Karla Johnson
3 MS. BARLOW: NEXT WE WOULD CALL KARLA JOHNSON.
4 THE COURT: KARLA JOHNSON.
5 CAN I HAVE COUNSEL APPROACH THE BENCH FOR A MINUTE,
6 PLEASE?
7 (OFF-THE-RECORD DISCUSSION AT THE BENCH BETWEEN THE
8 COURT, MS. BARLOW, MR. WILSON, MR. BUGDEN AND MS. ISAACSON.)
9 THE COURT: MS. JOHNSON, WOULD YOU STEP UP, PLEASE?
10 IF YOU'D COME RIGHT UP HERE, RAISE YOUR RIGHT HAND. JUST
11 COME RIGHT UP HERE. RAISE YOUR RIGHT HAND, PLEASE, AND FACE
12 THE CLERK.
13 KARLA JOHNSON,
14 BEING FIRST DULY SWORN, WAS EXAMINED AND
15 TESTIFIED AS FOLLOWS:
16 THE COURT: IF YOU'LL HAVE A SEAT OVER HERE, PLEASE,
17 ON THE WITNESS STAND.
18 GIVE US YOUR FULL NAME, IF YOU WOULD, AND SPELL YOUR
19 LAST NAME.
20 THE WITNESS: MY NAME IS KARLA JOHNSON,
21 J-O-H-N-S-O-N.
22 THE COURT: THANK YOU.
23 THE WITNESS: AND KARLA WITH A K.
24 THE COURT: GO AHEAD.
25 MS. BARLOW: THANK YOU, YOUR HONOR.
1 DIRECT EXAMINATION
2 BY MS. BARLOW:
3 Q. GOOD AFTERNOON.
4 A. GOOD AFTERNOON.
5 Q. MS. JOHNSON, WOULD YOU TELL US WHAT YOUR OCCUPATION IS
6 CURRENTLY?
7 A. I AM A REGISTERED NURSE AND MY POSITION AT THE HOSPITAL
8 CURRENTLY IS DIRECTOR OF QUALITY RESOURCES.
9 Q. WHAT HOSPITAL IS THAT?
10 A. DAVIS HOSPITAL AND MEDICAL CENTER.
11 Q. WHERE IS THAT?
12 A. LAYTON, UTAH.
13 Q. AND IS IT THE HOSPITAL WHERE THE GEROPSYCH UNIT THAT
14 WE'RE TALKING WAS IN '94 --
15 A. YES, MA'AM.
16 Q. -- '95 AND '96?
17 A. UH-HUH.
18 Q. WHAT IS -- WHAT ARE YOUR SPECIFIC DUTIES AS DIRECTOR OF
19 QUALITY MANAGEMENT?
20 A. I HAVE BEEN IN THIS POSITION SINCE JANUARY OF 2001 AND I
21 AM THE RISK MANAGER. I AM OVER QUALITY. I AM OVER CASE
22 MANAGEMENT, SOCIAL WORKERS, EDUCATION.
23 Q. OKAY. HAVE YOU -- WELL, WHAT EDUCATION AND TRAINING HAVE
24 YOU RECEIVED?
25 A. FOR MY NURSING?
1 Q. YES.
2 A. I GRADUATED IN 1972 FROM THE UNIVERSITY OF OKLAHOMA WITH
3 A B.S. OF R.N. DEGREE, AND HAVE TAKEN CLASSES SINCE THEN:
4 QUALITY CLASSES, RISK MANAGEMENT, EDUCATION, TEACHING, THOSE
5 KIND OF THINGS.
6 Q. SO YOU BECAME A NURSE AND THEN YOU PICKED UP THIS
7 OTHER WHAT ON-THE-JOB TRAINING SORT OF THING?
8 A. IN -- MOVED HERE FROM TEXAS IN 1977 AND STARTED OFF IN
9 THE PEDIATRIC DEPARTMENT. I'VE BEEN A PEDIATRIC I.C.U. NURSE
10 BY HISTORY. AND THEN IN FEBRUARY OF 1978, I STARTED THE
11 EDUCATION DEPARTMENT AT THE HOSPITAL AND I'VE BEEN IN THAT
12 POSITION FOR THE LAST 20 SOME ODD YEARS.
13 Q. YOU'RE VERY FAMILIAR THEN WITH THE HOSPITAL?
14 A. YES, MA'AM, I AM.
15 Q. OKAY.
16 MS. BARLOW: YOUR HONOR, MAY I SHOW AN EXHIBIT?
17 THIS IS EXHIBIT NUMBER -- OOPS, WE DON'T HAVE A NUMBER ON IT
18 YET.
19 TACY, SORRY ABOUT THAT. IT'S -- I APOLOGIZES, YOUR
20 HONOR. I THOUGHT I HAD THAT.
21 THE COURT: IS IT EXHIBIT NUMBER 30 OF THE --
22 MS. BARLOW: TWENTY-ONE. IT'S NUMBER 21.
23 THE COURT: IT ISN'T MARKED? IT'S ON THE LIST.
24 MS. BARLOW: IT HASN'T GOT THE STICKER ON IT YET.
25 MAY I APPROACH THE WITNESS, YOUR HONOR?
1 THE COURT: YOU MAY.
2 Q. (BY MS. BARLOW) MS. JOHNSON, I'LL SHOW YOU WHAT'S BEEN
3 MARKED STATE'S EXHIBIT 21. DO YOU RECOGNIZE THAT?
4 A. YES, I DO.
5 Q. WHAT IS IT?
6 A. IT'S A FLOOR PLAN OF THE THIRD FLOOR, AND I BELIEVE IT
7 SHOULD BE THE LISTED ON THE BOTTOM. RIGHT THERE
8 (INDICATING).
9 Q. OKAY. AND WERE YOU PRESENT WHEN THIS PHOTOGRAPH WAS
10 ORIGINALLY TAKEN?
11 A. YES.
12 Q. OKAY. AND WHAT'S IT TAKEN OF?
13 A. IT IS ACTUALLY EXIT ROUTES THAT WE HAVE POSTED THROUGHOUT
14 THE HOSPITAL ON ALL FLOORS FOR EMERGENCIES.
15 Q. OKAY.
16 MS. BARLOW: YOUR HONOR, WE WOULD MOVE FOR ADMISSION
17 OF STATE'S EXHIBIT 21.
18 THE COURT: ANY OBJECTION, MS. ISAACSON, MR. BUGDEN?
19 MS. ISAACSON: NO.
20 MR. BUGDEN: NO OBJECTION.
21 THE COURT: TWENTY-ONE WILL BE RECEIVED.
22 MS. BARLOW: IF I MAY PUT IT HERE, YOUR HONOR, SO
23 PEOPLE CAN SEE IT.
24 THE COURT: CAN YOU SEE FOLKS SEE THAT OKAY OVER
25 THERE?
1 MS. BARLOW: AS LONG AS I DON'T STAND IN FRONT OF IT
2 MAYBE.
3 A JUROR: PODIUM IS PART WAY IN THE WAY.
4 THE COURT: LET'S WAIT. WE'LL GET AN EASEL AND
5 BRING IT OUT OVER THERE.
6 PUT IT RIGHT THERE IN FRONT OF THE SCREEN, IF YOU WOULD,
7 BAILIFF. THAT'S GOOD RIGHT THERE.
8 IF YOU'LL LET US KNOW IN ADVANCE WHEN YOU'RE GOING TO
9 USE THESE EXHIBITS, WE'LL TRY TO PREPARE FOR IT.
10 MS. BARLOW: THANK YOU, YOUR HONOR. I APOLOGIZE.
11 THE COURT: LADIES AND GENTLEMEN OF THE JURY, CAN
12 YOU SEE THAT EXHIBIT OKAY?
13 A JUROR: NEEDS TO GO THAT WAY A LITTLE BIT. I CAN
14 SEE HALF OF IT.
15 THE BAILIFF: THIS WAY?
16 A JUROR: YES.
17 MS. BARLOW: WHOOPS.
18 THE COURT: IS THAT OKAY? ALL RIGHT.
19 MS. BARLOW: THANK YOU.
20 Q. (BY MS. BARLOW) IS THIS THE WHOLE FLOOR THEN OF THE --
21 OF THE THIRD FLOOR?
22 A. YES, MA'AM, IT IS.
23 Q. THERE IS AN AREA UP ON THE UPPER RIGHT-HAND CORNER THAT'S
24 OUTLINED IN GREEN. DO YOU RECOGNIZE WHAT THAT IS?
25 A. THAT WOULD BE THE POSITION OF OUR GEROPSYCH UNIT AT THAT
1 TIME.
2 Q. DO YOU STILL HAVE A GEROPSYCH UNIT?
3 A. NO.
4 Q. WHAT DOES THE GEROPSYCH UNIT, JUST BRIEFLY, CONSIST OF?
5 A. IT WAS A 10-BED UNIT, AND IF YOU LOOK AT THE TOP, YOU CAN
6 SEE THAT THERE ARE FIVE ROOMS GOING ACROSS THE TOP. AND THEN
7 OVER IN THE CORNER WOULD BE -- THAT WOULD BE THE WEST CORNER,
8 WOULD BE LIKE THE DAY ROOM WHERE THEY DID ACTIVITIES. AND
9 THEN THE ROOM NEXT TO THAT WAS, I BELIEVE, WHERE THEY DID
10 GROUP THERAPY. THEN YOU'LL SEE THE STAIRWAYS GOING DOWN AND
11 THAT WAS LOCKED. AND THEN THERE WAS A DOOR THAT WAS LEADING
12 OVER INTO A SKILLED NURSING FACILITY AND THAT WAS LOCKED.
13 THEN COMING BACK ON THE BOTTOM HALF OF THAT AREA WOULD
14 BE THE NURSES' STATION. I BELIEVE THERE'S A SUPPLY ROOM
15 THERE, AND THERE WAS ALSO A SECLUSION ROOM THERE AND IT WAS
16 LOCKED.
17 Q. OKAY. SO THE GEROPSYCH UNIT IS NO LONGER THERE; IS THAT
18 CORRECT?
19 A. NO, IT'S NO LONGER THERE.
20 Q. SO THE SKILLED NURSING FACILITY IS IN THE BOTTOM
21 RIGHT-HAND PORTION; IS THAT CORRECT?
22 A. YES, UH-HUH. IT'S ON THE FLIP OF THE NORTH SIDE -- I
23 MEAN ON THE TOP, AND THEN IT'S ON THIS SIDE RIGHT OVER HERE.
24 AND IT'S A 10-BED UNIT.
25 Q. AND WHAT IS A SKILLED NURSING FACILITY?
1 A. IT IS A -- WE CALL IT A SNF. BUT IT'S A REHAB UNIT WHERE
2 PEOPLE WHO HAVE LIKE ORTHOPEDIC SURGERY OR MAYBE THEY'RE -- A
3 STROKE. SOMEONE WHO'S GOING TO BE REHABABLE FOR LIKE SPEECH
4 THERAPY OR PHYSICAL THERAPY OR SOMETHING LIKE THAT.
5 Q. HAVE YOU HAD THE OCCASION TO LOOK AT SOME DOCUMENTS AND
6 COMPARE THEM TO MAKE SURE THAT THEY ARE ACCURATE COPIES OF
7 WHAT IS IN THE HOSPITAL RECORDS?
8 A. YES, MA'AM.
9 MS. BARLOW: YOUR HONOR, MAY I APPROACH THE WITNESS?
10 THE COURT: YOU MAY.
11 (MS. BARLOW SHOWS DOCUMENTS TO DEFENSE COUNSEL.)
12 MS. BARLOW: IF I MAY APPROACH?
13 Q. (BY MS. BARLOW) SHOW YOU WHAT'S BEEN MARKED STATE'S
14 EXHIBIT 7 FOR IDENTIFICATION. DO YOU RECOGNIZE THAT
15 DOCUMENT?
16 A. YES, I DO.
17 Q. WHAT IS IT?
18 A. IT'S A POLICY AND PROCEDURE FROM OUR HOSPITAL ON APPROVED
19 ABBREVIATIONS OF -- THAT ARE USED IN THE HOSPITAL AT THE
20 TIME.
21 Q. IN 1995 AND '96?
22 A. YES, MA'AM.
23 MS. BARLOW: YOUR HONOR, I'D MOVE FOR ADMISSION OF
24 EXHIBIT 7.
25 THE COURT: ANY OBJECTION?
1 MS. ISAACSON: NO OBJECTION.
2 THE COURT: SEVEN IS RECEIVED.
3 Q. (BY MS. BARLOW) I SHOW YOU WHAT'S BEEN MARKED STATE'S
4 EXHIBIT 18 FOR IDENTIFICATION. DO YOU RECOGNIZE THAT
5 DOCUMENT?
6 A. YES, I DO.
7 Q. WHAT IS THAT?
8 A. THIS IS THE -- CAME OUT OF THE EQUIPMENT INSTRUCTION
9 MANUAL ON USING OUR DICTATION EQUIPMENT.
10 Q. IS THAT AN ACCURATE COPY OF THE MANUAL?
11 A. YES, MA'AM.
12 MS. BARLOW: I'D MOVE FOR ADMISSION OF NUMBER 18.
13 MS. ISAACSON: NO OBJECTION.
14 THE COURT: EIGHTEEN IS RECEIVED.
15 Q. (BY MS. BARLOW) ARE YOU FAMILIAR WITH HOW THE DICTATION
16 EQUIPMENT WORKS --
17 A. YOU MEAN --
18 Q. -- AT THE HOSPITAL?
19 A. -- COULD I USE IT?
20 Q. ARE YOU FAMILIAR WITH HOW IT WORKS.
21 A. NOT REALLY. I KNOW HOW TO INTERPRET THE INFORMATION
22 AFTER IT'S ALREADY BEEN USED.
23 Q. IS THERE -- ARE THEY HANDHELD DICTAPHONES OR -- OR HOW --
24 A. NO. THEY SPEAK INTO THE PHONE AND THEY DIAL SPECIFIC
25 NUMBERS TO ACTIVATE THAT.
1 Q. OKAY. WHO -- WHO HAS ACCESS TO THOSE NUMBERS?
2 A. PHYSICIANS.
3 Q. IF A PHYSICIAN IS MAKING A DICTATION THEN, WHAT EXACTLY
4 WOULD HE OR SHE DO?
5 A. HE WOULD HAVE TO DIAL IN TO THE SPECIFIC NUMBERS TO
6 ACTIVATE THE SYSTEM, AND THEN HE WOULD HAVE TO PROBABLY GIVE
7 HIS NAME OR HIS NUMBER. AND THEN THE MACHINE WOULD
8 AUTOMATICALLY KEEP TRACK OF WHATEVER, JUST KIND OF LIKE YOU
9 WERE TALKING IN A TAPE RECORDER, AND IT WOULD LOG IN THE TIME
10 THAT IT WAS RECEIVED. AND THAT WOULD BE LIKE THE TIME
11 DICTATED.
12 Q. AND THEN WHAT HAPPENS?
13 A. THEN WE HAVE TRANSCRIPTIONIST WHO THEN GO ON TO THE LINE
14 AND THEN WOULD TRANSCRIBE THE INFORMATION. AND THEN THE
15 PRINTED PAPER WOULD BE -- COME OUT OF A PRINTER AND WE'D PUT
16 IT IN THE PATIENT'S CHART.
17 Q. AND IF ON ANY OF THESE RECORDS IT HAS DICTATION AND THEN
18 THERE'S A D: AND A DATE AND TIME AND A T: AND A DATE AND
19 TIME, WHAT WOULD THAT SIGNIFY?
20 A. THE D. WOULD SIGNIFY WHEN THE REPORT WAS DICTATED BY THE
21 PHYSICIAN. AND THEN T. WOULD -- WOULD BY DATE AND TIME WHERE
22 IT WAS TRANSCRIBED BY THE TRANSCRIPTIONIST.
23 Q. OKAY. THANK YOU.
24 MS. BARLOW: IF I MAY APPROACH AGAIN, YOUR HONOR?
25 THE COURT: YOU MAY.
1 Q. (BY MS. BARLOW) SHOW YOU WHAT'S BEEN MARKED STATE'S
2 EXHIBIT 29 FOR IDENTIFICATION. DO YOU RECOGNIZE THAT
3 DOCUMENT?
4 A. YES, I DO.
5 Q. AND WHAT IS IT?
6 A. THIS WOULD BE OUR CLINICAL PRIVILEGES THAT WE WOULD HAVE
7 FOR A PHYSICIAN THAT'S ASKING FOR PRIVILEGES IN OUR HOSPITAL.
8 Q. IS THAT A CORRECT COPY OF PRIVILEGES FOR ANY PARTICULAR
9 PERSON?
10 A. YES.
11 Q. WHO IS IT FOR?
12 A. DR. WEITZEL.
13 Q. OKAY. DO YOU HAVE ANY PERSONAL KNOWLEDGE ABOUT WHAT
14 SPECIFIC PRIVILEGES HE ASKED FOR?
15 A. NO.
16 MS. BARLOW: YOUR HONOR, I'D MOVE FOR ADMISSION OF
17 NUMBER 29.
18 MS. ISAACSON: OBJECTION. RELEVANCE.
19 THE COURT: WHAT IS THE RELEVANCE?
20 MS. BARLOW: WELL, YOUR HONOR, I WILL HOLD OFF
21 MOVING FOR ADMISSION. I THINK IT WILL --
22 THE COURT: ALL RIGHT.
23 MS. BARLOW: -- BECOME MORE RELEVANT AS WE CONTINUE.
24 Q. (BY MS. BARLOW) ARE DOCTORS USUALLY EMPLOYS OF A
25 HOSPITAL?
1 A. NO, MA'AM, THEY'RE NOT.
2 Q. WHAT -- WHAT CONNECTION USUALLY IS THERE BETWEEN DOCTORS
3 AND HOSPITALS?
4 A. WELL, FOR A PHYSICIAN, WHAT WE HAVE IS A CREDENTIALING
5 PROCESS THAT THEY NEED TO APPLY FOR CERTAIN PRIVILEGES AND
6 THEN THEY ARE GRANTED THOSE PRIVILEGES BASED ON THEIR
7 EDUCATION AND THEIR EXPERIENCE. AND THAT IS DONE BY A
8 DIFFERENT GROUP OF PHYSICIANS. THEY ARE NOT EMPLOYEES,
9 PER SE. THEY ARE INDEPENDENT PRACTITIONERS.
10 Q. DOES THE HOSPITAL BILL FOR THE PHYSICIANS?
11 A. NO, UH-UH. THEY BILL FOR THEIR OWN WORK.
12 MS. BARLOW: IF I MAY APPROACH AGAIN, YOUR HONOR?
13 THE COURT: YOU MAY.
14 Q. (BY MS. BARLOW) SHOW YOU STATE'S NUMBER -- EXHIBIT
15 NUMBER 17 FOR IDENTIFICATION. DO YOU RECOGNIZE THAT
16 DOCUMENT?
17 A. YES, I DO.
18 Q. WHAT IS IT?
19 A. THIS WOULD BE THE MEDICATION CONTROL SHEET FOR NARCOTICS
20 THAT WE USED AT THAT TIME.
21 Q. AND IS THIS AN ACCURATE COPY OF --
22 A. YES, MA'AM.
23 Q. -- WHAT IS AT THE HOSPITAL.
24 MS. BARLOW: I WON'T MOVE FOR ADMISSION OF THIS AT
25 THIS TIME, YOUR HONOR.
1 Q. (BY MS. BARLOW) WERE YOU FAMILIAR IN '94, '95, AND '96
2 WITH THE GEROPSYCH UNIT?
3 A. I KNEW WE HAD A GEROPSYCH UNIT. IT WAS NOT OWNED BY THE
4 HOSPITAL. IT WAS DONE BY -- MANAGEMENT OF THAT WAS DONE BY A
5 SEPARATE CORPORATION AND THE NURSES WERE OURS.
6 Q. WERE YOU INVOLVED AT ALL IN THE HIRING OF THOSE NURSES?
7 A. NO, I WAS NOT.
8 Q. DOES -- DID THE HOSPITAL AT THAT TIME HAVE ANY MEANS BY
9 WHICH NURSES COULD EXPRESS CONCERNS ABOUT CARE AND TREATMENT
10 OF PATIENTS?
11 A. YES.
12 MS. ISAACSON: YOUR HONOR, OBJECTION. RELEVANCE.
13 MS. BARLOW: YOUR HONOR, WE'LL HAVE TO TIE THIS
14 TOGETHER WITH OTHER WITNESSES, BUT --
15 THE COURT: I'LL OVERRULE THE OBJECTION.
16 Q. (BY MS. BARLOW) WAS -- YOU SAY THERE WAS A PROCEDURE?
17 A. THERE WAS A PROCEDURE.
18 Q. WHAT WAS THE PROCEDURE FOR A NURSE HAVING CONCERNS?
19 A. IF AT ANY TIME A NURSE HAD A CONCERN THEY COULD ALWAYS GO
20 TO THEIR HEAD NURSE, OR WE HAD NURSING SUPERVISORS THAT ARE
21 THERE 24 HOURS A DAY THAT THEY COULD ADDRESS THEIR CONCERNS
22 WITH.
23 IF AT THAT TIME WE COULD GO TO THE PHYSICIAN, OR IF THE
24 PHYSICIAN DID NOT RESPOND THAT WE FELT COMFORTABLE WITH, THEN
25 WE COULD GO TO THE CHIEF OF SERVICE.
1 Q. ARE YOU FAMILIAR WITH THE WAY MEDICAL RECORDS OR CHARTS S
2 ARE COMPILED OR WERE COMPILED IN 1995, '96, ON THIS UNIT?
3 A. UH-HUH.
4 Q. AND HOW ARE YOU FAMILIAR WITH THAT?
5 A. BECAUSE I WOULD DO CHART REVIEWS SOMETIMES ON ANY OF THE
6 CHARTS IN THE HOSPITAL.
7 Q. WERE PHOTOGRAPHS EVER INCLUDED IN THE MEDICAL CHARTS OF
8 PATIENTS?
9 A. THEY WERE IN THE GEROPSYCH UNIT. THAT WAS PART OF OUR
10 POLICIES THAT WE WOULD TAKE PICTURES OF THE CLIENTS WHEN THEY
11 WERE ADMITTED INTO A PSYCH UNIT.
12 Q. AND WHAT WAS THE PURPOSE OF THAT?
13 A. FOR IDENTIFICATION, AND A LOT OF YOUR PSYCH PATIENTS
14 SOMETIME HAVE A TENDENCY TO WANDER, SO THAT IF THEY DID
15 WANDER, WE WOULD KNOW WHO WE WERE LOOKING FOR IN THE
16 POPULATION.
17 Q. DID YOU HAVE TO GET THE CONSENT OF ANYONE TO HAVE THESE
18 PHOTOGRAPHS TAKEN?
19 A. YES, WE DID HAVE CONSENTS MADE. AND THEN UPON DISCHARGE,
20 THEY HAD THE RIGHT TO TAKE THE PICTURE WITH THEM.
21 Q. SO YOU DIDN'T -- THE FAMILY DIDN'T HAVE TO LEAVE THE
22 PICTURES THERE?
23 A. NO, THEY COULD TAKE THEM.
24 Q. HAVE YOU HAD THE OCCASION TO LOOK AT THE MEDICAL RECORDS
25 OF THESE FIVE PEOPLE THAT WE'RE DEALING WITH IN THIS TRIAL?
1 A. I HAVE LOOKED AT SOME OF THEM, YES.
2 Q. HAVE YOU SEEN ANY PHOTOGRAPHS IN THOSE?
3 A. I HAVE SEEN SOME WITH PHOTOGRAPHS AND SOME WITHOUT
4 PHOTOGRAPHS.
5 Q. THERE HAVE BEEN SOME PHOTOGRAPHS SHOWN BY THE DEFENSE
6 THIS MORNING TO THE JURY WHICH ARE SMALL PHOTOGRAPHS THAT
7 APPEAR TO BE PHOTOGRAPHS TAKEN AT THE TIME OF ADMISSION OF
8 THESE PEOPLE. ARE YOU AWARE HOW THE DEFENSE OBTAINED THESE
9 COLOR PHOTOGRAPHS?
10 A. THEY DID THAT THROUGH A SUBPOENA, AND THEY CAME AND THEY
11 SCANNED THEM.
12 Q. BECAUSE THEY ARE COLOR PHOTOGRAPHS; IS THAT CORRECT?
13 A. YES, THEY ARE.
14 Q. WERE -- WOULD ANYONE, EITHER THE STATE OR THE DEFENSE,
15 BEEN ALLOWED TO TAKE THESE COLOR PHOTOGRAPHS OUT OF THE
16 HOSPITAL AND HAVE COLOR COPIES MADE OF THEM?
17 A. NO, UH-UH. WE MAKE COPIES OURSELVES, THEN THEY WILL BE
18 BLACK AND WHITE BECAUSE THAT'S WHAT OUR COPY CAPABILITIES
19 ARE.
20 Q. SO TO GET THESE COLOR PHOTOGRAPHS --
21 A. YEAH.
22 Q. -- THEY HAD TO DO A SPECIAL -- BRING THEIR OWN SCANNER
23 IN. THANK YOU.
24 AS FAR AS CHARTING --
25 MS. BARLOW: YOUR HONOR, MAYBE IF I COULD APPROACH
1 WITH AN EXHIBIT HERE. MAY I APPROACH THE WITNESS, YOUR
2 HONOR?
3 THE COURT: YES.
4 Q. (BY MS. BARLOW) I SHOW YOU WHAT IS MARKED -- I BELIEVE
5 IT'S EXHIBIT 6(B); IS THAT CORRECT? ENNIS ALLREDGE?
6 MR. WILSON: YES.
7 MS. BARLOW: I BELIEVE IT'S 6(B), YOUR HONOR.
8 Q. (BY MS. BARLOW) I DON'T WANT TO ASK YOU, OF COURSE, TO
9 GO THROUGH EVERY PAGE OR THAT SORT OF THING, BUT CAN YOU --
10 ARE THERE CERTAIN --
11 THE COURT: I THINK WE'VE ALREADY SEEN 6(B), HAVEN'T
12 WE? ARE YOU SURE THIS IS 69(B)?
13 MS. BARLOW: LET'S SEE. ENNIS ALLREDGE HOSPITAL
14 RECORDS.
15 THE COURT: THAT'S WHAT IT SHOWS, BUT I SHOW A 6(B)
16 WAS TALKED ABOUT PREVIOUSLY.
17 MR. BUGDEN: YOUR HONOR, I THINK IT'S THE SAME
18 RECORD THAT WAS --
19 THE COURT: MAYBE IT WAS ONE PAGE OF THAT RECORD.
20 THAT'S WHAT IT WAS.
21 MS. BARLOW: RIGHT. THAT WAS ONE PAGE.
22 THE COURT: YOU NEED TO CLARIFY THAT ON THE RECORD
23 WHEN YOU DO THAT. ALL RIGHT.
24 MS. BARLOW: THIS IS THE WHOLE RECORD ITSELF.
25 THE COURT: OKAY.
1 Q. (BY MS. BARLOW) ARE THERE -- IS THERE MORE THAN ONE PAGE
2 IN THIS -- IN THIS EXHIBIT?
3 A. YES, MA'AM.
4 Q. WHAT DOES THAT EXHIBIT COMPRISE? WHAT IS IT?
5 A. THIS WOULD BE FROM TIME OF ADMISSION TO TIME OF
6 DISCHARGE. EVERYTHING THAT WOULD HAVE OCCURRED ON A PATIENT
7 FROM ALL DISCIPLINES.
8 Q. SO THE PEOPLE WHO CARE FOR THIS PATIENT ARE REQUIRED TO
9 WHAT? MAKE NOTES?
10 A. YES. WE'RE ALL REQUIRED TO MAKE NOTES ABOUT THE CARE
11 THAT WE'VE RENDERED.
12 Q. ARE THERE ANY SPECIFIC WAYS THAT THESE KIND OF RECORDS
13 ARE SUPPOSED TO BE KEPT?
14 A. MEANING?
15 Q. MEANING IS THERE ANY PARTICULAR ORDER THAT THESE CHARTS
16 ARE IN?
17 A. WE DO HAVE A STANDARD KIND OF A CHART ORDER THAT WE LIKE
18 TO FOLLOW ONLY BECAUSE IT'S EASIER FOR EVERYBODY TO FIND THE
19 ITEMS THAT WOULD BE NECESSARY WITHIN THE RECORD. WE DON'T
20 ALWAYS FOLLOW IT A HUNDRED PERCENT OF THE TIME, BUT WE
21 USUALLY START OFF WITH THE FACE PAGE AND THEN YOU'LL HAVE THE
22 HISTORY AS TO WHY THEY WERE BEING ADMITTED. THEN YOU HAVE
23 YOUR DOCTOR'S ORDERS AND THEN HOW WE'VE TAKEN OFF THE
24 DOCTOR'S ORDERS, AND THEN YOU'D HAVE YOUR DISCIPLINE
25 CHARTING. A LOT OF TIMES DISCIPLINE CHARTING OTHER THAN THE
1 PHYSICIAN WOULD BE ON THE SAME PAGES SO THAT WE CAN ALL
2 COMMUNICATE AND READ WHAT OTHER DISCIPLINES ARE WRITING.
3 Q. WHEN YOU SAY OTHER DISCIPLINES, TO WHAT ARE YOU
4 REFERRING?
5 A. THAT WOULD BE THE NURSES, IT COULD BE DIETARY, IT COULD
6 BE SOCIAL WORKERS, IT COULD BE PHYSICAL THERAPISTS,
7 RECREATION THERAPISTS, OCCUPATIONAL THERAPISTS, AND
8 RESPIRATORY THERAPISTS WOULD BE THE DISCIPLINES THAT WE WOULD
9 HAVE CHART ON OUR RECORD.
10 Q. WHEN YOU TALK ABOUT OCCUPATIONAL THERAPISTS WITH THESE
11 PEOPLE ON THE GEROPSYCH UNIT, I MEAN OCCUPATION WE TEND TO
12 THINK OF A JOB OR SOMETHING. WHAT -- WHAT DO YOU MEAN BY
13 OCCUPATIONAL THERAPIST?
14 A. WELL, THE ROLE OF AN OCCUPATIONAL THERAPIST IS TO
15 ACTUALLY TRY TO SEE DOES THE PATIENT NEED HELP WITH
16 ACTIVITIES OF DAILY LIVING, WHICH WOULD BE LIKE BATHING OR
17 PUTTING THEIR CLOTHING ON OR FEEDING THEMSELVES, AMBULATING.
18 AND SO THE OCCUPATIONAL THERAPIST WOULD DO THERAPY TO ASSIST
19 THEM WITH THOSE KIND OF BEHAVIORS.
20 Q. YOU MENTIONED A SPOT -- A PLACE FOR DOCTORS TO WRITE
21 THEIR ORDERS.
22 A. UH-HUH.
23 Q. WHAT DO YOU MEAN BY DOCTOR'S ORDER?
24 A. THIS WOULD BE WHERE THE PHYSICIAN HAS WRITTEN WHAT HE
25 WOULD LIKE TO HAVE ACCOMPLISHED ON THAT PATIENT AFTER THE
1 VISIT, AFTER HE'S MADE ROUNDS.
2 Q. UH-HUH.
3 A. AND THEN THAT ORDER WOULD BE TRANSCRIBED ON TO OTHER
4 DOCUMENTS SUCH AS MEDICATION ADMINISTRATION RECORD, PUT INTO
5 THE COMPUTER IF IT'S LAB WORK TO GO DOWN TO THE LAB OR TO
6 X-RAY OR TO DIETARY TO CARRY OUT THOSE ORDERS.
7 Q. DO DOCTORS EVER TELEPHONE IN ORDERS?
8 A. UH-HUH. THERE'S THREE WAYS THAT WE CAN ACCEPT ORDERS.
9 ONE WOULD BE THE WRITTEN ORDER, TELEPHONE ORDER, OR VERBAL
10 ORDER.
11 Q. AND A VERBAL ORDER IS WHAT? THE DOCTOR'S THERE BUT SAYS
12 IT RATHER THAN WRITES IT?
13 A. THAT IS CORRECT, AND THEN WE'D WRITE THAT AS A VERBAL
14 ORDER.
15 Q. IF A DOCTOR WERE TO ORDER SOME KIND OF CONTROLLED
16 SUBSTANCE AND WERE TO WRITE IT IN THE PHYSICIAN'S ORDER,
17 WHAT -- WHAT THEN WOULD HAPPEN TO SEE THAT THAT ORDER IS
18 CARRIED OUT?
19 A. WELL, WHAT WE WOULD DO WOULD BE TO TAKE OFF THE ORDER AND
20 PUT IT ON WHAT'S CALLED THE PATIENT'S CARDEX SO THAT --
21 THAT'S A DEVICE THAT WE KIND OF USE TO GIVE REPORT ON. AND
22 THEN WE PUT IT ON THE PATIENT'S ADMINISTRATION RECORD. THE
23 PHYSICIAN ORDER IS A THREE-COPY DOCUMENT AND THE -- ONE COPY
24 GOES TO THE PHARMACY AND SO THEY WOULD THEN FILE IT AND FILL
25 AND BRING IT TO -- THE MEDICATION TO US, OR I BELIEVE AT THAT
1 TIME WE DIDN'T HAVE THE PYXIS IN PLACE AND SO WE HAD LOCK
2 BOXES FOR THE NARCOTICS.
3 Q. WHEN YOU SAY TAKE IT OFF, WHO WOULD DO THAT?
4 A. YOU COULD HAVE A WARD CLERK OR MAYBE EVEN A NURSES' AIDE
5 THAT WOULD TRANSCRIBE WHICH WOULD MEAN WRITE THE ORDER ON TO
6 THE M.A.R. OR THE CARDEX, BUT ONLY A NURSE COULD -- A
7 REGISTERED NOTE COULD NOTE THAT ORDER. AND IN DOING SO SHE'S
8 VERIFYING THE ACCURACY, THAT IT'S BEEN TRANSCRIBED CORRECTLY
9 AND HAS BEEN CARRIED OUT.
10 Q. AFTER THE PHYSICIAN'S ORDERS I BELIEVE THERE'S A SECTION
11 CALLED PROGRESS NOTES. DO YOU KNOW WHAT THAT IS?
12 A. THAT'S -- IN OUR HOSPITAL WE -- OUR -- OUR CHART IS THAT
13 THE PHYSICIAN HAS THE ORDERS ON ONE SIDE AND THE PROGRESS
14 NOTES ON THE OTHER SIDE SO THAT IN THE PROGRESS NOTES IT
15 WOULD BE DIRECTLY LINKED TO THE REASONING WHY OR WHAT HIS
16 PLAN OF ACTION WOULD BE FOR THIS PATIENT AFTER HE'S MADE HIS
17 VISIT.
18 Q. DID THE NURSES EVER WRITE ANY NOTES?
19 A. WE CAN. SOCIAL WORKERS CAN WRITE ON THAT AS WELL. IN
20 FACT, ALL -- ALL OF OUR DISCIPLINES CAN WRITE ON THAT IF NEED
21 BE.
22 Q. YOU ALSO INDICATE THERE'S THE CARDEX, AND IS THAT WHAT
23 THE MEDICATIONS ARE KEPT TRACK OF?
24 A. WE KIND OF KEEP TRACK OF EVERYTHING THAT'S GOING ON WITH
25 THE PATIENT IN THE CARDEX. IT'S JUST A COMMUNICATION TOOL SO
1 THAT WE CAN COMMUNICATE BETWEEN ONE NURSE AND ANOTHER. BUT
2 THE REGULAR MEDICATION ADMINISTRATION RECORD IS WHERE WE
3 REALLY DOCUMENT THE MEDICATIONS THAT'S GIVEN THAT'S BEEN
4 ORDERED AND THAT KIND OF THING.
5 Q. IS THERE A SEPARATE SECTION FOR NURSES' NOTES THAT JUST
6 NURSES WRITE IN OR -- OR NURSES AND C.N.A.S, THE NURSING
7 STAFF?
8 A. WE CAN ALL WRITE ON OUR NOTES. I'M TRYING TO REMEMBER,
9 I -- I CANNOT RECALL FOR SURE IF AT THAT TIME WE DID WHAT WE
10 CALL NOW INTERDISCIPLINARY CHARTING WHERE WE ALL WRITE ON THE
11 SAME FORM. AND I THINK WE WERE JUST BEGINNING TO GO THAT
12 WAY. AND WHEN I LOOK AT THE RECORD, AT THIS TIME IT WAS OUR
13 NURSING NOTES COMPLETELY SO THAT THE SOCIAL WORKERS AND
14 SPEECH THERAPISTS, OCCUPATIONAL THERAPISTS, THEY WROTE ON A
15 DIFFERENT DOCUMENT AND WE WROTE ON THE NURSES' NOTES.
16 Q. WAS THERE MORE THAN ONE SHIFT OF NURSES?
17 A. OH, YES.
18 Q. HOW MANY SHIFTS WERE THERE IN A DAY?
19 A. WE EITHER WORK 8-HOUR SHIFTS OR 12-HOUR SHIFTS, AND I
20 BELIEVE THAT IN THIS UNIT WE HAVE 12-HOUR SHIFTS.
21 Q. OKAY. YOU DON'T RECALL THOUGH.
22 A. NO, MA'AM.
23 Q. BECAUSE YOU DIDN'T WORK THERE YOURSELF.
24 A. NO.
25 Q. IS THAT CORRECT?
1 A. (NODS HEAD.)
2 Q. SO IF IT WERE AN EIGHT-HOUR SHIFT, WHAT WOULD BE THE
3 SHIFT HOURS?
4 A. MOST OF OUR SHIFT HOURS GO FROM SEVEN TO THREE, THREE TO
5 ELEVEN, AND ELEVEN TO SEVEN.
6 Q. OKAY. IS THERE ANY OVERLAP WHEN NURSES ARE HANDING OFF
7 THE PATIENTS, AS IT WERE?
8 A. UH-HUH. WE DO WHAT'S CALLED GIVING REPORT, AND USUALLY
9 THE SHIFT THAT COMES ON STARTS ON THE HOUR AND THE SHIFT THAT
10 LEAVES WOULD THEN LEAVE ON THE HALF HOUR. FOR EXAMPLE, FROM
11 7:00 TO 7:30 IN THE MORNING WOULD BE WHEN WE WOULD BE GIVING
12 REPORT TO ONE ANOTHER.
13 MS. BARLOW: MAY I HAVE JUST A MOMENT, YOUR HONOR?
14 THE COURT: SURE.
15 MS. BARLOW: IF I MAY RETRIEVE THAT EXHIBIT FROM
16 YOU.
17 I BELIEVE THAT'S ALL I HAVE OF THIS WITNESS, YOUR HONOR.
18 THE COURT: CROSS-EXAMINE, MR. BUGDEN?
19 MR. BUGDEN: IT'S ACTUALLY MS. ISAACSON'S WITNESS,
20 YOUR HONOR. THANK YOU THOUGH.
21 MS. ISAACSON: YOUR HONOR, BY STIPULATION THE
22 PARTIES HAVE AGREED THAT EXHIBITS 1, 2, AND 3 COULD BE
23 ADMITTED. THESE ARE THE ADMISSION PHOTOGRAPHS OF JUDITH ITS
24 LARSEN, LYDIA SMITH AND ENNIS ALLREDGE.
25 THE COURT: THAT WOULD BE 1, 2, AND 3?
1 MS. ISAACSON: THAT'S RIGHT.
2 THE COURT: IS THAT THE STATE'S AGREEMENT,
3 MR. WILSON?
4 MR. WILSON: IT IS, YOUR HONOR.
5 THE COURT: EXHIBITS 1, 2, AND 3 THEN WILL BE
6 RECEIVED.
7 CROSS-EXAMINATION
8 BY MS. ISAACSON:
9 Q. MS. JOHNSON, IF I COULD JUST ASK YOU A FEW QUESTIONS.
10 WITH REGARD TO THE DICTATION, THE WAY THE DICTATION WORKS IS
11 THAT YOU DON'T NECESSARILY DO THAT RIGHT WHEN YOU'RE
12 CONDUCTING AN EXAMINATION.
13 A. OH, NO. USUALLY YOU GO IN AND -- AND YOU MAKE YOUR VISIT
14 WITH THE PATIENT, AND THEN YOU WOULD COME BACK OUT TO THE
15 STATION AND SIT AT A PHONE. WE TRY TO HAVE THEM WHERE IT'S
16 QUIET SO THAT THEY -- THE PHYSICIAN WON'T BE DISTURBED WHEN
17 HE'S MAKING HIS DICTATION.
18 Q. AND SO, FOR EXAMPLE, IF DR. WEITZEL HAD DONE A
19 PSYCHIATRIC EVALUATION ON A PATIENT, HE COULD LATER DICTATE
20 THAT EVALUATION AT ANY TIME.
21 A. SURE.
22 MS. ISAACSON: NOTHING FURTHER.
23 MR. BUGDEN: ACTUALLY --
24 THE COURT: REDIRECT?
25 MR. BUGDEN: EXCUSE ME. EXCUSES ME, YOUR HONOR.
1 MS. ISAACSON: SORRY, YOUR HONOR. ONE MORE.
2 Q. (BY MS. ISAACSON) YOU'D INDICATED ON YOUR DIRECT
3 TESTIMONY THAT DOCTOR'S ORDERS WENT TO THE CHART, TO THE
4 NURSES, AND TO THE PHARMACY.
5 A. YES.
6 Q. AND SO THAT WOULD MEAN THAT THE PHARMACY WOULD ALWAYS BE
7 AWARE OF ALL OF THE PHYSICIAN'S ORDERS FOR MEDICATIONS.
8 A. YES.
9 Q. FOR EXAMPLE, THE AMOUNT OF MORPHINE THAT WAS BEING
10 ORDERED.
11 A. YES.
12 MS. ISAACSON: THANK YOU. NOTHING FURTHER.
13 MS. BARLOW: NO RE-- REDIRECT, YOUR HONOR.
14 THE COURT: YOU MAY STEP DOWN THEN, MS. JOHNSON.
15 MAY THIS WITNESS BE EXCUSED, MS. BARLOW?
16 MS. BARLOW: YES. YES, YOUR HONOR.
17 MS. ISAACSON: YES.
18 THE COURT: MS. ISAACSON?
19 YOU MAY BE EXCUSED, MS. JOHNSON, AND THANK YOU FOR
20 TESTIFYING.