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Lindsay Clancy’s Psychiatrist Grilled Over Missed Warning Signs · Murder Files Unsealed

• 0:00
  Speaker 1: Imagine for a second that you are sitting on a
• 0:03
  Speaker 1: witness stand.
• 0:04
  Speaker 2: Oh, man. That is stressful already.
• 0:05
  Speaker 1: Right. You're in a courtroom. You are under oath, but
• 0:08
  Speaker 1: you're not on trial for some, you know, elaborate or
• 0:12
  Speaker 1: cinematic crime.
• 0:13
  Speaker 2: Yeah.
• 0:13
  Speaker 1: You are literally on trial for doing your everyday job. Wow. Okay.
• 0:18
  Speaker 1: So I want you to picture this really hostile, incredibly
• 0:21
  Speaker 1: sharp attorney standing across from you, and he is armed with, like,
• 0:27
  Speaker 1: Every routine email you've sent over the past year.
• 0:30
  Speaker 2: Every single one.
• 0:31
  Speaker 1: Every single one. Every click of a button you've made
• 0:34
  Speaker 1: in your company software. every mundane 15 minute video meeting
• 0:39
  Speaker 1: you've had.
• 0:39
  Speaker 2: That sounds like an absolute nightmare, honestly.
• 0:41
  Speaker 1: It is. And this attorney is just tearing all of
• 0:43
  Speaker 1: it apart piece by piece, trying to prove that your
• 0:46
  Speaker 1: ordinary everyday workflow was actually like a series of catastrophic
• 0:51
  Speaker 1: negligent failures.
• 0:53
  Speaker 2: Yeah, which is just a terrifying thought for anyone doing
• 0:56
  Speaker 2: their job.
• 0:56
  Speaker 1: It really is. So welcome to the deep dive. Today,
• 0:59
  Speaker 1: we are immersing ourselves in this really raw, gripping trial transcript.
• 1:03
  Speaker 1: It's from the YouTube channel law and crime trials. And
• 1:07
  Speaker 1: we have this stack of primary source material, and it
• 1:10
  Speaker 1: consists entirely of the cross-examination of a psychiatrist, Dr. Jennifer Tuss.
• 1:15
  Speaker 2: And she was treating a woman named Lindsay Clancy, right?
• 1:17
  Speaker 1: Yes, exactly. She was treating her for postpartum anxiety.
• 1:21
  Speaker 2: Yeah, and I have to say, it is an incredibly
• 1:23
  Speaker 2: tense exchange to read through.
• 1:25
  Speaker 1: Oh, for sure.
• 1:26
  Speaker 2: I mean, the attorney is just aggressively questioning the doctor
• 1:29
  Speaker 2: about the care she provided. And in doing so, he
• 1:32
  Speaker 2: is essentially, you know, Putting the entire modern health care
• 1:36
  Speaker 2: system on trial.
• 1:37
  Speaker 1: Yeah, he really is.
• 1:38
  Speaker 2: So our mission today is to unpack this really intense
• 1:41
  Speaker 2: collision between routine medical practice and that unforgiving, hyper-focused lens
• 1:48
  Speaker 2: of the legal system.
• 1:49
  Speaker 1: Right.
• 1:49
  Speaker 2: We are going to explore what this transcript actually reveals
• 1:52
  Speaker 2: about the realities of modern health care. You know, things
• 1:54
  Speaker 2: like the inherent limitations of telemedicine.
• 1:56
  Speaker 1: Which is huge right now.
• 1:58
  Speaker 2: Exactly. And the biological realities of the medications we just
• 2:01
  Speaker 2: casually prescribe every day. Plus... The incredibly heavy burden placed
• 2:05
  Speaker 2: on both doctors and patients when it comes to psychiatric diagnosis.
• 2:09
  Speaker 1: OK, let's unpack this, because reading through this transcript, you
• 2:12
  Speaker 1: immediately feel the friction.
• 2:14
  Speaker 2: Oh, yeah.
• 2:14
  Speaker 1: And it doesn't even start with complex medical jargon. You know,
• 2:18
  Speaker 1: it starts with the most basic human element. Right.
• 2:20
  Speaker 2: The setup.
• 2:21
  Speaker 1: Yeah. The attorney establishes right out of the gate that Dr.
• 2:26
  Speaker 1: Tuss and her patient had 14 meetings, 14 evaluations.
• 2:31
  Speaker 2: That's a lot of sessions.
• 2:32
  Speaker 1: It is. And every single one of them was conducted
• 2:36
  Speaker 1: via television and web, telemedicine. Yeah. The doctor literally never
• 2:41
  Speaker 1: saw her patient in person until the day they were
• 2:43
  Speaker 1: both sitting in that courtroom.
• 2:45
  Speaker 2: Which is such a crucial foundation for the attorney's entire argument.
• 2:49
  Speaker 1: Why is that? I mean, telehealth is so common now.
• 2:52
  Speaker 2: It is. But to understand why he focuses on it,
• 2:55
  Speaker 2: we have to look at the mechanics of a cross-examination.
• 2:57
  Speaker 1: Okay.
• 2:58
  Speaker 2: In an adversarial legal system, the attorney's goal isn't just to, like,
• 3:02
  Speaker 2: gather facts. Facts are usually already established in depositions way
• 3:06
  Speaker 2: before the trial.
• 3:07
  Speaker 1: Right. So he already knows the answers to what he's asking.
• 3:10
  Speaker 2: Exactly. The goal on the stand is to craft a
• 3:12
  Speaker 2: narrative for the jury.
• 3:13
  Speaker 1: Oh, I see.
• 3:14
  Speaker 2: He is intentionally, right from the very first question, contrasting
• 3:19
  Speaker 2: the cold, digital, distanced nature of a webcam with the traditional,
• 3:24
  Speaker 2: culturally ingrained image we all have of a warm, physically
• 3:28
  Speaker 2: present caring doctor.
• 3:30
  Speaker 1: That classic, like, bedside manner idea.
• 3:33
  Speaker 2: Exactly. He is setting a stage where the doctor is
• 3:36
  Speaker 2: separated from the patient by a screen. He's implying this
• 3:39
  Speaker 2: fundamental separation of care.
• 3:41
  Speaker 1: And he hammers this physical limitation home in such a
• 3:44
  Speaker 1: visceral way in the transcript.
• 3:46
  Speaker 2: He really does.
• 3:47
  Speaker 1: He asks the doctor about the patient crying, about the
• 3:49
  Speaker 1: patient being unable to get out of bed because she
• 3:52
  Speaker 1: was so depressed. Yeah. And then he hits her with
• 3:55
  Speaker 1: this incredible question. He asks, and did you give her
• 3:57
  Speaker 1: a hug? Wow. Right. And the doctor replies, oh, no,
• 4:00
  Speaker 1: you're on telemedicine. So you couldn't give her a hug,
• 4:02
  Speaker 1: could you? Yeah.
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  Speaker 2: That is such a loaded emotional accusation to throw at
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  Speaker 2: a medical professional.
• 4:07
  Speaker 1: It's intense.
• 4:08
  Speaker 2: It is incredibly loaded. But, you know, the doctor's defense
• 4:11
  Speaker 2: is actually fascinating in its pragmatism.
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  Speaker 1: How so?
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  Speaker 2: Well, she calmly pushes back and says essentially that even
• 4:19
  Speaker 2: if they were in the exact same room, hugging is
• 4:22
  Speaker 2: not actually something psychiatrists typically do with patients.
• 4:25
  Speaker 1: Oh, right. Because of boundaries.
• 4:27
  Speaker 2: Yes, which is medically accurate. Psychiatric boundaries usually preclude physical touch,
• 4:32
  Speaker 2: like hugging. You have to maintain clinical distance and prevent
• 4:36
  Speaker 2: what's known as transference. Transference?
• 4:38
  Speaker 1: What is that?
• 4:39
  Speaker 2: It's basically where a patient redirects feelings about a significant
• 4:44
  Speaker 2: person in their own life onto the therapist.
• 4:47
  Speaker 1: Oh, I see. So you want to avoid that entirely.
• 4:49
  Speaker 2: Right. But the thing is, the lawyer isn't asking about
• 4:52
  Speaker 2: psychiatric protocols or transference.
• 4:54
  Speaker 1: No, no, not at all.
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  Speaker 2: He's appealing directly to the jury's emotional understanding of human comfort.
• 4:59
  Speaker 1: Yeah, he wants them to feel that lack of warmth.
• 5:02
  Speaker 2: Exactly. He's weaponizing the screen as a shield that prevented
• 5:06
  Speaker 2: human connection.
• 5:07
  Speaker 1: He even uses the physical space of the courtroom to
• 5:09
  Speaker 1: make his point, which I just thought was brilliant courtroom theater.
• 5:12
  Speaker 2: What does he do?
• 5:13
  Speaker 1: He says to the doctor, I'm looking at you and
• 5:15
  Speaker 1: you've got the witness stand cutting you off in half, right?
• 5:19
  Speaker 1: So I can't see from your waist down, your legs,
• 5:21
  Speaker 1: your feet, your hands, anything. That's the same view that
• 5:23
  Speaker 1: you have on the telemedicine, right?
• 5:25
  Speaker 2: Oh, wow.
• 5:25
  Speaker 1: Yeah. He is forcing everyone in that room to realize
• 5:29
  Speaker 1: that a video call is literally just half a picture.
• 5:32
  Speaker 2: That is brilliant. This is where he brilliantly transitions from
• 5:35
  Speaker 2: an emotional argument, you know, the lack of a hug,
• 5:39
  Speaker 2: to a strictly clinical argument. Okay.
• 5:41
  Speaker 1: How does he do that?
• 5:43
  Speaker 2: He brings up the concept of objective manifestations.
• 5:45
  Speaker 1: Which means what exactly?
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  Speaker 2: So in psychiatric care, diagnosis relies really heavily on a
• 5:51
  Speaker 2: mental status exam. And that includes observing physical tells of
• 5:54
  Speaker 2: emotional distress.
• 5:56
  Speaker 1: Right, like body language.
• 5:57
  Speaker 2: Exactly. Think about the somatic symptoms of severe anxiety. When
• 6:01
  Speaker 2: your sympathetic nervous system is in overdrive, pumping cortisol and
• 6:05
  Speaker 2: adrenaline through your body, it has to go somewhere.
• 6:07
  Speaker 1: Right, like the classic fight or flight response.
• 6:10
  Speaker 2: Precisely. So how does that manifest physically? Leg bouncing, foot tapping,
• 6:15
  Speaker 2: hand wringing, white knuckling the armrests of a chair.
• 6:18
  Speaker 1: Things you might not even realize you're doing.
• 6:20
  Speaker 2: Right. They are involuntary motor responses to internal psychological terror.
• 6:26
  Speaker 1: And you'd only see those if you could see the
• 6:27
  Speaker 1: whole person.
• 6:28
  Speaker 2: Exactly. So the lawyer forces the doctor to admit that
• 6:31
  Speaker 2: these are real vital indicators of stress. And then he
• 6:35
  Speaker 2: forces her to admit that because of the webcam frame,
• 6:38
  Speaker 2: she couldn't see the patient's hands or legs for 14
• 6:41
  Speaker 2: straight sessions.
• 6:42
  Speaker 1: Wow.
• 6:43
  Speaker 2: He is systematically dismantling the clinical efficacy of telemedicine right
• 6:48
  Speaker 2: there in front of the jury.
• 6:49
  Speaker 1: But wait, I have to jump in here. Even if
• 6:50
  Speaker 1: hugging isn't standard, isn't the lawyer right that seeing full
• 6:54
  Speaker 1: body body language is vital for a psychiatrist? Well, it's...
• 6:58
  Speaker 1: Because if a core part of anxiety is physical, you know, tremors,
• 7:02
  Speaker 1: restless legs, and you literally cannot see the patient's legs,
• 7:05
  Speaker 1: aren't you essentially doing half a medical exam?
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  Speaker 2: That is the exact tension the medical field is grappling
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  Speaker 2: with right now.
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  Speaker 1: I mean, if you're trying to diagnose severe debilitating anxiety...
• 7:15
  Speaker 1: and you are betting everything on a cropped two-dimensional image
• 7:19
  Speaker 1: from the collarbone up, haven't we lost something fundamental in
• 7:22
  Speaker 1: the shift to convenience?
• 7:23
  Speaker 2: It's a very fair point. There is undeniably a loss
• 7:26
  Speaker 2: of diagnostic data when we move from a physical room
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  Speaker 2: to a digital space.
• 7:31
  Speaker 1: It's like playing a high-stakes game of poker with someone
• 7:34
  Speaker 1: where you can only see their shoulders and head. How
• 7:37
  Speaker 1: can you spot their tell?
• 7:38
  Speaker 2: That's a great analogy. In a physical room, a psychiatrist
• 7:42
  Speaker 2: observes how a patient walks in, their posture, the energy
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  Speaker 2: they carry, the microexpressions that might just be blurred out
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  Speaker 2: by a low-resolution webcam.
• 7:51
  Speaker 1: Yeah, you lose all that nuance.
• 7:53
  Speaker 2: You lose the ability to read the room. However, to
• 7:55
  Speaker 2: look at this impartially, we also have to consider the
• 7:58
  Speaker 2: reality of accessibility and triage in modern medicine.
• 8:02
  Speaker 1: What do you mean by triage in this specific context?
• 8:05
  Speaker 2: Well, look at the patient's condition. We're talking about a
• 8:07
  Speaker 2: severely depressed postpartum mother whose as the transcript notes, finds
• 8:11
  Speaker 2: it difficult to even get out of bed.
• 8:13
  Speaker 1: Right. She's struggling just to function.
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  Speaker 2: The biological reality of postpartum depression often involves crushing fatigue.
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  Speaker 2: If the standard of care requires this woman to shower, dress,
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  Speaker 2: put her baby in a car seat, drive across town,
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  Speaker 2: sit in a waiting room, and physically present herself in
• 8:28
  Speaker 2: an office.
• 8:29
  Speaker 1: She probably just wouldn't do it.
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  Speaker 2: Exactly. She likely just wouldn't do it.
• 8:32
  Speaker 1: Yeah.
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  Speaker 2: A telemedicine appointment, even with its cropped view, might be
• 8:35
  Speaker 2: the only appointment she can actually attend.
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  Speaker 1: Okay. That makes a lot of sense. The lawyer might
• 8:40
  Speaker 1: be demanding this idealized, romanticized version of medicine that just
• 8:44
  Speaker 1: isn't practical for a mother in the depths of postpartum paralysis. Right.
• 8:48
  Speaker 1: A cropped view is better than absolutely no view at all.
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  Speaker 2: Precisely.
• 8:52
  Speaker 1: Yeah.
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  Speaker 2: And Dr. Toucan has to defend that cropped image. Her
• 8:57
  Speaker 2: response on the stand is actually very telling.
• 8:59
  Speaker 1: What does she say?
• 9:01
  Speaker 2: She says, I couldn't see her legs, but I knew
• 9:03
  Speaker 2: that she was under stress.
• 9:04
  Speaker 1: She just knew. Yeah.
• 9:06
  Speaker 2: She is arguing that her clinical expertise allows her to
• 9:09
  Speaker 2: perceive distress even without the full physical picture.
• 9:12
  Speaker 1: Okay, I can see that.
• 9:14
  Speaker 2: She relies on the patient's words, the cadence of her speech,
• 9:17
  Speaker 2: her tone of voice, her facial affect. She is arguing
• 9:20
  Speaker 2: that the mind can still be evaluated even if the
• 9:23
  Speaker 2: legs are hidden.
• 9:24
  Speaker 1: Right, the upper half gives enough clues.
• 9:26
  Speaker 2: But the lawyer's tactic is still highly effective because it
• 9:29
  Speaker 2: plants a seed of doubt. He makes the jury wonder,
• 9:32
  Speaker 2: you know, what vital clues were happening just below the
• 9:35
  Speaker 2: frame of that camera.
• 9:36
  Speaker 1: Yeah, it really makes you think. But, you know, if
• 9:39
  Speaker 1: a doctor is forced to compress a patient's complex trauma
• 9:42
  Speaker 1: into this tiny video box, it begs a terrifying question
• 9:45
  Speaker 1: about how else the system is compressing this woman's reality.
• 9:49
  Speaker 2: Absolutely.
• 9:49
  Speaker 1: And that brings us to the software itself. Because if
• 9:52
  Speaker 1: the physical window into the patient's mind was limited by
• 9:55
  Speaker 1: a computer screen, the transcript reveals that the clinical window
• 9:59
  Speaker 1: was just as severely limited by the computer program the
• 10:02
  Speaker 1: doctor was using.
• 10:03
  Speaker 2: Yes. This brings us to the profound tension surrounding electronic
• 10:06
  Speaker 2: health records, or EHR.
• 10:09
  Speaker 1: The dreaded EHR.
• 10:11
  Speaker 2: Exactly. The transcript details a really fierce debate over diagnostics
• 10:15
  Speaker 2: and the specific tools used to measure the human mind.
• 10:19
  Speaker 2: The attorney focuses heavily on the standardized tests administered to
• 10:22
  Speaker 2: the patient.
• 10:23
  Speaker 1: And he highlights a massive discrepancy in the paperwork, right?
• 10:26
  Speaker 2: He does. What's fascinating here is how the medical system
• 10:29
  Speaker 2: relies on these specific tools as absolute barometers of truth. Right.
• 10:33
  Speaker 1: He asks about a test called the Edinburgh Postnatal Depression Scale. Yeah.
• 10:37
  Speaker 1: He calls it a major test, like the one specifically
• 10:40
  Speaker 1: designed for a doctor to evaluate a patient for postpartum depression. Right.
• 10:44
  Speaker 1: But Dr. Tyus didn't use that test during her evaluations.
• 10:48
  Speaker 1: She used something called the PHQ-9.
• 10:51
  Speaker 2: And to understand why the lawyer attacks this so hard,
• 10:54
  Speaker 2: we have to look at the mechanics of these two
• 10:56
  Speaker 2: specific diagnostic tools.
• 10:58
  Speaker 1: Okay, break it down for us.
• 10:59
  Speaker 2: So the PHQ-9 stands for the Patient Health Questionnaire 9.
• 11:03
  Speaker 2: It is a generalized depression screening form.
• 11:06
  Speaker 1: Just general depression.
• 11:07
  Speaker 2: Exactly. It asks nine standard questions based on the diagnostic
• 11:11
  Speaker 2: criteria for major depressive disorder. It asks things like, do
• 11:15
  Speaker 2: you have little interest or pleasure in doing things? Are
• 11:18
  Speaker 2: you feeling down, depressed, or hopeless? Are you having trouble
• 11:21
  Speaker 2: falling or staying asleep?
• 11:23
  Speaker 1: Seems pretty standard. It is.
• 11:24
  Speaker 2: It is a highly effective, statistically validated tool for the
• 11:27
  Speaker 2: general population.
• 11:28
  Speaker 1: So what's wrong with using it on a postpartum mother?
• 11:31
  Speaker 1: Why is the lawyer making such a big deal out
• 11:33
  Speaker 1: of it?
• 11:34
  Speaker 2: The problem, as the lawyer points out, is that the
• 11:36
  Speaker 2: neurobiology and psychological landscape of a postpartum woman is completely
• 11:41
  Speaker 2: different from a standard case of clinical depression.
• 11:43
  Speaker 1: How so?
• 11:44
  Speaker 2: After giving birth, A woman experiences the single largest, most
• 11:48
  Speaker 2: sudden hormonal drop in human biology. Wow.
• 11:51
  Speaker 1: The largest.
• 11:52
  Speaker 2: Yes. Estrogen and progesterone just plummets. This isn't just standard sadness,
• 11:58
  Speaker 2: you know. It is a profound chemical shock to the system.
• 12:02
  Speaker 2: And that shock produces very specific symptoms.
• 12:04
  Speaker 1: And the Edinburgh test catches those specific symptoms.
• 12:08
  Speaker 2: Exactly. The Edinburgh Postnatal Depression Scale is highly specialized. it
• 12:12
  Speaker 2: intentionally avoids focusing too heavily on somatic symptoms like sleep
• 12:16
  Speaker 2: deprivation or changes in appetite.
• 12:18
  Speaker 1: Oh, because every single mother of a newborn is sleep-deprived
• 12:20
  Speaker 1: and has a disrupted appetite. Right.
• 12:22
  Speaker 2: If you use a general test like the PHQ-9 on
• 12:25
  Speaker 2: a new mother, the results are skewed by the mere
• 12:27
  Speaker 2: reality of having a baby in the house.
• 12:29
  Speaker 1: That makes total sense.
• 12:31
  Speaker 2: The Edinburgh test instead asks about feelings of guilt, panic,
• 12:34
  Speaker 2: feeling overwhelmed, and the inability to laugh or see the
• 12:38
  Speaker 2: funny side of things. It focuses on the cognitive and
• 12:41
  Speaker 2: emotional distortions specific to that postpartum period.
• 12:45
  Speaker 1: So the lawyer's strategy is to highlight that Dr. Tones
• 12:48
  Speaker 1: used a blunt general instrument for a highly specific, uniquely
• 12:52
  Speaker 1: vulnerable condition. Yes.
• 12:54
  Speaker 2: He literally says the PHQ-9 has nothing to do with
• 12:57
  Speaker 2: a woman suffering from postpartum depression.
• 12:59
  Speaker 1: Wow. And how does the doctor respond?
• 13:01
  Speaker 2: Dr. Tones disagrees, of course. She defends the PHQ-9 as
• 13:05
  Speaker 2: a standard accepted psychiatric tool. But then... And this is
• 13:09
  Speaker 2: a huge moment. The lawyer drops an absolute bombshell into
• 13:13
  Speaker 2: the cross-examination.
• 13:14
  Speaker 1: Oh, I remember this part. It's crazy.
• 13:16
  Speaker 2: He reveals that at some prior point, completely unknown to Dr. Tones,
• 13:20
  Speaker 2: someone else in the medical system had actually administered the
• 13:23
  Speaker 2: highly specialized Edinburgh test to this patient.
• 13:26
  Speaker 1: Yes, and the score was a 23.
• 13:28
  Speaker 2: Exactly.
• 13:28
  Speaker 1: And for context, the attorney establishes that a score of
• 13:31
  Speaker 1: 15 on the Edinburgh scale is the cutoff for severe depression.
• 13:34
  Speaker 1: So a 23 isn't just a red flag. It's like
• 13:37
  Speaker 1: a blaring siren.
• 13:38
  Speaker 2: It is a massive indicator of severe distress. And Dr.
• 13:43
  Speaker 1: Tess testifies, under oath, I was not aware of this test.
• 13:46
  Speaker 1: I was not aware that this had been administered to her.
• 13:49
  Speaker 2: That is a staggering revelation to hear in a courtroom.
• 13:52
  Speaker 2: And it highlights a terrifying fragmentation in our health care system.
• 13:55
  Speaker 1: It really does. It's like taking your car to a
• 13:59
  Speaker 1: mechanic for a failing transmission, but the mechanic isn't allowed
• 14:03
  Speaker 1: to see the diagnostic notes from the specialist who inspected
• 14:07
  Speaker 1: your engine yesterday?
• 14:08
  Speaker 2: That's a perfect way to put it.
• 14:09
  Speaker 1: You're demanding that this professional fix a highly complex machine,
• 14:13
  Speaker 1: but you force them to wear blinders. I mean, how
• 14:16
  Speaker 1: does a massive piece of data like a score of
• 14:18
  Speaker 1: 23 just vanish into thin air?
• 14:20
  Speaker 2: It vanishes because of the way electronic health records are
• 14:23
  Speaker 2: built and siloed.
• 14:24
  Speaker 1: Siloed.
• 14:25
  Speaker 2: Yeah. We tend to think of the medical system as
• 14:27
  Speaker 2: one giant interconnected brain. Like it's all one big network. Right.
• 14:32
  Speaker 1: Like my doctor can just pull up my entire history
• 14:33
  Speaker 1: in one click.
• 14:34
  Speaker 2: But it isn't. It is a fractured landscape of different
• 14:38
  Speaker 2: software systems. You have Evic, Cerner, Athena, and they often
• 14:42
  Speaker 2: do not talk to each other.
• 14:43
  Speaker 1: So they're basically speaking different languages.
• 14:46
  Speaker 2: Exactly. A test administered by an OBGYN in one hospital
• 14:50
  Speaker 2: network might be completely 100 percent invisible to a psychiatrist
• 14:55
  Speaker 2: operating in a private practice using a different software platform.
• 14:59
  Speaker 1: That is terrifying.
• 15:00
  Speaker 2: Interoperability, which is the ability of these systems to seamlessly
• 15:04
  Speaker 2: share data, is the holy grail of modern health tech.
• 15:09
  Speaker 2: But it is far from a universal reality right now.
• 15:12
  Speaker 2: So one hand simply does not know what the other
• 15:15
  Speaker 2: is doing.
• 15:15
  Speaker 1: And it gets so much worse when we look at
• 15:17
  Speaker 1: how the doctor is forced to record her own observations
• 15:20
  Speaker 1: within her own system.
• 15:22
  Speaker 2: Oh, the drop-down menus.
• 15:23
  Speaker 1: Yes. The lawyer brings up Dr. Tuss's medical records and
• 15:26
  Speaker 1: points out that during the fall of October, November, December,
• 15:30
  Speaker 1: the records literally state the patient was deteriorating.
• 15:33
  Speaker 2: This is where the transcript moves from the tragic to
• 15:35
  Speaker 2: the systemic. The lawyer uses the doctor's own notes against her,
• 15:40
  Speaker 2: basically painting a picture of a patient in a free fall.
• 15:42
  Speaker 1: But Dr. Tuss pushes back on that word. Right. She
• 15:44
  Speaker 1: says she wouldn't have actually chosen the word deteriorating. She
• 15:48
  Speaker 1: testifies that the patient was, you know, a little bit
• 15:51
  Speaker 1: worse at certain appointments, fluctuating. but that deteriorating wasn't her
• 15:56
  Speaker 1: actual medical opinion.
• 15:58
  Speaker 2: And why was it in the notes then?
• 15:59
  Speaker 1: Because it was simply the only word choice available in
• 16:02
  Speaker 1: the drop-down menu of her software program.
• 16:05
  Speaker 2: That is just... It's perhaps the most breathtaking moment in
• 16:09
  Speaker 2: the entire cross-examination.
• 16:11
  Speaker 1: I couldn't believe it when I read it.
• 16:13
  Speaker 2: The attorney pounces on this. He treats her almost like
• 16:15
  Speaker 2: a machine, saying, you're like a robot, you can't take
• 16:18
  Speaker 2: a pen and write something down, you have to do
• 16:20
  Speaker 2: the drop box and the X's on the computer.
• 16:23
  Speaker 1: Just brutal.
• 16:24
  Speaker 2: He forces her to admit that her clinical judgment was
• 16:27
  Speaker 2: literally overridden by the user interface of an app.
• 16:30
  Speaker 1: I mean, think about your last doctor's appointment. When you
• 16:33
  Speaker 1: were trying to explain a nuanced, fluctuating symptom, maybe a
• 16:37
  Speaker 1: pain that only happens sometimes or a mood that goes
• 16:39
  Speaker 1: up and down, did you notice the doctor just clicking
• 16:42
  Speaker 1: through a drop-down menu on an iPad?
• 16:44
  Speaker 2: They're always looking at the screen. Always.
• 16:46
  Speaker 1: You have to wonder... Is my reality actually fitting into
• 16:50
  Speaker 1: their software? It's like trying to explain a highly complicated
• 16:54
  Speaker 1: dietary allergy to a waiter, but they just hand you
• 16:57
  Speaker 1: an app and say you can only select vegan or
• 16:59
  Speaker 1: meat eater. Right.
• 17:00
  Speaker 2: There's no room for the in-between.
• 17:01
  Speaker 1: So what does this all mean for the patient? If
• 17:04
  Speaker 1: the doctor can't physically write down what she's seeing, who
• 17:07
  Speaker 1: is actually treating the patient, the doctor or the software developer,
• 17:11
  Speaker 1: what happens when a human being's complex mental state doesn't
• 17:15
  Speaker 1: fit into one of three pre-programmed choices coded by a
• 17:19
  Speaker 1: developer in Silicon Valley.
• 17:20
  Speaker 2: What happens is a dangerous reduction of the human experience. But,
• 17:24
  Speaker 2: you know, to look at this impartially, we have to
• 17:26
  Speaker 2: understand why these drop-down menus exist in the first place.
• 17:30
  Speaker 1: Okay, why do we use them if they're so restrictive?
• 17:32
  Speaker 2: The shift to electronic health records, which was accelerated by
• 17:35
  Speaker 2: federal mandates like the Heddy Tech Act, wasn't done maliciously.
• 17:39
  Speaker 1: No, of course not.
• 17:40
  Speaker 2: It was done to standardize global health data, to track
• 17:43
  Speaker 2: population health metrics, And to prevent lethal drug interactions by
• 17:48
  Speaker 2: cross-referencing prescriptions automatically. And, frankly, to streamline the massive bureaucracy
• 17:55
  Speaker 2: of insurance billing.
• 17:56
  Speaker 1: Right, because an algorithm needs standard data.
• 17:58
  Speaker 2: Exactly. A computer algorithm can't easily read a doctor's nuanced
• 18:02
  Speaker 2: handwritten paragraph about a patient's fluctuating mood. But an algorithm
• 18:07
  Speaker 2: can instantly process a checked box that says deteriorating. The
• 18:11
  Speaker 2: system prioritizes data uniformity over clinical nuance.
• 18:15
  Speaker 1: But the cost of that uniformity is just staggering.
• 18:18
  Speaker 2: It is.
• 18:18
  Speaker 1: And we see it again in the transcript when the
• 18:20
  Speaker 1: lawyer brings up the patient's effect versus her mood.
• 18:23
  Speaker 2: This is a huge point.
• 18:24
  Speaker 1: For anyone not steeped in psychology, can you just explain
• 18:26
  Speaker 1: the difference between those two terms? Because they sound like
• 18:29
  Speaker 1: the same thing.
• 18:30
  Speaker 2: Absolutely. It's a crucial distinction in a mental status exam.
• 18:34
  Speaker 2: Mood is a patient's internal subjective experience, is what they
• 18:37
  Speaker 2: tell you they are feeling. For example, a patient might say,
• 18:40
  Speaker 2: I feel fine. That's their stated mood. Effect, on the
• 18:44
  Speaker 2: other hand, is the external observable manifestation of emotion. This
• 18:48
  Speaker 2: is what the doctor actually sees.
• 18:49
  Speaker 1: Oh, I see.
• 18:51
  Speaker 2: So a patient might say, I feel fine, but they
• 18:53
  Speaker 2: are weeping, their voice is trembling, and they won't make
• 18:56
  Speaker 2: eye contact.
• 18:56
  Speaker 1: So they don't match. Right.
• 18:58
  Speaker 2: When mood and effect do not match, psychiatrists call this
• 19:01
  Speaker 2: being incongruent.
• 19:03
  Speaker 1: Incongruent. Got it.
• 19:04
  Speaker 2: And it is a massive clinical red flag. It can
• 19:08
  Speaker 2: indicate profound distress, disassociation. or a patient actively trying to
• 19:13
  Speaker 2: hide their symptoms.
• 19:14
  Speaker 1: And this is exactly what the lawyer zeroes in on
• 19:16
  Speaker 1: in the trial.
• 19:17
  Speaker 2: Yep.
• 19:17
  Speaker 1: The transcript shows the doctor noting that the patient said
• 19:20
  Speaker 1: she was feeling okay, but she objectively appeared anxious.
• 19:24
  Speaker 2: Right, the mismatch.
• 19:25
  Speaker 1: The lawyer asks if this means she was incongruent, and
• 19:28
  Speaker 1: then he asks the most damning question. He asks, did
• 19:31
  Speaker 1: she put that in the report? Did she note that
• 19:33
  Speaker 1: her affect and mood were in conflict?
• 19:35
  Speaker 2: And what does Dr. Tooze say?
• 19:37
  Speaker 1: She has to answer, that is not an option for
• 19:39
  Speaker 1: me to indicate in that section. She literally could not
• 19:42
  Speaker 1: record a vital, nuanced psychiatric observation because the digital box
• 19:46
  Speaker 1: on her screen didn't allow for it.
• 19:49
  Speaker 2: The software simply didn't. did not possess the vocabulary for
• 19:51
  Speaker 2: human complexity.
• 19:52
  Speaker 1: Exactly. And the lawyer seizes on this. He challenges her, saying,
• 19:57
  Speaker 1: you're a doctor. Why are you limited because of the technology?
• 20:00
  Speaker 2: Which is a fair question from a layman's perspective. It is.
• 20:04
  Speaker 1: But Dr. Tis offers this really profound defense. She says
• 20:08
  Speaker 1: what's most important was the treatment, not what is checked
• 20:11
  Speaker 1: off on a box.
• 20:12
  Speaker 2: That's a strong statement.
• 20:13
  Speaker 1: Yeah. She is trying to argue that her actual care,
• 20:17
  Speaker 1: her human interaction with the patient, superseded the flawed documentation.
• 20:21
  Speaker 2: And it is a noble defense of the medical profession.
• 20:24
  Speaker 2: She is essentially arguing that the map is not the territory.
• 20:27
  Speaker 1: Oh, I like that.
• 20:28
  Speaker 2: The EHR is just a clumsy map. Her clinical interaction
• 20:31
  Speaker 2: was the actual territory.
• 20:32
  Speaker 1: Right.
• 20:33
  Speaker 2: But the tragedy of the legal system is that in
• 20:35
  Speaker 2: a courtroom... years after the fact, the territory's gone.
• 20:40
  Speaker 1: That human interaction is just a memory.
• 20:42
  Speaker 2: Exactly. The checked box, that clumsy map, is often the
• 20:46
  Speaker 2: only truth that remains. A jury cannot observe the empathy
• 20:50
  Speaker 2: in a room three years ago. They can only read
• 20:52
  Speaker 2: a piece of paper that says, deteriorating.
• 20:54
  Speaker 1: That is so bleak. Having established these massive flaws in
• 20:58
  Speaker 1: observation and documentation, the discussion must now move to the
• 21:02
  Speaker 1: treatment itself.
• 21:02
  Speaker 2: Yes, the prescription and the immense risks involved.
• 21:05
  Speaker 1: Because if a doctor is forced to compress a patient's
• 21:08
  Speaker 1: complex trauma into a single inaccurate checkbox, it begs a
• 21:12
  Speaker 1: terrifying question. How did they decide what chemical to put
• 21:16
  Speaker 1: into that patient's brain?
• 21:17
  Speaker 2: Right.
• 21:18
  Speaker 1: That blind spot is exactly what makes the next phase
• 21:21
  Speaker 1: of this trial, the prescription phase, so explosive.
• 21:24
  Speaker 2: So let's look at the actual diagnosis and treatment. The
• 21:26
  Speaker 2: diagnosis recorded was generalized anxiety disorder, or GAD, and an
• 21:31
  Speaker 2: adjustment disorder with depressed mood. Okay. The prescribed treatment was
• 21:34
  Speaker 2: 25 milligrams of Zoloft to be increased to 50 milligrams
• 21:38
  Speaker 2: after one week.
• 21:38
  Speaker 1: Now, Zoloft is a pretty standard SSRI starting point, right?
• 21:41
  Speaker 2: Yes, very standard. Zoloft is the brand name for Sertraline.
• 21:46
  Speaker 2: It belongs to a class of drugs called selective serotonin
• 21:48
  Speaker 2: reuptake inhibitors.
• 21:50
  Speaker 1: Okay, can you just give us a quick refresher on
• 21:51
  Speaker 1: how those actually work in the brain?
• 21:53
  Speaker 2: Sure, let's look at the mechanics. Serotonin is a neurotransmitter.
• 21:57
  Speaker 2: It's a chemical messenger in the brain that helps regulate mood, sleep, appetite,
• 22:02
  Speaker 2: and digestion.
• 22:03
  Speaker 1: Right.
• 22:03
  Speaker 2: In simplified terms, when a neuron releases serotonin to send
• 22:06
  Speaker 2: a message, it eventually reabsorbs whatever is left over. That's
• 22:10
  Speaker 2: the reuptake part.
• 22:11
  Speaker 1: Okay, so it cleans up after itself.
• 22:12
  Speaker 2: Exactly. And SSRI blocks that reabsorption process. It traps more
• 22:17
  Speaker 2: serotonin in the synaptic gap between neurons. This increases the
• 22:21
  Speaker 2: overall level of active serotonin in the brain, which generally
• 22:25
  Speaker 2: helps improve mood and reduce anxiety.
• 22:26
  Speaker 1: But the transcript reveals a really heartbreaking detail about this
• 22:30
  Speaker 1: specific prescription.
• 22:32
  Speaker 2: Yes, it does.
• 22:33
  Speaker 1: The patient didn't take it. She walked out with the prescription,
• 22:36
  Speaker 1: but she waited an entire month to actually start the medication.
• 22:39
  Speaker 2: A whole month of just waiting while suffering.
• 22:41
  Speaker 1: The doctor testifies that the patient was deeply afraid of
• 22:44
  Speaker 1: the side effects. And when you look at how the
• 22:46
  Speaker 1: attorney cross-examines the doctor regarding those exact side effects, you
• 22:50
  Speaker 1: can begin to understand that fear.
• 22:53
  Speaker 2: Oh, absolutely. The attorney corners Dr. Tuss on two massive,
• 22:57
  Speaker 2: incredibly serious side effects of Zoloft.
• 23:00
  Speaker 1: Let's start with the first one.
• 23:01
  Speaker 2: The first is insomnia. He paints a picture of cruel,
• 23:05
  Speaker 2: almost absurd irony in the courtroom.
• 23:07
  Speaker 1: He really does.
• 23:08
  Speaker 2: He establishes that the patient, this young postpartum mother, came
• 23:12
  Speaker 2: to the doctors specifically complaining of severe, debilitating trouble sleeping.
• 23:16
  Speaker 1: He practically yells it in the transcript.
• 23:18
  Speaker 2: Yeah, he does.
• 23:19
  Speaker 1: He says, why would you prescribe Zoloft to a young
• 23:22
  Speaker 1: woman who's postpartum, who's coming to you with anxiety, who's
• 23:25
  Speaker 1: telling you she can't sleep, and you prescribe a medication
• 23:29
  Speaker 1: that would have a side effect of trouble sleeping?
• 23:31
  Speaker 2: It's a powerful moment.
• 23:32
  Speaker 1: I mean, if you are a jury member, it sounds
• 23:35
  Speaker 1: like absolute madness when he frames it that way. It
• 23:38
  Speaker 1: sounds like medical malpractice on his face. It's like you
• 23:41
  Speaker 1: come to me because you are dying of thirst and
• 23:43
  Speaker 1: I give you a pill that dehydrates you.
• 23:45
  Speaker 2: It is a devastatingly effective argument for a jury. But
• 23:48
  Speaker 2: to analyze this impartially, we have to look at the
• 23:51
  Speaker 2: medical reality Dr. Tess is actually operating within.
• 23:54
  Speaker 1: OK, so logically, the lawyer has a point, right? If
• 23:57
  Speaker 1: she is desperate for sleep, why roll the dice on
• 24:00
  Speaker 1: a pill that might keep her awake? Are doctors too
• 24:03
  Speaker 1: reliant on a first-line drug instead of tailoring to the
• 24:06
  Speaker 1: specific symptom?
• 24:08
  Speaker 2: It's a valid question. Why doesn't SSRI cause insomnia in
• 24:12
  Speaker 2: the first place? Because serotonin doesn't just regulate mood, it
• 24:16
  Speaker 2: is intimately involved in sleep architecture.
• 24:19
  Speaker 1: Oh, I didn't know that.
• 24:20
  Speaker 2: Yeah, when you flood the brain with serotonin by blocking
• 24:23
  Speaker 2: its reuptake, it can suppress REM sleep and increase wakefulness.
• 24:27
  Speaker 2: particularly in the first few weeks as the brain's receptors
• 24:30
  Speaker 2: try to adapt to the new chemical environment.
• 24:33
  Speaker 1: So the lawyer is scientifically correct. It does cause insomnia.
• 24:37
  Speaker 2: Yes. But the expert medical context, which Dr. Tulis attempts
• 24:40
  Speaker 2: to explain on the stand, is that this side effect
• 24:43
  Speaker 2: is highly unpredictable and is usually transient.
• 24:46
  Speaker 1: Meaning it goes away. Right.
• 24:48
  Speaker 2: Zoloft is widely considered a safe first-line medication for anxiety.
• 24:52
  Speaker 2: And the logic of a first-line drug is based on
• 24:54
  Speaker 2: vast statistical consensus.
• 24:56
  Speaker 1: Okay, what does that mean for the patient's sleep, though?
• 24:58
  Speaker 2: Well, for many patients, the underlying root cause of their
• 25:01
  Speaker 2: insomnia is the racing thoughts of anxiety.
• 25:04
  Speaker 1: Ah, okay. The anxiety is keeping them up.
• 25:07
  Speaker 2: Exactly. So if the Zoloft can biochemically quiet the anxiety,
• 25:11
  Speaker 2: the patient will actually finally be able to sleep despite
• 25:14
  Speaker 2: the drug's potential stimulant effect.
• 25:16
  Speaker 1: The benefit outweighs the risk.
• 25:18
  Speaker 2: Yes. The medical consensus is that the statistical probability of
• 25:21
  Speaker 2: overall benefit outweighs the risk of the temporary insomnia side effect.
• 25:25
  Speaker 1: But the lawyer isn't arguing statistics, is he?
• 25:28
  Speaker 2: Exactly. This is the core conflict of the courtroom. The
• 25:31
  Speaker 2: doctor must practice medicine based on broad statistical consensus and
• 25:35
  Speaker 2: standardized guidelines. You treat the probabilities.
• 25:37
  Speaker 1: Right.
• 25:37
  Speaker 2: But the lawyer is arguing based entirely on the specific
• 25:41
  Speaker 2: singular reality of the individual in the room.
• 25:43
  Speaker 1: Yeah.
• 25:43
  Speaker 2: He is pointing out the massive friction between broad medical
• 25:46
  Speaker 2: data and a single human body. Statistically, Zoloft is overwhelmingly safe.
• 25:52
  Speaker 2: But for the individual patients sitting in the dark at
• 25:55
  Speaker 2: 3 a.m., if they happen to land in that tiny
• 25:57
  Speaker 2: percentage of severe adverse reactions, those reassuring statistics are completely meaningless.
• 26:03
  Speaker 1: And if you think the insomnia argument is a red flag,
• 26:06
  Speaker 1: wait until you look at the FDA warning.
• 26:08
  Speaker 2: On the box. Oh, the black box warning.
• 26:11
  Speaker 1: Yes, because insomnia is just the warm-up for the lawyer's
• 26:14
  Speaker 1: main attack on this medication. He brings up the FDA's
• 26:17
  Speaker 1: black box warning for SSRIs.
• 26:20
  Speaker 2: And for context, a black box warning is the strictest,
• 26:23
  Speaker 2: most severe warning put in the labeling of prescription drugs
• 26:27
  Speaker 2: by the Food and Drug Administration.
• 26:29
  Speaker 1: It's literally bordered in heavy black ink. Right.
• 26:32
  Speaker 2: It is deployed when there is reasonable evidence of an
• 26:35
  Speaker 2: association between a drug and a serious, potentially life-threatening hazard.
• 26:40
  Speaker 1: And what is the hazard the lawyer points out for Zoloft?
• 26:43
  Speaker 1: Suicidal and homicidal ideation.
• 26:45
  Speaker 2: Which is just a devastating lie of questioning.
• 26:47
  Speaker 1: It really is.
• 26:48
  Speaker 2: The attorney establishes that this specific black box warning for
• 26:52
  Speaker 2: SSRIs exists primarily for children and young adults.
• 26:56
  Speaker 1: Here's where it gets really interesting.
• 26:57
  Speaker 2: Yeah.
• 26:58
  Speaker 1: The FDA cutoff age for this heightened risk warning is
• 27:01
  Speaker 1: 24 years old. But the patient, Lindsay Clancy, was 29
• 27:06
  Speaker 1: or 30 years old at the time she was prescribed
• 27:08
  Speaker 1: the drug.
• 27:09
  Speaker 2: Right. She's passed the cutoff.
• 27:10
  Speaker 1: The lawyer pounces on this age discrepancy with pure aggressive logic.
• 27:15
  Speaker 1: He essentially argues that human biology doesn't just magically switch
• 27:19
  Speaker 1: off its vulnerabilities on your 24th birthday.
• 27:21
  Speaker 2: That's a compelling argument to a layperson.
• 27:24
  Speaker 1: He asks the doctor, are you suggesting to the jury
• 27:27
  Speaker 1: that a drug that increases the risk of suicide in
• 27:30
  Speaker 1: a 24-year-old patient cannot increase the risk of suicide in
• 27:34
  Speaker 1: a 29- or a 30-year-old patient just a little bit?
• 27:37
  Speaker 2: And Dr. Toose relies firmly on the established medical science.
• 27:41
  Speaker 2: She replies that the brain is fully matured past age 24.
• 27:45
  Speaker 2: so it is less vulnerable to these severe psychiatric side effects.
• 27:48
  Speaker 1: Okay.
• 27:49
  Speaker 2: But she states, I don't believe there's evidence that it
• 27:51
  Speaker 2: causes that at all in individuals over 24. She is
• 27:54
  Speaker 2: anchoring herself to the hard data, you know, the statistical
• 27:57
  Speaker 2: cutoffs established by decades of FDA trials and psychiatric research.
• 28:01
  Speaker 1: Okay, I have to push back here on behalf of
• 28:03
  Speaker 1: the lawyers' common sense.
• 28:04
  Speaker 2: Sure.
• 28:05
  Speaker 1: Does human biology really operate on such a strict timeline?
• 28:08
  Speaker 1: I mean, why is 24 the magic number?
• 28:10
  Speaker 2: It sounds arbitrary.
• 28:11
  Speaker 1: It does. If a patient is deeply vulnerable, sleep-deprived, Their
• 28:15
  Speaker 1: hormones are crashing from childbirth, and they are suffering from
• 28:18
  Speaker 1: severe postpartum anxiety. Is a five-year age difference a guaranteed
• 28:23
  Speaker 1: ironclad shield against a black box warning?
• 28:25
  Speaker 2: Well, the science behind the age 24 cutoff is based
• 28:28
  Speaker 2: on the developmental timeline of the prefrontal cortex.
• 28:31
  Speaker 1: Okay, the prefrontal cortex. What does that do again?
• 28:33
  Speaker 2: It is the part of the brain responsible for impulse control,
• 28:37
  Speaker 2: complex decision-making, and regulating emotional responses. Right. Throughout adolescence and
• 28:42
  Speaker 2: early adulthood... This area is undergoing a process called myelination.
• 28:46
  Speaker 1: Myelination.
• 28:47
  Speaker 2: Yeah, where nerve fibers are coated with a fatty sheath
• 28:49
  Speaker 2: to make communication faster and more efficient. This process of
• 28:53
  Speaker 2: structural maturation generally finishes around age 24, 25.
• 28:56
  Speaker 1: So a younger brain is physically more volatile. Yes.
• 29:00
  Speaker 2: The medical consensus is that introducing a powerful neurochemical modifier
• 29:04
  Speaker 2: like an SSRI into a brain that is still structurally
• 29:08
  Speaker 2: wiring its impulse control centers carries a higher risk of
• 29:11
  Speaker 2: triggering impulsive dangerous ideation.
• 29:13
  Speaker 1: Ah, because the brakes aren't fully installed yet.
• 29:16
  Speaker 2: Exactly. Once that wiring is completed 25, the statistical risk
• 29:20
  Speaker 2: drops precipitously. That is the science Dr. Tess is defending.
• 29:24
  Speaker 1: But the lawyer isn't having it. To emphasize the danger,
• 29:27
  Speaker 1: the attorney uses a wildly inflammatory, highly charged comparison.
• 29:31
  Speaker 2: He really goes there.
• 29:32
  Speaker 1: He brings up, and I'm going to quote directly from
• 29:34
  Speaker 1: the transcript here, the kids that shoot other kids in
• 29:37
  Speaker 1: high schools and the lawsuits that come out of that
• 29:40
  Speaker 1: against the use of SSRIs.
• 29:42
  Speaker 2: Wow. We must pause here and look at this impartially
• 29:46
  Speaker 2: as an aggressive courtroom tactic.
• 29:47
  Speaker 1: It's pure shock value.
• 29:49
  Speaker 2: It is. The attorney is intentionally dropping the most terrifying,
• 29:53
  Speaker 2: culturally resonant image possible into the minds of the jury.
• 29:57
  Speaker 2: He is trying to emotionally prime them to associate this
• 30:00
  Speaker 2: standard everyday anxiety medication with catastrophic headline-grabbing violence.
• 30:06
  Speaker 1: And Dr. Tusk just calmly rejects this. She states she
• 30:09
  Speaker 1: is not aware of any evidence linking SSRIs to that
• 30:12
  Speaker 1: kind of behavior, maintaining her clinical, evidence-based stance in the
• 30:16
  Speaker 1: face of incredible emotional provocation.
• 30:18
  Speaker 2: She holds her ground.
• 30:19
  Speaker 1: She does, but rhetorically speaking, the damage is done, isn't it?
• 30:22
  Speaker 2: Oh, absolutely. The pill is no longer just a tool
• 30:26
  Speaker 2: for healing in the eyes of the jury. The lawyer
• 30:28
  Speaker 2: has successfully painted it as a ticking time bomb.
• 30:31
  Speaker 1: Yeah.
• 30:31
  Speaker 2: And this forces us to consider the impossible reality of
• 30:35
  Speaker 2: prescribing medication. The doctor is relying on a standard first-line drug.
• 30:40
  Speaker 2: It is the accepted starting point for millions of people.
• 30:43
  Speaker 1: Right.
• 30:44
  Speaker 2: But the lawyer is demanding a perfectly tailored treatment that
• 30:48
  Speaker 2: guarantees absolutely no harm, which is a standard that medicine
• 30:51
  Speaker 2: simply cannot meet. Every single chemical intervention carries risk.
• 30:55
  Speaker 1: But to even attempt to tailor a treatment, to get
• 30:58
  Speaker 1: anywhere close to perfectly safe, a doctor would need a
• 31:02
  Speaker 1: perfect encyclopedic understanding of the patient's entire medical history, right? Right.
• 31:06
  Speaker 2: They would need everything.
• 31:07
  Speaker 1: Every prior reaction, every hidden symptom, every drug they've ever taken.
• 31:11
  Speaker 1: But as we move into the final and perhaps most
• 31:13
  Speaker 1: disturbing phase of this transcript, we realize that getting that
• 31:17
  Speaker 1: perfect history is incredibly dangerously complicated.
• 31:21
  Speaker 2: It really is. The transcript reveals that Dr. Toose knew
• 31:24
  Speaker 2: shockingly little about the patient's medical past.
• 31:27
  Speaker 1: Almost nothing.
• 31:28
  Speaker 2: The doctor testifies that she was aware the patient did
• 31:30
  Speaker 2: not have a, quote, significant past psychiatric history. She only
• 31:34
  Speaker 2: knew about a brief period in nursing school years prior
• 31:37
  Speaker 2: where the patient took Prozac for public speaking anxiety.
• 31:41
  Speaker 1: Just a brief stint. Right.
• 31:43
  Speaker 2: And then there is a mention of a medication recorded
• 31:46
  Speaker 2: phonetically in the transcript as Prozac. Bobby Tran.
• 31:49
  Speaker 1: Bobby Tran. Let's decode that because any medical professional listening
• 31:53
  Speaker 1: probably caught that immediately. Bobby Tran is almost certainly a
• 31:56
  Speaker 1: court reporter's phonetic misspelling of Wellbutrin, right?
• 31:59
  Speaker 2: Yes, without a doubt. It happens all the time in
• 32:01
  Speaker 2: court transcripts. Wellbutrin is the brand name for bupropion.
• 32:05
  Speaker 1: Okay, so why does that matter?
• 32:06
  Speaker 2: Because understanding what bupropion is is vital to understanding why
• 32:10
  Speaker 2: a doctor needs an accurate medical history. Bupropion is not
• 32:13
  Speaker 2: an SSRI.
• 32:14
  Speaker 1: What is it then?
• 32:15
  Speaker 2: It is an NDRI. A norepinephrine dopamine reuptake inhibitor. It
• 32:20
  Speaker 2: works on entirely different neurotransmitters than Zoloft. It is highly stimulating.
• 32:25
  Speaker 2: It is often prescribed for depression, ADHD, and smoking cessation.
• 32:29
  Speaker 1: So it's a completely different kind of drug. Why does
• 32:32
  Speaker 1: it matter if a doctor doesn't have a perfect record
• 32:34
  Speaker 1: of a patient taking Welbutrin in the past?
• 32:37
  Speaker 2: Because past pharmacological reactions dictate future prescriptions. Oh, I see.
• 32:41
  Speaker 2: If a patient had severe anxiety and took a stimulating
• 32:45
  Speaker 2: drug like Welbutrin... It might have exacerbated their symptoms.
• 32:48
  Speaker 1: Making them more anxious.
• 32:50
  Speaker 2: Right. Or if it worked perfectly, it might be the
• 32:52
  Speaker 2: exact drug they need now instead of an SSRI. If
• 32:56
  Speaker 2: a psychiatrist doesn't know the precise timeline, dosage, and behavioral
• 33:01
  Speaker 2: reaction to every psychotropic drug a patient has ever ingested,
• 33:05
  Speaker 2: they're prescribing in the dark.
• 33:07
  Speaker 1: And we already know from the lawyer's earlier questions that
• 33:09
  Speaker 1: there was a massive piece of history missing.
• 33:11
  Speaker 2: The Edinburgh test.
• 33:13
  Speaker 1: Yes. Dr. Tussey did not know about the prior Edinburgh
• 33:16
  Speaker 1: test where the patient scored a 23, indicating severe depression.
• 33:21
  Speaker 1: She didn't know about it.
• 33:22
  Speaker 2: That's a huge missing piece of the puzzle.
• 33:23
  Speaker 1: So the lawyer presses her on this massive gap in knowledge.
• 33:27
  Speaker 1: He says, isn't that important for you as a doctor
• 33:29
  Speaker 1: to take a history? And he asks how she could
• 33:31
  Speaker 1: possibly know what's going on if the patient doesn't report it.
• 33:34
  Speaker 2: And Dr. Tussey's response to this is one of the
• 33:37
  Speaker 2: most defining moments of the trial, I think.
• 33:39
  Speaker 1: What does she say?
• 33:40
  Speaker 2: She defends her lack of knowledge by stating a core
• 33:43
  Speaker 2: tenet of modern outpatient psychiatry. She says, when patients are
• 33:48
  Speaker 2: able to advocate for themselves and share their medical history,
• 33:51
  Speaker 2: we rely on what they tell us.
• 33:53
  Speaker 1: Advocate for themselves.
• 33:54
  Speaker 2: Yes, advocate for themselves. If we connect this to the
• 33:57
  Speaker 2: bigger picture, we have to look closely at what that
• 34:00
  Speaker 2: phrase actually demands.
• 34:01
  Speaker 1: That's a huge burden.
• 34:02
  Speaker 2: It is. We are talking about a health care system
• 34:05
  Speaker 2: that places the ultimate unforgiving burden of information gathering on
• 34:10
  Speaker 2: the person who is currently suffering the most.
• 34:13
  Speaker 1: Think about this dynamic. You have a woman suffering from
• 34:16
  Speaker 1: severe postpartum anxiety. She is, by her own admission to
• 34:19
  Speaker 1: the doctor, having massive difficulty sleeping. Right. She is so
• 34:23
  Speaker 1: depressed she finds it difficult to get out of bed.
• 34:25
  Speaker 1: She's terrified of medication side effects. And we know that
• 34:28
  Speaker 1: severe sleep deprivation literally destroys a person's working memory and
• 34:32
  Speaker 1: cognitive processing speed.
• 34:33
  Speaker 2: It impairs everything.
• 34:35
  Speaker 1: Exactly. And the medical system expects this deeply compromised, exhausted
• 34:39
  Speaker 1: person to perfectly curate, recall, and verbally present her own
• 34:43
  Speaker 1: complex medical history to a doctor she's meeting for the
• 34:47
  Speaker 1: very first time through a glitchy computer screen.
• 34:49
  Speaker 2: It is a profound, almost absurd expectation when you really
• 34:53
  Speaker 2: think about it.
• 34:53
  Speaker 1: It really is.
• 34:54
  Speaker 2: And the lawyer challenges the doctor on this directly. He asks,
• 34:58
  Speaker 2: was she able to advocate for herself, in your opinion,
• 35:01
  Speaker 2: when she came to see you?
• 35:02
  Speaker 1: And how does the doctor answer?
• 35:04
  Speaker 2: She answers, absolutely. She maintains that throughout September, October, November,
• 35:08
  Speaker 2: and December, the patient was fully capable of this self-advocacy.
• 35:12
  Speaker 1: It raises a terrifying question for anyone seeking help. I mean,
• 35:16
  Speaker 1: ask yourself, if you are in the middle of a
• 35:17
  Speaker 1: mental health crisis, are you truly capable of reliable self-advocacy?
• 35:22
  Speaker 2: Many people aren't.
• 35:23
  Speaker 1: Right. Is this expectation of perfect self-reporting a fatal flaw
• 35:27
  Speaker 1: in modern psychiatry? Because if you forget one detail, like
• 35:30
  Speaker 1: a test score of 23, or if you intentionally hide
• 35:33
  Speaker 1: something out of shame or fear, the doctor's entire treatment
• 35:36
  Speaker 1: plan is built on a fractured foundation.
• 35:39
  Speaker 2: We see this exact dangerous dynamic play out in the
• 35:42
  Speaker 2: transcript regarding the patient's alcohol use.
• 35:46
  Speaker 1: Oh, this part was so tense.
• 35:48
  Speaker 2: The discussion is fragmented and incredibly tense. The lawyer asks
• 35:52
  Speaker 2: if the patient had stopped drinking, pointing out that the
• 35:54
  Speaker 2: doctor seemingly never dug deep into the details.
• 35:58
  Speaker 1: And the doctor says she wasn't concerned about it. Right.
• 36:00
  Speaker 2: Dr. Tuss replies calmly, I was not concerned about her
• 36:03
  Speaker 2: level of drinking. The transcript notes the patient reported drinking
• 36:07
  Speaker 2: one to two times a week, one to two servings
• 36:10
  Speaker 2: five times a week.
• 36:11
  Speaker 1: Which is so confusingly documented.
• 36:13
  Speaker 2: It is. And the record itself is confusing, likely due
• 36:16
  Speaker 2: to those very EHR or software limitations we discussed earlier.
• 36:20
  Speaker 2: But the crucial detail the lawyer focuses on isn't the
• 36:23
  Speaker 2: volume of alcohol.
• 36:25
  Speaker 1: What is it then?
• 36:25
  Speaker 2: It's the intent.
• 36:26
  Speaker 1: Right. The doctor admits the patient mentioned the alcohol was calming.
• 36:30
  Speaker 2: Yes.
• 36:31
  Speaker 1: And the lawyer immediately jumps on that word. He says,
• 36:34
  Speaker 1: so it was numbing. It was like trying to numb something.
• 36:36
  Speaker 1: He completely reframes a casual glass of wine into a
• 36:40
  Speaker 1: psychological defense mechanism.
• 36:41
  Speaker 2: And look at the massive psychological leap the lawyer makes next.
• 36:45
  Speaker 1: It's huge.
• 36:45
  Speaker 2: He equates this postpartum mother's use of alcohol... to military
• 36:50
  Speaker 2: veterans suffering from post-traumatic stress disorder.
• 36:53
  Speaker 1: Wow.
• 36:54
  Speaker 2: He says to the doctor, I imagine you've treated veterans
• 36:57
  Speaker 2: that have post-traumatic stress disorder. Would you agree with me
• 37:01
  Speaker 2: that many times when people have an anxiety disorder or PTSD,
• 37:05
  Speaker 2: they try to numb? Sometimes they use alcohol, right?
• 37:10
  Speaker 1: He is actively elevating her postpartum anxiety to the level
• 37:14
  Speaker 1: of wartime trauma.
• 37:15
  Speaker 2: Yes, suggesting to the jury that she was desperately self-medicating...
• 37:19
  Speaker 2: a severe hidden psychological wound.
• 37:21
  Speaker 1: And Dr. Tynes just brushes it off. She says she
• 37:24
  Speaker 1: didn't think the specific type of alcohol was relevant and
• 37:27
  Speaker 1: reiterates she wasn't concerned the patient was an alcoholic.
• 37:30
  Speaker 2: Two very different perspectives.
• 37:31
  Speaker 1: It's literally two completely different realities crashing into each other.
• 37:35
  Speaker 1: The doctor looks at the data and sees a common, minimal,
• 37:37
  Speaker 1: socially acceptable behavior. The lawyer looks at the exact same
• 37:41
  Speaker 1: data and sees a desperate cry for help, a frantic
• 37:44
  Speaker 1: attempt to self-medicate a failing mind.
• 37:47
  Speaker 2: This fundamental disconnect brings us to the actual therapy provided
• 37:50
  Speaker 2: during these telemedicine sessions.
• 37:52
  Speaker 1: Right.
• 37:52
  Speaker 2: Because if the history is flawed and the diagnosis is
• 37:56
  Speaker 2: limited by software, what does the treatment actually look like?
• 38:00
  Speaker 1: It's not what you expect.
• 38:01
  Speaker 2: No. The attorney zeroes in on the duration of care.
• 38:05
  Speaker 2: He establishes the sessions were scheduled for 25 to 30
• 38:08
  Speaker 2: minutes long in total. Okay. But the actual therapy component
• 38:12
  Speaker 2: noted in the billing records was only 17 minutes.
• 38:16
  Speaker 1: 17 minutes. Imagine that timeline.
• 38:17
  Speaker 2: It's so short.
• 38:18
  Speaker 1: You have a month-long wait to take a medication out
• 38:21
  Speaker 1: of sheer biological terror of the side effects. You have
• 38:25
  Speaker 1: a history of severe depression hidden in a file somewhere
• 38:28
  Speaker 1: else that your doctor can't see. You are exhausted. And
• 38:31
  Speaker 1: your actual psychiatric treatment consists of logging onto a webcam
• 38:35
  Speaker 1: for a 17-minute window.
• 38:36
  Speaker 2: And the lawyer asks what she actually did for therapy
• 38:39
  Speaker 2: in that tiny sliver of time.
• 38:41
  Speaker 1: And the doctor's answer is just so stark. She says,
• 38:43
  Speaker 1: I listened to her concerns and provided support. I tried
• 38:46
  Speaker 1: to provide her with hope that eventually things would improve.
• 38:49
  Speaker 2: The phrase supportive therapy is used in the transcript. The
• 38:52
  Speaker 2: doctor defines it clinically as providing emotional support, empathy, and validation.
• 38:56
  Speaker 1: Which is standard, right? Yes.
• 38:59
  Speaker 2: But the attorney's tone drips with withering skepticism. He summarizes
• 39:04
  Speaker 2: the entire span of care in one brutal paragraph.
• 39:07
  Speaker 1: What does he say?
• 39:08
  Speaker 2: He says, so emotional support and validation all sounds good.
• 39:11
  Speaker 2: Here's a young woman who was 29, 30 years old,
• 39:15
  Speaker 2: came to see you for help, told you she couldn't
• 39:17
  Speaker 2: sleep and she was anxious. You know, she's postpartum. And
• 39:21
  Speaker 2: you tried to provide therapy by giving her hope. And
• 39:24
  Speaker 2: how long do you figure did that take? Five minutes,
• 39:26
  Speaker 2: Ten minutes? Two minutes?
• 39:27
  Speaker 1: It just strips away all the sterile medical terminology and
• 39:30
  Speaker 1: leaves you with this incredibly bleak image of modern mental
• 39:33
  Speaker 1: health care. But to be impartial here, why 17 minutes?
• 39:37
  Speaker 1: Why not an hour? Is the doctor just rushing people
• 39:39
  Speaker 1: out the virtual door?
• 39:40
  Speaker 2: No, it's not malicious rushing. It is the grim reality
• 39:43
  Speaker 2: of medical economics and triage.
• 39:44
  Speaker 1: How so?
• 39:45
  Speaker 2: In the American health care system, psychiatric visits are dictated
• 39:48
  Speaker 2: by insurance billing codes.
• 39:50
  Speaker 1: Ah, insurance. Always.
• 39:52
  Speaker 2: A common code for a medication management visit combined with
• 39:54
  Speaker 2: a brief therapy component, like a 99213 or 99214, allocates
• 39:59
  Speaker 2: specific time frames, often 15 to 25 minutes.
• 40:02
  Speaker 1: So the system literally dictates the time.
• 40:04
  Speaker 2: Furthermore, we are facing a massive, unprecedented shortage of psychiatric
• 40:09
  Speaker 2: professionals right now. If Dr. Tess spends an hour with
• 40:12
  Speaker 2: one patient, two other patients in crisis don't get seen
• 40:15
  Speaker 2: at all.
• 40:15
  Speaker 1: Wow, that's a tough spot to be in.
• 40:17
  Speaker 2: The system is designed for volume because the demand is
• 40:20
  Speaker 2: simply overwhelming. The 17-minute therapy session is a symptom of
• 40:24
  Speaker 2: a system frantically trying to keep its head above water.
• 40:27
  Speaker 1: So we have a desperately frightened woman, a doctor constrained
• 40:31
  Speaker 1: by software drop-down menus and insurance billing codes, communicating through
• 40:35
  Speaker 1: a video feed, relying on a sleep-deprived patient for medical history,
• 40:39
  Speaker 1: and dispensing hope in 17-minute intervals.
• 40:42
  Speaker 2: That's the reality. To summarize the incredible friction we've unpacked
• 40:45
  Speaker 2: from this raw source material today, we have looked deep
• 40:48
  Speaker 2: into a healthcare system that is fundamentally built on mechanical efficiency.
• 40:52
  Speaker 1: Yeah, efficiency over everything.
• 40:54
  Speaker 2: It is a system of 25-minute video calls designed to
• 40:57
  Speaker 2: maximize patient triage. It relies on rigid drop-down menus and
• 41:01
  Speaker 2: non-interoperable software to standardize complex human emotions into actionable billing data.
• 41:07
  Speaker 2: It utilizes broad, standard, first-line prescriptions based on statistical consensus
• 41:13
  Speaker 2: rather than individualized guarantees. And, perhaps most significantly, it operates
• 41:18
  Speaker 2: on the heavy, often biologically unrealistic expectation that patients in
• 41:23
  Speaker 2: the midst of a neurochemical crisis can perfectly self-advocate.
• 41:26
  Speaker 1: And this matters to you, because this isn't just about
• 41:29
  Speaker 1: a dramatic trial on a YouTube channel. This is a
• 41:32
  Speaker 1: mirror held up to the everyday reality of navigating modern medicine.
• 41:36
  Speaker 2: It really is.
• 41:37
  Speaker 1: Think about it. The next time you log into a
• 41:39
  Speaker 1: patient portal or fill out a digital intake form on
• 41:42
  Speaker 1: a tablet in a waiting room, or have a brief
• 41:44
  Speaker 1: telehealth consultation where your doctor is checking boxes on a screen,
• 41:48
  Speaker 1: you are participating in this exact same machinery.
• 41:51
  Speaker 2: We all are.
• 41:51
  Speaker 1: It forces you to look at your own doctor's visits
• 41:54
  Speaker 1: and the digital charts they fill out about you in
• 41:56
  Speaker 1: a completely new light. Are you being seen as a complex,
• 42:00
  Speaker 1: nuanced human being, or are your symptoms being bent to
• 42:04
  Speaker 1: fit the architecture of the system?
• 42:06
  Speaker 2: It's a vital perspective shift. We must recognize the inherent
• 42:10
  Speaker 2: structural limitations of of the tools our healthcare providers are
• 42:13
  Speaker 2: forced to use every day, and the incredible, sometimes impossible,
• 42:17
  Speaker 2: responsibility that places on us to perfectly advocate for our
• 42:21
  Speaker 2: own care.
• 42:22
  Speaker 1: We've built a medical system that is incredibly efficient. It
• 42:25
  Speaker 1: operates on checkboxes, video screens, statistical probabilities, and standardized FDA labels.
• 42:31
  Speaker 1: But when human tragedy strikes and we put that entire
• 42:34
  Speaker 1: machine on a witness stand under the microscope of a hostile,
• 42:37
  Speaker 1: hyper-focused cross-examination, it suddenly looks completely inadequate. It looks incredibly fragile.
• 42:43
  Speaker 2: It does.
• 42:44
  Speaker 1: So I want to leave you with this final thought.
• 42:46
  Speaker 1: If technology, remote access, and rigid data standardization are the
• 42:49
  Speaker 1: inevitable future of medicine, how do we make sure the
• 42:52
  Speaker 1: actual suffering human being doesn't just get lost in the
• 42:55
  Speaker 1: drop-down menu? Thank you so much for joining us for
• 42:57
  Speaker 1: this deep dive.