Scott Cunningham, DO
5 SCOTT CUNNINGHAM,
6 CALLED AS A WITNESS, BEING FIRST DULY SWORN,
7 WAS EXAMINED AND TESTIFIED AS FOLLOWS:
8 DIRECT EXAMINATION
9 BY MR. MAJOR:
10 Q. DOCTOR, WOULD YOU STATE YOUR NAME AND OCCUPATION?
11 A. THOMAS SCOTT CUNNINGHAM, PHYSICIAN.
12 Q. AND WHERE DO YOU PRACTICE, DOCTOR?
13 A. LOGAN, UTAH.
14 Q. AND WHAT DOES YOUR PRACTICE CONSIST OF?
15 A. GENERAL INTERNAL MEDICINE.
16 Q. AND WHAT DOES GENERAL INTERNAL MEDICINE ENTAIL?
17 A. SPECIFICALLY, IT'S ADULT MEDICAL CARE, NONSURGICAL. I
18 TREAT ADULT MEDICAL PROBLEMS OF A NONSURGICAL BASIS.
19 Q. WHEN WE TALK ADULT, IS THERE ANY PARTICULAR AGE?
20 A. OH, GENERALLY 16 OR GREATER.
21 Q. WHAT -- CAN YOU GIVE US A LITTLE BIT ABOUT YOUR
22 TRAINING, YOUR EDUCATION AND TRAINING BACKGROUND?
23 A. WENT TO UNDERGRADUATE AT UNIVERSITY OF MISSOURI,
24 COLUMBIA. MEDICAL SCHOOL AT UNIVERSITY OF HEALTH SCIENCES
25 IN KANSAS CITY. I DID A YEAR OF A ROTATING INTERNSHIP IN
854
1 MICHIGAN, BOTTSFORD GENERAL HOSPITAL. AND THEN I DID AN
2 INTERNAL MEDICINE RESIDENCY AT THE UNIVERSITY OF MISSOURI,
3 KANSAS CITY, '83 TO -- 1983 TO 1986.
4 Q. AND AFTER 1986 WHERE DID YOU PRACTICE?
5 A. I WAS IN THE NATIONAL HEALTH SERVICE CORPS, PUBLIC
6 HEALTH SERVICE IN MICHIGAN FOR FOUR YEARS IN A SMALL
7 COMMUNITY, AND THEN I PRACTICED IN A TOWN IN SOUTHERN
8 WISCONSIN FOR FOUR YEARS. AND THEN I CAME TO LOGAN.
9 Q. AND HOW LONG HAVE YOU BEEN IN LOGAN?
10 A. SINCE 1994.
11 Q. AND DO YOU HAVE ANY CERTIFICATES? ARE YOU BOARD
12 CERTIFIED IN --
13 A. I'M, YEAH, BOARD CERTIFIED IN INTERNAL MEDICINE IN 1986.
14 Q. OKAY. NOW, DOES YOUR PRACTICE INDICATE DEALING WITH
15 INTERNAL MEDICINE IN ADULTS ENTAIL ANYTHING ELSE? DO YOU DO
16 ANY OTHER TYPES OF CARE?
17 A. I'M A -- I WORK FOR THE LOCAL HOSPICE. I'M THE MEDICAL
18 DIRECTOR FOR THE CACHE VALLEY HOSPICE.
19 Q. AND THAT'S LOCATED WHERE?
20 A. LOGAN. BUT IT SERVES THE WHOLE CACHE VALLEY.
21 Q. WHAT DOES THAT ENTAIL?
22 MR. STIRBA: YOUR HONOR, I'M GONNA OBJECT AS TO
23 RELEVANCY IN TERMS OF WHAT HE DOES IN TERMS OF HOSPICE.
24 THE COURT: WHAT DOES THAT HAVE TO DO --
25 MR. MAJOR: YOUR HONOR, IT JUST GO TO HIS
855
1 BACKGROUND AND TRAINING, EXPERIENCE IN DEALING WITH ELDERLY
2 PATIENTS, DEALING WITH ENNIS ALLDREDGE.
3 THE COURT: JUST BRIEF BACKGROUND, BUT GO ON.
4 Q. (BY MR. MAJOR) WHY DON'T YOU JUST EXPLAIN THOSE, WHAT
5 THAT ENTAILS.
6 A. WE WORK AS A TEAM. WE MEET EVERY TWO WEEKS. WE REVIEW
7 HOSPICE PATIENTS, AND I HELP ANSWER MEDICAL PROBLEMS THAT
8 MIGHT OCCUR DURING THEIR CARE.
9 Q. OKAY. AND DOES THAT INVOLVE DEALING WITH END-OF-LIFE
10 CARE?
11 A. YEAH.
12 Q. I'M ASSUMING THAT'S WHAT HOSPICE MEANS?
13 A. THAT'S WHAT IT IS.
14 Q. NOW, DOCTOR, DID YOU HAVE A -- COME A TIME WHEN YOU HAD
15 AN OPPORTUNITY TO MEET WITH ENNIS ALLDREDGE?
16 A. YEAH, YEAH.
17 Q. AND WHAT WERE THE INITIAL CIRCUMSTANCES SURROUNDING
18 MEETING WITH HIM?
19 A. IN APRIL OF 1995, MR. ALLDREDGE CAME IN, I BELIEVE WITH
20 HIS WIFE, TO ESTABLISH CARE WITH ME. THEY HAD RECENTLY
21 MOVED TO LOGAN AND NEEDED A PHYSICIAN.
22 Q. AND THEY CHOSE YOU.
23 A. (WITNESS NODDED.)
24 Q. AND WHAT DID YOU DO ON THIS INITIAL MEETING?
25 A. TOOK HIS GENERAL MEDICAL HISTORY AND PERFORMED A
856
1 PHYSICAL EXAMINATION AND PERFORMED SOME LABORATORY STUDIES.
2 Q. AND DO YOU RECALL WHAT THE RESULTS OF THAT WAS?
3 A. ENTIRE -- YOU MEAN THE -- ALL OF THOSE THINGS?
4 Q. YES, AT THIS POINT, ALL THAT, THESE THINGS IN YOUR
5 INITIAL CONTACT WITH HIM.
6 A. HE WAS AN ELDERLY MAN WHO'D HAD A HISTORY OF DEMENTIA
7 WITH MEMORY LOSS. DIFFICULTY WITH THINKING. HIS -- THEY
8 HAD MOVED UP TO LOGAN APPARENTLY BECAUSE THE WIFE WAS
9 REQUIRING SOME SUPPORTIVE CARE AND THERE WAS APPARENTLY SOME
10 FAMILY MEMBERS, I DON'T RECALL EXACTLY WHO, BUT THAT LIVED
11 IN LOGAN SO THEY MOVED UP FROM DELTA, UTAH. HE ALSO HAD
12 DIABETES. HE HAD HYPERTENSION. HE HAD A HISTORY OF
13 CORONARY ARTERY DISEASE. AND THE MAJORITY -- HIS MEDICAL
14 PROBLEMS GENERALLY WERE STABLE. THEY WEREN'T PROBLEMATIC AT
15 THE TIME. HIS LABORATORY STUDIES WERE UNREMARKABLE.
16 Q. NOW, YOU MENTIONED HE HAD DIABETES. DO YOU KNOW HOW
17 LONG HE'D HAD DIABETES?
18 A. I DON'T KNOW. 20 years.
19 Q. LONG -- A FAIRLY LENGTHY PERIOD OF TIME, DO YOU RECALL?
20 A. I DON'T HAVE ANY MEMORY OF THAT.
21 Q. HOW ABOUT THE HYPERTENSION, DO YOU RECALL WHAT HE -- WAS
22 HE RECEIVING ANY MEDICATION FOR THE HYPERTENSION?
23 A. YEAH, HE WAS ON -- HE WAS ON HYTRIN WHICH IS A BLOOD
24 PRESSURE MEDICATION. AND I BELIEVE THAT'S ALL FOR HIS
25 HYPERTENSION.
857
1 Q. NOW, JUST FOR THE CLARIFICATION BENEFIT OF THE JURY,
2 WHAT DOES HYPERTENSION MEAN, COULD YOU EXPLAIN THAT?
3 A. HYPERTENSION'S HIGH BLOOD PRESSURE.
4 Q. THAT'S ALL IT MEANS. HIGH BLOOD PRESSURE CAN BE A RISK
5 FACTOR, CAN IT NOT? RISK OF DEATH?
6 A. RIGHT.
7 Q. COMPLICATION --
8 A. RIGHT. IT'S A RISK FACTOR FOR HEART DISEASE AND STROKE.
9 Q. IN YOUR TREATMENT OF MR. ALLDREDGE, YOU INDICATED HE
10 WAS -- APPEARED TO BE UNDER CONTROL?
11 A. RIGHT.
12 Q. HOW ABOUT THE DIABETES?
13 A. IN TERMS OF THE CONTROL?
14 Q. CONTROL, YEAH, WHAT TYPE OF CONTROL WAS BEING INITIATED?
15 A. HIS BLOOD SUGARS WERE RUNNING IN MEDIUM RANGE. THEY
16 WERE IN THE UPPER ONE HUNDREDS. I FELT IT WAS ADEQUATE
17 ENOUGH FOR HIM GIVEN HIS OTHER MEDICAL PROBLEMS. FOR
18 SOMEONE YOUNGER, I PROBABLY WOULD HAVE NEEDED TIGHTER
19 CONTROL, BUT FOR HIS -- HIM, I THOUGHT THAT WAS ADEQUATE.
20 GENERALLY SAFE.
21 Q. DID YOU ON THIS INITIAL VISIT FIND ANY UNUSUAL PHYSICAL
22 OR MENTAL CONDITION -- I MEAN PHYSICAL CONDITION, I SHOULD
23 SAY?
24 A. PHYSICALLY? NO, NOT PARTICULARLY.
25 Q. DID HE APPEAR TO BE IN GOOD HEALTH?
858
1 A. PHYSICALLY.
2 Q. PHYSICALLY.
3 A. RIGHT. He was quite strong...
4 Q. MENTALLY, HE HAD SOME -- THE PROBLEMS YOU DESCRIBED.
5 A. MENTALLY HE HAD MEMORY IMPAIRMENT.
6 Q. WHAT THEN OCCURRED? WHAT WAS NEXT AFTER THAT? WHAT'S
7 THE NEXT THING THAT YOU HAD WITH HIM AND WHY?
8 A. WELL, I SAW HIM A MONTH LATER JUST TO FOLLOW UP ON
9 THINGS AND -- AND HE WAS GENERALLY DOING REASONABLY WELL.
10 NO -- NO SIGNIFICANT CHANGES HAD OCCURRED.
11 Q. WHAT TYPE OF TESTS DID YOU RUN AT THAT TIME?
12 A. CAN I LOOK AT MY NOTES?
13 Q. YEAH, GO AHEAD.
14 A. I DIDN'T DO ANY OTHER TESTS AT THAT VISIT.
15 Q. BUT YOU JUST -- DID YOU INDICATE WHAT HIS PHYSICAL AND
16 MENTAL CONDITION WERE AT THAT TIME?
17 A. YEAH, AND I FELT THAT THEY HAD REMAINED ABOUT THE SAME.
18 Q. NO MAJOR CHANGES? NO CONCERNS?
19 A. I MODIFIED HIS INSULIN A LITTLE BIT. HIS BLOOD SUGARS
20 WERE RUNNING A LITTLE BIT LOW IN THE MORNINGS. AND I WAS
21 CONCERNED, I DIDN'T WANT HIM TO -- I DIDN'T WANT HIS BLOOD
22 SUGARS TO DROP TOO LOW, SO I DROPPED BACK ON SOME OF HIS
23 INSULIN. AND THAT'S ABOUT ALL I DID AT THAT VISIT.
24 Q. OKAY. AND THEN WHERE -- WHERE WAS THIS MEETING OR THIS
25 EXAM TAKE PLACE?
859
1 A. MY OFFICE, LOGAN.
2 Q. OKAY. DO YOU KNOW WHERE HE WAS LIVING AT THAT TIME?
3 A. IN MY RECORDS I LISTED MILLVILLE, WHICH IS RIGHT OUTSIDE
4 OF LOGAN.
5 Q. BUT THAT WAS STILL LIVING AT HOME.
6 A. HE WAS AT HOME, RIGHT. His home was in Delta, UT, 200 miles SW.
7 Q. WHAT WAS THE NEXT CONTACT YOU HAD WITH MR. ALLDREDGE?
8 A. AUGUST 3RD, AND APPARENTLY BY THAT TIME -- LET ME JUST
9 GO AHEAD AND DISCUSS --
10 MR. STIRBA: YOUR HONOR, IF I MAY, I HAVE NO
11 PROBLEM WITH HIM REFRESHING HIS MEMORY, BUT IF HE'S GONNA BE
12 REFERRING TO A DOCUMENT OR FILE, CAN WE IDENTIFY WHAT IT IS
13 SO WE KNOW WHAT HE'S REFERRING TO?
14 Q. (BY MR. MAJOR) THESE ARE YOUR -- I CAN DO THAT --
15 A. THESE ARE MY OFFICE NOTES.
16 Q. -- OFFICE NOTES. THESE WERE TAKEN AT THE TIME THAT YOU
17 DID THE INTERVIEWS --
18 A. RIGHT.
19 Q. -- THE TIME YOU DID THE PHYSICAL --
20 A. RIGHT.
21 Q. -- AND SO FORTH.
22 A. RIGHT, RIGHT.
23 Q. AND THEY DO HELP YOU REFRESH YOUR MEMORY?
24 A. RIGHT.
25 Q. OKAY. GO AHEAD, YOU MAY REFER TO REFRESH YOUR MEMORY.
860
1 A. SO AUGUST 3RD WAS THE NEXT VISIT. HE HAD BEEN SEEN BY
2 THE -- HE HAD BEEN EVALUATED BY A HOME HEALTHCARE OUTFIT THE
3 MONTH BEFORE, AND THEY FELT THAT HE QUALIFIED FOR HOME
4 ASSISTANCE WITH HEALTH AIDES AND PHYSICAL THERAPY, SO THAT
5 WAS ONE THING THAT HAPPENED. THE REMAINDER OF THE
6 EXAMINATION AGAIN WAS RELATIVELY UNREMARKABLE. THINGS HAD
7 NOT SUBSTANTIALLY CHANGED MEDICALLY.
8 Q. PHYSICAL CONDITION THE SAME?
9 A. YEAH.
10 Q. STILL APPARENTLY FAIRLY HEALTHY?
11 A. PHYSICALLY, RIGHT.
12 Q. PHYSICALLY. DID THE MENTAL HEALTH APPEAR TO CHANGE ANY?
13 A. NO, IT HADN'T. NOT DRAMATICALLY AT THAT POINT IN TIME.
14 Q. DURING THESE VISITS, WAS HE COMPLAINING OF ANY PAIN, ANY
15 PROBLEMS THAT WAY?
16 A. NO -- NO PAIN COMPLAINTS.
17 Q. OKAY. THANK YOU. THEN WHAT WAS THE NEXT CONTACT OR
18 VISIT YOU HAD?
19 A. SAW HIM AGAIN ON AUGUST 31ST, 1995. HE HAD BEEN
20 ADMITTED TO A NURSING HOME IN LOGAN. I DON'T PARTICULARLY
21 KNOW THE CIRCUMSTANCES UNDER WHICH HE WAS ADMITTED THERE. I
22 DON'T HAVE ANY REFERENCE IN MY NOTES TO THAT SO I CAN'T
23 RECALL THAT. AND BLOOD SUGARS ARE RELATIVELY WELL
24 CONTROLLED. HIS BLOOD PRESSURE WAS REASONABLY CONTROLLED.
25 AND THINGS WERE GENERALLY STABLE.
861
1 Q. HAD THERE BEEN ANY CHANGE IN HIS PHYSICAL HEALTH?
2 A. PHYSICALLY?
3 Q. YEAH.
4 A. NO.
5 Q. HAD THERE BEEN ANY CHANGE IN HIS MENTAL HEALTH AT THAT
6 TIME?
7 A. AGAIN, I'M REFERRING TO MY NOTES, BUT THE IMPL -- THE
8 SUGGESTION MY NOTES IS THAT HIS SPEECH WAS BECOMING A LITTLE
9 MORE DIFFICULT TO UNDERSTAND, A LITTLE BIT CONFUSED FROM
10 TIME TO TIME. AND THAT WAS THE FIRST REFERENCE I HAD MADE
11 ABOUT THAT SINCE I HAD SEEN HIM. SO HE'S HAVING SOME
12 DIFFICULTY WITH HIS SPEECH.
13 Q. OKAY. AND THIS POINT IN TIME HE'S IN A REST HOME, I
14 ASSUME CONTACTED YOUR OFFICE.
15 A. RIGHT, YEAH.
16 Q. SO HE WAS BROUGHT INTO YOUR OFFICE.
17 A. RIGHT.
18 Q. SO HE WAS CAPABLE OF AMBUL -- AMBULATORY.
19 A. RIGHT. MY INITIAL NOTE IN APRIL SAID THAT HE USED A
20 WALKER FOR AMBULATION, SO APPARENTLY HE WASN'T ABLE TO
21 AMBULATE WITHOUT ASSISTANCE.
22 Q. BUT NOTHING UNUSUAL THAT YOU PUT IN YOUR NOTES.
23 A. RIGHT.
24 Q. THEN WHAT WAS THE NEXT CONTACT YOU HAD WITH HIM?
25 A. NEXT CONTACT WAS OCTOBER 12TH, 1995. AND BETWEEN AUGUST
862
1 AND OCTOBER HE HAD MOVED AGAIN TO A DIFFERENT NURSING HOME,
2 TO SUNSHINE TERRACE. AGAIN, I DON'T KNOW WHY THE CHANGE WAS
3 MADE. AND HE WAS BROUGHT IN BECAUSE HE WAS FEELING
4 NAUSEATED AND HE WAS HAVING SOME VOMITING EPISODES OVER A
5 PERIOD OF, I SAID IN HERE, 24 HOURS.
6 Q. AND WHAT TREATMENT DID YOU GIVE IF ANY?
7 A. I DIDN'T -- WHEN I EXAMINED HIM, I DIDN'T FIND ANYTHING
8 ON THE EXAMINATION THAT SUGGESTED A SOURCE OF HIS ACUTE
9 MEDICAL ILLNESS. I EXAMINED HIM. I DIDN'T FIND ANYTHING
10 SUSPICIOUS. I DID BLOOD TESTS. I DID A BLOOD COUNT, A
11 BLOOD ANALYSIS, AND A URANALYSIS, AND THOSE WERE OKAY. SO I
12 DECIDED TO JUST OBSERVE HIM.
13 Q. OKAY. AND DID THAT NAUSEA GO AWAY?
14 A. I DON'T MAKE ANY OTHER REFERENCES TO IT, SO --
15 Q. SO ON --
16 A. -- I ASSUME IT DID.
17 Q. OKAY. NOW, DURING THIS PERIOD OF TIME, WAS HIS DIABETES
18 PRETTY MUCH IN CONTROL?
19 A. IT WAS REASONABLY CONTROLLED. AGAIN, I WAS A LITTLE BIT
20 LOOSE WITH HIM BECAUSE I DIDN'T WANT TO RISK ANY
21 HYPOGLYCEMIA, SO IT WAS REASONABLY CONTROLLED.
22 Q. HOW ABOUT HIS HYPERTENSION, BLOOD PRESSURE, ANY PROBLEM?
23 A. REASONABLY CONTROLLED, YEAH.
24 Q. AND WHAT WAS THE NEXT CONTACT YOU HAD WITH HIM?
25 A. I MIGHT STATE, IF I MIGHT ADD THIS, HIS -- MY NOTE, MY
863
1 OFFICE NOTE FROM THAT VISIT STATED THAT HE WASN'T REALLY
2 ABLE TO GIVE ME ANY SPECIFIC HISTORY ABOUT HIS PROBLEM, SO I
3 CAN ASSUME FROM MY NOTE IN THIS REGARD THAT HIS THINKING
4 PROCESS WASN'T AS -- AS SHARP AS IT WAS IN APRIL. AND HIS
5 SPEECH WAS AGAIN, SEEMINGLY LESS COHERENT AND HE WAS ABLE TO
6 COMMUNICATE EVEN LESS.
7 Q. OKAY. AND WHAT WAS THE NEXT THING THAT YOU WERE
8 INVOLVED WITH WITH MR. ALLDREDGE?
9 A. THE NEXT VISIT WAS NOVEMBER, AND HE WAS SEEN IN NOVEMBER
10 JUST AS A ROUTINE CHECK. BLOOD SUGARS WERE IN THE MID ONE
11 HUNDREDS, WHICH I -- WHICH IS ADEQUATE. AND HE WAS HAVING
12 AGAIN, SIGNIFICANT DIFFICULTY WITH EXPRESSING,
13 COMMUNICATION, SPEECH. THAT WAS MY ONLY COMMENT THERE.
14 Q. ANY INDICATION OF ANY PHYSICAL PROBLEMS THAT ALERTED
15 YOU, CAUSED YOU ANY CONCERNS?
16 A. NO.
17 Q. THEN WHAT WAS THE NEXT CONTACT?
18 A. JUNE 4TH. I ASKED TO HAVE THE NURSE -- I ASKED THE
19 NURSING HOME TO BRING HIM IN BECAUSE HE WAS BECOMING QUITE
20 VIOLENT. HE HAD BECOME VIOLENT, PHYSICALLY ABUSIVE DURING
21 DECEMBER. IT HAD KIND OF CRESCENDOED DURING THAT MONTH.
22 AND I ASKED THEM TO BRING HIM IN SO I COULD EVALUATE HIM ON
23 JANUARY 4TH TO SEE IF I COULD COME UP WITH A REASON HE MIGHT
24 BE DOING THAT.
25 Q. NOW, I THINK THE FIRST TIME YOU SAID IT WAS JUNE 4TH?
864
1 A. JANUARY 4TH --
2 Q. JANUARY 4TH?
3 A. -- 1996.
4 Q. OKAY. THAT'S -- WITH THAT CLARIFICATION. AND WHAT
5 TYPE -- WHAT OCCURRED WHEN HE WAS BROUGHT IN ON THIS
6 OCCASION? WHAT DO YOU OBSERVE?
7 A. HE WAS -- ACCORDING TO MY NOTE, I SEE HE WAS COMPLETELY
8 DISORIENTED. HE WAS AWAKE, ALERT, BUT HE WASN'T ABLE TO
9 REALLY -- COULDN'T UNDERSTAND HIM.
10 Q. UH-HUH.
11 A. HIS SPEECH HAD SIGNIFICANTLY DETERIORATED.
12 Q. OKAY.
13 A. HE COULDN'T EVEN GIVE ME ANY ANSWERS TO BASIC SIMPLE
14 QUESTIONS, WHO ARE YOU, THOSE SORTS OF THINGS. PHYSICAL
15 EXAMINATION AGAIN WAS UNREMARKABLE. AND WHAT I DECIDED TO
16 DO AT THAT VISIT -- I HAD BEEN USING SOME MEDICATIONS TO TRY
17 TO CONTROL HIS AGITATED BEHAVIOR IN DECEMBER. AND THEY
18 WEREN'T -- THEY WEREN'T WORKING EVEN BY INCREASING THE
19 DOSAGE, SO I SWITCHED HIM TO A DIFFERENT MEDICATION AT THAT
20 TIME.
21 Q. NOW, WHY WOULD YOU SWITCH TO A DIFFERENT MEDICATION?
22 A. BECAUSE THE ONE I WAS USING WASN'T WORKING.
23 Q. OKAY.
24 A. SO OFTENTIMES TRY TO -- DIFFERENT MEDICATION TO SEE IF
25 YOU CAN GET A -- CONTROL HIS BEHAVIOR THAT WAY.
865
1 Q. WAS THERE ANY -- OTHER THAN HIS MENTAL PROBLEM YOU
2 MENTIONED, WAS THERE ANY PHYSICAL PROBLEMS THAT YOU WERE
3 CONCERNED ABOUT?
4 A. NOT THAT I COULD FIND ON THE EXAMINATION.
5 Q. ANY PAIN THAT HE WAS CONCERNED WITH?
6 A. (WITNESS SHAKES HEAD.)
7 Q. WHAT HAPPENED THEN?
8 A. THAT WAS JUNE 4TH, AND THEN I RECEIVED A PHONE CALL FROM
9 THE NURSING HOME ON JUNE 8TH. HE HAD BECOME EVEN MORE
10 COMBATIVE. THE VISIT -- WHEN I SAW HIM ON JUNE 4TH, WHAT --
11 WHAT INITIATED THAT WAS HE APPARENTLY HAD THROWN A
12 WHEELCHAIR INTO A WOMAN WHO FELL AT THE NURSING HOME AND
13 BROKE HER HIP. SO I TOLD 'EM TO GET HIM IN SO I COULD
14 EVALUATE HIM, AND THEN SUBSEQUENTLY, AFTER THAT JUNE 4TH
15 VISIT, HE CONTINUED TO BE BELLIGERENT. HE APPARENTLY HIT AN
16 AIDE IN THE ABDOMEN. AND WAS THROWING THINGS. AND AT THAT
17 POINT IN TIME, I MEDICATED HIM AND ASKED THAT HE -- WE
18 INQUIRE ABOUT TRANSFERRING HIM TO DAVIS HOSPITAL.
19 Q. NOW, SO I'M ASSUMING AT THIS POINT IN TIME THAT HE'S --
20 HE'S DOING THIS, HIS PHYSICAL HEALTH WAS FAIRLY GOOD IF HE'S
21 THROWING THINGS?
22 A. YEAH, HE HAD EXCELLENT STRENGTH.
23 Q. AND HOW DID YOU COME TO KNOW ABOUT DAVIS NORTH HOSPITAL?
24 A. WELL, NOT ENTIRE -- I DON'T REALLY REMEMBER EXACTLY.
25 THINKING ABOUT IT, IT WAS EITHER THROUGH THE RECOMMENDATION
866
1 FROM THE NURSING HOME OR THROUGH A COLLEAGUE, AND THAT'S
2 ABOUT AS PRECISE AS I CAN BE.
3 Q. WHAT WAS YOUR UNDERSTANDING OF WHAT THE UNIT DID AT THE
4 HOSPITAL IN LAYTON?
5 A. CONTROL THIS KIND OF BEHAVIOR UNDER A FAIRLY -- UNDER A
6 PROTECTED SETTING. I MEAN I WAS QUITE CONCERNED THAT HE WAS
7 GOING TO HARM OTHERS AT THE NURSING HOME. HE WAS OUT OF
8 CONTROL. I COULDN'T CONTROL HIM. HE HAD ALREADY INJURED
9 ONE WOMAN, AND I NEEDED TO GET HIM INTO A PROTECTED SETTING
10 WHERE THEY COULD TITRATE HIS MEDICATIONS OR SEARCH FOR
11 TREATABLE CAUSES.
12 Q. AND DID YOU INITIATE THE CONTACT OR DID THE NURSING HOME
13 WITH THE GEROPSYCH UNIT?
14 A. APPARENTLY -- AND THIS IS JUST IN MY NOTES. APPARENTLY,
15 THIS WAS -- THIS WAS PERFORMED THROUGH A SOCIAL WORKER. AND
16 I DON'T KNOW -- I COULDN'T UNDERSTAND IN REVIEWING MY NOTES
17 WHETHER IT WAS A SOCIAL WORKER AT DAVIS HOSPITAL OR A SOCIAL
18 WORKER AT THE NURSING HOME, BUT --
19 Q. BUT YOU DIDN'T REALLY HAVE ANY PART IN THE INTAKE
20 PROCESS.
21 A. NOT THAT I RECALL.
22 Q. DID YOU HAVE ANY CONCERNS WHEN YOU RECOMMENDED MR.
23 ALLDREDGE TO GO DOWN TO THE GEROPSYCH UNIT? DID YOU HAVE
24 ANY CONCERNS FOR HIS PHYSICAL HEALTH AT THAT TIME?
25 A. NO.
867
1 Q. DID YOU HAVE ANY OTHER CONTACT WITH HIM AFTER HE LEFT
2 THE NURSING HOME?
3 A. NO.
4 MR. MAJOR: WE HAVE NO FURTHER QUESTIONS, YOUR
5 HONOR.
6 MS. BARLOW: JUST A MINUTE, YOUR HONOR.
7 MR. MAJOR: I THINK MAYBE I HAVE ANOTHER ONE.
8 MS. BARLOW: SORRY.
9 MR. MAJOR: OKAY. THAT'S A GOOD IDEA. I THANK
10 MISS BARLOW, YOUR HONOR, I -- SHE INDICATED WE HAVE USED A
11 COUPLE OF TERMS WE MAY WANNA DEFINE.
12 Q. YOU MENTIONED ON THE THING ABOUT TITRATE MEDS.
13 A. UH-HUH.
14 Q. WHAT DOES THAT MEAN FOR THE JURY?
15 A. MODIFY THE DOSE, INCREASE THE DOSE, REDUCE THE DOSE, BUT
16 GENERALLY INCREASE THE DOSE OF THE MEDICATION TO TRY TO
17 BRING ABOUT A -- THE EFFECT YOU'RE TRYING TO ACHIEVE.
18 Q. OKAY. AND JUST FOR MY OWN CLARIFICATION, ANY TESTIMONY
19 THAT -- WHEN WE MIGHT HAVE SAID JUNE, YOU WERE REALLY
20 TALKING ABOUT JANUARY OF '96. BECAUSE I MAY HAVE USED --
21 A. RIGHT. THE ONLY TIME I SAW HIM WAS -- IN 1996 WAS
22 JANUARY 4TH.
23 Q. OKAY. BECAUSE I DON'T -- I APOLOGIZE, I MAY HAVE USED
24 THE TERM JUNE, TOO. SO THANK YOU. WITH THAT, WE HAVE NO
25 FURTHER QUESTIONS.
868
1 THE COURT: CROSS-EXAMINATION?
2 MR. STIRBA: YES, YOUR HONOR. THANK YOU.
3 CROSS-EXAMINATION
4 BY MR. STIRBA:
5 Q. GOOD MORNING, DOCTOR.
6 A. HI.
7 Q. I WAS REVIEWING YOUR MEDICAL RECORDS AND I NOTICE
8 THERE'S A D.O. --
9 A. RIGHT.
10 Q. -- AFTER YOUR NAME, NOT AN M.D.
11 A. RIGHT.
12 Q. D.O. STANDS FOR DOCTOR OF OSTEOPATHY?
13 A. RIGHT.
14 Q. SO YOU'RE NOT A MEDICAL DOCTOR, IS THAT RIGHT?
15 A. I'M A -- YEAH, WELL, I'M AN OSTEOPATHIC PHYSICIAN.
16 Q. WHICH IS DIFFERENT THAN A MEDICAL DOCTOR, ISN'T THAT
17 TRUE?
18 A. RIGHT.
19 Q. DO YOU -- DOCTOR, ARE YOU FAMILIAR WITH THE TERM ATAXIC?
20 A. SURE.
21 Q. AND TELL US PLEASE WHAT ATAXIC IS.
22 A. ATAXIC REFERS TO SOMEONE'S GAIT. THEY HAVE DIFFICULTY
23 WALKING. AND THE GAIT IS CALLED ATAXIC.
24 Q. AND BY HAVING DIFFICULTY WITH THE GAIT AND BEING ATAXIC,
25 MIGHT THAT BE A SYMPTOM OR A SIGN OF SOMEONE HAVING A STROKE
869
1 EVENT?
2 A. POSSIBLY, RIGHT.
3 Q. AND WOULD ALSO A SYSTEM, A SIGN OF A STROKE EVENT BE,
4 FOR EXAMPLE, SOMEBODY HAVING SLURRED SPEECH?
5 MR. MAJOR: WELL, YOUR HONOR, WE'RE GONNA OBJECT.
6 IT'S UNDER OUR --
7 MR. STIRBA: I'M GETTING THERE.
8 MR. MAJOR: -- CONVERSATION, I DON'T BELIEVE THIS
9 IS AN EXPERT THAT CAN TALK ABOUT THESE TYPE OF THINGS.
10 MR. STIRBA: YOUR HONOR, IF YOU WOULD INDULGE ME,
11 IT'S RELEVANT TO HIS TREATMENT OF THIS PATIENT.
12 THE COURT: IF YOU'RE ASKING A QUESTION OF THIS
13 PATIENT --
14 Q. (BY MR. STIRBA) SLURRED SPEECH, DOCTOR, WOULD THAT BE
15 A SIGN AND SYMPTOM OF PERHAPS A STROKE EVENT?
16 A. OF PERHAPS? PERHAPS, YES.
17 Q. CERTAINLY. IN OTHER WORDS, THERE'S A WHOLE
18 MANIFESTATION OF CLINICAL FACTORS THAT GO INTO DETERMINING
19 CERTAINLY CLINICALLY WHETHER SOMEONE'S HAVING A STROKE. ONE
20 OF THOSE SIGNS AND SYMPTOMS MAY BE SLURRED SPEECH, ISN'T
21 THAT TRUE?
22 A. CORRECT.
23 Q. NOW, YOU SAW MR. ALLDREDGE STARTING IN APRIL OF 1995, IS
24 THAT CORRECT?
25 A. RIGHT.
870
1 Q. AND YOU HAVE YOUR FILE IN FRONT OF YOU THERE?
2 A. CORRECT.
3 Q. AND I'D LIKE YOU TO TURN PLEASE TO YOUR I GUESS LAST
4 FULL VISIT ENTRY WHICH WOULD BE ON JANUARY 4TH OF 1996.
5 A. OKAY.
6 Q. DO YOU HAVE THAT IN FRONT OF YOU?
7 A. SURE.
8 Q. I'M GONNA PLACE THAT HERE SO THE JURY CAN SEE IT.
9 NOW, AT THE TOP YOU HAVE INDICATED THE MEDICAL HISTORY,
10 AND IT PRETTY MUCH SPEAKS FOR ITSELF; HOWEVER, I WANNA ASK
11 YOU ABOUT -- YOU SAY AFTER YOU DESCRIBE A CIRCUMSTANCE, YOU
12 SAY, WE HAVE BEEN ACCELERATING HIS MELLARIL.
13 A. UH-HUH.
14 Q. UP TO A DOSE OF CURRENTLY 50 MILLIGRAMS T.I.D. MY FIRST
15 QUESTION TO YOU IS, AND FOR OUR HELP, WHAT DOES T.I.D. STAND
16 FOR?
17 A. THREE TIMES DAILY.
18 Q. AND 50 MILLIGRAMS IS A DOSAGE LEVEL?
19 A. CORRECT.
20 Q. AND MELLARIL, IS IT NOT, IS A PSYCHOTROPIC MEDICATION,
21 CORRECT?
22 A. CORRECT, UH-HUH.
23 Q. AND PSYCHOTROPIC, WOULD YOU EXPLAIN TO US WHAT THAT
24 MEANS PLEASE?
25 A. MEANS IT AFFECTS BEHAVIOR.
871
1 Q. AND DO YOU KNOW WHAT CATEGORY MELLARIL IS IN TERMS OF
2 PSYCHOTROPIC MEDICATION?
3 A. IT'S A THIORIDAZINE. IT'S NEUROLEPTIC MEDICATION.
4 Q. WELL, THOSE -- AND I'LL ASK YOU TO EXPLAIN THOSE --
5 A. OKAY.
6 Q. -- BUT REALLY WHAT I WAS AFTER IS, IS IT AN
7 ANTIPSYCHOTIC MEDICATION, AN ANTIDEPRESSANT MEDICATION, OR
8 ANTIANXIETY MEDICATION?
9 A. ANTIPSYCHOTIC.
10 Q. AND WHAT DO YOU MEAN BY ANTIPSYCHOTIC?
11 A. MEANS IT CONTROLS INAPPROPRIATE BEHAVIOR.
12 Q. AND IT'S TRUE, IS IT NOT, THAT MELLARIL IS ALSO A
13 SEDATING DRUG?
14 MR. MAJOR: YOUR HONOR, AGAIN WE'RE GONNA RAISE
15 THIS ISSUE, WHETHER OR NOT THIS PATIENT IS QUALIFIED AS AN
16 EXPERT TO BE ABLE TO TESTIFY TO THESE TYPE OF DRUGS AND
17 SITUATIONS.
18 THE COURT: WELL, THIS IS A DOCTOR --
19 THE WITNESS: I'M NOT A PATIENT. I MEAN THE --
20 THE COURT: THIS DOCTOR PRESCRIBED THIS MEDICATION.
21 OVERRULED.
22 Q. (BY MR. STIRBA) IT'S A SEDATING MEDICATION, IS IT NOT?
23 A. CORRECT.
24 Q. AND BY SEDATING, YOU UNDERSTAND THAT TO MEAN IT HAS AN
25 EFFECT ON THE CENTRAL NERVOUS SYSTEM.
872
1 A. UH-HUH.
2 Q. TRUE?
3 A. TRUE.
4 Q. AND ALSO YOU INDICATE THAT YOU AT THAT POINT, YOU'RE
5 ACCELERATED THE MELLARIL UP --
6 A. UH-HUH.
7 Q. -- WITH THE ADDITION OF BUSPAR APPROXIMATELY TWO WEEKS
8 AGO OF 10 MILLIGRAMS, THREE TIMES A DAY. WE HAVE THAT
9 T.I.D. DO YOU SEE THAT?
10 A. RIGHT.
11 Q. NOW, BUSPAR IS ALSO A PSYCHOTROPIC MEDICATION, IS IT
12 NOT?
13 A. IT'S MORE OF A SEDATIVE.
14 Q. IT'S A SEDATIVE, NOT A PSYCHOTROPIC MEDICATION. It's both.
15 A. RIGHT.
16 Q. WHAT DO YOU MEAN BY A SEDATIVE?
17 A. I MEAN A MEDICATION THAT WILL CALM -- CALM DOWN ONE'S
18 AGITATION.
19 Q. AND IT'S TRUE THAT IN MR. ALLDREDGE'S CASE THE REASON
20 WHY YOU WERE PRESCRIBING MELLARIL IN CONJUNCTION WITH
21 BUSPAR, IT WAS AN ATTEMPT TO CONTROL HIS BEHAVIOR, ISN'T
22 THAT CORRECT?
23 A. RIGHT.
24 Q. IN OTHER WORDS, THE THINGS YOU HAVE DESCRIBED TO US IN
25 TERMS OF HIS BEHAVIOR, YOU WERE ATTEMPTING TO MEDICATE HIM
873
1 SO THAT YOU COULD CONTROL HIS BEHAVIOR, TRUE?
2 A. RIGHT.
3 Q. AND IN FACT, ONE OF THE THINGS THAT YOU WERE TRYING TO
4 DO WAS SEDATE HIM, ISN'T THAT CORRECT?
5 A. TRUE.
6 Q. AND ISN'T IT ALSO TRUE THAT DURING THE TIME THAT YOU
7 TREATED HIM, YOU ADJUSTED THE MEDICATION DEPENDING ON
8 CERTAIN CIRCUMSTANCES TO MAKE SURE THAT THERE WAS SOME FINE
9 LINE THAT WAS NOT REACHED WHERE HE WAS OVERSEDATED VERSUS
10 THE APPROPRIATE SEDATION. IS THAT A FAIR STATEMENT?
11 A. TRUE.
12 Q. IN OTHER WORDS, IT'S A SORT OF A JUGGLING ACT TO MAKE
13 SURE THE MEDICATION GETS RIGHT, ISN'T THAT CORRECT?
14 A. RIGHT, RIGHT.
15 Q. THEN UNDER CURRENT MEDICATIONS, AND THIS IS THE JANUARY
16 4TH, 1996 VISIT, YOU HAVE INSULIN 20 UNITS OF -- AND THERE'S
17 A WORD, HOW DO YOU PRONOUNCE THAT?
18 A. LENTE.
19 Q. AND WHAT IS LENTE.
20 A. THAT'S A FORM OF INSULIN. IT'S A TYPE OF INSULIN.
21 Q. AND INSULIN IS WHAT?
22 A. IT'S A HORMONE THAT REGULATES THE BODY'S BLOOD SUGARS.
23 Q. AND YOU MADE A DETERMINATION, DID YOU NOT, THAT
24 MR. ALLDREDGE WAS SUFFERING FROM DIABETES?
25 A. CORRECT.
874
1 Q. AND IN FACT, DID YOU DETERMINE HE HAD UNCONTROLLABLE
2 DIABETES FOR OVER 25 YEARS AT THE TIME HE SAW YOU?
3 A. I DIDN'T MAKE A DETERMINATION THAT HE HAD UNCONTROLLABLE
4 DIABETES. I HAD, HE HAD DIABETES.
5 Q. YEAH, CONTROLLED ONLY THROUGH MEDICATION, TRUE?
6 A. RIGHT.
7 Q. YOU WITHDRAW THE MEDICATION, AND HE WOULD BE IN VERY
8 SERIOUS MEDICAL CONDITION, WOULD HE NOT?
9 A. TRUE.
10 Q. AND WOULD YOU TELL US WHAT DIABETES IS?
11 A. IT'S SYSTEMIC DISORDER OF THE BODY WITH EITHER A LACK OF
12 INSULIN OR LACK OF RESPONSE TO INSULIN THE BODY MAKES.
13 Q. OKAY. AND COULD YOU EXPLAIN HOW -- HOW IF YOU HAVE
14 DIABETES, HOW IT'S A PROBLEM FOR YOU PHYSICALLY OR
15 PHYSIOLOGICALLY?
16 A. IT -- ASSOCIATED WITH DIABETES, IT'S CONSIDERED A
17 SYSTEMIC ILLNESS, SO NOT ONLY DO YOU HAVE PROBLEMS WITH
18 SIMPLY BLOOD SUGAR LEVELS, BUT IT ALSO CAUSES OTHER PROBLEMS
19 IN THE BODY INCLUDING CORONARY ARTERY DISEASE, HEART
20 ATTACKS. MR. ALLDREDGE HAD CORONARY ARTERY DISEASE. CAN
21 HAVE AN EFFECT ON THE EYES, ON THE NERVES, ON THE KIDNEYS.
22 Q. IT'S TRUE, IS IT NOT, THAT ESSENTIALLY IT'S AN ELEVATED
23 SUGAR LEVEL IN THE BLOOD?
24 A. WELL, YEAH, THAT'S ONE OF THE MANIFESTATIONS OF
25 DIABETES.
875
1 Q. AND THE ATTEMPT OF THE INSULIN IS TO CONTROL THE GLUCOSE
2 LEVEL IN THE BLOOD?
3 A. RIGHT.
4 Q. AND IT'S TRUE, IS IT NOT, THAT IF YOU HAVE TOO HIGH OF A
5 GLUCOSE LEVEL IN THE BLOOD, FOR EXAMPLE, LIKE MR. ALLDREDGE
6 EXPERIENCED, THAT COULD BE A VERY SERIOUS MEDICAL ISSUE FOR
7 YOU, ISN'T THAT RIGHT?
8 A. I MEAN SERIOUS -- IT DEPENDS ON LEVELS OF ELEVATION.
9 BLOOD SUGARS IN THE 200, 300 RANGE ARE WELL TOLERATED.
10 BLOOD SUGARS IN THE 800 OR 900 AREN'T. SO IT'S A RELATIVE
11 SITUATION ABOUT HOW UNCONTROLLED THE SUGARS ARE IN TERMS OF
12 HOW IMMEDIATE THE EFFECT WOULD BE.
13 Q. THEN YOU GO ON TO SAY, YOU HAVE TAGAMET, 800 MILLIGRAMS
14 UNDER CURRENT MEDICATION --
15 A. RIGHT.
16 Q. -- DID I PRONOUNCE THAT RIGHT?
17 A. RIGHT.
18 Q. WHAT KIND OF MEDICATION IS THAT, SIR?
19 A. THAT CONTROLS ACID, STOMACH ACID, IT'S AN ACID
20 SUPPRESSANT.
21 Q. THEN YOU INDICATE A NUMBER OF OTHER MEDICATIONS THERE AS
22 WELL. THAT -- THAT THYROXIN, WHAT IS THAT FOR?
23 A. THYROID.
24 Q. WHAT KIND OF --
25 A. HYPOTHYROIDISM.
876
1 Q. WHAT KIND OF THYROID CONDITION DID MR. ALLDREDGE HAVE?
2 A. LOW THYROID.
3 Q. AND WHAT EFFECT DOES THAT HAVE?
4 A. IF TREATED OR IF NOT TREATED? IF NOT TREATED --
5 Q. APPARENTLY IT WAS BEING TREATED --
6 A. IT WAS BEING TREATED, RIGHT, SO --
7 Q. IF NOT TREATED, SIR?
8 A. ULTIMATELY YOU CAN DIE IF YOU DON'T TREAT
9 HYPOTHYROIDISM.
10 Q. NOW, THEN YOU GO ON UNDER PHYSICAL EXAMINATION AND YOU
11 DESCRIBE THE CIRCUMSTANCES. SPECIFICALLY YOU STATE THAT HE
12 WAS UNABLE TO GIVE INTELLIGENT ANSWERS TO SIMPLE QUESTIONS.
13 IS THAT YOUR RECOLLECTION?
14 A. I RECOLLECT WHAT'S IN THIS CHART, SO YES.
15 Q. OKAY. AND YOU SAY HIS COMMUNICATION'S WITHOUT
16 SIGNIFICANT MEANING, TRUE?
17 A. TRUE.
18 Q. AND THEN YOU HAVE IMPRESSION. AND YOU INDICATE AGITATED
19 DEMENTIA, THAT'S YOUR --
20 A. RIGHT.
21 THE COURT: YOUR IMPRESSIONS ARE NOT ON THE SCREEN.
22 MR. STIRBA: OH, THANK YOU, YOUR HONOR. SORRY.
23 THANK YOU. THERE WE GO.
24 Q. UNDER IMPRESSION, YOU HAVE AGITATED DEMENTIA, TRUE?
25 A. TRUE.
877
1 Q. AND THAT'S YOUR ASSESSMENT OF, BASED UPON WHAT YOU
2 OBSERVED, HIS MENTAL CONDITION, CORRECT?
3 A. RIGHT.
4 Q. THEN YOU HAVE CORONARY ARTERY DISEASE, TRUE?
5 A. TRUE.
6 Q. AND YOU CERTAINLY ARE NOT TELLING THE JURY, ARE YOU,
7 THAT YOU ARE IN GOOD HEALTH IF YOU HAVE CORONARY ARTERY
8 DISEASE?
9 A. I DON'T -- NO, YOU'RE NOT IN GOOD HEALTH, BUT THERE'S A
10 QUESTION OF STABILITY OF THE PROCESS. SO HIS CORONARY
11 DISEASE WAS STABLE. IT WASN'T CAUSING HIM ANY IMMEDIATE
12 PROBLEMS.
13 Q. AND THAT COULD CHANGE THE NEXT DAY, CORRECT?
14 A. SURE.
15 Q. SO THE FACT THAT HE HAD CORONARY ARTERY DISEASE DOESN'T
16 MEAN HE WAS IN GOOD HEALTH, CORRECT?
17 A. RIGHT.
18 Q. AND THEN YOU HAVE TYPE 2 DIABETES MELLA -- YOU BETTER
19 PRONOUNCE THAT.
20 A. DIABETES MELLITUS.
21 Q. OKAY. AND THAT'S THE DIABETIC CONDITION WE'VE TALKED
22 ABOUT, CORRECT?
23 A. RIGHT.
24 Q. AND IT'S TRUE, IS IT NOT, IF YOU LOOK IN YOUR -- IF YOU
25 LOOK IN YOUR FILE, WHICH YOU HAVE IN FRONT OF YOU, YOU DID A
878
1 LITTLE TEST TO SEE HOW HE WAS DOING ON THE 4TH OF JANUARY.
2 A. UH-HUH.
3 Q. AND CAN YOU FLIP TO THAT PLEASE?
4 A. FLIP TO THE TEST?
5 Q. YEAH. OR MAYBE I'LL GIVE YOU --
6 A. SURE, I SEE IT.
7 Q. -- JANUARY 5TH.
8 A. SURE.
9 Q. AND THAT TEST WAS TO DETERMINE HOW MUCH CONTROL THERE
10 WAS --
11 A. RIGHT.
12 Q. -- FOR HIS DIABETIC CONDITION --
13 A. RIGHT.
14 Q. -- CORRECT?
15 A. RIGHT.
16 Q. AND IN FACT, I CAN JUST TURN TO THAT HERE. I HAVE PUT
17 UP ON THE SCREEN THE TEST THAT WAS DONE ON JANUARY 5TH,
18 1996.
19 A. UH-HUH.
20 Q. AND YOU HAVE -- YOU'RE GONNA HAVE TO PRONOUNCE THAT WORD
21 FOR ME -- GLYCATED --
22 A. GLYCATED HEMOGLOBIN.
23 Q. OKAY. WHAT IS GLYCATED HEMOGLOBIN?
24 A. THAT'S A MEASUREMENT TRYING TO GET A DETERMINATION AS TO
25 THE ADEQUACY OF BLOOD SUGAR CONTROL OVER SIX WEEKS OR SO.
879
1 Q. AND THE RESULT IS -- AS I INDICATE OR IT'S INDICATED,
2 12.4, CORRECT?
3 A. RIGHT.
4 Q. AND THEN IF YOU GO DOWN YOUR LITTLE --
5 A. POOR.
6 Q. POOR. POOR CONTROL RANGE --
7 A. RIGHT.
8 Q. -- GREATER THAN 12 PERCENT.
9 A. RIGHT.
10 Q. THAT'S WHAT THE TEST DETERMINED AT THAT TIME --
11 A. RIGHT.
12 Q. -- IS THAT CORRECT?
13 A. RIGHT.
14 Q. THEN GOING BACK TO YOUR NOTE ON JANUARY 4TH OF 1996, YOU
15 INDICATE HYPERTHYROIDISM. DO YOU SEE THAT?
16 A. NUMBER 5? ITEM 5.
17 THE COURT: 4.
18 Q. (BY MR. STIRBA) NUMBER 4.
19 A. I'M SORRY. IT'S THE WRONG PAGE.
20 Q. YEAH, IT'S THE JANUARY --
21 A. ITEM 4, RIGHT.
22 Q. YEAH, JANUARY 4TH ENTRY.
23 A. RIGHT.
24 Q. AND THEN OF COURSE YOU TESTIFIED WAS BEING TREATED WITH
25 THYROID --
880
1 A. RIGHT.
2 Q. -- REPLACEMENT --
3 A. RIGHT.
4 Q. -- THERAPY.
5 A. RIGHT.
6 Q. AND THEN WE HAVE HYPERTENSION, AND I GUESS YOU'RE SAYING
7 BY STABLE, HE WAS ON MEDICATION FOR HYPERTENSION, WHICH WAS
8 ADEQUATELY CONTROLLING HIS BLOOD PRESSURE, IS THAT RIGHT?
9 A. CORRECT.
10 Q. AND HYPERTENSION AS YOU'VE ALREADY TESTIFIED TO I
11 BELIEVE ON DIRECT, THAT COULD BE A SERIOUS CONDITION THAT
12 COULD END IN DEATH, ISN'T IT TRUE, IF NOT TREATED?
13 A. CORRECT.
14 Q. AND THEN YOU HAVE THE INDICATION OF URINARY
15 INCONTINENCE, DO YOU SEE THAT?
16 A. CORRECT, YES.
17 Q. AND THEN ON THE NEXT PAGE, PAGE 2 OF YOUR REPORT, THIS
18 IS JANUARY 4, 1996, YOU INDICATE, WE WILL DISCONTINUE
19 MELLARIL AND TRY -- RESPECTFUL --
20 A. YEAH, I THINK THAT'S A TYPOGRAPHICAL ERROR.
21 Q. OKAY. THAT'S WHY I KINDA LOOKED.
22 A. YEAH.
23 Q. THAT WORD DIDN'T SEEM TO FIT THERE. WHAT WORD DO YOU
24 THINK IT SHOULD HAVE BEEN?
25 A. RISPERDAL, I THINK IS WHAT THAT WAS MEANT TO BE.
881
1 RISPERDAL.
2 Q. RISPERDAL.
3 A. RIGHT.
4 Q. AND THAT WOULD BE .5 MILLIGRAMS?
5 A. CORRECT.
6 Q. AND THAT'S ONCE AGAIN, YOU'RE GONNA HAVE TO TELL US --
7 A. TWICE DAILY.
8 Q. -- WHAT DOES P.O.B.I.D. MEAN?
9 A. ORALLY. TWICE DAILY.
10 Q. OKAY. IN COMBINATION WITH BUSPAR, THE SEDATIVE,
11 CORRECT?
12 A. CORRECT, CORRECT.
13 Q. AND THEN YOU HAVE 10 MILLIGRAMS T.I.D. AND WHAT DOES
14 THAT STAND FOR AGAIN?
15 A. 10 MILLIGRAMS THREE TIMES DAILY.
16 Q. NOW, RISPERDAL IS ANOTHER MEDICATION, AND WHAT KIND OF
17 MEDICATION IS THAT?
18 A. THAT'S AN ANTIPSYCHOTIC AS WELL.
19 Q. OKAY. SO THAT'S ONE OF THESE PSYCHOTROPIC
20 MEDICATIONS --
21 A. RIGHT.
22 Q. -- CORRECT? AND IT'S TRUE, IS IT NOT, THAT RISPERDAL
23 ALSO HAS SEDATING QUALITIES, CORRECT?
24 A. TRUE.
25 Q. ONCE AGAIN, IT HAS AN EFFECT ON THE CENTRAL NERVOUS
882
1 SYSTEM, CORRECT?
2 A. UH-HUH.
3 Q. AND THAT'S WHY YOU GO ON TO --
4 THE COURT: CAN YOU ANSWER THAT LAST QUESTION?
5 THE WITNESS: YES.
6 Q. (BY MR. STIRBA) THAT'S WHY YOU GO ON TO SAY, OBVIOUSLY
7 IF THIS MEDICINE CAUSES OVERSEDATION, WE WILL HAVE TO
8 DISCONTINUE IT. RIGHT?
9 A. CORRECT.
10 Q. IN OTHER WORDS, THAT'S SOMETHING ONCE AGAIN, YOU WERE
11 CONCERNED ABOUT, YOU HAVE THE BUSPAR WHICH IS THE SEDATING
12 MEDICATION, AND YOU'RE CONJOINING THAT WITH THE RISPERDAL,
13 AND YOU HAVE SOME CONCERNS ABOUT OVERSEDATION, TRUE?
14 A. CORRECT.
15 Q. AND YOU DIDN'T KNOW, DID YOU, DOCTOR, WHEN YOU DECIDED
16 TO ORDER UP THOSE MEDICATIONS OR THAT REGIMEN, YOU DIDN'T
17 KNOW IN ADVANCE WHETHER IT WAS GONNA CAUSE OVERSEDATION OR
18 NOT, DID YOU?
19 A. YOU NEVER DO, SO YOU START AT A LOW DOSE AND YOU TITRATE
20 UPWARD, SO YOU ALWAYS START UPWARD. SO YOU ALWAYS START AT
21 THE LOWEST POSSIBLE DOSE AND TITRATE UP.
22 Q. TRUE, THERE'S A CERTAIN AMOUNT OF EXPERIMENTATION THAT
23 GOES ON BECAUSE AS YOU SAY, YOU NEVER KNOW, TRUE?
24 A. CORRECT.
25 Q. NOW, DOCTOR, YOU HAD RESPONSIBILITIES FOR TAKING CARE OF
883
1 MR. ALLDREDGE WHEN HE WAS AT THE SUNSHINE NURSING HOME, IS
2 THAT RIGHT?
3 A. TRUE.
4 Q. IN FACT, DURING THAT TIME PERIOD, I GUESS YOU WERE HIS
5 TREATING PHYSICIAN, CORRECT?
6 A. UH-HUH.
7 Q. AND IT'S TRUE, IS IT NOT, THAT THERE WERE TIMES,
8 ESPECIALLY TOWARDS THE END OF HIS STAY THERE, THAT HE
9 EXPERIENCED A SIGNIFICANT NUMBER OF TIMES WHERE HE FELL,
10 ISN'T THAT CORRECT?
11 A. HOW MANY TIMES?
12 Q. WELL --
13 A. I'D HAVE TO REFER TO MY NOTES. I HAVE A NOTE --
14 Q. YOU TELL ME HOW MANY TIMES YOU THINK HE FELL.
15 A. THERE'S A RECORD IN MY CHART FROM JANUARY 3RD, '96 THAT
16 HE FELL ON THE 29TH AND THE 31ST OF DECEMBER.
17 Q. AND HE COULD HAVE FALLEN OTHER TIMES AS REFLECTED IN THE
18 NURSING HOME RECORDS, BUT YOU WOULDN'T KNOW THAT, WOULD YOU?
19 AS YOU SIT HERE NOW.
20 A. NO.
21 Q. BECAUSE YOU DON'T HAVE SOMETHING IN FRONT OF YOU TO
22 REFRESH YOUR RECOLLECTION, CORRECT?
23 A. RIGHT.
24 Q. IT'S TRUE, IS IT NOT, THAT FALLING CAN BE AN OUTCOME OF
25 A STROKE EVENT?
884
1 A. CAN BE.
2 Q. AND IT'S TRUE, IS IT NOT, THAT THERE WERE TIMES WHEN HE
3 FELL THAT THE NURSING HOME WOULD CONTACT YOU --
4 MR. MAJOR: OBJECTION, YOUR HONOR. WE MIGHT, HE'S
5 ALREADY TESTIFIED THAT HE'S ONLY HAD THOSE TWO TIMES WHEN HE
6 HAD ANY CONTACT ABOUT FALLING. WE WANNA LIMIT HIS TESTIMONY
7 TO THOSE TWO TIMES, HE'S TESTIFIED HE DOESN'T HAVE ANY
8 KNOWLEDGE OF ANY OTHER TIMES IN THE NURSING HOME AND I THINK
9 THAT WOULD BE IRRELEVANT AND HE'S NOT CAPABLE OF TESTIFYING
10 TO ANY OTHER TIMES THAT HE FELL OR ANYTHING ABOUT THOSE
11 TIMES.
12 THE COURT: I DON'T BELIEVE THERE'S A QUESTION.
13 LET'S HEAR THE QUESTION, THEN MAKE THE OBJECTION. WHAT WAS
14 THE QUESTION?
15 MR. STIRBA: YEAH, THE QUESTION I WAS GONNA ASK,
16 YOUR HONOR, WAS:
17 Q. AND THERE WERE TIMES WHEN HE FELL THAT THE NURSING HOME
18 WOULD CONTACT YOU, TRUE?
19 A. THE ONLY TIME I'M AWARE OF THAT I WAS CONTACTED BY THE
20 NURSING HOME ABOUT A FALL WAS JANUARY 3RD, REPORTING A FALL
21 ON THE 29TH AND THE 31ST OF DECEMBER. AND THEY APPARENTLY,
22 ACCORDING AS TO MY RECORD, SAID NO INJURIES. NOW, THAT'S
23 ALL I HAVE DOWN.
24 Q. OKAY. AND THAT'S -- THAT'S BASED UPON YOUR RECORDS, IS
25 THAT RIGHT?
885
1 A. TRUE, SURE.
2 MR. MAJOR: WELL, IF WE'RE GONNA GET INTO THE
3 NURSING HOME RECORDS, HE'S ALREADY TESTIFIED HE -- HE
4 DOESN'T KNOW ANYTHING ABOUT THEM --
5 THE COURT: WELL, THERE ISN'T A PENDING QUESTION,
6 SO --
7 MR. MAJOR: I KNOW, BUT I'M ANTICIPATING THAT HE'S
8 ABOUT TO PLACE A DOCUMENT ON THE STAND AND EXPOSE IT TO THE
9 JURY --
10 MR. STIRBA: THIS -- AND I AM, YOUR HONOR. I DON'T
11 KNOW THE NUMBER OF THIS STATE EXHIBIT, BUT THIS IS THE
12 NURSING HOME RECORDS PROVIDED TO US BY THE STATE OF UTAH FOR
13 THE SUNSHINE CARE CENTER. AND I'M ABOUT TO REFER TO THE
14 VERY THING I THINK THE DOCTOR JUST TESTIFIED TO AS REFLECTED
15 IN THE NOTES FROM THE CARE CENTER. I'D OFFER THE EXHIBIT,
16 YOUR HONOR. I JUST DON'T KNOW WHAT NUMBER THE STATE WANTS
17 ME TO PUT ON IT.
18 MR. MAJOR: WELL, THE PROBLEM WITH THAT IS, YOUR
19 HONOR, HE'S ALREADY EXPRESSED -- THE WITNESS HAS EXPRESSED
20 THAT HE DOES NOT KNOW ANYTHING ABOUT THE NURSING NOTES,
21 NOTES, RECORDS. I DON'T THINK HE'S IN A POSITION HE CAN
22 TESTIFY TO THOSE UNLESS HE'S HAD ANY PERSONAL KNOWLEDGE
23 ABOUT IT.
24 THE COURT: WELL, UNTIL WE KNOW WHAT IT IS, I DON'T
25 KNOW WHAT THE DOCUMENT IS --
886
1 MR. MAJOR: AND I DON'T KNOW WHAT THE DOCUMENT --
2 THE COURT: -- BUT WHY DON'T YOU SHOW IT TO THE
3 WITNESS FIRST?
4 MR. MAJOR: BUT I DON'T WANT IT EXPOSED TO THE JURY
5 UNTIL WE KNOW EXACTLY WHAT --
6 THE COURT: OKAY. LET HIM SHOW IT TO THE WITNESS
7 AND ASK A QUESTION.
8 MR. STIRBA: OKAY, SURE.
9 Q. (BY THE COURT) SURE LET ME SHOW YOU WHAT IS A NOTE,
10 DOCTOR, FROM THE NURSING HOME RECORDS AND IT'S DATED 1/4 OF
11 '96. DO YOU SEE THE NOTE I HAVE IN FRONT OF YOU?
12 A. UH-HUH.
13 Q. AND IT REFERS TO AN EVENT THAT -- JUST READ SILENTLY TO
14 YOURSELF AND YOU'LL SEE THERE'S A REFERENCE TO YOU THERE.
15 THAT'S WHY I'M ASKING YOU ABOUT IT.
16 A. UH-HUH. OKAY.
17 Q. AND THERE IS YOUR NAME REFERENCED IN TERMS OF AN ATTEMPT
18 BY THE NURSING HOME TO CONTACT YOU CONCERNING THAT EVENT,
19 TRUE?
20 A. YEAH, THEY HAVE A NOTE THAT I WAS CALLED.
21 MR. STIRBA: OKAY. YOUR HONOR --
22 THE WITNESS: I DON'T KNOW WHY.
23 MR. STIRBA: -- WE WOULD -- WE WOULD NOW LIKE TO --
24 AS I SAY, THIS IS A STATE EXHIBIT, YOUR HONOR. I'M OFFERING
25 IT. AND I'D LIKE TO BE ABLE TO CROSS-EXAMINE THE WITNESS
887
1 CONCERNING THE RECORDS OF THE NURSING HOME.
2 THE COURT: OKAY. DO YOU WANT TO MARK IT AND SHOW
3 IT --
4 MR. MAJOR: WE HAVE -- WE HAVE IT. MY PROBLEM IS,
5 NUMBER ONE, I DON'T SEE THE RELEVANCY. NUMBER TWO --
6 THE COURT: OKAY. WELL, FIRST OF ALL, LET'S --
7 LET'S DO THIS: LADIES AND GENTLEMEN, I'M -- HOW MUCH MORE
8 TIME DO WE HAVE WITH THIS WITNESS?
9 MR. STIRBA: I HAVE ABOUT FIVE MINUTES, YOUR HONOR.
10 THE COURT: OKAY. LADIES AND GENTLEMEN, LET'S JUST
11 TAKE A REAL SHORT BREAK, JUST GO TO THE JURY ROOM, AND WE'RE
12 JUST GOING TO RESOLVE ONE ISSUE AND GET THIS WITNESS DONE
13 BEFORE WE TAKE OUR LUNCH BREAK.
14 (AFTER ADMONISHING THE JURY, THE COURT
15 EXCUSED THE JURY FROM THE COURTROOM.)
16 THE COURT: OKAY. PLEASE BE SEATED. THE RECORD
17 SHOULD REFLECT THE JURY IS NOT IN THE COURTROOM. OKAY. CAN
18 I JUST SEE THE EXHIBIT?
19 MR. STIRBA: CERTAINLY.
20 MR. MAJOR: WE HAD -- WE'RE TRYING TO FIND -- WE
21 THOUGHT WE HAD OUR COPY OF IT, BUT I'M NOT SURE IF WE'VE GOT
22 THE RIGHT PAGE.
23 THE COURT: WELL, WHY DON'T YOU SHOW IT TO COUNSEL
24 FIRST.
25 MR. STIRBA: WELL, NOW I LOST IT. OR IT'S GONE.
888
1 MS. BARLOW: STILL UP WITH THE WITNESS?
2 THE WITNESS: I HID IT. I DON'T --
3 MR. STIRBA: DID I GIVE IT TO YOU, VICKI?
4 THE CLERK: NO.
5 MR. STIRBA: I HAD IT.
6 THE COURT: WELL, I TOLD HER TO MARK IT.
7 MR. STIRBA: I CAN'T BELIEVE THAT'S WHAT
8 HAPPENED -- LET ME FIND IT, JUDGE.
9 THE COURT: ALL RIGHT. ANYONE WHO HAS THE EXHIBIT,
10 COME FORWARD.
11 MR. STIRBA: HERE IT IS, YOUR HONOR.
12 THE COURT: WHY DON'T YOU SHOW IT TO THEM FIRST SO
13 THEY KNOW WHAT WE'RE TALKING ABOUT.
14 MS. BARLOW: WHAT I GUESS, YOUR HONOR, WE CAN'T SEE
15 IS WHERE HE'S REFERRING IN THE REPORT OF THE FALL.
16 THE COURT: WELL, THINK IT'S 1/4/96 ON THE BOTTOM
17 OF THE PAGE. IT SAYS PUT TO BED. FOUND ON FLOOR IN ROOM.
18 IS THAT WHAT YOU'RE TALKING ABOUT?
19 MR. STIRBA: THAT'S RIGHT, YOUR HONOR. THAT'S ONE
20 OF THE ENTRIES.
21 THE COURT: ABOUT FOUR -- FOUR LINES FROM THE
22 BOTTOM.
23 MS. BARLOW: WELL, THIS -- EXCUSE ME.
24 MR. MAJOR: GO AHEAD, YOU TAKE IT.
25 MS. BARLOW: HE HAS TESTIFIED THAT ON THE 3RD OF
889
1 JANUARY HE WAS TOLD OF FALLS THAT HAPPENED ON THE 29TH AND
2 THE 30TH. THIS EVIDENTLY IS A PERSON WHO'S OUT ON BED ON
3 THE 4TH. DOESN'T SAY A FALL, FOR ONE THING.
4 MR. STIRBA: I'M OFFERING THE DOCUMENT. THAT'S
5 WHAT I WANNA DO. AND IF THERE'S SOME QUESTION ABOUT ITS
6 AUTHENTICITY OR SOMETHING ELSE, FINE. BUT I'M OFFERING THE
7 DOCUMENT AND I'M ENTITLED TO CROSS I THINK IF IT'S EVIDENCE.
8 THE COURT: OKAY. IS THERE ANY OBJECTION TO THE
9 DOCUMENT?
10 MR. MAJOR: TO THE ACTUAL DOCUMENT COMING IN, NO.
11 CROSS --
12 THE COURT: OKAY. THEN LET'S MARK IT AS YOUR --
13 ARE WE MARKING IT HAS A WHOLE RECORD OR ARE WE GONNA MARK --
14 MR. STIRBA: I WOULD PREFER, YOUR HONOR, THIS IS
15 THE NOTEBOOK FROM THE RECORDS THAT THE STATE PROVIDED ME. I
16 WOULD PREFER TO JUST OFFER THIS AS THEIR EXHIBIT BECAUSE
17 ULTIMATELY I THINK THAT'S WHAT THEY WANNA DO AND I'LL JUST
18 USE THESE TWO PAGES.
19 THE COURT: OKAY.
20 MR. STIRBA: I JUST DON'T KNOW WHAT EXHIBIT NUMBER
21 THEY WANT --
22 THE COURT: DO YOU HAVE ANY OBJECTION TO HAVING --
23 PARDON ME -- HAVING -- WHAT ARE THOSE RECORDS?
24 MR. STIRBA: THESE ARE THE SUNSHINE CARE NURSING
25 HOME RECORDS PROVIDED BY THE STATE.
890
1 THE COURT: OKAY. THIS FOR JUST ONLY
2 MR. ALLDREDGE.
3 MR. STIRBA: YES, THAT'S CORRECT, YOUR HONOR.
4 MR. MAJOR: WE HAVE NO OBJECTION TO THAT.
5 THE COURT: OKAY. WELL, WHAT DO YOU WANT IT TO BE
6 MARKED THEN? DO YOU WANT IT TO BE MARKED AS YOUR EXHIBIT?
7 MR. MAJOR: IT'D BE MARKED AS OUR EXHIBIT, BUT
8 WHATEVER --
9 THE COURT: OKAY. WHAT'S THE NEXT ONE? OKAY.
10 DEFENDANT EXHIBIT 11 THEN, SO WHY DON'T YOU -- DO YOU WANNA
11 BRING THAT -- DO WE HAVE THE BOOK?
12 MR. MAJOR: YOUR HONOR, IS THIS DEFENDANT'S EXHIBIT
13 OR PLAINTIFF'S EXHIBIT?
14 MR. STIRBA: MAY I MAKE THIS SUGGESTION? I
15 THINK --
16 MS. BARLOW: HERE IS -- HERE IS AN UNMARKED FOR THE
17 COURT, A COPY THAT WE HAD MADE. THAT IS THE SAME --
18 MR. STIRBA: CAN THIS BE THE EXHIBIT THEN?
19 MS. BARLOW: THAT CAN BE THE EXHIBIT THAT WE
20 CREATED.
21 MR. STIRBA: WHAT NUMBER DO YOU WISH?
22 THE CLERK: STATE 11.
23 THE COURT: DO YOU WANT IT TO BE A DEFENDANT
24 EXHIBIT OR DO YOU WANT IT TO BE A PROSECUTION EXHIBIT?
25 MR. MAY: IT'S THE PROSECUTION'S EXHIBIT, YOUR
891
1 HONOR.
2 THE COURT: OKAY. SO IT WOULD BE P-11? WHAT IS
3 THE P., WHERE ARE WE AT ON THE --
4 THE CLERK: 11.
5 MS. BARLOW: SO IT'S P-11.
6 THE COURT: PLAINTIFF'S EXHIBIT 11.
7 MS. BARLOW: MAKE SURE WE'RE ALL ON THE SAME PAGE.
8 THE COURT: OKAY. SO YOU HAVE NO OBJECTION TO
9 PLAINTIFF'S EXHIBIT 11 BEING RECEIVED?
10 MR. STIRBA: I DO NOT, YOUR HONOR.
11 THE COURT: WELL, NO, I'M TALKING --
12 MR. STIRBA: SORRY.
13 THE COURT: I GUESS IT'S THE -- IS THERE ANY
14 OBJECTION?
15 MS. BARLOW: NO.
16 MR. MAJOR: WE HAVE NO -- "Who's on first?"
17 THE COURT: OKAY. THEN IT'S RECEIVED. OKAY THEN.
18 OKAY. BEFORE WE GET THE JURY BACK IN, DO YOU HAVE ANY OTHER
19 OBJECTION ABOUT HIM BEING ABLE TO USE THIS EXHIBIT WITH THIS
20 WITNESS?
21 MR. MAJOR: WELL, OUR OBJECTION IS, YOUR HONOR, IS
22 THAT HE HAS ALREADY TESTIFIED THAT HE ONLY HAS NOTES, ONLY
23 RECALLS BEING CALLED BY THE NURSING HOME I THINK HE SAID ON
24 THE 3RD. THIS IS ON THE 4TH. THERE IS A NOTE IN THERE THAT
25 SAYS DR. CUNNINGHAM CALLED. WE DON'T KNOW IF IT WAS HIS
892
1 OFFICE THAT WAS CALLED. DID THEY SPEAK TO A NURSE, DID THEY
2 MISS --
3 THE COURT: BUT ISN'T THAT WHAT HE'S TRYING TO DO?
4 I MEAN --
5 MR. MAJOR: WELL, I MEAN WE'VE GOTTA GET -- I
6 DON'T -- MY PROBLEM IS, IF DR. CUNNINGHAM TESTIFIES, I DON'T
7 RECEIVE -- RECALL RECEIVING THAT CALL, I DON'T RECALL --
8 THE COURT: WELL, OKAY. IF HE SAYS I DON'T RECALL
9 RECEIVING THE CALL, THAT ENDS IT. BUT IF IT'S JUST LIKE
10 OUR -- ONE OF THE LAST WITNESSES THAT WE HAD BEFORE THE
11 BREAK THIS MORNING, THEY SAW AN EXHIBIT AND THEN IT STARTS
12 GIVING SOME IDEA, OH, YEAH, I REMEMBER, OKAY --
13 MR. MAJOR: AND MY OBJECTION SIMPLY IS IS THAT'S
14 ALL WE -- WE DON'T WANT HIM TO GO INTO THE DETAILS OF THAT.
15 IF HE SAYS, I DON'T REMEMBER, WE DON'T WANT THE DEFENSE
16 READING THAT AND SAYING, WELL, WHAT DO YOU THINK ABOUT THIS,
17 WHAT DOES THIS MEAN OR --
18 THE COURT: WELL, HOW DO YOU ASK THE QUESTION IF
19 YOU'VE HEARD ABOUT IT UNLESS -- IF YOU'VE GOT A DOCUMENT
20 THAT'S RECEIVED INTO EVIDENCE, IT'S RECEIVED INTO EVIDENCE,
21 IT CAN BE READ --
22 MR. MAJOR: SURE.
23 THE COURT: -- AND HOW CAN HE NOT DO THIS? I MEAN
24 I DON'T UNDERSTAND, YOU KNOW, WHY WE'RE HAVING THIS BIG
25 HASSLE. ALL THESE MEDICAL RECORDS ABOUT THESE INDIVIDUALS,
893
1 IT SEEMS TO ME THE MEDICAL CONDITION OF EACH OF THESE
2 PATIENTS BEFORE THEY GO TO THE DAVIS HOSPITAL IS EXTREMELY
3 IMPORTANT. AND WHAT THEIR CONDITION -- THEY'RE TRYING TO
4 SAY, YOU KNOW, THEY'RE IN A CERTAIN CONDITION. THE DEFENSE
5 ATTORNEYS SAY THEY'RE IN ANOTHER CONDITION. WHATEVER THE
6 CONDITION IS NEEDS TO BE STATED. AND THERE'S -- I DON'T
7 UNDERSTAND WHY WE'RE HAVING AN ARGUMENT OVER RECORDS THAT
8 ARE RECEIVED INTO EVIDENCE AND ASKING WITNESSES IF -- YEAH,
9 I'M NOT GONNA LET IT GO ON AND -- IF HE ASKS A QUESTION,
10 HERE'S A REFERENCE, DOCTOR, THAT THE CARE CENTER CALLED YOU.
11 DOES THAT REFRESH YOUR MEMORY. IF HE SAYS NO, THAT KIND OF
12 ENDS THE DISCUSSION. IF HE SAYS, OH, YEAH, THAT DOES
13 REFRESH MY MEMORY, THEN OKAY, TELL US ABOUT IT.
14 MR. MAJOR: WELL, AND MY ONLY CONCERN, YOUR HONOR,
15 THIS GOES TO THE ONE OF THE THINGS I WANTED TO TALK TO YOU
16 ABOUT LUNCH. I GUESS WE CAN ADDRESS IT HERE. MY CONCERN ???
17 THAT WE HAVE IS THAT THESE RECORDS ARE COMING IN, BUT
18 THEY'RE COMING IN JUST SIMPLY BY STIPULATION. BUT THE
19 PERSON WHO WROTE THESE NOTES, THE PERSON WHO INTERPRETED
20 THESE NOTES ISN'T HERE TO TESTIFY. WE'VE ALREADY HAD THIS
21 SITUATION HAPPEN EARLIER WITH FAMILY MEMBERS OF ELLEN
22 ANDERSON. DR. KELLER'S NOTE WAS PUT ON THE STAND TALKING
23 ABOUT A TUMOR IN THE LUNG, TALKING ABOUT WE'RE GONNA SEND
24 THIS TO THE RADIOLOGIST. NOW, THAT'S IMPLIED IN THE JURY'S
25 MIND THAT SHE HAD A PROBLEM.
894
1 THE COURT: WELL, BUT THAT RECORD'S COMING INTO
2 EVIDENCE.
3 MR. MAJOR: WELL, I KNOW, BUT THE PROBLEM WITH THAT
4 IS, YOUR HONOR, IS WE DID NOT LIST DR. KELLER ON OUR WITNESS
5 LIST. WE NOW HAVE GOTTA MAKE A MOTION FOR THIS COURT TO
6 BRING DR. KELLER IN TO INTERPRET WHAT THAT NOTE MEANT AND
7 WHAT THE RESULTS OF THAT RADIOLOGIST'S TEST WAS, WHETHER
8 THERE WAS A TUMOR IN THERE OR NOT.
9 THE COURT: OKAY. WELL, LET'S JUST GO BACK TO
10 BASIC EVIDENCE. BASIC EVIDENCE SAYS THAT IF A DOCUMENT
11 COMES INTO EVIDENCE, IT CAN BE USED FOR ANY PURPOSE. ONCE
12 IT'S IN EVIDENCE, IT DOESN'T MATTER, WE DON'T HAVE TO HAVE
13 THE WRITER OF THE DOCUMENT. WE CAN ASK -- THAT CAN BE USED
14 AS EVIDENCE. THE JURY COULD SEE IT RIGHT NOW. IF IT'S IN
15 EVIDENCE, THE JURY CAN SEE IT.
16 NOW, IF IT ISN'T APPROPRIATE, I'M NOT JUST GONNA HAVE
17 THE JURY SEEING EXHIBITS THAT SOMEBODY ISN'T BEING
18 QUESTIONED ABOUT. IT MAKES NO SENSE. BUT WHAT WE'VE HAD UP
19 TO THIS POINT IS A QUESTION LIKE -- AND THE DR. KELLER
20 EXAMPLE IS, OKAY, THE DOCTOR PUTS THIS IN HIS RECORD. DOES
21 THAT -- DO YOU REMEMBER HAVING A CONVERSATION WITH THIS
22 DOCTOR, AND THE WITNESS SAYS, NO, I REALLY DON'T --
23 MR. MAJOR: YEAH, I GUESS --
24 THE COURT: -- BUT THE POINT IS, YOU HAVE TO HAVE
25 WHAT WAS SAID SO THAT YOU KNOW --
895
1 MR. MAJOR: RIGHT.
2 THE COURT: -- TO REFRESH THE MEMORY OF THE
3 WITNESS.
4 MR. MAJOR: AND I GUESS I DIDN'T MAKE MYSELF
5 EXACTLY CLEAR ON WHAT I'M GETTING AT. WE HAVE NO OBJECTION
6 TO THAT. WE HAVE NO OBJECTION TO -- IF THAT'S THE CASE, IF
7 THIS COMES IN, THIS GOING TO THE JURY. IF WE HAVE THIS
8 DOCTOR TESTIFYING TO THAT LIKE WE HAD BROUGHT OUT WITH
9 DR. KELLER, THEN THE STATE SHOULD BE ALLOWED TO CALL IN THE
10 WITNESS, FOR EXAMPLE, WHO WROTE THAT NOTE. WE SHOULD BE
11 ABLE -- NOW BE ABLE TO CALL IN AS PART OF OUR CASE IN CHIEF
12 DR. KELLER TO EXPLAIN WHAT THAT NOTE MEANT, WHAT THE TUMOR
13 WAS HE SENT IT TO THE RADIOLOGIST TO GET A RESULT. WE NEED
14 TO BRING HIM IN TO TESTIFY AS TO WHAT THAT RESULT WAS. WE
15 NEED TO BRING DR. WILDING IN NOW TO TALK ABOUT HIS -- Incomprehensible.
16 THE COURT: WASN'T DR. WILEY COMING?
17 MR. MAJOR: NO, WE HAVE NO -- DID THE COURTS --
18 THE COURT: WILDING.
19 MR. MAJOR: WILDING.
20 THE COURT: WE HAD HIM LISTED.
21 MR. MAJOR: WE DID BUT BECAUSE OF THE COURT'S
22 PERSISTENCE ON WE DID NOT WANNA HAVE CUMULATIVE TESTIMONY,
23 CUMULATIVE EVIDENCE, WE DID NOT CALL HIM SIMPLY BECAUSE WE
24 DIDN'T THINK HE WAS GONNA ADD ANYTHING. NOW WE HAVE HIS
25 RECORDS COMING IN WITHOUT HAVING ANY REAL FOUNDATION AS TO,
896
1 YOU KNOW, I MEAN THE PERSON TESTIFIED --
2 THE COURT: WELL, FIRST OF ALL, YOU SAY NO
3 FOUNDATION. THE RECORDS ARE IN EVIDENCE --
4 MR. MAJOR: NO, WELL, I -- I -- AND I -- OKAY --
5 THE COURT: -- FOUNDATION IS MEANINGLESS AT THIS
6 POINT. IF THE RECORDS ARE IN EVIDENCE, WE'RE NOT TALKING
7 ABOUT FOUNDATION ANYMORE --
8 MR. MAJOR: WELL, AND I UNDERSTAND THAT, BUT WE
9 HAVE NOT NECESSARILY -- WHAT I'M GETTING AT THEN IS FOR THE
10 FOUNDATION -- I MEAN HAVING THE PERSON WHO WROTE THAT NOTE
11 COME IN AND TALK ABOUT IT. I WON'T USE THE TERM FOUNDATION.
12 THE COURT: WELL, YOU'RE -- ARE YOU SAYING THAT
13 ONLY THE PERSON -- ONLY THE PERSON WHO WROTE THE DOCUMENT --
14 MR. MAJOR: NO.
15 THE COURT: -- CAN TALK ABOUT IT?
16 MR. MAJOR: NO. I'M SAYING -- I'M NOT SAYING THAT.
17 I'M NOT OBJECTING TO THEM COMING IN. THAT'S NOT MY
18 OBJECTION.
19 THE COURT: YEAH, BUT YOU'RE SAYING NOW, OKAY, THEY
20 CAN COME IN, BUT WE CAN'T USE THEM.
21 MR. MAJOR: NO. WHAT I'M SAYING IS IF THEY COME IN
22 AND HE'S ALLOWED TO TESTIFY TO THOSE RECORDS, THE STATE HAS
23 A RIGHT TO CALL ADDITIONAL WITNESSES THAT WE DO NOT HAVE ON
24 OUR WITNESS LIST AND DID NOT SUBMIT TO THIS COURT TO DISCUSS
25 THOSE NOTES AND DISCUSS --
897
1 THE COURT: WELL, WHY ARE YOU STIPULATING TO
2 DOCUMENTS COMING INTO EVIDENCE THAT STATE WHAT THE MEDICAL
3 RECORDS ARE, YOU KNOW, AND THEN SAY, WELL, NOW WE NEED TO
4 HAVE THE WITNESS COME IN? I MEAN I DON'T KNOW, IF YOU HAVE
5 TO HAVE A WITNESS COME IN AND THERE'S A REASON TO HAVE A
6 WITNESS IF THERE'S AN ISSUE, BUT RIGHT NOW, ALL OF THOSE
7 RECORDS, THE MEDICAL RECORDS ARE IMPORTANT BECAUSE THEY SAY
8 WHAT THE CONDITIONS ARE. WE DON'T NEED A DOCTOR -- I MEAN
9 IF YOU THINK THERE'S A DOCTOR THAT'S NECESSARY TO COME IN TO
10 EXPLAIN SOMETHING IF IT NEEDS TO BE EXPLAINED, FINE.
11 OTHERWISE, THE JURY IS GOING TO GET THE MEDICAL CONDITION OF
12 ALL OF THESE PATIENTS THROUGH TWO SOURCES: LIVE WITNESSES
13 AND THE FAMILY MEMBERS THAT SAY WHAT WERE THEY LIKE, DOCTORS
14 WHO TESTIFIED WHO SAY WHAT THEY WERE LIKE, AND MEDICAL
15 RECORDS WHO SAY WHAT THEY WERE LIKE.
16 MR. MAJOR: AND I THINK WE'RE TALKING ABOUT TWO
17 SEPARATE POINTS HERE.
18 THE COURT: WELL, I THOUGHT ABOUT THAT FOR FOUR OR
19 FIVE DAYS --
20 MR. MAJOR: OKAY. WELL, WHILE I'M SAYING THIS, IF
21 WE DECIDE THAT AT THIS POINT IN TIME HAVING -- WE HAVEN'T
22 STIPULATED, FOR EXAMPLE, TO DR. WILDING'S AND DR. KELLER'S
23 MEDICAL RECORDS COMING IN. BUT THEY WERE BROUGHT -- SO
24 THOSE RECORDS COME IN, AND THAT'S FINE WITH ME. BUT I'M
25 JUST WANNA SAY WHEN WE CALL DR. KELLER TO THE STAND, WHICH
898
1 WE ARE PLANNING ON DOING -- WE'RE MAKING SUBPOENAS FOR HIM
2 RIGHT NOW -- I DON'T WANT AN OBJECTION FROM THE DEFENSE THAT
3 SAYS, HEY, HE WASN'T ON OUR WITNESS LIST, WE WEREN'T GIVEN
4 NOTIFICATION OF HIS BEING CALLED. I DON'T WANT A PROBLEM
5 WITH CUMULATIVE EVIDENCE SAYING, HEY, HE'S JUST GONNA BE
6 CUMULATIVE TO WHAT WE HAVE --
7 THE COURT: WELL, I GUESS THE QUESTION I HAVE IS,
8 IF YOU WERE GOING TO STIPULATE TO DR. KELLER AND
9 DR. WILDING'S EXHIBITS COMING IN --
10 MR. MAJOR: WE HAVEN'T STIPULATED TO THEM YET.
11 THE COURT: WELL, OKAY. I THOUGHT THAT WHAT WE
12 SAID WHEN WE HAD PRETRIAL MOTIONS -- AND I GUESS MAYBE I WAS
13 UNDER A DIFFERENT UNDERSTANDING. I WAS UNDER THE
14 UNDERSTANDING IF I TOOK TWO WEEKS TO REVIEW 25 MOTIONS IN
15 THIS CASE AND I MADE RULINGS, THAT THEY WERE GOING TO HAVE
16 SOME MEANING. AND I GUESS I CAME AWAY FROM THOSE THINGS
17 SAYING THAT WE WERE GOING TO HAVE COMPLETE MEDICAL RECORDS
18 OF THE HOSPITAL, AND I ASSUMED THAT WE WERE GONNA HAVE
19 MEDICAL RECORDS OF EVERYONE SO THAT WE COULD SAY WHAT WAS
20 THE MEDICAL CONDITION OF THE PATIENTS IN THIS CASE --
21 MR. MAJOR: THAT'S NOT THE UNDERSTANDING OF THE
22 STATE, AND THAT'S THE PROBLEM WE'RE RUNNING INTO.
23 THE COURT: OKAY. WELL, I GUESS THE POINT IS LIKE
24 RIGHT NOW, WE HAVE HAD TWO OFFERS OF EXHIBITS. LIKE AFTER
25 WE ENDED YESTERDAY, THERE WAS D-9, D-20, D-20.1 THROUGH
899
1 D-20.9 AND D-22. THIS MORNING D-8, 10, 11, AND 13, ALL
2 EXHIBITS OF PEOPLE'S MEDICAL RECORDS. AND THE ONLY RESPONSE
3 TO THAT IS WE HAVE TO LOOK THROUGH THEM.
4 MR. MAJOR: YEAH.
5 THE COURT: OKAY. WELL, IF THEY ARE THESE PEOPLE'S
6 MEDICAL RECORDS, ARE YOU GOING TO HAVE AN OBJECTION FOR THEM
7 COMING INTO EVIDENCE?
8 MR. MAJOR: IF -- WITH A CAVEAT THAT IF THERE IS
9 ADDITIONAL WITNESSES WE MAY NEED TO CALL AS A RESULT OF THE
10 MEDICAL RECORDS, THEN NO.
11 THE COURT: OKAY. WELL, I GUESS WE'LL HAVE TO DEAL
12 WITH PROBLEMS AS THEY COME UP. I CAN'T DEAL IN ADVANCE OF
13 SOMETHING. IF WHAT YOU'RE SAYING IS --
14 MR. MAJOR: WELL --
15 THE COURT: -- THAT YOU MIGHT BE CALLING THESE
16 PEOPLE TO EXPLAIN THEIR MEDICAL RECORDS, I GUESS THE
17 QUESTION IS, IF YOU KNEW THAT THE OTHER SIDE WAS GOING TO
18 INTRODUCE MEDICAL RECORDS OF THESE DOCTORS, AND LIKE WITH
19 DR. WILDING, YOU HAVE DESIGNATED A DR. WILDING. KELLER
20 ISN'T DESIGNATED --
21 MR. MAJOR: NO.
22 THE COURT: -- BUT, YOU KNOW, WILDING IS. SO IF
23 YOU WERE GOING TO LET THE -- IF YOU KNEW THAT THE DEFENSE
24 WAS GOING TO PUT MEDICAL RECORDS IN AND NOT CALL THE
25 WITNESSES, THAT'S ONE ISSUE. IF YOU THOUGHT -- IF YOU'RE
900
1 SAYING THIS IS SOME SORT OF SURPRISE THAT THESE RECORDS ARE
2 COMING IN --
3 MR. MAJOR: YOUR HONOR, WE --
4 THE COURT: -- I DON'T KNOW WHAT --
5 MR. MAJOR: THE FIRST TIME WE SAW ANY OF THE
6 MEDICAL RECORDS DEFENSE HAD OR OFFERED WAS TODAY, THEY
7 WALKED IN AND HANDED THEM. THE FIRST TIME I SAW RACHAEL
8 STUBBS' MEDICAL RECORDS, FOR EXAMPLE, WAS WHEN DEFENSE
9 COUNSEL HANDED THEM TO HER.
10 MR. STIRBA: THAT'S NOT TRUE. SHE HAD A BINDER
11 RIGHT THERE PROVIDED BY BETSY BOWMAN, SHE TESTIFIED TO IT,
12 OF HER MEDICAL FILE. THIS IS --
13 MR. MAJOR: NO, YOUR HONOR --
14 MR. STIRBA: -- THE STATE OF UTAH --
15 MR. MAJOR: -- THAT WAS NOT HER MEDICAL FILE. THAT
16 WAS THE REST HOME FILE. DIDN'T HAVE ANYTHING TO COME FROM
17 HER OFFICE. IT WAS THE REST HOME FILE.
18 THE COURT: WELL --
19 MR. MAJOR: FIRST TIME WE HEARD THAT WE HAD
20 ANYTHING FROM DR. KELLER AND DR. WILDING IS WHEN THEY HANDED
21 IT TO US YESTERDAY MORNING.
22 THE COURT: WELL, GUESS WHAT, THE FIRST TIME THAT
23 THEY GOT THE INTERVIEW OF ONE OF THE WITNESSES YESTERDAY WAS
24 THE DAY BEFORE, TOO --
25 MR. MAJOR: SURE.
901
1 THE COURT: -- I MEAN, LET ME TELL YOU, I WOULD
2 HOPE THAT ON A CASE OF THIS MAGNITUDE, AND HOW MUCH IS
3 INVOLVED AND SIX WEEKS OF EVERYONE'S TIME, THAT PEOPLE WOULD
4 BE PREPARED. AND THAT PEOPLE WILL COME INTO HERE AS MUCH AS
5 THEY CAN. NOW, WE ARE STUCK WITH THE SITUATION THAT WE'RE
6 IN, IN THAT YOU HAVE THE RECORDS OR YOU DON'T HAVE THE
7 RECORDS. BUT ALL I CAN SAY IS THAT I'M ABSOLUTELY BAFFLED
8 BY THE IDEA THAT IF ONE SIDE OR THE OTHER SUBPOENAS RECORDS
9 FROM A DOCTOR'S OFFICE OR A CARE CENTER, AND THEN -- AND
10 THEN THEY'RE -- THEY COME BACK FROM THE SUBPOENA WITH THOSE
11 RECORDS, AND THEN PEOPLE SAYING, OH, WELL, WE'RE GONNA
12 OBJECT TO THOSE RECORDS, WHEN THEY DON'T HAVE ANYTHING TO
13 OBJECT TO OTHER THAN SAYING, WE DON'T HAVE A COPY OF THEM.
14 MR. MAJOR: WELL, LET ME GIVE YOU MY -- AGAIN, LET
15 ME GIVE YOU MY CONCERN, WHAT WAS BROUGHT UP BY MR. STIRBA.
16 HE HANDED RACHEL STUBBS A SET OF RECORDS. HE REPRESENTED TO
17 THIS COURT THAT THAT WAS EVERYTHING THEY HAD RECEIVED FROM
18 THAT MEDICAL OFFICE.
19 THE COURT: CORRECT.
20 MR. MAJOR: OKAY.
21 MR. STIRBA: UH-HUH.
22 MR. MAJOR: BUT IT WASN'T --
23 THE COURT: WELL, AND THE WITNESS --
24 MR. MAY: NO.
25 THE COURT: BUT SEE, HERE'S THE POINT: HE GETS
902
1 THOSE AND HE ASKS THE WITNESS WHOSE RECORDS THEY ARE. ARE
2 THESE YOUR COMPLETE RECORDS, AND SHE SAYS, WELL, ACTUALLY,
3 THERE'S THESE OTHER THINGS BECAUSE THEY -- IT CAME FROM THE
4 DAY CARE CENTER, I GET IT, I WRITE SOMETHING ON IT, AND IT
5 GOES BACK TO THE DAY CARE CENTER.
6 NOW, WHATEVER IT WAS, RACHAEL STUBBS WAS NOT AT THE
7 PLACE WORKING --
8 MR. MAJOR: RIGHT.
9 THE COURT: -- WHERE SHE IS NOW. AND SO THAT
10 WHEN -- IN HER RECORDS, THAT'S PROBABLY ALL THAT WAS IN
11 THERE IN THAT FILE. I MEAN I DON'T -- IT IS NOT UNUSUAL TO
12 ME THAT WHENEVER YOU SUBPOENA RECORDS, AND I HAVE DONE IT AS
13 AN ATTORNEY THOUSANDS OF TIMES, THAT YOU ALWAYS FIND OUT
14 THAT THERE ARE OTHER RECORDS SOMEHOW, EVEN THOUGH THEY SAID
15 THIS IS ALL WE HAVE. THAT IS NOT UNUSUAL TO ME AND THAT'S
16 WHY YOU GIVE IT TO A WITNESS AND WITNESS SAYS, IS THIS THE
17 COMPLETE FILE? SHE SAYS NO, THERE SHOULD BE THESE 15
18 SHEETS. ALL RIGHT. LET'S PUT THESE 15 SHEETS. NOW IS THIS
19 THE COMPLETE FILE? YEAH, I THINK IT IS. SO THERE'S NOTHING
20 WRONG WITH THAT --
21 MR. MAJOR: WELL, I GUESS -- I GUESS MY PROBLEM IS
22 WE'RE GETTING OFF THE POINT. I MEAN I DON'T HAVE ANY
23 PROBLEMS WITH --
24 THE COURT: NO, I THINK -- I THINK ONE OF THE
25 POINTS THAT WE'RE DEALING WITH IS THAT I DON'T UNDERSTAND
903
1 WHY WE'RE HAVING SUCH A HASSLE OVER MEDICAL RECORDS. I
2 THINK, YOU KNOW, THAT AS SOON AS YOU CAN REVIEW THE MEDICAL
3 RECORDS, YOU KNOW, THE MEDICAL RECORDS -- I AM PRONE TO
4 ALLOW THE MEDICAL RECORDS OF THESE PATIENTS TO COME INTO
5 EVIDENCE. I MEAN IT IS THE MOST RELEVANT THING FOR BOTH
6 SIDES.
7 MR. MAJOR: WELL, YOUR HONOR, SEE, AND I'M KIND OF
8 LOST BECAUSE I'M NOT MAKING THAT OBJECTION.
9 THE COURT: OKAY. BUT WHAT YOU'RE SAYING IS THAT,
10 OKAY, SINCE WE'RE MAKING THIS, WELL, WE STARTED WITH
11 MR. STIRBA TRYING TO ASK THIS WITNESS A QUESTION ABOUT ONE
12 OF THESE MEDICAL RECORDS AND YOU OBJECTED IT TO.
13 MR. MAJOR: BASED ON THE HEARSAY RULE. BASED ON
14 THE FACT THAT THIS WITNESS -- WITH THIS WITNESS. I'M NOT
15 NECESSARILY TESTIFYING THAT THE RECORDS CAN'T COME IN AND
16 THE JURY CAN'T READ 'EM. I'M JUST SAYING WITH THIS
17 WITNESS --
18 THE COURT: OKAY. WELL, I GUESS I WILL HAVE TO
19 MAKE IT REAL CLEAR. THEN WHAT I'M SAYING IS, IF A RECORD IS
20 RECEIVED INTO EVIDENCE, A MEDICAL RECORD, AND THEN IT REFERS
21 TO A WITNESS ON THE STAND'S ACTIVITY, THAT WITNESS CAN
22 OBVIOUSLY BE QUESTIONED ABOUT A RECORD THAT'S IN EVIDENCE.
23 AND THAT'S WHAT I UNDERSTAND WE'RE DOING --
24 MR. MAJOR: OKAY. AND THAT'S IT. AND I HAVE --
25 I'M NOT OBJECTING TO THAT.
904
1 THE COURT: OKAY. WELL, THAT'S WHAT YOU WERE
2 BEFORE THE JURY WENT OUT --
3 MR. MAJOR: WELL, I WAS -- NO, I WAS --
4 THE COURT: -- OBJECT TO HIM USING THAT.
5 MR. MAJOR: BECAUSE HAD HE SAID THAT HE IS -- WAS
6 NOT FAMILIAR WITH THAT RECORD. I WANT THAT QUESTION ASKED.
7 DO YOU -- DOES THAT -- IF YOU WANT TO REFRESH HIS MEMORY,
8 I'D LIKE TO REQUEST THAT WE DON'T PUT IT ON THE OVERHEAD
9 PROJECTOR BEFORE WE GET THOSE FOUNDATION QUESTIONS RAISED.
10 WE DON'T STICK IT UP ON THERE UNTIL --
11 THE COURT: OKAY. DO YOU HAVE ANY OBJECTION TO
12 THAT, THAT YOU ASK THE QUESTION FIRST?
13 MR. STIRBA: YES, I DO. I -- THE REASON WHY I --
14 AND I DIDN'T -- I DIDN'T DO IT. BUT I DIDN'T THINK THERE
15 WAS ANY ISSUE. BUT I'M OFFERING IT. AND IF I OFFER IT,
16 IT'S BEEN RECEIVED, I'M GONNA PUT IT ON THE ELMO. AND I'M
17 ENTITLED TO DO THAT. I'M ENTITLED TO CONDUCT MY CROSS ANY
18 WAY I WANT AS LONG AS I'M IN SYNC WITH THE COURT IN TERMS OF
19 QUESTIONING, AND AS LONG AS I'M DOING IT APPROPRIATELY. AND
20 I THINK I HAVE BEEN, AND I'M ENTITLED TO USE THESE RECORDS
21 TO CROSS-EXAMINE THEIR DOCTORS. THAT'S ALL I'M DOING. AND
22 I DON'T THINK I'VE ABUSED THAT PRIVILEGE, YOUR HONOR. AND I
23 THINK I'VE BEEN CONSISTENT WITH IT. AND REALLY MY POINT IS
24 VERY SIMPLE, WE -- I CAN DO IT THE HARD WAY. I CAN GET ALL
25 THE CUSTODIANS IN HERE AND WE CAN GO THROUGH THAT DRILL.
905
1 THEN THEY'RE GONNA DO THAT. THAT'S JUST BIG WASTE. I'VE
2 TOLD THEM ALL ALONG, OFFER YOUR MEDICAL RECORDS. THEY'RE
3 IN. WE'LL OFFER OUR MEDICAL RECORDS TO THE EXTENT YOU DON'T
4 HAVE THEM. THEY'RE IN. THEN WE DEAL WITH THEM. I MEAN
5 THAT'S -- THAT'S WHAT I'VE DONE ALL ALONG. THAT'S ALL I'M
6 TRYING TO DO HERE.
7 MR. MAJOR: BUT I GUESS I DON'T WANNA WASTE THE
8 COURT'S TIME OR BE FRUSTRATED, BUT THAT'S NOT WHAT I'M
9 SAYING. I MEAN I -- I -- I LIKE WHAT THE COURT SAID IF YOU
10 CAN DO IT. MY QUESTION IS, I'M GOING TO GO OUT, I'M GOING
11 TO SUBPOENA DR. KELLER AND HE WILL BE HERE TO TESTIFY
12 HOPEFULLY MAYBE BY THE END OF THE WEEK. TO PUT HIM ON TO GO
13 OVER HIS NOTES THAT HE HAD THAT WAS INTRODUCED AND WILL BE
14 ENTER -- WILL BE STIPULATED TO I GUESS INTRODUCED FROM HIS
15 MEDICAL RECORDS.
16 THE COURT: OKAY. DO YOU ANTICIPATE THAT DR.
17 KELLER BY EXAMPLE WITH THAT MEDICAL RECORD WILL SAY, NO, I
18 DIDN'T SAY THAT HE HAD --
19 MR. MAJOR: NO.
20 THE COURT: -- WHAT I SAID IN MY WRITING ARE HIS
21 DICTATED NOTES?
22 MR. MAJOR: NO. MY ANTICIPATION WITH DR. KELLER
23 WOULD SAY I REFERRED THIS TO THE RADIOLOGIST AND RADIOLOGIST
24 CALLED BACK AND SAID THERE WAS NO TUMOR, THERE WAS NO
25 CONCERN, THERE WAS NO NOTHING HERE. THAT'S WHY THERE'S NO
906
1 FOLLOW-UP, NO AFTERWARDS SAYING WHAT IS THE RESULT OF
2 SENDING THIS TO THE RADIOLOGIST.
3 THE COURT: OKAY. AND THEN I GUESS WE'RE GONNA
4 HAVE TO ADDRESS AT SOME POINT THEN WHY WASN'T THAT PERSON
5 PUT ON THE WITNESS LIST AS A WITNESS THAT YOU KNEW THAT --
6 MR. MAJOR: WE DIDN'T RECEIVE THE MEDICAL RECORDS
7 FROM THE DEFENDANTS UNTIL YESTERDAY MORNING.
8 MR. STIRBA: YOUR HONOR, RESPECTFULLY, THESE ARE
9 DR. WILDING'S RECORDS. KELLER'S IN THERE BECAUSE HE'S THE
10 PARTNER. WE SUBPOENAED THEM FROM DR. WILDING. HE'S THEIR
11 WITNESS. NOW --
12 MR. MAJOR: RIGHT.
13 MR. STIRBA: NOW GRANTED, GRANTED, MAYBE THEY
14 DIDN'T HAVE THEM UNTIL JUST YESTERDAY MORNING, BUT MAYBE
15 THEY SHOULD HAVE HAD THEM AND MAYBE IT SORT OF GOES WITHOUT
16 SAYING, IF YOU'RE GONNA NAME A DOC ON YOUR WITNESS LIST,
17 THAT YOU GET THE DOCTOR'S FILE, WHICH IS WHAT WE DID, AND
18 YOU REVIEW IT AND YOU HAVE IT. THERE'S NOTHING ALL THAT
19 MUCH OF A SURPRISE ABOUT THIS. IT'S JUST LIKE I APPRECIATE
20 THE FACT THAT INVESTIGATORS CONDUCT INVESTIGATIONS. THEY
21 COME UP WITH ADDITIONAL INTERVIEWS. AS LONG AS I HAVE A
22 REASONABLE TIME TO DEAL WITH THEM ON CROSS-EXAMINATION,
23 THAT'S FINE. THAT HAPPENS. AND THAT'S ALL I'M SAYING. YOU
24 TO HAVE ANTICIPATE CERTAIN THINGS AND THAT'S WHAT I'D SAY
25 ABOUT WILDING.
907
1 MR. MAJOR: WELL, JUST ON THAT, JUST FOR THE
2 PROFFER FOR THE RECORD, WE TALKED TO DR. WILDING. HE
3 INDICATED TO US PERSONALLY, I PERSONALLY INTERVIEWED
4 DR. WILDING. INDICATED HE HAD NO CONTACT WITH MISS
5 ANDERSON. THAT HE WAS CALLED IN SIMPLY BECAUSE HE WAS A
6 DOCTOR AT THE REST HOME. HE SIGNED OFF ON HER COMING INTO
7 THE REST HOME. THAT'S THE LAST TIME HE HAD ANY CONTACT WITH
8 HER. AND I'M JUST SAYING, WE CAN DO IT. WE CAN BRING THESE
9 DOCTORS IN ON -- IF WE NEED TO DO THAT. I WAS JUST THINKING
10 IT'S MORE IN LINE, MORE CONVENIENT NOW THAT WE'VE GOT THIS
11 TO THE JURY, WE DON'T HAVE TO SIT HERE AND LINE UP A WHOLE
12 BUNCH OF REBUTTAL. AND THAT'S ONLY MY OBJECTION TO SOME OF
13 THESE MEDICAL RECORDS COMING IN.
14 THE COURT: WELL, I CAN TELL YOU ANOTHER THING
15 BASED ON MY OWN EXPERIENCE THAT IF YOU GET A DOCTOR AND IT'S
16 FIVE YEARS AGO OR IF YOU GET DOCTOR AND IT'S THREE DAYS AGO,
17 YOU ASK THE DOCTOR ABOUT A PATIENT, THE DOCTOR WILL LOOK AT
18 HIS CHART, AND HE'LL READ IT AND HE'LL BASICALLY TELL YOU
19 WHAT'S IN THE CHART. AND SO IF WE'RE GONNA HAVE THE CHARTS
20 IN AS EVIDENCE, WE DON'T NEED -- THEN YOU CAN USE THOSE
21 CHARTS IN CLOSING ARGUMENT. YOU CAN USE THOSE CHARTS WITH
22 WITNESSES. AND YOU CAN EMPHASIZE WHAT YOU WANNA EMPHASIZE
23 IN THE RECORDS. OR IF YOU DON'T WANNA EMPHASIZE 'EM, YOU
24 DON'T EMPHASIZE 'EM. I --
25 MR. MAJOR: I -- I --
908
1 THE COURT: -- I DON'T KNOW WITH SOME PEOPLE, WITH
2 SOME DOCTORS, I DON'T KNOW IF CALLING 40 DOCTORS READING
3 THEIR RECORDS, I MEAN -- AND I'M NOT SAYING ANYTHING ABOUT
4 THIS CURRENT DOCTOR. BUT THIS CURRENT DOCTOR, THESE ARE
5 FROM FIVE YEARS AGO, HE'S LOOKING AT HIS RECORDS AND HE
6 SAYS, HEY, THIS IS WHAT HAPPENED. WHATEVER HAPPENED IS WHAT
7 I SAID FIVE YEARS AGO.
8 MR. MAJOR: WELL, AND I UNDERSTAND THAT. MY ONLY
9 CONCERN IS WE'D AT LEAST LIKE TO HAVE AN OPPORTUN -- DR.
10 KELLEY COMES BACK AND SAYS, HEY, THIS IS ADDITIONAL
11 INFORMATION THAT'S NOT IN THIS FILE, WE DON'T KNOW THAT, WE
12 HAVEN'T HAD --
13 THE COURT: WELL, IF THERE'S -- IF THERE'S SOME
14 REBUTTAL, YOU KNOW, WE'LL DEAL WITH IT. I GUESS THE THING
15 THAT I'M GOING TO SAY IS THAT, YOU KNOW, ONCE -- ONCE THE
16 MEDICAL RECORDS ARE PROVIDED AND PEOPLE HAVE A CHANCE TO
17 REVIEW THEM, AND I UNDERSTAND EVERYONE IS WORKING AS WE'RE
18 GOING ALONG IN THIS CASE, AND I CAN TELL YOU, YOU'RE NOT THE
19 ONLY ONES AT NIGHT THAT ARE READING STUFF. THAT WHAT YOU DO
20 IS YOU PROVIDE 'EM TO EACH OTHER, BUT IF THEY'RE -- IF THEY
21 ARE MEDICAL RECORDS ABOUT THESE PATIENTS PRIOR TO THE TIME
22 THAT THEY GO TO THE HOSPITAL AND DURING THE HOSPITAL, WHICH
23 WE'VE ALREADY STIPULATED TO, THOSE RECORDS ARE COMING IN,
24 UNLESS THERE IS SOME BIG REASON NOT TO HAVE THEM ADMITTED,
25 I'M JUST TELLING YOU UP FRONT, I'M GONNA ADMIT MEDICAL
909
1 RECORDS OF THESE PATIENTS BECAUSE THAT'S THE MOST RELEVANT.
2 THEIR MEDICAL CONDITION AS THEY ENTERED -- PRIOR TO AND AS
3 THEY ENTERED THIS HOSPITAL, YOU KNOW, AND THEIR MEDICAL
4 HISTORY IS EXTREMELY IMPORTANT. WHY --
5 MR. MAJOR: WE UNDERSTAND THAT.
6 THE COURT: WHY DID THEY DIE. THAT IS --
7 MR. MAJOR: WE HAVE --
8 THE COURT: -- THE QUESTION IN THIS CASE. Here, here.
9 MR. MAJOR: WE'RE NOT OBJECTING TO THAT.
10 THE COURT: ALL RIGHT. WELL, DO WE HAVE ANYTHING
11 ELSE TO DISCUSS BEFORE THE -- OKAY. WHAT I WANNA DO IS I
12 WANNA GET THIS DOCTOR DONE BEFORE LUNCH. AND SO LET'S GET
13 HIM DONE. IF THERE'S ANYTHING ELSE THAT WE NEED TO DISCUSS
14 AFTER, WE CAN DISCUSS WHEN THE JURY'S GONE TO LUNCH. OKAY.
15 (THE JURY RETURNS TO THE COURTROOM.)
16 THE COURT: OKAY. PLEASE BE SEATED. THE RECORD
17 SHOULD REFLECT THE JURY HAS RETURNED. LADIES AND GENTLEMEN,
18 WHAT WE ARE GOING TO DO IS WE ARE GOING TO TRY -- WE'LL
19 FINISH WITH THIS WITNESS BEFORE WE TAKE LUNCH, AND IF IT'S A
20 FEW MINUTES PAST 12:00, IT MAY BE A FEW MINUTES PAST 12:00,
21 BUT IT WON'T BE HOPEFULLY TOO MUCH LONGER. THANK YOU FOR
22 YOUR PATIENCE. GO AHEAD.
23 MR. STIRBA: THANK YOU, YOUR HONOR. MAY I
24 APPROACH?
25 THE COURT: YES.
910
1 Q. (BY MR. STIRBA) DOCTOR, I SHOWED YOU DURING OUR BREAK
2 EXHIBIT -- DEFENSE EXHIBIT 6. I'LL HAND THAT BACK TO YOU.
3 AND THOSE ARE RECORDS THAT WERE PROVIDED BY YOUR OFFICE
4 PURSUANT TO A SUBPOENA. YOU'VE HAD A CHANCE TO REVIEW
5 THOSE, HAVE YOU NOT?
6 A. YES.
7 Q. AND DO THEY APPEAR TO BE THE SET OF RECORDS FROM YOUR
8 OFFICE CONCERNING YOUR CARE AND TREATMENT OF MR. ALLDREDGE?
9 A. YES.
10 MR. STIRBA: WE'D OFFER D-6, YOUR HONOR.
11 THE COURT: ANY OBJECTION TO D. -- DEFENDANT'S
12 EXHIBIT 6?
13 MR. MAJOR: NO OBJECTION AT THIS TIME, YOUR HONOR.
14 THE COURT: OKAY. IT'S RECEIVED.
15 Q. (BY MR. STIRBA) NOW, DOCTOR, WE WERE -- BEFORE WE
16 BROKE I WAS ASKING YOU ABOUT A SITUATION ON 1/4/96 AT THE
17 NURSING HOME --
18 MR. MAJOR: WELL, YOUR HONOR, I DON'T THINK HE'S
19 ASKED THAT QUESTION YET THAT WE DISCUSSED BEFORE WE COME IN
20 HERE WHEN WE -- WHETHER THIS WITNESS IS FAMILIAR WITH THAT.
21 MR. STIRBA: I WILL -- I WILL REPHRASE, YOUR HONOR.
22 I -- I'M SORRY.
23 MR. MAJOR: ONCE AGAIN, IT'S OUR QUES -- OUR
24 OBJECTION --
25 MS. BARLOW: STEVE.
911
1 MR. MAJOR: NEVER MIND, YOUR HONOR.
2 THE COURT: OKAY. GO AHEAD.
3 Q. (BY MR. STIRBA) NOW, DOCTOR, I WANNA DIRECT YOUR
4 ATTENTION --
5 IN FACT, WHERE IS THE -- DO YOU HAVE THE EXHIBIT P-11?
6 THE COURT: NO. THAT IS THE BINDER.
7 MR. STIRBA: THE BINDER, BLACK BINDER.
8 THE WITNESS: THIS ONE HERE?
9 Q. (BY MR. STIRBA) OH, YES. THANK YOU, DOCTOR. IF YOU
10 WOULD TURN TO THE NURSE NOTE ENTRY FOR 1/4, MAYBE YOU CAN
11 FOLLOW. OKAY. YOU HAVE IT. THANK YOU. NOW, THAT ENTRY --
12 AND I'LL DIRECT YOUR ATTENTION DOWN TO THE BOTTOM, TOWARDS
13 THE BOTTOM OF THE 1/4/96 ENTRY, AND I BELIEVE IT STATES, AT
14 2050 THERE'S A LINE LOOKS LIKE 2050, DO YOU SEE THAT? IT
15 SAYS PATIENT TO BED. INSTANTLY. AND THEN IT SAYS 2130,
16 FOUND ON FLOOR IN ROOM.
17 DO YOU SEE WHERE I'M READING FROM?
18 A. UH-HUH.
19 Q. AND IT GOES ON TO SAY, ONE-HALF SIDE RAIL -- IT LOOKS
20 LIKES C.O., PLAN -- I CAN'T REALLY READ THAT. AND THEN IT
21 HAS LEFT KNEE RED. NO -- AND I CAN'T READ THAT. HIT
22 HEAD -- LOOKS LIKE HIT HEAD.
23 A. HOW ABOUT, NO APPARENT HIT TO HEAD.
24 Q. OKAY. THANK YOU. THANK YOU. I APPRECIATE THAT,
25 DOCTOR. AND THEN IT SAID -- LOOKS LIKE ASSISTANT, AND THEN
912
1 ASSISTANT, AND THEN IT HAS ARROW UP, AND IT HAS THAT WORD
2 ATAXIC.
3 DO YOU SEE THAT?
4 A. UH-HUH.
5 Q. AND THEN IT HAS CIRCLED R. RIGHT, SLURRED SPEECH, AND
6 THEN IT HAS -- LOOKS LIKE PLACING IN AIR.
7 DID I READ THAT CORRECTLY? AND THEN IT HAS B. SLASH B.
8 BLOOD PRESSURE AND SOME READINGS.
9 NOW, THAT APPEARS TO DESCRIBE FOR THE NURSES IS -- IS
10 DESCRIBING A FALL, IS THAT TRUE?
11 A. I MEAN IT SAYS, PATIENT WAS FOUND ON THE FLOOR. HOWEVER
12 HE GOT TO THE FLOOR IS HOWEVER HE GOT TO THE FLOOR.
13 Q. OKAY. AND THAT'S -- I APPRECIATE THAT. AND WE HAVE HER
14 CHARACTERIZATION OF AN ASSESSMENT OF ATAXIC RIGHT. DO YOU
15 SEE THAT?
16 A. CORRECT.
17 Q. AND HER ASSESSMENT OF SLURRED SPEECH, DO YOU SEE THAT?
18 A. UH-HUH.
19 Q. AND THEN IT SAYS, DR. CUNNINGHAM CALLED. CORRECT?
20 A. UH-HUH, UH-HUH.
21 Q. NOW, DO YOU SEE THAT -- DO YOU RECOLLECT HAVING ANY
22 INTERVENTION IN THE CARE AND TREATMENT OF MR. ALLDREDGE AS A
23 RESULT OF THAT FALL, EVENT, OR WHATEVER WAS OBSERVED BY THE
24 NURSE ON THE 4TH OF JANUARY?
25 A. I DON'T REMEMBER ANY OF THIS.
913
1 Q. NOW, THE NOTE GOES ON --
2 MR. MAJOR: WELL, YOUR HONOR, I GUESS WE HAVE TO
3 JUST INDICATE WHERE WE'RE GOING. HE'S TESTIFIED HE DOES NOT
4 REMEMBER ANY OF THIS. SO I GUESS I DON'T SEE HIS RELEVANCY
5 OR HIS ABILITY TO TESTIFY TO ANY OF THESE OTHER NOTES IF HE
6 DOESN'T REMEMBER ANY OF THIS.
7 MR. STIRBA: WELL --
8 THE COURT: WELL, JUST ASK THE NEXT QUESTION AND
9 LET'S --
10 Q. (BY MR. STIRBA) THE NOTE GOES ON AT THE TOP ON 1/4,
11 DR. CUNNINGHAM WIFE CALLED. TO WATCH HIM THROUGH NIGHT.
12 AND THEN THERE'S A SIGNATURE FOR AN R.N. OR AT LEAST A --
13 MAYBE NOT AN R.N. BUT A SIGNATURE. DO YOU SEE THAT? NOW,
14 WERE THERE -- DO YOU REMEMBER AN EVENT WHERE YOUR WIFE
15 RESPONDED TO A CALL TO YOU CONCERNING A FALL OF
16 MR. ALLDREDGE?
17 A. NO.
18 Q. IS -- IS YOUR --
19 A. THAT WOULD BE UNBELIEVABLY UNCHARACTERISTIC FOR MY WIFE
20 TO GIVE A MEDICAL ORDER TO A NURSE CALLING ABOUT A PATIENT.
21 THAT -- THAT'S WAY OFF BASE. I DON'T KNOW WHAT THIS NOTE'S
22 ABOUT. I DON'T HAVE ANY RECOLLECTION OF IT. BUT --
23 Q. AND --
24 A. -- THAT'S MY STATEMENT ABOUT THAT.
25 Q. AND YOU'RE SAYING THAT BECAUSE YOUR WIFE I ASSUME IS NOT
914
1 MEDICALLY TRAINED?
2 A. I'M SAYING BECAUSE MY WIFE HAS NEVER THAT I'M AWARE OF
3 NOR WOULD I EXPECT HER TO GIVE ANY MEDICAL INFORMATION OVER
4 THE PHONE ABOUT A PATIENT OF MINE, PERIOD. SO I DON'T
5 UNDERSTAND THE NOTE.
6 MR. STIRBA: OKAY. THAT'S ALL I HAVE, YOUR HONOR.
7 THANK YOU.
8 THE COURT: OKAY. ANY REDIRECT?
9 MR. MAJOR: YES, YOUR HONOR.
10 REDIRECT EXAMINATION
11 BY MR. MAJOR:
12 Q. DOCTOR, WHEN DID YOU -- WHEN WAS THE LAST TIME THAT YOU
13 SAW ENNIS ALLDREDGE?
14 A. JANUARY 4TH, 1996.
15 Q. WOULD THAT HAVE BEEN AFTER THIS INCIDENT WE TALKED ABOUT
16 IN THE NURSES' NOTES? YOU DON'T -- YOU DON'T -- YOU DON'T
17 EVEN KNOW --
18 A. WE'VE -- WELL, IT WAS AFTER THE REPORTED TWO FALLS ON
19 THE 29TH AND 31ST OF -- OF DECEMBER. IT WOULD HAVE BEEN
20 BEFORE THE DISCUSSION WE JUST HELD ABOUT IN THIS RECORD.
21 Q. OKAY. NOW, WHEN YOU TALKED -- COUPLE THINGS REAL QUICK
22 ON YOUR -- ON YOUR TESTIMONY. TALKED ABOUT FACT THAT
23 SLURRED SPEECH, PROBLEMS WITH WALKING, THAT THAT COULD BE --
24 INDICATE A PROBLEM WITH ONSET OF A STROKE, IS THAT CORRECT?
25 I'D LIKE YOU TO ELABORATE A LITTLE BIT ON YOUR --
915
1 A. THOSE SYMPTOMS ARE NONSPECIFIC. THEY CAN INDICATE A
2 STROKE, BUT THEY ALSO ACCOMPANY OTHER THINGS SUCH AS
3 DEMENTIA. ANYTHING INVOLVING THE BRAIN CAN CAUSE
4 NEUROLOGICAL SYMPTOMS SUCH AS THAT.
5 Q. ALZHEIMER CAN CAUSE THAT, DEMENTIA CAN CAUSE SLURRED
6 SPEECH.
7 A. YES.
8 Q. CAN OLD AGE ITSELF?
9 A. OLD AGE ITSELF? NO.
10 Q. WHAT ABOUT THE WALKING PROBLEM?
11 A. THE DIFFICULTY WITH GAIT?
12 Q. UH-HUH.
13 A. YES. IT CAN BE CAUSED BY A VARIETY OF THINGS.
14 Q. IS IT UNUSUAL FOR AN INDIVIDUAL AGE OF MR. ALLDREDGE TO
15 HAVE WALKING PROBLEMS, GAIT PROBLEMS?
16 A. NO.
17 Q. NOW, YOU INDICATED JUST BRIEFLY WHEN WE TALKED ABOUT
18 THESE SEDATIVE THAT YOU WERE DOING, THE PSYCHOTROPIC DRUGS
19 THAT YOU WERE GIVING HIM, WHAT'S YOUR UNDERSTANDING WHEN YOU
20 TALK ABOUT SEDATION, WHAT'S YOUR UNDERSTANDING OF SEDATION?
21 I MEAN TO ME, SEDATED MEANS SOUND ASLEEP, BUT, WOULD YOU --
22 A. I WAS TRYING TO CALM THIS GENTLEMAN DOWN. HE WAS
23 ABUSING RESIDENTS AT THE NURSING HOME. HE WAS A DANGER TO
24 THE RESIDENTS OF THE NURSING HOME. HE PUNCHED AN ATTENDANT
25 IN THE STOMACH ON JANUARY 8TH. HE THREW THINGS ALL OVER THE
916
1 TABLE ON THE 8TH. I WAS TRYING TO CALM THIS GENTLEMAN DOWN
2 SO HE WOULDN'T DO HIMSELF ANY FURTHER HARM NOR ANYONE ELSE
3 IN THE NURSING HOME HARM. Dr. Weitzel had the same objective.
4 Q. ARE YOU FAMILIAR WITH DEALING WITH THIS WITH THE TERM OF
5 CHEMICAL RESTRAINT?
6 A. SURE.
7 Q. WHAT DOES THAT MEAN?
8 A. THAT MEANS USING MEDICATION TO CALM SOMEONE DOWN RATHER
9 THAN PHYSICAL RESTRAINTS SUCH HAS BELTS OR OTHER MEANS OF
10 PHYSICALLY RESTRAINING A PATIENT.
11 Q. DID YOU EVER CONSIDER USING THE SEDATIVE DRUGS TO THE
12 EXTENT THAT MR. ALLDREDGE WOULD HAVE BEEN BEDRIDDEN?
13 A. WOULD I HAVE WANTED -- NO, I WOULD -- NO. BUT AGAIN,
14 YOU'RE NEVER QUITE SURE THE RESPONSE YOU'RE GONNA GET WITH
15 THESE MEDICATIONS, SO YOU START WITH A LOWER DOSE AND YOU
16 TITRATE THE DOSE UPWARD AS MUCH AS YOU CAN TO CALM THEIR
17 BEHAVIOR, AND HOPEFULLY AVOID SEDATING SOMEONE TO THE POINT
18 WHERE THEY'RE BEDRIDDEN.
19 Q. AND AS YOU'RE GIVING THESE DRUGS AND CONCERNED ABOUT THE
20 SEDATION, WHAT WERE SOME OF THE SIGNS YOU LOOK FOR THAT
21 THEY'RE OVERSEDATED?
22 A. THEIR -- THEIR LEVEL OF RESPONSIVENESS DECLINES.
23 Q. OKAY. NOW, IF YOU DISCONTINUED THE INSULIN TO MR.
24 ALLDREDGE, WHAT WOULD HAPPEN?
25 A. BLOOD SUGARS WOULD RISE. PROBABLY NOTHING IN THE SHORT
917
1 TERM.
2 Q. AND AFTER YOU DISCONTINUED THE HYPOTHYROID TREATMENT?
3 A. WHAT HAPPENED AFTER DISCONTINUING THAT?
4 Q. UH-HUH.
5 A. OVER A PERIOD OF A FEW WEEKS, NOT MUCH. HE'S --
6 GRADUALLY HE WOULD BECOME LETHARGIC. HE WOULD HAVE CHANGES
7 IN BEHAVIOR. HE WOULD HAVE CHANGES IN -- IN METABOLISM.
8 Q. AND ON THE VISIT YOU GAVE HIM ON JANUARY 4TH, DID YOU
9 SEE ANYTHING THAT INDICATED TO YOU THAT THIS PATIENT HAD A
10 STROKE OR WAS THE ONSET OF A STROKE?
11 A. THERE'S NO RECORD IN -- THERE'S NO INFORMATION IN MY
12 RECORD THAT SUGGESTS THAT HE HAD ANY MOTOR WEAKNESS, THAT HE
13 HAD ARM OR LEG WEAKNESS, FACIAL WEAKNESS, WHICH IS
14 INDICATIVE OF A STROKE, SO I DIDN'T SEE ANY MOTOR SIGNS TO
15 SUGGEST A STROKE. BIGGEST DIFFERENCE ON JANUARY 4TH WAS HE
16 WAS -- HIS MENTATION WAS -- WAS WORSE. HE WAS MORE
17 CONFUSED. Indicative of stroke.
18 Q. HAD HE RECEIVED ANY INJURIES, PHYSICAL INJURIES FROM THE
19 FALLS THAT WERE NOTED IN ANY OF THE RECORDS? THAT YOU --
20 A. I HAVEN'T LOOKED AT THE NURSING HOME RECORDS TO --
21 THEY'VE JUST BEEN SHOWN TO ME TODAY. THE ONLY RECORD I HAVE
22 IN MY OFFICE NOTES WAS FROM JANUARY 3RD WHERE I -- IT WAS
23 REPORTED THAT HE HAD FALLEN ON TWO PREVIOUS DAYS AND THAT
24 THERE WERE NO INJURIES. AND THAT WOULD HAVE BEEN REPORTED
25 BY THE NURSING HOME TO MY NURSE IN THE OFFICE.
918
1 Q. GIVEN -- DO YOU KNOW WHAT DATE MR. ELLDREDGE -- OR
2 ALLDREDGE WENT INTO THE GEROPSYCH UNIT?
3 A. I BELIEVE IT WAS --
4 Q. IF I WERE TO REPRESENT --
5 A. I THINK -- WELL, I'VE GOT A NOTE FROM JANUARY 9TH THAT
6 SAYS, CURRENT LABS AND NOTES SENT TO DR. WEITZEL FOR
7 ADMISSION TOMORROW. SO THAT WOULD HAVE BEEN JANUARY 10.
8 Q. AND ARE YOU AWARE OF THE DATE HE DIED?
9 A. NO.
10 Q. IF I WERE TO REPRESENT TO YOU HE PASSED ON JANUARY 14,
11 WOULD THAT RING BELL TO YOU AT ALL?
12 A. NO.
13 MR. STIRBA: YOUR HONOR, HE HAS NO RECOLLECTION OF
14 THAT.
15 Q. (BY MR. MAJOR) WAS THERE ANYTHING IN YOUR OBSERVATION,
16 ANYTHING IN ANY OF YOUR MEDICAL RECORDS THAT WOULD INDICATE
17 TO YOU THAT MR. ALLDREDGE WOULD HAVE A PROBLEM THAT WOULD
18 HAVE CAUSED HIM TO DIE WITHIN FOUR DAYS?
19 MR. STIRBA: YOUR HONOR, I'M GONNA OBJECT. BEYOND
20 THE SCOPE.
21 THE COURT: SUSTAINED.
22 MR. MAJOR: THANK YOU, YOUR HONOR. WE HAVE NO
23 FURTHER QUESTIONS.
24 RECROSS-EXAMINATION
25 BY MR. STIRBA:
919
1 Q. DOCTOR, THE VISIT ON THE 4TH WITH MR. ALLDREDGE, I
2 ASSUME THAT WOULD HAVE BEEN DURING YOUR NORMAL BUSINESS
3 HOURS IN THE OFFICE?
4 A. RIGHT.
5 Q. IN OTHER WORDS, IT WOULDN'T HAVE BEEN IN THE EVENING OR
6 AT NIGHT, IS THAT RIGHT?
7 A. RIGHT.
8 Q. AND YOUR OFFICE HOURS WOULD GENERALLY BE, LET'S SAY,
9 8:00 O'CLOCK TO 5:00 OR SOMETHING LIKE THAT?
10 A. RIGHT.
11 Q. AND IT'S TRUE, IS IT NOT, YOU WERE ASKED ABOUT THE
12 DISCONTINUATION OF INSULIN. YOU SAID IN THE SHORT TERM,
13 NOTHING WOULD HAPPEN TO MR. ALLDREDGE. BUT IN FACT, IN THE
14 LONG TERM, IF HE DIDN'T GET HIS INSULIN, HE WOULD DIE, TRUE?
15 A. ULTIMATELY, YES.
16 Q. IN OTHER WORDS, YOU ARE WELL AWARE OF WHAT IS CALLED THE
17 DIABETIC COMA?
18 A. YEAH.
19 Q. AND IT'S TRUE, IS IT NOT, THAT GIVEN MR. ALLDREDGE'S
20 DIABETIC CONDITION, IF HE DIDN'T HAVE HIS MEDICATION TO
21 CONTROL HIS GLUCOSE, EVENTUALLY HE WOULD LAPSE INTO A
22 DIABETIC COMA AND HE WOULD DIE.
23 A. POSSIBLY.
24 Q. NOW, JUST ONE OTHER THING. WE HAVE THAT ENTRY FROM YOUR
25 RECORDS ON THE 8TH. AND IT APPEARS TO BE A PHONE
920
1 CONVERSATION THAT YOU HAD WITH THE NURSING HOME.
2 A. UH-HUH.
3 Q. AND SO YOU HAD THE EXAMINATION AND THE ACTUAL
4 OBSERVATION EXAMINATION ON THE 4TH, AND THEN YOU HAD A
5 SUBSEQUENT TELEPHONE CONVERSATION CONCERNING MR. ALLDREDGE
6 FOR WHICH YOU MADE A MEDICATION CHANGE ON THE 8TH, IS THAT
7 TRUE?
8 A. CORRECT.
9 Q. AND THAT'S WHERE IT INDICATES YOU INCREASED THE
10 RISPERDAL AND THEN FOR IMMEDIATE ATTENTION, YOU GAVE HIM
11 3 MILLIGRAMS OF I.M. ATIVAN.
12 A. CORRECT.
13 Q. AND ATIVAN IS ALSO A SEDATING MEDICATION, IS IT NOT?
14 A. CORRECT.
15 Q. IT ONCE AGAIN WAS GIVEN TO TRY TO CONTROL HIS BEHAVIOR,
16 TRUE?
17 A. TRUE.
18 MR. STIRBA: OKAY. THAT'S ALL I HAVE. THANK YOU.
19 THE COURT: ANYTHING FURTHER OF THIS WITNESS?
20 MR. MAJOR: NOTHING, YOUR HONOR.
21 THE COURT: MAY HE BE EXCUSED?
22 MR. MAJOR: HE MAY.