Steven Meek, MD
5 STEVEN CHARLES MEEK,
6 HAVING BEEN DULY SWORN, WAS EXAMINED AND
7 TESTIFIED AS FOLLOWS:
8 THE COURT: IF YOU'LL HAVE A SEAT UP HERE, AND
9 DOCTOR. IF YOU WOULD'S GIVE US YOUR FULL NAME AND SPELL YOUR
10 LAST NAME.
11 THE WITNESS: OKAY. STEVEN CHARLES MEEK, M-E-E-K.
12 THE COURT: YOU MAY PROCEED, MR. WILSON.
13 MR. WILSON: THANK YOU.
14 DIRECT EXAMINATION
15 BY MR. WILSON:
16 Q. DR. MEEK, WHERE ARE YOU CURRENTLY PRACTICING MEDICINE?
17 A. I PRACTICE AT DAVIS HOSPITAL AND HAVE PRIVILEGES AT
18 MCKAY-DEE HOSPITAL.
19 Q. OKAY. AND WHEN DID YOU GRADUATE FROM MEDICAL SCHOOL?
20 A. MEDICAL SCHOOL IN 1984.
21 Q. AND SUBSEQUENT TO YOUR GRADUATION, DID YOU OBTAIN ANY
22 BOARD CERTIFICATIONS?
23 A. I COMPLETED A RESIDENCY AT BEAUMONT HOSPITAL IN ROYAL
24 OAK, MICHIGAN AND FINISHED IN 1988 AND THEN WAS BOARD
25 CERTIFIED IN DECEMBER OF 1989.
1 Q. AND WHAT PARTICULAR AREAS WERE YOU BOARD CERTIFIED?
2 A. OBSTETRICS AND GYNECOLOGY.
3 Q. OKAY. AND WHERE DID YOU BEGIN TO PRACTICE AFTER THAT?
4 A. I MOVED BACK TO UTAH AND STARTED PRACTICE IN BRIGHAM
5 CITY, BUT SUBSEQUENTLY MOVED DOWN IN MARCH OF '89 TO TANNER
6 CLINIC AND PRACTICED AT THE DAVIS HOSPITAL.
7 Q. OKAY. AND ARE YOU CURRENTLY PRACTICING THERE?
8 A. YES.
9 Q. WITH TANNER CLINIC ALSO?
10 A. YES.
11 Q. ARE YOU CURRENTLY -- WELL, STRIKE THAT.
12 DID YOU HAVE OCCASION TO BE PRACTICING IN THAT AREA IN
13 HAD 1995 AND EARLY 1996?
14 A. YES.
15 Q. CAN YOU TELL US, DID YOU ACT IN THE CAPACITY AS A
16 CONSULTANT TO DAVIS HOSPITAL?
17 A. YES.
18 Q. IN PARTICULAR, WERE YOU FROM TIME TO TIME CALLED TO
19 CONSULT WITH PATIENTS WHO WERE HOUSED IN THE WHAT WAS CALLED
20 THE GERIATRIC-PSYCHIATRIC UNIT ON THE HOSPITAL?
21 A. YES.
22 Q. AND CAN YOU TELL US, SIR, DRAWING YOUR ATTENTION TO THE
23 CASE THAT'S BEFORE THE COURT, DID YOU HAVE OCCASION TO EVER
24 ATTEND TO A PATIENT BY THE NAME OF MARY CRANE?
25 A. YES. I CONSULTED.
1 Q. AND CAN YOU TELL US WHAT THE NATURE OF THAT CONSULTATION
2 WAS?
3 A. I WAS CALLED TO SEE MARY CRANE BECAUSE IN HER TIME THERE
4 IN THE UNIT SOMEONE HAD FOUND THAT THERE WAS FECAL MATTER IN
5 HER VAGINA AND PASSING OUT OF HER VAGINA.
6 Q. OKAY. DO YOU RECALL WHEN THAT CONSULTATION -- PARTICULAR
7 CONSULTATION TOOK PLACE?
8 A. FROM MY NOTES, THE 2ND OF JANUARY '96.
9 Q. OKAY. AND DO YOU RECALL WHERE IT TOOK PLACE?
10 A. I WOULD PRESUME ON THAT UNIT.
11 Q. OKAY. AND YOU MADE SOME NOTES THAT ARE CONTAINED -- LET
12 ME SHOW YOU WHAT'S BEEN PREVIOUSLY MARKED AS STATE'S EXHIBIT
13 4B. AND I'M REFERRING TO PAGE -- MED PAGE 244 IF YOU WOULD
14 TAKE A LOOK AT THAT IF YOU WOULD, PLEASE.
15 IS THAT THE NOTE REFLECTING YOUR CONSULTATION?
16 A. YES.
17 Q. AS YOU INDICATED PREVIOUSLY IT BEARS THE DATE OF JANUARY
18 2ND OF '96?
19 A. CORRECT.
20 Q. CAN YOU TELL US FROM REVIEWING THAT NOTE, SIR, WHAT IT
21 WAS -- HOW YOU WENT ABOUT YOUR EXAMINATION ON THAT PARTICULAR
22 DAY?
23 A. FROM MY NOTES AT THE BEGINNING OF THE NOTE I REITERATE
24 THE COMPLAINT OR THE PROBLEM. AND THEN FROM EXAMINING HER I
25 FOUND THAT SHE HAD A HIGH RECTAL VAGINAL FISTULA.
1 Q. CAN YOU EXPLAIN TO THE JURY WHAT A HIGH RECTAL VAGINAL
2 FISTULA IS?
3 A. A HIGH RECTAL VAGNIAL FISTULA IS A HOLE BETWEEN THE
4 RECTUM AND THE VAGINA. THE WORD HIGH WOULD DENOTE FARTHER
5 INTO THE VAGINA OR AT A HIGHER PLACE IN THE RECTUM, THE HOLE
6 BEING BETWEEN THOSE TWO.
7 Q. OKAY. DOES YOUR NOTE REFLECT THE SIZE OF THAT PARTICULAR
8 HOLE?
9 A. IT DOES NOT.
10 Q. OKAY. CAN YOU TELL US A LITTLE BIT ABOUT HOW THIS
11 PARTICULAR PROBLEM OCCURS?
12 A. A RECTOVAGINAL FISTULA CAN OCCUR AFTER A PATIENT HAS
13 HAD SURGERY. IT CAN OCCUR AFTER CERTAIN MEDICAL PROBLEMS
14 WHERE THERE'S A INFLAMMATORY PROBLEM EITHER WITH THE BOWEL OR
15 THE VAGINA AND AFTER TRAUMATIC DELIVERIES OR SURGERIES.
16 Q. IF I WAS TO TELL YOU THERE'S EVIDENCE BEFORE THE COURT
17 THIS PARTICULAR PATIENT SUFFERED FREQUENT URINARY TRACT
18 INFECTIONS, WOULD THAT BE CONSISTENT WITH THIS FINDING?
19 A. CONSISTENT WITH WOULD BE A FAIR STATEMENT.
20 Q. OKAY. NOW, ON THIS PARTICULAR DATE CAN YOU TELL US
21 WHETHER YOU MADE ANY NOTATIONS RELATIVE TO ANY OTHER
22 OBSERVATIONS ABOUT THE VAGINAL FISTULA AS IT CONCERNED ANY
23 INFECTIOUS PROCESS?
24 A. I DID NOT.
25 Q. IS THAT SOMETHING IF YOU HAD OBSERVED YOU WOULD HAVE
1 NOTED, DO YOU THINK?
2 A. YES.
3 Q. DO YOU KNOW WHETHER OR NOT THE PATIENT WAS -- HAD ANY
4 FEVER OR OTHER INDICATIONS THAT MIGHT INDICATE AN INFECTIOUS
5 PROCESS?
6 A. FROM MY NOTE I DON'T NOTE ANY OF THAT, NOR I DON'T HAVE
7 ANY INDEPENDENT RECOLLECTION OF THAT. SO I WOULD ASSUME
8 SINCE IT'S NOT IN MY NOTE THAT THERE WAS NOT ANY FEVER.
9 Q. OKAY. NOW IN A CONSULTANT CAPACITY, WHAT IS IT YOU'RE
10 REQUIRED TO DO OR ASKED TO DO?
11 A. AFTER MAKING AN EVALUATION OF THE MEDICAL PROBLEM AND A
12 DIAGNOSIS, THEN AS A CONSULTANT WE CAN MAKE RECOMMENDATIONS
13 FOR DIFFERENT APPROACHES TO SOLVING THE PROBLEM.
14 Q. AND YOU DID THAT ON THIS OCCASION, DID YOU NOT?
15 A. YES.
16 Q. WHAT WAS YOUR RECOMMENDATIONS?
17 A. I POINTED OUT THAT THERE COULD BE TWO POSSIBILITIES TO
18 TRY AND TAKE CARE OF THE PROBLEM. THE FIRST WOULD BE THAT WE
19 COULD TRY TREATING THE PATIENT WITH A LOW RESIDUE DIET TO TRY
20 AND MAKE HER A LITTLE CONSTIPATED SO THAT THAT AREA WASN'T
21 IRRITATED AND TREAT IT WITH BROAD-SPECTRUM ANTIBIOTICS, AND
22 THAT IN A 25 TO 35 PERCENT OF THE TIME THERE WOULD BE A
23 CHANCE FOR THAT FISTULA TO HEAL ON ITS OWN OR SPONTANEOUSLY.
24 Q. SO THAT --
25 A. THE OTHER --
1 Q. THAT WAS ONE OF THE OPTIONS THAT YOU RECOMMENDED?
2 A. YES.
3 Q. OKAY. THERE WAS ANOTHER OPTION?
4 A. THE OTHER OPTION WOULD BE THAT IF HER PRIMARY CARE
5 PHYSICIAN OR INTERNIST FELT LIKE THAT SHE WAS STABLE ENOUGH
6 THEN WE COULD APPROACH THAT PROBLEM SURGICALLY AND REPAIR IT
7 SURGICALLY.
8 Q. OKAY. IN TERMS OF THE DECISION AS TO THE SURGICAL
9 RECOMMENDATION, YOU INDICATED SHE WAS CLEARED BY THE PRIMARY
10 ATTENDING PHYSICIAN OR THE INTERNIST FOR SURGERY?
11 A. IF SHE WERE CLEARED -- THAT'S -- LET ME EXPLAIN THAT --
12 Q. OKAY. IF YOU WOULD, PLEASE.
13 A. -- WHAT THAT MEANS TO US. WHAT THAT MEANS IS THAT THE
14 INTERNIST OR THE PERSON WHO KNEW THE PATIENT WELL AND KNEW OF
15 ALL OF HER MEDICAL PROBLEMS, IF THEY FELT LIKE THAT SHE WAS
16 STABLE ENOUGH TO UNDERGO A OPERATIVE PROCEDURE, THEN WE WOULD
17 BE HAPPY TO ENTERTAIN THAT AND TAKE CARE OF THAT FOR THEM.
18 Q. AS THE CONSULTANT, WOULD YOU HAVE -- IF THEY HAD ELECTED
19 TO FOLLOW THAT RECOMMENDATION, WOULD YOU HAVE BEEN THE
20 SURGEON THAT WOULD HAVE COMPLETED THE SURGICAL PROCEDURE?
21 A. I WOULD PRESUME THAT. BECAUSE IF THE PATIENT OR THE
22 FAMILY HAD SOMEONE ELSE THAT THEY WANTED TO DO THAT, MY
23 ASSUMPTION WOULD HAVE BEEN THAT WHEN SHE HAD THE PROBLEM THEY
24 WOULD HAVE MADE THE REQUEST OF THAT PERSON TO COME AND SEE
25 HER AND CONSULT IN THE UNIT. SO THAT NOT BEING THE CASE, I
1 WOULD PRESUME THAT THEY WOULD CALL ME AGAIN TO DO THE SURGERY
2 IF THEY FELT THAT SHE WAS STABLE ENOUGH TO DO IT.
3 Q. AS THE CONSULTANT, WAS THERE ANY FOLLOW UP THAT YOU WOULD
4 HAVE DONE IN RESPECT TO THIS PATIENT?
5 A. AFTER THIS NOTE I -- WE BASICALLY LEAVE IT TO THE PRIMARY
6 PHYSICIAN AND I WOULD EXPECT TO HEAR FROM THEM IF THEY WANTED
7 US TO FURTHER EVALUATE AND TREAT THE PROBLEM.
8 Q. OKAY. DO YOU RECALL WHETHER OR NOT YOU EVER HEARD FROM
9 THE PRIMARY PHYSICIAN?
10 A. I DON'T THINK THAT I WAS -- THAT I CONSULTED ON THE CASE
11 FURTHER AFTER THIS.
12 Q. CAN YOU TELL US IF THE CONDITION ITSELF THAT YOU OBSERVED
13 ON THAT THAT OCCASION WAS OF ANY KIND OF A LIFE-THREATENING
14 CONDITION?
15 A. FROM THE NOTE AND MY RECOMMENDATIONS, I WOULD SAY NOT.
16 Q. CAN YOU TELL US, SIR, WHETHER OR NOT IN THE COURSE OF
17 YOUR EXAMINATION YOU DETERMINED WHETHER OR NOT THIS PATIENT
18 WAS EXPERIENCING ANY PAIN AS A RESULT OF THIS CONDITION?
19 A. I DON'T HAVE ANY INDEPENDENT RECOLLECTION OF THAT AND
20 IT'S -- IT'S NOT IN MY NOTES SO I DON'T THINK I CAN ANSWER
21 THAT.
22 Q. OKAY. FROM YOUR EXPERIENCE CAN YOU TELL US WHETHER OR
23 NOT THERE COULD BE PAIN ASSOCIATED WITH THIS PARTICULAR
24 CONDITION?
25 A. THERE CERTAINLY -- IT'S WITHIN THE REALM OF POSSIBILITY.
1 AT THE TIME, THERE ARE MANY PEOPLE WHO HAVE THIS CONDITION
2 WHERE IT'S NOT PARTICULARLY PAINFUL.
3 Q. I ASSUME THE RISK OF INFECTION SINCE YOU RECOMMENDED A
4 BROAD-SPECTRUM ANTIBIOTIC IS A RISK THAT IS ASSOCIATED WITH
5 NOT TREATING THIS PARTICULAR CONDITION, IS THAT RIGHT?
6 A. THE -- I WOULDN'T SAY IT MEDICALLY THE WAY YOU SAID IT,
7 SIR, NOT DISRESPECTFULLY.
8 Q. OKAY. HOW WOULD YOU SAY IT?
9 A. THE REASON TO TRY THE ANTIBIOTICS IS THAT WHENEVER --
10 OBVIOUSLY THE RECTUM IS A SOURCE OF A LOT OF BACTERIA. AND
11 SO BECAUSE OF THAT AND THE FISTULA OR HOLE BETWEEN THE RECTUM
12 AND THE VAGINA, THE RECOMMENDATION FOR THE ANTIBIOTICS AND
13 THE LOW RESIDUE DIET TOGETHER IS TO TRY AND DECREASE THE
14 AMOUNT OF, IF YOU WILL, NORMAL TRAUMA TO THAT PART OF THE
15 BOWEL AND TO LOWER THAT LOAD OF BACTERIA BY THE ANTIBIOTICS
16 TO HOPEFULLY ALLOW THAT LITTLE HOLE TO HEAL ON ITS OWN.
17 THEREFORE, THE RECOMMENDATION FOR ANTIBIOTICS WAS MORE
18 ALONG THOSE LINES THAN BECAUSE OF ANY FEELING THAT I HAD THAT
19 BECAUSE OF THE CONDITION SHE COULD DEVELOP SOME MORE OF A
20 BROAD INFECTION THROUGHOUT HER SYSTEM.
21 Q. CAN YOU TELL US IN YOUR EXPERIENCE HOW LONG IT WOULD
22 PROBABLY -- POSSIBLY TAKE FOR THAT VAGINA FISTULA TO HEAL ON
23 ITS OWN?
24 A. WE OFTEN WILL GIVE THOSE MANY WEEKS TO A FEW MONTHS WITH
25 THAT TYPE OF APPROACH TO TRY AND SEE IF THEY WILL HEAL ON
1 THEIR OWN.
2 Q. OKAY.
3 MR. WILSON: THANK YOU, DOCTOR. I HAVE NO FURTHER
4 QUESTIONS.
5 THE COURT: CROSS-EXAMINE, MS. ISAACSON.
6 CROSS-EXAMINATION
7 BY MS. ISAACSON:
8 Q. DR. MEEK, ARE CIPRO AND KEFLEX TWO TYPES OF ANTIBIOTICS
9 THAT YOU WOULD RECOMMEND FOR TREATMENT OF THIS SORT OF
10 CONDITION?
11 A. YES. THEY ARE -- THEY ARE -- THEY WOULD BE GOOD CHOICES.
12 MS. ISAACSON: THAT'S ALL I HAVE.
13 THE COURT: REDIRECT, MR. WILSON?
14 MR. WILSON: COULD I HAVE JUST A SECOND, YOUR HONOR?
15 THE COURT: WELL, THERE CAN'T BE MUCH CROSS.
16 MR. WILSON: I HAVE NO FURTHER QUESTIONS, YOUR
17 HONOR.
18 THE COURT: THANK YOU. MAY THIS WITNESS BE EXCUSED?
19 MR. WILSON: HE MAY, YOUR HONOR.
20 MS. ISAACSON: YES, YOUR HONOR.
21 THE COURT: THANKS FOR COMING. YOU MAY BE EXCUSED.