Neil Clinger, MD
15 MR. WILSON: NEXT CALL DR. NEAL CLINGER. I BELIEVE
16 HE'S JUST RIGHT NOW OUTSIDE. DR. CLINGER.
17 THE COURT: DR. CLINGER, WOULD YOU STEP UP HERE,
18 PLEASE. RAISE YOUR RIGHT HAND AND FACE THE CLERK, SHE'LL
19 PLACE YOU UNDER OATH.
20 NEAL J. CLINGER,
21 HAVING BEEN DULY SWORN, WAS EXAMINED AND
22 TESTIFIED AS FOLLOWS:
23 THE COURT: IF YOU'LL HAVE A SEAT UP HERE, DOCTOR.
24 TELL US YOUR FULL NAME, PLEASE AND SPELL YOUR LAST NAME.
25 THE WITNESS: NEAL J. CLINGER C-L-I-N-G-E-R.
1 THE COURT: THANK YOU. YOU MAY PROCEED, MS. BARLOW.
2 MS. BARLOW: THANK YOU, YOUR HONOR.
3 DIRECT EXAMINATION
4 BY MS. BARLOW:
5 Q. GOOD AFTERNOON DR. CLINGER?
6 A. AFTERNOON.
7 Q. I APPRECIATE YOU COMING IN THIS AFTERNOON.
8 A. YOU BET.
9 Q. CAN YOU TELL US WHERE YOU GRADUATED FROM MEDICAL SCHOOL?
10 A. UNIVERSITY OF WASHINGTON IN SEATTLE.
11 Q. AND WHEN WAS THAT?
12 A. 1984.
13 Q. WHAT OTHER TRAINING HAVE YOU RECEIVED FOR YOUR SPECIALTY?
14 A. I DID A RADIOLOGY RESIDENCY UNIVERSITY OF ARIZONA 1984
15 THROUGH '88 AND THEN A YEAR FELLOWSHIP IN NEURORADIOLOGY IN
16 UNIVERSITY OF ARIZONA UNTIL 1989. AND THEN I'VE BEEN
17 PRACTICING MEDICINE HERE AT DAVIS HOSPITAL AND OGDEN REGIONAL
18 MEDICAL CENTER SINCE THAT TIME.
19 Q. YOUR SPECIALTY THEN IS RADIOLOGY?
20 A. RADIOLOGY WITH A SUBSPECIALTY IN NEURORADIOLOGY WHICH
21 DEALS WITH THE BRAIN AND SPINE.
22 Q. I'M SORRY. I JUST HAD A -- YOU MENTIONED BRAIN AND MINE
23 JUST QUIT.
24 ARE YOU BOARD CERTIFIED?
25 A. YES, I AM.
1 Q. WHEN DID YOU BECOME BOARD CERTIFIED?
2 A. 1989.
3 Q. DID YOU HAVE OCCASION TO -- AND YOU MAY NOT REMEMBER
4 THIS, HOW MANY MRIS DO YOU DO IN A DAY THAT YOU READ IN A
5 DAY?
6 A. ANYWHERE FROM 25 TO 30.
7 Q. WE'VE ALREADY HEARD TALK ABOUT CT SCANS AND X-RAYS AND
8 HOW THEY WORK. WHAT IS AN MRI?
9 A. AN MRI IS A STUDY THAT IS ABLE TO IMAGE DIFFERENT PARTS
10 OF THE BODY BASED ON HYDROGEN ATOMS IT DOESN'T USE ANY
11 RADIATION, IT'S JUST USED ON THE SPIN OF THE HYDROGEN ATOM
12 INSIDE MOLECULES. YOU PUT -- IT'S A GIANT MAGNETIC FIELD
13 HIGH STRENGTH MAGNETIC THAT THE PATIENT IS PLACED INTO AND IS
14 ABLE TO IMAGE AREAS OF THE BODY DOWN FROM THE BRAIN TO THE
15 ANKLES AND THE FEET.
16 Q. I BELIEVE YOU HAVE IN FRONT OF YOU A GRAY BOOK THAT HAS
17 P6B ON THE FRONT OF IT. IT IS THE MEDICAL RECORDS FOR ENNIS
18 ALLDREDGE, DO YOU SEE THAT THERE?
19 A. YES, UH-HUH.
20 Q. WOULD YOU TURN TO MEDICAL PAGE 27.
21 MS. BARLOW: AGAIN, THIS IS 6B MED 27, YOUR HONOR?
22 THE WITNESS: OKAY.
23 Q. (BY MS. BARLOW) DID YOU HAVE OCCASION TO READ AN MRI FOR
24 ENNIS ALLDREDGE?
25 A. YES, I DID.
1 Q. DO YOU ACTUALLY PERFORM THE MRI OR DO OTHERS DO THAT.
2 A. THE TECHNOLOGIST PERFORMS THE STUDIES AND THEN WE
3 INTERPRET THE IMAGES THAT COME FROM THAT STUDY.
4 Q. WHAT DAY DID YOU INTERPRET THIS MRI FOR ENNIS ALLDREDGE?
5 A. 12TH OF JANUARY 1996.
6 Q. DO YOU HAVE ANY INDEPENDENT RECOLLECTION OF THAT
7 OCCURRENCE?
8 A. I WISH MY MEMORY WERE THAT GOOD BUT, NO, I CAN'T
9 REMEMBER.
10 Q. WISH MINE WERE GOOD ENOUGH TO REMEMBER FOR TWO MINUTES.
11 WAS THIS -- WELL, LET'S JUST START WITH THE FIRST
12 PARAGRAPH. THE DATE OF THE EXAM IS 1/12, WOULD YOU READ THE
13 FIRST PARAGRAPH OF WHAT YOU WROTE IN YOUR REPORT?
14 A. MRI OF THE BRAIN PATIENT WAS SEDATED BUT STILL COMBATIVE
15 AND WOULD NOT LAY STILL AS A RESULT THE STUDY IS QUITE
16 COMPROMISED DUE TO MOTION. THERE IS MODERATE ATROPHY PRESENT
17 BILATERALLY. THE VENTRICLES PROMINENT SIZE PROBABLY DUE TO
18 COMPENSATORY ENLARGEMENT FROM THE ATROPHY RATHER THAN ANY
19 DEFINITE HYDROCEPHALOUS BUT A CLINICAL CORRELATION IS URGED.
20 Q. THE PATIENT WAS SEDATED --
21 A. YES, UH-HUH.
22 Q. -- YOU INDICATED. AS A RESULT THE STUDY WAS QUITE
23 COMPROMISED DUE TO MOTION. WHAT DOES THAT MEAN?
24 A. THAT MEANS IN ORDER TO HAVE AN OPTIMAL MRI STUDY THE
25 PATIENT NEEDS TO LAY STILL, NOT MOVE. ANY TIME THEY MOVE
1 THERE'S ARTIFACT FROM MOTION, A MRI IS VERY MOTION SENSITIVE
2 AND SO IT DEGRADES THE OVERALL IMAGE QUALITY OF THE STUDY.
3 Q. DID IT CAUSE YOU ANY CONCERN ABOUT THE ACCURACY OF YOUR
4 STUDY?
5 A. IT CAN.
6 Q. YOU FELT THAT THERE'S SOME ATROPHY BILATERALLY, DOES THAT
7 MEAN ON BOTH SIDES?
8 A. YES.
9 Q. WHAT CAUSES THE ATROPHY?
10 A. AGING. SOMETIMES OTHER INSULTS TO THE BRAIN, IT CAN BE
11 ALCOHOL, DRUGS, THINGS LIKE THAT. USUALLY IS AGING.
12 Q. THE VENTRICLES ARE PROMINENT BUT YOU FELT THAT WAS
13 COMPENSATORY ENLARGEMENT BY ATROPHY. WHAT DO YOU MEAN BY
14 THAT SENTENCE.
15 A. WELL, ANY TIME YOU SEE ENLARGED VENTRICLES YOU HAVE TO
16 DECIDE WHETHER IT'S DUE TO IF THE BRAIN SHRINKS, SOMETHING
17 HAS TO OCCUPY THAT SPACE INSIDE THE SKULL AND IT'S USUALLY
18 THE VENTRICLES FROM THE ATROPHY. THE DIFFERENTIAL BEING
19 HYDROCEPHALOUS WHICH IS SOME TYPE OF A BLOCKAGE OF THE
20 DRAINAGE OF THE CSF FLUID FROM THE VENTRICLES WHERE THEY CAN
21 BECOME ENLARGED FROM THAT FACT.
22 Q. DID YOU BELIEVE OR HAVE FEAR THAT THAT'S WHAT THE PROBLEM
23 WAS?
24 A. I FELT IT WAS MOST CONSISTENT WITH ATROPHY GIVEN THE
25 PATIENT'S AGE AND THE APPEARANCE OF THE VENTRICLES.
1 Q. LET'S START IN THE NEXT PARAGRAPH MAYBE IF YOU JUST READ
2 A SENTENCE AND THEN EXPLAIN IT TO US IN LAYMAN'S TERMS.
3 A. OKAY. NO OBVIOUS MASS EFFECT OR MIDLINE SHIFT IS SEEN OR
4 AREA OF DEFINITE HEMORRHAGE OR INFARCTION, ALTHOUGH FINE
5 DETAILS OBSCURED ON THE STUDY DUE TO MOTION.
6 SO MASS EFFECT OR MIDLINE SHIFT, THAT MEANS IF THERE'S
7 SOME TYPE OF MASS IN THERE OR EDEMA A LOT OF ABNORMAL FLUID
8 CAN CAUSE THE BRAIN TO SHIFT OR HERNIATE, AND I SAID THERE
9 WAS NOTHING LIKE THAT GOING ON.
10 I ALSO SAID THERE'S NO DEFINITE HEMORRHAGE OR INFARCTION
11 SEEN, JUST THAT HEMORRHAGE IS BLEEDING INSIDE THE BRAIN.
12 INFARCTION IS A STROKE THAT YOU CAN SEE THE SEQUELAE OF THE
13 STROKE BY MRI.
14 Q. WHAT'S SEQUELAE?
15 A. RESULTS OF.
16 Q. THE RESULTS OF?
17 A. YOU CAN SEE IT AFTER. FROM SEVERAL MINUTES TO HOURS
18 LATER IF THEY'VE HAD A STROKE OR NOT.
19 Q. YOU INDICATE THE FINE DETAIL IS, AGAIN, COMPROMISED
20 BECAUSE OF THE MOTION?
21 A. CORRECT.
22 Q. WOULD YOU READ THE NEXT SENTENCE AND EXPLAIN IT TO US.
23 A. THERE MAY BE A SMALL AREA OF INFARCTION WITHIN THE LEFT
24 CEREBRAL PEDUNCLE OF UNDETERMINATE AGE AND AGAIN DETAIL IS
25 LIMITED. THAT'S AN AREA THERE OF THE BRAIN STEM ON THE LEFT
1 SIDE THAT SAID THERE'S AN AREA OF ABNORMAL SIGNAL WHICH
2 SUGGESTS THAT THERE COULD BE AN AREA OF STROKE INVOLVING THAT
3 LEFT SIDE OF THE BRAIN STEM, BUT DETAIL IS LIMITED BECAUSE OF
4 MOTION. IT'S HARD TO SAY WHETHER IT'S A TRUE FINDING OR NOT.
5 Q. AND IF IT WERE A TRUE FINDING, COULD YOU TELL HOW OLD
6 THAT STROKE WAS?
7 A. IT WOULD BE DIFFICULT PROBABLY TO AGE THAT UNLESS THERE'S
8 AGAIN SHIFT OR MOVEMENT OF THE BRAIN FROM EDEMA WHICH IS
9 USUALLY SEEN IN ACUTE STROKE. IF IT WAS AN OLD STROKE
10 USUALLY YOU DON'T SEE MUCH SHIFTING OF THE BRAIN.
11 Q. AGAIN THE NEXT SENTENCE, IF YOU WOULD EXCEPT WE'VE GOT A
12 PUNCH HOLE RIGHT IN THE MIDDLE OF SOME WORDS.
13 A. YES. SOME WHITE MATTER ISCHEMIC CHANGE AND VENTRICLE
14 BILATERALLY IS NOTED. THAT IS USUALLY A FINDING AS YOU'LL
15 SEE AS ONE AGES THAT THERE ARE VERY SMALL VESSELS THAT
16 PENETRATE THE DEEP SUBSTANCE OF THE BRAIN THAT THEY'LL BECOME
17 OCCLUDED AND THEY'LL SHOW TINY LITTLE STROKE OR INFARCT
18 CHANGES THERE, AND THAT'S A FAIRLY COMMON FINDING THERE FOR
19 SEE IN OLDER PATIENTS.
20 Q. AND THEN THE NEXT SENTENCE?
21 A. MORE HEAVILY T WAVE INVOLVING INCREASE SIGNAL WITHIN THE
22 GRAY MATTER OF THE LEFT OCCIPUT LOBE IS NOTED WHICH APPEARS
23 ASYMMETRIC AND COULD BE DUE TO INFARCTION WHICH MAY BE ACUTE
24 AS THERE IS QUESTION OF EFFACEMENT OF THE ADJACENT LATERAL
25 VENTRICLE. SO IN THE GRAY MATTER WHICH IS THE MORE OUTSIDE
1 PORTION OF THE BRAIN THERE IS AN AREA OF INCREASED SIGNAL
2 SUGGESTING INFARCTION OR STROKE THAT HAS OCCURRED, BECAUSE IT
3 LOOKS LIKE THERE IS PUSHING ON THE VENTRICLE OR LATERAL
4 VENTRICLE THAT SUGGESTS IT'S AN ACUTE STROKE WITHIN THE LAST
5 SEVERAL HOURS OR EVEN DAYS HAS OCCURRED.
6 Q. YOU DO USE WORDS LIKE COULD BE DUE AND MAY BE ACUTE, WHY
7 WERE YOU USING THOSE WORDS AS OPPOSED TO IT DEFINITELY IS?
8 A. PROBABLY TWO REASONS: FIRST OF ALL, THE MOTION ON THE
9 PART OF THE PATIENT, YOU CAN GET SOME ARTIFACT WHICH IS
10 INCREASED SIGNAL FROM THE MOTION ITSELF. THE OTHER THING IS
11 THAT IT CAN BE HARD ON AN MRI OF THIS EIGHT YEARS AGO SIX --
12 SEVEN YEARS AGO TO DATE SPECIFICALLY HOW OLD THE INFARCT OR
13 STROKE MAY HAVE BEEN. SO YOU CAN'T SAY THIS IS DEFINITELY
14 LIKE 72 HOURS OLD OR IT'S 96 HOURS OLD FROM AN MRI ALONE.
15 YOU HAVE TO CORRELATE IT CLINICALLY WITH THE HISTORY AND WHEN
16 THE SYMPTOMS WERE FOUND IN THE PATIENT.
17 Q. THOSE WOULD BE OUTWARD SYMPTOMS THAT A NURSE OR DOCTOR OR
18 A PHYSICIAN WOULD SEE?
19 A. CORRECT, AND THAT'S VERY IMPORTANT FOR US.
20 Q. THAT'S WHY YOU HAVE THE NEXT SINCE WHICH IS?
21 A. CLINICAL CORRELATION IS RECOMMENDED.
22 Q. THAT'S WHAT YOU'RE ASKING SOMEBODY TO SAY?
23 A. YES.
24 Q. LOOK AND SEE IF HE'S GOT --
25 A. RIGHT.
1 Q. WHAT OTHER SYMPTOMS WOULD YOU EXPECT TO SEE IF THERE WERE
2 AN ACUTE STROKE CVA OR INFARCTION?
3 A. WELL, YEAH. YOU COULD HAVE WEAKNESS, YOU CAN HAVE
4 NUMBNESS ON THAT PARTICULAR SIDE OF THE BODY, YOU CAN HAVE
5 DIFFICULTY IN SPEAKING OR DIFFICULTY IN UNDERSTANDING WHAT'S
6 GOING ON OR EXPRESSING YOURSELF. DEPENDS ON THE SIDE OF THE
7 INJURY AND HOW WIDESPREAD IT IS.
8 Q. AND THE PERSON OF MR. ALLDREDGE'S AGE, 83, IF HE'S
9 ALREADY CONFUSED AND HAVING SOME KIND SOME OF THOSE KIND OF
10 PROBLEMS, WHAT KIND OF CLINICAL CORRELATION COULD A DOCTOR DO
11 IF HE'S ALREADY SHOWING CONFUSION AT THAT SORT --
12 A. WELL, YOU WOULD HAVE TO GO WITH A NEUROLOGIC EXAMINATION
13 AND SEE IF HE'S LOST SOME MOVEMENT, IF HE STILL HAS THE SAME
14 AMOUNT OF STRENGTH IN BOTH SIDES OF HIS EXTREMITIES. IF HE
15 HAS ANY CHANGES IN HIS ABILITY TO MOVE HIS EYES, COMPREHEND
16 WHAT'S BEING SAID TO HIM. SO THERE'S OTHER STUDIES BEHIND
17 THE CONFUSION AND MAY BE SOME NEUROLOGIC EXAMINATIONS TO BE
18 PERFORMED.
19 Q. AND WHO WOULD YOU ASK TO DO THAT?
20 A. WELL --
21 Q. WHO WOULD A PHYSICIAN ASK TO DO THAT?
22 A. OPTIMALLY IT WOULD BE A NEUROLOGIST BUT YOU CAN HAVE A
23 FAMILY DOCTOR AN INTERNIST OR, YOU KNOW, ANYONE THAT'S DEALT
24 WITH THE PATIENTS TO ANY DEGREE THEY CAN PERFORM THE
25 EXAMINATION AND SEE IF THERE'S BEEN A CHANGE.
1 Q. WOULD YOU HAVE SAY SQUEEZE WITH BOTH HANDS SEE IF
2 THERE'S A DIFFERENCE?
3 A. YEAH, THAT'S ONE OF THE STUDIES THERE.
4 Q. THEN YOU ALSO HAVE THAT LAST SENTENCE IN THAT PARAGRAPH?
5 A. IF MAY BE USEFUL TO CONSIDER EITHER A CT OR ANESTHESIA
6 HELP WITH MRI.
7 Q. WHAT DOES THAT MEAN?
8 A. WELL, A CT WOULD BE LESS PRONE TO HAVE ARTIFACT BECAUSE
9 OF MOTION AND YOU COULD FOLLOW IT UP WITH A CT OR YOU CAN
10 HAVE THE ANESTHESIOLOGIST MORE THOROUGHLY SEDATE THE PATIENT
11 ON THE TABLE SO YOU CAN GET A BETTER QUALITY MRI, THAT'S WHAT
12 MY RECOMMENDATION WAS, YOU KNOW, BECAUSE OF THE MOTION. IF
13 YOU'RE CONCERNED ABOUT THE AGE OF THE STROKE AND WHAT WAS
14 GOING ON, WE COULD FOLLOW UP WITH ANOTHER STUDY?
15 Q. THEN YOU HAVE YOUR IMPRESSION. WHAT'S THE FIRST
16 IMPRESSION YOU WROTE.
17 A. QUITE SUBOPTIMAL MAGNETIC RESONANCE IMAGING WITH PATIENT
18 MOTION.
19 Q. WHAT'S SUBOPTIMAL?
20 A. WELL, LESS THAN GOOD. LESS THAN OPTIMAL. I MEAN, IT'S
21 COMPROMISED. IT'S NOT THE QUALITY WE WOULD HOPE TO HAVE BUT
22 SOMETIMES THAT'S THE BEST YOU CAN DO IN THAT CIRCUMSTANCE.
23 Q. AND THEN THE NEXT SENTENCE.
24 A. QUESTION OF INFARCTION INVOLVING LEFT OCCIPITAL AND GRAY
25 MATTER. THAT MEANS THAT THERE'S QUESTION OF A STROKE. IT
1 LOOKS LIKE HE'S HAD A STROKE INVOLVING THE GRAY MATTER OF THE
2 LEFT OCCIPITAL LOBE OF THE BRAIN.
3 Q. NEXT SENTENCE.
4 A. I CANNOT POSSIBLY DATE THIS POSSIBLE INFARCTION ALTHOUGH
5 THERE CAN BE SOME EARLY COMPRESSION OF THE OCCIPITAL LOBE OR
6 I'M SUGGESTING ACUTE SUBACUTE EVENT.
7 Q. WHAT DOES THAT MEAN?
8 A. THAT MEANS FROM THE INCREASE OF THE PUSHING ON THE
9 VENTRICLES IT SUGGESTS THAT THERE IS EDEMA ASSOCIATED WITH IT
10 THAT'S PROBABLY ACUTE WITHIN A FEW HOURS OR DAYS TO SUBACUTE
11 WHICH MAY BE SEVERAL DAYS TO A FEW WEEKS OLD.
12 Q. AND THEN YOUR LAST SENTENCE?
13 A. CLINICAL CORRELATION URGED AND FOLLOW UP WITH CT OR LATER
14 MRI WITH BETTER SEDATION MAY BE USEFUL. IT'S JUST A
15 SUGGESTION TO THE REFERRING PHYSICIAN THAT DEPENDING ON HIS
16 SUSPICION AND WHAT HIS SUGGESTION FOLLOW-UP WITH ANOTHER
17 STUDY LATER ON (MARK).
18 Q. WERE YOU EVER ASKED TO DO A FOLLOW-UP STUDY, ANOTHER CT
19 OR MRI?
20 A. NOT THAT I'M AWARE OF.
21 Q. I DO SEE ANY IN THE RECORD THERE THAT THERE WAS A FOLLOW
22 UP CT OR MRI?
23 A. I DON'T SEE ANY ON THE FOLLOW-UP STUDY.
24 Q. FROM THIS -- IF YOU HAVE OCCASION -- DO YOU RECALL TO
25 TALK TO DR. WEITZEL ABOUT WHAT THESE FINDINGS MEANT?
1 A. I CAN'T REMEMBER.
2 Q. FROM THIS WOULD YOU -- WOULD YOU SAY TO THE ATTENDING
3 PHYSICIAN THAT THIS PERSON HAD HAD A MASSIVE STROKE?
4 A. I WOULDN'T CLASSIFY IT AS MASSIVE. I WOULD PROBABLY SAY
5 IT'S PROBABLY MORE OF A MILD STROKE AT THIS TIME BUT YOU
6 WOULD HAVE TO CORRELATE IT, AGAIN, WITH THE PATIENT'S
7 SYMPTOMS AND A NEUROLOGIC CHANGES AND SEE WHAT THE GRAY
8 COMPROMISE THE PATIENT WAS HAVING. SOME PATIENTS DO QUITE
9 WELL WITH THIS TYPE OF A STROKE. SOME PATIENTS ARE MORE
10 INCAPACITATED THAN OTHERS. IT DEPENDS ON A LOT OF DIFFERENT
11 FACTORS.
12 Q. BASED ON THIS THAT YOU COULD READ HERE, YOU KNOW,
13 ESPECIALLY WITH THE MOTION AND THAT SORT OF THING, DID YOU
14 SEE ANYTHING THAT WAS IMMEDIATELY LIFE THREATENING IN THIS
15 MRI READ?
16 A. NO.
17 MS. BARLOW: THAT'S ALL I HAVE. THANKS.
18 THE COURT: CROSS EXAM.
19 CROSS-EXAMINATION
20 BY MR. BUGDEN:
21 Q. HOW DO YOU DO, DOCTOR. MY NAME IS WALLY BUGDEN I HAVE A
22 FEW QUESTIONS FOR YOU THIS AFTERNOON.
23 A. OKAY.
24 Q. DOCTOR, AS I UNDERSTAND IT THIS PATIENT WAS REFERRED TO
25 YOU TO TRY TO EVALUATE WHETHER THE PATIENT HAD HAD A STROKE?
1 A. YES.
2 Q. AND TRY TO RULE OUT AN INFARCT, A STROKE, IS THAT RIGHT?
3 A. YES.
4 Q. AND YOU WERE NOT ABLE TO RULE OUT THE STROKE BECAUSE OF
5 THE PATIENT MOVING, IS THAT RIGHT?
6 A. AH --
7 Q. OR DID YOU CONCLUDE THE PATIENT HAD HAD A STROKE?
8 A. I CONCLUDED THE PATIENT HAD A STROKE. IT WAS DIFFICULT
9 TO SAY HOW RECENT THE STROKE WAS BECAUSE OF THE MOVEMENT OF
10 THE PATIENT.
11 Q. AND YOU'VE USED THE PHRASE IT WAS SUBOPTIMAL, THIS MRI
12 WAS SUBOPTIMAL BECAUSE OF THE PATIENT'S MOTION, IS THAT
13 RIGHT?
14 A. CORRECT.
15 Q. AND YOU WERE AWARE JUST FROM THE REPORT THAT THE PATIENT
16 HAD ACTUALLY BEEN SEDATED FOR THIS MRI, IS THAT RIGHT?
17 A. CORRECT.
18 Q. BUT IN ORDER TO HAVE A BETTER MRI, ONE POSSIBILITY WAS TO
19 REPEAT THE MRI AND TO FURTHER SEDATE, TO FURTHER ANESTHETIZE
20 THE PATIENT, IS THAT RIGHT?
21 A. YES, THAT WOULD BE AN OPTION.
22 Q. AND AM I RIGHT THAT AN MRI COSTS ABOUT A THOUSAND
23 DOLLARS, DOCTOR?
24 A. WITH PROFESSIONAL TECHNICAL FEES, YEAH, APPROXIMATELY
25 THOUSAND DOLLARS.
1 Q. AND SO THE IN ORDER TO IMPROVE THE QUALITY, THOUGH, AT
2 LEAST BASED ON THIS CIRCUMSTANCES WHERE THE PATIENT WAS
3 MOVING IN SPITE OF SEDATION, WOULD THE PATIENT HAVE
4 ACTUALLY -- IN ORDER TO IMPROVE QUALITY ACTUALLY HAVE TO BE
5 WOULD YOU HAVE TO PUT THE PATIENT COMPLETELY ASLEEP, DO YOU
6 THINK?
7 A. NO.
8 Q. NOT NECESSARILY?
9 A. NOT NECESSARILY.
10 Q. AND THEN YOU INDICATE THAT OR YOU RECOMMEND OR YOU AGREE
11 THAT THERE WOULD NEED TO BE CLINICAL CORRELATION WITH THE MRI
12 TO TRY TO OBSERVE THE PATIENT IN OTHER WORDS TO SEE WHETHER
13 OR NOT THERE WERE SYMPTOMS OF STROKE?
14 A. YES.
15 Q. AM I RIGHT THAT BASICALLY WHAT YOU HAVE HERE THEN IS A
16 SITUATION WHERE YOU COULD TELL THAT THERE HAD BEEN AN EVENT,
17 IT APPEARED LIKE THERE WAS A STROKE, IS THAT RIGHT?
18 A. YES.
19 Q. YOU COULDN'T SAY EXACTLY HOW BIG OF AN EVENT IT WAS OR
20 EVEN EXACTLY WHEN IT HAD OCCURRED, IS THAT RIGHT?
21 A. WELL, YOU COULD -- AN IDEA OF THE SIZE OF THAT FROM YOUR
22 FINDINGS AS FAR AS THE AGE WAS MORE DIFFICULT TO STATE THAT.
23 BUT I COULD TELL THERE WAS NOT A LOT OF MASS EFFECT OR SHIFT
24 OR HERNIATION AT THIS TIME AND IT WOULD HELP TO SIZE THE
25 EXTENT OF THE STROKE.
1 MR. BUGDEN: THAT'S ALL I HAVE. THANK YOU.
2 THE COURT: REDIRECT.
3 MS. BARLOW: JUST ONE QUESTION, YOUR HONOR.
4 RECROSS-EXAMINATION
5 BY MS. BARLOW:
6 Q. YOU INDICATED MRIS ARE ABOUT A THOUSAND DOLLARS. HOW
7 MUCH DOES A CT SCAN COST DO YOU RECALL OR APPROXIMATELY?
8 A. OH, PROBABLY ABOUT $500.
9 MS. BARLOW: THAT'S ALL I HAVE, YOUR HONOR. THANK
10 YOU, DOCTOR.
11 THE COURT: YOU MAY STEP DOWN, DOCTOR. MAY THIS
12 WITNESS BE EXCUSED?
13 MS. BARLOW: YES.
14 THE COURT: BE EXCUSED?
15 MR. BUGDEN: YES.
16 THE COURT: YOU MAY BE EXCUSED. AND THANK YOU FOR
17 COMING.