3.Donald Condie — Direct/Cross/Redirect/Recross
610 linesTHE COURT: All right. So I think probably it makes more sense to address the, whatever the technological issues were in the Zoom, maybe that can be done during the lunch period. And then we can go forward. I know the defense next witness would be, is it Dr. Condie?
MR. REDDINGTON: Yes. Arnold Condie, C-O-N-D-I-E.
THE COURT: And I know that we had talked about a possible voir dire in regards to Dr. Condie. Do the parties see the need for the doctor to testify that, or maybe we could just hear the offered proof or what the expectations of the testimony is, and then we can—
MR. REDDINGTON: I don't know what the objection is, so.
THE COURT: All right. Yeah.
MS. BUCKINGHAM: Well, so the objection is that we were provided with an affidavit. The original affidavit that was provided, counsel agreed that it referred to standard of care, which is not the issue in this case. It really reflects his opinions in a civil case. So we were provided another affidavit, which appears to factually have the same numbered paragraphs and just deletes the ultimate opinion section and adds that Dr. Tufts and Nurse Jollotta were aware that Lindsay was experiencing symptoms of suicidal ideation and a critically deteriorating condition while under their care and failed to take reasonable steps. So it's unclear from his affidavit what exactly he's going to testify to. Is he going to just reiterate everything that has been presented in the records, everything that we would expect defense counsel to offer through expert testimony in the criminal responsibility area about the medication regimens that the defendant was on over the course of several months? Because if that's the case, then I would suggest that this is cumulative testimony, and that it didn't, it doesn't need to be presented in this manner to the jury.
THE COURT: But let me ask this, similar to the question I asked earlier, to a similar objection regarding cumulative. The defense has input it, this isn't the... This is their first witness in regards to that. Wouldn't the cumulative analysis be done if there's a follow-up expert that would be addressing these areas?
MS. BUCKINGHAM: Potentially.
THE COURT: Yeah.
MS. BUCKINGHAM: But that then becomes the defense's strategic choice about whether, if he's go- if they're gonna call Dr. Condie for this piece of it and the other experts for another piece of it. I- it's unclear, especially where the reports we've been provided by Dr. Spinelli and Dr. Zeizel talk about polypharmacology as part of the basis of their opinions in this case. So it's difficult to assess that, and we're obviously flagging it and objecting at this point based on-
THE COURT: Right.
MS. BUCKINGHAM: ... what we know the anticipated evidence to be. So I don't know if a proffer is necessary at this point to outline what exactly he-
THE COURT: All right.
MS. BUCKINGHAM: ... expects Dr. Condie to say and how that differs from the opinions of the other experts.
THE COURT: It seems to me that the main objection may lay in regards to Dr. Spinelli then, whether or not... a- and depends on what her testimony is and how that overlaps with whatever Dr. Condie's is at this point.
MR. REDDINGTON: But, Judge—
THE COURT: Yeah.
MR. REDDINGTON: ... and I appreciate the fact that you recognize that we have not yet put on a doctor yet. I don't have to accept their evidence. I don't have to accept their doctors. Our doctors, this is our first doctor, who is a very qualified psychopharmacologist. I expect to elicit from him the treatment, very briefly, that she received and the medications that she was on and the effect of these medications as it relates to her condition when she was seeking medical help. That's it. I'm not gonna get into criminal responsibility with him. I'm not gonna get into lack of criminal responsibility with him. Basically, psychopharmacology and the treatment that she received. He's not gonna, you know, be criticizing what Jollotta did, what Tufts did. He's just gonna detail her condition according to the medical records and the medications that were provided. I am well aware and very experienced in trying jury cases and know when you lose the jury. I know when you l- I'm not gonna have Dr.
Zeizel and doctor, I'm not gonna have, make Spinelli wax eloquently for hours and bore the jury to death. I'm gonna get right to the chase. Dr. Spinelli is a well-qualified doctor on the issues of postpartum psychosis and postpartum depression and treating a pregnant woman and/or a postpartum, perinatal, client or a patient. Dr. Zeizel is a general psychologist and will be discussing a number of issues, as you're well aware, because he's been involved with Lindsay for literally three years. Forty six times he's seen her or something like that. So I'm gonna focus their testimony on those fields. I don't think it's necessary for us to have Dr. Condie get up here on a voir dire so that they can hear what he's gonna testify to. I'm not gonna have him rambling or going off the script. He's signed an affidavit, which is even, I think, better than a medical report, you know, that you usually get. So they have plenty to cross-examine him from.
THE COURT: All right. And the intention is not to ask the question regarding standard of care?
MR. REDDINGTON: That's correct.
THE COURT: All right.
MR. REDDINGTON: Yeah. It's all been deleted because the objection, we-
THE COURT: All right.
MR. REDDINGTON: ... had removed. Yep.
THE COURT: All right. So, over the Commonwealth's objection, I'm going to allow, at this point, Dr. Condie's testimony, in line with the affidavit, basically in line with that affidavit, with the holding he's not to testify as to the standard of care—
MR. REDDINGTON: Right.
THE COURT: ... opinion as he had the original statement.
MR. REDDINGTON: Can I just tell him that to make sure that he—
THE COURT: Sure. Yeah. I think that's a great idea.
THE COURT: All right. So with that, counsel, are we ready for the jury?
MR. REDDINGTON: Yes, we are.
MS. BUCKINGHAM: Yes.
THE COURT: Okay.
BAILIFF: All rise, please. Juror's entering.
MR. REDDINGTON: Your Honor, could we approach for a bit?
THE COURT: Sure, yeah.
THE COURT: Okay. And basically the real problem is a technological issue. It was gonna be a Zoom call. There's been some problems. We're gonna try and work on that. So instead of going with that witness, we're gonna go on to the next witness, and then we'll put the technological problems for later. All right? So with that, Attorney Reddington.
MR. REDDINGTON: Yes. Thank you, Judge. Dr. Condie.
COURT CLERK: Good morning. [oath administered]
DONALD CONDIE: I do.
COURT CLERK: Thank you, sir. You may have a seat.
THE COURT: All right. Good morning, Doctor.
DONALD CONDIE: Morning, Your Honor.
THE COURT: All right. Attorney Reddington.
MR. REDDINGTON: Thank you, Judge. Doctor, could you keep your voice up so all the jurors and counsel can hear you, and tell us your name and spell your last name?
DONALD CONDIE: My name is Donald Condie, C-O-N-D-I-E.
MR. REDDINGTON: And tell us, what do you do for work, sir?
DONALD CONDIE: I'm a child, adolescent, and adult clinical and forensic psychiatrist.
MR. REDDINGTON: And can you tell us your background as to where you went to school and when you got your medical degree, and things of that nature?
DONALD CONDIE: I graduated from Tulane University, then spent some time in graduate school at the University of New Orleans, and went to medical school at Louisiana State University in New Orleans. And then I came to Boston to the Massachusetts Mental Health Center to train in psychiatry.
MR. REDDINGTON: And where was that?
DONALD CONDIE: The Massachusetts Mental Health Center was at 74 Fenwood Road. That building has been demolished, and now they're at 75 Fenwood Road—
MR. REDDINGTON: Okay.
DONALD CONDIE: ... in Boston.
MR. REDDINGTON: I was referring to, more like, is that affiliated with any particular medical schools?
DONALD CONDIE: Yes.
MR. REDDINGTON: What is it?
DONALD CONDIE: Harvard.
MR. REDDINGTON: And what years were you working at the Mass Mental Health Center, affiliated with Harvard?
DONALD CONDIE: I started there after medical school. I graduated in 1982 from medical school, was an intern in 1982 to '83. And that was a Harvard affiliated internship. And then residency was '83 to '85 for adult training, two years. Then '85 to '87, which was two years of training for child and adolescent. Then I did a forensic fellowship, also at the Mass Mental Health Center. And during that year, I spent some time at Harvard Law School as a visiting fellow.
MR. REDDINGTON: And do you have, or did you have any board certifications that you can tell us about?
DONALD CONDIE: I'm board certified in adult and child and adolescent psychiatry.
MR. REDDINGTON: Do you have a particular focus also on medications that are utilized in the course of psychiatry?
DONALD CONDIE: Yes. I've spent a great deal of my career treating people in the state system with psychotic disorders and mood disorders.
MR. REDDINGTON: Tell us a little bit about that. Was there one particular period of time that you worked with literally, you know, more than 100 people that had serious psychotic disorders?
DONALD CONDIE: Well, the Massachusetts Mental Health Center was a state inpatient facility. So we had many people with either no insurance or MassHealth insurance. Probably at least half of the patients at any given time would've had psychosis or a major depressive disorder.
MR. REDDINGTON: Have you, in the course of your career, following through on psychosis or a major depressive disorder, had any focus or treatment on women that are either pregnant or have had little babies, and they are looking for help in the postpartum period?
DONALD CONDIE: Yes.
MR. REDDINGTON: Tell us about that.
DONALD CONDIE: Well, starting in my residency, so 1983, we had several patients at the Massachusetts Mental Health Center who were pregnant and were also sometimes afflicted with psychosis. We also had people who had delivered a child, but were then hospitalized, sometimes with a psychotic depression or sometimes with simply suicidal ideation. And I've encountered that very frequently since then. I was, for 14 years, the chief medical officer of Vinfen, which is a very large agency with contracts from the Department of Mental Health and the Department of Mental Retardation in Massachusetts and in Connecticut. We ran about 350 group homes, about 10 people per home, so maybe 3,500 patients. We frequently had people who were pregnant and were taking medications for psychosis. Sometimes after delivery, the severity of their psychosis would increase, so I'm fairly familiar with that phenomenon.
MR. REDDINGTON: Doctor, how many years have you actually been practicing now as a physician?
DONALD CONDIE: I've been a licensed physician in Massachusetts since 1983.
MR. REDDINGTON: So what's that? '83, 90, 2000, 2026. Okay, about 40 years.
DONALD CONDIE: Yeah, a little more than 40 years.
MR. REDDINGTON: Okay. From 1990 through 2012, were you affiliated with forensic child psychiatry with Mass General Hospital?
DONALD CONDIE: Yes.
MR. REDDINGTON: And were you also affiliated through 2013 with Mass General on forensic case consults in this field?
DONALD CONDIE: Yes.
MR. REDDINGTON: All right. I'm asking, have you had occasion to make a number of presentations? We don't have to go through them, but did you make a number of presentations and working as a lecturer for various medical schools, law schools, things like that?
DONALD CONDIE: Yes. Well, during the time that I was at Mass Mental Health Center, I was a fellow at Harvard Medical School.
MR. REDDINGTON: What does that mean, to be a fellow?
DONALD CONDIE: It means you're a resident in a training program, and you're teaching Harvard Medical students things about the specialty in which you happen to be practicing.
MR. REDDINGTON: And what was the specialty that you were a fellow lecturing Harvard Medical students about?
DONALD CONDIE: First it was general psychiatry. Then it was child and adolescent psychiatry. And then it was forensic psychiatry.
MR. REDDINGTON: You also have had various scientific and medical publications that you have been authored on a number of occasions, articles. Is that correct?
DONALD CONDIE: Yes.
MR. REDDINGTON: All right. Your Honor, I'd offer his CV if I could, just if, as an exhibit, if that's accepted.
THE COURT: Commonwealth.
MS. BUCKINGHAM: No objection.
THE COURT: Okay, that may be admitted.
MR. REDDINGTON: Thank you.
COURT REPORTER: Exhibit 280.
MR. REDDINGTON: Now, Doctor, if you can tell me, do you know, not necessarily personally, but do you know of Lindsay Clancy?
DONALD CONDIE: I know about the case—
MR. REDDINGTON: Okay.
DONALD CONDIE: ... in general, but I don't know anyone personally.
MR. REDDINGTON: Now, you have never met her. Is that correct?
DONALD CONDIE: That's correct.
MR. REDDINGTON: You've never talked to her, right?
DONALD CONDIE: Never have.
MR. REDDINGTON: You've never evaluated her for what's called criminal responsibility. Is that correct?
DONALD CONDIE: That's correct. I have not.
MR. REDDINGTON: I consulted with you for purposes of psychopharmacology and issues like that in this case. Is that right?
DONALD CONDIE: Yes.
MR. REDDINGTON: Fair to say that we've had a number of conversations in the evening, off hours, about various medications administered to women that are pregnant or postpartum. Is that right?
DONALD CONDIE: Yes.
MR. REDDINGTON: Excuse me. Can you tell the jury, in a summary, what documentation, medical records, police reports, things of that nature in this case that you've had a chance to review?
DONALD CONDIE: Well, I've reviewed the records of Rebecca Gilada, the nurse practitioner, Dr. Jennifer Tufts, the psychiatrist that saw Ms. Clancy. I've reviewed the Brigham and Women's Hospital records, and the Women and Infants records. I've reviewed the McLean records. And I might be leaving something out.
MR. REDDINGTON: You know about her background as far as her employment as a labor and delivery nurse and her family, her three children, and her husband, that she was married, right?
DONALD CONDIE: Yes, I'm familiar with that.
MR. REDDINGTON: Okay. So if I could, Doctor, direct your attention to, let's say the fall of 2022, end of September. Can you tell us what Lindsay's status was as far as her maternity leave with work and any complaints that she had at that time regarding her mental state?
DONALD CONDIE: From my re— Excuse me. Could I get some water?
THE COURT: Sure. We've got some on the way.
DONALD CONDIE: Thank you.
MR. REDDINGTON: Thank you.
DONALD CONDIE: Appreciate it.
DONALD CONDIE: Sorry, my allergies are kicking up.
DONALD CONDIE: So from my review of the records, which would start with Dr. Tufts' records, my understanding is that Ms. Clancy was planning to go back to work as a labor and delivery nurse at Mass General. She worked, I believe, the 12 midnight to 12:00 AM shift. And she began to experience, as she had to some extent after her first two deliveries, some postpartum anxiety and consulted Dr. Tufts at that time.
MR. REDDINGTON: Now, after she had her third child, Callan, was she in... Would you strike that? It's fair to say she was in treatment with Dr. Tufts as a treating physician?
DONALD CONDIE: Yes.
MR. REDDINGTON: Okay. In looking at your affidavit, I believe on paragraph nine, did you determine from looking at the medical records as to the timeframe that Lindsay treated with Dr. Tufts?
DONALD CONDIE: Yes.
MR. REDDINGTON: And what was that?
DONALD CONDIE: She started in the middle of September 2022, and I'm sure that her last appointment was January 23rd, 2023.
MR. REDDINGTON: Now, did you have a chance to review Dr. Tufts' medical records?
DONALD CONDIE: Yes, I did.
MR. REDDINGTON: Can you describe them for us, please?
DONALD CONDIE: They are somewhat sparse and there are many checkboxes in the records, but not a great deal of sentences that describe what was done during sessions.
MR. REDDINGTON: Were you aware that the sessions that Dr. Tufts conducted with Lindsay from September, the end of September, up through January 23rd, were all televised on a computer?
DONALD CONDIE: Yes. They were all video.
MR. REDDINGTON: Do you recall the medications that Dr. Tufts prescribed Lindsay?
DONALD CONDIE: I believe the first medication she started was Zoloft, 25 milligrams.
MR. REDDINGTON: And what does that... Tell us what Zoloft is.
DONALD CONDIE: Zoloft is-
MR. REDDINGTON: What effect does it have on a person?
DONALD CONDIE: I'm sorry?
MR. REDDINGTON: What effect does that have on a person?
DONALD CONDIE: Well, Zoloft is a selective serotonin reuptake inhibitor, which is a type of antidepressant that started being used around 1988, I believe. Prozac was the first one. Zoloft was the second. When it's works to be helpful, it combats both anxiety and depressive symptoms that people might have. It also has, in some people, an effect of causing a feeling of jitteriness and increasing anxiety. So it's something that does have some potential side effects as well as beneficial effects.
MR. REDDINGTON: And when she was prescribed the original 25 milligrams of Zoloft, did she in fact take that, or did she defer on taking that?
DONALD CONDIE: My recollection of the records is that she had it prescribed, picked it up, but did not take it for at least a couple of weeks because she did not wish to take medication. She was, I believe, still breastfeeding at that time. There are medications, and Zoloft would be one, that would likely appear to some extent in the breast milk.
MR. REDDINGTON: Okay. So because she was worried about that, she held off on that, but ultimately did take the prescription from Dr. Tufts. Is that right?
DONALD CONDIE: The records indicate that she did eventually start taking—
MR. REDDINGTON: Does it indicate—
DONALD CONDIE: ... the 25 milligrams.
MR. REDDINGTON: ... I'm sorry. Does it indicate when she started taking them after that little hiatus?
DONALD CONDIE: To be exact, I'd have to look at the records, but I believe it was at the end of September.
MR. REDDINGTON: And was that dosage increased at some point?
DONALD CONDIE: It increased from 25 milligrams to 50 milligrams.
MR. REDDINGTON: And what happened when Lindsay took the 50 milligrams of Zoloft prescribed by Dr. Tufts?
DONALD CONDIE: The records indicate that she had a rather rapid series of difficulties, that she had insomnia for, I believe the records say 48 hours, couldn't sleep. It's something that would be called activation, that these medications can cause in some people who are more susceptible.
MR. REDDINGTON: Yeah. By mid-October, after she began taking the Zoloft, was it—would you agree that the records indicate a week after starting the medication and increasing the dose, she reported in October to Dr. Tufts what you're relating is that she felt... How did she describe it to Dr. Tufts, if you could... I don't wanna put words in your mouth.
DONALD CONDIE: Well, she felt that she was—she talked about being numb. She talked about not being herself. She talked about feeling worse, not better. Antidepressants usually take at least two to three and frequently four to six weeks to have useful effects. But sometimes side effects can happen very quickly.
MR. REDDINGTON: Did she also indicate, looking at your affidavit, that she was crying all day, she was experiencing mental fog, terrified to start something new, anxiety had gotten much worse? Did she tell that to Dr. Tufts at that time in the end of October?
DONALD CONDIE: Yes, I do recall those things being in the record.
MR. REDDINGTON: All right. And following through again on your affidavit, was there further explanation from Lindsay's recitation of symptomology to Dr. Tufts? Did she further state about racing thoughts, paranoia? What did she say?
MR. REDDINGTON: Look at your report. Look at your affidavit if that helps you refresh your memory.
DONALD CONDIE: I actually don't have the affidavit with me at the moment. I do have some of the records, but—
MR. REDDINGTON: Well, let me just approach you then and hand you your affidavit, paragraph 13, and see if that refreshes your memory.
DONALD CONDIE: Thank you.
DONALD CONDIE: Yes.
MR. REDDINGTON: What did she say to Dr. Tufts?
DONALD CONDIE: She reported—Dr. Tufts reported that Lindsay's psychiatric condition was generally deteriorating. That's a checkbox on one of the forms that her records—
MR. REDDINGTON: What did Lindsay say her symptoms were at that point?
DONALD CONDIE: That she was having the racing thoughts and that she was also feeling, as I said, not like herself. That her depression was worse than it had been. I believe that's also around the time that Dr. Tufts thought of trying a medication called ZULRESSO.
MR. REDDINGTON: ZULRESSO.
DONALD CONDIE: Yes.
MR. REDDINGTON: And what is that? Is that... You need that by way of injection?
DONALD CONDIE: Yeah, ZULRESSO is no longer marketed. It wasn't a particularly successful medication. It requires a 60-hour continuous IV infusion.
MR. REDDINGTON: In a hospital setting or in a medical setting?
DONALD CONDIE: You have to be medically monitored. It doesn't necessarily need to be a hospital, but those are not necessarily things that can be done outside of a hospital.
MR. REDDINGTON: So she didn't do the ZULRESSO though, right?
DONALD CONDIE: She did not. It also costs $34,000 just for the medication, not for the monitoring.
MR. REDDINGTON: Okay.
MR. REDDINGTON: What's the next thing that happened with Dr. Tufts and Lindsay Clancy, sir?
DONALD CONDIE: Well, if I look at my affidavit, the... When she stopped taking the medication, the Zoloft, she now felt better as she had felt before she took the Zoloft. But she was less anxious.
MR. REDDINGTON: What was the next medication?
DONALD CONDIE: She was put on Benadryl and had some difficulty sleeping, but also was worried that night because her son was coughing, and she worried a great deal about the children's health.
MR. REDDINGTON: And that would be something that would also intrude on her sleep, worrying about her children?
DONALD CONDIE: Yes.
MR. REDDINGTON: Okay. What other symptomology, traveling through November into December, did she relate to Dr. Tufts according to your review of the medical records?
DONALD CONDIE: Well, she talked about things like dizziness, feeling sedated in the morning when she woke up, if she got any sleep at all. But—and I think she used the term brain fog at times. These are sometimes symptoms that people who are experiencing postpartum depression frequently complain about. She continued to complain about anxiety.
MR. REDDINGTON: Well, it's not what they're complaining about, it's what they're living, right?
DONALD CONDIE: It is a very unpleasant experience, yes.
MR. REDDINGTON: And continuing on through November, at some point did she leave or stop with Tufts and go to another healthcare provider by way of either emergency room initially and then another healthcare provider?
DONALD CONDIE: Yes.
MR. REDDINGTON: Who was that?
DONALD CONDIE: She started treatment with Rebecca Jollotta, a nurse practitioner at South Shore Perinatal Program.
MR. REDDINGTON: Now, one of the things that was apparent that we, if you recall, I believe, that she also had initially been referred there by a friend of the family. Is that right, to that perinatal clinic?
DONALD CONDIE: Yes. My understanding from the records is that Ms. Clancy's mother-in-law was friendly with a nurse practitioner who practiced in the perinatal program, and I believe had actually started the perinatal program.
MR. REDDINGTON: Yes. And ultimately, or in the beginning, she was treated by a Julie Paul. Is that correct?
DONALD CONDIE: Yes.
MR. REDDINGTON: Do you remember looking at the medical records, and that on November 27th of 2022, the nurse practitioner, Julie Paul, reported that Lindsay stated that she was disassociated, that she was not in touch with reality? Do you remember that?
DONALD CONDIE: Yes.
MR. REDDINGTON: And what... Is that a symptomology? Is that a symptom of psychosis to be disassociated and not in touch with reality?
DONALD CONDIE: It certainly can be. Dissociation, it can mean that people feel like things around them are not real.
MR. REDDINGTON: Right. And that's a pretty serious feeling to have, right?
DONALD CONDIE: It is.
MR. REDDINGTON: And that's pretty common, unfortunately with women that have postpartum psychosis, right?
DONALD CONDIE: It certainly can be, yes.
MR. REDDINGTON: And what are the other symptomologies of postpartum psychosis, sir?
DONALD CONDIE: Well, psychosis in general just means a lack of understanding of what's real as opposed to what is not. So a person with psychosis can have delusions, which are fixed false beliefs. They could believe that, for example, they have been told by God to do something.
MR. REDDINGTON: Okay.
DONALD CONDIE: They can also have hallucinations at times.
MR. REDDINGTON: What kind of hallucinations?
DONALD CONDIE: Most people have auditory hallucinations, not visual hallucinations.
MR. REDDINGTON: Hearing, is that correct? Auditory is hearing, right?
DONALD CONDIE: Yes.
MR. REDDINGTON: Okay. As opposed to what?
DONALD CONDIE: As opposed to visual hallucinations.
MR. REDDINGTON: Visual. And in the course of reviewing the medical records, did you see that in fact that Lindsay had auditory—no, no visual hallucinations, but auditory voices?
DONALD CONDIE: At times, she reported that she had heard a voice, yes.
MR. REDDINGTON: Okay. Do you recall that, as the time went by that she, in December, do you remember seeing in the medical records that she was relating that she was heavy, that she couldn't get out of bed, that she couldn't bathe, that she couldn't react, she couldn't love, she couldn't feel? Do you remember any of that from looking at the medical records?
DONALD CONDIE: Yes, those are all phrases that I recall from the medical records.
MR. REDDINGTON: They were all coming from her, right?
DONALD CONDIE: Yes.
MR. REDDINGTON: To the doctors.
DONALD CONDIE: Yes.
MR. REDDINGTON: That would be Dr. Tufts and then Dr. Jollotta. Is that right?
DONALD CONDIE: Nurse Jollotta.
MR. REDDINGTON: Sorry. Nurse Practitioner Jollotta. You recall, sir, that Nurse Practitioner Jollotta prescribed additional medications to Lindsay during that period of time from November through December?
DONALD CONDIE: Yes.
MR. REDDINGTON: Can you tell us what they were?
DONALD CONDIE: I'd have to look to be sure, but I believe she continued the Benadryl at times. And there was some talk about the use of Buspar, but I believe that was Dr. Tufts.
MR. REDDINGTON: About the what? I'm sorry.
DONALD CONDIE: I said... I'm sorry?
MR. REDDINGTON: What was the word you just used?
DONALD CONDIE: Oh, sorry. Buspar, which is the brand name for buspirone, which is an anti-anxiety medication.
MR. REDDINGTON: Right. How about Remeron? Was there ever a prescription for Remeron?
DONALD CONDIE: Remeron is a different kind of antidepressant, which helps people sleep a little bit and also sometimes helps their appetite. Yes. That was another—
MR. REDDINGTON: The answer is yes, she was prescribed Remeron?
DONALD CONDIE: Yes, she was.
MR. REDDINGTON: And that's an antidepressant?
DONALD CONDIE: It is.
MR. REDDINGTON: Is that marking or similar to, but not exactly the same as the selective serotonin reuptake inhibitors, Zoloft, Prozac, things of that nature, right?
DONALD CONDIE: It's similar in the sense that it has an antidepressant effect. It has some effect on serotonin. It has some effect on the adrenal- adrenergic system as well.
MR. REDDINGTON: The what?
DONALD CONDIE: The adrenergic system. Adrenaline is a neurotransmitter. It's also a hormone that circulates. If you are suddenly scared or something like that, you get a surge of adrenaline. So if you were in a near-miss car accident, you might find yourself shaking because adrenaline will flood into your system from the adrenal glands. But it's also a neurotransmitter, and mirtazapine has some effect on that.
MR. REDDINGTON: And you said mirtazapine. Is that the same as Remeron?
DONALD CONDIE: Yes. Sorry.
MR. REDDINGTON: Okay. So it's just two, two different names. Generic and not generic.
DONALD CONDIE: Mirtazapine is the generic name, and I was taught to use generic names, but—
MR. REDDINGTON: Okay.
DONALD CONDIE: ... Yes, Remeron is.
MR. REDDINGTON: Around this time, Lindsay has been prescribed the Prozac. She had been prescribed the Remeron. She had been prescribed the Benadryl. She had been prescribed other medications very similar to the SSRIs. Is that correct?
DONALD CONDIE: Yes.
MR. REDDINGTON: All right. And does the selective serotonin reuptake inhibitor—that's a fancy word. What does it mean? Isn't that serotonin in your brain? Doesn't it block or in some fashion affect your brain?
DONALD CONDIE: It's a little complicated to explain, but serotonin—
MR. REDDINGTON: Well, explain it. Tell the jury what serotonin means and what happens when you take an SSRI, please.
DONALD CONDIE: Okay. Serotonin in this sense is a neurotransmitter. The brain is a relatively complicated place. It has about 86 billion nerve cells. They've got thousands of connections to each other, but they're not like the wires in your house where you put two pieces of wire together, twist the copper, and then put a nut on that. Nerves don't touch. They go close to each other, but there's a space between them, and that's called the synaptic cleft. One nerve secretes a neurotransmitter into the synaptic cleft, and it moves over to the next nerve in line where there's a receptor. Serotonin does that in the synaptic cleft, but it's also taken back up by the nerve that secreted it as a... So it's reuptaked. So a selective serotonin reuptake inhibitor slows down the reuptake of serotonin, prolonging its activity in the synaptic cleft, which causes the next nerve in line to be activated. I'm sorry that it's so complicated. So that's what serotonin is doing, and that's what a reuptake inhibitor does.
MR. REDDINGTON: When a woman is pregnant or has just had a baby, can you tell me what effect, for example, hormones have when a person has a baby? I know we're two guys, but, I mean, do you know what happens when a woman has a baby?
DONALD CONDIE: I've been at quite a few deliveries, yes.
MR. REDDINGTON: Okay.
DONALD CONDIE: The fact is that many hormones increase. So progesterone is a hormone that many people have heard of. It's a component of birth control pills because it promotes gestation. So progesterone in a birth control pill fools the body into thinking it's pregnant, which means it doesn't—the woman doesn't produce eggs that could be fertilized, and that's the way the birth control pill works, or some of them do. Progesterone goes down very quickly after birth, as do many other hormones that are going up and then down after birth.
MR. REDDINGTON: So if the hormones go up, and if there's an overload, if you will, might be the wrong word, of hormones, what effect does that have on the human body? What effect does that have on a woman who's just had a baby?
DONALD CONDIE: Well, it's quite complicated.
MR. REDDINGTON: Just tell us basically what your feeling is. If they wanna get into it, they can ask, but what effect does it have on a woman that has a baby?
DONALD CONDIE: Well, one of the other hormones that goes up is prolactin. So after the woman gives birth, prolactin promotes lactation, and it's a hormone that increases so that the mother can then breastfeed. These hormones are also seen in all mammals that feed their young through producing milk. So it's a very common mammalian thing to do. But other kinds of things can happen to—
MR. REDDINGTON: Excuse me. Did you say males or mammals?
DONALD CONDIE: Mammals.
MR. REDDINGTON: Okay, 'cause mammals don't breastfeed, right?
DONALD CONDIE: I'm sure they don't, yes.
MR. REDDINGTON: Okay. So, as far as the hormone, again, I would ask when a woman has a baby, and the placenta, I think I pronounced that right, is, you know, through the birth, all of a sudden, what happens? It stops the—that massive influx of hormones, or it increases that influx of hormones?
DONALD CONDIE: Well, some hormones go up, like prolactin, and some hormones go down very quickly.
MR. REDDINGTON: What effect does that have, in your experience, in your education, in your research on women that have a baby? What effect does that have on them?
DONALD CONDIE: Well, many women experience postpartum blues.
MR. REDDINGTON: What is postpartum blues?
DONALD CONDIE: It's a feeling of—
MR. REDDINGTON: ... thing.
DONALD CONDIE: I'm sorry?
MR. REDDINGTON: Sounds like a '50s thing. What's postpartum blues?
DONALD CONDIE: It's a feeling of low energy and being sad, not as serious or usually as long as postpartum depression.
MR. REDDINGTON: What is postpartum depression? Is that the next level?
DONALD CONDIE: It's a more serious condition where the woman may feel that she can't connect to the baby, that she feels isolated. She has no energy. She may also have insomnia.
MR. REDDINGTON: So for example, if a woman is unable to sleep, feels as though she's losing a contact or connection with her infant, is stressing about not having that contact with her infant, feels that she's unable to emote or feel love or any emotions, and can't relate to people, and also is out of reality, are those... Or disassociated state. Are those, in your opinion, symptoms of postpartum depression and/or leading to postpartum psychosis?
DONALD CONDIE: Yes, they are.
MR. REDDINGTON: And Lindsay had those symptoms, didn't she?
DONALD CONDIE: She reported all those symptoms, yes.
MR. REDDINGTON: Doctor, when a doctor like Tufts is meeting with a person and checking the boxes, can that doctor give a blood test to the patient?
DONALD CONDIE: Certainly.
MR. REDDINGTON: Is that important in your opinion that a doctor give a patient, especially a woman who's coming to them for help with these symptoms, give them a blood test?
DONALD CONDIE: Yes.
MR. REDDINGTON: And again, we all know what blood tests are, but just tell me, I mean, is that a simple test? Is it a complicated test?
DONALD CONDIE: It's fairly simple to have blood drawn. And there are many tests that are relevant, particularly after a woman has given birth.
MR. REDDINGTON: Why?
DONALD CONDIE: Well, some women become anemic. Depends on how much blood loss might have occurred during birth, but there's usually some blood loss. So checking hemoglobin levels is important. The thyroid can be affected by delivery of the baby, and some women in the postpartum period develop inflammation of the thyroid. The thyroid is a very important gland that regulates many parts of the body.
MR. REDDINGTON: Is that why many times when a competent psychiatrist is treating a patient that is postpartum after having a baby, that they might run, and I may be wrong saying it, but a thyroid test?
DONALD CONDIE: They would do most commonly two different kinds of thyroid tests. They would test for thyroid-stimulating hormone, which goes up when the thyroid hormones that also can be tested for actually go down. So thyroid-stimulating hormone is telling the body, "Make more thyroid hormone because there's not enough in the circulation."
MR. REDDINGTON: Did Tufts ever use a blood test at all in her treatment?
DONALD CONDIE: No, she did not.
MR. REDDINGTON: Did Tufts ever check the thyroid levels of Lindsay Clancy at all during her treatment?
DONALD CONDIE: No, she did not.
MR. REDDINGTON: How about Jollotta? Did they test any of those things?
DONALD CONDIE: No, Nurse Jollotta did not do blood testing either.
MR. REDDINGTON: Now, you've made reference, sir, to postpartum depression, postpartum psychosis. You're familiar with the DSM, what is referred to as DSM's...
DONALD CONDIE: 5-TR?
MR. REDDINGTON: Diagnostic Statistical Manual on Mental Disorders. 5, you said TR. That would be right. Do you mean text revision?
DONALD CONDIE: Correct.
MR. REDDINGTON: All right. And I'm approaching you with this and asking, you see that section there?
DONALD CONDIE: Yes.
MR. REDDINGTON: And what is that section?
DONALD CONDIE: The bipolar and related disorder section.
MR. REDDINGTON: What is bipolar disorder? What does that mean?
DONALD CONDIE: Bipolar is the newer name for what used to be called manic depressive illness. It describes an illness where people's moods go up, which is the manic phase, and then go down, which is the depressed phase. There are different categories of bipolar disorder. Bipolar I is the most serious. Bipolar II disorder also has similar fluctuations of mood, but in both cases of bipolar disorder, most people spend more time being depressed than they do being manic.
MR. REDDINGTON: Now, just tell me, what does manic mean? What does that actually mean?
DONALD CONDIE: They feel usually euphoric, that they don't have—
MR. REDDINGTON: That they're up?
DONALD CONDIE: You're really up.
MR. REDDINGTON: Okay.
DONALD CONDIE: You're extremely optimistic. You might spend a lot of money foolishly. But you wouldn't worry about that because certainly you're going to win the lottery. You can just feel it. So there can be psychotic thoughts along with bipolar mania, unreasonable expectations, like I said, that you're destined to win the lottery or, in serious cases, you can believe that God is speaking to you and has appointed you to do some special thing in life.
MR. REDDINGTON: But how about excessive cleaning and, let's say divesting oneself of personal property, cleaning garages, things of that nature?
DONALD CONDIE: There was talk in the records of an episode where Ms. Clancy and her husband cleaned out the garage, but it was difficult to tell from the records whether or not that represented—
MR. REDDINGTON: How about exercise?
DONALD CONDIE: ... what we would call a hypomanic episode.
MR. REDDINGTON: How about exercise? Was there a lot of references to exercise?
DONALD CONDIE: There were a lot of records, references to exercise. And exercise can be a very useful thing.
MR. REDDINGTON: Sure. That's one of the things that a woman in postpartum may very well be prescribed to do by a doctor or a nurse practitioner like Jollotta, right?
DONALD CONDIE: I believe that nurse practitioner Julie Paul recommended a long run at one point.
MR. REDDINGTON: So there's nothing wrong with a woman going to, let's say, Kingsbury or whatever it is, or taking her kids to the local gym, with a swimming pool and trying to get some exercise in the postpartum stage. That doesn't... That's something you wouldn't hold against her, right?
MR. REDDINGTON: Okay. Now, how about, are you aware that within a very short period of time after she had baby Callan, that she actually ran a road race?
DONALD CONDIE: Yes.
MR. REDDINGTON: Is that indicative of a person that's kinda ramped up and then doing these things you're talking about?
DONALD CONDIE: It's unusual to decide to run so soon after delivering a baby. I believe that she ran on the day that she might have delivered her last child, Callan.
MR. REDDINGTON: That's correct. So during the month of December, in your review of the records, would you agree that her symptoms that she has related to the doctors that were there to help her, they basically increased, did they not?
DONALD CONDIE: I'm sorry, I couldn't quite hear.
MR. REDDINGTON: They increased.
DONALD CONDIE: They... Yes.
MR. REDDINGTON: And are you aware that then she went somewhere voluntarily in December?
DONALD CONDIE: Yes.
MR. REDDINGTON: Where?
DONALD CONDIE: She went to the Mass General emergency room on... I believe that was in December. She'd gone to the South Shore emergency room previously.
MR. REDDINGTON: And did you, in the records, see that in fact she had gone to Women and Infants program in Rhode Island for a day?
DONALD CONDIE: Yes.
MR. REDDINGTON: And are you familiar with that particular establishment? Is that a... supposedly helps pregnant women?
DONALD CONDIE: Yes. I reviewed those records as well.
MR. REDDINGTON: And do you know why she was discharged after a day?
DONALD CONDIE: The records stated that they thought that she was having complications from medications more than she was suffering from postpartum issues and therefore was not a good candidate for their program.
MR. REDDINGTON: And this was after getting there at 8:00 in the morning and leaving there around 4:00 in the afternoon, right?
DONALD CONDIE: That's my understanding, yes.
MR. REDDINGTON: And the records indicate, if you read them, that during that period of time, there were little group discussions and coloring sessions and things like that. Is that correct?
DONALD CONDIE: Yes.
MR. REDDINGTON: You know that there are suicide hotlines that people are told to call, right?
DONALD CONDIE: Yes.
MR. REDDINGTON: Especially if a woman is in postpartum and is experiencing these difficulties and is describing the symptomology and on all these medications that if you feel like you're gonna kill yourself, you're supposed to call a telephone number, right?
DONALD CONDIE: Well, it wouldn't be the advice I would give, but that was some advice that was given, yes.
MR. REDDINGTON: And did she call, to your knowledge from reviewing the records, to telephone?
DONALD CONDIE: She called the Aspire hotline, I believe on two occasions.
MR. REDDINGTON: And was she given any help by the Aspire hotline?
DONALD CONDIE: I believe the records say that she was told by Aspire that since she did not have a suicide plan, she did not require what's called a higher level of care, meaning an in-patient admission.
MR. REDDINGTON: So she basically had been to Nurse Jollotta. She had contacted Aspire on two occasions. She went to Rhode Island Hospital on a recommendation the day after she was recommended to go there, and left after not being accepted. After calling the suicide hotlines, things got to the point where she and her husband went to an emergency room. Is that right?
DONALD CONDIE: Yes.
MR. REDDINGTON: And did they get treatment at the... Did she get treatment at the emergency room?
DONALD CONDIE: I believe the first time that she went to the Mass General Emergency Room, they recommended that she consider an admission at McLean. But she and her husband decided that they did not want her to go in-patient at that time.
MR. REDDINGTON: How about the next time she went to the emergency room?
DONALD CONDIE: The next time she went to the emergency room, which was not very long after, she was admitted to McLean.
MR. REDDINGTON: McLean Hospital. And that would be the—
DONALD CONDIE: McLean Hospital.
MR. REDDINGTON: ...that would be the locked wards for a period of about four days, correct?
DONALD CONDIE: Yes.
MR. REDDINGTON: In reference to the bipolar disorder that we touched upon, sir, is that something that's a consideration when you're treating, as a psychiatrist, a woman who's coming to you for help and expressing concerns about the symptoms that we've talked about?
DONALD CONDIE: Yes.
MR. REDDINGTON: Why?
DONALD CONDIE: Well, some people with bipolar disorder, especially given the fact that depression is a prominent symptom in bipolar disorder, become suicidal, and can even commit suicide. So that's a very serious possibility that has to be considered.
MR. REDDINGTON: Did any of the nurse practitioners consider that as a possible diagnosis?
DONALD CONDIE: The records indicate that Ms. Clancy was frequently asked if she had a plan to kill herself, even after she reported having what was called passive suicidal ideation. But it was reported very, very frequently in the records.
MR. REDDINGTON: And in reference to her treatment with Nurse Practitioner Jollotta, did, to your knowledge, Nurse Practitioner Jollotta consider as a secondary diagnosis or a working diagnosis the possibility of bipolar disorder?
DONALD CONDIE: Yes.
MR. REDDINGTON: Was anything followed through on that?
DONALD CONDIE: I believe she discussed the possibility of a mood stabilizer. But I believe that she then ended up using Seroquel or quetiapine, which is—
MR. REDDINGTON: That would... That's Seroquel and quetiapine with a Q, right?
DONALD CONDIE: I'm sorry?
MR. REDDINGTON: Seroquel and quetiapine with a Q.
DONALD CONDIE: Q—quetiapine with a Q, yes.
MR. REDDINGTON: ...using the two words again. I just wanna make sure it's clear.
DONALD CONDIE: Seroquel is the brand name. Quetiapine is the generic name.
MR. REDDINGTON: All right. And did she, meaning Lindsay, to your knowledge in the medical records dealing with these providers, complain about the effect that Seroquel had on her?
DONALD CONDIE: Yes.
MR. REDDINGTON: And what did she say? What were the symptoms or what did she feel?
DONALD CONDIE: Well, she often felt spacey, as if she was not her normal self. She felt... It's fairly commonly reported that she felt hungover in the morning because these medicines, that particular medicine does make people somewhat sleepy. I believe the beginning doses were described as a sleeping dose, which is a very low dose of the medication that does in fact help sleep to some extent.
MR. REDDINGTON: Was the Seroquel ultimately increased to 400 milligrams a day, 200 milligrams a day? Do you recall that?
DONALD CONDIE: Yes. It started at 25 and—
MR. REDDINGTON: It was bumped up pretty significantly, wasn't it?
DONALD CONDIE: Yes. 400's a lot more than 25.
MR. REDDINGTON: And she was complaining about the effect of the Seroquel. Is that correct?
DONALD CONDIE: She was.
MR. REDDINGTON: And she was complaining about the fact that she couldn't sleep. All those symptoms that we went through continued on through the month of December after McLean. She went there for the New Year's period. I know. I'm almost there. She went to the McLean for treatment and still complained of these symptoms. Is that correct?
DONALD CONDIE: Yes.
MR. REDDINGTON: Did the symptoms ever resolve themselves for Lindsay in January, if you know?
DONALD CONDIE: There were times when she appeared to be a little less distressed, but the symptoms were never completely resolved, no.
MR. REDDINGTON: And did you know that she went to see Dr. Jennifer Tufts in January 9th and that she was prescribed diazepam?
DONALD CONDIE: Yes.
MR. REDDINGTON: And then on the 12th, she was prescribed trazodone, 150 milligrams, by Dr. Tufts.
DONALD CONDIE: Yes.
MR. REDDINGTON: January 16th, two milligrams of diazepam by Dr. Tufts. January 16th, the same day, 10 milligrams of amitriptyline by Dr. Tufts.
DONALD CONDIE: Yes.
MR. REDDINGTON: What is amitriptyline?
DONALD CONDIE: Amitriptyline is one of the older types of antidepressants. It's what's called a tricyclic antidepressant. It has more side effects, but one of the useful side effects in some cases is that it makes people sleepy.
MR. REDDINGTON: Did it help her sleep?
DONALD CONDIE: Not really.
MR. REDDINGTON: Now, in reference to the DSM, out of that revision, you agree with me that they have DSM-I, DSM-II, Revised, Pre-Published, Reconsidered DSM-III, all the way up to DSM-V Text Revision, right?
DONALD CONDIE: Correct.
MR. REDDINGTON: And consisting of over 1,000 pages, right?
DONALD CONDIE: Yes.
MR. REDDINGTON: Is this, like, considered, some people say, the bible of psychiatry, or is it like a cookbook?
DONALD CONDIE: I would call it a dictionary. It's a list of definitions.
MR. REDDINGTON: If I looked under P in this dictionary, would it contain anything about postpartum psychosis for a woman?
DONALD CONDIE: There is one mention on page 148.
MR. REDDINGTON: That's it?
DONALD CONDIE: That's it.
MR. REDDINGTON: The rest of the world, they don't care about the DSM. They have some other—
DONALD CONDIE: Yes.
MR. REDDINGTON: ... information, right? What is that called?
DONALD CONDIE: The World Health Organization publishes something called the International Classification of Disease, which is now in its 11th edition. It lists postpartum psychosis as a separate entity. And that's the one that insurance companies use for billing purposes.
MR. REDDINGTON: Right, not this.
DONALD CONDIE: Correct.
MR. REDDINGTON: Are you familiar, sir, with the way other countries treat pregnant women in postpartum condition when they seek—let me finish. When they see a doctor for medical treatment, yes or no?
MS. BUCKINGHAM: Objection.
THE COURT: All right, just I'll allow that question, then we'll...
DONALD CONDIE: Yes.
MR. REDDINGTON: And how does that differ from the United States of America?
MS. BUCKINGHAM: Objection.
THE COURT: Sustained.
MR. REDDINGTON: Go ahead.
THE COURT: All right. Commonwealth.
MS. BUCKINGHAM: Good afternoon.
DONALD CONDIE: Afternoon.
MS. BUCKINGHAM: You spent some time, when you first got to the stand, going over your qualifications, and I think counsel now has admitted your curriculum vitae into evidence, right?
DONALD CONDIE: I'm sorry, I didn't hear the last part.
MS. BUCKINGHAM: Your curriculum vitae—
DONALD CONDIE: Yes.
MS. BUCKINGHAM: ... you went through that with counsel, you recall that?
DONALD CONDIE: Yes.
MS. BUCKINGHAM: And fair to say the majority of the entries in your experience and your presentations, and your teaching, and fellowships, most of which revolve around child and adolescent psychiatry, correct?
DONALD CONDIE: I wouldn't say the majority.
MS. BUCKINGHAM: Well, where in your CV does it say that you worked with postpartum women?
DONALD CONDIE: It doesn't say that specifically.
MS. BUCKINGHAM: Okay. So your testimony is that back in 1983 when you were at the—was it the Massachusetts, sorry, Mental Health Center—you worked with the postpartum women, is that correct?
DONALD CONDIE: There were patients who had—either were pregnant while they were there or delivered and were hospitalized after that, yes.
MS. BUCKINGHAM: Okay. And your involvement in this case, with counsel, with defense counsel, wasn't directly that he reached out to you, was it? It was that you had provided some information as it pertains to a civil lawsuit that's pending.
DONALD CONDIE: That's correct.
MS. BUCKINGHAM: Okay. And so this affidavit that counsel's been referring to that you drafted, you revised it for these proceedings, but fair to say you went through a series of records that didn't include anything related to this criminal case, meaning no police reports, interviews, photos from the scene. Is that fair to say?
DONALD CONDIE: No police reports, no photos from the scene.
MS. BUCKINGHAM: So the majority of what you reviewed pertained to medical records, right?
DONALD CONDIE: Yes.
MS. BUCKINGHAM: And in fact, you cite, too, in your affidavit a New Yorker article for facts.
DONALD CONDIE: Yes.
MS. BUCKINGHAM: That's where you got most of your facts is from a New Yorker article?
DONALD CONDIE: No, I also spoke to Mr. Clancy.
MS. BUCKINGHAM: You spoke to Mr. Clancy?
DONALD CONDIE: Yes.
MS. BUCKINGHAM: Is that in your affidavit?
DONALD CONDIE: Uh...
MS. BUCKINGHAM: Well, you have it before you. Can you point to a paragraph where you indicate that you got a report directly from Mr. Clancy?
DONALD CONDIE: I don't know if it's in the affidavit.
MS. BUCKINGHAM: Okay.
DONALD CONDIE: But I did interview Mr. Clancy for 90 to 100 minutes.
MS. BUCKINGHAM: Now, in relation to kind of going through the medical treatment, you indicate that the defendant reported that she was hesitant about taking medications. Do you recall that in paragraph 11?
DONALD CONDIE: Yes.
MS. BUCKINGHAM: But you're aware that she sought out a psychiatrist, not a therapist, not a psychotherapist or a psychologist. She sought a psychiatrist as her first contact in the postpartum period, correct?
DONALD CONDIE: Correct.
MS. BUCKINGHAM: And psychiatrists presumably prescribe medications and don't necessarily offer psychotherapy, do they?
DONALD CONDIE: Well, all psychiatrists are trained to do psychotherapy, to some extent at least. But yes, they can also prescribe medication.
MS. BUCKINGHAM: And through the records you learned that the defendant did have reactions to low dose of Zoloft. And you—your testimony is that a blood test would have helped. Is that your testimony?
DONALD CONDIE: Yes.
MS. BUCKINGHAM: So a blood test that's about four or five months postpartum, how is that gonna help prescribers?
DONALD CONDIE: Well, the blood test I was thinking of was, you could do a level of the antidepressant in her blood, and that would tell you whether it was average, expected given the dose, or too high or too low.
MS. BUCKINGHAM: And that would yield results if a person's only been taking medication for less than a week?
DONALD CONDIE: Yes.
MS. BUCKINGHAM: But you indicate that over a period of four to six weeks is when you would expect to see a medication start to take effect, correct?
DONALD CONDIE: It sometimes takes that long, yes.
MS. BUCKINGHAM: Now, you also spoke a little bit about Zulresso. You're aware from reviewing the records of Jennifer Tufts that she researched Zulresso and spoke about Zulresso, but never made a recommendation to the defendant that she do that injection?
DONALD CONDIE: Yes.
MS. BUCKINGHAM: You also describe that by November 21st, that the defendant was experiencing, suggesting symptoms of mania, like racing thoughts. But in fact, the criteria is not just racing thoughts, it's racing thoughts, pressured speech, correct?
DONALD CONDIE: There are a number of criteria that are listed, but racing thoughts is one of them, yes.
MS. BUCKINGHAM: Okay.
DONALD CONDIE: And-
MS. BUCKINGHAM: And you also list, or you identify in your affidavit extreme insomnia, but for mania, it's not just insomnia, it's that there's insomnia with a decreased need for sleep, correct?
DONALD CONDIE: It can be a decreased feeling that you need to sleep even if you didn't sleep for several days, but it's also true that some people feel very tired.
DONALD CONDIE: It's not just one or the other.
MS. BUCKINGHAM: ... you're aware that the defendant denied a decreased need for sleep around that time period in November, from the records, aren't you?
DONALD CONDIE: In that period, yes.
MS. BUCKINGHAM: Okay. You also indicated that in reviewing records pertaining to, I think you noted Jennifer Tufts, that her notes were a series of check, or the record was a series of check boxes, right? That was your testimony.
DONALD CONDIE: There are a few sentences, but they are mostly check boxes, yes.
MS. BUCKINGHAM: And fair to say the way in which those notes are created, there are several areas in which notes are placed at different points in those records?
DONALD CONDIE: There are notes at certain places, yes.
MS. BUCKINGHAM: And those notes are reflective of statements that the defendant was making about her mood and how she was feeling and symptoms, correct?
DONALD CONDIE: Yes.
MS. BUCKINGHAM: Those are all important things for a treating psychiatrist to consider when they're considering a patient's overall presentation. Is that fair to say?
DONALD CONDIE: Yes, fair to say.
MS. BUCKINGHAM: Now, you also reference in your affidavit that the defendant had reported that she had these increased symptoms with Zoloft and didn't sleep for 48 hours after increasing the dose. Remember that in the record?
DONALD CONDIE: Yes, from twenty-five to fifty.
MS. BUCKINGHAM: And you didn't review any police reports to identify that there were only seven pills missing from that bottle of sertraline, did you?
DONALD CONDIE: I did not review a police report, no.
MS. BUCKINGHAM: So if a person takes seven pills over a one-week period at twenty-five milligrams, how do they increase the dose without more pills missing from the bottle?
DONALD CONDIE: Well, I believe if you took three or four pills for a few days of twenty-five, then you still would have enough pills to take two twenty-fives and increase the dose to fifty.
MS. BUCKINGHAM: Right. But if a prescription reads that if thirty are filled, and only seven are missing from the pill bottle when it's located months later, then if you've taken seven pills, you've taken one pill each day, correct?
DONALD CONDIE: Not necessarily. I believe that she stopped taking the medication rather quickly, and I'm not sure which pill bottle you're discussing because, as you said, I didn't review a police report.
MS. BUCKINGHAM: Okay.
MS. BUCKINGHAM: Now, you're aware that on December 15th that the defendant and her husband reported that she was having persistent intrusive thoughts that day, correct?
DONALD CONDIE: Yes.
MS. BUCKINGHAM: And that's the day she first presented to Mass General Hospital?
DONALD CONDIE: Yes.
MS. BUCKINGHAM: And you're aware that Mass General Hospital is directly affiliated with McLean Hospital, right?
DONALD CONDIE: They are affiliated, yes.
MS. BUCKINGHAM: And that she was advised to go to the inpatient program, and she chose not to go?
DONALD CONDIE: Yes.
MS. BUCKINGHAM: From reviewing the records, did you see how Latiesha Dukes, a social worker, or a mental health worker, excuse me, from the South Shore Perinatal Behavioral Health Clinic, had previously had discussions with the defendant about going to Women and Infants before her presentation to the Mass General ER on December 15th?
DONALD CONDIE: Yes.
MS. BUCKINGHAM: And she didn't, in fact, go to that program until December 20th. Is that fair to say?
DONALD CONDIE: Yes.
MS. BUCKINGHAM: Now, you also mention in your review of the medications, lamotrigine. You recall that?
DONALD CONDIE: Yes.
MS. BUCKINGHAM: And that was a medication that was prescribed to the defendant in December of 2022, correct?
DONALD CONDIE: Correct.
MS. BUCKINGHAM: You're aware that she never took lamotrigine?
DONALD CONDIE: I believe that's what she said, yes.
MS. BUCKINGHAM: Now, you also were asked, or you spoke about Seroquel. So you're familiar with the prescriptions, or the—what was prescribed of the Seroquel over the period of time from November 30th through early December, correct?
DONALD CONDIE: Yes.
MS. BUCKINGHAM: You've reviewed that. And so I think you testified on direct examination that the initial dose was a low dose, 25 milligrams?
DONALD CONDIE: Correct.
MS. BUCKINGHAM: And you're familiar, that is a fairly common dosage, a low dose to prescribe to address some sleep issues?
DONALD CONDIE: It is, yes.
MS. BUCKINGHAM: And you're aware that for people who are suspected or have bipolar disorder, that the levels of prescribed are generally much higher than 25 milligrams, right?
DONALD CONDIE: Yes, they would be.
MS. BUCKINGHAM: They could range anywhere from 100 milligrams to up to—well, what is the range, if you know?
DONALD CONDIE: It would go up to 800 milligrams.
MS. BUCKINGHAM: And so in this circumstance, you're aware that Rebecca Jollotta had suspicions about bipolar disorder, right?
DONALD CONDIE: She mentions it as a distinct possibility, yes.
MS. BUCKINGHAM: And without relief, she recommends titrating or going up on the Seroquel over a period of time, right?
DONALD CONDIE: Yes.
MS. BUCKINGHAM: And you settled on a number of 400. But you know from the records that that was the goal, to titrate up to 400 milligrams. Do you know if the defendant ever took 400 milligrams?
DONALD CONDIE: I do not.
MS. BUCKINGHAM: And you're also aware that once the defendant started reporting having symptoms and concerns about the Seroquel, that she had requested to taper off the Seroquel, correct?
DONALD CONDIE: Yes.
MS. BUCKINGHAM: And you're aware that prior to her presentation at McLean Hospital, that Rebecca Jollotta actually did send in a prescription that would allow for her to taper down?
DONALD CONDIE: Yes.
MS. BUCKINGHAM: And when the defendant was admitted to McLean Hospital on January 1st, she was already on a taper plan?
DONALD CONDIE: Yes.
MS. BUCKINGHAM: Meaning she had gone back down to approximately 100 milligrams per night?
DONALD CONDIE: I believe she was, yes.
MS. BUCKINGHAM: And that at McLean, they further immediately started to reduce the dosage with each night?
DONALD CONDIE: I believe that was the plan at McLean, yes.
MS. BUCKINGHAM: So the first night she was there, she went down to 75 milligrams, correct?
DONALD CONDIE: I believe that's correct, yes.
MS. BUCKINGHAM: And then by the time she was discharged, she was at zero?
DONALD CONDIE: Yes, and they were talking about the amitriptyline.
MS. BUCKINGHAM: Well, did she leave McLean Hospital with a prescription for amitriptyline?
DONALD CONDIE: I don't know if she left with a prescription, but it was discussed in the records that they recommended that.
MS. BUCKINGHAM: And as of January 12th of 2023, you're aware that the only active prescriptions for the defendant were for amitriptyline, right?
DONALD CONDIE: Yes.
MS. BUCKINGHAM: And Valium as needed, and trazodone?
DONALD CONDIE: That sounds correct, yes.
MS. BUCKINGHAM: So throughout the course of your review of the records and all of the different medications that she was on, from October through January, she wasn't on all the medications at the same time, correct?
DONALD CONDIE: No, not at the same time.
MS. BUCKINGHAM: And it's fair to say she was only on maybe three medications at one time?
DONALD CONDIE: Three, there might have been four at one point, but yes.
MS. BUCKINGHAM: And she had expressed a particular medications that she wished to return to, like Ativan at some point, correct?
DONALD CONDIE: She was quite ambivalent about Ativan, and talked a great deal in the records about being worried that she was addicted to it.
MS. BUCKINGHAM: But Ativan tended to work for her, correct?
DONALD CONDIE: It made her feel less anxious, yes.
MS. BUCKINGHAM: And she actually described that at certain points to the providers that when she felt intrusive thoughts or she had a bad experience, that she took the Ativan and the thoughts were gone. Didn't she note?
DONALD CONDIE: I'm not sure that she said the intrusive thoughts were gone, but she would feel less anxious when she took it.
MS. BUCKINGHAM: And as far as your conversations about hallucinations and auditory hallucinations, you indicated that at some point, or at points, I think was your testimony, that the defendant did hear a voice. But you're aware that she never reported to Jennifer Tufts that she heard a voice?
DONALD CONDIE: She did not.
MS. BUCKINGHAM: She never reported to Rebecca Jollotta that she heard a voice, did she?
DONALD CONDIE: She did not.
MS. BUCKINGHAM: She never reported to Latiesha Dukes that she heard a voice?
DONALD CONDIE: She did not.
MS. BUCKINGHAM: And the only time she's ever said that she heard this voice was on January 24th of 2023. Is that fair to say?
DONALD CONDIE: Correct.
MS. BUCKINGHAM: Thank you. Nothing further.
MR. REDDINGTON: Excuse me, so when the district attorney asks you whether or not Lindsay, after all the symptoms that we've already gone through, told Rebecca Jollotta that she heard a voice, told Dr. Tufts that she heard a voice and denied that she heard a voice. Would you agree that there are reasons that a woman would not tell the doctor or minimize their symptoms out of fear?
DONALD CONDIE: Yes.
MR. REDDINGTON: What kind of fear? Fear of what?
DONALD CONDIE: Well, in the records it's stated that Ms. Clancy reported she was worried that her children would be taken away from her, perhaps by the Department of Children and Families if she reported very severe symptoms. The other thing is, as a healthcare professional, boards of registration sometimes take a dim view of people who have been in treatment for certain psychiatric illnesses. And so, she might have been concerned about her nursing license, but that's speculation.
MR. REDDINGTON: So there are other reasons why a person may be concerned about telling healthcare providers, mandated reporters, that they're hearing voices, correct?
DONALD CONDIE: Yes.
MR. REDDINGTON: Would you agree with me that you don't have to see the proverbial unicorn in the corner to your health provider to be suffering from psychosis?
DONALD CONDIE: Yes, that's true.
MR. REDDINGTON: And can you tell us, counsel was asking about the symptomology, psychosis. Is that something that just grinds on for day after week after month, or is that something that comes on out of nowhere very quickly?
MS. BUCKINGHAM: Objection.
THE COURT: No, overruled.
DONALD CONDIE: It can be quite episodic.
MR. REDDINGTON: What does that mean?
DONALD CONDIE: It means that an episode can start and stop, and then an interval of time goes by. It could be days, weeks, or months. And then another episode occurs.
MR. REDDINGTON: Counsel asked you about bipolar disorder, the suspicions of bipolar disorder from Dr. Jollotta, and then talked about the prescriptions that were prescribed. Is it, in your opinion, appropriate to prescribe a selective serotonin reuptake inhibitor to a person that is bipolar?
MS. BUCKINGHAM: Objection. Beyond the scope.
THE COURT: No, overruled.
DONALD CONDIE: It would be considered something to be done cautiously and usually with a mood stabilizer begun at the same time to prevent the possibility of making manic symptoms worse.
MR. REDDINGTON: Thank you, sir.
THE COURT: Buckingham.
MS. BUCKINGHAM: So just briefly, you didn't interview the defendant, did you?
DONALD CONDIE: I did not.
MS. BUCKINGHAM: You don't know what she was concerned about. You're speculating.
DONALD CONDIE: Yes.
MS. BUCKINGHAM: And for a person who's begging for help, wouldn't it be important to be honest with the providers about what you're feeling, seeing, and hearing?
DONALD CONDIE: It should be, but that's not always what doctors find.
MS. BUCKINGHAM: Nothing further.
THE COURT: All right. Anything further?
MR. REDDINGTON: No, thank you, Judge.
THE COURT: All right. Thank you, Doc. You may step down. Thank you.
THE COURT: Could I see you sidebar again scheduling?
THE COURT: All right. So members of the jury, what we're going to do is we're gonna break at this point till 2:00. All right? And much of the next longer break will be trying to resolve the technology issue that we had. And so, if it's resolved, we may call one witness. If it's not, we'll call another witness. So, but, so we're gonna try and get that all done during the break. So with my skills and technology, that's why we probably need a little bit longer than just the hour. So, be, we'll ex- in recess till 2:00. We'll come back in for the next witness. Okay. Thank you.
BAILIFF: All rise, please. Jurors exiting.
BAILIFF: Jurors have exited the courtroom.
THE COURT: All right. So counsel, anything we need to discuss before the break? All right, so we'll come back at 2:00. We'll be in recess till 2:00, and we have one of two different witnesses, depending on how things work out over the break.
MR. REDDINGTON: Yep. We can go all day. No problem.
THE COURT: All right. Thank you.
MR. REDDINGTON: Thank you.