2.Latiesha Dukes — Direct (Part 1)
495 linesMS. BUCKINGHAM: The Commonwealth would call Latiesha Dukes as its next witness, please.
COURT CLERK: [oath administered]
LATIESHA DUKES: I do.
COURT CLERK: Okay. You may have a seat.
THE COURT: Good morning.
LATIESHA DUKES: Good morning.
THE COURT: All right. I'm gonna ask you to keep your voice up and speak into that microphone, okay?
LATIESHA DUKES: Sure.
THE COURT: All right. Thank you. Yes, counsel.
MS. BUCKINGHAM: Thank you. Could you please tell the jury your first and last name?
LATIESHA DUKES: My name is Latiesha Dukes.
MS. BUCKINGHAM: And how do you spell your first name?
LATIESHA DUKES: L-A-T-I-E-S-H-A.
MS. BUCKINGHAM: And how do you spell Dukes?
LATIESHA DUKES: D-U-K-E-S.
MS. BUCKINGHAM: What do you do for work?
LATIESHA DUKES: So I'm a licensed mental health counselor. I worked as a perinatal clinician at South Shore Hospital.
MS. BUCKINGHAM: And what kind of education did you receive in order to do that?
LATIESHA DUKES: So I have a bachelor's in psychology, a master's in mental health counseling, and a master's of education and mental health counseling.
MS. BUCKINGHAM: And you mentioned the South Shore Perinatal Clinic.
LATIESHA DUKES: Mm-hmm.
MS. BUCKINGHAM: Do you still work there?
LATIESHA DUKES: No, I do not currently still work there.
MS. BUCKINGHAM: How long did you work there?
LATIESHA DUKES: I worked there for about five years.
MS. BUCKINGHAM: What did you do there?
LATIESHA DUKES: At the perinatal clinic, I worked as a perinatal clinician, which involves, like, short-term therapy, from prior to birth, birth to postpartum, and supported with connection to care, whether that be therapy or higher levels of care, so intensive outpatient therapy, partial hospitalization, or inpatient care.
MS. BUCKINGHAM: And do you often collaborate with patients and other clinicians at the clinic or nurses about treatment plans for patients?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: And do you help to manage the treatment plans with the patient?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: How do patients... Or strike that. For your role at the clinic, doing the therapy and being the clinician, are you often referred patients by the nurse practitioners or somebody else who had seen the patient or did an intake with the patient?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: And do you work with that prescriber or practitioner over the course of the treatment with that patient?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: And as far as your role and what you do with patients, is it fair to say that a large amount of your ability to work with a patient is based on your relationship and rapport that you develop with the patient?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: And do you rely heavily on things that they report to you when you're assessing them diagnostically and trying to help them come up with a treatment plan and offering therapy?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: And one of the things that might be important in that is to assess a patient's presentation each and every time you meet with them, right?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: So do you do that in each appointment or each interaction with a patient, assess them for various things?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: And what kinds of assessments do you perform?
LATIESHA DUKES: So I typically perform a psychosocial assessment, which is getting their behavioral health history, as well as their current presentation and reason for coming in for therapy. So whether that be a specific diagnosis or a current concern, or recent, like, crisis or trauma, and also a risk assessment that assesses how they're doing in that moment.
MS. BUCKINGHAM: Okay. And as far as the therapy component of your interactions, is that largely based on the patient?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: And what kinds of therapy can you offer in that short-term therapy?
LATIESHA DUKES: In that short-term therapy, we offer cognitive behavioral therapy, dialectical behavioral therapy. I also offer something called EMDR, eye movement desensitization and reprocessing therapy for patients that have gone through trauma. As well as it could be even short-term support, like a couple of weeks until they're transferred to the appropriate level of care.
MS. BUCKINGHAM: And in your sessions with patients, is there a minimum or a maximum time limit?
LATIESHA DUKES: Typically, our program would go from birth to postpartum up to two years. If it did go a little bit over two years because of lack of connection to care, then it would go a little beyond that. But typically, it's two years.
MS. BUCKINGHAM: Okay, and that's the duration of your treatment or your interaction with patients. But what about in each appointment that you have? Is there a minimum or maximum time set by the clinic of when you see a patient? In a particular visit?
LATIESHA DUKES: Yes. So do you mean as far as, like, weekly or, like, hour, half an hour?
MS. BUCKINGHAM: Well, I guess the question is, if a patient's coming into you because they were referred and you're meeting with them on a regular basis, how long are the appointments in duration?
LATIESHA DUKES: Sure.
MS. BUCKINGHAM: An hour? Half an hour?
LATIESHA DUKES: So appointments could be anywhere from a half an hour to a hour based on the patient need at that time.
MS. BUCKINGHAM: And when you're interacting with a patient and you're making all those assessments, are there tools available to you if you feel or you experience that a patient needs a higher level of care or is heading or is in some sort of crisis? What tools are available to you for that?
LATIESHA DUKES: So tools that are available to me is connection to my direct supervisor as well as crisis coordination, as well as, like, the crisis support numbers that are in that area. So I could either call with the patient or sit with the family, create a safety plan, and the patient can call later on if they feel like they're safe to go home and they have supports at home.
MS. BUCKINGHAM: Okay. And at some points, could it be that you would need to involve authorities like the police?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: And you also are familiar with the Section 12?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: And that it's an involuntary procedure where the court gets involved?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: Okay. Now, as far as when you do meet with patients on that regular basis, either for a follow-up or an intake, is it a telehealth situation, an in-person situation?
LATIESHA DUKES: It depends on what the patient is comfortable with and what the patient is able to do as far as, like, access. So we offer both in-person and virtual appointments.
MS. BUCKINGHAM: Okay. As far as when you first meet with a patient when they've been referred to you, that first intake procedure, is there a recommendation for whether that be in person or telehealth?
LATIESHA DUKES: All the perinatal behavioral health appointments for mental health counseling are in person.
MS. BUCKINGHAM: Okay.
LATIESHA DUKES: That initial visit.
MS. BUCKINGHAM: And then, the subsequent appointments are oftentimes directed by the patient?
LATIESHA DUKES: Correct.
MS. BUCKINGHAM: Would there be instances where you would insist or prefer that the patient actually come in person if they've elected for telehealth?
LATIESHA DUKES: Typically you prefer someone to come in person because they have either, like, fallen out of care or there are concerns for their safety for some reason.
MS. BUCKINGHAM: Okay. And if you don't have those immediate concerns and it's the preference of the patient, do you often engage via telehealth?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: I'm gonna draw your attention to a particular patient by the name of Lindsay Clancy. Do you remember when your first contact was with her?
LATIESHA DUKES: I remember it was around late November, early December.
MS. BUCKINGHAM: Okay. And you're aware that she came to the perinatal clinic, and was being initially treated by Julie Paul?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: And by the time you engaged with her, she had trans- her care had been transferred to Rebecca Jollotta, correct?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: So fair to say you had the most contact with Rebecca Jollotta about this particular patient?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: And if I mention December 2nd, does that sound- ... familiar as the first intake with Lindsay Clancy?
LATIESHA DUKES: Yes. As I said, around late November, early December. So that sounds about right.
MS. BUCKINGHAM: Okay. And the intake appointment, was it in person with Lindsay Clancy?
LATIESHA DUKES: Yes, it was in person.
MS. BUCKINGHAM: And what were the services that were being offered for her? Why was she referred to you?
LATIESHA DUKES: So she was referred to me for postpartum anxiety and depression symptoms. She... Yeah, that's what she was referred for.
MS. BUCKINGHAM: Okay. And in this first intake, did you go through that psychosocial history with Lindsay Clancy?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: And did you have some previous information from an intake with Rebecca... Excuse me, with Julie Paul, or did you do it fresh on your own?
LATIESHA DUKES: Fresh on my own.
MS. BUCKINGHAM: Okay. And so again, this is information that the patient is reporting to you about their history.
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: And so in this instance, you noted that the defendant told you or Lin- Lindsay Clancy told you that she had, she had been, had some prior contact with mental health, right?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: That she had engaged with a psychiatrist in nursing school and that she had been prescribed medication at that point, correct?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: And that she, prior to coming to the clinic, that she had been engaged with a psychiatrist?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: Did she identify what her concerns were or what her presenting concerns were to you?
LATIESHA DUKES: Yes, she did.
MS. BUCKINGHAM: And what were the concerns?
LATIESHA DUKES: Her presenting concerns were anxiety, lack of sleep, depression symptoms, frequent passive suicidal ideation, thoughts of wanting to die and no longer be here.
MS. BUCKINGHAM: Okay. And had she reported to you that she had been on a number of different medications?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: And you're aware that she was—those medications were being managed by the nurse practitioners in the clinic?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: And as far as your role as a social worker, do you often kind of get into the weeds with patients about their medication?
LATIESHA DUKES: So I'm not a social worker, I'm a mental health counselor.
MS. BUCKINGHAM: I'm sorry.
LATIESHA DUKES: Yeah, no problem. But I typically have a overview of medications, but I don't particularly get into prescribing or how to take medications.
MS. BUCKINGHAM: Okay. And so what's the focus of your role in offering counseling services to women with postpartum anxiety and depression—
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: … if that's adequate?
LATIESHA DUKES: So my role would be to create a treatment plan to address the concerns, which would be like the anxiety and depression symptoms, and work on coping skills and building community supports around that. Or if she needed a referral to a higher level of care, I would do that.
MS. BUCKINGHAM: And do you come to your own conclusions as far as diagnosis goes based on your interaction with the patient?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: And in this first interaction with Ms. Clancy, you got her history. You also did some of those assessments, correct?
LATIESHA DUKES: Mm-hmm.
MS. BUCKINGHAM: And so as far as assessing her present condition, kind of how she presented to you, did you make observations of her mood?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: And do you recall her mood being low? That she was—felt numb and unable to laugh?
MR. REDDINGTON: No, I apologize. If it's medical record, I don't have any objection, but I'd prefer not the leading. I have no problem if she reads from the record though.
THE COURT: All right. If you just—there's objection. In fact, leading, leading question sustained. But is there any… So there's no objection—
THE COURT: … if this witness, if you wanna look at your notes. I don't know if you have your notes with you.
LATIESHA DUKES: I do not. Do they have a copy that they can give me?
THE COURT: I don't know if the parties have a copy that she could look at.
MR. REDDINGTON: I do. I could—I can provide a copy for it.
MS. BUCKINGHAM: Do you have a blank copy?
MR. REDDINGTON: Well, I mean, it has like a date on it. It doesn't have a lot of notes on it. It just has the name.
MS. BUCKINGHAM: I can approach page by page.
THE COURT: All right.
MS. BUCKINGHAM: It's fine.
THE COURT: Sure, that's fine. If you need or want to look at the rec—just let us know and we'll do that.
LATIESHA DUKES: Sure thing. Thank you.
MS. BUCKINGHAM: Just gonna show you that page.
LATIESHA DUKES: Sure.
MS. BUCKINGHAM: I can leave that with her if that's okay.
THE COURT: Sure, yeah.
MS. BUCKINGHAM: So Ms. Dukes, on this particular visit on 12/2, what was her mood?
LATIESHA DUKES: So she reported having low mood and feeling numb.
MS. BUCKINGHAM: Okay. And so, you said she reported. So in the note that you're reviewing, these particular questions or these observations that you noted, are they based on her reports to you about these areas?
LATIESHA DUKES: Yes, and as well as my observation of her.
MS. BUCKINGHAM: Okay. So did it appear that her mood was consistent with what she was reporting to you based on your observations?
LATIESHA DUKES: She appeared to have, if you can say, like normal mood. There was no like tears or sadness or like there was no blunted interaction. She was able to make contact, eye contact.
MS. BUCKINGHAM: Okay.
MS. BUCKINGHAM: And kind of moving to what's identified in your record as mental status exam.
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: What is a mental status exam?
LATIESHA DUKES: So a mental status exam is an exam that's assessing how the patient is appearing, what she is reporting, as well as any concerns about safety, which would be any suicidal ideation, homicidal ideation, as well as any intrusive thoughts or worry, any hallucinations or delusions.
MS. BUCKINGHAM: Okay. And so in this exam, is it a mixture of what the patient tells you and what you're observing?
LATIESHA DUKES: Correct.
MS. BUCKINGHAM: Okay. And if I can approach you with another page, page 53.
LATIESHA DUKES: Thank you.
MS. BUCKINGHAM: In regards to on this particular first encounter on December 2nd, when it comes to the mental status exam, were you able to observe her facial expressions?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: And what were your observations of her facial expressions?
LATIESHA DUKES: She was tearful when discussing her anxiety symptoms.
MS. BUCKINGHAM: Okay. And did you also ask those questions about thought content? You just have to answer out loud.
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: Okay. And so what did she say about thought content?
LATIESHA DUKES: So thought content, worry about her infant, and that she had an addiction to Ativan.
MS. BUCKINGHAM: And you said you also in this assessment assessed suicidal thoughts, correct?
LATIESHA DUKES: Correct.
MS. BUCKINGHAM: And so did you ask her anything more about those passive thoughts that you indicated she reported?
LATIESHA DUKES: Yes. And what she reported as far as like passive thoughts were thoughts of not wanting to be here or no longer wanting to live, but no plan.
MS. BUCKINGHAM: And is that significant to you, the fact that she identified there was no plan?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: And why is it significant?
LATIESHA DUKES: Because if she identified that she in fact had a plan, then that would escalate me to see it as a crisis and request higher level of support at that time.
MS. BUCKINGHAM: As far as your observations of her thought process, were those within normal limits?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: And her intellectual functioning, were those within normal limits?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: Okay. Did she report to you any past attempts to harm herself or others?
MS. BUCKINGHAM: Okay.
MS. BUCKINGHAM: Did you go through with her her behavioral health history?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: And other than what you indicated as the anxiety and sleep, did she identify any concerns for, around substance abuse issues?
LATIESHA DUKES: So she did identify concerns about, not in her history but in that visit, about misuse of Ativan.
MS. BUCKINGHAM: And if somebody expresses concern about that substance use, do you have a tool available to you to assess whether they have substance use issues?
LATIESHA DUKES: Yes. So there is an assessment within the initial intake appointment that has a specific section to further assess substance use disorder.
MS. BUCKINGHAM: Okay. And did you identify whether she presented with any substance use disorder issues?
LATIESHA DUKES: I did assess that she did not present with any substance use disorder issues.
MS. BUCKINGHAM: And as far as her expressed concern to you, fair to say it was focused on the one particular medication, the medication Ativan, correct?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: And why did you not find that to be an issue based on your assessment?
LATIESHA DUKES: Based on my assessment and how she stated she was supposed to be using it, it was used correctly to remedy the anxiety symptoms.
MS. BUCKINGHAM: Okay. And after this initial intake... Oh, I guess the first question is approximately how long is this initial intake appointment?
LATIESHA DUKES: The initial intake appointment is typically an hour.
MS. BUCKINGHAM: Okay. And after having spent the hour, gone through these assessments, spoken to her about her history, were you able to come up with or give an opinion about diagnosis?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: And based on her presentation to you, what was your opinion about diagnosis?
LATIESHA DUKES: At the time, my opinion about her diagnosis was postpartum anxiety because she had a lot of anxiety about most things.
MS. BUCKINGHAM: Okay. And so what were your recommendations as far as a treatment plan for her?
LATIESHA DUKES: My recommendations at that visit was outpatient therapy, continued medication, and weekly visits with me.
MS. BUCKINGHAM: Okay. And why did you recommend outpatient therapy on top of therapy with you?
LATIESHA DUKES: So outpatient therapy was kind of like a blanket therapy, but more so like intensive outpatient therapy, partial hospitalization therapy.
MS. BUCKINGHAM: And was your role in offering her weekly sessions an attempt to kind of bridge services and make sure she was getting everything she needed or something different?
LATIESHA DUKES: To bridge services.
MS. BUCKINGHAM: And so after that meeting with the recommendation for weekly visits, did you begin to schedule additional visits with her?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: And after that particular visit on December 12th, did you send her any particular information?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: And how do you do that? How do you send patients information if you, if they're not able to, you're not able to give it to them?
LATIESHA DUKES: I can send it through my chart messaging.
MS. BUCKINGHAM: And on this particular day, after your meeting with her, you sent her some resources about cognitive behavioral therapy, did you not?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: Your next contact with her was December 5th. Why December 5th if you had just met with her on the 2nd?
LATIESHA DUKES: That may have been the soonest available appointment that week for her.
MS. BUCKINGHAM: Okay. And it was shy of the one week, right?
LATIESHA DUKES: Mm-hmm.
MS. BUCKINGHAM: Did you... Was there anything in your meeting with her on the 2nd that made it necessary to have a shorter appointment?
MS. BUCKINGHAM: This next contact on the 5th, was that in person or telehealth?
LATIESHA DUKES: Telehealth.
MS. BUCKINGHAM: And on this day, on the 5th, when you met with her, did she report some additional information or report how things had gone over the weekend to you?
LATIESHA DUKES: May I see my notes?
MS. BUCKINGHAM: Sure.
MS. BUCKINGHAM: If it's okay, I'm just gonna give her all the pages from that note.
THE COURT: That's fine.
LATIESHA DUKES: Thank you.
MS. BUCKINGHAM: Okay.
LATIESHA DUKES: Yep.
MS. BUCKINGHAM: Thank you.
LATIESHA DUKES: Okay. I'm just reviewing the note.
MS. BUCKINGHAM: Sure. Take your time.
LATIESHA DUKES: And can you repeat the question?
MS. BUCKINGHAM: Sure. In that visit on December 5th, did she indicate to you or did she report to you how the weekend went for her?
LATIESHA DUKES: Yes, she did.
MS. BUCKINGHAM: And what did she say about the weekend?
LATIESHA DUKES: She reported that over the weekend she had a difficult weekend, having intrusive thoughts about wanting to die, and that she had contacted Aspire Crisis Support. She met with the clinician virtually, and was told that she did not meet the criteria for inpatient treatment due to having no SI plan, suicidal ideation plan.
MS. BUCKINGHAM: And so when she reported the intrusive thoughts and having a tough weekend, did you follow up with her and begin to kind of talk with her about that?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: And what did she tell you about what she was feeling in those intrusive thoughts?
LATIESHA DUKES: So in those times, what she reported was that it was continuous intrusive thoughts of not wanting to be there.
MS. BUCKINGHAM: Okay.
LATIESHA DUKES: But no plan.
MS. BUCKINGHAM: Okay.
LATIESHA DUKES: Kind of like the same report that she gave to Crisis.
MS. BUCKINGHAM: Okay. And as far as kind of the difficulty of the weekend and how she was feeling, did she tell you how she was feeling?
MS. BUCKINGHAM: In that particular meeting, when she had talked about wanting to die or not wanting to be there anymore, did you kind of follow up with her about those statements and whether she had any sort of intent or plan?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: And did you ask her additional information and complete that full mental status exam-
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: ... on that meeting? And were there any signs of psychosis or signs of mania or homicidal or homicidal ideation?
MS. BUCKINGHAM: And at the time that you met with her on the 5th, was she currently having those thoughts about wanting to die, do you know?
LATIESHA DUKES: Just review a minute.
MS. BUCKINGHAM: Sure.
LATIESHA DUKES: In that visit she had no suicidal ideation.
MS. BUCKINGHAM: Okay. And on this particular visit on the 5th, via telehealth, did somebody else participate in the visit as well?
MS. BUCKINGHAM: I could direct you to page 45.
MS. BUCKINGHAM: Yeah.
LATIESHA DUKES: Okay.
LATIESHA DUKES: Yes. Her husband joined the visit.
MS. BUCKINGHAM: And this visit, approximately how long was it, if you recall?
LATIESHA DUKES: This visit was approximately 30 minutes.
MS. BUCKINGHAM: Okay. And fair to say focus of the visit was to kind of deal with that bad weekend in-
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: ... calling the crisis center?
LATIESHA DUKES: Yeah.
MS. BUCKINGHAM: So what did you offer her as far as recommendations or assessments or assistance during this meeting?
LATIESHA DUKES: So support during this meeting, I offered her support in connecting to... It seemed like she needed a higher level of care, so intensive outpatient therapy, partial hospitalization therapy. As well as we reviewed, one of her main concerns was also issues with sleeping, so we reviewed sleep hygiene and how to support better sleep to see if that would help with some of the intrusive thoughts.
MS. BUCKINGHAM: Okay. And as far as the recommendation for intensive outpatient or partial hospitalization, was... Did she wanna connect with those programs at that time?
LATIESHA DUKES: At that time she didn't decline services, but she was interested in the information.
MS. BUCKINGHAM: Okay. And so did you agree to send her some information?
LATIESHA DUKES: At that time I did not agree to send her information.
MS. BUCKINGHAM: Okay. Did she ask for any other information in that meeting?
LATIESHA DUKES: She did ask for information and support connecting to psychological testing.
MS. BUCKINGHAM: And is that something that you do at your clinic, do psychological testing?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: Okay. And so did you make a referral to, for her to see somebody else in the clinic or did you provide her other information?
LATIESHA DUKES: So I discussed this information with a provider at the time, which was the psychiatrist and medication provider at the time.
MS. BUCKINGHAM: And would that have been Rebecca Jollotta?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: And so did you subsequently send Lindsay Clancy some information about psychological testing?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: But there was no recommendation for it to be done at the clinic?
MS. BUCKINGHAM: Do you know why?
LATIESHA DUKES: At the time it sounded like she wanted extra support or, like, outside opinion as far as, like, diagnosis and medication.
MS. BUCKINGHAM: Okay. And was the testing something that she brought up or did it come out naturally in your conversations with her?
LATIESHA DUKES: That's something she brought up.
MS. BUCKINGHAM: In your meetings did she wanna, or did she discuss medication side effects with you?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: Okay. And what were your observations of her demeanor during this visit on the 5th?
LATIESHA DUKES: On the 5th? One second.
LATIESHA DUKES: Her presentation overall was at, within normal limits. She didn't appear, like, anxious or different than any other visit I had with her.
MS. BUCKINGHAM: And in, and the... This is kind of your second meeting with her, right?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: And how many meetings did you have overall with her during the time she's at the clinic, if you know?
LATIESHA DUKES: Four.
MS. BUCKINGHAM: Four. So, but you had spent an hour with her on that intake where there's a lot of information exchange, right?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: So was there anything different about how she presented, how she spoke to you or answered questions during this follow-up on the 5th?
MS. BUCKINGHAM: And as far as the conversations about the bad weekend and calling crisis, did you have any concern that she was in crisis?
[audio missing]
MS. BUCKINGHAM: But nothing that would have prompted you for those other interventions that you've previously described to us, right?
LATIESHA DUKES: Right.
MS. BUCKINGHAM: Did you ever in this visit see signs of mania?
MS. BUCKINGHAM: And is that something you look for?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: And did you ever see signs of delusions or paranoia?
MS. BUCKINGHAM: How about psychosis?
MS. BUCKINGHAM: Now your next contact with her was December 12th, correct?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: And was that in person or telehealth, if you recall?
LATIESHA DUKES: Telehealth.
MS. BUCKINGHAM: And on the 12th, did you have further conversation with her about your previous recommendations about partial hospitalization programs?
LATIESHA DUKES: May I review?
MS. BUCKINGHAM: Yeah.
LATIESHA DUKES: Yes, we did have further conversation about recommendations.
MS. BUCKINGHAM: Okay. And did she indicate to you that she would be starting a program soon?
LATIESHA DUKES: Yes. She indicated that she would be starting a partial hospitalization program in Norwell on December 20th, 2022.
MS. BUCKINGHAM: Did she provide you any details about that program? Do you know?
LATIESHA DUKES: No, just that she would be starting a program in Norwell.
MS. BUCKINGHAM: Was that... had you referred her to any programs in Norwell?
MS. BUCKINGHAM: And in this meeting with her, did you continue to talk about her need for higher level of care?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: And did you make recommendations on a different program?
LATIESHA DUKES: I need to look.
LATIESHA DUKES: Yes, I did make a recommendation on Women and Infants.
MS. BUCKINGHAM: And why did you recommend Women and Infants, or why were you recommending this higher level of care?
LATIESHA DUKES: I was recommending this higher level of care because of continued passive suicidal ideation, even with crisis intervention. As well as Women and Infants was more so for postpartum women. And the infant would be able to come to the program with her.
MS. BUCKINGHAM: And so the program at Women and Infants is something that you're familiar with working through your clinic, correct?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: And you often make referrals over there?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: Do you require the patient's consent to make a referral?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: Did Lindsay Clancy consent to the referral at that time?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: And so did you work to make that referral after that visit?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: Now, you mentioned that she had continued passive suicidal ideation. In this meeting that you had with her, did you assess that? Her suicidal ideation?
LATIESHA DUKES: In this visit particularly, did she have passive suicidal ideation?
MS. BUCKINGHAM: Well, do you ask if they still have that?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: Or if they currently have thoughts of suicide?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: And in this instance, did she have thoughts of suicide or wanting to die?
LATIESHA DUKES: Just reviewing. Hold on.
LATIESHA DUKES: So yes, she reported like continued suicidal ideation at the time.
MS. BUCKINGHAM: Okay. And but did she ever indicate a plan?
MS. BUCKINGHAM: Having met with her on the 12th, did she ever articulate to you that she had made any attempts?
MS. BUCKINGHAM: And in your conversation with her on the 12th, were you able to identify any protective factors based on everything that you knew about her at this time? Now, this is your third time with her, right?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: So what were you able to identify as protective factors for this particular patient?
LATIESHA DUKES: At this time, she had supports, which were her husband and her mother-in-law. At this time, she was able to, from the past visit I had with her, able to contact crisis when she felt like she needed extra support. So she was able to follow through with suggestions that I had given her in the previous visit.
MS. BUCKINGHAM: Okay. And based on your visit with her on the 12th, she accepted a willingness to go to one of those programs, right?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: Or be at least be referred.
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: So was there anything about your interaction with her on December 12th that warranted any of those higher levels of intervention from you?
MS. BUCKINGHAM: Now the next time you met with her was on December 19th, correct?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: And was that the final time that you met with her?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: On that day of December 19th, was that a in-person or a telehealth?
LATIESHA DUKES: May I review the note?
MS. BUCKINGHAM: Sure.
LATIESHA DUKES: That visit was virtual. And what was the question?
MS. BUCKINGHAM: That was the question.
LATIESHA DUKES: Okay.
MS. BUCKINGHAM: Thank you.
LATIESHA DUKES: No problem.
MS. BUCKINGHAM: So on this particular visit on the December 19th, did she report any further issues or anything that had happened between the 12th and the 19th that were of concern?
LATIESHA DUKES: So she was continuing to have low mood and numbness. She did not have any SI and had no need for crisis intervention over that weekend.
MS. BUCKINGHAM: Okay. And did she indicate to you that she had been doing things at home to try to help with her mood?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: And what was she doing?
LATIESHA DUKES: Let's see. She was spending time with family and her children, and exercising.
MS. BUCKINGHAM: Now at this point, as the December 19th rolled around, had you already put in that referral to Women and Infants?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: And do you know if she engaged with Women and Infants by that point?
LATIESHA DUKES: By that point, Women and Infants had reached out to her, but she had missed the call, but said she would contact them back.
MS. BUCKINGHAM: Okay. Now, one of the concerns that you often talked about in your meetings with her was sleep, right?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: And in this meeting with her on December 19th, did she report any improvements in her sleep?
MS. BUCKINGHAM: Well, if I direct your attention to page 13, at the top of the page where it says risk assessment.
MS. BUCKINGHAM: There's a category for neurovegetative disturbances. Do you see that?
LATIESHA DUKES: Yes.
MR. REDDINGTON: Can you show me what you mean by page 13?
LATIESHA DUKES: Okay.
MR. REDDINGTON: What is this page 13?
MS. BUCKINGHAM: I'm looking at prior ones, and those don't have page numbers. But the one I gave her has them. It's December 19th.
MR. REDDINGTON: Okay.
MS. BUCKINGHAM: That's the last page. And then it-
MR. REDDINGTON: It's this one here, right?
MS. BUCKINGHAM: Yeah.
MR. REDDINGTON: Okay. Okay.
MS. BUCKINGHAM: There should be three pages.
MR. REDDINGTON: Well, I got one. Sorry.
MS. BUCKINGHAM: What did you note under neurovegetative disturbances?
LATIESHA DUKES: I reported that sleep has improved.
MS. BUCKINGHAM: And that would be information that's reported to you, correct?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: You can't make observations of whether somebody's sleep has improved, can you?
MS. BUCKINGHAM: Okay. So in this instance, she told you she was gonna follow up with the referral, that she was waiting for a call back, that she had improved sleep, but that her mood kind of had remained the same. Low mood, numbness, right?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: Okay. Anything about your interaction with her that day that was different from the prior interactions?
LATIESHA DUKES: That day she seemed to be more engaged. She was able to smile. She was able to laugh. And she was enjoying time with family.
MS. BUCKINGHAM: And so did you look at that as something positive?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: Was there anything about your interaction with her on this day, on December 19th, that made you think that you needed to invoke a higher level of care?
MS. BUCKINGHAM: As far as in-person visits, did you have any other in-person visits with Lindsay Clancy after the 19th?
MS. BUCKINGHAM: Fair to say your contact with her was very limited after that point?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: And on December 27th, did you have some interaction with her and her husband?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: And why did you have interaction with them?
LATIESHA DUKES: May I see the note?
MS. BUCKINGHAM: Sure.
LATIESHA DUKES: There's four notes.
MS. BUCKINGHAM: Thank you.
LATIESHA DUKES: Can you repeat the question?
MS. BUCKINGHAM: On December 27th, why did you have contact with her? Why did you make contact with Lindsay?
LATIESHA DUKES: I was calling her to inform her that her referral had been completed.
MS. BUCKINGHAM: Okay. And so you had a call with her at 10:23, 10:17. Going back, 9:44. Do you see that in the records that you have? The four notes that you have in front of you?
MS. BUCKINGHAM: They kinda go in reverse order.
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: But prior to the contact about the referral being completed and just reaching out to her and letting her know, did you have a conversation with her husband?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: And was that at Lindsay's request? Did she give consent for that?
LATIESHA DUKES: She did give consent for that.
MS. BUCKINGHAM: Okay. And fair to say he was reporting concerns of prescriptions, right?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: And that's not your area in the clinic, is it?
MS. BUCKINGHAM: So did you refer her or refer him to the prescriber?
LATIESHA DUKES: At this time, yes, I redirected him to speak to the prescriber.
MS. BUCKINGHAM: Okay. And again, in each and every encounter that you've had, did you further recommend that she engage with a higher level of care, either a partial hospitalization program or an outpatient program?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: Now, at any point that you were interacting with her between December 2nd and the last contact with December 27th, albeit limited, did you ever have any concerns about her physical wellbeing?
MS. BUCKINGHAM: Did you ever have any concerns about the physical wellbeing of others in her presence?
MS. BUCKINGHAM: Did you ever see or observe any signs of mania, delusion, or paranoia?
MS. BUCKINGHAM: Any signs of psychosis observed by you?
MS. BUCKINGHAM: Did you ever have any difficulty understanding what she was saying or notice any differences in her speech patterns?
MS. BUCKINGHAM: Did you ever have any concerns that she wasn't accurately reporting things to you?
MS. BUCKINGHAM: And did you ever feel the need to collaborate with your provider for higher level of care or an additional intervention?
LATIESHA DUKES: When I did, yes.
MS. BUCKINGHAM: And so would that be for the calling the police, Section 12 or safety?
THE COURT: Hold on. Go ahead.
MS. BUCKINGHAM: My question was in any of the times that you engaged with her, did you ever engage with your provider to come up with a plan for safety planning, Section 12, or any other of those interventions you discussed before?
LATIESHA DUKES: No safety or Section 12, no.
MS. BUCKINGHAM: So as far as recommendations, would you agree that those were the recommendations for higher level of care?
LATIESHA DUKES: Yes, for IOP or PHP services.
MS. BUCKINGHAM: Okay.
MS. BUCKINGHAM: And on that last visit that you had with her, she reported doing things outside of the home, right?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: And that stood out to you?
LATIESHA DUKES: Yes.
MS. BUCKINGHAM: As what?
LATIESHA DUKES: As an improvement in mood and ability to connect with others.
MS. BUCKINGHAM: Okay. Thank you.
MS. BUCKINGHAM: If I may have a moment to put these back together.
THE COURT: Why, why don't we take the delayed morning break at this point? So, hopefully it'll be a little bit shorter than normal, but we'll get you... We can stretch our legs. We'll have you back here in a couple minutes, okay?
BAILIFF: Court, all rise please. Jurors, close your notebooks.
THE COURT: So we'll be in a short recess at this time. Thank you.
MR. REDDINGTON: Thank you.
BAILIFF: Court is back the session. You may be seated.
THE COURT: All right. Hi. We all set for the jury?
MR. REDDINGTON: Yes.
THE COURT: Okay.
BAILIFF: Court, all rise. Jurors entering.
BAILIFF: This court's now in session. Please be seated.
COURT CLERK: Your Honor, for the purpose of the record, we return back to the trial, Commonwealth versus Lindsay Clancy. All parties are present, including the defendant and including the 18 jurors.
THE COURT: All right. Counsel?