Lindsay Clancy: Examining the Healthcare System's Failures

17 Minutes. That's how long Lindsay Clancy's final psychiatric appointment lasted the day before her three children died. Not a follow up, not a check in.Her final visit with the provider managing a rapid psychiatric crisis was 17 minutes long.

Not a true crime sensationalized story. This is about healthcare operations. 17 Minutes is scheduling. It's understanding billing.It's understanding why a visit is being built around how much you get paid.

We're talking about what didn't prevent this calamity from happening.And we're going to go into the malpractice aspect of it, where the malpractice lawsuit says the healthcare system had every opportunity to catch it and they didn't.They're going to review these allegations and we're going to share our thoughts around this wasn't perhaps because one clinician failed, but because there was no mechanism whose job it was to catch it.

Yeah, and I think, Alex, you know, this was a VBCA episode likely talked about, but we didn't know that we would make it because it's sensitive. You know, there's an ongoing criminal trial related to this subject, and it's obviously about a real family.But the operator questions underneath this whole case are very interesting, and every listener here would be curious to know how they manage things at their own organization.

Long story short, it's risk management discussion.It's how to protect yourself not only from the legal and financial exposure, but also the moral and ethical responsibilities that one would have as a health system. But before we go any further, some ground rules for this episode, because we take this seriously.

First, everything we discussed today comes from Lindsey Clancy's civil complaint filed in Norfolk superior court in January 2026, plus subsequent public reporting on that filing. It's a lawsuit, and the allegations in it have not yet been proven, and the defendants have not been found liable for anything.

Second, one of the named defendants, psychiatrist Dr. Jennifer Tufts, has since asked the court to convene a medical malpractice tribunal Massachusetts screening panel, which is comprised of a judge, a physician from the same group, and an attorney. And they get together and decide after reviewing the claims before them, whether the malpractice suit could go through or not.Enough evidence was found, so it is not a ruling on guilt or liability, and it hasn't happened yet as of this recording.

We are not covering the criminal case in this episode. We're not describing what happened to the children, and we're not speculating on Lindsey Clancy's state of mind that day. That's not our lane.And frankly, it's been covered exhaustively elsewhere and speculated upon. Our lane is more.What did the care delivery system look like in the months before that event and what does that tell operators, payers, providers about where the coordination may have broken down?

Fourth, where institutions have responded will tell you exactly what they said. South Shore Health has stated it cannot comment on the specifics of pending litigation, citing patient privacy and other concerns.Women in infant hospitals, operator has said the same as their mental health. Not responded to requests for comment. And we're not filling those silences with speculation.

With that said, let's talk about what this case actually shows us, which is air coordination management issues.

Gaps.

Gaps.

We're going to hear gaps.

We're going to go to gap a lot, the care coordination gaps.

De Gap yourself. Jasmine, walk us through the shape of this. How does it look to you? Because on paper, Lindsay was not an underserved patient. That was she.She had access. She, she saw providers. We're going to talk through some of the examples of her behavior as described in a lawsuit.

She had some education too, right. She's a nurse, so she's, you know, in the medical field, which I think served her better than if she was less educated, if you will. So.But you know, it's definitely not about access. She had access. Right. But what about the operators of the care that she was receiving?And I think the complaint is primarily centered around a treatment history banning multiple prescribers, multiple facilities and ER crisis lines, inpatient postpartum centers, five day inpatient at a mental institution. And that's all within a matter of months. So that's not a network gap. There's access there. But was the system set up adequately?

That's such a fine point on it. It's such a succinct way of putting a huge systematic problem into perspective. Right. Because first of all, it wasn't a very long amount of time.Right. All within a short period of time.And it wasn't like this person was underserved on Medicaid or not insured or any number of these things, although we haven't been able to find exactly those details in any of the public publicly available information. We know that she was not lower socioeconomic and et cetera, but she suffered outcomes that are tragic in a word.

Case scenario, just failure.

Right. And so it's interesting because you mentioned that there was a network. She went to this nap provider, all of which are named.But she fell through the cracks.

Yeah, even she fell through the cracks. And you know, this is, I think you had an episode where you talked about a ghost network. Right. And this feels like the opposite of that.

Yes, exactly.

Like the mirror image. Because they are.When you're talking about the ghost network, you're saying, here's all these providers, but there's no care and no access kind of behind those directories. But here, allegedly the network is failing because there's no connectivity between these real credentialed providers.These are, there are real points of care here. These are real people that she went and saw and who are named in this Civil War suit.You have a psychiatrist, nurse practitioner, ER crisis line, two hospitals, and none of them are maybe operating from the same. Right. When you zoom out, maybe they don't all have the same view.

So fragmented. So fragmented. Now let's bring this to life.Let's what's called significant and hypomanic behavior, which is cited several times in these, in this filing. Concrete for a second, because the phrase alone doesn't really land with the general audience.The complaint itself alleges that starting just one week after her third child's birth, Clancy was walk, walking at 4am she was walking every day, waking up earlier than the children, walking around, she was running three miles. Now remember, this is just one week after her third child's birth. Okay.She's walking at 4:00am every day, running three miles, doing 30 minutes on a Peloton. She's, she's cycling 30 minutes upon a Pelo.

Better than me.

I'm, I'm inspired. It's just motivational. It's truly. Talk about such activation.

Yeah.

Then another 30 minutes of a second workout, which was described as aerobics in the, in the filing. And by five weeks postpartum, this filing alleges that she ran a race.

Yeah, 5K. And you know, we're not here to criticize or condemn, you know, a new mother who's exercising.It's that this complaint is framing this as a specific pattern. Right. That, that level of activation. Some would say it's a textbook hypomanic presentation.And you know, postpartum women are usually exhausted, recovering from childbirth. But this is kind of giving the.

Opposite that giving such opposite of that, because here's why it matters operationally. Again, the complaint alleges that this wasn't a one time thing. To your point.Even in the complaint after her second childbirth in 2019, it alleges that she showed similar pattern.Now, I don't even want to go all the way back because within the same year, in span of a short amount of time, the variety of medications that were prescribed and unprescribed, changed and changed again. Again, this isn't the clinical discussion.They couldn't even catch these happening within a single year, let alone finding a trend from her postpartum experiences.

I think there was medicated period in college as well. Right. So it's not like this was the patient's or, you know, Lindsay Clancy's first time interacting clinically with the psychiatric system.So I don't think that a lot of this was considered in how her third postpartum session was going.

So then from a operator perspective, maybe the question is, was that pattern ever captured anywhere and these clinicians just didn't look at it, or was it not captured at all and so they couldn't look at it? Or did each provider only ever see a single snapshot in a single visit?Were they not connected to health information exchanges with no record connecting how this happened with baby number two? Is it going to happen again with baby number three? Past is a good predictor of the future.And this should have definitely been captured even in medical history.

I guess, you know, my question to you would be like, and maybe that, you know, kind of the basis of the complaint is maybe this was captured and not considered.

That's actually another step further because I was thinking if it was captured, was it even looked at? It could have been looked at but not considered.

The answer to that is that there was no consideration. That's the allegation anyways.Necessarily one bad actor, but just an absence of, of acting and no single accountable prescriber talking about a medication cascade.Allegedly close to nine or ten different psychiatric medications prescribed across those months, Several within a three week window without it alleges a single clinician kind of focused on the regimen. That's kind of the care coordination question that we're coming back to is, you know, multiple providers is not the same thing as coordinated care.Who in this picture is supposed to own that long lens, view that big picture and stick with the patient throughout this process?

And what is the role of provider or just staff communication in this case? Healthcare provider because they're licensed. What is the role of their communication in this whole thing?And so we're going to share Dr. Testifying in the criminal case and we'll highlight communication opportunity. The defense attorney's sound is a bit mumbled. And who you're hearing testifying is Dr.

Tufts psychiatrist falls asleep after 40 minutes. Heart racing, severe anxiety, worrying about kids, baby sleep. Yawns but not drowsy, not hyper pressured speech.

What was that Hyper what?

Not hyper, not pressured speech is what I meant. I know it doesn't say not, but that is exactly what I meant.

When did you see this? That you noticed that it did not say not.

I don't care what it says. I know what I meant.

Well, when you wrote this, you did not say not pressured speech. You said in the medical record pressured speech, right?

No.

Does it say that?

Yeah, the word is. The word not is right before not hyper, comma, pressured speech. The two are following the knot.

When you put down in a medical record, heart racing, comma, severe anxiety, comma, worried about kids, baby sleep, comma, yarns, but not drowsy, period. Not hyper karma. Pressured speech. That's what you wrote, right?

She did not have pressured speech. I wrote that. But you're misinterpreting my note.

Am I reading this correctly? And the jury will be able to look at it that you put not hyper Prussian speech. Did you? Did I read that right?

Yes, but your interpretation is incorrect.

Oh, spicy.

So there you. There you have it. So now let's say you have all the coordination in the world. Now let's say I gave you a good contract that even pays for it.But if you can't interpret because the interpretation only exists within the confines of another practitioner's mind or brain.

Right. No two people are reading the notes the same is what I'm hearing.

No two people are interpreting the written word the same. So you should not leave up to interpretation your clinical notes.

And you know, is there a standardization that's been, that's been a long time complaint of provider care. Right.

There's no quality control. Did they have a medical director look at these notes and see whether they are interpreting it the same?

On the care coordination front, I'm curious to hear your thoughts on where there's an opportunity here for value based incentives to keep providers focus on the coordination aspect.

Yeah, there are reimbursement and payment mechanisms available for coordinating care. Now when I say available, it's not up for grabs. You have to work it into your contracts.You can have all the reimbursement and contracts out in the world, but if you're not utilizing them, you're not realizing those revenues.It's interesting because here it's like beyond operations, it's clinical documentation and quality control to see whether two providers of a sound mind would interpret the notes the same. Because there shouldn't be room for interpretation. This is an artwork. It's documentation that belongs to the patient.So the duty there is to document this individual's experience as precise and clinical and surgical you can. That's why they call you cli nition.

Actually, that's quite an interesting segue into precision and standard, doing things by the book and not leaving things up for interpretation. Because in the civil suit that Lindsay Clancy did contact multiple times a crisis hotline for suicide.So where does that land in this coordination aspect? And is precision a good thing or a bad thing?

So let's tee that up for the listeners or the viewers. Basically, the complaint alleges that she did contact New Bedford suicide hotline and she was told that there wasn't an emergency.So already the screening aspect and admission criteria seem not to match with the actual reality.And the next day, she reportedly met virtually with another crisis support clinician, was told the same thing, that she didn't meet a certain criteria, no plan for this person.

And I guess, you know, you can also interpret it as if someone is. Someone would have to reach a certain threshold to even get in contact with one of these types of organizations.The operator question is whether that same threshold is calibrated for different subsets of people. And here specifically is postpartum patient.Because if this kind of call, this kind of emergency call is coming from someone who is experiencing throes of postpartum depression or anxiety, whatever that might be, that can be a kind of an unpredictable escalation point, not only for her, but for the child.

Because postpartum has generally not been included in these screenings or maybe even been.

Triggered, maybe because something like a postpartum psychosis, as is being alleged in this case, it's still relatively rare. I think it's like four out of every 2,000 women. We're not talking about the Koh I Noor diamond. It's, you know, four out of 2,000 people.But I guess some of these systems are kind of focused on a larger, like bucket, so to speak, the standard patient, the kind of non postpartum case we might be seeing.

That's the salient point here, which is if you're not getting paid for it, you're likely not incentivized to do it. So not being paid for postpartum care up until very recently, well, the systems haven't really implemented any of these.Getting paid much more for a C section versus a vaginal delivery. Of course the system is incentivized to do C section.

Right.

You pay me more at company B. Well, it's not always about money, but I might join Company B as opposed to the other one that's paying me much less.

It's basic economics of operating these healthcare systems. And that speaks to, again, more of a systemic failure than an individual one.Because I liked your point about the C section versus vaginal birth delivery. Right. That's something that's very recently, you know, kind of come into the purview of a lot of operators now.They're kind of seeing downstream the effects of that and maybe not focus so much on incentivizing a certain birth method over another.

Yeah. And it depends on who you are, who you. If you're the hospital, you love it. If you're the health plan, depends. But that's neither here nor there.Now, the piece that is going to be the most controversial with our listeners, our audience, because a lot of you have built telehealth first behavioral programs.

Yeah.

17 Minute visits.

She had two telehealth visits, reportedly 10 minutes actually, and 17 minutes per the civil complaint, and during what should have been an acute psychiatric stabilization period following a five day inpatient stay at McLean. So not just kind of, you know, your run of the mill appointment.

Let's see the testimony of this physician talking about telemedicine.

That's the jury fought through appointments that you've had with Lindsay during that period. Every single one of them were by telephone. I said, where I come.

Guest.

Yeah. This is Guest President talking.

Talking with her over the video did not seem like an issue. It didn't seem like there was anything that I was missing or that there was any need to see her in person.

Were you?

So she didn't see a need. She didn't feel like there was a reason. I wonder what would make her think.

Information despite her patient going to an inpatient stay? I agree with that.You know, maybe, you know, we're, we're here, we're telecommunicating and there could be things I'm not seeing, honestly, especially if I keep seeing a pattern or, you know, the patient keeps feeling like they're deteriorating.

Yep. I heard this too. She said, although the audio was a little poor, what she says isn't, I made a mistake.It's that it didn't seem like there was anything that I was missing.

Yeah.

Right. Now from that same cross examination, let's listen to what she has to say. Slot 3.

Were you ever concerned about her mental health as a person?

Absolutely.

She was crying. She told you symptoms that she couldn't get out of bed. Why was it difficult for Lindsey Clancy to get out of bed?

Because she was very depressed and did.

You give her a hug? Oh, no. You're on telemedicine. So you couldn't give her a husband.

The point here is essentially, you know, especially as a clinician, you should have been trained to be able to know body language is a big part of how we communicate. And if you're not capturing the full picture, she's already told you she can't get out of bed.In her own words, she just said that means she was like severely depressed. What drove that clinician or that health system to not make the decision to see this patient? Watch the last segment of this testimony.

I, I could look at her. It was, it was always a video appointment. I couldn't give her a hug. But that's not actually something that psychiatrists typically do with patients.

Now I'm looking at you and you've got the witness standard cutting you off in half, right? So I can't see from your waist down, your legs, your feet, your hands, anything. That's the same view that you have over the toes.

Tess.

Finn said that you've studied and that you've learned that there are objective manifestations that patients may have that would be a tell.

So here the defense attorney in a criminal case is making the case that, hey, you're on the witness stand and I could only see half of you. If it's the same view via tele.

Officer, he says other things right after.I think like with someone ringing their hands, you wouldn't be able to see that if they have anxiety or like I think somebody could be like tapping their foot and you are not really just getting that full picture. They might be like looking totally fine. There are certain cues that we can interpret from body language sometimes in person.

I really like the point you made about feet. Tapping of the feet. Yeah, because that's salient example. It's like one of those simple things that still turns on a light bulb.You can't tell the feet if the hands are out of view. Maybe moving forward, all hands should be in view. And telehealth isn't for everyone. Yeah.There's a story where when I was at El Dorado managing these 28 clinics and their health insurance contracts and we did an innovation, this is many years ago, before telehealth was even a thing that was being used. The head of that MSO had these iPads he wanted to use on these Segway looking robots.He also had a clinic where he would send all of his high cost patients to because he knows if he manages their any number of chronic conditions and they're less likely coming to the hospital for which is paying the bills.What we did is we embedded these segues with an iPad upon them using our care coordinator and our therapist who deliver mental health services, because that's what was lacking there.I got a call about three months into the project and there was a patient whose delusions of persecution were being further affirmed because he turned around to the care coordinator and with such conviction her claim that I told you that the TV is talking to me and you know, the coordinator wasn't equipped.

I can't say that the TV is watching you and you're like already worried.I mean, you're crying for that especially, you know, if your perception's not at the level, you know, that you are hallucinating, maybe with insights. Right. It's also about like qualifying, right? Like okay, maybe that's the type of patient who should be seen in person.And I think in this case here you have 14 appointments and they're all telehealth. And you see this like these like spikes of crisis maybe for the patient.And maybe that's a time when you say like, you know what, come on in, what am I missing? What am I not seeing?

And I'll be curious to hear your thoughts about what kind of AI could essentially be implemented within medical record systems and these type of record keeping so as to proactively identify these concerns and flag them to the medical director.Because right now the expectation is that hey, for, you know, well, running clinics, you have a certain percentage of records that are peer reviewed and if it's a mid level, you have a certain percentage higher than the peer review that is reviewed by a licensure above that essential mid level license within the same specialty.So as a nurse practitioner, psychiatric nurse practitioner, gets their notes reviewed certain percentage of time by a MD or a physician, psychiatrist. Not by a physician, gastroenterologist. Because no, they're not trained and credentialed within the same specialty.So they can't make that determination. It's technically called privileging. What do you think? What have you been seeing about? Is there a use case for AI to detect these within the records?Or is it that the records are so bad that the AI would also think this patient doesn't qualify, just like all these other humans did?

Yeah, of course, you know, AI is not a foolproof technology as of yet for something as sensitive as patient data. I think they're still kind of working that out. But where it can help is administratively, and I think you and I have talked quite a bit about that.But from the administration Side, we're already asking a lot of these physicians in terms of understanding billing and note taking. And now we're asking them to study a boatload of electronic health record before every appointment.And it's not like they're just sitting around, you know, having a mimosa before the patient comes in. They're stressed. They're busy too. And they're accountable to higher ups who are expecting certain billing of them as well.Where AI can be helpful is something more proactive. Hey, here's a summary of this patient, right? This is something, this is what happened last time.This is something that she wrote in my chart that she called a suicide hotline. Here's a, here's a ping, here's a notification for the provider to schedule an appointment. I, I found a block for her tomorrow. Right.Like, I think that's the kind of helpful kind of hand holding that these physicians need because they are burnt out too. It's not to villainize them. It again, is a systemic issue.

Ultimately gotta follow the money and the money flows where volume and higher reimbursing services are not. These types of onesie twosies, which we admittedly say, oh, this is a rare case. So ultimately, what's the financial hit? Ultimately?Is there going to be a change? Unlikely. Unlikely.

Unless there is some sort of, you know, kind of regulatory interference maybe, kind of coming out of such a high profile case like this.

Perhaps, perhaps. But I mean, I don't know if this is a regulatory issue.Maybe what I've been seeing on that side is the pushing of postpartum and maternal health to pay for these things and encourage these non high cost maternity experiences. High cost, not only in dollars, but in, in terms of social and human costs. The toll here you have as many people who've perished.

I think there is an incentive, right? We're seeing hospitalizations, we're seeing ER usage, we're seeing all these different medications.It's not like that was saving the system money, you know, so to speak, for, you know, I think even, of course, you said the lives that were lost. That's, that's something even such a meta lens, I like, I hate to say something like gdp, the mom who can't go back to work, she can't earn.She can't earn, she can't spend. Right.That, that becomes like an economics issue too, is how do we take care of our moms so that they're healthy and able to continue on with their life and not feel trapped by something like their mental health, a lot of.

Which they they say, oh, it's in your head. Well, yeah, my brain is in my head. And that's where a lot of these are being regulated.

Really. Everything that's happening here, it's like, okay,.

Well what is the duty here? So it comes down to, well, system. It's overbearing, overwhelming by the time you adjust the system.And it's like turning around one of these tankers in the Hormuz current event.Now it's a process that we turned around a tinker Industry like Healthcare Admin is very similar where you could be under fire at any given point in time and it takes a while to turn.

It.

Waterways that would never want to.

One of the waterways.

Yeah.

So it's one of those. Yeah, it's just one of those where it's hard to move the needle because it's so human based. Right.There isn't like a fix that someone authoritative is going to put into place and going to fix everything. There is the expectation even, right. That there's a duty of care. Standard of care, which I looked up.I already knew what it was, but I was like, let me look it up once more.And it's exactly what I understood it was still, which is the expectation that any person act within the realm of reasonable people doing what reasonable people would do. Now, reasonable people is not an exact measurement. I cannot find a yardstick to say, okay, here is the duty of care. Yeah, I think that is insane.What if the person isn't reasonable? What they know what reasonable people do?

Something that was really interesting in coming across in those clips that you put up for Dr. Tufts not to pick on her in this episode, but you might have the credentials. You're being categorized as an expert. But do you have the experience to back that up?You know, kind of the wisdom to understand what's reasonable or not. I think that sometimes just comes with experience. That's for any job.But you know, in something this sensitive, if you've not been exposed to a patient with postpartum psychosis that's presenting maybe this way, are you, Are you the best, you know, person in line to then deal with this? And especially in kind of a removed way through telemedicine.

What's interesting is that she's not even an independent provider. Right. She works well in again in this. Reportedly she's. Lindsay wasn't speaking. Exactly. Lindsay wasn't seen in private practice. Right.So maybe there's an expectation on her part that the system, quote, the system will kind of take care of the rest. All I need to do is sit here and change the dosage or whatever.You know, she has no per se aspect of quality control operations because again, that's not what physicians are trained to do, but the duty of care dictates it. Again, the thing you can't measure sometimes.

Just the human aspect. No, no two positions are the same. And obviously there were a lot of different positions involved in this whole civil suit that we've gone through.As a reminder, this is civil litigation. So nothing we've said, you know, has been proven in court and the defendants haven't had their side heard yet.We're making a lot of assumptions based on the healthcare experience that we have here. And what can people do? How do people know if this is an issue in their practice?

Comment here and let's see how many of you are not doing it because you're not getting paid for it or you don't know whether it's being done at your organization. Well, thank you so much. We really appreciate the insight you bring all of our listeners. Thank you.

Thank you for having me on.

Of course. Well, that's it for today's episode. VBCA will be covering the Rise West Conference in San Diego from September, September 2nd to the 4th of 2026.We look forward to seeing you there. If you're there, send us a tweet or x a LinkedIn message and hopefully we'll see each other there. Thank you so much. And stay well and.