Rachel Stubbs
8 RACHEL STUBBS,
9 CALLED AS A WITNESS, BEING FIRST DULY SWORN,
10 WAS EXAMINED AND TESTIFIED AS FOLLOWS:
11 DIRECT EXAMINATION
12 BY MR. MAJOR:
13 Q. DOCTOR, WILL YOU STATE YOUR FULL NAME FOR THE RECORD
14 PLEASE?
15 A. RACHEL STUBBS.
16 Q. AND WHAT IS YOUR OCCUPATION?
17 A. I'M A PHYSICIAN.
18 Q. AND HOW LONG HAVE YOU BEEN A PHYSICIAN?
19 A. GRADUATED FROM MEDICAL SCHOOL IN 1989, AND COMPLETED MY
20 RESIDENCY IN 1992.
21 Q. AND AFTER COMPLETING YOUR RESIDENCY, WHAT TYPE OF
22 PRACTICE DID YOU ENTER INTO?
23 A. INTERNAL MEDICINE PRACTICE.
24 Q. AND WHERE WAS THAT PRACTICE LOCATED?
25 A. IN SALT LAKE CITY.
409
1 Q. AND HOW LONG WERE YOU PRACTICING IN INTERNAL MEDICINE?
2 A. I WAS WITH -- I WAS A MEMBER OF THAT PRIVATE PRACTICE
3 FOR ABOUT SIX YEARS.
4 Q. OKAY. AND AFTER YOU HAD DONE THAT, WHERE DID YOU GO?
5 A. I LEFT THAT PRACTICE ABOUT EXACTLY TWO YEARS AGO TO
6 STRICTLY FOCUS ON GERIATRIC CARE, AND I GO TO A NUMBER OF
7 DIFFERENT NURSING HOMES AND SEE RESIDENTS THERE.
8 Q. SO BACK IN 1994 THROUGH ABOUT 1996, YOU WOULD HAVE BEEN
9 WORKING AS AN INTERNAL MEDICINE SPECIALIST.
10 A. RIGHT.
11 Q. AND ARE YOU BOARD CERTIFIED IN ANY AREAS?
12 A. BOARD CERTIFIED IN INTERNAL MEDICINE.
13 Q. AND GENERALLY WOULD YOU TELL THE JURY WHAT WAS THE
14 NATURE OF YOUR PRACTICE DURING 1994 TO '96 PERIOD?
15 A. AN OUTPATIENT INTERNAL MEDICINE PRACTICE. SAW A VARIETY
16 OF PEOPLE FROM YOUNG HEALTHY PEOPLE COMING IN FOR ROUTINE
17 EXAMS TO PEOPLE BOTH YOUNG AND OLD WITH SERIOUS MEDICAL
18 PROBLEMS.
19 Q. AND WHEN YOU SAY OUTPATIENT, WHAT DOES THAT BASICALLY
20 IMPLY?
21 A. AN OFFICE PRACTICE WHERE PEOPLE WOULD COME TO SEE ME IN
22 MY OFFICE.
23 Q. NOW, ARE YOU FAMILIAR WITH AN INDIVIDUAL THAT WAS NAMED
24 MARY CRANE?
25 A. YES, I AM.
410
1 Q. WHEN DID YOU FIRST START SEEING MISS CRANE?
2 A. ACCORDING TO THE NOTES THAT I HAVE ON HER, COPIES OF
3 NOTES I HAVE ON HER, I STARTED SEEING HER EARLY DECEMBER OF
4 1994.
5 Q. WHAT WAS THE REASON THAT YOU STARTED SEEING HER IN 1994?
6 A. MARY LIVED AT A NURSING HOME AND BY REQUIREMENT HAD
7 EVERY 60-DAY RECERTIFICATION VISITS, AND SO THE FIRST VISIT
8 WOULD HAVE JUST BEEN A ROUTINE VISIT.
9 Q. AND WHAT NURSING HOME WAS SHE LIVING IN?
10 A. SANDY REGIONAL.
11 Q. AND SO YOU SAW HER YOU SAID EVERY 60 DAYS?
12 A. RIGHT.
13 Q. FOR HOW LONG A PERIOD OF TIME DID THAT GO?
14 A. WELL, UNTIL SHE LEFT SANDY REGIONAL TO GO TO THE
15 GERIATRIC PSYCHIATRIC UNIT.
16 Q. AND HOW WOULD YOU -- WHAT WAS THE CIRCUMSTANCES
17 SURROUNDING YOUR SEEING HER? BASICALLY DESCRIBE HOW THAT
18 WOULD WORK.
19 A. I SAW HER RIGHT IN MY OFFICE. USUALLY HER DAUGHTER.
20 KAREN BRINGHURST WOULD BRING HER FROM THE NURSING HOME TO MY
21 OFFICE.
22 Q. AND WHAT TYPE OF THINGS WOULD YOU DO WHEN SHE CAME TO
23 YOUR OFFICE GENERALLY?
24 A. MARY WOULD COME WITH A REFERRAL SHEET FROM THE NURSING
25 HOME WHICH WOULD HAVE ANY CONCERNS THAT THE NURSES AT THE
411
1 NURSING HOME HAD ON THERE AS WELL AS A LIST OF HER
2 MEDICATIONS, AND I WOULD REVIEW THOSE THINGS WITH HER
3 DAUGHTER KAREN. WE'D DISCUSS ANY CONCERNS THAT KAREN HAD
4 ALSO. AND I WOULD DO A PHYSICAL EXAM AND SOMETIMES LAB WORK
5 AND THEN WRITE ORDERS AND SHE'D GO BACK.
6 Q. AND WHAT DID THE PHYSICAL EXAM USUALLY CONSIST OF JUST
7 GENERALLY?
8 A. MOST OF THE TIME IS KIND OF A BASIC EXAM, VITAL SIGNS,
9 LISTENING TO HER HEART, LUNGS.
10 Q. THOSE TYPE THINGS.
11 A. A BASIC EXAM. PERIODICALLY SHE'D HAVE A MORE COMPLETE
12 EXAM.
13 Q. AND THIS OCCURRED ABOUT EVERY 60 DAYS YOU SAID?
14 A. YEAH, RIGHT.
15 Q. AND WHAT WAS -- DURING THIS PERIOD OF TIME THAT YOU WERE
16 DOING THIS EXAM OF MARY CRANE EVERY 60 DAYS, WHAT WAS HER
17 GENERAL HEALTH LIKE?
18 A. MARY'S -- MARY'S HEALTH DURING THE TIME I SAW HER WAS
19 QUITE STABLE. IN FACT, I DON'T RECALL ANY SERIOUS MEDICAL
20 PROBLEMS COMING UP WHILE I WAS -- DURING THE TIME THAT I SAW
21 HER. REALLY QUITE STABLE.
22 Q. AND WHAT WAS HER GENERAL MENTAL HEALTH, DO YOU KNOW?
23 A. SHE DID HAVE A HISTORY OF DEPRESSION WITH SOME PSYCHOTIC
24 FEATURES, AND WAS ON MEDICATION FOR THIS. SHE DID HAVE SOME
25 BEHAVIORAL PROBLEMS AT THE NURSING HOME, COMBATIVENESS,
412
1 YELLING OUT, REPETITIVE TYPE BEHAVIORS. AND THAT WOULD SORT
2 OF, YOU KNOW, SHE'D GO THROUGH PERIODS WHERE IT WAS OKAY AND
3 PERIODS WHERE IT WAS WORSE AND --
4 Q. AND FOR ABOUT HOW LONG A PERIOD OF TIME DID THIS TAKE
5 PLACE?
6 A. THE ENTIRE TIME THAT I WAS SEEING HER.
7 Q. AND DID IT APPEAR TO BECOME WORSE DURING THE TIME THAT
8 YOU KNEW HER?
9 A. NOT -- NOT OVERALL. LIKE I SAY, THERE WERE TIMES WHEN
10 IT WOULD BE WORSE AND TIMES WHEN IT WAS NOT SO BAD AND JUST
11 KIND OF COME AND GO LIKE THAT.
12 Q. OKAY. AND YOU INDICATED EVENTUALLY THAT SHE WAS SENT UP
13 TO THE GEROPSYCH UNIT AT DAVIS HOSPITAL, IS THAT CORRECT?
14 A. RIGHT.
15 Q. WERE YOU FAMILIAR WITH THAT UNIT?
16 A. I WAS NOT AT ALL.
17 Q. AND HOW WAS IT THAT THIS UNIT CAME TO YOUR ATTENTION OR
18 THE FACT THAT MARY WAS BEING TAKEN TO THAT UNIT?
19 A. I'M NOT SURE THAT I -- THAT I REALLY RECALL THAT. I
20 KNOW THAT MARY WAS GOING THROUGH A PERIOD WHERE HER
21 BEHAVIORAL PROBLEMS WERE WORSE, AND I WASN'T REALLY INVOLVED
22 IN THE DECISION TO SEND HER UP THERE. THE FAMILY WAS KIND
23 OF GIVEN AN ULTIMATUM I BELIEVE, EITHER THEY WOULD NEED TO
24 GET HER SOME INPATIENT PSYCHIATRIC ATTENTION OR MOVE HER TO
25 ANOTHER FACILITY, AND THEY CHOSE TO SEND HER UP THERE.
413
1 Q. DO YOU RECALL ABOUT WHEN IT WAS THAT MARY WAS
2 TRANSFERRED UP TO THE DAVIS UNIT?
3 A. I BELIEVE IT WAS THE END OF DECEMBER OF '95.
4 Q. HAD YOU SEEN HER PRIOR TO HER GOING UP TO THAT UNIT?
5 A. IT HAD BEEN ABOUT A MONTH, SHE WOULD HAVE BEEN -- SHE
6 WOULD HAVE BEEN DUE FOR HER NEXT VISIT IN JANUARY.
7 Q. OKAY. AND DO YOU RECALL -- YOU'VE HAD A CHANCE TO
8 REVIEW THE MEDICAL NOTES INVOLVED WITH THAT. DO YOU RECALL
9 ANYTHING SPECIFIC ABOUT THE LAST TIME THAT YOU CONDUCTED A
10 CONSULT WITH MARY BEFORE SHE WENT TO THE UNIT?
11 A. THERE WAS NOTHING REMARKABLE. IT WAS JUST A ROUTINE
12 EXAMINATION, NOTHING OUT OF THE ORDINARY.
13 Q. WHAT WAS HER PHYSICAL CONDITION LIKE?
14 A. SAME AS USUAL. STABLE, YOU KNOW, SHE WAS IN A
15 WHEELCHAIR DUE TO HER PRIOR STROKE, BUT UNCHANGED FROM
16 BEFORE.
17 Q. DO YOU KNOW APPROXIMATELY WHEN HER STROKE HAD OCCURRED?
18 A. I THINK -- I THINK IT WAS SOMEWHERE AROUND 1990.
19 Q. SO SHE'D BEEN IN A WHEELCHAIR FOR MOST OF THE TIME THAT
20 YOU KNEW HER?
21 A. RIGHT.
22 Q. OKAY. SO THIS IS NOT SOMETHING THAT WAS JUST
23 SUDDENLY --
24 A. OH, RIGHT.
25 Q. -- BROUGHT ON?
414
1 A. NO, NO CHANGE.
2 Q. AND PRIOR TO HER GOING ONTO THIS UNIT, HAD SHE SUFFERED
3 ANY TYPE OF INJURIES?
4 A. SHE DID HAVE A -- A PELVIC FRACTURE THAT SHE SUFFERED AS
5 A RESULT OF A FALL. I DON'T REMEMBER THE EXACT DATE. AND
6 SHE WAS SEEN BY AN ORTHOPEDIC SURGEON, DR. BORN, WHO SAID
7 THAT IT COULD BE TREATED WITHOUT SURGERY, AND HE SENT HER
8 BACK TO THE NURSING HOME.
9 Q. BASED ON YOUR REVIEW OF THE MEDICAL RECORDS, WAS SHE
10 HOSPITALIZED AT ALL?
11 A. FROM THE RECORDS THAT I'VE SEEN, I DIDN'T SEE THAT SHE
12 WAS. I SAW AN EMERGENCY ROOM REPORT WHERE DR. BORN
13 EVALUATED HER. WHETHER SHE WAS ADMITTED, I'M NOT SURE ABOUT
14 THAT.
15 Q. AND DURING THE PERIOD OF TIME THAT YOU WERE TREATING
16 MARY CRANE, AND LET'S SAY SPECIFICALLY DURING THE SIX MONTHS
17 PRIOR TO HER GOING ONTO THE UNIT, HAD SHE -- BASED ON YOUR
18 EXAMINATION, WAS SHE SUFFERING FROM ANY PAIN?
19 A. MARY WOULD COMPLAIN EVERY TIME I SAW HER OF HAVING A
20 HEADACHE, AND THIS WAS APPARENTLY KIND OF AN ONGOING THING
21 EVEN FROM BEFORE I KNEW HER. AND SOMETIMES I WOULD LOOK AT
22 HER AND COULD SEE THAT SHE DID HAVE A HEADACHE, THAT SHE
23 LOOKED UNCOMFORTABLE. AND OTHER TIMES SHE DID NOT LOOK LIKE
24 SHE WAS IN PAIN. AND THIS WAS HAPPENING AT THE NURSING
25 HOME, TOO. Practitioners now know better than to second guess this.
415
1 Q. OKAY. AND WHAT DID YOU DO FOR THIS?
2 A. MARY HAD THIS TYLENOL ORDERED FOR HEADACHES. SHE ALSO
3 DID HAVE SOME HYDROCODONE ORDERED WHERE SHE DID HAVE MORE
4 SEVERE PAIN, SEVERE HEADACHE. AND FROM WHAT -- FROM
5 REVIEWING THE RECORDS AND ALSO FROM TALKING TO HER DAUGHTER,
6 THE HYDROCODONE WAS USED INFREQUENTLY, LESS THAN ONE PER
7 DAY. MOST OF THE TIME THEY GAVE HER TYLENOL, AND FROM !!
8 LOOKING AT THE NURSES' NOTES, IT WAS CHARTED AS BEING
9 HELPFUL.
10 Q. AND WHAT WAS THAT BEING GIVEN FOR, THE HYDROCODONE AND
11 THE TYLENOL?
12 A. USUALLY FOR HEADACHES, I BELIEVE.
13 Q. OKAY. BASED ON YOUR REVIEW OF THE NOTES AND YOUR
14 EXAMINATION OF HER, DID SHE HAVE ANY PAIN IN ANY OTHER
15 AREAS?
16 A. WELL, IMMEDIATELY AFTER THIS PELVIC FRACTURE OF COURSE
17 SHE HAD SOME PELVIC PAIN.
18 Q. UH-HUH. DO YOU KNOW WHAT SHE WAS GIVEN FOR THAT?
19 A. I -- AS FAR AS I KNOW, SAME ORDERS. I -- FROM --
20 NOTHING ELSE WAS ORDERED BY ME, I KNOW THAT. AND I DON'T
21 SEE ANY RECORD OF ANYTHING ELSE BEING ORDERED BY DR. BORN.
22 Q. NOW, OTHER THAN THE PAIN THAT -- HER HIP, THE PAIN SHE
23 WOULD HAVE FROM THE HIP FRACTURE, WAS THERE ANYTHING ELSE
24 THAT YOU OBSERVED THAT WOULD HAVE CAUSED PAIN?
25 A. NO. JUST HER ONGOING HEADACHE COMPLAINTS. AND SHE'D
416
1 SOMETIMES COMPLAIN OF SOME LOW BACK PAIN, BUT THAT WAS MORE
2 A CHRONIC STABLE THING, NOT ANYTHING ACUTE.
3 Q. NOW, DURING THESE VISITS, WAS SHE LUCID?
4 A. SOMETIMES MORE THAN OTHERS.
5 Q. BUT SHE COULD COMMUNICATE WITH YOU.
6 A. RIGHT.
7 Q. EXPRESS PAIN.
8 A. RIGHT.
9 Q. WAS THAT PRETTY MUCH THE SAME UP UNTIL THE MONTH -- LAST
10 TIME YOU SAW HER BEFORE SHE WENT IN THE UNIT?
11 A. IT -- IT WAS, YEAH.
12 Q. UP UNTIL THAT POINT IN TIME AND BASED ON YOUR
13 EXAMINATION AND REVIEW OF THE REPORTS, DID YOU SEE ANY
14 MEDICAL CONDITION AT ALL THAT MARY CRANE SUFFERED FROM,
15 PHYSICAL CONDITION?
16 A. YOU MEAN SOMETHING -- AN ACUTE PROBLEM OR --
17 Q. AN ACUTE PROBLEM.
18 A. NO. SHE HAD SOME OTHER ONGOING CHRONIC PROBLEMS, BUT
19 NOTHING ACUTE. SHE WOULD HAVE BLADDER INFECTIONS
20 PERIODICALLY.
21 Q. OKAY. AND WHEN YOU HAD TALKED ABOUT THE PHYSICAL PAIN,
22 PHYSICAL THAT YOU DID ABOUT EVERY 60 DAYS, WAS THERE ANY
23 TYPE OF BLOOD WORK THAT WAS RUN ON HER?
24 A. SOMETIMES -- SOMETIMES WE ORDERED BLOOD WORK THROUGH MY
25 OFFICE. USUALLY IT WAS DONE THROUGH HER NURSING HOME. IN
417
1 FACT, SHE WAS ON A SCHEDULE, I THINK, EVERY SIX WEEKS OF
2 HAVING SOME ROUTINE BLOOD WORK.
3 Q. OKAY. WHAT WAS THE REASON FOR THAT?
4 A. SHE HAD A HISTORY OF HAVING HYPONATREMIA, LOW SODIUM IN
5 HER BLOOD, AND SO IT WAS PRIMARILY DONE TO CHECK AND MAKE
6 SURE HER SODIUM WAS OKAY.
7 Q. AND WHAT IS THAT? CAN YOU DESCRIBE WHAT THAT IS FOR THE
8 JURY?
9 A. HYPONATREMIA? IT'S -- JUST MEANS LOW SODIUM IN THE
10 BLOOD.
11 Q. AND DO YOU KNOW HOW THAT'S CAUSED OR WHAT WAS CAUSING
12 THAT --
13 A. I'M NOT SURE. I DON'T RECALL IN MARY. IT CAN BE CAUSED
14 BY A VARIETY OF THINGS. AND I -- I'M ACTUALLY NOT SURE THAT
15 I RECALL. This woman calls herself an internal medicine specialist.
16 Q. OKAY. HOW LONG HAD SHE HAD THIS SITUATION?
17 A. I'M NOT SURE ABOUT THAT EITHER. SINCE BEFORE I KNEW
18 HER.
19 Q. BUT AT LEAST DURING THE PERIOD OF TIME FROM '94 UNTIL
20 '96, AT THE TIME YOU KNEW HER, SHE HAD THAT SITUATION.
21 A. RIGHT.
22 Q. HOW WAS SHE TREATED? WHAT WAS SHE GIVEN FOR THAT
23 CONDITION?
24 A. DURING THE TIME THAT I WAS SEEING HER, I DON'T THINK WE
25 HAD TO GIVE HER ANYTHING. IT WAS NEVER -- IT NEVER BECAME A
418
1 BIG PROBLEM DURING THE TIME I WAS SEEING HER. I -- I
2 BELIEVE THAT THEY DID TRY TO RESTRICT THE AMOUNT OF WATER
3 THAT SHE DRANK. AND AS I RECALL IT MAY HAVE BEEN A
4 CONTRIBUTING FACTOR THAT SHE'D DRINK EXCESSIVE AMOUNTS OF
5 WATER.
6 Q. NOW, IF YOU'RE DRINKING EXCESSIVE AMOUNTS OF WATER, HOW
7 DOES THAT AFFECT YOUR SODIUM?
8 A. WELL, IT CAN MAKE YOUR -- IT CAN DROP YOUR BLOOD SODIUM
9 IF YOU DRINK TO EXTREME, DRINKING WATER TO EXTREME.
10 Q. HOW DOES IT DO THAT?
11 A. WELL, BASICALLY A DILUTIONAL EFFECT.
12 Q. OKAY. AND DRINKING EXCESSIVE AMOUNTS OF WATER I ASSUME
13 MAKES YOU URINATE MORE FREQUENTLY.
14 A. RIGHT.
15 Q. SO YOU PASS SODIUM OUT OF THE BODY? SO MARY DID HAVE
16 THAT SITUATION, THEY WERE RESTRICTING FLUID INTAKES.
17 A. RIGHT. BUT DURING THE TIME THAT I SAW HER, IT WAS NEVER
18 A SERIOUS ENOUGH PROBLEM THAT WE HAD TO HOSPITALIZE HER OR
19 DO ANYTHING LIKE THAT.
20 Q. OKAY. AND BASED ON YOUR TRAINING AND EXPERIENCE, IS
21 THAT TYPE OF A CONDITION SOMETHING THAT IS CHRONIC?
22 A. IT IS. WELL, YEAH.
23 Q. DOES IT EVER BECOME ACUTE WHERE IT SUDDENLY BECOMES
24 LIFE-THREATENING?
25 A. IT CAN, BUT AS I SAY WITH HER, THAT NEVER HAPPENED. IN
419
1 FACT, SHE HAD -- HER LAST BLOOD PANEL WAS JUST ABOUT TWO
2 WEEKS BEFORE SHE LEFT SANDY REGIONAL AND HER SODIUM WAS FINE
3 THEN, IT WAS OKAY.
4 Q. AND WAS ANY OF YOUR -- I GUESS URINALYSIS, WHEN YOU'RE
5 TESTING HER URINE DONE WHILE SHE WAS UNDER YOUR CARE?
6 A. OH, FAIRLY FREQUENTLY BECAUSE SHE DID HAVE A NUMBER OF
7 BLADDER INFECTIONS WHICH WERE TREATED WITH ANTIBIOTICS. AND
8 ACTUALLY ON -- IN MY LAST NOTE FROM NOVEMBER, KAREN, HER
9 DAUGHTER, AND I DISCUSSED THIS AND WE DECIDED TO JUST ORDER
10 A ROUTINE MONTHLY URINALYSIS JUST TO -- TO LOOK FOR BLADDER
11 INFECTIONS.
12 Q. OKAY. AND SO THAT WAS DONE HOW OFTEN DID YOU SAY? I
13 MISSED THAT.
14 A. MONTHLY.
15 Q. MONTHLY. OKAY. DURING THE PERIOD OF TIME THAT YOU WERE
16 DOING THAT, DID YOU FIND BLADDER INFECTIONS WITH MARY CRANE?
17 A. WELL, THAT WAS -- THAT WAS ON MY LAST VISIT WITH HER
18 THAT I WROTE THAT ORDER.
19 Q. DID -- DURING PRI -- PRIOR TO THAT TIME, HAD YOU EVER
20 TREATED HER FOR BLADDER INFECTION?
21 A. YES. MORE THAN ONCE, I'M CERTAIN.
22 Q. OKAY. NOW, WHEN YOU'RE TREATING HER AND YOU'RE MAKING
23 THESE NOTES FOR HAVING URINALYSIS TAKEN, WERE THEY PLACED IN
24 HER MEDICAL RECORDS FROM THE HOSPITAL OR FROM THE NURSING
25 HOME?
420
1 A. SAY THAT AGAIN?
2 Q. I -- I -- I PROBABLY STUMBLED OVER THAT. THE ORDERS
3 THAT YOU HAD ABOUT TAKING THE URINE AND TESTING IT FOR
4 BLADDER INFECTION, WOULD THAT HAVE BEEN PART OF THE NURSING
5 HOME RECORDS, MEDICAL RECORDS?
6 A. THE ORDER FOR THAT?
7 Q. PARDON?
8 A. THE ORDER FOR THAT?
9 Q. YEAH.
10 A. RIGHT. THAT WAS WRITTEN ON -- WHAT HAPPENS WHEN A
11 NURSING HOME RESIDENT GOES TO A DOCTOR'S OFFICE IS A NURSING
12 HOME REFERRAL FORM GOES WITH THEM, AND ANY ORDERS I JUST
13 WRITE RIGHT ON THAT FORM AND THAT GOES BACK AND THEN THE
14 NURSES TAKE OFF THOSE ORDERS AND WRITE THEIR OWN --
15 Q. NOW, AS AN INTERNIST, I'M ASSUMING THAT IF SOMEONE WERE
16 TO HAVE A BLADDER INFECTION AND THAT WERE TO GO UNTREATED,
17 THAT COULD BECOME LIFE-THREATENING?
18 A. SURE, YES.
19 Q. IS THAT WHAT WE CALL SEPSIS?
20 A. RIGHT.
21 Q. IS THAT WHAT THE WORD IS? AND WHAT DOES THAT MEAN?
22 A. WELL, IF SOMEBODY REACHED THE POINT OF BEING SEPTIC,
23 THAT WOULD MEAN THE -- THEY'RE -- FROM A BLADDER INFECTION,
24 THAT WOULD MEAN THAT IT WAS SEVERE ENOUGH THAT BACTERIA WERE
25 THROUGHOUT THEIR BLOODSTREAM.
421
1 Q. OKAY. AND IS THERE ANY -- LET ME ASK YOU THIS: IS
2 THERE ANY PARTICULAR PERIOD OF TIME -- HOW LONG WOULD IT
3 TAKE FROM THE TIME YOU FIRST OBTAINED THE BLADDER INFECTION,
4 LET'S SAY IT WAS UNTREATED UNTIL YOU REACH A POINT OF
5 SEPSIS?
6 A. I THINK THAT COULD BE QUITE VARIABLE REALLY, JUST
7 DEPENDING ON THE PERSON.
8 Q. WELL, I UNDERSTAND. WOULD IT BE, YOU KNOW, DAY, TWO
9 DAYS, A WEEK?
10 A. PROBABLY MORE THAN A DAY TO TWO DAYS, BUT BEYOND THAT,
11 I'D SAY IT'S JUST AN INDIVIDUAL --
12 Q. TYPE OF THING.
13 A. -- THING.
14 Q. AND I KNOW I MAY BE -- WELL, LET ME ASK YOU THIS: WHAT
15 TYPE OF SYMPTOMS WOULD APPEAR IF SOMEONE WERE HAVING A
16 BLADDER INFECTION?
17 A. WELL, IF SOMEBODY -- IF THE PERSON WAS ABLE TO -- TO
18 TELL YOU, PROBABLY BURNING WITH URINATION, FREQUENCY OF
19 URINATION. MAY HAVE BLOOD IN THE URINE. FEVER. CHILLS.
20 Q. THOSE TYPE OF THINGS.
21 A. THAT -- PAIN OVER THE KIDNEY AREA.
22 Q. OKAY. NOW, DURING THE PERIOD OF TIME THAT MISS CRANE
23 WAS UNDER YOUR CARE, HAD SHE EVER -- YOU MENTIONED
24 HYDROCODONE, I THINK TYLENOL. HAD SHE EVER RECEIVED ANY
25 OTHER TYPE OF PAIN MEDICATION?
422
1 A. NOT THAT I PRESCRIBED. NOT -- I DON'T BELIEVE THAT I
2 PRESCRIBED ANY OTHER TYPE OF PAIN MEDICATION FOR HER. Codeine and Darvocet are charted.
3 Q. HAVING REVIEWED THE MEDICAL RECORDS FROM THE REST HOME,
4 DID YOU FIND ANY OTHER PAIN MEDICATION OTHER THAN THE
5 TYLENOL AND THE --
6 A. NO --
7 Q. -- CODONE?
8 A. -- NOT THAT I SAW.
9 Q. DID YOU SEE ANYWHERE WHERE SHE HAD BEEN ADMINISTERED ANY
10 MORPHINE?
11 A. NO.
12 Q. DID YOU YOURSELF ORDER ANY MORPHINE FOR MISS CRANE?
13 A. NO, I DON'T BELIEVE SO, NO.
14 Q. AND YOU DID NOT SEE ANYWHERE IN MEDICAL RECORDS WHERE
15 MORPHINE HAD BEEN ORDERED FOR HER?
16 A. NOT IN THE RECORDS THAT I SEEN FROM HER NURSING HOME.
17 Q. OKAY. WERE YOU DEALING WITH HER ON ANY OF HER
18 PSYCHOTIC -- PSYCHOTROPIC MEDICATIONS AT ALL THAT SHE WAS
19 ON?
20 A. I WAS, I -- SHE HAD BEEN FOLLOWED BY VALLEY MENTAL
21 HEALTH FOR I DON'T KNOW HOW LONG, SINCE BEFORE I'D SEEN HER,
22 AND SOMETIME DURING THAT TIME, I BELIEVE IT WAS IN 1994,
23 SOME -- NO, IN 1995 SOMETIME, THE VALLEY MENTAL HEALTH
24 DOCTOR CLOSED HER CASE. SHE HAD BEEN STABLE FROM A
25 PSYCHIATRIC STANDPOINT AND THEY JUST TURNED THAT OVER TO ME.
423
1 Q. OKAY. AND DURING THE PERIOD OF TIME THAT YOU'RE
2 TREATING HER FROM '95 TO '96, DID YOU SEE ANY CHANGE IN HER
3 MEDICATIONS? PSYCHOTROPIC TYPE OF MEDICATIONS?
4 A. I'D PROBABLY HAVE TO LOOK THROUGH, HERE AGAIN, TO BE
5 SURE. THERE -- I KNOW HER -- I BELIEVE HER TRANXENE DOSE
6 WAS INCREASED AT ONE POINT WHILE I WAS SEEING HER. AND
7 ACTUALLY, I CAN'T REMEMBER IF THAT WAS DURING THE PERIOD OF
8 TIME THAT VALLEY MENTAL HEALTH WAS DEALING WITH THAT OR
9 WHETHER THAT WAS ME.
10 Q. OKAY. LET ME ASK YOU THIS: ARE YOU ALSO FAMILIAR WITH
11 WHAT'S REFERRED TO A DURAGESIC PATCH?
12 A. YES.
13 Q. WHAT IS THAT?
14 A. IT'S A -- IT'S A NARCOTIC, IT'S -- IT CAN BE APPLIED AS
15 A PATCH TO THE SKIN AND IT'S SLOWLY ABSORBED. JUST NEEDS TO
16 BE CHANGED EVERY THREE DAYS.
17 Q. BASED ON YOUR TRAINING AND EXPERIENCE, WHAT IS THOSE
18 PATCHES GENERALLY USED FOR?
19 MR. STIRBA: YOUR HONOR, I'M NOT CLEAR. IS THIS AN
20 EXPERT WITNESS OR IS THIS A TREATING PHYSICIAN? IF IT'S AN
21 EXPERT WITNESS, I DON'T THINK ADEQUATE FOUNDATION'S BEEN
22 LAID.
23 MR. MAJOR: YOUR HONOR, WE'RE NOT ASKING FOR HER AS
24 AN EXPERT WITNESS. SHE'S TESTIFYING BASICALLY SOME
25 FOUNDATION. WE'RE GONNA GET INTO WHAT HER BASIC SITUATION
424
1 HAVING EXAMINED MARY CRANE AND HER UNDERSTANDING OF MORPHINE
2 AND THESE PATCHES, IF SHE SAW ANYTHING WITHIN HER PHYSICAL
3 EXAMINATION OF MARY CRANE WHICH WOULD LEAD HER TO BELIEVE
4 THAT PATCHES NEEDED TO BE USED --
5 MR. STIRBA: IS THAT --
6 MR. MAJOR: -- PRIOR TO HER GOING ON THE UNIT.
7 MR. STIRBA: IF THAT'S THE CASE, THEN THIS IS GONNA
8 BE INCREDIBLY CUMULATIVE. WE HAVE FIVE EXPERTS WHO ARE
9 GONNA COME IN AND TESTIFY ALL ABOUT THAT. I SEE NO PURPOSE
10 TO HAVE HER TESTIFY ABOUT IT AS WELL.
11 MR. MAJOR: OTHER THAN THE FACT THAT THOSE EXPERTS
12 WON'T TESTIFY ABOUT THEIR PERSONAL EXPERIENCE WITH THIS
13 PATIENT.
14 MR. STIRBA: AND INADEQUATE FOUNDATION. THERE'S
15 BEEN NO TESTIMONY SHE EVER DID A DURAGESIC PATCH OR DID
16 ANYTHING LIKE THIS WITH RESPECT --
17 THE COURT: WELL, LAY MORE FOUNDATION IF YOU CAN.
18 Q. (BY MR. MAJOR) HAVE YOU HAD AN OPPORTUNITY TO USE
19 DURAGESIC PATCHES IN YOUR PRACTICE?
20 A. YES.
21 Q. HAVE YOU HAD AN OPPORTUNITY TO USE MORPHINE IN YOUR
22 PRACTICE?
23 A. YES.
24 Q. HAVE YOU HAD AN OPPORTUNITY TO UNDERSTAND AND KNOW THE
25 EFFECTS OF MORPHINE?
425
1 A. SURE, YES.
2 Q. AND WHAT IS YOUR UNDERSTANDING OF WHAT IS MORPHINE
3 GENERALLY USED --
4 MR. STIRBA: I'M GONNA OBJECT, YOUR HONOR.
5 IRRELEVANT. JUST IRRELEVANT.
6 MR. MAJOR: WELL --
7 THE COURT: WELL --
8 MR. MAJOR: -- WE MIGHT APPROACH THE BENCH I GUESS,
9 YOUR HONOR.
10 THE COURT: WELL, I GUESS WE'RE GONNA HAVE THE JURY
11 GO OUT FOR A MINUTE. LADIES AND GENTLEMEN, I'M SORRY, BUT
12 WE HAVE TO DISCUSS A LEGAL ISSUE AND SO I CAN PROMISE YOU
13 THIS WILL BE YOUR LAST BREAK AND IT MAY NOT BE VERY LONG, SO
14 AS I'VE SAID BEFORE, EVEN THOUGH YOU'VE HEARD THIS JUST
15 RECENTLY, DO NOT CONVERSE AMONG YOURSELVES OR ALLOW
16 YOURSELVES TO BE ADDRESSED BY ANY OTHER PERSON ON THE
17 SUBJECT OF THIS TRIAL. AND IT'S YOUR DUTY NOT FORM OR
18 EXPRESS ANY OPINION UNTIL THE CASE IS FINALLY SUBMITTED TO
19 YOU. SO TAKE A REAL SHORT BREAK. AND THEN IF YOU COULD
20 JUST STAY NEAR THE JURY ROOM, AND THEN WE'LL BE CALLING YOU
21 BACK.
22 (THE JURY LEAVES THE COURTROOM.)
23 THE COURT: OKAY. YOU MAY BE SEATED. THE RECORD
24 SHOULD REFLECT THAT THE JURY HAS LEFT THE COURTROOM. OKAY.
25 AS I UNDERSTAND IT, THE QUESTION IS ABOUT THESE PATCHES AND
426
1 ABOUT THE USE OF MORPHINE. I UNDERSTAND THAT DR. STUBBS WAS
2 TREATING PHYSICIAN FOR MARY CRANE. WHERE ARE WE GOING?
3 MR. MAJOR: WELL, WHERE WE'RE GOING, YOUR HONOR, IS
4 TWOFOLD. ONE IS, THE EXPERTS I ANTICIPATE WILL TESTIFY
5 NUMBER ONE THAT MORPHINE CAN VARY. THE AMOUNT OF MORPHINE A
6 BODY CAN TOLERATE WILL VARY ON THEIR EXPERIENCE IN THE USE
7 OF MORPHINE. FOR EXAMPLE, IF I HAVE NEVER HAD MORPHINE
8 BEFORE, TWO, MAYBE THREE MILLIGRAMS OF MORPHINE WOULD BE
9 ENOUGH TO CURE MOST OF MY PAIN. IF I'VE BEEN ON EXTENSIVE
10 MORPHINE USE OR OTHER TYPE OF PAIN MEDICATION, IT MAY TAKE
11 MORE MORPHINE IN ORDER FOR ME TO REACH THE SAME PAIN LEVEL.
12 ALSO AN INDIVIDUAL -- I UNDERSTAND THE EXPERTS WILL TESTIFY
13 TO THAT A PERSON WHO HAS VERY LITTLE EXPERIENCE WITH
14 MORPHINE OR A PAINKILLER, IF I GIVE A LARGE DOSE, WILL HAVE
15 A DIFFERENT EFFECT. I MEAN THE FACT THAT IT'S A BRAND NEW
16 DRUG TO ME COULD HAVE DIFFERENT EFFECT ON ME. SO ONE THING
17 I'M ESTABLISHING WITH DR. STUBBS IS THE FACT THAT THIS
18 PATIENT AS FAR AS SHE KNOWS DID NOT RECEIVE ANY INDICATION
19 OF MORPHINE OR ANY INDICATION OF THESE DURAGESIC PATCHES.
20 SO THAT IN FACT WHEN THE EXPERTS TESTIFY, THE JURY CAN
21 UNDERSTAND THAT THIS IS A PATIENT WHO DID NOT HAVE
22 EXPERIENCE USING THIS DRUG. NUMBER TWO, WHAT I'M ASKING
23 FOR -- I'M NOT SAYING WHAT HAPPENED. THERE MAY HAVE BEEN
24 CHANGES THAT MAY HAVE TAKEN PLACE IN THE HOSPITAL. OKAY.
25 OUR EXPERTS ARE GONNA TESTIFY, MY UNDERSTANDING IS, THAT USE
427
1 OF MORPHINE AND DURAGESIC PATCHES IS A FAIRLY EXTREME
2 MEASURE TO BE USED TO -- FOR EXTREME PAIN CONTROL. AND WHAT
3 I WANNA ESTABLISH WITH MS. STUBBS -- DR. STUBBS HERE IS THAT
4 SHE'S TREATED MARY CRANE FROM '94 TO '96, ABOUT TWO-YEARS
5 PERIOD OF TIME. SHE KNOWS THIS PATIENT FAR BETTER THAN DR.
6 WEITZEL OR ANYONE ELSE AT THAT HOSPITAL. SHE WAS TREATING
7 HER EVERY 60 DAYS, DOING THESE ANALYSIS, AND I THINK SHE HAS
8 A CAPABILITY BASED ON HER TRAINING, HER BOARD CERTIFICATION
9 AS AN INTERNALIST. I'M NOT ASKING HER FOR HER EXPERT
10 OPINION GENERALLY HOW MORPHINE DOES. JUST SIMPLY, DID SHE
11 FIND ANY CONDITION WITH MARY CRANE UP UNTIL THE TIME SHE
12 WENT INTO THE HOSPITAL THAT WOULD REQUIRE HER TO HAVE
13 MORPHINE OR HAVE THE DURAGESIC PATCHES APPLIED. BECAUSE I
14 THINK THE EVIDENCE IS GONNA BE, IT WAS FAIRLY QUICK AFTER
15 MARY CRANE ENTERED THE DAVIS NORTH HOSPITAL THAT SHE STARTED
16 GETTING THE DURAGESIC PATCHES AND THE MORPHINE. I THINK WE
17 HAVE A RIGHT WITH THIS WITNESS TO ESTABLISH BASED ON HER
18 TRAINING AND EXPERIENCE, HER BACKGROUND WITH MARY CRANE, HER
19 PHYSICAL EXAMINATION OF MARY CRANE, WHETHER OR NOT SHE SAW
20 ANY CONDITION THAT IN HER OPINION WOULD REQUIRE HER TO FEEL
21 THAT THERE WAS A NEED FOR HER TO GET THESE MORPHINE
22 DURAGESIC PATCHES. THAT'S BASICALLY WHERE WE'RE GOING.
23 THE COURT: OKAY.
24 MR. STIRBA: TWO PROBLEMS, JUDGE. AND I THINK IT'S
25 REALLY A CONFUSION ISSUE AS MUCH AS ANYTHING. SHE'S A
428
1 TREATING PHYSICIAN. WE HAVE HER RECORDS. HER RECORDS WILL
2 BE IN EVIDENCE. THEIR EXPERTS CAN REVIEW THE RECORDS. THEY
3 ARE WHAT THEY ARE. IT'S OBVIOUS THERE'S NO INDICATION THAT
4 SHE EVER PRESCRIBED MORPHINE OR EVER GAVE A DURAGESIC PATCH.
5 I MEAN THOSE ARE FACTS. THAT'S WHAT HAPPENED. BUT WHEN WE
6 GET INTO THE HOSPITAL, THEN WE HAVE A SITUATION THAT
7 CHANGES. ONE OF THE INTERNAL MEDICINE GUYS AT THE HOSPITAL
8 APPROVED THE 25 MICROGRAM DURAGESIC PATCH ON ADMISSION,
9 SUPPORTING WHAT DR. WEITZEL DID. AND THE PROBLEM ABOUT
10 ASKING HER A QUESTION ABOUT HER OPINION WHETHER THERE WAS
11 EVER ANY INDICATION WHEN SHE TREATED MARY CRANE IS REALLY
12 WHAT YOU'RE ENDING UP WITH IS CONFUSING THE ISSUES BEFORE
13 THE JURY BECAUSE ESSENTIALLY, YOU HAVE ALL THESE DIFFERENT
14 DISPARATE OPINIONS BY THE PHYSICIANS WHEN REALLY, SHE CAN
15 TESTIFY AFFIRMATIVELY AS TO WHAT SHE DID. THAT'S FINE. SHE
16 FACTUALLY DID WHAT SHE DID. BUT TO THEN TO GO ON,
17 HYPOTHESIZE IN ANY WAY, SHAPE, OR FORM ABOUT WHY SHE DIDN'T
18 GIVE MORPHINE, WHY SHE DIDN'T DO A DURAGESIC PATCH, I MEAN
19 IT'S -- IT'S SORT OF SELF-EVIDENT. AND THE QUESTION ITSELF
20 I THINK COMPOUNDS THE CONFUSION FOR THIS JURY BECAUSE THESE
21 ARE CLINICAL ASSESSMENTS MADE AT CERTAIN TIME PERIODS WITH
22 ELDERLY PATIENTS WHOSE MEDICAL SITUATION CHANGES QUITE
23 QUICKLY FROM DAY TO DAY, HOUR TO HOUR, MINUTE TO MINUTE, AND
24 IT SEEMS TO ME THAT IF YOU'RE GONNA HAVE AN EXPERT COME IN
25 AND HAS REVIEWED ALL THESE RECORDS AND GONNA SAY NO
429
1 DURAGESIC PATCH JUSTIFICATION, NO MORPHINE JUSTIFICATION,
2 I'VE REVIEWED IT, WHAT ELSE DO YOU NEED? SO THIS IS REALLY
3 ESSENTIALLY CUMULATIVE, IT'S MISLEADING.
4 AND QUITE FRANKLY, SHE WASN'T THERE. SO REALLY TO EVEN
5 HAVE HER SUGGEST THAT THERE'S SOME LOGICAL INFERENCE THAT
6 CAN BE DRAWN FROM WHAT SHE SAW TO WHAT HAPPENED AT THE
7 HOSPITAL, I WOULD SUBMIT GOES AGAINST BASICALLY THE WAY
8 MEDICINE IS PRACTICED AND GOES AGAINST PRECISELY WHAT TWO
9 DOCTORS DID AT THE DAVIS HOSPITAL.
10 SO I WOULD OBJECT IN TERMS OF FOUNDATION, RELEVANCY,
11 HER QUALIFICATION TO TESTIFY, AND ALSO UNDER 403, I THINK
12 IT'S CUMULATIVE AND IS GONNA BE MISLEADING TO THE JURY.
13 MR. MAJOR: YOUR HONOR, IF I JUST MIGHT RESPOND,
14 NUMBER ONE, WHAT MR. STIRBA HAS DESCRIBED IS A CREDIBILITY
15 ARGUMENT FOR THE JURY. I MEAN WHAT HE'S ASSUMING IS THAT
16 THE DOCTORS WHO TREATED THIS PATIENT AT THE HOSPITAL MADE
17 THE RIGHT DECISION AND WE MAY HAVE EVIDENCE --
18 THE COURT: WELL, I THINK -- I THINK WHAT WE'RE
19 DOING -- I MEAN THIS WITNESS HAS TESTIFIED WHAT SHE DID.
20 SHE OBVIOUSLY HAS NOT TESTIFIED THAT SHE GAVE MORPHINE OR
21 THAT SHE GAVE ONE OF THESE PATCHES. NOW, IF YOU WANT TO
22 HAVE THIS WITNESS GO INTO ALL OF THAT, THEN YOU'VE GOT TWO
23 OR THREE MORE LINED UP TO SAY THE SAME OPINION, AT SOME
24 POINT I'M GOING TO SAY, THAT'S GOING TO BE A NEEDLESS
25 CONSUMPTION OF TIME. SO IF YOU WANT HER TO BE THE EXPERT ON
430
1 THIS ISSUE AND NOT HAVE SOMEBODY ELSE TESTIFY ABOUT THIS
2 ISSUE, I'M MORE THAN HAPPY TO DO THAT --
3 MR. MAJOR: BUT, YOUR HONOR --
4 THE COURT: -- IF YOU WANNA ASK HER A QUESTION
5 BASICALLY THAT SAYS, DID YOU GIVE HER MORPHINE OR DID YOU
6 GIVE HER ONE OF THESE PATCHES, I'LL -- AND WHY, THEN THAT'S
7 FINE. IF IT GOES BEYOND THAT, THEN WHEN IT GETS TO WITNESS
8 NUMBER TWO, THREE, FOUR ON THIS ISSUE --
9 MR. MAJOR: BUT THEY'RE NOT GONNA BE TESTIFYING
10 ABOUT THE SAME THING, YOUR HONOR. THE EXPERT WITNESSES --
11 MR. STIRBA'S MADE REPRESENTATIONS OF WHAT OUR WITNESSES --
12 THE COURT: WELL, THIS -- THIS DOCTOR SAW HER IN
13 NOVEMBER AND HAS NOT SEEN HER SINCE --
14 MR. MAJOR: THAT'S CORRECT.
15 THE COURT: -- AND SO THIS DOCTOR CAN ONLY TESTIFY,
16 DID SHE GIVE IT, DID SHE NOT GIVE IT, AND WHY DIDN'T SHE --
17 MR. MAJOR: BUT SHE CAN TESTIFY WHAT PHYSICAL
18 CONDITION MARY CRANE WAS SUFFERING FROM IF ANY PRIOR TO HER
19 ADMISSION TO THAT HOSPITAL.
20 THE COURT: OKAY -- WHAT I'M --
21 MR. MAJOR: WHETHER THAT REQUIRED --
22 THE COURT: -- WHAT I'VE JUST SAID, IF YOU
23 LISTENED, WAS, SHE CAN TESTIFY THAT DID SHE GIVE MORPHINE,
24 DID SHE GIVE THIS PATCH OR NOT, AND WHY DID OR DIDN'T SHE DO
25 THAT. AND BEYOND THAT, I DON'T THINK --
431
1 MR. MAJOR: WELL --
2 THE COURT: -- THAT'S WHAT -- UNLESS YOU'RE SAYING
3 THAT SHE'S ONE OF YOUR EXPERTS, YOU -- YOU'VE LISTED HER AS
4 ONE OF THE PHYSICIANS AND DELINEATED ON YOUR THINGS EXPERTS
5 VERSUS PHYSICIANS --
6 MR. MAJOR: WELL, I'M A LITTLE CONFUSED, YOUR
7 HONOR, BECAUSE YOU SAY WHY DIDN'T SHE GIVE HER THE PATCH.
8 THAT'S EXACTLY THE QUESTION I'M ASKING HER. WHY DIDN'T YOU
9 GIVE HER A MORPHINE PATCH OR DURAGESIC PATCH. DID YOU SEE
10 ANYTHING --
11 THE COURT: MAYBE I'M NOT COMMUNICATING, MAYBE IT'S
12 LATE IN THE DAY. I'M SAYING YOU CAN ASK HER, DID YOU GIVE
13 HER MORPHINE, DID YOU GIVE HER THIS PATCH, WHY OR WHY NOT --
14 MR. MAJOR: RIGHT, AND THAT WAS THE QUESTION I
15 ASKED HER. WHY DID YOU GIVE -- WHY --
16 THE COURT: MR. MAJOR, I'M SAYING --
17 MR. MAJOR: OKAY --
18 THE COURT: -- YOU CAN ASK THOSE QUESTIONS.
19 MR. MAJOR: I APOLOGIZE, YOUR HONOR. I'LL ASK THAT
20 QUESTION --
21 THE COURT: I MAYBE HAVE SAID IT THREE TIMES THAT
22 IF I'M NOT MAKING MYSELF CLEAR, IT MUST BE TOO LATE IN THE
23 DAY. LET'S GET THE JURY --
24 MR. MAJOR: I APOLOGIZE, YOUR HONOR, YOU'RE MAKING
25 YOURSELF CLEAR. I'LL ASK THAT PARTICULAR QUESTION. THERE'S
432
1 ONE OTHER QUESTION I WANNA ASK BEFORE WE GET THE JURY BACK.
2 NOT TO UPSET THE COURT. AND ONE OF THE QUESTIONS I'M GONNA
3 ASK, AND I EXPECT TO BE OBJECTION TO IT, IS I WANNA ASK HER
4 OPINION WHEN SHE FIRST HEARD ABOUT MARY CRANE'S DEATH, WHAT
5 WAS HER REACTION UPON HEARING ABOUT THE FACT THAT MARY CRANE
6 HAD DIED. WHEN SHE HEARD ABOUT THE DEATH AND WHAT HER
7 REACTION WAS AT THE TIME SHE DIED. I'M ASSUMING I'LL GET AN
8 OBJECTION TO THAT, SO TO SAVE TIME --
9 THE COURT: OKAY.
10 MR. MAJOR: -- WE'LL RAISE THAT RIGHT NOW.
11 THE COURT: ALL RIGHT.
12 MR. STIRBA: IT'S JUST IRRELEVANT. PLUS IT'S NOT
13 EVEN A MEDICAL QUESTION, WHAT'S HER REACTION. I MEAN I'M
14 ASSUMING THERE COULD HAVE BEEN ALL KINDS OF REACTIONS. BUT
15 THE REAL ISSUE IS, IS IT A REACTION BASED UPON SOME THOROUGH
16 MEDICAL ANALYSIS OF THE ENTIRE SITUATION, SUCH THAT SHE'S
17 GONNA COME IN HERE AND TESTIFY AS A MEDICAL DOCTOR BASED
18 UPON HER EXPERTISE AFTER REVIEWING THIS. HER REACTION IS
19 REALLY IRRELEVANT. I MEAN OBVIOUSLY, JUDGE, SHE MAY HAVE
20 HAD A VERY CLOSE AFFINITY FOR MISS CRANE AND MAYBE
21 APPROPRIATELY SO. HER REACTION COULD HAVE BEEN PURELY
22 PERSONAL. THERE'S ALL KINDS OF SITUATIONS. IT'S JUST
23 IRRELEVANT. SHE WASN'T THE TREATING PHYSICIAN, SHE DOESN'T
24 KNOW, AND THEREFORE, IT'S IRRELEVANT.
25 MR. MAJOR: WELL, YOUR HONOR, IF I MIGHT JUST
433
1 RESPOND TO THAT, SHE WAS THE TREATING PHYSICIAN UP UNTIL
2 NOVEMBER. HER REACTION WAS GONNA BE BASICALLY SHE'S GONNA
3 INDICATE THAT HER REACTION WAS THAT SHE WAS QUITE SHOCKED
4 BASED ON THE FACT OF WHAT SHE KNEW OF MARY CRANE -- MARY
5 CRANE'S CONDITION WHEN SHE WENT INTO THE NURSING HOME.
6 THE COURT: OKAY. AND WHAT IS THE RELEVANCE OF HER
7 BEING SHOCKED BY THE DEATH?
8 MR. MAJOR: THE FACT THAT MARY CRANE WENT INTO THIS
9 NURSING HOME IN A -- IN A CONDITION THAT DID NOT INDICATE A
10 TERMINAL ILLNESS OR ANY TYPE OF CHRONIC OR ACUTE PROBLEMS.
11 THE COURT: OKAY. AND SHE'S ALSO TESTIFIED ABOUT
12 THAT. SHE'S TESTIFIED --
13 MR. MAJOR: OKAY. THAT'S WHY I WANTED TO RAISE THE
14 ISSUE BECAUSE I KNEW THE COURT WOULD BE RULING --
15 THE COURT: OKAY. I'M GONNA SUSTAIN THE OBJECTION.
16 OKAY. LET'S BRING THE JURY IN.
17 (THE JURY RETURNS TO THE COURTROOM.)
18 THE COURT: YOU MAY BE SEATED. THE RECORD SHOULD
19 REFLECT THAT THE JURY IS BACK. I KNOW, LADIES AND
20 GENTLEMEN, THAT WHEN WE HAD THE JURY SELECTION PROCESS A
21 NUMBER OF YOU SOMETIMES MENTIONED ABOUT BACKS AND KNEES AND
22 THINGS AND SO I SAID WE'D AT LEAST HAVE A BREAK ONCE EVERY
23 HOUR. SEE, WE'VE BEEN DOING IT MORE FREQUENTLY, SO
24 EVERYBODY'S BACK SHOULD BE IN PRETTY GOOD SHAPE. OKAY.
25 THANK YOU FOR YOUR PATIENCE. AND, MR. MAJOR, PLEASE GO
434
1 AHEAD.
2 Q. (BY MR. MAJOR) SO, DR. STUBBS, DURING THE COURSE OF
3 YOUR TREATMENT WITH MISS CRANE, WHY DID YOU NOT PRESCRIBE
4 ANY DURAGESIC PATCHES OR MORPHINE INJECTIONS?
5 A. I DIDN'T SEE ANY INDICATION THAT SHE NEEDED IT.
6 MR. MAJOR: THANK YOU. WE NO FURTHER QUESTIONS,
7 YOUR HONOR.
8 THE COURT: ANY CROSS-EXAMINATION?
9 MR. STIRBA: YES, YOUR HONOR.
10 CROSS-EXAMINATION
11 BY MR. STIRBA:
12 Q. DR. STUBBS, YOU'VE BROUGHT WITH YOU A BINDER. IS THAT
13 YOUR MEDICAL FILE?
14 A. IT'S NOT MINE. IT WAS -- THAT'S BETSY BOWMAN'S FROM THE
15 ATTORNEY GENERAL --
16 Q. PARDON ME?
17 A. BETSY BOWMAN FROM THE ATTORNEY GENERAL'S OFFICE SENT
18 THIS TO ME AND INCLUDED IN THERE ARE MY NOTES.
19 MR. STIRBA: MAY I APPROACH, YOUR HONOR?
20 THE COURT: YES.
21 Q. (BY MR. STIRBA) LET ME HAND YOU A GROUP OF DOCUMENTS,
22 AND MAYBE I'LL GET THIS OUT OF YOUR WAY, TOO. DO YOU
23 RECALL, WE SUBPOENAED SOME RECORDS FROM YOUR OFFICE,
24 DR. STUBBS?
25 A. I DON'T RECALL. I HAVEN'T BEEN WITH THAT OFFICE FOR TWO
435
1 YEARS, SO ACTUALLY, I DON'T RECALL THAT.
2 Q. OKAY. COULD YOU REVIEW WHAT YOU HAVE IN FRONT OF YOU
3 AND SEE IF YOU CAN IDENTIFY THOSE AS BEING RECORDS THAT
4 WOULD HAVE BEEN MEDICAL RECORDS CONCERNING YOUR CARE AND
5 TREATMENT OF MISS CRANE?
6 A. RIGHT, THESE ARE -- THESE ARE FROM MY OFFICE. AND IN
7 ADDITION TO THAT, IN ADDITION TO THESE, THERE ARE THE --
8 MOST OF THE NURSING HOME REFERRAL FORMS ARE NOT IN HERE IN
9 THIS GROUP OF PAPERS.
10 Q. OKAY. DO YOU HAVE THEM AS PART OF THE BINDER --
11 A. I DO, YES.
12 Q. -- IN FRONT OF YOU?
13 A. AT LEAST SOME OF THEM.
14 Q. ARE THEY SOMETHING THAT -- SOMETHING THAT YOU COULD
15 EASILY TAKE OUT OF THAT BINDER, SEGREGATE IT OUT SO WE
16 HAVE --
17 A. THERE.
18 Q. -- A COMPLETE FILE OF YOUR RECORD? YOU'VE HANDED ME --
19 THESE ARE THE NURSING HOME REFERRALS?
20 A. RIGHT.
21 Q. SO IF WE TAKE THE NURSING HOME REFERRALS THAT YOU JUST
22 GAVE ME AND PUT THEM WITH THESE DOCUMENTS, WOULD WE HAVE
23 THEN YOUR ESSENTIAL MEDICAL FILE?
24 A. SHOULD BE.
25 Q. ALL RIGHT. MAY I HAVE THIS BACK PLEASE? I'LL PUT THESE
436
1 IN THE BACK SO THEY'RE EASY TO REFER TO.
2 CAN WE MARK THIS?
3 MR. MAY: PETER, WHY DON'T YOU USE THIS ONE? IT'S
4 NOT --
5 MR. STIRBA: OH, YEAH, LET'S CHANGE THAT FRONT
6 PAGE.
7 MR. MAJOR: YOUR HONOR, WE'D LIKE TO -- WHILE
8 THEY'RE DOING THIS, WE'D LIKE TO VOIR DIRE THIS WITNESS IF
9 WE MIGHT. JUST A QUESTION ON THIS RECORD. CAN WE HAVE A --
10 JUST A QUICK CONCERN AS TO WHETHER SHE SAYS SHE THINKS
11 THEY'RE THE FULL DOCUMENTS, WHETHER SHE ACTUALLY KNOWS,
12 WHETHER SHE'S HAD A CHANCE TO REVIEW THE DOCUMENTS --
13 THE COURT: GO AHEAD.
14 MR. MAJOR: -- SO I DON'T KNOW IF THEY ARE COMPLETE
15 OR NOT COMPLETE. SO I GUESS BASICALLY WHAT WE'RE SAYING ON
16 THAT, I GUESS WE'RE OBJECTING TO THE FOUNDATION FOR THIS
17 DOCUMENT UNLESS THERE'S --
18 THE COURT: WELL, DID YOU WANNA VOIR DIRE?
19 MR. MAJOR: I COULD JUST -- I COULD JUST DO THAT.
20 VOIR DIRE EXAMINATION
21 BY MR. MAJOR:
22 Q. MISS STUBBS, HAVE YOU EVER -- WHEN WAS THE LAST TIME YOU
23 HAD A CHANCE TO REVIEW THOSE DOCU -- SEE THOSE DOCUMENTS?
24 A. THE ONES THAT HE HAS?
25 Q. YEAH, THAT HE JUST HANDED TO YOU.
437
1 A. WELL, PRIOR TO -- PROBABLY PRIOR TO HER DEATH.
2 Q. OKAY. SO WE'RE TALKING BACK IN 1996 SOMETIME?
3 A. RIGHT.
4 Q. AND HAVING JUST REVIEWED THEM FROM WHEN MR. STIRBA GAVE
5 THEM, ARE YOU -- HAVE YOU HAD A CHANCE TO REVIEW THOSE TO
6 THE EXTENT -- EXTENT THAT YOU COULD SAY THAT THEY'RE NOT
7 MISSING DOCUMENTS?
8 A. NO.
9 Q. DID YOU REVIEW THEM TO THE EXTENT THAT YOU COULD SAY
10 THEY'RE NOT DOCUMENTS BEEN ADDED TO IT THAT WASN'T IN THE
11 ORIGINAL?
12 A. NO --
13 Q. HAVE YOU HAD A --
14 A. -- JUST LOOKED THROUGH THERE.
15 Q. -- CHANCE TO REVIEW ORIGINALS SINCE 1996?
16 A. (WITNESS SHAKES HEAD.)
17 MR. MAJOR: WE'D OBJECT TO THE INTRODUCTION OF
18 THOSE DOCUMENTS, YOUR HONOR. SHE'S NOT THE PROPER
19 FOUNDATION. SHE CAN'T SAY WHETHER THEY'RE THE ACTUAL
20 DOCUMENTS, IF THERE'S MISSING DOCUMENTS, IF THERE'S
21 ADDITIONAL DOCUMENTS ADDED TO IT.
22 THE COURT: WELL, I DON'T THINK THEY'VE BEEN
23 OFFERED YET.
24 MR. STIRBA: WE'D OFFER D-2, YOUR HONOR.
25 THE COURT: OKAY. AND WHAT IS THE RESPONSE TO HIS
438
1 OBJECTION?
2 MR. STIRBA: I SHOWED THEM TO HER. SHE IDENTIFIED
3 THEM AS FROM HER OFFICE. WITH THE ADDITION, SHE MADE A VERY
4 SPECIFIC ADDITION OF THE NURSING HOME REFERRALS WHICH THEN
5 SHE PULLED OUT OF THE BINDER AND THEN I ASKED HER IF THIS
6 WOULD BE A COMPLETE RECORD AND SHE SAID YES.
7 MR. MAJOR: I THINK SHE SAID SHE THOUGHT THEY WOULD
8 BE.
9 THE COURT: WELL, DO WE HAVE -- I MEAN WHAT WE'RE
10 TRYING TO DO IS GET THE COMPLETE MEDICAL RECORDS --
11 MR. STIRBA: I'LL --
12 THE COURT: -- FROM THESE FIVE INDIVIDUALS. IS
13 THERE ANY REASON TO DOUBT THAT THIS IS NOT WHAT IT PURPORTS
14 TO BE? AND WHO BUT THIS DOCTOR IS GOING TO BE ABLE TO TELL
15 US ANYTHING BETTER THAN WHAT WE'VE HEARD --
16 MR. MAJOR: YOUR HONOR, WE HAVE NOT HAD A CHANCE TO
17 SEE THOSE RECORDS. NO ONE HAS ACTUALLY GONE THROUGH PAGE BY
18 PAGE AND COMPARED THEM WITH THE ORIGINALS. I KNOW WHEN WE
19 DID OUR MEDICAL RECORDS FROM THE HOSPITAL, WE DISCOVERED
20 THERE WAS SEVERAL PAGES MISSING, THAT THERE WERE SEVERAL
21 DUPLICATE COPIES MADE. WE JUST DON'T THINK THAT THERE'S --
22 WITHOUT A CHANCE TO REVIEW IT, THAT SHE CAN ACTUALLY TESTIFY
23 THAT ALL OF THESE DOCUMENTS ARE PRESENT, AND THIS IS A TRUE
24 AND CORRECT AND COMPLETE COPY OF WHAT WAS --
25 THE COURT: OKAY. DOES YOUR OBJECTION -- IF HE
439
1 WANTS TO USE SOME OF THESE DOCUMENTS THAT ARE HERE AND THAT
2 ARE HER RECORD, DO YOU HAVE ANY PROBLEM WITH THAT?
3 MR. MAJOR: NO, YOUR HONOR, IF WE --
4 THE COURT: OKAY. WHAT I'M GOING TO DO IS I'M
5 GONNA RESERVE THE RULING ON THE EXHIBIT AS A WHOLE COMING
6 IN, BUT IF YOU WANT TO USE THE EXHIBIT AND ASK HER
7 QUESTIONS --
8 MR. STIRBA: SURE, YOUR HONOR.
9 THE COURT: -- THAT SHE CAN IDENTIFY IF THOSE ARE
10 PART OF HER RECORD.
11 MR. STIRBA: THAT'S FINE.
12 CROSS-EXAMINATION, CONT'D
13 BY MR. STIRBA:
14 Q. I'M GONNA HAND THIS BACK TO YOU, DR. STUBBS. AND AS WE
15 GO THROUGH HERE, PLEASE IF THERE IS A DOCUMENT IN EXHIBIT
16 D-2 THAT YOU CAN'T IDENTIFY AS BEING PART OF THE MEDICAL
17 RECORD WITH RESPECT TO YOUR CARE AND TREATMENT OF MISS
18 CRANE, WOULD YOU PLEASE TELL ME?
19 A. OKAY.
20 Q. NOW, THE FIRST -- THE FIRST PAGE OF THE DOCUMENT, IT
21 LOOKS LIKE A MONTHLY REFERRAL TO PHYSICIANS AND CLINIC, AND
22 THIS IS ONE OF THE REFERRALS FROM THE NURSING HOME, IS THAT
23 RIGHT?
24 A. RIGHT. SOMEONE MUST HAVE COPIED THAT.
25 Q. AND IT HAS AT THE TOP, MARY CRANE, AND THEN IT HAS
440
1 DR. STUBBS. AND THEN DOWN AT THE BOTTOM IT HAS YOUR
2 SIGNATURE, DR. STUBBS, TRUE?
3 A. RIGHT.
4 Q. NOW, IS THIS A DOCUMENT THAT IS GENERATED BY THE NURSING
5 HOME FOLKS THAT YOU RECEIVE WHEN YOU WOULD HAVE SEEN MISS
6 CRANE?
7 A. IT IS.
8 Q. AND SO THEY'RE THE ONES THAT PROVIDE ALL THE INFORMATION
9 HERE WITH THE EXCEPTION OF YOUR SIGNATURE?
10 A. NO. FROM WHERE, YOU KNOW, JUST BELOW THE MIDDLE OF THE
11 PAGE WHERE IT SAYS NURSE'S SIGNATURE? EVERYTHING BELOW THAT
12 IS WRITTEN BY ME. THOSE ARE MY NOTES.
13 Q. OKAY. SO, FOR EXAMPLE, THE DIAGNOSIS PORTION OF THE
14 DOCUMENT, IS THAT A DIAGNOSIS PORTION?
15 A. THAT'S -- THAT'S -- THOSE ARE -- THE NURSES FILL THAT
16 PART OUT.
17 Q. OKAY. AND YOU FILLED OUT WHAT PORTION OF THE DOCUMENT?
18 A. UNDER WHERE -- UNDER WHERE IT SAYS NURSE'S SIGNATURE,
19 EVERYTHING BELOW THAT IS MY WRITING.
20 Q. I SEE. NOW, THE DIAGNOSIS PORTION HAS IN IT CERTAIN
21 DIAGNOSES OF MISS CRANE, CORRECT?
22 A. IT'S -- IT'S SUPPOSED TO HAVE. WHAT THE NURSES USUALLY
23 DO IS LIST ALL THE DIAGNOSES THAT ARE -- THAT THEY HAVE AND
24 IN THEIR RECORD.
25 Q. I'M GONNA DO A LITTLE TECHNOLOGY HERE. AND THOSE ARE --
441
1 THOSE ARE DIAGNOSES OF MISS CRANE, IS THAT RIGHT?
2 A. RIGHT.
3 Q. AND, FOR EXAMPLE, IF I CAN ZOOM IN HERE, THE DIAGNOSES
4 PORTION. THERE WE GO. WE HAVE FIRST OF ALL RIGHT C.V.A.
5 DO YOU SEE THAT? THAT'S STANDS FOR CEREBROVASCULAR
6 ACCIDENT, TRUE?
7 A. RIGHT.
8 Q. IN OTHER WORDS, A STROKE?
9 A. RIGHT.
10 Q. THAT'S SOMETHING A NURSE PUT IN AS FAR AS A DIAGNOSES.
11 THEN WE HAVE H.T.N. DO YOU SEE THAT? THAT'S STANDS FOR
12 HYPERTENSION, TRUE?
13 A. YES.
14 Q. IS THAT ALSO A CONDITION THAT YOU WERE ABLE TO DETERMINE
15 MISS CRANE HAD BASED UPON YOUR CARE AND TREATMENT OF HER?
16 A. IT IS.
17 Q. AND IN FACT, SHE GOT LOPRESSOR FOR THAT, IS THAT RIGHT?
18 A. RIGHT.
19 Q. LOPRESSOR IS A HYPERTENSION MEDICATION, TRUE?
20 A. RIGHT.
21 Q. THEN WE HAVE CHRONIC HYPONATREMIA. DO YOU SEE THAT?
22 THAT'S ALSO A CONDITION --
23 A. HYPONATREMIA, RIGHT.
24 Q. -- THAT YOU DIAGNOSED?
25 A. (WITNESS NODS.)
442
1 Q. AND THAT'S THE CONDITION THAT RELATES TO HER LOW SODIUM,
2 TRUE?
3 A. RIGHT.
4 Q. AND THAT MEANS THAT SHE'S CONSTANTLY THIRSTY AND WANTING
5 TO DRINK, IS THAT CORRECT?
6 A. WELL, NOT NECESSARILY. IT MEANS HER BLOOD SODIUM IS
7 LOW.
8 Q. LOW. SYMPTOMATICALLY, SHE GETS THIRSTY?
9 A. WELL, NOT NECESSARILY.
10 Q. ALL RIGHT. THEN WE HAVE HISTORY, H.X., PEPTIC ULCER
11 DISEASE. DID YOU MAKE SUCH A DIAGNOSIS AS WELL?
12 A. WELL, IT WAS A DIAGNOSIS THAT HAD BEEN MADE PRIOR TO ME
13 EVER SEEING HER.
14 Q. OKAY. THEN WE HAVE GASTRECTOMY. DO YOU SEE THAT?
15 A. RIGHT.
16 Q. WHAT IS A GASTRECTOMY, DOCTOR?
17 A. SHE HAD PART OF HER STOMACH REMOVED.
18 Q. IS THAT A SIMILAR CONDITION THAT YOU DIAGNOSED AS WELL
19 OR AT LEAST CONFIRMED?
20 A. WELL, IT'S A PROCEDURE, AN OPERATION THAT HAD ALREADY
21 BEEN DONE BEFORE I KNEW MARY.
22 Q. OKAY. AND THEN WE HAVE VAGOTOMY. DO YOU SEE THAT?
23 THAT'S ANOTHER DIAGNOSIS. WHAT'S A VAGOTOMY?
24 A. ALSO RELATES TO HER STOMACH PROBLEM, SURGERY WHERE THEY
25 CUT SOME NERVES TO TRY TO PREVENT THE PROBLEMS SHE WAS
443
1 HAVING WITH -- WITH ACID.
2 Q. WELL, WHAT PRECISELY --
3 A. PEPTIC ULCER DISEASE.
4 Q. WHAT PRECISELY IS A VAGOTOMY? YOU SAY RELATES TO. WHAT
5 IS IT?
6 A. IT'S -- IT'S A -- IT DOESN'T USUALLY -- IT'S NOT A
7 PROCEDURE THAT USUALLY IS JUST ON ITS OWN LIKE THAT. I'M
8 NOT SURE THAT THE WAY THAT'S WRITTEN ON THERE IS -- IS
9 CORRECT. IT WOULD HAVE GONE ALONG WITH ANOTHER SURGERY, AND
10 I'M NOT SURE IN MARY WHAT SPECIFICALLY THAT WAS. I DON'T
11 REMEMBER WELL ENOUGH TO TELL YOU.
12 Q. OKAY. SO YOU KNOW WHAT IT IS, BUT YOU'RE NOT SURE
13 ENOUGH ABOUT HER SITUATION TO TESTIFY ABOUT IT, IS THAT
14 RIGHT?
15 A. THAT PARTICULAR THING, YES, SURE.
16 Q. OKAY. THEN WE HAVE LUMBAR DISK SURGERY. DO YOU SEE
17 THAT? THAT'S A CONDITION THAT MANIFESTED ITSELF IN MARY
18 HAVING CHRONIC BACK PAIN, TRUE?
19 A. WELL, PROBABLY SHE MAY HAVE SOMETIME IN THE PAST, SHE
20 HAD SURGERY ON HER TO CORRECT A PROBLEM WITH HER BACK.
21 Q. SURE. AND YOU WEREN'T AWARE THAT AS A RESULT OF THAT
22 PARTICULAR DISK PROBLEM AND THE SURGERY ATTENDANT TO IT, SHE
23 DIDN'T HAVE CHRONIC BACK PAIN?
24 MR. MAJOR: OBJECTION, YOUR HONOR. I THINK THAT'S
25 ASSUMING FACTS NOT IN ISSUE IN THIS CASE. THERE'S NO
444
1 INDICATION -- ALL WE HAVE HERE IS A DIAGNOSIS. WE DON'T
2 KNOW WHEN THIS DIAGNOSIS WAS MADE. WHO MADE THIS DIAGNOSIS,
3 WHETHER IT'S A MEDICAL DIAGNOSIS. IT JUST -- WE'RE ASSUMING
4 SHE HAD THIS CAUSE FOR CHRONIC BACK PAIN. I THINK THERE'S
5 ABSOLUTELY NO FOUNDATION FOR THAT.
6 THE COURT: OKAY. DO YOU WANNA LAY MORE
7 FOUNDATION.
8 MR. STIRBA: SURE.
9 Q. YOU TREATED HER FOR APPROXIMATELY TWO YEARS, CORRECT?
10 A. RIGHT.
11 Q. AND DID YOU CONFIRM THAT IN FACT SHE HAD A DISK SURGERY
12 AT ANY POINT PRIOR TO YOU SEEING HER?
13 A. WELL, YES, IT WAS IN HER RECORDS AND --
14 Q. SURE, IT WAS IN HER RECORDS AND ALSO THERE'S A SURGICAL
15 SCAR, IS THERE NOT?
16 A. RIGHT.
17 Q. AND YOU CERTAINLY OBSERVED THAT, TRUE?
18 A. RIGHT.
19 Q. NOW, AS A RESULT OF WHAT YOU CONFIRMED BASED UPON YOUR
20 EXAMINATION OF HER --
21 MR. MAJOR: YOUR HONOR, WE'RE GONNA OBJECT AGAIN.
22 WE NEED -- FOR FOUNDATION WE NEED TO KNOW WHEN THIS
23 OPERATION OCCURRED. DID IT HAPPEN TEN YEARS AGO, 12 YEARS
24 AGO, 20 YEARS AGO, ONE YEAR -- ONE YEAR BEFORE SHE STARTED
25 TO SEE HER. I MEAN IT'S -- TO SAY SHE HAD A SURGERY THAT
445
1 CAUSED BACK PAIN --
2 THE COURT: WELL, I THINK WHAT WE'RE DOING IS
3 LOOKING AT A MEDICAL RECORD AND THE RECORD DOESN'T GIVE THE
4 DATE, AND SO I THINK WE'RE -- THIS IS THE RECORD THAT SHE
5 RECEIVED, IS THIS CORRECT?
6 MR. STIRBA: THAT'S TRUE, YOUR HONOR.
7 MR. MAJOR: BUT, YOU KNOW, IF I MIGHT --
8 MR. STIRBA: AND I'M REALLY -- I'M REALLY NOT
9 ASKING HER NOW ABOUT SURGERY. I REALIZE SHE DIDN'T DO IT
10 AND THERE'S NO REFERENCE AS TO A DATE.
11 THE COURT: OVERRULED. THIS IS JUST BACKGROUND.
12 Q. (BY MR. STIRBA) AND BASED UPON WHAT YOU DID FOR THE
13 TWO YEARS THAT YOU SAW HER, ARE YOU AWARE THAT SHE SUFFERED
14 CHRONIC BACK PAIN?
15 MR. MAJOR: OBJECTION AGAIN, YOUR HONOR. THERE'S
16 NO EVIDENCE THAT SHE SUFFERED BACK PAIN. ALL WE KNOW IS
17 THAT SHE HAD A SURGERY AT SOME POINT IN TIME. AND
18 MR. STIRBA'S ASSUMING THAT THERE WAS BACK PAIN.
19 THE COURT: NO, I THINK HE'S ASKING A QUESTION TO
20 THE DOCTOR, IF SHE EVER COMPLAINED OF BACK PAIN AND WAS
21 AWARE THAT SHE SUFFERED BACK PAIN WHILE SHE --
22 MR. MAJOR: THAT'S AWFULLY CUMULATIVE AS TO WHAT
23 WE'VE ALREADY GONE THROUGH AS FAR AS PAIN AND ALL OF THAT
24 KIND OF STUFF ON THE DIRECT. I KNOW HE CAN GET INTO IT,
25 BUT --
446
1 THE COURT: OVERRULED.
2 MR. STIRBA: COULD YOU READ BACK THE QUESTION?
3 (THE REPORTER READ BACK THE LAST QUESTION.)
4 THE WITNESS: AS I SAID EARLIER, MARY
5 OCCASIONALLY -- ACTUALLY, I WOULD SAY SELDOM COMPLAINED OF
6 BACK PAIN. SHE -- WHEN I SAW HER SHE PRIMARILY COMPLAINED
7 OF HEADACHES. I ASKED HER DAUGHTER EVERY TIME I -- EVERY
8 TIME SHE BROUGHT HER IN ABOUT OTHER COMPLAINTS SUCH AS ANY
9 OTHER KIND OF PAIN, AND SHE WOULD TELL ME THAT SHE
10 OCCASIONALLY HAD BACKACHES, BUT IT WAS NOT A FREQUENT
11 COMPLAINT BY ANY MEANS.
12 Q. (BY MR. STIRBA) OKAY. SO TO SHORTEN THIS UP, YOUR
13 TESTIMONY IS THAT BASED UPON YOUR EXPERIENCE WITH HER, THAT
14 WAS NOT A MALADY THAT YOU WERE ACCUSTOMED TO SEEING OR
15 HEARING ABOUT, IS THAT RIGHT?
16 A. RIGHT. I INFREQUENTLY HEARD ABOUT HER HAVING BACK PAIN.
17 Q. THEN WE HAVE D.M. YOU SEE THAT, DOCTOR. IT HAS
18 DEPRESSED EQUALS PSYCHOTIC MOODS --
19 A. DEPRESSION --
20 Q. YEAH, WHAT IS THAT --
21 A. DEPRESSION WITH PSYCHOTIC -- THAT'S ALSO NOT EXACTLY
22 WRITTEN CORRECTLY, BUT SHE HAD DEPRESSION WITH PSYCHOTIC
23 FEATURES AS A DIAGNOSIS GIVEN TO HER BY A PSYCHIATRIST.
24 Q. NOW, ALSO THERE'S AN INDICATION OF MEDICATION. DO YOU
25 SEE THAT, PRESENT MEDICATIONS? AND THIS IS DATED 7/14/95.
447
1 DO YOU SEE THAT?
2 A. RIGHT.
3 Q. AND, FOR EXAMPLE, ZANTAC IS THE FIRST ONE, AND THEN WE
4 HAVE TYLENOL, LOOKS LIKES E.S. Q-8 HOURS. DO YOU SEE THAT?
5 A. RIGHT.
6 Q. AND THAT'S FOR PAIN, TRUE?
7 A. RIGHT.
8 Q. LOPRESSOR, THAT'S FOR HIGH BLOOD PRESSURE, HYPERTENSION,
9 TRUE?
10 A. RIGHT.
11 Q. THEN IF YOU GO DOWN, YOU HAVE A HY-PHEN. DO YOU SEE
12 THAT, Q-4, THAT'S EVERY FOUR HOURS, CORRECT?
13 A. WELL, IT'S -- IT WASN'T ACTUALLY Q-4 HOURS. IT WAS Q-4
14 HOURS -- THE ORDER PROBABLY WAS Q-4 HOURS AS NEEDED.
15 Q. WELL, IT SAYS HERE, THOUGH -- AND I APPRECIATE YOUR
16 CLARIFICATION, BUT IT SAYS HERE HY-PHEN Q-4 HOURS, CORRECT?
17 A. THAT'S WHAT IT SAYS, BUT THAT'S NOT WHAT SHE WAS
18 RECEIVING.
19 Q. AND HY-PHEN'S A PAIN MEDICATION, TRUE?
20 A. IT IS.
21 Q. IN FACT, HY-PHEN HAS ANOTHER NAME, DOESN'T IT?
22 A. HYDROCODONE.
23 Q. ISN'T THAT A GENERIC NAME, HY-PHEN?
24 A. IT'S -- THAT'S THE BRAND NAME FOR --
25 Q. AND WHAT ELSE IS IT CALLED?
448
1 A. -- HYDROCODONE.
2 Q. HYDROCODONE. COULD ALSO BE CALLED LORTAB?
3 A. LORTAB WOULD BE ANOTHER BRAND NAME.
4 Q. SURE. AND IT COMES IN VARIOUS AMOUNTS, 5 MILLIGRAMS AND
5 7.5 MILLIGRAMS, ISN'T THAT TRUE?
6 A. AND TENS.
7 Q. AND TENS? DO YOU KNOW IN THIS PARTICULAR INSTANCE WHAT
8 LEVEL OF DOSAGE MARY WAS RECEIVING?
9 A. I DON'T REMEMBER. I COULD LOOK IN HERE AND TELL YOU.
10 Q. LOOK IN WHAT?
11 A. THIS -- THIS HAS A RECORD OF HER MEDICATIONS.
12 Q. OKAY. PLEASE DO THAT.
13 A. ACTUALLY, I CAN'T FIND WHERE THEY -- WHERE THAT IS
14 WRITTEN IN HERE. I CAN'T FIND THE DOSAGE.
15 Q. SO FAIR TO SAY AT THIS POINT, WE DON'T KNOW, CORRECT?
16 A. I DON'T KNOW RIGHT NOW, I DON'T REMEMBER.
17 Q. OKAY. NOW, ALSO IT INDICATES FURTHER THERE'S TYLENOL
18 650 MILLIGRAMS. IS THAT A PRESCRIPTION DOSAGE?
19 A. A PRESCRIPTION DOSAGE?
20 Q. YES. IS THAT SOMETHING YOU CAN BUY OVER THE COUNTER OR
21 IS THAT SOMETHING THAT HAS TO BE PRESCRIBED --
22 A. SURE.
23 Q. -- BY A DOCTOR?
24 A. OVER THE -- YOU CAN BUY TYLENOL OVER THE COUNTER, SURE.
25 Q. OKAY. TYLENOL 650 MILLIGRAMS?
449
1 A. WELL, YOU CAN BUY 325 MILLIGRAM TYLENOL AND TAKE TWO OF
2 THEM.
3 Q. OKAY. SO THAT'S NOT PURSUANT TO A PRESCRIPTION THEN,
4 THAT'S AN OVER-THE-COUNTER MEDICATION. THAT'S FOR PAIN,
5 CORRECT?
6 A. RIGHT.
7 Q. AND THEN WE ALSO HAVE --
8 A. ALSO -- ALSO AS NEEDED.
9 Q. PARDON ME?
10 A. ALSO AS NEEDED IS HOW THAT SHOULD BE WRITTEN.
11 Q. OKAY. AND THEN IF YOU GO DOWN THE NEXT LINE, YOU HAVE
12 SOME OTHER MEDICATION, XANAX. DO YOU SEE THAT? 25
13 MILLIGRAMS, Q-8?
14 A. 25 MILLIGRAMS.
15 Q. OKAY. XANAX IS AN ANTIANXIETY MEDICATION, ISN'T THAT
16 RIGHT?
17 A. (WITNESS NODS.)
18 Q. AND IN FACT, XANAX IS A C.N.S. DEPRESSANT, ISN'T THAT
19 TRUE?
20 A. IT CAN BE, SURE.
21 Q. IN OTHER WORDS, THIS IS SEDATING MEDICATION, ISN'T THAT
22 CORRECT?
23 A. IT CAN BE.
24 Q. HAS SEDATING QUALITIES, DOES IT NOT?
25 A. IT CAN.
450
1 Q. AND THEN UNDER PSYCH MEDS, WE HAVE TRAZODONE,
2 7.5 MILLIGRAMS. DO YOU SEE THAT?
3 A. TRANXENE.
4 Q. I'M SORRY, TRANXENE. THANK YOU. TRANXENE IS ALSO A
5 SEDATING MEDICATION, CORRECT?
6 A. IT CAN BE.
7 Q. AND THAT'S ONCE AGAIN AN ANTIANXIETY MEDICATION, TRUE?
8 A. RIGHT --
9 Q. YES?
10 A. -- THAT WAS PRESCRIBED BY HER PSYCHIATRIST.
11 Q. THAT WASN'T MY QUESTION. MY QUESTION IS, IT IS AN
12 ANTIANXIETY MEDICATION, TRUE?
13 A. RIGHT. IT WAS BEING USED IN HER TO TREAT ANXIETY
14 PROBLEMS.
15 Q. ZOLOFT IS AN ANTIDEPRESSANT, TRUE?
16 A. TRUE.
17 Q. IT ALSO HAS SEDATING QUALITIES, DOES IT NOT?
18 A. THAT'S A POTENTIAL SIDE EFFECT.
19 Q. AND THEN WE HAVE IT -- SEEMS LIKE IT'S TWICE, IT'S
20 THORAZINE AND IT LOOKS LIKE ONE IS 20 MILLIGRAMS OR TEN
21 MILLIGRAMS, THEN WE HAVE THORAZINE AGAIN 25 MILLIGRAMS.
22 THORAZINE ALSO IS A SEDATING MEDICATION, IS IT NOT?
23 A. IT CAN BE.
24 Q. IN FACT, THORAZINE IS ALSO AN ANTIDEPRESSANT, TRUE?
25 A. ANTIPSYCHOTIC.
451
1 Q. ANTIPSYCHOTIC, I'M SORRY. THANK YOU. AND THEN WE GO
2 DOWN A LITTLE BIT FURTHER AND WHERE IT SAYS DOCTOR'S
3 PROGRESS NOTES, THAT'S YOUR WRITING, TRUE?
4 A. RIGHT.
5 Q. AND YOU'RE GONNA HAVE TO READ THAT FOR ME PLEASE.
6 A. ONYCHOMYCOSIS OF HER FIFTH FINGER. THESE ARE JUST THE
7 PROBLEMS THAT ARE SORT OF NEW THINGS ON THAT PARTICULAR
8 VISIT. IT'S JUST FUNGAL INFECTION OF HER FINGER.
9 Q. AND WHAT'S THE NEXT ONE SAY?
10 A. FALLING OCCASIONALLY.
11 Q. AND THAT'S FALLING IN THE NURSING HOME, CORRECT?
12 A. RIGHT.
13 Q. AND IN FACT, DURING THE TWO YEARS THAT YOU SAW HER
14 APPROXIMATELY, THAT'S SOMETHING THAT HAPPENED MORE THAN
15 ONCE, TRUE?
16 A. YES.
17 Q. AND IN FACT, THAT WAS OF SOME CONCERN TO YOU AS HER
18 TREATING PHYSICIAN, ISN'T THAT CORRECT?
19 A. RIGHT.
20 Q. BECAUSE CERTAINLY ONE OF THE THINGS THAT CAN HAPPEN TO
21 SOMEBODY WHO'S ELDERLY AND THEY FALL, FOR EXAMPLE, THEY
22 COULD FRACTURE THEIR HIP, CORRECT?
23 A. RIGHT.
24 Q. AND THAT CERTAINLY CAN BE A VERY SERIOUS PROBLEM IN
25 SOMEBODY WHO'S ELDERLY, TRUE?
452
1 A. YES.
2 Q. AND IN FACT, THAT'S WHAT HAPPENED IN JUNE OF 1995 WHEN
3 MISS CRANE FELL AND INJURED AND FRACTURED HER PELVIS, ISN'T
4 THAT TRUE?
5 A. YES, SHE DID.
6 Q. NOW, IT'S TRUE, IS IT NOT, DR. STUBBS, THAT AS YOU
7 TESTIFIED, MARY HAD A NUMBER OF URINARY TRACT INFECTIONS
8 DURING THE TIME THAT YOU TREATED HER, CORRECT?
9 A. SHE DID.
10 Q. AND IN FACT, THAT WAS -- WOULD YOU CHARACTERIZE THAT AS
11 A CHRONIC CONDITION IN HER CASE?
12 A. WELL, FREQUENT, ANYWAY. SHE HAD FREQUENT -- I'D SAY IT
13 WAS -- SHE HAD FREQUENT URINARY TRACT INFECTIONS.
14 Q. AND WOULD SHE FREQUENTLY REPORT TO YOU THAT SHE WAS IN
15 PAIN?
16 A. PAIN RELATED TO THAT, TO THE URINARY TRACT IN --
17 Q. NO, JUST PAIN IN GENERAL.
18 A. WELL, AS I SAID, SHE OFTEN WOULD SAY SHE HAD A HEADACHE
19 AT THE TIME I WAS SEEING HER.
20 Q. NOW, YOU TESTIFIED THAT YOU -- YOU'RE NOT AWARE SHE WAS
21 HOSPITALIZED IN -- I THINK IT'S JULY OR APRIL OF 1994 AS A
22 RESULT OF A FALL AT ALTA VIEW HOSPITAL?
23 A. JULY OF 1994?
24 Q. RIGHT.
25 A. I DON'T REMEMBER THAT HOSPITALIZATION AND I DON'T --
453
1 MR. MAJOR: WELL, YOUR HONOR, WE'RE GONNA OBJECT AT
2 THIS POINT. JUST AS A CLARIFICATION, WE'RE TALKING ABOUT
3 HOSPITALIZATION. AND WE OBJECT TO THE CHARACTERIZATION.
4 THERE WAS NO HOSPITALIZATION. SHE WAS BROUGHT INTO THE
5 EMERGENCY ROOM, LOOKED AT, AND RETURNED BACK TO THE
6 MEDICAL -- TO THE --
7 THE COURT: WELL, I DON'T THINK COUNSEL OUGHT TO
8 TESTIFY. YOU MAKE AN OBJECTION, MAKE A OBJECTION. THE
9 WITNESS SAYS SHE DOESN'T KNOW ABOUT IT, SO I THINK THAT ENDS
10 IT.
11 Q. (BY MR. STIRBA) NOW, YOU -- DID THERE COME A TIME WHEN
12 YOU -- WELL, LET ME ASK THIS: AS A PHYSICIAN, AND
13 ESPECIALLY IN SOMEBODY LIKE MARY'S CASE, IT'S TRUE, IS IT
14 NOT, THAT GENERALLY PHYSICIANS RELY ON SELF-REPORTING BY
15 PATIENTS AS SORT OF THE FIRST INDICATION OF SOMEBODY'S PAIN.
16 IS THAT A FAIR STATEMENT?
17 A. IF THAT PATIENT IS ABLE TO REPORT THE PAIN.
18 Q. SURE. IN OTHER WORDS, TYPICALLY IT'S A SELF-REPORTING
19 PHENOMENON, ISN'T IT, AS IT'S PRESENT?
20 A. YES.
21 Q. I HAVE PAIN, RIGHT?
22 A. RIGHT.
23 Q. AND PAIN GENERALLY IS SUBJECTIVE, TRUE?
24 A. RIGHT.
25 Q. VERY DIFFICULT, ISN'T IT, IN MANY INSTANCES TO ISOLATE
454
1 PHYSIOLOGICALLY PAIN, TRUE?
2 MR. MAJOR: WELL, YOUR HONOR, I THINK WE'RE GOING
3 TO OBJECT. I THINK, NUMBER ONE, THIS IS NOT -- AS MR.
4 STIRBA RAISED UP EARLIER, THIS IS NOT AN EXPERT IN THAT
5 PARTICULAR AREA. THE ONLY THING SHE'S BEEN QUALIFIED FOR IS
6 AN INTERNIST. SHE'S NOT A PAIN EXPERT AS WE DO HAVE
7 EXPERTS, BOTH DEFENSE AND PLAINTIFFS HAVING EXPERTS COMING
8 IN TO DISCUSS PAIN. I DON'T BELIEVE -- THIS I THINK IS
9 BEYOND HER EXPERTISE TO BE ANSWERING THESE QUESTIONS.
10 THE COURT: WELL, I BELIEVE YOU ASKED IF SHE -- IF
11 THE PATIENT WAS IN PAIN AND WHETHER THIS DOCTOR THOUGHT SHE
12 WAS IN PAIN. AND THIS IS CROSS-EXAMINATION. IT'S
13 OVERRULED.
14 THE WITNESS: COULD YOU REPEAT THAT QUESTION?
15 Q. (BY MR. STIRBA) PROBABLY NOT BUT I'LL TRY. I THINK
16 WHERE I WAS IS THAT PAIN BEING SUBJECTIVE IN MANY INSTANCES
17 IS HARD TO PINPOINT PHYSIOLOGICALLY. IN OTHER WORDS, YOU
18 CAN'T TAKE A TEST OR YOU CAN'T DO AN X-RAY OR YOU CAN'T DO
19 SOME DIAGNOSTIC PROCEDURE AND IT SAYS THERE'S THE PAIN, IS
20 THAT TRUE?
21 A. I'D SAY GENERALLY THAT'S TRUE. THERE ARE SOME -- I
22 THINK THERE ARE SIGNS THAT -- THAT PEOPLE CAN HAVE THAT
23 THEY'RE IN PAIN.
24 Q. DO YOU BELIEVE IN YOUR PRACTICE THAT IT'S ETHICALLY
25 APPROPRIATE FOR A PHYSICIAN, IF A PATIENT IS REPORTING PAIN
455
1 FOR THE PHYSICIAN --
2 MR. MAJOR: OBJECTION, YOUR HONOR. THAT'S BEYOND
3 THE SCOPE OF DIRECT. HE'S GOING INTO ANY TYPE OF USING
4 MEDICATION, COMFORT CARE, THOSE TYPE OF THINGS, THAT'S
5 BEYOND THE DIRECT, THIS IS NOT --
6 THE COURT: OKAY, SUSTAINED.
7 Q. (BY MR. STIRBA) DID THERE COME A TIME, DR. STUBBS,
8 WHEN YOU DID NOT BELIEVE WHAT WAS BEING REPORTED TO YOU BY
9 MISS CRANE?
10 A. NO.
11 Q. FOR EXAMPLE, IN YOUR MEDICAL RECORDS, YOU HAVE CHARTED
12 THAT YOU PRESCRIBED FOR MISS CRANE A PLACEBO; I.E., CALCIUM.
13 WHAT'S A PLACEBO?
14 A. IT'S SOMETHING THAT CAN -- BASICALLY WHAT PEOPLE CALL A
15 SUGAR PILL. IT'S SOMETHING -- A PILL THAT WOULD BE GIVEN
16 FOR A SPECIFIC SYMPTOM THAT IS NOT CHEMICALLY SOMETHING THAT
17 WOULD ACTUALLY TREAT --
18 Q. NOT ACTUALLY WHAT?
19 A. NOT CHEMICALLY A MEDICATION OR A SUBSTANCE THAT WOULD --
20 Q. AND IT'S --
21 A. -- HELP THAT SYMPTOM.
22 Q. IT'S TRUE, IS IT NOT, THAT AT SOME POINT IN YOUR CARE OF
23 MISS CRANE, YOU PRESCRIBED HER A SUGAR PILL, TRUE?
24 A. WELL, SHE -- IF SHE WAS FELT TO BE IN PAIN, SHE DID NOT
25 RECEIVE A SUGAR PILL.
456
1 Q. TURN TO -- IN THE EXHIBIT D-2, THE DOCUMENT STUB 00010.
2 THAT PAGE HAS A NUMBER OF ENTRIES. THOSE ARE YOUR MEDICAL
3 ENTRIES, ARE THEY NOT?
4 A. MOSTLY NOT, NO. THE ONLY THING THAT'S MY ENTRY IS THE
5 LAST ENTRY BELOW WHAT YOU HAVE HIGHLIGHTED ON THIS PIECE OF
6 PAPER.
7 Q. LET'S SEE WHAT WE'VE GOT HERE SO I CAN UNDERSTAND --
8 MR. MAJOR: WELL, YOUR HONOR, I DON'T WANNA DO THE
9 COURT, BUT IF THOSE ARE NOT HER NOTES, THIS HAS NOT BEEN
10 INTRODUCED INTO EVIDENCE AND WHAT'S ON THERE IS HEARSAY, WE
11 OBJECT TO HAVING THE JURY BE ABLE TO SEE AND READ ANYTHING
12 ON THAT PAGE, UNLESS IT'S HER PARTICULAR -- THAT SHE'S
13 PLACED ON THAT RECORD HERSELF.
14 MR. STIRBA: I APPRECIATE THAT. MAY I FURTHER
15 CROSS HER? MAYBE I CAN GET TO THIS.
16 THE COURT: YES.
17 Q. (BY MR. STIRBA) I HAVE IN FRONT OF ME A SERIES OF --
18 THIS IS ONCE AGAIN WAS PROVIDED BY YOUR OFFICE PURSUANT TO
19 SUBPOENA. IT'S A DOCUMENT AND IT STARTS IT APPEARS AT
20 1/6/94. AND THEN IT'S A SERIES OF ENTRIES THAT PURPORT TO
21 BE THE CARE GIVEN TO MISS CRANE DOWN TO -- IT LOOKS LIKE
22 2/27/95. DO YOU SEE THAT?
23 A. YES.
24 Q. ARE THESE NOTES OF THE VISITS THAT MARY CRANE HAD WITH
25 YOU DURING THE TIME THAT SHE WAS IN YOUR CARE?
457
1 A. THE LAST, THE ONE AT THE BOTTOM, THE 2/27/95, IS.
2 EVERYTHING ABOVE THAT IS NOT. THOSE ARE PROBABLY THINGS
3 THAT A NURSE IN OUR OFFICE WROTE BASED ON PHONE
4 CONVERSATIONS WITH THE NURSING HOME.
5 Q. OKAY. IS THERE ANYTHING ABOUT WHAT IS ON HERE THAT YOU
6 DON'T BELIEVE IS CORRECT AND APPROPRIATE IN TERMS OF WHAT
7 CARE WAS PROVIDED TO MISS CRANE DURING THIS TIME PERIOD BY
8 YOUR OFFICE?
9 MR. MAJOR: WELL, YOUR HONOR, WE'RE STILL GONNA
10 OBJECT AT THOSE BEING HEARSAY. THIS HAS NOT BEEN OFFERED OR
11 ANY FOUNDATION LAID THAT THIS IS ACCURATE. SHE CAN'T
12 TESTIFY AS TO WHAT IS ON THESE NOTES, WHAT WAS ON THE NOTES
13 IS ACCURATE OR NOT. IT'S HEARSAY UNLESS WE BRING IN THE
14 ACTUAL PERSON WHO WROTE THIS.
15 THE COURT: WELL, SHE CAN ANSWER THAT QUESTION
16 WHETHER SHE CAN OR SHE CAN'T.
17 THE WITNESS: YOU WANNA KNOW WHETHER THERE'S
18 ANYTHING ON HERE THAT I BELIEVE IS NOT --
19 Q. (BY MR. STIRBA) DOCTOR, LET'S LOOK AT IT THIS WAY:
20 YOU HAVE AN OFFICE AND YOU SAW MISS CRANE, TRUE?
21 A. RIGHT.
22 Q. AND AS PART OF YOUR OFFICE, IT'S INCUMBENT UPON THE
23 OFFICE TO CREATE RECORDS OF THOSE VISITS, CORRECT?
24 A. RIGHT.
25 Q. AND THESE ARE MEDICAL RECORDS THAT PURPORT TO REPRESENT
458
1 CERTAIN CIRCUMSTANCES CONCERNING HER CARE, ISN'T THAT TRUE?
2 A. RIGHT.
3 Q. DONE BY YOUR OFFICE, CORRECT?
4 A. RIGHT.
5 Q. IF NOT WRITTEN BY YOU, WRITTEN BY ONE OF YOUR NURSES,
6 TRUE?
7 A. RIGHT. THERE'S SOME THINGS ON HERE WRITTEN BY OTHER
8 PHYSICIANS IN OUR OFFICE.
9 Q. OKAY. LET ME ASK YOU ABOUT THE ENTRY THAT APPEARS --
10 THAT STARTS WITH SPOKE WITH SHANNON AT SANDY REGIONAL.
11 DR. STUBBS TO PRESCRIBE CALCIUM, PAREN, AS PLACEBO, FOR
12 HEADACHES. DO YOU SEE THAT?
13 A. YES.
14 Q. AND ISN'T THAT IN FACT WHAT AT ONE POINT YOU DID WITH
15 MISS CRANE?
16 A. NOT -- NOT FOR -- THAT WAS NOT FOR HEADACHES IF THE --
17 IF THE NURSING STAFF BELIEVED SHE HAD HEADACHES. MARY CRANE
18 HAD A PSYCHIATRIC CONDITION WHICH RESULTED IN HER SOMETIMES
19 HAVING REPETITIVE BEHAVIORS OR REPETITIVE STATEMENTS, AND
20 THAT HAPPENED TO BE ONE OF THEM. IT WAS -- I MEAN -- AND
21 THERE WERE OTHERS. THAT WAS ONE OF THE REPETITIVE
22 STATEMENTS. SHE RECEIVED A PLACEBO IF THE NURSING STAFF OR
23 HER FAMILY FELT THAT THIS WAS ONE OF THOSE REPETITIVE
24 BEHAVIORS AND NOT TRULY A HEADACHE, NOT TRULY PAIN. IF SHE
25 WAS TRULY FELT TO HAVE A HEADACHE, THEN SHE WOULD BE GIVEN
459
1 EITHER THE TYLENOL OR IF THE NURSING STAFF FELT THAT IT WAS
2 MORE SEVERE, THEN THE HY-PHEN.
3 Q. OKAY. ON 2/28/94, RIGHT UNDER THAT, IT SAYS DR. STUBBS
4 WANTS TO CONTINUE CALCIUM. CALCIUM IS THE PLACEBO. WAS
5 THAT YOUR OPINION AT THAT TIME? AND YOUR DIRECTION?
6 A. I DON'T REMEMBER THAT. THAT WAS WRITTEN BY A MEDICAL
7 ASSISTANT IN OUR -- THAT WRITING IS A MEDICAL ASSISTANT IN
8 OUR OFFICE AND I DON'T RECALL A CONVERSATION RELATED TO
9 THAT. I DON'T REMEMBER.
10 Q. BUT IS IT TRUE THEN, DR. STUBBS, THAT THERE WERE TIMES
11 WHEN MARY WOULD COMPLAIN OF HEADACHES AND YOU THOUGHT IT WAS
12 APPROPRIATE THAT SHE BE GIVEN A SUGAR PILL?
13 A. THERE WERE TIMES WHEN MARY COMPLAINED OF HEADACHES. AS
14 I SAID, THIS REPETITIVE STATEMENT KIND OF THING THAT SHE DID
15 WHEN SHE WAS NOT FELT TO BE IN PAIN, AND AFTER TALKING WITH
16 THE NURSING HOME STAFF AND HER FAMILY, IT WAS FELT THAT A
17 PLACEBO WOULD BE HELPFUL TO HER, AND IT WAS. IT --
18 Q. AND YET THERE WERE OTHER TIMES WHILE SHE WAS IN THE
19 NURSING HOME UNDER YOUR CARE WHEN SHE COMPLAINED OF PAIN AND
20 SHE GOT TYLENOL, TRUE?
21 A. RIGHT.
22 Q. AND THEN THERE WERE OTHER TIMES WHEN SHE WAS IN YOUR
23 CARE AT THE NURSING HOME AND COMPLAINED OF PAIN, AND SHE GOT
24 HYDROCODONE, TRUE?
25 A. RIGHT.
460
1 Q. AND HYDROCODONE IS A NARCOTIC, ANALGESIC, CORRECT?
2 A. RIGHT.
3 Q. IN FACT, IT'S SOMETHING THAT CAN ONLY BE PRESCRIBED BY A
4 PHYSICIAN, TRUE?
5 A. YES.
6 Q. IN FACT, IT'S OPIATE-BASED, IS IT NOT? IT'S A
7 SYNTHETIC?
8 A. RIGHT.
9 Q. DOCTOR, LET ME SEE IF I COULD DIRECT YOUR ATTENTION TO
10 ANOTHER ENTRY. IF YOU'D LOOK AT THE DOCUMENT, IT HAS STUB
11 00011. AND UP AT THE TOP IT LOOKS LIKE 11/10/95. IS THAT
12 YOUR WRITING?
13 A. THAT'S NOT, BUT UNDER THERE WHERE IT SAYS S. AND THEN
14 DOWN BELOW, THAT'S MY WRITING.
15 Q. OKAY. DO YOU HAVE ANY REASON TO BELIEVE THAT ISN'T A
16 MEDICAL RECORD CONCERNING MARY CRANE, THAT ENTRY ON --
17 A. IT IS.
18 Q. OKAY.
19 MR. MAJOR: YOUR HONOR, WE'RE GONNA MAKE THE SAME
20 OBJECTION AT THIS TIME. WE DON'T KNOW WHO WROTE IT. WE
21 DON'T KNOW THE CIRCUMSTANCES. IT'S HEARSAY UNLESS WE -- AND
22 THESE HAVE NOT BEEN INTRODUCED INTO EVIDENCE. AND WE OBJECT
23 TO THIS BECOMING IN AT THIS POINT IN TIME AS BEING
24 HEARSAY --
25 THE COURT: WELL, WHAT I THOUGHT YOU SAID, YOU
461
1 WANTED TO COMPARE THE THING, YOU WANTED TO COMPARE IT TO
2 WHAT YOU HAVE TO SEE IF IT'S A COMPLETE RECORD.
3 MR. MAJOR: WE WANT TO COMPARE IT WITH THE ORIGINAL
4 RECORDS THAT ARE IN MISS STUBBS' OFFICE. SHE'S INDICATED
5 SHE HASN'T WORKED IN THAT OFFICE FOR TWO YEARS. SHE HAS NOT
6 HAD A CHANCE TO GO BACK, LOOK AT THE ORIGINALS AND COMPARE
7 THE ORIGINALS WITH THESE.
8 THE COURT: IS THE RECORD THAT WE'RE -- THAT YOU
9 WERE JUST ASKED, IS THAT A RECORD THAT WAS IN YOUR RECORDS
10 THAT YOU HAVE IN YOUR POSSESSION?
11 THE WITNESS: IS THIS WHAT?
12 THE COURT: IS THAT A RECORD THAT IS IN YOUR
13 MEDICAL RECORDS THAT WAS IN YOUR POSSESSION?
14 THE WITNESS: THIS CAME FROM THE OFFICE THAT I USED
15 TO BE WITH.
16 THE COURT: WHERE YOU WORKED, WHERE YOU TREATED
17 HER --
18 THE WITNESS: RIGHT.
19 THE COURT: -- MARY CRANE?
20 THE WITNESS: RIGHT.
21 THE COURT: OKAY. WELL, THIS IS A MEDICAL RECORD
22 AND --
23 MR. MAJOR: BUT IT HASN'T BEEN INTRODUCED. WE
24 HAVEN'T LAID THE FOUNDATION FOR IT. WE HAVEN'T GOT ANY
25 DOCUMENTATION. AND WE'RE MAKING THE SAME OBJECTION WE DID
462
1 EARLIER. WE OBJECT TO INTRODUCING MEDICAL RECORDS PIECEMEAL
2 BY PIECEMEAL WITHOUT KNOWING WHAT THE REST OF THE RECORDS
3 SAY.
4 THE COURT: WELL, THIS WOULD HAVE ALL BEEN RECEIVED
5 INTO EVIDENCE BUT FOR YOUR REQUEST --
6 MR. MAJOR: EXACTLY.
7 THE COURT: -- THAT YOU LOOK AT THESE OTHER THINGS.
8 THIS DOCTOR IS NOT GOING TO BE HERE PROBABLY IN THE NEXT FEW
9 DAYS AND SO THE ONLY WAY THEY OUGHT TO BE ABLE TO -- BE ABLE
10 TO QUESTION THIS WITNESS, IF SHE SAYS THESE ARE THE RECORDS
11 FROM HER OFFICE, THEY'RE MEDICAL RECORDS ABOUT THE PATIENTS
12 THAT ARE AT ISSUE IN THE LAWSUIT. IT'S OVERRULED.
13 MR. MAJOR: WELL, THEN I GUESS IS THE COURT
14 ACCEPTING THEM AS EV -- AS EXHIBITS --
15 THE COURT: NO --
16 MR. MAJOR: -- INDIVIDUALLY --
17 THE COURT: -- I'M SAYING -- I'M NOT ACCEPTING THEM
18 INDIVIDUALLY. I'M SAYING THAT THEY WILL BE ACCEPTED AS A
19 GROUP WHEN YOU'VE HAD A CHANCE TO LOOK AT THEM, BUT I SAID
20 WHEN WE STARTED THE CROSS-EXAMINATION, IF THIS WITNESS WILL
21 SAY THAT THESE ARE EXHIBITS THAT SHE'S FAMILIAR WITH AND
22 THEY'VE COME FROM THE OFFICE THAT SHE PRACTICED IN WHEN SHE
23 TREATED MARY CRANE, THEY CAN BE USED FOR CROSS-EXAMINATION.
24 THEY WILL BE RECEIVED AS A GROUP WHEN YOU'VE HAD A CHANCE TO
25 LOOK THROUGH THEM. BUT IF THE DOCTOR ON THE STAND TESTIFIES
463
1 THAT THEY ARE HER RECORDS OR THEY'RE FROM HER OFFICE, THOSE
2 ARE MEDICAL RECORDS AND IT COMES UNDER A MEDICAL RECORDS
3 EXCEPTION. GO AHEAD.
4 MR. STIRBA: THANK YOU, YOUR HONOR.
5 Q. NOW I'LL PUT THIS UP ON THE SCREEN, DR. STUBBS. AND I
6 GUESS YOU'VE TESTIFIED 11/10/95 AND EVERYTHING AFTER THAT,
7 THAT'S NOT YOUR WRITING, CORRECT? WHERE IT SAYS, LOOKS LIKE
8 BLOOD PRESSURE 110 OVER 64, THAT'S NOT YOUR WRITING.
9 A. THAT WOULD BE THE -- THE MEDICAL ASSISTANT WHO CHECKS
10 THE PATIENT IN.
11 Q. OKAY. THEN WHERE IT SAYS S., THAT'S YOUR WRITING, TRUE?
12 A. RIGHT.
13 Q. WHAT DOES S. STAND FOR?
14 A. SUBJECTIVE. THAT MEANS WHAT THE PATIENT TELLS ME OR
15 WHAT THE FAMILY OR NURSES TELL ME ABOUT HER.
16 Q. AND IT SAYS SOME NAUSEA. DID I READ THAT CORRECTLY?
17 A. RIGHT.
18 Q. AND THEN WHAT'S THE NEXT --
19 A. NO, NO -- NO ABDOMINAL PAIN.
20 Q. NO ABDOMINAL PAIN. AND THEN UNDER S., THERE'S A -- WHAT
21 IS S.?
22 A. THAT'S AN O.
23 Q. AND WHAT DOES THAT STAND FOR?
24 A. OBJECTIVE. THAT'S THE -- THAT WOULD BE THE PHYSICAL
25 EXAM.
464
1 Q. AND WOULD YOU PLEASE READ THAT LINE AFTER O.
2 A. LUNGS CLEAR. NEXT LINE IS CARDIOVASCULAR, REGULAR.
3 NEXT LINE, ABDOMEN IS NONTENDER.
4 Q. DO YOU KNOW IF AT THE TIME OF THIS VISIT THERE WAS A
5 COMPLAINT OF ABDOMINAL PAIN?
6 A. WELL, I'M -- I DON'T SPECIFICALLY REMEMBER THIS VISIT,
7 BUT I'M ASSUMING NOT SINCE I WROTE NO ABDOMINAL PAIN.
8 Q. NO, I -- OKAY. BUT I'M TRYING TO DERIVE, WAS THERE A
9 PARTICULAR REASON WHY YOU WOULD HAVE WRITTEN THAT? IS THAT
10 NORMALLY IN RESPONSE TO A COMPLAINT OF ABDOMINAL PAIN OR IS
11 IT SOMETHING THAT TYPICALLY YOU WOULD CHART?
12 A. OH, IT'S BECAUSE NAUSEA WAS REPORTED, AND JUST BE -- IF
13 SOMEONE TELLS ME THEY'RE NAUSEATED, I WOULD ASK THEM IF THEY
14 HAVE ABDOMINAL PAIN.
15 Q. I SEE. AND THEN UNDERNEATH THAT, I BELIEVE YOU'RE
16 TALKING ABOUT HEART. AND THEN WHAT IS THE NEXT LANGUAGE
17 PLEASE?
18 A. ABDOMEN NONTENDER.
19 Q. OKAY. THEN YOU HAVE A.P.
20 A. ASSESSMENT AND PLAN.
21 Q. AND WHAT DOES THAT SAY?
22 A. NAUSEA. MAY BE -- MAY BE DUE TO LOW SODIUM. WILL CHECK
23 TODAY, MEANING CHECK HER SODIUM LEVEL IN HER BLOOD. AND
24 NEXT LINE SAYS, OTHER PROBLEMS STABLE. STABLE. HAS HAD FLU
25 SHOT. AND INITIALS BELOW THAT.
465
1 Q. THAT'S YOUR INITIALS. NOW, THE LINES THAT YOU'VE
2 WRITTEN THERE, WAS THAT BASED UPON AN OFFICE VISIT AND
3 EXAMINATION OF THE PATIENT?
4 A. IT WAS. IN FACT, THAT WAS THE LAST OFFICE VISIT THAT I
5 HAD WITH HER.
6 Q. AND DO YOU KNOW IF THAT PARTICULAR OFFICE VISIT WOULD
7 HAVE BEEN EITHER A BRIEF, INTERMEDIATE, OR A COMPREHENSIVE
8 OFFICE VISIT?
9 A. THAT WAS JUST A BRIEF ROUTINE RECERTIFICATION EVERY
10 60-DAY VISIT.
11 Q. HOW MUCH TIME DO YOU THINK YOU WOULD HAVE SPENT WITH
12 MISS CRANE SUCH THAT YOU CREATED THAT PARTICULAR NOTE?
13 A. OH, MAYBE I -- IT'S LIKELY THAT I SPENT 15, 20 MINUTES
14 TALKING TO HER AND HER DAUGHTER AND EXAMINING HER.
15 Q. DO YOU STILL HAVE THE EXHIBIT D-2 IN FRONT OF YOU?
16 A. RIGHT.
17 Q. IF YOU COULD, AND I APOLOGIZE TO THE COURT AND EVERYBODY
18 ELSE ABOUT THIS, BUT UNDER THE CIRCUMSTANCES, COULD YOU
19 PLEASE JUST GO THROUGH THERE, SOMEWHAT QUICKLY, IF YOU
20 COULD, AND TELL US IF THERE ARE ANY DOCUMENTS IN THERE THAT
21 YOU BELIEVE ARE NOT PART OF YOUR MEDICAL FILE OR THE MEDICAL
22 FILE KEPT AT YOUR OLD OFFICE.
23 A. THIS WHOLE THING THAT YOU PASSED TO ME?
24 Q. D-2, YES.
25 A. THOSE ALL LOOK LIKE THINGS THAT WOULD HAVE BEEN IN OUR
466
1 OFFICE RECORD. WHETHER IT'S COMPLETE, I COULDN'T TELL YOU.
2 Q. VERY WELL. I'LL PUT A CLIP ON THAT, MAKE IT A LITTLE
3 BIT EASIER FOR SOMEBODY IN THE FUTURE. OH, ARE THESE THE --
4 A. GUESS THESE ARE ALL THE ONES THAT CAME OUT OF HERE,
5 RIGHT?
6 Q. YOU WANTED TO INCLUDE THESE IN D-2, IS THAT RIGHT? YOU
7 THOUGHT THEY WERE PART OF THE MEDICAL FILE AS WELL? THAT'S
8 THE MONTHLY REPORTS FROM THE NURSING HOME?
9 A. RIGHT. ACTUALLY, A COUPLE OF THESE ARE FROM DR. BORN,
10 NOT ME. THESE ARE MY NOTES.
11 MR. STIRBA: OKAY. THAT'S ALL I HAVE OF THIS
12 WITNESS, YOUR HONOR.
13 THE COURT: OKAY. ANY REDIRECT?
14 MR. MAJOR: COUPLE.
15 REDIRECT EXAMINATION
16 BY MR. MAJOR:
17 Q. MISS STUBBS, HOPEFULLY WE WON'T BE MORE THAN JUST A
18 COUPLE QUESTIONS, BUT WE ATTORNEYS ALWAYS SAY THAT AND NEVER
19 VERY GOOD ABOUT KEEPING IT SHORT. YOU ALSO -- YOU TESTIFIED
20 IN WHAT WAS MARKED I GUESS WAS IDENTIFIED FOR THE PLAINTIFF
21 AS STUBBS 00001. AND HE TALKED LITTLE BIT ABOUT THE
22 SITUATION ACROSS THE TOP OF THAT. DO YOU KNOW --
23 A. RIGHT.
24 Q. DO YOU KNOW WHEN THOSE THINGS OCCURRED?
25 A. WHEN THOSE DIAGNOSES WERE MADE?
467
1 Q. UH-HUH.
2 A. ALL THOSE DIAGNOSES HAD BEEN MADE BEFORE I EVER SAW
3 MARY. I KNOW THAT HER STROKE WAS SOMEWHERE AROUND 1990, BUT
4 I --
5 Q. 1990 WHAT?
6 A. I KNOW THAT HER STROKE WAS SOMEWHERE AROUND 1990, BUT
7 THE OTHER DIAGNOSES, I COULDN'T TELL YOU WITHOUT LOOKING AT
8 FURTHER INFORMATION. WE HAVE -- IN OUR OFFICE, WE WOULD
9 HAVE HAD MEDICAL RECORDS FROM SARAH JANE ANDERSON, WHO WAS
10 HER DOCTOR BEFORE ME --
11 Q. OKAY.
12 A. -- THAT MAYBE WOULD ANSWER THOSE QUESTIONS.
13 Q. YEAH, THAT'S FINE. NOW ALSO, DURING YOUR PHYSICAL
14 EXAMINATION OF MISS CRANE DURING THIS PERIOD OF TIME, WOULD
15 THAT BROUGHT ON ANY INDICATIONS OF PAIN IF SHE WAS HAVING
16 THE CHRONIC BACK PAIN?
17 A. WELL, YES, I WOULD ALWAYS ASK HER AND ASK HER DAUGHTER
18 IF SHE WAS HAVING ANY COMPLAINTS OF PAIN OTHER THAN THE
19 HEADACHES WHICH SHE FREQUENTLY COMPLAINED OF, AND ALSO, IF
20 SHE WAS, IT WOULD, YOU KNOW, THE NURSES WOULD -- IF SHE HAD
21 COMPLAINED TO THE NURSES, THEY WOULD HAVE WRITTEN THAT UNDER
22 THE NURSING OBSERVATION SECTION.
23 Q. ARE THERE CERTAIN TYPES OF PHYSICAL OBSERVATIONS YOU CAN
24 MAKE AS TO WHETHER A PERSON'S SUFFERING FROM BACK PAIN?
25 A. FROM -- WELL, I -- THERE'S CERTAIN OBSERVATIONS YOU CAN
468
1 MAKE ABOUT WHETHER SOMEONE IS IN PAIN.
2 Q. AND WHAT WOULD THOSE BE?
3 A. FACIAL EXPRESSIONS, GRIMACING, YOU KNOW, HOLDING THEIR
4 BODY RIGIDLY. PEOPLE'S HEART RATE AND BLOOD PRESSURE MAY BE
5 ELEVATED IF THEY'RE IN PAIN. Seen in the patients, often.
6 Q. WOULD THE WAY A PERSON MOVES OR WALKS -- ESPECIALLY BACK
7 PAIN, I'M REFERRING TO?
8 A. SURE. THAT -- YOU MAY BE ABLE TO DETECT THAT, ALTHOUGH
9 IN MARY, SHE WAS IN A WHEELCHAIR, AND SO --
10 Q. BUT YOU'D NOT --
11 A. SHE DIDN'T --
12 Q. IN YOUR EXAMINATION OF MARY CRANE, YOU DID NOT SEE
13 ANYTHING THAT YOU -- PHYSICALLY THAT WOULD INDICATE TO YOU
14 THAT SHE WAS IN PAIN?
15 A. IN BACK PAIN?
16 Q. YEAH.
17 A. RIGHT.
18 Q. NOW, YOU ALSO INDICATED AS FAR AS THAT EXHIBIT THAT I'VE
19 GIVEN YOU, IT INDICATES THAT HYDROCODONE -- I BELIEVE IT'S
20 HYDROCODONE, THE LORTAB THAT WAS GIVEN TO HER AND THE
21 TYLENOL, YOU INDICATED THAT WAS AS NEEDED. HOW -- WHAT WAS
22 YOUR BASIS FOR THAT?
23 A. THAT WOULD BE ASSESSED BY THE NURSES AT THE NURSING
24 HOME. BECAUSE I BELIEVE THAT SHE SOMETIMES DID HAVE
25 HEADACHES AND OCCASIONALLY SHE DID COMPLAIN OF BACK OR OTHER
469
1 PAIN. AND THOSE WERE PRESCRIBED SO THAT IF THE NURSES OR --
2 FELT THAT SHE WAS INDEED IN PAIN, THEY WOULD HAVE SOMETHING
3 TO GIVE HER.
4 Q. BASED ON YOUR REVIEW OF THOSE RECORDS, HOW OFTEN WERE
5 THEY GIVEN? ACTUALLY GIVEN?
6 A. AT ONE POINT, SHE WAS -- LET'S SEE, I'M NOT SURE ABOUT
7 THE TYLENOL. THE TYLENOL MAY BE MORE FREQUENTLY THAN THE
8 HY-PHEN. I DIDN'T SPECIFICALLY LOOK FOR THAT. I -- WHEN I
9 WAS LOOKING THROUGH THE RECORD EARLIER TODAY, I WAS MORE
10 LOOKING AT HOW OFTEN SHE RECEIVED NARCOTIC PAIN MEDICATION
11 AND SPECIFICALLY, I JUST LOOKED AT THE LAST COUPLE MONTHS,
12 TWO MONTHS BEFORE SHE LEFT SANDY REGIONAL AND -- AND AVERAGE
13 WAS LESS THAN ONE HYDROCODONE PER DAY. LESS THAN ONE PAIN
14 PILL PER DAY.
15 Q. LET ME SHOW YOU AGAIN WHAT HAS BEEN MARKED AS D-2 AND
16 ASK YOU, WOULD YOU LOOK AT WHAT IS -- THE FRONT PAGE OF THAT
17 I BELIEVE IS MISS STUBBS 00001. AND WOULD YOU GO TO THE
18 VERY LAST PAGE WHICH I BELIEVE IS H.N.H. 00553. PERHAPS YOU
19 COULD SEPARATE THE LAST PAGE AND --
20 A. YEAH, I'M HERE, UH-HUH.
21 Q. AND THAT LAST -- WHAT IS THAT LAST PAGE, THAT 00553?
22 A. THAT IS THE NURSING HOME REFERRAL FORM FOR AN OFFICE
23 VISIT SHE HAD WITH ME NOVEMBER 10TH OF '95. THAT WAS THE
24 LAST TIME I SAW HER.
25 Q. OKAY. NOW, WOULD YOU LOOK AT THAT AND COMPARE IT TO THE
470
1 ONE THAT WAS 7/14/95 WHICH IS 00001?
2 A. YES.
3 Q. OKAY. IN DIAGNOSIS WHERE IT SAYS C.V.A., H.T.N., AND
4 THAT TYPE OF THING, ARE THOSE THE SAME?
5 A. YES.
6 Q. THERE HAD BEEN REALLY NO CHANGE IN THE DIAGNOSIS AT THAT
7 TIME.
8 A. RIGHT.
9 Q. OKAY. NOW, GOING ON DOWN, IF YOU LOOK AT THE PRESENT
10 MEDICATIONS THAT HAVE BEEN GIVEN, DOES IT SHOW THAT ON 11/10
11 OF '95, DOES IT INDICATE THAT SHE WAS RECEIVING ANY LORTAB
12 OR ANY HYDROCODONE?
13 A. WELL, IT SHOWS THAT SHE HAD AN ORDER FOR HY-PHEN P.R.N.
14 Q. SO THIS ONE IT DOES INDICATE IT'S THE P.R.N.
15 A. RIGHT.
16 Q. AND ALSO FOR THE TYLENOL?
17 A. RIGHT.
18 Q. OKAY. SO BASED ON 11/10 OF '95, THAT MEDI -- PAIN
19 MEDICATION SHE WAS GIVEN HAD BEEN CHANGED AS NEEDED, P.R.N.
20 A. IT WAS ALWAYS THAT WAY. IT JUST HAD BEEN WRITTEN
21 INCORRECTLY ON THE FORM IN JULY.
22 Q. OKAY. NOW, JUST ONE LAST FINAL QUESTION. WHEN WE
23 TALKED ON CROSS-EXAMINATION, MR. STIRBA INDICATED TO YOU
24 THAT SHE'D BEEN RECEIVING SOME OF THESE PSYCHOTROPIC DRUGS,
25 XANAX AND SO FORTH.
471
1 A. RIGHT.
2 Q. YOU INDICATED THAT THEY COULD BE SEDATIVE.
3 A. RIGHT.
4 Q. WHAT DOES THAT -- WHAT WOULD CAUSE THEM TO BE SEDATIVE?
5 DO YOU SEE WHAT I'M SAYING?
6 A. I'M NOT SURE WHAT YOU MEAN BY --
7 Q. WELL, YOU SAID THEY COULD BE, AND THAT IMPLIES TO ME
8 THAT THEY ALSO COULD NOT BE.
9 A. OH. WELL, I -- I THINK IT'S, YOU KNOW, A DOSE-RELATED
10 THING. DEPENDS ON THE DOSE PEOPLE ARE GIVEN. DEPENDS ON
11 WHAT OTHER MEDICATIONS THEY MAY BE TAKING THAT MAY INTERACT
12 WITH THOSE MEDICATIONS.
13 Q. SO THE HIGHER THE DOSAGE YOU GET, THE MORE SEDATED THE
14 DRUG WOULD BE?
15 A. LIKELY, YES.
16 Q. DID YOU NOTICE ANYTHING ABOUT THE DRUGS THAT -- THESE
17 DRUGS THAT MISS CRANE WAS RECEIVING, WHETHER THEY WERE
18 SEDATIVE TO HER IN ANY WAY?
19 A. FROM THE REPORTS THAT I HAVE IN MY OBSERVATION, I WOULD
20 SAY THEY WERE NOT --
21 Q. OKAY.
22 A. -- REAL SEDATIVE.
23 Q. WELL, FINALLY IN REVIEWING THE LAST NOTE, THE N.H.
24 00553, THERE WAS A MENTION ABOUT NAUSEA AND MAYBE ABDOMINAL
25 PAIN. BASED ON YOUR READING YOUR DOCTOR'S ORDERS, DOES THAT
472
1 APPEAR TO HAVE BEEN A PROBLEM AT THE TIME?
2 A. WELL, APPARENTLY. I DON'T SPECIFICALLY REMEMBER THAT
3 VISIT, BUT I WROTE THAT SHE WAS NAUSEATED AND -- AND THERE
4 WERE SOME ORDERS WRITTEN RELATED TO THAT.
5 Q. BUT NOTHING THAT WOULD INDICATE THAT WAS FOR ABDOMINAL
6 PAIN.
7 A. NO.
8 MR. MAJOR: WE HAVE NO FURTHER QUESTIONS, YOUR
9 HONOR.
10 THE COURT: ANYTHING FURTHER OF THIS WITNESS?
11 MR. STIRBA: JUST A COUPLE, YOUR HONOR.
12 RECROSS-EXAMINATION
13 BY MR. STIRBA:
14 Q. P.R.N., THAT -- USE OF THAT TERM IN MEDICAL PARLANCE
15 MEANS AS NEEDED, CORRECT?
16 A. (WITNESS NODS.)
17 THE COURT: ANSWER OUT LOUD.
18 THE WITNESS: YES, IT DOES.
19 Q. (BY MR. STIRBA) WHEN YOU'RE TALKING ABOUT PAIN
20 MEDICATION, YOU HAVE A P.R.N. ORDER, YOU'RE TALKING ABOUT
21 USUALLY, FOR EXAMPLE, IN MARY'S CASE, A NURSE AT THE NURSING
22 HOME WOULD ASSESS SIGNS AND SYMPTOMS OF PAIN.
23 A. RIGHT.
24 Q. IF THEY MADE SUCH A ASSESSMENT, THEN THEY WOULD GIVE THE
25 PAIN MEDICATION, CORRECT?
473
1 A. RIGHT.
2 Q. AND THAT'S -- THAT'S WHAT YOU MEAN BY AS NEEDED, TRUE?
3 A. RIGHT.
4 Q. SO IF WE HAD, FOR EXAMPLE, THE LAST TWO MONTHS OF MARY'S
5 STAY IN THE NURSING HOME AND THOSE RECORDS SHOW THAT SHE
6 RECEIVED A PAIN PILL, A NARCOTIC PAIN PILL, EVERY DAY THE
7 LAST TWO MONTHS SHE WAS THERE, IF I UNDERSTAND YOUR
8 TESTIMONY, WHAT YOU'RE SAYING IS THAT SOME NURSE OR SOMEBODY
9 HAD ASSESSED HER NEED FOR THAT MEDICATION EACH AND EVERY
10 DAY, IS THAT CORRECT?
11 A. RIGHT.
12 Q. AND WHEN WE TALK ABOUT SEDATING QUALITIES OF
13 MEDICATIONS, WE'RE REALLY TALKING ABOUT THE PHARMACOLOGY OF
14 THE MEDICATIONS, ISN'T THAT TRUE?
15 A. RIGHT.
16 Q. FOR EXAMPLE, MEDICATIONS HAVE CERTAIN PROPERTIES, AND
17 ONE OF THE PROPERTIES A MEDICATION, FOR EXAMPLE, A PSYCH MED
18 MAY HAVE IS IT'S CALLED A C.N.S. DEPRESSANT OR A CENTRAL
19 NERVOUS SYSTEM DEPRESSANT, ISN'T THAT CORRECT?
20 A. RIGHT.
21 Q. AND SO WHEN WE TALK ABOUT SEDATION OR SEDATING
22 QUALITIES, WE'RE TALKING ABOUT THOSE MEDICATIONS THAT MAY
23 HAVE AS A SIDE EFFECT A DEPRESSANT EFFECT ON THE CENTRAL
24 NERVOUS SYSTEM, TRUE?
25 A. THAT'S CORRECT.
474
1 Q. FOR EXAMPLE, LOPRESSOR, WHICH IS ONE THAT MARY WAS ON,
2 WHICH IS A HIGH BLOOD PRESSURE MEDICATION OR A -- FOR
3 HYPERTENSION, DOESN'T HAVE THAT CENTRAL NERVOUS SYSTEM
4 DEPRESSING QUALITY, DOES IT?
5 A. WELL, EVEN OTHER MEDICATIONS OTHER THAN PAIN MEDICATIONS
6 AND THESE ANTI-ANXIETY, ANTI-DEPRESSANT MEDICATIONS,
7 THOSE -- SOME OTHER MEDICATIONS CAN ALSO.
8 Q. SURE. AND REALLY ALL I'M JUST TRYING TO MAKE SURE IS
9 THE FOLKS IN THE JURY UNDERSTAND THAT WHEN WE TALK ABOUT
10 SEDATION AND WE TALK ABOUT MEDICATIONS THAT ARE SEDATING,
11 WE'RE TALKING ABOUT MEDICATIONS THAT HAVE AS A PHARMACOLOGY
12 PROPERTY A DEPRESSANT EFFECT ON THE CENTRAL NERVOUS SYSTEM.
13 A. RIGHT, RIGHT.
14 Q. AND SOME MEDS HAVE THOSE, TRUE?
15 A. RIGHT.
16 Q. AND SOME MEDS DON'T.
17 A. RIGHT.
18 Q. AND THAT'S REALLY WHAT WE'RE TALKING ABOUT, CORRECT?
19 A. RIGHT.
20 Q. AND IT'S ALSO TRUE, IS IT NOT, THAT PROBABLY THE BEST
21 EVIDENCE FOR WHAT IS HAPPENING WITH MARY IN THE NURSING HOME
22 IN TERMS OF HER REACTION TO MEDICATIONS WOULD BE THE ACTUAL
23 PEOPLE, FOR EXAMPLE, THE NURSES WHO WERE ASSESSING HER
24 CONDITION ON A DAY-BY-DAY OR HOUR-BY-HOUR BASIS, ISN'T THAT
25 CORRECT?
475
1 A. RIGHT.
2 Q. CERTAINLY, YOU AREN'T THERE THE WHOLE TIME WATCHING OVER
3 HER, ISN'T THAT TRUE?
4 A. RIGHT.
5 Q. AND ISN'T IT TRUE THAT NURSES IN THE NURSING HOME IN THE
6 SANDY REGIONAL CONVALESCENT CENTER WOULD, LIKE ALL NURSES,
7 THEY WOULD CHART THE DAILY EVENTS THAT HAPPENED WITH RESPECT
8 TO MARY, CORRECT?
9 A. RIGHT.
10 Q. AND CERTAINLY, ONE OF THE THINGS THEY WOULD CHART WOULD
11 BE, FOR EXAMPLE, LETHARGY, TRUE? OR OTHER KINDS OF PROBLEMS
12 THAT THEY NOTICED AND WOULD NOTE ON THEIR CHART, CORRECT?
13 A. RIGHT.
14 MR. STIRBA: THANK YOU.
15 THE COURT: ANYTHING FURTHER?
16 MR. MAJOR: NOTHING, YOUR HONOR.
17 THE COURT: MAY THIS WITNESS BE EXCUSED?
18 MR. MAJOR: SHE MAY.