Steven Meek, MD
1 STEVEN MEEK,
2 CALLED BY THE PLAINTIFF, HAVING BEEN DULY
3 SWORN, WAS EXAMINED AND TESTIFIED AS FOLLOWS:
4 DIRECT EXAMINATION
5 BY MR. WILSON:
6 Q. GOOD MORNING, DOCTOR.
7 A. GOOD MORNING.
8 Q. WOULD YOU STATE YOUR FULL NAME FOR THE RECORD, PLEASE?
9 A. STEVEN CHARLES MEEK.
10 Q. AND YOU ARE EMPLOYED IN WHAT CAPACITY?
11 A. I'M A PHYSICIAN AT THE TANNER MEMORIAL CLINIC.
12 Q. CAN YOU TELL US WHEN YOU GRADUATED FROM MEDICAL SCHOOL,
13 DOCTOR?
14 A. 1984.
15 Q. FROM WHAT SCHOOL DID YOU GRADUATE?
16 A. UNIVERSITY OF UTAH SCHOOL OF MEDICINE.
17 Q. AND DO YOU CURRENTLY HOLD ANY BOARD CERTIFICATIONS?
18 A. BOARD CERTIFIED IN OBSTETRICS AND GYNECOLOGY.
19 Q. HOW LONG HAVE YOU HELD THAT PARTICULAR CERTIFICATION?
20 A. SINCE 1989, DECEMBER.
21 Q. AND HOW LONG HAVE YOU BEEN IN BUSINESS AT THE TANNER
22 MEMORIAL CLINIC?
23 A. SINCE MARCH OF '89.
24 Q. IN CONNECTION WITH YOUR POSITION AT TANNER MEMORIAL, DO
25 YOU ALSO HAVE PRIVILEGES AT THE DAVIS HOSPITAL?
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1 A. YES.
2 Q. AND DO YOU PRACTICE THERE FREQUENTLY?
3 A. YES.
4 Q. ARE YOU FREQUENTLY ON CALL AS A CONSULTANT?
5 A. YES.
6 Q. WERE YOU ON -- WERE YOU INVOLVED IN THAT PARTICULAR
7 SPECIALTY AND ON CALL BACK IN 1995 AND EARLY 1996?
8 A. YES.
9 Q. DID YOU HAVE OCCASION DURING THAT TIME FRAME TO CONSULT
10 WITH PATIENTS WHO WERE HOUSED IN THE GEROPSYCH UNIT ON THE
11 HOSPITAL?
12 A. YES.
13 Q. NOW, CALLING YOUR ATTENTION IN PARTICULAR TO A PATIENT
14 BY THE NAME OF MARY CRANE. DID YOU EVER HAVE OCCASION TO BE
15 CALLED TO DO A CONSULT, A GYNECOLOGICAL CONSULT IN RESPECT
16 TO THAT PARTICULAR PATIENT?
17 A. YES.
18 Q. CAN YOU TELL THE COURT WHEN THAT WAS?
19 A. ACCORDING TO MY NOTES, IT WAS THE SECOND OF JANUARY,
20 1996.
21 Q. OKAY. NOW, YOU ARE REFERRING TO A DOCUMENT THAT YOU
22 HAVE IN YOUR HAND; IS THAT CORRECT?
23 A. UH-HUH, YES.
24 Q. WHAT IS THAT DOCUMENT?
25 A. IT'S A PHOTOCOPY OF A PHYSICIAN'S ORDER AND PROGRESS
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1 RECORD.
2 Q. OKAY. I'M GOING TO PUT THAT NOTE UP THERE. FIRST OF
3 ALL, DOCTOR, CAN YOU TELL US, DO YOU HAVE ANY INDEPENDENT
4 RECOLLECTION ABOUT THIS PARTICULAR ENTRY?
5 A. NO.
6 Q. FOR THE RECORD, THIS IS MED NOTE 00244 OUT OF THE FILE
7 OF MARY CRANE. THAT IS YOUR HANDWRITING, I ASSUME, ON THAT
8 NOTE?
9 A. YES.
10 Q. IN REVIEWING THE NOTE, FIRST OF ALL, MAYBE WE OUGHT TO
11 HAVE YOU INTERPRET IT AND THEN WE CAN GO OVER IT IN SOME
12 DETAIL. CAN YOU JUST TELL US WHAT THE NOTE SAYS?
13 A. IT SAYS THE DATE, THAT IT WAS THE 2ND OF JANUARY 1996.
14 IT WAS A G.Y.N. CONSULT. THE FIRST SENTENCE IS A
15 DESCRIPTION OF WHY I WAS CALLED TO SEE THE PATIENT. SOME OF
16 THE NURSING STAFF HAD NOTICED THAT THERE WAS FECAL MATTER IN
17 THE PATIENT'S VAGINA. SECOND LINE SAYS THAT WHEN I WAS
18 CALLED TO SEE HER, THAT WHEN I EXAMINED HER, THAT I FOUND ON
19 EXAMINATION A RECTAL/VAGINAL FISTULA, WHICH MEANS A HOLE
20 BETWEEN THE PATIENT'S RECTUM AND THE VAGINA. AND THEN THE
21 REST OF THE NOTE IS POSSIBLE WAYS THAT WE COULD APPROACH THE
22 PROBLEM.
23 Q. THEN IT BEARS YOUR THANKS AND YOUR SIGNATURE, I TAKE IT?
24 A. RIGHT.
25 Q. YOU SAID A RECTAL/VAGINAL FISTULA?
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1 A. THE RECTAL --
2 Q. I'M NOT READING THAT RIGHT. I'M GOING TO POINT TO WHAT
3 YOU SAY THERE IS A HOLE BETWEEN THE VAGINA AND THE RECTAL
4 AREA.
5 A. UH-HUH.
6 Q. HOW FAR INTO THE VAGINA IS THAT -- WAS THAT LOCATED OR
7 CAN YOU REMEMBER?
8 A. I CAN'T REMEMBER.
9 Q. IN RESPECT TO THE SIZE OF THE HOLE, CAN YOU TELL US
10 ANYTHING ABOUT THAT?
11 A. HONESTLY, NO. I HAVE NO RECOLLECTION.
12 Q. YOU INDICATE AFTER MAKING THOSE OBSERVATIONS THAT YOU
13 COULD DO TWO THINGS, AS I UNDERSTAND IT. YOU CAN EITHER DO
14 SURGERY TO REPAIR IT OR YOU COULD TRY TO TREAT IT WITH
15 ANTIBIOTICS; IS THAT CORRECT?
16 A. YES. THE ANTIBIOTICS WOULD BE PART OF A CONSERVATIVE
17 APPROACH TO TRY AND GET IT TO HEAL BY ITSELF.
18 Q. DO YOU RECALL WHETHER OR NOT YOU EVER -- STRIKE THAT.
19 DO YOU RECALL WHETHER THERE WAS EVER ANY FOLLOW-UP DONE BY
20 YOU IN CONNECTION WITH THIS PARTICULAR PATIENT?
21 A. MY RECOLLECTION IS THAT AFTER THIS NOTE THAT I DIDN'T
22 HEAR ANYTHING MORE ABOUT IT.
23 Q. OKAY. YOU INDICATE THAT YOU RECOMMEND CONSULTING WITH
24 THE INTERNIST PRIOR TO ANY SURGERY; IS THAT RIGHT?
25 A. YES.
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1 Q. YOU WOULD HAVE TO CLEAR HER FOR SURGERY?
2 A. UH-HUH.
3 Q. DO YOU RECALL, SIR, WHETHER OR NOT YOU HAD ANY
4 IMPRESSIONS AS TO WHETHER THIS PARTICULAR PATIENT WAS IN
5 PAIN?
6 A. I HAVE NO RECOLLECTION OF THAT.
7 Q. OKAY. DO YOU RECALL, SIR, WHETHER OR NOT YOU HAD ANY
8 IMPRESSIONS AS TO WHETHER OR NOT THERE WAS ANY INFECTION
9 PRESENT?
10 A. THE ONLY THING I CAN SAY CONCERNING THAT IS IF I WOULD
11 HAVE BEEN IMPRESSED WITH A SIGNIFICANT INFECTION I WOULD
12 HAVE NOTED THAT IN MY NOTE.
13 Q. NOW, IN TERMS OF TREATING IT WITH THE BROAD SPECTRUM OF
14 ANTIBIOTICS, IS THE NOTE ON THE 25 TO 35 PERCENT, IS THAT A
15 PROBABILITY OF SUCCESS AS FAR AS THAT TREATMENT GOES?
16 A. YES.
17 Q. OKAY. DO YOU REMEMBER HAVING ANY CONVERSATIONS WITH A
18 DR. DIENHART CONCERNING THIS PATIENT?
19 A. I DO NOT.
20 MR. WILSON: OKAY. I HAVE NO FURTHER QUESTIONS,
21 YOUR HONOR.
22 THE COURT: MR. STIRBA.
23 CROSS-EXAMINATION
24 BY MR. STIRBA:
25 Q. DOCTOR, YOU TESTIFIED THAT YOU PRESENTLY WORK AT THE
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1 TANNER CLINIC; IS THAT RIGHT?
2 A. YES.
3 Q. AND DID YOU DO SO BACK WHEN THIS OCCURRED I GUESS IN
4 1996?
5 A. YES.
6 Q. AND YOU RECALL THAT YOU RESPONDED FOR THE CONSULT IN
7 RESPONSE TO SOMETHING A NURSE OR SOMEONE CONTACTED THE
8 CLINIC CONCERNING; IS THAT RIGHT?
9 A. YES.
10 Q. NOW, DOWN AT THE BOTTOM THERE, AND I'M REFERRING TO THIS
11 ENTRY HERE WHICH APPEARS TO BE 1/1 OF '96, IT SAYS 2000
12 TELEPHONE CONVERSATION, DR. HALL ON-CALL GYNECOLOGIST AT THE
13 TANNER CLINIC CONTACTED. DID DR. HALL WORK THERE AT THE
14 TIME?
15 A. HE DID.
16 Q. AND HE'S A GYNECOLOGIST; IS THAT RIGHT?
17 A. ONE OF MY PARTNERS, YES.
18 Q. ONE OF YOUR PARTNERS. OKAY. AND THEN IT SAYS NOTICED A
19 LARGE AMOUNT OF FECAL MATTER, LOOKS LIKE EXCRETED THROUGH
20 VAGINA. DOCTOR ADVISED GETTING CONSULT A.M. AS PLANNED.
21 SINCE IT LOOKS LIKE VITAL SIGNS -- THIS V.S. YOU UNDERSTAND
22 TO BE VITAL SIGNS -- ARE STABLE AT THIS TIME AND NO
23 INFECTION IS INDICATED. THEN IT APPEARS TO BE SIGNED LYNN
24 LONG, R.N. DO YOU SEE THAT?
25 A. I DO.
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1 Q. WOULD THAT BE CONSISTENT THEN WITH HOW YOU BELIEVE IT
2 CAME TO PASS THAT YOU WERE CONTACTED AND ULTIMATELY PROVIDED
3 THE CONSULT?
4 A. I HAVE NEVER SEEN THIS NOTE, BUT THAT WOULD BE
5 CONSISTENT, YES.
6 Q. NOW, PUTTING YOUR NOTE BACK UP ON THE SCREEN AND YOU DO
7 REFERENCE, I BELIEVE, IN THAT NOTE YOU SAY SPINAL ANESTHETIC
8 IF PATIENT CLEARED FOR SURGERY BY HER INTERNIST. DID I READ
9 THAT CORRECTLY?
10 A. YES.
11 Q. IT'S TRUE, IS IT NOT, THAT WHAT YOU WERE INDICATING
12 THERE WAS -- THAT IF SURGERY WAS GOING TO BE AN OPTION FOR
13 PURPOSES OF REPAIR, YOU WANTED TO MAKE SURE THAT HER
14 INTERNIST THOUGHT THAT SHE WAS APPROPRIATE AND MEDICALLY
15 STABLE ENOUGH SO SHE COULD WITHSTAND THE ANESTHESIA AND THE
16 SURGICAL PROCEDURE; IS THAT RIGHT?
17 A. YES.
18 Q. AND YOU THOUGHT CERTAINLY THAT IN TERMS OF THAT
19 DETERMINATION THAT IT WAS APPROPRIATE THAT HER INTERNIST
20 MAKE IT; IS THAT TRUE?
21 A. YES.
22 Q. THAT WAS NOT SOMETHING THAT YOU WERE GOING TO DO; IS
23 THAT CORRECT?
24 A. THAT'S CORRECT.
25 Q. AND IT'S TRUE, IS IT NOT, IN TERMS OF THEN YOU GO AND
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1 SAY ALSO -- IT'S EASIER FOR ME TO SEE IT FROM UP HERE --
2 ALSO MAY TRY TO HEAL SPONTANEOUSLY, PROBABILITY 25 TO
3 35 PERCENT. AND WHAT YOU ARE SAYING THERE IS THAT YOU CAN
4 TRY THE BROAD SPECTRUM ANTIBIOTICS AND YOU ARE SAYING THE
5 PROBABILITY OF ACTUALLY REPAIRING ITSELF OR ADHERING ITSELF
6 IS ABOUT 25 TO 35 PERCENT, TRUE?
7 A. YES.
8 Q. AND IF IT DOES NOT HEAL ITSELF, IN OTHER WORDS, LET'S
9 SAY THE ANTIBIOTICS ARE TRIED. IT DOES NOT HEAL ITSELF, I'M
10 ASSUMING THAT THEN YOU DO HAVE TO CONSIDER A SURGICAL
11 PROCEDURE; IS THAT CORRECT?
12 A. YES.
13 Q. AND IT'S TRUE, IS IT NOT, THAT WHERE YOU SAY BY TREATING
14 WITH BROAD SPECTRUM -- THIS STAND FOR ANTIBIOTICS, CORRECT?
15 A. YES.
16 Q. IT'S TRUE, IS IT NOT, THAT ONE OF THE REASONS WHY YOU
17 MIGHT TREAT SUCH A CONDITION WITH ANTIBIOTICS IS BECAUSE YOU
18 ARE CONCERNED, ARE YOU NOT, ABOUT AN INFECTIOUS PROCESS?
19 A. THE REASON FOR USING THE ANTIBIOTICS IN THIS SITUATION
20 IS IF THERE IS AN INFECTION, IT WILL HELP WITH THE
21 INFECTION. BUT THERE'S ALSO A LOT OF BACTERIA IN THE STOOL
22 AND SO YOU -- WHAT YOU TRY TO DO IS MAKE -- AS INDICATED BY
23 THE PARENTHESES -- KIND OF CONSTIPATE THE PATIENT, LOWER THE
24 AMOUNT OF BACTERIA IN THE STOOL AND SOMETIMES THE FISTULA
25 WILL HEAL THEMSELVES.
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1 Q. AND THAT BACTERIA THAT'S IN THE STOOL IS OF CONCERN FOR
2 PURPOSES OF THE DEVELOPMENT OF AN INFECTION, IS IT NOT?
3 A. IT IS.
4 Q. AND CERTAINLY ONE OF THE PROBLEMS BY HAVING A
5 PERFORATION OF ESSENTIALLY THE VAGINAL WALL IS THAT THERE
6 MIGHT BE A TRANSMISSION OR A COMMUNICATION SUCH THAT THE
7 BACTERIA FROM THE STOOL MAY ESSENTIALLY INVADE THE BODY?
8 A. IT CAN GET INTO THE VAGINA, CERTAINLY.
9 Q. AND THAT POTENTIALLY CAN CAUSE AN INFECTIOUS DISEASE
10 PROCESS; IS THAT CORRECT?
11 A. YES, THAT IS CORRECT.
12 MR. STIRBA: THAT'S ALL I HAVE, YOUR HONOR. THANK
13 YOU.
14 THE COURT: ANYTHING FURTHER?
15 MR. WILSON: I THINK NOT, YOUR HONOR.
16 THE COURT: MAY THIS WITNESS BE EXCUSED? THANK
17 YOU.
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