1.Beverly Wood — Direct/Cross/Redirect

BEVERLY WOOD: Beverly N. Wood, W-O-O-D.

BEVERLY WOOD: I'm employed by the South Carolina Department of Corrections.

BEVERLY WOOD: Thirteen years.

BEVERLY WOOD: I'm the chief of psychiatry there, but I also have a case load and I manage all the psychiatric services for the Department of Corrections.

BEVERLY WOOD: Yes. I went to undergraduate school at Virginia Tech. I went to medical school at Virginia Commonwealth University, the Medical College of Virginia in Richmond, Virginia. I did my psychiatry residency at Penn State University's medical school, which is in Hershey, Pennsylvania. And I also did Fellowship in child psychiatry, but I didn't actually work in child psychiatry. I worked two years for the Pennsylvania Department of Mental Health. Then I came to South Carolina in 1991 and I worked for the South Carolina Department of Mental Health until 2006, when I came to the Department of Corrections to be the chief psychiatrist, and I've been there since that time.

BEVERLY WOOD: Yes. I happened to be covering the unit that he first resided in. That was one of my areas of responsibility when he came to the Department of Corrections, so I -- he came as a pretrial detainee. Sometimes we get people that haven't been to trial yet. Most of our inmates have already been to trial. We get a few that haven't. And I evaluated him and treated him. And then when he was moved to another campus, I also -- that's one of the campuses I covered, so I continued treating him. So I treated him during his entire stay with the Department of Corrections.

BEVERLY WOOD: He came September of 2014, I think, the 12th -- I'm not sure of the day. September 2014, and the last time I saw him was in December of 2018. Because I don't know the exact date that he came back to Lexington County, but that was the last time I saw him was in December.

BEVERLY WOOD: Probably.

BEVERLY WOOD: I first saw him, basically, to obtain history and figure out what's going on. People don't generally come to us with any information, so we just interview them and try to get as much information as we can, which is what I did. And -- you want me to talk about the actual interview, is that what you want me to talk about?

BEVERLY WOOD: Okay. He gave me a history of -- family history of schizophrenia, said his mother had suffered from schizophrenia. He said that he had started hearing voices, I think, around age 12, I think is what he said. He had a head injury in an automobile accident. That was in his teens, I don't remember the exact age. I think he told me he started using drugs around age 15, started with alcohol, progressed. Used a variety of drugs, marijuana, synthetic marijuanas, cough syrup. Had used cocaine, occasional Ectasy, I think he said.

BEVERLY WOOD: Well, yes, he told me what he had used and -- I mean, I didn't get information about how many times a day and that type of thing in that initial, but he did give me extensive use of drugs. I think he said cocaine was his drug of choice, but I don't think that was the one he used the most though.

BEVERLY WOOD: He told me he had used synthetic, yes, he did tell me that.

BEVERLY WOOD: Well, I mean, based on his mental status exam about the voices he said he heard. He said he saw more like strange things. Sometimes when he looked at the walls, he would see like shapes or movement, sometimes faces. He had been depressed. He said -- I guess, he was kind of a loner, I gathered, for most of his life. He liked to do things fast and I think he said he ran wide open sometimes, had been depressed sometimes. So I thought there was a psychotic component with the voices. He also expressed a little paranoia. And I thought there was an affective component because there were some bits of maybe hypomanic or manic behavior, although he did not give me a history of a full blown manic episode, and some depression. So my working diagnosis that I gave him at that time was schizo-affective disorder, although there was also a history of substance abuse. And I had to rule out personality disorder because he said he had been in trouble some in his youth, so that was a rule out, too, that I put in there.

BEVERLY WOOD: Probably, yes.

BEVERLY WOOD: Yes, Geodon, which is an antipsychotic that's also a mood stabilizer.

BEVERLY WOOD: Yeah, you have to have food in your stomach, at least, about 360 calories in order for it to be effective, which is a little bit of a challenge within the Department of Corrections to time it with food. I mean, we're supposed to be getting snacks, but that doesn't always work out. But I like to use it because it is a good mood stabilizer and then antipsychotic and the side effect profile is pretty good. I mean, it's -- generally, people maybe get a little tremor, but the side effects are not usually as severe as with the older antipsychotics. And we have a list of preferred antipsychotics that we're supposed to use, you know, it's called a formulary, within the Department of Corrections, so we try to stick to that whenever possible. So Geodon is one that I like to start with because people usually tolerate it pretty well and it's usually fairly effective.

BEVERLY WOOD: Well, I had to keep increasing the dose with him. I mean, he did respond. He said he felt better. We didn't completely get rid -- it took a while to completely get rid of the voices and we mostly got rid of the permutations or -- that's what he called them sometimes, the things he would see. But, again, it was -- so he used a much higher dose than I usually used. I tried to change -- he did have a little tremor, so I gave him Propranolol, which is treatment for tremors of antipsychotics. We tried to switch to Fluphenazine or Prolixin, which is an older, since we were getting so high with the Geodon dose. That was helping him, but then we weren't able to obtain it from the manufacturer because they weren't making enough. It just wasn't available, the tablets. We used the liquid for a little while because we could get that and then that became unavailable, so we had to go back to just the Geodon. And then I think by the end, we had added Perphenazine or Trilafon, which is another antipsychotic. So we were trying to not be on so much Geodon. But throughout with the Geodon, we had trouble with the food, you know. I mean, for a while, I was able to get him Ensure or Boost and then we weren't able to do that. And they were supposed to start bringing snacks and that worked better in some locations than others.

BEVERLY WOOD: They get two meals a day on weekends. That's why it's important to get the snacks. But the meds are mostly twice a day throughout -- with the exception of a few special programs, the meds are twice a day. But on the weekends, they don't coincide with mealtime because they get a brunch and a dinner on weekends. So that's another challenge there.

BEVERLY WOOD: Yeah. Then he says something doesn't feel right.

BEVERLY WOOD: That the voices had decreased, but he wasn't completely adjusted to the medication.

BEVERLY WOOD: Well, I think he certainly liked that the voices were decreased because I know later, when we were on a really high dose and were trying to decrease it, he said the voices have returned. And I remember him telling me I'd rather have brain fog than hear voices. Because sometimes, if you're on a lot of antipsychotic, the guys do tell me it's like thinking through a fog or something. And he did tell me that at one time, that he would rather have that than hear the voices.

BEVERLY WOOD: Well, in that locale, I consider that with everybody because we do have a number of people that do fake for various reasons, to get in special programs or just for a variety of reasons. However, I never saw anything in his behavior that would confirm that or make me think that he was faking. I can't imagine somebody would -- generally, people that are faking don't ever make it to the doses of medication that he's on. You're either going to tell me yeah, that dose stopped or they're going to ask me for something or try to flatter me or intimidate me to get me to do something that they want done. There's just a lot of things that people that try to manipulate us do, and that happens a lot. That never happened with him. He never asked me to do anything or did any of those things. And he would tell me if the medicine was working or wasn't working. He never suggested that I give him one of the medicines that they can sell on the black market or anything like that. So I did not -- although I entertained it, I never felt that he was trying to manipulate me. And none of the staff ever told me they felt like he was trying to manipulate them either.

BEVERLY WOOD: I've not had anybody say that that was trying to manipulate me.

BEVERLY WOOD: Yes. Because I thought there was an affective component because sometimes he's had the pressured speech. And again, I never saw a full blown manic attack. You can -- some people with mania are happy and some get agitated. So, I mean, he did have described periods of agitation, which could be consistent with that. And diagnoses in psychiatry are not as clear cut, it's not as easy as it is in other forms of medicine. There's nothing I can measure like a blood pressure or culture for a bacteria because a lot of the criteria of the diagnoses overlap and a lot of it's based upon the psychiatrist or the person treating or interviewing. So that's a big criticism, I guess, with the DSM-5 and it takes years for them to come up with new books because there's so much controversy.

BEVERLY WOOD: I added it at one point in time. I don't know if that was the exact date, but I did add Prozac when he said he was depressed, yes.

BEVERLY WOOD: I don't know. I don't know for sure. But it's not unusual if someone is hearing voices and depressed that I would use an antidepressant and an antipsychotic. Although Geodon is a mood stabilizer, it's not a great, by itself, antidepressant.

BEVERLY WOOD: Yes. He hadn't -- we were switching to a new medical record system, not all the medication orders were going through, so there was a problem for a little while. I think he was without the Prozac and he said he didn't feel any different without it than he did with it and he didn't see a need to continue it. So I was okay with that.

BEVERLY WOOD: There was a long period of time that when he would rate his mood, I think when the counselor went by regularly, and he would say he was eight out of ten. He was okay. So, I mean, there was a period of time that he was doing fairly well, yes.

BEVERLY WOOD: I know that I wasn't present when it happened, but he had made a suicidal gesture or attempt. Some rules had been, I guess, enforced in a program he was in that are usually -- had been enforced in the lockup units, which is that when medication is distributed -- because they have -- it's done through the door, they have to stand at the back of the room because, in some units, people would throw things on the nurses or grab or do things. So they had him stand in the back of the room and medication was placed at the door flap. And, apparently, they implemented it in his unit, but they didn't tell people. And I think he thought that they were just doing that to him. And he got -- he didn't get his medication because he didn't stand in the back of the room for, I think, maybe a couple pill passes. And he made a suicidal gesture or attempt to hang himself. Like I said, I was not there. I did see the video later and I talked to him. He said he was angry. I mean, he had told, I think -- the counselor, I think, he had told that, you know, it was the anniversary of his children's death, but he didn't tell me that. Just was --

BEVERLY WOOD: Yes, that's correct on this page.

BEVERLY WOOD: Yes, thought that it needed to be increased, this says. That was August 18. And we did increase it. And he said after the increase that he felt more angry, which sometimes, the restlessness, the side effect, akathisia, the movement can be an internal restlessness that people that interpret as anger. And -- I'm seeing if that's the day that I -- that's not the day that I started the Propranolol for the side effects. So I'm not sure why he was more angry, but it could have been more side effects or it could have been -- it could have been a lot of things. I don't know.

BEVERLY WOOD: Apparently, he was scheduled to be seen in psych clinic that day, but they were unable to pull him. There was not enough security staff available, so I was unable to see him that day. And then the nurse said that because he didn't go to the back of his cell, they listed that as refusal of medication. If you don't fully comply with their rules, that's counted as a refusal. And he did not receive medication.

BEVERLY WOOD: Yes, I think so.

BEVERLY WOOD: I did watch the tape.

BEVERLY WOOD: He was very restless. He kept moving around in the bed, getting up, lying down, getting up, lying down. I mean, he tied the sheet -- I think it was a sheet -- around his neck and then he untied it. I mean, it seemed there was some ambivalence about the whole thing. Finally, he did tie it and, eventually, the staff came and got him out.

BEVERLY WOOD: He told me multiple times he hallucinated, yes, so I -- that was my evidence, was his word and I had no reason not to believe him.

BEVERLY WOOD: Yes, the auditory hallucinations stopped with medication. Occasionally, I think he still had the permutations would come and go, things he would see, but the things he heard stopped.

BEVERLY WOOD: I wouldn't say it was disorganized. At times, it was strange and it wasn't -- his thoughts were jumbled back and forth between two topics, maybe, so more like flight of ideas I might call that. But if you separate those two things out, I guess they kind of made sense if you could keep up with several trains of thought at the same time. But he did have strange ideas. Like, one time, he was telling me about the way he saw his psyche in a triangle. It wasn't disorganized really, I understood what he was saying, but it was strange.

BEVERLY WOOD: Yes, that was part of that, yes.

BEVERLY WOOD: He did have pressured speech several times, yes, that just -- I could hardly talk because he had to get it all out, you know.

BEVERLY WOOD: More of an affective component. More on the -- that would be leaning more toward like bipolar, maybe. Again, I never -- I have no documentation he ever had a full blown manic episode, but like hypomania.

BEVERLY WOOD: Yes, because of the affective components with the depression and the pressured speech and the agitation, that could have been that.

BEVERLY WOOD: Absolutely. I mean, I cared more about his hygiene and whether they gave him clean uniforms or he got a shave or a haircut than he did. He didn't really -- those things weren't important to him for a lot of time. And I'd have to go get the officer and say, you've got to get a clean uniform, you know. Because he didn't ask, he didn't really care. He's not a particularly talkative person, so, I mean, that may just be his personality structure that he doesn't talk a lot or explain a lot or anything, but there was paucity of speech a lot. But I'm not sure if that's just the way he is or that could also be a negative symptom.

BEVERLY WOOD: No.

BEVERLY WOOD: Yes.

BEVERLY WOOD: No. No, I believe he's mentally ill.

BEVERLY WOOD: You did. I can't remember -- I did it for you, but I don't remember the numbers. As we were changing medicines and trying to treat side effects, I mean, sometimes he was on a lot of medications. And the Department of Corrections doesn't always carry the highest strength available of some medications, so. Like, they make an 80 milligram Prozac, but we only carry 20, so -- 20 milligrams, if you want to give somebody 80, you've got to give them four pills. That's part of the problem. At Kirkland, one of the times he was on the most pills, he was taking ten in the morning and eight in the evening, that was April of 2017. And when he was at Lee, which was toward the end, he was taking three pills in the morning and five pills in the evening.

BEVERLY WOOD: And five in the evening.

BEVERLY WOOD: Yes, that's what he was on at the end of when I was seeing him, eight a day, yes.

BEVERLY WOOD: I've seen a number of our inmates on synthetic marijuanas. So, I mean, usually, we call it K2 and they all -- there's a lot of variability in the synthetic marijuanas because we don't know what they add into it, yes.

BEVERLY WOOD: Yes.

BEVERLY WOOD: Yes.

BEVERLY WOOD: Yes.

BEVERLY WOOD: Well, generally, they're better within a few days. Those that have underlying psychotic disorders sometimes take a few months to get better.

BEVERLY WOOD: I believe he has an underlying mental illness. It could have been exacerbated with his drug usage. I mean, certainly, he used drugs. That could change your brain's chemistry.

BEVERLY WOOD: I think he still has -- the last time I saw him, I thought he still had an underlying mental illness and it's one that would not go away, so I would assume he's still mentally ill now.

BEVERLY WOOD: I do not. I saw him consistently for a little over four years. In the beginning, I probably saw him every other week, sometimes every week, depending on how things were going with him. His level of care when he was at Lee was outpatient mental health. Our policy requires us to see people on medication or outpatient mental health, at least, every three months. So, I mean, it went from more frequently to less frequently. And at Lee, it's a lot more difficult to get people pulled to be seen. So I didn't count the number of times, but I saw him a number of times. And I can't -- I didn't count them, I'm sorry, I don't know how many.

BEVERLY WOOD: A lot. I don't know, a lot, though.

BEVERLY WOOD: Good morning.

BEVERLY WOOD: Yes. You guys pointed that out to me and I told you I like my job, so, yes.

BEVERLY WOOD: I do.

BEVERLY WOOD: That is correct. I don't -- we don't have a lot of pretrial detainees, but for those we do, I don't talk to them about their crime unless it involves their current treatment, something from it. So, I mean, that's not my role is to deal with the crime, but to deal with the symptoms and treatment, that is correct.

BEVERLY WOOD: That is correct.

BEVERLY WOOD: Right. That's in -- I mentioned that I did additional training in child psychiatry, but I chose not to work with children. They do additional training in forensic psychiatry, so.

BEVERLY WOOD: That's correct.

BEVERLY WOOD: That is correct.

BEVERLY WOOD: That is correct. I didn't talk to him about his state of mind that day.

BEVERLY WOOD: Yes.

BEVERLY WOOD: Yes.

BEVERLY WOOD: For most of his history, yes.

BEVERLY WOOD: Yes, that is correct. I mean, it's -- with hallucinations, you pretty much always have to take someone's word. You're correct, yes.

BEVERLY WOOD: He is a clinical counselor that works with me and that saw Mr. Jones sometimes with me or independently.

BEVERLY WOOD: Mr. Inabinet was the -- he's now associate warden at Evans, but at that time, he was the counselor in charge of the unit at Kirkland that Mr. Jones was assigned to. And he made regular rounds and saw -- saw the guys on a regular basis. Made daily rounds and I think he made weekly notes of how they were doing.

BEVERLY WOOD: That is correct.

BEVERLY WOOD: Yes. I review some of the notes. Now, I don't read all of the group notes. Of course, I don't -- he wasn't allowed to be in groups because he can't mix with the other inmates. But, in general, yes, I review a lot of the notes, not all of them.

BEVERLY WOOD: Yes, he did meet with us.

BEVERLY WOOD: That is correct.

BEVERLY WOOD: No, we see him a lot.

BEVERLY WOOD: That's correct. I never saw him totally lose it and have disorganized behavior. I did not see that.

BEVERLY WOOD: I don't recall seeing it. Not all the people that hallucinate respond. Mr -- I mean, I never saw him respond either, but a lot of them do not. And he was on medication every time I saw him except the very first time, so. But that's true, I never saw him respond to.

BEVERLY WOOD: Not everybody that I see that hallucinates actually responds to them, so I wouldn't say that discounts it, but I never witnessed that with him.

BEVERLY WOOD: That's correct.

BEVERLY WOOD: That is correct.

BEVERLY WOOD: I discussed in a meeting with someone. Mr. Gudvangen was the HCA, the head nurse, at that unit. He didn't actually come up there very often, so I don't know where he got the information for his note. I did discuss that note with him afterwards because I was concerned about why he would say that, so.

BEVERLY WOOD: That's what Mr. Gudvangen said.

BEVERLY WOOD: I wouldn't expect full fledged voices to return with missing one dose. I think it was two doses, but, anyway, I would not expect that. He did his Propranolol, I think, and I thought he might be experiencing withdrawal akathisia, the abnormal movements, internal restlessness is what I thought. But yes, I did not concur with Mr. Gudvangen's assessment and I don't know anyone else who did.

BEVERLY WOOD: And he wasn't up there. I don't think he observed that either, but he came to that conclusion somehow.

BEVERLY WOOD: Well, flight of ideas that he would be jumping from topic to topic and talking about strange things, but I didn't feel that it was disorganized. It made some sense to me.

BEVERLY WOOD: He was explaining to me how he -- various things, yes.

BEVERLY WOOD: I recall seeing that note. That's what the note says. I mean, he never told me about that, but there is a note that says that.

BEVERLY WOOD: I mean, that's what he told the person, that's all I know.

BEVERLY WOOD: That does not indicate disorganized thinking to me.

BEVERLY WOOD: No. That one, I do not recall.

BEVERLY WOOD: Every time I saw him, I asked him about homicidal ideation and I don't think he ever acknowledged that to me.

BEVERLY WOOD: That particular statement by itself, taking out of context would not indicate disorganized thinking.

BEVERLY WOOD: Yes.

BEVERLY WOOD: That is correct.

BEVERLY WOOD: Uh-huh.

BEVERLY WOOD: It can be, yes.

BEVERLY WOOD: Yes, he did describe that to me at one point in time.

BEVERLY WOOD: For some people, yes.

BEVERLY WOOD: Yes.

BEVERLY WOOD: We never did a level. And again, if you don't have food, it's like half as effective, so -- but if you have a high level, you are correct. So, I mean, I can't say for sure how much he actually absorbed.

BEVERLY WOOD: It could cause sedation, which could affect that.

BEVERLY WOOD: Generally, we prescribe Geodon as an antipsychotic for people that are out of touch with reality or hearing things or seeing things, or as a mood stabilizer.

BEVERLY WOOD: Yes. Yes, it is.

BEVERLY WOOD: Yes.

BEVERLY WOOD: Yes, we do.

BEVERLY WOOD: No, we don't. We have very strict guidelines on insomnia. We don't use Geodon for that.

BEVERLY WOOD: That is correct.

BEVERLY WOOD: Yes, that I think there was a mood component to his illness. Because you can have bipolar with psychosis, so you can have primarily bipolar and still hear voices or see things, yes.

BEVERLY WOOD: Yes.

BEVERLY WOOD: No. I say he has a mental illness that has psychotic components and I think affective components as well. I don't think he neatly -- in my opinion, didn't fit in any of the boxes completely, yes.

BEVERLY WOOD: The diagnostic criteria, yes.

BEVERLY WOOD: Yes, that's generally --

BEVERLY WOOD: Yes, that's generally an exclusion for most of them.

BEVERLY WOOD: No.

BEVERLY WOOD: No, we did not have those records.

BEVERLY WOOD: Other than he told me cocaine was his drug of choice, no. We don't have the outside information. I mean, he did say he used a number of drugs. I'm pretty certain he did not use drugs during the four years he was SCDC, so whatever effects he had were permanent changes, which may -- you know, certain drugs can cause permanent brain changes.

BEVERLY WOOD: That is correct, but, again, he told me that the voices started before the drug use. So that is the information that I had.

BEVERLY WOOD: Well, he said synthetic marijuana, yes.

BEVERLY WOOD: Different -- I mean, it contains lots of ingredients because you never know what people put in it, right.

BEVERLY WOOD: No.

BEVERLY WOOD: Just of general synthetic cannabinoids, not that particular one -- I mean, not one particular possible component, no.

BEVERLY WOOD: That is correct.

BEVERLY WOOD: Not their records, no. We did not have their records.

BEVERLY WOOD: I did not have anything -- any information about 2001, no.

BEVERLY WOOD: He did say that he had used cocaine in the past.

BEVERLY WOOD: That is correct. He said it was his drug of choice, but I don't think -- when he talked to me, that was not what he used most often, but it was his drug of choice.

BEVERLY WOOD: The marijuana, maybe the synthetic marijuana as well, I don't recall.

BEVERLY WOOD: Yes, he had started using it as a teenager.

BEVERLY WOOD: Yes.

BEVERLY WOOD: It is -- yeah, it's helpful to observe them.

BEVERLY WOOD: I'm not sure what you mean.

BEVERLY WOOD: Yes, that can. Of course, he did not have a cell phone in -- while he was with us.

BEVERLY WOOD: No, I did not have any information about his phone.

BEVERLY WOOD: No, I did not see any information about his phone usage.

BEVERLY WOOD: No, I had no records.

BEVERLY WOOD: I had no records of any kind.

BEVERLY WOOD: No, sir.

BEVERLY WOOD: Just the treating psychiatrist, yes, sir.

BEVERLY WOOD: No. That's one of the list of criteria that you have to have, at least, two of, but you don't have to have that particular one, no.

BEVERLY WOOD: Thank you.