Greg Stevens, MD
15 GREGORY STEVENS,
16 CALLED BY THE PLAINTIFF, HAVING BEEN DULY
17 SWORN, WAS EXAMINED AND TESTIFIED AS FOLLOWS:
18 DIRECT EXAMINATION
19 BY MR. WILSON:
20 Q. DR. STEVENS, WOULD YOU STATE YOUR FULL NAME, PLEASE?
21 A. GREGORY PAUL STEVENS.
22 Q. AND WHERE ARE YOU EMPLOYED, SIR?
23 A. I PRACTICE IN HOLLADAY NEAR THE COTTONWOOD ON HIGHLAND
24 DRIVE AND 5600 SOUTH.
25 Q. CAN YOU GIVE US A BRIEF RUNDOWN AS TO YOUR EDUCATIONAL
968
1 BACKGROUND?
2 A. I GRADUATED FROM THE UNIVERSITY OF UTAH. ATTENDED
3 MEDICAL SCHOOL AT UNIVERSITY OF UTAH AND DID MY RESIDENCY
4 THERE AS WELL. THEN PRACTICED FOR 11 YEARS IN THE MESA,
5 ARIZONA AREA AND RETURNED HERE IN 1994 TO PRACTICE INTERNAL
6 MEDICINE.
7 Q. WHEN DID YOU GRADUATE FROM THE UNIVERSITY MEDICAL
8 SCHOOL?
9 A. 1980.
10 Q. OKAY. AND YOUR RESIDENCY WAS COMPLETED WHEN?
11 A. 1983.
12 Q. ARE YOU BOARD CERTIFIED IN ANY SPECIALTIES?
13 A. I'M BOARD CERTIFIED IN INTERNAL MEDICINE, YES.
14 Q. AND WHEN DID THAT OCCUR?
15 A. 1983, SEPTEMBER.
16 Q. SO YOU'VE ESSENTIALLY BEEN IN PRACTICE SOME 17 YEARS
17 NOW?
18 A. CORRECT.
19 Q. ARE YOU ASSOCIATED WITH ANY OTHER -- EXCUSE ME. WHERE
20 IS YOUR OFFICE LOCATED?
21 A. OFFICE IS AT 1955 EAST 5600 SOUTH, AND I'M ASSOCIATED
22 WITH INTERMOUNTAIN HEALTH CARE AS A PHYSICIAN WITH
23 INTERMOUNTAIN HEALTH CARE.
24 Q. IS THAT A CLINIC THAT YOU OPERATE AT THAT LOCATION?
25 A. IT'S A GROUP OF SIX INTERNISTS THERE THAT SERVES THE
969
1 HOLLADAY AREA.
2 Q. OKAY. ARE YOU FAMILIAR WITH AN INDIVIDUAL BY THE NAME
3 OF JUDITH LARSEN?
4 A. YES, I AM.
5 Q. AND COULD YOU TELL US WHAT YOUR RELATIONSHIP IS WITH
6 JUDITH LARSEN?
7 A. JUDITH'S SON, MERLIN, HAS BEEN A LIFELONG FRIEND OF MY
8 FATHER-IN-LAW, AND WHEN I MOVED BACK FROM ARIZONA I WAS
9 ASKED BY MERLIN IF I WOULD SEE AND TAKE CARE OF HIS MOTHER
10 JUDITH. I SAW HER FOR THE FIRST TIME AFTER SHE HAD SUFFERED
11 A STROKE. SHE SUFFERED THE STROKE IN JANUARY. I SAW HER IN
12 FEBRUARY OF 1995 FOR THE FIRST TIME.
13 Q. AND HAVE YOU HAD AN OPPORTUNITY, SIR, TO REVIEW THE
14 MEDICAL RECORDS MAINTAINED AT YOUR CLINIC?
15 A. YES, I HAVE, AND I BROUGHT THEM WITH ME.
16 Q. OKAY. AND THESE MEDICAL RECORDS COVER WHAT PERIOD OF
17 TIME?
18 A. ACTUALLY THERE WERE SOME MEDICAL RECORDS FROM HER
19 PREVIOUS PHYSICIAN. WHEN I CAME TO SALT LAKE I JOINED THE
20 SALT LAKE CLINIC AND THEY MAINTAINED JUST ONE CHART, WHICH
21 DR. WESTERMANN HAD BEEN CARING FOR HER AT MEMORIAL CLINIC.
22 HIS RECORDS ARE IN THIS MASTER RECORD AS WELL AND THEY GO
23 BACK TO 1989. BUT SPECIFICALLY I HAVE MY RECORDS FOR THE
24 YEAR OF 1995 WHEN I WAS TAKING CARE OF HER.
25 Q. SO SHE CAME TO YOU IN FEBRUARY OF 1995?
970
1 A. CORRECT.
2 Q. AFTER HAVING SUFFERED A STROKE IN JANUARY; IS THAT
3 CORRECT?
4 A. CORRECT.
5 Q. CAN YOU DESCRIBE FOR US THE INITIAL VISIT AND WHAT, IF
6 ANYTHING, WAS DONE TO EVALUATE HER SITUATION AT THAT TIME?
7 A. OKAY. SHE WAS BROUGHT IN BY HER SON AND IN MY NOTE I
8 SPECIFICALLY SAY THAT SHE WAS NOT HAPPY TO BE THERE. SHE
9 APPARENTLY BEFORE HER STROKE, ACCORDING TO THE EARLIER
10 RECORDS, HAD BEEN CARING FOR HERSELF AT HOME. AFTER THE
11 STROKE SPENT SOME TIME IN A CARE CENTER. THE FAMILY WAS AT
12 THE POINT OF TRYING TO GET HER INTO A FOSTER CARE SETTING
13 AND WANTED ME TO TAKE CARE OF HER IN THE FOSTER CARE
14 SETTING. SHE WOULD SPEAK IN SHORT SENTENCES, WAS CONFUSED,
15 BUT ABLE TO GET AROUND BY HERSELF.
16 MY EXAMINATION REVEALED HER TO BE A LITTLE BIT DROWSY.
17 SHE HAD JUST BEEN STARTED ON AN ANTIDEPRESSANT BY THE NAME
18 OF ZOLOFT AND AT THAT EVALUATION I FELT THAT THAT MIGHT BE
19 THE CAUSE OF THE DROWSINESS, AND I DISCONTINUED THE ZOLOFT
20 AT THAT TIME.
21 SHE HAD A HISTORY OF HYPOTHYROIDISM AND WAS ON THYROID.
22 THE STROKE AFFECTED HER VISION MORE THAN ANYTHING. WELL, AS
23 WELL AS HER MENTATION, ALTHOUGH THERE IS A NOTE BY THE
24 EARLIER PHYSICIAN THAT SHE HAD A LITTLE BIT OF DEMENTIA
25 SHOWING UP THE YEAR BEFORE, PRIOR TO THE STROKE.
971
1 Q. DID SHE HAVE ANY COMPLAINT OF PAIN AT THAT TIME?
2 A. NO. I HAVE NO RECORD OF ANY COMPLAINTS OF PAIN AT THAT
3 TIME.
4 Q. YOU INDICATED THE CONDITION OF HYPOTHYROIDISM. CAN YOU
5 DEFINE THAT OR EXPLAIN THAT FOR US?
6 A. THE THYROID GLAND IS HERE IN THE THROAT. IT
7 MALFUNCTIONS IN A FAIRLY SIGNIFICANT PORTION OF THE
8 POPULATION EITHER ENLARGING IN THE GOITER OR IN SOME CASES
9 JUST FAILING TO PRODUCE ENOUGH THYROID HORMONE TO SUSTAIN
10 THE METABOLISM OF THE BODY. USUALLY PEOPLE MANIFEST
11 SLUGGISHNESS, WEIGHT GAIN, COARSE HAIR, THICKENED SKIN WHEN
12 THE THYROID GLAND STARTS TO FAIL. IT'S A VERY SIMPLE
13 DIAGNOSIS TO MAKE WITH A BLOOD TEST AND THE TREATMENT IS
14 TAKE A THYROID REPLACEMENT PILL ON A DAILY BASIS.
15 Q. SO WAS SHE GIVEN THAT KIND OF MEDICATION?
16 A. SHE HAD BEEN ON THAT BEFORE SHE SAW ME AND I CONTINUED
17 IT.
18 Q. YOU TOOK HER OFF THE ZOLOFT?
19 A. CORRECT.
20 Q. WERE YOU PROVIDING ANY OTHER MEDICATION TO HER AT THAT
21 TIME?
22 A. WELL, I WAS GOING TO HAVE HER COME BACK IN ABOUT TWO OR
23 THREE MONTHS TO REASSESS IF WE NEEDED SOMETHING TO HELP
24 CONTROL SOME OF HER OUTBURSTS AT TIMES. AS IS FAIRLY COMMON
25 IN OLDER DEMENTED PEOPLE SHE WOULD HAVE SOME OUTBURSTS AT
972
1 THE NURSING HOME THAT THE NURSES WOULD COMPLAIN OF. AND I
2 THINK OVER THE PHONE WE TRIED SOMETHING CALLED XANAX, WHICH
3 IS A MILD TRANQUILIZER. WE HAD TRIED SOMETHING CALLED
4 TRAZODONE, WHICH IS AN ANTIDEPRESSANT, BUT GIVEN AT BEDTIME
5 HELPS PEOPLE SLEEP AT NIGHT.
6 I NEGLECTED TO MENTION SHE WAS ALSO TAKING A FORM OF
7 NITROGLYCERIN BECAUSE OF A PREVIOUS HISTORY OF CORONARY
8 ARTERY DISEASE. IT WAS A TIME-RELEASED FORM OF
9 NITROGLYCERIN TO PREVENT CHEST PAINS.
10 Q. NOW, THESE OUTBURSTS THAT YOU REFERENCED, HOW DID YOU
11 BECOME AWARE OF THAT PARTICULAR BEHAVIOR PATTERN?
12 A. USUALLY THE NURSING PERSONNEL. I'VE A NOTE HERE FROM
13 FEBRUARY 27 WHERE ACTUALLY WE TRIED ATIVAN, WHICH IS ANOTHER
14 MILD TRANQUILIZER, INITIALLY. THE NEXT --
15 Q. CAN YOU TELL US IN WHAT AMOUNTS YOU ADMINISTERED
16 PARTICULARLY THE TRAZODONE?
17 A. TRAZODONE WAS 100 MILLIGRAMS AT BEDTIME. TRAZODONE
18 COMES IN 50, 150, AND 300 MILLIGRAM STRENGTHS. 100 IS KIND
19 OF A LOW, MODERATE DOSE.
20 Q. ATIVAN. WHAT ABOUT THAT?
21 A. ATIVAN WAS PRESCRIBED IN A HALF A MILLIGRAM. THAT IS
22 THE SMALLEST SIZE I BELIEVE THE PILL COMES IN. IT DOES NOT
23 SEDATE, BUT HELPS RELAX PEOPLE. I USE THAT WHEN I DON'T
24 WANT TO REALLY KNOCK SOMEBODY OUT, BUT CONTROL SOME OF THEIR
25 OUTBURSTS.
973
1 Q. NOW, THESE PARTICULAR MEDICATIONS WERE PRESCRIBED OVER
2 WHAT TIME PERIOD?
3 A. THE ATIVAN WAS BEFORE HER ADMISSION TO THE HOSPITAL IN
4 JULY, AND THE TRAZODONE WAS STARTED AFTER SHE WAS ADMITTED
5 TO THE HOSPITAL -- COTTONWOOD HOSPITAL IN JULY.
6 Q. DID YOU HAVE OCCASION TO SEE HER AT YOUR OFFICE BEFORE
7 THE HOSPITALIZATION IN JULY?
8 A. NO, I DID NOT.
9 Q. OKAY. SO THE NEXT REFERENCE YOU HAVE IN YOUR REPORT
10 DEALS WITH THE HOSPITALIZATION OCCURRING IN JULY?
11 A. YES, AND IT MUST HAVE EITHER BEEN ON A WEEKEND OR A TIME
12 WHEN I WAS OUT OF TOWN BECAUSE ANOTHER DOCTOR IN MY OFFICE,
13 DR. JAMES PEARCE, DID THE ADMISSION AND DISCHARGE AT THAT
14 TIME.
15 Q. DO YOU KNOW HOW LONG THAT HOSPITALIZATION WAS FOR?
16 A. ACCORDING TO MY RECORDS SHE WAS ADMITTED ON JULY 15TH
17 AND WAS DISCHARGED ON THE 16TH, SO JUST OVERNIGHT.
18 APPARENTLY CAME INTO THE EMERGENCY ROOM SOMEWHAT DEHYDRATED
19 AND WAS GIVEN SOME INTRAVENOUS FLUID.
20 SHE -- THE OTHER ITEMS MENTIONED IN THE NOTE ARE THAT
21 SHE HAD SOME HEARTBURN OR REFLUX, AND THE DEPRESSION, THE
22 DEMENTED STATE.
23 Q. SO YOU DID NOT SEE HER ON THAT PARTICULAR OCCASION?
24 A. I WAS NOT INVOLVED IN THE CARE AT THAT PARTICULAR TIME.
25 Q. DID YOU HAVE OCCASION TO REVIEW THAT WITH DR. PEARCE?
974
1 A. I'M SURE WE TALKED, BUT THERE'S NOTHING IN THE RECORD
2 DOCUMENTING WHAT WAS SAID SO -- IT'S BEEN FIVE YEARS. I
3 CAN'T REMEMBER.
4 Q. SO WAS IT AFTER THAT YOU INDICATED THAT YOU STARTED HER
5 ON THE TRAZODONE?
6 A. YEAH. THE NEXT NOTE -- ACTUALLY THERE WAS ONE
7 ADDITIONAL HOSPITALIZATION IN AUGUST THAT ALSO DR. PEARCE
8 WAS LUCKY ENOUGH TO BE ON CALL FOR ME.
9 Q. WHAT WAS THE DATE OF THAT HOSPITALIZATION?
10 A. THAT ONE WAS AUGUST 25 AND DISCHARGED THE 27TH. AT THAT
11 POINT, ACCORDING TO HIS NOTE, THE FAMILY THOUGHT MAYBE SHE
12 HAD HAD ANOTHER STROKE 'CAUSE SHE WASN'T SPEAKING AS MUCH AS
13 SHE HAD BEEN BEFORE. SHE WAS ADMITTED AND GIVEN SOME
14 INTRAVENOUS FLUIDS.
15 LET'S SEE IF HE CHANGED THE MEDICINES THERE. THERE WAS
16 SOME DISCUSSION AT THAT TIME OF THE FACT THAT IF SHE DIDN'T
17 START EATING, MAYBE A FEEDING TUBE MIGHT BE APPROPRIATE.
18 THE FAMILY DID NOT FEEL LIKE THEY WANTED TO PURSUE FORCED
19 FEEDING. AND AT THAT POINT DR. PEARCE WAS A LITTLE BIT
20 PESSIMISTIC ABOUT HOW SHE WOULD DO AND SENT HER BACK TO A
21 DIFFERENT NURSING HOME FOR HER CARE. AND THAT'S WHEN WE
22 STARTED THE TRAZODONE TO HELP HER REST AT NIGHT.
23 Q. DID YOU SEE HER IN YOUR OFFICE AT ANY TIME BETWEEN THE
24 JULY 15TH HOSPITALIZATION AND THE AUGUST 25TH
25 HOSPITALIZATION?
975
1 A. I DID NOT.
2 Q. WHEN WAS THE NEXT TIME YOU ACTUALLY HAD AN OPPORTUNITY
3 TO OBSERVE HER? WAS THERE A THIRD HOSPITALIZATION?
4 A. YES. ON SEPTEMBER 14 I'D HAD A CALL FROM THE HOLLADAY
5 HEALTH CARE CENTER SHE WAS AT AND THAT WAS WHEN SHE WAS A
6 LITTLE BIT AGITATED AND THAT'S WHERE WE STARTED THE XANAX,
7 WHICH IS SIMILAR TO ATIVAN, A MILD TRANQUILIZING AGENT. I
8 CHOSE THE .25 MILLIGRAM, WHICH IS THE SMALLEST DOSE THAT IT
9 COMES IN, TWO OR THREE TIMES A DAY, AS NEEDED.
10 SHE FELL -- ONE OF THE PROBLEMS SHE HAD WAS SHE WOULD
11 GET OUT OF BED WITHOUT ASSISTANCE AND HAD FALLEN A COUPLE OF
12 TIMES. AND SHE FELT -- SHE FELL ON THE NIGHT OF THE 13TH OR
13 THE MORNING OF THE 14TH AND I WAS AROUND AT THAT POINT AND I
14 DID THE ADMISSION. I DID MENTION --
15 Q. HOW OLD WAS JUDITH AT THIS TIME?
16 A. NINETY-THREE, I BELIEVE. SHE WAS BORN IN 1902, SO 93.
17 Q. SO THAT PARTICULAR HOSPITALIZATION ON SEPTEMBER THE 14TH
18 WAS PRECIPITATED BY WHAT EVENT?
19 A. SHE FELL AND HIT HER HEAD AND HAD A LACERATION ON HER
20 HEAD. WAS TAKEN TO THE EMERGENCY ROOM WHERE THEY STITCHED
21 IT UP. BUT THEY FELT THAT SHE HAD SUFFERED A LITTLE BIT OF
22 A CONCUSSION AND SO WE ADMITTED HER TO OBSERVE HER AND SEE
23 HOW SHE WOULD DO.
24 Q. WHEN WAS SHE RELEASED?
25 A. SHE WAS RELEASED ON THE -- LET'S SEE. UNFORTUNATELY --
976
1 IT IS -- NO. I'VE GOT MY RECORDS A LITTLE BIT OUT OF ORDER
2 HERE. THE 19TH -- LET'S SEE -- NO. THE 17TH OF JULY, 14TH
3 THROUGH THE 17TH, SO FOUR-DAY ADMISSION.
4 Q. YOU ARE TALKING ABOUT SEPTEMBER?
5 A. SEPTEMBER 17.
6 Q. DID YOU SEE HER IN THE HOSPITAL AT THAT TIME?
7 A. YES. I TOOK CARE OF HER IN THAT HOSPITALIZATION.
8 Q. AGAIN, WERE THERE ANY COMPLAINTS OF PAIN THAT SHE
9 EXPRESSED TO YOU ON THAT PARTICULAR HOSPITALIZATION?
10 A. AT THAT TIME SHE HAD A BIG BUMP ON HER HEAD AND HAD THE
11 LACERATION, BUT I DON'T HAVE THE MEDICATION LIST HERE. I
12 BELIEVE WE JUST TREATED HER WITH TYLENOL AT THAT TIME.
13 Q. OKAY. YOU ARE NOT AWARE, OTHER THAN THE TYLENOL, IF SHE
14 RECEIVED ANY FORM OF PAIN MEDICATION?
15 A. I DON'T HAVE A RECORD OF ANYTHING.
16 Q. DID YOU HAVE OCCASION AFTER SEPTEMBER 14, 1995, TO SEE
17 HER EITHER IN YOUR OFFICE OR ANY SUBSEQUENT HOSPITALIZATION?
18 A. YES. I DID SEE HER ON OCTOBER 3RD. MAKE SURE I DIDN'T
19 SEE HER BEFORE THAT.
20 Q. THIS WOULD BE APPROXIMATELY TWO WEEKS AFTER THE
21 HOSPITALIZATION?
22 A. UH-HUH. AND AT THAT TIME WE HAD STARTED THE TRAZODONE
23 TO HELP HER REST AT NIGHT AND WE MADE A MINOR ADJUSTMENT. I
24 REEVALUATED HER BECAUSE OF THE FALL AND THE CONCUSSION. THE
25 STITCHES HAD BEEN REMOVED. NURSING HOME STATED THAT SHE HAD
977
1 BEEN DOING WELL ON THE XANAX THREE TIMES A DAY AND THE
2 TRAZODONE AT BEDTIME, BUT BECAUSE OF HER TENDENCY TO FALL,
3 WE HAD DECIDED RATHER THAN PUTTING HER UP ON A BED THAT WE'D
4 PUT A MATTRESS ON THE FLOOR SO THAT IF SHE GOT OUT OF BED IT
5 WOULD BE A LITTLE BIT SHORTER FALL. SHE WOULDN'T HURT
6 HERSELF.
7 Q. REFERENCING THAT TIME FRAME FROM THE HOSPITALIZATION IN
8 SEPTEMBER UP UNTIL OCTOBER THE 3RD, DID YOU MAKE ANY KIND
9 OF -- OR DID YOU FORM ANY KIND OF IMPRESSIONS RELATIVE TO
10 HER GENERAL HEALTH FOR A 93-YEAR-OLD WOMAN?
11 A. I THINK THE STROKE HAD REALLY TAKEN ITS TOLL. SHE
12 WAS -- WOULD PERSEVERATE, MEANING SHE WOULD KEEP SAYING THE
13 SAME THING OVER AND OVER AGAIN. YOU COULDN'T INVOLVE HER IN
14 CONVERSATION WHERE YOU COULD DISCUSS THINGS BACK AND FORTH.
15 SHE WOULDN'T SPEAK A LITTLE BIT. APPARENTLY WAS --
16 ACCORDING TO THE NURSING HOME WAS EATING BETTER. WAS TAKING
17 HER MEALS. THAT THEY WERE TAKING CARE OF MOST OF HER
18 ACTIVITIES OF DAILY LIVING INCLUDED DRESSING, BRUSHING
19 TEETH, THOSE TYPE OF THINGS.
20 Q. YOU MADE A COMMENT EARLIER ABOUT A REFERENCE THAT YOUR
21 COLLEAGUE HAD MADE BACK IN AUGUST. I THINK HE REFERENCED AS
22 BEING PESSIMISTIC. HAVE YOU REVIEWED HIS --
23 A. YES. AT THE TIME HE DISCHARGED HER AFTER THE AUGUST ONE
24 HE DID MENTION THAT --
25 MR. STIRBA: YOUR HONOR, I'M NOT SURE THAT'S
978
1 RESPONSIVE TO THE QUESTION. THE QUESTION WAS DID YOU REVIEW
2 IT, AND THAT'S YES OR NO.
3 THE WITNESS: YES, I REVIEWED IT.
4 Q. (BY MR. WILSON) AND BASED UPON YOUR REVIEW, DID YOU
5 FORM ANY IMPRESSIONS AS TO WHETHER OR NOT THERE WAS ANY
6 DIFFERENCE BETWEEN HOW SHE WAS ACTING IN SEPTEMBER OVER HOW
7 SHE WAS RESPONDING IN AUGUST?
8 A. IN SEPTEMBER I STATED IN MY DICTATED NOTE, THE PATIENT
9 ON LAST HOSPITAL ADMISSION WAS REFUSING TO EAT AND LATER
10 REGAINED HER APPETITE. SHE SEEMED TO BE DOING MUCH BETTER
11 AT NURSING HOME WHEN THE EVENT HAPPENED LAST EVENING --
12 REFERRING TO THE FALL AND CONCUSSION.
13 Q. SO YOU SEE HER AGAIN ON OCTOBER THE 3RD. IS THERE ANY
14 OTHER TIME THAT YOU'D SEEN HER SUBSEQUENT TO OCTOBER THE
15 3RD?
16 A. I SAW HER TWO MORE TIMES, ONE A MONTH LATER ON NOVEMBER
17 THE 3RD. AT THAT POINT SHE CAME IN A WHEELCHAIR. I
18 MENTIONED THAT SHE WAS WHINING A LITTLE BIT. PERSEVERATED
19 AGAIN, JUST REPEATING THINGS SHE HAD HEARD. CRIED OUT A
20 COUPLE OF TIMES IN THE OFFICE. I POKED AND PRODDED. DIDN'T
21 FIND ANY PARTICULAR SPOT. SINCE SHE WAS PRONE TO FALLS, I
22 ALWAYS CHECKED AND MAKE SURE THERE ISN'T AN AREA OF THE BODY
23 WHERE SHE MIGHT HAVE CRACKED A RIB OR BUMPED A HIP OR
24 SOMETHING. BUT I DID NOT REPORT ANYTHING THAT I THOUGHT WAS
25 A TENDER SPOT ON HER. I DID NOT CHANGE THE MEDICATIONS.
979
1 LET'S SEE. STILL THE XANAX AND THE TRAZODONE WERE THE
2 TWO -- WE'LL CALL IT PSYCHOTROPIC DRUGS, THE ONES THAT HELP
3 WITH THE CONFUSION. SHE HAD HAD A LITTLE YEAST INFECTION
4 UNDER THE BREAST AND WE HAD GIVEN HER SOME CREAM FOR THAT.
5 Q. SO DID YOU FORM AN IMPRESSION IN NOVEMBER AS TO HER
6 GENERAL HEALTH?
7 A. MY ASSESSMENT WAS THAT SHE CONTINUED TO BE DEMENTED AND
8 CONTINUED NEEDED NURSING HOME CARE.
9 Q. WHAT WAS THE REASON FOR THIS PARTICULAR VISIT? WAS
10 THERE ANY?
11 A. I THINK MY NOTE HERE SAYS I WAS ASSESSING HER TENDENCY
12 TO FALL. SHE CAME IN IN A WHEELCHAIR. MY GUESS IS MOST
13 NURSING HOMES, ONCE THEY ADMIT A MEDICARE PATIENT, REQUIRE A
14 30 AND 60 DAY FOLLOW-UP AND I THINK THAT WAS MORE RATHER
15 ROUTINE UNDER MEDICARE RULES AS OPPOSED TO THE FAMILY HAVING
16 SPECIFIC CONCERNS.
17 Q. OKAY. THE LAST TIME YOU HAD OCCASION TO MEET WITH HER
18 WAS WHEN?
19 A. DECEMBER 4TH.
20 Q. AND WHERE DID THIS VISIT TAKE PLACE?
21 A. THIS -- ACTUALLY I DIDN'T SEE HER. THE FAMILY CAME IN
22 WITH A FORM FOR ME TO FILL OUT. THE NURSING HOME WHERE SHE
23 WAS AT WAS CONCERNED ABOUT HER AGITATION AT NIGHT. THEY
24 FELT THAT SHE NEEDED SOME PSYCHIATRIC EVALUATION AND PERHAPS
25 A CHANGE IN HER PSYCHIATRIC MEDICATION. THE FAMILY HAD
980
1 RESEARCHED AND FOUND A PLACE IN BOUNTIFUL THAT THEY WANTED
2 TO TAKE HER AND THERE WERE FORMS TO BE FILLED OUT TO HAVE
3 HER TRANSFERRED. I BELIEVE THE MAIN PURPOSE OF DECEMBER 4TH
4 WAS TO FILL OUT THE FORMS FOR THE NURSING OR THE CARE CENTER
5 IN BOUNTIFUL AND SIGN A REQUEST FOR A PSYCHIATRIC EVALUATION
6 THERE.
7 Q. OKAY. SO DID YOU FILL OUT THOSE FORMS AND ASSIST IN
8 THAT TRANSFER?
9 A. I DID.
10 Q. DO YOUR NOTES REFLECT, SIR, BETWEEN YOUR NOVEMBER 3RD
11 MEETING AND YOUR DECEMBER 4TH WHEN YOU FILLED OUT THE FORMS
12 ANY -- DO THEY HAVE ANY REFERENCES TO ANY INCIDENTS OR CALLS
13 FROM A NURSING HOME?
14 A. THE CALLS ARE REPORTED SEPARATELY FROM THAT. THE NOTE
15 THAT CAME FROM THE NURSING HOME ON DECEMBER 4 STATED THAT
16 THE PATIENT SLEEPS WELL AT NIGHT ON PRESENT MEDICATIONS. IS
17 MORE COOPERATIVE WITH CARE. LISTS THE XANAX AND THE
18 TRAZODONE, THE THYROID, A BABY ASPIRIN, AND NITROGLYCERIN
19 AND SOME EYE DROPS THAT SHE WAS TAKING. AND AS FAR AS PAIN
20 MEDICATION IS LISTED, TYLENOL EVERY SIX HOURS AS NEEDED FOR
21 DISCOMFORT OR PAIN, AND THEN SOME ZANTAC FOR HEARTBURN.
22 Q. AND TYLENOL ITSELF, IS THAT A PRESCRIPTION TYLENOL?
23 A. NO, IT'S NOT. BUT IN NURSING HOMES EVEN
24 NON-PRESCRIPTION MEDICATION HAS TO BE APPROVED BY THE
25 PHYSICIAN.
981
1 Q. OKAY. I TAKE IT YOU DID NOT HAVE ANY -- WELL, LET'S
2 JUST ASK YOU THIS. HAVE YOU GOT ANY NOTES IN YOUR FILE AS
3 HAVING CONFERRED WITH ANYBODY IN THE GEROPSYCH UNIT AT THE
4 DAVIS HOSPITAL?
5 A. I HAVE A NOTE FROM THE SOCIAL WORKER THAT REQUESTS ME TO
6 TALK PERSON TO PERSON WITH, I BELIEVE IT MENTIONED -- TRYING
7 TO FIND THAT -- DR. WEITZEL'S NAME IS THE PERSON I NEEDED TO
8 TALK TO TO HAVE THE PATIENT TRANSFERRED TO THE GEROPSYCH
9 UNIT. SO I DON'T HAVE ANY RECORD THAT WE HAD THAT
10 CONVERSATION. MY GUESS IS THAT I PROBABLY DID UPDATE HIM ON
11 THE CONDITION, BUT I DON'T HAVE ANY RECORD HERE OF IT.
12 Q. YOU DON'T HAVE ANY RECORD REFLECTING WHETHER OR NOT
13 THERE WAS SUCH A CONVERSATION?
14 A. CORRECT.
15 Q. WHAT WAS YOUR OPINION BASED UPON YOUR REVIEW OF THE
16 RECORDS AS TO -- FIRST OF ALL, AS TO THE PHYSICAL HEALTH OF
17 JUDITH LARSEN, AT LEAST AS TO THE LAST TIME YOU ACTUALLY MET
18 WITH HER?
19 A. ELDERLY, FRAIL LADY WHO SHOWED A REMARKABLE RESILIENCE
20 TO BOUNCE BACK FROM THE HOSPITALIZATIONS, BUT NEVERTHELESS
21 93 YEARS OLD, NOT OF SOUND MIND, CONFUSED AND REQUIRED MORE
22 CARE THAN THE HOLLADAY CARE CENTER COULD PROVIDE HER.
23 Q. AS TO PHYSICAL DISABILITIES THEMSELVES, DO YOU NOTE IN
24 YOUR EXAMS AND YOUR PREVIOUS EXAMS, OTHER THAN THE STROKE
25 THAT SHE HAD INCURRED, WHETHER OR NOT SHE HAD ANY OTHER -- I
982
1 GUESS FOR LACK OF A BETTER EXPRESSION -- CATEGORIZED AS
2 SERIOUS HEALTH PROBLEMS?
3 A. WELL, SHE'D HAD PREVIOUS HEART DISEASE, BUT I'M NOT SURE
4 SHE WAS ABLE TO TELL ME WHETHER OR NOT SHE WAS HAVING
5 ANGINA. THE THYROID CONDITION. OBVIOUSLY HAD GOOD BONES
6 'CAUSE SHE HAD FALLEN A FEW TIMES AND HADN'T BROKEN
7 ANYTHING. BUT AT 93 IT'S -- I COULDN'T SAY THAT SHE WAS THE
8 PICTURE OF HEALTH.
9 Q. SO OTHER THAN THE TYLENOL, THERE WAS NO PAIN MEDICATION
10 DURING THE COURSE OF YOUR TREATMENT YOU ADMINISTERED TO HER?
11 A. NO. THE NURSES DID REPORT THE TIMES THAT SHE WOULD CRY
12 OUT. AND WHEN SOMEONE CAN'T TELL YOU EXACTLY WHAT'S WRONG,
13 IT'S DIFFICULT TO TELL WHETHER THAT CRY IS AGITATION OR
14 WHETHER THAT CRY MIGHT BE PAIN. BUT I WAS NEVER -- THE
15 NURSES NEVER TOLD ME THAT SPECIFICALLY SHE WAS FAVORING THIS
16 HIP OR THAT SHE WAS BREATHING FUNNY OR WOULDN'T USE AN ARM
17 OR ANYTHING LIKE THAT THAT WOULD LEAD US TO BELIEVE THAT
18 THERE WAS PAIN.
19 MR. WILSON: I HAVE NO FURTHER QUESTIONS, YOUR
20 HONOR.
21 THE COURT: MR. STIRBA.
22 CROSS-EXAMINATION
23 BY MR. STIRBA:
24 Q. GOOD AFTERNOON, DR. STEVENS. IT'S TRUE, JUST FOLLOWING
25 UP FROM WHAT YOU JUST SAID, THAT DEALING WITH SOMEONE OF
983
1 JUDITH'S AGE AND HER INABILITY TO COMMUNICATE MAKES CERTAIN
2 CLINICAL ASSESSMENTS DIFFICULT?
3 A. IT IS. FREQUENTLY WE CAN SYMPATHIZE WITH THE
4 PEDIATRICIANS WITH THE SMALL BABY THAT CAN'T TELL YOU
5 WHAT'S WRONG OR EVEN VETERINARIANS THAT DEAL WITH ANIMALS
6 THAT CAN'T TELL YOU WHAT'S WRONG. IT'S VERY DIFFICULT.
7 Q. AND FOR EXAMPLE IN HER CASE, THERE'S NO QUESTION BASED
8 UPON THE STROKE EVENT THAT OCCURRED IN THE BEGINNING OF 1995
9 AND THEN WHAT APPEARED TO BE ANOTHER STROKE IN AUGUST OF
10 1995, SHE SUFFERED FROM CEREBROVASCULAR DISEASE?
11 A. THAT'S A GOOD ASSUMPTION, YES.
12 Q. AND WOULD YOU JUST TELL THE FOLKS ON THE JURY WHAT
13 CEREBROVASCULAR DISEASE IS?
14 A. GENERALLY IN THE VERY OLD WHEN YOU HAVE A -- THERE'S TWO
15 OR THREE DIFFERENT TYPES OF STROKES. CEREBROVASCULAR
16 DISEASE REFERS TO WHAT WE COMMONLY CALL STROKES. THERE IS
17 TWO OR THREE DIFFERENT TYPES. YOU CAN BE BLEEDING OR
18 HEMORRHAGE. THAT'S LESS COMMON NOW 'CAUSE THAT'S USUALLY
19 FROM UNCONTROLLED HIGH BLOOD PRESSURE AND HOPEFULLY WE'RE
20 GETTING BETTER AT CONTROLLING THAT.
21 THERE ARE BLOCKAGES OF LARGE ARTERIES AND BLOCKAGES OF
22 SMALL ARTERIES. IF YOU HAVE A BLOCKAGE OF A LARGE ARTERY
23 YOU CAN HAVE A PRETTY DEVASTATING STROKE THAT CAN LEAVE YOU
24 EITHER PARALYZED ON ONE SIDE OR UNABLE TO SPEAK. THE SMALL
25 VESSEL DISEASE IS WHAT IS PROBABLY MORE COMMON IN THAT AGE
984
1 GROUP AND CAN LEAD TO DEMENTIA. CAN LEAD TO JUST SMALL
2 DEFICITS.
3 I BELIEVE THE STROKES SHE HAD IN JANUARY DID SHOW UP ON
4 A C.A.T. SCAN AS A LITTLE BIT OF A LARGER ONE, BUT WE ALL
5 FELT THAT SHE PROBABLY WAS HAVING SOME SMALLER STROKES THAT
6 WERE AFFECTING HER ABILITY TO THINK AND CAUSING HER DEMENTIA
7 AND CONFUSION.
8 Q. AND IT'S TRUE, IS IT NOT, IN TERMS OF THE EVENTS -- AND,
9 FOR EXAMPLE, THIS MAY BE TRUE IN JUDITH'S CASE. REALLY
10 WHAT'S SIGNIFICANT IN TERMS OF ULTIMATELY THE DAMAGE THAT IS
11 CAUSED IS NOT NECESSARILY THE SIZE OF THE EVENT, BUT THE
12 LOCATION OF THE EVENT?
13 A. CORRECT.
14 Q. SO IN OTHER WORDS, YOU COULD HAVE WHAT IS ESSENTIALLY A
15 SMALL EVENT, BUT IT'S IN A BAD PLACE IN THE BRAIN, THEN IT
16 COULD HAVE DEVASTATING CONSEQUENCES?
17 A. CORRECT.
18 Q. SIMILARLY YOU COULD HAVE A LARGE EVENT IN A CERTAIN AREA
19 OF THE BRAIN AND PERHAPS VERY LITTLE RESIDUAL CONSEQUENCE TO
20 THE PATIENT; IS THAT TRUE?
21 A. THAT'S TRUE.
22 Q. AND IT'S TRUE, IS IT NOT, THAT IN AUGUST THERE WAS SOME
23 DETERMINATION THAT PERHAPS THE EVENTS WERE SUBACUTE?
24 A. CORRECT. I BELIEVE I LOOKED AT THE C.A.T. SCAN REPORT
25 AND IT WAS UNCHANGED FROM THE PREVIOUS ONE, BUT THE TINY
985
1 STROKES -- THAT'S POSSIBLE THAT A TINY STROKE WAS NOT PICKED
2 UP ON A C.A.T. SCAN.
3 Q. AND ALSO YOU TESTIFIED THAT JUDITH HAD SOME CONGESTIVE
4 HEART FAILURE; IS THAT RIGHT?
5 A. I HAVEN'T SAID THAT YET TODAY. I DON'T KNOW THAT MY --
6 Q. I'M SORRY. I MIGHT HAVE MISHEARD.
7 A. CORONARY ARTERY DISEASE.
8 Q. I'M SORRY. THANK YOU. CORONARY ARTERY DISEASE. AND
9 WOULD YOU TELL THE FOLKS ON THE JURY WHAT THAT IS?
10 A. BLOCKAGES IN THE ARTERIES THAT FEED THE HEART, AND WHEN
11 THEY BECOME SIGNIFICANT ENOUGH, WITH EXERTION YOU COULD FEEL
12 PAIN OR DISCOMFORT THAT WE TERM ANGINA, CHEST PAINS. IF A
13 BLOOD CLOT FORMS WHERE THERE IS KIND OF A BLOCKAGE YOU COULD
14 HAVE A HEART ATTACK.
15 Q. DID SHE HAVE ANY OTHER DIAGNOSABLE CIRCULATORY OR
16 CARDIAC DYSFUNCTIONS OR PROBLEMS?
17 A. NOT ACCORDING TO THE RECORDS THAT I HAVE, BUT SHE WAS
18 NOT A GREAT HISTORY GIVER. SO IT WOULD BE DIFFICULT TO KNOW
19 WHAT ELSE WAS GOING ON.
20 Q. NOW, YOU STARTED TO SEE HER IN FEBRUARY OF '95 AFTER THE
21 STROKE; IS THAT RIGHT?
22 A. CORRECT.
23 Q. AND THEN, OF COURSE, YOU SAW HER AT LEAST THROUGH THE
24 TIME SHE WAS ADMITTED TO THE DAVIS HOSPITAL IN THE BEGINNING
25 OF DECEMBER OF 1995 AND, IF I UNDERSTAND YOUR TESTIMONY,
986
1 THERE WERE THREE HOSPITALIZATIONS AT LEAST THAT'S REFLECTED
2 IN YOUR RECORDS; IS THAT RIGHT?
3 A. THAT'S CORRECT.
4 Q. THERE WAS THE JULY '95 HOSPITALIZATION WHEN YOU IN FACT
5 CARED FOR HER; IS THAT CORRECT?
6 A. DR. PEARCE CARED FOR HER.
7 Q. I'M SORRY. DR. PEARCE CARED FOR HER. THEN THERE WAS
8 AUGUST 1995 HOSPITALIZATION AND DR. PEARCE ALSO CARED FOR
9 HER; IS THAT RIGHT?
10 A. YES.
11 Q. AND THEN THERE WAS THE SEPTEMBER 14, 1995
12 HOSPITALIZATION AND YOU PROVIDED THE CARE, TRUE?
13 A. CORRECT.
14 Q. THIS WAS ALL ESSENTIALLY AT COTTONWOOD HOSPITAL?
15 A. COTTONWOOD HOSPITAL.
16 Q. YOU HAVE THOSE RECORDS IN FRONT OF YOU AS PART OF YOUR
17 FILE.
18 A. I JUST HAVE THE DICTATIONS. I DON'T HAVE THE FULL
19 HOSPITALIZATIONS. I HAVE -- THE ADMITTING AND DISCHARGE
20 DICTATIONS ARE SENT BACK TO THE DOCTOR'S OFFICE AND I HAVE
21 MY OFFICE FILE. I DON'T HAVE THAT IN FRONT OF ME, ANY
22 HOSPITAL RECORDS THAT WOULD INCLUDE NURSES' NOTES.
23 Q. WELL, FOR EXAMPLE, THE SEPTEMBER 14, 1995 ADMISSION, DO
24 YOU HAVE THAT IN FRONT OF YOU, FOR EXAMPLE, YOUR DISCHARGE
25 SUMMARY?
987
1 A. I HAVE THE ADMISSION ONE AND I WAS LOOKING FOR THE
2 DISCHARGE SUMMARY. AND MY FILING PEOPLE MUST HAVE GOT IT
3 OUT OF PLACE 'CAUSE I DON'T HAVE IT DIRECTLY IN FRONT OF ME.
4 DO YOU HAVE A COPY OF IT? IT MIGHT HELP ME IF I COULD LOOK
5 AT THAT. WAIT A MINUTE. HERE, I'VE GOT IT. ACTUALLY IT
6 WAS THE AGE.
7 Q. YOU HAVE IT. IT'S ONE OF THOSE WHERE IT SAYS, I
8 AUTHORIZE MY NAME TO BE AUTOMATICALLY AFFIXED TO THIS
9 REPORT, GREGORY P. STEVENS. AND IT LOOKS LIKE IT WAS
10 DICTATED ON 9/18/95, TRANSCRIBED ON 9/19/95?
11 A. CORRECT.
12 Q. YOU HAVE THAT IN FRONT OF YOU?
13 A. I DO.
14 Q. FOR YOU IT HAS A PORTION OF THE DISCHARGE SUMMARY FOR
15 THE SEPTEMBER 14, 1995 ADMISSION; IS THAT RIGHT?
16 A. CORRECT.
17 Q. AND THE ADMISSION WAS CAUSED BECAUSE JUDITH HAD A FALL
18 IN THE NURSING HOME; IS THAT RIGHT?
19 A. THAT'S CORRECT.
20 Q. AND, IN FACT, SUFFERED A LACERATION ON HER HEAD; ISN'T
21 THAT TRUE?
22 A. CORRECT.
23 Q. AND, IN FACT, THIS LACERATION WAS ABOUT THREE INCHES
24 LONG?
25 A. I DON'T KNOW IF I DESCRIBED IT. IT WOULD BE FROM THE
988
1 EMERGENCY ROOM DOCTOR'S NOTE, SO I DON'T HAVE THAT WITH ME.
2 Q. OKAY. NOW, YOU INDICATE UNDER DISCHARGE DIAGNOSIS -- DO
3 YOU SEE THAT?
4 A. UH-HUH.
5 Q. YOU HAVE INTRACTABLE NAUSEA AND VOMITING SECONDARY TO
6 CONCUSSION. THE CONCUSSION THAT YOU ARE REFERRING TO IS THE
7 CONCUSSION THAT WAS CAUSED EARLIER FROM A FALL?
8 A. FROM THE FALL.
9 Q. AND THAT WOULD HAVE BEEN IN AUGUST?
10 A. NOVEMBER, THE ONE JUST PRIOR TO THE ONE THAT GAVE HER
11 THE LACERATION ON THE HEAD.
12 Q. SO THE CONCUSSION WOULD HAVE BEEN AS A RESULT OF THIS
13 FALL?
14 A. YES.
15 Q. COULD YOU TELL US, PLEASE, WHAT A CONCUSSION IS?
16 A. CONCUSSION IS BASICALLY BRUISING OF THE BRAIN, IN SIMPLE
17 TERMS. THE BRAIN IS SURROUNDED BY FLUID AND WHEN YOU FALL
18 AND WHACK THE BRAIN, IT LITERALLY BOUNCES BACK AND FORTH
19 BETWEEN THE BONES INSIDE YOUR HEAD AND CAN CAUSE BRUISING
20 BOTH IN THE FRONT -- IF YOU FELL ON THE FRONT OF YOUR HEAD
21 IT COULD CAUSE BRUISING ON THE FRONT OF THE BRAIN, BUT ALSO
22 BECAUSE THE BRAIN KIND OF BOUNCES BACK AND FORTH YOU CAN
23 SIMILARLY GET -- ON THE OPPOSITE SIDE FROM THE FALL YOU CAN
24 GET BRUISING OF THE BRAIN AS WELL.
25 Q. AND THEN YOU INDICATE NEXT, CONCUSSION FROM FALL, WHICH
989
1 YOU JUST DESCRIBED.
2 AND THEN YOU HAVE LISTED NUMBER THREE, DEMENTIA.
3 THAT'S THE MENTAL COMPONENT OF THE PROBLEMS THAT JUDITH WAS
4 SUFFERING AT THE TIME; IS THAT RIGHT?
5 A. CORRECT.
6 Q. AND THEN WE HAVE CORONARY ARTERY DISEASE WHICH YOU JUST
7 TESTIFIED THAT SHE HAD; IS THAT RIGHT?
8 A. CORRECT.
9 Q. AND THEN YOU HAVE HYPOTHYROIDISM WHICH YOU TESTIFIED TO
10 AS WELL ON DIRECT EXAMINATION; IS THAT RIGHT?
11 A. CORRECT.
12 Q. AND THEN YOU HAVE UNDER MEDICATIONS OR HOSPITAL COURSE,
13 RATHER IT SAYS THE PATIENT WILL BE DISCHARGED BACK TO THE
14 NURSING HOME ON THE FOLLOWING MEDICATIONS. I JUST WANT TO
15 ASK YOU ABOUT A COUPLE OF THEM. THERE'S ONE THAT SAYS
16 ISOSORBIDE, AND IT HAS 10 MILLIGRAMS AND IT HAS P.O. B.I.D.
17 WHAT DOES THAT STAND FOR?
18 A. ISOSORBIDE IS TIME-RELEASED NITROGLYCERIN 10 MILLIGRAMS
19 BY MOUTH TWICE A DAY.
20 Q. AND THAT IS A HEART MEDICATION?
21 A. THAT'S HEART, UH-HUH.
22 Q. AND THEN WE HAVE ALSO TRAZODONE WHICH YOU TESTIFIED TO
23 ON DIRECT. 50 MILLIGRAMS AT LEAST AS OF THAT POINT. IS
24 THAT TWICE A DAY?
25 A. THAT IS AT BEDTIME. Q.H.S. MEANS AT BEDTIME.
990
1 Q. SO THAT WOULD BE 50 MILLIGRAMS, ONE PILL AT BEDTIME?
2 A. UH-HUH.
3 Q. AND TRAZODONE IS WHAT KIND OF MEDICATION AGAIN?
4 A. IT'S AN ANTIDEPRESSANT THAT HELPS WITH SLEEP.
5 Q. AND IT'S TRUE, IS IT NOT, IT HAS SEDATING QUALITIES?
6 A. YES, IT DOES.
7 Q. IN FACT, IT IS A SEDATIVE, TRUE?
8 A. CORRECT.
9 Q. BY SEDATIVE WE MEAN DEPRESSION OF THE CENTRAL NERVOUS
10 SYSTEM, ESSENTIALLY?
11 A. ACTUALLY, FRANKLY SPEAKING IT'S ANTIDEPRESSANT THAT HAS
12 SEDATING EFFECTS, SIDE EFFECTS.
13 Q. AND YOU PRESCRIBE THAT FOR SLEEP OR FOR DEPRESSION?
14 A. USUALLY A LITTLE OF BOTH. IF SOMEBODY IS DEPRESSED AND
15 AGITATED AT NIGHT AND CAN'T SLEEP, IT'S NICE TO HAVE A
16 SLEEPING PILL -- ANTIDEPRESSANT PILL THAT HELPS YOU REST AT
17 NIGHTTIME.
18 Q. THEN WE HAVE XANAX AND XANAX IS ESSENTIALLY ANTIANXIETY
19 MEDICATION?
20 A. CORRECT.
21 Q. AND I THINK -- DID YOU DESCRIBE XANAX AS A TRANQUILIZER
22 PREVIOUSLY?
23 A. YES.
24 Q. SO THAT'S A SEDATING MEDICATION AS WELL?
25 A. WELL, IT'S NOT AS SEDATING AS TRANQUILIZING. I CHOSE
991
1 THAT OVER VALIUM 'CAUSE I FEEL VALIUM CAUSES MORE
2 DROWSINESS. THE XANAX DOESN'T CAUSE QUITE AS MUCH
3 DROWSINESS WHEN IT'S TAKEN.
4 Q. TELL US, PLEASE, THE DIFFERENCE BETWEEN A TRANQUILIZER
5 MEDICATION AND A SEDATING MEDICATION.
6 A. I THINK YOU CAN PROBABLY SAY THEY ARE ABOUT THE SAME.
7 Q. DO THEY HAVE THE SAME EFFECT PHYSIOLOGICALLY?
8 A. OH, TO GET INTO THE PHARMACOLOGY OF THEM, I DON'T
9 THINK -- I DON'T THINK THAT'S ANYTHING THAT IS GOING TO HELP
10 US UNDERSTAND A LITTLE BIT. WHAT WE'RE LOOKING FOR IN THIS
11 EFFECT WAS SOMEBODY WITH AGITATION. I WANTED SOMETHING THAT
12 WOULD HELP CONTROL THE AGITATION. WHETHER YOU CALL THAT
13 SEDATING THEM OR TRANQUILIZING THEM, I THINK IT MEANS THE
14 SAME THING.
15 Q. SO THE SEDATION FACTOR HELPS IN CONTROLLING THE
16 BEHAVIOR?
17 A. IT CAN SOMETIMES.
18 Q. AND WAS THAT THE CASE HERE WITH THE ORDERING OR
19 PRESCRIBING OF XANAX?
20 A. WELL, I WASN'T LOOKING SO MUCH FOR SEDATION. I WOULD
21 HAVE CHOSEN VALIUM FOR TRUE SEDATION. I WAS LOOKING MORE
22 FOR PREVENTING AGITATION.
23 Q. IT SAYS FOR ANXIETY?
24 A. CORRECT.
25 Q. SO IS IT FOR ANXIETY OR FOR AGITATION?
992
1 A. IN MY MIND THOSE ARE PRETTY EQUIVALENT.
2 Q. AND THEN, ALSO, THERE WAS ANOTHER PRESCRIPTION THAT I
3 BELIEVE YOU PROVIDED FOR JUDITH AND THAT WAS ATIVAN?
4 A. SHE HAD BEEN ON ATIVAN EARLIER AND WE HAD MADE THE
5 SWITCH TO XANAX, AND I BELIEVE WE HAD TRIED BOTH OF THEM AND
6 THE NURSING HOME REPORTED SHE RESPONDED BETTER TO XANAX.
7 ATIVAN AND XANAX ARE USED FOR THE SAME PURPOSE.
8 Q. IS ATIVAN ALSO ANTIANXIETY MEDICATION?
9 A. ANTIANXIETY, LESS SEDATING THAN VALIUM BUT IN THE SAME
10 CLASS.
11 Q. THEN IT SAYS, AFTER BABY ASPIRIN ONE A DAY IT SAYS THE
12 PATIENT IS NO CODE. WHAT DOES THE PATIENT BEING NO CODE
13 MEAN?
14 A. THAT MEANS THE FAMILY HAD REQUESTED THAT SHOULD SHE HAVE
15 A MAJOR HEART ATTACK THAT WE NOT PUT A TUBE DOWN HER THROAT
16 OR PRESS ON HER CHEST TO TRY AND GET THE HEART RESTARTED.
17 BECAUSE OF HER AGE AND HER OTHER HEALTH PROBLEMS THEY
18 DESIRED NATURE TO TAKE ITS COURSE IF SHE WOULD HAVE A HEART
19 ATTACK.
20 Q. HAVE YOU HAD CONVERSATIONS WITH EITHER HER SON OR
21 SOMEBODY FROM THE FAMILY ABOUT THIS VERY ISSUE?
22 A. YES, I HAD.
23 Q. AND DO YOU RECALL APPROXIMATELY WHEN YOU HAD
24 CONVERSATIONS IN THAT RESPECT?
25 A. I HAVE A NOTE IN MY CHART REGARDING THAT. I CAN'T GIVE
993
1 THE EXACT DAY. I KNOW THAT WE SPOKE ABOUT IT IN THE OFFICE
2 AND WE SPOKE ABOUT IT AT THE HOSPITAL, SO I CAN'T GIVE YOU
3 AN EXACT DAY.
4 Q. WAS YOUR CONVERSATION WITH MERLIN LARSEN?
5 A. YEAH. MOST OF WITH THE FAMILY. HE WAS MY MAIN CONTACT.
6 Q. AND DO YOU RECALL, IN ADDITION TO WHAT YOU JUST
7 DESCRIBED, IF THERE WERE ANY OTHER DIRECTIONS THAT YOU
8 RECEIVED EITHER FROM MR. LARSEN OR THE FAMILY IN THIS
9 RESPECT?
10 A. I THINK THEY WERE UNCOMFORTABLE HAVING HER RESTRAINED.
11 I DO HAVE A NOTE HERE THAT THEY WOULD -- THEY WERE HOPING I
12 COULD FIND THE RIGHT COMBINATION OF MEDICATIONS THAT WOULD
13 KEEP HER FROM GETTING UP AND FALLING. THAT THEY WOULDN'T
14 HAVE TO PUT RESTRAINTS ON HER TO HOLD HER IN HER CHAIR OR
15 RESTRAIN HER.
16 Q. THAT WAS SOMETHING THAT WAS OCCURRING AT THE NURSING
17 HOME?
18 A. THE NURSES FELT TO PROTECT HER AND PROTECT HER FROM
19 FALLING AND INJURING HERSELF THEY HAD TO USE ONE OF THOSE
20 VESTS THAT TIE IN THE BACK OF THE CHAIR SO SHE CAN'T FALL
21 OUT OF THE CHAIR.
22 Q. SO I NOTICE ON THIS DISCHARGE SUMMARY, ONCE AGAIN IT
23 STATES, THE NURSING HOME WILL BE ENCOURAGED TO RESTRAIN THE
24 PATIENT AT ALL TIMES AS THIS IS THE THIRD FALL IN WHICH
25 SHE--
994
1 A. IT SHOULD BE SHE.
2 Q. -- SUSTAINED LACERATIONS. IN TERMS OF YOUR CARE, WERE
3 YOU ABLE TO DETERMINE IF THERE WAS A MEDICAL REASON FOR HER
4 FALLS?
5 A. SHE DIDN'T SEE WELL. WITH THE STROKE, THE MAJOR STROKE
6 CAUSED HALF OF HER VISUAL FIELD TO BE MISSING, SO SHE WAS
7 ONLY SEEING -- I CAN'T REMEMBER WHETHER IT WAS THE LEFT HALF
8 OR THE RIGHT HALF. AND THAT IS VERY DISORIENTING AND IT
9 AFFECTS YOUR BALANCE. I THINK THAT WAS ONE OF THE MAIN
10 REASONS. SHE WAS ALSO 93 AND WEAK AND BEING A LITTLE BIT
11 CONFUSED AS WELL ON TOP OF THAT. THAT'S KIND OF A BAD
12 COMBINATION.
13 Q. DID THE MEDICATIONS THAT SHE WAS RECEIVING AT THE TIME
14 CONTRIBUTE TO HER INSTABILITY?
15 A. IT'S HARD TO DETERMINE. I WOULD SAY THEY WOULD HAVE
16 THAT POTENTIAL.
17 Q. ONCE AGAIN, THESE ARE DIFFICULT CLINICAL ASSESSMENTS
18 GIVEN THE NATURE OF THE CIRCUMSTANCES; IS THAT RIGHT?
19 A. CORRECT.
20 Q. NOW, THE HOSPITALIZATION, THE AUGUST -- WELL, LET ME ASK
21 YOU ONE THING. DO YOU HAVE -- FROM THE SEPTEMBER 14
22 HOSPITALIZATION, DO YOU HAVE THE HISTORY AND PHYSICAL
23 EXAMINATION --
24 A. I DO.
25 Q. -- THAT YOU DICTATED. THAT'S THE DOCUMENT, IS IT NOT,
995
1 THAT YOU DICTATED?
2 A. CORRECT.
3 Q. I'M INTERESTED SPECIFICALLY UNDER SOCIAL HISTORY, YOU
4 SAY, THE PATIENT HAS BEEN LIVING AT HOLLADAY CARE CENTER
5 SINCE HER LAST HOSPITAL ADMISSION. INITIALLY SHE WAS SENT
6 THERE FOR TERMINAL CARE, BUT IMPROVED TO THE POINT WHERE SHE
7 WAS TAKING NOURISHMENT AND SEEMED TO BE RALLYING. WHAT DID
8 YOU MEAN WHEN YOU USED THE TERM "TERMINAL CARE?"
9 A. AT THAT AGE ONCE SOMEBODY REFUSES TO EAT AND IF THE
10 FAMILY DESIRES NOT TO PLACE TUBES TO FORCE FEEDING, PEOPLE
11 DON'T LAST TOO LONG WITHOUT NOURISHMENT, A FEW WEEKS. AND
12 TERMINAL CARE, YOU KNOW, UNDER THOSE CIRCUMSTANCES WOULD BE
13 WE DO EVERYTHING TO KEEP HER COMFORTABLE, BUT WOULD NOT --
14 FAMILY AT THAT TIME HAD DETERMINED THEY DID NOT WANT TUBES
15 DOWN HER NOSE OR TUBES DIRECTLY THROUGH THE STOMACH WALL
16 INTO THE STOMACH TO PROVIDE NOURISHMENT. SO HONORING THAT
17 WISH I BELIEVE DR. PEARCE IS THE ONE WHO FELT THAT IF SHE'S
18 NOT GOING TO EAT, SHE'S PROBABLY NOT GOING TO LAST VERY
19 LONG. BUT APPARENTLY SHE REGAINED HER APPETITE AND WAS
20 EATING MUCH BETTER AND THAT'S WHAT I MEANT BY RALLYING.
21 Q. DID YOU BELIEVE, BASED UPON YOUR CARE OF JUDITH, THAT
22 HER CESSATION OF EATING WAS A SIGN THAT PERHAPS SHE WAS
23 DYING?
24 A. OBVIOUSLY NOT EATING CAN LEAD TO DYING. BUT THERE ARE A
25 NUMBER OF REASONS WHY PEOPLE QUIT EATING: NAUSEA,
996
1 CONFUSION. SO I DON'T KNOW THAT I WOULD SAY THAT'S A SIGN.
2 I HAVE LOTS OF PATIENTS IN THIS AGE GROUP THAT WILL STOP
3 EATING FOR A WHILE AND THEN EITHER WITH A CHANGE IN
4 MEDICATIONS OR RESOLUTION OF A STOMACH FLU OR WHATEVER WILL
5 BEGIN EATING AGAIN.
6 Q. BUT CERTAINLY DR. PEARCE HAD THAT THOUGHT IN MIND, DID
7 HE NOT, WHEN HE REFERRED HER --
8 MR. WILSON: I'M GOING TO OBJECT AS TO WHAT
9 DR. PEARCE MAY HAVE THOUGHT, YOUR HONOR.
10 THE COURT: SUSTAINED.
11 THE WITNESS: I THINK HE'S GOING TO BE HERE TO
12 ANSWER THAT.
13 Q. (BY MR. STIRBA) ONE OTHER THING I WANT TO ASK YOU
14 ABOUT ON THIS DOCUMENT, THIS IS THE SECOND PAGE OF YOUR
15 HISTORY, PHYSICAL EXAMINATION. IT'S THE SAME DOCUMENT WE'VE
16 BEEN TALKING ABOUT AND YOU HAVE UNDER IMPRESSION AND PLAN,
17 YOU PUT CONCUSSION. AND THEN YOU HAVE, WE WILL OBSERVE THE
18 PATIENT IN HOSPITAL SETTING AND WATCH FOR SIGNS AND SYMPTOMS
19 OF EPIDURAL OR SUBDURAL HEMATOMA. THESE ARE WORDS THAT I
20 THINK -- COULD YOU EXPLAIN FOR US, PLEASE?
21 A. SURE. BOTH OF THEM INVOLVE BLEEDING OF BLOOD VESSELS IN
22 THAT FLUID SPACE BETWEEN THE BRAIN AND THE SKULL. AND IF
23 YOU GET LARGE BLOOD -- OR A LARGE AMOUNT OF BLOOD, IT
24 COMPRESSES THE BRAIN. AND IF YOU COMPRESS THE BRAIN ENOUGH,
25 PEOPLE CAN STOP BREATHING.
997
1 SO THE REASON FOR THE C.A.T. SCAN THIS ADMISSION WAS TO
2 MAKE SURE THERE WASN'T EVIDENCE OF BLEEDING IN THAT SPACE OR
3 THE BRAIN ITSELF.
4 Q. AND ALSO YOU INDICATED ELEVATED GLUCOSE. UNDER POINT
5 THREE YOU SAY, THIS IS THE FIRST MANIFESTATION OF THIS.
6 WE'LL OBSERVE SLIDING SCALE IS WRITTEN. WERE YOU ABLE TO
7 DETERMINE WHY AT THIS POINT SHE HAD AN ELEVATED GLUCOSE?
8 A. I DIDN'T MENTION THE DISCHARGE SUMMARY. I'M GOING TO
9 ASSUME A LOT OF BLOOD IS DRAWN AFTER THE I.V. IS STARTED BY
10 THE PARAMEDICS AND THAT CONTAINS SUGAR. FREQUENTLY YOU'LL
11 SEE AN ELEVATED SUGAR IN SOMEBODY THAT COMES INTO THE
12 EMERGENCY ROOM EITHER BECAUSE OF THE I.V., OR STRESS IN AND
13 OF ITSELF WILL RAISE YOUR SUGAR A LITTLE BIT. THE FACT THAT
14 I DIDN'T MENTION IT IN THE DISCHARGE AS BEING A PROBLEM, I
15 GUESS RESOLVED AND IS NOT ANYTHING THAT I PURSUED.
16 Q. YOU DO HAVE THE NOTES FROM THE SALT LAKE CLINIC IN FRONT
17 OF YOU AS PART OF YOUR FILE?
18 A. YES.
19 Q. MINE ARE NOT IN ORDER EITHER. LET ME SHOW YOU AN ENTRY.
20 YOU HAVE DR. WESTERMANN'S ENTRY FOR 2/1/95?
21 A. YES, I DO.
22 Q. THAT'S FROM THE SALT LAKE CLINIC. I WANT TO ASK YOU,
23 UNDER ASSESSMENT AND PLAN HE STATES, GIVEN HER HYPOTENSION
24 AND SOMNOLENCE TODAY THEY WILL DISCONTINUE HER ISOSORBIDE.
25 IS THAT THE HEART MEDICATION THAT YOU TESTIFIED THAT YOU HAD
998
1 PRESCRIBED FOR HER?
2 A. CORRECT.
3 Q. AND CAN YOU EXPLAIN TO US WHY DR. WESTERMANN -- WELL,
4 FIRST OF ALL, HE MADE A DETERMINATION OF HYPOTENSION. WHAT
5 IS THAT?
6 A. THAT'S A LOW BLOOD PRESSURE.
7 Q. AND HE ALSO INDICATED THAT -- SOMNOLENCE IS OBVIOUSLY
8 SLEEPINESS; IS THAT RIGHT?
9 A. CORRECT.
10 Q. AND HE DISCONTINUED THAT PARTICULAR HEART MEDICATION.
11 IS THERE A REASON WHY HE DISCONTINUED IT AT THIS TIME AND
12 YOU PRESCRIBED IT AT A LATER TIME?
13 A. ACTUALLY WHEN SHE CAME TO SEE ME SHE WAS STILL TAKING IT
14 ON THE 16TH AND HER BLOOD PRESSURE WAS OKAY AND SO I LEFT
15 HER ON IT.
16 Q. DO YOU KNOW WHY WHAT IS REFERENCED THERE BY
17 DR. WESTERMANN WOULD CALL FOR A CESSATION OF THAT PARTICULAR
18 HEART MEDICATION?
19 A. HE WAS CONCERNED THAT IT WAS -- SINCE IT DILATES BLOOD
20 VESSELS AND CAN CONTRIBUTE TO A LOWERING OF THE BLOOD
21 PRESSURE, HE PROBABLY DIDN'T WANT TO HAVE THE BLOOD PRESSURE
22 ANY LOWER THAN THE 90 OVER 60 AS IT SHOWS UP THERE. THAT
23 WOULD MAKE HER MORE UNSTABLE ON HER FEET AND HAVE MORE OF A
24 TENDENCY TO FALL AND I'M SURE HE WAS JUST BEING CAUTIOUS. I
25 DON'T KNOW IF THE WORD GOT TO THE FAMILY BECAUSE WHEN I SAW
999
1 HER ON THE 16TH THEY WERE STILL GIVING IT TO HER. THE BLOOD
2 PRESSURE WAS OKAY.
3 Q. AND THERE'S ALSO A REFERENCE TO LORAZEPAM. IT SAYS SHE
4 HAS NOT BEEN GETTING LORAZEPAM.
5 A. IT'S THE GENERIC NAME FOR ATIVAN, ONE OF THE MEDICINES
6 WE'VE TALKED ABOUT.
7 Q. THAT'S ONE YOU PRESCRIBED FOR HER AS WELL AT SOME POINT?
8 A. INITIALLY SHE WAS ON THAT AND WE LATER SWITCHED TO
9 XANAX.
10 Q. THAT'S ALL I HAVE, DOCTOR. THANK YOU.
11 THE COURT: REDIRECT?
12 MR. STIRBA: ONE OTHER THING.
13 Q. (BY MR. STIRBA) YOU HAVE YOUR ENTIRE FILE IN FRONT OF
14 YOU?
15 A. I DO, YES.
16 MR. STIRBA: YOUR HONOR, WE WOULD LIKE TO DO THE
17 SAME THING WITH THE DOCTOR, IF WE COULD. IF WE COULD MAKE A
18 COPY OF THIS AND MAKE IT DEFENDANT'S EXHIBIT 19 AND THEN
19 RETURN THE ORIGINAL TO THE DOCTOR. WE'D OFFER IT AS
20 DEFENDANT'S EXHIBIT 19.
21 THE COURT: ANY OBJECTION TO THAT EXHIBIT?
22 MR. WILSON: NO OBJECTION, YOUR HONOR.
23 THE WITNESS: WOULD THAT MEAN MY FILE CLERK DOESN'T
24 HAVE TO COME TO TESTIFY THIS IS THE RECORD?
25 THE COURT: THEY WILL TAKE THAT RIGHT NOW AND COPY
1000
1 THAT.
2 THE WITNESS: MARCY WAS WORRIED ABOUT COMING ALL
3 THE WAY UP HERE JUST TO SAY THIS IS JUST THE RECORD.
4 THE COURT: MAY THIS WITNESS BE EXCUSED?
5 MR. WILSON: WE WOULD -- WELL, I HAVE A FEW
6 QUESTIONS.
7 THE COURT: EXCUSE ME.
8 REDIRECT EXAMINATION
9 BY MR. WILSON:
10 Q. YOU INDICATED THAT THERE WAS A TERM USED IN THE
11 CROSS-EXAMINATION, SUBACUTE. WHAT DOES THAT MEAN, SUBACUTE?
12 A. IT HAS TO DO WITH THE TIME FRAME AND I'M NOT SURE
13 THERE'S A STRICT DEFINITION. BUT ACUTE WOULD BE IF SOMEBODY
14 HAD A STROKE AND IT HAPPENED TEN MINUTES AGO. ACUTE REFERS
15 TO THAT IT'S HAPPENING RIGHT NOW. SUBACUTE GENERALLY MEANS
16 IT'S HAPPENED WITHIN THE LAST SIX WEEKS AND YOU DON'T KNOW
17 THE EXACT TIME, BUT IT ISN'T SOMETHING THAT HAPPENED YEARS
18 AGO WHICH WOULD BE CHRONIC. AND SO THOSE ARE THE THREE
19 TERMS WE USE. CHRONIC MEANING SEVERAL MONTHS AGO; SUBACUTE,
20 SIX WEEKS TO MAYBE A WEEK AGO; AND ACUTE, SOMETHING THAT
21 JUST BARELY HAPPENED.
22 Q. SO IN TERMS OF THE HOSPITALIZATION THAT TOOK PLACE IN
23 AUGUST, LATTER PART OF AUGUST, AUGUST 25, AS I RECALL?
24 A. CORRECT.
25 Q. WAS THAT DESCRIBED IN ANY FASHION AS AN ACUTE EVENT OR
1001
1 SUBACUTE EVENT OR DO YOU KNOW?
2 A. MY CHART'S GONE.
3 MR. STIRBA: DO YOU WANT A COPY OF THE REPORT?
4 WOULD THAT HELP YOU?
5 THE WITNESS: YEAH, JUST THE WORDING. THAT WOULD
6 BE DR. PEARCE'S NOTE. JUST THE WORDING SO I CAN SEE WHAT
7 HE'S REFERRING TO. THAT WOULD BE HELPFUL.
8 MR. STIRBA: MAY I APPROACH, YOUR HONOR?
9 THE COURT: YES. IS THAT WHAT YOU NEED?
10 THE WITNESS: THAT'S A BRAIN C.A.T. SCAN. THIS IS
11 8/25, REFERRING TO DR. PEARCE'S NOTES.
12 MR. WILSON: I ASSUME SO.
13 MR. STIRBA: WAIT A MINUTE. SHE WAS ACTUALLY AT
14 L.D.S. HOSPITAL, THEN THEY TRANSFERRED. HERE'S THE
15 COTTONWOOD RECORD. THAT'S AT L.D.S. HOSPITAL.
16 THE WITNESS: OKAY. THERE. I'M TRYING TO REMEMBER
17 WHAT WE WERE TALKING ABOUT WHEN SUBACUTE CAME UP.
18 THE COURT: DO YOU WANT TO REPHRASE THE QUESTION OR
19 JUST ASK IT AGAIN?
20 Q. (BY MR. WILSON) WHY DON'T I JUST MOVE ON AT THIS TIME.
21 WELL, I CAN ASK A FURTHER QUESTION AS TO THE SUBACUTE. DO I
22 UNDERSTAND THE MEANING OF THAT TO MEAN THAT MAYBE THE SIGNS
23 OR THE SYMPTOMS AS A RESULT OF HAVING A SUBACUTE EVENT MAY
24 NOT BE MANIFEST UNTIL SEVERAL DAYS DOWN THE ROAD OR IS IT
25 JUST SOMETHING THAT MAYBE WAS NOT PICKED UP ON UNTIL --
1002
1 A. IT COULD BE MORE SUBTLE AND THEN SOMEBODY FINALLY
2 RECOGNIZES SAYING, HEY, SHE HAD BEEN ACTING FUNNY FOR A
3 LITTLE WHILE, BUT THIS IS GETTING WORSE. WE NEED TO CHECK
4 IT OUT.
5 Q. WAS THERE ANY EVIDENCE THAT THIS WAS AN ACUTE EVENT?
6 A. C.A.T. SCAN DID NOT REVEAL THAT AND SO WE DON'T HAVE
7 EVIDENCE THAT IT WAS.
8 Q. NOW, C.A.T. SCAN DIDN'T REVEAL ANY INTRACRANIAL
9 BLEEDING?
10 A. NO.
11 Q. WAS THERE A SUBSEQUENT C.A.T. SCAN DONE 'CAUSE YOU HAD
12 HER UNDER OBSERVATION FOR SEVERAL DAYS FOR SUBDURAL
13 HEMATOMAS?
14 A. THERE WAS A C.A.T. SCAN DONE IN AUGUST. THEY WERE
15 TALKING ABOUT THE AUGUST ONE AND ONE DONE IN SEPTEMBER.
16 BACK UP. THERE WAS ONLY ONE DURING THAT SEPTEMBER
17 ADMISSION.
18 Q. THE SEPTEMBER ADMISSION WAS FOR THE FALL?
19 A. YES.
20 Q. OKAY. AND YOU DID NOT NOTE ANY -- THAT WAS JUST THE ONE
21 C.A.T. SCAN THAT WAS DONE ON THAT PARTICULAR --
22 A. IT WAS A C.A.T. SCAN DONE TO -- I DON'T KNOW HOW
23 AGGRESSIVE WE WOULD HAVE GOTTEN HAD WE SHOWN BLEEDING IN THE
24 HEAD IN LIGHT OF HOW THE FAMILY FELT, BUT YOU ALWAYS LIKE TO
25 KNOW WHAT'S GOING ON SO YOU CAN RECOMMEND TO THE FAMILY AND
1003
1 THEN THEY CAN HELP YOU MAKE THE DECISION.
2 Q. NOW, YOU INDICATED YOU DIAGNOSED HER WITH CORONARY
3 ARTERY DISEASE; IS THAT CORRECT?
4 A. WELL, THE FAMILY TOLD ME THAT SHE HAD IT AND THAT WAS
5 THE EXTENT OF MY DIAGNOSING.
6 Q. SO YOU DIDN'T DO ANY TESTING TO DETERMINE --
7 A. NO.
8 Q. -- EVIDENCE OF THAT PARTICULAR DISEASE?
9 A. I DID NOT.
10 Q. OKAY. WAS THERE ANYTHING THAT WOULD INDICATE TO YOU AS
11 TO THE NATURE OR THE SEVERITY OF THE CORONARY ARTERY DISEASE
12 THIS INDIVIDUAL MAY HAVE HAD?
13 A. I BELIEVE THEY MENTIONED THAT SHE HAD HAD EITHER
14 PREVIOUS CHEST PAIN OR A PREVIOUS SMALL HEART ATTACK IS THE
15 WAY THAT WAS DIAGNOSED IN THE PAST.
16 Q. SO YOU WOULDN'T HAVE ANY INFORMATION INDEPENDENT OF WHAT
17 WAS REPRESENTED TO YOU ON THAT MATTER?
18 A. NO.
19 Q. OKAY. DID SHE SEEM TO HAVE A FULL RECOVERY FROM THE
20 FALL IN SEPTEMBER?
21 A. I DON'T KNOW THAT I WOULD SAY FULL BECAUSE SHE DID SEEM
22 TO BE A LITTLE BIT MORE AGITATED OVER THE FOLLOWING TWO OR
23 THREE MONTHS AND WHETHER THAT WAS A RESULT OF THE FALL OR
24 JUST THE DEMENTIA PROCESS GETTING A LITTLE WORSE, IT'S HARD
25 TO SAY. BUT I THINK SHE HAD A LITTLE BIT OF A DECLINE FROM
1004
1 SEPTEMBER TILL DECEMBER.
2 Q. COUNSEL MADE A COMMENT TO YOU THAT THESE TYPES OF
3 CLINICAL OBSERVATIONS ARE DIFFICULT GIVEN THE NATURE OF
4 THESE CIRCUMSTANCES. WHAT TYPE OF CIRCUMSTANCES ARE WE
5 TALKING ABOUT HERE WHEN YOU ANSWERED YES TO THAT PARTICULAR
6 QUESTION?
7 A. WHEN YOU HAVE THE PATIENT THAT'S CONFUSED AND YOU ARE
8 RECEIVING REPORTS FROM VARIOUS OBSERVERS, SOME THAT ARE
9 SKILLED IN OBSERVING AND SOME THAT AREN'T SKILLED IN
10 OBSERVING, AND THEN YOU TRY AND PUT THE WHOLE PICTURE
11 TOGETHER, SOMETIMES IT'S DIFFICULT TO DRAW AN ACCURATE
12 CONCLUSION. THE PATIENT WASN'T ABLE TO TELL ME IF SHE HURT
13 OR WHERE IT HURT. THE PATIENT WASN'T ABLE TO TELL ME THAT
14 SHE WAS HUNGRY OR NOT HUNGRY. THE NURSES SAID THAT SHE
15 WOULD TRY AND GET OUT OF HER BED WHEN SHE WASN'T SUPPOSED TO
16 AND THEY WEREN'T WATCHING HER. THESE ARE THE TYPE OF
17 INFORMATION I WAS TRYING TO SIFT THROUGH AND MAKE A DECISION
18 ON WHAT TO DO ABOUT IT.
19 Q. SO I TAKE IT THE MORE INFORMATION YOU CAN GATHER ABOUT
20 THE PATIENT --
21 A. THE BETTER.
22 Q. -- THE MORE CAPABLE YOU WERE OF MAKING THOSE KIND OF
23 OBSERVATIONS?
24 A. CORRECT.
25 Q. OKAY.
1005
1 MR. WILSON: I HAVE NO FURTHER QUESTIONS, YOUR
2 HONOR.
3 THE COURT: ANYTHING FURTHER OF THIS WITNESS?
4 MR. STIRBA: NO, YOUR HONOR, THANK YOU.
5 THE COURT: MAY HE BE EXCUSED?
6 MR. STIRBA: YES.