Prosecution Closing Argument
12 MR. WILSON: HEAVEN FORBID, YOUR HONOR.
13 IF IT PLEASE THE COURT, COUNSEL, LADIES AND GENTLEMEN
14 OF THE JURY. BEFORE I BEGIN MY INITIAL CLOSING STATEMENT, I
15 WOULD LIKE TO TAKE AN OPPORTUNITY TO THANK YOU ON BEHALF OF
16 MYSELF AND MY STAFF AND THOSE ATTORNEYS WHO ASSISTED US IN
17 THIS TRIAL PROCEEDING. YOU'VE BEEN EXTREMELY ATTENTIVE
18 THROUGHOUT THIS LONG AND ARDUOUS PROCESS AND I'M VERY
19 APPRECIATIVE OF THAT FACT AND THE FACT THAT YOU HAVE DONE
20 SO. AND AT THIS TIME WHEN WE FINISH ARGUING, THE CASE WILL
21 BE TURNED OVER TO YOU SO YOU CAN COMPLETE YOUR SERVICE IN
22 THIS MATTER. I'M VERY CONFIDENT AND RESPECTFUL OF THE
23 DIGNITY THAT YOU'VE CONDUCTED YOURSELVES HEREIN.
24 I THINK THE FIRST THING THAT YOU NEED TO UNDERSTAND IS
25 THAT THIS DEFENDANT STANDS BEFORE YOU ACCUSED OF THE CRIME
4381
1 OF FIVE COUNTS OF MURDER. UNDER THE LAWS OF THE STATE OF
2 UTAH AND THE LAWS OF JURISDICTION THROUGHOUT THIS NATION, WE
3 RECOGNIZE THE CONCEPT AND HAVE LONG RECOGNIZED THAT THROUGH
4 THE HISTORY OF THIS WORLD THAT IT IS UNLAWFUL TO TAKE THE
5 LIFE OF ANOTHER HUMAN BEING. NOW, WE'VE CHARGED -- THE
6 STATE OF UTAH HAS CHARGED THIS DEFENDANT WITH THE UNLAWFUL
7 TAKING OF THE LIFE OF FIVE HUMAN BEINGS; THOSE INDIVIDUALS
8 BEING ELLEN ANDERSON, JUDITH LARSEN, MARY CRANE, LYDIA SMITH
9 AND ENNIS ALLDREDGE.
10 NOW, YOU'VE SAT THROUGH THE PROCEEDINGS HERE AND YOU'VE
11 HEARD THE EVIDENCE. AND I'M GOING TO INDICATE TO YOU WHAT
12 THE THEORY OF THE STATE'S CASE IS AND HAS BEEN FROM THE VERY
13 START. IT'S OUR CONTENTION THAT THE DEFENDANT, WITH THE
14 EXCEPTION OF ELLEN ANDERSON, THE FIRST DEATH, ENGAGED IN A
15 PROCESS OF ACTIVE EUTHANASIA. I THINK YOU ALL KNOW WHAT
16 EUTHANASIA IS. AND EUTHANASIA IS ANOTHER FORM OF THE
17 UNLAWFUL TAKING OF A HUMAN LIFE. IN THIS PARTICULAR CONTEXT
18 IT WAS DONE IN A HOSPITAL SETTING.
19 AS TO ELLEN ANDERSON, THE STATE'S POSITION IS THAT HER
20 DEATH RESULTED FROM THE DEFENDANT'S CONDUCT IN ADMINISTERING
21 MORPHINE TO HER WHICH IN A MANNER EVIDENCED DEPRAVED
22 INDIFFERENCE TO ELLEN ANDERSON CREATING A GRAVE RISK OF
23 DEATH AND THEREBY CAUSED HER DEATH. THAT'S THE SECOND PRONG
24 OF THE ELEMENTS IN EACH COUNT THAT THIS DEFENDANT IS CHARGED
25 WITH.
4382
1 NOW, AS I'VE INDICATED, WE'VE HAD AN OPPORTUNITY FOR
2 THESE PAST FOUR OR FIVE WEEKS FOR YOU TO HEAR THE EVIDENCE
3 IN SUPPORT OF THE STATE'S POSITION AS TO WHY WE BELIEVE THE
4 FACTS DEMONSTRATE BEYOND A REASONABLE DOUBT THAT THIS
5 DEFENDANT DID INDEED COMMIT THESE CRIMES. BEFORE WE TALK
6 ABOUT THE CRIMES THEMSELVES AND THE SPECIFIC CONDUCT LEADING
7 UP TO THAT, THOUGH, I THINK WE NEED TO DISCUSS THE SETTING,
8 IF YOU WILL, THE CRIME SCENE IN THIS PARTICULAR MATTER.
9 AS YOU'LL RECALL, EARLY IN THE PROCEEDINGS WE PRODUCED
10 WITNESSES WHO TALKED ABOUT HOW THIS GEROPSYCHIATRIC UNIT WAS
11 ESTABLISHED AND THE PURPOSE FOR WHICH IT WAS ESTABLISHED.
12 IF YOU'LL REMEMBER RIGHT, THERE WAS TESTIMONY FROM TODD
13 CHAMBERS TO THAT EFFECT WHO INITIALLY ASSISTED IN THE
14 ESTABLISHMENT OF THE GEROPSYCH UNIT. NOW, THE CONCEPT IS A
15 GOOD CONCEPT. IT WAS ESTABLISHED FOR THE PURPOSE OF HELPING
16 THOSE INDIVIDUALS, PARTICULARLY ELDERLY INDIVIDUALS, WHO
17 WERE EXPERIENCING DIFFICULTIES IN TERMS OF ACTING OUT IN A
18 VARIETY OF FASHIONS AND IN THE PARTICULAR SETTINGS THAT THEY
19 WERE HOUSED IN, PRIMARILY NURSING HOME FACILITIES. AND IT
20 WAS A PURPOSE TO ADJUST THEIR MEDICATIONS TO ASSIST THEM IN
21 MIND-ALTERING PROCESS THAT WOULD GIVE THEM A BETTER QUALITY
22 OF LIFE. NOW, IT'S A PSYCHIATRIC SETTING. IT'S NOT A
23 HOSPICE SETTING. IT'S NOT A CRITICAL CARE UNIT. IT WAS A
24 PSYCHIATRIC SETTING. IT WAS MORE FROM A STANDPOINT OF BEING
25 ABLE TO MONITOR THESE PATIENTS BECAUSE IT WAS PRECISELY THE
4383
1 REASON THAT THESE INDIVIDUALS WERE GOING TO THAT UNIT.
2 YOU HEARD FROM THE TESTIMONY OF WELBY JENSEN WHO WAS
3 THE INITIAL MEDICAL DIRECTOR OF THE UNIT AS TO THE FACT THAT
4 ONE OF THE THINGS THAT WAS SO PLEASING OR SO VALUABLE TO HIM
5 IN THIS CONTEXT WAS THE FACT THAT THIS UNIT WAS NOT HOUSED
6 SEPARATELY AND APART FROM THE HOSPITAL, BUT WAS WITHIN THE
7 CONFINES OF THE HOSPITAL. AND THE REASON THAT IT WAS WITHIN
8 THE CONFINES OF THE HOSPITAL AND THE REASON HE LIKED THAT
9 SETUP WAS BECAUSE HE DID NOT HAVE TO WORRY ABOUT ADDRESSING
10 THE OTHER MEDICAL PROBLEMS THAT MAY BE ASSOCIATED WITH THE
11 CARE OF THESE INDIVIDUALS, THAT THEY HAD RIGHT THERE IN THE
12 HOSPITAL AN INTERNIST AND OTHER MEDICAL SPECIALISTS WHO
13 COULD DEAL WITH ANY KIND OF MEDICAL PROBLEM THAT THESE
14 INDIVIDUALS MAY BE EXPERIENCING WHILE IN THAT PARTICULAR
15 SETTING, AND IT FREED HIM UP TO CONCENTRATE ON HIS
16 SPECIALTY, THAT SPECIALTY BEING THE TREATMENT OF THE MENTAL
17 PROBLEMS OF THESE PATIENTS. THAT LADIES AND GENTLEMEN, WAS
18 THE PURPOSE OF THIS UNIT.
19 LET'S TALK A LITTLE BIT ABOUT NOW THE CHARACTERISTICS
20 OF THE PATIENTS WHO WERE ADMITTED TO THAT UNIT, AND EACH ONE
21 OF THESE FIVE INDIVIDUALS EXHIBITED THOSE CHARACTERISTICS.
22 WE KNOW THAT THEY WERE PEOPLE WHO WERE EXPERIENCING
23 PRIMARILY BEHAVIORAL PROBLEMS. THEY WERE BROUGHT INTO THAT
24 UNIT TO STABILIZE THEIR SITUATION. BUT IT WAS VERY CLEAR
25 THAT ONE OF THE CRITERIA THAT EXISTED ON THE UNIT WAS THE
4384
1 FACT THAT THEY COULD NOT BE SUFFERING FROM ANY ACUTE OR
2 LIFE-THREATENING ILLNESSES. THAT WAS ONE OF THE CRITERIA.
3 SO WHEN THESE PATIENTS WERE ADMITTED AND FIT THAT CRITERIA,
4 THERE WAS A PROCESS THAT THEY WENT THROUGH TO ENSURE THAT
5 THEY WERE FIT FOR THE PURPOSES OF THAT UNIT. AND IT WAS A
6 FUNDAMENTAL PROCESS THAT THEY WENT THROUGH. THEY HAVE TO BE
7 EVALUATED. THEY WERE TO BE EVALUATED PHYSICALLY BY AN
8 INTERNIST. THEY HAVE TO BE EVALUATED BY THE PSYCHIATRIST
9 AND ASSESSED AS TO THEIR MENTAL STATUS AND THEY WERE TO BE
10 RAN THROUGH VARIOUS TESTING PROCEDURES TO DETERMINE JUST
11 EXACTLY WHAT THEIR PHYSICAL SITUATION WAS. WHY? LADIES AND
12 GENTLEMEN, I WOULD SUBMIT TO YOU THERE'S A VARIETY OF
13 REASONS. ONE OF THOSE REASONS BEING THEY WANTED TO
14 ELIMINATE POSSIBLE PHYSICAL PROBLEMS THAT MIGHT BE
15 ASSOCIATED WITH THE MENTAL PROBLEMS THESE PEOPLE WERE HAVING
16 WITH THE BURIAL PROBLEMS, IF YOU WILL.
17 PUT YOURSELF IN THEIR SHOES, THOUGH. YOU ARE SITTING
18 IN A NURSING HOME SETTING, AND I THINK MOST OF YOU HAVE
19 PROBABLY HAD EXPERIENCE WITH LOVED ONES WHO HAVE BEEN PLACED
20 IN THAT TYPE OF A SETTING WHERE THEY ARE SUFFERING FROM THE
21 DISEASE PROCESS OF OLD AGE AND THEY ARE HAVING VARIOUS
22 STAGES OF DEMENTIA, PROGRESSION OF DEMENTIA, THEY ARE NOT
23 REMEMBERING THINGS, THEY ARE NOT ORIENTATED TO TIME AND
24 PLACE, THEY CAN'T ARTICULATE, THEY CAN'T DRESS THEMSELVES,
25 MANY OF THEM ARE INCONTINENT, THEY ARE SUFFERING FROM THESE
4385
1 DISEASES OF DEGENERATION OF AGE, CAN YOU IMAGINE IF YOU ARE
2 MOVED FROM A SETTING THAT YOU ARE FAMILIAR IN TO A NEW
3 SETTING, THE CONFUSION, THE FEAR THAT THAT WOULD INSPIRE IN
4 THOSE INDIVIDUALS? AND I WOULD SUBMIT TO YOU THAT IN EACH
5 ONE OF THESE INSTANCES THERE WAS EVIDENCE OF THAT CONFUSION,
6 THAT INABILITY TO UNDERSTAND.
7 I GUESS IF I CAN LIKEN IT TO ANYTHING I WOULD LIKEN IT
8 TO A SMALL CHILD. I THINK ELLEN ANDERSON'S CASE IS A GOOD
9 DESCRIPTION, BECAUSE AS YOU RECALL, THE TESTIMONY OF JAY
10 POHLMAN AND BARBARA POHLMAN WHEN THEY WERE TALKING ABOUT
11 LEAVING HER AND SHE IS CALLING OUT TO THEM AND THAT'S WHEN
12 SHE BECOMES VERY DISTURBED AT THAT POINT. SHE'S LEFT ALONE.
13 IF YOU TAKE A CHILD AND MAYBE ANY OF YOU HAVE HAD THAT
14 EXPERIENCE WHERE YOU GO PUT THEM IN A SETTING, EVEN IN YOUR
15 OWN HOME WITH A BABY-SITTER SOMETIMES AND YOU LEAVE THEM AND
16 THEY SCREAM AND THEY BECOME VERY AGITATED AND UPSET. THAT'S
17 THE TYPE OF BEHAVIOR YOU SEE EXHIBITED IN THESE PEOPLE.
18 THEN ANOTHER PART OF THAT PARTICULAR SETTING I THINK AND A
19 VERY SIGNIFICANT PART OF THAT SETTING IS THE
20 PHYSICIAN-PATIENT-FAMILY RELATIONSHIP.
21 YOU HEARD TESTIMONY FROM ALL FAMILY MEMBERS WHEN THEY
22 BROUGHT THEIR LOVED ONE TO THIS UNIT FOR PURPOSES OF TRYING
23 TO MODIFY THEIR LIFE THEY WOULD ACT MORE APPROPRIATELY IN
24 THE NURSING HOME SETTING. DO YOU THINK IT EVER CROSSED
25 THEIR MIND THAT THEY WERE GOING TO DIE IN THIS SETTING? DO
4386
1 YOU THINK THAT WAS SOMETHING THAT YOU WOULD ORDINARILY LOOK
2 AT IN A PSYCHIATRIC SETTING WHERE YOU ARE BRINGING YOUR
3 FAMILY MEMBER TO IT FOR TREATMENT? I THINK NOT. THEY ALSO
4 BROUGHT THEM INTO A SETTING WHERE THEY ARE IN A HOSPITAL.
5 THERE'S OTHER FACILITIES AND OTHER MEDICAL UNITS AVAILABLE
6 AND THEY HAVE A PSYCHIATRIST WHO'S IN CHARGE OF THIS
7 PARTICULAR UNIT, AND THEY ARE ASSURED, I'M SURE, THAT THEIR
8 LOVED ONES ARE GOING TO BE WELL TAKEN CARE OF IN THIS
9 CONTEXT AND UNDERSTANDABLY SO.
10 NOW, THEY DO NOT HAVE THE SPECIAL KNOWLEDGE THAT A
11 PHYSICIAN HAS. THEY DO NOT HAVE THE SPECIAL KNOWLEDGE THAT
12 A NURSE HAS IN A GEROPSYCH UNIT. THEY ENTRUST THEIR LOVED
13 ONE TO THE CARE. AND WHAT IS THE STATUS OF THAT LOVED ONE?
14 THAT STATUS OF THAT LOVED ONE IS TRULY AS A RESULT THAT
15 PERSON WHO HAS NO ABILITY WHATSOEVER TO EVEN BEGIN TO ASSESS
16 OR EVALUATE THE CARE THAT'S BEING ADMINISTERED TO THEM.
17 THERE IS THREE AREAS THAT I WANTED TO GO OVER WITH YOU
18 THAT I THINK DEMONSTRATE THE FACTUAL ELEMENTS OF EACH COUNT
19 IN THIS CASE. THE FIRST AREA THAT WE WANT TO TALK ABOUT IS
20 KNOWLEDGE. WHAT KNOWLEDGE DOES THE PHYSICIAN, THE TREATING
21 PHYSICIAN, HAVE IN RESPECT TO THESE PARTICULAR PATIENTS?
22 THERE'S SOME GENERAL CONCEPTS THAT I WOULD LIKE TO REVIEW
23 WITH YOU THAT YOU WERE TAUGHT IN TERMS OF THE TESTIMONY THAT
24 WAS GIVEN IN PARTICULAR BY DR. FEHLAUER. AND I THINK WE
25 NEED TO REVIEW THOSE SO THAT WHEN YOU GET AROUND TO
4387
1 EVALUATING THE EVIDENCE IN THIS PARTICULAR SETTING, YOU CAN
2 DETERMINE BY THAT EVIDENCE, NUMBER ONE, WHAT THE RISK WAS,
3 THE GRAVE RISK OF DEATH, AND, NUMBER TWO, WHAT KNOWLEDGE DID
4 THIS PHYSICIAN HAVE OR SHOULD HAVE HAD IN ADMINISTERING
5 THESE TYPES OF MEDICATIONS TO THESE PATIENTS IN THE MANNER
6 IN WHICH THEY WERE ADMINISTERED?
7 AS YOU RECALL, DR. FEHLAUER TALKED ABOUT A NUMBER OF
8 DRUGS THAT YOU ARE FAMILIAR WITH HERE. AND I POINT OUT TO
9 YOU -- USE THIS POINTER -- IF YOU'LL REMEMBER THIS
10 PARTICULAR EXHIBIT, THERE WAS, AS HE REFERENCED HERE, THE
11 VARIOUS DRUGS, MORPHINE SULFATE, TRAZODONE, BUSPAR. BUT AS
12 HE WENT DOWN THROUGH THESE DRUGS HE SHOWED YOU WHAT WAS THE
13 RECOMMENDED ADULT STARTING DOSE WHICH HE OBTAINED FROM THE
14 1995 PHYSICIANS DESK REFERENCE.
15 HE ALSO TESTIFIED TO YOU AS TO WHAT THE RECOMMENDED
16 ELDERLY STARTING DOSE WAS WHICH HE HAD OBTAINED FROM THE
17 GERIATRIC DOSAGE HANDBOOK. AND IF YOU'LL LOOK THROUGH THESE
18 PARTICULAR DRUGS YOU SEE THAT ALL OF THE ONES LISTED HAVE
19 WHAT WE CALL CENTRAL NERVOUS SYSTEM DEPRESSANT QUALITIES TO
20 THEM. AND HE'S INDICATED AS TO THE -- IN PARTICULAR THE
21 PAIN KILLING DRUGS MORPHINE SULFATE.
22 HE'S INDICATED THAT IN AN ELDERLY PERSON A STARTING
23 DOSE, WHICH I THINK IS SIGNIFICANT FOR YOU TO REMEMBER, 2.5
24 MILLIGRAMS INTRAMUSCULARLY EVERY FOUR TO SIX HOURS AS
25 NEEDED. HE WENT DOWN THROUGH EACH ONE OF THESE DRUGS AND AS
4388
1 I LOOK THROUGH THERE, AND I WOULD WANT TO CALL YOUR
2 ATTENTION TO A COUPLE THAT RING PARTICULARLY IMPORTANT IN
3 THIS CASE. HALDOL, WHICH IS A PSYCHOTROPIC MEDICATION AND
4 AN ANTIPSYCHOTIC DRUG. HALDOL, THE RECOMMENDED DOSAGE FOR
5 AN ADULT CAN BE UP TO 15 MILLIGRAMS PER DAY STARTING. BUT
6 LOOK WHAT IT CHANGES TO IN AN ELDERLY PERSON .25 TO .5
7 MILLIGRAMS BY MOUTH ONE TO TWO TIMES PER DAY. ONE MILLIGRAM
8 PER DAY MAXIMUM STARTING. ONE MILLIGRAM.
9 THE GENERAL THEME THAT YOU SEE IN ALL OF THESE DRUGS
10 FOR THE ELDERLY, IT'S CONSISTENT ACROSS THE BOARD, THAT IF
11 YOU ARE DEALING WITH AN ELDERLY PERSON YOU DEAL IN VERY
12 CONSERVATIVE DOSAGES. YOU DON'T START WITH REGULAR STARTING
13 ADULT DOSAGES. THIS IS SOMETHING THAT I WOULD SUBMIT A
14 PERSON HOLDING THEMSELVES OUT AS A GERIATRIC PSYCHIATRIST
15 WHO SPECIALIZED IN THAT FIELD WOULD KNOW.
16 NOW, I POINT YOU TO ANOTHER EXHIBIT AND, AGAIN, THIS
17 WAS REFERENCED IN DR. FEHLAUER'S TESTIMONY, AND WE TALK
18 ABOUT THE GENERAL CONSENSUS OF HALF LIFE AND DURATION OF
19 EFFECT. AND HE'S GONE DOWN THROUGH IN THIS PARTICULAR
20 EXHIBIT AND DEMONSTRATES FOR YOU, NUMBER ONE, HALF LIFE IS
21 DESCRIBED AS THE AMOUNT OF TIME IT TAKES FOR THE BLOOD
22 CONCENTRATION OF A DRUG TO DECREASE BY 50 PERCENT. I THINK
23 YOU'VE HEARD ENOUGH ABOUT HALF LIFE. DURATION OF EFFECT,
24 HOWEVER, IS THE AMOUNT OF TIME IN HOURS THAT THE DRUG HAS
25 ACTIVITY IN THE BODY. YOU'LL NOTE THAT IN EACH ONE OF THE
4389
1 AREAS PHYSIOLOGICALLY THAT WE HAVE DEFINED HERE, DRUG
2 METABOLISM, DRUG EXCRETION, PROTEIN BINDING, LEAN BODY MASS,
3 FAT BODY MASS, BUT EACH ONE OF THOSE PARTICULAR
4 PHYSIOLOGICAL CHARACTERISTICS CREATES DIFFERENT EFFECTS IN
5 THE ELDERLY. THIS IS SOMETHING YOU NEED TO KNOW, SHOULD
6 KNOW, AND A PHYSICIAN HOLDING HIMSELF OUT AS A SPECIALIST
7 GERIATRIC PSYCHIATRIST WOULD KNOW, THAT THE EFFECTS ON DRUGS
8 IN THE ELDERLY GENERALLY SPEAKING IS GOING TO BE THAT THE
9 DURATION OF EFFECT IS LONGER. IT'S LONGER.
10 I LOOK AT IT AS BEING SORT OF A STAIRCASE. I THINK
11 THAT'S THE BEST DESCRIPTION I CAN DESCRIBE TO YOU AS YOU
12 TAKE AN INDIVIDUAL, YOU GIVE HIM DRUGS. AND THE DURATION
13 YOU HAVE, THAT EFFECT, IT DROPS THEM DOWN A STEP. BEFORE
14 THEY CAN TAKE THAT STEP BACK UP, IF YOU GIVE THEM MORE
15 DRUGS, IT DROPS THEM DOWN ANOTHER STEP UNTIL YOU CONTINUE TO
16 HAVE THE STEP DOWNS TO THE POINT THAT THE PATIENT CAN NO
17 LONGER GET BACK UP THE STEPS. OKAY.
18 WE THEN RELATE THE DRUGS IN THE PREVIOUS EXHIBIT TO THE
19 PHARMACOLOGY IN THE ELDERLY. IN ADDITION TO THE DOSAGE
20 AMOUNTS, NOW WE FIND OUT THAT PHARMACOLOGY FOR MORPHINE
21 SULFATE, THE DURATION OF ACTION MAY BE PROLONGED IN THE
22 ELDERLY. AND AS WAS AGREED BY I THINK EVERY EXPERT THAT
23 TESTIFIED THAT ELDERLY GENERALLY HAVE MORE SUSCEPTIBLITY TO
24 CENTRAL NERVOUS SYSTEM DEPRESSANT EFFECTS OF THAT NARCOTICS.
25 LOOK AT THE DRUGS. TRAZODONE, VERY SEDATING. ATIVAN, THIS
4390
1 ONE IS PREPARED FOR THE ELDERLY. HALDOL, LOOK AT SIDE FOR
2 SPECIAL CONSIDERATION, INCREASED CONFUSION, MEMORY LOSS,
3 PSYCHOTIC BEHAVIOR, AGITATION, SEDATION, THESE ARE ALL SIDE
4 EFFECTS OF THESE VARIOUS DRUGS, LADIES AND GENTLEMEN OF THE
5 JURY. AND THIS HALDOL HAS A HALF LIFE 20 TO 40 HOURS AND
6 MAY BE PROLONGED IN THE ELDERLY.
7 EVERY EXPERT TESTIFIED CONSISTENTLY THAT IF YOU ADD
8 CENTRAL NERVOUS SYSTEM DEPRESSANT ON THE CENTRAL NERVOUS
9 SYSTEM DEPRESSANTS YOU HAVE THE ADMINISTRATIVE EFFECT. YOU
10 HAVE THE ADDED EFFECT, A RISK THAT IS KNOWN BY A GERIATRIC
11 PSYCHIATRIST WHO HELD HIMSELF OUT AS A SPECIALIST.
12 DR. HARE ALSO TESTIFIED AS TO A COUPLE OF EXHIBITS,
13 FIRST OF ALL, THAT HE'D PREPARED AS IT RELATED TO THE
14 CENTRAL NERVOUS SYSTEM DEPRESSANTS. NOW, THESE ARE -- THIS
15 WAS PREPARED IN RESPECT TO THE PSYCHOTROPIC MEDICATIONS, THE
16 TRAZODONE AND HALDOL. SOME OF THESE PARTICULAR DRUGS THAT
17 RELATE TO THAT HAVE THE QUALITIES OF CENTRAL NERVOUS SYSTEM
18 DEPRESSANTS. BUT THE IMMEDIATE EFFECTS, SLEEPINESS, COMA,
19 DECREASED BREATHING, ASPIRATION, DECREASED BLOOD PRESSURE,
20 DECREASED FOOD AND WATER INTAKE, NOW AS HE TESTIFIED, THE
21 DECREASED FOOD AND WATER INTAKE OBVIOUSLY IS A SECONDARY
22 EFFECT AS A RESULT OF THE INDIVIDUAL. WHEN AN INDIVIDUAL IS
23 IN A COMA, THERE IS NO WAY THEY ARE GOING TO TAKE WATER OR
24 FOOD. THE LONG-TERM EFFECT AS RESULTING FROM THE DRUGS AND
25 THE INTERACTION OF THE DRUGS WITH THE VARIOUS FUNCTIONS OF
4391
1 THE BODY ARE DECREASED OXYGEN TO THE BRAIN, THE HEART, THE
2 KIDNEYS, THE REDUCED ORGAN FUNCTION, EVENTUALLY RESULTING IN
3 ORGANIC DAMAGE, DEHYDRATION AND INCREASED SENSITIVITY TO
4 DRUG EFFECTS AND PNEUMONIA. THE DRUG OF CHOICE HERE FOR THE
5 CARE AS IT'S ALLEGEDLY DONE IS THE PAIN RELIEF IS AN
6 IMMEDIATE EFFECT OF MORPHINE. THAT'S THE RELIEF.
7 BUT DO YOU RECALL HARE'S TESTIMONY? YOU DON'T USE
8 MORPHINE EXCEPT IN THE CONTEXT OF TALK ABOUT CHRONIC PAIN.
9 HE TALKED ABOUT SEVERE PAIN. HE TALKED ABOUT POST-OPERATIVE
10 PAIN. WE'RE NOT TALKING ABOUT THE ORDINARY DAY TO DAY PAIN
11 THAT SO MANY OF US EXPERIENCE. MORPHINE IS, AS THEY HAVE
12 TESTIFIED, THE GOLD STANDARD BY WHICH ALL OTHER PAIN DRUGS
13 ARE JUDGED BY. MORPHINE -- AND THEY ALL TESTIFIED TO
14 THIS -- IS RECOGNIZED HAS A POTENTIAL TO CAUSE DEATH. IT
15 CREATES A RISK OF DEATH IN PATIENTS. AND THE MONITORING
16 ASPECT, IF YOU ARE GOING TO ADMINISTER MORPHINE, IS A VERY
17 SIGNIFICANT PART OF THAT PROCESS TO MAKE SURE YOU DO NOT
18 SUBJECT THOSE PATIENTS TO A RISK OF DEATH. AGAIN, YOU HAVE
19 THE SAME SIMILAR TYPES OF LONG-TERM EFFECTS THAT RESULT FOR
20 AN INDIVIDUAL WHO'S ADMINISTERING THE DRUG MORPHINE.
21 AS I INDICATED TO YOU, THE STATE'S POSITION IS, IS THAT
22 THE DEFENDANT CAUSED THE DEATHS OF THESE FIVE PATIENTS,
23 AGAIN, WITH THE USE OF THESE CENTRAL NERVOUS SYSTEM
24 DEPRESSANT DRUGS BY ADMINISTERING THEM IN SUCH QUANTITIES
25 AND IN SUCH A MANNER THAT IT CREATED THE DEATH OF EACH AND
4392
1 EVERY ONE OF THESE PATIENTS.
2 NOW, WE'VE TALKED A LITTLE BIT ABOUT KNOWLEDGE,
3 KNOWLEDGE THAT THIS -- A PHYSICIAN HAS AND KNOWLEDGE OF THE
4 RISK CREATED BY THE ADMINISTRATION OF THESE DRUGS. LET'S
5 NOW TALK ABOUT CAUSATION. I WOULD SUBMIT THAT IN EACH ONE
6 OF THESE CASES, AGAIN WITH THE EXCEPTION OF ELLEN ANDERSON,
7 THAT YOU SEE A PATTERN OF CONDUCT WHERE THE DOCTOR ENGAGES
8 IN A PROCESS WHERE HE ESSENTIALLY BLASTS EACH PATIENT WITH
9 THE ADMINISTRATION OF THESE PSYCHOTROPIC MEDICATIONS WHICH
10 CREATE THE EFFECTS THAT WE'VE SEEN AS TESTIFIED TO BY
11 DR. HARE WHICH WEAKENED THE INDIVIDUALS' SYSTEM TO THE POINT
12 THAT THEY APPEARED TO BE DYING. AND THEN, LADIES AND
13 GENTLEMEN, THEN IN MOST INSTANCES -- NOT ALL, BECAUSE THERE
14 ARE SOME VARIATIONS ON THAT THEME -- BUT IN MOST INSTANCES
15 THE PATIENT'S DEATH IS THEN CAUSED AS A RESULT OF THE
16 ADMINISTRATION OF MORPHINE. THAT'S WHAT CAUSED THE DEATHS.
17 THAT IS WHAT HAS BEEN TESTIFIED TO BY DR. HARE, BY
18 DR. FEHLAUER, AND BY DR. CROOKSTON. THEY ARE ALL CONSISTENT
19 IN THEIR TESTIMONY AS TO MORPHINE IN COMBINATION WITH THESE
20 OTHER DRUGS. IN SOME INSTANCES WAS THE PRIMARY ACT OF
21 DEATH.
22 AS YOU RECALL, DR. HARE TESTIFIED TO ESSENTIALLY WHAT
23 HAPPENED WITH A MORPHINE-INDUCED DEATH. THEY STOP
24 BREATHING, THEY FORGET HOW TO BREATHE, THE CENTRAL NERVOUS
25 SYSTEM IN THE BACK PART OF THE SPINE IS DEPRESSED SO THAT IT
4393
1 NO LONGER SIGNALS THE BRAIN TO ACTIVATE THE BREATHING
2 PROCESS AND YOU DIE.
3 LET'S TALK ABOUT ELLEN ANDERSON. I HAVE ILLUSTRATIVE
4 AIDS HERE THAT I PREPARED FOR YOU IN CONNECTION WITH THESE
5 CHARTS. THIS PART HERE DEALS WITH THE ADMINISTRATION OF THE
6 MORPHINE ELLEN ANDERSON RECEIVED. THIS CHART OVER HERE IS A
7 DEFINITION OF THE SCALE BY WHICH WE PREPARED ELLEN
8 ANDERSON'S LEVEL OF ACTIVITY, ALERTNESS AND AWARENESS IN
9 CONNECTION WITH HER STAY AT THE GEROPSYCH UNIT. YOU'LL NOTE
10 THAT A-3 -- THESE HAVE BEEN REFERENCED OFF PRIMARILY THE
11 NURSING NOTES IN REVIEW OF THE MEDICAL RECORDS WHICH I WILL
12 HAVE IN EVIDENCE. BUT YOU WILL NOTE THAT A-3 MEANS
13 AGITATED. A-1 MEANS LETHARGIC AND UNRESPONSIVE. SO IT'S
14 THE WHITE AREA HERE. THIS YELLOW LINE HERE DENOTES THE TIME
15 THAT SHE WAS ADMITTED.
16 NOW, I WANTED TO TAKE YOU THROUGH ELLEN ANDERSON'S CASE
17 JUST SO THAT YOU CAN SEE THE DEMONSTRATION CHART-WISE AS TO
18 WHAT OCCURRED HERE. YOU'LL RECALL THAT SHE WAS ADMITTED ON
19 DECEMBER 29 AT APPROXIMATELY 4 O'CLOCK. THAT AT THE TIME OF
20 HER ADMISSION SHE WAS ACCOMPANIED BY JAY POHLMAN AND HIS
21 WIFE, THE DAUGHTER OF ELLEN ANDERSON, MARY POHLMAN. YOU'LL
22 RECALL THEIR TESTIMONY TO THE EFFECT THAT THEY REMAINED WITH
23 HER DURING THE ADMISSION PROCESS, THAT SHE WAS WITH THEM
24 THIS TOTAL TIME AND UP UNTIL ABOUT 7:30 IN THE EVENING WHEN
25 THEY WERE TOLD THEY WOULD HAVE TO LEAVE. NOW, YOU'LL RECALL
4394
1 THAT ELLEN ANDERSON, AT LEAST ACCORDING TO JAY POHLMAN, HE'D
2 INDICATED THAT SHE WAS REMARKABLY CALM FOR BEING PUT IN THIS
3 PARTICULAR CIRCUMSTANCE. BUT THAT CALMNESS DISSIPATED AS
4 SOON AS THEY LEFT HER SIDE.
5 IN LOOKING AT THE NURSING NOTES WE SHOW THAT THE
6 DEFENDANT CALLED IN AN ORDER FOR MEDICATIONS AND HE CALLED
7 THAT ORDER IN SOMETIME BEFORE IT WAS NOTED AT -- IT WASN'T
8 NOTED UNTIL 2130 HOURS BY LAURIE WILLSON. BUT THEY HAD
9 BEGUN. APPARENTLY THERE WAS A NOTE FROM LAURIE WILLSON TO
10 THE EFFECT THAT ELLEN ANDERSON APPEARED TO BE IN SEVERE
11 PAIN. NOW, KEEP IN MIND THE TELEPHONE ORDER ITSELF WAS FOR
12 10 MILLIGRAMS OF MORPHINE NOW. NOW, THAT MORPHINE WAS
13 ADMINISTERED TO ELLEN ANDERSON. IT HAPPENS SOMEWHERE AROUND
14 7:30 IN THE EVENING OF HER ADMISSION. IT'S NOTED IN THE
15 RECORD THAT A FEW HOURS LATER SHE SEEMS TO BE RESTING
16 COMFORTABLY.
17 A NURSE SHIFT CHANGE TAKES PLACE AND I THINK IT WAS AT
18 11 O'CLOCK. TRACY SCHOLL COMES ON BOARD AT 11 O'CLOCK AND
19 TRACY SCHOLL AT 1 O'CLOCK IN THE MORNING INDICATES THAT
20 ELLEN ANDERSON'S RESPIRATIONS ARE ERRATIC, BETWEEN 8 TO 16.
21 BUT MORE SIGNIFICANTLY -- OR I SHOULD SAY EQUALLY
22 SIGNIFICANT, HER BLOOD PRESSURE IS DOWN TO 70 OVER 50,
23 EXTREMELY LOW BLOOD PRESSURE AT 1 O'CLOCK IN THE MORNING.
24 THAT CONCERNS HER. THAT CONCERNS HER SO MUCH SHE PAGES
25 DR. WEITZEL.
4395
1 SHE ALSO PAGES -- OR NOT PAGES BUT SHE INFORMS THE
2 NURSE SUPERVISOR OF THAT PARTICULAR PROBLEM. SO WHAT
3 HAPPENS NEXT? WELL, IF YOU LOOK AT JUDITH LARSEN'S RECORD
4 YOU'LL FIND THAT BETWEEN THE HOURS OF 7 O'CLOCK TO I THINK
5 THE LAST PAGE WAS IN THE AREA OF 3 O'CLOCK, THAT DR. WEITZEL
6 IS ALSO BEING PAGED IN CONNECTION WITH JUDITH LARSEN. WHY?
7 BECAUSE SHE'S VOMITING AND SHE SEEMS TO BE VOMITING TIME AND
8 TIME AGAIN. NOW, THAT PROCESS IS GOING ON AT THE SAME TIME
9 THAT WE HAVE THE OTHER PROCESS. THERE IS A TOTAL OF SEVEN
10 PAGES MADE TO DR. WEITZEL BETWEEN THE HOURS OF 7 O'CLOCK IN
11 THE EVENING AND 3 O'CLOCK IN THE MORNING ON THAT PARTICULAR
12 DATE IN CONNECTION WITH JUDITH LARSEN AND IN CONNECTION WITH
13 ELLEN ANDERSON. DR. WEITZEL RESPONDS AT 3:30.
14 NOW, ONE OTHER ITEM OF INTEREST HERE IS THE FACT THAT
15 DR. HARE, WHEN HE REVIEWED THESE RECORDS SAID, THE 1 O'CLOCK
16 NOTATION OF THE MORPHINE OR OF THE BLOOD PRESSURE AND
17 RESPIRATIONS WAS INDICATIVE OF THE TOXIC EFFECT ON ELLEN
18 ANDERSON OF THE MORPHINE. NOW, THIS TAKES PLACE FIVE AND A
19 HALF HOURS AFTER THE INITIAL SHOT. AGAIN, REFERRING YOU
20 BACK TO THE DURATION OF ACTION AND THE EFFECT THAT THESE
21 DRUGS HAVE ON THE ELDERLY.
22 3:30, TRACY SCHOLL TESTIFIES THAT SHE INDEED NOTIFIED
23 DR. WEITZEL NOT ONLY OF THE FACT THAT THE PATIENT WAS NOW
24 APPEARING RESTLESS AGAIN AND AGITATED AND THRASHING, NOW
25 THERE IS NO INDICATION OF PAIN IN THAT PARTICULAR NOTE. BUT
4396
1 SHE DOES INDICATE AGITATION AT THAT JUNCTURE, AND I WOULD
2 SUGGEST ON THE CHART THAT'S THE SPIKE RIGHT HERE. ELLEN
3 ANDERSON IS -- THEN THE DOCTOR ORDERS AN ADDITIONAL 10
4 MILLIGRAMS OF MORPHINE. NOW GO BACK. GO BACK IF YOU WILL
5 TO THE CHART. MAYBE WE SHOULD PUT IT UP HERE. ADULTS
6 STARTING DOSE. ELDERLY STARTING DOSE 2.5 MILLIGRAMS
7 INTRAMUSCULARLY EVERY FOUR TO SIX HOURS AS NEEDED. ON THE
8 LOW END OF THAT SCALE 10 MILLIGRAMS IS FOUR TIMES THE
9 STARTING DOSE FOR ELLEN ANDERSON. FOUR TIMES. WHAT HAPPENS
10 AT 3:30? SHE'S ADMINISTERED ANOTHER 10 MILLIGRAMS OF
11 MORPHINE. 5:30 SHE GOES IN AND APPARENTLY HAS AN E.K.G. AND
12 ALSO AN X-RAY WHICH LATER SHOWS THAT SHE HAD SOME
13 INDICATIONS THAT SHE HAD PNEUMONIA.
14 NOW, I WOULD SUGGEST TO YOU MORPHINE ON TOP OF
15 PNEUMONIA, IF YOU ARE REDUCING THE RESPIRATIONS OF A PERSON
16 WHO'S ALREADY SUFFERING FROM PNEUMONIA, I DON'T THINK IT
17 TAKES TOO MUCH OF AN OBSERVATION TO FIGURE OUT WHAT'S GOING
18 TO HAPPEN THERE. THAT YOU ARE GOING TO INCREASE THE RISK OF
19 DEATH TO THIS PATIENT. INCREASE IT.
20 NOW, WHAT WAS THE NECESSITY OF GIVING ELLEN ANDERSON
21 MORPHINE? ACCORDING TO THE DEFENDANT'S TESTIMONY, THE
22 NECESSITY WAS SHE WAS IN SEVERE PAIN AS REFERENCED BY NURSE
23 LAURIE WILLSON. NOW THE DOCTOR KNEW, AT LEAST HE SAID HE
24 KNEW, THAT SHE HAD BEEN PRESCRIBED LORTAB IN THE PAST FOR
25 HER PAIN. THERE'S A RECORD THAT'S BEEN PUT INTO EVIDENCE
4397
1 FROM THE PIONEER -- I THINK THE PIONEER CARE CENTER AS TO
2 ELLEN ANDERSON. THERE'S A RECORD THAT RELATES TO THE
3 MEDICATIONS THAT SHE WAS PRESCRIBED OR ADMINISTERED WHILE IN
4 THAT CARE CENTER. AND YOU MAY HAVE TO REFERENCE THIS PAGE
5 NOTE. BUT IN THOSE RECORDS IT'S REFERENCED AS PAGES 337,
6 339, 341, AND 343. THOSE RECORDS INDICATE THAT ELLEN
7 ANDERSON DID NOT RECEIVE ANY LORTAB FOR THE MONTH OF
8 SEPTEMBER. SHE DID NOT RECEIVE ANY LORTAB FOR THE MONTH OF
9 OCTOBER. SHE RECEIVED TWO PILLS IN THE MONTH OF NOVEMBER.
10 AND SHE DID NOT RECEIVE ANY LORTAB IN THE MONTH OF DECEMBER.
11 WHY THE NECESSITY OF PRESCRIBING A DRUG SO POTENT AND SO
12 RISKY AS MORPHINE?
13 NOW, THE DEFENDANT'S TESTIFIED THAT HE DID A MENTAL
14 ASSESSMENT ON THIS PATIENT THE EVENING OF HER -- OR THE
15 AFTERNOON OF HER ADMISSION ABOUT 5 O'CLOCK AND HE EXPLAINED
16 TO YOU THE REASON THAT HE DID. THERE'S A PSYCHIATRIC
17 EVALUATION WHICH WAS REFERENCED AS BEING DICTATED THE
18 FOLLOWING DAY AFTER THE DEATH OF THIS PATIENT AND TYPED ON
19 THAT SAME DATE. THE REASON BEING IS HE MADE THE ASSESSMENT.
20 HE WAS IN A HURRY AND HE JUST WROTE THAT. HE WOULD
21 ORDINARILY WRITE DICTATED ON PSYCHIATRIC ASSESSMENT ON THE
22 29TH. THERE'S NO INDEPENDENT INDICATION THE TESTIMONY OF
23 BARBARA POHLMAN AND JAY POHLMAN THAT SHE -- THAT THEY SAW
24 THE DEFENDANT. THERE'S NO INDICATION ANYWHERE IN THOSE
25 RECORDS THAT HE SAW THE VICTIM. THE ONLY RECORD WE HAVE IS
4398
1 HIS OWN SELF-SERVING STATEMENT THAT'S CONTAINED IN THE -- IN
2 THE PROGRESS NOTE.
3 NOW TAKE A LOOK, IF YOU WILL, AT THAT PROGRESS NOTE AND
4 ALSO TAKE A LOOK AT THE PSYCHIATRIC EVALUATION AND THEN WHEN
5 YOU ARE REVIEWING SOME OF THESE OTHER PATIENTS' RECORDS, I
6 WOULD SUGGEST MAYBE YOU TAKE A LOOK AT THEIR RECORDS AS TO
7 WHEN THE PROGRESS NOTE REFLECTS IT WAS DICTATED AND WHEN IT
8 WAS, IN FACT, TYPED AND DICTATED ACCORDING TO THE DICTATION
9 EQUIPMENT AT THE HOSPITAL. IN EVERY OTHER INSTANCE, LADIES
10 AND GENTLEMEN OF THE JURY, YOU'LL FIND THAT THAT DICTATION
11 TAKES PLACE ON THE SAME DATE IT'S TRANSCRIBED.
12 ELLEN ANDERSON AFTER THE E.K.G. AND THE RADIOLOGY
13 REPORT, STARTS TO EXHIBIT -- I THINK IT'S SIGNIFICANT TO
14 NOTE SHE STARTS TO EXHIBIT AGAIN RESPIRATORY -- ERRATIC
15 RESPIRATION. SHE STARTS TO EXHIBIT THE FACT THAT HER BLOOD
16 PRESSURE IS GOING DOWN AGAIN. AS I RECALL, AT 7:30 THEY ARE
17 HAVING A HARD TIME GETTING ANY KIND OF -- KIND OF BLOOD
18 PRESSURE ON HER AND AT 8:55, APPROXIMATELY FIVE AND HALF
19 HOURS AFTER THE SECOND SHOT IS ADMINISTERED, ELLEN ANDERSON
20 DIES. LOOK AT THE CHART AS A COMPARISON TO THE MORPHINE
21 THAT WAS PRESCRIBED. I THINK IT DEMONSTRATES THE WHOLE
22 STORY RIGHT THERE.
23 I THINK I SHOULD SAY I THINK THE EVIDENCE BEFORE YOU
24 SHOWS THAT SHE WAS NOT EVALUATED. HER WEIGHT WAS NOT TAKEN
25 INTO CONSIDERATION FOR A PERSON OF HER AGE AND SIZE, AND I
4399
1 WOULD SUGGEST TO YOU ACCORDING TO DR. CROOKSTON'S TESTIMONY
2 WITH HER WEIGHT OF 81 POUNDS, THAT SHOULD HAVE EVEN ADJUSTED
3 DOWNWARD. IT SHOULDN'T EVEN HAVE TO BE .5 MILLIGRAMS. BUT
4 I WOULD FURTHER SUBMIT THERE WAS NO NECESSITY. THEY COULD
5 HAVE USED THE LORTAB. THEY COULD HAVE USED OTHER MEASURES
6 THAT WERE FAR LESS RISKY AND THEY COULD HAVE WAITED UNTIL
7 THEY HAD THE PHYSICAL EVALUATION, UNTIL THEY HAD THE E.K.G.
8 UNTIL THEY HAD THE RADIOLOGY REPORT BEFORE ADMINISTERING A
9 DRUG OF THAT NATURE. THIS DOCTOR ORDERED THAT
10 ADMINISTRATION. HE WAS THE ATTENDING PHYSICIAN. HE WAS THE
11 ONE WHO WAS AWARE OF THOSE RISKS, BUT YET HE SUBJECTED THAT
12 PATIENT TO THOSE RISKS KNOWING FULL WELL WHAT THE
13 CONSEQUENCES WOULD BE.
14 JUDITH LARSEN. AGAIN, WE HAVE ON THE TOP PART OF THE
15 EXHIBIT THE ADMINISTRATION OF THE VARIOUS DRUGS. KEEP IN
16 MIND THAT ALL OF THESE DRUG DOSAGES ARE REPRESENTED BY THE
17 GERIATRIC HANDBOOK, THE DOSING HANDBOOK. SO WHEN YOU SEE
18 LIKE, FOR INSTANCE, HERE ON THE 7TH THE DRUG TRAZODONE, IT
19 SHOWS THAT THERE WERE DOSAGES OF -- TWO DOSAGES EQUIVALENT
20 TO WHAT WOULD HAVE BEEN THE DAILY DOSE FOR THAT RECOMMENDED
21 GERIATRIC HANDBOOK.
22 NOW, SOME OF THESE DRUGS ADMITTEDLY HAD BEEN GIVEN TO
23 THE PATIENT -- SOME OF THE PATIENTS BEFORE, SO THERE HAS TO
24 BE SOME ADJUSTMENT AS IT RELATES TO THE FACT THAT THEY'D
25 ALREADY RECEIVED SOME OF THEM. BUT FOR THE MOST PART I
4400
1 THINK YOU CAN LOOK AT THAT PARTICULAR EXHIBIT AND I THINK IT
2 EXPLAINS FOR THE MOST PART NOT ONLY WHAT WOULD BE A
3 RECOMMENDED DOSAGE, BUT ALSO THE FACT THAT YOU ARE COMBINING
4 THEM IN COMBINATION WITH OTHER CENTRAL NERVOUS SYSTEM
5 DEPRESSANTS.
6 AGAIN, THE ACTIVITY -- JUDITH LARSEN'S LEVEL OF
7 ALERTNESS AND ACTIVITY IS TAKEN FROM THE NURSES' NOTES AND
8 YOU SEE THE VARIATIONS IN HER ACTIVITY. WE COME ALONG HERE
9 TO AROUND DECEMBER THE 10TH, AND IF YOU'LL REMEMBER THE
10 TESTIMONY, THAT AROUND THAT TIME SHE TOOK A TURN FOR THE
11 WORSE AND IT SEEMS TO BE VERY MUCH DEMONSTRATED ON THIS
12 CHART. YOU SEE HER GOING DOWN, CLEAR DOWN, LETHARGIC AND
13 SHE CONTINUES THAT UP UNTIL THE TIME SHE -- RIGHT IN HERE WE
14 HAVE DRUGS WITHHELD. THIS WAS THE NURSES WITHHOLDING THESE
15 ADMINISTRATION OF THESE DRUGS. THEY DID NOT FEEL IT WAS
16 NECESSARY IN CONNECTION WITH JUDITH LARSEN. THEY DID NOT
17 FEEL THE NEED TO GIVE HER THESE OTHER MEDICATIONS. WHAT
18 HAPPENS? YOU SEE THE NOTE, I THINK IT WAS ON DECEMBER 14 OR
19 RIGHT AROUND THAT TIME FROM DR. WEITZEL THAT IN RESPECT TO
20 HIS CONVERSATION -- I CAN'T REMEMBER WHICH NURSE IT WAS --
21 WHERE HE WRITES IN HIS NOTE AND SHE INDICATES JUDITH LARSEN
22 HAS MADE A MIRACULOUS RECOVERY. PATIENT HAS MADE A
23 MIRACULOUS RECOVERY. WHAT HAPPENS? WE AGAIN SEE INCREASING
24 DOSAGES OVER THESE NEXT SEVERAL WEEKS. SHE CONTINUES TO
25 MAINTAIN ANOTHER -- A FAIRLY DECENT LEVEL, AND THEN WE SEE A
4401
1 DROP HERE ON THE 21ST AND IT'S RIGHT AROUND THIS PERIOD OF
2 TIME.
3 AS YOU RECALL MERLIN LARSEN'S TESTIMONY THAT HE HAS A
4 CONVERSATION WITH -- I GUESS IT WAS WITH SOMEBODY ON THE
5 STAFF INDICATING HE WAS GOING TO HAVE TO MAKE ARRANGEMENTS
6 TO TAKE HIS MOTHER OUT. I THINK HE TALKS TO MAYBE IT'S THE
7 SOCIAL WORKER, AND HE TALKS WITH THE DOCTOR ABOUT THAT FACT.
8 AND THEN SUBSEQUENTLY WE GET INTO RIGHT AROUND
9 CHRISTMASTIME. AND THERE'S A PIECE OF EVIDENCE THAT I WANT
10 TO CALL YOUR ATTENTION TO, IT'S EXHIBIT NUMBER 48. THIS IS
11 THE CONTROLLED SUBSTANCES LOG. NOW, THIS LOG WAS NOT
12 MAINTAINED ON THE UNIT. THIS IS A LOG THAT WAS MAINTAINED
13 IN THE PHARMACY FOR CONTROLLED SUBSTANCES WHICH WERE TAKEN
14 OUT OF THE PHARMACY FOR PURPOSES OF ADMINISTERING TO THE
15 PATIENTS IN THE GEROPSYCH UNIT. THAT LOG IS FROM DECEMBER 6
16 THROUGH JANUARY 14. GO THROUGH THAT LOG. YOU'LL FIND THAT
17 THERE ARE NO -- THERE'S NO MORPHINE ADMINISTERED AT ANY TIME
18 DURING THE TIME PERIOD UP UNTIL CHRISTMAS DAY OF 1995.
19 NOW, THERE WAS MORPHINE ORDERED BY DR. WEITZEL FOR
20 15 MILLIGRAMS BACK ON DECEMBER THE 13TH FOR JUDITH LARSEN.
21 THAT WAS A P.R.N. ORDER, AND AS YOU'LL RECALL, I THINK IT
22 WAS NURSE HARDEY'S TESTIMONY, THAT ORDER REMAINED
23 OUTSTANDING UP UNTIL ABOUT THE 19TH WHEN SHE FINALLY
24 PERSUADED THE DOCTOR HE SHOULD RESCIND THAT ORDER BECAUSE
25 SHE WAS FEARFUL THAT SOME NURSE, BECAUSE IT'S A P.R.N.
4402
1 ORDER, MIGHT ADMINISTER THAT MORPHINE TO JUDITH LARSEN AND
2 SHE'D DONE HER OWN RESEARCH AND KNEW ABOUT THE
3 ADMINISTRATIVE EFFECTS OF THESE PARTICULAR DRUGS ALONG WITH
4 MORPHINE. SO SHE WAS AWARE OF THE RISKS AND SHE DID NOT
5 WANT TO SEE THAT OCCUR.
6 BUT ANOTHER SIGNIFICANT NOTE OF INTEREST HERE IS HE
7 ORDERS 15 MILLIGRAMS BACK HERE, FAIRLY SIGNIFICANT DOSE
8 ACCORDING TO THE GERIATRIC HANDBOOK WHICH WOULD BE SIX TIMES
9 WHAT A STARTING DOSE FOR A GERIATRIC PATIENT WOULD BE. THAT
10 ORDER IS NOT FILLED. BUT COME DECEMBER 25TH, THE RECORDS
11 NOTE TO DR. WEITZEL'S PROGRESS NOTES OR TO HIS PHYSICIAN'S
12 ORDERS THAT HE PERCEIVES OR SEES HER IN SOME DISCOMFORT. SO
13 HE ORDERS THREE DOSAGES, TWO MILLIGRAMS EACH, TO TAKE PLACE
14 OVER A FOUR-HOUR TIME PERIOD EVERY TWO HOURS. I DON'T
15 UNDERSTAND THE RATIONALE, THAT ONE IS IF THERE WAS PAIN
16 PRESENT, IS PROBABLY VERY MUCH IN CONFORMANCE WITH THE
17 GERIATRIC HANDBOOK FROM THAT STANDPOINT. SO WHAT'S THE
18 RATIONALE?
19 THE NEXT DAY, JUDITH LARSEN SUFFERS A SEIZURE.
20 DR. DIENHART IS BROUGHT IN. DR. DIENHART MAKES -- THERE'S
21 TWO OBSERVATIONS HERE. WELL, WHAT HE SEES WITH THE SEIZURE
22 IS THAT HE RECOMMENDS OR AT LEAST HE ORDERS THE TREATMENT OF
23 THE SEIZURE WITH AN I.V. OF DILANTIN AND HE GIVES THE
24 PATIENT -- HE ORDERS ATIVAN, AS I RECALL, WHICH IS DOWN
25 HERE. SUBSEQUENTLY, THE DEFENDANT COMES IN AND
4403
1 HE DISCONTINUES THE ATIVAN. HE TAKES IT AWAY AND ORDERS TWO
2 MILLIGRAMS OF MORPHINE TO BE ADMINISTERED TO THIS PATIENT.
3 WE SEE A PERIOD OF TIME HERE BETWEEN THE 26TH AND 27TH AND I
4 SUSPECT ON THE 28TH -- OR 29TH, EXCUSE ME -- IS WHEN WE HAVE
5 THE CONVERSATION WITH MERLIN LARSEN AND DR. WEITZEL WHERE
6 DR. WEITZEL TELLS MERLIN, YOUR MOTHER IS DYING. SHE'S DYING
7 AND WE DON'T WANT TO TAKE ANY HEROIC MEASURES.
8 THERE WAS NO DISCUSSION, AS I RECALL, FROM THE
9 TESTIMONY OF MERLIN OR THE PHYSICIAN OR THE DEFENDANT, FOR
10 THAT MATTER, AS TO EXACTLY WHAT WAS IN THAT CONVERSATION
11 EXCEPT HER CHILDREN WAS OF THE IMPRESSION THAT SHE WAS
12 DYING. THERE WAS NO INDICATION THAT SHE WAS -- WHAT SHE WAS
13 DYING FROM. AND THE RECOMMENDATION AND THE INSTRUCTIONS AND
14 LATER THE DIRECTIONS OF THIS PHYSICIAN ARE, WE'LL GIVE HER
15 COMFORT CARE. WE STOP ALL OTHER MEDICATIONS. AND NOW WE
16 JUST START GIVING HER MORPHINE.
17 WELL, LOOK WHAT HAPPENS ON THE ACTIVITY CHART, LADIES
18 AND GENTLEMEN. BAM BAM BAM, SHE'S GIVEN 15 MILLIGRAMS THE
19 FIRST DAY, 35 MILLIGRAMS THE SECOND DAY, 45 MILLIGRAMS THE
20 THIRD DAY, 45 MILLIGRAMS THE FOURTH DAY, AND 140 MILLIGRAMS
21 THE LAST DAY, 140 MILLIGRAMS IS ORDERED.
22 I NEED TO CLARIFY BECAUSE WE HAVE, SEE, THESE LITTLE
23 WHITE SPACES HERE ON THE CHART. WHAT THAT WAS WAS THE
24 NURSES WITHHOLDING THE MORPHINE BECAUSE THE RESPIRATION RATE
25 WAS SO LOW. THEY WERE FEARFUL OF CAUSING HER DEATH. LET ME
4404
1 SHOW YOU SOMETHING. IT'S IN THE RECORD. FIRST OF ALL, THIS
2 IS THE NURSING NOTES. ROUTINE MORPHINE, M.S. HELD TIMES
3 THREE DUE TO RESPIRATIONS FIVE TO EIGHT. NOW, THIS IS ON
4 THE 3RD. LOOK AT THE NEXT NOTE IN FROM DR. WEITZEL ON THE
5 3RD. DESPITE FIVE MILLIGRAMS OF I.M. MORPHINE AT 7:30 AND
6 9:30, PATIENT HAS NOT RESPONDED AT ALL. EYES OPEN,
7 GROANING, PERHAPS SOME PAIN. UNFORTUNATELY, NURSING STAFF
8 HAVE BEEN HOLDING M.S. FOR LOW RESPIRATION RATE.
9 WAS IT WRONG FOR THE NURSING STAFF TO WITHHOLD THE
10 MORPHINE FOR THE LOW RESPIRATION RATE? THAT'S WHAT THEY
11 HAVE BEEN TAUGHT. IF YOU DON'T WITHHOLD IT, YOU MAY KILL
12 THE PATIENT. UNFORTUNATELY, NURSING STAFF HAVE BEEN HOLDING
13 M.S. FOR LOW RESPIRATION RATE. REMAINS UNRESPONSIVE TO ANY
14 QUESTIONS AND THEN WHAT DOES HE DO? HE ORDERS 25 MILLIGRAMS
15 OF MORPHINE NOW. CONTINUE THE 5 MILLIGRAMS EVERY THREE
16 HOURS. AS YOU RECALL, AGAIN, THE ADMINISTRATIVE EFFECTS OF
17 GIVING MORPHINE EVERY THREE HOURS. NOT ONLY THAT, BUT ON
18 THAT SAME DATE, HE ORDERS AN ADDITIONAL 30 MILLIGRAMS IT
19 LOOKS LIKE 11 O'CLOCK. AN ADDITIONAL 30 MILLIGRAMS AT 1445
20 IN ADDITION TO ALL OF THE OTHER SHOTS THAT ARE BEING
21 ADMINISTERED TO THIS PATIENT. CAUSE OF DEATH. IS THAT
22 CONSISTENT WITH MORPHINE TOXICITY? YOU DON'T THINK THERE
23 WAS ANY INTENT TO CAUSE HER DEATH? JUST LOOKING AT THAT
24 CHART THERE'S NO QUESTION THAT THAT WAS THE INTENT OF THIS
25 PHYSICIAN.
4405
1 I FORGOT TO SHOW YOU SOMETHING ELSE. PATIENT -- THIS
2 IS ON 1/4. THIS IS AFTER JUDITH LARSEN DIES. PATIENT GIVEN
3 LARGE AMOUNTS OF MORPHINE YESTERDAY P.M. FOR COMFORT.
4 FINALLY SHE EXPIRED AT 8 P.M. FINALLY SHE EXPIRES, EVIDENCE
5 OF INTENT TO CAUSE DEATH. I WOULD SUBMIT IT'S CLEARLY
6 EVIDENCE OF INTENT TO CAUSE DEATH.
7 YOUR HONOR, IF YOU WOULD LIKE TO TAKE A BREAK AT THIS
8 TIME.
9 THE COURT: LADIES AND GENTLEMEN, WHAT WE WILL DO,
10 I WOULD LIKE TO TAKE A TEN-MINUTE BREAK. LET THE COURT
11 REPORTER HAVE SOME TIME OFF HERE. IT IS YOUR DUTY DURING
12 THAT TIME NOT TO CONVERSE AMONG YOURSELVES OR TO CONVERSE
13 WITH OR ALLOW YOURSELVES TO BE ADDRESSED BY ANY OTHER PERSON
14 ON THE SUBJECT OF TRIAL. AGAIN, IT'S YOUR DUTY NOT TO FORM
15 OR EXPRESS ANY OPINION UNTIL THE CASE IS FINALLY SUBMITTED
16 TO YOU AFTER YOU'VE HEARD ALL OF THE CLOSING ARGUMENTS. SO
17 IF YOU COME BACK AT ABOUT FIVE TO.
18 (COURT IN RECESS.)
19 (JURY RETURNS TO THE COURTROOM AT 11 O'CLOCK.)
20 THE COURT: THE RECORD WILL REFLECT THAT THE JURY
21 HAS RETURNED. YOU LIKE TO CONTINUE, MR. WILSON.
22 MR. WILSON: THANK YOU, YOUR HONOR. JUST A COUPLE
23 MORE COMMENTS ABOUT JUDITH LARSEN. SHE EXPIRED ON JANUARY
24 THE 3RD AT ABOUT 8 -- 8:10 P.M. AND ON THAT DATE IT
25 INDICATED ON THE CHART, IT SAYS, RECEIVED 130 MILLIGRAMS OF
4406
1 MORPHINE. LAST MORPHINE ADMINISTERED TO HER WAS
2 ADMINISTERED ABOUT IN ADDITION TO A 6:30 P.M. SHOT,
3 APPARENTLY SHE RECEIVED AN ADDITIONAL 6:30 P.M. SHOT OF
4 15 MILLIGRAMS OF BOTH GIVEN BY NURSE RICHARD CLARK. AND
5 THEN SHE EXPIRES A SHORT TIME, I THINK IT WAS ABOUT TWO
6 HOURS, THEREAFTER.
7 KEEP IN MIND A COUPLE OF THINGS HERE. YOU HAVE ELLEN
8 ANDERSON DYING ON THE 30TH. NOW WE HAVE JUDITH LARSEN DYING
9 ON THE 3RD OF JANUARY. IN CONNECTION WITH ELLEN ANDERSON'S
10 CASE, IN REVIEWING THAT CASE, I WOULD SUBMIT TO YOU THAT THE
11 ONLY DRUG THAT ELLEN ANDERSON WAS ADMINISTERED OF ANY RISKY
12 NATURE AT THAT TIME WAS THE MORPHINE. TO ME THAT IS THE
13 SMOKING GUN. NOW, IF ANYTHING, IF THE DEFENDANT WERE TO
14 CLAIM SOME IGNORANCE ABOUT THE FACT OF THE RISK OF DEATH OF
15 USING MORPHINE, IF ANYTHING SHOULD HAVE ALERTED HIM TO THAT
16 FACT, IT WAS ELLEN ANDERSON. IN TERMS OF JUDITH LARSEN, HE
17 CONTINUES WITH THE PATTERN OF ADMINISTERING MORPHINE, ONLY
18 IN THIS CASE THE AMOUNTS ARE TREMENDOUS. I MEAN, THEY ARE
19 EXCESSIVE EVEN BY HIS OWN ADMISSION. IN HIS NOTE HE SAYS
20 LARGE AMOUNTS.
21 NEXT WE HAVE THE CASE OF MARY CRANE. MARY CRANE,
22 YOU'LL RECALL, WAS ADMITTED ON DECEMBER 28 AND AT THE TIME
23 OF HER ADMISSION THERE IS SOME NOTATIONS IN THE RECORD THAT
24 SHE HAD BEEN SUFFERING FROM CHRONIC BACK PAIN OR LOW BACK
25 PAIN, AS I RECALL. AND THE DEFENSE HAS SUBMITTED AN EXHIBIT
4407
1 TO YOU -- I CAN'T REMEMBER THE NUMBER OF THAT EXHIBIT --
2 WHICH SHOWS MARY CRANE'S MEDICATION RECORDS ALONG WITH A
3 SUMMARY OF HER MEDICATION RECORDS AS IT PERTAINS TO PAIN
4 KILLERS.
5 YOU'LL NOTE AS YOU REVIEW THAT EXHIBIT IN YOUR
6 DELIBERATIONS, THAT MARY CRANE WAS GIVEN THE EQUIVALENT OF
7 ABOUT ONE PAIN PILL A DAY. YOU SHOULD ALSO NOTE THAT IN
8 DR. HARE'S TESTIMONY THAT THAT WAS A LOW DOSAGE AMOUNT AND
9 THAT THE ADMINISTRATION OF THAT PARTICULAR SUBSTANCE OVER
10 THAT TIME PERIOD WOULD NOT MAKE HER OPIOID TOLERANT.
11 REMEMBER THAT TERM, MEANING SOME TOLERANCE TO THE USE OF AN
12 OPIOID TYPE C.N.S. DEPRESSANT SUCH AS MORPHINE.
13 NOW, MARY CRANE'S CASE IS A LITTLE BIT DIFFERENT
14 BECAUSE WE HAVE THE INTRODUCTION RIGHT FROM THE VERY START
15 OF A DURAGESIC PATCH. DURAGESIC PATCH. FIRST OF ALL YOU
16 NEED TO BE REMINDED THAT -- AND THIS WAS THE P.D.R. DOCUMENT
17 THAT DR. HARE REFERRED TO -- THIS SHOWS A REFERENCE WITH
18 ORAL MORPHINE IN MILLIGRAM AMOUNTS AS COMPARED TO THE
19 VARIOUS MICROGRAM PATCHES OF DURAGESIC PATCH. DR. HARE
20 TESTIFIED THAT THE CONVERSION RATE BETWEEN THESE IS
21 APPROXIMATELY ONE-THIRD. SO YOU'VE GOT A 25 MICROGRAM PATCH
22 ON. IT WOULD BE EQUIVALENT TO 15 TO 45 MILLIGRAMS OF
23 MORPHINE A DAY WOULD BE THE CONVERSION RATE. THE DEFENDANT
24 TESTIFIED THAT THAT CONVERSION RATE WOULD PROBABLY BE LOWER
25 OR MAYBE APPROXIMATELY THE LOW END OF THAT PARTICULAR SCALE.
4408
1 NOW, WE NOTE FROM THE RECORDS THAT INITIALLY A 25
2 MICROGRAM PATCH WAS PRESCRIBED THAT DID NOT GET PLACED UPON
3 MARY CRANE. SUBSEQUENTLY THAT WAS UPPED BY THE DEFENDANT TO
4 50 MICROGRAMS. SO THE MINUTE SHE WOULD HAVE -- SHE WOULD
5 HAVE ON BOARD THE EQUIVALENT OF SOME 15 MILLIGRAMS TO ABOUT
6 45 MILLIGRAMS A DAY OF MORPHINE. EXCUSE ME. WHEN SHE WAS
7 GIVEN THE 50 SHE WOULD HAVE THE EQUIVALENT OF ABOUT 45 TO
8 APPROXIMATELY 75 MILLIGRAMS OF MORPHINE PER DAY.
9 NOW, THE DURAGESIC PATCH, AS HAS BEEN TESTIFIED, WORKS
10 AS IT'S ABSORBED INTO THE BODY. AND AS DR. HARE TESTIFIED,
11 IT TAKES ABOUT 18 HOURS FOR THAT TO REACH ITS MAXIMUM LEVEL
12 AND THEN ITS MAINTAINED FOR THREE DAYS AND THEN A NEW PATCH
13 IS PLACED ON IT SO THAT YOU HAVE A CONTINUOUS LEVEL OF THOSE
14 DOSAGES OVER THAT PERIOD OF TIME. AGAIN, OTHER C.N.S.
15 DEPRESSANTS ARE GIVEN TO THE PATIENT AND SHE HAS THE
16 ADMINISTRATIVE EFFECT OF THOSE.
17 AND AS YOU CAN LOOK AT THE CHART -- I'M LOOKING FOR THE
18 POINTER HERE. THERE IT IS -- IF YOU LOOK AT THE CHART YOU
19 CAN SEE THAT THERE'S AN ESCALATING INCREASE IN THE DOSAGES.
20 NOW MARY CRANE, SHE HAS THAT FIRST DURAGESIC PATCH ON HERE
21 ON THE 31ST. SHE'S GIVEN, IN ADDITION TO THE SERZONE AND
22 RISPERDAL AND TRAZODONE, SHE'S GIVEN ATIVAN. THAT'S ADDED
23 TO IT. THIS IS THE DATE THAT THE PATCH CHANGES AND SHE GETS
24 AN ADDITIONAL PATCH HERE. I FORGOT TO NOTE THERE WAS A
25 PATCH THAT FELL OFF BACK HERE AND THEN ANOTHER ONE WAS
4409
1 PLACED ON. SO YOU HAVE SOME MORE ADMINISTRATIVE EFFECTS
2 FROM THAT STANDPOINT.
3 BUT THEN WE GET OVER HERE TO THE 1ST AND THAT'S THE
4 FIRST EVENT THAT I THINK OF ANY SIGNIFICANCE IN THE MEDICAL
5 RECORDS THAT WE SEE. AND THAT'S THE DATE THAT THE NURSE
6 NOTES THE VAGINAL FISTULA AND SHE CALLS IN DR. DIENHART TO
7 CONSULT ON THAT DATE. AND I THINK IT'S IMPORTANT THAT
8 THERE'S NOTHING IN THE NOTE THAT REFLECTS THAT THIS PATIENT
9 WAS EXPERIENCING ANY PAIN WITH THAT. THE NURSE NOTES IT
10 BECAUSE SHE SEES WHAT THEY CALL A VAGINAL STOOL.
11 SO DR. DIENHART IS CALLED IN AND HE SEES THIS AND SO HE
12 CALLS IN DR. MEEKS. DR. MEEKS COMES IN THE FOLLOWING DAY ON
13 JANUARY THE 2ND. AND HE MAKES HIS -- DOES HIS CONSULT. AND
14 AS HE TESTIFIED TO ON THE STAND, HE DID NOT NOTE ANY
15 INFECTION IN HIS NOTES AND HE SAID, I WOULD HAVE PROBABLY
16 WRITTEN THAT IN MY NOTE HAD I NOTED IT. NOR DID HE NOTE
17 ANYTHING RELATIVE TO ANY PAIN THAT THE PATIENT WAS
18 EXPERIENCING AT THAT TIME.
19 THE FOLLOWING DAY ON THE 3RD, AS I RECALL, THE NOTES
20 REFLECT THAT DR. WEITZEL WAS -- THAT DR. DIENHART BE
21 CONSULTED BECAUSE OF MEEKS' NOTE ABOUT DIAGNOSIS WITH
22 SURGERY AND HE WANTED HER TO BE EVALUATED AS TO HER
23 CONDITION BEFORE ANY SURGERY. THE ONLY THING IN THE RECORD
24 THAT WE HAVE IS THE NURSE SAYING, WELL, I NOTIFIED
25 DR. DIENHART'S RECEPTIONIST OF THE PHONE NUMBER, THE PAGER
4410
1 NUMBER FOR DR. WEITZEL. BUT EVEN THOUGH THE RECOMMENDATION
2 IS MADE THAT IT COULD BE TREATED AT LEAST FOR A 25 TO
3 35 PERCENT PROBABILITY WITH ANTIBIOTICS, THERE IS NO
4 ANTIBIOTICS GIVEN TO THIS PATIENT AT THAT TIME.
5 SO THEN THE NEXT THING WE SEE IS THAT SHE'S
6 ADMINISTERED FOR SOME REASON AN EIGHT -- I THINK THERE WERE
7 TWO SHOTS, ONE 3 MILLIGRAM AND ONE 5 MILLIGRAM OF MORPHINE
8 ON THE JANUARY 3RD IN ADDITION TO THE DURAGESIC PATCH THAT
9 SHE ALREADY HAS ON. THAT MORPHINE CONTINUES INTO THE NEXT
10 DAY WITH A FIVE MILLIGRAM SHOT, BUT WE ALSO HAVE A NEW DRUG
11 THAT'S ADDED ALONG WITH THE DAY BEFORE AND THAT'S DEPAKENE.
12 BUT HERE'S THE DATE THAT THE DURAGESIC PATCH IS NOW
13 DECREASED. NOW INCREASED TO 75 MICROGRAMS, EQUIVALENT TO
14 ABOUT 75 TO 105 MILLIGRAMS OF MORPHINE PER DAY. THAT'S WHAT
15 THE CONVERSION CHART INDICATES.
16 THERE IS ALSO IN THE RECORD, I NEGLECTED TO POINT THIS
17 OUT, BACK WHEN DIENHART IS INITIALLY CALLED TO CONSULT ON
18 THE FISTULA, HE NOTES THAT SHE APPEARS TO BE SEDATED. AND
19 AT THAT TIME HE RECOMMENDS THAT THE DURAGESIC PATCH BE
20 DECREASED TO 25 MICROGRAMS. THAT ORDER AGAIN IS CANCELED BY
21 DR. WEITZEL AND IT REMAINS AT THE 50 MICROGRAM LEVEL. WE GO
22 ON HERE TO JANUARY 5TH. SHE RECEIVES 10 MILLIGRAMS OF
23 MORPHINE THAT DAY AND SHE ALREADY HAS ON BOARD THE
24 EQUIVALENT OF AT LEAST, ACCORDING TO THE CONVERSION CHART,
25 75 MILLIGRAMS. SO A TOTAL OF 85 MILLIGRAMS EQUIVALENT TO
4411
1 MORPHINE ON THE JANUARY 5TH.
2 NOW, YOU CAN SEE FROM THE ACTIVITY LEVEL ON THE CHART
3 ALL OF A SUDDEN WE'RE STARTING TO SEE THAT THIS PATIENT IS
4 GOING DOWNHILL AND SHE CONTINUES TO GO DOWNHILL. SHE
5 DOESN'T QUITE MAKE IT UP TO THE NORMAL LEVEL. SHE'S NOT
6 GIVEN ANY MORPHINE ON THE 6TH. SHE STILL HAS THE DURAGESIC
7 PATCH IN PLACE, AND THEN ON THE 7TH THESE ARE THE THINGS --
8 THE SIGNIFICANT EVENT THAT OCCURRED. FIRST OF ALL, SHE'S
9 GIVEN A NEW 75 MICROGRAM PATCH AS THE OTHER ONE'S BEEN ON
10 THREE DAYS NOW. SECOND OF ALL, THE PATIENT IS PERCEIVED TO
11 BE VERY UNRESPONSIVE. SHE'S DYING. IT'S ON THIS DATE THAT
12 DR. WEITZEL HAS HIS FIRST CONTACT, HIS FIRST CONTACT EVER
13 WITH KAREN BRINGHURST, THE DAUGHTER OF MARY CRANE.
14 THE FAMILY'S CALLED IN. DR. DIENHART WAS CONSULTED ON
15 THIS PARTICULAR EVENT AND DR. DIENHART INDICATES IN HIS NOTE
16 A NUMBER OF THINGS THAT MAY BE WRONG HERE AND HE TESTIFIED
17 THAT HE HAD RECOMMENDED TREATMENT. IT WOULD HAVE TO BE
18 AGGRESSIVE TREATMENT, BUT THEN HE ALSO TESTIFIED THAT HE
19 DIDN'T KNOW WHETHER THAT TREATMENT WOULD BE SUCCESSFUL. BUT
20 SHE'S DYING. IT'S EVIDENT SHE'S DYING. I WOULD SUBMIT TO
21 YOU, WHY IS SHE DYING AT THIS JUNCTURE HERE? OUR POSITION
22 IS THE DURAGESIC PATCH IN COMBINATION WITH THE MORPHINE AND
23 THE OTHER PSYCHOTROPIC MEDICATIONS THAT ARE ALSO CENTRAL
24 NERVOUS SYSTEM DEPRESSANTS HAS BROUGHT HER DOWN TO THE POINT
25 THAT HER FUNCTIONS WOULD REPRESENT THAT SHE IS DYING.
4412
1 LADIES AND GENTLEMEN OF THE JURY, THE QUESTION IS NOT
2 WHETHER OR NOT ON THE 7TH SHE WAS DYING. THE QUESTION IS
3 HOW DID SHE GET TO THE POINT OF DYING.
4 KAREN TESTIFIES SHE COMES IN, MEETS WITH THE DOCTOR.
5 THEY HAVE A BRIEF CONVERSATION ASIDE FROM HER SISTER AND
6 FAMILY WHERE SHE -- THE DOCTOR REPRESENTS TO HER, YOUR
7 MOTHER IS DYING. KAREN APPROPRIATELY RESPONDS, WHAT CAN WE
8 DO FOR HER. AND THE ANSWER IS, AS I RECALL HER WORDS WAS,
9 WE CAN GIVE YOUR MOTHER MORPHINE TO HASTEN THE INEVITABLE.
10 NOW, INTERESTING FACTOR HERE. HE DOESN'T TELL KAREN
11 THAT HE'S BEEN ADMINISTERING MORPHINE BEFORE THE 7TH.
12 THERE'S NO REFERENCE TO THAT. AND MORPHINE THEN BECOMES THE
13 DRUG OF CHOICE FOR HIM TO ADMINISTER TO HER TO PRECIPITATE
14 HER DEATH ALONG WITH THE DURAGESIC PATCH AS WAS TESTIFIED TO
15 BY DR. HARE, DR. CROOKSTON AND DR. FEHLAUER. BUT THOSE
16 DRUGS IN COMBINATION ARE DEADLY. AND A PSYCHIATRIST WHO
17 HOLDS HIMSELF OUT AS SPECIALIZED MEDICINE AS GERIATRIC
18 PSYCHIATRIST WOULD KNOW THOSE THINGS, WOULD KNOW THOSE
19 COMBINATIONS HAVE THOSE KINDS OF RISKS. MARY CRANE DIES I
20 THINK AT AROUND 11:30 THAT NIGHT. YOU KNOW, THERE'S ALSO --
21 SO NOW WE HAVE ELLEN ANDERSON, WE HAVE JUDITH LARSEN, AND
22 NOW WE HAVE MARY CRANE.
23 I PUT THIS OTHER CHART UP JUST TO REFERENCE WITH YOU
24 REALLY QUICKLY THE WARNINGS THAT ARE CONTAINED IN THE P.D.R.
25 AS THEY RELATE TO DURAGESIC PATCH. FIRST OF ALL, THE P.D.R.
4413
1 RECOMMENDS DOSES GREATER THAN 25 ARE TOO HIGH FOR INITIATION
2 OF THERAPY IN NONOPIOID TOLERANT PATIENTS AND SHOULD NOT BE
3 USED TO BEGIN DURAGESIC THERAPY IN THESE PATIENTS. THE
4 OTHER PART, WHICH RELATES TO THE PRESCRIBING OF THESE
5 MEDICATIONS IN COMBINATION, TALKS ABOUT THE FACT -- AND THIS
6 IS PRECISELY WHAT DR. DIENHART DID -- IT TALKS ABOUT THE
7 FACT THAT YOU'VE GOT TO DO IT IN CONJUNCTION WITH OTHER
8 ARGUMENTS. YOU SHOULD REDUCE IT BY AT LEAST 50 PERCENT.
9 LYDIA SMITH. LYDIA SMITH, I THINK, PRESENTS AN
10 EXTREMELY GOOD EXAMPLE OF THE PATTERN OF CONDUCT OF
11 CONTINUOUSLY OVERMEDICATING THESE C.N.S. DEPRESSANT DRUGS.
12 NOW, YOU RECALL LYDIA CAME ON THE UNIT BACK IN DECEMBER 20
13 OF 1995. SHE HAS -- IT'S A REAL INTERESTING PATTERN HERE,
14 BECAUSE AS YOU RECALL, LYDIA HAD EXPERIENCED A STROKE BACK
15 IN NOVEMBER. NOW, I THINK THERE'S BEEN TESTIMONY THAT THIS
16 WAS A SEVERE STROKE, THAT SHE ALMOST DIED. BUT AS YOU
17 RECALL THE TESTIMONY OF HER FAMILY MEMBERS, THEY INDICATED
18 AFTER THE STROKE HAD OCCURRED THAT WHERE SHE WAS STILL AT
19 THE SOUTH DAVIS COMMUNITY HOSPITAL THAT SHE HAD SOME
20 EVIDENCE OF APHASIA. SO NOW DON'T HOLD ME TO THAT BECAUSE
21 THERE'S SO MANY WORDS FLOATING AROUND HERE. I MAY HAVE THE
22 WRONG WORD. BUT AS I UNDERSTAND IT, IT'S WHERE SHE'S -- HER
23 SPEECH HAS BEEN IMPACTED AND SHE CAN'T SPEAK AS CLEARLY.
24 BUT SHORTLY AFTER THAT LYDIA IS UP AND RUNNING AROUND.
25 SHE'S CAUSING ALL KINDS OF TROUBLE AT THAT SOUTH DAVIS
4414
1 COMMUNITY CARE CENTER. SO MUCH TROUBLE THEY HAD TO GO AND
2 ASSIGN ONE PERSON TO MANAGE HER SO THAT SHE WOULDN'T ESCAPE
3 FROM THE UNIT AND SHE WOULDN'T HARM HERSELF OR SHE WOULDN'T
4 HARM POSSIBLY OTHER PATIENTS. AND IT WAS THAT BEHAVIORAL
5 PROBLEM THAT COMES OUT OF THAT ACUTE SETTING WITH THE STROKE
6 THAT NEEDS TO BE MODIFIED. BUT YOU ALSO RECALL SHE
7 TESTIFIED SHE'S STILL ABLE TO PLAY THE PIANO. SHE WAS STILL
8 ABLE TO PLAY MUSIC. SO I WOULD SUBMIT TO YOU I DON'T THINK
9 THAT THE STROKE AS IT'S BEEN CHARACTERIZED WAS THAT
10 SIGNIFICANT OF AN EVENT IN LYDIA SMITH'S LIFE EXCEPT TO
11 PRECIPITATE SOME CHANGES IN HER BEHAVIORAL PATTERN.
12 SHE GOES ONTO THE UNIT IN DECEMBER AND, YES, THE FAMILY
13 OBVIOUSLY IS CONCERNED ABOUT GETTING THE BEHAVIOR PATTERN
14 UNDER CONTROL SO THAT SHE CAN GO BACK TO A CARE CENTER, SIT
15 AND BE ADEQUATELY TAKEN CARE OF IN A DIFFERENT SETTING. AND
16 THIS IS A SPECIALTY UNIT. YOU ARE NOT SUPPOSED TO BE HERE
17 FOR THE REST OF YOUR LIFE. WE SEE IN LYDIA'S CASE A VARIETY
18 OF PSYCHOTROPIC MEDICATIONS BEING ADMINISTERED TO HER. YOU
19 SEE OVER THE COURSE AND EVENTS HER DESIRE AT THE HOSPITAL
20 THAT THOSE INCREASE, AND IN PARTICULAR IT'S INTERESTING TO
21 SEE THE DOSAGES OF HALDOL ARE ADMINISTERED TO HER AROUND
22 JANUARY 3RD AND IT'S AT THAT TIME YOU START TO SEE THE
23 PATTERN IN THE ACTIVITY REALLY GOING DOWN. THE LEVEL OF HER
24 ACTIVITY GOES FROM A HIGH IN ONE DAY DOWN TO A LOW. A HIGH
25 DOWN TO A LOW. ON JANUARY 5TH ON THROUGH THERE'S A PERIOD
4415
1 OF TIME HERE ON THE 6TH WHERE SHE SEEMS TO FLUCTUATE, AND
2 THEN ON THE 7TH YOU SEE A SUBSTANTIAL DROP IN HER ACTIVITY
3 TO THE POINT YOU DON'T SEE ANYTHING COMING BACK OUT OF THAT.
4 NOW THAT'S ON THE 7TH.
5 YOU'LL REMEMBER THE TESTIMONY OF THE FAMILY MEMBERS TO
6 THE EFFECT THAT THEY CAME INTO VISIT HER, I THINK IT WAS ON
7 THE 6TH. THEY FOUND HER IN THE CAFETERIA. THEY FOUND HER
8 SLUMPED OVER IN HER CHAIR, THEY FOUND FOOD OUT OF HER MOUTH,
9 COMING OUT OF HER MOUTH. THEY IMMEDIATELY GOT ASSISTANCE
10 AND PUT HER BACK INTO BED. AND THE TESTIMONY IS CONSISTENT
11 FROM THAT DAY FORWARD THEY DID NOT NOTE ANY IMPROVEMENT.
12 HOWEVER, ON THE NIGHT OF THE 7TH THEY ARE CALLED INTO A
13 FAMILY MEETING WITH DR. WEITZEL. AND AT THAT TIME, THAT
14 FAMILY MEETING OF WHICH I DON'T KNOW WHICH ONE OCCURRED
15 FIRST, BUT IF YOU'LL REMEMBER RIGHT MARY CRANE'S FAMILY
16 MEETING WAS ALSO ON THE 7TH. SO NOW WE GOT TWO PATIENTS
17 BOTH DYING AT THE SAME TIME. THEY COME INTO THE MEETING
18 WITH DR. WEITZEL AND AT THAT MEETING, AGAIN, THE FAMILY IS
19 TOLD THAT THEIR MOTHER IS DYING AND THEY CAN SEE HER LAYING
20 THERE UNCONSCIOUS. AND THIS GOES TO THE TYPE OF STATE. I
21 THINK THERE WAS SOME TESTIMONY TO THE FACT THAT SHE RAISED
22 HER ARM SORT OF FEEBLY AT ONE TIME, BUT SHE'S LAYING THERE,
23 THEY CAN SEE. I MEAN, IT DOESN'T TAKE A GENIUS TO FIGURE
24 OUT THAT THEIR MOTHER IS IN SERIOUS CONDITION AND THAT'S
25 CONFIRMED BY A PHYSICIAN, A PHYSICIAN IN CHARGE OF HER CARE
4416
1 AND DIRECTING HER CARE AT THIS TIME. WHAT ARE THEY TOLD.
2 WELL, AS I UNDERSTAND, THEY WERE WEREN'T TOLD ANYTHING ABOUT
3 WHAT THEIR MOTHER WAS DYING FROM. THEY WERE JUST TOLD THAT
4 SHE WAS DYING.
5 AT THAT SAME TIME, KENT SMITH EXECUTES A MEDICAL
6 TREATMENT PLAN WHICH IS AN ADVANCE DIRECTIVE IN CONNECTION
7 WITH HIS MOTHER'S TREATMENT, AN INDICATION TO WITHHOLD
8 CERTAIN THINGS. SO THEY ARE TOLD SHE'S GOING TO GET COMFORT
9 CARE. WHAT KIND OF COMFORT CARE IS THAT? WE'RE GOING TO
10 GIVE HER MORPHINE FOR THE PAIN. I DON'T THINK THERE'S
11 ANYTHING IN THAT RECORD THAT INDICATES THAT THIS PATIENT WAS
12 SUFFERING ANY PAIN.
13 AS I RECALL THE TESTIMONY OF DR. WEITZEL, HE RELATED
14 THAT IT'S VERY PAINFUL TO HAVE A DEATH BY DEHYDRATION. YOU
15 CAN'T DO AN I.V., YOU CAN'T HYDRATE, THEREFORE MORPHINE IS
16 GIVEN FOR COMFORT CARE. IT'S SIGNIFICANT TO NOTE SHE'S
17 GIVEN TWO 5 MILLIGRAM SHOTS ON THE 7TH. YOU HAVE THE
18 PATTERN WHERE SHE IMMEDIATELY DROPS DOWN AND HER LEVEL OF
19 THE NEXT DAY SHE'S GIVEN THE EQUIVALENT OF 30 MILLIGRAMS.
20 THERE IS TWO 5 MILLIGRAM SHOTS EARLY IN THE MORNING AND THEN
21 PURSUANT TO THE DEFENDANT'S ORDERS, MORPHINE IS INCREASED TO
22 10 MILLIGRAMS.
23 NOW, REMEMBER THE TESTIMONY FIRST OF ALL SHARON SMITH.
24 SHE TESTIFIES THAT SHE COMES IN AND SHE OBSERVES A SHOT
25 BEING ADMINISTERED TO HER MOTHER-IN-LAW IN THE MORNING WHEN
4417
1 SHE'S THERE TO ATTEND TO HER. BONNIE COMES IN AT 12
2 O'CLOCK, AROUND NOON. BONNIE SAYS THAT DR. WEITZEL COMES IN
3 AT THAT TIME, TELLS HER THAT HE'S GOING TO HAVE HER GIVE A
4 10 MILLIGRAM SHOT OF MORPHINE. SHE QUESTIONS HIM ON THAT
5 AND AT THAT TIME SAYS, WHY? WHY? SHE'S NOT IN ANY PAIN.
6 SHE'S JUST LAYING THERE. AND AT THAT POINT HE MAKES SOME
7 EXCUSES, LEAVES TO GO TO WEST VALLEY OR WHATEVER AND THEN A
8 FEW MINUTES LATER IN WALKS A NURSE. BONNIE TRIES TO PROTEST
9 AND BEFORE SHE CAN EVEN GET UP ON HER FEET, THE NURSE ROLLS
10 THE PATIENT OVER AND GIVES HER THE SHOT OF MORPHINE. AND
11 WHAT HAPPENS? 45 MINUTES LATER SHE'S DEAD. CAUSATION. IS
12 THAT NOT CONSISTENT WITH CAUSE OF DEATH?
13 ENNIS ALLDREDGE. NOW, WE'VE HAD FOUR PATIENTS DIE UP
14 TO THIS POINT. WE COME TO ENNIS ALLDREDGE WHO'S ADMITTED ON
15 JANUARY THE 10TH. AND IMMEDIATELY BECAUSE OF THE BEHAVIORAL
16 PATTERN THAT HE'S EXHIBITED AT THE CARE CENTER UP IN LOGAN,
17 HE'S PLACED ON SUBSTANTIAL DOSAGES OF HALDOL. HE RECEIVES A
18 HALF DOSE OF ATIVAN. AND THERE'S OTHER DRUGS ORDERED BUT
19 THEY WERE NOT GIVEN. THE NEXT DAY ON THE 11TH HE RECEIVES
20 SOME ADDITIONAL PSYCHOTROPIC MEDICATIONS BUT IT'S NOT UNTIL
21 THE 12TH THAT WE SEE A DISTINCT PATTERN START TO DEVELOPE
22 WITH ENNIS BECAUSE HE'S GIVEN MORE HALDOL, SOME BUSPAR, MORE
23 ATIVAN. AND IT'S ON THAT DATE THAT ENNIS ALLDREDGE IS TAKEN
24 DOWN FOR AN M.R.I. AND HE'S -- THE RADIOLOGY REPORT COMES
25 BACK. DR. WEITZEL READS THAT RADIOLOGY REPORT THE FOLLOWING
4418
1 MORNING ON JANUARY 13.
2 THE RADIOLOGY REPORT -- AND YOU CAN SEE IN THE RECORDS
3 THAT YOU'LL HAVE INDICATED THAT IT IS COMPROMISED. IT'S
4 COMPROMISED. THE RADIOLOGIST IS SAYING, HEY, I CANNOT TELL
5 FOR SURE WHETHER OR NOT THIS INDIVIDUAL SUFFERED A STROKE.
6 THERE ARE SOME FINDINGS THAT MIGHT INDICATE THAT, BUT THERE
7 WAS SO MUCH MOVEMENT BY MR. ALLDREDGE, IT'S A COMPROMISED
8 REPORT. WHAT DO WE HAVE? THE RESPONSE TO THAT BY THE
9 DEFENDANT IS CALL VONDA ALLDREDGE. AND ACCORDING TO HIS
10 TESTIMONY, SHE AGREED TO TAKE ENNIS OFF EVERYTHING AND TO
11 ADMINISTER COMFORT CARE. AND THAT COMFORT CARE AGAIN
12 BECOMES MORPHINE.
13 IF MORPHINE -- NOW, THE DEFENDANT KNOWS THAT FOUR
14 PATIENTS BEFORE THAT HAVE BEEN ADMINISTERED MORPHINE AND
15 DURAGESIC PATCH IN THE CARE OF MARY CRANE. ALL HAVE DIED.
16 SO HE ADMINISTERS MORPHINE TO ENNIS ALLDREDGE. IN ADDITION
17 TO THE MORPHINE, HE ALSO GIVES ATIVAN, ANOTHER CENTRAL
18 NERVOUS SYSTEM DEPRESSANT. ON THE 13TH ENNIS RECEIVES A
19 TOTAL OF 60 MILLIGRAMS OF MORPHINE. LOOK AT THE CHART, THE
20 ACTIVITY, HE'S DOWN AT THE BOTTOM. ON THE 14TH YOU'LL NOTE
21 AGAIN A WHITE SPACE HERE. THAT MORPHINE WAS WITHHELD. OF
22 COURSE, IT WAS WITHHELD AT THE END OF HIS LIFE OR TOWARD THE
23 END OF HIS LIFE, BUT HERE YOU HAVE A DISTINCT PATTERN AGAIN.
24 HE DROPS DOWN. I WOULD SUBMIT TO YOU CAUSATION. IS THIS
25 SUPPORTIVE OF THE TESTIMONY OF THE EXPERTS IN THIS MATTER
4419
1 FOR THE STATE? I THINK IT DEMONSTRATES THE WHOLE PICTURE,
2 LADIES AND GENTLEMEN. THE TESTIMONY DEMONSTRATES THE
3 PICTURE OF CAUSATION AND IT ALSO DEMONSTRATES THE KNOWLEDGE
4 THAT THIS PHYSICIAN HAS.
5 WHEN YOU GET INTO YOUR DELIBERATIONS, ONE OF THE THINGS
6 YOU CAN DO IS WHETHER WE HAVE THE FIVE DEATHS IN CONJUNCTION
7 WITH ONE ANOTHER, YOU CAN INFER CONDUCT FROM THE OTHER
8 DEATHS IF IT'S CONSISTENT WITH THE CONDUCT IN A PARTICULAR
9 CASE. THIS IS CONSISTENT CONDUCT. THE ACT OF DEATH IN
10 THESE CASES IS PRIMARILY MORPHINE. THE MECHANICS OF DEATH
11 THAT PRECIPITATES THE DYING PROCESS IS USUALLY THE OTHER
12 MEDICATIONS THAT ARE ADMINISTERED IN EXCESSIVE MANNER. I'VE
13 GONE ON A LONG TIME HERE, BUT I HOPE IT'S HELPED TO CLARIFY
14 WHAT THE STATE FEELS IS THE IMPORTANT EVIDENCE THAT
15 DEMONSTRATES THIS DEFENDANT'S CONDUCT IN CAUSING THESE
16 DEATHS.
17 THE LAST SECTION THAT I NEED TO TALK ABOUT FOR A FEW
18 MINUTES IS INTENT. YOU HAVE KNOWLEDGE, YOU HAVE CAUSATION
19 AND YOU HAVE INTENT. INTENT IS -- AS YOU ARE INSTRUCTED IN
20 INSTRUCTION 26, INTENT IS BEING A STATE OF MIND AS SELDOM IS
21 ACCEPTABLE BY PROFFER, BY DIRECT AND POST-EVIDENCE AND MAY
22 BE ORDINARILY -- AND IT MAY ORDINARILY BE INFERRED FROM
23 ACTS, CONDUCT, STATEMENTS AND CIRCUMSTANCES. THAT MAKES
24 SENSE.
25 HOW DO I KNOW WHAT'S IN YOUR MIND WHEN YOU DO
4420
1 SOMETHING? THE ONLY WAY THAT I CAN PERCEIVE WHAT'S IN YOUR
2 MIND IS BY WHAT YOU DO, OBVIOUSLY. AND WHAT THIS
3 INSTRUCTION IS SAYING? SO WHAT YOU DO IS YOU RELATE THE
4 CONDUCT AND THEN YOU CAN INFER FROM THAT CONDUCT THE
5 REQUISITE INTENT.
6 NOW, THERE IS A COUPLE OF OTHER INSTRUCTIONS THAT GO
7 ALONG WITH THAT. AND THE COURT HAS TALKED TO YOU AND YOU'VE
8 INDICATED OR IT'S INDICATED IN THE INSTRUCTIONS THAT WHEN
9 YOU REVIEW THIS EVIDENCE AS IT RELATES TO THESES FIVE
10 INDIVIDUALS YOU HAD, THAT YOU WILL HAVE THE OPPORTUNITY TO
11 CONSIDER NOT ONLY THE INTENT ASPECT FOR THE CRIME OF MURDER,
12 WHICH IS INTENTIONALLY, KNOWINGLY OR ACTING UNDER
13 CIRCUMSTANCES OF DEPRAVED INDIFFERENCE, BUT YOU ALSO HAVE
14 THE OPPORTUNITY IF YOU DO NOT FEEL THAT THERE IS SUFFICIENT
15 EVIDENCE TO SUPPORT THE INTENTIONAL AND KNOWING ABILITY, TO
16 LOOK AT THAT FROM THE STANDPOINT OF CRIMINAL RECKLESSNESS OR
17 CRIMINAL NEGLIGENCE. THOSE ARE ALTERNATIVES THAT YOU HAVE
18 AVAILABLE TO YOU IN MAKING YOUR DECISION. I DON'T THINK
19 THAT'S THE EVIDENCE, EVEN THOUGH THE EVIDENCE SUPPORTS THOSE
20 LESSER INTENT ASPECTS.
21 IT'S THE STATE'S POSITION THAT THE EVIDENCE CLEARLY
22 DEMONSTRATES THAT THE DEFENDANT KNEW THAT HE ENGAGED IN
23 CONDUCT PURSUANT TO HIS KNOWLEDGE OF THE EFFECT OF THESE
24 DRUGS WITH THE INTENT TO CAUSE A DEATH. SO I WOULD SUBMIT
25 TO YOU THAT THE EVIDENCE CLEARLY DEMONSTRATES THAT THIS
4421
1 DEFENDANT ACTED KNOWINGLY AND INTENTIONALLY, AT LEAST IN
2 RESPECT TO THE FOUR CASES WHICH FROM THE OPENING STATEMENT
3 WERE CATEGORIZED AS COMFORT CARE CASES.
4 IN RESPECT TO ELLEN ANDERSON, IN THAT PARTICULAR CASE I
5 THINK THE CONDUCT IN THIS SETTING IS ONE OF DISREGARD TO THE
6 POINT THAT IT BECOMES DEPRAVED. HE DIDN'T EVALUATE. HE
7 CALLS IN ON THE TELEPHONE. IN FACT, IN ALL OF THESE CASES
8 IF YOU REVIEW THE RECORD YOU'LL FIND THAT A GOOD NUMBER OF
9 THOSE MEDICATION ORDERS ARE MADE OVER THE TELEPHONE. THEY
10 ARE NOT MADE IN RESPECT TO THE PERSONAL EVALUATION OF THE
11 PATIENT. THEY ARE MADE OVER THE TELEPHONE BY THIS
12 PHYSICIAN. IN A GOOD NUMBER OF THOSE CASES YOU'LL FIND THAT
13 HE FAILS TO MONITOR EFFECTIVELY.
14 NOW, IN ONE INSTANCE, IN JUDITH LARSEN, HE TELLS THEM
15 TO STOP MONITORING HER ANY MORE THAN ONCE EVERY SHIFT. HE
16 HAS THIS PATIENT ON MORPHINE. HE INDICATES THAT THE NURSES
17 UNFORTUNATELY WERE WITHHOLDING THAT. AGAIN, AN INTENTIONAL,
18 KNOWING ACT ON HIS PART. IT'S CONDUCT THAT HE'S AWARE OF
19 AND CONDUCT THAT HE'S AWARE OF IN RESPECT TO THE RISKS
20 ASSOCIATED WITH THAT.
21 A COUPLE OF OTHER QUICK COMMENTS. INSTRUCTION NUMBER
22 37 TALKS ABOUT THE CREDIBILITY OF WITNESSES AND IT SAYS,
23 "YOU ARE THE SOLE JUDGES OF THE WEIGHT OF THE EVIDENCE,
24 CREDIBILITY OF THE WITNESSES AND THE FACTS. IN CONSIDERING
25 THE TESTIMONY OF A WITNESS YOU MAY CONSIDER THEIR APPEARANCE
4422
1 AND THEIR DEMEANOR, THEIR FRANKNESS AND THEIR CANDOR OR WANT
2 OF IT, THEIR OPPORTUNITY TO OBSERVE, THEIR ABILITY TO
3 UNDERSTAND, THEIR CAPACITY TO REMEMBER. YOU MAY CONSIDER
4 THE INTEREST, IF ANY IS SHOWN, WHICH ANY WITNESS MAY HAVE IN
5 THE RESULT OF THIS TRIAL OR ALSO ANY BIAS THEY MAY HAVE OR
6 ANY MOTIVE OR PROBABLE MOTIVE WHICH ANY WITNESS MAY HAVE TO
7 TESTIFY FOR OR AGAINST A PARTY."
8 YOU OUGHT TO INCLUDE THAT INSTRUCTION AND YOU OUGHT TO
9 CONSIDER IT IN LIGHT OF THE WITNESSES AND ALONG WITH THOSE
10 WITNESSES, REVIEW THAT SAME INSTRUCTION ALONG WITH ANOTHER
11 INSTRUCTION YOU ARE GIVEN AS TO EXPERT WITNESSES.
12 NOW, YOU'VE HAD WHAT, 20 DOCTORS TESTIFY IN THESE
13 PROCEEDINGS AND WE'VE ALL HEARD MORE MEDICAL TERMINOLOGY WE
14 PROBABLY EVER WANTED TO HEAR IN OUR LIVES. BUT DON'T LET
15 THAT CONFUSE YOU. DON'T LET THE TESTIMONY CONFUSE YOU
16 BECAUSE I THINK WHAT YOU HAVE TO DO IS YOU HAVE TO USE YOUR
17 COMMON SENSE AND YOU HAVE TO LOOK AT THESE PATTERNS OF
18 CONDUCT THAT THIS DOCTOR HAS ENGAGED IN.
19 I WOULD RESPECTFULLY SUBMIT TO YOU THAT IN EACH COUNT
20 THE STATE HAS MET ITS BURDEN OF PROOF BEYOND A REASONABLE
21 DOUBT. THAT THE EVIDENCE BEFORE YOU AT THIS TIME
22 DEMONSTRATES THAT THE DEFENDANT ENGAGED IN A PROCESS OF
23 EUTHANASIA, A PROCESS THAT IS NOT ALLOWED BY THE LAWS OF THE
24 STATE OF UTAH. THAT FOUR OF THESE PATIENTS WERE PUT TO
25 DEATH BY THE DEFENDANT. THIS IS NOT A COMFORT CARE CASE,
4423
1 THIS IS NOT A MEDICAL DIRECTIVE CASE, SEEMS TO BE -- SEEMS
2 TO ME VERY DIFFICULT TO EXPLAIN A MEDICAL DIRECTIVE CASE OF
3 ACTING IN GOOD FAITH. HOW CAN YOU ACT IN GOOD FAITH AND
4 COMMIT MURDER? HOW CAN YOU TAKE THE LIFE OF A HUMAN BEING
5 AND ACT IN GOOD FAITH? THOSE ARE THE QUESTIONS AND WE THINK
6 THE FACTS DEMONSTRATE BEYOND ANY REASONABLE DOUBT THAT HE
7 ENGAGED IN THE PROCESS AND THAT HE ACTED WITH DEPRAVED
8 INDIFFERENCE WHEN IT CAME TO ELLEN ANDERSON IN CAUSING HER
9 DEATH IN THE FASHION THAT HE CAUSED IT. AND I WOULD
10 RESPECTFULLY REQUEST THAT YOU RETURN A VERDICT OF GUILTY AS
11 CHARGED ON ALL FIVE COUNTS. THANK YOU.