Greg Stevens, MD
9 MR. WILSON: WE'D CALL DR. GREG STEVENS TO THE STAND AT
10 THIS TIME, YOUR HONOR.
11 THE COURT: DR. STEVENS, WOULD YOU STEP UP PLEASE? IF
12 YOU'D COME RIGHT UP HERE. IF YOU'D RAISE YOUR RIGHT HAND AND
13 BE SWORN.
14 GREGORY STEVENS,
15 BEING FIRST DULY SWORN, WAS EXAMINED
16 AND TESTIFIED AS FOLLOWS:
17 DIRECT EXAMINATION
18 THE COURT: IF YOU'LL GIVE US YOUR FULL NAME AND SPELL
19 YOUR LAST NAME PLEASE.
20 A. OKAY. GREGORY PAUL STEVENS. AND STEVENS IS
21 S-T-E-V-E-N-S.
22 BY MR. WILSON:
23 Q. DR. STEVENS, WOULD YOU STATE YOUR FULL NAME FOR THE
24 RECORD PLEASE?
25 A. GREGORY PAUL STEVENS.
1 Q. EXCUSE ME. I'M SORRY I ASKED YOU THAT. YOU'D ALREADY
2 TESTIFIED TO THAT. WHERE ARE YOU CURRENTLY EMPLOYED SIR?
3 A. I HAVE A PRACTICE IN HOLLADAY.
4 Q. AND WHAT IS THE NATURE OF YOUR PRACTICE?
5 A. INTERNAL MEDICINE.
6 Q. ARE YOU A PHYSICIAN?
7 A. YES.
8 Q. AND COULD YOU TELL US BRIEFLY YOUR MEDICAL BACKGROUND?
9 A. ATTENDED MEDICAL SCHOOL AT THE UNIVERSITY OF UTAH FROM
10 1976 TO 1980 AND THEN THREE-YEAR INTERNAL MEDICINE RESIDENCY
11 PROGRAM AT THE UNIVERSITY OF UTAH-AFFILIATED HOSPITALS. AND
12 I AM BOARD CERTIFIED IN INTERNAL MEDICINE.
13 Q. OKAY. AND WHEN DID THAT OCCUR SIR?
14 A. 1983.
15 Q. WHERE IS YOUR CURRENT OFFICE LOCATED AT?
16 A. AT 1955 EAST 5600 SOUTH.
17 Q. HOW LONG HAVE YOU BEEN PRACTICING OUT OF THAT OFFICE
18 SIR?
19 A. APPROXIMATELY EIGHT YEARS.
20 Q. OKAY. WERE YOU PRACTICING IN THAT OFFICE BACK THEN IN
21 1995?
22 A. YES, I WAS.
23 Q. ARE YOU ACQUAINTED WITH AN INDIVIDUAL BY THE NAME OF
24 JUDITH LARSON?
25 A. YES.
1 Q. AND WHAT WAS THE NATURE OF YOUR ACQUAINTANCESHIP WITH
2 HER?
3 A. SHE WAS A PATIENT OF MINE. SHE WAS ALSO THE MOTHER OF A
4 PERSONAL FRIEND OF MY FATHER-IN-LAW'S.
5 Q. DO YOU RECALL WHEN YOU FIRST BEGAN TO TREAT OR WHEN YOU
6 FIRST -- SHE BECAME YOUR PATIENT?
7 A. WITHOUT RECORDS IN FRONT OF ME I COULDN'T SAY THE EXACT
8 TIME. SHE WAS BROUGHT IN BY HER SON FOR MY CARE AND I CAN'T
9 TELL YOU EXACT DATE.
10 Q. MAY I HAVE JUST A MINUTE, YOUR HONOR?
11 THE COURT: YOU MAY. (ATTORNEYS CONFER).
12 Q. (BY MR. WILSON) DOCTOR, I'M GONNA SHOW YOU WHAT'S BEEN
13 PREVIOUSLY IDENTIFIED AS DEFENDANTS EXHIBITS D-7. AND IF
14 YOU'D TAKE A LOOK AT THAT EXHIBIT PLEASE.
15 A. THERE ARE SOME PAGES OUT OF ORDER BUT OTHER THAN THAT IT
16 LOOKS LIKE --
17 Q. CAN YOU TELL US WHAT THAT EXHIBIT IS?
18 A. APPEARS TO BE THE NOTES FROM MY OFFICE CHART.
19 Q. OKAY. IN RELATIONSHIP TO JUDITH LARSON?
20 A. JUDITH LARSON CORRECT.
21 A. OKAY.
22 Q. CAN YOU TELL FROM THOSE NOTES WHEN YOU FIRST BEGAN TO
23 TREAT JUDITH LARSON?
24 A. YES, I BELIEVE IT WOULD BE SEPTEMBER 14TH, 1995. I HAVE
25 A NOTE SEPTEMBER 14TH.
1 Q. IS THAT THE FIRST NOTE THAT YOU HAVE IN THE FILE?
2 A. THERE IS A PREVIOUS NOTE BY DR. PEARCE AND I BELIEVE
3 THAT IS MY FIRST NOTE.
4 Q. OKAY. DO YOU RECALL SIR WHETHER OR NOT SHE MAY HAVE
5 BECOME YOUR PATIENT BACK --
6 A. WAIT A MINUTE, I DO FIND A NOTE HERE FROM FEBRUARY 16TH,
7 1995.
8 Q. OKAY THANK YOU. WOULD THAT BE THE FIRST NOTE THAT YOU
9 HAVE RELATIVE TO THE PATIENT JUDITH LARSON?
10 A. YES IT APPEARS AS THOUGH IT IS. IT WAS -- THINGS ARE A
11 LITTLE OUT OF ORDER CHRONOLOGICALLY SO IT'S DIFFICULT TO
12 FIND.
13 Q. I APOLOGIZE. IN REGARDS TO THAT PARTICULAR NOTE DID YOU
14 HAVE OCCASION TO SEE HER ON THAT PARTICULAR DATE?
15 A. YES. IT WAS OUR FIRST VISIT. THERE'S A TYPED, DICTATED
16 NOTE AS WELL AS A FILLED OUT FORM THAT I USE FOR NEW
17 PATIENTS.
18 Q. OKAY. AND DID YOU COMPLETE ANY PARTICULAR TESTS OR
19 EXAMINATION AT THAT TIME?
20 A. LOOKS LIKE I TOOK A HISTORY BOTH FROM HER AND I'M
21 ASSUMING FAMILY. TRYING TO SEE IF IT INDICATES WHICH FAMILY
22 MEMBERS THERE WERE WITH HER. I BELIEVE THE IT WAS FILLED OUT
23 BY FAMILY AND SOMEBODY WAS FROM FAMILY THAT WAS WITH HER
24 BECAUSE SHE WAS UNABLE TO GIVE ALL THE INFORMATION HERSELF.
25 AND I DID A COMPLETE EXAMINATION.
1 Q. OKAY. CAN YOU TELL US WHETHER OR NOT SHE HAD ANY
2 COMPLAINTS RELATED TO ANY KIND OF PAINFUL CONDITIONS OR ANY
3 PAIN THAT SHE WAS EXPERIENCING THAT TIME?
4 A. NO. THE CIRCUMSTANCES WERE SHE HAD HAD A RECENT STROKE,
5 HAD HAD A SLOWLY PROGRESSIVE DEMENTIA OVER THE PREVIOUS YEAR.
6 AND CAME IN FOR WHAT IS STATED HERE AS GET ACQUAINTED VISIT
7 FROM A NURSING CARE FACILITY, AND WE DISCUSSED FUTURE CARE.
8 AND SHE HAD BEEN ON A COUPLE OF MEDICATIONS AND WE MADE SOME
9 MINOR ADJUSTMENTS TO THE MEDICATION, BUT THERE WAS NOTHING
10 MENTIONED ABOUT PAIN OR DISCOMFORT.
11 Q. CAN YOU CHARACTERIZE FROM THAT INITIAL VISIT FOR US IF
12 WOULD YOU PLEASE THE GENERAL STATUS OF HER PHYSICAL HEALTH?
13 A. VITAL SIGNS APPEARED TO BE APPROPRIATE. NEUROLOGICAL
14 EXAM, SHE WAS MOVING EVERYTHING BUT WAS NOT -- TRYING TO LOOK
15 FOR MY NOTE ON MENTAL. SHE HAD -- WELL WAIT A MINUTE. SHE
16 HAD SOME LEFT-SIDED WEAKNESS I BELIEVE. SHE DID HAVE GRIPS
17 IN BOTH HANDS, THOUGH.
18 Q. OKAY.
19 A. AND --
20 Q. AS TO HER MENTAL STATUS, DID YOU MAKE SOME NOTES AS TO
21 THAT?
22 A. I MENTION THAT UNDER THE ASSESSMENT DEMENTIA THAT I FELT
23 THAT ONE OF THE MEDICINES SHE WAS ON, THE ZOLOFT, WAS MAKING
24 HER A LITTLE BIT GROGGY AND WE WERE GONNA DISCONTINUE THAT TO
25 SEE IF SHE WOULD BECOME A LITTLE MORE ALERT. SO I'M ASSUMING
1 FROM THAT THAT SHE WAS NOT AS ALERT AS THE FAMILY WOULD LIKE
2 HER TO BE.
3 Q. AFTER THAT PARTICULAR VISIT DID YOU CONTINUE TO SEE HER
4 AT YOUR OFFICE THERE IN COTTONWOOD?
5 A. I SAW HER ON FEW ADDITIONAL OCCASIONS. LET ME SHE. SHE
6 WAS ADMITTED TO THE HOSPITAL BY ONE OF MY ASSOCIATES IN JULY.
7 Q. CAN YOU TELL US THE DATE OF THAT PARTICULAR ADMISSION?
8 A. JULY 15TH.
9 Q. AND WHO WAS THE ASSOCIATE THAT ADMITTED HER ON THAT
10 DATE?
11 A. DR. JAMES PEARCE.
12 Q. OKAY.
13 A. SHE HAD -- SHE WAS BROUGHT TO THE EMERGENCY ROOM FROM A
14 NURSING HOME. HAD HAD SOME VOMITING AND ABDOMINAL PAIN. AND
15 FAIRLY INCOHERENT. BUT AFTER SOME FLUID IN THE EMERGENCY
16 ROOM BECAME A LITTLE BIT MORE MENTALLY CLEAR AS NOTED IN THE
17 NOTE.
18 Q. OKAY. HOW LONG WAS SHE HOSPITALIZED FOR ON THAT
19 PARTICULAR EVENT?
20 A. THE DISCHARGE NOTE FROM DR. PEARCE LOOKS LIKE IT WAS
21 JUST OVERNIGHT. HOSPITAL COURSE, LET'S SEE, ON THE 16TH
22 THERE'S A DISCHARGE NOTE, STATING THAT SHE WAS GIVEN I.V.
23 FLUIDS. HAD AN UNEVENTFUL HOSPITAL COURSE. AND LOT -- BUT
24 DID LOSE HER BALANCE THE MORNING OF DISCHARGE WHEN FAMILY WAS
25 WALKING WITH HER. AND FELL DOWN AND HIT HER TAIL BONE BUT
1 DID NOT SUSTAIN ANY INJURY FROM THAT OTHER THAN A LITTLE
2 BRUISING.
3 Q. OKAY. WHEN IS THE NEXT CONTACT THAT YOU HAD WITH HER?
4 A. THE NEXT NOTE I BELIEVE IS ONE THAT I MENTIONED BEFORE
5 AS BEING MY FIRST NOTE ON SEPTEMBER 14TH, 1995.
6 Q. NOW THAT WAS YOUR --
7 A. OH, THAT IS MY -- THIS IS MY ADMITTING NOTE, I BELIEVE.
8 Q. WAS THERE A PRIOR ADMITTING NOTE ON -- IN AUGUST BY
9 DR. PEARCE IN THE RECORD?
10 A. LET'S SEE, I'M NOT FINDING ONE HERE IN THESE RECORDS.
11 Q. OKAY. RELATIVE TO THE SEPTEMBER, I THINK I SAID
12 SEPTEMBER THE 14TH WAS --
13 A. CORRECT.
14 Q. -- WAS THE NOTE THAT YOU RECALL AND WHERE -- WHAT DOES
15 THAT NOTE REFERENCE? DOES IT REFERENCE ANY PARTICULAR EVENT?
16 A. AGAIN, THIS ONCE AGAIN IS AT COTTONWOOD HOSPITAL WHERE
17 SHE WAS ADMITTED. SHE HAD BEEN ABLE TO GET OUT OF SOME OF
18 THE PROTECTIVE RESTRAINTS THAT SHE HAD BEEN IN, HAD FALLEN,
19 AND HIT HER FOREHEAD. HAD A CUT THRE THAT HAD BEEN SUTURED
20 IN THE EMERGENCY ROOM. AND ASSUMED THAT BECAUSE SHE WAS NOT
21 AS MENTALLY ALERT THAT SHE HAD A MILD CONCUSSION ALONG WITH
22 THAT. SHE'D ALSO HAD, LET'S SEE, SOME NAUSEA AND VOMITING
23 ASSOCIATED WITH IT WHICH IS ANOTHER SIGN AND SYMPTOM OF
24 POSSIBLE CONCUSSION.
25 Q. DO YOU RECALL WHETHER OR NOT YOU ORDERED ANY CHANGE IN
1 HER MEDICATIONS AT THAT TIME? OR TREATED HER RELATIVE TO
2 THAT PARTICULAR EVENT?
3 A. I DO NOT FIND MY DISCHARGE NOTE SO I CAN'T COMPARE
4 ADMITTING MEDICATIONS TO THE DISCHARGE MEDICATIONS. SO I
5 DON'T KNOW THAT I'M ABLE TO --
6 Q. TO ANSWER THAT QUESTION?
7 A. TO ANSWER THAT. SHE DID HAVE THE ONE THING I NOTED HERE
8 FOR THE FIRST TIME WAS A BLOOD SUGAR THAT WAS SLIGHTLY
9 ELEVATED --
10 Q. OKAY.
11 A. -- BUT THEN THEY HAD BEEN RUNNING SUGAR IN THE I.V. AND
12 SOMETIMES WE SEE THAT AND THAT DOESN'T NECESSARILY MEAN
13 DIABETES.
14 Q. IN RESPECT TO THE -- THOSE EVENTS OF THAT DATE, CAN YOU
15 TELL US HOW LONG SHE WAS IN THE HOSPITAL FOR?
16 A. WITHOUT THE DISCHARGE NOTE, I PROBABLY COULDN'T.
17 Q. OKAY. CAN YOU TELL US, SIR --
18 A. MY RECOLLECTION IS IT WAS ONLY A FEW DAYS. WAS NOT A
19 LENGTHY HOSPITALIZATION.
20 Q. OKAY. CAN YOU TELL US, SIR, WERE THERE ANY COMPLAINTS
21 RELATED TO HER EXPERIENCING ANY KIND OF PAIN AT THAT TIME?
22 A. LOOK BACK TO THE NOTE. MY NEUROLOGICAL EXAM INDICATES
23 THAT SHE ANSWERED SIMPLE QUESTIONS. IF I -- SOMETIMES JUST
24 TO MAKE SURE THAT SOMEBODY IS AWARE AND ALERT, I WILL PINCH
25 THEIR FINGIERNAIL A LITTLE BIT AND SHE WITHDREW TO THAT. I
1 MENTIONED HERE WITHDRAWS TO PAIN OR DISCOMFORT. I PINCHED
2 HER TO MAKE SURE SHE COULD FEEL THE SENSATION IN HER HANNDS
3 AND HER FEET. AND SHE DID THAT APPROPRIATELY. BUT THERE IS
4 NO OTHER -- OTHER THAN THE DISCOMFORT ASSOCIATED WITH HER
5 LACERATION, THERE WAS NO OTHER MENTION OF PAIN OR DISCOMFORT.
6 Q. OKAY. RELATIVE TO HER CONTINUED -- WELL, STRIKE THAT.
7 DID YOU HAVE ANY FURTHER CONTACT WITH THE -- WITH JUDITH
8 LARSON AFTER THE DATE OF THE SEPTEMBER THE 14TH?
9 A. ON SEPTEMBER THE 19TH I FOUND A NOTE FROM MY NURSE THAT
10 INDICATES THAT HER SON HAD COME BY MY OFFICE, SO APPARENTLY
11 SHE WAS IN A NURSING HOME. IT SAYS THAT SHE HAD BEEN IN A --
12 AT HOLLADAY HEALTH CHAIR CENTER AND HIS CONCERN WAS THAT SHE
13 SEEMED TO DO A LITTLE BIT BETTER WITHOUT THE RESTRAINTS, WITH
14 MORE CONTINUAL OBSERVATION BY THE NURSES, AND WE DECIDED
15 BECAUSE OF THE RISK OF FALLING OUT OF BED WAS GREAT WITH HER,
16 SHE SEEMED TO BE ABLE TO GET OUT OF RESTRAINTS AND MOVE
17 AROUND A LITTLE BIT IN SPITE OF HER AGE, THAT WE WOULD HAVE
18 THE CARE CENTER PUT THE MATTRESS ON THE FLOOR SO IF SHE DID
19 GET OUT, THERE WAS NOT A FALL THAT SHE WOULD HAVE TO DEAL
20 WITH.
21 Q. DID YOU -- DO YOU HAVE ANY NOTES THAT REFLECT ANY
22 FURTHER VISITS TO YOU?
23 A. YES, I HAVE ONE ADDITIONAL VISIT ON 10-3-95, OCTOBER
24 THIRD.
25 Q. AND WHERE DID THAT TAKE PLACE SIR?
1 A. THAT WAS IN MY OFFICE IT APPEARS. ACTUALLY THERE'S TWO
2 ADDITIONAL NOTES.
3 Q. OKAY. ONE ON TEN THREE?
4 A. ONE ON TEN THREE. AGAIN SHE'D HAD THE STITCHES REMOVED
5 FROM HER FOREHEAD AND THAT APPEARED TO BE HEALING OKAY. THE
6 RECORD SHEET FROM THE NURSING HOME INDICATED THAT SHE SEEMED
7 TO BE A LITTLE MORE CALM WITH A MILD TRANQUILIZER BY THE NAME
8 OF XANAX THAT SHE WAS TAKING THREE TIMES A DAY. I MENTIONED
9 MY CONCERN ABOUT HER TENDENCY TOWARDS FALLING. THEY REPORTED
10 TO ME THAT THE MATTRESS ON THE FLOOR SEEMED TO BE WORKING
11 WELL. THAT SHE HAD AT LEAST NOT FALLEN OUT OF BED SINCE I'D
12 SEEN HER.
13 Q. DID YOU CONDUCT ANY TESTS OR PHYSICAL EXAMINATIONS ON
14 HER ON THAT PARTICULAR DATE?
15 A. I TOOK THE VITALS, I LISTENED TO HER LUNGS AND HEART.
16 AND ASSESSED HER JUST NEUROLOGICALLY.
17 Q. OKAY. CAN YOU CHARACTERIZE FOR US WITH -- IF YOU WOULD,
18 WHAT HER HEALTH SITUATION WAS AT THAT TIME?
19 A. WELL, I MENTION SHE'S A LITTLE DROWSY BUT AROUSABLE AND
20 WOULD ANSWER SIMPLE QUESTIONS BUT MOST OF THE INFORMATION
21 CAME FROM FAMILY MEMBERS THAT BROUGHT HER.
22 Q. OKAY. DID YOU SEE ANYTHING THAT -- OF A -- WELL, STRIKE
23 THAT. YOU SAY YOU HAVE ONE OTHER NOTE?
24 A. YES. NOVEMBER THIRD.
25 Q. AND THAT WOULD HAVE BEEN APPROXIMATELY ONE MONTH
1 LATER --
2 A. ONE MONTH LATER --
3 Q. -- IS THAT CORRECT?
4 A. -- OF '95.
5 Q. WAS THAT A VISIT TO YOUR OFFICE?
6 A. THAT WAS ALSO A VISIT, AND THIS TIME SHE CAME IN A
7 WHEELCHAIR. AND I DID MENTION IN THAT NOTE THAT SHE WAS
8 WHINING AND CRYING A LITTLE BIT. AND ALSO PERSEVERATED, THAT
9 MEANS THAT SHE KEPT SAYING THE SAME THING OVER AND OVER
10 AGAIN. AND THAT IS A -- THAT IS A SIGN OF DEMENTIA. YOU GET
11 ONE THOUGHT IN YOUR MIND AND YOU KEEP SAYING IT OVER AND OVER
12 AGAIN AND NEW THOUGHTS DON'T COME IN. SO SHE DIDN'T ANSWER
13 MY QUESTIONS VERY WELL. DIDN'T SEEM TO BE HAPPY IN HER
14 WHEELCHAIR AND CRIED OUT A LITTLE BIT.
15 Q. ANY COMPLAINTS RELATIVE TO ANY KIND PAINFUL CONDITIONS?
16 A. I WAS -- I DIDN'T HAVE ANYTHING ADDITIONAL THERE OTHER
17 THAN THAT THE FACT THAT SHE APPEARED TO BE A LITTLE WHINY AND
18 CRIED IN HER WHEELCHAIR AND PERSEVERATED A LITTLE BIT. BUT
19 ON MY EXAMINATION THERE WAS NO NOTE OF A TENDER ABDOMEN OR
20 ANYTHING, THAT THE ABDOMEN WAS NON TENDER. HEART OKAY AND
21 LUNGS WERE CLEAR.
22 Q. OKAY. AND YOU DID NOT SEE HER ANY FURTHER AFTER THAT
23 DATE, IS THAT CORRECT?
24 A. DID NOT. THE NEXT NOTE, I BELIEVE WE DISCONTINUED THE
25 XANAX BECAUSE IT SAYS HERE, THE PATIENT'S ANXIETY OR ADVERSE
1 BEHAVIORS HAD DECREASED. SHE WAS RECEIVING SOMETHING CALLED
2 TRAZODONE WHICH IS A MILD ANTIDEPRESSANT AND SOMETHING TO
3 HELP PEOPLE SLEEP AT NIGHT. WAIT A MINUTE. THIS IS -- LET'S
4 SEE, I TAKE THAT BACK. WE DIDN'T CHANGE THE MEDICINE BECAUSE
5 THE NOTE HERE SAYS THAT DISCONTINUING THE MEDICATIONS WAS
6 CONTRAINDICAITED BECAUSE SHE APPEARED TO BE DOING WELL. AND
7 SHE WAS RECEIVING THE TRAZODONE AT BEDTIME AND THE XANAX
8 THREE TIMES A DAY. AGAIN, XANAX IS A MILD VALIUM LIKE
9 TRANQUILIZER.
10 Q. OKAY. DID YOU EVER MAKE -- DURING YOUR TREATMENT AND --
11 OF JUDITH LARSEN, DID YOU EVER MAKE ANY DIAGNOSIS RELATIVE TO
12 ANY TERMINAL CONDITION?
13 A. NO. THE MEDICAL PROBLEMS WERE THE PREVIOUS STROKE AND
14 THE DEMENTIA.
15 Q. I HAVE NO FURTHER QUESTIONS YOUR HONOR.
16 THE COURT: CROSS-EXAMINE MR. BUGDEN.
17 CROSS-EXAMINATION
18 BY MR. BUGDEN:
19 Q. HOW DO YOU DO, DOCTOR. I'M WALTER BUGDEN. I ALONG WITH
20 MY PARTNER REPRESENT DR. WEITZEL. I'M GONNA -- MAY I
21 APPROACH THE WITNESS, JUDGE?
22 THE COURT: YOU MAY.
23 Q. (BY MR. BUGDEN) I'M GONNA PUT THOSE BACK IN HERE AND I'M
24 GONNA GIVE YOU -- THEY'RE PROBABLY THE SAME RECORDS, BUT --
25 A. OKAY.
1 Q. -- ORGANIZED IN A DIFFERENT WAY.
2 A. OKAY. BE OKAY WITH ME.
3 Q. I'M GONNA GIVE YOU THIS STACK, DOCTOR. AND I'M JUST
4 GONNA FAMILIARIZE YOU WITH ONE THING BEFORE WE GET GOING.
5 YOU'LL SEE A MED NUMBER ON THE BOTTOM THAT SOMETIMES I REFER
6 TO AND THEN YOU'LL SEE A DIFFERENT NUMBER THAT IS A LARGER
7 NUMBER ON THE RIGHT-HAND CORNER AND THAT --
8 A. OKAY.
9 Q. -- THOSE ARE THE TWO DIFFERENT KINDS OF NUMBERS THAT
10 I'LL BE REFERRING TO WHILE WE'RE TALKING ABOUT MRS. LARSON.
11 Q. DR. STEVENS, YOU BEGAN TREATING MRS. LARSEN IN 1995, IS
12 THAT RIGHT?
13 A. CORRECT.
14 Q. AND YOU'RE AN INTERNIST, FAMILY DOCTOR, IS THAT RIGHT?
15 A. INTERNAL MEDICINE.
16 Q. INTERNAL MEDICINE. I'M GONNA TURN THE LIGHTS DOWN,
17 DOCTOR. DURING YOUR CARE OF THIS PATIENT, YOU ENTERED INTO
18 OR SIGNED A MEDICAL TREATMENT PLAN FOR THIS PATIENT, IS THAT
19 RIGHT? I THINK YOU HAVE THE SAME EXHIBIT, DOCTOR.
20 A. YES, I'M NOTICING THAT FOR SOME REASON IT SAYS 1985, NOT
21 '95. I WAS IN ARIZONA IN '85 SO I THINK THAT MUST HAVE BEEN
22 A MISTAKE ON THE DATE.
23 Q. IT WAS A TYPOGRAPHICAL OR IT WAS WRITTEN MISTAKE AND I
24 THINK THAT'S ACTUALLY BEEN CLARIFIED BUT THAT WAS ONE THING I
25 WANTED TO ASK YOU IS, YOU TREATED HER IN '95, NOT '85.
1 A. CORRECT.
2 Q. AND AT THE TIME THAT YOU FILLED THIS DOCUMENT OUT,
3 DR. STEVENS, THERE'S A CHECK MARK INDICATING THAT THE
4 DECLARANT WAS IN A PHYSICAL OR MEDICAL CONDITION WHICH
5 RENDERED HIM OR HER INCAPABLE OF DOING THIS FOR HERSELF. AND
6 SO BECAUSE OF THAT, MERLIN LARSEN THE SON OF JUDITH SIGNED
7 THE DOCUMENT. DO YOU SEE THAT?
8 A. CORRECT.
9 Q. AND DOES THAT COMPORT WITH YOUR MEMORY TODAY ABOUT
10 MRS. LARSEN'S CANNOT; WHEN THIS DOCUMENT WOULD HAVE BEEN
11 FILLED OUT IN SEPTEMBER AND THAT IS THAT SHE WAS NOT ABLE --
12 HER MENTAL CONDITION WAS SUCH THAT SHE COULDN'T MAKE THOSE
13 DECISIONS FOR HERSELF?
14 A. CORRECT.
15 Q. AND I NOTICED DOCTOR THAT NOT ALL OF THIS DOCUMENT IS
16 FILLED OUT. IN THE VERY TOP UNDERNEATH THE NAME OF --
17 UNDERNEATH YOUR NAME DR. GREGORY STEVENS, IT DOES SAY JUDITH
18 LARSEN BUT IT DOESN'T HAVE A DATE AND IT DOESN'T HAVE THE
19 CONDITION THAT THE PATIENT WAS CURRENTLY BEING TREATED FOR,
20 INJURY, DISEASE, OR ILLNESS. DO YOU SEE THAT?
21 A. I SEE THAT YES.
22 Q. DOES THAT HAPPEN WITH SOME FREQUENCY IN MEDICINE THAT
23 DOCUMENTS DON'T GET COMPLETELY FILLED OUT?
24 A. YES IT DOES. I WOULD SAY IT'S LITTLE BIT MORE UNUSUAL
25 IN MY PRACTICE AND -- BUT, YEAH, OCCASIONALLY THINGS ARE
1 BROUGHT IN AND I JUST LOOK FOR THE PLACE TO SIGN INSTEAD OF,
2 YOU KNOW, GLANCE THINGS OVER AND TALK WITH THE FAMILY.
3 Q. MIGHT IT BE TYPICAL DR. JUST SO THAT WE CAN UNDERSTAND
4 HOW A DOCUMENT LIKE THIS MIGHT BE FILLED OUT, MIGHT IT BE
5 TYPICAL, DR. STEVENS, FOR YOUR STAFF FOR EXAMPLE TO PERHAPS
6 PREPARE MUCH OF THE DOCUMENT AND THEN PUSH THE DOCUMENT IN
7 FRONT OF YOU AND THEN YOU MIGHT SIT DOWN WITH MIS -- MERLIN
8 LARSEN TOGETHER YOU -- THE TWO OF YOU MIGHT THEN SIGN IT?
9 A. YEAH, OR IT COULD HAVE BEEN MR. LARSEN HIMSELF THAT
10 FILLED THAT OUT. I DON'T KNOW. BUT THAT'S POSSIBLE.
11 SOMETIMES I END UP DOING IT. SOMETIMES IT'S ALREADY FILLED
12 OUT BY THE TIME I SEE IT.
13 Q. SO IN A PERFECT WORLD OBVIOUSLY IT WOULD HAVE ALL BEEN
14 FILLED OUT. THIS TIME IT WASN'T, IS THAT RIGHT?
15 A. CORRECT, UH-HUH.
16 Q. NOW THIS WOMAN YOU JUST TOLD US AND LET ME JUST SAY SOME
17 THINGS AND SEE IF THIS COMPORTS WITH YOUR MEMORY AND YOU'VE
18 JUST TESTIFIED TO SOME OF THESE THINGS. SO MRS. LARSEN
19 SUFFERED TWO STROKES IN 1995, IS THAT RIGHT?
20 A. THE ONE THAT WAS IN THE RECORD WAS IN JANUARY, I
21 BELIEVE, AT L.D.S. HOSPITAL, AND WITHOUT SEEING SOMETHING IN
22 THE RECORD, I COULDN'T SAY ABOUT TWO, BUT ONE ANYWAY.
23 Q. I THINK WE'LL BE ABLE TO TALK ABOUT THE SECOND ONE IN A
24 MOMENT, BUT I THINK THAT THERE WAS A SECOND STROKE IN AUGUST
25 OF 1995?
1 A. OKAY. AND THAT WAS THE RECORD THAT I DIDN'T SEE IN THE
2 OTHER --
3 Q. NOW DR. THIS PATIENT MRS. LARSEN WAS SUFFERING FROM
4 DEMENTIA, ISN'T THAT RIGHT?
5 A. CORRECT.
6 Q. AND THIS WOMAN WAS SEVERLY DEMENTED. DO YOU AGREE WITH
7 THAT?
8 A. BY NOVEMBER I WOULD AGREE WITH THAT. IN FEBRUARY, SHE
9 WAS CERTAINLY DEMENTED BUT I'M NOT SURE WITH MY FIRST VISIT
10 FROM LOOKING OVER MY NOTES THAT I WOULD CHARACTERIZE HER AS
11 SEVERELY DEMENTED IN FEBRUARY.
12 Q. BUT YOU DID SEE OVER THE COURSE OF YOUR TREATMENT OF
13 THIS ELDERLY WOMAN, YOU SAW MENTAL DECLINE, IS THAT RIGHT?
14 A. I WOULD SAY THAT'S ACCURATE.
15 Q. AND END STAGE DEMENTIA, THAT IS -- THAT'S NOT A
16 REVERSIBLE SITUATION, IS IT?
17 A. CERTAINLY NOT AT 93. GENERALLY WE LOOK FOR THE THINGS
18 THAT ARE REVERSIBLE. WHEN WE FIRST SEE SOMEONE WITH
19 DEMENTIA, THERE ARE A FEW THINGS THAT CAN BE DONE SUCH AS
20 THYROID, DEPRESSION, THOSE THINGS HAD BEEN LOOKED AT AND
21 CHECKED OUT, SO I DID NOT SEE A REVERSIBLE CAUSE OF DEMENTIA.
22 Q. AND DOES IT SOUND CORRECT -- WE COULD LOOK THROUGH THE
23 RECORD, BUT LET ME JUST ASK YOU. DOES THIS SOUND CORRECT
24 DR. THAT ONCE SHE CAME UNDER YOUR CARE THAT SHE HAD THREE
25 DIFFERENT HOSPITALIZATIONS IN 1995?
1 A. YES.
2 Q. OKAY. AND NOW, DR. PEARCE IS A DOCTOR THAT WORKS WITH
3 YOU IN YOUR PRACTICE, IS THAT RIGHT?
4 A. YEAH, HE WAS PREVIOUSLY IN MY OFFICE. HE'S NOT THERE
5 NOW BUT BE WAS IN 95.
6 Q. AND IN JULY AND IN AUGUST, HE TREATED MRS. LARSEN ON
7 YOUR BEHALF. DOES THAT SOUND RIGHT?
8 A. IN JULY. I'M TRYING TO FIND THE AUGUST ADMISSION.
9 Q. I THINK I'M GONNA BE ABLE TO TAKE YOU THERE SO --
10 A. OKAY.
11 Q. YOUR HONOR, WE'RE GONNA NOW LOOK AT EXHIBIT 3-A N.H.
12 1243.
13 THE COURT: THAT'S PLAINTIFF'S 3-A?
14 MR. BUGDEN: HAVE I SAID IT WRONG?
15 MS. ISAACSON: YOU SAID NUMBER 6.
16 MR. BUGDEN: IT IS PLAINTIFF'S EXHIBIT 3-A JUDGE.
17 THE COURT: ALL RIGHT.
18 MR. BUGDEN: AND NURSING HOME RECORD 1243 WHICH IS SLIDE
19 SIX.
20 MS. ISAACSON: RIGHT.
21 Q. (BY MR. BUGDEN) AND CAN WE BLOW THAT UP? DR. STEVENS I
22 REALIZE THAT THIS WAS -- THIS MAY HAVE BEEN A NOTE PREPARED
23 BY DR. PEARCE AT THE TIME BUT --
24 A. ACTUALLY IT LOOKS LIKE THE PHYSICAL THERAPIST.
25 Q. THIS IS THE PHYSICAL THERAPIST NOTE?
1 A. YES. AT THE TOP IT SAYS PHYSICAL THERAPY EVALUATION.
2 FROM THE HOLLADAY HEALTH CARE CENTER WHICH WAS THE NURSING
3 HOME THAT SHE WAS AT.
4 Q. AND THERE'S A SECTION THERE THAT YOU CAN SEE WHERE IT
5 SAYS PATIENT WAS FOUND UNCONSCIOUS, WAS NOT ABLE TO MOVE.
6 PATIENT WAS THEN HOSPITALIZED. AND WAS D.X. IS THAT
7 DISCHARGE?
8 A. DIAGNOSED.
9 Q. DIAGNOSED. THEY HAVE A CEREBROVASCULAR ACCIDENT?
10 A. CORRECT.
11 Q. C.V.A. THAT'S A STROKE IS THAT RIGHT?
12 A. CORRECT.
13 Q. THEN THE PATIENT WAS LATER ADMITTED TO HOLLADAY HEALTH
14 CENTER UNCONSCIOUS AND WAS ADMITTED FOR TERMINAL CARE. DOES
15 THAT SOUND RIGHT?
16 A. SOUNDS EXACTLY WHAT, YEAH, IT --
17 Q. DOES IT REFRESH YOUR MEMORY TOO THAT SHE HAD TO ACTUALLY
18 BE MOVED, TRANSFERRED IN AN UNCONSCIOUS CONDITION?
19 A. PROBABLY. IT'D BE REALLY NICE TO SEE THE HOSPITAL ADMIT
20 NOTE. THAT WOULD HELP ME. BUT THIS IS A PHYSICAL THERAPIST
21 NOTE BUT THAT VERY WELL COULD HAVE BEEN.
22 Q. AND COULD WE SEE SLIDE 8?. IN SEPTEMBER OF 19 -- OR I'M
23 SORRY. AT THIS SAME TIME THERE'S A NURSING NOTE ENTRY AND
24 I'M WONDERING IF WE COULD SEE A BLOW UP OF THE NURSING NOTE
25 ENTRY. AND FOR YOU, DR. I THINK IT'S NUMBER 9. THERE'S A
1 NOTATION THAT THE PATIENT AND FAMILY WERE REALISTIC ABOUT THE
2 OUTCOME AND THAT WOULD BE RELATING TO REALISTIC ABOUT THE
3 OUTCOME OF THE -- OF MRS. LARSEN HAVING BEEN TRANSFERRED --
4 MR. WILSON: OBJECTION, YOUR HONOR --
5 THE COURT: SUSTAINED.
6 Q. (BY MR. BUGDEN) CAN YOU BY LOOKING AT THE DOCUMENT, CAN
7 YOU TELL WHAT THAT DESCRIBES, WHAT THE FAMILY WAS REALISTIC
8 ABOUT?
9 A. I CAN BECAUSE I KNOW THE FAMILY AND IT MEANS THEY WERE
10 REALISTIC ABOUT THE FACT THAT SHE WAS IN TERMINAL CARE AND
11 THAT SHE PROBABLY WASN'T GONNA GET BETTER AND THAT OUR GOAL
12 WAS TO MAKE HER COMFORTABLE AND TAKE CARE OF HER AS BEST WE
13 COULD WITHOUT GETTING AGGRESSIVE MUCH -- MUCH AS WAS
14 MENTIONED IN THE FIRST PAGE, THE MEDICAL TREATMENT PLAN.
15 Q. AND CAN YOU RECALL THAT YOU DID HAVE CONVERSATIONS
16 DR. STEVENS WITH THE FAMILY ABOUT PROVIDING MRS. LARSEN WITH
17 COMFORT CARE?
18 A. YES.
19 Q. AND COMFORT CARE MEANT TO YOU -- CAN YOU TELL ME WHAT
20 THAT PHRASE MEANT TO YOU, DR. ?
21 A. HAVE HER IN A SAFE ENVIRONMENT. AND IF SHE WAS AGITATED
22 OR ANXIOUS, DO WHAT WE COULD TO ALLEVIATE THAT. EITHER BY
23 CHANGING THE ENVIRONMENT OR PROVIDING A MEDICATION THAT
24 CALMED HER. TRYING TO PROTECT HER FROM FALLS WHICH SHE WAS
25 PRONE TO.
1 Q. CAN YOU --
2 A. THAT'S --
3 Q. I'M SORRY.
4 A. AND IF SHE WERE IN PAIN, PROVIDE SOME RELIEF FOR THE
5 PAIN.
6 Q. AND CAN YOU RECALL THAT YOU DID DISCUSS WITH THE FAMILY
7 THAT RATHER THAN PROVIDING THIS WOMAN WITH AGGRESSIVE MEDICAL
8 INTERVENTIONS, THAT IF SHE BECAME ILL, THAT THE DECISION HAD
9 BEEN MADE BY THE FAMILY AND BY YOU AS THE TREATING DOC THAT
10 YOU'D LET HER PASS AWAY WITH COMFORT, WITH DIGNITY?
11 A. NOW, THAT'S PART OF WHAT MEDICAL TREATMENT PLAN
12 INDICATES.
13 Q. SO THAT'S WHAT IT MEANT.
14 A. YES, THAT'S WHAT IT MEANT TO ME.
15 Q. NOW, LET'S TALK ABOUT THE FALLS, WHEN SHE WAS IN THE
16 HOLLADAY HEALTH CARE CENTER, SHE WAS STILL YOUR PATIENT, IS
17 THAT RIGHT?
18 A. CORRECT.
19 Q. AND SHE HAD A NUMBER OF FALLS IN THE CENTER THAT YOU'VE
20 TOLD US ABOUT --
21 A. THAT WAS MY UNDERSTAND -- YES, THAT'S MY RECOLLECTION.
22 EXCUSE ME.
23 Q. AND I BELIEVE YOU TOLD ME IN A CONVERSATION WE HAD LAST
24 WEEK THAT SHE WAS BIT OF HOUDINI?
25 A. SHE COULD GET OUT OF RESTRAINTS, YES, SHE WAS VERY
1 SKILLED. THEY WOULD TRY AND GET HER PROTECTED IN BED, AND
2 SOMEHOW SHE WAS ABLE TO GET OUT, AND THAT RESULTED IN SOME OF
3 THE FALLS AND THAT WAS THE MAIN REASON WE DECIDED TO PUT THE
4 MATTRESS ON THE FLOOR SO THAT IF SHE DID GET OUT, SHE
5 WOULDN'T HAVE VERY FAR TO FALL.
6 Q. LET'S TALK ABOUT RESTRAINTS FOR JUST A MOMENT. THE
7 REASON THAT MRS. LARSEN HAD TO BE PUT IN RESTRAINTS WAS
8 BECAUSE OF HER AGITATION, IS THAT RIGHT?
9 A. CORRECT.
10 Q. BECAUSE OF HER SORT OF MOVING ABOUT, THRASHING ABOUT?
11 A. (WITNESS NODS.)
12 Q. IS THAT RIGHT?
13 A. (WITNESS NODS.)
14 Q. I SEE THAT YOU'RE --
15 A. THAT'S MY RECOLLECTION YES.
16 Q. -- NODDING YOUR HEAD, BUT I NEED TO ASK YOU TO ANSWER
17 OUT LOUD.
18 A. KEEP FORGETTING.
19 Q. AND IT'S VERY HARD ON PATIENTS OR AT LEAST ON SOME
20 PATIENTS TO BE TIED DOWN, IS THAT RIGHT?
21 A. IT IS. AND THERE WAS THE NOTE IN MY CHART THAT REFERRED
22 TO BEFORE WHERE THE FAMILY HAD SAID THAT MAYBE WE OUGHT TO
23 TRY NOT RESTRAINING HER, THAT THE MEDICATON SEEMED TO BE
24 WORKING AND THEY WOULD PREFER NOT TO HAVE HER RESTRAINED AS
25 MUCH.
1 Q. LET ME ASK YOU TO TURN TO -- LET'S SEE -- NUMBER 14 AND
2 THIS IS STILL THE SAME EXHIBIT, JUDGE. WELL, ACTUALLY, I'M
3 SORRY, THIS IS DEFENDANT'S EXHIBIT 7 AND IT'S STEVENS PAGE
4 21, COUNSEL. BUT THERE'S ALSO THE NUMBER 14 IN THE CORNER,
5 DR. STEVENS.
6 A. LIKE THIS?
7 Q. ARE YOU THERE?
8 A. I BELIEVE I AM. DOES IT HAVE 10/03/95 AT THE TOP?
9 Q. CORRECT.
10 Q. YEAH. NOW YOU SAW MRS. LARSEN ON THAT DATE, OCTOBER
11 3RD?
12 A. YES IN MY OFFICE.
13 Q. AND SHE WAS STILL IN THE NURSING HOME AT THAT TIME AND
14 SHE'D BEEN DOING WELL ON XANAX, IS THAT RIGHT?
15 A. XANAX AND TRAZODONE.
16 Q. AND THE XANAX, THAT'S A CENTRAL NERVOUS SYSTEM
17 DEPRESSANT, IS THAT RIGHT?
18 A. IT'S A TRANQUILIZING AGENT IN THE SAME CLASS AS VALIUM.
19 Q. AND THEN THE TRAZODONE, WHAT WAS THE TRAZODONE FOR?
20 A. TRAZODONE IS A MILD ANTIDEPRESSANT THAT WE FREQUENTLY
21 USE IN SMALL DOSES TO HELP ASSIST WITH THE SLEEPING AT NIGHT.
22 IT'S USED MORE FOR ITS SIDE EFFECT OF DROWSINESS THAN FOR ITS
23 ACTUAL ANTIDEPRESSANT PROPERTIES.
24 Q. AND THEN, IF I COULD ASK YOU TO TURN TO NOVEMBER 3RD.
25 AND I THINK THAT'S NUMBER 21. THE 21 IS IN THE LARGER NUMBER
1 IN THE LOWER RIGHT-HAND CORNER, DOCTOR.
2 A. GOT IT.
3 Q. WAS THIS ANOTHER OFFICE VISIT DOCTOR?
4 A. I BELIEVE THIS WAS THE LAST OFFICE VISIT. THIS IS THE
5 ONE I MENTIONED WHERE SHE WAS IN THE WHEELCHAIR AND WHINED
6 AND CRIED OUT A LITTLE BIT.
7 Q. AND THIS IS WHERE HER DEMENTIA SEEMED TO HAVE CERTAINLY
8 HAVE PROGRESSED SINCE FEBRUARY WHEN YOU BEGAN TREATING HER,
9 IS THAT RIGHT?
10 A. CORRECT. IT SEEMS LIKE SHE WAS A LITTLE BIT WORSE WHEN
11 SHE WAS UNCONSCIOUS AND NOT RESPONDING, SO AT LEAST SHE WAS
12 IN A CHAIR AND SAYING THINGS.
13 Q. BY NOW SHE'S SUFFERED THE SECOND STROKE AND THAT MAY --
14 A. CORRECT.
15 Q. -- EXPLAIN WHY SHE'S IN THE WHEELCHAIR, IS THAT RIGHT?
16 A. CORRECT. BECAUSE PRIOR TO THAT I BELIEVE SHE WAS
17 AMBULATORY WITH ASSISTANCE.
18 Q. BUT DURING --
19 A. SHE COULD WALK AROUND.
20 Q. I'M SORRY. BUT DURING THIS VISIT, SHE WAS WHINING AND
21 SHE WAS CRYING IS THAT RIGHT?
22 A. CORRECT.
23 Q. AND UNABLE TO ANSWER YOUR QUESTIONS IS THAT RIGHT?
24 A. CORRECT.
25 Q. AND YOU USED THE WORD PERSEVERATING, AND THAT'S A SIGN
1 OF DEMENTIA WHEN PEOPLE REPEAT THEMSELVES OVER AND OVER
2 AGAIN, IS THAT RIGHT?
3 A. CORRECT.
4 Q. AND I BELIEVE YOU MEASURED HER BLOOD PRESSURE THAT DAY?
5 A. I DID AND IT WAS A LITTLE LOW.
6 Q. 86 OVER 07 IS JUST A LITTLE LOW ISN'T IT?
7 A. CORRECT.
8 Q. DID THAT CONCERN YOU PARTICULARLY?
9 A. IT WOULD HAVE HAD SHE BEEN ON ON DIURETICS AND
10 MEDICATIONS THAT ARE KNOWN TO LOWER THE BLOOD PRESSURE. IT'S
11 KIND OF AN INDICATION THAT SHE MAYBE WAS IN A SLIGHTLY
12 DEHYDRATED STATE. AND AGAIN, WE HAD AGREED THAT WE WOULDN'T
13 GET AGGRESSIVE WITH THAT, SO I DIDN'T -- I DIDN'T CHANGE MY
14 PLAN BASED ON THAT ALONE.
15 Q. SO, YOU KNOW, IF THIS WAS A YOUNGER PERSON OR SOMEONE
16 WHO DIDN'T HAVE THIS MEDICAL TREATMENT PLAN IN PLACE FOR NO
17 AGGRESSIVE MEDICAL TREATMENT, YOU MIGHT HAVE DONE SOMETHING
18 ELSE WITH THAT LOW BLOOD PRESSURE, BUT WHERE YOU HAD A
19 93-YEAR-OLD PATIENT, WITH THIS MEDICAL TREATMENT PLAN IN
20 PLACE, AND THE FAMILY READY TO LET THIS WOMAN GO, YOU DIDN'T
21 DO ANYTHING ABOUT THAT.
22 A. CORRECT WE DID NOT.
23 Q. YOU DID PUT THIS WOMAN ON -- OR MAYBE SHE ALREADY WAS
24 WHO PSYCHOTROPIC MEDICATIONS IS THAT RIGHT?
25 A. WELL XANAX WOULD BE ONE THAT YOU COULD CALL A
1 PSYCHOTROPIC MEDICATION BECAUSE IT WORKS ON THE MIND. THAT'S
2 THE MILD TRANQUILIZER.
3 Q. OKAY. AND ON NOVEMBER 16TH, LET'S SEE, NOVEMBER 16TH I
4 THINK IS NUMBER 25 FOR YOU, DOCTOR.
5 A. YES.
6 Q. AM I CORRECT THAT THE HOLLADAY HEALTH CARE CENTER
7 PSYCHOTROPIC COMMITTEE CONTACTED YOUR OFFICE ON THAT DAY?
8 A. YES, AND ACCORDING TO THE NOTE, THEY FELT LIKE SHE WAS
9 ON A LOW ENOUGH DOSE OF TRAZODONE THAT MAYBE WE OUGHT TO
10 RAISE THAT TO SEE IF WE COULD GET HER TO BE A LITTLE MORE
11 RESTFUL. SHE WAS -- THEY SAID SHE WAS STILL QUITE RESTLESS.
12 Q. THEY WANTED TO INCREASE IT TO 100 MILLIGRAMS?
13 A. THAT WOULD BE TWICE WHAT I HAD ORIGINALLY ORDERED, AND
14 THAT'S CORRECT.
15 Q. AND SO THEY WERE TITRATING TO EFFECT?
16 A. CORRECT.
17 Q. THEY WERE RESPONDING TO HER SYMPTOMS.
18 A. CORRECT.
19 Q. THE 50 MILLIGRAMS WASN'T GETTING THE JOB DONE OR
20 CONTROLLING THE AGITATION AND SO THEY HAD CONTACTED YOU AND
21 WANTED YOU TO DOUBLE IT?
22 A. YES.
23 Q. AND IS A HUNDRED MILLIGRAMS, IS THAT A BIG DOSE?
24 A. WELL, IT COMES IN A 300 MILLIGRAM PILL, SO THAT'S STILL
25 A SMALL DOSE. AND SHE WAS A SMALL LADY. SO --
1 Q. SO IN SPITE OF HER AGE, 93 AND HER --
2 A. MAYBE FOR 93, I WOULD BE UNCOMFORTABLE GOING MUCH HIGHER
3 THAN THAT. ALTHOUGH, AGAIN, I WOULD PROBABLY CHANGE TO
4 ANOTHER MEDICINE IF IT WASN'T DOING THE JOB AT THAT POINT.
5 Q. BUT THEY HAD CONTACTED -- YOU WERE THERE TRYING TO TREAT
6 THE SYMPTOM AND YOU WERE COMFORTABLE RAISING THE DOSAGE,
7 RIGHT?
8 A. YES BECAUSE THE BEGINNING DOSE WAS VERY SMALL. I FELT
9 THAT THAT INCREMENTAL INCREASE WOULDN'T BE DANGEROUS TO HER.
10 BECAUSE WE CHARGED FIRST DO NO HARM.
11 Q. DR. AT DIFFERENT TIMES WHEN YOU SAW HER, FOR EXAMPLE IN
12 NOVEMBER WHEN YOU SAW THIS WOMAN, AND SHE WAS IN THE
13 WHEELCHAIR I GUESS THE LAST VISIT YOU HAD WITH HER, THIS WAS
14 A DEMENTED PATIENT. THIS WAS SOMEONE WHO WAS WHINING AND WHO
15 WAS CRYING. COULD THOSE HAVE BEEN SYMPTOMS, DR. STEVENS, OF
16 PAIN?
17 A. THAT IS CERTAINLY POSSIBLE.
18 Q. OKAY.
19 A. ONE OF THE OTHER NOTES, THE HOLLADAY PSYCHOTROPIC
20 COMMITTEE ASKED ME, COULD SHE HAVE SOME TYLENOL, AND I SAID
21 YES.
22 Q. AND NOW JUST THE LAST QUESTION DR. THIS WAS A WOMAN WHO
23 HAD -- HAD SUFFERED TWO STROKES, HAD THREE OR FOUR
24 HOSPITALIZATIONS. TWO STROKES IN 1995. THREE OR FOUR
25 HOSPITALIZATIONS. HISTORY OF FALLS. SEVERELY DEMENTED BY THE
1 TIME YOU SAW HER IN NOVEMBER, AND BY AUGUST AFTER HER SECOND
2 STROKE, THE FAMILY IN CONSULTATION WITH YOU HAD DECIDED ON
3 COMFORT CARE FOR THIS WOMAN, IS THAT RIGHT?
4 A. CORRECT. THAT IS CORRECT.
5 Q. THANK YOU.
6 THE COURT: MR. WILSON, REDIRECT.
7 REDIRECT EXAMINATION
8 BY MR. WILSON:
9 Q. COUPLE OF QUESTIONS DOCTOR. I SHOW YOU WHAT -- MAY I
10 APPROACH, YOUR HONOR?
11 THE COURT: MAY.
12 Q. (BY MR. WILSON) I'M GOING TO SHOW YOU PAGES OUT OF
13 STATE'S EXHIBIT 3-C, WHICH I THINK YOU READ FROM ON A PRIOR
14 OCCASION. AND I'LL REFER YOU TO THE SECOND PART OF THAT --
15 THE COURT: CAN'T BE 3-C.
16 MR. WILSON: -- HAVE YOU REVIEW --
17 MR. BUGDEN: YOUR HONOR --
18 MR. MAJOR: YOUR HONOR, THAT SHOULD BE 3-A.
19 MR. WILSON: 3-A EXCUSE ME.
20 Q. (BY MR. WILSON) CAN YOU REFER TO PAGE 2 OF THAT
21 PARTICULAR NOTE? YOU WERE SHOWN TO IT -- EXHIBIT BY COUNSEL.
22 CAN YOU TELL US, DOES THIS NOTE PERTAIN TO THE
23 HOSPITALIZATION THAT TOOK PLACE IN AUGUST?
24 A. THIS IS A PHYSICAL THERAPY. AFTER THE HOSPITALIZATION
25 IN AUGUST, SHE OBVIOUSLY WENT FOR SOME ADDITIONAL THERAPY FOR
1 THE STROKE AND WE COMMONLY DO THAT. SHE WENT TO HOLLADAY
2 CARE CENTER, AND THIS NOTE IS FROM HOLLADAY HEALTH CARE
3 CENTER AND THIS WAS THE PHYSICAL THERAPIST WHO WAS CHARGED
4 WITH EVALUATING HER AND TRYING TO SEE IF SHE COULD IMPROVE
5 THE PATIENT'S STATUS. SO THIS IS I GUESS DIRECTLY AS A
6 RESULT OF THE AUGUST HOSPITALIZATION FOR THE STROKE, AND
7 THOSE ARE THE NOTES THAT I DON'T HAVE THE COMPLETE TEXT OF,
8 BUT PUTTING IT TOGETHER, STROKE, UNABLE TO SWALLOW VERY WELL,
9 HISTORY OF HIGH BLOOD PRESSURE, THEY WERE CHARGED WITH TRYING
10 TO MAKE HER MORE MOBILE, AND THEIR GOALS WERE TO TRY AND
11 ALLOW -- GET HER SO THAT SHE COULD GET UP OUT OF A CHAIR
12 SAFELY, AND PERHAPS WALK WITH A WALKER A LITTLE BIT SAFELY.
13 Q. WERE THEY ABLE TO MAKE PROGRESS WITH HER ACCORDING TO
14 THE SECOND PART OF THE NOTE?
15 A. THEY -- THEIR ASSESSMENT WAS THAT SHE WAS A FAIR TO GOOD
16 REHABILITATATION -- HAD FAIR TO GOOD REHABILITATATION
17 POTENTIAL.
18 Q. OKAY. IN REGARDS TO THE -- MAY I HAVE JUST A MINUTE,
19 YOUR HONOR? I'M ALSO GOING TO SHOW YOU WHAT'S IDENTIFIED AS
20 PLAINTIFF'S -- OR DEFENDANT'S EXHIBIT D-7. I THINK THERE WAS
21 A NOTE, IT'S MARKED AS STEVENS. I THINK THIS IS DR. STEVENS
22 FILE. 00022 OF THAT PARTICULAR EXHIBIT. AND ASK YOU TO TAKE
23 A LOOK AT THAT PARTICULAR NOTE. JUST -- THIS NOTE PERTAINS
24 TO THE XANAX THAT WE WERE JUST PREVIOUSLY SHOWN THAT
25 PARTICULAR EXHIBIT.
1 A. YES.
2 Q. WILL YOU TURN TO THE NEXT PAGE OF THAT PARTICULAR
3 EXHIBIT AND TELL US, SIR, CAN YOU TELL US WHETHER OR NOT THE
4 XANAX WAS DISCONTINUED?
5 A. THE FIRST NOTE I HAD ORIGINALLY WRITTEN THE XANAX ON AN
6 AS NEEDED BASIS THREE TIMES A DAY AT A .25 MILLIGRAM. AND
7 THEY WANTED TO KNOW IF THEY COULD GIVE IT REGULARLY RATHER
8 THAN JUST AS NEEDED BECAUSE -- AND ONLY HOLD IT IF SHE WAS
9 EXCESSIVELY DROWSY, AND I TOLD THEM THAT WOULD BE FINE. I'M
10 ASSUMING IN THE CONTEXT OF THAT NOTE AND THE FOLLOWING NOTE
11 THAT IT WAS HELPFUL BECAUSE IT SAYS THAT PATIENT WAS
12 RECEIVING TRAZODONE, THE INCREASED DOSE OF A HUNDRED
13 MILLIGRAMS AND XANAX .5 MILLIGRAMS THIS TIME, THREE TIMES A
14 DAY, AND THE PATIENT'S BEHAVIORS HAVE DECREASED SOME SINCE
15 STARTING THE MEDICATION. SO THIS NOTE INDICATES THAT THAT
16 COMBINATION IN A SLIGHTLY DIFFERENT WAY THAN WE STARTED AT
17 THE BEGINNING OF OCTOBER -- OR OF NOVEMBER SEEMED TO BE
18 HAVING SOME EFFECT.
19 Q. OKAY.
20 A. AND THEY WROTE THERE THAT DISCONTINUING THESE
21 MEDICATIONS MIGHT BE CONTRAINDICATED AT THAT TIME.
22 THE COURT: NEED TO PICK UP THE PACE, MR. WILSON.
23 MR. WILSON: THANK YOU, YOUR HONOR. I DON'T HAVE ANY
24 FURTHER QUESTIONS AT THIS TIME.
25 THE COURT: MR. BUGDEN.
1 RECROSS-EXAMINATION
2 BY MR. BUGDEN:
3 Q. JUST A FEW. THE XANAX, THE VERY NOTE THAT WE'VE JUST
4 BEEN TALKING ABOUT, DR. STEVENS, SHE HAD A P.R.N. ORDER FOR
5 XANAX, RIGHT?
6 A. CORRECT. P.R.N. MEANS AS NEEDED.
7 Q. AS NEEDED, WHICH MEANS IT'S NOT GIVEN ON A ROUTINE
8 BASIS, JUST --
9 A. CORRECT.
10 Q. -- WHENEVER THE NURSES FELT IT WAS APPROPRIATE, IS THAT
11 RIGHT?
12 A. CORRECT.
13 Q. AND WHAT -- APPARENTLY WHAT HAPPENED IS THAT HER
14 AGITATION WAS INCREASING OR WAS -- THERE WAS ENOUGH AGITATION
15 THAT THEY WANTED A ROUTINE ORDER, AN ORDER IN PLACE TO BE
16 ABLE TO GIVE HER XANAX ON A REGULAR BASIS.
17 A. CORRECT. SOMETIMES THAT'S DONE IF PATIENT ISN'T ALERT
18 ENOUGH TO ASK FOR IT ON THEIR OWN, AND RATHER THAN RELYING ON
19 SOMEBODY ACTUALLY BEING THERE OBSERVING THAT, SO, MY GUESS IS
20 THEY FELT LIKE IT WAS HELPFUL AND THEY WANTED TO HAVE THE
21 LIBERTY TO USE IT MORE OFTEN, ON A REGULAR BASIS.
22 Q. WELL, WITH A PATIENT LIKE JUDITH LARSEN THAT WAS
23 SUFFERING FROM DEMENTIA, THIS WAS NOT SOMEONE THAT COULD
24 SELF-REPORT.
25 A. CORRECT, AND THAT'S -- THAT'S THE PURPOSE FOR CHANGING
1 IT TO ROUTINE.
2 Q. THAT'S THE POINT.
3 A. YES.
4 Q. THANK YOU.
5 THE COURT: MR. WILSON.
6 MR. WILSON: NO FURTHER QUESTIONS YOUR HONOR.
7 THE COURT: YOU MAY STEP DOWN, DOCTOR. MAY THIS WITNESS
8 BE EXCUSED, MR. WILSON.
9 MR. WILSON: HE MAY.
10 THE COURT: MR. BUGDEN.
11 MR. BUGDEN: YES, SIR.
12 THE COURT: MAY BE EXCUSED, DR. STEVENS, AND THANK YOU.