Bonnie Hardey
16 BONITA HARDEY,
17 CALLED AS A WITNESS, BEING FIRST DULY SWORN TO TELL THE
18 TRUTH, WAS EXAMINED AND TESTIFIED AS FOLLOWS:
19 DIRECT EXAMINATION
20 BY MS. BARLOW:
21 Q. GOOD AFTERNOON. WOULD YOU PLEASE STATE YOUR NAME AND
22 SPELL IT FOR THE RECORD.
23 A. BONITA, B-O-N-I-T-A; HARDEY, H-A-R-D-E-Y.
24 Q. AND WHAT IS YOUR OCCUPATION, MS. HARDEY?
25 A. A REGISTERED NURSE.
1605
1 Q. HOW LONG HAVE YOU BEEN A REGISTERED NURSE?
2 A. SINCE 1993.
3 Q. AND DID YOU HAVE ANY MEDICAL TRAINING PRIOR TO THAT?
4 A. YES. I WAS AN L.P.N. SINCE 1980.
5 Q. WHAT TRAINING DID YOU HAVE TO RECEIVE TO GET YOUR R.N.?
6 A. UMM, I GRADUATED FROM WEBER STATE UNIVERSITY. PRIOR TO
7 THAT I WAS AN L.P.N. I GOT MY TRAINING THROUGH THE UNITED
8 STATES AIR FORCE.
9 Q. DO YOU HAVE A BACHELOR'S DEGREE?
10 A. NO. I HAVE AN ASSOCIATES.
11 Q. THANK YOU. YOUR TRAINING THROUGH THE AIR FORCE, WAS
12 THAT PRIOR TO 1980, THEN?
13 A. IT WAS 1980 UP UNTIL 1987 WHEN I GOT OUT.
14 Q. OKAY. WHAT EXPERIENCE HAVE YOU HAD IN THE MEDICAL FIELD
15 SINCE, SAY, YOU GOT YOUR R.N.?
16 A. SINCE THE R.N. I'VE WORKED AT ST. BENEDICT'S HOSPITAL IN
17 THE FLOAT POOL. I WAS THE DIRECTOR OF NURSING OVER AT A
18 GERIATRIC NURSING HOME IN BOUNTIFUL. THEN I WENT TO DAVIS
19 HOSPITAL AND WORKED ON THE GERO-PSYCH UNIT. AND CURRENTLY
20 I'M WORKING AT MCKAY-DEE ON THE SURGICAL FLOOR.
21 Q. LET'S GO BACK TO WAS IT ST. BENEDICT'S?
22 A. YES.
23 Q. WHAT YEAR WAS THAT?
24 A. 1993.
25 Q. AND YOU WERE IN THE FLOAT POOL?
1606
1 A. YES.
2 Q. AND WHAT DID THAT ENTAIL?
3 A. VARIOUS UNITS. YOU GO AND FLOAT LIKE I.C.U., MED
4 SEARCH, PSYCH. ANYPLACE THAT THEY NEEDED YOU.
5 Q. DO YOU RECALL HOW MUCH YOU WORKED ON THE PSYCH UNIT AT
6 ST. BENEDICT'S?
7 A. PROBABLY THREE MONTHS TOTAL AT THAT TIME.
8 Q. AND AFTER THAT YOU WENT WHERE?
9 A. I WENT TO ROCKY MOUNTAIN NURSING HOME. I WAS DIRECTOR
10 OF NURSING THERE.
11 Q. AND WHERE IS THAT?
12 A. IN BOUNTIFUL.
13 Q. AS DIRECTOR OF NURSING WHAT WERE YOUR RESPONSIBILITIES?
14 A. THE CARE OF GERIATRIC PATIENTS, THE STAFF. BASICALLY
15 RUNNING THE NURSING HOME.
16 Q. HOW LONG WERE YOU THERE AS DIRECTOR OF NURSING?
17 A. APPROXIMATELY A YEAR.
18 Q. AND THEN WHERE DID YOU GO?
19 A. I WENT TO THE GERO-PSYCH UNIT AT DAVIS.
20 Q. AND WHEN WAS THAT?
21 A. DECEMBER OF '94.
22 Q. DO YOU RECALL WHO WAS DIRECTOR OF NURSING OVER THE PSYCH
23 UNIT AT DAVIS NORTH?
24 A. WHEN I FIRST ARRIVED IT WAS SHEILA MOORE.
25 Q. AND DID IT CHANGE?
1607
1 A. SEVERAL TIMES, YES. FROM SHEILA MOORE IT WENT TO SHEILA
2 HANSEN AND THEN SHANNON. I DON'T RECALL HER LAST NAME. SHE
3 WAS THE LAST DIRECTOR BEFORE I LEFT.
4 Q. IN THE PSYCH UNIT?
5 A. YES.
6 Q. WAS THERE A DIRECTOR OF NURSING ABOVE THE PSYCH UNIT?
7 A. YES. THAT WOULD BE KAREN CHAPMAN.
8 Q. WHEN YOU REPORTED, THEN, TO THE NURSING, IS THAT THE
9 ROUTE YOU WOULD GO?
10 A. I WOULD GO THROUGH THE IMMEDIATE SUPERVISOR, WHICH WOULD
11 BE SHEILA HANSEN OR SHEILA MOORE. THEN THEY WOULD REPORT TO
12 KAREN CHAPMAN. OR SOMETIMES, IF WE WERE INCLINED, WE WOULD
13 GO TO KAREN OURSELF IF SHE WAS AVAILABLE.
14 Q. DID YOU LEAVE THE GERO-PSYCH UNIT?
15 A. YES.
16 Q. AND WHEN WAS THAT?
17 A. OCTOBER OF '96.
18 Q. WHY DID YOU --
19 MR. STIRBA: OBJECTION. I'M SORRY. I DIDN'T MEAN
20 TO INTERRUPT.
21 THE COURT: GO AHEAD. ASK YOUR QUESTION.
22 Q. (BY MS. BARLOW) WHY DID YOU GO TO THE GERO-PSYCH UNIT?
23 WHAT CAUSED YOU TO APPLY THERE?
24 A. THE CONDITIONS ON THE GERO-PSYCH UNIT --
25 Q. NOT LEAVING. WHY DID YOU GO TO THE PSYCH UNIT?
1608
1 A. OH, GO TO THE PSYCH UNIT?
2 Q. YES.
3 A. WHILE I WAS DIRECTOR OF NURSING I RECEIVED A BROCHURE
4 INVITING ALL OF THE DIRECTORS TO COME VIEW THE NEW UNIT. AS
5 A DIRECTOR OF NURSING I KNEW THAT THERE WAS A NEED OUT THERE
6 FOR THE GERO-PSYCH PATIENT. THERE WASN'T REALLY A CURRENT
7 PROGRAM IN THE AREA. I HAD EXPERIENCED THAT THE GERIATRIC
8 PATIENT DID HAVE PSYCHOLOGICAL PROBLEMS THAT WEREN'T ABLE TO
9 BE HANDLED PROPERLY IN THE NURSING ENVIRONMENT, SO I WAS
10 PRETTY MATTER EXCITED ABOUT OBTAINING THE EXPERIENCE AND
11 GOING THERE AND HELPING THESE PEOPLE.
12 Q. WHAT SHIFTS DID YOU WORK AT THE GERO-PSYCH UNIT?
13 A. DAY SHIFT OR THREE TO 11.
14 Q. SO DAY WAS SEVEN TO THREE?
15 A. SEVEN TO THREE OR THREE TO 11.
16 Q. HOW MANY DAYS A WEEK DID YOU WORK?
17 A. I WAS -- I STARTED OFF PART TIME FOR A COUPLE OF MONTHS
18 AND THEN EVOLVED TO FULL TIME, 40 HOURS.
19 Q. WHEN DID YOU BECOME FULL TIME?
20 A. UMM, PROBABLY THE SUMMER OF '95.
21 Q. WAS THERE ANY TRAINING, ON-THE-JOB TRAINING, AT THE
22 GERO-PSYCH UNIT?
23 A. YES. THEY HAD DIFFERENT IN-SERVICES. WE HAD A LOT OF
24 LITERATURE AVAILABLE. PRIOR TO THAT, AT ROCKY MOUNTAIN
25 CARE, I TOOK ADVANTAGE OF A LOT OF THE IN-SERVICE GIVEN BY
1609
1 SPECIALTY PEOPLE IN THE GERIATRIC AREA.
2 Q. IF I GO THROUGH THE NAMES OF THE FIVE PATIENTS THAT ARE
3 INVOLVED IN THIS CASE, CAN YOU TELL ME IF YOU REMEMBER THESE
4 PATIENTS BY NAME, EACH ONE?
5 A. YES.
6 Q. ELLEN ANDERSON?
7 A. YES.
8 Q. JUDITH LARSEN?
9 A. YES.
10 Q. MARY CRANE?
11 A. YES.
12 Q. LYDIA SMITH?
13 A. YES.
14 Q. AND ENNIS ALLDREDGE?
15 A. YES.
16 Q. LET'S TALK FIRST ABOUT MRS. ANDERSON. WERE YOU PRESENT
17 WHEN MRS. ANDERSON WAS ADMITTED TO THE UNIT?
18 A. I WAS PRESENT AT THE END OF THE SHIFT. I WAS ON THREE
19 SHIFTS AFTER HER ADMISSION. SO THERE WERE TWO PRIOR R.N.'S.
20 ONE WHO ADMITTED HER; ONE WHO CARED FOR HER THROUGH THE
21 NIGHT; AND THEN I CAME ON.
22 Q. IF YOU WOULD OPEN UP MRS. ANDERSON'S BINDER THERE.
23 A. (WITNESS COMPLIED.)
24 Q. IF YOU WOULD OPEN TO MED-PAGE 178.
25 A. MEDICAL LEGAL?
1610
1 Q. NO. I'M SORRY. UNDER THE NURSE'S NOTES.
2 A. AND WHAT WERE YOU WANTING?
3 Q. 178, THE VERY FIRST PAGE.
4 A. OKAY.
5 Q. CAN YOU TELL FROM THAT DOCUMENT WHO WAS THE FIRST NURSE?
6 A. LAURIE. WILLIAMS WAS HER LAST NAME.
7 Q. IF YOU WOULD TURN OVER TO MED NUMBER 190.
8 A. OKAY.
9 Q. WHEN YOU CAME ONTO THE UNIT, YOU SAY THREE SHIFTS LATER,
10 DID YOU HAVE OCCASION TO GO BACK AND LOOK AT ANY OF THESE
11 PREVIOUS NURSING NOTES?
12 A. IT DEPENDED ON THE TIME OF DAY WHEN YOU ACTUALLY GOT ON
13 SHIFT WHAT TIME YOU WOULD SIT DOWN AND BE ABLE TO PERUSE
14 BACK OVER THE OTHER NOTES. USUALLY YOU RELIED UPON THE
15 NURSE BEFORE YOU TO GIVE YOU A SHIFT REPORT AND SUMMARIZE
16 WHAT HAD GONE ON AND THEN GO FROM THERE.
17 Q. OKAY. DO YOU RECALL EVER GOING BACK AND LOOKING AT 190,
18 WHICH WAS WHAT LAURIE WILLSON HAD WRITTEN?
19 A. I RECALL READING IT, BUT THE TIME FRAME I WOULDN'T BE
20 ABLE TO TELL YOU EXACTLY.
21 Q. THEN THE NEXT PAGE, 191, IT APPEARS TO BE HANDWRITING.
22 IN FACT, I THINK TRACY SCHOLL HAS IDENTIFIED IT AS HER
23 HANDWRITING. THAT IS WHO WAS ON JUST BEFORE YOU?
24 A. YES, IT WAS.
25 Q. DO YOU REMEMBER TALKING TO TRACY ABOUT ELLEN ANDERSON'S
1611
1 CONDITION WHEN YOU CAME ON?
2 A. YES, I DO.
3 Q. DO YOU RECALL WHAT SHE TOLD YOU?
4 MR. STIRBA: I'LL OBJECT. HEARSAY, YOUR HONOR.
5 THE COURT: SUSTAINED.
6 Q. (BY MS. BARLOW) IS WHAT SHE TOLD YOU CONSISTENT --
7 DON'T TELL US WHAT IT IS, BUT CONSISTENT WITH WHAT YOU READ
8 IN 191 ABOUT ELLEN'S CONDITION?
9 A. THAT AND A LITTLE MORE.
10 Q. AND THEN THERE'S SOME HANDWRITING THAT WE GET INTO THAT
11 APPEARS TO BE YOURS, IS THAT CORRECT?
12 A. IT IS.
13 Q. SO ON 191, DOWN AT THE BOTTOM HERE, WHICH IS 0730, SO
14 WHAT SHIFT WERE YOU ON?
15 A. THAT WAS DAY SHIFT THAT DAY.
16 Q. WHAT DID YOU WRITE THEN ABOUT ELLEN'S CONDITION THAT
17 MORNING AT 7:30?
18 A. I'LL READ FROM THE TEXT HERE. "PATIENT RESTING IN BED.
19 VITAL SIGNS 97.9." THAT WOULD BE THE TEMPERATURE.
20 RESPIRATION IS 12. 60, UNABLE TO GET BP.
21 Q. WHAT IS BP?
22 A. BLOOD PRESSURE.
23 Q. OKAY.
24 A. "PATIENT NOT RESPONSIVE TO VERBAL OR TACTILE TOUCH.
25 PATIENT ABLE TO BLINK EYES. FAMILY NOTIFIED IN BRIGHAM CITY
1612
1 OF PATIENT," AND THE ARROW DECLINED. "GOT ANSWERING MACHINE
2 AND LEFT MESSAGE TO CONTACT DAVIS HOSPITAL."
3 Q. OKAY. THEN WE GET INTO THE NEXT PAGE. LET ME PUT THAT
4 HERE WHERE IT CAN BE SEEN. IT'S A CONTINUATION OF WHAT
5 YOU'VE WRITTEN THERE?
6 A. CORRECT.
7 Q. AND WHAT DID YOU WRITE?
8 A. AT 0855 PATIENT WITHOUT RESPIRATIONS. NO HEART RATE
9 TIMES FIVE MINUTES. DR. WEITZEL NOTIFIED. NURSING
10 SUPERVISOR NOTIFIED. AWAITING RETURN CALL FROM ONLY
11 RELATIVE LISTED IN THE CHART WITH PHONE NUMBER.
12 Q. OKAY. LET'S STOP THERE. DO YOU RECALL MS. ANDERSON AND
13 THIS CIRCUMSTANCE THAT YOU'VE CHARTED HERE?
14 A. YES.
15 Q. WHAT DID YOU FIND WITH MS. ANDERSON WHEN YOU ARRIVED?
16 A. UMM, A PATIENT WHO WASN'T VERY RESPONSIVE.
17 Q. OKAY. THE RESPIRATIONS WERE 12, YOU INDICATED?
18 A. YES.
19 Q. BASED ON YOUR EXPERIENCE AND TRAINING AS A NURSE, WHERE
20 DOES THAT FALL IN THE RANGE OF NORMAL, ABNORMAL, THAT SORT
21 OF THING?
22 A. 16 WOULD BE A NORMAL RANGE THAT WE'RE SHOOTING FOR. 12
23 IS JUST WHERE IT STARTS TO GO A LITTLE TOWARDS THE LOW END,
24 WHERE WE DON'T LIKE IT TO GO. !!!
25 Q. OKAY. AND WHAT ARE YOUR CONCERNS AS A NURSE WHEN YOU
1613
1 SEE A 12 BREATHS PER MINUTE?
2 A. THAT PERHAPS SHE'S NOT GETTING ENOUGH OXYGEN.
3 Q. DID YOU KNOW WHAT MEDICATIONS, IF ANY, SHE'D BEEN GIVEN
4 WITHIN THE PREVIOUS EIGHT HOURS?
5 A. TRACY DID TELL ME THAT SHE WAS GIVEN MORPHINE.
6 Q. AND BASED ON YOUR TRAINING AND EXPERIENCE AS A NURSE, DO
7 YOU KNOW, YES OR NO, WHAT MORPHINE DOES TO THE RESPIRATION?
8 A. YES, I DO.
9 Q. AND WHAT DOES IT DO TO THE RESPIRATION SYSTEM?
10 MR. STIRBA: YOUR HONOR, HER UNDERSTANDING IS
11 BEYOND THE SCOPE.
12 MS. BARLOW: BASED ON HER --
13 THE COURT: YOU CAN ASK HER UNDERSTANDING. YOU
14 RAISED THE QUESTION OF WHAT DOES IT DO. YOU CAN ASK HER
15 UNDERSTANDING.
16 Q. (BY MS. BARLOW) WHAT IS YOUR UNDERSTANDING, BASED ON
17 YOUR TRAINING AND EXPERIENCE, OF WHAT MORPHINE DOES TO THE
18 RESPIRATORY SYSTEM?
19 A. ONE OF THE FIRST THINGS WE'RE POINTED OUT IN NURSING
20 SCHOOL IS IF RESPIRATION GOES LOW YOU NEED TO BE CONCERNED
21 BECAUSE MORPHINE DOES SEDATE THEM AND THAT'S THE FIRST SIGN
22 OF RESPIRATORY FAILURE. !!!
23 Q. OKAY. YOU NOTIFIED THE FAMILY. WHY DID YOU DO THAT?
24 A. BECAUSE I FELT AS THOUGH HER CONDITION, BASED ON -- FOR
25 HER TO COME TO THE UNIT SHE HAD TO BE FAIRLY HEALTHY.
1614
1 MR. STIRBA: I'LL OBJECT AND MOVE TO STRIKE THAT
2 LAST AS NOT RESPONSIVE. THE QUESTION IS WHY DID YOU NOTIFY
3 THE FAMILY.
4 MS. BARLOW: I WILL GET INTO THE REST OF IT.
5 THE WITNESS: I FELT THERE WAS A DECLINE IN THE
6 PATIENT'S CONDITION.
7 Q. (BY MS. BARLOW) LET'S BACK UP. WERE YOU FAMILIAR WITH
8 THE CRITERIA FOR PEOPLE TO COME ON THE UNIT?
9 A. YES, I WAS.
10 Q. AND HOW WERE YOU FAMILIAR WITH THAT?
11 A. USUALLY THROUGH GROUP MEETINGS, DISCUSSIONS, SOCIAL
12 WORKER INTAKE, INFORMATION THEY WOULD TRY TO GATHER FROM US
13 AND WE WOULD QUESTION THEM. THE SOCIAL WORKER WAS USUALLY
14 THE PERSON WHO WENT TO THE NURSING HOME AND OBTAINED THE
15 INFORMATION AND COORDINATED THROUGH THE DOCTOR ABOUT
16 ADMISSION.
17 Q. AND BASED ON YOUR -- ON ALL THE INFORMATION THAT CAME TO
18 YOU ABOUT CRITERIA FOR ADMISSION ON THE UNIT, WHAT WAS THE
19 CRITERIA AS FAR AS PHYSICAL CONDITION?
20 MR. STIRBA: I'LL OBJECT. THE BEST EVIDENCE OF
21 THAT IS THE POLICY THAT'S IN EVIDENCE. IF SHE WANTS TO ASK
22 AN UNDERSTANDING, FINE, BUT THE BEST EVIDENCE IS IN
23 EVIDENCE.
24 Q. (BY MS. BARLOW) WHAT IS YOUR UNDERSTANDING OF WHAT THE
25 CRITERIA WAS FOR A PHYSICAL CONDITION TO COME ONTO THE UNIT?
1615
1 A. THEIR PSYCHO-SOCIAL NEEDS HAD TO BE GREATER THAN THEIR
2 MEDICAL NEEDS. Nonsense. Often their very problem was entirely physical.
3 Q. WHEN YOU SAW MRS. ANDERSON AT 7:30 ON THE 30TH OF
4 DECEMBER DID SHE FIT THAT CRITERIA?
5 MR. STIRBA: OBJECTION. IRRELEVANT, YOUR HONOR.
6 THE COURT: SUSTAINED.
7 Q. (BY MS. BARLOW) HOW DID HER PSYCHO-SOCIAL NEEDS
8 COMPARE WITH HER PHYSICAL CONDITION AT THAT TIME?
9 MR. STIRBA: I'LL OBJECT. LACK OF FOUNDATION.
10 THE COURT: LAY A FOUNDATION.
11 Q. (BY MS. BARLOW) WHAT DID YOU SEE OF HER PHYSICAL NEEDS
12 AT 7:30 ON THE MORNING OF THE 30TH?
13 A. HER VITAL SIGNS, WHICH ARE THE FOREMOST THING TO LOOK AT
14 AS A NURSE, WERE DECLINING.
15 Q. WHAT DID YOU SEE OF HER PSYCHO-SOCIAL NEEDS AT THAT
16 POINT?
17 A. THEY TOOK SECOND PLACE TO HER MEDICAL NEEDS.
18 Q. WERE YOU ABLE TO COMMUNICATE WITH HER?
19 A. NO.
20 Q. IN ORDER TO MEET HER PSYCHO-SOCIAL NEEDS, WHAT DID YOU
21 NEED OUT OF HER AS FAR AS RESPONSIVENESS?
22 MR. STIRBA: I'M GOING TO OBJECT. IRRELEVANT.
23 THE COURT: WHAT DO YOU CLAIM THE RELEVANCY IS?
24 MS. BARLOW: I THINK IT LAYS THE FOUNDATION FOR THE
25 QUESTION I ASKED EARLIER ABOUT WHETHER SHE MET THE CRITERIA.
1616
1 THE COURT: SUSTAINED.
2 Q. (BY MS. BARLOW) AT 8:55 YOU MADE THIS NOTATION. WOULD
3 YOU READ THAT, PLEASE.
4 A. 8:55. "PATIENT WITHOUT RESPIRATIONS. NO HEART RATE
5 TIMES FIVE MINUTES. DR. WEITZEL NOTIFIED. NURSING
6 SUPERVISOR NOTIFIED. AWAITING RETURN CALL FROM ONLY
7 RELATIVE LISTED IN CHART WITH PHONE NUMBER."
8 Q. NO RESPIRATIONS, NO HEART RATE FOR FIVE MINUTES. WHAT
9 DID THAT MEAN?
10 A. TO MY INTERPRETATION, DEATH.
11 Q. DEATH?
12 A. DEATH.
13 Q. I'M SORRY. SOMETIMES I GET OVER BY THIS MACHINE AND I
14 CAN'T HEAR VERY WELL.
15 A YES OR NO QUESTION. DID YOU EVER TALK TO DR. WEITZEL
16 ABOUT WHAT HAD HAPPENED TO ELLEN ANDERSON?
17 A. NO.
18 Q. THANK YOU. NOW LET'S LOOK AT JUDITH LARSEN. IF YOU
19 WOULD PULL HER BINDER OUT.
20 A. (WITNESS COMPLIED.)
21 Q. DO YOU RECALL JUDITH LARSEN?
22 A. YES, I DO.
23 Q. AND WHY IS IT THAT YOU RECALL HER?
24 A. SHE WAS THERE A PRETTY LONG TIME.
25 Q. DID YOU HAVE AN UNDERSTANDING OF WHAT WAS THE INTENDED
1617
1 LENGTH OF STAY OF ANY OF THESE FIVE PEOPLE IN THE UNIT, YES
2 OR NO?
3 A. YES.
4 Q. AND WHAT WAS YOUR UNDERSTANDING BASED ON?
5 A. USUALLY, AFTER THE DOCTOR'S INITIAL EVALUATION, IT WOULD
6 BE CONVEYED TO US THROUGH THE NURSING STAFF WHAT THE LENGTH
7 OF TIME WAS. WE COULD READ HIS EVALUATION AND SEE WHAT HE
8 ANTICIPATED THE LENGTH OF TIME TO BE.
9 Q. AND IS THAT EVALUATION THE ONE THAT'S LISTED UNDER PSYCH
10 EVALUATION, 444 AND 445?
11 A. YES.
12 Q. AND LET'S PULL OUT 446. WHO WROTE THIS EVALUATION?
13 A. I ASSUME DR. WEITZEL.
14 Q. DOES IT HAVE HIS NAME AT THE TOP?
15 A. AT THE END OF IT AND AT THE TOP.
16 Q. AND WHAT WAS THE ESTIMATED LENGTH OF HOSPITALIZATION?
17 A. HE GAVE NO TYPE OF THING, BUT JUST BACK TO HOLLADAY.
18 Q. LET'S LOOK AT 446.
19 A. OH, TWO WEEKS. I'M SORRY.
20 Q. AND THERE WAS A DISCHARGE PLAN?
21 A. CORRECT.
22 Q. AND WHAT IS A DISCHARGE PLAN?
23 A. WHAT THE INTENTIONS ARE ONCE THE PATIENT IS DISMISSED
24 FROM THE HOSPITAL.
25 Q. IF YOU WOULD TURN TO PAGE 451.
1618
1 A. (WITNESS COMPLIED.)
2 Q. THIS IS, AGAIN, REGARDING JUDITH LARSEN. WHAT DATE WAS
3 THAT?
4 A. 12/6/95.
5 Q. IS THAT THE DATE THAT MRS. LARSEN CAME IN?
6 A. THAT WOULD BE.
7 Q. THERE'S A V.O. HERE. WHAT DOES THAT MEAN?
8 A. VERBAL ORDER.
9 Q. DR. WEITZEL TO LYNN LONG?
10 A. YES.
11 Q. DO YOU KNOW WHO LYNN LONG IS?
12 A. YES, I DO.
13 Q. WHO IS SHE?
14 A. SHE WAS ANOTHER REGISTERED NURSE ON THE GERO-PSYCH UNIT
15 AT THAT TIME.
16 Q. THERE ARE SEVERAL MEDICATIONS LISTED FURTHER DOWN HERE.
17 LET'S LOOK RIGHT HERE UNDER MEDS. IT SAYS TYLENOL AND THEN
18 IT HAS TWO FUNNY SYMBOLS. IT LOOKS LIKE A T WITH A DOT OVER
19 IT AND THEN TWO T'S WITH TWO DOTS OVER IT. DO YOU SEE WHERE
20 I'M LOOKING AT, ABOUT A THIRD OF THE WAY DOWN UNDER VS:BID?
21 A. OH, UP HERE. TYLENOL, ONE OR TWO TABS.
22 Q. IS THAT WHAT THOSE SYMBOLS MEAN?
23 A. YES.
24 Q. ONE OR TWO TABS. WHAT IS P.R.N.?
25 A. AS NEEDED, AS NECESSARY.
1619
1 Q. AND THEN WE HAVE MYLANTA FOR DYSPEPSIA. WHAT IS
2 DYSPEPSIA?
3 A. STOMACH UPSET.
4 Q. WHAT IS M.O.M.?
5 A. MILK OF MAGNESIA.
6 Q. I GUESS THAT'S FOR P.R.N., IF THEY HAVE -- I MEAN, IF A
7 PERSON HAD CONSTIPATION YOU COULDN'T JUST GIVE THEM MILK OF
8 MAGNESIA?
9 A. WE COULD.
10 Q. WITHOUT AN ORDER?
11 A. WITHOUT AN ORDER, NO. WE HAD TO HAVE A P.R.N. ORDER.
12 Q. OKAY. AND YOU HAVE SPECIAL PRECAUTIONS, EVERY 15 MINUTE
13 CHECK. DO YOU KNOW WHAT THAT IS?
14 A. YES. USUALLY ON A PSYCH UNIT YOU'LL HAVE, FOR THE FIRST
15 24 HOURS, A SUICIDAL TYPE WATCH, WHERE YOU WATCH THEM EVERY
16 15 MINUTES FOR THE FIRST 24, BECAUSE IT'S A CRUCIAL TIME
17 PERIOD.
18 Q. DO YOU KNOW WHAT BETAGAN IS, YES OR NO?
19 A. YES.
20 Q. WHAT IS IT?
21 A. EYE DROPS FOR GLAUCOMA.
22 Q. WHAT ABOUT SURFAK?
23 A. IT'S A STOOL SOFTENER.
24 Q. AND THEN KLONOPIN, DO YOU KNOW WHAT THAT IS?
25 A. KLONOPIN CAN BE USED IN TWO WAYS. AS AN ANTI-CONVULSIVE
1620
1 AND ALSO THEY USE IT FOR PSYCHOSIS SOMETIMES. Where?
2 Q. AND THEN TRAZODONE, DO YOU KNOW WHAT THAT IS?
3 A. TRAZODONE CAN BE USED -- FOR THE GERIATRIC POPULATION
4 THEY USE IT A LOT OF TIMES FOR A SLEEPER AND ALSO AN
5 ANTIDEPRESSANT.
6 Q. WHAT ABOUT SYNTHROID, DO YOU KNOW WHAT THAT IS?
7 A. A THYROID MEDICATION.
8 Q. AND THEN BABY A.S.A.?
9 A. BABY ASPIRIN IS USUALLY USED AS A PROPHYLACTIC TO
10 PREVENT CARDIOVASCULAR -- KEEP THE BLOOD A LITTLE THIN FOR
11 HEART PROBLEMS, THINGS LIKE THAT.
12 Q. ISOSORBIDE?
13 A. THAT WOULD BE USED FOR HIGH BLOOD PRESSURE.
14 Q. AND THEN WE HAVE ATIVAN AND THAT'S ONE OR TWO
15 MILLIGRAMS?
16 A. YES.
17 Q. AND WHAT IS ATIVAN?
18 A. IN THIS CASE IT'S USED FOR AGITATION. IT'S MORE OF --
19 IT'S ANOTHER FORM OF A HYPNOTIC TYPE OF DRUG, SEDATION.
20 Q. AND THEN WE HAVE ANOTHER TRAZODONE. HOW DOES THAT
21 RELATE TO THE EARLIER TRAZODONE?
22 A. IF THE SCHEDULED TRAZODONE GIVEN IN THE EVENING DOESN'T
23 HELP THEM -- THIS IS FOR INSOMNIA, MEANING IF THEY CAN'T
24 SLEEP YOU'RE ALLOWED TO GIVE ONE MORE DOSE AFTER THE EVENING
25 DOSE IS GIVEN.
1621
1 Q. AND THEN ZANTAC, DO YOU KNOW WHAT THAT IS?
2 A. ZANTAC IS FOR STOMACH -- IT'S AN H-2 BLOCKER WHICH
3 DECREASES ACID IN THE STOMACH.
4 Q. AND THEN D.N.R. IS WRITTEN OUT TO THE SIDE. DO YOU KNOW
5 WHAT THAT IS?
6 A. DO NOT RESUSCITATE.
7 Q. AND WHAT DOES IT MEAN TO NOT RESUSCITATE?
8 A. UMM, USUALLY PATIENTS HAVE A FORM, THE MAJORITY OF THE
9 TIME, THAT THEY FILL OUT. IN CASE THEY'RE TERMINALLY ILL
10 THEY DON'T WANT CERTAIN PROCEDURES DONE TO THEM TO PROLONG
11 THEIR LIFE.
12 Q. NOW, THAT WAS THE 6TH OF DECEMBER. WOULD YOU TURN OVER
13 TO 456.
14 A. (WITNESS COMPLIED.)
15 Q. DO YOU RECOGNIZE WHAT THAT IS?
16 A. WHICH ONE?
17 Q. WHAT THAT DOCUMENT IS?
18 A. ON 456, YES.
19 Q. WHAT IS THE DOCUMENT ITSELF, THE WHOLE DOCUMENT?
20 A. IT'S A PHYSICIAN'S ORDER SHEET.
21 Q. UP AT THE TOP WE HAVE THE DATE, WHICH IS WHAT?
22 A. 12/13/95.
23 Q. AND THEN IT SAYS, AND READ THAT FOR US?
24 A. M.S., 15 MILLIGRAMS; I.M., Q FOUR HOURS, P.R.N., SEVERE
25 PAIN OR AGITATION.
1622
1 Q. SO THAT IS P.R.N., IS THAT CORRECT?
2 A. CORRECT.
3 Q. THIS MIGHT GET A LITTLE CONFUSING. WE'VE GOT TO TURN
4 NOW TO THE MEDICAL RECORDS FOR AFTER THE 13TH OF DECEMBER.
5 HAVE YOU HAD OCCASION TO LOOK AT THE MEDICINE ADMINISTRATION
6 RECORDS IN THIS CASE?
7 A. OKAY.
8 Q. DO YOU RECALL LOOKING AT THOSE PREVIOUSLY?
9 A. YES.
10 Q. LET'S LOOK THROUGH UNTIL WE GET TO THE FIRST TIME THAT
11 WE SEE THE ACTUAL ADMINISTRATION OF MORPHINE. WELL, LET'S
12 LOOK AT 497 FIRST.
13 A. 497?
14 Q. YES.
15 A. OKAY.
16 Q. WHEN WAS MORPHINE ADMINISTERED UNDER THAT ORDER? WELL,
17 I SHOULDN'T SAY UNDER THIS ORDER, ON THIS PAGE?
18 A. ON THIS PAGE?
19 Q. YES.
20 A. IT WAS ADMINISTERED ON 12/30.
21 Q. OKAY.
22 A. AT 2:30 IN THE AFTERNOON, 6:30 IN THE EVENING, AND 10:30
23 AT NIGHT.
24 Q. LET ME PUT THAT ON HERE. NOW, THERE ARE LINES DRAWN
25 ACROSS HERE. DOES THAT INDICATE THAT IT WAS GIVEN OR NOT
1623
1 GIVEN?
2 A. YOU MEAN THE DARKENED AREA THAT GOES ACROSS?
3 Q. YES.
4 A. THAT MEANS IT WAS GIVEN -- WHAT WE DO IS WHEN THE ORDER
5 IS CHANGED WE HAVE TO YELLOW OUT THAT ENTRY AND THEN REWRITE
6 IT IN ANOTHER AREA. SO THAT WOULD JUST BE THE YELLOW MARKER
7 THAT'S REFLECTING ON THERE.
8 Q. LET'S LOOK THROUGH -- TURN TO 507.
9 A. (WITNESS COMPLIED.)
10 Q. DOES THAT RECORD SHOW ANY ADMINISTRATION OF MORPHINE?
11 A. YES, IT DOES.
12 Q. AND ON THIS RECORD WHAT WAS THE FIRST DAY THAT MORPHINE
13 WAS ADMINISTERED?
14 A. ON 1/1/95.
15 Q. AND THAT WAS DONE AT 1830?
16 A. YES.
17 Q. IF YOU WILL LOOK NOW AT 509. WAS MORPHINE ADMINISTERED
18 AND RECORDED ON THAT RECORD?
19 A. YES, IT WAS.
20 Q. AND WHAT DATE?
21 A. 1/3 AT 1830.
22 Q. THE NEXT PAGE IS 510. DOES THAT RECORD SHOW THE
23 ADMINISTRATION OF MORPHINE?
24 A. YES, IT DOES.
25 Q. WHAT DATES?
1624
1 A. UMM --
2 Q. LET'S START WITH THIS ONE RIGHT UP HERE.
3 A. ON 1/1 AT 2245. AT 1/2 AT 1630. AND THEN --
4 Q. THESE ARE THE REGULARLY SCHEDULED ONES?
5 A. NO. THESE WERE P.R.N., AS NEEDED.
6 Q. OKAY. THEN DOWN HERE UNDERNEATH THERE ARE SOME MORE.
7 A. THOSE WERE "NOW" ORDERS, WHICH MEANS IT WAS GIVEN
8 ADDITIONALLY.
9 Q. AND WHAT DATES WERE THOSE GIVEN?
10 A. 12/31 AT 1930; 1/1 AT 1730; 1/1 AT 2330; 1/3 AT TEN
11 O'CLOCK; 1/3 AT ELEVEN O'CLOCK; 1/3 AT 1445.
12 Q. AND THEN FINALLY THE NEXT PAGE, 511.
13 A. MORPHINE ALSO?
14 Q. IT LOOKS LIKE TYLENOL; BUT DOWN AT THE BOTTOM DO YOU SEE
15 MORPHINE BEING ADMINISTERED?
16 A. YES. MORPHINE ON 12/25 AT 0730. 12/25 AT 0930. 12/25
17 AT -- I CAN'T REALLY MAKE THAT OUT. 1-1-3.
18 Q. THESE DON'T COME OUT VERY WELL. IT LOOKS LIKE MAYBE
19 11:30.
20 A. THEN ON 12/26 AT 0810.
21 Q. LET'S LOOK BACK, THEN. THERE HAD BEEN THE ORDER THAT
22 YOU POINTED OUT ON THE 13TH. DOES IT APPEAR THAT ANY
23 MORPHINE WAS EVER GIVEN ON THE 13TH?
24 A. NOT ON THE 13TH. THE 13TH OF DECEMBER?
25 Q. YES.
1625
1 A. NO.
2 Q. WOULD YOU LOOK FOR THE 14TH, 15TH, 16TH, 17TH AND 18TH
3 WHILE YOU'RE GOING THROUGH THERE?
4 A. (PAUSE.) NO, IT WAS NOT.
5 Q. WOULD YOU TURN TO 458.
6 A. (WITNESS COMPLIED.)
7 Q. DO YOU SEE THIS BOTTOM NOTATION?
8 A. YES.
9 Q. WHAT DOES IT SAY?
10 A. D.C., M.S., P.R.N. THANKS, R. WEITZEL, M.D.
11 Q. WHAT DATE WAS THAT?
12 A. 12/19.
13 Q. WHAT DOES D.C. MEAN?
14 A. DISCONTINUE.
15 Q. AND THAT IS NOTED BY WHOM?
16 A. BY ME.
17 Q. WHAT TIME?
18 A. AT 2300. ELEVEN P.M. AT NIGHT ON THE 19TH.
19 Q. DO YOU HAVE ANY RECOLLECTION, OTHER THAN THESE NOTES,
20 ABOUT THAT DISCONTINUATION OF THE MORPHINE ON THE 19TH OF
21 DECEMBER?
22 A. YES, I DO.
23 Q. WHAT'S THAT RECOLLECTION BASED ON?
24 A. MY INTERACTION WITH DR. WEITZEL.
25 Q. WERE YOU AWARE, FROM THE 13TH TO THE 19TH, THAT MORPHINE
1626
1 HAD BEEN ORDERED?
2 A. YES, I WAS.
3 Q. ARE YOU AWARE WHETHER IT WAS EVER ADMINISTERED?
4 A. I WAS AWARE IT WAS NOT ADMINISTERED.
5 Q. DID YOU BRING THAT TO ANYONE'S ATTENTION?
6 A. YES.
7 Q. AND TO WHOM'S ATTENTION?
8 A. DR. WEITZEL'S.
9 Q. AND WHAT DAY WAS IT THAT YOU BROUGHT THAT TO HIS
10 ATTENTION?
11 A. ON THE 19TH.
12 Q. WHERE WERE YOU WHEN YOU TALKED TO HIM?
13 A. THE GERO-PSYCH UNIT, NURSING STATION.
14 Q. WAS ANYONE ELSE PRESENT?
15 A. I DON'T RECALL.
16 Q. WHAT DID YOU SAY TO DR. WEITZEL ON THE 19TH?
17 A. USUALLY IN THE EVENING HOURS, WHEN I HAVE A SLOW TIME,
18 I'LL GO THROUGH THE PATIENTS' RECORDS AND THEIR MEDICATIONS
19 AND LOOK THEM UP IN THE GERATOLOGY BOOK, LOOK AT THEIR
20 DOSES, JUST TO REVIEW. I NOTICED THAT THE MEDICATIONS THAT
21 SHE WAS CURRENTLY ON WERE A LITTLE -- WERE ABOVE THE LEVELS
22 THAT THE GERATOLOGY BOOK RECOMMENDED AND --
23 MR. STIRBA: YOUR HONOR, I'M GOING TO OBJECT.
24 THE COURT: THE QUESTION WAS WHAT DID YOU SAY TO
25 DR. WEITZEL.
1627
1 THE WITNESS: I EXPRESSED MY CONCERNS THAT MORPHINE
2 WOULD ENHANCE THE EFFECTS OF THESE OTHER ANTI-PSYCHOTROPICS
3 THAT SHE WAS CURRENTLY ON AND SHE WASN'T USING THE MORPHINE.
4 I DIDN'T THINK IT WOULD BE WISE TO KEEP IT ON THE M.A.R.,
5 SINCE IF IT WAS USED IT COULD MAKE --
6 MR. STIRBA: I'M GOING TO OBJECT AGAIN. I DON'T
7 THINK WE'RE IN A CONVERSATION. I THINK SHE'S EXPLAINING HER
8 STATEMENT TO DR. WEITZEL.
9 THE COURT: PHRASE THE QUESTION AS WHAT DID HE SAY,
10 WHAT DID I SAY.
11 MS. BARLOW: I WILL DO THAT.
12 THE COURT: AND THEN ANSWER THE QUESTION ABOUT WHAT
13 WAS SAID, NOT WHAT WAS THOUGHT.
14 Q. (BY MS. BARLOW) SO YOU SAID TO DR. WEITZEL -- WHAT
15 EXACTLY DID YOU SAY TO DR. WEITZEL? JUST LIMIT IT TO WHAT
16 YOU SAID.
17 A. I SAID THAT I'M CONCERNED ABOUT THE MORPHINE BEING ON
18 THE SHEET WITH THE PSYCHOTROPIC MEDICATIONS.
19 Q. AND WHAT DID HE SAY?
20 A. HE JUST KIND OF BENT HIS HEAD DOWN AND LOOKED OVER HIS
21 GLASSES AND STARED AT ME.
22 Q. DID HE SAY ANYTHING?
23 A. WELL, I CONTINUED TO EXPRESS MY CONCERNS, SAYING I HAD
24 LOOKED IT UP. HE SAID, I'M THE DOCTOR, I PRESCRIBE. YOU'RE
25 THE NURSE. THEN WHEN HE LEFT HE WROTE IN THE BOOK AND THEN
1628
1 JUST PUSHED IT AT ME AND SAID THERE. THAT WAS THE END OF
2 THE CONVERSATION.
3 Q. AND WAS THAT THE D.C. NOTE?
4 A. YES.
5 Q. WHAT WAS BEHIND YOUR CONCERN?
6 MR. STIRBA: I'M GOING TO OBJECT AS TO RELEVANCE.
7 THE COURT: CAN YOU MOVE ON TO SOMETHING ELSE AND
8 WE'LL DISCUSS THAT AT THE BREAK?
9 MS. BARLOW: I'LL DO THAT.
10 Q. (BY MS. BARLOW) DID YOU OBSERVE MRS. LARSEN DURING
11 THIS TIME?
12 A. YES.
13 Q. I MEAN, THE 13TH THROUGH THE 19TH?
14 A. YES.
15 Q. DO YOU RECALL WHAT HER MENTAL CONDITION WAS AT THAT
16 TIME?
17 A. SHE WOULD HAVE MOMENTS OF AGITATION, BUT AT THE SAME
18 TIME SHE'D BE CLEAR WHERE SHE WOULD MAKE A BREAK THROUGH AND
19 CONNECT AND DO THINGS APPROPRIATELY. SO SHE WAS MAKING SOME
20 HEADWAY IN THAT ASPECT. SHE WAS ATTENDING GROUP AND THAT
21 WAS A VERY IMPORTANT PART OF BEING ON THE UNIT, WAS BEING
22 ABLE TO ATTEND THE GROUPS.
23 Q. IF YOU WOULD TURN TO 546.
24 A. (WITNESS COMPLIED.)
25 Q. IS YOUR HANDWRITING ON THAT DOCUMENT?
1629
1 A. 546. I'M SORRY. (PAUSE.) YES, IT IS.
2 Q. WHAT DATE WAS THAT?
3 A. THAT WAS ON 12/16.
4 Q. AND WHAT TIME ARE WE TALKING ABOUT?
5 A. AT THREE O'CLOCK IN THE AFTERNOON.
6 Q. AND WHAT DID YOU WRITE?
7 A. THIS IS A CONTINUATION, IT LOOKS LIKE, OF ANOTHER PAGE,
8 BECAUSE I HAVE C.O.N.T. BEFORE THAT FAMILY STATES.
9 THE COURT: DO YOU WANT THE OTHER PAGE?
10 Q. (BY MS. BARLOW) LET'S START WITH 545, WHICH IT LOOKS
11 LIKE IS THE 15TH. WE'VE HAD PEOPLE TELL US WHAT B.I.R.P.
12 MEANS, BUT WHAT WAS THE BEHAVIOR YOU OBSERVED ON THE 15TH?
13 A. THE 15TH?
14 Q. THE DAY BEFORE, ON 545. YOU KNOW, I THINK -- LET ME
15 LOOK.
16 MR. STIRBA: IT'S NOT HER NOTE.
17 THE COURT: I THOUGHT SHE SAID THERE WAS A
18 CONTINUATION. WAS IT CONTINUED FROM ANOTHER --
19 THE WITNESS: IT LOOKS LIKE PAGE 548 IS WHERE I
20 INITIALLY STARTED.
21 MS. BARLOW: SO WHAT WE HAVE ARE SOME THINGS OUT OF
22 ORDER. YES, IT IS. 548 IS THE ONE WE WANT TO LOOK AT.
23 THANK YOU.
24 Q. (BY MS. BARLOW) 548, WHAT DATE IS THAT?
25 A. 12/16.
1630
1 Q. IT LOOKS LIKE 1500?
2 A. YES. USUALLY, WHEN WE PUT 1500, WE DO A SHIFT EVAL AT
3 THE END OF THE SHIFT.
4 Q. AND THAT'S THREE P.M.?
5 A. CORRECT.
6 Q. WHAT DID YOU WRITE AS AN EVALUATION OF THE SHIFT THAT
7 DAY?
8 A. BEHAVIOR, THAT'S THE B CIRCLED. "PATIENT BECAME
9 AGITATED TIMES ONE DURING SHIFT. PATIENT WAS LETHARGIC AT
10 START OF SHIFT. INCREASED ALERTNESS AS SHIFT PROGRESSED.
11 PATIENT SAT THROUGH ENTIRE MOVIE AND EXPRESSED EMOTIONAL
12 APPROPRIATENESS AT TIMES. PATIENT FED SELF LUNCH. PATIENT
13 INCREASED AGITATION AFTER LUNCH, WANTING TO LEAVE THIS
14 PLACE. ATTEMPTING TO AMBULATE ON OWN. STAFF ASSISTED
15 PATIENT TO FEET AND AMBULATED PATIENT WITH TWO PERSON
16 ASSIST."
17 Q. WHAT DOES AMBULATE WITH TWO PERSON ASSIST MEAN?
18 A. THAT MEANS TWO PEOPLE HELPED HER WALK TO MAKE SURE SHE
19 WAS STEADY AND SAFE. "PATIENT MADE STATEMENTS I GO FROM ONE
20 PLACE TO ANOTHER. I CAN GO WHERE I WAS YESTERDAY. FAMILY
21 IN TO VISIT. FAMILY STATES PATIENT IS MUCH IMPROVED FROM
22 LAST WEEK AND HOPES THIS PROGRESS WILL CONTINUE."
23 INTERVENTION IS WHAT THE I STANDS FOR. "GAVE P.R.N.
24 MEDICATIONS." THAT'S THE AS NECESSARY MEDICATIONS.
25 "PROVIDED ASSISTANCE WITH AMBULATION. ONE ON ONE TO ALLOW
1631
1 PATIENT TO VERBALIZE FRUSTRATION."
2 R WOULD BE THE RESPONSE OF THE PATIENT. "PATIENT
3 VOCALIZED A LOT, BUT UNSENSICAL RAMBLING AT TIMES. PATIENT
4 NEEDED ONE ON ONE TO REMAIN SEATED AND SAFE. PLAN, CONTINUE
5 TO PROVIDE SAFE ENVIRONMENT AND MONITOR BEHAVIOR."
6 Q. DID YOU NOTE ANY INDICATIONS OF PAIN?
7 A. NO, I DID NOT.
8 Q. LET'S TURN NOW TO 460.
9 A. (WITNESS COMPLIED.)
10 Q. DO YOU GET CONFUSED GOING BACK AND FORTH BETWEEN ALL OF
11 THESE RECORDS IN THE CHART? OKAY. ON 460 -- BETWEEN THE
12 19TH AND THE DATE ON THIS, WHICH IS THE 25TH, DO YOU KNOW
13 WHETHER MRS. LARSEN RECEIVED ANY MORPHINE AFTER THE D.C.?
14 A. NO, SHE DID NOT.
15 Q. NOW WE HAVE THE 25TH OF DECEMBER. THIS IS NUMBER 460.
16 WHAT WAS THE ORDER ON THE 25TH OF DECEMBER?
17 A. 12/25/95 AT 0930. T.O., MEANING A TELEPHONE ORDER. DR.
18 WEITZEL TO LYNN LONG. M.S., TWO MILLIGRAMS; I.M. NOW.
19 Q. OKAY. THAT'S DOWN AT THE BOTTOM ONE. I'M SORRY.
20 A. THE NEXT ONE ON 12/25. ABOVE THAT IS M.S., TWO
21 MILLIGRAMS; I.M. NOW. THAT WAS 0150 ON THE 25TH.
22 Q. AND YOU JUST READ THE TWO MILLIGRAMS, I.M. NOW AT 9:30?
23 A. I MEAN 7:30. THE 0150 WAS FROM TRACY. SO THE FIRST
24 I.M. WAS AT 0730. THE SECOND ONE WAS AT 0930.
25 Q. LET'S LOOK BACK AT THE NURSING NOTES FOR THE 25TH OF
1632
1 DECEMBER. IN FACT, LET'S LOOK AT THE 24TH FIRST, WHICH IS
2 564. IS YOUR HANDWRITING THERE IN THE NARRATIVE PART?
3 A. YES, IT IS, UP ON THE TOP.
4 Q. THE 2030?
5 A. AT 2030, CORRECT.
6 Q. WHAT SHIFT WOULD YOU HAVE BEEN ON?
7 A. THE THREE TO ELEVEN SHIFT.
8 Q. AFTER THAT, AT 2245, THIS IS NOT YOUR WRITING, BUT WHAT
9 WAS WRITTEN FOR BEHAVIOR? WOULD THAT BE FOR THE WHOLE
10 SHIFT?
11 A. THAT WOULD BE FOR THE THREE TO ELEVEN SHIFT, CORRECT.
12 Q. OKAY. SO THE SHIFT YOU WERE ON?
13 A. CORRECT.
14 Q. ALTHOUGH YOU DIDN'T WRITE IT?
15 A. CORRECT.
16 Q. WHO DID WRITE IT?
17 A. IT WOULD BE LYNNETTE, I BELIEVE HER NAME WAS. SHE WAS A
18 C.N.A. WE WOULD DIVIDE UP THE CHARTS. C.N.A.'S WOULD CHART
19 ON SOME PEOPLE AND THE R.N.'S ON THE OTHER. IT WOULD
20 USUALLY BE FIVE AND FIVE.
21 Q. DID YOU TALK BETWEEN YOURSELVES ABOUT WHAT TO CHART?
22 A. NOT WHAT TO CHART, BUT WE WOULD DISCUSS THE PATIENT'S
23 BEHAVIOR THROUGH THE SHIFT AND THEN THEY WOULD GO AHEAD AND
24 DERIVE ON THEIR OWN HOW THEY WERE GOING TO NARRATE IT.
25 Q. AND LET'S LOOK AT JUST THE BEHAVIOR PART OF HOW MRS.
1633
1 LARSEN HAD BEEN DURING THAT SHIFT?
2 A. "PATIENT WAS VERY SLEEPY. SHE DIDN'T PARTICIPATE IN
3 ACTIVITY BECAUSE SHE WAS TIRED. PATIENT SHOWED NO SIGNS OF
4 AGITATION."
5 Q. NOW LET'S GO TO THE NEXT ONE, WHICH IS 565, WHICH IS THE
6 25TH OF DECEMBER. WERE YOU ON SHIFT ON THIS ONE AT ALL?
7 A. ON THE 25TH, I BELIEVE I WAS ON SHIFT ON THREE TO ELEVEN
8 THAT DAY.
9 Q. SO THIS THAT WAS SEVEN TO 1300 WAS NOT WHILE YOU WERE ON
10 SHIFT?
11 A. NO, IT WASN'T.
12 Q. WOULD YOU STILL READ THE BEHAVIOR?
13 A. "PATIENT BECAME INCREASED ALERTNESS AS SHIFT PROGRESSED,
14 BUT MADE NO VERBALIZATIONS, ALTHOUGH SHE WOULD TURN HER HEAD
15 TO LEFT OR RIGHT WHEN ASKED."
16 Q. AND THEN DOWN HERE IT SAYS MEDICAL, OR MED NOTE. WOULD
17 YOU READ THAT.
18 A. "WAS MEDICATED WITH M.S., TWO MILLIGRAMS, I.M. AT 0730,
19 0930 AND 1130, WITH PATIENT'S LEVEL OF ALERTNESS INCREASING
20 THROUGHOUT THE MORNING AND CONTINUING THROUGHOUT THE SHIFT."
21 Q. OKAY. DO YOU SEE ANYTHING IN THAT CHART INDICATING THAT
22 THERE WAS ANY PAIN?
23 A. NO, I DO NOT. See note>>
24 Q. AND THE DAY BEFORE, WHEN YOU SAW HER ON THE 24TH, DID
25 YOU NOTE ANY INDICATIONS OF PAIN?
1634
1 A. NO, I DID NOT.
2 Q. NOW LET'S GO TO 566. WHAT DATE IS THIS?
3 A. THIS IS DECEMBER 25TH.
4 Q. AND WHOSE HANDWRITING IS THAT?
5 A. MINE.
6 Q. AND WHAT WAS THE BEHAVIOR THAT YOU NOTED?
7 A. "PATIENT HAD NO AGITATED BEHAVIOR. PATIENT DID NOT
8 COMMUNICATE VERBALLY. PATIENT BECAME VERY TEARFUL DURING
9 WRAP-UP GROUP. WHEN STAFF HELD PATIENT'S HAND PATIENT
10 REFUSED TO EAT DINNER. TOOK TOWEL OFF LAP AND PLACED IT
11 OVER TRAY AND PUSHED TRAY AWAY. PATIENT WOULD NOT ALLOW
12 STAFF TO FEED HER, WHICH SHE COMMUNICATED BY CLENCHING HER
13 TEETH. PATIENT SPIT P.O. MEDICATIONS," BY MOUTH
14 MEDICATIONS, "OUT, WHICH WERE CRUSHED AND PLACED IN
15 APPLESAUCE."
16 Q. DOES THAT MEAN IT WOULD HAVE BEEN GIVEN WHEN SHE SPIT IT
17 OUT?
18 A. SPIT OUT MEDICATION. NO. SHE SPIT THEM OUT.
19 Q. THEN I WONDERED ABOUT THE CRUSHED?
20 A. THEY WERE CRUSHED AND SHE SPIT THEM OUT.
21 Q. OKAY.
22 A. "PATIENT PLACED IN BED WITH TWO SIDE RAILS AND BED
23 MONITOR IN PLACE. PATIENT RIGID, KEEPING EYES OPEN. COLD
24 ICE APPLIED TO EXTREMITIES AND FOREHEAD. PATIENT RESPONDED
25 WITH DECREASED FACIAL TIGHTNESS AND MOVEMENT OF EYES.
1635
1 PATIENT REFUSED WATER."
2 Q. WOULD YOU EXPLAIN TO US -- SO SHE'S RIGID AND YOU PUT
3 COLD ICE ON EXTREMITIES AND ON THE FOREHEAD. WHY DID YOU DO
4 THAT?
5 A. TO TRY AND RELAX HER. SOMETIMES THEY GET A LITTLE
6 DIAPHORETIC.
7 Q. WHAT IS DIAPHORETIC?
8 A. THEY GET A LITTLE PERSPIRATION ON THEM. AND USUALLY
9 SHE'S JUST A LITTLE TENSE AND WE'LL TRIAL TO RELAX HER,
10 SOOTHE HER WITH OTHER THINGS THAN MEDICATION. WE'LL TRY THE
11 LEAST DRASTIC APPROACH, I GUESS, TO CALM HER DOWN.
12 Q. DID THAT WORK HERE?
13 A. YES, IT DID.
14 Q. DID YOU NOTE ANY SYMPTOMS OF PAIN IN THAT CHART?
15 A. NO, I DID NOT.
16 Q. WHAT ABOUT THE RIGIDITY?
17 A. THAT CAN BE HER WAY OF REFUSING THINGS. I MEAN, YOU
18 JUST WATCH THEIR BEHAVIOR, YOU TRY THE LEAST --
19 MR. STIRBA: YOUR HONOR, I'M GOING TO OBJECT. I
20 DON'T THINK THIS IS RESPONSIVE.
21 THE COURT: WHY DON'T YOU JUST ASK THE QUESTION
22 AGAIN.
23 MS. BARLOW: I ASKED WHAT ABOUT THE RIGIDITY.
24 THE COURT: MAYBE THAT'S A KIND OF VAGUE QUESTION.
25 CAN YOU CLARIFY IT?
1636
1 Q. (BY MS. BARLOW) COULD THE RIGIDITY BE A SIGN OF PAIN?
2 A. IT DEPENDS ON THE INTERPRETER, HOW THEY INTERPRET IT.
3 Q. AND DID YOU INTERPRET THAT RIGIDITY AS PAIN?
4 A. NO, I DID NOT.
5 Q. DID YOU GIVE ANY PAIN MEDICATION FOR THE RIGIDITY?
6 A. NO, I DID NOT.
7 Q. DID THE RIGIDITY RESOLVE?
8 A. IT SUBSIDED, YES.
9 Q. WERE YOU PRESENT WHEN JUDITH LARSEN HAD A SEIZURE?
10 A. THE SEIZURE, SHE WAS GIVEN DILANTIN FOR THAT ONE.
11 Q. ON THE 26TH OF DECEMBER, WHICH IS NUMBER 568, DID YOU
12 CHART THAT DAY?
13 A. YES, I DID.
14 Q. AGAIN, THIS IS THE B.I.R.P. WHEN WAS THAT WRITTEN?
15 A. THAT WAS WRITTEN ON THE 26TH. THAT WOULD HAVE BEEN THE
16 THREE TO ELEVEN SHIFT.
17 Q. AND WHEN DID YOU WRITE IT DURING THE SHIFT?
18 A. USUALLY YOU'LL WRITE IT AT THE END OF THE SHIFT.
19 Q. WHAT WAS THE BEHAVIOR THAT YOU SAW?
20 A. "PATIENT HAS HAD NO AGITATION THIS SHIFT. PATIENT
21 REMAINED IN BED ENTIRE SHIFT. PATIENT WITH 02 AT TWO
22 LITERS."
23 Q. AND WHAT DOES THAT MEAN?
24 A. OXYGEN AT TWO LITERS.
25 Q. AND HOW WAS THAT ADMINISTERED?
1637
1 A. THROUGH THE NASAL CANNULA, A TUBE THROUGH THE NOSE.
2 Q. NOT A MASK, BUT A --
3 A. CORRECT.
4 Q. OKAY. THANK YOU.
5 A. "NO DISTRESS NOTED. PATIENT OPENED EYES OCCASIONALLY
6 DURING CARES. NO VERBALIZATION. PATIENT REMAINS VERY
7 LETHARGIC. PATIENT ABLE TO P.O. 60 PERCENT," WHICH MEANS
8 INTAKE. "60 PERCENT OF MEAL WITH STAFF. INCREASED
9 ENCOURAGEMENT AND SMALL LIQUID. FIVE PORTIONS GIVEN.
10 PATIENT NOT ABLE TO TURN SELF. STAFF REPOSITIONED, Q TWO
11 HOURS," MEANING EVERY TWO HOURS. "GAVE SIPS OF H20,"
12 MEANING WATER. "PATIENT DID NOT MOAN OR MAKE ANY VERBAL
13 COMMUNICATIONS."
14 Q. DID YOU SEE ANY OR CHART ANY SYMPTOMS OF PAIN?
15 A. NO, I DID NOT. See symptoms reported by nurse>>
16 Q. DO YOU RECALL SEEING ANY SYMPTOMS OF PAIN?
17 A. NO, I DID NOT.
18 Q. 569 IS THE NEXT PAGE. WHAT DATE IS THAT?
19 A. 12/26.
20 Q. AND THAT WAS AT WHAT TIME THAT FIRST ONE?
21 A. THE MORNING SHIFT THERE.
22 Q. AND THE FIRST NOTATION IS NOT YOURS?
23 A. NO, IT IS NOT.
24 Q. WERE YOU STILL ON SHIFT?
25 A. THAT MORNING, NO.
1638
1 Q. SO THE FIRST NOTATION IS AT WHAT TIME?
2 A. 0800.
3 Q. WHAT IS THE NOTATION?
4 A. M.S., TWO MILLIGRAMS, I.M. I TAKE IT THAT'S RIGHT
5 GLUTEAL. I DON'T KNOW. "COMPLAINS OF MOANING. APPEARS TO
6 BE IN SOME DISCOMFORT."
7 Q. HAD YOU SEEN ANY DISCOMFORT BEFORE YOU LEFT YOUR SHIFT?
8 A. NO, I DID NOT.
9 Q. LET'S GO ON. AT NINE O'CLOCK WHAT WAS WRITTEN?
10 A. PATIENT GIVEN -- I DON'T KNOW WHAT THAT IS.
11 "UNRESPONSIVE TO EVEN DEEP PAINFUL STIMULI. ALL COMFORT
12 MEASURES CONTINUED."
13 Q. DO YOU KNOW WHAT IT MEANS TO SAY UNRESPONSIVE TO EVEN
14 DEEP PAINFUL STIMULI?
15 A. USUALLY DEEP --
16 MR. STIRBA: YOUR HONOR --
17 MS. BARLOW: I ASKED IF SHE KNOWS WHAT IT MEANS.
18 THE WITNESS: YES.
19 MR. STIRBA: BUT IN THE CONTEXT OF A NOTE SHE
20 DIDN'T CREATE I THINK IT'S BEYOND HER ABILITY TO SPECULATE.
21 MS. BARLOW: PERHAPS IF I COULD LAY SOME
22 FOUNDATION.
23 THE COURT: GO AHEAD.
24 Q. (BY MS. BARLOW) RESPONSIVE TO DEEP PAINFUL STIMULI.
25 DOES THAT HAVE ANY PARTICULAR SIGNIFICANCE IN A NURSING
1639
1 CONTEXT?
2 A. YES, IT DOES.
3 Q. AND WHERE DO YOU LEARN WHAT THAT SIGNIFICANCE IS?
4 A. DURING NURSING SCHOOL YOU'RE INSTRUCTED ON HOW TO
5 STIMULATE DEEP PAINFUL STIMULI ON A PATIENT TO SEE WHAT THE
6 RESPONSIVE LEVEL IS.
7 Q. AND THEN WE HAVE 1400. WOULD YOU READ WHAT B SAYS IN
8 1400?
9 A. BEHAVIOR. "PATIENT UNRESPONSIVE AS YET, BUT APPEARS TO
10 BE," AND I DON'T KNOW WHAT THAT IS. LIGHTER. I DON'T KNOW.
11 "NOT MOVING IN BED BUT MAKING VERBAL NOISE IN RESPONSE TO
12 CONVERSATION WITH HER."
13 Q. OKAY. STOP THERE. IN THE NURSING PROFESSION IS THERE A
14 PARTICULAR MEANING, YES OR NO, TO THE TERM LIGHTER?
15 A. NOT THAT I'M AWARE OF.
16 Q. WERE YOU ON SHIFT WHEN A VOMITING SPELL HAPPENED?
17 A. I WAS AWARE OF THE VOMITING SPELL WITH JUDITH.
18 Q. LET'S TURN TO 575.
19 A. (WITNESS COMPLIED.)
20 Q. WHAT DATE WAS THAT?
21 A. ON 575?
22 Q. YES.
23 A. 12/29.
24 Q. AND THIS FIRST PART WAS WRITTEN WHEN?
25 A. AT THE END OF THE THREE TO ELEVEN SHIFT.
1640
1 Q. WHAT IS THE BEHAVIOR THAT WAS NOTED THERE?
2 A. "PATIENT ATTENDING GROUP BUT SLEPT THROUGH THEM. AT
3 1600 PATIENT BEGAN A FIVE HOUR CYCLE OF SEVERE EMESIS."
4 Q. WHAT IS EMESIS?
5 A. THROWING UP. TIMES SEVEN.
6 Q. WHAT DOES TIMES SEVEN MEAN?
7 A. IT MEANS SEVEN TIMES, SEVEN EPISODES. "AND DIAPHORETIC
8 SKIN TO TOUCH," MEANING PERSPIRATION. "VITAL SIGNS TAKEN.
9 TEMP ROSE TO 99.5 AT 2200. LARGE AMOUNTS OF EMESIS.
10 CHANGED BED TIMES THREE," MEANING THREE TIMES. "WAS PUT TO
11 BED AT 1700. DID NOT EAT ANY DINNER. VOMITED MEDS."
12 Q. LET'S LOOK DOWN TO -- WELL, WHAT IS THE I? FOR
13 INTERVENTION?
14 A. YES. "ATTENDED GROUP AT BEGINNING OF SHIFT. DID NOT
15 PARTICIPATE. RESPONSE. EMESIS CONTINUED AFTER BEING PUT IN
16 BED. RAISED HEAD OF BED TO 90 DEGREES TO PREVENT CHOKING.
17 WAS UNABLE TO KEEP ANYTHING DOWN INCLUDING LIQUIDS. IS
18 PRESENTLY SLEEPING. NO EMESIS SINCE 2100. WILL CONTINUE TO
19 MONITOR."
20 Q. DOWN HERE AT 1900, AGAIN, AND I RECOGNIZE THAT'S NOT
21 YOUR WRITING, BUT WHAT WAS CHARTED?
22 A. "PAGED DR. WEITZEL TO NOTIFY HIM OF PATIENT'S PERSISTENT
23 NAUSEA AND VOMITING. VITAL SIGNS. PATIENT IS AWAKE.
24 VOMITUS CLEAR, YELLOW, WITH FOOD PARTICLES."
25 Q. AND THEN WHAT IS THIS NEXT LINE?
1641
1 A. IT'S HARD TO READ. IT LOOKS LIKE 2000. IT'S DIFFICULT
2 TO READ. "PAGED DR. WEITZEL AGAIN. PATIENT CONTINUES TO
3 VOMIT."
4 Q. 2130?
5 A. "PAGED DR. WEITZEL AGAIN. PATIENT CONTINUES TO VOMIT.
6 HAS BEEN N.P.O.," MEANING NOTHING BY MOUTH, "SINCE 1730."
7 Q. IT'S HARD TO READ THE REST.
8 A. MEDICATIONS HELD.
9 Q. HELD?
10 A. HELD.
11 Q. OKAY. THEN AT MIDNIGHT ON THE 30TH WHAT WAS HAPPENING?
12 A. "PATIENT WAS VOMITING. EMESIS COFFEE GROUND LIKE IN
13 APPEARANCE WITH PASTY TEXTURE. VITAL SIGNS. DR. WEITZEL
14 AND DR. DIENHART PAGED. PATIENT CLEANED UP AND BEDDING
15 CHANGED."
16 Q. WAS THIS, THEN, A CONTINUANCE OF --
17 A. THIS WAS A NEW SHIFT STARTING AT ELEVEN. THEN SHE WAS
18 JUST FREE TEXTING IN SOMETHING THAT WAS CRITICAL THAT SHE
19 NEEDED TO CHART, I GUESS, AS SHE WAS GOING ALONG IN HER
20 SHIFT.
21 Q. DOWN HERE -- I RECOGNIZE THIS STILL ISN'T YOUR
22 HANDWRITING. WE HAD TRACY SCHOLL HERE TO TESTIFY. BY THE
23 TIME 7:30 CAME AROUND WHAT DID YOU SEE AS BEHAVIOR?
24 A. "PATIENT UNRESPONSIVE TO VERBAL STIMULI. PATIENT WEAK.
25 HEART RATE IRREGULAR. RESPIRATIONS EVEN, NOT LABORED AT
1642
1 THIS TIME. PATIENT'S DIAPER CHANGED TIMES ONE WITH URINE
2 OUTPUT. PATIENT NOT ABLE TO P.O. INTAKE. DR. WEITZEL
3 NOTIFIED OF CONDITION. DOCTOR STATED HE WOULD BE ARRIVING
4 SOON."
5 THE COURT: IS THIS AN APPROPRIATE TIME TO TAKE A
6 BREAK?
7 MS. BARLOW: IT IS, YOUR HONOR. IT WILL PROBABLY
8 TAKE A WHILE WITH THIS.
9 THE COURT: LADIES AND GENTLEMEN, WE'VE BEEN GOING
10 FOR ABOUT AN HOUR. LET'S COME BACK ABOUT TEN -- AT TEN
11 MINUTES TO THREE. DURING THE TIME THAT YOU ARE OUT PLEASE
12 REMEMBER THAT IT'S YOUR DUTY TO NOT CONVERSE AMONG
13 YOURSELVES OR TO CONVERSE WITH ANYONE ELSE, BE ADDRESSED BY
14 ANY PERSON ON THE SUBJECT OF THIS TRIAL. IT IS ALSO YOUR
15 DUTY NOT TO FORM OR EXPRESS AN OPINION ON THIS CASE UNTIL
16 THE CASE IS FINALLY SUBMITTED TO YOU. IF YOU'LL PLEASE COME
17 BACK AT TEN MINUTES TO THREE.
18 (JURY LEFT THE COURTROOM.)
19 THE COURT: THE RECORD SHOULD REFLECT THAT THE JURY
20 IS GONE. I WOULD LIKE TO HAVE COUNSEL BACK HERE AT 15
21 MINUTES TO AND THEN TALK ABOUT THAT ONE OBJECTION AND THAT
22 OTHER ISSUE THAT WE TALKED ABOUT BEFORE. IF YOU CAN COME
23 BACK AT QUARTER TO AND I'LL HAVE THE JURY BACK AT TEN TO.
24 (SHORT RECESS.)
25 THE COURT: WE HAD TWO ISSUES. ONE FROM EARLIER
1643
1 REGARDING THE SIX PATIENT COMMENTS. AND THEN THE ONE THAT
2 THERE WAS AN OBJECTION ABOUT RELEVANCE REGARDING THE
3 CONVERSATION THAT THIS LAST WITNESS HAD WITH DR. WEITZEL
4 REGARDING JUDITH LARSEN AND THE MORPHINE. THERE WAS A
5 QUESTION THAT SAID WHAT WAS BEHIND YOUR CONCERN. IS THAT
6 THE QUESTION? THAT'S WHAT I WROTE DOWN.
7 MS. BARLOW: I THINK SO.
8 THE COURT: DO YOU WANT TO EXPRESS -- YOUR
9 OBJECTION WAS RELEVANCE. HOW DO YOU SAY IT'S NOT RELEVANT?
10 MR. STIRBA: WELL, SHE TESTIFIED AS TO THE
11 CONVERSATION. HER NURSING OPINION ABOUT SOMETHING IS REALLY
12 IRRELEVANT. I MEAN, I'M SURE THERE ARE AS MANY OPINIONS
13 ABOUT THE CARE AS YOU HAD NURSES. IF WE'RE GOING TO HAVE
14 EVERY SINGLE NURSE TESTIFY ABOUT THESE ISSUES, THEN IT SEEMS
15 TO ME THAT THESE ARE COLLATERAL ISSUES WHICH ARE NOT
16 RELEVANT TO THE FUNDAMENTAL FACT OF DID THIS GENTLEMAN, DR.
17 WEITZEL, COMMIT THE CRIMES CHARGED, WHICH HAS TO DO WITH
18 PRECISELY HIS CARE.
19 SHE CAN TESTIFY ABOUT WHAT SHE DID, CONVERSATIONS SHE
20 HAD, BUT HER OWN SORT OF PERSONAL INNER CONCERN IS REALLY
21 IRRELEVANT AND OF NO MOMENT.
22 THE COURT: MS. BARLOW, YOUR RESPONSE TO THAT.
23 MS. BARLOW: YES. I THINK SHE SHOULD BE ALLOWED TO
24 TESTIFY AS TO HER BACKGROUND AND WHAT IN HER BACKGROUND
25 RAISED THE -- BROUGHT ABOUT THE CONVERSATION. THE
1644
1 CONVERSATION IS RELEVANT BECAUSE IT GOES TO THE DEFENDANT'S
2 KNOWLEDGE.
3 THE COURT: THE CONVERSATIONS ARE IN AND SHE'S
4 TESTIFIED ABOUT THEM.
5 MS. BARLOW: RIGHT. I THINK SHE SHOULD BE ALLOWED
6 TO TESTIFY AS TO, IN HER NURSING BACKGROUND AND IN HER
7 MEDICAL TRAINING, WHY THESE WERE PROBLEMS. I THINK THEY
8 ALSO GO TO THE FACT THAT THE DEFENDANT AS A DOCTOR SHOULD
9 ALSO KNOW WHY THESE ARE PROBLEMS, BECAUSE IT'S A STANDARD
10 MEDICAL -- I MEAN, EVEN NURSES KNOW, AS IT WERE, THAT THESE
11 ARE PROBLEMS. But they don't. They just think they do.
12 MR. STIRBA: ONE OTHER THING. SEE, WE'RE BACK INTO
13 THAT SAME PROBLEM OF SHE'S RENDERING ESSENTIALLY AN OPINION.
14 WE'RE GOING TO HAVE PLENTY OF EXPERTS COME IN AND CRITIQUE
15 WHATEVER HAPPENED. BUT HER OPINION IS NOT REALLY RELEVANT.
16 I MEAN, WHAT SHE DID IS REALLY THE BEST EVIDENCE OF ANYTHING
17 THAT MAY BE PROBATIVE IN THIS CASE. BUT TO GO FIVE YEARS
18 LATER AND SAY BY THE WAY WHAT WAS YOUR CONCERN, SHE'S
19 ESSENTIALLY RENDERING AN OPINION FOR WHICH WE DON'T HAVE ANY
20 EXPERT FOUNDATION. AND REALLY SHE'S NOT HERE AS AN EXPERT,
21 SHE'S HERE AS A FACT WITNESS. SHE'S TESTIFYING TO
22 CONVERSATIONS, WHAT SHE DID, WHAT SHE OBSERVED, WHAT SHE
23 ASSESSED AND ESSENTIALLY WHAT FACTUALLY TRANSPIRED FOR WHICH
24 SHE WAS PERSONALLY INVOLVED.
25 MS. BARLOW: I DON'T THINK IT'S OPINION TESTIMONY
1645
1 AT ALL. IT'S WHY SHE DID WHAT SHE DID.
2 THE COURT: OKAY. DO YOU THINK IT'S -- WHAT STRUCK
3 ME AS A LITTLE ODD IS IF SHE HAD THAT CONCERN, SHE HASN'T
4 SAID THAT THAT CONCERN WAS EXPRESSED TO THE DOCTOR, FROM MY
5 LISTENING TO HER CONVERSATION. SHE BASICALLY SAID -- SHE
6 DIDN'T SAY I HAVE THIS CONCERN AND MY CONCERN IS THIS. SHE
7 DID SAY I DON'T THINK SHE SHOULD HAVE THIS MORPHINE, BUT NOT
8 WHAT WAS BEHIND HER STATEMENT. IF SHE SAID THAT TO THE
9 DOCTOR, THAT SHOULD CLEARLY COME IN. SHE DIDN'T SAY IT TO
10 THE DOCTOR.
11 MS. BARLOW: THE WHY SHE DIDN'T SAY TO THE DOCTOR,
12 IS THAT WHAT YOU'RE SAYING?
13 THE COURT: YES. IF SHE SAID THE WHY, THAT SHOULD
14 COME IN, IF IT WAS IN A CONVERSATION. IF SHE DIDN'T, IT
15 WON'T COME IN.
16 AS TO THE ISSUE ABOUT THE JUDITH LARSEN CARE REGARDING
17 THE STATEMENT ABOUT I NEED SIX PATIENTS TO MAKE IT
18 WORTHWHILE, I'LL ALLOW THAT TO BE ASKED.
19 MS. BARLOW: YOU SAY YOU WILL?
20 THE COURT: I'LL ALLOW THAT QUESTION TO BE ASKED.
21 I'LL OVERRULE THE OBJECTION.
22 IS THERE ANYTHING ELSE TO DISCUSS BEFORE WE HAVE THE
23 JURY COME BACK? THOSE WERE THE TWO THINGS THAT I HAD.
24 MS. BARLOW: RIGHT. SO IF SHE CAN TESTIFY THAT SHE
25 DID EXPRESS WHY SHE HAD CONCERNS, THE COURT WILL ALLOW THAT?
1646
1 THE COURT: WHATEVER WAS EXPRESSED TO THE DOCTOR.
2 MS. BARLOW: THANK YOU.
3 THE COURT: OKAY. IF THERE'S NOTHING ELSE, LET'S
4 ASK TO HAVE THE JURY BACK.
5 (JURY RETURNED TO THE COURTROOM.)
6 THE COURT: THE RECORD WILL REFLECT THAT THE JURY
7 HAS RETURNED. MS. BARLOW, IF YOU WOULD LIKE TO PROCEED.
8 MS. BARLOW: THANK YOU, YOUR HONOR.
9 Q. (BY MS. BARLOW) MS. HARDEY, WE HAD TALKED A LITTLE BIT
10 EARLIER ABOUT YOU EXPRESSING YOUR CONCERNS TO THE DEFENDANT
11 ABOUT MORPHINE BEING ORDERED FOR JUDITH LARSEN EARLIER IN
12 DECEMBER. DO YOU RECALL THAT?
13 A. YES, I DO.
14 Q. DID YOU EXPRESS TO HIM WHY YOU WERE CONCERNED ABOUT THAT
15 MORPHINE ORDER?
16 A. YES, I DID. I PROBABLY DIDN'T MAKE MYSELF CLEAR THE
17 LAST TIME I SPOKE.
18 Q. WELL, WHEN DID YOU EXPRESS YOURSELF TO HIM?
19 A. ON THE 19TH, WHEN HE DISCONTINUED THE MORPHINE. I WENT
20 INTO THE DISCUSSION OF WHY I WAS CONCERNED, BECAUSE I HAD
21 LOOKED UP THE MEDICATIONS AND I THOUGHT MORPHINE WOULD
22 POTENTIATE THE EFFECT OF WHAT MEDICATIONS SHE WAS CURRENTLY
23 ON.
24 Q. WHAT DOES POTENTIATE MEAN?
25 A. WOULD INCREASE WHAT THEY'RE DOING, THE LEVELS OF WHAT
1647
1 THEY WERE MEANT TO DO.
2 Q. AND DID YOU TELL THE DEFENDANT THAT?
3 A. YES, I DID.
4 Q. DID YOU TELL HIM ANYTHING MORE ABOUT YOUR CONCERNS?
5 A. UMM, JUST THAT I WAS CONCERNED ABOUT HER RESPONSIVENESS
6 TO THAT IN CASE IT WAS INTRODUCED. IT HADN'T BEEN GIVEN AT
7 THAT POINT. I DID NOT SEE ANY PAIN AND I WAS CONCERNED
8 ABOUT IT BEING GIVEN.
9 MR. STIRBA: YOUR HONOR, I'M GOING TO OBJECT. I
10 THINK THIS ISN'T RESPONSIVE TO THE QUESTION ABOUT WHAT WAS
11 SAID.
12 Q. (BY MS. BARLOW) IS THAT WHAT YOU SAID?
13 A. THIS IS WHEN I WAS SPEAKING TO HIM. I'M SORRY I'M NOT
14 PUTTING IT IN THE RIGHT FORMAT. I WAS DISCUSSING IT WITH
15 HIM IN THIS MANNER. MY CONCERN WAS THE MORPHINE AND IT
16 INTERACTING WITH THE OTHER MEDICATIONS. I TOLD HIM I DIDN'T
17 THINK IT WOULD BE SAFE TO KEEP IT AS A SCHEDULED P.R.N. MED.
18 Q. AND THEN YOU ALREADY SAID WHAT HIS RESPONSE WAS?
19 A. YES.
20 Q. AT THE BREAK WE WERE TALKING ABOUT COFFEE GROUND EMESIS
21 LIKE -- WELL, EMESIS, COFFEE GROUND LIKE IN APPEARANCE.
22 BASED ON YOUR NURSING BACKGROUND, IS THERE ANY WAY OF
23 NARROWING DOWN WHAT CAUSES THAT KIND OF PROBLEM, YES OR NO?
24 A. YES, THERE IS.
25 Q. AND IN YOUR NURSING BACKGROUND, HOW DO YOU NARROW DOWN
1648
1 WHAT CAUSES THAT KIND OF PROBLEM?
2 A. FIRST WE WOULD DISTINGUISH WHAT EXACTLY THE EMESIS IS
3 RELATED TO.
4 MR. STIRBA: I WOULD OBJECT AS TO RELEVANCY. WHAT
5 SHE DID IS FINE, BUT SHE'S RENDERING AN OPINION NOW.
6 THE COURT: SUSTAINED.
7 Q. (BY MS. BARLOW) DID YOU YOURSELF SEE ANY OF THIS
8 VOMITING THAT SHE DID?
9 A. YES, I DID. I SAW THE AFTER RESULTS, NOT HER ACTUALLY
10 DOING IT.
11 Q. WHAT WERE -- WHEN DID YOU SEE THOSE AFTER RESULTS?
12 A. ON THE 30TH OF DECEMBER.
13 Q. AND WHAT PAGE IS THAT ON?
14 A. PAGE 576.
15 Q. IS THAT DOWN AT THE BOTTOM HERE?
16 A. YES, IT IS.
17 Q. 9:20 IN THE EVENING?
18 A. YES, IT IS.
19 Q. AND WHAT DID YOU CHART AT THAT TIME?
20 A. OKAY. PAGE 578 IS OUT OF ORDER. THAT SHOULD GO IN
21 FRONT OF 577 BECAUSE IT'S A CONTINUATION. AT 0920,
22 APPROXIMATELY 100 CC'S OF EMESIS, DARK BROWN, COFFEE GROUND,
23 COMING FROM NARES AND MOUTH. NARES MEANING NOSE.
24 Q. HOW MUCH IS A HUNDRED CC'S?
25 A. IT'S ABOUT THIS MUCH. ABOUT UP TO HERE.
1649
1 Q. YOU'RE INDICATING A SMALL CUP, MAYBE A 6-OUNCE CUP, AND
2 ABOUT HALF OF THAT?
3 A. YES.
4 Q. THANK YOU. COMING FROM NARES AND MOUTH. AND YOU SAID
5 THAT WAS WHAT?
6 A. NARES REFERS TO THE NOSE.
7 Q. AND THEN WHAT DID YOU WRITE?
8 A. "PATIENT CLEANSED. NO RESPONSE. HEART RATE TACHY,
9 IRREGULAR."
10 Q. EXCUSE ME. WHAT IS TACHY?
11 A. TACHY MEANS HIGH PACED, RAPID.
12 Q. TACHY AND IRREGULAR, WHAT DOES THAT MEAN?
13 A. IRREGULAR, NOT A REGULAR BEAT.
14 Q. OKAY. AND THEN WHAT DID YOU WRITE?
15 A. "RESPIRATIONS WERE EVEN AND UNLABORED AND SHALLOW."
16 Q. DID YOU INFORM THE DEFENDANT OF THIS VOMITING EPISODE
17 THAT YOU SAW THE RESULTS OF?
18 A. YES, I DID.
19 Q. WHEN DID YOU DO THAT?
20 A. WHEN HE PHONED ME BACK.
21 Q. AND WHEN WAS THAT?
22 A. AT 1400.
23 Q. THAT IS ON 578?
24 A. YES, IT IS.
25 Q. WHAT DID YOU CHART AT 1400?
1650
1 A. "DR. WEITZEL ORDERED M.S., I.M., TO BE GIVEN Q FOUR
2 HOURS ROUND THE CLOCK. PATIENT NOT P.O. INTAKE," MEANING
3 NOT TAKING ANYTHING BY MOUTH. "ORAL CARE GIVEN AND POSITION
4 CHANGED."
5 Q. DO YOU RECALL THAT CONVERSATION WITH THE DEFENDANT?
6 A. YES, I DO.
7 Q. YOU SAY IT HAPPENED -- WAS IT FACE TO FACE OR TELEPHONE?
8 A. OVER THE PHONE.
9 Q. HOW DID YOU GET HIM ON THE PHONE?
10 A. I PAGED HIM EARLIER AND THEN HE FINALLY CALLED BACK.
11 Q. WHAT DID YOU TELL HIM ABOUT MRS. LARSEN'S CONDITION AT
12 THAT TIME?
13 A. THE TACHY HEART RATE, THE COFFEE GROUND EMESIS.
14 Q. AND WHAT DID HE SAY BACK?
15 A. HE SAID GIVE HER THE MORPHINE AND I REITERATED AGAIN HER
16 CONDITION IS THIS. AND HE SAYS I SAID TO GIVE THE MORPHINE.
17 I SAID SHE'S NOT IN PAIN. THEN HE SAID I WANT THE MORPHINE
18 GIVEN ROUND THE CLOCK. I SAID DO YOU WANT ANYTHING DONE
19 ABOUT THE EMESIS. HE SAID I WANT THE MORPHINE GIVEN ROUND
20 THE CLOCK.
21 Q. DID YOU GIVE MORPHINE THAT DAY?
22 A. I'LL HAVE TO REFER BACK TO THE --
23 Q. BACK TO THE M.A.R.S.
24 A. (PAUSE.) I DID NOT. THE ORDER WAS WRITTEN, THOUGH, IN
25 THE M.A.R.
1651
1 Q. WHERE WAS THE ORDER WRITTEN?
2 A. ON PAGE 497.
3 Q. WHO WROTE THAT ORDER IN?
4 A. I WROTE THE ORDER IN BECAUSE I HAD BEEN THE PERSON WHO
5 HAD TAKEN IT OVER THE PHONE.
6 Q. THIS IS 497. WHICH ORDER? THERE APPEAR TO BE TWO.
7 A. I STARTED RIGHT THERE, BUT THE TIME FRAME I WANTED TO
8 REWRITE IT SO THAT IT WAS WRITTEN IN THE PROPER ORDER WITH
9 THE EARLIEST DOSE BEING AT 0230. THIS WAS THE ACTUAL TRUE
10 TRANSCRIPTION ON THE BOTTOM. AT 1430 WAS THE START OF THE
11 FIRST DOSE.
12 Q. AND WHOSE WRITING IS THAT?
13 A. I DON'T RECALL WHOSE INITIALS THOSE ARE.
14 Q. AND THIS WAS FIVE MILLIGRAMS ROUND THE CLOCK?
15 A. CORRECT.
16 Q. DID YOU GIVE ANY OF THOSE DOSES ON THAT DAY?
17 A. NO, I DID NOT.
18 Q. WHAT ABOUT THE NEXT DAY ON THE 31ST?
19 A. NO, I DID NOT.
20 Q. THE NEXT DAY ON THE 1ST?
21 A. NO, I DID NOT.
22 Q. WERE YOU JUST NOT ON SHIFT DURING THOSE DAYS?
23 A. WELL, I DIDN'T -- THE DAY I RECEIVED THE ORDER I DID NOT
24 SEE THE NEED FOR THE MORPHINE, SO I WROTE THE ORDER AND WENT
25 HOME AFTER I GAVE THE REPORT.
1652
1 Q. SO WAS THE ORDER GIVEN CLOSE TO THE END OF YOUR SHIFT?
2 A. YES, IT WAS.
3 Q. DID YOU TELL DR. WEITZEL YOU DIDN'T GIVE THAT ORDER?
4 A. NO, I DID NOT.
5 Q. IT APPEARS SOMEONE ELSE CAME IN AND DID GIVE IT, IS THAT
6 CORRECT?
7 A. YES, THEY DID.
8 Q. IF YOU WOULD TURN TO 580.
9 A. (WITNESS COMPLIED.)
10 Q. NOW, THE 31ST OF DECEMBER, DO YOU KNOW WHAT SHIFT YOU
11 WORKED?
12 A. THE 31ST OF DECEMBER?
13 Q. YES.
14 A. THAT WOULD BE A DAY SHIFT.
15 Q. AND THE TIME WAS SEVEN TO THREE?
16 A. YES.
17 Q. LET'S LOOK AT 581 FIRST. IN FACT, I THINK THIS MAY BE
18 ANOTHER ONE OF THOSE WHERE WE'RE OUT OF ORDER. LET'S LOOK
19 AT 582.
20 A. OKAY.
21 Q. IS YOUR HANDWRITING ON 582?
22 A. YES, IT IS.
23 Q. WOULD YOU LOOK THROUGH THAT AND THE CONTINUATION FROM
24 THE NEXT DAY -- WELL, LET'S GO BACK. SO, 7:30, WHAT DID YOU
25 WRITE?
1653
1 A. "PATIENT WITH EYES OPEN."
2 Q. I'M SORRY. LET'S START FIRST WITH WHAT DAY IS THIS?
3 A. THE 31ST OF DECEMBER.
4 Q. OKAY. WHAT DID YOU WRITE AT 7:30?
5 A. "PATIENT WITH EYES OPEN. NO BLINKING. NOT RESPONDING
6 TO VERBAL STIMULI. NO TACTILE STIMULI."
7 Q. WHAT IS VERBAL STIMULI?
8 A. WHERE YOU JUST GO UP AND MENTION THEIR NAME. THEY'LL
9 USUALLY RESPOND TO A NAME.
10 Q. WHAT ABOUT TACTILE?
11 A. USUALLY YOU TOUCH THEM. YOU DO SOME MOVEMENT ON THE
12 STERNUM AREA, THE CHEST, MIDSECTION. THAT'S VERY SENSITIVE
13 TO A PERSON.
14 Q. AND THE MOVEMENT YOU'RE MAKING IS WITH YOUR KNUCKLES?
15 A. CORRECT. THAT'S FOR DEEP STIMULUS.
16 Q. AND WHAT DID YOU DO THAT FOR?
17 A. TO SEE IF THEY'RE RESPONSIVE. TO SEE IF THEIR CENTRAL
18 NERVOUS SYSTEM IS COMPROMISED.
19 Q. DID YOU GET ANY RESPONSE?
20 A. NO.
21 Q. WHAT DID YOU WRITE?
22 A. "NO OUTPUT," REFERRING TO URINE OUTPUT. "PATIENT TURNED
23 IN POSITION. ORAL CARE PROVIDED."
24 Q. WHAT IS PATIENT TURNED IN POSITION?
25 A. USUALLY, IF THEY'RE NOT MOVING THEMSELVES, AS A NURSE
1654
1 YOU TURN AND POSITION THEM TO PREVENT BED SORES FROM
2 HAPPENING.
3 Q. OKAY. WHAT IS ORAL CARE?
4 A. ORAL CARE, YOU USUALLY TAKE A SWAB AND CLEANSE THEIR
5 MOUTH. IF THEY'RE NOT TAKING ANY WATER IN THEY USUALLY GET
6 VERY DRY. IT'S UNCOMFORTABLE. IT'S BASICALLY A COMFORT
7 MEASURE.
8 Q. AND THEN WHAT DID YOU WRITE?
9 A. "MOIST CLOTH TO COVER EYES TO PREVENT DRYING OUT,"
10 BECAUSE SHE WAS STARING AND NOT CLOSING HER EYES. I PUT A
11 MOIST CLOTH ON FOR EYE COMFORT.
12 "SON TELEPHONED CONCERNED ABOUT PATIENT'S MEDICAL
13 CONDITION. WANTED TO KNOW WHEN PATIENT WOULD BE DYING.
14 STAFF NURSE TOLD SON PATIENT'S MEDICAL STATUS AND RESPONSES
15 TO CARE AND MEDICATIONS BEING GIVEN. FAMILY MEMBER UPSET
16 THAT STAFF NURSE WOULD NOT STATE PATIENT WAS DYING. PATIENT
17 CONDITION POOR."
18 Q. DID YOU -- ARE YOU ONE WHO TALKED TO THE SON?
19 A. YES.
20 Q. DO YOU REMEMBER THAT CONVERSATION?
21 A. A LITTLE.
22 Q. LET'S GO NOW TO THE CONTINUATION ON 581. WHAT DID YOU
23 WRITE?
24 A. "SON CONCERNED THAT FAMILY MEMBERS WERE FLYING IN FROM
25 OUT OF STATE DUE TO NIGHT SHIFT NURSE'S REPORT TO SON ON
1655
1 12/30/95."
2 Q. AND THEN DID YOU TAKE THE VITAL STATS?
3 A. YES.
4 Q. AND WHAT DID YOU FIND?
5 A. 99.1 TEMP. 88 OVER 52 BLOOD PRESSURE. 60 PULSE. 16
6 RESPIRATIONS.
7 Q. THE 99.1, IS THAT WITHIN NORMAL RANGE FOR TEMPERATURE?
8 A. SLIGHTLY ELEVATED.
9 Q. WHAT ABOUT 88 OVER 52?
10 A. SLIGHTLY LOW.
11 Q. WHAT ABOUT 60?
12 A. THAT'S ABOUT NORMAL.
13 Q. FOR A PULSE?
14 A. A LITTLE ON THE LOW SIDE, BUT AN ACCEPTABLE RANGE.
15 Q. WHAT ABOUT 16?
16 A. THAT'S ACCEPTABLE.
17 Q. THEN WHAT DID YOU WRITE AT 9:45?
18 A. "PATIENT TURNED IN POSITION. ORAL CARE PROVIDED. NO
19 URINE OUTPUT. PATIENT NOT RESPONDING TO TACTILE OR VERBAL
20 STIMULI. RESPIRATIONS EVEN. PATIENT CONTINUES WITH EYES
21 OPEN."
22 Q. LET'S JUMP DOWN TO 1430. WHAT DID YOU WRITE THEN?
23 A. "PATIENT TURNED IN POSITION. ORAL CARE GIVEN. PATIENT
24 NONRESPONSIVE TO VERBAL, TACTILE TOUCH. VITAL SIGNS, 98
25 OVER 50; 22 RESPIRATIONS; 88 HEART RATE; 99.2 TEMPERATURE."
1656
1 Q. WHAT ABOUT THAT BLOOD PRESSURE?
2 A. IT'S ACCEPTABLE RANGE.
3 Q. WHAT ABOUT THE 22 RESPIRATIONS?
4 A. SLIGHTLY ELEVATED.
5 Q. AND 88?
6 A. THAT'S JUST A LITTLE ABOVE WHAT WE WOULD CONSIDER
7 NORMAL.
8 Q. AND THE TEMPERATURE?
9 A. THE SAME, SLIGHTLY ABOVE NORMAL.
10 Q. AND THE FAMILY WAS IN TO VISIT. DO YOU RECALL THIS DAY?
11 A. SOMEWHAT.
12 Q. DO YOU RECALL WHETHER YOU SAW ANY SIGNS AND SYMPTOMS OF
13 PAIN?
14 A. NO, I DID NOT.
15 Q. DID YOU CHART ANY?
16 A. NO, I DID NOT.
17 Q. NOW WE HAVE SOME EVENING SHIFT NURSING NOTES, WHICH IS
18 580. UNFORTUNATELY, OUR DATES UP AT THE TOP LOOK LIKE
19 THEY'VE BEEN STAMPED OUT WITH HOLE PUNCHES. WE HAVE AGAIN
20 THE B.I.R.P. WHAT WAS THE BEHAVIOR?
21 A. "PATIENT HAS BEEN UNRESPONSIVE THIS SHIFT, EXCEPT TO
22 MAKE SMALL GLUTEAL NOISE." I DON'T KNOW. "I.M. SHOTS GIVEN Guttural.
23 PER DOCTOR'S ORDERS."
24 Q. DID YOU WRITE THAT?
25 A. NO.
1657
1 Q. WHO DID?
2 A. LYNN LONG.
3 Q. ON THE 31ST DID YOU GIVE ANY MORPHINE SHOTS? IF YOU
4 WILL LOOK AT 510.
5 A. (PAUSE.) NO, I DID NOT.
6 Q. SO LYNN LONG WROTE THESE ORDERS HERE AT 1830. WHAT DID
7 SHE WRITE?
8 A. WHAT PAGE?
9 Q. I'M SORRY. 580. SORRY WE HAVE TO GO BACK AND FORTH.
10 A. OKAY.
11 Q. WHAT DID SHE WRITE FOR 1830?
12 A. FREE TEXT. "VITAL SIGNS 118 OVER 60. 12 RESPIRATIONS.
13 72 HEART RATE. 96.7 TEMPERATURE. MORPHINE, FIVE
14 MILLIGRAMS, I.M., GIVEN RIGHT GLUTEUS."
15 Q. DID SHE CHART ANY PAIN AT THAT TIME?
16 A. NO, SHE DID NOT.
17 Q. LET'S LOOK AT 1930, AN HOUR LATER. WHAT DID SHE CHART?
18 A. FREE TEXT. "VITAL SIGNS, 115 OVER 65. 12 RESPIRATIONS.
19 92 PULSE RATE. 97.3 TEMP. M.S., FIVE MILLIGRAMS, I.M.,
20 GIVEN LEFT GLUTEUS PER DOCTOR'S NOW ORDER. PATIENT MOANING
21 SLIGHTLY WHEN TURNED FOR INJECTION."
22 Q. DID SHE CHART ANY PAIN?
23 A. NO, SHE DID NOT.
24 Q. AND 2230, THREE HOURS LATER, WHAT DID SHE CHART?
25 A. FREE TEXT. "VITAL SIGNS, 120 OVER 65. RESPIRATIONS,
1658
1 12. HEART RATE, 100. 99.4 TEMP. M.S., FIVE MILLIGRAMS,
2 I.M., RIGHT GLUTEUS. RESPIRATIONS EVEN AT 12 A MINUTE."
3 Q. 120 OVER 65, IS THAT WITHIN THE RANGE?
4 A. ACCEPTABLE, YES.
5 Q. WHAT ABOUT 12?
6 A. SLIGHTLY LOW.
7 Q. WHAT ABOUT 100 FOR THE PULSE RATE?
8 A. YOU'RE STARTING TO GET WHAT WE CONSIDER TACHY, AN
9 ELEVATED HEART RATE.
10 Q. AND THE 99.4?
11 A. SLIGHTLY ELEVATED.
12 Q. DID YOU SEE JUDITH ON THE 1ST OF JANUARY?
13 A. YES, I DID.
14 Q. WHAT SHIFT WAS THAT?
15 A. THAT WOULD BE THE MORNING SHIFT.
16 Q. IS THAT PAGE NUMBER 583?
17 A. CORRECT.
18 Q. AT 7:30 WHAT DID YOU SEE?
19 A. "PATIENT REPOSITIONED. ORAL CARE GIVEN. SKIN WARM TO
20 TOUCH. PATIENT RIGID WITH EXTREMITY MOVEMENT."
21 Q. WHAT DOES THAT MEAN?
22 A. SHE WAS RIGID, KIND OF STIFF.
23 Q. WHAT DOES EXTREMITY MOVEMENT MEAN?
24 A. HER ARMS AND LEGS ARE MOVING.
25 Q. ARE THEY MOVING -- IS SHE MOVING THEM?
1659
1 A. SHE'S WILLFULLY MOVING THEM. IT IS AN INVOLUNTARY Incredible.
2 MOVEMENT, HOWEVER. SHE WAS DIAPERED AT THIS TIME AND IT WAS
3 DRY.
4 Q. AND THEN AT 9:35?
5 A. "PATIENT REPOSITIONED. ORAL CARE GIVEN. PULSE SLOW AND
6 IRREGULAR. EVEN UNLABORED BREATHING."
7 Q. AND THEN YOU TAKE THE VITALS?
8 A. YES. 112 OVER 78. 14 RESPIRATIONS. 66 HEART RATE AND
9 103 TEMPERATURE.
10 Q. ANY OF THOSE OUTSIDE THE RANGE OF NORMAL?
11 A. THE TEMPERATURE AND THE RESPIRATIONS.
12 Q. AND THEN WHAT DID YOU WRITE AT 11:30?
13 A. "PATIENT REPOSITIONED. ORAL CARE GIVEN. DUODERM
14 REMAINS IN PLACE." THAT IS A DRESSING THAT IS USUALLY
15 APPLIED TO A SKIN THAT IS STARTING TO GET COMPROMISED
16 BECAUSE OF BREAKDOWN IN PRESSURE IN THAT AREA.
17 Q. WHAT DOES THAT MEAN IN LAYMAN'S LANGUAGE?
18 A. IT MEANS THAT THE SKIN IS BEING PRESSURED FROM LAYING IN
19 THE BED AND WE PUT LIKE A SECOND SKIN ON IT. IT'S CALLED A
20 DUODERM. IT'S LIKE A SOFT SPONGE THAT ADHERES TO THE SKIN
21 AND PREVENTS FURTHER BREAKDOWN.
22 Q. AND THEN CAN YOU FIGURE OUT WHAT IS WRITTEN JUST ABOVE
23 YOUR SIGNATURE?
24 A. COCCYX. THAT WOULD BE THE TAIL BONE.
25 Q. OKAY. THANK YOU. I HADN'T BEEN ABLE TO READ THAT.
1660
1 THEN THE NEXT PAGE, WHICH IS THE CONTINUATION?
2 A. "FAMILY IN TO VISIT. PATIENT WITHOUT PAIN. MORPHINE
3 GIVEN Q FOUR AS SCHEDULED. COMFORT MEASURES PROVIDED. NO
4 P.O. INTAKE," MEANING ORAL INTAKE.
5 Q. IT SAYS PATIENT WITHOUT PAIN. M.S. GIVEN. DID YOU GIVE
6 THE MORPHINE SHOT?
7 A. NO, I DID NOT.
8 Q. WHO DID?
9 A. RICHARD CLARK.
10 Q. AND WHAT PAGE NUMBER ARE YOU FINDING THAT ON?
11 A. ON PAGE 497.
12 Q. WHO'S RICHARD CLARK?
13 A. HE WAS AN L.P.N. THAT WAS ON THE UNIT THAT DAY.
14 Q. AND DO YOU HAVE ANY PERSONAL KNOWLEDGE AS TO WHY HE GAVE
15 IT INSTEAD OF YOU?
16 MR. STIRBA: I'LL OBJECT, YOUR HONOR. SHE CAN'T
17 SPECULATE FOR HIM. HE WAS A WITNESS HERE AND HE DIDN'T EVEN
18 KNOW.
19 THE COURT: SUSTAINED.
20 Q. (BY MS. BARLOW) DID YOU MAKE ANY STATEMENTS ABOUT
21 GIVING THIS SHOT?
22 MR. STIRBA: OBJECTION. IRRELEVANT. HEARSAY.
23 THE COURT: OVERRULED.
24 Q. (BY MS. BARLOW) DID YOU MAKE ANY STATEMENTS ABOUT
25 GIVING THIS SHOT?
1661
1 A. RICHARD CLARK WAS IN CHARGE OF GIVING THE MEDICATIONS.
2 MR. STIRBA: I'LL OBJECT.
3 THE COURT: IT'S NOT RESPONSIVE. SUSTAINED.
4 Q. (BY MS. BARLOW) WAS IT YOUR OBLIGATION AT THAT TIME TO
5 GIVE THE SHOT?
6 A. NO, IT WAS NOT.
7 Q. OKAY. THANK YOU. DID YOU SEE IT GIVEN?
8 A. NO, I DID NOT.
9 Q. THEN AT 1400 WHAT DID YOU WRITE?
10 A. THIS IS THE END OF SHIFT REPORT. "PATIENT GIVEN COMFORT
11 CARE. RIGID MOVEMENTS WITH EXTREMITIES. PROVIDED
12 MEDICATION, INJECTIONS, COMFORT CARES. PATIENT REMAINS
13 UNRESPONSIVE TO STIMULI. EYES OPEN, STARING. CONTINUE
14 COMFORT MEASURES."
15 Q. AND THEN WE SHIFT TO SOMEONE ELSE'S WRITING?
16 A. YES. THAT'S LYNN LONG.
17 Q. WHAT DID SHE WRITE FOR BEHAVIOR?
18 A. "PATIENT UNRESPONSIVE EXCEPT TO PAINFUL STIMULI. GROANS
19 AS INJECTIONS GIVEN. PATIENT OFTEN GROANED WHEN TURNED FOR
20 PERI MOUTH CARE OR SHOTS. GAVE M.S. AS SCHEDULED. P.R.N.
21 WHEN PATIENT GROANING. PATIENT TURNED Q TWO HOURS. COMFORT
22 CARE IS GIVEN. PATIENT RESPONDED AS DESCRIBED ABOVE. EYES
23 OPENED, STARING. COMFORT MEASURES."
24 Q. I'M SORRY. I KEEP FORGETTING THAT WHAT I SEE HERE IS
25 NOT NECESSARILY GOING UP THERE. I'M TRYING TO FOLLOW ALONG.
1662
1 WHEN WAS THAT THAT SHE WROTE THESE?
2 A. THAT WOULD HAVE BEEN ON THE THREE TO ELEVEN SHIFT ON
3 1/1.
4 Q. DID YOU SEE ANY SIGNS OR SYMPTOMS OF PAIN CHARTED THERE?
5 MR. STIRBA: I'M GOING TO OBJECT. IT CALLS FOR HER
6 TO CHARACTERIZE THE RECORD. IT'S NOT HER RECORD.
7 THE COURT: SUSTAINED.
8 Q. (BY MS. BARLOW) LET'S TURN TO 587. DID YOU MAKE ANY
9 NOTATIONS ON THE 2ND OF JANUARY?
10 A. YES, I DID.
11 Q. AT WHAT TIME?
12 A. AT 1630.
13 Q. WHAT DID YOU SEE AT -- AT LEAST NOTE AT 1630?
14 A. "PATIENT WITH EYES OPEN, STARING. JERKING ALL
15 EXTREMITIES. MOANING. FIVE MILLIGRAMS M.S. P.R.N. GIVEN,
16 I.M. PATIENT TURNED AND POSITIONED. ORAL CARE GIVEN."
17 Q. DID YOU GIVE THAT MORPHINE SHOT?
18 A. YES, I DID.
19 Q. AND WHAT NUMBER?
20 A. PAGE 510.
21 Q. I GUESS I'M CONFUSED. OH, I SEE. DID YOU GIVE ANY
22 OTHER MORPHINE SHOTS ON THE 2ND OF JANUARY?
23 A. ON THE 2ND?
24 Q. YES.
25 A. YES, I DID.
1663
1 Q. WHAT PAGE ARE YOU LOOKING AT NOW?
2 A. PAGE 507.
3 Q. HOW MANY SHOTS OF MORPHINE DID YOU GIVE THAT DAY?
4 A. I GAVE THE ONE AT 1630 AND ONE AT 1830.
5 Q. WHY DID YOU GIVE THOSE SHOTS?
6 A. BECAUSE THEY WERE SCHEDULED.
7 Q. DO YOU RECALL SEEING ANY SIGNS OR SYMPTOMS OF PAIN?
8 A. NO, I DID NOT.
9 Q. DID YOU TALK TO DR. WEITZEL ABOUT GIVING THE SHOTS
10 BEFORE YOU GAVE THEM?
11 A. NO, I DID NOT.
12 Q. THAT WAS THE 2ND, I BELIEVE, OF JANUARY. DID YOU SEE
13 JUDITH LARSEN ON THE 3RD OF JANUARY?
14 A. YES, I DID.
15 Q. IS THAT 590?
16 A. YES, IT IS.
17 Q. WHAT DID YOU WRITE? FIRST, YOU'VE GOT WHAT TIME?
18 A. 1530. 3:30 IN THE AFTERNOON.
19 Q. AND WHAT DID YOU WRITE?
20 A. FREE TEXT. "FIVE MILLIGRAMS M.S. I.M. GIVEN PER
21 SCHEDULED DOSE BY L.P.N."
22 Q. DID YOU SEE ANY SYMPTOMS OF PAIN?
23 A. NO, I DID NOT.
24 Q. AND THEN AT 1440 WHAT DID YOU NOTE?
25 A. AT 1740.
1664
1 Q. 1740, YES, EXCUSE ME.
2 A. THAT'S 5:40 IN THE AFTERNOON. "PATIENT REPOSITIONED.
3 ORAL CARE GIVEN. PATIENT WITH CYANOTIC EXTREMITIES.
4 MOTTLING EVIDENT ON LOWER EXTREMITIES AND BACK."
5 Q. WHAT DOES CYANOTIC EXTREMITIES MEAN?
6 A. TURNING BLUE.
7 Q. AND WHAT CAUSES THEM TO TURN BLUE?
8 A. POOR CIRCULATION OF THE BLOOD TO THOSE EXTREMITIES.
9 Q. WHAT ABOUT MOTTLING EVIDENT ON LOWER EXTREMITIES AND
10 BACK?
11 A. THAT IS USUALLY THEY GET VERY PALE AND A RING OF
12 REDNESS, WHICH IS ANOTHER SIGN OF DECREASED CIRCULATION.
13 Q. AT 1800 WHAT DID YOU WRITE?
14 A. "PATIENT WITH LOUD MOANING. EXTREMITIES TWITCHING.
15 PATIENT POSITIONED. ORAL CARE GIVEN."
16 Q. 1830?
17 A. "RECEIVED DOCTOR'S ORDERS PER M.S., 15 MILLIGRAMS I.M.
18 NOW AND INCREASE M.S. TO TEN MILLIGRAMS EVERY THREE HOURS
19 DUE TO PATIENT'S AGITATED STATE."
20 Q. HOW DID THAT CONVERSATION COME ABOUT?
21 A. I TELEPHONED HIM BECAUSE OF THE TWITCHING. CAN I SAY
22 HOW I FELT, WHAT I WAS THINKING?
23 Q. NO. LET ME ASK SOME QUESTIONS. YOU TELEPHONED HIM?
24 A. YES.
25 Q. BASED ON YOUR NURSING EXPERIENCE, DID YOU TELL DR.
1665
1 WEITZEL WHAT YOU THOUGHT WAS GOING ON?
2 A. YES, I DID.
3 Q. AND WHEN DID THIS CONVERSATION TAKE PLACE?
4 A. IT WAS RIGHT AT 6:30 THAT AFTERNOON.
5 Q. OKAY. WHAT DID YOU TELL DR. WEITZEL WAS GOING ON?
6 A. I TOLD HIM I WAS CONCERNED ABOUT HER TWITCHING, HER
7 HISTORY OF SEIZURES AND TOLD HER -- TOLD HIM WHAT HER
8 PHYSICAL STATE WAS AT THAT TIME.
9 Q. WHAT WAS HIS RESPONSE?
10 A. HE GAVE THE MORPHINE ORDER.
11 Q. DID YOU SAY ANYTHING FURTHER TO HIM AFTER HE GAVE THE
12 ORDER FOR MORPHINE?
13 A. I MENTIONED THAT SHE'D BEEN ON DILANTIN BEFORE AND I HAD
14 NO RESPONSE FROM HIM.
15 Q. AND WHAT IS THE PURPOSE OF DILANTIN?
16 A. TO TREAT SEIZURES.
17 Q. DID YOU GIVE THE MORPHINE?
18 A. (PAUSE.) RICHARD CLARK DID.
19 Q. WHEN YOU WROTE THAT MORPHINE WAS INCREASED TO -- 15
20 MILLIGRAMS NOW AND INCREASED TO TEN MILLIGRAMS EVERY THREE
21 HOURS, AND IS THAT DUE TO?
22 A. YES, DUE TO.
23 Q. PATIENT'S AGITATED STATE?
24 A. UH-HUH.
25 Q. WHO DETERMINED SHE WAS AGITATED?
1666
1 A. DR. WEITZEL DETERMINED IT WAS AGITATION. See Nurse Hardey's note>>
2 Q. AND THEN WHAT HAPPENED AFTER THAT?
3 A. AFTER THE INJECTION?
4 Q. AFTER THE INJECTION.
5 A. IT SAYS, "PATIENT RESTING WITH EYES CLOSED. NO
6 TWITCHING. DEEP RESPIRATIONS NOTED."
7 Q. WHAT DID YOU FIND AT 2000 HOURS?
8 A. "PATIENT WITH DECREASED HEART RATE AND DEEP
9 RESPIRATIONS, TEN," WHICH IS GETTING AT A CRITICAL VALUE.
10 Q. TEN WHAT?
11 A. BREATHS PER MINUTE. "WITH MOMENTS OF DEEP SIGHS AND
12 IRREGULARITY WITHOUT TWITCHING MOVEMENT."
13 Q. AND WHAT DID YOU WRITE AT 2010?
14 A. "PATIENT WITHOUT VITAL SIGNS PRESENT. LISTENED TIMES
15 FIVE MINUTES FOR HEART RATE AND RESPIRATIONS. NONE NOTED.
16 SUPERVISOR, DOCTOR, SOCIAL WORKER NOTIFIED."
17 Q. WHAT DID YOU DETERMINE WHEN SHE WAS WITHOUT VITAL SIGNS?
18 A. THAT SHE HAD DIED.
19 Q. HAVE YOU HAD OCCASION TO GO BACK AND LOOK AT THE
20 MORPHINE SHOTS THAT WERE GIVEN ON THE 3RD OF JANUARY TO
21 JUDITH LARSEN?
22 A. YES.
23 Q. LET'S GET TO THE RIGHT PAGE HERE. LET'S LOOK AT 507.
24 EVIDENTLY THIS WAS WRITTEN UP HERE AT 1/1 AND DOWN HERE AT
25 1/3. WHY IS IT WRITTEN IN TWO DIFFERENT PLACES LIKE THAT?
1667
1 A. THE FIRST ORDER WAS MORPHINE AT FIVE MILLIGRAMS. AND
2 THEN, WHEN I RECEIVED THE ORDER TO INCREASE IT TO TEN, I HAD
3 TO YELLOW OUT THE STOP SECTION AND REWRITE THE CURRENT NEW
4 ORDER.
5 Q. AND THEN THE ACTUAL DATE THAT THEY WERE GIVEN IS WRITTEN
6 ACROSS THE TOP, IS THAT CORRECT?
7 A. CORRECT. ON THE VERY TOP WHERE IT SAYS 1/3.
8 Q. OKAY. AT 1/3 WE HAVE FIVE MILLIGRAMS AND YOU HAVE T.S.
9 AT 0030, OR 12:30 IN THE MORNING?
10 A. UH-HUH.
11 Q. T.S., BUT IT'S CIRCLED. WHAT DOES THAT MEAN?
12 A. IT WASN'T GIVEN.
13 Q. IS THAT TRACY SCHOLL?
14 A. YES, IT IS.
15 Q. AND THEN YOU HAVE AT 3:30 T.S., AND AGAIN CIRCLED.
16 AGAIN, WHAT DOES THAT MEAN?
17 A. NOT GIVEN.
18 Q. DID YOU EVER -- WERE YOU AT ANY MEETING WHERE THE
19 WITHHOLDING OF MORPHINE WAS DISCUSSED WITH DR. WEITZEL?
20 A. YES.
21 Q. DO YOU RECALL WHEN THAT WAS IN RELATIONSHIP TO THE 3RD
22 OF JANUARY?
23 A. IT WAS THAT DAY.
24 Q. AT WHAT TIME?
25 A. IN BETWEEN SHIFT CHANGES.
1668
1 Q. THERE'S SEVERAL SHIFTS.
2 A. RIGHT AROUND 1500.
3 Q. AND WHO WAS PRESENT AT THAT MEETING?
4 A. UMM, SHEILA HANSEN, OUR BOSS. TODD CHAMBERS WAS IN ON
5 IT FOR A SHORT TIME. MYSELF, TRACY, LYNN LONG. I'M TRYING
6 TO THINK. THERE WERE A COUPLE OF OTHER NURSES. I THINK
7 EARLENE COZZEN WAS. ONE OTHER NURSE. I CAN'T THINK OF HER
8 NAME.
9 Q. DO YOU RECALL WHAT THE DEFENDANT SAID AT THAT MEETING
10 ABOUT WITHHOLDING MORPHINE?
11 A. HE TOLD US THAT YOU WILL NOT HOLD MORPHINE IF
12 RESPIRATIONS ARE LOW. YOU WILL GIVE IT ROUND THE CLOCK. IF
13 YOU DON'T GIVE IT YOU WILL CALL ME FIRST.
14 Q. THEN WE HAVE AT 6:30 THAT MORNING L.L. WHO IS THAT?
15 A. LYNN LONG.
16 Q. WHAT TIME DID SHE GIVE IT?
17 A. AT 7:30.
18 Q. WHAT ABOUT 9:30?
19 A. SHE GAVE IT AGAIN.
20 Q. 12:30?
21 A. SHE GAVE IT AGAIN.
22 Q. 1530?
23 A. RICHARD CLARK GAVE THAT DOSE AT 1700.
24 Q. AND THEN WE HAVE NOTHING FURTHER THERE. WHY IS THAT?
25 IF YOU LOOK DOWN TO THE BOTTOM PART.
1669
1 A. OKAY. THE 1830, THAT WAS WHEN DR. WEITZEL WAS CALLED
2 AND HE INCREASED THE DOSE TO 10 MILLIGRAMS.
3 Q. SO THAT'S WHAT IS CHARTED DOWN BELOW?
4 A. CORRECT.
5 Q. WAS THAT DOSE GIVEN AT 1830?
6 A. YES, IT WAS.
7 Q. WAS THE DOSE GIVEN AT 2130?
8 A. NO, IT WAS NOT.
9 Q. DO YOU KNOW WHY IT WASN'T GIVEN AT 2130?
10 A. THE PATIENT WAS DECEASED, OR CLOSE TO. SHE WAS DECEASED
11 AT 2010 ACCORDING TO THIS RECORD.
12 Q. THIS WAS WHAT YOU CALL A SCHEDULED DOSE?
13 A. YES.
14 Q. WERE THERE ANY OTHER DOSES GIVEN ON THE 3RD OF JANUARY?
15 LET'S LOOK AT NUMBER 509.
16 A. THERE WERE A TOTAL OF NINE INJECTIONS GIVEN ON THE 3RD
17 OF MORPHINE.
18 Q. OKAY. WE HAD THIS ONE, THAT LOOKS LIKE RICHARD CLARK,
19 CHARTED AS GIVING 10 MILLIGRAMS AT 1830?
20 A. CORRECT.
21 Q. NOW LET'S LOOK AT 509. DO YOU SEE ANY CHARTING OF
22 MORPHINE ON THAT?
23 A. YES. THAT WAS THE 15 MILLIGRAMS NOW ORDERED. THAT WAS
24 A VERBAL ORDER.
25 Q. AT WHAT TIME?
1670
1 A. IT WAS GIVEN AT 1830.
2 Q. SO THE SAME TIME?
3 A. CORRECT.
4 Q. NOW LET'S LOOK AT 510. DO YOU SEE ANY DOSAGES ON THE
5 3RD OF JANUARY ON THIS DOCUMENT?
6 A. YES. THREE DOSAGES GIVEN ON THE 3RD.
7 Q. WHAT TIME WAS THE FIRST ONE?
8 A. IT LOOKS LIKE TEN O'CLOCK.
9 Q. WHO GAVE THAT ONE?
10 A. LYNN LONG.
11 Q. HOW MUCH WAS IT?
12 A. 25 MILLIGRAMS.
13 Q. WHAT'S THE NEXT ONE?
14 A. 30 MILLIGRAMS AT ELEVEN O'CLOCK.
15 Q. WHO GAVE THAT ONE?
16 A. LYNN LONG.
17 Q. WHAT ABOUT THE NEXT ONE?
18 A. 30 MILLIGRAMS GIVEN AT 2:45 THAT AFTERNOON BY LYNN LONG.
19 Q. WERE THOSE IN ADDITION TO THOSE LISTED ON THE SCHEDULE?
20 A. YES. THOSE ARE ADDITIONAL ONES WHEN THEY'RE PUT IN THAT
21 AREA.
22 Q. DID YOU HAVE OCCASION TO GO THROUGH AND ADD UP HOW MANY
23 MILLIGRAMS WERE GIVEN ON THE 3RD OF JANUARY?
24 A. I HAVE NOT ADDED UP THE MILLIGRAMS, JUST THE AMOUNT OF
25 INJECTIONS, OR THE NUMBER, I MEAN.
1671
1 Q. BUT THE INJECTIONS WERE DIFFERENT, IS THAT CORRECT,
2 DIFFERENT AMOUNTS?
3 A. DIFFERENT AMOUNTS, YES.
4 Q. LET'S LOOK AT 507 AND ADD THEM UP. WE HAVE THE TWO FIVE
5 MILLIGRAMS AT --
6 A. WHAT TIME FRAME?
7 Q. 507. WE'RE TALKING FROM, IT LOOKS LIKE, MIDNIGHT ON THE
8 3RD OF JANUARY.
9 A. OKAY.
10 Q. LET'S ADD THEM UP TOGETHER. SO THE FIRST TWO FIVE
11 MILLIGRAMS WERE NOT GIVEN?
12 A. CORRECT.
13 Q. SO WE HAVE 5, 10, 15, 20 GIVEN UP TO 1530. AND THEN AT
14 1830 ANOTHER TEN, IS THAT WHAT --
15 A. 30 TOTAL.
16 Q. SO 30 TOTAL. THEN WE HAVE THE ADDITIONAL 1830 THAT WAS
17 15 MILLIGRAMS. HOW MUCH IS THAT NOW?
18 A. 45.
19 Q. THEN WE HAVE THREE MORE HERE. WE HAVE 25.
20 A. SO 65.
21 Q. 60 OR 65. AND THEN 30 MORE?
22 A. ANOTHER 90.
23 Q. UP TO 90. THEN YOU HAVE ANOTHER 30 OVER HERE AT 1445.
24 A. THAT'S 120 MILLIGRAMS.
25 MS. BARLOW: IF I MAY HAVE A MOMENT, YOUR HONOR?
1672
1 THE COURT: YOU MAY.
2 (PAUSE IN THE PROCEEDINGS.)
3 Q. (BY MS. BARLOW) IF YOU WILL PULL OUT -- LET ME --
4 BEFORE WE LEAVE JUDITH LARSEN, ON THE 3RD OF JANUARY, WHILE
5 YOU WERE ON SHIFT, DID YOU SEE ANY SIGNS OR SYMPTOMS OF
6 PAIN?
7 A. NO, I DID NOT. See symptoms of pain>> So disingenuous.
8 Q. LET'S PULL MARY CRANE'S BINDER.
9 A. (WITNESS COMPLIED.)
10 Q. DO YOU RECALL MARY CRANE?
11 A. YES, I DO.
12 Q. DID YOU WORK WHILE SHE WAS THERE?
13 A. I BELIEVE I DID. I CAN CHECK. (PAUSE.) YES.
14 Q. DO YOU RECALL WHAT DAY SHE CAME ON THE UNIT?
15 A. JUST FROM HER PAPERWORK HERE. IT WOULD HAVE BEEN ON THE
16 28TH OF DECEMBER.
17 Q. AT WHAT TIME?
18 A. AT 1500.
19 Q. IF YOU WOULD TURN TO PAGE 231.
20 A. (WITNESS COMPLIED.)
21 Q. WHAT IS 231? WELL, 231, 232 AND 233, WHAT ARE THOSE?
22 A. THAT'S DR. WEITZEL'S PSYCHIATRIC EVALUATION.
23 Q. DO YOU RECOGNIZE WHAT THIS DOCUMENT IS? WELL, I THINK
24 YOU JUST ANSWERED THAT. I'M SORRY. I'LL GO TO SOMETHING
25 THAT'S NOT REPETITIVE.
1673
1 PAST PSYCHIATRIC HISTORY ON 231. THERE'S SOME WORDS IN
2 THERE THAT IF YOU CAN HELP US WITH THEM I'D APPRECIATE THAT.
3 APPARENT PSYCHOGENIC POLYDIPSIA?
4 A. YES.
5 Q. DO YOU KNOW WHAT THAT IS?
6 A. POLYDIPSIA IS AN EXCESSIVE AMOUNT OF WATER INTAKE.
7 Q. OKAY. WITH HYPONATREMIA. WHAT'S THAT?
8 A. HYPONATREMIA IS LOW SODIUM IN THE BLOOD.
9 Q. AND ARE THOSE TWO CONNECTED?
10 A. YES, THEY ARE.
11 Q. AND THEN WE'VE GOT, DOWN AT THE BOTTOM, SOME SIGN OF
12 TARDY DYSKINESIA. WHAT IS THAT?
13 A. THAT IS USUALLY A SYMPTOM, AFTER THEY'VE BEEN ON SOME
14 PSYCHOTROPICS, THAT THEY EXHIBIT. IT'S AN ADVERSE EFFECT.
15 Q. WHAT'S THE SYMPTOM THAT SHOWS?
16 A. THEY CAN HAVE SOME SHUFFLING OF THEIR FEET; A RIGIDNESS
17 WHERE THEY'RE KIND OF JERKY AS THEY MOVE. Wrong. She's describing akasthisia.
18 Q. GOING TO THE NEXT PAGE, 232, IF YOU'LL HELP US WITH SOME
19 WORDS. THE WORD DYSPHORIC. "SPEECH IS NORMAL IN RATE,
20 RHYTHM, FLUENCY. MOOD IS QUITE DYSPHORIC." WHAT'S THAT?
21 A. ACTUALLY NOT RESPONDING, KIND OF FLAT, DESPONDENT.
22 Q. KIND OF QUIET?
23 A. DEPRESSED.
24 Q. OKAY. AFFECT SLIGHTLY LABILE?
25 A. IT GOES FROM HAPPY TO SAD. IT'S NOT AT A CONSISTENT
1674
1 LEVEL. IT KIND OF GOES BACK AND FORTH.
2 Q. WHAT IS AFFECT?
3 A. AFFECT IS THE FACIAL, THEIR POSTURE. HOW THEY POSITION
4 THEMSELVES, HOW THEY PRESENT THEMSELVES PHYSICALLY TO YOU.
5 Q. LET'S GO TO THE NEXT PAGE. RIGHT IN THE CENTER THERE,
6 WHAT WAS THE ESTIMATED LENGTH OF HOSPITALIZATION?
7 A. TWO TO THREE WEEKS.
8 Q. IF YOU'LL TURN TO 238, PLEASE.
9 A. (WITNESS COMPLIED.)
10 Q. CAN YOU TELL US WHAT THIS IS?
11 A. THAT'S THE ADMISSION ORDER.
12 Q. AND CAN YOU TELL WHO TOOK THIS ORDER?
13 A. LAURIE WILLSON.
14 Q. WAS IT BY TELEPHONE OR IN PERSON OR DO YOU KNOW?
15 A. IT'S A TELEPHONE ORDER, ACCORDING TO HER ANNOTATION.
16 Q. MAYBE JUST BRIEFLY, WE TALKED ABOUT TYLENOL AND MYLANTA
17 AND MILK OF MAGNESIA AND ZANTAC. WHAT'S LOPRESSOR?
18 A. YOU'RE BASICALLY GIVING THAT FOR BLOOD PRESSURE, HEART
19 CONDITIONS.
20 Q. AND GLUCOTROL?
21 A. THAT'S A DIABETIC MEDICATION.
22 Q. ACCU-CHECK?
23 A. THAT'S WHERE WE TEST THE BLOOD SUGAR.
24 Q. DYAZIDE?
25 A. DYAZIDE IS A DIURETIC, WHICH MEANS WE TAKE OFF EXCESS
1675
1 FLUID. IT HELPS WITH HEART RATE, BLOOD PRESSURE.
2 Q. ARTIFICIAL TEARS?
3 A. THAT'S JUST TO KEEP THE EYES FROM DRYING OUT.
4 Q. IS IT CARAFATE?
5 A. CORRECT.
6 Q. WHAT'S THAT FOR?
7 A. ANOTHER MEDICATION FOR STOMACH UPSET, LIKE A ZANTAC, BUT
8 A LITTLE GENTLER.
9 Q. WHAT ABOUT LASIX?
10 A. THAT'S ANOTHER DIURETIC WHICH GETS RID OF EXCESS FLUID.
11 Q. YOU HAVE TWO DIURETICS. ONE SAYS EVEN, ONE SAYS ODD.
12 A. THEY KIND OF SWITCH. LASIX, WHEN YOU GIVE IT YOU
13 SOMETIMES DEPLETE THE BODY OF POTASSIUM, A NECESSARY ELEMENT
14 IN YOUR BODY. THEY KIND OF TAPER IT BETWEEN THE TWO SO YOU
15 DON'T GET TOO LOW IN POTASSIUM.
16 Q. WOULD THAT BE EVEN AND ODD DAYS?
17 A. CORRECT.
18 Q. AND THEN FERROUS SULFATE?
19 A. AN IRON PILL.
20 Q. METAMUCIL?
21 A. THAT'S TO HELP WITH STOOLS.
22 Q. WHAT IS RISPERDAL?
23 A. AN ANTI-PSYCHOTROPIC. !!!!
24 Q. HOW ABOUT SERZONE?
25 A. IT'S THE OTHER ONE, AN ANTIDEPRESSANT.
1676
1 Q. AND THERE'S TWO THINGS FOR SERZONE. YOU HAVE 50
2 MILLIGRAMS TWICE A DAY FOR TWO DAYS, THEN INCREASE TO 100
3 MILLIGRAMS. AM I READING THAT CORRECTLY?
4 A. CORRECT.
5 Q. TRAZODONE?
6 A. THAT'S ANOTHER ANTIDEPRESSANT SLEEPER.
7 Q. AND WHAT IS M.R.P.T.?
8 A. MAY REPEAT. WELL, IT'S SUPPOSED TO BE MAY REPEAT TIMES
9 ONE.
10 Q. IS THAT THE TRAZODONE?
11 A. YES.
12 Q. SIMILAR TO WHAT WE READ ON JUDITH LARSEN?
13 A. YES.
14 Q. IF YOU'LL TURN TO 239.
15 A. (WITNESS COMPLIED.)
16 Q. WHAT IS THAT TOP ORDER?
17 A. DURAGESIC PATCH, 25 MILLIGRAMS, TRANSDERMAL.
18 Q. WHAT DOES THAT MEAN?
19 A. TRANSDERMAL MEANS AN EXTERIOR PATCH. YOUR BODY
20 NATURALLY ABSORBS IT THROUGH THE SKIN. IT'S A DOSING TO
21 HAVE A LEVEL TYPE OF DOSING FOR PAIN.
22 Q. SO DURAGESIC PATCHES ARE FOR WHAT?
23 A. FOR PAIN.
24 Q. THAT'S A VERBAL ORDER?
25 A. YES, THAT IS.
1677
1 Q. AND THEN D.N.R. IS?
2 A. DO NOT RESUSCITATE.
3 Q. THEN IT LOOKS LIKE WE HAVE RELAFEN. WHAT IS THAT FOR?
4 A. THEY USE IT FOR ARTHRITIC PAINS, THINGS LIKE THAT. A
5 THOUSAND MILLIGRAMS WITH FOOD IT SAYS.
6 Q. UP HERE WE HAVE THIS ONE NOTED AT WHAT TIME, THE
7 DURAGESIC PATCH?
8 A. IT LOOKS LIKE -- I DON'T KNOW. THE ORDER WAS TAKEN AT
9 1950. I DON'T KNOW WHAT TIME SHE SIGNED IT OFF. IT LOOKS
10 LIKE 1900.
11 Q. AND THEN WE HAVE HERE ON THE SAME DATE CHANGED DURAGESIC
12 TO WHAT?
13 A. TO 50 MEGS.
14 Q. WHAT IS THAT?
15 A. JUST LIKE A MILLIGRAM. IT'S A DOSING. Thank you, Dr. Bonnie.
16 Q. DO YOU KNOW WHEN THAT WAS NOTED?
17 A. THAT WAS NOTED ON 12/28 AT 2100 BY LAURIE WILLSON.
18 Q. LET'S TURN TO THE NURSING NOTES.
19 A. (WITNESS COMPLIED.)
20 Q. ON 12/28, WHICH IS NUMBER 306, DID YOU WRITE THAT AT THE
21 TOP?
22 A. NO, I DID NOT.
23 Q. OKAY. BUT WHAT IS CHARTED THERE?
24 A. "P.R.N. MED GIVEN," MEANING AS NECESSARY," TYLENOL 650
25 MILLIGRAMS, P.O.,&q