2.Kirk Heilbrun — Cross (Part 3)
1,207 linesTHE COURT: All right, Attorney Reddington.
MR. REDDINGTON: Thank you.
MR. REDDINGTON: Sorry.
MR. REDDINGTON: Doctor, I'd just like to ask you about one of the things you just said to this jury that apparently stood out in your mind, and that would be the dichotomy of the difference between two statements that Lindsay made. One being, I believe, in the hospital. And you felt that there was a subsequent statement that was made by her that contradicted that, or was different from that, and that would be after three days of you and Mack testing her. Is that right?
MR. REDDINGTON: Can you just say, is it right or wrong?
KIRK HEILBRUN: Mr. Reddington, it's not quite right.
MR. REDDINGTON: Okay. Why don't we do it this way.
KIRK HEILBRUN: Yeah.
MR. REDDINGTON: You just told this jury that Lindsay made a statement to you at the conclusion of the three days that you and Mack were questioning her, and testing her, and interviewing her. Is that fair? Yes or no?
KIRK HEILBRUN: What I would say is—
MR. REDDINGTON: Yes or no.
KIRK HEILBRUN: No.
MR. REDDINGTON: Did you tell this jury, in addition, that Lindsay made a different statement when she was in the hospital? Yes or no.
KIRK HEILBRUN: What I said to the jury is—
MR. REDDINGTON: I'm asking you, sir, did you make that statement to this jury?
KIRK HEILBRUN: What I intended to say—
MR. REDDINGTON: No, not what you intended. Can you answer my question? Yes or no.
KIRK HEILBRUN: No.
MR. REDDINGTON: Now, is Dr. Heilbrun aware of the concept of post-intensive care syndrome?
KIRK HEILBRUN: Post-intensive care syndrome.
MR. REDDINGTON: Yeah, PICS. It's called PICS.
KIRK HEILBRUN: No, I have not heard of post-intensive care syndrome.
MR. REDDINGTON: Is Dr. Heilbrun aware of when a person is coming out of major surgery and has been subject to anesthesia, that it is known that they have delusions, hallucinations, make statements that don't make sense? Are you aware of that, sir?
KIRK HEILBRUN: Yes, I'm aware of that.
MR. REDDINGTON: And is that from your personal experience, professional experience? 'Cause you didn't know what PICS was when I asked you, right?
KIRK HEILBRUN: Yes, it's not from my personal experience, or my professional experience.
MR. REDDINGTON: You received a notification to evaluate Lindsay Clancy on this criminal case from the district attorney's office, right?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: And do you recall when you received that notification?
KIRK HEILBRUN: It would have been sometime before January of 2025, because that's when I started reviewing the documents that they provided.
MR. REDDINGTON: Okay. So January of '25, January of '26, and then in the spring of '26, you go to the Tewksbury Hospital with Mack and you interview Lindsay, right?
KIRK HEILBRUN: Correct.
MR. REDDINGTON: So how many months is it from the time that you were appointed, or requested, or asked to help the DA's office to the time you saw Lindsay? How much time passed?
KIRK HEILBRUN: Probably about 18 months.
MR. REDDINGTON: About a year and a half. And how much time passed from that point, going backwards to January of '23?
KIRK HEILBRUN: I'm not sure what the question is.
MR. REDDINGTON: Okay, January of '23, you add a year, that's January of '24, right?
KIRK HEILBRUN: Yeah.
MR. REDDINGTON: One year.
KIRK HEILBRUN: Yeah.
MR. REDDINGTON: January of '24, you add a year, up to January '25. That's two years, right?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: January of '25 up to when you and Mack finally go out to Tewksbury to interview this young lady is how many months?
KIRK HEILBRUN: Well, it would be about three years.
MR. REDDINGTON: Okay. And are you telling this jury that it's good, using the term loosely, medical practice to interview a young lady like this three years after the event for purposes of helping the DA, in your opinion?
KIRK HEILBRUN: Do you mean in the context of a forensic mental health assessment, sir?
MR. REDDINGTON: That's the only reason you're here, right?
KIRK HEILBRUN: Yes, it is.
MR. REDDINGTON: Okay. So can you answer my question?
KIRK HEILBRUN: The answer to your question is the sooner that I'm able to evaluate somebody after their involvement in the alleged offense, the more closely I can come to using that current state information as something that is relevant to their mental state at the time of the offense.
MR. REDDINGTON: Okay. So in other words, yes, it is better to see them sooner rather than later to coin a phrase, right?
KIRK HEILBRUN: Yes, it is.
MR. REDDINGTON: Okay. And have in mind January of '25 that you were retained by… And again, you know, not only this isn't an issue, who cares, but how much money did you make on this case, is they wanna ask my doctor. How much money did you make on this case?
KIRK HEILBRUN: That depends when I'm finished, but I mentioned earlier that I had spent 180 hours before coming to Plymouth.
MR. REDDINGTON: How much money did you make on the case, Doctor? Simple.
KIRK HEILBRUN: Well, it's not that simple, but I'm being paid at $300 an hour.
MR. REDDINGTON: Okay, so how much money did you make on the case?
KIRK HEILBRUN: Well, $300 an hour times 180.
MR. REDDINGTON: What's your last billing?
KIRK HEILBRUN: I've been billing monthly, sir.
MR. REDDINGTON: Okay. You must know what the total billing is up to this point, don't you?
KIRK HEILBRUN: I actually have not added it up.
MR. REDDINGTON: How about you just give us your best estimate, Doctor?
KIRK HEILBRUN: Well, let's see. Probably, up to this point, it's been about $54,000.
MR. REDDINGTON: $54,000. And it will be more, right? When we get finished with you today, right, it'll be more.
KIRK HEILBRUN: Yes.
MR. REDDINGTON: Okay. So you received from me, by certified mail, video interview of Lindsay by my guy, Dr. Resnick, right?
KIRK HEILBRUN: Correct.
MR. REDDINGTON: You received the notes from Dr. Margaret Spinelli, right?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: You received the notes from my doctor, Paul Zeizel, right?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: You received the report that was prepared and submitted by Dr. Phillip Resnick, right?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: You received the report prepared and submitted by Dr. Margaret Spinelli, right?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: And you received the report prepared by Dr. Zeizel, right?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: And then I said, "If you have any questions, give me a call, drop me a line, whatever," but we never talked until today, right?
KIRK HEILBRUN: That's correct.
MR. REDDINGTON: All right. Now, you have a curriculum vitae that talks about that you are a clinical psychologist, correct? As you've told us yesterday, right?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: Have you ever treated a woman in postpartum psychosis?
KIRK HEILBRUN: When I was a staff psychologist at the forensic service at Florida State Hospital—
MR. REDDINGTON: When was that, please?
KIRK HEILBRUN: That was back in 1982.
MR. REDDINGTON: '82?
KIRK HEILBRUN: Yes. I had a therapy group which was comprised of women who had killed their children. They were severely mentally ill and, at that time, it was important to recognize the severity of their mental illness, and so I worked with them in a group at that time.
MR. REDDINGTON: Okay. And this is 44 years ago?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: All right. And where was it?
KIRK HEILBRUN: It was at the Florida State Hospital in Chattahoochee. Forensic unit.
MR. REDDINGTON: How many—
KIRK HEILBRUN: Forensic service.
MR. REDDINGTON: ... How many of these people did you have a chance to interview in group or whatever you did?
KIRK HEILBRUN: There were four or five in the group.
MR. REDDINGTON: Four or five. Okay. Well, you are also a forensic psychology expert working for Park Dietz and Associates, right?
KIRK HEILBRUN: I have an affiliation with Park Dietz and Associates, yes.
MR. REDDINGTON: That's basically... That's the letterhead that you have on all your stuff, right? Park Dietz and Associates Inc. Is that right?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: Okay. You know Mack, do you?
KIRK HEILBRUN: Do I know—
MR. REDDINGTON: Yeah.
KIRK HEILBRUN: ... Dr. Mack?
MR. REDDINGTON: Yeah, Dr. Mack. Yeah, the guy that was here testifying for the last two days, Friday and Monday. You know him?
KIRK HEILBRUN: Yes, I do know him. Yes.
MR. REDDINGTON: All right. And he works with Park Dietz as well, right?
KIRK HEILBRUN: I think he has the same kind of affiliation I do, which is we both have jobs and do things elsewhere, but we occasionally do cases in affiliation with Park Dietz and Associates.
MR. REDDINGTON: Right. And continuing on, and if you have it, you can certainly take a look at it. Make sure I don't misrepresent anything on your vitae, as you refer to it. You also were involved with Giant Food Corporation. You do fitness for duty assessments. What is that?
KIRK HEILBRUN: What are fitness for duty assessments?
MR. REDDINGTON: Yeah. Giant Food Cor— What's Giant Food Corporation?
KIRK HEILBRUN: Oh, oh, that's something that I did many years ago. Basically, a company or an organization might refer someone who is having difficulty at work, having symptoms, making threats, that sort of thing, and they would ask for an evaluation from a psychiatrist or a psychologist.
MR. REDDINGTON: Okay.
KIRK HEILBRUN: And I did that for a while for Giant Food Corporations.
MR. REDDINGTON: And you also did it for US Airways, apparently. Evaluations and consultation, right?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: You also did it for the Texas Education Commission. You put on your resume the forensic, clinical site visitor, Sam Houston State Hospital or University, right?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: You were a grant reviewer for the Office of Victims of Crime for the United States Department of Justice. That's the feds. That's the US Attorney's Office, right?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: Okay. You also worked, and you did violence risk assessment consultant as a consultant to the New Jersey Department of Mental Health Services, right?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: You also consulted as a research consultant with the Community Education Centers in New Jersey, right?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: Research advisory board, the Center for the Analysis of... Actually, the FBI. You work for the FBI?
KIRK HEILBRUN: I consulted with the FBI, yes.
MR. REDDINGTON: And, in consulting with the FBI, you also consult with the Bureau of Prisons, right? BOP?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: When you're consulting for... Well, okay, let... Site visit at Juvenile Justice and Psychology, you were involved with that, right?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: Consultant forensic psychology service for the Walter Reed Medical Center, correct?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: When you work on the consulting with the Bureau of Prisons, basically what you're doing is you're evaluating, as you told us a couple of times, people that are wrongfully convicted, and they're in jail for decades. And you would evaluate them for the Bureau of Prisons to see if they're okay to release to society, right?
KIRK HEILBRUN: That does not sound like a typical question that I would evaluate for the Bureau of Prisons.
MR. REDDINGTON: All right. Well, what would you evaluate for the Bureau of Prisons? That's-
KIRK HEILBRUN: Well, for example-
MR. REDDINGTON: Just, wait, wait, hold on. Just so we know, Bureau of Prisons is federal as opposed to the Department of Correction, which is state, right?
KIRK HEILBRUN: Yes, that's right.
MR. REDDINGTON: Okay. So go ahead. Tell me what you do for the Bureau of Prisons.
KIRK HEILBRUN: Well, one of the things that I might do is conduct a meeting or a workshop on a topic such as violence risk assessment or something like that. So I have done that, deliver a workshop or provide an organizational meeting, provide information and so on, on a number of occasions.
MR. REDDINGTON: And do you evaluate people to see if they're able to be reintegrated into society?
KIRK HEILBRUN: I do that as well, yes.
MR. REDDINGTON: Okay. You also are involved with sexual violence risk. Is that correct? You-
KIRK HEILBRUN: Yes, it is.
MR. REDDINGTON: You also are involved with specialized police response and collaboration with behavioral health systems in Pennsylvania, right?
KIRK HEILBRUN: Correct.
MR. REDDINGTON: Sexual violence risk, again, for purposes of the Department of Correction. You've focused on that, right?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: Principles of forensic assessments, that you would be assessing juveniles for purposes of juvenile assessment and risk assessment, right?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: You also are involved with violence risk and sexual violence risk, correct?
KIRK HEILBRUN: Yes, correct.
MR. REDDINGTON: Juvenile assessments, risk assessments, and principles of forensic assessment for the American Academy of Forensic Psychology. Is that right?
KIRK HEILBRUN: Yes, that's right.
MR. REDDINGTON: And also a focus on juvenile assessment and risk assessment of juveniles, right?
KIRK HEILBRUN: Yes, correct.
MR. REDDINGTON: Violence towards others, psychiatrically hospitalized populations. That would be what? Patient-on-patient assaults or something like that when somebody's in a mental institution?
KIRK HEILBRUN: Patient... Yeah, patients against patients, patients—
MR. REDDINGTON: Okay.
KIRK HEILBRUN: ... against staff, that sort of thing.
MR. REDDINGTON: They can be pretty violent places, can't they?
KIRK HEILBRUN: They can be sometimes, yes.
MR. REDDINGTON: Sexual violence risk. You involved with New, New Orleans, Louisiana, sexual violence risk assessment, right?
KIRK HEILBRUN: Correct.
MR. REDDINGTON: Obtaining and using mental health experts. Obtaining and using mental health experts in criminal litigation for the Administrative Office of the United States Courts, right?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: What does that mean? What did you do with that when you were dealing with obtaining and using mental health experts in criminal litigation?
KIRK HEILBRUN: Well, I have had the occasion to provide workshops to prosecutors, to defense attorneys, to judges, and so on. And depending on some of the questions that arise, such as what's the most effective way to obtain and present a forensic psychologist or forensic psychiatrist expert, I might do a half-day or a full-day workshop on that.
MR. REDDINGTON: Okay. So my question, sir, I know you get in there, but who... Where did you lecture or give a lecture to criminal defense attorneys?
KIRK HEILBRUN: I've given a number of those lectures over the years. I can't recall them all offhand.
MR. REDDINGTON: Okay. But my question, sir, was that you were working on behalf of the Administrative Office of the United States Courts, federal courts, right?
KIRK HEILBRUN: Yes, that's right.
MR. REDDINGTON: Did I ask you that question? Okay.
KIRK HEILBRUN: Yeah.
MR. REDDINGTON: You also work for the forensic mental health assessment for the Ohio Forensic Psychiatric Center.
KIRK HEILBRUN: Yes, that's right.
MR. REDDINGTON: Inmates, right?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: You also participate and have written about “To Kill or Not Kill: That Is the Question,” for Drexel University, where you were a professor, correct?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: All right. Assessing risk of violence towards others in psychiatrically hospitalized populations. You focused on that, right?
KIRK HEILBRUN: Yes, that's right.
MR. REDDINGTON: You had a chance here to give a total of, let's see, 131 lectures or workshops presented in the area of violence, risk assessment, sexual offenses, and forensic mental health and ethics, right?
KIRK HEILBRUN: Yes, that's right.
MR. REDDINGTON: Is that right?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: Aggression, forensic psychological assessment, risk assessment, treatment of mentally disordered offenders and juveniles. That's another focus, correct?
KIRK HEILBRUN: Yes, it is.
MR. REDDINGTON: You've had a number of publications that you put in your CV. Basically, you're talking about justice-involved youths, correct?
KIRK HEILBRUN: Yes, that's one of the things I talk about.
MR. REDDINGTON: Appraising Jackson-based un-restorability to competence to stand trial deals with the standard of competence to stand trial, correct?
KIRK HEILBRUN: Yes, it is.
MR. REDDINGTON: Public perception on policies to address prenatal substance use, recommendations regarding maternal criminal prosecutions. What is that? Prosecute a woman that's pregnant who's involved with drug use?
KIRK HEILBRUN: Yeah, that sounds like something that would have been a dissertation where I served on the committee and was a co-author of some kind. But the individual who, uh—
MR. REDDINGTON: Okay.
KIRK HEILBRUN: …who wrote the dissertation would have been the first author there.
MR. REDDINGTON: All right. And life sentence for juveniles. Sequential model for juvenile justice. Justice involving men. Forced medication and competency to stand trial. These are interests or focuses of yours, sir?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: Urine drug screens as a baseline for predictors of graduation from drug court.
KIRK HEILBRUN: Yes.
MR. REDDINGTON: What does that mean? That you were involved with drug court?
KIRK HEILBRUN: Yes, I've been involved in writing about and consulting to drug courts over the years, yes.
MR. REDDINGTON: And disputed paraphilia diagnoses in legal decision-making is one of your other focuses, right?
KIRK HEILBRUN: That was one of my graduate students, and I was a supervising and second author.
MR. REDDINGTON: Ah. Paraphilias would be in the… I mean, that's basically if you have some kind of weird sexual things that you do, right?
KIRK HEILBRUN: Something like that, yes.
MR. REDDINGTON: Yeah. Continuing on, juvenile… A lot of juvenile focus on your resume, correct, sir?
KIRK HEILBRUN: Yes, there's a fair amount of juvenile work that I've done over the years.
MR. REDDINGTON: …involuntary medication, trial competence, clinical dilemmas, substance-abusing adjudicated adolescents. And your resume basically is a number of pages, correct? Would you agree with me? It's almost 70 pages, right?
KIRK HEILBRUN: Yes. I would agree with you.
MR. REDDINGTON: Okay. Flipping through and jumping ahead, sir, you wrote book chapters, correct?
KIRK HEILBRUN: Yes, that's correct.
MR. REDDINGTON: You dealt with forensic mental health assessments, principles and standards of care, right?
KIRK HEILBRUN: That's right.
MR. REDDINGTON: Violence risk assessment, right?
KIRK HEILBRUN: Correct.
MR. REDDINGTON: Juvenile violence risk assessment, right?
KIRK HEILBRUN: Yes, that's correct.
MR. REDDINGTON: Managing hindsight bias in unstructured judgments, implications for legal decision-making is an article that you had, chapter or whatever, that you wrote, right?
KIRK HEILBRUN: Yes, it is.
MR. REDDINGTON: Again, juvenile delinquency, juvenile delinquency, juvenile delinquency, juvenile delinquency. A lot of focus on juveniles, right?
KIRK HEILBRUN: Yes, there's a fair amount of—
MR. REDDINGTON: Then you have—
KIRK HEILBRUN: …focus on juveniles over the years, yes.
MR. REDDINGTON: …a number of reviews that you have published, presentations that you've presented, a lot of them dealing, again, with juveniles and dealing with assessments of prisoners to have them released into society, things of that nature, right?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: Life-sentenced juveniles, for example, is one of the things you focus on, right?
KIRK HEILBRUN: Yes. Again there's been a fair amount of juvenile work and—
MR. REDDINGTON: Handling difficult cross-examination, integrating perspectives, combining substance with style and learning. What does that mean, handling difficult cross-examination?
KIRK HEILBRUN: Well, one of the things that people, as forensic psychologists, need to do is convey what they have done in a way that is effective. And so there are things that you—
MR. REDDINGTON: To a jury?
KIRK HEILBRUN: To a jury, to a judge, to an attorney, various kinds of—
MR. REDDINGTON: Well, when you're dealing with an attorney, sir, you're presenting information to the attorney. You're not dealing with difficult cross-examination, are you?
KIRK HEILBRUN: Could you repeat the question, please?
MR. REDDINGTON: Sure. You wrote about handling difficult cross-examination, integrating perspectives, combining substance with style.
KIRK HEILBRUN: Yes.
MR. REDDINGTON: And what is—25 words or less—what is that basically telling people? How to, what, withstand cross-examination?
KIRK HEILBRUN: It's how most effectively to convey the results of the evaluation that you have done.
MR. REDDINGTON: And then, again, just hundreds of articles on topics that the jurors can look at because your resume is in evidence. Finishing it off on that end, sexual abuse behavior, juvenile forensic mental health, violence risk assessment of juveniles, behavioral measure of sexual offense behavior, influencing third-party informant observations dealing with juveniles, should the courts coerce offenders into substance abuse treatment? Is there one article, one, that you wrote about a woman who is pregnant, who is undergoing postpartum depression, and God forbid, psychosis?
MR. REDDINGTON: But you did write an article 48 year, 49 years ago. You published an article on psychosis in 1977 with your dad before... Well, you were in college, apparently, right? Right?
KIRK HEILBRUN: Yeah.
MR. REDDINGTON: Yeah, okay. So—
KIRK HEILBRUN: I was his research assistant at that time—
MR. REDDINGTON: Yeah.
KIRK HEILBRUN: ... when I was in college, yes.
MR. REDDINGTON: Okay. And this is before you went to graduate school, and you used a diagnostic framework that no longer exists, didn't you, back then?
KIRK HEILBRUN: It was a long time ago.
MR. REDDINGTON: Right. And actually, it was three years before the DSM was even written, DSM-I, back in the Stone Age.
KIRK HEILBRUN: It was a while ago.
MR. REDDINGTON: That's the only article you ever wrote dealing with that issue. Is that correct, sir?
KIRK HEILBRUN: Dealing with what issue, sir?
MR. REDDINGTON: Postpartum psychosis.
KIRK HEILBRUN: Ah. Yes.
MR. REDDINGTON: Does 'ah' mean yes? Thank you.
MR. REDDINGTON: So...
MR. REDDINGTON: You make arrangements with the district attorney's office to get all this discovery that I sent you, that the DA sent you, police reports that you went through with the jury, and you read it, right?
KIRK HEILBRUN: Yes, that's right.
MR. REDDINGTON: And you must have talked to the DAs before you saw Lindsay, right?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: Okay. How many times?
KIRK HEILBRUN: I don't, I don't remember how many times.
MR. REDDINGTON: Well, you billed them for it, I'll bet, right?
KIRK HEILBRUN: Any time I spend on a case like this, I record, and it gets billed.
MR. REDDINGTON: Of course. So you do have records, but who cares at this point? I mean, you're here testifying based on your opinion at the request of the prosecutors, right?
KIRK HEILBRUN: I'm here based on... Yes. At this point, I've completed the evaluation and don't remember things like how many times I talked to the DAs.
MR. REDDINGTON: Okay.
KIRK HEILBRUN: That's part of it.
MR. REDDINGTON: But basically, in your conversations with these two prosecutors, sir, did you talk to the state police at all? Detectives?
KIRK HEILBRUN: I reviewed a massive amount of reports, some by the state police, some by other individuals. So I reviewed records for many, many hours.
MR. REDDINGTON: And when you get involved with this case three years later, or two and a half years later, you'd agree with me that it was quite publicized, right?
KIRK HEILBRUN: Yes, I would agree with that.
MR. REDDINGTON: You've heard of confirmation bias, I'm sure, right?
KIRK HEILBRUN: I have indeed.
MR. REDDINGTON: Yes. And however many times you talked to the DAs and reviewed the information, would you agree with me, sir, that before you met with Lindsay in Tewksbury, you pretty much had an idea that this woman was a beast, killed her three kids, didn't you?
KIRK HEILBRUN: I would not agree with you at all.
MR. REDDINGTON: So you had an open mind when you went in there to Tewksbury to see and speak to for three days Lindsay Clancy?
KIRK HEILBRUN: I did my best to have an open mind, yes.
MR. REDDINGTON: I know. You told us yesterday. You had some difficult decisions to make, correct?
KIRK HEILBRUN: Yes, that's correct.
MR. REDDINGTON: Right. So when did you first meet Avram?
KIRK HEILBRUN: When did I first meet him?
MR. REDDINGTON: Yeah.
KIRK HEILBRUN: That probably would have been late 2025, early 2026.
MR. REDDINGTON: Okay. Around the same time that you first got involved with the case?
KIRK HEILBRUN: No, it would have been considerably after I first got involved with the case.
MR. REDDINGTON: Where did you meet him?
KIRK HEILBRUN: Where did I meet him?
MR. REDDINGTON: That's what I said. Where'd you meet him?
KIRK HEILBRUN: Virtually.
MR. REDDINGTON: Oh, virtually.
KIRK HEILBRUN: Yes.
MR. REDDINGTON: Okay. So it's like a Zoom thing or—
KIRK HEILBRUN: Yeah.
MR. REDDINGTON: … FaceTime or something.
KIRK HEILBRUN: Exactly.
MR. REDDINGTON: You ever meet him in person before you went to Tewksbury?
KIRK HEILBRUN: No, I didn't.
MR. REDDINGTON: So did you guys have a plan to meet up somewhere before you went to evaluate Lindsay?
KIRK HEILBRUN: In the lobby of the hospital.
MR. REDDINGTON: Okay. Did you stay somewhere the night before?
KIRK HEILBRUN: I did, yes.
MR. REDDINGTON: Yeah. Where'd you stay?
KIRK HEILBRUN: I don't remember.
MR. REDDINGTON: You don't remem— were you with Mack that night?
MR. REDDINGTON: No? Did you stay in a private house?
MR. REDDINGTON: You stay in a hotel?
KIRK HEILBRUN: Yes, I did.
MR. REDDINGTON: Wasn't a van down by the river for sure, right?
KIRK HEILBRUN: I don't remember the name of the hotel, but it was a hotel in Tewksbury.
MR. REDDINGTON: All right. So you're in a hotel. You meet with Avram Mack in the parking lot, and then you go into Tewksbury Hospital to meet with this young lady, right?
KIRK HEILBRUN: Correct.
MR. REDDINGTON: And the two of you, day number one, you spend how many hours, the two of you, questioning her?
KIRK HEILBRUN: Four and a half.
MR. REDDINGTON: And day number two, you don't bring Mack with you. You're by yourself, and you administer the psychological testing, correct?
KIRK HEILBRUN: Correct.
MR. REDDINGTON: And how long was that, sir?
KIRK HEILBRUN: Three hours.
MR. REDDINGTON: And day number three, how long did you speak to Lindsay in the hospital?
KIRK HEILBRUN: Three hours.
MR. REDDINGTON: So what was your total period of time over a three-day period that this young woman was dealing with you and Avram Mack?
KIRK HEILBRUN: 10 and a half hours.
MR. REDDINGTON: So for 10 and a half hours, this young lady is in a room in a wheelchair being questioned by you and Avram Mack while she's on medication, right?
KIRK HEILBRUN: Yes, that's correct.
MR. REDDINGTON: And she was still answering your questions, trying to be cooperative, and being affable and friendly, you put in your report, right?
KIRK HEILBRUN: Yes, that's right.
MR. REDDINGTON: Did at any time she express to you that she was tired and wanted to take a break?
KIRK HEILBRUN: We offered her in the beginning—
MR. REDDINGTON: My question, sir, was—
MS. SPRAGUE: Objection. If he could answer the—
MR. REDDINGTON: No, he's not gonna, he's gonna answer my question.
THE COURT: No. Hold, hold on. Hold on. Why don't you ask the specific question? Doctor, if you'd listen to that question, okay?
MR. REDDINGTON: My question, sir, was at any time did you or Avram Mack offer to her to take a break?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: Did she accept that offer?
KIRK HEILBRUN: Once she did, and once she did not.
MR. REDDINGTON: And basically indicated that she wanted to get through this interview and get it over with, right?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: You weren't her buddy going there to talk to her that those three days, were you?
MR. REDDINGTON: She knew that you were there on behalf of the district attorney's office to testify against her in a trial and say to a jury that she knew and was able to conform to the law. She killed her three kids. Isn't that right?
KIRK HEILBRUN: No, that's not right.
MR. REDDINGTON: Your diagnosis is depressive bipolar 2, right?
KIRK HEILBRUN: Bipolar 2 disorder, right.
MR. REDDINGTON: Okay. And that's a serious mental disease, isn't it?
KIRK HEILBRUN: Yes, it is.
MR. REDDINGTON: You would agree with me, sir, that Lindsay is a, in your opinion, testified she's a very hard-working and highly self-disciplined individual, right?
KIRK HEILBRUN: Yes, I would agree with that.
MR. REDDINGTON: You testified to that yesterday, right?
KIRK HEILBRUN: Yes, that's right.
MR. REDDINGTON: Right. That's funny?
KIRK HEILBRUN: No, it's not funny. It's just that you asked me whether I agree with something that I testified to yesterday.
MR. REDDINGTON: So what does that mean?
KIRK HEILBRUN: It means that I testified to it yesterday, and that means I do believe it. Yes.
MR. REDDINGTON: Okay. So we established that. In your opinion, granted through those three days that you had interactions with Lindsay, is it your opinion that she is a controlling individual, sir?
KIRK HEILBRUN: It depends what you mean by controlling.
MR. REDDINGTON: Well, let me ask you, for example, would you agree that if a young mother prepares lists for a babysitter, for example, to chop up the carrots and dice them up small, and how to prepare the spinach, and how to prepare the Chicken McNuggets, and then leaves them in a note and puts them on the kitchen table, is that controlling, in your opinion, of that individual?
KIRK HEILBRUN: That is something that is working hard and being disciplined and exerting a certain amount of control, yes.
MR. REDDINGTON: That's not something that you would use against her in this opinion you have for this jury, is it?
KIRK HEILBRUN: What I do is do my best to describe what she does, what she thinks, what she feels at certain times, what symptoms she has, and so on. And if that's a part of that overall picture, then it's not that I'm using it in favor of her or against her; it's just part of the overall picture, which I'm trying to present.
MR. REDDINGTON: I mean, it's not a bad thing to chop up the carrots and tell somebody, "This is how I like my child to be fed," right? There's nothing wrong with that, right?
KIRK HEILBRUN: Not that I know.
MR. REDDINGTON: And you would agree, sir, that she was a good student. You told us about, you know, she'd get all As. She was hard-driving and actually drove herself pretty good to try to succeed in college and in nursing school, right?
KIRK HEILBRUN: I would.
MR. REDDINGTON: And did you interview any of her coworkers, or did you review any of her five-star reviews from Mass General Hospital, a flagship of hospitals?
KIRK HEILBRUN: I reviewed every record that was provided to me.
MR. REDDINGTON: And that would be by them, right?
KIRK HEILBRUN: I— it was records that were provided to me by individuals who were a part of the investigation, and a lot of that were interviews with people who had known her before or were currently friends with her, things like that.
MR. REDDINGTON: Okay. So things like that. I'm asking you, sir, about what, with her seven-year career as a nurse, labor and delivery nurse, at a very, very well-established hospital, did you talk to any of the nurses that she worked with, or did you review any of the records of her work reviews, anything like that?
MR. REDDINGTON: Would you agree with me, sir, that she also, by all accounts, is and was an incredible mother, taking care of her kids?
KIRK HEILBRUN: I would describe her as a very good mother, yes.
MR. REDDINGTON: And in fact, sir, in the past six weeks or five weeks, there hasn't been one person that's had one thing bad to say about her other than these two. Isn't that right?
MS. SPRAGUE: Objection.
THE COURT: Sustained.
MR. REDDINGTON: Did anybody, to your knowledge, come into this court in front of this jury and say that Lindsay Clancy was a bad wife?
KIRK HEILBRUN: I don't know.
MR. REDDINGTON: How about bad mother?
KIRK HEILBRUN: Again, I don't know.
MR. REDDINGTON: So in your readings about her as a mother, you were able to see that she would sing to her daughter when she put her to bed.
MR. REDDINGTON: That's in the reports. You read the reports, right?
KIRK HEILBRUN: You might have to ask me that question again.
MR. REDDINGTON: You know Rascal Flatts?
KIRK HEILBRUN: I'm sorry?
MR. REDDINGTON: Rascal Flatts. You ever heard of them?
MR. REDDINGTON: Okay. So if I suggest to you, sir, that Lindsay would sing to her daughter every night, is that important to you in your evaluation?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: You didn't know that, though, apparently, right?
KIRK HEILBRUN: I knew that she was very good with her kids, paid a lot of attention to them, spent a lot of time with them, and really enjoyed it.
MR. REDDINGTON: Even right up to within hours of their killing, she was making snowmen with them, right?
KIRK HEILBRUN: Yes. She was playing with the two older children out in the backyard.
MR. REDDINGTON: And then bringing her life experience, which you testified yesterday that she never had any abuse in her life, was raised by loving mother and father, good student, hard worker, great mother, good friend, wonderful wife. She then randomly decides to kill her children by strangling them? That's the facts we're dealing with, sir?
MR. REDDINGTON: Right?
KIRK HEILBRUN: No, not right.
MR. REDDINGTON: So one of the things you testified to yesterday is that—and you went like this and said that this is difficult, but then you were able to power through and tell the jury that Lindsay didn't like to leave the kids alone. She got anxious about that. Remember telling that to the jury?
KIRK HEILBRUN: I do.
MR. REDDINGTON: And this is one of the things that you kinda hang your hat on, that you felt was important in your evaluation, right?
KIRK HEILBRUN: It was important. It was an important part of my evaluation, that she did not like to leave her kids, and it made her anxious, yes.
MR. REDDINGTON: That's not a bad thing, is it, for a mother not to wanna leave her children and be anxious when they're out of her home, right?
KIRK HEILBRUN: Well, it depends. It could be difficult and so on if it—depending on how anxious and even disabling it was, if she just couldn't leave her kids. But on the other hand, if it just reflected that she was close to them and wanted to be with them, and wasn't a problem or disabling, then it's not a problem.
MR. REDDINGTON: Did you know, sir, that Pat's mother and father would come over to the house and babysit for the kids when Lindsay and her husband would go out to dinner, or go out to a movie, or go out with their friends? Did you know that, sir?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: Did you know that the children were actually in Learning Sprouts School? Did you know that?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: They had to leave the house to go to school, didn't they?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: She wasn't anxious when they would go to school, was she?
KIRK HEILBRUN: It made her a little anxious to drop her kids off. She didn't like to be separated from them.
MR. REDDINGTON: Well, that's because the kids, many times—not on occasion—would cry, like little kids do when you drop them off somewhere, right?
KIRK HEILBRUN: I don't know if she was anxious only when they cried.
MR. REDDINGTON: You know that, in addition to the date nights, in addition to socializing with friends, in addition to the children leaving to go to the Little Sprouts School, you know that there were a number of occasions that Lindsay alone, or Lindsay with her husband, would leave the kids and go out and do any number of things. Shopping, socializing, go to Boston, things like that. Did you ask third-party contacts about that?
KIRK HEILBRUN: I asked Patrick about that, and one of the things he said is that it was difficult for her to leave the kids, and he used as an example date night for their fifth anniversary. It was hard for her to leave.
MR. REDDINGTON: Was that in '22?
KIRK HEILBRUN: Was date night for their fifth anniversary in '22?
MR. REDDINGTON: Just mention it to the jury. Was that in 2022, their fifth anniversary? Their anniversary's in December, right?
KIRK HEILBRUN: I don't know what year it was, it was in, Mr. Reddington.
MR. REDDINGTON: Well, what was the problem? What did he say, third party collateral, what did he tell you?
KIRK HEILBRUN: What he said, in response to that question, is that on date night for their fifth anniversary, she was anxious about leaving the kids.
MR. REDDINGTON: Right. Did they ultimately go out that night?
KIRK HEILBRUN: They did.
MR. REDDINGTON: Do you know where they went?
KIRK HEILBRUN: I don't.
MR. REDDINGTON: Did she have fun? Did she appear to be enjoying herself away from the kids?
KIRK HEILBRUN: That was not part of the question I asked him.
MR. REDDINGTON: I mean, there's nothing wrong with a woman being concerned about her babies when she's not at home, right? There's nothing wrong with that.
KIRK HEILBRUN: I wasn't presenting it as something that is wrong.
MR. REDDINGTON: I'll back off. I'm sorry. I thought you did. I thought yesterday you were telling this jury that because Lindsay didn't like to leave the kids at home, that was a factor that Dr. Heilbrun considered, in his opinion, but that's fine. You agree that there's nothing wrong with a woman being concerned about her children, leaving them out of the house, right?
KIRK HEILBRUN: No, I don't believe I said that.
MR. REDDINGTON: Okay.
KIRK HEILBRUN: I... One of the things that I s-
MR. REDDINGTON: No, no, no. Never mind one of the things. Next. They can ask you on- They can finish up.
THE COURT: All right. Okay. You, the answer is, you did not say that.
KIRK HEILBRUN: Judge, I'm getting a little confused here between-
THE COURT: Well, listen. No. See if you... My question is not that confusing.
KIRK HEILBRUN: Okay.
THE COURT: Did you testify... Are you done saying that you did not say what Mr. Reddington said?
KIRK HEILBRUN: Yes, I'm done saying that.
THE COURT: Okay. All right.
KIRK HEILBRUN: Yes.
THE COURT: That's good. Next question.
MR. REDDINGTON: One of the other issues is that, also factored into when Tufts prescribed her the SSRI, she didn't wanna take it because she was afraid of the breast milk being contaminated by this drug, right?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: And then ultimately, when she stopped breastfeeding, at that point, she was able to take the SSRI, correct?
KIRK HEILBRUN: Yes, that's correct.
MR. REDDINGTON: And then Tufts increased it to 50, right?
KIRK HEILBRUN: I don't recall offhand what the-
MR. REDDINGTON: Okay. Well, you agree that Tufts increased the SSRI, right?
KIRK HEILBRUN: I do.
MR. REDDINGTON: You agree that before the end of September of 2022, this young woman was living her life with her husband and her kids. Summer of '22, happy, had a great time. Do you agree with that, sir?
KIRK HEILBRUN: I do.
MR. REDDINGTON: And when she saw Tufts from September end up until the killing of these children, and the state of her condition that you told the jury was confusing. You remember using that word yesterday? It was confusing with these number of diagnoses that she dealt with.
KIRK HEILBRUN: Yes, I did use that word.
MR. REDDINGTON: And the confusing with the number of drugs. That was one drug on top of another drug, and stop this drug, stop that drug. That was confusing, wasn't it, sir?
KIRK HEILBRUN: Yes, it was.
MR. REDDINGTON: And it was confusing and upsetting to her and her husband to the point where they went to these doctors and said to them, “You're turning her into a zombie,” right?
KIRK HEILBRUN: Yes, that's right.
MR. REDDINGTON: But prior to seeing Tufts and the other healthcare providers, she was a happy woman, wasn't she?
KIRK HEILBRUN: She was in many respects happy, pleased with her life. So she wasn't happy in an unqualified way, but she was, yes, she was very happy with certain aspects of her life.
MR. REDDINGTON: So as September turns into October, middle of October or thereabouts, how was she doing at that point between her depression, anxiety, drugs prescribed, how was she doing?
KIRK HEILBRUN: She was anxious about going back to work, but she hadn't started taking the-
MR. REDDINGTON: Okay. Wait, wait, wait, wait, wait.
KIRK HEILBRUN: ... drugs that were prescribed.
MR. REDDINGTON: No, no, no. Whoa.
THE COURT: You gotta let him finish. Go ahead. Go ahead, doctor.
KIRK HEILBRUN: Yes. In September, she was anxious about returning to work. She had not yet started taking the medications that Dr. Tufts had prescribed though.
MR. REDDINGTON: How about a text that she had sent to her mother, on October 20th, sir? I know you indicate in your report you've had a chance to review all of the computer searches, text messages, Apple Watches, all that stuff, right?
KIRK HEILBRUN: Yes, that's right.
MR. REDDINGTON: All right. Read that text, please. October 20th. This is a text that she sent to her mother. Read it.
KIRK HEILBRUN: Would you like me to read it out loud?
MR. REDDINGTON: I'd like you to read it out loud.
KIRK HEILBRUN: All right. “Mom, will you please come up and stay with me for a bit? I'm really sick. Something is wrong. I had horrible insomnia all night, and I just don't know how I'm going to get through the day. I started taking the medicine my doctor prescribed for anxiety, and I think it's made things worse. It's just really scary, and I don't want to be alone.”
MR. REDDINGTON: Did her mother come up the next day and stay with her?
KIRK HEILBRUN: Oh, I don't know. I'd have to go back and look at the records.
MR. REDDINGTON: I'm sure. You know, sir, that she actually climbed into the bed with the mother to sleep, with the mother, when the mother was staying with her during this period of time?
KIRK HEILBRUN: No, I didn't know that.
MR. REDDINGTON: In the middle of November, sir, she texted her mother-in-law, which would be Pat's mother, Sue. This would be Sue Clancy, who was also a labor and delivery nurse, right?
KIRK HEILBRUN: Yes, that's correct.
MR. REDDINGTON: She texted Sue while she was at work as a nurse, right?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: And Sue was in the emergency room and actually realized that Lindsay was at the hospital and stated that she felt unwell. Is that right?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: Did Sue see her in the hospital, if you know?
KIRK HEILBRUN: I think she met with her in the emergency room.
MR. REDDINGTON: Okay. And then her mother-in-law was trying to help her out and referred her to another person that was a friend of a friend, so to speak, right, to help her out?
KIRK HEILBRUN: The nurse practitioner. Is that who—
MR. REDDINGTON: Yep.
KIRK HEILBRUN: ... you're talking about?
MR. REDDINGTON: Yes. Yeah.
KIRK HEILBRUN: Yes, that's right.
MR. REDDINGTON: And she was able to meet with that individual, Paul, until she left, I think like a week later. She went on to another job, right?
KIRK HEILBRUN: I think that's right, yes.
MR. REDDINGTON: And that's when she saw Nurse Jollotta. Was that correct?
KIRK HEILBRUN: To my memory, that's correct, yes.
MR. REDDINGTON: And then, would you agree with me, sir, that at this timeframe in November, she was having real difficulty with sleep disruption, yes?
KIRK HEILBRUN: Yes, I would.
MR. REDDINGTON: You had concerns all along about this starting in mid-October about the impact of the medications on her insomnia, correct?
KIRK HEILBRUN: Yes, insomnia was one of the first problems that she experienced when she started taking the medication in October.
MR. REDDINGTON: And she expressed the fact that she believed that the medications were obviously having an adverse effect on her. They were damaging her brain, right?
KIRK HEILBRUN: She did express that view, yes.
MR. REDDINGTON: And then she still, however, had a positive outlook and was hoping that things would turn around in her life and that she could get back to being herself, is a quote, right?
KIRK HEILBRUN: Yes, that's right.
MR. REDDINGTON: But instead, and I quote your words yesterday, "It got worse."
KIRK HEILBRUN: Yes.
MR. REDDINGTON: Late in November, she was still having a lot of trouble sleeping. She thought that she was close to, and I quote, "The end of her rope." Bad analogy, but nevertheless, that's what she said, right?
KIRK HEILBRUN: Yes, it is.
MR. REDDINGTON: She was feeling off, disconnected, sort of like a zombie. Your words testifying here yesterday, sir. Correct?
KIRK HEILBRUN: Correct.
MR. REDDINGTON: She was reporting at this point panic symptoms, concerns about the benzodiazepines, correct?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: Indicated that she was disoriented and forgetful, correct?
KIRK HEILBRUN: Correct.
MR. REDDINGTON: You told us that she stated that she was disconnected from her body. Isn't that correct?
KIRK HEILBRUN: That's how she described feeling, yes.
MR. REDDINGTON: Could not relate to people, felt that she was in a disassociative state. Isn't that right?
KIRK HEILBRUN: Yes, that is right.
MR. REDDINGTON: Thought that the medication was resulting in this type of development in her life, correct?
MR. REDDINGTON: She felt the medications were contributing to this.
KIRK HEILBRUN: Yes, that's correct.
MR. REDDINGTON: And in December, and I quote you, “It's not getting better.” It go- from worse, it got better. Well, actually, not better. It got worse again, didn't it, in December?
KIRK HEILBRUN: December was probably the worst month for her, as she described it.
MR. REDDINGTON: And in December, sir, you recall that she indicated, and I quote from your testimony, “Horrible, intrusive thoughts.” She had thoughts about harming herself, potentially as she continued to experience these thoughts later into December, correct?
KIRK HEILBRUN: Yes, that's right.
MR. REDDINGTON: These thoughts, did anyone, anyone say to her, “Are these thoughts? Are these coming from outside your head? Are they coming from inside your head? Are they male voices? Are they female voi-”—anybody ask anything about thoughts, what they were? According to the medical records, not according to your guess.
KIRK HEILBRUN: That's a standard kind of question when you're being treated.
MR. REDDINGTON: My question, sir, is you read the medical records—
THE COURT: No, overruled.
MR. REDDINGTON: Can you answer that question based on Dr. Heilbrun's review of the medical records of what this young lady went through and that hell that she was living?
KIRK HEILBRUN: Is your question, did someone ask her about hallucinations or thoughts?
MR. REDDINGTON: Yeah, if I come to you for help and I say, “I've got intrusive thoughts about killing myself, and God forbid, I'm thinking about killing my kids. I've got these thoughts in my head,” would you ask me, “Do you hear voices?”
KIRK HEILBRUN: Thoughts?
MR. REDDINGTON: Whatever. Does anybody ask that question?
KIRK HEILBRUN: Yes, that's a standard question that psychiatrists ask at the beginning of each appointment. It's a standard mental status question.
MR. REDDINGTON: Okay. Did any one of those psychiatrists ask Lindsay Clancy that question, according to the medical records? Anyone?
KIRK HEILBRUN: Ms. Clancy completed the answer to those questions, uh—
MR. REDDINGTON: What question?
KIRK HEILBRUN: On a number of occasions.
MR. REDDINGTON: Sir.
KIRK HEILBRUN: If I might.
MR. REDDINGTON: What questions?
MS. SPRAGUE: Objection.
THE COURT: Go ahead.
MR. REDDINGTON: What questions?
THE COURT: Finish that question and I'll let you have that question.
KIRK HEILBRUN: Okay.
THE COURT: Finish the answer.
KIRK HEILBRUN: Questions such as, “Are you hearing voices?” If so, describe those, and so on. And the typical response that she gave in, as part of a question like that was no.
MR. REDDINGTON: How about when someone says, “I've got dark thoughts,” does anybody, professionals, ask, “What are the dark thoughts?” Does anybody—
KIRK HEILBRUN: If somebody said, “I'm having dark thoughts,” then the follow-up question would be, “Tell me more. What are the thoughts? Tell me, just give me some descriptions of what you're having, what you're thinking, what it's like,” and so on.
MR. REDDINGTON: So if a patient goes to a doctor and says, "I'm having these intrusive thoughts, I'm having dark thoughts, I'm having thoughts of..." And at the same timeframe, in December.
KIRK HEILBRUN: Mm-hmm.
MR. REDDINGTON: She's talking about harming the children, correct?
KIRK HEILBRUN: She said that those thoughts had come to her at times.
MR. REDDINGTON: At times.
KIRK HEILBRUN: Yes.
MR. REDDINGTON: And she mentioned that to her husband, didn't she?
KIRK HEILBRUN: That's what she said, yes.
MR. REDDINGTON: She mentioned... Did you talk to her husband about it?
KIRK HEILBRUN: Yes, I did talk to her husband about it.
MR. REDDINGTON: Tell him that she said that to him?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: A couple of times she said it to him, right?
KIRK HEILBRUN: A couple of times she said, "I'm having thoughts," and he asked her, "Give me more detail if you could." And she said, "They're just thoughts. It's not a plan." That sort of thing.
MR. REDDINGTON: You got this girl living in her house with her kids saying she's having dark thoughts, saying she's thinking of harming the children. And Patrick's response according to your testimony is just basically just power through it, you'll be okay?
MS. SPRAGUE: Objection.
THE COURT: Overruled.
MR. REDDINGTON: Sir.
KIRK HEILBRUN: No, that was not his response as he described it. He asked more questions, because one of the things that she had been dealing with for some time are thoughts about hurting herself and possibly the kids. And so what he did was try to get more information about the details. Do you... He asked questions that a mental health professional would also ask, which is, how often, what are they like, do you have a plan, things like that. And she pretty consistently said, "No, I don't have a plan. And this is how often it happens, but they're just thoughts."
MR. REDDINGTON: So that's, let's talk about that, because that's apparently the standard reaction if a patient comes to a doctor and says, "I'm having dark thoughts, intrusive thoughts. I'm thinking of hurting myself. I'm thinking of hurting the kids." You say, "Do you have a plan?" That's the question you ask, right?
KIRK HEILBRUN: That's one of the questions that you ask, yes.
MR. REDDINGTON: And the person says, "Nah, I don't have a plan. I'm just having these thoughts," and you just basically move on and give them more drugs? What do you do?
KIRK HEILBRUN: No, you don't move on. You're aware that the person has reported having those thoughts, and you've appraised the risk, and the risk has to do with things like, how imminent is it, how serious is it, are there means—
MR. REDDINGTON: Meaning?
KIRK HEILBRUN: ... How, is there a plan, what sort of detail is involved, and so on. And so basically what you do at that point is you take it seriously.
MR. REDDINGTON: Mm-hmm.
KIRK HEILBRUN: But you also try to describe how seriously to take it. So.
MR. REDDINGTON: Okay. Would you agree, sir, that she was complaining through December about these unwelcome and internal thoughts? Is that correct?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: It's important for your evaluation because, when you ask the question, 'When you're experiencing these thoughts, were they your own thoughts or were they auditory hallucinations?' And she indicated to you, 'They're my own thoughts,' is what your testimony was, right, yesterday?
KIRK HEILBRUN: That's correct.
MR. REDDINGTON: But she made clear that these were unwelcome and that they were intrusive. Is that correct?
KIRK HEILBRUN: Yes, yes, she did.
MR. REDDINGTON: So she's answering your questions honestly. She certainly isn't trying to fake that she's hearing all sorts of voices yelling at her and things like that. She's answering honestly, correct?
KIRK HEILBRUN: Yes. I, yes.
MR. REDDINGTON: Very cooperative, correct?
KIRK HEILBRUN: Yes, correct.
MR. REDDINGTON: You then would indicate, sir, that in your evaluation as you went on, that she described an experience on December 15th. And she described December 15th as being literally one of the worst days in her life, right?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: And that's... Why was it one of the worst days of her life?
KIRK HEILBRUN: Well, it was one of the worst days because things were getting more intense and difficult, and the thoughts that she was experiencing were harder to handle for her.
MR. REDDINGTON: As a result of that, her husband, Pat, took her to the hospital, right?
KIRK HEILBRUN: Correct.
MR. REDDINGTON: And you indicated that it looked like she was having general anxiety symptoms, right? That's your testimony yesterday.
KIRK HEILBRUN: It looked from what the records reflected that anxiety was something that they were focusing on her experiencing.
MR. REDDINGTON: And then you said in your testimony, 'But not so much the—not so much the postpartum.' What does that mean?
KIRK HEILBRUN: It means that in December she would have been...
KIRK HEILBRUN: Seven months away from giving birth to Callan, and consequently, it was less likely to be postpartum than depression for other reasons or bipolar or major depression or something like that, rather than postpartum depression or postpartum psychosis. Something like that.
MR. REDDINGTON: 'Cause you know that postpartum is not a medical diagnosis. That's just the fact that you had a baby, right?
KIRK HEILBRUN: I do know that, yes.
MR. REDDINGTON: Okay. And when she went to that hospital, did they provide any help for her or any medication, or what happened on December 15th?
KIRK HEILBRUN: She did not stay in the hospital very long, and so, no, she didn't remain there long enough to get the kind of help that you would usually get on an in-patient basis.
MR. REDDINGTON: But the next day or thereabouts, she goes back to see Tufts, right?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: Okay. So she immediately tries to reach out for help to anybody that would listen to her, right?
KIRK HEILBRUN: She was trying hard to get help.
MR. REDDINGTON: Now we get to December 20th. December 20th wasn't a very good day either, was it?
KIRK HEILBRUN: Well, that was the day she went to the—she went to the Rhode Island Hospital that had a postpartum program.
MR. REDDINGTON: Now, you know from looking at the medical records that, in fact, it was recommended to her, I think by maybe the LASCW young lady, Latiesha Dukes, but maybe I'm wrong. They're in the records. Someone told her to get in touch with this Rhode Island Hospital, right?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: They specialized in postpartum care for women that possibly are going through postpartum psychosis or postpartum depression, right?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: And Pat, her husband, took her and dropped her off, and then he went skiing with Cara. Is that correct?
KIRK HEILBRUN: Correct.
MR. REDDINGTON: And he dropped her off in that hospital and she was evaluated by a doctor and some people, correct?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: And you reviewed those medical records, right?
KIRK HEILBRUN: I did.
MR. REDDINGTON: And when you reviewed the medical records, did you see that she was also involved in group discussions and crayons and coloring and things like that?
KIRK HEILBRUN: Yes, I did.
MR. REDDINGTON: Yeah. Did that help her out, do you think, the coloring?
KIRK HEILBRUN: There's a number of things that they try to do. I think coloring as such would not be helpful but there's art therapy and there's various other kinds of things that people are involved in.
MR. REDDINGTON: All right, so various other things that people are involved in, so I assume the people you're referring to would be the employees of the hospital.
KIRK HEILBRUN: Or the patients who are attending the postpartum program.
MR. REDDINGTON: Okay. So what exactly was the program? What did they do that one day that she was there? She was there for eight hours. What did they do?
KIRK HEILBRUN: She wasn't accepted as part of that program.
MR. REDDINGTON: I didn't ask you about that. I asked you what did they do?
KIRK HEILBRUN: Well, they evaluated her, is my understanding from reviewing the records.
MR. REDDINGTON: And then what happened, sir, when they evaluated her?
KIRK HEILBRUN: They evaluated her, and they indicated that she was not appropriate for their program.
MR. REDDINGTON: And you testified yesterday that, and I quote, “They said she did not necessarily fit into their postpartum program. They did offer her three other programs.” You remember that, sir?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: Okay. And then you indicated that patient was offered several options, including in-patient treatment for medication management, right?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: A partial hospitalization program focused on general mental health.
KIRK HEILBRUN: Yes.
MR. REDDINGTON: Right?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: Where was that program?
KIRK HEILBRUN: I don't know.
MR. REDDINGTON: Oh. Or continued outpatient management, right?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: What is that, like going to see Tufts, outpatient management?
KIRK HEILBRUN: Yes, that's living at home in the community and being treated by a psychiatrist, which is what Dr. Tufts was.
MR. REDDINGTON: Right. Well, okay. So patient plans to follow up with her outpatient provider for guidance is what you said yesterday, right?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: And she did the next day, right?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: And do you think that a doctor who has been licensed as a physician psychiatrist, advertising that they specialize in postpartum, postnatal issues, is qualified to treat a young woman with this symptomology that she brought to that desk—oh, I'm sorry, to the television set?
KIRK HEILBRUN: I don't understand your question.
MR. REDDINGTON: Well, you know that she never met—Tufts never met this girl. She never met her, ever, until she sat in that witness stand.
KIRK HEILBRUN: I understand that their treatment was done remotely.
MR. REDDINGTON: Was remotely? So when I say the television, that's what I mean. It's like you were on Zoom, you were on whatever.
MR. REDDINGTON: That's... I apologize for that.
KIRK HEILBRUN: Yes. Yeah.
MR. REDDINGTON: So she went the next day and actually remotely accessed a meeting with Dr. Tufts, right?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: And then she went back onto her schedule with Dr. Tufts, but that didn't help so much. Is that correct? You indicated that she was still numb. She was still having suicidal ideation, things of that nature, right?
KIRK HEILBRUN: Correct.
MR. REDDINGTON: Okay. One of the things that you said though, sir, yesterday is that her admission to the hospital was because they did not feel, and I quote, “That she did not necessarily fit into their program.” You recall that?
KIRK HEILBRUN: You mean their failure to accept her into the day program?
MR. REDDINGTON: Their failure to help her, period. They let... They told her to leave.
KIRK HEILBRUN: It's my understanding that what they said was that you don't fit with our program because it's not a postpartum phenomenon, and that's what the program is about.
MR. REDDINGTON: Did you really read those records—
KIRK HEILBRUN: Yes.
MR. REDDINGTON: ...seriously?
KIRK HEILBRUN: Yes, I did.
MR. REDDINGTON: Okay.
MR. REDDINGTON: So tell me then—
KIRK HEILBRUN: And I wrote something about, in my report, I wrote something about it.
THE COURT: ...Wait for the next, wait for the next question. Okay?
KIRK HEILBRUN: Yes, Your Honor.
MR. REDDINGTON: So you read the records from that Women and Infants Hospital in Rhode Island?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: You're telling this jury, right?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: And what was the word, the language, the word, sir, you just said to me, that they didn't accept her because of what?
MS. SPRAGUE: Objection.
THE COURT: Yeah. You rephrase that.
MR. REDDINGTON: What was it you just said to this jury they wouldn't accept her? Why?
KIRK HEILBRUN: It was a day program for women experiencing postpartum difficulties, and their evaluation of Ms. Clancy was that her difficulties were more related to general mental health, but not particularly to postpartum difficulties.
MR. REDDINGTON: Would it surp—
KIRK HEILBRUN: And so she did not—
MR. REDDINGTON: Go ahead.
KIRK HEILBRUN: If I might.
MR. REDDINGTON: Yeah, you might.
KIRK HEILBRUN: If she might be more appropriate for somebody... She might be more appropriate for a general mental health program, but not so much for a postpartum day program, which is what they had. So they didn't say that you don't need help. It just said that you don't fit with our program.
MR. REDDINGTON: Would it surprise you to know, sir, that they said that she didn't fit with their program, as you put it, because of the overlay of overmedication that her doctors had caused to that point? Do you have any memory of that at all?
KIRK HEILBRUN: There were questions that they raised about the medication.
MR. REDDINGTON: It wasn't just questions. They said that's the reason. The secondary diagnosis as to why they wouldn't accept this young lady is because of the medications that she had been prescribed. Over-medicated.
KIRK HEILBRUN: The—
MR. REDDINGTON: Do you recall seeing that in those records?
KIRK HEILBRUN: Yes. I recall a diagnosis of depression, which was not specified further because there were medical, medicine complications.
MR. REDDINGTON: Do I have to get the medical records and read them to you?
KIRK HEILBRUN: I actually have something in my report—
MR. REDDINGTON: Good.
KIRK HEILBRUN: …so I can read it back to you.
MR. REDDINGTON: Can you pull it out—
KIRK HEILBRUN: Yes.
MR. REDDINGTON: …and tell me what the discharge diagnosis was?
MR. REDDINGTON: Exhibit 220.
MS. SPRAGUE: Which one's are you looking for?
MR. REDDINGTON: 220, I guess. Women and Infants Hospital records.
KIRK HEILBRUN: I'm on page 18—
MR. REDDINGTON: Okay.
KIRK HEILBRUN: …of my report. And—
MR. REDDINGTON: Is that Ms. Clancy's diagnosis?
KIRK HEILBRUN: The records indicate a diagnosis of generalized anxiety disorder and depressive disorder without further specification, and I quote, “Due to adverse drug effects.”
MR. REDDINGTON: Anything else?
KIRK HEILBRUN: Yes. They indicate that her chief complaint was feeling numb and crazy depressed. Identified passive suicidal ideation. Notes that the… Well.
MR. REDDINGTON: I'm sure you can read all the diagnoses. My question, sir, is simple. It's on the discharge diagnosis. That's all.
KIRK HEILBRUN: Yes. The discharge diagnosis was anxiety and depression.
MR. REDDINGTON: …and secondary to what?
KIRK HEILBRUN: They didn't specify more about the depression—
MR. REDDINGTON: But you're just reading it.
KIRK HEILBRUN: …because it was due to adverse drug effects.
MR. REDDINGTON: Okay. And in your review of the records, sir, did you then see that the doctor at the Women and Infants at least was concerned enough about the over-prescriptions that she reached out to Dr. Jollotta to speak to her?
KIRK HEILBRUN: Dr. Jollotta?
MR. REDDINGTON: Sorry, Nurse Practitioner Jollotta.
KIRK HEILBRUN: Yes.
MR. REDDINGTON: Yeah, okay. It's like captain, major, that type of thing. But Jollotta, you know who she is, right?
KIRK HEILBRUN: I do, yes.
MR. REDDINGTON: Okay. Did they reach out to Nurse Practitioner Jollotta?
KIRK HEILBRUN: I did not see that in the records.
MR. REDDINGTON: Can we break here, Judge? Because I gotta get the records.
THE COURT: All right. All right, it's 11:00. So why don't we take the morning recess at this time, and we'll come back shortly. Okay?
BAILIFF: Court, all rise, please.
BAILIFF: Jurors may exit the courtroom.
THE COURT: All right. We'll be in recess at this time. Thank you.
BAILIFF: Court is in recess. Please exit the courtroom.
BAILIFF: Court is back in session. You can be seated.
COURT CLERK: Your Honor, for the purpose of the record, we return back to the trial of Commonwealth versus Lindsay Clancy. All parties are present excluding the jury.
THE COURT: All right. Are we ready for the jury, counsel? Okay. Yeah.
BAILIFF: All rise. Jurors enter.
BAILIFF: This court is now in session. You may be seated, please.
COURT CLERK: Your Honor, for the purpose of the record, we return back to the trial of Commonwealth versus Lindsay Clancy. All parties are present, including the defendant and including the 18 jurors.
THE COURT: All right. Attorney Reddington?
MR. REDDINGTON: Thank you. So I now have, sir, exhibit 220, which would be the records from the Women and Infants Hospital that you read prior to coming in here today, correct?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: And when you read the records, would you agree with me, sir, that there was a history of present illness? Which means they would ask Lindsay questions about how she felt, what her medications were, things like that, right?
KIRK HEILBRUN: Yes, I would.
MR. REDDINGTON: And when you were reviewing this, did you note that she indicated that she was feeling, and I quote 'cause it's in quotes, "Crazy depressed, numb to all emotion." End quote. Quote, "Can't feel love." End quote. Quote, "My life is becoming a disaster," end quote. You saw those?
KIRK HEILBRUN: Are you quoting from the records or from my report?
MR. REDDINGTON: The records, exhibit 220.
KIRK HEILBRUN: Okay. Yes, I would agree that those were words that were used when I reviewed the records.
MR. REDDINGTON: And when you were talking with Lindsay, you asked her what she meant by saying she can't feel love?
KIRK HEILBRUN: Yes. She said that she felt like a shell. She felt hollow. She felt like a zombie. She felt emotionally flat as a pancake, which is also one of the phrases that was used in those records to describe her mood.
MR. REDDINGTON: Okay. "My life is becoming a disaster." Quote, "Can't feel fear," end quote. What did that mean? Did you ask her anything like that? Can't feel fear.
KIRK HEILBRUN: I didn't ask her specifically about can't feel fear. She indicated that she was having—she couldn't feel things emotionally that—
MR. REDDINGTON: Worried that she is, quote, "Messed up beyond repair," end quote. That was in the records, correct?
KIRK HEILBRUN: That was several places, yes, including the records.
MR. REDDINGTON: Quote, "Takes all the effort in the world just to breathe," end quote. That was in the records, correct?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: And in the interviews of friends and family, would you agree in this timeframe, which was in December, to the end of December, that she was having difficulty even getting out of bed?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: She felt very heavy. She couldn't even walk. She had difficulty with her personal hygiene, correct?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: Was worried about how she's gonna take care of her kids and feed them and watch them while Patrick was working, right?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: And one of her goals, and I quote, "Was to come off meds and be able to sleep," end quote.
KIRK HEILBRUN: Yes.
MR. REDDINGTON: Now, insomnia, you agree with me, is very serious?
KIRK HEILBRUN: So I would absolutely agree with you, yes.
MR. REDDINGTON: And that can lead to any number of things, right?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: Can even lead to psychosis, right?
KIRK HEILBRUN: I... Yes.
MR. REDDINGTON: Okay. I asked you about the treatment plan and recommendations that the district attorney had asked you about as well. And if I may, and if you need to look at it, let me know. It says, "Treatment plan: admit to DHP." Do you know what DHP is?
MR. REDDINGTON: Okay. Medication: recommended tapering off Seroquel, starting with 200 milligrams tonight and follow up with outpatient provider. That would be who? Jollotta?
KIRK HEILBRUN: At the time, it could have been Jollotta or Tufts.
MR. REDDINGTON: And then indicating, sir, that diagnosis that we talked about, if I may approach, can you... Right here. Just read number one and two for the jury, please.
KIRK HEILBRUN: Number one is GAD, which stands for generalized anxiety disorder. Number two is depression unspecified, rule out due to adverse drug effects.
MR. REDDINGTON: So when you rule out and have a concern about adverse drug effects, one of the things that I imagine one would do is to reach out to the person that's prescribing the drugs, right?
KIRK HEILBRUN: It's possible. There could be other strategies as well. You could change the medication, you could discontinue it. There could be a number of things.
MR. REDDINGTON: And when you read the records, sir, again, page nine under treatment plan, did you make note of the fact that, I quote, "Of note, we attempted to reach current outpatient provider Rebecca Jollotta, NP, but did not receive a call back." You see that?
KIRK HEILBRUN: I may have seen that. I didn't note it in what I wrote here.
MR. REDDINGTON: In any event, patient plans to reach out to previous provider, who would be Jennifer Tufts, and she did that, right?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: Okay.
MR. REDDINGTON: Now, one of the other things that you had made reference to, sir, is that you relied on, is when her husband came home and found Lindsay on the ground in the snow after she had jumped out the window, he spoke with her, is what you told this jury, right?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: And can you tell us again what it is that he said to her and what she said to him?
KIRK HEILBRUN: He said, "What did you do?" And she said, "I tried to kill myself." And then he said, "Where are the kids?" And she said, "In the basement."
MR. REDDINGTON: Now, what is your source of that information, sir?
KIRK HEILBRUN: It was in the records, and I also did a collateral interview with-
MR. REDDINGTON: Of whom?
KIRK HEILBRUN: Patrick Clancy.
MR. REDDINGTON: Did you listen to the 911 tape?
KIRK HEILBRUN: No, I did not.
MR. REDDINGTON: If I tell you, would you be surprised, sir, that she had significant damage not only to her back, her spine, and was hemorrhaging, but also to her throat?
KIRK HEILBRUN: No, I would not be surprised. That was a—she injured herself very badly when she jumped out that window.
MR. REDDINGTON: If I suggest to you, sir, that if you listen to the 911 tape as it relates to Patrick Clancy interacting with her, that she can only make grunting noises, would you be surprised at that?
KIRK HEILBRUN: I would be surprised, yes.
MR. REDDINGTON: And you never listened to that tape?
KIRK HEILBRUN: I did not.
MR. REDDINGTON: Went into McLean Hospital, and that would be the locked wards of McLean Hospital. She was there for five days, correct?
KIRK HEILBRUN: That's correct.
MR. REDDINGTON: And then she was released at her request to attend Cora's birthday, right?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: When she was released, would you agree, sir, that, well, while she was there, she continued to describe her mood as numb, denying things like that she's not having hallucinations and suicidal thoughts or homicidal thinking at the time, and that would be prior to her discharge. Is that right?
KIRK HEILBRUN: There was a lot in that question, so if you could break it down for me, I'd appreciate it.
MR. REDDINGTON: No, I'm just gonna ask, sir, would you agree with me that she indicated what her mood was prior to discharge, right?
MR. REDDINGTON: Well, as a doctor, you're not gonna let somebody walk out the door of a locked ward in a hospital without making sure that, in your opinion, that it's okay for the person to be released to their home, family, things of that nature, right?
KIRK HEILBRUN: I'm looking at the part of my report—
MR. REDDINGTON: Sir, can you understand my question? I'm not—I don't care about your report. I'm asking you about when someone is in a hospital, you don't release them unless you feel they're not a danger to themself or others, right?
KIRK HEILBRUN: I... Yes.
MR. REDDINGTON: Okay.
KIRK HEILBRUN: The answer to that question is yes.
MR. REDDINGTON: And she was released, right, from the hospital?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: And she then was allowed to go home and go to her daughter Cora's birthday, right?
KIRK HEILBRUN: That's correct.
MR. REDDINGTON: And this was on January 5?
KIRK HEILBRUN: January 5, yes.
MR. REDDINGTON: And she was described in the records as being cooperative and pleasant, right?
KIRK HEILBRUN: Cooperative, pleasant, no psychosis, no suicidal or homicidal ideation, mood described as good, in quotes, and not anxious.
MR. REDDINGTON: Good for you. Anything else you wanna add?
MS. SPRAGUE: Objection.
THE COURT: Sustained. Next question.
MR. REDDINGTON: So after discharge, would you agree, sir, that she had what she described as a small shred of hope after discharge because she thought that she was off the Seroquel and felt that was what was causing her a lot of her problems, right?
KIRK HEILBRUN: Yes, I would agree with that.
MR. REDDINGTON: Okay. But the intrusive suicidal ideation and thoughts returned. Isn't that right?
KIRK HEILBRUN: Within a week, yes.
MR. REDDINGTON: And they were pretty bad, weren't they?
KIRK HEILBRUN: Yes, they were.
MR. REDDINGTON: And again, she's describing, according to your testimony yesterday, symptomology that you said of combined two and three. That would be on the little diagram you put up on the board, right, for the jurors to look at, the blue thing that you had with the one, two, three, four, five, six, seven?
KIRK HEILBRUN: The PowerPoint slide, yes.
MR. REDDINGTON: Right. So you combine two and three on the slide, but you talked about this before, is what you indicate. And this is after she started taking the medication. Anxiety didn't get better. She had difficulty, great difficulty, with insomnia, and that she was numb, right? Yet again, right?
KIRK HEILBRUN: Yes. Correct.
MR. REDDINGTON: And a zombie, yet again, right?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: And she didn't see any improvement. Is that right, sir?
KIRK HEILBRUN: No, that's not right.
MR. REDDINGTON: Okay. Well, quote, "In fact, she thought it was getting a lot worse." And so basically what she thought is that the symptoms that she was experiencing following taking the medications prescribed beginning in October, she said the symptoms were getting worse, particularly new symptoms which were insomnia. It's page 126 of your testimony yesterday.
KIRK HEILBRUN: Oh, okay. I mis—
MR. REDDINGTON: Okay. All right.
KIRK HEILBRUN: I misunderstood your question.
MR. REDDINGTON: That's all right. No problem.
KIRK HEILBRUN: Sorry.
MR. REDDINGTON: That's okay. And then you further indicated that, moving on to number five on your chart, one of the things she also said is that she was focusing on making the anxiety, helping the anxiety getting better through medication, right?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: It was also counseling. She went to the counseling through Latiesha Dukes. Miss Jollotta was still treating her, correct?
KIRK HEILBRUN: The counseling was limited, but yes, that is correct. She was involved in some counseling.
MR. REDDINGTON: So it was limited. Is that a bad thing?
KIRK HEILBRUN: It was—
MR. REDDINGTON: Did this woman, did this woman not wanna—
MS. SPRAGUE: Objection.
MR. REDDINGTON: … go to anybody that would help her, sir? Are you trying to tell the jury that she was avoiding help?
MS. SPRAGUE: Objection.
THE COURT: Sustained. Next question.
MR. REDDINGTON: So it was limited. How was it limited?
KIRK HEILBRUN: It was short-term and supportive, as opposed to something where in the field you might pick a cognitive behavioral therapist, which is empirically supported for things like anxiety and depression and patients and things like that.
MR. REDDINGTON: Who makes that decision? Does a person like this make that decision, sir? Is it up to the patient to make a decision of cognitive whatever it is you just said?
KIRK HEILBRUN: Yes. It's certainly one of the things that an individual can do, is looking for a referral from somebody who would be a cognitive behavior therapist or something like that. So yes.
MR. REDDINGTON: So… Go ahead. Don't wanna cut you off.
KIRK HEILBRUN: I'm finished.
MR. REDDINGTON: All set?
KIRK HEILBRUN: I'm finished.
MR. REDDINGTON: She was focusing on trying to make this anxiety and make her feelings about her feelings go away. She wanted to be herself again, right?
KIRK HEILBRUN: Yes, that's right.
MR. REDDINGTON: Now, there's nothing wrong with that, right, for a person to wanna do that?
KIRK HEILBRUN: Not at all.
MR. REDDINGTON: Okay. You indicated that she was concerned about resolving her problems, and the district attorney then asked you about if this is some type of her taking control of her life. You indicated that she is trying to take control of her life. Remember that?
KIRK HEILBRUN: I testified that it was important that she felt in control and that she could make things happen and improve things through focusing and discipline and hard work.
MR. REDDINGTON: And that's what you've already agreed, that she was a person that wasn't afraid of hard work, right?
KIRK HEILBRUN: Yeah. On the contrary. She worked hard and she got a lot of results from working hard.
MR. REDDINGTON: So that's not an issue that would be something that would be a black mark against her, that she's trying to take control of her life as it relates to these medications and what they're doing to her and her internal feelings of postpartum, if that's what she believed?
KIRK HEILBRUN: I was not trying to develop black marks against her. I was just trying to describe—
MR. REDDINGTON: Oh, well, I'm sorry. I thought you said—
KIRK HEILBRUN: ...how she thinks and feels and behaves...
THE COURT: Let him finish.
MR. REDDINGTON: Sorry. You're right.
THE COURT: Next question.
MR. REDDINGTON: I thought you said yesterday that, you know, you put two marks over this category, three marks over this category. This is possible. That's possible. You were considering these things, right?
KIRK HEILBRUN: That was on another issue.
MR. REDDINGTON: Okay.
KIRK HEILBRUN: Yeah.
MR. REDDINGTON: So as it relates to resolving the problems, that would include talking to doctors about different medications to try, researching medications on her own, this is your testimony, asking friends and family for tips. Really? You're supposed to ask friends and family for tips about your mental psychosis, your mental state?
KIRK HEILBRUN: I'm not sure what the question is.
MR. REDDINGTON: Well, Dr. Heilbrun testified yesterday as it relates to, in response to questions from the district attorney, about her resolving of problems, including talking to doctors about different medications to try, researching medications on her own, and asking friends and family for tips.
MS. SPRAGUE: Objection. Is there a question?
MR. REDDINGTON: Yeah. The question is, is that good medical advice, sir, to tell a sick person who comes to a doctor for help to go ask their friends and family for tips?
KIRK HEILBRUN: One of the things I would say is that when you want very much to improve, you of course ask— ... your doctor and whoever else you're working with. But you might also ask other people in the family or friends any recommendations that they might have. That's sort of something that you do.
MR. REDDINGTON: And when you say, "Sort of something you do," what are you referring to? The women that come to a doctor in the postpartum depression, postpartum psychosis, and ask for help, that they should go talk to their neighbors?
KIRK HEILBRUN: I think that one of the things that's kind of a natural human inclination is to talk to people who are close to you, friends and family and so on, and say, "This is a problem I'm having. Do you have any advice or can you help in any way?"
MR. REDDINGTON: And then over the course of the time that she was going through this experience into late January, she had a lot of providers offer a lot of diagnoses, and there were a lot of complicated considerations. So much so that the diagnosis that was given to her, being at that time adjustment disorder with anxiety and depressions, generalized anxiety disorder, major depressive disorder, bipolar disorder, bipolar disorder II, postpartum depression, postpartum psychosis, postpartum stress disorder. Those are your words, sir.
KIRK HEILBRUN: Yes.
MR. REDDINGTON: And that was all in January, wasn't it? Right?
KIRK HEILBRUN: Um, uh, uh—
MR. REDDINGTON: Stop saying, "No."
KIRK HEILBRUN: Are you asking me whether she had all the symptoms of all those disorders in January?
MR. REDDINGTON: Your words, sir. Your words, sir, for late January.
MS. SPRAGUE: Objection.
KIRK HEILBRUN: Yeah.
THE COURT: If we could have the question and the response.
THE COURT: Yeah. Good. Next question. Go ahead.
MR. REDDINGTON: Did I just read right what you said in your testimony yesterday?
KIRK HEILBRUN: I'm not understanding your question, Mr. Reddington.
MR. REDDINGTON: Okay. She also had psychotropic medication with adverse reaction. Your words to this jury yesterday.
KIRK HEILBRUN: Yes.
MR. REDDINGTON: What is psychotropic medication with adverse reaction? What does that mean?
KIRK HEILBRUN: It's pronounced psychotropic. And s—
MR. REDDINGTON: I'm sorry.
KIRK HEILBRUN: Oh, okay. Psychotropic medication is medication that is prescribed to help treat symptoms of mental or emotional disorder, and it helps to improve, hopefully, the symptoms that you experience. And so... And there was another part to your question, I think.
MR. REDDINGTON: Yeah. It was called adverse.
KIRK HEILBRUN: Yes. These medications are available because, for what they're prescribed for, they help most people. They have to go through clinical trials and all sorts of things. But for a few people, there are side effects and what we call adverse reactions, and they don't help. In fact, they might make things worse. And it appeared to me from reviewing the records that for Ms. Clancy, she's one of those few people where the reactions were very, very different, very poor, very... They were not the kind of reactions that were designed to have the medication prescribed for and improve the symptoms. She just had sort of the opposite happen.
MR. REDDINGTON: Look at her. You look at her, sir. Did she have adverse reactions, in your mind, after you evaluated her, looked at the medical records, and looked at all of the scripts that she had—
MS. SPRAGUE: Objection.
MR. REDDINGTON: ...do you believe that she had adverse reactions?
THE COURT: Sustained as to the form.
MR. REDDINGTON: Do you believe that she had adverse reactions?
KIRK HEILBRUN: To the medication that she had been prescribed since September?
MR. REDDINGTON: Did she have adverse reactions, sir, up to the time of late January when you had no problem answering questions for the DA yesterday? Did she have adverse reactions into late January?
KIRK HEILBRUN: I believe she was having adverse reactions from the time she began taking the medication in October, up to and including January.
MR. REDDINGTON: Do you think that the treatment that she got from Tufts and Jollotta was good?
MS. SPRAGUE: Objection.
THE COURT: Overruled.
KIRK HEILBRUN: I don't know. That's not something that I evaluated as part of my evaluation of Ms. Clancy.
MR. REDDINGTON: You testified yesterday that she was returning to exercising in December. And then the district attorney followed up and indicated, well, she went to the Kingsbury Club in December. Remember that question?
KIRK HEILBRUN: I don't, actually.
MR. REDDINGTON: No? Do you know what the Kingsbury Club is? It sounds pretty fancy.
KIRK HEILBRUN: I don't, actually.
MR. REDDINGTON: Do you know that it's just an exercise place with a pool—you can bring your kids—and a little restaurant?
KIRK HEILBRUN: Once again, I don't know what the Kingsbury Club is.
MR. REDDINGTON: Well, there's no problem with a woman trying to exercise to try to avoid drugs and try to get herself out of any depressed state that she might be in after having a baby, right? No problem with that.
KIRK HEILBRUN: On the contrary, it's a good idea if she can do it, and it's something that she used, exercise, all her life-
MR. REDDINGTON: That's right.
KIRK HEILBRUN: ... to help manage her mood and do better.
MR. REDDINGTON: One of the questions the DA asked you yesterday is about the manic state, or hypomanic state, and exercise, and things of that nature, and you answered that she did some exercise. Well, she did more than some exercise right after having Callan, didn't she?
KIRK HEILBRUN: She did.
MR. REDDINGTON: What'd she do?
KIRK HEILBRUN: She got up at 4:00 AM. She ran three miles. She did half an hour on the Peloton. Did an exercise class. So she was doing a fair amount of exercise.
MR. REDDINGTON: How about a road race shortly after she had the baby?
KIRK HEILBRUN: Yes. It's my understanding that she did that, too. Yes.
MR. REDDINGTON: During that period of time while she's exercising, and running, and road races, and all the rest, sir, would you agree, sir, that that coincided with the same time that they were involved with the height- with the cleaning out of the garage and removing property and selling things? Would you agree with that?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: Would you agree that at the same time she was doing the Beach Blanket Bingo or whatever it is on television, where she's selling people things like videos and lost money doing it?
KIRK HEILBRUN: Would I agree what?
MR. REDDINGTON: Would you agree that she was selling videos online, and it turned out that it was a scam and she lost her money?
KIRK HEILBRUN: I would agree that she was involved in something like that. I didn't know-
MR. REDDINGTON: Okay. So we have-
KIRK HEILBRUN: …that she lost her money.
MR. REDDINGTON: …the exercise, we have the scam, we have the hypo cleaning, all of that. Would you agree that that is just a little bit indicative of what you said to this jury, that you were struggling over, trying to find mania, manic, hypomania? Agree with that?
KIRK HEILBRUN: I would agree that those could be symptoms of a manic episode, which I was having a hard time identifying, as she was clearly experiencing something like that. But I did end up with a diagnosis of bipolar II, and that reflected my thinking that some of those things that Mr. Reddington has just described could be symptoms of a manic disorder, although less serious than a bipolar I diagnosis.
MR. REDDINGTON: Okay. The district attorney asked you about anxiety, that you felt that she was suffering. Your answer was, “Well, if it works—”
MS. SPRAGUE: Objection. May we approach sidebar?
THE COURT: Sure. Yeah. Counsel.
MR. REDDINGTON: So district attorney asked you a question yesterday, sir, and it was in reference to doing things, and I quote, “Like exercise to complement medication and therapy.” And your answer, and I quote, “Well, if it works. If it doesn't work, it doesn't work for some people. It… And the use effectively over the course of their lives, particularly if they have anxiety that might not fully need treatment, but it's something that might interfere your life a little bit.” What did you mean by that?
KIRK HEILBRUN: I mean that exercise is something that isn't useful for managing anxiety for some people, but for other people it's quite useful.
MR. REDDINGTON: Okay. In reference to determination as to a manic episode.
MS. SPRAGUE: Thank you.
MR. REDDINGTON: Yeah, no problem. Your response, sir, was that, “There were times when she felt, as she described it, after the birth of different children, she felt good. She felt on top of the world. She felt really close to them, her husband and her kids and so on. But it's also something that it didn't look like a manic episode so much that it looked like she was feeling good and getting back into exercise and stuff.”
KIRK HEILBRUN: Yes.
MR. REDDINGTON: That was your answer yesterday. Is that in reference to the struggle that you had to try to get to a manic episode? That's what you said yesterday, right?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: Okay.
MR. REDDINGTON: The answer's yes?
MR. REDDINGTON: Can I ask him off the transcript for a minute, if she can cover?
MS. SPRAGUE: I have to read it first.
MR. REDDINGTON: Okay.
MS. SPRAGUE: Thank you.
MR. REDDINGTON: Okay. When you were talking with her in Tewksbury, either you or the other guy in the hospital interviewing her, one of those three days—
KIRK HEILBRUN: Yes.
MR. REDDINGTON: …let me back up. Do you agree with me, sir, that if a person has a memory while they're in a psychosis, that it's very possible that they could be imagining that they did something, but in fact, the facts, objective facts would show she didn't?
KIRK HEILBRUN: It's possible that being in an actively psychotic condition could affect the way information is processed—
MR. REDDINGTON: Okay.
KIRK HEILBRUN: …and therefore could affect the accuracy of their memory.
MR. REDDINGTON: So for example, she told you that after she slashed her wrists, and after she tried to slit her throat, that she used the knife to cut the screen before she threw herself out the window, right?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: Was the screen cut?
KIRK HEILBRUN: I understand that it was not.
MR. REDDINGTON: Did that give you pause?
KIRK HEILBRUN: There are a number of things that I don't think are all that important, in terms of memory difficulties and accuracy of memory, and that was one of them.
MR. REDDINGTON: Do you recall this morning, indicating that, you recounted that Lindsay told you that she felt, quote, "Like it wasn't her," end quote, as though she were watching herself commit the killings, and that she was simply responding—to the voice rather than consciously deciding what to do. Do you remember saying that this morning, sir?
KIRK HEILBRUN: I do, yes.
MR. REDDINGTON: Would you agree that that description is consistent, almost black letter definition, with profound disassociation?
KIRK HEILBRUN: I... My testimony was—
MR. REDDINGTON: No, no, no. Is that, sir, consistent with profound disassociation?
KIRK HEILBRUN: No, it is consistent—
MR. REDDINGTON: So the answer's no. The answer's no?
KIRK HEILBRUN: Well, I was about to give the rest of the answer.
MR. REDDINGTON: I'm sure you were, but the answer is no, is what you're saying, right? I just read to you what you testified to this jury this morning, right? Did I?
KIRK HEILBRUN: You used—
MR. REDDINGTON: Did I read, sir... Hello? Did I read what your words were this morning?
KIRK HEILBRUN: I don't remember exactly what my words were this morning.
MR. REDDINGTON: So, if Dr. Heilbrun told this jury that when Lindsay was talking to you and/or Mack in the hospital, she felt, and I quote, "Like it wasn't her. As though she were watching herself commit the killings, and that she was simply responding to the voice rather than consciously deciding what to do." End quote. Question is, would you agree, sir, that that watching oneself is consistent with disassociation?
KIRK HEILBRUN: Disassociation, that is peri-traumatic, which is what I testified—
MR. REDDINGTON: So the answer's yes.
KIRK HEILBRUN: Well, you said profound disassociation, so the answer was no.
MR. REDDINGTON: No, the last time I knocked out profound. I'm just asking—
KIRK HEILBRUN: Oh, yeah. Okay.
MR. REDDINGTON: …if it's consistent with disassociation.
KIRK HEILBRUN: It is consistent with peri-traumatic disassociation.
MR. REDDINGTON: Okay.
KIRK HEILBRUN: Yes.
MR. REDDINGTON: And briefly, what is disassociation?
KIRK HEILBRUN: Disassociation is sort of the sense that you are removed from yourself. You're not feeling like yourself. It's something like, you're in a position where your sense of time and your sense of self are altered, and it's also the sort of thing where you don't feel as if it's you anymore. Sometimes you feel as though you're watching a body that's you, but it's not really you.
MR. REDDINGTON: And at disassociation, you agree in the DSM, using that book, is in fact defined as an altered mental state. Is that correct?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: Okay. And would you agree with me that in your evaluations of Lindsay, after you guys had the chance to speak to her and consider all of the documentation, your opinion ended up, using your words, being in your mind two possible explanations. We talked about that, right?
KIRK HEILBRUN: Yes, we did.
MR. REDDINGTON: Okay. And then you indicated that there were some possible things that made me believe that there was severe mental illness involved, right?
KIRK HEILBRUN: Yes, there were.
MR. REDDINGTON: And there was severe mental illness involved, right?
KIRK HEILBRUN: There were some possible things that made me think that it might have been a psychotic episode.
MR. REDDINGTON: Right. But there were severe mental illness, illnesses involved here, right?
KIRK HEILBRUN: Yes, there were.
MR. REDDINGTON: Okay. And—
KIRK HEILBRUN: It's just a question of which kind—
MR. REDDINGTON: … Semantics.
KIRK HEILBRUN: Yes.
MR. REDDINGTON: You talked about thought broadcasting, right?
KIRK HEILBRUN: Yes, I did.
MR. REDDINGTON: And thought broadcasting, sir, would be if somebody hears a voice and is concerned that somebody else might have heard it, right?
MR. REDDINGTON: Okay.
KIRK HEILBRUN: Thought broadcasting—
MR. REDDINGTON: Let me ask you what thought broadcasting is. Are you aware that Lindsay Clancy indicated to anybody that she was hearing or having these intrusive thoughts in her mind? Yes or no.
KIRK HEILBRUN: Yes.
MR. REDDINGTON: Did she indicate that she was afraid people could read her mind or knew what these thoughts were, or whatever they were in her mind, intrusive thoughts?
KIRK HEILBRUN: She was afraid of that, and so one of the reasons that I ask her about the difference between hallucinations—
MS. SPRAGUE: Objection.
THE COURT: All right. Sir, hold on, please.
MR. REDDINGTON: I can't be more clear, Judge.
THE COURT: Just a question, all right? And then if the Commonwealth wants to follow up, they'll be able to do that.
KIRK HEILBRUN: All right.
THE COURT: Go ahead.
MR. REDDINGTON: Did she, according to Dr. Heilbrun's review of all the information, in all the hours of talking with Ms. Clancy—
KIRK HEILBRUN: Yes.
MR. REDDINGTON: … determine that she was afraid that people could read her thoughts or knew what her intrusive, dark thoughts were?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: Who did she say that to? I'd like… Just who?
KIRK HEILBRUN: Well, she said it to me.
MR. REDDINGTON: Okay.
KIRK HEILBRUN: She said it to Dr. Mack.
MR. REDDINGTON: Yeah, I'm sure she said it to Mack, too. Putting you guys aside, who else, like people, normal people, did she say that to? Not that you're not normal, but I mean people like friends or family or citizens or whatever.
KIRK HEILBRUN: I believe she said it to Patrick.
MR. REDDINGTON: Okay.
KIRK HEILBRUN: And she may have said it to others as well.
MR. REDDINGTON: She may have said it to others as well. This is one of the—
KIRK HEILBRUN: I don't remember who else she said it to, but she said it to Patrick during my evaluation.
MR. REDDINGTON: Well, how can you come in here and testify about a young lady that is saying to people that she's having thoughts that are intrusive and dark, and that she's worried that other people are reading her mind and know about it, and you don't even know who she said it to?
MS. SPRAGUE: Objection.
THE COURT: Overruled.
KIRK HEILBRUN: One of the things that she said is that her thoughts were kind of intrusive and loud, and, I mean, that sort of thing. And one of the things that she said was that she thought that because of that, other people might be hearing them or might know what they were.
MR. REDDINGTON: Like even worried about dropping little Cora off at the school, and she was afraid that the teachers could hear her voices or thoughts? Did you read that?
KIRK HEILBRUN: I did read that, and that's one of the reason I asked her for the difference.
MR. REDDINGTON: Right. When I asked you if there were any... So that refreshed your memory, that there was another person that she was concerned about—
KIRK HEILBRUN: Yes, I believe that's right. Yes.
MR. REDDINGTON: ... Okay. How about her friends? Do you recall her telling her friends that she was worried about her teachers being able to read her thoughts?
KIRK HEILBRUN: I do not.
MR. REDDINGTON: You indicated yesterday that one of the concerns or one of the issues or possibilities was at the time of the killings was acute psychosis, right?
KIRK HEILBRUN: I thought one of the possible explanations—
MR. REDDINGTON: Did that... I don't want to let you run off, sir.
THE COURT: No. Counsel, next question.
MR. REDDINGTON: Do you agree, sir, that you testified yesterday that at the time of the killings, one of the possible concerns that you had was whether or not there was an acute psychosis?
KIRK HEILBRUN: One of the possible explanations for her motivation and her state at the time, yes.
MR. REDDINGTON: So the answer is yes, right?
MS. SPRAGUE: Objection.
THE COURT: No, overruled.
MR. REDDINGTON: That's what you said yesterday, right?
KIRK HEILBRUN: Not exactly the way you phrased it, and that's what—
MR. REDDINGTON: Okay.
KIRK HEILBRUN: ... I'm responding to.
MR. REDDINGTON: Thanks.
MR. REDDINGTON: Yesterday, sir, you were asked, “The next part of the evidence or what you saw against acute psychosis,” and you referenced this discussion of whether this was postpartum. So let's stop there for a minute. Again, you know that postpartum is not a diagnosis, right?
KIRK HEILBRUN: I do know that, yes.
MR. REDDINGTON: Okay. But the reason that it was not, as you put it, postpartum, is because she was about eight months away from having given birth to Callan, right?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: And most of the explanations from the authorities, like DSM-5, would point to maybe one month after birth, or maybe give a little bit, maybe two months after birth, or something like that. That's what you said yesterday to the jury.
KIRK HEILBRUN: Yes.
MR. REDDINGTON: And what's that based on in Dr. Heilbrun's mind? What's that cut off about, one month, maybe two?
KIRK HEILBRUN: It's based on what DSM-5 says, or the Cleveland Clinic actually said six to eight weeks if you look at their website. So it's based on accepted authority within the field.
MR. REDDINGTON: Uh-huh. Is the World Health Organization accepted authority in the field?
KIRK HEILBRUN: It's one accepted authority, yes.
MR. REDDINGTON: Okay, and what do they say?
KIRK HEILBRUN: I don't know what they say.
MR. REDDINGTON: Right. Would you be surprised if I told you they say up to a year that a woman can be experiencing postpartum psychosis or postpartum depression, up to a year or even longer?
KIRK HEILBRUN: There are different kinds of outcomes and time periods that different organizations use.
MR. REDDINGTON: I'm not asking about outcomes and time periods. I'm asking about the World Health Organization cutoff for a woman with postpartum depression or psychosis. What's the timeframe?
KIRK HEILBRUN: Well, I don't know.
MR. REDDINGTON: And then you indicated, "Now, it could be something else, and there was certainly some stuff that I saw that were symptoms of depression and other sorts of things that she experienced in January. But it was, given the time, it was less likely, I thought, to be postpartum." What did you mean by that?
KIRK HEILBRUN: I meant that she was eight months after giving birth to Callan. And if you look at two sources of authority, which I relied on, the DSM-5 and the Cleveland Clinic, then neither one of those would suggest that postpartum was the more likely explanation as opposed to something else.
MR. REDDINGTON: So if we put aside the DSM... When was the DSM... Strike that. Would you agree that the DSM virtually only mentions the whole concept of postpartum psychosis, postpartum depression in two paragraphs?
KIRK HEILBRUN: I would agree that they don't consider it to be a mental diagnosis in the same sense that other diagnostic areas are described in that manual.
MR. REDDINGTON: Okay. You think that should change?
MS. SPRAGUE: Objection.
THE COURT: No, overruled.
KIRK HEILBRUN: Do I think it should change?
MR. REDDINGTON: Yeah, you.
KIRK HEILBRUN: The way I look at this is that the DSM-5 and the Cleveland Clinic and the World He- World Health Organization reflect different outcomes. And I think that one of the things that they do on the conservative end is they reflect something that is basically a month... Excuse me. Yeah, a month, or two months. And one, something else on the very extended end is a good bit longer. I think it depends on a number of things in terms of how it changes, and I'm not in a position to offer an informed opinion on that really.
MR. REDDINGTON: Obviously.
MS. SPRAGUE: Objection.
THE COURT: It'll be stricken.
MR. REDDINGTON: Doctor, if Ms. Clancy had a genuine command hallucination, which in fact did cause her to feel compelled to carry out the killing of her children—
KIRK HEILBRUN: Yes.
MR. REDDINGTON: ...and herself, would you agree that she lacked substantial capacity to conform her conduct to the requirements of the law?
MR. REDDINGTON: If in fact that was a genuine command hallucination that she believed?
KIRK HEILBRUN: That would depend on a number of things. It would depend, for example—
MR. REDDINGTON: Let's not go through a number of things. So your answer is no?
KIRK HEILBRUN: And my answer would be, it depends.
MR. REDDINGTON: Okay, so it depends.
THE COURT: Next question.
MR. REDDINGTON: Would you agree, sir, that in December of 2022, and she told you that at that timeframe she had these thoughts that were in her head that would, quote, “pop into her head,” intrusive thoughts that included that her brain was damaged and that she had to kill herself, and she told you that, right?
KIRK HEILBRUN: She did.
MR. REDDINGTON: Do you believe that she was telling you the truth, sir?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: I stand corrected in one regard, sir. This morning I started off my questions by asking you about 44, 49 years ago when you published an article on postpartum psychosis, and you agreed. You were in college or something. But in fact, it was not postpartum psychosis, it was about schizophrenia, wasn't it?
KIRK HEILBRUN: I'd have to think back 49 years, but I think that's right, yes.
MR. REDDINGTON: You, transcripts of interviews with 32 schizophrenic patients, 15 male, 17 female, all with primary or secondary paranoid symptomology, were edited only to delusion relevant material. Does that refresh your memory, sir?
KIRK HEILBRUN: It does.
MR. REDDINGTON: Okay. So it wasn't postpartum psychosis. You'd never written about postpartum psychosis, right?
KIRK HEILBRUN: That's right.
MR. REDDINGTON: Okay. So finally, sir, would you agree, and if you don't, just say, “No, I don't agree.” Postpartum depression. Are there tests that can be administered to... I'm not talking about a guy who's upset about his job. I'm talking about a woman who's just had a baby, who's going through the postpartum period exhibiting signs of depression and/or psychosis. Okay?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: All right. Would you agree with me, person can complain that they're less able to laugh or see the funny side of their life? Is that a symptom, sir, if you know?
KIRK HEILBRUN: Are you asking me if that's a symptom of postpartum depression specifically, or depression more generally?
MR. REDDINGTON: Oh, no. I'm asking you about postpartum depression, sir. That's what I'm talking about right now.
KIRK HEILBRUN: All right.
MR. REDDINGTON: Okay. Do you agree that a patient would complain that they're less able to laugh and see the funny side of life?
KIRK HEILBRUN: That's a symptom of depression.
MR. REDDINGTON: All right. You're gonna tell me—
KIRK HEILBRUN: Could be postpartum or it could be—
MR. REDDINGTON: ... it's a symptom of depression constantly.
KIRK HEILBRUN: Right.
MR. REDDINGTON: My question is, do you agree that it's a symptom of postpartum depression?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: Okay. Not looking forward to things.
KIRK HEILBRUN: And let me just say—
MR. REDDINGTON: Oh, no, I don't want to let you do anything. Can you just tell me if—
KIRK HEILBRUN: You don't—
MR. REDDINGTON: ... letting someone, stopping looking forward to things is a complaint that is common to postpartum depression?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: Anxious and worried for no good reason?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: And Lindsay complained of anxiety and being worried for no good reason constantly, right?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: She blamed herself for a lot of things in her life. Isn't that right?
KIRK HEILBRUN: She did, yes.
MR. REDDINGTON: And she was not looking forward to the future. She was not happy with her life in the sense of the way she felt and wanted to go back to the way she was, right?
KIRK HEILBRUN: That's right.
MR. REDDINGTON: How about complain... When I say complain, I don't mean complaining, it's just that that's the language you guys use. Complained about overwhelmed, her day as overwhelming.
KIRK HEILBRUN: Yes.
MR. REDDINGTON: So unhappy that she would cry constantly.
KIRK HEILBRUN: Yes.
MR. REDDINGTON: Sad and miserable.
KIRK HEILBRUN: Yes.
MR. REDDINGTON: Thoughts of harming herself, which is, according to the Mass Department of Mental Health, a flag in and of itself. She had thoughts of harming herself, right?
KIRK HEILBRUN: She did.
MR. REDDINGTON: Okay. So those are all of the postpartum depression symptoms that a person can have according to Mass General Hospital's three-year review of postpartum depression and psychosis. So she hit all of these symptoms, right?
KIRK HEILBRUN: Those are symptoms of postpartum depression. They're also symptoms of depression more broadly.
MR. REDDINGTON: I don't care what the... I'm asking you, sir, are they symptoms of postpartum depression?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: All right. And there's a tool that psychologists can use with a woman who's coming to a doctor for help because of the symptoms of postpartum depression. Is that correct?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: And what is that tool?
KIRK HEILBRUN: I don't know what the tool is, but I'm sure there is a measure of it, yes, of postpartum depression.
MR. REDDINGTON: Okay. Have you ever used that measure?
KIRK HEILBRUN: I have not.
MR. REDDINGTON: Have you ever read about it?
KIRK HEILBRUN: Mm, possibly.
MR. REDDINGTON: Do you even know what it is?
KIRK HEILBRUN: I don't know what it is.
MR. REDDINGTON: How about postpartum psychosis, sir? Same study. Hearing voices or a voice commanding a person to act. That's in the DSM, right?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: Okay.
KIRK HEILBRUN: Command hallucinations, yes.
MR. REDDINGTON: Delusional beliefs or distorted reality is a symptom that a person can complain of, right?
KIRK HEILBRUN: Delusional beliefs, yes.
MR. REDDINGTON: And distorted reality.
KIRK HEILBRUN: ... or false beliefs, yes.
MR. REDDINGTON: Yeah, it's just next statement: confused, disorganized thinking. She had that, right? She w- It's in your report, I think, that she was baking or making a pie or something and forgot where she was. You said—
KIRK HEILBRUN: Yes. She was having trouble with memory, attention, and concentration.
MR. REDDINGTON: All right. Anxious and worried for no good... Strike that. Apologize. Severe sleep deprivation. She had that, right?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: Rapid mood swings. She had that, right?
KIRK HEILBRUN: Not sure she had that.
MR. REDDINGTON: Well, how about the time that Patrick told you that she would repeatedly find herself in the living room on the sofa and bury her head in the pillow and rock back and forth, crying hysterically?
KIRK HEILBRUN: When you said mood swings, that implies that at one moment you're feeling down and sad and depressed, and another—and in another moment you're feeling quite differently.
MR. REDDINGTON: Right. I know she took the kids—
KIRK HEILBRUN: So I don't see that the mood swings she had—
MR. REDDINGTON: She... Oh, all right. Go ahead. Go ahead.
THE COURT: Go ahead, doctor.
KIRK HEILBRUN: Yeah. I don't see that she was experiencing mood swings, so much as she was experiencing symptoms of sadness and feeling down and lack of motivation, which are symptoms of depression.
MR. REDDINGTON: What is akathisia?
MR. REDDINGTON: A-K-A-S-T-H-E-S-I-A, I believe.
KIRK HEILBRUN: Yeah. I'd have to look that one up.
MR. REDDINGTON: Okay. Feeling overwhelmed. She felt overwhelmed?
KIRK HEILBRUN: She did, yes.
MR. REDDINGTON: Not herself, family seeing the change. Obviously, right?
KIRK HEILBRUN: Repeat the question, please.
MR. REDDINGTON: Yeah. Not herself, semicolon, family seeing the change.
KIRK HEILBRUN: Yes. Correct.
MR. REDDINGTON: Right. Lord knows. I mean, the mother-in-law, the father-in-law, her mother, her father, her husband, neighbors, people could see the change in her, right?
KIRK HEILBRUN: Yes, they could.
MR. REDDINGTON: Okay. Continuing on with postpartum psychosis. Not herself, thoughts of harming her children.
MR. REDDINGTON: That's a big red flag, isn't it?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: Okay. Thoughts of suicide. She complained of that, right?
KIRK HEILBRUN: Correct.
MR. REDDINGTON: Poor insight. She had poor insight the end of January, didn't she?
KIRK HEILBRUN: Mm, I would not say she had poor insight. No, I think she understood pretty much where she was and the difficulty she was having, and was aware of a number of things about that.
MR. REDDINGTON: That's all I have, Your Honor. Thank you.