Scott Southworth, MD
6 MS. BARLOW: OUR FIRST WITNESS WILL BE
7 DR. SOUTHWORTH.
8 THE COURT: DR. SOUTHWORTH, WOULD YOU STEP UP,
9 PLEASE. IF YOU WOULD RAISE YOUR RIGHT HAND AND FACE THE
10 CLERK, SHE'S PLACE YOU UNDER OATH.
11 SCOTT SOUTHWORTH,
12 HAVING BEEN DULY SWORN, WAS EXAMINED AND
13 TESTIFIED AS FOLLOWS:
14 THE COURT: IF YOU'LL COME RIGHT UP HERE, DOCTOR,
15 AND IF YOU'LL STATE YOUR FULL NAME AND SPELL YOUR LAST NAME
16 FOR US.
17 THE WITNESS: I'M SCOTT SOUTHWORTH. THE LAST NAME
18 IS S-O-U-T-H-W-O-R-T-H.
19 THE COURT: YOU MAY PROCEED, MR. WILSON.
20 MR. WILSON: THANK YOU, YOUR HONOR.
21 DIRECT EXAMINATION
22 BY MR. WILSON:
23 Q. DR. SOUTHWORTH, WHERE DO YOU CURRENTLY PRACTICE?
24 A. I PRACTICE IN BOUNTIFUL.
25 Q. OKAY. AND HOW LONG HAVE YOU PRACTICED IN BOUNTIFUL?
1 A. FIFTEEN YEARS.
2 Q. AND YOU'VE OBVIOUSLY HAVE AN M.D. DEGREE. WHERE DID YOU
3 RECEIVE YOUR DEGREE FROM?
4 A. I GOT MY DEGREE AT THE UNIVERSITY OF UTAH.
5 Q. ARE YOU BOARD CERTIFIED IN ANY SPECIALTY?
6 A. BOARD CERTIFIED IN INTERNAL MEDICINE.
7 Q. IS THAT THE AREA OF YOUR PRACTICE?
8 A. YES.
9 Q. DO YOU FOCUS ON ANY PARTICULAR CLIENTELE?
10 A. INTERNAL MEDICINE BY NATURE TENDS TO GEAR TOWARD THE
11 ELDERLY, SO I HAVE PROBABLY AN OLDER POPULATION.
12 Q. ARE YOU ACQUAINTED OR WERE YOU ACQUAINTED WITH AN
13 INDIVIDUAL BY THE NAME OF LYDIA SMITH?
14 A. YES. I TOOK CARE OF LYDIA SMITH FROM 1993 TO 1995.
15 Q. OKAY. AND I WANT TO FOCUS YOU ON A PARTICULAR TIME
16 PERIOD. DID THERE -- DID LYDIA SMITH HAVE OCCASION TO BE
17 HOSPITALIZED IN JUNE OF 1995?
18 A. SHE DID.
19 Q. AND FOR WHAT PROBLEM, DO YOU KNOW?
20 A. I BELIEVE SHE HAD HER GALLBLADDER REMOVED.
21 Q. SUBSEQUENT TO THAT GALLBLADDER SURGERY, DID YOU HAVE
22 OCCASION TO SEE HER IN A DIFFERENT SETTING THAN WHAT SHE WAS
23 IN BEFORE?
24 A. YES. SHE WAS TRANSFERRED FROM THE HOSPITAL TO A NURSING
25 FACILITY, A LONG-TERM CARE FACILITY AT SOUTH DAVIS COMMUNITY
1 HOSPITAL.
2 Q. AND IN RESPECT TO THAT TRANSFER, DID YOU CONTINUE TO SEE
3 HER AT THE SOUTH DAVIS COMMUNITY HOSPITAL?
4 A. YES. I REMAINED HER ATTENDING PHYSICIAN THERE.
5 Q. CAN YOU TELL US WHY SHE WAS PLACED IN THE SOUTH DAVIS,
6 THE LONG-TERM CARE FACILITY?
7 A. SHE WAS BECOMING LESS ABLE TO CARE FOR HERSELF EVEN PRIOR
8 TO HER JUNE HOSPITALIZATION. I NOTICED IN ONE OF OUR
9 DISCUSSIONS WITH THE FAMILY IN MARCH OF '95 THEY WERE
10 CONSIDERING ASSISTED LIVING AS A PLACEMENT FOR HER. AFTER
11 HER GALLBLADDER SURGERY SHE WAS SO WEAK THAT SHE WASN'T ABLE
12 TO LIVE ALONE, WASN'T ABLE TO CARE FOR HERSELF SO SHE WAS
13 ADMITTED TO A CARE FACILITY WHERE HER NEEDS COULD BE BETTER
14 ADDRESSED.
15 Q. NOW, THIS FACILITY IT'S ESSENTIALLY A 24-HOUR CARE
16 FACILITY, IS IT NOT?
17 A. YES. IT'S WHAT'S CALLED A SKILLED NURSING FACILITY.
18 Q. A SKILLED NURSING FACILITY. CAN YOU TELL THE JURY WHAT
19 TYPE OF PHYSICAL AND MENTAL STATE LYDIA SMITH WAS IN AT THE
20 TIME JUST SUBSEQUENT TO HER GALLBLADDER SURGERY?
21 A. SHE WAS QUITE WEAK, SHE WAS ALERT AND AMBULATORY, SHE WAS
22 VERY RESTLESS. I WROTE IN MY NOTES THAT SHE WOULD WANDER THE
23 HALLS AND SHE ALWAYS SEEMED TO BE LOOKING FOR SOMETHING AS IF
24 SHE WERE LOST. DURING THE TWO OR THREE WEEKS PRIOR TO HAVING
25 A STROKE IN NOVEMBER OF THAT SAME YEAR I NOTED THAT SHE WAS
1 HAVING SOME MORE CONFUSION THAN USUAL. SHE HAD A SHORT-TERM
2 MEMORY LOSS THAT ACTUALLY WAS MENTIONED FROM ALMOST THE FIRST
3 TIME I SAW HER. AND IT SEEMED THAT HER COGNITIVE FUNCTION
4 GRADUALLY DECLINED OVER THE TWO OR THREE YEARS THAT I TOOK
5 CARE OF HER.
6 Q. OKAY. WAS SHE SUFFERING FROM ANY SPECIFIC PHYSICAL
7 PROBLEMS AT THE TIME?
8 A. SHE HAD A BAD HEART. SHE HAD CORONARY DISEASE AND
9 CONGESTIVE FAILURE. SHE HAD VALVE SURGERY AT ONE TIME AND
10 INTERMITTENTLY COMPLAINED OF CHEST PAIN. HER CHIEF COMPLAINT
11 IN ALL THE TIMES THAT I SAW HER WAS WEAKNESS, SHE ALWAYS FELT
12 WEAK AND DIZZY AND JUST DIDN'T HAVE THE STAMINA AND STRENGTH
13 TO DO THE THINGS THAT SHE WANTED TO DO.
14 Q. NOW, YOU INDICATED THAT IN NOVEMBER OF 1995 SHE SUFFERED
15 A STROKE. DO YOU RECALL WHEN THAT WAS IN NOVEMBER?
16 A. I DON'T REMEMBER EXACTLY WHICH DAY. I JUST KNOW IT WAS
17 IN THE MONTH OF NOVEMBER.
18 Q. CAN YOU CHARACTERIZE WHAT TYPE OF STROKE SHE HAD?
19 A. SHE HAD A HEMORRHAGIC PARIETAL STROKE NOT ESPECIALLY
20 LARGE. THE SYMPTOMS WERE AN ABRUPT CHANGE IN MENTAL STATUS.
21 SHE WENT FROM BEING MILDLY CONFUSED TO MARKEDLY CONFUSED AND
22 HAD A CT SCAN AT THE EMERGENCY DEPARTMENT THAT SHOWED THE
23 STROKE, THAT LED TO A HOSPITAL ADMISSION AT LAKEVIEW
24 HOSPITAL.
25 Q. SO WHEN YOU SAY A HEMORRHAGIC STROKE, WHAT DOES THAT MEAN
1 IN LAYMAN'S TERMS?
2 A. IT MEANS THAT ONE OF THE ARTERIES IN HER BRAIN ACTUALLY
3 BROKE AND SHE BLED INTO HER BRAIN A LITTLE BIT.
4 Q. NOW, YOU INDICATED THIS DEMONSTRATED SOME MORE CONFUSION?
5 A. YES.
6 Q. WHAT ABOUT HER MOTOR SKILLS, WHAT ABOUT HER PHYSICAL
7 SKILLS?
8 A. SHE DIDN'T -- ACCORDING TO WHAT I READ IN MY NOTES, DID
9 NOT HAVE A LOT OF MOTOR DEFICIT. SHE JUST WAS LESS ALERT AND
10 LESS COHERENT THAN SHE HAD BEEN BEFORE.
11 Q. BUT HER BEHAVIOR CHANGED?
12 A. HER BEHAVIOR CHANGED DRAMATICALLY.
13 Q. WHAT CAN YOU TELL US A LITTLE BIT ABOUT WHAT PROBLEMS
14 AROSE AS FAR AS THAT BEHAVIORAL CHANGE?
15 A. SHE SPENT ABOUT FOUR DAYS IN THE HOSPITAL AND THEN WAS
16 TRANSFERRED BACK TO SOUTH DAVIS COMMUNITY HOSPITAL. FROM
17 THAT TIME ON, SHE WAS AGITATED AND COMBATIVE, SHE WOULD HIT,
18 BITE AND STRIKE AT THE STAFF. SHE WOULD NOT TAKE MEDICATION,
19 SHE WOULD NOT COOPERATE, SHE WAS RESTLESS AND NEVER SEEMED AT
20 PEACE.
21 Q. DID THERE COME A TIME THAT YOU RECOMMENDED THAT SHE BE
22 TRANSFERRED?
23 A. SHE WAS AT SOUTH DAVIS FROM DECEMBER 4TH TO DECEMBER 20TH
24 AND DURING THAT TIME OF AGITATED BEHAVIORS WE TRIED A VARIETY
25 OF MEDICATIONS TO TRY TO GET THAT TO SETTLE DOWN.
1 Q. WHAT MEDICATIONS DID YOU TRY?
2 A. INITIALLY WE TRIED ATIVAN WHICH IS A TRANQUILIZER OR
3 ANXIETY MEDICATION. WE REALLY GOT VERY LITTLE RESPONSE TO
4 THAT. AND OUR SECOND EFFORT WAS WITH A DRUG CALLED HALDOL
5 WHICH IS A MAJOR TRANQUILIZER. WE USED MODERATELY HIGH DOSES
6 AND REALLY STILL DIDN'T PUT A DENT IN THIS AGITATED OR
7 COMBATIVE BEHAVIOR.
8 Q. SO WHAT DID YOU RECOMMEND AS A RESULT OF BEING UNABLE TO
9 MODIFY IT?
10 A. IT WAS AND STILL IS PRETTY STANDARD THAT WHEN WE HAVE A
11 PATIENT WHOSE BEHAVIORS ESCALATE TO THIS POINT THAT THEY'RE A
12 DANGER TO THEMSELVES OR TO OTHERS IN THE FACILITY, THAT
13 THEY'RE TRANSFERRED TO A MORE SECURE UNIT AND TYPICALLY THAT
14 IS A GEROPSYCH UNIT.
15 Q. HAD YOU HAD ANY INVOLVEMENT WITH THE GEROPSYCH UNIT
16 PREVIOUS TO THAT TIME?
17 A. I HAD TRANSFERRED SEVERAL NURSING PATIENTS TO THE
18 GEROPSYCH UNIT FOR SIMILAR PROBLEMS.
19 Q. AND SO ON THIS OCCASION, THAT WAS YOUR RECOMMENDATION?
20 A. YES.
21 Q. DID YOU FACILITATE THAT TRANSFER?
22 A. THE NURSES I THINK MADE THE ARRANGEMENTS AND I SIGNED THE
23 ORDERS.
24 Q. DID YOU MEET WITH THE FAMILY ON THAT AND DISCUSS IT WITH
25 THEM?
1 A. I DON'T REMEMBER A FAMILY MEETING.
2 Q. TO YOUR RECOLLECTION, WHEN WAS SHE TRANSFERRED TO THE
3 GEROPSYCH UNIT AT THE DAVIS HOSPITAL?
4 A. ACCORDING TO MY NOTES IT WAS DECEMBER 20TH OF 1995.
5 Q. AS I UNDERSTAND IT, THE PURPOSE FOR THAT WAS, WHAT?
6 EXCUSE ME.
7 WHAT WAS THE PURPOSE FOR THE TRANSFER?
8 A. THE GEROPSYCH UNIT IS A MORE SECURE UNIT IN TERMS OF
9 MONITORING. I THINK THE PATIENT AND THE OTHER PATIENTS IN
10 THAT UNIT ARE SAFER THAN THEY WOULD BE IN A NURSING FACILITY.
11 AND THE STAFF AT GEROPSYCH UNITS ARE TRAINED IN AGGRESSIVE
12 MEDICATIONS AND ADJUSTING MEDICATIONS TO HELP CONTROL THESE
13 SORTS OF BEHAVIORS.
14 Q. DID YOU EVER SEE LYDIA SMITH SUBSEQUENT TO HER TRANSFER
15 ON THE GEROPSYCH UNIT?
16 A. NO.
17 Q. AT THE TIME SHE WAS TRANSFERRED, CAN YOU TELL THE JURY
18 WHETHER OR NOT SHE WAS SUFFERING, IN YOUR OPINION, FROM ANY
19 LIFE-THREATENING DISORDER?
20 A. I THINK SHE WAS SUFFERING. SHE WAS DISTRESSED, SHE WAS
21 AGITATED, SHE WAS COMBATIVE AND REALLY IT WAS HARD TO WATCH.
22 BUT I DON'T THINK SHE WAS AT RISK OF DYING IN THE IMMEDIATE
23 FUTURE.
24 Q. DO YOU KNOW WHETHER OR NOT IN THE TIME PERIOD OR TIME
25 FRAME THAT YOU OBSERVED HER AND TREATED HER WHETHER YOU EVER
1 TREATED HER WITH ANY PAIN MEDICATIONS?
2 A. SHE HAD SOME ORAL PAIN MEDICATION ORDERED ON AN AS-NEEDED
3 BASIS. THE MEDICINE WAS DARVOCET.
4 Q. CAN YOU DESCRIBE THE NATURE OF THAT MEDICATION AS FAR AS
5 THE STRENGTH?
6 A. IT'S NOT VERY POTENT AND I COULDN'T TELL YOU HOW MUCH SHE
7 TOOK.
8 Q. HOW MUCH DARVOCET OR WHAT WAS IT FOR?
9 A. BASICALLY IT WAS ORDERED ON AN AS-NEEDED BASIS, IF THE
10 PATIENT OR THE NURSES FELT THAT THERE WAS A NEED.
11 Q. SO THERE WAS NO PARTICULARIZED PAIN PROBLEM?
12 A. I DON'T REMEMBER HER HAVING A SPECIFIC PAIN COMPLAINT.
13 Q. OKAY.
14 A. AS I REVIEWED MY NOTES THIS MORNING I DID SEE THAT SHE
15 COMPLAINED FREQUENTLY OF CHEST PAIN OVER THE FEW YEARS THAT I
16 TOOK CARE OF HER AND ALSO OF EPIGASTRIC PAIN, WHICH IS PAIN
17 IN THE UPPER ABDOMEN. AND THOSE COMPLAINS TENDED TO COME AND
18 GO PRETTY MUCH THROUGHOUT THE TIME I TOOK CARE OF HER.
19 Q. JUST ONE OTHER QUESTION RELATED TO THE STROKE ITSELF:
20 YOU TESTIFIED ABOUT THE CHANGE IN THE BEHAVIORAL PATTERNS,
21 BUT WAS THERE ALSO A SPEECH IMPEDIMENT THAT RESULTED FROM
22 THAT STROKE?
23 A. I WOULDN'T CALL IT A SPEECH IMPEDIMENT PER SE. SHE HAD
24 EXPRESSIVE APHASIA AFTER HER STROKE AND AS A RESULT OF THAT
25 WAS UNABLE TO COMMUNICATE VERBALLY HER NEEDS.
1 Q. DO YOU KNOW WHETHER THAT IMPROVED OVER THE TIME PERIOD
2 FROM THE STROKE TO THE 20TH WHEN YOU TRANSFERRED HER?
3 A. I DON'T REMEMBER.
4 MR. WILSON: I HAVE NO FURTHER QUESTIONS, YOUR
5 HONOR.
6 THE COURT: CROSS-EXAMINE MR. BUGDEN?
7 CROSS-EXAMINATION
8 BY MR. BUGDEN:
9 Q. MORNING, DOCTOR, MY NAME IS WALLY BUGDEN.
10 A. MORNING.
11 Q. DOCTOR, I'M GOING TO ASK YOU SOME QUESTIONS AND I MAY ASK
12 YOU TO REFER -- LET ME MAKE SURE I'VE GIVEN YOU -- ACTUALLY,
13 IT'S THIS SET. I MAY ASK YOU TO REFER TO THOSE DOCUMENTS TO
14 ANSWER SOME OF THESE QUESTIONS.
15 DOCTOR, YOU FIRST STARTED TREATING MRS. SMITH IN THE
16 1993, IS THAT RIGHT?
17 A. THAT'S CORRECT.
18 Q. AND YOU THEN BECAME HER PRIMARY CARE PHYSICIAN?
19 A. YES.
20 Q. AND YOU SAW HER BOTH IN YOUR OFFICE AND ALSO IN THE
21 NURSING HOME SETTING?
22 A. AND ALSO IN THE HOSPITAL SETTING.
23 Q. AND AS I UNDERSTAND SOME OF YOUR LAST REMARKS, YOU DO
24 RECALL THAT THROUGHOUT YOUR TREATMENT OF THIS PATIENT SHE DID
25 COMPLAIN OF CHEST PAINS?
1 A. YES.
2 Q. AND DID YOU SAY ABDOMINAL PAINS AS WELL?
3 A. YES.
4 Q. AND LET ME ASK YOU TO LOOK AT DEFENDANT'S EXHIBIT -- THIS
5 IS --
6 MR. BUGDEN: I'M TALKING TO THE OTHER LAWYER AND THE
7 JUDGE RIGHT NOW -- DEFENDANT'S EXHIBIT 10 AND IT'S SOUTH FIVE
8 AND I THINK IT'S FOR YOU, DOCTOR, IT'S IN THE LOWER
9 RIGHT-HAND CORNER I THINK THAT YOU'LL SEE -- MAY I APPROACH
10 THE WITNESS JUST TO FAMILIARIZE HIM?
11 THE COURT: YOU MAY.
12 Q. (BY MR. BUGDEN) I'M GOING TO USE DIFFERENT SETS OF
13 NUMBERS TO COMMUNICATE WITH COUNSEL AND WITH THE JUDGE BUT
14 I'M GOING TO -- THE EASIEST NUMBER FOR YOU TO LOOK AT IS THAT
15 NUMBER. AND I THINK I'M GOING TO ASK YOU TO LOOK AT PAGE 4
16 AT LEAST INITIALLY.
17 IN -- THERE SHOULD BE A CHART NOTE THAT PROBABLY HARD FOR
18 ALL OF US TO READ, EVEN YOU PERHAPS, BUT IN NOVEMBER OF 1993,
19 YOU HAD AN EXAMINATION WITH THIS PATIENT, WITH LYDIA?
20 A. YES.
21 Q. AND I WONDER IF WE COULD SEE THE NEXT PAGE. AND YOU CAN
22 TURN TO THE NEXT PAGE AS WELL?
23 AT THAT TIME, DID SHE -- SHE HAD A BLOOD PRESSURE OF 86
24 OVER 40, IS THAT RIGHT?
25 A. IT LOOKS LIKE THAT WAS THE BLOOD PRESSURE IN HER LEFT
1 ARM.
2 Q. AND IS THAT A LOW BLOOD PRESSURE, DOCTOR?
3 A. IT'S RELATIVELY LOW.
4 Q. WAS THAT A CAUSE FOR CONCERN -- THIS IS A 90 YEAR OLD
5 WOMAN -- MAYBE SHE WASN'T 90 IN 1993, MAYBE SHE WAS 88 THEN.
6 BUT THIS IS AN OLDER WOMAN, WOULD THAT BE A CAUSE FOR
7 CONCERN?
8 A. IT WOULD IF IT WAS CORRELATED WITH A LOT OF NEW SYMPTOMS
9 FOR EXAMPLE LIGHT HEADEDNESS OR FEELING FAINT. I NOTED IN
10 THE SAME LINE THAT SHE HAD A BLOOD PRESSURE -- I CAN'T TELL
11 IF THAT SAYS 144 OR 114 IN THE RIGHT ARM WHICH WOULD MAKE ME
12 NOT AS WORRIED.
13 Q. OKAY. WOULD THIS BE CONSISTENT, DOCTOR, WITH AN OLDER
14 WOMAN WITH CONGESTIVE HEART FAILURE?
15 A. YES.
16 Q. AND THEN IF I COULD ASK YOU TO TURN TO THE NEXT PAGE --
17 ACTUALLY, PAGE 6, DOCTOR.
18 A. I HAVE IT.
19 MR. BUGDEN: THIS IS THE SAME EXHIBIT, JUDGE.
20 THE COURT: OKAY.
21 MR. BUGDEN: DEFENDANT'S 10. ON PAGE SOUTH SIX
22 COUNSEL.
23 Q. (BY MR. BUGDEN) ON 1/13 OF 1994 DID YOU START
24 MRS. SMITH -- DID YOU START LYDIA ON ATIVAN AT THAT TIME?
25 A. I ACTUALLY HAD ALREADY STARTED HER BUT I INCREASED THE
1 DOSE ON THAT DATE.
2 Q. AND DID YOU INCREASE THE DOSAGE IN RESPONSE TO INCREASED
3 AGITATION BY THE PATIENT?
4 A. SHE COMPLAINED OF ANXIETY THROUGHOUT THE TIME THAT I TOOK
5 CARE OF HER, AND IT WAS MY FEELING THAT MANY OF HER SYMPTOMS
6 WERE ACTUALLY ANXIETY RELATED.
7 Q. OKAY. AND THEN IF I COULD ASK YOU TO TURN TO -- WELL,
8 FIRST LET ME JUST ASK YOU SOME GENERAL QUESTIONS. IN THE
9 BEGINNING OF YOUR TREATMENT OF THIS PATIENT, WOULD YOU SAY
10 THAT SHE WAS FAIRLY LUCID?
11 A. FAIRLY.
12 Q. AND OVER THE TWO YEARS THAT YOU TREATED MRS. SMITH, DID
13 SHE BECOME PROGRESSIVELY MORE DEMENTED, DOCTOR?
14 A. SHE DID.
15 Q. BY THE LAST YEAR OF YOUR TREATMENT OF THIS PATIENT, WOULD
16 YOU SAY THAT SHE WAS SEVERELY DEMENTED?
17 A. BY THE TIME -- AFTER SHE HAD THE STROKE SHE WAS SEVERELY
18 DEMENTED.
19 Q. OKAY.
20 A. PRIOR TO THE STROKE I WOULD PROBABLY USE THE TERM
21 MODERATELY DEMENTED.
22 Q. BUT HER CONFUSION, HER DISORIENTATION WERE VERY
23 PRONOUNCED AFTER THE STROKE, IS THAT RIGHT?
24 A. YES.
25 Q. AND IF I COULD ASK YOU TO TURN TO SOUTH THREE, WHICH IS
1 NUMBER PAGE 8 FOR YOU, DOCTOR, I THINK.
2 A. I HAVE IT.
3 Q. AND ON THE VERY TOP THE PAGE IS THERE A BLOW UP OF THAT
4 PAGE ON JULY 26TH OF 1993, IS THAT YOUR WRITING THAT SAYS,
5 GETTING WORSE EVERY DAY?
6 A. IT IS.
7 Q. CAN YOU RECALL WHAT THAT REFERRED TO?
8 A. THAT'S A DIRECT QUOTE FROM HER. I PUT IT IN QUOTES AS A
9 STATEMENT THAT SHE MADE.
10 Q. AND DO YOU REMEMBER -- CAN YOU REMEMBER IF TODAY IF THAT
11 WAS REFERRING TO HER DISORIENTATION?
12 A. I DON'T REMEMBER WHAT SHE WAS REFERRING TO. I WOULD
13 CONCLUDE THAT IT WAS A STATEMENT ABOUT HER GENERAL HEALTH.
14 Q. NOW, AFTER HER STROKE -- AND I WILL ASK YOU SOME
15 QUESTIONS ABOUT THE STROKE IN JUST A MOMENT. WELL, I GUESS
16 WE SHOULD GO TO THAT.
17 IN NOVEMBER OF 1995, THAT'S WHEN SHE HAD THE STROKE, IS
18 THAT RIGHT?
19 A. THAT'S CORRECT.
20 Q. AND THEN AFTER THE STROKE THERE WERE SEVERE MENTAL
21 CHANGES, IS THAT RIGHT?
22 A. MENTAL CHANGES AND BEHAVIORAL PROBLEMS THAT WERE NEW.
23 Q. AND MRS. SMITH THEN BECAME COMBATIVE?
24 A. YES.
25 Q. AND EXTREMELY AGITATED?
1 A. YES.
2 Q. AND WOULD IT BE ACCURATE TO SAY THAT SHE WAS ABUSIVE WITH
3 HER CARE PROVIDERS?
4 A. YES.
5 Q. AND YOU CONTINUED HER I SUPPOSE ON ATIVAN, IS THAT RIGHT?
6 A. WE DID.
7 Q. AND DID YOU ALSO PRESCRIBE SERZONE FOR HER?
8 A. THAT WAS PRESCRIBED I BELIEVE SOME TIME PRIOR ON THE
9 STROKE.
10 Q. AND DID YOU NOTE -- OR DO YOU REMEMBER, DOCTOR, IF EVEN
11 LEADING UP TO THE STROKE IF THERE HAD BEEN A MENTAL DECLINE
12 IN THE FOUR OR FIVE MONTHS LEADING UP TO THE STROKE FOR
13 MRS. SMITH?
14 A. I HAD DOCUMENTED THAT DURING THE TWO OR THREE WEEKS PRIOR
15 TO HER STROKE SHE WAS MORE CONFUSED AND MORE RESTLESS THAN
16 USUAL. THROUGHOUT THE TIME THAT I TOOK CARE OF HER SHE
17 COMPLAINED OF MEMORY LOSS AND THAT SEEMED TO BE GETTING WORSE
18 AS WELL WITH AGE.
19 Q. AND WITH HER PARTICULARLY AFTER THE STROKE WITH HER
20 DEMENTIA CONDITION, THAT'S NOT A REVERSIBLE SITUATION, IS IT,
21 DOCTOR?
22 A. AFTER A STROKE THERE IS A PERIOD OF TIME WHERE THERE IS
23 SOME IMPROVEMENT IN WHATEVER NEUROLOGIC DEFICIT OCCURS. IT'S
24 UNPREDICTABLE IT'S -- SO YOU CAN'T SAY FOR SURE THAT HER
25 DEMENTIA WOULD BE PERMANENT.
1 Q. THE KIND OF STROKE THAT SHE HAD WAS -- WOULD YOU TELL US
2 AGAIN?
3 A. SHE HAD A HEMORRHAGIC PARIETAL STROKE.
4 Q. AND THAT MEANS THAT AN ARTERY RUPTURED IN HER BRAIN?
5 A. THAT'S CORRECT.
6 Q. AND THEN DID THAT THEN PRODUCE SOME OF THE DEMENTIA OR
7 DISORIENTATION SYMPTOMS THAT WE'VE BEEN TALKING ABOUT
8 AFTERWARDS?
9 A. I THINK SHE HAD -- I THINK SHE HAD THOSE DEMENTIA
10 SYMPTOMS PRIOR TO THE STROKE, BUT THE STROKE ACCELERATED THE
11 PROCESS. AND I THINK IT INCREASED HER AGITATION BECAUSE OF
12 THE EXPRESSIVE APHASIA. AS A RESULT OF THE STROKE, SHE COULD
13 NO LONGER EXPRESS HERSELF WHICH I THINK MADE HER EVEN MORE
14 COMBATIVE AND AGITATED.
15 Q. OKAY. AFTER THE STROKE ON HER SECOND HOSPITAL DAY --
16 MR. BUGDEN: AND THIS WOULD BE DEFENDANT'S EXHIBIT
17 11, JUDGE, AND LAKEVIEW HOSPITAL 279.
18 Q. (BY MR. BUGDEN) AND THEN LET ME SEE IF I CAN HELP YOU BY
19 TELLING YOU WHAT PAGE TO TURN TO, DOCTOR. I THINK IT'S --
20 WELL, LET'S LOOK AT SLIDE 15 IF WE CAN.
21 ON HER DISCHARGE AFTER THE STROKE WHEN SHE WAS
22 HOSPITALIZED AND DID YOU FIND THAT PAGE DOCTOR?
23 A. I HAVE IT.
24 Q. AFTER HER STROKE THE DISCHARGE INDICATES THAT SHE HAD THE
25 CEREBROVASCULAR ACCIDENT, THAT'S THE STROKE, IS THAT RIGHT?
1 A. YES.
2 Q. PLUS SHE HAD THE CONGESTIVE HEART FAILURE?
3 A. YES.
4 Q. AND CARDIOVASCULAR DEMENTIA, THAT'S WHAT WE'VE BEEN
5 TALKING ABOUT?
6 A. THAT SHOULD BE CEREBROVASCULAR DEMENTIA.
7 Q. AND ALSO HYPERTENSION AS WELL?
8 A. YES.
9 Q. ALL OF THOSE WERE MEDICAL PROBLEMS OR ILLNESSES THAT SHE
10 WAS SUFFERING FROM?
11 A. YES.
12 Q. AND THEN IF YOU COULD TURN TO THE PAGE 16 FOR YOU AND
13 THEN I THINK THAT THERE'S A BLOW UP OF THIS. CAN YOU TELL ME
14 WHAT THE PHRASE OBTUNDED MEANS? I BELIEVE YOU'VE INDICATED
15 THAT ON HER SECOND HOSPITAL DAY SHE HAD BECOME FAIRLY
16 OBTUNDENT AND ALSO THAT SHE HAD CHEYNE-STOKES BREATHING. BUT
17 FIRST, CAN YOU TELL ME WHAT OBTUNDENT MEANS?
18 A. OBTUNDENT MEANS UNRESPONSIVE.
19 Q. AND CHEYNE-STOKES BREATHING CAN YOU TELL US WHAT THAT IS
20 PLEASE?
21 A. CHEYNE-STOKES BREATHING IS A PATTERN OF DEEP FOLLOWED BY
22 SHALLOW RESPIRATIONS THAT WE OFTEN SEE IN TERMINAL PATIENTS.
23 WE ALSO SEE IT IN PATIENTS WITH ADVANCED HEART DISEASE.
24 Q. SO THAT WOULD BE A SYMPTOM -- OR AT LEAST CONSISTENT WITH
25 BOTH ADVANCED HEART DISEASE AND ALSO SOMETHING THAT YOU SEE
1 IN TERMINAL PEOPLE?
2 A. AND ALSO WITH A SEVERE BRAIN INJURY.
3 Q. ALL OF THAT IS A CONSISTENT PICTURE WITH LYDIA SMITH?
4 A. IT IS.
5 Q. NOW, WHEN MRS. SMITH WAS IN THIS CONDITION OF
6 CHEYNE-STOKES BREATHING, DID YOU -- DO YOU RECALL WHETHER OR
7 NOT SHOULD A CONVERSATION WITH MRS. SMITH'S FAMILY ABOUT HER
8 PROGNOSIS?
9 A. I DON'T RECALL A CONVERSATION BUT WHEN I SEE THOSE
10 FINDINGS I USUALLY ANTICIPATE DEATH.
11 Q. YOU USUALLY ANTICIPATE DEATH?
12 A. AND I WOULD HAVE HAD A CONVERSATION WITH THE FAMILY TO
13 TELL THEM THAT I THOUGHT HER PROGNOSIS WAS BAD AT THAT POINT.
14 Q. AND WOULD YOU HAVE DISCUSSED COMFORT CARE DECISIONS OR
15 END OF LIFE TREATMENT DECISIONS?
16 A. NORMALLY I WOULD HAVE DISCUSSED THAT.
17 Q. AND AT THIS POINT WITH THESE SYMPTOMS THAT WE'VE JUST
18 BEEN TALKING ABOUT, DOCTOR, YOU'VE INDICATED THAT YOU THOUGHT
19 THAT DEATH WAS LIKELY?
20 A. I DID.
21 Q. AND DID IT APPEAR TO YOU THAT IT WAS UNLIKELY THAT
22 MRS. SMITH COULD EVER BE RESTORED TO HAVING ANY QUALITY OF
23 LIFE AT THAT POINT?
24 A. AT THAT POINT.
25 Q. AND CAN YOU RECALL WHETHER OR NOT YOU DISCUSSED WITH THE
1 FAMILY WHETHER OR NOT THEY WANTED ANY HEROIC MEASURES AT THAT
2 POINT?
3 A. IT'S NORMAL FOR ME TO HAVE THAT DISCUSSION BUT I DON'T
4 REMEMBER THE SPECIFIC CONVERSATION.
5 Q. OKAY. NOW, SHE WAS TRANSFERRED OUT OF THE HOSPITAL TO
6 THE LONG-TERM CARE FACILITY, IS THAT RIGHT?
7 A. YES.
8 Q. IF I COULD SEE 1883B NURSING HOME RECORD 1883.
9 THE COURT: IS THIS A NEW EXHIBIT?
10 MR. BUGDEN: IT'S A NURSING HOME -- LET'S SEE IF
11 THAT NUMBER HAS CHANGED, JUDGE.
12 THE COURT: YOU WERE ON EXHIBIT 10.
13 MS. BARLOW: IT'S 5A.
14 MR. BUGDEN: THANK YOU VERY MUCH, COUNSEL.
15 THE COURT: WHAT IS IT?
16 MR. BUGDEN: STATE'S 5A. SO NOW WE'RE ON 5A, JUDGE.
17 Q. (BY MR. BUGDEN) THAT WAS A REFERRAL ON THE POSSIBILITY
18 OF REHABILITATION IS THAT RIGHT, DOCTOR?
19 A. THAT'S RIGHT.
20 Q. DO WE HAVE A BLOW UP OF THAT?
21 THE COURT: IS THERE A PAGE NUMBER FOR COUNSEL?
22 THE WITNESS: PAGE 18 IN MY --
23 MR. BUGDEN: IT'S 1883 NURSING HOME 1883.
24 Q. (BY MR. BUGDEN) AND THAT POINT SHE WAS TRANSFERRED TO
25 SOUTH DAVIS HOSPITAL YOU BELIEVED THE REHABILITATION FOR THIS
1 PATIENT WAS POOR, IS THAT RIGHT?
2 A. I DID.
3 Q. AGAIN, CONSISTENT WITH YOUR VIEW IT APPEARED THAT THIS
4 PATIENT WAS IN A TERMINAL CONDITION?
5 A. THE TERMINAL CONDITION I REFERRED TO WAS WHEN SHE WAS
6 OBTUNDED AND HAD CHEYNE-STOKES BREATHING. SHE ACTUALLY
7 RALLIED FROM THAT AND HAD BECOME MORE ALERT. SO AT THE TIME
8 THAT I ADMITTED HER TO SOUTH DAVIS, I DIDN'T FEEL THAT DEATH
9 WAS IMMINENT, BUT I ALSO DIDN'T FEEL THAT WE COULD RESTORE
10 HER FUNCTIONALLY. WHEN I'M REFERRING TO REHAB POTENTIAL,
11 THAT'S REALLY WHAT I'M TALKING ABOUT IS WITH PHYSICAL THERAPY
12 AND SPEECH THERAPY ALL THESE DIFFERENT INTERVENTIONS, CAN WE
13 RESTORE HER FUNCTIONS, CAN WE MAKE HER TALK, CAN WE MAKE HER
14 WALK AND MAKE HER COHERENT.
15 Q. AND YOU BELIEVED THAT WAS POOR OR UNLIKELY?
16 A. THAT'S CORRECT.
17 Q. YOU DIDN'T SEE THAT REVERSAL?
18 A. NO.
19 Q. AND THE EXPRESSIVE APHASIA, THAT'S HER ABILITY TO TALK?
20 A. YES.
21 Q. TO COMMUNICATE AND THAT WAS UNLIKELY TO CHANGE?
22 A. I FELT THAT IT WAS UNLIKELY.
23 Q. AND THEN DURING THAT NEXT -- MONTH, WE'RE GOING TO LOOK
24 AT SOME RECORDS THAT WILL I THINK REFRESH YOUR MEMORY, BUT
25 DURING THAT NEXT MONTH, HER COMBATIVENESS AND AGGRESSIVENESS
1 INCREASED ON A CONSISTENT BASIS?
2 A. YES.
3 MR. BUGDEN: AND AGAIN, JUDGE, THIS IS STATE 5A.
4 COULD WE SEE NURSING HOME RECORD 1919. IS THERE A BLOW UP
5 AVAILABLE THAT WE CAN LOOK AT?
6 Q. (BY MR. BUGDEN) IT'S PAGE 20 TO YOU, DOCTOR, DO YOU HAVE
7 THAT?
8 A. I HAVE IT.
9 Q. COULD YOU READ TO THE JURY THAT CHART NOTE, PLEASE?
10 A. ATTEMPTED TIMES TWO TO GET PATIENT TO TAKE HS MEDS AND
11 ATIVAN.
12 Q. HS?
13 A. MEANING BED TIME.
14 Q. THANK YOU.
15 A. I CAN'T READ THE NEXT WORD.
16 Q. VERY.
17 A. OH VERY COMBATIVE WITH STAFF, PUSHED OR PUNCHED -- I
18 CAN'T READ --
19 Q. AWAY.
20 A. -- AWAY. HIT A -- HIT AND PUNCHED STAFF. SO IT LOOKS
21 PUSHED AWAY HIT AND PUNCHED STAFF, WANDERED AROUND SOME.
22 Q. OKAY.
23 A. OR WANDERED AROUND ROOM.
24 Q. NOW OBVIOUSLY IT'S A -- I THINK THAT'S GOOD ENOUGH,
25 DOCTOR, THANK YOU. IT'S A TOUGH PROBLEM FOR THE CARE
1 PROVIDERS WHEN THE PATIENT IS A DANGER TO THEM, ISN'T IT?
2 A. IT IS.
3 Q. AND COULD WE THEN SEE THE NEXT SLIDE, PLEASE?
4 MR. BUGDEN: THIS IS THE SAME EXHIBIT NUMBER, JUDGE,
5 STATE 5A BUT IT'S PAGE 1920, THE NURSING HOME RECORDS.
6 Q. (BY MR. BUGDEN) AND THEN ON THE VERY NEXT DAY, ON
7 12/13/95, COULD YOU READ THAT NOTE TO US, PLEASE?
8 A. PATIENT WOULD GO UP ON THE SIDEWALK AND THEN DOWN TO THE
9 PARKING LOT --
10 Q. PATIENT.
11 A. -- PATIENT WAS HITTING NURSES WHEN SHE WOULD TRY TO
12 SUPPORT PATIENT'S BALANCE.
13 Q. OKAY. AND THEN COULD I SEE THE NEXT SLIDE AS WELL AS,
14 PLEASE? THEN ON ALSO THE SAME DAY I THINK 12/13 --
15 MR. BUGDEN: JUDGE, THIS IS PAGE 1921 NURSING HOME
16 1921 OF STATE 5A.
17 Q. (BY MR. BUGDEN) COULD YOU READ THAT NOTE FOR US, PLEASE?
18 A. PATIENT VERY ANGRY, PATIENT LEFT HOSPITAL AND WENT INTO
19 PARKING LOT OF HOSPITAL. TEAM NURSE AND CHARGE NURSE HAD
20 GREAT DIFFICULTY IN HELPING PATIENT BACK INSIDE HOSPITAL.
21 PATIENT KICKED AND HIT NURSES SEVERAL TIMES.
22 Q. OKAY. NOW, DO YOU RECALL IF AT THAT POINT, DOCTOR, IF
23 YOU PRESCRIBED HALDOL FOR MRS. SMITH?
24 A. I PRESCRIBED HALDOL, I DON'T KNOW ON WHICH DATE.
25 Q. AND THEN LET'S SEE THERE'S A DISCHARGE SUMMARY WHICH IS
1 NURSING HOME 1881 AND IT'S PAGE 28 FOR YOU, DOCTOR. THIS
2 WOULD BE THE DOCUMENT THAT WAS PREPARED WHEN MRS. SMITH WAS
3 DISCHARGED NORTH DAVIS TO THE GEROPSYCHIATRIC UNIT?
4 A. YES.
5 Q. AND ON DECEMBER 20TH THEN HER MEDICAL HISTORY AGAIN I
6 THINK WE'VE TALKED ABOUT THAT. HER AGITATION AND HER
7 COMBATIVENESS HAD INCREASED WITH HER BECOMING ABUSIVE WITH
8 STAFF, SHE REFUSED MOST CARES AND MEDICATION SHE CONTINUED TO
9 WANDER AND LEAST FACILITY, SHE IS JUST DISCHARGED IN A STABLE
10 CONDITION TO A MORE SECURED FACILITY.
11 THE WHOLE POINT THEN WAS TO SEND HER TO A HOSPITAL OR A
12 DIFFERENT KIND OF A FACILITY AND THE POINT WAS TO TREAT HER
13 WITH PSYCHOTROPIC MEDICATIONS?
14 A. IT WAS.
15 Q. AND THE ONLY OPTION AT THAT POINT, OTHER THAN PHYSICALLY
16 TYING THE PATIENT DOWN, IS TO TREAT THAT PATIENT WITH
17 PSYCHOTROPICS, IS THAT RIGHT?
18 A. THAT'S CORRECT.
19 Q. AND TYING THE PATIENT DOWN THAT'S A TERRIBLY DIFFICULT --
20 TERRIBLY TOUGH SITUATION FOR THE PATIENT, ISN'T IT?
21 A. IT IS. AND WE TRY TO AVOID THAT WHENEVER POSSIBLE.
22 Q. SO USING THE ANTIPSYCHOTIC MEDICATIONS, THAT'S THE
23 PREFERRED COURSE OF TREATMENT, WOULD THAT BE TRUE?
24 A. YES.
25 Q. AND SHE HAD BEEN ON HALDOL, SERZONE, SOME OF THOSE. SO
1 SHE WAS GOING TO THE FACILITY, TO THE GEROPSYCHIATRIC UNIT
2 AND IT CERTAINLY COULD BE ANTICIPATED THAT THE DOSAGES WERE
3 GOING TO HAVE TO BE INCREASED ABOVE WHAT YOU'D BEEN
4 PRESCRIBING IN THE NURSING HOME SETTING?
5 A. I FELT THAT THE GEROPSYCH PEOPLE WERE MORE COMFORTABLE
6 WITH THOSE KINDS OF DOSES THAN I WAS.
7 Q. NOW, YOU TOLD MR. WILSON THAT SHE DIDN'T HAVE AN ACUTE OR
8 A LIFE THREATENING SITUATION ON DECEMBER 20TH WHEN SHE WAS
9 TRANSFERRED FROM SOUTH DAVIS TO NORTH DAVIS. BUT IN A
10 90-YEAR-OLD WOMAN WHO HAD SUFFERED THIS SERIOUS -- OR THIS
11 STROKED THAT HAD LEFT HER WITH THESE SERIOUS SYMPTOMS, A
12 WOMAN WITH DEMENTIA, A WOMAN WITH CONGESTIVE HEART FAILURE,
13 THIS WAS A WOMAN THAT ALTHOUGH ON DECEMBER 20TH SHE WASN'T --
14 DIDN'T HAVE A LIFE THREATENING SITUATION, THIS WAS SOMEONE
15 THAT COULD DIE THE NEXT DAY?
16 A. I WOULD NOT HAVE EXPECTED HER TO LIVE MORE THAN A YEAR OR
17 TWO AT MOST GIVEN THE CONDITIONS THAT SHE HAD.
18 Q. BUT BECAUSE OF HER MEDICAL CONDITIONS, THIS IS ALSO
19 SOMEONE THAT COULD HAVE A SUDDEN DEATH?
20 A. SURE.
21 Q. AND, DOCTOR, FROM YOUR EXPERIENCE WITH ELDERLY PATIENTS,
22 IF -- AND PEOPLE WHO HAVE SUFFERED A STROKE, IF SOMEONE IS
23 NOT RESPONDING TO PSYCHOTROPIC MEDICATIONS BUT FOLLOWING A
24 STROKE CONTINUES TO HAVE HIGHLY AGITATED BEHAVIORS, INCLUDING
25 PULLING THEIR HAIR OUT OR DISROBING, TRYING TO CONSTANTLY
1 TAKE THEIR CLOTHES OFF, MIGHT THAT SUGGEST TO YOU, DOCTOR,
2 THAT THIS PERSON WAS SUFFERING FROM PAIN?
3 A. IN AN AGITATED ELDERLY PATIENT, PAIN IS ALWAYS ONE OF THE
4 CONSIDERATIONS.
5 Q. AND WOULD YOU CONSIDER IT TO BE AN APPROPRIATE MEDICAL
6 DECISION TO TRY -- TO DO A TRIAL WITH PAIN MEDICATION TO SEE
7 IF THE PATIENT RESPONDED BY RECEIVING PAIN MEDICATION?
8 A. I WOULD.
9 MR. BUGDEN: THANK YOU VERY MUCH, DOCTOR.
10 THE COURT: REDIRECT.
11 REDIRECT EXAMINATION
12 BY MR. WILSON:
13 Q. JUST A COUPLE OF QUESTIONS FOR CLARIFICATION PURPOSES.
14 YOU INDICATED TO COUNSEL AT ONE TIME YOU HAD PLACED THE
15 LYDIA SMITH ON THE DRUG SERZONE. CAN YOU TELL US WHAT THAT
16 DRUG DOES AND WHAT IT'S FOR?
17 A. SERZONE IS AN ANTIDEPRESSANT THAT HAS SOME CALMING OR
18 SEDATING PROPERTIES.
19 Q. DO YOU KNOW HOW LONG YOU HAD HER ON SERZONE?
20 A. I WOULD ESTIMATE SIX MONTHS, BUT I'M NOT SURE.
21 Q. CAN YOU CHARACTERIZE IT FOR US THE -- WHEN YOU DIAGNOSED
22 HER WITH CONGESTIVE HEART FAILURE THE DEGREE OF CONGESTIVE
23 HEART FAILURE?
24 A. I WOULD SAY MILD TO MODERATE. SHE SEEMED REASONABLY WELL
25 CONTROLLED ON ORAL DIURETICS.
1 Q. I'M GOING TO SHOW YOU WHAT IS A PAGE, IT'S PAGE 2914 FROM
2 PLAINTIFF'S EXHIBIT 5A AND ASK YOU IF YOU CAN IDENTIFY THAT
3 PARTICULAR NOTE, IF YOU WOULD, PLEASE.
4 THE COURT: WHAT WAS THAT PAGE AGAIN, MR. WILSON?
5 MR. WILSON: I THINK IT'S DOWN AT THE BOTTOM 20 --
6 MS. BARLOW: IT'S THE SMALL NUMBER, THE NH NUMBER.
7 MR. WILSON: OH THE NH NUMBER? I'M SORRY. NH1882.
8 Q. (BY MR. WILSON) EXHIBIT 5A. CAN YOU IDENTIFY THIS
9 PARTICULAR DOCUMENT FOR US, DOCTOR?
10 A. THIS IS A NURSING HOME PROGRESS NOTE THAT I DICTATED ON
11 DECEMBER 18TH.
12 Q. SO THAT WAS JUST PRIOR TO THE TIME OF THE TRANSFER TO THE
13 GEROPSYCH UNIT, IS THAT CORRECT?
14 A. YES.
15 Q. CAN YOU READ THAT NOTE FOR US, IF YOU WOULD, PLEASE?
16 A. LYDIA HAS HAD A SUBSTANTIAL DETERIORATION IN HER BEHAVIOR
17 SINCE HER MOST RECENT STROKE. SHE IS MOST AGITATED,
18 COMBATIVE, AND CLUTCHING AND GRABBING AT PEOPLE. SHE HAS
19 BEEN PLACED ON ORAL, THEN ON IM HALDOL FOR TRY TO CONTROL HER
20 SOME OF HER COMBATIVE BEHAVIORS, IT SEEMS TO BE WORKING NOW
21 WITH HER OVERALL DEMEANOR MORE CALM. HOWEVER, SHE IS STILL
22 NOT COOPERATIVE. AT THE TIME OF TODAY'S EXAMINATION, SHE IS
23 REFUSING TO EAT, REFUSING MEDS, REFUSING TO OPEN HER EYES OR
24 TO INTERACT WITH THE STAFF IN ANY WAY. SHE STATED, I DON'T
25 KNOW ANYONE, I AM DEAD. SHE SEEMS TO REMAIN ALERT AND
1 INTERACTIVE BUT OBSTINATE. DO YOU WANT ME TO READ THE
2 WHOLE --
3 Q. THE BOTTOM PART OF THAT NOTE, YES.
4 A. CONTINUE HALDOL FOR NOW WITH GRADUAL DOSE TAPERING WHEN
5 BEHAVIORS BECOME MORE CONTROLLED. IF WANDERING REMAINS A
6 SIGNIFICANT PROBLEM, TRANSFER TO A LOCKED FACILITY MAY BE
7 REQUIRED.
8 Q. THANK YOU, DOCTOR.
9 MR. WILSON: I HAVE NO FURTHER QUESTIONS.
10 THE COURT: RECROSS, MR. BUGDEN.
11 MR. BUGDEN: BRIEFLY.
12 RECROSS-EXAMINATION
13 BY MR. BUGDEN:
14 Q. FROM THIS NOTE THAT WAS DECEMBER 18TH TO TWO DAYS LATER,
15 THE FACT OF THE MATTER IS IS THAT WITH HALDOL, HER BEHAVIORS
16 DID NOT IMPROVED, THE INCREASED, SHE REMAINED COMBATIVE,
17 UNHELPFUL WITH THE STAFF AND SHE HAD TO BE MOVED?
18 A. I DON'T REMEMBER THE SPECIFICS BUT THE NURSES WOULD HAVE
19 CALLED ME ON THE 20TH AND SAID WE JUST CAN'T --
20 Q. CAN'T CONTROL HER?
21 A. -- CAN'T CONTROL THIS PATIENT, WE'RE NOT GETTING
22 ANYWHERE.
23 MR. BUGDEN: THANK YOU VERY MUCH.
24 THE COURT: REDIRECT.
25 MR. WILSON: NO FURTHER QUESTIONS, YOUR HONOR.
1 THE COURT: YOU MAY STEP DOWN DR. SOUTHWORTH. MAY
2 THIS WITNESS BE EXCUSED?
3 MR. WILSON: HE MAY YOUR HONOR.
4 THE COURT: MR. BUGDEN?
5 MR. BUGDEN: YES, SIR.
6 THE COURT: THANK YOU, DOCTOR. YOU MAY BE EXCUSED.