James Pearce, MD
18 MR. WILSON: WE'D CALL DR. JAMES PEARCE TO THE STAND AT
19 THIS TIME, YOUR HONOR.
20 THE COURT: DR. JAMES PEARCE. DON'T YOU HAVE HIM HERE
21 READY TO GO, MR. WILSON?
22 MR. WILSON: WELL, HE'S OUT IN THE HALLWAY, YOUR HONOR.
23 THE COURT: DR. PEARCE, WOULD STEP RIGHT UP HERE PLEASE?
24 WOULD YOU RAISE YOUR RIGHT HAND PLEASE AND FACE THE CLERK AND
25 SHE'LL PLACE YOU UNDER OATH.
1 JAMES PEARCE,
2 BEING FIRST DULY SWORN, WAS EXAMINED
3 AND TESTIFIED AS FOLLOWS:
4 DIRECT EXAMINATION
5 THE COURT: IN YOU'LL HAVE A SEAT UP HERE PLEASE,
6 DOCTOR. GIVE US YOUR FULL NAME AND SPELL YOUR LAST LAST NAME
7 PLEASE.
8 A. IT'S JAMES RICHARD MCGEE PEARCE, P-E-A-R-C-E.
9 BY MR. WILSON:
10 Q. WHERE ARE YOU CURRENTLY EMPLOYED, DOCTOR?
11 A. I'M SELF-EMPLOYED IN MURRAY.
12 Q. OKAY. AND YOU'RE EMPLOYED AS A PHYSICIAN?
13 A. I AM.
14 Q. DO YOU SPECIALIZE IN ANY GIVEN AREA?
15 A. INTERNAL MEDICINE.
16 Q. AND WHEN DID YOU GRADUATE FROM MEDICAL SCHOOL?
17 A. 1970.
18 Q. AND ARE YOU BOARD CERTIFIED IN ANY PARTICULAR AREA?
19 A. INTERNAL MEDICINE.
20 Q. AND WHEN DID YOU OBTAIN YOUR CERTIFICATION SIR?
21 A. JUNE OF 1974.
22 Q. AND HOW LONG HAVE YOU BEEN PRACTICING IN THE STATE OF
23 UTAH?
24 A. 28 YEARS.
25 Q. AND YOU SAY YOU'RE CURRENTLY -- WELL WHERE ARE YOU
1 CURRENTLY LOCATED AT AS FAR AS YOU BUSINESS GOES?
2 A. IT'S 6095 SOUTH FASHION BOULEVARD.
3 Q. ARE YOU ASSOCIATED WITH ANY OTHER PHYSICIANS IN THAT
4 FACILITY?
5 A. NO.
6 Q. OKAY. WERE YOU ASSOCIATED WITH ANY OTHER PHYSICIANS
7 BACK IN 1995?
8 A. YES.
9 Q. AND WHO WERE YOU ASSOCIATED WITH AT THAT TIME?
10 A. WELL, I WAS IN THE I.H.C. HOLLADAY CLINIC, AND THERE
11 WERE A NUMBER OF PHYSICIANS IN THE CLINIC, DR. STEVENS, DR.
12 MCCAW, DR. WRIGHT, DR. PAULDOLSKI, AND MYSELF.
13 Q. IN RESPECT TO THAT PRACTICE THAT YOU WERE ENGAGED IN
14 BACK AT THAT TIME, DID YOU HAVE -- WOULD YOU FROM TIME TO
15 TIME COVER FOR EACH OTHER IN THAT ASSOCIATION?
16 A. YES.
17 Q. ARE YOU ACQUAINTED WITH A PATIENT AT THAT TIME WHO WAS
18 NAMED JUDITH LARSEN?
19 A. I HAVE THE RECORDS. THAT'S ALL.
20 Q. OKAY HAVE YOU HAD A CHANCE TO REVIEW THOSE?
21 A. YES. I HAVEN'T HAD -- I DON'T HAVE THE CLINIC CHART. I
22 WAS JUST HANDED SOME OF DR. STEVENS NOTES AND HOSPITAL NOTES
23 AND SO FORTH BUT I HAVEN'T HAD A CHANCE TO REVIEW THE
24 HOSPITAL CHART.
25 Q. DO YOU RECALL WHEN YOU MAY HAVE FIRST HAD CONTACT WITH
1 JUDITH LARSEN?
2 A. WELL I WAS JUST LOOKING THROUGH THIS NOTE HERE. IT
3 LOOKS LIKE IT WAS 7/15/95.
4 Q. THAT WOULD BE JULY 15TH OF '95?
5 A. YES.
6 Q. AND DO YOU RECALL THE CONTEXT OF THAT OCCURRED IN?
7 A. WELL APPARENTLY SHE WAS ADMITTED FROM A NURSING HOME FOR
8 DEHYDRATION.
9 Q. OKAY. AND DID YOU TREAT HER ON THAT OCCASION?
10 A. YES.
11 Q. WHEN WAS THE NEXT OCCASION THAT YOU CAN RECALL THAT YOU
12 MAY HAVE HAD ANY CONTACT WITH JUDITH LARSEN?
13 A. I THINK THAT SHE WAS ADMITTED AGAIN IN AUGUST. OF THAT
14 SAME YEAR.
15 Q. DO YOU HAVE ANY RECORDS OF THAT PARTICULAR ADMISSION?
16 A. ALL I HAVE IS THE TRANSCRIPT THAT I WAS GIVEN OF MY
17 TESTIMONY LAST TIME I WAS HERE.
18 Q. DID YOU HAVE A CHANCE TO REVIEW THAT TRANSCRIPT?
19 A. YES.
20 Q. AND DO YOU HAVE BASED UPON THAT REVIEW, DO YOU HAVE ANY
21 INDEPENDENT RECOLLECTION RELATED TO THOSE EVENTS?
22 A. NO.
23 Q. OKAY. CAN YOU TELL US IN REVIEWING THE TRANSCRIPT
24 WHETHER OR NOT THE STATEMENTS THAT YOU MADE AT THAT TIME
25 WERE -- DO YOU HAVE A RECOLLECTION NOW AS TO THOSE
1 STATEMENTS?
2 A. I DIDN'T -- I DON'T -- I DIDN'T REMEMBER THOSE
3 STATEMENTS AT ALL, BUT I HAVE READ THEM AND REVIEWED THEM.
4 Q. OKAY DO YOU RECALL ANYTHING AT ALL ABOUT HAVING MET WITH
5 THIS PATIENT?
6 A. OTHER THAN THE TRANSCRIPT, YOU MEAN?
7 Q. UH-HUH?
8 A. NO.
9 Q. DID YOU SEE ANY NOTES IN ITEM D-7 OF THE RECORD THAT
10 YOU'VE REVIEWED OF DR. STEVENS PERTAINING TO YOUR TREATMENT
11 OR THE -- IN RESPECT TO AUGUST 25TH?
12 A. I'M SORRY, WOULD YOU REPHRASE THAT OR RESTATE THAT
13 QUESTION?
14 Q. YES, I'LL TRY AND BE MORE CLEAR. ARE THERE ANY NOTES IN
15 THE -- IN THE EXHIBIT THAT YOU'VE REVIEWED WHICH IS -- WHICH
16 IS MARKED AS DEFENDANTS D-7, PERTAINING TO A HOSPITALIZATION
17 OF JUDITH LARSEN THAT OCCURRED ON AUGUST 25TH?
18 A. I'M SORRY, DID YOU ASK ME A QUESTION IN THAT OR DID YOU
19 JUST MAKE A STATEMENT? J
20 Q. YEAH, I WAS ASKING YOU IF THERE WAS ANY NOTES IN THAT
21 PARTICULAR EXHIBIT THAT YOU REVIEWED.
22 A. THERE ARE NOTES. THERE ARE CLINIC NOTES BY DR. STEVENS
23 AND DR. WESTERLAND APPARENTLY.
24 Q. ARE THERE ANY NOTES OF YOURS IN THAT?
25 A. THERE IS A HOSPITAL FROM -- HOSPITAL NOTE FROM 7/15.
1 YEAH, I DON'T BELIEVE --
2 Q. THAT'S THE ONLY NOTE THAT YOU HAVE IN THAT RECORD?
3 A. I BELIEVE THAT'S THE ONLY ONE THAT'S IN HERE.
4 Q. OKAY.
5 A. I'M NOT SURE IF THE AUGUST ADMISSION IS IN HERE OR NOT.
6 Q. OKAY.
7 A. I DON'T BELIEVE SO.
8 Q. I HAVE NO FURTHER QUESTIONS YOUR HONOR.
9 THE COURT: MR. BUGDEN.
10 MR. BUGDEN: I NEED JUST A MOMENT PLEASE.
11 CROSS-EXAMINATION
12 BY MR. BUGDEN:
13 Q. DR. PEARCE, I'M GONNA ASK YOU TO LOOK AT SOME DOCUMENTS
14 AND IN A DIFFERENT FASHION THAN MR. WILSON DID AND I'M GONNA
15 TURN THE LIGHTS DOWN AND I'M GONNA ASK YOU -- UNFORTUNATELY I
16 DON'T HAVE A COPY TO GIVE YOU BUT I THINK YOU'LL BE ABLE TO
17 READ IT ON THE SCREEN. DR. I'VE INTRODUCED MYSELF IN THE
18 HALL, BUT I'LL DO IT AGAIN. WALTER BUGDEN AND I REPRESENT
19 DR. WEITZEL. I'M GONNA AND YOU SOME QUESTIONS THIS
20 AFTERNOON. YOU SAW THE -- MRS. LARSEN TWO TIMES, DOES THAT
21 SOUND RIGHT SIR?
22 A. YES.
23 Q. AND THE FIRST WAS AT A HOSPITAL, HER HOSPITALIZATION IN
24 JULY OF 1995?
25 A. YES.
1 Q. YOUR HONOR, THIS IS EXHIBIT D-6 THAT HAS BEEN RECEIVED.
2 AND IT'S -- COUNSEL, IT'S -- I GUESS I DON'T HAVE THE PAGE
3 FOR YOU EITHER. I'M SORRY. YOU'RE GONNA HAVE TO LOOK AT THE
4 SCREEN.
5 MR. WILSON: THAT'S FINE.
6 Q. (BY MR. BUGDEN) WHAT WE HAVE HERE DOCTOR IS YOUR
7 DISCHARGE SUMMARY AND YOU CAN SEE THE DATE THAT IT WAS -- SHE
8 WAS ADMITTED SEVEN -- AND YOU MAY NEED TO, SO THAT WE'RE BOTH
9 TRACKING, I MAY ASK YOU TO USE THE SCREEN. I APOLOGIZE TO
10 HAVE YOU STEP DOWN. IS THAT ALL RIGHT, JUDGE?
11 THE COURT: THAT'S OKAY.
12 Q. (BY MR. BUGDEN) SO SHE WASADMITTED ON 7/15 AND I GUESS
13 DISCHARGED PERHAPS LOOKS LIKE 7/16 THE VERY NEXT DAY, IS THAT
14 RIGHT?
15 A. LOOKS LIKE IT YES.
16 Q. (BY THE COURT) YOU NEED TO SPEAK UP DOCTOR IF YOU WOULD
17 PLEASE.
18 THE WITNESS: I THINK SO.
19 THE COURT: YOU'RE ALL RIGHT RIGHT THERE IF YOU JUST
20 SPEAK UP. OKAY.
21 Q. (BY MR. BUGDEN) IF WE COULD SEE THE HISTORY AND
22 PHYSICAL. YOU DID DO -- YOU PREPARED A SECTION CALLED
23 HISTORY AND PHYSICAL ON THAT SAME DAY, 7/15/95, AND IF WE
24 COULD SEE THE BLOW UP OF THAT PLEASE. UNDER IMPRESSION THEN,
25 SHE -- DOES IT SOUND RIGHT, DR, THAT SHE WAS ADMITTED FOR
1 DEHYDRATION?
2 A. THAT'S CORRECT.
3 Q. AND SHE HAD HYPOTHYROIDISM?
4 A. YES.
5 Q. WOULD YOU TELL US WHAT THAT IS PLEASE?
6 A. THAT'S WHERE THE THYROID GLAND DOES NOT MAKE ENOUGH
7 THYROID HORMONE.
8 Q. AND THEN SHE ALSO HAD A VARIETY OF OTHER THINGS,
9 INCLUDING THE PAST HISTORY OF A CEREBROVASCULAR ACCIDENT.
10 THAT'S NUMBER 10. IS THAT RIGHT?
11 A. THAT'S CORRECT.
12 Q. AND COULD WE ALSO SEE -- I THINK IT'S THE VERY NEXT
13 SLIDE. AND IS THERE A BLOW UP -- DOES IT SOUND CORRECT, DR,
14 DOES IT REFRESH YOUR MEMORY THAT MRS. LARSEN WAS INCOHERENT
15 AT THE TIME?
16 A. THAT'S CORRECT.
17 Q. OKAY. AND THEN DURING HER HOSPITALIZATION DID SHE
18 SUFFER A FALL, DOES THAT SOUND RIGHT?
19 A. THAT'S IN THE HOSPITAL RECORD YES.
20 Q. OKAY. AND WHEN SHE WAS DISCHARGED, I THINK THAT'S --
21 THAT MAY BE THE NEXT -- I THINK WE HAVE TO BLOW THAT UP.
22 NUMBER 3 DOCTOR ON YOUR DISCHARGE SUMMARY, SHE WAS SUSPECTED
23 OF HAVING ESCHEMIC HEART DISEASE, IS THAT RIGHT?
24 A. YES.
25 Q. AND ESCHEMIC MEANS THAT THE TISSUES ARE NOT GETTING
1 ENOUGH BLOOD IS THAT RIGHT DR. PEARCE.
2 A. THAT'S CORRECT.
3 Q. AND IF THE HEART WAS NOT RECEIVING AN ADEQUATE BLOOD
4 SUPPLY COULD THAT LEAD TO A HEART ATTACK, DR. ?
5 A. YEAH, WHAT IT REALLY SAYS IS THAT THERE'S CORONARY
6 ARTERY DISEASE AND THAT -- THAT SHE COULD HAVE A HEART ATTACK
7 OR THERE'S SOME PLAQUES IN THE ARTERIES OR SOME RESTRICTION
8 OF THE ARTERIAL CIRCULATION TO THE MUSCLE OF THE HEART.
9 Q. DR. WHEN YOU'RE DEALING WITH A PATIENT THAT'S 93 YEARS
10 OLD, ALTHOUGH THAT PATIENT MIGHT BE STABLE ON A PARTICULAR
11 DAY, WITH A PROBLEM LIKE THIS PATIENT HAD, THAT ESCHEMIC
12 HEART DISEASE --
13 MR. WILSON: I'M GONNA OBJECT TO THE FORM OF THE
14 QUESTION YOUR HONOR,.
15 THE COURT: OVERRULED. GO AHEAD AND ASK THE QUESTION.
16 Q. (BY MR. BUGDEN) DR. PEARCE, ALTHOUGH THIS PATIENT MIGHT
17 BE STABLE ON A PARTICULAR DAY, AT AGE 93 WITH THIS HEART
18 DISEASE THAT IS DESCRIBED ON THE DISCHARGE, IS THIS SOMEONE
19 THAT COULD DIE TOMORROW?
20 A. YES.
21 Q. THEN IF WE COULD TURN TO THE SECOND HOSPITALIZATION AT
22 COTTONWOOD HOSPITAL, AND THAT MAY BE THE NEXT SLIDE. THANK
23 YOU. THIS WAS ON AUGUST 25TH. THERE HAD BEEN A CHANGE IN
24 HER NEUROLOGIC FUNCTION BY THIS TIME, IS THAT CORRECT DR. ?
25 A. YES.
1 Q. AND SHE SUFFERED BY THIS TIME A LOSS OF SPEECH?
2 A. I DON'T RECALL BUT --
3 Q. SHE WAS NOT VERBALIZING, DO YOU SEE THAT?
4 A. YES.
5 Q. AND IT'S ALSO INDICATED THAT SHE WAS NOT RESPONDING AS
6 SHE HAD BEEN IN THE PAST?
7 A. THAT'S CORRECT.
8 Q. AND THEN IT ALSO SAYS SHE WAS REFUSING TO EAT OR TO TAKE
9 FLUIDS. IN, YOU KNOW, AN OLDER PERSON, 93 YEARS OLD, THAT
10 CERTAINLY CAN BECOME A SERIOUS PROBLEM, CAN'T IT, IF THE
11 PATIENT WON'T TAKE FLUIDS?
12 A. THAT'S CORRECT.
13 Q. AND YOUR ASSESSMENT IN YOUR ASSESSMENT, YOU CONCLUDED --
14 YOU'D ALREADY I BELIEVE CONCLUDED THAT WHEN YOU'D SEEN HER
15 BACK IN JULY THAT HE SUFFERED FROM DEMENTIA AND HERE IT DOES
16 SAY DEMENTIA, IS THAT RIGHT?
17 A. THAT'S CORRECT.
18 Q. AND THERE ARE DIFFERENT KINDS OF DEMENTIA. ONE KIND OF
19 DEMENTIA CAN BE CAUSED BY RECURRENT STROKES, IS THAT RIGHT
20 DOCTOR?
21 A. THAT'S CORRECT.
22 Q. AND THAT WOULD CERTAINLY BE CONSISTENT WITH THIS WOMAN'S
23 MEDICAL HISTORY IS THAT RIGHT?
24 A. YES.
25 Q. AND THEN THERE SHOULD BE ANOTHER NOTE, I THINK IT'S THE
1 NEXT SLIDE. AND THAT READS THAT HAD YOU A DISCUSSION WITH
2 THE PATIENT'S FAMILY TODAY. AND THEY WANT NO INTRAVENOUS
3 LINES, NO GASTRIC TUBE OR NASOGASTRIC TUBE AND SUPPORT OTHER
4 THAN FLUIDS BY MOUTH. DOES THAT SOUND FAMILIAR DR. ?
5 A. YES.
6 Q. AND WOULD YOU HAVE IN ORDER TO HAVE MADE A CHART NOTE
7 LIKE THAT WOULD YOU HAVE -- WELL TELL ME ABOUT HOW CHARTING
8 OCCURS. IF YOU MADE A CHART NOTE THAT INDICATED THAT YOU'D
9 SPOKEN TO THE FAMILY TODAY, WOULD YOU EVER MAKE A CHART NOTE
10 THAT SAID THAT IF YOU HADN'T SPOKEN TO FAMILY ABOUT THESE
11 ISSUES?
12 A. NO. IT'S JUST REPORTING THE FACTS. IN TRYING TO MAKE A
13 DISPOSITION, WE'RE TRYING TO SEND THE PERSON HOME WITH AS
14 MUCH SUPPORT AS WE CAN, AS MUCH AS THE FAMILY WOULD LIKE.
15 WE'RE NOT TRYING TO VIOLATE THE FAMILY'S WISHES. WE TRY TO
16 GET A CONSENSUS OF EVERY MEMBER OF THE FAMILY SO THERE ISN'T
17 ONE MAVERICK THAT COMES IN LATER PERHAPS AND DISAGREES OR
18 WHATEVER. OF COURSE, WE'RE TRYING TO SUPPORT THE PATIENT IN
19 WAYS THAT WE CAN AND AND COMPLY WITH THEIR WISHES. AND SO
20 THIS IS -- A STATEMENT LIKE THIS IS ONLY MADE AFTER A
21 THOROUGH DISCUSSION WITH THE FAMILY AND THERE WE'RE JUST
22 DOCUMENTING WHAT HAPPENED.
23 Q. AND WELL ALL RIGHT. LET ME ASK YOU THIS, FROM YOUR
24 EXPERIENCE, DR. , ARE THERE OCCASIONS THAT YOU'LL TALK TO
25 PATIENTS OR MEMBERS OF A PATIENT'S FAMILY AND THEY WON'T EVEN
1 RECALL THAT THEY'VE SPOKEN TO YOU, IS THAT SOMETHING THAT
2 HAPPENS FROM TIME TO TIME, DR. PEARCE?
3 A. OH, YES ABSOLUTELY.
4 Q. OKAY. THEN IF WE COULD LOOK AT THE DISCHARGE SUMMARY
5 FROM THIS HOSPITALIZATION I THINK IT'S THE -- AND THEN I
6 THINK THAT THERE'S A BLOW UP HERE. CAN YOU READ THAT TO THE
7 JURY?
8 A. SHE WILL BE TRANSFERRED TO A NURSING HOME FOR TERMINAL
9 CARE.
10 Q. LET ME ASK YOU TO ALSO LOOK AT THE PLAN PORTION AND IF
11 YOU COULD READ THAT OUT LOUD PLEASE?
12 A. IN DISCUSSION WITH THE FAMILY, IT IS DECIDED THAT THE
13 LAST SIX MONTHS OF HER LIFE HAVE BEEN VERY POOR QUALITY. AND
14 IN FACT NO QUALITY AT ALL. WITH POOR RECOGNITION OF PEOPLE.
15 NO CONVERSATION. NO DECISION MAKING. THE OPTION --
16 Q. AT THE TIME OF DISCHARGE.
17 A. AT THE TIME OF DISCHARGE TO PLACE A FEEDING TUBE,
18 PERIPHERAL WITH NUTRITION OR N.G. TUBE, AND THE FAMILY FEELS
19 THAT THAT WOULD BE AGGRESSIVE AND INAPPROPRIATE. THEY ALSO
20 WANTED TO -- WANTED NO TREATMENT OF INFECTION SUCH AS URINARY
21 INFECTIONS, PULMONARY, ET CETERA.
22 Q. AND AGAIN SAME STORY, I SUPPOSE IT'S TRUE, DR. THAT YOU
23 WOULD NEVER HAVE MADE THIS -- CREATED THIS KIND OF A CHART
24 NOTE IF YOU HADN'T HAD THIS CONVERSATION WITH THE FAMILY.
25 A. YEAH, THAT'S CORRECT. YOU KNOW, WE TRY TO GIVE THE
1 PEOPLE THAT ARE GOING TO BE TAKING CARE OF HER SOME SORT OF
2 GUIDELINE ABOUT WHAT THE FAMILY WISHES ARE, THE PATIENTS
3 WISHES IF THEY HAVE A LIVING WILL THAT THEY'VE SIGNED, SO
4 THAT WHEN SOMETHING COMES UP LIKE A PERSON RUNS A TEMPERATURE
5 AND HAS URINARY TRACT INFECTION OR PNEUMONIA, THEY KNOW
6 WHETHER OR NOT TO TRANSFER TO THE HOSPITAL, WHETHER OR NOT TO
7 GIVE ANTIBIOTICS IN THE NURSING HOME, ET CETERA.
8 Q. AND DR. WHERE IT TALKS FOR EXAMPLE ABOUT AFTER YOU SAID
9 NO -- THAT MRS. LARSEN HAD NO CONVERSATION, NO DISCUSSION
10 MAKING, THEN IT SAYS THE OPTION AT THE TIME OF DISCHARGE TO
11 PLACE FEEDING TUBE, DOES THAT INDICATE THAT YOU WOULD HAVE
12 ACTUALLY SAID TO THE FAMILY, WHOEVER YOU WERE TALKING TO IN
13 MRS. LARSEN'S FAMILY, LOOK, WE COULD DO A GASTRIC FEEDING
14 TUBE. WE COULD DO INTRAVENOUS INTERVENTIONS, WE COULD DO
15 PULMONARY INTERVENTIONS, BUT ALL OF THOSE THINGS WERE
16 DISCUSSED, AND THE LARSEN FAMILY SAID WE DON'T WANNA DO ANY
17 OF THOSE THINGS?
18 A. THAT'S CORRECT.
19 Q. AND THEN THERE IS THIS DISPOSITION NOTE THAT SAYS SHE'LL
20 BE TRANSFERRED TO A NURSING HOME FOR TERMINAL CARE. TERMINAL
21 CARE MEANING TO PASS AWAY, IS THAT RIGHT?
22 A. YES. NO ONE CAN PREDICT LIFE, BUT THEY'RE SAYING, WELL,
23 LET'S KEEP THIS PERSON COMFORTABLE, BUT LET'S NOT DO ANYTHING
24 TO -- TO MAINTAIN LIFE ARTIFICIALLY, IF YOU WILL.
25 Q. AND FOR EXAMPLE, URINARY INFECTIONS, THAT'S SOMETHING
1 THAT'S ACTUALLY QUITE COMMON IN OLDER PEOPLE, ISN'T IT,
2 DR. PEARCE?
3 A. THAT'S CORRECT.
4 Q. AND URINARY INFECTIONS ARE SOMETHING THAT ACTUALLY CAN
5 BE TREATED WITH ANTIBIOTICS, INTRA -- I.V. ANTIBIOTICS, IS
6 THAT RIGHT?
7 A. THAT'S CORRECT.
8 MR. WILSON: YOUR HONOR, I'M GONNA OBJECT THIS LINE OF
9 QUESTIONING. I DON'T THINK THERE'S ANY EVIDENCE BEFORE THE
10 COURT THAT THIS PARTICULAR PATIENT SUFFERED FROM URINARY
11 TRACT INFECTION.
12 THE COURT: DOESN'T MATTER. HE CAN STILL RESPOND. IT'S
13 WITHIN HIS KNOWLEDGE.
14 Q. (BY MR. BUGDEN) SO AGAIN THAT WAS ONE OF THE OPTIONS
15 THAT WAS DISCUSSED WITH THIS FAMILY THAT EVEN IF MRS. LARSEN
16 CAME DOWN WITH A URINARY TRACT INFECTION THAT ARE COMMON IN
17 OLDER WOMEN, THAT THEY WEREN'T EVEN GOING TO TREAT THAT,
18 ISN'T A RIGHT?
19 A. YES. FOR PEOPLE LIKE THIS, IN THE MEDICAL LITERATURE,
20 IT'S OFTEN STATED THAT IT'S THE OLD PERSON'S FRIEND. IN
21 OTHER WORDS, IF THE PERSON REALLY HAS A VERY POOR QUALITY OF
22 LIFE BUT THEY CAN'T DIE, AND THEN THEY GET A URINARY
23 INFECTION OR A PNEUMONIA OR SOMETHING OF THAT NATURE, AND IT
24 TERMINATES THEM.
25 Q. AND SO IT'S CERTAINLY CLEAR THAT THE FAMILY DIDN'T WANT
1 TO SEND THEIR MOTHER TO THE INTENSIVE CARE UNIT IF SOMETHING
2 CAME?
3 A. NO, DEFINITELY NOT.
4 Q. IT'S I SUPPOSE, DR. PEARCE, HARD FOR FAMILIES TO KNOW --
5 THE COURT: ARE YOU GONNA TALK TO HIM ABOUT WHAT'S UP ON
6 THE BOARD?
7 MR. BUGDEN: I THINK -- THANK YOU VERY MUCH FOR STANDING.
8 I APOLOGIZE.
9 THE COURT: HAVE A SEAT THERE IF YOU WOULD, DR. THANK
10 YOU.
11 MR. BUGDEN: THANK YOU, JUDGE.
12 Q. (BY MR. BUGDEN) DR. PEARCE, I SUPPOSE IT IS HARD TO KNOW
13 FOR FAMILIES WHEN -- WHEN TO STOP?
14 A. YES THAT'S TRUE.
15 Q. IT'S A PAINFUL DECISION?
16 A. VERY PAINFUL, YES, VERY HARD TO LET GO AT TIMES.
17 Q. AND IN PROVIDING THE BEST DOCTORING THAT YOU COULD TO
18 THIS FAMILY, YOU TRIED TO GRAPPLE WITH THOSE ISSUES AND
19 DISCUSS THOSE ISSUES WITH THE FAMILY, IS THAT RIGHT?
20 A. YES, I -- YES. I BELIEVE THAT WE DID. JUST LOOKING AT
21 THE WHOLE INFORMATION THAT WE HAVE HERE, THAT'S THE KIND OF
22 THING WE WOULD DISCUSS WITH THEM SO THAT EVERYONE WOULD BE
23 PREPARED IF SOMETHING CAME UP THAT WE'D ALL KNOW WHAT RULES
24 OF THE GAME WERE GOING TO BE AND WHAT MRS. LARSEN WOULD HAVE
25 LIKED. WHAT THE FAMILY WANTS TO DO AND SO FORTH.
1 Q. AND THE RULES OF THE GAME THAT WERE LAID OUT IN AUGUST
2 WHEN YOU SPOKE WITH THE LARSEN FAMILY, THE RULES OF THE GAME
3 WERE THAT THEY HAD DECIDED TO LET THEIR MOTHER PASS AWAY IF
4 ANYTHING HAPPENED TO HER?
5 A. THAT'S -- YES, THAT'S THE CASE, YES.
6 Q. TO DIE WITH COMFORT AND DIGNITY.
7 A. YES.
8 Q. THANK YOU.
9 THE COURT: MR. WILSON, REDIRECT.
10 REDIRECT EXAMINATION
11 BY MR. WILSON:
12 Q. DR. WHAT DOES THE TERM TERMINAL CONDITION MEAN?
13 A. WELL IT MEANS THAT THEY HAVE A CONDITION FROM WHICH THEY
14 CAN'T RECOVER.
15 Q. IS THERE ANY PROJECTIONS RELATIVE TO LIFE EXPECTANCY
16 WITH THAT DEFINITION?
17 A. IT DEPENDS ON WHAT THE TERMINAL EVENT IS. A LOT OF TIME
18 YOU CAN GIVE FAMILIES A PRETTY GOOD IDEA OF WHAT'S GOING TO
19 EVOLVE.
20 Q. RELATIVE TO THE ASSESSMENT THAT YOU MADE WITH THIS
21 PARTICULAR PATIENT ON -- ON -- IN AUGUST I THINK IT WAS OF
22 1995, AUGUST 27TH OF 1995, WHAT WOULD THE TERMINAL CONDITION
23 BE THAT YOU NOTED IN YOUR ASSESSMENT?
24 A. WELL, I THINK YOUR QUESTION IS REALLY, WAS SHE -- WAS
25 SHE HAVING A TERMINAL CONDITION AT THE TIME THAT SHE LEFT THE
1 HOSPITAL, AND THE ANSWER'S NO. WHAT WE WERE DISCUSSING WAS
2 WHAT SHOULD WE DO IF SHE HAS CHEST PAIN. SHOULD SHE GO BACK
3 TO THE HOSPITAL? OR IF SHE DEVELOPS AN INFECTION THAT
4 COULD -- COULD TAKE HER LIFE, WHAT WOULD YOU LIKE US TO DO.
5 BUT SHE DIDN'T HAVE THOSE THINGS AT THE TIME SHE LEFT.
6 Q. OKAY. SO -- SO YOU WERE ESSENTIALLY TRYING TO ASSESS
7 WHAT MIGHT HAPPEN IN THE FUTURE AND THEN MAKE A DETERMINATION
8 AS TO WHAT THE FAMILY SHOULD DO OR OUGHT TO DO IN CONNECTION
9 WITH THOSE EVENTS?
10 A. IN ONE CONTINGENCY.
11 Q. IF THEY OCCURRED.
12 A. YES.
13 Q. OKAY. NO FURTHER QUESTIONS.
14 THE COURT: REDIRECT -- OR RECROSS, EXCUSE ME.
15 RECROSS-EXAMINATION
16 BY MR. BUGDEN:
17 Q. DR. PEARCE, BASED ON THE CONVERSATIONS THAT YOU HAD WITH
18 THE FAMILY ABOUT NO CODE STATUS AND COMFORT CARE AND MEDICAL
19 INTERVENTIONS, IF THIS PATIENT HAD DEVELOPED A
20 GASTROINTESTINAL BLEED, THIS FAMILY HAD ALREADY DECIDED TO
21 NOT TREAT THAT CONDITION.
22 A. YES, YOU KNOW, I THINK PRACTICALLY SPEAKING, WE'D
23 PROBABLY CONFRONT THE FAMILY WITH THAT AGAIN, YOU KNOW, TO
24 GIVE THEM AN OPTION AND ASK THEM WHAT THEY WOULD LIKE TO DO.
25 YOU KNOW WE WOULD -- EVEN IF -- EVEN IF THEY HAD A -- IF THE
1 PERSON HAD URINARY TRACT INFECTION OR PNEUMONIA OR WHATEVER
2 WE WOULD PROBABLY POSE THAT TO THEM AGAIN AND SAY, WELL, THIS
3 IS WHAT'S HAPPENING. PREPARE YOURSELVES AND WHAT WOULD YOU
4 LIKE US TO DO. WHAT WOULD MRS. LARSEN LIKE, WHAT WOULD HAVE
5 BEEN HER CHOICE.
6 Q. AND WHAT YOU DO AS A CARING PHYSICIAN IS YOU DO
7 COMMUNICATE WITH THE FAMILIES AND YOU TRY TO MAKE SURE THAT
8 YOU UNDERSTAND WHAT THEIR WISHES ARE?
9 A. YES. I DON'T THINK WE EVER MAKE THESE DECISIONS ON OUR
10 OWN. AND I DON'T THINK THE NURSING HOME STAFF WOULD MAKE ANY
11 KIND OF DECISION LIKE THAT ON THEIR OWN. I THINK THEY'D
12 ALWAYS CONSULT THE FAMILY.
13 Q. SO WHEN YOU'RE TREATING A PATIENT AND A FAMILY, YOU
14 MIGHT LOOK TO SUBSEQUENT OR SUCCESSIVE CONVERSATIONS TO MAKE
15 SURE THAT EVERYONE WAS COMFORTABLE WITH THE DECISION.
16 A. THAT'S CORRECT.
17 Q. AND YOU MIGHT THEN BE GUIDED BY LATER STATEMENTS THAT A
18 FAMILY MIGHT MIKE, LIKE, WE DON'T HAVE ANY FANTASIES ABOUT
19 THE OUTCOME OF OUR MOTHER THAT WOULD BE THE KIND OF THING
20 THAT WOULD INFLUENCE YOU, IS THAT RIGHT?
21 A. SURELY. MANY FAMILIES JUST SAY, DON'T TREAT. YOU KNOW,
22 THEY JUST GIVE US VERY CLEAR DIRECTIVES THAT THEY -- THAT
23 THEY DON'T WANT ANY -- ANY ANTIBIOTICS, FOR INSTANCE, OR THEY
24 DON'T WANT ANY TRANSFER TO THE HOSPITAL AGAIN. THAT THIS --
25 SHE'S BEEN THROUGH ENOUGH. SHE'S HAD ENOUGH STROKES AND IS
1 DEMENTED ENOUGH AND HAS A POOR ENOUGH QUALITY OF LIFE THAT
2 IT'S TIME TO SAY GOODBYE.
3 Q. AND IF FAMILY MEMBERS, FOR EXAMPLE, HAD TOLD YOU DR.
4 PEARCE, TWO OR THREE DIFFERENT TIMES THAT THEY WERE
5 REAFFIRMING A D.N.R., A NO CODE STATUS, YOU WOULD BELIEVE YOU
6 UNDERSTOOD WHAT THEIR WISHES WERE, ISN'T THAT RIGHT?
7 A. THAT'S CORRECT.
8 Q. THANK YOU.
9 THE COURT: REDIRECT?
10 MR. WILSON: NO FURTHER QUESTIONS YOUR HONOR.
11 THE COURT: MAY STEP DOWN DR. PEARCE AND THANK YOU FOR
12 TESTIFYING. MAY THIS WITNESS BE EXCUSED MR. WILSON.
13 MR. WILSON: HE MAY.
14 THE COURT: MR. BUGDEN.
15 MR. BUGDEN: YES.
16 THE COURT: YOU'RE EXCUSED, DOCTOR, AND THANK YOU FOR
17 COMING.