3.Kirk Heilbrun — Redirect/Recross (Part 4)
220 linesTHE COURT: Attorney Sprague.
MS. SPRAGUE: Thank you, Your Honor.
MS. SPRAGUE: Doctor, those symptoms that Attorney Reddington just read you about postpartum depression, are those also symptoms for general depression?
KIRK HEILBRUN: They're symptoms for general depression. They are, to some extent, symptoms of major depression, which is a more extreme example, a more extreme version of general depression, and they're also symptoms of bipolar disorder and bipolar II. And I thought at the end of this evaluation that her correct diagnosis was bipolar II.
MS. SPRAGUE: And why was that?
KIRK HEILBRUN: One of the reasons, as I testified yesterday, is that she has been in Tewksbury for three and a half years, and that is her diagnosis of record, bipolar disorder. But what that indicates to me is that having had the chance to see her, prescribe medications, and do a number of things, that they really think that she has a mood disorder of a fluctuating kind, a bipolar sort, as opposed to a major depression or some other kind of disorder.
MS. SPRAGUE: Now, you were asked by defense counsel about the fact that you interviewed Ms. Clancy three years, a little over three years after she killed her children. And your testimony was it's better to interview the person as soon as possible, right?
KIRK HEILBRUN: Correct.
MS. SPRAGUE: But you were able to watch Dr. Resnick's interview of the defendant about three months, three and a half months after the incident happened, correct?
KIRK HEILBRUN: Yes.
MS. SPRAGUE: And you were able to review all of her records leading up to when she killed the children, and then after she killed the children all the way up to present day, correct?
KIRK HEILBRUN: Yes.
MS. SPRAGUE: Is that something that you typically have when you do these forensic reviews, that much information, medical history and information on a patient?
KIRK HEILBRUN: I had more records information in this case than I have ever had in my career.
MS. SPRAGUE: And so, also, were you aware that you weren't allowed to interview the defendant until the court gave permission?
KIRK HEILBRUN: I really wasn't. I didn't know how the process worked.
MS. SPRAGUE: But as soon as you were informed that you could meet with the defendant, you did, correct?
KIRK HEILBRUN: Yes.
MS. SPRAGUE: And the fact that you had all of these resources, the records, the prior interviews, the recorded interviews of witnesses, the criminal file, the collateral interviews that you did, did that in any way aid you in overcoming whatever deficits you might have had in interviewing her three years later?
KIRK HEILBRUN: It did, yes.
MS. SPRAGUE: And how so?
KIRK HEILBRUN: Because of how extensive the records were from different people, different observations, different times and so on, they in effect created something that a- I would have tried to do myself if there had been fewer records available. So I would have tried, for example, to—
MR. REDDINGTON: Well, I'm gonna object to what he would have done.
THE COURT: No, overruled.
KIRK HEILBRUN: I would have tried to conduct a number of collateral interviews. I would have tried to go out and get some of the records myself if they'd not been available and provided to me. Usually I have to work a lot harder to get 10% of the records that I had in this case.
MS. SPRAGUE: And you were provided with her complete psychiatric history from September through present day, correct?
KIRK HEILBRUN: I was.
MS. SPRAGUE: Now, you were asked about being retained by our office and speaking to the prosecutors in the case. Did anyone from my office or myself or Ms. Buckingham ever tell you what your decision or what your evaluation should say in this case?
KIRK HEILBRUN: No.
MS. SPRAGUE: And did we ever put any pressure on you in any way, shape, or form to come out on what defense counsel calls our side?
KIRK HEILBRUN: No.
MS. SPRAGUE: And he also asked you about your interview itself with the defendant. At any point in time, was your conversation with Ms. Clancy hostile or aggressive or rude in any way?
KIRK HEILBRUN: No.
MS. SPRAGUE: Did she ever ask you to stop and say she couldn't do it any longer?
KIRK HEILBRUN: She did not.
MS. SPRAGUE: In fact, she declined a break at one point in time, correct?
KIRK HEILBRUN: For one of the days, yes. That was the third day.
MS. SPRAGUE: Prior to going into... Prior to reading the records in this case, did you form an opinion as to what her criminal responsibility was?
KIRK HEILBRUN: No. In fact, I worked very hard to avoid forming any kind of opinion until very late in the process when I'd had the chance to go through all the records, do the three days of evaluation, do the collateral interviews, and get everything I could have, because that's the kind of thing that helps you handle what's been referred to as confirmation bias, which is starting out with a good idea or a conclusion and then being drawn to the things that support that and avoiding the things that don't.
MS. SPRAGUE: Would an example of confirmation bias be giving a press conference in which you diagnose a patient before you even do an evaluation of that patient? And then finding that same diagnosis that you initially made?
KIRK HEILBRUN: Well, an example of that would be saying before you had ever met with somebody that I have a diagnosis, and then meeting with them, and then possibly resulting in your providing that diagnosis. So it could well be an influence of, associated with confirmation bias.
MS. SPRAGUE: Now, you were asked about the defendant telling you that she didn't like to leave the children and how that impacted your evaluation of the defendant, and I think you were cut off on your answer. So if you could just tell us why, what you saw in terms of or heard from the defendant in terms of her not wanting to leave her children and how that impacted or influenced your evaluation.
KIRK HEILBRUN: That was an important consideration.
MR. REDDINGTON: Objection. It's not responsive.
THE COURT: No, I'll allow it. Go ahead.
MS. SPRAGUE: If you could answer.
KIRK HEILBRUN: Yeah. That was an important consideration because one of the things that would go through your mind if you decided to take your own life would be something very important to you, like your children. And over a number of years and in a number of different-
THE COURT: Wait, sorry.
MR. REDDINGTON: This is way outside the scope of cross-examination.
THE COURT: No, I would allow this. Go ahead.
MS. SPRAGUE: Proceed.
KIRK HEILBRUN: Over a number of years and in a number of different contexts, she didn't like to leave the kids. So the question might be, if you were possibly inclined to think about taking your own life, what would happen with the kids, and would they suffer without you, and could other people take care of them? And that turned out to be something that I thought was consistent with not wanting to leave your kids and not wanting them to suffer and so on. It all went together in how she thought about her own kids, felt about her own kids.
MS. SPRAGUE: You were also asked by defense counsel in cross-examination about the defendant's concerns about taking Zoloft while breastfeeding. Do you recall in your interview with the defendant when she mentioned that as a result of her practice in labor and delivery as a nurse, she was aware that millions of pregnant women and postpartum women took Zyprexa, sorry, took Zoloft with no problem?
KIRK HEILBRUN: I do not recall that, no.
MS. SPRAGUE: But that would be in your interview if it happened?
KIRK HEILBRUN: Yes.
MS. SPRAGUE: Now,
MS. SPRAGUE: Defense counsel asked you about your answer from direct testimony about all of the prescriptions and the different doctors being confusing. But the being confusing was your description of the amount, of seeing all that information, not the defendant's description, correct?
KIRK HEILBRUN: Yes, that's right.
MS. SPRAGUE: And could you explain that, how it was confusing in what way?
KIRK HEILBRUN: She had a number of diagnoses that people assigned to her, a number of symptoms, and one of the things that she experienced is that people were saying that she had something pretty minor, adjustment disorder with anxiety or adjustment disorder with mild depression or things like that, all the way up to things that were really major and really severe, postpartum psychosis, that sort of thing, and there were a number of things in between. So she was not sure what they were saying, and she was not sure whether they were prescribing the right medication for her, and even if it was something that she experienced, whether she was reacting badly to that medication. So that's basically my understanding, that there were a lot of things that people said—mental health care providers. Some of them were pretty minor as far as what was wrong with her, and some of them were not minor.
MS. SPRAGUE: And in terms of the defendant being unsure about the effects the medication was having on her, she expressed a specific concern about Seroquel, correct?
KIRK HEILBRUN: Yes.
MS. SPRAGUE: And what was her concern about Seroquel?
KIRK HEILBRUN: It was giving her big problems with sleeping, and she thought that part of the numbness and not being able to feel and that sort of thing was associated with that medication as well. So she thought it was really affecting her badly.
MS. SPRAGUE: And after she went to McLean Hospital, she was no longer on any of those medications that she had been on from September through December, correct?
KIRK HEILBRUN: Correct.
MS. SPRAGUE: And she had been weaned off the Seroquel in particular, correct?
KIRK HEILBRUN: Yes.
MS. SPRAGUE: And so after leaving McLean Hospital, the two medications she was on upon discharge was Trazodone and Valium, correct?
KIRK HEILBRUN: Yes.
MS. SPRAGUE: Now, you were asked about thought broadcasting and the defendant thinking that people could hear her thoughts, and you said there was some difference there between thought broadcasting and what the defendant explained to you was happening. Could you tell us what she said to you in your interview and how that impacted your evaluation?
KIRK HEILBRUN: Yeah. She said that they were thoughts. They were unwelcome and intrusive thoughts. But they were thoughts, just like many people would have. And if they were particularly insistent or they were particularly vivid thoughts, then you might think that, "Oh, people can pick this up from what I'm experiencing." But that is not a psychotic symptom, having vivid thoughts. On the other hand, if you hear a voice like somebody might hear my voice, it's an external sort of a thing, then that is very likely a psychotic symptom. And so I tried to ask her to describe the difference between the two and specify whether it was an external voice, which would have been an hallucination, or an internal thought, which would have been an unwelcome, intrusive thought. And she said except for on January 24th, what she was experiencing were thoughts rather than hallucinations.
MS. SPRAGUE: Internal thoughts versus external auditory hallucinations. Is that right?
KIRK HEILBRUN: Yes.
MS. SPRAGUE: Now, defense counsel asked you if before all of these medications and before all the treatment, if Lindsay Clancy was a happy woman. But didn't she go to Dr. Tufts in the first place because she was struggling?
KIRK HEILBRUN: She was anxious about returning to work. She had been having a very good time with her family that summer. But as the fall approached and Patrick's paternity leave expired and she was thinking about returning to work and scheduled to return to work, that made her anxious.
MS. SPRAGUE: And so it's not as if Dr. Tufts went to her home randomly and handed her a prescription. She actually went to Dr. Tufts with some mental health concerns, and Dr. Tufts treated her, correct?
KIRK HEILBRUN: Yes.
MS. SPRAGUE: And from your review of the records and from everything that you've learned in this case, including your interviews with her, is it accurate that Ms. Clancy never told any of her providers, any of her medical providers or any of the hospitals that she visited, that she had thoughts of harming her children?
KIRK HEILBRUN: That is my recollection, that she did not share that information with any, any mental health providers.
MS. SPRAGUE: And in your review of the records for Dr. Tufts, Nurse Practitioner Jollotta, mental health worker Latiesha Dukes, and also at McLean Hospital, isn't it true, isn't it accurate that in all of those records it indicates that the defendant denied suicidal ideation, denied homicidal ideation, denied auditory hallucinations, denied visual hallucinations, except for saying that she felt suicidal in December?
KIRK HEILBRUN: Yes, that is accurate.
MS. SPRAGUE: And isn't it accurate that throughout those records, they all document, all those providers document, that there are no signs or symptoms of psychosis that are either observable or that she reported?
KIRK HEILBRUN: Yes, that is accurate.
MS. SPRAGUE: Now, you were asked about her visit to Women and Infants in Rhode Island. And defense counsel asked you if they refused to help her and told her to leave. But they did offer to help her, didn't they? They offered her three different programs. Isn't that correct?
KIRK HEILBRUN: Yes. They referred her elsewhere to programs that they thought were more appropriate for what was wrong with her.
MS. SPRAGUE: And reading from page nine of exhibit 220 in the records, it states, "Currently she's complaining of insomnia and mental numbness, which she attributes to taking Seroquel. She desires to down titrate the Seroquel and work on getting better sleep. Because her symptoms occurred late in postpartum period and are not clearly related to perinatal factors, the patient was advised that the WIH DHP," which would be the Women and Infants Hospital postpartum program, "is not a suitable treatment facility for her. This was discussed with both patient and husband, and both are in agreement with this. Patient's husband feels strongly that patient has been overmedicated and misdiagnosed. Patient was offered several options for her, including inpatient treatment for medication management, a partial hospitalization program focused on general mental health, or continued outpatient management. Patient plans to follow up with her outpatient provider for guidance," correct?
KIRK HEILBRUN: Yes.
MS. SPRAGUE: And so it was Patrick who said that she was overmedicated, correct?
KIRK HEILBRUN: Well, he was one of the two of them who said that. She also thought that she was overmedicated.
MS. SPRAGUE: But the people at Women and Infants Hospital, the ones who were doing the evaluation, don't say in their diagnosis that she was overmedicated. They list adverse drug effects, correct?
KIRK HEILBRUN: They listed rule out adverse drug effects.
MS. SPRAGUE: And what does it mean when they write in a diagnosis, "rule out adverse drug effects"?
KIRK HEILBRUN: It means it's possible, but it has yet to be confirmed.
MS. SPRAGUE: And there's nowhere in the diagnosis any doctor or mental health professional saying that she was, in fact, overmedicated, correct?
MS. SPRAGUE: In the diagnosis portion here.
KIRK HEILBRUN: Oh, of Women and Infants?
MS. SPRAGUE: Yes. I'm sorry. Women and Infants.
KIRK HEILBRUN: Yes, I did not see anything like that.
MS. SPRAGUE: And is there a difference between being overmedicated and having adverse drug effects?
KIRK HEILBRUN: Well, I think you're asking a medical question right now, and I'm a psychologist, not a medical professional, so I don't think I'm gonna answer that.
MS. SPRAGUE: Okay. Now, in the diagnosis, you stated earlier that there was general anxiety disorder, correct?
KIRK HEILBRUN: Among the diagnoses, yes.
MS. SPRAGUE: And depression unspecified, rule out due to adverse drug effects, correct?
KIRK HEILBRUN: Yes.
MS. SPRAGUE: So that means depression, but you have to look further into it to rule out or rule in whether or not the medication's having an effect.
KIRK HEILBRUN: Yes.
MS. SPRAGUE: So that's not sure. That's not a— that's not saying she's depressed because of the medication, correct?
KIRK HEILBRUN: That was just saying it's possible. Need to look into it.
MS. SPRAGUE: And in this, what I just read to you, the defendant was telling them that she thought it was the Seroquel, and she wanted to titrate down, meaning slowly go off of the medication, correct?
KIRK HEILBRUN: Yes.
MS. SPRAGUE: And then she went to Dr. Tufts after this and to Nurse Practitioner Jollotta. And Nurse Practitioner Jollotta actually gave her a prescription to titrate down, correct?
KIRK HEILBRUN: Yes.
MS. SPRAGUE: Exactly what the defendant was looking for, correct?
KIRK HEILBRUN: Yes, that's correct.
MS. SPRAGUE: You were asked by defense counsel about the defendant getting worse and worse and worse. But was that between September and December, or was that in January?
KIRK HEILBRUN: It didn't begin until October, when she began taking the medication, and she seemed to get worse and worse into November and December. And then following her discharge from McLean on January 5th, she seemed to be somewhat improved in different ways, including her sleep was better, and her mood was slightly better, and things like that. So if I had to describe it, it was worse from October into November, into December, and then somewhat better and somewhat improving in January.
MS. SPRAGUE: And you were asked by defense counsel about— you had mentioned cognitive behavioral therapy might be something that someone would look into, and he asked you if that was on the patient to do that, correct?
KIRK HEILBRUN: Yes, I think that's right.
MS. SPRAGUE: Were you aware that there are searches on the defendant's cell phone where she looked up cognitive behavioral therapy or CBT therapy?
KIRK HEILBRUN: Yes.
MS. SPRAGUE: And so she was actively engaging in her treatment and looking up that type of therapy, correct?
KIRK HEILBRUN: That was one of a number of things that she was searching for information on and looking for, yes.
MS. SPRAGUE: And despite searching for information on it and looking for— she never made an appointment, to your knowledge, for that type of therapy.
KIRK HEILBRUN: To my knowledge, she did not.
MS. SPRAGUE: You were asked about peri-traumatic disassociation, about how a person feels outside of their body, watching what they're doing. Did I describe that accurately?
KIRK HEILBRUN: Yes.
MS. SPRAGUE: And in that scenario where someone might be experiencing that during a traumatic event, does that mean they're not in control of what they're doing?
KIRK HEILBRUN: No, it doesn't mean that. It means it kind of influences their perception and their memory and so on, but it doesn't completely remove their self-control.
MS. SPRAGUE: You were asked about psychosis and whether someone in psychosis would automatically act on a command hallucination. And you said, not be responsible, and you said it depends.
KIRK HEILBRUN: Yes.
MS. SPRAGUE: Is that correct?
KIRK HEILBRUN: Yes.
MS. SPRAGUE: Why does it depend?
KIRK HEILBRUN: Because symptoms of psychosis, including command hallucinations, don't necessarily take away your knowledge, your understanding, or your self-control. They can in some instances. But in other instances, they don't. And one of the things that people do to try to retain more control is things like distracting themselves, praying, doing other things that basically make a difference in terms of supporting and boosting their self-control. And so there's no—there's no automatic connection between any mental disorder, including psychotic mental disorders, and the legal standard for knowing that something is wrong or conforming one's conduct to the requirements of the law. That's why we go through all this in such detail.
THE COURT: Well, next question.
MS. SPRAGUE: Doctor, can someone who is experiencing psychosis with a command hallucination, can that person know the difference between right and wrong?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: It's outside, way outside the scope of questions.
THE COURT: Yeah. All right. Next question.
MS. SPRAGUE: And can someone who is experiencing psychosis conform their behavior to the law?
MR. REDDINGTON: Same objection.
THE COURT: No, overruled.
KIRK HEILBRUN: In some cases they can, yes.
MS. SPRAGUE: And is that what you were talking about just a few moments ago, when someone can be in a state of psychosis, hearing a command, telling them to do something, and they try to avoid doing what they're told to do?
KIRK HEILBRUN: Yes.
MS. SPRAGUE: And you gave some examples, but someone trying to distract themselves with music or something like that, correct?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: I'm gonna stop objecting, but I have a standing objection to the leading, Judge. This is my objection.
THE COURT: All right. It's redirect. I'll allow Commonwealth to use a leading question to direct the witness to a certain area of inquiry, and then just non-leading questions at that point.
MS. SPRAGUE: Okay. I have nothing further. Thank you.
THE COURT: All right.
MR. REDDINGTON: Couple of things. Sir, first of all,
MR. REDDINGTON: Counsel was asking you a question about the inconsistent statement or what have you. You indicated, sir, if I stand corrected, you administered a test, the MMPI, to her, right?
KIRK HEILBRUN: Yes, I did.
MR. REDDINGTON: And one of the, one of the sub-ca-
MS. SPRAGUE: Objection.
THE COURT: Mm-hmm.
MS. SPRAGUE: Beyond the scope.
MR. REDDINGTON: No, she asked about inconsistent statements.
THE COURT: No. Yeah, overruled.
MR. REDDINGTON: Is the K scale or the lies scale, right? Yes or no. Just please, yes or no.
KIRK HEILBRUN: The MMPI does have a K scale—
MR. REDDINGTON: Okay.
KIRK HEILBRUN: … and it—
MR. REDDINGTON: And it measures—
KIRK HEILBRUN: … does have an L scale.
MR. REDDINGTON: … that measures if a person, to you as the administering psychologist, is bluntly lying, right?
MR. REDDINGTON: Okay. Does it also, in your testing, determine if the person is exaggerating their symptoms?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: Okay. The answer's yes.
KIRK HEILBRUN: It's much closer to that.
MR. REDDINGTON: The answer's yes. Thank you. And when you administered the test to Lindsay close to three years later, you indicated that it was the fact that it was late that you administered the test. It was testing her at the time it was administered, right?
KIRK HEILBRUN: That's right.
MR. REDDINGTON: And one of the things that—the results, by the way, if I understand, looking at your transcript of testimony, is regardless of all of your explanations about MMPI and the other psychological testing, she was not elevated on anything except the suicide scale, right?
KIRK HEILBRUN: That's correct.
MR. REDDINGTON: Okay. So she wasn't, according to the testing you administered when you saw her with Mack, exaggerating, lying, malingering, anything like that, right?
KIRK HEILBRUN: That's correct.
MR. REDDINGTON: Okay. And one of the things that you did in your report, sir, is regarding the lying or the malingering, is you made reference to, I believe, Dr. Resnick, Phillip Resnick. You know him, right?
KIRK HEILBRUN: I do.
MR. REDDINGTON: He's a significant authority in the field of filicide, is that right?
KIRK HEILBRUN: He is.
MR. REDDINGTON: And Dr. Resnick indicated, sir, that his opinion as to the lack of malingering and, as well as yours, right?
KIRK HEILBRUN: Yes, he did.
MR. REDDINGTON: Okay. And you made reference to one of Dr. Resnick's articles, actually, in your report, correct?
KIRK HEILBRUN: Some of his research on—
MR. REDDINGTON: The answer's yes. We can make this easy. The answer's yes. Did you look at and cite Dr. Phillip Resnick's research report?
KIRK HEILBRUN: His research. Yes, I did.
MR. REDDINGTON: Okay. And are you aware, sir, that what you cited is outdated? Are you familiar with the 2012 article by Dr. McCarthy Jones collaborating with Dr. Resnick, talking about the largest study of hallucinations ever conducted in the world?
KIRK HEILBRUN: I'm aware that as a researcher, you build on some of the things—
MR. REDDINGTON: No, not what researchers do. Are you aware of that report?
MR. REDDINGTON: Okay. Are you aware, sir, that that study was after the report that you cited in your report, and it involved 191 individuals who were asked almost 400 questions about auditory hallucinations. You aware of that?
MR. REDDINGTON: And are you aware, sir, that in fact it was determined that auditory hallucinations can come from within, and it can come from without in that report? You're not aware of that, right?
MR. REDDINGTON: Okay. Only other thing, there's been a lot of talk about how you had to wait, took a while. You had to get court orders to visit with Lindsay to conduct your investigation, right?
KIRK HEILBRUN: Yes.
MR. REDDINGTON: Okay. You're not suggesting or trying to leave with this jury that it was me or my office that interfered or impeded. I think the question was that you were unable to see her. I had nothing to do with that, right?
MS. SPRAGUE: Objection. Can we sidebar?
THE COURT: Yeah. Come on.
MR. REDDINGTON: I have no further questions, Your Honor.
THE COURT: Commonwealth?
MS. SPRAGUE: No.
THE COURT: All right. Thank you, doctor. You may step down. Thank you.
KIRK HEILBRUN: Thank you, Your Honor.
THE COURT: All right. Members of the jury, we're gonna take the afternoon recess at this point. We'll come back. Commonwealth will call their last witness. And so during lunch, you know, you know the drill. Don't talk about it, don't read about it, don't listen to it. Put it out of your head. I'll have you back here at 2:00, okay? Thank you.
BAILIFF: Court, all rise.
BAILIFF: Jurors have exited the courtroom.
THE COURT: Anything we need to discuss before 2:00?
MS. SPRAGUE: No, Your Honor.
THE COURT: Counsel?
MR. REDDINGTON: Very good.
THE COURT: All right. We'll see everybody at 2:00. Thank you.
BAILIFF: Court stands in recess.