Lindsay Clancy Trial and Psychiatry

[Stumpyman]

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Has anyone been following the trial and have any thoughts? It was worrying how they grilled her psychiatrist, who by all accounts seems to have done right by the patient and didn't seem neglectful to me. I've read discourse online about people calling for mandates on psychiatrists prescribing SSRIs and for there to be less or no telehealth.
I just think this was such a difficult case, where the patient was hospitalized in an inpatient setting and no one saw evidence of postpartum psychosis.

 

[psydocc]

Given that there were no objectively observable, collaterally reported, or subjectively endorsed psychotic symptoms prior to the killings, I'll be curious to hear what the defense team's forensic sellout has to say when asked what would have allowed Clancy’s treating clinicians to distinguish her "psychosis" from the vastly larger population of women experiencing nonpsychotic postpartum depression, anxiety, and insomnia. By all accounts, across multiple settings, multiple providers, and even friends/family observations, there was nothing to indicate her case was a postpartum psychosis.

If Clancy succeeds in getting away with the murder of those 3 babies and succeeds in her lawsuit against the psych providers, the take home message to the psych community will be that any distressed postpartum mother should be treated as covertly psychotic and homicidal even if she appears completely organized, nonpsychotic, and repeatedly denying any psychotic/homicidal symptoms. It would be a colossal setback for women's mental health.

 

[lobstar]

Given that there were no objectively observable, collaterally reported, or subjectively endorsed psychotic symptoms prior to the killings, I'll be curious to hear what the defense team's forensic sellout has to say when asked what would have allowed Clancy’s treating clinicians to distinguish her "psychosis" from the vastly larger population of women experiencing nonpsychotic postpartum depression, anxiety, and insomnia. By all accounts, across multiple settings, multiple providers, and even friends/family observations, there was nothing to indicate her case was a postpartum psychosis.

If Clancy succeeds in getting away with the murder of those 3 babies and succeeds in her lawsuit against the psych providers, the take home message to the psych community will be that any distressed postpartum mother should be treated as covertly psychotic and homicidal even if she appears completely organized, nonpsychotic, and repeatedly denying any psychotic/homicidal symptoms. It would be a colossal setback for women's mental health.

In the same way my ED buddies say the CT scanner is the legal shield of EM perhaps psych can evolve into every patient gets an antipsychotic just in case.

 

[calvnandhobbs68]

I mean just join the psychiatry network facebook group or go on reddit and you can discuss to your hearts content lol.

I haven't felt the need to watch all the testimony directly but from what I have seen and my impression from what I know about the defense cross exam is that the defense is basically trying to make it seem like all these various psychiatrists and psych NPs missed the fact that she was psychotic or manic-psychotic because they're about to bring Phillip Resnick (I believe) up as an expert witness to testify that she was in fact psychotic at the time of the incident. Thus the NGRI plea. So they basically have to try to poke holes in her care and documentation or else they've got much less of a leg to stand on to say she was psychotic at the time of the incident.

Some of the cross exams were bizarre though like the attorney saying the psychiatrist couldn't give her a hug over the computer or seemingly not understanding what an insurance case manager was?

Also realize there is a pending civil suit against her providers so if she does get the NGRI, it gives even more ammo for the malpractice/civil suit.

Outside of whether she was actually psychotic or not, I do feel terrible for especially her primary outpatient psychiatrist who was pretty fresh out of residency who had to deal with her seemingly doctor shopping, seeming to constantly want to switch medication or being variably compliant with medications, jumping into the perinatal PHP but seemingly not going back after being discharged from inpatient (from what I can tell of the timeline?) and just getting dumped back into her lap. The outpatient psychiatrist did make some questionable decisions but it's not the stuff the laypeople are trying to rake her over the coals for (ex. what's up with the titration of subtheraputic doses of amitriptyline as the patient is deteriorating over the couple weeks prior to the actual incident...)

 

[Stumpyman]

I mean just join the psychiatry network facebook group or go on reddit and you can discuss to your hearts content lol.

I haven't felt the need to watch all the testimony directly but from what I have seen and my impression from what I know about the defense cross exam is that the defense is basically trying to make it seem like all these various psychiatrists and psych NPs missed the fact that she was psychotic or manic-psychotic because they're about to bring Phillip Resnick (I believe) up as an expert witness to testify that she was in fact psychotic at the time of the incident. Thus the NGRI plea. So they basically have to try to poke holes in her care and documentation or else they've got much less of a leg to stand on to say she was psychotic at the time of the incident.

Some of the cross exams were bizarre though like the attorney saying the psychiatrist couldn't give her a hug over the computer or seemingly not understanding what an insurance case manager was?

Also realize there is a pending civil suit against her providers so if she does get the NGRI, it gives even more ammo for the malpractice/civil suit.

Outside of whether she was actually psychotic or not, I do feel terrible for especially her primary outpatient psychiatrist who was pretty fresh out of residency who had to deal with her seemingly doctor shopping, seeming to constantly want to switch medication or being variably compliant with medications, jumping into the perinatal PHP but seemingly not going back after being discharged from inpatient (from what I can tell of the timeline?) and just getting dumped back into her lap. The outpatient psychiatrist did make some questionable decisions but it's not the stuff the laypeople are trying to rake her over the coals for (ex. what's up with the titration of subtheraputic doses of amitriptyline as the patient is deteriorating over the couple weeks prior to the actual incident...)

My apologies if double posted from FB/reddit! I work in a facility where those sites are blocked so I peruse SDN instead.

I agree, feel terrible for the outpatient psychiatrist. I don’t think she was negligent and if there were signs of psychosis im sure at some point it would have been documented or noticed inpatient or outpatient. The defense attorney seems angry and incompetent to me, there are more legitimate ways he could criticize the medical staff than being belligerent

 

[FlowRate]

In the same way my ED buddies say the CT scanner is the legal shield of EM perhaps psych can evolve into every patient gets an antipsychotic just in case.

The NP's (and some psychiatrists) are way ahead of you on that one...

 

[the5thelement]

Certainly seems like a stuff of nightmares for the newly minted psychiatrist. One of my bosses told me to always write the progress notes imagining you are being grilled in the court about what you have written. I wonder if her malpractice insurance lawyers coached her about what to expect and how to respond professionally to the defense attorneys questions in court.

 

[MedMan80]

It kind of cements our thoughts that there are a lot of poor psychiatrists out there and only a few good ones (everyone on this board, of course). The standard of care is very low.

 

[smalltownpsych]

I haven’t been watching this but just off the cuff thoughts, one could make an argument that not being in the room, aka telehealth, could make one more likely to miss psychosis. Also, I would think that since we should all know the high profile cases of postpartum depression and killing their kids, such as Andrea Yates, if she is severe enough to be inpatient, it would be part of my thinking or evaluation. I don’t run into it every day or even every year, but these cases seem to happen enough that when I had one last year, I was definitely thinking from a risk management stance.

 

[calvnandhobbs68]

My apologies if double posted from FB/reddit! I work in a facility where those sites are blocked so I peruse SDN instead.

I agree, feel terrible for the outpatient psychiatrist. I don’t think she was negligent and if there were signs of psychosis im sure at some point it would have been documented or noticed inpatient or outpatient. The defense attorney seems angry and incompetent to me, there are more legitimate ways he could criticize the medical staff than being belligerent

Ha no my point was just it's like the hot topic all over the place. Lots of people also unnecessarily freaking out about how they don't want to keep working in psychiatry anymore too because of all the public scrutiny over this.

I did watch some of Dr. Tufts cross exam yesterday and I think part of the issue was she was just unprepared for how adversarial the defense lawyer was going to be. She needed to push back on things like him questioning her experience, if you watch it he basically starts accusing her of falsely putting herself out as a "perinatal expert" or something like that. I think it would have played much better if she responded something like "I've never falsified my credentials or my prior experience counsel and I don't appreciate this insinuation, if there is a specific documented misrepresentation you'd like to present me with please do so".
Or stupid stuff like him saying SSRIs are "powerful drugs", she just needed to push back on his language and aggression more directly. Unfortunately she kind of came off like he was trying to portray her, which is somewhat hesitant and not experienced.

I also think she was just unprepared in general oddly enough, like not knowing exactly what she had written in her notes, why she had written it that way, what they discussed during her intake, what was on her intake forms, etc. Just little stuff he grilled her on to make her seem less competent that she really should have been able to answer in a heartbeat.
Even odd things like him asking Dr. Tufts if she asked Lindsay about if she had any side effects from Prozac prior and she seemed unsure about it.
I'd know my notes backwards, forwards, upside down and sideways along with being confident about every detail of every interaction I had if I knew I was going into a high profile televised case like this.

I haven’t been watching this but just off the cuff thoughts, one could make an argument that not being in the room, aka telehealth, could make one more likely to miss psychosis. Also, I would think that since we should all know the high profile cases of postpartum depression and killing their kids, such as Andrea Yates, if she is severe enough to be inpatient, it would be part of my thinking or evaluation. I don’t run into it every day or even every year, but these cases seem to happen enough that when I had one last year, I was definitely thinking from a risk management stance.

Andrea Yates was 25 years ago though....the whole reason this is such a sensation is because these cases are so rare. You're not alone, people keep referencing the Yates case but like just think about what that means in terms of risk management. What we need to do is continue to push back on the idea that psychiatrists and psychologists are some kind of mind readers who can anticipate and prevent extremely rare violent acts from occurring somehow.

 

[comp1]

What is the prosecutor's idea for a motive that isn't based in mental illness? We don't have crystal balls, we can't predict behavior like this, of course, but I don't quite get the motive outside of that. Of course the documentation and care seemed fine from a professional perspective. You can have perfect care in mental health and horrific outcomes, as in all other areas of medicine.

 

[Stagg737]

I haven’t been watching this but just off the cuff thoughts, one could make an argument that not being in the room, aka telehealth, could make one more likely to miss psychosis. Also, I would think that since we should all know the high profile cases of postpartum depression and killing their kids, such as Andrea Yates, if she is severe enough to be inpatient, it would be part of my thinking or evaluation. I don’t run into it every day or even every year, but these cases seem to happen enough that when I had one last year, I was definitely thinking from a risk management stance.

This is true, but if she didn’t report SI/HI and wasn’t floridly psychotic per multiple psychiatrists (including inpatient docs) how are we supposed to be able to discern when this is a Clancy/Yates type of patient?

I have not been keeping up with the case so not sure if she ever made any statements of SI/HI. I do know our inpatient unit gets several cases of postpartum psychosis per year and it is not uncommon for the husband to start demanding (sometimes immediately) that we discharge the patient, sometimes from the ER before they ever get admitted. I like reproductive psych, but cases like this make me want to stay away with a 100 foot pole.

 

[PsyDr]

You can see the defense attorney’s escalation of behavior. The more submissive she acts, the more he closes the distance with her. I’ve never seen an attorney physically touch a witness or rip something I hurt of anyone’s hands, before.

 

[Merovinge]

I mean just join the psychiatry network facebook group or go on reddit and you can discuss to your hearts content lol.

I haven't felt the need to watch all the testimony directly but from what I have seen and my impression from what I know about the defense cross exam is that the defense is basically trying to make it seem like all these various psychiatrists and psych NPs missed the fact that she was psychotic or manic-psychotic because they're about to bring Phillip Resnick (I believe) up as an expert witness to testify that she was in fact psychotic at the time of the incident. Thus the NGRI plea. So they basically have to try to poke holes in her care and documentation or else they've got much less of a leg to stand on to say she was psychotic at the time of the incident.

Some of the cross exams were bizarre though like the attorney saying the psychiatrist couldn't give her a hug over the computer or seemingly not understanding what an insurance case manager was?

Also realize there is a pending civil suit against her providers so if she does get the NGRI, it gives even more ammo for the malpractice/civil suit.

Outside of whether she was actually psychotic or not, I do feel terrible for especially her primary outpatient psychiatrist who was pretty fresh out of residency who had to deal with her seemingly doctor shopping, seeming to constantly want to switch medication or being variably compliant with medications, jumping into the perinatal PHP but seemingly not going back after being discharged from inpatient (from what I can tell of the timeline?) and just getting dumped back into her lap. The outpatient psychiatrist did make some questionable decisions but it's not the stuff the laypeople are trying to rake her over the coals for (ex. what's up with the titration of subtheraputic doses of amitriptyline as the patient is deteriorating over the couple weeks prior to the actual incident...)

This is almost exactly my view of everything thus far, very interested in any updates once Resnick gets on the stand.

 

[FatherPsychiatry]

I've been staying away as much as I can from following this case - I'll read up on it maybe in a year or two when the dust has (hopefully) settled and I can read a JAAPL review or another objective review about it. The social media commentary, including physician and even psychiatrists, and bot turfing about it all around, which itself influences the evening news, the feeds, the overall zeitgeist, with their ****ty uninformed opinions has been frustrating, especially as I have done similar (but thankfully less publicized) infanticide cases in the past, both from the forensic as well as therapeutic side.

 

[Stagg737]

I've been staying away as much as I can from following this case - I'll read up on it maybe in a year or two when the dust has (hopefully) settled and I can read a JAAPL review or another objective review about it. The social media commentary, including physician and even psychiatrists, and bot turfing about it all around, which itself influences the evening news, the feeds, the overall zeitgeist, with their ****ty uninformed opinions has been frustrating, especially as I have done similar (but thankfully less publicized) infanticide cases in the past, both from the forensic as well as therapeutic side.

Same, my SIL asked me about it and I said the only think I can tell is that the media coverage is awful. So many misconceptions, inaccuracies, and straight up lies. The stupidity of the average person about psychiatry is both unsettling and comforting at the same time as it makes me feel like I'll have job security for a very long time as long as there aren't too many pitchforks and torches coming out from a political/legal side.

 

[Orgone]

Same, my SIL asked me about it and I said the only think I can tell is that the media coverage is awful. So many misconceptions, inaccuracies, and straight up lies. The stupidity of the average person about psychiatry is both unsettling and comforting at the same time as it makes me feel like I'll have job security for a very long time as long as there aren't too many pitchforks and torches coming out from a political/legal side.

I had the same feelings and thoughts every time I had to testify in court. The questions and conclusions coming from the attorneys and judges were consistently so jaw-droppingly terrible ... I'm somewhat cynical by nature but I lost whatever faith I'd had in the legal system.

 

[Ahamis]

What is the prosecutor's idea for a motive that isn't based in mental illness? We don't have crystal balls, we can't predict behavior like this, of course, but I don't quite get the motive outside of that. Of course the documentation and care seemed fine from a professional perspective. You can have perfect care in mental health and horrific outcomes, as in all other areas of medicine.

"Magda Goebbels, wife of Nazi propaganda minister Joseph Goebbels, murdered her six children on May 1, 1945, inside Adolf Hitler's bunker in Berlin before she and her husband committed suicide. [1, 2, 3, 4]"

You don't necessarily need a motive on a trial.

Many people in prison have some sort of mental illness.
I would suspect she was bipolar and had some impulsivity issues.
But what is it essential to know is whether she could "differentiate right from wrong" at the time of the incident.

Having mental illness is not enough to qualify as NGRI. That's what some lay people are getting wrong.

 

[Ahamis]

So this forensic psychiatrist Phillip Resnick will testify in favor that the defendant had a psychotic break that none saw? is that correct?
I can't believe it.

All this litigation happening against all the mental health providers will make outpatient psychiatrists avoiding even more SMI.
I have vast training in SMI but in my clinic I avoid taking those cases because it demands much higher level of care (and much more involvement of the family).
I will extend that to postpartum depression (who knows when they will become psychotic?)

 

[Sushirolls]

Resnick is still alive?

 

[Stumpyman]

So this forensic psychiatrist Phillip Resnick will testify in favor that the defendant had a psychotic break that none saw? is that correct?
I can't believe it.

All this litigation happening against all the mental health providers will make outpatient psychiatrists avoiding even more SMI.
I have vast training in SMI but in my clinic I avoid taking those cases because it demands much higher level of care (and much more involvement of the family).
I will extend that to postpartum depression (who knows when they will become psychotic?)

I don't know too much about Resnick other than he's a legendary forensics guy from CWRU. Is he getting paid from the defense's side to make that testimony? If he does testify that she was psychotic, that seems like a huge stain on his reputation, does it not? He somehow knows better than the outpatient psychiatrist and the CL/inpatient docs that all saw her? I get that expert witnesses do that sort of thing but I just wouldn't expect it from an esteemed academic forensic psychiatrist. Maybe it'll be more nuanced 🤷‍♂️

 

[psydocc]

I don't know too much about Resnick other than he's a legendary forensics guy from CWRU. Is he getting paid from the defense's side to make that testimony? If he does testify that she was psychotic, that seems like a huge stain on his reputation, does it not? He somehow knows better than the outpatient psychiatrist and the CL/inpatient docs that all saw her? I get that expert witnesses do that sort of thing but I just wouldn't expect it from an esteemed academic forensic psychiatrist. Maybe it'll be more nuanced 🤷‍♂️

Everyone has a price, I suppose. If he testifies then it rightfully deserves to permanently ruin his reputation and legacy. Every single one of her mental health providers around that time (4 psychiatrists + 2 psych NPs + 1 therapist) independently noted no psychotic symptoms. The idea that he, and his 90 year old brain, can somehow accurately conclude that Clancy was psychotic on January 24 2023 is laughable. I don't see how he does this without throwing all of psychiatry and our normal standard of care under the bus. I think it's time for great grandpa Resnick to retire.

 

[2025DandW]

I am not following the case closely, but it is my understanding she has been at Tewksbury State Hospital since 2023. It will be interesting to know if they diagnosed her with postpartum psychosis and bipolar disorder. Maybe Resnick is not selling his soul to the Devil. I have treated a number of patients that you wouldn’t know they were psychotic based on a 15 or 20 minute interview. I have even treated patients with psychosis who were able to keep it together for a significant period of time.

 

[comp1]

I doubt whatever he says will ruin his reputation. If he is testifying for the defense, I would expect a lot of handwaving, more educational statements about what postpartum psychosis is. I expect very little about Clancy in specific.

 

[vanfanal]

It maybe sounded like depression with mixed features? It's scary to think that I think I would have done mostly the same. The check boxes and limited MSE options in the EMR is a problem. As is the fact there probably isn't much clerical support to get outside records...unlike lawyers, we don't have a team on interns to do the leg work and increase hourly billings. And how often do you call for collateral for standard opt visits. Unrealistic in the real world.

 

[nexus73]

The defense has 3 or 4 psychiatry/psychologist experts I believe. I heard Resnick is coming in as an expert in filicide, so may not be opining specifically on NGRI.

 

[calvnandhobbs68]

It maybe sounded like depression with mixed features? It's scary to think that I think I would have done mostly the same. The check boxes and limited MSE options in the EMR is a problem. As is the fact there probably isn't much clerical support to get outside records...unlike lawyers, we don't have a team on interns to do the leg work and increase hourly billings. And how often do you call for collateral for standard opt visits. Unrealistic in the real world.

Yeah it doesn't seem like the outpatient psychiatrist did anything terribly out of line, she just looked bad because she wasn't prepared for the aggressive cross-exam.

Honestly I think she's gonna get the NGRI. I didn't know this but Mass has a pretty low bar....once the defense is properly raised the burden is on the prosecution to prove criminal responsibility beyond a reasonable doubt. The example jury instructions make it pretty clear:

https://www.mass.gov/doc/9200-lack-of-criminal-responsibility/download

So yeah there's likely to be plenty of reasonable doubt raised here for various reasons. I'm actually surprised her defense attorney went so hard at the outpatient providers because another very valid approach would be to establish that she had severe postpartum anxiety/depressive symptoms that could have possibly resulted in transient psychosis at the time of the event. All you need to do is raise doubt about her responsibility and you're done.

 

[smalltownpsych]

I wasn't implying that we should catch or prevent everything, more a warning to other students that certain presentations should trigger a little extra documentation and to document the absence of stuff. Its like the document about writing a suicide note and thinking about why you didn't hospitalize. Often we consider these factors but we don't always document negatives which makes sense, but sometimes its a good cya
Also, if a total of 7 mental health people evaluated her mental status didn't document psychosis, including 4 psychiatrists, then it would be hard to argue that it was there or that all of them were negligent in some way.
On a side note, I just gave a deposition a couple of weeks ago on a totally unrelated topic, but hearing how poorly this poor psychiatrist performed makes me feel better about my own testimony. 😉 Seriously though, competent practitioners can be made to look bad by an attorney, especially if the judge allows a lot of crap and thats not right in any way and did she even get paid for it. This can be a thankless job.

 

[mistafab]

I agree. I didn't look too much into the case but did also pull up mass' NGRI laws. One of the lower bars for a state. Will be hard for her to not get that.

Yeah it doesn't seem like the outpatient psychiatrist did anything terribly out of line, she just looked bad because she wasn't prepared for the aggressive cross-exam.

Honestly I think she's gonna get the NGRI. I didn't know this but Mass has a pretty low bar....once the defense is properly raised the burden is on the prosecution to prove criminal responsibility beyond a reasonable doubt. The example jury instructions make it pretty clear:

https://www.mass.gov/doc/9200-lack-of-criminal-responsibility/download

So yeah there's likely to be plenty of reasonable doubt raised here for various reasons. I'm actually surprised her defense attorney went so hard at the outpatient providers because another very valid approach would be to establish that she had severe postpartum anxiety/depressive symptoms that could have possibly resulted in transient psychosis at the time of the event. All you need to do is raise doubt about her responsibility and you're done.

 

[Ahamis]

If "proved" NGRI, it will affect the result in the malpractice lawsuit against the mental health providers/hospital. I wonder if they are going to to settle.

I wonder the long-therm repercussion for our practice in regards to treating postpartum depression in the community, new criteria for discharging a patient from inpatient, and approach of suicidal ideation (since the "protective factors were not enough") in the outpatient setting.

The public opinion is very much against our field. 😕

 

[comp1]

I'm not sure there will be long term repercussions. We are very bad at predicting violence. Fortunately, everyone else is also very bad at it. This is not something that most people in mental health go around saying they are great at.

 

[psydocc]

If "proved" NGRI, it will affect the result in the malpractice lawsuit against the mental health providers/hospital. I wonder if they are going to to settle.

I wonder the long-therm repercussion for our practice in regards to treating postpartum depression in the community, new criteria for discharging a patient from inpatient, and approach of suicidal ideation (since the "protective factors were not enough") in the outpatient setting.

The public opinion is very much against our field. 😕

My group is already seriously considering not taking on any peripartum patients going forward.

 

[Stagg737]

I'm not sure there will be long term repercussions. We are very bad at predicting violence. Fortunately, everyone else is also very bad at it. This is not something that most people in mental health go around saying they are great at.

The problem here isn’t that everyone is bad at predicting violence. The problem is certain sectors of the public believe we SHOULD be able to predict violence and prevent it. Ironically these are often people who think we’re overmedicating everyone and that psych drugs are always dangerous.

We also know that big cases CAN have major repercussions. The Libby Zion case is a great example of this where the resident got completely screwed for a drug interaction that wasn’t even known about at the time. That case, fortunately, led to positive changes in the form of decreased hours and better working schedule for medical residence as a whole. I do have a hard time seeing what positives would come out of this case though.

 

[comp1]

They certainly can have big repercussions, including the bizarre judicial creation out of whole cloth responsibilities for warning people in Tarasoff. However, I think Andrea Yates is a much closer example and I don't really see any long term repercussions that arose there for the field. If anything, the outcome that should come is that mental health professionals in general are recognized formally as not able to make meaningful predictions about future violence.

 

[Stumpyman]

I think the landscape has changed so much in the last few years with perceptions of psychiatry, it's nothing like the early 00s Yates era. I have had many coworkers and family members all talk to me about the dangers of SSRIs and the over-prescribing of them in the US. Partially thanks to MAHA/RFK, there's a lot of attention placed on our field and skepticism about our medications and generally how we operate (I just can't imagine telehealth for psychiatry being as ubiquitous as it has been anymore). In some ways, it's not bad to have updates to our field and better guidelines, as we've been the Wild West for a long time and I always groan when I inherit a patient with a busted up drug regimen from a colleague. I don't necessarily think the people with power shining a spotlight on us are going to implement the best changes, though.

 

[2025DandW]

I think the landscape has changed so much in the last few years with perceptions of psychiatry, it's nothing like the early 00s Yates era. I have had many coworkers and family members all talk to me about the dangers of SSRIs and the over-prescribing of them in the US. Partially thanks to MAHA/RFK, there's a lot of attention placed on our field and skepticism about our medications and generally how we operate (I just can't imagine telehealth for psychiatry being as ubiquitous as it has been anymore). In some ways, it's not bad to have updates to our field and better guidelines, as we've been the Wild West for a long time and I always groan when I inherit a patient with a busted up drug regimen from a colleague. I don't necessarily think the people with power shining a spotlight on us are going to implement the best changes, though.

I don’t know that we will see any major long term changes. I think about the Aurora theater shooting where lay people suggested the antidepressants triggered the shooting, and they were therefore dangerous. This would make sense if he had bipolar disorder, but I don’t recall anyone diagnosing him with this. Reality is antidepressants can trigger mania. When I was going through school, I don’t remember this being emphasized; although, one of my attendings did caution me about placing a bipolar patient on trazodone. In the current era, I believe residents are being taught this along with making sure to rule out bipolar disorder in anyone that presents with depression. This doesn’t mean having a knee jerk reaction of placing everyone on atypicals and never using antidepressants. I agree that this is a case where multiple psychiatrists and providers saw the patient and no one diagnosed her with bipolar disorder or postpartum psychosis. Just because she is found NGRI doesn’t mean that anyone wasn’t following good standard of care. If I was Dr. Tuft, I would try to fight this tooth and nail, but her malpractice may just settle to have this go away.

 

[splik]

If "proved" NGRI, it will affect the result in the malpractice lawsuit against the mental health providers/hospital. I wonder if they are going to to settle.
😕

The two suits are different. Although the defense attorney Reddington falsely claimed to contrary in order to discredit Dr. Tufts, in reality, it is largely irrelevant to the malpractice case whether or not she is found NGRI. Remember, this is a criminal trial. although it appears that psychiatry itself is on trial, ultimately this a murder trial. In the unlikely scenario that the malpractice cases went to trial, it would be highly unusual that the criminal trial verdict would be admissible, and it would not bind a jury whether or not she were found NGRI since that has nothing to do with whether there were deviations from the standard of care that led to the damages and whether the damages were foreseeable. The NGRI case only concerns the issue of right and wrong. very different issues.

That said, most medical malpractice cases settle, so most likely these cases (i believe clancy is suing, and her ex husband is suing on behalf of the estate of his deceased children) would settle. The suit on behalf of the children is probably less controversial. Lindsay clancy's own suit would be a bit more contested because juries are more conflicted about rewarding people for their own actions, especially if it involves attempted suicide or triple filicide.

At any rate as mentioned above, MA has old school insanity criteria so once an NGRI instruction is given, the jury has to assume she was insane unless the prosecution can provide beyond a reasonable doubt that she was sane. Also, they don't have the m'naughten standard, so it's not just about right or wrong but whether or not she had substantial capacity to conform her behavior to the requirements of the law. Also, psychosis is not even required, non-psychotic mania or depression etc would be sufficient

 

[futureapppsy2]

I haven't watched all the testimony, but I think the biggest potential error I've seen is lacking detail in documentation, like putting that the patient was decompensating but not why she made that determination, not saying what the side effects were that made the patient want to d/c the med, etc. Things that are probably never going to come up outside of a med-mal context but can introduce vulnerability within one. Also, the in-patient psychiatrist seems to have not really interacted with her, which probably didn't look good on the stand.

 

[Ceke2002]

The defence's approach to cross examining medical professionals is a tad, shall we say "interesting"

Some transcript "highlights"

https://www.rev.com/transcripts/ma-v-lindsay-clancy-day-10

____________________________________________

Kevin Reddington (04:10):

So you basically were working as either a person studying to be a doctor, graduating, and then becoming a resident through the entire pandemic?

Dr Jennifer Tufts (04:25):

For the first part of the pandemic, yes.

Kevin Reddington (04:27):

Well, the pandemic ended when Joe Biden said it ended. I think it was July of 2022, right?

(no idea what Joe Biden has to do with the trial, but okay?)
--------------------------------------------

So you were practicing as a psychiatrist for a little more than a month?

Dr Jennifer Tufts (10:31):

I was practicing independently with my full credentials for about a month, but the training is just immense that goes on before that.

Kevin Reddington (10:41):

Absolutely. It must be. But that's a residency that you're talking about, right?

Dr Jennifer Tufts (10:44):

Yes.

Kevin Reddington (10:45):

And you know with a residency... I mean, all I know is Grey's Anatomy, but I mean, you're working under a doctor, the doctors are supervising you, and they tell you what to do, and then you report to them, correct?

Dr Jennifer Tufts (10:55):

They don't really tell you what to do. They're there as a resource if you need additional support, but I followed many of my own patients. I was the only person in the room with them. And my notes were signed off by an attending physician and that attending was available for any support I needed.

(please note, he will eventually blather on about Dr Tufts misleading patients by only having practiced Psychiatry for a month and therefore 'falsely' advertising her services via a website that was set up by the clinic she worked for)

--------------------------------------------

I'm asking you about when you started working in August of '22 for Aster. And you are now on your own as an employee. How many patients had you treated before you saw Lindsay Clancy for postpartum psychosis?

Dr Jennifer Tufts (12:54):

Well, in the span of one month, I would say none because it's a very rare disorder.

Kevin Reddington (12:59):

Okay. But it exists, doesn't it?

Dr Jennifer Tufts (13:02):

Absolutely.

Kevin Reddington (13:10):

And one of the things would be the voices that people hear, right?

Dr Jennifer Tufts (13:10):

That is a symptom of psychosis. Absolutely.

Kevin Reddington (13:12):

And that's legitimate, isn't it?

Dr Jennifer Tufts (13:15):

It is a legitimate diagnosis. Absolutely.

Kevin Reddington (13:17):

Ignore the diagnosis. People that have postpartum psychosis hear voices, do they not?

(yes, actually trained medical professional, just ignore the diagnosis )

--------------------------------------------

And Lindsay told you that she was on SSRIs in the past, right?

Dr Jennifer Tufts (22:37):

Yes.

Kevin Reddington (22:39):

And SSRI means what?

Dr Jennifer Tufts (22:40):

Selective serotonin reuptake inhibitors.

Kevin Reddington (22:44):

And that's pretty powerful stuff.

Dr Jennifer Tufts (22:47):

It's an effective treatment for depression and anxiety.

Kevin Reddington (22:50):

Well, it affects the serotonin levels in the brain, doesn't it?

Dr Jennifer Tufts (22:53):

Yes.

Kevin Reddington (22:54):

It rewires the brain, doesn't it?

WUT?

--------------------------------------------

Were you ever concerned about her mental health as a person?

Dr Jennifer Tufts (27:34):

Absolutely.

Kevin Reddington (27:35):

She was crying. She told you symptoms that she couldn't get out of bed. Isn't that right?

Dr Jennifer Tufts (27:42):

At one time she said it was difficult to get out of bed.

Kevin Reddington (27:45):

Oh, difficult to get out. Why was it difficult for Lindsay Clancy to get out of bed?

Dr Jennifer Tufts (27:49):

Because she was very depressed.

Kevin Reddington (27:51):

And did you give her a hug? Oh no, you're on telemedicine, so you couldn't give her a hug, could you? You didn't have any chance to even look at her in person, did you?

(again I say, WUT?! There's also a not so subtle dig about whether she shook Lindsay Clancy's husband's hand and asked how he was in person)

______________________________________________

There's more (link to full transcript above), but honestly he sounds like a right tosser. 🙄

 

[ObsequiousAplomb]

I would think that the best part of telehealth is that nobody can claim I hugged them, try to hug me, or any of that.
If only she had documented the patient said it was hard to get out of bed but she joined the call from a chair.

 

[futureapppsy2]

Yeah, the hugging line of testimony was super weird. I do feel bad for Dr. Tufts having a case so soon out of residency turn into a triple homicide.

 

[MedMan80]

Yeah, the hugging line of testimony was super weird. I do feel bad for Dr. Tufts having a case so soon out of residency turn into a triple homicide.

I remember how crummy i felt after my first patient loss due to drug OD and my first suicide..can't imagine what she's going through.

 

[Ceke2002]

I'm waiting to see what testimony the defense will come up with in regards to her allegedly claiming to have heard a command hallucination. Every medical person, thus far, has testified to there being no signs or indications of psychosis or mania; and yet she's apparently gone from PPD with anxiety and intrusive thoughts, to hearing a command hallucination that lines up nicely with her defense claim (according to some news reports). I usually have a fair amount of sympathy in these sorts of situations (Post Partum Psychosis), but reading through transcripts so far my BS metre has gone to 11.

 

[Ceke2002]

Transcripts aren't up yet, but I'm just catching up on today's testimony, and about to switch over to live watching in a minute.

They had a forensic digital analyst on the stand to show evidence of multiple searches for depression treatment, including ketamine treatment for suicidal ideation.

A co-worker took the stand and testified that she had discussed the Andrea Yates case with Lindsay, who apparently seemed very upset by it.

Her sister took the stand and testified as to the severity of Linday's depression, but also testified she saw no indication, as a mandated reporter, of any imminent risk of harm to the children. Sister also testified Lindsay had apparently not reacted well to Zoloft, was essentially shopping around different Doctors to find a medication that worked, and had voluntarily admitted herself into hospital to wean off what she recalled as seroquel. Now I get the 'not having a good reaction to a medication' part, but previous testimony from medical professionals she'd apparently been told multiple times that antidepressants had to be given time to work, also if she was showing any signs of post partum psychosis it makes no sense to me that she would be weaned off of an antipsychotic (unless they were switching her over to something else?)

Her Mother has taken the stand now (they've just broken for lunch) and again there's testimony as to the severity of Lindsay's depression, and also anxiety, and that at one point she did apparently say to her Mother that she was afraid she was going to harm the kids. But they also seem to be leaning into this 'the medication did something to her brain' line of defense, like I'm almost expecting to hear the words 'big pharma' given in evidence.

There's still no evidence, so far, that indicates anything beyond serious depression and anxiety, and certainly nothing (as far as I'm aware) that would rise to the level of an insanity defense.

 

[Ceke2002]

Okay the Mother's continued testimony was interesting, and lines up with some of the sister's observations regarding Lindsay appearing to do better in the 2 weeks leading up to the event.

According to the texts they exchanged she had been weaned off Seroquel, and also had a reduction in Ativan she'd been taking. Her Mum was checking in with her almost daily and it sounded like all signs were encouraging - she was sleeping better, able to do more things with the kids, getting out more, going to the gym, etc. Whoever the Psychiatrist was that she was seeing at the time, according to her text messages, had also recommended a trial of Amitryptiline (sp?) as Lindsay's mood was still a bit low, and she was open to that. Like every text message is basically her saying, "I'm doing better", "I'm sleeping better", "I'm trying this new medication so I can get back to feel normal", etc. Now I know that a sudden improvement in mood, motivation, etc with depression can be an indication that someone is preparing to put a suicide plan in place, but again I'm not hearing any evidence of actual psychosis going on, and weaning someone with alleged post partum psychosis off of an anti psychotic makes no sense to me, and also doesn't line up with a diagnosis of PPP.

Okay, Doctor on the stand now, someone from Emergency Medicine. Defense is questioning so not sure if defense witness or prosecution witness. I need to go back and see if I've missed any Forensic Psychiatry testimony or if that's still coming up?

 

[splik]

There's still no evidence, so far, that indicates anything beyond serious depression and anxiety, and certainly nothing (as far as I'm aware) that would rise to the level of an insanity defense.

I'm not sure what you mean. Depression alone is enough for an NCR defense in massachusetts. She didn't even need to be psychotic. And once a NCR instruction has been given, there is no presumption of sanity in MA. So the burden of proof is on the prosecution to show beyond a reasonable doubt that she was criminally responsible. Put another way, if her defense can raise a reasonable doubt about her criminal responsibility (which does NOT require psychosis), then she would likely be acquitted not criminally responsible. In many other states they have much stricter statutes.

 

[PsyDr]

If she didn't think the actions were wrong, why wait for the husband to leave, lock the door, and self inflict injuries?

 

[calvnandhobbs68]

I'm not sure what you mean. Depression alone is enough for an NCR defense in massachusetts. She didn't even need to be psychotic. And once a NCR instruction has been given, there is no presumption of sanity in MA. So the burden of proof is on the prosecution to show beyond a reasonable doubt that she was criminally responsible. Put another way, if her defense can raise a reasonable doubt about her criminal responsibility (which does NOT require psychosis), then she would likely be acquitted not criminally responsible. In many other states they have much stricter statutes.

Yeah I mean I think it's difficult for most laypeople to understand, even many psychiatrists I've seen online don't seem to understand this. I myself didn't realize it until I saw the NCR jury instructions spell it out.

If she didn't think the actions were wrong, why wait for the husband to leave, lock the door, and self inflict injuries?

You don't have to believe your actions are wrong to take steps to prevent others from stopping your actions. That's not a great argument.

 

[comp1]

Is MA unique in how it treats NGRI claims? I thought most affirmative defense burdens were on the defendant. It just seems like an impossible burden for the prosecution because they have to somehow come up with a reasonable justification for her behavior that isn't based in mental illness. I just don't see how "she didn't want to be a mother any more" is going to get there. I was taught that NGRI claims almost always failed, but they must have at least some success in MA if jurors follow the letter of the law.

 

[Ceke2002]

I'm not sure what you mean. Depression alone is enough for an NCR defense in massachusetts. She didn't even need to be psychotic. And once a NCR instruction has been given, there is no presumption of sanity in MA. So the burden of proof is on the prosecution to show beyond a reasonable doubt that she was criminally responsible. Put another way, if her defense can raise a reasonable doubt about her criminal responsibility (which does NOT require psychosis), then she would likely be acquitted not criminally responsible. In many other states they have much stricter statutes.

Ah, okay so it's a NCR defense then and not an NGRI. I assumed they were going the whole hog with the 'not guilty by reason of insanity defence', as in the 'McNaughton Rules' defense. Or are they both the same thing? And if NCR is another term for NGRI then how have the prosecution so far proved either to the level of the Mcnaughton Rules? Does MA have a lower bar to clear in terms of this?