06August 5, 2026
day-06
the evidence you shall give to the court and the jury [inaudible 02:10:11]?Hillary Griffiths (02:09:16):I do.Court Clerk (02:09:16):Thank you. You may have a seat, please.Hillary Griffiths (02:09:16):Thank you.Judge (02:09:16):Hi, good afternoon.Hillary Griffiths (02:09:16):Good afternoon.Judge (02:10:25):All right. Counsel?Shannon Buckingham (02:10:26):Thank you.Hillary Griffiths (02:10:29):Sorry.Shannon Buckingham (02:10:29):It's okay. Good afternoon. Can you tell the jurors your first and last name?Hillary Griffiths (02:10:33):Hillary Griffiths.Shannon Buckingham (02:10:35):And can you spell your last name for the record?Hillary Griffiths (02:10:37):G-R-I-F-F-I-T-H-S.Shannon Buckingham (02:10:40):And where do you work?Hillary Griffiths (02:10:41):I work at the Massachusetts State Police Crime Laboratory.Shannon Buckingham (02:10:44):What do you do there?Hillary Griffiths (02:10:45):I am a forensic scientist in the toxicology unit.Shannon Buckingham (02:10:48):How long have you been with the state police?Hillary Griffiths (02:10:50):For 21 years.Shannon Buckingham (02:10:52):And have you spent your entire career in the toxicology unit or have you worked in other units?Hillary Griffiths (02:10:56):Initially, I worked in the DNA unit and then in the office of alcohol testing, but I have been in the toxicology unit since 2011.Shannon Buckingham (02:11:04):What does the toxicology unit do at the crime lab?Hillary Griffiths (02:11:07):We test biological specimens, primarily blood and urine and some other sample types for the presence of drugs, alcohol, and some poisons to aid in criminal and legal investigations.Shannon Buckingham (02:11:21):Where does the samples, the blood and urine, come from before it gets to your lab?Hillary Griffiths (02:11:27):They could come from, often, hospital collections of blood and urine. Occasionally, urine samples can be collected from a defendant at a police station. Also, we receive samples from the medical examiner's office.Shannon Buckingham (02:11:44):So normally, it comes through some law enforcement channel, right?Hillary Griffiths (02:11:48):Yes.Shannon Buckingham (02:11:48):And sometimes through the medical examiner's office?Hillary Griffiths (02:11:51):Yes.Shannon Buckingham (02:11:52):You don't have any direct involvement in the collection of the blood or urine from an individual, correct?Hillary Griffiths (02:12:00):Correct.Shannon Buckingham (02:12:00):You're just looking at the blood itself?Hillary Griffiths (02:12:02):Yes.Shannon Buckingham (02:12:02):Or the urine?Hillary Griffiths (02:12:03):Yes.Hillary Griffiths (02:12:00):... correct.Shannon Buckingham (02:12:00):You're just looking at the blood itself?Hillary Griffiths (02:12:02):Yes.Shannon Buckingham (02:12:02):Or the urine?Hillary Griffiths (02:12:03):Yes.Shannon Buckingham (02:12:04):Okay. So what kinds of testing is done in the toxicology unit? You mentioned alcohol and drugs and poison. So how does the toxicology unit handle those things?Hillary Griffiths (02:12:17):We initially screen samples following a particular testing strategy depending on case type. And we will screen samples and then confirm whatever is found positive in the screening using a second methodology or repeating the initial methodology using a variety of different techniques.Shannon Buckingham (02:12:39):And when a sample comes to your unit, can you explain to us how the personnel in that unit divides up the work?Hillary Griffiths (02:12:51):Yes. Our samples are tested in a batch system. So each analyst is assigned a particular task for the month. And then any case that requires that test during that month is performed by that individual. So often, cases could need anywhere from three to 10 different tests to be done. And so, different individuals will conduct each different test.Shannon Buckingham (02:13:17):And for any given case or any different lab number, is there an analyst that's assigned at the end of it all to digest or analyze all of the data?Hillary Griffiths (02:13:28):Yes. When all of the testing is completed for a case, an analyst takes responsibility for that case and they will review all of the raw data that's generated by the different analysts involved. They'll review the case specific information like the police report, the documentation on the evidence itself. They'll assess the case as a whole and they'll generate a report containing their findings.Shannon Buckingham (02:13:53):And do you receive some sort of specialized training to be part of the toxicology unit?Hillary Griffiths (02:13:57):Yes.Shannon Buckingham (02:13:58):What training do you receive?Hillary Griffiths (02:13:59):When I began working in the toxicology unit, I participated in approximately a year long training program where I conducted literature reviews, attended lectures to learn the theory behind the testing and the testing process itself, as well as the interpretation of the results. And then I practiced each of the techniques on mock cases and then took tests to ensure that I understood the logic and the background behind the testing. I understood the interpretation. And I was able to test these mock cases and get the correct results prior to performing those methods on casework samples.Shannon Buckingham (02:14:38):And you described to us that the work is done in a batch flow process so that you could be doing different things at various points. Are you trained to do each part of the process?Hillary Griffiths (02:14:49):Yes.Shannon Buckingham (02:14:50):And so, ultimately, you could interpret, but you don't always interpret with every single case that you work on?Hillary Griffiths (02:14:57):Correct.Shannon Buckingham (02:14:58):Now, in the toxicology unit, you mentioned that there are screening tests and there are confirmatory tests and those are usually assigned differently in this batch process, correct?Hillary Griffiths (02:15:09):They can be, yes.Shannon Buckingham (02:15:10):What are generally the screen tests that are done when a case comes into the toxicology unit?Hillary Griffiths (02:15:19):For the most part, all cases receive an ELISA screen, which is a very quick color screening test that looks for eight different types of drugs. It's very sensitive, but not very specific. So it basically says this type of drug might be present. Now go do follow-up testing to find out specifically what's present.(02:15:40)They also all receive a general unknown screen, which looks for several hundred different prescription drugs, over the counter drugs and drugs of abuse. Then depending on the case type, they can be screened for alcohol and they can be screened... Specific screening tests for GHB can be performed if the case type warrants that-Kevin Reddington (02:16:01):GHB, alcohol, I mean really?William Sullivan (02:16:03):Overruled. I'll allow it. Go ahead.Hillary Griffiths (02:16:06):You can continue. And then depending on what is present from those screening tests, that will guide the follow-up testing.Shannon Buckingham (02:16:12):And with the follow-up testing, that's the process of going through that secondary confirmatory testing, right?Hillary Griffiths (02:16:18):Correct.Shannon Buckingham (02:16:19):And in some instances with the screens, are you looking to get any specific information about a particular drug or substance that might be present or is it just a determination of whether something is detected or not detected?Hillary Griffiths (02:16:33):It depends on the test itself and the sample. The general unknown screen only tells us if a substance is detected or not detected. The general unknown screen can be run as both a screening test and a confirmatory test. With other tests, the screening test would just be qualitative and we would determine if a substance is present or not. Such as when we test urine, we can only determine or report out if a substance is present or not. With some tests, when testing blood, we can determine a concentration and know how much of the drug is present.Shannon Buckingham (02:17:09):And are there limitations at your lab as far as determining concentration of certain types of drugs in blood?Hillary Griffiths (02:17:15):Yes.Shannon Buckingham (02:17:16):And so, what happens when your lab might've screened or detected a substance but doesn't have the ability to give a concentration? What do you do with that?Hillary Griffiths (02:17:27):If the substance is confirmed, so if we've tested it twice and verified that it's definitely present, we can report it out as just detected as opposed to giving the concentration.Shannon Buckingham (02:17:37):Do you often work with other independent outside laboratories to do additional testing that you can't as far as determining concentrations or levels?Hillary Griffiths (02:17:45):Yes. If it's important for the case to know a concentration of a substance that we can't quantify ourselves, we can send it to a different laboratory that can perform that testing.Shannon Buckingham (02:17:56):I'm going to draw your attention to a laboratory number 23- 01723. Do you recall doing work on that particular lab number?Hillary Griffiths (02:18:09):Yes.Shannon Buckingham (02:18:09):Do you recall what your role was in that batch process for the lab number?Hillary Griffiths (02:18:17):Yes. I performed the confirmation method for benzodiazepines on the urine sample and the quantitation method for benzodiazepines on the blood sample.Shannon Buckingham (02:18:31):And in order to do... Well, can you tell us a little bit about the benzodiazepine? What did you do as far as that particular test?Hillary Griffiths (02:18:42):When testing both the blood and the urine, for the most part, the same method is used. We use a solid phase extraction method to separate the drugs from the rest of the biological material. Biological materials can have things like lipids and steroids and blood cells and bacteria and other things that can interfere with our testing. So, we use the solid phase extraction method to separate the drugs and concentrate them to be able to run on our instrument. And then we run them on a LCMSMS, which is a liquid chromatograph mass spectrometer that can separate the different drugs and identify specifically which one is present and how much is there. When we're testing blood samples, we can report out that value for how much is present.(02:19:31)When testing urine samples by this method, although the method itself can determine how much is present, we don't report that out because concentrations in urine aren't really meaningful. They don't reflect any concentration that had previously been in the blood. They mostly just reflect how much of the drug was present in the urine. So we don't report that. There is an additional step that's needed when testing urine at the beginning of the method, but otherwise, both the blood and the urine are tested in the same manner using the solid phase extraction and the LCMSMS.Shannon Buckingham (02:20:06):And in this case, with this laboratory number, the toxicology unit was in fact provided with six vials of blood and one vial of urine, correct?Hillary Griffiths (02:20:15):There were four vials of blood and then two vials of serum plasma, which had started out as blood but were serum by the time we received them and then one tube of urine.Shannon Buckingham (02:20:24):Okay. And as far as the urine goes, in your role in this batch process, you conducted that benzodiazepine screen, correct?Hillary Griffiths (02:20:34):Yes.Shannon Buckingham (02:20:34):And it was positive?Hillary Griffiths (02:20:36):Yes.Shannon Buckingham (02:20:37):And then the further testing, were you able to detect any particular benzodiazepines in the urine?Hillary Griffiths (02:20:47):I didn't conduct the initial benzodiazepine screen through the ELISA method, which was positive. Based on that positive result, I ran the confirmation method on the urine, which identified the specific drugs that were present. And that identified in urine, nordiazepam, oxazepam, temazepam, and lorazepam.Shannon Buckingham (02:21:05):And based on your training experience when it comes to those substances, if it's detected in either blood or urine, does it mean that there are those four separate substances or could they be derivatives of one particular drug?Hillary Griffiths (02:21:21):Yes. Each of those substances is available as its own drug. You can get prescriptions for them, you can purchase them. However, diazepam that's more commonly used than nordiazepam, oxazepam and temazepam breaks down into those other three substances. So often, when we detect nordiazepam, oxazepam, and temazepam, they actually are present in the body because diazepam or another benzodiazepine was initially taken and it broke down to those three.Shannon Buckingham (02:21:55):But as far as your testing when it comes to urine, you can't determine or quantify what it was or if it was one drug or multiple?Hillary Griffiths (02:22:03):Correct.Shannon Buckingham (02:22:04):Now, in this particular case, you indicated that there was also further testing done on the blood, correct?Hillary Griffiths (02:22:10):Yes.Shannon Buckingham (02:22:11):And was it as well for the benzodiazepines?Hillary Griffiths (02:22:14):Yes.Shannon Buckingham (02:22:15):And that was just because that was your role in the batch testing for this case?Hillary Griffiths (02:22:18):Yes.Shannon Buckingham (02:22:20):What were the results in the testing of the benzodiazepines in the blood?Hillary Griffiths (02:22:26):The blood contained 8.8 nanograms per mil a liter of diazepam and 20 nanograms per milliliter of nordiazepam, and 4.8 nanograms per mil of oxazepam, and 1.9 nanograms per mil of temazepam, and 61 nanograms per mil of lorazepam.Shannon Buckingham (02:22:49):And in your role in this testing process, you're just running the equipment, running the test and getting the data, correct?Hillary Griffiths (02:22:56):There is some analysis of the data. I have to ensure that the controls performed appropriately, that the instrument was running properly, and make a decision based on the instrument data, what I consider to be positive or not. But then it's handed off to another analyst who generates the final report.Shannon Buckingham (02:23:14):And in this case, were all the controls appropriate, all the equipment running effectively and everything done according to the policies and procedures of the lab?Hillary Griffiths (02:23:25):Ultimately, all of the relevant controls that were associated with the samples performed appropriately.Shannon Buckingham (02:23:30):And what did you do with the information or the data that you received as a result of these tests? What did you do with it?Hillary Griffiths (02:23:36):I put it together in a batch file that contained all the data for my analysis. It contained the case data for the samples that were run on that day, as well as all the control data that was run simultaneously and other traceability type info and gave it to another analyst who reviewed it to ensure that laboratory policies and procedures were followed, that the controls performed appropriately in order to report the results, and that the results were scientifically accurate. And then after that analyst agreed with my findings, the data was put into the individual case files.Shannon Buckingham (02:24:13):And in this case, the reporting analyst for the entire lab number of 23-01723 was in fact, somebody by the name of Nicholas Roberts, correct?Hillary Griffiths (02:24:23):Yes.Shannon Buckingham (02:24:24):And you're aware that there were other forensic scientists who did other testing for other types of drugs in the same test, but it wasn't part of your role or your batch?Hillary Griffiths (02:24:33):Correct.Shannon Buckingham (02:24:34):Thank you.William Sullivan (02:24:35):All right, Mr. Reddington.Kevin Reddington (02:24:35):Right. So the toxicology report you're familiar with was dated February 24th of 2023. Is that correct? Do you have it in front of you?Hillary Griffiths (02:24:53):I can refer to it. Yeah.Kevin Reddington (02:24:54):Yeah. Great. Thank you.Hillary Griffiths (02:25:01):Yes.Kevin Reddington (02:25:03):Okay. And you can keep it right there and look at it. And then you have, it makes reference to your lab number. And then it talks about the specimens that you've indicated, which would be the toxicology blood times four. Serum plasma. You noted serum plasma and then urine, right?Hillary Griffiths (02:25:18):Yes.Kevin Reddington (02:25:19):And when you say serum plasma, what is that? Is that just a breakdown of the blood or is it that that was actual plasma that was submitted? How did that come about as opposed to the actual blood in items number one, two, and three?Hillary Griffiths (02:25:34):We received samples that were taken for medical reasons. And the sample that was initially drawn would have been blood, but the hospital would have separated the blood cells from the liquid portion of the sample prior to it being submitted to our lab. So when I received it, it was serum plasma, but it would've initially been blood.Kevin Reddington (02:25:56):Okay. And likewise with the urine, correct?Hillary Griffiths (02:25:59):Yes.Kevin Reddington (02:26:00):And you received all of these items in a, indicating light blue top tube, potassium, oxalate, sodium, fluoride. That would just so prevent coagulation, right?Hillary Griffiths (02:26:10):Yes.Kevin Reddington (02:26:13):And then looking down further, it says on the toxicology blood, you make reference to, as you indicated, the 8.8 diazepam, the nordiazepam, the oxazepam, temazepam, lorazepam. And you're putting down, would that be nanograms per milliliters, NGML?Hillary Griffiths (02:26:31):Yes.Kevin Reddington (02:26:33):Okay. And it's hard to follow through with that. So, I'm going to approach you. This is a copy of the blood toxicology report that you're referring to, right?Hillary Griffiths (02:26:53):Let me [inaudible 02:26:54].Kevin Reddington (02:26:53):Sure, of course.Hillary Griffiths (02:26:53):Yes.Kevin Reddington (02:26:53):And this is the tox report for Lindsay Clancy, right?Hillary Griffiths (02:26:53):Yes.Kevin Reddington (02:26:54):And it's making reference to incident date of January 24th of '23, correct?Hillary Griffiths (02:26:58):Yes.Kevin Reddington (02:26:59):I'd offer this, your Honor.William Sullivan (02:27:01):Any objection?Shannon Buckingham (02:27:03):No.William Sullivan (02:27:04):That may be admitted.Speaker 16 (02:27:04):[inaudible 02:27:09].Kevin Reddington (02:27:12):Now, you can continue [inaudible 02:27:14]. You then make reference to organic bases and neutrals, right?Hillary Griffiths (02:27:19):Yes.Kevin Reddington (02:27:20):Can you tell me what is an organic base and a neutral? What does that mean?Hillary Griffiths (02:27:24):That refers to... So the line above that, the organic acids and neutrals and the organic bases and neutrals refer to the results from the general unknown screen, which is another screen that was performed by a different analyst.Kevin Reddington (02:27:39):Okay. Do you know who the analyst was?Hillary Griffiths (02:27:40):Lisa Yelle.Kevin Reddington (02:27:40):And would that be with the Department of the Massachusetts State Police?Hillary Griffiths (02:27:46):Yes.Kevin Reddington (02:27:46):Okay. And as it relates to the tox report, it also notes that. What is an organic base and a neutral? What does that mean though? I just don't know.Hillary Griffiths (02:27:55):This testing procedure separates the drugs present in the sample into drugs that are more basic in nature and drugs that are more acidic in nature. This test looks for several hundred types of drugs. And so, in order to customize the extraction method to target certain drugs, the sample is divided into two fractions.Kevin Reddington (02:28:18):So, in other words, it gives you a broader spectrum, if you will, of the drugs that would be in the person's sample of their blood, right?Hillary Griffiths (02:28:25):Yes.Kevin Reddington (02:28:27):And that detected mirtazapine, right?Hillary Griffiths (02:28:29):Yes.Kevin Reddington (02:28:30):Lamotrigine, right?Hillary Griffiths (02:28:32):Yes.Kevin Reddington (02:28:33):Probably mispronouncing this. Quetiapine?Hillary Griffiths (02:28:34):Quetiapine.Kevin Reddington (02:28:38):Quetiapine. And quetiapine metabolite, right?Hillary Griffiths (02:28:40):Yes.Kevin Reddington (02:28:40):As well as trazodone, right?Hillary Griffiths (02:28:42):Correct.Kevin Reddington (02:28:43):And just tell me, what is a metabolite? What does that mean? Quetiapine metabolite?Hillary Griffiths (02:28:47):When we consume drugs, our body will break down the drug often into another molecule before it's being excreted. And sometimes, our testing can detect these breakdown molecules as well. So, this test detected both quetiapine as well as its breakdown product.Kevin Reddington (02:29:04):So, that would indicate that there was quetiapine that was in the blood as well as a quetiapine metabolite or a breakdown over a passage of time?Hillary Griffiths (02:29:15):Yes.Kevin Reddington (02:29:16):Also, just you guys check for everything. There's no alcohol detected, right?Hillary Griffiths (02:29:21):Correct.Kevin Reddington (02:29:21):No amphetamines detected, right?Hillary Griffiths (02:29:23):Correct.Kevin Reddington (02:29:24):There was a benzo screen that was positive, which we've already talked about, correct?Hillary Griffiths (02:29:28):Yes.Kevin Reddington (02:29:31):Buprenorphine screen, none detected, right?Hillary Griffiths (02:29:34):Yes.Kevin Reddington (02:29:34):Cocaine and fentanyl, none, right?Hillary Griffiths (02:29:36):Yes.Kevin Reddington (02:29:42):Methamphetamines, none? Correct?Hillary Griffiths (02:29:45):Yes.Kevin Reddington (02:29:46):Opiates, none?Hillary Griffiths (02:29:47):Yes.Kevin Reddington (02:29:47):Cannabinoids, that'd be weed, right? None?Hillary Griffiths (02:29:50):It's the active molecule in there.Kevin Reddington (02:29:52):Okay. Diazepam, none?Hillary Griffiths (02:29:56):Yes.Kevin Reddington (02:30:02):Nordiazepam detected?Hillary Griffiths (02:30:04):Correct.Kevin Reddington (02:30:04):Oxazepam detected?Hillary Griffiths (02:30:05):Yes.Kevin Reddington (02:30:05):Temazepam detected?Hillary Griffiths (02:30:07):Yes.Kevin Reddington (02:30:08):Lorazepam detected, right?Hillary Griffiths (02:30:09):Yes.Kevin Reddington (02:30:10):And then finally, it says organic acids and neutrals, none detected. Right?Hillary Griffiths (02:30:15):Yes.Kevin Reddington (02:30:17):And then you talk about. And that would be the acids. Then you talk about the actual organic basis and it lists all of the other items that we just went through. Trazodone, trazodone metabolite, for example. So you have the trazodone plus the breakdown of the metabolite.Hillary Griffiths (02:30:30):Yes.Kevin Reddington (02:30:31):You have the mirtazapine as well as mirtazapine metabolite, right?Hillary Griffiths (02:30:36):Correct.Kevin Reddington (02:30:36):Lamotrigine, quetiapine and the quetiapine metabolite, right?Hillary Griffiths (02:30:41):Correct.Kevin Reddington (02:30:42):Now, you had also, in your direct examination, made reference to another lab that you all work with apparently, or that you've had occasion to work with, right?Hillary Griffiths (02:30:52):Occasionally, we have sent samples to another lab.Kevin Reddington (02:30:55):Okay. Would that be NMS Labs located in Horsham, H- O-R-S-H-A-M, Pennsylvania?Hillary Griffiths (02:31:03):NMS Labs. I don't recall the location of the lab.Kevin Reddington (02:31:06):Okay. But you know NMS Labs?Hillary Griffiths (02:31:08):Yes.Kevin Reddington (02:31:08):And that's pretty well known, right?Hillary Griffiths (02:31:09):Yes.Kevin Reddington (02:31:09):You guys, right? And was a sample of Lindsay's blood sent to that place as well?Hillary Griffiths (02:31:14):Yes.Kevin Reddington (02:31:15):And were there results for that as a result of the examination?Hillary Griffiths (02:31:19):I believe so.Kevin Reddington (02:31:21):Okay. I'm going to approach you with a toxicology report.Shannon Buckingham (02:31:22):[inaudible 02:31:25] sidebar.William Sullivan (02:31:22):Sure. Counsel, please stand by.(02:31:22)Yeah.Kevin Reddington (02:31:22):[inaudible 02:34:02] Thank you.William Sullivan (02:31:22):All right. Redirect?Shannon Buckingham (02:31:22):Nothing further. Thank you.William Sullivan (02:31:22):Okay. Thank you, ma'am. You may step down.Hillary Griffiths (02:31:22):Thank you.William Sullivan (02:31:22):Thank you. Yeah, Commonwealth.Shannon Buckingham (02:31:22):The Commonwealth would call Lisa Yelle as its next witness, please.William Sullivan (02:31:22):Thank you so much.Lisa Yelle (02:31:22):Thank you.Speaker 15 (02:35:10):Good afternoon.Lisa Yelle (02:35:10):Good afternoon.Speaker 15 (02:35:10):Can you stop right here and raise your right hand for the clerk, please?Speaker 16 (02:35:10):Good afternoon. Do you solemnly swear that the testimony that you shall give to the Court and the jury [inaudible 02:35:11] shall be the truth, the whole truth, and nothing but the truth, so help you God?Lisa Yelle (02:35:10):Yes, I do.Speaker 16 (02:35:10):You may have a seat.Speaker 15 (02:35:10):Watch your step right there, please.William Sullivan (02:35:10):Hi, good afternoon.Lisa Yelle (02:35:10):Good afternoon.William Sullivan (02:35:10):Hi. Commonwealth.Shannon Buckingham (02:35:11):Thank you. Good afternoon, ma'am. Can you please tell the jurors your first and last name?Lisa Yelle (02:35:18):My name is Lisa Yell, spelled Y-E-L-L-E.Shannon Buckingham (02:35:22):And what do you do for work?Lisa Yelle (02:35:24):I currently work at a biotech pharmacy company.Shannon Buckingham (02:35:28):Did you work for the Massachusetts State Police Crime Lab at some point?Lisa Yelle (02:35:31):Yes, I did.Shannon Buckingham (02:35:32):And how long did you work for the crime lab?Lisa Yelle (02:35:34):For 15 years.Shannon Buckingham (02:35:36):And in January of 2023, what unit were you working with at the crime lab?Lisa Yelle (02:35:41):The toxicology unit.Shannon Buckingham (02:35:43):Okay. And more specifically, I guess, February of 2023, were you still in that unit?Lisa Yelle (02:35:49):Yes.Shannon Buckingham (02:35:49):Okay. Now, I'm just going to draw your attention right to this particular case. We're talking about laboratory number 23- 01723. Did you do any batch work on this particular case?Lisa Yelle (02:36:04):Yes, I did.Shannon Buckingham (02:36:06):And what testing did you do in relation to the samples of this lab number?Lisa Yelle (02:36:11):It was a test that was known as the general unknown screen.Shannon Buckingham (02:36:15):Can you tell the jury what the general unknown screen does? What it tests for?Lisa Yelle (02:36:20):Sure. That's a screening test for drugs. It essentially would test for hundreds of different prescription medications or drugs of abuse.Shannon Buckingham (02:36:29):And in this particular test, the general unknown screen, is there a portion of testing in the lab for general unknowns that would allow you to quantify when certain substances are detected?Lisa Yelle (02:36:45):The general unknown screen is not a quantifiable test. It's just an identification screen. So you wouldn't be able to attribute a specific level of the drug, but just the identification that it was present or not.Shannon Buckingham (02:36:57):So it would be a detected or non-detected situation?Lisa Yelle (02:37:00):Correct.Shannon Buckingham (02:37:01):And in this particular case, items 10-101 involved a vial of blood that was submitted to the laboratory, correct?Lisa Yelle (02:37:13):Yes.Shannon Buckingham (02:37:13):And you did the general unknown screen for the blood?Lisa Yelle (02:37:16):Yes.Shannon Buckingham (02:37:17):And what were the substances that were detected in that sample of blood?Lisa Yelle (02:37:23):Would I be able to reference?Shannon Buckingham (02:37:25):Sure.Lisa Yelle (02:37:26):Just to ensure that I'm attributing everything?Shannon Buckingham (02:37:28):Yeah, go ahead.William Sullivan (02:37:28):Any objection?Kevin Reddington (02:37:29):No, of course you can. Sure.Shannon Buckingham (02:37:32):I can actually show you what's been already marked as Exhibit 183.Lisa Yelle (02:37:32):Okay.Shannon Buckingham (02:37:47):Does that refresh your memory as to the substances?Lisa Yelle (02:37:49):Yes.Shannon Buckingham (02:37:49):Okay. So fair to say it's mirtazapine, lamotrigine.Lisa Yelle (02:37:49):Trazodone.Shannon Buckingham (02:37:49):Trazodone.Lisa Yelle (02:37:49):And quetiapine.Shannon Buckingham (02:37:59):Quetiapine and the quetiapine metabolite, correct?Lisa Yelle (02:38:04):Yes.Shannon Buckingham (02:38:05):And in that particular screen of the blood, all you're able to tell is whether they're detected or not?Lisa Yelle (02:38:11):Correct.Shannon Buckingham (02:38:12):In your work with testing for those items and running that general unknown screen, were there any issues with the controls in that test?Lisa Yelle (02:38:22):No, there weren't.Shannon Buckingham (02:38:23):Were there any problems with the equipment in that test?Lisa Yelle (02:38:27):There was a syringe issue, which means essentially, if you consider a needle that has a plunger on the top, it would've essentially gotten stuck at some point within the batch run, which could run for 24 to 48 hours. It's a very lengthy run. So once the error is notified, it's a very simple switch. You just pull the syringe out, place a new one back into that same spot. And then you would restart your run from that point forward, including a control just to ensure that the instrument is still functioning the way that it should.Shannon Buckingham (02:38:55):And so, would that type of error that you observed in the equipment affect the results of the test?Lisa Yelle (02:39:02):Not in any way.Shannon Buckingham (02:39:04):Okay. And in addition to the testing or running this general unknown screen on the blood, you also ran a general unknown screen on urine, which was identified as item 10-201, correct?Lisa Yelle (02:39:16):That's correct.Shannon Buckingham (02:39:16):And were those same substances detected in the urine?Lisa Yelle (02:39:19):Yes, they were.Shannon Buckingham (02:39:20):And again, as far as those particular substances in the general unknown screen or unknown screen test for urine, are you able to quantify it in any way?Lisa Yelle (02:39:29):No.Shannon Buckingham (02:39:31):Okay. Is it fair to say that there are other laboratories across the country that potentially could quantify those substances?Lisa Yelle (02:39:38):Yes.Shannon Buckingham (02:39:38):And so, in this case, are you aware that there were samples of the blood that were sent to another lab because of those positive tests for those substances?Lisa Yelle (02:39:50):I am not aware.Shannon Buckingham (02:39:51):Okay. You weren't the reporting analyst in this case, correct?Lisa Yelle (02:39:55):Correct. I was not.Shannon Buckingham (02:39:56):So after you did those general unknown screens in the blood in the urine, what did you do with the information?Lisa Yelle (02:40:02):The testing, every independent sample receives its own summary sheet where you document any possible drugs that were detected. All of the sheets are submitted to what's called a batch review. So a secondary person will independently review everything and ensure that they drew the same conclusions that I did. Once both people have agreed, all of the paperwork that is generated is filed within the respective case files. And then that's later submitted to an analyst at random to author the report and review the entirety of the case.Shannon Buckingham (02:40:34):And in this particular case for lab number 23-101723, you're aware that Nicholas Roberts was the reporting analyst, correct?Lisa Yelle (02:40:44):Correct.Shannon Buckingham (02:40:45):And any decisions on any further testing were likely made through him in your experience?Lisa Yelle (02:40:51):Yes. It definitely would not have been part of the role for someone doing a portion of the testing within a case.Shannon Buckingham (02:40:57):And as far as the particular substances that were detected, when you are running these tests, it doesn't tell you that there were several different drugs that were necessarily consumed by the individual, correct?Lisa Yelle (02:41:13):I don't know if I understand your question.Shannon Buckingham (02:41:14):Well, are there certain substances that come up in these screens that could be attributable to the same type of drug?Lisa Yelle (02:41:22):There are certain, we would call them parent drugs and metabolites. Once you ingest the medication, your body will begin to metabolize or break that drug down. So there could be metabolites that are related to the parent compound of the medication that was taken.Shannon Buckingham (02:41:36):So where there were five positive or detected substances doesn't mean that there was five specific substances, especially where there was a metabolite detected, correct? I guess that...Lisa Yelle (02:41:52):I'm not sure I follow your question again.Shannon Buckingham (02:41:53):That's okay. As far as these particular items or these particular substances that were detected in these screens, you weren't able to provide any further information for final review other than they were detected?Lisa Yelle (02:42:08):Correct.Shannon Buckingham (02:42:09):Okay. Thank you. Nothing further.William Sullivan (02:42:10):All right. Mr. Reddington?Kevin Reddington (02:42:17):So basically, as the court knows, we agree to this. We stipulate to all of this. As far as the blood, the chain of custody, the testing, you didn't have any problems with the quality of the testing, right? It was a good test?Lisa Yelle (02:42:28):It was a good test, correct.Kevin Reddington (02:42:29):Okay. So in the results that have been described numerous times, there's the reference to metabolite and there's five drugs, doesn't mean there's five drugs. It could be one drug with a metabolite. All a metabolite means is that it's a breakdown of the same drug at some point, right?Lisa Yelle (02:42:45):Correct.Kevin Reddington (02:42:46):Like if you're smoking marijuana or something, you have Oxynine or whatever they call it. It can be some residue in your blood, right?Lisa Yelle (02:42:54):Yes. The way that-Kevin Reddington (02:42:55):From the breakdown?Lisa Yelle (02:42:56):Yes.Kevin Reddington (02:42:57):And the lab that counsel was referring to again would be the, is it the NMS lab? You're familiar with that NMS?Lisa Yelle (02:43:08):I'm familiar with the lab. That lab does exist, yes.Kevin Reddington (02:43:10):Yeah. And what does that mean? Do you know what NMS means? Is it like national something?Lisa Yelle (02:43:15):I'm not familiar with the acronym.Kevin Reddington (02:43:16):All right. Thank you. That's all I have. Thanks.William Sullivan (02:43:18):All right. Commonwealth?Shannon Buckingham (02:43:19):Nothing further. Thank you.William Sullivan (02:43:20):All right. Thank you, ma'am. You step down. Thank you. Counsel, can I see you at sidebar.(02:43:23)Afternoon recess at this point, I'm going to ask you to come back 2:00, there's another couple of witnesses. Are we still... I'm not even going to make a commitment, but we'll have a couple witnesses this afternoon. We'll kind of see where we go. Okay? All right. Thank you.Speaker 15 (02:44:55):The Court, all rise. [inaudible 02:44:55] chairs, please.Speaker 18 (02:45:30):Jury is going to exit the courtroom.Judge (02:45:33):All right. So we'll be in recess on this matter till two o'clock. Okay. Thank you.Speaker 18 (02:45:37):Court, all rise.Kevin Reddington (02:45:44):Can you make sure that this is the [inaudible 02:45:45] woman is the same thing that you have over here?Speaker 18 (02:45:44):Court is back in session. Please be seated.Speaker 17 (02:45:58):Your Honor, for the purpose of the record, we return back to the trial of Commonwealth versus Lindsay Clancy. All parties are present, including the defendant, excluding the jury.Judge (02:46:06):All right. Counsel, can I see it sidebar just for a second?Speaker 18 (02:46:06):Court, all rise. Juries enter. This court's now in session. Be seated, please.Speaker 17 (02:51:24):Your Honor, for the purpose of the record, we return back to the trial of Commonwealth versus Lindsay Clancy. All parties are present, including the defendant and including 18 jurors.Judge (02:51:32):All right. Again, members of the jury, thank you for your patience with us. We're going to do at this point, we're going to return now to the Commonwealth's presentation of the evidence. And Commonwealth, call your next witness, please.Shannon Buckingham (02:51:44):Your Honor, before calling the witness, Commonwealth would like to move to enter three stipulations as the next three exhibits. The first regarding postmortem toxicology-Judge (02:51:53):Actually, before we get there, let me just give a little explanation about stipulation. So members of the jury, what you're going to hear is what's called a stipulation. All right. And what a stipulation is an agreement between the parties, agreement as to facts. Now keep in mind that the Commonwealth has the burden of proof for every fact and in the elements in this case. All right? But the defendant has stipulated and the Commonwealth has stipulated to these specific facts. All right? And the stipulation is basically may be accepted by you as facts and can be relied by you along with other facts that you find during the course of the evidence. All right? And so with that, counsel?Shannon Buckingham (02:52:39):Thank you. The next exhibit, it's a stipulation regarding postmortem toxicology testing of Cora Clancy?Speaker 19 (02:52:45):Exhibit 184.Shannon Buckingham (02:52:54):As the next exhibit, a stipulation regarding the postmortem toxicology testing of Dawson Clancy?Speaker 19 (02:52:59):Exhibit 185.Shannon Buckingham (02:53:05):And the third stipulation regarding postmortem toxicology testing, excuse me, for Callan Clancy?Speaker 19 (02:53:12):Exhibit 186.Judge (02:53:15):All right. Thank you.Shannon Buckingham (02:53:17):Your Honor, at the defendant's request, I would defer to the court as far as reading them in.Judge (02:53:22):All right. Do you want to...Shannon Buckingham (02:53:23):Here.Speaker 17 (02:53:23):Thank you.Judge (02:53:28):All right. All right. So members of the jury, I'm going to read you what these stipulations are. But keep in mind, you'll have these since they've been entered as exhibits. You'll have them with you back in the deliberations during the deliberations. All right? Back in the jury room. So you'll have these, but let me just read these to you so you can kind of have this as the case is going forward. All right?(02:53:49)So Exhibit 184 is a stipulation regarding the postmortem toxicology testing of Cora Clancy. In the above captioned matter, the parties agree to the following facts as it pertains to postmortem toxicology testing conducted for Cora Clancy.(02:54:08)Number one, in accordance with laboratory policy and procedure, laboratory staff screen, analyze and review samples submitted for testing using batch testing processing prior to final review and interpretation by the assigned analyst. Two, all policies and procedures were followed in this case. And three, in addition to forensic scientist two, Alicia Zimmermann being the assigned analyst and processing samples associated with case number 23-01875, Cora Clancy, laboratory staff had the following roles in the testing process.(02:54:47)A, Brittany Massett and Natalie Law conducted screening analysis on item 1-01, which was the heart blood of Cora Clancy. B, Hannah Knowles conducted batch review analysis of screening tests conducted by Messette and Law. C, Marissa Dreyer and Seth Utter conducted further analysis on items 1-1-01. D, Emily McCall and Jacob O'Connell conducted batch review analysis of testing by Dreyer and Utter respectively. E, Tashie Washington conducted a technical review of the entire case prior to the issuance of Alicia Zimmermann's report. And F, Jennifer Mejia documented the measurements of the specimens collected for possible postmortem toxicology testing. So that's the stipulation on Exhibit 184 regarding the testing related to Cora Clancy.(02:55:55)Exhibit 185 is a stipulation regarding postmortem toxicology testing relating to Dawson Clancy. And so number one, in accordance with laboratory policy and procedure, laboratory staff screen, analyze and review samples submitted for testing using batch testing processing prior to final review and interpretation by the assigned analyst. Two, all policies and procedures were followed in this case. Three, in addition to forensic scientist two, Alicia Zimmermann being the assigned analyst and processing samples associated with case number 23-01874, which was Dawson Clancy. Laboratory staff had the following roles in the testing process.(02:56:45)A, Brittany Massett and Natalie Law conducted screening analysis on item 1-1-01, which was the heart blood of Dawson Clancy. B, Hannah Knowles conducted batch review analysis of screening tests conducted by Messette and Law. C, Marissa Dreyer and Seth Utter conducted further analysis on item 1-1-01. D, Emily McCall and Jacob O'Connell conducted batch review analysis of testing by Dreyer and Utter respectfully. E, Tashie Washington conducted a technical review of the entire case prior to the issuance of Alicia Zimmermann's report. And F, Jennifer Mejia documented the measurements of the specimens collected for possible postmortem toxicology testing. And that's the exhibit regarding Dawson Clancy. All right.(02:57:48)And then the last stipulation at this time is Exhibit 186. And that stipulation is regarding the postmortem toxicology testing of Callan Clancy. Number one, in accordance with laboratory policy and procedures, laboratory staff screen, analyze and review samples submitted for testing using batch testing processing prior to final review and interpretation by the assigned analyst. Two, all policies and procedures were followed in this case. Three, in addition to forensic scientist two, Alicia Zimmermann, being the assigned analyst and processing samples associated with case number 23-0214, which was for Callan Clancy. Laboratory staff had the following roles in the testing process.(02:58:43)A, Brittany Massett was a screening analyst for item 1-1-01, which was blood from Beth Israel Deaconess Hospital in Plymouth. B, Natalie Law and Marissa Dreyer conducted further analysis on item 1-1-01. C, Hannah Knowles and Emily McCall conducted batch review analysis of item 1-1-01. D, Seth Utter conducted analysis on item 1-1-07, which was blood from Boston Children's Hospital. And 1-1-04, which was urine from Beth Israel Deaconess Hospital Plymouth. E, Nathaniel Almeda, conducted batch review analysis on item 1-1-07. And F, Robert Anderson conducted batch review analysis on item 1-1-04. He also conducted a technical review of the entire case prior to the issuance of Alicia Zimmermann's report. And G, Jennifer Mejia documented the measurements of the specimens collected for possible postmortem toxicology testing.(03:00:08)So those are the stipulations at this time. Keeping in mind that you'll have those with you and everything that's contained there with you back in the jury room. Okay? All right. Commonwealth?Shannon Buckingham (03:00:20):Thank you. The Commonwealth would call Alicia Zimmermann.Speaker 18 (03:00:53):Stop right here and raise your right hand.Speaker 17 (03:00:57):Good afternoon. Do you solemnly swear that the testimony and the evidence you shall give to the court [inaudible 03:01:01]Alicia Zimmermann (03:00:57):I do.Speaker 17 (03:00:57):Thank you. You may have a seat, ma'am.Speaker 18 (03:00:57):Watch your step, please.Judge (03:01:10):All right. Well, good afternoon.Alicia Zimmermann (03:01:12):Good afternoon.Judge (03:01:12):All right. Commonwealth?Shannon Buckingham (03:01:15):Thank you. Could you please tell the jurors your first and last name?Alicia Zimmermann (03:01:18):Alicia Zimmermann.Shannon Buckingham (03:01:19):Would you mind spelling your last name for the record?Alicia Zimmermann (03:01:22):Z-I-M-M-E-R-M-A-N-N.Shannon Buckingham (03:01:27):And where do you work?Alicia Zimmermann (03:01:28):I work at the Massachusetts State Police Crime Lab.Shannon Buckingham (03:01:31):And where do you work at the crime lab?Alicia Zimmermann (03:01:33):I'm in the toxicology unit.Shannon Buckingham (03:01:35):And what's your role there?Alicia Zimmermann (03:01:36):I'm a forensic scientist two.Shannon Buckingham (03:01:38):How long have you been with the crime lab?Alicia Zimmermann (03:01:41):Since August 2014.Shannon Buckingham (03:01:46):And in order to work in the toxicology unit, did you receive some specialized training and education?Alicia Zimmermann (03:01:52):Yes. I have a Bachelor's of Science in Forensic Science from the Pennsylvania State University, a Master's of Science in Forensic Science from the Virginia Commonwealth University. I also completed the Toxicologies Unit training program, which included wet lab work, literature review, competency exams, and written exams.Shannon Buckingham (03:02:12):And in your role as a forensic scientist two at the Massachusetts State Police Crime Lab Toxicology Unit, you're familiar with the batch review testing?Alicia Zimmermann (03:02:21):Yes.Shannon Buckingham (03:02:22):And as part of that process of working, the workflow being in batches, is it fair to say at various points, different members of the unit are assigned to different tasks within the toxicology unit?Alicia Zimmermann (03:02:36):Correct.Shannon Buckingham (03:02:36):And at some point you might be doing work on a case where you're actually asked to author a report at the end of the testing. Is that fair to say?Alicia Zimmermann (03:02:45):Yes, if you're authorized.Shannon Buckingham (03:02:47):And are you authorized to issue reports?Alicia Zimmermann (03:02:49):Yes.Shannon Buckingham (03:02:49):And what kind of forensic, or excuse me, toxicology testing are you authorized to issue reports for?Alicia Zimmermann (03:02:57):I'm authorized for postmortem investigation.Shannon Buckingham (03:03:00):Now as it pertains to postmortem investigation in the toxicology unit, where do samples come from?Alicia Zimmermann (03:03:08):So the samples are submitted from the office of the chief medical examiner to the evidence control unit in Sudbury. They then assign a unique LIMS number. It's a laboratory information management system number and a corresponding barcode to the evidence. They then transport the evidence to our unit in Maynard. And then we put the evidence into our custody sample... Sorry. Sample the evidence and assign testing to it.Shannon Buckingham (03:03:37):And so when a sample comes to you in a postmortem situation, that's because somebody has passed away, correct?Alicia Zimmermann (03:03:44):Correct.â€Shannon Buckingham (03:03:45):And there doesn't always have to be a corresponding state police crime lab investigation?Alicia Zimmermann (03:03:51):No, our cases are separate.Shannon Buckingham (03:03:53):So your case comes to you and gets a separate lab number from the crime lab?Alicia Zimmermann (03:03:58):Correct.Shannon Buckingham (03:03:58):And it also is tracked by a lab number or a case number from the medical examiner's office, correct?Alicia Zimmermann (03:04:04):Yes.Shannon Buckingham (03:04:05):And so when you receive in the postmortem toxicology samples, do you sometimes receive blood?Alicia Zimmermann (03:04:14):Yes.Shannon Buckingham (03:04:16):At times, do you also receive urine samples?Alicia Zimmermann (03:04:19):Yes.Shannon Buckingham (03:04:21):What types of screening tests does the postmortem toxicology testing, what are the screening tests used in those instances? Or those cases, I should say.Alicia Zimmermann (03:04:31):So every case that we receive gets three preliminary screening tests. The first one is a volatile analysis. The second one is an eight panel of commonly abused drugs by enzyme linked immunoabsorbent assay, also known as ELISA. And then the third thing we do is a general and known screen by gas chromatography, mass spectrometry, and that looks for illicit and pharmaceutical drugs.Shannon Buckingham (03:04:54):Now in a circumstance where the decedent or the person who died is a child, are there additional screens that can be done?Alicia Zimmermann (03:05:01):Yes.Shannon Buckingham (03:05:01):And what's the additional screen in a child case?Alicia Zimmermann (03:05:05):If the decedent is less than or equal to 11 years old, we also perform an ELISA pediatric panel, a generally known screen for acidic and neutral drugs, and a vitreous chemistry analysis.Shannon Buckingham (03:05:22):Now in cases where your unit receives these samples from the medical examiner and a screening test is done, if no substance is detected in either of those three screens, or if in a pediatric case, that fourth screen, what happens?Alicia Zimmermann (03:05:38):No further testing is performed.Shannon Buckingham (03:05:39):And so if you are the reporting analyst in those cases, you would simply note none detected?Alicia Zimmermann (03:05:46):Yes.Shannon Buckingham (03:05:46):Okay. I'm going to draw your attention to a case that was submitted by the medical examiner in January of 2023. I think your unit might have reviewed the evidence in February of 2023. Are you familiar with the case involving three different postmortem toxicology testing, but all related?Alicia Zimmermann (03:06:12):They are three separate reports.Shannon Buckingham (03:06:14):Right. But you're aware that the children that were the subjects were related?Alicia Zimmermann (03:06:18):Yes.Shannon Buckingham (03:06:19):Okay. So just referring to first what's identified as the state police lab number 23- 2141 involving the decedent, Callan Clancy. You recall receiving several items in the postmortem toxicology unit to test?Alicia Zimmermann (03:06:41):Yes.Shannon Buckingham (03:06:42):And it included toxicology blood that was taken from the Beth Israel Deaconess Hospital in Plymouth, right? Is that correct?Alicia Zimmermann (03:06:51):Yes.Shannon Buckingham (03:06:52):As well as blood that was collected from the Children's Hospital in Boston?Alicia Zimmermann (03:06:59):Yes.Shannon Buckingham (03:07:00):And urine also collected from the Beth Israel Deaconess Hospital in Plymouth?Alicia Zimmermann (03:07:05):Yes.Shannon Buckingham (03:07:06):And were screens done on the samples, namely the blood from BID Plymouth, the urine from BID Plymouth, and the blood from Children's Hospital?Alicia Zimmermann (03:07:17):Yes.Shannon Buckingham (03:07:17):Were any substances detected on those three screens and the pediatric screen that you've just described to the jury?Alicia Zimmermann (03:07:23):No. They were not.Shannon Buckingham (03:07:24):And as far as the next case, which would be laboratory number 23-01875, the decedent being Cora Clancy, you received some heart blood from the medical examiner's office postmortem, correct?Alicia Zimmermann (03:07:41):Yes.Shannon Buckingham (03:07:41):And as far as that, were those screening tests conducted in this case for Cora?Alicia Zimmermann (03:07:47):Yes.Shannon Buckingham (03:07:47):And were there any substances detected?Alicia Zimmermann (03:07:50):No. We did not detect anything.Shannon Buckingham (03:07:52):And as far as laboratory number 23-01874, which is the decedent, Dawson Clancy, your unit received an item 1-101 of heart blood from Dawson Clancy, correct?Alicia Zimmermann (03:08:06):Yes.Shannon Buckingham (03:08:07):And that was also postmortem?Alicia Zimmermann (03:08:08):Yes.Shannon Buckingham (03:08:09):And were those screening tests, those same three tests plus the pediatric tests run for Dawson?Alicia Zimmermann (03:08:14):Correct.Shannon Buckingham (03:08:15):Were any substances detected?Alicia Zimmermann (03:08:17):No, they were not.Shannon Buckingham (03:08:18):And so where in each one of these three separate cases there was no detection of any substances, did you do anything further other than issue a report saying none detected?Alicia Zimmermann (03:08:29):No. I reviewed the data and then I issued the report with the non-detected results.Shannon Buckingham (03:08:34):If there had been any positive findings, additional testing would've been conducted, correct?Alicia Zimmermann (03:08:38):Yes. If we receive a positive screen, we will either perform confirmatory analysis or quantitative analysis depending on the testing.Shannon Buckingham (03:08:46):And just as it pertains to these three cases, the samples received for Cal and Clancy, why did they come from a different source than the other two?Alicia Zimmermann (03:08:58):So the medical examiner sends us the samples. If the decedent is in the hospital prior to the autopsy, they will typically send us those hospital samples as well. They prefer to have the hospital samples tested because that date and time is usually prior to the decedent's death. And we can sometimes determine what sort of drugs or poisons may have been in that decedent's body prior to their death and before drugs may have been given at the hospital.Shannon Buckingham (03:09:29):And once these tests are conducted in the postmortem toxicology unit, the results, where are they sent to?Alicia Zimmermann (03:09:36):They are sent to the medical examiner to go with their report.Shannon Buckingham (03:09:39):Thank you. Nothing further.Judge (03:09:52):All right. Attorney Reddington?Kevin Reddington (03:09:52):No questions. Thank you.Judge (03:09:52):All right. Thank you, ma'am.Alicia Zimmermann (03:09:52):Thank you.Judge (03:09:52):Thank you. All right. Attorney Sprague?Jennifer Sprague (03:09:53):Thank you, Your Honor. Commonwealth calls Sherri Crook.Speaker 18 (03:10:55):Stop right here. Raise your right hand for the clerk, please.Speaker 17 (03:10:56):Good afternoon. Do you solemnly swear that the testimony and the evidence you shall give to the court and the jury [inaudible 03:10:57]Sherri Crook (03:10:56):I do.Speaker 17 (03:10:59):Thank you. You may have a seat, ma'am.Speaker 18 (03:10:59):Watch your step, please.Judge (03:10:59):Good afternoon.Sherri Crook (03:10:59):Good afternoon.Judge (03:10:59):Attorney Sprague, please.Jennifer Sprague (03:11:00):Thank you, Your Honor. Good afternoon. Can you please state and spell your name for the record?Sherri Crook (03:11:03):Good afternoon. My name is Sherri Crook. S-H-E-R-R-I, last name C-R-O-O-K.Jennifer Sprague (03:11:12):What do you do for work?Sherri Crook (03:11:13):I'm a supervisor in the Crime Scene Response Unit at the Massachusetts State Police Crime Laboratory in Lakeville.Jennifer Sprague (03:11:19):And how long have you held that position at the lab?Sherri Crook (03:11:22):I've been a supervisor in that unit approximately 18 years, and I've worked at the lab for 26 years.Jennifer Sprague (03:11:30):Can you describe for us your educational background, please?Sherri Crook (03:11:33):I have a Bachelor's of Science in Biology from UMass Dartmouth and a Master's of Science in Criminal Justice from Westfield State College.Jennifer Sprague (03:11:41):And if you could just describe for us the nature of your work and your duties at the lab.Sherri Crook (03:11:46):So my main job is a supervisor in the Crime Scene Response Unit. As a supervisor, I am a liaison for the state when crime scenes occur and a forensic scientist is needed. So I answer calls, figure out what type of services are needed. I then get forensic scientists to respond to areas.(03:12:09)I oversee generally the Southern region, which would be Plymouth County, Cape & Islands, Norfolk, Bristol County, but I do take calls for the entire state. I oversee the forensic scientists that respond to my area. I technically review reports.(03:12:26)I also am involved in the criminalistics unit where I test and examine physical evidence for the presence of biological fluids. This would be blood, semen and saliva and trace materials, hairs, fibers, gunshot residues. These cases include fatal and non-fatal beatings, stabbings, shootings, sexual assaults, and motor vehicle accidents. We do the testing in the lab similar to the testing at crime scenes.Jennifer Sprague (03:12:51):And what type of training have you had to be qualified to be a forensic scientist in all these different areas at the lab?Sherri Crook (03:12:58):So when I first began, I've always worked in the criminalistics unit. I went through a training process where I first observed trained chemists in the analysis of evidence. I then performed this analysis under the strict supervision of my supervisor. At the completion of each area that I was testing in, I took written and oral competency exams. So there are several areas in blood, semen, saliva that we take tests on to prove our proficiency.Jennifer Sprague (03:13:28):And have you passed all of these competency tests?Sherri Crook (03:13:30):I have.Jennifer Sprague (03:13:31):And have you passed all of your proficiency tests?Sherri Crook (03:13:33):I have.Jennifer Sprague (03:13:35):Does your casework go through any type of review process?Sherri Crook (03:13:38):It does. It goes through a technical review as well as an administrative review.Jennifer Sprague (03:13:44):And have you had any specialized training in the field of forensics?Sherri Crook (03:13:47):I have.Jennifer Sprague (03:13:48):And what type of training?Sherri Crook (03:13:50):So I first had training in the lab, and then I have had external training that has included bloodstain pattern analysis training, crime scene reconstruction training, and a microscope class.Jennifer Sprague (03:14:03):And are you affiliated with any professional organizations?Sherri Crook (03:14:06):I am. I'm a member of the IABPA, which is the International Association of Bloodstain Pattern Analysts.Jennifer Sprague (03:14:14):And you've testified in court many times in the Commonwealth, correct?Sherri Crook (03:14:16):I have.Jennifer Sprague (03:14:19):Going back to what you talked about bloodstain pattern analysis, can you describe the training you've had in that field in particular?Sherri Crook (03:14:28):So it first began with taking a 40-hour course in the basics of bloodstain pattern analysis that was used in my original training at the laboratory. It consisted of a 40-hour course where we do experimentations, look at bloodstains, and prepare reports, as well as taking an exam at the end. So that was my original course that I took. I've since taken seven other additional courses that include another basic bloodstain class. I've taken advanced bloodstain pattern classes. I've taken fluid dynamics of bloodstains, and I've also taken bloodstain classes on fabrics.Jennifer Sprague (03:15:14):Now do you undergo any continuing education after all of that training on bloodstain pattern analysis?Sherri Crook (03:15:22):I do.Jennifer Sprague (03:15:23):Can you describe that?Sherri Crook (03:15:24):So we continually get training every year. We have to do at least eight hours, which could be training from readings, attending a course, attending workshops that we have through the IABPA, some sort of educational trainings.Jennifer Sprague (03:15:42):And is bloodstain pattern analysis, that discipline, is it accredited?Sherri Crook (03:15:47):It is.Jennifer Sprague (03:15:48):How so?Sherri Crook (03:15:49):It was accredited through our lab during our accreditation in 2008. It became accredited for the Mass State Police Lab.Jennifer Sprague (03:15:57):And is it still currently accredited?Sherri Crook (03:15:59):It is.Jennifer Sprague (03:16:00):Okay. And do you have to take proficiency tests specifically in bloodstain pattern analysis?Sherri Crook (03:16:04):I do.Jennifer Sprague (03:16:05):How often?Sherri Crook (03:16:06):Take a yearly test from an outside vendor agency.Jennifer Sprague (03:16:10):And have you passed all of those tests?Sherri Crook (03:16:11):I have.Jennifer Sprague (03:16:14):And have you testified in courts in the Commonwealth about bloodstain pattern analysis?Sherri Crook (03:16:19):I have.Jennifer Sprague (03:16:20):And how many times have you done that?Sherri Crook (03:16:22):I've testified as an expert more than 10 times in Plymouth County, Bristol County, Norfolk County, and Cape & Islands.Jennifer Sprague (03:16:29):What is a bloodstain?Sherri Crook (03:16:31):A bloodstain is a deposit of blood on a surface.Jennifer Sprague (03:16:35):And what would be a bloodstain pattern?Sherri Crook (03:16:38):A bloodstain pattern is stains on the surface by which we look at it and identify how it was created.Jennifer Sprague (03:16:46):So could you describe for us what bloodstain pattern analysis is?Sherri Crook (03:16:51):So bloodstain pattern analysis is the examination of bloodstains and bloodstain patterns by which that they are deposited on a surface. We can give information about how the blood was deposited, as well as how the incident occurred to deposit those blood stains.Jennifer Sprague (03:17:11):And are there different blood stains and blood stain patterns and are there terms ascribed to those that tell you what kind of patterns they are or what kind of blood stains they are?Sherri Crook (03:17:21):There are.Jennifer Sprague (03:17:22):And what are some of the features and characteristics that you look at when you're performing urinalysis to determine the type of stain or pattern?Sherri Crook (03:17:32):So we look at specifically the size, shape, and the distribution of those stains. With looking at that information, we can tell you the how, what, when, where, and how things were created by looking at those stains. That information, the size, shape, and distribution will answer some of those questions.Jennifer Sprague (03:17:53):Can you tell the direction of a blood stain pattern?Sherri Crook (03:17:57):You sometimes can, yes.Jennifer Sprague (03:17:58):And how do you go about doing that and why is that important?Sherri Crook (03:18:02):So in some stains-Jennifer Sprague (03:18:00):You go about doing that and why is that important?Witness (03:18:02):So in some stains, there is an identifying feature that we look for. It's called a tail. So when blood flies through the air and lands on a surface, it usually will land in an oval shape, an elliptical shape that may cause it to have a tail. The tail is an extension of that elliptical shape. We use that to identify the direction that the blood is traveling.(03:18:27)So the tail will point in the direction that the blood was flying when it landed on a surface. So we can tell by that tail where that stain may have originated from.Jennifer Sprague (03:18:38):And are there different categories of stains?Witness (03:18:41):There are.Jennifer Sprague (03:18:42):And what would those be?Witness (03:18:43):We describe them as passive stains, transfer stains, and dynamic stains.Jennifer Sprague (03:18:48):And could you define what those are?Witness (03:18:50):Sure. So passive stains are stains where only the force of gravity is acting upon that stain. Some of the examples would be a drip stain, a flow, or a blood pool. We have transfer stains, which are stains that are created when a bloody object or body comes into contact with another surface, transferring that stain there. For that, we have smears or wipes.(03:19:19)And then for dynamic stains, dynamic stains are where a outside force has been acted upon the blood. A forceful force that has projected the blood onto a surface either by projecting it out or compression that projects the blood out. In that case, we have projected blood patterns, arterial spurts that are used that term as dynamic stains.Jennifer Sprague (03:19:47):And in your analysis, you use the word target?Witness (03:19:50):Yes.Jennifer Sprague (03:19:51):And what does that mean in bloodstain pattern analysis?Witness (03:19:54):So the target is the surface that the bloodstain lands on. Could be a floor, a wall, anything that the bloodstain lands on.Jennifer Sprague (03:20:02):So for example, if I have a cut on my arm and blood drops to the floor as I'm just standing here, would that be a passive act and the target is the floor?Witness (03:20:12):So yes, it'd be a passive act because just gravity is reacting with that blood, pulling it to the ground, and the floor would be the target surface that it landed on.Jennifer Sprague (03:20:24):What is a drip stain?Witness (03:20:26):So with that example, if you have a blood source, say, I have a cut in my finger, I hold my finger out, gravity acts on that blood, pulling it to the floor. That would be a drip stain, a single stain hitting the floor due to gravity.Jennifer Sprague (03:20:41):What would be a spatter stain?Witness (03:20:43):So a spatter stain is a stain where some sort of force is acted on it. So if you think about my finger again, the blood is coming out. If I apply force to my finger, if I flick it, the blood is now flying in the air and landing on a surface, say, a wall. It will land in an elliptical shape and it will be considered a spatter stain.Jennifer Sprague (03:21:05):And are you familiar with the phrase cast-off pattern?Witness (03:21:08):I am.Jennifer Sprague (03:21:09):And what is that?Witness (03:21:10):So a cast-off pattern is a collection of stains, usually elliptical or circular in shape. It's created when blood flies off of an object. So if you think of my finger again and the blood is coming out, if I take my finger and I swing it up over my head, the blood is going to release as it goes along, creating elliptical stains, circular stains, and more elliptical stains. The cast-off pattern is created in a linear form, so in a line of those stains.Jennifer Sprague (03:21:42):And what is a transfer stain?Witness (03:21:44):So a transfer stain is when a bloody object comes into contact with a surface. So if you think of my hand and I put it on the top here and blood is left behind, I lift it up, that's a transfer stain of blood.Jennifer Sprague (03:22:03):Okay. And what is a wipe?Witness (03:22:07):So if you think of my hand, it's a transfer stain. A wipe is you think of my hand and there's a blood pool on the surface, and I run my hand through that blood pool. I'm wiping that blood, causing a wipe stain. The original stain, which is a blood pool, would now be called an altered stain because there is movement through that stain when I drag my hand through it.Jennifer Sprague (03:22:32):Is a swipe different than a wipe?Witness (03:22:35):It is.Jennifer Sprague (03:22:35):What is a swipe?Witness (03:22:37):A swipe is a transfer of blood, but, say, I've made that white stain and I lift my hand up and I have blood on the surface, I then go to a clean surface and wipe it on that. That would be considered a swipe stain. So wipe is going through the blood. I lift it. Swipe is taking that blood and applying it to a secondary surface.Jennifer Sprague (03:23:00):And what would be a smear?Witness (03:23:02):A smear is usually a combination of swipes and wipes. If there is a blood pool on the floor and you make lateral movements for it, say, you had a socked foot or a cloth that you were wiping it with, using those lateral movements going back and forth would be considered a smear.Jennifer Sprague (03:23:25):And what is a pool?Witness (03:23:27):A pool is a liquid portion of blood accumulated in one area.Jennifer Sprague (03:23:34):So if I'm, for example, standing here and, again, have a cut on my arm and blood is just dropping in that same area, is all the blood that gathers there considered a pool?Witness (03:23:44):The stain itself is not considered a pool. We use it to identify blood from a source. So if there is a body laying down and there is an injury and it's seeping out of the injury onto a surface, that would be considered a blood pool. What you have described as a different type of staining.Jennifer Sprague (03:24:02):What would that be?Witness (03:24:03):That would be considered a drip pattern where you're dripping just due to gravity. The blood falls. It falls into another liquid source in blood stains. It's usually blood into blood. When that drip is hitting and they're hitting each other, it's causing an accumulation on the floor. And the stains that are formed, the accumulation of blood as well as smaller stains would form the drip pattern.Jennifer Sprague (03:24:36):And sticking with that for a moment, if the blood is falling and the person is moving, does that create some type of trail or something along those lines?Witness (03:24:45):It does. So we would identify that as single drip stains. And then if it's a line with some movement, that would be considered a drip trail of the drip stains.Jennifer Sprague (03:24:58):And what is a saturation stain?Witness (03:25:00):So a saturation stain is similar to a blood pool, but the surface that is on is an absorbent surface. So it's a portion of liquid blood on, say, a mattress or a carpet that seeps into that absorbent material.Jennifer Sprague (03:25:16):And what about a satellite stain?Witness (03:25:19):So a satellite stain is a secondary stain. So if you think about my drip stain as it's dripping from my finger, as it hits the ground or the surface, it can break apart. When it breaks apart, those little stains are called satellite stains. They come from the original parent stain.Jennifer Sprague (03:25:38):And what about the term flow?Witness (03:25:41):Flow is a term that we use when there's an accumulation of blood on a surface and there's enough that gravity can take hold of it and pull it down. So if you think of water dripping down a surface or if there's a large accumulation of blood, it'll create like a stream going down to where gravity is.Jennifer Sprague (03:26:02):And are there some blood stains where no determination can be made?Witness (03:26:06):Yes.Jennifer Sprague (03:26:07):And how so?Witness (03:26:09):So we have some blood stains that just don't give us enough information by their size, shape or distribution. So sometimes we can just generally call them red brown stains. When we do our examination, depending on what we're examining and how we're examining it, say it's a blurry photo, we may just call it a red brown stain because we cannot identify anything from the features because the photo is bad.Jennifer Sprague (03:26:36):And how are blood stains typically documented at a crime scene?Witness (03:26:41):So there's a trained forensic scientist that is at every scene that we document as far as blood stain pattern analysis. They are trained in documenting the stains as far as a sketch. We also document them with ruler tape. We want to know how high up stains are from the floor. And we also use very small ruler tape with individual stains. That tape is used to show the size. It is then photoed by crime scene services. They'll do a far away shot so we can get the whole information in one shot. They will do a medium and then a closeup of stains so we can get the sizes of the stains. Those photos are used for documentation and reviewing when we do our exam.Jennifer Sprague (03:27:32):And do you do your interpretation and analysis at the scene or through photographs?Witness (03:27:39):So with those photographs, we do the examination back at the laboratory.Jennifer Sprague (03:27:43):I want to show you some things on the screen here. Are you familiar with this slide here?Witness (03:27:58):I am.Jennifer Sprague (03:27:59):And how are you familiar with it?Witness (03:28:01):So that is a slide that pictures of drip stains that I've used during my trainings to show how those stains were formed when it hits at a different angle. So depending on how it hits on an angle is how it will form. So the bottom stains, which are more circular, will fall at a 90-degree angle. And as you get to more of elliptical shapes, they fall at different higher angles when they hit the target surface.Jennifer Sprague (03:28:32):But these that are shown here labeled drip stains, these are all drip stains. It's just how they fall at different angles?Witness (03:28:40):Correct.Jennifer Sprague (03:28:42):Mark this as the next exhibit.Judge (03:28:44):Any objection? All right. That may be admitted.Jennifer Sprague (03:28:47):I'm showing you this next slide. Are you familiar with this slide?Witness (03:28:59):I am.Jennifer Sprague (03:29:00):And how are you familiar with that?Witness (03:29:02):So this is pictures of spatter stains. So this is blood that is in flight, some force acted on the blood to cause it to fly. And you can see the elliptical shapes that it has created.Jennifer Sprague (03:29:16):And when you say elliptical, you're talking about kind of the oval shape?Witness (03:29:21):I'm talking about the oval shape and as also how I described the tail. Some of them are evident on the bottom side of those elliptical shapes showing the direction when they hit the target, they were moving.Jennifer Sprague (03:29:35):So where the tail... So looking at this slide here, this small middle photo at the top where the tail seems to be at the bottom, what does that tell you about the direction of that stain?Witness (03:29:52):So if I may refer to the one on the right, it's a little bit more descriptive. So the one on the right. May I stand?Judge (03:30:00):Yes, please.Witness (03:30:01):If you look at these stains, they are elliptical in shape, and they all have an extension, which we call the tail. So they're hitting the wall and the tail is pointing in the direction that it is moving. So we have the elliptical shape and then the extension. So they are going from a left to right in a downward direction.Jennifer Sprague (03:30:23):I could have this marked as the next exhibit.Speaker 20 (03:30:25):No objection.Judge (03:30:26):All right. That may be admitted.Clerk (03:30:27):Exhibit 188.Judge (03:30:30):Thank you.Jennifer Sprague (03:30:38):Then showing you this next slide. Are you familiar with this?Witness (03:30:42):I am.Jennifer Sprague (03:30:43):And what are we seeing here?Witness (03:30:45):So this is an example of a projected pattern, which is one of those dynamic stains. On the left is an arterial spurt. So there was an artery cut. Say, it was in the arm. With the compression of that blood, it is projected out, and it has landed on the wall in a curvy linear fashion.Jennifer Sprague (03:31:07):And did you say that's on the left?Witness (03:31:08):On the left, yes.Jennifer Sprague (03:31:11):And what about on the right?Witness (03:31:11):That is the blood when it hits the ground on the right.Jennifer Sprague (03:31:13):So on the left, it's hitting the wall. And then on the right, it's dripping down to the ground?Witness (03:31:18):Well, it's projecting out and hitting the ground. It's not dripping onto the ground. It's coming out of the blood source and hitting the ground.Jennifer Sprague (03:31:25):Okay. So would it be accurate to state that for a spraying type of flow of blood, say, from an artery, that's on the left is what it would look like as it hits a wall, and on the right is what it looks like hitting the floor?Witness (03:31:38):Correct.Jennifer Sprague (03:31:39):We could have this marked as the next exhibit.Judge (03:31:41):Any objection?Speaker 20 (03:31:42):No.Judge (03:31:42):All right. That may be admitted.Clerk (03:31:49):Exhibit 189.Jennifer Sprague (03:31:51):Now, were you asked to do blood stain pattern analysis on this case?Witness (03:31:57):I was.Jennifer Sprague (03:31:58):And what did you use in terms of materials to conduct that analysis?Witness (03:32:05):I used photographs that were supplied from crime scene services. I utilized reports that were written by Maureen Hartnett, the chemist.Jennifer Sprague (03:32:17):And were there stains that were labeled by letter?Witness (03:32:25):They were.Jennifer Sprague (03:32:26):Okay. Did you label them by those letters or did you use the letters that were in the prior reports?Witness (03:32:32):I used the letters that they were labeled in the prior reports.Jennifer Sprague (03:32:36):And so to start with, did you look at what was labeled stain A on the floor of the basement at 47 Summer Street?Witness (03:32:46):I did.Jennifer Sprague (03:32:48):And showing you this page here. What are we looking at here?Witness (03:32:55):So this is a page of my notes when I was doing my exam. So it has a picture of the stains themselves and then all of the identifying factors written in my handwriting when I was doing my examination.Jennifer Sprague (03:33:09):And when you did your examination on this item, what did you determine about the blood stain?Witness (03:33:17):So that is a red-brown stain on the carpet in the basement. It was deemed a saturation stain with transfer stain surrounding it. So you have the center stain that's darker red. That is the saturation stain. And then surrounding it, there is lighter red brown staining that was a transfer from that saturation stain across the carpet.Jennifer Sprague (03:33:41):And you're not able to say how that transfer happened, correct?Witness (03:33:44):I am not.Jennifer Sprague (03:33:46):But basically looking here, this larger area in the middle of the bottom photo, that's the original saturation stain where it's soaked into the carpet?Witness (03:33:56):Yes.Jennifer Sprague (03:33:57):And then at some point, something touched this saturation stain and then touched to the side of it?Witness (03:34:03):If I may?Judge (03:34:04):You may. Sure.Witness (03:34:06):So this is a saturation stain in the center and then surrounding is the lighter red brown. That is the transfer as something moved across the actual saturation stain.Jennifer Sprague (03:34:17):And what about the mark to the left there?Witness (03:34:21):I think that's just another portion of the saturation stain.Jennifer Sprague (03:34:23):Okay. Objection to this? Move to submit this as the next exhibit.Judge (03:34:30):All right. It may be admitted.Clerk (03:34:30):Exhibit 190.Jennifer Sprague (03:34:41):Did you also look at some blood stains on the floor of the master bedroom?â€Witness (03:34:46):I did.Jennifer Sprague (03:34:47):And specifically referring to stain B, showing you what's been marked SJC. SJC, are those your initials?Witness (03:35:00):They are.Jennifer Sprague (03:35:02):E12. These are also from your notes. Is that correct?Witness (03:35:05):They are.Jennifer Sprague (03:35:06):And is this from the master bedroom floor between the mirror and the bed?Witness (03:35:14):It is.Jennifer Sprague (03:35:15):Okay. And what did you learn from your analysis of this item?Witness (03:35:20):So from my analysis in looking at the stains, there's a couple of different things going on here. So the round circular stains, which are on the outside are drip stains. So that is blood coming from a bloodletting event and going to the ground just due to gravity. The stains that are overlapping are considered a drip pattern. So standing there for a period of time, the blood is dripping due to gravity into itself, causing the overlapping stains as well as the small stains that are all surrounding it.(03:35:56)Over here on the right side, there is some movement through some of the red brown stains causing them to have lateral determination. And so those would be smear stains. So they're originally drip stains that were smeared through.Jennifer Sprague (03:36:16):And I'm showing you E13 from your notes. Is this a closeup of that same area?Witness (03:36:23):It is.Jennifer Sprague (03:36:24):And if you could just point out again for us in this lower photo what we're looking at here.Witness (03:36:30):So this is just a closeup of it showing some of the drip stains that are singular by themselves and then the drip pattern itself. So that is blood dripping into blood. And then the chalk one that's not in view will have a closeup of these smear stains. So movement through those blood stains.Jennifer Sprague (03:36:51):We should have E12 as the next exhibit and E13 as the following.Judge (03:36:56):All right. That may be admitted.Clerk (03:36:56):Exhibit 191 and 192.Jennifer Sprague (03:37:11):And just for clarification, showing you what's been previously marked as Exhibit 159. That's that same area for E12 and E13?Witness (03:37:23):It is. The staining on the ground is right in front of the mirror, and the bottom portion is the bed. So between the mirror and the bed.Jennifer Sprague (03:37:48):Now, showing you what's been marked previously as Exhibit 161. Is that the mirror we were just discussing?Witness (03:37:58):Yes.Jennifer Sprague (03:38:01):And did you do an analysis on the blood stains on the mirror?Witness (03:38:07):I did.Jennifer Sprague (03:38:10):Showing you what's been marked as E14 in your report. I'm just going to zoom in here to the top photo. Now, the stains have been marked there with a ruler, correct, as you described previously?Witness (03:38:28):Correct. Yes.Jennifer Sprague (03:38:30):And then in the lower left, can you tell us what we're looking at here?Witness (03:38:34):So this is a closeup of these stains from the top picture with the ruler attached.Jennifer Sprague (03:38:40):And what, if anything, were you able to determine about these blood stains on the mirror?Witness (03:38:45):So the blood stains themselves were elliptical in shape. So it did give me some information. There was a larger amount of blood. So you can see on the stains that it starts to go down the mirror. That's due to gravity. So we call that flow. Because they were elliptical in shape, there are two different categories that they could go into, which would be a drip stain that just landed at an angle or an actually a spatter stain, which is a blood in flight, because I couldn't tell the difference, but I did limit it down to either a drip stain that fell at an angle or a spatter stain that was forced onto that mirror. So I couldn't come to a definite conclusion. So I brought it down to either a drip stain or a spatter stain.Jennifer Sprague (03:39:36):So would it be accurate to say it could either be from someone being near the mirror bleeding and blood dropping on it or someone with blood or an instrument or something with blood on it moving and spattering the blood on it?Witness (03:39:49):Correct. Either of those motions.Jennifer Sprague (03:39:53):We could have E14 as the next exhibit.Judge (03:39:55):All right. That may be admitted.Clerk (03:40:01):193.Jennifer Sprague (03:40:04):Showing you what's been previously marked as Exhibit 162. It's the bedroom window sill.Witness (03:40:16):Correct.Jennifer Sprague (03:40:17):And showing you a close up at 163. Did you examine this blood stain?Witness (03:40:24):I did identify it as stain D.Jennifer Sprague (03:40:27):And what did you determine based on your training and experience about this blood stain?Witness (03:40:33):This blood stain didn't give us too much information. It was irregular in shape. So I couldn't tell exactly what it came from, but I did classify it as a transfer stain. So something bloody, having a red brown stain, coming into contact with a non-bloody surface, leaving that stain there. So a transfer stain on the window sill.Jennifer Sprague (03:41:12):Did you also examine the nightstand in that same bedroom?Witness (03:41:18):I did.Jennifer Sprague (03:41:20):Showing you what's been marked Exhibit 164. Is this the area that you examined?Witness (03:41:28):I examined the whole area. So a picture that shows the whole knife and then the area surrounding it.Jennifer Sprague (03:41:36):Okay. Showing you another photo. Is this the entire area that you examined?Witness (03:42:21):It is.Jennifer Sprague (03:42:22):And can you tell us what, if anything, you determined from examining the blood stains on the nightstand?Witness (03:42:28):So I identified two different types of bloodstains in that area. There's a point on the bottom portion here as well as the top. They are circular stains. Those would be drip stains. So blood coming from a bloody area due to gravity falling onto the nightstand causing the circular stains. So those would be drip stains.(03:42:54)I also identified the linear blood stain up at the top, which is the right of the knife. So that is a transfer stain from the knife itself. The bloody edge of the knife came in contact with the nightstand and left that stain there. Once that stain was left there, it has since been moved. Whether someone knocked into the table or actually pushed the knife over, I can't tell you. But it was originally in the position where it left that linear stain. So drip stains and then a linear red brown stain.Jennifer Sprague (03:43:30):And are you able to determine that that was the original position of the knife based on the fact that the line tracks the shape and size of the knife's edge?Witness (03:43:40):I wouldn't say that it's an original location, but it is a location that that knife was at for a period of time for that blood to transfer onto the table.Jennifer Sprague (03:43:50):Because you can't tell the order of when these blood stains happened, correct?Witness (03:43:55):At our lab, we don't necessarily do an order in our examination. There are some things we can tell you in order to. So I know at some point that it was on the table where that linear stain is and has since moved from there. But I can't tell you if that was the original location that it landed.Jennifer Sprague (03:44:18):We could have this photo marked as the next exhibit, please.Judge (03:44:21):It may be admitted.Clerk (03:44:24):194.Jennifer Sprague (03:44:57):Showing you what's been marked SGCE17 from your notes. Can you tell us what we're looking at here?Witness (03:45:05):So that was stain F, which is a red brown stain in the snow below the windows of the bedroom.Jennifer Sprague (03:45:14):And what, if anything, were you able to... What are you able to tell us about this stain based on your training and experience?Witness (03:45:22):There's not much information that I can tell you from that stain. It's a diluted red brown stain. It's irregular in shape, so I just classified it as a red brown stain.Jennifer Sprague (03:45:31):So that's an example of what you had told us previously in your testimony that sometimes you just don't know?Witness (03:45:37):Correct. The pictures were sufficient to see areas of the stain. There's just not a lot of information in the stain itself to determine what it is.Jennifer Sprague (03:45:47):We could have E17 marked as the next exhibit.Judge (03:45:49):Sure. That may be admitted.Clerk (03:45:53):Exhibit 195.Jennifer Sprague (03:46:13):Did you also look at some stains on the floor of the master bedroom entrance?Witness (03:46:18):I did.Jennifer Sprague (03:46:21):Showing you a photograph here. Do you recognize what you see here?Witness (03:46:24):I do.Jennifer Sprague (03:46:25):And what is that?Witness (03:46:26):So those are red brown stains at the doorway to the entrance of the bedroom.Jennifer Sprague (03:46:33):And at some point in time... Oh, strike that.(03:46:39)What, if anything, can you tell us about these blood stains?Witness (03:46:42):So the pictures that were taken were never taken with a ruler tape, but the pictures are good enough that it gave me information on how those stains were formed. So I was able to determine that those are drip stains on the floor.Jennifer Sprague (03:46:57):And just zooming in on those a little bit. Again, what we have here, similar to some of the other stains you call drip stains, that's that circular spot of blood?Witness (03:47:10):Yes. Circular stain where gravity took a hold of some sort of blood and brought it to the floor, causing those circular stains.Jennifer Sprague (03:47:19):And as you described earlier, is that consistent with the blood falling at a 90-degree angle?Witness (03:47:24):Correct.Jennifer Sprague (03:47:24):So straight down?Witness (03:47:25):Correct.Jennifer Sprague (03:47:26):If we could have this photo marked as the next exhibit.Judge (03:47:29):It may be admitted.Clerk (03:47:29):Exhibit 196.Jennifer Sprague (03:48:03):Excuse me. Did you also look at what's depicted here in Exhibit 46?Witness (03:48:13):I did.Jennifer Sprague (03:48:14):And looking at what you've marked in your notes as E21, are these three photos of that same area?Witness (03:48:30):They are.Jennifer Sprague (03:48:31):Okay. What can you tell us about what you observed when you looked at these blood stains?Witness (03:48:38):So these stains were further up on the side of the bed from the area that was between the bed and the mirror. Similar to the stains that were between the bed and the mirror are stains up here, which are circular in nature. So there are drip stains and then an area where the drip stains fell into each other, causing another drip pattern. So this is a drip pattern with singular drip stains in an area between the bed.Jennifer Sprague (03:49:12):And showing you another photograph. Does this depict that same area, but also going over to the right of the nightstand?Witness (03:49:22):It does. So this is the area on the left side of the bed. Down below it is the area that was between the bed and the mirror, and the window is up over here. So you can see the singular drip stains. you can see the drip pattern where blood is dripping into blood. And then all of the smaller stains are the satellite stains that occur when the blood is hitting and causing it to fly.Jennifer Sprague (03:49:46):Are you able to look at the stains here in the drip pattern and tell whether there was any movement or in what direction the movement was?Witness (03:49:56):We can't tell what type of movement there was because there are circular stains. The only thing we can say about this is for a drip pattern to be formed, there has to be a stationary blood source. Say, it was your finger. you would have to stand there for a while and allow the blood to drip out into each other, causing that drip pattern. So we know... or I've deemed that there was a period of time that the blood source was in a stationary position causing that drip pattern.Jennifer Sprague (03:50:26):And the amount of time that it would take for that amount of blood to pool, would that be dependent on the wound and how it was bleeding at the time?Witness (03:50:34):Correct.Jennifer Sprague (03:50:35):And you can't tell that from the photograph, correct?Witness (03:50:37):I cannot.Jennifer Sprague (03:50:39):We could have this photograph marked as the next exhibit.Judge (03:50:41):All right. That may be admitted.Clerk (03:50:58):Exhibit 197.Ms. Sprague (03:51:00):Let me show you some photos of the exterior of the house, what's been marked as Exhibit 106, what's been marked as Exhibit 105 and 108. Are these areas or photographs that you examined as part of your analysis?Witness (03:51:25):They are.Ms. Sprague (03:51:43):Showing you what you've marked E19 from your notes, what can you tell us about the patterns we're seeing here on the shingles on the exterior of the home?Witness (03:52:03):So these are photos of the red-brown stains on the shingles between the second and first floor window.Ms. Sprague (03:52:11):A far away view up on the top left and then closer pictures blown up to show the red-brown stains. There were two areas and then there was some excess of blood. You can actually see it dripping down due to gravity-Kevin Reddington (03:52:25):I'm going to object to the concept of blood because we all know that that was never tested.Ms. Sprague (03:52:25):It actually was tested.The Court (03:52:25):All right. Can I see over here?(03:52:25)All right, Attorney Sprague.Ms. Sprague (03:55:24):Thank you. And so in the upper left-hand corner here, we have the upper window and the lower window, correct?Witness (03:55:28):Correct.Ms. Sprague (03:55:29):All right. And I'm going to zoom in here on this upper right-hand photo. What are we seeing here?Witness (03:55:34):So those are areas of red and brown staining on the shingles between the second floor window and the first floor window.Ms. Sprague (03:55:41):And what, if anything, can you tell us about this red-brown staining on the shingles underneath that open window based on your training and experience?Witness (03:55:49):So those two areas, which were to the left and the right below the window, were identified as transfer stains. So a bloody object coming in contact with a surface leaving the blood stain there.Ms. Sprague (03:56:03):So that would have to be an actual something with blood on it touching those shingles?Witness (03:56:08):Correct.Ms. Sprague (03:56:10):And showing you below that, the small photo to the right, what is depicted there?Witness (03:56:19):So this is an area of the transfer stain where there was an accumulation of blood that was coming off as a droplet off the bottom of the shingle.Ms. Sprague (03:56:29):And showing you E20 from your notes, perhaps a little bit clearer here. The top right photo, is that that same area of red-brown staining that you saw in the photos underneath the open window?Witness (03:56:47):It is. So the one on-Ms. Sprague (03:56:47):Can you get up and point it out with the court permission?The Court (03:56:48):Sure.Witness (03:56:49):So the window is up above. So to the right looking at the window is an area of the red-brown staining. To the left is the other area of red-brown stain. That left one had the accumulation of blood that was a droplet coming off the shingle.Ms. Sprague (03:57:05):And the two photos at the bottom there?Witness (03:57:08):Those were a blow up of the right-hand side red-brown stain. As you can see my arrows, they're pointing to the picture above, just showing a closeup of the stains.Ms. Sprague (03:57:21):We could mark E19 as the next exhibit and then E20.The Court (03:57:25):All right. Any objection?Kevin Reddington (03:57:27):No.The Court (03:57:28):All right. That may be admitted. Or they may be admitted.Ms. Sprague (03:57:43):And then showing you what's been marked as Exhibit 105 and zooming in here on the open window and the orange ball there at the bottom, the red-brown staining right above that. Did you examine photos of that?Witness (03:58:07):I did.Ms. Sprague (03:58:08):And showing you your notes E18. Is that a closeup of that red-brown staining on the open windowsill?Witness (03:58:25):It is.Ms. Sprague (03:58:26):And what, if anything, can you tell us based on your training and experience about this area?Witness (03:58:30):So similar to the stain that was on the inside of the window on the windowsill, this stain on the outside didn't give me enough information to say the size or shape. So the only thing I could come to the conclusion was that it was a transfer stain. So some sort of bloody object coming in contact with a surface causing the transfer of that blood.Ms. Sprague (03:58:57):And are you able to tell the direction of that blood or how it was applied or anything like that?Witness (03:59:02):There's not enough information in that stain to give that conclusion.Ms. Sprague (03:59:07):So basically all you can tell us is that something with blood on it touched that windowsill and left blood. Something with a red-brown stain on it, touched that windowsill and left a red-brown stain?Witness (03:59:18):Correct.Ms. Sprague (03:59:18):We could have E18 marked as the next exhibit.The Court (03:59:24):All right. That may be admitted.Ms. Sprague (03:59:35):And then showing you what's previously been marked as Exhibit 108, the top of the first floor windowsill, did you examine those red-brown stains?Witness (03:59:54):I did not.Ms. Sprague (04:00:17):I have no further questions.The Court (04:00:18):All right. Mr. Reddington.Kevin Reddington (04:00:20):Good afternoon.Witness (04:00:30):Good afternoon, sir.Kevin Reddington (04:00:32):Just a couple of questions. Is it correct you're a trained scientist? Is that what you're referred to?Witness (04:00:39):I'm classified as a forensic scientist at the supervisory level.Kevin Reddington (04:00:44):Okay. And Maureen Hartnett would be classified as what?Witness (04:00:48):She's a forensic scientist as well. The step below me, Forensic Scientist 2.Kevin Reddington (04:00:55):Okay. And is she the one that does testing on objects or items or substances to see if there are particular, for example, blood?Witness (04:01:05):She does do that. She is also trained in documentation of blood stains. So generally, that's why we do a lot of our examination through photos. So a Forensic Scientist 2 could be at the scene, do all of the documentation, make sure the photos are taken, and then those are examined back at the laboratory by a, in our case in Massachusetts, it's all supervisors in the Crime Scene Response Unit that do bloodstain pattern analysis. We are also all trained in the identification of those biological fluids, doing a screening test as well as confirmatory test for blood.Kevin Reddington (04:01:47):I don't want to be referred to as grumpy, but I'm just going to ask if you can just kind of keep your answers down a little bit to maybe a yes in the sentence after that.Witness (04:01:58):Okay.Kevin Reddington (04:01:58):Okay. So when you go to a crime scene, you're usually with a team. In other words, like Maureen Hartnett might be there, right?Witness (04:02:07):Correct.Kevin Reddington (04:02:07):And other state troopers might be there searching the area, right?Witness (04:02:10):Correct.Kevin Reddington (04:02:12):And one of the things that you are doing is relying, if you will, on your associates or other people that are working that particular crime scene to do appropriate and adequate testing of substances, right?Witness (04:02:28):Correct.Kevin Reddington (04:02:29):So for example, and again, when you're investigating on a murder case and you're dealing with substances that are deposited, for example, in that bedroom, the master bedroom, it's not appropriate, if you will, to speculate that something is blood and that's why it's referred to as a red-brown stain, right?Witness (04:02:49):Correct. We use-Kevin Reddington (04:02:52):But your experience is such that you have a wealth of knowledge as to the ability to draw an inference as to what it might be, right?Witness (04:03:02):We're not able to look at a red-brown stain and call it blood. We call it by adjectives, so it would be deemed as a red-brown stain. We have to wait until we do a confirmatory test to say whether we call it human blood or not.Kevin Reddington (04:03:19):All right. So when you say a confirmatory test, you're referring to the fact that you have a screening test you can do that initially would determine if it's possibly blood, right?Witness (04:03:30):Correct.Kevin Reddington (04:03:31):Then it goes to the next phase, which would be a confirmatory test, which Ms. Hartnett would do, right?Witness (04:03:37):Correct.Kevin Reddington (04:03:38):And then you go to the determination as to whether it's animal or human. It might be a primate blood, but it could be a human blood. And then you determine that it's human blood, right?Witness (04:03:48):The next step after Maureen is actual DNA. So it will tell you whether it's human or not human and whose blood it actually is.Kevin Reddington (04:03:57):Okay. So we know that there was a transfer of stain from the inside of the house, if you will, onto that ledge on the right-hand side of the window, right?Witness (04:04:11):I believe it was on the left-hand side.Kevin Reddington (04:04:13):Okay. So as you're looking out the window, it's your understanding that the smudge, if you will, that was on that window was on the left-hand side?Witness (04:04:23):I believe so.Kevin Reddington (04:04:41):Looking at Exhibit 106, that shows the first floor window, right?Witness (04:04:50):Correct.Kevin Reddington (04:04:51):And then further up, it shows the second floor window, right?Witness (04:04:56):Correct.Kevin Reddington (04:04:56):So if one was standing on the inside of the master bedroom and leaned on it with blood on their hand or red substance, it would be on the right-hand side of that ledge on the window, right?Witness (04:05:10):Correct. The one on the outside was on the right-hand side. The one on the inside, I believe was on the left-hand side.Kevin Reddington (04:05:16):Now, you know that that was not tested, right?Witness (04:05:19):I don't know if it was tested.Kevin Reddington (04:05:21):All right. You don't know what it is, right?Witness (04:05:23):I called it a red-brown stain.Kevin Reddington (04:05:25):But the bottom line is, in your experience, looking at that bedroom with all of what you determined in the investigation to be blood, the inference that you would draw is that that's blood from somebody's hand, right?Witness (04:05:40):Correct, and that is what is stated in my report. We infer that it is blood that we are examining.Kevin Reddington (04:05:50):Okay. So it shows in Exhibit 105, the same window with the little hornet ball or that substance that was injected, like insulation is what I think you described it. That also has red-brown substance on it, correct?Witness (04:06:11):I don't know from that picture. I only looked at the stain that was on the windowsill.Kevin Reddington (04:06:16):All right. Did you look at that object?Witness (04:06:18):I did not. Just at-Kevin Reddington (04:06:25):Okay. Would you agree that underneath that window would be the two equidistant, if you will, red-brown stains on the shingles, right?Witness (04:06:36):Correct.Kevin Reddington (04:06:37):And that would be an object or something that has blood, or we don't know if it's blood, a red-brown stain on hands or something that was a transfer onto that side of the house, right?Witness (04:06:52):Correct.Kevin Reddington (04:06:59):Okay. Other areas of the bedroom, for example, counsel showed you the door coming into the bedroom and there were two drop marks of the red-brown stains. You know those were never even tested. I'm just saying this is a murder case, it was never tested, right? But you're assuming fairly that that would be blood, right?Witness (04:07:18):I don't know whether they were tested, but I deemed those that they were blood in my examination.Kevin Reddington (04:07:24):And blood on the doorknob itself too. So that from the inside of the bedroom going up, right?Witness (04:07:31):The windowsill?Kevin Reddington (04:07:31):No, no. The doorknob.Witness (04:07:33):I don't know of any red-brown stains on the doorknob.Kevin Reddington (04:07:37):Okay. Now the knife, the photograph of the knife, and I know people can recall that, that has that linear stain that you referred to that you were able to observe, correct?Witness (04:07:50):Correct.Kevin Reddington (04:07:52):And looking at Exhibit 162, that would show the left side that you were referring to as to the red marks or the blood, if you will, on the window, right?Witness (04:08:11):Correct. That was the left side interior of the window that I examined.Kevin Reddington (04:08:14):I can't correct it when I say I was talking about the other side, but it's in both. It's on the right hand and the other side, right?Witness (04:08:21):Correct.Kevin Reddington (04:08:21):So that would be, again, drawing an inference would be somewhat conceivable with a person with blood on their hands leaning on the window. This portion of the hand out here, this portion of the hand on the inside, leaving the transfer, right?Witness (04:08:33):A hand or some sort of bloody object, yes.Kevin Reddington (04:08:37):All right. And the knife also has the transfer that you can see. Now, is that coagulated blood? Do you know?Witness (04:08:55):In which area?Kevin Reddington (04:08:57):With a knife. I mean, you see that linear line? It almost looks like the knife was put down with blood on it, and then it coagulated or it got sticky, I guess, and then it was moved again. Does that sound-Witness (04:09:09):I wouldn't call it coagulation. So if you're referring to these areas right here.Kevin Reddington (04:09:13):Yes. The linear line, yep.Witness (04:09:13):Those were red, brown circular stains that were actually on top of the linear. I could not determine what they came from, so I did not give them any sort of bloodstain pattern terminology. But they were on top of the linear line.Kevin Reddington (04:09:31):All right. And you would agree with me that one of the inferences that would possibly be drawn is that something banged into it or moved it, one or the other?Witness (04:09:39):Yes, correct. To get that original linear line and then for the knife to be in a different position.Kevin Reddington (04:09:44):Now, the photograph in Exhibit 45 is the mirror?Witness (04:09:54):Correct.Kevin Reddington (04:09:55):And then you were referring to the drip marks on the mirror. I'm having trouble here again. There we go.Witness (04:10:12):So I referred to them either as drip stains or spatter stains because I was not able-Kevin Reddington (04:10:18):That would be consistent with some type of a violent movement, would it not? I mean, if the person's cutting their throat, for example, and then cast off onto the mirror or leaning, I guess you'd set it in an angle.Witness (04:10:29):So it would be either due to gravity or due to blood in flight. So a force applied sending that blood to land on there or drip due to gravity.Kevin Reddington (04:10:43):And blood in flight, the inference would be that it's cast off, if you will, from the knife going in a particular direction towards the mirror, right?Witness (04:10:51):It would be a spatter stain coming off of any sort of blood source, whether it be the tip of a knife, a cut on the hand, something in flight.Kevin Reddington (04:11:00):That's all I have, Your Honor. Thank you.The Court (04:11:12):Redirect?Ms. Sprague (04:11:13):Thank you. So you were asked about the documentation and collection of samples of red-brown stains at a scene and that there is an initial test done at the scene typically to determine if it might be blood, correct?Witness (04:11:34):Correct.Ms. Sprague (04:11:34):And you had test that?Witness (04:11:36):We do a screening test called the Kastle-Meyer Test. So it identifies possible blood. It does not identify whether it's human or animal though.Ms. Sprague (04:11:46):And when that test is positive, but you have a limited sample, do you sometimes skip the confirmatory step and send it right to DNA for testing?Witness (04:11:57):Correct. If it's a limited sample, so a smaller stain, like something like a spatter stain, we may not do the in-between step, which is our confirmatory test, because we don't want to use up any portion that we've collected. So we would go right to DNA for that testing if it's a smaller sample.Ms. Sprague (04:12:15):And then the DNA testing can tell you if that red-brown stain is from a human and potentially which human it's from.Witness (04:12:23):Yeah. We identify who it is from. We don't identify it as human because we only do a human DNA test.Ms. Sprague (04:12:30):And defense counsel asked you about the red-brown stains on the windowsill, the one on the exterior and the interior, and asked if it could be from someone leaning out the window, correct?Witness (04:12:41):Correct.Ms. Sprague (04:12:42):Could it also be from someone hanging out the window holding on in those spots?Witness (04:12:46):Correct.Ms. Sprague (04:12:47):Nothing further.Kevin Reddington (04:12:48):Wouldn't there be drops? If somebody was bleeding significantly from cuts on their wrist to the extent that one of the marks on the shingle you said had a drip on it, right?Witness (04:13:03):So depending on the amount of blood, where that contact is coming into place is what is deposited.Kevin Reddington (04:13:09):So if somebody was going to climb out the window and hang on the ledge and then what, do a Spider-Man and go down the side of the shingles, they would leave a smear going all the way down on the shingles, wouldn't they?Witness (04:13:23):If they came in contact the entire way down, yes, there would be a transfer all the way down.The Court (04:13:29):Any further?Ms. Sprague (04:13:29):No.The Court (04:13:30):All right. Thank you, ma'am. You may step down.Witness (04:13:31):Thank you.The Court (04:13:32):And counsel, could I just talk to you a second? Sidebar.(04:13:35)Jury, rather than start another witness and break it up, I'm going to excuse you till tomorrow. All right? I don't think we'd finish with this next witness anyway. So I'm going to excuse you.(04:15:06)Now tomorrow's schedule, we are not going to be sitting in the afternoon. All right? I can tell you that. So I'm going to ask you to be here at 9:00. Remember, I'm going to ask you those same questions, same instructions. Don't talk about this, don't do any research, don't watch anything. Don't listen to anything about this. I appreciate all the work you've done so far. I appreciate all your time. And so I'm going to ask you to follow those and continue to follow those instructions. And I'll see you tomorrow morning and we'll get right back to the case. Okay?Bailiff (04:15:40):Court, all rise. Sir, please close the notebooks. Place them on the chairs.The Court (04:16:20):All right. Counsel, anything we need to address at this point?Ms. Sprague (04:16:23):No, Your Honor.Kevin Reddington (04:16:24):No.The Court (04:16:24):All right. So like I said, the schedule tomorrow will start at 9:00. We'll go till 1:00 and then we will not sit tomorrow afternoon. So with that, you has a nice evening. We'll see everybody tomorrow.Kevin Reddington (04:16:40):Thank you.Ms. Sprague (04:16:40):Thank you.Bailiff (04:16:42):Court stands in recess.â€
13August 27, 2026
day-21
the doctor who was on the stand yesterday, and it's anticipated that that is the last witness in the trial.(02:53)And then we will then take a break because before we go to the next portion of the trial, which is the closing arguments and the legal instructions, the court has to make some arrangements. I've got to speak to Counsel, so it takes a little while.(03:07)So, I'm going to excuse you at that point and have you come back tomorrow. All right? So we're going to finish the evidence today. We're going to excuse you. I'm going to then deal with Counsel and then we will do hopefully arguments and charge tomorrow.(03:26)All right? So, again, I can't tell you how much I appreciate everybody's dedication and commitment in following those instructions and being here every day. So, that's kind of where we are at this point. All right?(03:39)And so with that, I'm going to ask the Commonwealth, if you could have the doctor retake the stand please.Attorney Sprague (03:46):Yes, Your Honor.Bailiff II (04:32):Good morning. Stop right there raise your right hand for the clerk, please.Madam Clerk (04:32):Good morning. Do you solemnly swear that the testimony and the evidence you shall [inaudible 00:04:33] now pending between the Commonwealth and the Defendant now shall be the truth, the whole truth and nothing but the truth, so help you God?Witness, Doctor (04:32):I do.Madam Clerk (04:32):Thank you, sir. You may be seated.Bailiff II (04:32):Watch your step, please.Judge William Sullivan (04:32):All right. Good morning, Doctor.Witness, Doctor (04:33):Good morning.Judge William Sullivan (04:35):All right. Attorney Sprague.Attorney Sprague (04:36):Thank you, Your Honor. Good morning.Witness, Doctor (04:38):Good morning.Attorney Sprague (04:40):Yesterday when we left off, you were testifying about the decision-making process of the Defendant and what she told you about that. Going to what she told you about the voice and what it said to her, did the Defendant tell you that the voice told her where to kill the children?Witness, Doctor (05:02):No.Attorney Sprague (05:03):Did the voice tell her how to kill the children?Witness, Doctor (05:06):No.Attorney Sprague (05:07):Did the voice tell her what to use to kill the children?Witness, Doctor (05:10):No.Attorney Sprague (05:11):Did the voice tell her in what order to kill the children?Witness, Doctor (05:15):No.Attorney Sprague (05:16):Did the voice tell her where to try to kill herself?Witness, Doctor (05:20):No.Attorney Sprague (05:20):Did the voice tell her in what way to kill herself?Witness, Doctor (05:24):No.Attorney Sprague (05:26):The fact that the voice... According to the Defendant, the voice didn't tell her any of those things, but instead just said, "Kill the kids so you can kill yourself." Is that significant in your evaluation in any way?Witness, Doctor (05:38):Yes.Attorney Sprague (05:39):How so?Witness, Doctor (05:41):Well, in the small amount of time that Ms. Clancy had in the home without her husband, it was important in order to carry this out as well as her suicide to do this quickly, methodically, and the like.(06:01)And so, this is having no instructions as to how to do it, but being able to execute those decisions, including being able to get a phone call and then return it to her husband in the process of all of this; certainly the phone call was not expected.(06:25)That is surprising that she was able to accomplish all of this without any other kind of direction or plan.Attorney Sprague (06:37):Does that indicate to you that she was making decisions about those things, about where and how and when?Attorney Kevin Reddington (06:43):Your Honor, this is again, for the record, direct examination. It's leading. I object, but I have a standing objection.Judge William Sullivan (06:50):Yeah, if you could just rephrase that.Attorney Sprague (06:51):What does the fact that she was able to do all of that indicate to you, if anything?Witness, Doctor (06:57):Well, it indicated that she had control, control of the sequence of what she was doing throughout.Attorney Sprague (07:08):Doctor, you talk in your report about interpersonal psychological theory of suicide. What is that?Witness, Doctor (07:15):Well, that has to do with the decision-making process or the capability for someone who attempts suicide.Attorney Sprague (07:26):And are there three parts to that theory?Witness, Doctor (07:29):Yes.Attorney Sprague (07:29):And what are they?Witness, Doctor (07:32):Well, one would be called aloneness or the sense of isolation, people not understanding. So, that is a real difficult challenge for people to face. They feel that they can't fully share with others.(07:57)Another is burdensome-ness. If someone feels that they are a burden to others, that is also something that we find is a component to those who make serious suicide attempts and completions.(08:19)And third is what I would call capability. But you can have that sense of aloneness, you can have that sense of burdensome-ness. But if you don't have the capability of taking your life, you can be very suicidal, but not ultimately accomplish the suicide.(08:42)It does not mean that you're not suicidal, but that issue of capability is one that's very difficult because we have a natural will to live, and that is the most difficult thing for people to overcome.Attorney Sprague (09:03):The thing that's the most difficult thing to overcome, that's the capability of actually committing suicide, is that what you're saying?Witness, Doctor (09:09):Correct.Attorney Sprague (09:10):And this theory in the three parts, did you compare what Ms. Clancy told you and what you saw in the records to this theory and have any conclusions about that?Witness, Doctor (09:23):Yes.Attorney Sprague (09:24):And what were they?Witness, Doctor (09:25):Well, certainly the documentation from the medical and mental health records demonstrates that sense of isolation she felt, even in the company of others.(09:39)That sense that she was just having a problem that was difficult. Difficult for her to understand, difficult for others to understand, and, of course, the suicidal feelings that came about, and then ultimately those feelings about harming her children. This is not something that she could share.(10:10)The sense of burdensome-ness, she had planned to go back to work as she had for her first two children, Cora and Dawson. And the time that she was expecting to go to work kept extending because she just did not feel mentally healthy enough to be able to return to work and to function.(10:38)And so, in some of the documentation where she filled out concerns and was asked about the kind of stressors in her life, she indicated that financial was one of the stressors that she was encountering.(10:58)So, to believe that her brain had been damaged, that she was not able to do what she loved, which was labor and delivery nursing, but also not in a position to help support the family, really would be a burden for anyone. And certainly that sense of burdensome-ness was something that I believe she was experiencing.(11:29)And then the last component, capability, I truly believe that her suicide attempt was very, very serious, which is why she employed three different methods. The fact that the use of the knife and the lacerations were not deep doesn't mean that she wasn't intending to kill herself with a knife. But oftentimes that, as I mentioned, is the most difficult thing.(12:06)I think the employment of the three different avenues, locking the door and also not being dressed for the cold, indicate to me that this attempt was very, very serious, despite the fact that the use of the knife was not successful in cutting her arms, cutting her neck.Attorney Sprague (12:35):And so, Doctor, in terms of the cutting on the arms and the neck not being sufficient to cause death, is that what you're referring to is that as someone faces difficulty or an inability to be capable of actually following through to commit suicide?Witness, Doctor (12:52):Correct.Attorney Sprague (12:54):So, in this case, it's your opinion that she was trying to commit suicide, but struggling with that third capability issue?Witness, Doctor (13:03):Correct.Attorney Sprague (13:08):Now, you testified yesterday about the intrusive thoughts that Ms. Clancy was having about harming herself in the fall leading up through December into January. And those thoughts at times, would it be accurate to state that Ms. Clancy reported at times that taking Ativan helped with those thoughts?Witness, Doctor (13:32):Yes.Attorney Sprague (13:33):And was there anything significant in your review of the case in terms of her reporting that Ativan helped her with those thoughts?Witness, Doctor (13:42):Yes.Attorney Sprague (13:42):How so?Witness, Doctor (13:43):So, Ativan is a Lorazepam, a benzodiazepine. This is a medication that is very helpful for treating anxiety. It also can help relax people, help them sleep, which was very helpful to Ms. Clancy.(14:04)And she stated that when she had the intrusive thoughts, taking the Ativan resolved those thoughts. And I think that's significant because it's not a medication. Ativan, Lorazepam is not an antipsychotic medication. It's not meant to treat psychosis. It make people feel more calm, and sometimes it's used for people who are having significant symptoms. But in terms of actually treating psychosis, making a voice go away, it's just not designed to do that.Attorney Sprague (14:49):And Doctor, did the fact that the intrusive thoughts went away when taking the Ativan, according to Ms. Clancy, give you further evidence that it was, in fact, internal thoughts and not an external voice?Witness, Doctor (15:04):Yes.Attorney Sprague (15:04):Now, if someone is experiencing psychosis and is experiencing command hallucinations, can that person still know the difference between right and wrong?Witness, Doctor (15:20):Yes.Attorney Sprague (15:20):How so?Witness, Doctor (15:26):Well, hallucinations, even command hallucinations when they occur, do not propel an individual to automatically obey them. And, in fact, many people will engage in behaviors to stop the actions that the voice is claiming.(15:55)That's something that makes sense, particularly when the command is just so serious and so against someone's values. So, it's possible and common for people to engage in behaviors to avoid doing what a command hallucination is saying.Attorney Sprague (16:31):And, Doctor, is it possible for someone who is experiencing psychosis and command hallucinations to conform their behavior to the law?Witness, Doctor (16:39):Yes.Attorney Sprague (16:41):And how so? Is it basically what you were just telling us?Witness, Doctor (16:44):Yes. If someone is having a command hallucination to do something out in public, but there is a police officer nearby, it certainly is possible for that person to choose not to engage in that behavior because of the consequences.(17:12)Even though a voice might be saying this, there's other decision-making going on based upon the environment.Attorney Sprague (17:22):Now, Doctor, in your evaluation of Lindsay Clancy, did you come to an opinion to a reasonable degree of medical certainty as to whether or not she was suffering from a mental disease or defect on January 24th, 2023?Witness, Doctor (17:36):Yes.Attorney Sprague (17:37):And what was that opinion?Witness, Doctor (17:39):I believe that Ms. Clancy was suffering from a mental disease or defect. And I felt that based upon the presentation, a Bipolar II diagnosis seemed to make the most sense given the symptoms of insomnia that she had that were precipitated by the Zoloft.(18:07)And this was just very, very significant. And while it didn't fulfill all the criteria or many of the criteria, if she were a patient of mine, I would diagnose her as Bipolar II, because I would want to make sure that any doctor who saw her afterwards would be very wary of using an SSRI antidepressant in treating her.Attorney Sprague (18:41):And, Doctor, you mentioned the drug effects, Zoloft had an effect and SSRIs might have an effect. Is there a difference when you're treating someone and they're taking medications between being overmedicated and having an adverse reaction to medication?Witness, Doctor (18:59):Yes.Attorney Sprague (19:00):And what is the difference?Witness, Doctor (19:02):Well, when we think about side effects, that is an example of a medication having a response. Now, sometimes we have side effects when we're not necessarily overmedicated, but we put up with those side effects.(19:21)When there is too much medication, certainly. We can experience those side effects. For example, over sedation, or there are some medications that can cause stimulation, so people are not able to sleep.(19:40)An adverse reaction is much more serious. An adverse reaction could be, for example, an allergic reaction that could cause death. Or some type of reaction that you don't see in most people, but has been reported.(20:06)So, there is a difference between side effects, no matter how difficult they are, and what we would call, adverse effects, which can be extremely serious.Attorney Sprague (20:22):And in your review of the records of the medications that the Defendant was prescribed from September through December, did you see any evidence of her having adverse effects from the medication?Witness, Doctor (20:44):Well, the insomnia secondary to the Zoloft was very concerning to me, and it would mean not just cutting the Zoloft back, but stopping it.(20:56)I would say that the Zoloft was precipitating insomnia. I mean, she reported 48 hours straight of not being able to sleep, but that was an adverse effect. And an adverse effect really requires one to stop the medication.Attorney Sprague (21:15):And that is what Dr. Jennifer Tufts did with Ms. Clancy, correct? She had her stop the medication?Witness, Doctor (21:21):Correct.Attorney Sprague (21:23):And in reviewing those records again from September through December of 2022, did you see any evidence that Ms. Clancy was overmedicated?Witness, Doctor (21:49):She experienced some significant side effects from some of her medications. She was given, I think Nurse Practitioner Paul gave her Clonazepam, which is also a benzodiazepine.(22:06)And she really had a uncomfortable reaction to that, just woke up and felt quite confused. So, she stopped that medication, understandably. Seroquel is a medication, quetiapine, that at high doses can cause some significant side effects. At lower doses, it generally helps treat insomnia. At higher doses, it can have more significant effects and in terms of just ability to think and organize one's thoughts.(23:11)However, Ms. Clancy in December of 2022 chose at that time to continue on Seroquel, a combination of Seroquel and Valium. Nurse Practitioner, Julotta, had suggested another medication, olanzapine, Zyprexa, which she's taking now, and Ms. Clancy asked that she continue on the Seroquel at that point and the Valium.(23:51)So, it's a challenge. One has side effects, but one also sees benefit in the medication. And certainly that combination at that time, I think it was around December 7th, December 9th, that was really helping her sleep. And so, she asked to continue on those two medications.Attorney Sprague (24:15):So I guess when I ask about overmedication and you talk about the side effects of the medication, there seems to be a disconnect between maybe what a lay person calls overmedicated versus what the medical definition of that is.(24:30)So, is what you're saying that being overmedicated medically means having side effects to the medication?Witness, Doctor (24:40):Well, no, not necessarily.Attorney Sprague (24:44):So, what does overmedicated mean to you in your profession?Witness, Doctor (24:50):Well, if someone were to prescribe a medication that was beyond the limit that safely can be prescribed. For example, it's possible to be toxic on say, lithium, which is a medication that she took for a while while she was at Tewksbury.(25:15)And if I were prescribing, say, 1,200 milligrams of lithium twice a day and her lithium level was toxic as it would likely be, that would clearly be an example of overmedication.Attorney Sprague (25:35):And did you see any evidence of that scenario in the Defendant's records that she was prescribed too high a dose to make her be at a toxic level of any medication?Witness, Doctor (25:53):I think those who were prescribing for her were responding to the symptoms that she was bringing. There was a kind of a rapid increase in the dose of Seroquel.(26:09)And that higher dose of Seroquel was... I believe she was ultimately prescribed at 400 milligrams and she never ended up taking that. But, as a clinician, we do our best to try and treat symptoms.Attorney Kevin Reddington (26:36):Objection.Attorney Sprague (26:37):So, Doctor, did you see-Judge William Sullivan (26:37):Next question.Attorney Sprague (26:39):Doctor, did you see, other than the Seroquel, any medications that the amount that was prescribed, you would think would be over medication?Witness, Doctor (26:50):No.Attorney Sprague (26:51):And then the Seroquel itself, you said she was prescribed up to 400 milligrams, but she reported that she never took that amount, correct?Witness, Doctor (26:57):Correct.Attorney Sprague (26:59):And after her stay at McLean Hospital, she had been weaned off of the Seroquel, correct?Witness, Doctor (27:05):That's right.Attorney Sprague (27:06):And the only medications immediately after leaving McLean Hospital were Trazodone and Valium, correct?Witness, Doctor (27:14):Correct.Attorney Sprague (27:15):Dr. Tufts added a medication as a result of her appointments with the Defendant in January, is that correct?Witness, Doctor (27:24):That's right.Attorney Sprague (27:25):And what was that medication?Witness, Doctor (27:27):That was amitriptyline, also known as Elavil.Attorney Sprague (27:31):And you saw what the initial dose of that was, correct?Witness, Doctor (27:35):Correct.Attorney Sprague (27:36):What was that?Witness, Doctor (27:37):The initial dose from Dr. Tufts was 10 milligrams.Attorney Sprague (27:41):Is that a high dose for an adult?Witness, Doctor (27:44):No, it's the very smallest dose possible.Attorney Sprague (27:49):And then did Dr. Tufts increase that dose?Witness, Doctor (27:54):Yes.Attorney Sprague (27:54):And when was that?Witness, Doctor (27:56):After a week, she increased the dose from 10 milligrams to 20 milligrams.Attorney Sprague (28:01):And is that a significant increase in the dose?Witness, Doctor (28:04):No.Attorney Sprague (28:05):Is 20 milligrams a significant or large dose for an adult?Witness, Doctor (28:10):Not at all.Attorney Sprague (28:11):10 milligrams or 20 milligrams of amitriptyline, is that something you could even prescribe to a child?Witness, Doctor (28:19):Yes.Attorney Sprague (28:25):Now, Doctor, based on your review of all of the records and your meetings with Ms. Clancy and your collateral interviews, did you form an opinion to a reasonable degree of medical certainty as to whether or not Lindsay Clancy on January 24th, 2023, could appreciate the difference between right and wrong?Witness, Doctor (28:45):Yes.Attorney Sprague (28:46):And what was that opinion?Witness, Doctor (28:48):My opinion is that she did have the capacity to appreciate right from wrong.Attorney Sprague (28:54):And what do you base that on?Witness, Doctor (28:57):Well, on a number of things. Ms. Clancy had just met with her psychiatrist, Dr. Tufts, the day before. And in that discussion with Dr. Tufts, as documented, she denied suicidal ideation, and she also denied thoughts of harm to others.(29:21)And also, there was an ongoing conversation regarding future possible treatments, esketamine or TMS, which I spoke about yesterday, that could be employed to help her.(29:41)Also, with regard to the appreciation between right and wrong, the planning involved prior to the strangling of her children, I thought was significant.(29:59)The searches for distance of ThreeV, the searches of CVS, all done prior to her sending fairly late in the afternoon a text asking her husband if he didn't mind takeout from ThreeV and then adding on. So, that planning, that preparatory planning, I thought was significant.(30:38)The avoidance of witnesses. A witness during a time when one is committing a crime can intervene, not just report, but also intervene. And so, the fact that this was done without any witness present during a time where she had asked the potential witness to go on a longer errand, also I thought was significant.(31:08)Concealment is another thing that I think indicated an understanding of right and wrong. I mean, the children were strangled all in the basement. And according to Mr. Clancy, the door to his office had been closed when he arrived to the basement.(31:36)Timing. Timing was really, really significant in this. There was a window of time that Ms. Clancy was aware of in which she would need to kill her three children as well as to kill herself, which she expected would happen. She was conscious of time and told me that she had mapped out the distance, et cetera, because she didn't want her husband to be gone too long. But in this case, I think the issue of time and her husband returning rather than being a solution for her was a problem. And so, to accomplish all of this in the course of that amount of time that Mr. Clancy was gone, I thought was significant, really showed an awareness of time.(32:46)In terms of the weapons used, now these were exercise bands, but they were all near where the children were strangled. They were placed there. That's where they kept those exercise bands.(33:03)And the exercise bands were nearly identical. I mean, very similar in terms of what they could do as ligatures. And so, that use of weapons that were readily available and nearby also was significant to me in terms of her understanding of and planning.(33:33)I did not see any evidence that she had delusions about her children, delusions as to something wrong with them or something that required them, because of a delusion, that they needed to die. I don't recall that she ever spoke about her children in a delusional way.Witness, Doctor (34:00):... spoke about her children in a delusional way. Now-Attorney Kevin Reddington (34:07):[inaudible 00:34:09].Speaker 1 (34:10):Sure. Next question.Attorney Sprague (34:11):Were there other factors that influenced your opinion that she knew the difference between right and wrong?Witness, Doctor (34:16):Yes.Attorney Sprague (34:17):And what were they?Witness, Doctor (34:18):Well, the phone call at what, 5:34 in the afternoon, I thought was significant. So Mr. Clancy was at CVS and he called his wife and she did not pick up, she did not answer, but she called him back and had that ability to deviate from what she was doing to be able to respond. And so had the presence of mind to do that, but also to conceal from him what was going on.(35:05)Locking the door is another example. I mean, certainly Ms. Clancy was aware of time and the limited amount of time to accomplish this. But by locking the door, it kept her husband from being able to enter the bedroom and therefore being able to see what had happened. So delayed that time. On arrival, her husband asked her what happened and she did not confess. She did not tell him what had happened other than I tried to kill myself. She also did not report auditory hallucinations, but rather said that the children were in the basement. It's my belief that she expected to die and that by the time Mr. Clancy arrived, she would have successfully been able to take her life.Attorney Sprague (36:13):And sir, did you form an opinion to an unreasonable degree of medical certainty as to whether or not Lindsay Clancy on January 24th, 2023 had the ability to conform her behavior to the requirements of the law?Witness, Doctor (36:28):Yes.Attorney Sprague (36:28):And what is that opinion?Witness, Doctor (36:31):Well, if we look at that day, we know that in the morning, she took Cora to a pediatrician's appointment. And all physicians receive training in psychiatry, no matter what specialty they go in. That's part of medical school. And so like other doctors who had seen her who were not psychiatrists at appointments and whatever, the pediatrician also did not notice any unusual things about her. She was able to conform to the type of behavior that a concerned mother would engage in. She was able to drive to the pediatrician's office and then back.(37:26)And the day was really one of significant control. The activities that she engaged in that day, spending time with her children with Play-Doh, taking them outside to build a snowman, sending photographs of the children to her mother, to her husband on Instagram. Fixing lunch and also fixing dinner for the children. So the activities of that day were controlled, as were the activities in terms of the planning that we already mentioned. So throughout the day, she was methodical and quite controlled and organized even in that space of time that was short. There was a lot to do in terms of killing her children and also killing herself.(38:37)And I would say that the last point with regard to conforming to the law is that when she received the phone call from her husband, she did not report to him that she was in distress, that she was having hallucinations, that she needed help. So with that phone... By calling her husband back and reassuring him by the fact that yes, she knew the medication, whatever, that helped guarantee that he would continue on the errands. Had she not called him back, it certainly was possible that he would be concerned enough that he would return home. And so I think the phone figures in just in terms of her awareness and conforming her behavior such that the strangling of her children could be concealed.Attorney Sprague (40:00):And, Doctor, did you form an opinion to a reasonable degree of medical certainty as to whether Lindsay Clancy on January 24th, 2023 when she strangled her children was criminally responsible?Witness, Doctor (40:12):Yes.Attorney Sprague (40:12):And what is that opinion?Witness, Doctor (40:14):Yes. It is my opinion within a reasonable degree of medical certainty that Ms. Clancy was criminally responsible.Attorney Sprague (40:23):Move to submit Dr. Saathoff's CV as the next exhibit.Speaker 1 (40:28):Any objection, counsel?Attorney Kevin Reddington (40:28):No.Speaker 1 (40:28):All right. That may be admitted.Attorney Sprague (40:30):I have no further questions. Thank you.Speaker 1 (40:33):Okay. Hold on a sec, Mr. Reddington.Attorney Sprague (40:34):[inaudible 00:40:43].Speaker 1 (40:46):Thank you. All right, Counsel.Attorney Kevin Reddington (40:46):Good morning.Witness, Doctor (40:51):Good morning.Attorney Kevin Reddington (41:01):So Dr. Saathoff, as I understand it, you conducted your investigation or examination of Lindsay by Zoom, correct?Witness, Doctor (41:15):Did you say by June?Attorney Kevin Reddington (41:17):Sorry, Zoom.Witness, Doctor (41:17):By Zoom. Okay.Attorney Kevin Reddington (41:18):Zoom. [inaudible 00:41:19].Witness, Doctor (41:20):I thought you said because it was the 4th of June. Yes, sir.Attorney Kevin Reddington (41:23):Okay. And can you tell us when you were first engaged by the district attorney's office to assist them in this case?Witness, Doctor (41:34):I first was informed about the case, I think in January or early February of 2026, of this year. The final contract with the university was not completed, as I recall, until April.Attorney Kevin Reddington (41:59):And is that a matter of significant import when you're engaged in evaluating a young woman that's charged with triple homicide and you're hired by the government, the fact that there's a contract that wasn't signed by your school?Witness, Doctor (42:17):Well, sometimes it's a long process that I don't have any control over.Attorney Kevin Reddington (42:25):Sure. I understand.Witness, Doctor (42:26):I've seen those kinds of things take a while, take longer than one would necessarily want.Attorney Kevin Reddington (42:32):So the contract with your school that you're talking about would be the contract for your compensation, for your opinion?Witness, Doctor (42:43):Well, I would never be contracted for an opinion.Attorney Kevin Reddington (42:47):Okay. But you're getting paid, right?Witness, Doctor (42:51):No, I'm getting paid a salary.Attorney Kevin Reddington (42:53):Yes.Witness, Doctor (42:54):The university's getting paid.Attorney Kevin Reddington (42:55):And the university is deriving a benefit monetarily from your testimony or working on this case for the DA, right?Witness, Doctor (43:04):That's right.Attorney Kevin Reddington (43:05):All right. And how much did the university get as a result of your involvement in this case?Witness, Doctor (43:12):I don't know what the hourly rate is that they charge.Attorney Kevin Reddington (43:16):So you don't know what the hourly rate for your time is, right?Witness, Doctor (43:20):Correct.Attorney Kevin Reddington (43:20):You don't know how much money was paid by the district attorney's office to the university, right?Witness, Doctor (43:25):Correct.Attorney Kevin Reddington (43:26):You don't know how much money will be paid for perhaps yesterday, today, whatever balance billing. You don't know that either, right?Witness, Doctor (43:34):That's right.Attorney Kevin Reddington (43:34):You were retained or engaged in January of '26, right?Witness, Doctor (43:39):Yes.Attorney Kevin Reddington (43:39):This is an incident that occurred on January of '23, right?Witness, Doctor (43:45):Yes.Attorney Kevin Reddington (43:45):In January of '23 to January of '26, three years-Witness, Doctor (43:51):That's right.Attorney Kevin Reddington (43:51):... to being engaged on the case, right?Witness, Doctor (43:54):Correct.Attorney Kevin Reddington (43:55):And when you were engaged on the case, at some point, the university must have been out of the picture and you must have started to communicate with the DA's office, the police or whoever.Witness, Doctor (44:06):That's right.Attorney Kevin Reddington (44:07):And you knew about this case, it had a significant amount of publicity, right?Witness, Doctor (44:12):Yes.Attorney Kevin Reddington (44:13):Did you know that other doctors, on behalf of the district attorney's office, were being hired to also evaluate Lindsay?Witness, Doctor (44:22):I didn't specifically know that, but that's usually the case.Attorney Kevin Reddington (44:27):Is it important to see someone, to evaluate them as close in time as the incident is alleged to have occurred to your evaluation, or does it matter? In other words, is it better to see someone within a month or two after an incident or three, three and a half years later?Witness, Doctor (44:53):Well, what's most important is the collateral information that was gathered at the time to understand what was going on at the time. Ms. Clancy's behavior during her hospitalization and the like, there are records, but certainly there are benefits to an examination closer to the event.Attorney Kevin Reddington (45:19):And you would agree with me, sir, that you actually saw and questioned or interrogated Lindsay, what, two months ago?Witness, Doctor (45:34):May 29th and June 4th.Attorney Kevin Reddington (45:36):Okay. And when you went to interview her in purposes of your evaluation, you had already accessed the collateral information, sir?Witness, Doctor (45:49):Yes.Attorney Kevin Reddington (45:51):Before I go there, let me just review a few things here on your CV, which the jurors will have to examine. You indicated to us your present employment, you have a private practice as a psychiatrist?Witness, Doctor (46:07):No.Attorney Kevin Reddington (46:08):Okay. So where do you see patients?Witness, Doctor (46:11):Well, I see patients in the prison system.Attorney Kevin Reddington (46:17):They're your patients?Witness, Doctor (46:19):Yes.Attorney Kevin Reddington (46:20):What do you do for those people that are in jail?Witness, Doctor (46:24):In prison within the Virginia Department of Corrections, we have inmates within the prison system who suffer from mental illness and require assessment and treatment.Attorney Kevin Reddington (46:40):I see. When you said to the jury a little while ago, "If I'm treating my patient, I would prescribe a particular prescription for my patient and I wouldn't tell my patient to do," whatever it is you said, it's not people that go to an office or see you or even on the television to be treated. These are people that are in jail, right?Witness, Doctor (47:03):Prison, yes.Attorney Kevin Reddington (47:05):So there's a difference between jail and prison, right?Witness, Doctor (47:07):Yes.Attorney Kevin Reddington (47:09):And this would be in Virginia, is it?Witness, Doctor (47:11):Correct.Attorney Kevin Reddington (47:12):So you're dealing with people that are serving hard time in the Iron Mansion, as they say. It's not a house of correction down the street, right?Witness, Doctor (47:24):I see patients who have different varying sentences. Some have life sentences. Some are scheduled for release in the coming months, so that really varies.Attorney Kevin Reddington (47:40):And you work on behalf of the state to evaluate prisoners to determine whether or not they are fit, if you will, to be released into society, right?Witness, Doctor (47:57):Once someone's sentence is over, the only way that they could be continued within a prison system would be to be committed to a psychiatric hospital. And I would say that in the 34 years that I've been treating inmates who are patients, I can only recall two times where when discharge came up, their condition was such that they required to be civilly committed because of mental illness.Attorney Kevin Reddington (48:31):And when you are talking as a forensic psychiatrist evaluator, would that be on behalf of the BOP, Bureau of Prisons?Witness, Doctor (48:41):I have consulted with the Bureau of Prisons on just a few occasions, but Bureau of Prisons is federal and-Attorney Kevin Reddington (48:51):Yeah, I know that.Witness, Doctor (48:51):... most of my work has been with the state.Attorney Kevin Reddington (48:53):Okay. But on your resume, sir, you indicate from 2019 through the present, that's a number of years, that you have been employed or engaged as a forensic psychiatrist evaluator on behalf of the United States Bureau of Prisons as it relates to probation or parole. Is that in your resume?Witness, Doctor (49:16):Yes.Attorney Kevin Reddington (49:16):And that means, sir, that you evaluate inmates that are trying to get out of jail, and you would evaluate them to determine if they're appropriate for parole, right?Witness, Doctor (49:30):No.Attorney Kevin Reddington (49:31):Okay. So when you indicate on your resume from 2019 through the present, you were employed as a forensic psychiatrist evaluator for the United States Bureau of Prisons, how many of these evaluations did you do in the years from 2019 through 2026, seven years?Witness, Doctor (50:02):I think I've done two or three.Attorney Kevin Reddington (50:07):Two or three?Witness, Doctor (50:08):Yes.Attorney Kevin Reddington (50:09):Okay. 2016 through 2022, you're engaged as a consultant psychiatrist for the Elson Student Health Center. What is that?Witness, Doctor (50:21):That's the Student Health Center at the University of Virginia, so that serves students who are at the university.Attorney Kevin Reddington (50:32):Like what? I mean, do you evaluate them? Do you treat them? Do you analyze them? What do you do for college students?Witness, Doctor (50:41):My work with the university and the health center really had to do with students who were having difficulty and had left the university and were interested in getting back. And so I was part of a three person panel to evaluate the students to see whether or not it would be appropriate to bring them back to the university.Attorney Kevin Reddington (51:10):Were they thrown out of the university or they were disciplined or something? Why would you bring them back? What does that mean?Witness, Doctor (51:18):Well, if there was an event that caused concern, potentially was a threat, for example, then just for the student safety and the safety of all, they would leave the university in order to get the type of care that they needed. And then if they want to come back, then I was part of a panel that would evaluate these students and make a determination about whether it was safe for them to come back.Attorney Kevin Reddington (51:57):I'm sorry, I cut you off. Go ahead.Witness, Doctor (51:59):Yeah. No, that's all right.Attorney Kevin Reddington (52:01):Okay. These are students, right?Witness, Doctor (52:03):Correct.Attorney Kevin Reddington (52:03):In college, right?Witness, Doctor (52:04):That's right.Attorney Kevin Reddington (52:05):That have been thrown out or disciplined or suspended or something, and they're trying to get back into school, right?Witness, Doctor (52:11):That's right.Attorney Kevin Reddington (52:12):And when the parents of the students come, they retain you to advocate on their behalf?Witness, Doctor (52:17):No.Attorney Kevin Reddington (52:17):No, you work for the school, right?Witness, Doctor (52:19):Correct.Attorney Kevin Reddington (52:20):You evaluate them and then back the school up so that these kids can't get back into the school, right?Witness, Doctor (52:29):Can you ask that question again?Attorney Kevin Reddington (52:30):No, that's all right. 1999 through the present, you work for the United States Department of Justice, the United States Department of State, right?Witness, Doctor (52:41):Yes.Attorney Kevin Reddington (52:41):Okay. And that would be the United States Attorney's Office, the prosecutors. They're the state prosecutors, you get federal prosecutors, right?Witness, Doctor (52:50):Well, federal prosecutors and defenders. I've worked with both.Attorney Kevin Reddington (52:55):Well, the defenders certainly don't work for the United States Department of Justice or the United States Department of State, do they?Witness, Doctor (53:03):I was under the impression that federal public defenders were under the umbrella of the Department of Justice.Attorney Kevin Reddington (53:11):No, that's called the CJAC. That would be a totally different group of people. Those are people that defend people to try to have them not be abused by the system, if you will.Attorney Sprague (53:21):Objection.Speaker 1 (53:22):Yeah, that question will be stricken.Attorney Kevin Reddington (53:24):2015, you're a psychiatric consultant for the Virginia Office of the Attorney General, another prosecuting arm, right?Witness, Doctor (53:34):Yes.Attorney Kevin Reddington (53:36):2013, Virginia Department of Corrections, Least Restrictive Measures for Segregation. You evaluate people to determine if they should be in like max or disciplinary unit as opposed to general population, is that what you do?Witness, Doctor (54:00):Yes, I've been asked to do that.Attorney Kevin Reddington (54:02):Okay. And you certainly don't advocate on behalf of the prisoners that are being placed in seg or being placed in those closed units with higher security, right?Witness, Doctor (54:14):No, that's not true at all.Attorney Kevin Reddington (54:17):The National Security Expert 2007 to the present, Oak Ridge United Associated Universities, what is that?Witness, Doctor (54:28):Yes, that is a group that does research with the Behavioral Analysis Unit and the National Center for Analysis of Violent Crime, and I have done work with them.Attorney Kevin Reddington (54:45):Okay. Critical Incident Analysis Group, CIAG, University of Virginia?Witness, Doctor (54:51):Yes.Attorney Kevin Reddington (54:52):Okay. Behavioral Analysis Unit, as you told us yesterday for the FBI at Quantico, right?Witness, Doctor (54:58):That's right.Attorney Kevin Reddington (54:59):Psychiatric consultant to the Virginia Department of Corrections, medium, maximum, and super max facilities, right?Witness, Doctor (55:07):Yes.Attorney Kevin Reddington (55:08):Continuing on with your experience, sir, as a witness in this case, you agree with me that you were involved as a psychiatric consultant with the Macro Task Force onsite consultation for the Australian Police Service?Witness, Doctor (55:23):Yes.â€Attorney Kevin Reddington (55:25):Former Soviet Union Project, Republic of Georgia, T-B-I- L-I-S-I, Georgia. You were involved with that, sir?Witness, Doctor (55:34):Tbilisi.Attorney Kevin Reddington (55:35):Tbilisi, yeah. Critical Incident Response Group for the US Air Force, you're in the Assessment Unit?Witness, Doctor (55:43):Yes.Attorney Kevin Reddington (55:45):Crisis Management Unit, Investigative Support for Operation Gray Sunset Jordan?Witness, Doctor (55:53):Correct.Attorney Kevin Reddington (55:54):Crisis Management Unit, Investigative Support Unit, Critical Incident Response in Montreal, Quebec?Witness, Doctor (56:01):Yes.Attorney Kevin Reddington (56:02):FBI, National Center for Analysis of Violent Crime Operation New Hope?Witness, Doctor (56:07):Yes.Attorney Kevin Reddington (56:11):Bureau of Criminal Investigation, that's BCI, for the Department of the State Police, would that be Virginia?Witness, Doctor (56:17):Yes.Attorney Kevin Reddington (56:19):You also have an interest in and have studied or written about various topics in your career, correct?Witness, Doctor (56:33):Yes.Attorney Kevin Reddington (56:36):Okay. Hostage Negotiations Course, Crisis Management Unit, you were involved with that, is that correct?Witness, Doctor (56:43):Correct.Attorney Kevin Reddington (56:43):That was a number of years ago though. I guess that was like 1996.Witness, Doctor (56:47):That's right.Attorney Kevin Reddington (56:48):But you've been involved with the FBI for a long time, right?Witness, Doctor (56:50):Yes.Attorney Kevin Reddington (56:51):Fair to say that you're a government man?Attorney Sprague (56:54):Objection.Speaker 1 (56:55):Sustained.Attorney Kevin Reddington (56:57):Hostage negotiation course. How about Virginia Department of State Police? You involved with them as well, sir? Yes?Witness, Doctor (57:07):Yes.Attorney Kevin Reddington (57:08):Advisory positions. You deal with Islam in Prison is one of your interests, right? That was a TV program or something?Witness, Doctor (57:18):Correct.Attorney Kevin Reddington (57:20):Talk about National Institute for Justice, standing committee to advise the Department of State on unexplained health effects on US government employees and their families overseas, right?Witness, Doctor (57:35):Yes.Attorney Kevin Reddington (57:36):Analysis of pre-attack behaviors of the Las Vegas Shooter Behavioral Analysis Unit for the FBI?Witness, Doctor (57:44):Yes.Attorney Kevin Reddington (57:45):Skipping ahead, papers published. Now, when a doctor or a psychiatrist, or any doctor really, I guess, publishes a paper that's of interest to other doctors or people, that's called a learned treatise, right? Peer review?Witness, Doctor (58:07):Yes.Attorney Kevin Reddington (58:08):Okay. Can you tell me, what is peer review? What does that mean when you're dealing with a person's focus and interest in writing about what they're focused on?Witness, Doctor (58:18):So a peer review journal is one in which once an article is submitted, a paper for publication, that goes to qualify people within the same field who review it and make determinations about the quality and whether or not it should be published. Oftentimes, there will be some edits or suggested edits from those who have expertise. It's a blind process, so if I submit a paper and it's peer reviewed, I don't know necessarily at all who is reviewing it, but it's a way to ensure quality of articles that are published, and that's just an important standard.Attorney Kevin Reddington (59:10):So it's kind of a rigorous standard to make sure that what you're writing about is reliable and would be helpful to others that are interested in it, right?Witness, Doctor (59:18):Correct.Attorney Kevin Reddington (59:19):Okay. So for example... But also it depends on where you're publishing it. You can put something in the National Enquirer or you could put it in International Psychiatric something or other, which would be a better publication.Witness, Doctor (59:33):I don't think The Enquirer is peer reviewed, but.Attorney Kevin Reddington (59:35):So you certainly would agree with me that the International Journal of Law and Psychiatry is a respected source for learning treatises, right?Witness, Doctor (59:45):Yes.Attorney Kevin Reddington (59:46):And you would agree with me, sir, that you've been in here telling this jury all about Lindsay and how she didn't hear voices or did hear voices or exaggerated and lied. Have you written any articles at all on the concept of auditory hallucinations?Witness, Doctor (01:00:02):No.Attorney Kevin Reddington (01:00:03):Have you read any of them?Witness, Doctor (01:00:05):Read any articles? Yes.Attorney Kevin Reddington (01:00:07):Yeah. Okay. You certainly have heard of Dr. Phillip Resnick, yes?Witness, Doctor (01:00:12):Yes.Attorney Kevin Reddington (01:00:12):And fair to say, tell me if I'm wrong, is he literally a world known authority in your field for filicide or the killing of children by their parents?Witness, Doctor (01:00:24):Yes, he's well known.Attorney Kevin Reddington (01:00:26):And is he also well-written as far as auditory hallucinations, same stuff you've been testifying about?Witness, Doctor (01:00:35):Yes.Attorney Kevin Reddington (01:00:36):And he published an article in the International Journal of Law and Psychiatry, which is considered to be, if you know, a landmark article about, and I captioned, "Listening to voices: the use of phenomenology to differentiate malingered from genuine auditory verbal hallucinations." Now, did you read that article?Witness, Doctor (01:01:03):Yes.Attorney Kevin Reddington (01:01:04):So it is a peer-reviewed article published in a recognized journal, correct?Witness, Doctor (01:01:11):Correct.Attorney Kevin Reddington (01:01:11):Your Honor, I would offer this under Commonwealth versus need for the jury if they wish.Attorney Sprague (01:01:16):Objection.Speaker 1 (01:01:18):Counsel, can I see at sidebar?Attorney Kevin Reddington (01:01:43):Your Honor, while the copy is being made for the district attorney, could I continue?Speaker 1 (01:01:48):Sure.Attorney Kevin Reddington (01:01:49):Thank you. Leaving aside peer review article and the article written by Dr. Phillip Resnick, sir, for a minute, papers that you published and you have in your resume, it says peer reviewed, so that's just what we were talking about, right?Witness, Doctor (01:02:05):That's right.Attorney Kevin Reddington (01:02:05):All right. Using the Moral Situational Action Model of Extremist Violence to Assess Fluctuating Levels of Risk in Women: The Relevance of Risk, Promotive, and Protective Factors, what does that mean, levels of risk in women with extremist violence?Witness, Doctor (01:02:35):We're looking at risk assessment in terms of violence and what may be mitigating factors, in other words, decreasing the risk or the threat or increasing, that would be enhancing factors, but this is looking at a group in terms of research.Attorney Kevin Reddington (01:02:59):And it's research about women that are involved with extremist violence?Witness, Doctor (01:03:04):Yes.Attorney Kevin Reddington (01:03:05):Okay. Assessing... Strike that. Using the Moral Situational Action Violence Risk Model for Assessing Women Involved in Extremist Violence and Empirical Study, is that a similar article?Witness, Doctor (01:03:21):Yes.Attorney Kevin Reddington (01:03:23):Operationalizing Theory: A Moral Situational Action Model for Extremist Violence. That would include guys plus women, I guess, right?Witness, Doctor (01:03:31):I'm sorry?Attorney Kevin Reddington (01:03:32):That would include men plus women, I guess, right because-Witness, Doctor (01:03:34):Yes.Attorney Kevin Reddington (01:03:35):... it doesn't say women. Suicide Terrorism: Performance Violence as Public Plunge. You wrote that, right?Witness, Doctor (01:03:44):Correct.Attorney Kevin Reddington (01:03:45):It's another interest there. Crisis Leadership and Military Community Resilience. Wrote that, right?Witness, Doctor (01:03:52):Correct.Attorney Kevin Reddington (01:03:52):Painting by numbers: Capturing the Pathology of Sociopolitical Conflict Dealing with Depression Amongst Palestinians, you wrote that, right?Witness, Doctor (01:04:04):Correct.Attorney Kevin Reddington (01:04:06):Psychological Challenges of Bioterror, you wrote that, right?Witness, Doctor (01:04:11):Correct.Attorney Kevin Reddington (01:04:12):Trauma and Intergenerations Transmissions in Kuwait, you wrote that, right?Witness, Doctor (01:04:18):Yes.Attorney Kevin Reddington (01:04:19):Recognizing Borderline Personality Disorder in the Family Practice Setting, you wrote that, right?Witness, Doctor (01:04:24):That's right.Attorney Kevin Reddington (01:04:26):Mortality Among Elderly Patients Discharged from a State Hospital, it's one of your interests, right?Witness, Doctor (01:04:31):That's right.Attorney Kevin Reddington (01:04:33):Postpartum Psychosis Induced by Bromocriptine, that's the one that you told the jury about originally that you published 40 years ago, right?Witness, Doctor (01:04:45):Yes.Attorney Kevin Reddington (01:04:46):Okay. Morality and the Radicalization of Women, what is that? What was that all about?Witness, Doctor (01:05:03):Could I be refreshed with that?Attorney Kevin Reddington (01:05:04):Sure. I mean, you can look at your resume if you wish. I'm just going through it. It's under B, books and chapters. This one is the first one and it deals with radicalization of women, a handbook, I guess, for terrorism studies. You remember that? It was only four years ago.Witness, Doctor (01:05:25):Yes.Attorney Kevin Reddington (01:05:25):Okay. Application of Big Data for National Security: A Practitioner's Guide, you wrote that, right?Witness, Doctor (01:05:33):Correct. I was one of four editors.Attorney Kevin Reddington (01:05:36):Crisis Guide of Psychoactive Drugs and Poisons for the Crisis Negotiation Unit, you wrote that, right?Witness, Doctor (01:05:44):That's right.Attorney Kevin Reddington (01:05:44):International Handbook of Threat Assessment, right?Witness, Doctor (01:05:49):Yes.Attorney Kevin Reddington (01:05:50):Protection of Children During Armed Political Conflicts: A Multidisciplinary Perspective, right?Witness, Doctor (01:05:56):Yes.Attorney Kevin Reddington (01:05:57):The Negotiator's Guide, like when somebody's locked in a building and they're threatening to kill people or something, the Negotiator's Guide to Psychoactive Drugs Second Edition. You wrote a chapter on that, right?Witness, Doctor (01:06:08):That's right.Attorney Kevin Reddington (01:06:08):The Negotiator's Guide, and it goes on and on with the negotiators and things like that. Terrorism negotiators, right? Is it fair to say that's your focus?Witness, Doctor (01:06:18):Correct.Attorney Kevin Reddington (01:06:18):Well, I know you can talk about postpartum, but I mean, I'm asking you if your resume that you prepared, I imagine well before you were hired by this DA's office, sets forth your interest, right?Witness, Doctor (01:06:29):Yes.Attorney Kevin Reddington (01:06:30):Okay.Witness, Doctor (01:06:34):The characterization of negotiation as trying to stop killers is not accurate.Attorney Kevin Reddington (01:06:40):I'm probably wrong?Witness, Doctor (01:06:42):Not comprehensive.Attorney Kevin Reddington (01:06:47):I apologize. You see it on TV that negotiators and they're trying to help people that are being kidnappedWitness, Doctor (01:06:53):On a bridge, in crisis, something like that.Attorney Kevin Reddington (01:06:56):Just a few more, Doctor. Panels and symposia, you'd agree with, let's see, national security. I just want to run through a quick... Attachment theory, mental wellness as it relates to threat management, threat assessments, corrections, psychiatry presentations, substance abuse and misuse in prisons, perspective on providing medical support during conflict and chaos, targeted violence in the media, lessons from history, the profile of poisons, understanding the female extremist, crisis operations, leadership, how to fool doctors by injecting chemicals into muscle to obtain opioids, a prison inmate comes clean. Did I read all those topics correctly, sir?Witness, Doctor (01:07:43):Correct.Attorney Kevin Reddington (01:07:44):Invited lectures, talk about extremism, extremism, terrorism, the future of policing, children in long-term abductions, how to prevent terrorism, mass shooters, US prisoners, religious rights, religious radicalization, terrorism and the unknown enemy. Basically-Attorney Kevin Reddington (01:08:00):... terrorism and the unknown enemy, basically that's what your focus is, sir, correct?Witness, Doctor (01:08:07):No.Attorney Kevin Reddington (01:08:07):And that's coupled with your experience of the two people or so that you recall dealing with in your.... It's not a practice, but working for the Bureau of Prisons or the state for Virginia, the people that are in jail, that is the sum total, to be respected, of Dr. Sadoff, correct? I mean, you treated two people. You've written a lot about terrorism and other issues that we went through.Witness, Doctor (01:08:43):That's not at all a correct characterization.Attorney Kevin Reddington (01:08:46):Oh, I'm sorry. Because I read your resume right, right?Witness, Doctor (01:08:50):Yes.Attorney Kevin Reddington (01:08:50):Okay. And I related what you indicated to the jury, your experience when I asked you about patients or treating people. I said that right, right?Witness, Doctor (01:08:58):I've been treating patients and I continue to for the last 40 years.Attorney Kevin Reddington (01:09:03):Now, in all of your experience, sir, have you ever treated a woman suffering from postpartum psychosis?Witness, Doctor (01:09:14):Yes.Attorney Kevin Reddington (01:09:15):When?Witness, Doctor (01:09:15):In the late 1980s and also during the 1990s when I ran a unit in a state hospital.Attorney Kevin Reddington (01:09:33):So this would be women, 1980s, about 30 years ago or 20 years ago, depending on which one, in a prison that you were-Witness, Doctor (01:09:44):No.Attorney Kevin Reddington (01:09:45):Oh, was it?Witness, Doctor (01:09:46):In a state hospital.Attorney Kevin Reddington (01:09:47):State hospital.Witness, Doctor (01:09:47):Correct.Attorney Kevin Reddington (01:09:48):Were they committed? Were they there because they wanted to be there or were they committed by order of the court?Witness, Doctor (01:09:53):Yes.Attorney Kevin Reddington (01:09:55):Yes what?Witness, Doctor (01:09:55):Usually committed.Attorney Kevin Reddington (01:09:56):Okay. So other than that, sir, do you have any interest, writing, knowledge about postpartum depression, postpartum psychosis?Witness, Doctor (01:10:14):Well, it really is a requirement when you assess and treat women to be aware of their histories and making determinations. So that has continued really throughout my career. Men and women.Attorney Kevin Reddington (01:10:33):What did you just say? Can you repeat that again? You're treating women with what?Witness, Doctor (01:10:40):Treating women with psychiatric problems, serious illness, psychosis.Attorney Kevin Reddington (01:10:46):So when you define for the district attorney the concept of, let's say psychosis yesterday, were you referring, in any degree, to a woman who has had a baby and is in a period of postpartum depression, shall we say?Witness, Doctor (01:11:06):Yes.Attorney Kevin Reddington (01:11:06):Okay. And when and how were you treating those people?Witness, Doctor (01:11:15):That was during the period of 15 years when I ran a unit of men and women who came in with serious psychiatric symptoms.Attorney Kevin Reddington (01:11:27):So what would you do? Would you analyze them? Would you talk to them? Counsel them? What would you do while they're in the hospital?Witness, Doctor (01:11:39):Well, do a full assessment with a multidisciplinary team and make determinations about proper treatment, proper therapy, medications and the like to treat the symptoms.Attorney Kevin Reddington (01:11:55):And generally, what would the symptoms be, sir, in your experience?Witness, Doctor (01:12:00):Symptoms of postpartum depression?Attorney Kevin Reddington (01:12:04):Yeah.Witness, Doctor (01:12:05):Okay. Well, certainly within that period of time around birth or after birth, the DSM has a four-week period. Others expand that to as much as a year. But certainly depressive symptoms, postpartum are similar to the symptoms that you see in a regular depression. You can have suicidality, you can have guilt, changes in appetite, changes in weight, changes in concentration, changes in physical activity. You can also have significant problems with sleep, either sleeping too much or not enough. So these are depressive symptoms that come in the postpartum period and require assessment-Attorney Kevin Reddington (01:13:23):Are you aware, sir, in your practice or studies of the number of women that commit suicide during the postpartum period? Are you aware of that?Witness, Doctor (01:13:38):I can't quote you a figure.Attorney Kevin Reddington (01:13:40):Do you have any clue at all?Witness, Doctor (01:13:44):No.Attorney Kevin Reddington (01:13:47):Would you agree with me, sir, that one of the unfortunate components... who has had a baby and is suffering from postpartum depression and living with it, that can on a dime turn into postpartum psychosis very quick, right?Witness, Doctor (01:14:09):It can be rapid.Attorney Kevin Reddington (01:14:11):And you indicated, sir, that there, according to the DSM, is a four-week cutoff for symptomology. And then you mentioned that there are others. Is it the World Health Organization that you said that talks about a year?Witness, Doctor (01:14:26):Correct.Attorney Kevin Reddington (01:14:27):There are some other psychiatric organizations that talk about different periods of time, six weeks, eight weeks, right?Witness, Doctor (01:14:36):Correct.Attorney Kevin Reddington (01:14:40):So when a woman is dealing with these symptoms and goes to a doctor, or even you when you're treating, as you indicated, 15, 20 years ago you were treating, is it important to take a blood test?Witness, Doctor (01:14:54):I'm sorry, can you repeat that?Attorney Kevin Reddington (01:14:55):I'm sorry. My bad. Is it important to take a blood test?Witness, Doctor (01:14:58):Is it important to take a blood test?Attorney Kevin Reddington (01:15:00):Yeah. You just went through the whole thing about, we're going to have the team and they're going to evaluate and we're going to prescribe. I'm just asking, is it important to take a blood test of the patient?Witness, Doctor (01:15:10):It can be.Attorney Kevin Reddington (01:15:12):Based on what?Witness, Doctor (01:15:13):Based on the presenting symptoms, based on the history, based on medical history. For example, if someone has recently been in a hospital and been treated, there may not be a necessity for drawing blood again, depending on the types of symptoms that you encounter. It's not a standard that everyone who presents to a psychiatrist requires blood tests.Attorney Kevin Reddington (01:15:50):So if you're a psychiatrist who's been practicing private practice for about, I don't know, a month, maybe two, and is prescribing anti-psychotic medications, selective serotonin reuptake inhibitor medications, benzodiazepine medications to a young woman who is complaining of what the young woman perceives to be difficulties postpartum, is it important to take a blood test to find out what, if any, prescription drugs they have on board in their system?Witness, Doctor (01:16:28):To check and find out, did you say, what drugs are on board?Attorney Kevin Reddington (01:16:30):Yeah. I mean, you're treating this patient, right? And they're coming off this... Hypothetically with you, but they're coming off the street to see a psychiatrist for help, right?Witness, Doctor (01:16:41):Yes.Attorney Kevin Reddington (01:16:42):And if they're already been prescribed drug after drug after drug by a particular doctor with their two months of robust experience, is it a fair statement that you should take a blood test of that person?Witness, Doctor (01:16:57):Well, it really depends on the medication. There are some medications that really require blood tests because of levels and the like. Many psychotropic medications are not easily... There's not an easy test for the amount of medication in a system. So it depends on the circumstances and it depends on the medication. I mean, for example, lithium or carbamazepine or valproic acid, those are all mood stabilizers. Certainly taking a blood test would be very important. So it depends.Attorney Kevin Reddington (01:17:39):Depends. Can I just ask you to spell those two drugs that you just pronounced for the stenographer, please?Witness, Doctor (01:17:44):Carbamazepine?Attorney Kevin Reddington (01:17:45):Yeah.Witness, Doctor (01:17:46):C-A-R-B-A-M-E-Z-A-P-I-N-E.Attorney Kevin Reddington (01:17:54):Okay.Witness, Doctor (01:17:55):Valproic acid, V-A-L-P-R-O-I-C, acid, also known as valproate, V-A-L-P-R-O-A-T-E. And did I mention lithium?Attorney Kevin Reddington (01:18:10):That's not a hard one. The record has to be accurate, that's all.Witness, Doctor (01:18:13):Understood.Attorney Kevin Reddington (01:18:14):Okay. Now, Doctor, are there other tests in your experience that are or can be or should be administered to a young woman or a woman who's had a baby and is coming to a doctor like Dr. Tufts, for example? Are there other tests that can be administered to determine if in fact that person is suffering from postpartum depression?Witness, Doctor (01:18:42):I'm not aware of any specific test that specifically diagnoses depression years and years ago.Attorney Kevin Reddington (01:18:55):Postpartum depression, sir.Witness, Doctor (01:18:56):Pardon me?Attorney Kevin Reddington (01:18:57):Postpartum depression is my question.Witness, Doctor (01:19:00):Correct.Attorney Kevin Reddington (01:19:00):Correction. I know you want to say it's the same thing, but postpartum depression is my question.Witness, Doctor (01:19:06):And you're asking if there's a blood test for postpartum depression?Attorney Kevin Reddington (01:19:08):I'm asking if there's any tests at all that a psychiatrist can or should administer to the patient, coming to them for help.Witness, Doctor (01:19:19):Well, there's the Edinburgh scale, which is a self-report that patients fill out who are postpartum.Attorney Kevin Reddington (01:19:30):You look that up last night?Witness, Doctor (01:19:31):No.Attorney Kevin Reddington (01:19:32):No? You knew about the Edinburgh scale?Witness, Doctor (01:19:35):Yes.Attorney Kevin Reddington (01:19:35):Have you administer the Edinburgh scale?Witness, Doctor (01:19:38):Pardon me?Attorney Kevin Reddington (01:19:38):Have you administered the Edinburgh scale?Witness, Doctor (01:19:41):No. It's a self-report usually given by nurses.Attorney Kevin Reddington (01:19:45):Nurses? Okay. In any event, it's a scale that is a useful tool to determine the level or degree of depression that a person may be expressing that is suffering from postpartum depression, correct?Witness, Doctor (01:20:06):That's right.Attorney Kevin Reddington (01:20:07):And do you know what the numbers are on the scale? Is it 1 to 23 or is it 1 to 50 or do you know what it is?Witness, Doctor (01:20:14):It's a 30-point scale.Attorney Kevin Reddington (01:20:16):And when you say-Witness, Doctor (01:20:17):So 1 to 30 as I understand it.Attorney Kevin Reddington (01:20:19):And when you say a self report, the patient would then advise what symptomology they're suffering at that particular point in time, right?Witness, Doctor (01:20:28):Correct.Attorney Kevin Reddington (01:20:28):And then the doctor would then determine whether or not there is a risk or an extreme risk or a deadly risk of this person committing suicide, harming someone else, whether it's a baby or anybody else, and determine what the level of their postpartum depression is, right?Witness, Doctor (01:20:48):Yes, it can help.Attorney Kevin Reddington (01:20:50):And did Dr. Tufts administer Edinburgh test to this young woman?Witness, Doctor (01:21:00):I know that Ms. Clancy, there were a number of Edinburgh tests that were given to her so that there are some scores in her record. I can't recall which practitioner gave her the Edinburgh test, but I do recall that there are a number of scores within her medical record.Attorney Kevin Reddington (01:21:32):Right. And what was her highest score?Witness, Doctor (01:21:39):The highest score that I recall was 23.Attorney Kevin Reddington (01:21:42):23 out of 30, right?Witness, Doctor (01:21:44):Correct.Attorney Kevin Reddington (01:21:45):And over 15, the patient is in pretty serious trouble, right?Witness, Doctor (01:21:51):Over 15 is concerning, definitely.Attorney Kevin Reddington (01:21:54):Right. And she was 23, right?Witness, Doctor (01:21:57):Yes, I believe so. I think they ranged from 19 to 23, just from my memory.Attorney Kevin Reddington (01:22:03):They increased as time went by, right? She was getting worse, right?Witness, Doctor (01:22:05):Correct.Attorney Kevin Reddington (01:22:05):Yeah. All right. And in addition to the regular blood test, which costs like, I don't know, about 100 bucks to administer a blood test to see what somebody's got in their system, it's not a lot of money, right, for the insurance company?Witness, Doctor (01:22:23):I just didn't hear you.Attorney Kevin Reddington (01:22:25):Blood test. It's not a lot of money for an insurance company to pay, right? To cover?Witness, Doctor (01:22:33):Correct.Attorney Kevin Reddington (01:22:34):Okay. So do you feel that it is reasonable medical procedure for a psychiatrist dealing with a woman... on the Edinburgh scale off the charts or serious trouble who is on medication as we went through, the antipsychotic drugs, the SSRI drugs, the amitriptylines at the end of the period of treatment with these people, the benzodiazepines, it's helpful to take a blood test, right?Witness, Doctor (01:23:05):It can be.Attorney Kevin Reddington (01:23:06):And is that, in your opinion, sir, to a reasonable degree of medical certainty, a step that should be taken by a competent doctor?Witness, Doctor (01:23:17):That taking blood tests can be appropriate, yes.Attorney Kevin Reddington (01:23:21):And then there's an additional blood test that you can use when you're dealing with a woman who's suffering from postpartum depression or coming to the doctor for help and they have significant narcotics or prescription drugs in their system, and that would be an enzyme test, right?Witness, Doctor (01:23:46):I'm not aware of an enzyme test being typically available or used.Attorney Kevin Reddington (01:23:54):Well, it costs a lot of money, doesn't it? It costs a couple of grand?Witness, Doctor (01:23:59):I don't know.Attorney Kevin Reddington (01:24:01):All right. In any event, sir, are there any other concerns that one would have, if they're competent and they're treating somebody that's come to them for help in addition to a blood test and perhaps enzyme test to determine the metabolizing aspect of the person's system, metabolizing or processing these drugs that are in their system, the enzyme test, are there any other tests or concerns that you have with a woman whose postpartum depression complaints come to your doorstep?Witness, Doctor (01:24:37):Well, depending on the presentation, sometimes it's helpful to check thyroid function. That can certainly be a cause of psychiatric symptoms.Attorney Kevin Reddington (01:24:56):Did they do a thyroid test on Lindsay?Witness, Doctor (01:24:59):No.Attorney Kevin Reddington (01:25:01):That's not a lot of money that the insurance company would complain about, right?Witness, Doctor (01:25:04):Correct.Attorney Kevin Reddington (01:25:09):One of the things that I just don't want to forget, sir, is that the district attorney asked you while we're talking about the drugs, about the Lamictal, otherwise known as lamotrigine. Did I pronounce that right?Witness, Doctor (01:25:22):Lamotrigine, yes.Attorney Kevin Reddington (01:25:23):Lamotrigine. And she said that Lamictal, it has a side effect of a rash, right? Do you recall that, sir?Witness, Doctor (01:25:31):I think I said serious rash.Attorney Kevin Reddington (01:25:32):No, I think she said rash.Witness, Doctor (01:25:34):Oh.Attorney Kevin Reddington (01:25:35):It's up to the jury what their recollection is, but you may have said serious rash, but we both agree it's a serious rash, right?Witness, Doctor (01:25:43):Yes.Attorney Kevin Reddington (01:25:44):In fact, it can be fatal, right?Witness, Doctor (01:25:46):In very rare occasions, yes.Attorney Kevin Reddington (01:25:49):It can be fatal, right?Witness, Doctor (01:25:52):Yes, in very rare occasions.Attorney Kevin Reddington (01:25:54):Well, if one person out of a thousand gets Stevens-Johnson syndrome or Prurigo Nodularis as a result of taking that medication, that's something that we should not tolerate as doctors, right?Witness, Doctor (01:26:17):Risks and benefits are something that every physician, every prescriber needs to think about.Attorney Kevin Reddington (01:26:24):So you've heard of, as it relates to Lamictal as a prescription drug, what's called TEN, you've heard of that, right, as a side effect?Witness, Doctor (01:26:35):Yes.Attorney Kevin Reddington (01:26:36):And that means that what?Witness, Doctor (01:26:39):It is a pretty severe reaction of the skin, as I recall, causing blistering. I mean, it's very significant.Attorney Kevin Reddington (01:26:50):So if you have a young woman who is a nurse, an RN, who worked for seven years in a very prestigious hospital's labor and delivery unit, who was so nervous about drugs that were being prescribed to her that she would at night sit in her kitchen on her phone and Google all sorts of side effects of narcotics, the drugs, the Seroquel, Lamotrigine, all of these drugs, is it an unreasonable decision for her to say, "I don't want to take that drug," in your opinion?Witness, Doctor (01:27:47):It seems like you're asking, is it reasonable to decide not to take the drug?Attorney Kevin Reddington (01:27:52):Yeah, that's what she did. That's what you told us yesterday. That's what the DA asked her yesterday, right?Witness, Doctor (01:27:56):It was a decision that she made.Attorney Kevin Reddington (01:27:59):And in your opinion, sir, after we just went through all of this with the TENS, with the toxic epidural necrolysis and all the rest of that, and she's a nurse and she's looking up these drugs that she's being prescribed and says, "I don't wish to take that drug," in your opinion, to a reasonable degree of psychiatric certainty based on your experience, is that a reasonable decision for her to say, "I don't want to take it"?Witness, Doctor (01:28:31):The benefits of that drug are profound, and millions and millions of Americans take that medication and find it to be very important for them.Attorney Kevin Reddington (01:28:45):Doctor, you're an intelligent man, you're a doctor, you've got a lot of experience dealing with the prison system. We've already gone over all of that. You understand my question, don't you?Witness, Doctor (01:28:53):Yes.Attorney Kevin Reddington (01:28:55):I'm just asking, is that a reasonable decision for Lindsay to make to say, "I don't wish to take that drug?" Based on all the side effects, whether or not it's rare that people die, whether or not it's rare that they break out on their skin with these permanent lesions and bleeding pustules, is it reasonable for her to say, "I don't want to take it"?Witness, Doctor (01:29:24):In her mind, it was.Attorney Kevin Reddington (01:29:25):Yeah. And certainly, we don't want to leave it with the jury that she's so vain that she just didn't want to take something that she might get a little rash.(01:29:42)In any event, now have in mind, there's no blood test, there's no enzyme test for metabolite test, there's no thyroid test, but we still have the pill factory through Dr. Tufts and then into Dr. Jolotta for that period of time. You're telling this jury that that is, in your opinion, reasonable little, little drug doses that she was prescribed. Is that what you're telling this jury, sir?Witness, Doctor (01:30:14):That it was reasonable to prescribe?Attorney Kevin Reddington (01:30:16):Yeah, the drugs one right after the other. And then stopping the SSRI, not weaning off, stopping it flat out. Is that reasonable?Speaker 2 (01:30:25):Objection.Judge (01:30:26):Sustained. Just as to form.Attorney Kevin Reddington (01:30:29):Is it reasonable, sir, in your opinion, to tell someone who's on an SSRI such as-Witness, Doctor (01:30:37):... expressed concerns that she was not following a plan and that it would've been better for her had she tried to stick with a plan.Attorney Kevin Reddington (01:30:54):Is that that one sentence in all of the medical records where it makes reference to the fact that she said something like, "I should have stuck with the plan." Is that what you're referring to?Witness, Doctor (01:31:04):Yes.Attorney Kevin Reddington (01:31:04):Okay. My question, sir, was Dr. Tufts, Dr. Paul, Dr. Jolotta.Witness, Doctor (01:31:14):Nurse Practitioner Paul and Jolotta.Attorney Kevin Reddington (01:31:16):I apologize. Again, it's-Witness, Doctor (01:31:17):It's all right.Attorney Kevin Reddington (01:31:18):... my bad. Nurse Practitioner Jolotta, up to that point, bringing us into November, these people... And other emergency room visits that she had, she was not going out looking to score drugs off of drug prescriptions. Is that fair?Witness, Doctor (01:31:37):Correct.Attorney Kevin Reddington (01:31:38):And she, in fact, looked up Tufts, but she didn't even know who Tufts was. She went online and Googled postpartum depression and found an expert, isn't that right?Witness, Doctor (01:31:54):That's my understanding.Attorney Kevin Reddington (01:31:55):But she was only practicing for like a month or two. Was she, in your opinion, to a reasonable degree of psychiatric certainty, an expert?Speaker 2 (01:32:03):Objection.Judge (01:32:06):Overruled.Witness, Doctor (01:32:13):It depends on the amount of training that she received, not just as a physician and a resident, but also in the area of women's health.Attorney Kevin Reddington (01:32:23):So the young lady goes online, Google's trying to get help, goes to see the expert, Dr. Tufts, ultimately deals with Nurse Practitioner Jolotta and counselor that worked in that medical field business, Leticia Dukes, I believe is her name.Witness, Doctor (01:32:50):Right.Attorney Kevin Reddington (01:32:52):And then she had the need to go to an emergency room and went to Mass General Hospital, right?Witness, Doctor (01:32:59):That's right.Attorney Kevin Reddington (01:33:00):And she was with her husband, Pat, right?Witness, Doctor (01:33:03):Correct.Attorney Kevin Reddington (01:33:03):And she had been complaining about lack of sleep, insomnia, right?Witness, Doctor (01:33:08):Yes, as I understand.Attorney Kevin Reddington (01:33:09):She had been complaining about inability to emote, feeling hollow, "not myself," right?Witness, Doctor (01:33:17):Correct.Attorney Kevin Reddington (01:33:18):And a number of other complaints that were brought to the fore, and the hospital made a recommendation that she go to McLean Hospital, which is a locked ward mental institution in Massachusetts, and she chose not to do that, correct?Witness, Doctor (01:33:33):That's right.Attorney Kevin Reddington (01:33:33):So then what she did is went back to her home and immediately hooked up again, if you will, with Tufts, right?Witness, Doctor (01:33:42):That's right.Attorney Kevin Reddington (01:33:45):In December, one of the people at the South Shore Perinatal Unit advised her to go to a hospital that specializes in postpartum women, that would be Women & Infants Hospital in Rhode Island, right?Witness, Doctor (01:34:04):That's right.Attorney Kevin Reddington (01:34:05):And she went there the next day, right after they called, right?Witness, Doctor (01:34:10):Yes. I think they fit her in pretty quickly. Was it maybe the 20th of December?Attorney Kevin Reddington (01:34:15):And her husband dropped her off for that day program, right?Witness, Doctor (01:34:19):That's right.Attorney Kevin Reddington (01:34:20):And she participated with the coloring with the conferences or with the discussions and evaluations with the doctor, right?Witness, Doctor (01:34:27):Yes.Attorney Kevin Reddington (01:34:28):For about eight hours. It was about an eight-hour day, right?Witness, Doctor (01:34:31):Something like that.Attorney Kevin Reddington (01:34:32):And on that date, in December 20th, she was turned away basically, right?Witness, Doctor (01:34:43):I don't know that I would term it turned away-Attorney Kevin Reddington (01:34:47):Did they help her.Witness, Doctor (01:34:48):But by Dr. Diaz's notes, but-Attorney Kevin Reddington (01:34:50):Did they help her?Witness, Doctor (01:34:52):Pardon me?Attorney Kevin Reddington (01:34:52):Did they help her?Witness, Doctor (01:34:55):They felt that another program might be more appropriate, either inpatient...(01:35:01)... impression that most of the women who were in that program were much closer to having had given birth to their children. And so in that respect, it was not. The group that they served were much closer to that postpartum period, as I understand.Attorney Kevin Reddington (01:36:05):You're not going to say to this jury that because Lindsay was outside of the, let's say, four month cutoff, that she was not a good candidate for postpartum depression treatment? Is that what you're [inaudible 01:36:25]?Witness, Doctor (01:36:23):No.Attorney Kevin Reddington (01:36:26):Oh, okay. I'm sorry. I thought you said because of the timeframe from giving birth to the time that she went to see them.Witness, Doctor (01:36:33):I was just speaking about my understanding from the note from Women & Infants in terms of their decision making.Attorney Kevin Reddington (01:36:41):Okay. And Women & Infants basically discharged her after about eight hours, right?Witness, Doctor (01:36:47):Yes.Attorney Kevin Reddington (01:36:48):And her husband was up skiing, and then she contacted him and he had to come down and pick her up and bring her home, right?Witness, Doctor (01:36:54):That's right.Attorney Kevin Reddington (01:36:56):And the reason that she was discharged from Infants Hospital in Rhode Island included a statement RO, rule out issues regarding prescription medications, correct?Witness, Doctor (01:37:15):Yes, that's my recollection.Attorney Kevin Reddington (01:37:16):She indicated that she was going to go right back to Tufts, right?Witness, Doctor (01:37:22):Yes.Attorney Kevin Reddington (01:37:23):And she did, didn't she?Witness, Doctor (01:37:25):Yes, as I understand.Attorney Kevin Reddington (01:37:27):And would you agree, sir, that every time a doctor said to Lindsay to do something, whether it was to make an appointment somewhere, whether it was to take another drug, any advice, that she was on it immediately, is that fair?Witness, Doctor (01:37:53):She attended her appointments, yes.Attorney Kevin Reddington (01:37:57):Well, not just that. She attended them right away. She was told, for example, at McLean, you read those records, that she should hook up with her provider and she did the very next day, right?Witness, Doctor (01:38:08):Yes.Attorney Kevin Reddington (01:38:08):Okay. So she wasn't avoiding seeing healthcare professionals, was she?Witness, Doctor (01:38:16):No.Attorney Kevin Reddington (01:38:16):And she was continuing to express concern about her state of mind. She felt that her mind, her brain was being damaged. Isn't that right?Witness, Doctor (01:38:29):That's right.Attorney Kevin Reddington (01:38:30):Those are in the records, right?Witness, Doctor (01:38:32):Correct.Attorney Kevin Reddington (01:38:32):And she felt that her brain being damaged was permanent and she was never going to get better, right?Witness, Doctor (01:38:40):Yes.Attorney Kevin Reddington (01:38:41):She was complaining not just to her physicians, but she was complaining to people in her community that she was having intrusive thoughts, dark thoughts, suicidal thoughts, and homicidal ideation. She said that, correct?Witness, Doctor (01:39:03):The homicidal ideation, as I understand, was just voiced to her husband and her mother.Attorney Kevin Reddington (01:39:13):Just voiced? Is that what you just said? Just voiced? Is that like talking about the Red Sox?Speaker 2 (01:39:20):Objection.Attorney Kevin Reddington (01:39:20):She's talking about homicidal ideation of her children.Judge (01:39:23):Sustained. Next question.Attorney Kevin Reddington (01:39:27):I asked you about her complaints of intrusive thoughts, complaining to doctors, complaining to friends, complaining to neighbors, family about dark, intrusive thoughts of suicide and homicidal ideation, didn't she?Witness, Doctor (01:39:50):I just don't recall that she complained of homicidal ideation to-Attorney Kevin Reddington (01:39:58):Okay. So-Witness, Doctor (01:39:59):... healthcare providers.Speaker 2 (01:40:02):Let him finish answering.Judge (01:40:03):Doc, did you finish? Did you finish the answer?(01:40:07)Doctor, did you finish that last answer?Witness, Doctor (01:40:09):[inaudible 01:40:09]. Okay.Judge (01:40:09):All right. Next question.Attorney Kevin Reddington (01:40:12):So we'll put homicidal ideation aside for a minute. Would you agree that for that period of time, short as it may have been in her life, November into December, that she was reaching out to people that would listen to her for help?Witness, Doctor (01:40:32):Yes.Attorney Kevin Reddington (01:40:34):Would you agree, sir, that she would tell, for example, neighbors or friends with the Learning Sprouts School, her family, her doctors, that she was having these dark, intrusive thoughts of suicide? Yes or no?Witness, Doctor (01:40:59):Did you ask whether or not she was telling her children's teachers at Learning Sprouts?Attorney Kevin Reddington (01:41:05):Anyone that she would come in contact with at Learning Sprouts, whether it's another mother, whether it's a friend, whether it's a teacher, whether it's an administrator, whether it's somebody that just watches the kids in the playground. Did she tell anyone that she had dark, intrusive thoughts, to your investigation?Witness, Doctor (01:41:28):Those people that you named, I wasn't aware that she informed them about that.Attorney Kevin Reddington (01:41:35):When someone says with her history up to this point in December that they're having dark, intrusive thoughts to a professional, in your opinion, sir, to a reasonable degree of medical certainty, does it make sense that the professional should ask the person whether or not these are voices that they're hearing in their head or whether or not they are just thoughts that they're having?Attorney Kevin Reddington (01:42:00):... whether or not they are just thoughts that they're having.Witness, Doctor (01:42:11):Certainly exploring that is important.Attorney Kevin Reddington (01:42:15):And would you agree with me, sir, that when you have a young woman that, again, by all accounts, done nothing wrong in her life, exemplary citizen, has these issues and sees the doctors that, to a reasonable degree of medical certainty, a physician should do a little bit more than asking, "Do you have a plan?" I mean, is that accepted practice just to say, "Do you have a plan?" And if they say no, you're okay.Witness, Doctor (01:42:45):I wasn't aware that that was the only question.Attorney Kevin Reddington (01:42:48):Okay. She was also told that counsel had asked you yesterday about other recommendations that were given to her by women and infants and that you said that she did not follow through on that, but she did see Dr. Tufts pretty much the next day, right?Witness, Doctor (01:43:12):That's my understanding, yes.Attorney Kevin Reddington (01:43:13):Okay. And she said that, that she was going to go see Dr. Tufts the next day, right?Witness, Doctor (01:43:17):Yes.Attorney Kevin Reddington (01:43:19):And just to mention, before I forget it, the Lamictal, I think you mentioned to the jury that she had a prescription for Lamictal that she was able to fill, right?Witness, Doctor (01:43:31):Correct.Attorney Kevin Reddington (01:43:32):But she didn't take it, right?Witness, Doctor (01:43:34):That's right.Attorney Kevin Reddington (01:43:35):And then Tufts told her that she was going to, she meaning Tufts, was going to give her a script for Lamictal. And she said, "No, I already have one." Right?Witness, Doctor (01:43:44):It was Nurse Jollotta.Attorney Kevin Reddington (01:43:46):Okay, sorry.Witness, Doctor (01:43:48):She had gotten the prescription and filled it from Dr. Tufts. And Nurse Jollotta, when asked about the Lamictal, was very favorable about it and said, "Yes, that's great. That would be great."Attorney Kevin Reddington (01:44:00):Sir, I know. I know. You want to tell me that it's wonderful drug. Did she tell Nurse Practitioner Jollotta, "I already have a script. I don't need it"?Witness, Doctor (01:44:16):Yes.Attorney Kevin Reddington (01:44:22):Among other things, when people are in trouble and they're having dark suicidal thoughts, whether or not it's voices in their head, whether or not it's thoughts that they can't go on anymore, they can't live life, they have to kill themselves, many times they're told to call suicide hotlines, right?Witness, Doctor (01:44:42):Yes. Aspire.Attorney Kevin Reddington (01:44:44):Aspire. What is Aspire?Witness, Doctor (01:44:47):I don't know what it stands for, but it is a hotline that Ms. Clancy called twice because of her suicidal ideation.Attorney Kevin Reddington (01:45:01):When did she call Aspire saying that she had thoughts of killing herself?Witness, Doctor (01:45:13):I can't recall specifically.Attorney Kevin Reddington (01:45:15):But she did call them not once, but twice and told them... So she complained and told them that she was going to kill herself, right? Twice. Right?Witness, Doctor (01:45:38):She spoke to them about suicidality.Attorney Kevin Reddington (01:45:41):So here's a young woman with all of what she's been through who now is to the verge of killing herself and reaches out to people that her healthcare providers told her to call for help, said that she was going to kill herself, and what did Aspire do?Witness, Doctor (01:46:10):As I understand, they redirected her to her provider. They did not make a decision to hospitalize or to recommend hospitalization.Attorney Kevin Reddington (01:46:21):They didn't make a decision to do anything.Attorney Sprague (01:46:25):Objection.Judge (01:46:26):Yeah. So you could form that as a question, please.Attorney Kevin Reddington (01:46:28):Did you read the records dealing with Aspire? Did they do anything other than tell her, "No, you're not someone that we can help"?Witness, Doctor (01:46:35):I know that they were not responsive to her suicidality because she did not indicate that she had a plan.Attorney Kevin Reddington (01:47:09):And did you read a transcript or listen to a tape or how do you know that?Witness, Doctor (01:47:25):I recall it someplace in the documents it being referred to, but I can't tell you exactly where.Attorney Kevin Reddington (01:47:41):So this sir obviously is a murder trial and you are a witness for the government and you've indicated that you've read the records. You just told this jury that in the conversation that she had with the people from Aspire that she expressed suicidal ideation and was asked if she had a plan. Where were you getting that from?Witness, Doctor (01:48:10):I can't tell you exactly within the records.Attorney Kevin Reddington (01:48:17):How about the second time she called Aspire? Why would she call Aspire again if they wouldn't help her the first time, in your opinion as a psychiatrist? Looking for help?Witness, Doctor (01:48:27):Continuing to seek help.Attorney Kevin Reddington (01:48:29):And yet again, she didn't get any, did she?Witness, Doctor (01:48:35):That's my understanding.Attorney Kevin Reddington (01:48:38):To a reasonable degree of psychiatric certainty with treating the patients to the extent that you've told this jury that you have, what kind of a devastating effect would that have on a person who's ready to kill themselves, that's called Aspire hotline twice and has been turned away?Attorney Sprague (01:48:58):Objection.Judge (01:48:59):Overruled.Witness, Doctor (01:49:01):It could have a very serious effect.Attorney Kevin Reddington (01:49:06):And after being discharged from Women & Infants Hospital and reaching out to Aspire, you'd agree with me that one of the concerns that the doctor at Women's Hospital in Rhode Island had is the medication that she had been prescribed by Tufts and Nurse Practitioner Jollotta, right?Witness, Doctor (01:49:34):Correct.Attorney Kevin Reddington (01:49:35):And that's one of the reasons that they could not treat her. It wasn't just that, "No, we don't think that you're postpartum depressed. We just think that there's a complicated overlay involving the medications that you've been prescribed," right?Witness, Doctor (01:49:52):Yes.Attorney Kevin Reddington (01:49:52):â€And these medications obviously included selective serotonin reuptake inhibitors, right?Witness, Doctor (01:50:00):Yes. Prozac and Zoloft.Attorney Kevin Reddington (01:50:03):Right. And one of the things that a doctor would be concerned about, especially with a woman who's had a baby and has stopped breastfeeding the baby, is the effect that that may have on the woman physically, mentally, emotionally when they stop breastfeeding a baby, right?Witness, Doctor (01:50:26):Yes.Attorney Kevin Reddington (01:50:28):And you've heard of gamma aminobutyric acid, otherwise known as GABA, right?Witness, Doctor (01:50:39):Yes.Attorney Kevin Reddington (01:50:40):And can you tell us please what that is, sir?Witness, Doctor (01:50:44):I'm sorry?Attorney Kevin Reddington (01:50:45):Can you tell us please what that is, sir? What is GABA?Witness, Doctor (01:50:50):I believe that you're referring to Lyrica.Attorney Kevin Reddington (01:50:53):No, I'm asking about the actual acid in the person's system, their blood that is gamma amino, B-U-L-R-Y-C acid. It's got nothing to do with Lamictal. It's got nothing to do with Seroquel. It's got nothing to do with the drug industry. This is in the body. When a woman stops lactating, woman stops breastfeeding-Witness, Doctor (01:51:21):Yes.Attorney Kevin Reddington (01:51:22):... there is a physical effect on the person, the body, right?Witness, Doctor (01:51:26):Yes.Attorney Kevin Reddington (01:51:26):What is that effect?Witness, Doctor (01:51:37):It depends on the individual. There's variable responses, postpartum. And as I understand, she stopped breastfeeding around October, by October 21st or so, when the Ativan was started.Attorney Kevin Reddington (01:52:05):Would you agree with me, sir, that the GABA, make it easier to type, is basically affects, its primary effect is on the neurotransmitters in the brain, right?Witness, Doctor (01:52:17):Yes.Attorney Kevin Reddington (01:52:18):Okay. That sounds pretty complicated. Neurotransmitters, I mean, is that like where you have a spark plug on a motorcycle and you can actually gap it and get it to kick over? It's a neurotransmitter in the brain. That sounds like it.Witness, Doctor (01:52:33):Well, yeah, it's more complicated than that-Attorney Kevin Reddington (01:52:35):I figured.Witness, Doctor (01:52:36):... obviously.Attorney Kevin Reddington (01:52:36):But nevertheless, it's still basically, you're talking about the actual organic matter of the brain, right?Witness, Doctor (01:52:43):Yes.Attorney Kevin Reddington (01:52:44):And would you agree, sir, that when a woman is pregnant, that there are progesterone hormone surges during that pregnancy?Witness, Doctor (01:52:59):Yes. There are hormonal changes.Attorney Kevin Reddington (01:53:01):Their hormone doesn't just change. It can actually surge and it can be quite impactful to the person, right?Witness, Doctor (01:53:11):Yes.Attorney Kevin Reddington (01:53:12):And would you agree with me, sir, that one of the metabolites of progesterone, which has been unleashed when a person, a woman is pregnant, with the progesterone hormone surging through their body, that you have a metabolite that actually enhances or increases the GABA activity of the neurons in the brain, right?Witness, Doctor (01:53:38):It can, yes.Attorney Kevin Reddington (01:53:39):And what is that metabolite, sir, that increases that activity in the very organ of the brain?Witness, Doctor (01:53:49):I can't tell you.Attorney Kevin Reddington (01:53:50):Is it a allopregnanolone, if you know?Witness, Doctor (01:53:57):No.Attorney Kevin Reddington (01:53:58):No, it's not, or no, you don't know?Witness, Doctor (01:53:59):I don't know.Attorney Kevin Reddington (01:54:01):Immediately after a woman has a baby, would you agree, sir, that the progesterone that we just talked about and the allopregnanolone that you don't know about drops precipitously according to the medical treatises, right?Attorney Sprague (01:54:16):Objection.Judge (01:54:18):If he knows, he can answer that.Witness, Doctor (01:54:22):Yes.Attorney Kevin Reddington (01:54:24):And what does that mean, sir? Tell me when it says that the progesterone and the allopregnanolone in the body drops precipitously? What does that mean, precipitously?Witness, Doctor (01:54:35):That means rapidly.Attorney Kevin Reddington (01:54:36):And a sudden drop, sir, you would agree would cause, has a significant potential of causing serious GABA dysfunction, right?Witness, Doctor (01:54:48):That certainly would be possible.Attorney Kevin Reddington (01:54:50):Do you know that or are you just agreeing with me?Witness, Doctor (01:54:56):I'm agreeing with you.Attorney Kevin Reddington (01:54:58):Okay. Do you want me to keep going?Judge (01:55:03):You want to take a short break?Attorney Kevin Reddington (01:55:05):I don't care. I'm just saying that-Judge (01:55:06):Yes. Why don't we take the morning recess at this point? All right.Speaker 3 (01:55:11):Court, all rise, please. Jurors, kindly close you notebooks. [inaudible 01:55:15]. Jurors have exited the courtrooms.Judge (01:55:57):All right, Counsel, can I see you at sidebar just briefly? Doctor [inaudible 01:55:59]Speaker 5 (01:56:17):This court is back in session. You may be seated.Speaker 4 (01:56:19):Your Honor, for the purpose of the record, we return back to the trial of Commonwealth versus Lindsay Clancy. All parties are present excluding the jurors.Judge (01:56:26):All right. Counsel, are we ready for the jury?Attorney Kevin Reddington (01:56:26):Yes, Your Honor.Attorney Sprague (01:56:27):Yes.Judge (01:56:27):All right.Speaker 3 (01:56:27):All rise. Jurors enter. This court's now in session. Please be seated.Speaker 4 (01:57:13):Your Honor, for the practice of the record, we return back to the trial of Commonwealth versus Lindsay Clancy. All parties are present, including the defendant and including the 18 jurors.Judge (01:57:19):All right. Counsel?Attorney Kevin Reddington (01:57:20):Thank you, Judge. Sir, when we left off, I believe the question was that, and you agreed, the sudden drop can cause significant GABA dysfunction. Recall that question where we broke off talking about-Witness, Doctor (01:57:35):Yes.Attorney Kevin Reddington (01:57:36):... the gamma? And you're familiar with the concept of, in that regard, talking about the gamma aminobutyric acid and its effect on the progesterone and its effect on the brain synapses is that referred to as breaks, B-R-E-A-K-S. You've heard of that term, right?Witness, Doctor (01:57:58):No.Attorney Kevin Reddington (01:58:00):You aware, sir, that when you get to the point where you have that precipitous drop in the progesterone and the allopregnanolone dropping precipitously, that in fact it constitutes and causes significant neurotransmitter malfunction, referred to as broken breaks?Witness, Doctor (01:58:26):I'm not familiar with that term.Attorney Kevin Reddington (01:58:28):Can you tell me what a neurotransmitter in the brain is?Witness, Doctor (01:58:33):You're asking what is a neurotransmitter?Attorney Kevin Reddington (01:58:35):Sure. I don't know.Witness, Doctor (01:58:36):Neurotransmitters function in the brain and have responsibility for not only aspects of mood, but also psychosis. Dopamine is a neurotransmitter that is significant in terms of psychosis. When it's too high, [inaudible 01:59:06]. And the neurotransmitters function in a number of different ways, number of different pathways. When we think about psychiatry, we really think about the mesolimbic pathway and not just dopamine, but also serotonin, norepinephrine. And so depending on the disorder, there are different medications that can be helpful in treating those disorders. So really from the standpoint of psychiatric illness and brain dysfunction, medication can be very helpful in regulating the neurotransmitters and difficulties.Attorney Kevin Reddington (01:59:57):Have you heard of the broken breaks hypothesis as it relates to the impact of the precipitous drop of progesterone in the enhancement of the GABA activity? Have you heard of that concept?Witness, Doctor (02:00:13):No.Attorney Kevin Reddington (02:00:14):Would you agree, sir, that when a woman is in that position of the precipitous drop of the progesterone after ceasing the breastfeeding activity, the enhancement with the GABA-Witness, Doctor (02:00:27):You mean prolactin?Attorney Kevin Reddington (02:00:28):Prolactin. The enhancement of the GABA activity, that would be a dysfunction in the brain, right?Witness, Doctor (02:00:41):Certainly mood symptoms can be significant.Attorney Kevin Reddington (02:00:45):Would you agree, sir, that the dysfunction in the brain caused by those two items is consistent with intrusive and hard to control thoughts and highly impulsive, uncontrollable behavior? Would you agree with that?Witness, Doctor (02:01:08):I would say it's possible.Attorney Kevin Reddington (02:01:10):And that would relate to the capacity of a person to conform their conduct if in fact, because of the GABA and the progesterone and all that we just talked about [inaudible 02:01:24]Judge (02:01:46):Let doctor finish. Did you finish that answer?Witness, Doctor (02:01:50):Yes.Judge (02:01:50):Okay. All right, go ahead. Next question.Attorney Kevin Reddington (02:01:53):So did I hear you say that Patrick is the source, the third party collateral source of Lindsey saying, "I tried to kill myself"? Is that what you said? Let me rephrase it for you. I mean, did you tell the jury about an hour ago or so that-Witness, Doctor (02:02:24):When her husband found her on the ground?Attorney Kevin Reddington (02:02:26):Yes. Yeah.Witness, Doctor (02:02:28):Yes, sir. Something to that effect.Attorney Kevin Reddington (02:02:30):Something to that effect. Okay. And did you listen to the 911 tape when Patrick was actually speaking with Lindsay as she's laying prostate in the snow on the ground with the broken neck and the slashes and the slits?Witness, Doctor (02:02:44):Yes, I did.Attorney Kevin Reddington (02:02:45):Did you hear her response to Patrick's comment, "What did you do"?Witness, Doctor (02:02:53):No.Attorney Kevin Reddington (02:02:54):Did you hear her respond to anything other than what would be described as guttural grunts?Witness, Doctor (02:03:03):Not on that call.Attorney Kevin Reddington (02:03:05):So when this conversation occurred, and this is the conversation that you're talking about where she said, "I tried to kill myself, kids are in the basement," he then goes into the house, right?Witness, Doctor (02:03:18):Correct.Attorney Kevin Reddington (02:03:18):All right. So now we have the EMTs and people are helping her out. You've seen the medical records, you know what the injuries were, you know the damage to her throat, you know the damage to her thyroid, right?Witness, Doctor (02:03:30):Yes.Attorney Kevin Reddington (02:03:31):And is it your testimony to a reasonable degree of doctor certainty that a person with those injuries, with the prescription drugs that were crushed up, that she consumed with a broken neck, would be able to have a conversation?Witness, Doctor (02:03:52):Based on the witness testimony from her husband, yes.Attorney Kevin Reddington (02:03:57):Okay. So let's put the witness testimony from Patrick aside for a minute, and you listened to the 911 call. Are you telling this jury that she had a conversation that you could discern what she was saying?Witness, Doctor (02:04:10):Not on the 911 call, no.Attorney Kevin Reddington (02:04:12):Would you agree that they were all grunts?Witness, Doctor (02:04:17):Yes, from what I heard.Attorney Kevin Reddington (02:04:21):So Patrick goes in the house, relates the fact that he found the children, and you told the jury that his office door was closed, is what he said, is that right?Witness, Doctor (02:04:34):Yes.Attorney Kevin Reddington (02:04:34):Where did you get that from?Witness, Doctor (02:04:38):I believe Patrick told me that.Attorney Kevin Reddington (02:04:41):Is that in your report?Witness, Doctor (02:04:42):Yes.Attorney Kevin Reddington (02:04:43):And when he told you that, when was that conversation that you had with Patrick?Witness, Doctor (02:04:48):When I interviewed Patrick Clancy.Attorney Kevin Reddington (02:04:50):Okay. So you read the grand jury minutes, right?Witness, Doctor (02:04:54):Yes.Attorney Kevin Reddington (02:04:54):You read the police report, right?Witness, Doctor (02:04:56):Yes.Attorney Kevin Reddington (02:04:57):You know that Patrick went up the stairs, and when he went up the stairs, the door was locked, right? Meaning the bedroom door, not the office door.Witness, Doctor (02:05:03):Correct.Attorney Kevin Reddington (02:05:04):And then he was able to open the door, right?Witness, Doctor (02:05:07):Yes, with the key.Attorney Kevin Reddington (02:05:07):And there was blood on the doorknob, right?Witness, Doctor (02:05:17):There was blood in the room-Attorney Kevin Reddington (02:05:19):Describe the room.Witness, Doctor (02:05:20):... on the floor.Attorney Kevin Reddington (02:05:21):Certainly. We'll talk about that, but there's blood on the doorknob, right? Was there blood on the doorknob, if you know?Witness, Doctor (02:05:27):I don't recall.Attorney Kevin Reddington (02:05:28):Do you recall there being blood drops in the area of the door itself, like where you had the threshold? Or what appeared to be blood because nobody tested it. We don't know what it is, but it appeared to be blood.Witness, Doctor (02:05:41):I don't recall the specific. I know that there was blood that was observed.Attorney Kevin Reddington (02:05:46):Okay. And you would agree that there was a lot of blood drops, drips on the mirror, drops on the floor, drops on the nightstand, right?Witness, Doctor (02:05:57):That's my recollection.Attorney Kevin Reddington (02:05:58):And you looked at the photographs in your investigation and looked at the testimony, third party collaterals, as you testified yesterday, right?Witness, Doctor (02:06:06):Yes.Attorney Kevin Reddington (02:06:07):And you told the jurors that one of the things that was of interest to you is the fact that there was a glass or a wine mug or something that had crushed narcotics, or I think you used the word anti-psychotic drugs, crushed up inside that cup. Do you remember that?Witness, Doctor (02:06:29):Yes.Attorney Kevin Reddington (02:06:30):Okay.Witness, Doctor (02:06:30):Wine tumbler.Attorney Kevin Reddington (02:06:31):Thank you. How do you know they were anti-psychotic drugs?Witness, Doctor (02:06:36):I don't recall saying that they were anti-psychotic drugs.Attorney Kevin Reddington (02:06:39):Oh, did you say they were drugs?Witness, Doctor (02:06:44):I thought I said medications.Attorney Kevin Reddington (02:06:45):Medications. All right. So drugs, medications, and they were crushed up?Witness, Doctor (02:06:51):There was evidence of powder on the tumbler that Patrick told me about, and I went back and looked more closely at the photographs and saw that.Attorney Kevin Reddington (02:07:05):Did you look more closely at the NMS laboratory or the state police crime laboratory or any testing that was done on the powder?Witness, Doctor (02:07:15):Yes.Attorney Kevin Reddington (02:07:15):And was there a report that said that indeed it was crushed up medication?Witness, Doctor (02:07:22):They wouldn't...Attorney Kevin Reddington (02:07:26):Then there isn't.Witness, Doctor (02:07:26):They didn't indicate whether or not they were pills or-Attorney Kevin Reddington (02:07:30):I'm not asking about pills or powder. Did they ever test the residue?Witness, Doctor (02:07:36):Not that I'm aware of.Attorney Kevin Reddington (02:07:38):So how do we know that that's even drugs or medications, whatever word you want to use?Witness, Doctor (02:07:49):It was Patrick Clancy's observation.Attorney Kevin Reddington (02:07:51):So basically when you're testifying, sir, and you're waxing on about all of the facts of the case that you took into consideration prior to your opinion for the DA in this case, you're getting a lot of it from Patrick, is that right?Witness, Doctor (02:08:04):That aspect he brought up to me, yes.Attorney Kevin Reddington (02:08:11):Okay. So the crushing of the pills, was there a pill crusher found in the bedroom?Witness, Doctor (02:08:18):Not that I'm aware of.Attorney Kevin Reddington (02:08:20):Was there any residue found anywhere in the bedroom?Witness, Doctor (02:08:24):Not that I'm aware of.Attorney Kevin Reddington (02:08:26):So if someone's in a psychotic state and they're going to kill themselves and they're taking the pills, yesterday you said the fist full of pills, and then the DA said after painful questioning that they were crushed and you agreed that they were crushed, wouldn't it be a residue?Witness, Doctor (02:08:43):A residue?Attorney Kevin Reddington (02:08:45):Yeah, you know what a residue is, right?Witness, Doctor (02:08:46):Yes.Attorney Kevin Reddington (02:08:48):Was there a residue on the table, on the nightstand, anywhere?Witness, Doctor (02:08:52):Not that I saw.Attorney Kevin Reddington (02:08:53):So there's no pill crusher, right?Witness, Doctor (02:08:56):Not that I saw.Attorney Kevin Reddington (02:08:57):There's no investigation by the police to determine what was in that powder, right?Witness, Doctor (02:09:02):Not that I'm aware of.Attorney Kevin Reddington (02:09:03):There's no indication that there's any residue on or in the actual nightstand next to the bed, right?Witness, Doctor (02:09:12):Not that I'm aware of.Attorney Kevin Reddington (02:09:13):Does it seem appropriate, sir, that a person would be in a psychotic state after slashing their wrist and slicing their throat and ready to propel themselves out a window would neatly put the bottles into the drawer of the nightstand, or would they just scatter them around the bedroom floor, not caring?Witness, Doctor (02:09:35):I'm not aware of the exact sequence of the events in terms of-Attorney Kevin Reddington (02:09:41):Well, if I tell you, sir, that a couple of days after this incident, I went into the home with Patrick and I was able to locate in the bedroom right next to the bed, with all the blood all over the place, this drawer, and inside this drawer would be a lot of medication bottles, does that refresh your memory on your investigation as to what happened to the bottles? They're all empty.Witness, Doctor (02:10:09):Yes.Attorney Kevin Reddington (02:10:10):Okay. So how'd they get in the drawer?Witness, Doctor (02:10:12):How did they get in the drawer? I don't know.Attorney Kevin Reddington (02:10:14):You can fingerprint them, right? Did you know, did anybody do any testing at all in this investigation, if you know? You told the jury yesterday you read all the stuff, grand jury minutes, police reports, lots of witnesses.Witness, Doctor (02:10:28):I did not read that.Attorney Kevin Reddington (02:10:29):Is it your understanding, sir, that a person can be in a state of psychosis and, I guess, misremember something?Witness, Doctor (02:10:45):Yes.Attorney Kevin Reddington (02:10:46):Or have a false memory?Witness, Doctor (02:10:48):It's possible.Attorney Kevin Reddington (02:10:50):Did Lindsay tell you that she slashed the screen with the big turkey knife?Witness, Doctor (02:10:57):I'm sorry, can you repeat that?Attorney Kevin Reddington (02:10:58):Yeah. Did she tell you that she slashed the screen with the knife before she went out the window?Witness, Doctor (02:11:03):Yes, that's what she told me.Attorney Kevin Reddington (02:11:05):But the screen wasn't slashed, was it?Witness, Doctor (02:11:07):No.Attorney Kevin Reddington (02:11:09):Do you think she was malingering and lying to you at that point, sir, when she told you that?Witness, Doctor (02:11:15):No.Attorney Kevin Reddington (02:11:16):Because one of the things you told this jury is that what stood out to you is I think you made reference to the fact that Lindsay betrayed her family by misleading her family. Remember saying that to this jury yesterday, sir?Witness, Doctor (02:11:45):Portrayed?Attorney Kevin Reddington (02:11:46):Betrayed is what you said.Witness, Doctor (02:11:47):No, I said portrayed.Attorney Kevin Reddington (02:11:49):So Lindsay portrayed and misled her family, is what you said to the jury?Witness, Doctor (02:11:56):Yes.Attorney Kevin Reddington (02:11:57):How did she mislead her family?Witness, Doctor (02:12:03):Well, in text messages, for example, in the days prior to the event, her parents had visited over that weekend and the communications that she was providing did not give a sense of her state of mind regarding suicidality.Attorney Kevin Reddington (02:12:30):Are you kidding me? They stayed up in their house to help them.Attorney Sprague (02:12:34):Objection.Judge (02:12:34):Sustained. [inaudible 02:12:35]Attorney Kevin Reddington (02:12:34):They stayed at the house, didn't they?Witness, Doctor (02:12:37):Yes.Attorney Kevin Reddington (02:12:38):Why did they stay at the house?Witness, Doctor (02:12:40):I'm sorry?Attorney Kevin Reddington (02:12:40):Why did they stay at the house?Witness, Doctor (02:12:44):They were visiting.Attorney Kevin Reddington (02:12:45):They were staying at the house. They weren't just visiting.Attorney Sprague (02:12:48):Objection.Judge (02:12:48):Overruled.Attorney Kevin Reddington (02:12:48):Did they sleep over?Witness, Doctor (02:12:52):As I understand.Attorney Kevin Reddington (02:12:53):Okay. As you understand. How long did they stay at the house and sleep over?Witness, Doctor (02:12:59):I think they came up for that weekend. They weren't there constantly.Attorney Kevin Reddington (02:13:09):No.Witness, Doctor (02:13:09):They came back and forth.Attorney Kevin Reddington (02:13:11):Back and forth. Well, they stayed about one, two, three, about three, four days, three nights, they stayed continuously and stayed at the Clancy home. You knew that from your investigation, right?Witness, Doctor (02:13:27):Yes. That's my recollection.Attorney Kevin Reddington (02:13:30):The answer's yes, right?Witness, Doctor (02:13:30):Yes.Attorney Kevin Reddington (02:13:33):Okay. So they're staying. At the same time, you're telling this jury that she's sending text messages basically saying, "I'm okay, I guess." Is that right?Witness, Doctor (02:13:45):Following their departure, there were the photographs that Lindsay Clancy sent to her mother.Attorney Kevin Reddington (02:13:56):She didn't send her mother a photograph showing that she was smiling or happy with her family, did she?Witness, Doctor (02:14:02):I think there was a photograph of her and the children by the snowman.Attorney Kevin Reddington (02:14:05):No. Is that a bad thing to do that and send a picture of you with your kids making a snowman to your parents?Witness, Doctor (02:14:11):No.Attorney Kevin Reddington (02:14:13):Is that something in your opinion, Dr. Saathoff's opinion for the district attorney, that a person who is involved with postpartum psychosis, postpartum depression, wouldn't take a picture of the snowman and their kids, send it to their mother?Witness, Doctor (02:14:35):Given the prior texts that you showed to her mother in terms of being in terrible distress, that she was able to do that, that was not what happened when she sent the picture with her children and the snowman. And so did not raise concerns from the mother, as I understand.Attorney Kevin Reddington (02:14:57):Did you talk to the mother?Witness, Doctor (02:14:59):Pardon me?Attorney Kevin Reddington (02:15:00):Did you talk to the mother?Witness, Doctor (02:15:01):No, I tried to.Attorney Kevin Reddington (02:15:04):Did you review police reports or statements? You tried to? How'd you do that? What'd you do? Call her up and say, "I want to talk to you"?Witness, Doctor (02:15:11):No.Attorney Kevin Reddington (02:15:12):Did the district attorney call them up?Witness, Doctor (02:15:15):I asked Ms. Clancy who would be good for me to speak with, and she said her husband and her family.Attorney Kevin Reddington (02:15:24):Okay. So based on that, what did you do?Witness, Doctor (02:15:28):I contacted the district attorney and I-Attorney Kevin Reddington (02:15:32):Which one? Which one of these two?Witness, Doctor (02:15:34):Ms. Sprague.Attorney Kevin Reddington (02:15:35):Ms. Sprague. Okay. You spoke to Jen Sprague and what did you say to-Attorney Sprague (02:15:42):Attorney Sprague.Attorney Kevin Reddington (02:15:42):What is it?Attorney Sprague (02:15:43):Attorney Sprague.Attorney Kevin Reddington (02:15:44):You spoke to Jen Sprague and what did she tell you?Attorney Sprague (02:15:44):Objection.Judge (02:15:44):Attorney Sprague.Witness, Doctor (02:15:46):She told me that she would reach out and attempt to see if I could interview Mr. Clancy and Ms. Clancy's family.Attorney Kevin Reddington (02:16:01):Okay. So did you do that? Did you reach out-Witness, Doctor (02:16:00):Family.Attorney Kevin Reddington (02:16:01):Okay. So, did you do that? Did you reach out to her mother?Witness, Doctor (02:16:04):Did I reach out?Attorney Kevin Reddington (02:16:04):Yeah.Witness, Doctor (02:16:04):No.Attorney Kevin Reddington (02:16:09):Okay. Did someone tell you that she wouldn't speak to you?Witness, Doctor (02:16:12):Yes.Attorney Kevin Reddington (02:16:13):And when was this, sir? About two months ago?Witness, Doctor (02:16:22):It would have been probably June 5th.Attorney Kevin Reddington (02:16:28):This is August, right?Witness, Doctor (02:16:31):Pardon me?Attorney Kevin Reddington (02:16:31):This is August. We're in August right now, right?Witness, Doctor (02:16:33):Yes.Attorney Kevin Reddington (02:16:34):You called to speak to the mother in June, right? Yes? Come on.Witness, Doctor (02:16:41):Yes.Attorney Kevin Reddington (02:16:41):Okay. And when you called the mother, did she say ...Witness, Doctor (02:16:45):I did not call the mother. I did not call the mother.Attorney Kevin Reddington (02:16:47):Okay. You did not call the mother. Who told you that you couldn't talk to the mother?Witness, Doctor (02:16:52):Ms. Sprague.Attorney Kevin Reddington (02:16:53):Attorney Sprague, please.Witness, Doctor (02:16:54):Right. Attorney Sprague.Attorney Kevin Reddington (02:16:56):Now, when Attorney Sprague called you and said you cannot talk to the mother, did it ever occur to you to reach out to me? You're being objective and all.Witness, Doctor (02:17:07):No.Attorney Kevin Reddington (02:17:08):Did you know, sir, that Lindsay had signed repeatedly every and any HIPAA form that was needed by the DA or other cops to get access to every single medical record that she had, probably going back to when she was in grammar school. Did you know that?Witness, Doctor (02:17:29):I know she's been open to it and she told me that she would like for me to speak with them.Attorney Kevin Reddington (02:17:36):Right. And she's been open to pretty much anything and everything that was asked of her as far as signing documents, getting medical records, doing interviews, videotaping, making appointments to talk to guys like Mac and Heilbrun and you in Tewksbury Hospital, right?Witness, Doctor (02:17:59):I'm sorry. Can you repeat the question?Attorney Kevin Reddington (02:18:01):All of your investigation, sir, led up to the fact that you were going to meet with Lindsay two months ago, two months prior to our beginning, this five-week triple murder trial. Is that fair?Witness, Doctor (02:18:18):That's true.Attorney Kevin Reddington (02:18:19):And you told this jury that you wanted to establish a rapport with this kid?Witness, Doctor (02:18:25):Yes.Attorney Kevin Reddington (02:18:26):Do you think for one minute when you're trying to put her in jail for her life that she wants to talk to you and have a rapport?Attorney Sprague (02:18:34):Objection.Judge William Sullivan (02:18:34):Sustained. Next question.Attorney Kevin Reddington (02:18:35):Did you establish a rapport?Witness, Doctor (02:18:39):I believe so.Attorney Kevin Reddington (02:18:40):She was cooperative?Witness, Doctor (02:18:42):Yes.Attorney Kevin Reddington (02:18:42):She was polite?Witness, Doctor (02:18:43):Yes.Attorney Kevin Reddington (02:18:44):She was pleasant?Witness, Doctor (02:18:45):Yes. And I asked her at the end if there was any question that I had asked that made her feel uncomfortable and she responded in a positive way.Attorney Kevin Reddington (02:18:56):Okay. One of the things that you told the jury is that you felt that she was malingering or basically lying. I guess you were telling the jury in your opinion that she was making stuff up to make herself look like she's crazy when she killed the children. Is that what you told the jury?Witness, Doctor (02:19:13):I didn't use those words.Attorney Kevin Reddington (02:19:14):No. You're a little more finesse than I was. But nevertheless, sir, you're talking about malingering, right?Witness, Doctor (02:19:33):Yes. The statements about the auditory hallucination.Attorney Kevin Reddington (02:19:36):Excuse me. The answer is yes. You were talking about malingering is my question. Yes or no, right? That's all?Witness, Doctor (02:19:40):Yes.Attorney Kevin Reddington (02:19:41):Okay. And when you're talking about malingering, sir, basically that would be when a person finds it in their interest to basically exaggerate or lie to an investigating psychiatrist, right?Witness, Doctor (02:19:57):Correct.Attorney Kevin Reddington (02:19:57):And that would be because it's in their interest, like I want to pretend that I'm crazy so a jury thinks I'm crazy and I don't have to pay for a crime. That would be in a criminal sense, right?Witness, Doctor (02:20:08):Yes.Attorney Kevin Reddington (02:20:08):Workman's comp cases, a guy gets hurt in the truck and then they end up having interviews by guys like you to make sure to see if in fact they're legitimately hurt for a workman's comp claim, right?Witness, Doctor (02:20:20):Yes.Attorney Kevin Reddington (02:20:20):Or a civil case like an auto accident, right?Witness, Doctor (02:20:24):Yes.Attorney Kevin Reddington (02:20:24):And there are tests that can be administered to people to see from a psychiatrist standpoint, whether or not there is objective indicia of the fact that the person is indeed malingering.Witness, Doctor (02:20:39):Yes.Attorney Kevin Reddington (02:20:40):And what are those tests?Witness, Doctor (02:20:42):Well, I'm not a neuropsychologist, but there's a test called the SIRS, also the TOMM's test of memory. So, there are certain tests that can be given by neuropsychologists to assess malingering about certain aspects, certain issues.Attorney Kevin Reddington (02:21:05):You've also heard, I imagine, of the MMPI, which is the Minnesota Multiphasic Personality Inventory Test, right?Witness, Doctor (02:21:13):Yes.Attorney Kevin Reddington (02:21:13):And that's one that has different scales that you can examine to determine if somebody is lying or malingering or exaggerating or anything like that, right?Witness, Doctor (02:21:22):Correct.Attorney Kevin Reddington (02:21:23):And you know that Dr. Heilbrun administered that very test to Lindsay about, I don't know, two months before you got there, right?Witness, Doctor (02:21:32):Yes.Attorney Kevin Reddington (02:21:32):Which would be about four months from now where we stand now, right?Witness, Doctor (02:21:37):Something like that.Attorney Kevin Reddington (02:21:39):And would you agree, sir, that even though it would have been perhaps better to actually meet with Lindsay within the first six months after the incident or a year even, or maybe even two years. But nevertheless, it still has reliability and validity, does it not, when it's administered to her?Witness, Doctor (02:21:55):The MMPI does, yes.Attorney Kevin Reddington (02:21:57):Okay. And you know, sir, that she in fact had no impact on the scales at all with the exception of likelihood of suicide?Witness, Doctor (02:22:16):Yes, that's my understanding.Attorney Kevin Reddington (02:22:19):Indicating that as far as that test that was administered to her by Dr. Heilbrun did not have any evidence at all this kid was lying, exaggerating, suppressing anything. She was being truthful, right?Attorney Sprague (02:22:36):Objection.Judge William Sullivan (02:22:37):Overruled.Witness, Doctor (02:22:39):About the questions that were on the MMPI, yes.Attorney Kevin Reddington (02:22:42):And those questions, sir, pertain to personality traits, they pertain to her recollection, they pertain to all of the investigation that Heilbrun was conducting, right?Witness, Doctor (02:22:56):No.Attorney Kevin Reddington (02:22:58):Okay. So, when the tests were administered and the results were provided, would you agree with me, yes or no, that specifically the test indicated that she was not malingering?Witness, Doctor (02:23:22):Yes.Attorney Kevin Reddington (02:23:23):Okay. You mentioned one of the other things that you were concerned ... Oh, by the way, would you agree with me that Dr. Phillip Resnick, as you indicated, is like a world-renowned person on Phillip's side of the killing of your children. He's also a person that is in the forefront, pretty much worldwide on malingering, right?Witness, Doctor (02:23:46):Yes. He has written about that.Attorney Kevin Reddington (02:23:50):He's done more than write about it. He's basically given hundreds of lectures and many, many, many learned treatises, all about people that lie to psychiatrists to try to get away with something, right? Right?Witness, Doctor (02:24:07):Yes.Attorney Kevin Reddington (02:24:08):Okay. And you know, sir, that Dr. Resnick examined Lindsay and one of the first things that he did was determine whether or not, in his opinion, she was malingering, lying, suppressing, exaggerating, or doing anything like that, right?Witness, Doctor (02:24:25):Yes.Attorney Kevin Reddington (02:24:25):In his opinion, sir, when you read his report after all the testing, his examination, is that she was not lying to him at all, isn't that right?Witness, Doctor (02:24:35):Yes.Attorney Kevin Reddington (02:24:38):One of the things that you referenced, sir, was you felt that Lindsay was lying about standing at the refrigerator and making Chicken McNuggets or whatever and carrots or peas or something, and you felt that that wasn't right because the child had already had a bowl and was eating, I think you told the jury, chicken nuggets and vegetables or something like that, right?Witness, Doctor (02:25:01):Green beans.Attorney Kevin Reddington (02:25:02):Green beans. Have you looked at the photographs, sir, that's in evidence in this case about that bowl?Witness, Doctor (02:25:12):Quite some time ago.Attorney Kevin Reddington (02:25:14):Does that show any residue of chicken nuggets or green beans in the bowl?Witness, Doctor (02:25:22):Not that I recall.Attorney Kevin Reddington (02:25:23):No. It shows like sliced up residue of a cucumber, possibly a carrot, like vegetables, right?Witness, Doctor (02:25:31):Not that I recall.Attorney Kevin Reddington (02:25:32):So. there are three kids, one of which is an infant who obviously pretty recently got finished breastfeeding, is on the bottle, so he's not going to eat Chicken McNuggets, right?Witness, Doctor (02:25:42):Right.Attorney Kevin Reddington (02:25:43):So, we have two young children that have to be fed, correct?Witness, Doctor (02:25:47):Yes.Attorney Kevin Reddington (02:25:48):You have two young children that Lindsay indicated that she was at the refrigerator getting the chicken and the vegetables so that she could feed the kids, correct?Witness, Doctor (02:26:00):Yes.Attorney Kevin Reddington (02:26:00):Told you that she would not give the kids Chicken McNuggets and vegetables in a bowl, that she would have a plate, right?Witness, Doctor (02:26:10):Not necessarily.Attorney Kevin Reddington (02:26:12):So, when she was at the refrigerator, sir, it's your understanding that she was not being truthful telling you that? Is that what you're telling the jury?Witness, Doctor (02:26:23):I think what I said was very inconsistent with what she had told Dr. Spinelli.Attorney Kevin Reddington (02:26:30):So, when she's at the refrigerator and telling you, in your interview, I know you imported Dr. Spinelli's report, you imported Dr. Resnick's report, you imported Dr. Zeizel's report. When you were talking to Lindsay, did she tell you she was getting food for the kids out of the fridge?Witness, Doctor (02:26:52):That's my recollection.Attorney Kevin Reddington (02:26:54):Now, with all of the understanding and your testimony, sir, about the voices, correct me if I'm wrong, you're telling this jury and Dr. Saathoff's opinion, based on your experience and all of your writings and everything, that when one hears voices, they would be internal or external, to be legit?Witness, Doctor (02:27:26):They can be either.Attorney Kevin Reddington (02:27:28):Really? I'm sorry. I thought you said that they had to be a particular type, like not internal. If they're internal, they're probably lying, but that's not true. I'm wrong?Witness, Doctor (02:27:39):The voice that Ms. Clancy told me about during the time of this event, she said was external.Attorney Kevin Reddington (02:27:46):Okay. And is that consistent with your understanding, sir, of the research on auditory hallucinations?Witness, Doctor (02:27:56):Well, some auditory hallucinations can be internal for people who are psychotic.Attorney Kevin Reddington (02:28:04):And you were aware, sir, that Phillip Resnick, Dr. Resnick, did publish the article in the International Journal of Lauren Psychiatry in 2014 in conjunction with Simon McCarthy-Jones. You're aware of that treatise?Witness, Doctor (02:28:23):Yes.Attorney Kevin Reddington (02:28:23):Yes. And would you agree with me, sir, that in fact, just if some doctors might feel that hallucinations auditory must originate from the exterior as opposed to interior. Would you agree, sir, that in this article, claim number one, doctors may say, "Voices are typically heard as coming from inside the head with the corollary that voices heard as coming from outside the head are atypical." Would you agree with that?Witness, Doctor (02:29:02):That was not my recollection of the research that I understood that it was a minority of ...Attorney Kevin Reddington (02:29:08):No, no, no. Excuse me. It doesn't matter what you're ...Judge William Sullivan (02:29:10):Hold on. Good. Next question.Attorney Kevin Reddington (02:29:13):I'm going to approach you with the article. We've already established who authored it right after all that. Okay?Witness, Doctor (02:29:23):It was quite some time ago.Attorney Kevin Reddington (02:29:24):Sure. Let me put your papers over here just so I don't knock them over. So, if we can share that.Witness, Doctor (02:29:32):Do you want me to say it?Attorney Kevin Reddington (02:29:36):No. I want you to share it. Put it right here so I can look at it. Okay.Witness, Doctor (02:29:38):All right.Attorney Kevin Reddington (02:29:39):Would you agree, sir, that it said voices are typically heard ... This is a claim number one. In other words, doctors would feel voices are typically heard as coming from inside the head with the [inaudible 02:29:57] that voices heard as coming from outside the head are atypical. Did I read that right?Witness, Doctor (02:30:05):Yes.Attorney Kevin Reddington (02:30:06):Okay. And what does atypical mean?Witness, Doctor (02:30:11):Atypical means unusual.Attorney Kevin Reddington (02:30:13):All right. And this article is saying that there are psychiatrists that feel that voices heard outside of the head area hallucinations are indeed not legitimate. Is that fair?Witness, Doctor (02:30:27):That was the old original way of thinking, that was the way it was taught at one time that they had to be external for someone to actually be experiencing psychosis.Attorney Kevin Reddington (02:30:41):Okay. So, we agree that, as Dr. Resnick indicates, that the research evidence does not support the claim that internal located voices are emblematic of genuine, AVH.Witness, Doctor (02:30:55):Auditory verbal hallucinations.Attorney Kevin Reddington (02:30:58):And externally located voices are atypical. He cites a particular word, correct?Witness, Doctor (02:31:04):Yes.Attorney Kevin Reddington (02:31:05):For example, it says, "The largest study on this question, Kathy Jones was in 2012." That's what you're referring to as the old research, right? Oh, one of the things you were in med school and we talked about too.Witness, Doctor (02:31:20):Yeah. I was speaking about very old.Attorney Kevin Reddington (02:31:28):Okay. Basically, found that of 199 psychiatric patients, 81% who have been diagnosed with schizophrenia, 38% heard both voices coming from inside and outside their head. Did I read that right?Witness, Doctor (02:31:45):You did.Attorney Kevin Reddington (02:31:47):All right. So, when Lindsay indicated to you that she indeed heard a loud auditory hallucination voice, deep male commanding her to do what she told you, that was external, correct?Witness, Doctor (02:32:05):Yes.Attorney Kevin Reddington (02:32:05):And you don't have any issues with that? In other words, that is very likely could be legitimate?Witness, Doctor (02:32:11):Yes.Attorney Kevin Reddington (02:32:15):Okay. Now, if you take a young woman who, as the evidence has shown, is suffering with her medical condition or psychiatric condition and seeing doctors and being prescribed medications and reaching out to people for help and suicide hotlines and people down in Rhode Island and McLean Lockwoods Institute, if I hold an opening statement, sir, would you agree that in her efforts to maintain control, she, meaning Lindsay, withheld ...Judge William Sullivan (02:32:47):Form of the question.Attorney Sprague (02:32:47):Yeah. If we could approach?Judge William Sullivan (02:32:47):Sure.Attorney Kevin Reddington (02:34:10):Would you agree, sir, based on your investigation, police reports, statements of witnesses, grand jury, photographs, videos, interviews, interviews of Lindsay, review of witness statements, all of that that you told us yesterday that you reviewed. That in fact, on January 24th of 2023, Lindsay made a calculated decision. She was a woman who no longer liked the life she thought she wanted. It was getting harder and harder for her to control. And when she saw the opportunity to escape, she made the selfish choice to take it and to take Cora, Dawson and Callan first before attempting to take her own life.(02:34:58)Continuing on, sir, she chose to manipulate her providers, seek out a quick and easy fix when she was feeling depressed and anxious, and when she didn't get what she expected, she chose the alternate route. She would seek a different doctor. She would change medications after days. She disengaged from treatment that she didn't like the plan. And after only four months in treatment, she made a choice, a deliberate and intentional decision that she did not want to try anymore. And because no one could take care of her kids the way she wanted them to, she had to take them with her too. Would you agree that the evidence in your opinion supports that contention, sir?Witness, Doctor (02:35:45):Well, there's a lot in that.Attorney Kevin Reddington (02:35:46):Yeah, it is. Do you agree that it would support your contention, sir, or it would not?Witness, Doctor (02:35:53):I think that statement that you read really minimizes what she was going through.Attorney Kevin Reddington (02:36:02):Okay. All right. Thank you.Judge William Sullivan (02:36:07):Attorney Sprague?Attorney Sprague (02:36:08):Thank you, Your Honor. Sir, you were asked during cross-examination about your work as a forensic psychiatrist for the Bureau of Prisons and for the prisons in Virginia and about that work and kind of minimizing what your experience was there, what was your work there? What did that entail?Witness, Doctor (02:36:40):Well, I continued to work there and I continued to teach students in that system. Seeing patients who are inmates in a number of different facilities, men's and women's facilities over the years, and doing assessments, evaluations, making determinations about treatment and the like, gathering information. So, really, treating these inmate patients as patients who have significant mental illness and really require the best treatment that we can provide in the system.Attorney Sprague (02:37:31):And during the course of your many, many years working in that system and treating these patients, have you treated patients with psychosis?Witness, Doctor (02:37:39):Yes.Attorney Sprague (02:37:40):And does that include treating women with psychosis?Witness, Doctor (02:37:43):Yes.Attorney Sprague (02:37:44):And how often have you done that?Attorney Kevin Reddington (02:37:46):I'm going to object. I didn't ask about who ... He said two already. He's already said twice.Judge William Sullivan (02:37:50):Overruled. She may have that. Go ahead.Witness, Doctor (02:37:54):Since 1992?Attorney Sprague (02:37:55):Yes.Witness, Doctor (02:37:56):So, 34 years.Attorney Sprague (02:37:58):How many patients have you treated in the prison system, women patients dealing with psychosis, approximately?Witness, Doctor (02:38:12):Several hundred.Attorney Sprague (02:38:14):And are there certain common signs or symptoms that these women display who have psychosis?Witness, Doctor (02:38:22):Yes.Attorney Sprague (02:38:26):And what are those?Witness, Doctor (02:38:32):Well, some have delusions, fix false beliefs about certain things, though they can present as being psychotic that way. Also, they can present with hallucinations, what we call perceptual disturbances. And generally, they are, in most cases, auditory hallucinations, auditory verbal hallucinations. And they also can present with disorganized thinking, having words, making up words that have special meaning, really having a great difficulty communicating.Attorney Sprague (02:39:14):And you also mentioned that you all worked for a state hospital for, I think you said 15 years, is that correct?Witness, Doctor (02:39:20):Correct.Attorney Sprague (02:39:21):And did you treat patients with psychosis during those 15 years?Witness, Doctor (02:39:25):Yes.Attorney Sprague (02:39:25):And did those include women with psychosis?Witness, Doctor (02:39:28):Yes.Attorney Sprague (02:39:29):And in terms of your treatment of women with psychosis, were you responsible for diagnosing them with their underlying mental condition?Witness, Doctor (02:39:37):Yes.Attorney Sprague (02:39:37):Diagnosing psychosis as being one of their symptoms?Witness, Doctor (02:39:42):Correct.Attorney Sprague (02:39:42):And then treating the underlying condition and the symptom of psychosis for those women?Witness, Doctor (02:39:48):Yes.Attorney Sprague (02:39:48):And you did that for approximately 15 years, correct?Witness, Doctor (02:39:51):â€Yes.Attorney Sprague (02:39:53):And you mentioned two specific patients, females that you dealt with postpartum depression or postpartum psychosis. Do you recall that?Witness, Doctor (02:40:01):Yes.Attorney Sprague (02:40:02):And what did you learn from treating those two patients?Witness, Doctor (02:40:06):So, those are the two patients that are mentioned in the case reports.Attorney Sprague (02:40:15):Which case reports?Witness, Doctor (02:40:16):The case report about postpartum psychosis that was written.Attorney Sprague (02:40:22):On the medication interaction?Witness, Doctor (02:40:25):Yes. Are you asking how those patients presented?Attorney Sprague (02:40:29):Yes.Witness, Doctor (02:40:31):Okay. There were, as I recall, it's been a while since I've looked at the paper, but one was an 18-year-old woman who had delivered her child and had decided not to take, or that she did not want to breastfeed. And so, in those days, this medication, bromocriptine also called Parlodel was given. And we found that within, I think, just a couple of days of the time that she was given this medication, she became convinced that she had to kill her child.(02:41:18)And I believe that she was experiencing auditory hallucinations, and she was so distressed about that, that she wanted to kill herself and was suicidal. And that was how she was brought to our attention in evaluating her. We removed the Parlodel, the bromocriptine, and she responded and resolved her symptoms, her psychotic symptoms, and we were able to discharge her back to her family.(02:41:53)The other case, I believe, was another female, a bit older, maybe mid-20s, and she was also given this medication and also became psychotic. For her, it was more a manifestation of mania. She was hypersexual with her husband. She, I think, was quite hyper-religious and she was ...Attorney Sprague (02:42:26):And doctor ...Witness, Doctor (02:42:26):Sorry.Attorney Sprague (02:42:28):In terms of her delusions, those were more of religious delusions?Witness, Doctor (02:42:32):Pardon me?Attorney Sprague (02:42:33):Her delusions regarding her child were religious delusions?Witness, Doctor (02:42:37):Yes, I believe so.Attorney Sprague (02:42:38):Okay. And once that medication was removed from that woman, did her symptoms subside?Witness, Doctor (02:42:45):Yes. I think in that case, she was also given ... She was so disruptive on the ward, taking her clothes off, et cetera, et cetera, that she was also given antipsychotic medication for a period of time, and her symptoms resolved.Attorney Sprague (02:43:01):And going back to the first patient that you described, you said that she had voices instructing her to harm her child, and was it as a result of her feelings of guilt about those thoughts and voices that she was suicidal?Witness, Doctor (02:43:15):Yes.Attorney Sprague (02:43:16):Okay. So, she wanted to kill herself instead of killing her children, correct?Witness, Doctor (02:43:20):Yes.Attorney Sprague (02:43:24):Now, you were asked by Attorney Reddington about your curriculum vitae and focusing in on terrorism, and is that your sole focus, and you said no. What has been your focus over your career?Witness, Doctor (02:43:39):Well, from the time that I finished my residency, I've been very interested in public psychiatry. And so, upon realizing the seriousness of mental illness within the prison system and the value of teaching psychiatry to students within the system, I began doing that while I was also doing work with the state hospital, seeing patients, whatever.(02:44:12)I would say that of all the things that I do and consider myself, what is most important to me is working with patients, and it's the value of also being with students and having them learn from these patients is going to make them better doctors, even if they don't choose to go into psychiatry. So, I see my identity actually as a clinician, and I have patients I'm scheduled to see. I was supposed to see some yesterday, and also, I'm going to see patients on Friday.Attorney Sprague (02:44:56):Doctor, defense counsel asked you about the onset of postpartum depression and postpartum psychosis, and you had said that the DSM-5 lists postpartum onset within four weeks, correct?Witness, Doctor (02:45:11):Correct.Attorney Sprague (02:45:12):And he asked you about other organizations going up to approximately a year, correct?Witness, Doctor (02:45:17):That's right.Attorney Sprague (02:45:18):Are you aware that the World Health Organization has a clinical descriptions and diagnostic requirements for behavioral and neurodevelopmental disorders that has a section on mental and behavioral disorders associated with pregnancy, childbirth, or the puerperium, P-U-E-R-P-E-R-I-M, which does that mean during or after birth?Witness, Doctor (02:45:44):Yes.Attorney Sprague (02:45:45):And that in that section by the World Health Organization, they state that mental and ...Attorney Kevin Reddington (02:45:54):Objection. She's not going to read that to him, and then he's going to agree with it. She can ask him if he's read it.Judge William Sullivan (02:45:56):Well, let's hear the question first, and then ...Attorney Kevin Reddington (02:45:57):I've been aware of ...Judge William Sullivan (02:46:00):I'll assume there'll be an objection.Attorney Sprague (02:46:02):Are you aware that in that section it states that mental and behavioral disorders associated with pregnancy, childbirth, or the puerperium are syndromes associated with pregnancy or the puerperium commencing within about six weeks after delivery?Attorney Kevin Reddington (02:46:16):Objection.Judge William Sullivan (02:46:17):Overruled. I'll allow that if you know that, Doctor.Witness, Doctor (02:46:19):Yes.Judge William Sullivan (02:46:20):Okay.Attorney Sprague (02:46:20):And are you also aware that there's a section talking about mental and behavioral disorders associated with pregnancy, childbirth, or the puerperium with psychotic symptoms that says onset of a syndrome involving significant mental and behavioral features occurring during pregnancy or the puerperium, i.e., up to about six weeks following delivery is required for diagnosis?Witness, Doctor (02:46:46):That's my understanding.Attorney Sprague (02:46:47):And that's from the World Health Organization, correct?Witness, Doctor (02:46:49):Yes.Attorney Sprague (02:46:49):Now, you were asked about whether blood testing would be appropriate for a patient and you said that it would depend on the history of the patient, the symptoms, the medication. Do you recall that?Witness, Doctor (02:47:05):Yes.Attorney Sprague (02:47:05):Okay. Did you see anything in the records about Lindsay Clancy that would have required blood testing?Witness, Doctor (02:47:13):No.Attorney Sprague (02:47:15):You were also asked about thyroid function and how sometimes you might want to test thyroid function in a postpartum woman. Do you recall that?Witness, Doctor (02:47:23):Yes.Attorney Sprague (02:47:26):Are you aware that, reading from exhibit 222, I believe, that Ms. Clancy's thyroid levels were checked when she visited the South Shore Hospital emergency room on November 16th, 2022, and her levels were within normal limits?Witness, Doctor (02:47:45):Yes.Attorney Sprague (02:47:46):I just move to submit this page from exhibit 222 showing the thyroid levels.Judge William Sullivan (02:47:52):All right. So, that's in ... it's just a follow-up of a sheet that's in. I'll allow that.Attorney Sprague (02:48:00):Recognize this? And doctor, just for the jury to know, in that page that's just been marked in as exhibit, the thyroid levels would be marked by TSH, correct?Witness, Doctor (02:48:10):Correct.Attorney Sprague (02:48:13):You were asked about Lamictal and the serious rash that could occur. You said that the serious rash is rare. How rare is it?Witness, Doctor (02:48:24):Approximately 1 in 1,000.Attorney Sprague (02:48:28):And you mentioned that millions of people take Lamictal with no problem at all, correct?Witness, Doctor (02:48:34):That's right.Attorney Sprague (02:48:35):And is there anything that providers do to be aware of the potential for the rash and to explain that to patients and to try to just basically keep an eye out to see if the patient's developing that symptom?Witness, Doctor (02:48:51):Yes.Attorney Sprague (02:48:52):And what is that?Witness, Doctor (02:48:53):It's a medication that needs to be started at a low dose, 25 milligrams, and only gradually moving up. Finally, after a number of weeks to a dose as much as 200 milligrams, perhaps even more. When the medication is given in what we call titrated slow process, the potential for this serious rash is greatly, greatly decreased. So, it really is a medication that requires a slow titration. So, the patient needs to be patient with that process. But it's now, one of the most used mood stabilizers for bipolar disorder that it really is a very, very important valuable medicine.Witness, Doctor (02:50:01):A very, very important, valuable medicine for bipolar disorder.Attorney Sprague (02:50:05):And you said that it's important to start at a low dose. Did you say 25 milligrams?Witness, Doctor (02:50:09):Correct.Attorney Sprague (02:50:10):Do you recall what dose Dr. Tufts wrote the prescription for, for Ms. Clancy?Witness, Doctor (02:50:15):Yes.Attorney Sprague (02:50:15):And what was that?Witness, Doctor (02:50:16):25 milligrams.Attorney Sprague (02:50:18):And do you recall from the records whether the plan was, if she were to take it, to titrate in the manner you described?Witness, Doctor (02:50:24):Correct.Attorney Sprague (02:50:28):Putting aside whether or not someone chooses to take the medication because of a rash, is there any significance to the person, to a patient being prescribed a medication and then not telling that provider that they chose not to take it?Witness, Doctor (02:50:42):Yes.Attorney Sprague (02:50:42):And what is that?Witness, Doctor (02:50:47):Well, it really limits the provider in making other decisions. If a decision is made that a patient's not going to take a certain category of medication, it's helpful to let that provider know and say, "I've decided against it. What are some other alternatives?"Attorney Sprague (02:51:07):Doctor, you were asked about lack of sleep potentially causing psychosis, correct?Witness, Doctor (02:51:14):Correct.Attorney Sprague (02:51:17):And sleep was definitely an issue for Ms. Clancy in the fall leading into December of 2022, correct?Witness, Doctor (02:51:26):Yes.Attorney Sprague (02:51:26):Looking back to the McLean records, would it be accurate to state that her sleep got progressively better while at McLean?Witness, Doctor (02:51:32):Yes.Attorney Sprague (02:51:33):And then directing your memory to the text messages that Ms. Clancy had with her mother from January 7th through January 22nd of 2023, would it be accurate to state that she told her mother she was sleeping better during that time?Witness, Doctor (02:51:49):Yes.Attorney Sprague (02:51:54):Defense Counsel asked you if by all the evidence and witnesses that the defendant was a happy wife, mother, daughter, all of that, and you said no. What were you referring to when you said no?Witness, Doctor (02:52:11):Well, I was thinking about the paper that she filled out on September 12th of 2022 in which she expressed some of the concerns that she had significant anxiety, but also, as I recall, insomnia was a concern of hers. And she was followed up with Jennifer McAllister who worked with Dr. Tufts. And I think in Ms. McAllister's note, Ms. Clancy mentioned that she had waning confidence in being able to take care of her children as they were growing up. And that, I think in a note of Dr. Tufts, Dr. Tufts noted that she said that she found that Callan needed more attention and that as the kids were growing older, that she was finding them more challenging.Attorney Sprague (02:53:18):Did Ms. Clancy give any information about why it was more challenging as the kids got older?Attorney Kevin Reddington (02:53:27):I'm going to object. This is pretty far afield.Judge William Sullivan (02:53:29):Yeah, sustained. It goes beyond cross.Attorney Sprague (02:53:41):Doctor, Defense Counsel asked you about Dr. Tufts and her treatment of the defendant and mentioned repeatedly how she had only been in the practice on her own for a few months. Do you remember that?Witness, Doctor (02:53:54):Yes.Attorney Sprague (02:53:55):In reviewing Dr. Tufts' treatment of the defendant and the medications she prescribed and the methods she used in prescribing those medications, did you have any issues or concerns about the approach she took of what she prescribed?Witness, Doctor (02:54:12):No.Attorney Sprague (02:54:14):What were your thoughts about her approach to treating this defendant?Witness, Doctor (02:54:21):Well, possibly because Dr. Tufts was new and had just come into practice, she was more available. And so I think she was able to see Ms. Clancy over video 14 times. For example, when Ms. Clancy was discharged from McLean, the request for McLean was that she needed immediate outpatient follow-up. And so Dr. Tufts arranged it the following day. And so there were some weeks where Dr. Tufts saw Ms. Clancy more than once a week.(02:55:13)I will also say that when Ms. Clancy decided to go to Nurse Practitioner Paul and then saw Nurse Jollotta, I think early December, it might have been December 1st, she then went to Dr. Tufts, and Dr. Tufts wrote a note saying that she felt uncomfortable making prescriptions while Ms. Clancy was going to another provider, but in that note suggested that Lamictal could be helpful. So Dr. Tufts was very responsive to concerns of Ms. Clancy in terms of seeing her. Was seeing her weekly and saw her on the 23rd of January and then had another appointment the next week and had talked about future treatments, possible treatments, esketamine, as well as TMS.(02:56:21)So perhaps the fact that she had just left her residency meant that she could be more responsive to seeing patients quickly, and she did that.Attorney Sprague (02:56:38):And speaking specifically to the prescribing, prescribing which medications she's prescribed, which doses, what different options she tried, did you have an opinion based on your training and experience of Dr. Tuft's method with prescriptions?Witness, Doctor (02:56:54):Yes.Attorney Sprague (02:56:54):What was that?Witness, Doctor (02:56:57):I felt that the prescribing was very reasonable.Attorney Sprague (02:57:04):How so?Witness, Doctor (02:57:06):Well, back in 2013, 2014, Ms. Clancy had taken Prozac, an SSRI, and it was helpful. She also took Wellbutrin and propranolol. After Dawson was born, Ms. Clancy had some significant anxiety and actually went to a doctor and was prescribed Zoloft, so this would've been in 2019, early 2020, but then decided not to take the Zoloft. Her anxiety symptoms resolved. It was a difficult time, particularly as he got older because of COVID, but she decided that even though she had the prescription of Zoloft, she decided not to take it. The anxiety that she experienced after Callan's birth was more significant and lasted longer.(02:58:12)And so she went to Dr. Tufts, who got a history of Ms. Clancy having taken the Prozac and done well on it. Having seriously considered Zoloft to the extent that she got a prescription for it, decided not to take it, that Zoloft at 25 milligrams, which is the lowest dose starting that, would be a reasonable choice, really perhaps the most reasonable choice of an antidepressant given Ms. Clancy's history up to that point. I believe that there were only seven pills taken. Ms. Clancy was directed to take 25 milligrams for a week and then increased to 50 milligrams, two tablets, but had, I think maybe after five days, taken that increase and increased from 25 to 50 milligrams and then had the adverse reaction of insomnia, very significant insomnia.Attorney Sprague (02:59:24):And in terms of after seeing the effects from the Zoloft and stopping that prescription, the various prescriptions that Dr. Tufts tried with the defendant, did you have an opinion, based on your training experience, about whether that trial and error process in what she prescribed and what she tried with the defendant, whether that was reasonable?Attorney Kevin Reddington (02:59:46):Objection.Judge William Sullivan (02:59:47):Overruled.Witness, Doctor (02:59:49):Yes.Attorney Sprague (02:59:49):And was it reasonable?Witness, Doctor (02:59:50):Was it reasonable?Attorney Sprague (02:59:53):Yes.Witness, Doctor (02:59:53):Yes.Attorney Sprague (02:59:54):How so?Witness, Doctor (02:59:56):Well, Ms. Clancy, after having the insomnia, was very upset and concerned, as anyone would be. I think that was around October 21st. And so Dr. Tufts assessed her and told her to stop the Zoloft and started her on Ativan, I understand, and Benadryl. And that medication was helpful for a while, but Ms. Clancy was concerned about Ativan, benzodiazepines being addictive and concerned about getting hooked on these types of medications. And that is a concern over the long term. And so part of the process was to see if she could be treated effectively by decreasing the benzodiazepines or maybe giving her a longer acting benzodiazepine. The medication BuSpar, buspirone, was prescribed by Dr. Tufts, but Ms. Clancy, in a note-Attorney Kevin Reddington (03:01:18):Excuse me, doctor. I apologize. Can I have a standing objection to the rambling answers? This is redirect. I object.Judge William Sullivan (03:01:24):Right. [inaudible 03:01:25], Counsel. I just want to put something on the record. Counsel.Attorney Sprague (03:01:45):And so doctor, if you could continue your answer as-Judge William Sullivan (03:01:49):Just for a second. Members of you, we're going to go a little past the 1:00, the usual time of the break here for certain scheduling reasons. Okay?Attorney Sprague (03:02:00):If you could just summarize briefly what... You said that you thought that Dr. Tufts' approach was reasonable. If you could just summarize briefly why you thought her approach was reasonable.Witness, Doctor (03:02:15):According to the notes and also the emails, communications between Dr. Tufts and Ms. Clancy, I found Dr. Tufts to be very responsive to Ms. Clancy's symptoms and concerns in really trying to make adjustments according to how Ms. Clancy was doing.Attorney Sprague (03:02:44):Thank you. And you were asked by Defense Counsel about her visit to Women in Infants Hospital and about the defendant. I believe what Defense Counsel asked you was that every time a doctor told the defendant to do something, she was on it immediately. Do you remember being asked that?Witness, Doctor (03:03:05):Yes.Attorney Sprague (03:03:06):Do you recall that in the women and infants records, that they offered her three programs, an inpatient hospitalization, a partial hospitalization program, and an outpatient program, and the defendant said that she would talk to her provider for guidance about those programs?Witness, Doctor (03:03:23):Yes.Attorney Sprague (03:03:24):Do you recall reading in the notes and records of Dr. Tufts, Nurse Practitioner Jollotta, that she never discussed those three programs with her doctor or her nurse practitioner, correct?Witness, Doctor (03:03:38):That's my recollection.Attorney Sprague (03:03:43):Now, in terms of the calls to Aspire, to the suicide hotline, you were asked about where in the records you saw that. And I would just like to approach also from exhibit 222, the note from December 8th, 2022 of Leticia Dukes. And if you could just review this note here and then look up when you're finished. Doctor, is this the record that you were referring to that gave you the information about the defendant's call to the suicide hotline?Witness, Doctor (03:04:54):Yes.Attorney Sprague (03:04:55):And reading from this page from the exhibit, page 45, it states that, "Patient contacted Aspire Crisis Support. She met with an Aspire clinician virtually and was told that she did not meet the criteria for inpatient treatment due to not having an SI plan." That's a suicidal ideation plan, correct?Witness, Doctor (03:05:17):Correct.Attorney Sprague (03:05:18):And then reading again, "Aspire clinician recommended that the patient attend a day program. The clinician said he would be sending the patient resources. Clinician informed the patient that it would be beneficial to attend an IOP or a PHP to help the patient build coping skills and build community." What's an IOP and a PHP? Do you know?Witness, Doctor (03:05:43):PHP is partial hospitalization program, and IOP is I believe an inpatient program.Attorney Sprague (03:05:54):And so when the defendant called the suicide hotline, she told them she was having suicidal thoughts, correct?Witness, Doctor (03:06:00):Correct.Attorney Sprague (03:06:01):But she told them she did not have a plan, correct?Witness, Doctor (03:06:03):Correct.Attorney Sprague (03:06:04):And they didn't just hang up on her. They sent her resources and recommended a day program and a partial hospitalization program or an inpatient program, correct?Witness, Doctor (03:06:14):Correct.Attorney Sprague (03:06:15):Move to submit these two pages, 45 and 46, as the next exhibit. They're apart from exhibit 222.Judge William Sullivan (03:06:23):All right. Subject to the same objection. That may be admitted.Speaker 6 (03:06:26):[inaudible 03:06:30] 97.Attorney Sprague (03:06:35):You were asked a lot of questions about hormone changes after pregnancy and stopping breastfeeding and if that could affect someone's mental health. Do you remember that?Witness, Doctor (03:06:50):Yes.Attorney Sprague (03:06:50):And you said something about the timing matters. Why does the timing matter?Witness, Doctor (03:06:57):Well, after lactation and a postpartum period, and it may be the decision for a woman to stop lactation can occur at various times, not just during a circumscribed one-month period, but stopping lactation causes a decrease in prolactin levels, an increase in estrogen and progesterone. And it really depends on when someone decides to stop breastfeeding, those significant hormonal changes that are tied to breastfeeding or lactation. And so that's why timing and the time is important to see at what point did breastfeeding stop and at what point are we seeing symptoms.Attorney Sprague (03:08:02):And Doctor, with the defendant, the breastfeeding stopped sometime in October; is that correct?Witness, Doctor (03:08:07):Yes.Attorney Sprague (03:08:07):And then looking ahead to January, January 24th, 2023, would you still be expecting to see hormonal problems from stopping breastfeeding in October, in January, that many months later?Witness, Doctor (03:08:21):No.Attorney Sprague (03:08:23):Now, you were asked about the statements Patrick made regarding his interaction with the defendant when he found her outside in the snow. Is it correct that he told you he found her and said, "What did you do?" And she said, "I tried to kill myself."Witness, Doctor (03:08:43):Yes.Attorney Sprague (03:08:43):Did he then say, "Where are the kids?" And she said, "They're in the basement."Witness, Doctor (03:08:47):Yes.Attorney Sprague (03:08:48):Did he then tell you that he then called 911?Witness, Doctor (03:08:56):I don't recall exactly when he told me that he called 911. What I recall is his statement about what she said to him.Attorney Sprague (03:09:06):And that was her statements to him when he immediately found her on the ground?Witness, Doctor (03:09:11):Correct.Attorney Sprague (03:09:12):Okay. And you're aware that at some point, he made a 911 call, correct?Witness, Doctor (03:09:15):Yes.Attorney Sprague (03:09:16):And during that 911 call that you listened to, you didn't hear the defendant saying any words at that point, correct?Witness, Doctor (03:09:22):I did not.Attorney Sprague (03:09:23):As a physician, are you aware that someone who's been injured can deteriorate over time?Witness, Doctor (03:09:30):Yes, particularly after an overdose.Attorney Sprague (03:09:33):Can they be speaking in one moment and then unable to speak moments later?Witness, Doctor (03:09:37):Yes.Attorney Sprague (03:09:41):Now, you were also asked about the crushed up pills and whether there was any residue on the nightstand or anywhere in the house that the police saw, correct?Witness, Doctor (03:09:54):Yes.Attorney Sprague (03:09:54):And there was no residue in the photos, correct?Witness, Doctor (03:09:57):Not that I saw.Attorney Sprague (03:09:58):But you don't know when she crushed up the pills, do you?Witness, Doctor (03:10:01):I don't.Attorney Sprague (03:10:02):If she had crushed them up earlier in the day, there wouldn't necessarily be residue, correct?Witness, Doctor (03:10:08):Correct.Attorney Sprague (03:10:09):If she had crushed them up days before and put the empty bottles in a drawer-Attorney Kevin Reddington (03:10:12):Objection. [inaudible 03:10:13].Attorney Sprague (03:10:12):... there wouldn't necessarily be residue, correct?Judge William Sullivan (03:10:15):Sustained.Attorney Kevin Reddington (03:10:16):Yes.Attorney Sprague (03:10:26):There were many texts between the defendant and her mother in January, correct?Witness, Doctor (03:10:31):Yes.Attorney Sprague (03:10:32):And from January 7th until January 22nd, when Ms. Clancy's mother and father visited her at her home, the text messages clearly indicated that they were in two separate locations, correct?Witness, Doctor (03:10:46):Yes.Attorney Sprague (03:10:47):And in those text messages, the defendant repeatedly told her mother that she was doing a little bit better, a little bit better, sleeping's a little bit better, correct?Witness, Doctor (03:10:55):Yes.Attorney Sprague (03:11:01):You were asked about Dr. Resnick and how many articles and how many books he's written and how he's well known in this area, correct?Witness, Doctor (03:11:12):Yes.Attorney Sprague (03:11:13):And are you familiar with Dr. Resnick's teachings about malingering and about psychosis?Witness, Doctor (03:11:20):Yes.Attorney Sprague (03:11:21):Is it fair to say that Dr. Resnick teaches others that one of the red flags to look for in malingering-Attorney Kevin Reddington (03:11:28):[inaudible 03:11:29]. You can ask him what he's read, not tell him what she wants him to say.Judge William Sullivan (03:11:33):No, hold on. Let me hear the question first.Attorney Sprague (03:11:36):Are you aware that one of the red flags that Dr. Resnick teaches to look for in malingering and faking hearing voices is that someone automatically obeys a command?Judge William Sullivan (03:11:47):Yes. It's stricken at this time. Can I see Counsel? Members of the jury, that last answer, I think, as I said, was stricken. Okay. Yeah, [inaudible 03:12:16].Attorney Sprague (03:12:16):Thank you, Your Honor. Now, you were asked about trying to do collateral interviews with the defendant's family, correct?Witness, Doctor (03:12:26):Yes.Attorney Sprague (03:12:26):And you had requested of our office to make arrangements to interview the defendant's parents and her sister, correct?Witness, Doctor (03:12:34):Yes.Attorney Sprague (03:12:35):Were you aware that an email was sent to... I'm sorry. Were you aware that a phone message was left for Paula Musgrove asking if she and her husband would be willing to meet with you on June 11th, 2026, and that they did not return the call?Witness, Doctor (03:12:53):That's my understanding.Attorney Sprague (03:12:55):Are you aware that an email was sent to Allison Ozga, the defendant's sister, requesting that she meet with you, and her response to that email was, "I am awaiting a response from Kevin advising me on participating in Dr. Saathoff's assessment. I will respond once I speak to him." Were you aware of that?Witness, Doctor (03:13:16):That was my understanding.Attorney Sprague (03:13:17):And were you aware that she did not respond after that?Witness, Doctor (03:13:20):Correct.Attorney Sprague (03:13:21):I have nothing further. Thank you.Attorney Kevin Reddington (03:13:23):You weren't aware that Kevin was on a month-long federal trial during that period of time either, were you? That'd be me.Witness, Doctor (03:13:32):Is that a question?Attorney Kevin Reddington (03:13:33):Yeah.Witness, Doctor (03:13:34):Can you repeat it?Attorney Kevin Reddington (03:13:35):You weren't aware-Judge William Sullivan (03:13:36):Maybe get a little closer to the microphone. I had problems.Attorney Kevin Reddington (03:13:38):Aware, sir, that during the time that Ozga, her sister, said she's waiting to hear from Kevin, and I'm the Kevin, that I was on trial on a month-long federal case out of my office. You didn't know that, did you?Witness, Doctor (03:13:49):I did not know that.Attorney Kevin Reddington (03:13:50):Did you ever think to call me directly or at my secretary, my office manager to ask about me reaching out to these people?Witness, Doctor (03:14:00):No.Attorney Kevin Reddington (03:14:01):That's all I have, Judge. Thank you.Judge William Sullivan (03:14:03):Anything else?Attorney Sprague (03:14:03):No.Judge William Sullivan (03:14:18):All right thank you, Doctor. You may sit down. Thank you.(03:14:18)All right. Attorney Sprague?Attorney Sprague (03:14:20):Commonwealth rests.Judge William Sullivan (03:14:20):All right. Members of the jury, the Commonwealth has now rested their rebuttal case. So you have the evidence. All right. And so at this point, what I'm going to do is excuse you until tomorrow morning. All right? And tomorrow morning, you should be ready. We're going to have closing arguments and the legal instructions in the morning, and then the jury will begin deliberating. All right, so that's tomorrow. So I would suggest you go home, rest up, and be ready for tomorrow.(03:14:56)And so now you've heard all the evidence. For the first time, I can say that you've heard all the evidence, but you haven't heard the arguments from the attorneys. You haven't even heard, like I said, before the law that you do apply. So you still have to keep an open mind, all right? So those instructions that I gave you for the last four or five weeks, they're doubled down today. All right? Don't read anything. Don't talk about this. Don't watch anything. Don't discuss this with anyone. Keep an open mind. Come this far with that open mind. Bring it with you tomorrow. All right?(03:15:32)And so get a good night's sleep. I look forward to seeing you tomorrow and we will get as soon as we can. Sometimes there's a little delay when we get to this next section, so we'll try and get you out here as soon as we can tomorrow morning. But if there's a little bit of a delay, as you probably already know, it's probably on me, right? But we'll try and get you out here as soon as we can and get you right back into this. So again, thank you so much for all your work, all your commitment, all your dedication, and I look forward to seeing you tomorrow. Okay.Speaker 1 (03:16:00):Court, all rise, please. Jurors [inaudible 03:16:06]. Jurors have exited the floor. This closes in session.Judge William Sullivan (03:16:43):All right. What I thought we'd do is maybe I'll hear from the defendant in regards to any motions at this point. Then we take a break probably until about 2:30, come back, do the charge conference. Before you leave, I have that draft so you could impose on your lunch hour. You can be looking at my instructions. So with that, Mr. Reddington?Attorney Kevin Reddington (03:17:08):Yes, Your Honor. I know it's not crafted by learned at hand, but nevertheless, I did file a motion for required finding that I have to renew. So I'm renewing it and waive argument.Judge William Sullivan (03:17:17):Okay.Attorney Sprague (03:17:20):We'd object to the motion.Judge William Sullivan (03:17:22):All right. The motion at this point is denied. All right. And so we will be in recess until 2:30. And if Counsel can just wait, I'll get those copies. I should have brought them out with me. They're in my lobby, and then we'll be in recess.Attorney Kevin Reddington (03:17:38):All right.Judge William Sullivan (03:17:39):All right. Thank you, everyone.Speaker 7 (03:17:40):Court, all rise.Speaker 8 (03:17:42):Your Honor, for the purpose of the record, we return back to the trial of Commonwealth versus Lindsay Clancy. All parties are present, excluding the 18 jurors.Judge William Sullivan (03:18:04):All right. All right. Counsel, I though we'd have our charge conference at this time. Everybody get a chance. I know you just got them about an hour ago. So in regards to the draft that I gave, I know I got one set of proposed instructions from the defendant. Does Commonwealth have any that you wish to offer?Madam Clerk (03:18:36):We don't have to upline any motion, but we just do have a few comments and-Judge William Sullivan (03:18:39):Sure. Well, that's what I expected. I know everybody's been on trial, so that's why I thought I'd give you the draft and we could just walk through it. So my thought would be to first go through the Commonwealth's position and then I'll hear from the defendant. So Attorney Buckingham?Madam Clerk (03:19:00):Thank you, Your Honor. In relation to your proposed draft instructions, I think that Your Honor's instruction regarding criminal responsibility is pretty much the cut and paste of the model instruction. So overall, there's no objection to it. However, the Commonwealth would just like to put on the record that we don't think that voluntary intoxication, the three points that were added into Your Honor's draft are necessary. And I'll just cite to the Commonwealth versus Brown 449 Mass 747. It's a 2007 case where it says that, "An instruction on voluntary intoxication is not required absent evidence of debilitating intoxication. Such evidence must support the inference that at the time of the killing, intoxication impaired the defendant's ability to form any requisite criminal intent."(03:19:56)And so in this case, I understand Counsel is going to argue medications, and he's free to argue that to the jury. But as far as instruction goes, we're talking about criminal responsibility, we're talking about mental status. At the time of the event on the day in question of January 24th, 2023, there is no evidence to support that there was intoxication to a debilitating effect as the Brown case indicates. I think what the best evidence the court has is that the defendant, in her journals and some statements that she made to the experts, indicated that at the time of the offense she was taking amitriptyline and one other medication that she had been on for quite some time. And Your Honor now has evidence that it was a very low dose of amitriptyline and there is nothing about the observed behavior of her on that day suggesting that there was any debilitating effects of the consumption of the prescription medications on that day.(03:20:56)So we would ask that those sections not be included in the instruction. If Your Honor is inclined to include them in the instruction, we are asking that you add a qualifier into what's listed as paragraph three where it starts to talk about the-Judge William Sullivan (03:21:18):Is it on page three, Roman numeral three?Madam Clerk (03:21:20):Yes.Judge William Sullivan (03:21:20):Okay.Madam Clerk (03:21:20):Roman numeral three.Judge William Sullivan (03:21:21):Yeah, okay.Madam Clerk (03:21:24):It says, the defendant lost the substantial capacity I have just described involuntarily intoxicated by prescription drugs. We would just ask that you add on the day of the offense to again, just be clear to the jury that we're talking about her consumption or the consumption of the medication on that day.(03:21:46)I did notice a quick typo on page four under Roman numeral four in that first full paragraph where it's the consequences of a finding. It says in the maybe fifth line, it starts, "If the court concludes the defendant is mentally ill and that her discharge would create a substantial likelihood of serious harm to himself." It's just a pronoun.Judge William Sullivan (03:22:14):Right. Okay. No, I appreciate that.Madam Clerk (03:22:20):As far as the remaining instructions on the charges of first degree with deliberate premeditation and extreme atrocity or cruelty, the commonwealth has no objection to that. I would just note another typo on page seven. Your Honor lists out the Castillo factors on the third factor. C and D appear to be in the same line and there are just some numbers in there that I don't think makes sense. It says the manner and degree and severity of the force used.Judge William Sullivan (03:22:58):Oh, I got you. Yep.Madam Clerk (03:22:59):And as far as the instruction on involuntary manslaughter, the Commonwealth would object to the involuntary manslaughter. And I would cite to the case of Commonwealth versus Garabedian, which is an older case, 399 Mass 304. It's from 1987. It says, in that case, the defendant argued that involuntary manslaughter was required because of evidence of involuntary chemical intoxication. That was a case where the guy, he sprayed chemicals on lawns and he had an interaction with a homeowner and ended up getting into a physical altercation with her strangling her, falling off a ledge, hitting her with a rock and then strangling her with a shoelace. So in that particular case, the court held that an unlawful battery was quite likely to endanger life and hence could not be classified as involuntary manslaughter.(03:23:52)So where it's a wanton and reckless conduct theory, I think that Garabedian is right on point to say that in situations like this where we have the strangle-Madam Clerk (03:24:00):That in situations like this where we have the strangling of the individuals, of the babies, of the kids, unlawful battery is quite likely to endanger life, that it shouldn't be an instruction for involuntary manslaughter. So I'd rely on that case to argue that that should not be included in the instructions. And there's one more point. Your Honor, at one point when we were arguing about particular pieces of evidence and duplicative evidence.Judge William Sullivan (03:24:33):Yeah.Madam Clerk (03:24:33):Your Honor did indicate giving some sort of instruction that the jury didn't consider the fact that there might be duplicative evidence as giving any more weight or importance. And I know you do have a small line in that where it says in the evidence section about the strength or proof is not determined by the volume. But I do think, again, based on the particular way in which the evidence came in and how the parties chose to display the evidence and the fact that we have text messages in several different forms that are presented, some of them the full record, some of them condensed records, that some instruction to them that indicates that they're to give no more weight to any one than the other, even if it does appear duplicative in the record, I'd ask that something to that effect be added.Judge William Sullivan (03:25:27):I think it says that on page 11, because I do remember that request. If you look at under what is evidence, in this case there may be certain documents or photographs that are entered multiple times. This does not mean that that evidence is any more or less important than any other evidence. So I put that in there and I understand the request to maybe put that in a separate paragraph, but I have addressed it that way. I'll consider not whether or not I give it a separate paragraph. I do understand the request, but at least that's why I put that in there. All right. Anything else? Okay. All right. Mr. Reddington.Attorney Kevin Reddington (03:26:07):Thank you. Thank you for the time to review this stuff, Judge. If I may, just going through your proposed instructions, Roman numeral one, introduction is fine. Criminal responsibility, paragraph one is fine. Going down in page two, criminal responsibility, you indicate is a legal term, not criminally responsible with a mental disease or defect. And then you make reference to lacking substantial capacity either to appreciate criminality or wrongfulness of the conduct or conform the conduct. That's fine. And then you define mental... You don't define it, but you talk about mental disease and defect. I understand that the law is pretty clear that the court does not have to define mental disease or defect, but you've given them a framework within which to make that decision, which is acceptable to the defendant. There is one reference in there where, if I may, does not include abnormality [inaudible 03:27:21] only by [inaudible 03:27:23]. So you say in that sentence, the phrase mental disease or defect is a legal-Judge William Sullivan (03:27:28):Hold on, let me find that.Attorney Kevin Reddington (03:27:29):I'm sorry. It's page two, second paragraph down after that first sentence.Judge William Sullivan (03:27:34):I got the phrase. Go ahead.Attorney Kevin Reddington (03:27:34):Yeah. Mental disease or defect in quotes is a legal term, not a medical term. That's fine. It need not fit into a formal medical diagnosis. Fine. The phrase, "Mental disease or defect does not include abnormality." This is what I'm just looking at. Characterized only by repeated criminal conduct. So number one, I just would suggest, I don't think we have repeated criminal conduct here. I'm just wondering if it might just be a little confusing. It is for you to determine in light of all the evidence whether defendant has a mental disease or defect. If the Commonwealth has proved to you beyond a reasonable doubt that the defendant was not suffering from a mental disease or defect, Commonwealth has satisfied its burden of proving that defendant was criminally responsible.(03:28:20)So I understand and have no problem with... I would think all the way from it is for you to determine. My only question is in reference to where you put in the phrase about mental disease or defect does not include an abnormality characterized only by repeated criminal conduct. I don't think that that's based on the evidence. So it might be hypo-technical, but I just assume not have that in.(03:28:48)If the Commonwealth has not proved to you beyond a reasonable doubt defendant was not suffering from a mental disease or defect, then you must consider whether as a result of mental disease or defect, the defendant lacked substantial capacity either to appreciate or the wrongfulness of conduct or conform. That's a fair statement of the law. To establish that the defendant had substantial capacity to conform her conduct, the Commonwealth must prove beyond a reasonable doubt that any disease or defect that may have existed did not deprive defendant of her ability to behave as the law requires, that is to obey the law. And then you do indicate that that would relate to the word appreciate, understand more than merely to know. And then criminality and then you do get into means the legal significance of conduct and wrongfulness means the moral significance, which is fine. I would ask that on the next paragraph you add in before wrong in the second sentence.(03:29:54)Commonwealth must prove that the defendant knew and understood that her conduct was illegal or it was... And I would ask that you put in there morally wrong, in front of wrong. And then the rest of that paragraph is fine from my point of view. Last sentence, the court notes, defendant must have been able to realize in some meaningful way that her conduct was illegal or wrong. And again, I would just ask that you would insert the word morally wrong.(03:30:25)That paragraph is fine. Roman numeral two. A defendant's lack of criminal responsibility must be because of a mental disease or defect. That's fine. But then the court says all that you need to determine, and I just would ask respectfully that you delete the all that you need to determine. It seems to kind of... And I know that's in some of the instructions, but I think it dilutes the gravity of the issue for the jury. It's almost minimizing the burden for the government and it's unnecessary. So I would ask that that go. And then you could say the jury has to determine the issue and then go into the rest of the instruction as you put it rather than saying all you need to determine.(03:31:06)Further, in that paragraph where defendant lacks substantial capacity to appreciate, again, that's appreciate the criminality or wrongfulness of her conduct or to conform her conduct to the law solely as... Okay, voluntary intoxication. Believe it or not, after five weeks, I think we agree. I would ask that the court not instruct on voluntary intoxication. I appreciate the fact that looking at the model charge, and I know when Your Honor is using that as a guide, they do make reference to voluntary intoxication. I just don't see that there's any evidence here of voluntary intoxication that would trigger a preexisting mental disease or defect. I don't see that there's any issue such as... A lot of the cases, as you all know, when you're dealing with a defendant who's snorting cocaine or shooting fentanyl or smoking weed. I know the case, the recent case of Commonwealth v. Aldo Dunphe, D-U-N-P-H-E, is a guy that had a marijuana psychosis dependency. And we don't have any of that here. We just have prescription medications that were provided to the defendant. So I would ask that the court not reference voluntary intoxication. I would ask, going down to Roman numeral-Judge William Sullivan (03:32:24):So would you ask... So Roman numeral two on page two, not give?Attorney Kevin Reddington (03:32:30):Yes.Judge William Sullivan (03:32:30):And Commonwealth that you would be in agreement with that?Madam Clerk (03:32:38):Yes, but I think two also follows with Roman numeral three.Judge William Sullivan (03:32:44):We got to three. So I want to make sure... But I just kind of want to make sure as I'm going through this, it's kind of dense, as am I sometimes.Attorney Kevin Reddington (03:32:52):Yeah, it is.Judge William Sullivan (03:32:53):So I just wanted to make sure. So Roman numeral two, both parties are of the position not to give based on the evidence as it's developed.Attorney Kevin Reddington (03:33:03):Correct.Judge William Sullivan (03:33:03):Okay.Attorney Kevin Reddington (03:33:04):Yeah. Thank you.Judge William Sullivan (03:33:05):I'll consider that. I'll strongly consider that.Attorney Kevin Reddington (03:33:07):All right.Judge William Sullivan (03:33:07):And then so that takes us to paragraph three.Attorney Kevin Reddington (03:33:11):In paragraph three, if I'm not mistaken, I did skim it pretty quickly. I think it does also reference voluntary intoxication. And here you're specifying prescription drugs and if the defendant knew or had reason to know that her intoxication would trigger or intensify a mental disease or defect, I don't think that the evidence supports that. I agree with the Commonwealth. I would ask that Roman numeral three-Judge William Sullivan (03:33:36):Right, so by agreement, nobody's requesting paragraph three and I'm highly-Attorney Kevin Reddington (03:33:42):Thank you.Judge William Sullivan (03:33:43):... likely not to give that.Attorney Kevin Reddington (03:33:44):All right. Four is fine, Judge. Roman numeral five.Madam Clerk (03:33:49):Or it goes to the same thing. It's just a reiteration of the final. So if we're saying-Attorney Kevin Reddington (03:33:53):Yeah, so that would go-Judge William Sullivan (03:33:55):Four is a trailer to three.Madam Clerk (03:33:59):Right.Judge William Sullivan (03:33:59):Okay.Attorney Kevin Reddington (03:33:59):Roman numeral five is okay. Paragraph three, four. Okay. So again, if I may just say without skimming them now, anytime it's referencing voluntary intoxication, maybe that could be deleted. Because I see in paragraph four on Roman numeral five on page three, it does reference again her voluntary intoxication from prescription drugs and that type of thing. So that would go out. Paragraph six, talking about in the event that the defendant is indeed acquitted by reason of lack of criminal responsibility, I know the court has the obligation to instruct the jury as to what potential ramifications would flow from that. I believe that's a fair statement of the law. Instructions on murder in the first degree, deliberate premeditation, cruelty and atrocity, those are all fine. Second degree, that's fine. Involuntary manslaughter, I do think certainly the facts as presented and the evidence does justify the instruction as the court-Judge William Sullivan (03:35:11):Let me hear you. What's the argument in regards to the involuntary manslaughter?Attorney Kevin Reddington (03:35:12):Well, the argument regarding the involuntary manslaughter is clearly that the defendant intended the conduct that resulted in the death of the deceased and the conduct in the event that it was not such that her conduct was as a result of her suffering from a disease, a defect, intentional, premeditated and intended to be cruel and atrocious that would reduce it down to manslaughter and it would most certainly be wanton or reckless. I will be addressing voluntary as well, but I think it's clear that on the evidence that if the jury determines that defendant committed an act, defendant as a result of the act, the victims were indeed died, that there's a high degree of likelihood that substantial harm would result to the individuals as a result of the defendant's conduct. But yet we're not talking about a disease, a defect that rises to the level of not guilty by reason of lack of criminal responsibility.(03:36:14)You would then revert to or default, if you will, to the standard of wanton and reckless conduct. And we know that wanton and reckless conduct under the Welansky case, basically if a defendant does an intentional act that is not just negligent, it would have to rise to the criminal standard or the criminal level of being wanton or reckless. So I think that that would in fact justify an instruction on involuntary manslaughter. If you want, I can continue with the voluntary manslaughter that I would ask the court to instruct. And that would relate to the issue of diminished capacity. I know the court is very familiar with Commonwealth v. Gould. I believe it's 380 Mass. 672 Supreme Court decision, Patterson versus New York that talks about evidence of a defendant's emotional or intellectual or mental state of mind that does not rise to the level of lack of criminal responsibility, but it could certainly rise to the level of extreme emotional disturbance that that would be manslaughter, not murder.(03:37:25)And that would be under and consistent with the United States Constitution as well as the Massachusetts Constitution because in addition to Commonwealth v. Gould, we have case law, as I know Your Honor is aware, that talks about diminished capacity. It talks about mental disease or defect. If in fact there's evidence of a mental disease or defect, mental impairment, but it does not rise to the level of lack of criminal responsibility, then under all of those cases I just cited, plus Garabedian at 399 Mass 34, as well as my old case of Thomas Toolan, 490 Mass. 698, you can have evidence of mental disease or defect that does not rise to the level of lack of criminal responsibility, but it would mitigate or reduce from the ability of the person to know that what they're doing is in fact cruel and atrocious, to know what they're doing does constitute premeditated malice of forethought.(03:38:27)We all know what the concept of malice is. You get the three prongs of malice. There's no doubt that mens rea is important on the concept of malice. And if a jury says, "Well, look, the evidence is that she was going to these doctors, that she was getting prescribed medication, she was taking the medication, she was in a postpartum depression stage." I don't buy the postpartum psychosis, but I think that clearly she was over-medicated or had medications that she was involved with plus her postpartum depression. That would then justify them to say it reduces her ability to think, to react, to know as it relates to malice, which under those cases I cited would reduce to voluntary manslaughter. So that would be voluntary manslaughter. The willful, wanton conduct would be involuntary manslaughter.(03:39:23)Reasonable doubt obviously is fine. All the rest of the instructions that you gave or that you would give are fine. I would ask that the court consider the prospect and by way of considering involuntary intoxication. And I did cite a couple of cases, Commonwealth versus Wallace and Dash Piantedosi as it relates to evidence of involuntary intoxication. And that would apply if in fact there's no intentional ingestion of cocaine or some type of illicit drug, but in fact it's a prescription drug that she was ingesting consistent with the drug instructions, if you will. The drug laboratories and the pharmaceutical companies, they market these products. Some of them have black box warnings on them. We've talked about that a little bit in this trial, talked about the age cutoff, but nevertheless, it's scary stuff. You're talking the selective serotonin uptake inhibitors, you're talking about tricyclics, you're talking about anti-psychotics.(03:40:28)So if in fact this young lady did not have a disease or a defect that rose to the level of lack of criminal responsibility, but as a result of the drugs that she was prescribed, not abusing, not mixing with illegal or illicit drugs, that would allow a jury to determine that it would be manslaughter based upon the involuntary intoxication. And finally, I would ask that the court entertain giving a Bowden charge in this case. We know that the case law under Commonwealth v. Bowden allows the court upon evidence presented to a jury of inadequate police investigation. Because if you recall, way back in the day on this case, I did move for a bifurcation and my argument to the court was that defendants in lack of criminal responsibility cases are really hogtied, if you will, because to have the lack of criminal responsibility, you have to admit involvement in the crime.(03:41:38)But yet when you're trying the case with lack of criminal responsibility, the government still has the burden to prove to a jury beyond a reasonable doubt that the defendant is guilty of, based on the evidence, that particular crime. And if there's evidence of a police investigation that is deficient, a jury does have a right to consider that as a basis of an acquittal. They can consider that for purposes of finding reasonable doubt based upon the lousy investigation. In this case, it wasn't just a lousy investigation. It wasn't even an atrocious investigation. It was no investigation. In this case, Judge, the police, I think we all would agree, even the government, they basically accepted the fact that she strangled the kids, the kids are in the basement, she's guilty, and we move on. They didn't investigate anything. They didn't test the screen. They didn't even take a picture of the screen.(03:42:36)They didn't see if there's any blood on the screen. There's no crushers for the alleged crushing of the medications. There's no indication that there's powder, that she was crushing the medication to ingest the medication. There's all sorts of questions regarding the blood spatter, the blood... The police never investigated. They come into the court, they talk about their investigation through the crime scene laboratory and state police. And every question that I would ask about the door, about the blood drop on the door, about the siding, they come six months later or whatever, they take the siding. It's degraded. They can't even test it. I could go on and on and on with the horrific investigation in this case. So I think it would be fair for the court to instruct them on Bowden. That's it.Judge William Sullivan (03:43:22):All right. Commonwealth, I know there was one... Well, there were two requests I think you may not have been aware of, but I wanted to give you an opportunity to be heard. One is the Bowden instruction also. One is the voluntary manslaughter. Before I let you do that, if I'm looking at the instruction that I have as a possible instruction regarding involuntary manslaughter, Mr. Reddington, if we took the word involuntary out of there, doesn't that instruction there apply to the argument that you're making considering the last paragraph?Attorney Kevin Reddington (03:44:06):I'm sorry, which paragraph?Judge William Sullivan (03:44:07):Yeah, on page eight.Attorney Kevin Reddington (03:44:10):Okay.Judge William Sullivan (03:44:11):Where it's talking about the manslaughter instruction.Attorney Kevin Reddington (03:44:13):Yes, I do.Judge William Sullivan (03:44:15):In the last paragraph, it talks about the ability to consider evidence from either a mental impairment or consumption of the prescription drugs.Attorney Kevin Reddington (03:44:27):I agree with that, Your Honor. If we were to fashion that, I think that that instruction would-Judge William Sullivan (03:44:32):Just one instruction.Attorney Kevin Reddington (03:44:33):Voluntary, involuntary. It doesn't really matter.Judge William Sullivan (03:44:36):That's what I was thinking, just to go-Attorney Kevin Reddington (03:44:39):I agree with you.Judge William Sullivan (03:44:39):If I give it would just be one instruction and I wouldn't name it either involuntary or voluntary. It would just be if I give that. Okay. And I think Attorney Buckingham, I don't know if the only... I know the Commonwealth objects to that anyway, so I'm not asking for the assent on that, but what about the Bowden instruction?Madam Clerk (03:45:01):So Your Honor, we would object to the Bowden instruction. Again, counsel's free to argue whatever he wants about the police investigation in this case, but as far as failures of the investigation that have been identified in the course of the trial, I don't see that there is any. And everything that Attorney Reddington just said about what they didn't test, they didn't test the screen. Well, there's clear photographs of the screen and the condition of the screen, and that was very apparent. That was done on the day of the incident. It was documented. Witnesses testified about that. Witnesses gave statements about the window in and of itself. The blood on the outside of the house was observed. There's been adequate testimony about why it wasn't swabbed on that particular day. And there also has been adequate testimony about subsequent decisions to go back and get information or get the swabs from that area and what testing was done and that there was testing done to identify that it was the defendant's blood that was on the outside.(03:46:02)So I think that the evidence... The claims have been made, but the evidence shows that there has been an adequate police investigation. The only point of contention appears to be the drawer and the pill bottles, and there's been some claims made about things that were not done about those things. But again, I think there's been adequate testimony about why those things weren't flagged on that day of the incident. Police weren't aware of the fact that there was actually an ingestion of medications on that particular day. And when they did notify or when they were aware, we had prescription bottles that were provided by Patrick Clancy, but those bottles in that drawer conveniently never got produced for testing or further analysis. So I think again, he's free to argue it. I don't think it rises to the level of an instruction. And just as a side note on a comment about involuntary instruction, I don't think there is one.(03:46:59)So I would ask that the court not consider that because I don't think there is an actual instruction about it. Again, counsel's free to argue that in the form of intent, in the form of whether the commonwealth has met its burden regarding criminal responsibility. But as far as I can find, there's no particular instruction on that. And if Your Honor were to provide an instruction, then according to the case law, if it's raised to that level, then we would have the burden of proving voluntary consumption, which would put all of that back into play that we've now disagreed.Judge William Sullivan (03:47:31):All right. All right. Well, I am going to give a manslaughter instruction in line with basically what's on page eight. I am not going to give a Bowden instruction. The defendant is free to argue that. Any deficiencies that he feels that are in the investigation, certainly free to argue. I will not give the voluntary intoxication instructions in regards to the criminal responsibilities. And so I'll have a better draft in the morning, but I just wanted to let you know what the instructions are so that you can prepare your closing arguments. And speaking of those closings, how much time do you think you may need on that?Attorney Kevin Reddington (03:48:36):I'm usually pretty quick. I would say half hour.Judge William Sullivan (03:48:45):All right.Attorney Sprague (03:48:45):I was thinking more of an hour.Judge William Sullivan (03:48:45):All right. I was thinking of all the testimony, all the exhibits. If the parties want an hour, you don't have to use it all. And like I said, I've seen all three of you try cases, so I know you'll be making progress. So if it gets to one hour and one minute, I'm not going to push the button. So just so we can have some estimate. All right. Anything else we need to address you think before tomorrow?Attorney Kevin Reddington (03:49:13):No, thank you.Attorney Sprague (03:49:16):No, thank you.Judge William Sullivan (03:49:16):All right. Well, counsel, again, thanks for all your efforts in regards to this. So I'll have a full copy of this first thing in the morning and we'll do arguments to charge hopefully as soon as we are ready tomorrow morning.Attorney Kevin Reddington (03:49:31):There is one other minor matter that we've talked about. There is that police report, the security sergeant from the hospital, Brigham and Women's, that we're going to redact and just reduce to a paragraph. She's the one that I summons, but she's on maternity leave and we could introduce that, just that one paragraph. And we're missing one exhibit, which is the Infants Hospital in Rhode Island, but we're going to look and see if the government has it.Attorney Sprague (03:50:04):We don't have it. I though that... We'll double check. I thought that defense had decided not to put in anything from that report because he was going to provide a proper... Not a proper, I'm sorry, a proposed stipulation for portions of that report. And then he didn't, so I didn't think that. And then we both rested and then I rested again. So I didn't think that was coming in, but I'm happy to look over what defense wants to stipulate to.Judge William Sullivan (03:50:34):So why don't we do that? If there's a need to technically reopen the case so that the parties could put in what they thought they put in, if it's by agreement, if it's just in regards to some of those records, I think we could do that.Attorney Kevin Reddington (03:50:54):Okay.Judge William Sullivan (03:50:55):So anything else?Attorney Kevin Reddington (03:50:57):No, [inaudible 03:50:58].Judge William Sullivan (03:50:58):How about redactions? That was the other thing. Was it just that one report or a couple reports we're going to have to deal with?Attorney Sprague (03:51:06):I believe that everything that requires redaction has been redacted.Judge William Sullivan (03:51:10):All right.Attorney Kevin Reddington (03:51:10):I think so. Yeah. I'm not aware of anything we have to-Judge William Sullivan (03:51:12):All right. I'm just asking. All right. All right. So thank you very much. We'll see everybody tomorrow morning.Attorney Kevin Reddington (03:51:19):Thank you, Your Honor.Judge William Sullivan (03:51:20):All right. Thank you.Speaker 9 (03:51:21):Court, all rise.