4.Gregory Saathoff — Direct (Part 1)

GREGORY SAATHOFF: I do.

GREGORY SAATHOFF: Good afternoon.

GREGORY SAATHOFF: Yes. First name is Gregory.

GREGORY SAATHOFF: G-R-E-G-O-R-Y. Last name Saathoff. S-A-A-T-H-O-F-F.

GREGORY SAATHOFF: Yes. I received my undergraduate degree at the University of Notre Dame, and then my medical degree, my MD, at the University of Missouri, and then my residency in psychiatry at the University of Virginia.

GREGORY SAATHOFF: Yes. I'm a professor of Emergency Medicine and Public Health Sciences at the University of Virginia. I also see patients in the Virginia Department of Corrections, where I also teach students. Then I also serve as the senior psychiatrist for the FBI's Behavioral Analysis Unit in Quantico.

GREGORY SAATHOFF: Since 1996.

GREGORY SAATHOFF: Well, certainly for the FBI writ large, there are psychiatrists who work with them. But as for the Behavioral Analysis Unit at Quantico, we sometimes have Walter Reed fellows who are psychiatrists. But other than that, I am the psychiatrist for the Behavioral Analysis Unit.

GREGORY SAATHOFF: It entails working with the behavioral analysis units on crimes and concerns, whether it is with children. I'm occasionally asked to consult with the behavioral analysis unit relating to children, crimes against children, also crimes against adults, and also national security issues and in particular issues relating to threat assessment.

GREGORY SAATHOFF: A psychiatrist, yes.

GREGORY SAATHOFF: Well, a forensic psychiatrist is—examines issues with mental illness, and it's really the interface of mental illness and the law. Sometimes that can involve criminality. Most often forensic psychiatrists are engaged in assessing mental status at the time of an offense or competency. But also forensic psychiatrists can consult institutions or also treat patients within facilities such as jails and prisons.

GREGORY SAATHOFF: Yes.

GREGORY SAATHOFF: Yes.

GREGORY SAATHOFF: Maybe forty to forty-five times, something like that.

GREGORY SAATHOFF: No.

GREGORY SAATHOFF: Well, when I finished my residency, I was interested in public psychiatry, and so I also was in the military. And so military psychiatry and public psychiatry in a teaching hospital was very important to me. As time went on, I was consulted by the FBI. They wanted to meet with me based upon a paper that I had published. And by the time I was more heavily involved in forensic psychiatry and particular assessment of individuals, by that point, the way to be board-certified within forensic psychiatry would require a one-year fellowship. And at that point in my life, I just did not have the time to be able to devote to a one-year fellowship in addition to the other things that I was doing.

GREGORY SAATHOFF: Yes.

GREGORY SAATHOFF: Yes, I have. And let me just say also in addition to on-the-job experience, it's important to get teaching and training. And so I've taken advantage of courses within the Institute for Law, Psychiatry and Public Policy at the University of Virginia and other opportunities as well in terms of even taking a board review course that was very helpful and quite comprehensive.

GREGORY SAATHOFF: Yes.

GREGORY SAATHOFF: I'm sorry. Can you repeat that?

GREGORY SAATHOFF: Yes. Well, specifically, most of my work has been with the Virginia Department of Corrections rather than the Bureau of Prisons. And since nineteen ninety-two, I guess, maybe thirty-four years, I have assessed and treated patients within the prison system, both men and women at men and women's facilities. And in that time, I have brought medical students and residents and fellows and taught them. So over the course of my career thus far, I've brought more than twenty-five hundred medical students and residents into the prison system to learn about psychiatry and significant mental illness.

GREGORY SAATHOFF: Yes.

GREGORY SAATHOFF: Well, in consulting to a maximum security women's prison, I would say—

GREGORY SAATHOFF: Five to seven women who had killed their children.

GREGORY SAATHOFF: Correct.

GREGORY SAATHOFF: Treatment involved working with a team within the system. Prisons have psychologists and social workers and those who are responsible for working with patient inmates. Medication treatment is very important. But also there are important therapeutic aspects. For a number of years I ran a group in prison as I felt that that was important and my students felt that that was important as well.

GREGORY SAATHOFF: It was a therapy group in which individuals were brought together, all who had... were diagnosed with a significant mental illness, and being able to speak about their experience. And also how to deal with issues or how they dealt with issues over and above the medications that they were receiving.

GREGORY SAATHOFF: Yes, very much so.

GREGORY SAATHOFF: Thousands. I spent 15 years running an inpatient admissions unit in a teaching state hospital, and so—

GREGORY SAATHOFF: Yes.

GREGORY SAATHOFF: It was a state hospital in Virginia, near Charlottesville, Virginia, where the University of Virginia is. It was a teaching hospital with medical students and residents, and was a facility that dealt with some of the most severely mentally ill individuals who would've been committed to the hospital.

GREGORY SAATHOFF: Fifteen years.

GREGORY SAATHOFF: I saw them there, yes. But also within the prison system, and of course during training during my residency.

GREGORY SAATHOFF: Yes.

GREGORY SAATHOFF: An article—we published an article in 1987 relating to two cases of postpartum psychosis that I actually saw when I was an intern. One was my patient, and one was one that I consulted on.

GREGORY SAATHOFF: Yes.

GREGORY SAATHOFF: So bromocriptine, at that time, was a medication that was used to inhibit or to stop lactation. Some women would, after birth, make a decision, for whatever reason, that they were not able to breastfeed. And so in those days, this medication, bromocriptine, was used to inhibit lactation.

GREGORY SAATHOFF: Yes.

GREGORY SAATHOFF: Yes.

GREGORY SAATHOFF: Yes. And let me just emphasize, I was one of five authors of that article.

GREGORY SAATHOFF: Yes. The FDA took it off the market, I believe in 1994 or 1995. Not just for the reason of postpartum psychosis, but also for other problems, cardiac problems and the rest that bromocriptine sometimes caused in people.

GREGORY SAATHOFF: I'm sorry, can you ask that question again?

GREGORY SAATHOFF: That's my understanding. There were a few letters to journals commenting about bromocriptine and a connection. But I think the first article that was written was ours, that we wrote about the two, the two women who suffered postpartum psychosis.

GREGORY SAATHOFF: Well, psychosis is... It can take a number of forms. I think we most often think about people who are psychotic as having hallucinations. And so we call those perceptual disturbances. That it's oftentimes auditory hallucinations, so people hearing voices or sounds. But they also can be other types of hallucinations as well. Not as common in psychosis, such as visual hallucinations, or even what we call tactile hallucinations, where the sense of touch is affected, or olfactory hallucinations. Most commonly it is auditory hallucinations, though, if we're talking about those perceptual disturbances. Now, there are other areas that psychosis can show itself.

GREGORY SAATHOFF: Delusions are fixed false beliefs. They can be bizarre or non-bizarre. And sometimes people who have auditory hallucinations also have delusions. Sometimes you can have psychosis, or someone can be psychotic with just a delusion and no, no perceptual disturbance, no, no type of hallucination. And the third area is with regard to thought and how people communicate. So in that part of psychosis, when it demonstrates itself, is that people have a great difficulty communicating, with even speech disorganization. They may engage in what we call neologisms or making up words that have a specific meaning for them, but no one else. And the way that thought is translated either in writing or in speech, oftentimes people who are psychotic and also have a difficult time with stringing their words together, so what we would call looseness of associations. So really there are three arenas that psychosis can show itself, maybe in all three: the perceptual disturbances, the delusions, but also the thought and related to thought and communication. But it's also possible to be psychotic and have just one of those three elements.

GREGORY SAATHOFF: Psychosis is a symptom.

GREGORY SAATHOFF: Well, because there are many different possible causes of psychosis. Someone who has a serious medical problem, for example, can actually become psychotic. A brain tumor is one, one example in which those symptoms of psychosis show themselves. But there are other ways that people can experience psychosis. Some can be secondary to, say, drug abuse. There are certain drugs like cocaine or amphetamines or bath salts that can cause people to have the kind of perceptual disturbances or delusions or problems with communicating, you know, that I talked about. So really, I think it's just important to know that it is not a cause. It is—it represents a significant finding or presentation. Schizophrenia is one diagnosis where we will see psychosis in a number of forms. But also someone who has a serious mood disorder, or schizoaffective disorder or a brief psychosis. So there are many different roads that can lead to psychosis. And so it's important to find out what's originating because that's how we make the best decisions about how to treat any psychotic symptoms that we're seeing.

GREGORY SAATHOFF: Yes. When you say dependent...

GREGORY SAATHOFF: It just is clearly something that is a result of or a manifestation of the illness. For example, there are many different things that can cause a fever, right? And so while a fever is a symptom, it's a presentation that can—that's very significant and can be very significant, what we need to do in medicine and psychiatry is find out, well, what is the cause? Because that is what's gonna lead to the most appropriate treatment.

GREGORY SAATHOFF: Correct.

GREGORY SAATHOFF: Well, serious mental illnesses affect a small portion of the population, a smaller portion, maybe four percent. So people who have schizophrenia have a serious mental illness. People who have bipolar I, which is manic depressive illness, that is a serious mental illness. Schizoaffective disorder is also a serious mental illness. So while many people can have symptoms of mental illness and can benefit from treatment, either psychotherapy or medication or some kinda combination, there are some that are just really, really profound and that's a much smaller percentage.

GREGORY SAATHOFF: Yes.

GREGORY SAATHOFF: Yes.

GREGORY SAATHOFF: So any mental illness would be certainly adjustment disorders, or anxiety disorders, mild depression, you know, depression without psychotic features, for example. PTSD, which can have significant symptoms, is also something that would go under the category of any mental illness.

GREGORY SAATHOFF: Yes.

GREGORY SAATHOFF: Correct.

GREGORY SAATHOFF: No.

GREGORY SAATHOFF: So I do my work in testimony and the like through the University of Virginia. So my department is the recipient of any funds that come from the work that I do. I get a salary from the university that is not dependent on the number of cases that I am involved with or whatever. So I don't receive payment myself. I see it as part of my job as a professor.

GREGORY SAATHOFF: No, not at all.

GREGORY SAATHOFF: Well, it was—they were extensive. They involved significant medical records. Not just the psychiatric records, outpatient, inpatient, but also medical records. Certainly the hospital records from McLean, the hospital records from Tewksbury, but also emergency department visits at South Shore and Mass General Hospital. So significant body of medical and mental health records, both inpatient and outpatient. But in addition, there was a substantial amount of grand jury materials that I reviewed, and videos. For example, videos, not only of interviews of individuals, but also in January when the Clancy family went to the museum or they went to the Cape Codder water park. Was able to review those kinds of videos as well. I also received the reports from both the government but also the defense. And so those experts who were retained, I had an opportunity to review those. I mean, the list of materials is very significant. CVS records, for example, pharmacy records, and law enforcement records. For example, the police reports and things like that from that day, twenty-fourth January 2023, in which the event occurred.

GREGORY SAATHOFF: No, I wouldn't say that's typical. Certainly for any evaluation, it's important to try and obtain as much information as possible. But in this case, I think the amount of information was truly significant.

GREGORY SAATHOFF: Yes, I did.

GREGORY SAATHOFF: I interviewed Ms. Clancy on two occasions. One was on the 29th of May of this year, and the other was the 4th of June. I believe, though, on the 29th of May, I interviewed her for approximately six, six and a half hours, and then the second time in June, June 4th, it was about five hours.

GREGORY SAATHOFF: They were by way of Zoom.

GREGORY SAATHOFF: I... For personal reasons, I was unable to travel at that time, and so I requested the ability to have an interview by way of a Zoom video platform. And that was approved.

GREGORY SAATHOFF: Well, I think there are always limitations when one is not physically present. When one is seeing someone in a video setting, sometimes it's... takes longer to be able to get information and establish rapport. Some limita- other limitations are just kind of having an opportunity to see the environment, you know, that the individual is in. I have done evaluations in the past using a Zoom format. There are certainly advantages to being in person.

GREGORY SAATHOFF: No. She was very pleasant. Very responsive to questions that I asked on both occasions.

GREGORY SAATHOFF: Well, one benefit that one doesn't always have with an in-person evaluation is that a platform like this can also save the entire interview and both video of the interviewer, myself, but also Ms. Clancy. So if someone wants to really understand that the interview and how it went, you not only have a transcript, but you have a video that really demonstrates the course of the interview, how it went. And that can be very helpful. That can be more helpful than if, as a clinician or as an assessor, I am writing notes. Because when you're writing notes, sometimes it's harder to be able to attend to the individual. So certainly, being able to have a transcript of the interview is helpful, and I think it makes the process more transparent as well, which I think is a positive.

GREGORY SAATHOFF: Yes, I did.

GREGORY SAATHOFF: Well, I interviewed Patrick Clancy, also on a Zoom platform.

GREGORY SAATHOFF: Yes.

GREGORY SAATHOFF: Yes.

GREGORY SAATHOFF: So Ms. Clancy stated to me and some other evaluators that her hallucination, that of an external voice, something coming from outside, outside of her head, occurred when she was standing at the refrigerator. She said that she was in the process of making her children their dinner when she received a call from Patrick Clancy. Returned the call, and then as soon as she finished the call with Patrick Clancy, she said that that is when she heard the voice: "This is your last chance. You have to kill your kids and then kill yourself." And so that was what she told a number of us. There are also other accounts that she made to individuals that were quite a bit different. To Dr. Spinelli, for example, she said that the voice happened at, what, 5:10 or 5:15 PM, as soon as Patrick Clancy left on his errands. And that the voice—she described the voice to Dr.

GREGORY SAATHOFF: Spinelli as increasing in intensity, but saying, "This is your last chance. You have to kill the ch-—kill your kids before you kill yourself." But also that it was—that her children would suffer if she did not do that.

GREGORY SAATHOFF: When I asked her about the voice that she heard, again, she said that it started really right after the telephone call at 5:34 with her husband, Patrick. And she said it was a man's voice. It was very clear. It was external. In other words, it came from outside of her head. That it was constant. So this phrase, "This is your last chance. You have to kill your kids and then kill yourself," was something that was repeated over and over and over and over again during that period that she strangled her children. And then, just as soon as it started, had started, it stopped at the—when she had finished killing the children, strangling the children.

GREGORY SAATHOFF: Well, what was significant to me is that she had not spoken about hearing voices before that in any of the mental health professionals, the psychiatrists, the nurse practitioners, the physicians, and staff in the emergency departments or at McLean. And so this was the first time that she reported—that was, it was documented—but also that she experienced an auditory hallucination according to what she told me. So that was unusual. And then also I... What was very unusual was the fact that the voice stopped with the death of, or the strangling of her youngest son, Callan. And that—

GREGORY SAATHOFF: She went upstairs and then proceeded to engage in behavior in an effort to kill herself. But that the voice had stopped as soon as she had strangled her last—Callan, her youngest child.

GREGORY SAATHOFF: Well, she had certainly suffered with symptoms of mental illness, depression and anxiety, you know, most specifically. Anxiety that she had reported to Dr. Tufts in mid-September. And then certainly symptoms that later on included suicidal ideation and also what she said were dark or intrusive thoughts to harm her children, that she mentioned to her husband and her mother on, I think, two occasions.

GREGORY SAATHOFF: Well,

GREGORY SAATHOFF: I've worked with... Compared to other patients that I've treated, who have had command auditory hallucinations—

GREGORY SAATHOFF: No.

GREGORY SAATHOFF: No, that is not typical.

GREGORY SAATHOFF: Well, an intermittent voice would come and go. It wouldn't necessarily just keep playing over and over again, as if it were on a tape, which Ms. Clancy told me that it was a voice. It's the same thing in the same tone repeated over and over and over, until she had strangled Callan.

GREGORY SAATHOFF: No. Committing the act is not curative of the voice. I've not, I've not ever seen that.

GREGORY SAATHOFF: That is— that would be pretty rare. And it's absolutely not, not typical.

GREGORY SAATHOFF: Yes.

GREGORY SAATHOFF: No. Certainly with the requirements that healthcare professionals have to report any issues that could cause harm to children, for example, as required reporters, it's very rational for her to be concerned that by voicing her thoughts of harm could cause her children... Certainly, an assessment and a rapid assessment and a determination about how best to keep the children safe. So I didn't see that as irrational, but rather rational, just understanding the healthcare system.

GREGORY SAATHOFF: No, I didn't.

GREGORY SAATHOFF: No.

GREGORY SAATHOFF: Correct.

GREGORY SAATHOFF: Yes.

GREGORY SAATHOFF: Yes. She said she was at the refrigerator, and that the refrigerator door was open, and that she was getting chicken nuggets out of the refrigerator section for her children.

GREGORY SAATHOFF: Yes.

GREGORY SAATHOFF: Yes. That's what he told me.

GREGORY SAATHOFF: Yes.

GREGORY SAATHOFF: Well, it's inconsistent.

GREGORY SAATHOFF: Yes.

GREGORY SAATHOFF: Well,

GREGORY SAATHOFF: Looking at someone's mental status at the time of an offense, it's important to understand what was going on in their mind at the time. And in this case, the widely divergent reports from Lindsay Clancy versus her husband Patrick raise questions about what she is telling me and how things are happening. So certainly, that's a cause for significant concern, is one of them is not correct in their statement.

GREGORY SAATHOFF: Yes.

GREGORY SAATHOFF: Well, again, it's markedly inconsistent. Ms. Clancy was very clear with me about the time that the voice started, and that it was constant for a period of time until the children were killed, and then it stopped. And…

GREGORY SAATHOFF: According to Dr. Spinelli's report, Ms. Clancy stated that the voice started much, much earlier, actually, when Patrick Clancy left. And so we're talking about a, you know, significant difference in time. And those two just—they don't match. So it's hard to… Well, which version is the one that…

GREGORY SAATHOFF: I should consider?

GREGORY SAATHOFF: Yes.

GREGORY SAATHOFF: Well, in looking back at her history, for example, with Patrick, she dated Patrick when she was in nursing school. And that was at a time that she was experiencing fairly significant anxiety, according to her, such that she went to a psychiatrist and was treated for her anxiety with Prozac and Wellbutrin, and also Propranolol. And this was for a fairly significant period of time during their dating, approximately a year. And when I spoke with Mr. Clancy, and also in other testimony and collateral information, he was completely unaware that she was experiencing mental health symptoms at that time that they were dating, or that she was taking medication. And he said he did not learn that she had taken medication, mental health medication, Prozac, Wellbutrin—those are both antidepressants—as well as Propranolol, which helps with anxiety, particularly with the kind of presentations that she was doing. But he was unaware until during this time that she was having, you know, great difficulty, November, December time period.

GREGORY SAATHOFF: Yes. But there are other aspects, too, where the portrayal—her portrayal—misled others in terms of how she was doing.

GREGORY SAATHOFF: Yes. Well, in the numerous text messages, which really varied, there were times when she stated that she was doing very well. And, for example, even in the days leading up to the 24th of January 2023, the photographs that she was sending on Instagram and the like really portrayed something very different than what she, you know, stated—later stated—was going on inside. With regard to providers—

GREGORY SAATHOFF: Ms. Clancy told me that during this period that she was having such difficulty, and that was really, really starting in October. She started taking medication in October. Ms. Clancy told me that—

GREGORY SAATHOFF: She was having a real difficulty with some symptoms and anxiety and the like.

GREGORY SAATHOFF: Her mother-in-law suggested to her that there was a doctor that she knew named Rose, who was willing to talk with her just on an informal basis. And so as I understand, this doctor made time for her to be seen, not in an official way, not as in a doctor-patient relationship, but just to get an understanding about Ms. Clancy's problems. And that this doctor recommended Lamictal or lamotrigine as a medication that could be very helpful, you know, with regard to the depression she was experiencing, the issues with mood and the like. And so, in looking at Dr. Tufts' notes, there is a note, I believe, on December 1st of 2022, in which they discuss Lamictal as a real possible medication. And then by mid-December, it was really a very, very difficult time. The whole month of December in many ways was very difficult. But after this—

GREGORY SAATHOFF: Experience—

GREGORY SAATHOFF: Yes.

GREGORY SAATHOFF: That was a nurse practitioner, Jollotta.

GREGORY SAATHOFF: Well, really by both. And it—when you say talking, it was a written communication and not a verbal one.

GREGORY SAATHOFF: Yes.

GREGORY SAATHOFF: Lamotrigine is actually—Lamictal is an anticonvulsant that was approved for bipolar disorder back in the early 2000s, I think 2003, for bipolar disorder. Now, it's used for epilepsy, but also been found by the FDA to be extremely helpful in depression related to bipolar disorder.

GREGORY SAATHOFF: She told me that she had decided not to take the Lamictal because she was concerned about the potential for a rash, a serious rash.

GREGORY SAATHOFF: Yes.

GREGORY SAATHOFF: Well, Dr. Tufts had written the prescription, and it had been filled. Actually, Nurse Jollotta also wrote a prescription for the Lamictal, and Ms. Clancy told her, "Well, you can cancel that because I already have a prescription of Lamictal from Dr. Tufts." What was concerning was that I don't see evidence that Dr. Tufts was notified that she had decided against the Lamictal. And so, that would have given a provider an opportunity to think about something else that also could help in this domain. But yet Ms. Clancy had decided not to take it, but also not to tell the doctor that she had decided not to take it.

GREGORY SAATHOFF: Yes.

GREGORY SAATHOFF: I recall that she told me that her—she felt like a zombie. Very, very significantly affected. And certainly while the records at McLean demonstrate that she was not doing well, there were differences in terms of how she characterized that.

GREGORY SAATHOFF: Well, yes.

GREGORY SAATHOFF: Well, the more candid a patient can be with the symptoms that they're experiencing, the better able the prescriber is to make a determination about how best to treat those symptoms. And also it can be very helpful in diagnosis as well.

GREGORY SAATHOFF: Yes.

GREGORY SAATHOFF: Well, Ms. Clancy had been looking into alternative treatments, and had discussed with Dr. Tufts earlier the potential for esketamine. This is an FDA-approved medication that can... that has to be administered by a doctor within a facility. But it can have rapid positive effects in treating depression. And so in that note, Dr. Tufts wrote that the potential for esketamine treatment, or transcranial magnetic stimulation, were ones that they were exploring.

GREGORY SAATHOFF: Yes.

GREGORY SAATHOFF: Well, I believe it was a Christmas time with her family, a morning breakfast, in which she stated she was not feeling well. Not, not doing well, but yet felt the need to act like she was cooking and helping her husband cook. And she questioned why she would do that or engage in that behavior, when her family knew that she was struggling and having difficulty. So she used the word fake with regard to just how she was attempting to present to her family. So this was on reflection in talking to me about that behavior at that time.

GREGORY SAATHOFF: Yes.

GREGORY SAATHOFF: She told me that this friend who visited was a longtime friend from when they were both really quite young. And that when this friend visited, Ms. Clancy engaged in—trying to remember how she characterized it—gossip. Really talking about kind of the old times and catching up basically on news that this friend, I believe her name was Amy, Amy Bevins.

GREGORY SAATHOFF: They had similar or shared experiences. And so Ms. Clancy told me she was upset at Spaulding Hospital because this superficial conversation that she had without discussion of the incident of 24 January 2023, that gave an impression, maybe a false impression of Ms. Clancy. And that it hurt the friendship as a result.

GREGORY SAATHOFF: And she felt that Spaulding Hospital, had they provided better psychiatric care, better mental health care, she would not have been so superficial in talking with her friend.

GREGORY SAATHOFF: I'm sorry. Can you repeat that?

GREGORY SAATHOFF: Yes.

GREGORY SAATHOFF: Yes.

GREGORY SAATHOFF: Yes.

GREGORY SAATHOFF: Well, it's inconsistent and doesn't, doesn't match up with that collateral information. So the—her depiction of the lack of mental health care at Spaulding didn't match up with the evidence from Spaulding in terms of the documents. Spaulding is a rehab hospital. And that is re-... They were really concentrated on the spinal injury, but also did have mental health services available.

GREGORY SAATHOFF: Yes.

GREGORY SAATHOFF: I asked Ms. Clancy to tell me about that afternoon and specifically that decision for takeout. And as I recall, she told me that she texted her husband, Patrick, basically to say, how—"What would you think about ta- having takeout? It's been a long day." And, but sh- a fairly broad, open-ended request, and that he responded positively. And from then, she made the arrangements to look up the distance between her home, their home, and 3V Restaurant in Plymouth. But also looking at, you know, basically making plans to have the food ordered. And she had texted her husband ultimately and asked him about, you know, to tell her what order to make. And so in looking at the record,

GREGORY SAATHOFF: It was really reversed. Instead of starting with asking her husband, "What would you think about takeout? How about getting us take—getting takeout?"

GREGORY SAATHOFF: The record shows that Ms. Clancy

GREGORY SAATHOFF: Did a lot of searching prior to that in terms of 3V, the distance, and the like. So there were a n- just getting information prior to requesting a text, or sending a text to her husband. And in the text, rather than saying, "What would you think about takeout, getting takeout?" she said, "How about getting takeout at 3V? I am... You know, it's been a long day," et cetera. And so this reversal in terms of what she told me and what actually we see in the collateral, I thought was significant.

GREGORY SAATHOFF: Well, she told me that the only restaurant that she could think of, could remember, about getting takeout was 3V. And Patrick told me that they had never gotten takeout from 3V. He named West End Grill and Chestnut Grill as places that were in Duxbury and close by that they liked and that they often got takeout from. They had been to 3V, and they liked it. They had gone as a family. But they had never gotten takeout there, takeout from 3V. And so, presenting not just the idea of takeout, but how about, you know, how about 3V, and she had already done lots of checking about, you know, distance and the like, I thought was inconsistent. What we... What I saw from the record was not what she told me in terms of the order in which she made those decisions. And so I saw that as being significant.

GREGORY SAATHOFF: Yes.

GREGORY SAATHOFF: Well, the research for, I think it was MiraLAX, which was suggested for Cora's constipation. They had had an appointment that morning in pediatrics, and this was suggested. That the MiraLAX and CVS was something that Ms. Clancy looked into sometime after 4:00, but not long after 4:00, and well before she contacted her husband. But that she did not communicate to her husband the importance of picking up MiraLAX at CVS, who she had called, until really right before he left. So he had planned on going to 3B, driving to 3B, almost six miles, to get the takeout, and then she also added on that other errand right before he left.

GREGORY SAATHOFF: Yes.

GREGORY SAATHOFF: Well, it lengthened the trip. It added one extra obligation for Patrick. And that would make for a longer time that he was away.

GREGORY SAATHOFF: Can you just repeat that? I'm sorry.

GREGORY SAATHOFF: Correct.

GREGORY SAATHOFF: Yes.

GREGORY SAATHOFF: Well, I think, in looking over her records, previous to that day, twenty-four January, she had contacted Aspire twice, the suicide hotline, and spoken to them. And really, as I recall, since early December had been speaking about suicidal ideation. So this was something that was significant for her.

GREGORY SAATHOFF: There was, of course, an assessment at, in the emergency department that, on the fifteenth of December. So you look through the record, and then you do see that she was concerned about self-harm and suicidal ideation. If we look at the actual day, after the children were killed or after the children were strangled, Callan was still living at the time that EMS arrived.

GREGORY SAATHOFF: She told me that she got a knife from the, like, butcher block in the kitchen and then went upstairs and attempted to cut herself, that she also took pills or took an overdose. And I asked her about that, really trying to understand how—

GREGORY SAATHOFF: Really to try and understand how she accomplished the overdose. Because if you're swallowing lots and lots of pills, that can be difficult. And so how many ... Essentially, how many times, how many handfuls of pills did you take, or whatever. And then she told me that she had slashed the screen and dove out of the window.

GREGORY SAATHOFF: I'm sorry?

GREGORY SAATHOFF: It wasn't really very, very clear. I was—

GREGORY SAATHOFF: I'm sorry?

GREGORY SAATHOFF: Oh, she did not say that she took handfuls. She did not describe the overdose in any specific terms.

GREGORY SAATHOFF: No.

GREGORY SAATHOFF: Well,

GREGORY SAATHOFF: As I mentioned, she, after strangling the three children with the exercise bands, she went up the steps, went to the kitchen. She got a knife and then ascended yet another group of steps to her bedroom, to their bedroom. And—

GREGORY SAATHOFF: Described the attempt or cutting her wrists as well as her neck. And also described the overdose in barely ... I just ... It was just hard for me to get a good idea about how specifically the overdose occurred, what she did. But she omitted some things that I thought were significant.

GREGORY SAATHOFF: Well, she omitted the fact that she had actually crushed the pills. And I found that to be, you know, quite significant.

GREGORY SAATHOFF: I learned after interviewing her husband, Patrick. And he went through that evening and talked about coming to the home and the like. And mentioned that on the bedside table, there was a wine tumbler with powdered, like, medication, crushed up medication, that there was still some in the wine tumbler. And I had not heard... I mean, she had not told me that she had actually crushed the medication. And I know that in Dr. Resnick's report, and also in what Lindsay Clancy told me, that she had lemonade in that wine tumbler when she took the overdose. And when I asked Patrick Clancy, he told me that they did not have... He didn't think they had any lemonade in the house, that that was not typical at all.

GREGORY SAATHOFF: Yes.

GREGORY SAATHOFF: You say what is atypical?

GREGORY SAATHOFF: Correct.

GREGORY SAATHOFF: Yes. It, I mean, it made sense that lemonade would be in the cup if you're trying to take an overdose of medication that you've crushed, just because of the bitterness that these pills have. So that made sense. I asked her more about the lemonade, and she told me that it had been in the wine tumbler from the night before.

GREGORY SAATHOFF: Well.

GREGORY SAATHOFF: Crushing pills is really a challenge if you don't have the right equipment. If you don't have, like, a mortar and a pestle that they might have in a pharmacy. And so what I wondered about was that process of crushing the pills to the point that they were powder, in order then to put them in lemonade, and then drink them. And so that is... I mean, to crush pills, significant number of pills into fine powder, is not an easy thing to do. You know, particularly if you don't have the right equipment. It's just kind of a laborious process. So... And she also did not... It was Patrick Clancy who told me about the door being locked, and she told me she did not recall locking the door.

GREGORY SAATHOFF: Yes.

GREGORY SAATHOFF: Ms. Clancy told me that she, after the phone call with her husband, she returned the call, that was when she took Dawson down the steps, into her husband's office, to strangle him. And I asked Ms. Clancy about what she remembered about how she... what she said to Dawson to get him to go down the steps, and leave, you know, his sister and brother upstairs. And was there resistance, did verbalization, you know, et cetera, crying? And she said she could not recall that. She could only recall bringing him down the steps and then strangling him. And then she repeated that the next child was Cora. That she went back upstairs and did not recall how she got Cora down the steps, how Cora came down the steps, but then brought her into a different area, kind of a living room area in the basement, and strangled Cora. And then lastly, that she went up to get Callan. And I asked her, I said, "Where was Ca- where was Callan upstairs?" And she said, "Well, maybe in a playpen." You know, often, you know, he... She said she couldn't really remember. But then bringing Callan down, and he was the last child to be strangled. All during this time where this voice is over and over, over again saying, "This is your last chance. You have to kill the children before you kill yourself."

GREGORY SAATHOFF: Yes.

GREGORY SAATHOFF: You know, just like adults, children have a will to survive. Strong, strong will to survive. I think it's just part of being human. And so...

GREGORY SAATHOFF: I know that Dr. Resnick described Ms. Clancy as acting as if she were a puppet. But the children are not puppets. And just in looking at the Cape Codder video where Ms. Clancy is holding Callan, and Dawson and Cora are there. I mean, they both are active. They can walk, they can run. And so to make the determination about—

GREGORY SAATHOFF: Step down?