Latarsha Sanders, Lindsay Clancy, and the Broader Picture about the State of the United States’ Systems

I’ve been working on this for nearly a week, so buckle up, because it’s a long one.

Author’s Notes:

This article discusses filicide, murder, and some ableist language is quoted, which may be disturbing to some readers. Your discretion is advised. If you or someone you know is actively experiencing a mental health crisis, please seek emergency medical attention at your nearest emergency department.
I know some of you may be tired of hearing about a particular case mentioned in this article, but I will be discussing another, very similar case that was tried in a very different manner. There’s a lot to learn from these two cases in the aspects of medical advocacy and systemic racism. If you need to scroll on, feel free to do so. If you’d like to stick around to read my thoughts about the failures of our medical system contributing to both cases in very specific ways, how one case was handled differently due to racial discrimination, access to mental healthcare, and the broader picture of how these systemic failures impact disabled people and especially disabled women of color in this country, read on.

In the same state and same county as Lindsay Clancy’s trial, under the same district attorney, and under the same presiding judge, is Latarsha Sanders’ case from 2018. Latarsha, like Lindsay, was charged with murdering her children, and her defense asserts she was not criminally responsible by reason of insanity (schizophrenic psychosis). But Latarsha’s case was handled in a drastically different manner by the legal system— particularly by the court disallowing the admission of Latarsha’s medical records.

Lindsay is a white woman, and Latarsha is a Black woman.

The media coverage has not been even remotely the same, nor has public support, and I’m sure you can guess why. If you’re mad about the way Lindsay’s case has been handled and care about women’s healthcare, then you need to have the same energy for Latarsha.

Latarsha did not have a lengthy, “official” paper trail of medical documentation regarding her mental illness prior to the incident like Lindsay did. However, Latarsha’s family said she exhibited bizarre behavior and clear signs of mental instability/illness for several months leading up to the incident. Her mother described her to law enforcement as, “mentally unstable and crazy.” There were concerns that she, too, was dealing with severe Postpartum Depression (PPD) and Postpartum Psychosis (PPP).

After Latarsha’s arrest, she was incarcerated at the Massachusetts Correctional Institution in Framingham and later committed to Worcester Recovery Center and Hospital. Both facilities produced thousands of pages of medical records after she finally received mental health evaluation and treatment. Her defense attorney also hired an expert, Dr. Thomas Deters, a clinical neuropsychiatrist who is affiliated with McLean Hospital. Dr. Deters performed an evaluation of Latarsha that included the review of thousands of pages of medical records, Latarsha’s notebook entries, the crime scene photos and reports, two interviews spaced one month apart and lasting a combined nine hours, with seven hours of neuropsychological testing. He also reviewed a report by Dr. Stacey Fiore, a psychologist hired by the Commonwealth who suspiciously was not called to testify by prosecutors.

Ultimately, Dr. Deters diagnosed Latarsha Sanders with, “schizophrenia spectrum and other psychotic disorders,” and concluded that she was, “grossly psychotic,” at the time of the murders.

However, Latarsha’s medical records and subsequent diagnoses weren’t allowed to be admitted to the record. The prosecution team argued that they were, “irrelevant,” because the records addressed her mental health after the crime had taken place. Judge Sullivan agreed, and ruled that her medical records could not be used unless the prosecution chose to allow them.

Interestingly, Judge Sullivan -who had a reputation of being one of the state’s top defense attorneys- represented Nathan Fujita while Sullivan was a partner attorney at Sullivan & Sweeney LLP. Fujita was accused of murdering his girlfriend, and Sullivan used reason of insanity and specificity, psychosis, as an argument in his defense. He even said that his client’s psychiatric issues such as schizophrenia were not known at the time of the original trial and only appeared after his incarceration, but his client’s records were allowed to be admitted. His own history and background as a defense attorney didn’t matter in how he presided over Latarsha’s case as a judge.

Latarsha was ultimately convicted by a jury in December 2022 of murdering her two sons and witness intimidation, and was sentenced by Judge Sullivan to two life terms in prison without the possibility of parole, plus an additional ten years for lying to police during her videotaped interrogation.

Latarsha’s trial lasted nine days and the jury deliberated for a mere four hours.

Three years later, the Massachusetts Supreme Judicial Court unanimously ruled to grant Latarsha a new trial after she successfully appealed that excluding her medical records constituted prejudicial error. The news broke during the Lindsay Clancy trial. Latarsha’s case now returns to the lower court to set a new court date.

Latarsha’s case is a poignant reminder that the judicial system frequently treats Black women differently, and tends to weaponize mental illness rather than consider it as a factor in a person’s defense. I wonder if Latarsha even had access to adequate mental healthcare in the first place. Just because one doesn’t have mountains of official medical records proving a mental illness or disability, doesn’t mean that mental illness or disability doesn’t exist— and the Massachusetts Judicial Supreme Court agrees.

So does federal law.

Under the Americans with Disabilities Act, the definition of a person with a disability is not a medical term, but rather, a legal one. In order to meet this definition, a person has to have a physical or mental impairment that substantially limits one or more major life activities. Albeit helpful, a person does not need to have a history or record of such an impairment, either. If they are perceived or regarded by others as having such an impairment, they still meet the legal definition of a person with a disability.

It is clear that Latarsha was not only perceived as having a severe mental impairment, but later records and assessments by experts backed this up.

So why was Latarsha Sanders’ case treated so differently? Enter systemic racism and ableism.

But even if someone charged with a crime does have extensive medical documentation of a mental illness, does it actually matter?

Even though Lindsay Clancy sought out mental healthcare resources for several years, especially so in the months leading up to the murder of her own three children, it’s become extremely evident that inaccurate medical records and a lack of obtaining medical records has caused some major issues during her trial.

One example in Lindsay’s case is psychiatrist, Dr. Jennifer Tufts, who treated Lindsay and became notably agitated on the witness stand when providing testimony about the medical notes she actually wrote, versus what she had intended to write. Another example is the multiple psych medicine providers who simply took Lindsay’s word about what medications she was taking, dosages, and timeframes, rather than requesting a copy of those records from other healthcare systems that weren’t directly linked to their own. The records request process is very simple; it requires a Release of Information (ROI) form signed by the patient in order for records to be transferred. Lindsay was willing to do so but was never asked to.

These psychiatric medical providers trusted Lindsay’s ‘word for it’ because, as one of those psychiatrists, Dr. Alia Goodheart, testified, “I had no reason to believe she was not a reliable reporter.” Lindsay presented as cooperative, coherent, and capable of advocating for herself and describing her symptoms. After all, Lindsay is a licensed labor and delivery nurse and even tracked her medications, symptoms, and side effects in a journal without being prompted to by her own medical providers.

That said, Lindsay also repeatedly reported experiencing “brain fog”— which typically means that thoughts aren’t easy to reach or organize, or one may have trouble recalling information. The term “brain fog” is often used to describe feelings of confusion, forgetfulness, and poor focus.

“Brain fog” is not a new term, having first appeared in print in 1853. British physician James Tunstall described a precursor condition called “brain fag” in 1850 for mental exhaustion from overwork, while the exact phrase “brain fog” was recorded by the Oxford English Dictionary in 1853. In the 19th Century, writers commonly used the term informally to describe sluggish thinking, mental fatigue, or temporary confusion. The term “brain fog” re-emerged and gained popular traction in patient advocacy circles in the 1990s. It was widely adopted by people living with chronic fatigue syndrome (ME/CFS), fibromyalgia (sometimes called “fibro fog”), and autoimmune disorders. The COVID-19 pandemic in 2020 brought the phrase into global mainstream vocabulary as a primary way to describe the persistent cognitive symptoms associated with long COVID.

Lindsay reporting that she was experiencing “brain fog” is significant. It implies that her state of mind was altered in ways that could have impacted the reliability of her self-reports of symptoms, medications, dosages, and side effects. I am not a medical professional, but it doesn’t take an expert to know that it would have been wisest for her providers to request Lindsay’s medical records to get the most accurate information possible, especially because alterations to her prescription psych medications were being made.

As an important side note, the Commonwealth’s prosecution team is alleging -especially in their closing argument- that Lindsay lied to her providers, mother, and partner about her condition, didn’t disclose how severe her symptoms and thoughts actually were, and essentially postured that she did not give reliable information.

There are many occasions where patients admitted for emergency psychiatric care are not coherent or cooperative, and those patients cannot reliably self-report their symptom or medication histories. In those cases, records are typically requested with urgent status.

It is not best practice to rely on a patient’s word alone when creating an inventory of their medications, side effects, symptoms, and thoughts. Reviewing medical records from other providers often paints a far more accurate picture of the full scope of the situation.

But what happens when the medical records that have been requested aren’t accurate?

In the instance of the discrepancies in Dr. Tufts’ medical records, certain symptoms were listed that she allegedly intended to notate the opposite of. While Dr. Tufts maintains that she remembers exactly what she meant to say in those records nearly four years later, what is written in the record cannot be changed during court proceedings. A provider who requests those records won’t know to ask if the provider who wrote the record did so in an accurate fashion. Further, the reliability of Dr. Tuft’s own memory recall for one small -but important- portion of a single patient’s record is called to question when any reasonable person would presume that she sees many patients throughout the day, and has likely seen hundreds of other patients in the time since she took notes of her encounters with Lindsay as a patient.

This is precisely why medical records should be reviewed by the person who is writing them, and they should make appropriate changes/edits as soon as possible while accurate information is fresh in their mind

Errors in medical records can cause extreme complications. For patients and/or other treating providers who rely on accurate records for medical treatment, those complications can include: delays in receiving care, receiving inadequate care, prescribing inappropriate or potentially harmful medication and/or making possibly dangerous dosage changes, and more.

In the context of legal settings, errors in medical records can call a provider’s reliability or a patient’s character into question. Errors can cause confusion and insinuate inconsistencies about what symptoms the patient was actually experiencing; unintentionally exaggerating less important or nonexistent symptoms, or understating critically important symptoms. This can be weaponized very easily in the legal system.

For example: a patient applies for Social Security benefits because of their severe and disabling eczema. All of the patient’s/claimant’s medical records must be submitted for review, and the patient/claimant does so.

Their primary care provider’s records briefly mention eczema in the ‘Subjective Summary’ section for one or two visits, but not for other visits, as it wasn’t a chief complaint to the primary care provider since the patient sees a dermatologist for ongoing care for their eczema. In the ‘Physical Exam’ section, the primary care provider’s record states, “General: Skin is Warm and Dry. Findings: Normal.” No physical exam was actually performed on the patient, but the section was completed regardless— even if it was simply left in its normal pre-formatted state and isn’t technically accurate. The primary care provider is aware of the patient’s history of severe eczema, but this isn’t adequately reflected in their patient’s medical records.

The patient/claimant also regularly sees a dermatologist, and their records consistently notate a rash being present on a large percentage of the patient’s skin. The records detail a lengthy, years-long history of severe and disabling eczema, treatment plans, and ongoing monitoring.

The Social Security Administration’s (SSA) Administrative Law Judge (ALJ) looks at the two sets of records and determines that the claimant/patient does not qualify for social security benefits, due to the inconsistency in the claimant’s medical records. Even though the claimant/patient meets the SSA’s Listing of Impairments criteria for Skin Disorders, and the claimant/patient has a specialist (dermatologist) who provides a detailed record of their disabling symptoms and has established a lengthy history of the condition’s severity, frequency, duration, limitations, and prognosis, the ALJ denies the claim based on the claimant’s/patient’s primary care provider not having the same records about their disabling eczema.

Even if the SSA’s own medical expert examines the claimant during a required medical appointment and agrees with the claimant’s dermatologist, the ALJ could discount their opinion -or ignore it altogether- based on it being a, “one time encounter.” [End of Example]

The medical and legal systems both require accuracy, especially pertaining to medical records. But these systems don’t take certain factors into account concerning why medical records may not be as accurate as we’d all like them to be.

Historically, medical charting was written by the treating provider’s own hand, often using the ‘SOAP’ method (Subjective, Objective, Assessment, Plan). Medical providers didn’t have the massive volume of patients 20 years ago that they typically have present day, so they had more time to complete charting at the end of the day. And with the modernization of the medical system and new technology, human transcribers have been replaced by dictation devices and AI, which are often woefully inaccurate. Now, providers are rushed into ticking off boxes and writing a quick summary instead of being able to perform comprehensive charting.

Boxes get missed. Pre-filled responses aren’t changed. Summaries are inaccurate.

Errors made that used to be corrected are now left on the record. The time providers used to have to carefully review and edit their notes is now shaved down to practically nothing. Private healthcare facilities and investors are more focused on how many patients a provider can see in one day, rather than the quality of care being administered; there’s immense pressure for providers to meet nearly impossible quotas.

Volume outweighs quality.

Access to care -like medications and surgical procedures- can be negatively impacted by inaccurate medical records, too. Insurance companies will delay or deny a different medication because the patient’s medical records don’t clearly indicate they’ve unsuccessfully tried three to four other medications used for the same condition. A patient’s surgery could be denied by their insurance company because the patient’s new doctor didn’t indicate their treatment history and duration of the existing issue that was notated by a previous doctor. A patient tries to go to a specialty clinic with a referral, but is denied because of an inaccurate diagnosis listed by the referring provider; the specialty clinic won’t take the patient’s word for it— the patient has to go back to the referring provider, submit for a correction, or be referred by someone else. And even so, some clinics will cling to inaccuracies and refuse to admit a patient to their program based on a one-time mistake. No “take backs”, apparently.

Further, racial discrimination in the medical system is just as prevalent as it is in the judicial system. Black women in this country frequently experience under-diagnosis, delayed diagnosis, and misdiagnosis for mental health conditions due to overlapping cultural, systemic, and diagnostic factors. More than 50% of postpartum depression cases in women of color go unreported, and Black women are half as likely to receive treatment for maternal mental health conditions compared to white women despite facing double the risk. Unfortunately, women of color make up less than 5% of psychiatrists, psychologists and social workers available to treat patients, which may contribute to patients not seeking care in the first place if they (understandably) feel unsafe or uncomfortable doing so with a non-WOC provider.

The cases of Latarsha Sanders and Lindsay Clancy both highlight deeply problematic systemic failures in the medical and judicial systems. One of these women had extensive records after the crime with a lack of access or the ability to obtain care, and one had extensive records prior to the crime and access to care beforehand. But having those records and access to care didn’t save anyone. Primarily, in my opinion, because the records weren’t accurate, and no one bothered to request prior records before prescribing new medications or making dosage adjustments.

I believe that had each of these women had equal, safe, and culturally conscious access to care, had they been given adequate care, had the records been accurate, and had their new providers obtained records from previous treating providers and actually reviewed those records or asked questions directly to previous providers, perhaps their children would still be alive.

We cannot have anger for how Lindsay’s case is being handled without having anger for how Latarsha’s case was handled. These cases alone likely won’t change the judicial system’s handling of cases involving a mental health crisis and/or involving Black women, nor will they change the quality of women’s healthcare by themselves— but public pressure to make systemic changes based upon how these women’s cases have been handled can be very powerful. We need to talk about them. We need to learn from them. And we need to take collective action.

Sources:

https://www.newsnationnow.com/opinion/lindsay-clancy-trial-latarsha-sanders/amp/

https://www.nbcboston.com/news/local/brockton-latarsha-sanders-new-trial-massachusetts-supreme-judicial-court/3993229/

https://www.yahoo.com/news/us/articles/lindsay-clancy-judge-once-defended-235520276.html