Dorene Klei
4 DORENE KLEI,
5 CALLED AS A WITNESS, BEING FIRST DULY SWORN,
6 WAS EXAMINED AND TESTIFIED AS FOLLOWS:
7 DIRECT EXAMINATION
8 BY MS. BARLOW:
9 Q. GET THIS PULLED OVER. GOOD AFTERNOON.
10 A. HI.
11 Q. WOULD YOU PLEASE STATE YOUR NAME AND SPELL IT FOR THE
12 RECORD?
13 A. DORENE, D-O-R-E-N-E, KLEI, K-L-E-I.
14 Q. IS IT KLEI?
15 A. KLEI.
16 Q. I'M SORRY. I'VE BEEN PRONOUNCING IT KLEY ALL THIS TIME.
17 I APOLOGIZE FOR THAT. DORENE, WHAT IS YOUR OCCUPATION?
18 A. I'M A REGISTERED NURSE.
19 Q. AS A REGISTERED NURSE, WHAT MEDICAL -- OR EXCUSE ME,
20 EDUCATIONAL BACKGROUND DO YOU HAVE?
21 A. I HAVE AN ASSOCIATION DEGREE IN NURSING.
22 Q. FROM WHERE?
23 A. SALT LAKE COMMUNITY, DAVIS.
24 Q. HOW LONG HAVE YOU BEEN AN R.N.?
25 A. SINCE '94.
1387
1 Q. 1994? WHERE DO YOU WORK NOW?
2 A. MCKAY-DEE HOSPITAL.
3 Q. AND WHAT ARE YOUR DUTIES NOW?
4 A. I'M A CASE MANAGER ON CALL.
5 Q. BETWEEN 1994 WHEN YOU BECAME AN R.N. AND THE PRESENT,
6 WHAT HAS BEEN YOUR EXPERIENCE IN NURSING?
7 A. I WORKED IN A NURSING HOME WAS MY FIRST NURSING
8 EXPERIENCE FOR APPROXIMATELY ONE YEAR. AND THEN WENT TO
9 DAVIS WITH THE GEROPSYCH UNIT, AND I WAS WORKING THERE WHILE
10 I WAS STILL AT THE NURSING HOME.
11 Q. SO YOU WERE --
12 A. UH-HUH. I WAS PART TIME --
13 Q. -- WORKING --
14 A. -- AT DAVIS.
15 Q. -- PART TIME AT DAVIS. THANK YOU.
16 THE COURT: EXCUSE ME. THE -- CAN YOU SPEAK UP A
17 LITTLE BIT? IT'S HARD -- WE HAVE -- ARE YOU GONNA BE
18 USING --
19 MS. BARLOW: I WILL.
20 THE COURT: OKAY. THEN IF YOU COULD KIND OF JUST
21 PROJECT YOUR VOICE. IT'S HARD. WE HAVE THIS PROJECTOR
22 THAT'S MAKING SOME SOUNDS, SO IF YOU COULD SPEAK LOUDER AND
23 KIND OF POINT TOWARD THE JURY, IT WOULD HELP. THANK YOU.
24 Q. (BY MS. BARLOW) HOW LONG WERE YOU AT DAVIS NORTH?
25 A. I BELIEVE IT WAS NINE MONTHS.
1388
1 Q. WAS THAT AT THE GEROPSYCH UNIT?
2 A. YES.
3 Q. SINCE THAT TIME, WHERE YOU HAVE YOU BEEN WORKING?
4 A. AT MCKAY-DEE.
5 Q. AS CASE MANAGER THE FULL TIME?
6 A. NO. I WENT THERE TO THE MEDICAL SURGICAL FLOOR. AND I
7 DID HAVE A ONE-YEAR STINT AT A DOCTOR'S OFFICE AND BACK AT
8 MCKAY WHERE I'VE BEEN A CASE MANAGER FOR THE PAST TWO YEARS.
9 Q. DO YOU RECALL WHEN YOU STARTED AT THE GEROPSYCH UNIT?
10 AT DAVIS NORTH?
11 A. THE DATES?
12 Q. MONTHS AT LEAST, MONTH AND YEAR?
13 A. I BELIEVE IT WAS FALL OF '95.
14 Q. AND WHEN DID YOU LEAVE?
15 A. JUNE OF '96.
16 Q. AND DO YOU RECALL WHY YOU LEFT THE UNIT?
17 A. I HAD AN OFFER AT MCKAY THAT I DIDN'T WANNA TURN DOWN.
18 Q. AND HAD YOU EVER WORKED IN A PSYCH UNIT BEFORE?
19 A. NO.
20 Q. HAVE YOU EVER WORKED IN ONE SINCE?
21 A. NO.
22 Q. HAVE YOU EVER BEEN TRAINED TO DO HOSPICE CARE?
23 A. NO.
24 Q. DID YOU RECEIVE ANY TRAINING OR EDUCATION REGARDING
25 GEROPSYCHIATRIC MEDICATIONS?
1389
1 A. NO.
2 Q. DID YOU -- WHILE YOU WERE AT DAVIS NORTH, DID YOU HAVE
3 ANY IN-SERVICE TRAINING FOR WHERE YOU WERE WORKING?
4 A. I FOLLOWED A NURSE FOR I BELIEVE IT WAS TWO WEEKS.
5 Q. OKAY. KIND OF LEARN ON THE JOB, AS IT WERE?
6 A. YEAH.
7 Q. WHEN YOU WERE AT THE GEROPSYCH UNIT, WHO WAS THE MEDICAL
8 DIRECTOR?
9 A. I CAN'T RECALL HIS NAME. HE WAS VERY TALL.
10 Q. OKAY. WELBY JENSEN? JUST A VERY TALL DOCTOR. DID HE
11 EVENTUALLY LEAVE THE UNIT?
12 A. NOT THAT I'M AWARE OF.
13 Q. DID THE DEFENDANT, ROBERT WEITZEL, EVER BECOME THE
14 MEDICAL DIRECTOR? No.
15 A. I DON'T BELIEVE HE WAS WHILE I WAS THERE.
16 Q. WHAT SHIFTS DID YOU WORK AT DAVIS NORTH?
17 A. 3:00 TO 11:00.
18 Q. SO THAT WOULD BE CONSIDERED WHAT, THE EVENING --
19 A. EVENING SHIFT.
20 Q. -- EVENING SHIFT? OKAY. HOW MANY DAYS A WEEK WOULD YOU
21 WORK PART TIME?
22 A. I BELIEVE IT WAS TWO.
23 Q. YOU RECALL -- I'D LIKE TO CALL YOUR ATTENTION TO
24 DECEMBER AND JANUARY, DECEMBER '95 TO JANUARY '96. DO YOU
25 EVER RECALL SEEING A PATIENT NAMED ENNIS ALLDREDGE?
1390
1 A. NO RECOLLECTION.
2 Q. IF YOU CHARTED HIM AT ALL, YOU DON'T HAVE ANY
3 RECOLLECTION OTHER THAN WHAT'S IN THE CHARTS, IS THAT
4 CORRECT?
5 A. CORRECT.
6 Q. IN FRONT OF YOU IS A BINDER THAT HAS ENNIS ALLDREDGE'S
7 NAME ON IT. IF WOULD YOU TURN TO THAT, AND IF YOU WOULD
8 OPEN IT TO PAGE 65, MED NUMBER 00065. DID YOU MAKE ANY
9 NOTATIONS ON 65, 66, AND 67?
10 A. ON -- IS THAT A -- IS THIS A DATE, FIVE SIXTY-SIX?
11 Q. I'M SORRY, ON PAGE NUMBER 65.
12 A. YES.
13 Q. ARE ANY OF THOSE NOTATIONS YOUR OWN?
14 A. YES.
15 Q. WHAT ABOUT ON 66, ARE THOSE YOUR OWN?
16 A. YES.
17 Q. AND 67?
18 A. YES.
19 Q. DOES LOOKING AT THAT GIVE YOU ANY RECOLLECTION OF HAVING
20 WORKED WITH MR. ALLDREDGE DURING THIS TIME PERIOD, I GUESS
21 IT WOULD BE THE 11TH OF JANUARY?
22 A. NO.
23 Q. OKAY. I THINK THE LAST PAGE NUMBER -- LET'S SEE, WHAT
24 DO I NEED TO TURN ON HERE, JOHN? ON, OFF?
25 MR. MAY: ON.
1391
1 MS. BARLOW: OKAY. THANK YOU VERY MUCH. BE THERE
2 SHORTLY. OKAY. HERE WE GO.
3 Q. WHAT'S THE DATE OF THAT ENTRY?
4 A. WHAT PAGE ARE YOU ON?
5 Q. I'M SORRY, I'M ON PAGE 67.
6 A. 11 -- 1/11/96.
7 Q. AND THEN APPEARS AT 2220, YOU WROTE THAT PATIENT WAS
8 AWAKE AND AGITATED, IS THAT CORRECT?
9 A. YES.
10 Q. AND THEN 2230, REMAINS AGITATED, AND THEN YOU GAVE AN
11 INJECTION, IS THAT CORRECT?
12 A. YES.
13 Q. DID YOU -- DO YOU KNOW WHAT ATIVAN IS USED FOR?
14 A. TO CALM PATIENTS.
15 Q. WAS THIS A P.R.N. OR AS NEEDED ORDER OR WAS THIS A NOW
16 ORDER?
17 A. I WOULD NEED TO LOOK AT OTHER RECORDS TO BE ABLE TO
18 ANSWER THAT.
19 Q. DID IT HAVE ANY EFFECT THEN, THE SHOT THAT YOU GAVE?
20 A. ON THE CHART AT 2300, IT CALMED HIM DOWN, NO LONGER
21 AGITATED.
22 Q. SO IT DID, IT WAS EFFECTIVE?
23 A. IT WAS EFFECTIVE, IT WOULD APPEAR.
24 Q. NOW, THE NEXT PATIENT THAT ALPHABETICALLY IS ELLEN
25 ANDERSON. DID YOU HAVE ANYTHING -- WERE YOU ON SHIFT AT ALL
1392
1 WHEN ELLEN ANDERSON WAS ON THE UNIT?
2 A. I DON'T RECALL.
3 Q. AND IF THERE ARE NO -- IF YOUR INITIALS DON'T APPEAR
4 ANYWHERE IN THE RECORD, WHAT WOULD THAT SIGNIFY?
5 A. THAT I WASN'T ON DUTY.
6 Q. OKAY. LET'S LOOK AT MARY CRANE. TURN TO MED RECORD
7 306, PAGE 306, IT'S UNDER THE NURSING NOTES. DID YOU MAKE
8 ANY NOTATIONS ON THAT PAGE?
9 A. YES, I DID.
10 Q. WHAT DATE WAS THAT?
11 A. 12/28/95.
12 Q. AND WHICH PART OF THAT IS YOUR NOTATION?
13 A. 1800 AND 2000 NOTES.
14 Q. AND THEN THOSE ARE YOUR -- THAT'S YOUR NAME?
15 A. YES.
16 Q. OKAY. WHAT DID YOU -- WHAT DID YOU PROVIDE FOR MARY
17 CRANE?
18 A. LOOKS LIKE I GAVE HER TYLENOL FOR A HEADACHE.
19 Q. AND WAS IT EFFECTIVE?
20 A. IT LOOKS LIKE IT WAS HELPFUL. HEADACHE BETTER.
21 Q. DO YOU RECALL MARY CRANE BY NAME OR BY -- DO YOU RECALL
22 WORKING WITH HER AT ALL?
23 A. I DON'T.
24 Q. ARE YOU FAMILIAR WITH THE FACT THAT MARY CRANE HAD A
25 DURAGESIC PATCH ORDERED FOR HER?
1393
1 A. NOT WITHOUT GOING THROUGH THE RECORDS, NOT OFF THE TOP
2 OF MY HEAD.
3 Q. IT IS ASKING YOU A LOT TO REMEMBER, ALL THESE PEOPLE
4 FIVE YEARS AGO. IF YOU WOULD TURN TO PAGE 282, WHICH IS IN
5 THE MEDS SECTION. ABOUT A THIRD OF THE WAY DOWN, TO THE
6 LEFT YOU HAVE A DATE AND AT THE TOP SAYS, ORDER DATE. WHAT
7 DOES THAT MEAN?
8 A. THAT'S THE DATE THE DOCTOR ORDERED.
9 Q. AND THEN IT HAS A STOP DATE NEXT TO IT. WHAT DOES THAT
10 MEAN?
11 A. THAT'S -- IF I RECALL CORRECTLY, WE HAD TO HAVE A
12 RENEWAL OF THE ORDERS AT THAT TIME.
13 Q. SO THE START DATE WAS THE 28TH?
14 A. UH-HUH.
15 Q. AND THE STOP DATE WAS THE 31ST. THEN IT SAYS, DURAGESIC
16 PATCH, 25 MILLIGRAMS. CHANGE EVERY THREE DAYS IN THE
17 EVENING BEGINNING 12/28. OVER HERE IS A CIRCLE WITH NOTHING
18 IN IT. DO YOU KNOW WHAT THAT MEANS?
19 A. THE SQUARE?
20 Q. A SQUARE, EXCUSE ME?
21 A. THAT MEANS THAT'S WHEN IT SHOULD HAVE BEEN GIVEN, BUT
22 THERE'S NO INITIALS, SO IT LOOKS LIKE THAT DOSE --
23 Q. I'M SORRY, I CAN'T HEAR YOU VERY WELL.
24 A. IT LOOKS LIKE -- THE SQUARE INDICATES THAT'S THE DATE
25 AND TIME THAT SHOULD HAVE BEEN GIVEN, BUT WITH NO INITIALS,
1394
1 IT WOULD LOOK LIKE IT WASN'T GIVEN.
2 Q. SO THAT PATCH WAS NOT PUT ON?
3 A. THAT'S WHAT IT LOOKS LIKE.
4 Q. AND THEN UNDERNEATH IT SAYS DURAGESIC PATCH, 50
5 MICROGRAMS, NOT MILLIGRAMS, BUT MICROGRAMS, AND IT LOOKS
6 LIKE THERE'S SOME SCRATCHES OUT HERE. CAN YOU TELL WHAT
7 THOSE ARE SAYING?
8 A. THE TIMES LOOK LIKE THEY'RE LINED OUT. AND IT LOOKS
9 LIKE IT WAS CHANGED FROM 2000 TO 1900. THE OTHER WRITING
10 UNDER MY INITIALS IS NOT MY WRITING.
11 Q. IS THAT YOUR INITIAL THEN?
12 A. IN THE BOX, YES.
13 Q. IN THE BOX. DOES THAT INDICATE YOU PUT THAT PATCH ON?
14 A. YES.
15 Q. AND UNDERNEATH IT SAYS, FELL OFF?
16 A. AND THAT'S NOT MY WRITING.
17 Q. OKAY. BUT IT DOES SAY, FELL OFF 0800?
18 A. I CAN'T --
19 Q. OKAY. YOU CAN'T TELL IF THAT --
20 A. IT'S NOT THAT LEGIBLE TO ME.
21 Q. OKAY. THANK YOU. BUT YOU DID PUT THAT DURAGESIC PATCH
22 ON?
23 A. THAT'S WHAT IT WOULD LOOK LIKE FROM THE INITIALS.
24 Q. DO YOU KNOW -- ARE YOU FAMILIAR WITH WHAT DURAGESIC IS?
25 A. IT'S A PAIN MEDICATION.
1395
1 Q. IS IT -- DOES IT COMPARE -- WELL, WHAT KIND OF PAIN
2 MEDICATION?
3 A. NARCOTIC.
4 Q. A NARCOTIC? WHAT ABOUT MORPHINE?
5 A. NARCOTIC PAIN MEDICATION.
6 Q. IF WOULD YOU TURN BACK TO PAGE NUMBER 322, DID YOU MAKE
7 THAT NOTE?
8 A. YES.
9 Q. WHAT DATE WAS THAT?
10 A. 1/4/96.
11 Q. AND IT LOOKS LIKE 2010, WHICH WAS WHAT, 8:10 IN THE
12 EVENING?
13 A. UH-HUH.
14 Q. YOU WRITE, COUGHING PROFUSELY, AUDIBLE WET LUNG SOUNDS.
15 DO YOU RECALL WHAT YOU WERE HEARING AT THAT TIME?
16 A. WET LUNGS SOUNDS.
17 Q. OKAY. DO YOU KNOW WHAT WET LUNG SOUNDS ARE CAUSED BY?
18 A. WELL, WHEN A PATIENT ASPIRATES, THEY HAVE WET LUNG
19 SOUNDS. CONGESTIVE HEART FAILURE, WHEN THEY -- WATER BACK
20 UP INTO THE LUNGS CAN CAUSE WET LUNG SOUNDS.
21 Q. LET'S -- ASPIRATION IS A TERM THAT WE'VE HEARD QUITE A
22 BIT HERE AND I'M NOT SURE THAT WE HAVE TOTALLY EXPLAINED IT
23 TO THE JURY. WHAT IS AN ASPIRATION?
24 A. SUCKING SOMETHING DOWN INTO THE WINDPIPE THAT DOESN'T
25 BELONG THERE, DOWN INTO THE LUNGS.
1396
1 Q. SO --
2 A. SECRETIONS --
3 Q. -- WHEN WE SWALLOW DOWN THE WRONG PIPE, THAT'S WHAT
4 YOU'RE TALKING ABOUT?
5 A. YEAH.
6 Q. DOES THAT HAPPEN WITH ELDERLY PEOPLE?
7 A. YES. CAN HAPPEN WITH ANYBODY.
8 Q. CAN HAPPEN WITH ANYONE, THAT'S TRUE. AND THEN YOU SAY
9 CONGESTIVE HEART FAILURE ALSO CAN CAUSE THAT, IS THAT
10 CORRECT?
11 A. UH-HUH.
12 Q. AND BASED ON YOUR NURSING KNOWLEDGE, WHAT IS CONGESTIVE
13 HEART FAILURE?
14 A. IT'S WHEN THE HEART IS NOT PUMPING VERY STRONGLY, THE
15 FLUIDS IN THE BLOODSTREAM BACK UP INTO THE LUNGS.
16 Q. AND THEN WE'VE LEARNED THAT THIS SYMBOL MEANS NO OR NONE
17 OR ZERO.
18 A. RIGHT.
19 Q. AND CYANOSIS NOTED. WHAT'S THAT?
20 A. CYANOSIS IS A BLUISH DISCOLORATION THAT PEOPLE WILL
21 EXHIBIT WHEN THEY DON'T HAVE ENOUGH OXYGEN.
22 Q. THEN YOU WRITE DOWN AT 2015, PATIENT COUGHING UP THICK
23 MUCOUS BROWN FROM FOOD OR APPLESAUCE, AND THEN YOU HAVE A
24 QUESTION MARK. WHY WOULD YOU WRITE THAT?
25 A. BECAUSE I WOULD REALLY HAVE NO WAY OF KNOWING WHAT SHE
1397
1 WAS BRINGING UP. IT WAS A GUESS.
2 Q. THEN AFTER SHE COUGHED, SHE WAS LESS DISTRESSED?
3 A. RIGHT.
4 Q. AFTER THAT SHE RESTED QUIETLY, IT APPEARS, AND THEN YOU
5 LISTEN AND DECREASED LUNG SOUNDS. MAYBE LITTLE EDUCATION
6 AGAIN. SAYS SCATTERED -- THAT LOOKS LIKE RALES?
7 A. UH-HUH.
8 Q. WHAT IS RALES?
9 A. IT'S AN ABNORMAL LUNG SOUND. HARD TO DESCRIBE. WHEN
10 YOU HAVE FLUID IN YOUR LUNGS, KIND OF RATTLING.
11 Q. NOW, DOWN AT THE BOTTOM AT 2205, YOU SAY THE PATIENT'S
12 BEEN SOMEWHAT QUIET AND SOMEWHAT GLASSY EXPRESSION OR STARE.
13 OCCASIONALLY YELLS OUT, HELP ME. AND THEN YOU GO ON TO THE
14 NEXT PAGE. WHEN ASKED WHAT SHE NEEDS, DOES NOT ANSWER.
15 WERE YOU ABLE TO GET FROM HER WHAT -- WHAT HER CONCERN OR
16 HER PROBLEM WAS AT THAT TIME?
17 A. NOT FROM THOSE NOTES RIGHT THERE, IT DOESN'T LOOK LIKE
18 IT.
19 Q. NOW, IF YOU'LL TURN TO PAGE 327, AND THAT APPEARS TO BE
20 THE 6TH OF JANUARY. 2200, YOU WROTE, PATIENT HAS MOANED,
21 OH, HELP ME, MUCH OF THE SHIFT.
22 WERE YOU ABLE TO TELL WHAT HER PROBLEM WAS, WHAT SHE
23 NEEDED HELP WITH?
24 A. IT SAYS, WHEN I ASKED HER, SHE DOES NOT VERBALIZE HER
25 NEEDS.
1398
1 Q. SHE HAS TAKEN HER MEDS, HER MEDICATIONS AS ORDERED. HAS
2 NOT STRUCK OUT AT STAFF. HOWEVER, GRABS HOLD OF WHOMEVER IS
3 NEAR. AND THEN YOU'VE GOT ADMINISTERED MEDS AS ORDERED.
4 PATIENT DOES NOT VERBALIZE NEEDS. MOANS -- MOANED MOST OF
5 SHIFT. P.R.N. PAIN MED GIVEN.
6 DO YOU RECALL WHAT PAIN MED THAT WAS?
7 A. NOT WITHOUT LOOKING AT THE MEDICATION SHEET.
8 Q. MAYBE I CAN GET THAT. MAYBE BEING THE OPERATIVE WORD.
9 PROBABLY NOT GOING TO BE ABLE TO FIND IT, SO I'LL GO
10 ONTO SOMETHING ELSE HERE. DO YOU REMEMBER JUDITH LARSEN?
11 A. NO.
12 Q. A PATIENT ON THE UNIT? IF YOU WOULD TURN TO MED NUMBER
13 577.
14 A. ARE WE IN A NEW BOOK?
15 Q. YES, I'M SORRY, WE ARE IN THE JUDITH LARSEN BINDER. IT
16 APPEARS TO BE THE 30TH OF DECEMBER. WOULD YOU READ THAT
17 FIRST? IT LOOKS LIKE IT IS 1650.
18 A. YEAH.
19 Q. SO IT WOULD BE 4:50 IN THE AFTERNOON?
20 A. UH-HUH.
21 Q. WOULD YOU READ THAT FIRST ENTRY THAT YOU HAVE THERE?
22 A. LUNG SOUNDS DECREASED IN BASES BILATERALLY.
23 Q. AND THEN THE NEXT ONE?
24 A. PATIENT'S RESPIRATIONS IRREGULAR, CHEYNE-STOKING. OPENS
25 EYES TO NAME. RESTING QUIETLY.
1399
1 Q. WHAT'S CHEYNE-STOKING? AND I GETS THAT'S C-H-E-Y-N-E?
2 A. UH-HUH.
3 Q. WHAT IS CHEYNE-STOKES?
4 A. IT'S AN ABNORMAL BREATHING PATTERN WHERE THEY'LL HAVE
5 PERIODS OF APNEA OR NO BREATHING, AND THEN THEY'LL BREATHE
6 AGAIN. AND IT SORT OF CRESCENDOS AND --
7 Q. SO IT'S -- OKAY. I THINK THAT -- BUT OTHER THAN THAT,
8 SHE'D BEEN RESTING QUIETLY THAT WHOLE SHIFT, LOOKS LIKE, IS
9 THAT CORRECT?
10 A. YES.
11 Q. DO YOU KNOW, BASED ON YOUR NURSING BACKGROUND, WHAT
12 CAUSES CHEYNE-STOKES RESPIRATIONS?
13 A. MY ONLY EXPERIENCE WITH IT IS END-OF-LIFE BREATHING
14 PATTERN.
15 Q. TURN BACK TO 497. THIS IS WHAT'S BEEN REFERRED TO AS A
16 MARS. ARE YOU FAMILIAR WITH THAT TERM?
17 A. YES.
18 Q. MEDICAL ADMINISTRATION RECORD? IT APPEARS HERE THAT WE
19 HAVE MORPHINE, 5 MILLIGRAMS I.M., EVERY FOUR HOURS AROUND
20 THE CLOCK. THAT WAS ORDERED FOR THE -- WELL, IT'S ORDERED
21 ON THE 30TH, AND THEN THIS FIRST COLUMN IS THE 30TH. WAS
22 THAT ORDER GIVEN?
23 A. AT WHICH TIME?
24 Q. THE 1430 AND THE 1830?
25 A. IT WOULDN'T APPEAR TO BE. IT'S NOT SIGNED UP AS BEING
1400
1 GIVEN.
2 Q. AND THEN UNDERNEATH THAT IS ANOTHER ORDER FOR 5
3 MILLIGRAMS AROUND THE CLOCK AT 2360, ET CETERA. THEN WE'VE
4 GOT 1430, 1830, AND 2230. DID YOU GIVE ANY OF THOSE
5 DOSAGES?
6 A. I DON'T SEE MY INITIALS THERE, SO NO.
7 Q. DO YOU REMEMBER LYDIA SMITH?
8 A. I DO NOT.
9 Q. DID YOU EVER WITHHOLD ANY DOSES OF NARCOTICS FOR ANY OF
10 THESE PATIENTS THAT YOU KNOW OF?
11 A. WITHOUT LOOKING AT THE RECORDS, I COULDN'T -- I
12 WOULDN'T -- I COULDN'T KNOW.
13 Q. DID YOU EVER HAVE OCCASION TO TALK TO DR. WEITZEL
14 DIRECTLY ABOUT -- OR SUGGESTING ANY CONCERNS ABOUT PATIENT
15 CARE OR MONITORING?
16 MR. STIRBA: YOUR HONOR, I'M GONNA OBJECT.
17 QUESTION IS --
18 THE COURT: RELATING IT TO THESE FIVE?
19 MR. STIRBA: YEAH.
20 MS. BARLOW: TO THESE FIVE, YES -- WELL, OR TO THIS
21 TIME PERIOD.
22 MR. STIRBA: YOUR HONOR, I'M GONNA OBJECT --
23 THE COURT: OKAY. WELL, THESE FIVE --
24 Q. (BY MS. BARLOW) DO YOU RECALL EVER TALKING TO
25 DR. WEITZEL ABOUT PATIENT CARE OR MONITORING OF THESE FIVE
1401
1 PATIENTS?
2 A. NOT -- I DON'T REMEM -- HAVE ANY SPECIFIC RECOLLECTIONS
3 OF --
4 Q. THAT'S WHAT I'M ASKING. I RECOGNIZE, YOU KNOW, AND I
5 DON'T KNOW THAT WE WANT TO GO THROUGH EVER PAGE --
6 A. OF SUCH CONVER -- YEAH, I HAVE NO RECOLLECTION OF SUCH
7 CONVERSATIONS REGARDING ANY OF THESE PATIENTS.
8 MS. BARLOW: YOUR HONOR, I'M ASSUMING FROM THAT
9 LAST RULING THAT I WILL NOT BE ALLOWED TO BRING IN ANYTHING
10 ABOUT ANY OTHER PATIENTS IN THIS TIME FRAME --
11 MR. STIRBA: YOUR HONOR --
12 MS. BARLOW: -- IS THAT CORRECT?
13 THE COURT: WELL, ASK THE QUESTION. I MEAN, I --
14 THERE WAS AN OBJECTION TO A CERTAIN QUESTION AND I RULED ON
15 THAT, SO ASK YOUR NEXT QUESTION.
16 Q. (BY MS. BARLOW) DID YOU EVER REFUSE TO GIVE ANY
17 MORPHINE THAT WAS ORDERED BY DR. WEITZEL?
18 MR. STIRBA: YOUR HONOR, I'M GONNA OBJECT.
19 THE COURT: SUSTAINED.
20 Q. (BY MS. BARLOW) NOW, SOME OF THESE -- SOME OF THESE
21 SPECIFIC PATIENTS WERE GIVEN 10 MILLIGRAMS OF MORPHINE --
22 MR. STIRBA: YOUR HONOR, I'M GONNA OBJECT. IT'S
23 LEADING AND SUGGESTIVE.
24 MS. BARLOW: IT'S MERELY FOUNDATIONAL, YOUR HONOR.
25 THE COURT: WELL, LET'S HEAR THE -- OVERRULED.
1402
1 LET'S ASK THE QUESTION.
2 Q. (BY MS. BARLOW) ARE YOU FAMILIAR WITH MORPHINE?
3 A. YES, I AM.
4 Q. AND THE DOSAGE OF MORPHINE?
5 A. YES, I AM.
6 Q. YOU WORKED IN A NURSING HOME, IS THAT CORRECT?
7 A. YES.
8 Q. AT THE NURSING HOME, WAS MORPHINE EVER ADMINISTERED?
9 MR. STIRBA: OBJECTION. RELEVANCY, YOUR HONOR.
10 THERE'S NO FOUNDATION THAT THIS WITNESS EVEN GAVE AN
11 INJECTION OF MORPHINE TO ANY OF THESE FIVE PATIENTS.
12 THE COURT: SUSTAINED.
13 Q. (BY MS. BARLOW) AS I INDICATED, 10 MILLIGRAMS WAS
14 GIVEN. DO YOU HAVE -- BASED ON YOUR NURSING EXPERIENCE, DO
15 YOU HAVE AN OPINION AS TO THE -- WHETHER THAT'S AN
16 APPROPRIATE DOSE FOR AN ELDERLY PATIENT?
17 MR. STIRBA: OBJECTION. FOUNDATION, COMPETENCY,
18 INAPPROPRIATE, AND IRRELEVANT HYPOTHETICAL NOT RELATED TO
19 THESE FIVE PATIENTS.
20 THE COURT: SUSTAINED.
21 Q. (BY MS. BARLOW) DID YOU EVER HEAR DR. WEITZEL RESPOND
22 TO EITHER YOU OR TO ANY OTHER OF THE NURSES DURING THIS
23 RELEVANT TIME PERIOD TO A QUESTION ABOUT THE AMOUNT OF
24 MEDICATION THAT WAS BEING GIVEN TO THESE PATIENTS?
25 MR. STIRBA: YOUR HONOR -- YOUR HONOR, I'M GONNA
1403
1 OBJECT.
2 THE COURT: ARE YOU SAYING TO THESE PATIENTS?
3 MS. BARLOW: YES.
4 THE COURT: OKAY.
5 THE WITNESS: COULD YOU REPEAT THE QUESTION PLEASE?
6 Q. (BY MS. BARLOW) I'M NOT SURE I CAN, BUT I'LL TRY. DID
7 YOU EVER HEAR DR. WEITZEL RESPOND TO ANY -- ANYBODY
8 QUESTIONING THE AMOUNT OF MEDICATIONS BEING GIVEN TO THESE
9 PATIENTS?
10 A. NO.
11 MS. BARLOW: WITH THAT, I HAVE NO FURTHER
12 QUESTIONS, YOUR HONOR.
13 THE COURT: MR. STIRBA.
14 MR. STIRBA: THANK YOU, YOUR HONOR.
15 MS. BARLOW: WELL, JUST A SECOND, YOUR HONOR, MAYBE
16 I HAVE -- NO, I'M THROUGH, YOUR HONOR.
17 THE COURT: OKAY. MR. STIRBA.
18 MR. STIRBA: THANK YOU, YOUR HONOR.
19 CROSS-EXAMINATION
20 BY MR. STIRBA:
21 Q. GOOD AFTERNOON, MISS KLEE.
22 A. IT'S KLEI.
23 Q. KLEI. IS IT PART OF THE NURSING FUNCTION TO AT TIMES
24 MAKE AN ASSESSMENT OF THE DEATH AND DYING PROCESS?
25 A. COULD YOU CLARIFY THAT QUESTION?
1404
1 Q. SURE. IS IT PART OF YOUR NURSING DUTIES AS A NURSE TO
2 AT TIMES MAKE AN ASSESSMENT OF THE DEATH AND DYING PROCESS
3 IN A PATIENT?
4 A. I'M NOT SURE I UNDERSTAND THE QUESTION.
5 Q. OKAY. ARE YOU FAMILIAR WITH THE CARE PLAN THAT NURSES
6 RECOGNIZE FOR DEATH AND DYING?
7 A. A CARE PLAN SPECIFICALLY FOR DEATH AND DYING? NO, I'M
8 NOT --
9 MS. BARLOW: YOUR HONOR, OBJECTION. IT'S NOT
10 REFERRING TO THESE SPECIFIC PATIENTS.
11 THE COURT: OKAY. SHE SAID SHE DIDN'T KNOW.
12 MR. STIRBA: SHE DOESN'T KNOW.
13 Q. DO YOU STILL HAVE THE MARY CRANE BINDER IN FRONT OF YOU?
14 A. YES, I DO.
15 Q. AND IF YOU COULD AGAIN GO TO 322, MED-00322, WHICH IS
16 THE NOTE YOU TESTIFIED CONCERNING ON 1/4 OF '96.
17 THE COURT: FOR THE RECORD, WE SHOULD SAY THAT THIS
18 WITNESS HAS THE BEST HANDWRITING.
19 MR. STIRBA: NO QUESTION ABOUT IT. SHE SHOULD BE
20 UP HERE FOR HOURS.
21 Q. MISS KLEE, ON THAT ONE, YOU NOTED PATIENT COUGHING
22 PROFUSELY. AUDIBLE WET LUNG SOUNDS. NOTED TRANSFER TO BED.
23 AND THEN YOU PUT ZERO CYANOSIS NOTED. IS THAT FACE
24 REDDENED?
25 A. YES.
1405
1 Q. OKAY. AND THEN YOU INDICATE, DR. WEITZEL NOTIFIED.
2 ORDERED TO NOTIFY R.T. FOR -- T.X. IS TREATMENT?
3 A. YES.
4 Q. AND THEN R.T. NOTIFIED. SUCTION SET UP AT BEDSIDE IF
5 NEEDED. DID I READ THAT CORRECTLY?
6 A. WITH THE EXCEPTION, THE AUDIBLE WET LUNG SOUNDS CAME
7 AFTER TRANSFER TO BED. YOU LEFT OUT THE AFTER.
8 Q. OH, OKAY. I APPRECIATE THAT. SO IT'S TRUE, IS IT NOT,
9 THAT ON THIS OCCASION AFTER YOU ASSESSED WHAT YOU HEARD IN
10 TERMS OF THE AUDIBLE WET LUNG SIGNS, YOU NOTIFIED DR.
11 WEITZEL, IS THAT CORRECT?
12 A. THAT'S CORRECT.
13 Q. AND THEN IN RESPONSE TO A CONVERSATION WITH DR. WEITZEL,
14 THEN YOU CONTACTED A RESPIRATORY THERAPIST, IS THAT TRUE?
15 A. PER HIS ORDERS, THAT'S CORRECT.
16 Q. AND THEN THE RESPIRATORY THERAPIST WAS CALLED IN AND
17 ENGAGED IN THE SUCTIONING THAT YOU DESCRIBE IN YOUR NOTE, IS
18 THAT CORRECT?
19 A. I CAN'T ANSWER TO THAT. I JUST SAY THAT SUCTION SET UP
20 AT BEDSIDE IF NEEDED.
21 Q. OKAY. I APPRECIATE THAT. NOW ALSO ON THIS PAGE, DOWN
22 TOWARDS THE BOTTOM HERE -- MAKE SURE I GET IT ALL UP
23 THERE -- THERE'S AN ENTRY UNDER 2200 HOURS, PATIENT TURNED
24 ONTO LEFT SIDE. RESTING QUIETLY AND EYES OPEN.
25 RESPIRATIONS EVEN AND UNLABORED. DECREASED LUNG SOUND AND
1406
1 BASES --
2 A. WITH.
3 Q. WITHOUT, IS THAT WHAT THAT IS?
4 A. NO, IT'S WITH.
5 Q. WITH, I'M SORRY. WHAT IS THAT WORD?
6 A. INSPIRATORY.
7 Q. SCATTERED RALES, SLASH, WHEEZES THROUGHOUT. DAUGHTER
8 KAREN NOTIFIED OF INCIDENT. DOES THAT MEAN THAT YOU
9 NOTIFIED THE DAUGHTER?
10 A. IT MEANS THAT KNOWING MY CHARTING, I PROBABLY UPDATED
11 HER OF THE -- THE COUGHING INCIDENT.
12 Q. AND IN THIS -- GIVEN WHAT YOU HAVE READ, CAN YOU TELL
13 US, WAS THERE A PARTICULAR REASON WHY YOU NOTIFIED KAREN AT
14 THIS TIME?
15 A. IT'S MY STANDARD OF PRACTICE TO UPDATE FAMILY MEMBERS OF
16 CHANGES OR EVENTS WITH THEIR FAMILY MEMBERS.
17 Q. AND YOU THOUGHT THIS -- THIS I GUESS LUNG CONGESTION WAS
18 A SIGNIFICANT ENOUGH CHANGE THAT YOU THOUGHT IT WAS
19 APPROPRIATE TO NOTIFY THE FAMILY?
20 A. YES.
21 Q. NOW, THERE'S ANOTHER ENTRY HERE THAT I WANNA SEE IF IT'S
22 IN MISS JUDITH LARSEN'S BINDER. DO YOU HAVE THAT IN FRONT
23 OF YOU AS WELL?
24 A. YES, I DO.
25 Q. AND I THINK IT'S GOING TO BE IN THE NURSES' NOTE SECTION
1407
1 AND IT WOULD BE ON THE 30TH OF DECEMBER OF 1995.
2 A. DO YOU HAVE A PAGE?
3 Q. I CAN'T GIVE YOU A MED NUMBER JUST YET, BUT I'LL TRY.
4 YEAH IT WOULD BE MED-00577 IS THE ACTUAL PAGE NUMBER. DO
5 YOU HAVE THAT?
6 A. YES, I DO.
7 Q. AND I'LL DISPLAY IT UP HERE AGAIN. AND WHAT I'M
8 PARTICULARLY GONNA CALL YOUR ATTENTION TO, MISS KLEE, IS THE
9 ENTRY AT 2100 HOURS. AND IN YOUR WRITING, IT'S NOTED,
10 CALLED SON, GAVE -- I THINK THAT'S STATUS. IT'S KIND OF CUT
11 OFF THERE. DOES THAT LOOK LIKE STATUS?
12 A. YES.
13 Q. YES. REPORT ON PATIENT'S CONDITION. SON, MERLIN,
14 STRESSED THAT, QUOTE, ONLY WISHED TO KEEP HER COMFORTABLE,
15 UNQUOTE, AND THEN YOUR SIGNATURE. DID I READ THAT
16 CORRECTLY?
17 A. YES.
18 Q. IS THERE ANY SIGNIFICANCE TO THE FACT THAT YOU HAVE ONLY
19 WISHED TO KEEP HER COMFORTABLE IN QUOTES?
20 A. THAT'S WHAT HE SAID.
21 Q. OKAY. SO YOU'RE ATTEMPTING TO PUT IN YOUR NOTE VERBATIM
22 WHAT THE CONVERSATION -- A PORTION OF THE CONVERSATION WAS,
23 IS THAT RIGHT?
24 A. THAT'S CORRECT.
25 Q. AND CAN YOU TELL US WHY YOU WOULD HAVE CALLED THE SON,
1408
1 MERLIN, ON THIS OCCASION ABOUT THE CONDITION OR THE STATUS
2 REPORT OF MS. LARSEN?
3 A. AGAIN, UPDATING A FAMILY MEMBER. EARLIER I HAVE CHARTED
4 THAT SHE WAS CHEYNE-STOKING. SO AN UPDATE ON HER CONDITION.
5 Q. AND I -- IF I HEARD YOU CORRECTLY, AND I MAY NOT HAVE,
6 BUT I THINK YOU SAID THAT ON DIRECT EXAMINATION THAT
7 CHEYNE-STOKE -- STOKING OR CHEYNE-STOKE BREATHING, YOU
8 ASSOCIATE WITH END OF LIFE?
9 A. YES.
10 Q. AND SO WAS IT IN RESPONSE TO WHAT YOU PERCEIVED TO BE AN
11 EVENT THAT YOU ASSOCIATE WITH END OF LIFE THAT YOU THEN
12 NOTIFIED THE SON, MERLIN?
13 A. KNOWING THAT MY NURSING STYLE AND MY CHARTING, THIS
14 PATIENT WOULD HAVE ALREADY BEEN IN THE COMFORT CARE PHASE.
15 THAT'S WHY WHEN SHE'S CHEYNE-STOKING, YOU'LL -- I DIDN'T
16 CALL THE DOCTOR, KNOWING ME, HE ALREADY IS AWARE OF HER
17 CONDITION. BUT I WANT TO AT SOME POINT DURING MY SHIFT GIVE
18 AN UPDATE OF WHERE THIS PATIENT'S AT TO HIS -- TO THE
19 PATIENT'S FAMILY MEMBER.
20 Q. AND THE COMFORT CARE PHASE, WOULD YOU EXPLAIN THAT, WHAT
21 YOU MEAN TO THE JURY?
22 A. IT MEANS THAT WE'RE NOT -- THE DOCTOR* HAS GIVEN US (really the family)
23 INSTRUCTIONS, WE'RE NOT DOING AGGRESSIVE TREATMENTS. WE'RE
24 NOT DOING THINGS LIKE, IF THEY HAD AN INFECTION, WE'RE NOT
25 GONNA GIVE AN ANTIBIOTIC. WE'RE JUST GOING TO KEEP THE
1409
1 PATIENT COMFORTABLE.
2 Q. AND ARE THERE CERTAIN RESPONSIBILITIES THAT YOU HAVE AS
3 A NURSE DURING THIS PHASE?
4 A. KEEPING THE PATIENT COMFORTABLE.
5 Q. AND CAN YOU TELL US PLEASE MAYBE WHAT SOME OF THOSE
6 THINGS WOULD BE IN TERMS OF NURSING CARE?
7 A. PAIN MEDICATIONS IF NEEDED AND ORDERED. TURNING A
8 PATIENT BECAUSE THEY'RE NOT GOING TO BE ABLE TO TURN
9 THEIRSELVES AT THIS POINT IN LIFE. ORAL CARE. KEEPING THEM
10 CLEAN AND DRY. KEEPING THE BED LINENS STRAIGHT SO THEY'RE
11 NOT LYING ON WRINKLES AND LUMPS. COMFORT CARE.
12 Q. NOW, IN THIS PARTICULAR ENTRY IN THIS NOTE WHERE YOU
13 QUOTED THE SON, MERLIN, WHO ONLY WISHED TO KEEP HER
14 COMFORTABLE, DO YOU HAVE -- DO YOU HAVE AN UNDERSTANDING AS
15 YOU SIT HERE TODAY OF WHAT HE WAS TELLING YOU?
16 A. YES. TO KEEP HER COMFORTABLE.
17 Q. AND DO --
18 A. NOT WANTING AGGRESSIVE TREATMENTS.
19 Q. I SEE. AND THE NOTE UP HERE, IT SAYS IT 12/30/95. THAT
20 WOULD HAVE BEEN THE DATE WHEN THIS CONVERSATION TOOK PLACE
21 AT 2100 HOURS APPROXIMATELY?
22 A. YES.
23 Q. YOU WERE SHOWN -- IF I CAN FIND IT. OKAY. I'VE FOUND
24 IT. IT'S IN WHAT'S MISS LARSEN'S BINDER, AND IT WAS THAT
25 MEDICATION ADMINISTRATION SHEET WHICH WAS AT 497. IT'S THE
1410
1 SAME ONE THAT COUNSEL SHOWED YOU ON DIRECT. AND WHAT I
2 REALLY WANNA FOCUS YOU IN ON AND ASK YOU ABOUT IS, FOR
3 EXAMPLE, IF YOU LOOK AT THE ENTRIES ON 12/30 -- AND THERE
4 ARE VARIOUS MEDICATIONS. FOR EXAMPLE, IT LOOKS LIKE
5 BETAGAN, SYNTHROID, ISOSORBIDE, SURFAK, SERZONE, AND
6 RISPERDAL, FOR THAT DAY 12/30. AND IT SEEMS LIKE IN MOST
7 COLUMNS AND AREAS, THERE'S A CIRCLE AROUND THE INITIALS. DO
8 YOU SEE THAT?
9 A. YES.
10 Q. COULD YOU TELL US WHAT THE SIGNIFICANCE IS IF ANY OF THE
11 CIRCLE?
12 A. NOT GIVEN. IT MEANS NOT GIVEN.
13 Q. SO, FOR EXAMPLE, IF THIS WERE CLEAR, IF I LOOK IN 12/30,
14 AND I LOOK UNDER SYNTHROID WHICH IS THE FIRST ENTRY I
15 BELIEVE THAT IS ACTUALLY CIRCLED, AT 8:00 O'CLOCK THERE'S A
16 TIME AND THEN THERE'S A CIRCLED INITIAL, THAT MEDICATION WAS
17 NOT GIVEN, IS THAT TRUE?
18 A. CORRECT.
19 Q. AND THEN I NOTICE, TOO, ON THIS DOCUMENT, MISS KLEE,
20 THERE ARE SOME NUMBERS. FOR EXAMPLE, IF YOU LOOK AT
21 ISOSORBIDE, AND IF YOU GO 12/31, AND YOU KIND OF GO DOWN, IT
22 LOOKS LIKES THERE'S THE NUMBERS 3, 6 IN ONE COLUMN AND THEN
23 5, 6 IN ANOTHER COLUMN. CAN YOU TELL US WHAT THOSE
24 REPRESENT?
25 A. WELL, THAT COLUMN SAYS CODE, AND IF YOU LOOK UP THE TOP
1411
1 MIDDLE OF THAT PAGE, IT SAYS NONADMINISTRATION CODES. AND
2 THE NUMBER TELLS YOU THE REASON FOR NOT GIVEN.
3 Q. I SEE. SO THERE IS A CODE REFERENCE HERE THAT RELATES
4 TO THESE NUMBERS IN THE VARIOUS COLUMNS UNDER CODE, AND THEY
5 REPRESENT ANOTHER REASON AS CODED FOR WHY THE MEDICATION WAS
6 NOT GIVEN.
7 A. CORRECT.
8 Q. FOR EXAMPLE, IT'S TRUE, IS IT NOT, THAT ONE OF THE CODES
9 IS WHERE THE PATIENT JUST REFUSES THE MEDICATION, IS THAT
10 RIGHT?
11 A. YES.
12 Q. AND THERE MAY BE OTHER CIRCUMSTANCES SIMILAR TO THAT
13 WHERE THE MEDICATION JUST IS NOT GIVEN, IS THAT RIGHT?
14 A. CORRECT.
15 MR. STIRBA: THANK YOU. THAT'S ALL I HAVE. THANK
16 YOU, MA'AM.
17 THE COURT: ANY REDIRECT?
18 MS. BARLOW: JUST A COUPLE OF MATTERS, YOUR HONOR,
19 JUST FOLLOWING UP ON THAT.
20 REDIRECT EXAMINATION
21 BY MS. BARLOW:
22 Q. IF YOU CAN KEEP YOUR FINGER IN THAT SPACE BECAUSE WE'LL
23 COME BACK TO IT.
24 A. I SHUT IT.
25 Q. OH, OKAY. THEN IF YOU WILL OPEN TO 577 --
1412
1 A. WHICH PATIENT?
2 Q. I'M SORRY, THE ONE WE WERE JUST TALKING ABOUT, JUDITH
3 LARSEN. THANK YOU. ARE YOU THERE?
4 A. YES.
5 Q. OKAY. 577 YOU WROTE AT 2240, MEDS HELD THIS SHIFT AS DO
6 NOT FEEL PATIENT ALERT ENOUGH TO SWALLOW.
7 AND WHAT WOULD THAT MEAN?
8 A. PATIENT WAS NOT ALERT ENOUGH TO SWALLOW.
9 Q. SO ANY BY MOUTH MEDICATIONS IS WHAT YOU'RE TALKING
10 ABOUT.
11 A. YES.
12 Q. OKAY. IF YOU'LL TURN TO 579, WHICH ACTUALLY IS A
13 CONTINUATION OF 577, BUT ANOTHER ONE GOT STUCK IN THE
14 MIDDLE, SAYS, NO SKIN BREAKDOWN NOTED. OPENS EYES TO NAME.
15 DOES NOT RESPOND VERBALLY. CONTINUE TO ADMINISTER I.M.
16 MORPHINE AS ORDERED. THEN TURN EVERY TWO HOURS. ORAL CARE,
17 AND THAT SORT OF THING. DO YOU SEE ANYTHING IN THIS RECORD
18 INDICATING THAT HE WAS IN ANY -- THAT SHE, EXCUSE ME, THAT
19 JUDITH LARSEN WAS IN ANY PAIN AT THAT TIME?
20 A. FROM THE PLAN NOTE?
21 Q. FROM -- FROM THESE NOTES HERE.
22 A. CAN I HAVE A MINUTE TO READ THEM?
23 YOU'RE ASKING ME ON 12/30 ON MY SHIFT IF THERE'S
24 ANYTHING THAT INDICATES THAT SHE WAS IN PAIN --
25 Q. IS THERE ANYTHING IN YOUR NOTES THAT INDICATES JUDITH
1413
1 LARSEN WAS EXPERIENCING ANY PAIN AT THAT TIME?
2 A. NOT PAIN, BUT I KNOW THAT CHEYNE-STOKING SOMETIMES CAN
3 BE -- APPEAR TO BE UNCOMFORTABLE FOR A PATIENT.
4 Q. BUT YOU DIDN'T NOTE THAT THE PATIENT APPEARED TO BE
5 UNCOMFORTABLE.
6 A. NO, I DIDN'T NOTE THAT.
7 Q. THEN LET'S GO BACK TO 497. AND AGAIN, THIS IS ONE WE'VE
8 BEEN LOOKING AT. AND THIS FIRST COLUMN IS 12/30. YOU SEE
9 THAT MOST OF THE -- WELL, ALL OF THE BY MOUTH MEDS WERE
10 HELD -- EXCUSE ME, EXCEPT FOR THIS ONE UP HERE.
11 A. THAT'S AN EYE DROP.
12 Q. PARDON ME?
13 A. THAT TOP ONE IS AN EYE DROP.
14 Q. AND AN EYE DROP. OKAY. THAT'S WHY IT WAS NOT HELD, I'M
15 SURE. WE GET DOWN HERE TO THE INJECTION, AND 1430, 1830,
16 AND 2230, THAT MORPHINE WAS ADMINISTERED, IS THAT CORRECT?
17 A. YES.
18 Q. AND WHO TOLD YOU THAT COMFORT CARE WAS APPROPRIATE FOR
19 JUDITH LARSEN AT THIS TIME?
20 A. THAT WOULD HAVE COME FROM THE DOCTOR.
21 Q. NOW, YOU INDICATED THAT COMFORT CARE MEANT PAIN
22 MEDICATIONS AS NEEDED, IS THAT CORRECT?
23 A. CORRECT.
24 Q. BUT ON THIS, ON 579, YOU SAID CONTINUE TO ADMINISTER
25 I.M. MORPHINE AS ORDERED. WAS THAT P.R.N.?
1414
1 MAYBE IT WOULD BE JUST AS EASY IF I PUT THIS -- IF WE
2 LOOK BACK AT 497, WHICH IS UP HERE IF YOU DON'T WANNA TRY TO
3 FIND IT AGAIN, THIS MORPHINE SULFATE 5 MILLIGRAMS I.M. EVERY
4 FOUR HOURS AROUND THE CLOCK. WAS THAT P.R.N.?
5 A. NO. THAT'S EVERY FOUR HOURS.
6 Q. SO YOU GAVE THAT -- YOU GAVE THAT INJECTION.
7 A. I DIDN'T. THOSE AREN'T MY INITIALS.
8 Q. OH, EXCUSE ME. YOU INDICATE THAT THIS INJECTION WAS
9 GIVEN.
10 A. THAT'S THE PLAN THAT YOU'RE READING. THAT'S OUR PLAN.
11 THAT DOESN'T -- P. PART OF OUR CHARTING IS NOT WHAT WE'VE
12 DONE; IT IS WHAT OUR PLAN IS. AND IF THE DOCTORS ORDERED IT
13 FOR PAIN, THEN WE WOULD CONTINUE TO FOLLOW HIS ORDER FOR
14 PAIN.
15 Q. OKAY. THANK YOU. I THINK THAT -- OH, AND MR. STIRBA
16 ASKED YOU ABOUT THE NURSING PLAN.
17 A. THE CARE PLAN.
18 Q. THE CARE PLAN, EXCUSE ME. BUT -- NO, I THINK I'M
19 THROUGH, YOUR HONOR.
20 THE COURT: OKAY. ANYTHING FURTHER OF THIS
21 WITNESS?
22 MR. STIRBA: JUST BRIEFLY.
23 RECROSS-EXAMINATION
24 BY MR. STIRBA:
25 Q. MISS KLEE, YOU STILL THAT HAVE 12/30/95 NOTE IN FRONT OF
1415
1 YOU?
2 A. THE NURSES' NOTE.
3 Q. YES.
4 A. YES, I DO.
5 Q. YOU ALSO GO ON TO SAY, AND I THINK IT'S CLEAR, IS IT
6 NOT, THAT WHAT YOU ARE CHARTING THERE, IT SAYS P. FOR PLAN,
7 CONTINUE TO ADMINISTER I.M. MORPHINE AS ORDERED. YOU WERE
8 NOT INDICATING THERE THAT YOU IN FACT GAVE MS. LARSEN AT
9 THIS POINT AN INJECTION FOR MORPHINE, TRUE?
10 A. CORRECT.
11 Q. AND IN FACT, THE MEDICAL ADMINISTRATION RECORD FOR THE
12 12/30/95 DATE INDICATES THAT YOU DID NOT IN FACT GIVE HER AN
13 INJECTION ON THIS DAY, TRUE?
14 A. CORRECT.
15 Q. SO YOU'RE JUST ESSENTIALLY DEALING PROSPECTIVELY WITH
16 THE PLAN AND CHARTING IT APPROPRIATELY, CORRECT?
17 A. YES.
18 Q. THEN YOU INDICATE, PROVIDE FREQUENT ORAL CARE, AND OF
19 COURSE THAT'S -- THAT'S PART OF COMFORT MEASURE CARE?
20 A. YES.
21 Q. AND THEN YOU SAY KEEP M.D. FAMILY AWARE OF PATIENT'S
22 STATUS.
23 IS THERE A PARTICULAR REASON WHY UNDER THIS
24 CIRCUMSTANCE YOU WOULD NOTE THAT YOU WERE GOING TO ADVISE
25 THEM, THE M.D., WHICH I ASSUME WOULD BE DR. WEITZEL, AND THE
1416
1 FAMILY OF COURSE, MS. LARSEN'S FAMILY OF THE STATUS AS YOU
2 INDICATE?
3 A. WELL, THE DOCTOR, IN CASE THE PATIENT NEEDS ANYTHING, IF
4 WE'RE NOT MEETING THEIR NEEDS, HE COULD GIVE US APPROPRIATE
5 ORDERS. THE FAMILY, YOU HAVE A PATIENT THAT IS DYING. IT
6 WOULD BE NICE AS YOU'RE GETTING CLOSER TO LET THEM KNOW THAT
7 THEY MAY WANNA BE THERE WITH THE PATIENT.
8 Q. YOU THEN GO ON TO SAY, MONITOR FOR SKIN BREAKDOWN.
9 COULD YOU TELL US THE SIGNIFICANCE OF THAT PLEASE?
10 A. THAT'S ANOTHER -- CAN BE ANOTHER COMFORT CARE MEASURE.
11 PATIENT'S NOT GONNA BE TURNING THEIRSELVES AT THIS POINT, SO
12 IT'S OUR RESPONSIBILITY TO LOOK AT THEIR SKIN AND MAKE SURE
13 THEY DON'T HAVE BREAKDOWN BECAUSE PRESSURE SORES ARE COMMON
14 WHEN A PATIENT CAN'T CHANGE POSITION BY THEMSELVES.
15 MR. STIRBA: OKAY. THANK YOU, MA'AM. THAT'S ALL I
16 HAVE.
17 THE COURT: ANYTHING FURTHER?
18 MS. BARLOW: NOTHING FURTHER, YOUR HONOR.
19 THE COURT: OKAY. MAY THIS WITNESS BE EXCUSED?
20 MS. BARLOW: YES, PLEASE.