SUICIDE AND ALTRUISTIC FILICIDE — 6:34:18
 
JENNIFER SPRAGUE:
And um if we could go to the the next slide, I think um if you could describe for us the evidence that you saw for suicide combined with altruistic filicide.
 
DR. KIRK HEILBRUN:
Yeah, altruistic filicide is a term that's used that means killing your kids out of love. Not because you're trying to be uh cruel or for material gain or because you want them out of your lives or any of that, but killing them out of love so that you could uh basically um they wouldn't have to suffer, so you could prevent their suffering. Uh, and what she did, I thought, was begin with what I said a minute ago was a highly lethal and very serious suicide attempt.
 
JENNIFER SPRAGUE:
And that was preceded by
 
DR. KIRK HEILBRUN:
it was preceded by months of thoughts and impulses about uh you should harm yourself, you should kill yourself, your brain is damaged, that sort of thing. And that I think is the beginning of the way to understand what happened that day. The second point is that as I've said before, she didn't like to leave her children. Uh whether that was for date night or school or uh going back to work or anything, she did not like to leave her children. And if she had taken her own life, then her children would have been without her and she thought that they would suffer. And she'd been having these thoughts both about herself and about her children over a several month period. And the other thing that I will say is that she was in pain. She was suffering. She was doing a little bit better than she had been before she went into McLean, but she was still in pain. She was suffering. I think she was even desperate. And that is something that is often characterizes people who try to take their own life. They're in pain, they're suffering, and they're trying to put a stop to it. And I think when she decided at some point that she was going to put a stop to it, uh then she had to answer the question of what to do about the kids and she didn't want to leave them and she was convinced that they would be they would suffer without her.
 
JENNIFER SPRAGUE:
The next slide
 
## RELIGIOUS TESTIMONY AND SIDEBAR — 6:37:01
 
JENNIFER SPRAGUE:
and further evidence that you saw for the uh suicide combined with altruistic filicide.
 
DR. KIRK HEILBRUN:
There was uh one of the things that she said when asked about what happened is that in the course of strangling each child, she said, "Go to God, baby. Go to God." And that was part of her expectation that she and the children would be together in heaven with God. She was raised as a Catholic. And this As I understand Catholic considerations, that's not necessarily what happens. But but when I asked her about that, when I said, "Isn't suicide a mortal sin?"
 
HONORABLE WILLIAM SULLIVAN:
Yeah. Can I see counsel over here? All right. And so I'm going to ask you to go back to the jury room. Uh and then we'll bring you back in a couple of minutes. All right. in session.
 
HONORABLE WILLIAM SULLIVAN:
All right, we'll be in a short recess and I'll come out as soon as I can.
 
BAILIFF:
All right. This court is back in session. Please be seated. Your
 
## MISTRIAL MOTION, RULING, AND JURY INSTRUCTION — 7:04:04
 
CLERK:
honor, for the purpose of the record, we return back to the trial of Commonwealth versus Lindsay Clancy. All parties are present, excluding the jury.
 
HONORABLE WILLIAM SULLIVAN:
All right. Uh after the following uh sidebar conference, uh I think the defendant made a motion. I'm going to allow uh argument in regards to the motion. I'll hear first from the uh defendant and then I will hear from the comm. Mr. Reddington.
 
KEVIN REDDINGTON:
Thank you, judge. Your honor, um this has been a obviously a long trial and a lot of work on the part of everybody involved from the court to the staff to the prosecutors to myself and needless to say the strain on um Lindsay Clancy. Um I have to move for a mistrial reluctantly. The reason is that this is intentional misconduct on the part of the prosecution. you know that this whole idea of injecting Roman Catholic faith, the concept of mortal sin um into this trial occurred I don't even remember now about a week ago and I objected but before I could get the objection out your honor had us at the sidebar at the same time and very forcefully um in my opinion indicated to the jurors that they should not consider that to any degree. At the time, I put on record the fact that I did not uh feel that I I I felt that the court's instructions were sufficient. They were forceful. They were right on point. And um I we move forward without a motion for a mistrial. I made a tactical decision. But unfortunately, at this point, it's a concern I have because this is just over the top. It's the same thing again. Talking about religion, talking about heaven, talking about um killing people and the and the impact of the effect that it would have on on on Lindsay as well as her children. uh the fact that this is not the first time that it occurred during the trial and the prosecution has previously brought up the concept of mortal sin based on your ruling in the past in conjunction with the fact that they brought it up again. Um I believe it was intentional misconduct and I feel that the court should grant a motion for mistrol.
 
HONORABLE WILLIAM SULLIVAN:
All right. Thank you.
 
JENNIFER SPRAGUE:
Thank you honor. The question I asked the witness did not ask for any um testimony about religion, about Catholicism, about mortal sins or anything like that. And the the slide is still up on the screen. There's nothing on the slide about Catholicism, about mortal sins, about any of that. The witness was explaining his reasoning. I don't think it was intentional on part of the witness either. If we look at his interview of Miss Clancy, one of the things that this witness has to do is determine whether the defendant knew the wrongfulness of her conduct. And that can be either that it was criminally wrong or morally wrong. And he explored that with her in the interview and um asked her about whether she knew it was legally wrong. And she said she she had no concept of legal consequences. And then he went on to ask her about moral wrongfulness and about um her religion and and whether she knew it was morally wrong. and she did say that she had knowledge um that suicide was considered sinful. So I I believe that's where the witness was going um in trying to explain his reasoning. I don't think he was intentionally trying to inflame the jury or cause an issue in this case. I know I certainly wasn't because I didn't ask a question about her religion or a question that would invoke that kind of response. Um I asked them to explain what was on the slides and that's not on the slides. Um, so there was no intentional conduct by the Commonwealth. That was not where I intended to go with this questioning. And I don't think um that the the witness intended to to do any harm either. He was just explaining his rationale. Um, so I would ask that the jury be instructed to disregard the answer. And I can stop speak to the witness and tell him not to um talk about that reasoning for um behind his thoughts that he can testify about his conclusions, but to leave that portion of his reasoning out of his testimony.
 
HONORABLE WILLIAM SULLIVAN:
Well, here's a concern I have is what the witness did say um uh in regards to go to it said go to God, baby, go to God. That was statements that had been made in evidence already. Um, and then he indicated that was part of her expectation that she and the children would be together in heaven with God. All right. Now, we're getting a little closer to problematic area. Then he testified she was raised as a Catholic. And as I understand Catholic considerations, that's not necessarily what happens. How is any of that proper at this point? But it was not
 
HONORABLE WILLIAM SULLIVAN:
I'm not going to declare a mistrial at this time. What I am going to do is I'm going to bring the jury in. I'm going to tell them to disregard it. I'm going to tell them that's an inappropriate area of inquiry and that this witness's understanding of Catholic dogma or Catholic teaching is irrelevant. There's no evidence of his background or training or having been to the seminary or any of that. And so I am giving that. But the Commonwealth, I'm going to strongly, and perhaps in the strongest language, talk to him and let him know that he can't go into that. And then my thought is I'm going to bring the jury back in. I'm going to give them that instruction and I'm going to send them home. I don't want them leaving here today with the last thing they heard was a discussion about this witness's understanding of the Catholic teaching. That's not the last thing they're going to hear. And so my thought is that, as best I can, is to address that and minimize the damage or prejudice because I do presume that this jury will be able to follow those instructions. And so that would be my thought. We'll come back. That will give the Commonwealth plenty of time to talk to this witness to let him know the areas that he should and should not go into. And then we can come back tomorrow and we can resume his direct examination and cross-examination. All right. So that'll be my thought. We'll bring the jury in. I'll give them that instruction and then we will recess until tomorrow.
 
KEVIN REDDINGTON:
Your Honor, just for the record, could I note my objection?
 
HONORABLE WILLIAM SULLIVAN:
Sure. Absolutely. All right. So, are we ready for the jury?
 
HONORABLE WILLIAM SULLIVAN:
The religion that the defendant was raised with is absolutely an inappropriate area of testimony. It is to be stricken. It is not to be considered. Secondly, the witness's understanding of Catholic teachings and considerations is immaterial; it's irrelevant; it is to be disregarded based on that testimony.
 
The jury was excused for the day. Jennifer Sprague's direct examination of Dr. Kirk Heilbrun remained ongoing and was scheduled to resume the following trial day.

Deanna · Aug 25, 2026, 6:11 AM · #post-144

ACUTE PSYCHOSIS AND COMMAND HALLUCINATIONS — 6:13:09
 
JENNIFER SPRAGUE:
And so doctor if you if we could go to the next slide and you could talk to us tell us um what evidence you saw for acute psychosis with command hallucinations.
 
DR. KIRK HEILBRUN:
Yes. Uh the first was that's what she said. I asked her that question and that's what that's the way she explained it happened. She said uh sometime on the afternoon of January 24th, 2023 uh that she uh she heard a voice and the voice said, "This is your last chance. you have to kill the kids so you can kill yourself. Uh if she actually heard a voice like that, that would be evidence of uh psychosis being experienced and what we call command hallucinations where the voice is instructing her to do something. There were some other possible things that made me think that it could be uh a severe mental illness that she was experiencing and two in particular. One was thinking that others might know her thoughts. Now this is something that is a symptom of psychosis called thought broadcasting if it's experienced in a certain way. in thought broadcasting, uh, if I'm experiencing that, I literally have the idea that, uh, that if I'm thinking it, you can hear what I'm saying just as if I were putting it on the television or or podcast or a movie or whatever. It's just coming out that way. Uh I asked her about that and she said and other people asked her about that too and she said it was not thought broadcasting but these were very vivid thoughts and she she thought that it might be that people could could hear them uh as vivid and strong as they were. The second possible symptom is that thinking police might take her children. Now, some of the records, in some of the records, I saw people saying, "Well, this looks like a paranoid delusion to me." And I will tell you that it didn't look either either paranoid or like a delusion to me. And here's why. Um, I I'm a health care professional. And that means that in Pennsylvania and every other state I know, I'm a I'm a mandated reporter. If someone tells me in therapy or in an assessment that they think that uh a child is going to be injured or severely hurt or that might happen, then I'm required by law to contact Childline in Pennsylvania. Miss Clancy is a labor and delivery nurse. She's a health care professional as well. And so it's one of those things where if she had thought if she had said to a psychiatrist, psychologist, anyone providing treatment that she thought she was experiencing ideas like she might harm her kids, she would know as a mandated reporter that they would were legally required to report that. Now, that might not mean that the police would literally come and take her kids away, but it would mean that there would be an investigation. She would have to answer questions, and it might be that for a period of time, she would be separated from the children.
 
JENNIFER SPRAGUE:
And doctor, um, is it
 
DR. KIRK HEILBRUN:
she has
 
JENNIFER SPRAGUE:
I thought he was done.
 
HONORABLE WILLIAM SULLIVAN:
I don't know.
 
HONORABLE WILLIAM SULLIVAN:
We'll find out. Were you done?
 
JENNIFER SPRAGUE:
I just want to ask a follow-up point question about your last point. Is that okay?
 
DR. KIRK HEILBRUN:
Oh yes, that's okay.
 
JENNIFER SPRAGUE:
And so you you mentioned you didn't think it was a delusion. Is it true that a delusion is a fixed false belief?
 
DR. KIRK HEILBRUN:
Yes, that's the way it's defined.
 
JENNIFER SPRAGUE:
And so Miss Clancy thinking that if someone knew she thought of harming her kids, her kids might be taken away. That's not a false belief. Correct.
 
DR. KIRK HEILBRUN:
Well, that was what I was trying to say is that it is not a false belief. uh it's quite possible that it could come to pass.
 
JENNIFER SPRAGUE:
Um and if you could continue with your discussion of why uh the the evidence you saw for acute psychosis.
 
DR. KIRK HEILBRUN:
Yes. Uh the other point there at the bottom is that it's it's appealing as an explanation because it could explain acts that seem so out of character for her. You don't have to get complicated at all. It's just I had a psychotic episode. I heard a voice. The voice told me to do something terrible. I did it.
 
## EVIDENCE AGAINST ACUTE PSYCHOSIS — 6:18:11
 
JENNIFER SPRAGUE:
And after considering the evidence for acute psychosis command hallucinations, did you then consider evidence against acute psychosis with um command hallucinations?
 
DR. KIRK HEILBRUN:
I did. Yes.
 
JENNIFER SPRAGUE:
And what did you see?
 
DR. KIRK HEILBRUN:
Uh, one of the one of the reasons, well, the first bullet point here is that the way she described this as happening is that she heard a voice that she'd never heard before, experienced it, an hallucination, and she's never experienced it since, but she only experienced it for the 18 minutes or so that it took to kill the children. And to put it mildly, that would be a very very unusual pattern or or manifestation of how this kind of thing comes about. Uh very unusual. I've been doing this kind of evaluation for many many years and I'm always very careful when someone tells me that they experience a symptom only during the course of committing an offense. Uh
 
JENNIFER SPRAGUE:
why is that doctor? Why why are you careful when someone tells you that they only experience this voice during a criminal offense?
 
DR. KIRK HEILBRUN:
Well, because it provides a convenient way of of lessening your own culpability. Uh I mean, it's always possible, but as I said, I find it very very rare. Whereas um an explanation for um for why somebody uh did something uh somebody might look at that and say uh it's it's a convenient way of somebody looks at me and and it's I don't have the same culpability that I would otherwise.
 
## DIFFERING ACCOUNTS OF THE VOICE — 6:20:10
 
JENNIFER SPRAGUE:
And what was the the next part of evidence that you saw against acute psychosis?
 
DR. KIRK HEILBRUN:
There was some discussion of whether this was postpartum. And so she was about 8 months a away from having um having given birth to Callan, her youngest child. And most of the uh explanations or or most of the sources of authority like DSM5 or the Cleveland Clinic will point to maybe one month after birth or 2 months after birth or something like that. But the farther away you get timewise from the birth, the less likely it is under those kinds of authority to to be uh postpartum. Now, it could be something else. And there were certainly some things that I saw that were symptoms of depression and other sorts of things that she experienced in January, but it was given the time it was less likely I thought to be postpartum. Then the next bullet was inconsistencies in her account. To me, uh, when asked about this, she said the voice said, "This is your last chance. you have to kill the kids so you can kill yourself. And it just kept repeating that and only that and only that for about 18 minutes or the duration of the time it took to to do this. Um there were other times though for instance uh when she was in the hospital after this happened and was talking to a psychiatric attending when she said that the voice had said other things uh for example the children will suffer without you or you have to take the kids with you or things like that. So uh inconsistency is important because it suggests inaccuracy. In other words, which version is accurate? Is it the first? Is it the second? Is it neither? I mean, here it couldn't be both because she said, "I only heard this." To some people, she said that. And then I heard this plus this to other people. She said that.
 
JENNIFER SPRAGUE:
And doctor, if she had said to a third person that it was a different version, such as you have to kill the kids so you can kill yourself because there's a danger to you and the kids, would that be a further consideration of the the inconsistencies?
 
KEVIN REDDINGTON:
Objection.
 
HONORABLE WILLIAM SULLIVAN:
Yeah. Overall, yes.
 
DR. KIRK HEILBRUN:
Uh the more inconsistency there is,
 
KEVIN REDDINGTON:
can we have a basis for that please? He's ask a hypothetical.
 
JENNIFER SPRAGUE:
Hypothetical. Yes,
 
HONORABLE WILLIAM SULLIVAN:
I'll allow that.
 
KEVIN REDDINGTON:
So, it's not based on evidence. It's a hypothetical.
 
HONORABLE WILLIAM SULLIVAN:
Hypothetical.
 
DR. KIRK HEILBRUN:
You might have to repeat the question.
 
JENNIFER SPRAGUE:
So, if there the person has a third version of what happened uh what the voice said and what the reasons the voice gave. Would would that be important in your assessment as well regarding in inconsistency?
 
KEVIN REDDINGTON:
Objection. It's speculation. It's not based on evidence and there's no foundation for a hypothetical question.
 
HONORABLE WILLIAM SULLIVAN:
Well, just just ask it as the hypothetical, you know, assuming this and go that way.
 
JENNIFER SPRAGUE:
Doctor, um, a hypothetical question for you. Assuming that a person has already given two versions of a voice, what the voice said for them to do, and then gives a third version of what the voice told them to do, would that be significant to you in assessing the inconsistencies?
 
KEVIN REDDINGTON:
Objection for the record.
 
HONORABLE WILLIAM SULLIVAN:
Yeah. Overall, go ahead.
 
DR. KIRK HEILBRUN:
What I would say is the more inconsistency there is, the more problematic I find it to take any one particular account and say this is the accurate one.
 
JENNIFER SPRAGUE:
And then uh what other evidence did you find against acute psychosis?
 
## GENUINE AND FABRICATED HALLUCINATION FEATURES — 6:24:22
 
DR. KIRK HEILBRUN:
There is some research that's been conducted on malingered hallucinations which are accounts of hallucinations that are exaggerated or fabricated. And I found it useful to look at those look at that research and see what it suggested and kind of lay it out there in terms of the way she described it. So uh some research suggests that uh that one consideration is whether the voices are internal or external, whether they're coming from your own thoughts or whether they're coming from outside of your head. and Miss Clancy perceived this voice as external which is more consistent with genuine hallucinations. However, uh command hallucinations are often in about 88% of individuals reporting them by one account accompanied by a related delusion. Uh Miss Clancy did not uh report any accompanied delusions. So, thus far you've got one point for genuine and one point for possible exaggerated. Uh, then there's frequency and control. Uh, genuine psychotic hallucinations are more often intermittent than constant. They'll come and they'll go. Uh, you'll hear it, stop hearing it, you'll hear it again, stop hearing it, and this can extend over a period of time. Miss Clancy in this instance reported that the voice was constant for 18 to 20 minutes and then it stopped. It had not been experienced before and it has not been experienced since. And she also uh did not report having any control over the voice or over her actions in response to the voice. Then the next item is content. So genuine hallucinations are often familiar uh use both genders and are clear rather than vague. As Clancy described this voice as clear, but it was unfamiliar and it was a single male voice. So that was sort of mixed. I'm not counting it as one direction or another. And then finally, uh reaction and coping. Individuals who experience hallucinations like this often try to reduce their influence by different in different ways. Could be praying, could be listening to music. Uh and while those who inaccurately report the experience of such hallucinations often do not describe coping mechanisms and Miss Clancy didn't didn't report any attempt to stop the voice or distract herself from it or what have you. So there were about three points on which her account more closely resembled uh exaggerated or fabricated hallucinations. One where it looked more genuine and one that was kind of mixed.
 
JENNIFER SPRAGUE:
If I could ask you a question. Um you said that there were more points indicating malingering malingering or exaggerating um the existence of the voice but earlier you testified about your your psychological testing of Miss Clancy and it showed minimization um and it didn't show malingering. Could could you explain how those two things could occur in the same person at the same time?
 
DR. KIRK HEILBRUN:
Yes. Uh when we try to appraise through testing or specialized measures uh something that looks like malingering or exaggeration, the way we typically do it as psychologists who develop the measures is it looks like somebody who is going to take a shotgun approach. They're going to say unusual things are wrong and strange things are wrong and many things are wrong and things like that. Uh, if you do that, we're pretty good at picking up that shotgun approach to malingering. But if I ask you a bunch of questions and you answer them almost entirely in a genuine way that you're being as accurate as you can, except with one exception, when I ask you about one experience or one symptom and you exaggerate or fabricate that, it's very we can't pick that up through our testing. So what we have to do instead is uh we have to kind of develop our ideas about how it might have been experienced, what it was consistent with, what the disorder is. We we take a a broader approach which is what I've tried to do in in talking about this.
 
JENNIFER SPRAGUE:
We go to the next slide please. And uh was there further evidence against acute psychosis?
 
## INTRUSIVE THOUGHTS, MEMORY, AND WRONGFULNESS — 6:29:08
 
DR. KIRK HEILBRUN:
Yes. Uh I'm going to start with the question of thoughts or hallucinations. I've already said that I found the account of hallucinations to be as she described it. It would be very very unusual to experience it that way. Never having not before not since constantly for 18 minutes. However, if this was a thought, an unwelcome, intrusive thought, but still a thought that's basically this is your last chance. You have to kill the kids so you can kill yourself. Then that would be consistent with thoughts that she'd been experiencing for some time. uh she'd been having thoughts about harming herself, that she was uh it was going to be very difficult uh for her to um to do this uh in a way that was that that made sense. Uh she was she was experiencing thoughts about hurting herself because her brain might have been uh damaged. She was experiencing thoughts about hurting the kids. She was experiencing all sorts of unwelcome thoughts. If that were the case on January 24th, if these were thoughts, then that would be consistent with what she'd been experiencing for months before. So that was something that made more sense to me that rather than an auditory hallucination, it would have been an unwelcome intrusive thought. The next bullet is her response to her husband's question, "What did you do?" So, when he got home around 6:00 p.m. on January 24th, and the house was quiet, and he went in, thought people might have been playing hide-and-seek with him. Called downstairs, didn't get an answer. Called upstairs, didn't get an answer. went upstairs, found the bedroom door locked, unlocked it with his key, went in, saw some blood there, saw the window was open, ran downstairs, and he saw his wife Lindsay lying there semi-conscious. And he said, his first question was, "What did you do?" And her response was, "I tried to kill myself." Now, I thought that if she had actually experienced this command hallucination that she might have said something like, "I did what I had to do." I did what the voice said, or something like that. But no, she said, "I tried to kill myself." And this is consistent with my looking at this and starting from the perspective of this is a serious, highly lethal suicide attempt. And that's the way to understand it. And then the last bullet point has to do with u the recovery of memories. So when she regained consciousness that night in the hospital, one of the things she said is that she she wasn't able to to remember what had happened and she was informed of it. But if she if this had been a genuine memory loss, then human memory is funny. And one of the things that happens is that when you're trying to remember something that actually happened, things can interfere with that. Things that you read, things that you're told, other sorts of things like that. So it would have been hard to understand how she would recover that memory accurately, including the particular memory of um the command auditory hallucination and what it said.
 
JENNIFER SPRAGUE:
And doctor, did you already go over the first bullet point, the inconsistencies in her description of knowing wrongfulness?
 
DR. KIRK HEILBRUN:
Yeah, I'm going to I'm going to pass on that one. Go to the next slide.
 
JENNIFER SPRAGUE:
Okay. You don't have an that's not a consideration.
 
DR. KIRK HEILBRUN:
Uh well, there were some there were some additional inconsistencies uh in terms of whether she knew that when I asked her uh whether she was aware that it was illegal or immoral. She said basically I wasn't thinking about this at all. No no thoughts, no decisions, none of that. It was just all action. Uh one of the things that uh Dr. Resnick wrote in his report is that she was intellectually aware that it was wrong or illegal, but not morally. And what she said to me is that I just don't think it I wasn't thinking about that at all. I didn't know any of that.
 
DR. KIRK HEILBRUN:
Okay.

Deanna · Aug 25, 2026, 6:11 AM · #post-143

COURT RESUMES — 6:00:29
 
CLERK:
Your honor, for the purpose of the record, we return back to the trial. Commonwealth versus Lindsay Clancy. All parties are present, including the defendant and including the 18 jurors.
 
HONORABLE WILLIAM SULLIVAN:
All right. Thank you, madam clerk. Jury, we're going to return now to the direct exam of this witness. All right, counsel.
 
## PSYCHOLOGICAL TESTING RESULTS — 6:00:44
 
JENNIFER SPRAGUE:
Thank you, honor. Doctor, before we broke, you were describing the various psychological tests that you conducted on Miss Clancy. Can you tell us the results of those tests?
 
DR. KIRK HEILBRUN:
Yes, I can. on the MMPI which I spoke about uh first uh and this was of course three and a half years uh after the um after the alleged offense. Uh so it's going to describe much of it is going to describe her thinking and feeling and behavior uh in April of 2026 rather than January of u 2023. But it's something that I that that's always a challenge when you try to reconstruct what happened some time ago. And so some of these tests were were administered from the standpoint of what was it like for you back then? But the MMPI was uh delivered in terms of how you're doing right now. And she uh on the response style scales that I talked about earlier, she uh showed a slight tendency to uh under report, to deny unusual experiences, although she she did that in a in a way that was uh was pretty sophisticated. Uh she's a she's a bright woman. Um and so given this uh we kind of take into account a little bit the uh the the fact that she might uh be under reportporting a little bit in terms of what's really wrong with her. Uh however uh there are a number of what we call clinical scales on this test and she was not elevated on any of them meaning that she's not actively symptomatic in many areas or in great distress in in certain ways. Uh but there was one scale that is elevated and that is the uh the suicide and death ideation scale. thinking about suicide and death. And I should say that Miss Clancy uh has been on one to one suicide precautions, which is the highest level of precautions that a hospital can take since she came to Tewksbury. This is a very long time to be on that kind of precautions. And what what it says to me is that she was at risk for suicide. she remains at risk for suicide and so she still is. Uh the adverse childhood experience questionnaire I mentioned earlier basically it's a measure of whether somebody uh is reporting experiencing as a child or adolescent adverse or traumatic events and she was not. So she had a zero on that. Uh there were two measures of suicide intent. uh one is called Beck's suicide intent scale and the other is called the Columbia Suicide severity rating scale. Uh, and I can sum up those results very quickly by saying that when she responded to one of them, as she would have if she'd been filling it out in January of 2023, uh, what it suggested is that that this was a very serious suicide attempt at that time. And when she responded to both of them as she feels right now, she uh also was indicating that she remains at high risk for suicide and hence the the uh onetoone supervision for uh three and a half years. Uh the brief symptom inventory is something where you ask people about a number of possible uh symptoms that they've been experiencing within the last month or so. Gave it to her under two circumstances. One is how are you doing right now? That is around April of this year. And the other was how are you doing in January of 2023? Her description of how she was doing in January of 2023 is that she endorsed uh feeling blue or uh still extremely depressed, feeling no interest in things, thoughts of death or dying, feeling hopeless about the future, feeling very self-conscious with others, and the idea that something is wrong with her mind. Uh she thought depression, suspiciousness, memory problems, uh problems with attention and concentration, uh and things like she she was having trouble concentrating, so she'd be cooking for instance, and she'd forget what step she was on. Uh so most of these are consistent with symptoms of depression. And so I thought that they were good indications that she was endorsing feelings of depression, although she was improving somewhat from her December feelings. Uh the something called the obsessional beliefs questionnaire has three scales. Uh one scale is uh kind of responsibility threat estimation which is uh a belief about your personal responsibility and overestimation of threats. She was not elevated on that. A second was perfectionism and certainty. She was not elevated on that either. Although she is she works hard and so on, but she's she was not elevated on the perfectionist aspect of this test right now. However, she was elevated on something called importance and control of thoughts. Meaning that for her, it's always been important to be able to work hard and control what's going on with her mind and her life. And one of the things that I'm going to talk about in a few minutes that I think was making her depressed and hopeless and sad and so on is that she had been trying very hard since October to um to to basically control the problems that she was having and it wasn't working. It was not succeeding for her. Okay. Okay. And then there was something called the uh Leah Slate Slate Hallucination Scale. Uh and so she endorsed the following things. Sometimes a passing thought will seem so real it frightens me. Uh sometimes I get distracted uh trying to concentrate on my work. That was something she endorsed back in 22 and 23. Um, in the past I've had the experience of hearing a person's voice and then found there was no one there. That was only on January 24th. Uh, I often hear a voice speaking my thoughts aloud. Again, only on January 24th. I've been troubled by hearing voices in my head. Again, only on January 2024th. Um, all right. So, those were the psychological testing results. And I'm going to move to the last item on uh on the PowerPoint here, which is why it was important for me to consider her motivation for killing her children. And this is something that if you look at Lindsay Clancy, uh would be described as so out of character that I just like to know what was uh what was po what could possibly have been going on. Uh because for instance when I talked to her and talked to her husband as well about how do you discipline your kids, it was never spanking. It was never hands-on. It was never anything like that. Uh they both felt bad when they yelled at the kids. So, it was one of those things that to imagine her doing something like this is really uh seems so out of character that I I thought it was very important to try to figure out why it might have happened. So, this is how I approached it. Um, the the other thing about the why question is it could well be something that is valuable to know when we're thinking about uh whether she understood that something was wrong or when she was thinking about whether she could conform her conduct to the requirements of the law or control herself, the why question seemed important. So if I could add the next slide.
 
COURTROOM SPEAKER:
Sure.
 
## COMPETING EXPLANATIONS — 6:10:06
 
JENNIFER SPRAGUE:
And in evaluating the why, did you come up with two possible explanations?
 
DR. KIRK HEILBRUN:
I did. Yes. Which is on this slide.
 
JENNIFER SPRAGUE:
And so can you explain that please?
 
DR. KIRK HEILBRUN:
I can. Yes. Uh there are a number of reasons in my experience why people harm one another, why people kill one another. And most of these reasons ended up not applying to Miss Clancy. I mean, it it wasn't jobrelated. She wasn't in the military or the police. Didn't have to do with money or property or fame or anger or being callous or abusive or being being afraid or doing it himself. None of those there was any evidence for, but uh there were a couple of things that started to uh to have some evidence for. And this is what it looked like. one is the the psychosis, the the possibility that she had a severe mental illness, experiencing hallucinations, delusions, that sort of thing. And as part of that, on January 24th, experienced uh those symptoms that we're going to talk about in a minute. And I'm calling that the first bullet point there, acute psychosis with command hallucinations. The second possible explanation was as part of a an attempt to take one's own life, as part of a suicide, uh, one might harm one's children if you thought that would prevent them from suffering. Um, and let me see if I can give you an example of that. If if one of us were to learn and we had no doubt in our mind that the Holocaust was coming tomorrow and we thought that was going to be awful and I I can't I can't live through that and so I'm going to take my own life. If I had children, the question might come up, do I take them with me? Do I take their lives as well? Now, I'm not saying that I would definitely do that, but what I'm saying is that it would come up as a possibility in what I thought about. And so, uh, so the there ended up being in my mind two possible explanations for why she did what she did. The first being the acute psychosis with command hallucinations and the second being this was a serious suicide attempt and she wanted the children to be with her so she wouldn't be separated from them and so they wouldn't have to suffer after she was gone. Now in a minute I'm going to talk about the evidence that I saw supporting each of those. But I will uh will tell you right now uh in advance of talking about that that most of the evidence that I saw I saw supported the second one and not the first.

Deanna · Aug 25, 2026, 6:10 AM · #post-142

MENTAL-HEALTH HISTORY BEFORE SEPTEMBER 2022 — 4:00:30
 
JENNIFER SPRAGUE:
I did. Yes. And if you could tell us um what were your major findings regarding uh Miss Clancy's mental health history before September of 2022. She had a fairly limited uh mental health history before September 2022. Uh this was she did experience some anxiety related to achievement. Uh she's a very strong student in school and she got straight A's basically. Uh she experienced some anxiety while in nursing school doing case presentations because you have to stand up in front of a a a group and that was that made her kind of anxious. And then she had some anxiety connected with her three pregnancies. Uh some in the beginning about the ultrasounds and so on and some sort of as she was uh returning to work. So after each child uh she she'd have uh some time off with a child and then uh after several months she would return to work. And on each of those occasions uh with Cora and Dawson and Callan, she had some anxiety because she didn't like to leave her children. Uh that was an important consideration for her. uh whether it was dropping them off at school or returning to work or leaving them with a babysitter or going out with friends, going out on date night, uh she didn't like to leave them. And so those were some of the things that were connected with her mental health history before September of 2022. And this was in the context of her uh growing up as a a highly achieving individual, getting very strong grades, uh competing in sports and competitive cheerleading. Uh these are these are all things that that the anxiety probably pushed her a little bit more in the direction of uh of doing this very well because she was a very hardworking and highly self-disciplined individual. Uh she also grew up in a family that was close and comfortable and uh and had a number of friends uh that she was uh she spent time with uh both uh as a as a girl and a teen teenager and so on. But she she was very uh very highly achieving and I think one of the important aspects of her mental health history before uh September of 2022 is that she she really did not experience anxiety in a way that interfered very much with her uh with her functioning. uh she had a little bit of treat. She had about 6 months worth of treatment uh for the anxiety connected with the nursing school. Uh but it was not something that interfered with her life very much prior to September of 2022. And doctor, did you also learn that um growing up as a child um she didn't experience any type of um abuse, witness any domestic violence, have any sort of um trauma um or anything like that um as she was growing up?
 
DR. KIRK HEILBRUN:
Yes. One of the psychological tests, which I'll talk about a little bit later, uh is called the adverse childhood experiences uh measure. And that's that's something that uh asks an individual whether they went through what we would call adverse experiences or traumatic experiences as a child and and and an adolescent. And uh there are 10 of them and if you have four or more of them that puts you at higher risk for different kinds of adverse outcomes as an adult. She did not endorse any of those. So on the on the ASUS questionnaire, she had a a zero, which really goes to the the question that you ask of whether she had uh adverse or traumatic experiences as a child.
 
JENNIFER SPRAGUE:
And so she did not correct.
 
DR. KIRK HEILBRUN:
She did not report any.
 
JENNIFER SPRAGUE:
She did not report any. And there were any number of individuals who were asked similar questions about her uh her childhood and her adolescence. and they all said basically no she did not.
 
JENNIFER SPRAGUE:
And then if can you tell us about your major findings for the mental health health history beginning in September 2022?
 
DR. KIRK HEILBRUN:
Yes, I can. So, it was about 12 weeks after her son Callan was born and she was feeling uh very anxious and sometimes depressed about having to leave him when he went back to work. Uh there were two reasons for that. One is that she had felt anxious about leaving her children on a number of occasions and with the previous kids. But the second reason was she was breastfeeding and Callan was not taking the bottle. And so she was worried if she went back to work, she worked as a labor and delivery nurse on the night shifts and she was worried that if she left Callan home and he woke up in the night and wouldn't take the bottle, there would be a problem. And so uh that was what got her particularly anxious. And what happened was she looked searched for a psychiatrist found one Dr. Jennifer Tufts in September and went to Dr. Tufts and got a prescription for Zoloft to she wanted to reduce her anxiety somewhat and she didn't begin taking it immediately. She was a little bit worried about the impact that it might have on the on the breast milk. But sometime in October, she began taking the the Zoloft and things started getting very difficult at that point.
 
JENNIFER SPRAGUE:
And doctor, did you learn how things became difficult from the records in in your interview of her?
 
DR. KIRK HEILBRUN:
I did uh both of those and from uh I guess you could say the the records because a number of people had talked about that including her husband Patrick. And I also uh got some of that information from him as well during the collateral interview.
 
JENNIFER SPRAGUE:
And what did you learn?
 
JENNIFER SPRAGUE:
What was happening uh toward the end of of his 12week paternity leave is that she was getting more anxious when she started in mid-occtober taking the the Zoloft. uh she immediately began to have some difficulty. Uh the anxiety did not get better. In fact, it got worse. Uh there were some symptoms of depression. Uh she immediately started having some really difficult insomnia. Uh and felt a lot of stress and so on. And so um in October and moving uh into November, uh she had hoped to return to work and planned to return to work, but it was not going to uh to work out for her because her symptoms were really difficult. So, in the middle of November, uh she texted her mother-in-law, uh Sue Clancy, who was at work, also a nurse, and she was in the emergency room, uh at Southshore Hospital. She felt unwell. She was having problems sleeping. She had a racing heart. She had lost some of her appetite. uh continuing into November, she was struggling with anxiety, uh severe insomnia, palpitations. Uh she was just having a lot of difficulty uh with the thought of leaving the baby, erasing thoughts, feeling overwhelmed and things like that. So moving further into November uh into late November uh she was just having real difficulty with sleep disruption and she had concerns all along starting in mid October about the impact of the medications. It was her thought that the medications were were giving her some of these adverse uh reactions. Uh because it was really difficult for her to look at this and say I I wanted to get some improvement in the anxiety and I did not. Instead it got worse. And so late in November, uh she was still having a lot of trouble sleeping. Uh she thought that she she was close to what she called the end of her rope. Uh she was feeling off and disconnected and sort of like a a zombie and she began to report panic symptoms. Uh concerns about being addicted uh or dependent on the benzoazipines. uh some kind of disoriented and forgetful and disconnected from her body. So she was having a lot of difficulty with what she thought were the the medication uh that was that was uh resulting in this kind of impact. Uh and then into uh December it was not getting better. Um,
 
JENNIFER SPRAGUE:
and sir, if I could just interrupt you. Yes. Um, on your PowerPoint here, are we still on number three here or have we moved on?
 
JENNIFER SPRAGUE:
I I I don't know. Is he finished his answer?
 
DR. KIRK HEILBRUN:
I want She's coming focused.
 
JENNIFER SPRAGUE:
Are we still on number three or have we moved on?
 
DR. KIRK HEILBRUN:
Uh, we're still on number two, but I'm also uh slipping in a little bit of number three as I answer number two.
 
## RETURN TO WORK AND INTRUSIVE THOUGHTS — 4:07:13
 
JENNIFER SPRAGUE:
Okay. And if you could please continue um describing what was happening in December of 2022.
 
DR. KIRK HEILBRUN:
Yes. Uh around this time, late November, early December, she began to experience what she called uh horrible intrusive thoughts. And those thoughts were about harming herself potentially. And as she continued to experience these kinds of thoughts later into December and January, they would occasionally be about harming the children. But for the most part, uh particularly early on, these were thoughts about possible suicide and harming herself. And the way she described it is these thoughts would just pop into my head. Uh and they included things like your brain is damaged, you need to kill yourself. Uh now the way she described these is they were not auditory hallucinations. Instead they were her own thoughts. They were intrusive and unwelcome but they were not auditory hallucinations. And that's important because if she would if she had been hearing a voice like you're hearing my voice right now. It comes from outside of your head. And that's a that's a different kind of a symptom than having thoughts even unwelcome and intrusive thoughts that are in your head. Uh if it's coming from outside that is very likely a psychotic symptom. And if it's a psychotic symptom, then that has different implications for what's wrong with you as opposed to something that is unwelcome and intrusive but inside your own head.
 
JENNIFER SPRAGUE:
And doctor, the way she described um these thoughts that she was having in December um about harming herself in the the medical records and in her conversations with you, she described those as unwelcome but internal thoughts. Correct.
 
DR. KIRK HEILBRUN:
Yes, that's right. Uh it was important because of what I just said that I asked her the question uh when you were experiencing these thoughts were they like your own thoughts or were they like auditory hallucinations and she said they were like my own thoughts and she made it clear that they were unwelcome and intrusive but they were like my own thoughts and she didn't get to talking about experiencing auditory hallucinations as I will talk about a little bit later until uh January 24th. Um, and so she continued to have real difficulty with various kinds of uh problems. She had lost about 15 lbs, not intending to. Uh, she was having tremors and sweating and GI symptoms and sadness, uh, severe depression, that sort of thing. uh as she described it, feeling numb and zombie-like were her words again in December. Um and then by middle December, it was getting very difficult for her as she as she talked about it. Her sleep was getting a little bit better, but she was continuing to have significant uh symptoms of depression, things like hopelessness and the loss of capacity for pleasure and things like that. Uh she described her her experience on December 14 December 15th of 2022 as one of her worst days. Um uh she went to her husband took her to Mass General that day and she she did not stay very long but but it was one of those things that was really difficult. The symptoms were as she saw it pretty bad. And then on December 20th, she went to a hospital called Women and Infants in Rhode Island, and they had a a day program uh for uh postpartum uh in individuals having difficulties. And they said that they weren't going to take her, that she didn't meet their criteria for the postpartum program. And generally that was because uh they said that she was she looked like she was having a uh general anxiety symptoms and depressive disorders but not so much the postpartum necessarily. And
 
JENNIFER SPRAGUE:
and doctor if I could just stop you a little bit.
 
JENNIFER SPRAGUE:
You finished with that description of what information you got from that provider.
 
DR. KIRK HEILBRUN:
Uh not quite judge but almost.
 
JENNIFER SPRAGUE:
Okay. Yes,
 
JENNIFER SPRAGUE:
can finish.
 
DR. KIRK HEILBRUN:
Um, so she was uh she was not uh going to remain in women and infants and the the next step that she took was hospitalization at McLean.
 
JENNIFER SPRAGUE:
And so if I could ask you a follow-up question now before we go on to McLean.
 
DR. KIRK HEILBRUN:
Yes. about women and infants. Were you able to review the women and infants records?
 
JENNIFER SPRAGUE:
I was. Yes.
 
DR. KIRK HEILBRUN:
And um looking at the women and infants records um on page nine I have here um it states that patient was offered several options for her including inpatient treatment for medication management, a partial hospital program focused on general mental health or continued outpatient management. Patient plans to follow up with her outpatient provider for guidance. So even though they said she didn't necessarily fit into their postpartum program, they did offer her three other programs. Correct.
 
JENNIFER SPRAGUE:
They did. Yes.
 
DR. KIRK HEILBRUN:
And her response, Miss Clancy's response was that she was going to discuss that with her provider for guidance. Correct.
 
DR. KIRK HEILBRUN:
Yes.
 
JENNIFER SPRAGUE:
And in reviewing the records of um Dr. Tufts and Rebecca Jollotta. Did you ever see any mention of the defendant actually following through with that and discussing with them those three options that were offered by women and infants?
 
DR. KIRK HEILBRUN:
No, what I saw is that they were back to uh being treated um according to their the plan and the medication and so on, but but she she was back to being treated uh discussing with Dr. Tufts what the what the the best implications were for treatment.
 
JENNIFER SPRAGUE:
Okay. And then you were about to talk about um what happened at McLean. So, if you could please tell us what you learned about um McLean and how that was impactful to your analysis or your evaluation.
 
DR. KIRK HEILBRUN:
Yes. Uh she was admitted to McLean on January 1st of 2023 and what got her there was suicidal thinking. Uh that was very difficult for her. That was a very difficult uh time to experience that sort of thing. And so she went into McLean on January 1st and their admission documentation listed postpartum depression and major depressive disorder which they described as recurrent and mild. While she was in McLean, what she reported as her primary concern was insomnia. And she said that while she was hospitalized, uh it actually made her more anxious than being at home. And when she was asked about the suicidal impulses and and thoughts, she said that she would not commit suicide because of her children and her mother. So she had some that they ask about reasons for living among other things and and those were some of the ones that she cited.
 
JENNIFER SPRAGUE:
Doctor, would those be uh would that be called a protective factor?
 
DR. KIRK HEILBRUN:
Yes, sometimes it's called a protective factor
 
JENNIFER SPRAGUE:
and that's something that protects you or prevents you from from committing suicide. Yes. Would keep you from from doing something like that.
 
## MCLEAN HOSPITAL AND MEDICATION RESPONSE — 4:18:42
 
JENNIFER SPRAGUE:
And then what were your further findings?
 
DR. KIRK HEILBRUN:
Uh so she she stayed at McLean for uh five days and she was documented as not having safety concerns and uh at minimal risk for returning to the community uh by January 3rd. Uh she described her mood there as numb. Uh but she denied things like delusions or hallucinations or suicidal thoughts that were continuing or or homicidal thinking. And at the time she was discharged on the 5th of January, she was described as cooperative and pleasant uh with no psychosis uh no suicidal or homicidal thinking. Um, and she said, uh, when I was asking her about it that when she left McLean, she had a what she described as a small shred of hope uh, after discharge because she was off of medication CQL, which she thought was causing her a lot of trouble. and but but the intrusive suicidal thoughts uh returned she said within a week or so following her discharge from McLean
 
JENNIFER SPRAGUE:
and um would we be moving on now to number three on your PowerPoint?
 
DR. KIRK HEILBRUN:
Yes, we are.
 
JENNIFER SPRAGUE:
Symptoms following the beginning of medication. So, what were your major findings in that area?
 
DR. KIRK HEILBRUN:
Well, I I I I have I think I've combined two and three as I've talked about this because one of the things about this is after she started taking the medication in October, the Zoloft, she had uh the anxiety didn't get better. uh she had difficulty with great difficulty with insomnia and she she said she she was numb. She felt like a like a zombie. Uh it wasn't something that she was able to uh to see any improvement in. In fact, she thought uh it was getting a lot worse. And so so basically the what she thought is that the symptoms that she was experiencing following uh following taking the the medication that was prescribed beginning in October. She said the symptoms uh were getting worse uh particularly particularly a new symptom which was insomnia.
 
JENNIFER SPRAGUE:
We could move on to the next slide.
 
JENNIFER SPRAGUE:
Uh doctor and does that bring us to number four on your PowerPoint?
 
DR. KIRK HEILBRUN:
the adverse response to medications including bad insomnia.
 
DR. KIRK HEILBRUN:
Yes. And I won't take nearly as long in talking about that because one of the things that she thought was happening when she began taking that medication in October is that it was the medication itself was far from making the anxiety better. It was making it worse and keeping her from sleeping and and it was she thought making it difficult for her to uh she she thought that the the medication was actually uh making it a real problem for her to uh uh to sleep to feel she felt emotionally numb and that sort of thing. And so accompanying the bad insomnia with the apparent adverse responses producing the insomnia and other things was a real problem for her as she saw it. And it's one of the things that she continued to emphasize to providers whether it was Dr. Tufts or Miss Jollotta, a nurse practitioner. She said basically uh I think this is I think these medications are making me worse. Uh but uh one of the things moving on to number five there. One of the things she also said is that um she she was focusing on making the anxiety helping the anxiety get better through medication. There was a little bit of counseling going on with Miss Jollotta, but one of the things that she she did not really have was uh say a cognitive behavioral therapist or something like that to help her uh work through the uh the problems. She thought uh that that medication was going to try to help and she and it really did. Uh it was something that she focused on a a good deal. Um,
 
JENNIFER SPRAGUE:
and when you say she was focused, the defendant was focused on um medication resolving her problems, uh, would that include, uh, talking to doctors about different medications to try, re researching medications on her own, asking friends and family for for tips on medications, things like that?
 
DR. KIRK HEILBRUN:
Yes. All of those things.
 
JENNIFER SPRAGUE:
Okay. And um, then should we move on to number six, the mixed evidence about diagnosis and the nature of her problems?
 
DR. KIRK HEILBRUN:
Yes. And what were your major findings in that area? over the course of the time that she was going through these experiences between midocctober and uh late January. She'd had a lot of providers offer a lot of diagnosis uh and there were a lot of complicating considerations. So among some of the diagnoses that she'd been given were adjustment disorder with anxiety and depression, uh generalized anxiety disorder, major depressive disorder, bipolar disorder, bipolar disorder 2, postpartum depression, postpartum psychosis, uh post-traumatic stress disorder, that that last one was not uh before January of 2023, uh but it's something that she has right now. And in addition to those diagnoses which sort of implies that that she has a disorder and she has symptoms there were complicating factors. Uh uh she had um psychotropic medication with apparent adverse reaction. She had serious sleep deprivation over a 3-month period. She had uh between 5 and 8 months after the birth of her third child. She had anxiety about returning to work in the fall of 22. Uh she was worried about leaving her baby for work. Uh and and he was not uh taking the bottle. And and the other thing which was important for her is she was always someone who was uh she was into exercise and she stopped exercising sometime in October when she started having these adverse reactions. But it's one of these things that she it was a real difficult thing for her to handle when she couldn't do the running or the yoga or the pelaton or other things that she used to keep her her anxiety managed.
 
JENNIFER SPRAGUE:
Were you aware that she was able to return to exercising on several dates in December and in January going to the Kingsbury Club where she was a member?
 
JENNIFER SPRAGUE:
Uh yes, she was she was trying that. Yes. Yeah. And and is that something that um as putting on your clinician hat for a moment, is that something that you would recommend to a patient that they in this situation that they try to do things like exercise to to complement uh medication and therapy?
 
JENNIFER SPRAGUE:
Well, if it works, uh it it does work for some people and they use it effectively over the course of their lives, particularly if they have some anxiety that might not fully need treatment, but it's something that might interfere with your life a little bit. And um what were your next observations?
 
DR. KIRK HEILBRUN:
Well, if we could move on to the next uh slide, please.
 
## BIPOLAR II DIAGNOSIS — 4:28:37
 
JENNIFER SPRAGUE:
So, here we have number seven, your diagnosis bipolar 2 disorder. So, um it was that your diagnosis of Miss Clancy?
 
DR. KIRK HEILBRUN:
It was. And it was it was hard because of all the diagnoses in the records and all the symptoms that she experienced and so on. uh to make a diagnosis of bipolar disorder or bipolar 2 disorder, which is a kind of a a less serious way of uh experiencing bipolar disorder, you have to have identifiable mood swings. And one is a a period of depression, which she she certainly certainly had, but a period of depression. And that was something that made a uh a big difference over a certain period of time and depressed symptoms and and sadness and uh and and not having much uh or not having much motivation and things like that. But you also for a bipolar diagnosis uh need something where you have an identifiable period where the mood is uh much greater uh it's it's much one of the things that I might say is that one feels during a manic period uh sort of high jumpy decreased need for sleep racing thoughts uh sort sort of flight of ideas, thinking really fast, uh excessive appetites uh for different kinds of things, uh not getting tired, uh feeling important and powerful and things like that. And uh I was having a hard time finding something that looked like it was a manic episode. There were times when she felt, as she described it after the birth of different children, she felt good. She felt on top of the world. She felt really close to them, uh, her husband and her kids and so on. But, uh, it's also something that it didn't look like a manic episode so much as it looked like she was really feeling good and getting back into exercise and things like that. So, it's it's one of those considerations where the thing that sort of kept me gave me pause for a while in diagnosing a bipolar disorder is that I didn't see that manic episode. But what really convinced me is that she's been at Tewksbury now for more than three and a half years. And the diagnosis of record at Tewksbury is bipolar disorder. And they are, as I read the records, very careful about what they prescribe and how much and various other kinds of considerations. And one of the things that the records reflect is that uh when she was on some medication that's prescribed to help stabilize her mood and it was discontinued for medical reasons, she had a kind of immediate response to that, which is to say uh she noticed it and that's that's a consideration as well. So, I ended up with a diagnosis making a diagnosis of bipolar 2 disorder, which is a slightly less not slightly, it's a it's a less severe form of bipolar disorder. Um,
 
JENNIFER SPRAGUE:
and doctor, why did you why did you diagnose with bipolar 2 and not bipolar?
 
DR. KIRK HEILBRUN:
Uh, because bipolar, as I said, is a more severe kind of diagnosis. It's it's more noticeable. And if you had a bipolar diagnosis, then I would want to see something that looks that clearly and definitely looks like a manic episode. And I did not see any evidence of that before January 24th of 2023.
 
JENNIFER SPRAGUE:
And there were some incidents that have been described by witnesses who have testified and in the medical records, things like uh the defendant cleaning out her garage with her husband um at one point in time. Was that something that you did or did not see as manic and why?
 
DR. KIRK HEILBRUN:
Well, there was some indication in the records uh that some people thought it was manic. Uh I did not see it that way. Uh she did not describe when I asked her uh whether she did not describe that as a manic episode. She didn't think it was. And when I talked to Patrick Clancy, he said he didn't think it was either. And basically it was cleaning out the garage and getting a lot of uh getting a lot of stuff into 20 trash bags and so on. But the one of the things he said is, you know, they were both working hard, but it wasn't all her out there putting stuff in 20 trash bags and he wasn't a part of it. He said he was definitely a part of it.
 
JENNIFER SPRAGUE:
Okay. And um would it be accurate that um bipolar disorder requires that period of mania for I believe it's 7 days where bipolar 2 requires hypomomania for 4 days? Is that right?
 
DR. KIRK HEILBRUN:
Yes, that's right. Okay.
 
JENNIFER SPRAGUE:
And so did you see signs of hypomomania?
 
DR. KIRK HEILBRUN:
Well, that's something where it's less clear that it's manic. And that's one of the the things that inclined me toward bipolar 2 is I just did not see signs that were clearly manic episodes, but it looked like something that it possibly could have been a a less serious or less severe manic episode. And in terms of this diagnosis, this bipolar too, is there a way to determine whether she always had this disorder or if it's something new and if it's something new when it appeared. It's a disorder that typically comes on in adulthood. It's not something that you have as a kid or or even for the most part as as an adolescent. It's something that you start to show the signs of when you are in your 20s or 30s.
 
JENNIFER SPRAGUE:
Okay. Um and so at this point, would it be time to move on to number eight on your PowerPoint?
 
DR. KIRK HEILBRUN:
Yes.
 
## CRIMINAL-RESPONSIBILITY STANDARD — 4:35:10
 
JENNIFER SPRAGUE:
Um which would be criminal responsibility evaluation. So mental, state, and legal standard are relevant. So, what were your findings um on number eight?
 
JENNIFER SPRAGUE:
Well, one of the things that I wanted to say about number eight is that I wasn't called up here just to make a diagnosis or talk about symptoms. Uh this is a criminal responsibility evaluation. And one of the things that I take a look at very carefully when I'm doing something like this is what's the standard for criminal responsibility in the jurisdiction. Now, I'm aware that the court will instruct the jury about the standard and how you apply it and so on, but my understanding of the standard for criminal responsibility in Massachusetts is that a person is not criminally responsible if at the time of the offense they suffered from a mental disease or defect and as a result lacked substantial capacity either to appreciate the criminality or wrongfulness of their conduct. or to conform their conduct to the requirements of the law. So there were really three parts there really are three parts to that uh criminal responsibility standard. The first is mental disease or defect and that's one of the reasons why I I have paid so much attention to the symptoms and when they began and things like that. But the other thing that I try to do is take those symptoms and see how they affect uh somebody in this case Miss Clancy's capacity for knowing uh that that something like this was illegal or wrong or how they affected her capacity for conforming her conduct to the requirements of the law which I think of as kind of controlling her behavior and um and to to determine is that something that those three elements are those things that you kept in mind throughout your evaluation of the records and your interview of the defendant um and the psychological testing that you did?
 
DR. KIRK HEILBRUN:
It is. Yes. And it's something that I put on page one of my report because I always try to do that to try to make it as clear as I can that this is something I'm paying attention to throughout the entire evaluation. So that's your mindset when approaching um the evaluation of Miss Clancy.
 
DR. KIRK HEILBRUN:
It is. Yes.
 
JENNIFER SPRAGUE:
Okay. And um so what types of psychological testing u did you do with Miss Clancy?
 
DR. KIRK HEILBRUN:
Um there were several reasons why I wanted to do psychological testing. Uh one is what we call response style. In a matter like this, somebody like Miss Clancy during an interview could respond what we call reliably, which is within the limits of her memory as accurately as she possibly can. But there are other response styles. One is that somebody could do what we call exaggeration or even fabrication. Sometimes that's called malingering, which is they distort the um or they they take uh the kind of report that they do and they exaggerate or even fabricate the severity of of what they are experiencing. Uh and then the other kind of response style is to under reportport basically to say um I'm going to minimize or even deny things that I actually experience. So response style is always important in doing a forensic evaluation like this and I paid attention to it and one of the psychological tests that I administered something called the Minnesota multifphasic personality inventory uh has scales that allow me to look and say is she uh is she being kind of reliable or is she exaggerating or fabricating or is she minimizing or denying. So that was one of the reasons that I wanted to do these tests. The second is I wanted to pay attention to possible symptoms of what we call severe mental illness. Things like hallucinations or delusions or mental disorganization. uh they can't really uh kind of focus on what's being discussed so much as you tend to get off track or or have tangential speech which is uh kind of running off uh off the topic and going to different uh different ways and so on. Cognitive disorganization is another speech. Uh uh there's also review of her uh reported symptoms around January 24th of 2023 and I wanted to ask her questions in a fairly comprehensive way about that. There are other symptoms that she was experiencing reportedly depression uh in particular and I wanted to know uh how depressed she was feeling. And so that was something that I could also measure with these psychological tests. And then finally, suicidal thinking was quite important. Uh and I wanted to ask her questions about her thinking and feeling and behavior related to suicide kind of leading up to January 24th and then around that time. So these are all reasons why I gave her psychological tests.
 
## PSYCHOLOGICAL TESTING AND AFTERNOON RECESS — 4:41:07
 
JENNIFER SPRAGUE:
Can I have you pause there for just for a moment?
 
DR. KIRK HEILBRUN:
Yes. I'm not sure if if it's a good time to break.
 
HONORABLE WILLIAM SULLIVAN:
Good time to to break. All right. Why don't we do that? This uh Thank you. All right. So, members of the jury, we're going to uh take the afternoon recess at this point. Uh you know, my instructions, so they're going to be the same. Don't talk about this case. Don't do any research about this case. Don't listen to anything about it. Don't read anything about it. Uh have a nice break, and we'll have you come back here about 2:00. Okay.
 
COURT OFFICER:
Of course. All right.
 
HONORABLE WILLIAM SULLIVAN:
All right. Good. Close your notebooks. Place them on your chair. Just like this. All right, doc. You may step down.

Deanna · Aug 25, 2026, 6:10 AM · #post-141

COURT RESUMES AND WITNESS IS CALLED — 3:36:17
 
CLERK:
honor, for the purpose of the record, we return back to the trial of Commonwealth versus Lindsay Clancy. All parties are present, excluding the jury.
 
HONORABLE WILLIAM SULLIVAN:
All right. Commun, we ready for the jury?
 
JENNIFER SPRAGUE:
Yes, your honor.
 
BAILIFF:
All right. All right. And entering This court is now in session. Please be seated. for the return back to the trial of Commonwealth versus Lindsay Clancy and all parties are present including the defendant and including the 18 jurors.
 
HONORABLE WILLIAM SULLIVAN:
All right. Thank you, Madam Clerk. Uh Jennifer Sprague, you call your next witness.
 
JENNIFER SPRAGUE:
Thank you. Come call Dr. Kirk Heilbrun. Good morning, sir.
 
DR. KIRK HEILBRUN:
Good morning.
 
CLERK:
Start right here. Raise your right hand for the clerk, please.
 
CLERK:
Good morning. As long as the testimony here and she shall get to the court and the jury in the matter now coming between you
 
DR. KIRK HEILBRUN:
I do.
 
CLERK:
Thank you sir.
 
COURT OFFICER:
Watch your stuff please.
 
HONORABLE WILLIAM SULLIVAN:
All right. Good morning doctor.
 
DR. KIRK HEILBRUN:
Morning sir.
 
HONORABLE WILLIAM SULLIVAN:
Hi. I'm going to ask you to keep your voice up so the jury can hear you. And uh with that break.
 
## QUALIFICATIONS AND FORENSIC PRACTICE — 3:38:41
 
JENNIFER SPRAGUE:
Thank you honor. Good afternoon. Can you please state and spell your name for the record?
 
DR. KIRK HEILBRUN:
Yes. My name is Kirk Heilbrun. That's spelled K I R K. And then H E I L B R U N.
 
JENNIFER SPRAGUE:
What is your occupation?
 
DR. KIRK HEILBRUN:
I'm a psychologist. Uh I am uh in the department of psychology at Drexel University in Philadelphia. And uh as part of that I run two clinics. Uh one is uh a clinic where I conduct uh psychological evaluations for Thank you sir. um for courts and attorneys and the other is what we call the re-entry project where we provide uh assessment and uh treatment services to individuals who are either returning from uh federal prison or under the jurisdiction of a federal mental health court. uh or have been exonerated uh following a false conviction.
 
JENNIFER SPRAGUE:
And do you um specialize in certain areas of psychology?
 
DR. KIRK HEILBRUN:
Uh yes, I do. I'm a forensic psychologist and that means that I take the application of clinical psychology and I apply it to legal proceedings uh in criminal and civil matters.
 
JENNIFER SPRAGUE:
Can you describe your training in clinical psychology?
 
DR. KIRK HEILBRUN:
Yes, I can. uh I received a doctoral degree from the University of Texas at Austin in 1980. uh and I as part of that I was received training in uh various sorts of uh assessment and treatment and uh therapy and research and things like that. And then as also as part of that uh I was uh involved in a full-time uh internship uh between 1979 and 1980 at the University of Texas Health Science Center at San Antonio.
 
JENNIFER SPRAGUE:
And did you receive u specialized post-graduate training in forensic psychology?
 
DR. KIRK HEILBRUN:
I did. uh I received from 1981 to 1982 I did a post-doal fellowship in the applications of psychology to uh crime and criminal justice.
 
JENNIFER SPRAGUE:
And what did that involve?
 
DR. KIRK HEILBRUN:
uh that involved a full-time exposure to clinical work in correctional and forensic populations and also a thorough exposure to the clinical and research literature on assessment and interventions with these individuals.
 
JENNIFER SPRAGUE:
And um are you licensed to practice psychology?
 
DR. KIRK HEILBRUN:
I am licensed in the state of Pennsylvania and I'm also part of something called CYPACT which allows people licensed in one state to practice on a temporary basis in another state.
 
JENNIFER SPRAGUE:
And are you board certified in clinical psychology?
 
DR. KIRK HEILBRUN:
I'm board certified with the American Board of Professional Psychology, which is the older oldest and most rigorous kind of uh board certification agency uh organization in the country.
 
JENNIFER SPRAGUE:
And are you board certified in forensic psychology?
 
DR. KIRK HEILBRUN:
Yes, I'm also board certified in forensic psychology with the American Board of Professional Psychology.
 
JENNIFER SPRAGUE:
And do you have experience in the treatment of individuals found either incompetent to stand trial or not guilty due to lack of criminal responsibility?
 
DR. KIRK HEILBRUN:
I do. between uh 198 1982 and 1991. I was first a staff psychologist, then a chief psychologist at at the Florida State Hospital in Chattahuchi, Florida. And then between 1991 and 1994, uh I served as the clinical director of the forensic unit at Central State Hospital in Petersburg, Virginia. And at that time I was also serving as an associate professor in the department of psychiatry at the medical college of Virginia in Richmond. And as a part of these positions I had responsibilities for providing uh assessment and treatment services myself and also for supervising such services provided by others.
 
JENNIFER SPRAGUE:
And could you describe your job responsibilities at Drexel University?
 
DR. KIRK HEILBRUN:
I could uh I teach graduate and undergraduate courses in forensic assessment and law and psychology. uh and as part of the clinic that I mentioned a moment ago, I conduct forensic evaluations uh at the request of judges and attorneys and I supervise individuals who are providing services to the individuals who are either coming back to the community from uh from prison or under the jurisdiction of a federal mental health court uh or who are leaving prison having been exonerated following a false conviction. Uh and finally, I I conduct research and supervise students uh who are working in psychology and law areas.
 
JENNIFER SPRAGUE:
And have you conducted research in the areas of abnormal behavior and um criminality?
 
DR. KIRK HEILBRUN:
I have. Over the course of my career, I've published about 240 articles, chapters, and books in the areas of aggression and violence, uh, juveniles, uh, mentally disordered adult offenders, uh, forensic assessment, ethics, and malingering and deception. And two of my interests uh two of those interests that are particularly applicable to to the present case are risk assessment which helps us understand the influences contributing to violent behavior. Um and and also forensic mental health assessment where we consider the important principles and steps that are connected with psychological and psychiatric evaluations in legal contexts such as criminal or civil proceedings.
 
JENNIFER SPRAGUE:
And are you involved in providing continuing education to mental health and legal professionals?
 
DR. KIRK HEILBRUN:
Yes. Over the past 15 years, I've presented about 50 lectures and workshops in the areas of forensic assessment, uh risk assessment, treatment, uh sexual offenders, and ethics.
 
JENNIFER SPRAGUE:
And doctor, in your um experience in doing forensic evaluations and in teaching people how to do forensic evaluations, would you call someone you're doing a forensic evaluation on your patient?
 
DR. KIRK HEILBRUN:
No, I would call them perhaps someone who's being evaluated or an evalue or something like that. Uh they're not a patient because the role of therapist in treating a patient is different from the role of a psychologist or psychiatrist in conducting a forensic mental health assessment. Uh they're different in a number of different ways, but basically uh what we try to do uh as a as a forensic evaluator is we try our best to uh conduct a thorough evaluation uh in which we are out there and trying our best to be accurate and and uh just come up with something that is as true and accurate as we can possibly uh make it in terms of evaluating the the questions that we're asked when we're working as a therapist. Basically, we're we're working to help somebody improve in their uh in various kinds of uh difficulties that they're having in life, symptoms, problems, and that sort of thing. And the two can conflict sometimes because uh as a therapist, I just want to do my best to help somebody. As a forensic evaluator, I want to do my best to be as accurate and open and thorough as possible, even if it doesn't necessarily help someone.
 
JENNIFER SPRAGUE:
And seeing as you've treated patients and you've conducted forensic evaluations, would you conduct a forensic evaluation on one of your patients if requested?
 
JENNIFER SPRAGUE:
Uh, I would not. No. If I were asked to do that, I would explain that those are two different roles, that there is very likely a conflict of interest that could arise if I try to do both. And I would refer whoever requested it to another individual to to uh conduct the evaluation. And have you testified in cases um as a witness on issues like competence to stand trial, criminal responsibility at the time of an offense, civil commitment in other areas?
 
DR. KIRK HEILBRUN:
I have over the course of my career, I've testified about 330 times uh with adults and juveniles. Uh the issues have included things like transfer and sentencing, competence to stand trial, uh mental state at the time of the offense, uh civil commitment, and personal injury. I've testified on behalf of both the defense and the prosecution, and I've been qualified as an expert in juvenile criminal and civil litigation in both state and federal court. And I estimate that over the course of my career uh I have conducted uh about about 75% of the time I've conducted evaluation and testified on behalf of the defense. Uh and the remaining 25% have been uh conducted and testified on behalf of the prosecution or by order of the court. And have there been times in that 25% of your casework that you've been retained by the prosecution, say for a criminal responsibility evaluation, where you find that the defendant is not criminally responsible and you have to tell the prosecutor that.
 
DR. KIRK HEILBRUN:
Yes, that happens with the prosecutor and it also happens with the defense. And it's just something that we have to be able to do if we're in the profession of forensic psychology because if we are try to be thorough and accurate and impartial then sometimes the results will favor the whoever asked us to conduct the evaluation and sometimes they won't. And what they have to hear if the if the my findings don't favor them is that they're probably not going to want to use it.
 
JENNIFER SPRAGUE:
And is there something called retention bias?
 
## IMPARTIALITY AND RETENTION BIAS — 3:49:47
 
DR. KIRK HEILBRUN:
There is. That's something that's been discussed particularly in the last 10 or 15 years. And there are a number of different kinds of biases that the field has paid particular attention to uh potentially uh over the last 20 years or so. And retention bias is the the bias that is a part of what we can uh experience when we uh want to uh or inclined to favor the side that ask us to conduct the evaluation. And that's an important consideration and I I'm aware of it and I try to guard against it as much as possible by talking with others, getting multiple sources of information and a variety of other ways of doing that.
 
JENNIFER SPRAGUE:
So when you conduct an a a forensic evaluation, you're actively guarding against having that retention bias.
 
DR. KIRK HEILBRUN:
Yes. Now, have you specialized in any particular diagnosis or type of offense or legal question?
 
JENNIFER SPRAGUE:
I have not specialized in that way. Most of my forensic evaluation experience has been with uh criminal and juvenile matters and they have often included alleged crimes of violence. But I haven't specialized in in any particular kind of mental or emotional disorder, any particular kind of crime, anything like that.
 
JENNIFER SPRAGUE:
And when you say criminal and juvenile matters, are you referring to adults as the the criminal portion and juveniles as juvenile?
 
DR. KIRK HEILBRUN:
I am. Yes.
 
JENNIFER SPRAGUE:
Okay. And is do you find that there's a benefit to not focusing in on a particular um illness or diagnosis or type of offense?
 
DR. KIRK HEILBRUN:
Yes, I do. Uh the among the biases I talked about a minute ago, there's something called confirmation bias. And basically that's if you make up your mind earlier or inclined toward one particular diagnosis or uh anything like that then there can be a a real problem because when you get conflicting information that is information that's not consistent with that decision that you've made or leaned toward early on then the the problem becomes uh you pay attention to the information that's consistent with it and you stay away from the information that isn't. And so in some ways for me not specializing uh gives me an advantage because what I can do is come in and not be inclined toward any particular diagnosis or possible uh uh answer to a particular set of questions or particular hypothesis or anything like that. What I can do is do my best to look at the different possibilities and when there's evidence favoring one or supporting one, I'm inclined toward that and when there is not, then I set it aside.
 
JENNIFER SPRAGUE:
And have you had experience, leadership experience in your field?
 
DR. KIRK HEILBRUN:
I have. Yes. I I served as the chair of my department at Drexel for 15 years. And I've also served as the president of two national organizations. The two that are most strongly associated with forensic psychology in this country. One is the American Psychology Law Society and the other is the American Board of Forensic Psychology.
 
JENNIFER SPRAGUE:
And I'd move to submit Dr. Heilbrun's CD as the next exhibit
 
DR. KIRK HEILBRUN:
that may be admitted.
 
## EXPERT QUALIFICATION — 3:53:25
 
JENNIFER SPRAGUE:
Dr. Were you asked to conduct a forensic evaluation of Lindsay Clancy?
 
DR. KIRK HEILBRUN:
I was. Yes.
 
JENNIFER SPRAGUE:
And what did that entail?
 
DR. KIRK HEILBRUN:
That forensic evaluation?
 
## RECORDS, INTERVIEWS, AND EVALUATION METHOD — 3:53:49
 
JENNIFER SPRAGUE:
One of the things it entailed is uh doing my best to review a lot of information. uh to meet with Miss Clancy in an interview uh to speak with her in in particular about uh what happened around the time of the alleged offense to conduct collateral interviews with other individuals and review a a wide range of documents. And so I have been reviewing documents since January of 2025. Uh I had the opportunity to meet with Miss Clancy in April of this year, 2026. And at that time, uh spent three days with her along with Dr. Avram Mack. Uh one of those days, uh which was uh video video recorded, uh we talked about her background and a lot of information like that. the second day where I met with her myself and did not video that because some of these psychological tests are are are private and and they should not be uh uh videoed. Uh so we we did some psychological testing during that second day and then on the third day back with the video back with Dr. Mack, we talked with Miss Clancy about uh the things that she was thinking and feeling and doing around the time of the uh the alleged offense. And so, uh I mentioned that I reviewed records. Uh I've got a report sitting in front of me. Uh, and those records are spelled out over four pages. So, I'm not going to run through the whole list with you, but those records did include things like cell phone records, uh, the defense expert, uh, forensic psychiatric evaluation reports by Dr. Resnick and Dr. Spanelli, uh, some Department of Children of Family records, uh, digital forensic records, including texts and, uh, information that was provided by, uh, the, uh, the watch that she wore, the Apple Watch, and the, uh, the phone. uh variety of medical records, uh police investigative records, uh police interviews with many people and grand jury proceedings, uh as well as uh surveillance footage uh of the Clancy family going to uh various places, Museum of Science visit, Cape Carter, CVS, that sort of thing. And in total, you all the time that you took to review these documents, look at the evidence, interview and test Miss Clancy, approximately how much time have you spent on this case?
 
JENNIFER SPRAGUE:
About 180 hours uh prior to coming to Plymouth?
 
DR. KIRK HEILBRUN:
Uh so uh most of that was spent in reviewing records. Uh about 10 and a half hours was spent in meeting with Miss Clancy and doing the testing and then another uh hour and a half was spent in collateral interviews.
 
JENNIFER SPRAGUE:
And what did who did you interview in collateral interviews?
 
JENNIFER SPRAGUE:
I interviewed her former husband Patrick Clancy and his mother, Miss Clancy's uh mother-in-law, Sue Clancy. And uh did you also request to interview um Miss Clint's mother and sister?
 
DR. KIRK HEILBRUN:
Uh not her mother. I did request to interview her sister and I think she decided against that.
 
JENNIFER SPRAGUE:
Now you mentioned that when you interviewed Miss Clancy on the first and third days, you were with Dr. Mack. Correct.
 
DR. KIRK HEILBRUN:
Correct.
 
JENNIFER SPRAGUE:
Why is it that you two were interviewing Miss Clancy together on those days?
 
DR. KIRK HEILBRUN:
Well, that's something that I do sometimes conduct a joint interview that's done in training contexts, for example, a fair amount. And in this case, uh many of the questions that we were going to ask her, uh a large number of the questions that we're going to ask her about her background and her history were going to be similar. So, we were able to uh conduct those uh ask those questions in a way and save some time, keep her from having to go through and ask and answer them twice. Uh then the third day, again, many of the questions that we were going to ask had to do with her thinking, feeling, and behavior leading up to the time of January 24th. And basically it involves kind of a stepbystep process going very slowly getting a lot of detail. And I expected we expected that that many of those questions sort of stepby-step detail were going to be things that we we would uh be able to work on or or they were going to be things that we could uh ask twice or we could ask once and see it on the video. And in terms of your interviewing Miss Clancy together, after that was done, did you the two of you come up with a joint opinion on a diagnosis?
 
JENNIFER SPRAGUE:
We did not. know that it although we were interviewing her together on two days, we took that information and we each independently came up with our own report, our own review of that information, our own analysis of what it meant and so on. So no, uh we wrote separate reports. We actually did not agree on the diagnosis. Um,
 
JENNIFER SPRAGUE:
now if we could have the PowerPoint in terms of your evaluation of Miss Clancy, including the records and um the collateral interviews and your interviews of her, did you um form some main conclusions?

Deanna · Aug 25, 2026, 6:10 AM · #post-140

POSTPARTUM DIAGNOSTIC TIMEFRAMES — 1:47:03
 
KEVIN REDDINGTON:
What I would have intended to say,
 
HONORABLE WILLIAM SULLIVAN:
no, what did you say to the Come on. What did you say to the jury last Friday? Doctor, please listen to the question and just answer the question as asked. Okay. And then if the Commonwealth has any redirect, they can follow up uh with their questions. Uh go ahead.
 
KEVIN REDDINGTON:
Thank you.
 
KEVIN REDDINGTON:
Do you recall saying that the person has to be postpartum within 4 weeks according to the DSM?
 
DR. AVRAM MACK:
Recall saying that. Yeah.
 
KEVIN REDDINGTON:
Right. Well, do you understand, sir, that every woman that has a baby for the rest of their life is postpartum?
 
DR. AVRAM MACK:
Because postpartum quite frankly means having a baby, right?
 
DR. AVRAM MACK:
Sure.
 
KEVIN REDDINGTON:
So,
 
DR. AVRAM MACK:
but that wouldn't be the specifier of with postpartum onset.
 
KEVIN REDDINGTON:
Yeah. But you can't postpartum is not a disease doctor.
 
DR. AVRAM MACK:
Postpartum application that is defined in terms of four weeks.
 
KEVIN REDDINGTON:
Okay. According to you, right? You understand that World Health Organization is different, right?
 
DR. AVRAM MACK:
If you're talking about the ICD,
 
KEVIN REDDINGTON:
what is what is what is that time frame, sir?
 
DR. AVRAM MACK:
I'm not sure what it is. I think you said it was 12 weeks.
 
KEVIN REDDINGTON:
How about the uh proposal to amend the um DSM 5 text revision or TR? What's the proposal for that?
 
DR. AVRAM MACK:
Well, there's a proposal specifically around the proposed diagnosis called postpartum psychosis. And for that, it's a six-w week period. So, you've got four weeks, you got 6 weeks, you got 12 weeks. You would you agree, sir, that postpartum depression, postpartum psychosis can occur up to a year or even a year or longer?
 
DR. AVRAM MACK:
I don't know. But I am telling you what the DSM says in terms of how to diagnose it and how to code it.
 
KEVIN REDDINGTON:
Okay. Um you would agree sir that she is at Tukesberry with a diagnosis of bipolar, right?
 
DR. AVRAM MACK:
That may be among her diagnosis.
 
KEVIN REDDINGTON:
Okay. And she's on medication, right?
 
DR. AVRAM MACK:
Yes. and she hasn't had over the past three and a half years any problems with sleep, anxiety, uh depression, symptomology of the same while she's been medicated at Tewksbury, right?
 
KEVIN REDDINGTON:
She has not demonstrated any signs of mania
 
KEVIN REDDINGTON:
and she hasn't demonstrated any signs of anxiety either, has she?
 
DR. AVRAM MACK:
While she's been on the medication, the right medication, right? I note that she's complaining of anxiety. I'm not sure she's demonstrating signs of anxiety.
 
KEVIN REDDINGTON:
Um other than the fact that she's paralyzed and has to be in a wheelchair, um she's not exhibiting u the inability to bathe, uh the inability to emote, to have feelings, to talk to people. She's able to communicate with people, right?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
Okay. Do you know what medications that she's on while she's at Tewksbury?
 
DR. AVRAM MACK:
Um, she's taking I think we discussed this the other day. Um, a low dose of Zyprea. Um, I believe Clonodine and Trazadone and Propranol occasionally.
 
KEVIN REDDINGTON:
Okay. Now, after you had a chance to review the medical records from Dr. Tufts, which would be from end of September of 22 up through October of 22, for example, initial prescription, right?
 
DR. AVRAM MACK:
I've reviewed all the records from Dr. Toss. Yes.
 
KEVIN REDDINGTON:
And and you recall what the first prescription was that she got, right?
 
DR. AVRAM MACK:
searching
 
KEVIN REDDINGTON:
and that would be what 25?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
Was that increased?
 
DR. AVRAM MACK:
It was.
 
KEVIN REDDINGTON:
And was there an issue or a problem according to Lindsay when that was increased from 25 to 50?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
And what was the problem that she indicated to the doctor?
 
KEVIN REDDINGTON:
She wanted to sleep but she was finding it hard to sleep. She was unable to sleep for a period in excess of 48 hours is what she said, right?
 
DR. AVRAM MACK:
Um I I think it was at that point. Um yes.
 
KEVIN REDDINGTON:
And also she indicated that there was in her opinion symptoms that she didn't really have a need to sleep even though she had gone 48 hours without sleeping. Right.
 
DR. AVRAM MACK:
No, she wanted to sleep.
 
KEVIN REDDINGTON:
Well, would you agree with me, sir? was tolerating. She she described that she was tolerating during the daytime uh and functional uh sufficiently without the sleep, but um she found that she was trying very hard to sleep and she couldn't sleep.
 
KEVIN REDDINGTON:
And do you recall her indicating that she did not feel regardless of 48 hours straight without sleep that she had a need?
 
DR. AVRAM MACK:
She said she didn't feel like she had a need to sleep. Did you see that in the records? Uh, I'm not sure that it would be characterized that way.
 
KEVIN REDDINGTON:
Did you see Okay. Did you see anything in the record one at a time?
 
DR. AVRAM MACK:
Go ahead, Mr. Rig.
 
KEVIN REDDINGTON:
Did you see anything in the records that indicated that she complained of the fact that she had gone 48 hours without sleeping after she was on the searchine and then felt that she did not need to sleep even though she'd been without for 48 hours?
 
DR. AVRAM MACK:
I don't exactly recall what was written by um Dr. Tufts, but she described to me um that in that period.
 
KEVIN REDDINGTON:
Doctor, I'm asking you about the medical records, not what you think she told you 3 years later. The medical records,
 
KEVIN REDDINGTON:
the medical records review the fact that she was not able to sleep. And would you agree with me that one of the symptoms, sir, that you would be concerned about as a psychiatrist is when a when a when a a woman who is postpartum after having a baby is complaining of a number of symptoms. One of which is that she went a long period of time unable to sleep but didn't feel that she had the need to sleep. That's textbook, isn't it?
 
DR. AVRAM MACK:
Well, the DSM textbook refers to a decreased need for sleep as the seventh element of mania.
 
KEVIN REDDINGTON:
Okay. So, that is an indisha of mania. Is that can I get that out of you?
 
DR. AVRAM MACK:
The way it's written is a decreased need for sleep.
 
KEVIN REDDINGTON:
Okay.
 
DR. AVRAM MACK:
I don't know. And in the medical gohead,
 
KEVIN REDDINGTON:
I think she desperately wanted to sleep. Is that what you think sir or is that what your opinion is based on the medical records?
 
DR. AVRAM MACK:
Uh that is my understanding based on the totality of the information.
 
KEVIN REDDINGTON:
Okay. So is it your understanding that she also exhibited signs or or symptoms of postpartum depression?
 
DR. AVRAM MACK:
So to the extent that she had depression in a period after having had a baby um that is not how DSM would refer to it but as you said everybody would be postpartum in that regard. So my opinion is that she had major depressive episodes in this year um or within four or five months following birth.
 
DR. AVRAM MACK:
Sure. You're familiar with the uh postpartum psychosis. You're familiar with that, right?
 
KEVIN REDDINGTON:
So, there's the concept of having psychosis.
 
KEVIN REDDINGTON:
Are you familiar with postpartum psychosis, sir?
 
DR. AVRAM MACK:
Yes or no? I'm familiar with a proposed diagnostic entity called postpartum psychosis and the idea that people can have psychosis as a mental disorder at other times.
 
KEVIN REDDINGTON:
You're familiar with the department of mental health in Massachusetts, right?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
You're familiar with the funding of the department of mental health for the Massachusetts child psychiatry access product. You're you're you're familiar with that, right?
 
DR. AVRAM MACK:
No.
 
KEVIN REDDINGTON:
Called the MCPAP that focuses on postpartum psychosis and postpartum depression. Are you familiar with that, sir?
 
DR. AVRAM MACK:
No.
 
KEVIN REDDINGTON:
Would you agree with me that when a person has a child and is within the postpartum period that they may present to a doctor with symptoms that might lead the doctor to believe that they are suffering from postpartum depression?
 
KEVIN REDDINGTON:
Would you agree with that?
 
DR. AVRAM MACK:
I'm not familiar with that particular program. I'm happy to
 
KEVIN REDDINGTON:
Right. I'm no I know you're happy but I'm just asking sir about postpartum depression. Forget the program. You're not familiar with the program. We get it. I'm asking you now sir about your familiarity with postpartum depression.
 
DR. AVRAM MACK:
Yeah.
 
KEVIN REDDINGTON:
Okay. Um and there are symptoms of postpartum depression. Fair to say
 
DR. AVRAM MACK:
postpartum depression.
 
KEVIN REDDINGTON:
Are there symptoms sir?
 
DR. AVRAM MACK:
Yes.
 
DR. AVRAM MACK:
I am familiar.
 
KEVIN REDDINGTON:
Okay. and and forget the DSM. Let's just focus on the symptoms as you understand it for postpartum depression, which according to you has to occur within the first four weeks of birth. But quite frankly, it could be 6 weeks, it could be 12 weeks, it could be a year, right? You said forget the DSM except that making diagnoses in psychiatry requires an authority and we utilize in this country the DSM.
 
DR. AVRAM MACK:
Maybe we shouldn't.
 
DR. AVRAM MACK:
No.
 
HONORABLE WILLIAM SULLIVAN:
Sustain. Next question.
 
KEVIN REDDINGTON:
So are you familiar, sir? You're not familiar with MCPAP for mothers in Massachusetts. You're not familiar with with that subsidiary of the Department of Mental Health, right?
 
DR. AVRAM MACK:
No. Are you familiar with the department of mental health postpartum psychosis provider training? In other words, what the LCWs are learning and what the psychologists or psychiatrists working for the DMH are learning about postpartum depression, postpartum psychosis. Are you familiar with those standards?
 
DR. AVRAM MACK:
No.
 
KEVIN REDDINGTON:
How about the the uh Edinburg postnatal depression scale?
 
DR. AVRAM MACK:
We talked about that Friday. You're familiar with that, sir?
 
DR. AVRAM MACK:
I am. But you don't feel it's important. You think the regular GAD scale, general anxiety scale is sufficient, I guess. Right.
 
DR. AVRAM MACK:
I don't think I've said that.
 
KEVIN REDDINGTON:
Oh, okay. So, do you think that the Edenberg postnatal depression scale is important as a tool for a diagnosing physician dealing with a woman that's within the time frame and exhibiting symptoms of postpartum depression?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
Okay. So, what was Lindsay's scale if you know now? You had the weekend, I imagine, to look it up.
 
DR. AVRAM MACK:
I don't offhand know what it was.
 
KEVIN REDDINGTON:
Okay. So, if I offhand told you that it was pretty much off the chart, would that have any impact on on your opinion as to the utility of the post natal depression scale that was administered to her?
 
DR. AVRAM MACK:
Question.
 
HONORABLE WILLIAM SULLIVAN:
No, sustained. I mean, overruled to me as sorry. It's a scale that elicits distress, which she had, and it elicits depression, which she had. And it's not just limited to distress and depression. It's it's focused on, and again, I'll read it, the Edenberg postnatal depression scale. Right.
 
KEVIN REDDINGTON:
Right.
 
DR. AVRAM MACK:
So, no, the answer is right.
 
KEVIN REDDINGTON:
Had diagnosis of depression. She was being treated for All right. So, you in any event, you don't utilize apparently the uh EPDS, right? You don't utilize it in your practice, whatever that may be.
 
DR. AVRAM MACK:
Correct.
 
KEVIN REDDINGTON:
Okay.
 
## POSTPARTUM SCREENING AND SYMPTOMS — 1:58:29
 
DR. AVRAM MACK:
Not that I'm against it. I just haven't had the opportunity to use it in some.
 
KEVIN REDDINGTON:
Just like you think that, you know, an epistoottomy is a tear, I guess, when a person has a baby, right?
 
DR. AVRAM MACK:
I'm sorry. You remember Friday you said that when a baby is born and and the woman suffers a tear that you called it a particular name
 
KEVIN REDDINGTON:
an aesiottomy
 
DR. AVRAM MACK:
right
 
KEVIN REDDINGTON:
when there's a need for repair for a tear there are several different
 
DR. AVRAM MACK:
No no no no wait a minute hold on now hold on excuse me sir Friday you said that the pesio is in fact a tear do you remember saying that
 
DR. AVRAM MACK:
I'm not sure exactly the wording Did somebody tell you that you were way off base on that testimony Friday, sir?
 
DR. AVRAM MACK:
I'm not sure what you're referring to.
 
DR. AVRAM MACK:
I'm referring to you saying that an aziottomy is a tear. And it's not.
 
KEVIN REDDINGTON:
Can your honor, is there a question before the witness?
 
DR. AVRAM MACK:
I
 
KEVIN REDDINGTON:
I already asked the question. I'm looking at him staring back at me. All right. I want you
 
DR. AVRAM MACK:
the last
 
KEVIN REDDINGTON:
just hold on. Oh, you can rephrase that.
 
KEVIN REDDINGTON:
Do you remember saying Friday that piottomy is a tear? Do you remember saying that to this jury, sir?
 
DR. AVRAM MACK:
I don't remember the exact words that I stated.
 
KEVIN REDDINGTON:
Okay. Did anybody did anybody?
 
KEVIN REDDINGTON:
Did anybody over the weekend tell you that in fact you were wrong and that it is a surgical procedure and that a natural tear has nothing to do with that procedure other than repairing? Did anybody talk to you about that at all over the weekend?
 
DR. AVRAM MACK:
No.
 
KEVIN REDDINGTON:
Okay.
 
DR. AVRAM MACK:
No. So, you would agree with me at least that postpartum depression, even though you don't use the EPDS, does have symptoms that a doctor would consider if a patient came to him or her for help, right?
 
DR. AVRAM MACK:
Yes or no? Yes or no? You're asking me about a condition which is not the way that defined.
 
DR. AVRAM MACK:
I'm asking you sir whether or not you understand as a doctor that if a woman has a baby and comes to you because she is in trouble that you would look for symptoms.
 
KEVIN REDDINGTON:
Would you not?
 
DR. AVRAM MACK:
Yes or no?
 
KEVIN REDDINGTON:
Yeah.
 
KEVIN REDDINGTON:
Okay.
 
KEVIN REDDINGTON:
Yeah. And if the woman told you that she was less able to laugh, no emotion, unable to see the funny side, is that a symptom, sir, in your opinion of postpartum depression?
 
DR. AVRAM MACK:
Yes or no?
 
DR. AVRAM MACK:
It's a symptom of depression.
 
KEVIN REDDINGTON:
Was Lindsay Clancy complaining that she was unable to laugh or emote or see the funny side, if you will, of life when she went to see Dr. Tufts and Dr. Jollotta? Do you recall that, sir?
 
DR. AVRAM MACK:
Yes. Okay. Okay. Okay. So let's just say the next issue would be stopped looking forward to things. You're familiar with that. People don't look forward to things and they what is that called? Anahedonia or something like that.
 
KEVIN REDDINGTON:
Right. So the other that was one of the several elements of major depressive episode that I referred to the other day.
 
DR. AVRAM MACK:
Right. But it's also one of the symptoms of postpartum depression. Correct.
 
KEVIN REDDINGTON:
They are the same. When you have depression and you meet the qualifier, then you can call it you can call it depression with postpartum onset.
 
KEVIN REDDINGTON:
How about a person that comes to you and says that they're anxious and worried constantly for no good reason. Would you agree, sir, yes or no, that that's a symptom of postpartum depression according to the authorities?
 
DR. AVRAM MACK:
So,
 
KEVIN REDDINGTON:
can you answer that yes or no, sir?
 
DR. AVRAM MACK:
It's really easy.
 
KEVIN REDDINGTON:
Sir, hold on. If you can't answer the question as asked, doctor, just say you can't answer it as asked and I'll I'll ask counsel to rephrase it.
 
DR. AVRAM MACK:
Go ahead.
 
KEVIN REDDINGTON:
So, would you agree with me, sir, that the next symptom of postpartum depression would be anxious or worried for no good reason?
 
DR. AVRAM MACK:
So, I can't answer that question.
 
KEVIN REDDINGTON:
You can't. You can't.
 
DR. AVRAM MACK:
I said I can't.
 
KEVIN REDDINGTON:
Okay. Was Lindsay Clancy expressing to the doctors and the nurse practitioners and the LICSSWS or whatever on on the medical records that she was anxious and worried on a daily basis for no apparent reason?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
Did Lindsay Clancy also indicate that she was would have episodes of fear or panic for no good reason?
 
DR. AVRAM MACK:
Yes. Did she also indicate sir that she was overwhelmed by life? Basically overwhelmed.
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
Did she also indicate that she was so unhappy and worried and anxious that she had trouble sleeping?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
Did she indicate that she was sad or miserable and unable to enjoy things like family, friends, society?
 
DR. AVRAM MACK:
That is a symptom that progressed as those months moved on. Yes,
 
DR. AVRAM MACK:
sure did. Did she also say that she's unhappy? She was so unhappy that she was crying on a daily basis.
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
Does she also indicate that she had thoughts of harming herself?
 
KEVIN REDDINGTON:
Well, or suiciding?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
So, if she's successful in harming herself and she dies, then it's suicide. Either way, it's a thought of harming herself, right?
 
DR. AVRAM MACK:
I don't think she had the interest of harming herself simply for the interest of harming herself. She had the interest of suiciding.
 
KEVIN REDDINGTON:
Um, and she wasn't successful obviously, right?
 
KEVIN REDDINGTON:
Are you referring to January 24th?
 
DR. AVRAM MACK:
So the postpartum depression sir which invariably involves the EPDS which you don't use consists of one to 10 symptoms and she hits every one in the medical records that you reviewed. Is that correct?
 
KEVIN REDDINGTON:
First of all, I'm not sure what you're Well, I can't answer the question that you asked. I'll put
 
KEVIN REDDINGTON:
Let's talk about postpartum psychosis because that is something that can can follow postpartum depression. Is that right? You're using terms that make it that I can't answer your question.
 
KEVIN REDDINGTON:
Postpartum psychosis. You can't answer. You know what that is, don't you?
 
KEVIN REDDINGTON:
Are you referring to the proposed diagnosis that we referred to earlier?
 
DR. AVRAM MACK:
The one
 
DR. AVRAM MACK:
I'm referring to. The fact that this young lady was suffering from postpartum psychosis when she killed her kids. Do you do you know what postpartum psychosis means? So there is a observation that a person may have psychosis or there is the proposed diagnosis um that we referred to the other day. Let's do this symptoms of postpartum psychosis. Number one, hearing voices.
 
KEVIN REDDINGTON:
Would you agree, sir, that hearing voices is indicative of of having a symptom of postpartum psychosis?
 
KEVIN REDDINGTON:
You're referring to a condition or illness called postpartum psychosis, and I don't know that I can answer questions uh as a psychiatrist based on that.
 
KEVIN REDDINGTON:
Would you agree, sir, that when a a person is suffering from postpartum psychosis, you understand that term, do you not? When we elicit, Sarah,
 
KEVIN REDDINGTON:
do you understand the term postpartum psychosis, it's real easy. Do you understand that term?
 
DR. AVRAM MACK:
It's actually not easy.
 
DR. AVRAM MACK:
It's serious. But when we do elicit psychic
 
KEVIN REDDINGTON:
after a birth, we take it very seriously. Typically,
 
KEVIN REDDINGTON:
who's we?
 
KEVIN REDDINGTON:
Who's we?
 
KEVIN REDDINGTON:
We take it seriously. Who's we?
 
DR. AVRAM MACK:
We psychiatrists I as a psychiatrist.
 
KEVIN REDDINGTON:
Yeah. So would you agree with me sir that when you are diagnosing if you do a patient that's coming to you for help after having a baby so it's postpartum and has been through let's say postpartum depression and is now complaining of hearing voices or voice commanding her to act. That is a symptom of postpartum psychosis. Yes or no?
 
KEVIN REDDINGTON:
Is it
 
DR. AVRAM MACK:
that would be psychosis? I don't know exactly based on your hypothetical as to whether it would count as the proposed postpartum psychosis illness disease, but it certainly would be a concerning symptom or sign.
 
KEVIN REDDINGTON:
Okay. So if you had administered the uh Edenberg test, that is something that may have assisted you in evaluating the claim that the person is hearing voices because that's one of the things that that you would be concerned about with a patient, right?
 
KEVIN REDDINGTON:
You're always concerned if you're if you're encountering somebody who's hearing voices, especially if they're new,
 
KEVIN REDDINGTON:
especially if they're a mother, right?
 
DR. AVRAM MACK:
Anybody?
 
KEVIN REDDINGTON:
How about thought broadcasting? You ever heard of that?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
Okay. Um, how about a patient that says that they're worried about hearing voices and they're worried that people such as teachers could hear the voices in their head? Is that something that would concern you?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
How about if the person was afraid that uh somebody is able to hear the voices in their head and would call the police or DCF and they'd lose their kids? Is that something that would concern you
 
KEVIN REDDINGTON:
hypothetically?
 
DR. AVRAM MACK:
Yes, it would be a concern.
 
KEVIN REDDINGTON:
How about actually in this case with Lindsay Clancy? Did you come across that in all of your investigation?
 
DR. AVRAM MACK:
I came across in my evaluation um a period where she worried that people could hear what she was thinking. That's different first of all from thought broadcasting. But in either event, as I've said, she was in a serious uh psychiatric state and um she was suffering.
 
KEVIN REDDINGTON:
How about number two, postpartum psychosis symptomology?
 
DR. AVRAM MACK:
Delusional beliefs with distorted reality. Did she complain to TUS or Jollotta about having distorted reality being disassociated? Things weren't real. Do you recall coming across that?
 
KEVIN REDDINGTON:
So there were times that in the context of some of the medication she was taking that she felt um that things weren't real. Yes.
 
KEVIN REDDINGTON:
Okay. So
 
DR. AVRAM MACK:
my question my question
 
KEVIN REDDINGTON:
uncomfortable.
 
KEVIN REDDINGTON:
My question sir is whether or not she complained of that to her health care providers. You'd agree with me that she did right?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
Okay. How about appears normal in between episodes?
 
DR. AVRAM MACK:
Calm, even laughing.
 
KEVIN REDDINGTON:
Would you agree with me, sir, that postpartum psychosis waxes and waines?
 
DR. AVRAM MACK:
It comes and it goes, right?
 
KEVIN REDDINGTON:
So, are you referring to a particular
 
DR. AVRAM MACK:
I'm asking you a simple question. Do you agree that postpartum psychosis waxes and wanes that it can come out of nowhere and then leave and a person can appear normal? They can even laugh.
 
KEVIN REDDINGTON:
Would you agree with that?
 
DR. AVRAM MACK:
Sir,
 
KEVIN REDDINGTON:
are you referring to postpartum psychosis and illness
 
KEVIN REDDINGTON:
or the findings of psychosis in somebody's postpartum?
 
DR. AVRAM MACK:
I am asking you about Lindsay Clancy, the young lady that's sitting right here that you're testifying against in front of this jury, telling this jury that she was responsible for the death of her children. You with me?
 
DR. AVRAM MACK:
I'm not sure I understand exactly the context that you just stated.
 
KEVIN REDDINGTON:
Okay. The context I'm giving it is
 
DR. AVRAM MACK:
the national course of an illness called postpartum psychosis. That illness has not been refined. It's not something that we in psychiatry, at least as far as I'm aware, can talk about as an illness where we understand its typical course and
 
KEVIN REDDINGTON:
Okay, time out. Time out.
 
KEVIN REDDINGTON:
Hold on. Doc, you done with that answer?
 
DR. AVRAM MACK:
I'm done.
 
KEVIN REDDINGTON:
Okay, go ahead.
 
KEVIN REDDINGTON:
You're telling me, sir, that you don't basically you don't believe or buy postpartum psychosis. Is that what you're telling me?
 
DR. AVRAM MACK:
I didn't say that at all. Okay. So, you do believe that postpartum psychosis is a serious mental illness.
 
## MEDICATIONS, BLOODWORK, AND THYROID TESTING — 2:12:18
 
DR. AVRAM MACK:
I don't think it's a matter of belief or not belief. I'm aware of how to elicit the symptom or sign of psychosis. I am also aware that there's a proposal for an illness that would be recognized where we understand its typical course and how it progresses uh that has been proposed and that has not been approved for use in psychiatry in the
 
KEVIN REDDINGTON:
approved by who
 
DR. AVRAM MACK:
by the American Psychiatric Association
 
KEVIN REDDINGTON:
the the APA. So you
 
DR. AVRAM MACK:
by the team that let me if I can finish
 
DR. AVRAM MACK:
by the body within the American Psych.
 
KEVIN REDDINGTON:
Do you agree that postpartum psychosis is a legitimate disease or defect?
 
DR. AVRAM MACK:
Yes or no? When you have a symptom or sign of postpartum of psychosis at any time, but particularly in the postpartum period, it is a legitimate finding and something to be concerned about and to treat.
 
KEVIN REDDINGTON:
Okay. And when you say within the time frame, you're referring to the Dr. Matt time frame of four weeks, right?
 
DR. AVRAM MACK:
Uh, no. I think as I said anytime that a person has psychosis.
 
KEVIN REDDINGTON:
Okay. So
 
DR. AVRAM MACK:
the issue about four weeks has to do with how we would diagnose it or what wording we would use to diagnose it. But that doesn't have to do with the reality of the individual.
 
KEVIN REDDINGTON:
Okay?
 
DR. AVRAM MACK:
So anytime that there is a psychosis and if it's postpartum, you would agree that you can put the two words together and it's postpartum psychosis, right?
 
KEVIN REDDINGTON:
You would not utilize that in your diagnostic terminology. Well, you would agree, sir.
 
KEVIN REDDINGTON:
And you would be concerned about it, but according to the DFM, you would not utilize that.
 
DR. AVRAM MACK:
I'm sorry,
 
KEVIN REDDINGTON:
Dr. V. You could uh repeat that answer. Uh we had some problems following it. Go ahead. So the presence of psychosis is always of concern especially if it's new onset. To the extent that we are talking about the proper terminology of labeling something whether it is postpartum onset or not the DSM provides guidance as to the time frame that is different than my saying that it is a not serious condition. So symptom number one complaint according to the uh Mass General Hospital major research project along with the department of mental health dealing with postpartum psychosis would indicate that hearing voices a voice commanding her to act is a symptom of postpartum psychosis. Do you agree with that?
 
DR. AVRAM MACK:
Yes or no? Just give me a yes or no.
 
KEVIN REDDINGTON:
I can't answer.
 
KEVIN REDDINGTON:
Okay. The answer is no. The answer is no.
 
HONORABLE WILLIAM SULLIVAN:
All right. He just doesn't agree with it. Next question.
 
DR. AVRAM MACK:
Ask answer these questions several times now.
 
KEVIN REDDINGTON:
Really?
 
HONORABLE WILLIAM SULLIVAN:
Overruled. We're going to let him ask that question if you want to ask that again.
 
KEVIN REDDINGTON:
So, let's move on, sir, so we don't fight over number one. How about number two?
 
DR. AVRAM MACK:
Delusional beliefs, distorted reality.
 
KEVIN REDDINGTON:
Would you agree that that's a symptom of postpartum psychosis, sir?
 
DR. AVRAM MACK:
Yes or no?
 
KEVIN REDDINGTON:
You said number one. two. I don't know what authority you're referring to.
 
KEVIN REDDINGTON:
Do you agree, sir, that a symptom of postpartum psychosis, in addition to the hearing of the voices, would be delusional beliefs and a distorted reality?
 
DR. AVRAM MACK:
I can't answer because I still don't know if you're referring to the phenomenon of psychosis or you're referring to some illness. I'm referring to the illness that Lindsay Clancy was suffering. That's in her medical record, sir. That you tell this jury. You read. That's all I'm asking.
 
KEVIN REDDINGTON:
Well, I didn't find any OB uh evidence of psychosis in her record. Okay. Other than
 
KEVIN REDDINGTON:
Was there any indic Excuse me. Was there any indication that she was hearing voices? Did she complain about that, sir?
 
DR. AVRAM MACK:
Yes or no?
 
KEVIN REDDINGTON:
She complained about intrusive thoughts.
 
KEVIN REDDINGTON:
Okay.
 
DR. AVRAM MACK:
If that's where you're
 
KEVIN REDDINGTON:
How about the delusional beliefs and distorted reality? Do you recall her complaining about distorted reality, sir?
 
DR. AVRAM MACK:
Yes or no?
 
DR. AVRAM MACK:
I'm not sure she used those terms. If you're referring
 
DR. AVRAM MACK:
No, no, never mind what I'm referring to. Your answer is no, right?
 
DR. AVRAM MACK:
No, she did not display psychotic features.
 
KEVIN REDDINGTON:
I didn't ask about psychotic features. I'm asking you about delusional beliefs and distorted reality. Doctor,
 
DR. AVRAM MACK:
that is a type of psychosis. So, I didn't see any evidence of any psychotic features throughout the medical records.
 
KEVIN REDDINGTON:
So, it's your understanding from reviewing her medical records that Lindsay never indicated that she was not participating in reality, that she was in a disassociated state, that she was out of touch with reality. You're telling this jury you never saw that?
 
DR. AVRAM MACK:
I did see that evidence that component that you discussed with your physician.
 
KEVIN REDDINGTON:
Great.
 
DR. AVRAM MACK:
I don't see that as a sign strictly speaking of psychosis. It may have been in some cases but
 
DR. AVRAM MACK:
I don't see any signs of psychosis or delusions
 
KEVIN REDDINGTON:
like in this postpartum psychosis. Sir, um you'd agree that delusional beliefs, distorted reality is a symptom. Yes or no?
 
DR. AVRAM MACK:
Not waxing and waning with your answer. Yes or no? Are you referring to an authority there,
 
KEVIN REDDINGTON:
doctor?
 
DR. AVRAM MACK:
Agree.
 
KEVIN REDDINGTON:
Doctor, hold on.
 
DR. AVRAM MACK:
Here's the way this works. All right. You don't really ask a lot of questions. You answer the questions. All right. If I told you before, if you can't answer a question the way it's framed, just let me know and I'll tell counsel to frame it in a different way. All right. So, that's that's the rules. That's how it works here. So, go ahead, Mr. Reddington.
 
KEVIN REDDINGTON:
Thank you. Would you agree, sir, that um a symptom of postpartum psychosis with a woman who is coming to a physician for treatment um indicates that they appear to have normal periods between episodes of disassociation where they're calm, they're even laughing, and they can drive cars, they can talk to people, they can use telephones, all of that, right?
 
DR. AVRAM MACK:
It would be that that description may be of of other things but it's not necessarily of psychosis.
 
KEVIN REDDINGTON:
How about severe sleep deprivation?
 
DR. AVRAM MACK:
Sarah, do you agree that severe sleep deprivation is a symptom when you're considering the whole of the patient complaining of various symptoms? Severe sleep deprivation is a symptom of postpartum psychosis. I can't answer the question the way you phrased it.
 
KEVIN REDDINGTON:
Okay. So, let's say postpartum psychosis. You're somewhat familiar with it. And would you agree that severe sleep deprivation is a symptom of it?
 
DR. AVRAM MACK:
I can't answer the question.
 
KEVIN REDDINGTON:
You can't answer it. Okay. How about rapid mood swings? Would you agree that rapid mood swings are a symptom of postpartum psychosis?
 
DR. AVRAM MACK:
Sir,
 
DR. AVRAM MACK:
I'm not sure I understand your question.
 
KEVIN REDDINGTON:
Okay. How about a person saying that they're not herself?
 
DR. AVRAM MACK:
I want to be myself. I want to go back to being myself. I can't be myself. Is that a complaint that is a symptom of postpartum psychosis, sir?
 
DR. AVRAM MACK:
It might be if the person has Okay, the answer is it might be. Did Lindsay Clancy indicate that she wanted to go back to being herself?
 
DR. AVRAM MACK:
Yes. Now did she also was there any evidence sir of thoughts of harming her children?
 
DR. AVRAM MACK:
There were periods when she had impulses or um intrusive thoughts about harming her children. And when you say intrusive, if I come to you and if a person comes to you and postpartum psychosis is on your radar and says that they're having intrusive thoughts about harming their children, would would you not ask them what that means? In other words, is it a voice in their head? Is it their thought process? What what is it? Do you ask that question? Of
 
KEVIN REDDINGTON:
course. Did anybody ask that question when she was complaining about having intrusive thoughts about suicide for example? Did anybody ask her what that meant?
 
DR. AVRAM MACK:
Voices in the head or thoughts? I believe that the clinicians at McLean at Mass General um Dr. Jollotta Dr. Tufts all asked about or all made inquiries to understand the nature of her suicidal ideation. Do you believe that based on your review of the medical records and based on your review of the numerous cocktail of drugs that were prescribed to her that she received good medical care from Jollotta and Tus?
 
DR. AVRAM MACK:
No world.
 
DR. AVRAM MACK:
I don't have an opinion on that.
 
KEVIN REDDINGTON:
Did she complain that she was not herself and her family could see the change?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
Okay. Um, did she also complain of thoughts of suicide?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
Did she also have poor insight?
 
DR. AVRAM MACK:
Um, I'm not sure that she had poor insight. Well, if you uh are looking at postpartum psychosis and the symptoms are 1 through 10, if a person is complaining to you as a doctor, and when I say complain, I don't mean complaining. I mean that's medical language that they're complaining or giving you a symptom of 1 through nine. That is a very very strong indisha that the person is suffering from postpartum psychosis. Is it not
 
KEVIN REDDINGTON:
one through nine?
 
DR. AVRAM MACK:
I'm not sure I can answer that question.
 
KEVIN REDDINGTON:
Okay. How about blood tests? You think they're important when you're dealing with uh prescribing medications like TUS was after a month?
 
DR. AVRAM MACK:
They can be.
 
KEVIN REDDINGTON:
And do you think, sir, to a reasonable degree of medical certainty that a person should be given a basic blood test when you're prescribing these medications to them?
 
HONORABLE WILLIAM SULLIVAN:
No. Overruled. There are some situations where um blood tests are required or needed and other times when um psychiatrists may feel comfortable making prescriptions without um such tests.
 
KEVIN REDDINGTON:
So there is a uh further test that can be given that would actually determine whether or not a person's enzymes are reacting to the drugs, the narcotics that are being prescribed to them. Isn't that right? You say narcotics.
 
DR. AVRAM MACK:
Well, drugs, you know, like circuline or
 
KEVIN REDDINGTON:
can you say the question again?
 
DR. AVRAM MACK:
Sure. Prescriptions. When a person is prescribed prescriptions, it is well within reason that a competent physician would number one take a simple blood test. Right. It's It's possible.
 
KEVIN REDDINGTON:
Okay. And I guess that's up to the doctor that you're seeing, right?
 
KEVIN REDDINGTON:
Well, sure. Or depends on what concerns the person may have. What's their medical history? Um what's your awareness of um other factors that are affecting their biological health?
 
DR. AVRAM MACK:
So, let's take Lindsay Clancy.
 
KEVIN REDDINGTON:
Which medication we're talking about also?
 
KEVIN REDDINGTON:
Let's take Lindsay Clancy for example. Sir, the medical records that you reviewed when she's dealing with Tus and Jelada, did they administer any blood test to her at all?
 
DR. AVRAM MACK:
Not that I recall.
 
KEVIN REDDINGTON:
Is there a further analysis that can be performed on the blood that is drawn from the woman when she sees the doctor to determine whether or not there are enzyme reactions to the prescription drugs that they're prescribed?
 
DR. AVRAM MACK:
There are tests that can be done to determine the relative degree of one enzyme or another and how much they would um do in terms of breaking down the medications if that's what you're talking about.
 
KEVIN REDDINGTON:
Well, that test wasn't administered to Lindsay, was it?
 
DR. AVRAM MACK:
I don't think so. In spite of numerous innumerable which we won't have to go through complaints that she had and her husband about what was happening to her as a result of her postpartum as well as postpartum depression symptomology of postpartum psychosis in conjunction with the narcotics the drugs the prescriptions that she was given. It never did any further testing. Right. Correct.
 
KEVIN REDDINGTON:
How about thyroid? Is that something that's important to you as a doctor uh dealing with a postpartum depression or postpartum psychosis?
 
KEVIN REDDINGTON:
Thyroid would be important to assess in a person complaining of mood problems. Yes. Well, how about a woman who is complaining that during the postpartum which goes on at infinitum is complaining of postpartum depression symptoms and or postpartum psychosis. It's important to check their thyroid level, isn't it?
 
DR. AVRAM MACK:
It would be important to check thyroid in multiple different psychiatric conditions.
 
KEVIN REDDINGTON:
So the answer is yes, right?
 
DR. AVRAM MACK:
Answer is yes.
 
DR. AVRAM MACK:
I'm not sure that that specifically answers your question.
 
KEVIN REDDINGTON:
I don't care. Thank you. That's all I have. Judge.
 
HONORABLE WILLIAM SULLIVAN:
No. That's come redirect.
 
## REDIRECT EXAMINATION — 2:27:52
 
KEVIN REDDINGTON:
Good morning, Dr. Mack. Um now defense counsel kept referring to um your investigation in this case. Do you see your role as an investigator when you're retained to do these evaluations?
 
DR. AVRAM MACK:
No.
 
KEVIN REDDINGTON:
And in fact you are evaluating for a specific question. Correct.
 
DR. AVRAM MACK:
That's correct. And in your evaluation in this case, you were asked to focus on the mental condition of Lindsay Clancy at the time of January 24th, 2023. Right.
 
KEVIN REDDINGTON:
So, excuse me. He's able to answer yes or no, but this is direct. So, I'm objecting to the leading.
 
DR. AVRAM MACK:
I'm going to allow just to kind of focus to the area and then we'll go from there. Go ahead, counsel.
 
KEVIN REDDINGTON:
Thank you. You can answer that question.
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
Now, were you provided the information that you reviewed?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
And were you aware where that came from, whether it was the court or the district attorney's office or from defense?
 
DR. AVRAM MACK:
I am not necessarily aware of the origin of any of the documents that I reviewed only that I they that I did review them and I did possess them. And um as far as the timing of when you were retained in this case, I believe your testimony on Friday was that your memory was early 2020 2025 you were retained. Is that right?
 
DR. AVRAM MACK:
Yes. I would say that um the initial discussion about it was at the end of 2024. I am not exactly sure when um Commonwealth or the District Attorney's Office exactly uh made the retention happen, but I understand it to be early 2025.
 
KEVIN REDDINGTON:
And you were provided a significant amount of information um uh after you were retained. Correct.
 
DR. AVRAM MACK:
Yes. And that information continued to come to you up until the point that you were going to meet with the defendant in April of 2026.
 
KEVIN REDDINGTON:
Is that fair to say?
 
DR. AVRAM MACK:
That's correct.
 
KEVIN REDDINGTON:
And were you able to set up that interview with her on your own?
 
DR. AVRAM MACK:
No.
 
KEVIN REDDINGTON:
Is it your understanding that it had to be with the permission of the court and the parties?
 
DR. AVRAM MACK:
That's my understanding. And that date in April was a date that was provided to you um as a date that could you could go and speak with her. Correct?
 
DR. AVRAM MACK:
Yes.
 
DR. AVRAM MACK:
Yes. The two dates, April 10th and April 12th.
 
KEVIN REDDINGTON:
And in conducting these evaluations, is it standard or best practice to review as much information as you can prior to that interview?
 
DR. AVRAM MACK:
That's correct.
 
KEVIN REDDINGTON:
And you were provided records from the Tewksbury State Hospital um in the weeks prior to your interview. Is that fair to say?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
Now, can um when you're retained on cases, this case and any other, you're paid for your time and your work, regardless of what your ultimate opinion is. Correct.
 
DR. AVRAM MACK:
That's right.
 
KEVIN REDDINGTON:
Can you explain to us the relationship that you have with de uh Park Deetsz and Associates?
 
DR. AVRAM MACK:
Yes. Um there are times that attorneys around the country um go to Park Dietz and Associates um seeking or asking if they have an expert in a particular field. um and Park Deetsz and Associates um may be able to uh propose one expert or another who might be able to help that attorney or law firm.
 
KEVIN REDDINGTON:
And so in your relationship with that company, you are simply an independent contractor or are you employed by the company?
 
KEVIN REDDINGTON:
Independent contractor. Um, and fair to say there's not kind of a a group email that somebody can send out asking for experts on all these types of um areas in which you testify, right?
 
DR. AVRAM MACK:
No, the Park Dietz and Associates would go to individual experts uh that they think might be appropriate for one or another case given the topic.
 
KEVIN REDDINGTON:
Now, in um you were asked some questions about Dr. Halin. And I think uh last week on Friday you indicated that you didn't know him prior to um working on this case. Is that correct?
 
DR. AVRAM MACK:
Correct. I had never met him.
 
KEVIN REDDINGTON:
And so um you is he name that was familiar to you in your area of general psychiatry?
 
KEVIN REDDINGTON:
I knew that he was another expert um you that works with the Park Deetsson Associates group, but I had never met him. And in fact, he's not in your he's not a general psychiatrist, is he?
 
DR. AVRAM MACK:
I believe he's a psychologist.
 
KEVIN REDDINGTON:
Okay. And so your focus is different than his focus. Correct.
 
DR. AVRAM MACK:
To some degree. Yes.
 
KEVIN REDDINGTON:
Now, um why was it what how did it come about that you and Dr. Heilbrun ended up going to Tukesberry at the same time?
 
DR. AVRAM MACK:
Well, my memory is that to the extent that he also had been retained that there was a need to um be um uh that there was only going to be one opportunity for an examination um by the prosecution. And so rather than create two different sets of interviews for Miss Clancy um uh it was better to overlap them and have them happen concurrently. And in relation to the um purpose of the interview with the the person being evaluated, the defendant here, um was there anything different about your approach and his approach as far as the information you were seeking to gather?
 
KEVIN REDDINGTON:
Generally, no. As has been mentioned, he went ahead and did psychological testing um on the on the second day. Um but other than that uh it's still the same topic, the individual's mental health.
 
DR. AVRAM MACK:
And in regards to that particular um those those days that you were there, um it wasn't just you and Dr. Heilbrun in the room with the defendant. Correct.
 
DR. AVRAM MACK:
That's right.
 
KEVIN REDDINGTON:
Who else was in the room?
 
DR. AVRAM MACK:
One person who served as a videographer. Uh well, two individuals who served as videographers.
 
KEVIN REDDINGTON:
Do you know um who retained the videographer?
 
DR. AVRAM MACK:
I don't.
 
KEVIN REDDINGTON:
And um you're aware that Miss Clancy was also on a onetoone. So was there a staff member from Tewksbury um close by if not in the room?
 
DR. AVRAM MACK:
Close by. But not in the room.
 
KEVIN REDDINGTON:
And the person who was um conducting the video, they were in the room running the video the whole time.
 
DR. AVRAM MACK:
That's correct. And fair to say as it pertained to taking breaks, um you and Dr. Heilbrun offered the defendant multiple opportunities to take a break. Correct.
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
And um
 
DR. AVRAM MACK:
we made it clear that we could take a break any time.
 
KEVIN REDDINGTON:
And she repeatedly declined a break, right?
 
DR. AVRAM MACK:
I I do I recall that. Yes.
 
KEVIN REDDINGTON:
Okay. And that would be contained within the video that was running throughout the course of your interaction with her. Correct.
 
DR. AVRAM MACK:
Yeah.
 
KEVIN REDDINGTON:
At this time, your honor, I'd like to present as the next exhibit the recorded interview with the experts.
 
DR. AVRAM MACK:
I see counsel sidebar. There'll be exhibit. Yes.
 
KEVIN REDDINGTON:
292.
 
KEVIN REDDINGTON:
Okay. No objection. Go.
 
KEVIN REDDINGTON:
Dr. Mack, um, on cross- examination, you were asked about, um, the LeBron case that you were involved in. You recall that line of questioning?
 
DR. AVRAM MACK:
I do. And um in that case you were retained by the state of Florida. Is that right?
 
DR. AVRAM MACK:
Yes. The executive office of the governor.
 
KEVIN REDDINGTON:
And you offered an opinion in that case. Correct.
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
And was that testimony or by way of a declaration or a report?
 
DR. AVRAM MACK:
It was a report and then there was a deposition. And so you were part of a hearing with the court in Florida to determine whether your ultimate opinions could be considered in the case. Correct.
 
DR. AVRAM MACK:
I don't think that there was a specific separate hearing as to that point.
 
KEVIN REDDINGTON:
Okay. as a my recollection is that in the in the phase of a summary judgement um pro proceeding um that the use of my testimony was discussed uh in the summary judgment documents on from each side
 
DR. AVRAM MACK:
and then ultimately your opinion wasn't utilized by the court right
 
KEVIN REDDINGTON:
if I recall statement of the court in the document it was that Dr. Mach is not an expert in this case or it may have said Dr. Mach is not a qualified expert in this case.
 
KEVIN REDDINGTON:
And why was that?
 
DR. AVRAM MACK:
My recollection of the case, which is now almost 15 years ago, um was that the information that I was aware of in terms of um the rate of substance use in individuals who received TANF was nationwide and was not specific to Florida. and the issue was a Florida
 
KEVIN REDDINGTON:
um taniff case, right, having to do with residents in the state of Florida.
 
DR. AVRAM MACK:
So, as far as the limitations there and um your testimony in these types of cases is could be nationwide. In that particular case, it was just that you weren't you didn't have enough information about the residents in that state. Correct. Well, that was
 
KEVIN REDDINGTON:
go if you can answer that and then go ahead.
 
DR. AVRAM MACK:
My understanding is that that was one of the elements uh by which the court determined or made the statement that it did.
 
KEVIN REDDINGTON:
Okay. And you were um offering uh some opinions about your expertise in the area of addiction during that time period. Correct.
 
DR. AVRAM MACK:
Yes. Okay.
 
KEVIN REDDINGTON:
Had nothing to do with criminal responsibility.
 
DR. AVRAM MACK:
Correct. Now, um, you talked a lot with defense counsel about the DSM, so I don't want to go too far into it, but on Friday, you directed at Tony Bington to a particular part of the bipolar and related disorder chapter having to do with specifiers. Do you remember that?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
And you directed him to page 173, which referred to the specifier with parartum onset. Can you just explain to us first what is a specifier when we're talking about the DSM?
 
DR. AVRAM MACK:
Specifiers are um a way in which the DSM allows an a diagnostician to highlight certain details of the individual's presentation. But as I was mentioning the other day, psychiatric classification nowadays refers to the larger presenting symptoms that the individual has and specifiers can be added on. So a person can have um a severe mood disorder and then um one can add on the specifier of with postpartum onset um or atypical features or other specifiers that have been defined. And so when you were referring to page 173 where it starts the um long paragraph about with parartum onset is that the portion of the um specifier categories for bipolar related disorders where we're talking about um postpartum periods. Yes, there is a defined way in which a person can add as a diagnosis whether or not there was onset in that particular time frame.
 
KEVIN REDDINGTON:
And that's where we find the four the four-week timeline. Correct.
 
DR. AVRAM MACK:
Correct.
 
KEVIN REDDINGTON:
And it also talks about different mood episodes including manic and depressive episodes in that section. Right.
 
DR. AVRAM MACK:
That's right. And that section also talks about the fact that it could present mood episodes could present with psychotic symptoms and without psychotic symptoms or psychotic features I should say. Is that right?
 
KEVIN REDDINGTON:
Right. Bipolar disorder is a yes. Bipolar disorder is a disorder of mood. Abnormal mood is what the diagnostician observes and is aware of. Um, and if there is a way to determine that it's a major depressive episode or a bip manic episode or a hypomomanic episode, that will help to determine if this severe mood condition is bipolar or major depressive disorder.
 
DR. AVRAM MACK:
And so in that regard, the same um specifier is also part of the um major depressive uh category. Correct. As I said, the specifiers provide detail, but they are not the so to speak the major element of the diagnosis. The major element of the diagnosis in DSM are the observable major symptoms and signs.
 
KEVIN REDDINGTON:
Well, I'm asking about just what's contained within those specifiers because you and counsel went back and forth quite a bit on Friday um about what's in there and what's not in the DSM when it comes to the parartum onset. But as far as in both the specifier for bipolar and depressive disorder, there are a number of those features that you were discussing that is in the DSM as a specifier.
 
KEVIN REDDINGTON:
Okay. Um and they those are presentation with psychotic features, the frequency of occurrence or reoccurrence of the um parartum onset for these disorders, right?
 
DR. AVRAM MACK:
That's in there as that. Yes. as well as the risk of um postpartum episodes being greater when people have history of depressive disorders or bipolar disorder. That's within that specifier for each of those two chapters, is it not?
 
DR. AVRAM MACK:
Yes, that portion of the specifier is a description of what's been observed over time. It's not necessarily the criteria, but it's it's the observations that have been so commonly observed that they were able to write that in the manual. Okay.
 
KEVIN REDDINGTON:
So, this concept of a parartum onset or we've been using it as postpartum interchangeably, it's within the DSM5, right?
 
DR. AVRAM MACK:
Yes. The DSM the DSM5 provides a manner by which to make a diagnosis that provides this specification or highlights this detail of the individual's illness.
 
KEVIN REDDINGTON:
And as far as your um conclusions, again, when you're asked to do an evaluation, do you rely on other people's conclusions about diagnosis when making your own diagnosis?
 
DR. AVRAM MACK:
It's important to understand what others have observed um and what they're concerned about and then as a physician one will make one's own diagnosis.
 
KEVIN REDDINGTON:
And so in this case you came to the conclusion that the defendant presented with a major depressive episode. Right.
 
DR. AVRAM MACK:
Correct.
 
KEVIN REDDINGTON:
And you relied on um diagnostic criteria in the major depressive disorder category. Is that fair to say?
 
DR. AVRAM MACK:
Yes, that was the diagnostic criteria that I used to support that diagnosis.
 
KEVIN REDDINGTON:
And you counsel went through with you today a number of different um I think he called them symptoms of postpartum depression. But as far as major depressive disorder, what are the nine um general symptoms that you see or you you can find five or more of to find that somebody suffers from a major depressive disorder?
 
DR. AVRAM MACK:
So a major depressive episode is defined and this is parallel to the description I was giving earlier of a manic episode. They're both problems of mood. They're both discrete um ear periods of mood mood problems. So a major depressive episode would be a two-week discreet change in a person's mood and um it include you have to have at least five of nine different symptoms or signs and it has to be persistent and it has to be most of most of the day most of the days. So um the nine include um um starting out with anhidonia meaning lack of feeling pleasure. Um secondly actually feeling depressed mood. It can be um feelings of guilt or worthlessness. Um and then it also may include um problems with um thinking about death or suicidality. Furthermore, problems with sleep, eating, what we call um energy, uh psycho motor activity, either psychot motor um slowing or agitation. Um and then um all these you have to have five out of these nine,
 
KEVIN REDDINGTON:
right?
 
DR. AVRAM MACK:
Uh in order to meet the major depressive episode. Um,
 
KEVIN REDDINGTON:
and I think maybe you might have missed one. Diminished ability to think or concentrate. Is that one?
 
DR. AVRAM MACK:
Concentration.
 
KEVIN REDDINGTON:
Concentration.
 
DR. AVRAM MACK:
So, um,
 
KEVIN REDDINGTON:
so a lot of the the symptoms that counsel read to you are symptoms that are in the category of a major depressive disorder. Is that correct?
 
DR. AVRAM MACK:
Yes. The this is the method of making the diagnosis of a major depressive episode. So, when you were asked on cross-examination about postpartum depression and you kept in um answering that you found her to have a depressive disorder, is that are those the symptoms that you were speaking of when you were saying you found a major depressive disorder?
 
SHANAN BUCKINGHAM:
Can I object?
 
DR. AVRAM MACK:
No, bleeding.
 
DR. AVRAM MACK:
Correct.
 
HONORABLE WILLIAM SULLIVAN:
No overrule. I'll allow it.
 
KEVIN REDDINGTON:
I I have nothing further.
 
KEVIN REDDINGTON:
Okay.
 
KEVIN REDDINGTON:
Thank you.
 
## RECROSS-EXAMINATION AND WITNESS RELEASE — 2:51:58
 
HONORABLE WILLIAM SULLIVAN:
Anything further? Just uh briefly, Sarah, are you suggesting that my office had any control over when you were able to go visit Lindsay in the hospital?
 
SHANAN BUCKINGHAM:
Objection.
 
DR. AVRAM MACK:
Overall,
 
DR. AVRAM MACK:
I don't know if your office was involved. Um but I imagine So I don't know.
 
KEVIN REDDINGTON:
You don't know?
 
DR. AVRAM MACK:
I imagine your office was aware.
 
HONORABLE WILLIAM SULLIVAN:
But I don't Doctor, I think you've answered the question. All right. Next. Anything further? Thank you.
 
HONORABLE WILLIAM SULLIVAN:
Anything further com? All right. Thank you, doctor. Thank you very much.
 
KEVIN REDDINGTON:
Thank you.
 
KEVIN REDDINGTON:
All right.
 
HONORABLE WILLIAM SULLIVAN:
All right. Take a break.
 
## MORNING RECESS — 2:52:31
 
HONORABLE WILLIAM SULLIVAN:
All right. So, uh, members of the jury, uh, we're going to take the morning break at this point. Uh, we're going to come back, uh, continue with the Commonwealth's uh, uh, rebuttal case. Uh, we'll have a witness, uh, that'll go on to stand after we get back. All right.
 
HONORABLE WILLIAM SULLIVAN:
So, uh, so we'll take the break at this time. Thank you.
 
HONORABLE WILLIAM SULLIVAN:
Of course. All right. Current please. All right. Anything Anything we needed to discuss before the break?
 
COUNSEL:
No, your honor.
 
HONORABLE WILLIAM SULLIVAN:
All right. So, we'll be in the morning recess at this time. Thank you.

Deanna · Aug 25, 2026, 6:10 AM · #post-139

OPENING PROCEEDINGS — 55:12
 
BAILIFF:
This court is now in session. You may be seated.
 
HONORABLE WILLIAM SULLIVAN:
Yes, please.
 
CLERK:
Attorneys assistant district attorney Jennifer Sprague and Assistant District Attorney Shanan Buckingham.
 
HONORABLE WILLIAM SULLIVAN:
All right. All right. Well, good morning everyone. Good morning, counsel.
 
COUNSEL:
Morning.
 
HONORABLE WILLIAM SULLIVAN:
Good morning, Miss Clancy.
 
LINDSAY CLANCY:
Morning, your honor.
 
HONORABLE WILLIAM SULLIVAN:
All right. So, are we ready for the jury?
 
COUNSEL:
We are.
 
HONORABLE WILLIAM SULLIVAN:
All right. So, we'll do is we'll uh can I see counsel just very briefly just in regards to today's schedule. All right. What's the next exhibit?
 
COURTROOM SPEAKER:
H
 
HONORABLE WILLIAM SULLIVAN:
What's the next exhibit?
 
BAILIFF:
292BB. Hey, hey, hey. All persons having anything to do before the honorable William Sullivan, justice of the Superior Court, now setting up within and for the Commonwealth. Draw near and give your attendance and you shall be heard. While state of the Commonwealth of Massachusetts, this court is now in session. Please be seated.
 
CLERK:
Good morning, your honor. May I proceed?
 
HONORABLE WILLIAM SULLIVAN:
Yes, please.
 
CLERK:
Your honor, before the court today, we have the continuation of the jury trial in the matter of Commonwealth versus Lindsay Clancy. Miss Clancy is present. She is represented by attorney Kevin Reddington. The Commonwealth is represented by Assistant District Attorney Jennifer Sprague and Assistant District Attorney Shanan Buckingham.
 
HONORABLE WILLIAM SULLIVAN:
All right. Well, thank you, Madam Clerk. Good morning, members of the jury.
 
HONORABLE WILLIAM SULLIVAN:
I hope everybody had a nice weekend. Uh, and so what we're going to do, as we have done so many times before, I'm going to ask you those questions. Uh, and then we're kind of going to go over what today's schedule is. Uh, and then we'll get right back uh to the trial. So, uh, so the first question, has any member of the jury read, seen, heard, or overheard anything from any source about any aspect of this case uh that would affect your ability to be a fair and impartial juror? All right, last question. Is there any other serious matter of concern bearing on your service as a juror in this case that anybody needs to bring to my attention at this time? Again, thank you so much for following those uh instructions. Uh what uh what we are going to do from the schedule today, uh if you remember on Friday, um there was we were in during cross-examination of uh of Dr. Mack who had testified Friday afternoon. We're going to return to the cross examination. Uh, and the only difference is, uh, Dr. Mack is going to be available by Zoom. Uh, here we've we've had a couple other witnesses, so you all kind of know how how that's going to work. So, we're going to finish the cross-examination of Dr. Mack uh by Zoom. Commonwealth, if they have redirect question uh and then, uh, we're going to continue with the Commonwealth's rebuttal. All right. And so, uh, just to kind of go back as far as the procedures that we followed, we, so the Commonwealth, uh, presented their case, then after they were done, the defendant presented their case, and we're now on to the Commonwealth rebuttal. All right. And when the commos rebuttal is done, uh, we're going to move to the next portion of the procedure uh, process, which will be the closing arguments and the, uh, legal instructions. All right. So that comes after uh the Commonwealth rebuttal witnesses. So that's kind of where we are at this point. Um and so uh as we go through today, I'll kind of keep you up to date in regards to uh the schedule for going forward. All right. Uh so that's where we are. So at this point, uh I'm going to uh we'll get Dr. Mack uh on the screen and then it'll be uh Mr. Reddington uh continuing cross examination. to swear.
 
HONORABLE WILLIAM SULLIVAN:
Yeah, please.
 
CLERK:
Welcome, ma'am. Could you please raise your right hand?
 
CLERK:
Do you solemnly swear that the testimony and the evidence you shall give to the court and the jury in the matter now pending between the Commonwealth and the defendant the bar shall be the truth, the whole truth, and nothing but the truth to help you God?
 
DR. AVRAM MACK:
I do.
 
CLERK:
Thank you, sir.
 
HONORABLE WILLIAM SULLIVAN:
All right, attorney Reddington.
 
## RESUMED CROSS-EXAMINATION — 1:02:06
 
KEVIN REDDINGTON:
Thank you. Um sir, how many times have you testified in courts on the issue of criminal responsibility?
 
DR. AVRAM MACK:
I would estimate one or two.
 
KEVIN REDDINGTON:
So if you estimate one or two times, would this be your third time?
 
DR. AVRAM MACK:
By that estimation, yes.
 
KEVIN REDDINGTON:
Okay. So it's not by my estimation though. It's by your estimation and you would know better than me, right?
 
DR. AVRAM MACK:
Yeah.
 
KEVIN REDDINGTON:
Okay. So, this is the third time in your career that you've testified on a criminal trial on the issue of lack of criminal responsibility. Is that correct?
 
DR. AVRAM MACK:
It's I know there are other times that I've created opinions.
 
KEVIN REDDINGTON:
Well, I'm sure
 
DR. AVRAM MACK:
I'm not sure how much I'm
 
KEVIN REDDINGTON:
I'm just asking about criminal responsibility. That's it.
 
DR. AVRAM MACK:
I'm talking about criminal responsibility. And I know there are other times I've created opinions, but I'm not sure that I've testified about them,
 
KEVIN REDDINGTON:
okay, in the courtroom.
 
KEVIN REDDINGTON:
So my question was simply, how many times have you testified in court on criminal cases regarding the issue of lack of criminal responsibility? And this would be your third time, right?
 
DR. AVRAM MACK:
That is my recollection.
 
KEVIN REDDINGTON:
Okay. Um and you have testified in court on behalf of various governmental agencies on other matters in addition to criminal responsibility. Correct.
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
and you are operating under the umbrella, if you will, of the Park Dietz um conglomerate of of a lot of expert witnesses that, as I understand, would would parcel out cases to different people. Is that right?
 
DR. AVRAM MACK:
There are times that I do cases um through Park Dietz and associates. Um, I can't speak to how many experts they have and exactly how they, as you put it, parcel things out, but um, over the span of my career, there have been times that I've done it, um, when cases have been presented through Park Dietz and associates and times that I've done it through other entities. As I discussed the other day, I had a role for the state of Maryland and at times um and in this case uh there was a criminal responsibility trial that I was a part of uh when I was a had a role for the state of Maryland. So going throughout my career, it's been multiple different entities.
 
KEVIN REDDINGTON:
Um you've also testified since we're talking about in the state of Pennsylvania, right?
 
DR. AVRAM MACK:
Say what's your question?
 
KEVIN REDDINGTON:
You've also testified since we're talking about it in the state of Pennsylvania, right?
 
DR. AVRAM MACK:
I believe I have.
 
KEVIN REDDINGTON:
Was that a Park Dietz or was that you individually or one of your other entities?
 
DR. AVRAM MACK:
You'd have to specify which case.
 
KEVIN REDDINGTON:
Commonwealth versus Torres 342 MAL 2021 Pennsylvania.
 
DR. AVRAM MACK:
Can you cite that case again, please?
 
DR. AVRAM MACK:
Sure. Commonwealth versus Torres 342 MAL 2021 Pennsylvania where the court held that uh you that would be Avram Mack was apparently certified only in child and adolescent psychiatry you lacked forensic certification to testify in the field that you were ostensibly going to testify in. Does that refresh your memory?
 
## PRIOR CASES AND QUALIFICATIONS — 1:05:19
 
DR. AVRAM MACK:
No.
 
KEVIN REDDINGTON:
Did you testify in
 
KEVIN REDDINGTON:
Did you testify in Commonwealth versus Torres in Pennsylvania?
 
DR. AVRAM MACK:
I don't remember. No.
 
KEVIN REDDINGTON:
How about Commonwealth versus Carter in New Jersey? You remember that one?
 
DR. AVRAM MACK:
No.
 
KEVIN REDDINGTON:
Do you recall that the uh the court held on on an appeal that the you used an approach that fell below the standard of forensic practice?
 
DR. AVRAM MACK:
No.
 
KEVIN REDDINGTON:
How about Feder LeBron versus the Secretary of DCF 710 Fed 3rd 1202 in Florida? You remember that case, I'm sure, right?
 
DR. AVRAM MACK:
I do.
 
KEVIN REDDINGTON:
And in Feder, um, that was a gentleman, Mr. Feder Lebron, who was a Navy veteran who was a single father and had a child and he was a member, a person that was able to get benefits from what's called TANF, TF, temporary aid to needy families. You remember that?
 
DR. AVRAM MACK:
I do. And the uh state of Florida decided that because needy families consisted of either minorities or drug users or people that would not be reliable to work uh in the confines of working underneath the tent. So they wanted to have blood testing and drug testing of all the people that were uh temporary aid to needy families. Right.
 
KEVIN REDDINGTON:
Uh that's your conception of what was happening with that. Well, it's my conception from reading the case, sir. Do you agree, sir, that TANF is a an acronym for temporary aid to needy families?
 
DR. AVRAM MACK:
Yes, it is.
 
KEVIN REDDINGTON:
Do you agree, sir, that Mr. uh does this gentleman, Mr. Federal Lebron, was a plaintiff in a lawsuit against the state of Florida?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
Do you agree, sir, that it was in federal court?
 
DR. AVRAM MACK:
Yes. You agree, sir, that in federal court, the court held that in fact um you were unqualified to give an opinion that you attempted to give saying that it was perfectly appropriate to test by way of urine or blood people that are benefiting from the TANF program because your your your testimony was that they belong to a class of people that I guess had to be tested,
 
KEVIN REDDINGTON:
right?
 
DR. AVRAM MACK:
I don't agree with your conceptualization.
 
KEVIN REDDINGTON:
Okay. So, the court ultimately ruled that um your argument uh your testimony on behalf of the state of Florida, the government um and you indicated that TANF benefits um applicants for TANF were people that were involved with drug use, violence, and higher rates of suicide. Remember those words?
 
DR. AVRAM MACK:
Those three words. the testimony that I provided. Do
 
KEVIN REDDINGTON:
you remember testifying, sir, about the people that are the beneficiaries of the TANF program?
 
DR. AVRAM MACK:
People that need aid because of needy families are people that should be tested by way of blood or urine. And your argument, sir, was because they are of a class that would be more likely to commit a crime or have suicide or drug use. Did you testify to that? That is not the way that that testimony or that report was presented. No disagree.
 
KEVIN REDDINGTON:
So your answer is no. Let's keep it that way. Your answer is no. So you recall sir that there was an appeal and in fact on the appeal it was determined that again yet again you were not qualified to offer a relevant opinion because number one you never studied the TANF. Recall that.
 
DR. AVRAM MACK:
No that is not the correct conceptualization. says you. Number two, that you did not survey any data. Recall that, sir,
 
KEVIN REDDINGTON:
specifically in Florida is the uh nuance on that issue.
 
KEVIN REDDINGTON:
And number three, that um you had no research whatsoever on the data that you based your opinion on. Would you agree with that, sir?
 
DR. AVRAM MACK:
No. Do you agree, sir, that the court held that you relied on other researchers studies and didn't make any effort whatsoever to form an opinion based on your own research?
 
KEVIN REDDINGTON:
Do you agree with that?
 
DR. AVRAM MACK:
I don't remember the specific language of the court.
 
KEVIN REDDINGTON:
All right. Do you recall that ultimately your testimony was stricken?
 
DR. AVRAM MACK:
No, I don't believe that it was stricken.
 
KEVIN REDDINGTON:
Okay. In any event, sir, you would agree with me that you have a memory of of uh Avram Mack being subject to this attack, if you will, by the attorneys on behalf of the people that were involved with TF, right? You remember that much, right?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
Okay,
 
DR. AVRAM MACK:
I do.
 
KEVIN REDDINGTON:
Thank you. Now, in summary, sir, um you're here to testify in front of this jury um regarding your testimony and opinion that you've given regarding Lindsay Clancy's state of mind at the time of the killing of her children. Is that correct?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
And you evaluated her in 2026. Is that right?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
So you really evaluated her about 3 years after the incident that occurred in January 22. Right.
 
## RETENTION AND INDEPENDENCE — 1:10:39
 
DR. AVRAM MACK:
January 2023.
 
KEVIN REDDINGTON:
So you do recall the date that the incident occurred 23. Right.
 
DR. AVRAM MACK:
Right. So the answer
 
KEVIN REDDINGTON:
Okay. The answer the answer is right. Okay. And in reference to your answer, sir, you would agree with me that there was a significant passage of time between the incident in 2023 and when you saw her about 2 or 3 months ago, right?
 
DR. AVRAM MACK:
Correct.
 
KEVIN REDDINGTON:
Okay. And you drove out there with the guy that's going to be in here testifying in about an hour or so. Uh Hellburn. Is it Heilbrun or Hilbrin?
 
KEVIN REDDINGTON:
When you say that I drove out there,
 
DR. AVRAM MACK:
I'm just asking the guy's name. Is it Heilbrun or Heilbrun?
 
KEVIN REDDINGTON:
You'll have to ask him how he likes to pronounce it.
 
KEVIN REDDINGTON:
Well, did you know how to call him or what what to call him when you were out there with him for two days at Toubury?
 
DR. AVRAM MACK:
Kirk.
 
KEVIN REDDINGTON:
Kirk. Okay. And you met Kirk, I imagine, that morning that you were going to evaluate Lindsay.
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
And what was the date that you evaluated her?
 
KEVIN REDDINGTON:
Was it February?
 
DR. AVRAM MACK:
I think the first the first date was April 10th.
 
KEVIN REDDINGTON:
Okay. The second date was April 12th. U and those were the two days that I was there.
 
KEVIN REDDINGTON:
Right. Because Kirk had to give her psychological testing on the middle day, right?
 
DR. AVRAM MACK:
Correct.
 
KEVIN REDDINGTON:
Okay. So, did you stay in a hotel or a van or would you Where'd you stay?
 
KEVIN REDDINGTON:
You're asking me where I stayed?
 
DR. AVRAM MACK:
Yeah. I I don't want to meet up. I just want to know where you stayed. I stayed in Massachusetts.
 
KEVIN REDDINGTON:
Where?
 
DR. AVRAM MACK:
I believe in Welssley.
 
KEVIN REDDINGTON:
Where was it?
 
DR. AVRAM MACK:
Like Holiday Inn? Was it a Ritz Scoutton? Where?
 
KEVIN REDDINGTON:
A private home.
 
KEVIN REDDINGTON:
A private home. Okay. Kirk didn't stay there, did he?
 
DR. AVRAM MACK:
I don't know.
 
KEVIN REDDINGTON:
You don't know?
 
DR. AVRAM MACK:
No, he didn't stay there. I He didn't stay there, that's for sure.
 
KEVIN REDDINGTON:
Okay. So, in any event, you you must have had plans to meet up with Kirk at Tewksbury Hospital, right?
 
DR. AVRAM MACK:
I did meet Dr. Halurn at Dukesbury Hospital. Yeah.
 
KEVIN REDDINGTON:
Okay. I I'm calling him Kirk because that's what you told me is that you refer to him as, but Dr. Hoffman, how do you pronounce it?
 
DR. AVRAM MACK:
I believe it's Heilbrun, but you'll have to ask him how he prefers it.
 
KEVIN REDDINGTON:
Okay, I will. Um, and then did you meet him in the parking lot of Tewksbury?
 
DR. AVRAM MACK:
Yes, I think that's right. And
 
KEVIN REDDINGTON:
in the lobby,
 
KEVIN REDDINGTON:
sorry, what' you say?
 
DR. AVRAM MACK:
Or in the lobby.
 
KEVIN REDDINGTON:
Okay. So, when you went there on that date in April, the first day, you already had your information that you were able to form your opinion based upon. Is that right?
 
DR. AVRAM MACK:
At the time that I initiated the examination, I had reviewed records related to Miss Clancy. Um, but creation of the ultimate opinion.
 
DR. AVRAM MACK:
No, no, no. I'm asking I'm asking about the records, sir. Real simple. The records that you reviewed, you had already reviewed them before you went to Tewksbury Hospital. Is that fair?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
Okay. And the records would be um obviously cell phone extraction records. Yes.
 
DR. AVRAM MACK:
I don't know exactly when I reviewed those cell phone records.
 
KEVIN REDDINGTON:
How about um defense expert forensic psychiatric evaluations?
 
DR. AVRAM MACK:
Dr. Philip Resnik, Dr. Margaret Spanelli, you you reviewed the reports that were already prepared by my experts. Is that correct? And also Dr. is it Zizel?
 
KEVIN REDDINGTON:
Zel. Yeah. Thank you. Okay. You were because I had sent them to you. Isn't that right?
 
KEVIN REDDINGTON:
You had sent them I believe to Dr. Heilbrun. Um
 
KEVIN REDDINGTON:
to Dr. who?
 
DR. AVRAM MACK:
I'm sorry.
 
KEVIN REDDINGTON:
I think Dr. Kirk Heilbrun and um I think um he was able to give them to me.
 
KEVIN REDDINGTON:
Okay. Fine. So, you also were able to review division or department of children and family records dated February 3rd of 2023. Correct.
 
DR. AVRAM MACK:
Correct.
 
KEVIN REDDINGTON:
And those would be records that pertained obviously after the death of the children, but it was just an interview of Patrick, the father, and the and Lindsay's husband. Right. That's what those were. That was a substantial uh component of that, but that was the DCF evaluation uh that occurred and they I believe interviewed him when he was at Boston Children's Hospital.
 
KEVIN REDDINGTON:
Okay. All All I'm asking is all I'm asking is that the DCF, In other words, there's no DCF records that shows that Lindsay was abusive to her children, right?
 
DR. AVRAM MACK:
I don't think that that was necessarily the conclusion of that report. Well, it wasn't a conclusion of any report. There were no other reports other than February 3rd. Correct.
 
DR. AVRAM MACK:
Yes, that's right.
 
KEVIN REDDINGTON:
Okay. And that would be interviewing Pat, the father and the husband, right?
 
DR. AVRAM MACK:
As I said, I think effectively that is the core component of that report.
 
KEVIN REDDINGTON:
Okay, that's the component of the report. The answer is yes. You also had medical records from Aster Mental Health Records, right?
 
DR. AVRAM MACK:
Yes. That would be Jennifer Tufts.
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
Um Jennifer Mallister, right?
 
DR. AVRAM MACK:
Um I'm not sure if that's the name of another doctor in that practice, but substantially after mental health included the work of Dr. Tufts.
 
KEVIN REDDINGTON:
Dr. Tufts. And how about uh nurse practitioner Jollotta? Did you review her records as well?
 
KEVIN REDDINGTON:
The records of hers that came from the organization that she had worked in?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
What organization was that? Do you know?
 
DR. AVRAM MACK:
I I'm not exactly recalling the title of it, but I believe it's Southshore Mental Health, but I'm not exactly sure of the exact title.
 
KEVIN REDDINGTON:
Boston Children's Hospital, Brighamin Women's Hospital, and McLean Hospital records. You reviewed them, correct?
 
DR. AVRAM MACK:
Yep.
 
KEVIN REDDINGTON:
Spalding Rehab, right?
 
KEVIN REDDINGTON:
Yep. Tewksbury Hospital from March 7, March 27th of 23 up through April 1st of 26, which is a little bit before you saw Lindsay, right?
 
DR. AVRAM MACK:
Correct.
 
KEVIN REDDINGTON:
They were about 7,000 pages. A lot of lot of paper, right?
 
DR. AVRAM MACK:
Yes.
 
## EVALUATION METHOD AND SOURCES — 1:17:18
 
KEVIN REDDINGTON:
Um, toxicology records, police reports, grand jury testimony. You read all that, too, right?
 
DR. AVRAM MACK:
Correct. police interviews, interviews of witnesses, right?
 
DR. AVRAM MACK:
Correct.
 
KEVIN REDDINGTON:
And you had met with, I imagine, or spoken to by telephone perhaps, with the district attorneys, the prosecutors here.
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
And And where did you meet them?
 
KEVIN REDDINGTON:
The prosecutors?
 
DR. AVRAM MACK:
Yeah.
 
KEVIN REDDINGTON:
Uh, only by phone.
 
KEVIN REDDINGTON:
Okay. So, you met them by phone. When was that?
 
DR. AVRAM MACK:
I don't know off hand when that was.
 
KEVIN REDDINGTON:
How long was the conversation?
 
DR. AVRAM MACK:
Um I don't recall. It could have been somewhere between 15 minutes to 45 minutes.
 
KEVIN REDDINGTON:
And basically they told you that they wanted you to evaluate a defendant who had been indicted for triple homicide of her own children um by the name of Lindsay Clancy. You knew that from speaking with them, right?
 
KEVIN REDDINGTON:
Effectively. I knew that. Yes. And you know, I I normally don't go there with expert witnesses, but it was fair game on Dr. Zizel. How much money do you make a year on your forensic evaluations?
 
DR. AVRAM MACK:
It ranges over the years. Um, se, you know, several hundred thousand of dollars.
 
KEVIN REDDINGTON:
Yeah.
 
DR. AVRAM MACK:
Um, can be a few.
 
KEVIN REDDINGTON:
And a lot of that
 
DR. AVRAM MACK:
I'm sorry. Go ahead.
 
DR. AVRAM MACK:
No, go ahead. So a lot of that would be appointed cases or cases either from pack deets or some other warehouse that asks you to evaluate people and testify in the court right
 
KEVIN REDDINGTON:
or over the years people contact me directly
 
DR. AVRAM MACK:
really
 
KEVIN REDDINGTON:
we're talking about over the last 15 to 20 years
 
KEVIN REDDINGTON:
right so when you were contacted by strike that did the DAS here call you or did you call them?
 
DR. AVRAM MACK:
I don't recall.
 
HONORABLE WILLIAM SULLIVAN:
Do you recall that they told you what a horrible case this was that this woman killed her three children by strangling them? Did they tell you that? Sustained. Next question.
 
KEVIN REDDINGTON:
Well, did you know what the factual allegations were of the case?
 
DR. AVRAM MACK:
Yes or no?
 
KEVIN REDDINGTON:
Well, all the factual allegations, yes. I believe they were conveyed to me during a phone call.
 
KEVIN REDDINGTON:
Yeah. Okay. And um when you were engaged or retained through Park Deetsz and Associates to work for the Plymouth County District Attorney's Office, I mean that's fair to say you were working for them, right?
 
DR. AVRAM MACK:
Effectively, I was retained by the District Attorney's Office. Yeah.
 
KEVIN REDDINGTON:
All right. And and let's talk about confirmatory bias. You know what that is?
 
DR. AVRAM MACK:
Well, you were asking me the other day about the um cognitive bias think tank and we talked about how as a part of my work in patient safety
 
DR. AVRAM MACK:
No, no, no, no, no, no. This is this is like
 
KEVIN REDDINGTON:
Hold on, doctor. Please listen to the question and answer the question. Go ahead.
 
KEVIN REDDINGTON:
This is confirmatory bias, sir. Not not a think tank talking about safety of anybody. Okay?
 
DR. AVRAM MACK:
Confirmatory bias. Have you heard of that term?
 
KEVIN REDDINGTON:
I have. And what does it mean?
 
DR. AVRAM MACK:
Well, if you're talking about the work in diagnosis in medicine, as I was getting at before, it refers to the idea that an individual has a idea as to what they're aiming for and they gather information um that seeds to that and that brings uh that point together.
 
KEVIN REDDINGTON:
Okay. So would you agree with me sir that when you are retained in your practice working whether it's for deets or somebody else and you are engaged by a prosecutor such as the Plymouth County DA's office is it fair to say that you go into your work and your evaluation and I hesitate to use the word investigation but you have a confirmatory bias. You're hoping that you're going to be able to help him out right?
 
DR. AVRAM MACK:
No.
 
DR. AVRAM MACK:
No. Okay. So, you had read all this material. You had spoken with the prosecutors and and I imagine you had done a team back with with Kirk Heilbrun, right?
 
KEVIN REDDINGTON:
A what?
 
KEVIN REDDINGTON:
You you talked to Kirk Heilbrun about the fact that you guys were going to go in and evaluate Lindsay, right?
 
DR. AVRAM MACK:
We had worked with the prosecutors and I believe them with you. Um,
 
KEVIN REDDINGTON:
you didn't Excuse me. You didn't work with me. What do you mean you didn't work with me?
 
DR. AVRAM MACK:
I imagine there was um interactions in terms of setting up the dates on which this would occur.
 
KEVIN REDDINGTON:
I had nothing to do with it. My my office manager Laura Mather would have done that. I had nothing to do with it, sir.
 
HONORABLE WILLIAM SULLIVAN:
Yeah. Okay. Next question.
 
DR. AVRAM MACK:
So, when you went out there on the two days that you went out, forget the middle day cuz that's when Kurt was by himself. When you went out there, the two of you met in the parking lot or the lobby, one or the other. Correct.
 
DR. AVRAM MACK:
Yes.
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
I said yes.
 
DR. AVRAM MACK:
And and the purpose was to go interview her, right,
 
KEVIN REDDINGTON:
Miss Clansy?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
So, you guys go down the hallway, you go in the elevator, you go upstairs to the locked wards, they have to open the door. They have orderly and people that escort you. Is that right?
 
KEVIN REDDINGTON:
Yeah. You have to sign in. You have to have ID because it's a locked word, right?
 
DR. AVRAM MACK:
Effectively. Yes.
 
KEVIN REDDINGTON:
Effectively. And the two of you, you and Kirk, go into a room where she's sitting in her wheelchair by herself so that you two of you can interview her. Is that correct?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
For how many hours did you interview her the first time?
 
DR. AVRAM MACK:
The first day it was roughly ended up being about I think four or five hours.
 
KEVIN REDDINGTON:
And have in mind sir as as counsel has already elicited she's incontinent. She has issues because of being paralyzed and had to have a break, didn't she?
 
DR. AVRAM MACK:
She did not ask for a break.
 
KEVIN REDDINGTON:
Oh, she she was able to power through
 
KEVIN REDDINGTON:
the four hours. I don't know if that's the appropriate way to frame it. We um we took a break. Um during the interview we discussed um the schedule that she has for SC for caization if that's your question. So you and uh Kirk Heilbrun sat down and you questioned Lindsay. the both of you together or one at a time or how'd that work out?
 
DR. AVRAM MACK:
One would ask questions and if another one had additional questions to ask about that particular topic um then the other would ask
 
KEVIN REDDINGTON:
and she was feel fair to say she was pretty cooperative with you guys, right?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
She was polite. She was affable, right?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
She answered your questions, right?
 
DR. AVRAM MACK:
Yes. Um, and then when you concluded that first day, then the next day Kirk Heilbrun went on his own to Tewksbury and had another multi-hour interrogation, questioning or whatever of Lindsay, right?
 
KEVIN REDDINGTON:
He was there for a second day for psychological testing.
 
KEVIN REDDINGTON:
So, you're aware of the fact that he was there for psychological testing, right?
 
DR. AVRAM MACK:
Yes. Now a psychiatrist doesn't do psychological testing. The psychologist does, right?
 
KEVIN REDDINGTON:
Typically that's true.
 
KEVIN REDDINGTON:
And there are a number of tests that are administered to people um when they are being evaluated for purposes of a criminal case such as this. Right?
 
DR. AVRAM MACK:
There is a number of different tests that test different aspects of an individual's um psychiatric or psychologic or cognitive functioning.
 
KEVIN REDDINGTON:
Right. like uh for example, you want to determine, I would imagine, whether or not they're lying or exaggerating or minimizing their symptoms, right?
 
DR. AVRAM MACK:
That's always an interest. Yes. And it's of interest because if a person is in fact masking or lying about their mind trying to fake out an evaluating forensic psychiatrist or psychologist when you say that's of interest, that's something that can be the test result that a jury could look at. Right.
 
KEVIN REDDINGTON:
Well, I'm not sure if they're the test that specifically states a person is lying.
 
DR. AVRAM MACK:
No. You ever heard of the um MMPA?
 
KEVIN REDDINGTON:
I have.
 
KEVIN REDDINGTON:
Okay. You ever heard of the K scale?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
What is that?
 
DR. AVRAM MACK:
Well, the K scale is among the internal validity scales of the MMPI. The MMPI is an assessment of the individual's personality.
 
KEVIN REDDINGTON:
Okay. So, let's focus on the K scale. Sir, when you say that it's a let let me ask you again. What is your understanding of what the K scale is seeking to find out?
 
DR. AVRAM MACK:
I answer this in the context of the purpose of the MMPI and what the MMPI uh is designed.
 
KEVIN REDDINGTON:
What are you smiling for?
 
DR. AVRAM MACK:
This is not funny. Sir,
 
HONORABLE WILLIAM SULLIVAN:
the stain next question.
 
KEVIN REDDINGTON:
MMPI K scale focus. What does it mean, sir?
 
DR. AVRAM MACK:
So the MMPI is an assessment of personality and it is a set of questions that the individual responds to to provide the test and to provide the user of the test to understand what is their personality like. The K scale is a set of questions embedded in the MNPI that are designed to see whether or not the individual is exaggerating in their responses generally speaking. Okay. Or or or lying, right? They call the K scale the lie scale, right? Well, if you're simply referring to your own personality style, um the issue is whether or not the answers are reliable or valid. It's not a matter of assessing if the person is lying on the MMPI.
 
KEVIN REDDINGTON:
Does the MMPI assess to any degree whether or not a person is lying in your opinion?
 
DR. AVRAM MACK:
No,
 
DR. AVRAM MACK:
no. So, let's stay with Dr. Mack opinion on the K scale.
 
KEVIN REDDINGTON:
What would that do?
 
DR. AVRAM MACK:
It would determine if somebody is not being truthful about their symptoms or they're exaggerating their symptoms.
 
KEVIN REDDINGTON:
Well, the MMPI assesses the individual's personality and their thoughts about themselves. So, the question is how to get an accurate reading of the person's personality. If it is the case that they are having a deviation on the K scale, then you might not utilize the MMPI as a whole.
 
DR. AVRAM MACK:
But the MMPI is not designed in the sense as a lie detector.
 
KEVIN REDDINGTON:
So what does that mean, sir? When you say um if there's a manipulation of the K scale, what does that mean?
 
DR. AVRAM MACK:
I don't think I used the word manipulation.
 
KEVIN REDDINGTON:
What word did you use?
 
DR. AVRAM MACK:
I may have said deviation.
 
KEVIN REDDINGTON:
Okay. So if there's a deviation on the K scale according to you, what does that mean?
 
DR. AVRAM MACK:
It may come to a threshold that the MMPI is not usable and because the users cannot gather information about the individual's personality as a result
 
KEVIN REDDINGTON:
because they're lying and it's not a reliable test. Right. That's the ultimate consideration. Right.
 
DR. AVRAM MACK:
Right. So it's not saying that the person is lying. It's saying that the test is not reliable
 
KEVIN REDDINGTON:
because the person who's the subject of the test is not being let's say forthright. Is that fair?
 
DR. AVRAM MACK:
I don't know that it's always necessarily a conscious act. Uh an individual it simply reflects the tendency the individual has when pro when answering the questions that are on that subp part of the test.
 
KEVIN REDDINGTON:
Okay. So, if somebody is is has been indicted by the Plymouth County by the Plymouth County District Attorney's Office for triple murder and you are working for the DA evaluating whether or not they are suffering from a mental disease or defect, would you agree with me, sir, that there may be a tendency for somebody to exaggerate their symptoms to try to paint a positive picture of themsel?
 
DR. AVRAM MACK:
No rule. Not necessarily.
 
KEVIN REDDINGTON:
Well, how about a little bit necessarily?
 
DR. AVRAM MACK:
I don't know that there's a relationship.
 
KEVIN REDDINGTON:
Okay. So, you are aware regardless that when Lindsay took the test for Dr. Kirk Halurn that there was no indication whatsoever of any malingering, uh, exaggeration or anything along those lines in that test. Would you agree with that?
 
DR. AVRAM MACK:
If you're talking about the MMPI, correct?
 
DR. AVRAM MACK:
That's what we've been talking about.
 
DR. AVRAM MACK:
I don't know. We're looking at each other, right?
 
KEVIN REDDINGTON:
I wasn't sure if he was going to answer.
 
DR. AVRAM MACK:
Yeah. Okay. So, so tell me again what your answer was, sir. that effectively that's what the testing elicited that she was that her case scale effectively it was a valid test.
 
KEVIN REDDINGTON:
Okay. Now you in your review of all of the records, TUS, Jollotta, McLean, you knew that one of the health care providers, which would be Jollotta, was focusing on the possibility that Lindsay could have been suffering from bipolar 2. Is that right?
 
DR. AVRAM MACK:
I am aware that that was on her mind that that was something she was concerned about. Yes.
 
KEVIN REDDINGTON:
And bipolar too is quite common is it not sir as a precursor of a person who is suffering from um postpartum depression or postpartum psychosis. Right.
 
DR. AVRAM MACK:
I don't understand your question.
 
KEVIN REDDINGTON:
Okay. Well, how about is it appropriate in Dr. Max's opinion to give a person suffering from bipolar two or bipolar one an SSR an individual there is a need in one's practice um traditionally at least that if an individual might be suffering from bipolar one or bipolar 2 to avoid using SSRI medications. However, that has been um reduced um in terms of u our worry about that over time. But that was maybe 20 years ago, 15 years ago something that psychiatrists were more concerned about. But the concern has lessened over time.
 
DR. AVRAM MACK:
It has. So, in in your opinion, sir, it's okay to give a a woman who is coming to you for help who's been diagnosed with a bipolar 2, it's okay to give her the SSRI in your opinion. Is that what you're telling this jury?
 
DR. AVRAM MACK:
That's not what I said.
 
KEVIN REDDINGTON:
Oh, okay. Tell me what you said. I said the concern about the relationship between and mania or bipolar disorder has lessened, but that doesn't necessarily mean that people's practices have changed.
 
KEVIN REDDINGTON:
And when you say mania, what does that mean to you, sir?
 
DR. AVRAM MACK:
Mania is a state defined in the DSM. I believe we discussed this the other day.
 
KEVIN REDDINGTON:
Go ahead. What is it? What What are the symptoms of mania?
 
DR. AVRAM MACK:
So mania is um a condition and it's defined not only by the symptoms that I'm going to mention but also by a time frame. Um and as we discussed the other day it is a um mood state that is used as a building block for bipolar type one. Um so one would need to see seven days consecutive and where the following symptoms four at least of the following symptoms are present most of the day for all of these days. Um and that would include a thought process called slight of ideas. Secondly distractability. Um thirdly an engagement in activities that um are pleasurable but have painful consequences. um rapid speech or pre what we would call pressured speech.
 
KEVIN REDDINGTON:
Pressured speech
 
DR. AVRAM MACK:
um or rapid speech. Um additionally um grandiosity and an exaggerated amount or excess degree um of goal- directed behavior
 
KEVIN REDDINGTON:
and what is your go ahead.
 
KEVIN REDDINGTON:
Oh, go ahead. What is your understanding sir of the symptoms of bipolar 2?
 
DR. AVRAM MACK:
So bipolar 2, well we didn't finish the definition of bipolar one, but in terms of bipolar type two, in terms of bipolar type two, one would need to have had a major depressive episode. I believe we discussed that the other day as well. And also one needs to have had um what's called a hypomomanic episode which is similar to a manic episode but lesser in terms of time course that's required and only three out of the seven symptoms are required.
 
KEVIN REDDINGTON:
So bipolar 2 you would agree with me sir is in fact a major or serious mental illness right?
 
DR. AVRAM MACK:
Yes. and your opinion after you had your opportunity to go back again with uh Kirk on the third day and and interview Lindsay in Tewksbury Hospital. And how long did you interview her for the third day asking her questions?
 
DR. AVRAM MACK:
I'm not sure I remember. It was perhaps perhaps three hours. So after you completed your evaluation, you came to a conclusion that in fact Lindsay was suffering from a major mental disease or defect to wit bipolar 2. Is that correct?
 
DR. AVRAM MACK:
No.
 
DR. AVRAM MACK:
No. So, why don't we look at your report and you tell me what your ultimate opinion was of your diagnosis of Lindsay after evaluating her, sir?
 
KEVIN REDDINGTON:
I think I said this the other day that my opinion
 
KEVIN REDDINGTON:
Why don't you say it again, sir?
 
KEVIN REDDINGTON:
Was Yes, I'm happy to. My opinion was that and is that she suffered from a major depressive episode and that that was a part of major depressive disorder.
 
KEVIN REDDINGTON:
Well, looking at your reports, sir, on your conclusions, would you agree with your honor?
 
DR. AVRAM MACK:
He's reading
 
KEVIN REDDINGTON:
you have do you have your report?
 
DR. AVRAM MACK:
He's reading from the wrong report.
 
KEVIN REDDINGTON:
Do you have your report, sir? Can I see it side by just for a second?
 
DR. AVRAM MACK:
It's not the wrong report. So sir, you would agree that your opinion on page 35 is that at the time of the incident that Lindsay Clancy was suffering from a mental disease.
 
KEVIN REDDINGTON:
And then you have the opinion, however, she retains substantial capacity to appreciate the wrongfulness or criminality of her conduct. Is that correct?
 
KEVIN REDDINGTON:
Did I read that right?
 
KEVIN REDDINGTON:
Um, and the mental disease from which she suffered in your opinion was a mood disorder, major depressive episode. Is that right?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
And you further opine that she may have also had an anxiety disorder that preceded or continued to be present while the major depressive episode preceded through January 24th. Is that right?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
Okay. Now, you're aware that she has been at Tewksbury under a particular diagnosis of a mental disease or defect, right?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
What is that?
 
DR. AVRAM MACK:
I believe it's adjustment disorder.
 
KEVIN REDDINGTON:
Adjustment disorder. Is it not your understanding, sir, that she's suffering according to a diagnosis of bipolar disorder?
 
DR. AVRAM MACK:
Um, I think she Well, you'd have to show me where you're referring to.
 
KEVIN REDDINGTON:
So, did you have a chance to review Dr. Heilbrun's report?
 
DR. AVRAM MACK:
I did.
 
KEVIN REDDINGTON:
And do you know what Dr. Hellburn's opinion was?
 
DR. AVRAM MACK:
of a diagnosis of
 
KEVIN REDDINGTON:
diagnosis.
 
DR. AVRAM MACK:
Yeah.
 
KEVIN REDDINGTON:
What was it?
 
DR. AVRAM MACK:
I think he uh made a diagnosis of bipolar type two.
 
KEVIN REDDINGTON:
So you have nurse practitioner Jollotta who as a treating practitioner indicates that the diagnosis possibly is bipolar disorder. Correct. I don't know that she used those terms, but I know that she was concerned about the
 
KEVIN REDDINGTON:
and and you know because you've you've obviously read and incorporated into your report Dr. Resnick's opinion correct
 
DR. AVRAM MACK:
correct
 
KEVIN REDDINGTON:
and what is Dr. Resnick's opinion sir to your understanding
 
KEVIN REDDINGTON:
in terms of the diagnosis?
 
DR. AVRAM MACK:
Yeah.
 
KEVIN REDDINGTON:
Bipolar type two.
 
KEVIN REDDINGTON:
Okay. How about Dr. Zazelle? You also had access to and incorporated into his report, your report his diagnosis. What was that?
 
DR. AVRAM MACK:
No. Offhand, I don't remember what his diagnosis was.
 
KEVIN REDDINGTON:
How about uh Meg Spanelli? Did you have a chance to review her report and incorporate that into your report?
 
DR. AVRAM MACK:
I reviewed her report.
 
KEVIN REDDINGTON:
Do you know what her diagnosis was, sir?
 
DR. AVRAM MACK:
I believe it was bipolar type one.
 
KEVIN REDDINGTON:
Right. So with all of the various health care providers that have an opinion of bipolar type one, would you agree that that is a very strong indicator that a person could very well be suffering from postpartum depression?
 
DR. AVRAM MACK:
I'm confused by your question because that last piece is not necessarily inconsistent with um the diagnosis of major depressive episode.
 
DR. AVRAM MACK:
I'm asking you sir about
 
KEVIN REDDINGTON:
I discussed the other day was when that specifier is able to be used. That would be a diagnostic question. So with the understanding that nurse practitioner Jollotta is bipolar or looking at bipolar that zizel report you don't know or recall what it is but you incorporated it into your report Dr. Resnick is bipolar too. um you feel that this is or is not indicative of a precursor to a person suffering from postpartum depression. It's in the it's in the in the in the the books in the articles, right?
 
DR. AVRAM MACK:
your use of terms um to me seems um apples and oranges. The question of postpartum depression
 
KEVIN REDDINGTON:
uh would be does the person have a mood disorder and is it in the time frame following um birth?
 
KEVIN REDDINGTON:
I can't hear you. I'm sorry. So I can't Can you say that again please? You're talking about categories that are not aligned with each other.
 
DR. AVRAM MACK:
No, I'm asking you what your answer was.
 
KEVIN REDDINGTON:
What's your answer?
 
DR. AVRAM MACK:
You'd have to restate the question.
 
KEVIN REDDINGTON:
Okay. You recall Friday, sir, that you were talking about onset of postpartum depression symptoms occurring within a particular time frame. Do you recall that sir?
 
DR. AVRAM MACK:
The diagnosis would be
 
KEVIN REDDINGTON:
My question is simple. Do you recall saying what the time frame was?
 
DR. AVRAM MACK:
Friday.
 
DR. AVRAM MACK:
I'm trying to answer your question.
 
KEVIN REDDINGTON:
What is the time frame?
 
DR. AVRAM MACK:
The time frame
 
KEVIN REDDINGTON:
the time frame designated for the diagnostic specifier called with postpartum onset is four weeks.
 
KEVIN REDDINGTON:
Okay. And that's your opinion, right?
 
DR. AVRAM MACK:
Well, I believe that's what the DSM says. The four-we period.
 
KEVIN REDDINGTON:
So, let's let's talk about
 
DR. AVRAM MACK:
the four-we period. The four-week period in which that specifier may be added.
 
KEVIN REDDINGTON:
Okay. You recall saying that
 
DR. AVRAM MACK:
the diagnostic,
 
KEVIN REDDINGTON:
you recall saying that a person can be postpartum and it has to be within four weeks. You recall saying that Friday.

Deanna · Aug 25, 2026, 6:09 AM · #post-138

DSM DIAGNOSTIC STANDARD — 03:36:41
 
KEVIN REDDINGTON:
Okay. We'll leave it at that. Now, you had mentioned, sir, I believe, that the DSM is something that you all use in your diagnoses of people, right?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
And one of the things that you are here to testify about would be postpartum issues, postpartum psychosis, postpartum depression, right?
 
DR. AVRAM MACK:
Are you referring to postpartum psychosis, the disorder? The proposed disorder or as a symptom?
 
KEVIN REDDINGTON:
Well, when you come in here as an expert hired by the DA to tell this jury that this woman was not suffering from postpartum psychosis, and you in your testimony refer to the fact that you use the DSM to guide you, if that's the right word, in your diagnoses, would you agree with me that that's a fair statement?
 
DR. AVRAM MACK:
That the DSM is the standard for making diagnoses? Yes.
 
KEVIN REDDINGTON:
Right. It's not a very good standard though, is it?
 
DR. AVRAM MACK:
Well, it is the standard.
 
## INTERNATIONAL CLASSIFICATION OF DISEASES — 03:37:51
 
KEVIN REDDINGTON:
It is the standard. How about, are there other standards, sir? For example, World Health Organization, International Disease Control, IDC, have you ever heard of them?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
Okay. Does the IDC, what does that stand for?
 
DR. AVRAM MACK:
The ICD.
 
KEVIN REDDINGTON:
What does that stand for?
 
DR. AVRAM MACK:
The International Classification of Disease.
 
KEVIN REDDINGTON:
Does that classify postpartum psychosis?
 
DR. AVRAM MACK:
I think it actually does not.
 
KEVIN REDDINGTON:
Does it classify... you think? Are you sure?
 
DR. AVRAM MACK:
My recollection is that it does not.
 
KEVIN REDDINGTON:
Okay. How about postpartum depression? Does the international category indicate that?
 
DR. AVRAM MACK:
I'm not sure. We in the United States-
 
KEVIN REDDINGTON:
No, no, no. I'm asking about the other, the IUCD or whatever it is.
 
DR. AVRAM MACK:
I don't know.
 
## POSTPARTUM PSYCHOSIS AS A DIAGNOSIS — 03:38:34
 
KEVIN REDDINGTON:
Okay. That's good enough. This here is what you're talking about, the DSM though, right? Five TR text revision, right?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
Are you talking about the fact that at some point in DSM-6, there it appears as though postpartum depression, postpartum psychosis will be added into the DSM-6. Is that correct?
 
DR. AVRAM MACK:
Who said that?
 
KEVIN REDDINGTON:
I'm asking you if that's what you mean when you told the jury about it possibly being put into the next edition.
 
DR. AVRAM MACK:
There is a syndrome that's been proposed called postpartum psychosis. So I would differentiate that from the idea of psychosis in a postpartum period. The syndrome, proposed syndrome of postpartum psychosis has not been included, and I am not aware that it is going to be included, although I understand there are calls for that. I would also say actually the movement for DSM-6 is not necessarily active at this point. But I would highlight again, because I wrote my college history thesis on the history of the DSMs, that-
 
KEVIN REDDINGTON:
What was it? DSM-1, 2, 3 back then?
 
DR. AVRAM MACK:
Well, there's been a classification made by the American Medical Association going back to the end of the 19th century. DSM-1 was in 1952. DSM-2 was 1968. DSM-3 was 1980. The main change in 1980 was to fall in, as I discussed earlier, the descriptive model for diagnoses. And that is to say that since DSM-3, diagnostic groups are grouped or disorders are grouped by what you see, what symptoms we are seeing, not by what we assume is the cause of the illness and not by any theories about how the illness works. So since DSM-4 in 1994, as a part of making DSM-4, a literature review was completed by a Dr. Ellen Frank, which indicated a roadmap for what to include in terms of postpartum designations. And since then, there has been what's called a specifier. So if you highlight depression, you can add a specifier to say when this depression occurred. The limit is that it's a four-week limit. So under the rules of DSM, after four weeks, you wouldn't necessarily... well, you wouldn't call it postpartum. Postpartum psychosis, and here I'm referring mainly to literature, including a review in biological psychiatry in the last 12 months, is a proposal that there is a type of bipolar disorder called postpartum psychosis where you can have mania or bipolar attributes, you can have depression, you can have delirium. And so when you think about the rules and the guidelines that have been in place since 1980 for revisions of the DSM, they look for can this category be sufficiently separated from other categories and does it help treatment? And over time, even though there have been calls... well, there have been hundreds of diagnoses that have been proposed or requested to be on the DSMs, very few new diagnoses get inserted. And right now, that is the situation for the syndrome called postpartum psychosis, that it is not something that has been approved. I know there are people who are calling for it, but in the current time-
 
HONORABLE WILLIAM SULLIVAN:
Okay. Next question, please.
 
KEVIN REDDINGTON:
Thank you. Are you aware, sir, that postpartum psychosis and postpartum depression are pretty much virtually not even mentioned in your DSM- 5 TR?
 
DR. AVRAM MACK:
I wouldn't agree with that. I was about to say-
 
KEVIN REDDINGTON:
Okay. So you would not agree with it, right?
 
DR. AVRAM MACK:
Actually, I was about to get to that.
 
KEVIN REDDINGTON:
Sure you were, but you would not agree with it, right? Is that correct?
 
DR. AVRAM MACK:
I don't have a basis to say that.
 
KEVIN REDDINGTON:
Okay. And this is 1050 pages of people putting together like a cookbook, fair to say, right?
 
DR. AVRAM MACK:
No, I wouldn't call it a cookbook.
 
KEVIN REDDINGTON:
No? Would you agree, sir, that postpartum is referred to page 147 in sex and gender related diagnostic issues? Would you agree with that, sir?
 
DR. AVRAM MACK:
Is that the introductory chapter?
 
KEVIN REDDINGTON:
This is the chapter, sir, that is pertinent to bipolar disorder. You're familiar with it, I'm sure.
 
## DSM TEXT AND SEX-RELATED FEATURES — 03:43:14
 
DR. AVRAM MACK:
Okay. So it's the bipolar chapter.
 
KEVIN REDDINGTON:
And referencing 147, sex and gender related diagnostic issues. You're familiar with that, I imagine, right?
 
DR. AVRAM MACK:
That's a subset. That's a portion of the chapter I imagine that describes the issues.
 
KEVIN REDDINGTON:
It's a paragraph.
 
DR. AVRAM MACK:
Okay.
 
KEVIN REDDINGTON:
It's a paragraph. Out of a thousand pages, it's a paragraph.
 
DR. AVRAM MACK:
What's your question?
 
KEVIN REDDINGTON:
Women may be more likely to experience rapid cycling and mixed states and to have patterns of comorbidity that differ from those of men, including higher rates of lifetime eating disorders. Come on. This is what they talk about with postpartum psychosis and postpartum depression, eating disorders and the difference between women and men.
 
DR. AVRAM MACK:
Is that your question? I'm not sure I understand your question.
 
KEVIN REDDINGTON:
Yeah, you answer it. Yeah.
 
DR. AVRAM MACK:
What's your question?
 
KEVIN REDDINGTON:
Postpartum disorders, sir. The difference between women and men, and they make reference to eating disorders.
 
DR. AVRAM MACK:
Well, I think the section header, if you don't mind reading it again, was aspects about gender. And so in that section, I imagine they're describing it. I didn't write the DSM, so I'm not here to represent it.
 
KEVIN REDDINGTON:
Okay.
 
DR. AVRAM MACK:
I can just tell you about it.
 
KEVIN REDDINGTON:
All right. Okay. Right here. Sex and gender related diagnostic issues. Right? Would you agree that's under the bipolar and related disorder section?
 
DR. AVRAM MACK:
Next page.
 
KEVIN REDDINGTON:
The DSM. Okay. Page 147 talks about women are more likely to experience rapid cycling in mixed states and have patterns of comorbidity that differ from those of men, including higher rates of lifetime eating disorders. Right? Did I read that right?
 
DR. AVRAM MACK:
Oh my God.
 
KEVIN REDDINGTON:
That's all right.
 
DR. AVRAM MACK:
Yeah.
 
KEVIN REDDINGTON:
Okay. And then it goes on for the rest of the paragraph that women with bipolar one or two disorder are more likely to experience depressive symptoms than are men. Did I read that right?
 
DR. AVRAM MACK:
Yeah.
 
KEVIN REDDINGTON:
That they, meaning women, apparently, have a higher lifetime risk of alcohol use disorder than men. Really? Did I read that right?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
And that they also have much greater likelihood of alcohol misuse disorder than women. In the general population, some women with bipolar disorder experience exacerbation of mood symptoms during their premenstrual time period. Right?
 
DR. AVRAM MACK:
It says that, yeah.
 
KEVIN REDDINGTON:
Yeah. And that this has been associated with a worst course of illness. Many women with bipolar disorder also report severe emotional disturbances during perimenopause when estrogen levels are decreasing. Did I read that right?
 
DR. AVRAM MACK:
All right. It does say that. Yeah.
 
KEVIN REDDINGTON:
Okay. And that there does not appear to be an increased risk of mood episodes in pregnant women with bipolar disorder, except for those who discontinue medications for pregnancy. Right? Is that what it says there in the DSM?
 
DR. AVRAM MACK:
Yes, it is.
 
KEVIN REDDINGTON:
So what does that tell you? 25 words or lesser, that sentence where it talks about, "There does not appear to be an increased risk of mood episodes in pregnant women with bipolar disorder except for those who discontinue medication for pregnancy." What does that mean?
 
DR. AVRAM MACK:
What it means is when thinking about women who have bipolar disorder who are pregnant, the risk of having either a manic episode or a hypomanic episode or a depressive episode generally stays stable compared to when the person is not pregnant, except in people who do not take medications for bipolar during the pregnancy.
 
KEVIN REDDINGTON:
And then it goes on to read, "The specifier with peripartum onset should be used for mood episodes that begin during pregnancy or within four weeks of delivery." Is that the four-week cutoff that you're telling the jury about?
 
DR. AVRAM MACK:
That's the four-week cutoff that's on that specifier. The peripartum specifier.
 
KEVIN REDDINGTON:
When was this last amended? 1958?
 
## BIPOLAR DISORDER AND POSTPARTUM ONSET — 03:47:37
 
DR. AVRAM MACK:
Well, you're talking about a four-week number?
 
KEVIN REDDINGTON:
Yeah.
 
DR. AVRAM MACK:
That was created in DSM four in 1994.
 
KEVIN REDDINGTON:
And how about the World Health Organization? What's their cutoff using that term?
 
DR. AVRAM MACK:
I don't know. I can tell you-
 
KEVIN REDDINGTON:
How about the-
 
DR. AVRAM MACK:
About the components of postpartum psychosis? The illness utilized, I believe, 12 weeks, maybe 6 weeks, but not more than 12.
 
KEVIN REDDINGTON:
How about the, what is it? IDC? ICD?
 
DR. AVRAM MACK:
The World Health Organization's International Classification.
 
KEVIN REDDINGTON:
If I tell you it's a year, would that mean anything to you? It's not 6, maybe 12. It's a year.
 
DR. AVRAM MACK:
Does it mean anything to me?
 
KEVIN REDDINGTON:
Yeah. Does it mean anything to you?
 
DR. AVRAM MACK:
With regard to what?
 
KEVIN REDDINGTON:
It's a year. You're talking about four weeks, but they're referring to a year.
 
DR. AVRAM MACK:
Well, the distinction between the ICD and the DSM is substantial. The DSM-
 
HONORABLE WILLIAM SULLIVAN:
All right. Mr. Reddington, why don't you ask a question?
 
KEVIN REDDINGTON:
Thank you. So would you agree with me, sir, that the way that women are treated postpartum after having babies, prior to having babies in Europe is a heck of a lot different than we treat women here, right?
 
SPEAKER 8:
Objection.
 
HONORABLE WILLIAM SULLIVAN:
Sustained.
 
KEVIN REDDINGTON:
So that paragraph that we just went through, we're talking about sex and gender related diagnostic issues, right?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
They mentioned the words postpartum, period. I don't mean period like the end of a sentence. I mean postpartum period. They mentioned that, right?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
And I read that correct. That's a paragraph, right?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
And then out of the 1050 pages, we can then go to another, page 156. Sex and gender related diagnostic issues. And it makes reference to the gender ratio for bipolar I disorder, right?
 
DR. AVRAM MACK:
Okay.
 
KEVIN REDDINGTON:
Would you agree that the gender ratio for bipolar I disorder is equal between women and men?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
And does it then go on and say that bipolar II disorder are mixed differing by type or sample? There is little or no evidence of bipolar gender difference in the general population. And some but not all clinical examples suggested bipolar II disorder is more common in women than in men. Is that right?
 
DR. AVRAM MACK:
It may be. As I was saying-
 
KEVIN REDDINGTON:
Maybe because you want to look at it or it may be because they might be wrong.
 
DR. AVRAM MACK:
Well, women have depression more than men, unfortunately. And so that is something that it gets reflected when it comes to bipolar type II.
 
KEVIN REDDINGTON:
So patterns of illness and comorbidity, however, differ by sex with females being more likely than males to report hypomania. Does that sound right?
 
DR. AVRAM MACK:
It sounds right.
 
KEVIN REDDINGTON:
And that women would have mixed depressive features in a rapid cycling course, correct?
 
DR. AVRAM MACK:
That sounds right.
 
KEVIN REDDINGTON:
And childbirth may be a trigger for the hypomanic episode, which can occur in 10 to 20% of females in nonclinical populations most typically in the early postpartum period. Does that sound right to you?
 
DR. AVRAM MACK:
You're reading it, so I agree.
 
## CHILDBIRTH AS A TRIGGER — 03:51:07
 
KEVIN REDDINGTON:
Yeah, I am.
 
DR. AVRAM MACK:
Okay.
 
KEVIN REDDINGTON:
Okay. And there's a big difference between DSM and WHO, right?
 
DR. AVRAM MACK:
I don't know that WHO's 12 months, what it refers to. When it comes to the proposed postpartum psychosis, one of the elements of the proposal is that it is particularly related to the physiologic changes that happen at the time of birth. And actually one of the objections that that group has to the way that the DSM is written right now is that they would like it to be solely post-birth rather than one that encompasses pregnancy and birth because it aligns with the theory that this type of disorder is related to those physiologic changes. So the timing of being closest to birth is instrumental in that proposal for postpartum psychosis, the disorder. When it's described, it's described as a disorder that occurs almost right away at the time of birth. And it is urgent.
 
KEVIN REDDINGTON:
Who says that? Who?
 
DR. AVRAM MACK:
The literature on postpartum psychosis, whether it's postpartum psychosis-
 
KEVIN REDDINGTON:
What literature? It's not in the Bible, right?
 
DR. AVRAM MACK:
Well, it's not in the Bible, but the reports by the people who are advocates and expert consensus panel who are advocates for inclusion of the syndrome of postpartum psychosis.
 
KEVIN REDDINGTON:
And they've been trying real hard-
 
HONORABLE WILLIAM SULLIVAN:
Let him finish.
 
KEVIN REDDINGTON:
Well, he's just going to go on for another half hour.
 
HONORABLE WILLIAM SULLIVAN:
Finish, doctor. Go ahead.
 
DR. AVRAM MACK:
I don't have anything more. Sorry.
 
HONORABLE WILLIAM SULLIVAN:
All right. Go ahead.
 
KEVIN REDDINGTON:
Would you agree with me, sir, as it relates to this panel of people that you're talking about, these are the people that are trying to get postpartum psychosis, postpartum depression into the DSM 6, right?
 
DR. AVRAM MACK:
I don't think they're trying to get postpartum depression included because it already is there.
 
KEVIN REDDINGTON:
In the two paragraphs that I just read?
 
DR. AVRAM MACK:
No.
 
KEVIN REDDINGTON:
Okay. Is there somewhere else that talks about postpartum depression?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
Okay. Where?
 
DR. AVRAM MACK:
Well, the report mentions, and I'll find for you what are called the specifiers for both bipolar disorder and also for depressive disorders.
 
KEVIN REDDINGTON:
There you go.
 
DR. AVRAM MACK:
Well, it's in there, but I'll find it in the book.
 
KEVIN REDDINGTON:
Okay. Why don't you look for it?
 
HONORABLE WILLIAM SULLIVAN:
Why don't we do one thing at a time?
 
DR. AVRAM MACK:
I'd like to finish speaking.
 
HONORABLE WILLIAM SULLIVAN:
And that would be, you said you're going to find it. Just find it.
 
DR. AVRAM MACK:
Okay.
 
HONORABLE WILLIAM SULLIVAN:
And then once you find it, then we'll go on to the second part, which would be asking questions and answering questions.
 
DR. AVRAM MACK:
Okay. So right here on page 173-
 
KEVIN REDDINGTON:
Read it.
 
## PERIPARTUM-ONSET SPECIFIER — 03:54:13
 
DR. AVRAM MACK:
I'll describe what I'm talking about before I read it, if that's okay. So this is the section, actually it starts on page 169, where it goes through what are called the specifiers for the bipolar disorders. And so those include with a typical features, with rapid cycling, with melancholic features. And here on page 173 is the portion about with peripartum onset.
 
KEVIN REDDINGTON:
Read it.
 
DR. AVRAM MACK:
Well, let me see how many paragraphs it is. It's 10 paragraphs. Do you want me to read all the way?
 
KEVIN REDDINGTON:
No, that's all right. Just summarize it as best you can.
 
DR. AVRAM MACK:
What I would summarize, and a similar passage is in the chapter on depressive disorders, is that it provides a way to designate that somebody's depressive disorder, or in this case their bipolar disorder, had peripartum onset. Now that's important. And they provide a lot of important information there about epidemiology and the course... by course I mean how it's going to go in terms of the disease. That's what the DSM does. Besides giving criteria for disorders, it provides basic information about course, epidemiology, and the features that the individual has. So there's a similar section in the depressive disorders.
 
KEVIN REDDINGTON:
Stick with the section that you just pointed out. Okay?
 
DR. AVRAM MACK:
Yes, sir.
 
KEVIN REDDINGTON:
You'd agree with me in a nutshell that that talks about with psychotic features, delusions, hallucinations present at any time in the current manic or major depressive episode in bipolar I disorder, right?
 
DR. AVRAM MACK:
No, I'd have to see where you're reading from.
 
KEVIN REDDINGTON:
Okay. Sure. It's right here.
 
DR. AVRAM MACK:
Yeah, but that's a different portion.
 
KEVIN REDDINGTON:
Oh, no, no. That's what you were reading from. Okay-
 
DR. AVRAM MACK:
No.
 
KEVIN REDDINGTON:
Sir. So how about down below here where it says with peripartum onset?
 
DR. AVRAM MACK:
Yes, that was what I was referring to.
 
KEVIN REDDINGTON:
The specifier, what's the specifier?
 
DR. AVRAM MACK:
So the system has a way where we can emphasize features of a person's illness. Remember, as I said, the groupings in the DSM revolve around the major psychiatric symptoms. So this is the bipolar chapter. There's a depression chapter. There's an anxiety chapter. So here, the specifier is our way of communicating that the person's problem, in this case, has peripartum onset.
 
KEVIN REDDINGTON:
Okay.
 
DR. AVRAM MACK:
And if I could connect it all, the emphasis on the proposed postpartum psychosis disorder, they object to it being peripartum. They would like it to be postpartum.
 
KEVIN REDDINGTON:
And who's they?
 
DR. AVRAM MACK:
The authors of the expert consensus group that I referred to published a paper in biological psychiatry in the last year.
 
KEVIN REDDINGTON:
About what? Psychiatry covers a large ground.
 
DR. AVRAM MACK:
Yes. It's a paper that summarizes information about this proposed disorder, highlights their assumption that it is actually a type of bipolar disorder.
 
## PROPOSED POSTPARTUM-PSYCHOSIS DISORDER — 03:56:57
 
KEVIN REDDINGTON:
Can I just interrupt? What disorder are you referring to?
 
DR. AVRAM MACK:
The proposed postpartum psychosis disorder.
 
KEVIN REDDINGTON:
All right. So there is a group of people that are trying, to your knowledge, to get postpartum disorder in the next version of the Bible, right?
 
DR. AVRAM MACK:
Effectively, yes. But I wouldn't use all those words, but yes.
 
KEVIN REDDINGTON:
Okay. And then when you're referring to the peripartum onset, one paragraph, you're talking about the specifier applied to current manic, hypomanic, or major depressive episode in bipolar one disorder, right? Did I read that right?
 
DR. AVRAM MACK:
Well, it's more than just one paragraph. It goes on to all the next day.
 
## JURY DISMISSED FOR THE WEEKEND — 03:57:38
 
HONORABLE WILLIAM SULLIVAN:
Counsel, let me see, counsel, sidebar here, just in regard to scheduling. Members of the jury, we're going to break at this point. All right? So you know what I'm going to tell you? All right? You've now heard more evidence. You've heard testimony from a number of people. You've got more and more exhibits, but you still have to keep that open mind. All right? Because you haven't heard all the evidence. You haven't heard the closing arguments, as I've said before. You haven't even heard the law that you are to apply to this in arriving at your verdict. So I'm going to stress, as I always do, don't talk about this case. Don't read anything about it. Don't listen to anything about it. Just really, just guard against that and really keep an open mind. All right? So I'm going to excuse you till Monday morning. And then I'd ask you to be here hopefully at nine o'clock. We'll come back out and we'll continue with the evidence. All right? And as I'm telling you, we are well on schedule. All right? So I don't want to get ahead of myself, but in case you're wondering, we are definitely well on schedule, much because of your work on this. So I hope everybody has a nice weekend. Maybe it'll stop raining, get outside a little bit. So again, thank you for all your time and dedication on this, and we'll see you on Monday. Okay?
 
BAILIFF:
All rise, please, [inaudible 03:59:27]. Judge has exited the floor, the [inaudible 03:59:55] session. You may seated.
 
## SCHEDULING AND ADJOURNMENT — 03:59:56
 
HONORABLE WILLIAM SULLIVAN:
Doctor, you may sit down.
 
DR. AVRAM MACK:
Oh, am I excused, sir?
 
HONORABLE WILLIAM SULLIVAN:
You talk to the that to the DA's office and guys' schedule. We did discuss that.
 
DR. AVRAM MACK:
Okay.
 
HONORABLE WILLIAM SULLIVAN:
Okay. All right. Counsel, anything else we need to address before Monday?
 
KEVIN REDDINGTON:
No.
 
SPEAKER 8:
No, Your Honor.
 
HONORABLE WILLIAM SULLIVAN:
All right. And so the plan would be we'll continue with the Commonwealth's rebuttal. At some point we'll do the final charge conference and we'll go from there. So I want to thank everybody for their work. I hope everybody has a nice weekend. Thank you.
 
KEVIN REDDINGTON:
Thank you.
 
BAILIFF:
Court, all rise.

Deanna · Aug 25, 2026, 4:55 AM · #post-137

EXPERT INDEPENDENCE — 03:11:52
 
KEVIN REDDINGTON:
But let's just take a look at it now. Is it your understanding that when you are, and I mean you individually, not Park Dietz & Associates, requested to look at and investigate into the lack of criminal responsibility of a individual charged with a crime, that you got to try to be independent?
 
DR. AVRAM MACK:
Being independent is the expectation.
 
KEVIN REDDINGTON:
The answer yes, you try to be independent?
 
DR. AVRAM MACK:
Yes, I do.
 
## JOINT EVALUATION WITH DR. HEILBRUN — 03:12:22
 
KEVIN REDDINGTON:
Okay. Is it appropriate for you to evaluate an individual with another Park Dietz & Associates guy?
 
DR. AVRAM MACK:
Are you referring to Dr. Heilbrun?
 
KEVIN REDDINGTON:
I am referring to Dr. Heilbrun. He's another one of the DA's witnesses in this case, right?
 
DR. AVRAM MACK:
Correct.
 
KEVIN REDDINGTON:
And you know Heilbrun, right?
 
DR. AVRAM MACK:
I had not met him until we jointly went to do the evaluation this April.
 
KEVIN REDDINGTON:
Jointly went to do the evaluation?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
What'd you do? Both ride in the same car over to Tewkesbury to talk to her?
 
DR. AVRAM MACK:
No.
 
KEVIN REDDINGTON:
Did you have separate cars?
 
DR. AVRAM MACK:
We did.
 
KEVIN REDDINGTON:
And then you met up beforehand and you went in to meet with Lindsay?
 
DR. AVRAM MACK:
Yes. I think that that was-
 
KEVIN REDDINGTON:
Both of you together? Both of you together?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
So you work under the umbrella of Park Dietz & Associates. Heilbrun, who's going to be testifying Monday for the government, works under the umbrella of Park Dietz & Associates, and the both of you interviewed her at the same time is what you're telling this jury?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
In your opinion, is that appropriate, sir?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
Did you talk to Kirk about your opinion?
 
DR. AVRAM MACK:
We have talked about each other's opinion. We have different opinions as far as I understand it.
 
KEVIN REDDINGTON:
Did you talk to him about his report?
 
DR. AVRAM MACK:
No.
 
KEVIN REDDINGTON:
No?
 
DR. AVRAM MACK:
I have not talked to him about his report.
 
KEVIN REDDINGTON:
Have you talked to him about testifying here today?
 
DR. AVRAM MACK:
Not in terms of content, no.
 
KEVIN REDDINGTON:
What does that mean?
 
DR. AVRAM MACK:
The other day he called me and said, "What day are you going up to Boston?"
 
KEVIN REDDINGTON:
Okay. Tripping up to Boston. Did you tell him?
 
DR. AVRAM MACK:
No, I wasn't sure what day I was going up to Boston.
 
KEVIN REDDINGTON:
Okay. Did you review his report?
 
## PROFESSIONAL LICENSES — 03:14:16
 
DR. AVRAM MACK:
I have reviewed his report.
 
KEVIN REDDINGTON:
All right. And has he reviewed your report?
 
DR. AVRAM MACK:
I don't know. I assume so, but I don't know.
 
KEVIN REDDINGTON:
Now, looking at your CV, you indicate that you're educated at Cornell, you got your medical degree, you had some fellowships. Do you have any particular interest in your practice, sir?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
And you have licensure in Delaware, right?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
Pennsylvania?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
District of Columbia?
 
DR. AVRAM MACK:
Not at the moment.
 
KEVIN REDDINGTON:
It says 2005 to the present, but not anymore?
 
DR. AVRAM MACK:
Well, I'm not sure what date that CV is, but I allowed my DC license to not be renewed.
 
KEVIN REDDINGTON:
Okay. Maryland?
 
DR. AVRAM MACK:
Same. I let it not be renewed.
 
KEVIN REDDINGTON:
New York?
 
DR. AVRAM MACK:
I actually renewed that recently.
 
KEVIN REDDINGTON:
Massachusetts?
 
DR. AVRAM MACK:
No, I haven't had that since I left here.
 
KEVIN REDDINGTON:
South Carolina.
 
DR. AVRAM MACK:
I haven't renewed that in many years.
 
KEVIN REDDINGTON:
Connecticut?
 
DR. AVRAM MACK:
Same.
 
KEVIN REDDINGTON:
Virginia?
 
DR. AVRAM MACK:
Same.
 
KEVIN REDDINGTON:
So what does that mean, that you have licensure? Does that mean you can be a psychiatrist in these states as long as it's active? Or what does that mean?
 
DR. AVRAM MACK:
Licensure means that one can act as a physician when your licensure is in effect, yes.
 
KEVIN REDDINGTON:
Okay. And as far as professional and scientific societies, you belong to the American Academy of Child and Adolescent Psychiatry, right?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
You belong to the American Academy of Juvenile and Family Court Judges. Is that correct?
 
DR. AVRAM MACK:
I don't belong to that group at the moment.
 
KEVIN REDDINGTON:
Well, did you? Is that in your resume?
 
DR. AVRAM MACK:
Yes. There was a moment when I was the representative from the American Academy of Child and Adolescent Psychiatry and the American Psychiatric Association and also the American Academy of Psychiatry and Law of all three to the National Council of Juvenile and Family Court Judges.
 
KEVIN REDDINGTON:
Okay.
 
DR. AVRAM MACK:
So at that point, I was a member of the National Council.
 
## TEACHING AND PUBLICATIONS — 03:16:27
 
KEVIN REDDINGTON:
Okay. So I asked you about your interests or focus as a doctor. Would you agree, sir, that one of the things you put down is that you were involved in ad hoc reviewerships on the Journal of American Academy of Child and Adolescent Psychiatry, right?
 
DR. AVRAM MACK:
It does say that, yes.
 
KEVIN REDDINGTON:
And then American Journal of Addictions?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
Pediatric Quality & Safety?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
That's dealing with little kids, right? Pediatrics?
 
DR. AVRAM MACK:
Well, at the Children's Hospital of Philadelphia, we see patients up to 24.
 
KEVIN REDDINGTON:
Okay.
 
DR. AVRAM MACK:
At Nemours, I believe up to 21.
 
KEVIN REDDINGTON:
So you also express interest in child psychiatry. This comes under academic responsibilities, child psychiatry, right?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
You have been involved in the doctoring course for first year medical students, right?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
Supervision of adult psychiatry residents, right?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
Clinical evaluation Department of Psychiatry dealing with children and adolescents, right?
 
DR. AVRAM MACK:
I'm not sure of that last one that you read, but ...
 
KEVIN REDDINGTON:
Number eight on ...
 
DR. AVRAM MACK:
No, but what does it say in its entirety?
 
KEVIN REDDINGTON:
Ongoing Clinical Education of PGY-3 residents, Department of Psychiatry, Georgetown University Hospital Institute for Children and Adolescents.
 
DR. AVRAM MACK:
Do you mean Regional Institute for Children and Adolescents?
 
KEVIN REDDINGTON:
Resume. I don't know what it means.
 
DR. AVRAM MACK:
I'm just wanting to make sure I'm responding to your question.
 
KEVIN REDDINGTON:
Do you have it with you? I mean, you can look at it.
 
DR. AVRAM MACK:
The Regional Institute for Children and Adolescents was a residential center outside the Beltway where I served for three years.
 
KEVIN REDDINGTON:
Okay. The focus, nevertheless, is on children and adolescents, right?
 
DR. AVRAM MACK:
Not at that time. Well, you mean when I was at Georgetown?
 
KEVIN REDDINGTON:
I'm just looking at your resume.
 
DR. AVRAM MACK:
Okay.
 
KEVIN REDDINGTON:
How about lecture of Patient Safety and Quality Improvement in Child and Adolescent Mental Health? That something that you were involved with as a lecturer, sir?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
Okay.
 
DR. AVRAM MACK:
About patient safety and quality, yes.
 
KEVIN REDDINGTON:
Answer is yes?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
Just make it quick. You were a lecturer on a Morass Returns, Adolescent Cannabis, Devil's Lettuce and Other Hallucinogen Use. Dealing with what? Pediatrics, kids?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
Okay. You also did under lectures by invitation that you've been involved with lecturing on Whither Psychosis in Adolescents, right?
 
DR. AVRAM MACK:
That was the title of a paper I gave, yes.
 
KEVIN REDDINGTON:
So the answer is yes, right?
 
DR. AVRAM MACK:
The answer is I gave that paper, yes.
 
KEVIN REDDINGTON:
Okay. Adolescents Accused of Murder and Manslaughter, right?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
Okay. Whither Psychosis, Adolescent Killers a couple of years later again. Maybe an update, right?
 
DR. AVRAM MACK:
Right.
 
KEVIN REDDINGTON:
Divorce for the Clinician, right?
 
DR. AVRAM MACK:
Right.
 
KEVIN REDDINGTON:
Divorce Legal Process in Medical, Social and Psychiatric Sequelae, right?
 
DR. AVRAM MACK:
Right.
 
KEVIN REDDINGTON:
Killer Adolescents, Drugs, School and the Courts, right?
 
DR. AVRAM MACK:
Right.
 
KEVIN REDDINGTON:
Jumping ahead, 2014, for example, you had the Morass Returns, Adolescent Cannabis and Other Hallucinogens, right? 2014.
 
DR. AVRAM MACK:
I imagine, yes. I don't know exactly which one you're looking at, but that's the title of a lecture that I was giving.
 
KEVIN REDDINGTON:
Childhood Development and Psychopathology, right? Is an interest, right?
 
DR. AVRAM MACK:
It is an interest, yes.
 
KEVIN REDDINGTON:
Childhood Development, again, in Psychopathology, lecture to the United States Department of Justice, right?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
Lecturing to the United States Department of Justice Department of Immigration, right?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
Cognitive Bias Think Tank is another one of the lectures that you gave. Is that correct?
 
DR. AVRAM MACK:
Well, it was a committee or a task force that I co-led about the prospect of diagnostic error when people have cognitive biases.
 
KEVIN REDDINGTON:
And what's a cognitive bias? Just curious.
 
DR. AVRAM MACK:
So when you think about diagnoses, there's always a possibility that an individual is sort of guided to one diagnosis or another based on various forms of preconceptions or biases. So a major part of this concept of patient safety is to prevent misdiagnosis. And there are a lot of techniques that are used in medicine, and in this case in pediatric hospitals, and also in psychiatry to try to make sure that the users or the diagnosticians biases don't creep into making the wrong diagnosis.
 
KEVIN REDDINGTON:
Research publication, sir, Dealing with Neuropsychiatric Systemic Lupus, Erythematosus Age and the Neurodevelopment Model. That's one of your research publications, right?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
Dealing with Psychiatric Classification: From the Ancients to DSM-IV, Psychiatric Clinics of North America, right?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
Alcohol abuse is another research that you did.
 
DR. AVRAM MACK:
I've written or edited several textbooks on substance use disorders.
 
KEVIN REDDINGTON:
Right.
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
Okay. So in addition to child and adolescent aspects of psychiatry, you're also interested in focusing in on alcohol abuse, substance related disorders, alcohol abuse disorders, addictive disorders, treatment of addictive disorders, right?
 
DR. AVRAM MACK:
Those are some of the areas of interest, yes.
 
KEVIN REDDINGTON:
Novel Risk Factors for Central-Line Associated Bloodstream Infections in Critically Ill Children, right?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
And it goes on and on with a lot of your focuses on children, minors, probate court, correct? I don't
 
DR. AVRAM MACK:
Know about probate court, but-
 
KEVIN REDDINGTON:
Well, you've had occasion to do evaluations for probate court, haven't you?
 
DR. AVRAM MACK:
You'd have to remind me. There was a period when I-
 
KEVIN REDDINGTON:
Okay. Nevermind probate court.
 
DR. AVRAM MACK:
... was the physician leader of the state of Maryland's Office of Forensic Services.
 
KEVIN REDDINGTON:
Right. That's what you said on direct, so that's why I'm asking it. How about the New Tools in the Toolbox, Proactive Prevention of CLABSI in Patients with Behavioral Health and Concerns. What does that mean?
 
DR. AVRAM MACK:
Well, CLABSI, central-line associated bloodstream infections, are something that is a major concern of all hospitals around the country. And preventing them from happening is not only the work of cleaning the apparatus that touches patients, but also we learned that when patients have psychiatric problems, they actually are at a greater risk of developing a central-line associated bloodstream infection, which is a significant complication of being in the hospital. So I started that work when I was at Georgetown when I was an adult, mainly focused on adults and carried it on when I was at Children's Hospital Philadelphia and at Nemours in terms of the pediatric risks for CLABSI.
 
KEVIN REDDINGTON:
Okay. How about Clinical Manual of Adolescent Substance Abuse Disorder. That's another one of your chapters, right? Book?
 
DR. AVRAM MACK:
I don't think I wrote a book about adolescent substances.
 
## SUBSTANCE-ABUSE WORK — 03:23:54
 
KEVIN REDDINGTON:
Well, it says number 29, Mack A. H. Clinical Manual of Adolescent Substance Abuse Treatment Journal of Psychiatric Practice.
 
DR. AVRAM MACK:
Yeah, that was a chapter, not a book, but yes.
 
KEVIN REDDINGTON:
Okay. But nevertheless, your focus and your interest is on adolescents that like to smoke weed and drink, right?
 
DR. AVRAM MACK:
No.
 
KEVIN REDDINGTON:
Okay. Would you agree, sir, that you were interested in the American Psychiatric Press textbook you wrote for substance abuse treatment, right?
 
DR. AVRAM MACK:
Yes.
 
## EXPERIENCE WITH PREGNANT AND POSTPARTUM PATIENTS — 03:24:22
 
KEVIN REDDINGTON:
All right. And Think like a Psychiatrist But Always a Doctor, Be a Doctor, Web Drug Store Perils, Drugs, Alcohol, Bloodstream Infections in Children's Hospital, focusing on that, right? Where in here does it say that you ever came within breathing distance of a pregnant woman and your practice and your interest in your writings?
 
DR. AVRAM MACK:
So I remember being at the Brigham as a resident and going to-
 
KEVIN REDDINGTON:
How long ago was that?
 
DR. AVRAM MACK:
How long ago was that?
 
KEVIN REDDINGTON:
Yeah, give us a year.
 
DR. AVRAM MACK:
Well, you asked me when. So I'm starting ...
 
KEVIN REDDINGTON:
Yeah, I'm asking you when. When?
 
DR. AVRAM MACK:
The memory I have for that particular situation was 2001.
 
KEVIN REDDINGTON:
2001, so 25 years ago.
 
DR. AVRAM MACK:
Right.
 
KEVIN REDDINGTON:
And what did you do?
 
DR. AVRAM MACK:
And since then I went to the Medical University of South Carolina and then I went to Georgetown, and all that period up until 2015 I was doing general psychiatry work with areas of focus in peds or in addictions, but also with forensics as an area. I see myself as somebody who's a generalist, who happens to have a couple of areas of focus. In 2015, I did move from that generalist model. When I left Georgetown, I moved to the Children's Hospital of Philadelphia and the University of Pennsylvania. In those years, since then, I've been working in pediatric hospitals. Where at CHOP, Children's Hospital of Philadelphia, the age is up to 24 and at Nemours it's up to 21. So that is the overall area of adult and child psychiatry that I've been working in. Throughout the years at Georgetown-
 
KEVIN REDDINGTON:
Okay.
 
DR. AVRAM MACK:
I would like to answer because I have more to tell you.
 
HONORABLE WILLIAM SULLIVAN:
Let him finish the answer. Go ahead.
 
DR. AVRAM MACK:
So at Georgetown, certainly that was all adult, and Georgetown has its own labor and delivery unit, so that was plenty of engagement with women who were pregnant or who had just given birth. Then at both Children's Hospital of Philadelphia and at Nemours, there are these special units that have been under design for the last several years of high risk pregnancy units. So actually at CHOP, one of my first roles there was to develop the psychiatry services coverage of the high risk maternity unit there called the special delivery unit. I was the co-leader and then the leader of the consultation service at CHOP. I led the group of adult and child psychiatrists to tend to the psychiatric needs of that unit. Recently at Nemours, the same unit was built. And so yes, in these pediatric hospitals, there actually are units of women who are about to have birth, who have just had birth.
 
KEVIN REDDINGTON:
Well, I'm sure in these pediatric hospitals, there are women about to have birth and have had birth, and I'm sure that there are competent doctors that treat that, correct?
 
DR. AVRAM MACK:
I agree with you.
 
## POSTPARTUM-PSYCHOSIS TREATMENT EXPERIENCE — 03:27:22
 
KEVIN REDDINGTON:
How about you? How many women with postpartum psychosis have you treated?
 
DR. AVRAM MACK:
Roughly 10 would be my estimate.
 
KEVIN REDDINGTON:
Over what period of time?
 
DR. AVRAM MACK:
Over the period since 2001.
 
KEVIN REDDINGTON:
And when you would treat these women, would you be involved in, for example, testing them for their mental health?
 
DR. AVRAM MACK:
Well, usually the teaching has been that what was called postpartum psychosis is actually a form of bipolar disorder. So what is important is to say, let's do a full evaluation of the individual symptoms and signs and then treat them and engage in treatment. Usually that's going to be a form of bipolar disorder treatment. That's the teaching. That is the general perspective.
 
KEVIN REDDINGTON:
So with your wealth of knowledge on women that are pregnant and suffering from postpartum psychosis, do you know whether or not Lindsay was ever diagnosed with postpartum depression?
 
DR. AVRAM MACK:
I believe that the various notes from the clinicians over the year of 2022, 2023 utilized the term unspecified mood disorder.
 
KEVIN REDDINGTON:
Right. How about postpartum depression?
 
DR. AVRAM MACK:
I don't think that appellation was used.
 
## EDINBURGH POSTNATAL DEPRESSION SCALE — 03:28:49
 
KEVIN REDDINGTON:
Okay. So was she ever administered the, what is it, EPDS?
 
DR. AVRAM MACK:
You mean the Edinburgh?
 
KEVIN REDDINGTON:
Yeah. Was she ever administered that?
 
DR. AVRAM MACK:
I don't know if she was or wasn't. I don't remember.
 
KEVIN REDDINGTON:
Isn't that something, you're in here testifying about this case, wouldn't that be important to know that she was almost off the chart on the Edinburgh scale for postnatal depression?
 
DR. AVRAM MACK:
Well, I have said that she had depression.
 
KEVIN REDDINGTON:
Well, postnatal depression for a woman who's pregnant or had a baby recently is a heck of a lot different than some guy who's just depressed about his job, right?
 
DR. AVRAM MACK:
I don't understand your question.
 
KEVIN REDDINGTON:
Well, do you know what her readings were on the Edinburgh test?
 
DR. AVRAM MACK:
Not to my memory at the moment, no.
 
KEVIN REDDINGTON:
Why not? You read the medical records, didn't you?
 
DR. AVRAM MACK:
I mean, if you would like to show me, I'd be happy to review it.
 
KEVIN REDDINGTON:
I don't want to show you anything. I'm asking you as a testifying witness for this jury, did you look at her medical records?
 
DR. AVRAM MACK:
I did.
 
KEVIN REDDINGTON:
And the medical records pertain to her being a person that just had a baby, right?
 
DR. AVRAM MACK:
I'm not sure which records you're talking about, but-
 
KEVIN REDDINGTON:
I'm talking about-
 
DR. AVRAM MACK:
Can I finish?
 
KEVIN REDDINGTON:
I'm talking about-
 
DR. AVRAM MACK:
Can I finish?
 
KEVIN REDDINGTON:
You're going to finish. 2022, obviously, because we already talked about the summer. She was fine. When did she see ...
 
KEVIN REDDINGTON:
Because we already talked about the summer. She was fine. When did she see Tufts?
 
## MEDICAL RECORDS AND MEDICATIONS — 03:30:05
 
DR. AVRAM MACK:
She started to see Dr. Tufts in 2022.
 
KEVIN REDDINGTON:
When?
 
DR. AVRAM MACK:
Well, she went to Dr. Tufts in September and it was in October that she started taking the medication that Dr. Tufts had prescribed.
 
KEVIN REDDINGTON:
Okay. And that was for what?
 
DR. AVRAM MACK:
You mean which medication or what was the purpose?
 
KEVIN REDDINGTON:
Medication.
 
DR. AVRAM MACK:
Sertraline.
 
KEVIN REDDINGTON:
And otherwise known as?
 
DR. AVRAM MACK:
Zoloft.
 
KEVIN REDDINGTON:
And she took it after a while, is that correct? Is that what you said?
 
DR. AVRAM MACK:
A few weeks, yes.
 
KEVIN REDDINGTON:
And the reason she didn't take it was what?
 
DR. AVRAM MACK:
Time as my evaluation-
 
KEVIN REDDINGTON:
Hold that for a second.
 
HONORABLE WILLIAM SULLIVAN:
Hold on a second, Doc.
 
SPEAKER 7:
Sorry.
 
HONORABLE WILLIAM SULLIVAN:
All right. Go ahead. Do you want him to re-ask that question?
 
DR. AVRAM MACK:
I'm okay.
 
HONORABLE WILLIAM SULLIVAN:
Okay.
 
DR. AVRAM MACK:
So over time, Ms. Clancy has avoided taking medications.
 
KEVIN REDDINGTON:
She's what?
 
DR. AVRAM MACK:
Avoided taking medications.
 
KEVIN REDDINGTON:
Says who?
 
DR. AVRAM MACK:
The description she gave me.
 
KEVIN REDDINGTON:
She told you that?
 
DR. AVRAM MACK:
My awareness from my evaluation is that she resists taking medications. And for example-
 
KEVIN REDDINGTON:
No, no, no. Tell me what you mean by she resists taking medications.
 
## LIFELONG RESISTANCE TO MEDICATION — 03:31:23
 
DR. AVRAM MACK:
There are individuals in this world who do not want to take medications, and I think she described that she is one of them.
 
KEVIN REDDINGTON:
S=We know that she saw Dr. Tufts because she apparently was anxious, right?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
Prior to that, other than having anxiety about public speaking as a nurse in nursing school, and after she had one of her children, she didn't have any psychiatric history of medications, right?
 
DR. AVRAM MACK:
She had not taken medications, but she had had a lifelong degree of anxiety. It hadn't been at the level of disorder, but she had a-
 
KEVIN REDDINGTON:
Lifelong.
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
Okay. How about grammar school, high school, college? Did she have difficulty that she was anxious?
 
DR. AVRAM MACK:
So what I was saying is that anxiety can drive people, but she had a lot of anxiety and she was hardworking, and the anxiety helped her to be hardworking. But when it comes to medications.
 
HONORABLE WILLIAM SULLIVAN:
Mr. Reddington, go ahead. Doctor, finish the question.
 
DR. AVRAM MACK:
But when it comes to medications, she described that she didn't want to take medications. And an example was the time that after the birth of her second child that sertraline had been prescribed, but she chose to get through her anxiety and depression by exercising. And that is something that people do. But it also highlights that in this case, she didn't want to be taking medications. And I think that we also understand that in the fall of 2022-
 
HONORABLE WILLIAM SULLIVAN:
All right. At this point, I'm going to stop you. Next question.
 
KEVIN REDDINGTON:
My question was, you said that she had a lifelong resistance to taking medication. That's what you said, right?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
Yes? Okay.
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
Then I asked you, grammar school, high school, college, did she have any records, any witnesses, any documents that she had a resistance to taking medication?
 
DR. AVRAM MACK:
Only her description to me.
 
KEVIN REDDINGTON:
She didn't tell you that she was resistant to medication in grammar school and high school and college? What, are you making this up?
 
SPEAKER 8:
Objection.
 
HONORABLE WILLIAM SULLIVAN:
Yeah. Sustained. Next question.
 
KEVIN REDDINGTON:
She didn't tell you that.
 
DR. AVRAM MACK:
I understand her to have told me that generally she did not want to be taking medications. She didn't necessarily specify in grammar school, but that is her basic-
 
KEVIN REDDINGTON:
No college.
 
DR. AVRAM MACK:
Yes. I think that her description was as a adolescent and as a young adult, she was not interested in taking medications. D
 
KEVIN REDDINGTON:
Do you really have that written down somewhere?
 
DR. AVRAM MACK:
I'm happy to be proven wrong, but I believe that that's what I understand it to be.
 
KEVIN REDDINGTON:
Do you believe that's what it is? You don't know whether you have it written down somewhere, right?
 
DR. AVRAM MACK:
Can I refer to my report?
 
KEVIN REDDINGTON:
[inaudible 03:34:09], I don't care because it's not there.
 
DR. AVRAM MACK:
Well, on page 8, what I had written was Ms. Clancy's reluctance to take medication generally was accompanied by her concern for medications entering her breast milk. So the general-
 
KEVIN REDDINGTON:
It's breast milk, she's pregnant. Come on. That's the only time that she indicates that she did not want to take... except for benzos, medication because she was breastfeeding, right?
 
DR. AVRAM MACK:
I don't agree. I'm happy to be proven wrong, but my understanding is that she described that she generally did not want to take medication. Benzodiazepines included.
 
KEVIN REDDINGTON:
Let's not guess. All right. Let's look at Dr. Mack's report. Okay? Medication history. During the period before January '24, '23, she was taking several medications and that would be Tufts and Gelada and all the rest of them, right?
 
DR. AVRAM MACK:
Okay.
 
KEVIN REDDINGTON:
Is that right?
 
DR. AVRAM MACK:
I didn't exactly hear your question. I'm sorry. Can you repeat it?
 
## PRESCRIBERS AND BREAST-MILK CONCERNS — 03:35:27
 
KEVIN REDDINGTON:
You said in your report, defendant was taking several medications that had been prescribed for her, right?
 
DR. AVRAM MACK:
In the fall and December of 2022, yes.
 
KEVIN REDDINGTON:
So it's real easy. It's Tufts and Gelada that were prescribing these meds, right?
 
DR. AVRAM MACK:
They were among the prescribers, yes.
 
KEVIN REDDINGTON:
All right. And her reluctance to take medication was accompanied by her concern for medications entering her what?
 
DR. AVRAM MACK:
I believe it says breast milk.
 
KEVIN REDDINGTON:
Breast milk. Okay. So other than her concerns as a mother about her breast milk and having these drugs get into an infant's body, when else did she tell you that she was resistant, as you just told this jury, to taking medication? Like she's somebody who doesn't want to take the medication, doesn't care to take the medication. Where is it?
 
HONORABLE WILLIAM SULLIVAN:
Overruled.
 
DR. AVRAM MACK:
Well, I didn't say that she didn't care.
 
KEVIN REDDINGTON:
Okay. How about if she was resistant?
 
DR. AVRAM MACK:
My recollection, and I'm happy to, if you would like me to spend time finding it-
 
KEVIN REDDINGTON:
Prove you wrong.
 
DR. AVRAM MACK:
What?
 
KEVIN REDDINGTON:
Prove you wrong. It's not in your report though, is it?
 
DR. AVRAM MACK:
Okay.

Deanna · Aug 25, 2026, 4:55 AM · #post-136

CROSS-EXAMINATION — 02:53:43
 
KEVIN REDDINGTON:
Dr. Mack, part of your evaluation would be an intent to investigate the person that you're being asked to evaluate for purposes of an opinion regarding criminal responsibility or lack thereof for the district attorney's office, correct?
 
DR. AVRAM MACK:
What do you mean by investigate?
 
## RETENTION BY THE DISTRICT ATTORNEY — 02:54:08
 
KEVIN REDDINGTON:
You don't know what investigate means? You want me to explain that to you? You're a psychiatrist that's employed by the district attorney, right?
 
DR. AVRAM MACK:
Retained by, yes.
 
KEVIN REDDINGTON:
Oh, okay. So we're going to talk semantics. Isn't employed by, retained by mean that you get money from it, right?
 
DR. AVRAM MACK:
I'm paid for my time, yes.
 
KEVIN REDDINGTON:
Exactly. And normally I don't even go there. Every one of us are getting paid for our time. Jurors, not so much, but nevertheless, you get paid for your time, right?
 
DR. AVRAM MACK:
Correct.
 
KEVIN REDDINGTON:
I get paid for my time. The judge, Chrissy, Don, everybody gets paid for their time, right?
 
DR. AVRAM MACK:
I imagine, yes.
 
KEVIN REDDINGTON:
So when you are retained by the district attorney's office, you are to evaluate an individual, right?
 
DR. AVRAM MACK:
Yes.
 
## EVALUATION AT TEWKSBURY — 02:54:58
 
KEVIN REDDINGTON:
And the individual in this case is Lindsay Clancy, correct?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
This case is Lindsay Clancy, correct?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
And you recognize her, do you not?
 
DR. AVRAM MACK:
I do.
 
KEVIN REDDINGTON:
And you actually had a chance to meet with her and do your evaluation, right?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
And part of your evaluation, you had to investigate into who she was. For example, her education, what she did for work, friends, family, right?
 
DR. AVRAM MACK:
I asked her about her life and I reviewed records to learn about her life, yes.
 
KEVIN REDDINGTON:
Okay. So you're in a mental institution investigating or questioning a woman who's on medication, who is there because she's suicidal and under one-on-one 24/7 observation. Would you agree with that?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
And you get the history from her?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
So did you talk to any collateral contacts?
 
DR. AVRAM MACK:
No.
 
KEVIN REDDINGTON:
So how is it that you can tell this jury what her life story is? Did you get it from her?
 
DR. AVRAM MACK:
I got it from her to the extent that-
 
## EDUCATION AND LIFE HISTORY — 02:56:03
 
KEVIN REDDINGTON:
What did she tell you about her education?
 
DR. AVRAM MACK:
I'm sorry.
 
KEVIN REDDINGTON:
What did she tell you about her-
 
DR. AVRAM MACK:
Can you say your ...
 
KEVIN REDDINGTON:
Nevermind looking at the judge.
 
JENNIFER SPRAGUE:
Objection.
 
KEVIN REDDINGTON:
What did she tell you about the education?
 
JENNIFER SPRAGUE:
You're going to-
 
HONORABLE WILLIAM SULLIVAN:
Wait, listen. You look over there and listen to the question and answer the question.
 
DR. AVRAM MACK:
Can you say the question, please?
 
JENNIFER SPRAGUE:
Well, if Attorney Reddington would let him answer the question.
 
KEVIN REDDINGTON:
What did she tell you about ... I'm sorry.
 
HONORABLE WILLIAM SULLIVAN:
Ask the question.
 
KEVIN REDDINGTON:
What did she tell you-
 
HONORABLE WILLIAM SULLIVAN:
Answer the question and we'll go from there.
 
KEVIN REDDINGTON:
What did she tell you about her education?
 
DR. AVRAM MACK:
She described her education in terms of being a hard worker through high school and college and then going to nursing school.
 
KEVIN REDDINGTON:
Okay. Where'd she go to nursing school?
 
DR. AVRAM MACK:
I think the nursing school was through Partners HealthCare, I think at the MJH.
 
KEVIN REDDINGTON:
And do you recall what the nature of the nursing was?
 
DR. AVRAM MACK:
Well, she had always wanted to be a labor and delivery nurse and she was able to achieve that.
 
KEVIN REDDINGTON:
So she worked as a labor and delivery nurse?
 
DR. AVRAM MACK:
That's my understanding, yes.
 
KEVIN REDDINGTON:
For a period of time?
 
DR. AVRAM MACK:
For several years, yes.
 
KEVIN REDDINGTON:
Nine years, seven years?
 
DR. AVRAM MACK:
I'm not sure exactly.
 
KEVIN REDDINGTON:
Did you talk to any of the nurses that she worked with? I mean, was she respected? Was she a hard worker? Was she somebody that was ducking out early or didn't want to work?
 
DR. AVRAM MACK:
I didn't talk to any of her colleagues. I'm aware that she had been there for some time and I did not hear about any aspects in which her work was deleterious.
 
KEVIN REDDINGTON:
Who would you hear from? Them?
 
DR. AVRAM MACK:
Well, one might have heard it from the notes from her spouse, might've heard it from the defendant herself.
 
KEVIN REDDINGTON:
Let's talk about one might've heard it. Is the one you? You're testifying.
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
Did you hear about it through the notes of the spouse?
 
DR. AVRAM MACK:
No, I didn't hear about any way in which her work wasn't-
 
KEVIN REDDINGTON:
Okay. So why are you telling me that? Why are you saying one might have heard about it through the notes of the spouse?
 
DR. AVRAM MACK:
Well, I think your question was how would one learn about any deleterious acts or components of the person's work. So I didn't hear about any way in which she wasn't working hard and retained as a nurse at an excellent institution.
 
KEVIN REDDINGTON:
So basically you don't know is what you're telling me. You don't know what her reputation for work ethic was. You don't know what her hours were. You don't know what her reputation in her work community was. You just don't know. Isn't that right?
 
DR. AVRAM MACK:
Combined with the records and also the report from Dr. Resnick who described her own view of herself as being a hard worker, I don't know further than that.
 
KEVIN REDDINGTON:
So in addition to being a labor and delivery nurse at Mass General Hospital for a number of years, you knew that she obviously was married, right?
 
## MARRIAGE AND CHILDREN — 02:58:48
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
And her husband was Patrick, right?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
You know how many years she was married, right?
 
DR. AVRAM MACK:
I do.
 
KEVIN REDDINGTON:
How many?
 
DR. AVRAM MACK:
I don't know it offhand, but I believe I understand or knew the date when they were married, which may have been 2013.
 
KEVIN REDDINGTON:
So the fact that she was married, you know that ... Did she want to have kids or did she find them to be a birth?
 
DR. AVRAM MACK:
She very much wanted to have children. She described that that was her lifelong interest.
 
KEVIN REDDINGTON:
Okay. Had one child, Cora, right?
 
DR. AVRAM MACK:
I can't hear you.
 
KEVIN REDDINGTON:
First child was Cora, right?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
Did she have any delivery issues with Cora?
 
## PREGNANCIES AND POSTPARTUM PERIODS — 02:59:33
 
DR. AVRAM MACK:
Not that I recall.
 
KEVIN REDDINGTON:
How about the second child? What was the second child's name?
 
DR. AVRAM MACK:
Dawson.
 
KEVIN REDDINGTON:
And how old was Dawson at the time of the incident, as we say?
 
DR. AVRAM MACK:
I think he was around four.
 
KEVIN REDDINGTON:
And did she have any issues with his delivery?
 
DR. AVRAM MACK:
Do you mean the delivery or in the postpartum period?
 
KEVIN REDDINGTON:
I mean the delivery.
 
DR. AVRAM MACK:
If I recall, I think she had a tear, which is called an episiotomy, and that was something she was unhappy about.
 
KEVIN REDDINGTON:
Sure. Did she have medication prescribed to her after Dawson?
 
DR. AVRAM MACK:
Do you mean psychiatric medication?
 
KEVIN REDDINGTON:
Sure.
 
DR. AVRAM MACK:
At some point, I think she was prescribed an antidepressant medication in that period.
 
KEVIN REDDINGTON:
What was it?
 
DR. AVRAM MACK:
I think it was Sertraline.
 
KEVIN REDDINGTON:
And do you know whether she took it?
 
DR. AVRAM MACK:
She has told us that she did not.
 
KEVIN REDDINGTON:
And when she went home after having the baby, Dawson, she then came home to a little daughter, obviously Cora, had Dawson as an infant, correct?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
And was she living in town or was she living ... Where was she living when she had these two kids?
 
DR. AVRAM MACK:
I think she was living in the same house in Duxbury.
 
KEVIN REDDINGTON:
She was living in Weymouth or ...
 
DR. AVRAM MACK:
She may have been. I'm sorry, I don't know.
 
KEVIN REDDINGTON:
That's all right. So at some point she moves to Duxbury, she's with her husband, and she goes back to work, does she?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
In your investigation, you didn't come across any information that she didn't want to go back to work because she was lazy or just didn't want to work, right?
 
DR. AVRAM MACK:
No, I think she always wanted to work.
 
## ANXIETY AFTER CHILDBIRTH — 03:01:18
 
KEVIN REDDINGTON:
Okay. Did she have anxiety about going back to work after Callan, the third child?
 
DR. AVRAM MACK:
After Callan?
 
KEVIN REDDINGTON:
Yeah, Callan. It's Callan, C-A-L-L-A-N.
 
DR. AVRAM MACK:
Yes. Yes. She wanted to go back. As August and September arrived, she was hopeful to go back to work, but she became anxious about working. There were other factors too. She became anxious-
 
KEVIN REDDINGTON:
No, no, no, no other factors yet. We'll get to the other factors. Why was she anxious about going back to work?
 
DR. AVRAM MACK:
Well, I was about to say-
 
KEVIN REDDINGTON:
Go ahead.
 
DR. AVRAM MACK:
... she was anxious about the wellbeing and nurturance of her children as she went back to work. One being that the baby was not taking a bottle. Another that in that span between the points that her husband went back to work and she was expected to go back to work, it was overwhelming to have three young children that she was caring for all by herself. As time went on, she was ambivalent about hiring somebody to help, hiring a nanny, and that was another area of anxiety. So there were several areas of anxiety. And as we've discussed earlier today, anxiety was something that she had had throughout her life.
 
KEVIN REDDINGTON:
Hey, you know what? I'm going to pull you in, okay? This is a cross-examination, sir. I gave you no room.
 
HONORABLE WILLIAM SULLIVAN:
All right. Just ask the next question.
 
KEVIN REDDINGTON:
So when you say that she had anxiety and the anxiety was about having her youngest child, Callan, correct?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
She was anxious about going back to work, correct?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
But you also, as you were waxing eloquently, indicated that she was having anxiety about having a nanny.
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
What was she anxious about with the nanny?
 
DR. AVRAM MACK:
In my understanding-
 
KEVIN REDDINGTON:
No, no, no, tell the jury what you investigated about her anxiety with the nanny.
 
DR. AVRAM MACK:
So through my evaluation, what I understood was that there was ambivalence about having a nanny, that is to say having somebody who helped. There was some degree of wanting to be able to handle the children on her own. The other part of it is some ambivalence about other people other than herself or perhaps her mother caring for the children. Because I know that my evaluation discerned that she felt very positively about her ability to take care of her children, but also some ambivalence about other people taking care of the children.
 
KEVIN REDDINGTON:
What timeframe are we talking about? Summertime? Fall?
 
DR. AVRAM MACK:
The end of summer. Late August, early September.
 
## FALL 2022 SYMPTOMS — 03:04:06
 
KEVIN REDDINGTON:
Well, isn't it true that in the summer she and Patrick and the kids felt that they were on top of the world, having a great summer, right?
 
DR. AVRAM MACK:
Well, that's what she said. That's her quote.
 
KEVIN REDDINGTON:
Okay. And then come the fall, towards the end of September, that's when she started to have symptoms of anxiety, right?
 
DR. AVRAM MACK:
Yes. Most-
 
KEVIN REDDINGTON:
But to this point, in your investigation, you have a young woman who is a nurse for a number of years. We assume from your investigation, a good reputation, is a hard worker, right?
 
DR. AVRAM MACK:
I can't hear you. I'm sorry.
 
KEVIN REDDINGTON:
Yeah. One of the things that you had mentioned is that she was ... What about exercise? Did she like to do exercise?
 
DR. AVRAM MACK:
Yes. In the past, exercise was her-
 
KEVIN REDDINGTON:
The answer is yeah, right? Yes?
 
DR. AVRAM MACK:
Can you repeat the question?
 
JENNIFER SPRAGUE:
[inaudible 03:04:55]
 
KEVIN REDDINGTON:
Sure. I can repeat the question. I asked you, sir-
 
JENNIFER SPRAGUE:
I'm objecting because he's interrupting the witness and not letting him answer the question.
 
HONORABLE WILLIAM SULLIVAN:
The question called for a yes or no answer, all right? And so, go ahead.
 
KEVIN REDDINGTON:
Go ahead.
 
DR. AVRAM MACK:
Can you state the question, please?
 
KEVIN REDDINGTON:
Sure. You mentioned in direct examination for the DA that she liked to do exercise, correct?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
And would you consider a person who is an exercise aficionado, especially a woman who, for example, runs, let's say, a 5K or a five-mile road race within about a couple of weeks after having a baby? Is that hyper exercise? Is that hypomanic [inaudible 03:05:39]?
 
DR. AVRAM MACK:
In of itself, it's not hypomanic, no.
 
KEVIN REDDINGTON:
How about if there's a string of exercise that is a little bit out of the norm coupled with decluttering, removing personal property from the home, cleaning out the home, things of that nature? Would that be hypomanic in your opinion?
 
DR. AVRAM MACK:
Not in and of itself. But when you were asking about exercise, were you talking about in the period 2022 or 2020?
 
KEVIN REDDINGTON:
2022
 
DR. AVRAM MACK:
Okay.
 
KEVIN REDDINGTON:
After Callan, okay? And I asked you about running the road race after Callan, okay? You with me?
 
DR. AVRAM MACK:
Yes, I am.
 
KEVIN REDDINGTON:
Good. So would you suggest, sir, that that is something that one would at least anticipate, consider, or investigate as being this manic or hypomanic that you're talking about?
 
DR. AVRAM MACK:
No.
 
## TIMING OF RETENTION — 03:06:35
 
KEVIN REDDINGTON:
So by the way, one of the questions that you were asked, sir, is that when you got involved with investigating this case, do you recall that from the DA? Do you recall that from the DA?
 
DR. AVRAM MACK:
The term investigate, if it's okay, I'll use the term evaluate, but-
 
KEVIN REDDINGTON:
When you got appointed or retained by the DA.
 
DR. AVRAM MACK:
Right. And your question is?
 
KEVIN REDDINGTON:
My question is, when were you retained by the district attorney, the prosecutors?
 
DR. AVRAM MACK:
It was sometime in early 2025.
 
KEVIN REDDINGTON:
Early 2025. So like what? February, January?
 
DR. AVRAM MACK:
I think the reach out had occurred in maybe December of 2024, and I think that the retention was early in 2025.
 
KEVIN REDDINGTON:
And what's a reach out?
 
DR. AVRAM MACK:
Well, the communication, the reaching out.
 
KEVIN REDDINGTON:
From?
 
DR. AVRAM MACK:
From the district attorney's office.
 
KEVIN REDDINGTON:
Okay. And then when you were asked that question, you indicated that you had to wait for a motion to be filed or something with the court. Do you recall answering that question?
 
DR. AVRAM MACK:
No.
 
KEVIN REDDINGTON:
Well, if I suggest to you, sir, it was in December of 2024 that a notice of lack of criminal responsibility was filed. Does that seem to fit with the reach out?
 
## NOTICE OF CRIMINAL-RESPONSIBILITY DEFENSE — 03:07:58
 
JENNIFER SPRAGUE:
Objection. Can we approach?
 
HONORABLE WILLIAM SULLIVAN:
Sure. All right, Counsel.
 
KEVIN REDDINGTON:
Thank you, Judge. So your understanding of the procedure is that a notice has to be given to the court that a person, like Lindsay, is raising the issue of criminal responsibility, correct?
 
DR. AVRAM MACK:
I imagine that's the case, but I don't know the procedure here in Massachusetts in that regard.
 
KEVIN REDDINGTON:
Okay. You don't know the procedure?
 
DR. AVRAM MACK:
The procedure for making notice?
 
KEVIN REDDINGTON:
Right.
 
DR. AVRAM MACK:
No, I do not.
 
KEVIN REDDINGTON:
If I tell you, sir, that the notice is filed in December of '24, when was it that you had the reach out?
 
DR. AVRAM MACK:
The first communication about the case was in, as I said, a few minutes ago, in late 2024.
 
KEVIN REDDINGTON:
And do you recall the circumstances of that communication? DA call you, letter, what?
 
## PARK DIETZ AND ASSOCIATES — 03:09:07
 
DR. AVRAM MACK:
No, I was contacted through a retention firm called Park Dietz & Associates.
 
KEVIN REDDINGTON:
Dietz?
 
DR. AVRAM MACK:
Mm-hmm.
 
KEVIN REDDINGTON:
He's a psychiatrist, isn't he?
 
DR. AVRAM MACK:
It sounds like you know him.
 
KEVIN REDDINGTON:
I do know him. And actually, Park Diets is a rather famous psychiatrist, is he not?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
He's testified in many cases, correct?
 
DR. AVRAM MACK:
Yes, but-
 
JENNIFER SPRAGUE:
Objection.
 
HONORABLE WILLIAM SULLIVAN:
No, overruled.
 
DR. AVRAM MACK:
I said Park Dietz & Associates, I didn't say Park Dietz himself.
 
KEVIN REDDINGTON:
Okay. Well, you know Park Dietz, I imagine, right?
 
DR. AVRAM MACK:
I do.
 
KEVIN REDDINGTON:
Yeah. And you know that he's the guy that testified in a case and cited a Law & Order episode that didn't exist at the time he gave his-
 
JENNIFER SPRAGUE:
Objection.
 
HONORABLE WILLIAM SULLIVAN:
Sustained.
 
KEVIN REDDINGTON:
So is he still active?
 
HONORABLE WILLIAM SULLIVAN:
Objection.
 
JENNIFER SPRAGUE:
Sustained.
 
KEVIN REDDINGTON:
Is he a psychiatrist now?
 
DR. AVRAM MACK:
Yes, he's a psychiatrist.
 
KEVIN REDDINGTON:
And on your letterhead, it says Park Dietz, D-I-E-T-Z & Associates Forensic Experts, right?
 
DR. AVRAM MACK:
I can't see what you're looking at, but that's what the letterhead basically says.
 
KEVIN REDDINGTON:
Well, it said Dr. Avram Mack, right?
 
DR. AVRAM MACK:
I am.
 
KEVIN REDDINGTON:
Okay. And this is your curriculum vitae, right?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
In big letters up above, it says Park Dietz & Associates, right?
 
DR. AVRAM MACK:
Yes.
 
## EXPERT ASSIGNMENT AND CURRICULUM VITAE — 03:10:29
 
KEVIN REDDINGTON:
Now, how does that work? You get a call from this retention group, Park Dietz, and then you get assigned a case?
 
DR. AVRAM MACK:
When an attorney or a district attorney's office contacts them, they might think that it might be a case that I might want to be retained on.
 
KEVIN REDDINGTON:
Okay. Do they, to your knowledge, try to get someone that's familiar with that particular topic or just anybody that has a random psychiatry degree?
 
DR. AVRAM MACK:
Well, there are only certain people that they think of or consider, people that Dr. Dietz has thought of in terms of having a robust career and background.
 
KEVIN REDDINGTON:
You have a robust career?
 
DR. AVRAM MACK:
I've been active as a teacher and as a clinician over about 22 years, and I've been a full professor at Penn and Jefferson and Georgetown.
 
KEVIN REDDINGTON:
So that's in your curriculum vitae, correct?
 
DR. AVRAM MACK:
The three professor level appointments?
 
KEVIN REDDINGTON:
All of your stuff. The things you wrote, things that you're interested in, your fellowships, professorships, all that, right?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
Okay. And that's introduced into evidence by the DA, right?
 
DR. AVRAM MACK:
Yes.
 
KEVIN REDDINGTON:
So the jury's going to have it to look at, right?
 
DR. AVRAM MACK:
Okay. I didn't know that, but-

Deanna · Aug 25, 2026, 4:55 AM · #post-135

DAY 18, PART 4: DR. AVRAM MACK — CRIMINAL-RESPONSIBILITY OPINIONS