David Wilding, MD
7 MS. BARLOW: STATE WOULD CALL DR. DAVID WILDING.
8 THE COURT: DR. WILDING, WOULD YOU STEP UP, PLEASE?
9 IF YOU WOULD RAISE YOUR RIGHT HAND, PLEASE, AND FACE THE
10 CLERK, SHE'LL PLACE YOU UNDER OATH.
11 DAVID WILDING,
12 BEING FIRST DULY SWORN, WAS EXAMINED AND
13 TESTIFIED AS FOLLOWS:
14 THE COURT: IF YOU'LL HAVE A SEAT UP HERE, PLEASE.
15 DOCTOR, IF YOU'LL GIVE US YOUR FULL NAME AND SPELL YOUR
16 LAST NAME, PLEASE.
17 THE WITNESS: DAVID GREG WILDING, W-I-L-D-I-N-G.
18 THE COURT: THANK YOU.
19 DIRECT EXAMINATION
20 BY MS. BARLOW:
21 Q. GOOD MORNING.
22 A. GOOD MORNING.
23 Q. DR. WILDING, WHERE DO YOU WORK?
24 A. AT THE BRIGHAM MEDICAL CLINIC IN BRIGHAM CITY, UTAH.
25 Q. OKAY. WOULD YOU PLEASE -- AND WHAT IS YOUR OCCUPATION?
1 A. I'M A PHYSICIAN.
2 Q. CAN YOU GIVE US A LITTLE BACKGROUND, WHAT YOUR EDUCATION
3 AND TRAINING FOR YOUR POSITION IS?
4 A. I GRADUATED FROM THE UNIVERSITY OF UTAH IN 1990. I DID
5 AN INTERNAL MEDICINE RESIDENCY PROGRAM AT THE L.D.S. HOSPITAL
6 IN SALT LAKE CITY.
7 Q. AND WHEN DID YOU RECEIVE YOUR PHYSICIAN'S LICENSE?
8 A. IN 1990 WAS THE YEAR I GRADUATED FROM MEDICAL SCHOOL.
9 Q. HOW LONG HAVE YOU BEEN PRACTICING IN BRIGHAM CITY?
10 A. I'VE BEEN IN BRIGHAM CITY NOW FOR NINE YEARS.
11 Q. WHAT -- IS THERE ANY SPECIALITY THAT YOU HAVE?
12 A. MY SPECIALITY IS INTERNAL MEDICAL.
13 Q. HAVE YOU SOUGHT A BOARD CERTIFICATION FOR THAT
14 SPECIALITY?
15 A. I HAVE NOT.
16 Q. OKAY. IS THERE ANY REQUIREMENT THAT PEOPLE BE BOARD
17 CERTIFIED?
18 A. NO, THERE IS NOT. MY PRACTICE IS SUCH THAT IN BRIGHAM
19 CITY, IT'S A SMALL TOWN, AND FAMILY MEDICINE IS PRIMARILY
20 WHAT WE DO.
21 Q. OKAY. AS A FAMILY PRACTITIONER, BASICALLY, DO YOU TREAT
22 ELDERLY PEOPLE?
23 A. YES.
24 Q. DID YOU HAVE OCCASION TO TREAT ELLEN ANDERSON?
25 A. YES, I DID.
1 Q. DO YOU RECALL WHEN SHE FIRST BECAME YOUR PATIENT?
2 A. ACCORDING TO THE MEDICAL RECORD IT WAS IN 1994.
3 Q. DO YOU RECALL ANYTHING ABOUT HER -- YOUR FIRST MEETING
4 WITH HER?
5 A. THERE ARE CERTAINLY ASPECTS THAT I RECALL BETTER THAN
6 OTHERS. IT HAS BEEN A LONG TIME. I'VE HAD NO CONTACT FOR A
7 NUMBER OF YEARS, AND AS -- AS YOU'RE AWARE, I WAS NOT
8 INVOLVED DIRECTLY WITH THE FIRST TRIAL SO I'VE -- I'VE NOT
9 TESTIFIED TO THIS POINT.
10 BUT MRS. ANDERSON, AS I DO RECALL, WAS AN ELDERLY LADY.
11 SHE WAS IN -- IN POOR HEALTH. SHE WAS FRAIL.
12 Q. UH-HUH.
13 A. SHE'D HAD PROBLEMS WITH ANXIETY AND DEPRESSION. SHE'D
14 HAD SOME MEDICAL ISSUES. SHE'D HAD A HIP FRACTURE, A
15 GALLBLADDER PROBLEM AND SO ON, BUT SHE WAS JUST A FRAIL
16 LITTLE LADY WHO WAS AFRAID TO BE AWAY FROM HER DAUGHTER, HAD
17 A LOT OF ANXIETY OVER THAT. WOULD FREQUENTLY, YOU KNOW,
18 REQUEST HER OR CALL OUT FOR HER TO BE PRESENT.
19 Q. YOU INDICATE SHE WAS AN ELDERLY LADY. DID SHE HAVE ANY
20 HEART PROBLEMS THAT YOU'RE AWARE OF?
21 A. NOT THAT I WAS AWARE OF.
22 Q. ANY CARDIO OR VASCULAR PROBLEMS?
23 A. SHE DID HAVE SOME VASCULAR PROBLEMS. I DID SEE HER FOR
24 SOME -- WHAT I TERM TO BE CONGESTIVE HEART FAILURE. SHE
25 PRESENTED WITH SWELLING IN HER LEGS ON ONE OCCASION THAT I
1 NOTED IN THE CHART. SHE HAD REDNESS, RUBOR, IN -- INTO HER
2 LEGS. SHE'D HAD SOME CONGESTION INTO HER LUNGS AT ONE TIME
3 WHEN I SAW HER.
4 Q. OKAY. WE'LL GET INTO THOSE A LITTLE MORE SPECIFICALLY.
5 WERE YOU THE FIRST PHYSICIAN SHE CONTACTED OR THAT SHE CAME
6 TO WHEN SHE HAD HER HIP FRACTURE?
7 A. SHE SAW DR. JOHN MARKESON WHO IS A COLLEAGUE OF MINE.
8 Q. WERE YOU INVOLVED IN HER SURGERY, HER HIP SURGERY AT ALL?
9 A. I WAS NOT.
10 Q. OKAY. WERE YOU INVOLVED IN HER CARE AFTER THE HIP
11 SURGERY WHEN SHE WENT TO THE PIONEER CARE CENTER?
12 A. ULTIMATELY, YES, BUT IT WAS ONE MONTH POST-OPERATIVELY.
13 Q. WHICH WAS WHAT?
14 A. ACCORDING TO THE RECORDS WHICH I HAVE, I SAW HER ON
15 JULY 22ND, 1995, THAT WAS AFTER HER HIP SURGERY. HER
16 COMPLAINTS WERE NOT NECESSARILY ABOUT THAT THOUGH SHE DID
17 MENTION THE SURGERY.
18 Q. OKAY. DID SHE HAVE ANY PAIN COMPLAINTS AT THAT TIME THAT
19 YOU CAN RECALL?
20 A. ACCORDING TO THE RECORD FROM MY CLINIC, SHE'D HAD SOME
21 ABDOMINAL PAIN THAT HAD BEEN PRESENT FOR A WEEK AND A HALF
22 AFTER THE SURGERY -- I'M SORRY. BEEN PRESENT FOR A WEEK AND
23 A HALF PRIOR TO HER VISIT.
24 Q. OKAY.
25 A. SHE'D MENTIONED SHE'D HAD THE SURGERY. SHE JUST HAD
1 DIFFUSE ACHES AND PAINS.
2 Q. DID SHE HAVE ANY HIP PAINS THAT SHE COMPLAINED ABOUT AT
3 THAT TIME AFTER -- FROM THE SURGERY?
4 A. THERE WAS NOTHING THAT WAS NOTED IN THE CHART.
5 Q. DID YOU VISIT HER AT THE CARE CENTER OR WHAT WAS SHE
6 BROUGHT TO YOUR HOSPITAL, IF YOU RECALL?
7 A. SHE WAS BROUGHT DOWN TO THE OFFICE.
8 Q. EXCUSE ME. AT YOUR OFFICE. I'M SORRY. I MISSPOKE.
9 SO SHE WAS ABLE TO GET OUT?
10 A. YES.
11 Q. OKAY. SO THAT WAS IN 1995, YOU INDICATE?
12 A. THAT IS CORRECT.
13 Q. DID YOU HAVE OCCASION TO PRESCRIBE ANY PAIN MEDICATIONS
14 FOR HER FROM SAY JULY WHEN YOU SAW HER IN 1995 UNTIL SAY
15 DECEMBER OF 1995?
16 A. I DO NOT RECALL PRESCRIBING ANY SPECIFIC PAIN
17 MEDICATIONS.
18 Q. LET'S TURN TO NOVEMBER OF 1995. IF THERE WERE A CONCERN
19 AT THE NURSING HOME, WOULD YOU BE -- WOULD -- WOULD YOU HAVE
20 BEEN MADE AWARE OF ANY MEDICAL CONCERN THAT THEY HAD ABOUT
21 HER CONDITION?
22 A. YES.
23 Q. WERE YOU MADE AWARE OF SUCH A CONCERN IN NOVEMBER OF
24 1995?
25 A. ACCORDING TO THE MEDICAL RECORD, NOVEMBER 15TH OF THAT
1 YEAR, SHE DID PRESENT TO MY OFFICE.
2 Q. DID SHE COME TO YOUR OFFICE?
3 A. YES.
4 Q. DID YOU RECEIVE A REFERRAL FROM THE NURSING HOME, ANY
5 KIND OF WRITTEN DOCUMENT REGARDING THAT?
6 A. THAT WOULD HAVE BEEN TRUE.
7 Q. OKAY. WHAT, IF ANYTHING, DO YOU RECALL ABOUT THAT
8 MEETING WITH ELLEN ANDERSON ON THE 15TH OF NOVEMBER?
9 A. ACCORDING TO OUR RECORDS SHE PRESENTED WITH LEG SWELLING,
10 COUGH, AND SHORTNESS OF BREATH.
11 Q. DID YOU DIAGNOSE THAT PROBLEM?
12 A. IT WAS FELT THAT THE SWELLING WAS CONSISTENT WITH
13 CONGESTIVE HEART FAILURE AS WELL AS THE COUGH AND THE
14 SHORTNESS OF BREATH.
15 Q. WHAT IS CONGESTIVE HEART FAILURE?
16 A. CONGESTIVE HEART FAILURE IS A CONDITION WHERE THE HEART
17 IS NOT ABLE TO PUMP BLOOD AS EFFICIENTLY AS IT SHOULD AND THE
18 BLOODS TENDS TO BUILD UP WITH FLUID IN DIFFERENT PARTS OF
19 YOUR BODY. LUNGS AND LEGS SEEM TO BE PRIMARILY PLACES
20 BECAUSE OF THE EFFECTS OF GRAVITY.
21 Q. CAN THIS BE FATAL?
22 A. OH, YES.
23 Q. HOW DOES IT COMPARE WITH A -- WHAT WE CALL A HEART
24 ATTACK, A MYOCARDIAL INFARCTION?
25 A. CONGESTIVE HEART FAILURE IS NOWHERE NEAR AS SERIOUS. IT
1 IS A CONDITION PEOPLE WITH A NUMBER OF YEARS. IT CAN BE
2 TREATED MEDICALLY VERY EFFECTIVELY. A HEART ATTACK IS -- IS
3 MORE SERIOUS. IT ACTUALLY IMPLIES MUSCLE DEATH.
4 Q. UH-HUH.
5 A. THE HEART THEN DOES NOT BEAT AS EFFECTIVELY, AS STRONGLY.
6 SCAR WILL DEVELOP IF -- IN THE OCCASION THAT THERE IS
7 HEALING. BUT SUDDEN DEATH IN -- IN HEART ATTACK ARE VERY
8 MUCH DIFFERENT THAN CONGESTIVE HEART FAILURE.
9 Q. DID YOU SEE ANY INDICATION OF -- OF A HEART ATTACK --
10 A. THERE WASN'T --
11 Q. -- IN ELLEN ANDERSON?
12 A. WE SAW NO INDICATION.
13 MS. BARLOW: IF I CAN USE THIS MACHINE -- IF I CAN
14 FIGURE OUT HOW TO USE THIS MACHINE. MR. MAJOR IS THE EXPERT
15 HERE.
16 (OFF-THE-RECORD DISCUSSION)
17 MS. BARLOW: PERHAPS WHILE HE'S DOING THE MECHANICAL
18 STUFF I CAN ASK YOU SOME OTHER -- SOME FURTHER QUESTIONS.
19 Q. (BY MS. BARLOW) WHAT -- WHAT TREATMENT IS THERE FOR
20 CONGESTIVE HEART FAILURE?
21 A. CONGESTIVE HEART FAILURE CAN BE TREATED IN A NUMBER OF
22 WAYS. FIRST LIMITING SALT INTAKE IS EFFECTIVE. DECREASING
23 THE FLUIDS WHICH WILL ACCUMULATE IN THE BODY IS EFFECTIVE.
24 WE CAN TREAT PATIENTS WITH DIERETICS WHICH ARE WATER PILLS.
25 Q. UH-HUH.
1 A. REST IS EFFECTIVE, ELEVATING THE LEGS.
2 Q. WHAT DID YOU RECOMMEND FOR ELLEN ANDERSON ON THE 15TH OF
3 NOVEMBER?
4 A. ACCORDING TO THE RECORD, SHE RECEIVED LASIX WHICH IS A
5 DIERETIC OR A WATER PILL, IN ADDITION WITH THE POTASSIUM.
6 Q. WHY WOULD YOU GIVE HER POTASSIUM IN ADDITION?
7 A. LASIX IS A VERY POWERFUL DIERETIC THAT CAUSES THE BODY TO
8 LOSE POTASSIUM, AND IN ORDER TO PREVENT THAT, SUPPLEMENTAL
9 POTASSIUM IS GIVEN.
10 Q. I HAVE ON -- TRYING TO AT LEAST -- A DOCUMENT THAT IS
11 DATED THE 15TH OF NOVEMBER, 1995. DO YOU HAVE A SIMILAR
12 DOCUMENT TO THAT -- WELL, PROBABLY THE ORIGINAL?
13 THE COURT: LADIES AND GENTLEMEN OF THE JURY, CAN
14 YOU SEE THAT? OKAY. THANK YOU.
15 MS. BARLOW: YOUR HONOR, THIS IS B-4.
16 THE COURT: THANK YOU.
17 MS. BARLOW: DEFENDANT'S 4. B-4.
18 THE COURT: GRATUITOUS EXHIBIT NUMBER.
19 MS. BARLOW: AND I THINK --
20 THE COURT: IT CAN'T BE B-4. IT'S GOT TO BE D.
21 MS. BARLOW: IT'S THE WILDING RECORDS. I'M SORRY IF
22 I'VE GOT THE WRONG NUMBER.
23 MR. WILSON: DID YOU SAY B. OR D.?
24 MS. BARLOW: IT'S DEFENDANT 4.
25 THE COURT: DEFENDANT'S 4? ALL RIGHT.
1 MR. BUGDEN: WE HAVE NO OBJECTION TO D-4 BEING
2 RECEIVED.
3 THE COURT: D-4 WILL BE RECEIVED.
4 Q. (BY MS. BARLOW) DO YOU -- HAVE YOU SEEN THIS DOCUMENT
5 BEFORE?
6 A. I HAVE A COPY OF IT IN FRONT OF ME, YES.
7 Q. AND IS THIS THE REFERRAL THAT CAME TO YOU FROM THE
8 NURSING HOME?
9 A. THAT IS -- THAT IS CORRECT.
10 Q. AND THEN THERE IS SOME -- THERE IS SOME WRITING UNDER
11 DOCTOR'S OBSERVATIONS AND NEW FINDINGS. WHOSE WRITING IS
12 THAT?
13 A. THAT IS MY WRITING.
14 Q. IS THAT YOUR WRITING? IS THAT YOUR SIGNATURE AT THE
15 BOTTOM?
16 A. THAT IS MY SIGNATURE AT THE BOTTOM.
17 Q. ACTUALLY IT'S MORE READABLE THAN A LOT.
18 A. THANK YOU.
19 Q. WHAT DOES THAT INDICATE -- WHAT YOUR OBSERVATIONS WERE
20 THEN?
21 A. I CAN READ IT, IF -- IF THAT'S WHAT YOU'RE ASKING.
22 Q. WELL, HAVE YOU ALREADY TESTIFIED AS TO WHAT YOUR
23 OBSERVATIONS WERE?
24 A. NOT THAT I'M AWARE OF.
25 Q. OKAY. WOULD YOU READ IT FOR US, PLEASE?
1 A. UNDER THE LINE THAT SAYS DOCTOR'S OBSERVATIONS AND
2 FINDINGS, SAYS PROBLEMS SLEEPING, AGITATION. LEG SWELLING.
3 ON THE EXAM, ALERT AND ORIENTED. LUNGS CRACKLES AT
4 BASES. HEART REGULAR. LEGS TWO PLUS EDEMA. DELAYED
5 CAPILLARY REFILL.
6 Q. AND I THINK ALERT AND ORIENTED WE PROBABLY CAN
7 UNDERSTAND. LUNGS CRACKLY AT BASES? WHAT DOES THAT MEAN?
8 A. CRACKLES IS A SOUND WHICH SOUNDS VERY MUCH LIKE SARAN
9 WRAP IF YOU WERE TO WRINKLE IT IN YOUR FINGERS. THAT IF
10 THERE IS FLUID IN THE LUNGS AND YOU HAVE THE PATIENT TAKE A
11 DEEP BREATHE IT IS A -- A SOUND THAT IS VERY EASY TO HEAR
12 WITH THE STETHOSCOPE. IT -- IT IS CONSISTENT WITH
13 INTERSTITIAL FLUID IN THE LUNGS.
14 Q. YOU SAY -- INDICATE THE HEART IS REGULAR. WHAT -- WHAT
15 DOES THAT MEAN?
16 A. REGULAR WOULD IMPLY THAT THERE IS A REGULAR RATE AND
17 RHYTHM. IT IS NOT IRREGULAR IN ANY MANNER. IT -- IT BEATS
18 IN A VERY NORMAL, REGULAR FASHION.
19 Q. OKAY.
20 A. IT IS NOT TOO FAST, IT IS NOT TOO SLOW.
21 Q. DOES THAT HELP YOU -- IN HEARING THAT, DOES THAT MAKE ANY
22 DIFFERENCE ABOUT WHAT YOUR DIAGNOSIS, WHETHER IT'S CONGESTIVE
23 HEART FAILURE OR A HEART ATTACK?
24 A. A HEART ATTACK CANNOT BE DIAGNOSED WITH A STETHOSCOPE.
25 IF YOUR HEART IS IRREGULAR, THERE ARE IRREGULAR BEATS THAT GO
1 ALONG WITH HEART PROBLEMS. THAT IS -- THAT IS CORRECT.
2 ATRIAL FIBRILLATION, VENTRICULAR TACHYCARDIA, CERTAINLY
3 ARE -- ARE DANGEROUS THINGS. BUT NOT TO BELABOR THE POINT,
4 THERE WAS NOTHING THAT WAS ABNORMAL ABOUT HER HEART RATE.
5 Q. THEN YOU HAVE LEGS TWO PLUS EDEMA. WHAT DOES THAT MEAN?
6 A. EDEMA IS A -- ANOTHER WORD FOR SWELLING. IF THERE IS
7 SWELLING INTO THE LEGS, WE CAN MEASURE IT BY PUTTING PRESSURE
8 ON THE ANKLES JUST ABOVE THE FEET. AND IF THERE IS SWELLING
9 PRESENT, IT IS QUITE OBVIOUS BECAUSE AS YOU PUSH ON THE --
10 THE LEGS FOR A NUMBER OF SECONDS, 15 TO 30 SECONDS, A
11 DIMPLING WILL OCCUR. SO WHEN YOU REMOVE YOUR THUMB, THE
12 EDEMA, THE PRINT WILL STILL BE PRESENT. AND SO IT IS
13 MEASURED AS TRACE, ONE PLUS, OR TWO PLUS. TWO PLUS BEING
14 THAT THERE WAS SIGNIFICANT EDEMA IN HER LEGS.
15 Q. AND THAT'S INDICATIVE OF FLUID?
16 A. CORRECT.
17 Q. POOLING IN THE LEGS?
18 A. CORRECT.
19 Q. AND THEN DELAYED CAPILLARY --
20 A. REFILL.
21 Q. -- REFILL. THANK YOU. WHAT DOES THAT MEAN?
22 A. CAPILLARY REFILL IS THE AMOUNT OF TIME IT TAKES FOR BLOOD
23 TO REENTER THE TISSUE. IF -- IF ANY ONE PUTS THEIR -- THEIR
24 HAND -- THEIR FINGER ON THEIR HAND AND SQUEEZES IT AND THEN
25 RELEASES, IT'S THE AMOUNT OF TIME THAT IT TAKES THE COLOR TO
1 COME BACK INTO THE FINGER.
2 Q. OKAY. THEN YOU HAVE INSTRUCTIONS FOR NURSING CARE.
3 AGAIN, THAT'S IN YOUR HANDWRITING. WHAT DID YOU INSTRUCT
4 THE -- BASICALLY THE CARE CENTER TO -- TO PROVIDE FOR HER?
5 A. THE FIRST WORD THERE SAYS REST, ELEVATE LEGS. LASIX,
6 40 MILLIGRAMS DAILY. K.C.L. -- THAT IS POTASSIUM CHLORIDE
7 WHICH YOU ASKED ME ABOUT BEFORE -- 20 MILLIEQUIVALENTS DAILY.
8 INCREASE THE AMITRIPTYLINE. AMITRIPTYLINE IS A TRICYCLIC
9 ANTIDEPRESSANT THAT WE WILL FREQUENTLY USE TO HELP PATIENTS
10 SLEEP.
11 Q. AND DOES THAT HAVE ANYTHING TO DO WITH THE EDEMA AND THE
12 POSSIBLE CONGESTIVE HEART FAILURE?
13 A. NO. MRS. ANDERSON HAD DIFFICULTY SLEEPING. THIS WAS A
14 MEDICATION WHICH WE HAD GIVEN HER. SHE WAS STILL HAVING
15 DIFFICULTY AT THE TIME. CONGESTIVE HEART FAILURE CAN BE
16 QUITE MISERABLE, NOT BEING ABLE TO CATCH YOUR BREATH AND SO
17 ON. SO WE INCREASE THAT JUST TO HELP HER GET SOME REST.
18 H.S. MEANS AT NIGHT.
19 Q. OKAY.
20 A. AND THEN AMBIEN IS A SLEEPING MEDICATION, 5 MILLIGRAMS.
21 IT SAYS ONE H.S., AT NIGHT; P.R.N. MEANING AS NEEDED FOR
22 INSOMNIA. FOR MEDICAL FOLLOW-UP, SAYS RECHECK ONE MONTH.
23 Q. AND IT LOOKS LIKE ALMOST A PI SIGN WITH A DOT OR TWO
24 ABOVE IT AFTER THE 5 MILLIGRAM OF AMBIEN. WHAT DOES THAT
25 MEAN?
1 A. THAT WAS -- THAT'S INDICATER FOR ONE. THAT WAS --
2 Q. ONE -- ONE TABLET OR ONE --
3 A. ONE 5 MILLIGRAM TABLET AT NIGHT.
4 Q. THAT'S ANOTHER ONE OF THOSE MEDICAL TERMS THAT WE WILL
5 LEARN HERE. DID YOU FOLLOW UP THEN WITH HER CARE FROM THIS
6 WHAT YOU EVIDENTLY THOUGHT WAS PERHAPS CONGESTIVE HEART
7 FAILURE?
8 A. THE LAST TIME, ACCORDING TO THE MEDICAL RECORD, THAT I
9 SAW ELLEN WAS 11/15/95.
10 Q. DO YOU KNOW DR. BRUCE KELLER?
11 A. YES, I DO.
12 Q. AND WHO IS HE?
13 A. DR. KELLER IS ANOTHER ONE OF MY -- THE PHYSICIANS IN OUR
14 PRACTICE. HE'S ANOTHER ONE OF MY COLLEAGUES.
15 Q. IS THERE ANY NOTATION IN THE RECORD THAT DR. KELLER SAW
16 MRS. ANDERSON AFTER YOU SAW HER ON THE 15TH?
17 A. ACCORDING TO THE RECORD, HE SAW HER ON 11/18/95 WHICH
18 WOULD HAVE BEEN THREE DAYS LATER.
19 Q. AND DID HE NOTE HIS FINDINGS, ET CETERA, IN THE SAME
20 RECORD?
21 A. HE DID.
22 (OFF-THE-RECORD DISCUSSION)
23 Q. (BY MS. BARLOW) IF I MAY SHOW YOU -- DO YOU HAVE A
24 DOCUMENT SIMILAR TO THIS WHICH IS ANOTHER REFERRAL? AND I'M
25 SORRY, BUT THIS THING IS COUNTERINTUITIVE ABOUT HOW YOU WANT
1 TO PUT IT ON THERE. FOR THE 18TH OF NOVEMBER? DO YOU
2 HAVE --
3 THE COURT: IS THIS AN EXHIBIT?
4 MS. BARLOW: THIS IS, AGAIN, EXHIBIT DEFENDANT 4,
5 YOUR HONOR.
6 THE COURT: ALL RIGHT.
7 MS. BARLOW: IT'S JUST A -- PAGE 2 IN EXHIBIT 4.
8 A. YES, I HAVE A COPY OF THAT.
9 Q. (BY MS. BARLOW) LET ME PUSH THAT.
10 AND WHAT WAS THE PROBLEM THAT MRS. ANDERSON WAS HAVING
11 THAT DAY?
12 A. ON PATIENT COMPLAINTS AND NURSE'S OBSERVATIONS IT SAYS,
13 FELL ON RIGHT SIDE YESTERDAY AFTERNOON. COMPLAINT OF PAIN
14 RIGHT RIB CAGE AREA TODAY. LORTAB GIVEN AT 12:30. DAUGHTER
15 WISH A CONSULT.
16 Q. WOULD THE NURSING HOME HAVE GIVEN LORTAB TO MRS. ANDERSON
17 IF IT HAD NOT BEEN ORDERED PREVIOUSLY?
18 A. NO.
19 Q. WHAT IS LORTAB?
20 A. LORTAB IS A HYDROCODONE DERIVATIVE. IT IS THE SAME
21 MEDICATION AS VICODIN. IT IS A MORPHINE ANALOG. IT COMES
22 FROM --
23 Q. WHAT DO YOU MEAN BY ANALOG? EXCUSE ME.
24 A. MORPHINE IS A OPIUM DERIVATIVE. IT IS THE STANDARD BY
25 WHICH ALL MEDICATIONS IN THAT CATEGORY ARE -- ARE JUDGED.
1 LORTAB OR HYDROCODONE IS A ORAL FORM THAT HAS MANY OF THE
2 PROPERTIES.
3 Q. IS IT A MORPHINE BASED?
4 A. YES.
5 Q. OKAY. WHERE IS IT, IN COMPARISON, AS FAR AS STRENGTH?
6 CAN YOU INDICATE THAT?
7 A. IN COMPARISON TO WHAT?
8 Q. IN COMPARISON TO MORPHINE.
9 A. ALL OF THESE MEDICATIONS ARE BASED UPON MILLIGRAMS.
10 Q. UH-HUH.
11 A. LORTAB COMES IN 5, 7.5 AND 10.
12 Q. UH-HUH.
13 A. LORTAB IS COMBINED WITH OTHER AGENTS. AND SO THE
14 COMBINATION, YOU KIND OF HAVE TO LOOK AT THE WHOLE PICTURE.
15 BUT TO GIVE YOU SOME IDEA, IF A PERSON WERE TO FALLEN AND
16 TWIST THEIR ANKLE OR -- OR BREAK AN ELBOW OR SUFFER A CAR
17 ACCIDENT OR WHATEVER, SOME TYPE OF INJURY, IT'S NOT UNCOMMON
18 TO GIVE LORTAB, WHICH IS A PAIN PILL.
19 Q. OKAY.
20 A. THERE'S PROBABLY MANY IN THIS GROUP WHO HAVE TAKEN THAT
21 AND IT IS JUST A -- A PAIN PILL THAT WE FREQUENTLY WOULD USE.
22 NOW, A 5 MILLIGRAM IS -- IS NOT AS STRONG AS A 7.5, AND
23 THAT'S NOT AS STRONG AS A 10. BUT THESE ARE ORAL MEDICATIONS
24 THAT CAN BE DOSED EVERY FOUR HOURS. THEY ARE MODERATE, AS
25 FAR AS STRENGTH. THEY'RE -- THEY'RE A MODERATE STRENGTH
1 MEDICATION.
2 Q. THEY ARE A CONTROLLED SUBSTANCE.
3 A. OH, YES.
4 Q. THEY MUST BE ORDERED BY A DOCTOR.
5 A. YES.
6 Q. IT'S NOT LIKE TYLENOL THAT YOU CAN BUY OVER THE COUNTER.
7 A. THAT IS CORRECT.
8 Q. COUNTER. THANK YOU.
9 SO LORTAB HAD BEEN GIVEN, ACCORDING TO THIS DOCUMENT.
10 AND THEN WE HAVE DOWN BELOW THE DOCTOR'S OBSERVATIONS AND
11 FINDINGS. AND WHOSE HANDWRITING IS THAT?
12 A. THAT IS DR. KELLER'S.
13 Q. WHAT -- WHAT DID HE INDICATE HE OBSERVED? WE'LL LET YOU
14 READ IT.
15 A. ON THE DOCTOR'S OBSERVATIONS AND NEW FINDINGS, I BELIEVE
16 THAT SAYS RIGHT CHEST PAIN FROM FALL YESTERDAY. LUNGS CLEAR.
17 X-RAY, WITH A FORWARD ARROW, POSSIBLE LUNG TUMOR.
18 Q. YOU SAID THAT'S PROBABLY RIGHT. THAT'S AN R. WITH A
19 CIRCLE. IS THAT A TYPICAL --
20 A. THAT'S TYPICAL.
21 Q. -- RATHER THAN WRITE THE WORD OUT.
22 SO THE X-RAY SHOWED A POSSIBLE LUNG TUMOR IN HIS POINT
23 OF VIEW; IS THAT CORRECT?
24 A. THAT IS CORRECT.
25 Q. AND THEN WHAT HAD HE INDICATED FOR INSTRUCTIONS?
1 A. CHECK ON RADIOLOGIST REPORT MON., STANDING FOR MONDAY.
2 Q. OKAY. DOES THAT TELL YOU THEN THAT THE RADIOLOGIST
3 REPORT WASN'T DONE YET?
4 A. THAT IS CORRECT.
5 Q. OR AT LEAST HE HADN'T HAD A CHANCE TO CHECK IT?
6 A. IN -- IN OUR CLINIC, AND IN FACT IN BRIGHAM CITY, WE HAVE
7 A RADIOLOGIST WHO REVIEWS ALL OF THE X-RAYS WHICH WE TAKE.
8 IF WE TAKE AN X-RAY, WE HAVE TO MAKE AN INITIAL IMPRESSION
9 BASED UPON WHAT WE SEE. BUT THAT WILL GO TO A RADIOLOGIST
10 FOR CONFIRMATION. HE IS NOT THERE AT -- AT OUR FACILITY.
11 Q. UH-HUH.
12 A. HE IS AT THE HOSPITAL AND SO ALL OF OUR -- OUR CHARTS AS
13 FAR AS THE X-RAYS WILL GO TO HIS OFFICE. HE GIVES US HIS
14 REPORT AND THEN TELLS US WHAT HE READ ON THE X-RAY. AND SO
15 WE WILL FREQUENTLY, AS PHYSICIANS, MAKE AN ASSESSMENT BASED
16 UPON WHAT WE THINK WE SAW AND THEN WE WILL DEFER NOW TO THE
17 SPECIALIST.
18 Q. SO CLEARLY THERE'S AN ABNORMALITY ON THE X-RAY.
19 A. THERE WAS AN ABNORMALITY, ACCORDING TO DR. KELLER, ON THE
20 X-RAY.
21 Q. RADIOLOGISTS HAVE SPECIAL TRAINING FOR ANYTHING IN
22 PARTICULAR?
23 A. A RADIOLOGIST IS AN EXPERT IN RADIOGRAPHIC PROCEDURES,
24 X-RAYS BEING A COMMON TYPE.
25 Q. DO YOUR RECORDS INDICATE THAT --
1 MR. BUGDEN: COUNSEL, PERHAPS YOU WANT TO STOP FOR
2 JUST A SECOND. I'M NOT SURE --
3 THE COURT: IS THERE A PROBLEM, BAILIFF? JUROR
4 NUMBER 18?
5 A JUROR: YES, YOUR HONOR.
6 THE COURT: IS THERE A PROBLEM?
7 A JUROR: I'M SORRY. I JUST WAS THINKING I DIDN'T
8 HEAR HOW MANY MILLIGRAMS OF AMITRIPTYLINE OR ELAVIL WAS GIVEN
9 ON THE 15TH. J
10 THE COURT: WELL, IT MAY NOT BE THAT RELEVANT, BUT
11 AT ANY RATE, LET'S MOVE ON. JJ
12 A JUROR: OKAY.
13 Q. (BY MS. BARLOW) DO YOU HAVE IN YOUR RECORDS OF
14 MRS. ANDERSON'S CARE A COPY OF THE RADIOLOGIST REPORT FROM
15 THE 18TH OF -- OF NOVEMBER, 1995?
16 A. I DO.
17 MS. BARLOW: THIS, AGAIN, IS DEFENDANT'S EXHIBIT 4,
18 YOUR HONOR, PAGE NUMBER 27.
19 Q. (BY MS. BARLOW) I'LL SHOW YOU -- IGNORE THE BOTTOM PART
20 BECAUSE I DON'T KNOW THAT THAT'S RELEVANT TO US RIGHT NOW.
21 DO YOU RECOGNIZE THIS DOCUMENT?
22 A. YES.
23 Q. IS THAT THE DOCUMENT THAT YOU HAVE IN YOUR FILE -- AT
24 LEAST A COPY OF IT?
25 A. YES, IT IS.
1 Q. AND WHAT IS THIS?
2 A. THIS IS THE REPORT -- A DICTATED REPORT THAT WE RECEIVE
3 FROM THE RADIOLOGIST SPECIFIC TO EACH INDIVIDUAL PATIENT WHEN
4 HE REVIEWS OUR X-RAYS.
5 Q. WHO IS THE RADIOLOGIST?
6 A. DR. RICHARD DUNN.
7 Q. I BELIEVE THERE'S SOME INITIALS DOWN AT THE RIGHT, C.R.D.
8 IS THAT DR. DUNN?
9 A. THAT IS CORRECT.
10 Q. OKAY. WHAT DID THE RADIOLOGIST FIND WHEN HE READ THE
11 X-RAY FOR ELLEN ANDERSON ON THE 18TH OF NOVEMBER?
12 A. THAT IS MUCH MORE CLEARER THAN THE DOCTOR'S HANDWRITING.
13 THE FIRST PART IS THE ACTUAL FINDING. THE SECOND PART IS A
14 CONCLUSION, A SUMMARY OR SYNOPSIS OF WHAT -- OF WHAT HE SAW.
15 Q. OKAY. WOULD YOU PLEASE READ THE FINDING FOR US? AND I
16 MAY TOP YOU EVERY ONCE IN A WHILE TO EXPLAIN SOME OF THE
17 TERMS.
18 A. STARTING WITH THE BEGINNING THEN OF THE --
19 Q. YES.
20 A. INCREASING COMPRESSION FRACTURES IN THE LOWER THORACIC
21 SPINE ARE PRESENT WITH AN ACCENTUATED KYPHOTIC CURVE.
22 Q. LET'S STOP THERE. WHAT ARE COMPRESSION FRACTURES?
23 A. COMPRESSION FRACTURES ARE CONDITIONS WHERE THE SPINE
24 ACTUALLY COLLAPSES ONTO ITSELF. SO IF YOU WERE TO TAKE
25 BLOCKS AS THIS AND THEN EXERT SOME OUTSIDE PRESSURE, THEY
1 WOULD TEND TO SQUISH OR COLLAPSE.
2 Q. AND MRS. ANDERSON HAD OSTEOPOROSIS. HOW DOES THAT
3 COMPORT OR -- OR COMPARE WITH THESE COMPRESSION FRACTURES?
4 A. OSTEOPOROSIS IS A CONDITION WITH BONE DENSITY LOSS. IT
5 SUBJECTS THE BONE TO DECREASED CALCIUM OR DECREASED
6 MINERALIZATION WHICH PROMOTES THIS TYPE OF ACTIVITY. SO AS
7 YOU TAKE THE MINERAL OUT OF THE BONE IT BECOMES VERY FRAGILE.
8 A FALL IS -- IS LIKELY TO RESULT IN SOME TYPE OF A FRACTURE.
9 A COMPRESSION FRACTURE CAN OCCUR SPONTANEOUSLY, BUT IT IS A
10 CONDITION WHERE THE SPINE ACTUALLY COLLAPSES DOWN UPON
11 ITSELF.
12 Q. CAN THAT BE PAINFUL?
13 A. IS IT VERY PAINFUL.
14 Q. DID MRS. ANDERSON COMPLAIN OF PAIN FROM THESE COMPRESSION
15 FRACTURES TO YOU?
16 A. MRS. ANDERSON WOULD FREQUENTLY COMPLAIN OF MULTIPLE ACHES
17 AND PAINS.
18 Q. WERE THEY SEVERE PAIN?
19 A. CERTAINLY SEVERE ENOUGH FOR HER TO MENTION THEM. THIS
20 TYPE OF FRACTURE CAN BE VERY, VERY PAINFUL.
21 Q. AND THEN I -- AND THORACIC SPINE, WHAT IS THAT?
22 A. THE SPINE IS DIVIDED INTO THREE CATEGORIES, JUST FOR
23 EASE. THE CERVICAL SPINE INCLUDES THE NECK. THERE ARE
24 ACTUALLY 7 CERVICAL VERTEBRAE, AND THEN THERE ARE 12 THORACIC
25 VERTEBRAE. SO IF YOU START AT THE BASE OF THE SKULL YOU HAVE
1 C 1 THROUGH 7, T 1 THROUGH T 12 WHICH TAKES YOU DOWN JUST
2 ABOVE THE HIPS. THEN THERE ARE 5 LUMBAR VERTEBRAE WHICH ARE
3 THE LOWER BACK, AND THEN THE SACRUM.
4 Q. WHAT -- WHAT'S AN ACCENTUATED KYPHOTICS CURVE?
5 A. KYPHOTASIS (SIC) IS A CONDITION WHERE -- A HUNCHED OVER
6 STATE WHERE -- NOT NECESSARILY HUNCHBACK, BUT THAT MAY GIVE
7 YOU THE IDEA OF WHAT THAT MEANS WHERE THE HEAD IS FORWARD,
8 THE SPINE GOES ALMOST IN A CURVE FROM THE HEAD BACK. IT'S
9 FREQUENTLY SEEN IN ELDERLY PATIENTS WITH THESE TYPES OF
10 PROBLEMS.
11 Q. AND DO YOU RECALL MRS. ANDERSON HAVING SUCH A CURVE?
12 A. YES.
13 Q. IT WAS NOTICEABLE?
14 A. OH, YES.
15 Q. IF YOU'D READ THE NEXT SENTENCE FOR US, PLEASE?
16 A. IN ADDITION, THERE IS INCREASING ATELECTASIS AND/OR
17 PNEUMONIA IN BOTH LUNG BASES, RIGHT GREATER THAN LEFT.
18 Q. WHAT -- WHAT IS ATELECTASIS?
19 A. ATELECTASIS IS A COLLAPSE OF THE LUNG UPON ITSELF AS IT
20 FILLS WITH FLUID OR HAS EXTRA FLUID PRESENT. IT IS THE --
21 THE ACTUAL COMPRESSION OR -- OR INCREASED DENSITY YOU'LL SEE
22 AS THE LUNG FILLS WITH THAT FLUID.
23 Q. WELL, AND THEN WHAT IS PNEUMONIA?
24 A. PNEUMONIA IS AN INFECTION. CAN BE CAUSED BY A VARIETY OF
25 PROBLEMS AND -- AND ORGANISMS, BUT IT IS AN INFECTION IN THE
1 LUNG.
2 Q. HE INDICATED ATELECTASIS AND/OR PNEUMONIA. HOW WOULD YOU
3 BE ABLE TO TELL WHICH IT WAS? DO THEY LOOK THE SAME, I
4 GUESS, ON AN X-RAY?
5 A. THEY CAN LOOK VERY MUCH THE SAME. ATELECTASIS WOULD TEND
6 TO BE BILATERAL; PNEUMONIA WOULD TEND TO BE --
7 Q. BILATERAL MEANING BOTH SIDES?
8 A. BOTH SIDES. PNEUMONIA WOULD TEND TO BE UNILATERAL.
9 THOSE ARE NOT FAST AND SURE, BUT THAT'S TO GIVE YOU AN IDEA.
10 ATELECTASIS IN THE PICTURE -- OF THE WHOLE CLINICAL PICTURE
11 OF -- OF SWELLING AS WE HAD NOTED PREVIOUSLY. THE EDEMA INTO
12 HER LEGS CERTAINLY WOULD -- WOULD TEND TO PROMOTE
13 ATELECTASIS, BUT PNEUMONIA WOULD SOMETIMES GO WITH FEVER.
14 THAT'S HARD TO TELL IN -- IN ELDERLY PATIENT. SOMETIMES THEY
15 DO OR DON'T HAVE FEVERS. ELEVATED LABORATORIES, WHITE BLOOD
16 COUNT, CERTAINLY WOULD GO WITH PNEUMONIA, MORE OFTEN THAN
17 ATELECTASIS. SO YOU -- YOU NEED TO LOOK AT THE WHOLE
18 PICTURE. THIS IS KIND OF THOSE YES, THERE MAY HAVE BEEN ONE;
19 THERE MIGHT HAVE BEEN BOTH.
20 Q. OKAY. YOU -- YOU DID COMPARE -- WELL, AND MAYBE I BETTER
21 ASK IT THIS WAY. ON THE 15TH YOU HAD -- HAD YOU SEEN EDEMA
22 AND YOU HAD HEARD PROBLEMS IN THE HER LUNGS. IS THERE ANY
23 COMPARISON THREE DAYS LATER -- HE HAD INDICATED THE LUNGS
24 WERE CLEAR. HOW -- HOW DOES THAT CORRELATE?
25 A. THE ATELECTASIS IN THIS SETTING WHEN I SAW HER WOULD
1 CERTAINLY NOT BE SURPRISING. THAT WOULD HAVE BEEN A VERY
2 PLAUSIBLE EXPLANATION. IN ALL FAIRNESS, PNEUMONIA COULD ALSO
3 HAVE BEEN PRESENT.
4 Q. UH-HUH.
5 A. ELDERLY PEOPLE DON'T ALWAYS SHOW YOU THE TYPICAL SIGNS
6 OF -- OF FEVER AND -- AND THAT, AND THEY DON'T TEND TO
7 COMPLAIN NEAR AS MUCH. SO IT'S -- IN RETROSPECT, EITHER ONE
8 COULD HAVE BEEN PRESENT.
9 Q. OKAY. LET'S GO AHEAD AND READ -- READ THE REST OF THAT
10 PARAGRAPH, IF YOU WOULD, PLEASE.
11 A. BONY -- IT CONCLUDED WITH RIGHT GREATER THAN LEFT. BONY
12 STRUCTURES ARE OSTEOPOROTIC, AND RIB FRACTURES CERTAINLY
13 CANNOT BE EXCLUDED. THE HEART IS UNCHANGED IN SIZE. THE
14 AORTA IS VERY TORTUOUS.
15 Q. WHAT -- WHAT'S A TORTUOUS AORTA? WHAT IS AN AORTA FIRST?
16 A. THE AORTA IS THE MAJOR BLOOD VESSEL THAT COMES OFF OF THE
17 HEART.
18 Q. WHAT DOES --
19 A. IT SUPPLIES BLOOD TO THE REST OF YOUR BODY.
20 Q. WHAT DOES IT MEAN TO BE TORTUOUS?
21 A. THAT IT TWISTS. THAT IT IS -- I DON'T KNOW HOW I'D
22 EXPLAIN THAT TO YOU. IT'S NOT -- IT'S NOT AS STRAIGHT
23 PERHAPS AS ONE WOULD EXPECT.
24 Q. AND IS THAT LIFE-THREATENING --
25 A. NO.
1 Q. -- PER SE. AND SO HE HAS HIS IMPRESSION. WHY DON'T YOU
2 READ NUMBER 1 FOR US.
3 A. BI-BASILAR ATELECTASIS AND OR PNEUMONIA, RIGHT GREATER
4 THAN THE LEFT.
5 Q. AND YOU'VE EXPLAINED THAT TO US ALREADY, THE ATELECTASIS
6 AND/OR PNEUMONIA?
7 A. YES.
8 Q. AND THEN NUMBER 2?
9 A. INCREASING COMPRESSION FRACTURES IN THE THORACIC SPINE.
10 Q. THANK YOU. IN LOOKING AT YOUR RECORDS, WERE THERE ANY
11 OTHER REFERRALS FROM THE NURSING HOME AFTER THE 18TH OF
12 NOVEMBER, 1995, TO YOUR OFFICE OF MRS. ANDERSON?
13 A. NOT IN THE RECORDS; HOWEVER, I WAS CONTACTED BY THE
14 FAMILY -- AND I DID NOT MAKE A NOTE AT THAT POINT -- WHERE
15 THEY REQUESTED THAT SHE BE TRANSFERRED TO A NEUROPSYCHIATRIC
16 UNIT UNDER THE CARE OF DR. WEITZEL. THEY PRESENTED THAT TO
17 ME, WONDERED IF MAYBE THAT WOULD BE ANOTHER OPTION, IF IT
18 WOULD BE HELPFUL.
19 Q. AND WHAT DID YOU TELL THEM?
20 A. I WAS VERY MUCH IN FAVOR OF THAT. NURSING HOME
21 HABITATION IS -- IS DIFFICULT. IT IS NOT PLEASANT, AND SHE
22 HAD SUFFERED FROM SOME -- SOME PSYCHIATRIC ILLNESSES. AND
23 ANYTHING THAT I COULD OFFER THEM, IF THEY CAME TO ME AND SAID
24 DR. WILDING, DO YOU THINK THAT THIS WOULD BE APPROPRIATE? I
25 AM CERTAINLY IN FAVOR OF THAT.
1 Q. WAS THERE ANYTHING IN ELLEN ANDERSON'S MEDICAL CONDITION
2 THAT YOU THOUGHT MIGHT CAUSE PROBLEMS IF SHE WERE MOVED OR
3 THAT -- THAT YOU THOUGHT WAS IMMEDIATELY LIFE-THREATENING TO
4 HER?
5 A. NO, THERE WAS NOT.
6 Q. THE INDICATION THEN ON THE 18TH OF NOVEMBER IS THAT THERE
7 MIGHT BE SOME PNEUMONIA.
8 A. CORRECT.
9 Q. AND THERE'S OBVIOUSLY FLUID. DID THE LASIX CONTINUE FOR
10 MRS. ANDERSON?
11 A. I DO NOT HAVE ANYTHING TO MAKE ANY DECLARATION ON THAT.
12 CERTAINLY THE NURSING HOME KEEPS VERY ADEQUATE RECORDS OF
13 WHAT MEDICATIONS WERE GIVEN WHEN AND I HAVE NO REASON TO
14 THINK THAT IT WAS NOT GIVEN.
15 Q. YOU DIDN'T CHANGE THE ORDER? YOU DIDN'T RESCIND IT?
16 A. I DIDN'T. I DID NOT CHANGE THE ORDER.
17 Q. THE -- THE POSSIBLE PNEUMONIA, THE ATELECTASIS -- AND/OR
18 ATELECTASIS THAT DR. KELLER SAW ON THE 18TH OF NOVEMBER, IS
19 THERE ANY POSSIBILITY OF THAT KIND OF PNEUMONIA BASICALLY
20 CURING ITSELF WITHOUT ANY INTERVENTION OF ANTIBIOTICS OR THAT
21 SORT OF THING?
22 A. YES, THAT IS POSSIBLE.
23 Q. IS THERE ANY POSSIBILITY OF IT GETTING WORSE OVER TIME?
24 A. YES, THAT IS POSSIBLE.
25 Q. DID YOU RECEIVE ANY NOTE -- NOTIFICATION FROM THE NURSING
1 HOME THAT SHE WAS GETTING WORSE, THAT THE PNEUMONIA WAS
2 GETTING WORSE FROM THE TIME -- FROM THE 18TH OF NOVEMBER
3 UNTIL SHE LEFT THE NURSING HOME?
4 A. NO.
5 Q. WOULD YOU EXPECT THERE TO HAVE BEEN ANY DETERIORATION IN
6 HER CONDITION IF THE PNEUMONIA HAD CONTINUED?
7 A. I THINK WE'RE MAKING THE ASSUMPTION THAT SHE HAD
8 PNEUMONIA AND I -- I DON'T KNOW THAT THAT WAS TRUE. THE FACT
9 THAT SHE ACTUALLY DID STABILIZE WITH THE LASIX AND THE
10 POTASSIUM AND THE -- SOME OF THE CHANGES WE MADE WOULD
11 SUGGEST TO ME THAT SHE MAY NOT HAVE HAD PNEUMONIA AT ALL. SO
12 TO SAY THAT SHE -- SHE DID, I -- I DON'T KNOW THAT WE CAN
13 DETERMINE THAT, BUT CERTAINLY SHE DID NOT SHOW ANY COMPROMISE
14 IN HER HEALTH AFTER THAT POINT.
15 Q. DID YOU HAVE OCCASION TO SEE ANY OF THE ANXIOUSNESS THAT
16 SHE DISPLAYED?
17 A. I DID.
18 Q. CAN YOU DESCRIBE IT FOR THE COURT AND THE JURY?
19 A. MRS. ANDERSON FELT -- SHE WAS QUITE ANXIOUS AND IRRITABLE
20 AND VERY UNCOMFORTABLE IF HER DAUGHTER WERE OUT OF THE ROOM.
21 SHE WOULD CALL OUT FOR HER. SHE HAD DIFFICULTY SLEEPING.
22 SHE'D BEEN ON MEDICATIONS FOR THE ANXIETY AND IT WAS JUST --
23 JUST A STATE OF AGITATION OR -- OR UNEASINESS.
24 Q. YOU HAD WRITTEN ON THE 15TH OF NOVEMBER THAT SHE WAS
25 ALERT AND ORIENTED. WAS SHE ABLE TO CARRY ON A CONVERSATION
1 WITH YOU?
2 A. YES, SHE WAS.
3 Q. WAS SHE ABLE TO EXPRESS TO YOU ANY OF THE MEDICAL
4 CONCERNS OR PROBLEMS SHE HAD?
5 A. SHE WAS ABLE TO TELL US HOW SHE FELT.
6 Q. AND ON THAT DAY DO YOU RECALL HER TELLING YOU ANYTHING
7 ABOUT BEING IN PAIN?
8 A. ACCORDING AGAIN TO THE RECORDS, SHE JUST DIDN'T -- SHE
9 DID NOT FEEL WELL. SHE HAD MULTIPLE ACHES, MULTIPLE PAINS.
10 IN RETROSPECT, THAT WOULD MAKE SENSE WITH THE COMPRESSION
11 FRACTURES IN HER BACK. SHE'D BEEN THROUGH A HIP SURGERY,
12 WHICH IS QUITE A -- A MAJOR SURGERY FOR AN OLDER PATIENT.
13 Q. WAS --
14 A. SO SHE HAD -- I'M SORRY.
15 Q. NO. GO AHEAD.
16 A. SO SHE HAD CERTAINLY -- SHE WAS ABLE TO VOICE THESE
17 THINGS, BUT AS FAR AS HER OVERALL WAS SHE -- WAS SHE
18 COMPLETELY APPROPRIATE AS FAR AS WAS SHE CLEAR AND THAT, SHE
19 WAS CLEAR AS FAR AS WHAT SHE HAD TO SAY. BUT SHE HAD SOME
20 DEMENTIA WHICH IS NOT SURPRISING CONSIDERING HER AGE.
21 MS. BARLOW: IF I MAY HAVE JUST ONE MOMENT, YOUR
22 HONOR.
23 (OFF-THE-RECORD DISCUSSION.)
24 THE COURT: YES?
25 A JUROR: COULD WE HAVE THE LIGHT TURNED OFF HERE?
1 THE COURT: IF THEY'RE THROUGH WITH IT, WE'LL DO
2 THAT.
3 MS. BARLOW: UNFORTUNATELY, I'M NOT QUITE.
4 A JUROR: OKAY.
5 MS. BARLOW: AS SOON AS WE CAN.
6 YOUR HONOR, I'M NOW GOING TO TURN TO THE NURSING HOME
7 RECORDS, 2-A, FOR ELLEN ANDERSON, AND PULL OUT A COUPLE OF
8 DOCUMENTS TO HAVE HIM LOOK AT, IF I MAY.
9 THE COURT: YOU MAY.
10 Q. (BY MS. BARLOW) DR. WILDING -- I DON'T KNOW IF I COULD
11 GET THIS -- THIS IS A DOCUMENT FROM ELLEN ANDERSON'S NURSING
12 HOME RECORDS. IT'S PAGE NUMBER NH 342. I DON'T KNOW THAT
13 YOU WOULD HAVE THAT NECESSARILY BECAUSE IT IS FROM THE
14 NURSING HOME RECORDS. HAVE YOU EVER SEEN A DOCUMENT SUCH AS
15 THIS?
16 A. YES, I HAVE.
17 Q. WHAT IS IT?
18 A. THAT IS AN ORDER SHEET THAT THE NURSING HOME KEEPS AND IT
19 LISTS EVERYTHING FROM DIET TO ALLERGIES TO MEDICATIONS TO
20 PHYSICAL THERAPY. ANY -- ANY ORDERS THAT WE WOULD GIVE TO
21 THE NURSING HOME.
22 Q. AND SO YOU'RE THE ONES WHO ORDERS -- YOU ARE THE ONE, AS
23 HER PHYSICIAN, WHO ORDERED THESE MEDICATIONS FOR ELLEN
24 ANDERSON?
25 A. MYSELF OR ONE OF MY PARTNERS. THERE ARE SIX OF US IN OUR
1 GROUP, AND SINCE WE'RE NEVER ALWAYS THERE, SOMETIMES OTHER
2 PHYSICIANS WILL MAKE ORDERS. BUT THAT IS WHAT THAT IS.
3 Q. THIS IS FOR THE MONTH OF DECEMBER, 1995. THERE ARE SOME
4 DIETS AND THEN THERE'S AMITRIPTYLINE. YOU INDICATED THAT YOU
5 HAD ORDERED AMITRIPTYLINE FOR ELLEN ANDERSON; IS THAT
6 CORRECT?
7 A. THAT IS CORRECT.
8 Q. HOW MUCH DID YOU ORDER FOR HER?
9 A. 50 MILLIGRAMS.
10 Q. AND THAT WAS TO BE GIVEN AT BEDTIME?
11 A. THAT IS CORRECT.
12 Q. THEN UNDERNEATH THAT IS NITROSTAT. AND WHAT IS
13 NITROSTAT?
14 A. NITROSTAT IS A VERY QUICK ACTING NITROGLYCERIN
15 PREPARATION.
16 Q. AND WHAT IS THAT FOR?
17 A. THAT IS FOR HEART PAIN OR ANGINA.
18 Q. IS IT NECESSARILY A HEART ATTACK IF A PERSON HAS ANGINA?
19 A. OH, NO. THIS IS -- THIS IS A QUITE COMMON MEDICATION
20 GIVEN TO RELIEVE HEART PAIN. IT IS FREQUENTLY USED FOR OTHER
21 CONDITIONS, HELPS WITH G.I. PAIN. BUT IT IS -- IT IS
22 ACTUALLY A -- A VERY RAPID ACTING VASODILATOR THAT WILL OPEN
23 UP THE BLOOD VESSELS. PATIENTS TAKE THIS MEDICATION
24 FREQUENTLY.
25 Q. AND UNDERNEATH THAT IS K.C.L. YOU INDICATED THAT'S
1 POTASSIUM CHLORIDE; IS THAT CORRECT?
2 A. THAT'S CORRECT.
3 Q. AND UNDER THAT IS LASIX. IS THAT WHAT YOU ORDERED FOR
4 HER?
5 A. THAT IS CORRECT.
6 Q. AND THEN IT SEEMS THAT THERE'S ANOTHER K.C.L. AND THEN
7 FLUGEN. WHAT IS FLUGEN?
8 A. FLUGEN IS ACTUALLY A FLU SHOT.
9 Q. OKAY. SO THAT COULD BE GIVEN ANNUALLY; ISN'T THAT
10 CORRECT?
11 A. THAT'S CORRECT.
12 Q. AND THEN WHAT'S ANNUAL -- IS THAT P.P.C. OR G.? PER
13 PROTOCOL.
14 A. I'M NOT SURE IF THAT SAYS P.P.O. OR P.P.Q. I CANNOT TELL
15 FROM HERE.
16 Q. IS THAT --
17 A. I'M NOT EVEN SURE WHAT THAT IS.
18 Q. OKAY. THANK YOU. AND THEN CIPRO 250 --
19 A. OH, I'M SORRY. THAT SAYS P.P.D.
20 Q. OH, OKAY.
21 A. THAT'S A T.B. SKIN TEST.
22 Q. OH.
23 A. TUBERCULOSIS SKIN TEST.
24 Q. THANK YOU. THEN THERE'S CIPRO. WHAT IS -- WHAT
25 MEDICATION IS THAT?
1 A. CIPRO IS AN ANTIBIOTIC. CIPROFLOXACIN IS A QUINOLONE.
2 IT'S AN ANTIBIOTIC WE WOULD FREQUENTLY USE FOR LUNG
3 INFECTION, SOMETIMES FOR SKIN INFECTIONS.
4 Q. OKAY. SO SHE DID HAVE A -- WHAT, AN ANTIBIOTIC? IS
5 THAT --
6 A. WELL, IT SAYS CIPRO 250 MILLIGRAMS, P.O -- MEANING BY
7 MOUTH -- FOR 10 DAYS FOR -- U.T.I. IS A URINARY TRACT
8 INFECTION.
9 Q. SO SOMEONE MUST HAVE DECIDED SHE HAD A URINARY TRACT
10 INFECTION?
11 A. YES. FREQUENTLY IF A PATIENT EXHIBITS SOME SIGNS OF
12 URINARY FREQUENCY OR PAIN, THE NURSING HOME WILL UNDER OUR
13 DIRECTION GET A URINE SPECIMEN, SEND IT FOR ANALYSIS, AND
14 CULTURE AND SEE IF THERE IS IN FACT AN INFECTION. BY THAT
15 ONE WOULD IMPLY THAT THAT WAS THE CASE AND SHE RECEIVED THE
16 ANTIBIOTIC.
17 Q. IT WAS GIVEN FOR THE URINARY TRACT INFECTION, BUT IF SHE
18 HAD HAD THE PNEUMONIA, WOULD CIPRO HAVE ADDRESSED THAT
19 CONCERN?
20 A. CIPRO IS A GOOD MEDICINE FOR PNEUMONIA. THAT WOULD NOT
21 NECESSARILY BE THE DOSE THAT WE WOULD TYPICALLY USE FOR
22 PNEUMONIA.
23 Q. OKAY. AND THEN BENADRYL?
24 A. BENADRYL IS A SLEEPING MEDICATION, DIPHENHYDRAMINE. IT
25 IS USED FOR SLEEP. IT IS USED FOR ALLERGIC REACTIONS, BUT IT
1 IS -- IT IS A SEDATING ANTIHISTAMINE. IT'S AVAILABLE
2 OVER-THE-COUNTER.
3 Q. AND IT SAYS P.R.N. WHAT DOES THAT MEAN?
4 A. P.R.N. MEANS AS NEEDED.
5 Q. AND WHO DETERMINES WHETHER IT'S NEEDED?
6 A. THE NURSING STAFF WOULD.
7 Q. AND THAT SAYS RASH, I BELIEVE, SO THAT MUST HAVE BEEN
8 WHAT WAS THE PROBLEM.
9 A. RIGHT. IT'S AN ANTIHISTAMINE.
10 Q. NOW, THERE ARE BOXES OUT TO THE SIDE. WHAT ARE THOSE
11 BOXES OUT TO THE SIDE INDICATIVE OF?
12 A. THOSE -- THOSE SHOULD INDICATE THE DAYS.
13 Q. THE DAYS OF WHAT?
14 A. THE DAYS OF THE MONTH.
15 Q. OKAY. AND SOME OF THEM APPEAR TO BE FILLED OUT ALL THE
16 WAY ACROSS, SOME ONLY HAVE CERTAIN DAYS. WHAT DOES THAT
17 MEAN?
18 A. WELL, THE -- THE DAILY MEDICATIONS -- FOR EXAMPLE, THE
19 LASIX YOU MIGHT SEE OR THE POTASSIUM WAS GIVEN ON AN EVERYDAY
20 BASIS AND THOSE WERE THE TIMES AND PERHAPS EVEN SOME NOTATION
21 ON WHO GAVE THE MEDICATION. BUT THE AS NEEDED ONES WOULD
22 ONLY BE GIVEN AS NEEDED AND THEREFORE THEY WOULDN'T BE FILLED
23 IN IN EVERY BLOCK. BUT WHENEVER A MEDICATION WOULD HAVE BEEN
24 GIVEN, IT SHOULD HAVE BEEN FILLED IN THERE. FOR EXAMPLE, IF
25 YOU LOOK AT THE -- AT THE AMITRIPTYLINE, IT LOOKS LIKE IT WAS
1 GIVEN EVERY NIGHT, BUT IF YOU GO DOWN BELOW THAT TO THE
2 NITROGLYCERIN, THE NITROSTAT, IT LOOKS LIKE IT WAS MAYBE
3 GIVEN ONCE, SO I CAN'T TELL FOR SURE.
4 Q. I CAN'T TELL IF THAT'S A 7. IS THE DATE USUALLY AT THE
5 TOP -- TOP OF THE BOX?
6 A. THAT IS CORRECT.
7 Q. AND THEN THE NEXT PAGE WHICH IS NURSING HOME 343, AMBIEN
8 IS ALSO ORDERED. AND -- AND YOU GAVE THAT ORDER; IS THAT
9 CORRECT?
10 A. THAT IS CORRECT.
11 Q. AND CAN YOU TELL HOW OFTEN IT WAS GIVEN IN THE MONTH OF
12 DECEMBER?
13 A. LOOKS LIKE IT WAS GIVEN TWICE.
14 Q. AND DULCOLAX, WHAT'S THAT?
15 A. DULCOLAX IS A LAXATIVE. HELPS WITH CONSTIPATION.
16 Q. AND THEN ATIVAN, LOOKS LIKE IT WAS NEVER GIVEN IN THAT
17 MONTH. AND THEN IT SAYS LORTAB. LORTAB-5. AGAIN, IT SAYS
18 P.R.N. WHAT --
19 A. AS NEEDED.
20 Q. AND THE FACT THAT IT'S NOT SHOWING THERE MEANS WHAT?
21 A. THAT SHE DIDN'T RECEIVE IT.
22 Q. OKAY. AND THEN BELOW THAT IS TYLENOL -- IS THAT 10
23 GRAMS? OR 10 GR --
24 A. PROBABLY 10 GRAINS.
25 Q. GRAINS. THANK YOU. GRAMS SOUNDS AWFULLY LARGE, DOESN'T
1 IT?
2 HOW OFTEN WAS THAT GIVEN IN THAT MONTH?
3 A. I'M NOT ACTUALLY SURE WHY THAT WAS WRITTEN IN THAT
4 REGARD, BUT THAT WAS JUST AS NEEDED FOR -- FOR ELEVATED
5 TEMPERATURE OR FOR FEVER. IT LOOKS LIKE IT WAS MAYBE GIVEN
6 ONE TIME.
7 MS. BARLOW: MAY I HAVE JUST A MOMENT, YOUR HONOR?
8 THE COURT: YOU MAY, BUT TURN YOUR MACHINE OFF IF
9 YOU'RE FINISHED WITH IT.
10 MS. BARLOW: YES. I THINK I'M THROUGH WITH IT NOW.
11 MR. MAJOR: IF I MIGHT DO THAT, YOUR HONOR?
12 MS. BARLOW: MAYBE IT WOULD BE BETTER FOR YOU TO DO
13 THAT SO I DON'T BREAK IT.
14 THE COURT: MAY NEED IT ON CROSS, SO DON'T PUT IT
15 AWAY, MR. MAJOR.
16 MR. MAJOR: I WON'T PUT IT AWAY, YOUR HONOR. I'M
17 JUST LOWERING THE THING. I DON'T BELIEVE THEY'LL BE USING IT
18 ACTUALLY.
19 MS. BARLOW: THAT'S ALL THE QUESTIONS I HAVE, YOUR
20 HONOR.
21 THE COURT: YOU MAY CROSS-EXAMINE, MR. BUGDEN.
22 CROSS-EXAMINATION
23 BY MR. BUGDEN:
24 Q. DR. WILDING, MY NAME IS WALLY BUGDEN. HOW DO YOU DO?
25 A. VERY GOOD, SIR, THANK YOU.
1 Q. I'M GOING TO GIVE YOU SOME DOCUMENTS BECAUSE IT'S NOT
2 ALWAYS EASY TO SEE THE SCREEN.
3 A. THANK YOU.
4 Q. SO I'M GOING TO GIVE YOU A STACK OF DOCUMENTS THAT WE'RE
5 GOING TO PROBABLY TALK ABOUT. I THINK IT PROBABLY WOULD BE
6 BEST IF I DID HAVE YOU TURN THE LIGHTS OFF.
7 NOW, DOCTOR, AS I UNDERSTAND IT, MRS. ANDERSON WAS YOUR
8 PATIENT FOR SEVERAL YEARS; IS THAT RIGHT?
9 A. YES.
10 MR. BUGDEN: YOUR HONOR, I'M GOING TO BE REFERRING
11 TO A NUMBER OF DOCUMENTS THAT NOW HAVE BEEN RECEIVED UNDER
12 THE EXHIBIT NUMBER D-4.
13 THE COURT: THANK YOU.
14 MR. BUGDEN: AND THEN COUNSEL, I'M REALLY JUST GOING
15 TO GO IN THE ORDER I'VE GIVEN YOU.
16 Q. (BY MR. BUGDEN) SO SHE WAS YOUR PATIENT DATING BACK TO
17 MARCH OF 1994; IS THAT RIGHT?
18 A. THAT IS CORRECT.
19 THE COURT: JUST A MOMENT, MR. BUGDEN?
20 CAN YOU SEE THAT, LADIES AND GENTLEMEN OF THE JURY?
21 EVERYBODY SEE IT OKAY?
22 A. PERHAPS A CORRECTION ON THAT, SIR. IT LOOKS LIKE
23 FEBRUARY MAY HAVE BEEN THE BETTER DATE.
24 Q. (BY MR. BUGDEN) OF '93.
25 A. ACCORDING TO THE RECORDS YOU GAVE ME, FEBRUARY 18TH, '94
1 IS THE FIRST NOTE THAT YOU GAVE ME.
2 Q. HOLD ON FOR JUST A SECOND HERE. LET'S SEE WHAT WE'RE
3 DOING.
4 MR. BUGDEN: MAY I APPROACH THE WITNESS WHILE
5 THEY'RE DOING WHAT THEY'RE DOING? MAY I LOOK AT WHAT I GAVE
6 THE DOCTOR?
7 (OFF-THE-RECORD DISCUSSION.)
8 MS. ISAACSON: YOUR HONOR, WE HAVE A PROJECTOR
9 THAT'S BEING SUBSTITUTED FROM THE ONE THAT WAS USED YESTERDAY
10 THAT'S OWNED BY THE STATE, SO WE'RE JUST HAVING A LITTLE
11 DIFFICULTY WITH IT. THE OLD ONE WILL BE BACK TOMORROW.
12 MR. BUGDEN: PERHAPS WE NEED TO ASK THE COURT, YOUR
13 HONOR, FOR A BRIEF BREAK SO THAT WE CAN HAVE OUR AUDIO-VISUAL
14 EXPERTS TRY TO MAKE THIS WORK.
15 THE COURT: PERHAPS WE OUGHT TO HAVE COUNSEL GET
16 THEIR EQUIPMENT GOING SO WE DON'T WASTE TIME.
17 MR. BUGDEN: WELL, WE HAD IT GOING, YOUR HONOR.
18 THE COURT: I REALIZE THAT.
19 WE'LL TAKE A 10-MINUTE RECESS, LADIES AND GENTLEMEN.
20 YOU MAY STEP DOWN.
21 (RECESS TAKEN)
22 THE COURT: WE ARE BACK IN SESSION. PARTIES AND
23 COUNSEL ARE PRESENT. THE JURY IS PRESENT. DR. WILDING IS ON
24 THE STAND.
25 AND, DOCTOR, I REMIND YOU THAT YOU'RE STILL UNDER OATH.
1 THE WITNESS: OKAY.
2 THE COURT: YOU MAY PROCEED, MR. BUGDEN.
3 Q. (BY MR. BUGDEN) SO, DOCTOR, I'LL JUST REPEAT -- FIRST,
4 I'M SORRY ABOUT THE TECHNOLOGICAL GLITCH.
5 YOU'RE GOING TO HAVE PAGES THAT I'M GOING TO ASK YOU
6 SOME QUESTIONS ABOUT AND THEN MY PARTNER IS GOING TO HELP ME
7 OUT AND WE'RE GOING TO USE THIS OTHER DEVICE. AND THE SCREEN
8 WILL MOSTLY BE FOR THE JURY, ALTHOUGH YOU'RE WELCOME TO TRY
9 TO READ THAT WAY AS WELL.
10 SO LET'S BEGIN THEN, IF I CAN, WITH THE FIRST PAGE I'VE
11 GIVEN YOU. YOU'VE EXPLAINED TO THE JURY THAT YOU'VE GOT
12 PARTNERS OR OTHER PEOPLE IN YOUR -- IN YOUR OFFICE THAT WILL
13 SEE THE SAME PATIENTS; IS THAT RIGHT?
14 A. THAT'S CORRECT.
15 Q. SO, FOR EXAMPLE, YOU SAW MRS. ANDERSON, DR. KELLER SAW
16 HER, AND THEN THERE'S ALSO A BEGINNING ENTRY HERE --
17 MR. BUGDEN: AND, YOUR HONOR, I'VE PREVIOUSLY
18 INDICATED THIS IS D-4 AND IT'S WILDING PAGE 3.
19 Q. (BY MR. BUGDEN) ON 3-27 OF 1993 ANOTHER PHYSICIAN IN
20 YOUR OFFICE TREATED MRS. ANDERSON; IS THAT RIGHT?
21 A. THAT IS CORRECT.
22 Q. AND AT THAT TIME, SHE WAS COMPLAINING OF OR PRESENTING
23 WITH A COUGH, BUT ALSO BACK PAIN; IS THAT RIGHT?
24 A. YES.
25 Q. AND THEN ON APRIL -- APRIL 9TH OF 1993, SHE WAS STILL
1 COUGHING AND SHE STILL HAD BACK PAIN; IS THAT RIGHT?
2 A. YES.
3 Q. AND YOU'VE TOLD US, DOCTOR, THAT MRS. ANDERSON HAD
4 OSTEOPOROSIS, AND THAT WAS SECONDARY TO OR RELATED TO THIS
5 VERTEBRAL COLLAPSE THAT YOU TOLD US ABOUT?
6 A. THE VERTEBRAL COLLAPSE WOULD HAVE BEEN SECONDARY TO THE
7 OSTEOPOROSIS.
8 Q. I SAID IT THE WRONG WAY. THANK YOU.
9 AND THE VERTEBRAL COLLAPSE, THAT IS A CONDITION THAT IS
10 A PAINFUL CONDITION?
11 A. YES, IT CAN BE.
12 Q. AND IT APPEARS THAT UNDER THIS APRIL 9TH ENTRY THAT THE
13 PATIENT WAS ON DARVOCET; IS THAT RIGHT?
14 A. YES.
15 Q. AND THAT'S -- THAT'S A PAIN MEDICATION; IS THAT RIGHT?
16 A. THAT IS.
17 Q. AND SO THAT WAS TO DEAL WITH THE BACK PAIN?
18 A. YES.
19 Q. OR THE OSTEOPOROSIS?
20 A. YES.
21 Q. AND THEN IF I CAN, LET'S SEE, MOVE FORWARD TO WILDING
22 PAGE 22? AND YOU'LL HAVE TO MOVE, DOCTOR. I'M GOING TO
23 APPROACH THE WITNESS? DO I --
24 MR. BUGDEN: IS THAT ALL RIGHT, JUDGE?
25 THE COURT: SURE.
1 Q. (BY MR. BUGDEN) WHAT I'M GOING TO ASK YOU TO DO, SO THAT
2 YOU CAN SEE WHAT I'M DOING, DOCTOR, THERE WILL BE NUMBERS
3 LIKE THAT, AND THEN THAT WILL HELP.
4 A. THANK YOU.
5 Q. IS THAT ALL RIGHT?
6 A. THAT IS CORRECT. THAT WILL BE FINE.
7 Q. I'M JUST TRYING TO --
8 A. THAT'S FINE.
9 Q. -- MAKE SURE THAT WE'RE BOTH ABLE TO COMMUNICATE ABOUT
10 PAGINATION.
11 THEN BY JUNE OF 1995, YOU HAD AN X-RAY REPORT IN YOUR
12 OFFICE; IS THAT RIGHT?
13 A. THAT'S CORRECT.
14 Q. AND I GUESS IT'S AT THAT TIME THAT SHE -- YOU WERE AWARE
15 THAT SHE HAD A DISPLACED FRACTURE OF THE RIGHT FEMORAL NECK
16 OF HER HIP; IS THAT RIGHT?
17 A. SHE WAS ACTUALLY IN THE CARE OF DR. JOHN MARKESON WHO'S A
18 COLLEAGUE OF MINE IN OUR CLINIC.
19 Q. OKAY.
20 A. HE WAS THE ONE THAT FOUND THIS.
21 Q. OKAY.
22 A. BUT THAT IS THE REPORT.
23 Q. AND THEN -- AND WHAT WE'RE LOOKING AT IS THE RADIOLOGIST
24 OR THE X-RAY REPORT; IS THAT RIGHT?
25 A. YES.
1 Q. AND IT ALSO INDICATES, AGAIN, AS WE'VE TALKED ABOUT THAT
2 SHE HAD SEVERE DEGENERATIVE DISK DISEASE, ASSOCIATED WITH
3 DEGENERATIVE OSTEOARTHRITIS; IS THAT RIGHT?
4 A. YES.
5 Q. AND IS THAT THE SAME AS OSTEOPOROSIS?
6 A. IT IS NOT.
7 Q. THAT'S A DIFFERENT CONDITION?
8 A. OSTEOARTHRITIS IS MORE COMMONLY TERMED THE NORMAL
9 ARTHRITIS THAT ONE MIGHT HAVE AS THEY AGE. 0STEOPOROSIS IS
10 ACTUALLY A DEMINERALIZATION OF THE BONE WHERE THE BONES
11 BECOME BRITTLE. ARTHRITIS IS IN YOUR JOINTS. YOU MAY NOT
12 FEEL WELL, BE STIFF. THAT WOULD BE ARTHRITIS. OSTEOPOROSIS
13 IS ACTUALLY BONE LOSS.
14 Q. AND THEN UNDER THIS IMPRESSION, TOO, IT ALSO TALKS ABOUT
15 THE OSTEOPOROTIC SPINE WITH, AGAIN, THESE COMPRESSION
16 FRACTURES?
17 A. CORRECT.
18 Q. OKAY. AND, AGAIN, THAT -- THAT'S -- THE COMPRESSION
19 FRACTURES ARE THE SITUATION THAT CAN BE PAINFUL FOR THE
20 PATIENT?
21 A. YES.
22 Q. THEN ON JUNE 19TH, 1995 -- AND I GUESS THAT'S WHEN IT WAS
23 DETERMINED THAT SHE DID HAVE THIS FRACTURED HIP; IS THAT
24 RIGHT?
25 A. THAT IS CORRECT.
1 Q. OKAY. AND THEN SHE WAS REFERRED TO A SURGEON, AND
2 ULTIMATELY SHE HAD THE HIP SURGERY?
3 A. YES.
4 Q. HIP REPLACEMENT?
5 A. YES.
6 Q. THAT'S A SERIOUS CONDITION FOR SOMEONE THIS OLD, ISN'T
7 IT?
8 A. IT'S VERY SERIOUS.
9 Q. BUT I GUESS THE OPTIONS FOR THE -- MRS. ANDERSON AND HER
10 FAMILY WERE THAT EITHER SHE HAD THE SURGERY OR SHE REALLY
11 WOULD BE SUBJECTED TO A LOT OF PAIN.
12 A. THAT IS CORRECT.
13 Q. AND NOT ABLE TO AMBULATE, NOT ABLE TO MOVE AROUND AT ALL.
14 A. THAT IS CORRECT.
15 Q. OKAY. NOW, IF I CAN ASK YOU TO TURN TO WILDING 4, AND IT
16 MAY ALSO HAVE IN THE RIGHT LOWER CORNER, DOCTOR, A NUMBER 8.
17 THE COURT: WOULD THIS BE DEFENDANT'S 4 THAT WE'RE
18 STILL LOOKING AT?
19 MR. BUGDEN: I'LL TELL YOU WHEN I CHANGE, YES, SIR.
20 THE COURT: ALL RIGHT.
21 MR. BUGDEN: BUT I'M STILL ON, JUDGE, FOR ALL OF
22 THESE QUESTIONS AND FOR THE NEXT FEW QUESTIONS I'LL BE
23 DEALING WITH DEFENDANT'S EXHIBIT 4 AND DIFFERENT PAGES OF
24 THAT EXHIBIT.
25 THE COURT: AND THIS IS PAGE 4 THIS TIME?
1 MR. BUGDEN: WELL, ACTUALLY -- YES, SIR.
2 THE COURT: OKAY. THANK YOU.
3 MR. BUGDEN: THANK YOU, JUDGE.
4 Q. (BY MR. BUGDEN) WHAT I WANT TO ASK YOU ABOUT IF YOU CAN
5 REMEMBER, THERE'S AN ENTRY BETWEEN JUNE AND JULY, AND IT'S IN
6 MARCH OF 1995. DO YOU SEE THAT, DOCTOR?
7 A. I DO.
8 Q. AND APPARENTLY SHE WAS IN THE NURSING HOME, SHE WAS
9 DEPRESSED, THERE WAS A LONG DISCUSSION WITH THE DAUGHTER.
10 WAS THAT WITH YOU OR WAS THAT WITH DR. KELLER?
11 A. THAT'S WITH DR. JOHN MARKESON, THE INITIALS OFF TO THE
12 RIGHT AT THE BOTTOM.
13 Q. OKAY.
14 A. THE J.M. THE BIG INITIALS ARE THE DOCTOR; THE LITTLE
15 INITIALS ARE THE TRANSCRIPTIONIST.
16 Q. OH, I SEE. THANK YOU VERY MUCH.
17 SO YOU WOULDN'T KNOW WHAT THAT CONVERSATION WAS ABOUT?
18 A. I WOULD NOT.
19 Q. BUT AT LEAST ACCORDING TO THE CHART NOTE, MRS. ANDERSON
20 WAS DEPRESSED; IS THAT RIGHT?
21 A. THAT IS CORRECT.
22 Q. AND SO APPARENTLY THE DECISION WAS MADE TO PUT HER ON
23 ZOLOFT?
24 A. YES.
25 Q. AND THAT'S AN ANTIDEPRESSANT; IS THAT RIGHT?
1 A. THAT IS CORRECT.
2 Q. AND THEN ON 7-27, THIS IS THE SAME PAGE, THEN THERE WAS A
3 FOLLOW-UP EXAMINATION?
4 A. THAT WAS WITH ME.
5 Q. AND THEN THAT WAS WITH YOU. AND IF YOU TURN TO PAGE -- A
6 COUPLE OF PAGES MORE, DOCTOR, PAGE 10 IN THE BOTTOM. IT'S
7 JUST A BLOW-UP. IT'S EASIER I THINK TO SEE.
8 A. CORRECT.
9 Q. BUT APPARENTLY AT THAT TIME, DOCTOR, HER COGNITIVE
10 FUNCTIONING HAD DIMINISHED; IS THAT RIGHT?
11 A. YES.
12 Q. AND VARIOUS OPTIONS WERE DISCUSSED WITH THE FAMILY? IS
13 THAT ALSO RIGHT?
14 A. THAT IS CORRECT.
15 Q. AND AT THAT TIME, COMFORT CARE MEASURES WERE DECIDED ON
16 OR WERE TO BE EMPLOYED; IS THAT RIGHT?
17 A. CORRECT.
18 Q. AND BY THAT, COMFORT CARE MEASURES, DID -- DID THAT MEAN
19 THAT YOU AND THE FAMILY WERE CONCERNED ABOUT HER HEALTH
20 CONDITION?
21 A. YES.
22 Q. AND BY COMFORT CARE MEASURES, DOES THAT MEAN THAT A
23 DECISION WAS MADE AT THAT TIME IN DISCUSSION WITH THE FAMILY
24 ABOUT WHAT SORT OF MEDICAL INTERVENTIONS WOULD BE
25 APPROPRIATE?
1 A. CORRECT.
2 Q. AND THE PHRASE COMFORT CARE MEASURES, DOES THAT MEAN THAT
3 A DECISION WAS MADE AT THAT TIME, DOCTOR, WITH THE FAMILY,
4 THAT NO EXTRAORDINARY MEASURES WOULD BE TAKEN?
5 A. YES.
6 Q. TO KEEP MRS. ANDERSON ALIVE?
7 A. YES.
8 Q. SO, AGAIN, OBVIOUSLY BY -- BY THE END OF JULY, AFTER THE
9 HIP SURGERY, HER COGNITIVE FUNCTIONING HAD DIMINISHED AND YOU
10 DISCUSSED WITH THE FAMILY VARIOUS OPTIONS. AND AT THAT TIME
11 THE FAMILY MEMBERS DECIDED THAT IF ANYTHING -- ANY MEDICAL
12 PROBLEM AROSE, THAT THEY WERE NOT GOING TO TREAT THE MEDICAL
13 PROBLEM.
14 A. NOT EXACTLY. THIS WOULD BE MORE OF WHAT IF SHE HAD A
15 HEART ATTACK, WHAT IF SHE HAD SOME -- SOME DRASTIC MEDICAL
16 CONDITION, A STROKE, YOU KNOW, WOULD WE BE -- WOULD WE EMPLOY
17 ANY HEROIC MEASURES TO TRY TO SAVE HER.
18 Q. OKAY. THAT'S HELPFUL.
19 A. NOW, THAT DOES NOT MEAN WE WITHDRAW CARE. THAT JUST
20 MEANS THAT WE WON'T DO THE EXTRAORDINARY TRYING TO SAVE HER.
21 THAT'S WHAT THAT MEANS.
22 Q. AND IF THAT KIND OF A MEDICAL EMERGENCY AROSE, THEN THE
23 FAMILY WAS COMMUNICATING TO YOU AS THE FAMILY DOCTOR, THAT
24 WHAT WE WANT IS TO KEEP HER COMFORTABLE.
25 A. CORRECT.
1 Q. OKAY. THANK YOU.
2 THEN ABOUT A MONTH LATER ON AUGUST 23RD, 1995 -- AND I
3 THINK IT'S JUST THE NEXT PAGE, DOCTOR.
4 MR. BUGDEN: AND, JUDGE, I'M NOW GOING TO ASK FOR
5 THE INTRODUCTION OF EXHIBIT 2-A, WHICH ARE THE NURSING HOME
6 RECORDS OF ELLEN ANDERSON. AND THIS IS PLAINTIFF'S.
7 THE COURT: PREVIOUSLY BEEN REFERRED TO. ANY
8 OBJECTION?
9 MS. BARLOW: NO OBJECTION, YOUR HONOR.
10 THE COURT: EXHIBIT 2-A IS RECEIVED.
11 MR. BUGDEN: THANK YOU, JUDGE.
12 THE COURT: THAT IS THE PLAINTIFF'S EXHIBIT 2-A.
13 Q. (BY MR. BUGDEN) NOW, APPARENTLY ON THAT DATE A REFERRAL
14 WAS MADE FOR A GERIATRIC CONSULTATION WITH A DR. BRUCE
15 HARROW; IS THAT RIGHT?
16 A. I DON'T KNOW IF IT WAS DR. BRUCE HARROW. I SEE THAT
17 THERE WAS A GERIATRIC CONSULT REQUESTED, BUT --
18 Q. OKAY.
19 A. I -- I'M NOT SURE OF ANYMORE THAN THAT.
20 Q. HELP ME TO UNDERSTAND THIS -- THIS NOTE THEN. OF COURSE
21 AS YOU CAN SEE ON THE TOP IT HAS YOUR NAME, DOCTOR -- WELL,
22 THE JURY CAN'T SEE THAT. BUT ON THE PREVIOUS PAGE THAT YOU
23 WERE LOOKING AT, PAGE 11, HAS YOUR NAME ON THE TOP OF IT.
24 PHYSICIAN'S NAME, DR. WILDING.
25 A. RIGHT.
1 Q. AND THEN THERE'S THIS GERIATRIC MEDICINE CONSULT.
2 A. CORRECT.
3 Q. SO DOES THAT MEAN THAT YOU REFERRED THE PATIENT?
4 A. IT COULD HAVE DONE. I DON'T RECALL THAT THAT HAPPENED.
5 THE FAMILY VERY WELL COULD HAVE REQUESTED THAT WE HAVE A
6 CONSULTATION. AND, AGAIN, I'M NOT -- I WOULD NOT BE OPPOSED
7 TO ANYTHING OF THAT NATURE TO HELP OUT.
8 Q. THEN AT LEAST WHAT THIS -- THIS NOTE FROM THE NURSING
9 HOME INDICATES IS THAT THE 91-YEAR-OLD WHITE FEMALE -- IS
10 THAT WHAT THAT STANDS FOR?
11 A. THAT IS CORRECT.
12 Q. WAS ADMITTED FROM HER HOME. SO NOW SHE'S BEEN ADMITTED
13 TO PIONEER -- TO A NURSING HOME?
14 A. CORRECT.
15 Q. ON 8-7-95, CAREGIVER BURNOUT SECONDARY TO ANXIETY. AM I
16 READING THAT RIGHT?
17 A. THAT IS CORRECT.
18 Q. AND ON THE SAME PAGE YOU'RE LOOKING AT, DOCTOR, DOES IT
19 ALSO INDICATE -- WELL, ACTUALLY IF I COULD ASK YOU TO TURN TO
20 PAGE 13 OF THE PAGES THAT YOU HAVE. LOOKS LIKE SHE WAS
21 STARTED ON AMBIEN. DO YOU SEE THAT, DOCTOR?
22 A. I SEE WHERE IT SAYS MEDS, AND THEN IT SAYS AMBIEN, YES.
23 Q. FIVE TO 15 MILLIGRAMS; IS THAT RIGHT?
24 A. THAT'S WHAT IT SAYS.
25 Q. AND THEN THE H.S., WOULD THAT BE AT BEDTIME?
1 A. YES.
2 Q. AND 5 TO 15, WOULD THAT BE CONSIDERED A LARGE DOSE,
3 DOCTOR?
4 A. THE 5 WOULDN'T.
5 Q. HOW ABOUT THE 15?
6 A. THE 15 WOULD BE A LARGE DOSE.
7 Q. AND WOULD THAT BE STARTER -- LARGER THAN A SUGGESTED
8 GERIATRIC STARTING DOSE, DOCTOR?
9 A. YES, THAT WOULD BE.
10 Q. THE GERIATRIC DOSING GUIDELINES, THEY ARE JUST A
11 SUGGESTION --
12 A. THAT'S CORRECT.
13 Q. -- IS THAT RIGHT.
14 AND THEN IF I CAN ASK YOU TO TURN TO THE NEXT PAGE WHICH
15 I THINK IS 14. NOW, THERE'S A SECTION ON THAT PAGE, DOCTOR,
16 THAT SAYS ANXIETY, TOWARDS THE BOTTOM?
17 A. YES.
18 Q. AND R/O -- THERE'S R SLASH O. DOES -- DOES THAT STAND
19 FOR RULE OUT?
20 A. YES.
21 Q. AND SO AT THAT TIME THE ATTEMPT IS GOING TO BE MADE TO
22 RULE OUT PAIN; IS THAT RIGHT?
23 A. YES.
24 Q. RULE OUT A PAIN-RELATED DIAGNOSIS?
25 A. YES.
1 Q. OKAY. AND THEN IT SAYS E.S.R. WHAT IS THAT?
2 A. THAT'S A SEDIMENTATION RATE.
3 Q. OKAY.
4 A. IT -- IT IS A TEST -- IT'S A VERY NONSPECIFIC TEST THAT
5 WE'LL SOMETIME USE IN MEDICATION -- I'M SORRY, IN MEDICINE
6 WHERE IT DOESN'T NECESSARILY TELL US WHAT'S WRONG, BUT IT
7 WILL FREQUENTLY TELL US IF SOMETHING IS WRONG. SO AN
8 ELEVATED SEDIMENTATION RATE WILL BE SEEN IN CONDITIONS -- ANY
9 VARIETY OF CONDITIONS, BUT SPECIFICALLY BAD THINGS LIKE
10 CANCER, SEVERE RHEUMATOID ARTHRITIS, LUPUS. SOME OF THESE
11 VERY DEBILITATING ILLNESSES WILL HAVE AN ELEVATED
12 SEDIMENTATION RATE.
13 SO IT ISN'T SPECIFIC FOR ANYTHING, BUT IT'S KIND OF A
14 GENERAL -- IF YOU HAVE A NORMAL SED RATE, YOU HAVE A -- AT
15 LEAST SOME LEVEL OF COMFORT THAT THINGS ARE NOT GOING BAD.
16 Q. OKAY. AND THEN IT ALSO INDICATES THAT A SPINE X-RAY
17 WOULD BE DONE?
18 A. YES.
19 Q. AGAIN, AND THAT WAS ALL FOR THE PURPOSE OF TRYING TO RULE
20 OUT PAIN-RELATED -- OR A PAIN-RELATED DIAGNOSIS?
21 A. RIGHT. THESE -- I BELIEVE WHAT YOU'RE REFERRING TO,
22 THESE ARE ALL FROM A NOTE THAT WAS WRITTEN BY A -- A PERSON,
23 THIS CONSULT PERHAPS. AND SO THESE WERE THEIR
24 RECOMMENDATIONS.
25 Q. OKAY. AND THEN LET ME ASK YOU TO TURN FOR A MOMENT TO I
1 THINK IT'S PAGE 16. YOU MIGHT HAVE TO GO A LITTLE BIT OUT OF
2 ORDER. NOW, THIS IS A RADIOLOGY REPORT THAT CAME BACK,
3 DOCTOR?
4 A. YES.
5 Q. AND WOULD THIS HAVE BEEN SOMETHING THAT YOU WOULD HAVE
6 BEEN -- YOU WOULD HAVE REVIEWED?
7 A. YES.
8 Q. SO THE EXAM DATE WAS DONE AUGUST 24, 1995?
9 A. THAT'S CORRECT.
10 Q. AND IN RELATIONSHIP TO THE THORACIC SPINE, DO YOU SEE
11 THAT SECTION UNDER --
12 A. ON NUMBER 2?
13 Q. YES.
14 A. YES.
15 Q. WELL, THERE'S A HEADING THAT'S UNDERLINED THORACIC SPINE.
16 A. UNDER -- OH, YES, I SEE THAT.
17 Q. AND THE LAST SENTENCE READS THIS MAY OR MAY NOT -- I'M
18 SORRY, THE LAST SENTENCE READS, POSTERIOR ALIGNMENT ON THE
19 LATERAL VIEW APPEARS MAINTAINED WITHOUT DEFINITE SUBLUX --
20 SUBLUXATIONS OR BONY FRAGMENTS POSTERIORLY.
21 WHAT DOES THAT MEAN? CAN YOU PUT THAT IN ENGLISH -- OR
22 DIFFERENT LANGUAGE? WHAT -- WHAT ABOUT THE BONY FRAGMENTS
23 THAT ARE PROTRUDING POSTERIORLY? WHAT IS THAT?
24 A. WELL, WHAT IT -- WHAT IT SAYS IS THAT -- IT WENT THROUGH
25 AND IT TALKS ABOUT THE THORACIC SPINE. AND IT TALKS ABOUT
1 THE COMPRESSION FRACTURES AND SO ON. AND THEN IT SAYS THE
2 ALIGNMENT STILL APPEARS TO BE MAINTAINED WITHOUT ANY EVIDENCE
3 OF BONY FRAGMENTS OR OTHER PROBLEMS.
4 SO -- SO THE COMPRESSION FRACTURE IS THERE. THE
5 ALIGNMENT IS STABLE. AND THEN HE PUTS IN THIS POINT, WITHOUT
6 DEFINITE SUBLUXATION OR BONY FRAGMENTS PROTRUDING. SO HE SAW
7 NONE OF THAT.
8 Q. OKAY.
9 A. SO HE WAS TRYING TO SAY, BASED UPON WHAT WE SEE, THE
10 ALIGNMENT IS STABLE, EVERYTHING ELSE LOOKS OKAY.
11 Q. AND THEN UNDER IMPRESSION, NUMBER 1, THIS SAME DIAGNOSIS
12 THAT WE'VE HEARD BEFORE, ADVANCED OSTEOPOROTIC CHANGES OF THE
13 LUMBAR SPINE WITH MULTILEVEL DISK DEGENERATION AND MILD
14 COMPRESSION WEDGING.
15 AGAIN, THIS IS JUST THE OSTEOPOROTIC CONDITION OF THE
16 SPINE?
17 A. THE COMPRESSION FRACTURES.
18 Q. THE COMPRESSION FRACTURES.
19 AND THEN NUMBER 2 IS TALKING ABOUT -- I GUESS THAT'S
20 STILL TALKING ABOUT THE COMPRESSION FRACTURES?
21 A. YES.
22 Q. OKAY. THEN IF I CAN ASK YOU TO TURN TO PAGE 18. ARE YOU
23 THERE, DOCTOR?
24 A. YES, I AM.
25 Q. THIS DOCUMENT -- AND WE MAY HAVE -- THE STATE MAY HAVE
1 ASKED YOU ABOUT IT BEFORE, BUT THESE ARE THE PHYSICIAN'S
2 ORDERS. THESE ARE THE ORDERS THAT YOU AND YOUR PARTNERS
3 WOULD HAVE GIVEN FOR MEDICATION FOR THIS PATIENT?
4 A. YES.
5 Q. SO UP ON 8-7 OF '95 -- IT'S GOING TO BE HARD FOR THE JURY
6 TO SEE THIS -- BUT IT -- IT READS DEMENTIA WITH ANXIOUS
7 FEATURES?
8 A. YES.
9 Q. OKAY. AND THEN ON 8-28 OF '95, ATIVAN WAS PRESCRIBED
10 1 MILLIGRAM EVERY SIX HOURS, P.R.N. FOR ANXIETY; IS THAT
11 RIGHT?
12 A. YES.
13 Q. SO THE P.R.N., AS YOU TOLD US, MEANS AS NEEDED?
14 A. CORRECT.
15 Q. AND THEN IT ALSO SAYS ON THAT SAME DAY, LORTAB, ONE TAB
16 EVERY FOUR TO SIX HOURS, P.R.N. FOR PAIN.
17 A. YES.
18 Q. AND CAN YOU TELL -- ARE YOU -- WOULD YOU HAVE BEEN THE
19 PHYSICIAN THAT WOULD HAVE REQUESTED OR ORDERED THAT LORTAB
20 FOR THE PAIN? OR MIGHT -- MIGHT IT HAVE BEEN A PARTNER?
21 A. IT COULD HAVE BEEN. I -- I DO NOT KNOW. I WOULD HAVE TO
22 GO BACK AND LOOK.
23 Q. BUT IN ANY EVENT, ONE OF THE PHYSICIANS WHO WAS TREATING
24 MRS. ANDERSON CONCLUDED --
25 A. CORRECT.
1 Q. -- THAT LORTAB SHOULD BE PROVIDED ON AN AS-NEEDED
2 BASIS --
3 A. THAT IS CORRECT.
4 Q. -- FOR THIS PATIENT. AND THE LORTAB, I GUESS, AS YOU'VE
5 EXPLAINED IT TO US, THAT IS AN OPIATE; IS THAT RIGHT?
6 A. THAT IS CORRECT.
7 Q. AND 4 MILLIGRAMS -- LET'S SEE, WHAT'S -- WHAT'S THE
8 AMOUNT THAT'S ORDERED?
9 A. IT SAYS LORTAB-5.
10 Q. OKAY. AND THE -- IF THE STARTING DOSE FOR LORTAB FOR A
11 GERIATRIC PATIENT WAS 2 MILLIGRAMS, AGAIN, WOULD -- WOULD
12 THIS BE A SITUATION WHERE THE STARTING DOSAGES IN A -- IN A
13 GERIATRIC DOSING HANDBOOK, THEY'RE A GUIDELINE, THEY'RE A
14 SUGGESTION?
15 A. I'M SORRY, I DON'T UNDERSTAND YOUR QUESTION.
16 Q. WHAT'S THE -- THE DOSAGE THAT YOU WERE RECOMMENDING WAS 4
17 MILLIGRAMS?
18 A. IT SAYS LORTAB-5.
19 Q. OR 5 MILLIGRAMS?
20 A. THAT IS THE LOWEST LORTAB DOSE THAT'S AVAILABLE.
21 Q. OKAY. AND WHEN YOU PROVIDED FOR THE LORTAB OBVIOUSLY YOU
22 MUST HAVE BELIEVED THAT SHE MIGHT HAVE THE NEED FOR THIS PAIN
23 MEDICATION?
24 A. YES.
25 Q. THEN LET ME ASK YOU TO TURN TO PAGE 20. AND THIS RELATES
1 TO NOVEMBER 18TH OF 1995. AND YOUR PARTNER, DR. KELLER, SAW
2 THE PATIENT -- SAW THE PATIENT AT THAT TIME; IS THAT RIGHT?
3 A. YES.
4 Q. AND WAS THIS IN -- IN YOUR OFFICE, DO YOU THINK?
5 A. THIS IS IN OUR OFFICE.
6 Q. OKAY. AND MRS. ANDERSON HAD FALLEN THE NIGHT BEFORE?
7 A. YES.
8 Q. OKAY. APPARENTLY SHE'D HURT HER RIB CAGE, AND A CHEST
9 X-RAY WAS TAKEN; IS THAT RIGHT?
10 A. CORRECT.
11 Q. AND THEN APPARENTLY DR. KELLER WAS ABLE TO LOOK AT WHAT
12 HE THOUGHT MIGHT BE THE TUMOR IN THE LUNG THAT WE'VE TALKED
13 ABOUT?
14 A. YES.
15 Q. AND THEN LATER YOU RECEIVED -- OR HE RECEIVED AN X-RAY
16 REPORT FROM THE RADIOLOGIST?
17 A. THAT IS CORRECT.
18 Q. AND THEN THAT WAS THE SITUATION THAT MIGHT HAVE BEEN THE
19 PNEUMONIA OR THE -- HOW DO YOU SAY THE OTHER WORD?
20 A. AT ATELECTASIS.
21 Q. THE ATELECTASIS.
22 A. YES.
23 Q. OKAY. AND THEN, AT LEAST ACCORDING TO THIS NOTE, HER
24 DAUGHTER WAS -- WAS WITH MRS. ANDERSON AND INDICATED THAT
25 THEY DIDN'T WANT ANYTHING DONE, BUT THAT THEY WERE HOPING
1 THAT SHE COULD NOT SUFFER, AND THAT THEY WERE GOING TO LET
2 HER DIE IF SOMETHING SERIOUS WENT WRONG.
3 A. YES.
4 Q. AND I GUESS THAT WOULD BE CONSISTENT WITH THE SAME
5 UNDERSTANDING YOU HAD WITH THE FAMILY EARLIER WHEN WE TALKED
6 ABOUT COMFORT CARE?
7 A. CORRECT.
8 Q. SO MRS. ANDERSON'S CONDITION WAS SERIOUS ENOUGH BOTH WHEN
9 YOU SPOKE WITH THE FAMILY AND THEN AGAIN ON NOVEMBER 18TH,
10 1995 WHEN SHE SPOKE WITH DR. KELLER THAT THE FAMILY WAS
11 ALREADY THINKING ABOUT MRS. ANDERSON PASSING AWAY?
12 A. YES.
13 Q. THEN ALSO APPARENTLY ON 11/18 OF '95 -- AND YOU MAY HAVE
14 ALREADY TOLD THIS TO THE JURY, EXPLAINED THIS TO THE JURY.
15 MR. BUGDEN: I THINK THAT THIS IS ON NURSING HOME
16 RECORD WHICH IS EXHIBIT 2-A, JUDGE.
17 THE COURT: OKAY.
18 MR. BUGDEN: PAGE 398.
19 Q. (BY MR. BUGDEN) AND FOR YOU, DOCTOR, I THINK THAT THIS
20 IS PAGE 23.
21 A. OKAY.
22 Q. SO ON THIS SAME DATE 11/18/95 THAT WE WERE JUST BARELY
23 TALKING ABOUT AT -- AND NOW THIS DOCUMENT THAT WE'RE LOOKING
24 AT IS FROM THE PIONEER CARE CENTER; IS THAT RIGHT?
25 A. YES.
1 Q. THE PATIENT WAS COMPLAINING OF PAIN. I'M NOT SURE WHAT
2 THE NEXT WORD IS. IT -- OH. IT, MAYBE, HAD HER HAND -- OR
3 MAYBE IT'S SHE HAD HER HAND ON HER CHEST. AND LORTAB WAS
4 GIVEN ON THAT -- ON THAT DATE, APPARENTLY.
5 A. YES.
6 Q. AND THEN THE T.D. ORDER FOR NITROSTAT. THE T.D. MEANS?
7 WHAT DOES THAT MEAN? MAYBE IT'S NOT T.D.
8 A. I'M NOT EVEN SURE WHAT THAT T.D. OR T.C. OR --
9 Q. BUT IN ANY EVENT --
10 A. -- SOMETHING ELSE.
11 Q. -- NITROSTAT, IS THAT A PAIN MEDICATION?
12 A. NITROSTAT IS THE NITROGLYCERIN.
13 Q. IS THAT GIVEN FOR CHEST PAINS?
14 A. IT CAN BE.
15 Q. OKAY. AND THEN ON 12/13 OF 1995 -- AND THAT'S PAGE 25 TO
16 YOU, DOCTOR. AGAIN, THIS IS WHAT -- WHAT WE'RE LOOKING AT,
17 WHAT WE'RE LOOKING AT AND THE JURY IS LOOKING AT IS, AGAIN,
18 THE NURSING HOME NOTE. AND ON 12/13/95, THE SECOND TO THE
19 LAST ENTRY ON THE PAGE, THE PATIENT WAS VERY AGITATED,
20 YELLING I, I, I OVER AND OVER. RESIDENTS WERE IRRITATED.
21 I'M NOT SURE WHAT U.A. IS.
22 A. THAT'S URINALYSIS.
23 Q. THANK YOU.
24 SENT TO THE LAB THIS EVENING FOR F -- F.U.
25 A. FOLLOW-UP.
1 Q. THANK YOU.
2 SHE HAD A RASH ON HER THUMB.
3 A. TRUNK.
4 Q. OH, RASH ON TRUNK. UPPER -- WHAT IS THAT? CHAPPED?
5 A. UPPER LEGS.
6 Q. OH, THANKS. THEN CALLED DOCTOR, HE ORDERED BENADRYL.
7 WOULD THAT HAVE BEEN YOU?
8 A. IT COULD HAVE BEEN ME. I DO NOT KNOW.
9 Q. AND BENADRYL IS WHAT KIND OF A MEDICATION?
10 A. BENADRYL IS THE DIPHENHYDRAMINE, THE -- IT'S A -- IT'S AN
11 ANTIHISTAMINE.
12 Q. OKAY. THEN APPARENTLY THE PATIENT ELLEN FINALLY SETTLED
13 DOWN LATER THAT EVENING.
14 A. YES.
15 Q. OKAY. AND THEN THE VERY NEXT ENTRY ON THAT PAGE ON --
16 WOULD THIS HAVE BEEN -- WELL, YOU'RE NOT SURE IF THEY CALLED
17 YOU, SO YOU CAN REMEMBER NOW.
18 A. I'M SURE THEY CALLED THE CLINIC. THE NOTATION IS THE
19 3 TO 11 SHIFT. IF I WAS NOT ON CALL THAT NIGHT, WHOEVER THEY
20 WOULD HAVE CALLED AND SPOKE TO WOULD HAVE BEEN THE ONE THAT
21 SIGNED THIS. THAT INFORMATION IS AVAILABLE, BUT WE DON'T
22 HAVE IT HERE.
23 Q. THEN ON 12/16/95, ELLEN OR MRS. ANDERSON WAS CHANTING
24 LOUD. AS PEOPLE WOULD PASS BY THE PATIENT YELLED LOUDER AND
25 LOUDER. NUMEROUS RESIDENTS COMPLAINED. THREATENED PATIENT
1 TO BE QUIET. PATIENT WAS MOVED OUTSIDE OF HER ROOM IN VIEW
2 OF THE OTHER -- IN VIEW OF OTHERS, BUT AWAY FROM ANGER OF
3 RESIDENTS. PATIENT WAS MOVED FOR HER OWN PROTECTION.
4 DO YOU THINK THAT'S SOMETHING THAT WOULD HAVE BEEN
5 REPORTED TO YOU?
6 A. NOT TYPICALLY.
7 Q. OKAY. AND THEN NURSING HOME RECORD 400, WHICH IS PAGE 28
8 TO YOU, DOCTOR. AND THEN ON 12/18 OF '95, APPARENTLY THE
9 PATIENT HAD TO BE MOVED TO PROTECT HER FROM RETALIATION FROM
10 THE RESIDENTS THAT WERE UPSET WITH HER.
11 AGAIN, YOU'RE NOT SURE THAT YOU WOULD HAVE BEEN IN THE
12 LOOP ON THAT; IS THAT RIGHT?
13 A. TYPICALLY NOT.
14 Q. OKAY. AND THEN ON 12/23, WHICH IS PAGE 30 TO YOU. THE
15 DAUGHTER WAS WORRIED ABOUT HER -- THE PATIENT'S INCREASING
16 DEMENTIA.
17 SAME SITUATION? YOU MAY NOT HAVE HEARD ABOUT THAT THEN,
18 DOCTOR?
19 A. RIGHT. THIS WAS -- THIS WAS WRITTEN BY A NURSE OR AN
20 ASSISTANT AT THE NURSING HOME. DEMENTIA MAY OR MAY NOT EVEN
21 HAVE BEEN THE PROBLEM HERE.
22 Q. ON THAT DAY.
23 A. RIGHT. MOST LIKELY WHAT THEY TERM DEMENTIA WAS DELIRIUM.
24 AND THAT'S WHAT THE SECOND PART OF THE NOTE SAYS. THEY
25 WONDERED IF IT WAS FROM THE BENADRYL. THE BENADRYL COULD
1 HAVE CAUSED THIS DELIRIOUSNESS, THIS DELIRIUM THAT MADE HER
2 CONFUSED AND THAT. AND THAT'S NOT AN UNCOMMON PROBLEM WITH
3 MEDICATIONS. WE HAVE TO USE SOME CAUTION WITH THAT BECAUSE
4 THE MEDICINE PROBABLY MADE HER DELIRIOUS. THEY WROTE
5 DEMENTIA. I -- I THINK THAT WAS PROBABLY NOT WHAT THEY MEANT
6 TO WRITE.
7 Q. WOULD YOU AGREE, DR. WILDING, THAT BECAUSE OF THIS
8 WOMAN'S COMPRESSION FRACTURES AND HER OSTEOPOROSIS, SHE WAS A
9 PATIENT WHO CERTAINLY HAD MEDICAL CONDITIONS THAT COULD HAVE
10 BEEN PAINFUL CONDITIONS?
11 A. OH, YES.
12 MR. BUGDEN: THANK YOU VERY MUCH.
13 THE COURT: REDIRECT?
14 MS. BARLOW: THANK YOU, YOUR HONOR. YES.
15 REDIRECT EXAMINATION
16 BY MS. BARLOW:
17 Q. MR. BUGDEN ASKED YOU IF -- ASKED YOU ABOUT THE TWO TIMES
18 THAT THE DAUGHTERS OF MRS. ANDERSON INDICATED THAT MAYBE --
19 THAT THEY WANTED TO LET HER GO PEACEFULLY.
20 A. CORRECT.
21 Q. NOT TO TAKE HEROIC MEASURES?
22 A. (NODS HEAD.)
23 Q. SHE WAS 91 YEARS OLD. IS THAT AN UNCOMMON DISCUSSION TO
24 HAVE WITH FAMILY MEMBERS OF A 91 YEAR OLD?
25 A. NOT AT ALL.
1 Q. DID THAT MEAN THAT THERE WAS A -- SOMETHING AT THAT POINT
2 IN TIME THAT YOU THOUGHT WAS SO LIFE-THREATENING THAT WE
3 BETTER HURRY UP AND MAKE THIS DECISION BECAUSE SHE JUST MAY
4 GO ANY MINUTE?
5 MR. BUGDEN: OBJECTION. LEADING.
6 THE COURT: SUSTAINED.
7 MS. BARLOW: EXCUSE ME. I WILL REPHRASE IT. THANK
8 YOU, YOUR HONOR.
9 Q. (BY MS. BARLOW) WAS THERE ANYTHING IN MRS. ANDERSON'S
10 PHYSICAL CONDITION AT THAT TIME THAT YOU THOUGHT WAS
11 IMMEDIATELY LIFE-THREATENING?
12 A. NO.
13 Q. YOU'VE TALKED WITH MR. BUGDEN ABOUT COMFORT MEASURES. IS
14 PNEUMONIA UNCOMMON IN THE ELDERLY?
15 A. NO.
16 Q. IF -- IF FAMILY MEMBERS HAVE TOLD YOU WE DON'T WANT TO
17 TAKE HER HEROIC MEASURES AND THEIR LOVED ONE COMES DOWN WITH
18 PNEUMONIA, WHAT IF ANYTHING CAN YOU DO FOR THAT PERSON --
19 THAT ELDERLY PERSON?
20 A. ANTIBIOTICS CAN GENERALLY BE GIVEN ORALLY. SOMETIMES
21 I.V.'S ARE REQUIRED, BUT IF -- IF A PATIENT OR A FAMILY
22 REQUESTS THAT WE JUST DO COMFORT AND CARE, WE WOULD TEND
23 TOWARDS MORE CONSERVATIVE MANAGEMENT, SO ORAL MEDICATIONS
24 ONLY. WE WOULDN'T NECESSARILY UTILIZE OXYGEN SUPPLEMENTALLY
25 UNLESS WE FELT THAT IT WAS A HELP OR BENEFIT TO THEM, THAT IT
1 MADE THEM MORE COMFORTABLE.
2 BUT IT'S JUST A -- A CONDITION WHERE WE SAY LOOK, WHAT
3 CAN WE DO NOT TO MAKE THIS PERSON MISERABLE, BUT JUST TO HELP
4 DO WHAT WE CAN, TRY TO MAKE THEM AS COMFORTABLE AS POSSIBLE,
5 BUT WITHOUT WITHDRAWING SUPPORT. WITHDRAWING SUPPORT WOULD
6 IMPLY WITHHOLDING THINGS.
7 Q. UH-HUH.
8 A. THAT WOULD POTENTIALLY MAKE THINGS BETTER. THERE IS --
9 THERE IS A DIFFERENCE AND I THINK SOMETIMES WE GET THOSE TWO
10 CONFUSED. THIS WAS AN ORDER, THIS WAS A DISCUSSION, LET'S
11 NOT GO OVERBOARD. LET'S DO WHAT IS REASONABLE. LET'S NOT
12 MAKE HER MISERABLE. IF SOMETHING BAD HAPPENS, THAT'S OKAY.
13 Q. UH-HUH.
14 A. WE DON'T WANT TO PROLONG THINGS.
15 Q. OKAY. I THINK YOU WERE POINTED OUT A NOTE -- IT'S IN THE
16 NURSING NOTES I THINK THAT WERE SHOWN TO YOU AND YOU PROBABLY
17 HAVE THEM, A SERIES OF PAGES THERE. THERE WAS A NOTE ON THE
18 21ST OF DECEMBER THAT MRS. ANDERSON HAD LOST ABOUT THREE
19 POUNDS, SHE WAS DOWN TO 81 POUNDS. DO YOU RECALL HER BEING A
20 SMALL WOMAN?
21 A. SHE WAS VERY SMALL.
22 Q. OKAY. AND THEN IT WAS ON THE 29TH THAT SHE WAS
23 TRANSFERRED TO DAVIS NORTH HOSPITAL?
24 A. YES.
25 Q. DO YOU HAVE THAT NOTE IN FRONT OF YOU ABOUT THE 29TH?
1 A. THAT STARTS WITH SOCIAL WORKER IN TO VISIT?
2 Q. YES.
3 A. YES.
4 Q. WOULD YOU PLEASE READ THAT FOR US.
5 MS. BARLOW: IT'S AGAIN FROM THE NURSING HOME
6 RECORDS, YOUR HONOR. I THINK IT'S 2-A.
7 A. SOCIAL WORKER IN TO VISIT. FAMILY HAS --
8 Q. (BY MS. BARLOW) LET ME GRAB MINE.
9 A. -- DESIRED, PERHAPS? DECIDED?
10 Q. SHALL WE SAY DECIDED?
11 A. I THINK IT SAYS DECIDED.
12 Q. OKAY. THANK YOU.
13 A. THAT PATIENT BE DISCHARGED TO DAVIS COUNTY HOSPITAL, TO
14 BE TRANSFERRED TODAY AT 3 P.M. FAMILY TO TRANSFER BY CAR TO
15 DAVIS PSYCH UNIT. PLANS TO STAY THREE WEEKS WITH EVALUATION,
16 TEACHING TO OUR STAFF TO CONTINUE.
17 Q. T.X.?
18 A. TRANSFER FROM DAVIS --
19 Q. T.X.? IS THAT HER TREATMENT?
20 A. HER TREATMENT -- CONTINUE TREATMENT FROM DAVIS, YES.
21 Q. WAS SHE BEING TRANSFERRED FOR TERMINAL OR HOSPICE CARE?
22 A. NO. SHE WAS GOING TO BE TRANSFERRED TO A PSYCHIATRIC
23 UNIT.
24 Q. WHAT IS A HOSPICE UNIT?
25 A. HOSPICE IS -- HOSPICE IS A MEDICAL ENTITY THAT IS USED
1 WHEN LIFE EXPECTANCY IS LESS THAN SIX MONTHS FOR ANY TYPE OF
2 CONDITION. IT HELPS THE PATIENT, THE FAMILY, OTHER
3 CAREGIVERS TO KIND OF DEAL WITH THE -- THE EVENTS LEADING UP
4 TO A PERSON'S DEATH. IT IS VERY MUCH SUPPORTIVE CARE. THEY
5 DO A LOT WITH MEDICATIONS. IT'S -- IT'S COMFORT AND CARE
6 MEASURES TO THE N'TH DEGREE.
7 MS. BARLOW: THAT'S ALL I HAVE, YOUR HONOR.
8 THE COURT: RECROSS?
9 RECROSS-EXAMINATION
10 BY MR. BUGDEN:
11 Q. AGAIN, WITH REGARD TO THE COMFORT CARE, DISCUSSIONS THAT
12 YOU'D HAD WITH THE FAMILY MEMBERS, THEY WANTED -- THEY DIDN'T
13 WANT TO GO OVERBOARD ABOUT HOW THEY WOULD REACT TO A MEDICAL
14 SITUATION WITH THEIR MOTHER WHO WAS 91.
15 A. THAT'S CORRECT.
16 Q. AND 91, LOSING WEIGHT, A FRAIL, ELDERLY WOMAN.
17 A. CORRECT.
18 Q. AND LOOKS LIKE THE NOTES THAT WE TALKED ABOUT BEFORE
19 BEGAN TO AT LEAST SUGGEST THE POSSIBILITY OF PNEUMONIA IN
20 NOVEMBER.
21 A. THE POSSIBILITY, YES.
22 Q. AND YOUR STAFF -- YOU AND YOUR PARTNERS, ALTHOUGH THEY
23 WERE CONCERNED THAT IT COULD BE PNEUMONIA, DID YOU RULE OUT
24 PNEUMONIA?
25 A. NO.
1 Q. THAT WAS NEVER REALLY RULED OUT, WAS IT?
2 A. THERE'S -- RULING OUT PNEUMONIA WOULD BE MOST DIFFICULT
3 TO DO. AGAIN, YOU'VE GOT A LITTLE LADY THAT HAS ATELECTASIS
4 AND/OR PNEUMONIA ON A CHEST X-RAY. THAT'S ABOUT AS RULED OUT
5 AS IT CAN BE SHORT OF VERY AGGRESSIVE MEASURES WITH A
6 PULMONOLOGIST AND SO ON.
7 Q. AND THE FAMILY DIDN'T WANT TO DO THE AGGRESSIVE MEASURES.
8 A. THAT'S CORRECT.
9 Q. THEY -- THEY WERE IN A POSITION THAT THEY WERE WILLING TO
10 ACCEPT THEIR MOTHER PASSING AWAY AND THEY WANTED IT TO BE A
11 COMFORTABLE PASSING AWAY.
12 A. THAT IS CORRECT.
13 Q. AND SO YOU DIDN'T DO MORE AGGRESSIVE MEASURES EVEN THOUGH
14 MORE AGGRESSIVE MEASURES COULD HAVE BEEN DONE.
15 A. COULD HAVE, BUT USUALLY WOULD NEVER HAVE BEEN. USUALLY
16 NOT.
17 Q. NOT WITH A 91-YEAR-OLD WOMAN.
18 A. ABSOLUTELY.
19 Q. BECAUSE THERE'S SOME SORT OF REASONABLENESS ABOUT WHAT
20 SORT OF DIAGNOSTIC PROCEDURES YOU GO THROUGH WITH -- IS THAT
21 RIGHT?
22 A. WE HOPE SO.
23 Q. AND THERE IS A DIFFERENT APPROACH TO YOUR MEDICAL --
24 YOU'RE A FAMILY DOC?
25 A. YES.
1 Q. THERE'S A DIFFERENT APPROACH THAT YOU WOULD TAKE TO AN
2 EIGHT-YEAR-OLD CHILD AND A 91-YEAR-OLD PERSON.
3 A. YES.
4 Q. RIGHT?
5 A. THAT IS CORRECT.
6 Q. AND PNEUMONIA IS -- IS A CONDITION THAT ACTUALLY DOES
7 TAKE THE LIVES OF A LOT OF ELDERLY PEOPLE.
8 A. THAT IS CORRECT.
9 Q. A LOT OF OLDER PEOPLE AT THE END OF THEIR LIFE DO DIE
10 FROM PNEUMONIA.
11 A. THAT IS CORRECT.
12 Q. THEY GET THIS INFECTION IN THEIR LUNG AND THEY PASS AWAY.
13 A. THAT IS A VERY FREQUENT FINDING.
14 Q. AND WHEN THEY GET PNEUMONIA -- WELL, THAT'S FINE.
15 MR. BUGDEN: THANK YOU VERY MUCH.
16 THE WITNESS: THANK YOU.
17 MS. BARLOW: NO FURTHER QUESTIONS, YOUR HONOR.
18 THE COURT: YOU MAY STEP DOWN, DR. WILDING.
19 THE WITNESS: THANK YOU.
20 THE COURT: MAY THIS DOCTOR BE EXCUSED?
21 MS. BARLOW: YES, YOUR HONOR.
22 THE COURT: MR. BUGDEN?
23 MR. BUGDEN: YES, SIR.
24 THE COURT: YOU MAY BE EXCUSED.
25 THE WITNESS: YES, SIR.
1 THE COURT: THANK YOU FOR TESTIFYING.