Defense Opening Statement
19 MR. STIRBA, DO YOU WISH TO GIVE AN OPENING STATEMENT?
20 MR. STIRBA: I DO, YOUR HONOR. THANK YOU.
21 THE COURT: OKAY. PROCEED.
22 MR. STIRBA: MAY IT PLEASE THE COURT, COUNSEL, DR.
23 WEITZEL, LADIES AND GENTLEMEN OF THE JURY. THIS IS GOING TO
24 BE A DIFFICULT CASE. AND THE REASON WHY IT'S GOING TO BE A
25 DIFFICULT CASE IS BECAUSE WE'RE GOING TO BE DEALING WITH
47
1 FIVE PEOPLE WHO ARE AT THE END OF THEIR LIVES AND WERE IN
2 THE DYING PROCESS. AND NOT ONLY WERE THESE FIVE PEOPLE
3 SUFFERING FROM PSYCHIATRIC PROBLEMS, BUT THEY WERE SEVERELY
4 DEMENTED AND HAD A COMPLETE INABILITY TO COMMUNICATE AND TO
5 EXPRESS THEMSELVES.
6 THEY ALSO HAD MULTIPLE MEDICAL PROBLEMS. THE PROBLEMS
7 RANGE FROM VASCULAR DISEASE, HEART DISEASE, LUNG DYSFUNCTION
8 AND OTHER MEDICAL, SERIOUS MEDICAL PROBLEMS. AND ON TOP OF
9 ALL OF THIS, THEY WERE AT THE DAVIS HOSPITAL BECAUSE THE
10 NURSING HOME WHERE THEY WERE COULD NO LONGER HANDLE THEM.
11 THEY WERE COMBATIVE, UNCONTROLLABLE, ASSAULTIVE, AND THE
12 NURSING HOME COULD NO LONGER DEAL WITH THE BEHAVIOR
13 PROBLEMS. AND IN THE MIDST OF ALL THIS, THE FAMILIES HAD TO
14 MAKE VERY DIFFICULT, AND I EMPHASIZE DIFFICULT, JUDGMENTS AT
15 THE END ABOUT WHAT KIND OF CARE THEY WERE GOING TO RECEIVE
16 AT THE HOSPITAL AND WHAT CARE THEY WEREN'T GOING TO RECEIVE.
17 AND I HOPE THAT AT THE END OF THE OPENING STATEMENT
18 WHEN I SIT DOWN, AND HOPEFULLY IT WON'T BE TOO LONG FROM
19 NOW, THAT YOU REMEMBER THE CONTEXT IN WHICH TO VIEW THIS
20 CASE AND THE EVIDENCE IN THIS CASE. AND THE CONTEXT IS YOU
21 HAVE A DOCTOR WHO IS PART OF A MEDICAL TEAM PROVIDING CARE
22 TO VERY SERIOUSLY ILL AND VERY SERIOUSLY SICK, ELDERLY
23 PATIENTS IN A HOSPITAL SETTING WHERE THE FAMILIES HAVE MADE
24 CERTAIN LIMITATIONS IN ADVANCE UPON WHAT CARE SHOULD BE
25 GIVEN AND WHAT CARE SHOULD BE WITHHELD.
48
1 NOW, YOU ARE GOING TO HEAR EVIDENCE IN THIS CASE,
2 LADIES AND GENTLEMEN, ABOUT PAIN AND ABOUT SUFFERING. AND
3 YOU ARE GOING TO SEE THAT THE EVIDENCE WILL SHOW THAT DR.
4 WEITZEL AS PART OF A MEDICAL TEAM HAD AS HIS ONLY PURPOSE TO
5 ALLEVIATE PAIN AND SUFFERING. YOU ARE GOING TO ALSO HEAR
6 ABOUT FAMILIES AND THE DIFFICULT CHOICES THEY HAD TO MAKE IN
7 TERMS OF WHAT THEY WERE GOING TO DO WITH THEIR LOVED ONE
8 GIVEN THE CIRCUMSTANCES IN THE HOSPITAL WHERE HOME CARE AND
9 NURSING HOME CARE WERE NO LONGER OPTIONS.
10 YOU ARE GOING TO HEAR ALSO ABOUT THE FIVE VERY SICK AND
11 ELDERLY PATIENTS AND THE MEDICAL PROBLEMS THEY HAD AND THE
12 DIFFICULT AND COMPLICATED CARE THAT WAS REQUIRED, GIVEN THE
13 FACT THAT THEY WERE ELDERLY, GIVEN THE FACT THAT THEY WERE
14 DEMENTED, GIVEN THE FACT THAT THEIR CONDITIONS CHANGED, NOT
15 ONLY FROM DAY TO DAY, BUT FROM HOUR TO HOUR AND FROM MINUTE
16 TO MINUTE, AND NOW, LADIES AND GENTLEMEN, ALMOST FIVE YEARS
17 LATER THE STATE WANTS TO PICK APART WITH PERFECT 20/20
18 HINDSIGHT ALL THAT MEDICAL CARE AND CALL IT FIRST DEGREE
19 MURDER.
20 THE EVIDENCE WILL SHOW THAT NONE OF THIS WAS MURDER,
21 THAT THERE'S REASONABLE DOUBT WRITTEN ALL OVER THIS CASE AND
22 WHAT YOU HAVE AND WHAT THE EVIDENCE WILL SHOW IS YOU HAVE A
23 PHYSICIAN AND I'LL TELL YOU RIGHT NOW, NOT A PERFECT
24 PHYSICIAN, BUT A WELL-INTENTIONED PHYSICIAN AND A WHOLE
25 MEDICAL TEAM PROVIDING END-OF-LIFE CARE, NOTHING MORE,
49
1 NOTHING LESS.
2 YOU'LL ALSO SEE AND THE EVIDENCE WILL SHOW THAT THE
3 SOLE PURPOSE AND THE ONLY GOAL OF THIS MEDICAL TEAM WAS TO
4 PROVIDE COMFORT CARE AND MAKE SOMEBODY COMFORTABLE IN THE
5 LAST DAYS OF THEIR LIFE. AND FINALLY, LADIES AND GENTLEMEN,
6 THE EVIDENCE WILL SHOW THAT DR. WEITZEL DIDN'T CAUSE ANY OF
7 THESE DEATHS. IF HE DID ANYTHING, HE WAS ATTEMPTING TO
8 BRING COMFORT AND DIGNITY TO EACH ONE OF THEM.
9 ONE OF THE PATIENTS AT THE HOSPITAL WAS A WOMAN NAMED
10 JUDITH LARSEN, YOU SAW HER PHOTOGRAPH ON OPENING STATEMENT.
11 JUDITH WAS 93 YEARS OLD WHEN SHE WAS ADMITTED TO THE
12 HOSPITAL ON DECEMBER 6TH OF 1995. IN JANUARY OF 1995 SHE
13 HAD A VERY ACUTE SERIOUS STROKE AND SHE WAS HOSPITALIZED
14 FIRST AT LDS HOSPITAL IN SALT LAKE AND THEN AT COTTONWOOD
15 HOSPITAL AS A RESULT OF THAT STROKE. AND THAT STROKE CAUSED
16 JUDITH NOT ONLY TO BECOME CONFUSED, NOT ONLY TO BECOME
17 DISORIENTED, BUT ALSO DEPRIVED OF HER OF A GREAT ABILITY TO
18 COMMUNICATE. IT ALSO CAUSED HER OTHER IMPAIRMENTS IN TERMS
19 OF HER ABILITY TO WALK AND DO THE NORMALLY DAILY TASKS OF
20 EVERYDAY LIVING.
21 IN JULY OF 1995 SHE STARTED TO GET ILL AND SHE WAS SO
22 ILL, SHE WAS SICK, SHE WAS VOMITING, SHE WAS ONCE AGAIN
23 HOSPITALIZED AT COTTONWOOD HOSPITAL. AND IN AUGUST, THE
24 LATER PART OF AUGUST OF 1995, SHE HAD ANOTHER STROKE AND
25 THIS WAS ONCE AGAIN ANOTHER ACUTE STROKE, VERY SERIOUS
50
1 STROKE AND SHE WAS HOSPITALIZED AT COTTONWOOD HOSPITAL.
2 AND TO PUT THIS CASE IN SOME CONTEXT, I WANT TO READ TO
3 YOU THE ACTUAL ENTRY MADE BY DR. PEARCE AND THIS WILL BE IN
4 EVIDENCE IN THIS CASE. THIS IS IN AUGUST OF 1995 AND DR.
5 PEARCE IS THE DOCTOR AT COTTONWOOD WHO IS TAKING CARE OF
6 JUDITH AND HE WRITES IN HIS DISCHARGE SUMMARY, ASSESSMENT:
7 DEMENTIA, WHICH BY THE WAY, YOU'LL HEAR EVIDENCE IS A
8 TERMINAL CONDITION. TWO: NEW STROKE SYNDROME WITH APHASIA.
9 APHASIA IS A FANCY WORD FOR CAN'T SPEAK VERY WELL, YOU HAVE
10 DIFFICULTY COMMUNICATING. AND WITH LOSS OF INTEREST IN
11 SWALLOWING EITHER FOOD OR FLUIDS. THREE: PAST HISTORY OF
12 HYPERTENSION. FOUR: QUESTION OF ISCHEMIC HEART DISEASE.
13 HE GOES ON TO SAY, PLAN: IN DISCUSSION WITH THE
14 FAMILY, IT IS DECIDED THAT THE LAST SIX MONTHS OF HER LIFE
15 HAVE BEEN VERY POOR QUALITY. IN FACT, NO QUALITY AT ALL.
16 WITH POOR RECOGNITION OF PEOPLE, NO CONVERSATION, NO
17 DECISION-MAKING. THE OPTION AT THE TIME OF DISCHARGE IS TO
18 PLACE A FEEDING TUBE, PERIPHERAL NUTRITION OR N.G. TUBE,
19 N.G. STANDS FOR I THINK IT'S NASAL GASTRIC, IT'S A TUBE TO
20 ALLOW YOU TO EAT, AND THE FAMILY FEELS THAT THIS WOULD BE
21 AGGRESSIVE AND INAPPROPRIATE. THEY ALSO WANTED NO TREATMENT
22 OF INFECTION, SUCH AS URINARY INFECTIONS, PULMONARY, ET
23 CETERA. DISPOSITION: SHE WILL BE TRANSFERRED TO A NURSING
24 HOME FOR TERMINAL CARE.
25 JUDITH WENT TO A NURSING HOME AND SHE WENT TO THE
51
1 HOLLADAY CARE CENTER WHICH IS IN HOLLADAY AND THERE SHE
2 REBOUNDED. BUT WHILE SHE WAS AT THE NURSING HOME, SHE
3 BECAME VERY, VERY UNCONTROLLABLE AND THIS WAS A BIG PROBLEM.
4 AND YOU'LL SEE IN THE NURSING HOME NOTES, SOME OF THE MORE
5 POIGNANT NOTES I THINK ABOUT THIS CASE, BECAUSE HER SON
6 MERLIN -- WHAT HAPPENED IS JUDITH WOULD HAVE FALLS AND SHE
7 WOULD BE HOSPITALIZED. AND FALLS, AS YOU CAN IMAGINE, FOR
8 SOMEBODY OF 93 IS A PRETTY SERIOUS MATTER.
9 IN ONE FALL SHE HAD -- SHE SUFFERED A CONCUSSION.
10 ANOTHER FALL SHE HAD SHE HAD A THREE-INCH GASH IN HER HEAD.
11 AND YOU'LL SEE IN THE NOTES THAT HER SON MERLIN IS SAYING
12 SEDATE HER AND SEDATE HER MORE. WHY? BECAUSE HE'S
13 CONCERNED, OBVIOUSLY, ABOUT THE IMPACT OF A FALL ON A
14 93-YEAR-OLD MOTHER IN A NURSING HOME AND HE'S BEEN TO THE
15 HOSPITAL AND HE KNOWS WHAT'S HAPPENING. BUT SHE IS
16 UNCONTROLLABLE. THEY PUT RESTRAINTS ON HER, SHE GETS OUT OF
17 HER RESTRAINTS, SHE FALLS. SO FINALLY THE NURSING HOME SAYS
18 SEND HER TO DAVIS FOR AN EVALUATION.
19 SHE ARRIVES ON DECEMBER 6TH. AND I WOULD SAY THE FIRST
20 FEW WEEKS OF HER HOSPITAL STAY I WOULD SAY ARE RELATIVELY
21 UNEVENTFUL. HOWEVER, ON THE 26TH, ON OR ABOUT THE 26TH OF
22 DECEMBER, SHE HAS A SEIZURE AND IT'S A GRAND MAL SEIZURE AND
23 THEN SHE STARTS THROWING UP AND SHE THROWS UP CONTINUOUSLY
24 FOR 26 HOURS STRAIGHT. AND ONE OF THE THINGS THAT THEY
25 NOTICE WHEN SHE'S THROWING UP IS SHE'S THROWING UP WHAT THEY
52
1 CALL COFFEE GROUNDS. AND I ALWAYS HAVE A DIFFICULT TIME
2 WITH THIS WORD, EMESIS. AND WHAT THAT MEANS IS THAT'S A
3 FANCY WAY OF SAYING SHE HAS BLOOD IN HER VOMIT AND WHAT THAT
4 MEANS IS SHE'S BLEEDING INTERNALLY.
5 DR. WEITZEL TALKS TO MERLIN AND HE GOES OVER THE
6 SITUATION WITH HIS 93-YEAR-OLD MOM WHO HAS BEEN THROUGH THE
7 YEAR THAT SHE HAS JUST BEEN THROUGH. AND MERLIN SAYS,
8 CONSISTENT WITH WHAT HE SAID BACK IN AUGUST AND CONSISTENT
9 WITH EVERYTHING ELSE THAT YOU'LL SEE IN THE CHARTS, HE SAYS,
10 JUST KEEP HER COMFORTABLE IS ALL I WANT YOU TO DO. AND
11 THAT'S PRECISELY WHAT NOT ONLY DR. WEITZEL DID BUT THE WHOLE
12 NURSING STAFF THAT WAS ATTENDING TO HER. THEY KEPT HER
13 COMFORTABLE UNTIL SHE DIED ON JANUARY 3RD OF 1996.
14 AND PART OF COMFORT CARE -- AND YOU'LL HEAR EXPERTS.
15 AND THE GREAT THING ABOUT THIS CASE, IF YOU WANT TO HEAR A
16 LOT OF EXPERTS, YOU ARE IN A PERFECT POSITION BECAUSE THERE
17 WILL BE A LOT OF THEM IN THIS CASE. WE'LL CALL SOME, THE
18 STATE WILL CALL SOME. BUT THERE'S GOING TO BE A GENERAL
19 AGREEMENT NOT ONLY WITH OUR EXPERTS BUT ALSO THE STATE'S
20 EXPERTS, SOME OF THEM, AND THEY ARE GOING TO TELL YOU, THAT
21 COMFORT CARE OR END-OF-LIFE CARE INVOLVES A LOT OF THINGS.
22 AND ONE OF THE THINGS IT INVOLVES IS MEDICATION. AND
23 THE REASON WHY IS BECAUSE PEOPLE ARE EITHER IN PAIN OR THEY
24 ARE SUFFERING FOR A LOT OF DIFFERENT REASONS AND THAT'S AN
25 APPROPRIATE THING TO DO IS TO KEEP THEM COMFORTABLE. AND
53
1 THEY ARE GOING TO TELL YOU THAT MORPHINE AS A MEDICATION IS
2 SORT OF LIKE THE GOLD STANDARD, IF YOU WILL, IN TERMS OF A
3 MEDICATION THAT ROUTINELY IS USED IN END-OF-LIFE CARE. AND
4 THEY ARE GOING TO TELL YOU A PHYSICIAN HAS AN ABSOLUTE DUTY,
5 IN OTHER WORDS, IT'S ETHICAL AND IT'S ETHICALLY REQUIRED
6 THAT IF A PHYSICIAN SEES SOMEBODY IN PAIN OR A PHYSICIAN HAS
7 A PATIENT WHO IS SUFFERING, A PHYSICIAN HAS AN ABSOLUTE
8 ETHICAL RESPONSIBILITY TO DO SOMETHING ABOUT IT.
9 AND ALSO THEY ARE GOING TO TELL YOU THAT IF A PHYSICIAN
10 IN END-OF-LIFE CARE HAS TO PRESCRIBE MEDICATION TO PROVIDE
11 COMFORT, AND EVEN IF THAT PHYSICIAN KNOWS THAT THAT MIGHT
12 HAVE A TENDENCY TO HASTEN A DEATH, THAT'S STILL ETHICALLY
13 APPROPRIATE AND A PHYSICIAN IS OBLIGATED TO DO IT IF THE
14 PURPOSE OF ADMINISTERING AND PRESCRIBING THE MEDICATION IS
15 TO KEEP SOMEBODY COMFORTABLE AND TO ALLEVIATE PAIN AND
16 SUFFERING.
17 NOW, YOU HAVE FIVE CASES, FIVE COUNTS. IT'S ALMOST
18 LIKE WE HAVE FIVE DIFFERENT CASES, AND WE DO. THERE IS ONE
19 CASE THAT IS DIFFERENT THAN THE OTHER FOUR AND THAT'S THE
20 CASE OF ELLEN ANDERSON, PATIENT ELLEN ANDERSON. BECAUSE
21 ELLEN ANDERSON IS NOT REALLY A CASE AND THE FACTS WILL SHOW
22 THIS, THE EVIDENCE WILL SHOW THIS OF END-OF-LIFE CARE, ELLEN
23 ANDERSON IS PURELY AND SIMPLY, IF YOU WILL, A PAIN CASE
24 WHERE MEDICATION IS PRESCRIBED FOR PAIN. AND LET ME GIVE
25 YOU A LITTLE HISTORY ABOUT ELLEN BECAUSE I THINK THIS IS
54
1 IMPORTANT. REMEMBER, THERE'S GOING TO BE A LOT OF MEDICAL
2 TESTIMONY HERE BUT EVERY PATIENT HAS A HISTORY AND THAT
3 CIRCUMSTANCE OF GOING INTO THE HOSPITAL IS VERY IMPORTANT.
4 BUT BRIEFLY, ELLEN DID HAVE A HIP FRACTURE IN JUNE OF
5 1995 AND SHE LOST 30 POUNDS BY THE TIME WE HIT DECEMBER OF
6 1995 AND SHE WASN'T A VERY LARGE WOMAN TO BEGIN WITH. AND
7 HER FAMILY IS GOING TO TELL YOU THAT THEY HAD HER IN A
8 NURSING HOME AND AS THEY DESCRIBE IT FOR ABOUT SIX MONTHS
9 SHE WAS IN WHAT THEY WOULD CALL AN ACUTE PANIC ATTACK
10 CONSTANTLY, NEVER A MINUTE WASN'T SHE IN THIS STATE. AND
11 SHE WOULD SCREAM AND SHE WOULD SCREAM UNCONTROLLABLY AND SHE
12 WAS ABSOLUTELY TERRIFIED. AND THE FAMILY IS STRUGGLING
13 DEALING WITH THIS.
14 AND FINALLY ONE OF HER DAUGHTERS, DIANE, COMES INTO THE
15 NURSING HOME AT THE END OF DECEMBER OF 1995 AFTER HAVING
16 DEALT WITH THIS FOR SIX MONTHS AND SEEING THEIR POOR MOM IN
17 THAT SITUATION AND SAYS, I'VE HAD ENOUGH, I DON'T WANT HER
18 HERE ANYMORE BECAUSE WHATEVER YOU ARE GIVING HER ISN'T
19 WORKING. AND YOU KNOW WHAT? I WANT HER TO GET MORPHINE AND
20 HOW CAN I GET HER TO GET MORPHINE? I CAN'T DO IT IN A
21 NURSING HOME, BUT IF WE HOSPITALIZE HER, MAYBE SHE CAN GET
22 SOME MORPHINE BECAUSE WE'VE TRIED EVERYTHING ELSE AND AT
23 LEAST MAYBE MORPHINE WILL HAVE A SEDATING EFFECT. SO ELLEN
24 IS THEN TRANSFERRED TO THE DAVIS HOSPITAL.
25 AND I'M GOING TO PUT THIS UP THEN WE'LL GO THROUGH A
55
1 NUMBER OF THESE. CAN EVERYBODY SEE THAT? I DON'T KNOW IF
2 THIS IS THE BEST POSITION, BUT ANYWAY, THIS IS NOT A TIME
3 LINE BECAUSE ELLEN WAS IN THE HOSPITAL FROM 12/29 THROUGH
4 12/30. THIS IS ALL FROM THE MEDICAL RECORDS. THIS IS WHAT
5 THE ENTRIES ARE.
6 AND AS YOU CAN SEE IN THIS PARTICULAR CASE AND YOU'LL
7 SEE OTHERS, AND I'LL TELL YOU THEY ALL SORT OF -- THE
8 RECORDS ARE ALL SORT OF THE SAME, YOU CAN FOLLOW THEM.
9 THERE'S ALWAYS AN ADMISSION/EVALUATION AND OF COURSE THERE'S
10 SOME MEDICAL HISTORY THAT'S TAKEN BECAUSE OBVIOUSLY THAT'S
11 IMPORTANT FOR THE HEALTHCARE PROVIDERS. AND THEN THERE'S
12 USUALLY AN INDICATION OF WHAT MEDICATIONS THE PATIENTS WERE
13 ON ON ADMISSION BECAUSE OBVIOUSLY THAT'S IMPORTANT.
14 AND I'LL TELL YOU RIGHT NOW XANAX, THAT'S AN
15 ANTIANXIETY DRUG, IT'S A SEDATING DRUG, IT'S A SEDATIVE.
16 AMITRIPTYLINE IS A SEDATING DRUG, THAT'S AN ANTIDEPRESSANT.
17 AMBIEN IS ALSO A SEDATING DRUG. LORTAB IS A PAIN MEDICATION
18 AND YOU'LL HEAR DOCS TELL YOU ABOUT THIS, BUT I'M JUST
19 SAYING THESE ARE THE KIND OF THINGS YOU'LL SEE. AND THEN
20 THERE'S ALWAYS AN INITIAL ADMISSION NOTE THAT YOU'LL SEE FOR
21 EACH ONE, IT'S USUALLY DONE BY THE NURSES.
22 AND I JUST WANT YOU TO SEE AS WE GO THROUGH THESE TIME
23 LINES THERE ARE GOING TO BE ENTRIES IN THE MEDICAL RECORDS.
24 AND ONE THING WE'VE DONE WHICH HOPEFULLY WILL BE HELPFUL IS
25 INSTEAD OF HAVING TO READ THE CHICKEN SCRATCH OF SOME
56
1 PHYSICIAN, WE HAD THEM TRANSCRIBED AND TYPED UP SO YOU HAVE
2 THE PAGE IN FRONT OF AND YOU CAN SEE WHAT THE DOCTORS AND
3 NURSE WROTE AND RIGHT ACROSS IT WILL BE TYPED SO IT'S EASY
4 TO READ. ANYWAY, YOU'LL SEE ENTRIES BY DR. WEITZEL AND
5 ENTRIES BY NURSES AND THERE'S A WHOLE SERIES OF NURSES AND
6 THESE ARE IN THE NURSES' NOTES.
7 BUT THESE ARE THE FACTS WITH MS. ANDERSON. SHE COMES
8 IN AND SHE ARRIVED I BELIEVE AT ABOUT 4 O'CLOCK IN THE
9 AFTERNOON. AND I'LL TELL YOU DR. WEITZEL IS FULLY PREPARED
10 TO NOT ONLY DOCUMENT THAT HE SAW HER THE DAY SHE ARRIVED, HE
11 ACTUALLY SAW HER AND HE CAN DOCUMENT THAT, BUT HE'LL TELL
12 YOU ABOUT HIS EVALUATION. AND THIS IS WHAT HE PUTS IN HIS
13 INITIAL EVALUATION, GENERALLY THE OVERVIEW OF HER MEDICAL
14 SITUATION.
15 AND THEN HERE THE NURSE -- THIS IS WHAT THE NURSE
16 STATES, PATIENT ADMITTED IN COMPANY OF DAUGHTER FROM CARE
17 CENTER. DETERIORATING OVER THE PAST THREE WEEKS. CRYING
18 AND SCREAMING INCONSOLABLY EVEN WHEN FAMILY IS PRESENT.
19 MORPHINE 10 MILLIGRAMS, S.O. 4 BY THE WAY, I HAVE TO PUT IT
20 IN THERE BECAUSE IT'S IN THERE, IT MEANS -- IT'S SULFATE.
21 IT'S JUST -- THAT'S WHAT THEY ALWAYS PUT IN, S.O. 4 FOR
22 MORPHINE, BUT THAT'S WHAT WE'RE TALKING ABOUT, INTRAMUSCULAR
23 FOR SEVERE PAIN. PATIENT BECOMES RIGID AND SCREAMS WHEN
24 TOUCHED RELATED TO PROFOUND OSTEOPOROSIS WHICH CAUSED HER TO
25 HAVE A SERIES OF FRACTURES. SHE HAD A NUMBER OF COMPRESSION
57
1 FRACTURES BECAUSE THE BONES -- YOUR BONES ARE VERY BRITTLE
2 AND IT'S VERY PAINFUL WHEN YOU HAVE THOSE FRACTURES. SO
3 THAT IS THE FIRST MEDICATION.
4 THEN WE GO OVER TO THE NEXT DAY AT 1 O'CLOCK THE NURSE
5 CHARTS, PATIENT'S RESPIRATION IS VERY ERRATIC, 8 TO 16.
6 BLOOD PRESSURE 75/50. DR. WEITZEL PAGED, A NURSING
7 SUPERVISOR INFORMED OF PATIENT'S CONDITION. THE NURSING
8 SUPERVISOR IS ALWAYS NOTIFIED WHEN A NURSE BELIEVES THAT
9 SOMEONE IS ABOUT TO DIE, THAT WAS HOSPITAL PROTOCOL AND
10 THAT'S THE SIGNIFICANCE OF THAT ENTRY. AND THEN AT 3:15,
11 PATIENT AWAKENED, THRASHING ARMS AND ATTEMPTING TO THROW
12 BODY. PATIENT MOANING AND SCREAMING. DR. WEITZEL PAGED
13 AGAIN, THIS IS BY TRACY SCHOLL, A NURSE. AND THEN AT 3:30,
14 DR. WEITZEL RETURNS PAGE, INFORMED OF PATIENT'S CONDITION.
15 IN OTHER WORDS, ALL THROUGHOUT HERE AND COUNSEL IS
16 QUITE RIGHT IN HER OPENING STATEMENT, THE NURSES THERE ARE
17 PROVIDING MOST OF THE CARE. AND SO THEY ARE GIVING
18 INFORMATION TO THE DOCTORS ABOUT WHAT THEY ARE ASSESSING IS
19 THE CLINICAL POSITION OF THE PATIENT AND THAT'S WHAT NURSE
20 SCHOLL IS DOING HERE. SHE TELLS DR. WEITZEL AND THEN
21 MORPHINE IS GIVEN INTRAMUSCULAR PER THE DOCTOR'S ORDERS AND
22 THEN THAT'S WHAT HAPPENS, AND THEN MS. ANDERSON DIED AT 8:55
23 A.M.
24 THE FACTS IN THIS CASE AND THIS MS. ANDERSON WAS
25 AUTOPSIED BY THE MEDICAL EXAMINER AND HE'LL TESTIFY AND
58
1 HE'LL TELL YOU THAT IN HIS EXAMINATION SHE HAD ACUTE
2 PNEUMONIA. IN OTHER WORDS, REMEMBER, THERE WAS A CHEST
3 X-RAY DONE AT ABOUT FIVE OR SIX IN THE MORNING AND THERE WAS
4 AN E.K.G. THAT WAS DONE THAT WAS ABNORMAL. AND HE'LL TELL
5 YOU THAT THERE ARE AT LEAST FOUR OR FIVE REASONS, HE
6 COULDN'T TELL EXACTLY, BUT FOUR OR FIVE REASONS ALL OF WHICH
7 COULD HAVE CAUSED HER DEATH. HE DOES NOT KNOW BECAUSE ANY
8 ONE OF THEM WOULD BE BEEN SUFFICIENT, AND ONE OF THEM WAS
9 SHE HAD ACUTE PNEUMONIA UPON ADMISSION WHICH YOU'LL SEE IN
10 THE X-RAY. IT IS SHOWN RIGHT THERE IN THE X-RAY WHAT THE
11 PROBLEM IS AND THERE ARE OTHER THINGS, CARDIAC AND WHAT HAVE
12 YOU, RELATED TO THE CIRCUMSTANCES OF HER DEATH. AND WE'LL
13 HAVE OUR OWN EXPERT WHO IS GOING TO TELL YOU THAT SHE DIDN'T
14 DIE AT ALL ANYTHING RELATED TO MORPHINE.
15 NOW, YOU ARE GOING TO SEE A PATTERN HERE BUT IT'S A
16 PATTERN OF CIRCUMSTANCE. IT'S NOT GOING TO BE A PATTERN OF
17 CRIMINALITY. FOR EXAMPLE, YOU ARE GOING TO SEE IN THE OTHER
18 FOUR CASES THAT ALL OF THESE PATIENTS ARE SUFFERING FROM
19 SEVERE DEMENTIA OR ALZHEIMERS AND CAN'T COMMUNICATE. AND
20 YOU ARE GOING TO SEE THAT THEY ARE ALL ADMITTED BECAUSE THEY
21 NEED TO BE SEDATED. AND YOU'LL SEE IN THE PROGRESS NOTES
22 AND THE NURSING NOTES FROM THE NURSING HOMES THAT THEY ARE
23 ALL BEING SEDATED EITHER WITH ATIVAN OR HALDOL WHICH IS
24 ANOTHER SEDATING MEDICATION OR SOMETHING LIKE THAT. WHY?
25 BECAUSE THIS IS AN ATTEMPT TO CONTROL THEIR BEHAVIOR. SO
59
1 WHEN THEY ARE GOING INTO THE HOSPITAL THEY ARE ALL ON PSYCH
2 MEDS AND THEY ARE ALL ON SEDATING CONTROL MEDS.
3 YOU ARE ALSO GOING TO SEE THAT THEY ARE ALL HIGH-RISK
4 PATIENTS GIVEN THE NATURE OF THEIR AGE, THEIR DEMENTIA AND
5 THEIR OTHER MEDICAL COMPLICATIONS. AND YOU ARE GOING TO SEE
6 AND I THINK SIGNIFICANTLY THAT THEY ALL HAD, THEY ALL HAD --
7 THE OTHER FOUR ALL HAD LIVING WILLS OR MEDICAL DIRECTIVES
8 WHICH THEY PROVIDED TO THE HOSPITAL WHICH LIMITED THE KIND
9 OF CARE THEY COULD GET.
10 NOW, LET'S LOOK AT SOME OTHERS AND WE'LL GO THROUGH
11 THEM IN SORT OF A TIME LINE SO YOU CAN GET SOME FEEL FOR
12 WHAT THE FACTS WILL BE IN THIS CASE. HOW IS THAT? IS THAT
13 SOMETHING YOU ALL CAN SEE?
14 NOW, THIS IS -- THIS IS PATIENT ENNIS ALLDREDGE AND
15 YOU'LL SEE THESE AGAIN. BUT ONCE AGAIN, THEY ALL START WITH
16 THE DAY HE'S ADMITTED AND THEY GO THROUGH THE TIME OF THE
17 DEATH AT 1/14 IN THIS CASE OF '96. AND WHAT WE'VE ATTEMPTED
18 TO DO IS TO PROVIDE IN COLOR -- IN THE GREEN, THESE ARE THE
19 PSYCH MEDS THAT WERE ORDERED AND ACTUALLY GIVEN AT THE
20 HOSPITAL. THE BLUE IS THE MORPHINE WHICH WAS GIVEN TO THE
21 PATIENT AT THE HOSPITAL. AND IF YOU LOOK AT THIS ONE, ONCE
22 AGAIN IF WE START OUT WITH THE ADMISSION, WE HAVE AN
23 83-YEAR-OLD WHITE MALE ADMITTED AND ORIENTED TO THE UNIT.
24 PATIENT ACCOMPANIED BY HIS WIFE OF SEVEN YEARS. PATIENT IS
25 VERY COMBATIVE AND AGITATED. PATIENT NOT ORIENTED TO TIME,
60
1 PLACE OR SITUATION, AND IT GOES ON FROM THERE. AND EVEN
2 SAYS, IS VERY STRONG AND GRABS AT STAFF, HURTING STAFF.
3 THAT'S THE SIGNIFICANCE OF THE DIFFICULTY OF THE BEHAVIOR.
4 THEN WE HAVE HIS HISTORY, ALZHEIMERS, T-CELL LYMPHOMA,
5 WHICH IS A FORM OF CANCER, DIABETES WHICH WAS UNCONTROLLABLE
6 FOR 25 YEARS, HE WAS ON INSULIN. HERNIA REPAIR,
7 HYPERTENSION, AND HE HAD PREVIOUS BYPASS SURGERY. HE HAD
8 CORONARY ARTERY DISEASE ON ADMISSION. AND THEN HIS
9 MEDICATIONS ON ADMISSION, ATIVAN WHICH IS, ONCE AGAIN, A
10 SEDATING ANTIANXIETY MEDICATION. THIS WAS ALL THAT WAS
11 GIVEN WHEN HE WAS AT THE NURSING HOME. THIS HAS NOTHING TO
12 DO WITH THE HOSPITAL. RISPERDAL, WHICH IS A PSYCH
13 MEDICATION WHICH I BELIEVE HE ALSO GOT WHEN HE WAS IN THE
14 HOSPITAL. VOLMAX IS ANOTHER PSYCH MEDICATION, HYTRIN IS
15 ANOTHER ONE, BUSPAR IS ANOTHER ONE AND THEN HE ALSO GOT
16 MELLARIL AND HALDOL AT THE NURSING HOME. ONCE AGAIN, THESE
17 ARE ALL PSYCH MEDS THAT WERE PROVIDED. THEY ARE ALL
18 SEDATING TO HIM IN AN ATTEMPT TO CONTROL HIM. D.N.R., DO
19 NOT RESUSCITATE. HE HAD A LIVING WILL AND THERE WERE
20 MEDICAL DIRECTIVES LIMITING THE CARE.
21 NOW, SIGNIFICANTLY IF WE FLIP OVER TO HERE TO GIVE YOU
22 SOME IDEA HOW DIFFICULT THIS WAS. THIS IS -- TRACY SCHOLL
23 IS THE NURSE AGAIN, SHE STATES, PATIENT REMAINS POSEY. THEY
24 HAD TO PUT HIM IN A RESTRAINT BECAUSE HE WAS VIOLENT AND
25 COMBATIVE SO HE'S IN AN ACTUAL RESTRAINT IN THE BED AND
61
1 THAT'S WHAT THE POSEY IS. PATIENT HAD LARGE BOWEL MOVEMENT,
2 HAS SMEARED FECES ALL OVER, INCLUDING FACE, BED RAILS, ET
3 CETERA. ON THE 12TH, HE HAS AN M.R.I. AND YOU'LL SEE THIS,
4 THIS WILL BE PART OF THE RECORD. AN M.R.I. IS A WAY THAT
5 YOU GO -- I THINK IT'S CALLED MAGNETIC RESONANCE IMAGING,
6 BUT IT'S A WAY TO SEE IF THERE IS A PROBLEM WITH THE STROKE
7 EVENT.
8 AND THE M.R.I. REPORT COMES BACK, AND I'LL TELL YOU, IT
9 IS SOMEWHAT AMBIGUOUS AS TO WHAT REALLY IS FOUND. BUT IT
10 WAS CONSIDERED BY NOT ONLY DR. WEITZEL, BUT THE NURSING
11 STAFF AS INDICATING HE HAD A STROKE. AND LAURIE WILLSON IS
12 A NURSE AND SHE WRITES THIS -- THIS IS WHAT SHE WROTE ON
13 THIS DAY INTERVENTION: M.R.I., THAT'S THAT MAGNETIC
14 RESONANCE IMAGING, DR. CLINGER, HE'S THE GUY THAT DID IT,
15 CALLED TO REPORT EVIDENCE OF POSSIBLE NEW INFARCTION, THAT'S
16 A STROKE WHERE YOUR BRAIN DOESN'T GET THE BLOOD AND
17 THEREFORE THERE'S A PROBLEM, TO LEFT OCCIPITAL LOBE.
18 PATIENT REMAINS RESTLESS AND MINIMALLY RESPONSIVE EXCEPT TO
19 DISCOMFORT. DR. WEITZEL HAS BEEN NOTIFIED OF THE RESULTS.
20 IN VIEW OF HIS DIABETES AND POSSIBLE DEHYDRATION, DR.
21 WEITZEL HAS ORDERED I.V. DR. WEITZEL PLANS TO TALK WITH
22 FAMILY IN MORNING REGARDING M.R.I. RESULTS AND PLAN OF CARE.
23 THE NEXT DAY, THERE'S NO MORPHINE, NONE. ON THE 12TH,
24 THE 11TH OR THE 10TH FOR ANY PURPOSE. ON THE 13TH, DR.
25 WEITZEL SAYS, ADDENDUM -- THIS IS IN HIS PROGRESS NOTES,
62
1 YOU'LL HAVE THIS ALL WITH YOU, IT'S PART OF THE EVIDENCE.
2 SPOKE WITH WIFE EXTENSIVELY. SHE FEELS STRONGLY THAT NO
3 EXTRAORDINARY MEASURES SHOULD BE TAKEN TO PROLONG ENNIS'
4 LIFE. GIVEN THE STROKE FOUND ON THE M.R.I., SHE REQUESTS WE
5 DISCONTINUE I.V. NO FLUIDS, NO FOOD, NO NOURISHMENT, AND
6 GIVE COMFORT CARE. LET HIM EXPIRE NATURALLY.
7 SO THEN DR. WEITZEL PUTS IN HIS PLAN WHICH IS
8 CONSISTENT WITH THAT AND THEN HE DECIDES APPROPRIATELY THAT
9 HE'S GOING TO START MORPHINE 10 MILLIGRAMS EVERY THREE HOURS
10 INTRAMUSCULAR WITH ATIVAN. AND BY THE WAY, THE MORPHINE
11 STARTS AT 8 O'CLOCK IN THE MORNING. THE CONVERSATION WITH
12 THE WIFE TOOK PLACE BEFORE 8 O'CLOCK, I MEAN, THIS -- YOU
13 CAN'T SEE THAT RIGHT HERE BUT THAT'S WHEN IT OCCURRED. AND
14 THAT'S ALL GIVEN FOR COMFORT BECAUSE THE FAMILY HAS DECIDED
15 TO LET HIM GO. AND ONE OF THE THINGS THEY ALSO HAVE DECIDED
16 IS TO DECREASE THE INSULIN. THIS GENTLEMAN HAD
17 UNCONTROLLABLE DIABETES. AND YOU'LL HEAR -- THE MEDICAL
18 TESTIMONY WILL BE IF YOU WITHDRAW THE INSULIN FROM SOMEBODY
19 LIKE MR. ALLDREDGE, HE WILL EVENTUALLY LAPSE INTO A DIABETIC
20 COMA AND DIE.
21 NOW, FINALLY, THIS -- I'M JUST HIGHLIGHTING THESE,
22 YOU'LL HAVE ALL THIS, BUT IT'S RIGHT HERE. THE NURSE, ONCE
23 AGAIN, LAURIE WILLSON, SHE'LL TESTIFY IN THIS TRIAL. YOU'LL
24 HEAR FROM HER, WE'LL CALL HER, 600, DR. WEITZEL GAVE
25 TELEPHONE ORDER FOR MORPHINE 10 MILLIGRAMS INTRAMUSCULAR
63
1 GIVEN IN LEFT GLUTEUS. NO RESPONSE FROM PATIENT TO NEEDLE
2 STICK. FAMILY REMAINS WITH PATIENT COMFORTING HIM AND
3 TALKING WITH HIM ASKING HIM TO LET GO.
4 NOW, I'VE TOLD YOU ABOUT THE TEAM. TO HELP YOU, THESE
5 ARE ALL THE FOLKS WHO PROVIDED MR. ALLDREDGE CARE. IN OTHER
6 WORDS, IT WASN'T JUST DR. WEITZEL. THESE ARE ALL PEOPLE WHO
7 PROVIDED HIM SOME FORM OF CARE. EVERY ONE OF THESE PEOPLE
8 HAD FULL ACCESS AT ANY TIME TO THE MEDICAL RECORDS AND THE
9 MEDICAL CHARTS. ANY TIME THESE PEOPLE COULD HAVE SEEN WHAT
10 MEDICATIONS WERE BEING GIVEN AND WHAT THE CARE WAS BEING
11 PROVIDED.
12 AND MORE IMPORTANTLY, WE HAVE ASTERISKS UNDER THIS IS
13 EARLENE COZZENS, SHE'S A NURSE. WE HAVE AN ASTERISK BY
14 BONNIE HARDEY, SHE'S A NURSE, AN ASTERISK BY LYNN LONG,
15 NURSE, AND LAURIE WILLSON, NURSE. AND THE REASON FOR THAT
16 IS THOSE FOUR INDIVIDUALS ADMINISTERED THE MORPHINE. IN
17 OTHER WORDS, THERE WILL BE NO EVIDENCE IN THIS TRIAL THAT
18 DR. WEITZEL EVER GAVE ONE OF THESE PATIENTS AN INJECTION.
19 EVERY SINGLE INJECTION WAS GIVEN BY A NURSE, AND THESE
20 NURSES WILL TESTIFY.
21 AND I'LL TELL YOU RIGHT NOW THAT LYNN LONG WILL TESTIFY
22 AND SHE WILL TELL YOU BASED UPON HER CLINICAL ASSESSMENT,
23 SHE WAS THERE, SHE SAW THE PATIENT, SHE OBSERVED THE
24 PATIENT, SHE HAD A FEEL FOR WHAT THE MEDICAL SITUATION WAS,
25 AND SHE WILL TELL YOU THERE WAS ABSOLUTELY NOTHING WRONG,
64
1 NOTHING WITH THE MEDICATION PRACTICES IN TERMS OF
2 ADMINISTERING MORPHINE FOR COMFORT CARE.
3 LAURIE WILLSON, WE'RE GOING TO CALL HER. WE HAD TO
4 BRING HER IN ALL THE WAY IN FROM PENNSYLVANIA AND SHE'LL
5 TELL YOU -- AND SHE ACTUALLY HAS A MASTER'S AS A NURSE AND
6 SHE IS A NURSE PRACTITIONER SO THAT SHE HAS A LICENSE IN THE
7 STATE OF UTAH TO GIVE MEDICATIONS. AND SHE'LL TELL THAT YOU
8 SHE WAS THERE, TOO, AND WHAT SHE SAW WITH RESPECT TO EACH
9 ONE OF THESE PATIENTS WAS TOTALLY APPROPRIATE, WAS TOTALLY
10 CONSISTENT WITH GOOD NURSING PRACTICE AND CERTAINLY THERE
11 WAS NOTHING WRONG WITH THE CARE. AND I'LL ALSO TELL YOU
12 THERE'S NOT ONE NURSE THAT'S GOING TO TESTIFY IN THIS TRIAL
13 THAT'S GOING TO TELL YOU THAT ANY INJECTION THEY GAVE, ANY
14 INJECTION THEY GAVE WHEN THEY GAVE IT, THEY THOUGHT IT WAS
15 GOING TO KILL A PATIENT.
16 THIS IS ANOTHER TIME LINE, ONCE AGAIN, OUT OF THE
17 MEDICAL RECORDS FOR MS. SMITH, LYDIA SMITH. AND YOU CAN GO
18 THROUGH THE SAME PROCESS, I'M GOING THROUGH THIS QUICKLY FOR
19 PURPOSES OF JUST GIVING YOU SOME GENERALIZED UNDERSTANDING,
20 BUT HERE, ONCE AGAIN, THE GREEN ARE THE PSYCH MEDS. THESE
21 WERE ACTUALLY GIVEN THE TIMES AND THE DOSAGES IN THE
22 HOSPITAL. YOU'LL SEE THESE AND THEN I HAVE, OF COURSE, THE
23 DATE.
24 SHE WAS ADMITTED TO THE HOSPITAL ON 12/20/95, SHE DIED
25 ON 1/8/96. AND WHAT IS SIGNIFICANT HERE IS SHE INDEED WAS
65
1 VERY COMBATIVE. SHE HAD A STROKE RIGHT IN NOVEMBER OF 1995,
2 A SEVERE STROKE. SHE HAD A HISTORY OF CONGESTIVE HEART
3 FAILURE, ATRIAL FIBRILLATION WHICH IS AN EVENT THAT CAN
4 OCCUR WITH THE HEART THAT CAN CAUSE SUDDEN HEALTH, (DEATH?)
5 HYPERTENSION AND SHE HAD A HEART VALVE REPLACEMENT. SHE WAS
6 ON A NUMBER OF MEDICATIONS AND SERZONE, WHICH IS ONE OF THE
7 PSYCH MEDS THAT WAS SHE WAS ON WHEN SHE WAS ADMITTED, YOU'LL
8 SEE SHE WAS GIVEN SERZONE AGAIN IN THE HOSPITAL. HALDOL IS
9 ANOTHER PSYCH MED AND I'M NOT SURE SHE GOT ANY HALDOL IN THE
10 HOSPITAL BUT IT'S A SEDATING MEDICATION TO TRY TO GET
11 CONTROL.
12 AND SIGNIFICANTLY, SIGNIFICANTLY THERE'S AN ENTRY RIGHT
13 HERE THIS ENTRY ON 12/28 AND KAY STEGLICH IS A C.S.W. WHICH
14 IS A CERTIFIED SOCIAL WORKER. SHE'S ONE OF THE SOCIAL
15 WORKERS THAT WOULD COME IN AND PROVIDE CERTAIN KINDS OF
16 ASSISTANCE. SHE TALKS WITH THE FAMILY AND THE FAMILY
17 VERBALIZES CONCERN REGARDING DISCHARGE PLANS. THEY
18 EMPHASIZE IMPORTANCE OF DECREASE IN PATIENT'S AGGRESSIVE
19 BEHAVIOR IF SHE'S TO BE ADMITTED TO ROCKY MOUNTAIN BOUNTIFUL
20 AFTER DISCHARGE. THE NURSING HOMES -- ONCE SOMEBODY GETS
21 COMBATIVE OR ASSAULTIVE, THE NURSING HOMES NO LONGER WILL
22 TAKE THEM AND THE REASON FOR THAT IS IS THEY CAN BE A DANGER
23 TO THEMSELVES, THEY CAN BE A DANGER TO THE STAFF OR THEY CAN
24 BE A DANGER TO OTHER PATIENTS.
25 SO THE WHOLE PURPOSE OF HER BEING HERE IS TO TRY TO GET
66
1 MS. SMITH SO THAT SHE WOULDN'T BE SO COMBATIVE AND
2 ASSAULTIVE. AND IN THE NURSING HOME, YOU'LL READ THIS,
3 THERE WAS ONE INCIDENT RIGHT BEFORE SHE WAS ADMITTED WHERE
4 SHE ACTUALLY WENT OUT, OUT OF THE NURSING HOME, WAS IN THE
5 PARKING LOT, A BUNCH OF NURSES CAME OUT TO TRY TO GET HER TO
6 COME BACK AND SHE PHYSICALLY FOUGHT THEM. I MEAN, THAT'S
7 THE BEHAVIOR WE'RE TALKING ABOUT, AND OBVIOUSLY, THE FAMILY
8 IS CONCERNED ABOUT THE AGGRESSION AND TRYING TO RESOLVE IT.
9 WE GO OVER HERE AND YOU CAN -- YOU CAN READ THESE.
10 THESE BASICALLY -- BUT SEE THERE'S NOTHING THAT OCCURS
11 SIGNIFICANT IN TERMS OF ANY KIND OF SEDATION OR ANY KIND OF
12 POSITIVE EFFECT UNTIL WE GET TO THE 6TH OF JANUARY. AND
13 THERE YOU HAVE, FINALLY, BEHAVIOR IS NOT -- PATIENT HAS NOT
14 BEEN VERY AGGRESSIVE. SHE'S BEEN SLEEPING MOST OF THE DAY.
15 WHEN AWAKE SHE'S BEEN TRYING TO STRIP. WHEN OFFERED MEALS,
16 SHE HAS SPIT IT OUT AT US. BEHAVIOR: PATIENT HAS BEEN
17 QUIET THIS SHIFT. RESTING QUIETLY WITH EYES CLOSED MOST OF
18 THE SHIFT. RESPIRATION: EVEN AND UNLABORED.
19 AND THEN WE GET TO THE 7TH AND THIS IS A CRITICAL DAY.
20 AND YOU'LL SEE THAT DR. WEITZEL STATES IN HIS PROGRESS NOTE
21 DOWN HERE, VERY WEAK. WHAT HAPPENED IS MS. SMITH'S KIDNEYS
22 SHUT DOWN AND SHE STOPPED TAKING FOOD, SHE STOPPED TAKING
23 NOURISHMENT, SHE HAD NO URINE OUTPUT AND YOU'LL HEAR PEOPLE
24 COME IN AND THEY'LL TELL YOU, EXPERTS IN HOSPICE CARE AND
25 NURSES, THAT THOSE ARE SIGNS OF THE DEATH AND DYING PROCESS
67
1 WHEN THOSE THINGS OCCUR.
2 AND SO THERE WAS AN ASSESSMENT THAT MS. SMITH WAS DYING
3 AND DR. WEITZEL PUTS, FAMILY DISCUSSION WITH TWO SONS AND
4 DAUGHTER REVEALS THAT THEY DO NOT WANT HER LIFE PROLONGED
5 BUT ARE READY TO LET HER GO. AT TIMES SHE THRASHES ABOUT,
6 SEEMS TO BE IN PAIN AND ANXIETY. ASSESSMENT: QUITE ILL.
7 PLAN: HOLD MEDICATIONS, IN OTHER WORDS, HOLD THE PSYCH
8 MEDICATIONS BECAUSE THERE'S NO PURPOSE FOR HAVING THEM
9 ADMINISTERED AT THIS POINT, AND MORPHINE S.O. 4,
10 5 MILLIGRAMS EVERY THREE HOURS INTRAMUSCULARLY, WHICH IS
11 EXACTLY WHAT HAPPENS AFTER THE CONVERSATION WITH THE FAMILY.
12 AND THEN YOU HAVE THIS ON THE 8TH IN TERMS OF MORPHINE BEING
13 ADMINISTERED AND THEN THE PATIENT DIES.
14 AND INTERESTING THIS IS -- ONCE AGAIN, THIS IS A NURSE
15 WHO CHARTS THIS IN THE WEEKLY ADVOCATE NOTE. PATIENT'S
16 PHYSICAL CONDITION HAS MARKEDLY DETERIORATED. SHE'S UNABLE
17 TO SWALLOW FOOD OR MEDICATION. SHE'S NOT VISIBLY RESPONSIVE
18 TO HER ENVIRONMENT, AND THAT WAS THE CIRCUMSTANCE. ONE OF
19 THE THINGS -- THE CARE PLAN HAS BEEN CHANGED TO REFLECT
20 PATIENT AND FAMILY NEEDS AROUND DEATH AND DYING ISSUES.
21 THE NURSES WILL TELL YOU -- BECAUSE REMEMBER, THEY HAD
22 A VERY SIGNIFICANT ROLE IN THE CARE PROVIDED. AND WHAT
23 NURSES DO IS THEY ASSESS THINGS AND THEY'LL TELL YOU THIS:
24 THEY ARE NOT DOCTORS. THEY DON'T DIAGNOSE, THEY ASSESS.
25 THEY PERCEIVE THINGS. THEY SEE CONDITIONS AND THEN THEY
68
1 DEVELOP CARE PLANS. AND ONE OF THE CARE PLANS THAT NURSES
2 DEVELOP WHEN THEY SEE THAT A PATIENT IS DYING IS BASICALLY A
3 DEATH AND DYING CARE PLAN.
4 AND ONE OF THE THINGS THAT'S INCLUDED IN THAT PLAN IS
5 WHAT ARE CALLED COMFORT MEASURES, IT HAS NOTHING TO DO WITH
6 MEDICATION. AND THOSE COMFORT MEASURES, FOR EXAMPLE, WOULD
7 BE DIMMING THE LIGHTS, SOFTLY TALKING TO THE PATIENT,
8 PROVIDING SOME KIND OF COMFORT IN TERMS OF THEIR EYES, AND
9 YOU'LL SEE THIS IN THE NOTES BUT IT'S PART OF THE DEATH AND
10 DYING PROCESS THAT PEOPLE STARE AND THEIR EYELIDS DO NOT GO
11 UP AND DOWN SO THEIR EYES GET DRY SO THEY GET ARTIFICIAL
12 TEARS SO THERE'S A WHOLE HOST OF OTHER THINGS TO TRY TO GIVE
13 COMFORT AND COMPASSION TO A PERSON WHO IS DYING.
14 AND THIS IS WHAT MS. WILSON IS TALKING ABOUT IN TERMS
15 OF THE CARE PLAN. IT'S ACTUALLY A WRITTEN PLAN, IT'S IN THE
16 MEDICAL RECORDS BASED UPON HER CLINICAL ASSESSMENT THAT THIS
17 PERSON WAS IN FACT DYING. SAME THING AS WITH MR. ALLDREDGE.
18 THESE ARE ALL THE PEOPLE WHO YOU WILL SEE IN THE MEDICAL
19 RECORDS PROVIDED CARE AS PART OF THE MEDICAL TEAM TO
20 MS. SMITH, AND, ONCE AGAIN, THESE ARE THE NURSES, MS. SHEILA
21 HANSEN AND MS. LAURIE WILLSON WHO PROVIDED MORPHINE
22 INJECTIONS TO MS. SMITH.
23 NOW, I'LL TELL YOU ALSO MS. HANSEN IS GOING TO TESTIFY
24 IN THIS CASE. I DON'T KNOW WHETHER SHE'S GOING TO BE CALLED
25 BY THE PROSECUTION OR IS GOING TO BE CALLED BY US, BUT SHE'S
69
1 GOING TO TESTIFY. AND SHE'LL ALSO TELL YOU SHE HAS HAD
2 PROBABLY ABOUT 30 YEARS EXPERIENCE DOING ALL KINDS OF THINGS
3 IN THE NURSING WORLD AND SHE'S GOING TO TELL YOU THAT THE
4 CARE THAT WAS PROVIDED TO THESE PATIENTS WAS APPROPRIATE AND
5 THAT THE MEDICATION PROVIDED, THAT IS MORPHINE, WAS PROVIDED
6 FOR COMFORT MEASURES ONLY AND WAS TOTALLY APPROPRIATE GIVEN
7 THE NATURE OF THE DEATH AND DYING PROCESS WHICH SHE
8 ASSESSED.
9 NOW, THIS IS THE MOST COMPLICATED TIME LINE BECAUSE
10 JUDITH WAS ACTUALLY IN THE HOSPITAL FOR A LONGER TIME THAN
11 ANYONE ELSE. IN FACT, YOU SEE SHE WAS ADMITTED ON 1/26/95 (12/6/95)
12 AND SHE WAS IN THE HOSPITAL UNTIL 1/3 OF '96 SO IT'S A
13 FAIRLY EXTENSIVE MEDICAL CIRCUMSTANCE. AND I TOLD YOU ABOUT
14 MERLIN AND HIS DIFFICULTIES THAT HE WAS EXPERIENCING WITH
15 HIS MOM. ON ADMISSION THIS IS WHAT HE TOLD THE NURSE. HE
16 SAID, WE HAVE HOPES BUT NOT FANTASIES IN REGARD TO PATIENT'S
17 CHANCES FOR IMPROVEMENT. AND THEN ONCE AGAIN -- AND YOU'LL
18 SEE THESE. THEY ARE ACTUALLY WRITTEN DOCUMENTS THESE LIVING
19 WILLS AND THESE DO NOT RESUSCITATE ORDERS. YOU'LL SEE THEM
20 AND WHAT LIMITATIONS THEY IMPOSE.
21 BUT HERE ON THE 11TH, THE NURSE, THIS IS BONNIE HARDEY
22 THIS TIME WHO IS CHARTING THIS, PATIENT'S FAMILY MEMBER
23 CALLED AND REQUESTED INFORMATION ON PATIENT'S STATUS.
24 FAMILY CONTINUES TO NOT WANT I.V.'S, FEEDING TUBES, ET
25 CETERA, AS PER LIVING WILL. OXYGEN OKAY. FAMILY RELIEVED
70
1 TO HEAR THAT PATIENT IS NOT SCREAMING OUT AND/OR AGITATED
2 CURRENTLY. SO THERE'S SOME DEVELOPMENTS THROUGHOUT HERE.
3 AND YOU GET TO THE POINT WHERE WE'RE -- AT THIS POINT
4 ON THE 26TH WHICH IS WHERE I TOLD YOU THAT JUDITH STARTED TO
5 HAVE SOME VERY SERIOUS MEDICAL PROBLEMS. IT SAYS, SEIZURE
6 ACTIVITY NOTED. AND DR. DIENHART IS CALLED IN, HE'S AN
7 INTERNAL MEDICINE DOCTOR. HE'S CALLED IN TO DEAL WITH THIS
8 PROBLEM. AND HE ORDERS 3-MILLIGRAM ATIVAN WHICH IS A
9 SEDATING MEDICATION BE ADMINISTERED. NO IMPROVEMENT. AN
10 ADDITIONAL 1 MILLIGRAM ATIVAN IS ORDERED BY DR. DIENHART AS
11 WELL AS DILANTIN. NOW, DILANTIN IS ALSO A SEDATING
12 MEDICATION BUT IT'S AN ANTISEIZURE MEDICATION. IT'S GIVEN
13 TO DEAL WITH THE SEIZURES. HER BLOOD PRESSURE AT THIS POINT
14 IS 70 OVER 40. PERIODS OF APNEA. APNEA -- AND YOU'LL HEAR
15 ABOUT THIS. THIS IS WHERE YOU STOP BREATHING FOR 15, 20, 25
16 SECONDS AND THEN YOU BREATHE AGAIN. IT'S A PHENOMENON THAT
17 YOU SEE IT'S CALLED APNEA. IT'S ONE OF THOSE FANCY WORDS
18 FOR THAT CONDITION.
19 SO ANYWAY THAT'S HER CONDITION ON THE 26TH. AND THEN
20 NOTICE SHEILA HANSEN SAYS, COMPLAINT OF MOANING, APPEARS TO
21 BE IN SOME DISCOMFORT. PATIENT HAS SEEMED COMFORTABLE SINCE
22 RECEIVING MORPHINE, BECAUSE THERE WERE 2 MILLIGRAMS OF
23 MORPHINE GIVEN ON THIS DAY FOR THE VERY REASONS THAT WHAT
24 MS. HANSEN OBSERVED. AND THEN WE HAVE RIGHT HERE THIS
25 PARTICULAR ENTRY WHERE DR. WEITZEL SPEAKS WITH THE SON AND
71
1 THE DAUGHTER-IN-LAW AND SHE APPEARS MEDICALLY STABLE AT THIS
2 POINT, SO THE DILANTIN WHICH APPEARS TO BE CAUSING SEDATION
3 IS DISCONTINUED BY DR. WEITZEL.
4 AND THEN WE START ON 12/29 THE PROBLEM ABOUT HER
5 THROWING UP FOR 26 HOURS STRAIGHT WHICH IS CHARTED HERE AND
6 HERE. PATIENT -- AND THIS IS WHAT BONNIE HARDEY WRITES,
7 THIS IS AN EXACT QUOTE OUT OF THE NURSES' NOTES, PATIENT'S
8 FAMILY IN TO SEE PATIENT, AWARE OF PHYSICAL STATUS CHANGE.
9 FAMILY STATED THEY WANT DO NOT WANT RESUSCITATE STATUS
10 MAINTAINED AND COMFORT MEASURES GIVEN. THEN DR. WEITZEL HE
11 CHARTS SAME DAY, MET WITH SON AND DAUGHTER THIS P.M.
12 REGARDING PATIENT'S CONDITION. COFFEE GROUNDS VOMIT IS
13 GREATER THAN THIS MORNING WHICH IS, ONCE AGAIN, IT'S
14 EVIDENCE OF BLOOD. SO HE ASSESSES A GASTROINTESTINAL BLEED.
15 PLAN: MAKE SURE SHE IS COMFORTABLE WITH ROUTINE MORPHINE.
16 MERLIN CALLS AND TALKS TO MS. KLEI, MS. KLEI IS ANOTHER
17 NURSE WHO WAS ON SHIFT THAT NIGHT, CALLED SON AND GAVE SON
18 REPORT ON PATIENT'S CONDITION. MERLIN, STRESS THAT ONLY ,
19 THIS IS MERLIN STRESSING TO THE NURSE, ONLY WISH TO KEEP HER
20 COMFORTABLE. SO THAT'S WHERE WE ARE AS OF THIS DATE, THERE
21 ISN'T GOING TO BE ANY OTHER ATTEMPT TO TRY TO DEAL WITH THE
22 GASTROINTESTINAL BLEEDING OR ANY OTHER CIRCUMSTANCE OR THE
23 FACT THAT JUDITH BECAUSE OF THIS BLEEDING, AND THE MEDICAL
24 EVIDENCE WILL SHOW THIS, SHE LOST 25 PERCENT OF HER BLOOD
25 AND THAT WAS DONE PURSUANT TO A TEST THEY DID IN THE
72
1 HOSPITAL WHICH CAUSES INCREDIBLE PROBLEMS IN TERMS OF
2 OXYGENATION AND THINGS LIKE THAT.
3 SON GOES ON TO SAY ON THE 31ST, SON VERY CONCERNED
4 ABOUT PATIENT'S MEDICAL CONDITION. WANTED TO KNOW WHEN
5 PATIENT WOULD BE DYING. FAMILY MEMBER UPSET THAT STAFF
6 NURSE WOULD NOT STATE PATIENT WAS DYING. PATIENT'S
7 CONDITION POOR. AND THIS IS WELL BEFORE ANY SIGNIFICANT
8 AMOUNTS OF MORPHINE ARE EVEN PROVIDED TO THE PATIENT. GOES
9 ON TO SAY ON 12/30, SON CONCERNED THAT FAMILY MEMBERS WERE
10 FLYING IN FROM OUT OF STATE DUE TO NIGHT'S SHIFT REPORT TO
11 SON ON 12/30, AND THAT'S REFERRING TO THIS. THEN IT GOES ON
12 AND THERE'S A PROGRESSION HERE WHICH FINALLY ENDS UP WITH
13 JUDITH'S DEATH ON THE 3RD.
14 SIGNIFICANTLY, THIS IS WHAT LAURIE WILLSON SAID ABOUT
15 HER SITUATION IN THIS WEEKLY NOTE. WEEKLY R.N. ADVOCATE
16 NOTE, PATIENT'S MEDICAL STATUS HAS RAPIDLY AND PROFOUNDLY
17 DETERIORATED THIS WEEK. SHE HAS EXPERIENCED A SEIZURE AND
18 MULTIPLE EPISODES OF VOMITING COFFEE GROUNDS MATERIAL. SHE
19 IS NO LONGER VERBALLY RESPONSIVE, THE CARE PLAN, ONCE AGAIN,
20 THAT NURSING CARE PLAN, HAS BEEN ALTERED TO REFLECT THE NEED
21 TO SUPPORT THE PATIENT AND FAMILY THROUGH A POSITIVE DEATH
22 AND DYING PROCESS. PATIENT IS CURRENTLY RECEIVING MORPHINE
23 INTRAMUSCULAR EACH AND EVERY THREE HOURS FOR COMFORT.
24 SAME THING AS WITH THE OTHERS BUT BECAUSE JUDITH WAS IN
25 THE HOSPITAL FOR A LONGER PERIOD OF TIME THERE ARE A LOT
73
1 MORE FOLKS WHO HELPED HER AND PROVIDED HER CARE AND YOU SEE,
2 ONCE AGAIN, YOU HAVE IN HER CASE ONE, TWO, THREE, FOUR,
3 FIVE, SIX, SEVEN, NURSES WHO ALL GAVE HER MORPHINE
4 INJECTIONS. AND, ONCE AGAIN, THERE WERE NO INJECTIONS GIVEN
5 BY DR. WEITZEL. AND ALL OF THESE PEOPLE, ALL OF THESE
6 PEOPLE, INCLUDING THESE M.D.'S, THESE SOCIAL WORKERS AND
7 EVERYONE ELSE AT ANY POINT COULD JUST OPEN UP THE CHART,
8 TAKE A LOOK AT IT, SEE WHAT WAS GOING ON IN TERMS OF THE
9 PATIENT'S CONDITION AND THE MEDICATIONS.
10 THE FINAL ONE AND THIS IS MS. CRANE. OUR EXPERT -- AND
11 I'LL TELL YOU, WE'LL HAVE A CAUSE OF DEATH EXPERT, A MEDICAL
12 DOCTOR WHO WILL TELL YOU WHAT HE BELIEVES TO A REASONABLE
13 MEDICAL CERTAINTY CAUSED THE DEATH WITH RESPECT TO EACH ONE
14 OF THESE PATIENTS, AND HE'S GOING TO TELL YOU MORPHINE HAD
15 ABSOLUTELY NOTHING TO DO WITH IT.
16 AND HIS OPINION IS, IN ESSENCE, CONSISTENT WITH THE
17 MEDICAL EXAMINER, BECAUSE THE STATE MEDICAL EXAMINER IN
18 DOING AUTOPSIES ON FOUR OF THESE PATIENTS COULD NOT CONCLUDE
19 A CAUSE OF DEATH AND IS NOT GOING TO COME IN HERE AND GIVE
20 HIS OPINION THAT MORPHINE CAUSED THE DEATH OF THOSE FOUR
21 PATIENTS, ONE OF WHICH IS MARY CRANE. AND OUR EXPERT IS
22 GOING TO SAY THE REASON WHY MARY DIED IS BECAUSE MARY HAD A
23 VERY SERIOUS INFECTION AND THAT SERIOUS INFECTION EVENTUALLY
24 CREATED A CONDITION SO THAT SHE DIED FROM THE INFECTION.
25 AND THE SIGNIFICANT THINGS HERE, ONCE AGAIN, TO SHORT
74
1 CIRCUIT THIS -- AND MARY DID HAVE A NUMBER OF PROBLEMS WHICH
2 DR. DIENHART NOTED IN HIS INITIAL CONSULT, BUT SIGNIFICANTLY
3 ON 1/1 -- YEAH, SHE CAME IN WITH URINARY TRACT INFECTION AND
4 I THINK ALL THE DOCTORS WHO WILL TESTIFY IF ASKED THEY'LL
5 AGREE THAT IN AN ELDERLY PATIENT -- AN INFECTION PERHAPS IN
6 A YOUNGER PERSON IS NOT SIGNIFICANT, BUT AN INFECTION IN AN
7 ELDERLY PERSON CAN BE VERY, VERY -- IT CAN BE FATAL AND
8 VERY, VERY DIFFICULT. A URINARY TRACT INFECTION CAN BE A
9 TERMINAL EVENT IF NOT ADEQUATELY DEALT WITH IN AN ELDERLY
10 WOMAN.
11 SHE COMES IN WITH A URINARY TRACT INFECTION AND YOU'LL
12 SEE DR. WEITZEL PUT HER ON AN APPROPRIATE ANTIBIOTIC TO DEAL
13 WITH THAT. BUT HE NOTES AS THE NURSES' NOTE ON 1/1 HE SAYS,
14 SHE HAS A FISTULA FROM RECTUM TO VAGINA PASSING FECES
15 THROUGH THE VAGINA. NOW, I'LL TELL YOU, WE'RE GOING TO HAVE
16 A DOCTOR WHO WILL TELL YOU WHO'S TREATED THIS CONDITION, HE
17 WILL TELL YOU THAT'S EXCEEDINGLY, EXCEEDINGLY PAINFUL.
18 THAT'S THE FIRST THING HE'S GOING TO TELL YOU. THE SECOND
19 THING IS IT'S INFECTIOUS AS ALL GET-OUT. AND YOU'LL SEE
20 THAT DR. WEITZEL GETS A CONSULT IN FROM A GYNECOLOGICAL -- A
21 GYNECOLOGIST, RATHER, AND HE COMES IN ONE, TOO, BECAUSE HE
22 SUPPOSEDLY KNOWS ABOUT THESE THINGS AND THIS IS DR. MEEKS.
23 DR. MEEKS IN HIS CONSULT SAYS, COMPLAINT OF FECAL
24 MATTER OUT OF VAGINA. ON EXAM HAS HIGH RECTAL VAGINAL
25 FISTULA. SO THAT'S WHAT MARY HAS. CAN REPAIR IF CLEARED
75
1 FOR SURGERY BY HER INTERNIST, THAT WILL BE DR. DIENHART.
2 MAY TRY TO HEAL SPONTANEOUSLY PROBABLY WITH 25 TO 35 PERCENT
3 WITH BROAD-SPECTRUM ANTIBIOTICS, BECAUSE IT'S INFECTIOUS.
4 WELL, ON THE 3RD, DR. WEITZEL SAYS, PLEASE HAVE DR. DIENHART
5 MADE AWARE OF GYNECOLOGIST'S RECOMMENDATIONS. IN OTHER
6 WORDS, TELL THE INTERNAL MEDICINE GUY THAT DR. MEEKS HAS HIS
7 CONSULT AND IF WE'RE NOT GOING TO DO SURGERY, WE BETTER DO
8 ANTIBIOTICS. AND THERE'S AN ENTRY BY LYNN LONG SAYS, DR.
9 DIENHART'S SECRETARY NOTIFIED, ON THIS DAY.
10 NOW, THEREAFTER, DR. DIENHART DOESN'T SHOW UP IN THE
11 CARE OF THIS PATIENT UNTIL THE DAY SHE DIES. MEANWHILE
12 YOU'LL SEE IN THE RECORDS, DR. WEITZEL FINALLY BECAUSE OF
13 THIS SITUATION ORDERS AN ANTIBIOTICS, KEFLEX, IT'S ON THE
14 5TH. IT MAY NOT BE ON THIS CHART BUT I'M TELLING YOU THAT'S
15 WHAT HE DOES AND THE RECORD WILL SHOW THAT. SO SHE HAS A
16 VAGINAL FISTULA WHICH ESSENTIALLY IS UNTREATED.
17 AND THEN IF YOU GO TO THE 7TH, LOOK AT WHAT DR.
18 DIENHART IS ASSESSING. POSSIBLE SEIZURE. SHE DID HAVE A
19 SEIZURE. AND IMPRESSION AND HE GOES ON TO SAY, HYPOTENSIVE,
20 WHICH MEANS HER BLOOD PRESSURE WAS VERY, VERY SLOW AND
21 LETHARGIC, AND POSSIBLE SEPSIS. SEPSIS IS THE CONDITION
22 WHERE YOU ARE SO INFECTED THAT ESSENTIALLY YOU HAVE BACTERIA
23 IN YOUR BLOOD AND THAT IS A -- THAT'S A DEADLY CONDITION, NO
24 ABOUT IT AND IF UNTREATED, IT'S A TERMINAL CONDITION.
25 HE GOES ON TO SAY, CASE DISCUSSED WITH DR. WEITZEL,
76
1 PATIENT FELT TO HAVE DECLINING STATUS AND WISHED NOT TO HAVE
2 C.P.R. PERFORMED. ONCE AGAIN, SHE HAS MEDICAL DIRECTIVES IN
3 PLACE SIGNED BY HER DAUGHTER ON THE 28TH OF DECEMBER WHICH
4 ELIMINATE THE ABILITY OF A PHYSICIAN TO DO CERTAIN THINGS,
5 ONE OF WHICH IS THE C.P.R., ONE OF WHICH IS SURGERY, ONE OF
6 WHICH IS USING I.V. FLUIDS. THE PHYSICIAN IS ETHICALLY
7 OBLIGATED AND IS BOUND BY THEM.
8 AND THEN HE GOES ON TO SAY, AFTER DISCUSSION WITH
9 PRIMARY MEDICAL DOCTOR, THIS IS DR. DIENHART AND WILL NOT --
10 AND BASICALLY, IT'S 3:10 A.M., WILL NOT OFFER FURTHER
11 AGGRESSIVE SUPPORTIVE CARE. I SUSPECT SHE MAY DIE SOON.
12 AND THEN THERE'S A CONVERSATION BECAUSE THE HOSPITAL -- THE
13 EVIDENCE WILL BE THE HOSPITAL CALLS THE DAUGHTER, I THINK
14 KAREN BRINGHURST, AND SAYS, YOUR MOM IS IN REAL BAD SHAPE,
15 YOU BETTER COME TO THE HOSPITAL SOON AND SHE DOES. AND THEN
16 SHE HAS A CONVERSATION WITH DR. WEITZEL AND DR. WEITZEL
17 SAYS, I HAVE SPOKEN WITH HER TWO DAUGHTERS AND THEY DO NOT
18 WANT EXTRAORDINARY MEASURES TAKEN BUT WOULD RATHER HAVE
19 COMFORT CARE GIVEN. IN OTHER WORDS, DON'T DO ANYTHING TO
20 TREAT THE INFECTION, LET MS. CRANE DIE NATURALLY.
21 AND THEN, ASSESSMENT: PROBABLY ASPIRATION PNEUMONIA,
22 QUITE DEMENTED, HYPOTENSIVE, POSSIBLE SEPSIS. PLAN: WILL
23 RESPECT FAMILY'S WISHES, PROVIDE COMFORT CARE BUT NOT
24 EXTRAORDINARY CARE. AND MS. BRINGHURST WILL TESTIFY IN THIS
25 CASE. MS. BRINGHURST IS MARY'S DAUGHTER, ONE OF MARY'S
77
1 DAUGHTERS AND SHE'S BEEN A NURSE FOR OVER 20 YEARS AT THE
2 TIME THAT THIS OCCURRED. SHE CAME INTO THE HOSPITAL IN
3 RESPONSE TO A CALL FROM THE HOSPITAL THIS AFTERNOON, AFTER
4 DR. DIENHART HAD ALREADY DETERMINED THAT MARY MAY DIE SOON.
5 AND SHE'S GOING TO TELL THAT YOU HER ASSESSMENT WAS,
6 BASED UPON LOOKING AT HER MOM, SHE THOUGHT HER MOM WAS IN
7 PRETTY BAD SHAPE. AND SHE RECALLS THE CONVERSATION WITH DR.
8 WEITZEL AND SHE ALSO RECALLS THAT DR. WEITZEL SAID, WELL,
9 ONE OF THE WAYS WE CAN KEEP YOUR MOM COMFORTABLE IS TO GIVE
10 HER SOME MEDICATION, MORPHINE, IT'S A WAY TO KEEP HER
11 COMFORTABLE SO THAT SHE'S NOT IN THIS ANGUISH IF WE'RE NOT
12 GOING DO ANYTHING TO TRY TO TREAT THE INFECTION. AND SHE
13 RECALLS THAT CONVERSATION AND AT THE TIME GIVEN WHAT SHE SAW
14 AND WHAT SHE OBSERVED AND WHAT SHE ASSESSED, SHE DIDN'T FIND
15 ANYTHING INAPPROPRIATE ABOUT GIVING MORPHINE AT THAT TIME
16 UNDER THOSE CIRCUMSTANCES.
17 ONCE AGAIN, THESE WERE ALL THE PEOPLE WHO PROVIDED CARE
18 TO MARY CRANE. THESE ARE ALL THE DOCTORS. NOW REMEMBER,
19 EVERY ONE OF THESE DOCTORS AT ANY TIME COULD HAVE LOOKED AT
20 THAT FILE, COULD HAVE LOOKED AT THE CHART AND MADE ANY KIND
21 OF MEDICAL JUDGMENT THEY WANT. THE SAME IS TRUE WITH THE
22 CERTIFIED NURSING ASSISTANTS. THE SAME IS TRUE WITH THE
23 NURSES. ONCE AGAIN, WE HAVE MS. COZZENS WHO GAVE AT LEAST
24 ONE INJECTION OF MORPHINE AND MS. LONG AND MS. SCHOLL.
25 NOW, WE'RE GOING TO HAVE A NURSE EXPERT WHO IS GOING TO
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1 TELL YOU THAT A NURSE IS SUPPOSED TO MAKE SURE THAT IF THEY
2 ARE GOING TO DO ANYTHING IN TERMS OF MEDICATIONS THAT THEY
3 DO NO HARM TO THE PATIENT AND THAT A NURSE HAS A DUTY IF
4 THERE IS A PROBLEM WITH THE MEDICATION NOT TO GIVE IT. MORE
5 IMPORTANTLY, IF THE NURSE THINKS THERE IS A PROBLEM AND SHE
6 HAS A PROBLEM WITH THE PHYSICIAN, SHE'S SUPPOSED TO GO TO
7 THE PHYSICIAN AND TALK TO THE PHYSICIAN AND IF THE PHYSICIAN
8 AND HER CAN'T RESOLVE THE CONFLICT, SHE'S OBVIOUSLY SUPPOSED
9 TO GO UP THE LINE WITH RESPECT TO THE HOSPITAL
10 ADMINISTRATION. BUT UNDER NO CIRCUMSTANCES IS A NURSE
11 SUPPOSED TO DO HARM TO A PATIENT. AND A NURSE HAS AN
12 INDEPENDENT PROFESSIONAL DUTY TO MAKE SURE THAT WHEN SHE
13 GIVES AN INJECTION, FOR EXAMPLE, MORPHINE, THAT THAT
14 MORPHINE IS NOT GOING TO DO ANY HARM TO THE PATIENT AND
15 THERE WILL BE OTHER THINGS SHE'LL TELL YOU ABOUT AND THESE
16 NURSES WILL TELL YOU ABOUT.
17 NOW, DR. WEITZEL -- AS YOU'VE ALREADY BEEN INSTRUCTED
18 HERE, WE HAVE NO BURDEN HERE. WE HAVE NO DUTY TO CONVINCE
19 YOU OF ANYTHING AND DR. WEITZEL HAS A CONSTITUTIONAL RIGHT
20 NOT TO TESTIFY. HE'S GOING TO TESTIFY AND HE'S GOING TO
21 TAKE THE STAND AND HE'S GOING TO TELL YOU CERTAIN THINGS.
22 AND FIRST OF ALL HE'S GOING TO TELL YOU CERTAINLY THAT HIS
23 SOLE PURPOSE IN PROVIDING ANY MEDICATION TO PROVIDE CARE FOR
24 THESE PATIENTS WAS TO HELP THEM AND TO KEEP THEM COMFORTABLE
25 IN THE DYING PROCESS.
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1 HE'S ALSO GOING TO TELL YOU THAT HE ESSENTIALLY WAS
2 PROVIDING WHAT IS CALLED HOSPICE CARE IN THE HOSPITAL AND
3 HE'S GOING TO TELL YOU ONE OF THE REASONS WHY HE DID THAT.
4 IT'S BECAUSE WHEN SOMEBODY IS DYING AND THEY ARE ON A
5 PARTICULAR UNIT AND THEY ARE IN A HOSPITAL, TO TRANSFER THEM
6 OUT OF THE HOSPITAL, TO TRANSFER THEM TO ANOTHER PLACE CAN
7 BE VERY DISRUPTIVE, NOT ONLY TO THE FAMILY BUT TO THE
8 PATIENT. SO HE MADE A DECISION THAT IT WAS BETTER TO KEEP
9 THEM IN THE HOSPITAL RATHER THAN TRANSFER THEM OUT FOR
10 HOSPICE CARE WHICH HE COULD HAVE DONE.
11 HE'S ALSO GOING TO TESTIFY AND TELL YOU THAT THE
12 DECISIONS HE MADE, FOR EXAMPLE, THE JUDGMENT THAT HE MADE
13 THAT A PATIENT WAS DYING, WAS A CLINICAL JUDGMENT THAT HE
14 MADE IN CONJUNCTION WITH THE ENTIRE MEDICAL TEAM. HE'S ALSO
15 GOING TO TELL YOU THAT THE DECISIONS HE MADE ABOUT WHAT KIND
16 OF CARE WERE IN CONJUNCTION WITH THE FAMILY AND IN
17 CONJUNCTION WITH THE MEDICAL CHOICES AND THE LIVING WILLS
18 WHICH THE FAMILY HAD IN PLACE WHICH LIMITED HIS ABILITY TO
19 TAKE CERTAIN MEASURES WHICH MIGHT -- MIGHT HAVE REVERSED
20 SOME OF THESE PROCESSES.
21 AND HE'S FINALLY GOING TO TELL YOU, AND I THINK THIS IS
22 REALLY, LADIES AND GENTLEMEN, WHERE THIS CASE HINGES, ONCE A
23 DECISION WAS MADE IN THESE CASES, FOR EXAMPLE, ONCE A
24 DECISION WAS MADE ON MARY CRANE THAT WE'RE NOT GOING TO
25 TREAT THE INFECTION AS WE SHOULD WITH I.V. FLUIDS OR WE'RE
80
1 NOT GOING TO HAVE SURGERY WITH RESPECT TO THE VAGINAL
2 FISTULA, DR. WEITZEL HAS A DUTY INDEPENDENT OF ANYTHING ELSE
3 TO MAKE SURE THAT THAT PERSON IS KEPT COMFORTABLE IF THEY
4 ARE ABOUT TO DIE, AND THAT'S PRECISELY WHAT HE WAS DOING IN
5 TERMS OF HIS MEDICATION PRACTICES AND IN TERMS OF HIS CARE.
6 NOW, AS YOU GO THROUGH THE EVIDENCE AND I'M ABOUT TO
7 WRAP UP BECAUSE I -- BUT I THINK IT'S IMPORTANT YOU KNOW ONE
8 OF THE THINGS THAT'S GOING TO HAPPEN IN THIS CASE IS YOU ARE
9 GOING TO GET AS EVIDENCE, YOU ARE GOING TO GET A BUNCH OF
10 BINDERS. THEY MAY NOT BE RED BUT I'M TELLING YOU RIGHT NOW
11 HERE ARE ALL THE MEDICAL RECORDS AND THEY'LL BE RIGHT THERE
12 AND YOU'LL HAVE THEM. AND THEN YOU ARE GOING TO HAVE PEOPLE
13 WHO ARE GOING TO TAKE THIS WITNESS STAND AND THEY ARE GOING
14 TO SAY, WELL, FIVE YEARS AGO I REALLY DIDN'T SAY THAT OR
15 THAT REALLY DIDN'T HAPPEN AND I SUGGEST THINK ABOUT IT.
16 WHICH IS MORE TRUSTWORTHY, THE ACTUAL MEDICAL RECORDS WHICH
17 WAS MADE AT THE TIME BY PEOPLE WHOSE RESPONSIBILITY IT WAS
18 TO BE ACCURATE, OR SOMEBODY'S RECOLLECTION NOW FIVE YEARS
19 LATER WHEN MAYBE THAT RECOLLECTION IS NOT THAT GOOD OR MAYBE
20 THEY HAVE SOME OTHER MOTIVE OR BIAS TO TESTIFY THE WAY THEY
21 ARE?
22 THE OTHER THING IS I TOLD YOU ABOUT THESE EXPERTS.
23 WELL, THINK ABOUT THIS AS YOU HEAR THE EVIDENCE AND AS YOU
24 HEAR THE EXPERTS: WHO REALLY WAS IN A BETTER POSITION TO
25 DECIDE WHAT WAS GOING ON, SOME GUY WHO COMES UP HERE AND
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1 TESTIFIES AFTER BASICALLY JUST BEING A RECORD REVIEWER?
2 THAT'S ALL THE EXPERTS ARE GOING TO BE. THEY LOOK AT A
3 BUNCH OF RECORDS AND THEY SAY, WELL, THIS, THIS, THIS, AND
4 THAT HAPPENED. OR THE PEOPLE, THE NURSES, THE NURSES'
5 ASSISTANTS, THE SOCIAL WORKERS, THE DOCTORS WHO ARE ACTUALLY
6 TREATING THE PATIENTS AT THE TIME? THESE ARE CLINICAL
7 JUDGMENTS AND THEY ARE BASED UPON WHAT PEOPLE SEE AND WHAT
8 THEY OBSERVE AT THE TIME. WHO IS IN A BETTER POSITION TO
9 REALLY MAKE THOSE JUDGMENTS, SOMEBODY WHO JUST LOOKS AT A
10 BUNCH OF RECORDS COLD OR THE PEOPLE WHO WERE ACTUALLY
11 PROVIDING THE CARE?
12 LISTEN TO THE NURSES. WE'RE GOING TO CALL THEM. IF
13 THE STATE DOESN'T CALL THEM, WE'LL CALL THEM AND LISTEN TO
14 WHAT THEY ARE GOING TO SAY. BECAUSE, SEE, THEY ARE
15 INDEPENDENT AND THEY ARE MAKING THE SAME ASSESSMENTS AS PART
16 OF THE TEAM THE EVIDENCE WILL SHOW THAT DR. WEITZEL WAS
17 MAKING. SO LISTEN TO THEM, LISTEN TO LAURIE WILLSON, LISTEN
18 TO SHEILA HANSEN, LISTEN TO LYNN LONG AND LISTEN TO WHAT
19 THEY SAY ABOUT WHAT THEY SAW AND WHAT THEY ASSESSED AND WHAT
20 THEY THOUGHT WAS APPROPRIATE MEDICAL CARE AT THE TIME.
21 AND FINALLY, AS YOU HEAR THE EVIDENCE, IT'S TRUE, THE
22 PROSECUTION HAS NO BURDEN AND YOU'LL BE INSTRUCTED ON THIS
23 TO PROVE MOTIVE AS PART OF THIS CRIME. BUT ASK YOURSELF,
24 ASK YOURSELF WHY. WHY ON EARTH WOULD A DOCTOR, A DOCTOR WHO
25 STARTED -- STARTED WITH THIS GROUP IN NOVEMBER OF 1994, WHO
82
1 WAS GIVEN PRIVILEGES BY THE HOSPITAL IN NOVEMBER OF 1995,
2 WHY WOULD HE POSSIBLY AND WHAT MOTIVE COULD HE POSSIBLY HAVE
3 TO GO AND KILL INTENTIONALLY FIVE HUMAN BEINGS? AND THAT'S
4 WHAT WE'RE FOCUSING ON, THIS VERY SHORT PERIOD OF TIME. WHY
5 WOULD HE DO THAT? AND I'LL ANSWER THAT QUESTION AT CLOSING,
6 BUT I WANT YOU TO ASK YOURSELF THAT AS YOU HEAR THE
7 EVIDENCE. WHAT POSSIBLE MOTIVE COULD HE HAVE? AND I AGREE
8 WITH COUNSEL, IT'S ONE THAT IS REALLY HARD TO FIGURE OUT AND
9 I KNOW THE ANSWER WHY IT'S HARD TO FIGURE OUT BUT I'M NOT
10 GOING TO ARGUE THAT HERE, BUT THINK ABOUT IT.
11 AT THE CLOSE OF THIS CASE, LADIES AND GENTLEMEN, I WILL
12 COME BACK. YOU'LL HAVE ME AGAIN AND I'M GOING TO ASK YOU --
13 I'M GOING TO ARGUE ABOUT THE EVIDENCE. I'M GOING TO SAY
14 WHAT I THOUGHT IT SHOWED AND I'M GOING TO ASK YOU TO RETURN
15 A VERDICT OF NOT GUILTY ON EACH ONE OF THESE COUNTS BECAUSE
16 I THINK AT THE END OF THE CASE THE EVIDENCE WILL SHOW AT
17 LEAST THREE THINGS. IT'S GOING TO SHOW, FIRST OF ALL, THIS
18 CASE IS ABOUT MEDICAL JUDGMENT. IT'S NOT ABOUT CRIMINAL
19 INTENT. SECOND OF ALL, IT'S ABOUT END-OF-LIFE CARE, NOT DR.
20 WEITZEL TRYING TO END SOMEBODY'S LIFE. AND, FINALLY, LADIES
21 AND GENTLEMEN, IT'S NOT ABOUT MURDER. IT'S ABOUT MERCY.
22 THANK YOU.