Earline Cozzens
5 MS. BARLOW: We next call Earlene Cooper.
6 THE COURT: Step up, please. Raise your right hand
7 and face the clerk, she'll place you under oath.
8 EARLENE COOPER,
9 being first duly sworn, was examined and
10 testified as follows:
11 THE COURT: If you'll have a seat up here, please.
12 Pull your chair up close to the microphone. Tell us you're
13 name and spell the last name.
14 THE WITNESS: Earlene Cooper. C-o-o-p-e-r.
15 THE COURT: You may proceed.
16 MS. BARLOW: Thank you, Your Honor.
17 DIRECT EXAMINATION
18 BY MS. BARLOW:
19 Q. Good afternoon, Earlene. What is your occupation?
20 A. I'm a registered nurse.
21 Q. And how long have you been a registered nurse?
22 A. About 19 years.
23 Q. What education and training have you received to become a
24 registered nurse?
25 A. I received my Bachelor in nursing at Weber State.
1 Q. And when was that, what year?
2 A. I received my nursing degree in '82 and then I received a
3 Bachelor's in 2000.
4 Q. So you're one of these people that worked and went to
5 school at the same time?
6 A. Yes.
7 Q. What was your professional experience after 1982, after
8 you got your nursing degree?
9 A. I worked at Lakeview Hospital for ten years. I was in
10 med surg. I worked med surg.
11 Q. And what is med surg?
12 A. The medical surgery floor with patients that have had
13 surgery, post-operative, outpatient surgery.
14 THE COURT: Let me ask you to back off from that
15 microphone just a little bit and maybe tip it down. There
16 you go. Thank you.
17 MS. BARLOW: It's a sensitive little thing.
18 Q. (BY MS. BARLOW) So that was ten years that you did med
19 surg at Lakeview?
20 A. Yes. Well, and I did psych during that time too.
21 Q. You said psych?
22 A. Yes. And I did OB. I floated everywhere.
23 Q. Okay. Do you recall how much psych unit experience you
24 had during that ten years?
25 A. Probably about two years then.
1 Q. Was that child, adolescent, adult?
2 A. Adult.
3 Q. And in the adult arena did you have geriatric patients?
4 A. Yes.
5 Q. Did you work with demented patients?
6 A. Yes.
7 Q. After that ten years at Lakeview where did you go, what
8 did you do?
9 A. I went to McKay-Dee Hospital and I worked in their
10 psychiatric ward.
11 Q. What kind of a ward was it at McKay-Dee?
12 A. They actually had several different wards. We had an
13 adult ward that had adults and geriatric patients. We also
14 had a child adolescent unit. I worked with all of those.
15 Q. Approximately how many patients would there be on the
16 adult geriatric unit in any given time at McKay-Dee when you
17 were there?
18 A. 12, maybe 13.
19 Q. Were any of those patients demented?
20 A. Yes.
21 Q. What kind of -- based on your training and experience,
22 what kind of nursing care would you provide for these
23 patients?
24 A. Umm, medication, doctor's orders. I followed the normal
25 nurse things that we do. I'm not sure exactly what you're
1 asking. There's a big gamut.
2 Q. Were there groups offered to those patients?
3 A. Yes.
4 Q. What kind of groups?
5 A. Therapy groups, Self-esteem groups, skills building
6 groups, those kinds of things.
7 Q. Okay. Were you trained to give one to one treatment for
8 these patients?
9 A. Treatment, yes. Not therapy, not groups, not anything
10 else.
11 Q. After McKay-Dee where did you go?
12 A. I went to the Davis hospital.
13 Q. And why did you move to Davis?
14 A. Because there were -- they were cutting nurses at the
15 time. Two of the units that I had been working on were shut
16 down. They were backsliding, or downsizing.
17 Q. What unit did you go to at Davis Hospital?
18 A. The geropsych unit.
19 Q. What year was that?
20 A. That was probably '84. No, '94, I think.
21 Q. When it opened?
22 A. Shortly after.
23 Q. So if it opened in '94, probably '94?
24 A. Yeah.
25 Q. Okay. What shift did you work on at the geropsych unit?
1 A. I would work all of the shifts, but basically it was the
2 morning shift, which was seven to three.
3 Q. Were there any other nurses working with you during that
4 shift?
5 A. I would normally be the charge nurse. There would be
6 another nurse there that was over the unit, but she would be
7 in charge of administrative kinds of things. So I would
8 basically be the nurse on the floor taking care of the
9 patients.
10 Q. Would you have CNAs or LPNs helping you?
11 A. Yes.
12 Q. This is the time of day you're getting people up, getting
13 them fed, that sort of thing?
14 A. Yes.
15 Q. When you first started the unit was Dr. Weitzel the
16 psychiatrist in charge?
17 A. Yes, when I was there.
18 Q. Would you please identify Dr. Weitzel? Is he in the
19 courtroom today?
20 A. Yes. He's right there with the green pen.
21 Q. Sitting behind me basically?
22 A. Uh-huh.
23 Q. Thank you. Are you familiar with the medical consulting
24 that was a policy on this unit?
25 MR. BUGDEN: Say that again.
1 MS. BARLOW: You both seem to be confused. I'll
2 rephrase it.
3 Q. (BY MS. BARLOW) What about physical medical conditions
4 as opposed to psychiatric conditions, how were they handled
5 at this unit?
6 A. To start with we would have a medical doctor come in and
7 examine the patients. But then, as time went by, Dr. Weitzel
8 would begin to do his own history and physicals and medical
9 exams.
10 Q. Did that change back to where someone else was doing
11 those histories and physicals?
12 A. Yes, it did.
13 Q. Was that a policy change of the unit or did it just
14 happen?
15 MR. BUGDEN: Objection. Beyond her scope.
16 THE COURT: Sustained. No foundation.
17 Q. (BY MS. BARLOW) Are you aware of why there was a change
18 back to bringing in someone else to do a medical consult?
19 A. Because of the events that had occurred on the unit.
20 MR. BUGDEN: I'll object.
21 THE COURT: Sustained. Foundation.
22 Q. (BY MS. BARLOW) Do you recall when there was a change
23 from Dr. Weitzel doing the history and physical to --
24 MR. BUGDEN: Your Honor, if I could -- may we
25 approach the bench?
1 THE COURT: You may.
2 (Sidebar, not reported.)
3 Q. (BY MS. BARLOW) With the five patients that we're
4 talking about in this case, the histories and physicals were
5 done mostly by Dr. Dienhart but also Dr. Bitner, not by Dr.
6 Weitzel. Are you aware of that?
7 A. I was not. I knew that he had been following them
8 medically.
9 Q. Okay. Then I won't follow that path. Let's look at the
10 winter of 1995, 1996, particularly December of '95 and
11 January of '96. Were you working at Davis Hospital at that
12 time?
13 A. Yes, I was.
14 Q. Do you recall what time of day the defendant would come
15 in to see the patients during December of '95 and January of
16 '96?
17 A. It would typically be -- I don't remember. I remember
18 some specific times, but I don't remember typically. What I
19 remember was in the evening, sometimes in the morning. It
20 just depended.
21 THE COURT: You need to speak up, please.
22 Q. (BY MS. BARLOW) Don't get too close to the mic, but we
23 need you to project. You saw how the defendant would do his
24 progress notes and reports of the patients?
25 A. Yes, I would.8
1 Q. During this time frame, December and January?
2 A. Uh-huh.
3 Q. And how did he do his progress notes and reports of the
4 patients?
5 A. He would lots of times do them there at the desk, at the
6 nursing desk.
7 Q. Would he -- what, if any, interaction would he have with
8 the patients prior to doing his progress reports?
9 A. Most of the time he would come on the unit and would ask
10 the nurses how the patient was doing, what was going on.
11 Sometimes he'd go in and see the patient. Sometimes he'd
12 stop and see the patient first. But mostly he would ask the
13 nurse staff how it was going and then go in and see the
14 patient and then come back out and write notes.
15 Q. During December of '95 and January of '96, as a nurse did
16 you ever have occasion when you became concerned about the
17 patients' care?
18 A. Yes, I did.
19 Q. Did you do anything about your concerns?
20 A. Yes, I did.
21 Q. What did you do?
22 A. I talked to the nurses on the unit. At one point we did
23 go down to Karen Chatlin's office. We had a meeting where
24 everyone was called together.
25 Q. Who was Karen Chatlin?
1 A. She was the administrator over nursing.
2 Q. Did you express to her your concerns about patient care?
3 A. Yes, I did.
4 Q. Did anything change on the unit?
5 A. No.
6 Q. Let's talk a little bit about Judith Larsen. I don't
7 think you ever saw -- well, before I go there, just a moment.
8 Did the defendant ever ask you to chart any particular
9 words from your observations of patients?
10 A. Yes, he did.
11 Q. What words in particular were you asked to chart?
12 A. We were asked to -- if the patient moaned we were to
13 chart that as the patient was in pain so that we could cover
14 the medications that we were giving, that kind of thing.
15 Q. Do you recall what he told you? How did he tell you to
16 do that?
17 A. He said if they moan, grunt, anything, I want it charted
18 so that we can cover this pain medication; so that it can be
19 charted that they were in pain.
20 Q. Did there ever come a point when the defendant ordered
21 you not to give fluids to any of these five patients?
22 A. Yes, there was.
23 Q. Do you recall when that was, approximately?
24 A. It was during Judith and Lydia, when they were there on
25 the unit. So that would have been the first part of January.
1 Q. Do you recall what he told you about fluids with these
2 patients?
3 A. That they would -- it would prolong their suffering
4 because they would live longer.
5 Q. And what did he tell you to do about fluids?
6 A. He would get angry when he came in and found that we had
7 given a patient fluids.
8 Q. Why did you give them fluids in spite of the order?
9 A. Because their mouths would be dry, because they needed
10 fluids. Because that's part of my understanding of taking
11 care of a patient.
12 Q. When you talk about giving fluids, you're not talking
13 about intravenously?
14 A. No.
15 MR. BUGDEN: Objection, leading.
16 THE COURT: Sustained.
17 Q. (BY MS. BARLOW) What are you talking about, then?
18 A. Water, juices, milk. Those kinds of things.
19 Q. Part of their therapy was groups -- well, maybe I should
20 ask. What was part of their therapy?
21 A. Groups.
22 Q. Okay. How long would the groups go?
23 A. We had several different groups, so we would -- usually
24 we would bathe them and get them ready for breakfast. Then
25 they'd have several different groups. Then there would be
1 lunch and rest time and then some more groups. And then
2 later on they started to have more groups in the evening
3 also.
4 Q. Did the defendant ever give any orders about attendance
5 at groups?
6 A. He demanded that the patients all be there.
7 Q. Did you ever talk to him about that for patients that
8 maybe were lethargic?
9 A. Yes. And we were told that they needed to be gotten up
10 and that they needed to be there in the group.
11 Q. Were you at a meeting, and I believe it's involving
12 Judith Larsen, when Tracy Scholl had held some morphine for
13 Judith Larsen?
14 A. Yes, I was.
15 Q. Do you recall where that meeting was?
16 A. It was in -- there was a kind of kitchen area on the
17 unit. A group room and kitchen area, we had it there.
18 Q. Do you recall what, if anything, the defendant said at
19 that time about morphine?
20 A. That we were not to be holding any more doses back. That
21 he was capable of taking care of these patients medically.
22 And that we were not to be relying on the other doctors.
23 That we were to get ahold of him if there was something with
24 these patients that a doctor would need to know about. That
25 he was capable of following these patients and that we were
1 not to hold any more medication.
2 Q. Do you recall Judith Larsen?
3 A. Yes, I do.
4 Q. Okay. What do you recall of her on admission?
5 A. I don't recall exactly the admission on her. I do recall
6 her as a patient.
7 Q. The first time you saw her do you recall her general
8 condition?
9 A. The first time I saw her she was in bed and she was
10 sleepy. That's what I remember.
11 Q. If you would turn to -- I think in front of you is an
12 exhibit 3B, which is the medical records of Judith Larsen.
13 All right. If you would turn to page 542 in that.
14 A. (Witness complied.)
15 Q. Is your name on that page anywhere?
16 A. Yes, it is.
17 Q. And what does that signify?
18 A. That I was there that day.
19 Q. Did you write any notes?
20 A. No.
21 Q. Now, if you would turn back to med page 502.
22 A. (Witness complied.)
23 Q. And I neglected to ask you what day it was on 542?
24 A. It was 12/14.
25 Q. Okay. December 14th?
1 A. That's what I thought I saw.
2 Q. Yes.
3 A. Okay.
4 Q. On 502 were there any medications -- excuse me. I think
5 I need to go to 503. No, I don't. (Pause.) Okay. Page
6 502, on the 11th and the 12th what medications are listed
7 there as a routine order?
8 A. Serzone and Risperdal.
9 Q. On the 11th were any doses held on the Serzone?
10 A. Yes.
11 Q. How many?
12 A. One.
13 Q. How many were supposed to be given?
14 A. Two.
15 Q. And on the Risperdal how many were ordered?
16 A. Two. Actually, three.
17 Q. And how many were actually given on the 11th?
18 A. One.
19 Q. On the 12th how many were ordered for Serzone?
20 A. Two.
21 Q. And how many were given?
22 A. One.
23 Q. On the 12th how many were ordered for Risperdal?
24 A. Three.
25 Q. And how many were given?
1 A. Two.
2 Q. If you will turn now to 470. I believe that's in the
3 progress notes.
4 A. (Witness complied.)
5 Q. There's a notation on page 470, a physician's progress
6 note for the 14th of December?
7 A. I just found the page. Ask that again.
8 Q. Is there a physicians's progress note for the 14th of
9 December?
10 A. Yes, there is.
11 Q. Do you recall the circumstances surrounding that note?
12 A. Yes, I do.
13 Q. What was happening the day or two before that note, say
14 the 11th, 12th, 13th of December, as far as Judith Larsen was
15 concerned?
16 A. Judith had not been responding to staff. She'd just
17 basically been not able to eat and not really awake. Really
18 lethargic.
19 Q. And then you read on 502 and 503 of some medications
20 being held. Then on the 14th do you recall this note that
21 Dr. Weitzel wrote?
22 A. I do.
23 Q. What does it say?
24 A. "Has made a miraculous recovery. Ambulated yesterday.
25 Taking fluids well. Vital signs afebrile," which means she
1 didn't have a temp. "Doing much better. Remains demented.
2 Continue current treatment."
3 Q. Were you present when Dr. Weitzel wrote that note?
4 A. Yes, I was.
5 Q. And how do you know you were present? How do you know he
6 was writing that note when you were present?
7 A. Because he came on the unit and he -- we were really
8 excited about how well Judith was doing, because we had been
9 able to get her up, she'd started to eat, was doing much
10 better. He came on the unit and --
11 MR. BUGDEN: I think it would be appropriate for the
12 witness to only testify about her own thoughts.
13 THE COURT: I'll sustain that objection. Ask a
14 question. Go ahead.
15 Q. (BY MS. BARLOW) Your own thoughts, not what we were.
16 What was your reaction to Judith doing better at that point?
17 A. I was very pleased.
18 Q. Was anything said by either you or the nurses, in your
19 hearing, to Dr. Weitzel about Judith's improving condition?
20 A. Yes. When he came onto the unit, like I said, he would
21 typically ask how the patients were doing and we were letting
22 him know that she was doing a lot better, had been up, was
23 eating.
24 Q. What, if anything, did Dr. Weitzel say to that?
25 A. He had the chart in his hand. He stood right next to me,
1 right here, and he held the chart right in my face and he
2 says, oh, aren't you guys so good. Aren't you proud of
3 yourselves. Has made a miraculous recovery. And those two
4 little marks right there were for my benefit to let me know I
5 wasn't a good nurse because Judith was doing better.
6 MR. BUGDEN: Your Honor, I'll object to her
7 interpretation.
8 THE COURT: Sustained. Stricken.
9 MR. BUGDEN: I ask that we proceed by question and
10 answer.
11 THE COURT: Yes. Go ahead.
12 Q. (BY MS. BARLOW) Did you say anything to Dr. Weitzel
13 after he made that comment and wrote that note in front of
14 you about Judith?
15 A. No.
16 Q. Now, if you would turn to 497.
17 A. (Witness complied.)
18 Q. Were you present when Judith had a seizure?
19 A. No, I wasn't.
20 Q. Were you present when she had the vomiting?
21 A. Yes.
22 Q. And I believe that that occurred on the 29th and 30th
23 of -- I'll just --
24 MS. BARLOW: Your Honor, if I may just say that
25 rather than asking her to go through that?
1 THE COURT: You may.
2 Q. (BY MS. BARLOW) The 29th and 30th from other testimony.
3 Do you recall an order for morphine on the 30th of December
4 for Judith Larson? If you would turn to 497.
5 A. Okay. I'm looking at 497 now.
6 Q. Do you recall the defendant making an order for morphine
7 beginning that day?
8 A. It's here on the med sheet. I don't remember him writing
9 it specifically.
10 Q. Did you talk to Dr. Weitzel about ordering -- about this
11 order for morphine for Judith Larsen?
12 A. I don't believe that I talked to him about this
13 particular one. I talked to him about the vomiting that she
14 was having.
15 Q. So you don't recall talking -- okay. You said that. I
16 won't ask you to repeat it. If you would turn to 477 please.
17 A. (Witness complied.)
18 Q. Were you present when Judith Larsen passed away?
19 A. No.
20 Q. If you would look at the progress notes for -- I think
21 we've already read the 3rd of January, but if you would look
22 at the one for the 4th of January.
23 A. (Witness complied.)
24 Q. Can you read that? This is the note written by the M.D.,
25 which was Dr. Weitzel.
1 A. Patient given large amounts of morphine yesterday p.m.
2 for comfort. Finally, she expired at 8:00 p.m. Appeared to
3 be in no pain. Respirations down. Poor blood pressure.
4 Something to dehydration. Then it goes cardiac arrest. And
5 it says release to family.
6 Q. After her death did you ever hear Dr. Weitzel say
7 anything about Mrs. Larsen's death?
8 A. Yes, I did.
9 Q. When was that?
10 A. We would be sitting at the desk and we were talking about
11 Judith Larsen and he interrupted the conversation. Two of
12 the nurses were talking and he says, yeah, finally, I thought
13 she'd never die. As he says here in the notes, finally, that
14 was his word.
15 Q. Let's now turn to Mrs. Crane. Do you recall Mrs. Crane?
16 A. Yes, I do.
17 Q. What do you recall of her condition when you first saw
18 her in the hospital?
19 A. She was in a wheelchair, but she was -- she was a little
20 agitated, but was alert and able to talk to you. That's what
21 I recall of her. She had a lot of family.
22 Q. A lot of what?
23 A. Family.
24 Q. Okay. Were you there when the fistula was discovered?
25 A. Yes, I was.
1 Q. And in fact did you find it or was it another nurse?
2 A. It was another nurse.
3 Q. Was that ever reported to Dr. Weitzel?
4 A. Yes, it was.
5 Q. By whom?
6 A. The nursing staff.
7 Q. Were you present when he got the word about the fistula?
8 A. He came onto the unit and --
9 THE COURT: That's a yes or no answer.
10 THE WITNESS: Yes.
11 Q. (BY MS. BARLOW) Do you recall what time of day he was
12 informed of this fistula?
13 A. I don't remember exactly.
14 Q. What, if anything, did you hear Dr. Weitzel say about the
15 fistula and Mary Crane?
16 A. She was -- what did I hear him say? He says I'm not
17 going there. I don't want to deal with that. Dr. Dienhart
18 can deal with that one. And then he avoided going to her
19 room. He didn't even want to go in there.
20 MR. BUGDEN: Your Honor, this is not responsive.
21 THE COURT: Sustained. That portion is stricken.
22 Q. (BY MS. BARLOW) After he said that did you observe his
23 behavior?
24 A. Yes, I did.
25 Q. What was his behavior regarding Mary Crane, just that day
1 right after he said that?
2 A. He avoided going into her room. He didn't want to go in
3 there.
4 Q. Okay. If you'll turn to page 328, and this is in number
5 4B, which is Mary Crane's medical records.
6 A. (Witness complied.)
7 Q. What date was that -- excuse me. I'll wait until you get
8 to it.
9 A. Okay.
10 Q. What date was that note written?
11 A. On the 7th of January. January 7, 1996.
12 Q. Thank you. Did you write a note here?
13 A. Yes, I did.
14 Q. What time did you write your note?
15 A. That's 2:00 in the afternoon, 1400.
16 Q. Would you please --
17 THE COURT: Turn the lights off to see better.
18 MS. BARLOW: Yes.
19 Q. (BY MS. BARLOW) Read that note for us, please.
20 A. Patient has had no episodes of being combative because
21 she has been lethargic all shift. Dr. Dienhart notified of
22 patient status. Family notified. Patient had O2 per mask.
23 Suction times through three by nurse and times two by
24 respiratory therapy. Chest x-ray taken. Lab drawn. Patient
25 having labored respirations with periods of apnea. Sat
1 level, 80 to 70.
2 Q. What is sat?
3 A. Her oxygenation level.
4 Q. Okay.
5 A. Pulse irregular. Patient lethargic to almost
6 unresponsive. Meds as per doctor. Close observation.
7 Q. This is the BRIP. Is that a kind of shift worth of
8 notes?
9 A. Yes.
10 Q. Why did you call Dr. Dienhart?
11 A. Because his patient was having a hard time breathing and
12 I was concerned about her.
13 Q. Did you tell Dr. Weitzel that you had called Dr.
14 Dienhart, do you recall?
15 A. I don't recall.
16 Q. Did you inform Dr. Weitzel of the low oxygen saturation
17 for Mary Crane that day?
18 A. I had called him. I had tried to get ahold of him. Yes,
19 I did. I informed him of that later in the day.
20 Q. Later in the day. What, if anything, was his response to
21 you telling him that her oxygen saturation was low?
22 A. He said, well, let's keep monitoring it and documenting
23 it to cover ourselves, but don't call me. I don't care what
24 it is because I'm not going to do anything about it, is what
25 he said.
1 Q. On the next page, 329, is that your writing up at the
2 top?
3 A. Yes, it is.
4 Q. What time did you write that note? It's a little hard to
5 read.
6 A. 2200, or 10:00 at night.
7 Q. What did you write?
8 A. I wrote, "Patient has been unresponsive this whole shift.
9 Comfort measures. Turned Q2. Morphine given. Patient
10 Cheyne-Stoking. Very cyanotic. Family with patient.
11 Patient DNR. MS for comfort."
12 Q. Was morphine being given at this time?
13 A. Yes.
14 Q. If you would turn to page 290.
15 A. (Witness complied.)
16 Q. Did you administer any morphine on the 7th of January to
17 Mary Crane?
18 A. Yes, I did.
19 Q. I want to clarify something. This is the 7th of January.
20 It says MS at 2000. It says given and then are those your
21 initials?
22 A. Yes, they are.
23 Q. Why is it written that way?
24 A. Because I didn't give that dose.
25 Q. Do you know who did?
1 A. Lynn Long.
2 Q. And then 2300 there's a dose given. At that point did
3 you give that one?
4 A. Yes.
5 Q. And why did you not give the one at 2000?
6 A. Because I felt very uncomfortable about giving it. I was
7 afraid of what it would do to this patient and I didn't want
8 to give it.
9 Q. Why did you give the one at 2300?
10 A. Because I had already fought about giving this last one,
11 about giving the 2000 dose.
12 Q. Who did you fight with about giving the 2000 dose?
13 A. With Dr. Weitzel.
14 Q. How did that -- okay. At 8:00 the order is there. Do
15 you know how the order came to the unit?
16 A. Yes, I do.
17 Q. How?
18 A. Umm, we had been waiting for Dr. Weitzel to come. I had
19 called him several times before that. He had finally come
20 in. He wrote an order for her to receive the MS, five
21 milligrams every three hours. I didn't consider Mary to be
22 in pain at that time. She was basically unresponsive. There
23 was no moaning. I saw no signs of pain at all.
24 MR. BUGDEN: There's no question for this witness.
25 Q. (BY MS. BARLOW) Let me ask the question. Did you tell
1 Dr. Weitzel your findings or lack thereof?
2 A. Yes, I did.
3 Q. What exactly did you say to him, if you can remember?
4 A. I says I don't see that she's in pain. I don't see any
5 signs of pain.
6 Q. What did he say in response to that?
7 A. He says how do you know she's not in pain.
8 Q. What did you say?
9 A. I says because I don't see any signs of pain.
10 Q. What did he say?
11 A. He says, well, I think she's in pain and I think you need
12 to go give it.
13 Q. What did you say at that point?
14 A. Let me think. I said that I didn't think she was in pain
15 and -- I'm sorry.
16 Q. I recognize it has been a lot of years back. Did Dr.
17 Weitzel say anything further about you administering the
18 morphine?
19 A. He said that he felt like she was in pain and was I
20 willing to let her suffer because I didn't think that she
21 was.
22 Q. And what was your response?
23 A. I didn't fight with him anymore at that point. I went
24 and I called the pharmacy.
25 Q. You say you did not give the 2000 shot, someone else did?
1 A. Yes.
2 Q. Why is it that your initials are there and the word given
3 is there if you're not the one who gave it?
4 A. Umm, after I had called the pharmacy I went and talked
5 with Dr. Weitzel again, because even after talking with the
6 pharmacy I did not feel comfortable about giving it. So we
7 were having the exact same conversation. I was saying why
8 are we giving it and he was saying because she needs it for
9 pain.
10 So I'm sitting there arguing with him and Lynn Long came
11 and took the shot from me and said if you don't feel
12 comfortable giving it I do and she went and gave it, but she
13 didn't chart it here. And I didn't want the dose given
14 again. I didn't want it given the first time, so I wrote
15 given there because I didn't want anybody walking in and
16 giving it. But when Lynn left she hadn't initialed it and I
17 wanted to have my initials there so someone would know I
18 wrote given there.
19 MR. BUGDEN: I'm not sure what the question is.
20 Q. (BY MS. BARLOW) Let me ask a question. So that's what
21 happened with the 2000 dose. On the 2300 dose you did give
22 it?
23 A. Yes, I did.
24 Q. And why did you give it?
25 A. Dr. Weitzel had gone in and talked to the family and told
1 them that I would be in with the shot. That we were not
2 going to let their mother suffer and --
3 MR. BUGDEN: May I voir dire?
4 THE COURT: You may.
5 MR. BUGDEN: Were you present in that conversation?
6 Were you in the room, ma'am? Were you in the room when Dr.
7 Weitzel spoke to the family?
8 THE WITNESS: No.
9 MR. BUGDEN: Then I would ask that that be stricken.
10 THE COURT: It will be stricken.
11 Q. (BY MS. BARLOW) After he came out of the room did you
12 give the shot at 2300?
13 A. Yes, I did.
14 Q. Let's now talk -- there is one other thing I wanted to
15 cover with Mary Crane. Where you aware that she had a
16 Duragesic patch?
17 A. Yes, I was.
18 Q. Let's look at med number 249. Put a finger there and
19 also put a finger in 289. We'll be kind of comparing those
20 two.
21 A. (Witness complied.)
22 Q. How often is a Duragesic patch supposed to be changed?
23 A. Every three days.
24 Q. On 289, did you have anything to do with the Duragesic
25 patch on the 7th of January?
1 A. Yes. I had put it on that morning.
2 Q. What time that morning?
3 A. 8:00.
4 Q. Keep your finger there and turn back to page 249.
5 A. (Witness complied.)
6 Q. There is an order for the 7th of January on the left.
7 Can you read what that order is?
8 A. Hold all meds. Morphine, five milligrams IM now and Q
9 three hours around the clock.
10 Q. And it looks like you noted that, you took it off?
11 A. Yes.
12 Q. What time did you take that off?
13 A. 9:00 at night.
14 Q. Did you take the Duragesic patch off in connection with
15 this order that came at 9:00 that night?
16 A. No, I did not.
17 Q. And why did you not?
18 A. Because it says hold meds, it doesn't say discontinue
19 meds. When you hold meds you don't give any more of the meds
20 that are there, but you don't discontinue the meds that they
21 have. You can't take them back.
22 Q. Now let's talk about Lydia Smith, which is 5B. Do you
23 recall Lydia Smith?
24 A. Yes, I do.
25 Q. And what is it that you recall about her?
1 A. Lydia was a very very feisty lady. When she came onto
2 the unit she was all over the place. She was very energetic.
3 She was a darling little thing. She was very petite and very
4 lively.
5 Q. It appears that she came in on the 21st of December. Did
6 you see her condition change at all from the 21st of December
7 until, say, the 7th of January?
8 A. Yes, I did.
9 Q. And how did her condition change?
10 A. She continued to be pretty feisty, almost up until the
11 7th. She would have some times when she be kind of sleepy,
12 but would usually come out of it. On the 7th, when I came on
13 shift at seven in the morning, she was unresponsive. She
14 wasn't -- this was not the Lydia I knew and I became very
15 concerned.
16 Q. Did you express that concern to anyone?
17 A. I tried to get ahold of the doctor. I was able to get
18 ahold of her family. They said that they would come on in.
19 I was in hopes that when her --
20 MR. BUGDEN: Can we proceed with a question and
21 answer?
22 THE WITNESS: I'm sorry.
23 Q. (BY MS. BARLOW) Let's turn to page 800 in 5B.
24 A. (Witness complied.)
25 Q. What day is this? I'm sorry, you're not there yet.
1 A. I'm not.
2 Q. Did you write any notes on that day?
3 A. I did.
4 Q. What time did you write the note?
5 A. This is at 2:00 in the afternoon, 1400.
6 Q. And it has the BIRP. Is that a kind of shift wide thing?
7 A. Yes.
8 Q. Would you read that for us.
9 A. "Patient not able to take meds. Patient lethargic and
10 unresponsive. Patient not swallowing or responding to staff.
11 Patient family notified of patient's condition. Family in to
12 be with patient. Oral care given. Doctor called, times two,
13 without calling back. No wet diapers. No PO intake. Turn Q
14 two hours. Good ADL care. Follow doctor's orders."
15 Q. Now, it appears that after doctor called there is a word
16 written before the time?
17 A. I don't recall what it is.
18 Q. Okay. And then if you would turn to page 801. Did you
19 write this note as well?
20 A. I did.
21 Q. What time was that?
22 A. That was 10:00 at night.
23 Q. And would you read that note for us.
24 A. "Patient not able to take any meds. Patient unresponsive
25 most of shift. Support one to one. Time meds as per doctor.
1 Family and doctor notified of patient's condition. Family
2 and Dr. Weitzel in to see the patient. Respiration shallow.
3 Comfort measures."
4 Q. Did you have any concerns about Mrs. Smith's condition at
5 this time?
6 A. Yes.
7 MR. BUGDEN: I don't think her concerns are
8 relevant.
9 THE COURT: Sustained.
10 Q. (BY MS. BARLOW) Did you -- let's turn to 742.
11 A. (Witness complied.)
12 Q. This is a medication sheet for the 7th of January. Do
13 you recall getting this order and taking this order off? It
14 appears to be your handwriting. Is it?
15 A. Yes.
16 Q. So you were ordered to give that to Lydia Smith?
17 A. I was ordered to give morphine, five milligrams every
18 three hours.
19 Q. And it appears you gave the 2100 dose?
20 A. Yes, I did.
21 Q. When was this in relationship to your conversation with
22 Dr. Weitzel about the morphine for Mary Crane?
23 A. It was right after.
24 Q. Did you say anything to Dr. Weitzel when you saw this
25 order for morphine for Lydia Smith?
1 A. I did.
2 Q. Where did that conversation take place?
3 A. At the nursing desk.
4 Q. Was anyone else present?
5 A. Yes, there was.
6 Q. Who else was present?
7 A. Lynn Long and, I believe, Beverly Fulger was there, but
8 I'm not sure.
9 Q. Okay. What, if anything, did you say to Dr. Weitzel
10 about the morphine order for Lydia Smith?
11 A. I said to him, okay, we just had a conversation about
12 this on Mary.
13 THE COURT: Wait a minute. Is this what you said to
14 him actually?
15 THE WITNESS: Well, okay.
16 THE COURT: See what I'm trying to say?
17 THE WITNESS: Yes.
18 Q. (BY MS. BARLOW) What did you say to him?
19 A. I said, okay, you told me Mary was in pain. But I know
20 Lydia isn't in pain so why have we got a morphine order for
21 Lydia.
22 Q. And what was the defendant's response?
23 A. He said how do you know she's not in pain.
24 Q. What did you say?
25 A. I said because she's never complained of pain. She
1 hasn't told me she's in pain. I don't think she's in pain.
2 Why are we giving the morphine.
3 Q. And what did Dr. Weitzel say to you?
4 A. He said, so you're not willing to give her the shot
5 because you don't think she's in pain. I think she's in
6 pain and you're willing to let her suffer.
7 Q. What was your response?
8 A. I said that I didn't think she was in pain.
9 Q. Did you give the morphine?
10 A. I did.
11 Q. Why?
12 A. Because I had fought the fight with him.
13 Q. Now let's -- I'll just ask you about Mr. Alldredge. Do
14 you recall Mr. Alldredge?
15 A. I do.
16 Q. What do you recall of Mr. Alldredge?
17 A. He was a very strong man. He was very demented.
18 Q. Did you notice any change in his condition in the time
19 that he was on the unit?
20 A. He had gone to where he was just laying in bed and was
21 unresponsive.
22 Q. Did you have any discussion with Dr. Weitzel about any
23 medications regarding Ennis Alldredge?
24 A. I don't remember any, no.
25 MS. BARLOW: Thank you. I think that's all I have.
1 THE COURT: Cross-examine, Mr. Bugden.
2 CROSS-EXAMINATION
3 BY MR. BUGDEN:
4 Q. Ms. Cooper, my name is Walter Bugden. I'm one of the
5 lawyers representing Dr. Weitzel. I'm going to ask you some
6 questions.
7 Ma'am, you've not had, or at least in 1995, 1996, you had
8 not had any specialized training to recognize pain in the
9 demented patient, isn't that true?
10 A. In my nursing schooling they do teach you to assess pain.
11 Q. In your nursing schooling?
12 A. Uh-huh.
13 Q. Let me ask it a different way. After you graduated from
14 nursing school did you have any specialized training to
15 detect or to recognize pain in the cognitively impaired
16 demented patient? Do you want me to repeat it?
17 A. I've been trained to assess pain. I've been trained to
18 assess pain in geriatric patients and demented patients, yes.
19 Q. What specialized training did you receive to identify
20 pain in a demented patient? By that, what seminars, what
21 books had you read? Let's start with what books had you
22 read?
23 A. There weren't any books.
24 Q. What materials had you read?
25 A. There were materials that would be presented on pain. I
1 don't recall specifically.
2 Q. Well, tell me what did you learn, then, from -- was it
3 that you learned by going to a seminar?
4 A. No.
5 Q. Where was it that you had learned to recognize pain in a
6 demented patient that couldn't self report pain?
7 A. By working with them and by talking with other people and
8 by --
9 Q. I'm trying to understand the specialized training that
10 you received. I understand that maybe you picked up
11 something while serving as a nurse, you learned something in
12 that context. I'm asking about special education that you
13 had to recognize symptoms of pain in a demented patient?
14 A. Okay. I picked it up in my nursing experience.
15 Q. So does that mean you didn't have any specialized
16 educational nursing training on it?
17 A. No.
18 Q. Thank you. And you are telling the jury, then, that you
19 had learned how to recognize pain in a demented patient by
20 your on the job training, that you learned that way?
21 A. I think there was more to it than that. I think there
22 was experience. I think there was interaction with other
23 people. I think there was meetings on that.
24 Q. Well, taking the sum total of all of your experience,
25 then, in nursing, tell me what the symptoms are -- the pain
1 symptoms are in the cognitively impaired demented patient? A
2 patient that can't self report pain, what are the symptoms
3 that you had learned to recognize were symptoms of pain?
4 Tell us that, please. Do you understand the question?
5 A. I do. Sometimes with pain vital signs will go up.
6 There's various signs that you look for. You look for
7 grimacing.
8 Q. Keep your voice up. You said you look for grimacing?
9 A. Yes.
10 Q. What else, sort of behavioral things, are you trained to
11 look for as cues of pain?
12 A. Agitation.
13 Q. Agitation can be a sign of pain?
14 A. Uh-huh.
15 Q. What about moaning?
16 A. It could be, yes.
17 Q. About what screaming?
18 A. Could be.
19 Q. Are those -- is screaming something that you had come to
20 recognize as a symptom of pain?
21 MS. BARLOW: Objection. Asked and answered, Your
22 Honor.
23 THE COURT: Overruled.
24 THE WITNESS: It could be.
25 Q. (BY MR. BUGDEN) What about thrashing around in your bed,
1 is that something that you have come to learn was a symptom
2 of pain?
3 A. It could be.
4 Q. What about people that pull their hair out and strip
5 their clothes off, people that are post-stroke, one month
6 post-stroke, was that something that you learned in your
7 nursing training might be a symptom of post-stroke chronic
8 pain syndrome?
9 A. No, it wasn't.
10 Q. That's not something you had learned?
11 A. Huh-uh.
12 Q. With the cognitively impaired demented patient, isn't the
13 recognition of pain sort of an art form? It's not easy, is
14 it, would you agree?
15 A. I would agree with that.
16 Q. There is no painometer, no device you can attach to the
17 patient and know that that patient has pain, isn't that true?
18 A. That's true.
19 Q. And the patient can't say, Earlene, I really hurt? I
20 mean, generally a demented patient can't tell you that?
21 A. Generally they can't.
22 Q. They can't tell you where they hurt?
23 A. That's true.
24 Q. And would you agree that part of the nursing obligation
25 is to relieve the suffering of a patient?
1 A. Yes, I do.
2 Q. And if a patient is in pain, do you think that part of
3 the nurse's job is to relieve that symptom of pain even if
4 they can't tell you that they hurt?
5 A. Yes, I do.
6 Q. And you've told us about some conversations you
7 remembered today that you had with Dr. Weitzel at different
8 times during the treatment of some of these different
9 patients. This is a memory that you have now five or six
10 years after the event?
11 A. Yes.
12 Q. Let's begin with -- I think you told the jury and told
13 the prosecutor that you were concerned with the medical care
14 that the patients were receiving on the geropsych unit and so
15 you went to the administration of the hospital and
16 complained, is that right?
17 A. Yes.
18 Q. You complained to Karen Chatlin?
19 A. Yes.
20 Q. And you explained to her that you were concerned about
21 the care that was being given on the geropsych unit and you
22 had the opportunity to give -- to say your piece, but the
23 administration didn't implement any changes, is that right?
24 A. Yes.
25 Q. And I guess you were disappointed that your complaint
1 hadn't been honored, would that be fair to say?
2 A. I don't believe that that would be right. I don't think
3 that I was --
4 Q. So you were satisfied that you had had your opportunity
5 to complain and that nothing came of it and that was okay
6 with you, is that right? You weren't disappointed, weren't
7 frustrated, weren't angry, none of those? You didn't have
8 any of those emotions when the administration didn't back
9 you?
10 A. I don't remember having any of those emotions, no.
11 Q. Okay. I'm going to ask you some questions, ma'am, and I
12 have a different system of looking at the records than the
13 prosecutor. You'll see a number in the lower right-hand
14 corner and generally I'll refer to that number for you and
15 that will help direct you to a page. Is that all right?
16 A. That is fine.
17 Q. Mr. Alldredge, this was a patient that you didn't have a
18 lot to do with, am I right?
19 A. Actually, I think I did have quite a bit to do with him.
20 I just don't recall him as well as the others.
21 Q. Do you remember that this was a strong man?
22 A. Yes.
23 Q. Do you remember that he posed a threat to the nursing
24 staff?
25 A. Yes.
1 Q. Do you remember that he was combative and aggressive?
2 A. Yes.
3 Q. Do you remember that he had to be restrained in what are
4 called Posey restraints?
5 A. Yes.
6 Q. On January 10th at 2:00 p.m. did you treat the patient
7 that day? Before you look at the chart note, I'll help you
8 to look at the right page. Do you recall today -- I know
9 it's now six years later, but do you recall today that this
10 man came to you from a nursing home having thrown a
11 wheelchair at another resident and breaking that resident's
12 hip?
13 A. I didn't recall that, no.
14 Q. Did you know that the family doctor had tried increasing
15 doses of Ativan to control this man's agitation on the day
16 right before admission and had not been able to control this
17 man's behavior, did you know that?
18 A. No, I did not.
19 Q. Okay. So on January 10th you did provide nursing care to
20 Mr. Alldredge, is that right?
21 A. I can't read it. Is that the date he was admitted?
22 Q. Yes, it is.
23 A. Okay. There's no date on this one. My signature is
24 here, yes.
25 Q. Look at exhibit 6B, ma'am, page three. Do you see that?
1 A. Yes.
2 Q. If you would turn to the next page. On that page is some
3 of that note yours? It looks like after 1400 there's a long
4 narrative?
5 A. Yes.
6 Q. And then it is signed Cooper. Is that you?
7 A. That's me.
8 Q. Okay. And then on the next page, page four to you,
9 ma'am, there's a blowup. Mr. Alldredge was combative and
10 agitated. Not oriented to time, place or person. Is that
11 right?
12 A. Yes.
13 Q. And not oriented to person. Does that mean that Mr.
14 Alldredge -- is that a term of art, not oriented to person?
15 Does it mean that he didn't know who he was?
16 A. It means that he didn't know who some of the people
17 around him were.
18 Q. Okay. Then on January 13th, page -- med page 74, Judge,
19 and to you, ma'am, page six. Do you have a note on that
20 page?
21 A. I do.
22 Q. And I think there's a blowup for you that might be easier
23 to read on the screen. Would you read that to us, the 8:00
24 entry.
25 A. "Patient unresponsive. Family with patient. Posey and
1 restraints taken off. IV DC. Comfort measures given." Then
2 there's my signature.
3 Q. Comfort measures given. What does that phrase mean to
4 you, ma'am?
5 A. It means that we would make sure that he was turned and
6 that he was taken care of by staff. That he was bathed and
7 that we were following the doctor's orders of medication.
8 Q. The IV had been discontinued. At that point were you
9 aware that the family had decided that they were going to
10 stop, or at least were not going to allow, any extraordinary
11 medical measures to be taken to prolong his life?
12 A. Yes.
13 Q. And comfort measures, is that a term of art that you're
14 familiar with, ma'am? Comfort measures, are you familiar
15 with that phrase?
16 A. Yes.
17 Q. And at this point on January 13th did you understand that
18 the family had decided that they were going to stand back and
19 allow nature to take its course with Mr. Alldredge?
20 A. I think the family -- that was their intent.
21 Q. Okay. And then I understand you contacted Dr. Dienhart
22 that day?
23 A. Yes.
24 Q. And notified Dr.doctor Dienhart of the patient's
25 declining condition, is that right?
1 A. Yes.
2 Q. So Dr. Dienhart knew that the patient was slipping away,
3 if you will?
4 A. I had notified him.
5 Q. He knew that the IV had been discontinued, is that right?
6 A. I don't remember specifically telling him that.
7 Q. You can't remember that? You can remember other aspects
8 of the conversations with Robert Weitzel, but you can't
9 remember whether or not you told him -- as you look at the
10 note here whether or not you advised him that the IV had been
11 discontinued?
12 A. I don't remember.
13 Q. Okay. You certainly did communicate that the patient was
14 close to death, is that right?
15 A. I told him that the patient was unresponsive, that the
16 family was there. Those are things I would have told him.
17 Q. Wouldn't that have included that the patient was slipping
18 away?
19 A. I don't remember.
20 Q. Okay. Dr. Dienhart did not change any of the
21 medications, did he? He didn't enter any orders for the
22 patient, did he?
23 A. I don't see any here. I wouldn't know without looking.
24 Q. Let's look at med page 13. It is the very next page for
25 you, ma'am.
1 A. (Witness complied.)
2 Q. These are the medical orders from the physician on that
3 day. Did Dr. Dienhart -- are there any orders from Dr.
4 Dienhart?
5 A. No, there's not.
6 Q. Okay. Mary Crane, this was one of the patients -- do I
7 have it right that this is one of the patients that you
8 didn't see any pain in?
9 A. There was some pain with her.
10 Q. You did see some pain?
11 A. Not on the 7th.
12 Q. Okay. Well, we'll get there in a moment. You were the
13 nurse that prepared the nursing assessment, isn't that true?
14 A. Yes.
15 MR. BUGDEN: And can we see that note? I believe
16 it's med 296 in 4B, Judge.
17 THE COURT: Okay.
18 Q. (BY MR. BUGDEN) Does this document look familiar to you?
19 Is this your handwriting?
20 A. That's not my handwriting.
21 Q. Did you prepare the nursing assessment?
22 A. Mary had come during a shift change, so I started the
23 assessment on her but I did not finish it. So actually there
24 are two people who admitted this lady. There's myself and I
25 don't know who wrote this.
1 Q. Okay. Let me just ask you a few questions. We can look
2 at the records to refresh your recollection if you need that.
3 Maybe you'll remember some of these things without. Do you
4 remember that this woman had a herniated disk and had a
5 history of poor control of pain?
6 A. Yes, I do.
7 Q. Do you remember that this woman reported that she had a
8 pain scale, on a scale of zero to five, of a five?
9 A. I didn't remember that specifically. I don't know that I
10 even knew that.
11 Q. Would that be something that you as a nurse, trying to
12 care for the patient, would have familiarized yourself with
13 that aspect of the chart? Would you have ever taken the time
14 to do that, ma'am, when you were treating this patient?
15 A. I don't remember.
16 Q. Do you remember -- does it come as a surprise to you that
17 the patient did report on the nursing assessment that what
18 she most wanted changed in her circumstances at the hospital
19 was her pain, did you know that?
20 A. That doesn't surprise me, but I don't remember
21 specifically reading that.
22 Q. Okay. There came a time when it was discovered that this
23 patient had a rectal/vaginal fistula, is that right?
24 A. Yes.
25 Q. And would that be a painful condition, ma'am, a hole
1 between the rectum and the vagina?
2 A. I would think so.
3 Q. Okay. So you would think, with your expertise, that pain
4 control would be appropriate for someone who had a hole
5 between their rectum and vagina?
6 A. Yes.
7 Q. And you're critical because Dr. Weitzel deferred to the
8 internist, Dr. Dienhart, and also to the gynecologist, Dr.
9 Meeks?
10 MS. BARLOW: I'm going to object to his
11 characterization of critical. I don't think she said that.
12 THE COURT: I think her obvious testimony was to
13 that effect. I'll overrule the objection.
14 Q. (BY MR. BUGDEN) Haven't you earlier said that you
15 thought that medical problems should be handled by the
16 medical people like Dr. Dienhart, the internist?
17 A. Yes.
18 Q. And just so that we're both on the same page as to your
19 memory, didn't you begin your testimony by telling the jury
20 that Dr. Weitzel prepared the history and physical of these
21 patients and it was only when Ms. Barlow said you know, by
22 the way, you're wrong on that, Weitzel did not prepare any of
23 those, the internist Dienhart did four and Bitner did one,
24 but that wasn't your memory, was it?
25 A. No, it wasn't.
1 Q. So on the one hand you were critical that Weitzel was
2 trying to provide medical care for these patients that you
3 thought had serious medical problems, am I right?
4 A. Yes.
5 Q. And then on the other hand, when this patient, Mary
6 Crane, had a rectal/vaginal fistula and Dr. Weitzel deferred
7 to Dr. Meeks, a gynecologist, and Dr. Dienhart, the
8 internist, you thought that was a bad thing? You thought he
9 was avoiding the patient, is that right?
10 A. I didn't think it was a bad thing, just unusual for him.
11 Q. Okay. Thank you. By January 7th this patient, Mary
12 Crane, had a medical plan in place that provided for the
13 administration of comfort measures, isn't that true?
14 A. Yes.
15 Q. This was, again, another occasion that you contacted Dr.
16 Dienhart to advise him of her medical condition, isn't that
17 true?
18 A. It is.
19 Q. And by that I mean you advised Dr. Dienhart of her
20 declining condition, isn't that true?
21 A. Yes, it is.
22 Q. And in spite of her declining condition, Dr. Dienhart
23 gave you telephone orders, is that right?
24 A. Yes.
25 Q. It's not unusual for a doctor to respond in all sorts of
1 situations to nurse phone calls by giving telephone orders?
2 That's not an unusual practice, is it?
3 A. No.
4 Q. And it wasn't unusual to you, even though this patient
5 was in a declining condition, for the doctor to give you a
6 telephone order? You didn't consider it unusual?
7 A. No.
8 Q. And there was some concern about her oxygen level and so
9 Dr. Dienhart said to do some suctioning, is that right?
10 A. I don't recall any suctioning, no.
11 Q. I said it wrong. Saturation levels?
12 A. Yes.
13 Q. There was some concern about her oxygen levels so he
14 suggested that you do some saturation level tests, Dienhart
15 did?
16 A. He had -- we respiratory therapy at that point check her.
17 Q. Okay. Thank you. And then there's a physician's note,
18 page 249, med record 249. So on 1/7/96 Dr. Weitzel ordered a
19 hold of all above medications, is that right?
20 A. Yes.
21 Q. And the above medications would include the Duragesic
22 patch, isn't that right, Ms. Cooper?
23 A. No, it wouldn't.
24 Q. It wouldn't include the Duragesic patch? That's the way
25 you interpreted it?
1 A. Yes.
2 Q. You don't believe that a stop order to hold all above --
3 A. That's for a stop order. That's a hold.
4 Q. Hold all above meds. You didn't interpret that to
5 include the Duragesic patch?
6 MS. BARLOW: Objection. Asked and answered, Your
7 Honor.
8 THE COURT: Sustained.
9 Q. (BY MR. BUGDEN) You didn't take the Duragesic off?
10 A. No.
11 Q. You took this order off, or whatever the phrase is, but
12 you're the nurse that reported this or recorded this, is that
13 right?
14 A. I'm the one who signed it off.
15 Q. Signed it off. Thank you. And you did not take the
16 Duragesic off, you agree with that?
17 A. Yes.
18 Q. And then there was an order to start around the clock
19 morphine?
20 A. Yes.
21 Q. And then this is one of the patients where, with your
22 experience as a nurse and your training in recognizing pain
23 in the cognitively impaired patient, demented patient, you
24 didn't think this patient had pain, right?
25 A. Not on the 7th.
1 Q. Not on the 7th. So you had a conversation with the
2 attending physician, Dr. Weitzel, isn't that right?
3 A. I did.
4 Q. About whether -- about your inclination to hold the
5 morphine, not administer the morphine, right?
6 A. Yes.
7 Q. And the conversation went something like this. I don't
8 think she's in pain, that's you. Dr. Weitzel then followed
9 up by saying I think she is in pain. Is that right?
10 A. Okay.
11 Q. I don't mean to be tricking you here. You didn't think
12 she was in pain and said that, I don't think she's in pain,
13 is that right?
14 A. Uh-huh.
15 Q. You have to answer out loud?
16 A. Yes.
17 Q. And Dr. Weitzel said what makes you think she's not in
18 pain, something like that?
19 A. Yes.
20 Q. And you said she doesn't look like she's in pain to me,
21 is what you said?
22 A. Yes.
23 Q. So, again, you could see the symptoms of pain at that
24 point? You believed --
25 A. Yes.
1 Q. And then Dr. Weitzel said, well, did she tell you she was
2 in pain?
3 A. He said did she tell you she's not in pain.
4 Q. Okay. And in fact she wasn't someone who was able, at
5 that point, to self report her condition at all?
6 A. She was unresponsive.
7 Q. And then Dr. Weitzel said are you willing to let her
8 suffer, right?
9 A. Yes.
10 Q. And you didn't want her to suffer, did you?
11 A. No, I didn't.
12 Q. But --
13 A. But she wasn't suffering.
14 Q. But she wasn't suffering. You knew better than anyone
15 else that she wasn't suffering, is that your testimony?
16 MS. BARLOW: Argumentative, Your Honor.
17 THE COURT: Overruled.
18 Q. (BY MR. BUGDEN) You knew better than anyone else that
19 she wasn't suffering? You knew better than Dr. Weitzel,
20 right?
21 A. I knew her respirations were depressed. I knew that's
22 not what you do when respirations are depressed.
23 Q. We're talking about pain. We're not talking about
24 respirations, we're talking about pain symptoms.
25 A. I'm talking about the whole patient.
1 Q. I'm talking about pain. I'm asking you about pain. You
2 knew better than Dr. Weitzel that she wasn't in pain?
3 MR. BUGDEN: May I approach the bench?
4 THE COURT: You may.
5 (Sidebar, not reported.)
6 THE COURT: Let me give a caution. It has been
7 picked up by some members of the teams that there is a
8 reaction coming from the audience. If that continues, you'll
9 be asked to leave the courtroom and I won't let you back in.
10 Do you all understand that? Okay. Go ahead.
11 Q. (BY MR. BUGDEN) You knew better than anyone else that
12 she wasn't suffering pain? You, the nurse, knew that, is
13 that right?
14 A. No.
15 Q. But you called the pharmacy, didn't you?
16 A. Yes, I did.
17 Q. And told the pharmacy that there had been an order from
18 Dr. Weitzel to give an IM five milligrams, right?
19 A. Yes.
20 Q. And the pharmacy told you it would be okay, just watch
21 her, isn't that true?
22 A. Yes, it is.
23 Q. Thank you. The pharmacy was wrong too, right?
24 A. No. Watch her do what?
25 Q. I'd like to ask you some questions about Judith Larsen,
1 Ms. Cooper. I just need to find her pages before I'm ready
2 to ask the questions. (Pause.) Were you aware that when
3 Mrs. Larsen came to the hospital that her son had told the
4 nursing staff that was preparing the nursing admission that
5 they had hopes, but not fantasies, about the patient's
6 ability to recover, were you aware of that?
7 A. I don't recall.
8 Q. Would that be important to you to know what the family's
9 wishes were with this patient?
10 A. Yes.
11 Q. Were you aware that Merlin Larsen, the son, on numerous
12 occasions, before the gastrointestinal bleeding situation
13 arose, before the coffee ground emesis situation arose, that
14 Merlin Larsen repeatedly had told nursing staff members that
15 they didn't want IV's, that they wanted to withhold
16 treatment, and that they just wanted to keep Judith Larsen
17 comfortable? Were you aware of that at all, ma'am?
18 A. I don't recall right now for sure that I was aware of
19 that.
20 Q. Well, you know, you read with great feeling in your
21 voice, and I'm sure that you were trying to make a point to
22 the jury, that when this woman finally passed away that Dr.
23 Weitzel said this woman finally passed away. You said that
24 with great spirit in your voice to the jury.
25 What I want to know is were you aware that this woman had
1 a five week descent into death and that every step of the way
2 the family was ready to let this woman go, were you aware of
3 that?
4 A. She hung in there for a long time.
5 Q. Do you believe that you nurses should be able to
6 supersede, that is overrule, family wishes when a family says
7 enough is enough, let my mother die? Do you believe you
8 nurses have that power?
9 A. No.
10 Q. When Dr. Weitzel met with -- had some sort of a meeting
11 with the nursing staff after the medications had been
12 withhold by Tracy Scholl concerning this patient, Judith
13 Larsen, isn't it true that Dr. Weitzel told you, told the
14 staff, to call him if you were going to withhold the
15 medications?
16 A. Yes.
17 Q. Thank you. And don't you believe, ma'am, that in the
18 hierarchy of hospital settings the doctor, who gives the
19 orders, and the nurses who obey the orders, that the doctor
20 has the right to know if the nurse has decided to not follow
21 the doctor's order? Don't you believe that the doctor has a
22 right to know that?
23 A. Yes, he does.
24 Q. Thank you. Lydia Smith, I'll ask you some questions
25 about her now. You didn't have a lot to do with Lydia, am I
1 right?
2 A. I had a lot to do with Lydia.
3 Q. Sorry. I didn't understand that. This woman you
4 described as feisty. Does feisty also mean that this woman
5 kicked, hit, spit at the nursing staff?
6 A. Yes, she did.
7 MR. BUGDEN: 5B, Judge, for Lydia Smith.
8 Q. (BY MR. BUGDEN) And medical record 811. Is a medical
9 treatment plan, and you are familiar with these, aren't you?
10 A. Yes.
11 Q. And would you, as a nurse treating the patient,
12 familiarize yourself with the wishes of the family about what
13 sort of medical interventions the family wanted for a
14 patient?
15 A. Yes.
16 Q. That would be something you would do?
17 A. This is a form and my signature is right there. I would
18 have looked at this.
19 Q. You probably did look at this, since your signature is
20 there, so you saw all of the things that the family did not
21 want done?
22 A. Yes.
23 Q. It says do not resuscitate, no oxygen, no respiration, no
24 mechanical ventilation, no IV fluids, no IV antibiotics.
25 This is a very complete list of things that the family did
1 not want, is that true?
2 A. Yes.
3 Q. This was a sort of, would you agree, a sort of don't do
4 anything plan at this point?
5 A. Yes.
6 Q. Thank you. Are you familiar with the phrase master
7 treatment plan?
8 A. Yes.
9 Q. Is that something that the nurses make?
10 A. It's something they'd be involved in. It's not something
11 they would make.
12 THE COURT: I'll ask you to speak up, please.
13 Q. (BY MR. BUGDEN) Page 818. I'm probably not going to
14 take you to the page, we'll just look at this together.
15 THE COURT: If you need to slide over, you are
16 welcome to do so.
17 Q. (BY MR. BUGDEN) Tell the jury what a master treatment
18 plan is. Isn't it something that the nurses create that is a
19 plan of care for the patient? Am I not right? Are you not
20 familiar with the phrase?
21 A. Well, it's something that you do as a team. I see a
22 social worker signature on here. It's not just the nursing
23 staff.
24 Q. The nurses participate in the master treatment plan?
25 A. Yes.
1 Q. So on 1/8 a plan had been formulated with nurses and with
2 what other kind of careworkers, did you say? Therapists?
3 A. Yes.
4 Q. Patient will experience a peaceful, dignified death free
5 of pain. Is that the plan for this patient?
6 A. That's what it says.
7 Q. And free of pain, doesn't that mean prevent pain from
8 returning, ma'am? Letting the -- doesn't it mean that?
9 A. Lydia had never been in pain.
10 Q. I know you don't think she'd ever been in pain. I'm
11 asking you generically would you agree that experiencing a
12 death free of pain would contemplate some sort of
13 intervention by the hospital staff to make sure that pain
14 doesn't return? Would you agree with that phrase, that
15 statement, ma'am?
16 A. There is no where in this whole chart that Lydia had
17 pain.
18 THE COURT: Wait a minute. Just listen to the
19 question. Forget about Lydia. Just listen to the question.
20 It's a generic question.
21 Q. (BY MR. BUGDEN) Would you agree that a pain free death,
22 a death free of pain, that if a treatment plan was put in
23 place that had that concept, that that contemplates
24 preventing pain from returning to the patient? Eliminating
25 pain?
1 A. Eliminating pain. Not having pain.
2 Q. Not allowing pain to be present when the person passes?
3 A. Not having pain, yes.
4 Q. That's the goal of treatment, right?
5 A. That's what she's written.
6 Q. Did you disagree with it?
7 A. No, I agree with that. I don't think people should have
8 to die in pain.
9 MR. BUGDEN: Thank you. Your witness.
10 THE COURT: Redirect.
11 REDIRECT EXAMINATION
12 BY MS. BARLOW:
13 Q. Just a couple of questions here. First, with Lydia
14 Smith, which is the one I think you just were in and I can't
15 remember the number.
16 THE COURT: 5B.
17 MS. BARLOW: Thank you, Your Honor. 5B.
18 Q. (BY MS. BARLOW) If you would turn back to page 811 in
19 5B. This also is called a medical treatment plan, which is
20 confusing because it's not the one you were just talking
21 about.
22 A. (Witness complied.)
23 Q. And that is basically the one where the family has listed
24 what they do and do not want done?
25 A. Yes.
1 Q. At the top it says patient's name. Is that filled in?
2 A. No, it's not.
3 Q. Is the date filled in?
4 A. No, it's not.
5 Q. It says that I, Robert Weitzel, M.D, certify that I'm the
6 attending physician for the patient listed above. The
7 declarant, the above-named patient, is currently suffering
8 from the following disease or illness. Is that filled in?
9 A. No, it's not.
10 Q. And then the form says, I certify I've explained to the
11 declarant, to the extent he or she is able to understand, and
12 to all available persons acting as proxy, the reasonable
13 available alternatives for care and treatment. I certify
14 that the care and treatment alternatives directed below are,
15 and there's two choices. Either by the declarant or that the
16 declarant has a physical or mental condition that renders her
17 unable to give personal direction. Are either of those
18 checked?
19 A. No.
20 Q. And then if you would turn in Mary Crane. I believe that
21 one is 4B.
22 THE COURT: Mary Crane is 4B, yes.
23 MS. BARLOW: Thank you.
24 Q. (BY MS. BARLOW) If you would turn to 341, under the
25 medical/legal tab.
1 A. (Witness complied.)
2 Q. Do you have that?
3 A. I do.
4 Q. Is this a form provided by the hospital?
5 A. Yes, it is.
6 Q. Again, this is called a medical treatment plan. It says
7 patient name. Is that filled in?
8 A. No.
9 Q. Is the date filled in?
10 A. Yes.
11 Q. Who filled in the date? Does that look like your
12 handwriting?
13 A. It does look like my handwriting.
14 Q. And it says I, and there's a space for the doctor's name.
15 Is that filled in?
16 A. No.
17 Q. And then it says certify that I'm the attending
18 physician. And then it says currently suffering from the
19 following disease or illness? Is that filled in?
20 A. No, it's not.
21 Q. I certify that I've explained to the declarant, to the
22 extent she's able to understand. I don't want to read every
23 word again.
24 MR. BUGDEN: I think the document speaks for itself.
25 THE COURT: Overruled.
1 Q. (BY MS. BARLOW) It asks that it either be directed by
2 the declarant or by a family member if the declarant is not
3 capable of rendering a personal direction. Are either of
4 those marked?
5 A. No.
6 MS. BARLOW: I don't think I will belabor it
7 anymore. I have no further questions.
8 MR. BUGDEN: Nothing further, Your Honor.
9 THE COURT: You may step down, Ms. Cooper. May this
10 witness be excused?
11 MS. BARLOW: Yes.
12 MR. BUGDEN: Yes, sir.
13 THE COURT: You are excused. Thank you for
14 testifying.