Lindsay Clancy & the 13 Medications Prescribed to Her: 48 Hours of No Sleep After New Med

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27:03In October, October 24th, 2022 to be exact, Lindsay writes in her iPhone notes, Affirmations. I am strong. I am brave. I will get through this. I will overcome postpartum anxiety and depression. I'm a great mom. I love my kids. I love my family. I love my life. I am happy. I take care of myself Then she has a section titled gratitude My mom for being there for me no matter what and coming to help at the drop of a hat My husband for picking up the slack when i've been feeling so down My husband for taking the big kids out to do things when I felt like I can't The knowledge of how I can turn things around naturally the space in my house to do this routine So this is around the time that she starts taking the zoloft Start or mid-October?

27:52I see. Yeah, so around the time of Zoloft. Dr. Tufts does give her reasoning for why Zoloft, because that's a huge, again, topic of the conversation. And she says, so it's a first-line medication used for treating anxiety disorders. It's also a first-line treatment when women are breastfeeding. It is the safest SSRI for babies. Tufts says that her initial diagnosis of Lindsay is generalized anxiety disorder, and it was an adjustment disorder with depressed mood. Dr. Tufts prescribes the Zoloft, like I said, first at 25, then ups it to 50. Lindsay posts on a postpartum Facebook page. It's called I Am Not Alone Postpartum Depression, Anxiety, and Rage Facebook group.

28:33And she writes, looking for advice, no medications for PPA slash PPD. Postpartum anxiety, postpartum depression. I tried Zoloft and after taking it for a week and increasing it to 50 milligrams, I had extreme insomnia and also felt like it was worsening my depression and I had no appetite whatsoever. So I had to stop taking it. Has anyone had a similar experience and found a different medication that worked? Lindsay also reports list to Dr. Tufts that she took the Zoloft, increased her dosage, and she couldn't go to sleep. Tufts testified that Lindsay told her that she felt awful. She did have some stomach aches.

29:12She had some diarrhea and had a difficult time eating. She also had increased anxiety. She had some more depressed feelings. She had more difficulty sleeping. Tufts notes at the time read that she felt awful. She couldn't sleep, had insomnia, which became worse when she increased the dose. She didn't want to eat. She was having diarrhea. Food felt really unappealing. She was more depressed on it, crying all day yesterday, which is not normal for her. She had some mental fog and was terrified to start something new. Anxiety was really bad even before med. Now hard to differentiate. Overnight racing thoughts, paranoid of getting suicidal thoughts, something bad happening, doesn't want to be alone.

30:17Tufts immediately tells her stop taking the Zoloft. Now Zoloft and SSRIs are typically a medication that you cannot stop cold turkey. You have to taper down. But Tufts does explain this dosage was relatively low so there was no need to taper down off of it and a lot of physicians and a lot of psychiatrists agree online so stop the Zoloft and they meet again through telehealth six days later October 26th and at that meeting Dr. Tufts says Lindsay was feeling back to how she was before the Zoloft which is not great still and that she was considering a new medication around that time Lindsay writes in her iPhone notes I'm sad and depressed because I'm not able to parent my third child like my first.

30:59I want to treat any one of my babies like my first, but I know that's not a feasible possibility. I'm sad that I stopped breastfeeding. I feel not as connected with Cal now. I think I sort of resent my other children because they prevent me from treating Cal like my first baby. I know that's not fair to them. I know that. I was feeling so depressed last evening when Cora and Dawson came home from school. I know it rubs off on them, so we had a pretty rough evening. I want to feel love and connection with all my kids. I'm also probably having a bit of internal conflict because my whole life I wanted to have a lot of kids.

31:30I still don't want Cal to be our last, but I have a lot of figuring out what to do before I have another. I'm on the fence about starting a new medication for anxiety and depression. I just want to feel happy. I just want to be able to relax and take care of my kids and when they go to bed at night, I want to deeply relax and hang out with Pat and then fall asleep into a deep sleep for eight hours, get up and pour hard into myself for an hour and a half. Callan was so very planned and desired. I want to be able to give him all the love he deserves. I guess that's what it's like to be the third child though.

32:00He's not the first third child to exist. I think I know he'll be okay but it's really hard for me. I hate that he has to put himself to sleep. I'm sad I'm not breastfeeding anymore but I think deep down these are the right choices. She writes that she simply does not have the opportunity to catch up on sleep. She doesn't even have the chance to take a nap during the day. She says when Cal naps I have to take care of Cora and Dawson. That's just how it goes. I guess I also feel slightly traumatized by the sleep training, but that feeling was only really present when I was severely sleep deprived and paranoid.

32:30I know what we did was the right thing and okay. She writes, I still really want a fourth child, but I need a really good therapist before then. I'm on the fence about starting a new med or not. I want to feel happy, but it would be nice to feel authentically happy and not fake, but I need to feel happier than I did last evening because then I was pretty depressed and not enjoying any of my children. It was really sad. I'm struggling so hard because I wanted to parent each of my children like my first and since I can't, that's depressing to me. I mean, this is definitely the root cause of all our problems.

32:58Now I feel like I'm not parenting any of my kids the way I want to and that makes me sad, but I'm going to try my best today. I've just fallen out of the habit of doing anything for fun, anything for myself, anything for Patrick, and I need to work on that. On a positive note, I had a great deep night of sleep. I'm terrified of something happening to my kids or doing something wrong to mess up their development. Our generation is inundated with information about every aspect of parenting and everything that can go wrong if you just don't get it right. And all the scary things happening in the world, it's insane.

33:29For the past five years, I've just filled my mind with all these parenting and it's just unhealthy. This note has been interpreted all sorts of ways online. Some say this note is proof that she knew exactly what she was doing. They think that her journals and her future entries included, which we will cover, showed that Lindsay was not hearing any voices. Otherwise, her writing would have been a little bit more disorganized. There would have been some hint at a voice. There would have been more paranoia seeping through these notes. These sound like an exhausted mom who has no way out. Others argue that it shows that she's clearly struggling and trying to get better, that she's screaming for help.

34:07She's not getting much help. And a lot of others say this actually could indicate mania. Interesting. So there are a lot of people who have come forward and said that when they were in manic episodes, they write like crazy. They talk and they write extensively. And you know, there's a lot of debate online of people. I think the only way really that anyone would be able to know is if Lindsay was some sort of avid journaler prior to all of this, that would maybe clear the air a little bit. Other than that, we're just speculating at this point. But a lot of people have come forward to say, at this point in time, Lindsay is not seeing a therapist.

34:47She's seeing a psychiatrist. And nowhere in Dr. Tufts' testimony did she say, hey, I told Lindsay to write down her thoughts when she has thoughts. And a lot of people say that it is not a natural thing for many people suffering from depression to take a lot of notes unless instructed by a provider. because the act of taking notes, I mean, with people struggling from major depression, typically they can't even get out of bed. Even basic hygiene is difficult. And so to formulate these longer thoughts and write it all down, it does not seem like it's depression and could maybe be more so mania. And then also other people are indicating this feels like when people are in states of mania, there's something called pressured speech and we're gonna get into it.

35:34But it's when someone has so many thoughts and they want to detail all of their rapidly racing thoughts that they just keep talking and then you can't interrupt them. This feels like pressured writing, basically. But again, that is just speculative. We don't know. So there weren't a bunch of notes from her app, notes app, like messages she wrote, written. There's not like a ton of them. Well, there were, but in all in this period. So I don't know if like when Lindsay was pregnant with Callan or before, did she? Yeah, we don't have that information. From the police. We don't know if she's just someone who journals like this on a weekly basis.

36:11Because that could change things. Now, if she's someone that has never journaled in her life and suddenly she's like writing long monologues in a state where people are saying you look depressed or, you know, she's giving off symptoms of major depression. It just, a lot of people think it's kind of strange. I see. and another thing to note is some people say that there is this confusion with being in a manic state and it being associated with being euphoric or someone being overly energized and hyper and just talkative and non-stop go go go but there are states called mixed mania where you rapidly cycle through periods of energy and irritability and then it swings really quickly to depression and it just swings back and forth so rapidly it is actually considered one of the most dangerous kinds of mania because of the elevated risk of self-exit.

36:59Nevertheless, Dr. Tufts then prescribes Lindsay 0.5 milligrams of Ativan, which is basically lorazepam, and she prescribes a PRN, which means take as needed, so not a daily medication. Ativan is a benzodiazepine, which means it's going to instantly help with anxiety, but it doesn't do anything to fix the underlying issue of anxiety. Plus, it's highly addictive, so it's not for long-term use. Another example of a very common benzodiazepine that I think more people would be familiar with just due to culture of movies and TV shows, Xanax, right? It's a controlled substance. And by October 26, Lindsay tries the Ativan and reports that it did help with the anxiety, but it still didn't help her go to sleep.

37:44She tells Tufts that she tried taking over-the-counter Benadryl to help with the sleep since the Ativan only helped with the anxiety and not the sleep. So that is when Tufts prescribes hydroxyzine at 25 milligrams. Hydroxyzine is an antihistamine prescription, and it's offered as an alternative anxiety option. So this is another PRN prescription. So take as needed. So instead of taking the Benadryl, take the hydroxyzine. That's the idea here. And then take the Ativan when the anxiety is insurmountable, like when you really need to take the Ativan. But do not take the hydroxyzine and the Benadryl together.

38:18Then Tufts decides that she's going to prescribe Boost Bar at 5 milligrams twice daily. So Boost Bar is an anti-anxiety medication that you do have to take every day. And typically you feel the therapeutic effects within like a week or two. So we've dropped the Zoloft. We've added in Boost Bar, which is the daily anti-anxiety medication. Then you have the antihistamine, basically the prescription Benadryl, take as needed. And then you have the benzodiazepine, take as needed for severe anxiety. Lindsay is very hesitant to start the Boost Bar. According to Dr. Tufts, she's just overall very hesitant to start new medication.

38:54So while she has the Boost Bar prescription, it's unclear if she started taking it at this point. And Lindsay starts talking to Dr. Tufts about perhaps tapering down from the Ativan. This is November of 2022. So we're like two months in, right? Ativan is a very short-term prescription. There is a huge dependence risk there. So they decide to start a slow taper because you can't even just cut benzodiazepines because benzodiazepine withdrawal can be very, very serious. Some have described it as being plunged into the depths of literal hell. You can actually die from the withdrawal. And that's not like a figurative like, oh my gosh, you could actually die from the withdrawal.

39:35I don't think that would be the case for Lindsay in this particular dosage at this length. It goes to say it's very dangerous. and around this time on a postpartum forum november 8th 2022 lindsey writes in part about zoloft and ativan she writes also right now i feel the only medication that works for me is ativan it has the perfect effect of decreasing my anxiety and making me feel happy it makes me feel like myself again but i know that it's not a long-term solution as it is addictive any advice on any alternative that has a similar effect which there's not really many there's a reason benzodiazepines are controlled substances and are for short-term use.

40:17I actually knew someone who was heavily dependent on benzodiazepines and like I don't know if there really is anything other than benzodiazepines that could be a replacement. It's kind of considered unmatched for immediate anxiety relief and that is why it is quite dangerous and you do get physically addicted to it rather quickly. Then just for the sake of following the timeline, we also get another Boost Bar prescription in November, but Lindsay tells Dr. Tufts that she never started it because she was afraid of, you know, starting new medications, but that second Boost Bar prescription does show up.

40:53And this is where there is a lot of conversation and it's going to feel very tricky to follow and just confusing, but there were 13 different medications that were prescribed to Lindsay from September 22 to January 2023. However, some of these prescriptions are replacements to other medications and just because Lindsay was prescribed it does not mean that she took it and it does not mean that she was taking all 13 at the same time. It's just very confusing. I will say even for Boost Bar, just like to give you an example, she has two bottles of Boost Bar, two Boost Bar prescriptions, right? For one of them, out of 30 pills, all 30 pills are in there.

41:32But another one out of 30 pills, there's only 28 pills. So that means there's two Boost Bar pills unaccounted for. Did she take the two and then decided that she didn't want to take it anymore? If that's the case, it doesn't seem like she reported that to Dr. Tufts or Dr. Tufts never testified it or had it in her notes. So we don't know. Also, Boost Bar was not found in Lindsay's system on January 24th during the toxicology reports. I will say that Boost Bar's half-life is around two to three hours. And then usually within like a day, the boost bar would be out of the system. But did she take the two boost bar pills that are missing?

42:06When did she take them? Why did she stop? Why did Dr. Tufts not know that she had maybe possibly taken the two boost bar pills? So all of this is just, just because she's prescribed something doesn't mean that she took it. It's just confusing. Now, it's not the most pertinent question in this case, but it just goes to show there's a lot of mental work that we have to make work of, of what she's prescribed, what she ultimately takes, what actually impacts her, what she's prescribed but doesn't take, what she tells the prescribers, and then ultimately what's found in her system January 24th. It's confusing.

42:37Dr. Tufts' testimony has sparked a lot of conversation online with people either hating her or thinking Reddington was trying to make her a scapegoat. She is also named as a defendant in two civil suits, one by Lindsay Clancy for personal injury and basically malpractice, and a wrongful death civil suit brought on by Patrick Clancy. So they are separately suing a lot of the providers. And people have a lot of opinions about Patrick Clancy also suing the providers. So there's a lot of mixed feelings. Some people think that Patrick shouldn't be suing. Some people think that Lindsay shouldn't be suing.

43:13And it's just that is another fight in itself. For Lindsay's civil suit, it states that essentially after prescribing Zoloft and after hearing Lindsay's reaction to said Zoloft, Dr. Tufts did not recognize the significant role of the reaction. They're saying like any good provider would realize like this is not normal. This is a clear indication that she is probably has a bipolar diagnosis that's underlying. And this activated some sort of manic response. Is this being discussed in the courtroom? Yeah. About the bipolar? Yeah. I would say that it's not a big part of obviously the Commonwealth's case in chief.

43:51but the defense brings in a lot of experts and there is a lot of heavy discussion on bipolar disorder and then the prosecutors bring in rebuttal experts. It's a whole back and forth. It's not even just a debate of, did she have postpartum psychosis? It's also a debate of, does she have bipolar disorder too? I see. And should these providers have known it? But the civil suit says that Lindsay had such a strong, adverse response to a relatively low dose of Zoloft, they should have known. For Patrick's lawsuit, it reads in part, Dr. Tufts prescribed Lindsay a variety of different medications, but failed to monitor her reactions to these medications or attend to her worsening psychiatric condition.

44:33I will say, Lindsay's time as a patient with Dr. Tufts does not end with the new Boost Bar prescription, but there are other providers that get involved later. So just to keep it on Tufts right now, during her direct testimony, Tufts states that she's been a psychiatrist for close to four years now. Limsy comes in to see her and she indicates in her intake form that she feels decreased appetite, depressed mood, anxiety attacks, easily distracted, excessive worry, guilt, unable to feel pressure, unable to fall asleep, racing thoughts. She reports that she feels down, depressed, and hopeless more than half the days.

45:08And Dr. Tufts says it is part of her job to look for signs of psychosis in patients. So when she's asked about those signs, she says, it might be that they appear disheveled. I assess what their attitude is. If they might be agitated or very uncooperative, that's a red flag. I will assess what their speech is like. Is it very loud? Is it very fast? Or sometimes it could be the opposite where they're not really even speaking at all. I assess what their mood is like, what they're saying that they're feeling, and how they appear visually. She says that she looks for disorganized thoughts and that's typically through the content of the conversation.

45:45If anything sounds very bizarre or very paranoid, that would potentially be indicative of psychosis. And she says she does that by asking questions like, quote, have you ever heard voices? Have you ever seen something that other people didn't see? Which some people are like, these are pretty bad questions, but I mean, I think it's probably protocol, right? Tufts believes that she asked Lindsay and Lindsay's response was no. During the cross-examination defense attorney reddington first questions tufts experience as a psychiatrist because when she sees lindsey dr tufts had completed her residency and had been practicing as a psychiatrist for a little more than a month i do see a lot of people harping on this issue i have been down lots of forums of people that are in health care that's the whole point of residency is you get the experience through residency so a lot of people think that this is incredibly unfair for this to be the focal point.

46:42However, there are other things to take issue with. This just might not be one of them, but people have taken issue with it. Reddington asks Dr. Tufts, I'm asking you, when you started working in August of 2022, how many patients had you treated before you saw Lindsay Clancy for postpartum psychosis? So you're saying like, how many other? And she says, well, in the span of one month, I would say none because it's a very rare disorder. How about postpartum depression? How many people in that month or so before you met Lindsay, did you treat for postpartum depression? In the span of one month, it's really hard to pinpoint that.

47:14Maybe a couple? The clinic that Dr. Tufts is working for had her on the website as, okay, well, this is what Reddington says. Well, one of the things you did is that you said that you were basically a specialist in the postpartum. You indicated that on the website, didn't you? Tufts says it's listed as one of her interests. Lots of you have problems with this. Okay, netizens are like, yeah, okay, next time I'm just going to list shit on my resume and say it's an interest of mine. Reddington says, and again, forgive me, how many women did you treat for postpartum depression in that month and a half before you met Lindsay?

47:50I don't know, maybe a couple, but I've treated many of them in residency, which was just immediately before. Some believe that Reddington is too antagonistic asking about Tufts residency. And I think a lot of people can agree that maybe the clinic that she was working for probably should not have listed her for something that is as complicated even if it says the word interest on there like an interest of dr tufts's women's health care and postpartum people think that it's incredibly reckless for the clinic to list her who has just been working independently as an attending for like a month and a half when this is such a sensitive even for people with years and decades of experience very difficult to identify they think that was reckless.

48:36However, they think that Reddington on that same note is also reckless in his line of questioning. But you do have to remember the jurors are probably not healthcare professionals. I mean, there was a nurse on the jury, but you're talking about a lot of people who are not healthcare professionals. So while this cross-examination, when I was on healthcare forums, they were saying it was the worst thing that they've ever heard in their lives and they were getting pissed off at Reddington. But a lot of people are reminding them, Reddington is not doing this for you or for healthcare. Reddington is doing it for the jurors.

49:07He's picking whatever angle is going to work on a normal person. And this is the angle where he's asking about her doing residency during the pandemic. Did you touch people, shake their hand, give them a hug or anything like that while you were working in your residency during the pandemic? Sometimes I think everybody had to keep their distance at certain times. I began my program before the pandemic. So of course, there was a lot more handshaking and things like that then. Reddington asked Tufts, you're defendant in a very large lawsuit, are you not? Objection, overruled. Yes. And you know that the outcome of this case is very major to the outcome of your lawsuit.

49:46Objection, overruled. I don't actually know that. So you understand that if in fact it's determined that you advertised as an expert in postpartum and in postpartum psychiatry and you've had a month experience plus a residency, would you consider that to be negligent or misrepresentation? I do not believe that I have been negligent. With a month under your belt plus your residency, do you really want this jury to believe that you were an expert? I don't think that's exactly the wording that I used. I think I said it was an interest of mine. Are you an expert in postpartum? I may be. I don't know.

50:23I think it depends on what you define an expert as. Tell me what brought Lindsay Clancy to your office. Postpartum anxiety. Reddington points out that Dr. Tufts does not administer the Edenberg test for Lindsay, which Tufts says she did do a different test, the PHQ-9, which is kind of like an overall depression screening form. But Reddington argues that's like generalized anxiety disorder, generalized depression. It's got nothing to do with a woman suffering from postpartum depression, does it? I disagree. Well, do you agree that people perhaps that may know a little more than you determined that the Edenberg scale is the appropriate scale to administer to a pregnant or postpartum woman?

51:06Objection. Sustained as to form. The form of the question is not okay. You're familiar with the Edenberg scale, right? I've heard of it. And can you explain to me how it's graded? No, I cannot. There are 30 questions in it, are there not? I don't use the scale, so I don't know how many questions there are. This is not Dr. Tufts' problem if her clinic does not use the Edenberg scale. However, I think the point that Reddington is trying to make is even if you list postpartum as an interest, but you don't even know the Edenberg scale, which is one of the bigger bigger well-known screening tests for postpartum anxiety and depression is it really an interest of yours even if that's not the screening tool that you use at the clinic should you not at least know it because what if a patient comes in and is like hey yeah i took the edenberg scale with my last provider and i was like this should you not have a good idea of it and it's not an overly complicated scale either it's not like some crazy terminology and then you got to draw blood it's just like a screening tool like the GAD7.

52:14Tufts pushes back later saying that it's not really her choice whether or not she gets to use the Edenberg scale or the PHQ-9 scale. That's the practor, Aster, the clinic. That's what they use and that's what she uses because she works for them. Reddington also makes it a point to show the jurors that they had 14 appointments from September to January. 14 appointments between Dr. Tufts and Lindsay and every single one of them was telehealth. Yes. Every single one of them were by telemedicine, weren't they? Yes. Until you came in this courtroom Friday, you never saw this woman in person, did you?

52:51Correct. She was crying. She told you symptoms that she couldn't get out of bed. Isn't that right? At one time, she said it was, it was difficult to get out of bed. Oh, difficult to get out. Why was it difficult for Lindsay Clancy to get out of bed. Because she was very depressed. And did you give her a hug? Oh no, you're on telemedicine. So you couldn't give her a hug, could you? Okay, this is where I did think it went a little skewed. I do think like based off of the interviews that we've seen of the jurors so far, I think I can understand the ploy that Reddington is trying to make for the jurors that are in front of him.

53:28There's so many times he doesn't call it Zoom. He doesn't call it computer. He says, you saw her through the television. and he himself being an older man it does seem very old school but there might be many members of the jury that resonate with that however a lot of younger people online are like i only do telehealth so i don't know what he's talking about so there is a generational gap here of yeah but i can see why he's doing it he's critiquing the teller yeah now is that the morally correct thing to do that's up for debate is that the smartest thing for a defense attorney to do probably so that's probably why he's doing it.

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58:08Dr. Tufts argues, I mean, she doesn't argue, but she responds, I could look at her, but it was always a video appointment. I couldn't give her a hug, but that's not actually something that psychiatrists typically do with patients. Reddington points out that the angle of the camera and the teledoc appointments, you can't see certain manifestations that patients may have and that would point to them being stressed or emotionally disturbed, he says, like hand-wringing. she's like yeah were you able to see the hand ringing when you were on telemedicine i don't recall seeing her hands you recall how people sit there and they they do this with their leg and their leg bounces because they're going through some type of emotional stress you couldn't even see her legs could you i couldn't see her legs but i knew that she was under stress i think that um i think reddington is setting the scene he's setting the scene because later on a different provider comes on and she states that ultimately she felt lindsey's condition she wanted to see lindsey in person and i think he knows that's coming and i think he's making an extra emphasis on tufts testimony at this point i see to really hammer in throughout the times that you've seen her you never once even considered telling her to come into the office so this is again he's trying to pinpoint no one was giving lindsey the help that she needed Dr.

59:32Tufts says whether an appointment is in person or through telehealth that's really up to not just Dr. Tufts but also the patient She says if a patient ever wants to do it in person not through telehealth that is an option Some parts of the cross-examination that people are on the fence about I will say is Reddington asked Tufts about whether or not Tufts told Lindsay that self-exit thoughts and actions are side effects of Zoloft Tufts argues that that is mainly for children but Reddington says there's a black box warning on Zoloft and other SSRIs. Is there not? Tufts argues yes but it's mainly for children and adults that are younger than Lindsay.

1:00:08So the FDA determined that there is a self-exit risk for children and anyone under the age of 24 years old. So Reddington is arguing well Lindsay was 32 which is just like a few years older than 24 he says. He never even mentioned she's 32 he just keeps saying like a few years. So does that suddenly mean that she's no longer at risk taking Zoloft of having thoughts of self-exit? Tufts argues back there's a lot of development that happens in the brain between ages of 24 and closer to 30. The brain is fully matured at past age of 24 so it's less vulnerable than in a younger individual. So with 24 you're suggesting there's a cutoff.

1:00:46Are you suggesting to the jury that a drug that increases the risk of self-exit in a 24 year old patient cannot increase the risk of self-exit in a 29 or a 30 year old patient just a little bit, I don't believe there's evidence that it causes that at all in individuals over 24. Now, I can see why people don't love this argument. There is a lot of demonization and fear-mongering of SSRIs that is coming out of this case. And SSRIs have been life-saving, incredibly helpful for millions of people everywhere. Like on a global scale, SSRIs have, horror stories, of course, like with any medication, but there are people who would not be here without SSRIs.

1:01:26So they think that this type of language that Reddington is using is only going to scare people from starting an SSRI when it's probably the best line of treatment for them. I guess maybe a more valid argument could be Reddington argues that another side effect of Zoloft could be, quote, severe trouble sleeping. Insomnia. Did you tell her that? Well, insomnia is listed as a side effect. No, no, no, no, no. Did you tell her that Zoloft has a side effect of giving the patient severe trouble sleeping? That's all. So I didn't use the word severe because it typically doesn't cause severe trouble sleeping.

1:02:02But I thought that you were referring to when she told me that she had severe trouble sleeping. But she's basically saying like she didn't think that Zoloft and the problem of not falling asleep was a big problem for Lindsay. But Reddington is arguing, why would you prescribe Zoloft to a young woman who's postpartum, who's coming to you with anxiety, this is his direct quote, who's telling you she can't sleep, she's got all these symptoms, and then you prescribe a medication that would have had a side effect of trouble sleeping. So individuals have very varied responses to medications. Some have no side effects, some have one or two.

1:02:34It's impossible to predict that. Zoloft is a top choice, a first-line medication for her. Says who? The general consensus among Among psychiatrists, there's extensive research supporting the use of cetraline in this instance and the general consensus among psychiatrists that it's a first-line safe medication for individuals, including postpartum women. How about the kids that shoot other kids in high school and the lawsuits that come out against Zoloft? Okay, so again, this is the part where I do think that Reddington is demonizing Zoloft for... It's really interesting. He's going after a specific medication.

1:03:09Just for the defense of his client. I think there's a lot of other ways to defend his client. I think, again, we're just heading into weird territory here with the SSRIs. That gets subjected, overruled. But he continues to ask, so you didn't really talk to her about increased risk of self-exit with 24-year-olds because she's, what, four or five years older than that. You didn't talk to her about the trouble sleeping, which could be a side effect. He asks her if there couldn't be any other drugs that she could have prescribed that would have been perfectly safe and common and allows someone with no psychiatric history to sleep better.

1:03:42And she responds, not necessarily. Reddington starts asking about Lindsay's reaction to Zoloft. And again, one of the things that Lindsay tells Tufts is the mental fog. Racing thoughts. Doesn't want to be alone. Doesn't want to be alone? What does she mean by that? Well, those were a lot of her words, right? Isn't that a concern? If your patient is telling you she doesn't want to be alone, why didn't she want to be alone? So he's trying to hint at like usually people say that, but as a mental health professional, that typically means they might be scared of something or paranoid you can't just take it as i don't want to be alone and she says and i think you know there is a debate a lot of netizens also say you know when you are dealing with someone with pretty severe depression they want to be alone but she's saying she doesn't want to be alone after taking the zoloft and she's having these racing thoughts a lot of people think it's pointing towards mania and paranoia so it's just like she should be able to pick up on that is what people are saying.

1:04:40But Tufts says because she was very anxious and had the feeling like something bad might happen. But we never get a clear idea of like what that something bad is. And later Tufts says it's very different. There are fear of thoughts of self-exit versus actual thoughts of self-exit. She said say a patient might say they're having self-exit thoughts but when they describe them they're not actual self-exit thoughts. There are fears of self-exit. So that's the difference. And I'm sorry, I think I forgot exactly what your question was. Reddington points out more notes from Tufts near December where Lindsay denies to Tufts that she feels like she wants to self-exit, but she feels close to feeling suicidal.

1:05:22Reddington asks, so she was dwelling on it or thinking about it, right? Is that fair? she was fearful of eventually having those kinds of thoughts. To self-exit, yes. And how frequently were those thoughts? I'm not sure exactly how frequent they were. Did you ask her? It's very likely that I did ask her frequency, but they're not in the notes. Would that be in your medical records? When you see some patients, you have some patients other than Lindsay Clancy at that point, right? Yes. And you document when a patient, my God, when a patient comes in and tells you that she's postpartum distress and she's close to having self-exit thoughts to self-exit.

1:05:59That's important, isn't it? It's important that I'm aware that she's having these thoughts. What thoughts? That she is fearful to become suicidal. And she told you, I imagine, or you asked how frequently these thoughts were. I don't have that documented how frequently they were, but it is a question that I usually ask when we're talking about self-exit thoughts. When we're usually testifying in a murder case, we usually have facts that we can tell the jury, not speculation. Objection sustained. Would you agree with me that many times patients, especially psychiatric patients, may minimize their symptomology?

1:06:36Patients sometimes do. And sometimes when a woman that has just had a child and other little kids at home, you feel worried about the government taking the kids away from them because you're a mandated reporter, aren't you? Objection overworld. You're a mandated reporter, aren't you? I am. She says, having self-exit thoughts alone is not a reportable condition. Doctor said that. Yeah. We don't know how frequently she was having them, yeah? Today, I don't know how frequently, but at that point, I believe I did know how frequently. Tufts didn't know that Lindsay called the self-exit hotline twice during this time frame, nor did she ever ask about it.

1:07:15Reddington asks, is it a surprise to know that she called the hotline in that time frame, not once but twice and was turned away you guys were on the front line of this weren't you it does surprise me yes what do you mean turned away um this is where a lot of people are upset with the system but even that is a larger conversation right you can have thoughts of self-exit but typically you are not taken in on a psychiatric hold unless you have a plan okay So she called and they just... I guess they tried to talk her through it, right? I see, I see. That's what he meant by turned away. Yeah. She wasn't taken in and I see.

1:07:55And you never asked if she ever called a hotline, did you? I don't think that I did. Now, there is debate online of whether this is more of a problem with the field of how psychiatry is practiced or if it's a Dr. Tufts problem. But Reddington is asking Dr. Tufts about how Lindsay told Tufts that she's feeling like self-exiting and Tuff says, I asked her, so what do you mean when you say I'm feeling self-exit like suicidal? And that's when she said it means I'm feeling hopeless. And then I asked, do you have intention of harming yourself? Do you have a plan of hurting yourself? And she denied those.

1:08:29Which Reddington later asked, what's the difference? And Tuff says, a plan means that they know exactly what they're going to do to do the plan, you know, what they're going to use, maybe when, they've researched it and that presents an immediate threat and that is something that would require hospitalization. Which now a lot of people argue is just semantics and of course no one is going to risk being sectioned by saying yes I have exact plans and also a lot of self-exits are not meticulously planned either. In fact I think statistics show that most of the time that they are not planned but again does that fall on Tufts or does that fall on the guidelines that are put in place?

1:09:04But what would be the better alternative because I don't think that we should also just leave it fully up to the provider's full discretion whether or not a patient is sectioned because for their own malpractice they would just start sectioning fucking everybody and that would also be very dangerous and could result in worse outcomes so we could go in circles in pointe shoes but I just don't know if we would end up in the same spot and I don't think that I'm equipped because I have no experience in health care to even really understand the full scope but that is a full conversation that's happening online Reddington asks Tufts now you'd agree with me at this point prior to the next appointment which was November 2nd that it had gotten significantly worse even after all this medication that you've been prescribing, right?

1:09:45Did you make a note that she was telling you that she had depression and that she was crying had more anxiety insomnia had increased brain fog and worrying about self-exit? In the couple of weeks after starting those medicines I don't recall that the symptoms were significantly exacerbated. Okay, and did she tell you about intrusive thoughts that she was having and what were those intrusive thoughts it was the feeling like i'm going to die and this is where i guess people have some this is also another nuanced debate some people think that tufts comes off really cold okay this is aside from the medications right some people think that tufts comes off really cold and does not do enough to help lindsey other people argue that Tufts is a psychiatrist.

1:10:30So she really is a prescriber of medication. She's less of a talk therapy. Tufts does recommend Lindsay to a few therapists that she could talk to. So there is like this back and forth of people of, was it really her job? So for example, and this is the line of questioning that kind of sparks that debate. Reddington asks, you indicated that she can't sleep. She's panicking. She had worse depression, intrusive thoughts. She was numb. Nothing mattered. Quote, I feel like I'm gonna die. denies SI, but SI is suicide ideation. Denies SI, but quote, yesterday, close to it, feeling hopeless. Did you give her therapy and validations after she told you that?

1:11:12I believe I did. What did you do? You got a woman that's telling you that she's hopeless. She doesn't care if she dies, can't sleep. What did you do to validate her on your therapy? I told her that this is something that we could address, that there was hope, that there were treatments, there were different types of treatment programs that are more supportive like partial hospitalization programs. You agree that she had in your opinion a severe mental disturbance at that point that was manifesting itself. She had moderate and moderate heading towards severe. So this is where people are like, okay, well if you're in a really bad state and someone's telling you don't give up, there's hope, nope that would also send you into a spiral but then others are arguing yeah but she is a psychiatrist and like a lot of people are like I only see my psychiatrist like once a month and she asked me three questions of like how are the meds great okay prescribing another one sounds good bye so people are saying like are we looking for the wrong things with the wrong providers there's a lot of debate to be had other people are saying hindsight is 20 20 and she only seems heartless now but these are how all psychiatrists are and if you have a problem with that you probably have a problem with psychiatry but it's i don't know one interesting aspect though i think that does not get talked about enough is that lindsey stated to dr tufts that she was having about one to two alcoholic beverages about five times a week which is quite a bit considering she does have an ativan prn prescription you cannot mix benzodiazepines with alcohol oh and she told the doctors that but i imagine it's just like brushed up on tufts mentioned that she did not see a problem with that but i would imagine that tufts was telling her like you can't take benzos with alcohol but i mean some people think that is a lot of alcoholic beverages and maybe she was self-medicating through alcohol to stop with the anxiety no one but it's just um it's just not a bigger topic which is why we don't get much clarity but it is it's kind of weird but people are ultimately divided on how they feel about Dr.

1:13:12Tufts. Her care for Lindsay, her treatment decisions, her testimony, her court demeanor. There are a lot of people who defend Tufts saying Tufts spent more time with her than lots of doctors who get sued. So another writes, the worst is knowing that all these providers actually legitimately tried to help Lindsay. It's not like an obvious case of medical gaslighting or malpractice. Another person says, Dr. Tufts was not negligent. If you're dealing with a patient who is non-compliant and take some pills here and there and some pills there, who doesn't give the different prescriptions enough time to become effective, is not forthcoming with everything, that's not the psychiatrist's fault.

1:13:46Other comments that it's weird to defend Tufts, they write, Lindsay exhibited signs of bipolar. So people are saying like everyone's getting lost in all the testimony when the one thing that people should be worried about is that after Zoloft, Lindsay was exhibiting signs of bipolar. but others argue there were no like contemporaneous signs that Lindsay was exhibiting symptoms of mania. It's up for debate but they write Lindsay exhibited signs of bipolar and Tufts completely missed it. Not only did she continue feeding her medicine that counteracts with bipolar but she let the illness go and treat it as well.

1:14:22This is literally the equivalent of not treating cancer because you don't detect it. Her mental illness grew faster and stronger without proper medication and the incorrect meds, it is sickening to hear people say she did her best. Three babies died and a woman is paralyzed. Her best was not even close enough. Another thing is a lot of people in healthcare do point out that you have to be extra cautious when someone is postpartum because a very quick way to activate a manic state is sleep deprivation. And you're going to have a lot of sleep deprivation when you have a baby. Yeah, they're all sleep deprived.

1:15:01And a lot of times, people who give birth and then have bipolar episodes afterwards, they are not what is very obvious signs of bipolar manic episodes. They're usually in a mixed state. So it can easily be confused with postpartum depression. Another person in the residency subreddit points out that while they have sympathy for Tufts, they do think that there's a lot to learn from the way that she takes notes, her medical notes that were used in court. The fact that Tufts also wrote that Lindsay was, quote, close to SI, they think is really bad because either you have SI or you don't. That could be legally used against you.

1:15:36Or if someone is, quote, close to SI, that's a very insufficient description. You have to back it up with more notes. They also state that they understand why the general public who is not in psychiatry is not sympathetic towards Tufts. So while they are sympathetic, they can see easily why the general public is not. They think that she appeared grossly unprepared for cross-examination. An example being, you know, when questioned on why telehealth only and why she has never met Lindsay in real life, Dr. Tufts should have highlighted that it makes psychiatric care more accessible for a busy mom with three children.

1:16:09She did not answer any of those questions well. But another highlighted example is later, Dr. Tufts, she's asked about one of the notes about pressured speech. We're going to get into it in this episode. But she says to Reddington, I don't care what was written. I know what I meant. So she has a lot of these moments where her notes are not good enough and she's almost defensive about her own notes. And that could be the stress of the lawsuit and her career at risk. Right now, I can't tell you the exact data points, obviously, but it appears that a lot of therapists, physicians, psychiatrists, health care forums with practicing providers, they either feel like a little too somewhat too fully sympathetic for Dr.

1:16:49Tufts. They don't think that she did everything perfectly, but they can see how it happened. knowing the healthcare system, knowing how these things work. They don't necessarily think that she should be sued for malpractice, but they think her documentation was horrendous and that people need to learn from that. And her preparation for the cross-examination was also horrendous. They also critique a lot of the system rather than Tufts herself. Others are more focused just on the system as a whole, saying this shows what's wrong. Doctors are incentivized to prescribe medication, have quick visits, and pass blame to others.

1:17:21What a shame. Others believe that Tufts, whether you like her or not, and whether she did make small mistakes that are not negligence, not enough for a malpractice suit, they think that more of the hate should be on the system rather than the provider itself is what some people are saying. One person writes, it became very clear to me when watching her testimony that this was not negligence and rather a clinician who was operating within the constraints of the system given imperfect information difficult to detect presentation treating a patient whose engagement and medication decisions were changing however a lot of people in psychiatry point out no there there is some bad here so the first being that lindsey later has a lot of other providers and none of them are talking to each other i wouldn't say none but the most important ones are not talking to each other so how did that happen is it just how the system is set up yes So Lindsay goes and sees another provider who is also prescribing and then Lindsay goes and tells Tufts, oh, my other provider just prescribed me this and this and this and like, what do you think, right?

1:18:24It would make the most sense for Tufts to then say, hey, can you fill this form so I can get the records from that provider? And maybe I can even talk to that provider so that we can be on the same plan for the same treatment plan, right? She never does that. She just takes Lindsay's word for it. And the other provider equally does the same thing. Interesting. Yeah. Is that like a common practice? Is that? That's up for debate. so a lot of people on the healthcare forum say this is incredibly common wow other people say it's some people say it's like hindsight is 20 20 wait so they don't share their medical charts their histories and all of that no unless you're in the same system so the few people that do communicate with each other they're in the same healthcare system so they have the same like they both work at the same hospital so they have access to the other provider that's so interesting because like even when we take mango to the vet they have to get their records no yeah yeah you have to get but you have to sign the release forms and i think the point that reddington is pointing out is that tufts never even had lindsey sign their release forms and then other psychiatrists are saying it's really not the craziest thing like it's kind of pretty common to know that ssri's that type of response does point towards a mixed bipolar depressive state however they also argue the distinction can be really hard when um everyone responds to medications differently and maybe she was not showing signs of mania as much so it's it's still up in the air but others are saying you know that's a pretty common knowledge is like oh we should be working looking out for this but others just focus on the fact that listen she admittedly did not have specialized training in perinatal mood disorders it was inappropriate to advertise herself as having some sort of specialty or even interest in it.

1:20:10This alone deserves a lawsuit. Another person writes, she is aware that her notes are medical records, right? Dr. Tufts continues to see Lindsay throughout September, October, November, December, and ultimately January. Her last appointment with Lindsay is January 23rd, the day before the incident. And one of Tufts' notes will be argued and dissected in court. But first, we have to go through all the other providers that Lindsay had seen in that time frame. And that is where I leave you with the first half of this episode. Let me know your thoughts. The second half of this episode will be up for the audio podcast very quickly.

1:20:49And let me know your thoughts. Stay safe and I we'll see you in the second half.

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