1.Jennifer Tufts — Cross (Part 2)
2,036 linesTHE COURT: So first let me ask the questions. Has any member of the jury read, seen, heard, or overheard anything from any source about any aspect of this case that would affect your ability to be a fair and impartial juror?
JURORS: No.
THE COURT: All right. Next, is there any other serious matter of concern bearing on your service as a juror in this case that anybody needs to bring to my attention? All right. Thank you for following those instructions. And then in regards to today's schedule, we got a number of witnesses. I'm not quite sure how long it may go, so we may break a little bit early today, just kinda depending on the way the case comes in. And then in regards to where we are right now, we're going to, if you remember, when we broke on Friday, there was a witness, a Dr. Tufts. Commonwealth had finished their direct examination. We're now gonna have that witness return to the stand and the cross-examination by the defendant will begin. All right. And so, with that, if we could recall that witness.
THE COURT: All right. Good morning, doctor.
JENNIFER TUFTS: Good morning.
THE COURT: All right. Mr. Reddington.
MR. REDDINGTON: Thank you. Good morning, doctor.
JENNIFER TUFTS: Good morning.
MR. REDDINGTON: Do you have your record in front of you and your notes or—
JENNIFER TUFTS: I do.
MR. REDDINGTON: … have a record? Great. Thank you. And you can look at that anytime you want, just to refresh your memory as well. It's your record.
JENNIFER TUFTS: Thank you.
MR. REDDINGTON: Dr. Tufts, you are presently a psychiatrist, correct?
JENNIFER TUFTS: Correct.
MR. REDDINGTON: And can you tell me where you went to med school?
JENNIFER TUFTS: University of Vermont.
MR. REDDINGTON: And what were the years that you were at University of Vermont?
JENNIFER TUFTS: 2014 to 2018.
MR. REDDINGTON: Beautiful country up there. Great place to live, right?
JENNIFER TUFTS: It is. It's beautiful.
MR. REDDINGTON: And when you graduated from med school, you then did your residency?
JENNIFER TUFTS: Correct.
MR. REDDINGTON: And where was the residency?
JENNIFER TUFTS: Boston Medical Center.
MR. REDDINGTON: And can you tell me what is it exactly that you do as a psychiatric resident or a psychiatrist resident? What do you do?
JENNIFER TUFTS: You do a lot, a lot of different things. You rotate in all the different aspects of psychiatry, as well as internal medicine so that you have a foundational knowledge of broad medical topics. You admit patients into the inpatient hospital, you manage emergencies in the hospital and in the emergency room, decide whether patients need to be admitted psychiatrically or not, and also carry a panel of outpatients.
MR. REDDINGTON: And is this a hospital that you're working in or is it... This is Boston University. Is it a medical center?
JENNIFER TUFTS: So, yes, it's the Boston University program, located at the hospital Boston Medical Center, with also a lot of time spent at the various Boston VA locations.
MR. REDDINGTON: And what were the years, I'm sorry, that you were—did your residency?
JENNIFER TUFTS: 2018 to 2022.
MR. REDDINGTON: So you basically were working as either a person studying to be a doctor, graduating, and then becoming a resident through the entirety of the pandemic?
JENNIFER TUFTS: For the first part of the pandemic, yes.
MR. REDDINGTON: Well, the pandemic ended when Joe Biden said it ended in, I think it was July of 2022, right?
JENNIFER TUFTS: I'm not sure exactly when he said that.
MR. REDDINGTON: Would you agree with me that when the pandemic started around 2019, when you began your residency, 2020, '21 into '22, it was a much worse, if you will, of the pandemic timeframe?
MR. REDDINGTON: So when you finished, do you graduate from a residency or is it like you get a certificate or something?
JENNIFER TUFTS: Yes, there is a certificate for completing it.
MR. REDDINGTON: Okay. And then at that point, you are now a licensed doctor. Is that how it works?
JENNIFER TUFTS: Well, you're actually a licensed doctor the entire time that you're in residency. But upon the completion of that, you can obtain a full, unrestricted Massachusetts license and also become board certified.
MR. REDDINGTON: And the board certification, for example, you have a board certification in general psychiatry. Is that correct?
JENNIFER TUFTS: Yes, sir.
MR. REDDINGTON: And when was it that you got that certification?
JENNIFER TUFTS: When was it?
MR. REDDINGTON: Yes.
JENNIFER TUFTS: It was September 12th, 2022.
MR. REDDINGTON: When was it that you actually started working as a physician, as a psychiatrist?
JENNIFER TUFTS: I started working as a physician and as a psychiatrist during the residency training program. But I started practicing completely independently, at Master, at Aster Mental Health in August of 2022.
MR. REDDINGTON: August of '22.
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Now, prior to working with or at Aster, is that A-S-T-O-R or E-R?
JENNIFER TUFTS: A-S-T-E-R, like the flower.
MR. REDDINGTON: And what is Aster? Is it like a group of doctors? Is it a medical center? What is it?
JENNIFER TUFTS: It is a outpatient practice that is owned by a psychiatrist. It has a number of psychiatrists as well as therapists.
MR. REDDINGTON: And where's it located? Is it a brick-and-mortar-type place where you have offices?
JENNIFER TUFTS: Yes. The original offices were in Braintree, Massachusetts, and now there's an office in Peabody as well.
MR. REDDINGTON: Your office where you work is-
JENNIFER TUFTS: So, at the time I saw the patient, I was working in the Braintree office. I currently work in Peabody.
MR. REDDINGTON: Where? Where? I'm sorry.
JENNIFER TUFTS: Currently in Peabody, Massachusetts.
MR. REDDINGTON: Okay. So when you start working at Aster, obviously like anybody else, you submit a resume, an application, and you perhaps are then hired, right?
JENNIFER TUFTS: It's a fairly lengthy process and a number of interviews with different staff at the practice, and some recommendations, letters of reference, verification of credentials, all of that. But yes, it can be comparable to another profession in that process.
MR. REDDINGTON: Now, in August of '22, when you... Congratulations, obviously you were hired by Aster. How many women had you treated in your residency that were postpartum?
JENNIFER TUFTS: With postpartum depression? Or just in the postpartum period?
MR. REDDINGTON: How many women that were in the postpartum period did you treat prior to August of '22?
JENNIFER TUFTS: Many. It's hard to give an exact number, but I did have specific training in that population.
MR. REDDINGTON: In that population. And where did you have the training in that population?
JENNIFER TUFTS: At Boston Medical Center.
MR. REDDINGTON: And can you tell us, in that two-year period approximately, how many women that were in the postpartum period that you treated as a resident?
JENNIFER TUFTS: Okay. So it's really hard to give an exact number, but if I had to say, at least 50.
MR. REDDINGTON: So in the two-year period, you treated 50 people in the residency that had postpartum. And can you tell me, what is postpartum? What does that mean?
JENNIFER TUFTS: Well, I just wanna address that it was a four-year period, not a two-year period.
MR. REDDINGTON: Oh, I'm sorry. Okay.
JENNIFER TUFTS: And sorry, what was your question?
MR. REDDINGTON: Hold on. You saw 50 people in a four-year period that had postpartum. In other words, they had them after having a baby, right?
JENNIFER TUFTS: Possibly. Yeah, more or less. I saw a number of other patients. I-
MR. REDDINGTON: Of course.
JENNIFER TUFTS: ...saw much more than 50. But yes.
MR. REDDINGTON: So after you had your residency and after you were hired by Tuft- by Aster, is that when you began, in August of '22, your practice as a practicing psychiatrist?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And when was it that you actually got your DEA license that authorizes you to prescribe medication to citizens?
JENNIFER TUFTS: So during residency, I had a DEA license, but it was affiliated with Boston Medical Center. And then, when I started at Aster, I had my own DEA number. I don't know exactly when, maybe sometime around August.
MR. REDDINGTON: So August of '22, you start working at Aster. August of '22, you get your DEA license individually that authorized you to prescribe medication, correct?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And it was when that you saw Lindsay Clancy?
JENNIFER TUFTS: I believe our first visit was September 15th.
JENNIFER TUFTS: 2022.
MR. REDDINGTON: So you were practicing as a psychiatrist for a little more than a month.
JENNIFER TUFTS: I was practicing independently with my full credentials for about a month. But the training is just immense that goes on before that.
MR. REDDINGTON: Absolutely. It must be. But that's a residency that you're talking about, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And you know what a resident's... I mean, all I know is Grey's Anatomy. But I mean, you're working under a doctor. The doctors are supervising you, and they tell you what to do, and then you report to them, correct?
JENNIFER TUFTS: They don't really tell you what to do. They're there as a resource if you need additional support. But I followed many of my own patients. I was the only person in the room with them and, you know, my notes were signed off by an attending physician, and that attending was available for any support I needed.
MR. REDDINGTON: So in August of '22, when you started working at Aster, you actually filled out a form for your advertising. Is that correct?
JENNIFER TUFTS: I believe that was handled by other people at the practice.
MR. REDDINGTON: Ah. And who would that be?
JENNIFER TUFTS: Well, we have non-clinical staff that handle the administrative matters.
MR. REDDINGTON: Okay. But you're a doctor, and you're out there to the public. You're advertising yourself and your services to the public. Is that fair?
JENNIFER TUFTS: I believe yes. I am not directing the marketing of our office, but yes.
MR. REDDINGTON: Okay. Never mind your office. I'm talking about you. You had an ad that was in, on the computer that if somebody wanted to reach out to a doctor, they could see your ad amongst many others, right?
JENNIFER TUFTS: Well, I don't think there was an ad. I think we have a website that had some information about myself.
MR. REDDINGTON: Okay. Now, in August of '22, up until when you saw Lindsay, how many patients in that month or so had you treated for postpartum psychosis?
JENNIFER TUFTS: How many patients in a month up until that month, you mean?
MR. REDDINGTON: Yeah, I'm asking you about when you started working in August of '22 for Aster— and you are now on your own as an employee.
JENNIFER TUFTS: Mm-hmm.
MR. REDDINGTON: How many patients had you treated before you saw Lindsay Clancy for postpartum psychosis?
JENNIFER TUFTS: Well, in the span of one month, I would say none, because it's a very rare disorder.
MR. REDDINGTON: Yeah, okay. But it exists, doesn't it?
JENNIFER TUFTS: Absolutely.
MR. REDDINGTON: And one of the things would be the voices that people hear, right?
JENNIFER TUFTS: That is a symptom of psychosis, absolutely.
MR. REDDINGTON: And that's legitimate, isn't it?
JENNIFER TUFTS: It is a legitimate diagnosis, absolutely.
MR. REDDINGTON: It's not a diagnosis. People that have postpartum psychosis hear voices. Do they not?
JENNIFER TUFTS: Many do. I— the disorder can manifest differently in different people, but yes, many people do hear voices.
MR. REDDINGTON: How about postpartum depression? How many people in that month or so before you met Lindsay did you treat for postpartum depression?
JENNIFER TUFTS: In the span of one month, I— it's really hard to pinpoint that. Maybe a couple.
MR. REDDINGTON: Maybe a couple? And do you recall how long you treated them for?
JENNIFER TUFTS: Again, it's hard to really pin down the individuals in a short span of time.
MR. REDDINGTON: Can you tell the jury what you put in your ad or in the Aster website that you indicated that described you?
JENNIFER TUFTS: I don't recall.
MR. REDDINGTON: Well, one of the things you did is that you said that you basically were a specialist in postpartum, people that have postpartum psychiatry. You indicated that on your website, didn't you?
JENNIFER TUFTS: Are you able to read the actual document? I don't remember exactly the wording.
MR. REDDINGTON: Well, it's your ad on the website where you've been working now for how many months now?
JENNIFER TUFTS: Yeah.
MR. REDDINGTON: Three since you saw Lindsay, or more?
JENNIFER TUFTS: Almost four, yes.
MR. REDDINGTON: You haven't changed your ad on the website, have you?
JENNIFER TUFTS: I don't... I have not personally, no.
MR. REDDINGTON: And you've read it probably a bunch of times, right?
JENNIFER TUFTS: I read it a couple times, but I don't spend a lot of time on my website.
MR. REDDINGTON: Okay. Do you recall that you indicated that you were specializing in any particular aspect of psychiatry?
JENNIFER TUFTS: Yes. It probably includes a special interest in women's health, in perinatal psychiatry, in trauma related disorders, anxiety, and, you know, there may be some other things that were mentioned.
MR. REDDINGTON: Yeah, like women that have babies and they're suffering from postpartum depression, right?
JENNIFER TUFTS: Absolutely.
MR. REDDINGTON: You advertise that after a month in working for Aster, right?
JENNIFER TUFTS: That's listed as one of my interests, definitely.
MR. REDDINGTON: And again, forgive me. How many women did you treat for postpartum depression in that month and a half before you met Lindsay?
JENNIFER TUFTS: I don't know. Maybe a couple. But I've treated many of them in the residency, which was just immediately before.
MR. REDDINGTON: So when a person needs to see a psychiatrist, generally they're not well. Is that fair?
JENNIFER TUFTS: Some are not well. It really can vary.
MR. REDDINGTON: So when someone comes to see a psychiatrist like you, it's because they need help, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And when they come to you because they need help, for example, with Lindsay Clancy, she came to you because of your ad, right? Or your website for Aster, what you said about yourself.
JENNIFER TUFTS: I don't know exactly how she found us.
MR. REDDINGTON: Well, do you know why she came to see you?
JENNIFER TUFTS: I'm not sure exactly.
MR. REDDINGTON: Friday, we spent a long period of time going through your initial, or the initial intake that she had to fill out. Is that correct? You recall that?
JENNIFER TUFTS: Yes, we did.
MR. REDDINGTON: And the district attorney kept asking you, and this is in Septem- is it September 12th? Is that when that form was filled out?
JENNIFER TUFTS: I believe she completed the form on the 12th. The appointment was on the 15th.
MR. REDDINGTON: So what does a person do? Do they call you, or do they talk to somebody in administration? How do you get the form to fill out?
JENNIFER TUFTS: Yes. Our administration handles that.
MR. REDDINGTON: And what do they do? How does that happen?
JENNIFER TUFTS: They send them the documents probably by email, and the patient fills them out. Actually, it might be all within the portal that we use.
MR. REDDINGTON: Within the portal?
JENNIFER TUFTS: The patient portal, yes.
MR. REDDINGTON: Okay. And that means that you go online, and you can access Aster Mental Health, and then all these little dropdown boxes would come up?
JENNIFER TUFTS: Something like that.
MR. REDDINGTON: Are you aware? Is it something like that, or are you aware of what it does?
JENNIFER TUFTS: So because I don't handle the scheduling and the sending of forms, I don't know exactly what it looks like.
MR. REDDINGTON: Well, this is the form that you're giving a person that needs help because they're possibly mentally ill. Is that right?
JENNIFER TUFTS: Yes. And what's important is that I review the forms and we go through them—
MR. REDDINGTON: You do?
JENNIFER TUFTS: …in the appointment. Absolutely. I—oh, yes.
MR. REDDINGTON: Absolutely.
JENNIFER TUFTS: Yeah.
MR. REDDINGTON: Now understand that your records, Exhibit 219, I believe—the jury will have access to the Tufts records, okay? You're aware of that, right? You know it's an exhibit.
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Because you have talked to the prosecution about what an exhibit is, and you know that your records are now in evidence before this jury, right?
JENNIFER TUFTS: If that's what you say, yes.
MR. REDDINGTON: I wouldn't take what I say.
JENNIFER TUFTS: Well, I don't—
MR. REDDINGTON: If you don't know, that's fine.
JENNIFER TUFTS: …I don't know the details of how this works, but—
MR. REDDINGTON: All right. Have you talked to them prior to your testimony?
MR. REDDINGTON: You haven't talked to the DA's office?
JENNIFER TUFTS: No, not at all.
MR. REDDINGTON: You're a defendant in a very large lawsuit, are you not?
MS. SPRAGUE: Objection.
THE COURT: Overruled.
JENNIFER TUFTS: Yes.
MR. REDDINGTON: You wouldn't happen to be represented by an attorney, would you?
JENNIFER TUFTS: I am.
MR. REDDINGTON: And the fact that you have an attorney as your right under the Constitution doesn't mean that you're guilty of anything, right?
JENNIFER TUFTS: Right.
MR. REDDINGTON: Okay. And you know that the outcome of this case is very, very major to the outcome of your lawsuit, is that correct?
JENNIFER TUFTS: I don't actually know that.
MR. REDDINGTON: So you understand that if, in fact, it's determined that you advertised as an expert in postpartum and in postpartum psychiatry, and you've had a month experience plus a residency, would you consider that to be negligent or a misrepresentation?
JENNIFER TUFTS: I do not believe that I am negligent.
MR. REDDINGTON: Do you understand what misrepresentation is?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: For the month that you developed plus your residency, do you really want this jury to believe that you were an expert? And you advertised that?
JENNIFER TUFTS: I don't think that's exactly the wording that I used.
MR. REDDINGTON: What wording did you use?
JENNIFER TUFTS: I think I said that it was an interest of mine.
MR. REDDINGTON: That you were what?
MS. SPRAGUE: Asked and answered.
THE COURT: No. You can answer that.
JENNIFER TUFTS: I just think the wording was that it's an interest of mine. I don't believe I called myself an expert.
MR. REDDINGTON: Are you an expert in postpartum?
JENNIFER TUFTS: I may be if... I don't know. I think it depends on what you define an expert as.
MR. REDDINGTON: Well...
MR. REDDINGTON: When a patient comes to you and they fill out the form, you agree with me that your records reflect that form that she filled out on September 12th of 2022, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And the form that the district attorney went through painstakingly with you is basically, it looks something like this, right? This is one of the forms that you had people fill out, right? Right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: You see the little check mark?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Who puts the check mark?
JENNIFER TUFTS: The patient.
MR. REDDINGTON: So how many pages, 'cause I don't wanna go through all the pages again. How many pages does a patient, or how many pages did Lindsay go through to check the boxes for acid?
JENNIFER TUFTS: There were a lot of pages.
MR. REDDINGTON: What's a lot, 10, 20?
JENNIFER TUFTS: Yeah, maybe between 10 and 20.
MR. REDDINGTON: Okay. And basically, they're all little checks in boxes, correct?
JENNIFER TUFTS: Not just checks.
MR. REDDINGTON: No? So does the person then answer questions by typing in answers such as, “Do you have any pending legal problems?” “No.” “Have you been arrested?” “No.” Things of that nature, right?
JENNIFER TUFTS: Those are some of the questions.
MR. REDDINGTON: And the questions also, do they ask the patient what medications they were on—
JENNIFER TUFTS: Yes.
MR. REDDINGTON: ...before seeing you?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And Lindsay told you that she was on SSRIs in the past, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And SSRI means what?
JENNIFER TUFTS: A selective serotonin reuptake inhibitor.
MR. REDDINGTON: And that's a pretty powerful drug.
JENNIFER TUFTS: It's an effective treatment for depression and anxiety.
MR. REDDINGTON: Well, it affects the serotonin levels in the brain, doesn't it?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: It rewires the brain, doesn't it?
JENNIFER TUFTS: It doesn't rewire the brain. It increases the serotonin, and many individuals with depression have low levels of serotonin.
MR. REDDINGTON: So Lindsay told you that she had been prescribed an SSRI when she was in nursing school. Is that right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: What was the SSRI?
JENNIFER TUFTS: Prozac.
MR. REDDINGTON: And how long was she on the Prozac?
JENNIFER TUFTS: I'm not sure.
MR. REDDINGTON: Did you ever ask her?
JENNIFER TUFTS: I probably asked.
MR. REDDINGTON: You probably asked? Isn't it true, don't you guys have a saying that if it's not written, it didn't happen? You take copious notes, do you not?
JENNIFER TUFTS: It's impossible to write down every single, every single thing that's said, so I write down what is clinically relevant, clinically necessary. But there's a lot that is discussed over an hour that is not able to be written down.
MR. REDDINGTON: Such as the fact that a person was on an SSRI when they were in nursing school is not an important fact to find out if they have—
JENNIFER TUFTS: Oh, no, that's important.
MR. REDDINGTON: ...suicidal thoughts?
JENNIFER TUFTS: Sorry.
MR. REDDINGTON: No problem. I'm not, I'm not doing, you know, the Sophie Cunningham right now. I'm just asking a question, that's all, and you can answer it, okay? How about if she had a reaction to Prozac?
JENNIFER TUFTS: I asked her about the Prozac.
MR. REDDINGTON: Is that written in your notes?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And what did she say?
JENNIFER TUFTS: I mean, she said that she took it for a period of time.
MR. REDDINGTON: Right.
JENNIFER TUFTS: She didn't mention any side effects.
MR. REDDINGTON: Oh, she didn't tell you that she had side effects. I see. So when a patient comes to see you with a month under your belt, and they're sick, and they're looking for help, you wait for them to volunteer facts to you?
JENNIFER TUFTS: She volunteered a lot of information. She knew very well what her medical history was, and was able to provide that for me.
MR. REDDINGTON: Such as what? That she was in nursing school and took Prozac?
JENNIFER TUFTS: That's part of it.
MR. REDDINGTON: And she told you that, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And she was pretty upfront and honest with you, wasn't she, in answering these questions, right?
JENNIFER TUFTS: I believe that she was.
MR. REDDINGTON: We all spent some time talking about the fact that she declared that she had consumed alcohol, and that she felt guilty about it. You recalled that on Friday. We dwelled on that for a while, didn't we?
JENNIFER TUFTS: Yes. That was a component, yes.
MR. REDDINGTON: I mean, that's something that's important, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: What was her drink of choice?
JENNIFER TUFTS: I'm not sure.
MR. REDDINGTON: Did you ever ask her?
JENNIFER TUFTS: I'm not sure. We were not concerned that her level of alcohol use was—
MR. REDDINGTON: Well, the DA certainly was Friday, right?
MS. SPRAGUE: Objection.
THE COURT: Doctor, wait for the question, all right? And then same thing, I'll have counsel wait until you finish your answer. All right? Go ahead, Mr. Reddington.
MR. REDDINGTON: So is it important, Doctor, for you as a physician to know your patient? In other words, know who they are.
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And you know that Lindsay was a nurse, correct?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: You know that she graduated obviously from college, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Was she a good student?
JENNIFER TUFTS: I don't recall.
MR. REDDINGTON: Do you know when she got married?
JENNIFER TUFTS: I don't recall—
MR. REDDINGTON: Did you ask her?
JENNIFER TUFTS: …that specific detail. I don't know. I knew she was married.
MR. REDDINGTON: She had three kids, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And the reason that you know that she was married is because you spoke to her husband, Patrick, correct?
JENNIFER TUFTS: He attended—
MR. REDDINGTON: Or did you?
JENNIFER TUFTS: Sorry?
MR. REDDINGTON: Or did you?
JENNIFER TUFTS: He attended one of the appointments—
MR. REDDINGTON: Mm-hmm.
JENNIFER TUFTS: …and I spoke with him on that date.
MR. REDDINGTON: Ah. And did you say, "Hi, how are you?" And give him a handshake when he came into your office?
JENNIFER TUFTS: It was telemedicine.
MR. REDDINGTON: It was what?
JENNIFER TUFTS: Telemedicine.
MR. REDDINGTON: Telemedicine. Is it fair to say that after, what is it? 14, I think you said to the jury, 14 appointments that you had with Lindsay during that period from September till January. Was it 14 appointments?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Every single one of them were via telemedicine, weren't they?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Until you came in this courtroom Friday, you never saw this woman in person, did you?
JENNIFER TUFTS: Correct.
MR. REDDINGTON: Were you ever concerned about her mental health as a person?
JENNIFER TUFTS: Absolutely.
MR. REDDINGTON: She was crying. She told you symptoms that she couldn't get out of bed. Isn't that right?
JENNIFER TUFTS: That one time she said it was difficult to get out of bed.
MR. REDDINGTON: Oh, difficult to get out.
JENNIFER TUFTS: But—
MR. REDDINGTON: Why was it difficult for Lindsay Clancy to get out of bed?
JENNIFER TUFTS: Because she was very depressed.
MR. REDDINGTON: And did you give her a hug? Oh, no, you're on telemedicine, so you couldn't give her a hug, could you? You didn't have any chance to even look at her in person, did you?
JENNIFER TUFTS: I could look at her. It was always a video appointment. I couldn't give her a hug, but that's not actually something that psychiatrists typically do with patients.
MR. REDDINGTON: I imagine. Now, I'm looking at you, and you've got the witness stand cutting you off in half, right? So I can't see from your waist down, your legs, your feet, your hands, anything. That's the same view that you have on telemedicine, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Isn't it fair to say that you've studied and that you've learned that there are objective manifestations that patients may have that would be a tell. Like if you're playing poker, you have a tell. That would be an indicia of the fact that they're stressed or emotionally disturbed, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Like hand-wringing, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Were you able to see the hands wringing when you were on telemedicine?
JENNIFER TUFTS: I don't belie—I don't recall seeing her hands.
MR. REDDINGTON: You recall, you know how people sit there, and they do this with their leg, and the leg bounces because they're going through some type of emotional stress? You couldn't even see her legs, could you?
JENNIFER TUFTS: I couldn't see her legs, but I knew that she was under stress.
MR. REDDINGTON: So when she came to you, September 15th, I believe, is the first time that you all actually discussed her condition, correct?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And looking at the medical records, which the jury will be able to look at, it says visit date September 15th, 2022. And you can look up—you can look along with me if you wish. Indicates why she came to see you, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Right? Yes?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Okay. Why did she come to see you? According... Not, not guessing and speculating, never mind the TV. You just look at your notes. Tell me what brought Lindsay Clancy to your office.
JENNIFER TUFTS: Postpartum anxiety.
MR. REDDINGTON: Is that it? Is that what you noted in the records?
JENNIFER TUFTS: Well, those were her words when asked, “What are the problems for which you are seeking help?”
MR. REDDINGTON: I see. Postpartum anxiety. Now, as a psychiatrist meeting with this young woman—after a month or so of working as a psychiatrist at Aster, there are tests that you administer to a woman who's in postpartum to find out what type of anxiety they have, right?
JENNIFER TUFTS: There are some screening tests, but the most important thing is what the patient tells you and what my assessment is in the session.
MR. REDDINGTON: I see. And that would carry through the Tufts evaluations for all 14 of those meetings, is what the patient tells you, right?
JENNIFER TUFTS: Yes, and what I observe in the session.
MR. REDDINGTON: Through the television.
JENNIFER TUFTS: Through the computer.
MR. REDDINGTON: What, if you can tell me, is the Edinburgh test?
JENNIFER TUFTS: It is a scale that looks at symptoms of postpartum depression.
MR. REDDINGTON: And when you administer... That's a major test, isn't it, for a doctor to evaluate a patient for PPD?
JENNIFER TUFTS: I wouldn't say it's a major test.
MR. REDDINGTON: It's a pretty big one though, isn't it? It's really one that measures the postpartum depression, right?
JENNIFER TUFTS: It's a common one.
MR. REDDINGTON: It's a what?
JENNIFER TUFTS: Common.
MR. REDDINGTON: Common.
JENNIFER TUFTS: Commonly used.
MR. REDDINGTON: Commonly used. So when you used it on Lindsay, when was that administered to her?
JENNIFER TUFTS: I did not use it on Lindsay.
MR. REDDINGTON: Why?
JENNIFER TUFTS: We used the PHQ-9, which is a—
MR. REDDINGTON: What is the PHQ-9?
JENNIFER TUFTS: It's a depression screening form.
MR. REDDINGTON: That's like generalized anxiety disorder, general depression. It's got nothing to do with a woman suffering from postpartum depression, does it?
JENNIFER TUFTS: I disagree.
MR. REDDINGTON: Well, do you agree that people perhaps that may know a little more than you determined that the Edinburgh scale is the appropriate scale to administer to a pregnant or postpartum woman?
MS. SPRAGUE: Objection.
THE COURT: Sustained as a form.
MR. REDDINGTON: You're familiar with the Edinburgh scale, right?
JENNIFER TUFTS: I've heard of it.
MR. REDDINGTON: And can you explain to me how it's graded?
JENNIFER TUFTS: No, I cannot.
MR. REDDINGTON: There are 30 questions in it, are there not?
JENNIFER TUFTS: I don't use this scale, so I don't know how many questions there are.
MR. REDDINGTON: So the Edinburgh scale, do you even know that the cutoff for someone that is depressed in their condition of postpartum would be 15? Anything over that, they're in severe depression.
JENNIFER TUFTS: Okay.
MR. REDDINGTON: You know that her first Edinburgh test that was administered to her put her at a 23.
MS. SPRAGUE: Objection.
THE COURT: Overrule.
MR. REDDINGTON: Severe depression.
JENNIFER TUFTS: I was not aware of this test. I was not aware that this had been administered to her.
MR. REDDINGTON: Well, you know that except for the Prozac that she had when she was a nurse at, what, 23, 24, 23 years old, she hadn't, other than seeing her own doctor for having the baby, she hadn't seen any doctors. You knew that, right?
JENNIFER TUFTS: I didn't know exactly which doctor she sees. I think, you know, we ask about your primary care doctor. But she did not report any other medical issues that she was under treatment for.
MR. REDDINGTON: So is it important for Dr. Jennifer Tufts to know whether or not a patient who is coming to you for help has a prior medical history other than what they might tell you?
JENNIFER TUFTS: Well, when patients are able to advocate for themselves and share their medical history, we rely on what they tell us.
MR. REDDINGTON: Was she able to advocate for herself, in your opinion, when she came to see you, when you evaluated her in September?
JENNIFER TUFTS: Absolutely.
MR. REDDINGTON: What about October?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: What about November?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: What about December?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And your medical records, you would agree, show that during that period of time, that she was deteriorating, was a word that was used on Friday. Isn't that right?
MR. REDDINGTON: No, no, no "so." You used the word deteriorating on Friday, did you not?
JENNIFER TUFTS: She was a little bit worse at certain appointments, and the deteriorating word, which is not my word choice, is what is in the note because I had to select that.
MR. REDDINGTON: Because why? You have some kind of a program that you have to check the box, and you have to bring down the drop box? You can't take a pen and write something down about a patient?
JENNIFER TUFTS: There are certain parts of the note where I can write whatever I feel is necessary, but that specific aspect of the note is a button where you have to click one of three choices.
MR. REDDINGTON: So when the jury's going through your medical records, one of the things that they're gonna see is that when you meet with a patient, you have a form that you fill out where it says, "If you feel like you're gonna hurt yourself or somebody else, make sure you go to the emergency room." Right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: If you have any urges to hurt yourself or others, go to the nearest emergency room. That's in every single time that you meet with a patient, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And it indicates that if there's any—call the suicide prevention and crisis hotline. If you feel that you're in crisis, you may text HOME to a particular number any time. What's a suicide hotline?
JENNIFER TUFTS: It's a phone number that patients in crisis can call and speak to a trained counselor.
MR. REDDINGTON: Now a psychiatrist, you'd agree with me, is not a counselor, that's for sure, right?
JENNIFER TUFTS: Well, a psychiatrist has training in therapy as well as in medicine.
MR. REDDINGTON: Did you give Lindsay Clancy any therapy?
JENNIFER TUFTS: There was some therapy incorporated in our sessions—
MR. REDDINGTON: Like what?
JENNIFER TUFTS: But we did—
MR. REDDINGTON: Like what?
JENNIFER TUFTS: Providing emotional support, listening to her—
MR. REDDINGTON: But excuse me. Hold on.
MS. SPRAGUE: Objection.
MR. REDDINGTON: No, please.
MS. SPRAGUE: She didn't finish her answer.
MR. REDDINGTON: No, she can't.
THE COURT: Hold, hold on, everybody.
MS. SPRAGUE: I'm sorry, Judge.
THE COURT: You asked a question. You're gonna let her finish, and then you can follow up with any questions you want.
MR. REDDINGTON: Okay.
THE COURT: Go ahead, doc.
MR. REDDINGTON: Anything else you want to say?
JENNIFER TUFTS: So her sessions were largely focused on the medication management, but there was an aspect of therapy, including those items.
MR. REDDINGTON: Okay. And the sessions were for what, 17 minutes?
MR. REDDINGTON: How long were they?
JENNIFER TUFTS: Twenty-five to thirty minutes.
MR. REDDINGTON: So twenty-five to thirty minutes on the television, and were you face the TV screen with her for the full twenty-five minutes?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And that's not noted in the records. It says seventeen minutes in all the records, doesn't it?
JENNIFER TUFTS: So if you look closely, it says the therapy component was for seventeen minutes. It doesn't say the entire duration is seventeen minutes.
MR. REDDINGTON: So what do you do when you're trying to give therapy as a psychiatrist to a patient that came to see you? What do you do? What do you do with therapy?
JENNIFER TUFTS: It depends on the person.
MR. REDDINGTON: Well, how about Lindsay Clancy? What did you do for therapy with her?
JENNIFER TUFTS: I listened to her, I listened to her concerns, and provided support. I tried to provide her with hope that eventually things would improve.
MR. REDDINGTON: So you listened to her, you listened to her concerns, and you'd agree with me that her concerns were, for example, that she actually was unable to sleep, is one of her concerns, right?
JENNIFER TUFTS: She was having a lot of difficulty with sleep.
MR. REDDINGTON: On the September fifteenth meeting, you indicate that her mood was okay, but her affect was anxious, and you called it incongruent. What does that mean?
JENNIFER TUFTS: So her... She said she was feeling okay. She appeared anxious, and she also stated that she was anxious.
MR. REDDINGTON: So one of the things that you talked about Friday is when a patient presents with an incongruent something or other, I don't remember, appearance perhaps, that would mean that they're saying, "I'm okay," but they don't look like they're okay, right?
JENNIFER TUFTS: Well, it could. I don't think her affect and her mood were really that incongruent at that time. I think that she didn't appear terribly depressed. I didn't say she was terribly depressed in that initial visit. But she said she was anxious, and she appeared anxious. That's pretty congruent.
MR. REDDINGTON: Okay. So did you put in the report that she was congruent or incongruent?
JENNIFER TUFTS: So that is not an option for me to indicate in that section but it was congruent.
MR. REDDINGTON: You're like a robot. You can't take a pen and write something down. You have to do the drop box and the X's on the computer?
JENNIFER TUFTS: Well, if it's on the computer, I... They're... I'm limited by the options that are there.
MR. REDDINGTON: Why? Why? You're a doctor. Why are you limited?
JENNIFER TUFTS: Because of the technology.
MR. REDDINGTON: What technology? The fact that there's a form on a computer? You're trying to treat a human being who comes to you for help.
JENNIFER TUFTS: And that's what's most important. What's most important was the treatment, not what is checked off on a box.
MR. REDDINGTON: Makes sense. So you were unable to make a note as to whether or not her affect and her mood appeared to be in conflict and that she would have been incongruent, and that she had poor insight. You couldn't write that down. Is that right? Because the box doesn't let you.
JENNIFER TUFTS: Correct.
MR. REDDINGTON: So basically she's telling you that “I'm okay.” Well, actually, when she came, do you know that she never saw her other than when she was in nursing school? Would it surprise you, a psychiatrist? And that was only for like a week when she got the Prozac in nursing school because she was afraid of public speaking. Did you know that?
JENNIFER TUFTS: I was aware that she did not have a significant past psychiatric history. I was aware of that.
MR. REDDINGTON: Okay. So you were the first psychiatrist that she had the pleasure of meeting. Is that correct?
JENNIFER TUFTS: Yeah. I think it was.
MR. REDDINGTON: And isn't that important for you as a doctor to take a history?
JENNIFER TUFTS: I did take a history.
MR. REDDINGTON: So can you tell us? You're testifying here for the government. Tell us whether or not she had any past psychiatric history other than in nursing school for a week for the Prozac.
JENNIFER TUFTS: She did not report any other past psychiatric history other than the Prozac and Wellbutrin.
MR. REDDINGTON: So when a patient comes to see you and you're treating to help that patient, if they don't report something to you, you don't know about it apparently, right?
JENNIFER TUFTS: Well, I think it depends. There are certainly things I can assess, but if it's related to their history, I do need them to tell me.
MR. REDDINGTON: Well, you can't assess it unless you ask, right?
JENNIFER TUFTS: Not unless I ask or they volunteer it or they come out—
MR. REDDINGTON: Of course. We already talked about the volunteering. How about you as a doctor when you're evaluating a patient coming to you for help, do you ask them questions?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: You didn't ask her prior history.
JENNIFER TUFTS: I did.
MR. REDDINGTON: What did she tell you?
JENNIFER TUFTS: She said that her prior history was what we discussed about the Prozac in the nursing school.
MR. REDDINGTON: So basically, other than hoping to give her hope is what you said for the therapy. How do you give someone hope for therapy, the other doctor?
JENNIFER TUFTS: Try to encourage them and—
MR. REDDINGTON: What did you encourage her on September 15th?
JENNIFER TUFTS: Sorry?
MR. REDDINGTON: What did you encourage her to give her hope on September 15th?
JENNIFER TUFTS: What did I encourage her?
MR. REDDINGTON: Yeah.
JENNIFER TUFTS: I don't remember exactly the words. It was—
MR. REDDINGTON: Did you write it down in your records?
JENNIFER TUFTS: No, we don't, we don't write those, you know, details of everything that's said.
MR. REDDINGTON: Well, that's the therapy you're talking about, right? Yes?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And you don't write down the therapy you give a patient in the records, right?
JENNIFER TUFTS: Well, I write something about it. I—
MR. REDDINGTON: You write it down or not?
MR. REDDINGTON: Excuse me.
THE COURT: Hold on. Hold on.
MR. REDDINGTON: So yes or no?
THE COURT: Hold on. Just let her finish the question. You listen to the question and answer just what they ask, okay? Go ahead. You can rephrase that question.
MR. REDDINGTON: No, let her answer it.
THE COURT: All right.
JENNIFER TUFTS: I mentioned that I provided supportive therapy.
MR. REDDINGTON: What is supportive therapy?
JENNIFER TUFTS: It's listening to the patient's concerns and providing emotional support and validation.
MR. REDDINGTON: So emotional support and validation, all sounds good. Here's a young woman who was, what, 20, 29, 30 years old came to see you?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And came to see you for help, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Told you she couldn't sleep and she was anxious, correct?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: You know that she was postpartum, correct?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: You know that as a patient who was postpartum... By the way, what is your opinion of the period of postpartum wherein one can have postpartum depression, and more importantly, postpartum psychosis? What's the timeframe?
JENNIFER TUFTS: It's typically one year.
MR. REDDINGTON: So she was well within that timeframe, correct?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And you tried to provide therapy by giving her hope. And how long do you figure did that take? Five minutes, 10 minutes, two minutes?
JENNIFER TUFTS: I'm not sure. I think it was different in each session.
MR. REDDINGTON: Okay. So the only thing that you diagnosed Lindsay with on September 15th was GAD, generalized anxiety disorder, correct?
JENNIFER TUFTS: It was generalized anxiety disorder as well as an adjustment disorder with depressed mood.
MR. REDDINGTON: And you prescribed medications to her, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And the medication that you provided to her was sertraline, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And the sertraline would be Zoloft, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Now, this is a little chart that shows the prescriptions that Lindsay was on, and you are the yellow colors.
MR. REDDINGTON: You can see that.
MR. REDDINGTON: Would you agree with me that on September 15th, you prescribed sertraline, Zoloft, 30 count on September 15th, 25 milligrams, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Have you ever read the website for sertraline?
JENNIFER TUFTS: The website for sertraline?
MR. REDDINGTON: Yeah. I mean, sertraline, Zoloft is a chemical that is marketed as a pharmaceutical, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Right? It's a pill, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And as we said, it's an SSRI pill, correct?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Do you know that Zoloft is not indicated for generalized anxiety? Why'd you give her Zoloft?
JENNIFER TUFTS: It is a very effective medication for generalized anxiety disorder.
MR. REDDINGTON: So you're familiar with the drug labeling for Zoloft, is that correct?
JENNIFER TUFTS: Generally.
MR. REDDINGTON: Generally. Are you aware of what the manufacturer of Zoloft indicates it can be used for, to treat?
JENNIFER TUFTS: I'm aware that it's used to treat various forms of anxiety disorders as well as major depression.
MR. REDDINGTON: So when Lindsay came to see you, you know that she had stopped breastfeeding her son, right?
JENNIFER TUFTS: Not at the time of the first appointment.
MR. REDDINGTON: When did she stop breastfeeding, in October?
JENNIFER TUFTS: Something around then.
MR. REDDINGTON: You know that she had little or no psychiatric history other than seeing you, correct?
JENNIFER TUFTS: And the Prozac, yes.
MR. REDDINGTON: You know that, in fact, that she had stopped drinking whatever it was that she was drinking 'cause you never asked, right?
JENNIFER TUFTS: I was not concerned about her level of drinking.
MR. REDDINGTON: Well, it's in your form, right?
JENNIFER TUFTS: That was at the intake, but I-
MR. REDDINGTON: Wait. Did you know that she wasn't drinking when you were meeting with her, correct?
JENNIFER TUFTS: I, yeah, that's what she told me.
MR. REDDINGTON: Okay. And you believe what she told you, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: So when she sees you, she's not on any psychiatric, anti-tropics, or whatever they're called, medications, correct? She wasn't on any medication.
JENNIFER TUFTS: Correct.
MR. REDDINGTON: And she had stopped drinking anything, whatever it may have been, right?
JENNIFER TUFTS: I'm not sure when she completely stopped drinking, but yes.
MR. REDDINGTON: You don't know when she started, when she stopped, what she drank, do you?
JENNIFER TUFTS: Well, I was not concerned that she was an alcoholic.
MR. REDDINGTON: So that's a yes or no. Did you have any idea? 'Cause we spent a long time on Friday talking about her guilt and having... that she drank alcohol. You don't know what she drank, when she drank, when she started, when she stopped, do you?
JENNIFER TUFTS: I know some details about her alcohol use, but it was overall minimal, so I-
MR. REDDINGTON: What were the details then? Tell me what the details were. There was that one little box that was checked off. What other details were there?
JENNIFER TUFTS: That she drank one to two times a week. Five, one to two servings five times a week.
MR. REDDINGTON: And you don't know where, what it was. You have no idea, right?
JENNIFER TUFTS: I think she had mentioned at some point that it was calming. It was something that was-
MR. REDDINGTON: It was what? I'm sorry. I apologize.
JENNIFER TUFTS: ... Calming.
MR. REDDINGTON: Calming.
JENNIFER TUFTS: Calming.
MR. REDDINGTON: Okay. So she, it was numbing. It was really like trying to numb something, I guess, right?
JENNIFER TUFTS: That's one way of saying it.
MR. REDDINGTON: I mean, you've treated, I imagine you've treated veterans that had post-traumatic stress disorder, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And would you agree with me that many times when people have an anxiety disorder or PTSD, whatever the case may be, they try to numb their feelings? Is that fair?
JENNIFER TUFTS: Mm-hmm. Sometimes they do.
MR. REDDINGTON: And sometimes they use alcohol.
JENNIFER TUFTS: Sometimes they do.
MR. REDDINGTON: But we don't know what alcohol. We don't even know if it was a beer, do we?
JENNIFER TUFTS: I didn't think that was relevant to her.
MR. REDDINGTON: So with all of that in—well, with that information, you then prescribed Zoloft to her, correct?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: You went over the side effects of Zoloft, certainly and I imagine with her, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Did you tell her that one of the known side effects is suicidal thoughts and actions and ideation?
JENNIFER TUFTS: Well, that's specifically in children. So I don't think I mentioned that 'cause it wasn't relevant.
MR. REDDINGTON: Well, not really. Suicidal ideation and homicidal ideation, there's a black box warning—... on Zoloft, along with other SSRIs, right?
JENNIFER TUFTS: Under a—
MR. REDDINGTON: Yes or no?
JENNIFER TUFTS: For children—
MR. REDDINGTON: Excuse me.
JENNIFER TUFTS: ... and adults younger than 25.
MR. REDDINGTON: Excuse me, doctor. I apologize. Can you just listen to my question and answer it yes or no? Is there a black box warning on Zoloft?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: All right. And a black box warning is required or prescribed by what? The FDA?
JENNIFER TUFTS: Probably.
MR. REDDINGTON: Probably. And it basically warns that, especially with young people, or young adults, that it may cause suicidal or, God forbid, homicidal ideation. Yes?
JENNIFER TUFTS: Yes. And—
MR. REDDINGTON: And you're aware that, in fact, the FDA has determined that that goes up possibly to a 23, 24, 25-year-old. You know that, right?
JENNIFER TUFTS: I think 24 is—
JENNIFER TUFTS: ... is what they said.
MR. REDDINGTON: Yeah, I think it's 24. It's possible, is it not, that the SSRIs that get into a person's brain affect a person that's three or four years older than the FDA cutoff with suicidal ideation or homicidal ideation? It's possible?
JENNIFER TUFTS: There's a lot of development that happens in the brain between ages, like up to 24 and closer to 30. The brain is fully matured at, past age 24. And so it's less vulnerable than in a younger individual.
MR. REDDINGTON: So with 24, you're suggesting, as a cutoff, are you suggesting to the jury that a drug that increases the risk of suicide in a 24-year-old patient cannot increase the risk of suicide in a 29 or a 30-year-old patient, just a little bit?
JENNIFER TUFTS: There's, there... I don't believe there's evidence that it causes that at all in individuals over 24.
MR. REDDINGTON: So as a psychiatrist who had the ability to issue these types of medications to patients and citizens, what research did you do on Zoloft and suicidal ideation, homicidal ideation?
JENNIFER TUFTS: I was taught extensively about SSRIs and suicidal ideation in my training.
MR. REDDINGTON: And that's back in Vermont, right?
JENNIFER TUFTS: In Vermont, in Boston, yes.
MR. REDDINGTON: Okay. So it's Vermont was when you were getting your medical degree, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And Boston would be when you were a resident, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And you have board certification on general psychiatry, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: You can have a certification on a subspecialty, right?
JENNIFER TUFTS: There are some subspecialties, yes.
MR. REDDINGTON: Right. And some of the subspecialties deal with postpartum or women that are pregnant and have babies and have psychiatric symptomology.
JENNIFER TUFTS: There's no board certification for perinatal or reproductive psychiatry.
MR. REDDINGTON: Well, there are plenty of classes that are recognized as, for example, at Harvard Medical School, there's an annual class or symposium, if you will, for postpartum. Have you ever been to that?
JENNIFER TUFTS: No, sir.
MR. REDDINGTON: What have you done to research or to improve your educa— I understand you went to med school and that you're a resident. What programs, continuing education, symposiums have you attended since you got the ability to prescribe these medicines to people?
JENNIFER TUFTS: I have not attended a symposium.
MR. REDDINGTON: Have you attended anything?
JENNIFER TUFTS: I have not, but I have done a lot of reading on my own, of research and guidelines about this area in psychiatry.
MR. REDDINGTON: Did you tell Lindsay when you were going... 'Cause one of the things that you guys are always concerned about is what's called informed consent, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And what is informed consent? What does that mean?
JENNIFER TUFTS: It means—
MR. REDDINGTON: In a medical sense, not just like out in the street or something.
JENNIFER TUFTS: Explaining to a patient the risks and benefits of treatment, and possible alternatives, and making sure that the patient understands what you're saying.
MR. REDDINGTON: Now, when you were going over the symptomology or when you were going over the side effects of Zoloft, one of the side effects of Zoloft is, and I quote, "severe trouble sleeping," right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Did you tell her that?
JENNIFER TUFTS: Well, insomnia is listed as a side effect.
MR. REDDINGTON: No, no, no, no, no. You already said, yes, you know it. We just... Did you tell her that Zoloft has a side effect of giving the patient severe trouble sleeping? That's all.
JENNIFER TUFTS: So I didn't use the word severe, 'cause it typically doesn't cause severe trouble sleeping. But I thought you were referring to when she told me that she did have severe trouble sleeping and that was true.
MR. REDDINGTON: Well, that's what she told you, right? That she had severe trouble sleeping, right?
JENNIFER TUFTS: She told me, yes.
MR. REDDINGTON: Yes. And you know that one of the side effects of Zoloft is, let's say, trouble sleeping. You know that, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Your answer is yes. The jury has to be able to hear you.
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And why would you prescribe Zoloft to a young woman who's postpartum, who's coming to you with anxiety, who's telling you we can't... She can't sleep. She's got all of these symptoms, and you prescribe a medication that would have a side effect of trouble sleeping?
JENNIFER TUFTS: So individuals have very varied responses to medications. Some have no side effects. Some have one or two. It's impossible to predict. But Zoloft is a top choice, a first-line medication for—
MR. REDDINGTON: Says who? Says who?
JENNIFER TUFTS: Says it's the general consensus among psychiatrists—
MR. REDDINGTON: But you know about the lawsuits against Zoloft, right?
THE COURT: Hold on. Again, again, we can't have both of you talking at the same time. So let her finish her answer, and then I'll give you plenty of time to follow up any questions regarding her answer. So, can you finish your answer on that?
JENNIFER TUFTS: There's extensive research supporting the use of sertraline in this instance, and the general consensus among psychiatrists is that it's a first-line, safe medication for individuals, including postpartum women.
MR. REDDINGTON: How about the kids that shoot other kids in high schools and the lawsuits that come out of that against Zoloft? You ever read about them?
MS. SPRAGUE: Objection.
THE COURT: Overruled.
JENNIFER TUFTS: Sorry?
MR. REDDINGTON: You didn't hear me?
JENNIFER TUFTS: I wasn't sure what the question was.
MR. REDDINGTON: The question was in response to your observation about how all the psychiatrists or the psychiatrists think it's a very, very safe and wonderful first-line drug. You've researched it. How about the kids that kill other kids in schools with the lawsuits that arise out of the use of SSRIs? Have you ever researched that?
JENNIFER TUFTS: I don't know much about that.
MR. REDDINGTON: You know about the SSRIs and messing with someone's brain. They go out and they shoot people for no reason, right?
JENNIFER TUFTS: I'm not aware that that's linked to SSRIs.
MR. REDDINGTON: So you didn't really talk to her about increased risk of suicide, and 24-year-olds are down because she's four or five years older than that. You didn't talk to her about the trouble sleeping. That can be a side effect. But you prescribed ... There's other drugs that you could have given her that would be perfectly safe and calming and allow someone with no psychiatric history to sleep better, right?
JENNIFER TUFTS: Not necessarily.
MR. REDDINGTON: Okay. So you prescribed her with the Zoloft. It was 25 milligrams, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And when you prescribed her with the Zoloft, 25 milligrams, was that increased up to, .05 milligrams? Or did you increase it at some point?
JENNIFER TUFTS: The instructions were to increase it to 50 after one week.
MR. REDDINGTON: After one week?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And you expected that she would listen to your instructions, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And she did, right?
JENNIFER TUFTS: She waited about a month, but then, yes, she did.
MR. REDDINGTON: Why did she wait a month?
JENNIFER TUFTS: I think it took her some time to decide whether that was truly what she wanted to do.
MR. REDDINGTON: Right. She was afraid of the drugs, wasn't she?
JENNIFER TUFTS: She was afraid of side effects.
MR. REDDINGTON: And she didn't wanna take the pills, did she?
JENNIFER TUFTS: She eventually did want to take the pills because she wanted to feel better.
MR. REDDINGTON: A month later, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: So you prescribe the Zoloft, SSRI, and then you tell her after a week to increase it, and she doesn't take that medication for a month. Correct?
JENNIFER TUFTS: Correct.
MR. REDDINGTON: And then she did take the medication, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And did you meet with her or talk to her before she actually started to implement that particular regimen?
JENNIFER TUFTS: I had met with her beforehand, but I was not aware of when she made the decision to go ahead and take it.
MR. REDDINGTON: So you met her on the 15th of September, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: When was the next time you met her?
JENNIFER TUFTS: Can I check?
MR. REDDINGTON: Sure, of course. Absolutely. You can look at anything you want.
JENNIFER TUFTS: September 28th.
MR. REDDINGTON: And on September 28th, did you discuss with her the fact that she was afraid to take Zoloft?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And did you recommend that she do that?
JENNIFER TUFTS: Well, she said that she was feeling better at that point, and I told her she—
MR. REDDINGTON: It's a real easy question.
JENNIFER TUFTS: Okay.
MR. REDDINGTON: When you talked with her, did you recommend that she increase or take the Zoloft?
JENNIFER TUFTS: At that visit, I don't think that I did.
MR. REDDINGTON: Okay. So when did she actually take the Zoloft?
JENNIFER TUFTS: She told me in her October 20th visit that she had taken it one week prior.
MR. REDDINGTON: And she told you that when she increased it in accordance with your instructions, she went off the rails, right?
JENNIFER TUFTS: I don't think she used those words, but she had said that.
MR. REDDINGTON: What words did she use for you as her doctor?
JENNIFER TUFTS: She felt awful.
MR. REDDINGTON: Awful. Why did she feel awful? Did she have a stomachache? Did she have a headache? Why did she feel awful?
JENNIFER TUFTS: She did have some stomachaches. She had some diarrhea, and had a difficult time eating. She also had increased anxiety. She had some more depressed feelings. She had more difficulty sleeping.
MR. REDDINGTON: And what was your advice to her as her doctor on the 28th of October after she told you about the effect that Zoloft had on her?
JENNIFER TUFTS: I told her to stop it. Stop the medication.
MR. REDDINGTON: Okay. Now, Zoloft being an SSRI, and a patient that is taking Zoloft in the .05—we spent Friday afternoon going over the drugs, and .05 milligrams is the lowest dose and all that. That's the dose that is prescribed to people invariably, correct?
JENNIFER TUFTS: It goes up to 200, but that is the starting dose.
MR. REDDINGTON: For pretty much all of you psychiatrists would agree with that, right? .05, right?
JENNIFER TUFTS: Fifty.
MR. REDDINGTON: Fifty, okay. And you then told her to stop?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: What does it mean to titrate something?
JENNIFER TUFTS: To slowly increase the amount.
MR. REDDINGTON: What do you tell patients when they're on an SSRI as to weaning them off the SSRIs?
JENNIFER TUFTS: It depends what the dose is. If it's a high dose, you need to slowly decrease the dose, so kind of the opposite of titration. But if it's a low dose to begin with, you can stop it.
MR. REDDINGTON: Are you supposed to tell a person that's on an SSRI to stop immediately or to slowly withdraw from it?
JENNIFER TUFTS: At 50 milligrams, it is perfectly fine to stop it immediately.
MR. REDDINGTON: So you didn't have any concerns at all about telling her to immediately stop taking the Zoloft. And what'd you do? Put her on another drug?
JENNIFER TUFTS: Not immediately.
MR. REDDINGTON: Okay. So did she relate to you on that October 28th meeting that you had... Was it the 28th or the 26th?
JENNIFER TUFTS: I met with her the 21st and then the 26th.
MR. REDDINGTON: Okay. Now, on the 26th of October, what did she tell you her condition was?
JENNIFER TUFTS: So she was feeling back to how she was before the Zoloft, which is not great still, and that she was considering a new medication.
MR. REDDINGTON: So she was considering it. Did she do research on medication as to what medication she wanted to take? Is that what you're telling this jury?
JENNIFER TUFTS: She didn't specify exactly what medication she wanted to take, but that she wanted to try something else because she was still having significant anxiety.
MR. REDDINGTON: So when you say she wanted to try something else, I'm just asking, did you tell her what you recommended she try, or is that something that she decided to do on her own?
JENNIFER TUFTS: No, I gave her my recommendation.
MR. REDDINGTON: Okay. The only reason why I ask that is that, you know, a lot of times people might think that she's a psychopharmacologist, that she's a heart surgeon, that she's a vascular surgeon, that she knows everything about medicine. That's not true, is it?
MR. REDDINGTON: Would you agree with me that, prior to telling her to stop the Zoloft, that one of the concerns that you had is that Zoloft affects anxiety and affects sleep, and you hope that it treats the underlying anxiety by balancing brain chemistry and increasing serotonin, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Is that fair? And you'd agree with me that it does, as a side effect, have an impact on a person's falling asleep or staying asleep as a common side effect, right?
JENNIFER TUFTS: It can happen. It doesn't happen to everyone, but it certainly happens to some. But it is, it is temporary. That's the important distinction, is that there are many side effects that disappear entirely, and then the medicine is quite helpful for those certain conditions.
MR. REDDINGTON: What's that?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: She had problems sleeping, didn't she?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Even after the Zoloft, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: So you, not her, you recommended a particular drug that she should take, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And again, as it relates to what one would expect a young woman who's a labor and delivery nurse to know about psychiatric medication, what is methadone? Do you know?
JENNIFER TUFTS: I'm sorry?
MR. REDDINGTON: Methagene.
JENNIFER TUFTS: I'm not sure.
MR. REDDINGTON: How about hyper... How about Hermabate? B-A-T-E. H-E-R-M-A-B-A-T-E. How about that? You ever heard of that?
JENNIFER TUFTS: I'm not familiar with that.
MR. REDDINGTON: That's what's used to administer to a woman who's going through birth. You don't have an obligation to know that, do you?
MR. REDDINGTON: You have an obligation to know about psychiatric medications though, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: There's a difference between what's known as mens, which is not knowing, what you have no duty to know, and ignorance, which is you don't know what you should know. Is that fair?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: So did you ever gauge Lindsay's knowledge or ability to judge what medication would be good for her?
JENNIFER TUFTS: So that was my role. That was my role.
MR. REDDINGTON: Right.
JENNIFER TUFTS: ... I didn't expect her to know, significantly, the details about different psychiatric medications.
MR. REDDINGTON: Is it important to know that a woman that's coming to you because of postpartum issues, shall we say, had prior problems in prior deliveries?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And you'd agree with me that you're on the front line of healthcare for pregnant women when someone comes to see you, either pregnant or after having a baby, right?
JENNIFER TUFTS: They're usually referred by a therapist or an OB, but yes.
MR. REDDINGTON: Okay. So being on the front line of dealing with these people, and you advertised that you deal with pregnant people before they have babies, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And after, correct?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Did she have any prior issues with her prior babies?
JENNIFER TUFTS: I knew that she had had some anxiety symptoms with her prior, after her prior child was... Or sorry, after her second child was born.
MR. REDDINGTON: And that would be Dawson?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And when she saw you after having Callan, how old was Dawson, if you know?
JENNIFER TUFTS: A few years old, maybe two or three.
MR. REDDINGTON: Did she tell you what the side effects were after she had Dawson?
JENNIFER TUFTS: She did. I did not list them, because—
MR. REDDINGTON: Excuse me. That means you didn't write them down?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: So what is it, your memory? We'll go back, right?
JENNIFER TUFTS: Sorry?
MR. REDDINGTON: We'll go by your memory?
JENNIFER TUFTS: Go by my memory about what? I don't recall exactly which side effects she said, but I recall that they were some of the very common ones, the ones that are temporary.
MR. REDDINGTON: Wait, wait. Hold on, hold on. You're telling this jury that you don't recall what the side effects were that she told you, but you knew at least that they were general, chronic? Is that what you're saying?
JENNIFER TUFTS: Yes, because if they were anything else, I would've documented it and—
MR. REDDINGTON: Well, how about she took Zoloft? Did she take Zoloft, SSRI, after having Dawson?
JENNIFER TUFTS: I think she took it for about a week.
MR. REDDINGTON: You think, or she did?
JENNIFER TUFTS: She did.
MR. REDDINGTON: So isn't that something that would be indicative of the fact that there was some psychiatric issues after she had her second child?
JENNIFER TUFTS: Yes, but she did not describe them as being severe.
MR. REDDINGTON: Well, as a psychiatrist, can you ask her whether or not they're severe, or do you just wait for them to tell you?
JENNIFER TUFTS: Based on her description, they did not sound severe.
MR. REDDINGTON: Tell me about bipolar. What's bipolar?
JENNIFER TUFTS: Bipolar is a mood disorder that has both depressive episodes as well as episodes of mania.
MR. REDDINGTON: And is it your understanding that if a person has a difficult birth, and in fact has some psychiatric attributes as a result of that difficult birth, that you should not prescribe SSRIs to that person because they could be bipolar?
JENNIFER TUFTS: Having a difficult birth does not—is not a contraindication to an SSRI.
MR. REDDINGTON: So after she had her second child, she took Zoloft, and you did not detail any side effects, and you don't remember any side effects. Do you agree that Lindsay had, at this point, a history of mental problems during postpartum?
JENNIFER TUFTS: She had a history of anxiety postpartum.
MR. REDDINGTON: Anxiety to the point that she was prescribed an SSRI?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And she also had mental problems when she came to see you, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: So she had mental problems after she had the second child, mental problems after she had the third child, correct?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And you'd agree with me that this is not easy stuff for somebody to be talking about. People get embarrassed in our society if they have mental problems, don't they?
JENNIFER TUFTS: Some do.
MR. REDDINGTON: She did, didn't she?
JENNIFER TUFTS: I'm not sure.
MR. REDDINGTON: Not documenting any of the side effects, did you think it would be important to document the side effects of the drug before you prescribed Zoloft a second time? She's telling you that she had... You don't know, but she had side effects with Zoloft. Was it important for you to document the second time that you're giving her Zoloft?
JENNIFER TUFTS: I did not feel that it was necessary to document the specific side effects.
MR. REDDINGTON: So if someone comes to you as a person who is in postpartum and has all the symptomology that she had related to you, that if she told you that she was on Zoloft after her second child and had side effects, you don't think it's important to document the side effects, number one, right?
JENNIFER TUFTS: It depends what the side effects are.
MR. REDDINGTON: Which we don't know because you didn't write them down. You don't remember.
JENNIFER TUFTS: I would've written them down if I would've—
MR. REDDINGTON: Not if you would have done. What did you do?
JENNIFER TUFTS: I would've written them down if—
MR. REDDINGTON: What did you do?
JENNIFER TUFTS: I wrote that she had side effects.
MR. REDDINGTON: What are they?
JENNIFER TUFTS: I'm not sure.
MR. REDDINGTON: And then you prescribed Zoloft again, didn't you, in 2022?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Do you recall in the period of September of '22, October of '22 into November of '22, that she used the word overwhelmed, told you that she was overwhelmed? Is that correct?
JENNIFER TUFTS: Sorry, which visit are we looking at?
MR. REDDINGTON: Well, the period of time September, October, November, that she used the terminology that she was overwhelmed.
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Okay. And when you were treating her, you didn't think that she was just merely overwhelmed with three children. You knew she was really struggling, didn't you?
JENNIFER TUFTS: I did.
MR. REDDINGTON: And it was at that point that you diagnosed her with a psychiatric condition and you prescribed psychiatric meds, isn't that right?
JENNIFER TUFTS: I prescribed psychiatric medications, yes.
MR. REDDINGTON: So when you prescribed the Zoloft and told her to increase it, she told you that she was having all these difficulties. You told her to stop. Did you give her therapy when you saw her?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: What did you do?
JENNIFER TUFTS: I think that I...
MR. REDDINGTON: Not what you think.
JENNIFER TUFTS: I'm not sure.
MR. REDDINGTON: Again, I apologize, but not what you think. I wanna know what you did, and that's why you write stuff down. So take your time and look at your notes. What did you do for this young woman for therapy?
JENNIFER TUFTS: On which day?
MR. REDDINGTON: On what?
JENNIFER TUFTS: Which day are we talking about specifically?
MR. REDDINGTON: When she came to you and told you that she was overwhelmed, and you diagnosed her with a mental illness and prescribed psychiatric condition, the psychiatric meds. What therapy did you give her? 'Cause you told us that when you're on the television, you still give them therapy too, right?
JENNIFER TUFTS: I do.
MR. REDDINGTON: What did you do?
JENNIFER TUFTS: Well, I'm having trouble identifying exactly when she said the words overwhelmed.
MR. REDDINGTON: Okay.
JENNIFER TUFTS: So it's hard to pinpoint exactly what I said in a span of, you know, a number of different visits.
MR. REDDINGTON: Did you indicate that there's information on the website that if a person has an emergency that they should do something?
JENNIFER TUFTS: I did, and I advised her the same.
MR. REDDINGTON: So basically, if one of your patients becomes suicidal... And on that note, did she tell you at that point up to November of '22 that she was dwelling on suicidal thoughts?
JENNIFER TUFTS: It was a while before she mentioned anything about suicidal thoughts.
MR. REDDINGTON: Tell us when.
JENNIFER TUFTS: I might need to look through the records—
MR. REDDINGTON: Go right ahead.
JENNIFER TUFTS: ...to see when she first did.
JENNIFER TUFTS: December 1st.
MR. REDDINGTON: So on December 1st, what did she tell you?
JENNIFER TUFTS: That she denied feeling suicidal, but that she was close to feeling suicidal.
MR. REDDINGTON: That's kinda like being a fisherman out in the ocean who's worried about the possibility of a storm, and is thinking about the storm, and is dwelling on the storm, almost in fear of the storm, right?
MS. SPRAGUE: Objection.
THE COURT: Overruled.
MR. REDDINGTON: Isn't it?
JENNIFER TUFTS: I guess.
MR. REDDINGTON: So when she tells you that she's— and I don't want to put words in your mouth. What did she say? She's having suicidal thoughts, or what did she say?
JENNIFER TUFTS: Yeah.
MR. REDDINGTON: Or close to it?
JENNIFER TUFTS: She denied having suicidal thoughts, but felt that she was getting close to it.
MR. REDDINGTON: Okay. So she was dwelling on it or thinking about it, right? Is that fair?
JENNIFER TUFTS: She was fearful of eventually having those kinds of thoughts.
MR. REDDINGTON: To kill herself?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And how frequently were the thoughts?
JENNIFER TUFTS: I'm not sure exactly how frequent they were.
MR. REDDINGTON: Did you ask her?
MR. REDDINGTON: I'm sorry?
JENNIFER TUFTS: It's very likely that I did ask her the frequency.
MR. REDDINGTON: Would that be in your medical records? When you see some patients, you had some patients other than Lindsay Clancy at that point, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And you document when a patient... My God, when a patient comes in and tells you that she's in postpartum distress, and she's close to having suicide thoughts to kill herself, that's important, isn't it?
JENNIFER TUFTS: It's important that I am aware that she's having these thoughts.
MR. REDDINGTON: What thoughts?
JENNIFER TUFTS: That she is fearful she could become suicidal.
MR. REDDINGTON: And she told you, and I imagine, or you asked, how frequently these thoughts were?
JENNIFER TUFTS: I don't have it documented how frequently they were—
MR. REDDINGTON: Right.
JENNIFER TUFTS: ...but that is a question that I usually ask when we're talking about suicidal thoughts.
MR. REDDINGTON: So when you're usually testifying in a murder case, we usually have facts that we can tell the jury, not speculation.
MS. SPRAGUE: Objection.
THE COURT: Yeah. Sustained.
MR. REDDINGTON: Did she tell you, or did you ask about suicidal thoughts?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: What did she tell you? If you don't know, tell us.
JENNIFER TUFTS: No, I know. Sorry. But it's what I said before, that she denied having them, and she wasn't having them we were meeting. But she felt close to it, close to having those thoughts.
MR. REDDINGTON: Okay. So she... Would you agree with me that many times patients, especially psychiatric patients, may minimize their symptomology?
JENNIFER TUFTS: Patients sometimes do.
MR. REDDINGTON: And sometimes when a woman has just had a child and has other little kids at home, that they're worried about the government taking kids away from them, because you're a mandated reporter, right?
MS. SPRAGUE: Objection.
THE COURT: Overruled.
MR. REDDINGTON: You're a mandated reporter, right?
JENNIFER TUFTS: I am.
MR. REDDINGTON: And if she told you, "I'm having suicidal thoughts. I'm close to it. And homicidal thought," you'd report that, wouldn't you?
JENNIFER TUFTS: It— not necessarily. I think it really depends on the context, but having suicidal thoughts alone is not a reportable condition.
MR. REDDINGTON: All right. So basically, we know that she was close to having suicidal thoughts to kill herself, whatever that means. We don't know how frequently she was having them. Yeah?
JENNIFER TUFTS: Today, I don't know how frequently.
MR. REDDINGTON: Today.
JENNIFER TUFTS: But at that point, I believe I did know how frequently they were.
MR. REDDINGTON: Oh, okay. So as a result of that, you then gave her therapy, I imagine, right, through the television?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And what therapy did you give her in November of '22?
JENNIFER TUFTS: I gave her supportive psychotherapy.
MR. REDDINGTON: And what does that mean? It sounds great. What do you do?
JENNIFER TUFTS: It's listening to the patient and providing—
MR. REDDINGTON: Sorry. Listening to the patient—
MS. SPRAGUE: Objection.
MR. REDDINGTON: ...like when they say they're having—
THE COURT: Hold, hold on. Sustained. Next question.
MS. SPRAGUE: Well, she needs to finish the answer.
THE COURT: Right. Next question.
MR. REDDINGTON: Thank you, Judge.
MR. REDDINGTON: Listening to the patient, that would be when, for example, one of your patients tells you after all the treatment that you have provided prior to that, all the symptomology that she had, and the insomnia, and the anxiety, and all of that, that she's close to having suicidal thoughts. That would, I imagine, impact you?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: So what did you do with this psychotherapy?
JENNIFER TUFTS: So I provided emotional support, and validation, and—
MR. REDDINGTON: What does that mean, validation?
JENNIFER TUFTS: ...encouragement.
MR. REDDINGTON: What does that mean?
JENNIFER TUFTS: Something like, "I understand this is a very difficult time." It really, you know, it varies on the individual.
MR. REDDINGTON: Sure. But what is it?
JENNIFER TUFTS: I don't remember the exact therapeutic words that I used.
MR. REDDINGTON: Okay. How long did you give the therapy, validation, and all that stuff?
JENNIFER TUFTS: I don't remember exactly the duration.
MR. REDDINGTON: Maybe about 10 minutes?
JENNIFER TUFTS: Maybe.
MR. REDDINGTON: Through the television, right?
JENNIFER TUFTS: Through the computer.
MR. REDDINGTON: So as we've pointed out, you tell the people that come to see you, when I say you, I mean collectively Aster Medical, that you would expect that if a person is in crisis, as you guys say, or is suicidal, that they would have to go to a computer or their cell phone, right? They would have to punch in your office, right?
MR. REDDINGTON: Look up the number.
JENNIFER TUFTS: We advise them to call 911 or go to the emergency room as quickly as possible.
MR. REDDINGTON: How about suicide hotlines? Do you give them advice to call those?
JENNIFER TUFTS: That's an option as well. Yes.
MR. REDDINGTON: Sure. Did she call suicide hotlines?
JENNIFER TUFTS: I was not aware that she did.
MR. REDDINGTON: Did you ever ask her?
JENNIFER TUFTS: I don't think I specifically asked that question.
MR. REDDINGTON: How about not specifically? Did you ask her anything? Did you beat around the bush maybe? You ask her anything about suicide hotlines?
JENNIFER TUFTS: I don't think I asked her about suicide hotlines.
MR. REDDINGTON: Would it surprise you to know that she called suicide hotline in that timeframe not once, but twice, and was turned away? You guys are on the front lines of this, aren't you?
MS. SPRAGUE: Objection.
THE COURT: No, overruled.
JENNIFER TUFTS: It does surprise me, yes.
MR. REDDINGTON: It does what?
JENNIFER TUFTS: It surprises me that she called them twice.
MR. REDDINGTON: And you never asked her if she had ever called a suicide hotline, did you?
JENNIFER TUFTS: I don't think that I did.
MR. REDDINGTON: And I understand. You're a doctor. You were trying to do the right thing. You obviously... This is just horrible, isn't it?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: She continued on with her treatment with you, correct?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: What was the next medication that you put her on?
MR. REDDINGTON: Let's say we're up to, I guess it would be the October 26th
MR. REDDINGTON: Date.
JENNIFER TUFTS: Yeah.
MR. REDDINGTON: Is that right?
JENNIFER TUFTS: October 26th.
MR. REDDINGTON: Is that when you prescribed Ativan?
JENNIFER TUFTS: I prescribed that on the 21st.
MR. REDDINGTON: I'm sorry?
JENNIFER TUFTS: I prescribed the Ativan on the 21st.
MR. REDDINGTON: All right. Did you prescribe anything on the October 26th appointment?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And what was that?
JENNIFER TUFTS: Buspirone.
MR. REDDINGTON: Buspirone. And would you agree with me that... Is that also Vanspar?
JENNIFER TUFTS: Buspar or Buspirone are the common names for it.
MR. REDDINGTON: Okay. You ever heard of Vanspar, V-A-N, V as in Victor, A-N-S-P-A-R? You ever heard of that?
JENNIFER TUFTS: No, I haven't.
MR. REDDINGTON: Okay. And would you agree with me that there are a number of side effects of Buspirone?
JENNIFER TUFTS: Every medication has side effects, but—
MR. REDDINGTON: Okay, so my question is pretty simple. Buspirone, you mentioned it, I'm asking, any side effects?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: What did you... What are the side effects?
JENNIFER TUFTS: They could be tiredness or dizziness, or rarely some upset stomach. But it's generally a very, very well-tolerated, mild medicine.
MR. REDDINGTON: And do you recall, was she taking any other medication at that point, if you know?
JENNIFER TUFTS: Yeah, she was taking some of the Ativan.
MR. REDDINGTON: Some Ativan, right. Did you prescribe that to her?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: When did you prescribe the Ativan to her?
JENNIFER TUFTS: The 21st.
MR. REDDINGTON: And she was compliant with your recommendations, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Was she also reporting to you that she was taking Benadryl, like over-the-counter stuff?
JENNIFER TUFTS: It was being used as needed, yes.
MR. REDDINGTON: So that's PRN on the records, PRN or whatever. You take it as required, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And she reported to you that she was taking Benadryl, right?
JENNIFER TUFTS: She reported that, yes.
MR. REDDINGTON: And you didn't document how much she was taking, right?
JENNIFER TUFTS: It's only available as one dose over the counter.
MR. REDDINGTON: Okay. Did she re-up the dose over the counter? Do you know?
JENNIFER TUFTS: She didn't tell me that she did.
MR. REDDINGTON: Did you ask her?
JENNIFER TUFTS: I don't remember asking her about if she increased it. I think she was just taking one of them.
MR. REDDINGTON: You think. Did you know that Ativan and Benadryl are contraindicated, that they can have a serious impact to the central nervous system and depressant, depressant effects?
JENNIFER TUFTS: Yes, but can I explain that when they say depressant—
MR. REDDINGTON: Excuse me. The answer is yes, right? Is the answer yes?
THE COURT: Yeah, if the answer's yeah, if that's the question, the Commonwealth may be able to ask you further questions if you'd like.
JENNIFER TUFTS: Okay. Well, I can't say yes to that entire statement.
THE COURT: All right. Next question.
MR. REDDINGTON: Did you discuss anything about Benadryl combined with Ativan on October 26th?
JENNIFER TUFTS: I don't recall.
MR. REDDINGTON: On October 26th, was she still worried about suicidal thoughts?
JENNIFER TUFTS: She denied that.
MR. REDDINGTON: And on October 26th, how did she deny that? Is that—do you have that noted in your record?
JENNIFER TUFTS: I do.
MR. REDDINGTON: And what does it say?
JENNIFER TUFTS: Patient denies suicidal ideation.
MR. REDDINGTON: Okay. So there's a huge difference between suicidal ideation and somebody having thoughts of suicide or being close to it, right?
JENNIFER TUFTS: Not exactly.
MR. REDDINGTON: Well, you knew that the last time you spoke to the woman, she told you that she was close to having thoughts of killing herself, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And you're her doctor, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: So what do you do? You just say, "Do you have..." And check the box and say, "Do you have any suicidal ideation?" And she says no, and you check the box?
JENNIFER TUFTS: No, it's not that simple.
MR. REDDINGTON: Do you ask her, like, "Well, gee, the last time I spoke to you, you told me that you were close to having suicidal thoughts, thoughts of killing yourself." Did you pursue that on the 26th of October?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And what did she say?
JENNIFER TUFTS: That she wasn't.
MR. REDDINGTON: Now, how long was that appointment, if you recall? Would you agree it was 17 minutes, and then there was some therapy?
JENNIFER TUFTS: The entire appointment was something between 25 and 30 minutes.
MR. REDDINGTON: And that was, again, through the television, right?
JENNIFER TUFTS: The computer, yes.
MR. REDDINGTON: Computer. Did you also add a drug called hydroxyzine?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: When was that?
JENNIFER TUFTS: So that was the same visit as an alternative to the Benadryl.
MR. REDDINGTON: Okay, so on October 26th, when she told you that she was taking over-the-counter Benadryl, I asked you what you prescribed to her, and you said Ativan, right? Right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And then I asked you about the contraindication of Ativan and Benadryl, right?
JENNIFER TUFTS: You asked me about that, yes.
MR. REDDINGTON: And then you, on October 26th, started her on Buspar, correct?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And what is the purpose of Buspar? Is that for anxiety?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And what kind of drug is Buspar?
JENNIFER TUFTS: It doesn't really fall into a class, but it does act on serotonin.
MR. REDDINGTON: So it's another... Similar to an SSRI, right?
JENNIFER TUFTS: It's kind of like a more mild version of an SSRI.
MR. REDDINGTON: Okay. So she's on Benadryl over the counter; Ativan, which is a benzodiazepine; Buspar, which is an SSRI; and then you prescribe hydroxyzine on the same day, right?
JENNIFER TUFTS: They weren't all to be taken at the same time.
MR. REDDINGTON: What's hydroxyzine?
JENNIFER TUFTS: Hydroxyzine is an antihistamine.
MR. REDDINGTON: Okay. Is that over the counter, or is that... Can you just buy that over the counter, or do you have to go to the back where the pharmacist is?
JENNIFER TUFTS: You have to go to the pharmacist.
MR. REDDINGTON: Okay. And as far as you're concerned, she was taking the medications as she was required, right?
JENNIFER TUFTS: That's what I was told.
MR. REDDINGTON: I'm sorry?
JENNIFER TUFTS: Yes, that's what I was told.
MR. REDDINGTON: Did you... By her?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And did you at any time tell her that she should keep a diary of her medications and keep a diary of any side effects that she has?
JENNIFER TUFTS: I didn't instruct her to do that.
MR. REDDINGTON: You don't have to instruct somebody to do anything, but did you recommend it? Like, say, "Hey, if you're on all these meds, if you're having an effect, you should write it down, when, time, date," anything like that?
JENNIFER TUFTS: I didn't tell her to do that.
MR. REDDINGTON: Would that be helpful?
JENNIFER TUFTS: Maybe, but usually we go through all of that in the appointments, and we met very frequently.
MR. REDDINGTON: Now, you'd agree with me that at this point, prior to the next appointment, which was November 2nd, she had gotten significantly worse, even after all this medication that you had been prescribing, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Did you make a note that she was telling you that she had depression and that she was crying, had a- more anxiety, insomnia had increased, brain fog, and worrying about suicide?
JENNIFER TUFTS: In the couple weeks after starting those medicines, I don't recall that the symptoms were significantly exacerbated.
MR. REDDINGTON: Okay. Friday afternoon, you answered the DA, and you said that you recall that she used the word brain fog, right?
JENNIFER TUFTS: She used that at some point. I don't recall when.
MR. REDDINGTON: Okay. What is brain fog?
JENNIFER TUFTS: It's a very subjective feeling that someone might have where, maybe it's, you know, hard to think of a word that you're trying to think of, or maybe it feels like, you know, maybe you're thinking of things a little bit more slowly than you normally would.
MR. REDDINGTON: And how often was she dwelling on suicide?
JENNIFER TUFTS: At what point?
MR. REDDINGTON: At the point she told you that she had anxiety, insomnia, brain fog, crying inconsolably.
MS. SPRAGUE: Objection. If we could have a date.
THE COURT: I think he's gonna get to that. Go ahead.
MR. REDDINGTON: October 26th, heading into November 2nd.
MR. REDDINGTON: Do you recall... I'll rephrase it. Do you recall going into the November month, meeting with her, and she told you that she had brain fog?
JENNIFER TUFTS: It was mentioned at some point.
MR. REDDINGTON: Okay.
JENNIFER TUFTS: I don't see that on the 26th specifically.
MR. REDDINGTON: All right. So let's talk about brain fog. Did you ask her what that meant? 'Cause when you say subjective, that means that's her interpretation. That's in her head. She's telling you, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: As opposed to objective, which would be what people in general would think, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: So when she's telling you, in addition to the anxiety, in addition to the crying, in addition to the stress that she was undergoing, she was worrying about suicide, she talked about brain fog. So you must have asked her, "What does that mean? What... Subjectively, what does that mean?"
JENNIFER TUFTS: Subjectively means in the patient's, you know, own opinion. That's what their experience is.
MR. REDDINGTON: Okay, so she's the one that's inside her head, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: So what were the symptoms? What does it... When a patient tells you that they have brain fog, is that something you would consider as being a potential side effect of the medications that you would put her on?
JENNIFER TUFTS: It depends.
MR. REDDINGTON: On what?
JENNIFER TUFTS: I mean, sometimes it could be and sometimes it could be unrelated. It's a symptom of depression as well, so sometimes it's hard to tell what it's attributed to.
MR. REDDINGTON: So at this point, heading into November, your answer was to prescribe more medication. More, three more drugs, right? You prescribed Ativan, or increased the Ativan. What was her load for Ativan at this point? Do you remember?
JENNIFER TUFTS: Sorry?
MR. REDDINGTON: What was her milligrams, if that's right, or nanograms, whatever it is, on the Ativan, on the script that you had provided her?
MS. SPRAGUE: Objection. If we could just have a date.
THE COURT: I think she said... Do- If you can answer that, go ahead.
JENNIFER TUFTS: Which date are we referring to? For the Ativan?
MR. REDDINGTON: She already objected.
JENNIFER TUFTS: 'Cause there were, there... I'm sorry.
MR. REDDINGTON: She already objected.
MR. REDDINGTON: He already said you can answer it.
MR. REDDINGTON: When did you increase her Ativan and to what level?
JENNIFER TUFTS: So she was prescribed Ativan .5 milligrams.
MR. REDDINGTON: Right.
JENNIFER TUFTS: And then, when I next saw her, she said it was a little bit helpful. So I said, "You could increase it and see if one milligram is more helpful." And-
MR. REDDINGTON: Did she increase it?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And when was the next time you saw her to talk to her on the television or on the computer?
JENNIFER TUFTS: Well, I saw her on the 26th, and then I saw her on the 31st.
JENNIFER TUFTS: I'm sorry.
MR. REDDINGTON: Okay. How was she on the 31st? Halloween. How was she?
JENNIFER TUFTS: Yes. That's not my note. That's her therapy note.
MR. REDDINGTON: Okay. So how about this November 2nd? Was that the next time you saw her?
JENNIFER TUFTS: I saw her on November 2nd.
MR. REDDINGTON: And she told you that she was hesitant to use the medications, the Buspar and the hydroxyzine, right?
JENNIFER TUFTS: She said she was hesitant to try the Buspar.
MR. REDDINGTON: She was scared of the drug. She was scared of the drugs, right?
JENNIFER TUFTS: She was afraid to take a medication.
MR. REDDINGTON: She wasn't doctor shopping and asking you to give her drugs so she could get high. She was asking you for help. Isn't that right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And she was afraid to take the drugs and told you that she was afraid to take the drugs, right?
JENNIFER TUFTS: She told me she was afraid to take docusate.
MR. REDDINGTON: Did you advise her or counsel her or give her therapy about that? Validations?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And what did you tell her?
JENNIFER TUFTS: Well, I advised her of, you know, the risks.
MR. REDDINGTON: What were the risks?
JENNIFER TUFTS: Well, the risks of medicine, like we had said, sedation or dizziness.
MR. REDDINGTON: Okay. How about interfering with sleep?
JENNIFER TUFTS: Docusate doesn't usually interfere with sleep.
MR. REDDINGTON: Not usually? Did you ask her about any thoughts of suicide or being close to having thoughts of suicide?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Did she indicate to you that she had any thoughts of suicide at all?
JENNIFER TUFTS: Not at that date.
MR. REDDINGTON: Did she use those words, or is that a box that you checked off?
JENNIFER TUFTS: I don't remember her exact words. But we talked about suicide or, you know, thoughts of hurting yourself.
MR. REDDINGTON: Right. And there's a distinction between, in your records, in the notation, between suicidal ideation and I quote, "Worrying about thinking about suicide." Would you agree with that?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And what did she mean when she told you, as her doctor, that she was worrying about thinking about suicide?
JENNIFER TUFTS: You mean in the prior appointment?
MR. REDDINGTON: I'm talking about a woman that's sitting in front of you on your television or your computer telling you that she was worried about thinking about suicide.
JENNIFER TUFTS: Well, on the 2nd, she didn't say that.
MR. REDDINGTON: Okay. When was the next time that she told you that she was worried about or thinking about or suicidal ideation?
JENNIFER TUFTS: That was the December 1st visit.
MR. REDDINGTON: Okay. So go back to the November 2nd visit. Would you agree with me that she, after you talked with her for that period, however long it was, that you then brought up four medications to her, recommending that they might be safer, and I quote, "Safer alternatives"? Would you agree with that?
JENNIFER TUFTS: I see the word alternatives, not safer alternatives.
MR. REDDINGTON: Do you remember talking to her about Remeron?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Did you recommend that she take Remeron?
MR. REDDINGTON: Did you ever prescribe Remeron?
MR. REDDINGTON: And is that mirtazapine as far as its generic name?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And Remeron is an antidepressant, isn't that right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And you did not feel that that would be an appropriate medication for her to take at that time?
JENNIFER TUFTS: It was a very reasonable option, but we didn't decide to start it.
MR. REDDINGTON: So is this a collaboration? In other words, you and the patient, you would both make a decision as to when to start a drug, or is it your decision and advice to the patient?
JENNIFER TUFTS: Well, it's ultimately my decision, but the patient's thoughts about the matter are very important. At the end of the day, the patient has to go home and take it themselves. I'm not, I'm not there to ensure that that is happening or not.
MR. REDDINGTON: So you had a November 22nd appointment, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And it was at that time that she told you that she had been to see South Shore Perinatal Clinic, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And did she tell you why she was seeing someone from the South Shore Perinatal Clinic?
JENNIFER TUFTS: I think she told me that it was because they were exclusively focused on treating perinatal conditions.
MR. REDDINGTON: Yeah, but so are you, right?
JENNIFER TUFTS: Not exclusively. I'm a general psychiatrist.
MR. REDDINGTON: I see. And did she mention the name of any doctor or nurse practitioner that she was seeing at the South Shore Perinatal Clinic?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Who'd she mention?
JENNIFER TUFTS: I think she said something about Julie.
MR. REDDINGTON: Paul?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Okay. And a woman by the name of Nurse Jollotta?
JENNIFER TUFTS: I heard her name a little bit later.
MR. REDDINGTON: Okay.
JENNIFER TUFTS: But yes.
MR. REDDINGTON: Did she advise that, in fact, by script she was using Ativan and Benadryl, and you told her to taper off the Ativan at that appointment, right?
MR. REDDINGTON: Had she tapered off the Ativan?
JENNIFER TUFTS: I think I had told her to... I gave her a prescribed taper prior to that appointment.
MR. REDDINGTON: What does that mean? What does that mean, you gave her a prescribed taper?
JENNIFER TUFTS: So I told her that she should reduce her dose by .25 milligrams every two weeks until the medication was stopped.
MR. REDDINGTON: Did she do that?
JENNIFER TUFTS: I mean, I don't believe that she completely stopped it, no.
MR. REDDINGTON: No? You don't believe or she didn't?
JENNIFER TUFTS: Well, she—
MR. REDDINGTON: I'm trying to give the jury facts.
JENNIFER TUFTS: ... Yeah, she said she was taking Ativan, so no, she didn't completely stop it.
MR. REDDINGTON: Had she tapered?
JENNIFER TUFTS: I'm not sure how much she had reduced the dose 'cause I wasn't prescribing it again.
MR. REDDINGTON: Right. So did you know that she had been, or had she been, to any emergency wards between that period of time that you last saw her and when you were seeing her on this meeting?
JENNIFER TUFTS: I know she went to the ER, sorry, ER, but I think it was after that.
MR. REDDINGTON: Okay. Which ER did she go to, do you know?
JENNIFER TUFTS: I think she went to Mass General.
MR. REDDINGTON: Do you know why she went to the ER?
JENNIFER TUFTS: Because of depression.
MR. REDDINGTON: So was she treated at the ER? Did they make any, to your knowledge, as her doctor, make any recommendations?
JENNIFER TUFTS: I'm not sure what they told her, but they ultimately—
MR. REDDINGTON: Go ahead.
JENNIFER TUFTS: They ultimately discharged her. They didn't admit her.
MR. REDDINGTON: Go ahead.
JENNIFER TUFTS: Sorry.
MR. REDDINGTON: That's all right. Was she put on any medication?
JENNIFER TUFTS: Not from the ER.
MR. REDDINGTON: When you looked at the records from South Shore Perinatal Clinic, what did they indicate about suicidal ideation, worrying about suicide, close to suicide, anything?
JENNIFER TUFTS: I didn't have access to those records.
MR. REDDINGTON: You gotta keep your voice up so everybody can hear you. You what?
JENNIFER TUFTS: I did not have access to those records.
MR. REDDINGTON: Why not?
JENNIFER TUFTS: Because we're a completely separate clinic.
MR. REDDINGTON: Seriously?
MS. SPRAGUE: Objection.
MR. REDDINGTON: She's visiting with you as a patient, and you can't access her medical records, is what you're telling this jury?
JENNIFER TUFTS: I did not have access to them, no.
MR. REDDINGTON: Could she have signed a release, a HIPAA form?
JENNIFER TUFTS: Yes, she could have.
MR. REDDINGTON: And you could have got the records?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: But you didn't.
JENNIFER TUFTS: I did not feel like it was necessary because she provided all the relevant information about her treatment there.
MR. REDDINGTON: How do you know? She's got a mental disease, and she's seeing you, and she's on all this cocktail of drugs. How do you know that she is an accurate historian at this point in her life?
JENNIFER TUFTS: It felt very accurate when she was able to recall the names of the medicines, doses of the medicines, specific days. She provided a lot of incredibly detailed information, so it showed me she was capable of doing that.
MR. REDDINGTON: So when you talked to her husband, Pat... How many times did you talk to her husband, Pat?
JENNIFER TUFTS: I think it was—
MR. REDDINGTON: The guy who was living with her.
JENNIFER TUFTS: I think it was once.
MR. REDDINGTON: And he came to your office, right? No, he didn't. He got on the television or the computer screen, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And when was that?
JENNIFER TUFTS: I think it was the December 16th visit.
MR. REDDINGTON: So let's—
THE COURT: Mr. Reddington, why don't, before we get to that—
MR. REDDINGTON: Okay.
THE COURT: ... It's probably a good spot to stop. We're gonna take the morning recess, and then we'll come right back. Okay?
BAILIFF: All rise. Jurors please close your notebooks and place them on your chairs. This way please.
THE COURT: You all set for the jury?
MS. SPRAGUE: Yes.
BAILIFF: All rise, jurors entering.
BAILIFF: This court is now in session. Please be seated.
COURT CLERK: 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 the 18 jurors.
THE COURT: All right. Thank you. Mr. Reddington.
MR. REDDINGTON: One question. If you would just please look at the medical records that you have in front of you, I believe, and just go back to the October 20th entry where you have, I believe, an interview history.
JENNIFER TUFTS: I had a trouble hearing the date. Can you repeat that?
MR. REDDINGTON: Sure. October 20th. All right.
JENNIFER TUFTS: Okay.
MR. REDDINGTON: So looking at the interview history, that's when that you decided to start Zoloft, and it says a week ago, right?
JENNIFER TUFTS: That's when the patient started it, yes.
MR. REDDINGTON: Okay. And she then increased the dose, and it says last night, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And what was she telling you on the computer screen when you were talking to her? What did she say about increasing the dose of the Zoloft?
JENNIFER TUFTS: That she felt awful. She couldn't sleep. Had insomnia, which became worse when she increased her dose. She didn't want to eat. She was having diarrhea. Food felt really unappealing. She was more depressed on it, crying all day yesterday, which is not normal for her. She had some mental fog and was terrified to start something new.
MR. REDDINGTON: Did she also tell you about her anxiety level?
JENNIFER TUFTS: Anxiety was really bad even before med. Now hard to differentiate. Overnight racing thoughts. Paranoid of getting suicidal thoughts, something bad happening. Doesn't want to be alone.
MR. REDDINGTON: That must have given you concern that you had a pretty sick patient on your hands at that point, right?
JENNIFER TUFTS: I was concerned, yes.
MR. REDDINGTON: So you gave her some therapy, did you?
JENNIFER TUFTS: I gave her some therapy in conjunction with discussing all of her symptoms and assessing her and managing the medication.
MR. REDDINGTON: Okay. And again, I apologize. You have to keep your voice up so people can hear you way down here. So when you say that you were talking about the symptoms and—what did you do? Just talk about the same thing that we had just gone over, the symptoms?
JENNIFER TUFTS: Well, there were a number of them to discuss in more detail. That's the summary of them.
MR. REDDINGTON: Okay. So did she discuss it in detail?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Did she tell you that her symptomology at this point on October 20th was so bad that she had to have her mother come and stay with her?
JENNIFER TUFTS: Her mom was coming to provide support, yes.
MR. REDDINGTON: She wasn't coming to provide support. She was coming to stay with them, to live with them, wasn't she?
JENNIFER TUFTS: Yes. I don't know for how long, but yes.
MR. REDDINGTON: Did you bother to ask her why is her mother having to stay with them?
JENNIFER TUFTS: Because she needed some help.
MR. REDDINGTON: Do you know how long her mother stayed with her?
JENNIFER TUFTS: I don't.
MR. REDDINGTON: Do you know that she ended up sleeping in the basement?
JENNIFER TUFTS: I don't.
MR. REDDINGTON: Do you know that she ended up sleeping with her mother?
JENNIFER TUFTS: I don't.
MR. REDDINGTON: So you decided that you'd stop the Zoloft, and you would monitor closely, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: What does that mean, monitor closely?
JENNIFER TUFTS: I saw her the next day, so that's monitoring, an example—
MR. REDDINGTON: Okay.
JENNIFER TUFTS: ... of monitoring closely.
MR. REDDINGTON: So this would be on October 21st that you saw her the next day. Is that correct?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Now, on the 20th, you made reference to the fact... Oh, you also recommended that she try fish oil and things of that nature, natural remedies.
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Okay. You also wanted to look into what's called Zulresso, Z-U-L-R-E-S-S-O?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: What's Zulresso?
JENNIFER TUFTS: It is a treatment for postpartum depression.
MR. REDDINGTON: And when you say that you were looking into it, what did you do? Did you find out if it was available and if she could participate in the program?
JENNIFER TUFTS: I did some digging online to see where it is done and how to do it. I hadn't officially recommended it, so I had not started that for her. It's not really an easy medicine that I can just start because—
MR. REDDINGTON: Started what? I'm sorry.
JENNIFER TUFTS: Sorry. It's not a medication I can start on my own. It is—it's infused through an IV in a hospital, so it's a bit difficult to coordinate.
MR. REDDINGTON: It's a 60-hour infusion, right?
JENNIFER TUFTS: It's a long infusion. That sounds right.
MR. REDDINGTON: And it's about two and a half days of infusion, and it has to be under hospital circumstances. And the only hospital around here is in Rhode Island, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And did you ever recommend that she do that?
JENNIFER TUFTS: It was something to consider. I couldn't make the official recommendation—
MR. REDDINGTON: Why?
JENNIFER TUFTS: …because that's not something I prescribe.
MR. REDDINGTON: Why?
JENNIFER TUFTS: Because you can't pick that up at the pharmacy.
MR. REDDINGTON: Well, no, obviously you have to go to a hospital setting and basically have an infusion through your veins for 60 hours or two, 2.5 days. But why didn't you look into it or recommend that she do that?
JENNIFER TUFTS: Well, I did look into it.
MR. REDDINGTON: So what happened?
JENNIFER TUFTS: She ended up actually going to a partial hospitalization program at the hospital that does it. I don't believe the program was completed, but she went and I advised her to discuss it with them because they have access to that medicine. I don't have access to it.
MR. REDDINGTON: Of course not. Is this Women and Infants Hospital in Rhode Island that you're talking about?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: So when you looked at the medical records for the Women and Infants Hospital, did they make reference to your inquiry for Zulresso?
JENNIFER TUFTS: I never received records from Women and Infants.
MR. REDDINGTON: Did you ever look at them or even online?
JENNIFER TUFTS: Online?
MR. REDDINGTON: Yeah, like online, like you do when you talk to patients.
JENNIFER TUFTS: No, I never had access to them.
MR. REDDINGTON: Why?
JENNIFER TUFTS: Like, it's similar to South Shore. It's a completely separate hospital that I don't have access to. I don't work there.
MR. REDDINGTON: Well, of course you don't work there, but you're a doctor and you're treating a patient who's got medical records that you could access through a HIPAA release, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Why didn't you do that?
JENNIFER TUFTS: Well, she didn't ultimately end up having any treatment there, so it didn't seem necessary.
MR. REDDINGTON: She didn't end up having any treatment there, so it didn't seem necessary. You can't just walk into that place and say, "Hey, I'd like some Zulresso," can you?
JENNIFER TUFTS: I don't exactly know how it works.
MR. REDDINGTON: And then again, on that date, which would be October 20, and the jurors are looking at the records, you checked off the boxes again on objective findings, mental status exam, appearance, speech, things of that nature, correct?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Excuse me for one minute, Judge, jurors.
MR. REDDINGTON: So when she was telling you on that date that she was paranoid-—and quoting your records—"paranoid of getting suicidal thoughts and something bad happening, doesn't wanna be alone," what did she mean by that?
JENNIFER TUFTS: Well, those were a lot of her words.
MR. REDDINGTON: Right. Isn't that a concern? If your patient is telling you she doesn't wanna be alone, why didn't she wanna be alone?
JENNIFER TUFTS: Because she was very anxious and had the feeling like something bad might happen.
MR. REDDINGTON: Okay. Did her mother ultimately and dad come to stay with them?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: How long did they stay with them?
JENNIFER TUFTS: I don't know.
MR. REDDINGTON: When you talked to the mother and the father, did you say to them, "What is she doing? How does she appear? Is she in bed all day?" What did they tell you?
JENNIFER TUFTS: They never called my office, so I never spoke with them.
MR. REDDINGTON: They never called your office?
JENNIFER TUFTS: They never called me or sent a message, so I did not have communication with them.
MR. REDDINGTON: So it's their fault that they didn't call you, the doctor, I guess, right?
MS. SPRAGUE: Objection.
THE COURT: Sustained. Next question.
MR. REDDINGTON: Do you think maybe it would be reasonable if you're the doctor and you're investigating your patient's symptomology, that you might, when you know that the parents are staying with her, that you would make a phone call yourself?
JENNIFER TUFTS: It's not typical when you have an adult who is able to advocate for themselves to speak with their parents.
MR. REDDINGTON: So while she is telling you about her symptomology and tearfulness and crying and unable to get up and anxiety and the medications and the mental illness that she had, you felt that she could advocate for herself?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Okay. On the television, on the computer?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: The next time you saw her was on October 26, is that correct? And you can pull up your record.
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Now, and if you look again at the interval history where you put down what's going on in the patient's life that time, this is when she indicated that she's back to where she felt that she was before Zoloft, which was not great, and that you guys were considering a new medication. Is that right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And then you started her on Ativan, as we talked about, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And then you started her on the buspirone, right?
JENNIFER TUFTS: Well, she had already been started on the Ativan, and then we added the buspirone.
MR. REDDINGTON: So my question was, you started her on buspirone, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Okay. And also you added hydroxyzine as needed, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And you continued the Ativan, correct?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Did you discuss side effects with her at that point?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Did you also discuss the starting Remeron or pregabalin?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: What did you tell her about Remeron and pregabalin?
JENNIFER TUFTS: I don't think I went into any detail about those medicines, just that those might be things to consider in the future.
MR. REDDINGTON: And then you saw her on October 31st, right?
JENNIFER TUFTS: That was her... I think that was just a therapy appointment with a different provider.
MR. REDDINGTON: Would that be Jennifer McAllister?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: So she—it's a different provider in the sense that she works at, for ASDA, right?
JENNIFER TUFTS: Well, yes. It just wasn't myself.
MR. REDDINGTON: Right. So on October 31st, they did a suicide assessment. Or she did, right? McAllister?
JENNIFER TUFTS: I wasn't there.
MR. REDDINGTON: Well, I know you weren't there, but these are medical records that have been introduced into evidence that the jury's gonna have in the jury room.
MS. SPRAGUE: Objection, is that a question?
THE COURT: No, good. Next question.
MR. REDDINGTON: McAllister did a suicide assessment apparently, right?
JENNIFER TUFTS: I'm sure she assessed for suicide.
MR. REDDINGTON: No, no, no. Look at the record, please.
JENNIFER TUFTS: Mm-hmm. Where do you see it? Sorry.
MR. REDDINGTON: Where it says suicide assessment. There's only four pages for October 31st.
JENNIFER TUFTS: Yeah.
MR. REDDINGTON: Well, actually there's—there would be eight because it's two sides.
JENNIFER TUFTS: So that is the assessment that you go through if somebody reports any thoughts of suicide, then you ask those questions, which go into a lot more detail about them.
MR. REDDINGTON: So here you have a patient who's already reported to you as a psychiatrist that she's got suicidal ideation, worried about suicide, worried about killing herself, days before October 31st, and a suicide assessment was done by McAllister, right?
JENNIFER TUFTS: I wasn't there. You would have to ask her.
MR. REDDINGTON: Well, maybe I will—
JENNIFER TUFTS: Okay.
MR. REDDINGTON: ...if she comes in.
JENNIFER TUFTS: Okay.
MR. REDDINGTON: Why don't you tell me what the record shows?
MR. REDDINGTON: Did they do a suicide assessment? Did she check off the little boxes?
JENNIFER TUFTS: I'm looking for that section.
JENNIFER TUFTS: It says, "The patient denies suicidal or homicidal ideation at this time."
MR. REDDINGTON: Okay. So again, this is on October 31st, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: The patient, within a period of a couple of days in meetings with you, that McAllister has access to because the records are within your business, right?
JENNIFER TUFTS: It's not my business, but yes.
MR. REDDINGTON: Has reported suicidal ideation and fear and dwelling about killing herself and afraid of those thoughts, right?
JENNIFER TUFTS: She... I just wanna be absolutely clear.
JENNIFER TUFTS: So yes, you know, a-
MR. REDDINGTON: Yes, the answer, yes.
JENNIFER TUFTS: ...little while earlier she had voiced those concerns.
MR. REDDINGTON: Right. So as a result of voicing those concerns, is it your understanding that McAllister did not do any of the suicide assessment questions because Lindsay reported that she wasn't suicidal?
JENNIFER TUFTS: It appears that she asked about suicide ideation.
MR. REDDINGTON: Right. You already told us that. I'm asking you about... Excuse me. She said—
MS. SPRAGUE: Objection.
THE COURT: Hold on. Answer the next question. Go ahead.
MR. REDDINGTON: Thank you. I'm not asking you. You've told us three times now that she said she was not suicidal when she spoke to McAllister. I'm asking you about the suicide assessment for the third time. You see it in front of you?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Okay. Can you tell me, did Lindsay answer any of the questions that were asked over the two pages, possibly three, of the suicide assessment, yeah, three, done by McAllister?
JENNIFER TUFTS: I don't see anything written here.
MR. REDDINGTON: So was there a suicide assessment?
JENNIFER TUFTS: I don't know, because I wasn't there. I don't know what the conversation was.
MR. REDDINGTON: And you don't know from looking at the records, right?
JENNIFER TUFTS: From looking at the records, I don't see evidence of additional suicidal questions beyond asking if it was there or not.
MR. REDDINGTON: So a suicidal assessment, Doctor, is in the medical records. It consumes almost four pages, does it not? Yes?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Okay. And all of the questions, like asking, "Have you felt life is not worth living? Is death something you've thought about recently? Are you dwelling on that? What leads up to the thoughts? What are the thoughts?" All those questions, right? For four pages, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And there is not one notation indicating that that test was ever administered to her on October 31st, correct?
JENNIFER TUFTS: Correct. But it was, it looked like it was asked in other ways.
MR. REDDINGTON: Yeah, okay. November 2nd. It was asked in other ways? Is that what the little checkbox where it says, "Denies suicidal ideation"?
JENNIFER TUFTS: Can I read something that she wrote down?
MR. REDDINGTON: You have indicated repeatedly that she denied suicidal ideation, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Okay. The suicidal assessment was not administered according to the record that's in front of you by McAllister. Yes?
JENNIFER TUFTS: The additional suicidal assessment, yes.
MR. REDDINGTON: November 2nd. By the way, as a psychiatrist, not a psychologist, you have the ability to prescribe medication obviously, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And I think we talked about the DEA number and all of that, correct, which you had for about a month, other than when you were a resident, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: So you're prescribing these SSRIs and antipsychotics and antitropics or whatever they are, and it's important as to the metabolism of your patient with those drugs, isn't it?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Okay. You can voice it. What does metabolism mean?
JENNIFER TUFTS: The body breaking down the medication.
MR. REDDINGTON: So how is it that you can determine how the body of your patient is breaking down the medication that is in their brain, and they're complaining about all of these symptoms? How, as a doctor, do you determine how the body's breaking it down?
JENNIFER TUFTS: We don't typically have any specific testing that we do to understand that.
MR. REDDINGTON: How about a blood test?
JENNIFER TUFTS: It's not done for that.
MR. REDDINGTON: It's not done for that. Meaning a blood test is not done to determine the metabolism of your patient of your medications?
JENNIFER TUFTS: Are you referring to genetic testing?
MR. REDDINGTON: No, I'm asking about the metabolism. I'm not talking about genetics. I'm talking about the metabolism of the SSRIs in her body.
JENNIFER TUFTS: Okay.
MR. REDDINGTON: You can tell that metabolism rate through blood testing, right?
JENNIFER TUFTS: Not in the way that you're describing.
MR. REDDINGTON: Okay. What way would it be?
JENNIFER TUFTS: There is genetic testing that can give information about metabolism.
MR. REDDINGTON: Like what?
JENNIFER TUFTS: It can talk about different enzymes that a person might have to suggest... It provides information about the enzymes that a person might have the genes for.
MR. REDDINGTON: Okay. So it provides the enzymes that a person might have the genes for. Forgive me, I'm having difficulty with that. What does that mean?
JENNIFER TUFTS: It's a little complicated.
MR. REDDINGTON: Yeah. You wouldn't expect a patient that's going through what she was going through to understand that, would you?
MR. REDDINGTON: Did you guys do the enzyme test?
JENNIFER TUFTS: They are not typically done.
MR. REDDINGTON: Why?
JENNIFER TUFTS: Because, again, it's genetics and—
MR. REDDINGTON: Does insurance cover it?
MS. SPRAGUE: Objection. She's in the middle of answering.
THE COURT: Okay. Finish the answer, then I'll follow up. Go ahead, doc.
JENNIFER TUFTS: So it's not as simple as testing for an enzyme or not. You can test someone's genome. Like, we have the ability to test the entire human genome now. But it's... It, which is great, but it... The clinical, you know, use of that is not there yet. So while we can test these things, it does not yield meaningful clinical information, so it is not commonly done.
MR. REDDINGTON: Sorry. What is the CytoPro P4-50 system?
JENNIFER TUFTS: That's one of the enzymes I'm talking about.
MR. REDDINGTON: So the CytoPro P, P450 system talks about and tests for the breakdown of psychiatric meds in the blood, right?
JENNIFER TUFTS: It's not in the way that you're describing. It doesn't tell you the medicine—
MR. REDDINGTON: All I'm describing is that it's a test—
MS. SPRAGUE: Objection.
THE COURT: One at a time. Finish the answer, then you can ask follow-up.
JENNIFER TUFTS: Okay.
THE COURT: Go ahead, doc.
JENNIFER TUFTS: It just... Yes, this is a test that is done, but it doesn't tell you what medications a patient will do better on. It's not useful in that way.
MR. REDDINGTON: So what's it useful for?
JENNIFER TUFTS: I mean, I don't find it terribly useful.
MR. REDDINGTON: How long has the CytoPro P450 system been in use in your field?
JENNIFER TUFTS: I'm sorry?
MR. REDDINGTON: How long has the CytoPro P450 system been in use in your field, psychiatry?
JENNIFER TUFTS: Well, it's an enzyme in the body.
MR. REDDINGTON: Well, I know what it is. I'm asking you about the system, the testing. How long have they been using that?
JENNIFER TUFTS: The genetic testing?
MR. REDDINGTON: Yes, whatever it is.
JENNIFER TUFTS: ...maybe a few years. It's very new.
MR. REDDINGTON: Very new. Does insurance cover it?
JENNIFER TUFTS: Sometimes.
MR. REDDINGTON: Sometimes. So it is nevertheless a legitimate test to determine the breakdown of psychiatric meds in a patient's blood, correct?
JENNIFER TUFTS: It exists, yes.
MR. REDDINGTON: It exists. Well, it exists, but you didn't use it, right?
JENNIFER TUFTS: It would not have made a difference.
MR. REDDINGTON: In what—in your opinion?
JENNIFER TUFTS: In her treatment.
MR. REDDINGTON: Because you go by the checks in the checkbox and what she self-reports, right?
JENNIFER TUFTS: No. Not, not just the checks in the checkbox.
MR. REDDINGTON: Oh. In any event, tell me about the thyroid.
JENNIFER TUFTS: The thyroid?
MR. REDDINGTON: Tell me about the thyroid.
JENNIFER TUFTS: It's an organ in the human body that regulates hormones.
MR. REDDINGTON: And what, if any, import and impact do thyroid levels have on your evaluation of a woman who is in the throes of postpartum depression?
JENNIFER TUFTS: They don't.
MR. REDDINGTON: What is the purpose of a test to determine the thyroid levels?
JENNIFER TUFTS: Well, you can test something like the TSH.
MR. REDDINGTON: Well, I don't know what a TSH is. I'm sorry. What is a TSH?
JENNIFER TUFTS: A thyroid-stimulating hormone.
MR. REDDINGTON: Okay. Thank you.
JENNIFER TUFTS: That's something that can be tested, typically by maybe a PCP, primary care, or endocrinologist if they have concerns about someone's thyroid function.
MR. REDDINGTON: Were you aware of a study that was a major study that was peer-reviewed? What does peer-reviewed mean in your business?
JENNIFER TUFTS: That it was reviewed by other researchers in a similar field.
MR. REDDINGTON: And the report or the article or whatever it may be has to be approved by the peers that are reviewing it before it can be published, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And you'd agree with me that in the medical field it's a big deal to have publishing articles on your resume, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And how many articles have you published about postpartum depression, postpartum psychosis, anything?
JENNIFER TUFTS: I have published something, but it's not a full article. It's just a small thing.
MR. REDDINGTON: Okay. Are you aware of the psychiatry magazine article dealing with, in 2021, Thyroid Function in Postpartum Psychosis: An Exploratory Study? Have you ever heard of anything about that, let alone read an article about it?
MR. REDDINGTON: Are you aware that there are studies that have compared thyroid function between psychosis with postpartum onset, PPO, psychosis without postpartum onset, PWPO, and normal postpartum? You aware of that?
MR. REDDINGTON: Well, you're supposed to be an expert. Or you specialize or you have an interest in treating women that have suffered from postpartum, correct?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Have you written any articles at all about postpartum depression, anxiety, psychosis?
JENNIFER TUFTS: No. I'm not a researcher. I'm a clinician.
MR. REDDINGTON: Have you read any of the articles such as Thyroid Function in Postpartum Psychosis?
JENNIFER TUFTS: I've read many articles. There are thousands. I have not read that specific article.
MR. REDDINGTON: Thousands? Thousands of articles on postpartum psychosis and the thyroid?
JENNIFER TUFTS: No, not on that specific topic.
MR. REDDINGTON: Nothing. So when the Aster doctors are treating a person like Lindsay, it's your testimony to this jury that testing, whether it's blood testing or whether it's the CytoPro P4 testing, is not necessary because Jennifer Tufts doesn't think it's necessary, right?
JENNIFER TUFTS: It does not yield information that would influence treatment.
MR. REDDINGTON: Really? So if there was elevation in the thyroid, that wouldn't impact on your treatment at all, your evaluation, your investigation?
JENNIFER TUFTS: Sorry, I thought you had mentioned the cytochrome issue. Are we talking about that one or are we talking about the thyroid?
MR. REDDINGTON: We're talking about the thyroid.
JENNIFER TUFTS: Okay.
MR. REDDINGTON: Yeah. So if there were—
JENNIFER TUFTS: Can you repeat—
MR. REDDINGTON: ...tests that revealed elevation in the thyroid level, is it your testimony that you wouldn't care?
JENNIFER TUFTS: If I somehow found out that a patient had elevated thyroid levels, I would advise them to talk to their primary care or maybe get an endocrinologist to discuss it.
MR. REDDINGTON: Did you ever recommend that Lindsay get an endocrinologist?
JENNIFER TUFTS: No. She did not—
MR. REDDINGTON: And the reason that... The answer's no. And you basically did not have any information that you could use to even realize that there might have been a thyroid issue with this woman that was postpartum, right? 'Cause you didn't do any blood tests.
JENNIFER TUFTS: There was no clinical reason to obtain a blood test.
MR. REDDINGTON: All right. So you continue on with your meetings by the computer, correct?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: November 2nd. You can get November 2nd out.
MR. REDDINGTON: You got it?
JENNIFER TUFTS: November 22nd?
MR. REDDINGTON: No, it looks like November 2nd. I apologize. That's the one I'm looking at. Tufts, Jennifer, MD, Clancy, Lindsay, follow-up note, November 2nd.
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Okay. And you're still diagnosing her with generalized anxiety disorder, GAD, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: You add in there an adjustment disorder with depressed mood, I guess because of what she had been telling you, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Okay. Looking at the psychiatric condition, you note that it's improving.
MR. REDDINGTON: Right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And then you determine that you'll decrease the Ativan to 0.75 milligrams per, for two weeks— and then decrease it to 0.5 milligrams for two weeks, and consider alternatives for sleep anxiety. Is that correct?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And then you note, if she's having urges to harm herself or others, to go to the nearest emergency room and call 911, and things of that nature. Correct?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: So is that a form that you basically press a button and it re— 'Cause it seems to be kinda like a generic advice. Call 911 if you're feeling suicidal, and things of that nature.
JENNIFER TUFTS: Well, that's advice that we provide for every single patient.
MR. REDDINGTON: Okay. And then you note that half the encounter was on counseling or coordination of care on November 2nd, right?
JENNIFER TUFTS: Yes, that's a typical statement. It's just a part of documentation that doctors use.
MR. REDDINGTON: All right. Now on November 2nd, you were suggesting the four drugs that she would start would be Remeron, Trazodone, Pregabalin, and Hydroxyzine, right?
JENNIFER TUFTS: Those were just things we were considering.
JENNIFER TUFTS: I wasn't starting all of those medicines.
MR. REDDINGTON: I see. On November 22nd, now that would be almost three weeks later, right? You saw her, right?
MR. REDDINGTON: And did you ask her about whether or not she was still having suicidal thoughts or worrying about suicidal thoughts, for example? Did you ask her that?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And how do you know that? Because the box is checked?
JENNIFER TUFTS: It's written in my note.
MR. REDDINGTON: What does it say?
JENNIFER TUFTS: Patient denies SI.
MR. REDDINGTON: Okay. What did you ask her about that?
JENNIFER TUFTS: I don't remember the exact words, but I know that I asked about that.
MR. REDDINGTON: Did you ask her about how things were going at home with her father and father staying there?
JENNIFER TUFTS: That I don't, I don't remember. I didn't document how her parents were doing.
MR. REDDINGTON: Okay. Well, I don't really care about how her parents were doing. I'm asking about whether or not you asked her how it was working out while her parents were there helping out. If you did, fine. If you didn't, that's fine too.
JENNIFER TUFTS: I don't think that I did. In this appointment she—
MR. REDDINGTON: Okay. That's all. That's fine. December 1st was the next appointment, correct?
MR. REDDINGTON: And you can look at the interval history.
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Now on that December 1st appointment, this is after she had transferred to South Shore?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: She disclosed to you that she had been seeing South Shore, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: We already talked about the fact that you never got the records from South Shore, so you don't know, other than what Lindsay reported to you, what medications she was on, right?
JENNIFER TUFTS: I... Right. I knew what she was telling me.
MR. REDDINGTON: Right. And she told you that she was doing the Ativan taper, right?
JENNIFER TUFTS: Well, she said she had tried doing that, but that then she was having more sleep.
MR. REDDINGTON: Having difficulty sleeping is what she indicated to you, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And she tried other meds that you had suggested, but stated that she was having difficulty with those meds, including Trazodone, right?
JENNIFER TUFTS: Well, the Trazodone she didn't have a problem with. It just didn't seem like it was particularly helpful.
MR. REDDINGTON: Okay. Did you prescribe the Trazodone or somebody else?
JENNIFER TUFTS: This was somebody else.
MR. REDDINGTON: So do you know what the milligrams were that she was on?
JENNIFER TUFTS: It says she tried between 50 and 150 milligrams.
MR. REDDINGTON: All right. Now, did she at some point try Remeron?
JENNIFER TUFTS: She said that she did.
MR. REDDINGTON: Did you suggest in your discussions that she try Remeron?
JENNIFER TUFTS: No, I did not.
MR. REDDINGTON: Did she indicate to you that she had rebound anxiety and intrusive thoughts that she was gonna die? Do you recall that?
JENNIFER TUFTS: Well, she said worse depression and intrusive thoughts.
MR. REDDINGTON: Okay. Did she tell you what the intrusive thoughts were?
JENNIFER TUFTS: It was the feeling like I'm going to die.
MR. REDDINGTON: Did she then have a script for Prozac, 10 milligrams?
JENNIFER TUFTS: That's what she said.
MR. REDDINGTON: And she said that she couldn't sleep and had worse sleep, so that had to be stopped, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Then she tried—she was on Klonopin, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And what is Klonopin?
JENNIFER TUFTS: It's a benzodiazepine.
MR. REDDINGTON: And on December 1st is when she told you again that she was close to having suicidal ideation, feeling hopeless. Do you recall that?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Now, on the interval history on that date, you had indicated that she can't sleep, she's panicking, she had worse depression, intrusive thoughts, she was numb, nothing mattered, I feel like I'm gonna die.
MR. REDDINGTON: Denies suicidal ideation, but quote, "Yesterday, close to it. Feeling hopeless." Did you give her therapy and validations after she told you that?
JENNIFER TUFTS: I believe that I did.
MR. REDDINGTON: What did you do? You got a woman that's telling you that she's hopeless. She doesn't care if she dies. Can't sleep. What did you do to validate on your therapy?
JENNIFER TUFTS: Well, I told her that this was something that we could address. That there was hope. That there were treatments, and there are, you know, different types of treatment programs that are more supportive, like partial hospitalization programs. So she knew that she still had options and a reason to hope.
MR. REDDINGTON: Did you ever suggest to her that maybe you ought to come in to see me rather than talk on the computer?
JENNIFER TUFTS: Discussing—talking with her over the video did not seem like an issue. It didn't seem like there was anything that I was missing or that there was any need to see her in person.
MR. REDDINGTON: Now you'd agree with me that in December of 2022, COVID was all done, right?
JENNIFER TUFTS: It wasn't completely all done.
MR. REDDINGTON: Were you still nervous about dealing with people and wearing masks and stuff, or were you able to sit down and talk to somebody face to face?
JENNIFER TUFTS: We were definitely feeling more comfortable about being face to face with people. But I think, you know, it was still something that we thought about.
MR. REDDINGTON: You discussed trying Seroquel with her at that point, right?
JENNIFER TUFTS: I didn't really discuss it. Well, she had told me that that was something that she had discussed with her other provider.
MR. REDDINGTON: So looking at your notes, does it say, "Also discussed
MR. REDDINGTON: trying Seroquel alone tonight"? Do your notes say that?
JENNIFER TUFTS: It says, yes. Um—
MR. REDDINGTON: What did it say?
JENNIFER TUFTS: ... But I wasn't, I wasn't making a recommendation about the Seroquel. It was just a medicine I was providing her more information on.
MR. REDDINGTON: So you were telling her about the Seroquel? You were providing information?
JENNIFER TUFTS: Yes, we were talking about the Seroquel.
MR. REDDINGTON: Right. Why?
JENNIFER TUFTS: Because her other provider had recommended that she started it.
MR. REDDINGTON: What is Seroquel?
JENNIFER TUFTS: It's an antipsychotic.
MR. REDDINGTON: You also discussed with her the possibility of undiagnosed bipolar disorder, did you not?
JENNIFER TUFTS: It was discussed.
MR. REDDINGTON: An undiagnosed bipolar disorder was, in your opinion, as a result of, not a reaction, but extreme reaction to the SSRIs, right?
JENNIFER TUFTS: Not, so not as a result of the SSRIs, but that react-
MR. REDDINGTON: Does your—excuse me. Does your notes say, and I quote, "Also discussed possibility of undiagnosed bipolar disorder given extreme reaction to SSRIs and insomnia," period. Does it say that?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Those are your notes, right?
JENNIFER TUFTS: Yes. The way you were saying it made it sound a little bit different before, but that's exactly what I wrote.
MR. REDDINGTON: I read it directly from your note, right?
JENNIFER TUFTS: That's fine.
MR. REDDINGTON: I didn't make it sound different.
JENNIFER TUFTS: I don't know. It sounded different the first time you said it than the second.
MR. REDDINGTON: So did she have bipolar?
MR. REDDINGTON: Did you make that decision that night, that day?
JENNIFER TUFTS: I assessed that with her pretty much every time that I saw her. And she never had mania.
MR. REDDINGTON: What about mood stabilizer like Lamictal? Did you discuss that with her?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: What is Lamictal?
JENNIFER TUFTS: It's an anticonvulsant. But it's used in treating mood disorders.
MR. REDDINGTON: So what was the end result of your meeting with her on December 1st? What did you guys do? Did you give any recommendations, advice, anything?
JENNIFER TUFTS: Yeah. Well, so at this time I was not prescribing her medications. But I was still concerned. Not, not concerned enough that she was at imminent risk of hurting herself or anybody else, given what she said. But we had a plan for her to pursue a partial hospitalization program.
MR. REDDINGTON: And where was that?
JENNIFER TUFTS: Well, the one that I had recommended was HRI.
MR. REDDINGTON: What is HRI?
JENNIFER TUFTS: It's a hospital in Brookline.
MR. REDDINGTON: And did she ultimately go to another hospital?
JENNIFER TUFTS: She ultimately went to the Women and Infants Hospital for one day.
MR. REDDINGTON: And those are the records that you did get, right?
JENNIFER TUFTS: Correct.
MR. REDDINGTON: Okay. And you decided that she did not have bipolar disorder because in your opinion, she did not meet, and I quote, "the criteria," right? That would be the criteria in the DSM, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And the DSM, of course, is the Diagnostic Statistical Manual, Roman numeral five, fifth edition, text revision, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Is that what you were using back then? Would be this thing here, DSM-V-TR. That's the DSM, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: It's like a cookbook, right?
JENNIFER TUFTS: It's more of a guideline that we use to, you know, to help us in our treatment. But it's not, it's not the psychiatry bible that people sometimes think that it is.
MR. REDDINGTON: Right. Hypomanic bipolar disorder, how many days does that require under the DSM?
JENNIFER TUFTS: A hypomanic episode lasts for at least four days.
MR. REDDINGTON: And is that per the DSM?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: You remember on Friday you said that the most important criteria is seven days with continued high energy levels?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: So is it seven days or is it four days, and who says?
JENNIFER TUFTS: Well, mania is seven days. Hypomania is four.
MR. REDDINGTON: Discussed again another episode occurred on December 1st, and that's the lamotrigine, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And do you note in your records that she indicated that she was really struggling, and it was as a result of that that you recommended that hospital referral, correct?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Do you agree that she had, in your opinion, a severe mental disturbance at that point that was manifesting itself?
JENNIFER TUFTS: She had a maybe moderate, moderate heading towards severe.
MR. REDDINGTON: Moderate heading towards severe mental issue. Okay. You agree with me that she had increased anxiety, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: She had very, very increased depression, right?
JENNIFER TUFTS: Well, she did. She said—
MR. REDDINGTON: Okay. So as you answer this—
JENNIFER TUFTS: Since we were gone—
MR. REDDINGTON: ... Can you just answer yes or no?
JENNIFER TUFTS: I'm sorry. I was just trying to check the record.
MR. REDDINGTON: Okay. You can check the record all you want, but if I ask you a question respectfully, can you just not go on and ramble? Answer yes or no, that's all.
JENNIFER TUFTS: It's sometimes impossible to do that. There's—
THE COURT: If you can't answer yes or no, just say you can't answer yes or no. If you can answer yes or no, answer yes or no. Those are the... That's how we do it, all right?
JENNIFER TUFTS: Okay.
MR. REDDINGTON: Thank you. Now, mental issues like anxiety that was diagnosed, the depression that was diagnosed, and the fact that she indicated yet again that she was close to suicidal ideation, quote, "Worried about suicidal thoughts." But you indicated that she wasn't suffering from suicidal ideation on that date. Is that fair?
JENNIFER TUFTS: She denied it.
MR. REDDINGTON: But she told you that she was worried about suicidal ideation and having suicidal thoughts, right?
JENNIFER TUFTS: Well, this—yes, this was the time she said she was worried that she was close to having suicidal thoughts.
MR. REDDINGTON: So did you ask her what does that mean? Does that mean that she's standing at the edge of the stairs and she's thinking about falling down the stairs or what? What does that mean, close to suicidal ideation?
JENNIFER TUFTS: So I asked about that, and that's when she said, she described it further as using the word hopeless.
MR. REDDINGTON: So did you prescribe the lamotrigine on that occasion or no?
MR. REDDINGTON: On December 16th, that's the next appointment she had, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: That'd be two weeks later. Right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: She was still not well, correct? She told you she was having a really rough time.
JENNIFER TUFTS: She was sleeping, but she was still feeling very poorly.
MR. REDDINGTON: In your notes, does it say that she was having a really rough time?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: So when I ask you, if your notes reflect that, that she said she was having a really rough time, why do you feel compelled to say she was sleeping?
MS. SPRAGUE: Objection.
THE COURT: Overruled.
JENNIFER TUFTS: It's an important detail.
MR. REDDINGTON: Yeah. I guess. How about the rough time? What did that mean? What were the symptoms of having a really rough time for this kid?
JENNIFER TUFTS: Do you want me to—
MR. REDDINGTON: Yeah, I'd like you to answer that.
JENNIFER TUFTS: So finally works, referring to the Valium and quetiapine, but very depressed during the day. No motivation, some SI. Do you want me to continue?
MR. REDDINGTON: Sure.
JENNIFER TUFTS: Went to MGH emergency room for SI. Declined inpatient, feeling hopeless, no intent or plan, and feels like depression related to Seroquel.
MR. REDDINGTON: Okay. Now that's the question on Friday that... Well, strike that. So what was the SI, suicidal ideation?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And can you read that back to me again? What did she say about SI?
JENNIFER TUFTS: So that when she went to the hospital, she went because she had no motivation, some SI.
MR. REDDINGTON: Some SI, meaning that she had some suicidal ideation, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Yes?
JENNIFER TUFTS: In her words, yes.
MR. REDDINGTON: Yeah, in her words. As opposed to thinking about having suicidal ideation or worrying about suicidal ideation, she actually indicated that she had suicidal ideation, right?
JENNIFER TUFTS: I can't answer that as a yes or no.
MR. REDDINGTON: Well, it's in your notes that she said that, right? Yes?
JENNIFER TUFTS: What is in my note?
MR. REDDINGTON: Do you understand my questions?
JENNIFER TUFTS: I'm a little bit confused right now. Can you repeat what your question is?
MR. REDDINGTON: Oh, sure. Of course. We spent some time talking about thinking about suicidal ideation, worrying about suicidal ideation. Now, saying she had suicidal ideation, right?
JENNIFER TUFTS: She said it, yes.
MR. REDDINGTON: Yeah. Well, this is the only source of information that you're getting, apparently, is what she's telling you, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: So what suicidal ideation did she have? Was she thinking of cutting her throat? Was she thinking of throwing herself off a building or running out in front of a car, what?
MR. REDDINGTON: What was she thinking of?
JENNIFER TUFTS: So I asked her those important follow-up questions, and that's—
MR. REDDINGTON: Like what?
JENNIFER TUFTS: "So what do you mean when you say, 'I'm feeling suicidal?'"
MR. REDDINGTON: Okay.
JENNIFER TUFTS: And that's when she said, "It means I'm feeling hopeless." And—then I asked you, you know, "Do you, you know, have intention of hurting yourself? Do you have a plan for hurting yourself?" And she denied those.
MR. REDDINGTON: And that's where you left it?
JENNIFER TUFTS: I mean, I'm sure more was said, but that's the most important part of that clinical encounter.
MR. REDDINGTON: And did you give her therapy by the computer on that date, too?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: What did you do for therapy about her suicidal ideation and saying she wanted to kill herself?
JENNIFER TUFTS: Well, you know, we explored what that meant. And, you know, what to do if you're feeling that way.
MR. REDDINGTON: To do what? Call 911?
JENNIFER TUFTS: To go to the emergency room.
MR. REDDINGTON: Did you discuss prescribing Seroquel to her, or was she getting Seroquel? Did Seroquel enter into your discussion at all?
JENNIFER TUFTS: We talked about it. I was not prescribing it for her.
MR. REDDINGTON: What is Seroquel?
JENNIFER TUFTS: That's an antipsychotic.
MR. REDDINGTON: So at the conclusion of your meeting on December 16th, basically what you took away is that she had now increased the suicidal ideation, was feeling hopeless, all the rest of the things that we've talked about, and then she what? Just moved on, went home?
JENNIFER TUFTS: Well, she was assessed in the emergency room, and was not admitted, and I assessed her on that day again. And while she was certainly struggling, she did not require hospitalization at that moment. So she was planning on going to the Women and Infants Program, and I supported that.
MR. REDDINGTON: Did you know that around that time she confessed to her husband that she was having now thoughts of harming the children?
MR. REDDINGTON: Would that have been something you were concerned about?
JENNIFER TUFTS: If I heard that, I would've been very concerned.
MR. REDDINGTON: You would've called DCF, right?
JENNIFER TUFTS: I might have.
MR. REDDINGTON: And did... When you spoke to Pat, did you ever ask him what his observations were of her spiraling into November and December? Not that one time that he stuck his face on the computer and talked to you. Did you ever talk to him?
JENNIFER TUFTS: He never called me again, or he never called at all. I never spoke with him again.
MR. REDDINGTON: So he is a husband of a woman, just had a baby. She was postpartum with all of these symptoms that we talked about, all of the drugs that you were prescribing her, that she was dealing with trying to get help. You never talked to her husband about what he observed because he didn't call you?
JENNIFER TUFTS: Well, we did speak on that visit.
MR. REDDINGTON: Which visit?
JENNIFER TUFTS: The 16th, or I think that that's the one that he was at.
MR. REDDINGTON: You think it was. It's not noted in your records?
JENNIFER TUFTS: It's not noted, but I remember some of what we talked about, and so in reading that record, it seems like that's the likely one that he was at.
MR. REDDINGTON: December 16th, on your objective findings, you note that her mood was depressed, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And what does that mean? Did she just say, “I'm depressed,” or did she give you symptoms?
MR. REDDINGTON: I mean, you checked the little box.
JENNIFER TUFTS: Yeah. Yeah, it means she's saying that she's depressed.
MR. REDDINGTON: Okay, so you're the doctor. You checked the little box. What did your patient tell you about her symptoms that she was depressed on that day?
MR. REDDINGTON: Was she crying? Was she able to get out of bed? Was she worshiping at the porcelain god? What was going on in her life?
JENNIFER TUFTS: She was—she said she was having a really tough time.
MR. REDDINGTON: Her affect was flat, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And again, depressed, you check it off twice, one under mood and one under affect, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And then next page it says recent lab work. That wouldn't be blood testing, would it? I mean, Aster, does Aster do blood testing?
JENNIFER TUFTS: We don't have a phlebotomist or a lab, no.
MR. REDDINGTON: Well, why does it say recent lab work typed into your form where you check off the little boxes?
JENNIFER TUFTS: That's something that auto-populates. It's a template that—
MR. REDDINGTON: It's a what?
JENNIFER TUFTS: …you know, many different… It's a template.
MR. REDDINGTON: Template.
JENNIFER TUFTS: The whole note is something that psychiatrists or at, you know, probably all across the country use.
MR. REDDINGTON: Probably. You can't diagnose someone's illness by a template though, can you?
MR. REDDINGTON: You filled in no lab results were found, right?
JENNIFER TUFTS: There were none in the computer, yes. I didn't type that in though. It just—it auto-populated.
MR. REDDINGTON: So who typed it in?
JENNIFER TUFTS: It was auto-populated.
MR. REDDINGTON: So on the next page where it talks about symptom goals, treatment goals, I'm sorry, symptom reduction and improved functioning, what does that mean?
JENNIFER TUFTS: Symptom reduction is to have fewer mental health symptoms, and improved functioning means, you know, improved, you know, day-to-day life functioning. You know, things that she's doing in her daily life.
MR. REDDINGTON: Really? Did you tell her all that?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: You got a young woman that's obviously mentally ill, very sick. She's deteriorating, whether you like that word or it's automatically imported. What, on that date, did you do? Never mind all those words you just said. What did you tell her on the television or the computer?
JENNIFER TUFTS: I told her to go to the partial hospitalization program, and if she was having more suicidal thoughts again or felt like she was at risk of hurting herself or anybody else, that she should go immediately to the emergency room.
MR. REDDINGTON: How long did that meeting take?
JENNIFER TUFTS: Probably about 30 minutes.
MR. REDDINGTON: And was there any... Was that the therapy that you provided, in telling her to go to the emergency room?
JENNIFER TUFTS: I mean, that was probably a component.
MR. REDDINGTON: So the plan, excuse me, on December 16th was to follow up with Women and Infants, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Did she?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Do you know when?
JENNIFER TUFTS: I don't know exactly the day.
MR. REDDINGTON: Okay.
JENNIFER TUFTS: Shortly after.
MR. REDDINGTON: Then you were considering a Rexanoline or Rexanolone infusion, right?
JENNIFER TUFTS: That's the Zulresso.
MR. REDDINGTON: That's the same thing in Rhode Island?
JENNIFER TUFTS: Yeah.
MR. REDDINGTON: Okay. And that didn't go anywhere, right? That was... That's the end of that.
MR. REDDINGTON: It says start Lamictal 25 milligrams daily, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Continue Seroquel, right? What was the milligram for the Seroquel up to at this point?
JENNIFER TUFTS: Well, she had told me it was 200.
MR. REDDINGTON: Well, was it?
JENNIFER TUFTS: That was, that... I did not write that prescription, so it—that's what her provider had prescribed her.
MR. REDDINGTON: Okay. So you can ask somebody to show me the bottle, pill bottle. You can ask somebody to show me the CVS receipt. You can ask somebody, or you can call to verify, right?
JENNIFER TUFTS: I could.
MR. REDDINGTON: Yeah. But you... Anyway, she said that she was on Seroquel 200 milligrams, right, and had stopped with the Valium, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And then you go on with that form thing saying, “If you have urges to harm yourself or others, you gotta call 911,” crisis hotlines and everything else, right? That's the next two paragraphs that are in that report, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Was her mother and father still staying with her on December 16th, if you know, with Pat and the kids?
JENNIFER TUFTS: I'm not sure.
MR. REDDINGTON: Did you ever ask anybody other than her how she was doing?
JENNIFER TUFTS: I asked her husband when he was at the appointment.
MR. REDDINGTON: Yeah, that's the other appointment, though. How about now? We're talking December 16th into the month of December. Did you ever ask anyone how she was doing?
JENNIFER TUFTS: Well, I think he was at that visit.
MR. REDDINGTON: You think he was at the visit. How did he tell... What did he say to you about how she was doing?
JENNIFER TUFTS: He said she wasn't doing well.
MR. REDDINGTON: Look, she's got an objection. Go ahead.
MS. SPRAGUE: Objection.
THE COURT: Overruled.
MR. REDDINGTON: Go ahead.
JENNIFER TUFTS: He said she wasn't doing well.
MR. REDDINGTON: Anything else?
JENNIFER TUFTS: Yeah. He felt that it might have been—his opinion was that it was related to when she started the Seroquel.
MR. REDDINGTON: And he basically said you guys are turning her into a zombie, right?
MS. SPRAGUE: Objection.
MR. REDDINGTON: Are those his words?
THE COURT: Overruled.
JENNIFER TUFTS: I don't have that written. He may have said that.
MR. REDDINGTON: Does that kind of hit you, though, that you might remember that? You might have been... As some people worry about suicide, you might be thinking in your brain that he did say you're turning her into a zombie. It's possible.
JENNIFER TUFTS: It's very possible.
MR. REDDINGTON: Okay. Excuse me. Next meeting after the December 16th, was it?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: December 16th.
MR. REDDINGTON: Is that what we were just on then?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Okay. The next meeting was January 6th.
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Okay. And how does this happen? Does the patient call? I know you don't set up these appointments. Somebody has to deal with somebody in the administration or whatever. But do you like on December 16th say to Lindsay, "Call me or set up an appointment for January 6th," or do they have to do it themselves?
JENNIFER TUFTS: So at the end of an appointment, I typically will schedule their next appointment.
MR. REDDINGTON: So did you schedule January 6th?
JENNIFER TUFTS: I think that one she scheduled herself.
MR. REDDINGTON: That was the day after she got out of McLean, right?
JENNIFER TUFTS: Yeah. Usually the hospital coordinates the discharge appointment.
MR. REDDINGTON: Well, if I tell you that, in fact, the hospital told her to set up the appointment, and within an hour she set up the appointment. Is that in your notes?
JENNIFER TUFTS: It's not in my notes, no.
MR. REDDINGTON: Do you remember that? That was a pretty big deal that she was in McLean locked wards for four and a half days, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And she's your patient, and she's really gone downhill bad, right?
JENNIFER TUFTS: Yeah, she wasn't doing well.
MR. REDDINGTON: And she admitted herself to the locked wards at McLean, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And what was the diagnosis at McLean?
JENNIFER TUFTS: I believe they diagnosed her with major depression.
MR. REDDINGTON: Did they recommend any medication?
JENNIFER TUFTS: They took her off of the Seroquel.
MR. REDDINGTON: They took her—
JENNIFER TUFTS: Off of it.
MR. REDDINGTON: ... off. Okay. So did you look at the McLean records?
JENNIFER TUFTS: Yes, definitely.
MR. REDDINGTON: And those were employed easily because you're part of the same—structural way, I mean.
JENNIFER TUFTS: No, but after someone is hospitalized, the hospital usually faxes it to their doctor.
MR. REDDINGTON: All right. So if I tell you that the McLean records are really pretty voluminous, that's not what they faxed. They faxed you like a two-page discharge summary, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: You didn't get that by fax, right?
MR. REDDINGTON: So what does McLean tell you? Look in your notes.
JENNIFER TUFTS: Which part do you want me to read it?
MR. REDDINGTON: Did you ever have her sign a release from McLean? Did you ever get access to the McLean records?
JENNIFER TUFTS: I had access to the discharge summary.
MR. REDDINGTON: Okay. So put the discharge summary aside, 'cause that's what they faxed you— ... a couple of pages. What about the records?
JENNIFER TUFTS: No, but that's typically not done.
MR. REDDINGTON: Well, never mind typically. The answer's no. You never got the records, right?
JENNIFER TUFTS: A discharge summary is a record.
MR. REDDINGTON: Did you talk to the doctor that discharged her?
JENNIFER TUFTS: No, no one called me.
MR. REDDINGTON: No what?
JENNIFER TUFTS: No, no one called me. I wasn't notified about the hospitalization until she was discharged.
MR. REDDINGTON: So you just sit there behind your computer and wait for people, Patrick, wait for the doctor from McLean, wait for the sick person who's the patient to call you, and if these people don't call you, it doesn't exist apparently, right?
JENNIFER TUFTS: No, not exactly. I had no way of knowing she was even at McLean.
MR. REDDINGTON: Well, you did once she got discharged, right?
JENNIFER TUFTS: Yeah, but that was after the fact.
MR. REDDINGTON: Right. So did you care why she was in McLean?
JENNIFER TUFTS: Of course.
MR. REDDINGTON: And why was she in McLean?
JENNIFER TUFTS: Because she was depressed.
MR. REDDINGTON: And what was the— Does your record indicate that she was discharged yesterday under interval history?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And discharged from where?
JENNIFER TUFTS: Well, I said MGH.
MR. REDDINGTON: Is that Mass General Hospital?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And she was currently on Trazodone?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And she indicated that the goal was to come off Seroquel?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And she described herself as still being very numb?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: She couldn't sleep, right?
JENNIFER TUFTS: That's not entirely true.
MR. REDDINGTON: Am I lying? I'm reading the medical records here. Sleep, taking Ativan and Trazodone, slept five hours broken, wondering about increasing Trazodone and switching to Valium. What does that mean?
JENNIFER TUFTS: Well, it means she was having trouble sleeping. It wasn't that she wasn't sleeping at all.
MR. REDDINGTON: Ah, I see. Okay. So was the Trazodone increased at that point?
JENNIFER TUFTS: Yes.
JENNIFER TUFTS: Yes.
MR. REDDINGTON: How about on January 9th, did you see her through the computer or whatever then?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And did you prescribe medication to her on that date?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And was that Diazepam?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Fourteen count, one milligram? No, I'm sorry. Fourteen count, five milligrams.
JENNIFER TUFTS: That sounds right.
MR. REDDINGTON: Okay. Did you also, on January 12th, three days after January 9th meeting, prescribe additional medication to her?
JENNIFER TUFTS: I'm not sure. I don't have a record from January 12th.
MR. REDDINGTON: Do you recall on January 12th that, in fact, you prescribed Trazodone a hundred and fifty milligrams, 30 count?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Three days later, or a couple of days later, January 16th, do you recall prescribing Amitriptyline?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: What is Amitriptyline?
JENNIFER TUFTS: It's a tricyclic antidepressant.
MR. REDDINGTON: What does a tricyclic antidepressant mean?
JENNIFER TUFTS: Well, it's an older antidepressant. It's called a tricyclic 'cause it has three rings, if you look at the chemical itself, like a tricycle. But it's an older but efficacious medicine for depression and anxiety as well as insomnia.
MR. REDDINGTON: On January 16th, look at your interval history. She indicates here that her mood was very low, no motivation?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Numb?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Able to force herself out of bed, taking care of basics. Eating, concentration fine, caring for baby, bonding feels forced. Is that what she told you?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Through the computer, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: What did that tell you? Were you concerned about this woman postpartum, well within the year from the CDC at that point, with these symptoms that she's telling you about?
JENNIFER TUFTS: I was concerned that she was depressed.
MR. REDDINGTON: And in all of the times that you spoke to her, you'd agree with me that she appeared to be honest and forthright telling you what she felt, right?
JENNIFER TUFTS: That's what I thought she was, yes.
MR. REDDINGTON: Do you have any reason to think that she was lying to you?
MR. REDDINGTON: Diazepam taper on January 16th, five milligrams last two nights. Slept for four hours and then a light sleep, maybe two-hour stretches.
MR. REDDINGTON: Did she express that she was still having concerns about side effects from medications?
JENNIFER TUFTS: Not at that point.
MR. REDDINGTON: So what does ROS mean on the interval history that we're looking at?
JENNIFER TUFTS: Review of symptoms.
MR. REDDINGTON: Okay. And then it says, "Patient denies SIHI." That would be suicidal ideation, homicidal ideation, correct?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Denies other questions or concerns, and you recommend a low dose of amitriptyline for depression, correct?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Patient agrees with the treatment, and you guys were also gonna explore ketamine treatment, ketamine treatment. Is that right? Esketamine.
JENNIFER TUFTS: Yes.
MR. REDDINGTON: Now, did you know that she was on her computer looking up medication after medication after medication after medication and treatments, ketamine treatments, and all that? Did you know that?
MR. REDDINGTON: Did you ever ask her whether or not she was looking up the symptomology of pharmacology and having interactions between drugs?
MR. REDDINGTON: January 23rd, you had that meeting, correct, with her?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: And this is after obviously—excuse me—the January 16th appointment. And in the January 16th appointment, she told you that her mood was very low, and that's the worst that she ever reported her mood to you. Isn't that right?
JENNIFER TUFTS: On the 16th?
MR. REDDINGTON: Yeah.
JENNIFER TUFTS: I don't know if that was the worst it was ever reported, but it was certainly bad.
MR. REDDINGTON: And you didn't recommend that she have a hospital evaluation, did you? This is the day before she killed the kids, right?
JENNIFER TUFTS: The 23rd?
MR. REDDINGTON: Yeah.
JENNIFER TUFTS: It was the day before.
MR. REDDINGTON: You didn't recommend a hospital evaluation, did you?
JENNIFER TUFTS: No. There were no, um—
MR. REDDINGTON: The answer's no?
MR. REDDINGTON: They'll ask you all the questions they want.
JENNIFER TUFTS: Okay.
MR. REDDINGTON: Your answer's no. January 23rd, Friday, you testified that she said her mood was depressed, and you noted that her affect was depressed and flat, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: She also reported that her heart was racing, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: She had no motivation is what she told you, right?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: She told you that she had been feeling, you know, numb and no emotion for seventeen days straight is what she told you, right?
JENNIFER TUFTS: I'm not sure about seventeen days straight, but that's how she was feeling.
MR. REDDINGTON: You didn't reach out to her mother and father at that point. They didn't call you, I guess, right?
MR. REDDINGTON: And Patrick didn't call you at that point, right?
MR. REDDINGTON: So she's sitting in front of her computer getting help from her doctor on January 23rd, and what did you do?
JENNIFER TUFTS: Well, I thought about how I could best help her, the medicines that she'd tried and what her current symptoms were. And it made sense to slowly titrate the amitriptyline so that we could get her to a dose that reduced her depression so that she would feel better.
MR. REDDINGTON: But you increased the amitriptyline?
JENNIFER TUFTS: Yes.
MR. REDDINGTON: That pushed her over the edge, didn't it?
JENNIFER TUFTS: I don't think so.
MR. REDDINGTON: That's all I have.
THE COURT: Thanks. Members of the jury, we're gonna take the afternoon recess at this time. All righty.
BAILIFF: Court, all arise.
BAILIFF: Jurors have exited the courtroom. This court's in session.
THE COURT: Counsel, anything we need to discuss before the break?
MS. SPRAGUE: No, Your Honor.
MR. REDDINGTON: No, Your Honor. Thank you.
THE COURT: All right. So we'll be recessed. Oh, I'll just get out of this.
BAILIFF: All rise. Jurors entering.
COURT CLERK: All parties are present, including the defendant and including the 18 jurors.