Lindsay Clancy - A System Failure

A mother with three small kids reports that something is deeply wrong, her sleep collapses, her mood and cognition shift, and her fear escalates and the system responds with appointment fragments, screeners, and a revolving door of prescriptions. We’re following the Lindsay Clancy trial, but we’re not here to play lawyer. We’re here to look at postpartum depression, severe perinatal mental illness, medication management, and clinical decision-making the way providers should: through risk, oversight, and coordinated care. Content warning: we discuss suicide, infant death, and postpartum psychiatric crisis.

We walk through the timeline and the medication load that builds to an unbelievable number: 13 psychiatric medications in about four months, prescribed across multiple settings. That opens the door to polypharmacy risks, side effects that mimic worsening illness, and a brutal reality the testimony keeps revealing: no one provider appears to have the complete medical record, the full med list, or the full story. We also talk about access problems that normalize shortcuts, including telehealth constraints, rushed follow-ups, and the difficulty of getting inpatient stabilization even when someone is clearly deteriorating.

Then we zoom in on roles and standards. What should a psychiatrist do in a 15-minute medication visit? What should a therapist do in real CBT or DBT? What does EMDR training actually require, and why is “I’m trained” not enough when you’re working with the brain and nervous system? We close with what good coordination of care looks like, plus postpartum and crisis resources for anyone who needs support right now.

If this conversation matters to you, subscribe, share it with someone who works in healthcare, and leave a review so more people can find it. What part of the system do you think failed first?

Transcript

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Welcome And Content Warning

Intro 0:34

They say there are three things you don't talk about in polite company And we just made a podcast about all of them Politics, religion, sex, and a few other things that'll get you uninvited from Thanksgiving dinner So grab a drink, loosen your belt, maybe hide this one from your boss. Welcome to The Unmentionables Hey everyone, I'm Evan, the guy with way too many questions and just enough nerve to ask them. And I'm Melissa, therapist, mom. I'm here to answer those questions before the arguments start. So here's how it works. I bring the curiosity, the wait, why is that a thing energy, and Melissa keeps us from setting the whole conversation on fire. Most of the time.

Evan Q 1:17

I'm Evan. This is The Unmentionables. We're in the midst of the Lindsay Clancy trial that is sweeping the nation. My co-host, Melissa Smith, is a licensed clinical social worker, trauma certified, EMDR certified, all the certifications. All the certifications.

Melissa 1:32

All the certifications

Evan Q 1:33

the executive director of a counseling practice. She's been reading and watching this trial, uh, the way a clinician reads it, which is very different from how it's being covered. You're gonna get a lot of coverage about the law and the legal side of things, but Melissa's looking at it from a little bit different angle. Now, fair warning, we are going to discuss things like suicide, infant death, and severe postpartum mental illness. So if you're in a hard place right now, take care of yourself. I wanna start with talking a little bit about the basics of the case. We're gonna start with the family. Lindsay and Patrick Clancy

The Case Basics And Timeline

Evan Q 2:10

in Duxbury, Massachusetts, a coastal town south of Boston. Three kids: Cora, five years old, Dawson, three years old, and Callan, just eight months. Lindsay is a labor and delivery nurse. She had spent her career in the room with mothers throughout the process. Uh, Callan was born in May of 2022. Um, by her husband's testimony, the trouble surfaced as she prepared to go back to work. She had a hard time being apart from the kids, and especially the new baby Let me give you a little bit about the timeline here. September 2022, her first appointment with Dr. Jennifer Tuftss, who is telehealth at a practice called Astor Mental Health. October 3rd, initial therapy assessment with Jennifer McAlister, a licensed mental health counselor at the same practice. October 31st, another therapy appointment, days after she'd told her psychiatrist that she was afraid of thoughts about killing herself. We'll come back to this one. Uh, November, a second psychiatric nurse practitioner, uh, Julie Paul, and then the South Shore Hospital's Perinatal... Uh, she's at the South Shore Hospital's Perina-perinatal Behavioral Health Clinic. Easy for me to say. Uh, and then also nurse, uh, practitioner Rebecca Jollotta. We'll get into them as well. December 2nd, she had an intake with Letecia Dukes, a mental health counselor at the perinatal clinic. Uh, she saw her four times. Mid-December, the whole crisis. There's a hotline call, an emergency department visit, not admitted. Her Edinburgh Postpartum Depression Score was 21, which I understand is quite severe, and I think Melissa will talk a little bit about that as we go through this. In early January, voluntary inpatient admission at McLean Hospital, discharged shortly after, uh, on a, on a short stay. January 16th, a new medication added. January 23rd, an appointment with her psychiatrist. She was depressed, flat, uh, numb for 17 days. No hospitalization recommended. Uh, January 24th, her husband leaves to pick up takeout and a prescription. He's gone for just a handful of minutes, maybe 10 to 15, um, and that's when the tragedy occurs. Wanna talk a little bit about the medications. She was prescribed 13 psychiatric, psychiatric medications in four months. More than 30 prescriptions between September and January Zoloft, Ativan, Klonopin, Valium, Seroquel, Trazodone, Buspirone, Hydroxyzine, Lamictal, Amitriptyline, and others that were discussed and considered during the trial and during her encounter. Uh, they were prescribed by psychiatrists and nurse practitioners, by emergency room physicians, by inpatient staff. There were m- several duplicate prescriptions days apart from different providers. Her psychiatrist testified she never had access to the complete medical record. Nobody had the whole picture here. And then on January 24th, 2023, Lindsay Clancy killed Cora, Dawson, and Callan. She then attempted to end her own life, but survived, paralyzed from the waist down. We're not gonna go into all the hows and the legal sTufts. I'll leave that for people like Emily D. Baker and the others that are probably going to go through this trial from a legal perspective. But what we are gonna talk about, um, is the, the clinical side of things and, and the system that was involved around her. She's charged with three counts of murder. She has not disputed that she killed her children. Her defense is that she was not criminally responsible.

Melissa 5:55

She does not remember

Evan Q 5:56

Correct. She doesn't remember.

Melissa 5:57

I don't, I think it's important to note here actually that she is not saying, "I remember killing my children." She's not disputing that she did it and is saying, "I, I don't remember this."

Evan Q 6:12

Correct. Now, the Commonwealth hasn't rested their case yet. The defense hasn't called a signal witness, so we will be revisiting this in a future episode. But 12 days of testimony are on record, m- most of them being prescribers, evaluators, investigators, a medical examiner. And Melissa's been watching for some specific things in all of it. So Melissa, what are you not seeing?

Melissa 6:36

I have been having a very hard time watching this for sure because I know best practice, I know small practice, and I think it's very, it's abundantly clear that this is a large organization

Evan Q 6:57

with

Melissa 6:58

what should be high oversight and it would seem a lot of people not doing their jobs. Uh, this is a woman, a- and I know this is a super controversial issue. There's a lot of people who will sit here and say, "But she killed her kids." And I look at this and go, "Yeah, and she was begging for help." She was begging to go inpatient and was denied. Denied because she was overmedicated. I, I think that that's such an important thing to point out and even in some of the sTufts that we were watching last night, this is somebody who did not wanna take medications. She was resistant to what side effects it would have, what complications she would have. Would she be a functional parent? And when you hear it took her I think it was two months to agree to take Zoloft and she had side effects. Now the psychiatrist can't tell us what those side effects were. I don't know if the psychiatrist asked what they were. She could tell us the general side effects that many people that take Zoloft have but not any specific to Lindsay and this is the person who was responsible for overseeing the entire case. I have significant questions about the licensure level of the people who were treating her. Are they licensed to independently practice or are they licensed to practice in a supervised fashion? Because we have a psychiatrist that's supervising the whole thing

Evan Q 8:33

the whole thing- Mm-hmm I

Melissa 8:33

I I question what level of supervision that was. Were we just signing off on things because I have to sign off on them or were we actually reading things? Because if she was actually reading the documentation that she had available to her this whole situation was avoidable

Evan Q 8:53

Yeah, I mean, there, we're, there's so many questions that we're gonna go through on this episode, so if you are a Case Watcher or if you're interested in mental health or if this has touched you in, in some individual way, stay tuned 'cause we're gonna go through a lot of this sTufts

Melissa 9:09

And I also do wanna point out, um, prenatal, postnatal, perinatal

Polypharmacy And Missing Medical Records

Melissa 9:15

is not my area of specialty. So I am not speaking about all of this in regard specifically to how things were done in that setting. I'm looking at things from the external clinician standpoint and what is general best practice, what questions should we have been asking, what follow-through should there have been, where should higher levels of recommendation been made or been advocated more strongly for? Where should there have been communication? We're talking about risk of harm. Was she a risk of harm to those kids? And we have a duty then to discuss that with the husband or the police even. And w- uh, getting started on the whole Patrick piece is a whole separate issue because he's the one that left her alone with the kids knowing how poorly she was doing.

Evan Q 10:07

Yeah, and that's a great point. We are gonna get into that a little bit because he was a part of some of the, uh, therapy sessions and then also, uh, some of the discussions with the doctors about the medications

Melissa 10:19

wanted to meet with a psychiatrist- And- to be on the same page

Evan Q 10:23

page. Y- correct, and also was one of the people advocating that she's, she's different now that she's on the medication. Things are getting worse. And

Melissa 10:31

So

Evan Q 10:32

yeah. Um,

Melissa 10:33

but- also left her alone with the kids Agreed.

Evan Q 10:36

But also left her alone with the kids. Agreed. There's, there's a lot of inconsistencies there, and I think there's, there's a lot of points where during the trial the judge has looked and gone, "That's weird." It's not normal to him as a, as a judge, a layperson, and not in the medical field. Now, you have stated this a couple times and I wanna make sure that I am clear for the listeners, but you are not a doctor. I am not a medical doctor.

Melissa 10:58

I am not a medical doctor.

Evan Q 10:59

Uh, but I have heard you speak with doctors in relation to our kids, for example, and I'm always struck by how aligned you are with the understanding of the brain, uh, how it functions and how medications affect it. Um, and I know that as a professional you've done your own self-study, uh, on how medications affect the brain and the body. I also work with a lot-

Melissa 11:22

of different psychiatrists and take the time to learn and understand. And while I am not a doctor, I cannot write for medications, I cannot, um, give advice on medications, we're the ones as clinicians that are seeing these people week in and week out. We're seeing the shifts and the changes, and oftentimes the medical community does devalue the input that we have and the thoughts that we have that would guide medication. Um, the, the trend is they're a doctor. They know what they're doing.

Evan Q 12:00

Yeah.

Melissa 12:01

We're not. Yeah. So we should stay in our own lane.

Evan Q 12:05

Yeah, and we, we're gonna come back to that because I think there's a, there's a totality of care here that, that is, is... This case is highlighting how little that totality of care is really

Melissa 12:16

C- we call it coordination of care Coordination of care. Sure

Evan Q 12:19

Um, so I, I don't necessarily want you to comment specifically on the competence of the psychiatrist because I know you're not a doctor. Um, though you might. Uh, but in general, psychiatrists and therapists have different roles, right? We just kinda talked about that.

Melissa 12:34

was very upsetting actually to hear Dr. Tough, Tuftss or Tuftss

Evan Q 12:39

Tuftss, Dr. Jennifer Tuftss.

Melissa 12:41

Is there another second T in that, or is it two Fs?

Evan Q 12:45

Tuftss. Yeah, like the university.

Melissa 12:47

So, right. Um, yeah, I was actually very frustrated. That was one of those points where I went, "What the hell are you thinking or talking about?" Because she's trying to skirt around a couple issues here. There are some psychiatrists who are dually trained in psychology clinical work And they bill for 45, 60-minute sessions. The fact that she sat there, and her documentation shows it was a 17-minute session, and she wanted to try to say, "Oh, well, she billed for 25 minutes," and that 17 was the therapy portion. This woman doesn't do therapy. She looks at medications. Somebody goes to a psychiatrist to be prescribed medications, and you meet the, with the psychiatrist for actually what is a standard 15-minute appointment. Right. You talk about are the medications working, are there symptoms where I need more support from a medication, and what are we gonna change up, out the door, move on, next client.

Evan Q 14:03

Right

Melissa 14:05

Right. There is no deep CBT, DBT, EMDR work, um, somatic work. This is why she referred for a clinician to work with this woman on a weekly basis. So the fact that she is trying to say that she somehow is doing therapeutic work

Evan Q 14:26

is

Melissa 14:26

so wild to me, and it shows, uh, the lack of recognition really of what her lane is. Mm-hmm. She is there to prescribe medications.

Evan Q 14:36

Right

Melissa 14:37

Period.

Evan Q 14:38

Right. Now she... Uh, obviously you have strong opinions.

Melissa 14:43

Well, the fact that she calls herself an expert too. I wanna s- We'll get

Evan Q 14:46

I wanna stay on this 'cause I think it's interesting. She diagnosed Lindsay with generalized anxiety disorder, which I think you and I discussed as

Melissa 14:55

I reacted

Evan Q 14:56

everyone that comes into the office It's

Melissa 14:58

literally

Evan Q 14:58

not. So

Melissa 15:00

everyone that comes into the office It's actually not. So everybody that comes into the office pretty much has some kind of adjustment disorder. They're adjusting to something.

Evan Q 15:06

adjusting to something Yes, she did

Melissa 15:08

It's actually far more rare to have somebody that actually meets criteria for something like generalized anxiety disorder, major depressive disorder, even post-traumatic stress disorder. You can have some trauma and have more of an acute stress disorder, but to, to legitimately meet criteria as it is in the DSM presently is more rare. And she knew Lindsay was coming in because she was struggling since she had a baby

Evan Q 15:39

Right. Now, y- interesting side note, you brought up the DSM. Correct. But psychiatrists don't really use the DSM,

Melissa 15:47

use the ICD-10, that's correct.

Evan Q 15:49

Is it the same document but with different names, or are there- It is not

Melissa 15:53

So the ICD-10 includes all medical diagnoses. I broke my finger. I have diabetes. It, it includes all of

Evan Q 16:03

Okay. So it's the doctor

Oversight Failures And Inpatient Denials

Evan Q 16:05

part of why they're a doctor.

Melissa 16:06

they're a doctor. Correct. The DSM is, uh, for mental health. Okay. So we do not have the vast... I mean, our book is probably that big. Mm-hmm. The ICD-10 is- Is much bigger much-

Evan Q 16:20

a volume set or something

Melissa 16:21

more exhaustive. Ours is specialized for us. Mm-hmm. So there are places where what the DSM calls a diagnosis, the ICD-10 actually calls something different. Okay. It's a

Evan Q 16:34

medicalized

Melissa 16:36

medicalized term for the same diagnosis. Okay. Um, there are places where we just recognize things differently. Sure. they come from a medical perspective, and we come from person in environment perspective. We look at things more holistically, which is also often, I do wanna give credit where credit is due, nurse practitioners, um, tend to also be a little more holistic, but we'll get into that as we-

Evan Q 17:05

Which is also often, I do wanna give credit where credit is due, nurse practitioners, um, tend to also be a little more holistic, but we'll get into that in a minute. We, we are actually going right to nurse practitioners. We are gonna come back to the, the coordination of care and, and some of the differences, because you've touched on a few things, the CBT, DBT, EMDR, that some of the listeners and the viewers may not be familiar with or aware of and, and I want you to, you know, go into a little bit more detail about why those things are important-

Melissa 17:28

Well, we don't want Ms. Dukes to feel left out We are

Evan Q 17:31

our bases

Melissa 17:31

Dukes We do not want her to feel left out of this

Evan Q 17:34

or feel left out. We are gonna cover Ms. Dukes. Do not want her to feel left out of this. Now, I want, uh, on this topic of nurse practitioners, and I wanna start with I'm not throwing shade at nurses here, from my perspective. Not at

Melissa 17:41

at all

Evan Q 17:42

Nurses are absolutely essential to healthcare, and some nurse practitioners have an enormous amount of experience, especially in the psychiatric field.

Melissa 17:50

And they're wildly important

Evan Q 17:52

And are wildly important. But I have to admit, from my perspective, and this is my perspective, not Melissa's, Melissa can speak for herself. But I have to admit, I feel uncomfortable with how much prescribing authority we've handed to psychiatric nurse practitioners. And here's where that discomfort really comes from. We're not talking about antibiotics for an ear infection here. We're talking about medications that can alter mood, cognition, sleep, anxiety, impulse control, emotional regulation. These are medications that are acting directly on the brain. Correct. And you're gonna talk about just how powerful those effects can be. At the same time, when I look at the educational pathways that a doctor, a psychiatric doctor takes versus a nurse practitioner, there's a pretty dramatic difference between them. A psychiatrist goes through medical school. You talked about this a minute ago. Uh, they have a four-year psychiatric residency, years of supervised exposure to complicated psychiatric disease. They understand medication management, differential diagnosis, medical conditions that can look psychiatric, drug interactions, crisis situation, uh, in-patient psychia- uh, psychiatry and, and so forth.

Melissa 19:03

I'm gonna totally jump in on this though, because, uh, I'm biting my tongue. This is why nurse practitioners are not licensed to practice independently. Right. They require the supervision of a psychiatrist.

Evan Q 19:16

Right. And, and a psychiatric NP can absolutely become highly experienced and have some decades of-

Melissa 19:23

but a psychiatrist still has to sign off on what they're doing

Evan Q 19:26

they're doing Yes, exactly. They, they, they have all, all this experience, but that level of, of experience isn't necessarily built into the minimum credential in the same way that psychiatrists do. So to your point, they still have to be signed off by someone

Melissa 19:39

So who was looking at this sTufts?

Evan Q 19:41

And so that's-- here's what I'm wrestling with, right? We have created a system where the authority to prescribe some incredibly powerful psychiatric medications can sometimes outpace the depth of medical and psychiatric training required to prescribe them.

Melissa 19:57

You know what I think about here too is primary care doctor is a, an MD- Yeah or a DO. Yeah. These are meds, at least around here, they won't prescribe. Yes. They will refer to a psychiatrist that specializes. So they would prescribe the Zoloft. We talked about this- Sure the other day. Yeah. They would prescribe the Zoloft or, or the Ritalin, that kind of sTufts. At the same time, They recognize this is, this is outside my specialty,

Evan Q 20:30

Mm-hmm.

Melissa 20:31

I need a psychiatrist. And then they'll often take back over care management when things are stabilized. But I'm asking myself, how the hell did this nurse practitioner

Evan Q 20:43

of them, by the way. Jollotta and Paul

Melissa 20:46

Not say, "This case is really complicated. I need help."

Evan Q 20:56

And that, and th- that's a great segue to my next question, right? Which is gonna be, when does a case bec- You've talked about the, the, the, uh, primary care physicians, PCPs, referring to psychiatrists. When does a case become complicated enough that medication management really ought to be driven by a psychiatrist rather than a nurse practitioner?

Melissa 21:16

When does the case become complicated enough that medication management really ought to be driven by a psychiatrist rather than a nurse practitioner? Well, again, I'm not the medical professional, but I would think when we're talking about suicidality or homicidal ideations or somebody who, h- honestly, when you've tried a few things and you're not getting anywhere, why are we still shooting darts at a dartboard and not saying, "This, this needs a higher level"? And, uh, quite honestly, as a clinician who is licensed to independently practice, I still seek out supervision. I still seek out consultation when I have a case that feels complicated and say, "What am I missing here?"

Evan Q 21:56

Yeah.

Melissa 21:57

So why didn't they do that blows my mind because if nothing else, you should be considering the fact that this is your license on the line.

Evan Q 22:05

the line. I, I, I mean, I agree with you. There's a, there's a couple things here that, that are coming to mind as well. So, a- and this is interesting about this case, and I would like your take on it. So we talked about the importance of the psychiatrist in this. We've talked about, um, the, the nurse practitioners and the potential for them to be, uh, maybe under-credentialed or under-experienced and, uh, or, or just have a, a limited fund of knowledge. I think- All that time too. But- Well, it's not, it's not that they're under-experienced or under-trained or anything for their role. Sure. It's that

Melissa 22:41

Just have a a limited fund of knowledge Oh, that term too But- Well, it's not, it's not that they are under experienced or under-trained or anything for their role Sure it's that in a large setting like that, they are pushed to go outside of what their role should be- Yeah

Evan Q 22:49

Yeah.

Melissa 22:50

because it's more money in the door. Yeah. More people seen, more money in the door.

Evan Q 22:55

and you, you know, you touched on something earlier when you said, "This is not my area of expertise," talking about the perinatal, postnatal,

Melissa 23:02

Sure

Evan Q 23:03

Sure services. Well, let me just touch a little bit on the certifications of these nurse practitioners that they, that they did have. So Jollotta, the, the primary nurse practitioner who took over for Paul 'cause Paul moved on to a different role.

Melissa 23:15

Oh, I thought Paul was at a different practice and was a secondary consultation

Evan Q 23:18

a different practice and was a secondary consultation. No, Julie Paul was the referral from, uh, the mother-in-law, and then she moved into another role and, and in- couldn't provide that level of care to, to Lindsay, so she pushed her over to Jollotta. But I wanna get into these certifications 'cause they're interesting. Jollotta is a PSI cer- is PSI certified in perinatal

What Psychiatrists Do Versus Therapists

Evan Q 23:40

mental health and had treated postpartum psychosis before. Uh, Julie Paul is board certified as a PMHNP and a certified nurse midwife who built the program at, um, South Shore Hospital.

Melissa 23:56

And that's different than Aster, right?

Evan Q 23:58

Yes. Astor is where Tuftss and, um, uh, the The- uh, Leticia Dukes were. And Leticia Dukes and, uh, Alia Goodhart, who was the psychiatrist at the, um, at the mental health, the McLean Hospital, where she went for the in-patient stay, neither of them had ever seen postpartum psychosis cases. So- I do think it's important-

Melissa 24:24

it's important to note too here, uh, and we are gonna jump into where you're headed, that we're talking about two different organizations too. Correct. And care going on from both- at the same time. Yeah. Yeah. it's... it's... That's, again-

Evan Q 24:38

place where I feel like the complicated s- structure of this, who's paying attention to all of it, right? 'Cause you've got a patient with severe insomnia, suicidal thinking, possible bipolar symptoms, multiple psychiatric medications being started and stopped, multiple prescribers, questions about side effects, worries, anxiety about side effects, a rapidly changing clinical picture. Every time she takes a new medication, there's some new thing going on, and that's not to say she's done anything wrong, meaning the patient. She's reporting what she's feeling.

Melissa 25:12

Have we figured out if Astor is connected to South Shore?

Evan Q 25:16

I think they may be in the same area, but Astor Mental Health is like the clinic, the place where she was going for, trying to go for regular assistance. And South Shore was like the crisis hospital, ER, emergency room that they went to.

Melissa 25:30

So Jollotta was more of the crisis provider- Correct that was not coordinating care with the regular provider.

Evan Q 25:41

we actually got something wrong and I wanna back up and clear it up. So Tuftss referred her to Jennifer... mcLean. No, it wasn't McLean, it was McAllister. McAllister. Jennifer McAllister inside the Astor practice. The reason why we've got this wrong is that the, the, the prosecution has not yet called Jennifer McAllister to testify. Correct. Jollotta

Melissa 26:03

Jilada

Evan Q 26:03

and Paul at South Shore Hospital work with Leticia Dukes. So she's the crisis counselor.

Melissa 26:12

That was trying to get her in with a therapist when she already had one, 'cause that was in December

Evan Q 26:16

trying to get her into the women and infants program so that she would have a day place to go with her baby.

Melissa 26:22

I thought she also referred for outpatient. She-

Evan Q 26:24

she also referred for outpatient. She- When

Melissa 26:25

apparently she already had an outpatient

Evan Q 26:26

was tr- yeah, she was, she's referring everywhere.

Melissa 26:29

she was, she's referring everywhere. She is. 'Cause she said at one point that she was the, the- Like crossover care

Evan Q 26:38

the crossover care. At what point do you say, like, "This has exceeded routine medication management and we need a physician specialist in the room rather than a nurse practitioner and a, you know, a crisis counselor"? And, and is our mental health system actually designed to make that escalation happen or have we normalized psychiatric NPs functioning as substitutes for psychiatrists because psychiatrists are expensive and scarce and difficult to

Melissa 27:06

hard to get. They're difficult to access because of complexity of care. Right. It is so hard, at least in our area, you could wait a year to get in with a psychiatrist. Yeah.

Evan Q 27:18

get in with a psychiatrist. Yeah.

Melissa 27:20

And so people are going to other places, and this is where mistakes happen. Yeah.

Evan Q 27:25

You are

Melissa 27:26

There's no continuity.

Evan Q 27:29

going to other places, and this is where mistakes happen Yeah. Yeah. I- No continuity I just, I'm at a place where, you know, it feels to me, again, I'm a layperson. I'm a technologist and a business guy and not a clinical operator, but I just see doctor after doctor after doctor throwing meds at this woman who is begging them to help her get off the meds because of their side effects. And I know psychiatrists are the med people, but, like, shouldn't they, like, I don't know, be more careful

Melissa 27:52

Well, and believe me, I understand our hospitals these days are very anti keeping people, right? It's not an emergency, so out the door you go, here's some drugs. And yet, when this person is a-

Evan Q 28:06

own thoughts on too, but

Melissa 28:07

Yeah, my own mom's one too, right? Same. But when this person is coming back repeatedly to your facility, your hospital, saying, "Nothing is working. I am deteriorating," how are you not putting her in an inpatient setting, if for no other reason than to keep her for two weeks and figure them beds out?

Evan Q 28:30

when this person is coming back repeatedly to your facility, your hospital, saying, "Nothing is working. I am deteriorating," how are you not putting her in an inpatient setting if for no other reason than to keep her for two weeks and figure the meds

Melissa 28:32

personally, we've seen- We have seen this happen

Evan Q 28:34

So I don't know, I don't understand why it's not done, especially when you're dealing with, with a mother with young children. Uh, it, it just, it's, it's wild to me.

Melissa 28:43

Because nobody actually cared about the safety of those kids, that's why

Evan Q 28:47

So we've spent a lot of- Lindsay.

Melissa 28:50

Right Except Lindsay

Evan Q 28:51

Except Lindsay. W- which might sound interesting to you, but as we w- you know, if you go through the trial and as you look at some of the evidence and as we talk about things here, you'll understand that she, she was actually advocating for herself and for her kids,

Melissa 29:06

She tried.

Evan Q 29:07

being heard.

Melissa 29:08

She tried

Evan Q 29:09

She tried. We, we have talked a lot about meds, and we're going to hear a lot about meds whenever we talk about mental health. Lindsay Clancy was prescribed 13 different medications in multiple combinations over the course of five months, from September of '22 through January of 2023. The psychiatrists. There's a lot of focus on the psychiatrists. Um, I know that we can't go into all the individual medications, but, but suffice to say, of the medications that I listed earlier, a lot of them are, are very powerful

Melissa 29:39

heavy hitters. Those are

Evan Q 29:40

Those are heavy duty. I, I think we talked about at least one or two of them being a step below lithium at this point. Like, we're very close to-

Melissa 29:47

least one or two of them being a step below lithium at this point. Like we're very close to- I mean, we're talking serious, like don't drive on these Right Extreme drowsiness, lethargy

Evan Q 29:52

Yeah. And-

Melissa 29:52

Mood issues And

Evan Q 29:54

are asking, "Well, why is she doing me- uh, telehealth appointments?" Well, because she's got three kids, and she can't drive because she can barely walk and function, right? Like- Right I, yeah, I get that. They're-

Melissa 30:03

she's becoming a zombie

Evan Q 30:04

But meds are really just one part of the treatment process, right? We've spent a lot of time so far talking about psychiatrists, and honestly, we've barely scratched the surface of that discussion because there were so many involved in Lindsay's treatment. But I wanna shift gears to the therapists that were involved in Lindsay's treatment, if you can call it that.

Melissa 30:24

Well, we only know about one so far I'm

Evan Q 30:25

little skeptical here. Um, we heard in Dr. Tufts's testimony that Lindsay was referred to a therapist who was then practicing inside of Astor Mental Health practice. Uh, that's Jennifer McAllister. Interestingly, she's yet to be called to testify in the proceedings by the prosecution,

Melissa 30:42

Which does tell me a lot

Evan Q 30:43

tell me a lot frankly, I would have expected that to have happened by now. And so if they were planning to have her testify, some of her records were already discussed. I would have thought that she would have been called in order

Nurse Practitioners And Escalation Triggers

Melissa 30:55

of Jennifer Tufts the

Evan Q 30:56

that, right? Yeah. Jennifer Tufts went

Melissa 30:58

The things that she was documenting- Sure were contradictive to the care that was being given by psychiatry. Right. It was very clear that she had not read the notes.

Evan Q 31:09

was very clear that she had not read- It's quite interesting to me. Um, and I found that odd, but, um, I mean, unfortunately we can't really get into too much around her because she hasn't testified yet, so- Right you know, stay tuned

Melissa 31:18

But we can talk about Dukes

Evan Q 31:20

tuned for a future episode if and when she does testify to find out your, Melissa's thoughts on the clinical approach. That being said, we have heard, as you pointed out, from a counselor at South Shore Hospital Perinatal Program, who met with Lindsay while she was working with Nurse Jollotta and Nurse Paul. Her name's Leticia Dukes. Similar to Dr. Tufts's, I know you have some strong feelings and thoughts about Leticia, a mental health counselor, uh, who was, who testified as to her treatment, um, of Lindsay during the month of December. So give us your take.

Melissa 31:56

Well, you know I was texting you as I was watching her testimony Yeah going, "What in the world is happening here?" And so I, I just... I'm gonna overview my credentials real quick. Yes. I am a LCSW in the state of Pennsylvania. That is a licensed clinical social worker who has gone through the 3,000 hours of clinical work plus the supervision, and I am licensed to practice independently. Aside from that, I am a certified, um, clinical trauma professional. I am a certified prov- certified provider, not trained provider, in eye movement desensitization and reprocessing, or what we call EMDR. I am certified as a narcissistic abuse treatment clinician, uh, and I am DOT,

Evan Q 32:48

DOT, uh,

Melissa 32:49

uh, SAP, substance abuse professional. I feel like I'm missing a credential in there, but I can't remember. Um, and the reason that

Evan Q 32:58

She has a lot of letters at the end of her name, folks

Melissa 33:00

A lot of letters and, and that I don't typically point out to people, but here's why I'm pointing it out. Because in order to be certified in EMDR, I had to go through approximately 40 hours of EMDR-specific training. It was in a small group. I think there were 15 of us. It included, um, like, on-site practice that was supervised. Um, on top of that, we had to complete, I believe it was 32 hours of trauma-specific training. Um, we had to go through 10 hours of consultation on EMDR cases. I had to submit two recordings for review by my trainer. We had to read two additional books on EMDR practices. We are not talking about a short process. Right.

Evan Q 33:49

Is there a reason why that process is so long for the EMDR work?

Melissa 33:53

Because we're messing with people's brains. We're messing with the wiring, and when it is done incorrectly, that is when there are concerns about introducing false information, leading people down bad paths. Uh, you can do serious harm to clients when they are not well prepared for that work, when they don't have the appropriate, uh, we call them resourcing skills, but regulation. Uh, they're not prepared for the fallout that can happen after a session. If you don't keep them within the window of tolerance, they can just start to fall apart, and, and you're talking about major, major risks for that client. Now, what I see a lot in our area is everybody says they're trained. They're trained in EMDR. Well, what does training mean? Training could mean that you attended a two-day, 12-hour training on what is EMDR. Well, now I'm trained, and I'm gonna go say that I do EMDR, but I don't know what I'm doing, but I don't even know that I don't know what I'm doing.

Evan Q 35:05

Right.

Melissa 35:06

And I'm opening up things, and I get clients at my practice regularly that say, "Well, I did EMDR, but I, I don't think it worked," or, "I had a really bad response to it." And then I start to ask the questions. And you know what I find out? Nine times out of 10, they were, they were trained.

Evan Q 35:27

trained clinicians.

Melissa 35:27

They were trained. They were minimally, incompetently trained and decided, "I'm gonna market myself as an expert," which wait a second, isn't that the same thing Jennifer Tufts said? She was an expert after she had spent a month there. That does not make you an expert. Then she tried to say, "Well, it depends on how you define an expert."

Evan Q 35:46

Mm-hmm.

Melissa 35:48

Whole separate issue there. But that is why I want people to know, and this is just for everybody listening, if you are looking to do something that will mess with your brain, like EMDR, brainspotting is another one, find out the qualifications of that provider. Ask if they are trained or if they are certified, and what that process looked like, because clients don't know. They don't know that there's a difference. They don't know the questions to ask. It is our job, part of... We t- they talked about informed consent. What is informed consent? It is part of informed consent that that client understands what your qualifications are or are not, and what it took to get those, so that they understand the quality of care that they're getting. I don't know how I went off on that tangent, but I will let you refocus

Evan Q 36:39

to get those- Yep so that they understand the quality of care that they're getting. I don't know how I went off on that tangent, but I will- No, I, I, it's great that you went there because it's really important, and I, and I'm gonna go back to, um, when we talk about EMDR, I'm assuming that's a process that you want to be well-informed of your client about. It's, it's something that you don't necessarily perform on visit one. It's not a short-term thing that you do?

Melissa 37:01

It's very different if you're looking at somebody got into a car accident. It may be very short term. We're talking maybe six sessions of EMDR work. It's very quick to prep for, very, uh, I hate to use the word easy, but very easy to implement and rewire the brain very quickly. When we are talking about, again, not a postpartum professional, postpartum though is more complicated than a car accident.

Evan Q 37:27

Right.

Melissa 37:28

And there's lots of hormones and

Evan Q 37:32

and neurotransmitters

Melissa 37:33

neurotransmitters at play, not like a car accident. So when Latisha Dukes mentioned she saw the client, she saw Lindsay for four sessions, but did CBT, DBT, and EMDR all in 30-minute sessions, I went, "What in the world are you doing and how incompetent are you?" 'Cause she could have opened something up unintentionally- Mm-hmm and made that entire situation worse, and why, as a crisis person, are you even touching EMDR? Right.

Evan Q 38:11

Right.

Melissa 38:12

Unless it's to very quickly try to bring somebody down, which again, if they don't have the resourcing, if they don't have the other... Uh, this woman was over-medicated, and EMDR is contraindicated with clients that are on many of those meds.

Evan Q 38:28

Okay. Can you talk about what that means for the layperson who might be listening?

Melissa 38:32

Sure. So if you're on medications like Seroquel, Lamictal, r- Remeron, the way they interact with your brain chemistry, the way they override things, prevents EM- for us from accessing the areas of the brain that we need to to do the EMDR work. Right. So unless she was using a basic tapping approach just to help Lindsay calm down and ground and re-regulate, never talked about that. She never explained how she was utilizing it, which leaves everybody questioning, everybody hopefully that has an EMDR certification questioning, what in the world were you doing? I wanted to touch on that a

Evan Q 39:13

bit because I feel like we spent a lot of time in this trial listening to medications

EMDR Credentials And Therapy Quality

Evan Q 39:20

that were prescribed and when dosages were changed and all of those things, and that's certainly important. But we didn't see- hear a lot of is the details around the therapy. We heard about timelines. We heard about the intake process in person, one hour. We heard telehealth, 30 minutes. Patrick was there. They talked about, you know, the way she was feeling, and they talked about her medicine in- impacting. There was a lot of focus on these calls even about medicine, even though, you know, Dukes can't handle medicine, right? She's like, "Okay, well maybe she needs a higher level of care," which, you know, fine.

Melissa 39:55

did Yeah, right

Evan Q 39:56

She really did. Yeah, fine. And then she

Melissa 39:57

And then she was turned away from

Evan Q 39:58

when she went to the higher level of care in, in, uh, women's and infants, you know, she was turned away, to your point, because she was overmedicated, they said.

Melissa 40:06

they said. Right. So- So why didn't they hospitalize her to get off the meds so that she could go back to that program?

Evan Q 40:12

Right. So there, there's that. Um, but, but in addition to that, why do we spend so... And, and this is if you, if you've watched other trials that have involved mental health, I- it's... I've been struck just there was the, the, the was she in Colorado, the mom that killed the- Stepchild the stepchild and then drove the body to Florida and disposed of it. Um, there's been other, you know, uh, killers along the way, Casey Anthony, all the rest of them, right? So when you look at these cases, there's a lot of focus on the medication, the medication, medication. And fair point, right? Fair play. We've talked about how dangerous it is. But what I don't hear in these cases, a real in-depth understanding of the therapy that's involved in it. And I think it's important that we spend a little bit of time on that because we don't hear about it from, from the, the defense side or the prosecution side. What do they actually do? When we talk about CBT, DBT, EMDR, what is actually going on in these sessions? What are you getting down to? And I think one of the things that you have surfaced in these views is like, "Okay, great. You say you did that on that date. What did you do?" What did you actually do?

Melissa 41:24

you actually

Evan Q 41:25

What did you actually ask her? And when Leticia Dukes was being asked those questions by the defense, "What did you actually ask her?" "I have to refer to my notes." If that's all you got is notes- Right one has to ask how invested you are in your clients.

Melissa 41:39

Agreed.

Evan Q 41:41

and and I, I've asked you, I've asked other, uh, clinicians at this practice, if something like this occurred, if you had a, a former patient who you had maybe recently helped, and I know we're in 2026 now, but I mean, this happened in 2023, and I feel like when it happened, anybody that was affiliated with her or had been... They're in the local area. Wouldn't that turn you into like, "Let me go back to my notes and think about what did I do?" What did I do wrong? What did I miss? Yeah. Yeah. Heather said that the other day. What did I miss?

Melissa 42:15

You're in the local area. Wouldn't that turn you into like, let me go back to my notes and think about what- What I did wrong. What did I miss? Yeah. Heather said that the other day. Right. What did I miss? What did I miss? And I would be poring through every interaction with that client going, "Where did I go wrong?"

Evan Q 42:24

Yeah. I mean, you almost wouldn't even need your notes on the

Melissa 42:27

Yeah. I mean, you almost

Evan Q 42:27

you would know it, right? Mm-hmm.

Melissa 42:29

You would know it, right?

Evan Q 42:30

I

Melissa 42:30

Absolutely. And It tells me that they're trying to cover their own asses, and as I understand, there's also another lawsuit by Patrick toward all of the providers- Mm ...for what they didn't do, how they did not help his wife. Yeah. I mean, we're talking like a multimillion-dollar lawsuit happening. Yeah. So my sense says they are in cover your ass mode- Yeah and don't want to admit to anything they did or didn't do at this point. 'Cause everything from this trial will be used in that civil suit.

Evan Q 43:02

And on the, on the concept or the, the, the premise of, you know, notes and what's in it, um, there's been several times where both psychiatrists and therapists throughout the case have talked about sh- the client indicated. And what we found

Melissa 43:22

How did they indicate

Evan Q 43:23

the indication process, right, exactly, uh, is they, they can't say whether she said it out loud, what words she used. Fine. I get you don't remember conversations that happened three years ago necessarily, although again, in this case you might surface some of those things. But what we found out is the indication is actually happening on a medical form. Right. A screener.

Melissa 43:47

screener Which different people interpret different ways Right And, uh, both on the client side and the clinician side And so as-

Evan Q 43:56

somebody answers questions on a screener, do you review those questions? I

Melissa 43:59

I do, and I ask questions about

Evan Q 44:00

Okay. So if somebody put down there, for example, that, um, you know, they were able to smile and laugh now after a period of,

Melissa 44:08

Say, "That's an improvement. Great. Can you tell me more about that? Where, you know, u- under what circumstances were you able to smile and laugh?" And you know what tends to happen is, "Oh, well, I don't know if I can think of any."

Evan Q 44:26

Right

Melissa 44:27

Or, "Well, my baby laughed for the first time, and I smiled."

Evan Q 44:32

Mm-hmm

Melissa 44:32

But if we're not asking the question, are we thinking that it's happening, like, magically they're fixed? Right. I have a magic wand, apparently. The meds worked. The meds are, they're magically working when they haven't been, and that's where it's like somebody took this one shred, didn't investigate it, and was like, "Okay, things are better now." Right.

Evan Q 44:51

Right

Melissa 44:51

And they weren't. Nobody took the time to look into it. Now, I will say on, on behalf of Ms. Dukes, she's a crisis provider.

Evan Q 45:01

a crisis provider. Mm-hmm.

Melissa 45:01

They are not-

Evan Q 45:02

That very different from a- It is.

Melissa 45:05

We go in depth. They are much like the ER at the hospital. How do I try to make this woman safe and get her to a h- a better level of care? She really is crisis. That's why they're 30-minute sessions. Um, actually a lot of doctor's offices around here have a clinician on staff, but they're 30-minute appointments, and then they try to find you a regular clinician. They're, they're filling the gap, basically. What I don't understand, though, is the fact that she already had a clinician. Yeah.

Evan Q 45:35

Yeah.

Melissa 45:36

So what gap were we filling?

Evan Q 45:38

That's a great question. And without the testimony of that clinician, we don't really know, right? Um, it's, it's interesting. Um- L- so Dukes also testified that she saw no mania, delusions, paranoia, psychosis, and had no concerns about her physical wellbeing or the wellbeing of others in her presence. And one of the things that we also, we, we were discussing this the other day, had, had sort of brought up, and I'd like your thoughts on it. Um, is it... And I know psychiatrists call them patients, you call them clients. I'll just, you know, call them people. Fine. When people come into the office, do they always present exactly the way that their symptoms actually are?

Melissa 46:24

They don't. And also, Duke saw her four times between December 2nd and December 19th, and this situation didn't happen till January 24th. So there's a lot that could change in a month

Evan Q 46:36

Especially with all those medications changing in that period

Melissa 46:39

Correct. So the fact that she didn't pick up on any of that, which as a crisis provider, I wouldn't think that she would be a little more adept at picking up on those things because she's looking for crisis-y kind of symptoms. Um- So, and, and let me ask you this

Evan Q 46:58

to sort of build on that, right? So everybody has said she never su- suggested that she was going to hurt herself or others. She always... She answered this on the form. She answered that on the form that, you know. Is there, are there times where you don't just take their word for it about whether they're having, you know, if they're having, say, suicidal thoughts or suicidal ideations, is there a time where you say, "I have to dig deeper into this because she says she's not gonna hurt herself or the kids. She says she doesn't have a plan, so I'm not gonna refer her to inpatient." Is, or, uh, yeah, inpatient. Is there a place where or a time where you as a clinician go, "I am not taking your word for it. You've shown me too many signs that I think the inpatient is the referral I need to

Melissa 47:44

I think there's two different pieces to this. Yes, we call those smoke cases, where there's so much smoke that you know that they're imminent risk of snapping. Yes,

Evan Q 47:55

Even if they say, "No, I don't have any plans."

Melissa 47:57

have any plans." The problem isn't us trying to get the person the care. The problem is the inpatient facilities, that if the client

Screeners Risk Assessments And Crisis Care

Melissa 48:05

is unwilling, we can't get them... We call it a 302 here in Pennsylvania. Yes. I think they call it Section 12 up in Massachusetts, but it's an involuntary, um-

Evan Q 48:17

An involuntary

Melissa 48:18

commitment commitment. Thank you. That's the word I was looking for.

Evan Q 48:20

Thank you. That's the word I was looking for. Yep.

Melissa 48:21

It is very hard to get one, at least in our state, and unless somebody is expressing an active plan with intent, we won't get it. Right. And then we know that they're a risk, and this is similar to what happened when the military guy... Was that up in... It was somewhere up north. Maine, Boston, I can't remember. It was a couple years ago, that the guy-

Evan Q 48:43

shooter?

Melissa 48:43

The school shooter? No, the guy in the military, um, the wife kept on telling everybody, "He's a risk, he's a risk, he's a risk. He needs more health or more help." And then he went to the bowling alley and shot up her and, like, everybody else. Mm-hmm. And it was a failure of the system because the question is, do we have the right to take away this person's freedom? Except in Lindsay's case, she was begging them. And that's the other piece of this, is we wanna say, well, you know, she wasn't reporting these suicidal ideations or homicidal ideations or plan, and yet she was telling people from September that she had these thoughts and feelings, and nobody is listening to her. And how long do we keep repeating ourselves without just going, "What's the point? Nobody believes me anyway." The vulnerability it takes as a mother to say, "I am having these thoughts," and then to have somebody not believe you or downplay them or say you don't get the help, I, that's... I can't imagine.

Evan Q 49:53

Yeah. I can't help but wonder how much of this is the vacuum that we've created, and I, and this is kinda where I wanna go now. I wanna talk about the cooperation between providers and treatment, right? I would like to think that professionals treating the same person would wanna stay informed, um, with their updated treatment of their patients and clients, but I know from talking with you that there are times when you need to start with fresh eyes. Can you walk me through the way an ideal holistic mental health treatment system looks? What does that look like?

Melissa 50:29

Well, it depends on where it starts, right? So we've talked about the fact that if a client comes in to see me, I don't necessarily read all the intake paperwork. I know the gist of it because I want to get to know my client and build a relationship with my client before I go in and read through all of those things. If I have a client coming to me from a medical setting, I am darn well gonna pore through that discharge summary and talk to the referring provider there before I even agree to take the client to make sure that it's a good fit and that it's within my wheelhouse

Evan Q 51:03

I even agree to take the client to make sure that it's a good fit and that it's within my wheelhouse. Right. Dukes testifies she never reviewed Nurse Paul or Jollotta's notes. Same clinic, same program, same patient.

Melissa 51:11

Which in a crisis scenario makes zero sense Right Zero

Evan Q 51:16

Well on redirect, the prosecutor asked her why, and her answer was that she wanted a fresh set of eyes to assess the situation herself, and that this is typical practice.

Melissa 51:25

after session one, you go read those notes then

Evan Q 51:28

Okay. I was gonna say make the case for fresh eyes when- You

Melissa 51:32

your fresh

Evan Q 51:32

have your fresh

Melissa 51:33

Now you go read

Evan Q 51:34

go back and read them, right? And

Melissa 51:36

and you coordinate with the other

Evan Q 51:38

did I miss that I didn't see, right? Yep.

Melissa 51:40

is what I didn't see, right? Yep.

Evan Q 51:41

This patient had four active psychotropics and passive suicidal ideations. So is... That's at the point where, like you're saying, you go back and read what people are doing here, right? Like this...

Melissa 51:53

And you say this is a risk. We are putting, we're putting ourselves at risk. We're putting this mother at risk

Evan Q 52:04

And I wanna go into another topic here. And I know that clinicians, therapists, you're not prescribers, right? But-

Melissa 52:13

I feel like I'm on the stand. Correct

Evan Q 52:14

I feel like I'm on the stand. Correct. But I, I have mentioned this, and I want, uh, you know, to sort of put this out there. I think good clinicians at least get a sense of the medicines that are out there and

Melissa 52:26

Oh, absolutely. The psychotropics,

Evan Q 52:28

Especially the psychotropics, right? Dukes testified that the medication list in her notes is prefilled by the clinical system, and she didn't know what was actually prescribed or what was active. And, and, and my question is that, i- is that a sign of a good clinician versus bad clinician?

Melissa 52:47

No. Even in our first sessions, it's, "Okay, what meds are you cr- actively taking?"

Evan Q 52:52

it's, "Okay, what meds are you cr- actively taking?" And so, yeah. So someone-- A clinician that doesn't know what you're on is-

Melissa 52:57

missing a huge piece of your puzzle

Evan Q 53:01

Is there a, a version of this where you get a fresh assessment and then somebody still holds the whole record? There's somebody looking over this? I... That's what Tufts said. She said, "I am in charge. The psychiatrist is in charge of the entire component here." Should not have the nurse practitioners been saying, "Okay, we see the therapy notes, and we need to talk"?

Melissa 53:21

and we need to talk" I wanna know who was overseeing Jollotta.

Evan Q 53:24

Yeah.

Melissa 53:25

I w- they haven't called her either, her or him, but she's a nurse practitioner. Who was overseeing her?

Evan Q 53:32

Yeah.

Melissa 53:34

So,

Evan Q 53:36

Tuftss didn't obtain, uh, outside records and was unaware of the two Crisis Line contacts. Jollotta never spoke with Tufts, didn't have her records, never contacted Women's and Infants.

Melissa 53:47

Although didn't somebody try to leave Jollotta a message and Jollotta never res- returned the call?

Evan Q 53:52

That was Women and Infants apparently called her.

Melissa 53:55

women and infants apparently called her. Oh, and they never, she never called them back- She never

Evan Q 53:56

never called them back is

Melissa 53:58

to coordinate care

Evan Q 53:59

testified to. Yes, to coordinate

Melissa 54:01

she never got a phone call, she said. Right. Right.

Evan Q 54:03

Never obtained McLean's records after the inpatient stay while agreeing that the diagnosis and treatment would matter to her- Right if she'd have gotten that. Dukes didn't know about the December 15th Mass General ER visit that the, uh, that the Clancy's had. Dukes referred a patient who's already been referred four days earlier by an ER she'd never heard from to the same program. So there's two referrals, active referrals going on there, which I know not a lot about the clinical side, but I do know the operational side. When you see two versions of something, that's gonna cause a delay 'cause somebody's gotta figure out which one it

Melissa 54:37

Oh, I didn't even think about that

Evan Q 54:38

Right. Um, Dukes didn't know that Women and Influence, uh, uh, Influence rather, concluded on December 20th that Lindsay didn't qualify. Well,

Melissa 54:47

she didn't see her anymore after the

Evan Q 54:48

that it was... Exactly. Didn't know that it was because of medication, you know, o-over, being overmedicated. You have two integrated teams with Astor on one side with a therapist and a, and a, and a psychiatrist. You have South Shore that has nurse practitioners/psychiatric nurses and therapists.

Melissa 55:05

And you have a woman who's not stable, and somebody else

What Real Care Coordination Looks Like

Melissa 55:10

should've been stepping in and advocating for her too, and making sure that coordination was happening Right That would've been her husband's role

Evan Q 55:18

Right.

Melissa 55:19

I don't know what he was doing

Evan Q 55:20

I don't know what he was doing. Uh, uh, but by all accounts in the testimony, he attended some of these telehealths and talked about the medications. Right. And, you know, uh, uh, I- they can't tell you exactly what he said, although when we talked, you would've remembered what a third party that was invited to the meetings

Melissa 55:38

Especially if it was outside the norm

Evan Q 55:40

Usually if it was outside the norm. Right, if it was not normal. What is a closed-roup referral, closed-loop referral? Have you ever heard of that?

Melissa 55:47

I haven't

Evan Q 55:48

Okay. Um, a patient voluntary admits herself to an inpatient psychiatry. Right. Okay? Who obtains the discharge diagnosis and medication re-reconciliation before outpatient prescribing resumes? Like, who... Is there a, is there a, s- like-

Melissa 56:05

The facility should be setting up the discharge care

Evan Q 56:08

The

Melissa 56:09

And then they should be sending the discharge resource the discharge documents.

Evan Q 56:12

Exactly, and that's kinda where I was going with this, is that somebody at McLean, right? Yes. Had to know she was seeing Tuftss- at least, if not also Jollotta

Melissa 56:23

Gelada.

Evan Q 56:23

and

Melissa 56:24

would've been the discharge

Evan Q 56:25

And the discharge resource. And the discharge resource should've been sent the paperwork. Correct. And it's not on the, it's not on the patient to do that, right? No. We don't, we don't hand

Melissa 56:32

the medical- So-

Evan Q 56:33

paperwork- She would've- and say, "Make sure this gets delivered."

Melissa 56:35

would've needed to sign a release for all of that to be sent to Tuftss. And I would think if McLean is competent, they would say, "Who's your provider? We need to set up aftercare. Can you sign this release?" Because they're all saying she was able to do this sTufts, so sign the release here for us to send all of that so that they're up to date on things.

Evan Q 56:59

Right. At the top of this episode, I asked you whether psychiatrists and therapists have different roles. You said they do.

Melissa 57:10

Absolutely.

Evan Q 57:11

this case, did anybody have the role of holding the entire thing?

Melissa 57:15

Well, they say the psychiatrist did, which lays a lot of liability on the psychiatrist's hands

Evan Q 57:20

Mm-hmm But But

Melissa 57:24

did anybody

Evan Q 57:24

also have

Melissa 57:25

do it? We all sound like nitrous going. Right I didn't do it.

Evan Q 57:26

going. Right. I didn't do it

Melissa 57:28

So no, nobody was actually coordinating this woman's care, and honestly, the average person, I mean, I've had to advocate for our kids a lot. Yes. And I'm a social worker, so I'm a trained advocate, and I can't imagine the average person trying to navigate these things. Now, I mean, one benefit Lindsay had is at least she somewhat knew the system. I mean, she knew the, the labor and delivery side of the system, not the mental health side of the system, but no person should have to advocate this hard for help

Evan Q 58:04

Yeah.

Melissa 58:06

And then we have outcomes like this

Evan Q 58:08

So sad. One more question for you. What in this trial record, this, you know, bubble that we've seen so far, what, what parts of this could have happened here in your practice?

Melissa 58:22

Oh. Well, we don't have psychiatry.

Evan Q 58:27

Fair. You do work with psychiatrists

Melissa 58:29

but there are reasons that we don't have psychiatry here. We refer out, and we keep things separate

Evan Q 58:35

love to hear your reasons

Melissa 58:37

Um, because it is, and you learned this when we were working on our paperwork for, um, Medicaid.

Evan Q 58:45

Mm-hmm

Melissa 58:47

Psychiatrists, at least in Pennsylvania, have an unlimited number of unlicensed clinicians whose work they can supervise

Evan Q 59:01

Yeah.

Melissa 59:01

Unlimited. So-

Evan Q 59:05

Lots of things get miss- mixed when you, or missed when you have that many Lots

Melissa 59:13

is a recipe for disaster.

Evan Q 59:16

of things get missed. And it is a recipe for disaster. Mm-hmm.

Melissa 59:17

it's my gut intuition that that's exactly what happened here, is we have people supervising other staff and are just trusting them to do what they're supposed to do, and we're signing off on sTufts. We are asking providers to do far too much in not enough time for not enough money, and it is sacrificing the quality for the quantity, and that's people's pockets. And we refuse to do that here

Evan Q 59:48

So aside from the psychiatrist piece at Heart for Change

Melissa 59:53

We put quality above quantity

Evan Q 59:55

What,

Melissa 59:56

What, uh

Evan Q 59:57

N- none of the other misses would've happened, right? There, there wouldn't have been a lack of, of collaboration of care or coordination of care. There wouldn't have been, um, untrained or uncertified people utilizing, you know, uh, modalities that they don't fully understand or...

Melissa 1:00:17

strict on that. We're strict on becoming an expert, an actual expert in your area and doing what you do and doing it really well and consulting with others that are also practicing in that area. So we do a lot of consultation, a lot of supervision. We look at things from a lot of different angles, and we don't hesitate to say, "What am I missing here? Let me get fresh eyes in here on it." Absolutely. So we would have reached out for additional help, and if we are seeing sTufts like that, we're on the phone with that psychiatrist

Evan Q 1:00:57

Uh, yeah. And I think that's the difference, right? Is that there's, there's active collaboration

Melissa 1:01:02

Or we're pushing harder for those inpatient stays

Evan Q 1:01:06

Yeah.

Melissa 1:01:08

Well,

Evan Q 1:01:08

the Commonwealth hasn't rested. The defense hasn't called a witness yet. Jennifer McAllister hasn't testified. Um, there's a motion pending about a McLean social worker who says what the jury has heard about the hospital isn't true, uh, and wants to talk about that. There, there's been, you know, some, some rumors

Crisis Resources And Closing Thoughts

Evan Q 1:01:25

that maybe the hospital's not as, um not all it's cracked up to be. It's not as great as they're suggesting it is. Uh, we'll be back when all that sTufts plays out, but here's where we are after 12 days of trial. There's an enormous amount of mental health care in this case. There's almost no coordinated mental health care in this case. And everybody treated a piece of her, but nobody was treating the entire patient. Um, for those of you who are listening that might be going through crisis, I wanna give you some basic information here. The Postpartum Support International or PSI, uh, crisis line, 1-800-944-4773. The National Maternal Mental Health Hotline, 1-833-852-6262. 988 Suicide and Crisis Lifeline. These are s- resources, support that you can contact if you're ever in these kinds of situations. God forbid that ever be the case. Um, but we want you safe. We want you secure. Um,

Melissa 1:02:31

You want your kids safe

Evan Q 1:02:32

And your kids safe. Let's move it. We want your kids safe. We will, uh, we'll see you next time.