David Dedrickson, MD
5 MS. BARLOW: We were expecting to call Dr.
6 Dedrickson. We haven't seen him yet. I can go get Mr.
7 Wilson and he can bring in Cathy Charlesworth if Dr.
8 Dedrickson -- he was supposed to be here by now.
9 THE COURT: Okay. Call whoever you have ready as
10 quick as you can.
11 (Pause in the proceedings.)
12 MS. BARLOW: I found the doctor at the metal
13 detector, Your Honor.
14 THE COURT: Doctor, step up here, please, and be
15 sworn.
16 DR. DAVID DEDRICKSON,
17 being first duly sworn, was examined and
18 testified as follows:
19 THE COURT: If you'll have a seat up here. Give us
20 your full name, Doctor, and spell the last name.
21 THE WITNESS: David Ray Dedrickson.
22 D-e-d-r-i-c-k-s-o-n.
23 THE COURT: Thank you.
24 DIRECT EXAMINATION
25 BY MS. BARLOW:
1 Q. I've been pronouncing your name differently. I
2 apologize. Dr. Dedrickson, please state where you work
3 A. I work at both Davis Medical Center and Ogden Regional
4 Medical Center.
5 Q. And what is your specialty?
6 A. Raidology.
7 Q. And what education or training did you receive for this
8 specialty?
9 A. Four years of medical school, a year of internship, four
10 years of residency and one year of a fellowship.
11 Q. And how does raidology differ from, say, a family
12 practitioner?
13 A. Radiology is a field in which we are usually asked to be
14 consultants on cases, to read x-rays doing diagnostic studies
15 for other physicians.
16 Q. Do you recall doing an x-ray on Ellen Anderson on the
17 30th of December, 1995?
18 A. Not specifically, but I must have.
19 Q. How many x-rays do you do a year, or read a year?
20 A. We usually read up to a hundred x-rays a day.
21 MS. BARLOW: If I may approach the witness?
22 THE COURT: You may.
23 Q. (BY MS. BARLOW) This is exhibit number 2C and med page
24 174. I'll hand that to you. Dr. Dedrickson, I'll ask you to
25 go through this document and explain it for us. Tell us what
1 that document is, first.
2 A. This is an x-ray report for a chest x-ray performed on
3 12/30/95.
4 Q. Do you do the x-ray itself?
5 A. No. A technician does.
6 Q. What is your involvement with the x-ray?
7 A. My involvement is to interpret the x-ray and render an
8 opinion about the x-ray.
9 Q. Is that what you did in this case?
10 A. Yes, it is.
11 Q. Please read the first line and, if you would, read it
12 slowly. Then I'll have to stop you, because these are words
13 and terminologies that we're just not familiar with. If you
14 would now, please.
15 A. Okay. Do you want me to start with clinical history
16 dementia or single portable --
17 Q. You've said clinical history dementia. Where do you get
18 that from?
19 A. Usually from the requisition that's included with the
20 x-ray at the time that we interpret it.
21 Q. Okay. Would you please read the first sentence.
22 A. Single portable supine view shows --
23 THE COURT: Slow down, please.
24 THE WITNESS: Single portable supine view shows
25 considerable elevation of the right hemidiaphragm.
1 Q. (BY MS. BARLOW) What does that mean?
2 A. That means that the right side of the chest, the
3 diaphragm or muscle that helps you to ventilate the chest, or
4 to move air in and out of the lung, the diaphragm was
5 elevated.
6 Q. Do you have any idea what causes that problem?
7 A. There are several things that can cause an elevated
8 diaphragm. It can be due from any process inside the
9 abdomen. It can be from loss of innervation of the diaphragm
10 or the nerve leading to the diaphragm, usually the phrenic
11 nerve.
12 Q. Does it have anything to do with breathing difficulties?
13 A. Some people who lose the enervation, do not breath as
14 well or as adequately as other people.
15 Q. It says single portable view. What what do you mean by
16 portable?
17 A. Portable is a portable machine. That means that the
18 x-ray was not done in the raidology department. It was done
19 by a portable machine. Usually individuals who are not able
20 to come to the raidology department, who are in the emergency
21 room, usually we have portable films done first.
22 Q. Is there a difference between how the film is taken
23 between the portable and a regular radiology room?
24 A. Yes, there is. A portable film is usually taken from in
25 front of the patient. And because of the physics of it, the
1 structures that are anterior in the chest, or as we'd say
2 ventral chest, become more accentuated because the beam is
3 coming anterior through the chest, through the patient, and
4 onto the film which is situated behind the patient.
5 A normal film taken in the radiology department, the beam
6 is shot from behind the chest with a plate, or the film is
7 placed in front of the chest so as not to accentuate the
8 heart or the vascular structures as much.
9 Q. What does the difference between whether from the front
10 or back do to your ability to read what is happening with the
11 lungs?
12 A. Usually it doesn't limit us in reading it. However, a PA
13 view is usually considerably better, or can be better, for
14 diagnostic purposes. It's a better quality x-ray.
15 Q. What is a PA view?
16 A. Posterior to anterior. It means the beam is coming from
17 behind the chest.
18 Q. If you would read the next sentence.
19 A. There is a calcific type density above the left lateral
20 hemidiaphragm.
21 Q. Let's go back one.
22 A. The heart is enlarged and the aorta tortuous.
23 Q. Do you have any idea what that means?
24 A. Yes, I do. It means that, considering normal people, the
25 heart in this individual would have been more prominent or
1 larger than a normal individual would be.
2 Q. And what about the aorta tortuous?
3 A. The aorta is the main blood vessel that takes blood from
4 the heart to the body. It would be tortuous; or, instead of
5 following a normal course through the chest, it would be
6 bowed or -- I guess bowed would be the best way to say it.
7 Usually, as you get older, it does become tortuous.
8 Q. And are you trained to say what is causing any of this?
9 A. Sometimes we can tell. Usually not. It's usually just
10 incident to age.
11 Q. And you're just saying this is it, that's what has
12 happened?
13 A. Yes.
14 Q. And if you would read the next one.
15 A. There is a calcific type density above the left lateral
16 hemidiaphragm.
17 Q. What does that mean?
18 A. There's a calcific density around the left hemidiaphragm
19 that normally wouldn't be there.
20 Q. And calcific means what?
21 A. That it's calcium, usually from a chronic process within
22 the body.
23 Q. So you wouldn't expect that to be something new or
24 something that just came on suddenly?
25 A. No, I would not.
1 Q. And then the next sentence?
2 A. It is hard to tell if this is within the abdomen, splenic
3 artery. And that comma should not be there. Aneurism,
4 calcification or may represent a calcified structure within
5 the lung base. Those are the possibilities of where that
6 could be coming from.
7 Q. And is that the way you usually would phrase something,
8 all the different possibilities of what you read?
9 A. Yes. Either there or in the impression of the report.
10 Q. And why do you do that?
11 A. That's to give the diagnostician a chance to know what we
12 see and feel it representss.
13 Q. Okay. And is there any way of determining which of the
14 many things it is?
15 A. Yes. There are other studies that you can do.
16 Q. Then if you would read the next sentence.
17 A. There is density around the hilar regions bilaterally,
18 central air bronchograms.
19 Q. What does that mean?
20 A. That means that around the hilar region -- the hilar
21 areas of the lungs are where the pulmonary vascularity
22 extends from the center of the chest out into the lungs
23 itself. Both pulmonary arteries and veins. That's called
24 the pulmonary hilar area.
25 Q. Is that more in the center of the chest?
1 A. Rights towards the center of the chest. And around this
2 area there would be increased density or, most likely, a
3 consolidated or infiltrative process. That would mean where
4 there should be normal lung space there's probably something
5 filling that area.
6 Q. And is there any way you can tell, from looking at the
7 x-ray, what it is filling that area?
8 A. We can tell generally within two or three things what it
9 generally would be.
10 Q. And then the last sentence is just one word?
11 A. Yes. Osteopenia. That means that the mineralization of
12 the bones is not what it would be in a normal individual.
13 That's also a process of aging.
14 Q. That's related to osteoporosis?
15 A. Yes. Osteoporosis you really can't tell on an x-ray.
16 You have to do other studies. But generally osteopenia means
17 osteoporosis.
18 Q. And the word impression has a hole stamped through it.
19 What you do with the impression?
20 A. The impression is where you just summarize what you've
21 said and what you think it may represent.
22 Q. And what were your impressions, if you would read that?
23 A. Okay. Consolidated density on the hilar areas, extending
24 to the lung bases with loss of the left hemidiaphragm.
25 Suggestive of bilateral infiltrative process, such as
1 pneumonitis versus pulmonary edema or hemorrhage.
2 Q. What does that mean?
3 A. That means that with the density I'm seeing around the
4 central region of the lungs, extending down towards the
5 bottom of the lungs, something is going on or
6 consolidating -- extending into the air spaces of the lungs
7 that should not be there. The possibilities could be that
8 that could represent pneumonia, it could represent extra
9 fluid in the lungs, pulmonary edema, or in rare instances
10 pulmonary hemorrhage or blood.
11 Q. You couldn't tell from looking at it which it was?
12 A. No. You generally cannot.
13 Q. How do you find out which it is?
14 A. Usually clinical history.
15 Q. Meaning from?
16 A. From what the clinician gives you and the history and how
17 the patient presents. Such as if they presented with fever,
18 elevated white blood count, then you'd say that it's most
19 likely pneumonia. If the patient came in and had edema or
20 extra fluid in the legs, and was known to have heart failure,
21 then you'd probably feel this was extra fluid in the lungs or
22 pulmonary edema.
23 Q. Is that called congestive heart failure?
24 A. Yes.
25 Q. Because of the congestion in the chest or the lungs?
1 A. Congestion, or extra blood volume in the lungs or
2 vascular area, usually causes fluid to weep out. And this is
3 extra fluid that then becomes situated within the lung
4 alveolar sacks where air is normally exchanged in the lungs
5 and that's when it becomes pulmonary edema. It's usually a
6 progression of congestive failure and then to pulmonary
7 edema.
8 Q. And the next sentence you've already talked about.
9 A. Heart appears enlarged with aorta tortuous and calcified.
10 Q. Okay. And then what about the next paragraph?
11 A. Calcific density in the left region, which I feel is
12 splenic artery, aneurism, calcification. As you get older
13 some of the arteries within the abdomen, especially the
14 splenic artery, can get an outpouching or bulging on it that
15 calcifies and that can be a normal finaling.
16 Q. You don't see a hemorrhage there, though?
17 A. No, I do not.
18 Q. Hemorrhage being what? The aneurism busts?
19 A. If the aneurism bursts.
20 Q. Then blood comes out into the body cavity or whatever?
21 A. Right.
22 Q. And then the last sentence is a recommendation. Is this
23 typical?
24 A. Yes, it is. Depending on the clinical presentation of
25 the patient, we will recommend that they repeat the chest
1 x-rays within the raidology department because you get a
2 better quality x-ray and can tell more -- you're more apt to
3 be able to tell what is going on. In addition you get a
4 lateral view which helps you determine whether the density
5 may be anterior in the lung or posterior.
6 Q. And a lateral view meaning?
7 A. Short from the side.
8 Q. And anterior is front, posterior is back?
9 A. Back.
10 Q. So why did you recommend this?
11 A. Usually, if a patient is sick and there's going to be any
12 clinical decision made on what you're telling the clinician,
13 or through your report, and you want to verify what is going
14 on, I would recommend a better view be obtained.
15 Q. Are you in any position to order that different view?
16 A. No, I cannot.
17 Q. Who does?
18 A. Usually the clinician.
19 Q. When you say the clinician, are you --
20 A. The attending physician.
21 Q. Okay. I believe the doctor listed on this is Robert
22 Weitzel up at the top?
23 A. That is correct.
24 Q. So you made that recommendation, but you don't know if it
25 ever was followed up on?
1 A. I do not.
2 MS. BARLOW: That's all I have of this witness.
3 THE COURT: Cross-examine, Mr. Bugden.
4 A JUROR: Can we just turn this light down? It's in
5 everybody's face.
6 THE COURT: Okay. Does that help?
7 A JUROR: Thank you.
8 THE COURT: You can leave your sun glasses home
9 tomorrow.
10 CROSS-EXAMINATION
11 BY MR. BUGDEN:
12 Q. Doctor, just a couple of questions. With regard to the
13 finding that you had from this x-ray that the heart was
14 enlarged, is that consistent with congestive heart failure?
15 A. Usually the heart enlarges with congestive heart failure.
16 Q. And also, with regard to the density that you saw in the
17 central part, I guess, of the lungs, you offered the
18 clinician -- you offered the impression that that could be
19 caused or that -- that that could be a couple of different
20 things. It could be a pneumonia?
21 A. Yes.
22 Q. And it also could be pulmonary edema, did you say?
23 A. Yes.
24 Q. And the pulmonary edema, that is fluid in the lungs?
25 A. Yes.
1 Q. And I think you did explain this, but I'll ask you to say
2 it again, is that something, then, that would be consistent
3 with the congestive heart failure?
4 A. Yes. Usually you go from -- it's long stages. Usually
5 you get vascular congestion. And then it's considered
6 another stage in that line is congestive failure which leads
7 to pulmonary edema.
8 Q. So someone with a problem with congestive heart failure,
9 that could lead to the pulmonary edema?
10 A. Yes.
11 Q. The fluid in the lungs?
12 A. Yes.
13 Q. Those would be two steps?
14 A. Uh-huh.
15 Q. And pulmonary edema, that can take the life of a patient,
16 is that right?
17 A. If the pulmonary edema becomes severe enough, yes, it
18 can.
19 Q. And when did you -- you explained to us that the
20 radiologist interprets the radiogram, the x-ray. At what
21 time of day did you interpret this x-ray?
22 A. From this, I cannot tell specifically, from the report
23 here.
24 Q. Okay. And you recommended that in order to have a better
25 idea of what you were looking at you could -- you
1 recommended, or you presented the treating physician, with
2 the possibility of doing more x-rays?
3 A. That's correct.
4 Q. And with all due respect, I guess it's quite common for
5 the radiologist to recommend other views?
6 A. That's very common.
7 MR. BUGDEN: Thank you very much.
8 THE COURT: Redirect?
9 REDIRECT EXAMINATION
10 BY MS. BARLOW:
11 Q. Pulmonary edema can be fatal?
12 A. Yes, if it becomes strong enough.
13 Q. Is it treatable?
14 A. Yes.
15 Q. With what?
16 A. There are several ways to treat it. Usually with Lasix.
17 Q. Which is what?
18 A. Antidiuretics. Things that take fluid out of the body.
19 MS. BARLOW: That's all, Your Honor.
20 MR. BUGDEN: May I approach the witness?
21 THE COURT: Sure.
22 RECROSS-EXAMINATION
23 BY MR. BUGDEN:
24 Q. Do you have a copy of your report there, Doctor?
25 A. Yes, I do.
1 Q. Just making sure I'm looking at the same page. It looks
2 like the report wasn't dictated -- that you may not have
3 dictated the report until December 31st?
4 A. I can't tell if that's when it was dictated or
5 transcribed. Sometimes that will be the time that it was
6 transcribed. And it may have been, if this was performed in
7 the evening, and I don't have a time here, but it may not
8 have been dictated until the next day.
9 MR. BUGDEN: Thank you very much, Doctor.
10 THE COURT: Anything further?
11 MS. BARLOW: Nothing further, Your Honor.
12 THE COURT: You may step down, Doctor. Thanks for
13 testifying.