Paul Jensen, MD
7 PAUL R. JENSEN,
8 CALLED BY THE PLAINTIFF, HAVING BEEN DULY
9 SWORN, WAS EXAMINED AND TESTIFIED AS FOLLOWS:
10 DIRECT EXAMINATION
11 BY MR. MAJOR:
12 Q. WOULD YOU STATE YOUR NAME AND OCCUPATION?
13 A. MY NAME IS PAUL R. JENSEN. I'M A DIAGNOSTIC
14 RADIOLOGIST.
15 Q. AND WHAT IS A DIAGNOSTIC RADIOLOGIST?
16 A. A PHYSICIAN WHO INTERPRETS X-RAYS.
17 Q. AND WHEN YOU TALK ABOUT INTERPRETING X-RAYS, WHAT DOES
18 THAT INCLUDE?
19 A. THAT INCLUDES INVOLVEMENT IN EVALUATING PLAIN FILMS,
20 ULTRASOUND, M.R.I., C.T. NUCLEAR MEDICINE EXAMS AS WELL AS
21 PERFORMING THINGS SUCH AS ARTERIOGRAPHY.
22 Q. WHAT IS THAT?
23 A. WELL, THAT'S WHERE WE PERFORM ANGIOGRAMS AND THINGS LIKE
24 THAT. THE SCHOOLING REQUIRED IS I PERSONALLY WENT TO WEBER
25 STATE. GRADUATED FROM WEBER STATE IN 1981. AFTER THAT I
1817
1 SPENT FOUR YEARS AT THE UNIVERSITY OF UTAH TO GET MY M.D.
2 DEGREE. AND THEN AFTER THAT I SPENT A YEAR OF INTERNSHIP AT
3 HENNEPIN COUNTY MEDICAL CENTER IN MINNEAPOLIS, MINNESOTA AND
4 FOUR YEARS DIAGNOSTIC RADIOLOGY RESIDENCY AT THE UNIVERSITY
5 OF MINNESOTA IN MINNEAPOLIS, SO 13 YEARS OF COLLEGE.
6 Q. WHERE ARE YOU CURRENTLY EMPLOYED?
7 A. CURRENTLY EMPLOYED WITH ASSOCIATES IN RADIOLOGY WHICH
8 COVERS DAVIS HOSPITAL AND OGDEN REGIONAL MEDICAL CENTER.
9 Q. HOW LONG HAVE YOU BEEN THERE?
10 A. TEN YEARS.
11 Q. AND HAVE YOUR DUTIES BASICALLY INCLUDED WHAT YOU'VE JUST
12 DISCUSSED?
13 A. CORRECT.
14 Q. AND WHAT'S INVOLVED IN DOING THAT?
15 A. WELL, LET'S FOCUS IN ON WHAT WE'RE DEALING WITH HERE
16 WHICH IS C.T. SCANNING. C.T. SCANNING IS KIND OF LIKE A
17 VERY LARGE DONUT THAT TAKES A CROSS-SECTIONAL X-RAY PICTURES
18 OF PEOPLE. AND WHAT'S INVOLVED WITH THAT IS THAT THERE'S
19 USUALLY A PATIENT WHO IS BROUGHT INTO THE C.T. SCANNING ROOM
20 AND PLACED ON THE TABLE AND A TECHNOLOGIST PERFORMS THE
21 EXAMINATION, ACTUALLY MAKES THE PICTURES. THOSE PICTURES
22 ARE THEN GENERATED AND THEN BROUGHT TO ME AS THE RADIOLOGIST
23 AND I LOOK AT THEM AND INTERPRET THEM AND MAKE AN
24 INTERPRETATION OF WHAT THOSE PICTURES MEAN FOR THE
25 PHYSICIANS.
1818
1 Q. AND YOU DO A REPORT BASED ON THE INTERPRETATION?
2 A. CORRECT.
3 Q. AND HOW ARE THE PATIENTS -- HOW DO THE PATIENTS COME TO
4 YOU TO DO THIS?
5 A. USUALLY IT KIND OF DEPENDS. IF THEY ARE OUTPATIENTS THEY
6 WILL USUALLY COME TO THE DEPARTMENT, GO TO THE FRONT DESK
7 AND CHECK IN AND A TECHNOLOGIST WILL GREET THEM AND TAKE
8 THEM BACK TO THE C.T. SCAN AND TAKE THEM BACK.
9 ON THE BASIS OF AN INPATIENT EXAMINATION, WHERE THEY
10 WERE ALREADY IN THE HOSPITAL, THERE'S AN AID OR POTENTIALLY
11 A TECHNOLOGIST HIMSELF, WILL GET THE PATIENT, EITHER ON A
12 WHEELCHAIR OR GURNEY, BRING THEM DOWN, SCAN THEM AND THEN
13 TAKE THEM BACK.
14 Q. AND HOW ARE THESE PATIENTS REFERRED TO YOU?
15 A. THE REFERRALS COME FROM OTHER PHYSICIANS. OTHER
16 PHYSICIANS WRITE AN ORDER IN THE CHART OR THEY SEND AN ORDER
17 WITH A PATIENT TO HAVE AN EXAM PERFORMED. THOSE GO TO THE
18 FRONT DESK AND THEN THAT GETS SCHEDULED.
19 Q. ARE YOU MADE AWARE OF THOSE REQUESTS, WHAT THEY WERE
20 LOOKING FOR?
21 A. THE REQUESTS USUALLY END UP -- FOR THE VAST MAJORITY OF
22 THE TIME THE REQUESTS ARE WITH THE EXAM AFTER IT'S ALL DONE.
23 OCCASIONALLY THE DOCTORS WILL CALL AND CONSULT AND SAY,
24 OKAY, WHAT TESTS SHOULD I DO OR WHAT KIND OF TEST WOULD BE
25 THE MOST APPROPRIATE. OR, I HAVE THIS PATIENT THAT HAS
1819
1 THESE UNUSUAL CHARACTERISTICS OR UNUSUAL SYMPTOMS AND JUST
2 SO YOU KNOW ABOUT IT WHEN YOU DO THE INTERPRETATION. BUT
3 THAT'S A MINORITY OF THE TIME. MOST OF THE TIME IT'S SENT,
4 WRITTEN OR PUT IN THE COMPUTER AND THEN IT JUST COMES UP
5 WITH THE REQUEST. AND THEN THE FILMS AND REQUEST ARE HANDED
6 TO US AND WE DO THE INTERPRETATION.
7 Q. ARE YOU OFTEN ASKED TO CHECK PATIENTS FOR POSSIBLE
8 STROKE?
9 A. YES. THAT'S A VERY COMMON CASE FOR C.T.
10 Q. HOW OFTEN?
11 A. I WOULD SAY SOMEWHERE IN THE RANGE OF A FOURTH TO A
12 THIRD OF THE HEAD C.T.'S THAT WE DO ARE DEALING WITH STROKE
13 PATIENTS OR PATIENTS WHO ARE QUESTIONING OF STROKE.
14 Q. WHAT ARE YOU LOOKING FOR WHEN YOU DO THESE?
15 A. IN THE INSTANCE OF STROKE, THE MOST IMPORTANT THING
16 WE'RE LOOKING FOR IS PRESENCE OR ABSENCE OF INTRACRANIAL
17 HEMORRHAGE. THE REFERRING DOCTOR NEEDS TO KNOW SO THAT
18 BECAUSE IF THEY WERE WORRIED ABOUT THE STROKE, ONE OF THE
19 MAIN THINGS THEY NEED TO DO IS TO DECIDE WHETHER OR NOT THEY
20 WANT TO PERFORM ANTICOAGULANT THERAPY OR NOT.
21 Q. WHAT'S THAT?
22 A. THAT'S WHEN THEY PUT BLOOD THINNERS. IF THERE'S A CLOT
23 IN YOUR BRAIN THAT'S BLOCKING THE BLOOD FLOW THEY PUT YOU ON
24 BLOOD THINNERS AND HOPEFULLY THAT WILL BREAK UP THE CLOT AND
25 THE STROKE WILL BE SUBSTANTIALLY MINIMIZED OR EVEN GO AWAY.
1820
1 IF THERE'S BLEEDING IN THE HEAD ALREADY, YOU DON'T WANT TO
2 THIN THAT PERSON'S BLOOD BECAUSE IT WILL MAKE THE BLEEDING
3 WORSE AND YOU'LL END UP WITH A WORSE SITUATION THAN YOU
4 STARTED WITH. THE OTHER IMPORTANT THING THEY ARE LOOKING
5 FOR --
6 MR. STIRBA: YOUR HONOR, IF I MAY INTERRUPT. I
7 THINK THIS IS IRRELEVANT. HE'S NOT HERE AS AN EXPERT AND I
8 JUST QUESTION THE RELEVANCY.
9 THE COURT: LET'S JUST GET THE BACKGROUND.
10 MR. MAJOR: IT IS FOUNDATIONAL, YOUR HONOR.
11 THE WITNESS: THE OTHER THING THAT'S IMPORTANT FOR
12 THEM TO KNOW, THERE'S ANOTHER REASON BESIDES A STROKE THAT
13 COULD ACCOUNT FOR THE PATIENT'S SYMPTOMS. FOR EXAMPLE, A
14 MASS LESION OR TUMOR OR BIG INTRACRANIAL HEMORRHAGE THAT'S
15 PUSHING ON THE BRAIN OR SOME OTHER REASON THAT WOULD ACCOUNT
16 FOR THE PATIENT HAVING SYMPTOMS SUCH AS STROKE BUT IT'S NOT
17 A STROKE. SO THOSE ARE THE TWO MAIN THINGS THEY DO C.T.'S.
18 FOR.
19 Q. AFTER YOU PERFORM THESE M.R.I.'S, DO YOU USUALLY CONSULT
20 WITH THE ATTENDING PHYSICIANS?
21 A. IT WILL DEPEND UPON THE SITUATION.
22 MR. STIRBA: I'M GOING TO OBJECT, YOUR HONOR.
23 RELEVANCY?
24 THE COURT: LET'S KIND OF FOCUS ON THIS CASE.
25 MR. MAJOR: WE ARE, YOUR HONOR. THAT'S WHERE WE
1821
1 ARE GOING. THIS IS FOUNDATION. MAY I PROCEED?
2 THE COURT: GO AHEAD.
3 Q. (BY MR. MAJOR) WHAT TYPES OF THINGS DO YOU NORMALLY
4 CONSULT WITH?
5 A. IF IT'S AN ACUTE SITUATION IN THE EMERGENCY ROOM, THEN
6 WE'LL USUALLY CALL THOSE RESULTS. IF IT'S SOMETHING WITH AN
7 INPATIENT, SOMETIMES WE WILL AND SOMETIMES WE WON'T CALL A
8 REPORT, DEPENDING UPON THE SITUATION. BUT IN GENERAL, AND A
9 LOT OF TIMES IN A CASE OF RULING OUT C.V.A., THE MAJORITY OF
10 TIMES THEY ARE COMING THROUGH THE EMERGENCY ROOM AND WE WILL
11 CALL AND GIVE THEM A VERBAL REPORT.
12 THE COURT: BOTH OF YOU SLOW DOWN AND PAUSE BEFORE
13 ONE FINISHES THE QUESTION AND ONE FINISHES THE ANSWER
14 BECAUSE YOU BOTH TALK FAST AND IF THE COURT REPORTER DIES,
15 THAT'S ALL WE HAVE.
16 THE WITNESS: IN MOST INSTANCES WHEN THEY'RE COMING
17 THROUGH THE EMERGENCY ROOM THEY WILL BE -- THERE WILL BE AN
18 ORAL REPORT GIVEN IN ADDITION TO THE WRITTEN REPORT. IN
19 THIS INSTANCE, THIS PATIENT WAS AN INPATIENT SO I AM UNSURE
20 WHETHER OR NOT THERE WAS AN ORAL REPORT GIVEN ON TOP OF THE
21 WRITTEN REPORT.
22 Q. (BY MR. MAJOR) IF YOU WERE TO DETERMINE THAT A PATIENT
23 HAD AN ACUTE OR A SERIOUS PROBLEM, WHAT WOULD YOUR NORMAL
24 PROCEDURE BE?
25 MR. STIRBA: I OBJECT. RELEVANCY, YOUR HONOR.
1822
1 THE COURT: SUSTAINED.
2 MR. MAJOR: YOUR HONOR, MIGHT I --
3 THE COURT: NO. LET'S GO TO WHAT HE DID.
4 Q. (BY MR. MAJOR) OKAY. AS PART OF YOUR TRAINING AND
5 EXPERIENCE, DO YOU ALSO LOOK AT OTHER M.R.I.'S FROM THE SAME
6 PATIENT?
7 A. CORRECT.
8 Q. COMPARE THOSE?
9 A. YES.
10 Q. AND YOU ARE TRAINED IN DOING THAT?
11 A. YES.
12 Q. LET ME SHOW YOU WHAT'S BEEN MARKED FOR IDENTIFICATION AS
13 PLAINTIFF'S EXHIBIT NUMBER 6, SPECIFICALLY PAGE 00489, AND
14 ASK YOU IF YOU CAN IDENTIFY THAT?
15 A. THIS IS A C.T. REPORT THAT I PERFORMED ON 12/26/95 ON A
16 PATIENT, JUDITH LARSEN.
17 Q. DO YOU RECALL THE CIRCUMSTANCES OF HOW YOU CAME TO
18 PERFORM THIS?
19 A. I DON'T PERSONALLY RECALL, NO.
20 Q. BUT YOU DO HAVE A RECOLLECTION OF ACTUALLY PERFORMING
21 THIS PARTICULAR M.R.I.?
22 A. THIS PARTICULAR C.T., NO.
23 Q. BUT BASED ON YOUR RECORDS, THAT REFRESHES YOUR MEMORY?
24 A. YES.
25 Q. CAN YOU BRIEFLY GO THROUGH AND EXPLAIN WHAT YOU DID AND
1823
1 WHAT THE RESULTS WERE?
2 A. THIS IS A C.T. SCAN OF A HEAD. AS WE TALKED BEFORE, A
3 C.T. SCAN IS A VERY LARGE DONUT-LOOKING MACHINE THAT TAKES
4 CROSS-SECTIONAL SLICES THROUGH PEOPLE AND THEN LAYS THOSE
5 OUT SO WE CAN LOOK AT PEOPLE. THE HISTORY ON THIS ONE IS
6 PSYCHOSIS AND RULE OUT BLEED.
7 Q. WHAT DOES THAT MEAN?
8 A. THAT MEANS THAT'S THE INFORMATION THAT I HAD BEEN GIVEN
9 BY THE REFERRING PHYSICIAN, OR HAD BEEN TYPED INTO THE
10 COMPUTER, AS FAR AS WHY WE'RE DOING THIS STUDY.
11 Q. SO YOU ARE LOOKING FOR BLEEDING INSIDE THE CRANIUM?
12 A. CORRECT. MULTIPLE AXIAL SCANS ARE OBTAINED THROUGH THE
13 HEAD IS BASICALLY A DESCRIPTION OF HOW WE PERFORM THE
14 EXAMINATION. VENTRICLES AND SULCI FROM -- VENTRICLES AND
15 SULCI ARE VERY PROMINENT, CONSISTENT WITH CEREBRAL ATROPHY.
16 Q. WHAT WAS VENTRICLES, EXPLAIN THAT?
17 A. VENTRICLES ARE THE POCKETS IN YOUR BRAIN THAT HAVE FLUID
18 IN THEM. AND AS YOU AGE THEY CAN TEND TO GET LARGE. AND
19 THE SAME THING WITH THE CONVOLUTIONAL MARKINGS ON THE TOP OF
20 YOUR HEAD. THOSE ARE CALLED GYRI. AND THEN THE DIPS
21 BETWEEN THOSE PARTICULAR LUMPS ARE CALLED SULCI. AND THOSE
22 AREAS CAN BECOME PROMINENT AS THE BRAIN GETS SMALLER WITH
23 AGE OR ATROPHIES.
24 Q. THAT'S BASICALLY WHAT WE'RE SAYING HERE IS THE BRAIN IS
25 GETTING SMALLER?
1824
1 A. IS GETTING OLD, YES.
2 Q. IS THAT SIGNIFICANT AT ALL?
3 A. IN THIS AGE, NO. ACTUALLY THAT WOULD BE KIND OF
4 EXPECTED. SO THAT'S NOT UNUSUAL.
5 Q. WHAT WAS THE NEXT THING WE DO?
6 A. ALSO IDENTIFIED IS DECREASED DENSITY IN THE LEFT FRONTAL
7 LOBE WHICH MAY REFLECT A SUBACUTE INSULT/C.V.A.
8 Q. WHAT DOES THAT MEAN?
9 A. C.V.A., CEREBROVASCULAR ACCIDENT OR STROKE. THAT'S A
10 FANCY NAME FOR A STROKE. LOW DENSITY INDICATES MORE OF A
11 CHRONIC-TYPE PROCESS. WHEN YOU ARE DEALING WITH STROKES IN
12 PATIENTS, THE MOST COMMON INITIAL FINDING WITHIN THE FIRST,
13 SAY, 12 HOURS IS THAT YOU'LL SEE NOTHING ON A C.T. SCAN.
14 AFTER THAT YOU MAY SEE SUBTLE CHANGES IN THE GRAY WHITE
15 INTERFACE IN THE BRAIN. THOSE WOULD INDICATE SOMETHING
16 SUBACUTE OR WITHIN, SAY, 12 TO 48 HOURS. THEN, AS TIME GOES
17 ON OVER WEEKS AND MONTHS, THAT BRAIN SUBSTANCE BASICALLY
18 GOES AWAY AND IS FILLED IN WITH FLUID OR THE C.S.F.,
19 CEREBRAL SPINAL FLUID. AND THAT INDICATES MORE OF A CHRONIC
20 PROCESS OR THAT'S AN OLD PROBLEM, NOT A NEW PROBLEM.
21 Q. IS THAT WHAT WE'RE FINDING HERE THEN?
22 A. THAT'S WHAT WE'RE DISCUSSING HERE WITH REGARD TO THE
23 LEFT FRONTAL LOBE.
24 Q. THAT'S AN OLD SUBACUTE WHICH MEANS OLDER?
25 A. SUBACUTE IS ANYTHING FROM LIKE SOMETHING FROM 12 HOURS
1825
1 TO ANYWHERE -- DAYS TO WEEKS. AND THEN THE NEXT SENTENCE IS
2 ALSO IDENTIFIED AS SOME VASCULAR CALCIFICATIONS, WHICH IS
3 ALSO VERY COMMON IN SOMEONE THIS AGE GROUP. THEY GET
4 CALCIFICATIONS IN THEIR ARTERIES. THERE'S NO EVIDENCE OF
5 MIDLINE SHIFT, WHICH MEANS THERE'S NO PUSHING OF THE BRAIN
6 BY SOME PROCESS, EITHER A BIG MASS IN THE BRAIN OR SOME KIND
7 OF A TUMOR OR SOME TYPE OF A CRANIAL, INTRACRANIAL
8 HEMORRHAGE. THOSE KINDS OF THINGS ARE NOT VISIBLE ON THIS
9 EXAM.
10 Q. WHAT ELSE DID YOU DO?
11 A. THE NEXT, NO EVIDENCE OF INTRACRANIAL HEMORRHAGE.
12 THAT'S ONE OF THE QUESTIONS. WE'RE RULING OUT A BLEED AND
13 WE SAY NO, THERE'S NO BLEED.
14 Q. AND AS TO ANYTHING ELSE?
15 A. ALSO THERE IS A SECONDARY IN THE OCCIPITAL LOBE OF THE
16 BRAIN WHICH ALSO SHOWS THAT LOW DENSITY, SUGGESTING AN OLD
17 STROKE.
18 Q. WHERE IS THE OCCIPITAL?
19 A. IN THE BACK OF YOUR HEAD.
20 Q. THANK YOU. AND ANYTHING ELSE?
21 A. THEN IN THE IMPRESSION BASICALLY I RESTATE WHAT I SAID.
22 BUT I ALSO ADDED THAT THERE'S ALSO SOME SUBTLE CHANGES IN
23 THE LEFT FRONTAL REGION WHICH MAY REFLECT WHAT WE CALL
24 LUXURY OF PROFUSION.
25 Q. WHAT DOES THAT MEAN?
1826
1 A. THAT MEANS AN AREA THAT'S HAD MORE OF A POTENTIAL RECENT
2 STROKE AND MAY HAVE AN AREA OF INCREASED BLOOD FLOW TO THAT
3 AREA. AND WHERE THAT INCREASED BLOOD FLOW GOES IN THAT
4 REGION IT LOOKS MORE DENSE THAN IT MAY LOOK ON JUST A BASIC
5 NORMAL EXAM. BECAUSE THESE ARE KINDS OF QUESTIONABLE
6 THINGS. IT'S A QUESTION OF WHETHER OR NOT IT MIGHT BE THERE
7 OR NOT. IT'S NOT A HARD AND FAST FINDING.
8 Q. IS THERE ANYTHING BASED ON THIS SCAN THAT YOU DID THAT
9 INDICATED TO YOU THERE'S AN ACUTE PROBLEM HERE?
10 A. THERE MAY BE A SUBACUTE PROBLEM WITH REGARD TO THE
11 INCREASED DENSITY, BUT I DO NOT SEE ANY EVIDENCE OF ACUTE
12 INTRACRANIAL HEMORRHAGE WHICH THEY ARE TRYING TO RULE OUT.
13 Q. ANY TYPE OF LIFE THREATENING CONDITION THAT YOU CAN SEE?
14 A. NOT THAT I CAN SEE, BASED ON THAT REPORT, NO.
15 Q. LET ME SHOW YOU WHAT'S BEEN MARKED FOR IDENTIFICATION, A
16 COPY, AS DEFENDANT'S EXHIBIT NUMBER 17 AND ASK YOU TO TURN
17 TO PAGE 00035. YOU'VE HAD A -- DO YOU RECOGNIZE WHAT THAT
18 IS?
19 A. THIS IS A C.T. EXAMINATION REPORT DATED 1/14/95 FROM
20 L.D.S. HOSPITAL.
21 Q. AND IT REPRESENTS THIS IS ALSO DONE ON JUDITH LARSEN,
22 CORRECT?
23 A. CORRECT.
24 Q. DID YOU HAVE AN OPPORTUNITY TO -- PRIOR TO COMING TO
25 COURT TODAY DID YOU REVIEW THAT?
1827
1 MR. STIRBA: I'M GOING TO OBJECT, YOUR HONOR. HE'S
2 NOT HERE AS AN EXPERT. THIS ISN'T HIS REPORT. HE DIDN'T DO
3 IT.
4 MR. MAJOR: YOUR HONOR, IF I MIGHT RESPOND TO THAT?
5 THE COURT: OKAY. IS THERE ANYTHING ELSE WE CAN
6 DEAL WITH?
7 MR. MAJOR: NO. THIS WILL BE THE LAST AREA WE'RE
8 GETTING INTO, YOUR HONOR.
9 THE COURT: OKAY. LADIES AND GENTLEMEN, I GUESS WE
10 MAY HAVE TO TAKE A REAL SHORT BREAK. THIS IS JUST A WAY TO
11 KEEP YOU AWAKE. AND SO IF YOU WILL JUST GO OUT. IF YOU
12 WANT TO GO OUTSIDE FOR A FEW MINUTES, I'LL HAVE THE BAILIFF
13 CALL YOU IN WHEN IT'S TIME TO COME IN. DURING THAT TIME YOU
14 ARE NOT TO CONVERSE AMONG YOURSELVES OR CONVERSE WITH OR
15 ALLOW YOURSELVES TO BE ADDRESSED BY ANY OTHER PERSON
16 REGARDING THE SUBJECT OF THIS TRIAL. AND IT'S YOUR DUTY NOT
17 TO FORM OR EXPRESS AN OPINION UNTIL YOU'VE HEARD ALL THE
18 EVIDENCE AND THE CASE IS FINALLY SUBMITTED TO YOU. SO WE'LL
19 LET YOU KNOW WHEN YOU CAN COME BACK.
20 (JURY LEAVES THE COURTROOM.)
21 THE COURT: YOU MAY BE SEATED. THE RECORD WILL
22 REFLECT THAT THE JURY HAS LEFT THE COURTROOM. OKAY. WHAT
23 IS GOING TO BE THE QUESTION OF THIS WITNESS? FIRST OF ALL,
24 WHAT ARE YOU GOING TO ASK?
25 MR. MAJOR: YOUR HONOR, WHAT WE INTENDED TO ASK, AS
1828
1 A PROFFER, THESE ARE DEFENDANT'S DOCUMENTS. THEY HAVE BEEN
2 INTRODUCED INTO EVIDENCE. THEY HAVE BEEN TESTIFIED TO BY
3 DR. STEVENS AND DR. PEARCE. THEY WERE CROSS-EXAMINED
4 CONCERNING THOSE DOCUMENTS. THEY HAVE BEEN GOING THROUGH
5 THIS TRIAL INTRODUCING THESE, USING THESE DOCUMENTS, MEDICAL
6 RECORDS AND SO FORTH. WE'VE HAD NURSES READING OTHER
7 NURSES' NOTES AND SO FORTH AND INTERPRETING THEM.
8 DR. JENSEN IS A DOCTOR WHO IS FAMILIAR WITH
9 INTERPRETING THESE TYPES OF REPORTS. I BELIEVE HE HAS A
10 RIGHT TO SAY I'VE LOOKED AT THIS DOCUMENT. I'VE COMPARED IT
11 WITH THE ONE I DID ON DECEMBER 26 AND I FIND NO SIGNIFICANT
12 CHANGES FROM HER CONDITION WHEN IT WAS GIVEN ON JANUARY TO
13 WHEN IT WAS GIVEN ON DECEMBER.
14 WE ALSO WOULD INDICATE THAT WE HAVE THE ONE FOR AUGUST
15 AND THE M.R.I. OR THE SCAN THAT WAS DONE IN SEPTEMBER. HE'S
16 ALSO COMPARED THOSE TO THE ONE HE DID ON THE 26TH. I THINK
17 HE'S QUALIFIED TO DO IT.
18 THE COURT: IS THIS SOMETHING THAT HE DID WHILE HE
19 WAS TREATING OR DOING THE FIRST EVIDENCE HE TALKED ABOUT
20 JUDITH LARSEN ON 12/26/95 OR SOMETHING MORE RECENT?
21 MR. MAJOR: THIS IS SOMETHING I HAD HIM DO SINCE
22 DEFENDANT ENTERED THESE DOCUMENTS AND HAD CROSS-EXAMINED ON
23 IT.
24 THE COURT: WHAT IS YOUR OBJECTION?
25 MR. STIRBA: WELL, THE OBJECTION, AND I THINK WE
1829
1 HAD THIS COME UP WITH ANOTHER WITNESS. I CAN'T RECALL. BUT
2 ESSENTIALLY NOW THEY ARE TURNING A TREATING PHYSICIAN INTO
3 AN EXPERT WITNESS. AND I HAVE NO -- I'VE NEVER SEEN THE
4 REPORT. I'VE NEVER HAD AN OPINION EXPRESSED. I'VE NEVER
5 HAD DR. JENSEN -- IT'S NEVER BEEN TOLD ME THAT DR. JENSEN
6 WAS GOING TO LOOK AT THIS PARTICULAR REPORT AND WAS GOING TO
7 INTERPRET IT OR RENDER AN OPINION WITH RESPECT TO IT.
8 AND BY THE WAY, THEY ARE NOT DEFENDANT'S DOCUMENTS.
9 THEY ARE JUST A MEDICAL HISTORY OF EACH ONE OF THESE
10 PATIENTS. AND CERTAINLY IF IT WAS AN EXPERT OPINION OR AN
11 EXPERT -- OR THE BASIS FOR AN EXPERT REPORT, I WOULD HAVE NO
12 PROBLEM WITH IT. BUT THIS GENTLEMAN IS A TREATING
13 PHYSICIAN. I'VE HAD NO NOTICE THAT HE WAS GOING TO TESTIFY
14 AS TO ANYTHING BUT WHAT FACTUALLY HE DID WITH RESPECT TO THE
15 CARE HE PROVIDED TO, IN THIS INSTANCE, MS. LARSEN AND MAYBE
16 SOMEBODY ELSE. SO IT'S PRECLUDED BY OUR ORDER. AND IT'S
17 COME UP BEFORE. IT'S THE SAME PROBLEM AGAIN.
18 MR. MAJOR: WELL, YOUR HONOR, WHAT WE HAVE HERE, WE
19 DID NOT INTRODUCE THESE DOCUMENTS. AS A MATTER OF FACT,
20 INITIALLY I THINK WE BELIEVED THAT THEY WERE IRRELEVANT.
21 HOWEVER, THEY HAVE BEEN INTRODUCED. WE'VE BEEN ABLE TO HAVE
22 THE DEFENSE COUNSEL QUESTION OUR WITNESSES CONCERNING PRIOR
23 REPORTS, PRIOR NURSES' NOTES AND SO FORTH. WE EVEN HAD
24 FAMILY MEMBERS QUESTIONED CONCERNING DOCTORS' REPORTS, DR.
25 KELLER, DR. WILDING. I SEE NOTHING WRONG WITH THIS
1830
1 PHYSICIAN BEING ABLE TO DO THE SAME THING.
2 WE POINT OUT THAT WE HAVE SUBMITTED TO THE COURT A CASE
3 WHICH INDICATES THAT IN FACT A TREATING PHYSICIAN CAN
4 TESTIFY TO THESE THINGS. HE DOESN'T HAVE TO BE QUALIFIED AS
5 AN EXPERT. AT THIS POINT IN TIME HE HAS THE ABILITY TO MAKE
6 THAT INTERPRETATION. AND WE'D SUBMIT IT, YOUR HONOR.
7 THE COURT: WELL, ISN'T THIS THE SAME SITUATION? I
8 MEAN, I DON'T THINK THERE'S ANY QUESTION UNDER YOUR CASE
9 THAT THIS PERSON COULD GIVE AN OPINION AS A TREATING
10 PHYSICIAN IF THEY ARE QUALIFIED. THE QUESTION IS IF THEY
11 ARE GIVING AN OPINION DID THEY GIVE AN EXPERT REPORT 30 DAYS
12 BEFORE TRIAL AND WERE THEY DESIGNATED AS AN EXPERT?
13 MR. MAJOR: UNDER THAT CASE THEY WERE NOT QUALIFIED
14 TO -- THEY WERE NOT REQUIRED TO GIVE AN EXPERT OPINION. A
15 TREATING PHYSICIAN IS NOT TREATED AS AN EXPERT.
16 THE COURT: I KNOW. BUT I'VE -- I'VE ADDRESSED
17 THIS ISSUE AT LEAST TWICE. AND SO I DON'T UNDERSTAND IF YOU
18 KEEP ADDRESSING IT, I'M NOT GOING TO BE INCONSISTENT. HE'S
19 NOT GOING TO GIVE AN OPINION UNLESS HE WAS AN EXPERT
20 DESIGNATED AND HE GAVE A REPORT 30 DAYS BEFORE THE TRIAL TO
21 THE DEFENDANT.
22 MR. MAJOR: I APOLOGIZE, YOUR HONOR. I
23 MISINTERPRETED. I THOUGHT, WHEN WE HAD THE PROBLEM WITH THE
24 OTHER TWO DOCTORS, WE SUBMITTED A CASE AND ASKED THIS
25 QUESTION. TREAT HIM AS AN EXPERT. WE'LL REMOVE ONE OF THE
1831
1 EXPERTS.
2 THE COURT: THAT WAS THE FIRST ONE. THEN THE NEXT
3 ONE BECAME THE ISSUE OF I DIDN'T GET AN EXPERT REPORT AND
4 THEY HAVEN'T BEEN DESIGNATED AS EXPERTS. AND PEOPLE
5 DESIGNATED AS A TREATING PHYSICIAN AND EXPERT, AFTER THAT I
6 SAID PHYSICIANS WHO ARE TREATING PHYSICIANS AREN'T GOING TO
7 GIVE EXPERT OPINIONS. THAT WAS THE SECOND.
8 NOW, THE THIRD ONE IS I'M STANDING WHERE I'VE BEEN.
9 AND IT WILL BE THE SAME. IF IT HAPPENS AGAIN, I'LL GIVE THE
10 SAME RULING.
11 MR. MAJOR: I APOLOGIZE. I UNDERSTOOD THAT
12 DR. CLINGER WAS -- HE COULD NOT TESTIFY FROM HIS OWN REPORT.
13 SO IF THAT'S THE CASE, WE HAVE -- WELL, I DO APOLOGIZE TO --
14 MISS BARLOW DID POINT OUT, YOUR HONOR, THERE'S ONE OTHER
15 AREA WE NEED TO LOOK AT. I'LL PROFFER THAT DR. JENSEN DID
16 GIVE AN X-RAY TO ENNIS ALLDREDGE UPON HIS ADMISSION. WE
17 WERE GOING TO ADDRESS THAT WITH HIM. I JUST FORGOT WHEN WE
18 EXCUSED THE JURY.
19 THE COURT: ALL RIGHT. WHY DON'T WE HAVE THE JURY
20 COME BACK AND YOU CAN FINISH THAT.
21 (WHEREUPON, THE JURY RETURNS.)
22 THE COURT: PLEASE BE SEATED. THE JURY HAS
23 RETURNED. WOULD YOU LIKE TO GO AHEAD.
24 Q. (BY MR. MAJOR) DOCTOR, I WOULD LIKE TO SHOW YOU NOW
25 WHAT'S BEEN MARKED FOR IDENTIFICATION AS PLAINTIFF'S EXHIBIT
1832
1 NUMBER 7, SPECIFICALLY PAGE 0026, AND ASK YOU IF YOU CAN
2 IDENTIFY THAT?
3 A. THIS IS A REPORT OF A CHEST X-RAY DATED 1/10/96 ON ENNIS
4 ALLDREDGE.
5 Q. AND DID YOU PERFORM THIS TEST?
6 A. YES, I DID. ACTUALLY, I INTERPRETED. I DID NOT
7 PERFORM.
8 Q. YOU HAVE A TECHNICIAN THAT ACTUALLY PERFORMED THE TEST?
9 A. CORRECT.
10 Q. AND CAN YOU JUST BRIEFLY FOR THE JURY EXPLAIN WHAT
11 HAPPENED AND WHAT OCCURRED ON THIS OCCASION?
12 A. AGAIN, THIS IS A STANDARD CHEST RADIOGRAPH. IT IS NOT
13 THE FANCY BIG DONUT MACHINE. IT'S JUST A REGULAR X-RAY OF
14 THE CHEST. THE HISTORY THAT I HAD AT THE TIME WAS
15 PSYCHOSIS. AND THEN MY REPORT STATES, THE PATIENT IS STATUS
16 POST-MEDIAN STERNOTOMY.
17 Q. WHAT DOES THAT MEAN?
18 A. WHICH MEANS THEY PROBABLY HAD -- SOMEONE ENTERED THEIR
19 CHEST SURGICALLY. AND THE MOST COMMON REASON FOR THAT IS
20 FOR CORONARY ARTERY BYPASS, OR CABBAGE IS THE LAYMAN'S TERM,
21 WHERE THEY DO BYPASS GRAFTING ON HEARTS TO KEEP THEM ALIVE.
22 SOME BI-BASILAR FINDINGS. THAT MEANS BOTH LUNGS, THE
23 LOWER PART OF BOTH LUNGS, ARE NOTED WITH SOME PROMINENCE OF
24 THE LEFT LOWER LOBE. IN OTHER WORDS, THERE'S SOME LINEAR
25 CHANGES OR THERE'S SOME INCREASED DENSITY WITHIN THE LUNG
1833
1 BASES TO SUGGEST THAT THAT IS -- THAT'S NOT 100 PERCENT
2 NORMAL. THERE MAY BE SOME ATELECTASIS OR, IN OTHER WORDS,
3 THE LUNG HAS COLLAPSED A LITTLE BIT. OR THERE MAY BE A
4 POTENTIAL FOR EARLY INFILTRATOR PNEUMONIA.
5 ALSO SOME HAZINESS ALONG THE LEFT LATERAL COSTOPHRENIC
6 ANGLE CONSISTENT WITH A POTENTIAL SMALL PLEURAL EFFUSION.
7 THAT JUST MEANS THERE IS A POSSIBILITY OF SOME FLUID IN THAT
8 LUNG AS WELL THAT'S SITTING IN THE CORNER LIKE RIGHT ALONG
9 THE EDGE OF THE CHEST X-RAY. WHEN THEY GET A LITTLE BIT OF
10 FLUID IT WILL START TO ROUND INSTEAD OF BE A NICE SHARP EDGE
11 WHERE THE LUNGS MEET THE EDGE OF THE CHEST.
12 Q. DOES THAT HAVE ANY SIGNIFICANCE WITH THE HEALTH OF THE
13 PERSON?
14 A. IN A CASE OF THIS KIND OF SITUATION THERE IS A POTENTIAL
15 FOR THAT BEING A LITTLE MORE INDICATIVE OF EITHER PNEUMONIA
16 OR POTENTIALLY SOME MILD CONGESTIVE HEART FAILURE.
17 Q. AND WHAT ELSE DID YOU LOOK AT?
18 A. THE ONLY OTHER THING OF NOTE TO MENTION ON THAT
19 PARTICULAR CHEST RADIOGRAPH IS THAT IT WAS PROBABLY
20 PORTABLE. IT SAYS THAT ON THE TOP, WHICH MEANS WE DON'T
21 HAVE AS GOOD EQUIPMENT. THAT THEY ROLL UP ON THE FLOOR TO
22 TAKE THOSE PICTURES. AND IN THE END IT MIGHT BE HELPFUL TO
23 GET ONE DOWN AT THE DEPARTMENT WHERE THEY CAN STAND HIM UP
24 AND GET SOME REALLY GOOD PICTURES WITH THE REGULAR P.A. AND
25 LATERAL RADIOGRAPH. THAT MIGHT HELP FIGURE OUT IF SOMETHING
1834
1 IS GOING ON OR IS NOT GOING ON.
2 Q. THAT'S WHAT YOU ARE SUGGESTING?
3 A. YES.
4 Q. DID YOU SEE, BASED ON THIS CHEST X-RAY AT THE TIME IT
5 WAS GIVEN, ANYTHING ACUTE?
6 A. THE POTENTIAL FOR ACUTE PNEUMONIA IS THERE AND THE
7 POTENTIAL FOR SOME CONGESTIVE HEART FAILURE IS THERE, BUT
8 THE FINDINGS BASED UPON THE REPORT ARE RELATIVELY MILD.
9 Q. NOTHING APPARENTLY THAT IS LIFE THREATENING?
10 A. URGENT, SOMETHING THAT I WOULD NEED TO CALL A PHYSICIAN
11 ABOUT, NO.
12 MR. MAJOR: OKAY. WE HAVE NO FURTHER QUESTIONS AT
13 THIS TIME, YOUR HONOR.
14 THE COURT: ANY CROSS-EXAMINATION?
15 MR. STIRBA: YES, YOUR HONOR. THANK YOU.
16 CROSS-EXAMINATION
17 BY MR. STIRBA:
18 Q. DOCTOR, GOOD AFTERNOON. THE PLEURAL EFFUSION WHICH YOU
19 JUST IDENTIFIED ON THAT CHEST X-RAY THAT YOU DID ON
20 MR. ALLDREDGE ON THE 10TH, THERE ARE SOME CLINICAL FINDINGS
21 THAT CAN BE MADE TO ASSIST IN THE ACTUAL DIAGNOSIS OF
22 WHETHER WE HAVE A SIGNIFICANT PULMONARY PROBLEM; IS THAT
23 RIGHT?
24 A. THAT'S TRUE.
25 Q. FOR EXAMPLE, THE EFFUSION COULD RESULT IN SOME CHEST
1835
1 PAINS; IS THAT CORRECT?
2 A. POTENTIALLY, YES.
3 Q. AND THE EFFUSION COULD ALSO RESULT IN SOME DYSPNEA; IS
4 THAT RIGHT?
5 A. VERY TRUE.
6 Q. GASPING FOR AIR, THAT'S THE PHENOMENON?
7 A. CORRECT.
8 Q. AND IT ALSO COULD RESULT -- AS FAR AS A CLINICAL
9 CORRELATION THERE COULD BE A FEVER; ISN'T THAT TRUE?
10 A. FROM THE PLEURAL EFFUSION LIKELY NOT, UNLESS IT WAS
11 INFECTED PLEURAL EFFUSION. MOST COMMONLY THE PLEURAL
12 EFFUSION IS SECONDARY TO PNEUMONIA SO THAT ACTUALLY THE LUNG
13 IS WHAT'S INFECTED AND THE PLEURAL EFFUSION IS KIND OF AN
14 ALSO RAN.
15 Q. THERE IS A DIFFERENCE, IS THERE NOT, WHEN YOU USE THE
16 TERM PLEURAL EFFUSION AND, LET'S SAY, PNEUMONIA; IS THAT
17 CORRECT?
18 A. THAT IS.
19 Q. AND IT'S TRUE, IS IT NOT, THAT THE EFFUSION IS REALLY
20 YOU'RE TALKING ABOUT A LOSS OF FLUID FROM AN AREA OF THE
21 LUNG; IS THAT RIGHT?
22 A. NO. YOU ARE TALKING ABOUT AN INCREASED AMOUNT OF FLUID
23 WITHIN THE LUNG SO THAT THERE'S EXTRA FLUID IN THE CHEST
24 CAVITY. AND MOST COMMONLY IT'S BETWEEN THE CHEST WALL AND
25 THE LUNG. THAT'S WHERE PLEURAL EFFUSION ACCUMULATES IS THAT
1836
1 THAT FLUID ACCUMULATES BETWEEN THE LUNG AND THE CHEST WALL.
2 Q. HOW ARE YOU AT DRAWING? WOULD YOU LIKE TO SHOW US,
3 PLEASE?
4 A. I GUESS SO.
5 Q. WOULD YOU LIKE TO SHOW US, PLEASE?
6 A. I GUESS SO. THAT'S NOT MY STRONG SUIT.
7 Q. WELL, THAT'S ALL RIGHT. WE ALL UNDERSTAND THAT. I
8 THINK IT WOULD BE EASIER IF PERHAPS YOU COULD DRAW IT. NOW,
9 I'M GOING TO GIVE YOU THE MAGIC MARKER AND ASK YOU TO DO
10 WHAT YOU NEED TO DO SO WE CAN UNDERSTAND WHAT EFFUSION IS.
11 A. SO IF WE DRAW KIND OF A CHEST. LET ME GET THE
12 DIAPHRAGMS. WE GET -- USUALLY WE'LL GET AN AREA HERE WHERE
13 THE VESSELS AND THE STERNUM AND THINGS LIKE THAT ARE COMING
14 IN HERE AND THEN WE'VE GOT A HEART. AND THEN YOU'LL HAVE
15 THE TRACHEA WILL COME DOWN HERE AND DIVIDE AND GO INTO THE
16 LUNGS. YOU'VE GOT YOUR LUNG WHICH BASICALLY FILLS THIS
17 WHOLE CAVITY. AND THOSE WOULD BE THE LUNGS.
18 NOW, WHEN WE'RE TALKING ABOUT THE BASE OF THE CHEST,
19 YOU ARE TALKING ABOUT THE LOWER PART OF THE LUNG. SO KIND
20 OF THIS AREA BACK DOWN IN HERE IS WHERE WE ARE TALKING ABOUT
21 THE LUNG BASES.
22 NOW, THE FLUID THAT WE'RE TALKING ABOUT WITH PLEURAL
23 EFFUSION IS FLUID THAT ACCUMULATES RIGHT HERE BETWEEN THE
24 LUNG AND THE CHEST WALL. SO THE CHEST WALL IS OUT HERE AND
25 THEN THE LUNG IS RIGHT HERE. THEN THERE'S A POTENTIAL SPACE
1837
1 RIGHT HERE. NOW, IF IT'S FILLED WITH AIR IT'S CALLED A
2 PNEUMOTHORAX OR COLLAPSED LUNG; AND IF IT'S FILLED WITH
3 FLUID IT'S CALLED PLEURAL EFFUSION. THESE ACCUMULATE
4 BECAUSE OF TWO MAJOR THINGS, BASICALLY PNEUMONIAS AND
5 CONGESTIVE HEART FAILURE IS PROBABLY THE MOST COMMON REASON
6 WE'LL SEE FLUID ACCUMULATING IN THOSE SPACES.
7 Q. IT'S TRUE, IS IT NOT, IN THE X-RAY THAT YOU READ THAT
8 YOU DID NOT DETERMINE THAT IN FACT THERE WAS PNEUMONIA THAT
9 HAD DEVELOPED AS OF THAT POINT; IS THAT RIGHT?
10 A. WE WEREN'T CERTAIN. THERE WERE SOME FINDINGS AT THE
11 BASES RAISING A POSSIBILITY.
12 Q. SURE, BUT THE POINT IS YOU DIDN'T FIND IT?
13 A. NO, WE DIDN'T CALL AND SAY THIS LOOKS LIKE PNEUMONIA.
14 THE COURT: BOTH SPEAK ONE AT A TIME WITH SPACES IN
15 BETWEEN. GO AHEAD.
16 Q. (BY MR. STIRBA) AND IT'S TRUE THAT CERTAINLY ON A
17 CHEST X-RAY YOU CAN DETERMINE THE EXISTENCE OF PNEUMONIA; IS
18 THAT RIGHT?
19 A. THAT MAY NEED SOME QUALIFICATION. WHAT WE'RE LOOKING AT
20 ON A CHEST RADIOGRAPH IS THINGS THAT ARE DARK AND THINGS
21 THAT ARE LIGHT. AND WHEN WE FIND THINGS THAT ARE LIGHT OR
22 WHITE THAT DON'T BELONG IN THE WHITE OR LIGHT CATEGORY, THEN
23 THEY CAN BE A NUMBER OF THINGS. THEY CAN BE BLOOD. THEY
24 CAN BE CELLS, FOR EXAMPLE A TUMOR. THEY CAN BE PUSS SUCH AS
25 PNEUMONIA OR THEY CAN BE FLUID SUCH AS WATER. WE DON'T
1838
1 ALWAYS KNOW WHICH OF THOSE THINGS IT IS. ON THE CHEST
2 RADIOGRAPH WE CAN JUST SAY THAT LOOKS TOO WHITE.
3 THEN WE GO INTO TRYING TO FIGURE OUT, BASED UPON THE
4 CLINICAL PICTURE OF THE PATIENT, DOES THE PATIENT HAVE A
5 FEVER. ARE THEY COUGHING UP SPUTUM THAT LOOKS LIKE IT'S
6 INFECTED. THEN YOU SAY OKAY, THAT'S MOST LIKELY PNEUMONIA.
7 IF THEY DON'T HAVE ANY OF THOSE FINDINGS BUT THEY HAVE
8 PROBLEMS BREATHING OR HAVE HAD CONGESTIVE HEART FAILURE IN
9 THE PAST OR OTHER KINDS OF PROBLEMS, WE SAY THAT'S MOST
10 LIKELY GOING TO BE CONGESTIVE HEART FAILURE. THAT'S FLUID
11 BUILDING UP.
12 OCCASIONALLY, WHEN WE DON'T KNOW, WE HAVE TO DO MORE
13 EXTENSIVE TESTS SUCH AS C.T. SCANNING OR WE CAN HAVE --
14 OCCASIONALLY WE HAVE TO BIOPSY SOMETHING TO FIND OUT WHY IS
15 THAT TOO WHITE. BUT FOR THE VAST MAJORITY OF THE TIME, WHEN
16 WE ARE DEALING WITH THESE TYPES OF PATIENTS, IT'S USUALLY
17 CONGESTIVE HEART FAILURE OR IT'S PNEUMONIA.
18 Q. SO IN THIS CASE, BASED ON WHAT YOU FOUND IN YOUR REPORT,
19 WHAT YOU CAN TELL US IS THAT YOU DEFINITELY FOUND SOME FLUID
20 IN THAT SPACE BETWEEN THE CHEST WALL AND THE LUNGS, CORRECT?
21 A. CORRECT.
22 Q. AND THEN IT WAS NECESSARY TO DO SOME CLINICAL
23 CORRELATION TO AT LEAST DETERMINE FROM THE SYMPTOMS WHAT
24 SIGNIFICANCE, IF ANY, THAT EFFUSION PROCESS HAD; IS THAT
25 RIGHT?
1839
1 A. THAT'S CORRECT.
2 Q. IN FACT, AS YOU'VE DESCRIBED IT BASED UPON YOUR REPORT,
3 YOU THOUGHT THAT THIS WAS ESSENTIALLY A MILD CONDITION; IS
4 THAT CORRECT?
5 A. CORRECT.
6 Q. AND IT'S TRUE, IS IT NOT, THAT THERE MAY BE NO CLINICAL
7 SIGNIFICANCE OR NO CLINICAL SYMPTOMATOLOGY THAT ARISES WITH
8 RESPECT TO THE FINDING THAT IS REFLECTED IN YOUR REPORT; IS
9 THAT RIGHT?
10 A. THAT IS TRUE.
11 Q. WE JUST DON'T KNOW, BUT WE NEED TO OBSERVE THE PATIENT
12 TO DETERMINE WHAT MIGHT DEVELOP, IF ANYTHING?
13 A. CORRECT.
14 Q. ALL RIGHT. I WANT YOU TO GET CREDIT. JUST DATE THIS
15 AND PUT YOUR NAME ON IT, PLEASE. THANK YOU. YOU MAY RESUME
16 THE WITNESS STAND.
17 A. OKAY.
18 Q. NOW, DOCTOR, THE OTHER REPORT -- THE OTHER REPORT THAT
19 YOU TESTIFIED CONCERNING WAS THE REPORT INVOLVING THE C.T.
20 SCAN WHICH YOU DID ON 12/26/1995 OF PATIENT JUDITH LARSEN.
21 DO YOU REMEMBER THAT ONE?
22 A. CORRECT.
23 Q. DO YOU HAVE YOU THAT IN FRONT OF YOU?
24 A. I DO HAVE THAT IN FRONT OF ME.
25 Q. NOW, ON THAT REPORT IT'S TRUE THAT WHAT YOU HAD
1840
1 CONCLUDED FROM THE C.T. SCAN WAS THAT THERE WAS NO ACUTE
2 HEMORRHAGE FINDING; IS THAT RIGHT?
3 A. THAT'S CORRECT.
4 Q. BUT IT'S ALSO TRUE, IS IT NOT, THAT YOU COULD NOT RULE
5 OUT, BASED UPON WHAT YOU DID, A SUBACUTE PROCESS WHICH MIGHT
6 VERY WELL HAVE BEEN A CEREBROVASCULAR ACCIDENT; IS THAT
7 CORRECT?
8 A. THAT'S CORRECT.
9 Q. AND IT'S TRUE, AS YOU TOLD THE JURY, THAT YOU ALSO NOT
10 ONLY COULDN'T RULE THAT OUT, BUT YOU COULDN'T PRECISELY TELL
11 WHEN THAT EVENT, IF IT IN FACT OCCURRED, OCCURRED; IS THAT
12 RIGHT?
13 A. ARE YOU TALKING ABOUT THE --
14 Q. THE SUBACUTE PROCESS.
15 A. RIGHT.
16 Q. IN OTHER WORDS, I THINK YOUR TESTIMONY WAS THAT ALL YOU
17 KNOW IS THAT THE PROCESS THAT YOU AT LEAST OBSERVED,
18 TYPICALLY YOU WOULD ASSOCIATE WITH SOMETHING THAT WOULD
19 MANIFEST ITSELF 12 HOURS AFTER THE EVENT AND THEN SOMETIME
20 LATER; IS THAT RIGHT?
21 A. CORRECT.
22 Q. SO FOR -- I'M SORRY. I DON'T MEAN TO INTERRUPT.
23 THE COURT: WERE YOU DONE WITH YOUR ANSWER?
24 THE WITNESS: NO. I WAS GOING TO EXPLAIN A LITTLE
25 BIT MORE ABOUT THIS PARTICULAR REPORT. THERE'S A MULTITUDE
1841
1 OF FINDINGS AND SOME OF THOSE FIT YES AND NO AND SOME OF
2 THEM DON'T. FOR EXAMPLE, THERE IS EVIDENCE OF ATROPHY, THE
3 SMALL VESSEL ISCHEMIC DISEASE, AND THOSE AREAS ARE AREAS
4 THAT ARE LOW DENSITY THAT LOOK MORE CHRONIC. THOSE ARE
5 CHRONIC FINDINGS THAT WE THINK HAVE BEEN THERE FOR A WHILE.
6 THE ONE THAT'S KIND OF SUBACUTE IS THE LUXURY PROFUSION
7 THING WE'RE TALKING ABOUT IN THE FRONTAL LOBE. THAT ONE WE
8 DON'T KNOW. THAT'S ONE WHAT YOU ARE TALKING ABOUT WITH
9 REGARD TO THE COULD HAVE HAPPENED WITHIN THE LAST 12 HOURS,
10 NOT SURE, AND THE CLINICAL CORRELATION THAT WE'VE TALKED
11 ABOUT.
12 Q. RIGHT. ONCE AGAIN, IT'S IMPORTANT FOR A PHYSICIAN TO
13 ACTUALLY MAKE CLINICAL FINDINGS TO ASSIST IN DETERMINING
14 WHETHER OR NOT WE HAD A SUBACUTE EVENT; IS THAT RIGHT?
15 A. THAT'S CORRECT.
16 Q. NOW, I LOOKED AT THAT REPORT. I COULDN'T FIND A TIME
17 WHEN IT ACTUALLY WAS DONE. CAN YOU TELL FROM THAT REPORT?
18 A. NO, I CAN'T.
19 Q. THE TIME --
20 A. I CAN TELL WHEN IT WAS TYPED, BUT I CAN'T TELL WHEN IT
21 WAS PERFORMED.
22 Q. ARE YOU AWARE, AS YOU SIT HERE TODAY, THAT YOU WERE
23 ASKED TO DO THIS SCAN IN RESPONSE TO A SEIZURE EVENT WITH
24 RESPECT TO THIS PATIENT?
25 A. NO. I'M QUITE CERTAIN THAT ALL OF THE INFORMATION I HAD
1842
1 IS THERE ON THAT CLINICAL HISTORY. PSYCHOSIS, RULE OUT
2 BLEED. USUALLY, IF I HAVE MORE INFORMATION THAN THAT, I'LL
3 DICTATE THAT INTO THE REPORT.
4 Q. OKAY.
5 A. SO I'M QUITE CERTAIN I WAS UNAWARE OF A SEIZURE.
6 MR. STIRBA: ALL RIGHT. THANK YOU, DOCTOR. THAT'S
7 ALL I HAVE.
8 THE COURT: ANYTHING, MR. MAJOR?
9 REDIRECT EXAMINATION
10 BY MR. MAJOR:
11 Q. GOING BACK TO MR. ALLDREDGE, DOCTOR, WE TALKED ABOUT
12 THIS PROBLEM WITH THE WATER IN THE LUNGS. IS THAT USUALLY A
13 CONDITION THAT WAS TREATABLE?
14 A. YES. GIVEN THE FACT THAT MOST OF THEM ARE EITHER
15 PNEUMONIA OR CONGESTIVE HEART FAILURE, BOTH OF THOSE ARE
16 USUALLY TREATABLE CONDITIONS.
17 Q. ONE OF THE REASONS YOU DO THESE IS TO GIVE THE PHYSICIAN
18 SOME HELP IN EVALUATING THE PATIENT; IS THAT CORRECT?
19 A. THAT'S CORRECT.
20 Q. ARE YOU AWARE -- BASED ON YOUR TRAINING AND EXPERIENCE,
21 ARE THERE CERTAIN MEDICATIONS THAT CAN EXACERBATE THE
22 CONDITION MR. ALLDREDGE HAD?
23 MR. STIRBA: YOUR HONOR, I'M GOING TO OBJECT.
24 EXPERT OPINION.
25 THE COURT: SUSTAINED.
1843
1 MR. MAJOR: WE HAVE NO FURTHER QUESTIONS, YOUR
2 HONOR.
3 THE COURT: MAY THIS WITNESS BE EXCUSED?
4 MR. MAJOR: HE MAY, YOUR HONOR.