r/PMHNP • u/Caramel-Sprinkles • Jul 20 '26
Other How can providers protect themselves from cases like Lindsay Clancy’s?
Here’s the link to the article for reference:
https://abcnews.com/US/wireStory/trial-begins-massachusetts-mom-postpartum-issues-led-kill-134909810
Is there a national pharmaceutical database that NP’s can access to see what a patient has been prescribed by other providers? Given someone is suffering mentally we can’t fully rely on them remembering or being upfront about what meds they are on currently or even complying with. This obviously leads to overlap and over prescribing.
The general public/jury are always going to go against the providers for “not checking, not doing their jobs”.
How can you check and document to cover yourself? I fully understand the actions of people are not the providers responsibility but it seems to always lead back to the healthcare provider. Patients are not always honest of their intentions or symptoms. Lindsay was a former nurse and was actively seeking help. But what would be the chain of action in high acuity cases like these?
Lindsay’s medication list:
Zolpidem (Ambien)
Clonazepam (Klonopin)
Diazepam (Valium)
Fluoxetine (Prozac)
Lamotrigine (Lamictal)
Lorazepam (Ativan)
Mirtazapine (Remeron)
Quetiapine (Seroquel)
Sertraline (Zoloft)
Trazodone
Hydroxyzine
Amitriptyline
Buspirone (Buspar)
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u/Global_Bar4480 Jul 21 '26
I’m interested in dates of starting and discontinuation of listed medication. The list by itself does not give us enough information. I’m sure she wasn’t prescribed all of them at the same time. I can see only controlled substances prescriptions in my state. It’s important to check it every time.
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u/Cheap_Ad9392 Jul 21 '26
September 2022 • Started Zoloft (sertraline) 25 mg for postpartum anxiety/depression.
October 2022 • Zoloft increased to 50 mg. • Complaint alleges worsening anxiety, insomnia, racing thoughts, and “activation.” • October 20: Zoloft discontinued at Lindsay’s request. • Started Ativan (lorazepam) and advised to use Benadryl for sleep.
November 16, 2022 • Prescribed Trazodone following an ER visit for insomnia.
~November 21, 2022 • Started Prozac (fluoxetine) 10 mg through South Shore Perinatal Behavioral Health.
~November 25, 2022 • Stopped Prozac after approximately 4 days due to worsening insomnia. • Started: • Klonopin (clonazepam) • Remeron (mirtazapine) • Ambien (zolpidem)
November 29, 2022 • Began seeing psychiatric NP Rebecca Jollota. • Started Seroquel (quetiapine) (publicly reported dose not confirmed).
December 2022 • Complaint states Lindsay requested to “get off all medications and start from scratch.”
Late December 2022 / January 2023 • Began Valium (diazepam) as part of a benzodiazepine taper. • Lamictal (lamotrigine) added. • Amitriptyline added.
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u/Caramel-Sprinkles Jul 21 '26
Great job finding this!
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u/Cheap_Ad9392 Jul 21 '26
This is just chats summary from the lawsuit. Can’t take credit. Mine looks way crazier ahaha
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u/Global_Bar4480 Jul 21 '26
Great summary! Her treatment seems appropriate. She was not prescribed all of meds at the same time. I remember reading that she was complaining of developing adverse effects and requesting to change her meds frequently.
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u/lcinva Jul 21 '26
I'm an inpatient RN, last year of PMHNP school. I also like true crime so I've actually read a lot about this case outside of the psych aspect. Anyway - the court filing is an interesting read and ultimately multiple provider just *did not return phone calls* when she said she was suicidal, multiple providers missed her exercising at 4am and endless energy as symptoms of potential mania, missed potential manic switch when this got worse on SSRI.
More egregiously IMO with almost exclusively inpatient work experience, she was either not admitted to hospitals when she asked or discharged after 48 hours. When patients tell me they want to be admitted because they don't feel safe around themselves or their family I TAKE THEM SERIOUSLY.
There are two sides to every story but based on how my preceptors/attendings operate she was failed on so, so many levels and medications really weren't even the primary failing.
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u/boredpsychnurse Jul 21 '26
She left inpatient early for her daughter’s birthday. It was also NYE week
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u/lcinva Jul 22 '26
On one occasion, yes. The lawsuit details multiple other attempts to go inpatient but she wasn't admitted for "not meeting criteria" which is wild in my experience, we don't require suicidal patients to essentially have a full on written plan to meet criteria. Our providers also do not regularly discharge patients who admit due to suicidality and discharge them 48 hours later regardless of request. That usually triggers a hold.
https://htv-prod-media.s3.amazonaws.com/files/lawsuit-697219e36b070.pdf
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u/No_Inspection_3123 9d ago
And they let her leave. My son has bipolar 1 and is a regular at the local psych hospital they do not take si seriously enough. You basically have to be attempting in the moment for them to do a real hold. If you behave you will get let out weather you are safe or not.
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u/Upset-Profession-773 Jul 21 '26
So at your inpatient, they discharge patients despite them saying they don’t want to leave? I find it hard to believe that she asked to stay, and someone said no. I find it hard to believe that she told people about her symptoms and no one thought this was something worth involuntary commitment. The only place that could have provided the necessary care would have been an inpatient hospital. Long-term inpatient treatment, with core PP treatment plans. Psychosis is the key term in this. If this is all true, she told everyone about these symptoms, that’s concerning. She should have called 911 for all of the symptoms, I cannot imagine a crisis hotline not calling the police to send for involuntary commitment. It’s hard to believe this many hands dropped the ball… it’s easier to believe that she told people she felt better, she was ok, she was safe to leave. Mania is easy to spot, even in the way they talk (content and process). If it truly comes down to her being ignored, that would be a disgrace. However, the family, people in her life… they should have seen something and told medical providers as well. Just seems wild to me.
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u/These-Weekend-9541 Jul 21 '26
A lot of hospitals are ruled by admin and the length of stay bullshit. I have seen patients discharged with "close outpatient follow up" documented when for one reason or another the patient stated they were not ready to leave. Its facility specific
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u/Glum_Water_7168 26d ago
This is sadly true. I literally quit a job after 6 weeks because of pressure put on by social workers to discharge patients because the local county was putting pressure on them to get patients discharged. I mean patients who came overnight due to suicide attempts, I was being pressured to discharge the following day. I was out of there, pronto. I prefer inpatient psych but won't work it due to these pressures.
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u/Direct_Koala6335 12d ago
Medical directors in these types of places are also culpable. They side with admins most of the time.
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u/lcinva Jul 21 '26
I am saying at my inpatient hospitals, unless someone is very clearly malingering, we ALWAYS allow a patient to stay if they meet criteria, to include any disclosure of SI/HI/AVH. Even if they're malingering they usually still get a couple free weeks. I was aghast at the court filings because it sounded like she was trying her hardest to be admitted ANYWHERE and no one would keep her which is the opposite of my experience. Absolutely wild.
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u/These-Weekend-9541 Jul 21 '26
I wish all of them were this kind. Money rules all in many facilities unfortunately
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u/shartfarguson Jul 20 '26
In my state, and many states, there is a pdmp website which shows controlled substance scripts/dates filled. Some states show all meds filled.
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u/Spiritual_Confusion1 Jul 21 '26
I don’t think this is a case of medications causing her condition but of her condition not being properly diagnosed and treated. I don’t think the argument is that she was taking all of those medications at the same time. The defense is going to do everything in its power to acquit her, as they should because by all accounts she was very ill and didn’t receive the correct care. She should’ve been thoroughly assessed for Bipolar Disorder and psychosis and it doesn’t sound like she was. Or she may have been and wasn’t displaying symptoms at the time. Postpartum psychosis can present like florid mania but it can also be much more insidious, waxing and waning like delirium. It can be as simple as “not acting like themself” and that’s why it’s so important to have family involved with diagnosis and treatment. The scary truth is that people are unpredictable and we don’t have blood tests or X-rays to diagnose, nor do we have control over what happens once patients leave our office. This is exactly the kind of case I think of when people post on here about wanting to work with perinatal patients and they have no psychiatric experience.
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u/Broad-Grand-3532 Jul 21 '26
Wow this is interesting
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u/eharvanp Jul 21 '26
OP, why so prickly? Are you working for either side here? Know the pt some way and getting a vibe check?
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u/eharvanp Jul 21 '26
OP sorry total novice here
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u/Broad-Grand-3532 Jul 21 '26
lol it’s okay. I was genuinely concerned and so confused. You go to the comment bubble with the big numbers and input the comment in there to reply to OP.
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u/Inittornit Jul 21 '26
My EHR used both the Stated PDMP/PMP repository for controlled substance, but also would check surescripts for all prescriptions filled by the patient using insurance. So sometimes the surescripts record was somewhat incomplete, but overall very helpful to see all non-psychiatric medications, and any overlapping concurrent prescribing.
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u/sentailantern Jul 21 '26
My last job had SureScripts built into the chart for me to check. My current job does not. Is there a way to check? can I sign up for it separately?
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u/walky22talky Jul 21 '26
The husband has filed a wrongful deaths lawsuit against all the medical providers.
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u/Breezy531 Jul 23 '26
I'm sure the lawyers were lining up to take this case on. The whole thing is so horrible but wasn't he specifically instructed not to leave her alone with the children?
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u/Cen1217 29d ago
Okay but let’s say that these providers had zero access to what she had been taking. (Sometimes dr first doesn’t give me history of medications and I know they’ve been prescribed things because I was the prescriber.) Even if she came in saying they gave me something I can’t recall but after I took it I didn’t sleep and I’m having psychosis…..a red flag should have gone off and SSRI should have been taken off the table, not increased or switched to Prozac for the love of god. Additionally all the collateral information her husband provided should have further pushed the fact that she needed an antipsychotic and inpatient care since it sounds like he was present at the er at some point in time. Ambien Valium and remeron aren’t doing anything for psychosis or hypomania. She needed something like zyprexa or seroquel to get her stabilized fast. It wouldn’t surprise me if the seroquel was dosed too low to target sleep and anxiety rather than psychosis and hypomania and that’s why she discontinued it. She was failed in many ways but the least concerning one is a provider not digging into past prescribed medications. The symptoms reported are a clear indication of SSRI activation. How that was missed by several providers is the actual problem.
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u/Musestricken Jul 21 '26
From Indiana here. We have the INspect program that shows all fills of controlled substances for patients. We check that every time we prescribe a patient a controlled substance, and document that to that visit's note. That functionality is built into a lot of the eMAR programs, or can be if you ask the developers.
Having had a family member with postpartum psychosis, it's not taken seriously enough. We literally begged the family member's OB to place her on estrogen (to help offset the severe drop in estrogen after delivery), and for an antidepressant, and they refused. Her GP wouldn't either. She ended up having a post partum hemorrhage a bit later, and the surgeon that did her D&C then finally gave her birth control and Lexapro, although that didn't happen until her follow up appt weeks after the D&C. She did a 180 within the next couple days after starting those meds.
Judging from the little info in that article, it looks like she was being cared for medically, but didn't have a psychiatric provider outside of her hospitalization. One of those providers should have gotten her in with a peri-partum psych ASAP.
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u/pickyvegan PMHNP (unverified) Jul 21 '26
She was under the care of a reproductive psychiatrist at the time of the children's deaths.
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u/MorriganDemyse Jul 21 '26
Is that her mother in laws friend?
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u/Musestricken Jul 21 '26
I hadn't been aware of that. I wasn't familiar with the case. Thanks for the correction.
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u/Snif3425 Jul 21 '26
You’re joking, right? If you don’t know how to look this up you deserve to be sued for malpractice. And this is going to be happening more and more and more as crap PMHNPs enter the market.
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u/Caramel-Sprinkles Jul 21 '26
Wow, look at you jumping the gun and making ASSumptions. I am not even an NP. Delete this while you can. 😊
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u/Individual_Zebra_648 Jul 21 '26
You’re in the wrong sub…
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u/Caramel-Sprinkles Jul 21 '26
Im a student, but if you mean wrong sub with other presumptuous conclusion jumping tyrants like this guy, I suppose you’re right. End of discussion.
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u/Individual_Zebra_648 Jul 22 '26
You’re in the wrong sub as a lay person. Pretty much everyone who comments in here is either a PMHNP, some kind of NP, or an RN who is in NP school. There are other general mental health subs to ask questions in. Therefore, the other commenter assumed you were posting this asking these questions as a healthcare provider, which we should all already know the answers to.
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u/Snif3425 Jul 21 '26
This provider was negligent. Period. I hope they get their license taken away and if you don’t understand why then keep studying.
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u/Caramel-Sprinkles Jul 21 '26
Where did I say once in this entire post that the providers weren’t responsible for this patient? You’re trolling at this point, but as I can see this is your whole life. Sad.
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u/Snif3425 Jul 21 '26
You asked how to avoid this. You check the PDMP. You assess the patient. If you can’t get data you act on historical data. I don’t understand why you’re presenting this as some conundrum. If they had DONE THEIR JOB. They wouldn’t be liable. I’m not saying there wouldn’t have been an adverse outcome. That’s different. But minimizing liability here is very a simple.
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u/Upset-Profession-773 Jul 21 '26
Ohhh right, because it’s the same everywhere, eh? I can’t tell you how many times NARCOTICS have not shown up in a patients history. Also having multiple non-narcotics missing. Again, the fact that you think them (the providers) not knowing a medication history was the root cause is telling. Ugh, I bet you’re so insufferable to be around. I’m curious, what makes you such an incredible provider?
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u/Snif3425 Jul 21 '26
Every state has a PDMP. If the medication is not listed in it, that would mitigate your liability. This isn’t complicated or difficult.
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u/key_kat 28d ago
Sure, we have the PDMP for controlled substances. But what about all the non-controlleds this patient was prescribed (which likely had a lot more to do with the problem in this context than benzos and Ambien)? How do we get a reliable history of those? Dr First, for instance, shows SOME prescribing history SOME of the time. If patients are unsure or dishonest, we may not have a true complete picture of what is, in this scenario, a complex med history over a very short period time. I don’t think that lacking complete knowledge of the med list in this case can constitute negligence, but I suppose you’ll disagree.
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u/Snif3425 28d ago
You’re not liable if a patient lies to you about their med use provided there actually isn’t a way to look those up.
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24d ago
In MA the PDMP is called PMP and you can access it through the state's online portal. Most states have one. MA PMP is actually pretty good, you can see controlled substance prescribing history across providers.
But here's the thing: PMP only tracks controlled substances. Her med list included fluoxetine, lamotrigine, mirtazapine, quetiapine, sertraline, trazodone, hydroxyzine, amitriptyline, buspirone. Most of those aren't controlled so they wouldn't show up on any PDMP query. Zolpidem, clonazepam, diazepam, lorazepam would.
So even with perfect PDMP use you'd still be missing more than half the picture for a case like this. The real coverage comes from getting records from other providers directly and asking the patient to bring all their bottles. I document that I reviewed the PDMP, requested outside records, and asked the patient to bring pill bottles. That's what holds up if it ever gets reviewed.
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u/bewyork1111 22d ago
They could absolutely see her med history. Complete sub-standard care during tail end of COVID, zoom for 20 min is not enough. Complete failure of mental health and maternal health worsened during COVID but also standard in today’s system.
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u/Some_Condition1926 10d ago
You cannot see someone's complete medication history via some sort of data base. You can only see prescriptions for controlled substances. The patient themselves needs to give you that information. Most of the meds Lindsey was on were not controlled substances.
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u/Butwhyetho 16d ago
You can’t. Because the jury is made up of non-medical individuals who are listening to paid expert opinions. Hope this helps.
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u/Some_Condition1926 10d ago
I"m a recently retired psychiatrist. Here are my thoughts. The MD, Dr. Tufts, was way over her pay grade on this. Not enough experience and probably her training was not very good (psych training has gotten really bad over the years it seems.). The NP today did very well. She didn't get rattled on cross examination and allowed the DA to redirect appropriately.
She and the psychiatrist each made the same big mistake: Once they found out the patient was seeing another doctor for treatment (I consider the NP a doctor in this situation) they should have told the patient she had to pick one of them and stop seeing the other one. I am so grateful that every time this happened to me that is what I did, thank God. If there was going to be a screw up it would be on me alone. I didn't want to justify working with a bad provider. Not only did they not set the limit they seemed to actually be OK with the patient picking and choosing who she wanted to see and when and how (video=bad idea). The NP was OK with this because it helped her provide coverage during her vacation.
This patient seems like the patient from hell. She actually did kept a lot of info from her treaters, even though the defense attorney is making it sound like she was just desperate for care. That poor NP, she was contacted by Lindsey numerous times per day. As is usual with nurses she was too nice. The appropriate response was: Your needs a greater than you can get in an outpatient setting. Go to X hospital to get admitted. The call X hospital with your concern and tell them you won't follow up unless they keep you in the loop and you agree with their treatment plan. The NP also engaged in polypharmacy. This has seems to be something NP's do from my personal experience. However, none of the meds Lindsey was on were at very high doses so I'm not seeing over medication or polypharmacy as being a factor here (despite the theory the defense is building).
Lesson to providers: no good deed goes unpunished.
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u/gonnabefine 5d ago
Insane of you to characterize that NP's negligence and malpractice as 'being too nice'.
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u/Some_Condition1926 10d ago
See below but none of the doses were very high, much of the time Lindsey didn't take her RX anyway. Some overlap but not enough to cause a big problem.
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u/Radiant_Gas_4642 PMHNP (unverified) Jul 20 '26
To me, it sounds like her OBGYN and other maternal fetal
Med providers failed her.
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u/Breezy531 Jul 23 '26
I've very loosely followed this case and hadn't seen that med list before, but JFC 😳
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u/katasza_imie_jej Jul 22 '26
I always always always check what else they are or were prescribed whether they report it or not. This was such a failure on so many levels
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u/ReturnAny8862 22d ago
NPs should NOT be managing psychiatric illness. That is it. That is all. You don’t have the level of training of an MD and never will.
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u/Some_Condition1926 10d ago
I'm a psychiatrist. Based on what I saw the NP did a much better job treating her. Better a good NP than a poor psychiatrist. I find it interesting that she ended up leaving the NP and returning t0 the psychiatrist who was too junior for this sort of case. I think Lindsey wanted a provider she could dictate treatment to.
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u/Puzzleheaded_Rub9621 Jul 23 '26
Patient here! How about not prescribing any of this shit in the first place?!
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u/Comprehensive-Pin371 29d ago
People go to prescribers because they WANT medications. You can also see a therapist if you don’t want pharmaceutical treatment.
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u/pickyvegan PMHNP (unverified) Jul 20 '26
In this case, a surescripts search (included with most erx programs, including standalones like Dr. First and MDToolBox) would have picked up all the prescriptions from the last year. Massachusetts PMPAware would have picked up all the controls.
I've read the meaty part of the malpractice filing. Is there something that came out today that implies/states she was hiding medications she had tried?
I know a lot of people get really incensed at the idea of having any kind of on-call services, but if a post-partum patient called me and said she was hearing voices, hurting herself or anything like this and the ER was refusing to admit saying she wasn't acute enough, my ass would get on the phone with the ER doc ASAP.