1.Gregory Saathoff — Direct (Part 2)

GREGORY SAATHOFF: I do.

GREGORY SAATHOFF: Good morning.

GREGORY SAATHOFF: Good morning.

GREGORY SAATHOFF: No.

GREGORY SAATHOFF: No.

GREGORY SAATHOFF: No.

GREGORY SAATHOFF: No.

GREGORY SAATHOFF: No.

GREGORY SAATHOFF: No.

GREGORY SAATHOFF: Yes.

GREGORY SAATHOFF: Well, in the small amount of time that Ms. Clancy had in the home without her husband, it was important in order to carry this out, as well as her suicide, to do this quickly, methodically, and the like. And so this is— having no instructions as to how to do it, but being able to execute those decisions, including being able to get a phone call and then return it to her husband in the process of all of this. Certainly, the phone call was not expected. That is surprising that she was able to accomplish all of this without, without any other kind of direction or plan.

GREGORY SAATHOFF: Well, it indicated that she had control. Control of the sequence of what she was doing throughout.

GREGORY SAATHOFF: Well, that has to do with the decision-making process or the capability of, for someone who attempts suicide.

GREGORY SAATHOFF: Yes.

GREGORY SAATHOFF: Well, one would be called aloneness or the sense of isolation, people not understanding. So that is a real difficult challenge for people to face. They feel that they can't fully share with others. Another is burdensomeness. If someone feels that they are a burden to others, that is also something that we find is a component to those who make serious suicide attempts and completions. And third is what I would call capability. So you can have that sense of aloneness. You can have that sense of burdensomeness. But if you don't have the capability of taking your life, you can be very suicidal, but not ultimately accomplish the suicide. It does not mean that you're not suicidal, but that issue of capability is one that's very difficult because we have a natural will to live, and that is the most difficult thing for people to overcome.

GREGORY SAATHOFF: Correct.

GREGORY SAATHOFF: Yes.

GREGORY SAATHOFF: Well, certainly, you know, the documentation from the medical and mental health records, you know, demonstrates that sense of isolation she felt even, even in the company of others. That sense that she was just having a problem that was difficult. Difficult for her to understand, difficult for others to understand. And of course, the suicidal feelings that came about, and then ultimately those feelings about harming her children. This is not something that she could share. The sense of burdensomeness. She had planned to go back to work, as she had for her first two children, Cora and Dawson. And the time that she was expecting to go to work kept extending because she just was n- did not feel mentally healthy enough to be able to return to work and to function. And so, I... In some of the documentation, where she filled out concerns and was asked about the kind of stressors in her life, she indicated that financial was one of the stressors that she was encountering.

GREGORY SAATHOFF: So to believe that her brain had been damaged, that she was not able to do what she loved, which was labor and delivery nursing, but also not in a position to help support the family, really was a—would be a burden for anyone. And certainly that sense of burdensomeness was something that I believe she was experiencing. And then the last component, capability. I truly believe that her suicide attempt was very, very serious, which is why she employed three different methods. The fact that the use of the knife and the lacerations were not deep doesn't mean that she wasn't intending to kill herself with a knife. But oftentimes that, as I mentioned, is the most difficult thing. I think the employment of the three different avenues, locking the door, and also not being dressed for the cold, indicate to me that this attempt was very, very serious. Despite the fact that the use of the knife was not, not successful in cutting her arms, cutting her neck.

GREGORY SAATHOFF: Correct.

GREGORY SAATHOFF: Correct.

GREGORY SAATHOFF: Yes.

GREGORY SAATHOFF: Yes.

GREGORY SAATHOFF: So Ativan is a, it, lorazepam, a benzodiazepine. This is a medication that is very helpful for treating anxiety. It also can help relax people, help them sleep, which was very helpful to Ms. Clancy. And she stated that when she had the intrusive thoughts, taking the Ativan resolved those thoughts. And I think that's significant because it's not a medication. Ativan, lorazepam is not an antipsychotic medication. So it's not meant to treat psychosis. It can make people feel more calm, and sometimes it's used for people who are having significant symptoms. But in terms of actually treating psychosis, making a voice go away, it's just not designed to do that.

GREGORY SAATHOFF: Yes.

GREGORY SAATHOFF: Yes.

GREGORY SAATHOFF: Well, hallucinations, even command hallucinations, when they occur, do not propel an individual to automatically obey them. And in fact, many people will engage in behaviors to stop the actions that the voices is claiming. That's something that makes sense, particularly when the command is just so serious and so against someone's values. So it's possible and common for people to engage in behaviors to avoid doing what a command hallucination is saying.

GREGORY SAATHOFF: Yes.

GREGORY SAATHOFF: Yes.

GREGORY SAATHOFF: If someone is having a command hallucination to do something out in public, but there is a police officer nearby, it certainly is possible for that person to choose not to engage in that behavior because of the consequences. Even though a voice might be saying this, there's other decision-making going on based upon the environment.

GREGORY SAATHOFF: Yes.

GREGORY SAATHOFF: I believe that Ms. Clancy was suffering from a mental disease or defect. And I felt that based upon the presentation, a bipolar two diagnosis seemed to make the most sense, given the symptoms of insomnia that she had that were precipitated by the Zoloft. And this was just very, very significant. And while it didn't fulfill all the criteria, or many of the criteria—if she were a patient of mine, I would diagnose her as bipolar II, 'cause I would want to make sure that any doctor who saw her afterwards would be very wary of using an SSRI antidepressant in treating her.

GREGORY SAATHOFF: Yes.

GREGORY SAATHOFF: Well, when we think about side effects, that is an example of a medication having a response. Now, sometimes we have side effects when we're not necessarily overmedicated, but we put up with those side effects. When there is too much medication, certainly we can experience those side effects. For example, oversedation. Or there are some medications that can cause stimulation, so people are not able to sleep. An adverse reaction is much more serious. An adverse reaction would—could be, for example, an allergic reaction that could cause death. Or some type of reaction that you don't see in most people, but has been reported. So there is a difference between side effects, no matter how difficult they are, and what we would call adverse effects, which can be extremely serious.

GREGORY SAATHOFF: Well, the insomnia secondary to Zoloft was very concerning to me, and it would mean not just cutting the Zoloft back, but stopping it. I would say that the Zoloft was in precipitating insomnia. I mean, she reported 48 hours straight of not being able to sleep. That was an adverse effect. And an adverse effect really requires one to stop the medication.

GREGORY SAATHOFF: Correct.

GREGORY SAATHOFF: She experienced some significant side effects from some of her medications. She was given, I think—Nurse Practitioner Paul gave her clonazepam, which is also a benzodiazepine. And she really had a uncomfortable reaction to that. Just woke up and felt, you know, quite confused. So she stopped that medication, understandably. Seroquel is a medication, quetiapine, that at high doses can cause some significant side effects. At lower doses, it generally helps treat insomnia. At higher doses, it can have more significant effects. And in terms of just ability to think and organize one's thoughts.

GREGORY SAATHOFF: However, Ms. Clancy, in December of 2022, chose at that time to continue on Seroquel, a combination of Seroquel and Valium. Nurse Practitioner Shalala had suggested another medication, olanzapine, Zyprexa, which she's taking now. And Ms. Clancy asked that she continue on the Seroquel at that point, and the Valium. So, you know, it's a challenge. One has side effects, but one also sees benefit in the medication.

GREGORY SAATHOFF: And certainly that combination, at that time, I think it was around December 7th, December 9th, that was really helping her sleep. And so she asked to continue on those two medications.

GREGORY SAATHOFF: Well, no, not necessarily.

GREGORY SAATHOFF: Well, if someone were to prescribe a medication that was beyond the limit that safely can be prescribed, for example. It's possible to be toxic on, say, lithium, which is a medication that she took for a while while she was at Tewksbury. And if I were prescribing, say, 1,200 milligrams of lithium twice a day, and her lithium level was toxic, as it would likely be, that would clearly be an example of overmedication.

GREGORY SAATHOFF: I think those who were prescribing for her were responding to the symptoms that she was bringing. There was a kind of a rapid increase in the dose of Seroquel, and that higher dose of Seroquel was—she did not... I believe she was ultimately prescribed at 400 milligrams, and she never ended up taking that. But—

GREGORY SAATHOFF: As a clinician, we do our best to try and—

GREGORY SAATHOFF: ...treat symptoms.

GREGORY SAATHOFF: No.

GREGORY SAATHOFF: Correct.

GREGORY SAATHOFF: That's right.

GREGORY SAATHOFF: Correct.

GREGORY SAATHOFF: That's right.

GREGORY SAATHOFF: That was amitriptyline, also known as Elavil.

GREGORY SAATHOFF: Correct.

GREGORY SAATHOFF: The initial dose from Dr. Tufts was 10 milligrams.

GREGORY SAATHOFF: No. It's the very smallest dose possible.

GREGORY SAATHOFF: Yes.

GREGORY SAATHOFF: After a week, she increased the dose from 10 milligrams to 20 milligrams.

GREGORY SAATHOFF: No.

GREGORY SAATHOFF: Not at all.

GREGORY SAATHOFF: Yes.

GREGORY SAATHOFF: Yes.

GREGORY SAATHOFF: My opinion is that she did have the capacity to appreciate right from wrong.

GREGORY SAATHOFF: Well, on a number of things. Ms. Clancy had just met with her psychiatrist, Dr. Tufts, the day before. And in that discussion with Dr. Tufts, as documented, she denied suicidal ideation, and she also denied thoughts of harm to others. And also there was an ongoing conversation regarding future possible treatments, esketamine or TMS, which I spoke about yesterday, that could be employed to help her. Also with regard to the appreciation between right and wrong, the planning involved prior to the—

GREGORY SAATHOFF: The strangling of her children I thought was significant. The searches for distance of 3V, the searches of CVS, all done prior to her sending fairly late in the afternoon a text asking her husband if he didn't mind takeout from 3B, and then adding on. So that planning, that preparatory planning I thought was significant. The avoidance of witnesses. You know, a witness during a time when one is committing a crime can intervene. Not just report, but also intervene. And so the fact that this was done without any witness present during a time where she had asked the potential witness to go on a longer errand also I thought was significant. Concealment is another thing that we ... that I think indicated an understanding of right and wrong. I mean, the children were strangled all in the basement. And according to Mr. Clancy, the door to his office had been closed when he arrived to the basement. Timing. Timing was really, really significant in this. There was a window of time that Ms. Clancy was aware of in which she would need to kill her three children as well as to kill herself, which she expected would happen. She was conscious of time and told me that she had mapped out the distance, et cetera, because she didn't want her husband to be gone too long.

GREGORY SAATHOFF: But in this case, I think the issue of time and her husband returning, rather than being a solution for her, was a problem. And so to accomplish all of this in the course of that amount of time that Mr. Clancy was gone, I thought was significant. Really showed an awareness of time. In terms of the weapons used. Now, these were exercise bands. But they were all near where the children were strangled. They were placed there. That's where they kept those exercise bands. And the exercise bands were nearly identical. I mean, very similar in terms of what they could do as ligatures. And so that use of weapons that were readily available and nearby also was significant to me in terms of her understanding of, and planning. I did not see any evidence that she had delusions about her children. Delusions as to something wrong with them or something that required them, because of a delusion, that they needed to die. I don't recall that she ever spoke about her children in a delusional way. Now—

GREGORY SAATHOFF: Yes.

GREGORY SAATHOFF: Well, the phone call at what, 5:34, in the afternoon I thought was significant. So Mr. Clancy was at CVS and he called his wife, and she did not pick up. She did not answer. But she called him back, and had that ability to deviate from what she was doing to be able to respond, and so had the presence of mind to do that, but also to conceal from him what was going on.

GREGORY SAATHOFF: Locking the door is another example. I mean, certainly Ms. Clancy was aware of time and the limited amount of time to accomplish this, but by locking the door, it kept her husband from being able to enter the bedroom, and therefore being able to see what had happened, so delayed that time.

GREGORY SAATHOFF: On arrival, her husband asked her what happened and she did not confess. She did not tell him what had happened other than, "I tried to kill myself." She also did not report auditory hallucinations, but rather said that her, the children were in the basement. It's my belief that she expected to die, and that by the time Mr. Clancy arrived, she would have successfully been able to take her life.

GREGORY SAATHOFF: Yes.

GREGORY SAATHOFF: Well, if we look at that day, we know that in the morning she went, she took Cora to a pediatrician's appointment. And all physicians receive training in psychiatry, no matter what specialty they go in. That's part of medical school. And so like other doctors who had seen her who were not psychiatrists at appointments and whatever, the pediatrician also did not notice any unusual things about her. She did not ... I mean, she was able to conform, right, to the type of behavior that a concerned mother would engage in. She was able to drive to the pediatrician's office and then back. And the day was really one of significant control. The activities that she engaged in that day, spending time with her children with Play-Doh, taking them outside to build a snowman, sending photographs of the children to her mother, to her husband on Instagram, fixing lunch and also fixing dinner for the children. So the activities of that day were controlled, as were the activities in terms of the planning that we already mentioned. So throughout the day, I mean, she was methodical and quite controlled and organized. Even in that space of time that was short. There was a lot to do in terms of killing her children and also killing herself. And I would say that the last point with regard to conforming to the law is that when she received the phone call from her husband, she did not report to him that she was in distress, that she was having hallucinations, that she needed help. So with that phone, she ...

GREGORY SAATHOFF: By calling her husband back and reassuring him by the fact that, yes, she knew the medication, whatever, that helped guarantee that he would continue on the errands. Had she not called him back, it would likely—or it certainly was possible that he would be concerned enough that he would return home. And so I think the phone figures in just in terms of her awareness and conforming her behavior such that the—

GREGORY SAATHOFF: Strangling of her children could be concealed.

GREGORY SAATHOFF: Yes.

GREGORY SAATHOFF: Yes. It is my opinion within a reasonable degree of medical certainty that Ms. Clancy was criminally responsible.