:34:26.239 ensure that the patient understands the situation and you know, 1826 01:34:26.359 --> 01:34:28.800 all of the kind of parts around it. So this 1827 01:34:28.960 --> 01:34:31.800 comes into play much more when when it's about a 1828 01:34:31.920 --> 01:34:37.119 specific medical intervention like an invasive medical procedure or something 1829 01:34:37.199 --> 01:34:40.640 like an amputation or a surgery with a health care proxy. 1830 01:34:41.159 --> 01:34:42.640 One of the things you want to make sure is 1831 01:34:42.680 --> 01:34:44.399 that the person that they want to change their health 1832 01:34:44.439 --> 01:34:46.800 care proxy to or a point does their health care 1833 01:34:46.840 --> 01:34:47.800 proxy make. 1834 01:34:47.760 --> 01:34:49.800 Sense in the context of their life? 1835 01:34:50.600 --> 01:34:53.439 And you know, ms Clancy was able to talk about 1836 01:34:53.479 --> 01:34:55.520 how her parents were quite involved in her life, and 1837 01:34:55.640 --> 01:34:57.600 so that's one of the things that we would assess. 1838 01:34:58.560 --> 01:35:00.880 And then the last thing was making sure the patient 1839 01:35:01.000 --> 01:35:04.039 understands the risk if the change doesn't happen. Did you 1840 01:35:04.079 --> 01:35:06.199 go over that with mss Clancy and how did you 1841 01:35:06.279 --> 01:35:06.479 do that? 1842 01:35:06.720 --> 01:35:06.920 Yeah? 1843 01:35:07.319 --> 01:35:08.479 I did go over that with her. 1844 01:35:09.000 --> 01:35:11.640 We talked a little bit about how it could mean 1845 01:35:11.680 --> 01:35:14.079 that she would not have a health care proxy were 1846 01:35:14.199 --> 01:35:16.159 she not to appoint her parents, and so we went 1847 01:35:16.239 --> 01:35:19.840 through that. You know, it's always in healthcare we always 1848 01:35:19.840 --> 01:35:21.199 talk about how it's great to have a health care 1849 01:35:21.239 --> 01:35:24.039 proxy just in case you become unable to make medical 1850 01:35:24.119 --> 01:35:25.680 decisions and who would you want that to be. 1851 01:35:26.439 --> 01:35:29.920 And during this conversation with the defendant going over all 1852 01:35:29.960 --> 01:35:32.880 these points, did you ever have difficulty understanding her? 1853 01:35:33.319 --> 01:35:33.720 I did not. 1854 01:35:34.159 --> 01:35:36.319 Did she ever appear to have difficulty understanding you? 1855 01:35:36.840 --> 01:35:39.119 So the first day when I saw her on January 1856 01:35:39.199 --> 01:35:43.439 twenty ninth, she described herself as feeling confused, and I 1857 01:35:43.560 --> 01:35:48.039 definitely witnessed that as well. We went through a bedside 1858 01:35:48.199 --> 01:35:52.119 cognitive evaluation and she definitely made some mistakes on some 1859 01:35:52.239 --> 01:35:53.359 of the cognitive evaluation. 1860 01:35:53.640 --> 01:35:54.720 Therefore, I did. 1861 01:35:54.720 --> 01:35:57.399 Diagnose her at that time with delirium and then. 1862 01:35:57.319 --> 01:35:59.960 She was reevaluated the following day and there were no 1863 01:36:00.199 --> 01:36:03.159 issues with her understanding and the delirium was gone correct. 1864 01:36:03.319 --> 01:36:03.840 That's correct. 1865 01:36:05.239 --> 01:36:10.680 And were you aware during this evaluation that Miss Clansley 1866 01:36:10.840 --> 01:36:12.039 did not have a brain injury? 1867 01:36:13.640 --> 01:36:14.800 I'm sorry, I can you repeat the question? 1868 01:36:15.039 --> 01:36:17.000 Were you aware that Ms Clancy did not have a 1869 01:36:17.039 --> 01:36:18.319 brain injury at that time? 1870 01:36:19.319 --> 01:36:21.399 So one of the things that we look at is 1871 01:36:21.920 --> 01:36:24.520 any kind of relevant medical information that might be available 1872 01:36:24.600 --> 01:36:27.520 to us. And I noticed that her Glasgow COMA scale 1873 01:36:27.560 --> 01:36:29.960 when she was transferred to Bringham a Women's Hospital was 1874 01:36:30.000 --> 01:36:33.279 a ten, which would indicate that she potentially have had 1875 01:36:33.319 --> 01:36:34.359 a moderate brain injury. 1876 01:36:35.119 --> 01:36:38.159 But I don't recall thinking. 1877 01:36:37.920 --> 01:36:41.039 About whether you know specifically whether she had a brain injury. 1878 01:36:41.760 --> 01:36:44.479 Were you aware that a cat scan was done Page 1879 01:36:44.560 --> 01:36:50.279 one and ten of the records, and on the cat 1880 01:36:50.359 --> 01:36:54.720 scan the impression was no acute entracranial findings, so no 1881 01:36:55.159 --> 01:36:55.920 brain injury. 1882 01:36:56.560 --> 01:37:00.840 So you can essay, I did review the head imaging 1883 01:37:01.079 --> 01:37:02.359 that was available at the time. 1884 01:37:03.199 --> 01:37:05.520 You can have a normal cat scan and still have 1885 01:37:05.600 --> 01:37:06.279 a brain injury. 1886 01:37:06.880 --> 01:37:10.439 Were you aware that she had multiple cat scans that 1887 01:37:10.520 --> 01:37:14.560 showed no bleeding in the brain, no skull fractures, no injuries, 1888 01:37:15.680 --> 01:37:16.840 visible injuries whatsoever. 1889 01:37:18.239 --> 01:37:19.560 I'm sorry, but can you repeat the question? 1890 01:37:19.880 --> 01:37:22.039 Were you aware that she had multiple cat scans at 1891 01:37:22.119 --> 01:37:24.760 Self Shore Hospital and at Brigham and Woman's that showed 1892 01:37:24.880 --> 01:37:29.800 no skull fractures, no into cranial bleeding, no hemorrhaging, no 1893 01:37:29.960 --> 01:37:31.119 visible damage whatsoever. 1894 01:37:31.359 --> 01:37:31.560 Yes? 1895 01:37:32.159 --> 01:37:34.159 And were you aware that she was valued at Self 1896 01:37:34.159 --> 01:37:36.319 Shore Hospital and at the Brigham and she had no 1897 01:37:36.439 --> 01:37:38.159 external injuries on her head either. 1898 01:37:38.439 --> 01:37:38.640 Yes. 1899 01:37:40.439 --> 01:37:47.760 Now she was allowed to change your health care proxy 1900 01:37:47.800 --> 01:37:48.399 to her parents. 1901 01:37:48.439 --> 01:37:48.720 Correct. 1902 01:37:49.000 --> 01:37:49.600 That's correct. 1903 01:37:49.960 --> 01:37:52.960 So if someone had an injury, a brain injury to 1904 01:37:53.039 --> 01:37:54.680 the point where they didn't know what was going on, 1905 01:37:55.560 --> 01:37:58.880 or they were having trouble processing or thinking, they wouldn't 1906 01:37:58.880 --> 01:37:59.880 be allowed to change their healthcare. 1907 01:38:00.359 --> 01:38:00.640 Correct. 1908 01:38:00.840 --> 01:38:02.039 It depends to what extent. 1909 01:38:02.560 --> 01:38:06.560 Most patients that have either a head injury or severe 1910 01:38:06.640 --> 01:38:09.000 mental illness, let's say, just anything going on with the brain, 1911 01:38:09.399 --> 01:38:12.600 retain the ability to make most medical decisions, and we 1912 01:38:12.720 --> 01:38:15.520 think about changing health care proxies as a pretty low 1913 01:38:15.640 --> 01:38:19.279 risk decision. As I mentioned before, something like an amputation 1914 01:38:19.520 --> 01:38:22.279 or a major surgery invasive procedure is something that we 1915 01:38:22.319 --> 01:38:25.600 would hold somebody to a higher bar, But a health 1916 01:38:25.640 --> 01:38:28.520 care proxy is a pretty low risk, especially if it 1917 01:38:28.560 --> 01:38:30.680 makes sense in terms of who they want to change 1918 01:38:30.720 --> 01:38:30.880 it to. 1919 01:38:31.359 --> 01:38:32.800 And when was her Glasgow score? 1920 01:38:32.960 --> 01:38:33.119 Ten? 1921 01:38:33.840 --> 01:38:36.960 I believe it was as she was being transferred from 1922 01:38:37.000 --> 01:38:39.119 the outside hospital to Brigham and Women's. 1923 01:38:38.960 --> 01:38:42.079 And you're seeing her several days later, correct, correct? And 1924 01:38:42.199 --> 01:38:45.399 so when she was transferred from the outside hospital to Brigham, 1925 01:38:45.479 --> 01:38:48.880 she was unconscious, correct, I believe? So, Okay, so now 1926 01:38:48.960 --> 01:38:52.159 she's conscious, correct, that's correct. And when she was transferred 1927 01:38:52.199 --> 01:38:55.359 from the outside hospital to Brigham, she wasn't communicating or 1928 01:38:55.399 --> 01:38:57.600 speaking or opening her eyes on her own. 1929 01:38:57.640 --> 01:38:57.960 Correct. 1930 01:38:58.479 --> 01:39:00.439 That's what the reports that I was not there at 1931 01:39:00.479 --> 01:39:03.000 that time, but the notes that I read that's correct. 1932 01:39:03.159 --> 01:39:05.159 So when you're speaking to her a couple days later, 1933 01:39:05.560 --> 01:39:10.000 she's opening her eyes, she's communicating, she's responsive, she's interacting. Correct. Yes, 1934 01:39:10.279 --> 01:39:12.479 So it's fair to say that our Glasgow score would 1935 01:39:12.479 --> 01:39:15.039 be higher than the ten when you were speaking to her. 1936 01:39:15.079 --> 01:39:15.399 Correct. 1937 01:39:15.520 --> 01:39:17.439 Yes, Now. 1938 01:39:21.079 --> 01:39:24.560 You did a mental status examination of her while you 1939 01:39:24.720 --> 01:39:29.960 were doing this evaluation about her decision making capacity correct. Yes, 1940 01:39:30.520 --> 01:39:34.439 And it's fair to say under mood you listed okay, yes, 1941 01:39:35.720 --> 01:39:40.960 that you listed her thought processes organized, goal directed. Is 1942 01:39:41.000 --> 01:39:41.439 that correct? 1943 01:39:41.600 --> 01:39:41.800 Yes? 1944 01:39:43.039 --> 01:39:46.000 You asked her if she was having hallucinations or delusions 1945 01:39:46.039 --> 01:39:48.920 and she other than those initial ones the first day, 1946 01:39:49.039 --> 01:39:53.079 she denied those during my evaluation, yes, And she also 1947 01:39:53.359 --> 01:39:57.039 denied suicidal intent and homicidal intent correct. 1948 01:39:57.199 --> 01:39:57.399 Yes. 1949 01:39:58.079 --> 01:40:01.039 And you listed her insight and judgment as fair correct. 1950 01:40:01.319 --> 01:40:01.479 Yes. 1951 01:40:01.960 --> 01:40:03.880 Her behavior was calm and cooperative. 1952 01:40:04.159 --> 01:40:04.319 Yes. 1953 01:40:05.399 --> 01:40:12.279 And you didn't see anything about her behavior that would 1954 01:40:12.319 --> 01:40:16.000 indicate to you that she was responding to some type 1955 01:40:16.039 --> 01:40:19.359 of voices or hallucination that you couldn't. 1956 01:40:19.000 --> 01:40:20.359 See at that moment. 1957 01:40:20.640 --> 01:40:23.119 No, But as I mentioned, I did speak with the 1958 01:40:23.199 --> 01:40:25.760 nurse beforehand, and Mss Clancy was able to report to 1959 01:40:25.840 --> 01:40:28.399 me that she reported visual whose nations. 1960 01:40:28.119 --> 01:40:29.760 Overnight overnight after surgery. 1961 01:40:30.079 --> 01:40:34.800 That's right, okay, And then never again, not during my evaluation. 1962 01:40:36.920 --> 01:40:44.800 And did you speak to Mss Clancy again on February nineteenth, 1963 01:40:44.960 --> 01:40:48.600 twenty twenty three. Yes, And was the purpose for that 1964 01:40:48.840 --> 01:40:52.359 to prepare her for a transition from Brigham and Women's 1965 01:40:52.439 --> 01:40:53.960 to Spalding rehabilitation. 1966 01:40:54.359 --> 01:40:56.800 That was one of the reasons, and what were the 1967 01:40:56.880 --> 01:40:57.399 other reasons? 1968 01:40:57.760 --> 01:41:01.800 So it was an ongoing safety evaluation, ongoing evaluation of 1969 01:41:01.800 --> 01:41:06.479 psychiatric safety risk as well as medication evaluation to determine 1970 01:41:06.479 --> 01:41:09.600 if her medications were at the right level, the right dosage, 1971 01:41:09.960 --> 01:41:12.600 and that she was on the right medications, and then 1972 01:41:12.760 --> 01:41:16.039 just ongoing evaluation in terms of kind of her mental status. 1973 01:41:16.720 --> 01:41:21.239 And during that meeting, she denied suicidal intent, correct, that's correct, 1974 01:41:21.359 --> 01:41:26.000 She denied homicidal intent, correct. She denied having auditory or 1975 01:41:26.119 --> 01:41:27.640 visual hallucinations correct. 1976 01:41:27.880 --> 01:41:28.039 Yes. 1977 01:41:30.680 --> 01:41:33.319 She reported her mood as okay. Is that correct? Yes, 1978 01:41:33.880 --> 01:41:35.920 And she told you she was looking forward to moving 1979 01:41:35.960 --> 01:41:36.920 to Spalding correct. 1980 01:41:37.159 --> 01:41:37.359 Yes. 1981 01:41:41.760 --> 01:41:44.279 She also denied any confusion or disorientation. 1982 01:41:44.439 --> 01:41:45.000 Is that correct? 1983 01:41:45.159 --> 01:41:45.359 Yes? 1984 01:41:46.800 --> 01:41:51.039 And again you described her mood as okay on that day, yes. 1985 01:41:51.640 --> 01:41:55.920 And you described her as future oriented on that day. 1986 01:41:56.119 --> 01:41:56.319 Yes. 1987 01:41:57.760 --> 01:41:59.960 And then you spoke to her again on February twenty first, 1988 01:42:00.159 --> 01:42:00.920 twenty twenty three. 1989 01:42:01.039 --> 01:42:01.560 Is that correct? 1990 01:42:01.720 --> 01:42:06.279 Yes? And on that day this is the same purpose 1991 01:42:06.319 --> 01:42:09.359 that you just described, getting her ready, assessing her mental status, 1992 01:42:09.399 --> 01:42:12.520 and getting her ready to transfer to Falding. Yes, okay. 1993 01:42:12.880 --> 01:42:17.880 And during that time you wrote that the patient reported 1994 01:42:17.960 --> 01:42:22.640 feeling down about her current situation, her paralysis, and the 1995 01:42:22.720 --> 01:42:24.520 events leading up to her hospitalization. 1996 01:42:24.680 --> 01:42:25.199 Is that correct? 1997 01:42:25.319 --> 01:42:25.520 Yes? 1998 01:42:26.159 --> 01:42:31.039 And you also noted that she said her thoughts about 1999 01:42:31.079 --> 01:42:33.520 what she had done were not constant throughout the day. 2000 01:42:33.640 --> 01:42:33.960 Correct. 2001 01:42:34.159 --> 01:42:38.439 Correct, So she wasn't thinking about killing her children throughout. 2002 01:42:38.199 --> 01:42:39.960 The day every day correct? Correct. 2003 01:42:40.720 --> 01:42:44.800 And she said she had no suicidal intent, no homicidal intent. Correct, 2004 01:42:44.840 --> 01:42:50.399 But full about treatment at Spaulding. Yes, she was future oriented, yes, 2005 01:42:50.920 --> 01:42:56.000 and she denied suicidal ideation, homicidal ideation. Yes, she denied 2006 01:42:56.079 --> 01:43:02.720 audio hallucination, visual hallucination, and anything else of that nature. 2007 01:43:03.159 --> 01:43:04.800 Yes, thank you. 2008 01:43:12.359 --> 01:43:16.560 So doctor from your testimony and correct me if I'm wrong. 2009 01:43:17.600 --> 01:43:22.600 Was she, to your opinion and your experience, an honest 2010 01:43:22.720 --> 01:43:25.000 patient telling you what her symptoms were? 2011 01:43:25.319 --> 01:43:31.520 Finish, that's an evaluation and a psychiatric I allow that question. Yes. 2012 01:43:32.239 --> 01:43:34.319 In other words, she didn't go off and try to 2013 01:43:34.439 --> 01:43:37.399 exaggerate to you and say I'm seeing visions and I'm 2014 01:43:37.439 --> 01:43:42.680 hearing voices, and I'm suicidally ideated, and I'm homicidally ideated. 2015 01:43:42.720 --> 01:43:44.359 She didn't say any of those things to you, did 2016 01:43:44.399 --> 01:43:46.560 she She actually denied them? Right? 2017 01:43:46.880 --> 01:43:47.239 Correct? 2018 01:43:47.359 --> 01:43:49.640 So This is not, in your opinion, someone who was 2019 01:43:49.760 --> 01:43:54.239 trying to exaggerate her conditions for some legal reason. 2020 01:43:54.439 --> 01:43:54.800 Correct. 2021 01:43:55.039 --> 01:43:59.520 No, And you obviously were in close contact with her 2022 01:43:59.680 --> 01:44:05.000 for for about a month, right, just a couple of questions. 2023 01:44:07.720 --> 01:44:09.159 The council'll ask you whether or not. 2024 01:44:09.520 --> 01:44:11.239 And I think it may have been in the beginning 2025 01:44:11.319 --> 01:44:16.079 in January that you had difficulty understanding her. Obviously, after 2026 01:44:16.199 --> 01:44:19.000 removing the tools and everything else, you're able to talk 2027 01:44:19.079 --> 01:44:19.359 with her. 2028 01:44:19.479 --> 01:44:20.439 Correct Correct. 2029 01:44:20.840 --> 01:44:23.520 And you knew that one of the concerns, if you will, 2030 01:44:23.760 --> 01:44:29.079 was postpartum issues. You knew that, right, yes, And your 2031 01:44:29.159 --> 01:44:33.720 experience as a psychiatrist, you're familiar with the concept of 2032 01:44:33.800 --> 01:44:36.039 postpartum psychosis. 2033 01:44:36.199 --> 01:44:36.520 Correct. 2034 01:44:36.720 --> 01:44:36.880 Yes. 2035 01:44:37.199 --> 01:44:40.239 And you know that people can communicate and plan and 2036 01:44:40.520 --> 01:44:43.039 act on plans even if they're in the middle of 2037 01:44:43.079 --> 01:44:43.720 a psychosis. 2038 01:44:43.880 --> 01:44:44.000 Right. 2039 01:44:44.279 --> 01:44:44.439 Yes. 2040 01:44:46.199 --> 01:44:49.000 You don't have to be drooling and stumbling and unable 2041 01:44:49.119 --> 01:44:51.920 to walk and talk to be in a psychosis, do 2042 01:44:52.079 --> 01:44:54.920 you so? In other words, a person can be in 2043 01:44:55.000 --> 01:44:58.840 a psychosis and can communicate to friends, family, people talk. 2044 01:44:59.560 --> 01:44:59.880 Correct. 2045 01:45:00.039 --> 01:45:03.000 Yes, So you didn't, as console asked, you didn't have 2046 01:45:03.079 --> 01:45:06.560 any difficulty understanding her. She wasn't slurring her words or 2047 01:45:06.600 --> 01:45:09.439 anything like that when she was able to talk, right, Okay. 2048 01:45:13.119 --> 01:45:14.000 One of the things that. 2049 01:45:16.199 --> 01:45:19.279 When she was admitted and then without going through I'm 2050 01:45:19.319 --> 01:45:20.880 not going to go through all the stuff we've already 2051 01:45:20.880 --> 01:45:24.720 talked about with the medical condition and everything else, you indicated. 2052 01:45:24.680 --> 01:45:26.479 That she was very very ill. Correct. 2053 01:45:26.760 --> 01:45:27.119 Correct? 2054 01:45:28.319 --> 01:45:30.520 Did she appear to be cooperative to you when you 2055 01:45:30.560 --> 01:45:31.800 would interact with her? 2056 01:45:32.159 --> 01:45:32.359 Yes? 2057 01:45:34.600 --> 01:45:35.760 As a doctor. 2058 01:45:35.920 --> 01:45:40.760 As a psychiatrist, you're familiar with bipolar, the concept of 2059 01:45:40.800 --> 01:45:42.319 a bipolar diagnosis. 2060 01:45:42.359 --> 01:45:42.680 Correct. 2061 01:45:42.840 --> 01:45:43.159 Correct? 2062 01:45:43.399 --> 01:45:45.000 Can you tell me what bipolar means? 2063 01:45:45.520 --> 01:45:48.800 Yeah, So, bipolar disorder is a mood disorder categorized as 2064 01:45:48.800 --> 01:45:53.640 a mood disorder where patients have distinct depressive episodes as 2065 01:45:53.720 --> 01:45:56.399 well as, depending on the type of bipolar disorder, either 2066 01:45:56.760 --> 01:46:00.720 hypomanic episodes or manic episodes to the point where they 2067 01:46:00.760 --> 01:46:03.279 don't sleep for days. They still have lots of energy, 2068 01:46:03.760 --> 01:46:07.119 there's this decreased need for sleep. There could be irritability, 2069 01:46:08.119 --> 01:46:12.159 there can be impulsiveness, racing thoughts. A lot of patients 2070 01:46:12.239 --> 01:46:15.319 describe that they're out of control of their behavior, and 2071 01:46:15.399 --> 01:46:18.560 then severe episodes can also include psychosis. 2072 01:46:19.479 --> 01:46:23.560 In reference to bipolar, as you were referring to when 2073 01:46:23.640 --> 01:46:26.079 somebody is hypomanic, what does hypomanic mean. 2074 01:46:26.279 --> 01:46:28.079 Yeah, it's a lesser degree of mania. 2075 01:46:28.880 --> 01:46:32.239 So when patients are hypomanic, they don't always experience things 2076 01:46:32.359 --> 01:46:35.479 like psychosis, but they might experience some of the other 2077 01:46:35.920 --> 01:46:39.239 symptoms that I described, including racing thoughts, kind of moving 2078 01:46:39.279 --> 01:46:45.039 too quickly, talking too quickly, being irritable, And as. 2079 01:46:44.960 --> 01:46:48.279 It relates to the hypomania, would that include things such 2080 01:46:48.359 --> 01:46:51.199 as somebody who is getting up early in the morning 2081 01:46:51.239 --> 01:46:54.560 and exercising or cleaning out their house or selling their 2082 01:46:54.680 --> 01:46:58.479 property out of a garage and having difficulties. 2083 01:46:57.960 --> 01:46:59.399 Sleeping and they're awake all night. 2084 01:46:59.760 --> 01:46:59.960 Yeah. 2085 01:47:00.039 --> 01:47:00.119 Yes. 2086 01:47:03.439 --> 01:47:05.880 As a psychiatrist, one of the things you were concerned 2087 01:47:05.920 --> 01:47:08.079 about when you were first started to deal with her, 2088 01:47:08.199 --> 01:47:10.399 as well as when you were releasing her, if you will, 2089 01:47:11.399 --> 01:47:14.319 is the medication that she had on board, so to speak, 2090 01:47:14.359 --> 01:47:17.720 when she came into the hospital, right, Yes, do you remember, 2091 01:47:17.880 --> 01:47:19.960 and I know it's difficult to recall off hand, but 2092 01:47:20.039 --> 01:47:24.600 do you recall the medications that she was actually under 2093 01:47:25.159 --> 01:47:27.319 from purposes of taking her blood. 2094 01:47:27.119 --> 01:47:30.760 When it was tested when she first came to the hospital. 2095 01:47:30.880 --> 01:47:33.800 Yeah, if you know, I believe her medication list for 2096 01:47:35.000 --> 01:47:41.399 previous to the incident, she was on amatripolene, diazepam. I 2097 01:47:41.720 --> 01:47:45.880 believe she was also on prescribed laurazapam, and there may 2098 01:47:45.920 --> 01:47:46.520 have been one other. 2099 01:47:46.880 --> 01:47:50.520 Okay, So looking at that, if I tell you that 2100 01:47:51.680 --> 01:47:56.479 there was a toxicology report done on her as of 2101 01:47:56.600 --> 01:47:59.520 January twenty fourth, by way of taking her blood, you 2102 01:47:59.600 --> 01:48:03.000 familiar with that, right when they analyzed for toxicology, and 2103 01:48:03.119 --> 01:48:06.600 toxicology obviously would tell us what the medications, if any, 2104 01:48:06.720 --> 01:48:10.920 what type of drugs she had on board, booze, cocaine, anything, right, Yes, 2105 01:48:12.439 --> 01:48:16.960 And you're aware that the toxicology report as well as 2106 01:48:17.119 --> 01:48:19.560 the report from the Department of State Police, as well 2107 01:48:19.720 --> 01:48:25.359 as the NMS laboratory, which would be in Pennsylvania. So 2108 01:48:25.439 --> 01:48:29.119 that's an international or a national respected laboratory, isn't it 2109 01:48:29.199 --> 01:48:32.720 the NMS lab If you know, I don't know, okay, 2110 01:48:33.239 --> 01:48:35.680 but you know that they did take her blood, They 2111 01:48:35.720 --> 01:48:38.079 did test her blood, and it was at the State 2112 01:48:38.159 --> 01:48:41.960 Police laboratory as well as any other labs attested it. 2113 01:48:42.119 --> 01:48:42.239 Right. 2114 01:48:42.800 --> 01:48:44.279 Yes, I believe I found that out later. 2115 01:48:44.399 --> 01:48:46.199 I did not know that the first time I saw her, 2116 01:48:46.239 --> 01:48:47.960 because those labs take a little bit. 2117 01:48:47.920 --> 01:48:49.600 Of time to sh sure and you treated it for 2118 01:48:49.640 --> 01:48:51.439 about a month. So you were pretty close to her 2119 01:48:51.479 --> 01:48:52.600 and got to know her quite well. 2120 01:48:52.920 --> 01:48:53.079 Yes. 2121 01:48:53.680 --> 01:48:54.600 Would you agree with. 2122 01:48:54.680 --> 01:48:57.079 Me that one of the things that her blood reflected 2123 01:48:57.159 --> 01:48:58.840 or that she was on, was trasodote. 2124 01:48:59.159 --> 01:49:01.279 Yes, tell me what trazodone is. 2125 01:49:01.720 --> 01:49:03.880 Trasidone is an antidepressant medication. 2126 01:49:04.840 --> 01:49:09.039 It's more often utilized as a sleep aid because of 2127 01:49:09.399 --> 01:49:12.600 one of the side effects is sedation, and so patients 2128 01:49:12.640 --> 01:49:15.520 that are often having difficulty sleeping are placed on trasidone. 2129 01:49:16.279 --> 01:49:21.239 And is trasidone does that share some of the qualities 2130 01:49:21.479 --> 01:49:25.079 of what I referred to as SSRIs, even though or SSRA, 2131 01:49:25.279 --> 01:49:29.039 even though it's not an SSRI, shares similar qualities. 2132 01:49:29.239 --> 01:49:29.399 Yes. 2133 01:49:30.159 --> 01:49:32.239 Can you tell me what SSIRI means? 2134 01:49:32.479 --> 01:49:35.840 Yeah, So that's a selective serotonin reuptake inhibitor, and it's 2135 01:49:35.880 --> 01:49:40.560 a class of medications that are antidepressants. 2136 01:49:40.920 --> 01:49:46.079 And the ssiris that would also include zoloft for example, 2137 01:49:46.399 --> 01:49:51.960 correct would also include prozac for example. Yes, Are you, 2138 01:49:52.079 --> 01:49:57.279 as a psychiatrist aware that zoloft and or ssri prozac 2139 01:49:57.319 --> 01:50:00.000 should not be prescribed to a patient who has by. 2140 01:50:00.119 --> 01:50:02.880 Polar It can be prescribed. 2141 01:50:03.159 --> 01:50:06.319 Oftentimes it's prescribed together with another medication that can be 2142 01:50:06.439 --> 01:50:10.640 protective because patients with bipolar disorder may be experiencing depression, 2143 01:50:11.039 --> 01:50:13.840 and so they may be prescribed in antidepressant but along 2144 01:50:13.920 --> 01:50:17.279 with another medication that what we call protective. 2145 01:50:17.560 --> 01:50:20.920 And in reference to the SSIRI is a selective serotonin 2146 01:50:21.000 --> 01:50:21.880 reuptake inhibitor. 2147 01:50:21.920 --> 01:50:25.560 What does that mean? Selective serotonin reuptake inhibitor. What does 2148 01:50:25.600 --> 01:50:25.880 that mean? 2149 01:50:26.039 --> 01:50:30.359 Yeah, so oftentimes in depression, patients are kind of lacking 2150 01:50:30.520 --> 01:50:31.279 serotonin in. 2151 01:50:31.279 --> 01:50:34.720 The spaces in their brain that helps. 2152 01:50:35.439 --> 01:50:36.279 What is serotonin? 2153 01:50:36.399 --> 01:50:39.960 Yeah, serotonin is a neurotransmitter, So it's a hormone in 2154 01:50:40.039 --> 01:50:42.119 the brain that works on the brain. It works in 2155 01:50:42.199 --> 01:50:44.840 other areas in the body as well, but for these purposes, 2156 01:50:44.920 --> 01:50:49.039 it works in the brain at nerve endings throughout the body, 2157 01:50:50.000 --> 01:50:54.520 and that neurotransmitter helps with things like mood regulation. 2158 01:50:55.560 --> 01:50:56.319 For patients with. 2159 01:50:56.479 --> 01:50:59.720 Depression, they're often lacking kind of that ability to have 2160 01:50:59.760 --> 01:51:03.399 another serotonin in those spaces, and so a selective serotonin 2161 01:51:03.479 --> 01:51:08.479 reuptake inhibitor prevents serotonin being kind of sucked back into 2162 01:51:08.520 --> 01:51:11.800 the cell, so it allows for serotonin to be more available. 2163 01:51:12.279 --> 01:51:15.560 And what is an SSA I What does that mean? 2164 01:51:15.560 --> 01:51:18.600 An antagonist? Selective serotonin antagonist. 2165 01:51:19.079 --> 01:51:23.279 So those are medications that kind of do the opposite, okay, And. 2166 01:51:23.800 --> 01:51:26.840 You knew as a psychiatrist, at least looking at her history, 2167 01:51:26.920 --> 01:51:31.600 you knew that she had been seeing psychiatrists immediately prior 2168 01:51:31.720 --> 01:51:33.800 to her suicide attime, correct? 2169 01:51:34.000 --> 01:51:34.359 Correct? 2170 01:51:35.439 --> 01:51:37.760 And you knew that she had been prescribed a number 2171 01:51:38.039 --> 01:51:41.279 of drugs by these various psychiatrists. 2172 01:51:41.359 --> 01:51:41.680 Correct. 2173 01:51:41.840 --> 01:51:42.239 Correct? 2174 01:51:42.640 --> 01:51:46.720 And to your knowledge, was she prescribed diazepam yes? Rellion? 2175 01:51:46.960 --> 01:51:51.399 Was she prescribed busperone otherwise known as van spar Yes? 2176 01:51:51.960 --> 01:51:53.119 About wellbutrin? 2177 01:51:53.439 --> 01:51:53.600 Yes? 2178 01:51:53.880 --> 01:51:56.319 And what is albutrin? Is that an antidepressant? 2179 01:51:56.439 --> 01:51:57.560 It is an antidepressant. 2180 01:51:58.520 --> 01:51:59.399 Hydroxyzine? 2181 01:51:59.439 --> 01:52:01.520 What is hydro It can be used. 2182 01:52:01.359 --> 01:52:04.039 For a number of reasons, but for psychiatric purposes, it's 2183 01:52:04.079 --> 01:52:06.439 often used as an anti anxiety medication. 2184 01:52:06.960 --> 01:52:14.920 And clonopin, Yes, is hydroxyzine? Is that a strike that clonopin? 2185 01:52:15.000 --> 01:52:16.960 That's a benzo diazepin. 2186 01:52:16.520 --> 01:52:17.479 Right, that's correct. 2187 01:52:18.239 --> 01:52:23.960 And then la matrigene, Yeah, lomotrigene, lamotrigene. Sorry, yes, what 2188 01:52:24.119 --> 01:52:25.920 type of type of medication is that? Is that a 2189 01:52:26.000 --> 01:52:26.880 mood stabilizer? 2190 01:52:27.079 --> 01:52:27.279 It is? 2191 01:52:27.439 --> 01:52:29.920 Yeah, it's also an anti seizure medication, but in the 2192 01:52:29.960 --> 01:52:32.479 psychiatric realm it's used as a mood stabilizer, and. 2193 01:52:32.479 --> 01:52:35.720 Then we talked about prozac. That's an SSRI correct correct, 2194 01:52:36.079 --> 01:52:37.600 and what's remarn. 2195 01:52:37.640 --> 01:52:38.760 Also an antidepressant. 2196 01:52:39.239 --> 01:52:40.439 So in addition to all. 2197 01:52:40.279 --> 01:52:43.199 Of the drugs that I had mentioned, she was also 2198 01:52:43.399 --> 01:52:45.399 prescribed memarn correct correct. 2199 01:52:45.680 --> 01:52:47.800 She was also prescribed sarah quill or. 2200 01:52:49.720 --> 01:52:52.640 Weetipen ye critiopene yes with tytopine okay? 2201 01:52:52.800 --> 01:52:56.279 And what is sarahqual So, sarahquill is an antipsychotic medication, 2202 01:52:56.760 --> 01:52:57.079 and she. 2203 01:52:57.239 --> 01:53:03.720 Was prescribed, as we already talked, trazodone. She also prescribed amitryptlene. Yes, 2204 01:53:03.960 --> 01:53:05.119 what is amitriptlene. 2205 01:53:05.159 --> 01:53:09.000 Amatriptlen is one of the older antidepressants. It's a tricyclic 2206 01:53:09.119 --> 01:53:12.439 antidepressant that can often be used to. 2207 01:53:12.479 --> 01:53:14.399 Help with sleep, but also mood. 2208 01:53:16.079 --> 01:53:18.880 And and ambient correct correct in. 2209 01:53:19.640 --> 01:53:23.279 Zopidine zopidine Yeah, Zolpidem is the generic name of ambient. 2210 01:53:23.520 --> 01:53:24.119 Oh. Okay. 2211 01:53:25.560 --> 01:53:28.039 Some of these drugs they also have what's called a 2212 01:53:28.159 --> 01:53:30.359 suicide warning or a black box warning. 2213 01:53:30.439 --> 01:53:30.960 Isn't that right? 2214 01:53:31.199 --> 01:53:32.640 Yes? Can you tell me what that means? 2215 01:53:33.000 --> 01:53:33.199 Yeah? 2216 01:53:33.319 --> 01:53:35.920 So, in studies that have been that have been done, 2217 01:53:36.960 --> 01:53:41.520 some of them show that they, especially after starting an antidepressant, 2218 01:53:41.720 --> 01:53:46.279 it can increase someone's risk of suicidality. Many of those 2219 01:53:46.319 --> 01:53:49.800 studies showed that it was mostly in adolescence and young adults, 2220 01:53:50.279 --> 01:53:51.600 but it can happen in adults as well. 2221 01:53:55.520 --> 01:53:58.880 And Selexa was also a drug. Is that an s 2222 01:53:59.039 --> 01:54:02.319 s R too? And all of these drugs that we 2223 01:54:02.520 --> 01:54:10.159 just went through were all prescribed from September end of 2224 01:54:10.239 --> 01:54:11.840 September till January. 2225 01:54:12.920 --> 01:54:16.279 Yes, September twenty twenty two sustained. 2226 01:54:20.000 --> 01:54:21.000 Thank you, thank you. 2227 01:54:23.359 --> 01:54:29.199 Almost redirect Yes, doctor, all those drugs that defense Counsul 2228 01:54:29.399 --> 01:54:31.680 just listed, you're aware she wasn't on all of those 2229 01:54:31.720 --> 01:54:34.399 drugs at the same time, correct, Correct? And did you 2230 01:54:34.520 --> 01:54:37.119 know that many of those drugs she took very a 2231 01:54:37.239 --> 01:54:39.720 very small amount of some she didn't take any pills 2232 01:54:39.720 --> 01:54:39.960 at all. 2233 01:54:40.720 --> 01:54:41.520 I was not aware of that. 2234 01:54:42.000 --> 01:54:44.199 For abuse bar, which is one of the ones he mentioned. 2235 01:54:44.640 --> 01:54:46.600 Were you aware the first prescription she only took two 2236 01:54:46.640 --> 01:54:47.560 pills out of that bottle. 2237 01:54:47.800 --> 01:54:48.560 I was not aware. 2238 01:54:48.680 --> 01:54:50.880 Were you aware the second prescription a month or so 2239 01:54:51.079 --> 01:54:53.720 later form abuse bar she took zero pills. 2240 01:54:53.479 --> 01:54:54.960 Out of that bottle. I was not aware. 2241 01:54:55.720 --> 01:54:57.720 So you're just where you're getting this information about what 2242 01:54:57.800 --> 01:54:59.439 she was on and when. Yeah. 2243 01:54:59.560 --> 01:55:01.520 So one of the things that we do is try 2244 01:55:01.560 --> 01:55:04.199 to collect as much information as we can during our assessments, 2245 01:55:04.920 --> 01:55:06.600 and so we look through the record in terms of 2246 01:55:06.680 --> 01:55:10.079 what was prescribed. We also talk with other providers as 2247 01:55:10.119 --> 01:55:13.279 to what they prescribe. But in the context of the 2248 01:55:13.359 --> 01:55:15.880 assessments that we were doing, it did not require us 2249 01:55:15.960 --> 01:55:18.760 to determine, you know, what exactly she had been on before, 2250 01:55:18.800 --> 01:55:21.199 because we were using a different set of medications to 2251 01:55:21.319 --> 01:55:24.399 treat something different symptoms that she was experiencing. 2252 01:55:24.880 --> 01:55:27.960 So you really have no idea what she was taking 2253 01:55:28.239 --> 01:55:31.039 or when you just know what was prescribed. 2254 01:55:31.560 --> 01:55:33.479 I know what was prescribed, and then we were also 2255 01:55:33.520 --> 01:55:36.920 getting reports of what was being taken what wasn't being taken, but. 2256 01:55:37.000 --> 01:55:40.039 From the defendant, correct, Okay, So she's reporting to you 2257 01:55:40.159 --> 01:55:43.359 that she took those medications, but you'd be surprised to 2258 01:55:43.439 --> 01:55:46.079 know that at least one of them zero pills were taken. 2259 01:55:47.079 --> 01:55:48.760 I don't think I'm surprised, No, okay. 2260 01:55:50.000 --> 01:55:53.960 And you talked about, well talked about prescription and what 2261 01:55:54.079 --> 01:55:58.880 she was taking. Were you aware that in the timeframe 2262 01:55:59.039 --> 01:56:02.279 just prior to her being admitted to the hospital, she 2263 01:56:02.479 --> 01:56:08.119 was only prescribed trasitone valume and immatriptolene just three medications. Yes, 2264 01:56:09.479 --> 01:56:14.159 and you were asked about you know mania, and you 2265 01:56:14.239 --> 01:56:17.399 know exercising and cleaning out your garage and selling your 2266 01:56:17.439 --> 01:56:19.600 belongings could be signs of mania correct. 2267 01:56:19.760 --> 01:56:20.119 Correct. 2268 01:56:20.279 --> 01:56:23.000 But there are people who just exercise every day and 2269 01:56:23.079 --> 01:56:26.119 they're not manic correct correct. And there are people who 2270 01:56:26.239 --> 01:56:28.920 have a messy garage and have accumulated a lot of 2271 01:56:29.000 --> 01:56:31.840 junk and decide to clean out the garage that aren't 2272 01:56:31.840 --> 01:56:35.359 manic correct correct. And in fact, if someone is manic 2273 01:56:35.399 --> 01:56:37.560 and attempts to do one of those tasks like cleaning 2274 01:56:37.600 --> 01:56:40.680 out a garage, it's usually in a disorganized way, and 2275 01:56:41.039 --> 01:56:44.840 oftentimes they don't finish the task correct sometimes. So if 2276 01:56:44.880 --> 01:56:48.000 someone approaches a task by cleaning out the garage by 2277 01:56:48.199 --> 01:56:55.800 organizing with another party, organizing the belonging, separating them into keep, sell, throwout, 2278 01:56:56.079 --> 01:57:01.239 but that's pretty organized behavior correct correct. And if someone 2279 01:57:01.359 --> 01:57:04.720 sells belongings that they no longer need, that's not necessarily 2280 01:57:05.079 --> 01:57:08.279 a sign of mania correct correct. That's more if they're 2281 01:57:08.359 --> 01:57:10.199 selling their stove and then they have nothing to cook 2282 01:57:10.279 --> 01:57:13.359 with correct correct. So if they're selling junk in their 2283 01:57:13.399 --> 01:57:16.000 garage that they no longer need, that's not necessarily manic 2284 01:57:16.239 --> 01:57:18.560 correct not necessarily thank you. 2285 01:57:19.439 --> 01:57:20.039 It's drinking. 2286 01:57:20.920 --> 01:57:25.760 As Consols said, they're exercising every day, and they have 2287 01:57:25.880 --> 01:57:29.399 a messy garage that obviously would not be indicative of 2288 01:57:29.520 --> 01:57:33.479 hypermania warning. Probably sure, normal person could have, as Console 2289 01:57:33.560 --> 01:57:36.159 said it. How about a person that, at the same 2290 01:57:36.319 --> 01:57:39.720 time can't sleep because the insignia is so bad they 2291 01:57:39.840 --> 01:57:42.520 go forty eight hours without sleep. Is that something to 2292 01:57:42.600 --> 01:57:44.920 be considered in the whole evaluation. 2293 01:57:45.359 --> 01:57:45.560 Yes. 2294 01:57:46.199 --> 01:57:48.239 How about the fact that a person's saying that my 2295 01:57:48.359 --> 01:57:51.920 brain is broken and that they can't concentrate, they can't think. 2296 01:57:52.079 --> 01:57:54.920 Is that something that the person you would consider in 2297 01:57:55.039 --> 01:57:58.239 conjunction with the messy garage and the exercise. Yes, thoughts 2298 01:57:58.319 --> 01:58:03.039 of hurting themselves, sidal adeation, that's something that's important to evaluate. Yes, 2299 01:58:03.239 --> 01:58:06.880 homicidal ideation. Telling your husband that you're having thoughts about 2300 01:58:06.960 --> 01:58:09.279 hurting your children, that's something you consider, isn't it. 2301 01:58:09.479 --> 01:58:09.640 Yes. 2302 01:58:11.039 --> 01:58:15.359 In reference to Consul's comiment about just three medications that 2303 01:58:15.479 --> 01:58:18.960 she was on prior to coming trying to commit suicide, 2304 01:58:20.239 --> 01:58:23.840 you're not aware of the doctors telling her to discontinue 2305 01:58:23.920 --> 01:58:26.760 this medication. Stat a new medication, go on to a 2306 01:58:26.800 --> 01:58:29.680 different medication depending on the doctor you're not aware of 2307 01:58:29.760 --> 01:58:34.439 that right now. And finally, if you know, did she 2308 01:58:34.600 --> 01:58:37.000 sign a DNR do not res ascitate? 2309 01:58:37.239 --> 01:58:40.520 She asked to the day after the first evaluation that 2310 01:58:40.600 --> 01:58:42.720 I did of her, which was the capacity assessment to 2311 01:58:42.800 --> 01:58:43.920 change her health care proxy. 2312 01:58:44.680 --> 01:58:47.039 But in the context of her reporting a. 2313 01:58:47.079 --> 01:58:50.960 Serious suicide attempt, we did not change her code status. 2314 01:58:51.239 --> 01:58:53.640 We continued to chat with her about that, and she 2315 01:58:53.840 --> 01:58:56.359 ultimately came to the conclusion that it made sense to 2316 01:58:56.880 --> 01:58:59.319 make sure that her mental health was stable before she 2317 01:58:59.399 --> 01:59:00.680 considered her code status. 2318 01:59:00.840 --> 01:59:05.680 Okay, but her initial reaction or her conversations with you, 2319 01:59:05.800 --> 01:59:07.279 always that she wanted. 2320 01:59:07.279 --> 01:59:09.439 To have a do not Resuscitate status? 2321 01:59:09.640 --> 01:59:12.319 Correct, Thank you? Come up? 2322 01:59:13.239 --> 01:59:14.920 All right, Thank you doctor, Thank you your honor. 2323 01:59:15.840 --> 01:59:18.720 All right, the Jew, we can think the afternoon resiss 2324 01:59:18.760 --> 01:59:21.199 at this point, So I'm going to ask you to 2325 01:59:21.640 --> 01:59:24.520 go back to your room and then we'll come back here. 2326 01:59:24.680 --> 01:59:25.439 Approximate tour. 2327 01:59:26.159 --> 01:59:34.199 Okay, all right, excellently, cool. 2328 01:59:36.640 --> 01:59:36.960 Counsel. 2329 01:59:37.039 --> 01:59:40.399 I think we need to address before the break. All right, 2330 01:59:40.560 --> 01:59:42.399 so we'll be in resiss till about two o'clock. 2331 01:59:42.520 --> 01:59:42.760 Thank you. 2332 01:59:45.960 --> 01:59:48.319 Date of birth is nine twelve, nineteen eighty two. 2333 01:59:48.880 --> 01:59:49.800 What do you do for a living? 2334 01:59:50.479 --> 01:59:54.039 I am a forensic psychiatrist, and I work on at 2335 01:59:54.079 --> 01:59:55.279 Brigham and Women's Hospital. 2336 01:59:56.079 --> 01:59:59.199 And what is a forensic psychologist or psychiatrist. 2337 02:00:00.640 --> 02:00:06.000 Well, I'm a forensic psychiatrist by specialty training, and we 2338 02:00:06.359 --> 02:00:11.840 work in the courts, often doing forensic evaluations of individuals. 2339 02:00:12.119 --> 02:00:15.560 But I'm also an adult psychiatrist and I work at 2340 02:00:15.600 --> 02:00:18.039 Brigham and Women's Hospital as an adult psychiatrist on the 2341 02:00:18.119 --> 02:00:19.880 consult liaison unit. 2342 02:00:20.800 --> 02:00:24.439 And can you just briefly describe your education and training 2343 02:00:24.479 --> 02:00:25.920 background that qualifies. 2344 02:00:25.520 --> 02:00:26.119 You for this work. 2345 02:00:27.079 --> 02:00:29.960 Sure. I grew up in the South Shore. I went 2346 02:00:30.039 --> 02:00:34.039 to Dartmouth College and then I went to medical school 2347 02:00:34.159 --> 02:00:38.880 at UMass Chan Medical School. I then did my psychiatry 2348 02:00:39.079 --> 02:00:44.359 residency at Harvard Longwood, which consists of Brigaman Women's, Beth Israel, 2349 02:00:44.479 --> 02:00:48.960 Boston Children's at the time, and after that I did 2350 02:00:49.119 --> 02:00:55.000 sub specialty training after my psychiatry residency in forensic psychiatry 2351 02:00:55.319 --> 02:00:57.720 again at UMass Chan Medical School. 2352 02:00:58.199 --> 02:01:04.079 And focusing in on January of twenty twenty three, were 2353 02:01:04.119 --> 02:01:07.079 you working at the Brigham and Women's Hospital. I was, 2354 02:01:07.720 --> 02:01:11.119 And specifically on January twenty fifth, twenty twenty three, did 2355 02:01:11.159 --> 02:01:14.560 you interact with a woman a patient there named Lindsay Clancy. 2356 02:01:15.840 --> 02:01:18.239 I did on January twenty sixth, twenty sixth. 2357 02:01:18.279 --> 02:01:23.720 Okay, in what capacity did you interact with her as 2358 02:01:23.760 --> 02:01:27.039 a forensic psychiatrist or as a member of the staff 2359 02:01:27.119 --> 02:01:27.920 at Brigham. 2360 02:01:27.640 --> 02:01:31.000 And Women's I interacted with her as a member of 2361 02:01:31.079 --> 02:01:33.880 the staff, the psychiatry staff at Brigham and Women's Hospital. 2362 02:01:34.680 --> 02:01:37.920 And did you have a particular role that day on 2363 02:01:38.079 --> 02:01:39.840 January twenty sixth, twenty twenty three. 2364 02:01:41.640 --> 02:01:44.399 Yes, I was on the Consulate leaves On service, which 2365 02:01:44.479 --> 02:01:47.920 is the psychiatry service that's called by medical and surgical 2366 02:01:47.960 --> 02:01:53.640 specialties to help evaluate and provide psychiatric recommendations. 2367 02:01:54.319 --> 02:01:56.680 And when you did you meet with Mss Clancy on 2368 02:01:56.720 --> 02:01:59.239 that day on the twenty sixth, I did? And was 2369 02:01:59.279 --> 02:02:02.880 that around fourteen pm that you had that interaction. I 2370 02:02:02.920 --> 02:02:05.800 think it was somewhere between two and three o'clock, yes, 2371 02:02:06.479 --> 02:02:09.600 And when you met with Lindsay Clancy, was that in 2372 02:02:09.720 --> 02:02:11.079 her hospital room in the ICU? 2373 02:02:11.880 --> 02:02:12.159 It was? 2374 02:02:12.800 --> 02:02:16.079 And was she indbated at the time she was? And 2375 02:02:16.399 --> 02:02:17.000 was she awake? 2376 02:02:17.720 --> 02:02:18.399 She was awake? 2377 02:02:19.039 --> 02:02:20.760 And what was she oriented? 2378 02:02:22.840 --> 02:02:25.720 So she was intubated, so it was difficult for her 2379 02:02:25.880 --> 02:02:29.479 to really answer a lot a range of questions and 2380 02:02:29.720 --> 02:02:33.359 so she she gestured to me to be able to write, 2381 02:02:34.079 --> 02:02:37.680 and so we knew that she was really exhausted and 2382 02:02:37.760 --> 02:02:43.479 anxious from the entire experience and the evaluation, and so 2383 02:02:43.920 --> 02:02:47.039 we didn't ask her all of the questions around orientation. 2384 02:02:47.960 --> 02:02:50.079 When she gestured that she wanted to write, did you 2385 02:02:50.119 --> 02:02:52.600 give her something to write with or something to write on? 2386 02:02:53.239 --> 02:02:53.560 I did? 2387 02:02:53.760 --> 02:02:55.119 And what did you give her paper? 2388 02:02:55.760 --> 02:02:57.720 And did you also give her a pen or something 2389 02:02:57.840 --> 02:02:58.000 like that? 2390 02:02:58.600 --> 02:02:58.920 I did? 2391 02:03:00.279 --> 02:03:04.319 Was she able to when you asked her certain questions? 2392 02:03:04.479 --> 02:03:06.399 Was she able to answer those questions by writing the 2393 02:03:06.439 --> 02:03:07.279 answers on the paper? 2394 02:03:07.960 --> 02:03:08.359 She was? 2395 02:03:09.359 --> 02:03:12.000 And did you ask her about her mood that day? 2396 02:03:12.760 --> 02:03:13.840 I did ask her her mood? 2397 02:03:14.159 --> 02:03:15.239 And what did she write? 2398 02:03:16.000 --> 02:03:17.159 She wrote horrified? 2399 02:03:18.279 --> 02:03:20.680 And what was her affect during this interaction? 2400 02:03:21.880 --> 02:03:24.640 At the time that I saw her, she was intubated, 2401 02:03:24.880 --> 02:03:28.039 and that in and of itself is very uncomfortable, and 2402 02:03:28.479 --> 02:03:30.840 so she seemed very anxious. 2403 02:03:32.119 --> 02:03:36.560 And did she write anything else on that paper that 2404 02:03:36.720 --> 02:03:37.039 you saw? 2405 02:03:39.359 --> 02:03:43.039 Yes, the entire evaluation was done through writing because she 2406 02:03:43.159 --> 02:03:44.079 couldn't speak. 2407 02:03:44.760 --> 02:03:46.840 So what types of questions were you asking her? And 2408 02:03:46.920 --> 02:03:48.159 what was she repronging with? 2409 02:03:48.800 --> 02:03:53.720 So we asked her, you know, how are you feeling 2410 02:03:54.399 --> 02:04:00.920 horrified and then she wrote down do I have an attorney? 2411 02:04:01.800 --> 02:04:05.520 And I said with my team that at this time, 2412 02:04:05.840 --> 02:04:07.760 we're just getting to know you and getting to know 2413 02:04:08.159 --> 02:04:11.600 the case, and we're not sure exactly you know, what 2414 02:04:12.720 --> 02:04:19.800 is happening. And we asked her do you have questions 2415 02:04:19.920 --> 02:04:25.279 for us? And she asked, is my body broken? Are 2416 02:04:25.359 --> 02:04:32.800 my legs straight? And she then asked about can she 2417 02:04:32.960 --> 02:04:36.720 have visitors? And you know where her family is? 2418 02:04:38.039 --> 02:04:44.520 And when you are asking her questions, what is the 2419 02:04:44.600 --> 02:04:47.760 goal of the questions that you're asking her? What are 2420 02:04:47.800 --> 02:04:49.359 you trying to address or assess? 2421 02:04:50.119 --> 02:04:53.399 It depends. Psychiatrists are call for all kinds of issues 2422 02:04:53.399 --> 02:04:57.479 that happen in the hospital. In this situation, we were 2423 02:04:57.600 --> 02:05:01.680 asked around you know, diagnosed clarity that there was a 2424 02:05:01.920 --> 02:05:05.399 likely suicide event that occurred. Can you evaluate her for 2425 02:05:05.520 --> 02:05:09.279 safety at this time before she goes into. 2426 02:05:09.199 --> 02:05:13.680 Surgery and I know that she was intubated, so she's 2427 02:05:13.720 --> 02:05:17.520 writing her answers. But based on the answers she wrote 2428 02:05:17.520 --> 02:05:19.920 on the paper, did she seem to understand the questions 2429 02:05:19.960 --> 02:05:20.560 you were asking? 2430 02:05:21.520 --> 02:05:21.720 Yes? 2431 02:05:22.319 --> 02:05:25.439 And her response is did you understand those? 2432 02:05:27.600 --> 02:05:27.840 Yes? 2433 02:05:27.960 --> 02:05:30.439 She was anxious and she needed breaks. And I said 2434 02:05:30.600 --> 02:05:34.640 anytime you need a break, we can leave. But she 2435 02:05:35.720 --> 02:05:38.520 did write to us those particular answers. 2436 02:05:39.760 --> 02:05:42.640 So what she was writing, even when she asked if 2437 02:05:42.680 --> 02:05:45.640 she had a lawyer, those were things. What she was 2438 02:05:45.720 --> 02:05:49.159 writing made sense given the situation. She wasn't writing, is 2439 02:05:49.199 --> 02:05:50.479 there a unicorn in the corner? 2440 02:05:50.680 --> 02:05:50.800 Right? 2441 02:05:51.279 --> 02:05:55.199 Correct? That if there was a unicorn in the corner. 2442 02:05:56.800 --> 02:05:59.880 So what she's asking, do I have an a turn? 2443 02:06:01.119 --> 02:06:04.039 Are my legs straight? Is my body broken? Those all 2444 02:06:04.079 --> 02:06:08.279 made sense given the situation she was in. Correct, they 2445 02:06:08.319 --> 02:06:15.039 were relevant answers and questions she was asking. And are 2446 02:06:15.119 --> 02:06:19.479 you familiar with the characteristics of psychosis? 2447 02:06:20.840 --> 02:06:21.039 Yes? 2448 02:06:21.439 --> 02:06:21.720 Okay? 2449 02:06:22.159 --> 02:06:26.159 And what are the typical signs or symptoms of someone 2450 02:06:26.199 --> 02:06:27.720 who is in psychosis? 2451 02:06:31.079 --> 02:06:36.720 It really depends and it ranges across a spectrum of symptoms. 2452 02:06:37.600 --> 02:06:40.680 So we have a whole category of different types of 2453 02:06:40.760 --> 02:06:43.439 symptoms that we look at for psychosis, and they are 2454 02:06:43.560 --> 02:06:48.399 different for everyone. But you know, they can be what 2455 02:06:48.520 --> 02:06:54.159 we call negative symptoms, which are more internal isolating, not responding, 2456 02:06:54.760 --> 02:06:59.399 not reacting very much. And then we have symptoms like 2457 02:06:59.520 --> 02:07:02.479 positive symptoms, that's what we call them in psychiatry, but 2458 02:07:02.520 --> 02:07:05.880 they're a little bit more outward focused, where objectively, you 2459 02:07:06.000 --> 02:07:10.600 can see what those symptoms are, like being paranoid, darting 2460 02:07:10.640 --> 02:07:14.279 your eyes around, responding to internal stimuli, which means you're 2461 02:07:14.319 --> 02:07:21.960 responding to voices, and you know, being within a delusion. 2462 02:07:22.600 --> 02:07:25.720 So there's all kinds of symptoms and they look different 2463 02:07:25.840 --> 02:07:27.279 for each and every person. 2464 02:07:28.119 --> 02:07:32.000 In your conversation with Ms Clancy, did you notice any 2465 02:07:32.479 --> 02:07:35.640 internal or external signs of psychosis. 2466 02:07:36.720 --> 02:07:41.159 At the time, I documented that I did not note those. 2467 02:07:42.399 --> 02:07:47.199 And did you also note that you know she was 2468 02:07:47.479 --> 02:07:51.279 her thinking was linear, goal oriented, thoughtful, and she didn't 2469 02:07:51.319 --> 02:07:54.039 appear to be responding to internal stimuli. 2470 02:07:55.039 --> 02:07:58.319 Yes, that is typical language and psychiatric mental statuses, and 2471 02:07:58.439 --> 02:08:04.199 I did document that what is internal stimuli. Oftentimes it's 2472 02:08:04.560 --> 02:08:06.920 very difficult for our patients to be able to articulate 2473 02:08:07.199 --> 02:08:12.520 what they're hearing. They may have perceptual disturbances like hallucinations 2474 02:08:12.720 --> 02:08:20.119 or auditory hallucinations, and maybe hearing voices. When it's really active, 2475 02:08:20.399 --> 02:08:24.600 we often see those individuals interacting with those voices. I 2476 02:08:24.680 --> 02:08:26.680 didn't see that in that particular moment. 2477 02:08:27.199 --> 02:08:30.520 So, for example, you could see someone engaging in a conversation, 2478 02:08:30.560 --> 02:08:33.159 looks like they're engaging in a conversation with someone or 2479 02:08:33.239 --> 02:08:36.600 looks like they're looking over at something, thinking something or 2480 02:08:36.680 --> 02:08:38.199 someone is there when they're not. 2481 02:08:39.880 --> 02:08:43.560 Correct, that's what responding to internal stimuli is. 2482 02:08:44.119 --> 02:08:46.359 And you didn't see any of that present with miss Clancy. 2483 02:08:46.760 --> 02:08:47.119 Correct? 2484 02:08:48.560 --> 02:08:52.960 And would it be fair that some of the obvious 2485 02:08:53.039 --> 02:08:57.359 signs of psychosis would be someone whose thoughts are disorganized, 2486 02:08:57.439 --> 02:09:01.600 that they're thinking isn't linear, that they're not making sense 2487 02:09:01.680 --> 02:09:04.680 things like words salad, where they're just throwing in words, 2488 02:09:04.800 --> 02:09:06.239 making sentences that don't make sense. 2489 02:09:07.239 --> 02:09:10.520 So you describe symptoms that we can see in people 2490 02:09:10.680 --> 02:09:13.840 with serious mental illness, who have a psychotic disorder with 2491 02:09:14.000 --> 02:09:15.800 active symptoms, and. 2492 02:09:15.840 --> 02:09:17.600 You didn't see any of that with Ms Clancy. 2493 02:09:17.680 --> 02:09:18.119 Is that correct? 2494 02:09:18.600 --> 02:09:20.560 Not in that snapshot moment of time. 2495 02:09:21.039 --> 02:09:23.760 And to be clear, you only saw for a limited 2496 02:09:23.800 --> 02:09:25.399 amount of time on that one day. Correct. 2497 02:09:25.520 --> 02:09:26.239 That is correct? 2498 02:09:26.439 --> 02:09:30.640 And this is January twenty sixth, twenty twenty three, about 2499 02:09:31.479 --> 02:09:33.640 a day and a half or so after she's admitted 2500 02:09:33.680 --> 02:09:39.159 to Brigham in woman's that is correct. Yes, and she's 2501 02:09:39.199 --> 02:09:44.039 still intubated. And one of the first questions she ask 2502 02:09:44.199 --> 02:09:44.520 is do I. 2503 02:09:44.560 --> 02:09:45.039 Have a lawyer? 2504 02:09:46.239 --> 02:09:46.439 Yes? 2505 02:09:47.680 --> 02:09:52.960 And did you have any based on your training experience, 2506 02:09:53.079 --> 02:09:59.600 did you have any thoughts about her awareness or thoughtfulness 2507 02:09:59.600 --> 02:10:03.560 about the questions she asked or the answer she gave. 2508 02:10:06.640 --> 02:10:06.680 It. 2509 02:10:07.359 --> 02:10:15.439 Did you have any assessment professionally of the responses and awareness. 2510 02:10:15.000 --> 02:10:15.520 That she had. 2511 02:10:17.000 --> 02:10:20.359 Yes. At that time, I was trying to assess, you know, 2512 02:10:20.600 --> 02:10:26.840 is she confused or oriented? Is she completely disorganized? Is 2513 02:10:26.920 --> 02:10:30.079 she so anxious that she won't be able to sleep? 2514 02:10:30.479 --> 02:10:33.960 I was assessing suicidality mostly. I was being called into 2515 02:10:34.039 --> 02:10:37.960 the room for that, and so there were a lot 2516 02:10:38.079 --> 02:10:40.680 of things that I was assessing all at the same 2517 02:10:40.880 --> 02:10:44.960 time before the surgical intervention that was going to happen. 2518 02:10:46.439 --> 02:10:49.159 And did I answer your question, yes, okay. 2519 02:10:49.800 --> 02:10:54.840 And so in doing that and evaluating all of those things, 2520 02:10:55.760 --> 02:10:58.279 did you have any concerns at that point in time 2521 02:10:59.039 --> 02:11:01.560 that she couldn't make a decision to have the surgery, 2522 02:11:01.760 --> 02:11:04.560 or that there was some cause for concern there in 2523 02:11:04.640 --> 02:11:05.199 her behavior. 2524 02:11:06.800 --> 02:11:09.399 I felt she had the capability to make the decision 2525 02:11:09.439 --> 02:11:10.560 for surgery at that time. 2526 02:11:13.800 --> 02:11:17.760 Another the questions, thank you, thank you, it's strength. 2527 02:11:18.840 --> 02:11:20.680 Definitely good afternoon. 2528 02:11:21.880 --> 02:11:24.800 So just a couple of questions. The council was asking 2529 02:11:24.840 --> 02:11:28.159 you about psychosis. Apparently you've dealt with people, some of 2530 02:11:28.239 --> 02:11:30.479 your patients while you're working in the hospital that in 2531 02:11:30.560 --> 02:11:34.119 fact were florid, they had psychosis and symptoms of the psychosis. 2532 02:11:34.399 --> 02:11:38.239 Yes, so you've dealt with people. Is it a fair 2533 02:11:38.319 --> 02:11:40.760 amount of people that would actually hear voices? 2534 02:11:41.600 --> 02:11:44.039 Yes, I've seen many patients that are hearing voices. 2535 02:11:44.239 --> 02:11:47.760 And would they to your knowledge, were they involved with 2536 02:11:47.880 --> 02:11:50.000 command hallucinations. 2537 02:11:49.239 --> 02:11:50.439 Things of that nature. 2538 02:11:52.199 --> 02:11:53.479 My patients in the past. 2539 02:11:54.840 --> 02:11:57.640 Yes, Yeah, large. 2540 02:11:57.399 --> 02:11:59.439 Amount of people that you've treated over the years that 2541 02:11:59.600 --> 02:12:07.159 have suffered from command hallucinations, hearing voices, delusions. 2542 02:12:06.640 --> 02:12:09.119 Things of that nature right in my career. 2543 02:12:09.279 --> 02:12:09.479 Yes. 2544 02:12:10.960 --> 02:12:13.319 And do you know whether or not there had been 2545 02:12:13.439 --> 02:12:18.359 any indication from lindsay as to well in the hospital 2546 02:12:18.960 --> 02:12:24.720 having any delusions or psychosis symptoms of that nature, if 2547 02:12:24.760 --> 02:12:24.960 you know. 2548 02:12:27.560 --> 02:12:30.239 So I saw her, she had only been in the 2549 02:12:30.279 --> 02:12:34.439 hospital for a day and a half and I hadn't 2550 02:12:34.600 --> 02:12:39.600 heard about any psychotic delusions from anything I see. 2551 02:12:40.159 --> 02:12:42.079 I saw her one time once. 2552 02:12:42.680 --> 02:12:46.560 Okay, how long did how long were you evaluating her? 2553 02:12:48.279 --> 02:12:52.119 Probably because she was intubated, it was very excasting. How 2554 02:12:52.199 --> 02:12:54.199 long about twenty to thirty minutes? 2555 02:12:54.279 --> 02:12:55.399 Twenty minutes, thirty minutes? 2556 02:12:56.560 --> 02:13:01.000 And a psychosis is a psychosis to you knowledge, something 2557 02:13:01.079 --> 02:13:04.880 that has to continue or does it stop. 2558 02:13:08.439 --> 02:13:13.840 It absolutely depends on the patient. It depends on their age, 2559 02:13:14.000 --> 02:13:17.520 how many episodes of psychosis they have had, It depends 2560 02:13:17.560 --> 02:13:21.760 on the type of psychosis we're seeing. For some people 2561 02:13:21.840 --> 02:13:25.359 they can have moments of clarity, absolutely, and for some 2562 02:13:25.720 --> 02:13:28.640 it can be more continuous. It really depends on the 2563 02:13:28.760 --> 02:13:30.640 patient and their illness. 2564 02:13:31.640 --> 02:13:37.920 Okay, So basically you're saying that it would be case specific, Yes, 2565 02:13:38.199 --> 02:13:40.880 all right, And in the twenty minutes or so that 2566 02:13:40.960 --> 02:13:46.720 you had when you're dealing with Lindsey, were you aware 2567 02:13:47.199 --> 02:13:50.520 of her prior medical and psychiatric. 2568 02:13:50.079 --> 02:13:55.399 History when we get consulted on a case we I'm sorry, 2569 02:13:55.439 --> 02:13:56.119 I mean interrupt you. 2570 02:13:56.159 --> 02:14:01.520 I'm asking were you aware of her medical and psychiatric history? 2571 02:14:02.680 --> 02:14:05.319 I was aware of the portion that was in the 2572 02:14:05.399 --> 02:14:06.840 medical record before I saw her. 2573 02:14:06.960 --> 02:14:11.880 Okay, so that would deal with as far as postpartum psychosis. 2574 02:14:13.039 --> 02:14:16.520 I could you ask that question man, when you looked. 2575 02:14:16.359 --> 02:14:19.319 At the medical record and when you were involved evaluating 2576 02:14:19.359 --> 02:14:22.239 her on behalf of the hospital, because you weren't. You 2577 02:14:22.359 --> 02:14:25.159 weren't a psychiatrist that her mother or father had. 2578 02:14:25.119 --> 02:14:28.159 Retained and asked to go see her, right, correct. You 2579 02:14:28.239 --> 02:14:29.399 were working for the hospital. 2580 02:14:29.600 --> 02:14:31.800 I was working for Brigham and Women's Hospital, and you had. 2581 02:14:31.800 --> 02:14:34.479 Spoken to a number of people before you interacted with 2582 02:14:34.600 --> 02:14:36.600 her for the twenty minutes that you saw her while 2583 02:14:36.640 --> 02:14:36.960 she was. 2584 02:14:37.039 --> 02:14:40.720 There for a month, right, No? Okay? Now, were you 2585 02:14:40.880 --> 02:14:48.079 aware of her history of docum documented postpartum depression. 2586 02:14:49.279 --> 02:14:53.960 I was aware of mostly the postpartum anxiety that was 2587 02:14:54.319 --> 02:14:54.880 in the record. 2588 02:14:54.960 --> 02:14:59.359 Yes, and postpartum anxiety. The symptomology would be insomnia. 2589 02:15:01.319 --> 02:15:05.640 Yes. Did she have insomnia prior to seeing you for 2590 02:15:05.720 --> 02:15:06.279 twenty minutes? 2591 02:15:06.640 --> 02:15:06.840 Yes? 2592 02:15:07.319 --> 02:15:09.800 And do you recall the length of time that she 2593 02:15:09.880 --> 02:15:12.279 would be suffering from insomnia? Was it like a week, 2594 02:15:12.359 --> 02:15:13.319 a day, a month or what. 2595 02:15:14.039 --> 02:15:15.720 I don't recall the timing exactly. 2596 02:15:16.000 --> 02:15:16.960 Do you recall that at. 2597 02:15:16.920 --> 02:15:20.199 One point that she was on medication and actually went 2598 02:15:20.279 --> 02:15:21.920 for forty eight hours without sleep. 2599 02:15:24.640 --> 02:15:28.920 I don't recall that exactly from the record that number. 2600 02:15:29.800 --> 02:15:32.439 Do you recall, in addition to the insomnia, that she 2601 02:15:32.840 --> 02:15:37.520 was concerned as asking you if in fact her brain 2602 02:15:37.720 --> 02:15:38.159 was broken? 2603 02:15:40.520 --> 02:15:43.920 She asked me, is my body broken? 2604 02:15:44.119 --> 02:15:46.960 Okay? Did you see in the records that she was 2605 02:15:47.079 --> 02:15:49.479 concerned about the effect of the drugs and whether or 2606 02:15:49.520 --> 02:15:52.600 not her brain was broken quote unquote. 2607 02:15:52.880 --> 02:15:55.039 I did not see that language in the records. 2608 02:15:55.439 --> 02:16:00.479 How about acting on command, hallucinations, conversations, just statements to 2609 02:16:00.560 --> 02:16:03.600 the effect that she was having thoughts of suicidal ideation? 2610 02:16:04.079 --> 02:16:07.319 You know that, right, I did know about the suicidal ideation. 2611 02:16:07.560 --> 02:16:11.159 Yes, How many times did she express to people that 2612 02:16:11.319 --> 02:16:14.760 she would tell people that she had been concentrating on 2613 02:16:14.960 --> 02:16:16.439 committing suicide. 2614 02:16:17.640 --> 02:16:20.800 If you know, I don't recall the number of times. 2615 02:16:21.359 --> 02:16:23.840 So, in any event, you know that she was insomnia. 2616 02:16:23.920 --> 02:16:26.000 You know that there was a significant period of time 2617 02:16:26.039 --> 02:16:28.199 that she was suffering from insomnia. Knew that she was 2618 02:16:28.279 --> 02:16:32.719 expressing suicidal ideation. How about homicidal ideation? Did she express that? 2619 02:16:34.559 --> 02:16:34.600 Not? 2620 02:16:34.840 --> 02:16:36.440 From my review of the records? 2621 02:16:36.879 --> 02:16:37.159 Okay? 2622 02:16:37.239 --> 02:16:39.559 Would that be indicative of a person that could be 2623 02:16:39.639 --> 02:16:43.479 in psychosis expressing concerns about homicidal ideation. 2624 02:16:45.479 --> 02:16:46.360 Overall alone? 2625 02:16:49.079 --> 02:16:51.639 Sorry, I don't know that question. Could you repeat that question? 2626 02:16:52.760 --> 02:16:55.440 Is that one of the factors that one would be 2627 02:16:55.520 --> 02:16:58.520 concerned about as a psychiatrist if a person was expressing 2628 02:16:58.600 --> 02:17:01.399 homicidal ideation, I would. 2629 02:17:01.200 --> 02:17:02.879 Be concerned about that as a psychiatrist. 2630 02:17:03.200 --> 02:17:05.840 And in fact, in this case, you knew at least 2631 02:17:05.879 --> 02:17:10.040 about the suicidal ideation that she had been expressing. Right, Yes, 2632 02:17:10.280 --> 02:17:12.719 But you didn't know about any homicidal ideation. 2633 02:17:12.520 --> 02:17:13.319 She was expressing. 2634 02:17:13.399 --> 02:17:22.600 Right from the records. I knew that there was an 2635 02:17:22.680 --> 02:17:24.399 event that had occurred and that. 2636 02:17:24.600 --> 02:17:25.440 The children died. 2637 02:17:25.600 --> 02:17:29.959 That's the event you're referring to, right, Yes, Okay, next question, now, 2638 02:17:30.760 --> 02:17:33.479 as far as the period of time that she. 2639 02:17:33.719 --> 02:17:36.399 Was involved with. By the way, what's hypomania. 2640 02:17:37.959 --> 02:17:43.360 Hypomania is sort of the gradual increase towards mania, the 2641 02:17:43.399 --> 02:17:47.520 symptoms that we see in somebody who might have bipolar disorder. 2642 02:17:48.079 --> 02:17:52.680 And with bipolar disorder, we see mixed depression and we 2643 02:17:52.840 --> 02:17:56.879 see mania, and we see symptoms that kind of gradually 2644 02:17:57.000 --> 02:17:59.639 increase to mania, and we call that period hypomania. 2645 02:18:00.879 --> 02:18:03.879 Did she exhibit, to your knowledge from the medical records, 2646 02:18:03.920 --> 02:18:09.959 any periods of hypermania, excessive cleaning, exercise, or activities, being 2647 02:18:10.000 --> 02:18:11.760 awake at night, things of that nature. 2648 02:18:12.520 --> 02:18:15.799 At that moment on January twenty sixth, I don't remember 2649 02:18:15.879 --> 02:18:17.200 reading about that, Okay. 2650 02:18:17.719 --> 02:18:19.479 Do you have any memory of reading about it at 2651 02:18:19.520 --> 02:18:26.680 all other than that moment. As a treating physician, a doctor. 2652 02:18:26.520 --> 02:18:30.479 Psychiatrist, I don't remember. 2653 02:18:30.840 --> 02:18:32.799 So what is your purpose at the hospital. 2654 02:18:32.879 --> 02:18:36.639 I mean, you're not treating the person for any illness 2655 02:18:36.680 --> 02:18:39.399 that they have as far as their mental condition, right, 2656 02:18:39.440 --> 02:18:40.200 you're not treating them. 2657 02:18:41.280 --> 02:18:45.079 We are, Oh, you are, yes, So you're. 2658 02:18:44.959 --> 02:18:49.840 Concerned about obviously their symptomology of any that they present 2659 02:18:50.040 --> 02:18:52.399 at the time that you're looking at them and talking 2660 02:18:52.479 --> 02:18:52.760 to them. 2661 02:18:52.879 --> 02:18:54.479 Or in this case, she couldn't talk. 2662 02:18:54.600 --> 02:18:57.600 But she couldn't talk, and she was going into surgery, 2663 02:18:57.840 --> 02:19:02.959 and we had recommended suicidal precautions, We had recommended trauma 2664 02:19:03.120 --> 02:19:05.360 informed care so that she was getting the care that 2665 02:19:05.440 --> 02:19:08.079 she needed. She was going to go into surgery, and 2666 02:19:08.239 --> 02:19:10.920 then after that we were going to continue to follow 2667 02:19:11.000 --> 02:19:13.559 her and assess her and make sure that we were 2668 02:19:13.600 --> 02:19:17.760 evaluating her appropriately and making recommendations to the surgical team 2669 02:19:17.840 --> 02:19:18.840 for the care that she needed. 2670 02:19:20.120 --> 02:19:21.920 Go said objection. 2671 02:19:23.000 --> 02:19:26.920 So, when you're dealing with this person that's going into surgery, 2672 02:19:27.040 --> 02:19:29.639 did you know what type of surgery she was going 2673 02:19:29.799 --> 02:19:30.079 in for? 2674 02:19:32.799 --> 02:19:35.719 At the time, we knew that she was going into 2675 02:19:35.879 --> 02:19:38.680 surgery for her spine? 2676 02:19:39.239 --> 02:19:40.440 Did you know what happened with spaine? 2677 02:19:42.079 --> 02:19:43.879 I knew that she had injuries to her spine. 2678 02:19:44.239 --> 02:19:46.280 Did you know that there was a transaction injury that 2679 02:19:46.360 --> 02:19:52.079 her spine was basically exploded and five six other thoracic 2680 02:19:52.440 --> 02:19:57.879 vertebrae fractioned, including the cervical vertebrae up by her throat. 2681 02:19:57.920 --> 02:20:00.239 You knew all that we were reading about. It was 2682 02:20:00.319 --> 02:20:06.200 all actively happening at that time. Was she in pain, Yes, 2683 02:20:06.840 --> 02:20:07.760 I'm sure she was. 2684 02:20:08.520 --> 02:20:09.440 Was she on medication? 2685 02:20:12.079 --> 02:20:12.840 She was on. 2686 02:20:14.040 --> 02:20:18.680 She was on a few medications related to pain and 2687 02:20:19.280 --> 02:20:19.959 blood pressure. 2688 02:20:20.200 --> 02:20:23.159 So she's brought into the hospital. You knew from reviewing 2689 02:20:23.239 --> 02:20:27.159 her records as a psychiatrist that, in fact, she coded 2690 02:20:27.479 --> 02:20:28.639 the day before, right. 2691 02:20:31.959 --> 02:20:35.559 I don't recall her coding the day before I saw her. 2692 02:20:35.760 --> 02:20:38.479 I do recall from the records that she had a 2693 02:20:38.600 --> 02:20:42.200 coding event after, I think on the twenty seventh or 2694 02:20:42.239 --> 02:20:42.719 twenty eighth. 2695 02:20:42.920 --> 02:20:46.440 Okay, So you were not involved with her when she coded. 2696 02:20:46.520 --> 02:20:49.239 Did you know that she had any events of that 2697 02:20:49.479 --> 02:20:53.120 nature right after she was brought from the South Shore Hospital? 2698 02:20:55.440 --> 02:20:57.040 I don't know what you're referring to. 2699 02:20:57.680 --> 02:21:00.399 You know what a code is, right, Yes, you almost 2700 02:21:00.520 --> 02:21:01.639 die before you saw her. 2701 02:21:03.600 --> 02:21:04.399 I think it was after. 2702 02:21:04.760 --> 02:21:10.239 Okay. How about profusion blood in the body and tubes 2703 02:21:10.280 --> 02:21:11.639 being inserted into a chest? 2704 02:21:12.159 --> 02:21:14.559 Did you know that from looking at the records, I 2705 02:21:14.959 --> 02:21:17.879 think that happened after, But I don't recall because I 2706 02:21:17.959 --> 02:21:19.200 don't have the records on me. 2707 02:21:19.479 --> 02:21:23.399 Okay, so did you know that she had massive transfusions? 2708 02:21:26.120 --> 02:21:29.559 Not at on this jury that it was after she 2709 02:21:29.799 --> 02:21:33.760 saw you that she coded, had transfusions, had double tubes 2710 02:21:33.799 --> 02:21:37.360 put into her both sides of her lungs. It's you 2711 02:21:37.399 --> 02:21:39.600 had testimlonity that it was after she saw you. 2712 02:21:41.799 --> 02:21:42.440 You don't know, do you. 2713 02:21:43.239 --> 02:21:46.440 My understanding is the surgery happened after I saw her? 2714 02:21:46.559 --> 02:21:47.440 Oh, the surgery did. 2715 02:21:47.959 --> 02:21:52.719 I'm asking you about the massive transfusions. I'm asking you 2716 02:21:52.840 --> 02:21:55.520 about the toobs being inserted so that the three hundred 2717 02:21:55.600 --> 02:21:59.399 milligrams and whatever it is of blood can be perfused 2718 02:21:59.440 --> 02:22:00.639 to take them out of her chest. 2719 02:22:00.719 --> 02:22:00.920 Cat. 2720 02:22:01.600 --> 02:22:03.559 I'm asking about whether or not you knew that she 2721 02:22:03.719 --> 02:22:07.399 had coded. I'm not asking about the surgery, obviously, that 2722 02:22:07.600 --> 02:22:09.840 took place after you saw her, right. 2723 02:22:11.479 --> 02:22:15.479 Asked, An answered, because that's why you were talking to her, 2724 02:22:15.559 --> 02:22:17.520 right to see if she could make an informed consent 2725 02:22:17.639 --> 02:22:19.840 to a surgery. I guess no. 2726 02:22:20.239 --> 02:22:23.559 I was called for the for the suicidal ideation. 2727 02:22:24.959 --> 02:22:27.360 The suicidal ideation continues to this day? 2728 02:22:27.520 --> 02:22:30.520 Is it not objectionally sustained? 2729 02:22:31.440 --> 02:22:34.479 Did the suicidal ideation that you were concerned about continue 2730 02:22:34.559 --> 02:22:37.760 the time that she was in bringing the woman's hospital. 2731 02:22:37.440 --> 02:22:37.840 For a month. 2732 02:22:39.040 --> 02:22:44.440 I saw her one time, right, Yes, so you. 2733 02:22:44.559 --> 02:22:49.799 Know nothing about suicidal ideation after you saw her intubated 2734 02:22:50.200 --> 02:22:53.639 and then laying in the bed, and then you talk 2735 02:22:53.760 --> 02:22:55.559 to her as you've discussed with the jury. 2736 02:22:55.680 --> 02:22:57.920 Right, that's correct, that's it, that's correct. 2737 02:22:59.399 --> 02:23:03.760 How about the so many cops were there? I don't 2738 02:23:03.799 --> 02:23:07.399 recall there were some, right, there were armed men in 2739 02:23:07.520 --> 02:23:08.520 that room, were they not? 2740 02:23:11.040 --> 02:23:13.120 I don't recall. I think they were outside the room 2741 02:23:13.159 --> 02:23:15.760 if I remember correctly from three years ago. 2742 02:23:16.079 --> 02:23:18.879 Okay, I know it's been a while. Do you recall 2743 02:23:19.319 --> 02:23:21.840 armed police officers being outside the room? 2744 02:23:25.639 --> 02:23:26.040 I think I. 2745 02:23:27.559 --> 02:23:28.159 Don't recall. 2746 02:23:28.920 --> 02:23:31.639 Do you have any memory of any police officers being 2747 02:23:31.719 --> 02:23:34.760 outside the room where she was laying in that bed? 2748 02:23:37.399 --> 02:23:40.879 I knew she was in custody, and generally in custody. 2749 02:23:41.000 --> 02:23:43.040 No, no, not generally. Let's talk about Lindsay Clanton. 2750 02:23:43.120 --> 02:23:43.760 I can't recall. 2751 02:23:43.959 --> 02:23:47.719 Okay, did you know that she couldn't even have visitors 2752 02:23:47.799 --> 02:23:49.680 in the sense that the police would not even let 2753 02:23:49.719 --> 02:23:51.200 her mother or father visit with her. 2754 02:23:52.079 --> 02:23:52.879 I can't recall. 2755 02:23:53.719 --> 02:23:56.639 Did you know that when you were dealing with her, 2756 02:23:56.840 --> 02:23:59.920 was she handcuffed to the side of the granny of stretch. 2757 02:24:01.159 --> 02:24:04.879 She had a soft restraint according to my documentation restraints. 2758 02:24:04.920 --> 02:24:08.239 Okay, yes, did you have any conversation with the police 2759 02:24:08.280 --> 02:24:12.639 at all? No, And after you spoke to her for 2760 02:24:12.719 --> 02:24:17.600 twenty minutes, that really ended your involvement with Lindsay Clancy 2761 02:24:17.719 --> 02:24:18.319 until today. 2762 02:24:18.399 --> 02:24:19.520 Right, That is correct? 2763 02:24:19.959 --> 02:24:21.000 Thank you, Thank you. 2764 02:24:23.239 --> 02:24:26.719 Doctor. When you were being asked about these records that 2765 02:24:26.840 --> 02:24:28.959 you reviewed, what records did you review? 2766 02:24:30.000 --> 02:24:34.280 I reviewed the records in EPIC, which is our medical 2767 02:24:34.319 --> 02:24:36.920 record at Brigham and Women's Hospital, And. 2768 02:24:37.120 --> 02:24:41.360 So you didn't do a deep dive into mss Clancy's 2769 02:24:41.559 --> 02:24:46.040 entire psychiatric history prior to coming to Brigham and Woman's. Correct. 2770 02:24:47.600 --> 02:24:51.200 I did as you do, as is protocol for a 2771 02:24:51.319 --> 02:24:54.079 consult You look at the records and you make sure 2772 02:24:54.120 --> 02:24:56.840 you have an understanding of what's been happening with the patient. 2773 02:24:57.399 --> 02:24:59.920 But did you have access at that time to all 2774 02:25:00.000 --> 02:25:02.799 all the records for all the treatment providers Ms Clancy 2775 02:25:02.879 --> 02:25:05.639 had seen regarding her mental health for the last six months? 2776 02:25:06.479 --> 02:25:09.399 You know, I don't even know you get I had 2777 02:25:09.479 --> 02:25:11.319 some of the records. I don't know if I had 2778 02:25:11.360 --> 02:25:12.079 all of the records. 2779 02:25:12.680 --> 02:25:15.799 And so you reviewed what you had correct, correct, and 2780 02:25:15.920 --> 02:25:17.719 then you met with the patient. 2781 02:25:17.799 --> 02:25:18.120 Correct. 2782 02:25:18.399 --> 02:25:23.639 Correct, And in meeting with her, where she's you know, 2783 02:25:24.120 --> 02:25:30.280 she's she's she's had these events happen, she's had the 2784 02:25:30.399 --> 02:25:33.239 tubes in her chest. She she's about to go into surgery. 2785 02:25:34.000 --> 02:25:35.959 One of the first things on her mind is do 2786 02:25:36.120 --> 02:25:37.440 I have a lawyer? Correct? 2787 02:25:40.159 --> 02:25:42.719 Secondly, this is the fourth time the counsul has tried 2788 02:25:42.760 --> 02:25:43.920 to accentuate that. 2789 02:25:44.360 --> 02:25:45.440 Well, I love that question. 2790 02:25:47.399 --> 02:25:50.840 Well, that was one of her first thoughts was do 2791 02:25:50.959 --> 02:25:51.520 I have a lawyer? 2792 02:25:51.600 --> 02:25:51.920 Correct? 2793 02:25:53.079 --> 02:25:56.399 She wasn't able, she was exhausted, she was intbated, she 2794 02:25:56.479 --> 02:26:01.000 could barely talk, she was writing, and she was getting 2795 02:26:01.040 --> 02:26:03.840 ready for surgery. And so those were the few questions 2796 02:26:04.000 --> 02:26:04.799 that came up. 2797 02:26:04.920 --> 02:26:08.399 Right, She's exhausted, she's anxious, she's in pain, she's about 2798 02:26:08.440 --> 02:26:10.680 to go in for surgery, and she wants to know 2799 02:26:11.120 --> 02:26:12.079 do I have a lawyer? 2800 02:26:12.639 --> 02:26:13.200 Sustained. 2801 02:26:14.360 --> 02:26:16.959 So, given the condition she was in at that time, 2802 02:26:18.399 --> 02:26:20.479 you know, the defense counsel asked you about the pain 2803 02:26:20.600 --> 02:26:23.200 she was in. Defense counsel asked you about the surgery 2804 02:26:23.280 --> 02:26:26.200 she was about to go into. Those are the issues 2805 02:26:26.280 --> 02:26:28.959 that she was focused on in your conversation with her. 2806 02:26:29.399 --> 02:26:32.319 And I broken, are my legs straight? 2807 02:26:32.719 --> 02:26:33.600 Do I have a lawyer. 2808 02:26:34.319 --> 02:26:35.440 Yes, thank you. 2809 02:26:35.719 --> 02:26:39.000 She wasn't focused on much well, she was exhausted, in pain, 2810 02:26:39.479 --> 02:26:43.440 anxious and concerned about the future surgery that she was imminent. 2811 02:26:43.639 --> 02:26:43.799 Was she. 2812 02:26:45.719 --> 02:26:47.200 If you could speak up? 2813 02:26:47.239 --> 02:26:48.120 Asked that question. 2814 02:26:48.879 --> 02:26:52.239 She wasn't focused on much of anything while she was exhausted, 2815 02:26:52.399 --> 02:26:56.360 in pain, unable to talk, and anticipating imminent surgery. 2816 02:26:56.479 --> 02:26:58.280 Right, that's correct, thank you, that's all. 2817 02:26:58.360 --> 02:27:02.719 Yeah, anything, come hi, thank you doctor, Thank you, thank you. 2818 02:27:07.280 --> 02:27:08.680 Hye camel. 2819 02:27:11.159 --> 02:27:14.200 Common would called Robert Flynn as its next witness. 2820 02:27:14.239 --> 02:27:21.479 Please, thanks stuff please a rkay afternoon, sir, Yeah, twenty 2821 02:27:21.479 --> 02:27:22.799 bucky and please thank you. 2822 02:27:24.280 --> 02:27:26.239 Good afternoon. Could you please tell the jurors your. 2823 02:27:26.159 --> 02:27:28.680 First and last name, Robert Flynn f l Y And 2824 02:27:28.799 --> 02:27:30.319 then and how are you employed, sir? 2825 02:27:30.600 --> 02:27:31.840 For the Duxbury Please Apartment. 2826 02:27:32.200 --> 02:27:34.000 What is your current ranker assignment there? 2827 02:27:34.280 --> 02:27:35.959 Currently? I am a patrol sergeant. 2828 02:27:36.680 --> 02:27:39.520 How long have you been with the Duxbury Police About 2829 02:27:39.680 --> 02:27:43.559 seven and a half years, going back. 2830 02:27:43.440 --> 02:27:46.680 To January of twenty twenty three. What was your assignment then? 2831 02:27:47.159 --> 02:27:48.559 I was assigned to the detective Bureau. 2832 02:27:50.319 --> 02:27:52.639 So if I draw your attention to January twenty fourth 2833 02:27:52.680 --> 02:27:54.719 of twenty twenty three, were you working that day or 2834 02:27:54.760 --> 02:27:56.799 were you called in both? 2835 02:27:57.079 --> 02:27:59.040 I worked at the eight am to four pm shift 2836 02:27:59.280 --> 02:28:01.280 and I was called in and later after my shift. 2837 02:28:01.600 --> 02:28:04.799 Okay, So you became aware of an incident that occurred 2838 02:28:04.959 --> 02:28:08.399 in the town of Duxbury approximately six pm that evening, yes, ma'am. 2839 02:28:08.799 --> 02:28:13.079 And so when you come back in after working that 2840 02:28:13.239 --> 02:28:15.360 day shift, where do you go or where are you 2841 02:28:15.479 --> 02:28:16.079 directed to go? 2842 02:28:16.520 --> 02:28:19.360 I was contacted by a sergeant Detective Jamali, who informed 2843 02:28:19.399 --> 02:28:21.200 me to respond to forty seven Summer Street. 2844 02:28:21.680 --> 02:28:24.959 And so while you're en route to that location, are 2845 02:28:25.000 --> 02:28:28.639 you monitoring the radio, yes, ma'am. And are you monitoring 2846 02:28:28.719 --> 02:28:31.200 communications with other Duxbury officers? 2847 02:28:31.600 --> 02:28:34.840 Yes, ma'am. I had a department issued vehicle that I 2848 02:28:34.879 --> 02:28:39.200 took home and I responded to it in that vehicle, 2849 02:28:39.479 --> 02:28:42.399 and I had scan on, which is getting all surrounding agencies, 2850 02:28:42.440 --> 02:28:46.079 including fire, Pembrooke, Kingston, Marshfield. 2851 02:28:47.040 --> 02:28:51.200 And while you were en route and had that radio on, 2852 02:28:51.360 --> 02:28:55.879 could you hear officers screaming and being chaotic? 2853 02:28:56.239 --> 02:28:56.680 Yes, ma'am. 2854 02:28:58.000 --> 02:29:01.000 When you arrived at forty seven Summers were there already 2855 02:29:01.159 --> 02:29:02.440 other first responders there? 2856 02:29:03.159 --> 02:29:03.639 Yes'm? 2857 02:29:03.760 --> 02:29:05.879 And is it fair to say that when you actually 2858 02:29:05.959 --> 02:29:11.159 arrived at that location, you were made aware that the 2859 02:29:11.600 --> 02:29:16.879 children that were on scene had already been transported. No, okay, 2860 02:29:16.959 --> 02:29:19.159 So what did you know when you arrived? 2861 02:29:19.360 --> 02:29:22.959 What did you did appear that a mother had killed 2862 02:29:23.000 --> 02:29:23.559 her three kids? 2863 02:29:24.000 --> 02:29:25.920 Okay when you got there on the scene, were the 2864 02:29:26.040 --> 02:29:27.360 children still in the house? 2865 02:29:27.840 --> 02:29:29.360 So I was under the impression that they were still 2866 02:29:29.399 --> 02:29:33.239 in the house, because most incidents I've had involving a 2867 02:29:33.920 --> 02:29:37.840 sudden death at a house, the fire department declares them 2868 02:29:37.959 --> 02:29:40.360 on scene and it becomes a police matter and we. 2869 02:29:41.879 --> 02:29:42.760 Help the investigation. 2870 02:29:43.000 --> 02:29:46.120 Okay, that was your understanding based on the information that 2871 02:29:46.200 --> 02:29:48.799 you had. Correct. But did you come to learn that 2872 02:29:49.600 --> 02:29:54.120 the children had been transported? And how about the individual 2873 02:29:54.559 --> 02:29:59.239 the person the fourth person if you will, on scene 2874 02:29:59.319 --> 02:30:01.120 where you would vi that there was a woman who 2875 02:30:01.200 --> 02:30:05.520 had been transported from the scene as well. Yes, And 2876 02:30:05.760 --> 02:30:07.920 as a result of kind of the nature of what 2877 02:30:08.120 --> 02:30:10.559 you believed you were coming into, did you call for 2878 02:30:10.719 --> 02:30:11.559 extra help. 2879 02:30:13.120 --> 02:30:17.520 With that are own department or with an outside department. 2880 02:30:18.239 --> 02:30:22.440 Death investigation in town of Duxbury and other communities. So 2881 02:30:22.600 --> 02:30:28.399 we are to notify investigators of the state police, and as. 2882 02:30:28.319 --> 02:30:31.239 A detective of the Dexbury Police, you're familiar with that 2883 02:30:31.360 --> 02:30:34.319 relationship with the state police that oftentimes when a death 2884 02:30:34.360 --> 02:30:38.520 investigation occurs, that you work in connection with the state 2885 02:30:38.559 --> 02:30:43.000 police detective unit of that jurisdiction to conduct an investigation. Correct. 2886 02:30:43.920 --> 02:30:46.319 And so in this instance, when you went there, you 2887 02:30:46.520 --> 02:30:48.959 believed that the children had already passed, so you made 2888 02:30:49.000 --> 02:30:50.639 that phone call to the detective's unit. 2889 02:30:50.680 --> 02:30:51.479 Correct, that's correct. 2890 02:30:52.159 --> 02:30:57.959 And certainly well sometime thereafter you wore advice of the 2891 02:30:58.040 --> 02:31:00.799 children's passing and that this was a death invest stigation. Correct, 2892 02:31:00.920 --> 02:31:04.440 that's correct. Once the children had been removed from the 2893 02:31:04.520 --> 02:31:06.920 scene and the defendant had been removed to the scene, 2894 02:31:07.000 --> 02:31:09.719 did you and your other officers from the Duxbury Police 2895 02:31:09.719 --> 02:31:11.639 Department do anything to secure the scene? 2896 02:31:12.280 --> 02:31:13.120 Yeah, so I was. 2897 02:31:13.280 --> 02:31:16.680 Once we gathered more information and I notified the Master's 2898 02:31:16.680 --> 02:31:19.680 State Police, we decided to conduct a security sweep of 2899 02:31:19.760 --> 02:31:22.000 the house. This is to make sure that there was 2900 02:31:22.200 --> 02:31:26.159 no further suspects or for their victims or any other 2901 02:31:26.200 --> 02:31:29.239 people in the house that we may have missed. 2902 02:31:29.879 --> 02:31:34.040 In regards to the security sweep, what is the goal 2903 02:31:34.440 --> 02:31:38.719 you just described Its to kind of identify their other people. 2904 02:31:38.879 --> 02:31:42.079 But as far as your observations and your contact within 2905 02:31:42.120 --> 02:31:44.360 the house. You try to minimize your contact within the 2906 02:31:44.399 --> 02:31:45.319 house in those instances. 2907 02:31:45.479 --> 02:31:47.280 Yes, I'm not searching for any type of evidence and 2908 02:31:47.440 --> 02:31:50.840 just have different observations that I obviously noticed. 2909 02:31:51.559 --> 02:31:54.319 And what areas of the house did you go into 2910 02:31:54.920 --> 02:31:56.680 prior to their arrival of the state police? 2911 02:31:57.799 --> 02:32:01.200 I first entered. I entered with three three of us, 2912 02:32:02.000 --> 02:32:05.559 Sagan Patricus who's from the king Sipolice apartment, and it 2913 02:32:05.639 --> 02:32:08.879 was the Lieutenant Wiler at the time. So we all 2914 02:32:09.040 --> 02:32:11.280 kind of went into our own separate rooms and separate 2915 02:32:11.319 --> 02:32:13.959 ways throughout the house. But I think ultimately all three 2916 02:32:14.000 --> 02:32:15.520 of us went to all three floors of the. 2917 02:32:15.520 --> 02:32:16.280 Home, okay. 2918 02:32:16.319 --> 02:32:19.639 And so talking first about the main floor of the house, 2919 02:32:20.079 --> 02:32:23.360 did you go into the kitchen area? Yes, I did, 2920 02:32:23.639 --> 02:32:26.920 And did you make any observations in that kitchen area? 2921 02:32:27.600 --> 02:32:29.159 I observed it. 2922 02:32:29.239 --> 02:32:31.680 Was clear to me that there was young children living there. 2923 02:32:31.680 --> 02:32:35.680 There was some paintings on the wall. I noticed a. 2924 02:32:37.200 --> 02:32:38.200 Takeout food bag. 2925 02:32:38.799 --> 02:32:40.639 The only word I remember from that is it being 2926 02:32:40.719 --> 02:32:42.479 Mediterranean written on the receipt. 2927 02:32:43.159 --> 02:32:51.959 Okay, And if I may approach with a picture showing 2928 02:32:52.000 --> 02:32:55.399 you the picture is just accurately depicted the kitchen area 2929 02:32:55.479 --> 02:32:56.600 that you observed. 2930 02:33:00.040 --> 02:33:01.120 May be admitted. 2931 02:33:04.040 --> 02:33:07.200 Showing you on the screen what's snow ben marked at four? 2932 02:33:08.920 --> 02:33:11.479 This is the kitchen at forty seven Summer Street. And 2933 02:33:11.479 --> 02:33:14.159 in the middle of the photograph is a takeout bide correct. 2934 02:33:14.040 --> 02:33:14.440 Yes, Pam. 2935 02:33:15.280 --> 02:33:19.120 And you're aware that in the background here of the 2936 02:33:19.200 --> 02:33:21.600 photograph where there's a kitchen table, there's kind of a door. 2937 02:33:21.559 --> 02:33:23.399 Next to it, yes, ma'am. 2938 02:33:23.559 --> 02:33:25.520 And then there's on the other opposite side there's a. 2939 02:33:25.520 --> 02:33:26.440 Slider door correct. 2940 02:33:26.559 --> 02:33:26.879 Correct. 2941 02:33:28.000 --> 02:33:31.920 And in addition to making those general observations about the 2942 02:33:32.000 --> 02:33:33.959 kitchen area, did you go in other areas of the 2943 02:33:34.040 --> 02:33:34.680 main floor. 2944 02:33:34.520 --> 02:33:34.959 Of the house? 2945 02:33:35.200 --> 02:33:35.360 Yes? 2946 02:33:35.440 --> 02:33:35.639 I did. 2947 02:33:36.120 --> 02:33:39.040 And in the living room area, I'm sure you what's 2948 02:33:39.079 --> 02:33:42.719 been marked already is a bit twenty five. Is that 2949 02:33:42.799 --> 02:33:43.760 familiar to you as well? 2950 02:33:44.079 --> 02:33:44.520 Yes, ma'am. 2951 02:33:44.719 --> 02:33:47.360 And again, upon your kind of sweep of this house, 2952 02:33:47.399 --> 02:33:49.840 what stood out to you about the living room. 2953 02:33:49.719 --> 02:33:52.879 Area that appeared a young child lived there and there 2954 02:33:52.959 --> 02:33:56.879 was food on the couch, the snack and then this. 2955 02:33:56.920 --> 02:34:00.440 Photograph can you see a couple of holes of here 2956 02:34:00.680 --> 02:34:02.719 on the bottom of the photo and the further up 2957 02:34:02.760 --> 02:34:04.239 on the couch, yes, ma'am. 2958 02:34:07.680 --> 02:34:10.680 Now in that main area of the house, you didn't 2959 02:34:10.959 --> 02:34:12.559 find any other individuals correct? 2960 02:34:12.639 --> 02:34:13.000 Negative? 2961 02:34:13.319 --> 02:34:16.680 And had you been made aware that the husband, Patrick 2962 02:34:16.719 --> 02:34:19.559 Clancy had been a here to say? This was still 2963 02:34:19.799 --> 02:34:21.840 upon your arrival, a pretty chaotic scene. 2964 02:34:22.200 --> 02:34:22.479 Correct. 2965 02:34:22.600 --> 02:34:24.399 There was a lot of firefighters around, a lot of 2966 02:34:24.440 --> 02:34:25.680 equipment going around. 2967 02:34:26.159 --> 02:34:26.479 Correct. 2968 02:34:26.879 --> 02:34:30.360 Okay, in that basement, did you do a full sweep 2969 02:34:30.440 --> 02:34:32.319 of every room in the basement, Like. 2970 02:34:32.360 --> 02:34:34.959 I said, three of us too, combined and made sure 2971 02:34:34.959 --> 02:34:38.479 that we at least hit every part that a human 2972 02:34:38.639 --> 02:34:43.000 or something could be in. So yes, okay, But. 2973 02:34:43.159 --> 02:34:45.000 As far as you yourself, fair to say you just 2974 02:34:45.120 --> 02:34:46.920 kind of went in on the left side. 2975 02:34:47.040 --> 02:34:49.680 Yes, I went into the left And did you see. 2976 02:34:49.559 --> 02:34:52.559 A lot of the firefighters equipment still left behind? Yes, 2977 02:34:52.719 --> 02:34:56.399 a lot of medical supplies. Now going up to now 2978 02:34:56.440 --> 02:34:58.399 the second floor. Did you go to the second. 2979 02:34:58.159 --> 02:35:01.360 Floor of the home the Florida Yes, yes. 2980 02:35:02.319 --> 02:35:04.760 And did you enter into the master bedroom? 2981 02:35:04.879 --> 02:35:05.040 Yes? 2982 02:35:05.799 --> 02:35:08.200 And is there anything that kind of struck you about 2983 02:35:08.239 --> 02:35:11.440 walking into that master bedroom as far as the temperature. 2984 02:35:11.040 --> 02:35:14.079 Of the room, it was colder than the rest of 2985 02:35:14.120 --> 02:35:14.399 the house. 2986 02:35:15.120 --> 02:35:17.520 And did you notice that there was in fact a 2987 02:35:17.600 --> 02:35:20.280 window open, yes, ma'am. So I'm just going to show 2988 02:35:20.319 --> 02:35:24.000 you what's been market. Is that familiar to you as 2989 02:35:24.079 --> 02:35:25.920 the window that you observed open. 2990 02:35:25.879 --> 02:35:26.280 Yes, ma'am. 2991 02:35:28.520 --> 02:35:32.120 And as far as the furniture in that bedroom, did 2992 02:35:32.200 --> 02:35:35.000 you make any observations of a bed in the room? 2993 02:35:35.280 --> 02:35:35.760 Yes, ma'am. 2994 02:35:36.159 --> 02:35:39.040 Was there anything that stood out to you on the 2995 02:35:39.079 --> 02:35:40.319 bedding or in the area of the. 2996 02:35:40.360 --> 02:35:46.239 Bed, the bedding itself, if it stood out to you, 2997 02:35:47.040 --> 02:35:47.799 not necessarily? 2998 02:35:47.920 --> 02:35:51.559 No, how about items on the bed, yeah, so. 2999 02:35:51.639 --> 02:35:53.680 Sorry Triguez point out that there was a cell phone 3000 02:35:53.680 --> 02:35:54.040 on the bed. 3001 02:35:54.280 --> 02:35:55.200 Okay, I'm just going. 3002 02:35:55.120 --> 02:35:55.520 To show you. 3003 02:35:58.959 --> 02:36:02.280 See an object. Is that how it appeared when you 3004 02:36:02.520 --> 02:36:08.280 first entered into the bedroom, yes, ma'am. At some point, 3005 02:36:08.959 --> 02:36:10.920 were you able to go out to the backyard of. 3006 02:36:10.959 --> 02:36:13.840 The home, yes, ma'am. So after leaving the upstairs, we 3007 02:36:13.920 --> 02:36:16.399 went back through the kitchen and that's we talked about earlier, 3008 02:36:16.600 --> 02:36:17.760 and went up through the backslider. 3009 02:36:18.479 --> 02:36:21.360 And were you able to make observations of the backyard area. 3010 02:36:21.639 --> 02:36:21.799 Yes. 3011 02:36:21.959 --> 02:36:24.079 We came out to a porch and took a left 3012 02:36:24.120 --> 02:36:26.000 which would have been the back right side of the house, 3013 02:36:26.920 --> 02:36:30.799 and there was some matted doow snow and some other 3014 02:36:30.879 --> 02:36:34.680 medical equipment, which we believed was the window that Lindsay 3015 02:36:34.719 --> 02:36:35.479 Clancy came out of. 3016 02:36:36.360 --> 02:36:39.680 And from that area that vantage point in the backyard 3017 02:36:39.760 --> 02:36:43.000 where you were, could you see into other areas of 3018 02:36:43.040 --> 02:36:43.440 the house? 3019 02:36:44.440 --> 02:36:44.639 Yes? 3020 02:36:45.079 --> 02:36:46.840 In what areas of the house? Could you see into 3021 02:36:48.239 --> 02:36:49.520 Near where that area was? 3022 02:36:49.639 --> 02:36:53.399 There was a basement window that kind of went into 3023 02:36:56.639 --> 02:37:00.280 but I later learned what it was, but a basement 3024 02:37:00.360 --> 02:37:03.239 window to like an office or gym area. 3025 02:37:06.600 --> 02:37:13.799 Shay Exhibit thirty eight. Is that unfamiliar as the backyard view? 3026 02:37:14.799 --> 02:37:16.000 Yes, ma'am and fair to say. 3027 02:37:16.079 --> 02:37:17.440 There's an area here of. 3028 02:37:17.479 --> 02:37:19.239 The photo that I'm pointing to you with my pen, 3029 02:37:19.319 --> 02:37:23.719 which is kind of on my right that is a window. Well, 3030 02:37:24.920 --> 02:37:27.479 is that the window you could see into? And then 3031 02:37:27.520 --> 02:37:30.239 again in this photograph, do you see the open window 3032 02:37:30.280 --> 02:37:31.719 that you observed when you went into the bed. 3033 02:37:32.040 --> 02:37:34.799 Yes, As far as that open window when you were 3034 02:37:34.840 --> 02:37:38.440 in the backyard, did you see any screens or anything 3035 02:37:39.040 --> 02:37:42.239 around the property that would give you any indication of 3036 02:37:42.760 --> 02:37:45.680 how that window was open or the condition of the window. 3037 02:37:45.959 --> 02:37:47.959 No, to me, appeal that the scream was just pushed out. 3038 02:37:49.079 --> 02:37:52.159 Now again, as you and and did three other investigators 3039 02:37:52.399 --> 02:37:54.079 did that sweep at the house? You didn't touch or 3040 02:37:54.159 --> 02:37:55.120 move anything? Correct? 3041 02:37:55.200 --> 02:37:55.559 Negative? 3042 02:37:56.840 --> 02:37:59.920 And once you were did that security sweep? Is there 3043 02:38:00.159 --> 02:38:02.280 a protocol in place to make sure that the scene 3044 02:38:02.319 --> 02:38:04.319 remains as it is until the state police arrived. 3045 02:38:04.479 --> 02:38:08.719 Yeah, so there was. One of the officers was logging 3046 02:38:08.719 --> 02:38:11.479 individuals that were in and out of the house. Crime 3047 02:38:11.520 --> 02:38:15.440 scene tape was put up around the property, though doors 3048 02:38:15.479 --> 02:38:18.600 were secured, And around this time is when I received 3049 02:38:18.600 --> 02:38:19.399 a phone call from. 3050 02:38:19.319 --> 02:38:23.879 Trooper mckellokan and did you remain on scene. 3051 02:38:24.680 --> 02:38:27.319 We remained on scene until some troopers showed up to 3052 02:38:27.360 --> 02:38:27.719 the area. 3053 02:38:28.639 --> 02:38:30.959 And while you were on scene, did you attempt to 3054 02:38:30.959 --> 02:38:33.879 help coordinate other members of the Duxbury Police Department to 3055 02:38:34.440 --> 02:38:37.399 take care of other things like going to the hospitals 3056 02:38:37.520 --> 02:38:39.319 and securing coverage. 3057 02:38:40.040 --> 02:38:41.920 The decision for who was going to the hospital was 3058 02:38:41.959 --> 02:38:47.280 made by our command staff, but I met some of 3059 02:38:47.280 --> 02:38:49.600 the troopers out back at the station to coordinate further. 3060 02:38:50.399 --> 02:38:50.639 Okay. 3061 02:38:50.760 --> 02:38:52.879 And when you were back at the station, were you 3062 02:38:53.239 --> 02:38:55.959 aware or advised that a search point was sought for 3063 02:38:56.079 --> 02:38:59.920 the residents. Did you go back to forty seven Summers 3064 02:39:00.000 --> 02:39:04.079 Street with the team when the search warrant was received 3065 02:39:05.079 --> 02:39:09.000 and did you participate in the execution of that warrant? 3066 02:39:09.799 --> 02:39:10.840 I was present during it. 3067 02:39:11.159 --> 02:39:17.479 Okay, fair to say that you didn't. You weren't responsible 3068 02:39:17.520 --> 02:39:21.000 for searching any particular location or collecting any evidence, No, ma'am. 3069 02:39:21.920 --> 02:39:23.760 That was reserved for the state police. 3070 02:39:24.079 --> 02:39:24.680 For the most part. 3071 02:39:24.760 --> 02:39:24.920 Yes. 3072 02:39:26.719 --> 02:39:29.680 At the conclusion of that search warrant, were you asked 3073 02:39:29.719 --> 02:39:31.760 to go back into the house, yes, ma'am. And what 3074 02:39:31.920 --> 02:39:33.360 were you asked to go back in the house to 3075 02:39:33.479 --> 02:39:34.399 do once the. 3076 02:39:34.479 --> 02:39:37.520 Search warm was completed. My lieutenant told me to go 3077 02:39:37.639 --> 02:39:39.639 back up into the house and close the window in 3078 02:39:39.760 --> 02:39:40.920 the upstairs bedroom. 3079 02:39:42.440 --> 02:39:44.959 And when you went back in and got closer to 3080 02:39:45.000 --> 02:39:47.280 that window, did you make any observations of damage to 3081 02:39:47.360 --> 02:39:51.040 the window or the window screen. No, and were able 3082 02:39:51.120 --> 02:39:54.719 to close it and secure the window eventually. Yes, fair 3083 02:39:54.760 --> 02:39:58.000 to say there was blood in that area that kind 3084 02:39:58.040 --> 02:39:58.639 of was in the way. 3085 02:39:59.079 --> 02:40:01.079 Yes, in the bed was kind of pushed in front 3086 02:40:01.079 --> 02:40:02.639 of it, So did you have. 3087 02:40:02.680 --> 02:40:04.719 To move the bed in order to get to the window. 3088 02:40:05.840 --> 02:40:10.719 As far as anything removed from the home, did you 3089 02:40:10.799 --> 02:40:15.719 go back into the basement at somebody's direction at some point? 3090 02:40:15.879 --> 02:40:18.920 Had you helped to remove some medical equipment that the 3091 02:40:19.000 --> 02:40:19.879 fire department. 3092 02:40:19.600 --> 02:40:21.559 Had left behind during the search part? 3093 02:40:21.959 --> 02:40:22.239 Okay? 3094 02:40:23.200 --> 02:40:26.120 And is that the only items that you yourself removed 3095 02:40:26.159 --> 02:40:26.559 from the home? 3096 02:40:26.840 --> 02:40:27.120 Correct? 3097 02:40:29.000 --> 02:40:31.639 As part of the follow up investigation, did you work 3098 02:40:31.799 --> 02:40:35.040 with Trooper mc gallaghan and some of the other troopers 3099 02:40:35.079 --> 02:40:37.399 from the State Police Detective Unit to conduct follow up 3100 02:40:37.440 --> 02:40:41.600 interviews and gather more information? Is it fair to say 3101 02:40:41.639 --> 02:40:44.399 that the state Police were the primary investigators and they 3102 02:40:44.559 --> 02:40:47.760 took over pretty much everything from that point on. 3103 02:40:48.000 --> 02:40:48.479 That's correct. 3104 02:40:49.840 --> 02:40:52.959 Thank you, I'm miss ray. 3105 02:40:53.440 --> 02:40:54.680 I have no questions. Thank you, sir. 3106 02:40:54.760 --> 02:40:56.079 All right, thank you, sir, thank you. 3107 02:41:01.760 --> 02:41:03.239 I'm well called Mark Ferrioli. 3108 02:41:10.239 --> 02:41:14.479 A right, good athnute sir, an, thank. 3109 02:41:14.360 --> 02:41:16.639 You, good afternoon. Can you please stay and spell your 3110 02:41:16.719 --> 02:41:17.360 name for the record. 3111 02:41:18.360 --> 02:41:23.680 I'm Detective Mark Ferrioly far iol I. Where do you 3112 02:41:23.760 --> 02:41:26.399 work the Massachusetts State Police? 3113 02:41:26.719 --> 02:41:28.040 How long have you been a state tripper? 3114 02:41:28.600 --> 02:41:29.680 Since two thousand and five? 3115 02:41:30.520 --> 02:41:33.879 And back in January of twenty twenty three, where were 3116 02:41:33.920 --> 02:41:35.399 you assigned within the State Police? 3117 02:41:36.319 --> 02:41:39.520 I was assigned to the Plymouth County State Police Detective Unit. 3118 02:41:40.360 --> 02:41:41.639 And were you. 3119 02:41:43.319 --> 02:41:47.520 Involved in a limited way in the investigation regarding Lindsay Clancy. 3120 02:41:47.959 --> 02:41:50.559 Yes, I was, and specifically. 3121 02:41:50.520 --> 02:41:54.159 Directing your attention to January twenty seventh, twenty twenty three, 3122 02:41:55.079 --> 02:41:57.479 were you aware that a search warrant was obtained on 3123 02:41:57.559 --> 02:42:01.159 that date to collect the blood in urine of Lindsay 3124 02:42:01.239 --> 02:42:03.520 Clancy from Selfshare Hospital, Yes. 3125 02:42:03.399 --> 02:42:03.639 It was. 3126 02:42:04.319 --> 02:42:07.959 And then directing your attention to January thirty first, twenty 3127 02:42:08.040 --> 02:42:11.559 twenty three, at ten twenty five in the morning, did 3128 02:42:11.639 --> 02:42:14.959 you go to the Selfshore Hospital to collect the blood 3129 02:42:15.040 --> 02:42:16.319 and urine of Lindsay Clancy? 3130 02:42:16.680 --> 02:42:16.840 Yes? 3131 02:42:16.920 --> 02:42:17.159 I did? 3132 02:42:17.360 --> 02:42:18.319 And where did you collect that? 3133 02:42:18.440 --> 02:42:21.319 From the lab at Social Hospital? 3134 02:42:22.079 --> 02:42:27.040 And was that from the specimen process supervisor Melissa ker Dupain, 3135 02:42:27.399 --> 02:42:31.120 Yes it was. And if you recall how many vials 3136 02:42:31.200 --> 02:42:33.200 you collected in total? 3137 02:42:33.280 --> 02:42:38.159 I collected seven vials and was that all blood or 3138 02:42:38.319 --> 02:42:42.959 urine or both? Six were blood vials and one was urine. 3139 02:42:43.399 --> 02:42:45.879 And once you collected those vials, where did you bring them? 3140 02:42:46.399 --> 02:42:51.600 I brought them directly to the Massachusetts State Lab in Lakeville. 3141 02:42:52.360 --> 02:42:54.760 And did you drop those off at the State Lab 3142 02:42:54.799 --> 02:42:58.200 at approximately eleven fifteen am on January thirty first, twenty 3143 02:42:58.239 --> 02:43:00.840 twenty three, Yes, I did. Do you recall who you 3144 02:43:01.000 --> 02:43:03.959 gave the vials of blood and urine belonging to Lindsay 3145 02:43:04.000 --> 02:43:05.360 Clancy too at the lab? 3146 02:43:06.159 --> 02:43:09.440 Leah O'Connell, Thank. 3147 02:43:09.280 --> 02:43:14.200 You, it's Randon right. 3148 02:43:15.159 --> 02:43:20.399 We have stipulated to the train of custody. Any questions right, 3149 02:43:20.440 --> 02:43:22.479 all right, thank you, suirre having no time. Hi, thank you, 3150 02:43:23.040 --> 02:43:23.319 thank you. 3151 02:43:24.479 --> 02:43:33.120 Aliah O'Connell, Hey, good afternoon, Good afternon sa Hi council, 3152 02:43:33.360 --> 02:43:35.520 thank you, good afternoon. Can you please stay and spell 3153 02:43:35.520 --> 02:43:36.319 your name for the record. 3154 02:43:36.959 --> 02:43:39.840 My name is Leah O'Connell L E A H O 3155 02:43:40.040 --> 02:43:41.760 C O N N E L L. 3156 02:43:42.079 --> 02:43:44.159 Where do you work currently? 3157 02:43:44.200 --> 02:43:46.559 I'm employed with the Massachusetts State Police as a trooper. 3158 02:43:47.200 --> 02:43:49.840 Back in January of twenty twenty three, were you also 3159 02:43:49.879 --> 02:43:51.280 employed with the State Police? 3160 02:43:51.559 --> 02:43:54.600 I was at the crime lab and what were your. 3161 02:43:54.520 --> 02:43:56.639 Responsibilities at the crime lab at that time? 3162 02:43:57.520 --> 02:43:57.559 So? 3163 02:43:57.680 --> 02:44:00.520 I was a forensic evidence technician, So we were evidence 3164 02:44:00.559 --> 02:44:02.280 submitted to the lab for testing. 3165 02:44:02.520 --> 02:44:05.040 And once you receive that evidence, while we had some 3166 02:44:05.159 --> 02:44:06.639 local offices there with us as well. 3167 02:44:06.840 --> 02:44:07.040 Yeah. 3168 02:44:07.680 --> 02:44:11.840 So it was law enforcement that found the pill bottles 3169 02:44:12.040 --> 02:44:15.799 in the kitchen, right I believe so, and seized. 3170 02:44:15.520 --> 02:44:20.120 Them, is that correct? Correct? And documented that they had 3171 02:44:20.200 --> 02:44:23.280 seized them in the kitchen, feeling someone whoever it was, 3172 02:44:23.799 --> 02:44:27.440 that it was relevant material to this investigation, right correct? 3173 02:44:28.120 --> 02:44:39.520 And the books that we've just gone through, Patrick. 3174 02:44:40.879 --> 02:44:45.200 Plans would be relevant material to this investigation, right correct? 3175 02:44:46.120 --> 02:44:51.280 Yes, anxiety work right correct? 3176 02:44:54.520 --> 02:44:54.680 Yes. 3177 02:44:55.159 --> 02:45:02.239 One of the documents pregnant, right, yes, one or another 3178 02:45:02.319 --> 02:45:05.360 notebook that had post ittum depression of anxiety. 3179 02:45:05.520 --> 02:45:05.840 Correct. 3180 02:45:06.120 --> 02:45:07.639 Yes, there were also whether. 3181 02:45:08.399 --> 02:45:14.079 Documents that were said in the house and introduced the 3182 02:45:14.159 --> 02:45:15.520 record civity one. 3183 02:45:16.360 --> 02:45:23.239 Uh yeah, it looks like a diary three of sweat. 3184 02:45:23.000 --> 02:45:28.239 Blow last night, I believe so. Yes. 3185 02:45:30.000 --> 02:45:31.840 Do you know why all these were se. 3186 02:45:33.959 --> 02:45:34.760 Why the books that I. 3187 02:45:34.840 --> 02:45:35.639 Seized was seized? 3188 02:45:36.760 --> 02:45:38.959 You investigate lieutenant. 3189 02:45:38.600 --> 02:45:42.319 Decided I'm a captain, sir. Yes, sir, And back then, 3190 02:45:42.360 --> 02:45:44.440 what was your new captain? I was a lieutenant at 3191 02:45:44.479 --> 02:45:44.799 that time? 3192 02:45:46.639 --> 02:45:46.879 Search. 3193 02:45:47.520 --> 02:45:51.000 No, there was also a detective lieutenant assigned unit commander 3194 02:45:51.000 --> 02:45:51.520 at that time. 3195 02:45:51.920 --> 02:45:54.680 So, but your enough and you knew the investigation. 3196 02:45:55.120 --> 02:45:57.920 What was relevant in material in the investigation? 3197 02:45:58.159 --> 02:45:58.280 Right? 3198 02:45:58.799 --> 02:45:59.000 Yes? 3199 02:45:59.440 --> 02:46:01.879 And and I obviously you or somebody else working with 3200 02:46:02.040 --> 02:46:05.360 you determined that all of these items, the pills that 3201 02:46:05.440 --> 02:46:07.600 were sees, the books that were seized from the kitchen, 3202 02:46:07.680 --> 02:46:10.360 et cetera, were relevant and material correct. 3203 02:46:10.639 --> 02:46:16.840 Yes. Do you know who searched the bedroom? I know 3204 02:46:16.920 --> 02:46:19.200 you said you were in there. Did you search the bedroom? 3205 02:46:19.920 --> 02:46:22.159 I was part of the team that searched the bedroom. 3206 02:46:23.000 --> 02:46:25.239 There were a number of other offices that searched the 3207 02:46:25.280 --> 02:46:28.959 bedroom as well. I believe in the report it documents 3208 02:46:29.159 --> 02:46:32.799 who sees what from the bedroom? Okay, So I don't 3209 02:46:32.840 --> 02:46:34.479 know off the top of my head who that was, sir, 3210 02:46:34.600 --> 02:46:35.360 but I know it's. 3211 02:46:35.239 --> 02:46:37.239 Clearly labeled in the report. 3212 02:46:37.600 --> 02:46:38.719 Okay, do you have the report? 3213 02:46:39.040 --> 02:46:39.719 I do not know. 3214 02:46:40.840 --> 02:46:42.280 Do you recall how many. 3215 02:46:43.079 --> 02:46:46.959 Law officers were actually involved in that little bedroom searching? 3216 02:46:48.760 --> 02:46:51.079 I would have to guess the approximately five. 3217 02:46:51.360 --> 02:46:56.440 Vibe And as Consul asked, when somebody discovered something that 3218 02:46:56.760 --> 02:46:59.120 appeared to be relevant to the material, they would log 3219 02:46:59.200 --> 02:47:01.399 it in. Somebody would kind of be the record keeper, 3220 02:47:01.440 --> 02:47:02.040 would log it in. 3221 02:47:02.200 --> 02:47:08.239 Correct. Yes, is one of the things that you would also, you, yourself, 3222 02:47:08.280 --> 02:47:11.399 I believe sees would be the laptop computers that were 3223 02:47:11.440 --> 02:47:15.920 downstairs in the office, right, Yes, and you seized also 3224 02:47:16.479 --> 02:47:19.399 collectively you, I mean you or the other five people 3225 02:47:19.920 --> 02:47:22.360 seized the cell phone that was on the bed. 3226 02:47:24.399 --> 02:47:26.239 Yes, I believe there was a cell phone seize from 3227 02:47:26.239 --> 02:47:26.719 the bedroom. 3228 02:47:27.000 --> 02:47:30.879 So it made sense as an investigator that electronic media 3229 02:47:30.959 --> 02:47:32.680 and things of that nature would be important. 3230 02:47:32.799 --> 02:47:36.959 Correct. Yes, was there an Apple Watch involved in this investigation? 3231 02:47:37.120 --> 02:47:40.040 If you know, I believe there was an Apple Watch 3232 02:47:40.399 --> 02:47:42.399 recovered after the fact, that was. 3233 02:47:42.840 --> 02:47:46.399 We didn't recover at the search warrant, if I recall correctly, do. 3234 02:47:46.440 --> 02:47:48.040 You know when it was recovered? 3235 02:47:48.799 --> 02:47:50.440 I don't know exactly off the top of my head. 3236 02:47:50.520 --> 02:47:54.479 No Apple watch that I recovered with Pat Clancy, I 3237 02:47:54.600 --> 02:47:55.319 believe Selsa. 3238 02:47:55.479 --> 02:47:58.440 Yeah, I believe there was a watch that was turned 3239 02:47:58.520 --> 02:48:01.719 into us after the fact that wasn't recovered during the 3240 02:48:01.799 --> 02:48:02.360 search warrant. 3241 02:48:02.879 --> 02:48:03.479 Looking at. 3242 02:48:05.000 --> 02:48:09.600 Raw, do you recall it next to the mad in 3243 02:48:09.680 --> 02:48:12.040 the bedroom there was a night stand. There was a draw, 3244 02:48:14.319 --> 02:48:17.920 and inside the draw, we're a bunch of pill bottles, 3245 02:48:18.799 --> 02:48:21.360 an Apple watch, sleeping. 3246 02:48:21.040 --> 02:48:22.680 Aids that nature. 3247 02:48:23.360 --> 02:48:24.680 I didn't search that draw, sir. 3248 02:48:26.319 --> 02:48:31.399 Okay. I don't even know about just asking why nobody's search. 3249 02:48:32.760 --> 02:48:35.000 I don't know that it wasn't searched. I just know 3250 02:48:35.079 --> 02:48:37.239 that I didn't search it, sir. So it may have 3251 02:48:37.319 --> 02:48:40.239 been searched, and maybe who ever searched it didn't feel. 3252 02:48:40.120 --> 02:48:44.440 That that information was pertinent to seize. I can't speak 3253 02:48:44.440 --> 02:48:46.319 for them, but I can tell you that I didn't 3254 02:48:46.319 --> 02:48:46.920 search at draw. 3255 02:48:48.000 --> 02:48:50.000 We directed all right, thank you, sir? 3256 02:48:53.479 --> 02:48:54.319 As his next witness. 3257 02:48:55.520 --> 02:48:56.600 Okay, afternoon, sir. 3258 02:48:59.079 --> 02:49:03.200 Be Bucky, please thank you, good afternoon. Could you please tell. 3259 02:49:03.040 --> 02:49:06.239 The Jursey your first and last name Corey Mellow And. 3260 02:49:06.280 --> 02:49:09.879 Can you spell your first name for the Recordy. 3261 02:49:09.159 --> 02:49:10.520 And your last name am Mel? 3262 02:49:11.120 --> 02:49:13.280 And how are you employed work for the State Police 3263 02:49:13.840 --> 02:49:16.520 in what unit or what's your current assignment with the 3264 02:49:16.559 --> 02:49:17.600 state Police Currently? 3265 02:49:17.639 --> 02:49:19.479 I work for the Commercial Vehicle Enforcement Section. 3266 02:49:20.920 --> 02:49:23.840 Going back to January of twenty twenty three, what was 3267 02:49:23.879 --> 02:49:24.600 your assignment then? 3268 02:49:24.879 --> 02:49:27.239 I worked for the Plens Colony District Attorney's Office at 3269 02:49:27.280 --> 02:49:27.799 that time. 3270 02:49:28.120 --> 02:49:31.799 With the State Police Detective Unit. Correct, Yes, And I'm 3271 02:49:31.799 --> 02:49:34.440 going to draw your attention to January twenty fourth, twenty 3272 02:49:34.520 --> 02:49:39.360 twenty three. Were you involved in the investigation into the 3273 02:49:39.399 --> 02:49:41.879 incident that occurred at forty seven Summer Street in Duxbury 3274 02:49:42.040 --> 02:49:45.879 on January twenty fourth? Yes, I was, and fair to 3275 02:49:45.959 --> 02:49:50.040 say that when State Police got involved in that investigation, 3276 02:49:50.639 --> 02:49:53.360 a large group of the State Police Detective Unit went 3277 02:49:53.399 --> 02:49:56.479 out to Duxbury to work that investigation. 3278 02:49:56.799 --> 02:49:57.159 Correct. 3279 02:49:57.479 --> 02:49:59.440 Were you the case officer in that case? I was 3280 02:49:59.479 --> 02:50:02.639 not the case Your role in that case was that 3281 02:50:02.760 --> 02:50:07.520 to assist in things like search warrants, neighborhood canvases, interviewing 3282 02:50:07.600 --> 02:50:08.200 of witnesses. 3283 02:50:08.639 --> 02:50:08.959 Correct. 3284 02:50:09.040 --> 02:50:13.440 Yes, And in this particular investigation, you're aware that there 3285 02:50:13.600 --> 02:50:16.479 was a search warrant executed at forty seven Summer Street 3286 02:50:16.559 --> 02:50:17.840 after the incident occurred. 3287 02:50:17.879 --> 02:50:18.200 Correct. 3288 02:50:18.479 --> 02:50:22.079 Correct, And as part of the search weren't execution? Were 3289 02:50:22.120 --> 02:50:23.760 you involved in searching the home? 3290 02:50:24.159 --> 02:50:24.319 Yes? 3291 02:50:24.440 --> 02:50:27.360 I was. And did you search the various floors of 3292 02:50:27.399 --> 02:50:29.760 the home, meaning the basement, that first floor, and the 3293 02:50:29.799 --> 02:50:30.319 second floor. 3294 02:50:30.520 --> 02:50:30.680 Yes. 3295 02:50:31.840 --> 02:50:35.079 In searching that home there were a number of other 3296 02:50:35.959 --> 02:50:38.680 detectives and troopers also searching correct. 3297 02:50:38.920 --> 02:50:39.280 Correct. 3298 02:50:39.719 --> 02:50:45.600 Do you recall locating a phone in the upstairs bedroom, 3299 02:50:46.120 --> 02:50:49.440 a laptop, some workout bands in the basement that were 3300 02:50:49.479 --> 02:50:50.159 hanging on the door. 3301 02:50:50.520 --> 02:50:50.959 Yes, I do. 3302 02:50:51.559 --> 02:50:55.959 And when you recovered these particular items are relocated these items, 3303 02:50:57.799 --> 02:51:01.079 did you then turn them into an evidence officer, direct 3304 02:51:01.120 --> 02:51:03.840 an evidence officer to things that you thought might have 3305 02:51:04.000 --> 02:51:05.200 some evidentiary value. 3306 02:51:05.399 --> 02:51:05.600 Yes. 3307 02:51:07.000 --> 02:51:09.520 At some point after the search warrant was over, You're 3308 02:51:09.520 --> 02:51:12.639 aware a lot of items were brought back for exam 3309 02:51:12.799 --> 02:51:14.040 fur their examination correct. 3310 02:51:14.159 --> 02:51:14.479 Correct. 3311 02:51:14.719 --> 02:51:17.680 Is that common that when you're working on a search 3312 02:51:17.760 --> 02:51:19.239 warrant but things are kind of. 3313 02:51:22.600 --> 02:51:22.920 All right? 3314 02:51:26.239 --> 02:51:29.159 Is it common that a lot of times search warrant 3315 02:51:29.360 --> 02:51:32.239 things are collected and brought back for further examination. 3316 02:51:32.719 --> 02:51:32.879 Yes? 3317 02:51:33.239 --> 02:51:35.719 Is that because it's kind of chaotic there and can't 3318 02:51:35.760 --> 02:51:38.600 really examine things thoroughly on scene. 3319 02:51:38.879 --> 02:51:39.399 That's correct. 3320 02:51:39.479 --> 02:51:43.520 Yes, So in this particular circumstance, were you asked to 3321 02:51:43.600 --> 02:51:45.959 review some books and journals? 3322 02:51:46.200 --> 02:51:51.479 Yes? I was, and Goma it's a sleeping grate foot 3323 02:51:51.520 --> 02:51:55.079 Pat Pat is handling nighttime stuff, Julie for making a 3324 02:51:55.200 --> 02:51:58.760 plan for me. A big thing is I feel disconnected 3325 02:51:58.840 --> 02:52:03.680 with myself time reality. I think going back to work 3326 02:52:03.719 --> 02:52:06.920 will help with that. If you wrote that right, correct? 3327 02:52:07.079 --> 02:52:09.719 And then there are numbers of pages twenty two of 3328 02:52:09.840 --> 02:52:13.440 sixty three, twenty four, twenty five, twenty six, twenty seven, 3329 02:52:13.520 --> 02:52:17.159 twenty eight, all reproducing what council asked you about and 3330 02:52:17.200 --> 02:52:19.159 what I just went through that were from those journals, 3331 02:52:19.239 --> 02:52:24.120 right correct. Do you have anything to do with the 3332 02:52:24.159 --> 02:52:29.840 search of the house yes? Did you search in the bedroom? Yes? 3333 02:52:30.719 --> 02:52:33.239 How many other people were with you searching in the bedroom? 3334 02:52:33.559 --> 02:52:35.079 I don't call how many other people of the me 3335 02:52:35.120 --> 02:52:37.159 at that time? I'm not aware. 3336 02:52:38.639 --> 02:52:39.440 Did you see the draw? 3337 02:52:40.440 --> 02:52:43.360 I don't recall what I don't recall? 3338 02:52:44.040 --> 02:52:48.280 Okay, so yeah, redirect, thank you? 3339 02:52:48.520 --> 02:52:49.239 All right, thank you sir. 3340 02:52:49.719 --> 02:52:55.799 Now I see it, Cybar all right, So bim's the jury. 3341 02:52:56.639 --> 02:52:59.159 We're going to break at this point until tomorrow. 3342 02:53:00.079 --> 02:53:03.559 Talk talking to console my expectation is we have a 3343 02:53:03.760 --> 02:53:05.479 similar schedule tomorrow. 3344 02:53:06.559 --> 02:53:08.639 The hope would be I will go in the morning. 3345 02:53:08.399 --> 02:53:09.760 And should go into the afternoon. 3346 02:53:09.840 --> 02:53:13.120 But just to give you the that's the best estimate 3347 02:53:13.159 --> 02:53:16.760 that we have, all right, and so I'm gonna excuse. 3348 02:53:16.520 --> 02:53:19.040 You till tomorrow. We're gonna ask you those questions. I 3349 02:53:19.159 --> 02:53:20.639 don't listen to anything, don't. 3350 02:53:20.479 --> 02:53:24.600 Talk about this, don't take any road trips or do 3351 02:53:24.719 --> 02:53:27.239 any research on this. Put this out of your head 3352 02:53:27.280 --> 02:53:31.760 as best you can go tomorrow morning. Hopefully the rate 3353 02:53:31.840 --> 02:53:34.600 is stop and we'll see everybody tomorrow. Thank you so 3354 02:53:34.760 --> 02:53:36.600 much for all your work here today. 3355 02:53:36.799 --> 02:53:37.040 Thank you. 3356 02:53:37.840 --> 02:53:43.760 All right. Sure notebooks are basing on the trais follow. 3357 02:53:44.680 --> 02:53:46.920 All right, So we'll be in recess on this until 3358 02:53:47.479 --> 02:53:48.559 tomorrow morning at nine. 3359 02:53:48.639 --> 02:53:50.079 Thank you, Thank you. 3360 02:53:51.879 --> 02:53:52.319 All right. 3361 02:54:10.920 --> 02:54:11.200 Place