Paul Jensen, MD
22 MR. WILSON: WE WOULD CALL PAUL JENSEN TO THE STAND
23 AT THIS TIME, DR. PAUL JENSEN.
24 THE COURT: DR. JENSEN IF YOU'LL STEP UP HERE,
25 PLEASE. DR. JENSEN, IF YOU'LL RAISE YOUR RIGHT HAND AND
1 FACE THE CLERK, SHE'LL PLACE YOU UNDER OATH.
2 PAUL R. JENSEN,
3 HAVING BEEN DULY SWORN, WAS EXAMINED AND
4 TESTIFIED AS FOLLOWS:
5 THE COURT: IF YOU'LL HAVE A SEAT UP HERE, PLEASE.
6 INDICATE YOUR FULL NAME DOCTOR AND SPELL YOUR LAST NAME.
7 THE WITNESS: PAUL R. JENSEN, J-E-N-S-E-N.
8 THE COURT: THANK YOU. YOU MAY PROCEED, MR. WILSON.
9 MR. WILSON: THANK YOU, YOUR HONOR.
10 DIRECT EXAMINATION
11 BY MR. WILSON:
12 Q. DR. JENSEN, WHERE ARE YOU -- WELL, LET ME ASK YOU FIRST
13 OF ALL: WHERE DID YOU GRADUATE FROM MEDICAL SCHOOL AT?
14 A. UNIVERSITY OF UTAH.
15 Q. AND WHEN WAS THAT, SIR?
16 A. 19 -- EXCUSE ME -- 85.
17 Q. AND ARE YOU BOARD CERTIFIED IN ANY KIND OF SPECIALTY?
18 A. YES, I AM.
19 Q. AND CAN YOU TELL US WHEN YOU OBTAINED YOUR BOARD
20 CERTIFICATION?
21 A. 1991.
22 Q. OKAY. AND SUBSEQUENT TO THAT, OR EVEN CONSISTENT WITH
23 THAT, DID YOU PRACTICE MEDICINE IN THIS AREA?
24 A. YES, I HAVE.
25 Q. IN WHAT SPECIALTY DID YOU SAY?
1 A. I'M A DIAGNOSTIC RADIOLOGIST.
2 Q. OKAY. CAN YOU EXPLAIN A LITTLE BIT ABOUT WHAT YOU DO AS
3 A DIAGNOSTIC RADIOLOGIST?
4 A. DIAGNOSTIC RADIOLOGIST INTERPRETS X-RAYS SUCH AS CT
5 SCANS, ULTRASOUNDS, IMAGING OF PATIENTS.
6 Q. OKAY. WHERE DID YOU SAY YOUR OFFICE IS LOCATED?
7 A. OUR GROUP COVERS TWO HOSPITALS. DAVIS HOSPITAL MEDICAL
8 CENTER AND OGDEN REGIONAL MEDICAL CENTER. RIGHT NOW I'M
9 PRACTICING MAINLY AT OGDEN REGIONAL MEDICAL CENTER.
10 Q. DID YOU HAVE OCCASION IN 1995 AND 1996 TO BE PRACTICING
11 AT THE DAVIS MEDICAL CENTER IN LAYTON?
12 A. YES.
13 Q. PRIOR TO THIS TESTIMONY HAVE YOU HAD OCCASION TO REVIEW
14 SOME DIAGNOSTIC IMAGING REPORTS WHICH YOU PREPARED?
15 A. YES.
16 Q. I CALL YOUR ATTENTION TO WHAT'S DESIGNATED AS STATE
17 EXHIBIT 3B PERTAINING TO THE PATIENT JUDITH LARSEN AND ASK
18 YOU AND REFERENCE MED RECORD 00488 AND 489. IF YOU'D TAKE A
19 LOOK AT THOSE REPORTS, IF YOU WOULD, PLEASE.
20 A. YES. THE FIRST ONE IS A REPORT ON A CHEST X-RAY
21 PERFORMED ON THE 12/6/95. AND THE SECOND EXAMINATION IS THAT
22 OF A COMPUTED TOMOGRAPHY OR CT SCAN OF THE HEAD DATED
23 12/6/95.
24 Q. OKAY. LET'S TALK ABOUT THE CHEST X-RAY FIRST IF YOU
25 WOULD, PLEASE. NOW AS I UNDERSTAND IT YOU DON'T CONDUCT THE
1 X-RAY, IS THAT CORRECT?
2 A. CORRECT.
3 Q. YOU INTERPRET THE X-RAY?
4 A. CORRECT.
5 Q. AND ON THIS PARTICULAR OCCASION YOU INTERPRETED THIS
6 X-RAY AND YOU SAID IT WAS A DATE OF THE EXAM WAS 12/6 OF '95?
7 A. CORRECT.
8 Q. WOULD THAT BE THE SAME DATE THAT YOU PREPARED THIS
9 REPORT?
10 A. IT WAS -- AT THE BOTTOM OF THE PAGE THE D STANDS FOR
11 DICTATED AND THAT WAS 12/6/95 AND THEN T IS FOR TYPED SO
12 12/6/95 AS WELL SO EVERYTHING WAS PERFORMED ON THE SAME DATE.
13 Q. ON THE SAME DATE. CAN YOU TELL US RELATIVE TO THE EXAM
14 ITSELF OR THE REPORT ITSELF, YOU LIST A CLINICAL HISTORY AS A
15 PROVISIONAL PSYCHOSIS, WHAT DOES THAT MEAN?
16 A. THE CLINICAL HISTORY IS INFORMATION THAT WE USUALLY GET
17 UPON THE REQUEST FORM AND SO THE DOCTOR WHO HAS ORDERED THE
18 EXAMINATION OR THE CLERK OR SOMEONE THAT'S INVOLVED IN THE
19 PATIENT'S CARE HAS GIVEN THAT INFORMATION TO OUR DEPARTMENT
20 TO -- AS THE HISTORY OF WHAT'S GOING ON WITH THE PATIENT. SO
21 I WOULD HAVE GOTTEN THAT INFORMATION FROM A PIECE OF PAPER
22 THAT WAS WITH THE PATIENT'S CHEST X-RAY.
23 Q. OKAY. FOLLOWING THAT CLINICAL HISTORY PROVISION THERE IS
24 A STATEMENT THAT OR PARAGRAPH THAT CONTAINS I ASSUME SOME
25 FINDINGS BY YOU, IS THAT CORRECT?
1 A. THAT'S CORRECT.
2 Q. CAN YOU TELL US -- FIRST OF ALL MAYBE I -- WE NEED TO
3 JUST READ DOWN THROUGH THAT AS TO THE FIRST SENTENCE, WOULD
4 YOU READ THAT, PLEASE.
5 A. OKAY. THERE IS A LARGE LUCENCY IN THE RETROCARDIAC AREA
6 CONSISTENT WITH A LARGE HIATAL HERNIA.
7 Q. OKAY. CAN YOU TELL US IN LAYMAN TERMS WHAT THAT MEANS?
8 A. WELL, IT MEANS THAT THERE'S KIND OF A BLACK SPOT BEHIND
9 THE HEART AND THAT -- WE USUALLY SEE THAT WHERE THE STOMACH
10 HAS SLIPPED UP INTO THE CHEST THAT'S WHAT'S CALLED A HIATAL
11 HERNIA, THAT'S WHERE THE CHEST HAS SLIPPED UP BEHIND THE
12 HEART AND GIVEN US THAT APPEARANCE.
13 Q. OKAY. IS THAT SOMETHING OF -- THAT CAUSED YOU ANY
14 CONCERN RELATIVE TO THIS PARTICULAR PATIENT ON THAT DAY?
15 A. NOT NECESSARILY. IT'S QUITE A COMMON FINDING.
16 Q. OKAY. READ THE NEXT SENTENCE, IF YOU WILL.
17 A. ATELECTASIS NOTED IN THE RETROCARDIAC AREA AS WELL.
18 Q. AND WHAT DOES THAT MEAN, SIR?
19 A. ATELECTASIS MEANS THERE'S COLLAPSE OR FLATTENING OF AREAS
20 OF THE LUNG WHERE IT'S NOT QUITE AS BLOWN UP AS IT COULD BE.
21 SO IF YOU'RE AERATING YOUR LUNG, IF YOU'RE FILLING IT WITH
22 AIR THERE'S MAYBE AREAS THAT ARE NOT GETTING AS MUCH AIR AS
23 OTHER AREAS.
24 Q. OKAY. THE NEXT SENTENCE?
25 A. INTERSTITIAL MARKINGS ARE PROMINENT.
1 Q. CAN YOU EXPLAIN THAT TO US?
2 A. INTERSTITIAL MARKINGS ARE MARKINGS THAT ARE INVOLVED WITH
3 THE FRAMEWORK OF THE LUNG AND WHEN THOSE INTERSTITIAL
4 MARKINGS GET INCREASED IT CAN BE DUE IT A MYRIAD OF FACTORS.
5 BUT A COMMON FACTOR WOULD BE THINGS LIKE CONGESTIVE HEART
6 FAILURE OR OCCASIONALLY TUMORS CAN DO THIS OR BLEEDING CAN DO
7 THIS, BUT MOSTLY WE DEAL WITH INTERSTITIAL PROMINENCE DUE TO
8 PULMONARY EDEMA, WHICH IS THE EXCESS FLUID ON THE LUNG OR THE
9 OTHER OPTION SOMETIMES IS DUE TO LUNG DISEASE ITSELF SUCH AS
10 CHRONIC OBSTRUCTIVE PULMONARY DISEASE, SMOKING, WHERE IT'S
11 THICKENED BECAUSE OF FIBROSIS.
12 Q. I SEE. AS TO THE NEXT SENTENCE IF YOU COULD, PLEASE?
13 A. CARDIAC SILHOUETTE IS GENEROUS IN SIZE.
14 Q. THAT MEANS WHAT?
15 A. MEANS THE HEART IS KIND OF BIGGISH IN SIZE.
16 Q. OKAY. AND THEN I THINK YOU CAN MAKE A CONCLUSION HERE --
17 WELL, READ THE NEXT SENTENCE IF YOU WOULD, PLEASE.
18 A. I DO NOT, HOWEVER, DETECT ANY DEFINITE FOCAL INFILTRATES
19 BUT IT IS DIFFICULT TO EXCLUDE SOME EARLY CHANGES OF THE LEFT
20 BASE.
21 Q. OKAY. AND WHAT DOES THAT MEAN, SIR?
22 A. WELL, IN THIS CASE, WE'VE GOT A RELATIVELY PROMINENT
23 HEART AND BEHIND THAT HEART WE HAVE A STOMACH THAT DOESN'T
24 BELONG THERE. SO THAT AREA BECOMES MORE OBSCURED SO IT'S
25 DIFFICULT TO SEE BACK THERE. AND WHERE IT'S DIFFICULT TO
1 SEE, IT'S ALSO DIFFICULT TO EXCLUDE SOME EARLY PROCESS.
2 Q. OKAY. NOW, DO YOU KNOW WHAT THE PURPOSE OF THIS
3 PARTICULAR X-RAY WAS FOR?
4 A. FROM THE HISTORY, NO.
5 Q. BUT YOU DO KNOW IT WAS REQUESTED RELATIVE TO HER -- OR
6 HER ADMISSION INTO THE GEROPSYCH UNIT, I ASSUME?
7 A. CORRECT.
8 Q. IN YOUR IMPRESSIONS WHICH IS THE NEXT PARAGRAPH DOWN, CAN
9 YOU TESTIMONY US AGAIN IN LAYMAN'S TERMS -- WELL. LET ME
10 PHRASE IT THIS WAY:
11 FIRST OF ALL, WERE ANY FINDINGS RELATED TO THIS
12 PARTICULAR X-RAY INDICATIVE OF ANY ACUTE PROCESS THAT MAY BE
13 GOING ON?
14 A. NO.
15 Q. WERE ANY -- EXCUSE ME -- GO AHEAD.
16 A. NO.
17 Q. WERE ANY FINDINGS CONSISTENT WITH A CHRONIC PROCESS THAT
18 YOU OBSERVED?
19 A. YES.
20 Q. AS PART OF IT -- AND BY CHRONIC, WHAT DO WE MEAN?
21 A. IT MEANS THESE PROCESSES ARE PROBABLY BEEN GOING ON FOR
22 SOME TIME.
23 Q. OKAY. SO DID YOU SEE ANYTHING IN THAT PARTICULAR X-RAY
24 THAT WOULD INDICATE TO YOU THAT THIS PATIENT WAS SUFFERING
25 ANY KIND OF A LIFE-THREATENING CONDITION?
1 A. PROBABLY NOT ACUTELY, NO.
2 Q. OKAY. MAYBE I SHOULD HAVE PHRASED IT IN THAT RESPECT.
3 YOU INDICATE A FOLLOW-UP X-RAY MAY BE OF UTILITY, WHAT
4 DID YOU MEAN BY THAT?
5 A. IN SOME OF THESE INSTANCES WHERE YOU'VE GOT POTENTIALLY
6 SOME EARLY FINDINGS THAT YOU'RE NOT QUITE SURE OR THERE'S
7 AREAS YOU DON'T SEE VERY WELL, OCCASIONALLY IT'S USEFUL TO
8 THE PATIENT'S CARE TO GET A FOLLOW-UP EXAM TO SEE IF
9 SOMETHING'S JUST A LITTLE TOO EARLY TO SEE OR IF YOU CAN SEE
10 IT BETTER IN ANOTHER -- IN A FUTURE EXAM TO SEE IF ANYTHING'S
11 CHANGED THAT MAY WARRANT FURTHER EVALUATION.
12 Q. AND DO YOU KNOW WHETHER ANY FOLLOW-UP EXAMINATIONS WERE
13 DONE OF THE CHEST AREA?
14 A. NO, I DO NOT.
15 Q. OKAY. NOW TURNING YOUR ATTENTION TO THE NEXT PAGE WHICH
16 IS MED IT'S EXHIBIT I THINK 4B.
17 MS. BARLOW: WHICH ONE?
18 MR. WILSON: JUDITH LARSEN'S EXCUSE ME --
19 THE WITNESS: MED 00489 THE BOTTOM?
20 Q. (BY MR. WILSON) ANYWAY --
21 THE COURT: MR. WILSON WHICH ONE DO YOU --
22 THE WITNESS: THE CT SCAN?
23 MS. BARLOW: IT'S 3B.
24 Q. (BY MR. WILSON) 3B. MED 489.
25 A. OKAY.
1 Q. CAN YOU TELL US WHAT THAT REPORT IS ABOUT?
2 A. THIS IS A CT SCAN OF THE HEAD.
3 Q. AND WHEN WAS IT CONDUCTED?
4 A. THE SAME DAY 12/26 -- OH, NO, I LIED. IT'S 12/26/95,
5 NOT THE SAME DAY.
6 Q. THE PATIENT THAT THIS WAS CONDUCTED ON?
7 A. JUDITH LARSEN.
8 Q. OKAY. AND DO YOU KNOW YOU CONDUCTED THIS PARTICULAR CT
9 SCAN ON THAT DAY?
10 A. THE CLINICAL HISTORY GIVEN ON THIS EXAM WAS PSYCHOSIS AND
11 RULE OUT BLEED.
12 Q. OKAY. SO ESSENTIALLY WHAT WERE YOU ASKED TO DO?
13 A. I WAS ASKED TO EVALUATE WHETHER OR NOT THE PATIENT'S HAS
14 HAD AN INTRACRANIAL HEMORRHAGE OR NOT.
15 Q. AND CAN YOU TELL US MAYBE BEFORE WE GET INTO THE
16 FINDINGS, CAN YOU TELL US, SIR, HOW A CT SCAN IS CONDUCTED?
17 A. A CT SCAN IS KIND OF LIKE A LARGE DONUT. IT TAKES
18 CROSS-SECTIONAL PICTURES THROUGH ANY PART OF THE BODY WE TEND
19 TO WANT TO LOOK AT, OR IN THIS CASE, WE'LL DO THE BRAIN. SO
20 WE'LL PLACE THE BRAIN INSIDE THIS LARGE DONUT LOOKING MACHINE
21 IT TAKES AXILLAR CROSS-SECTIONAL PICTURES THROUGH THE HEAD
22 USING X-RAY BEAM.
23 Q. OKAY. AND HOW MANY -- AS I UNDERSTAND IT SORT OF SLICES
24 THE BRAIN?
25 A. SLICES, CORRECT.
1 Q. SO YOU CAN SEE THESE VARIOUS SLICES AS YOU GO DOWN
2 THROUGH THE BRAIN?
3 A. CORRECT.
4 Q. AND HOW MANY SLICES DO WE GET IN A CT SCAN OF THE BRAIN?
5 A. IT VARIES A LITTLE BIT DEPENDING ON HOW BIG THE HEAD IS
6 BUT IN MOST CASES IT'S RIGHT AROUND 20 TO 25 SLICES.
7 Q. OKAY. NOW YOU INDICATE BELOW THE CLINICAL HISTORY AGAIN
8 SOME FINDINGS AND IF YOU WOULD AGAIN READ THE FIRST SENTENCE?
9 A. OKAY. MULTIPLE AXIAL SCANS WERE OBTAINED THROUGH THE
10 HEAD WITHOUT IV CONTRAST.
11 Q. WHICH MEANS?
12 A. WHICH MEANS THERE'S INTRAVENOUS CONTRAST IT'S SOMETHING
13 WE'LL GIVE THAT WILL LIGHT UP CERTAIN THINGS LIKE CANCERS OR
14 MASSES AND THOSE KINDS OF THINGS. NOW IN THE CASE OF BLEED,
15 WHEN YOU'RE TRYING TO RULE OUT A BLEED YOU DON'T WANT TO GIVE
16 THAT BECAUSE IT WILL TEND TO OBSCURE THE PICTURE. SO YOU TRY
17 TO NOT GIVE IV CONTRAST WHEN YOU'RE TRYING TO LOOK FOR
18 BLEEDING. SO WE DID THESE AXIAL CUTS AND THEN WE DID NOT
19 GIVE ANY IV CONTRAST TO TRY TO LOOK FOR THAT BLEED.
20 Q. THE NEXT SENTENCE?
21 A. VENTRICLES AND SULCI ARE VERY PROMINENT CONSISTENT
22 CEREBRAL ATROPHY.
23 Q. AGAIN, CAN YOU EXPLAIN?
24 A. WELL, AS PEOPLE AGE, AS WE ALL AGE, OUR BRAINS TEND TO
25 SHRINK A LITTLE BIT OVER TIME, AND IN THIS CASE HER SHRINKAGE
1 IS RELATIVELY PROMINENT. SO THE VENTRICLES ARE THE FLUID
2 POCKETS INSIDE YOUR BRAIN AND THEN YOU'VE GOT GYRI AND SULCI
3 WHICH ARE THE OUTER CONVOLUTIONAL MARKINGS OF YOUR BRAIN AND
4 AS THOSE -- AS YOUR BRAIN SUBSTANCE DECREASES THEN THOSE --
5 IT'S KIND OF LIKE HAVING A RAISIN IN THE SUN. THE LONGER
6 IT'S IN THE SUN THE SMALLER IT GETS AND THAT'S A KIND OF A
7 SIMILAR ANALOGY TO WHAT HAPPENS IN THE BRAIN. I KNOW IT'S
8 KIND OF A BAD ANALOGY BUT IT'S KIND OF -- AS IT GETS SMALLER
9 AND SMALLER THERE'S MORE AND MORE SPACE FOR FLUID. THAT'S
10 WHAT WE'RE TALKING ABOUT IS THIS ATROPHY PROCESS OR THIS
11 SHRINKING PROCESS HAS GONE ON TO WHERE IT'S RELATIVELY
12 PROMINENT IN THIS PATIENT'S CASE.
13 Q. OKAY. I'M BEGINNING TO FEEL LIKE MAYBE THAT PROCESS IS
14 GOING ON IN MY MIND, TOO.
15 THE COURT: YOU DON'T WANT A RULING.
16 MR. WILSON: NO, YOUR HONOR. I PREFER YOU NOT RULE
17 ON THAT.
18 Q. (BY MR. WILSON) THE NEXT SENTENCE?
19 A. ALSO IDENTIFIED AS SOME DECREASED DENSITY IN THE FRONT --
20 IN THE LEFT FRONTAL LOBE WHICH MAY REFLECT A SUBACUTE INSULT
21 OR CVA.
22 Q. AND AGAIN, CAN YOU EXPLAIN THAT.
23 A. IN LOOKING AT BRAIN CTS, THE AREAS THAT SHOW UP AS MORE
24 BLACK THAN THEY SHOULD, USUALLY INDICATE THAT THEY'VE HAD
25 SOME KIND OF AN INSULT TO THAT PORTION OF THE BRAIN, OR IN
1 THIS CASE, A STROKE. IN THIS INSTANCE, WE'RE TALKING ABOUT
2 AN AREA OF THE LEFT FRONTAL LOBE OF THE BRAIN SHOWS A REGION
3 OF DECREASED DENSITY, IN OTHER WORDS, IT'S MORE BLACK THAN IT
4 SHOULD BE AND THOSE USUALLY ARE CONSISTENT WITH OLD OR
5 SUBACUTE IN THIS CASE WHICH MEANS WEEKS TO MONTHS INSULT SUCH
6 AS A STROKE.
7 Q. SO IT'S NOT AN ACUTE INSULT? IT'S NOT ONE THAT A PROCESS
8 THAT'S BEEN GOING ON IMMEDIATELY?
9 A. CORRECT. IN CT THE INITIAL -- IF SOMEONE WERE TO COME
10 INTO THE OFFICE WITH THEY'VE JUST BARELY HAD A STROKE A
11 COUPLE OF MINUTES AGO, IF THEY PERFORMED A CT IMMEDIATELY AT
12 THAT POINT, THE MOST COMMON THING IS IT LOOKS NORMAL. IT
13 STARTS OUT LOOKING NORMAL. THEN AFTER THAT IT TAKES USUALLY
14 24 TO 48 HOURS TO SHOW THE FIRST SIGNS ON A CT OF A STROKE
15 WHICH ARE USUALLY WHERE THINGS GET BLURRY WHERE THE GRAY
16 MATTER AND THE WHITE MATTER, YOU CAN'T TELL THE DIFFERENCE
17 BETWEEN THEM AND THAT'S THE VERY EARLIEST AND THAT'S USUALLY
18 AN ACUTE STROKE. AND THEN AS YOU GET MORE SUBACUTE TO
19 CHRONIC, IT TENDS TO GO MORE BLACK OVER TIME.
20 Q. OKAY. IS THERE ANY WAY TO AGE THIS PARTICULAR SUBACUTE
21 INSULT?
22 A. THE MOST CORRECT WAY WOULD BE TO HAVE AN OLD CT SCAN.
23 Q. I SEE.
24 A. THEN YOU CAN COMPARE AND SEE IF IT'S A CHANGE SINCE THEN.
25 Q. ALL RIGHT.
1 A. I DID NOT HAVE ONE AT THE TIME HERE.
2 Q. OKAY. THEN YOU INDICATE IN THE NEXT PARAGRAPH, IF YOU
3 READ THAT SENTENCE, PLEASE.
4 A. ALSO IDENTIFIED IS SOME VASCULAR CALCIFICATIONS.
5 Q. WHAT DOES THAT MEAN, SIR?
6 A. THAT'S HARDENING OF THE ARTERIES FOR WANT OF A BETTER
7 TERM. IT'S WHERE CALCIUM DEPOSITS IN THE WALL OF THE VESSELS
8 AND THAT HAPPENS VERY COMMONLY IN ELDERLY PEOPLE.
9 Q. AND THAT WAS SOMETHING YOU IDENTIFIED IN THE BRAIN
10 ITSELF?
11 A. CORRECT.
12 Q. OKAY. AND THEN THE NEXT SENTENCE?
13 A. NO EVIDENCE OF MIDLINE SHIFT IS IDENTIFIED.
14 Q. OKAY. CAN YOU EXPLAIN THAT TO US?
15 A. THAT'S -- MIDLINE SHIFT IS ONE OF THE THINGS WE LOOK FOR
16 FOR MASS EFFECT OR EDEMA OR SWELLING OF THE BRAIN OR SOME
17 TYPE OF AN INJURY THAT IS NOW PUSHING ON THE BRAIN AND THE
18 BRAIN IS BEING PUSHED IN ONE DIRECTION OR ANOTHER AND THEN
19 IT'S NOT WHERE IT'S SUPPOSED TO BE.
20 Q. OKAY. AND THEN THE LAST SENTENCE?
21 A. NO EVIDENCE OF INTRACRANIAL HEMORRHAGE IS NOTED. AND
22 THAT HAS TO DO WITH WHAT WE'RE TRYING TO FIND OUT IN THE
23 FIRST PLACE, IS THERE A BLEEDING IN THIS BRAIN OR IS THERE
24 NOT, AND THE ANSWER IS NO, THERE'S NOT.
25 Q. ALL RIGHT. SO THERE WAS NOTHING -- WELL, LET ME ASK YOU:
1 DID YOU FIND ANYTHING IN YOUR CT SCAN OF JUDITH LARSEN'S
2 BRAIN THAT CAUSED YOU ANY CONCERN AS TO AN ACUTE EVENT?
3 A. NO.
4 Q. THERE WAS NO PROCESS OF THAT NATURE GOING ON?
5 A. NOT THAT WE COULD IDENTIFY ON THE BASIS OF CT.
6 Q. LET ME JUST ASK YOU: IN TERMS OF A PATIENT WHO MAY BE
7 SUFFERING A SO CALLED I'VE HEARD THE EXPRESSION MINI-STROKE,
8 CAN YOU TELL US WHAT THAT MEAN?
9 A. MINI-STROKES ARE A COMMON TERM FOR WHAT WE CALL TRANSCIENT
10 ISCHEMIC ATTACKS WHICH MEANS THAT YOU'VE HAD SOME TYPE OF
11 INSULT TO YOUR BRAIN THAT'S KNOCKED OFF THE BLOOD SUPPLY FOR
12 A SHORT TIME, BUT THEN THAT BLOOD SUPPLY GETS RE-ESTABLISHED.
13 SO YOU'VE HAD SOMETHING GO UP THERE, BLOCKS THE BLOOD SUPPLY,
14 THEN IT BREAKS UP OR SOME OTHER PROCESS OR THE BLOOD GETS
15 BACK TO THAT AREA AND THEN IT RECOVERS. AND SO YOU HAVE A
16 RECOVERY AFTER THAT AND THOSE ARE CALLED MINI-STROKES.
17 Q. IS THAT SOMETHING THAT YOU WOULD BE ABLE TO OBSERVE ON A
18 CT SCAN?
19 A. USUALLY NOT.
20 Q. OKAY. IN TERMS OF THE -- EXCUSE ME.
21 MR. WILSON: HAVE WE GOT THE ENNIS ALLDREDGE?
22 Q. (BY MR. WILSON) I SHOW YOU NOW WHAT'S BEEN MARKED AS
23 STATE'S EXHIBIT NUMBER -- EXCUSE ME. MAYBE I NEED TO LOOK AT
24 THAT. 6B WHICH PURPORTS TO BE THE DAVIS HOSPITAL RECORDS FOR
25 ENNIS ALLDREDGE AND I'M REFERRING TO MED PAGE 26, DO YOU HAVE
1 THAT IN FRONT OF YOU, SIR?
2 A. YES, I DO.
3 Q. HAVE YOU HAD OCCASION TO REVIEW THAT PARTICULAR
4 DIAGNOSTIC IMAGING REPORT?
5 A. YES.
6 Q. AND CAN YOU TELL US WHEN THAT PARTICULAR REPORT WAS MADE?
7 A. DATE OF THE EXAM IS 1/10/96.
8 Q. AND WHO WAS IT MADE ON, WHO WAS THE PATIENT?
9 A. ENNIS ALLDREDGE?
10 Q. OKAY. AND WHAT TYPE OF DIAGNOSTIC EXAM WAS CONDUCTED ON
11 MR. ALLDREDGE AT THIS TIME?
12 A. THIS WAS A CHEST X-RAY, PORTABLE.
13 Q. AGAIN, THE CLINICAL HISTORY WAS PSYCHOSIS?
14 A. CORRECT.
15 Q. AND SO THIS WAS A REQUEST MADE BY THE GEROPSYCH UNIT?
16 A. CORRECT.
17 Q. CAN YOU TELL US AS TO THE -- I JUST WANT YOU TO GO DOWN
18 THROUGH THE SENTENCE AGAIN RELATIVE TO YOUR FINDINGS.
19 A. OKAY. PATIENT IS STATUS POST MEDIUM STERNOTOMY WHICH
20 MEANS THEY'VE HAD AN OPEN HEART SURGERY TYPE EXAMINATION --
21 OR SURGERY, I SHOULD SAY, AND THEY'VE LEFT SOME WIRES. SOME
22 ^BIBASILAR FINDINGS ARE NOTED WHICH ARE MOST PROMINENT WITHIN
23 THE LEFT LOWER LOBE.
24 Q. WHAT DOES THAT MEAN?
25 A. IN THIS CASE WE'RE TALKING ABOUT SOME INCREASED WHITENESS
1 TO THE CHEST X-RAY THAT DOESN'T BELONG AT THE BOTTOM PARTS OF
2 THE LUNG. SO BEHIND THE HEART AND IN THE RIGHT LUNG BASE SO
3 THE BOTTOM PARTS OF THE LUNG ARE TOO WHITE.
4 Q. WHICH MEANS -- I DON'T QUITE UNDERSTAND IF THEY'RE TOO
5 WHITE.
6 A. IT CAN MEAN MANY THINGS.
7 Q. OKAY.
8 A. IT CAN MEAN THE ATELECTASIS WE TALKED ABOUT BEFORE WHERE
9 THE LUNG HAS KIND OF COLLAPSED UPON ITSELF. IT CAN ALSO MEAN
10 THAT THERE'S PLURAL FLUID, OR IT CAN ALSO MEAN THERE'S
11 INFILTRATE INSIDE THE LUNG OR THINGS LIKE PNEUMONIA.
12 Q. OKAY. THE NEXT SENTENCE THEN.
13 A. ALSO SOME HAZINESS ALONG THE LEFT LATERAL
14 COSTOPHRENIC NOTED CONSISTENT WITH A POTENTIAL SMALL PLURAL
15 AFFUSION.
16 Q. AND WHAT DOES THAT MEAN, SIR?
17 A. IF YOU LOOK AT A CHEST X-RAY THE EDGES WHERE THE LUNGS
18 COME DOWN ALONG THE MARKINGS THERE'S WHAT WE CALL A
19 COSTOPHRENIC ANGLE. IT'S WHERE LIKE A SHARP ANGLE WHERE IT
20 COMES DOWN TO THAT EDGE. WHEN THAT GETS BLUNTED OR WHEN IT
21 BECOMES MORE ROUNDED, WE CALL THAT BLUNTING AND IT'S THE MOST
22 COMMON CAUSE OF THAT IS A PLURAL AFFUSION OR SOME TYPE OF
23 PROCESS OR FLUID WITHIN THE CHEST THAT'S BETWEEN THE LUNG AND
24 THE CHEST WALL.
25 Q. OKAY. YOU HAVE YOUR IMPRESSIONS ALSO NOTED AS PERTAINING
1 TO THAT. CAN YOU TELL US MAYBE IN TERMS OF WHAT YOUR
2 IMPRESSION IS OF THIS PARTICULAR RADIOLOGY REPORT AS AFAR AS
3 YOUR FINDINGS GO?
4 A. THE FINDINGS ON THIS REPORT SUGGEST THAT THERE'S A
5 PROCESS GOING ON WITHIN THE LUNG BASES, MOST NOTICEABLE IN
6 THE LEFT SIDE. SO WE'VE GOT A PROCESS OF SOME KIND. WE
7 THINK IT'S MOST LIKELY THIS AT ATELECTASIS, OKAY, IS THE MOST
8 COMMON THING. NOW IT COULD BE ALSO INFILTRATE WHICH USUALLY
9 MEANS PNEUMONIA. SO WE'RE NOT SURE IF IT'S THE ATELECTASIS
10 WHICH HAS COLLAPSED THE LUNG WHICH IS NOT INFECTED VERSUS THE
11 PNEUMONIA WHICH IS THE INFECTED PROCESS THAT WE ALL KNOW
12 ABOUT.
13 Q. HOW WOULD YOU GO ABOUT CLINICALLY CORRELATING WHETHER IT
14 WAS ATELECTASIS?
15 A. MOSTLY THERE'S USUALLY A HISTORY THAT GOES ABOUT THAT IF
16 WE'VE GOT A FEVER AND A WHITE BLOOD CELL COUNT AND A COUGH
17 THEN YOU'D THINK WELL IT'S PROBABLY PNEUMONIA. IF YOU DON'T
18 HAVE ANY OF THOSE THINGS AND THEY ARE ACTUALLY FEELING
19 RELATIVELY THEIR USUAL SELF, THEN YOU THINK WELL MAYBE IT'S
20 SOMETHING ELSE SUCH AS PLURAL EFFUSION OR MAYBE SOME
21 CONGESTIVE FAILURE OR MAYBE JUST AN AREA OF THE LUNG THAT'S
22 NOT BREATHING AS WELL AS IT COULD OTHERWISE.
23 Q. BUT THOSE ARE NOT THINGS THAT YOU CAN TELL FROM THE X-RAY
24 ITSELF?
25 A. NO.
1 Q. SO WITH THAT DESCRIPTION YOU'VE GIVEN IN TERMS OF YOU'RE
2 SEEING SOMETHING GOING ON THERE, WOULD THAT BE AN ACUTE
3 PROCESS THAT YOU IDENTIFIED?
4 A. YOU DON'T KNOW AT THIS POINT.
5 Q. OKAY.
6 A. AGAIN, AN OLD CHEST X-RAY WOULD BE HELPFUL. IN MY REPORT
7 I SAID THAT WE COULD POTENTIALLY GET A PA AND LATERAL CHEST
8 RADIOGRAPH TO HELP DEFINE SOME OF THESE AREAS BETTER BUT
9 SOMETIMES THAT HELPS AND SOMETIMES IT DOESN'T.
10 Q. WHEN YOU PREPARE THESE REPORTS ARE THEY PREPARED IN A
11 CONSULTATION BASIS SUBMITTED AS CONSULTATION OR WHAT?
12 A. IT VARIES.
13 Q. OKAY.
14 A. MOSTLY WHEN THESE TYPE OF REPORTS ARE COMING DOWN WE
15 USUALLY DON'T HAVE A DIRECT CONSULTATION WITH THE PHYSICIAN
16 OR WITH THE PATIENT. WE HAVE A PIECE OF PAPER THAT SAYS WE
17 HAVE A CLINICAL QUESTION OR WE HAVE SOMETHING WE WANT TO
18 INVESTIGATE, LOOK AT THE RADIOGRAPH AND TELL ME WHAT YOU
19 THINK. AND SO IT'S MOSTLY DONE THROUGH WRITTEN MEANS THROUGH
20 THE DICTATED REPORT.
21 MR. WILSON: THANK YOU, SIR. I HAVE NO FURTHER
22 QUESTIONS.
23 THE COURT: CROSS, MR. BUGDEN.
24 CROSS-EXAMINATION
25 BY MR. BUGDEN:
1 Q. HOW DO YOU? DO MY NAME IS WALTER BUGDEN. I'VE GOT A
2 COUPLE OF QUESTIONS FOR. YOU THANK YOU FOR BEING HERE AND
3 EXPLAINING THESE X-RAYS TO US.
4 A. THANK YOU.
5 Q. I REALLY DO HAVE ONLY A FEW QUESTIONS.
6 WITH REGARD TO JUDITH LARSEN YOU TOLD US ABOUT AN X-RAY
7 THAT WAS DONE ON 12/6/ OF '95 I BELIEVE THAT'S THE DAY SHE
8 CAME INTO THE HOSPITAL.
9 MR. BUGDEN: AND THIS WOULD BE EXHIBIT, JUDGE, 3B
10 AND IT'S MED NUMBER 488. I WONDER IF YOU CAN SHOW THAT TO
11 THE JURY PLEASE CAN YOU DO THAT, TARA. YOU DON'T NEED TO
12 STEP DOWN YET AND YOU'VE PROBABLY GOT THE BOOK RIGHT HERE.
13 THE WITNESS: HE'S GOT THE BOOK FOR THAT ONE.
14 Q. (BY MR. BUGDEN) OH, WELL. LET'S SEE IF WE CAN GET IT ON
15 THE SCREEN. IS IT POSSIBLE TO -- THERE WE GO.
16 CAN YOU SEE THAT FROM YOUR POSITION, DOCTOR?
17 A. YES, I CAN.
18 Q. JUST A COUPLE OF QUESTIONS ABOUT THIS. FIRST, THE PHRASE
19 INTERSTITIAL MARKINGS ARE PROMINENT, DID YOU TELL THE JURY
20 THAT THAT'S A FINDING THAT IS CONSISTENT WITH CONGESTIVE
21 HEART FAILURE?
22 A. IT IS.
23 Q. AND THEN IN THE IMPRESSION THE WORD CARDIOMEGALY?
24 A. MEGALY.
25 Q. MEGALY?
1 A. RIGHT.
2 Q. WHAT DOES THAT MEAN PLEASE, DOCTOR?
3 A. IT MEANS A BIG HEART.
4 Q. IS A BIG HEART SOMETHING THAT'S ALSO CONSISTENT, DOCTOR,
5 WITH CONGESTIVE HEART FAILURE?
6 A. YES, IT IS.
7 Q. AND CONGESTIVE HEART FAILURE THAT'S A CHRONIC ONGOING
8 PROCESS, IS THAT RIGHT?
9 A. IT CAN BE. IT CAN BE BOTH. IT CAN BE ACUTE PROCESS OR
10 CHRONIC PROCESS. MOST OF THE TIME IN PATIENTS WE DEAL WITH
11 THIS AGE, IT'S USUALLY A CHRONIC PROCESS.
12 Q. AND IN THIS CASE WITH, MRS. LARSEN, IT APPEARED -- THIS
13 DIDN'T APPEAR TO BE AN ACUTE PROBLEM THAT DAY, IT WAS AN
14 ONGOING PROBLEM, A CHRONIC PROBLEM?
15 A. CORRECT.
16 Q. SHE HAD CHRONIC HEART DISEASE?
17 A. CORRECT.
18 Q. CORRECT. THANK YOU. THEN IF WE COULD TURN TO MED 489.
19 MR. BUGDEN: IT'S THE VERY NEXT PAGE, JUDGE, SAME
20 EXHIBIT NUMBER. IS THERE A BLOW UP OF THAT.
21 Q. (BY MR. BUGDEN) DOCTOR, LET ME JUST ASK YOU IF THIS
22 MAKES SENSE TO YOU AND I BELIEVE I'M CORRECTLY STATING THE
23 EVIDENCE, THAT THIS PATIENT HAD BEEN OBSERVED BY NURSING
24 STAFF, TO HAVE HAD CLONIC TONIC SEIZURES, WOULD IT MAKE
25 SENSE THEN THAT DR. WEITZEL OR THE GEROPSYCHIATRIC PEOPLE HAD
1 SENT THE PATIENT TO YOU TO LOOK AT THE PATIENT?
2 A. YOU MEAN THE PATIENT OR THE CT?
3 Q. I'M SORRY. HAD SENT THE PATIENT TO YOU TO TRY TO
4 DETERMINE WHY THE PATIENT HAD HAD A SEIZURE?
5 A. CORRECT, YES. THAT WOULD BE -- THAT WOULD BE A ROUTINE
6 TYPE OF CONSULTATION REQUEST, YES.
7 Q. OKAY. AND ONE OF THE GOALS OR ONE OF THE REQUESTS THAT
8 WAS MADE WAS TO RULE OUT A BLEEDING HEMORRHAGING IN THE
9 BRAIN, IS THAT RIGHT?
10 A. CORRECT.
11 Q. AND LET ME ASK YOU ABOUT A COUPLE OF THE PHRASES IN THIS.
12 THE CEREBRAL ATROPHY HERE THAT YOU'VE MENTIONED BEFORE AND
13 YOU WROTE IN YOUR REPORT, THAT MEANS THAT THE BRAIN HAD
14 SHRUNKEN, IS THAT RIGHT?
15 A. CORRECT.
16 Q. WITH THIS PATIENT THAT WAS A PROMINENT, IS THAT WHAT YOU
17 SAID?
18 A. CORRECT.
19 Q. AND SECONDLY, AND I'M NOT SURE IF YOU EXPLAINED THIS TO
20 THE JURY SO I GUESS I'LL ASK YOU TO TELL ME WHAT IT MEANS.
21 SEE HERE. UNDER IMPRESSION IT SAYS THAT THERE ARE TWO FOCAL
22 ZONES OF DECREASED DENSITY NOTED IN THE LEFT FRONTAL LOBE,
23 THE ABSENCE OR THE HOLES DOES THAT MEAN THERE'S AN EMPTINESS
24 THERE?
25 A. CORRECT. THERE'S AREAS WHERE WHEN I WAS TALKING BEFORE
1 ABOUT THE DARK AREAS, THE BLACKER AREAS OF THE BRAIN.
2 THERE'S ACTUALLY TWO, THERE'S ONE IN THE FRONTAL LOBE AND ONE
3 IN THE OCCIPITAL, SO ONE IN THE FRONT AND ONE IN THE BACK OF
4 THE BRAIN ON THE LEFT SIDE.
5 Q. WOULD THOSE ABSENCES OR HOLES IF YOU WILL, WOULD THAT BE
6 CONSISTENT WITH SOMEONE WHO HAD HAD A STROKE?
7 A. CORRECT.
8 MR. BUGDEN: THAT'S ALL I HAVE. THANK YOU.
9 MR. WILSON: NO FURTHER QUESTIONS, YOUR HONOR.
10 THE COURT: YOU MAY STEP DOWN DR. JENSEN. MAY THIS
11 WITNESS BE EXCUSED?
12 MR. WILSON: HE MAY. THANK YOU, DOCTOR.
13 THE COURT: IF YOU FOR COMING, DOCTOR.