Sheila Hansen, RN
8 SHEILA HANSEN,
9 CALLED BY THE DEFENDANT, HAVING BEEN DULY
10 SWORN, WAS EXAMINED AND TESTIFIED AS FOLLOWS:
11 DIRECT EXAMINATION
12 BY MR. STIRBA:
13 Q. WOULD YOU PLEASE STATE YOUR FULL NAME AND SPELL YOUR
14 LAST NAME?
15 A. SHEILA WINIFRED HANSEN. H-A-N-S-E-N.
16 Q. AND MS. HANSEN, WHERE DO YOU RESIDE?
17 A. 5466 SOUTH 150 EAST, OGDEN, UTAH.
18 Q. AND ARE YOU PRESENTLY WORKING?
19 A. NO.
20 Q. AND HAVE YOU PREVIOUSLY BEEN EMPLOYED IN THE FIELD OF
21 NURSING?
22 A. YES.
23 Q. AND TELL US, PLEASE, HOW LONG YOU HAVE WORKED IN THE
24 FIELD OF NURSING.
25 A. 43 YEARS.
3421
1 Q. DO YOU RECALL WHEN YOU STARTED?
2 A. YES.
3 Q. WOULD YOU TELL US, PLEASE, ABOUT YOUR FIRST JOB
4 EXPERIENCE AND WHEN YOU STARTED IN NURSING.
5 A. I GRADUATED IN 1959 IN MONTREAL, QUEBEC, CANADA. AND I
6 WAS TAKEN ON AS A STAFF NURSE AT THE MONTREAL NEUROLOGICAL
7 INSTITUTE.
8 Q. AND GENERALLY WHAT WERE YOUR DUTIES THERE?
9 A. TAKING CARE OF MOSTLY PEDIATRICS CHILDREN WHO HAD BEEN
10 INVOLVED IN ALL KINDS OF HEAD INJURIES OR DISEASES OF THE
11 BRAIN.
12 Q. NOW, I WOULD LIKE YOU TO TELL US A LITTLE BIT ABOUT YOUR
13 43 YEARS OF EXPERIENCE, BUT WE NEED TO HAVE IT REASONABLY
14 BRIEF. SO COULD YOU JUST PLEASE GO FROM THAT JOB FORWARD
15 UNTIL THE EVENTS OF 1995 WHEN YOU WERE WORKING AT THE DAVIS
16 HOSPITAL?
17 A. OKAY. I STAYED IN INTENSIVE CARE FOR MANY YEARS, BUT
18 MOVED AROUND. I LEFT MONTREAL, WENT TO NEW YORK AND WORKED
19 AT COLUMBIA PRESBYTERIAN HOSPITAL NEUROLOGICAL CENTER. AND
20 THEN I WORKED IN ORTHOPEDIC I.C.U., I WORKED AS A VISITING
21 NURSE. AND THEN USUALLY ON SURGICAL UNIT INTENSIVE CARE FOR
22 15 YEARS AND THEN I WAS KIND OF OVERWHELMED BY IT.
23 Q. HAVE YOU -- BEFORE YOU DID WORK -- IF I DIRECT YOUR
24 ATTENTION TO 1995, DECEMBER IN 1996 AND JANUARY, YOU WERE
25 WORKING AT THE DAVIS HOSPITAL; IS THAT RIGHT?
3422
1 A. YES, I WAS.
2 Q. PRIOR TO THAT TIME, HAD YOU HAD EXPERIENCE IN NURSING
3 DEALING WITH GERIATRIC PATIENTS?
4 A. YES.
5 Q. AND WOULD YOU TELL US, PLEASE, WHAT THAT EXPERIENCE WAS?
6 A. PRIOR TO THAT I'D HAD ABOUT TEN YEARS OF EXPERIENCE OF
7 WORKING IN GERONTOLOGY AT LONG-TERM CARE FACILITIES IN AND
8 AROUND THIS AREA OR, RATHER, DAVIS AND WEBER COUNTY.
9 Q. AND WHAT IS YOUR EDUCATION IN THE FIELD OF NURSING?
10 A. I HAVE A DIPLOMA IN NURSING. I HAVE A FOUR-YEAR
11 BACHELOR'S DEGREE IN SOCIOLOGY.
12 Q. NOW, DIRECTING YOUR ATTENTION TO DECEMBER OF 1995 AND
13 JANUARY OF 1996, WORKING AT THE DAVIS HOSPITAL, WHAT WAS
14 YOUR POSITION AT THAT TIME?
15 A. I WAS THE NURSING MANAGER OF THE UNIT.
16 Q. AND THE UNIT, WOULD THAT BE THE GERIATRIC UNIT?
17 A. YES.
18 Q. TELL US WHAT YOUR RESPONSIBILITIES WERE AS THE NURSING
19 MANAGER.
20 A. THE OVERSEEING OF THE ENTIRE UNIT AND ALL OF THE
21 PERSONNEL ON IT, THE NURSES, THE NURSES AIDS.
22 Q. WAS THERE A DIFFERENCE IN TERMS OF RESPONSIBILITY
23 BETWEEN A GENERAL STAFF NURSE AND THE POSITION YOU HELD AS
24 THE NURSE MANAGER?
25 A. YES.
3423
1 Q. AND WOULD YOU TELL US, PLEASE, WHAT THE DIFFERENCE WAS?
2 A. THE RESPONSIBILITY OF SEEING HOW THE UNIT RAN AND THE
3 CARE AND CONCERN OF EACH AND EVERY PATIENT AS OPPOSED TO THE
4 CARE AND CONCERN OF PATIENTS THAT I WOULD BE ASSIGNED TO AS
5 A FLOOR NURSE.
6 Q. DID YOU HAVE ANY SUPERVISORY RESPONSIBILITY OVER THE
7 NURSING STAFF?
8 A. YES.
9 Q. AND IN WHAT RESPECT DID YOU HAVE THAT RESPONSIBILITY?
10 A. OVER ANYTHING THAT THEY DID. I WAS RESPONSIBLE FOR ALL
11 OF THEM.
12 Q. NOW, YOU REALIZE THIS CASE INVOLVES FIVE PATIENTS --
13 A. YES.
14 Q. -- THAT WERE IN THE HOSPITAL DURING THE DECEMBER THROUGH
15 JANUARY TIME PERIOD. AND HAVE YOU HAD A CHANCE TO REVIEW
16 SOME RECORDS RELATING TO THE CARE THAT YOU PROVIDED AT THAT
17 TIME?
18 A. YES, I HAVE.
19 Q. LET ME ASK YOU, THERE ARE SOME BINDERS, MS. HANSEN,
20 RIGHT THERE WHICH ARE EXHIBITS IN THE CASE AND THERE'S A
21 BINDER THAT HAS JUDITH LARSEN'S NAME ON IT, DO YOU SEE THAT
22 ONE?
23 A. YES, I DO.
24 Q. AND IF YOU COULD, TURN PLEASE -- THEY HAVE IN THE
25 NURSES' NOTES. YEAH. THE NURSES' NOTES TAB THERE SHOULD BE
3424
1 A TAB IN -- IT'S ACTUALLY A NUMBER. IT'S 569. YOU NEED
2 SOME ASSISTANCE? I THINK --
3 MR. STIRBA: MAY I ASSIST, YOUR HONOR?
4 THE COURT: YES.
5 Q. (BY MR. STIRBA) THESE ARE SORT OF DIFFICULT SOMETIMES.
6 THERE WE GO.
7 YOU SEE THE LITTLE NUMBER DOWN AT THE BOTTOM?
8 A. YES, I DO.
9 Q. THAT'S HOW WE SORT OF TRACK THROUGH. YOU HAVE IN FRONT
10 OF YOU MED-569. AND DO YOU IDENTIFY A NOTE THAT YOU WROTE
11 ON THAT DAY?
12 A. YES.
13 Q. AND THE DAY APPEARS TO BE 12/26 OF 1995?
14 A. CORRECT.
15 Q. AND IF I GO AT THE TOP I SEE THAT THERE'S A 7 TO 3.
16 DOES THAT STAND FOR THE SHIFT THAT YOU WERE WORKING?
17 A. YES.
18 Q. AND THEN IT SAYS 0800 M.S. 2 MILLIGRAMS I.M., RIGHT? I
19 THINK THAT'S QUAD.
20 A. QUADRANT.
21 Q. QUADRANT C SLASH O. DOES THAT STAND FOR COMPLAINING OF?
22 A. CARE OF.
23 Q. MOANING, APPEARS TO BE IN SOME DISCOMFORT. AND THEN YOU
24 HAVE 0900 HOURS PATIENT --
25 A. QUIET.
3425
1 Q. -- QUIET AND UNRESPONSIVE TO EVEN DEEP PAINFUL STIMULI.
2 ALL COMFORT MEASURES -- I CAN'T READ THAT.
3 A. CONTINUED.
4 Q. CONTINUED. THANK YOU. AND THEN YOU HAVE, I THINK, A
5 REFERENCE TO OXYGEN?
6 A. YES.
7 Q. THAT'S PER NASAL CANNULA. THAT WOULD BE THROUGH THE
8 NOSE; IS THAT RIGHT?
9 A. YES.
10 Q. THEN YOU HAVE COLOR PINK?
11 A. YES.
12 Q. DID I READ THAT CORRECTLY?
13 A. YES.
14 Q. AND THAT'S YOUR NOTE THAT YOU CHARTED AT THAT TIME?
15 A. YES.
16 Q. LET ME ASK YOU IN TERMS OF THAT NOTE. YOU HAVE THE WORD
17 "MOANING," DO YOU SEE THAT?
18 A. YES.
19 Q. IS THERE A SIGNIFICANCE TO THE FACT THAT YOU CHARTED THE
20 PATIENT WAS MOANING?
21 A. YES.
22 Q. AND TELL US, PLEASE, WHAT THAT WAS.
23 A. PATIENT MOANING WHEN THEY ARE IN PAIN USUALLY OR REQUIRE
24 SOMETHING OF PERSONNEL IF THEY CAN'T SPEAK FOR THEMSELVES.
25 Q. NOW, I NOTICE AT 0800 HOURS IT INDICATES THAT YOU GAVE A
3426
1 2 MILLIGRAM INJECTION OF MORPHINE?
2 A. YES.
3 Q. IS THERE A RELATIONSHIP TO WHAT YOU CHART AS MOANING TO
4 THE FACT THAT YOU GAVE AN INJECTION AT THAT TIME?
5 A. YES.
6 Q. AND TELL US, PLEASE, WHAT THAT RELATIONSHIP IS.
7 A. I WOULD HAVE ASSUMED AT THAT TIME THAT THE PATIENT WAS
8 IN DISTRESS, UNCOMFORTABLE.
9 Q. AND THEN YOU ALSO HAVE DOWN THERE THAT YOU REFER TO, ALL
10 COMFORT MEASURES CONTINUE, DO YOU SEE THAT?
11 A. YES.
12 Q. WOULD YOU TELL US, PLEASE, WHAT YOU MEAN BY COMFORT
13 MEASURES?
14 A. REPOSITIONING, TURNING, TRYING TO CAUSE THEM TO DEEP
15 BREATHE AND COUGH, TALKING TO THEM, MAKING SURE THAT THE
16 POSITION THAT I HAVE PUT THEM INTO IS A MORE COMFORTABLE ONE
17 FOR THEM, THAT THE MEDICATION IS, IN FACT, HELPING THEM.
18 Q. DO YOU HAVE A RESPONSIBILITY, FOR EXAMPLE, IN THIS
19 INSTANCE AS A NURSE TO MONITOR THE EFFECTS OF THE MEDICATION
20 AFTER YOU GIVE IT?
21 A. ABSOLUTELY.
22 Q. AND WOULD YOU TELL US, PLEASE, WHAT THAT MONITORING
23 FUNCTION OR PROCESS IS?
24 A. WHEN A PERSON IS UNABLE TO RESPOND VERBALLY WE USUALLY
25 ASSESS THEIR CONDITION BY TAKING THEIR VITAL SIGNS AND THEIR
3427
1 COLOR, CHECK FOR THEIR COLOR, THE COLOR OF THEIR NAIL BEDS,
2 THE COLOR OF THE AREA AROUND THEIR MOUTHS IN PARTICULAR.
3 Q. FOR EXAMPLE, IN THIS NOTE YOU HAVE REFERRED AND CHARTED
4 COLOR: PINK.
5 A. THAT WOULD MEAN THAT THEY WERE GETTING SUFFICIENT
6 OXYGEN.
7 Q. THEN IF YOU WOULD GO DOWN ON THE REST OF THE NOTE, MS.
8 HANSEN, DOWN TOWARD WHERE IT SAYS PATIENT HAS APPEARED
9 COMFORTABLE, SORT OF DOWN TOWARDS THE BOTTOM OF THE NOTE
10 WHICH WE PROBABLY PUT UP THERE.
11 A. UH-HUH, I SEE.
12 Q. IT SAYS, PATIENT HAS APPEARED COMFORTABLE SINCE
13 RECEIVING MORPHINE AT 8 O'CLOCK, DO YOU SEE THAT?
14 A. YES.
15 Q. AND WHAT IS THE SIGNIFICANCE OF YOU CHARTING THAT ON
16 THAT DAY?
17 A. IT WOULD MEAN THAT I HAD GIVEN MEDICATION TO ASSIST THE
18 PATIENT TO BE MORE COMFORTABLE AND THAT IT WAS EFFECTIVE IN
19 DOING THAT AND THAT IF THE PERSON WAS DISPLAYING SIGNS AND
20 SYMPTOMS OF BEING RESTLESS OR IN PAIN, THAT THAT HAD BEEN
21 ALLEVIATED.
22 Q. BY THE WAY, I JUST WANTED TO -- I WANT YOU TO IDENTIFY,
23 THAT'S YOUR SIGNATURE THERE DOWN AT THE BOTTOM?
24 A. YES, IT IS.
25 Q. SORT OF HAD AN ARRAY OF HANDWRITING IN THIS CASE. SO
3428
1 NOW I WANT YOU TO TURN TO 608 IN THAT BINDER, PLEASE, IF YOU
2 COULD.
3 A. OKAY.
4 Q. AND IF YOU COULD GO DOWN TOWARDS THE BOTTOM THERE IS A
5 NOTE HERE AND THAT APPEARS TO BE YOUR SIGNATURE?
6 A. YES.
7 Q. DO YOU SEE THAT?
8 A. YES.
9 Q. AND IT SAYS THE 28TH OFF TO THE LEFT. IT'S SORT OF HARD
10 TO SEE ON THIS COPY. IS THAT THE DAY WHEN YOU WROTE THIS
11 NOTE?
12 A. PROBABLY.
13 Q. AND IT HAS N.S.G., STAND FOR NURSING?
14 A. YES.
15 Q. NURSING PROGRESS. PATIENT EXPERIENCED A GRAND MAL
16 SEIZURE THIS WEEK. CONTINUES TO HAVE MANY TEARFUL EPISODES.
17 COMPLIANT -- IS THAT WITH OR WITHOUT?
18 A. WITH.
19 Q. -- WITH MEDS WHEN CRUSHED. K APPETITE AND YOU HAVE AN
20 ARROW DOWN. DOES THAT STAND FOR DECREASED?
21 A. DECREASED.
22 Q. FLUID INTAKE ADEQUATE. DID I READ THAT CORRECTLY?
23 A. YOU DID.
24 Q. WAS THERE A PARTICULAR REASON WHY YOU WROTE THIS NOTE AS
25 A NURSING PROGRESS NOTE?
3429
1 A. YES.
2 Q. AND TELL US WHY YOU DID THAT.
3 A. IT PROBABLY WAS A WEEKLY SUMMARY OF WHAT HAD OCCURRED TO
4 THE PATIENT, THAT IN ESSENCE SHE HAD HAD A GRAND MAL SEIZURE
5 THAT HAD NOT RECURRED.
6 Q. AND WAS THERE A REASON OR A PROCESS AT THE HOSPITAL SUCH
7 THAT AT TIMES NURSES WOULD CHART THEIR DAILY ACTIVITIES AS
8 OPPOSED TO THIS NOTE THAT IS A WEEKLY PROGRESS NOTE?
9 MS. BARLOW: OBJECTION, LEADING, YOUR HONOR.
10 THE COURT: SUSTAINED.
11 Q. (BY MR. STIRBA) THE PURPOSE OF THE WEEKLY PROGRESS
12 NOTE AS OPPOSED TO A NURSING NOTE WAS WHAT?
13 A. A SUMMARY OF WHAT HAD OCCURRED.
14 Q. AND YOU REFER TO EXPERIENCED A GRAND MAL SEIZURE. WHAT
15 DO YOU MEAN BY A GRAND MAL SEIZURE?
16 A. I DIDN'T WITNESS THE SEIZURE. IT REFERS TO A BIG
17 SEIZURE AS OPPOSED TO A PETTY MAL WHICH IS A SMALL SEIZURE,
18 THAT IT WAS VERY EVIDENT TO THE PEOPLE WHO HAD OBSERVED IT
19 THAT IT WAS A SEIZURE AND THAT IT WAS A BIG ONE.
20 Q. AND THEN YOU ALSO TALK ABOUT MANY TEARFUL EPISODES.
21 WHAT IS THAT RELATING TO?
22 A. WHEN THE PATIENT WAS ALERT, SHE CRIED A LOT THAT SHE WAS
23 UNCOMFORTABLE OR DEPRESSED.
24 Q. FROM A --
25 A. OR BOTH.
3430
1 Q. FROM A NURSING STANDPOINT, WAS THAT SIGNIFICANT TO YOU?
2 A. YES.
3 Q. AND TELL US IN WHAT WAY.
4 A. IT TELLS US THAT THE MEDICATION WAS HAVING EFFECT, A
5 GOOD EFFECT ON HER, BUT PERHAPS NOT AS GOOD EFFECT AS WE
6 WOULD HOPED IT WOULD HAVE. THAT SHE WASN'T HAPPY.
7 Q. NOW, FOR EXAMPLE, YOU MAKE ANOTHER REFERENCE WHERE YOU
8 SAY, COMPLIANT WITH MEDS. WHAT DO YOU MEAN BY THAT?
9 A. MEANS THAT SHE WAS INDEED TAKING HER MEDICATIONS ONE WAY
10 OR THE OTHER.
11 Q. OKAY. IF YOU COULD NOW TURN TO -- THERE'S ANOTHER
12 BINDER THERE. IT HAS LYDIA SMITH'S NAME ON IT, PLEASE. DO
13 YOU HAVE THAT?
14 A. YES, I DO.
15 Q. BEFORE I ASK YOU ABOUT MS. SMITH, I WANTED TO ASK YOU
16 THE QUESTION ABOUT THE MORPHINE INJECTION THAT YOU JUST
17 DESCRIBED AS NOTED IN YOUR CHART TO JUDITH LARSEN.
18 DID YOU BELIEVE AT THE TIME THAT YOU GAVE THAT
19 INJECTION THAT YOU WERE CAUSING OR CONTRIBUTING TO HER
20 DEATH?
21 A. NO.
22 Q. IF YOU WOULD LOOK, PLEASE, AT LYDIA SMITH'S BINDER MED
23 772, IT WOULD BE IN THE NURSING NOTE SECTION.
24 A. I HAVE IT.
25 Q. IT APPEARS IN THE MIDDLE OF THE PAGE AT 9 O'CLOCK
3431
1 THERE'S AN ENTRY THAT YOU WROTE; IS THAT RIGHT?
2 A. YES.
3 Q. AND THIS APPEARS AT THE TOP TO BE ON THE 27TH OF
4 DECEMBER OF '95?
5 A. YES.
6 Q. NOW, IT SAYS FREE TEXT MEDICAL ENTRY, REFUSED ALL MEDS,
7 AND I CAN'T READ THE NEXT WORD. CAN YOU READ IT FOR ME?
8 A. HITTING. HITTING AND SPITTING AT STAFF.
9 Q. I SEE. HITTING AND SPITTING AT STAFF. GIVEN HALDOL 2
10 MILLIGRAMS I.M. 1000 HOURS?
11 A. 10 O'CLOCK.
12 Q. PARDON ME?
13 A. 10 O'CLOCK.
14 Q. OKAY. THANK YOU. 10 O'CLOCK.
15 PATIENT CALM AND TOOK MEDS CRUSHED IN APPLESAUCE AND
16 THEN YOUR SIGNATURE, CORRECT?
17 A. CORRECT.
18 Q. NOW, IS THERE A SIGNIFICANCE THAT YOU CHARTED ON THAT
19 NOTE THAT IN CONJUNCTION WITH REFUSING ALL MEDS THAT THE
20 PATIENT WAS HITTING AND SPITTING AT STAFF?
21 A. WOULD YOU REPEAT THE QUESTION?
22 Q. SURE. IS THERE A SIGNIFICANCE THAT YOU CHARTED IN THAT
23 NOTE THAT THE PATIENT WAS HITTING AND SPITTING AT STAFF?
24 A. YES.
25 Q. AND TELL --
3432
1 A. SHE WASN'T TAKING HER MEDICATION.
2 Q. AND THEN IT GOES ON TO SAY THAT SHE WAS GIVEN HALDOL.
3 IS THERE A PARTICULAR REASON WHY HALDOL WAS ADMINISTERED AS
4 REFLECTED BY THAT NOTE?
5 A. YES. HER BEHAVIOR INDICATED GIVING HER HALDOL. WE
6 PROBABLY HAD A P.R.N. OR AN IF NECESSARY ORDER FOR THE
7 HALDOL AND I GAVE HER THE HALDOL SO THAT SHE WOULD BE
8 CALMER, MORE RESPONSIVE TO THE CARE THAT I WAS TRYING TO
9 GIVE HER.
10 Q. THAT APPEARS TO HAVE BEEN GIVEN INTRAMUSCULAR BY
11 INJECTION?
12 A. YES.
13 Q. IS THERE A SIGNIFICANCE TO THE FACT THAT THAT PARTICULAR
14 MEDICATION AT THAT TIME WAS GIVEN I.M.?
15 A. YES. IT WAS GIVEN I.M. BECAUSE SHE WAS NOT TAKING ORAL
16 MEDICATIONS. SHE WAS SPITTING THEM OUT.
17 Q. AND THEN YOU NOTE THAT PATIENT CALM AND TOOK MEDS
18 CRUSHED IN APPLESAUCE. IS THERE A PARTICULAR REASON WHY YOU
19 CHARTED THAT SHE WAS CALM?
20 A. YES. OBVIOUSLY THE HALDOL HAD HAD THE EFFECT THAT I WAS
21 LOOKING FOR. THE PATIENT WAS CALMER AND SHE WAS MORE
22 RESPONSIVE TO MY ATTEMPT TO GIVE HER MEDICATIONS.
23 Q. NOW, IF YOU COULD TURN TO 777 WHICH --
24 A. UH-HUH.
25 Q. -- IS ANOTHER NOTE AND THIS IS THE DATE OF 12/29 OF '95.
3433
1 DO YOU SEE THAT?
2 A. YES.
3 Q. AND THEN DOWN THE BOTTOM OF THE PAGE IT LOOKS LIKE 900.
4 IT SAYS MED-ENTRY, ONCE AGAIN, PATIENT REFUSES MEDS. HALDOL
5 2 MILLIGRAMS I.M. GIVEN AND THEN YOUR SIGNATURE; IS THAT
6 RIGHT?
7 A. YES.
8 Q. IS THAT A SIMILAR SITUATION TO WHAT YOU JUST DESCRIBED
9 TO US PREVIOUSLY ON THE 27TH?
10 A. IT LOOKS LIKE THE SAME THING OCCURRED.
11 Q. NOW, IF YOU COULD TURN, PLEASE, TO -- THERE'S A BINDER
12 FOR MARY CRANE. BY THE WAY, DO YOU REMEMBER DURING THE TIME
13 PERIOD THAT YOU WERE -- THE DECEMBER-JANUARY TIME PERIOD
14 THAT YOU WERE THE MANAGING -- THE NURSE MANAGER, DO YOU
15 RECALL HOW MANY OTHER R.N.'S WORKED ON THE UNIT AT THAT
16 TIME?
17 A. I DON'T THOSE PARTICULAR DAYS, BUT THERE WOULD HAVE BEEN
18 OTHER NURSES WORKING AT THAT TIME.
19 Q. CAN YOU RECALL BY NAME SOME OF THE NURSES WHO WORKED
20 THERE AT THAT TIME?
21 A. EARLENE, LYNN.
22 Q. YOU ARE GOING TO HAVE -- IS THAT EARLENE COZZENS?
23 A. EARLENE COZZENS. LYNN LONG. LAURIE WILLSON STEVENSON
24 MAY BE WORKING DAYS THAT DAY.
25 Q. DO YOU REMEMBER IF TRACY SCHOLLS WORKED THERE?
3434
1 A. YES.
2 Q. AND SHE WAS A NURSE?
3 A. YES.
4 Q. DO YOU HAVE THE MARY CRANE BINDER IN FRONT OF YOU?
5 A. YES.
6 Q. IF YOU WOULD TURN TO THE NURSING NOTE. IT WOULD BE
7 MED-326. DO YOU HAVE YOU THAT IN FRONT OF YOU?
8 A. NOT YET.
9 MR. STIRBA: MAY I ASSIST, YOUR HONOR?
10 THE COURT: YES.
11 THE WITNESS: ALMOST GOT IT.
12 Q. (BY MR. STIRBA) YES. NOW, THAT IS A NOTE CHARTING
13 NURSING ACTIVITY FOR THAT DAY.
14 A. UH-HUH.
15 Q. AND IT APPEARS AT THE TOP IT'S FOR JANUARY 6 OF 1996.
16 THE FIRST ENTRY AT 11:07. IT SAYS, FREE TEXT, PATIENT
17 APPEARED TO SLEEP THROUGH -- N.O.C. STANDS FOR NIGHT; IS
18 THAT RIGHT?
19 A. N.O.C. --
20 MS. BARLOW: YOUR HONOR, I OBJECT TO HER TESTIFYING
21 AS TO ANYTHING WRITTEN BY SOMEBODY ELSE. I MEAN, IT SPEAKS
22 FOR ITSELF. IT'S THERE. WE DON'T EVEN KNOW IF SHE WAS
23 THERE AT THE TIME THAT WAS WRITTEN OR OBSERVED.
24 THE COURT: I DON'T KNOW THERE'S BEEN A QUESTION.
25 MR. STIRBA: I HAVEN'T ASKED HER ONE.
3435
1 MS. BARLOW: I ASK RATHER THAN HAVING READ THAT
2 WHOLE THING THAT HE ASK HER A QUESTION ABOUT IT AND SEE IF
3 SHE KNOWS ANYTHING ABOUT IT BEFORE HE READS IT.
4 THE COURT: LET'S ASK THE QUESTION AND THEN MAKE
5 THE OBJECTION.
6 Q. (BY MR. STIRBA) OKAY. AFTER N.O.C., COULD YOU READ
7 WHAT THAT NOTE SAYS?
8 A. RESPIRATIONS MORE FREQUENT AND EVEN TONIGHT. OXYGEN WAS
9 BEING ADMINISTERED AT 2 LITERS PER NASAL CANNULA, BY NASAL
10 CANNULA. PATIENT BEGAN MOANING AT APPROXIMATELY 6 A.M. AT
11 WHICH TIME SHE RECEIVED 5 MILLIGRAMS OF MORPHINE
12 INTRAMUSCULARLY GIVEN FOR PAIN AS ORDERED. THAT WAS GIVEN
13 AT 6:15. AND THEN THE NURSE HAS WRITTEN THAT, THE PATIENT
14 APPEARED MORE COMFORTABLE AFTER RECEIVING THE MORPHINE.
15 Q. CAN YOU RECOGNIZE THOSE INITIALS OR THAT WRITING AFTER
16 THE M.S.?
17 A. TRACY SCHOLLS, I THINK.
18 Q. THEN IF YOU COULD TURN TO THE 248 IN THE BINDER, PLEASE.
19 A. OKAY.
20 Q. THAT PAGE, WHAT IS THAT DOCUMENT?
21 A. IT IS A DOCTOR'S ORDER SHEET AND HIS PROGRESS NOTES.
22 Q. AND WHAT IS A DOCTOR'S ORDER SHEET?
23 A. IT IS THE ORDER THAT HE HAS GIVEN EITHER VERBALLY BY
24 TELEPHONE OR HAS WRITTEN. IN THIS INSTANCE HE HAS ORDERED
25 MEDICATION BY TELEPHONE. AND THEN --
3436
1 THE COURT: I DON'T THINK THERE'S A QUESTION
2 PENDING.
3 MR. STIRBA: SURE. APPRECIATE THAT.
4 Q. (BY MR. STIRBA) AS YOU LOOK AT THIS ORDER SHEET IN ITS
5 TOTALITY STARTING AT THE TOP THERE'S AN ORDER ON 1/5 OF '96.
6 A. UH-HUH.
7 Q. DO YOU SEE AN ORDER BY THE PHYSICIAN FOR 1/6 OF '96?
8 A. NO.
9 Q. DO YOU SEE --
10 A. I SEE A 24-HOUR CHECK WHICH WE DID AT, ON, OR AROUND
11 MIDNIGHT EVERY NIGHT.
12 Q. AND THERE APPEARS TO BE INITIALS. IS THAT -- WHO'S
13 INITIALS ARE THAT?
14 A. TRACY'S.
15 Q. WHAT IS A 24-HOUR CHECK?
16 A. WE REVIEW ALL OF THE ORDERS EVERY 24 HOURS TO MAKE SURE
17 THAT THEY ARE CORRECT AND THAT THEY COINCIDE WITH WHAT THE
18 NURSES HAVE GIVEN.
19 Q. DO YOU SEE A PHYSICIAN ORDER FOR THE 6TH OF JANUARY ON
20 THAT PAGE?
21 MS. BARLOW: YOUR HONOR, I OBJECT TO -- THE
22 DOCUMENT SPEAKS FOR ITSELF.
23 THE COURT: SUSTAINED.
24 Q. (BY MR. STIRBA) IF YOU'LL TURN TO MED-249, PLEASE.
25 AND WHAT IS THIS?
3437
1 A. SAME THING, DOCTOR'S ORDERS AND PROGRESS NOTES.
2 Q. AND UP TO THE -- AT THE TOP, IS THAT A DOCTOR'S ORDER
3 THAT STARTS WITH S.M.O. SEVEN?
4 A. IT'S A VERBAL ORDER.
5 Q. WHAT'S THE DATE OF THAT ORDER?
6 A. THE 7TH.
7 Q. AND THIS IS MED-249. THIS IS THE NEXT PAGE FROM THE
8 PREVIOUS ONE YOU JUST READ, IS THAT RIGHT?
9 A. YES.
10 Q. IN THE MIDDLE OF THE DOCUMENT TO THE LEFT THERE'S
11 ANOTHER ORDER, YOU IDENTIFIED SUCH AN ORDER?
12 A. YES.
13 Q. AND THAT IS DATED THE 7TH?
14 A. YES.
15 Q. AND OFF TO THE RIGHT HERE IS -- DO YOU RECOGNIZE THAT AS
16 AN ORDER, A PROGRESS NOTE?
17 A. PROGRESS NOTE.
18 Q. NOW, WAS THERE A WAY DURING THIS TIME PERIOD THAT NURSES
19 HAD RESPONSIBILITY TO CHART MEDICATION THAT WAS GIVEN TO THE
20 PATIENTS?
21 A. YES.
22 Q. AND WOULD YOU, PLEASE, TELL US HOW A NURSE WOULD
23 INDICATE DURING THIS TIME PERIOD THAT A MEDICATION HAD BEEN
24 GIVEN?
25 A. IT WOULD BE ON THE M.A.R.S. WHICH IS THE MEDICAL RECORD
3438
1 OF MEDICATIONS AND IT WOULD ALSO BE IN THE NURSES' PROGRESS
2 NOTES.
3 Q. AND WHAT WOULD THE PROCESS BE OR THE SIGNIFICANCE OF
4 INDICATING SOMETHING ON THE M.A.R.S.?
5 A. THAT THE ORDER HAD BEEN WRITTEN OR A VERBAL ORDER HAD
6 BEEN GIVEN BY THE DOCTOR AND THEN IT WAS TRANSCRIBED TO THE
7 M.A.R.S.
8 Q. AND WAS THERE A REQUIREMENT THAT A NURSE DOCUMENT IN THE
9 M.A.R.S. A MEDICATION GIVEN?
10 A. YES.
11 Q. AND WHY IS THAT?
12 A. SO THAT WE KNEW WHEN A MEDICATION HAD BEEN ORDERED AND
13 WHEN IT HAD BEEN GIVEN.
14 Q. IF YOU WOULD TURN TO 288, PLEASE.
15 A. I HAVE IT.
16 Q. THAT PARTICULAR DOCUMENT IS A MEDICATION ADMINISTRATION
17 RECORD?
18 A. YES.
19 Q. AND CAN YOU TELL US WHAT DATES IT COVERS?
20 A. FROM JANUARY THE 7TH TO THE 13TH.
21 Q. IS THERE ANY SIGNIFICANCE -- IF YOU LOOK AT THE TOP
22 WHERE IT SAYS DATE IT HAS 1/5 AND THEN THERE'S A COLUMN WITH
23 INITIALS UNDERNEATH THAT. WHAT DOES THAT REPRESENT?
24 A. THAT THE ORDERS HAD BEEN RECOPIED ON THE 5TH OF JANUARY.
25 Q. SO FOR EXAMPLE, WE LOOK AT THE FIRST ONE IT HAS -- LET'S
3439
1 ACTUALLY GO TO ONE THAT'S EASIER. HOW ABOUT GLUCOTROL. DO
2 YOU SEE THAT, 5 MILLIGRAMS?
3 A. YES.
4 Q. AFTER TIME IT HAS 800 HOURS. WHAT DOES THAT INDICATE?
5 A. IT MEANS IT'S DUE TO BE GIVEN AT 8 O'CLOCK IN THE
6 MORNING.
7 Q. AND THEN THERE ARE SOME INITIALS IN THE BOX NEXT TO
8 THAT.
9 A. YES.
10 Q. AND WHAT DOES THAT MEAN?
11 A. IT MEANS THAT ON THE 5TH LYNN HAD -- LYNN LONG HAD GIVEN
12 IT. ON THE 6TH AND 7TH EARLENE COZZENS HAD GIVEN IT.
13 Q. IN OTHER WORDS, WE GO ALONG THE LINE HERE, WE HAVE L.L.
14 AND THEN YOU ARE IDENTIFYING ON THE 6TH, WHOSE INITIALS ARE
15 THOSE?
16 A. EARLENE'S.
17 Q. AND THEN ON THE 7TH, WHOSE INITIALS ARE THOSE?
18 A. EARLENE'S.
19 Q. DO YOU SEE ON THAT DOCUMENT IF THERE'S A REFERENCE TO
20 MORPHINE?
21 A. NO, I DON'T, NOT ON THAT PAGE.
22 Q. NOW, IF YOU'LL TURN TO THE NEXT PAGE WHICH IS MED-289.
23 A. YES.
24 Q. THAT'S JUST THE NEXT SEQUENTIAL PAGE. WE ALSO HAVE SOME
25 ADDITIONAL RECORDS AND, ONCE AGAIN, AT THE TOP, IF I CAN
3440
1 DIRECT YOUR ATTENTION, FOR EXAMPLE, TO RISPERDAL AND IF YOU
2 FOLLOW OVER IT SAYS TIME 0800 HOURS AND WE HAVE THE INITIALS
3 L.L., WHOSE INITIALS ARE THEY?
4 A. LYNN LONG'S.
5 Q. AND WHAT IS IT THAT ENTRY REPRESENTS?
6 A. THAT SHE GAVE IT AT THE TIME SHE WAS ASKED TO.
7 Q. AND WHAT WOULD BE THE DATE THAT SHE GAVE THAT?
8 A. THE 5TH.
9 Q. DO YOU SEE ON THAT DOCUMENT ANY REFERENCE TO MORPHINE?
10 A. NO.
11 Q. FINALLY, IF YOU WOULD TURN TO 290, PLEASE, IN THE
12 MEDICATION ADMINISTRATION RECORD.
13 A. UH-HUH.
14 Q. THERE'S A REFERENCE ON THIS DOCUMENT TO MORPHINE?
15 A. YES.
16 Q. AND THAT'S THE THIRD ENTRY ON THE PAGE; IS THAT RIGHT?
17 A. YES.
18 Q. AND WHAT DOES THAT SAY?
19 A. IT SAYS MORPHINE 5 MILLIGRAMS I.M. Q 3 HOUR, EVERY THREE
20 HOURS.
21 Q. NOW, THERE'S AN INDICATION ON THE 6TH BOX WHICH IS DATED
22 THE 6TH OF JANUARY, DO YOU SEE THAT?
23 A. YES.
24 Q. ARE THERE ANY INITIALS INDICATING THAT MORPHINE WAS
25 GIVEN ON THE 6TH?
3441
1 A. NO.
2 Q. NOW, MS. HANSEN, DO YOU RECALL AFTER YOU'VE REVIEWED --
3 YOU HAVE HAD A CHANCE TO REVIEW SOME OF THESE RECORDS BEFORE
4 YOU HAVE COME HERE THIS MORNING; IS THAT RIGHT?
5 A. YES.
6 Q. AND DO YOU RECALL REVIEWING THE RECORDS AND SEEING THAT
7 YOU GAVE A 5 MILLIGRAM INJECTION OF MORPHINE TO PATIENT
8 JUDITH LARSEN?
9 A. NO. WAIT A MINUTE. THIS IS MARY CRANE'S.
10 Q. LET'S JUST PULL THAT OUT. JUDITH LARSEN'S BINDER, IF
11 YOU WOULD.
12 A. IN THE SAME DATE?
13 Q. NO. IT WOULD BE THE 2ND OF JANUARY OF 1996. I CAN GIVE
14 YOU A PAGE REFERENCE. IT WOULD BE 507.
15 MR. STIRBA: MAY I ASSIST, YOUR HONOR?
16 THE COURT: YES.
17 THE WITNESS: IT'S COMING. I'VE GOT IT.
18 Q. (BY MR. STIRBA) YEAH. THAT'S RIGHT.
19 AND WHAT DO YOU HAVE IN FRONT OF YOU -- THAT IS
20 IDENTIFIED AS MED-507.
21 A. UH-HUH.
22 Q. WHAT DO YOU HAVE IN FRONT OF YOU, MS. HANSEN?
23 A. THERE'S AN ORDER FOR MORPHINE 5 MILLIGRAMS
24 INTRAMUSCULARLY EVERY THREE HOURS ROUTINE, ROUND-THE-CLOCK.
25 Q. AND WITH RESPECT TO THAT ORDER, DO YOU SEE YOUR
3442
1 INDICATION OF YOUR INITIALS?
2 A. YES. I SEE I GAVE IT AT 9:30 ON THE 2ND OF JANUARY.
3 Q. SO IF I GO TO 9:30 AND WE GO TO THE RIGHT, THAT APPEARS
4 TO BE S.H., ARE THOSE YOUR INITIALS?
5 A. YES.
6 Q. DID YOU BELIEVE AT THE TIME THAT YOU GAVE THAT INJECTION
7 THAT YOU WERE CAUSING OR CONTRIBUTING TO MS. LARSEN'S DEATH?
8 A. NO.
9 Q. THANK YOU.
10 MR. STIRBA: THAT'S ALL I HAVE, YOUR HONOR.
11 CROSS-EXAMINATION
12 BY MS. BARLOW:
13 Q. GOOD MORNING, MS. HANSEN.
14 A. GOOD.
15 Q. I'M CHARLENE BARLOW. I DON'T THINK WE'VE MET BEFORE.
16 A. NO.
17 Q. YOU INDICATE THAT YOU ARE NOT WORKING AT PRESENT. YOU
18 ARE BASICALLY RETIRED?
19 A. I'VE RETIRED BECAUSE OF DISABILITY.
20 Q. IS THERE ANYTHING ABOUT THAT DISABILITY THAT AFFECTS
21 YOUR RECOLLECTION, YOUR ABILITY TO REMEMBER WHAT HAPPENED IN
22 '95 AND '96?
23 A. YES. I HAVE SHORT-TERM DISABILITY BECAUSE OF A HEAD
24 INJURY.
25 Q. AND I DON'T MEAN TO PRY, BUT WHEN DID THAT HEAD INJURY
3443
1 OCCUR?
2 A. APRIL 28, 1998.
3 Q. SO IT DID OCCUR AFTER --
4 A. IT OCCURRED AFTER THIS, YES.
5 Q. HAS IT CAUSED YOU PROBLEMS REMEMBERING WHAT HAPPENED IN
6 '95 AND '96?
7 A. WELL, NOT WHEN THE WRITTEN RECORD IS IN FRONT OF ME.
8 Q. I UNDERSTAND THAT. WRITTEN RECORD, DOES THAT REFRESH
9 YOUR RECOLLECTION OR YOU JUST SEE WHAT'S ON THE RECORD AND
10 YOU WROTE IT CORRECTLY AT THE TIME; IS THAT CORRECT?
11 A. YES.
12 Q. DO YOU HAVE ANY INDEPENDENT RECOLLECTION WITHOUT THE
13 RECORDS OF WHAT HAPPENED IN DECEMBER OF '95 AND JANUARY OF
14 '96?
15 A. I HAVE SOME MEMORIES. SOME MEMORIES HAVE GONE.
16 Q. I UNDERSTAND. I THINK THAT HAPPENS TO ALL OF US EVEN
17 WITHOUT THE DISABILITY.
18 DO YOU RECALL THESE FIVE PATIENTS SPECIFICALLY?
19 A. YOU KNOW, I'M SORRY TO SAY I DON'T.
20 Q. I UNDERSTAND. YOU PROBABLY TREATED A LOT OF PATIENTS
21 BEFORE AND SINCE THEN; IS THAT RIGHT?
22 A. I HAVE.
23 Q. DO YOU RECALL THESE FIVE DEATHS SPECIFICALLY?
24 A. I RECALL THAT THERE WERE DEATHS AND I WAS VERY CONCERNED
25 ABOUT IT, BUT I DON'T RECALL THEM SPECIFICALLY.
3444
1 Q. I UNDERSTAND. DID YOU EVER EXPRESS YOUR CONCERNS TO
2 ANYONE ABOUT THOSE DEATHS?
3 A. YES. WE WERE VERY CONCERNED ABOUT THEM.
4 Q. TO WHOM DID YOU EXPRESS YOUR CONCERNS?
5 A. TODD CHAMBERS.
6 Q. AND HE WAS HEAD OF THE HORIZONS AT THAT TIME?
7 A. YES.
8 Q. DID YOU EVER TELL DR. WEITZEL THAT YOU WERE CONCERNED
9 ABOUT THESE PEOPLE DYING?
10 A. I DON'T REMEMBER SPECIFICALLY. WE HAD MANY, MANY
11 CONVERSATIONS.
12 Q. WHEN YOU SAY "WE," DO YOU MEAN THE NURSES TOGETHER?
13 A. NO. DR. WEITZEL AND I.
14 Q. OKAY. I'M SORRY. I DON'T WANT TO PUT WORDS IN YOUR
15 MOUTH. THANK YOU FOR STRAIGHTENING ME OUT.
16 WHEN YOU WERE IN THAT TEN YEARS OF GERIATRIC AND
17 LONG-TERM CARE, THAT WAS BASICALLY NURSING HOMES AND CARE
18 CENTERS; IS THAT CORRECT?
19 A. YES.
20 Q. AND THE PEOPLE HAD VARYING DEGREES OF PROBLEMS THAT ARE
21 COMMON TO THE ELDERLY?
22 A. YES.
23 Q. AND WAS THE DEMENTIA A PRETTY COMMON PROBLEM?
24 A. QUITE COMMON.
25 Q. DID YOU EVER -- BUT, OF COURSE, YOU DON'T DIAGNOSE THE
3445
1 TREATMENT BECAUSE THAT'S NOT YOUR ROLE AS A NURSE?
2 A. THAT IS CORRECT.
3 Q. YOU ASSESS AND YOU SEE HOW YOU CAN HELP THE PERSON ON
4 THE DAY-TO-DAY BASIS; IS THAT CORRECT?
5 A. YES.
6 Q. DO YOU HAVE ANY BACKGROUND IN PSYCHIATRIC PROBLEMS, ANY
7 NURSING BACKGROUND IN PSYCHIATRIC PROBLEMS OR DEALING WITH
8 PSYCHIATRIC PROBLEMS?
9 A. YES, I DO.
10 Q. WHAT WAS THAT?
11 A. I HAVE WORKED IN SEVERAL BEHAVIORAL HEALTH AREAS AS WELL
12 AS IN GEROPSYCH SPECIFICALLY.
13 Q. YOU'VE DONE WORK WITH PATIENTS THAT WERE DIAGNOSED AS
14 HAVING DELIRIUM?
15 A. YES.
16 Q. DO YOU RECOGNIZE DELIRIUM FROM DEMENTIA?
17 A. IT'S DIFFICULT AT TIMES, BUT YES.
18 Q. DO THEY OFTEN GO HAND IN HAND IN THE ELDERLY OR
19 SOMETIMES?
20 A. SOMETIMES.
21 Q. MAYBE OFTEN MIGHT BE TOO STRONG A WORD.
22 WHEN DID YOU JOIN DAVIS HOSPITAL?
23 A. '94, I THINK.
24 Q. WAS IT WHEN YOU WERE THE FIRST NURSE MANAGER THEN?
25 A. NO.
3446
1 Q. WHO WAS BEFORE YOU?
2 A. SHEILA MOORE.
3 Q. AND WHEN SHE LEFT YOU JOINED THE HOSPITAL?
4 A. NO. I WAS THERE AS A STAFF NURSE.
5 Q. AND THEN YOU WERE PROMOTED?
6 A. YES.
7 Q. OKAY. THANK YOU.
8 WHEN DID YOU LEAVE DAVIS HOSPITAL?
9 A. I THINK IT WAS AROUND MARCH OF '98.
10 Q. OF '98. AND BY THAT TIME WAS DR. WEITZEL STILL OVER THE
11 UNIT IN '98?
12 MR. STIRBA: RELEVANCE, YOUR HONOR.
13 THE COURT: SUSTAINED.
14 Q. (BY MS. BARLOW) YOU DON'T HAVE TO ANSWER THAT. IF HE
15 OBJECTS AND HE SUSTAINS, THEN YOU DON'T HAVE TO ANSWER THAT.
16 SO AS THE NURSING MANAGER, WERE YOU THE SAME AS THE
17 NURSING SUPERVISOR?
18 A. NO. THERE WAS A PERSON DESIGNATED WITH THE TITLE OF
19 NURSING SUPERVISOR.
20 Q. SO IF SOMEONE WROTE IN THE NOTES -- ONE OF THE NURSES
21 WROTE IN THE NOTES THAT SHE NOTIFIED THE NURSING SUPERVISOR,
22 THAT WOULD NOT NECESSARILY BE YOU; IS THAT CORRECT?
23 A. THAT'S CORRECT.
24 Q. HOW LONG WERE YOU THE NURSING MANAGER OF THAT UNIT?
25 A. THREE MONTHS.
3447
1 Q. WAS THERE ANY PARTICULAR REASON WHY YOU DID -- DID YOU
2 DECIDE NOT TO BE MANAGER ANYMORE?
3 A. NO. WE HAD A DOWNSIZING AND ALL NURSING MANAGERS WERE
4 TAKEN AWAY AND REDUCED TO NURSING, HEAD NURSES.
5 Q. MONEY THING, THEN?
6 A. NO.
7 Q. AT THE SAME PAY, JUST A DIFFERENT TITLE?
8 A. YES.
9 Q. WELL, THAT'S GOOD.
10 YOU HAVE REVIEWED THE RECORDS, DO YOU RECALL JUDITH
11 LARSEN SPECIFICALLY?
12 A. I DON'T. I RECALL THE NAME.
13 Q. WHEN DID YOU REVIEW THESE RECORDS FIRST?
14 A. ABOUT A WEEK AGO.
15 Q. AND WHO GAVE THEM TO YOU TO REVIEW?
16 A. MR. STIRBA.
17 Q. AND WHERE DID THAT REVIEW TAKE PLACE?
18 A. MR. STIRBA'S OFFICE.
19 Q. HAVE YOU LOOKED AT THESE BINDERS TO SEE IF THEY WERE THE
20 SAME RECORDS THAT YOU REVIEWED?
21 A. NO.
22 Q. PROBABLY BE ASKING A LOT AT THIS POINT AND I WON'T ASK
23 YOU TO GO THROUGH ALL OF THOSE.
24 WHAT WAS YOUR USUAL SHIFT THAT YOU WORKED?
25 A. WHEN?
3448
1 THE COURT: DURING THIS TIME PERIOD, DECEMBER '95
2 TO JANUARY OF '96.
3 THE WITNESS: 3 O'CLOCK IN THE MORNING UNTIL 3
4 O'CLOCK IN THE AFTERNOON.
5 Q. (BY MS. BARLOW) IS THAT BECAUSE YOU WERE THE MANAGER
6 THAT YOU WORKED SUCH A LONG SHIFT?
7 A. NO. WE ALL DID 12-HOUR SHIFTS. THAT WAS SUPPOSEDLY THE
8 DAY SHIFT.
9 Q. AND HOW MANY DAYS A WEEK WOULD YOU WORK?
10 A. THREE.
11 Q. ANY PARTICULAR DAYS USUALLY LIKE MONDAY, WEDNESDAY OR
12 DID IT VARY?
13 A. PARTICULAR DAYS.
14 Q. DO YOU RECALL WHICH DAYS YOU WORKED?
15 A. I DON'T.
16 Q. I KNOW IT'S BEEN FIVE YEARS. LET'S TURN AGAIN TO 569 IN
17 THE JUDITH LARSEN BINDER THAT YOU WENT OVER WITH MR. STIRBA.
18 A. YES.
19 Q. NOW, AT THE TOP THERE'S WRITTEN 7 TO 3 AND THEN IT'S
20 BEEN CROSSED OUT AND A M.E. IS WRITTEN UNDERNEATH THAT. DO
21 YOU KNOW WHAT THAT MEANS?
22 A. MISTAKEN ENTRY.
23 Q. SO DO YOU RECALL WHAT SHIFT YOU WERE WORKING THAT DAY?
24 A. 3 TO 3.
25 Q. 3 TO 3. SO THE 7 TO 3 IS SLIGHTLY WRONG. OKAY.
3449
1 DID YOU -- WOULD YOU HAVE OCCASION WHEN YOU CAME ON THE
2 SHIFT TO LOOK AT THE NOTES OF SAY THE PRIOR NURSING NOTES TO
3 SEE HOW PEOPLE WERE DOING?
4 A. I RECEIVED A VERBAL REPORT FROM THE NURSE GOING OFF. IF
5 I WAS LUCKY I HAD AN OPPORTUNITY TO LOOK OVER THE NOTES. MY
6 FIRST DUTY WAS TO GO AND SEE EACH PATIENT INDIVIDUALLY.
7 Q. NOW, IT WAS EVIDENTLY EITHER 12 -- IT MUST HAVE BEEN --
8 LET ME PUT IT ON HERE. THIS IS NOT YOUR NOTE, BUT IT IS THE
9 12/26 DATE WHICH IS THE SAME AS THE DATE THAT YOU PUT ON
10 NUMBER 569.
11 A. UH-HUH.
12 Q. AND THIS IS THE 11 TO 7 SHIFT AND I DON'T KNOW IF WE CAN
13 FIGURE OUT WHO WROTE THIS. CAN YOU TELL WHO WROTE THIS?
14 A. BONNIE HARDEY.
15 Q. ON 567. EXCUSE ME. I'VE MOVED AND I HAVEN'T TOLD YOU
16 WHERE I'VE GONE.
17 A. OH, TRACY.
18 Q. SO TRACY WROTE THIS AND THIS WAS ABOUT THE SEIZURE
19 ACTIVITY; IS THAT CORRECT?
20 A. YES.
21 Q. AT 5:40 PATIENT BEGAN TO GRUNT AND GRADUALLY PATIENT'S
22 RIGHT SIDE BEGAN TO JERK. IS THAT THE SEIZURE THAT YOU WERE
23 REFERRING TO?
24 A. YES.
25 Q. AND THIS WAS AT 5:40 IN THE MORNING. DO YOU RECALL
3450
1 WHETHER YOU WERE THERE AT THAT TIME?
2 A. NO, I WAS NOT THERE.
3 Q. SO YOU DIDN'T OBSERVE -- WELL, YOU'VE ALREADY TESTIFIED.
4 A. I DID NOT OBSERVE THE SEIZURE.
5 Q. SO YOUR NURSING -- YOUR WEEKLY NURSING NOTE THAT
6 INDICATED IT WAS A GRAND MAL SEIZURE WAS BASED ON WHAT OTHER
7 PEOPLE HAD TOLD YOU?
8 A. THAT'S RIGHT. I WOULD READ ALL OF THE NOTES BEFORE I
9 MADE A WEEKLY PROGRESS NOTE.
10 Q. NOW, ON 569 YOU INDICATED THAT JUDITH LARSEN WAS MOANING
11 AND APPEARED TO BE IN SOME DISCOMFORT. DO YOU HAVE AN
12 INDEPENDENT RECOLLECTION OF WHAT YOU SAW THAT WAS -- THAT
13 APPEARED TO BE DISCOMFORT TO YOU?
14 A. I DON'T. I'M SORRY.
15 Q. THAT'S FINE. I'M NOT TRYING TO MAKE YOU FEEL BAD OR
16 ANYTHING.
17 THERE'S COMPLAINT OF MOANING. DID MOANING ALWAYS
18 INDICATE PAIN TO YOU?
19 A. WHEN A PERSON WASN'T RESPONSIVE IN ANY OTHER WAY, YES.
20 Q. ARE THERE ANY OTHER KINDS OF DISCOMFORT THAT CAUSE
21 MOANING?
22 A. YES. SHE MIGHT HAVE BEEN IN A POSITION THAT SHE IS
23 EXTREMELY UNCOMFORTABLE AND PERHAPS ALL WE NEEDED TO DO WAS
24 REPOSITION HER.
25 Q. AND INDEED AN HOUR LATER AFTER THE MORPHINE, PATIENT
3451
1 QUIET AND UNRESPONSIVE TO EVEN DEEP PAINFUL STIMULI. WHAT
2 DO YOU MEAN BY DEEP PAINFUL STIMULI?
3 A. IF YOU PRESS A PATIENT'S STERNUM --
4 Q. THE BREAST BONE --
5 A. BREAST BONE.
6 Q. -- FOR US LAY PEOPLE.
7 A. MOVE OUR HANDS ON THE STERNUM, IT WILL CAUSE PAIN.
8 Q. AND IS THAT A TIME-HONORED WAY --
9 A. YES.
10 Q. -- TO SEE IF SOMEONE WILL RESPOND?
11 A. YES. YOU CAN ALSO TRY AND TALK TO THEM.
12 Q. AND THIS NOTE WAS, UNRESPONSIVE TO EVEN DEEP PAINFUL
13 STIMULI. BASED ON YOUR NURSING EXPERIENCE, IS A PERSON
14 CLOSE TO UNCONSCIOUSNESS IN A CIRCUMSTANCE LIKE THAT?
15 MR. STIRBA: OBJECT, YOUR HONOR. IT'S BEYOND THE
16 SCOPE. SHE'S NOT HERE AS AN EXPERT. SHE CAN TESTIFY AS TO
17 WHAT SHE DID.
18 MS. BARLOW: WELL, YOUR HONOR --
19 THE COURT: WHAT SHE OBSERVED. IF YOU WANT TO
20 REPHRASE THE QUESTION.
21 Q. (BY MS. BARLOW) BASED ON THIS NOTE, DID YOU OBSERVE
22 WHETHER JUDITH LARSEN WAS UNCONSCIOUS AT THE TIME?
23 A. I WASN'T THERE.
24 Q. I'M SORRY. WE'RE BACK ON THE ONE THAT YOU WROTE. ON
25 569. I'M SORRY TO KEEP MOVING BACK AND FORTH ON YOU LIKE
3452
1 THAT.
2 A. IT'S OKAY.
3 Q. I THINK PEOPLE ARE FOLLOWING MY BRAIN WHEN THEY AREN'T
4 SOMETIMES.
5 A. ALL RIGHT. WOULD YOU REPEAT THE QUESTION, PLEASE?
6 Q. YOU WROTE THE NOTE AT 0800. YOU ADMINISTERED THE
7 MORPHINE.
8 A. YES.
9 Q. 0900 PATIENT QUIET AND UNRESPONSIVE TO EVEN DEEP PAINFUL
10 STIMULI. BASED ON THAT NOTE, WOULD YOU CONSIDER JUDITH
11 LARSEN TO BE UNCONSCIOUS AT THE TIME?
12 A. YES.
13 Q. AND AT 1400 WHICH IS -- LET'S SEE, THAT'S ABOUT FIVE
14 HOURS LATER, YOU WRITE, PATIENT UNRESPONSIVE AS YET BUT
15 APPEARS TO BE LIGHTER. AND WHAT DO YOU MEAN BY THAT?
16 A. NOT AS DEEPLY UNCONSCIOUS. MAYBE SHE WAS TURNING HER
17 HEAD WHEN I SPOKE TO HER OR MOVING A HAND. SHE WAS DOING
18 SOMETHING THAT WAS -- WOULD CAUSE ME TO BELIEVE THAT SHE WAS
19 CLOSER TO CONSCIOUSNESS THAN SHE HAD BEEN BEFORE.
20 Q. 'CAUSE CONSCIOUSNESS IS NOT JUST BOOM, YOU'RE CONSCIOUS
21 OR BOOM, YOU ARE UNCONSCIOUS; IS THAT CORRECT? THERE ARE
22 DIFFERENT LEVELS?
23 A. DEPENDS.
24 Q. I GUESS A HIT ON THE HEAD JUST KNOCKS YOU RIGHT OUT.
25 YOU ARE UNCONSCIOUS. BUT WITH THE ADMINISTRATION OF DRUGS,
3453
1 YOU WOULD SEE EFFECT OF MAYBE THEY ARE LESS CONSCIOUS AND
2 THEN WOULD BECOME LIGHTER AS THE DRUG WORE ON; IS THAT
3 CORRECT?
4 A. YES.
5 MR. STIRBA: I OBJECT, YOUR HONOR. SHE'S NOT HERE
6 AS AN EXPERT. CALLS FOR SPECULATION.
7 THE COURT: SUSTAINED.
8 Q. (BY MS. BARLOW) 1400 YOU ALSO WROTE, FREE TEXT B.P.,
9 BLOOD PRESSURE GRADUALLY UP TO 108 OVER 70. IS THAT A
10 NORMAL BLOOD PRESSURE?
11 A. YES.
12 Q. WHAT DID YOU MEAN BY, "GRADUALLY UP"?
13 A. OBVIOUSLY IT HAD BEEN LOWER AND THAT -- AND THAT IT WAS
14 COMING UP AND I WAS MORE CONTENT WITH WHAT I WAS SEEING.
15 Q. READING THIS NOTE, WERE YOU CONCERNED ABOUT HER LEVEL OF
16 CONSCIOUSNESS DURING THAT DAY?
17 A. YES.
18 Q. YOU TALKED ABOUT COMFORT CARE, REPOSITIONING, CAUSING TO
19 BREATHE DEEPLY. YOU WANTED TO LOOK AT CAUSING TO BREATHE
20 DEEPLY. THAT IS PART OF WHAT YOU DO AS COMFORT CARE; IS
21 THAT CORRECT?
22 A. YES.
23 Q. AND WHY DO YOU DO THAT?
24 A. TO AERATE THEIR LUNGS. CAUSE THEM TO EXPAND SO THAT
25 MORE AIR IS IN THEIR LUNGS.
3454
1 Q. LACK OF OXYGEN --
2 A. IF THEY CAN DO IT.
3 Q. 'CAUSE LACK OF OXYGEN IS A PROBLEM, ISN'T IT?
4 A. YES.
5 Q. WAS IT A PROBLEM WITH JUDITH LARSEN?
6 A. I DON'T REMEMBER. I BELIEVE SHE WAS ON OXYGEN, WAS SHE
7 NOT?
8 Q. I BELIEVE SHE WAS, YES. IN FACT, ON THE VERY PAGE AT
9 THE TOP YOU INDICATE TWO LITERS.
10 A. YES.
11 Q. IS THAT A PRETTY NORMAL --
12 A. SO SHE WAS HAVING DIFFICULTY MAINTAINING HER OXYGEN
13 SATURATION AND WE WERE PROVIDING HER WITH OXYGEN WHICH IS
14 BOTH MEDICATION AND A COMFORT MEASURE.
15 Q. I UNDERSTAND. BECAUSE NOT BEING ABLE TO BREATHE IS NOT
16 COMFORTABLE?
17 A. NO, IT ISN'T.
18 Q. ONE THING WE ALL NEED IS AIR. ARE YOU -- BASED ON YOUR
19 NURSING EXPERIENCE, ARE YOU FAMILIAR WITH CENTRAL NERVOUS
20 SYSTEM DEPRESSANT MEDICATIONS?
21 A. YES.
22 Q. ARE YOU FAMILIAR WITH THEIR EFFECTS?
23 A. YES.
24 Q. AND THEIR SIDE EFFECTS?
25 A. YES.
3455
1 Q. ARE YOU FAMILIAR WITH THE PSYCHOTROPIC DRUGS THAT WERE
2 BEING ADMINISTERED TO JUDITH LARSEN AT THIS TIME?
3 A. YES.
4 Q. THE SERZONE AND TRAZODONE?
5 A. YES.
6 Q. ARE YOU FAMILIAR THAT THEY ARE CENTRAL NERVOUS SYSTEM
7 DEPRESSANT DRUGS?
8 A. YES.
9 Q. AND DO YOU MONITOR PEOPLE CLOSELY WHEN THEY ARE TAKING
10 THEM FOR THAT VERY REASON?
11 A. YES.
12 Q. TURN BACK TO 608 WHICH IS THE NURSING NOTE I BELIEVE
13 THAT YOU WROTE. IT'S BACK IN UNDER THE MASTER TREATMENT
14 PLAN TAB.
15 A. YES.
16 Q. THIS WAS ON THE 28TH OF DECEMBER. DO YOU RECALL OFFHAND
17 WHAT DRUGS OR MEDICATIONS JUDITH LARSEN WAS ON ON THE 28TH
18 OF DECEMBER?
19 A. NO, I DON'T.
20 Q. I DON'T KNOW WHY WE COULD EXPECT ANYONE TO. I'LL READ
21 TO YOU FROM 498 TO THE 28TH OF DECEMBER. THERE'S BETAGAN.
22 DO YOU KNOW WHAT THAT IS?
23 A. BETAGAN?
24 Q. YES.
25 A. YES.
3456
1 Q. WHAT IS THAT?
2 A. IT'S AN EYE DROP.
3 Q. SO THAT WOULDN'T AFFECT HER MOOD; IS THAT CORRECT? THE
4 TEARFUL EPISODES?
5 A. I WOULDN'T EXPECT SO.
6 Q. THE SYNTHROID IS THYROID MEDICATION?
7 A. YES.
8 Q. WOULD THAT AFFECT HER MOOD?
9 MR. STIRBA: YOUR HONOR, I'M GOING TO OBJECT.
10 BEYOND THE SCOPE OF DIRECT. IT'S ALSO BEYOND THE SCOPE OF
11 HER -- OF HER EXPERTISE.
12 THE COURT: SUSTAINED.
13 Q. (BY MS. BARLOW) ARE THERE ANY DRUGS LISTED ON 498 THAT
14 IN YOUR NURSING EXPERIENCE ARE GIVEN TO AFFECT MOOD?
15 MR. STIRBA: SAME OBJECTION.
16 THE COURT: SUSTAINED.
17 Q. (BY MS. BARLOW) DON'T ANSWER THAT QUESTION.
18 BEFORE WE LEAVE MS. LARSEN'S BINDER, IF YOU WOULD TURN
19 BACK TO 507.
20 A. YES.
21 Q. AND I BELIEVE IT'S THE 2ND OF JANUARY --
22 A. UH-HUH.
23 Q. -- THAT YOU HAVE. IT LOOKS LIKE LAURIE WILLSON'S
24 SIGNATURE FOR 0330 AND 6:30?
25 A. YES.
3457
1 Q. AND THEN WE HAVE YOUR INITIALS -- EXCUSE ME, AT 9:30?
2 A. YES.
3 Q. ON THE SECOND. AND THERE ARE NO INITIALS AT 12:30.
4 WHAT DOES THAT MEAN?
5 A. IT SHOULD MEAN THAT I DID NOT GIVE IT.
6 Q. WOULD YOU TURN TO 586.
7 A. YES.
8 Q. WHICH IS IN THE NURSING NOTES. YOU DID WRITE DOWN AT
9 THE BOTTOM 12:30.
10 A. UH-HUH.
11 Q. THAT YOU DID ADMINISTER THE 5 MILLIGRAMS; IS THAT
12 CORRECT?
13 A. I CAN'T READ MY OWN WRITING.
14 Q. APPEAR TO SAY MED-ENTRY M.S. 5 MILLIGRAMS I.M. THIS IS
15 AT 12:30.
16 A. PATIENT MOANING AT THIS TIME.
17 Q. RIGHT. SO YOU DID ADMINISTER THE 12:30 SHOT; IS THAT
18 CORRECT?
19 A. I DID AND I NEGLECTED TO CHART IT ON THE M.A.R.S.
20 Q. AND THAT HAPPENS SOMETIMES, DOESN'T IT?
21 A. I'M AFRAID SO.
22 Q. IF YOU WOULD GET LYDIA SMITH'S BINDER OUT, PLEASE. I
23 BELIEVE WE TALKED ABOUT 772. IF YOU WOULD TURN TO THAT.
24 IT'S IN THE NURSING NOTES, I BELIEVE.
25 A. I HAVE IT.
3458
1 Q. IT APPEARS THAT'S YOUR HANDWRITING RIGHT IN THE CENTER
2 THERE.
3 A. YES.
4 Q. AND THEN UNDERNEATH YOUR HANDWRITING IT APPEARS THERE IS
5 A C.N.A. WHO HAS WRITTEN SOME MATERIAL. DO YOU RECALL TYLER
6 SPRAGUE?
7 A. I'M SORRY.
8 Q. TYLER SPRAGUE?
9 A. YES.
10 Q. AS C.N.A.?
11 A. I DO.
12 Q. THAT APPEARS TO BE HIS SIGNATURE DOWN THERE AT THE
13 BOTTOM OF THAT NOTE?
14 A. YES.
15 Q. YOU WROTE ABOUT GIVING THE HALDOL. THEN HE WROTE,
16 BEHAVIOR: PATIENT WAS AGITATED AND MOANING. THEN AFTER
17 HALDOL WAS GIVEN PATIENT CALMED DOWN. PATIENT WAS -- IT
18 LOOKS LIKE -- UNCOOPERATIVE WITH STAFF AND STAFF TRIED TO
19 BUTTON UP SHIRT. PATIENT HAS BEEN DROWSY AFTER MEDS WERE
20 GIVEN. DO YOU RECALL HER BEING DROWSY THAT DAY?
21 A. I DON'T RECALL THAT DAY. I'M SORRY.
22 Q. WOULD YOU HAVE MONITORED FOR DROWSINESS AFTER THE
23 ADMINISTRATION OF THE HALDOL?
24 A. YES, AND I WOULD HAVE ANTICIPATED DROWSINESS.
25 Q. WOULD YOU HAVE ANTICIPATED -- LET'S SEE. I THINK THE
3459
1 HALDOL WAS GIVEN AFTER RISPERDAL WHICH IS A BY MOUTH
2 MEDICATION WAS REFUSED. THEN YOU WOULD ADMINISTER THE
3 HALDOL; IS THAT CORRECT?
4 A. IF THAT'S HOW IT WAS ORDERED.
5 Q. WOULD YOU HAVE MONITORED FOR DROWSINESS AFTER RISPERDAL?
6 A. YES.
7 Q. WOULD YOU HAVE MONITORED FOR BREATH SIGNS AFTER BOTH OF
8 THOSE DRUGS OR EITHER OF THOSE DRUGS?
9 A. YES.
10 Q. BECAUSE THEY ARE CENTRAL NERVOUS SYSTEM DEPRESSANTS; IS
11 THAT CORRECT?
12 A. YES.
13 Q. HAVE JUST A MOMENT. IF YOU WOULD OPEN TO 738. I
14 BELIEVE YOU WERE ASKED ON DIRECT ABOUT DECEMBER 29. THAT'S
15 UNDER THE MEDS.
16 A. YES, I'M GETTING THERE.
17 Q. BY THE TIME YOU FIGURE OUT HOW TO FIND THESE THINGS,
18 YOU'LL BE THROUGH.
19 A. I HAVE IT.
20 Q. WE HAVE THE MEDICATION FOR 29TH OF DECEMBER FOR LYDIA
21 SMITH?
22 A. YES.
23 Q. AND STARTING UP HERE WITH LASIX AND THAT'S A DIURETIC;
24 IS THAT CORRECT?
25 A. YES.
3460
1 Q. AND THEN K.C.L. WHICH IS POTASSIUM?
2 A. YES.
3 Q. YOU HELD BOTH OF THOSE ON THAT DAY; IS THAT CORRECT?
4 A. YES.
5 Q. DO YOU RECALL WHY YOU HELD THEM?
6 A. BECAUSE SHE WASN'T TAKING MEDICATIONS BY MOUTH.
7 Q. AND THESE ARE BOTH BY MOUTH MEDICATIONS; IS THAT
8 CORRECT?
9 A. YES.
10 Q. AND THEN WE HAVE LANOXIN WHICH IS A HEART MEDICATION; IS
11 THAT CORRECT?
12 A. YES.
13 Q. AND, AGAIN, SHE WOULDN'T TAKE THAT. NORMODYNE. WHAT'S
14 NORMODYNE?
15 A. DO YOU KNOW, I DON'T REMEMBER.
16 Q. OKAY. THAT'S FINE. VASOTEC. DO YOU KNOW WHAT THAT IS?
17 A. YES. IT'S A BLOOD PRESSURE MEDICATION.
18 Q. SERZONE. WHAT'S THAT FOR?
19 A. IT'S AN ANTIDEPRESSANT.
20 Q. AND RISPERDAL?
21 A. RISPERDAL IS AN ANTIPSYCHOTIC MEDICATION.
22 Q. AND IT SAYS PATIENT REFUSES RISPERDAL, GIVE HALDOL 3
23 MILLIGRAMS I.M.
24 A. YES.
25 Q. AND IT APPEARS THAT WAS GIVEN WHAT, ABOUT THE -- WELL,
3461
1 AND TRAZODONE WOULD HAVE BEEN AT NIGHT SO YOU WOULDN'T HAVE
2 BEEN THERE FOR THE TRAZODONE OR DEPAKENE; IS THAT CORRECT?
3 A. WHEN?
4 Q. THE TRAZODONE OR DEPAKENE WERE GIVEN IT LOOKS LIKE 8
5 P.M.
6 A. NO.
7 Q. WHEN YOU KNEW LAURIE WILLSON IN DECEMBER '95 AND JANUARY
8 OF '96, HER NAME WAS NOT STEVENSON; IS THAT CORRECT?
9 A. RIGHT.
10 Q. HAVE YOU HAD ANY CONTACT WITH HER RECENTLY?
11 A. NO, NOT UNTIL YESTERDAY.
12 Q. LET'S HAVE MARY CRANE. DO YOU RECALL THAT MARY CRANE
13 WAS ORDERED TO HAVE A DURAGESIC PATCH?
14 MR. STIRBA: OBJECTION, YOUR HONOR. BEYOND THE
15 SCOPE OF DIRECT.
16 THE COURT: SUSTAINED.
17 Q. (BY MS. BARLOW) IF YOU WOULD TURN TO 292. IT'S UNDER
18 THE MED AND GRAPHS. I BELIEVE YOU WENT THROUGH 288, 289 AND
19 290 ON DIRECT AND IT APPEARS THAT MORPHINE WAS ORDERED -- IF
20 YOU'D GO TO 290 FIRST. I JUST WANT TO LAY A LITTLE
21 FOUNDATION HERE.
22 A. OKAY.
23 Q. OKAY. NOW, ON DIRECT YOU INDICATED THAT THERE WERE NO
24 MORPHINE SHOTS GIVEN ON IT LOOKS LIKE THE 5TH AND THE 6TH.
25 A. LOOKS THAT WAY.
3462
1 Q. AND WHAT DATE WAS THE MORPHINE ORDERED ON THAT PAGE?
2 A. THE 7TH.
3 Q. SO THAT'S WHY IT'S CROSSED OUT?
4 A. YES.
5 Q. THE ORDER DIDN'T COME IN UNTIL THE 7TH. THANK YOU.
6 I HAVE THE NEXT PAGE, 291. IT HAS A DIFFERENT -- IT'S
7 LAID OUT IN A DIFFERENT FASHION THAN THE PREVIOUS ONE. WHY
8 IS THAT, DO YOU KNOW? THE PREVIOUS ONE ON PAGE 290 IS LAID
9 OUT LIKE THAT. THIS ONE HAS DIFFERENT BOXES. DO YOU KNOW
10 WHY THAT IS?
11 A. I DON'T.
12 Q. IS THERE ANY DIFFERENCE IN THE WAY THE MEDICATIONS ARE
13 ORDERED? FOR EXAMPLE, EACH ONE OF THESE HAS P.R.N. ON IT.
14 ISN'T IT TRUE THAT THESE ARE THE P.R.N. ORDERS?
15 MR. STIRBA: YOUR HONOR, I'M GOING TO OBJECT. I
16 THINK THIS IS BEYOND THE SCOPE OF DIRECT.
17 THE COURT: OVERRULED.
18 Q. (BY MS. BARLOW) THESE ARE THE P.R.N. ORDERS; IS THAT
19 CORRECT?
20 A. YES.
21 Q. AS OPPOSED TO THE OTHERS ARE SCHEDULED?
22 A. SCHEDULED.
23 Q. OKAY. THANK YOU.
24 NOW, ON PAGE 292 AND 293. FIRST AT 292.
25 A. UH-HUH.
3463
1 Q. UP AT THE TOP WE HAVE P.R.N. ORDERS AND THEN WE HAVE
2 HERE TO THE SIDE IT SAYS PREOP MEDICATIONS, BUT THESE ARE
3 NOT -- THESE ARE NOT PATIENTS THAT ARE BEING OPERATED ON; IS
4 THAT CORRECT?
5 A. I'M SORRY. I DON'T SEE WHERE THE PREOP.
6 Q. I'M SORRY. IN FACT, YOU CAN'T REALLY READ IT THERE.
7 I'LL WAIT TILL WE GET TO THE NEXT PAGE. WE DO HAVE MORPHINE
8 WRITTEN IN THE CENTER OF THAT PAGE AS BEING ADMINISTERED; IS
9 THAT CORRECT?
10 A. WE'RE STILL ON 92?
11 Q. 292.
12 MS. BARLOW: IF I MAY APPROACH, YOUR HONOR?
13 THE WITNESS: YES.
14 Q. (BY MS. BARLOW) YES. I'M TALKING ABOUT THIS.
15 A. YES.
16 Q. OKAY. THANK YOU.
17 AND THESE ARE WHAT IS CALLED NOW ORDERS; IS THAT
18 CORRECT?
19 A. YES.
20 Q. AND WHAT DOES THAT MEAN?
21 A. ONE DOSE ONLY.
22 Q. AND IT APPEARS THAT TWO DOSES WERE GIVEN ON THE 3RD OF
23 JANUARY, ONE ON THE 4TH AND ONE ON THE 5TH OF JANUARY ON
24 THAT PAGE. AND THEN WE HAVE OVER HERE AT THE TOP IS, P.R.N.
25 ORDER FOR MORPHINE FOR PAIN; IS THAT CORRECT?
3464
1 A. STILL 292?
2 Q. 293.
3 A. YES.
4 Q. AND THAT WAS ACTUALLY -- ONE WAS ADMINISTERED ON THE 5TH
5 OF JANUARY?
6 A. YES.
7 Q. APPEARS BY LYNN LONG, L.L.?
8 A. YES.
9 Q. AND THEN WE HAVE ON THE 7TH OF JANUARY A NOW ORDER IN
10 THE MIDDLE OF THE PAGE?
11 A. UH-HUH.
12 Q. THERE'S NOTHING INDICATING AN ORDER ON THE 6TH OF
13 JANUARY, IS THERE -- OR EXCUSE ME. ADMINISTRATION ON THE
14 6TH OF JANUARY, IS THERE?
15 A. NO.
16 Q. LET'S TURN TO THE NURSING NOTES FOR THE 6TH OF JANUARY.
17 SPECIFICALLY 326 WHICH IS THE NOTE I THINK YOU WERE TALKING
18 ABOUT EARLIER WITH MR. STIRBA. 326?
19 A. UH-HUH.
20 Q. THANK YOU.
21 THIS IS THE NOTE THAT HE REFERRED TO EARLIER 0600 M.S.
22 5 MILLIGRAM I.M. GIVEN FOR PAIN AS ORDERED. DID YOU SEE
23 ANYTHING IN THE MED-RECORD INDICATING THE ADMINISTRATION OF
24 THAT MORPHINE?
25 MR. STIRBA: YOUR HONOR, I'M GOING TO OBJECT TO
3465
1 THAT QUESTION.
2 THE COURT: THE RECORDS CAN SPEAK FOR THEMSELVES.
3 SUSTAINED.
4 Q. (BY MS. BARLOW) IF THAT WAS NOTED IN THE NURSING NOTES
5 BUT NOT THE MED-RECORDS, COULD THAT BE JUST AN OVERSIGHT?
6 MR. STIRBA: CALLS FOR SPECULATION.
7 THE COURT: SUSTAINED.
8 MS. BARLOW: COULD I HAVE JUST A MOMENT, YOUR
9 HONOR?
10 Q. (BY MS. BARLOW) MRS. HANSEN, DID YOU HAVE OCCASION IN
11 1990 WITH HAVING A PROBLEM WITH YOUR NURSING LICENSE?
12 A. YES, I DID.
13 Q. IN FACT --
14 MR. STIRBA: I'M GOING TO OBJECT, YOUR HONOR.
15 THE COURT: WHY DON'T WE -- LET'S TAKE -- LADIES
16 AND GENTLEMEN, I THOUGHT WE WERE GETTING KIND OF TOWARD THE
17 END. WE'VE BEEN GOING PRETTY MUCH OVER AN HOUR. LET'S TAKE
18 OUR -- ONE OF OUR MORNING BREAKS. AND SINCE WE'VE BEEN
19 GOING OVER, LET'S COME BACK AT QUARTER TO TEN. AND DURING
20 THIS TIME REMEMBER IT'S YOUR DUTY NOT TO CONVERSE AMONG
21 YOURSELVES OR WITH ANYONE ELSE OR ALLOW YOURSELVES TO BE
22 ADDRESSED BY ANY PERSON ON THE SUBJECT OF THE TRIAL. AND IT
23 IS YOUR DUTY NOT TO FORM OR EXPRESS AN OPINION UNTIL YOU'VE
24 HEARD ALL THE EVIDENCE AND THE CASE IS FINALLY SUBMITTED TO
25 YOU. SO YOU'LL WE'LL BE IN RECESS UNTIL QUARTER TO TEN.
3466
1 (WHEREUPON, THE JURY LEAVES THE COURTROOM.)
2 THE COURT: YOU MAY BE SEATED. THE RECORD WILL
3 REFLECT THAT THE JURY HAS LEFT THE COURTROOM. OKAY. ON
4 THEIR OBJECTION -- OKAY. WHAT WAS -- FIRST OF ALL, WHAT WAS
5 THE QUESTION AGAIN?
6 MS. BARLOW: YOUR HONOR, I WAS GOING TO GET INTO
7 THE FACT THAT MRS. HANSEN'S NURSING LICENSE WAS ON PROBATION
8 FOR TWO YEARS FROM '90 TO '92. BASED ON HER, NUMBER ONE,
9 ACTING BEYOND THE SCOPE OF HER LICENSE, DOING SOMETHING THAT
10 A DOCTOR SHOULD DO, AND, NUMBER TWO, HER GIVING ONE OF HER
11 OWN HALCION PILLS TO A PATIENT. AND I THINK IT GOES TO HER
12 CREDIBILITY AND SOMETHING THAT APPROPRIATELY CAN BE USED TO
13 IMPEACH A WITNESS.
14 THE COURT: HOW DOES THAT GO TO HER CREDIBILITY
15 THAT SHE ACTED BEYOND THE SCOPE OF HER LICENSE AND SHE GAVE
16 ONE OF HER OWN PILLS TO A PATIENT? HOW DOES THAT GO TO
17 WHETHER SHE'S TELLING THE TRUTH OR NOT TELLING THE TRUTH
18 ABOUT WHAT SHE'S TESTIFIED?
19 MS. BARLOW: WELL, IT GOES TO HER -- WELL, IT GOES
20 TO THE FACT THAT SHE IS WILLING TO GIVE A DRUG THAT HAS NOT
21 BEEN ORDERED FOR SOMEONE. AND IT ALSO GOES TO THE FACT THAT
22 SHE'S WILLING TO DO SOMETHING THAT A DOCTOR WOULD DO, BOTH
23 OF WHICH ARE THINGS THAT A CREDIBLE PERSON WOULD NOT DO. I
24 MEAN, THEY KNOW AN HONEST PERSON WOULD NOT BE ACTING
25 OUTSIDE -- WOULD BE DOING SOMETHING THAT A DOCTOR WOULD BE
3467
1 DOING AND ALSO WOULD NOT BE HANDING OUT THEIR PRESCRIPTION
2 MEDICINES TO OTHER PEOPLE.
3 THE COURT: IS THERE ANY EVIDENCE OF WHAT SHE HAS
4 TESTIFIED THAT SHE ACTED BEYOND THE SCOPE OF HER NURSING
5 LICENSE OR THAT SHE GAVE DRUGS OF HER OWN TO PATIENTS IN
6 THIS CASE?
7 MS. BARLOW: NO, YOUR HONOR.
8 THE COURT: WHAT IS THE OBJECTION?
9 MR. STIRBA: THE OBJECTION IS IT'S NOT A LEGITIMATE
10 IMPEACHMENT MATERIAL COVERED BY ANY OF THE RULES. AND I
11 THINK THAT THE COURT HAS ESSENTIALLY, IN COLLOQUY, INDICATED
12 OUR CONCERN, DOESN'T GO TO HER CREDIBILITY, SHE'S NOT HERE
13 AS AN EXPERT, SHE'S HERE AS A FACT WITNESS. SHE TESTIFIES
14 TO THE FACTS AND THE FACT THAT HER NURSING LICENSE WAS PUT
15 ON PROBATION ALMOST TEN YEARS AGO IS NOT REALLY RELEVANT
16 IMPEACHMENT MATERIAL. IT'S NOT A CREDENTIAL ISSUE. IN
17 OTHER WORDS, IF SHE'S HERE AS AN EXPERT, THEN MAYBE IT
18 WOULD. BUT AS A FACT WITNESS, GIVEN THE CIRCUMSTANCES OF
19 THIS CASE, IT'S INAPPROPRIATE IMPEACHMENT MATERIAL AND DOES
20 NOT ADDRESS CREDIBILITY OF HER TESTIMONY.
21 THE COURT: OKAY. WHICH RULE OF EVIDENCE ARE YOU
22 CLAIMING, MS. BARLOW, THAT THIS WOULD COME IN UNDER?
23 MS. BARLOW: I'M LOOKING, YOUR HONOR. I WAS
24 THINKING OF 609, BUT IT APPEARS 609 IS JUST TALKING ABOUT
25 CONVICTION OF A CRIME.
3468
1 THE COURT: WELL, 608 IS THE ONE THAT SAYS THE
2 CREDIBILITY OF THE WITNESS MAY BE ATTACKED OR SUPPORTED BY
3 EVIDENCE IN THE FORM OF AN OPINION, REPUTATION, EVIDENCE
4 THAT MAY REFER ONLY TO CHARACTER OR FOR TRUTHFULNESS OR
5 UNTRUTHFULNESS.
6 MS. BARLOW: JUST -- I CAN'T POINT TO ANY SPECIFIC
7 RULE THAT SAYS YOU MAY USE LICENSING, BUT I THINK THE JURY
8 SHOULD BE ALLOWED TO WEIGH THIS IN DETERMINING HER
9 CREDIBILITY, YOUR HONOR.
10 THE COURT: WELL, I DON'T SEE ANYTHING UNDER RULE
11 608 OR YOU HAVEN'T CITED ME TO A RULE THAT WOULD ALLOW THAT.
12 I DON'T THINK IT GOES TO HER CREDIBILITY AS TO WHETHER SHE'S
13 TELLING THE TRUTH OR NOT. ACTING BEYOND THE SCOPE OF THE
14 LICENSE OR GIVING HER OWN YOU SAID HALCION PILLS TO A
15 PATIENT, I DON'T SEE THAT BEING EVIDENCE THAT WOULD REFER TO
16 HER CHARACTER FOR TRUTHFULNESS OR UNTRUTHFULNESS. THAT
17 OBJECTION WILL BE SUSTAINED. IS THERE ANYTHING ELSE WE NEED
18 TO DISCUSS BEFORE 9:45?
19 MR. STIRBA: I HAVE NONE, JUDGE.
20 THE COURT: HOW MUCH MORE TIME DO WE HAVE WITH THIS
21 WITNESS?
22 MR. STIRBA: VERY SHORT.
23 MS. BARLOW: THAT WAS GOING TO BE THE LAST
24 QUESTION.
25 THE COURT: THEN YOU HAVE YOUR NEXT WITNESS
3469
1 PRESENT. LET'S COME BACK AT 9:45.
2 (WHEREUPON, COURT WAS IN RECESS.)
3 THE COURT: PLEASE BE SEATED. THE RECORD WILL
4 REFLECT THAT THE JURY HAS RETURNED AND COUNSEL AND THE
5 DEFENDANT ARE PRESENT. MS. BARLOW, DO YOU HAVE ANY FURTHER
6 QUESTIONS?
7 MS. BARLOW: NO FURTHER QUESTIONS.
8 THE COURT: ANY REDIRECT OF THIS WITNESS?
9 MR. STIRBA: JUST A LITTLE, YOUR HONOR. THANK YOU.
10 REDIRECT EXAMINATION
11 BY MR. STIRBA:
12 Q. MS. HANSEN, I'M JUST GOING TO PUT UP ON THE SCREEN AGAIN
13 YOUR NOTE 599. AND I'LL JUST TELL YOU, DOWN AT THE BOTTOM,
14 MAYBE YOU CAN SEE IT FROM WHERE YOU ARE, YOU STATE UNDER THE
15 FREE TEXT, BLOOD PRESSURE GRADUALLY UP 108 OVER 70 AND
16 SOMETHING PRESENT. AND THEN YOU SAY RESPIRATIONS EVEN AND
17 UNLABORED. WHEN YOU CHART THAT, WHAT DO YOU MEAN?
18 A. THAT THE PERSON DOESN'T SEEM TO BE HAVING ANY DIFFICULTY
19 BREATHING. THAT THEY WOULD BE BREATHING THE SAME WAY YOU
20 AND I ARE RIGHT NOW.
21 Q. NOW, WHEN YOU HAVE MET WITH ME I'VE ASKED YOU
22 SOMETHING, HAVE I NOT?
23 A. YES.
24 Q. WHAT HAVE I ASKED YOU TO DO?
25 A. BE HONEST.
3470
1 Q. THANK YOU.
2 MR. STIRBA: NOTHING FURTHER.
3 MS. BARLOW: NOTHING.
4 THE COURT: MAY THIS WITNESS BE EXCUSED? THANK
5 YOU.