7.Meghan Collins — Direct/Cross
191 linesMS. BUCKINGHAM: The Commonwealth would call Meghan Collins.
THE COURT: Watch your step, please. Hi, good afternoon.
MEGHAN COLLINS: Hi.
THE COURT: Can I ask you to speak into that microphone? Keep your voice up.
MEGHAN COLLINS: Oh, okay.
THE COURT: Okay? All right. Please begin, please.
MS. BUCKINGHAM: Thank you. Good afternoon.
MEGHAN COLLINS: Hi.
MS. BUCKINGHAM: Can you please tell the jury your first and last name?
MEGHAN COLLINS: Meghan Collins.
MS. BUCKINGHAM: Would you mind spelling your first name for the record?
MEGHAN COLLINS: M-E-G-H-A-N.
MS. BUCKINGHAM: And—
MEGHAN COLLINS: Collins, C-O-L-L-I-N-S.
MS. BUCKINGHAM: ... Thank you. And what do you do for work?
MEGHAN COLLINS: I'm an ICU nurse.
MS. BUCKINGHAM: And how long have you been a nurse?
MEGHAN COLLINS: 11 years.
MS. BUCKINGHAM: And did you go to school for that?
MEGHAN COLLINS: Yes.
MS. BUCKINGHAM: Where'd you go?
MEGHAN COLLINS: Sacred Heart.
MS. BUCKINGHAM: What hospital do you currently work at?
MEGHAN COLLINS: Brigham and Women's.
MS. BUCKINGHAM: And how long have you worked there?
MEGHAN COLLINS: Eight years.
MS. BUCKINGHAM: In January of 2023, what unit were you working on at the Brigham?
MEGHAN COLLINS: The trauma surgical ICU.
MS. BUCKINGHAM: Did you work a particular shift?
MEGHAN COLLINS: I did.
MS. BUCKINGHAM: And what shift was that?
MEGHAN COLLINS: 7A to 7P.
MS. BUCKINGHAM: So 7:00 AM to 7:00 PM. And you just have to answer out loud. Sorry.
MEGHAN COLLINS: Okay. Yes.
MS. BUCKINGHAM: I'm gonna draw your attention to a particular patient that was treated there beginning on January 24th, Lindsay Clancy. Are you familiar with that patient?
MEGHAN COLLINS: Yes.
MS. BUCKINGHAM: Were you a nurse that was treating her during the day shift while she was in the ICU?
MEGHAN COLLINS: I was.
MS. BUCKINGHAM: Are you aware that she arrived at the Brigham Hospital on January 24th of 2023?
MEGHAN COLLINS: When she was admitted to our ICU, it was overnight.
MS. BUCKINGHAM: So as far as the hospital, do you know when she arrived at the hospital?
MEGHAN COLLINS: I believe the day, evening prior.
MS. BUCKINGHAM: And you—a patient who comes to your hospital doesn't automatically come to the ICU, correct?
MEGHAN COLLINS: That's correct.
MS. BUCKINGHAM: Where do they go first usually?
MEGHAN COLLINS: The emergency room.
MS. BUCKINGHAM: Okay. And you're aware this particular patient actually went through a local hospital before being transferred to the emergency department at Brigham and then to the ICU, correct?
MEGHAN COLLINS: Correct.
MS. BUCKINGHAM: And so when you interacted with her, she had already been at the ICU unit for that night shift. Is that fair to say?
MEGHAN COLLINS: Correct. Interacted. She was intubated when she arrived.
MS. BUCKINGHAM: And were you with her the entire day of the 25th from that 7:00 AM to 7:00 PM shift?
MEGHAN COLLINS: Yes.
MS. BUCKINGHAM: And was she on what's called the one-to-one during that day?
MEGHAN COLLINS: Yes.
MS. BUCKINGHAM: And what does that mean for you as the nurse if she's on the one-to-one?
MEGHAN COLLINS: She was one-to-one nursing per our ratios because of how critically ill she was.
MS. BUCKINGHAM: And so you were there pretty much the entire time?
MEGHAN COLLINS: Correct.
MS. BUCKINGHAM: Were there any other people there other than the medical staff and yourself treating her? Were there any other people there?
MEGHAN COLLINS: There were officers, police officers.
MS. BUCKINGHAM: And they were outside the room?
MEGHAN COLLINS: Correct.
MS. BUCKINGHAM: Had you taken over care of this patient from another nurse on the night shift?
MEGHAN COLLINS: Yes.
MS. BUCKINGHAM: And who was that?
MEGHAN COLLINS: Rachelle.
MS. BUCKINGHAM: And you are familiar with Rachelle? You've worked with her before?
MEGHAN COLLINS: Yes, I have.
MS. BUCKINGHAM: And were you advised that over the course of the night shift that this patient had coded?
MEGHAN COLLINS: I was.
MS. BUCKINGHAM: And when you came on shift in the morning, because of what had happened overnight, were you aware that she was sent for additional CT scans?
MEGHAN COLLINS: We went for CT imaging in the morning when I got there because she was not stable overnight.
MS. BUCKINGHAM: And you said she was intubated, correct?
MEGHAN COLLINS: Correct.
MS. BUCKINGHAM: How about, was she responsive during that first day that you encountered her?
MEGHAN COLLINS: The first shift that I had her, we were focused on her injuries and keeping her sedated, so the interactions, responses were minimal. But that was intentional as she was, again, like I said, so critically ill.
MS. BUCKINGHAM: And so you also said that she was sedated for the majority of that day, correct?
MEGHAN COLLINS: Yes.
MS. BUCKINGHAM: And is that something that often happens when a person is intubated, that they're sedated?
MEGHAN COLLINS: It is.
MS. BUCKINGHAM: What happens if an individual isn't under sedation and they're intubated?
MEGHAN COLLINS: It is patient dependent, but majority of patients are not able to tolerate the breathing tube, and it's uncomfortable. So we give them medications to keep them as comfortable and tolerating the breathing tube as possible.
MS. BUCKINGHAM: Now, you mentioned treating injuries and keeping the patient stable as your primary goal, correct? Were you able to make note of some physical injuries that the patient had?
MEGHAN COLLINS: Yes.
MS. BUCKINGHAM: And were there some obvious injuries that you could observe?
MEGHAN COLLINS: Yes.
MS. BUCKINGHAM: To her neck and wrist area?
MEGHAN COLLINS: Correct.
MS. BUCKINGHAM: May I approach the witness?
THE COURT: Yes.
MS. BUCKINGHAM: I'm gonna show you two photographs, okay? Does that look familiar to you?
MEGHAN COLLINS: Mm-hmm, yes.
MS. BUCKINGHAM: Do you know that to be the patient, Lindsay Clancy?
MEGHAN COLLINS: I do.
MS. BUCKINGHAM: And fair to say, has a breathing tube?
MEGHAN COLLINS: She does.
MS. BUCKINGHAM: And then the second one, again, just the other side of her neck. Is that familiar to you?
MEGHAN COLLINS: Yes.
MS. BUCKINGHAM: Are these fair and accurate representations of the neck injury that you observed for this particular patient?
MEGHAN COLLINS: To the best of my memory, yes.
THE COURT: All right, they may be admitted.
MS. BUCKINGHAM: It's 142 and 143.
MS. BUCKINGHAM: I'm gonna show you on the screen what's been... Oops. Mark this exhibit 142 and 143. And you said that's to the best of your memory what the injuries on her neck looked like, correct?
MEGHAN COLLINS: That's correct.
MS. BUCKINGHAM: And during your treatment of her, did those injuries require constant attention?
MEGHAN COLLINS: They required dressing changes. It did not require constant attention. She had multiple injuries.
MS. BUCKINGHAM: So fair to say she had more significant spinal injuries and other issues that you were working to stabilize her on, correct?
MEGHAN COLLINS: Correct.
MS. BUCKINGHAM: Now, you treated her on the 25th, right? And did you treat her on the 26th, to the best of your memory?
MEGHAN COLLINS: I would have to go back and look.
MR. REDDINGTON: I don't have a problem if she leads her with records if she has to.
MS. BUCKINGHAM: As far as January 26th on that 7:00 AM to 7:00 PM shift, do you recall making notes that the patient required additional sedation due to the tube intolerance?
MEGHAN COLLINS: Yes.
MS. BUCKINGHAM: Okay. And that she was started on low dose of propofol?
MEGHAN COLLINS: That is correct.
MS. BUCKINGHAM: And that in the afternoon, that she had chest tubes and you kind of checked those chest tubes to... It says, “Interval CXR looked okay with chest tubes to water seal.”
MEGHAN COLLINS: Yes, that's correct.
MS. BUCKINGHAM: And so she had previously been given chest tubes, and your role was just to kind of make sure that everything was fine.
MEGHAN COLLINS: They placed bilateral chest tubes, and monitoring those is a part of my responsibilities in the ICU, and we were concerned for her respiratory status, so that is why I made a note of it.
MS. BUCKINGHAM: Okay.
MS. BUCKINGHAM: And as far as the injuries that were a part of your assessment of her, fair to say on January 29th, you also were treating her that day from 7:00 AM to 7:00 PM, and you made a note where you identified injuries, right?
MEGHAN COLLINS: Correct.
MS. BUCKINGHAM: And those injuries would have been things that were reported to you based on a doctor's review of labs and images and that kind of thing, correct?
MEGHAN COLLINS: Yes.
MS. BUCKINGHAM: You don't make your own assessment about thoracic injuries or cervical injuries?
MEGHAN COLLINS: I do not diagnose.
MS. BUCKINGHAM: Also, on the 29th or the 28th into the 29th, that is, at that point when the patient was extubated, correct?
MEGHAN COLLINS: Correct.
MS. BUCKINGHAM: Do you recall making observations of the patient when she was, after she was extubated?
MEGHAN COLLINS: She was not extubated on my shift. I was there the following day.
MS. BUCKINGHAM: Okay. Did you note how, her demeanor, her presentation the next day?
MEGHAN COLLINS: I did.
MS. BUCKINGHAM: And fair to say you noted increased confusion, agitation, and picking at lines and drains, correct?
MEGHAN COLLINS: That's correct.
MS. BUCKINGHAM: And fair to say the patient had to be restrained because of the activity?
MEGHAN COLLINS: That is correct.
MS. BUCKINGHAM: Is that something that you often see when patients come out of intubation, that when they're extubated that they exhibit signs of confusion or delirium?
MEGHAN COLLINS: Yes. It's called ICU delirium.
MS. BUCKINGHAM: Okay. And over the course of the next few days in your interactions with her, did you see that delirium decline or decrease?
MEGHAN COLLINS: Yes. It was a multi-modal approach to manage the delirium, agitation, and it did get better, and it did improve.
MS. BUCKINGHAM: And fair to say during the time that you were treating this particular patient, there was also sleep issues that were part of the treatment plan?
MEGHAN COLLINS: That is correct.
MS. BUCKINGHAM: And on January 29th and January 30th of 2023, were you present when the psych consult team came in to speak with the defendant?
MEGHAN COLLINS: Yes, I was.
MS. BUCKINGHAM: Okay. What was the purpose of you being present?
MEGHAN COLLINS: The purpose is we had consulted the psychiatry team to evaluate and determine capacity, and my role is the, as the ICU nurse, is advocacy on behalf of the patient and to alert the providers if there's any changes in the mental status.
MS. BUCKINGHAM: Now, when they came in, and you said advocate for their position, you're aware that the patient was looking to change her healthcare proxy, correct?
MEGHAN COLLINS: The patient was changing her healthcare proxy. That is correct.
MS. BUCKINGHAM: And that there has to be an evaluation to determine whether she's of a particular mental status and medically able to make that decision on her own. Is that fair to say?
MEGHAN COLLINS: Yes.
MS. BUCKINGHAM: Okay. And do you recall who was present other than yourself and the psych doctors, the doctors from the psychiatric unit?
MEGHAN COLLINS: There was the social worker, myself, and her lawyer was present.
MS. BUCKINGHAM: Had you been present when a lawyer or somebody else was with her prior to this consult?
MEGHAN COLLINS: There... No.
MS. BUCKINGHAM: And fair to say you were made aware very early on that there was a particular group of people that would be having access to this individual, correct?
MEGHAN COLLINS: Can you clarify?
MS. BUCKINGHAM: Well, is it fair to say that the treatment team was kept small on purpose, meaning the same people were coming in and being the nurse, day and night staff. There was limited access. Is that fair to say?
MEGHAN COLLINS: It was kept to a... Yes, it was kept to a smaller team, but that was also protection of privacy for the patient.
MS. BUCKINGHAM: Okay. And during the course of time when she's on the ICU, which is between the 24th to February 3rd, there's always law enforcement posted outside the room, correct?
MEGHAN COLLINS: Yes, and it was because she was—
MS. BUCKINGHAM: Well, I'm just asking you if there were law enforcement.
MEGHAN COLLINS: There was.
MS. BUCKINGHAM: Okay. Do you recall having to check with the nursing director and the legal team at the hospital to make sure that it was permissible to allow anyone in besides medical staff?
MEGHAN COLLINS: Yes. That's standard protocol.
MS. BUCKINGHAM: Okay. And when she was transferred off of your unit on February 3rd, did you have any further contact with her?
MEGHAN COLLINS: I did not.
MS. BUCKINGHAM: I have nothing further. Thank you.
THE COURT: All right. Attorney Reddington.
MR. REDDINGTON: Afternoon, I think. Yeah. How many years you been a nurse?
MR. REDDINGTON: And you obviously take that position as very serious, and your concern is to protect your patient. Is that right?
MEGHAN COLLINS: That is.
MR. REDDINGTON: You made reference to the fact that she was changing her documents as far as healthcare proxy.
MEGHAN COLLINS: Yes.
MR. REDDINGTON: Did you know anything, or did you know who she was changing it from, her husband to her mother and father, or did you know anything about the specifics?
MEGHAN COLLINS: She was changing it from Patrick to her parents.
MR. REDDINGTON: Thank you. And finally, what is a DNR?
MEGHAN COLLINS: DNR means do not resuscitate.
MR. REDDINGTON: Do you know what her DNR was?
MEGHAN COLLINS: Her code status was full at the time that I took care of her.
MR. REDDINGTON: Do you recall that she had indicated repeatedly that she wanted a DNR, that she did not want to be resuscitated if emergency arose?
MEGHAN COLLINS: I was not privy to that knowledge.
MR. REDDINGTON: Okay. But that's noted in the medical rec-—it would be noted in the records, right?
MEGHAN COLLINS: It would be, yes.
MR. REDDINGTON: Thank you very much.
MEGHAN COLLINS: Thank you.
THE COURT: Attorney Buckingham?
MS. BUCKINGHAM: No. Nothing further. Thank you.
THE COURT: All right. Thank you. You may step down.
MEGHAN COLLINS: Thank you.
THE COURT: Thank you.