MA v. Lindsay Clancy Day 11

Speaker 1 (00:00):

This court is now in session. You may be seated.

Clerk (00:04):

Good morning, Your Honor. May I proceed?

Judge (00:04):

Yes, please.

Clerk (00:06):

Your Honor, before the court today, we have the matter of Commonwealth versus Lindsay Clancy. Ms. Clancy is present. She is represented by Attorney Kevin Reddington, and the Commonwealth is represented by Assistant District Attorney Jennifer Sprague and Assistant District Attorney Shanan Buckingham.

Judge (00:18):

All right. Well, good morning everyone. Good morning, Counsel.

Mr. Reddington (00:20):

Morning.

Judge (00:20):

Good morning, Ms. Clancy.

Lindsay Clancy (00:21):

[inaudible 00:00:23].

Judge (00:22):

All right. What I want to do first, let me just talk to counsel just for a second. Before we get going, I just wanted to remind everybody that there is a media order that has been issued on this case. And for some of the media and the individuals who've been here for the last couple of weeks, I'm sure are familiar with it, but I know there's a constant people coming in and out.

(00:59)
So I just want to remind everyone that there is a specific media order that's been issued on this case, and everybody is presumed to have reviewed it and agreed to it. So if there are any violations or problems with that, we'll have to deal with it. But I just wanted to remind everybody, especially people who may have just come into the courtroom recently.

(01:26)
And if you have any questions about what that order is, you can speak to any of the court officers. They have a copy of it. We can get a copy of it to everybody who needs to see it and review it. All right. And with that, what we'll do is we're going to go. The defendant, excuse me, had filed a motion for addition to the witness list, to add to the witness list regarding a Ms. Thorndike. So what I'm going to do first, I'll hear from the defendant. Then I'll hear from the Commonwealth. Thank you. Mr. Reddington.

Mr. Reddington (01:58):

Thank you. Your Honor, basically as the motion speaks for itself, there is a woman. Her name is Emily Thorndike, who's a LICSW here in Massachusetts. She owns and is an independent operator of her own clinical social work establishment called Wise Mind Therapy. Your Honor has her resume. She graduated from Dover-Sherborn High School, received a Bachelor of Arts in Sociology from Hartwick College, master's degree from BC 2019, is licensed in Massachusetts.

(02:35)
And interestingly enough, she did work at the McLean Hospital in the very short term unit that the doctor was testifying that Lindsay was in for five days in January of '22 into '23. She worked for five years as a mental health specialist from May of 2014 to May of 2019.

(02:59)
She was a clinical social worker manager of that unit from 2019, 2021. So she's basically got about seven years and seven months of experience working in that unit for majority of that period of time, full-time employee, and then for one year as a supervisor.

(03:20)
She left, as the court is aware, from the motion. I vetted her out. I obviously would be concerned if there's any so-called ax to grind, if you will, any lawsuits pending. Were you fired? Did you have any difficulties? Any claims for harassment, hostile workplace? Absolutely nothing.

(03:43)
She has friends that are still employees that still work at McLean. And I do not know this woman. I have literally never met her. Her involvement in this case came about after one of the prosecutors, I don't recall which, made it out on direct examination that McLean is some kind of a five-star institution where the doctors, the psychiatrists, the psychotherapists, the counselors were all banging into each other in the hallway trying to interview Ms. Clancy, who was just blithely refusing care and treatment which is not the case.

(04:23)
Patrick testified as to his observations. The court is aware that Patrick's testimony clearly in all fours landed on the fact that it was clear to him that there was no staff that was available other than kids behind plexiglass on their cell phones. She colored. She took walks. There was no therapy. She didn't speak to any therapists or counselors.

(04:51)
So now, the jury is left with that image that McLean is purportedly some kind of a five-star hospital because they're affiliated quote, unquote, "with Harvard," which you, from your practice, I'm sure as I know from my practice, is as far from the truth as can be possible in my opinion.

(05:11)
But it doesn't matter what my opinion is. I could cross-examine somebody till the cows come home. It doesn't matter. This woman posted a video on TikTok, which much like yourself, I'm sure.

(05:24)
I hardly know what TikTok is, but I received an email from one of the very, very active people in the community of TikTok saying, "Look, you got to check this video out." So I did. This is about a week ago, maybe longer now. When I saw her video saying that she could not stand for, and I quote, "The lies and the misrepresentations from that witness stand about McLean Hospital." I then said to my private investigator, Bob Jones, I said, "Bob, I can't find this woman because she had a pseudonym name or whatever."

(05:59)
He went, we wrote, he called her, left messages. She never got back to us for three days. He went to her house. He sat out in front of her driveway. She came home from work. They interacted. He waved, didn't want to scare her. And she said, "I thought..." Oh, by the way, I believe that actually my wife had written her a letter as well because she's a nurse and was trying to reach out to her to have her get in touch with me to no response.

(06:25)
She then tells Bob, "I thought you guys were all AI. I didn't know that you were real. I though it was spam." He then gave me her number. I spoke to her. She told me exactly what I put in the affidavit or in the motion. And she is available, ready, willing, and able to testify to an employee's observations over seven years, including as a supervisor, as to what woeful environment McLean Hospital offers, especially on holidays such as major holidays like New Year's, which is fine. We all enjoy New Year's. But nevertheless, New Year's, the day after, that weekend, Monday, nobody was there. And I think it's important to rebut the inference that was created through the examination by the DA.

Judge (07:18):

All right. Ms. [inaudible 00:07:19], let me ask you this, and I'm going to ask the Commonwealth the same thing. What's the relevance? What's the argument for the relevance of what McLean's was at least the... Because she wasn't there for about a year if I looked at the motion. Is that correct?

Mr. Reddington (07:39):

[inaudible 00:07:40].

Judge (07:40):

That's all right.

Mr. Reddington (07:41):

Yeah, that's true. She left. She has her own business now, and she left, but it was just a year.

Judge (07:48):

Yeah.

Mr. Reddington (07:48):

There's no change in the circumstances from Lindsay going into that hospital on New Year's of 2022 to '23 and this woman's work experience where she left a year before. And I agree with you. This would've been a non-issue. Were it not for the flavor of the government's repeated argument that she was a person who was spurning healthcare, didn't want healthcare, had the opportunity and she walked away from the opportunity, which as I say, is as far from the truth as possible.

(08:24)
So I think it is now because of their questioning squarely before the jury to leave that impression. And the woman that was the doctor from McLean was just a pleasure. She was just a lovely, lovely woman and testified as best she could in the case. But they're left with the impression that McLean is this wonderful place that she just did not have any interest in utilizing what was available to her that was not available to her. And she's testifying to custom practice and her observations over seven and a half years.

Judge (09:01):

Is there another alternative to get there if someone who actually works there or worked there during this time period? It's the time period that-

Mr. Reddington (09:10):

A year?

Judge (09:10):

... is one of the things that. Well, yeah, but things can change in a year.

Mr. Reddington (09:14):

I don't think so at McLean.

Judge (09:17):

I don't know so. I guess that's the question. I don't know so. That's one of the things I may have to wrestle with, but that's what I was asking whether or not there is... I understand the argument.

Mr. Reddington (09:31):

Okay.

Judge (09:32):

And I understand the argument regarding relevance. But if we're talking about staffing or the availability of programs and how that work, this witness, there's a gap there. I guess that's all. I'm wondering if there's another way to get there.

Mr. Reddington (09:49):

So the realities of trial practice, if you're the government, you send summonses. You have people come to your office. You're interviewing witnesses. If you're the defense, they run for the hills.

(10:01)
For example, one motion I'm bringing with you is merely looking for pediatric records that I have had to have Bob Jones go and try to get the HIPAA forms, everything. And they're avoiding us horribly. And I'm going to have a contempt hearing request very shortly.

(10:16)
But the point I'm getting at is if they want to reach out to McLean, I'm sure that McLean administration would bend over backwards to give them every record that they would need as to how many employees they had, what their work records were, their doctors, their counselors, all available. I know I can't get it. So I'm suggesting to Your Honor that this is an opportunity for a person who worked there for all those years who does not have any dog in the fight to testify to what her observations were clearly within her timeframe.

(10:54)
She left a year before Lindsay went in there on New Year's. So I certainly agree with that cross-examination. They could get records if they wish, but I think it is relevant. I think it's material, and I think it has to be used to rebut the inference that was raised.

Judge (11:12):

All right. Thank you.

Mr. Reddington (11:13):

Thank you, Judge.

Judge (11:13):

Yeah. Commonwealth?

Attorney Buckingham (11:18):

Your Honor, the Commonwealth would object to the witness, the late disclosed witness. In addition to the obvious Rule 14 issues, the fact that we didn't have notice of this individual, there's been no discovery other than what's contained in the affidavit and what we could identify from this woman's TikTok video.

(11:34)
There's no report from the investigator who admittedly by counsel has spoken to this witness, this individual. Aside from that, we have a number of other issues with this witness. One is this isn't somebody that's proposed to be an expert. So they're not relieved. They wouldn't be relieved of a sequestration order.

(11:52)
But this woman's TikTok, admittedly, she's been following the trial. She goes on for several minutes in a very long TikTok video where she identifies what she thinks are lies based on her observations of Patrick Clancy's testimony. We have no idea what her thoughts are or what her comments are on the rest of the trial that we assume she's watched based on her comments in this particular video, that she outlines in this video her experiences at McLean and her observations and how they are different from what was portrayed in that particular witness's testimony.

(12:29)
But in the course of this trial, we not only have that particular witness's testimony, we have records from McLean and the records speak from themselves about what she was offered, what she did, what she declined, what the contact was with each and every person who wrote a note in that record.

(12:43)
But this witness admittedly wasn't there, had no contact, has no knowledge of the case in of itself. And in this case, Your Honor, we deal with facts. We're presenting facts to the jury. We're not presenting somebody's opinion about what kind of care the defendant got during her stay at McLean. That's not what this trial is about. That's not what it should be about. And if it wants to play out in the court of public opinion, that's fine, but not inside the walls of this courtroom.

(13:09)
So this person who said that she cares about Lindsay in this video, whether other people do or don't, this person who said that the prosecution of this case is an abomination, this person who said that the health profession needs to be held responsible for their care of the defendant, that's not a witness that presents facts to this jury.

(13:26)
And I would also agree that there is a problem with what relevant testimony that she could give. There is no indication that what her experiences were in those seven years up until December of 2021 are exactly the same as they would've been when the defendant was at that short-term unit at McLean. And the defense had the opportunity to ask that of Dr. Goodheart and he didn't. So there is-

Judge (13:51):

Wait a minute. I think she said, "I don't know what the staffing was." Didn't she say, "I don't know how many people were on. I don't know if it was a skeleton crew"?

Attorney Buckingham (14:02):

She said on that particular weekend. She didn't know what the staffing was. But she wasn't asked any-

Judge (14:07):

That's the only weekend we're talking about.

Attorney Buckingham (14:09):

Right. But now, he wants to make this an issue about the practices and the common practice of the hospital. But that was not a question that was asked of her, nor would Your Honor necessarily have permitted it where he was trying to tailor the testimony to the exchanges with the defendant.

(14:25)
So to then have the witness available to answer those questions that was at the facility during that time period, and then not take that opportunity and then offer this subsequent witness and call it a rebuttal witness, it's not a fair line of examination. It's not a fair line of rebuttal where she wasn't there during the time period. So we would object for all of those reasons.

Judge (14:50):

Just so everybody knows where we're going. I can't imagine that that witness would be allowed to give her, in a sense, review of McLean's. If it's five star and she may say it's two star, this is not TripAdvisor. I wouldn't allow that.

Attorney Buckingham (15:12):

And no one-

Judge (15:14):

But the question seems to be, for me, a closer call about what the standard staffing and programs may be available on a holiday weekend, because the Commonwealth's witness said, "I don't know that."

(15:32)
And that seems to be something that maybe the parties could come to an agreement about establishing either... There's got to be somebody who's still working there that says, "The weekend after this wasn't a holiday, we have X amount of people there. We have X amount of programs that are available. On the holiday weekend, we do or we don't."

(16:05)
To me, that's where the battle on this motion is. I do understand the Commonwealth's objections regarding allowing people who watched the trial to then say, "I disagree with it, and I want to testify about what I disagree with." That's troubling, but I'm talking about the facts on this thing. If it was anything other than those kind of facts and this witness had not worked there, I'm not sure we'd even be having this hearing.

Attorney Buckingham (16:39):

Well, and I would suggest that counsel indicated that in trial practice that people are reluctant to give information to the defense, but there are avenues, procedural avenues that he could pursue to get that information involving the court or involving subpoenas in which there's been no indication that he's actually tried to do.

(16:55)
And again, I would suggest to the court that we have the McLean records from that time period in evidence, and they are the best evidence of the contact that people there, staff that were there that day had, or those four days, had with the defendant on that day.

(17:11)
So from the perspective of if there's missing information, there are avenues he could pursue if he wants to rebut it. I would suggest that this person's testimony is not relevant because they weren't there. And I would agree that the better option from if defense wants to present this as a rebuttal would be from somebody that is there, but he doesn't have that. And so for those reasons, this motion should be denied.

Judge (17:35):

And you don't have to commit to this at all, but it seems to me that it would be a very simple solution to get the staffing records or somebody at McLean's who can testify to this. What was the program availability on mid-December weekend if you went in there as opposed to the weekend of New Year's?

(18:03)
And it may be no different whatsoever, and that eliminates the argument. So I think probably the best way to deal with this is to maybe have a voir dire of this witness. So then the record's clear too. But it also allows the parties to consider while we're setting this up. Maybe, there's another way to do it, a lesser alternative, so to speak, that would reduce the prejudice to both parties.

Attorney Buckingham (18:41):

I don't know how a voir dire of this particular witness who clearly wasn't there and didn't have contact with the facility during that time period would answer Your Honor's questions. But I do agree-

Judge (18:51):

Maybe, we can find out. I can ask the questions, and we could see. I understand. The problem that I had as the case was going, the individual that was probably, you would anticipate, could talk about the staffing, the difference of a holiday weekend and a non-holiday weekend, said she wasn't aware of that.

Attorney Buckingham (19:21):

Well, I don't know that she said she wasn't aware of the difference. She said she wasn't aware of who was there on that weekend because she wasn't working that weekend. So I think there's a slight distinction in that. But again, the witness was available.

(19:34)
Counsel could have crossed her on that subject to any sort of objection, and we could have addressed it at that time when the witness was on the stand. But again, that witness is under summons. And if counsel wants to recall her, he can. There are avenues that he could pursue if he wants to pursue this line of rebuttal that's short of calling this particular witness that's been proposed is the point that the Commonwealth wants to express.

Judge (20:00):

So I need to take this under advisement. I want to review it. Just so everybody can maybe make some idea where we may go with this, I'm inclined to have a voir dire with this witness or some other witness.

(20:18)
So maybe the defendant can get somebody who hasn't watched the trial because I do understand there's an issue regarding sequestration, but that may be a function of a trial like this that's being broadcast. How do we guard against that? But that's not going to affect really the relevance, the prejudice, the determinations I have to make really under all the rules, 401, 403, all of those considerations that I have to make.

(20:53)
So I'm inclined to do that unless the parties can think of a, I won't say better, alternative, that's not fair to this witness, a different alternative that might address everybody's-

Mr. Reddington (21:04):

[inaudible 00:21:04] we're going to be able to agree on anything, Judge. So it would really be up to the-

Judge (21:07):

I know.

Mr. Reddington (21:08):

... referee to make a decision.

Judge (21:10):

Right. What I'm trying to do is put that out there. If the parties can agree, I think the three of you know me. I don't have a problem making a decision. I really don't. But I just wanted to give everybody that opportunity to maybe craft the solution. And if I have to do it, that's what I'm saying by saying I'll take it under advisement. So I'll let the parties know.

Attorney Buckingham (21:32):

Can I just ask, Your Honor?

Judge (21:32):

Sure.

Attorney Buckingham (21:34):

If you're reviewing this, taking it under advisement, that you do look in more detail at those records, the McLean Hospital records [inaudible 00:21:42] evidence so that Your Honor can see the extent of the contact, the extent of the notes of people who actually dealt with her because, again, that is the issue. That is the factual issue here, is the contact that she actually had, not what maybe she wasn't offered at other points, but what she had while she was there. So I'd ask that you just review that.

Judge (22:01):

All right. I'll review that. I'll review my notes regarding the doctor who testified from McLean's, and then we can deal with this. This would be a witness that would be called later in the trial anyway. So give me a chance to do that, review that, get a decision to the three of you.

(22:20)
And then we can, depending what happens, either schedule a voir dire or go from there. All right.

Mr. Reddington (22:26):

All right.

Judge (22:27):

Thank you for everybody for agreeing to argue this a little bit earlier. So it gives me a chance to review the records and the arguments. All right. With that now, we ready for the jury?

Speaker 1 (22:38):

Yes.

Judge (22:38):

Come on. Yeah.

Clerk (22:38):

[inaudible 00:23:50]

Speaker 1 (25:16):

All right. All rise. Jurors entering.

(25:18)
Oyez, oyez, oyez. All persons having anything to do before the Honorable William Sullivan, Justice of the Superior Court, now sitting in Plymouth within and for the Commonwealth. Draw near, give attendance, and you shall be heard. God saved the Commonwealth of Massachusetts. This court is now in session. Please be seated.

Clerk (25:34):

Good morning, Your Honor. May I proceed?

Judge (25:36):

Yes, please.

Clerk (25:36):

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

Judge (25:51):

All right. Well, good morning, everyone.

Jury (25:56):

Good morning, Your Honor.

Judge (25:56):

Thanks for your patience. I told you we got a little late to start, but I appreciate you waiting for us. And so what I'm going to do is going to go through those questions. And then at that point, we'll talk a little bit about the schedule, and then we'll get right back into the trial.

(26:09)
So first question, as you all know by this point, has any member of the jury read, seen, heard, or overheard anything from any source about any aspect of this case that would affect your ability to be a fair and impartial juror?

Jury (26:22):

[inaudible 00:26:24].

Judge (26:23):

All right. Second question is there any other serious matter or concern bearing on your service as a juror in this case that anybody needs to bring to my attention?

Jury (26:31):

[inaudible 00:26:33].

Judge (26:33):

Again, thank you for following those instructions. And then in regards to today's schedule, I'll probably be wrong again, but the best aspect I think will probably be similar to yesterday, okay? So we'll return to the case. We'll take a break hopefully around 11:00. Take a break from 1:00 to 2:00, and then we'll go into the afternoon depending on how the case testimony goes.

(26:59)
And then at the end of the day, I'll try to remember, bring counsel over here. We'll talk about where we are on the timeline of the case, where we are scheduled for the week and going forward. So I'll try and give you that hopefully this afternoon before I send you home. All right.

(27:19)
So with that, we're going to return. There was a witness. Ms. Paul was on the stand. The Commonwealth had finished their direct examination, and we're about to begin cross-examination of that witness. So I would ask the witness if the witness could retake the stand, please.

Speaker 1 (27:36):

Good morning, ma'am.

Ms.Paul (27:36):

Good morning.

Speaker 1 (27:36):

Can you stop right there and raise your right hand for the clerk, please?

Clerk (27:51):

Good morning. Do you solemnly swear that the testimony you'll [inaudible 00:28:09]

Ms.Paul (28:08):

Yes.

Clerk (28:09):

Thank you. You may have a seat.

Speaker 1 (28:09):

Watch your step, please.

Judge (28:09):

All right. Good morning.

Ms.Paul (28:10):

Good morning.

Judge (28:12):

All right. Mr. Reddington?

Mr. Reddington (28:13):

Thank you, Judge. Morning, Nurse Paul.

Ms.Paul (28:15):

Good morning.

Mr. Reddington (28:16):

And if I understand, you now live and perhaps work in New Hampshire. Is that right?

Ms.Paul (28:24):

That's correct.

Mr. Reddington (28:25):

And are you still doing the same type of work that you were doing with the South Shore Health?

Ms.Paul (28:30):

Yes, I am.

Mr. Reddington (28:31):

Excellent. Very good. You obviously are a very, very dedicated person to this field, if you will, in helping people that are pregnant women after they had birth and during that postpartum period, right?

Ms.Paul (28:48):

Correct.

Mr. Reddington (28:50):

You worked with Lindsay. And the reason you were involved with Lindsay is because, if I understand it correctly, her mother-in- law, Patrick's mother, Sue, worked with a friend of yours.

Ms.Paul (29:05):

Correct.

Mr. Reddington (29:05):

So basically, Sue asked her friend if she could reach out and have you step in and help out.

Ms.Paul (29:14):

That's correct.

Mr. Reddington (29:15):

And then, that's what you did?

Ms.Paul (29:15):

Yes.

Mr. Reddington (29:16):

And you stepped up, and you treated this woman obviously with care and professionalism, in my opinion.

Judge (29:25):

Thank you.

Mr. Reddington (29:33):

Your Honor, I would like to offer the records from South Shore Health, if I could.

Judge (29:37):

Objection?

Attorney Buckingham (29:37):

No objection.

Judge (29:41):

Those records may be admitted.

Clerk (29:42):

Is that [inaudible 00:29:48] 222?

Mr. Reddington (29:55):

In the course of your treatment of Lindsay, actually, you went so far as to give you a cell phone, if I'm correct. Is that right?

Ms.Paul (30:02):

She did have my cell phone because I called her on my day off. Yes, sir.

Mr. Reddington (30:05):

Okay. I don't have any other questions, Judge. Thank you very much for your care.

Judge (30:10):

All right. Counsel, anything further?

Attorney Buckingham (30:13):

No, thank you.

Judge (30:15):

All right. Thank you. You may step down.

Ms.Paul (30:15):

Thank you.

Attorney Buckingham (30:24):

The Commonwealth would call Rebecca Jollotta as its next witness, please.

Speaker 1 (30:26):

Good morning, ma'am. Stop right there and raise your right hand for the clerk, please.

Clerk (30:26):

Good morning. Do you solemnly swear that the testimony you'll [inaudible 00:31:50]

Rebecca Jolotta (30:26):

[inaudible 00:31:50].

Clerk (30:26):

Thank you. You may have a seat.

Speaker 1 (31:52):

Watch your step, please.

Judge (31:52):

Hey, good morning. I'm going to ask you to keep your voice up and speak into that microphone, all right?

Rebecca Jolotta (32:02):

Okay. Thank you, Your Honor.

Judge (32:03):

All right. Yes. Attorney Buckingham, please.

Attorney Buckingham (32:08):

Thank you. Good morning.

Rebecca Jolotta (32:09):

Good morning.

Attorney Buckingham (32:09):

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

Rebecca Jolotta (32:13):

Rebecca Jolotta.

Attorney Buckingham (32:14):

And how do you spell your last name for the record?

Rebecca Jolotta (32:16):

J-O-L-L-O-T-T-A.

Attorney Buckingham (32:20):

And what do you do for work?

Rebecca Jolotta (32:22):

I'm a psychiatric nurse practitioner.

Attorney Buckingham (32:24):

And what kind of training and education did you do in order to become a psychiatric nurse practitioner?

Rebecca Jolotta (32:31):

Thank you. I have my bachelor's degree from the University of Connecticut in Allied Health Sciences. I then went on to get my master's actually in counseling psychology in 2013 from William James College in Newton. I worked in the mental health field as a clinician in various positions for a time. Then I went back to school. I've been an RN in Massachusetts since 2017. I got my MSN in 2019, at which time I became a licensed and credentialed psychiatric nurse practitioner.

Attorney Buckingham (33:04):

And where is that? Here in Massachusetts?

Rebecca Jolotta (33:07):

Yes.

Attorney Buckingham (33:08):

Are you licensed anywhere else?

Rebecca Jolotta (33:09):

No.

Attorney Buckingham (33:10):

Okay. And so can you tell us a little bit about your work history?

Rebecca Jolotta (33:14):

Sure. I have worked as a detox nurse at McLean. I have worked as a therapist in outpatient clinicians prior to becoming a nurse. I have worked in DMH respite facilities. And now, I'm a nurse practitioner.

Attorney Buckingham (33:41):

And when you were a therapist doing outpatient therapists, was that something you were doing on your own as a social worker or were you associated with a practice?

Rebecca Jolotta (33:50):

It was part of my training after I got my master's in counseling in 2013. So I had a panel of patients, but I was under the supervision of a licensed provider. It was up towards getting my licensure.

Attorney Buckingham (34:04):

And where do you currently work?

Rebecca Jolotta (34:06):

South Shore Health.

Attorney Buckingham (34:08):

And how long have you worked for South Shore Health?

Rebecca Jolotta (34:10):

Since 2021.

Attorney Buckingham (34:14):

And how did you come to work at South Shore Health? What was the role that you started?

Rebecca Jolotta (34:19):

I had been working in general practice as a psychiatric nurse practitioner, but I was interested in working in women's mental health specifically. And at that point, I was getting training to become more specialized in it. And when a job opportunity became available, I applied for it.

Attorney Buckingham (34:42):

And what kind of training is that that you were doing to be more specialized in women's health?

Rebecca Jolotta (34:47):

So postpartum support international is the certifying body so that somebody can become certified in perinatal mental health. I did the two-day... well actually, it was a two-day training plus a third day specific...

Rebecca Jolotta (35:00):

Actually, it was a two-day training plus a third day specifically for the psychopharmacology track of it. Then I took a examination and passed the examination.

Attorney Buckingham (35:12):

And so, are you certified by the Postpartum Support International?

Rebecca Jolotta (35:15):

I am.

Attorney Buckingham (35:15):

Now, as far as the South Shore Perinatal Behavioral Health Clinic, how did you become affiliated with that?

Rebecca Jolotta (35:28):

That was the job I applied to in 2021.

Attorney Buckingham (35:30):

Okay. When you came to the clinic, who was running the clinic or who was the director?

Rebecca Jolotta (35:37):

Julie Paul.

Attorney Buckingham (35:41):

As far as the clinic itself, what's the patient base or who does the clinic service?

Rebecca Jolotta (35:49):

We specialize in working with women who are pregnant and postpartum up to two years after the birth of their most recent baby. We offer medication management. We have a clinician on staff to do counseling. We have a few nurses that work in our program. We work with moms for any range of psychiatric disorders, including addiction.

Attorney Buckingham (36:13):

When we talk about the range of psychiatric disorders in women who are postpartum, what are we talking about?

Rebecca Jolotta (36:19):

Postpartum depression, anxiety, postpartum psychosis, bipolar disorder, panic disorder, obsessive compulsive disorder.

Attorney Buckingham (36:33):

You mentioned postpartum psychosis. Have you yourself had the experience of treating people, women with postpartum psychosis?

Rebecca Jolotta (36:40):

I have, yes.

Attorney Buckingham (36:41):

How many patients approximately over the course of the last five years?

Rebecca Jolotta (36:48):

Approximately five.

Attorney Buckingham (36:51):

How about postpartum depression and postpartum anxiety?

Rebecca Jolotta (36:55):

Hundreds.

Attorney Buckingham (37:01):

In the range of services that the clinic offers and the work that you do, do you oftentimes collaborate with other community providers to offer additional referrals or services to patients if they need it?

Rebecca Jolotta (37:14):

We do.

Attorney Buckingham (37:15):

How about when somebody appears before you and you believe they need a higher level of care than what you can offer? Do you have relationships with hospitalization programs, or are you able to make referrals for people for those services?

Rebecca Jolotta (37:30):

Yes.

Attorney Buckingham (37:30):

Is that pretty common practice?

Rebecca Jolotta (37:32):

Yes.

Attorney Buckingham (37:35):

You mentioned that one of the services or one of the things offered to patients at the clinic is medication management.

Rebecca Jolotta (37:42):

Yes.

Attorney Buckingham (37:43):

Is that a big part of what you do as a psychiatric nurse practitioner?

Rebecca Jolotta (37:46):

It is.

Attorney Buckingham (37:48):

What kind of training do you receive in order to be a prescriber?

Rebecca Jolotta (37:54):

In order to be a prescriber, it's part of my master's in nursing. You take courses in advanced pharmacology, advanced health assessment, pathophysiology. It's part of the coursework of my degree. Then you actually have to take a certification exam and you have to pass the exam. You have to go on and get a DEA license, a Massachusetts controlled substance license. You have to go on and get your advanced practice registered nursing license. It's education and certification and licensure.

Attorney Buckingham (38:34):

You've done the education, you did the certification, and do you have all the licensures that you just described here in Massachusetts?

Rebecca Jolotta (38:41):

I do.

Attorney Buckingham (38:45):

You also mentioned part of the services of working with social workers in the clinic. What do the social workers do?

Rebecca Jolotta (38:54):

They provide short-term counseling to patients. Again, because we specialize in up to two years postpartum, they could be available to provide counseling during that phase.

Attorney Buckingham (39:06):

Traditionally, postpartum period is a year after birth, right?

Rebecca Jolotta (39:10):

Correct.

Attorney Buckingham (39:10):

So why does the clinic offer support for women up to two years?

Rebecca Jolotta (39:14):

We do acknowledge that while the highest risk period is the first three months postpartum. Some women can struggle later on in the first year. They may have symptoms that emerge 9, 10 months in. We want to really be able to cover them and treat them if that happens and get them stable.

Attorney Buckingham (39:33):

Does it sometimes take some time to get a person stable?

Rebecca Jolotta (39:36):

Absolutely.

Attorney Buckingham (39:37):

Would that be why the program or your program goes up to two years?

Rebecca Jolotta (39:41):

Yes.

Attorney Buckingham (39:43):

I want to draw your attention to a particular patient, Lindsay Clancy. You're familiar with that patient?

Rebecca Jolotta (39:49):

I am.

Attorney Buckingham (39:50):

How did you become involved with the care of Lindsay Clancy?

Rebecca Jolotta (39:54):

I became involved. She had initially seen Julie and Julie was going to be leaving the clinic in December. She wanted somebody to take care of Lindsay, again, longer term since she would be leaving.

Attorney Buckingham (40:09):

At that time in 2022, when Julie was leaving, how many psychiatric nurse practitioners were at the clinic?

Rebecca Jolotta (40:18):

Three.

Attorney Buckingham (40:19):

That includes Julie?

Rebecca Jolotta (40:20):

Yes.

Attorney Buckingham (40:22):

Who was the other nurse practitioner?

Rebecca Jolotta (40:25):

Andrea Warden.

Attorney Buckingham (40:28):

Fair to say you had a conversation with Julie about transferring care of this particular patient?

Rebecca Jolotta (40:33):

Yes.

Attorney Buckingham (40:36):

Did you have more experience than the other nurse practitioner in the field, if you know?

Rebecca Jolotta (40:43):

Not necessarily.

Attorney Buckingham (40:46):

But as far as taking Lindsay on as a patient, you were agreeable to taking over for Julie?

Rebecca Jolotta (40:51):

Yeah. In all likelihood, Andrea Warden only works two days at our clinic, so it could have been that I was working five days at that time, so I would have been more available.

Attorney Buckingham (41:03):

Do you recall when the first contact you had with Lindsay Clancy, what date it was?

Rebecca Jolotta (41:09):

It was November 29th, 2022.

Attorney Buckingham (41:12):

That was prior to Julie actually leaving, right?

Rebecca Jolotta (41:17):

Correct.

Attorney Buckingham (41:17):

Fair to say on that November 29th date, you had an actual follow-up with Lindsay?

Rebecca Jolotta (41:24):

I did.

Attorney Buckingham (41:25):

You recall if it was virtual, or was it in person?

Rebecca Jolotta (41:29):

I recall that it was virtual.

Attorney Buckingham (41:33):

Okay. In the practice of the clinic, is there an option for patients to do in-person or face-to-face in-person visits?

Rebecca Jolotta (41:39):

Yes.

Attorney Buckingham (41:42):

How does it come about that a person is either inpatient... Excuse me, in-person or virtual?

Rebecca Jolotta (41:49):

Our model is that we do initial assessments in person, because new motherhood is very busy, there's a lot going on, we would rather see you than not. Sometimes it is just easier to log on to a screen. Sometimes if we feel like someone would benefit from that face-to-face assessment, we'll say, "Please book your next appointment in person." And I know I did see Lindsay in person on at least one occasion, but my first was virtual.

Attorney Buckingham (42:23):

As far as that choice about whether a patient appears virtual or in-person, is part of the calculus the patient's choice, what they want to have happen?

Rebecca Jolotta (42:33):

Yeah.

Attorney Buckingham (42:35):

If there were circumstances where you believed or insisted that an in-person visit was required, would you articulate that to the patient?

Rebecca Jolotta (42:45):

Yes.

Attorney Buckingham (42:45):

Then have them scheduled for an in-person?

Rebecca Jolotta (42:48):

Correct.

Attorney Buckingham (42:48):

As far as your contact, your first contact with Lindsey Clancy, were you aware that Julie Paul had done that initial intake with her in person?

Rebecca Jolotta (42:57):

I was.

Attorney Buckingham (42:58):

You had the chance to speak with Julie and to also review the records prior to meeting with her?

Rebecca Jolotta (43:03):

Correct.

Attorney Buckingham (43:04):

Were you aware that the day before, on November 28th, that Julie had had some contact with Lindsay Clancy?

Rebecca Jolotta (43:15):

I was.

Attorney Buckingham (43:15):

And that there was some phone interaction and there had been some messages sent to the clinic prior to you scheduling the meeting with her?

Rebecca Jolotta (43:23):

Correct. Yes.

Attorney Buckingham (43:25):

Would you agree that there was an issue that needed to be discussed and that led to you to have this appointment with her prior to Julie actually leaving the program?

Rebecca Jolotta (43:35):

Yes.

Attorney Buckingham (43:39):

When you met with Ms. Clancy, did you go through a history of her present presentation or present illness and things that had occurred in the past?

Rebecca Jolotta (43:54):

I did.

Attorney Buckingham (43:54):

Did you do a nuts and bolts start to finish, or did you rely on some of the previous information she had disclosed?

Rebecca Jolotta (44:03):

I relied on some of the previous information she had disclosed. Things like where she grew up, where she went to school, past clinical history, medication trials, but otherwise I would add my own clinical assessment.

Attorney Buckingham (44:22):

You were aware that in the history she presented to the clinic that she had previously been on some medications from another provider?

Rebecca Jolotta (44:29):

Correct. Yes.

Attorney Buckingham (44:30):

And that she started with Zoloft and Ativan and Benadryl?

Rebecca Jolotta (44:35):

Yes.

Attorney Buckingham (44:35):

And that at some point she had visited the South Shore Hospital emergency room?

Rebecca Jolotta (44:40):

I believe it was November 16th.

Attorney Buckingham (44:43):

As a clinic that's associated with the South Shore Health System, do you have access to those records to review when you're dealing with a patient?

Rebecca Jolotta (44:51):

I do. Yeah.

Attorney Buckingham (44:53):

And so you're aware that when she went to the ER on November 16th, that they prescribed her Trazodone?

Rebecca Jolotta (44:59):

I am.

Attorney Buckingham (44:59):

And that she was reporting significant sleep issues at that time?

Rebecca Jolotta (45:02):

I was aware.

Attorney Buckingham (45:04):

Then as far as the course of treatment at the clinic, were you able to review her course of treatment with Julie?

Rebecca Jolotta (45:10):

I was.

Attorney Buckingham (45:11):

Fair to say that had been very recent, correct?

Rebecca Jolotta (45:14):

Very recent, yes.

Attorney Buckingham (45:14):

Her first contact with the clinic was actually November 20th, correct?

Rebecca Jolotta (45:17):

Correct.

Attorney Buckingham (45:20):

You were aware that Julie had originally prescribed Prozac and had already changed the medication plan?

Rebecca Jolotta (45:28):

Yes, I was aware.

Attorney Buckingham (45:32):

In this meeting on November 29th, what was Lindsay reporting to you as the issues?

Rebecca Jolotta (45:42):

Would I be able to refer to my note, Your Honor?

Speaker 2 (45:45):

Sure, you can.

Rebecca Jolotta (45:45):

I know most of it by memory, but just... She had been taking mirtazapine, Remeron, at that point for four nights. I believe she started it on November 25th. I was then seeing her on November 29th. She wasn't yet appreciating much difference from mood, anxiety or insomnia. She would say, "I'm able to fall asleep for two hours. Then I'm up for three hours in the middle of the night." And finding herself in those three hours needing to take an Ativan to help her fall back asleep.

Attorney Buckingham (46:23):

Now, when she said not appreciating much difference after taking it for four nights, in your training and experience, is that something that you would normally see with that type of medication?

Rebecca Jolotta (46:34):

Yes. I wasn't surprised by that.

Attorney Buckingham (46:38):

For something like mirtazepam or what's referred to as Remeron, right?

Rebecca Jolotta (46:41):

Remeron, yep.

Attorney Buckingham (46:43):

What class of drug is that?

Rebecca Jolotta (46:46):

It is a noradrenergic specific serotonin antidepressant. It's slightly different than an SSRI. It does work on serotonin. It also works on... The noradrenergic part is alpha receptors, which is what our body... Those are the receptors that our body responds to adrenaline, so it should help calm you down. It also works on histamine receptors, which is why it can make people sleepy.

Attorney Buckingham (47:14):

For Remeron, the fact that it has a calming effect on somebody with anxiety, it's sometimes a good fit, right?

Rebecca Jolotta (47:21):

Correct. Yep.

Attorney Buckingham (47:22):

For somebody who might be complaining of sleep issues, it also has that secondary component that could help?

Rebecca Jolotta (47:27):

Yeah. It is a good choice for somebody who's having depression with prominent anxiety, insomnia, decreased appetite, because it can also increase appetite, which sometimes we want to happen.

Attorney Buckingham (47:39):

Based on your view of her course of treatment with the clinic, those were issues that had arisen, right?

Rebecca Jolotta (47:49):

Yeah. I had noticed she had lost weight. When she had gone to her PCP on October 20th, I believe she weighed like 130 pounds. On the 16th when she went to the ED, she weighed 124 pounds and they had done a pretty good medical workup on her with labs and everything, and she had reported decreased appetite. That was part of the clinical picture, of course, not sleeping and very anxious.

Attorney Buckingham (48:11):

With a medication like Remeron or mirtazapine, does it take time to work or to see results?

Rebecca Jolotta (48:20):

Yes.

Attorney Buckingham (48:21):

Typically, what's the timeframe for that drug?

Rebecca Jolotta (48:26):

I usually tell patients four to six weeks at a given dose is really going to give us a good idea of what that dose is going to do. You may start to see improvements in the first two weeks, but full clinical benefit can take a month, sometimes eight weeks even.

Attorney Buckingham (48:42):

You were aware prior to her coming to this follow-up appointment with you that she had been reporting after taking the Remeron, feeling disoriented, forgetful, not feeling connected to the body and anxious about whether she would actually sleep?

Rebecca Jolotta (48:59):

Correct.

Attorney Buckingham (49:03):

Were you aware that on November 28th that one of the nurses actually advised her to increase the Remeron?

Rebecca Jolotta (49:12):

I was.

Attorney Buckingham (49:13):

And in addition to the medication, there was also the recommendation that she add some cognitive behavioral therapy to her treatment plan?

Rebecca Jolotta (49:22):

Yes.

Attorney Buckingham (49:23):

At that point on November 29th, by November 29th, were you aware of whether she had met with the social worker at the clinic?

Rebecca Jolotta (49:31):

She had not.

Attorney Buckingham (49:34):

Did you have any indication that she had been engaging in some sort of cognitive behavioral or psychotherapy?

Rebecca Jolotta (49:42):

No.

Attorney Buckingham (49:42):

Now, in relation to the medication piece of this follow-up, did you have any conversations with her about the concerns with the Remeron and what to do about that?

Rebecca Jolotta (49:56):

Yes, I did. I explained to her that it takes time to work, that it has only been four days. I did encourage her to give it some more time. I also made additional recommendations as well.

Attorney Buckingham (50:16):

Okay. What were the recommendations for?

Rebecca Jolotta (50:20):

I had known that Julie had tried like 5 mg of Ambien. I had suggested maybe we could try 10. Maybe we could try Ambien controlled release formulation because she was having these wake-ups in the middle of the night. The controlled release, the outer layer gives you 60% of the dose, helps you sleep. Then throughout the night, the inner layer gives you 40% of the dose, keeps you asleep. I said that might be a good option while we're waiting for the Remeron to work, because I was thinking that maybe the underlying depression anxiety was causing the poor sleep, so while we're treating that, let's try these alternatives.

Attorney Buckingham (51:01):

Was she receptive to the Ambien?

Rebecca Jolotta (51:03):

No.

Attorney Buckingham (51:05):

Did she say why?

Rebecca Jolotta (51:06):

No, I don't recall.

Attorney Buckingham (51:10):

Did she express to you that she had some other concerns about taking certain types of medications for sleep, like benzodiazepines?

Rebecca Jolotta (51:17):

She did.

Attorney Buckingham (51:18):

What did she say about that?

Rebecca Jolotta (51:19):

She was concerned about taking benzo. She had mentioned something called rebound anxiety. What that is is once the dose wears off, your anxiety goes above your baseline once the dose of a benzodiazepine wears off. It usually typically has to do with half-life of a medication. For Ativan, that's usually between 8 and 24 hours. If she's taking it in the middle of the night, the next morning, she would feel more anxious. She was concerned about that. She was concerned about getting physically dependent on it, because she had needed to take it for a number of nights.

Attorney Buckingham (52:01):

When she used the term rebound anxiety, was that her terminology?

Rebecca Jolotta (52:05):

Yes, it was.

Attorney Buckingham (52:06):

Is that a terminology that you generally use in psychiatric care to describe that, what you just told us about?

Rebecca Jolotta (52:12):

Yes. It's a clinical term.

Attorney Buckingham (52:15):

Was that something that she mentioned first or did you mention?

Rebecca Jolotta (52:19):

I put it in quotes in my notes. That's usually when a patient mentioned it, I put it in quotes.

Attorney Buckingham (52:27):

As far as the plan to address the sleep and to help her with this complaint, with Ambien not a choice, what was your next recommendation?

Rebecca Jolotta (52:39):

I discussed hydroxyzine because it's an as-needed medication for anxiety, but it's not a benzodiazepine, doesn't really carry that risk of rebound anxiety or tolerance or dependence, and it could help her sleep, so I offered that as an alternative as well.

Attorney Buckingham (52:58):

Were you aware that she was offered hydroxyzine before?

Rebecca Jolotta (53:03):

I was not aware of that.

Attorney Buckingham (53:05):

Was she willing to try the hydroxyzine?

Rebecca Jolotta (53:08):

No.

Attorney Buckingham (53:10):

What was her preference?

Rebecca Jolotta (53:11):

Her preference was to continue with the mirtazapine, the Remeron, 15 milligrams, and with the as-needed lorazepam.

Attorney Buckingham (53:22):

Just so we stay with the same terminology when you're talking lorazepam with-

Rebecca Jolotta (53:27):

Sorry, Ativan. Yeah.

Attorney Buckingham (53:32):

That was something that she expressed to you?

Rebecca Jolotta (53:35):

Yes.

Attorney Buckingham (53:36):

Now, when you're dealing with a patient, and obviously this is your first interaction with her, right?

Rebecca Jolotta (53:41):

Mm-hmm.

Attorney Buckingham (53:42):

Do you take into account your contact and communication with them in assessing whether they have the ability to make these choices or make informed decisions?

Rebecca Jolotta (53:52):

Absolutely.

Attorney Buckingham (53:54):

Your conversation with her about her medication treatment that she had received and what you were proposing as a plan, was she able to engage with you in that conversation?

Rebecca Jolotta (54:03):

Yep. It was [inaudible 00:54:06] collaborative.

Attorney Buckingham (54:07):

Sorry.

Rebecca Jolotta (54:07):

It was collaborative.

Attorney Buckingham (54:07):

When she declined the options that you first offered, did you then present her with alternatives?

Rebecca Jolotta (54:13):

I did.

Attorney Buckingham (54:14):

Ultimately at the end of the day, whose choice is it as to what medication regimens a person would be on?

Rebecca Jolotta (54:19):

The patient.

Attorney Buckingham (54:20):

Why is that?

Rebecca Jolotta (54:24):

Because they have autonomy in their decisions. I'm only making recommendations based on my education, experience, training, what I'm seeing in terms of symptoms. The patient has the autonomy.

Attorney Buckingham (54:36):

Are there instances where you're dealing with a patient where you have concerns that they shouldn't have autonomy? Or that maybe if I rephrase that question. Are there instances where you're dealing with a patient where you're concerned that they don't have the ability to make the right choice for themselves?

Rebecca Jolotta (54:54):

There would be, yeah.

Attorney Buckingham (54:55):

What options do you have in those instances?

Rebecca Jolotta (54:59):

In those instances, I mean, that comes down to competency, capacity to make decisions. Sometimes we might get our legal or ethics team involved to make a determination about whether this patient needs a healthcare proxy to make their decisions, things like that.

Attorney Buckingham (55:19):

What about if a person presents with a very serious risk to their own physical health or the health of others? What are your options then?

Rebecca Jolotta (55:30):

I guess it would depend if they had capacity to make their decisions.

Attorney Buckingham (55:34):

In your interaction with her on November 29th, did you also go through with her and perform a mental screening test or a mental status screening?

Rebecca Jolotta (55:45):

I did.

Attorney Buckingham (55:46):

Why do you do that?

Rebecca Jolotta (55:48):

It gives me some objective data of how the patient presents, like how is their speech? How's their appearance? What is their thought process? What's their thought content? Things of that nature.

Attorney Buckingham (56:00):

In this meeting on November 29th of 2022, did you observe anything in which she displayed manic symptoms?

Rebecca Jolotta (56:09):

No.

Attorney Buckingham (56:10):

What traditionally are manic symptoms that you look for?

Rebecca Jolotta (56:14):

There's a mnemonic called Dig Fast. Try to do this quick. D is distractability. Patient is highly distracted to lots of extraneous stimuli. There is pressured speech, grandiosity, like suddenly someone's like, "I'm going to run for office. I'm going to be the president." And you're like, "Okay, you've never had an interest in that before." Sleep is really poor. Somebody might get two hours of sleep, but be like, "Go, go, go, go, go." Increased goal-directed activity. Somebody might be painting the exterior of their house, painting the interior of their house. They might be doing a bunch of different projects with no decompression time or feeling tired. Those are the general symptoms of mania. Sometimes there can be psychosis associated with it as well.

Attorney Buckingham (57:12):

When you say mania and psychosis, are those two different things?

Rebecca Jolotta (57:17):

Yes.

Attorney Buckingham (57:18):

Are you also looking in these screenings to identify signs of psychosis?

Rebecca Jolotta (57:23):

Absolutely.

Attorney Buckingham (57:23):

What would be signs of psychosis usually?

Rebecca Jolotta (57:27):

Signs of psychosis, they can be subtle. It might look like somebody's responding to stimuli in their head based on the way that their eyes are kind of tracking and they're not really paying attention. They may be quite guarded. They may have a delusional thought process. For example, they might think that somebody's out to get them when there's really no basis.

Attorney Buckingham (57:58):

When you say responding to internal stimuli, is that generally when a person hears things, auditory hallucinations or sees things that aren't there?

Rebecca Jolotta (58:06):

Yes.

Attorney Buckingham (58:08):

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