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.," BY MOUTH, "GIVEN AS ORDERED AS PATIENT
1678
1 COMPLAINS OF HEADACHE."
2 Q. SO C.O. AND H.A. IS COMPLAINS OF HEADACHE?
3 A. CORRECT.
4 Q. AND WHAT WAS CHARTED AT 2000 HOURS?
5 A. "TYLENOL HELPFUL. PATIENT COMPLAINS STILL HAS HEADACHE
6 BUT IT'S BETTER."
7 Q. IS TYLENOL 650 A PRESCRIPTION MEDICINE?
8 A. IT'S AN OVER-THE-COUNTER MEDICATION, BUT THAT'S A NORMAL
9 DOSE FOR IT.
10 Q. THEN IF YOU WOULD TURN TO 307. AT THE TOP, AT 6:45,
11 "PATIENT SLEPT ALL SHIFT." THEN IT LOOKS LIKE AT 800
12 SOMETHING HAPPENED. CAN YOU READ WHAT HAPPENED?
13 A. LET'S SEE. AT THE VERY TOP IT SAYS, "PATIENT SLEPT ALL
14 SHIFT UNTIL SHE WAS AWOKEN FOR -- AWAKENED FOR HER CHEST
15 X-RAY. NO PROBLEMS NOTED IN SHIFT." THEN AT 0800,
16 "DURAGESIC PATCH CAME OFF. NEW DURAGESIC APPLIED."
17 Q. ON 311, WHICH WAS 12/31, THAT APPEARS TO BE THE FIRST
18 TIME THAT YOU -- YOUR SIGNATURE APPEARS ON IT?
19 A. UH-HUH.
20 Q. NOW, THIS WAS THREE DAYS AFTER SHE CAME IN?
21 A. CORRECT.
22 Q. DO YOU RECALL WHETHER YOU WORKED THOSE THREE DAYS AT
23 ALL?
24 A. I DON'T RECALL UNLESS THERE'S AN ANNOTATION. LET ME
25 CHECK THAT. NO, THERE IS NOTHING PRIOR TO THAT.
1679
1 Q. ON THE -- THIS IS DECEMBER 31ST?
2 A. CORRECT.
3 Q. IS THIS YOUR HANDWRITING IN THE CENTER?
4 A. AT 1030, YES.
5 Q. AND WHAT DID YOU WRITE?
6 A. "PATIENT VERY DROWSY, NOT ABLE TO STAY AWAKE."
7 Q. DO YOU SEE ANY SIGNS OR SYMPTOMS -- DID YOU SEE ANY
8 SIGNS OR SYMPTOMS OF PAIN WITH HER THAT DAY?
9 A. NO.
10 Q. AND THEN FOR A DIFFERENT SHIFT HERE, ON NUMBER 312, IT
11 APPEARS AS THE 1625 TO 2300 SHIFT, WHO WROTE THAT?
12 A. LYNN LONG.
13 Q. AND WHAT DID SHE WRITE?
14 A. FREE TEXT. "PATIENT WAS INCREASED AGITATED FROM 1900
15 ON. SCREAMING, TRYING TO HIT. HITTING C.N.A." THAT'S THE
16 CERTIFIED NURSING ASSISTANT. "DOCTOR NOTIFIED. PATIENT
17 MEDICATED WITH ATIVAN, TWO MILLIGRAMS, I.M., WITH GOOD
18 RESULTS. PATIENT SETTLED DOWN AND AGREED TO TAKE HER P.M.
19 MEDS."
20 Q. IS THERE ANY NOTATION OF PAIN IN THAT?
21 A. NO.
22 Q. ON THE NEXT DAY, 313 AND 314, DID YOU SEE THE PATIENT
23 THAT DAY ON THE 1ST OF JANUARY?
24 A. YES, I DID.
25 Q. WERE YOU THE ONE WHO NOTICED THE FECAL MATERIAL COMING
1680
1 FROM THE VAGINA?
2 A. YES.
3 Q. AND WHEN DID THAT OCCUR?
4 A. UMM, THAT OCCURRED WHEN WE WERE DOING THE PERI CARE
5 AFTER SHE'D HAD A BOWEL MOVEMENT.
6 Q. WHAT IS PERI CARE?
7 A. WHERE YOU CLEANSE THE PRIVATE AREA OF A PATIENT.
8 Q. OKAY. DO YOU RECALL ANY SIGNS OR SYMPTOMS OF PAIN AS
9 YOU WERE NOTICING THIS FECAL MATERIAL?
10 A. NO, I DID NOT.
11 Q. WHAT DID YOU DO?
12 A. I CONTACTED DR. DIENHART.
13 Q. DID YOU TELL -- DID YOU EVER -- AFTER YOU FOUND THIS AND
14 YOU CONTACTED DR. DIENHART, DID YOU TELL DR. WEITZEL THAT
15 YOU HAD CONTACTED DR. DIENHART?
16 A. YES, I DID.
17 Q. WHEN DID YOU TELL HIM THAT?
18 A. I CAN'T RECALL THE EXACT TIME.
19 Q. WAS IT THE SAME DAY?
20 A. I WOULDN'T BE ABLE TO TELL YOU THAT.
21 Q. WAS IT WITHIN A SHORT TIME PERIOD?
22 A. YEAH, BECAUSE WE HAD -- HE HAD AGREED TO HAVE A
23 GYNECOLOGIST COME IN AND TAKE AN EXAM, HAVE ANOTHER OPINION.
24 Q. DID YOU HAVE ANY DISCUSSION WITH THE DEFENDANT ABOUT
25 CALLING IN DR. DIENHART FOR THIS CONSULTATION, OR YOU MAKING
1681
1 THIS PHONE CALL, I GUESS, TO DR. DIENHART?
2 A. ON THIS PARTICULAR PATIENT, NO, THERE WAS NO
3 CONFRONTATION OR ANYTHING ABOUT IT.
4 THE COURT: HOW MUCH MORE TIME DO YOU HAVE WITH
5 THIS WITNESS?
6 MS. BARLOW: I THINK IT WILL TAKE QUITE A WHILE.
7 THE COURT: OKAY. LADIES AND GENTLEMEN, LET'S TAKE
8 OUR LAST BREAK FOR THE DAY. REMEMBER THAT WHILE ON THE
9 BREAK IT'S YOUR DUTY NOT TO CONVERSE AMONG YOURSELVES OR TO
10 CONVERSE WITH ANYONE ELSE REGARDING THE SUBJECT OF THIS
11 TRIAL. IT'S YOUR DUTY NOT TO FORM OR EXPRESS AN OPINION
12 UNTIL THE CASE IS FINALLY SUBMITTED TO YOU. LET'S COME BACK
13 AT 4:05.
14 (JURY OUT OF THE COURTROOM.)
15 THE COURT: WHERE ARE WE AT IN TERMS OF -- ARE WE
16 GOING TO GET THIS WITNESS DONE TODAY?
17 MS. BARLOW: I DON'T THINK WE ARE, ESPECIALLY WITH
18 CROSS-EXAMINATION.
19 THE COURT: OKAY. LAST WEEK I THOUGHT YOU WERE
20 TELLING ME THAT YOU THOUGHT -- WE DIDN'T SAY THIS TO THE
21 JURY, BUT THAT THE PLAINTIFF'S CASE MIGHT BE DONE BY
22 THURSDAY. WHAT ARE WE LOOKING AT NOW IN LIGHT OF HOW IT'S
23 MOVING?
24 MR. WILSON: YOUR HONOR, IT IS A LITTLE BIT
25 DIFFICULT TO SAY. I THINK THERE HAVE BEEN A NUMBER OF
1682
1 THINGS THAT HAVE OCCURRED AS A RESULT OF SOME OF THE RULINGS
2 ON OUR MOTIONS SO THAT WE'VE HAD TO REVISE SOME OF OUR
3 EXHIBITS. I'M STILL HOPEFUL THAT WE CAN FINISH UP SOMETIME
4 THIS WEEK.
5 THE COURT: OKAY. ONE OF THE LAST THINGS THAT THE
6 WITNESS READ WAS IT SAID PATIENT VERY DROWSY, NOT ABLE TO
7 STAY AWAKE. I THINK THAT DESCRIBES EVERYBODY HERE. I'VE
8 NOTICED FOR THE FIRST TIME TWO JURORS KIND OF NODDING THEIR
9 HEADS LIKE THIS. SO WHATEVER YOU CAN DO TO KEEP THEM AWAKE
10 AND KEEP EVERYBODY AWAKE WOULD HELP. I THINK THEY ARE
11 GETTING DROWSY. WE'RE TAKING REGULAR ONE HOUR BREAKS, BUT
12 LET'S TRY TO DO AS MUCH AS WE CAN TO KEEP THEM AWAKE. IF
13 YOU SEE ANY OF THEM SLEEPING, RAISE YOUR VOICE OR SOMETHING.
14 OKAY. WE'LL SEE YOU AT 4:05 ALSO.
15 (SHORT RECESS.)
16 THE COURT: WAS THERE SOMETHING TO ADDRESS BEFORE
17 THE JURY COMES BACK?
18 MR. STIRBA: YES, YOUR HONOR. ONE OF OUR LONG-TIME
19 EMPLOYEES HAD A FAMILY TRAGEDY LAST WEEK. HER GRANDDAUGHTER
20 IS GOING TO BE BURIED AND THERE'S A FUNERAL TOMORROW. IT
21 STARTS AT ELEVEN O'CLOCK IN RIVERTON. ALL OF US, AS PART OF
22 THE DEFENSE TEAM, FEEL THAT IT'S IMPORTANT THAT WE ATTEND
23 THAT FUNERAL. I'M WONDERING IF THE COURT -- WITH THE
24 COURT'S PERMISSION, PERHAPS WE COULD BE EXCUSED AT TEN
25 O'CLOCK. THE FUNERAL STARTS AT ELEVEN. THEN MAYBE
1683
1 RECONVENE HERE AT MAYBE TWO O'CLOCK, GIVEN THE NATURE OF THE
2 DISTANCES AND THE CIRCUMSTANCES. THAT'S THE SCHEDULING
3 ISSUE.
4 THE COURT: HOW ARE PEOPLE ABOUT STARTING EARLIER?
5 MR. STIRBA: THAT'S FINE WITH ME, JUDGE.
6 THE COURT: I MEAN, I'M HERE AT SEVEN.
7 MS. BARLOW: EIGHT O'CLOCK IS FINE. I DRIVE UP
8 FROM UTAH COUNTY.
9 THE COURT: THAT'S A LONG WAY. OKAY. SO WHAT
10 ABOUT GOING EIGHT TO TEN AND THEN TWO TO FIVE? THAT IS WHAT
11 YOU'RE SAYING?
12 MR. STIRBA: THAT WOULD BE GREAT IF THE COURT WOULD
13 ACCOMMODATE US.
14 THE COURT: IS THAT ALL RIGHT WITH YOU?
15 MS. BARLOW: THAT IS FINE, JUDGE.
16 THE COURT: OKAY. LET'S TALK TO THE JURY ABOUT
17 THAT BEFORE THEY LEAVE.
18 MR. STIRBA: THANK YOU, JUDGE.
19 THE COURT: ANYTHING ELSE TO DISCUSS OR CAN WE
20 BRING THEM BACK?
21 MS. BARLOW: THE STATE IS FINE.
22 THE COURT: OKAY. BRING THE JURY IN.
23 (JURY RETURNED TO THE COURTROOM.)
24 THE COURT: LADIES AND GENTLEMEN, WE HAD A
25 DISCUSSION BEFORE YOU CAME IN REGARDING THAT SOME OF THE
1684
1 PEOPLE THAT ARE INVOLVED IN THIS TRIAL HAVE A FUNERAL OF
2 SOMEBODY CLOSE TO THEM TOMORROW. THIS FUNERAL IS AT ELEVEN
3 A.M. IN RIVERTON. RIVERTON IS SOUTH OF SALT LAKE CITY SO IT
4 TAKES A WHILE TO GET THERE.
5 THEY'RE PROPOSING, IN LIGHT OF THAT, AND BOTH SIDES
6 HAVE AGREED AND THE WITNESS SAID SHE COULD ALSO BE HERE, IF
7 WE CAN GO FROM EIGHT TO TEN TOMORROW AND THEN TWO TO FIVE.
8 IS THAT GOING TO CREATE ANY HUGE GRIEF FOR ANYONE? IT WOULD
9 MEAN THAT YOU WOULD BE FREE FROM TEN O'CLOCK UNTIL TWO. IF
10 THAT'S NOT GOING TO CAUSE ANY GRIEF THEN WE WOULD ASK YOU TO
11 BE HERE AT EIGHT O'CLOCK TOMORROW MORNING.
12 I SUGGEST THAT SINCE WE'RE ONLY GOING TO GO FOR TWO
13 HOURS, LET'S TRY TO MAKE IT TWO HOURS. IF YOU NEED TO STAND
14 UP, STAND UP BETWEEN WITNESSES. IF YOU NEED A REST ROOM
15 BREAK, WE'LL DO THAT. BUT IF WE CAN GO EIGHT TO TEN AND
16 HAVE TWO HOURS, THEN MAYBE TAKE ONE BREAK IN THE AFTERNOON,
17 SO WE CAN GET AS MANY WITNESSES DONE TO MAKE UP FOR THE TIME
18 THAT WE'RE NOT IN COURT.
19 LET'S JUST PLAN ON THAT, EIGHT A.M. TOMORROW TO TEN AND
20 THEN TWO P.M. UNTIL FIVE. I APPRECIATE THAT. MS. BARLOW.
21 MS. BARLOW: THANK YOU, YOUR HONOR. I THINK I
22 NOTICED SOME SMILES ON THE JURY'S FACES.
23 THE COURT: BECAUSE THEY WANT TO COME EARLIER. WE
24 CAN COME AT SEVEN.
25 MS. BARLOW: NO. I DON'T KNOW THAT THAT WOULD
1685
1 BRING ANY SMILES.
2 Q. (BY MS. BARLOW) WE WERE TALKING ABOUT MARY CRANE. I
3 THINK THAT WE WERE TALKING ABOUT THE 1ST OF JANUARY.
4 A. WHAT PAGE WAS THAT, AGAIN?
5 Q. 313.
6 A. OKAY.
7 Q. YOU MADE A NOTATION AT 12 NOON AND WHAT IS THAT
8 NOTATION?
9 A. "DR. DIENHART IN TO SEE PATIENT. RECEIVED ORDERS FOR A
10 C.B.C. WITH DIFF AND A G.Y.N. CONSULT."
11 Q. WHAT'S A C.B.C. WITH DIFF?
12 A. A LAB THAT TESTS YOUR BLOOD FOR THE RED BLOOD CELLS, THE
13 WHITE BLOOD CELLS, INFECTION, THINGS LIKE THAT.
14 Q. AND THEN WHAT HAVE YOU WRITTEN AFTER?
15 A. G.Y.N. CONSULT. THAT A GYNECOLOGY CONSULT.
16 Q. AND WHAT NEXT?
17 A. DECREASE DURAGESIC PATCH TO 25 MEGS.
18 Q. OKAY. LET'S SEE IF WE CAN FIND THAT IN THE MEDICAL
19 NOTES. (PAUSE.) 284, DO YOU HAVE THAT?
20 A. OKAY.
21 Q. IT SAYS 1/1 ORDER DATE. WAS THE DURAGESIC PATCH
22 ORDERED?
23 A. THAT WAS WHEN IT WAS ORDERED, BUT IT'S ALSO YELLOWED
24 THROUGH.
25 Q. AND WHAT DOES THAT MEAN?
1686
1 A. THAT MEANS IT WAS DISCONTINUED. ORDERED THAT DAY AND
2 DISCONTINUED.
3 Q. OKAY. LET'S SEE IF WE CAN MAKE SENSE OUT OF THAT.
4 LET'S TURN TO THE PROGRESS -- NO, TO THE PHYSICIAN'S ORDERS.
5 A. PAGE 242.
6 Q. THANK YOU. I'D GONE TOO FAR. MY BIGGEST PROBLEM IS I
7 DON'T HAVE 242. CAN I PULL IT OUT OF YOURS SO I CAN SHOW IT
8 TO THE JURY?
9 A. (WITNESS COMPLIED.)
10 Q. I KNOW IT'S HARD TO READ. THIS IS DR. DIENHART'S?
11 A. THAT'S WHO I CALLED FOR A CONSULT ON HER.
12 Q. AND HE WROTE WHAT?
13 A. "DECREASE DURAGESIC PATCH TO 25 MEGS, Q THREE DAYS."
14 THAT MEANS CHANGE IT EVERY THREE DAYS. THAT'S THE
15 TRANSDERMAL PATCH ON THE OUTSIDE. HE ORDERED A C.B.C. TODAY
16 WITH A DIFFERENTIAL."
17 Q. AND DID YOU NOTE THIS?
18 A. YES, I DID.
19 Q. AND WHAT TIME DID YOU NOTE IT?
20 A. AT 1210.
21 Q. NOW, IF YOU HAVE 243, WHICH I ALSO SEEM TO BE MISSING.
22 WHAT TIME WAS THAT, AGAIN?
23 A. 1210.
24 Q. 1210. NOW WE HAVE, ON 1/1 -- WHO WROTE THIS NOTE, OR
25 THIS ORDER?
1687
1 A. THIS IS DR. WEITZEL'S WRITING.
2 Q. ACCU-CHECK TO CONTINUE FOR THE DIABETES?
3 A. UH-HUH.
4 Q. WHAT'S THE INSULIN SLIDING SCALE?
5 A. THAT'S TO COVER THE BLOOD SUGARS. IN CASE THEY WERE
6 ELEVATED GIVE INSULIN TO BRING THEM DOWN.
7 Q. AND THEN NUMBER THREE SAYS -- WHAT DOES THAT SAY?
8 A. "DURAGESIC, 15 MEGS. Q THREE DAYS." THAT'S AN INCREASE
9 ON THE DURAGESIC PATCH.
10 Q. AND WHEN WAS THAT NOTED?
11 A. THAT WAS NOTED AT 1700. FIVE O'CLOCK THAT AFTERNOON.
12 Q. THAT WAS ON THE 1ST, IS THAT CORRECT?
13 A. YES.
14 Q. I'LL GIVE YOU THAT BACK. DO YOU KNOW IF THAT PATCH
15 WAS -- IF EITHER OF THOSE PATCHES WERE ACTUALLY PLACED ON?
16 A. I KNOW THE 25 WAS NEVER DECREASED BEFORE IT WAS
17 DISCONTINUED. IT WAS YELLOWED OUT AND THERE WAS NO
18 ANNOTATION THAT IT WAS PUT ON.
19 Q. AND THAT'S ON 284?
20 A. YES.
21 Q. AND HOW DO YOU KNOW IT WASN'T DONE?
22 A. BECAUSE IT WASN'T INITIALED. USUALLY WE DON'T KEEP
23 THOSE IN STOCK. BY THE TIME WE GET THE PHARMACY TO BRING
24 THEM UP IT COULD BE A WHILE.
25 Q. LET'S LOOK AT 285 NOW. LET'S DON'T. THAT'S AN EARLIER
1688
1 ONE THAT WON'T HELP US. LET'S LOOK AT 286.
2 A. YES.
3 Q. WAS THE DURAGESIC PATCH PLACED ON?
4 A. YES, IT WAS.
5 Q. AND THAT WAS WHAT DAY?
6 A. ON THE 1ST.
7 Q. AT WHAT TIME?
8 A. AT SEVEN O'CLOCK THAT NIGHT.
9 Q. WHO DID IT?
10 A. LYNN LONG.
11 Q. WHILE WE'RE TALKING ABOUT DURAGESIC PATCHES, THAT DAY
12 WAS WHAT?
13 A. ON THE 1ST.
14 Q. LET'S LOOK AT 287, THE MEDICAL RECORD. CAN YOU TELL US
15 WHAT HAPPENED WITH THE DURAGESIC PATCH ON THIS DOCUMENT?
16 A. ON THE 4TH IT LOOKS LIKE IT WAS INCREASED AGAIN TO 75.
17 Q. AND AT WHAT TIME?
18 A. THAT WAS DONE AT 0800.
19 Q. AND WE HAVE SOME INITIALS HERE. WHAT DOES THAT MEAN?
20 A. THAT IT WAS GIVEN, PLACED.
21 Q. DO YOU KNOW WHOSE INITIALS THOSE ARE?
22 A. I BELIEVE THAT'S A GAL WE CALL SUSAN. I'M NOT REAL SURE
23 ON THAT ONE.
24 Q. LET'S GO BACK TO THE NURSE'S NOTES. WE'VE HAD THE
25 DURAGESIC PATCH INCREASED ON THE 1ST OF JANUARY, RIGHT?
1689
1 A. YES. FIRST IT WAS DECREASED BY DR. DIENHART.
2 Q. BUT THAT WAS NEVER PLACED ON?
3 A. THAT WAS NEVER DONE.
4 Q. LET'S LOOK AT 315. WHAT DATE WAS THIS?
5 A. 1/2/96.
6 Q. AND THE FREE TEXT SOMEONE WROTE ON 315?
7 A. ON PAGE 315?
8 Q. YES.
9 A. FREE TEXT, NIGHT SHIFT, "PATIENT RESTED WELL ALL NIGHT.
10 DID NOT GET UP OR MAKE ANY COMPLAINTS."
11 Q. DO YOU KNOW WHOSE SIGNATURE THAT IS?
12 A. NICKI HANCOCK. SHE'S A CERTIFIED NURSING ASSISTANT.
13 Q. AND THEN SOMEONE ELSE AND IT LOOKS LIKE TYLER SPRAGUE?
14 A. YES.
15 Q. HE WROTE THE B.I.R.P.?
16 A. YES.
17 Q. WHAT DID HE WRITE FOR BEHAVIOR?
18 A. "PATIENT HAS BEEN HITTING, THROWING FOOD, TRAY, ON FLOOR
19 AND KICKING STAFF. PATIENT HAS BEEN UNCOOPERATIVE WITH
20 STAFF. PATIENT HAS BEEN ALERT AND DISORIENTED."
21 Q. NOW, THOSE ARE BOTH WRITTEN FOR THE SAME TIME FRAME, IS
22 THAT CORRECT?
23 A. NO. THE NIGHT SHIFT WAS NICKI AND TYLER WOULD HAVE BEEN
24 ON THE DAY SHIFT, BECAUSE THEY ONLY HAVE ONE C.N.A. ON AT
25 NIGHTS.
1690
1 Q. SO WE JUST DON'T HAVE THE TIME?
2 A. CORRECT.
3 Q. OKAY. ON 316 THERE IS YOUR SIGNATURE AT THE BOTTOM?
4 A. CORRECT.
5 Q. DID YOU WRITE ANYTHING ON IT?
6 A. I DID THE INITIAL PHYSICAL ASSESSMENT.
7 Q. OVER HERE UNDER NEUROLOGICAL, DID YOU DO THAT?
8 A. UMM, CORRECT.
9 Q. WHAT DID YOU SEE IN MARY CRANE THAT DAY?
10 A. SHE WAS ALERT AND ALSO DISORIENTED.
11 Q. DID YOU CHART ANY SIGNS OR SYMPTOMS OF PAIN?
12 A. NO, I DID NOT.
13 Q. AND THAT'S THE 2ND OF JANUARY?
14 A. YES.
15 Q. CAN YOU LOOK AT 317.
16 A. (WITNESS COMPLIED.)
17 Q. THIS IS THE DAY SHIFT. WERE YOU ON THAT DAY OR DURING
18 THE DAY SHIFT, THAT SHIFT?
19 A. PAGE 317. LET'S SEE. I WOULD HAVE BEEN ON THE THREE TO
20 ELEVEN SHIFT ON THE 2ND. ON THE 3RD I WAS NOT ON. WELL,
21 YES, I WAS.
22 Q. WHAT TIME DID YOU COME ON?
23 A. ON PAGE 320 I WAS DOING A THREE P. THAT'S A THREE P.M.
24 TO ELEVEN P.M. SHIFT ON THE 3RD.
25 Q. LET'S LOOK AT 317.
1691
1 A. OKAY.
2 Q. FREE TEXT AT NOON.
3 A. FREE TEXT, LATE ENTRY. "PATIENT WAS CALM AFTER LUNCH.
4 TOOK A NAP. MORPHINE EFFECTIVE WITH DECREASE IN PAIN."
5 Q. OKAY. DO YOU HAVE ANY IDEA WHAT A.E.B. IS?
6 A. NO, I DO NOT. As evidenced by.
7 Q. SO GO ON FROM THERE.
8 A. "PATIENT SAYING, WHEN ASKED IF SHE STILL HAS PAIN, NO."
9 Q. WHO WROTE THAT?
10 A. LYNN LONG.
11 Q. AND THEN AT 1400?
12 A. FREE TEXT?
13 Q. FREE TEXT.
14 A. LATE ENTRY. "PATIENT AWOKE FROM NAP YELLING. WHEN
15 ASKED IF SHE HAD PAIN SHE SAID YES. WHEN ASKED IF HER TUMMY
16 HURT PATIENT SAID NO. ASKED IF SHE HAD A HEADACHE PATIENT
17 SAID YES. THEN PATIENT YELLED OH, OH, OH, HURRY. DOCTOR
18 NOTIFIED. PATIENT MEDICATED WITH MORPHINE, FIVE MILLIGRAMS,
19 PER DOCTOR'S ORDER."
20 Q. AND THEN AT 1530, AN HOUR AND A HALF LATER, FREE TEXT
21 AND WHAT WAS NOTED?
22 A. "PATIENT ASKED IF SHE WAS STILL IN PAIN. PATIENT SAID
23 YES. PATIENT ASKED IF SHE HAD HEAD OR TUMMY PAIN. PATIENT
24 RESPONDED YES, ALTHOUGH HER DIMINISHED MENTAL CONDITION
25 MAKES HER RESPONSE SUSPECT AS FAR AS ACCURACY GOES."
1692
1 Q. DO YOU UNDERSTAND WHAT THAT -- WELL, LET'S NOT PUT IT
2 THAT WAY. DID YOU EVER ASK ANY OF THESE PATIENTS IF THEY
3 WERE IN PAIN?
4 A. UMM, NOT REALLY. BECAUSE OF THE COGNITIVE STATUS YOU
5 COULDN'T REALLY RELY A LOT ON A YES OR NO. IF THEY'RE ALERT
6 AND DISORIENTED, THEY'RE NOT ABLE TO PROCESS -- NORMALLY
7 WHAT A NURSE WOULD SAY --
8 MR. STIRBA: I'LL OBJECT. I THINK THE QUESTION WAS
9 DID YOU EVER ASK IF THESE PATIENTS WERE IN PAIN. NOW WE'RE
10 HAVING A NARRATIVE.
11 THE COURT: GO AHEAD.
12 Q. (BY MS. BARLOW) WHY DID YOU NOT ASK IF THEY WERE IN
13 PAIN?
14 A. I DIDN'T THINK --
15 MR. STIRBA: I'LL OBJECT. IRRELEVANT.
16 MS. BARLOW: I THINK IT'S VERY RELEVANT TO THIS
17 NOTATION.
18 MR. STIRBA: YEAH, BUT IT'S A COMMENT AND IT'S LAY
19 OPINION. IT'S NOT RELEVANT.
20 THE COURT: SUSTAINED.
21 Q. (BY MS. BARLOW) AS A NURSE DO YOU LOOK FOR SIGNS AND
22 SYMPTOMS OF PAIN?
23 A. YES, I DO.
24 Q. DO YOU ASK PATIENTS IF THEY'RE IN PAIN?
25 A. IF THEY'RE COGNITIVELY ABLE TO ANSWER YES OR NO.
1693
1 Q. IF A PATIENT'S COGNITIVE FUNCTION IS DECREASED, DO YOU
2 RELY ON --
3 MR. STIRBA: I'LL OBJECT, YOUR HONOR. IT'S
4 IRRELEVANT. IT'S NOT WITH RESPECT TO THESE FIVE PATIENTS.
5 THE COURT: I HAVEN'T HEARD THE QUESTION.
6 MR. STIRBA: I'M SORRY, YOUR HONOR.
7 Q. (BY MS. BARLOW) LET'S TALK ABOUT THESE FIVE PATIENTS.
8 WERE THESE FIVE PATIENTS COGNITIVELY DIMINISHED?
9 MR. STIRBA: OBJECTION. CALLS FOR AN OPINION SHE'S
10 NOT COMPETENT TO MAKE.
11 THE COURT: LAY A FOUNDATION. I THINK THE QUESTION
12 IS WHETHER SHE ASKED THEM ABOUT PAIN. WASN'T THAT WHAT YOU
13 WERE ASKING?
14 MS. BARLOW: THAT WAS THE INITIAL QUESTION, YES.
15 Q. (BY MS. BARLOW) DID YOU ASK ANY OF THESE PATIENTS
16 ABOUT PAIN?
17 A. NO, I DID NOT.
18 Q. AS A NURSE, BASED ON YOUR EXPERIENCE -- I NEED TO FIGURE
19 OUT HOW TO PHRASE THIS.
20 DID YOU HAVE OCCASION TO ASSESS THESE FIVE PATIENTS'
21 ABILITY TO UNDERSTAND WHAT WAS GOING ON, JUST YES OR NO?
22 A. YES.
23 Q. OKAY. AND WHAT DID YOU USE TO BASE THAT ASSESSMENT ON?
24 A. YOU WOULD WORK BY ASKING SIMPLE QUESTIONS. THE DATE, DO
25 THEY KNOW WHERE THEY'RE AT, THEIR NAME. BASIC ORIENTATION
1694
1 TYPE QUESTIONS TO SEE WHERE THEIR LEVEL OF UNDERSTANDING IS
2 AT.
3 Q. WITH THESE FIVE PATIENTS DID YOU DO THAT KIND OF AN
4 ASSESSMENT?
5 A. YES, I DID.
6 Q. AND WHAT DID YOU FIND, LET'S SAY WITH MARY CRANE, ABOUT
7 HER ABILITY TO ANSWER THOSE KINDS OF QUESTIONS?
8 A. SHE WAS ORIENTED TO SELF, MEANING THAT SHE KNEW WHO SHE
9 WAS. SHE WAS NOT ORIENTED TO TIME, PLACE OR THAT DAY'S
10 ENVIRONMENT.
11 Q. BASED ON THAT DID YOU MAKE A DETERMINATION AS TO WHETHER
12 TO ASK MARY CRANE WHETHER SHE WAS IN PAIN OR NOT?
13 A. YES.
14 Q. AND WHAT WAS YOUR DETERMINATION?
15 A. THAT SHE WOULD NOT BE ABLE TO ANSWER THAT APPROPRIATELY.
16 Q. THANK YOU. WHEN NEXT DID YOU SEE MARY CRANE AFTER THE
17 1ST OF JANUARY, 1996?
18 A. ON THE 3RD I DID HER ASSESSMENT.
19 Q. AND THAT IS NUMBER 320?
20 A. CORRECT.
21 Q. OVER TO THE RIGHT HERE IT SAYS MISTAKEN ENTRY AND IT
22 LOOKS LIKE R. CLARK, SO WE WON'T -- WELL, I WON'T ASSUME
23 ANYTHING. WHAT DOES THAT MEAN?
24 A. THAT MEANS THAT HE INADVERTENTLY CHARTED ON ANOTHER
25 PATIENT BY MISTAKE.
1695
1 Q. SO THAT HAS NOTHING TO DO WITH MARY CRANE?
2 A. NOTHING.
3 Q. WHAT PART, THEN, DID YOU FILL OUT OF THIS FORM?
4 A. THE PHYSICAL ASSESSMENT, WHERE IT STARTS WITH
5 NEUROLOGICAL.
6 Q. DOWN AT THE BOTTOM HERE?
7 A. YES. AND ALL THE WAY UP THROUGH ALL OF THE AREAS OF
8 PHYSICAL ASSESSMENT.
9 Q. WHAT DID YOU FIND ABOUT HER NEUROLOGICALLY?
10 A. SHE WAS ALERT AND DISORIENTED.
11 Q. DID YOU DO HER PSYCHO-SOCIAL ASSESSMENT?
12 A. YES.
13 Q. AND WHAT DID YOU FIND?
14 A. THAT SHE WAS ANXIOUS AND AGITATED; UNCOOPERATIVE WITH
15 THE SUPPORTIVE FAMILY.
16 Q. DID YOU CHART ANY PAIN ON THE 3RD OF JANUARY?
17 A. NO, I DID NOT.
18 Q. DO YOU RECALL SEEING ANY PAIN ON THE 3RD OF JANUARY?
19 A. NO, I DID NOT.
20 Q. WHEN NEXT DID YOU SEE MARY CRANE?
21 A. (PAUSE.) I DID NOT SEE HER AGAIN.
22 Q. DID YOU BECOME AWARE THAT SHE HAD DIED?
23 A. YES, I DID.
24 Q. NOW IF YOU WILL PULL OUT LYDIA SMITH'S BINDER.
25 A. (WITNESS COMPLIED.)
1696
1 Q. WHEN WAS LYDIA SMITH ADMITTED TO THE UNIT?
2 A. SHE WAS ADMITTED ON 12/20 AT 3:57 P.M. IN THE AFTERNOON.
3 Q. AND IF YOU'LL TURN TO 700.
4 A. (WITNESS COMPLIED.)
5 Q. WHAT IS THAT DOCUMENT?
6 A. THAT IS DR. WEITZEL'S PSYCH EVAL.
7 Q. LET'S TURN TO THE LAST PAGE OF IT. THAT'S NUMBER 702.
8 WHAT WAS THE ESTIMATED LENGTH OF HOSPITALIZATION?
9 A. THREE WEEKS.
10 Q. WHAT'S THE DISCHARGE CRITERIA?
11 A. NO AGGRESSIVENESS AND IMPROVED MOOD.
12 Q. WHAT DOES IT MEAN BY DISCHARGE CRITERIA?
13 A. WHAT WE HOPE FOR HER TO ACHIEVE TO BE DISCHARGED.
14 Q. AND THE DISCHARGE PLAN?
15 A. BACK TO THE ROCKY MOUNTAIN CARE CENTER.
16 Q. MAYBE, WHILE WE HAVE THAT IN FRONT OF YOU, DOWN HERE ARE
17 SOME INITIALS. DO YOU KNOW WHAT THE D STANDS FOR?
18 A. THAT'S THE DATE IT WAS DICTATED AND THE TIME.
19 Q. SO 12/21/95 AT 2238?
20 A. CORRECT.
21 Q. DO YOU KNOW HOW THAT TIME IS INDICATED FOR WHOEVER
22 WRITES THIS?
23 A. THE MACHINE PICKS IT UP WHEN HE TALKS ON THE PHONE AND
24 DICTATES. IT'S ALL DONE BY MACHINE.
25 Q. AND THEN WHAT IS THE T?
1697
1 A. THAT'S THE DATE THAT IT'S ACTUALLY TYPED BY THE
2 TRANSCRIPTIONIST.
3 Q. IS THAT THE SAME ON ALL OF THESE PSYCHIATRIC
4 EVALUATIONS?
5 A. YES, IT IS.
6 Q. LET'S TURN TO THE PHYSICIAN'S ORDER, WHICH IS 705.
7 WHAT'S THAT?
8 A. THAT THE ADMISSION ORDER, STANDING ORDER.
9 Q. AND WHO WROTE THIS?
10 A. UMM, I WROTE THE MEDICATION PART OF IT.
11 Q. DID YOU WRITE THIS TOP PART?
12 A. NO, I DID NOT.
13 Q. DO YOU KNOW WHO DID?
14 A. NO, I DO NOT. THOSE ARE STANDING ORDERS. THOSE ARE FOR
15 EVERYONE THAT COMES INTO THE UNIT, THAT FIRST SECTION.
16 Q. ABOUT THE E.K.G. AND THE TESTS?
17 A. THOSE ARE STANDING ORDERS FOR EVERYBODY THAT ENTERS THE
18 UNIT.
19 Q. WHEN WE GET DOWN HERE TO THE MEDS, WE WON'T GO THROUGH
20 TYLENOL AND MYLANTA, MILK OF MAGNESIA, SPECIAL PRECAUTIONS.
21 WHAT'S THE C.X.R.?
22 A. THAT'S A CHEST X-RAY.
23 Q. ABOVE THAT WHAT IS V.S., B.I.D.?
24 A. VITAL SIGNS TWICE A DAY.
25 Q. MEANING YOU ARE TO TAKE THE VITAL SIGNS?
1698
1 A. CORRECT.
2 Q. LASIX WE'VE TALKED ABOUT. K.C.L. IS WHAT?
3 A. POTASSIUM.
4 Q. AND WHY IS THAT ORDERED?
5 A. USUALLY, WHEN YOU'RE GIVEN LASIX, THE LASIX DEPLETES THE
6 BODY OF POTASSIUM SO YOU NEED TO REPLACE IT WITH AN ORAL
7 MEDICATION OR I.V. MEDICATION.
8 Q. WHAT'S LEVOXINE?
9 A. A HEART MEDICATION. IT SLOWS DOWN THE HEART TO PUMP
10 BETTER.
11 Q. NORMODYNE?
12 A. ALSO A HEART MEDICATION AND BLOOD PRESSURE.
13 Q. VASOTEC?
14 A. THE SAME THING.
15 Q. WE'VE TALKED ABOUT RISPERDAL. WE TALKED ABOUT SERZONE
16 AND ATIVAN. THIS IS A TELEPHONE ORDER HERE?
17 A. CORRECT.
18 Q. WHAT TIME DID YOU NOTE IT?
19 A. 6:15 THAT EVENING.
20 Q. LET'S LOOK AT THE NEXT ONE, 706. ON THE NEXT DAY
21 THERE'S AN ORDER FOR CIPRO?
22 A. CIPRO, 500 MILLIGRAMS. THAT'S AN ANTIBIOTIC.
23 Q. AND DOWN BELOW THAT, IT LOOKS LIKE THREE DAYS LATER,
24 U.A.?
25 A. YES. "U.A. TOMORROW. C. and S. IF INDICATED." THAT'S A
1699
1 CULTURE AND SENSITIVITY IF INDICATED.
2 Q. WHAT DO THESE ORDERS MEAN TO YOU?
3 A. HE WAS TREATING HER FOR A URINARY TRACT INFECTION.
4 Q. 707 IS THE ORDER ON CHRISTMAS, 12/25. WHO TOOK THAT
5 ORDER?
6 A. LYNN LONG.
7 Q. AND WHAT DOES IT SAY?
8 A. IT SAYS, "T.O. DR. WEITZEL TO LYNN LONG. IF PATIENT
9 REFUSES RISPERDAL GIVE HALDOL, TWO MILLIGRAMS I.M."
10 Q. WHAT'S RISPERDAL?
11 A. AN ANTI-PSYCHOTROPIC.
12 Q. AND HOW IS IT ADMINISTERED?
13 A. USUALLY BY MOUTH.
14 Q. AND HALDOL IS WHAT?
15 A. AN I.M. INJECTION. IT'S ALSO AN ANTI-PSYCHOTROPIC, AN
16 OLDER ONE.
17 Q. DID YOU HAVE WITH ANY OF THESE PATIENTS AN OCCASION
18 WHERE THEY REFUSED THE RISPERDAL?
19 A. YES.
20 Q. AND WHAT WOULD YOU DO?
21 A. USUALLY DR. WEITZEL COVERED THEM WITH THE HALDOL
22 INJECTION.
23 Q. DOWN AT THE BOTTOM HERE IT SAYS 12/29, DEPAKENE. DO YOU
24 KNOW WHAT THAT IS?
25 A. YES, I DO.
1700
1 Q. WHAT IS IT?
2 A. IT'S -- WELL, ITS AN ANTICONVULSIVE. IT HAS BEEN USED
3 WITH TREATMENTS OF PEOPLE WHO HAVE PSYCHOTIC DISORDERS.
4 IT'S KIND OF A NEW THING.
5 Q. THEN IT LOOKS LIKE COGENTIN?
6 A. YES.
7 Q. WHAT IS THAT?
8 A. THAT USUALLY REVERSES LIKE THE TARDY DYSKINESIA THAT WE
9 TALKED ABOUT, THOSE ADVERSE REACTIONS THAT WE DON'T WANT THE
10 PATIENT HAVING. IF WE NOTICE THEM RIGHT AWAY WE GIVE THE
11 COGENTIN AND IT KIND OF REVERSES IT. IF YOU DON'T TREAT IT
12 IT'S A LONG-TERM THING AND THEY CAN NEVER GET RID OF THAT.
13 Q. THESE MEDICATIONS HAVE SIDE EFFECTS?
14 A. YES, THEY DO.
15 Q. LET'S PULL OUT 710. DOWN AT THE BOTTOM, ON THE 3RD OF
16 JANUARY, THERE'S A QUINIDINE, TRANSDERMAL PATCH. DO YOU
17 KNOW WHAT THAT IS?
18 A. YES. THAT'S FOR BLOOD PRESSURE MEDICATION. USUALLY
19 THEY PUT THE PATCH ON TO TRY AND KEEP THE BLOOD PRESSURE
20 DOWN TO A MORE UNIFORM LEVEL.
21 Q. OKAY. AND THEN ON THE 7TH OF JANUARY, NUMBER 711,
22 WHAT'S THAT -- WELL, WE TALKED ABOUT THESE CHECKS. WHAT WAS
23 THE ORDER ON THE 7TH OF JANUARY?
24 A. MORPHINE SULFATE, FIVE MILLIGRAMS, IM, Q THREE HOURS
25 AROUND THE CLOCK.
1701
1 Q. AND THEN UNDERNEATH THAT WHAT IS WRITTEN?
2 A. "HOLD ALL OTHER MEDS." I DON'T KNOW WHAT THAT IS.
3 Q. IS IT OTHER THAN?
4 A. OTHER THAN MORPHINE, YES.
5 Q. AND WHAT IS UNDER THAT?
6 A. D.N.R., DO NOT RESUSCITATE.
7 Q. WHEN WAS THAT NOTED?
8 A. THAT WAS NOTED AT 9:30 THAT NIGHT.
9 Q. DOWN BELOW WE HAVE ONE THAT SAYS MISTAKEN ENTRY?
10 A. THAT HAS NOTHING TO DO WITH THIS PATIENT.
11 Q. THE NEXT PAGE, JANUARY 8TH, WHAT'S THAT ORDER?
12 A. "CHANGE MORPHINE ORDER TO M.S., 10 MILLIGRAMS, Q THREE,
13 ROUND THE CLOCK. TELEPHONE ORDER, DR. WEITZEL, NOTED AT
14 0900."
15 Q. DO YOU KNOW WHAT HAPPENED AFTER -- WELL, ON THE 8TH OF
16 JANUARY TO LYDIA SMITH?
17 A. UMM, I WOULDN'T KNOW UNLESS I READ THE NOTES.
18 Q. OKAY. LET'S TURN TO THE NOTES. 746, WHAT IS THAT?
19 A. THAT'S THE BASIC NURSING ASSESSMENT THAT WE DO UPON
20 ADMISSION.
21 Q. AND WHO FILLED THIS ONE OUT?
22 A. THIS ONE WAS FILLED OUT BY A FAMILY MEMBER AND MYSELF.
23 Q. THE INFORMATION THAT YOU PUT ON HERE, WHERE DID YOU GET
24 IT?
25 A. FROM THE FAMILY.
1702
1 Q. 758, WHAT DATE WAS THIS?
2 A. THIS WAS ON 12/20 AT 5:30.
3 Q. AND WHO WROTE THIS NOTE?
4 A. I DID.
5 Q. WHAT DID YOU WRITE?
6 A. "ADMIT NOTE. 90 YEAR OLD FEMALE ADMITTED FROM SOUTH
7 DAVIS HOSPITAL TO ROOM 311, BED TWO. PATIENT ACCOMPANIED BY
8 SEVERAL FAMILY MEMBERS. SON SIGNED ALL PAPERWORK. PATIENT
9 WAS AT" -- I DON'T KNOW. "LAKEVIEW HOSPITAL, NOVEMBER 1995,
10 DUE TO SUDDEN CONFUSION. WEAK AND INCONTINENT. INCREASED
11 FEVER WITH EXPRESSIVE APHASIA."
12 Q. WHAT IS EXPRESSIVE APHASIA?
13 A. NOT ABLE TO TALK. "C.T. SCAN REVEALED HEMORRHAGING.
14 PATIENT PLACED IN LONG-TERM CARE WHERE SHE BECAME SEVERELY
15 AGITATED, COMBATIVE. PATIENT CALMED DURING INTAKE PROCESS."
16 Q. SO WHAT YOU SAW OF HER THEN, WAS THERE ANY PROBLEM IN
17 HER MOOD OR HER ACTIONS?
18 A. NOT DURING INTAKE, NO.
19 Q. AND THEN AT 2000 WHAT DID YOU WRITE?
20 A. "PATIENT UP, AMBULATING, BANGING ON DOOR. STAFF
21 REDIRECTED SEVERAL TIMES."
22 Q. AND TWO HOURS LATER?
23 A. "PATIENT OUT OF BED. PATIENT GIVEN NOURISHMENT. SPEECH
24 GARBLED AND UNINTELLIGIBLE. PATIENT RESPONDED TO
25 REDIRECTION WITH SPITTING, KICKING, STRIKING OUT. ATIVAN,
1703
1 ONE MILLIGRAM I.M., GIVEN."
2 Q. AND THEN FINALLY AT 2330?
3 A. "PATIENT RESTING IN BED, NO DISTRESS NOTED."
4 Q. DO YOU RECALL LYDIA SMITH?
5 A. YES, I DO.
6 Q. IS THERE ANY ONE THING THAT BRINGS HER TO MIND?
7 A. SHE HAD REAL PRETTY HAIR.
8 Q. DID SHE? WHAT WAS HER HAIR?
9 A. IT WAS PRETTY AND LONG.
10 Q. DO YOU RECALL HER ATTITUDE AS SHE FIRST CAME IN?
11 A. WHEN SHE FIRST CAME IN SHE WAS QUIET. THEN THE NORMAL
12 AGITATED STATE, WHICH A LOT OF PATIENTS DO WHEN THEY'RE
13 ADMITTED BECAUSE OF THE UNFAMILIAR SURROUNDINGS.
14 Q. DO YOU RECALL WHEN YOU NEXT SAW LYDIA SMITH?
15 A. IT APPEARS TO BE ON THE 24TH OF DECEMBER.
16 Q. AND THAT'S 766?
17 A. CORRECT.
18 Q. WHAT BEHAVIOR DID YOU SEE ON THE 24TH OF DECEMBER?
19 A. "PATIENT VERY AGGRESSIVE, HITTING STAFF, SPITTING AT
20 STAFF. PATIENT GETTING OUT OF CHAIR, LAYING ON FLOOR,
21 REFUSING STAFF'S ASSISTANCE AND REDIRECTION. POSEY ORDERED
22 TO PROVIDE SAFETY FOR PATIENT AND PREVENT INJURY. PATIENT
23 REFUSED FLUIDS."
24 Q. AND THEN AT 2100?
25 A. "PATIENT OFFERED FLUIDS AND MEDICATION. PATIENT SPIT AT
1704
1 STAFF, CLENCHED TEETH. REFUSED ASSISTANCE WITH ADL'S."
2 THOSE ARE ACTIVITIES OF DAILY LIVING.
3 Q. WHAT KINDS OF THINGS?
4 A. THAT WOULD INCLUDE BRUSHING HER TEETH AT NIGHT, GETTING
5 HER CLEANED UP FOR BED. DEPENDING ON THE TYPE OF DAY WHAT
6 WE ASSIST THEM WITH.
7 Q. AND THEN 2130?
8 A. "PATIENT IN BED, RESTING WITH EYES CLOSED. POSEY BELT
9 REMOVED. WILL MONITOR WITH BED CHECK AND SIDE RAILS."
10 Q. DO YOU RECALL ANY AGITATION THAT NIGHT WITH HER?
11 A. UMM, NOT AFTER THAT.
12 Q. DID YOU NOTE ANY?
13 A. JUST AT THE BEGINNING WITH THE AGITATION AND WE TOOK THE
14 APPROPRIATE LESS AGGRESSIVE MEASURES TO TRY TO REDIRECT HER
15 AND CALM HER DOWN.
16 Q. DID THAT WORK?
17 A. YES, IT DID.
18 Q. DID YOU NOTE ANY PAIN?
19 A. NO, I DID NOT.
20 Q. WHEN NEXT DID YOU SEE MS. SMITH?
21 A. ON THE 25TH OF DECEMBER.
22 Q. AND THAT IS 767. WHAT TIME OF DAY WERE YOU WORKING?
23 A. I THINK LIKE THE THREE TO ELEVEN SHIFT.
24 Q. SO WE HAVE LYNN LONG AND WHERE DOES YOUR -- DID YOU
25 WRITE ANYTHING?
1705
1 A. YES, I DID. PAGE 769.
2 Q. I'M SORRY. I DON'T HAVE THE CORRECT ONE UP THERE.
3 OKAY. WHAT WAS LYDIA DOING THAT DAY?
4 A. "PATIENT THROWING MILK CARTONS AT PATIENTS. ATTEMPTING
5 TO BITE STAFF, STRIKING OUT AT STAFF. PATIENT PULLING ARM
6 OF ANOTHER PATIENT. NOT RESPONDING TO STAFF'S REDIRECTIONS.
7 SPITTING AND GRABBING AT STAFF WHEN THEY COME WITHIN
8 REACHING DISTANCE. ATIVAN, ONE MILLIGRAM, GIVEN I.M. THREE
9 PERSON ASSIST TO GET PATIENT POSITIONED."
10 Q. IT TOOK THREE PEOPLE TO HOLD HER?
11 A. YES. SO WE COULD GIVE HER THE INJECTION.
12 Q. OKAY. AND WHAT DID YOU WRITE?
13 A. AND THEN "PATIENT REFUSES TO TAKE P.O. MEDICATION.
14 SLAPS AT NURSES."
15 Q. LET'S BACK UP. AFTER THE ATIVAN WHAT DID YOU WRITE?
16 A. "PATIENT TOLERATED PROCEDURE WELL." THAT MEANS THERE
17 WAS NO HARM DONE DURING THE INJECTION.
18 Q. AND 2030?
19 A. "PATIENT REFUSES TO TAKE P.O. MEDICATIONS. SLAPS AT
20 NURSE'S HAND. CLENCHING TEETH. I.M. HELD. ALL TWO
21 MILLIGRAMS GIVEN PER DOCTOR'S ORDERS IF PATIENT REFUSES P.O.
22 MEDICATION."
23 Q. AND THEN WHAT?
24 A. "PATIENT PLACED IN BED WITH TWO SIDE RAILS UP AND BED
25 MONITORED."
1706
1 Q. WHEN NEXT DID YOU SEE LYDIA SMITH?
2 A. ON THE 26TH I DID THE PHYSICAL ASSESSMENT.
3 Q. AND THAT'S 771?
4 A. CORRECT.
5 Q. WHAT WERE THE ASSESSMENTS THAT YOU POINTED OUT FOR
6 NEUROLOGICAL AND ALSO PSYCHO-SOCIAL?
7 A. NEUROLOGICAL WAS THAT SHE WAS ALERT AND DISORIENTED.
8 PSYCHO-SOCIAL, AGITATED, UNCOOPERATIVE.
9 Q. WHEN NEXT DID YOU SEE HER?
10 A. IT LOOKS LIKE MY SIGNATURE ON 12/27.
11 Q. DID YOU DO ANY FREE TEXT ON THAT DAY?
12 A. NO, I DID NOT.
13 Q. ON THE 26TH AND THE 27TH DID YOU SEE ANY SIGNS OR
14 SYMPTOMS OF PAIN? DID YOU CHART ANY?
15 A. NO. I DID THE PHYSICAL ASSESSMENT AGAIN AND DID NOT
16 CHART ANY PAIN.
17 Q. WHEN NEXT DID YOU SEE LYDIA SMITH?
18 A. ON THE 30TH.
19 Q. THAT'S NUMBER 781?
20 A. CORRECT.
21 Q. WHAT BEHAVIOR DID YOU CHART IN THAT SHIFT?
22 A. "PATIENT HAD NO AGGRESSIVE BEHAVIOR THIS SHIFT. SHE GOT
23 UP IN A.M. AND AMBULATED TO BATHROOM TO VOID. ATE BREAKFAST
24 WITHOUT STAFF CUEING," MEANING SHE JUST ATE IT ON HER OWN
25 WITHOUT US HAVING TO PUT THE SPOON UP TO HER MOUTH.
1707
1 "PATIENT DID NOT GRAB AT PATIENTS OR STAFF. DAUGHTER IN TO
2 VISIT. PLEASED WITH PATIENT'S PROGRESS.
3 "PATIENT UPSET THAT DAUGHTER HAD A NECK BRACE ON AND
4 TOLD DAUGHTER TO REMOVE BRACE." THAT MEANS THAT SHE WAS
5 CONNECTING WITH THE OUTSIDE, SO IT WAS IMPORTANT TO CHART
6 THAT TYPE OF THING.
7 "PATIENT REQUESTED PAPER AND PEN TO WRITE." THAT WAS
8 ANOTHER BREAKTHROUGH, THAT SHE WAS ACTUALLY REALIZING WHAT A
9 PEN AND PAPER WERE USED FOR.
10 "PATIENT SET OFF DOOR ALARM TIMES ONE," WHICH WAS AN
11 EXIT DOOR THAT IF THEY PRESSED THE HANDLE IT SENDS OFF AN
12 ALARM.
13 Q. DO YOU RECALL THIS DAY?
14 A. JUST FROM THE ANNOTATIONS HERE.
15 Q. WHAT WAS LYDIA LIKE THAT DAY?
16 A. SHE WAS DOING QUITE WELL. WE WERE QUITE PLEASED.
17 Q. WHEN NEXT DID YOU SEE LYDIA?
18 A. ON THE 30TH.
19 Q. I'M SORRY. 783 IS A DUPLICATE. LET'S SKIP THAT.
20 A. OKAY.
21 Q. 785.
22 A. OKAY. I DID THE PHYSICAL ASSESSMENT.
23 Q. AND WHAT WAS SHE LIKE THAT DAY?
24 A. SHE WAS LETHARGIC, DISORIENTED. ON THE PSYCHO-SOCIAL
25 SHE WAS DROWSY.
1708
1 Q. AND WAS THIS DIFFERENT FROM WHAT YOU'D CHARTED BEFORE
2 WITH HER?
3 A. YES, IT WAS.
4 Q. WHAT DID YOU SEE AS A CHANGE IN HER BEHAVIOR?
5 A. HER ALERTNESS WAS DECREASING. HER -- SHE JUST WASN'T
6 RESPONDING AS WELL AS SHE HAD THE PREVIOUS DAYS.
7 Q. THIS WAS WHAT DAY IN RELATIONSHIP TO THE LAST CHART?
8 A. THIS WAS THE 31ST AND THAT WAS THE 30TH, SO ONE DAY.
9 Q. WHEN NEXT DID YOU SEE HER?
10 A. ON THE 1ST I DID THE PHYSICAL ASSESSMENT.
11 Q. AND WHAT WAS HER BEHAVIOR LIKE ON THAT DAY?
12 A. SHE WAS ALERT, DISORIENTED, AGITATED. UNCOOPERATIVE
13 WITH THE SUPPORTIVE FAMILY.
14 Q. AND WHEN NEXT DID YOU SEE HER?
15 A. ON THE 2ND.
16 Q. AND THAT'S NUMBER 790?
17 A. YES.
18 Q. WHAT DID YOU WRITE ABOUT BEHAVIOR ON THE 2ND OF JANUARY?
19 A. "PATIENT VERY DROWSY DURING FIRST HALF OF SHIFT. DURING
20 SECOND HALF PATIENT AGITATED. REFUSED MEDICATIONS BY MOUTH.
21 FAMILY MEMBER TRIED TO FEED PATIENT FOOD. PATIENT STILL
22 REFUSED TO OPEN MOUTH FOR ANYTHING. NO DINNER EATEN.
23 PATIENT UP, AMBULATING IN HALLWAY WITH UNSTEADY GAIT." THAT
24 MEANS HER BALANCE.
25 "HELD OFF FIVE MILLIGRAMS I.M. GIVEN PER DOCTOR ORDER
1709
1 WHEN SHE REFUSES HER BY MOUTH RISPERDAL. PATIENT GOT OUT OF
2 BED TIMES THREE. DRESSED SELF AND PULLED GOWN UP. PATIENT
3 SLEEPING CURRENTLY. GAVE PATIENT A.D.L.'S." THAT'S THE
4 DAILY LIVING CARE. "ATTEMPTED TO GIVE BY MOUTH MEDICATIONS
5 AND PROVIDED P.R.N.," AS NECESSARY, "MEDICATIONS AND
6 REDIRECTED HER TWICE."
7 Q. DID YOU NOTE ANY PAIN ON THE 2ND OF JANUARY?
8 A. NO, I DID NOT.
9 Q. WHEN NEXT DID YOU SEE HER?
10 A. ON THE 3RD OF JANUARY.
11 Q. AND WHAT WAS SHE LIKE THAT DAY?
12 A. SHE WAS LETHARGIC, DISORIENTED, DROWSY, WITH -- SHE
13 APPEARED ANXIOUS AT NIGHT.
14 Q. AND THE NEXT TIME?
15 A. THAT WAS THE LAST TIME.
16 Q. YOU WERE NOT PRESENT WHEN SHE PASSED AWAY?
17 A. NO, I WAS NOT.
18 Q. WHAT DAY DID SHE PASS AWAY?
19 A. IT LOOKS LIKE THE 8TH OF JANUARY.
20 Q. LET'S TURN BACK TO THE PHYSICIAN'S ORDERS. I THINK WE
21 TALKED ABOUT THEM. 711, THERE WAS AN ORDER FOR MORPHINE, IS
22 THAT CORRECT?
23 A. YES.
24 Q. AND LET'S TURN TO THE MED CHARTS. DID YOU GIVE ANY OF
25 THOSE INJECTIONS? I BELIEVE IT'S ON 742.
1710
1 A. NO, I DID NOT.
2 Q. IT LOOKS LIKE THIS CONTAINS THE ORDERS FOR BOTH THE 7TH
3 AND THE 8TH. SO ON THE 7TH A SHOT WAS GIVEN AT WHAT TIME?
4 A. ON THE 7TH IT LOOKS LIKE SHE WAS GIVEN MORPHINE, FIVE
5 MILLIGRAMS, AT NINE O'CLOCK.
6 Q. AND THEN WHAT HAPPENED AT MIDNIGHT?
7 A. MIDNIGHT, LAURIE WILLSON DID NOT GIVE THE MEDICATION. I
8 MEAN WILLIAMS.
9 Q. AND THEN THREE O'CLOCK?
10 A. MEDICATION WAS GIVEN BY LAURIE WILLIAMS, FIVE
11 MILLIGRAMS.
12 Q. AND AT SIX O'CLOCK?
13 A. FIVE MILLIGRAMS OF MORPHINE BY LAURIE WILLIAMS.
14 Q. AND DOWN HERE WE HAVE 1/8 TO THE LEFT. WHY IS THERE A
15 CHANGE BETWEEN --
16 A. THE FIVE MILLIGRAMS WAS DISCONTINUED AND TEN MILLIGRAMS
17 WAS ORDERED. AN INCREASE IN DOSAGE.
18 Q. AND THEN THIS SAYS NINE A.M.?
19 A. CORRECT.
20 Q. IS THAT ON THE 7TH OR WAS IT ON THE 8TH?
21 A. UMM, I'M NOT SURE.
22 Q. IT APPEARS TO BE CHARTED UNDER THE 7TH, BUT WAS WRITTEN
23 ON THE 8TH, IS THAT CORRECT?
24 A. I'D HAVE TO LOOK BACK. (PAUSE.) THAT WAS WRITTEN ON
25 THE 8TH AT 0800.
1711
1 Q. SOMETIMES MISTAKES HAPPEN AND IT GETS PUT IN THE WRONG
2 BOX?
3 A. YEAH.
4 Q. SO WE HAVE NINE AND TWELVE, SHOT WAS GIVEN?
5 A. CORRECT.
6 Q. BY WHOM?
7 A. BY SHEILA HANSEN. I DON'T RECOGNIZE THAT OTHER ONE,
8 THAT ONE INITIAL.
9 Q. LET'S LOOK AT THE NURSE'S NOTES FOR THE 7TH. LET'S
10 START WITH THE 6TH, ACTUALLY, 799. WHAT IS THE BEHAVIOR
11 NOTED UP THERE AT 2130?
12 A. "PATIENT HAS BEEN QUIET THIS SHIFT. RESTED QUIET WITH
13 EYES CLOSED MOST OF SHIFT. RESPIRATIONS EVEN AND UNLABORED.
14 ATE NOTHING, NO SUPPER. NO EPISODES OF COMBATIVENESS. TOOK
15 MEDS AS ORDERED."
16 Q. AND DROP DOWN TO R, THE RESPONSE.
17 A. "PATIENT APPEARED TO SLEEP MOST OF THIS SHIFT. RESTING
18 QUIETLY WITH EYES CLOSED. RESPIRATIONS EVEN AND UNLABORED.
19 SLEPT IN CHAIR. ATE SUPPER. TOOK MEDS AS ORDERED. DID NOT
20 INTERACT IN GROUP. NO COMBATIVE EPISODES NOTED THIS SHIFT."
21 Q. ZERO COMBATIVE EPISODES THIS SHIFT?
22 A. CORRECT.
23 Q. LET'S GO TO THE NEXT DAY. THE NOTATIONS FOR THE 7TH,
24 WHAT SHIFT IS THIS?
25 A. AT THE START OF THAT THAT'S THE NIGHT SHIFT.
1712
1 Q. CAN YOU READ WHAT IT SAYS ON THE SECOND AND THIRD LINES?
2 A. OKAY. NIGHT SHIFT, FREE TEXT. "PATIENT RESTED QUIETLY
3 THROUGHOUT SHIFT."
4 Q. AND DROP DOWN TO 1400 HOURS.
5 A. "PATIENT NOT ABLE TO TAKE MEDS. PATIENT LETHARGIC,"
6 WHICH MEANS VERY DROWSY. "PATIENT UNRESPONSIVE. PATIENT
7 NOT SWALLOWING OR RESPONDING TO STAFF."
8 Q. DO YOU SEE ANY CHARTING OF PAIN?
9 A. NO, I DO NOT.
10 Q. LET'S GO OVER TO THE 8TH, WHICH IS NUMBER 802. CAN YOU
11 READ WHAT THEY SAID ON THE ELEVEN TO SEVEN SHIFT?
12 A. THAT'S THE NIGHT SHIFT. FREE TEXT. "PATIENT LYING IN
13 BED WITH EYES OPEN THROUGHOUT SHIFT. DEMONSTRATES MUCH" --
14 I CAN'T MAKE THAT OUT. REFLEXES OR SOMETHING. "GRASPING IN
15 RESPONSE TO PHYSICAL STIMULI. UNABLE TO MAKE ANY VERBAL
16 RESPONSE. MORPHINE, Q THREE, IM, AS SCHEDULED FOR COMFORT.
17 2400 DOSE OMITTED DUE TO PATIENT APPEARED IN NO ACUTE
18 DISTRESS AT THIS TIME. NURSING STAFF WAS ATTENDING ANOTHER
19 DYING PATIENT AND HER FAMILY. 0300 DOSE WAS GIVEN AT 2:30.
20 RESPIRATION RATE WAS 10 TO 12," WHICH IS BELOW NORMAL.
21 MR. STIRBA: YOUR HONOR, IF THE WITNESS WOULD JUST
22 ANSWER THE QUESTION AND NOT EDITORIALIZE. THIS ISN'T EVEN
23 HER NOTE.
24 THE COURT: ASK HER ANOTHER QUESTION.
25 Q. (BY MS. BARLOW) THE RATE SAYS WHAT?
1713
1 A. TEN TO 20 SECONDS.
2 Q. BASED ON YOUR NURSING EXPERIENCE, IS THAT A NORMAL RATE?
3 A. APNEIC PERIODS, MEANING THEY TAKE A DEEP BREATH AND
4 DON'T BREATH FOR A WHILE. THEY KIND OF HOLD THEIR BREATH.
5 Q. SO THAT'S WHAT THIS LINE IS?
6 A. UH-HUH. FOR 10 TO 20 SECONDS. IT'S LIKE HOLDING YOUR
7 BREATH AND COUNTING TO 10 OR 20.
8 Q. OKAY. THANK YOU. AND THEN LONG PERIODS OF AND WHAT IS
9 THAT? IN FACT, I'M NOT SURE WE CAN READ THAT.
10 A. SHALLOW RESPIRATIONS.
11 Q. AND THEN AT 1245, RECOGNIZING THAT THIS ISN'T YOUR NOTE,
12 WHAT WAS WRITTEN?
13 A. "PATIENT'S DAUGHTER REQUESTED US TO CHECK PATIENT
14 STATUS. I DON'T THINK SHE'S BREATHING. PATIENT CHECKED.
15 NO RESPIRATIONS, NO PULSE. PATIENT PLACED ON HER BACK WITH
16 HANDS TO SIDE. TEETH PLACED IN MOUTH."
17 Q. IN THOSE NOTES FOR THOSE LAST TWO DAYS, WERE THERE ANY
18 NOTATIONS OF PAIN ON THE 7TH AND 8TH?
19 A. NO.
20 MS. BARLOW: YOUR HONOR, THIS WOULD PROBABLY BE A
21 GOOD TIME TO BREAK BEFORE I GET INTO THE FINAL PATIENT.
22 THE COURT: ALL RIGHT. LADIES AND GENTLEMEN, AS
23 YOU GO HOME TONIGHT REMEMBER THAT IT'S YOUR DUTY NOT TO
24 CONVERSE AMONG YOUR SEVERAL OR CONVERSE WITH ANYONE
25 REGARDING THE SUBJECT OF THIS TRIAL OR ALLOW YOURSELF TO BE
1714
1 ADDRESSED BY ANY OTHER PERSON. IT'S ALSO YOUR DUTY NOT TO
2 FORM OR EXPRESS AN OPINION UNTIL YOU'VE HEARD THE ENTIRE
3 CASE AND IT IS FINALLY SUBMITTED TO YOU.
4 SINCE THIS IS ALSO THE END OF THE DAY, REMEMBER THAT
5 RADIO, TELEVISION, NEWSPAPERS, YOU ARE NOT TO READ ANY
6 ACCOUNTS OR LISTEN TO ANY ACCOUNTS OR EVEN WATCH ACCOUNTS
7 WITH THE SOUND DOWN. YOU SHOULD HEAR EVERYTHING ABOUT THIS
8 CASE FROM THE COURTROOM AND NOT OUTSIDE OF IT.
9 SO WE WILL SEE YOU WITH THAT ABBREVIATED SCHEDULE
10 TOMORROW. BE HERE AT EIGHT A.M. UNTIL TEN AND THEN TWO TO
11 FIVE TOMORROW. WE'LL SEE YOU AT EIGHT A.M. TOMORROW
12 MORNING.
13 (JURY OUT OF THE COURTROOM.)
14 THE COURT: THE RECORD SHOULD REFLECT THAT THE JURY
15 HAS LEFT THE COURTROOM. DO YOU HAVE YOUR WITNESSES FOR
16 TUESDAY WHO YOU ANTICIPATE CALLING? I MEAN, STARTING AFTER
17 THIS WITNESS.
18 MR. WILSON: I ANTICIPATE AND WE -- I BECAME AWARE
19 THAT THERE HAD BEEN A SITUATION ARISE WHICH NECESSITATED THE
20 ABBREVIATED SCHEDULE FOR TOMORROW. THIS DOES CREATE
21 PROBLEMS WITH OUR SCHEDULING AND WE'RE TRYING TO WORK THOSE
22 SCHEDULES OUT. WE HAVE THE REMAINING WITNESSES THAT WE
23 LISTED. HOWEVER, WE ALSO HAVE A PROBLEM WITH THE MEDICAL
24 EXAMINER ON HIS AVAILABILITY.
25 WE WOULD ANTICIPATE TOMORROW MORNING CONTINUING WITH
1715
1 THIS PARTICULAR WITNESS. I WOULD ASSUME THAT AT THE VERY
2 MOST WE PROBABLY WOULD FINISH UP WITH THIS WITNESS POSSIBLY
3 BY TEN O'CLOCK.
4 THE COURT: OKAY.
5 MR. WILSON: IN THE AFTERNOON WE'VE TRIED TO WORK
6 OUT SOMETHING WITH THE MEDICAL EXAMINER'S OFFICE. WE'D HAVE
7 MAUREEN FRIKKE POSSIBLY, OR WE MAY HAVE TO SUBSTITUTE SOME
8 OF THE OTHER WITNESSES. WE'LL TRY TO ACCOMMODATE THE
9 SCHEDULING. IT IS WORKING A HARDSHIP, PARTICULARLY WHEN WE
10 DON'T HAVE THE AVAILABILITY OF MOVING THE MEDICAL EXAMINER
11 OVER TO WEDNESDAY, OR AT LEAST FOR MAUREEN FRIKKE. AND WE
12 DO HAVE A TIGHT TIME LINE ON WEDNESDAY WITH THE MEDICAL
13 EXAMINER. SO IF THE COURT WOULD GRANT ME SOME LATITUDE I
14 WOULD APPRECIATE IT.
15 THE COURT: SURE. WHEN I RAISED THE ISSUE ABOUT
16 THE FUNERAL, I ASKED IF THAT WAS ALL RIGHT. YOU WEREN'T
17 HERE. MS. BARLOW SAID OKAY. I DIDN'T KNOW THAT THERE WOULD
18 BE A PROBLEM.
19 WHAT ABOUT THESE OTHER WITNESSES? YOU HAD PAUL JENSEN
20 AND THE LARSENS THAT YOU MENTIONED MIGHT BE WITNESSES TODAY.
21 CAN THEY BE AVAILABLE TOMORROW?
22 MR. WILSON: THEY CAN BE. WE JUST HAVE THOSE
23 PROBLEMS WITH THE MEDICAL EXAMINER AS I INDICATED TO THE
24 COURT. THERE MAY HAVE TO BE SOME ACCOMMODATION SOME WAY OR
25 ANOTHER ON THAT. WE WILL TRY TO PUT ON SUFFICIENT WITNESSES
1716
1 TO KEEP GOING TOMORROW, YOUR HONOR.
2 THE COURT: OKAY. DID YOU SAY YOU MAY OR MAY NOT
3 HAVE THIS ONE PERSON FROM THE MEDICAL EXAMINER TOMORROW,
4 DEPENDING ON THEIR SCHEDULE?
5 MR. WILSON: THAT'S TRUE. WE'RE JUST TRYING TO
6 WORK THAT OUT.
7 THE COURT: IF THERE'S ANY OTHER THING -- I MEAN,
8 IF YOU SAY THEY CAN'T BE HERE WEDNESDAY, IS THERE ANY
9 PROBLEM WITH THURSDAY OR FRIDAY FOR THAT WITNESS?
10 MR. WILSON: THERE IS. HE'S SUPPOSED TO BE IN
11 SUMMIT COUNTY ALL DAY THURSDAY. WE'LL WORK WITH THAT. I
12 THINK THERE'S A POSSIBILITY THAT WE CAN TAKE HIM FIRST THING
13 WEDNESDAY AND THAT'S WHAT WE ANTICIPATE, WITH TODD GREY.
14 THE COURT: ALL RIGHT. SO RIGHT NOW YOU ANTICIPATE
15 COMPLETING THIS WITNESS; POSSIBLY PAUL JENSEN; NORMA AND
16 HAROLD LARSON. DR. PAUL JENSEN, IS THAT THE LAST TREATER
17 THAT WE HAVE?
18 MR. WILSON: THAT'S CORRECT.
19 THE COURT: DO YOU PLAN ON HAVING THIS BEVERLY
20 FULGER TOMORROW OR NOT?
21 MR. WILSON: WE DO NOT PLAN TO HAVE HER TOMORROW AT
22 THIS TIME.
23 THE COURT: OKAY. THEN WE'LL SEE EVERYBODY BACK AT
24 EIGHT A.M. TOMORROW AND WE'LL GO UNTIL TEN; TAKE THE BREAK
25 AND GO FROM TWO TO FIVE.
1717
1 MR. STIRBA: THANK YOU, YOUR HONOR.
2 THE COURT: THANK YOU.
3 (WHEREUPON, THE AFTERNOON SESSION ENDS.)
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1718
1 IN THE DISTRICT COURT OF DAVIS COUNTY
2 STATE OF UTAH
3 *****
4 STATE OF UTAH, )
)
5 PLAINTIFF, )
) REPORTER'S TRANSCRIPT
6 VS. )
) CASE NO. 991700983
7 ROBERT ALLEN WEITZEL, )
)
8 DEFENDANT. )
9 *****
10
11 TRIAL - VOLUME 8 OF 21
12 JUNE 20, 2000
13 HONORABLE THOMAS L. KAY
14
15 *****
16 APPEARANCES:
17 FOR THE STATE: MR. MELVIN C. WILSON
MR. STEVEN V. MAJOR
18 MS. CHARLENE BARLOW
19 FOR THE DEFENDANT: MR. PETER STIRBA
MR. JOHN WARREN MAY
20
21
22
23
24
25
1719
1 (WHEREUPON, THE MORNING SESSION BEGINS.)
2 THE COURT: WILL YOU PLEASE BE SEATED? OKAY. THE
3 RECORD SHOULD REFLECT THAT THE PARTIES ARE PRESENT. THE
4 JURY IS HERE. AND I APPRECIATE EVERYONE, THE WITNESS, THE
5 ATTORNEYS, AND THE JURY, BEING HERE AT THE EARLIER HOUR. GO
6 AHEAD, MISS BARLOW.
7 MS. BARLOW: THANK YOU, YOUR HONOR.
8 BONITA HARDEY,
9 DIRECT EXAMINATION, CONT'D
10 BY MS. BARLOW:
11 Q. GOOD MORNING, BONNIE.
12 A. MORNING.
13 Q. DO YOU HAVE THE BINDER FOR ENNIS ALLDREDGE THERE?
14 A. YES.
15 Q. DO YOU RECALL MR. ALLDREDGE?
16 A. YES, I DO.
17 Q. WHAT DAY DID HE COME INTO THE HOSPITAL?
18 A. HE CAME IN ON JANUARY 10TH AT 12:03 P.M.
19 Q. DO YOU RECALL WHETHER YOU WERE THERE WHEN HE FIRST CAME
20 IN?
21 A. I WAS ON DUTY ON THAT DAY, YES.
22 Q. LET'S TURN TO THE PHYSICIAN ORDERS WHICH IS MED PAGE
23 NUMBER 10. WHAT DATE -- WHOOPS, BETTER HIT THE -- THERE.
24 WHAT DATE WERE THOSE ORDERS WRITTEN?
25 A. ON 1/10 AT 1300.
1720
1 Q. EXCUSE ME. CAN YOU TELL WHO WROTE THEM?
2 A. LYNN LONG.
3 Q. WE HAVE THE TOP PART THERE. WHAT WAS THAT TOP PART?
4 A. WHICH TOP PART?
5 Q. THE FIRST SECTION HERE, DOWN TO THAT FIRST --
6 A. OH, VITAL SIGNS B.I.D. TWICE A DAY.
7 Q. THAT WHOLE SECTION THERE, WHAT WAS THAT WRITTEN FOR?
8 A. THE SPECIAL PRECAUTIONS.
9 Q. WELL, THE WHOLE SECTION, THAT WHOLE TOP SECTION.
10 A. I'M SORRY.
11 Q. I'M SORRY, THIS WHOLE TOP SECTION DOWN TO THIS LINE.
12 A. OH, WHAT WAS THAT WRITTEN FOR?
13 Q. YES.
14 A. THAT'S YOUR BASIC ADMITTING ORDERS THAT THEY HAD, AND IT
15 WOULD TELL YOU WHAT DIAGNOSIS THEY HAD. DID YOU WANT ME
16 READ THAT OR --
17 Q. NO. BUT LET'S DO LOOK AT THE PRELIMINARY, IS THAT --
18 D.X., WHAT'S D.X.?
19 A. DIAGNOSIS.
20 Q. AND WHAT DOES THAT -- WHAT WAS THE PRELIMINARY
21 DIAGNOSIS?
22 A. PSYCHOSIS.
23 Q. AND DO YOU KNOW WHAT N.O.S. WAS?
24 A. UNKNOWN ORIGIN TYPE OF THING. Not otherwise specified.
25 Q. LET'S GO DOWN. WE HAVE LOOKS LIKE MEDICATIONS THAT WERE
1721
1 ORDERED. THE STANDARD TYLENOL, MYLANTA, MILK OF MAGNESIA.
2 INSULIN WAS ORDERED. WHAT DOES THAT TELL YOU ABOUT
3 MR. ALLDREDGE?
4 A. THAT HE IS A DIABETIC.
5 Q. WE HAVE RISPERDAL. I THINK WE TALKED ABOUT THAT
6 YESTERDAY. PEPCID. WHAT IS THAT?
7 A. IT'S FOR STOMACH.
8 Q. AND L-THYROXINE?
9 A. IT'S FOR THYROID.
10 Q. TRAZODONE, WE TALKED ABOUT. HOW DO YOU PRONOUNCE, BU --
11 A. BUMETADINE --
12 Q. BUMET -- BUMETADINE?
13 A. YEAH, IT'S --
14 Q. OKAY. THANK YOU. WHAT'S THAT FOR?
15 A. IT'S FOR BLOOD PRESSURE, HEART.
16 Q. AND THEN WE HAVE E.C.A.S.A.
17 A. THAT IS EXTENDED RELEASE ASPIRIN.
18 Q. AND OXYBUTYNIN.
19 A. THAT IS FOR LIKE PROSTATE, WHERE THEY'RE NOT ABLE TO
20 EMPTY THEIR BLADDER.
21 Q. DOES IT ALLOW VOIDING THEN?
22 A. YES, IT MAKES IT A LITTLE MORE COMFORTABLE.
23 Q. WHAT'S MICRO-K?
24 A. IT'S POTASSIUM.
25 Q. AND AGAIN, WHY WOULD YOU HAVE POTASSIUM?
1722
1 A. IF THEY'RE ON A DIURETIC, THAT DEPLETES THEIR POTASSIUM.
2 Q. AND A DIURETIC IS WHAT?
3 A. IT RELEASES FLUID FROM THE BODY SO THEY DON'T SWELL UP,
4 THEIR LEGS, AND MAKES IT EASIER FOR THEIR HEART TO PUMP.
5 Q. WHAT'S HYTRIN?
6 A. IT'S ALSO USED LIKE FOR PROSTATE PROBLEMS.
7 Q. AND THEN D.S.S.?
8 A. THAT'S A STOOL SOFTENER.
9 Q. AND BUSPAR?
10 A. IS A -- ALSO A PSYCHOTROPIC MEDICATION.
11 Q. THEN OF COURSE WE HAVE THE D.N.R. AGAIN. NOW, TURN TO
12 THE PSYCHOLOGICAL EVALUATION WHICH IS PAGE NUMBER 3. AND
13 THE THIRD PAGE OF THAT WHICH IS PAGE NUMBER 5, WHAT WAS THE
14 ESTIMATED LENGTH OF HOSPITALIZATION?
15 A. TWO TO THREE WEEKS.
16 Q. AND DISCHARGE CRITERIA?
17 A. BACK TO SUNSHINE TERRACE.
18 Q. OH, THE CRITERIA IS?
19 A. OH, NO COMBATIVENESS.
20 Q. AND THEN THE PLAN.
21 A. BACK TO SUNSHINE TERRACE.
22 Q. ARE YOU FAMILIAR WITH THE TERM HOSPICE CARE?
23 A. YES, I AM.
24 Q. AND HOW ARE YOU FAMILIAR WITH IT?
25 A. THROUGH THE HOSPITAL USUALLY WHERE I WORK.
1723
1 Q. AND WHAT IS HOSPICE CARE?
2 A. YOU'RE GIVING COMFORT CARE TO TERMINALLY ILL PEOPLE,
3 PATIENTS.
4 Q. AND DO YOU HAVE ANY DISCHARGE CRITERIA FOR HOSPICE CARE?
5 MR. STIRBA: YOUR HONOR, I'M GONNA OBJECT TO
6 RELEVANCE.
7 THE COURT: SUSTAINED.
8 MS. BARLOW: IF YOU WOULD TURN TO MED PAGE NUMBER
9 11, THE UPPER LEFT-HAND CORNER, THERE'S SOME WRITING. WHO
10 WROTE THAT?
11 A. THAT WAS WOULD BE DR. WEITZEL.
12 Q. AND WHAT HAS HE ORDERED HERE?
13 A. ATIVAN 1 MILLIGRAM AND HALDOL 10 MILLIGRAMS I.M. NOW.
14 Q. MEANING TO GIVE IT IMMEDIATELY, IS THAT CORRECT?
15 A. CORRECT.
16 Q. THEN WHAT ELSE?
17 A. ATIVAN 1 TO 2 MILLIGRAMS I.M. Q-4 HOURS P.R.N. SEVERE
18 AGITATION.
19 Q. AND THAT MEANS WHAT?
20 A. TO BE GIVEN AS NECESSARY IF THE PATIENT BECOMES
21 AGITATED.
22 Q. AND THE NEXT ONE?
23 A. HALDOL, 5 MILLIGRAMS, I.M. Q-A.M. 1700. AND H.S. MEANING
24 IN THE EVENING.
25 Q. WHAT DOES A.M. 1700 N.H.S. ALL TOGETHER MEAN?
1724
1 A. USUALLY A DOSE AT 8:00 O'CLOCK IN THE MORNING, 5:00
2 O'CLOCK IN THE AFTERNOON, AND ONE ABOUT 9:00 O'CLOCK IN THE
3 EVENING.
4 Q. AND CAN YOU TELL WHAT --
5 A. TO BE GIVEN P.R.N. IF PATIENT REFUSES RISPERDAL.
6 Q. DO YOU KNOW WHAT ATIVAN IS FOR?
7 A. WE USUALLY USE IT FOR AGITATION.
8 Q. AND WHAT ABOUT HALDOL?
9 A. IT'S A -- A PSYCHOTROPIC THAT CAN BE GIVEN I.M. WHEREAS
10 RISPERDAL CAN BE GIVEN ONLY P.O.
11 Q. DO YOU KNOW IF THERE'S ANY DIFFERENCE BETWEEN WHAT
12 ATIVAN'S SUPPOSED TO DEAL WITH AND WHAT HALDOL IS SUPPOSED
13 TO DEAL WITH?
14 MR. STIRBA: YOUR HONOR --
15 MS. BARLOW: I ASKED IF SHE NEW. IF SHE DOESN'T
16 KNOW, THEN SHE DOESN'T KNOW.
17 MR. STIRBA: WELL --
18 THE COURT: GO AHEAD.
19 THE WITNESS: YES, I DO.
20 Q. (BY MS. BARLOW) AND WHAT IS THAT KNOWLEDGE BASED ON?
21 A. FROM READING PHARMACOLOGY BOOKS, OF PRIOR EXPERIENCE
22 USING THE MEDICATION.
23 Q. WHAT ARE PHARMACOLOGY BOOKS?
24 A. DRUG BOOKS THAT THE NURSES USE TO LOOK UP MEDICATIONS,
25 LOOK FOR THEIR ADVERSE EFFECTS, WHAT THEY'RE USED FOR.
1725
1 Q. BASED ON THAT, WHAT -- WHAT IS -- IS THERE ANY
2 DIFFERENCE BETWEEN THE USE OF ATIVAN AND HALDOL?
3 MR. STIRBA: YOUR HONOR, I'M GONNA OBJECT.
4 IRRELEVANT AND -- IT'S IRRELEVANT HYPOTHETICAL.
5 THE COURT: OVERRULED.
6 Q. (BY MS. BARLOW) IS THERE ANY DIFFERENCE IN THE USE OF
7 ATIVAN AND HALDOL?
8 A. THE USE THAT WE NORMAL USE ATIVAN FOR IS FOR EXTREME
9 AGITATION IN A PATIENT. HALDOL IS USUALLY USED FOR A
10 PSYCHOTROPIC EFFECT WHERE YOU'RE TRYING TO CALM DOWN THEIR
11 MAIN -- MANIC TYPE OF EPISODES. MOOD, USUALLY FOR A MOOD.
12 Q. IF YOU'D TURN TO THE NEXT PAGE, PAGE 12, IN THE UPPER
13 LEFT-HAND CORNER IS THE DATE 1/12/96. WHAT WAS THE ORDER
14 CHANGE AT THAT POINT?
15 A. INCREASE HALDOL TO 10 MILLIGRAMS I.M. P.R.N. PATIENT
16 REFUSING ORAL MEDICATIONS. GIVE IT A.M. 1700, MEANING
17 5:00 P.M. AND H.S., MEANING 9:00 O'CLOCK P.R.N.
18 Q. WHAT HAD BEEN THE DOSAGE BEFORE?
19 A. I BELIEVE IT WAS 5 MILLIGRAMS.
20 Q. AND DID YOU NOTE THAT?
21 A. YES, I DID NOTE THAT.
22 Q. AT WHAT TIME?
23 A. AT 10:45 A.M.
24 Q. THE NEXT NOTE, WHAT IS THAT?
25 A. M.R.I.
1726
1 Q. WHAT IS AN M.R.I.?
2 A. IT'S WHERE THEY GO AND DO A SCAN OF THE BRAIN, WHERE
3 THEY'RE IN A MACHINE AND IT DOES AN IMAGE OF THE INTERIOR
4 PART OF THE BRAIN.
5 Q. AND THEN THE BOTTOM PART, WHAT WAS THAT ORDER?
6 A. ATIVAN 1 MILLIGRAM I.M. NOW, HALDOL 5 MILLIGRAMS I.M.
7 NOW, TELEPHONE ORDER FROM DR. WEITZEL.
8 Q. AT WHAT TIME?
9 A. AT 1325.
10 Q. AND THE FIRST ONE WAS AT 10:45, SO THAT'S WHAT, LESS
11 THAN THREE HOURS?
12 A. YES.
13 Q. LET'S TURN OVER TO THE NURSING NOTES. SPECIFICALLY
14 NUMBER 60, DID YOU DO ANY CHARTING ON NUMBER 60 WHICH LOOKS
15 TO BE THE FIRST TIME MR. ALLDREDGE CAME IN?
16 A. NO, I DID NOT.
17 Q. LET'S LOOK AT 61. WHAT DATE WAS THIS?
18 A. THIS IS 1/10 ALSO.
19 Q. WHAT SHIFT?
20 A. THAT WOULD BE THE 3:00 TO 11:00 SHIFT.
21 Q. DID YOU WORK THAT SHIFT?
22 A. YES, I DID.
23 Q. HOW DO YOU KNOW YOU WORKED IT?
24 A. BECAUSE MY INITIALS ARE ON THE BOTTOM OF THE PAGE.
25 Q. LOOKS LIKE IT'S PARTIALLY COVERED. IS THAT YOUR NAME,
1727
1 YOUR INITIALS?
2 A. YES.
3 Q. WHAT PART OF THIS FORM DID YOU FILL OUT?
4 A. I USUALLY CO-SIGNED THE L.P.N. AND HE DID THE INITIAL
5 ASSESSMENT AND I WAS JUST CONCURRING THAT I AGREED WITH HIS
6 ASSESSMENT.
7 Q. OVER HERE UNDER NEUROLOGICAL, HOW DID MR. ALLDREDGE
8 APPEAR AT THE 3:00 TO 11:00 SHIFT.
9 A. LETHARGIC AND UNRESPONSIVE.
10 Q. AND UNDER PSYCHO -- PSYCHOSOCIAL AND EMOTIONS, WHAT WAS
11 WRITTEN IN THERE?
12 A. SLEEPY.
13 Q. WHO WAS THE L.P.N. THAT WROTE THIS?
14 A. RICHARD CLARK.
15 Q. WHAT DID HE WRITE ABOUT THE -- IN FREE TEXT ABOUT THE
16 STATE OF MR. ALLDREDGE AT THAT POINT -- OR THAT AFTERNOON,
17 EXCUSE ME?
18 A. OKAY. THE PERSON WHO WROTE THAT WAS TYLER SPRAGUE AT
19 THE TOP.
20 Q. OKAY.
21 A. THE NARRATIVE PART. GO AHEAD AND READ THAT --
22 Q. WHO WAS TYLER SPRAGUE?
23 A. HE WAS A CERTIFIED NURSING ASSISTANT ON THE FLOOR.
24 Q. AND BY SIGNING THIS, DID YOU CONCUR IN WHAT HE WROTE?
25 A. CORRECT.
1728
1 Q. WHAT DID HE WRITE?
2 A. PATIENT HAS BEEN LETHARGIC AND UNRESPONSIVE TO STAFF.
3 PATIENT HAS BEEN IN BED WITH RESTRAINTS ON BECAUSE OF
4 AGITATION. PATIENT HAS BEEN CHECKED EVERY TWO HOURS AND
5 RESTRAINT HAS BEEN RELEASED. OFFERED PATIENT WATER. RANGE
6 OF MOTION. PATIENT REFUSED WATER AND WAS RESTRAINED --
7 RESISTANT WITH RANGE OF MOTION AND COMBATIVE AT TIMES WITH
8 STAFF. FOLLOW CARE PLAN, REDIRECT PATIENT WHEN AGGRESSIVE
9 AND AGITATED.
10 Q. DID YOU SEE ANY SIGNS OR SYMPTOMS OF PAIN?
11 A. NO, I DID NOT.
12 Q. WOULD YOU LOOK OVER 62? WHAT IS THIS?
13 A. THIS IS USUALLY AN EXTENSION OF THE FORM IN FRONT WHEN
14 WE DON'T HAVE ROOM TO COMPLETE EVERYTHING ON THE ONE SHEET
15 THAT HAS THIS SMALL NARRATIVE SECTION, WE DO A CONTINUATION
16 SHEET.
17 Q. WHO WROTE THESE?
18 A. FIRST ENTRY WAS BY LYNN LONG.
19 Q. AND THEN THE OTHER ENTRIES?
20 A. THEY WERE BY TYLER SPRAGUE.
21 Q. CAN YOU QUICKLY LOOK THROUGH THAT?
22 A. OKAY.
23 Q. DID YOU SEE ANY SIGNS OF CHARTING OF SIGNS OR SYMPTOMS
24 OF PAIN? Once again, relevance? There isn't any morphine being given, at this point.
25 MR. STIRBA: YOUR HONOR, I'M GONNA OBJECT --
1729
1 THE COURT: SUSTAINED.
2 MR. STIRBA: -- TO THE FORM OF THAT --
3 Q. (BY MS. BARLOW) WELL, LET'S GET SPECIFIC THEN. SECOND
4 LINE DOWN, WOULD YOU READ THE SENTENCE THAT STARTS WITH,
5 PATIENT RESTRAINT REAPPLIED?
6 A. PATIENT'S RESTRAINT REAPPLIED AS PATIENT IS TRYING TO
7 GET UP WITHOUT ASSISTANCE, PLUS IS ASSAULTIVE TOWARDS STAFF.
8 HITTING, TRYING TO KICK, BITE.
9 Q. LET'S GO ON TO THE NEXT DAY. WOULD YOU LOOK AT NUMBER
10 63?
11 A. UH-HUH.
12 Q. WHAT DAY IS THIS?
13 A. THIS IS JANUARY 11TH.
14 Q. DID YOU FILL OUT ANY OF THIS?
15 A. NO, I DID NOT.
16 Q. 2400, WHAT WAS THE FIRST THING CHARTED?
17 A. PATIENT RESTLESS. POSEY --
18 Q. THEN LET'S JUMP DOWN TO -- IS THAT O200? WHAT'S THE
19 FIRST LINE CHARTED?
20 A. 0200, PATIENT CONTINUES RESTLESS, REMOVING BEDDING,
21 POSEY UNDONE.
22 Q. LET'S JUMP DOWN TO 0400?
23 A. PATIENT RESTLESS, BUT SLEEPING.
24 Q. 0600? WHAT'S THE FIRST -- DOWN TO RANGE OF MOTION,
25 WHAT -- WOULD YOU READ DOWN TO THERE?
1730
1 A. OKAY. THAT FIRST PART -- OH, U.A. OBTAINED PER STRAIGHT
2 CATH.
3 Q. WHAT DOES THAT MEAN?
4 A. THAT MEANS THAT THEY OBTAINED A SPECIMEN OF HIS URINE BY
5 INSERTING A TUBE INTO HIS BLADDER SO THAT THEY COULD GET A
6 CLEAN CATCH. PATIENT VERY AGITATED, CRYING LOUDLY. POSEY
7 REMOVED.
8 Q. WHEN WE GET DOWN HERE I -- THIS APPARENTLY IS LATER IN
9 THE DAY. IS THAT 2100?
10 A. 0800 --
11 Q. THERE'S 08, AND THEN WHAT'S THE NEXT ONE? I GUESS YOU
12 CAN'T TELL FOR SURE WHAT --
13 WOULD YOU READ THE BEHAVIOR RIGHT THERE AT THE BOTTOM
14 NEXT TO THAT?
15 A. PATIENT HAS BEEN AGITATED, HITTING, SPITTING.
16 Q. DO YOU SEE ANYTHING ON THIS CHART INDICATING PAIN?
17 MR. STIRBA: YOUR HONOR, I'M GONNA OBJECT.
18 THE COURT: SUSTAINED. THE DOCUMENT SPEAKS FOR
19 ITSELF.
20 Q. (BY MS. BARLOW) LET'S GO OVER TO THE NEXT PAGE, WHICH
21 IS TO BE A CONTINUATION, THIS IS NUMBER 64. LOOKS LIKE
22 THERE'S A BEHAVIOR LISTED UP THERE. WOULD YOU READ WHAT
23 THAT BEHAVIOR WAS?
24 A. IT'S RESPONSE.
25 Q. RESPONSE, EXCUSE ME.
1731
1 A. ATTENDED GROUPS, BUT SLEPT. WHEN OFFERED MEALS, KEPT
2 SPITTING IT OUT.
3 Q. LET'S GO OVER TO NUMBER 68. THE FIRST DATE HAS BEEN
4 PUNCHED, BUT THE OTHER DATES DOWN THE PAGE ARE WHAT?
5 A. JANUARY 12TH.
6 Q. 8:00 O'CLOCK. WHAT'S THE FREE TEXT?
7 A. POSEY RESTRAINT RELEASED FOR RANGE OF MOTION,
8 CIRCULATION --
9 Q. WHAT IS RANGE OF MOTION?
10 A. WHERE YOU MOVE THEIR WRIST BACK AND FORTH AND JUST TO
11 GIVE THEM SOME MOVEMENT SO THEY DON'T GET CONTRACTED WHERE
12 THEIR HANDS START DRAWING UP FOR CIRCULATION.
13 Q. THANK YOU. SO RELEASE FOR RANGE OF MOTION.
14 A. CIRCULATION CHECKED. PERI CARE, MEANING TAKING CARE OF
15 THE PRIVATE AREA. OFFER OF FOOD AND WATER. PATIENT TRYING
16 TO HIT AND SPIT AT STAFF AND TRYING TO GET UP WITHOUT
17 ASSISTANCE. REDIRECTION ATTEMPTED, BUT PATIENT UNRESPONSIVE
18 TO VERBAL CUES. POSEY BELT REAPPLIED FOR PATIENT SAFETY.
19 PATIENT HELPED TO DAY ROOM FOR BREAKFAST IN CHAIR WITH POSEY
20 ON.
21 Q. THEN AT 8:20 THERE'S ANOTHER FREE TEXT.
22 A. PATIENT REFUSED ALL ORAL MEDICATIONS BY SPITTING OUT
23 ANYTHING PUT HIS MOUTH. TRYING TO SLAP AWAY R.N.'S HANDS.
24 MUTTER -- MUTTERING ANGRILY. PATIENT MEDICATED WITH HALDOL.
25 5 MILLIGRAMS I.M.
1732
1 Q. AND THEN LOOKS LIKE 10:00 O'CLOCK?
2 A. PATIENT CONTINUES TO REFUSE ALL ORAL OFFERINGS AND
3 CONTINUES TO GET UP WITHOUT ASSISTANCE. POSEY RESTRAINT
4 RELEASED FOR PERI-CARE, CIRCULATION CHECK, RANGE OF MOTION,
5 OFFERED WATER AND FOOD. RESTRAINT REAPPLIED FOR PATIENT
6 SAFETY. PATIENT CONTINUES TO SPIT OUT ALL ORAL MATERIALS;
7 I.E., FOODS, MEDS, WATER.
8 Q. WHO HAS WRITTEN THESE NOTES?
9 A. LYNN LONG.
10 Q. AND WHAT ABOUT 12:00 O'CLOCK?
11 A. PATIENT RELEASED FROM RESTRAINT FOR CIRCULATION CHECK,
12 RANGE OF MOTION, PERI CARE. OFFER OF WATER AND FOOD.
13 PATIENT CONTINUES TO BE AGITATED. TRYING TO GET UP WITHOUT
14 ASSISTANCE. AND SPITTING, HITTING AT STAFF. RESTRAINT
15 REAPPLIED FOR PATIENT SAFETY.
16 Q. THEN AT 12:45?
17 A. PATIENT MEDICATED WITH ATIVAN 2 MILLIGRAMS I.M. FOR
18 EXTREME AGITATION PRIOR TO M.R.I. AND THAT WAS THE SCAN THAT
19 THEY DO FOR THE BRAIN, SCHEDULED FOR 1300, THAT'S 1:00
20 O'CLOCK IN THE AFTERNOON.
21 Q. THEN AT 1330, WHAT DID SHE WRITE?
22 A. M.R.I. PERSONNEL REPORT REMAINS AGITATED. PATIENT
23 MEDICATED WITH ATIVAN 1 MILLIGRAM, I.M. AND HALDOL 5
24 MILLIGRAMS I.M. PER DOCTOR'S ORDERS. RESULTS PENDING ON
25 MEDICATION.
1733
1 Q. THEN AT 1410, LET'S SEE, I'VE GOT THIS -- IT'S CONTINUED
2 HERE, BUT IF YOU'D READ THAT LINE?
3 A. PATIENT RETURNED FROM M.R.I. ROOM --
4 Q. AND THEN WHAT DID SHE CONTINUE TO WRITE?
5 A. -- BY M.R.I. PERSONNEL WHO REPORTED PATIENT REMAINS TOO
6 AGITATED TO CONDUCT M.R.I. PATIENT'S RESTRAINT RELEASED FOR
7 RANGE OF MOTION, PERI CARE, CIRCULATION CHECK. OFFER OF
8 WATER AND FOOD AND JUICE. PATIENT REFUSING EVERYTHING BY
9 MOUTH. CLENCHING TEETH. TRYING TO HIT STAFF, TRYING TO GET
10 UP WITHOUT ASSISTANCE. POSEY REAPPLIED FOR PATIENT SAFETY.
11 Q. LET'S JUMP DOWN TO THE BOTTOM, SAME DATE. 1800. CAN
12 YOU TELL WHO THIS WAS WRITTEN BY?
13 A. THAT LOOKS LIKE LAURIE. YEAH, LAURIE WILLIAMS.
14 Q. WHAT DID SHE WRITE AT 1800?
15 A. M.R.I. DR. CLINGER CALLED TO REPORT EVIDENCE OF
16 POSSIBLE NEW INFARCT WITH LEFT OCCIPITAL LOBE.
17 Q. WHAT'S AN INFARCT?
18 A. WHERE THERE'S DECREASED BLOOD FLOW TO A CERTAIN AREA OF
19 THE BRAIN.
20 Q. AND WHAT'S THE OCCIPITAL LOBE?
21 A. IT'S A SECTION OF THE BRAIN. IN THE BACK.
22 Q. WHAT DID SHE CONTINUE TO WRITE?
23 A. PATIENT REMAINS RESTLESS, AND MINIMALLY RESPONSIVE
24 EXCEPT TO DISCOMFORT. DR. WEITZEL HAS BEEN NOTIFIED OF
25 M.R.I. RESULTS.
1734
1 Q. LET'S -- LET'S -- WELL, LET'S GO AHEAD, YEAH, GO AHEAD
2 AND --
3 A. IN VIEW OF PATIENT'S DIABETES AND POSSIBLE DEHYDRATION,
4 DOCTOR HAS ORDERED I.V. D. 5 AND A HALF N.S. AT 100 C.C.S AN
5 HOUR. DR. WEITZEL PLANS TO TALK WITH FAMILY IN A.M.
6 REGARDING M.R.I. RESULTS AND PLANNED CARE. PATIENT RELEASED
7 -- I CAN'T READ THAT OUT. SOMETHING RESTRAINTS -- FROM
8 RESTRAINTS.
9 Q. AND THEN AT 2000, WHAT WAS WRITTEN?
10 A. AT 8:00 P.M., AN I.V. STICK VERY DIFFICULT. THIS R.N.
11 ATTEMPTED ONE TIME IN THE LEFT WRIST. PATIENT ROTATED AWAY
12 AS NEEDLE WAS IN THE VEIN. PRESSURE APPLIED TO LEFT WRIST
13 SITE. I.C.U. NURSE CALLED TO ASSIST WITH FUTURE NEEDLE
14 STICK WHILE GERO STAFF RESTRAINED THE PATIENT. PATIENT IS
15 NOT VERBALLY RESPONSIVE. SLOWS -- I DON'T KNOW WHAT THAT
16 IS. STRONG LIMB MOVEMENTS IN RESPONSE TO PAINFUL STIMULI.
17 I.C.U. NURSE ATTEMPTED THREE NEEDLE STICKS BEFORE SUCCESSFUL
18 STICK IN LEFT FOREARM. PATIENT HANDS HAVE BEEN LOOSELY
19 RESTRAINED IN ORDER TO PREVENT DISRUPTION OF I.V. SITE.
20 PATIENT REMAINS VERBALLY UNRESPONSIVE, WITH STRONG RANDOM
21 LIMB MOVEMENTS. I.V. INFUSING D. 5 AND A HALF IN 100 C.C.S
22 AN HOUR WITH A 22 GAUGE NEEDLE.
23 Q. AND THEN IF YOU'D READ THE FIRST TWO SENTENCES OF 2200.
24 A. PATIENT IS CALM AND THREE POINT RESTRAINT. ALL ORAL
25 MEDICATIONS HAVE BEEN HELD THIS EVENING DUE TO PATIENT'S
1735
1 INABILITY TO SWALLOW.
2 Q. AND THEN WHAT DID HE WRITE? OR SHE WRITE?
3 A. I.M. MEDICATIONS NOT UTILIZED DUE TO PATIENT'S EXTREME
4 SEDATION AND ALTERED MENTAL STATUS.
5 Q. WHAT IS SEDATION?
6 A. MEANS THAT THEIR LEVEL OF CONSCIOUSNESS IS -- IS LOW.
7 THEY'RE NOT ALERT, THEY'RE DROWSY.
8 Q. DID YOU SEE MR. ALLDREDGE ON THE 12TH?
9 A. YES, I DID.
10 Q. WHAT SHIFT?
11 A. THAT WOULD HAVE BEEN -- LET'S SEE, DAY SHIFT, I BELIEVE.
12 YES. I DID THE PHYSICAL ASSESSMENT THAT DAY.
13 Q. IS THAT ON NUMBER 71?
14 A. YES, IT IS.
15 Q. AND WHAT DID YOU WRITE ABOUT HIS -- OR WHAT DID YOU
16 INDICATE ABOUT HIS NEUROLOGICAL STATUS?
17 A. HE WAS LETHARGIC, MEANING VERY, VERY DROWSY.
18 Q. WHAT ABOUT HIS PSYCHOSOCIAL?
19 A. PSYCHOSOCIAL, AGAIN, HE WAS LETHARGIC.
20 Q. DO YOU RECALL THAT THIS WAS HIS STATUS AT THE TIME?
21 A. YES.
22 Q. LET'S THEN GO TO THE 13TH. DID YOU SEE HIM ON THE 13TH?
23 A. NOT ON THE 13TH.
24 Q. LET'S LOOK AT THE CHART NUMBER 74. PAGE NUMBER 74.
25 A. OKAY.
1736
1 Q. WHICH IS THE 13TH. AT 0800 WHAT WAS CHARTED?
2 A. PATIENT UNRESPONSIVE. FAMILY WITH PATIENT. POSEY
3 RESTRAINTS TAKEN OFF. I.V.'S DISCONTINUED. COMFORT
4 MEASURES GIVEN. DR. WEITZEL TALKED WITH FAMILY.
5 DR. DIENHART NOTIFIED OF PATIENT'S DECLINING CONDITION.
6 Q. AND WHAT WAS THE BEHAVIOR NOTICED AT 1500 HOURS?
7 A. PATIENT HAS BEEN UNRESPONSIVE THE WHOLE NIGHT, THE WHOLE
8 SHIFT.
9 Q. AND WHAT WAS THE RESPONSE?
10 A. RESPIRATIONS WERE IRREGULAR WITH PERIODS OF APNEA.
11 COLOR, PALE.
12 Q. LET'S TURN BACK TO THE PHYSICIAN'S ORDER -- ORDERS FOR
13 THE 13TH. THAT WOULD BE PAGE NUMBER 13. IN THE CENTER OF
14 THE PAGE THERE ON THE LEFT ARE SOME WRITTEN ORDERS. CAN YOU
15 READ WHAT THOSE ARE?
16 A. ON WHAT, JANUARY 13TH?
17 Q. JANUARY 13TH, YES.
18 A. DISCONTINUE I.V.
19 Q. WHAT WAS THE I.V. IN PLACE FOR?
20 A. FOR DEHYDRATION, AND HE WAS -- HE WAS TAKING NO ORAL
21 FOOD OR ANYTHING DURING THAT TIME. AND HE WAS A DIABETIC,
22 SO IT WAS IMPORTANT THAT HE HAVE SOME TYPE OF NOURISHMENT TO
23 MAKE SURE THAT THE INSULIN THAT WE WERE GIVING HIM HAD
24 SOMETHING TO BIND TO, BASICALLY, SOME TYPE OF GLUCOSE.
25 Q. SO I.V. WAS DISCONTINUED.
1737
1 A. YES, IT WAS.
2 Q. AND THEN WHAT ELSE WAS ORDERED?
3 A. MORPHINE SULFATE 10 MILLIGRAMS I.M. EVERY THREE HOURS.
4 ATIVAN .5 MILLIGRAMS I.M. EVERY THREE HOURS. DISCONTINUE
5 ALL ORAL MEDICATIONS. DISCONTINUE HALDOL AS NECESSARY, AS
6 WRITTEN.
7 Q. THAT'S P.R.N. AS NECESSARY?
8 A. YES. HALDOL 10 MILLIGRAMS I.M. EVERY FOUR HOURS.
9 P.R.N. SEVERE AGITATION. AND DID YOU WANNA READ FURTHER?
10 Q. WELL, IF YOU'D TELL US WHEN THIS ORDER WAS NOTED.
11 A. IT WAS NOTED AT 0800 THAT MORNING.
12 Q. HAD YOU SEEN ANY CHARTING OF PAIN ON THE 13TH?
13 MR. STIRBA: YOUR HONOR, I'M GONNA OBJECT.
14 THE COURT: SUSTAINED.
15 Q. (BY MS. BARLOW) YOU DON'T NEED TO ANSWER THAT ONE.
16 A. OKAY.
17 Q. THE OBJECTION HAS BEEN SUSTAINED. SO LET'S LOOK AT
18 NUMBER 75 WHICH IS BACK TO THE NURSES' NOTES. WHAT DATE WAS
19 THIS?
20 A. THAT WAS JANUARY 13TH.
21 Q. AND WHO WROTE IT?
22 A. LYNN LONG.
23 Q. WHAT WAS THE BEHAVIOR NOTED?
24 A. PATIENT UNRESPONSIVE THIS SHIFT DURING CARES AND I.M.
25 MEDICATION ADMINISTRATION. NO RESPONSE TO ADMINISTRATION.
1738
1 SOMETHING FAMILY MEMBER -- AT BEDSIDE.
2 Q. IT'S CUT OFF. MAYBE IT'S PRESENT AT BEDSIDE.
3 A. OH, PRESENT AT BEDSIDE, YEAH.
4 Q. LET'S GO DOWN TO THE RESPONSE.
5 A. RESPONSE IS PATIENT UNRESPONSIVE WITH LONG PERIODS OF
6 APNEA EVERY ONE TWO MINUTES.
7 Q. WHAT'S LONG PERIODS OF APNEA EVERY ONE TO TWO MINUTES?
8 A. AGAIN, WHERE YOU HOLD YOUR BREATH, DON'T BREATHE FOR A
9 FEW SECONDS, AND SHE WAS SAYING IT WAS GOING EVERY ONE TO
10 TWO MINUTES --
11 MR. STIRBA: YOUR HONOR, I'M GONNA OBJECT TO HER
12 INTERPRETING THE NOTE. THE NOTE --
13 THE COURT: LET'S -- GO ON.
14 Q. (BY MS. BARLOW) AND THEN WHAT DID SHE WRITE AFTER THE
15 APNEA?
16 A. NO DISCOMFORT NOTED DURING CARES.
17 Q. AND THEN THE PLAN?
18 A. MEDS AS ORDERED, COMFORT CARE.
19 Q. LET'S GO TO -- WELL, LET'S MOVE ON. WOULD YOU TURN TO
20 MED NUMBER 77? DO YOU HAVE THAT?
21 A. YES, I DO.
22 Q. OKAY. THANK YOU. WHAT DATE WAS THAT?
23 A. JANUARY 14TH.
24 Q. DID YOU SEE MR. ALLDREDGE THAT DAY?
25 A. YES, I DID.
1739
1 Q. WHAT SHIFT?
2 A. DAY SHIFT.
3 Q. FIRST ON 77, WE HAVE THE NIGHT SHIFT WAS WRITTEN, IS
4 THAT CORRECT?
5 A. YES.
6 Q. WOULD YOU READ THAT FOR US?
7 A. AT THE VERY TOP?
8 Q. YES.
9 A. NIGHT SHIFT FREE TEXT NOTE. PATIENT'S LEVEL OF
10 AWARENESS HAS BEEN PROGRESSIVELY SINKING OVER SHIFT. ALL
11 FAMILY MEMBERS HAVE BEEN PRESENT INTERMITTENTLY. WIFE HAS
12 REMAINED AT BEDSIDE THROUGHOUT SHIFT. THEN 0500 DOSE OF
13 MORPHINE. 10 MILLIGRAMS AND ATIVAN 0.5 MILLIGRAMS WERE
14 GIVEN AT 0430 DUE TO PATIENT GRIMACING AND LABORED
15 BREATHING. INDICATE -- I CAN'T MAKE OUT THAT ONE --
16 Q. I THINK INDICATING --
17 A. HIS -- HIS LEVEL OF DISTRESS. CHEYNE-STOKING.
18 Q. WHAT ARE CHEYNE-STOKES RESPIRATIONS?
19 A. AGAIN. IT'S A PATTERN OF BREATHING WHERE IT'S NOT
20 REGULAR LIKE A NORMAL BREATH, HE'S KIND OF GASPING FOR AIR.
21 Q. SO CHEYNE-STOKES RESPIRATION IS --
22 A. CONTINUE WITH PERIODS APNEA LASTING UP TO 30 SECONDS.
23 PATIENT WAS GIVEN NASAL TRACHEAL SUCTIONING BY RESPIRATORY
24 THERAPY.
25 Q. WHAT DOES THAT -- WHAT DOES NASAL TRACHEAL SUCTIONING
1740
1 MEAN?
2 A. USUALLY IF THEY HAVE SECRETIONS IN THEIR THROAT THAT
3 THEY'RE NOT ABLE TO SWALLOW ON THEIR OWN, THEY TAKE A
4 PLASTIC TUBE THAT'S CONNECTED TO AIR AND IT SUCTIONS AND
5 CLEARS OUT THEIR THROAT BECAUSE THEY'RE NOT ABLE TO DO IT
6 THEMSELVES, TO TRY AND MAINTAIN AIRWAY.
7 Q. SIMILAR TO WHAT YOU HAVE IN A DENTIST'S OFFICE WHERE
8 THEY --
9 A. YES.
10 Q. OKAY.
11 A. VERY SIMILAR. CONTINUE TO HAVE DEEP CHEST RATTLE AS OF
12 0600.
13 Q. THEN AT 0600 --
14 A. DOCTOR --
15 Q. -- WHAT WAS NOTED?
16 A. DR. WEITZEL GAVE TELEPHONE ORDER FOR MORPHINE 10
17 MILLIGRAMS I.M. GIVEN IN LEFT GLUTEUS WHICH IS THE --
18 Q. WHAT'S THE GLUTEUS?
19 A. IT'S YOUR BUTTOCKS AREA. NO RESPONSE FROM PATIENT TO
20 THAT NEEDLE STICK. FAMILY REMAINS WITH PATIENT COMFORTING
21 HIM AND TALKING WITH HIM, ASKING HIM TO LET GO.
22 Q. AND WHO WROTE THAT NOTE?
23 A. LAURIE WILLIAMS.
24 Q. AND DOWN AT THE BOTTOM, WHO STARTED WRITING?
25 A. THAT'S MY WRITING.
1741
1 Q. THAT'S --
2 A. 0735 IN THE MORNING.
3 Q. WHAT DID YOU SEE AT 0735 IN THE MORNING?
4 A. PATIENT DEEP LABORED RESPIRATIONS. PATIENT TURNED,
5 MOANING DURING TURNING PROCEDURE.
6 Q. SO THE TURNING WAS DONE BY WHOM?
7 A. BY MYSELF AND A CERTIFIED NURSING ASSISTANT.
8 Q. THEN THE NEXT PAGE, WHICH IS 78?
9 A. PATIENT HAS THICK MUCOUS DRAINAGE FROM MOUTH. ORAL CARE
10 GIVEN. LUNGS WITH RALES THROUGHOUT.
11 Q. WHAT ARE RALES?
12 A. IT'S A SOUND YOU HEAR WHEN YOU'RE TAKING A DEEP BREATH.
13 IT'S USUALLY INDICATING LIKE A FLUID BUILDUP IN THE LUNGS SO
14 THEY'RE NOT FULLY TAKING IN OXYGEN.
15 Q. SO THOSE SOUNDS WERE HEARD THROUGHOUT, AND THEN WHAT?
16 A. CYANOTIC EXTREMITIES. FAMILY MEMBERS AT BEDSIDE.
17 Q. AND AT 0800, WHAT DID YOU WRITE? FIRST, WHAT DID YOU
18 WRITE DOWN IN THIS SMALL SECTION HERE UNDER 0800?
19 A. VITAL SIGNS.
20 Q. WHAT WERE HIS VITAL SIGNS?
21 A. HIS TEMP WAS 101.8. HIS HEART RATE WAS 84.
22 RESPIRATIONS WERE 16. AND HIS BLOOD PRESSURE WAS 110 OVER
23 72.
24 Q. ANY OF THOSE OUTSIDE THE RANGE OF NORMAL?
25 A. THE TEMPERATURE.
1742
1 Q. WHAT DID YOU WRITE IN THE FREE TEXT?
2 A. PATIENT GIVEN 10 MILLIGRAMS MORPHINE I.M. DUE TO
3 CONTINUED MOANING. PATIENT'S RESPIRATIONS REMAIN LABORED.
4 PATIENT WITH EYES OPEN, STARING. FAMILY REMAINS AT BEDSIDE.
5 Q. AND THEN AT 9:20?
6 A. PATIENT TO BE GIVEN NOW ORDER OF MORPHINE I.M. AND
7 ATIVAN 0.5.
8 Q. DO YOU KNOW HOW THIS -- DO YOU RECALL HOW THIS NOW ORDER
9 CAME INTO PLACE?
10 A. THAT WAS FROM THE DOCTOR.
11 Q. DID YOU CALL HIM OR DO YOU RECALL?
12 A. YES, I CALLED HIM BECAUSE OF THE DECLINING CONDITION OF
13 THE PATIENT.
14 Q. WHAT DID YOU TELL HIM, THE DEFENDANT, THE CONDITION WAS?
15 A. PARDON?
16 Q. WHAT DO YOU TELL THE DEFENDANT THE CONDITION WAS?
17 A. HOW HIS BREATHING PATTERN WAS. HOW HE WAS -- HIS
18 EXTREMITIES WERE TURNING BLUE. HE WAS HAVING A HARD TIME
19 BREATHING.
20 Q. WHAT DID THE DEFENDANT SAY TO YOU IN THAT TELEPHONE
21 CONVERSATION?
22 A. HE ASKED IF I HAD BEEN GIVING THE SCHEDULED MORPHINE.
23 AND I SAID YES. AND THEN HE SAID TO GIVE A NOW ORDER OF
24 MORPHINE AND ATIVAN.
25 Q. DID YOU QUESTION HIM ABOUT THAT ORDER?
1743
1 A. I'VE LEARNED NOT TO QUESTION HIM ABOUT AFTER THAT --
2 Q. WELL, FIRST, DID YOU QUESTION HIM: YES OR NO?
3 A. NO.
4 Q. AND WHY DID YOU NOT QUESTION HIM?
5 MR. STIRBA: I'M GONNA OBJECT, YOUR HONOR.
6 IRRELEVANT.
7 THE COURT: OVERRULED.
8 Q. (BY MS. BARLOW) WHY DID YOU NOT QUESTION HIM?
9 A. BECAUSE IN THE PAST WHEN I HAVE QUESTIONED HIM ABOUT
10 MEDICATIONS, HE DIDN'T RESPOND APPROPRIATELY TO ME.
11 Q. WELL, YOU'VE GOTTA TELL WHAT --
12 A. OH.
13 Q. -- THE RESPONSE WAS --
14 MR. STIRBA: YOUR HONOR --
15 Q. (BY MS. BARLOW) -- NOT HOW YOU FELT --
16 MR. STIRBA: -- IM GONNA OBJECT. THIS IS -- THIS
17 IS IRRELEVANT AND --
18 THE COURT: EITHER ANS -- QUESTION HAS TO BE
19 ANSWERED, NOT A SPEECH.
20 Q. (BY MS. BARLOW) RIGHT. SO NOT -- NOT HOW YOU FELT
21 ABOUT HIS --
22 A. OH.
23 Q. -- RESPONSE, BUT WHAT WAS HIS RESPONSE IN THE PAST WHEN
24 YOU QUESTIONED HIM?
25 MR. STIRBA: YOUR HONOR, I'M GONNA OBJECT. IT'S
1744
1 HEARSAY, IT'S IRRELEVANT, IT'S 403, AND THIS IS --
2 THE COURT: THE LAST PART OF WHAT HE SAID IN THE
3 PAST HAS BEEN ASKED AND ANSWERED.
4 Q. (BY MS. BARLOW) SO YOU ADMINISTERED A DOSE OF MORPHINE
5 AT 9:20?
6 A. NO, I DID NOT.
7 Q. WHO DID?
8 A. IT WASN'T GIVEN, I BELIEVE.
9 Q. LET'S TURN -- I GUESS IT'S THE MED CHARTS, IS THAT WHAT
10 WE'D LOOK AT TO FOUND FIND OUT ABOUT THE ADMINISTRATION OF
11 THE MORPHINE?
12 A. UH-HUH. THAT WOULD HAVE BEEN ON PAGE 46.
13 Q. OKAY. LET ME GET THAT PULLED OUT HERE. THAT'S IN THE
14 CENTER OF THE PAGE. THERE SEEMS TO BE TWO -- TWO ORDERS FOR
15 MORPHINE. THE FIRST ONE --
16 A. THE SCHEDULED DOSE AT 8:00 O'CLOCK, I GAVE.
17 Q. IS THAT YOUR INITIALS THEN?
18 A. ON PAGE 47.
19 Q. OH, ON 47?
20 A. THAT WAS THE SCHEDULED DOSE THAT WE --
21 Q. OKAY.
22 A. -- HAD TO GIVE.
23 Q. LET ME GET THAT ONE ON HERE SO WE CAN --
24 A. AND THEN THE NOW ORDER THAT HE TOLD ME TO GIVE IN
25 ADDITION, I DID NOT GIVE. AND THAT'S ON PAGE 46 WHERE I PUT
1745
1 NOT GIVEN.
2 Q. WELL, FIRST, LET'S LOOK -- OKAY. LET ME GET TO THE
3 RIGHT ONE. THIS IS PAGE 47.
4 A. THAT'S THE SCHEDULED DOSE IN THERE AT 8:00 O'CLOCK. MY
5 INITIALS ARE RIGHT THERE WHERE --
6 Q. AND IT'S UNDER 114, SO THAT WAS THE ONE YOU GAVE AT
7 8:00 O'CLOCK, IS THAT CORRECT?
8 A. YES, THAT WAS THE SCHEDULED DOSE.
9 Q. OKAY. SO THIS WAS A SEPARATE --
10 A. THAT'S THE ONE --
11 Q. -- DOSE.
12 A. -- HE TOLD ME TO GIVE IN ADDITION. AND I DIDN'T GIVE
13 IT.
14 Q. DID YOU TELL DR. WEITZEL YOU DIDN'T GIVE IT?
15 A. NO.
16 Q. WHY DID YOU NOT GIVE IT?
17 MR. STIRBA: I'M GONNA OBJECT, YOUR HONOR.
18 IRRELEVANT.
19 MS. BARLOW: YOUR HONOR, I THINK IT'S VERY
20 RELEVANT.
21 MR. STIRBA: SHE SAID WHAT SHE DIDN'T DO. WHY SHE
22 DIDN'T DO IT IS IRRELEVANT. IT'S WAY AFTER THE FACT, YOUR
23 HONOR.
24 THE COURT: OKAY. SUSTAINED.
25 Q. (BY MS. BARLOW) SO LET'S GO BACK TO PAGE 78. OKAY.
1746
1 NOW, DOWN HERE YOU'VE CHARTED AT 9:20 FIRST THAT PATIENT TO
2 BE GIVEN. AND THEN WHAT DID YOU WRITE AFTER THAT?
3 A. PATIENT TO BE GIVEN NOW ORDER OF 10 MILLIGRAMS MORPHINE
4 I.M. AND ATIVAN 0.5. PATIENT WITH DECREASED FUNCTIONS.
5 APNEA EVERY 60 SECONDS. THAT MEANT HE WAS HOLDING HIS
6 BREATH FOR ABOUT 60 SECONDS WITHOUT BREATHING. HEART RATE
7 WAS TACHY, WHICH MEANT IT WAS -- IT WAS VERY FAST. AND
8 THREADY, MEANING IT WASN'T VERY STRONG, IT WAS JUST WEEK.
9 MEDICATION HELD. THERE WERE NO PERIPHERAL PULSES IN ANY
10 EXTREMITIES.
11 Q. WHAT ARE PERIPHERAL PULSES?
12 A. PULSES BY THE WRIST, THE ANKLES.
13 Q. SO YOU COULDN'T GET HIS PULSE, IS THAT --
14 A. ON THOSE EXTREMITIES. YOU COULD HEAR A HEART RATE, BUT
15 THE BLOOD, YOU COULDN'T FEEL IT FLOWING TO THE EXTREMITIES.
16 Q. THEN WHAT DID YOU WRITE?
17 A. CYANOTIC EXTREMITIES. FAMILY AT BEDSIDE. AWARE OF
18 DECLINING CONDITION. WIFE AWOKEN FROM SLEEP TO BE WITH
19 PATIENT.
20 Q. AND THEN AT 9:30, WHAT DID YOU WRITE?
21 A. PATIENT CONDITION DECLINING. RESPIRATIONS EVERY 80
22 SECONDS WITH GASPING NOTED. HEART RATE TACHY AND WEAK,
23 APICALLY, MEANING OVER THE HEART.
24 Q. WHAT DOES THAT MEAN?
25 A. THAT MEANS SINCE I COULDN'T GET A HEART PULSE FROM HIS
1747
1 EXTREMITIES, I WOULD PUT MY STETHOSCOPE ON HIS HEART AND
2 LISTEN THERE.
3 Q. AND THEN AT 9:36, WHAT DID YOU WRITE?
4 A. PATIENT HAS HAD NO HEART RATE, NO RESPIRATIONS, NO BLOOD
5 PRESSURE.
6 Q. WHAT DID THAT MEAN?
7 A. WELL, HE HAD DIED.
8 Q. CAN YOU TELL US AT THIS -- DURING THIS TIME PERIOD HOW
9 MORPHINE INJECTIONS WERE DISPENSED ON THE UNIT?
10 A. DURING THIS TIME?
11 Q. YES, DURING DECEMBER -- WELL, FROM DECEMBER 6TH, 1995 TO
12 JANUARY 14TH OF 1996.
13 A. THEY START --
14 MR. STIRBA: RELEVANCY, YOUR HONOR.
15 MS. BARLOW: YOUR HONOR, I THINK IT'S -- I THINK
16 THE JURY NEEDS TO KNOW HOW MORPHINE WAS DISPENSED BECAUSE
17 THAT'S WHAT'S AT ISSUE IN THIS CASE.
18 THE COURT: OVERRULED.
19 Q. (BY MS. BARLOW) HOW WAS IT DISPENSED?
20 A. IT WAS DISPENSED IN -- YOU MEAN WHAT TYPE OF PACKAGING
21 DID IT COME IN?
22 Q. YES.
23 A. IT CAME IN PREPACKAGED SYRINGES, 2 MILLIGRAMS,
24 4 MILLIGRAMS, 10 MILLIGRAMS. SOMETIMES 8, DEPENDING ON WHAT
25 THE PHARMACY HAD AVAILABLE.
1748
1 Q. YOU SAY THE PHARMACY. WAS IT KEPT ON THE UNIT?
2 A. IT WAS -- IT WAS A CONTROLLED ITEM, SO THAT MEANT IT WAS
3 UNDER LOCK AND KEY.
4 Q. ON THE UNIT?
5 A. ON THE UNIT. PRIOR TO DECEMBER, THOUGH, THEY DIDN'T
6 HAVE IT ON THE UNIT.
7 Q. WELL, WE CAN ONLY TALK --
8 THE COURT: OKAY. JUST -- JUST ANSWER THE QUESTION
9 THAT'S ASKED.
10 Q. (BY MS. BARLOW) LET'S SEE, WE'VE ALREADY COVERED THAT.
11 IN REGARDS TO MR. ALLDREDGE, AFTER MR. ALLDREDGE DIED, DID
12 YOU -- JUST YES OR NO -- DID YOU GO TO ANYONE AT HORIZON --
13 A. YES.
14 Q. -- ABOUT THE DEATH OF THIS PATIENT?
15 A. YES.
16 Q. TO WHOM DID YOU GO?
17 A. TODD CHAMBERS.
18 Q. AND WHO'S TODD CHAMBERS?
19 A. HE WAS THE DIRECTOR OF HORIZONS.
20 Q. WHEN DID THAT HAPPEN?
21 A. I FIRST WENT TO HIM ABOUT TWO DAYS BEFORE
22 MR. ALLDREDGE'S DEATH, AND THEN AGAIN AFTER.
23 Q. WAS ANYONE ELSE PRESENT AT EITHER OF THESE MEETINGS?
24 A. NO.
25 Q. WHERE DID THEY TAKE PLACE?
1749
1 A. IN HIS OFFICE.
2 Q. THE MEETING THAT HAPPENED TWO DAYS BEFORE THE DEATH ON
3 THE 12TH, WHAT DID YOU TELL MR. CHAMBERS?
4 A. THAT I WAS CONCERNED ABOUT THE PATIENT'S DECLINE IN
5 CONDITION AND HESITANT ABOUT GIVING MORPHINE DUE TO THIS
6 DECLINE IN CONDITION.
7 Q. WHAT RESPONSE DID YOU GET?
8 A. HE SAID HE WOULD LOOK INTO THE MATTER.
9 Q. DID HE EVER COME BACK TO YOU WITH ANY RESULTS?
10 A. HE JUST TOLD ME THEY WERE STILL CHECKING ON IT.
11 Q. WHAT ABOUT AFTER THE DEATH OF MR. ALLDREDGE, DID YOU --
12 YOU SAY YOU WENT TO MR. CHAMBERS.
13 A. I WENT TO MR. CHAMBERS AGAIN BECAUSE I WAS EXTREMELY
14 UPSET, AND TOLD HIM THAT IT NEEDED TO STOP.
15 Q. AND WHAT DID YOU MEAN BY IT NEEDED TO STOP?
16 A. ALL THESE DEATHS ON THE UNIT.
17 Q. DID YOU GET ANY RESPONSE FROM MR. CHAMBERS?
18 A. HE -- HE WAS CONCERNED, BUT HE DIDN'T VERBALIZE WHAT HE
19 WAS GONNA DO. HE SAID HE'D LOOK INTO THE MATTER, BUT HE
20 DIDN'T SAY HOW HE WAS GONNA DO THAT.
21 Q. DID YOU EVER TALK TO THE DEFENDANT ABOUT MR. ALLDREDGE
22 PRIOR TO HIS DEATH?
23 A. YES.
24 Q. WHEN DID THAT TAKE PLACE?
25 A. USUALLY WHEN I WOULD CALL HIM ABOUT HIS DECLINING
1750
1 CONDITION, I WOULD TRY TO EMPHASIZE HIS RESPIRATION RATE
2 BEING LOW -- LOWER THAN NORMAL AND ASK IF WE NEEDED TO GIVE
3 THE MORPHINE.
4 Q. AND WHAT WAS THE DEFENDANT'S RESPONSE?
5 A. WE HAD TO GIVE THE MORPHINE. IT WAS SCHEDULED AROUND
6 THE CLOCK.
7 Q. WERE YOU SEEING ANY SIGNS OR SYMPTOMS OF PAIN IN MR.
8 ALLDREDGE?
9 A. NO. Symptoms of pain>> (Signed by this very nurse!)
10 Q. DURING THE PERIOD OF THE 6TH OF DECEMBER, 1995 THROUGH
11 THE 14TH OF JANUARY, 1996, DID YOU EVER TALK TO THE
12 DEFENDANT ABOUT MOVING ANY OF THESE PATIENTS OFF OF THE
13 UNIT?
14 A. YES, I DID.
15 Q. DO YOU RECALL WHEN THAT CONVERSATION TOOK PLACE?
16 A. THE FIRST WAS WITH MARY CRANE.
17 Q. AFTER HER DEATH OR DURING HER DEATH OR I GUESS --
18 A. BEFORE HER DEATH.
19 Q. BEFORE HER DEATH. DO YOU RECALL WHEN THAT CONVERSATION
20 WAS?
21 A. IT WAS AFTER I HAD DISCOVERED THE FISTULA, WHICH WAS THE
22 OPENING BETWEEN HER RECTUM AND HER VAGINA SO THE STOOL WAS
23 GOING IN BETWEEN. I EXPRESSED CONCERN THAT SHE COULD, YOU
24 KNOW, GO SEPTIC BECAUSE OF THIS.
25 Q. LET'S BACK UP A LITTLE BIT. WHERE DID THIS CONVERSATION
1751
1 TAKE PLACE?
2 A. IT WAS ON THE PHONE THE DAY AFTER DR. DIENHART CAME IN
3 AND EXAMINED HER. I HAD CALLED ABOUT ANOTHER PATIENT.
4 Q. AND YOU TALKED TO DR. WEITZEL ABOUT MARY CRANE?
5 A. YES.
6 Q. AND WHAT DOES IT MEAN TO GO SEPTIC ON ME?
7 A. IT MEANS THAT YOUR WHITE BLOOD COUNT -- AND THAT'S THE
8 PART OF YOUR BLOOD THAT FIGHTS INFECTION -- IT STARTS
9 ELEVATING. AND WHEN IT GETS OUT OF CONTROL, YOUR BLOOD
10 PRESSURE STARTS DROPPING AND YOUR SYSTEMS JUST BASICALLY SIT
11 DOWN -- SHUT DOWN, AND IT COULD CAUSE DEATH.
12 Q. DID YOU EXPRESS THIS CONCERN TO THE DEFENDANT?
13 A. YES.
14 Q. IS THAT IN A TELEPHONE CONVERSATION?
15 A. YES.
16 Q. WAS ANYONE ELSE PRESENT IN THAT CONVERSATION?
17 A. NOT THAT I KNOW OF, I DON'T KNOW.
18 Q. WHAT WAS THE DEFENDANT'S RESPONSE?
19 A. THAT HE WAS THE DOCTOR AND I WAS THE NURSE.
20 Q. DID HE TELL YOU WHAT TO DO?
21 A. NO.
22 Q. SPEAKING -- WELL, LET'S -- LET ME BACKTRACK A LITTLE BIT
23 OR LET ME FOLLOW THAT LINE. DID YOU TALK TO THE DEFENDANT
24 ABOUT ANY OTHER OF THESE PATIENTS, CONCERNS YOU HAD?
25 MR. STIRBA: YOUR HONOR -- YOUR HONOR, VAGUE AND
1752
1 AMBIGUOUS. AND THIS IS UNFAIR SURPRISE AT THIS POINT. IT'S
2 NOT -- THIS IS -- THERE -- THE COURT HAS ADDRESSED THIS
3 ISSUE AND THIS IS UNFAIR SURPRISE, THESE CONVERSATIONS.
4 THE COURT: GO ON TO SOMETHING ELSE. WE'LL TALK
5 ABOUT THAT.
6 Q. (BY MS. BARLOW) DID YOU EVER TALK TO DEFENDANT ABOUT
7 THE NUMBER OF PATIENTS ON THE UNIT?
8 A. THE NUMBER OF PATIENTS, COULD YOU --
9 Q. WELL, IT WAS A TEN-BED UNIT.
10 A. YES, IT WAS.
11 Q. WE'VE HEARD THAT.
12 A. YES.
13 Q. DID YOU EVER TALK TO HIM ABOUT HOW MANY PATIENTS WERE ON
14 THE UNIT AT ANY ONE TIME?
15 A. IT WAS DISCUSSED IN A DISCUSSION ONCE, IT WAS BROUGHT
16 UP.
17 Q. WHEN WAS THAT DISCUSSION?
18 A. IT WAS THIS TIME FRAME.
19 Q. WAS IT A FACE-TO-FACE CONVERSATION?
20 A. YES.
21 Q. WAS ANYONE ELSE PRESENT?
22 A. I DON'T RECALL.
23 Q. WHERE DID THIS CONVERSATION TAKE PLACE?
24 A. AT THE NURSES' STATION.
25 Q. DO YOU RECALL WHAT BROUGHT THE CONVERSATION UP?
1753
1 A. IT WAS A DISCUSSION ABOUT PATIENTS NOT BEING MEDICALLY
2 APPROPRIATE AND ME WANTING TO TRANSFER THEM --
3 MR. STIRBA: YOUR HONOR --
4 THE WITNESS: -- OUT OF THE UNIT.
5 MR. STIRBA: YOUR HONOR, I'M GONNA OBJECT. THIS IS
6 UNFAIR SURPRISE AND I OBJECT TO THE RELEVANCY.
7 MS. BARLOW: YOUR HONOR --
8 THE COURT: LET'S -- LET'S --
9 MS. BARLOW: -- THIS IS MATERIAL WE TALKED ABOUT
10 YESTERDAY.
11 THE COURT: WELL, OKAY. DO YOU HAVE ANYTHING ELSE
12 THAT YOU'RE GONNA ASK THIS --
13 MS. BARLOW: NO. I MEAN THIS IS MATERIAL THE COURT
14 RULED ON YESTERDAY.
15 THE COURT: NO, BUT DO YOU HAVE ANY OTHER QUESTIONS
16 YOU WANNA ASK THIS WITNESS?
17 MS. BARLOW: NO, THIS IS --
18 THE COURT: OKAY. LADIES AND GENTLEMEN, WHY DON'T
19 WE TAKE JUST A FIVE-MINUTE BREAK SO THAT WE CAN DISCUSS THIS
20 LEGAL ISSUE.
21 (THE COURT ADMONISHED THE JURY, FOLLOWING
22 WHICH THE JURY LEFT THE COURTROOM.)
23 THE COURT: OKAY. YOU MAY BE SEATED. THE RECORD
24 SHOULD REFLECT THAT THE JURY HAS LEFT THE COURTROOM. OKAY.
25 THERE WERE TWO ISSUES. OKAY. THIS LAST ITEM, YES, WE
1754
1 DISCUSSED YESTERDAY A COMMENT ABOUT THE SIX, YOU KNOW,
2 NEEDED SIX TO MAKE IT WORK OR SOMETHING, BUT WHAT WAS YOUR
3 OBJECTION?
4 MR. STIRBA: WELL, I MEAN I HAD NO IDEA THAT ALL OF
5 THE SUDDEN THE WITNESS WAS GONNA VOLUNTEER. THE CONTEXT OF
6 THIS DISCUSSION WAS ABOUT INAPPROPRIATE CARE OF THESE
7 PATIENTS DURING THE RELEVANT TIME. I'M ENTITLED, IF THE
8 COURT SAYS THAT THESE PEOPLE HAVE TO GIVE ME SOME INDICATION
9 OF WHAT A CONVERSATION IS, I'M ENTITLED TO GET ALL THE
10 CONVERSATION. IT'S IMPOSSIBLE, JUDGE, FOR ME TO SIT HERE IN
11 FRONT OF THIS JURY AND ATTEMPT TO DEAL WITH THESE VERY
12 DIFFICULT ISSUES IF I'M NOT GIVEN A FULL PROFFER AS TO WHAT
13 HAPPENED. THE ONLY THING I WAS TOLD YESTERDAY WAS THAT
14 THERE WAS SOME CONVERSATION AND THE CONVERSATION WAS ABOUT,
15 I TOLD THE COURT WHAT I UNDERSTOOD. THAT'S WHAT I
16 UNDERSTOOD. I DIDN'T KNOW THAT WE WERE GONNA GET IN
17 ADDITION TO THAT THE WITNESS SAYING, OH, YEAH, IT WAS ABOUT
18 ALL THE INAPPROPRIATE CONCERNS AND INAPPROPRIATE CARE AND
19 ALL THIS KIND OF THING. AND I'M TELLING YOU, THIS SHOULD
20 NOT BE A TRIAL BY AMBUSH. THIS IS TOO IMPORTANT OF A CASE.
21 AND I'M SITTING THERE AND I'M TRYING MY GUTS OUT FOR MY
22 CLIENT, BUT IT'S IMPOSSIBLE IF I'M NOT GIVEN ADEQUATE
23 WARNING. THE COURT HAS ALREADY RULED ON 404(B). AND GIVEN
24 ADEQUATE WARNING OF WHAT PEOPLE ARE GONNA SAY AND WHEN
25 THEY'RE GONNA SAY IT. THIS WITNESS OBVIOUSLY -- WE'VE
1755
1 ALREADY HAD IT THIS MORNING -- WANTS TO VOLUNTEER ALL KINDS
2 OF WONDERFUL THINGS ABOUT THIS DEFENDANT. OBVIOUSLY HAS
3 STRONG FEELINGS ABOUT HIM. THAT'S FINE. BUT QUITE FRANKLY,
4 SHE OUGHT NOT TO BE ABLE TO GET AWAY WITH IT, A., AND B., I
5 OUGHT NOT TO BE AMBUSHED ABOUT THESE CONVERSATIONS. SO
6 THAT'S MY FIRST PROBLEM.
7 MY SECOND PROBLEM WITH THE QUESTION WAS, WE DID HAVE --
8 SHE TALKED ABOUT THE CONVERSATION ABOUT THE MOVEMENT OF
9 PATIENTS. SHE TESTIFIED TO IT. AND THEN THERE WAS ANOTHER
10 QUESTION OF, WELL, DID YOU HAVE OTHER CONCERNS ABOUT OR
11 OTHER CONVERSATIONS ABOUT OTHER PATIENTS. JUDGE, IT'S SO
12 VAGUE, I CAN'T EVEN BEGIN TO ADDRESS IT. IT'S NEVER BEEN
13 DISCLOSED TO ME. I HAVE NO REPORT ON THIS WITNESS. WELL, I
14 TAKE IT BACK. I HAVE TWO POLICE REPORTS ON THIS WITNESS.
15 THIS WITNESS IN THOSE TWO POLICE REPORTS NEVER ONCE, NEVER
16 ONCE MENTIONED ONE CONVERSATION THAT SHE HAD WITH THAT MAN
17 RIGHT OVER THERE. BUT SHE WALKS INTO THIS COURTROOM AND NOW
18 SHE HAS ALL KINDS OF CONVERSATIONS SHE'S WILLING TO
19 VOLUNTEER AND TESTIFY ABOUT. AND THE COURT'S DEALT WITH IT
20 AND THE COURT SAID, OKAY, TELL DEFENSE COUNSEL ABOUT THESE
21 CONVERSATIONS. I'M ENTITLED TO KNOW. WELL, I'M ENTITLED TO
22 KNOW THE FULL SCOPE OF THE CONVERSATIONS NOT JUST A LITTLE
23 SLICE, AND THEN WE KIND OF SLIDE INTO SOME OTHER, QUITE
24 FRANKLY, PREJUDICIAL INFORMATION. I JUST THINK THAT'S
25 PATENTLY UNFAIR. AND THAT'S MY PROBLEM AND THAT'S WHY I
1756
1 OBJECTED.
2 THE COURT: OKAY. MISS BARLOW.
3 MS. BARLOW: YOUR HONOR, I'VE GOT A COUPLE OF
4 RESPONSES. NUMBER ONE, THIS WITNESS WAS DEPOSED
5 EXTENSIVELY --
6 MR. STIRBA: NEVER DEPOSED HER EVER. NEVER TOOK
7 HER DEPOSITION, NEVER.
8 MS. BARLOW: EXCUSE ME, YOUR HONOR, I MISSPOKE. I
9 APOLOGIZE FOR THAT. I WAS UNDER THE IMPRESSION SHE HAD
10 BEEN.
11 THE COURT: WELL, WHETHER SHE'D BEEN DEPOSED OR
12 NOT, YESTERDAY I SAID THAT I'D ALLOWED YOU WITH THE OTHER
13 WITNESS TO HAVE THOSE CONVERSATIONS. I SAID FROM NOW ON IF
14 THERE ARE CONVERSATIONS, YOU'LL DISCLOSE THAT. AND THAT
15 DIDN'T MATTER WHETHER THERE WAS A DEPOSITION OR NOT. I JUST
16 SAID THAT WILL BE DISCLOSED. AND I AGREE THAT YESTERDAY WE
17 SAID SHE COULD TESTIFY REGARDING, IF I DIDN'T HAVE SIX
18 PEOPLE IN THIS UNIT, YOU KNOW, BUT THEN THE QUESTION WAS
19 ASKED, YOU KNOW, WHAT BROUGHT THAT ABOUT, AND THEN THAT WAS
20 SOMETHING NEW THAT I'D NEVER HEARD ABOUT.
21 MS. BARLOW: WELL, YOUR HONOR, I WAS JUST TRYING TO
22 LAY FOUNDATION FOR THE CONVERSATION. IF I CAN JUST JUMP TO
23 THE QUESTION AND WHAT DID HE SAY TO YOU ABOUT HOW MANY
24 PATIENTS HAD TO BE, I'LL DO THAT.
25 THE COURT: OKAY. IF THAT -- DO YOU HAVE ANY
1757
1 OBJECTION TO THAT?
2 MR. STIRBA: WELL, WE --
3 THE COURT: I MEAN BESIDES THE OBJECTION YOU STATED
4 YESTERDAY ABOUT THE SUBJECT ITSELF.
5 MR. STIRBA: NO, JUDGE. JUST WITH THE
6 UNDERSTANDING, I MEAN THE WITNESS IS HERE, SHE'S HEARD WHAT
7 WE'RE GOING OVER. AND THE IMPORTANCE OF JUST TESTIFYING AS
8 TO WHAT WAS SAID. AND NOT EDITORIALIZING OR GIVING
9 ADDITIONAL INFORMATION. BECAUSE THAT JUST WOULD NOT BE
10 RIGHT.
11 THE COURT: OKAY. ALL RIGHT. OKAY. WELL, THAT
12 TAKES CARE OF THAT ONE QUESTION. THE OTHER QUESTION YOU'RE
13 GONNA HAVE TO REFRESH MY MEMORY WHAT IT WAS ABOUT, JUST
14 OTHER CONVERSATIONS. NOW, SHE TESTIFIED ABOUT -- ARE THERE
15 OTHER CONVERSATIONS IN ADDITION TO WHAT SHE SAID?
16 MS. BARLOW: I'LL WITHDRAW THE QUESTION BECAUSE,
17 FRANKLY, YOUR HONOR, I CAN'T EVEN REMEMBER THE QUESTION
18 EITHER.
19 THE COURT: OKAY. ALL RIGHT. SO IS THERE ANYTHING
20 ELSE BESIDES THIS ONE QUESTION WE HAVE TO DEAL WITH?
21 MS. BARLOW: IF I MAY HAVE JUST A MOMENT.
22 THE COURT: OKAY.
23 MS. BARLOW: THAT'S THE ONLY QUESTION I WILL HAVE,
24 YOUR HONOR.
25 THE COURT: OKAY. THEN WHY DON'T WE HAVE THE JURY
1758
1 COME BACK?
2 (THE JURY RETURNS TO THE COURTROOM.)
3 THE COURT: OKAY. PLEASE BE SEATED. THE RECORD
4 WILL REFLECT THAT THE JURY HAS COME BACK. MISS BARLOW.
5 MS. BARLOW: OKAY. THANK YOU, YOUR HONOR.
6 Q. MISS HARDEY, IN THE CONVERSATION THAT HAD YOU WITH THE
7 DEFENDANT, DID HE EVER SAY ANYTHING TO YOU ABOUT HOW MANY
8 PATIENTS NEEDED TO BE ON THE UNIT?
9 A. YES, HE DID.
10 Q. AND WHAT DID HE SAY?
11 A. HE SAID HE NEEDED SIX PATIENTS ON THE UNIT TO MAKE IT
12 WORTH HIS WHILE TO COME DOWN FROM SALT LAKE.
13 MS. BARLOW: THOSE ARE ALL THE QUESTIONS I HAVE AT
14 THIS TIME, YOUR HONOR.
15 THE COURT: OKAY. MR. STIRBA.
16 MR. STIRBA: THANK YOU, YOUR HONOR.
17 CROSS-EXAMINATION
18 BY MR. STIRBA:
19 Q. YOU TESTIFIED ABOUT GOING TO MR. CHAMBERS, AND THAT
20 WOULD HAVE BEEN IN JANUARY OF 1996, IS THAT RIGHT?
21 A. THAT IS CORRECT.
22 Q. AND YOU SUPPOSEDLY WENT TO MR. CHAMBERS BECAUSE YOU WERE
23 CONCERNED ABOUT CIRCUMSTANCES ON THE UNIT, TRUE?
24 A. I WAS CONCERNED.
25 Q. AND IN FACT, AREN'T YOU AWARE, MA'AM, THAT HORIZONS DID
1759
1 AN INVESTIGATION OF THE VERY THINGS THAT YOU WERE CONCERNED
2 ABOUT, DO YOU UNDERSTAND THAT?
3 MS. BARLOW: YOUR HONOR, I'M GOING TO OBJECT TO
4 THIS LINE OF QUESTIONING AND ASK THAT HE NOT GET INTO IT
5 UNTIL WE'VE HAD TIME TO DISCUSS IT.
6 MR. STIRBA: THEY OPENED IT UP.
7 THE COURT: YOU ASKED THE QUESTION ABOUT
8 MR. CHAMBERS --
9 MS. BARLOW: YES, BUT THE INVESTIGATION WE NEED TO
10 DISCUSS OUTSIDE THE PRESENCE OF THE JURY, YOUR HONOR.
11 THE COURT: OKAY. LADIES AND GENTLEMEN, I'M GOING
12 TO TAKE JUST A REAL SHORT BREAK BECAUSE I WANT TO DO THIS
13 RIGHT NOW.
14 (THE COURT ADMONISHED THE JURY, FOLLOWING
15 WHICH THE JURY LEFT THE COURTROOM.)
16 THE COURT: YOU MAY BE SEATED. RECORD WILL REFLECT
17 THE JURY HAS LEFT THE COURTROOM. OKAY. WHAT IS THE
18 OBJECTION?
19 MS. BARLOW: YOUR HONOR, I'M SORRY TO SEND THEM OUT
20 AGAIN, BUT THIS IS THE REPORT OF AN INVESTIGATION THAT WE
21 DISCUSSED AT LENGTH FIRST OR SECOND DAY OF TRIAL. THE
22 MATERIAL --
23 THE COURT: I'M AWARE OF THE -- I'M AWARE OF IT.
24 I'M AWARE THAT THEY OFFERED FIVE SHEETS. I REFUSED TO HAVE
25 THEM BECAUSE WE DIDN'T HAVE EVERYTHING. THEN YOU ASKED A
1760
1 QUESTION THAT MR. CHAM -- DID YOU GO TO HORIZONS AND ASK
2 THAT THIS BE INVESTIGATED, AND WHAT DID HE SAY HE WOULD DO?
3 HE SAID THAT HE WOULD LOOK INTO IT. SO WE HAVE THAT
4 TESTIMONY OF THIS WITNESS. AND HOW IS THAT NOT OPENING THE
5 DOOR BECAUSE SHE HAS NOW SAID, I WENT TO HIM AND HE
6 BASICALLY DIDN'T SAY ANYTHING. I'LL LOOK INTO IT. AND NOW,
7 WHY ISN'T THE DOOR OPENED?
8 MS. BARLOW: BECAUSE WE HAVE NOT BEEN ALLOWED TO
9 HAVE THE RESULTS OF THAT REPORT. THAT WAS THE REPORT THAT
10 BOTH THE HOSPITAL -- EXCUSE ME, BOTH HORIZONS AND THE
11 DEFENDANT HAD TO --
12 THE COURT: WELL, THE QUESTION IS NOT WHETHER THE
13 REPORT'S COME IN OR NOT. THE QUESTION TO THIS WITNESS WAS,
14 WERE YOU AWARE THAT AN INVESTIGATION WAS DONE ABOUT THESE
15 ALLEGATIONS THAT YOU BROUGHT UP TO TODD CHAMBERS.
16 MS. BARLOW: AND IF SHE -- I HAVE NO PROBLEM WITH
17 HER TESTIFYING AS TO WHETHER SHE'S AWARE, BUT I DO NOT WANT
18 TO GET INTO THE RESULTS OF THAT INVESTIGATION BECAUSE SHE
19 WOULD NOT -- HAVE NO PERSONAL KNOWLEDGE OF IT. IT WOULD BE
20 HEARSAY, ANYTHING THAT SHE HEARD, IF SHE HEARD ANYTHING. I
21 DON'T KNOW IF SHE'S EVEN HEARD ANYTHING. IT WOULD BE
22 HEARSAY, NUMBER ONE. NUMBER TWO, WE DON'T HAVE ACCESS TO
23 THAT REPORT AND THAT REPORT IS -- THE COURT HAS ALREADY
24 RULED WILL NOT BE ALLOWED INTO EVIDENCE. AND SO I -- I
25 GUESS MY CONCERN IS GOING BEYOND DID SHE -- IS SHE AWARE OF
1761
1 IT. YOU KNOW, SHE CAN SAY WHETHER SHE'S AWARE OF IT, BUT I
2 WILL STRENUOUSLY OBJECT TO ANY QUESTIONS ABOUT WHAT WERE THE
3 RESULTS OF THAT, THAT INVESTIGATION.
4 THE COURT: OKAY. ALL RIGHT. MR. STIRBA.
5 MR. STIRBA: YOUR HONOR, THEY RAISED IT. I DIDN'T
6 RAISE IT. I'M ENTITLED TO GO INTO IT. AND I'LL TELL YOU,
7 I'M ENTITLED TO CROSS-EXAMINE THE WAY I WANNA CROSS-EXAMINE.
8 IF THE WITNESS DOESN'T KNOW, THE WITNESS WILL TELL ME, AND
9 I'LL MOVE ON. BUT I'M ENTITLED TO ASK QUESTIONS. SHE
10 RAISED IT BECAUSE THEY WANNA RAISE AN INNUENDO, QUITE
11 FRANKLY, THAT SOMETHING WAS AMISS HERE BY HER COMPLAINT.
12 AND I'M GONNA DISPEL THAT INNUENDO THROUGH THIS WITNESS.
13 AND I'M ENTITLED TO DO THAT. I DIDN'T BRING IT UP.
14 THE COURT: OKAY. ANYTHING FURTHER?
15 MS. BARLOW: YES, YOUR HONOR. SHE TESTIFIED TO HER
16 CONVERSATIONS WITH MR. CHAMBERS. SHE DIDN'T TESTIFY AS TO
17 WHAT THE RESULTS OF THAT INVESTIGATION WERE. AND FRANKLY,
18 IF WE'RE GOING TO GET INTO THAT, THEN, YOU KNOW, WE -- WE
19 WANT TO PUT THE WHOLE THING IN, WHICH INCLUDES THAT THERE
20 WERE THINGS THAT HAPPENED AND CAME OUT OF THIS
21 INVESTIGATION --
22 THE COURT: WELL, AS TO THIS --
23 MS. BARLOW: -- BUT -- WELL, YOU KNOW --
24 THE COURT: -- MATTER, WHATEVER SORT OF
25 INVESTIGATION WAS DONE IS BEYOND WHAT THIS WITNESS -- THE
1762
1 QUESTION TO THIS WITNESS WAS, WERE YOU AWARE THAT THE THINGS
2 THAT YOU BROUGHT UP WERE INVESTIGATED BY HORIZONS. AND WHAT
3 WERE THE RESULTS. AND IF SHE KNOWS IT, SHE DOESN'T KNOW IT.
4 BUT I MEAN YOU -- YOU ASKED THE QUESTION. YOUR QUESTION
5 WASN'T, DID YOU GO TO TODD CHAMBERS. YOUR QUESTION IS, DID
6 YOU GO TO HORIZON ABOUT THIS AND COMPLAIN TO HORIZON. AND
7 SO IT'S LEFT OUT THERE FOR THE JURY TO SAY -- AND THEN --
8 AND THEN YOU'RE SAYING, OKAY, THAT'S FINE, YOU CAN ANSWER
9 THAT QUESTION, BUT WE'RE NOT GONNA LET THE DEFENSE, YOU
10 KNOW, SAY INTO ANYTHING, YOU KNOW --
11 MS. BARLOW: WELL, IF -- IF THE DEFENSE GETS IN
12 THAT THERE WAS SOME RESULT, THEN WE WANT TO BE ABLE TO,
13 NUMBER ONE, GET -- GET THE REPORT OF THE --
14 THE COURT: WELL, WE'LL DO IT ONE QUESTION AT A
15 TIME. AS TO THE QUESTION ABOUT IN -- WHAT HAPPENED OR WHAT
16 SHE KNOWS ABOUT ANY INVESTIGATION AFTER SHE TALKED TO
17 HORIZON AND TODD CHAMBERS, THAT CAN BE ASKED.
18 MS. BARLOW: YOUR HONOR, THEN WE WOULD -- WE WOULD
19 LIKE TO RECEIVE A COPY OF THAT REPORT, AND THEN I GUESS
20 WE'LL PROBABLY HAVE TO GET SOME ORDER TO -- WOULDN'T BE THE
21 HOSPITAL, IT WOULD BE HORIZONS --
22 MR. MAJOR: BOTH HORIZON AND THE HOSPITAL.
23 THE COURT: WELL, THAT ISSUE IS NOT GONNA BE WITH
24 THIS WITNESS. WE CAN DISCUSS THAT AT A LATER TIME --
25 MS. BARLOW: THAT'S TRUE, BUT IT WILL OPEN UP
1763
1 BRINGING IN A LOT MORE WITNESSES ON --
2 THE COURT: WELL, WHEN YOU TALK ABOUT OPENING UP,
3 THE QUESTION -- YOU RAISED THE QUESTIONS ABOUT DID
4 HORIZON -- DID YOU TALK TO HORIZON ABOUT ALL THIS STUFF.
5 AND SO YOU OPENED IT.
6 OKAY. LET'S HAVE OF THE JURY COME BACK.
7 (THE JURY RETURNED TO THE COURTROOM.)
8 THE COURT: OKAY. PLEASE BE SEATED. THE RECORD
9 WILL REFLECT THAT THE JURY HAS RETURNED. MR. STIRBA, IF
10 YOU'D LIKE TO GO AHEAD.
11 MR. STIRBA: THANK YOU.
12 Q. YOU TESTIFIED, MISS HARDEY, THAT YOU TALKED TO
13 MR. CHAMBERS AND HE SAID HE'D LOOK INTO IT, TRUE?
14 A. CORRECT.
15 Q. AND IN FACT, HORIZON DID LOOK INTO IT, DID THEY NOT?
16 A. I HAVE NO KNOWLEDGE OF THAT.
17 Q. AND IN FACT, AFTER HORIZON LOOKED INTO IT, THEY DIDN'T
18 DISCIPLINE --
19 MS. BARLOW: OBJECTION, YOUR HONOR --
20 Q. (BY MR. STIRBA) -- DR. WEITZEL, DID THEY?
21 MS. BARLOW: -- SHE SAID SHE DIDN'T KNOW IF THEY
22 DID LOOK INTO IT AND HE SAID AFTER THEY LOOKED INTO IT, AND
23 I OBJECT TO ANY QUESTIONS ALONG THAT LINE.
24 THE COURT: OKAY. OVERRULED.
25 Q. (BY MR. STIRBA) THEY DIDN'T DISCIPLINE DR. WEITZEL TO
1764
1 YOUR KNOWLEDGE, DID THEY?
2 A. I HAVE NO IDEA.
3 Q. IN FACT, DR. WEITZEL CONTINUED TO WORK IN FEBRUARY AND
4 MARCH AND APRIL AND JULY ON THE UNIT, DIDN'T HE?
5 A. I HAVE NO KNOWLEDGE OF WHAT YOU'RE DISCUSSING RIGHT NOW.
6 Q. YOU HAVE NO KNOWLEDGE THAT DR. WEITZEL CONTINUED TO WORK
7 ON THE UNIT AFTER JANUARY OF 1996 DURING THE SAME TIME
8 PERIOD, MA'AM, WHEN YOU WERE WORKING THERE? YOU HAVE NO
9 KNOWLEDGE OF THAT?
10 A. THAT I DO.
11 Q. AND IN FACT, THAT'S TRUE, HE WORKED THERE IN FEBRUARY,
12 MARCH, APRIL, MAY, AND JUNE, ISN'T THAT TRUE?
13 A. THAT IS TRUE, HE WORKED.
14 Q. IN 1996, CORRECT?
15 A. YES.
16 Q. AND IT'S TRUE, IS IT NOT, MA'AM, THAT YOU FOLLOW THE
17 CODE AS A PROFESSIONAL NURSE OF THE AMERICAN NURSES'
18 ASSOCIATION?
19 A. YES, I DO.
20 Q. AND IT'S TRUE, IS IT NOT, THAT YOU BELIEVE THAT IT'S THE
21 PROFESSIONAL RESPONSIBILITY OF A NURSE TO SAFEGUARD THE
22 PATIENT AND THE PUBLIC WHEN HEALTH AND SAFETY ARE AFFECTED
23 BY INCOMPETENT, UNETHICAL, OR ILLEGAL PRACTICES OF ANY
24 PERSON?
25 A. THE BEST OF MY ABILITY.
1765
1 Q. AND YOU BELIEVE ALSO THAT A NURSE ASSUMES RESPONSIBILITY
2 AND ACCOUNTABILITY FOR INDIVIDUAL NURSING JUDGMENTS AND
3 ACTIONS?
4 A. YES, I DO.
5 Q. AND YOU CERTAINLY AGREE, DO YOU NOT, THAT ONE OF THE
6 FUNDAMENTAL REQUIREMENTS OF A NURSE IS THAT A NURSE DO NO
7 HARM. WOULD YOU AGREE WITH THAT?
8 A. I WOULD AGREE WITH THAT.
9 Q. AND IT'S TRUE, IS NOT, THAT WHEN YOU GAVE A P.R.N.
10 MORPHINE INJECTION ON THE 2ND OF JANUARY OF 1996 TO JUDITH
11 LARSEN, YOU DIDN'T BELIEVE YOU WERE DOING ANY HARM, ISN'T
12 THAT TRUE?
13 A. I'LL HAVE TO LOOK THAT UP. WHAT PAGE IS THAT ON?
14 Q. WELL, YOU HAVE THE BINDER IN FRONT OF YOU.
15 A. DO YOU HAVE A PAGE NUMBER?
16 Q. YOU KNOW WHERE THE MARS ARE. IS THERE ANY DOUBT IN YOUR
17 MIND, MA'AM, WHETHER OR NOT WHEN YOU GAVE --
18 A. I WOULD LIKE TO BE --
19 Q. -- THAT P.R.N. INJECTION --
20 MS. BARLOW: YOUR HONOR, HE'S ASKING --
21 THE COURT: OKAY. LET'S WAIT, LET HER LOOK.
22 MS. BARLOW: -- SECOND QUESTION.
23 THE WITNESS: THAT WAS NOT A P.R.N. INJECTION.
24 THAT WAS PART OF A SCHEDULED INJECTION AT 1530 THAT WAS NOT
25 REPORTED.
1766
1 Q. (BY MR. STIRBA) YOUR TESTIMONY THEN IS, MA'AM, YOU DID
2 NOT GIVE A P.R.N. INJECTION TO JUDITH LARSEN ON THE 2ND OF
3 JANUARY?
4 A. IF YOU LOOK AT PAGE 507, THERE WAS A 1530 SCHEDULED M.S.
5 ORDER THAT IS NOT ANNOTATED THERE.
6 Q. I'M TALKING ABOUT A P.R.N. ORDER, MA'AM.
7 A. RIGHT. THAT WAS NOT CONSIDERED A P.R.N. ORDER
8 BECAUSE --
9 Q. OKAY. THAT --
10 A. -- THE SCHEDULED DOSE WAS NOT GIVEN.
11 Q. MA'AM, MA'AM, IF IT'S NOT A P.R.N. ORDER, THEN I'M NOT
12 TALKING ABOUT IT. I'M TALKING ABOUT A P.R.N. ORDER --
13 A. I GAVE --
14 Q. -- ARE YOU TELLING THIS JURY -- I WANNA KNOW, ARE YOU
15 TELLING THIS JURY, DID YOU GIVE A P.R.N. ORDER FOR MORPHINE
16 TO JUDITH LARSEN ON THE 2ND OF JANUARY OF 1996?
17 A. I'M TELLING YOU I GAVE A DOSE OF MORPHINE 5 MILLIGRAMS
18 AT 1630 THAT WAS ANNOTATED BY THE P.R.N. SHEET ON PAGE 510,
19 BUT ON 507 THE SCHEDULED MORPHINE DOSE WAS NOT GIVEN, SO
20 THAT WAS IN PLACE OF THAT ONE THAT WAS NOT GIVEN AS
21 SCHEDULED.
22 Q. A P.R.N. ORDER IS ONE THAT'S GIVEN AT THE DISCRETION OF
23 THE NURSE, IS THAT RIGHT?
24 A. CORRECT.
25 Q. AND THERE'S A SECTION, IS THERE NOT, IN THE MEDICATION
1767
1 ADMINISTRATION RECORDS THAT DEALS WITH P.R.N. ORDERS OR NON
2 ROUTINE MEDICATIONS?
3 A. YES.
4 Q. AND IN FACT, THERE IS IN THE P.R.N. SECTION FOR MISS
5 LARSEN AN ENTRY ON 1/2 OF 1996 FOR MORPHINE, IS THAT RIGHT?
6 A. CORRECT.
7 Q. IN FACT, 5 MILLIGRAMS OF MORPHINE, TRUE?
8 A. CORRECT.
9 Q. AND IT'S INITIALLED BY YOU, IS IT NOT?
10 A. YES, IT IS.
11 Q. AND IT SAYS 1630.
12 A. CORRECT.
13 Q. NOW, I'M POINTING OUT RIGHT HERE, DOWN HERE AT THE
14 BOTTOM, THIS PARTICULAR SHEET SAYS P.R.N. AND I.V.
15 MEDICATION ADMINISTRATIVE RECORD, CORRECT?
16 A. CORRECT.
17 Q. AND WHAT I'M POINTING OUT IS AN ENTRY RIGHT HERE, SAYS
18 M.S. 5 MILLIGRAMS, Q-2, P.R.N., PAIN. DID I READ THAT
19 CORRECTLY?
20 A. YOU DID.
21 Q. AND THEN I GO OVER AND I FIND AND ENTRY WHICH RIGHT UP
22 THERE SAYS 1/2 OF '96, TRUE?
23 A. CORRECT.
24 Q. AND UNDERNEATH THAT IT SAYS 1630 HOURS, CORRECT?
25 MS. BARLOW: YOUR HONOR, THIS HAS BEEN ASKED AND
1768
1 ANSWERED. SHE SAID SHE GAVE IT.
2 THE COURT: OVERRULED.
3 Q. (BY MR. STIRBA) 1630 HOURS, TRUE?
4 A. YES.
5 Q. THAT'S YOUR WRITING, TRUE?
6 A. YES.
7 Q. IS IT?
8 A. YES, IT IS.
9 Q. AND THEN WE HAVE I.M. THAT MEANS INTRAMUSCULAR,
10 CORRECT?
11 A. CORRECT.
12 Q. AND THEN WE HAVE INITIALS, AND THOSE ARE YOURS.
13 A. YES, THEY ARE.
14 Q. TRUE?
15 A. YES.
16 Q. AND IT'S TRUE, IS IT NOT, THAT THE MEDICATION
17 ADMINISTRATIVE -- ADMINISTRATION RECORD FOR ROUTINE
18 MEDICATIONS FOR MORPHINE FOR MISS LARSEN ALSO SHOW, DO THEY
19 NOT, THAT YOU INITIALLED AT 1530 AND 1830 ON THE 2ND, GIVING
20 ALSO INJECTIONS FOR MORPHINE, CORRECT?
21 A. AT 1530 MY INITIALS ARE CROSSED OUT. WOULD YOU LIKE TO
22 KNOW THE CIRCUMSTANCES WHY?
23 Q. FOR EXAMPLE, IF WE LOOK AT THIS FORM, HERE IS THE 2ND.
24 A. CORRECT.
25 Q. AND THEN UNDER 1530, THOSE ARE YOUR INITIALS, ARE THEY
1769
1 NOT?
2 A. THEY'RE CROSSED OUT.
3 Q. YOU SAY THEY'RE CROSSED OUT.
4 A. YES, THEY ARE.
5 Q. OKAY. AND THEN AT 1830, THAT'S ALSO YOUR INITIALS,
6 TRUE?
7 A. THAT'S THE SCHEDULED DOSE, CORRECT.
8 Q. NOW, ARE YOU TELLING US, MA'AM, THAT THE P.R.N. ORDER
9 WHICH I JUST ASKED YOU ABOUT --
10 A. UH-HUH.
11 Q. -- WHICH IS IN THE P.R.N. SECTION OF THE MEDICATION
12 ADMINISTRATIVE RECORD FOR MISS LARSEN, YOU'RE SAYING THAT
13 YOU DID NOT GIVE THAT AS A P.R.N. FOR PAIN ON THE 2ND AT
14 1630 HOURS?
15 A. YOUR HONOR, CAN I EXPLAIN HOW THAT CAME ABOUT? I'M NOT
16 ABLE TO --
17 THE COURT: YOU ANSWER HIS QUESTION.
18 THE WITNESS: OKAY.
19 Q. (BY MR. STIRBA) THERE'S THE DOCUMENT. ARE YOU TELLING
20 THIS JURY ON THAT FORM WITH YOUR EXPERIENCE, YOU DIDN'T GIVE
21 THAT AS A P.R.N. AT 1630 HOURS ON 1/2/1996 FOR PAIN TO
22 JUDITH LARSEN; YES OR NO?
23 A. THAT DOSE WAS GIVEN AT 1630.
24 Q. IT WAS GIVEN AT 1630. THAT WASN'T MY QUESTION. MY
25 QUESTION IS, ARE YOU TELLING THIS JURY, EVEN THOUGH YOU
1770
1 FILLED OUT THIS FORM, WHICH IS CONCEDEDLY M.S. 5 MILLIGRAMS
2 Q-2 HOURS, P.R.N. PAIN, WITH YOUR INITIALS, AND YOU DATING
3 IT, AND YOU INDICATING IT WAS GIVEN, ARE YOU TELLING THIS
4 JURY NOW FIVE YEARS LATER THAT YOU DIDN'T GIVE A P.R.N. AT
5 1630 HOURS --
6 A. I'M SAYING --
7 Q. -- TO MISS LARSEN? YES OR NO, MA'AM, DID YOU OR DIDN'T
8 YOU?
9 A. I GAVE A DOSE OF MORPHINE CHARTED ON THE P.R.N. SHEET
10 AND NOT CHARTED ON THE SCHEDULED SHEET.
11 Q. SO YOU'RE SAYING THAT THIS PARTICULAR ENTRY IS A
12 MISREPRESENTATION OF FACT?
13 A. I WOULD NOT SAY IT WAS A MISREPRESENTATION --
14 Q. WELL, IT WASN'T --
15 A. -- BECAUSE 5 MILLIGRAMS WAS GIVEN.
16 Q. IT WASN'T A P.R.N. ORDER, WAS IT, MA'AM? THAT'S NOT
17 TRUE, IS IT?
18 A. MORPHINE IS USUALLY GIVEN P.R.N. WHEN I CAME OUT OF
19 REPORT, THE NURSE COMING ON SAID, YOU BETTER MAKE SURE --
20 BECAUSE WE WERE LATE WITH REPORT, SHE SAID, YOU BETTER MAKE
21 SURE YOU GIVE THAT MORPHINE OR DR. WEITZEL'S GONNA BE ANGRY.
22 SO I CAME OUT -- MORPHINE IS NORMALLY SCHEDULED AS A P.R.N.
23 IT IS NEVER SCHEDULED AROUND THE CLOCK LIKE THAT I.M. ON
24 PATIENTS. SO I TURNED TO THE P.R.N. SHEET BECAUSE THAT'S
25 WHERE YOU NORMALLY WOULD LOOK FOR MORPHINE. I ANNOTATED IT,
1771
1 GAVE THE MORPHINE SO THAT DR. WEITZEL WOULDN'T BE MAD. CAME
2 BACK. LOOKED AT THE M.R.I. SAW IT ON THE SCHEDULED PORTION
3 OF THE M.R.I. AND SAID, WELL, AS LONG AS IT'S ANNOTATED ON
4 THE OTHER SIDE, THEN IT'S OKAY. IT WAS ADMINISTERED IS THE
5 MAIN THING. I WASN'T ACCUSTOMED TO HAVING MORPHINE
6 SCHEDULED AND LOOKING AT THE SCHEDULED SHEET. I IMMEDIATELY
7 TURNED TO THE P.R.N. SECTION OF THE MARS TO GIVE THAT DOSE
8 OF MORPHINE SO THAT DR. WEITZEL WOULD BE NOT ANGRY THAT WE
9 DIDN'T GIVE IT.
10 Q. OKAY. I'M GONNA ASK MY QUESTION ONE MORE TIME. THIS
11 PARTICULAR ENTRY, WHICH IS P.R.N., WHICH YOU CERTAINLY KNOW
12 WITH THAT MEANS, DO YOU NOT?
13 A. YES, I DO.
14 Q. THAT MEDICATION AS YOU CHARTED IT THERE, WASN'T GIVEN
15 P.R.N., WAS IT? IS THAT YOUR TESTIMONY?
16 A. I'M SAYING I GAVE 5 MILLIGRAMS OF MORPHINE THAT WAS
17 SCHEDULED TO BE GIVEN AT 1530. I GAVE IT AT 1630 BECAUSE I
18 CAME OUT OF REPORT LATE.
19 Q. I'LL TRY ONE MORE TIME. DID YOU GIVE A P.R.N. ORDER AS
20 YOU DOCUMENTED HERE IN YOUR OWN HANDWRITING AT 15 -- I'M
21 SORRY, 1630 HOURS FOR 5 MILLIGRAMS OF MORPHINE TO JUDITH
22 LARSEN?
23 A. IT WAS GIVEN AS THE SCHEDULED DOSE, ANNOTATED IN THE
24 P.R.N. SECTION.
25 Q. THAT ENTRY, MA'AM, AS YOU INDICATED THERE, IS NOT TRUE,
1772
1 CORRECT?
2 MS. BARLOW: YOU KNOW, I THINK THAT'S AMBIGUOUS.
3 WHAT -- WHAT DOES IT MEAN --
4 THE COURT: OVERRULED.
5 Q. (BY MR. STIRBA) IT'S NOT TRUE, IS IT, MA'AM?
6 A. I GAVE IT AS A MORPHINE 5 MILLIGRAMS.
7 Q. BUT YOU DIDN'T GIVE IT AS A P.R.N., DID YOU?
8 A. IT WAS GIVEN AS A SCHEDULED DOSE WRITTEN IN THE P.R.N.
9 SECTION.
10 Q. BUT YOU DIDN'T GIVE IT AS A P.R.N., DID YOU?
11 A. NO.
12 Q. AND YOU CHARTED IT AS A P.R.N. ON THIS DOCUMENT, TRUE?
13 A. CORRECT.
14 Q. NOW, YOU UNDERSTAND, DO YOU NOT, MA'AM, AS A NURSE, THAT
15 NURSES HAVE CERTAIN STANDARDS THAT APPLY TO THEIR
16 PROFESSION, ONE OF WHICH IS TO CHART ACCURATELY --
17 A. CORRECT.
18 Q. -- CORRECT? IN FACT, IT'S A NURSE'S DUTY TO MAKE SURE
19 THAT THE INFORMATION THAT GOES IN A MEDICAL RECORD IS INDEED
20 CORRECT, TRUE?
21 A. CORRECT.
22 Q. AND CERTAINLY, ONE OF THE REASONS WHY IT'S INCUMBENT ON
23 NURSES TO CHART ACCURATELY AND CORRECTLY IS SO THAT SOMEONE
24 WHO PICKS UP THAT FILE WHO HAS TO PROVIDE SOME KIND OF
25 MEDICAL CARE, IS APPROPRIATELY AND CORRECTLY INFORMED, ISN'T
1773
1 THAT CORRECT?
2 A. CORRECT.
3 Q. AND IT'S ALSO TRUE, IS IT NOT, THAT NURSES AS OTHER
4 HEALTHCARE PROVIDERS, ARE ALWAYS WORRIED ABOUT LITIGATION
5 ISSUES AND THEREFORE, IT'S IMPORTANT THAT THE DOCUMENTS
6 REFLECT PRECISELY WHAT HAS OCCURRED, ISN'T THAT TRUE?
7 MS. BARLOW: OBJECTION. I OBJECT TO ANY TALK ABOUT
8 LITIGATION ISSUES. THAT'S-
9 MR. STIRBA: WELL, I COULD HAVE SAID LIABILITY.
10 IT'S JUST A GENERAL QUESTION, JUDGE.
11 MS. BARLOW: YOUR HONOR, LIABILITY ALSO HAS NOTHING
12 TO DO WITH THIS CASE.
13 THE COURT: OVERRULED.
14 Q. (BY MR. STIRBA) THAT'S TRUE, ISN'T IT?
15 A. WOULD YOU REPEAT THE QUESTION?
16 Q. SURE. IN OTHER WORDS, YOU ARE WELL AWARE THAT ONE OF
17 THE REASONS WHY WE WANNA CHART ACCURATELY IS NOT ONLY TO
18 PROVIDE ADEQUATE HEALTHCARE TO A PATIENT, BUT THERE ARE ALSO
19 SOMETIMES LIABILITY QUESTIONS RAISED, AND PEOPLE NEED TO
20 LOOK AT THESE RECORDS TO SEE WHAT HAPPENED. DO YOU
21 UNDERSTAND THAT?
22 A. YES.
23 Q. AND IT'S TRUE, IS IT NOT, AS YOU SIT HERE TODAY, THAT
24 REALLY WHAT YOU CHARTED AT THE TIME IS MORE ACCURATE THAN
25 WHAT YOU NOW REMEMBER ON THE WITNESS STAND?
1774
1 A. I WOULD THINK THAT YOUR CHARTING IS A GOOD BASIS FOR
2 YOUR RECALL.
3 Q. IN OTHER WORDS, YOU CHARTED ESSENTIALLY AS THE ACTIVITY
4 WAS GOING ON, DIDN'T YOU?
5 A. OR SHORTLY THEREAFTER OR AT THE END OF THE SHIFT.
6 Q. AND CERTAINLY THAT WOULD BE A BETTER RECOLLECTION OF
7 EVENTS THAN YOUR MEMORY FIVE YEARS LATER, ISN'T THAT TRUE?
8 A. YES.
9 Q. AND CERTAINLY AS YOU TESTIFIED AT LEAST TO THE STATE IN
10 THEIR DIRECT EXAMINATION, YOU SEEM TO HAVE A PRETTY GOOD
11 FAMILIARITY WITH THE THESE RECORDS, IS THAT RIGHT?
12 A. AS I REVIEW THEM, YES.
13 Q. YOU'VE REVIEWED THEM PRIOR TO COMING HERE, HAVEN'T YOU?
14 A. I'VE LOOKED 'EM OVER.
15 Q. TELL THE JURY HOW MANY HOURS YOU'VE SPENT IN LOOKING AT
16 THOSE RECORDS BEFORE YOU CAME HERE.
17 A. PROBABLY AT LEAST AN HOUR AND A HALF.
18 Q. DO YOU HAVE -- DO YOU HAVE ANY INDEPENDENT RECOLLECTION
19 OF EVENTS OTHER THAN WHAT IS CONTAINED IN THE MEDICAL
20 RECORDS?
21 A. YES, I DO.
22 Q. FOR EXAMPLE, CAN YOU -- DO YOU RECALL WHAT HAPPENED ON
23 DECEMBER 11TH WITH RESPECT TO JUDITH LARSEN AND HER FAMILY? See note>>
24 A. THE EXACT DATE, NO. I WOULD HAVE TO LOOK THROUGH THE
25 RECORDS.
1775
1 Q. OKAY. DO YOU HAVE ANY RECOLLECTION OF ANY INTERCHANGE
2 WITH HER FAMILY ON THAT DATE?
3 A. I COULD LOOK IT UP.
4 Q. NO, I'M JUST TALKING ABOUT RIGHT NOW, AS YOU SIT HERE
5 NOW --
6 A. I CAN --
7 Q. -- CAN YOU REMEMBER --
8 A. -- I CAN RECALL DIFFERENT INTERACTIONS WITH THEM, BUT
9 FOR ME TO --
10 Q. THEN WHAT HAPPENED ON DECEMBER 11TH?
11 A. I'LL HAVE TO LOOK UP DECEMBER 11TH. I CAN TELL YOU THE
12 INTERACTIONS THAT HAPPENED WITH THE FAMILY CONCERNING
13 JUDITH, BUT I CANNOT PUT AN EXACT DATE ON IT.
14 Q. I THINK YOU'VE TOLD US THAT. I'M ASKING, AS YOU SIT
15 HERE RIGHT NOW, CAN YOU TELL THIS JURY WHAT INTERACTION YOU
16 HAD WITH THE FAMILY WITHOUT LOOKING AT THE RECORDS ON
17 DECEMBER 11TH OF 1995?
18 A. NOT DECEMBER 11TH. I CAN TELL YOU OF INTERACTIONS WITH
19 THE FAMILY NOW, BUT NOT SPECIFIC TO THAT DATE.
20 Q. WHY DON'T YOU TURN TO THE NURSES' NOTES ON DECEMBER
21 11TH?
22 A. ON WHICH --
23 Q. BE MED-005 --
24 A. ON JUDITH LARSEN?
25 Q. -- 36. YES.
1776
1 A. OKAY.
2 Q. AND ACTUALLY ON THAT PARTICULAR PAGE IS A CONTINUATION
3 OF A NOTE, I'M INTERESTED IN THE LANGUAGE AT THE TOP. AND
4 IT SAYS -- IS IT 930 OR 1930?
5 A. 1930.
6 Q. OKAY. IT SAYS PATIENT'S FAMILY MEMBER CALLED AND
7 REQUESTED INFORMATION ON PATIENT'S STATUS.
8 A. CORRECT.
9 Q. CONTINUALLY -- CONTINUES TO NOT WANT I.V.'S, FEEDING
10 TUBES, ET CETERA, AS PER LIVING WILL. AND THEN IT SAYS 02.
11 WHAT DOES THAT X. STAND FOR?
12 A. OKAY.
13 Q. OKAY. FAMILY RELIEVED TO HEAR PATIENT IS NOT SCREAMING
14 OUT OR AGITATED CURRENTLY.
15 DID I READ THAT CORRECTLY?
16 A. YES, YOU DID.
17 Q. AND DO YOU REMEMBER AS YOU NOW SEE THAT NOTE WHICH
18 FAMILY MEMBER YOU TALKED TO?
19 A. THE SPECIFIC FAMILY MEMBER, NO.
20 Q. AND YOU'VE TESTIFIED ABOUT YOUR CONCERNS RELATING TO THE
21 MORPHINE THAT WAS ORDERED ON THE 13TH OF DECEMBER FOR MISS
22 LARSEN, TRUE?
23 A. CORRECT. CORRECT.
24 Q. NOW, JUST SO THE JURY UNDERSTANDS, IT'S TRUE, IS IT NOT,
25 AND YOU'VE REVIEWED THESE RECORDS AND CERTAINLY YOU'VE
1777
1 REVIEWED THEM QUITE CLOSELY, JUDITH LARSEN DID NOT RECEIVE
2 ANY MORPHINE, ANY INJECTION OF ANY MORPHINE FROM
3 DECEMBER 6TH UNTIL DECEMBER 25TH OF 1995, TRUE?
4 A. ACCORDING TO THE RECORDS, I WOULD HAVE TO LOOK AND MAKE
5 SURE.
6 Q. OKAY. YOU DON'T KNOW THAT JUST AS YOU SIT HERE TODAY
7 WITHOUT REVIEWING THE RECORDS --
8 A. CORRECT.
9 Q. -- CORRECT? AND IT'S ALSO TRUE, IS IT NOT, THAT THE
10 ORDER FOR MORPHINE ON THE 13TH OF DECEMBER WAS IN FACT A
11 P.R.N. ORDER, TRUE?
12 A. YES, IT WAS.
13 Q. WHICH MEANS THAT IT'S SOMETHING THAT IS ONLY GOING TO BE
14 GIVEN IF THE NURSE EXERCISES HIS OR HER DISCRETION AND
15 DETERMINES THAT IF THE DOSE IS APPROPRIATE, CORRECT?
16 A. CORRECT.
17 Q. AND IN THIS CASE, IT WAS A P.R.N. ORDER FOR PAIN, WASN'T
18 IT?
19 A. YES, IT WAS.
20 Q. SO IN OTHER WORDS, IT WOULDN'T BE GIVEN UNLESS A NURSE
21 IN FACT ASSESSED PAIN AND THOUGHT THAT WAS AN APPROPRIATE
22 THING TO DO, TRUE?
23 A. RIGHT.
24 Q. AND IT'S TRUE, IS IT NOT, THAT FROM THE 13TH OF
25 DECEMBER, 1995, UNTIL THE 19TH OF DECEMBER, 1995, WHEN THAT
1778
1 ORDER WAS DISCONTINUED BY DR. WEITZEL, THERE WAS NOT ONE
2 NURSE WHO IN FACT GAVE AN INJECTION OF MORPHINE PURSUANT TO
3 THAT ORDER, ISN'T THAT TRUE?
4 A. THAT IS TRUE.
5 Q. AND IT'S TRUE, IS IT NOT, THAT DURING THE TIME PERIOD OF
6 THE 13TH OF DECEMBER THROUGH THE 19TH OF DECEMBER,
7 ESSENTIALLY JUDITH LARSEN'S CONDITION DRAMATICALLY IMPROVED,
8 ISN'T THAT CORRECT?
9 A. YES, IT DID.
10 Q. IN FACT, IT IMPROVED EVEN THOUGH JUDITH LARSEN WAS
11 RECEIVING DURING THIS PARTICULAR TIME PERIOD PSYCHOTROPIC
12 MEDICATIONS, CORRECT?
13 A. CORRECT.
14 Q. SOME OF THE MEDICATIONS THAT YOU WERE CONCERNED ENOUGH
15 ABOUT THAT YOU HAD A CONVERSATION WITH DR. WEITZEL ON THE
16 19TH, CORRECT?
17 A. I WAS NOT CONCERNED ABOUT THOSE MEDICATIONS. I WAS
18 CONCERNED ABOUT THE COMBINATION IF THE MORPHINE WAS GIVEN
19 WITH THOSE MEDICATIONS.
20 Q. OH, SO YOU WEREN'T CONCERNED ABOUT WHAT WAS BEING
21 PRESCRIBED IN TERMS OF PSYCHOTROPIC MEDICATIONS, IS THAT
22 YOUR TESTIMONY?
23 A. NOT TO THE POINT -- THE MORPHINE WAS THE THING THAT I
24 THOUGHT WAS GONNA BE CRUCIAL BECAUSE OF THE HIGH DOSES OF
25 THE PSYCHOTROPICS WITH THE MORPHINE BEING INTRODUCED, IF A
1779
1 NURSE DECIDES, HEY, I THINK THEY'RE PAINFUL OR WHATEVER, AND
2 THAT MORPHINE IS GIVEN, IT CAN DEFINITELY ENHANCE THE OTHER
3 PSYCHOTROPICS. THAT'S WHAT MY CONCERN WAS.
4 Q. OKAY. YOU TESTIFY ABOUT HIGH DOSES OF PSYCHOTROPICS --
5 A. THEY WERE --
6 Q. -- BUT IT'S TRUE, IS IT NOT, DURING THIS TIME PERIOD
7 THAT YOU'RE TELLING US ABOUT, HER CONDITION DRAMATICALLY
8 IMPROVED, ISN'T THAT TRUE?
9 A. I WOULD HAVE TO REVIEW --
10 Q. AND --
11 A. -- SOME OF THE RECORDS --
12 Q. AND IN FACT, THAT'S REFLECTED IN THE PROGRESS NOTES BY
13 THE DOCTOR, TRUE?
14 A. I WOULD HAVE TO REFLECT --
15 Q. WHY DON'T YOU TURN TO MED-00470, LET'S JUST GO THROUGH
16 THESE DATES --
17 THE COURT: BOTH OF YOU JUST TRY TO WAIT. YOU'RE
18 KIND OF TALKING OVER EACH OTHER, AND THE COURT REPORTER'S
19 HAVING A HARD TIME TAKING THIS DOWN. SO IF YOU PAUSE
20 BETWEEN THE QUESTION AND ANSWER --
21 MR. STIRBA: THANK YOU, JUDGE. APOLOGIZE TO YOU
22 AND I APOLOGIZE TO THE WITNESS.
23 THE WITNESS: WHICH PAGE WAS THAT?
24 Q. (BY MR. STIRBA) STARTING WITH MED-00470. WE'RE GONNA
25 START FROM ESSENTIALLY WHEN THE ORDER STARTS AND WE'RE GONNA
1780
1 GO THROUGH TO THE TIME WHEN THE ORDER WAS DISCONTINUED.
2 A. OKAY.
3 Q. ARE YOU WITH ME?
4 A. 00470.
5 Q. RIGHT.
6 A. PROGRESS NOTES.
7 Q. NOW, FIRST OF ALL, 12/13/95 UP HERE. AND HERE'S THE --
8 HERE'S THE ORDER, THIS WAS A P.R.N. ORDER, M.S. FOR PAIN.
9 IT DOESN'T INDICATE THERE IN THE PROGRESS NOTES, BUT THAT'S
10 WHAT THE DOCTOR WROTE, AND THAT'S THE P.R.N. ORDER, TRUE?
11 A. I WOULDN'T KNOW UNLESS HE CHARTED ACCURATELY.
12 Q. YOU DON'T REMEMBER THAT IT WAS ON THE 13TH.
13 A. WELL, HE'S SAYING M.S. FOR PAIN. I DON'T KNOW WHETHER
14 IT'S P.R.N. OR SCHEDULED --
15 Q. YOU DON'T -- YOU DON'T KNOW THAT. ALL RIGHT. THEN
16 12/14/95 WE HAVE AN M.D. ENTRY BY DR. WEITZEL. HE SAYS, HAS
17 MADE A MIRACULOUS RECOVERY AND AMBULATED YESTERDAY. TAKING
18 FOOD WELL. THEN THAT'S VITAL SIGNS STABLE. CAN'T QUITE
19 READ THAT. LOOKS LIKE AFEBRILE, WHICH MEANS WITHOUT A
20 FEVER. ASSESSMENT, DOING MUCH BETTER. REMAINS DEMENTED.
21 PLAN, CONTINUE CURRENT TREATMENT. ROBERT WEITZEL, M.D.
22 DID I READ THAT CORRECTLY?
23 A. YES, YOU DID.
24 Q. AND THEN WE GO ON TO THE NEXT DAY, WHICH IS GONNA BE
25 MED-00471. AND UP AT THE TOP, THAT'S 4 --
1781
1 A. 12 --
2 Q. -- 12/16 --
3 A. WELL, WHAT ABOUT 12/15? DOCTOR ENTRY NOTE --
4 Q. IT SAYS, CONTINUES TO DO WELL DESPITE EARLIER MORIBUND
5 STATE. VITAL SIGNS STABLE. AFEBRILE. DEMENTED, BUT MUCH
6 MORE RESPONSIVE. EATING, SLASH, SLEEPING WELL.
7 ASSESSMENT -- I CAN'T READ THAT. PLAN, CONTINUE CURRENT
8 CARE. ROBERT WEITZEL.
9 CORRECT?
10 A. BUT THE 12/15 ENTRY WASN'T READ.
11 Q. THEN 12/17/95, STABLE, DOING WELL. VITAL SIGNS STABLE.
12 AFEBRILE. ASSESSMENT, STABLE. PLAN, CONTINUE CURRENT CARE.
13 ROBERT WEITZEL M.D.
14 TRUE? READ THAT CORRECTLY?
15 A. YES.
16 Q. AND THEN ON 12/18, I SPOKE EXTENSIVELY WITH HER SON THIS
17 MORNING AND INFORMED HIM OF THE CHANGE IN HER STATUS.
18 THAT MEANS HER IMPROVEMENT. DO YOU UNDERSTAND THAT?
19 A. I DON'T UNDERSTAND THAT AND YOU'RE INJECTING THAT.
20 Q. OKAY. WE WILL HAVE TO WAIT AND SEE HOW SHE DOES IN
21 FUTURE IN MAKING PLANS FOR PLACEMENT. ALTHOUGH QUITE
22 DEMENTED, SHE IS SELF-FEEDING, WALKING, AND RESPONDING IN A
23 SEMI -- I CAN'T READ THAT -- MANNER TO -- AND THEN THERE'S A
24 QUESTION MARK. VITAL SIGNS STABLE. I THINK THAT'S AFEBRILE
25 AGAIN. ASSESSMENT, MUCH IMPROVED. PLAN, AND THERE'S AN
1782
1 ARROW THERE WHICH MEANS DECREASE, DOES IT NOT?
2 A. THAT'S WHAT I WOULD ASSUME.
3 Q. AND RISPERDAL IS A PSYCHOTROPIC MEDICATION, IS IT NOT?
4 A. YES, IT IS.
5 Q. AND EVEN THOUGH YESTERDAY YOU WERE SAYING
6 ANTIPSYCHOTROPIC MEDICATIONS, THEY'RE REALLY CALLED
7 PSYCHOTROPIC MEDICATIONS, TRUE? IS THAT RIGHT?
8 A. YES.
9 Q. AND THEN EVEN IF WE LOOK AT THIS -- THIS ENTRY BY THE
10 RECREATIONAL PERSON, SAME DATE, RECREATION ACTIVITY, PATIENT
11 HAS MADE A LOT OF PROGRESS THIS WEEK. EARLIER SHE WASN'T
12 ABLE TO ATTEND GROUP --
13 THE COURT: RAISE IT UP.
14 MR. STIRBA: OH, I'M SORRY. THANK YOU, YOUR HONOR.
15 SORRY.
16 Q. -- DUE TO CONFUSION AND CALLING OUT. SHE HAS -- I CAN'T
17 READ THAT -- UP, ABLE TO FOLLOW SIMPLE COMMANDS. WILL
18 CONTINUE TO -- WILL CONTINUE ENCOURAGEMENT AND SOMETHING
19 WITH HER ENCOURAGING INTERACTION.
20 DO YOU SEE THAT? YES?
21 A. YES.
22 Q. THAT'S A POSITIVE REPORT, IS IT NOT, BY THE
23 OCCUPATIONAL -- I'M SORRY, THE RECREATIONAL THERAPIST, TRUE?
24 A. YES.
25 Q. AND THEN THE NEXT PAGE, WHICH IS MED-00472 AND THE 19TH
1783
1 IS THE DATE WHEN THE ORDER WAS DISCONTINUED, THE P.R.N.
2 ORDER, ISN'T THAT CORRECT?
3 A. YES, IS IT.
4 Q. AND THEN ON THE 19TH, WE HAVE DR. WEITZEL STATING, DOING
5 WELL. ALTHOUGH QUITE DEMENTED, VITAL SIGNS STABLE,
6 AFEBRILE. FED HERSELF TONIGHT. ASSESSMENT, STABLE. PLAN,
7 CONTINUE CURRENT CARE.
8 DID I READ THAT CORRECTLY?
9 A. YES.
10 Q. NOW, YOU -- YOU RECALL AND YOU'VE TESTIFIED TO IT THAT
11 THERE BECAME -- CAME A TIME WHEN MS. LARSEN'S CONDITION
12 DETERIORATED CERTAINLY FROM WHAT I'VE JUST READ YOU, ISN'T
13 THAT CORRECT?
14 A. PARDON?
15 Q. HER CONDITION DETERIORATED.
16 A. DURING WHAT TIME FRAME?
17 Q. AFTER DECEMBER 19TH OF 1995.
18 A. I WOULD HAVE TO RELATE BACK TO THE RECORDS ON THAT.
19 Q. IN FACT, MA'AM, SHE HAD A 40- TO 45-MINUTE SEIZURE ON
20 THE 26TH OF DECEMBER OF 1995. DO YOU REMEMBER THAT?
21 A. YES, THE DAY AFTER MORPHINE WAS GIVEN. Gratuitous, and telling.
22 Q. WELL, I APPRECIATE THAT COMMENT, BUT -- AND WE'RE GONNA
23 GET RIGHT INTO THAT, TOO. BUT I'M GONNA ASK YOU, JUST TELL
24 THE JURY, YOU RECALL SHE HAD A SEIZURE ON THE 26TH, CORRECT?
25 A. I RECALL SHE HAD A SEIZURE. I'M NOT SURE ABOUT THE
1784
1 DATE.
2 Q. AND YOU RECALL, DO YOU NOT, THAT SHE ALSO STARTED TO GET
3 SERIOUSLY ILL ON THE 30TH OF DECEMBER, TRUE?
4 A. I CAN'T RECALL THE EXACT DATE THAT SHE BECAME SERIOUSLY
5 ILL.
6 Q. NOW, YOU JUST TESTIFIED SHE HAD THE SEIZURE AFTER SHE
7 GOT MORPHINE.
8 A. YES.
9 Q. AND IT'S TRUE, IS IT NOT, THAT -- AND I THOUGHT I ASKED
10 YOU THIS QUESTION, AND YOU DIDN'T KNOW, BUT I GUESS YOU DO,
11 SHE GOT SOME MORPHINE ON THE 25TH FOR THE FIRST TIME, THAT
12 IS DECEMBER, ISN'T THAT RIGHT?
13 A. LIKE I'M TELLING, I CAN REMEMBER EVENTS. AS FAR AS YOU
14 WANTING ME TO PUT EXACT DATES AND TIMES ON THINGS, NO, BUT
15 WHEN --
16 Q. AND IN FACT, WHAT SHE GOT ON THE 25TH, IF YOU REMEMBER,
17 WAS SHE GOT THREE INJECTIONS OF 2 MILLIGRAMS OF MORPHINE.
18 DO YOU REMEMBER THAT?
19 A. I DON'T REMEMBER THE AMOUNTS. I'M TELLING YOU I
20 REMEMBER THAT IT WAS ADMINISTERED BECAUSE WE DISCUSSED IT,
21 AND --
22 Q. AND IT'S TRUE, IS IT NOT, THAT AFTER SHE GOT THOSE THREE
23 INJECTIONS ON THE 25TH OF 2 MILLIGRAMS APIECE, THAT IN FACT,
24 HER CONDITION IMPROVED IN THAT SHE BECAME MORE ALERT, ISN'T
25 THAT CORRECT?
1785
1 A. I WOULDN'T BE ABLE TO COMMENT ON THAT WITHOUT REFERRING
2 TO THE NOTES.
3 Q. AND CERTAINLY ALERTNESS IN MS. LARSEN'S CASE WOULD BE A
4 GOOD THING, WOULD IT NOT?
5 A. ALERTNESS WOULD BE A GOOD THING.
6 Q. AND IMPROVED ALERTNESS WOULD BE A GOOD THING, ISN'T THAT
7 TRUE?
8 A. BUT IN CONNECTION -- I COULDN'T COMMENT IF YOU'RE TRYING
9 TO CONNECT THAT INTO THAT TIME FRAME.
10 Q. WHY DON'T YOU TURN TO MED-00565? NOW, THAT'S AN ENTRY
11 BY A NURSE, MS. LONG, 12/25/95 AT THE TOP, AND THIS IS WHAT
12 MS. LONG REPORTS: PATIENT WAS MEDICATED WITH M.S., THAT'S
13 MORPHINE, 2 MILLIGRAMS I.M. AT 7:30, 9:30, AND 11:30. WITH
14 PATIENT'S LEVEL OF ALERTNESS INCREASING THROUGHOUT THE
15 MORNING AND CONTINUING THROUGHOUT SHIFT. ALTHOUGH BRIGHT,
16 PATIENT WOULD NOT SPEAK, BUT WATCHED THE MOVIE AND REMAINED
17 AWAKE AND ALERT. PATIENT THEN -- OH, PATIENT THERAPEUTIC
18 SAVE ENVIRONMENT, MEDS AS ORDERED. DEVISE FLASH CARD SYSTEM
19 TO FACILITATE COMMUNICATION. L. LONG, R.N.
20 DID I READ THAT CORRECTLY?
21 A. YES, YOU DID.
22 Q. THEN ON THE 26TH, THERE WAS ANOTHER TIME BEFORE THE 30TH
23 WHEN MS. LARSEN GOT SOME MORPHINE. DO YOU REMEMBER THAT?
24 A. YOU'D HAVE TO BE SPECIFIC AND POINT OUT THE PAGE.
25 Q. AND IN FACT, THAT MORPHINE WAS HELPFUL AS CHARTED BY THE
1786
1 NURSE, WAS IT NOT?
2 A. I WOULDN'T BE ABLE TO COMMENT WITHOUT LOOKING AT THE
3 PAPERWORK.
4 Q. TURN TO MED-00569. NOW, THIS PARTICULAR INJECTION,
5 WHICH WAS ALSO AT THE TOP, 2 MILLIGRAMS WAS GIVEN BY SHEILA
6 HANSEN. YOU SEE SHEILA HANSEN'S SIGNATURE ON THOSE NOTES?
7 A. YES, I DO.
8 Q. AND SHEILA HANSEN YOU'VE ALREADY TESTIFIED WAS THE
9 DIRECTOR OF NURSING AT THIS TIME, TRUE?
10 A. YES, SHE WAS.
11 Q. IN FACT, SHEILA HANSEN WAS YOUR SUPERIOR IN THE CHAIN OF
12 COMMAND ON THE GEROPSYCHIATRIC WARD AT THIS TIME, CORRECT?
13 A. YES, SHE WAS.
14 Q. AND SHEILA HANSEN SAYS ON 12/26/95 UNDER -- AT
15 8:00 O'CLOCK, SHE SAYS M.S., THAT'S MORPHINE, 2 MILLIGRAMS
16 I.M., I THINK THAT'S RIGHT WHERE -- IN THE BUTTOCKS AREA.
17 AND THEN SHE PUTS C. SLASH O., COMPLAINS OF MOANING.
18 APPEARS TO BE IN SOME DISCOMFORT.
19 DID I READ THAT CORRECTLY?
20 A. YES, YOU DID.
21 Q. AND THEN SHE GOES ON DOWN HERE LATER ON AT 1400, ABOUT
22 SIX HOURS LATER SHE WRITES, PATIENT HAS APPEARED
23 COMFORTABLE -- OR COMFORT, SINCE RECEIVING M.S. I.M. AT 800.
24 DID I READ THAT RIGHT?
25 A. YES, YOU DID.
1787
1 Q. NOW, THE 30TH WAS A SIGNIFICANT DAY BECAUSE, FIRST OF
2 ALL, IT'S THE FIRST TIME MS. LARSEN WAS ACTUALLY THROWING UP
3 COFFEE GROUNDS VOMIT, ISN'T THAT CORRECT?
4 A. I WOULD HAVE TO REFER TO THE PAPERWORK.
5 Q. YOU DON'T REMEMBER THAT?
6 A. I RECALL HER THROWING UP THE COFFEE GROUNDS. I CAN'T
7 PUT AN EXACT DATE ON IT.
8 Q. OKAY. AND YOU MAY NOT BE ABLE TO PUT AN EXACT DATE ON
9 IT, BUT YOU REMEMBER IT HAPPENED AND IT HAPPENED AFTER THE
10 SEIZURE, TRUE?
11 A. TRUE.
12 Q. AND WE AGREE THAT THE SEIZURE OCCURRED ON THE 26TH OF
13 DECEMBER, 1995?
14 A. I'D HAVE TO REFER FOR THE EXACT DATE. I KNOW THE
15 SEIZURE -- A SEIZURE OCCURRED.
16 Q. AND YOU'RE AWARE, ARE YOU NOT, THAT BETWEEN -- OTHER
17 THAN WHAT WE'VE -- WHAT -- WHAT I'VE SHOWN YOU, THAT IS, THE
18 25TH, THE THREE 2-MILLIGRAM INJECTIONS OF MORPHINE, AND THE
19 26TH, THE ONE 2-MILLIGRAM INJECTION OF MORPHINE CHARTED BY
20 MISS HANSEN, YOU'RE AWARE, ARE YOU NOT, THAT MS. LARSEN
21 RECEIVED NO OTHER MORPHINE UNTIL THE 30TH OF DECEMBER OF
22 1995.
23 A. I WOULD HAVE TO REFER BACK TO THE RECORDS.
24 Q. AND IT'S TRUE, IS IT NOT, THAT THERE WERE TIMES WHEN
25 THERE WOULD BE FAMILY INTERACTIONS, CERTAINLY WITH YOU, IS
1788
1 THAT RIGHT?
2 A. YES.
3 Q. AND AT TIMES THEY WOULD TELL YOU CERTAIN THINGS ABOUT
4 THE KIND OF CARE THAT THEY WOULD WANT FOR THEIR LOVED ONE,
5 ISN'T THAT CORRECT?
6 A. YES.
7 Q. AND IT'S TRUE, IS IT NOT, THAT THERE WOULD BE TIMES WHEN
8 THEY'D ASK YOU QUESTIONS ABOUT WHAT WAS GOING ON WITH THEIR
9 LOVED ONE, ISN'T THAT CORRECT?
10 A. I WOULDN'T BE ABLE TO STATE EXACTLY.
11 Q. FOR EXAMPLE, DIDN'T THERE COME A TIME WHEN MEMBERS OF
12 THE LARSEN FAMILY ASKED YOU WHEN JUDITH LARSEN WOULD DIE?
13 A. YES, THEY DID.
14 Q. THAT'S THE KIND OF QUESTION I'M TALKING ABOUT THAT
15 SOMETIMES WAS ASKED OF THE NURSING STAFF, TRUE?
16 A. I NEED MORE SPECIFICS FROM YOU. THAT IS TRUE. THEY DID
17 ASK ME THAT.
18 Q. AND IT'S TRUE -- LET ME JUST -- IF YOU'LL TURN TO
19 MED-00577, UP AT THE TOP IT'S 12/30/95. AND THERE'S AN
20 ENTRY IN THE MIDDLE AT 2100 HOURS, AND THAT'S MISS -- I'M
21 GONNA GET IT RIGHT THIS TIME, THAT'S MS. KLEI'S SIGNATURE,
22 CORRECT?
23 A. WHAT PAGE ARE YOU ON AGAIN?
24 Q. 577.
25 A. OKAY.
1789
1 Q. AND IN THE MIDDLE AT 2100 HOURS, MS. KLEI CHARTS, CALLED
2 SON, GAVE STATUS REPORT ON PATIENT'S CONDITION. SON, PAREN,
3 MERLIN STRESSED THAT, QUOTE, ONLY WISHED TO KEEP HER
4 COMFORTABLE, UNQUOTE.
5 DID I READ THAT CORRECTLY?
6 A. YES, YOU DID.
7 Q. AND THEN CONSISTENT WITH THAT, IF YOU'LL TURN TO 578, WE
8 HAVE AN ENTRY BY YOU ON 12/30/95, SPECIFICALLY DIRECTING
9 YOUR ATTENTION TO 11:30, PATIENT FAMILY IN TO SEE PATIENT.
10 AWARE OF PHYSICAL STATUS CHANGE. FAMILY STATES THEY WANT
11 D.N.R. STATUS MAINTAINED. COMFORT MEASURES GIVEN. AND THEN
12 IT HAS B. HARDEY, R.N.
13 DID I READ THAT CORRECTLY?
14 A. YES, YOU DID.
15 Q. AND THEN RIGHT UNDERNEATH THAT AT 1400 HOURS, YOU STATE,
16 DR. WEITZEL ORDERED M.S., THAT'S MORPHINE, TO BE GIVEN AT
17 Q-4 ROUND THE CLOCK. PATIENT NOT -- I THINK THAT'S P.O.
18 A. P.O.
19 Q. -- NO ORAL INTAKE, IS THAT RIGHT?
20 A. YES.
21 Q. ORAL CARE GIVEN AND POSTURE CHANGE --
22 A. POSITION.
23 Q. -- R. HARDEY -- POSITION CHANGE --
24 A. POSITION.
25 Q. -- I'M SORRY. R. HARDEY. DID I READ THAT CORRECTLY?
1790
1 A. B. HARDEY, YES.
2 Q. YEAH. AND CERTAINLY AS YOU CHARTED IT THERE IN TERMS OF
3 WHAT THE FAMILY INDICATED, THAT WAS DONE AT 11:30 BEFORE THE
4 ORDERED WAS NOTED IN YOUR NURSING NOTES BY DR. WEITZEL,
5 ISN'T THAT TRUE?
6 A. YES.
7 Q. AND CERTAINLY WHAT YOU INDICATED THERE WAS AN ACCURATE
8 REFLECTION OF THE CONVERSATION THAT YOU HAD WITH FAMILY
9 MEMBERS FROM THE LARSEN FAMILY, ISN'T THAT TRUE?
10 A. YES.
11 Q. AND IF YOU TURN TO MED-00476, WHICH IS IN THE PROGRESS
12 NOTES PORTION, DO YOU HAVE IT?
13 A. YES, I DO.
14 Q. AND THERE WE HAVE IN THE MIDDLE ON 12/30/1995,
15 DR. WEITZEL STATES, SAME DAY, MET WITH SON AND DAUGHTER THIS
16 P.M. IN PATIENT -- RE PATIENT'S CONDITION. SHE HAD COFFEE
17 GROUNDS VOMITUS OF -- I THINK THAT'S A QUESTION MARK -- 200
18 C.C. THIS A.M.
19 A. GREATER THAN.
20 Q. THANK YOU.
21 A. IT'S A GREATER THAN.
22 Q. GREATER THAN 200 C.C. STOMACH IS DISTENDED. HAS
23 HYPERACTIVE -- THAT SHOULD BE B.S. FOR BOWEL SOUNDS,
24 CORRECT?
25 A. CORRECT.
1791
1 Q. HEART RATE QUITE ERRATIC. ASSESSMENT, G.I. BLEED.
2 PLAN, WILL MAKE SURE SHE'S COMFORTABLE WITH ROUTINE M.S. FOR
3 MORPHINE.
4 DID I READ THAT CORRECTLY?
5 A. YES, YOU DID.
6 Q. AND YOU'RE AWARE NOW BASED UPON WHAT I HAVE JUST SHOWN
7 YOU THAT THE ROUTINE ORDERS FOR MORPHINE STARTED ON
8 DECEMBER 30 OF 1995.
9 A. YES, THE ROUTINE ORDERS DID START.
10 Q. AND THEN ON THE 31ST -- FIRST OF ALL, I'M GONNA JUST
11 SHOW YOU UP AT THE TOP, THE 31ST OF '95 --
12 A. WHICH PAGE ARE YOU ON?
13 Q. YEAH, 00582.
14 A. OKAY.
15 Q. DO YOU HAVE THAT IN FRONT OF YOU?
16 A. YES.
17 Q. THEN AT THE TOP, 12/31/95, WE HAVE A NARRATIVE HERE, AND
18 THAT -- THERE'S A SIGNATURE THERE. YOU KEEP SAYING
19 WILLIAMS. THAT'S ACTUALLY LAURIE WILLSON --
20 A. WILLSON.
21 Q. -- ISN'T THAT CORRECT?
22 A. I'M WOULD STAND TO BE CORRECTED IF IT IS.
23 Q. REMEMBER WILLSON RATHER THAN WILLIAMS NOW?
24 A. YEAH.
25 Q. AND SHE CHARTS WHAT SHE CHARTS, BUT IN HERE IN THE
1792
1 MIDDLE SHE SAYS, IT'S BASICALLY M.S. S.O., WHATEVER THAT IS,
2 MORPHINE 5 MILLIGRAMS I.M. GIVEN AT -- LOOKS LIKE 2:30 AND
3 6:30 FOR PAIN RELIEF.
4 DID I READ THAT CORRECTLY?
5 A. YES, YOU DID.
6 Q. AND SHE APPARENTLY UNDER 11/7, SHE'S ON THAT 11:00 P.M.
7 TO 7:00 O'CLOCK IN THE MORNING SHIFT, TRUE?
8 A. YES.
9 Q. AND THEN YOU GO ON AT 7:30, THERE'S AN ENTRY HERE WHICH
10 IS YOURS, AND YOU HAVE ANOTHER DISCUSSION WITH THE LARSEN
11 FAMILY OR THE SON, RATHER, STARTING RIGHT HERE IN THE
12 MIDDLE, IT SAYS SON --
13 THE COURT: WILL YOU LIFT IT UP?
14 MR. STIRBA: I'M SORRY, JUDGE. THANK YOU.
15 Q. THAT PLUS MEANS WHAT, MA'AM? RIGHT THERE.
16 A. SON TELEPHONE.
17 Q. OKAY. THANK YOU. SON TELEPHONED, CONCERNED ABOUT
18 PATIENT'S MEDICAL CONDITION. WANTED TO KNOW QUOTE, WHEN
19 PATIENT WOULD BE DYING.
20 NOW, IS THERE A SIGNIFICANCE THAT YOU HAVE IT IN
21 QUOTES?
22 A. YES, BECAUSE THAT'S HOW HE STATED WHEN SHE WOULD BE
23 DYING, SOMETHING I WOULDN'T BE ABLE TO ANSWER.
24 Q. OKAY. SO THAT'S -- WHEN YOU PUT IT IN QUOTES, THAT'S
25 EXACTLY AS YOU REMEMBER HE STATED IT.
1793
1 A. UH-HUH, UH-HUH.
2 Q. STAFF NURSE TOLD SON PATIENT'S MEDICAL STATUS AND
3 RESPONSES TO -- WHAT IS THAT WORD?
4 A. TO CARES.
5 Q. CARES, CARE AND MEDICATIONS, BEING GIVEN. FAMILY MEMBER
6 UPSET THAT STAFF NURSE WOULD NOT STATE PATIENT WAS DYING.
7 DO YOU KNOW WHICH FAMILY MEMBER THAT IS? IS THAT
8 REFERRING TO THE SON?
9 A. THAT'S REFERRING TO THE SON.
10 Q. OKAY. WOULD THAT BE MERLIN?
11 A. I WOULDN'T BE ABLE TO GIVE YOU A NAME.
12 Q. OKAY. AND THEN YOU STATE RIGHT HERE, PATIENT'S
13 CONDITION POOR. CORRECT?
14 A. CORRECT.
15 Q. NO QUESTION IN YOUR MIND THAT AS OF THAT TIME PERIOD,
16 THE 31ST OF DECEMBER OF 1995, YOU THOUGHT THAT HER CONDITION
17 WAS POOR.
18 A. UH-HUH. COMPARED TO HER STATUS WHEN SHE ENTERED THE
19 UNIT, YES.
20 Q. AND THEN AT THE TOP OF THE NEXT PAGE, YOU CONTINUE ON.
21 SON CONCERNED THAT FAMILY MEMBERS WERE FLYING IN FROM OUT OF
22 STATE -- WHAT IS THAT?
23 A. DUE TO.
24 Q. -- DUE TO NIGHT SHIFT NURSE REPORT TO SON ON 12/30/95.
25 DO YOU HAVE SOME RECOLLECTION NOW SEEING THAT NOTE OF THIS
1794
1 CONVERSATION --
2 A. YES.
3 Q. -- INDEPENDENT OF WHAT I'VE READ YOU?
4 A. UH-HUH.
5 Q. IT'S TRUE, IS IT NOT, THAT THE NIGHT NURSE THAT THEY ARE
6 REFERRING TO IS MISS KLEI?
7 A. I WOULD ASSUME THAT.
8 Q. AND IT'S TRUE, IS IT NOT, THAT APPARENTLY MISS KLEI
9 INFORMED THE FAMILY THAT JUDITH LARSEN WAS IN FACT DYING,
10 ISN'T THAT TRUE?
11 A. THAT'S WHAT THE FAMILY WAS RELATING TO ME.
12 Q. THAT'S WHAT THEY UNDERSTOOD.
13 A. UH-HUH.
14 Q. AND SO THEY WERE THEREFORE ASKING YOU TO GET BETTER
15 INFORMATION ABOUT WHEN THAT EVENT WOULD OCCUR BECAUSE THEY
16 WERE TRYING TO HAVE ARRANGEMENTS FOR THE FAMILY TO FLY IN,
17 ISN'T THAT TRUE?
18 A. THEY WERE WANTING ME TO COMMENT WHEN SHE WOULD DIE.
19 Q. AND BECAUSE THEY ALSO WERE CONCERNED THEY HAD FAMILY
20 MEMBERS FLYING IN, ISN'T THAT RIGHT?
21 A. CORRECT.
22 Q. BECAUSE THEY UNDERSTOOD THAT MS. LARSEN WAS IN FACT
23 DYING, CORRECT?
24 A. THAT WAS THEIR UNDERSTANDING.
25 Q. AND THEN YOU TESTIFIED A LITTLE ABOUT CARE PLANS. AND
1795
1 IT'S TRUE, IS IT NOT, THAT THERE WAS A CARE PLAN THAT WAS
2 CHANGED CONCERNING MISS LARSEN AS HER STATUS CHANGED, DO YOU
3 REMEMBER THAT?
4 A. I WOULD HAVE TO REFER TO PAPERWORK.
5 Q. LET ME SHOW YOU MED-00477. AND THIS IS DATED 1/2/96 UP
6 HERE. AND THAT'S -- ONCE AGAIN, THAT'S LAURIE WILLSON'S
7 R.N. SIGNATURE, CORRECT?
8 A. YES.
9 Q. SHE WRITES, WEEKLY R.N. ADVOCATE NOTE. PATIENT'S
10 MEDICAL STATUS HAS RAPIDLY AND PROFOUNDLY DETERIORATED THIS
11 WEEK. SHE HAS EXPERIENCED A SEIZURE AND MULTIPLE EPISODES
12 OF VOMITING COFFEE GROUNDS MATERIAL. SHE IS NO LONGER
13 VERBALLY RESPONSIVE. THE CARE PLAN HAS BEEN ALTERED TO
14 REFLECT THE NEED TO SUPPORT PATIENT AND FAMILY THROUGH A
15 POSSIBLE DEATH AND DYING PROCESS. PATIENT IS CURRENTLY
16 RECEIVING -- THAT'S MORPHINE, I.M., Q-3 HOURS FOR COMFORT.
17 LAURIE WILLSON.
18 DID I READ THAT CORRECTLY?
19 A. YES, YOU DID.
20 Q. AND YOU'RE AWARE AS YOU TESTIFIED THAT THERE WERE CARE
21 PLANS FOR EACH ONE OF THE PATIENTS AS THEY WERE ADMITTED TO
22 THE HOSPITAL, TRUE?
23 A. YES.
24 Q. AND IN FACT, THERE ARE WELL-RECOGNIZED NURSING CARE
25 PLANS, ARE THERE NOT?
1796
1 A. PARDON?
2 Q. THERE ARE WELL-RECOGNIZED NURSING CARE PLANS, ARE THERE
3 NOT?
4 A. THERE ARE WELL-RECOGNIZED NURSING CARE PLANS?
5 Q. YES.
6 A. BE MORE SPECIFIC THERE.
7 Q. DO YOU KNOW WHAT A NURSING CARE PLAN IS, MA'AM?
8 A. YES, I DO --
9 MS. BARLOW: YOUR HONOR, I OBJECT TO THE
10 WELL-RECOGNIZED. BY WHOM I THINK'S THE PROBLEM, WHAT DOES
11 HE MEAN BY WELL-RECOGNIZED?
12 MR. STIRBA: I'M MOVING ON.
13 THE COURT: OKAY.
14 MR. STIRBA: IF SHE DOESN'T UNDERSTAND, I'LL MOVE
15 ON.
16 THE COURT: ALL RIGHT.
17 Q. (BY MR. STIRBA) YOU UNDERSTAND WHAT A NURSING CARE
18 PLAN IS, MA'AM?
19 A. I UNDERSTAND WHAT A NURSING CARE PLAN IS.
20 Q. OKAY. AND YOU'RE CERTAINLY AWARE THAT IN THE NURSING
21 FIELD, THERE'S A CARE PLAN SPECIFICALLY FOR PEOPLE WHO ARE
22 IN THE DYING PROCESS. DO YOU UNDERSTAND THAT?
23 A. THERE'S A DIAGNOSIS FOR SOMEONE WHO IS IN THE DYING
24 PROCESS, YES.
25 Q. RIGHT. AND THAT'S AN ASSESSMENT THAT IS MADE BY THE
1797
1 NURSE, ISN'T THAT TRUE?
2 A. USUALLY AS A TEAM APPROACH, NOT BY ONE SINGULAR PERSON.
3 Q. NO, BUT IN OTHER WORDS, A NURSE, WHEN THEY DO A CARE
4 PLAN, AND IF IT'S A DEATH AND DYING CARE PLAN, THE NURSE IN
5 THIS INSTANCE HAS ASSESSED THAT SOMEBODY'S IN FACT DYING,
6 ISN'T THAT TRUE?
7 A. I WOULD NOT SAY SHE'S ASSESSED. THAT WOULD BE AN
8 ASSUMPTION. I WOULDN'T KNOW WHERE THE CRITERIA WOULD COME
9 FROM.
10 Q. OKAY. I'M NOT ASKING YOU TO PUT YOURSELF IN MS.
11 WILLSON'S SHOES. I'M JUST ASKING YOU, ISN'T IT A FAIR
12 STATEMENT THAT IF A NURSE ALTERS A CARE PLAN TO REFLECT
13 CERTAIN NURSING INTERVENTIONS --
14 A. UH-HUH.
15 Q. -- FOR DEATH AND DYING, THAT THERE'S BEEN AN ASSESSMENT
16 MADE BY THAT NURSE THAT SOMEONE IS IN FACT DYING.
17 A. BY THAT NURSE, YES. WHOEVER MADE THE ANNOTATION.
18 Q. AND IT'S TRUE THAT SOME OF THE THINGS THAT THE
19 INTERVENTIONS OR SOME OF THE INTERVENTIONS, RATHER, OF A
20 NURSE IN THIS PARTICULAR KIND OF DEATH AND DYING PLAN, IS
21 THE KINDS OF THINGS THAT SHE WAS REFERRING TO, AND THAT IS,
22 YOU SUPPORT THE FAMILY. ISN'T THAT ONE OF THE NURSING
23 INTERVENTIONS?
24 A. YOU DO.
25 Q. PERHAPS YOU PROVIDE COMFORT MEASURES TO THE PATIENT,
1798
1 ISN'T THAT TRUE?
2 A. COMFORT MEASURES CAN BE INCLUSIVE OF ORAL CARE,
3 POSITIONING. THERE'S JUST A FINE LINE BETWEEN COMFORT CARE
4 AND UNRESPONSIVENESS.
5 Q. WELL, THAT WASN'T WHAT I WAS ASKING YOU. I'M JUST
6 TRYING TO HELP THESE JURORS UNDERSTAND THAT WHEN NURSES HAVE
7 A CARE PLAN THAT INVOLVES DEATH AND DYING, THERE ARE CERTAIN
8 NURSING INTERVENTIONS WHICH INCLUDE MAKING THE PATIENT
9 COMFORTABLE, ISN'T THAT CORRECT?
10 A. CORRECT, YES.
11 Q. AND DESCRIBED SOME OF THOSE. ORAL CARE, IS THAT ONE OF
12 THE THINGS?
13 A. THAT IS, YES.
14 Q. AND SUBDUING THE LIGHTING WOULD MAYBE PERHAPS BE
15 ANOTHER?
16 A. YES.
17 Q. TALKING QUIETLY TO THE PATIENT IS ANOTHER?
18 A. YES.
19 Q. SUPPORTING THE FAMILY IS ANOTHER?
20 A. CORRECT.
21 Q. I MEAN, THOSE ARE ALL THE KINDS OF THINGS THAT THEN
22 NURSES DO AFTER THIS ASSESSMENT HAS BEEN MADE, ISN'T THAT
23 TRUE?
24 A. YES.
25 MR. STIRBA: MAY I HAVE A MOVEMENT, YOUR HONOR?
1799
1 THE COURT: YES.
2 MR. STIRBA: YOUR HONOR, I JUST WAS -- OH, IT'S
3 10:00 O'CLOCK AND --
4 THE COURT: OKAY. ALL RIGHT. WELL, THIS WOULD BE
5 A GOOD PLACE TO STOP, LADIES AND GENTLEMEN. WHAT WE ARE
6 GOING TO DO, AS I MENTIONED YESTERDAY, IS THAT WE'LL BE IN
7 RECESS FROM NOW UNTIL 2:00 O'CLOCK.
8 (AFTER ADMONISHING THE JURY, THE COURT
9 RECESSED FOR LUNCH.)
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
1800
1 (WHEREUPON, THE AFTERNOON SESSION BEGINS.)
2 THE COURT: OKAY. THE RECORD SHOULD REFLECT THAT
3 WE'RE HERE WITHOUT THE JURY. WHAT NEEDS TO BE ADDRESSED?
4 MR. WILSON: YOUR HONOR, I JUST WANTED TO ADDRESS A
5 COUPLE OF PROCEDURAL MATTERS WITH THE COURT AND SUGGEST
6 POSSIBLY A METHOD OF ADDRESSING THESE MATTERS. AS THE COURT
7 IS AWARE, WE WERE SERVED WITH A NEW MOTION THIS MORNING. WE
8 ARE IN THE PROCESS OF RESPONDING TO THAT MOTION. WE FEEL
9 WE'LL PROBABLY HAVE OUR RESPONSE PREPARED BY TOMORROW
10 MORNING EARLY.
11 WE ALSO HAVE FILED WITH THE COURT A COUPLE OF DISCOVERY
12 MOTIONS ESSENTIALLY TODAY. ONE IS INFORMATION CONCERNING
13 PROFFERS FROM THE DEFENDANT AS TO WITNESSES THEY HAVE LISTED
14 AND ALSO A MOTION DEALING -- WE HAVE YET TO DEAL WITH THE
15 MOTION DEALING WITH THE TESTIMONY OF SHANNON WALKER.
16 CURRENTLY ON THAT -- WE'RE STILL EVALUATING THAT. WE HAVE A
17 MOTION ALSO IN DEALING WITH THE COPIES OF THE DEMONSTRATIVE
18 AIDS THAT WERE USED IN THE OPENING. AND WE'RE IN THE
19 PROCESS OF PREPARING FOR THE COURT A TRIAL MEMORANDUM.
20 THE PROCESS THAT I WOULD LIKE TO SUGGEST TO THE COURT
21 WOULD BE THIS: THAT WE DEAL WITH -- OH, AND I FORGOT. WE
22 HAVE A NUMBER OF EXHIBITS THAT WE HAVE PREPARED IN
23 CONNECTION WITH OUR TESTIMONY OF OUR EXPERT WITNESSES AND
24 WE'LL HAVE THOSE COPIES AND WE'LL HAVE AVAILABILITY OF
25 COPIES FOR THE DEFENSE TOMORROW MORNING ALSO. AND WE WOULD
1801
1 ANTICIPATE THAT WHAT WE WOULD LIKE TO DO IS TO PROVIDE AT
2 THE CONCLUSION OF TESTIMONY TOMORROW -- AND WE ONLY HAVE
3 ABOUT THREE OR FOUR WITNESSES AT THE MOST THAT WE WOULD
4 ANTICIPATE GIVING TESTIMONY TOMORROW BEFORE WE WOULD BE IN A
5 POSITION TO START WITH OUR EXPERT WITNESSES. BUT WE FEEL
6 THAT THESE MOTIONS NEED TO BE DEALT WITH AND THESE EXHIBITS
7 NEED TO BE REVIEWED BY THE COURT AND BY COUNSEL FOR THE
8 DEFENSE PRIOR TO ELICITING THE TESTIMONY FROM THOSE
9 WITNESSES SO THAT WE DON'T JUST PUT UP THE EXHIBIT AND THEN
10 END UP IN AN OBJECTION AND A MOTION SITUATION.
11 THE COURT: NO. I THINK WHAT YOU ARE SUGGESTING IS
12 WHAT I'VE ASKED YOU TO DO IN ADVANCE BEFORE WE GET TO THAT
13 POINT.
14 MR. WILSON: YEAH. AND THIS MAY -- WE MAY HAVE
15 SORT OF A SHORT DAY IF WE GO WITH THIS RECOMMENDED PROCESS
16 TOMORROW, BUT AT LEAST IT WOULD ALLOW US THE OPPORTUNITY TO
17 APPROPRIATELY ADDRESS THESE ISSUES.
18 IN ADDITION, YOUR HONOR, WE INTEND ON FILING WITH THE
19 COURT A TRIAL MEMORANDUM DEALING WITH A LOT OF THE ISSUES
20 THAT WE SEE IN CONNECTION WITH THE EXPERT TESTIMONY. IT
21 WOULD TAKE SOME TIME, I THINK, FOR THE COURT TO DIGEST SO
22 THAT WE CAN PROBABLY ARGUE THAT BEFORE THE COURT. SO I'M
23 JUST PROPOSING THAT.
24 THE COURT: SO YOU ARE PROPOSING TO HAVE TESTIMONY
25 LIKE UP TO WHAT TIME TOMORROW?
1802
1 MR. WILSON: WELL, AGAIN, IT DEPENDS ON HOW LONG
2 CROSS GOES, BUT WE ANTICIPATE WE'LL HAVE THE TWO MEDICAL
3 EXAMINERS. IN ADDITION TO THEM WE MAY HAVE SHORT TESTIMONY
4 FROM TWO OTHER WITNESSES. SOME OF THAT DEPENDS ON WHETHER
5 OR NOT THERE'S AN OBJECTION TO CERTAIN EXHIBITS.
6 THE COURT: ALL RIGHT. THE OTHER THING THAT MIGHT
7 BE HELPFUL IS BEFORE WE LEAVE TODAY WE CAN ADDRESS THAT
8 MAYBE AFTER THE JURY'S GONE ABOUT TIMING OF THINGS AND
9 WHETHER CERTAIN WITNESSES ARE GOING TO BE HEARD OR NOT. I
10 MEAN, I HAVE THESE OTHER TWO MOTIONS REGARDING THIS ONE,
11 SHANNON WALKER, AND ONE ON THIS BEVERLY FULGER, BESIDES THE
12 MENS REA, EXPERT TESTIMONY REGARDING MENS REA, AND TWO
13 MOTIONS FROM THE COUNTY WITH DEMONSTRATIVE AIDS AND
14 PLAINTIFF'S MOTION FOR DISCOVERY.
15 I THINK THE OTHER ISSUE THAT WE NEED TO DISCUSS IS JUST
16 WHAT'S THE EASY WAY TO RESOLVE THIS MENS REA ISSUE. I'M
17 WONDERING ABOUT THE IDEA OF HAVING YOU GIVE ME MAYBE WHAT
18 THE QUESTION YOU ANTICIPATE THE EXPERTS ARE GOING TO ASK.
19 IT SEEMS TO ME THEY ARE GOING TO THE FORM OF THE QUESTION.
20 AND SO, YOU KNOW, I'VE READ 704. I HAVE LOOKED THROUGH
21 THESE CASES, STATE VERSUS TENNEY, UNITED STATES VERSUS RULE
22 704(B). AND JUST, YOU KNOW, WHAT -- RATHER THAN DOING THEM
23 IN THE VACUUM, SINCE THIS IS ONE OF THE MOST IMPORTANT
24 ISSUES I THINK OF THE CASE IS, WHAT IS GOING TO BE THE
25 QUESTIONS THAT ARE GOING TO BE POSED TO THESE EXPERTS AND
1803
1 HAVE THOSE BE REVIEWED, SO WE CAN SAY YES, THOSE ARE FINE.
2 MS. BARLOW: YOUR HONOR, I'LL BE QUESTIONING
3 DR. FEHLAUER AND WHILE I DON'T USUALLY WRITE OUT WORD FOR
4 WORD, I THINK THAT'S AN EXCELLENT WAY OF SAYING THESE ARE
5 THE KINDS OF QUESTIONS. THIS IS THE AREA THAT WE'RE GOING
6 TO GO INTO.
7 THE COURT: WELL, SEE, WHAT I HAD DONE IS AFTER
8 LOOKING THROUGH THESE CASES, IT JUST SEEMS TO ME THAT YOU
9 CAN'T DO THIS IN A VACUUM. YOU'VE GOT TO HAVE SOME
10 QUESTIONS AND RATHER THAN HAVE A QUESTION, SEND THE JURY
11 OUT, IT WOULD BE BETTER IF YOU COULD SAY THIS IS THE WAY
12 WE'RE GOING TO ASK THE QUESTIONS. AND, YOU KNOW, DO YOU
13 THINK THAT COMPLIES WITH 704(B) OR DOESN'T OR WHATEVER.
14 MR. WILSON: I THINK OUR TRIAL MEMORANDUM MAY BE OF
15 SOME ASSISTANCE.
16 THE COURT: WE CAN DISCUSS THAT AFTER WE END TODAY
17 WITH THE JURY. WE'LL SAY WHAT WE NEED TO ADDRESS AND WHAT
18 TIME. IS THERE ANYTHING ELSE BEFORE THE JURY COMES BACK?
19 OKAY. THEN WHY DON'T YOU ASK THE JURY TO COME IN.
20 (THE JURY ENTERS THE COURTROOM.)
21 THE COURT: PLEASE BE SEATED. THE RECORD WILL
22 REFLECT THAT THE JURY HAS COME BACK. AND, LADIES AND
23 GENTLEMEN, I APPRECIATE YOU ADAPTING TO THE SCHEDULE AND THE
24 NEED TO GO TWO TO FIVE TODAY.
25 I BELIEVE WHEN WE LEFT, MR. STIRBA, YOU WERE
1804
1 QUESTIONING THIS WITNESS. ARE THERE ANY FURTHER QUESTIONS?
2 MR. STIRBA: I HAVE NO OTHER QUESTIONS OF THIS
3 WITNESS, YOUR HONOR.
4 THE COURT: ANY REDIRECT?
5 MS. BARLOW: YES, YOUR HONOR. THANK YOU.
6 REDIRECT EXAMINATION
7 BY MS. BARLOW:
8 Q. GOOD AFTERNOON. I WOULD LIKE TO FOLLOW UP ON SOME OF
9 THE MATERIAL THAT MR. STIRBA BROUGHT OUT. IF YOU WOULD OPEN
10 JUDITH LARSEN'S BINDER. LET'S CLARIFY, IF WE CAN, A COUPLE
11 OF MATTERS. THIS IS THE 2ND OF JANUARY WITH JUDITH LARSEN.
12 MR. STIRBA ASKED YOU ABOUT, ABOUT A SHOT THAT YOU GAVE ON
13 THE 2ND OF JANUARY, A MORPHINE SHOT THAT YOU GAVE TO JUDITH
14 LARSEN ON THE 2ND OF JANUARY. DO YOU RECALL THAT?
15 A. YES.
16 Q. WHAT TIME DID YOU GIVE IT?
17 A. AT 1630. THAT'S 4:30 IN THE AFTERNOON.
18 Q. I'M GLAD YOU CAN READ THAT. 1630. YOU'D SAID SOMETHING
19 ABOUT REPORT. WHAT IS REPORT?
20 A. THAT IS DURING THE CHANGE OF SHIFT WHEN A NURSE COMING
21 OFF DUTY AND THE NURSE COMING ON, YOU USUALLY DISCUSS EACH
22 ONE OF THE PATIENTS AND GIVE A SHORT REPORT ON ANYTHING THAT
23 WAS UNUSUAL OR HOW THEY WERE DOING AND THEN YOU TAKE OVER
24 THE SHIFT BASICALLY.
25 Q. LET'S LOOK AT 507. AND THE 2ND OF JANUARY IS IN THAT
1805
1 MIDDLE COLUMN THERE?
2 A. UH-HUH.
3 Q. WHO HAD GIVEN THE SHOTS AT 7:30 AND 9:30? WELL, LET'S
4 SAY 9:30?
5 A. 9:30, SHEILA HANSEN.
6 Q. AND THE NEXT SCHEDULED SHOT WAS FOR WHAT TIME?
7 A. AT 12:30.
8 Q. WAS THAT SHOT GIVEN?
9 A. THERE WAS NO ANNOTATION.
10 Q. WHAT ABOUT -- WHEN WAS THE NEXT SCHEDULED SHOT TO BE
11 GIVEN?
12 A. AT 3:30 THAT AFTERNOON.
13 Q. WHICH IS 1530?
14 A. CORRECT.
15 Q. THAT'S THIS ONE RIGHT HERE?
16 A. YES.
17 Q. AND OVER HERE, WHAT IS IN THAT SLOT ON THE 1530?
18 A. THOSE ARE MY INITIALS AND THEY WERE CROSSED THROUGH.
19 Q. WHY DID YOU INITIAL THAT AND CROSS IT THROUGH?
20 A. BECAUSE THE MEDICATION, WHEN I CAME ON SHIFT AT THREE
21 O'CLOCK, WASN'T GIVEN. THE NURSE SAID THAT THE DOCTOR
22 STRESSED THAT WE NEED TO GIVE THE SCHEDULED MEDS. SO I GAVE
23 IT AS SOON AS I COULD AFTER I GOT OUR REPORT, WHICH WAS
24 CLOSE TO 1630, AND I ANNOTATED THAT ON THE P.R.N.
25 Q. THIS SHEET?
1806
1 A. YES.
2 Q. EXCUSE ME. IT'S NOT THAT ONE. I'VE GOT THE WRONG ONE.
3 ON 507?
4 A. RIGHT, AT 1630.
5 Q. AND THEN WHAT DID YOU DO AFTER YOU GAVE THAT SHOT AND
6 NOTED IT ON THE P.R.N.?
7 A. IT WAS NOT AN ADDITIONAL MEDICATION TO THE SCHEDULE, SO
8 THAT'S THE REASON IT WAS CROSSED THROUGH ON THE SCHEDULE
9 SHEET, THE 1530 ONE. USUALLY P.R.N.'S ARE ADDITIONAL
10 MEDICATIONS.
11 Q. DID YOU KNOW, WHEN YOU GAVE THAT SHOT AND NOTED IT ON
12 THE P.R.N., THAT IT WAS A SCHEDULED DOSE THAT WAS TO BE
13 GIVEN?
14 A. NOT AT THAT TIME. I JUST KNEW I HAD TO GIVE IT AND
15 USUALLY MORPHINE IS, YOU KNOW, NORMALLY --
16 MR. STIRBA: YOUR HONOR, I WOULD OBJECT. MOVE TO
17 STRIKE. I THINK SHE ANSWERED THE QUESTION.
18 MS. BARLOW: LET ME ASK THE NEXT QUESTION.
19 THE COURT: ASK THE NEXT QUESTION. LET'S GO.
20 Q. (BY MS. BARLOW) MY QUESTION HAD BEEN, DID YOU KNOW AND
21 YOU SAID NO?
22 A. NO.
23 Q. WHEN DID -- DID YOU FIND OUT LATER THAT THERE WAS A
24 SCHEDULE FOR GIVING MORPHINE TO THIS PATIENT ON THAT DATE?
25 A. YES.
1807
1 Q. WHEN DID YOU FIND THAT OUT?
2 A. WHEN I REVIEWED MY M.A.R.S.
3 Q. WHAT IS M.A.R.S.?
4 A. MEDICATION ADMINISTRATION RECORD.
5 Q. WHEN YOU FOUND THAT OUT, WHAT DID YOU DO?
6 A. I MADE SURE THE NEXT DOSE I DOCUMENTED IN THE SCHEDULED
7 DOSING SECTION.
8 Q. WHY DID YOU PUT YOUR INITIALS AND CROSS IT OUT FOR 1530
9 IN THE SCHEDULED SECTION?
10 A. BECAUSE THAT HADN'T BEEN GIVEN AT 1530.
11 Q. I THINK THAT IS ALL I WOULD LIKE TO COVER WITH THAT.
12 YOU WERE ASKED AS TO NURSE'S LIABILITY. IS THAT PART
13 OF THE REASON YOU DO ALL THIS DOCUMENTATION?
14 A. THAT AND TO PROVIDE AN ADMINISTRATION RECORD SO THAT THE
15 NEXT NURSE KNOWS WHAT WAS GIVEN.
16 Q. DOES ANYONE ELSE HAVE ANY LIABILITY THAT THIS TRIES TO
17 PRECLUDE?
18 A. IN WHAT WAY?
19 Q. I'M SORRY. THAT WAS A VERY AWKWARD QUESTION. NURSES
20 MAY HAVE LIABILITY FOR WHAT HAPPENS IN THIS UNIT; IS THAT
21 CORRECT?
22 A. AS EVERYBODY, YES.
23 Q. ANYONE ELSE WORKING ON THE UNIT HAVE POSSIBLE LIABILITY?
24 MR. STIRBA: YOUR HONOR, I'M GOING TO OBJECT. IT
25 CALLS FOR A LEGAL CONCLUSION. IT'S BEYOND THE SCOPE OF WHAT
1808
1 I ASKED HER.
2 THE COURT: SUSTAINED.
3 Q. (BY MS. BARLOW) LET'S TURN TO 470. IF YOU'LL KEEP
4 THAT OPEN BECAUSE I THINK THERE ARE SEVERAL PAGES IN A ROW
5 HERE I'LL WANT TO TALK ABOUT. I BELIEVE YOU READ THIS FIRST
6 SECTION HERE THAT WAS THE 13TH OF DECEMBER IN DR. WEITZEL'S
7 HANDWRITING, THE BOTTOM OF WHICH SAYS M.S., WHICH IS
8 MORPHINE, FOR PAIN; IS THAT CORRECT?
9 A. MORPHINE FOR PAIN, CORRECT.
10 Q. WHAT'S THE NEXT NOTATION UNDERNEATH THAT?
11 A. "PATIENT WAS UNABLE TO BE ASSESSED TODAY SECONDARY TO
12 MEDICATION."
13 Q. WHAT DO YOU MEAN, SECONDARY TO MEDICATION?
14 A. SECONDARY MEANS BECAUSE OF MEDICATION HE WASN'T ABLE TO
15 ASSESS THE PATIENT.
16 Q. AND DO YOU KNOW WHO WROTE THAT?
17 A. THAT WOULD BE THE OCCUPATIONAL THERAPIST.
18 Q. THEN WE READ WHAT THE DEFENDANT WROTE ON THE 14TH OF
19 DECEMBER. LET'S LOOK DOWN AT THE 15TH OF DECEMBER, THAT
20 LAST NOTATION?
21 A. UH-HUH.
22 Q. CAN YOU READ THAT FOR US?
23 A. "RESPONDED TO ME THIS A.M. FAIRLY APPROPRIATELY. BLOOD
24 PRESSURE A LITTLE LABILE. DYSPHORIC, OFTEN LETHARGIC." I
25 CAN'T MAKE OUT.
1809
1 Q. THAT MILDLY FEBRILE?
2 A. MILDLY FEBRILE. YESTERDAY SOMETHING ABOUT OKAY TODAY.
3 OKAY. M.D.D. WITH PSYCHIC FEATURES IMPROVED --
4 Q. WHAT'S M.D.D.?
5 A. MOOD DISORDER.
6 Q. IS THAT A DIAGNOSIS, THEN?
7 A. I DON'T KNOW.
8 MR. STIRBA: YOUR HONOR, I OBJECT. SHE'S
9 INTERPRETING SOMEBODY ELSE'S NOTE OF A PHYSICIAN.
10 THE COURT: SUSTAINED.
11 Q. (BY MS. BARLOW) LET'S SEE IF WE CAN READ THAT. I'LL
12 QUIT ASKING WHAT IT MEANS. WOULD YOU READ THAT LAST LINE,
13 M.D.D. WITH --
14 A. PSYCHOTIC FEATURES, I MEAN, IMPROVED.
15 Q. AND CAN YOU SPEAK UP. I'M SORRY. I'M OVER BY THIS
16 MACHINE. I CAN'T HEAR VERY WELL.
17 A. PSYCHOTIC FEATURES, IMPROVED, BETTER. I DON'T KNOW WHAT
18 THAT WORD IS.
19 Q. SO YOU DON'T KNOW WHAT THAT WORD IS AND WHAT DO WE HAVE?
20 A. CONTINUED TREATMENT. WON'T NEED HOSPICE.
21 Q. PROBLEM WON'T NEED HOSPICE? IS THAT WHAT IT SAID?
22 A. YES.
23 Q. AND THEN CONTINUATION -- ON THE NEXT PAGE WOULD YOU READ
24 THAT FOR THE 15TH?
25 A. CONTINUES TO DO WELL DESPITE EARLIER --
1810
1 Q. 16TH, EXCUSE ME.
2 A. I'M SORRY.
3 Q. GO AHEAD. THE 16TH, THAT NEXT PAGE.
4 A. OKAY. CONTINUES TO DO WELL DESPITE EARLIER MORBID
5 STATE. VITAL SIGNS AFEBRILE. DEMENTED BUT MUCH MORE
6 RESPONSIVE. EATING, SLEEPING WELL. IMPROVED. CONTINUE
7 CURRENT CARE.
8 Q. I BELIEVE THAT WE'VE READ THROUGH THE REST OF THAT PAGE.
9 ON THE 19TH WOULD YOU READ JUST THE FIRST SENTENCE ON THAT,
10 WHICH IS PAGE NUMBER 472.
11 A. DOING WELL, ALTHOUGH QUITE DEMENTED. VITAL SIGNS
12 STABLE. AFEBRILE.
13 Q. WELL, YEAH. AND THEN ON THE 20TH, JUST READ THE FIRST
14 SENTENCE.
15 A. CONTINUES WITH SLOW IMPROVEMENT.
16 Q. ON THE 21ST, THE FIRST SENTENCE?
17 A. SLEEPING WELL.
18 Q. AND THEN SKIP THE VITAL SIGNS AND THEN DOING WHAT.
19 WOULD YOU READ THE REST OF THAT SENTENCE?
20 A. DOING QUITE WELL, FEEDING SELF. HERSELF. MUCH MORE
21 ALERT. BETTER ENERGY. ANSWERS RESPONSIBLY. OCCASIONALLY
22 LABILE MOOD WITH TEARS.
23 Q. WHAT IS LABILE?
24 A. IT WAIVERS HIGH, LOW, BACK AND FORTH.
25 Q. AND THEN ON 12/22 READ THE FIRST TWO SENTENCES?
1811
1 A. 12/22. THE SOCIAL WORKER --
2 Q. THE CHART HERE. NOT THE SOCIAL WORKER, THE ONE THAT THE
3 DEFENDANT WROTE?
4 A. REMAINS DEMENTED. STABLE OVERALL.
5 Q. LET'S LOOK AT 12/23. WHAT DID HE WRITE?
6 A. I WAS CALLED REGARDING PATIENT BEING SOMEWHAT
7 UNRESPONSIVE WITH -- I DON'T KNOW WHAT THAT IS.
8 Q. YOU DON'T KNOW WHAT THAT WORD IS. AND THEN YESTERDAY
9 WHAT DOES IT SAY?
10 A. BUT NOW SHE'S DOING WELL OVERALL. MILD FEVER.
11 Q. SO THAT'S THE 23RD. IF YOU WOULD TURN TO 474. THAT
12 BOTTOM, IT LOOKS LIKE IT'S 12/26. WOULD YOU READ THAT ENTRY
13 FOR US?
14 A. YESTERDAY M.S. WAS TRIED FOR COMFORT CARE. SHE HAD A
15 SEIZURE THIS A.M. WAS STARTED ON DILANTIN. LOOKED PRETTY
16 ILL AT FIRST. BLOOD PRESSURE DOWN. NOW FEEDING SELF AGAIN.
17 UNSTABLE HEALTH STATUS.
18 Q. THE PLAN WAS TO DO WHAT?
19 A. CONTINUE CURRENT MEDS AND TREATMENT.
20 Q. LET'S LOOK AT THE NEXT PAGE, 475. ON THE 30TH, WOULD
21 YOU READ THAT?
22 A. 475?
23 Q. 476, EXCUSE ME.
24 A. "MET WITH SON AND DAUGHTER THIS P.M." AND I CAN'T MAKE
25 IT OUT. "I.E., PATIENT'S CONDITION. SHE HAD COFFEE GROUNDS
1812
1 VOMITUS OF GREATER THAN 200 CC'S THIS A.M. STOMACH IS
2 DISTENDED. HAS HYPERACTIVE BOWEL SOUNDS. HEART RATE QUITE
3 ERRATIC. AND ASSESSMENT G.I. BLEED. PLAN: WILL MAKE SURE
4 SHE'S COMFORTABLE WITH ROUTINE M.S."
5 Q. WHAT'S A G.I. BLEED?
6 A. IT'S WHERE THERE'S BLEEDING IN THE STOMACH.
7 Q. IS IT A TREATABLE CONDITION?
8 MR. STIRBA: YOUR HONOR, I'M GOING TO OBJECT. IT'S
9 BEYOND THE SCOPE.
10 THE COURT: SUSTAINED.
11 Q. (BY MS. BARLOW) AND THEN ON 12/31 JUST READ THE FIRST
12 WORD, PLEASE?
13 A. "UNRESPONSIVE."
14 Q. AND 1/1, THE FIRST TWO WORDS?
15 A. "GENERALLY UNRESPONSIVE."
16 Q. AND THEN ON THE 2ND, ON PAGE 477 ON THE 2ND OF JANUARY,
17 WOULD YOU READ THE FIRST LINE?
18 A. "STABLE VITAL SIGNS ACTUALLY. UNRESPONSIVE OVERALL.
19 DOES NOT OPEN EYES AT TIMES."
20 Q. OKAY. LET'S GO DOWN TO THE 3RD OF JANUARY. WOULD YOU
21 READ THAT?
22 A. "DESPITE FIVE MILLIGRAMS OF I.M. M.S. AT 07:30 AND 09:30
23 PATIENT HAS NOT RESPONDED AT ALL. EYES OPEN, GROANING,
24 APPEARS TO BE IN SOME PAIN. UNFORTUNATELY NURSING STAFF
25 HAVE BEEN HOLDING M.S. FOR LOW RESPIRATION RATE. REMAINS
1813
1 UNRESPONSIVE TO ANY QUESTIONS. VITAL SIGNS ACTUALLY --
2 VITAL SIGNS STABLE ACTUALLY AND SHE'S AFEBRILE."
3 Q. THE ASSESSMENT IS WHAT?
4 A. STABLE.
5 Q. THE PLAN IS WHAT?
6 A. MORPHINE FIVE MILLIGRAMS NOW AND CONTINUE WITH FIVE
7 EVERY THREE HOURS. P.R.N. AS NEEDED.
8 Q. FINALLY ON THE 4TH. WOULD YOU READ THAT?
9 A. "PATIENT GIVEN LARGE AMOUNTS OF MORPHINE YESTERDAY." I
10 THINK THAT'S DUE TO PAIN. I DON'T KNOW WHAT THAT IS, FOR
11 COMFORT.
12 Q. YESTERDAY?
13 A. FOR COMFORT. FINALLY SHE EXPIRED AT EIGHT P.M.
14 APPEARED TO BE IN NO PAIN.
15 Q. ASSESSMENT?
16 A. RESPIRATIONS DECREASED. POOR BLOOD PRESSURE SECONDARY
17 TO DEHYDRATION, CARDIAC ARREST.
18 Q. AND THEN THE PLAN?
19 A. RELEASE TO FAMILY. I DON'T KNOW WHAT THAT IS.
20 Q. ON 5/78, IS THIS IN YOUR HANDWRITING?
21 A. YES, IT IS.
22 Q. AND AT 11:30 WHAT DID YOU WRITE AT THE END?
23 A. AT THE END?
24 Q. YEAH. START WITH FAMILY STATES?
25 A. "FAMILY STATES THEY WANT D.N.R. STATUS MAINTAINED AND
1814
1 COMFORT MEASURES GIVEN."
2 Q. AND WHAT ARE COMFORT MEASURES?
3 A. IT CAN RANGE, LIKE I SAID, FROM ORAL CARE TO
4 REPOSITIONING THE PATIENT TO COMFORTING THE FAMILY AND
5 PROVIDING ANY OTHER MEDICATIONS AS ORDERED BY DOCTOR.
6 Q. LET'S LOOK AT 582. WELL, I DON'T KNOW IF WE NEED TO
7 LOOK AT IT. IT WAS READ ON CROSS EXAMINATION. THIS WAS
8 CONCERNING THE FAMILY MEMBERS ASKING ABOUT WHEN SHE WAS
9 GOING TO DIE. WERE YOU ABLE TO ANSWER THAT?
10 A. NO, I WAS NOT.
11 Q. AND WHY NOT?
12 A. I CAN'T PREDICT DEATH.
13 MS. BARLOW: I THINK THAT'S ALL I HAVE, YOUR HONOR.
14 THE COURT: ANYTHING FURTHER?
15 MR. STIRBA: YES, YOUR HONOR.
16 RECROSS-EXAMINATION
17 BY MR. STIRBA:
18 Q. WOULD YOU TURN TO 507 AGAIN, PLEASE.
19 A. YES.
20 Q. NOW, YOU WERE AWARE THAT THERE IS A PROCEDURE FOR
21 INDICATING WHEN A MEDICATION IS GIVEN AND THAT PROCEDURE IS
22 TO CIRCLE YOUR INITIALS, TRUE?
23 A. IF IT'S NOT GIVEN, CORRECT.
24 Q. AND FOR EXAMPLE, ON THIS PARTICULAR FORM WE HAVE
25 INITIALS UP HERE WHICH ARE CIRCLED INDICATING THAT THE
1815
1 MEDICATION WAS NOT GIVEN, CORRECT?
2 A. CORRECT.
3 Q. AND YOUR TESTIMONY TO THIS JURY IS AT 1530 ON 1/2 YOU
4 ARE TELLING US THAT YOU HAVE A LINE THROUGH YOUR INITIALS;
5 IS THAT RIGHT?
6 A. THAT IS CORRECT.
7 Q. AND YOU DIDN'T CIRCLE YOUR INITIALS TO INDICATE THAT NO
8 MEDICATION WAS GIVEN AT 1530; IS THAT TRUE?
9 A. YES.
10 MR. STIRBA: THAT'S ALL I HAVE.
11 THE COURT: ANYTHING FURTHER?
12 MS. BARLOW: YOUR HONOR, AT THE RISK OF BELABORING
13 THE POINT.
14 FURTHER REDIRECT EXAMINATION
15 BY MS. BARLOW:
16 Q. ALTHOUGH IT WAS NOT GIVEN AT 1530, WAS THAT INJECTION
17 ACTUALLY GIVEN?
18 A. IT WAS GIVEN AT 1630.
19 Q. AND NOTED ELSEWHERE?
20 A. AND NOTED ELSEWHERE.
21 MS. BARLOW: THANK YOU. NO FURTHER QUESTIONS.
22 MR. STIRBA: I HAVE NOTHING FURTHER, JUDGE.
23 THE COURT: MAY THIS WITNESS BE EXCUSED?
24 MS. BARLOW: WE WOULD ASK THAT SHE BE KEPT UNDER
25 SUBPOENA, YOUR HONOR.