Earline Cozzens
20 EARLENE COZZENS COOPER,
21 CALLED AS A WITNESS, BEING FIRST DULY SWORN,
22 WAS EXAMINED AND TESTIFIED AS FOLLOWS:
23 DIRECT EXAMINATION
24 BY MS. BARLOW:
25 Q. GOOD AFTERNOON. WOULD YOU PLEASE STATE YOUR NAME AND
1418
1 SPELL IT FOR THE RECORD?
2 A. EARLENE COZZENS COOPER. IT'S E-A-R-L-E-N-E,
3 C-O-Z-Z-E-N-S, C-O-O-P-E-R.
4 Q. WHAT IS YOUR OCCUPATION?
5 A. I'M A REGISTERED NURSE.
6 Q. WHERE DO YOU WORK AT THE PRESENT?
7 A. AT MCKAY-DEE.
8 Q. AS A REGISTERED NURSE, WHAT EDUCATIONAL BACKGROUND DO
9 YOU HAVE?
10 A. I HAVE A B.S. IN NURSING.
11 Q. WHERE DID YOU GET YOUR B.S.?
12 A. AT WEBER STATE UNIVERSITY.
13 Q. HOW LONG HAVE YOU BEEN AN R.N.?
14 A. SINCE '82. SO --
15 Q. 18 YEARS?
16 A. 18 YEARS.
17 Q. SINCE 1982, WHERE HAVE YOU WORKED?
18 A. I WORKED AT LAKEVIEW FOR TEN YEARS AND THEN I --
19 Q. AT LAKEVIEW WHAT?
20 A. HOSPITAL.
21 Q. OKAY. WHAT DID YOU DO AT LAKEVIEW?
22 A. I WORKED MEDICAL SURGICAL PATIENTS. I WORKED O.B. I
23 DID NURSING. I STARTED OUT AS A NURSE'S AIDE THERE AND THEN
24 I GOT MY L.P.N. AND THEN MY R.N.
25 Q. IN MED-SURG UNITS AND O.B. --
1419
1 A. AND I DID WORK PSYCH AND I WORKED LABOR AND DELIVERY. I
2 WORKED EVERYWHERE. I FLOATED EVERYWHERE.
3 Q. AFTER THE FIRST TEN YEARS, WHERE DID YOU GO TO WORK?
4 A. I WENT TO MCKAY-DEE. AND I WORKED THERE FOR SEVEN
5 YEARS.
6 Q. WHAT DID YOU DO AT MCKAY-DEE?
7 A. I WORKED IN THEIR PSYCHIATRIC UNITS. THEY HAVE A CHILD,
8 ADOLESCENT UNIT AND THEY HAVE AN ACUTE UNIT AND THEY HAVE
9 A --
10 Q. AND SOMEWHERE IN THERE DID YOU WORK AT DAVIS NORTH?
11 A. I DID. AFTER I LEFT MCKAY, THEN I WENT TO DAVIS NORTH.
12 Q. NOW, THE PSYCH UNIT THAT YOU WORKED ON AT LAKEVIEW, HOW
13 LONG DID YOU WORK THERE?
14 A. OH, PROBABLY FIVE YEARS.
15 Q. WHAT KIND OF PATIENTS DID YOU HAVE AT THAT PSYCH UNIT.
16 A. THEY WERE ADULT PATIENTS.
17 Q. WERE ANY OF THEM ELDERLY?
18 A. YES.
19 Q. WHAT ABOUT WHEN YOU WENT TO MCKAY-DEE IN THE PSYCH UNIT
20 THERE?
21 A. THEN I WORKED WITH CHILDREN AND ADOLESCENTS AND ADULTS
22 AND WHATEVER PSYCHIATRIC PATIENTS THEY HAD, THEY RANGED IN
23 ALL AGES.
24 Q. WHEN DID YOU GO TO THE GEROPSYCH UNIT AT DAVIS NORTH?
25 A. IT WAS '94? I CAN'T REMEMBER.
1420
1 Q. CLOSE --
2 A. I CAN'T REMEMBER.
3 Q. OKAY.
4 A. I'D HAVE TO THINK.
5 Q. WE'RE TALKING ABOUT A TIME FRAME THAT IS DECEMBER '95 TO
6 JANUARY '96?
7 A. I WAS THERE.
8 Q. AND YOU WERE THERE.
9 A. DURING THAT TIME PERIOD, YEAH.
10 Q. HAD YOU BEEN THERE QUITE A WHILE PRIOR TO DECEMBER OF
11 '95?
12 A. YES.
13 Q. WERE YOU THERE WHEN THE UNIT FIRST STARTED?
14 A. IT WAS A COUPLE OF -- MAYBE A MONTH OR TWO AFTER IT
15 STARTED.
16 Q. AND WHEN DID YOU LEAVE THE GEROPSYCH UNIT?
17 A. IN JUNE 19TH OF '96.
18 Q. WHY DID YOU LEAVE THE UNIT?
19 A. I HAD A BACK INJURY.
20 Q. DO YOU RECALL WHAT SHIFTS YOU WORKED AT THE GEROPSYCH
21 UNIT.
22 A. IT WAS MAINLY DAYS, BUT I WORKED EVERY SHIFT. I WORK
23 AFTERNOONS, I WORKS NIGHTS, BUT IT WAS MOSTLY DAYS.
24 Q. AND HOW MANY DAYS A WEEK WOULD YOU WORK?
25 A. I WAS FULL TIME.
1421
1 Q. WOULD THAT BE --
2 A. SO THAT WAS FIVE DAYS A WEEK.
3 Q. FIVE DAYS A WEEK. WOULD IT BE FIVE DAYS STRAIGHT?
4 A. NO. I'D WORK WEEKENDS AND SOME DAY SHIFTS DURING THE
5 WEEK, AND THEN SOME NIGHTS, DEPENDING.
6 Q. WERE YOU THERE WHEN ELLEN ANDERSON WAS ADMITTED TO THE
7 UNIT? I THINK IT WAS DECEMBER 20TH --
8 A. I WORKED THERE, BUT NO, I DON'T RECALL EVER HAVING HAD
9 HER AS A PATIENT.
10 Q. SO -- AND IF THERE ARE NO NOTATIONS THAT HAVE YOUR -- OR
11 NO CHARTING THAT HAVE YOUR SIGNATURE ON 'EM, WHAT WOULD THAT
12 TELL YOU ABOUT WHETHER YOU WERE THERE WHEN SHE WAS THERE?
13 A. THAT I HADN'T BEEN THERE.
14 Q. IF YOU WOULD OPEN UP ENNIS ALLDREDGE, THERE SHOULD BE
15 A --
16 A. IT'S RIGHT HERE.
17 Q. OKAY. IF YOU WOULD OPEN THAT UP TO MEDICAL NUMBER 48,
18 PAGE NUMBER 48, IT'S UNDER NURSES' NOTES.
19 A. I DON'T SEE PAGE NUMBERS ANYWHERE. IS THERE IS A DATE?
20 Q. OH, I'M SORRY, THERE'S A MED NUMBER AT THE BOTTOM THAT
21 SAYS MED-00048?
22 A. OH, OKAY. AND WHAT PAGE?
23 Q. IT'S NURSES' NOTES AND THEN 48.
24 A. 48.
25 Q. IN FACT, I THINK --
1422
1 A. OH, IT'S THE FIRST PAGE, OKAY.
2 Q. -- IT'S THE FIRST ONE AFTER THE TAB, YES. DO YOU
3 RECOGNIZE WHAT THAT DOCUMENT IS?
4 A. IT'S AN ADMISSION ASSESSMENT.
5 Q. AND IT SAYS ORIENTED TO UNIT BY, AND IS THAT YOUR --
6 A. THAT'S MY SIGNATURE, YES.
7 Q. ARE YOU FAMILIAR WITH THIS DOCUMENT? IT'S SEVERAL PAGES
8 LONG. ARE YOU FAMILIAR WITH IT?
9 A. YES.
10 Q. I THINK IT'S ABOUT 12 PAGES.
11 A. YEAH, IT'S OUR ADMISSION ASSESSMENT.
12 Q. WHAT WAS IT USED FOR?
13 A. WHEN A PATIENT WOULD COME ON TO THE UNIT, YOU WOULD GO
14 THROUGH THIS ASSESSMENT TO KIND OF DO A HISTORY AND PHYSICAL
15 ON 'EM AND FIND A HISTORY ON 'EM AND ASSESS THEM TO -- THEIR
16 APPROPRIATENESS ON THE UNIT, THEIR HEALTH.
17 Q. MACHINE'S MAKING STRANGE THINGS. PROBABLY TURNED IT ON
18 THE WRONG WAY, TOO.
19 WHAT WAS THE PURPOSE OF THIS NURSING ADMISSION
20 ASSESSMENT DOCUMENT?
21 A. TO GATHER INFORMATION ON THE PATIENT.
22 Q. NOW, THIS ONE PATIENT'S NAME IS ENNIS.
23 A. UH-HUH.
24 Q. DATE 1/10/96. TIME 1230. WHAT WOULD THAT MEAN?
25 A. THAT WOULD BE THAT HE WAS ADMITTED JANUARY 10TH AT 1230
1423
1 IN THE AFTERNOON. IT WOULD HAVE BEEN A DAY SHIFT.
2 Q. EXCUSE ME, SIGNIFICANT OTHERS LISTED THERE, THEN THERE'S
3 YOUR SIGNATURE, ORIENTED TO UNIT BY, AND THAT'S YOUR
4 SIGNATURE --
5 A. YES.
6 Q. -- I ASSUME? AND SAYS, PERSON INTERVIEWED. PATIENT,
7 THEN IT SAYS WIFE.
8 A. UH-HUH.
9 Q. DO YOU RECALL MR. ALLDREDGE?
10 A. I DON'T.
11 Q. WHERE WOULD YOU GET THE INFORMATION FOR THIS ASSESSMENT?
12 A. I WOULD HAVE ASKED HIS WIFE. IT SAYS RIGHT THERE THAT
13 THAT'S WHO I TALKED TO.
14 Q. IF MR. ALLDREDGE HAD BEEN ABLE TO RESPOND AND ANSWER
15 YOUR QUESTIONS, WOULD YOU HAVE ASKED HIM INSTEAD?
16 A. YEAH, I WOULD HAVE PUT THEM BOTH DOWN HERE. I PROBABLY
17 WOULD HAVE PUT WIFE AND PATIENT.
18 Q. THEN WE HAVE WHAT'S THAT, TEMPERATURE?
19 A. YES.
20 Q. 97. AND THEN P. IS WHAT?
21 A. PULSE.
22 Q. PULSE?
23 A. RESPIRATION.
24 Q. A THAT A HIGH PULSE RATE, 96?
25 A. IT'S A LITTLE HIGH.
1424
1 Q. THEN RESPIRATION, WHAT'S THAT, 20 PER MINUTE?
2 A. 20.
3 Q. YOU DIDN'T -- EVIDENTLY NO BLOOD PRESSURE WAS -- READING
4 WAS TAKEN?
5 A. IT DOESN'T LOOK LIKE IT.
6 Q. THEN HIS WEIGHT WAS 176 --
7 A. POINT 6 POUNDS, YEAH.
8 Q. WHAT KINDS OF INFORMATION WOULD YOU GATHER FOR THIS
9 DOCUMENT?
10 A. ANY MEDICATION THAT THEY HAD BEEN ON, THEIR HEALTH
11 HISTORY, THE BEHAVIORAL PROBLEMS THAT THEY'D BEEN HAVING.
12 AND ANY DIET THEY WERE ON, WHETHER THEY HAD DENTURES.
13 Q. IN FACT, THE SECOND PAGE OF THAT --
14 A. UH-HUH.
15 Q. -- WHAT CAUSED YOU TO HAVE TO COME TO THE HOSPITAL.
16 A. UH-HUH.
17 THE COURT: DO YOU WANNA HIT THAT BUTTON THAT --
18 MS. BARLOW: THERE, THANK YOU. SANDY TAUGHT ME
19 WHICH ONE TO PUSH HERE.
20 Q. BECAME VERY VIOLENT, HITTING AND SPITTING. RIPPED HIS
21 SHIRT.
22 A. UH-HUH.
23 Q. AND THEN WHAT ARE GOALS OF THE HOSPITALIZATION TO, AND
24 THEN THE ARROW DOWN MEANS WHAT?
25 A. TO HAVE A DECREASE IN HIS VIOLENT BEHAVIOR.
1425
1 Q. WAS HE A TERMINAL OR HOSPICE PATIENT WHEN HE CAME IN?
2 A. NOT THAT I RECALL. LIKE I SAY, I DON'T REMEMBER HIM.
3 Q. RIGHT. WHAT WERE THE CRITERIA FOR THIS UNIT AS FAR AS
4 PHYSICAL HEALTH?
5 A. BASICALLY, WE HAD TO BE ABLE TO HELP THEM. WE HAD TO BE
6 ABLE TO --
7 MR. STIRBA: YOUR HONOR, IF I MAY, THE POLICY IS
8 IN. IF SHE JUST WANTS UNDERSTANDING, I GUESS THAT'S FINE,
9 BUT --
10 THE COURT: IS THAT WHAT YOU'RE -- ARE YOU STATING
11 WHAT YOUR UNDERSTANDING OF THE POLICY IS?
12 THE WITNESS: I'M JUST ANSWERING HER QUESTIONS. I
13 WASN'T -- SHE DIDN'T ASK THAT POLICY, THAT I --
14 MR. STIRBA: THIS POLICY'S THE BEST EVIDENCE, YOUR
15 HONOR, I JUST --
16 THE COURT: OKAY. IF YOU WANNA ASK HER HER
17 UNDERSTANDING, THAT'S FINE.
18 MS. BARLOW: I WILL REPHRASE IT THEN.
19 Q. WHAT IS YOUR UNDERSTANDING OF THE CRITERIA FOR PEOPLE
20 BEING ADMITTED ONTO THIS UNIT?
21 A. THAT THEY WOULD -- THAT WE WOULD BE ABLE TO TREAT THEM
22 AND THAT WE WOULD BE ABLE TO HELP THEM GET BETTER.
23 Q. AND WHAT WAS YOUR UNDERSTANDING OF THE POLICY IF, YOU
24 KNOW, AFTER THEY CAME ON TO THE UNIT, IF A PHYSICAL MEDICAL
25 PROBLEM BECAME ACUTE, WHAT WOULD HAPPEN?
1426
1 A. THAT THEY WOULD RECEIVE CARE FOR THAT PHYSICAL PROBLEM,
2 THAT THAT WOULD BE TREATED.
3 Q. EXCUSE ME, ON THE -- ON THE UNIT OR ELSEWHERE OR DO YOU
4 KNOW?
5 A. WHICHEVER WOULD BE THE BEST TO TREAT THAT PHYSICAL
6 AILMENT. The truth outs.
7 Q. AND ON PAGE 3, IT TALKS ABOUT -- IT'S MEDICAL
8 HOSPITALIZATIONS.
9 A. UH-HUH.
10 Q. THEN IT LOOKS LIKE A HERNIA IN 1990. A FIVE-HEART
11 BYPASS. MEANING FIVE ARTERY BYPASS. DIABETIC SINCE THE
12 SEVENTIES. WHERE DID YOU GET THIS INFORMATION?
13 A. IT WOULD HAVE BEEN FROM THE WIFE.
14 Q. AFTER YOU FILLED OUT THIS ADMISSION FORM AND NURSING
15 ASSESSMENT -- WELL, LET'S LOOK AT THE LAST PAGE, THE 12TH
16 PAGE, WHICH IS MEDICAL NUMBER 59.
17 A. OKAY.
18 Q. AT THE TOP IT SAYS, DISCHARGE PLANNING. DO YOU USUALLY
19 DO DISCHARGE PLANNING AS YOU BROUGHT PEOPLE IN?
20 A. YES.
21 Q. AND WHY WAS THAT?
22 A. BECAUSE WE PLANNED ON THEM BEING DISCHARGED. WE PLANNED
23 ON THEM BEING ABLE TO GET BETTER AND IMPROVE AND GO BACK TO
24 EITHER WHERE THEY CAME OR HOME OR --
25 Q. WAS THIS INTENDED TO BE A LONG-TERM UNIT?
1427
1 A. NO.
2 Q. DO YOU HAVE -- DO YOU KNOW WHETHER -- WHETHER THERE WAS
3 ANY POLICY ABOUT HOW LONG PEOPLE WERE SUPPOSED TO STAY IN
4 THE UNIT?
5 A. I DON'T RECALL.
6 Q. AND THEN THIS DISCHARGE WAS TO RETURN TO SUNSHINE
7 TERRACE --
8 A. YES.
9 Q. -- WHICH IS A LONG-TERM CARE FACILITY?
10 A. YES.
11 Q. IF YOU'D TURN TO NUMBER 60, EXHIBIT 60, THIS DOESN'T
12 APPEAR TO HAVE A DATE ON IT AT THE TOP. BUT IT'S THE FIRST
13 NURSING NOTE AFTER ADMISSION.
14 A. UH-HUH.
15 Q. DO YOU RECALL WHEN -- AND IS THAT TOP PART YOUR
16 HANDWRITING?
17 A. YES, IT IS.
18 Q. DO YOU RECALL WHEN YOU WROTE THIS?
19 A. IT WOULD HAVE BEEN THE 10TH WHEN HE WAS ADMITTED. IT
20 WOULD HAVE BEEN JANUARY 10TH OF '96.
21 Q. AND WHAT IS THIS NOTE THAT YOU'VE WRITTEN HERE?
22 A. IT'S JUST A -- THAT HE WAS ADMITTED TO THE UNIT AND
23 MAYBE SOME OF HIS BEHAVIOR.
24 Q. SO YOU GET DOWN --
25 A. AND WHAT WE DID FOR HIM.
1428
1 Q. -- TO HERE, IT SAYS, PATIENT IS VERY COMBATIVE AND
2 AGITATED. PATIENT NOT ORIENTED TO TIME, PLACE, OR PERSON
3 SITUATION. NOT ABLE TO WALK. KEEPS TAKING OFF HIS CLOTHES.
4 REFUSES TO EAT. SO IT GOES DOWN HERE, AND THEN RIGHT HERE
5 IT STARTS, IT SAYS, IS REALLY STRONG --
6 A. IS THAT AND?
7 Q. OH, I'M WAY OFF THE CHART HERE. CAN YOU SEE WHERE IT
8 SAYS IS? IS THAT VERY OR VERY STRONG? IS ABOUT TWO-THIRDS
9 OF THE WAY DOWN. JUST ABOVE YOUR SIGNATURE.
10 A. IS VERY STRONG AND GRABS AT STAFF, HURTING STAFF.
11 Q. DO YOU RECALL HIM BEING A STRONG PERSON WHEN HE CAME ON
12 THE UNIT?
13 A. I SAID I DIDN'T REMEMBER HIM, BUT I DO REMEMBER HIM. HE
14 KEPT TRYING TO TAKE OFF HIS SHIRT, AND IN THE PROCESS, HE
15 WAS RIPPING HIS SHIRT, AND I REMEMBER TRYING TO PUT A
16 PATIENT GOWN ON HIM AND YES, HE WAS VERY -- HE WAS VERY
17 STRONG.
18 Q. IT APPEARS THAT THERE WERE A COUPLE TIMES IN THE NOTE
19 HERE WHICH -- IN WHICH ALL YOU HAVE IS JUST YOUR INITIALS AT
20 THE BOTTOM AND THERE'S NOTHING THAT APPEARS TO HAVE BEEN
21 WRITTEN BY YOU. FOR EXAMPLE, NUMBER 63 HAS YOUR INITIALS AT
22 THE BOTTOM. THAT LOOKS LIKE NOTHING WRITTEN BY YOU.
23 WHAT -- WHY WOULD YOUR INITIALS SHOW ON THE BOTTOM OF THIS
24 PAGE?
25 A. I WAS PROBABLY THE CHARGE NURSE, AND PROBABLY MY TECHS
1429
1 WOULD HAVE GONE AHEAD AND WRITTEN THE NURSES' NOTES. AND
2 THEN I WOULD JUST CO-SIGN.
3 Q. SO YOU WOULD CO-SIGN, IS THAT WHAT YOU SAID?
4 A. YES.
5 Q. WHAT'S A CHARGE NURSE?
6 A. YOU WOULD BE THE TEAM LEADER OF THE UNIT FOR THAT DAY.
7 Q. AND YOUR TECHS YOU SAY WOULD WRITE THIS. WHO WOULD BE
8 THE TECHS, C.N.A.'S OR --
9 A. UH-HUH, IT WOULD BE C.N.A.'S. SOMETIMES YOU'D HAVE
10 R.N.'S AS TECHS. SOMETIMES YOU'D HAVE L.P.N.'S. IT WOULD
11 JUST DEPEND ON WHAT STAFF YOU HAD. BUT MAINLY IT WAS
12 C.N.A.'S.
13 Q. DURING DAYS, WHAT KIND OF PERSONNEL WOULD YOU HAVE ON
14 THE UNIT?
15 A. YOU WOULD USUALLY HAVE MYSELF, THE CHARGE NURSE, AND YOU
16 WOULD USUALLY HAVE THE OTHER NURSE WHO DID MORE
17 ADMINISTRATIVE KINDS OF THINGS AND WOULD HELP WITH PATIENT
18 CARE. AND THEN YOU WOULD USUALLY HAVE A NURSE'S AID, A
19 TECH.
20 Q. AS TEAM LEADER, WERE YOU OVER OCCUPATIONAL THERAPISTS OR
21 RESPIRATORY THERAPISTS OR RECREATIONAL THERAPISTS OR
22 ANYTHING LIKE THAT?
23 A. NO.
24 Q. AND AS A NURSE, WHO DID YOU REPORT TO?
25 A. THE DOCTOR.
1430
1 Q. LET'S TURN OVER TO PAGE 74. THEY CAME IN ON THE 10TH.
2 THAT'S WHEN YOU DID THE ADMISSION, AND THIS IS WHAT DATE?
3 A. IT LOOKS LIKE THE 13TH, JANUARY 13TH OF '96.
4 Q. NOW, THERE'S SOME HANDWRITING AT THE TOP OF THAT.
5 A. UH-HUH.
6 Q. WHICH IS NOT YOURS, LOOKS LIKE.
7 A. UH-HUH.
8 Q. DO YOU KNOW WHOSE HANDWRITING THAT FIRST THREE LINES
9 ARE?
10 A. LOOKS LIKES IT COULD HAVE BEEN LAURIE WILLSON. BUT I
11 DON'T KNOW.
12 Q. BUT THEN IT AT 0800 YOU START WRITING, AND WHAT ARE
13 YOU -- WHAT DID YOU WRITE THERE?
14 A. I WROTE PATIENT UNRESPONSIVE. FAMILY WITH PATIENT.
15 POSEY AND RESTRAINTS TAKEN OFF. I.V. D/C'ED. COMFORT
16 MEASURES GIVEN. AND THEN I HAVE MY SIGNATURE. AND THEN I
17 WRITE, DR. WEITZEL TALKED WITH THE FAMILY. DR. DIENHART WAS
18 NOTIFIED OF PATIENT'S DOWNWARD CONDITION.
19 DO YOU WANT ME TO READ THE 1500?
20 Q. WELL, LET'S NOT GET INTO THE B.I.R.P. RIGHT AT THIS
21 MOMENT. HAD YOU SEEN HIM BETWEEN THE 10TH WHEN YOU WROTE
22 THE ASSESSMENT AND THE 13TH WHEN YOU WRITE THIS REPORT?
23 A. I DON'T RECALL.
24 Q. DO YOU RECALL A DIFFERENCE BETWEEN HIS BEHAVIOR AND
25 PHYSICAL APPEARANCE ON THE 10TH WHEN YOU ADMITTED HIM AND
1431
1 THEN THIS NOTE ON THE 13TH?
2 A. I DO REMEMBER HIM ON THE 10TH BEING VERY STRONG AND
3 RIPPING HIS SHIRT AND TRYING TO GET A GOWN ON HIM, AND IT
4 WAS VERY DIFFICULT. AND HE WOULD HAVE HAD TO BEEN POSEYED
5 TO PROTECT THE STAFF AT THAT POINT. AND IF WE'RE TAKING OFF
6 HIS POSEY AND RESTRAINTS AND HE'S UNRESPONSIVE, HE'S NO
7 LONGER ABLE TO FIGHT US.
8 Q. AND THEN YOU'VE GOT B. WHICH STAND -- AT 1500. B. WHICH
9 STANDS FOR WHAT?
10 A. BEHAVIOR.
11 Q. OKAY. AND THEN YOU LIST WHAT HIS BEHAVIORS WAS.
12 A. UNRESPONSIVE THE WHOLE SHIFT.
13 Q. AND WHAT IS I.?
14 A. INTERVENTION.
15 Q. OKAY. WHAT DOES THAT MEAN?
16 A. THAT WHAT WE DID FOR HIM.
17 Q. OKAY. AND YOU TURNED HIM EVERY TWO HOURS, COMFORT
18 MEASURES. R. STANDS FOR WHAT?
19 A. RESPONSE. HIS RESPONSE TO OUR INTERVENTIONS.
20 Q. AND WHAT DID YOU WRITE THERE?
21 A. RESPIRATORIES -- RESPIRATIONS WERE IRREGULAR WITH
22 PERIODS OF APNEA. APNEA MEANS THERE'S PERIODS OF HIM NOT
23 BREATHING. HIS COLOR'S PALE.
24 Q. AND THEN WHAT IS P.?
25 A. PLAN.
1432
1 Q. AND WHAT DID YOU -- WHAT WAS THE PLAN THAT THE TEAM HAD
2 COME UP WITH FOR HIM AT THAT POINT?
3 A. THAT COMFORT MEASURES AND FAMILY SUPPORT.
4 Q. WHAT DID COMFORT MEASURES MEAN IN THAT CONTEXT?
5 A. THAT WE WOULD MAKE SURE THAT HE WAS TURNED, THAT WE
6 WOULD MAKE SURE THAT -- SOMETIMES WE PUT VASELINE ON THEIR
7 LIPS. WE MAKE SURE THAT HIS FAMILY COULD BE THERE WITH HIM.
8 Q. WERE YOU PRESENT WHEN HE -- WHEN HE PASSED AWAY, I
9 BELIEVE IT WAS ON THE 14TH?
10 A. I THINK I WOULD REMEMBER IF I WAS, BUT I DON'T RECALL.
11 I DON'T RECALL BEING THERE, NO.
12 Q. DO YOU RECALL WHETHER ANYTHING STRUCK YOU ABOUT THE
13 CHANGE IN HIS DEMEANOR, HIS ACTIVITY LEVEL BETWEEN THE 10TH
14 AND THE 13TH?
15 MR. STIRBA: I'M GONNA OBJECT, YOUR HONOR. IT'S
16 VAGUE AND AMBIGUOUS, STRUCK YOU.
17 THE COURT: DO YOU WANT TO --
18 MS. BARLOW: SEE IF I CAN FIND A BETTER WAY TO
19 PHRASE IT.
20 Q. I NEED A THESAURUS I GUESS. LET ME GO ON AND HOPE I
21 COME UP WITH BETTER WORD AS WE GO ON. I DON'T WANT ANYONE
22 SITTING HERE WHILE I'M TRYING TO TRY TO THINK. It might be a while.
23 DID YOU SEE A DIFFERENCE THEN IN --
24 A. YES.
25 Q. -- HIS APPEARANCE?
1433
1 A. YES.
2 Q. WAS THERE ANYTHING UNUSUAL ABOUT THAT IN YOUR MIND?
3 MR. STIRBA: WELL, I'M GONNA OBJECT IN TERMS OF HER
4 MIND AND WHAT IS IN HER MIND. I MEAN IF WE WANNA TALK
5 ABOUT --
6 MS. BARLOW: I'LL WITHDRAW THE IN HER MIND, YOUR
7 HONOR.
8 Q. WAS THERE ANYTHING UNUSUAL ABOUT THAT?
9 A. HE HAD COME IN BECAUSE OF HIS AGITATED STATE AND TO SEE
10 IF WE COULD GET THE AGITATION UNDER CONTROL. AND -- AND TO
11 HELP HIM GET BETTER AND TO GO BACK TO THE -- TO THE CARE
12 CENTER.
13 THIS DEFINITELY WASN'T -- THAT WASN'T IN THE PLAN THAT
14 WE HAD PLANNED FOR HIM.
15 Q. WHEN YOU SAW HIM WITH THE COMFORT MEASURES ON THE 13TH
16 THERE WHEN YOU WERE WRITING THAT YOU WERE GOING TO KEEP
17 COMFORT MEASURES, DID YOU NOTE ANY INDICATIONS OF PAIN?
18 A. NO, I DIDN'T. Obviously. He's on analgesics to prevent that.
19 Q. LET'S -- IF YOU'LL PICK UP MARY CRANE'S BINDER THERE.
20 IF YOU'LL TURN TO THE NURSES' NOTES, THE VERY FIRST PAGE,
21 WHICH IS MED NUMBER 294.
22 A. UH-HUH.
23 Q. DID YOU FILL OUT THAT NURSING ASSESSMENT?
24 A. IT LOOKS LIKE I STARTED IT, BUT THIS WRITING BEHIND
25 THERE, SOMEBODY ELSE MUST HAVE FINISHED IT. BUT THAT IS MY
1434
1 WRITING ON THIS FIRST PAGE, YES.
2 Q. ON THE FIRST PAGE. WHO DID YOU TALK TO TO GET THE
3 INFORMATION?
4 A. THESE -- I BELIEVE THAT THESE WERE PROBABLY HER
5 DAUGHTERS.
6 Q. KAREN BRINGHURST AND KATHY CHARLESWORTH?
7 A. YES.
8 Q. AND AGAIN DOWN HERE WE HAVE TEMPERATURE, PULSE,
9 RESPIRATION, AND THEN YOU DO HAVE THE BLOOD PRESSURE HERE,
10 IS THAT CORRECT?
11 A. YES.
12 Q. IS THERE ANYTHING UNUSUAL ABOUT HER BLOOD PRESSURE AT
13 THAT TIME?
14 A. IT'S SLIGHTLY HIGH WHEN STANDING, BUT NOT REALLY.
15 Q. AND THEN IT APPEARS SHE WEIGHED ABOUT 148 POUNDS.
16 A. YES.
17 Q. AND THEN WHAT IS THAT, 60 AND A HALF INCHES, THAT ABOUT
18 FIVE FOOT?
19 A. YEAH FIVE FOOT AND A HALF INCH.
20 Q. AND THEN ON THE NEXT PAGE YOU, YOU KNOW, WROTE
21 MEDICATIONS, YOUR PERCEPTION OF WHAT -- OF HER -- OR AT
22 LEAST WHAT YOU TOLD OF HER BEHAVIOR.
23 IF YOU'D PULL OUT 296 -- OR NOT PULL OUT, BUT LOOK AT
24 296. DO YOU RECALL, DO YOU SEE UP AT THE TOP WHERE IT SAYS
25 REASONS FOR MEDICAL HOSPITALIZATION?
1435
1 A. YES, I SEE IT.
2 Q. WOULD YOU READ THAT FIRST LINE?
3 A. IT SAYS, HERNIATED DISK IN '84. POOR CONTROL OF PAIN.
4 AND I'M NOT SURE WHAT THAT OTHER WORD IS.
5 Q. UPON WHAT WOULD YOU BASE YOUR STATEMENT THAT THERE HAD
6 BEEN POOR CONTROL OF PAIN?
7 A. REPORT FROM THE FAMILY. I MIGHT HAVE LOOKED AT THE
8 RECORDS, BUT PROBABLY IT WOULD HAVE BEEN FROM THE FAMILY.
9 Q. IS THIS YOUR -- STILL YOUR HANDWRITING THEN?
10 A. NO.
11 Q. OH, OKAY. LET'S GET TO PAGE 12 OF THE -- WHICH IS
12 NUMBER 304. IT APPEARS THAT IS SIGNED BY WHOM?
13 A. LAURIE WILLSON.
14 Q. OKAY. SO LOOKS LIKE MAYBE SHE FINISHED IT UP?
15 A. YEAH.
16 Q. SEE THE DISCHARGE PLANNING, MAY NEED DIFFERENT CARE
17 CENTER AFTER DISCHARGE.
18 A. YES.
19 Q. BUT AGAIN, THE PLAN WAS TO DISCHARGE HER, IS THAT
20 CORRECT?
21 A. YES.
22 Q. NOW, YOU DID SEE HER AS SHE CAME IN ON THE 28TH OF
23 DECEMBER AT 1500, WHICH IS 3:00 O'CLOCK.
24 A. YES.
25 Q. DO YOU RECALL SEEING HER AGAIN AFTER THAT?
1436
1 A. YES.
2 Q. DO YOU RECALL MARY CRANE SPECIFICALLY?
3 A. YES.
4 Q. AND WHAT IS IT YOU RECALL ABOUT HER?
5 A. I ACTUALLY RECALL QUITE A BIT ABOUT HER. SHE DIED ON
6 ME. SHE --
7 Q. WHILE YOU WERE THERE?
8 A. WHILE I WAS THERE. YES, SHE'S ONE OF THEM THAT DIED ON
9 ME. THE DAY THAT SHE DIED, IT WAS JANUARY 7TH. AND
10 APPARENTLY I WAS WORKING A DOUBLE SHIFT AND I WOULD HAVE
11 WORKED THE DAY SHIFT AND THEN FOR SOME REASON EITHER WE HAD
12 A SICK CALL OR SOMETHING AND I ENDED UP WORKING THE
13 AFTERNOON SHIFT. AND I REMEMBER THAT SHE HAD STARTED GOING
14 DOWNHILL. I TRIED TO GET A HOLD OF THE DOCTOR. I WAS VERY
15 WORRIED ABOUT HER, SO I WENT AHEAD AND I CALLED DIENHART.
16 Q. DR. DIENHART?
17 A. UH-HUH. AND SHE -- HER FAMILY CAME IN, HER FAMILY WAS
18 ALL THERE WITH HER.
19 DR. WEITZEL DID COME IN, AND THIS WAS --
20 MR. STIRBA: YOUR HONOR, COULD WE PROCEED BY WAY OF
21 QUESTION AND ANSWER RATHER THAN A LONG NARRATIVE? I'M NOT
22 SURE --
23 THE COURT: OKAY. THAT WOULD BE APPROPRIATE. JUST
24 GO AHEAD AND ASK THE QUESTION MAYBE TO SET --
25 Q. (BY MS. BARLOW) SO DID DOCTOR -- YOU CALLED DR.
1437
1 DIENHART, IS THAT WHAT YOU SAID?
2 A. YES --
3 Q. OKAY.
4 A. -- I REMEMBER CALLING HIM.
5 Q. DID HE COME IN?
6 A. HE DIDN'T CAME IN -- HE DIDN'T COME IN. HE GAVE ME SOME
7 TELEPHONE ORDERS. SO I TALKED WITH HIM ON THE PHONE. AND Deinhart.
8 IF I REMEMBER RIGHT, HE GAVE ME SOME TELEPHONE ORDERS TO DO
9 WHAT THEY CALL SATURATION LEVEL, AND -- I CAN LOOK UP THE
10 ORDERS HERE AND FIND OUT EXACTLY WHAT -- WHAT HE GAVE ME AS
11 FAR AS ORDERS.
12 Q. WOULD THAT BE UNDER PHYSICIAN'S ORDERS?
13 A. YES.
14 Q. I BELIEVE IT'S PROBABLY 249?
15 A. OKAY. WE WERE WORRIED ABOUT HER BREATHING, AND SO HE
16 ORDERED AN 02 SAT LEVEL WHICH CHECKS THE OXYGEN LEVEL OF HER
17 BLOOD, HOW MUCH OXYGEN SHE'S ACTUALLY GETTING TO THE CELLS.
18 AND THEN TO ORDER A CHEST X-RAY TO FIND OUT WHY SHE'S HAVING
19 SUCH A DIFFICULT TIME BREATHING.
20 Q. AND WHAT DID THE O2 SAT LEVEL SHOW?
21 A. SHE WAS HYPOXIC. SHE WAS NOT GETTING ENOUGH OXYGEN.
22 SHE WAS NOT DOING WELL.
23 Q. IS THAT WHAT THAT MEANS, HYPOXIA MEANS NOT GETTING
24 ENOUGH OXYGEN?
25 YOU'LL HAVE TO ANSWER OUT LOUD.
1438
1 A. I AM SORRY. YES, IT MEANS THAT SHE WASN'T GETTING
2 ENOUGH OXYGEN.
3 Q. WAS THE CHEST X-RAY CONDUCTED?
4 A. I DON'T RECALL.
5 Q. LET'S LOOK AT PAGE 249. WE HAVE AT THE TOP ON THE LEFT,
6 02 SAT LEVEL CHEST X-RAY, TELEPHONE ORDER, DR. DIENHART, SO
7 DR. DIENHART DID NOT COME IN TO GIVE YOU THAT ORDER, HE
8 JUST --
9 A. IT WAS ON THE TELEPHONE.
10 Q. TELEPHONE?
11 A. T.O. MEANS TELEPHONE ORDER.
12 Q. AND THEN DOWN HERE, WHAT IS THAT? THAT'S -- AND DO YOU
13 KNOW?
14 A. THAT'S -- I WOULD ASSUME THAT'S THE DOCTOR'S
15 CO-SIGNATURE AFTER, THEY'LL COME IN LATER AND SIGN THE
16 ORDER. AND THEN MY SIGNATURE'S THERE ON THE RIGHT.
17 Q. AND UNDER YOUR SIGNATURE IS 1930.
18 A. YES.
19 Q. WHAT DOES THAT MEAN?
20 A. 7:30 IN THE AFTERNOON.
21 Q. AND WHAT DOES IT MEAN IN RELATIONSHIP TO THIS NOTE?
22 A. THAT THAT'S THE TIME I TOOK THE ORDER OFF, AND I WOULD
23 ASSUME THAT'S THE TIME I TALKED TO HIM ON THE PHONE. I
24 PROBABLY WOULD HAVE TAKEN THE ORDER OFF EXACTLY THE SAME
25 TIME I TOOK IT.
1439
1 Q. AND THEN AT 2100 WHICH APPEARS TO BE WHAT, AN HOUR AND A
2 HALF LATER?
3 A. YES -- NO, IT WAS -- YEAH, IT WOULD BE AN HOUR AND A
4 HALF LATER.
5 Q. YOU HAVE A NOTE IN DR. WEITZEL'S HANDWRITING, HOLD ALL
6 OF THE MEDS, MORPHINE 5 MILLIGRAM I.M. NOW AND EVERY THREE
7 HOURS ROUND THE CLOCK.
8 A. YES.
9 Q. AND DID YOU FOLLOW THAT ORDER?
10 A. I WAS NOT REAL HAPPY WITH THAT ORDER --
11 MR. STIRBA: YOUR HONOR, YOUR HONOR --
12 MS. BARLOW: IF YOU'D JUST ANSWER --
13 THE COURT: YOU NEED TO RESPOND TO THE QUESTION.
14 Q. (BY MS. BARLOW) RIGHT. DID YOU FOLLOW THAT ORDER?
15 WE'LL GET INTO ALL THE REST OF IT LATER. DID YOU FOLLOW
16 THAT ORDER?
17 A. NOT INITIALLY.
18 Q. WHAT DID YOU DO INITIALLY?
19 A. I TALKED WITH DR. WEITZEL. AND I'D LIKE THE JURY TO
20 UNDERSTAND IT WAS DIFFICULT FOR ME TO CONFRONT HIM.
21 Q. WELL --
22 THE COURT: EXCUSE ME, MA'AM --
23 THE WITNESS: I'M SORRY.
24 THE COURT: -- YOU'RE NOT HERE TO GIVE SPEECHES,
25 YOU'RE HERE TO ANSWER QUESTIONS THAT ANY OF THE ATTORNEYS
1440
1 ASK YOU.
2 THE WITNESS: OKAY.
3 THE COURT: SO PLEASE JUST WAIT UNTIL SHE ASKS YOU
4 A QUESTION, THEN ANSWER THE QUESTION.
5 THE WITNESS: OKAY.
6 Q. (BY MS. BARLOW) SO YOU TALKED DIRECTLY TO DR. WEITZEL
7 ABOUT THE ORDER FOR MORPHINE, IS THAT CORRECT?
8 A. YES, I DID.
9 Q. AND WHY DID YOU DO THAT?
10 A. BECAUSE OF HIS PREVIOUS BEHAVIOR --
11 MR. STIRBA: YOUR HONOR -- YOUR HONOR, I'M -- I'M
12 GONNA OBJECT. I DON'T KNOW WHERE WE'RE GOING WITH THIS, BUT
13 IF WE'RE GONNA GET INTO RELEVANT INFORMATION, I THINK I'M
14 ENTITLED TO KNOW ABOUT IT. WE DID HAVE AN ORDER RELATING TO
15 SOME OF THIS MATTER, AND THIS IS ALL NEW TO ME.
16 THE COURT: LADIES AND GENTLEMEN, I THINK IT
17 MIGHT -- OF THE JURY, IT MIGHT BE HELPFUL IF WE JUST CLARIFY
18 SOME LEGAL ISSUES. HOPEFULLY THIS WILL BE YOUR LAST BREAK
19 FOR THE DAY. YOU'RE NOT GONNA BE HOPEFULLY GONE FOR VERY
20 LONG. BUT I'D ASK THE BAILIFF THAT YOU GO OUT FOR -- UNTIL
21 YOU'RE NOTIFIED. AND DURING THAT TIME, PLEASE DON'T
22 CONVERSE AMONG YOURSELVES ABOUT THIS CASE OR ALLOW
23 YOURSELVES TO BE ADDRESSED BY ANY OTHER PERSON ABOUT THE
24 CASE. DON'T FORM ANY OPINION OR EXPRESS ANY OPINION UNTIL
25 THE CASE IS FINALLY SUBMITTED TO YOU. AND WE'LL LET YOU
1441
1 KNOW WHEN THE BAILIFF CALLS YOU BACK.
2 (THE JURY LEAVES THE COURTROOM.)
3 THE COURT: OKAY. YOU MAY BE SEATED. OKAY. THE
4 RECORD SHOULD REFLECT THAT THE JURY IS NOT PRESENT. OKAY.
5 CAN YOU TELL ME -- CAN YOU MAYBE JUST LET -- SAY WHAT YOU
6 EXPECT THIS WITNESS WILL TESTIFY ABOUT DURING THIS --
7 MS. BARLOW: YES.
8 THE COURT: WHERE WE'RE GOING RIGHT NOW?
9 MS. BARLOW: THIS WITNESS WILL TESTIFY THAT WITH
10 THIS PATIENT, SHE QUESTIONED THE ORDER OF MORPHINE. AND SHE
11 WILL THEN TESTIFY AS TO THE RESPONSE OF DR. WEITZEL AND
12 THEN --
13 THE COURT: OKAY. SO SHE'LL -- SHE'LL TESTIFY
14 REGARDING THE CONVERSATION.
15 MS. BARLOW: RIGHT.
16 THE COURT: OKAY. THEN WHAT ELSE?
17 MS. BARLOW: AND THEN I THINK WITH THIS PATIENT --
18 OR PATIENT, EXCUSE ME. WITH THIS WITNESS, WE WILL GET INTO
19 SOME STUFF THAT WE TALKED ABOUT EARLIER IN THE CONTEXT OF
20 THE EXPERT WITNESS. AS TO WHY SHE WENT AHEAD AND DID
21 AGAINST HER BETTER JUDGMENT WHAT SHE WAS ORDERED TO DO.
22 THE COURT: OKAY. AND JUST TELL ME WHAT THAT WILL
23 BE.
24 MS. BARLOW: WELL, LET ME MAKE SURE I UNDERSTAND,
25 IF I GET IT WRONG, EARLENE --
1442
1 THE COURT: WELL, GO AHEAD OR IF YOU JUST WANNA ASK
2 HER QUESTION, IT'S -- THE JURY'S NOT HERE.
3 MS. BARLOW: WHAT -- OKAY.
4 Q. YOU APPROACHED DR. WEITZEL. WHAT DID YOU TELL HIM?
5 A. I ASKED HIM WHY WE WERE GONNA GIVE MARY MORPHINE.
6 Q. AND WHY DID YOU ASK HIM THAT?
7 A. BECAUSE IN MY OPINION, SHE WAS ALREADY HAVING A HARD
8 TIME BREATHING. SHE DIDN'T APPEAR TO BE IN PAIN TO ME. IT
9 SEEMED LIKE WE NEEDED TO DO SOMETHING TO HELP HER. THE
10 MORPHINE WAS NOT SOMETHING IN MY OPINION THAT WAS GOING TO
11 HELP HER.
12 Q. AND WHAT DID DR. WEITZEL SAY TO YOU?
13 A. HE SAID, WHAT MAKES YOU THINK SHE'S NOT IN PAIN? AND I
14 SAID TO HIM, WELL, SHE DOESN'T LOOK LIKE SHE'S IN PAIN. AND
15 HE SAID TO ME, WELL, DID SHE TELL SHE'S NOT IN PAIN?
16 WELL, SHE'S NOT TALKING AT THIS POINT. SHE'S -- NO,
17 SHE DIDN'T TELL ME SHE'S NOT IN PAIN.
18 AND SO -- SO, WELL, ARE YOU WILLING TO LET HER SUFFER?
19 BECAUSE I THINK SHE'S IN PAIN, AND YOU'RE WILLING TO LET HER
20 SUFFER BECAUSE YOU -- YOU DON'T WANT TO THINK THAT SHE'S IN
21 PAIN?
22 Q. AND THAT'S WHAT DR. WEITZEL SAID TO YOU?
23 A. YES.
24 Q. AND WHAT WAS YOUR RESPONSE?
25 A. I DIDN'T WANT HER TO SUFFER. I DON'T THINK I SAID
1443
1 ANYTHING TO THAT. I JUST THINK I WENT OFF AND -- AND AT
2 THAT POINT I WENT AND CALLED THE PHARMACY BECAUSE THERE WERE
3 LOTS OF RED FLAGS GOING OFF HERE FOR ME.
4 Q. WHAT RED FLAGS?
5 A. I WAS AFRAID THAT THIS WAS GOING TO KILL HER. I WAS
6 AFRAID THAT SHE WOULD DIE ON ME, AND I DIDN'T WANT THAT. I
7 WANTED -- I WANTED A DIFFERENT OUTCOME, AND I DIDN'T WANNA
8 BE RESPONSIBLE FOR THAT.
9 Q. DID YOU REFUSE TO GIVE THE SHOT?
10 A. I DID.
11 Q. AND WHAT HAPPENED?
12 A. I CALLED THE PHARMACY TO ASK THEM ABOUT THE DOSE, TO ASK
13 THEM HER -- I SAID, THIS IS AN OLDER LADY, SHE'S HAVING A
14 HARD TIME BREATHING. AND I SPECIFICALLY ASKED THEM -- I --
15 I -- I DON'T WANT IT TO KILL HER. IS THIS GONNA CAUSE HER
16 TO DIE. AND 5 MILLIGRAMS, HE SAID, WELL, YOU KNOW, SHE
17 SHOULD BE OKAY. JUST KEEP AN EYE ON HER.
18 AND SO AT THAT POINT I STILL WAS NOT COMFORTABLE WITH
19 GIVING THIS, AND SO I WAS OUT AT THE DESK AND LYNN LONG AT
20 THAT TIME SAID THAT IF I DIDN'T FEEL COMFORTABLE GIVING IT,
21 SHE FELT COMFORTABLE GIVING IT, AND SHE WENT AHEAD AND GAVE
22 THAT SHOT.
23 Q. SO YOU ENDED UP NOT HAVING TO GIVE IT?
24 A. I ENDED UP NOT GIVING IT.
25 Q. BUT IT WAS GIVEN?
1444
1 A. IT WAS.
2 MS. BARLOW: YOUR HONOR, THAT WOULD BE --
3 THE COURT: OKAY. BUT ARE YOU GOING TO GET INTO
4 REASON WHY -- I THOUGHT WHEN WE HAD THIS OTHER DISCUSSION --
5 MS. BARLOW: WELL, IT --
6 THE COURT: -- THAT WAS -- THIS IS A WITNESS THAT'S
7 GONNA SAY WHY SHE CONFRONTED THE DOCTOR THIS TIME. THIS IS
8 NOT A WITNESS THAT SAYS THEY DIDN'T CONFRONT HIM BECAUSE OF
9 A PRIOR EXPERIENCE. IS THAT --
10 MS. BARLOW: NO, BUT I CAN -- DID -- ARE YOU AWARE
11 OF ANY EXPERIENCES THAT ANYBODY HAD WHO HAD REFUSED, YOU
12 KNOW, AND THE PROBLEM --
13 THE COURT: WELL, I GUESS --
14 MS. BARLOW: -- HOW TO PHRASE IT --
15 THE COURT: -- WHAT I WANNA KNOW IS THIS -- THIS
16 WITNESS, I UNDERSTOOD THERE MAY BE SOME WITNESSES, SOME
17 NURSE WITNESSES WHO WILL TESTIFY THAT THEY DID NOT CONFRONT
18 DR. WEITZEL BECAUSE OF SOME PAST EXPERIENCE THAT THEY WERE
19 AWARE OF. AND THAT'S WHY --
20 MS. BARLOW: AND I THINK WE'LL PROBABLY GET INTO
21 THAT WITH SUBSEQUENT PATIENTS --
22 THE COURT: NOT NECESSARILY -- YOU MEAN THE
23 WITNESS --
24 MS. BARLOW: BUT WITH THIS WITNESS, BUT --
25 Q. AND I CAN ASK YOU, WERE THERE OTHER TIMES WHEN YOU --
1445
1 WHEN YOU DID NOT WANT TO GIVE THE SHOT, BUT YOU DID IT
2 ANYWAY?
3 A. YES.
4 Q. AND WHY WAS THAT?
5 A. BECAUSE IT WAS A DOCTOR'S ORDER, AND HE WOULD TELL YOU
6 AND YOU KNEW THAT YOU HAD -- YOU WERE SUPPOSED TO FOLLOW
7 THOSE ORDERS BECAUSE HE'D BECOME EXTREMELY AGITATED. MY
8 EXPERIENCE WITH JUDITH WAS HE GOT REALLY IRATE BECAUSE WE
9 HAD BEEN HOLDING THE MEDICATION. AND --
10 MR. STIRBA: YOU KNOW -- YOU KNOW, THIS IS NICE,
11 BUT MY -- THERE ISN'T ONE SHRED OF EVIDENCE IN THIS WHOLE
12 CASE, ANY OF THESE DOCUMENTS WITH THE EXCEPTION OF MISS
13 SCHOLL'S TESTIFIED TO THAT THERE WAS WITHHOLDING OF ANY
14 MEDICATION WITH JUDITH LARSEN. THAT'S PART OF THE PROBLEM.
15 SHE CAN TESTIFY AS TO WHAT SHE DID, WHAT SHE OBSERVED,
16 CONVERSATIONS SHE HAD WITH DR. WEITZEL, BUT TO HAVE HER TO
17 NOW TALK ABOUT THIS IS A GROUP THING, IT BELIES THE EVIDENCE
18 BEFORE THE COURT. THERE'S ONLY FOUR INSTANCES IN ALL FIVE
19 MEDICAL RECORDS WHERE THERE WAS ANY WITHHOLDING OF ANY
20 MEDICATION, AND THE COURT'S ALREADY HEARD ABOUT ALL FOUR OF
21 'EM ESSENTIALLY, THE ONE BY MISS KLEI -- KLEE, RATHER, AND
22 THE ONES BY MISS SCHOLL. THAT'S IT. SHE NEVER DOCUMENTED
23 ANYTHING THAT SHE WITHHELD ANY MEDICATIONS, AND NEITHER DID
24 ANY OTHER NURSE. SO I HAVE SOME REAL CONCERN ABOUT HOW FAR
25 WE GO AND HOW MUCH EDITORIALIZING WE ALLOW. I HAVE NO
1446
1 PROBLEM WITH HER TESTIFYING AS TO WHAT SHE DID,
2 CONVERSATIONS SHE HAD, AND WHAT HAVE YOU, BUT WHEN WE TALK
3 ABOUT WE ASK THIS AND THAT, IT BELIES THE EVIDENCE. IT'S
4 JUST NOT FACTUAL.
5 MS. BARLOW: YOUR HONOR, I WOULD LAY THE FOUNDATION
6 WITH HER THAT SHE WAS AT THAT MEETING. WEREN'T YOU?
7 THE WITNESS: YES.
8 THE COURT: WHICH MEETING?
9 MS. BARLOW: THAT MISS SCHOLL TALKED -- OR
10 TESTIFIED ABOUT. THE ONE WHERE -- AND I THINK THAT'S WHAT
11 SHE WAS REFERRING TO, SHE WAS --
12 THE COURT: WELL SHE CAN TALK -- SHE CAN TALK ABOUT
13 THAT MEETING --
14 MS. BARLOW: OKAY.
15 THE COURT: AND THAT'S -- OKAY. AND WHAT ELSE DO
16 YOU ANTICIPATE --
17 MS. BARLOW: WELL, I THINK --
18 THE COURT: I GUESS THE ONE THING, I GUESS THE
19 THING THAT I'M A LITTLE CONCERNED ABOUT IS THAT THIS
20 WITNESS, WHEN NO QUESTION WAS PENDING, TURNED, LOOKED AT THE
21 JURY AND SAYS, I'VE GOT A -- I'VE GOT SOMETHING I'D LIKE TO
22 SAY.
23 MS. BARLOW: WELL, AND SHE'S BEEN ADMONISHED. AND
24 I DON'T THINK SHE WILL DO THAT AGAIN.
25 THE COURT: I UNDERSTAND, BUT I MEAN THAT'S A
1447
1 CONCERN, YOU KNOW. I MEAN WE NEED TO MAKE SURE THAT WHAT
2 WE'RE DOING IS ASKING QUESTIONS AND NOT GIVING SPEECHES.
3 MS. BARLOW: I UNDERSTAND THAT. AND I THINK SHE
4 DOES NOW, TOO.
5 THE COURT: OKAY. SO WHAT YOU'VE TALKED ABOUT,
6 CONVERSATION, YOU KNOW, WHAT -- HOW SHE TALKED TO
7 DR. WEITZEL, WHAT HAPPENED, THAT SHE STILL EVEN AFTER THAT
8 DID NOT WANNA GIVE THE SHOT. BUT WHAT HAPPENED TO GET THE
9 SHOT. THAT'S ALL FAIR GAME. THE CONFRONTATION WITH THE
10 GROUP OR THE DISCUSSION WITH THE GROUP, THAT THE OTHER ONE,
11 THAT'S ALL FAIR GAME. WHAT ELSE DO YOU HAVE A QUESTION
12 ABOUT?
13 MS. BARLOW: WELL, AND I WOULD -- AND I WOULD ASK
14 HER:
15 Q. ARE YOU AWARE OF THE PROTOCOL IF YOU CHALLENGE A DOCTOR
16 AND HE TELLS YOU TO DO IT ANYWAY, ARE YOU AWARE OF ANY
17 PROTOCOL THAT NEEDS TO BE FOLLOWED IF YOU STILL DISAGREE
18 WITH MEDICATION TO BE GIVEN; I.E., GOING UP THE CHAIN OR
19 ANYTHING LIKE THAT?
20 A. I DON'T REMEMBER ANY WRITTEN PROTOCOL, BUT --
21 Q. WELL, ANY ORAL PROTOCOL? WHAT -- WHAT COULD YOU DO IF
22 THE DOCTOR ORDERED YOU TO DO IT ANYWAY AND YOU STILL DIDN'T
23 WANNA DO IT?
24 A. WELL, THIS WAS ON AN AFTERNOON SHIFT. YOU'RE NOT GONNA
25 HAVE YOUR DAY PEOPLE THERE. I BASICALLY CALLED THE PHARMACY
1448
1 TO -- AND CHECKED OUT THE ORDER. I --
2 Q. DID YOU EVER GO HIGHER UP IN THE NURSING HIERARCHY?
3 A. I HAD PREVIOUSLY.
4 Q. WHEN WAS THAT?
5 A. THIS WAS WITH JUDITH AND THEN PREVIOUSLY TO JUDITH.
6 THE COURT: JUDITH --
7 MS. BARLOW: LARSEN.
8 THE WITNESS: LARSEN.
9 THE COURT: A PATIENT?
10 THE WITNESS: YES.
11 THE COURT: OKAY.
12 Q. (BY MS. BARLOW) WHAT HAPPENED WHEN YOU --
13 THE COURT: OKAY. WHEN WAS THAT?
14 THE WITNESS: I DON'T HAVE THE SPECIFIC DATES.
15 THE COURT: I MEAN -- IT WAS WHILE SHE WAS A
16 PATIENT THERE YOU MEAN?
17 THE WITNESS: YES.
18 THE COURT: OKAY. GO AHEAD.
19 Q. (BY MS. BARLOW) AND THEN WHAT HAPPENED WHEN YOU WENT
20 UP THE HIERARCHY WITH THE COMPLAINT -- WITH -- IN JUDITH'S
21 CIRCUMSTANCE? WE'LL HAVE TO LIMIT IT TO THAT.
22 A. WE WERE TOLD THAT --
23 Q. WHEN YOU SAY WE --
24 A. -- DR. WEITZEL WAS THE DOCTOR AND WE WERE TO FOLLOW --
25 THE COURT: WHO DID YOU TALK TO?
1449
1 THE WITNESS: I TALKED TO KAREN CHATELAIN.
2 THE COURT: WHO IS?
3 THE WITNESS: HOSPITAL ADMINISTER OVER NURSES.
4 SHE'S THE NURSING ADMINISTER.
5 Q. (BY MS. BARLOW) DID ANYONE ELSE GO WITH YOU WHEN YOU
6 TALKED TO HER?
7 A. SHEILA MOORE WENT WITH ME.
8 Q. AND WHAT CAME OUT OF YOUR CONVERSATION WITH KAREN
9 CHATELAIN?
10 A. THAT WE NEEDED TO FOLLOW DR. WEITZEL'S ORDERS.
11 Q. DID YOU STILL --
12 THE COURT: AND THAT -- AND THAT WAS BEFORE THIS
13 INCIDENT YOU'RE SAYING WITH MARY CRANE?
14 THE WITNESS: YES.
15 THE COURT: OKAY.
16 MS. BARLOW: YOUR HONOR, AND, YOU KNOW, MAYBE THIS
17 IS A LITTLE OUT OF ORDER, BUT I AM GOING TO TIE IT IN BY
18 HAVING HER TALK ABOUT JUDITH LARSEN, AND SO I WOULD ASK
19 LEAVE TO BE ALLOWED TO GO, YOU KNOW, GO AHEAD --
20 THE COURT: OKAY. WELL, ON THE -- ON THE JUDITH
21 LARSEN, WAS THAT ANOTHER SITUATION WHERE THERE WAS A SHOT
22 THAT WAS ORDERED AND THEN YOU WENT TO MISS CHATELAIN BECAUSE
23 YOU DIDN'T WANNA GIVE IT?
24 THE WITNESS: NO.
25 THE COURT: OKAY. WHAT WAS THE SITUATION?
1450
1 THE WITNESS: WE WANTED HER TO BE TRANSFERRED OFF
2 THE UNIT TO GET BETTER MEDICAL CARE. WE FELT LIKE SHE
3 WASN'T RECEIVING THE MEDICAL CARE. WE WANTED HER TO BE ABLE
4 TO HAVE A CHANCE TO GET BETTER AND -- Doctor Earline.
5 THE COURT: OKAY. SO THAT WASN'T ABOUT SHOTS, THAT
6 WAS ABOUT WHERE SHE WOULD BE IN THE HOSPITAL FOR HER
7 MEDICAL --
8 THE WITNESS: AND WHAT WOULD BE THE BEST PLACE FOR
9 HER TO GET THE CARE SHE NEEDED.
10 THE COURT: OKAY. THAT THE SAME SITUATION OR IS --
11 THE WITNESS: IT WAS ALSO ON MEDICATION. IT WAS --
12 ALSO HAD TOO WITH THE MEDICATION, NOT A SHOT THAT I DIDN'T
13 WANNA GIVE SPECIFICALLY, BUT -- BUT THE FACT THAT THERE WAS
14 A CONFLICT BETWEEN THE NURSING STAFF AND THE DOCTOR ABOUT
15 THE MEDICATION AND HER TREATMENT.
16 THE COURT: OKAY. OKAY. ANYTHING FURTHER?
17 MS. BARLOW: I THINK THAT THAT'S ALL THAT I WAS
18 GOING GET INTO IN THIS AREA.
19 THE COURT: OKAY. ALL RIGHT. ANYTHING FURTHER,
20 MR. STIRBA?
21 MR. STIRBA: YEAH, I WOULD LIKE TO POINT OUT THAT
22 THERE HAVE BEEN -- I MEAN THERE IS A PROCESS BY WAY OF
23 HOSPITAL POLICY IN TERMS OF THE NURSES FILING INCIDENT
24 REPORTS. THERE HAS BEEN A NUMBER OF SUBPOENAS ISSUED TO THE
25 DAVIS HOSPITAL FOR ANY SUCH REPORTS. NOT JUST BY US, BUT BY
1451
1 THE STATE. THE HOSPITAL HAS NONE. AND SO THERE IS SOME
2 QUESTION REALLY ABOUT THE NATURE OF THESE COMPLAINTS AND THE
3 NATURE OF THESE CONVERSATIONS, AND HOW REALLY RELEVANT THEY
4 ARE GIVEN THE FACT THERE'S NO DOCUMENTATION CERTAINLY WITHIN
5 THE HOSPITAL FILES TO ANY SUCH COMPLAINT WAS MADE.
6 THE COURT: WELL, WHETHER THERE'S NO DOCUMENTATION,
7 IF WITNESSES ARE GONNA TESTIFY, YOU CAN CROSS-EXAMINE THEM
8 ON THAT ISSUE. BUT IF THERE ARE CONVERSATIONS, YOU KNOW,
9 THEN -- REGARDING WHAT YOU'VE JUST GONE THROUGH, I MEAN THIS
10 SITUATION, YOU BETTER LAY A FOUNDATION ON THE ONE, THE
11 EARLIER ONE BEFORE THE MARY CRANE. BECAUSE RIGHT NOW,
12 IT'S -- IT'S LIKE IF THERE'S A PROBLEM ABOUT CARE AND
13 TREATMENT, YOU KNOW, IT JUST DOESN'T INVOLVE MEDICATION, YOU
14 KNOW, JUST LAY IT OUT WHAT -- BEFORE YOU START HER INTO A
15 SPEECH.
16 MS. BARLOW: WELL, I'LL TRY NOT TO START HER INTO A
17 SPEECH, BUT YES, YOUR HONOR --
18 THE COURT: NO, AND I WOULD JUST SAY -- AND I'M NOT
19 TRYING TO BE HARSH ON YOU, I'M JUST SAYING THAT THE ONLY WAY
20 THAT THIS PROCESS WORKS IS THAT WE ARE NOT HERE -- THERE ARE
21 STRONG EMOTIONS FROM FAMILY MEMBERS, FROM EVERYONE IN THIS
22 CASE, AND ALL YOU NEED TO DO IS JUST -- SHE WILL ASK YOU ALL
23 THE QUESTIONS SHE WANTS YOU TO ASK -- ANSWER --
24 THE WITNESS: OKAY.
25 THE COURT: -- THEN THERE'LL BE A CHANCE OF
1452
1 CROSS-EXAMINATION. YOU'LL GET A CHANCE TO SAY WHATEVER'S
2 RELEVANT. IF THEY DON'T GIVE YOU A QUESTION THAT GETS OFF
3 TO A THING YOU WANT TO SAY, THE POINT IS, YOU CAN SAY IT
4 SOMEWHERE ELSE, BUT IT WON'T BE HERE. OKAY?
5 THE WITNESS: OKAY.
6 THE COURT: OKAY? DO YOU HAVE ANY OTHER QUESTIONS
7 BEFORE WE START?
8 MS. BARLOW: I DON'T, YOUR HONOR.
9 THE COURT: OKAY. WHY DON'T WE HAVE THE JURY COME
10 BACK PLEASE? WELL, FIRST OF ALL, BEFORE THEY COME BACK, HOW
11 LONG DO YOU ANTICIPATE WE'RE GONNA BE WITH THIS WITNESS? I
12 MEAN I'M PRETTY COMMITTED TO 5:00 O'CLOCK ON A FRIDAY NOT
13 KEEPING THE JURY OVER.
14 MS. BARLOW: YOUR HONOR, IT'S -- IT'S GOING TO TAKE
15 QUITE A BIT OF TIME --
16 THE COURT: OKAY. SO WE'RE NOT GONNA GET DONE
17 TODAY --
18 MS. BARLOW: -- I'M SURE WE'RE GONNA HAVE TO --
19 THE COURT: -- WITH THIS WITNESS?
20 MS. BARLOW: WE'RE NOT GONNA FINISH TONIGHT.
21 THE COURT: OKAY. THAT'S ALL. LET'S GET THE JURY
22 BACK IN.
23 (THE JURY RETURNS TO THE COURTROOM.)
24 THE COURT: OKAY. YOU MAY BE SEATED. LADIES AND
25 GENTLEMEN, WE'RE -- I CAN PROMISE YOU THAT WE'RE GONNA STOP
1453
1 AT 5:00. WE PROBABLY WILL NOT FINISH WITH THIS WITNESS
2 TODAY. AND WE'LL GO -- BUT WE WILL NOT END ANY LATER THAN
3 5:00 TODAY. I DO WANNA EXPRESS, YOU KNOW, MY APPRECIATION.
4 YOU HAVE BEEN EXTREMELY PROMPT. YOU'RE ALWAYS HERE WHEN
5 I'VE ASKED YOU TO BE HERE, AND THAT'S MADE A WORLD OF
6 DIFFERENCE. BUT MORE THAN THAT, I JUST WANNA EXPRESS
7 APPRECIATION TO YOUR ALERTNESS. I MEAN I'VE SAT THROUGH --
8 AND I'VE GOT TO SAY THAT I DON'T KNOW WHAT IT IS, BUT OTHER
9 JUDGES SAY JURIES, YOU KNOW, MEMBERS OF JURIES FALL ASLEEP
10 IN CASES. THIS IS A PRIME CASE WHERE YOU START GOING
11 THROUGH THOSE MEDICAL RECORDS, YOU COULD GET SLEEPY. BUT
12 YOU'VE ALL BEEN ALERT. I NOTICED THAT YOU'VE ALL TAKEN
13 NOTES AND I REALLY NOT -- I VERY MUCH APPRECIATE EVERYTHING
14 THAT YOU'VE DONE, THAT YOU'VE KEPT AWAKE AND YOU'VE BEEN
15 ALERT AND YOU'VE BEEN ON TIME AND THAT HELPS THE PROCESS.
16 OKAY. MISS BARLOW, WOULD YOU LIKE TO GO AHEAD?
17 MS. BARLOW: YES. THANK YOU, YOUR HONOR.
18 Q. LET'S BACK UP A LITTLE BIT IN TIME. DO YOU RECALL
19 JUDITH LARSEN?
20 A. I DO.
21 Q. AND WHAT DO YOU RECALL ABOUT HER?
22 THE COURT: WELL, I THINK THAT'S A BROAD QUESTION.
23 IF YOU WANT TO ASK HER WHAT SHE DID, BUT THAT ELICITED SOME
24 OF THE OTHER --
25 MS. BARLOW: I'LL FOCUS IT IN. THANK YOU.
1454
1 Q. YOU RECALL JUDITH LARSEN. DID THERE COME A TIME BASED
2 ON YOUR NURSING EXPERIENCE AND YOUR OBSERVATIONS OF MISS
3 LARSEN WHEN YOU BECAME CONCERNED ABOUT HER?
4 A. YES.
5 Q. AND WHEN WAS THAT?
6 A. SHE HAD STARTED VOMITING SOME BLACK COLORED STUFF.
7 Q. UH-HUH.
8 A. AND AT THAT POINT, I FELT LIKE SHE NEEDED SOME -- SOME
9 MORE MEDICAL CARE, LIKE MAYBE WE OUGHTA DO SOME SCOPING AND
10 FIND OUT -- SOMETIMES WHEN YOU GET GRANULE --
11 MR. STIRBA: YOUR HONOR, I'M GONNA OBJECT. I THINK
12 SHE'S RENDERING OPINION NOW AND I THINK THAT'S BEYOND THE
13 SCOPE OF THE QUESTION.
14 THE COURT: OKAY. WHY DON'T YOU JUST PHRASE IT AS
15 TO WHAT HER CONCERNS WERE AND WHAT SHE DID.
16 Q. (BY MS. BARLOW) WHAT WERE YOUR CONCERNS? WHAT WERE
17 YOUR CONCERNS ABOUT JUDITH LARSEN?
18 A. I WAS AFRAID THAT SHE MIGHT --
19 MR. STIRBA: I'M GONNA OBJECT. RELEVANCY, YOUR
20 HONOR.
21 MS. BARLOW: YOUR HONOR, IT'S FOUNDATIONAL.
22 THE COURT: OVERRULED.
23 Q. (BY MS. BARLOW) WHAT WERE YOUR CONCERNS? JUST
24 BRIEFLY, WHAT WERE YOUR CONCERNS?
25 A. THAT MAYBE SHE WAS HAVING SOME G.I. BLEEDING.
1455
1 Q. AND WHAT DID YOU DO WHEN YOU BECAME CONCERNED ABOUT
2 THAT?
3 A. WE HAD TALKED --
4 Q. LET'S JUST TALK ABOUT WHAT YOU DID PERSONALLY, NOT WE,
5 BUT WHAT YOU PERSONALLY DID.
6 A. I WANTED HER TRANSFERRED OFF OF OUR UNIT ONTO A MEDICAL
7 FLOOR WHERE THEY COULD DO SCOPES AND FIND OUT WAS MEDICALLY
8 GOING ON.
9 Q. AND WHO DID YOU -- WHO DID YOU EXPRESS THAT TO?
10 A. SOME OF THE OTHER NURSING STAFF.
11 Q. DID YOU EVER EXPRESS IT TO THE DEFENDANT?
12 A. I DON'T REMEMBER.
13 Q. DID YOU EVER TAKE IT UP THE -- UP THE LINE? I MEAN YOU
14 WORK UNDER THE CONTROL OF -- NOT CONTROL, UNDER THE ORDERS
15 OF A DOCTOR --
16 A. UH-HUH.
17 Q. -- BUT DON'T YOU ALSO ANSWER TO SOMEBODY ELSE AS A NURSE
18 IN THE HOSPITAL?
19 A. YOU ANSWER TO ADMINISTRATION.
20 Q. DID YOU EVER GO UP THROUGH ADMINISTRATION ABOUT YOUR
21 CONCERNS ABOUT JUDITH LARSEN?
22 MR. STIRBA: OBJECTION, RELEVANCY, YOUR HONOR.
23 THE COURT: OVERRULED.
24 Q. (BY MS. BARLOW) DID YOU EVER GO UP TO ADMINISTRATION
25 TO YOUR -- ABOUT YOUR CONCERNS?
1456
1 A. I DON'T REMEMBER ON THIS ISSUE.
2 Q. DID YOU EVER GO UP THROUGH THE NURSING ADMINISTRATION?
3 MR. STIRBA: YOUR HONOR, SHE'S TESTIFIED SHE
4 DOESN'T REMEMBER. ASKED AND ANSWERED.
5 MS. BARLOW: YOUR HONOR, AND IT MAY BE THAT MY TERM
6 ADMINISTRATION IS THROWING HER OFF.
7 Q. AS A NURSE IN THE NURSING AREA, NOT ANSWERING TO THE
8 DOCTOR, WHO DID YOU GO TO NEXT IF YOU HAD A PROBLEM?
9 A. I TALKED TO THE OTHER NURSING STAFF TO SEE IF THEY HAD
10 THE SAME CONCERNS AS I DID.
11 Q. YOU CAN'T TESTIFY AS TO THEIR CONCERNS, ONLY YOUR OWN.
12 THE COURT: I THINK WHAT SHE'S ASKING YOU IS, IS
13 THERE A CHAIN OF TITLE THAT A NURSE GOES TO WHEN THERE'S A
14 PROBLEM BASICALLY WITH MEDICATION AND TREATMENT?
15 MR. STIRBA: AND, YOUR HONOR, COULD WE LIMIT IT TO
16 THIS PARTICULAR TIME PERIOD BECAUSE IT'S RELEVANT IN TERMS
17 OF THE PEOPLE WHO WERE THERE, IN TERMS OF THE WITNESSES, THE
18 UNDERSTANDING OF THE CASE.
19 THE COURT: YES. DURING THE TIME PERIOD --
20 MS. BARLOW: WE'RE TALKING ABOUT JUDITH LARSEN --
21 THE COURT: -- DECEMBER THROUGH JAN -- DECEMBER OF
22 '95 THROUGH JANUARY OF '96.
23 Q. (BY MS. BARLOW) DID YOU EVER GO TO THE DIRECTOR OF
24 NURSING WITH ANY CONCERNS ABOUT JUDITH LARSEN?
25 A. I KNOW I TALKED WITH SOME PEOPLE, AND I DON'T REMEMBER
1457
1 WHO, I DON'T RECALL EXACTLY WHO.
2 Q. HOW ABOUT AN ADMINISTRATOR OVER NURSING AT THE HOSPITAL?
3 A. I DON'T RECALL.
4 MS. BARLOW: YOUR HONOR, CAN I HAVE A MOMENT TO
5 SPEAK WITH THE WITNESS?
6 MR. STIRBA: YOUR HONOR, WE'RE IN THE MIDDLE OF
7 DIRECT EXAMINATION HERE.
8 THE COURT: WELL, WHY DON'T YOU GO ONTO SOMETHING
9 ELSE SO THEN WE'RE NOT GONNA BE FINISHING WITH THIS WITNESS
10 TODAY --
11 MS. BARLOW: THAT'S TRUE.
12 THE COURT: -- SO WHY DON'T YOU GO ONTO ANOTHER --
13 Q. (BY MS. BARLOW) DID YOU ATTEND NURSING MEETINGS?
14 A. YES.
15 Q. TEAM MEETINGS?
16 A. YES.
17 Q. DID YOU EVER ATTEND A NURSING MEETING AT WHICH THE
18 DEFENDANT CAME AND TALKED ABOUT HOLDING MEDS?
19 A. YES.
20 Q. DO YOU RECALL APPROXIMATELY WHEN THAT WAS?
21 A. IT WAS DURING THIS TIME PERIOD. I THINK IT -- I THINK
22 IT HAD TO DO WITH JUDITH.
23 Q. DO YOU RECALL WHERE THAT MEETING WAS HELD?
24 A. IT WAS ON THE UNIT. WE HAD A KITCHEN LOUNGE AREA.
25 Q. DO YOU RECALL WHO ELSE WAS PRESENT AT THAT MEETING?
1458
1 A. TODD, DR. WEITZEL --
2 THE COURT: TODD WHO?
3 THE WITNESS: CHAMBERLAIN -- CHAMBERS.
4 Q. (BY MS. BARLOW) CHAMBERS.
5 A. CHAMBERS.
6 Q. AND WHO IS TODD CHAMBERS?
7 A. HE WAS OVER HORIZON.
8 Q. OKAY. AND SO TODD WAS THERE, DR. WEITZEL. DO YOU
9 RECALL --
10 A. I THINK TRACY WAS THERE. SEVERAL OF THE NURSES WERE
11 THERE. I THINK BONNIE WAS THERE. I THINK LYNN WAS THERE --
12 Q. OKAY. TRACY SCHOLL AND BONNIE HARDEY?
13 A. YES.
14 Q. AND LYNN LONG?
15 A. AND I DON'T RECALL BEYOND THAT. I SEEM TO REMEMBER
16 STACEY, AND I DON'T REMEMBER HER LAST NAME. THE TECHS WERE
17 THERE. I THINK NICOLE WAS THERE, NICKI.
18 Q. WHAT DID DR. WEITZEL SAY IN THAT CONTEXT ABOUT
19 WITHHOLDING MEDS?
20 A. HE WAS VERY ANGRY AND AGITATED --
21 MR. STIRBA: YOUR HONOR, I'M GONNA OBJECT --
22 THE COURT: SUSTAINED.
23 MR. STIRBA: -- CHARACTERIZATION --
24 THE COURT: SUSTAINED.
25 Q. (BY MS. BARLOW) WHAT DID HE SAY IN THAT MEETING?
1459
1 A. THAT WE WERE NOT TO HOLD THE MEDS, THAT -- AND TODD
2 BACKED THAT STATEMENT UP, THAT WE WERE NOT TO HOLD THE MEDS.
3 THAT IF WE DID HOLD THE MEDS, WE WERE TO CALL HIM AND LET
4 HIM KNOW, AND THEN HE WOULD LET US KNOW WE NEEDED TO GIVE
5 THE MEDS.
6 Q. DID YOU AFTER THAT HAVE AN OCCASION TO CALL AND TO TELL
7 DR. WEITZEL THAT YOU INTENDED TO WITHHOLD MEDS?
8 A. NO.
9 Q. AND WHY?
10 A. BECAUSE WE HAD BEEN TOLD WE WERE GONNA GIVE 'EM. WE HAD
11 BEEN TOLD THAT HE WAS THE DOCTOR, HE WAS IN CHARGE, AND WE
12 WERE TO GIVE IT.
13 Q. OKAY. OTHER THAN THE OTHER NURSES, SOMEONE HIGHER UP IN
14 THE HIERARCHY, AS IT WERE, DID YOU TALK TO SOMEONE UP --
15 HIGHER UP IN THE HIERARCHY ABOUT THIS ORDER TO GIVE THE
16 MEDS?
17 A. I'M TRYING TO THINK SPECIFICALLY WHO I WOULD HAVE TALKED
18 TO. GIVE ME JUST A MINUTE.
19 I THINK AFTER THAT MEETING, THE HIERARCHIES WERE THERE.
20 TODD WAS THERE --
21 MR. STIRBA: YOUR HONOR --
22 THE WITNESS: -- WE HAD BEEN TOLD TO GIVE THEM --
23 MR. STIRBA: -- YOUR HONOR, THE QUESTION HAS BEEN
24 POSED AND I THINK NOW WE'RE NOT ANSWERING IT.
25 THE COURT: SUSTAINED.
1460
1 Q. (BY MS. BARLOW) DID YOU TALK TO ANYONE IN THE
2 HIERARCHY ABOUT THAT MEETING AFTER IT OCCURRED?
3 MR. STIRBA: I'M GONNA OBJECT. ASKED AND ANSWERED,
4 YOUR HONOR.
5 MS. BARLOW: WELL, SHE DIDN'T ANSWER --
6 THE COURT: NO, I DON'T THINK WE'VE GOT AN ANSWER.
7 I THINK THE PROBLEM IS THE QUESTION HAS BEEN ASKED, AND TRY
8 TO ANSWER THE QUESTION THAT THE ATTORNEY IS ASKING YOU.
9 Q. (BY MS. BARLOW) PEOPLE THERE WERE. DID YOU GO TO ANY
10 OF THE HIERARCHY AFTER THAT MEETING AND EXPRESS YOUR
11 CONCERNS ABOUT BEING TOLD TO GIVE THE MEDS?
12 A. I DON'T RECALL.
13 Q. DO YOU RECOGNIZE NAME KAREN CHATELAIN?
14 A. I DO.
15 Q. WHO IS SHE?
16 A. SHE'S THE ADMINISTRATOR OVER THE NURSES.
17 Q. AND IS SHE WITH HORIZON OR THE HOSPITAL?
18 A. THE HOSPITAL.
19 Q. AND THERE WAS A DIFFERENCE BETWEEN THE TWO, IS THAT
20 CORRECT?
21 A. YES.
22 MR. STIRBA: YOUR HONOR -- YOUR HONOR, WE'RE AT THE
23 POINT WHERE WE HAVE -- IT'S LEADING AND SUGGESTIVE. I MEAN
24 THIS IS DIRECT EXAMINATION.
25 THE COURT: OKAY. JUST ASK QUESTIONS. DON'T LEAD.
1461
1 Q. (BY MS. BARLOW) I'M SORRY, WHO WAS KAREN CHATELAIN
2 AGAIN?
3 A. SHE WAS THE ADMINISTRATOR OVER NURSING.
4 Q. WAS SHE IN YOUR HIERARCHY?
5 A. YES.
6 Q. DID YOU EVER HAVE OCCASION TO TALK TO HER?
7 A. YES.
8 MR. STIRBA: YOUR HONOR, I'M GONNA OBJECT. VAGUE
9 AND AMBIGUOUS. WITH RESPECT TO WHAT, RELEVANCE?
10 MS. BARLOW: WITH RESPECT TO THE MED, YOUR HONOR.
11 THE COURT: WELL, I THINK WE'RE -- WITH RESPECT TO
12 THE MEDS IS AMBIGUOUS. PHRASE THE QUESTION AS IT RELATES TO
13 WHAT YOU JUST ASKED HER.
14 Q. (BY MS. BARLOW) DID YOU EVER TALK TO KAREN CHATELAIN
15 IN RESPECT TO YOUR CONCERNS ABOUT THE CARE OF JUDITH LARSEN?
16 A. YES.
17 Q. AND DO YOU RECALL WHEN THAT WAS?
18 A. NOT EXACTLY, NO.
19 Q. WHEN WAS IT IN RELATIONSHIP TO THE CONCERNS THAT YOU
20 HAVE ALREADY EXPRESSED ABOUT JUDITH LARSEN?
21 A. IT WAS BEFORE SHE DIED, AND SHE WAS ON THE UNIT FOR A
22 LONG TIME. IT WOULD HAVE BEEN -- I'M NOT SURE, I CAN'T TELL
23 YOU EXACTLY.
24 Q. DO YOU RECALL WHERE THAT MEETING TOOK PLACE?
25 A. IN KAREN'S OFFICE.
1462
1 Q. AND WAS THAT AT DAVIS NORTH?
2 A. YES.
3 Q. WAS ANYONE ELSE PRESENT WHEN YOU HAD THAT MEETING?
4 A. IT SEEMS LIKE I TOOK SHEILA. I DON'T RECALL.
5 Q. WHAT DID YOU TELL KAREN CHATELAIN ABOUT YOUR CONCERNS?
6 MR. STIRBA: OBJECTION. IT'S ASKED AND ANSWERED.
7 HEARSAY. IT'S IRRELEVANT.
8 THE COURT: OVERRULED.
9 Q. (BY MS. BARLOW) WHAT DID YOU TELL KAREN CHATELAIN
10 ABOUT YOUR CONCERNS ABOUT JUDITH LARSEN?
11 A. THAT SHE NEEDED A DIFFERENT KIND OF CARE. THAT SHE
12 WAS -- SHE NEEDED SOME MEDICAL CARE. THAT PSYCHIATRIC CARE
13 WAS NOT GONNA HELP HER AT THIS POINT.
14 Q. AND THAT WAS BASED ON YOUR NURSING EXPERIENCE?
15 A. YES.
16 Q. YOU'D BEEN A PSYCH NURSE.
17 A. YES.
18 THE COURT: JUST -- ALL WE'RE DOING IS WHAT WAS
19 SAID DURING THIS CONVERSATION.
20 Q. (BY MS. BARLOW) WHAT DID KAREN CHATELAIN TELL YOU?
21 A. THAT DR. WEITZEL --
22 MR. STIRBA: OBJECTION. HEARSAY, YOUR HONOR.
23 THE COURT: OVERRULED.
24 Q. (BY MS. BARLOW) WHAT DID KAREN CHATELAIN TELL YOU?
25 A. THAT DR. WEITZEL WAS A PHYSICIAN, AND WAS CAPABLE OF
1463
1 HANDLING MEDICAL SITUATIONS.
2 Q. AFTER THAT MEETING, DID YOU EVER TAKE ANY CONCERNS TO
3 KAREN CHATELAIN AGAIN?
4 A. NOT THAT I RECALL.
5 Q. LET'S GO BACK THEN. DID THAT OCCUR PRIOR TO YOUR --
6 WHEN DID THAT OCCUR IN RELATIONSHIP TO -- I DON'T WANNA LEAD
7 YOU HERE. WHEN DID THAT OCCURRENCE, TALKING TO KAREN
8 CHATELAIN, OCCUR IN RELATIONSHIP TO THE -- THE ORDER ON THE
9 7TH OF JANUARY TO GIVE MORPHINE TO MARY CRANE?
10 A. IT WOULD HAVE BEEN BEFORE.
11 Q. AND LET'S GO BACK TO 249, AND WE HAVE OVER HERE, HOLD
12 ALL ABOVE MEDS. MORPHINE. AND LET'S KIND OF GO BACK TO --
13 I DON'T WANNA REPLOW THE GROUND BECAUSE YOU HAVE ALREADY
14 TESTIFIED AS TO WHAT YOU DID APPROACHING DR. WEITZEL.
15 AFTER YOU APPROACHED DR. WEITZEL ABOUT GIVING THIS
16 MORPHINE SHOT TO MARY CRANE, WHAT DID HE SAY TO YOU?
17 A. I EXPRESSED CONCERN THAT -- I ASKED WHY --
18 THE COURT: THE QUESTION IS --
19 Q. (BY MS. BARLOW) WHAT -- WHAT DID HE SAY TO YOU? OKAY.
20 LET'S START WITH, WHAT DID YOU SAY TO HIM?
21 THE COURT: WHY DON'T WE JUST GET THE FOUNDATION AS
22 TO WHO WAS ON THIS CONVERSATION AND WHAT WAS SAID.
23 MS. BARLOW: I WILL BE HAPPY TO DO THAT, YOUR
24 HONOR.
25 Q. DO YOUR RECALL WHERE THIS CONVERSATION BETWEEN YOURSELF
1464
1 AND THE DEFENDANT TOOK PLACE?
2 A. AT THE NURSES' DESK.
3 Q. AND WAS ANYONE ELSE PRESENT?
4 A. I BELIEVE LYNN LONG WAS THERE.
5 Q. AND IT HAPPENED ON THE 7TH OF JANUARY?
6 A. YES.
7 Q. WHEN WAS IT THAT -- THIS WAS AT 2100 THAT THE ORDER WAS
8 NOTED.
9 A. YES.
10 Q. WHEN WAS IT IN RELATIONSHIP TO THAT ORDER?
11 A. IT WAS AT THAT POINT, HE -- HE WROTE THE ORDER. IT
12 WOULD HAVE BEEN AT THAT SAME TIME. I LOOKED AT THE ORDER
13 AND ASKED HIM, WHY ARE WE GIVING HER MORPHINE.
14 Q. SO YOU -- YOU SAID WHAT?
15 A. WHY ARE WE GIVING HER THE MORPHINE.
16 Q. AND WHAT WAS HIS RESPONSE TO THAT QUESTION?
17 A. FOR PAIN.
18 Q. AND WHAT WAS YOUR STATEMENT? OR DID YOU MAKE ANOTHER
19 STATEMENT TO HIM?
20 A. I SAID, I DON'T THINK SHE'S IN PAIN.
21 Q. AND WHAT DID HE SAY?
22 A. HE SAID, HOW DO YOU KNOW SHE'S NOT IN PAIN.
23 Q. AND WHAT DID YOU SAY?
24 A. I -- I SAID, WELL, I -- I DON'T SEE ANY SIGNS OF IT.
25 Q. AND WHAT DID HE SAY?
1465
1 A. HE SAID, DID -- DID THE PATIENT TELL YOU SHE'S NOT IN
2 PAIN?
3 Q. AND WHAT WAS YOUR RESPONSE?
4 A. I DIDN'T RESPOND AT THAT POINT BECAUSE I HAD NO
5 RESPONSE. THE PATIENT WAS NOT ABLE TO RESPOND. I MEAN THE
6 PATIENT WASN'T ABLE TO TELL ME THAT SHE WAS NOT IN PAIN.
7 Q. WAS SHE SPEAKING AT ALL AT THAT POINT?
8 A. NO. SHE WAS COMATOSE.
9 Q. SO WHAT -- DID ANYONE SAY ANYTHING -- YOU DIDN'T
10 RESPOND. DID HE SAY ANYTHING MORE?
11 A. NO. NOT THAT I RECALL.
12 Q. DID YOU SAY ANYTHING MORE TO HIM ABOUT HER BEING IN PAIN
13 OR NOT BEING IN PAIN?
14 A. NO, NOT THAT I RECALL.
15 Q. FINISH UP THAT ARENA AND THEN I HAVE ANOTHER QUESTION
16 BACK ON THAT. IF YOU WOULD TURN TO PAGE NUMBER 290 IN MARY
17 CRANE. DO YOU HAVE THAT IN FRONT OF YOU? IT'S IN THE MEDS
18 AND GRAPHS.
19 A. YES, I DO.
20 Q. AND THIS IS A MARS. AND WHAT IS A MARS?
21 A. MEDICAL RECORD MEDICATION ADMINISTRATION RECORD.
22 Q. AND WHAT DO YOU WRITE ON THIS RECORD?
23 A. IT'S A RECORD OF THE ADMINISTRATION -- THE MEDICATIONS
24 THAT YOU GIVE, YOU WRITE TIMES AND -- AND WHO GAVE IT. THE
25 DOSE --
1466
1 Q. LET'S COME DOWN HERE WHERE IT SAYS 1/7, M.S., THAT'S
2 MORPHINE.
3 A. YES.
4 Q. 5 MILLIGRAM I.M., Q-3 DEGREE, WHICH MEANS WHAT?
5 A. EVERY THREE HOURS.
6 Q. AND THEN THE TIMES ARE LISTED OVER HERE FROM -- LOOKS
7 LIKE 8:00 P.M. AND EVERY THREE HOURS TIMES ARE LISTED. THIS
8 FIRST ONE IS THE 5TH. WAS ANY MORPHINE GIVEN ON THAT DATE?
9 A. YES.
10 Q. AND WHERE DOES IT INDICATE IT WAS GIVEN?
11 A. OH, ON THE 5TH? I'M SORRY. I WAS LOOKING AT 7TH. NO.
12 I DON'T SEE ANY.
13 Q. WHAT ABOUT ON THE 6TH?
14 A. NO.
15 Q. NOW, WE HAVE ON THE 7TH AT 2000 OR TWENTY -- TWENTY
16 HUNDRED, I GUESS, 8:00 P.M., IT SAYS GIVEN, AND THEN IS THAT
17 YOUR INITIAL UNDERNEATH IT?
18 A. YES, IT IS.
19 Q. NOW, IS THIS THE DOSE YOU WERE TALKING ABOUT THAT YOU
20 DIDN'T WANNA GIVE?
21 A. I DIDN'T WANNA GIVE IT, NO.
22 Q. OKAY. AND YOU -- DID YOU TELL THE DEFENDANT YOU DIDN'T
23 WANNA GIVE IT?
24 A. YES, I DID.
25 Q. AND HIS RESPONSE WAS?
1467
1 A. AGAIN, HOW DO YOU KNOW SHE'S NOT IN PAIN. ARE YOU
2 WILLING TO LET HER SUFFER BECAUSE YOU DON'T THINK SHE'S IN
3 PAIN. Seems like a good question.
4 Q. AND WHAT WAS YOUR RESPONSE?
5 A. I DON'T THINK I RESPONDED TO IT. I --
6 Q. WHAT DID YOU DO AFTER YOU GOT THAT RESPONSE FROM THE
7 DEFENDANT?
8 A. I LOOKED AT THE ORDER AND I TOOK IT OVER TO THE PHONE
9 AND I CALLED THE PHARMACY AND ASKED THEM WHAT THEY THOUGHT
10 ABOUT GIVING THIS LADY 5 MILLIGRAMS OF MORPHINE WITH HER
11 RESPIRATIONS DOWN, IF -- I THOUGHT IT WOULD KILL HER. IF
12 THEY THOUGHT IT WOULD KILL HER. AND THEY SAID JUST THAT
13 5 MILLIGRAMS, IT WAS WITHIN NORMAL RANGE AND IT WOULD BE
14 OKAY.
15 Q. DID YOU GO GIVE IT THEN?
16 A. NO. I WAS STILL REALLY UNCOMFORTABLE WITH IT.
17 Q. WHAT DID YOU DO?
18 A. I WAS TALKING OVER WITH LYNN HOW I HAD NOT WANTED TO
19 GIVE IT. AND SHE SAYS, WELL, IF YOU DON'T FEEL COMFORTABLE
20 GIVING IT, I FEEL OKAY ABOUT GIVING IT, I CAN GO AHEAD AND
21 GIVE IT.
22 Q. IS THAT LYNN LONG?
23 A. YES.
24 Q. DID YOU SEE THAT SHOT GIVEN?
25 A. SHE TOOK THE SHOT AND WENT IN THE ROOM. I DON'T RECALL
1468
1 IF I SAW IT GIVEN OR NOT.
2 Q. THIS SAYS GIVEN. IN WHOSE HANDWRITING IS THAT?
3 A. THAT'S MINE.
4 Q. AND THEN IT'S INITIALLED, BUT YOU DIDN'T GIVE THE SHOT?
5 A. NO.
6 Q. WHY IS THAT WRITTEN IN THAT FASHION?
7 A. BECAUSE I WAS WAITING FOR LYNN TO INITIAL IT BECAUSE SHE
8 HAD GIVEN THE SHOT. AND SHE LEFT THE UNIT WITHOUT
9 INITIALLING IT. AND I DID NOT WANT THAT SHOT GIVEN BY
10 SOMEONE ELSE NOT KNOWING THAT IT HAD BEEN GIVEN, AND SO I
11 WROTE GIVEN ABOVE THERE WAITING FOR HER TO INITIAL IT. BY
12 THE TIME I WENT OFF SHIFT, SHE STILL HADN'T INITIALED IT, SO
13 I WENT AHEAD AND PUT MY INITIALS THERE.
14 Q. AND THEN AT 2300, IS THAT YOUR INITIAL?
15 A. YES.
16 Q. DID YOU GIVE THAT SHOT?
17 A. I DID.
18 Q. WHY DID YOU DO THAT?
19 A. BECAUSE IT BECAME VERY APPARENT THAT I WAS NOT GONNA BE
20 ABLE TO HELP THIS PATIENT. THAT THERE -- THAT SHE WAS IN
21 SUCH A STATE THAT SHE WAS GONNA DIE ON ME, IT WAS GONNA MAKE
22 NO DIFFERENCE WHETHER SHE GOT THIS SHOT OR NOT. AND SO --
23 Q. AND DO YOU RECALL WHEN MARY CRANE PASSED AWAY?
24 A. JUST WITHIN MAYBE A HALF HOUR AFTER THAT 2300.
25 MS. BARLOW: YOUR HONOR, I RECOGNIZE IT'S ONLY
1469
1 4:30, BUT THIS -- AS FAR AS GETTING INTO ANOTHER PATIENT AND
2 THEN HAVING TO BREAK OFF --
3 THE COURT: WELL, LET'S KEEP GOING. I MEAN
4 THERE'S -- WE'LL BREAK AT APPROPRIATE TIME.
5 Q. (BY MS. BARLOW) AND WE TALKED A LITTLE BIT ABOUT
6 JUDITH LARSEN.
7 A. UH-HUH.
8 Q. DO YOU HAVE HER BINDER THERE IN FRONT OF YOU?
9 A. I DO.
10 Q. DID YOU HAPPEN TO DO HER INTAKE? NO, IT LOOKS LIKE YOU
11 DIDN'T, SO -- HER ASSESSMENT.
12 DO YOU RECALL WHEN JUDITH LARSEN CAME ON THE UNIT?
13 A. I HAVE TO LOOK AT THE DATE HERE. I DIDN'T RECALL IT
14 WITHOUT LOOKING, BUT IT'S --
15 Q. OKAY. 12/6 --
16 A. -- 12/6/95.
17 Q. AND WHEN'S THE FIRST TIME THAT YOU HAD ANY INVOLVEMENT
18 WITH HER?
19 A. I'LL HAVE TO LOOK FOR MY SIGNATURE TO KNOW.
20 Q. IF YOU'D LOOK AT 528.
21 A. THAT'S MY SIGNATURE.
22 Q. DID YOU WRITE ANYTHING ABOVE IT?
23 A. NO.
24 Q. WHY -- WHAT DO YOU RECALL AT THAT POINT OF JUDITH
25 LARSEN? ON THE 7TH?
1470
1 A. WHEN YOU SAY -- THERE'S NO WRITING ABOVE IT, BUT THIS --
2 THIS ASSESSMENT LOOKS LIKE I WOULD HAVE DONE THIS ASSESSMENT
3 THAT'S ON THE LEFT --
4 Q. CAN YOU OPEN THAT UP AND --
5 A. -- LEFT-HAND SIDE.
6 Q. WHEN YOU SAY THE ASSESSMENT, WHAT ARE YOU TALKING ABOUT?
7 WHAT ON THAT SHEET?
8 A. YOU WOULD GO, YOU WOULD LISTEN TO PATIENT'S LUNGS. YOU
9 WOULD CHECK THEIR PUPILS. YOU WOULD -- YOU WOULD SEE HOW
10 THEY WERE DOING. YOU WOULD ASSESS HOW THEY ARE.
11 Q. AND HOW WOULD YOU CHART THAT?
12 A. BY CIRCLING THE APPROPRIATE INFORMATION.
13 Q. IS THAT IN THE CENTER PART THERE?
14 A. YES.
15 Q. AND I GUESS A LITTLE BIT TO THE LEFT HERE.
16 A. UH-HUH.
17 Q. AT THE BOTTOM, THE ASSESSMENT TIME, YOU SAY THAT'S YOUR
18 HANDWRITING?
19 A. YES.
20 Q. OKAY. ON THE 7TH OF DECEMBER, WHAT DO YOU REMEMBER OF
21 JUDITH LARSEN?
22 A. WHAT'S WRITTEN HERE.
23 Q. OKAY. AND -- AND IF MOST OF THE MEDICAL NUMBERS THAT
24 HAVE YOUR SIGNATURE ON IT ALSO, YOU KNOW, DON'T HAVE ANY
25 FREE TEXT, WOULD WHAT THAT INDICATE TO YOU?
1471
1 A. THAT I WAS CO-SONING -- CO-SIGNING, THAT I WAS THERE AND
2 I WAS -- I WAS ON THE UNIT, BUT THAT EITHER A TECH OR
3 SOMEONE ELSE HAD CHARTED ON THE PATIENT.
4 Q. DO YOU RECALL ANY CHANGE IN JUDITH LARSEN FROM THE TIME
5 SHE CAME ON THE UNIT UNTIL SHE PASSED AWAY?
6 A. YES.
7 Q. DO YOU RECALL WHEN -- I MEAN SHE CAME ON THE 6TH OF
8 DECEMBER. DO YOU RECALL WHEN THERE BECAME A CHANGE?
9 A. THERE WERE LOTS OF CHANGES WITH JUDITH. SHE WOULD GO UP
10 AND DOWN, AND SHE HAD GOOD DAYS AND BAD DAYS.
11 Q. DO YOU REMEMBER HER TOWARDS THE END OF HER LIFE?
12 A. YES.
13 Q. WAS SHE STILL GOING UP AND DOWN AT THAT POINT?
14 A. SHE WAS HEADED STRAIGHT DOWN. SHE DIDN'T COME UP AGAIN.
15 Q. AND WHEN WE SAY HEADED STRAIGHT DOWN, WHAT WERE YOU
16 SEEING IN HER?
17 MR. STIRBA: CAN WE HAVE A LITTLE BIT MORE
18 FOUNDATION, YOUR HONOR, ABOUT WHEN THESE EVENTS TOOK PLACE
19 OTHER THAN JUST AT THE END OF HER LIFE?
20 THE COURT: YES, LET'S REFER TO DAYS OR TIMES THAT
21 YOU SAW HER.
22 Q. (BY MS. BARLOW) OKAY. IT APPEARS THAT -- IF I RECALL
23 CORRECTLY SHE PASSED AWAY ABOUT THE 3RD OF JANUARY, IS THAT
24 CORRECT?
25 A. YES.
1472
1 Q. WHEN IN RELATIONSHIP TO THE 3RD OF JANUARY DID YOU SEE A
2 CHANGE THAT SHE NEVER CAME -- DIDN'T COME UP AGAIN?
3 A. I'D HAVE TO LOOK.
4 Q. OKAY.
5 A. IT MIGHT TAKE ME A MINUTE TO -- TO FIGURE THAT OUT.
6 I DON'T RECALL EXACTLY. IT WOULD TAKE A LITTLE MORE
7 TIME FOR ME TO --
8 Q. LET'S LOOK AT 577, WHICH IS THE 30TH OF DECEMBER.
9 A. OKAY.
10 Q. ANY INDICATION YOU SAW HER THAT NIGHT? OR THAT DAY,
11 EXCUSE ME.
12 A. 577, THAT WOULD HAVE BEEN DECEMBER 30TH?
13 Q. YES.
14 A. I DON'T SEE ME THERE, NO.
15 Q. LET'S TURN TO 574. DO YOU SEE ANYTHING IN THAT -- ON
16 THAT PAGE THAT WOULD INDICATE TO YOU --
17 A. MY SIGNATURE'S AT THE BOTTOM ON THE RIGHT-HAND SIDE.
18 Q. WAS THERE ANYTHING ON THERE INDICATING SHE WAS GOING
19 DOWNHILL?
20 A. NO.
21 MR. STIRBA: YOUR HONOR -- YOUR HONOR -- OKAY.
22 THE COURT: I DON'T THINK DOWNHILL'S QUITE A
23 MEDICAL TERM.
24 MR. STIRBA: AND INDICATING, THESE ARE NURSES'
25 NOTES AND --
1473
1 THE COURT: YEAH, LET'S TRY TO USE MEDICAL PHRASES.
2 Q. (BY MS. BARLOW) LET'S GET OVER INTO -- LET'S TURN TO
3 586. DID YOU WRITE ANYTHING ON THAT?
4 A. IT HAS MY SIGNATURE AGAIN. I DON'T SEE ANY TEXT THAT
5 I'VE WRITTEN THERE.
6 Q. DO YOU SEE ANY INDICATION IN THERE OF HER BEHAVIOR?
7 A. SHE HAS AN IRREGULAR HEARTBEAT.
8 MR. STIRBA: YOUR HONOR --
9 THE WITNESS: SHE --
10 MR. STIRBA: -- YOUR HONOR, I'M GONNA OBJECT. THE
11 QUESTION WAS, DO YOU SEE ANY INDICATION. I PRESUME WE'RE
12 LOOKING AT THE NOTE. IS THERE SOMETHING CHARTED AS TO HER
13 BEHAVIOR. I THINK THE ANSWER IS EITHER YES OR NO, AND THEN
14 OF COURSE, WE CAN READ THE NOTE. THIS ISN'T EVEN HER NOTE.
15 MS. BARLOW: WELL, YOUR HONOR, IT'S --
16 THE COURT: OKAY. LET'S --
17 MS. BARLOW: -- MEDICAL RECORD.
18 THE COURT: WELL, LET'S ANSWER -- THE QUESTION WAS
19 YES OR NO, AND THEN SEE WHAT --
20 Q. (BY MS. BARLOW) IS THERE ANYTHING ON 586 THAT CHARTS
21 HER BEHAVIOR FOR THAT DAY?
22 A. I'VE DONE THE PHYSICAL ASSESSMENT ON HER. I DON'T HAVE
23 ANYTHING CHARTED ON THE RIGHT-HAND SIDE THAT I'VE WRITTEN
24 OUT, BUT I'VE DONE THE ASSESSMENT ON HER.
25 Q. WHEN YOU SAY THE ASSESSMENT, YOU MEAN THE STUFF IN THE
1474
1 MIDDLE COLUMN?
2 A. YES.
3 Q. DO YOU SEE ANYTHING THERE THAT INDICATES THAT HER --
4 THAT HER PHYSICAL HEALTH IS CHANGING?
5 A. IF SAYS, LABORED AND CYANOTIC ON HER BREATHING.
6 CYANOTIC MEANS THERE'S SOME BLUE COLOR. THAT MEANS SHE'S
7 NOT GETTING ENOUGH OXYGEN.
8 Q. SO THAT IS -- I GUESS I NEED TO FIND OUT WHERE THE --
9 OH, OKAY.
10 A. SAYS BREATH, IT SAYS RESPIRATIONS.
11 THE COURT: IT'S AT THE TOP.
12 MS. BARLOW: OH, I'M SORRY. THANK YOU.
13 Q. SO RESPIRATIONS, IT SAYS NO DISTRESS. THEN IT SAYS
14 LABORED AND CYANOTIC. IS THAT YOUR HANDWRITING?
15 A. YES.
16 Q. WHICH MEANS WHAT?
17 A. SHE'S -- SHE'S PRETTY SICK.
18 Q. WELL, WHAT DOES CYANOTIC MEAN?
19 A. SHE'S BLUE. SHE'S NOT GETTING ENOUGH OXYGEN.
20 Q. AND THEN DOWN HERE IN THE PSYCHOLOGICAL UNDER EMOTIONS,
21 YOU'VE CIRCLED CALM. AND THEN BEHAVIOR'S WITHDRAWN. IS
22 THAT A CHANGE IN HER BEHAVIOR?
23 A. YES.
24 Q. JUST -- I'M SORRY.
25 NOW, IF YOU'D TURN TO 589, AND WHAT DATE IS THAT?
1475
1 A. IT IS JANUARY 3RD.
2 Q. DO YOU KNOW WHETHER YOU WOULD BE WORKING DAYS, EVENINGS,
3 OR WHAT THAT -- WHAT SHIFT WOULD YOU WORK THAT DAY?
4 A. I DON'T KNOW.
5 Q. NOW, YOU DIDN'T WRITE ANYTHING OVER IN THE FREE TEXT ON
6 THE RIGHT, IS THAT CORRECT?
7 A. NO.
8 Q. OKAY. DID YOU -- WERE YOU INVOLVED IN FILLING OUT THE
9 ASSESSMENT IN THE MIDDLE?
10 A. NO.
11 Q. WAS THIS ASSESSMENT FILLED OUT UNDER YOUR DIRECTION?
12 A. IT WAS FILLED OUT BY LYNN LONG. SHE'S AN R.N. SHE
13 WOULD HAVE HAD THE AUTHORITY TO -- I WOULDN'T HAVE BEEN
14 TELLING HER WHAT TO DO.
15 Q. BUT YOU SIGNED OFF AS THE CHARGE NURSE, IS THAT CORRECT?
16 A. THAT'S WHAT I -- YES.
17 Q. WHEN YOU SIGN OFF AS THE CHARGE NURSE, DO YOU LOOK AT
18 WHAT'S BEEN PRESENTED THERE TO SEE IF IT'S CORRECT?
19 A. IT JUST DEPENDS. SOMETIMES YOU'RE SIGNING THAT YOU WERE
20 JUST THERE THAT DAY.
21 Q. NOW, UNDER EMOTIONS, IT SAYS, NONRESPONSIVE. BEHAVIOR,
22 WITHDRAWN. IS THIS A CHANGE FROM HER PREVIOUS BEHAVIOR?
23 A. YES.
24 Q. IS THIS THE CHANGE YOU EARLIER TESTIFIED TO THAT YOU SAW
25 A CHANGE IN HER BEHAVIOR?
1476
1 A. YES.
2 THE COURT: HOW MUCH MORE TIME DO YOU THINK YOU'RE
3 GOING TO BE WITH THIS WITNESS?
4 MS. BARLOW: YOUR HONOR, I THINK THAT FINISHES UP
5 JUDITH LARSEN. I THINK THAT IT WOULD BE A GOOD TIME TO
6 BREAK, IF THAT'S WHAT YOU'RE --
7 THE COURT: WELL, HOW MUCH MORE TIME, THOUGH, ARE
8 YOU GONNA TAKE?
9 MS. BARLOW: WITH THIS WITNESS, SHE WILL BE TALKING
10 ABOUT --
11 THE COURT: WELL, TELL ME ABOUT TIME.
12 MS. BARLOW: -- LYDIA SMITH, AND IT'S GOING TO
13 PROBABLY TAKE ANOTHER HALF HOUR OR SO.
14 THE COURT: OKAY. AND HOW MUCH TIME DO YOU
15 ANTICIPATE, MR. STIRBA, IF YOU CAN ANTICIPATE RIGHT NOW?
16 MR. STIRBA: OH, I'D WANT 15, 20 MINUTES, JUDGE, AT
17 LEAST.
18 THE COURT: OKAY. WELL, LADIES AND GENTLEMEN, I
19 THINK WHAT WE'RE GOING TO DO IS RECESS UNTIL MONDAY AT THIS
20 POINT.
24 MS. BARLOW: YES, YOUR HONOR. WE'D RECALL EARLENE
25 COOPER.
1480
1 THE COURT: IF YOU'D COME FORWARD. YOU ARE STILL
2 UNDER OATH.
3 DIRECT EXAMINATION, CONT'D
4 BY MS. BARLOW:
5 Q. MORNING.
6 WE WERE TALKING ON FRIDAY ABOUT -- WELL, PERHAPS IF YOU
7 WOULD RESTATE YOUR NAME FOR THE RECORD.
8 A. EARLENE COZZENS-COOPER.
9 Q. WE WERE SPEAKING OF YOUR EMPLOYMENT AT THE GEROPSYCH
10 UNIT AT THE DAVIS NORTH HOSPITAL LAST FRIDAY. I WOULD LIKE
11 TO TURN YOUR ATTENTION TO SOME MATTERS IN THE MEDICAL
12 RECORDS INVOLVING SOME OF THESE PATIENTS. DO YOU HAVE THE
13 MEDICAL RECORDS UP THERE?
14 A. I DO.
15 Q. WOULD YOU PULL OUT MARY CRANE'S MEDICAL RECORD, PLEASE.
16 AND I THINK FOR THE PURPOSE OF EDIFYING THE JURY A LITTLE
17 BIT, WOULD YOU TURN TO PAGE 231, MEDICAL NUMBER 231. IT'S
18 WAY BACK UNDER PSYCH EVAL.
19 A. OKAY.
20 Q. IT'S ONE OF THE FIRST DOCUMENTS.
21 A. OH, THERE IT IS.
22 Q. AND WHAT IS THAT DOCUMENT?
23 A. IT'S THE -- IT'S DR. WEITZEL'S EVALUATION OF THE
24 PATIENT.
25 Q. DO YOU KNOW WHETHER SUCH AN EVALUATION WAS STANDARD
1481
1 PROCEDURE WITH THESE PATIENTS?
2 A. YES, IT WAS.
3 Q. DO YOU KNOW WHEN THAT WAS DONE IN RELATIONSHIP TO THEIR
4 ADMISSION TO THE UNIT?
5 A. AS SOON AS POSSIBLE.
6 Q. AND THEN THERE'S THE NEXT CATEGORY THERE ARE THESE TABS
7 SAYS CONSULTATION, THE FIRST ONE THERE IS 234.
8 A. WHAT PAGE AGAIN?
9 Q. 234.
10 A. OKAY.
11 Q. REPORT OF CONSULTATION, WHAT IS THAT?
12 A. I WOULD ASSUME THAT ANOTHER PHYSICIAN WOULD HAVE COME IN
13 AND DONE A HISTORY AND PHYSICAL ON HER.
14 Q. WAS THAT A STANDARD PROCEDURE?
15 A. YES.
16 Q. WITH THESE PATIENTS?
17 A. YES.
18 Q. AND THAT HISTORY AND PHYSICAL, WHAT WAS THE PURPOSE OF
19 THAT?
20 A. TO MAKE SURE THAT THE PATIENT WAS HEALTHY ENOUGH TO BE
21 ON THE UNIT. Boy, nurses sure do get it wrong, sometimes.
22 Q. THEN THE NEXT CATEGORY IS CALLED PHYSICIAN'S ORDERS, 238
23 IS THE PAGE NUMBER.
24 A. OKAY.
25 Q. WHAT ARE THOSE?
1482
1 A. THOSE ARE THE ORDERS THE DOCTOR GIVES US TO FOLLOW TO
2 TAKE CARE OF THE PATIENT.
3 Q. AND WHAT KINDS OF ORDERS WOULD THOSE BE?
4 A. MEDICATION ORDERS, LAB ORDERS, VITAL SIGN ORDERS, DIET
5 ORDERS, EVERYTHING THAT HAS TO DO WITH A PATIENT.
6 EVERYTHING YOU DO WITH A PATIENT, THE DOCTOR ORDERS.
7 Q. AND LAB ORDERS ARE USUALLY, I MEAN, WHAT KINDS OF
8 THINGS?
9 A. C.B.C.'S, S.M.A.'S.
10 Q. WHAT'S A C.B.C?
11 A. BLOOD COUNT.
12 Q. WHAT'S IT --
13 A. A CELLULAR BLOOD COUNT. Actually, complete blood count.
14 Q. AND S.M.A., IS THAT WHAT YOU SAID NEXT?
15 A. THAT'S A CHEMISTRY THAT LOOKS AT THE DIFFERENT
16 CHEMISTRIES OF THE BODY.
17 Q. SO DIFFERENT KINDS OF TESTS THE ORDERS WOULD SHOW UP ON
18 THESE DOCUMENTS; IS THAT CORRECT?
19 A. YES, THEY WOULD.
20 Q. THE NEXT CATEGORY IS CALLED PROGRESS NOTES AND THAT'S
21 251.
22 A. YES, I HAVE THAT.
23 Q. WHAT IS THAT?
24 A. THIS IS -- WHENEVER THE DOCTOR CAME AND SAW THE PATIENT
25 HE WOULD UPDATE THE PROGRESS OF THAT PATIENT IN THESE OR THE
1483
1 DIETICIAN WOULD OR THE SOCIAL WORKER. IT WAS A PROGRESS
2 NOTE OF THE PATIENT.
3 Q. WHAT ABOUT OCCUPATIONAL THERAPIST OR RECREATIONAL
4 THERAPIST, DID YOU HAVE ANY OF THOSE ON THIS UNIT?
5 A. YES, AND THEY COULD DOCUMENT THESE PROGRESS NOTES ALSO.
6 Q. THEN LET'S JUMP OVER, WE HAVE LABS, 257.
7 A. YES.
8 Q. WHAT'S THAT CATEGORY OF DOCUMENTS?
9 A. THIS IS THE LABORATORY THAT WAS DRAWN AND AFTER WE GET
10 THOSE RESULTS BACK, THIS IS THE RESULTS OF THAT BLOOD THAT
11 WAS DRAWN.
12 Q. OR THE BLOOD TEST?
13 A. OR THE URINE OR WHATEVER LAB TEST YOU WERE DOING.
14 Q. THEN THE NEXT ONE IS RADIOLOGY AT 270. WHAT ARE THOSE
15 DOCUMENTS?
16 A. THEY ARE DOCUMENTATION OF ANY X-RAYS, M.R.I.'S, C.A.T.
17 SCANS, ANYTHING LIKE THAT WOULD GO IN THIS CATEGORY, ANY
18 PROCEDURES LIKE THAT.
19 Q. WHAT'S AN M.R.I.?
20 A. MAGNETIC RADIANCE IMAGERY IT'S --
21 Q. WHAT'S ITS PURPOSE?
22 A. TO LOOK AND SEE IF THERE'S ANY ABNORMALITIES IN EITHER
23 THE HEAD OR YOU CAN DO AN M.R.I. ON ANY PART OF THE BODY TO
24 LOOK FOR ABNORMALITIES.
25 Q. WHAT ABOUT A C.A.T. SCAN, DO YOU KNOW HOW A M.R.I. AND A
1484
1 C.A.T. SCAN CORRELATE?
2 MR. STIRBA: YOUR HONOR, I'M GOING TO OBJECT,
3 BEYOND THE SCOPE OF HER COMPETENCY.
4 MS. BARLOW: YOUR HONOR, I ASKED HER IF SHE KNEW.
5 IT'S A YES OR NO QUESTION.
6 THE COURT: OKAY. OVERRULED.
7 Q. (BY MS. BARLOW) BASED ON YOUR TRAINING, DO YOU HAVE
8 ANY KNOWLEDGE OR AM I GETTING FURTHER AFIELD THAN REALLY YOU
9 GET INTO?
10 A. IT'S A LITTLE BIT OUT OF MY FIELD BUT I KNOW THEY ARE
11 DIFFERENT.
12 Q. OKAY. AND THEN THE NEXT WE HAVE CATEGORY IS E.K.G.
13 SWALLOW AND E.E.G. WHAT'S AN E.K.G.?
14 A. IT'S A HEART, YOU ARE LOOKING AT THE HEART TO LOOK AT
15 THE RHYTHMS OF THE HEART, THE ELECTRICAL TRANSMISSION OF THE
16 HEART.
17 Q. AND THEN IT SAYS SWALLOW, WHAT WOULD THAT BE?
18 A. THAT WAS DONE BY SOMEONE WHO COULD FIND OUT IF A PATIENT
19 HAD ANY ABNORMALITIES IN THEIR ESOPHAGUS OR THROAT OR TO TRY
20 TO FIND OUT IF THERE WAS ANYTHING PHYSICALLY WRONG THAT WAS
21 PREVENTING THEM FROM EATING AND SWALLOWING.
22 Q. IS SWALLOWING A PROBLEM WITH THESE PATIENTS?
23 MR. STIRBA: YOUR HONOR, I'LL OBJECT, RELEVANCY.
24 Q. (BY MS. BARLOW) WITH THESE FIVE PATIENTS, WAS
25 SWALLOWING A PROBLEM?
1485
1 MR. STIRBA: I'LL OBJECT, LACK OF FOUNDATION.
2 THE COURT: WHAT'S THE FOUNDATION THAT SHE SAW ALL
3 FIVE PATIENTS?
4 Q. (BY MS. BARLOW) DID YOU SEE ALL FIVE OF THESE
5 PATIENTS?
6 A. YES.
7 Q. WELL, LET'S SEE, ELLEN ANDERSON, DID YOU SEE --
8 A. NO, I DIDN'T.
9 Q. OKAY. THE OTHER FOUR DID YOU SEE?
10 A. YES.
11 Q. DID YOU SEE AT ANY TIME ANY DIFFICULTY THEY HAD
12 SWALLOWING? CAN YOU SPECIFICALLY REMEMBER IF ANY HAD
13 DIFFICULTY SWALLOWING?
14 A. I REMEMBER THEY WOULDN'T EAT AND THE SWALLOWING EVAL WAS
15 DONE OUT TO FIND OUT WHY, IF IT WAS BECAUSE OF DIFFICULTY
16 SWALLOWING AND I DON'T REMEMBER SPECIFICALLY WHETHER THEY
17 DID OR NOT.
18 Q. LET'S GO BACK TO THE CATEGORY E.E.G., I MEAN, IT'S IN
19 THE SAME CATEGORY BUT E.E.G.?
20 A. THAT WOULD BE -- YOU WERE LOOKING AT THE ELECTRICAL
21 FUNCTIONING OF THE BRAIN.
22 Q. AND --
23 A. IT WOULD DENOTE SEIZURES OR SOMETHING LIKE THAT. AN
24 ABNORMAL E.E.G., WOULD BE YOU WOULD BE LOOKING FOR SEIZURES
25 OR ABNORMAL ELECTRICAL ACTIVITY IN THE BRAIN.
1486
1 Q. NOW THESE -- YOU DIDN'T GIVE THESE TESTS; IS THAT
2 CORRECT?
3 A. NO.
4 Q. WOULD YOU READ THESE TESTS?
5 A. NO, THE DOCTOR WOULD.
6 Q. WHAT DOCTOR WOULD READ AN E.K.G.?
7 A. IT COULD BE THE MEDICAL DOCTOR OR IT COULD BE --
8 SOMETIMES THEY HAD DOCTORS SPECIFICALLY IN THAT AREA THAT
9 WOULD READ THEM AND INTERPRET THEM.
10 Q. WHAT ABOUT AN E.E.G., WOULD YOU READ THAT?
11 A. NO.
12 Q. WHO WOULD READ THAT?
13 A. IT WOULD BE A DOCTOR.
14 Q. THEN OUR NEXT CATEGORY IS MEDS AND GRAPHS, WHAT IS THAT?
15 AND THAT'S 279.
16 A. THIS IS THE PATIENT'S VITAL SIGNS, THEIR TEMPERATURE,
17 RESPIRATION, PULSE AND THE MEDICATIONS THAT THEY RECEIVED.
18 Q. THERE'S TWO PAGES AT LEAST IN HERE APPEAR TO BE GRAPHS,
19 I THINK WE'VE SEEN THOSE BEFORE. AND THEN 281, WHAT IS THAT
20 CHART?
21 A. THAT IS AN INSULIN -- RECORD OF INSULIN, A BLOOD SUGAR
22 RECORD.
23 Q. IT SAYS DIABETIC CHART. WHAT WOULD YOU DO TO FILL OUT
24 THIS CHART?
25 A. YOU WOULD CHECK THE PATIENT'S BLOOD SUGAR WITH AN
1487
1 ACCUCHECK, THAT A.C.C.U. STANDS FOR ACCUCHECK. IT'S A
2 MACHINE YOU HAVE. YOU GET A DROP OF BLOOD AND IT INDICATES
3 TO YOU WHAT THEIR BLOOD SUGAR IS WHETHER IT'S HIGH OR LOW.
4 Q. AND IF IT WERE HIGH, WHAT WOULD YOU DO?
5 A. GENERALLY YOU WOULD GET AN INSULIN ORDER, OR YOU WOULD
6 HAVE A STANDING INSULIN ORDER TO GIVE THEM INSULIN.
7 Q. YOU WOULDN'T DO IT AUTOMATICALLY, YOU WOULD HAVE TO HAVE
8 AN ORDER?
9 A. YOU WOULD HAVE TO HAVE AN ORDER, YES.
10 Q. WHAT IF IT WERE LOW?
11 A. YOU WOULD GIVE WHAT WE CALL GLUCAGON OR YOU WOULD GIVE
12 THEM SOME ORANGE JUICE OR SOMETHING LIKE THAT TO SEE --
13 Q. TO RAISE THEIR BLOOD SUGAR?
14 A. TO RAISE THEIR BLOOD SUGAR.
15 Q. AND WE'VE HAD A LITTLE BIT OF TESTIMONY AND I'LL JUST
16 TAKE 282 AS AN EXAMPLE OF SOMETHING THAT'S CALLED A M.A.R.S.
17 AND THIS IS CALLED A MULTIPLE M.A.R.S. IT APPEARS, WHAT IS
18 THAT?
19 A. THAT'S THE MEDICATION THE PATIENT WAS RECEIVING AND A
20 RECORD OF WHEN THEY RECEIVED IT AND WHO GAVE THOSE
21 MEDICATIONS.
22 Q. WHO WOULD PUT THE KINDS OF MEDICATION ON THIS M.A.R.S.?
23 A. THE NURSE WOULD LOOK AT THE DOCTOR'S ORDER AND THEN TAKE
24 THOSE DOCTOR'S ORDERS AND PUT THEM ON HERE ON THE RECORD SO
25 WE COULD HAVE A RECORD OF WHEN THEY WERE TYPICALLY GIVEN.
1488
1 Q. I THINK YOU SAID THERE'S AN ORDER DATE AND A STOP DATE.
2 A. YES.
3 Q. THE NAME OF THE MEDICATION. AND THEN WHAT'S 0817HS?
4 A. THOSE ARE THE TIMES. 8 O'CLOCK WOULD BE 8 O'CLOCK IN
5 THE MORNING. SEVENTEEN WOULD BE FIVE IN THE AFTERNOON.
6 H.S. WAS USUALLY EIGHT AT NIGHT OR NINE AT NIGHT AT BEDTIME.
7 H.S. MEANS BEDTIME.
8 Q. THEN THE TIMES ARE WRITTEN DOWN HERE.
9 A. UH-HUH.
10 Q. AND THEN THERE'S AN INITIAL NEXT TO -- APPEARS TO BE --
11 IT LOOKED LIKE IT WAS 2000, NOW IT'S 2100. WHAT WOULD THAT
12 MEAN?
13 A. THAT MEANS THAT SHE GOT THIS MEDICATION AT BEDTIME.
14 Q. WHOSE INITIALS WOULD THAT BE?
15 A. THAT LOOKS LIKE DO'S.
16 Q. DORENE KLEI?
17 A. YES.
18 Q. AND AT THE TOP THAT SAYS 12/28. THE NEXT ONE OVER HERE
19 SAYS 12/29 IS THAT HOW YOU CHARTED WHETHER THESE DOSES WERE
20 GIVEN?
21 A. YES.
22 Q. DOWN HERE IT SAYS A DURAGESIC PATCH 50 MILLIGRAMS.
23 A. UH-HUH.
24 Q. THERE'S A SQUARE AND THIS ONE HAS INITIALS IN IT, THIS
25 ONE DOES NOT HAVE INITIALS IN IT. DO YOU KNOW WHAT THAT
1489
1 SQUARE MEANT?
2 A. THAT'S WHEN WE WERE TO GIVE THE DOSE. THE OTHER ONES
3 WERE CROSSED OFF BECAUSE YOU ONLY GAVE IT EVERY THREE DAYS
4 SO YOU WANTED TO MAKE SURE THAT IT WASN'T -- SO YOU DIDN'T
5 WANT TO GIVE IT EVERY DAY. YOU MADE A SQUARE TO KNOW THAT
6 WAS THE DAY YOU WERE TO GIVE THE DOSE.
7 Q. JUST AGAIN FOR POINT OF REFERENCE, IF YOU TURN TO 284.
8 A. OKAY.
9 Q. LET'S SEE, WE HAVE THIS MUST BE ACCUCHECK; IS THAT
10 CORRECT?
11 A. YES.
12 Q. SO EVEN WHEN YOU CHECKED THEIR BLOOD SUGAR IT HAD TO
13 COME OFF THIS; IS THAT CORRECT?
14 A. YES.
15 Q. SO THESE LINES THROUGH MEANT THAT AT 7 IN THE MORNING
16 AND 11 IN THE MORNING IT DIDN'T HAPPEN; IS THAT CORRECT?
17 A. YES.
18 Q. AND THEN I DON'T KNOW WHY -- ARE THOSE THE NUMBERS OF
19 THEIR BLOOD SUGAR?
20 A. THAT WOULD BE HIS BLOOD SUGAR OR HER BLOOD SUGAR, YES.
21 Q. I WANTED TO POINT OUT DOWN HERE ON THE 1ST OF JANUARY
22 THERE ARE A COUPLE OF PLACES WHERE THE INITIALS L.L. ARE.
23 A. UH-HUH.
24 Q. DO YOU KNOW WHO THAT IS?
25 A. THAT'S LYNN LONG.
1490
1 Q. AND THEY ARE CIRCLED?
2 A. YES.
3 Q. DO YOU KNOW WHAT THAT MEANS?
4 A. IT MEANS THAT THEY WEREN'T GIVEN AND THERE'S A LITTLE
5 CODE UP HERE IN THE MIDDLE THAT TELLS -- IT HAS A NUMBER BY
6 IT.
7 Q. AND THAT CODE IS SIX?
8 A. SHE'S WRITTEN OTHER, SEE THE NURSES' NOTES. SO SHE'S
9 WRITTEN A REASON WHY SHE DIDN'T GIVE THAT.
10 Q. IN THE NURSES' NOTES?
11 A. IN THE NURSES' NOTES.
12 Q. THE NEXT CATEGORY THAT WE HAVE IS CALLED NURSES' NOTES,
13 294.
14 A. UH-HUH.
15 Q. AND I THINK WE TALKED AND I WON'T GET INTO THIS A GREAT
16 DEAL, BUT THE FIRST THING IN THE NURSES' NOTES IS THIS
17 ASSESSMENT?
18 A. YES.
19 Q. AND I THINK YOU TESTIFIED YOU DID THIS ONE?
20 A. YES.
21 Q. NOW, BEHIND THE ASSESSMENT AND, AGAIN, I THINK YOU --
22 JUST TO SHOW -- I GUESS I SHOULD FINISH MY SENTENCES.
23 JUST TO SHOW WHERE WE ARE WITH THIS. THIS IS THE FIRST
24 PAGE AFTER THE ASSESSMENT AND LET'S NOT GOING INTO GREAT
25 DETAIL BECAUSE YOU DID LAST WEEK BUT WHAT IS THIS AGAIN?
1491
1 A. THIS IS THE NURSES' NOTES AND NURSING ASSESSMENT.
2 Q. THE NEXT SECTION IS CALLED CARDEX. CAN YOU TELL US WHAT
3 THE CARDEX WAS JUST IN GENERAL?
4 A. IT WAS HELD SEPARATE FROM THE CHART AND IT WAS A -- YOU
5 HAD ALL THE PATIENTS' CARDEX TOGETHER AND BASICALLY IT TOLD
6 YOU THE MEDICATIONS THE PATIENT WAS ON, THE DIET SO YOU
7 COULD HAVE A QUICK REFERENCE TO LOOK AT ALL THE PATIENTS AND
8 CHECK ORDERS AND STUFF, RATHER THAN HAVING TO GO THROUGH THE
9 CHART EVERY SINGLE TIME.
10 Q. SO IF YOU WANTED TO MAKE SURE ABOUT THE ORDER YOU
11 WOULDN'T HAVE TO GO BACK TO THE PHYSICIAN'S ORDERS, YOU
12 COULD LOOK AT THE CARDEX?
13 A. YOU COULD LOOK AT THE CARDEX, YES.
14 Q. AND THEY ARE SUPPOSED TO COINCIDE?
15 A. THEY ARE.
16 Q. NOW THE NEXT SECTION IS TERMED MEDICAL/LEGAL. CAN YOU
17 TELL US WHAT IS IN THAT SECTION?
18 A. THIS IS ALL THE CONSENTS TO TREAT. THIS IS ALL THE
19 CONSENTS TO HAVE ANY TEST DONE, THESE ARE THE CONCEPTS TO
20 WHO TO CONTACT, THE FAMILY THAT HAS THE RIGHT TO SAY WHAT
21 GOES ON WITH THE PATIENT.
22 Q. AND THEN THE MASTER TREATMENT PLAN IS THE NEXT SECTION,
23 347.
24 A. UH-HUH.
25 Q. CAN YOU TELL THE JURY WHAT THAT IS?
1492
1 A. YOU WOULD HAVE WHAT YOU CALL TEAM MEETINGS AND YOU WOULD
2 GET TOGETHER AND GO OVER THIS TO TRY AND FIND THE BEST PLAN
3 TO TREAT THIS PATIENT AND TO COME UP WITH WHAT ARE WE GOING
4 TO DO FOR THIS PATIENT, WHAT'S WRONG WITH THE PATIENT AND
5 WHAT ARE WE GOING TO DO ABOUT IT.
6 Q. WHEN YOU SAY TEAM MEETINGS, WHO WOULD BE AT THOSE TEAM
7 MEETINGS?
8 A. GENERALLY A NURSE, THE SOCIAL WORKER, THE DOCTOR, O.T.
9 COULD GO, RECREATIONAL THERAPY.
10 Q. O.T., WHAT IS --
11 A. OCCUPATIONAL THERAPY, I'M SORRY. THE SPEECH THERAPIST
12 COULD GO. IT WAS JUST SO WE COULD SIT DOWN AND LOOK AT THIS
13 PATIENT AND FIGURE OUT AS A TEAM WHAT WAS THE BEST THING TO
14 DO FOR THEM.
15 Q. AND COULD THIS TREATMENT PLAN CHANGE OVER TIME?
16 A. YES, IT WAS MEANT TO CHANGE. IT WAS MEANT T