1.Michael Snyder — Direct
120 linesBAILIFF: This court is in session. Please be seated.
COURT CLERK: May I proceed, Your Honor?
THE COURT: Yes, please.
COURT CLERK: Your Honor, before the court today, we have the matter of Commonwealth versus Lindsay Clancy. Ms. Clancy is present. She is represented by Attorney Kevin Reddington. The Commonwealth is represented by Assistant District Attorney Jennifer Sprague and Assistant District Attorney Shanan Buckingham.
THE COURT: All right. Good morning, counsel.
THE COURT: Hi. Good morning, Ms. Clancy.
MS. CLANCY: Good morning.
THE COURT: Counsel, can I just see you briefly just for a second, and then I think we'll be ready to bring the jury in?
BAILIFF: Court, all rise. Jury's entering.
BAILIFF: Hear ye, hear ye, hear ye. All persons having anything to do before the Honorable William Sullivan, Justice of the Superior Court now sitting in Plymouth within for the Commonwealth. Your Honor, give your attendance and you shall be heard. God save the Commonwealth of Massachusetts. This court is now in session. Please be seated.
COURT CLERK: Good morning, Your Honor. May I proceed?
THE COURT: Yes, please.
COURT CLERK: Your Honor, before the court today we have the continuation of the jury trial in the matter of Commonwealth versus Lindsay Clancy. Ms. Clancy is present. She is represented by Attorney Kevin Reddington. The Commonwealth is represented by Assistant District Attorney Jennifer Sprague and Assistant District Attorney Shanan Buckingham.
THE COURT: All right. Thank you, Madam Clerk.
THE COURT: Good morning, everyone.
JURORS: Good morning.
THE COURT: I hope everybody had a restful weekend. So what I wanna do is just kinda tell you—first I'm gonna go through those questions, make sure everybody was able to follow my instructions. Then I'm gonna go over what today's schedule is. And then we'll return to the Commonwealth's presentation of evidence. All right? And so let me ask those questions. First question: has any member of the jury read, seen, or overheard anything from any source about any aspect of this case that would affect your ability to be fair and impartial? All right. Next question: is there any other serious matter or concern bearing on your service as a juror in this case that anybody needs to bring to my attention? All right. Again, thank you for following those instructions. Now, today's schedule—let me say first thing about schedule. I know I haven't always been completely correct on some of the schedules we followed, but I wanna just let you know that those decisions about the scheduling is on me. All right? And sometimes I have to take into consideration other factors or things that are going on. So what I really wanted to tell you is that don't speculate why we might go a little late or a little early on any certain days, but certainly don't hold it against either side in regards to that. The person who's making those decisions or that decision is me. All right? So that's—so you should be aware of that.
THE COURT: So that being said, the thought is today, we should go into the afternoon. All right? And if that changes, I'll let you know. So, and what we're gonna do at this point, we're gonna return to the Commonwealth's case. And with that, Commonwealth, call your next witness, please.
MS. BUCKINGHAM: Thank you, Your Honor. The Commonwealth will call Michael Snyder.
MR. REDDINGTON: While we're waiting for Dr. Snyder, could we just approach quickly?
THE COURT: Oh, sure. Yeah.
MR. REDDINGTON: Thank you. I do apologize.
THE COURT: Hi. Good morning, Doctor.
MICHAEL SNYDER: Good morning.
THE COURT: All right.
MS. BUCKINGHAM: May I inquire?
THE COURT: Attorney Buckingham, please.
MS. BUCKINGHAM: Thank you. Good morning, sir. Could you please tell the jurors your first and last name?
MICHAEL SNYDER: Yep. Michael Snyder.
MS. BUCKINGHAM: Do you mind spelling your last name for the record, please?
MICHAEL SNYDER: S-N-Y-D-E-R.
MS. BUCKINGHAM: And how are you employed?
MICHAEL SNYDER: I'm a physician at Beth Israel.
MS. BUCKINGHAM: And how long have you been a physician?
MICHAEL SNYDER: Since 1998.
MS. BUCKINGHAM: Can you tell us a little bit about your educational background?
MICHAEL SNYDER: So undergrad at UMass Amherst. I did medical school at Tufts University, and then I did my residency in emergency medicine at Boston University.
MS. BUCKINGHAM: And how long have you worked at Beth Israel?
MICHAEL SNYDER: Since 2014, 12 years.
MS. BUCKINGHAM: And do you primarily work in the emergency department?
MICHAEL SNYDER: Yes.
MS. BUCKINGHAM: I'm gonna draw your attention to January 24th of the year 2023. Do you recall working in the emergency department on that day?
MICHAEL SNYDER: Yes.
MS. BUCKINGHAM: And in the evening were you made aware of multiple pediatric traumas that were coming into the emergency department?
MICHAEL SNYDER: Yes.
MS. BUCKINGHAM: And when you are made aware of things, people coming in, how does that occur?
MICHAEL SNYDER: So we'll typically get a call on the EMS phone that something's coming in that they want us to know about up front.
MS. BUCKINGHAM: And do they provide you with some basic background information about what's occurring or what occurred on scene and what's occurring during the transport?
MICHAEL SNYDER: When possible, yeah.
MS. BUCKINGHAM: Okay. And when the emergency personnel, the EMTs or paramedics arrived at Beth Israel, there were three patients, correct?
MICHAEL SNYDER: Correct.
MS. BUCKINGHAM: And you were assigned to treat one patient?
MICHAEL SNYDER: Correct.
MS. BUCKINGHAM: Do you recall which patient that was?
MICHAEL SNYDER: Cora.
MS. BUCKINGHAM: And prior to EMS arriving, did you learn more about Cora's presentation and what was occurring?
MICHAEL SNYDER: Yeah. So we had heard that, you know, all three were in cardiac arrest. And Cora in particular, they were still working on doing CPR and doing what we call pediatric advanced life support. So medications to try and restart the heart. And they also mentioned that they had used what we call a defibrillator to shock the heart to try to restart it. And they were still doing CPR when they were arriving.
MS. BUCKINGHAM: And is this information important to you as you're assessing a patient coming into the emergency department?
MICHAEL SNYDER: Yeah. Yeah. It's important to know, you know, what things look like in the field. How long the patient might have been without a pulse or how long they may not have been breathing for, so we can kind of expect or know what injuries to look out for, what we can potentially reverse.
MS. BUCKINGHAM: And were you aware of the age of Cora?
MICHAEL SNYDER: Yes.
MS. BUCKINGHAM: And she was five, correct?
MICHAEL SNYDER: Yes.
MS. BUCKINGHAM: And as far as the medications that you were aware of, what medications had been provided?
MICHAEL SNYDER: So, prior to coming to us, she had been given epinephrine, which is the primary medication we use in a cardiac arrest.
MS. BUCKINGHAM: And do you know how they had administered that medicine to her?
MICHAEL SNYDER: Yeah. So she had what we call an intraosseous device in her right tibia. Sometimes it's very difficult to get an IV in, so we can go directly into the bone or the bone marrow.
MS. BUCKINGHAM: And were you aware of whether she had been intubated en route?
MICHAEL SNYDER: So she was not intubated en route.
MS. BUCKINGHAM: When she arrived at the emergency department, were you there to greet the ambulance?
MICHAEL SNYDER: Yes.
MS. BUCKINGHAM: And what happens when a patient comes in through the emergency department via ambulance?
MICHAEL SNYDER: So when the patient first comes in, you know, we immediately have our team, you know, start to sort of take over care so there's no gap. And then we also get a sign out from the paramedics and EMTs and any other staff that had been involved in the case.
MS. BUCKINGHAM: And do you and your emergency room staff then perform your own initial assessment of the patient?
MICHAEL SNYDER: Yes.
MS. BUCKINGHAM: And what do you do for that?
MICHAEL SNYDER: So, initially, we sort of go through our ABCs, airway, breathing, circulation. So initially, you know, focusing on the primary things such as making sure we're getting air and oxygen into the patient, keeping the heart going. So continuing CPR at that point.
MS. BUCKINGHAM: And as far as Cora went, did you observe that she was breathing?
MICHAEL SNYDER: So she was not breathing on her own.
MS. BUCKINGHAM: How about the heart? Did you observe that her heart was beating?
MICHAEL SNYDER: There was no heartbeat.
MS. BUCKINGHAM: How about her physical appearance? What observations did you make of her physical appearance?
MICHAEL SNYDER: So initially when she had come in, you know, some of the things we noticed is sort of a blue tint to the skin, which typically, you know, we can see when there's less oxygen or lack of oxygen. And then the other things on a quick survey is there was some areas of bruising on the neck and around the eyes, called petechiae. Kind of little bleeding, episodes of bleeding under the skin and I believe a small amount of blood coming from the nose.
MS. BUCKINGHAM: Were you able to make observations of her hands or other parts of her body?
MICHAEL SNYDER: So the hands definitely had that, what we call cyanosis or blue hue.
MS. BUCKINGHAM: Now, as far as the eyes, you mentioned petechiae around the face and the eyes as well as the neck. Did you notice anything else about her eyes?
MICHAEL SNYDER: So the pupils were fixed and enlarged.
MS. BUCKINGHAM: What is—why is that significant to you?
MICHAEL SNYDER: So oftentimes it can—when we see it coming in, it can indicate two different things. Some of the medications like epinephrine can cause the pupils to dilate. But also if the brain is starting to become damaged or not functioning, then you start to lose, initially, some of the signals that would make the pupils smaller. So they'll tend to start to get enlarged or dilated if there's brain injury starting or has occurred.
MS. BUCKINGHAM: Now, you indicated that when Cora arrived, she did not—she was not intubated, meaning she did not have a breathing tube in. Did you and your team attempt to intubate her?
MICHAEL SNYDER: Yes.
MS. BUCKINGHAM: And did you do that on your own or with the assistance of other parts of the emergency department or the hospital?
MICHAEL SNYDER: So we had anesthesia there. After we got the phone calls of multiple patients coming in, typically we'll have all, you know, all the help that we could possibly need there, to be able to take care of all the patients. So I had an anesthesiologist in the room with me who put the breathing tube in.
MS. BUCKINGHAM: In instances where an individual might have suffered some sort of injury to their neck, does that complicate the insertion of a breathing tube?
MICHAEL SNYDER: It can, yeah, 'cause normally you might need to move or tilt the head to get a direct view where you can put a breathing tube in. But when there's a concern for neck injury, we stabilize it typically with a collar or manually. So there's—you don't have the ability to move the head and the neck around to try and get a better view.
MS. BUCKINGHAM: Once a breathing tube was put in, were you and your team able to manually give breath to Cora?
MICHAEL SNYDER: Yes.
MS. BUCKINGHAM: Now, did you then perform an assessment, a cardiac assessment of her?
MICHAEL SNYDER: Yeah. So in addition to listening to the heart, feeling for a pulse, we'll also tend to use an ultrasound machine in the room where we can kind of get a direct view of heart function.
MS. BUCKINGHAM: And you were aware that they had defibrillated her twice in the ambulance. Why is that significant when you're treating a patient that's in cardiac arrest?
MICHAEL SNYDER: So when they defibrillate a patient, it's typically the heart's in a—or might be in a rhythm where it can't pump blood. So it might be sort of out of sync or quivering, where we may attempt to use electricity to kind of shock it back into a rhythm.
MS. BUCKINGHAM: Once you performed the ultrasound, the cardiac ultrasound, were there any attempts made further to use a defibrillator or—
MS. BUCKINGHAM: ... Throughout your course of treatment with her, did you continue with various medications?
MICHAEL SNYDER: Yes.
MS. BUCKINGHAM: And was CPR ongoing throughout your entire time with her?
MICHAEL SNYDER: Yes.
MS. BUCKINGHAM: Were you consulting with any other colleagues or any other hospitals in regards to the care of Cora?
MICHAEL SNYDER: Yeah, so we actually had, in addition to all my colleagues in the emergency room, we had intensive care physicians from Children's that were on the phone with us kind of working through any things that may have come up in the case, also expecting that they would be receiving the patients from us.
MS. BUCKINGHAM: Is your hospital at the Beth Israel equipped to handle this type of pediatric trauma?
MICHAEL SNYDER: So we can do the initial stabilization, but then we need to ship the patients out to either get a specialty care or continued inpatient care.
MS. BUCKINGHAM: And how long did efforts in treating Cora continue?
MICHAEL SNYDER: So in the emergency room, roughly 30 minutes.
MS. BUCKINGHAM: And fair to say that all of the efforts that you made were not successful?
MICHAEL SNYDER: Correct.
MS. BUCKINGHAM: And at approximately 7:00—excuse me—19:28 or 7:28, did you finally declare Cora deceased?
MICHAEL SNYDER: Yes.
MS. BUCKINGHAM: Thank you. I have nothing further.
THE COURT: All right. Anything?
MR. REDDINGTON: I have no questions. Thank you, doctor.