Testimony of Rachel Stubb, MD November 6, 2002
(The more interesting notes have been typed in red, the most interesting are also emboldened.)
23 RACHEL STUBBS,
24 BEING FIRST DULY SWORN, WAS EXAMINED
25 AND TESTIFIED AS FOLLOWS:
1 DIRECT EXAMINATION
2 THE COURT: IF YOU'LL HAVE A SEAT UP HERE. DOCTOR, IF
3 YOU'LL STATE YOUR FULL NAME AND SPELL YOUR LAST NAME PLEASE.
4 A. MY NAME IS RACHEL STUBBS. SPELLING IS S-T-U-B-B-S.
5 THE COURT: MAY PROCEED, MR. WILSON.
6 MR. WILSON: THANK YOU YOUR HONOR.
7 Q. (BY MR. WILSON) DR. STUBBS WHERE ARE YOU CURRENTLY
8 PRACTICING?
9 A. I AM A PHYSICIAN IN SALT LAKE AND WHAT I DO IS I AM THE
10 MEDICAL DIRECTOR FOR SEVERAL NURSING HOMES IN THE SALT LAKE
11 VALLEY.
12 Q. OKAY. HOW LONG HAVE YOU OCCUPIED THAT PARTICULAR
13 POSITION?
14 A. OH, ABOUT FIVE YEARS.
15 Q. PREVIOUS TO THAT TIME -- AND MAYBE FOR THE RECORD WHEN
16 DID YOU GRADUATE FROM MEDICAL SCHOOL?
17 A. 1989.
18 Q. AND DO YOU HOLD ANY CERTIFICATIONS IN ANY SPECIALTIES AT
19 THIS TIME?
20 A. YES I'M BOARD CERTIFIED IN INTERNAL MEDICINE.
21 Q. AND WHEN DID THAT CERTIFICATION TAKE PLACE?
22 A. I BELIEVE THAT WOULD BE 1992.
23 Q. AND BACK IN -- CALLING YOUR ATTENTION BACK TO THE YEARS
24 IN THE EARLY 90S FROM 1993 TO THROUGH 1995, WHERE WAS YOUR
25 MEDICAL PRACTICE AT THAT TIME?
1 A. AT THAT TIME I WAS IN GROUP PRACTICE CALLED WASATCH
2 INTERNAL MEDICINE IN SALT LAKE.
3 Q. DID YOU HAVE A PATIENT BY THE NAME OF MARY CRANE?
4 A. YES, I DID.
5 Q. AND DO YOU RECALL DR. WHEN YOU FIRST -- WHEN SHE FIRST
6 BECAME YOUR PATIENT?
7 A. I BELIEVE IT WAS THE -- TOWARD THE END OF 1993.
8 Q. AND WHERE WOULD YOU SEE THIS PATIENT?
9 A. MRS. CRANE WAS LIVING AT A NURSING HOME BUT I ALWAYS SAW
10 HER IN MY OFFICE.
11 Q. OKAY. CAN YOU TELL US HOW LONG YOU CONTINUED TO SEE
12 HER?
13 A. THE LAST VISIT I HAD WITH HER WAS NOVEMBER OF 1995.
14 Q. OKAY. HOW OFTEN DURING THIS TIME PERIOD WOULD YOU SEE
15 HER?
16 A. I WOULD ROUTINELY SEE HER EVERY 60 DAYS.
17 Q. SO FROM LATE 1993 UP UNTIL NOVEMBER OF 1995, YOU WOULD
18 SEE HER EVERY 60 DAYS?
19 A. RIGHT.
20 Q. WAS THERE A REASON FOR SEEING HER EVERY 60 DAYS?
21 A. THAT'S A STATE REQUIREMENT FOR RESIDENTS OF LONG TERM
22 CARE FACILITIES.
23 Q. OKAY. DID YOU MAKE AN EVALUATION CONCERNING HER HEALTH
24 IN YOUR FIRST VISIT AS FAR AS DID YOU MAKE ANY KIND OF
25 PHYSICAL EXAMINATION OR CONDUCT ANY EXAMINATIONS OF THAT
1 NATURE?
2 A. YES I DID.
3 Q. AND CAN YOU TELL US DR. HAVE YOU HAD AN OPPORTUNITY TO
4 REVIEW YOUR MEDICAL RECORDS RELATED TO THOSE EXAMINATIONS?
5 A. YES I HAVE.
6 Q. AND CAN YOU TELL US OR CHARACTERIZE FOR THE JURY IF YOU
7 WOULD, WHAT YOUR FINDINGS WERE RELATIVE TO THE PHYSICAL AND
8 MENTAL HEALTH OF MARY CRANE BACK IN THE FALL OF 1993?
9 MR. BUGDEN: YOUR HONOR --
10 THE COURT: IS THAT RELEVANT, MR. WILSON?
11 MR. WILSON: I THINK IT IS, YOUR HONOR, AND I'LL SHOW
12 THE RELEVANCY AT THE NEXT QUESTION.
13 THE COURT: ALL RIGHT.
14 THE WITNESS: MRS. CRANE WAS NOT HAVING ANY ACUTE
15 MEDICAL PROBLEMS THE FIRST TIME I SAW HER. SHE DID HAVE SOME
16 CHRONIC ONGOING PROBLEMS. SHE HAD HAD A STROKE IN 1990
17 BEFORE I EVER MET HER WHICH LEFT HER WITH SOME WEAKNESS I
18 THINK ON HER LEFT SIDE. SHE HAD A HISTORY OF DEPRESSION WITH
19 SOME PSYCHOSIS RELATED TO THAT ALSO.
20 Q. (BY MR. WILSON) ANY OTHER PRIOR HISTORY THAT WAS
21 RELEVANT TO HER HEALTH THAT YOU -- WHEN YOU FIRST EVALUATED
22 HER?
23 A. SHE -- THE OTHER THINGS THAT I CAN RECALL WERE SHE HAD A
24 HISTORY OF HAVING LOW SODIUM LEVELS WHICH WAS BELIEVED TO BE
25 DUE TO SOME EXCESSIVE WATER DRINKING. SHE HAD FREQUENT -- A
1 HISTORY OF FREQUENT BLADDER INFECTIONS.
2 Q. NOW KEEPING IN MIND WHAT THE PHYSICAL CONDITION SHE WAS
3 IN AT THAT TIME UP UNTIL THE LAST TIME THAT YOU SAW HER, DID
4 YOU SEE ANY CHANGES IN HER PHYSICAL CONDITION? LET'S JUST
5 TALK ABOUT THE PHYSICAL CONDITION FROM THE FALL OF 1993 UP
6 UNTIL THE LAST TIME YOU SAW HER IN 1995 IN NOVEMBER?
7 A. NO. HER CONDITION, HER PHYSICAL CONDITION WAS REALLY
8 PRETTY STABLE DURING THE TIME I SAW HER.
9 Q. OKAY. RELATIVE TO HER MENTAL HEALTH, DID YOU FORM ANY
10 IMPRESSIONS BACK IN 1993 -- I THINK YOU TALKED A LITTLE BIT
11 ABOUT A DEPRESSION. AND CAN YOU TELL US FROM 1993 UP UNTIL
12 THE TIME OF -- YOU LAST SAW HER IN NOVEMBER OF 1995, DID YOU
13 FORM ANY IMPRESSIONS RELATED TO HER MENTAL HEALTH?
14 A. THERE WAS NO SIGNIFICANT CHANGE DURING THAT TIME. SHE
15 DID HAVE HER UPS AND DOWNS AS FAR AS SOME BEHAVIORAL PROBLEMS
16 AT THE NURSING HOME, BUT OVERALL NOT A SIGNIFICANT CHANGE.
17 Q. WERE YOU IN FACT TREATING HER IN RESPECT TO THOSE
18 BEHAVIORAL PROBLEMS?
19 A. I BELIEVE THAT DURING MOST OF THE TIME I WAS SEEING HER,
20 THAT A PSYCHIATRIST FROM VALLEY MENTAL HEALTH WAS TREATING
21 HER FOR THOSE PROBLEMS.
22 Q. DID MARY CRANE EVER COMPLAIN TO YOU DURING THAT TIME
23 FRAME CONCERNING ANY PAIN, PAINFUL CONDITION THAT SHE MAY BE
24 SUFFERING FROM?
25 A. THE ONE THING THAT SHE DID FREQUENTLY COMPLAIN OF WAS
1 HEADACHES.
2 Q. OKAY. AND DID YOU PRESCRIBE ANYTHING IN RESPECT TO
3 THOSE HEADACHES?
4 A. YES.
5 Q. AND WHAT WAS THAT, MA'AM?
6 A. SHE HAD A ORDER FOR JUST OVER THE COUNTER TYLENOL WHICH
7 SHE WOULD BE GIVEN IF THE NURSES OR FAMILY FELT THAT IT WAS A
8 MINOR HEADACHE. SHE ALSO HAD AN ORDER FOR HYPHEN WHICH IS A
9 NARCOTIC PAIN MEDICATION THAT THEY WOULD GIVE HER IF SHE
10 HAD --
11 MR. BUGDEN: CAN YOU KEEP YOUR VOICE UP JUST A LITTLE
12 BIT MORE, MA'AM?
13 THE WITNESS: SURE. THEY WOULD GIVE HER HYPHEN WHICH IS
14 A NARCOTIC PAIN MEDICATION IF THEY FELT SHE WAS HAVING MORE
15 SEVERE PAIN.
16 Q. (BY MR. WILSON) SO THAT WAS A CONTROLLED SUBSTANCE?
17 A. THAT'S RIGHT.
18 Q. AND CAN YOU TELL US THE -- RELATED TO THE HYPHEN, WHAT
19 THE DOSAGE WAS OR WHAT THE STRENGTH OF THAT PARTICULAR
20 PRESCRIPTION YOU ORDERED FOR HER WAS?
21 A. I WOULD HAVE TO LOOK AT HER RECORDS AGAIN TO BE ABLE TO
22 ANSWER THAT.
23 Q. ALL RIGHT. IN TERMS OF THE COMPLAINTS OF PAIN OTHER
24 THAN THE HEADACHES WERE THERE ANY OTHER COMPLAINTS THAT SHE
25 MADE TO YOU?
1 A. THE ONLY OTHER THING THAT I RECALL IS SHE WOULD HAVE
2 OCCASIONALLY COMPLAINT OF LOW BACK PAIN.
3 Q. OKAY. AND DID YOU PROVIDE ANY KIND OF TREATMENT OR
4 MEDICATION RELATED TO THE LOWER BACK PAIN?
5 A. IT WAS THE SAME, SAME TWO MEDICATIONS COULD BE USED AS
6 NEEDED FOR HER BACK PAIN.
7 Q. WERE THERE ANY OTHER MEDICATIONS THAT YOU PRESCRIBED FOR
8 HER DURING THE TIME FRAME YOU WERE TREATING HER?
9 A. ANY OTHER MEDICATIONS I PRESCRIBED FOR HER?
10 Q. UH-HUH?
11 A. WELL, SHE WAS ON A NUMBER OF MEDICATIONS.
12 Q. CAN YOU REMEMBER WHAT THOSE WERE?
13 A. SHE WAS ON AN ANTIDEPRESSANT MEDICATION, ZOLOFT.
14 Q. DID SHE RECEIVE ANY MEDICATIONS FOR THE CONDITION THAT
15 YOU WERE TALKING ABOUT, THE LOW SODIUM?
16 A. NO SHE DIDN'T RECEIVE MEDICATION FOR THAT.
17 Q. WHAT WAS THE TREATMENT THAT WAS RECOMMENDED FOR THAT
18 PARTICULAR CONDITION?
19 A. THE STAFF AT THE NURSING HOME WERE USUALLY ABLE TO
20 CONTROL THAT THROUGH TRYING TO CONTROL HER WATER DRINKING.
21 Q. NOW, YOU INDICATED THAT SHE DID SUFFER FROM TIME TO TIME
22 FROM BLADDER INFECTIONS, IS THAT CORRECT?
23 A. THAT'S RIGHT, FAIRLY FREQUENTLY.
24 Q. OKAY. AND WAS THERE ANY TREATMENT THAT YOU WOULD RENDER
25 IN CONNECTION WITH THAT?
1 A. YES, SHE DID RECEIVE ANTIBIOTICS FROM TIME TO TIME FOR
2 HER BLADDER INFECTIONS.
3 Q. OKAY. WERE YOU AWARE IN DECEMBER OF 1995 THAT SHE
4 WAS -- OR WERE YOU MADE AWARE THAT SHE WAS GONNA BE
5 TRANSFERRED TO THE DAVIS NORTH OR DAVIS HOSPITAL GERO-PSYCH
6 UNIT?
7 A. YES, I WAS.
8 Q. OKAY. AND AT THE TIME OF -- THAT YOU LAST SAW HER, CAN
9 YOU DESCRIBE FOR US WHETHER HER CONDITION, HER MEDICAL
10 CONDITION WAS STABLE AT THAT TIME?
11 A. IT WAS WHEN I LAST SAW HER IN NOVEMBER OF '95.
12 Q. OKAY. I HAVE NO FURTHER QUESTIONS, YOUR HONOR.
13 THE COURT: CROSS-EXAMINE, MR. BUGDEN.
14 CROSS-EXAMINATION
15 BY MR. BUGDEN:
16 Q. HOW DO YOU DO. MY NAME IS WALTER BUGDEN, DR. STUBBS. I
17 REPRESENT DR. WEITZEL AND I'M GONNA ASK YOU SOME QUESTIONS
18 THIS AFTERNOON. AND I'M GONNA GIVE YOU SOME DOCUMENTS DOCTOR
19 THAT WILL HELP YOU I THINK TO REFRESH YOUR RECOLLECTION. AND
20 LET ME JUST POINT SOMETHING OUT TO YOU, DOCTOR. OCCASIONALLY
21 I'LL REFER TO AN MED NUMBER LIKE THAT. OR AN N.H. NOTE
22 THAT'S HIGHLIGHTED. OR I MIGHT REFER TO A NUMBER IN THE
23 LOWER RIGHT-HAND PAGE.
24 A. OKAY.
25 Q. IS THAT ALL RIGHT?
1 A. SURE.
2 THE COURT: IF YOU NEED TO PULL YOUR CHAIR OVER TO THE
3 LEFT THERE TO SEE THAT PROPERLY, YOU'RE WELCOME TO DO THAT?
4 THE WITNESS: OKAY.
5 THE COURT: JUST SPEAK UP IF DO, OKAY?
6 THE WITNESS: OKAY.
7 Q. (BY MR. BUGDEN) YOU FIRST STARTED TREATING MRS. CRANE
8 WHEN SHE WAS A RESIDENT AT THE SANDY REGIONAL NURSING HOME IS
9 THAT RIGHT?
10 A. THAT'S CORRECT.
11 Q. AND WAS THAT IN 1994? LET'S TAKE A LOOK AT -- WELL,
12 DOES THAT SOUND CORRECT TO YOU THAT THAT WAS IN 1994?
13 A. LOOKING AT THE SOME RECORDS I REVIEWED EARLIER TODAY, I
14 THOUGHT IT WAS LATE 1993 THAT I FIRST SAW HER.
15 Q. THAT'S FINE. AND YOU'D SEE HER ABOUT EVERY 60 DAYS?
16 A. THAT'S RIGHT.
17 Q. AND HER DAUGHTER KAREN BRINGHURST WOULD USUALLY BRING
18 HER TO YOUR OFFICE?
19 A. IT WAS USUALLY KAREN THAT CAME WITH HER.
20 Q. AND ALL OF YOUR VISITS WITH THIS PATIENT WERE AT THE
21 OFFICE IS THAT RIGHT?
22 A. THAT'S RIGHT.
23 Q. AND LET'S LOOK AT THIS VERY FIRST DOCUMENT, AND THIS IS
24 2-A YOUR HONOR. IT HAS BEEN RECEIVED. THIS IS YOUR
25 DISCHARGE SUMMARY FROM WHEN MARY WENT TO THE HOSPITAL, IS
1 THAT RIGHT? IT'S THE SLIDE NUMBER, THE NUMBER 2. DO YOU SEE
2 THAT, DR. ?
3 A. RIGHT.
4 Q. LET'S LOOK AT THE NEXT SLIDE AND SEE IF THAT HELPS.
5 DOES THAT APPEAR TO YOU TO BE THE DISCHARGE SUMMARY THAT YOU
6 PREPARED FOR MARY CRANE? IT WAS THREE-PAGE DOCUMENT?
7 A. IT'S NOT PREPARED BY ME. THAT'S A DISCHARGE SUMMARY
8 THAT WAS PREPARED BY THE STAFF AT THE NURSING HOME AND THEN
9 SIGNED BY ME.
10 Q. WELL, IN FACT, YOU'RE ANTICIPATING MY QUESTION. OR AT
11 LEAST THAT'S HELPFUL FOR ME. THIS DISCHARGE DOCUMENT THEN --
12 COULD WE HAVE -- IS THERE BLOW UP ON -- I'M NOT SURE.
13 LET'S -- YEAH, LET'S STOP RIGHT THERE IF WE COULD. SO THAT
14 THREE-PAGE DOCUMENT THAT WE SAW BEFORE, THE MAJORITY OF THAT
15 DOCUMENT WOULD HAVE BEEN PREPARED BY SOMEONE ELSE, IS THAT
16 RIGHT?
17 A. CORRECT.
18 Q. AND THEN YOU WOULD TRY TO CONFIRM THE INFORMATION AND
19 THEN IT BEARS YOUR SIGNATURE, IS THAT RIGHT?
20 A. RIGHT.
21 Q. IS THIS YOUR SIGNATURE?
22 A. IT IS.
23 Q. AND THEN KAREN BRINGHURST, HER DAUGHTER, HAD ALSO SIGNED
24 IT, IS THAT RIGHT?
25 A. RIGHT. AND A NURSE.
1 Q. OKAY. IT'S NOT DATED I SEE. YOU DIDN'T HAPPEN TO DATE
2 IT AND THE NURSES DIDN'T HAPPEN TO DATE IT EITHER, IS THAT
3 RIGHT? I MEAN OBVIOUSLY IT'S NOT DATED.
4 A. MY ISN'T, BUT THE NURSE'S SIGNATURE IS DATED BUT --
5 Q. OKAY. AND THIS PATIENT HAD SUFFERED A STROKE IN 1990,
6 IS THAT RIGHT?
7 A. THAT'S RIGHT.
8 Q. AND SHE HAD LEFT SIDED PARALYSIS AFTER THE STROKE?
9 A. I BELIEVE THAT'S RIGHT.
10 Q. OKAY. AND SHE WAS TAKING OR SHE HAD HYPERTENSION IS
11 THAT RIGHT?
12 A. THAT'S RIGHT.
13 Q. SHE TOOK LOPRESSOR FOR THAT?
14 A. THAT'S RIGHT.
15 Q. SHE ALSO HAD CHRONIC HYPONATREMIA, IS THAT RIGHT?
16 A. RIGHT.
17 Q. AND THAT'S LOW SODIUM IN YOUR BLOOD SUGARS -- OR IN HER
18 BLOOD?
19 A. RIGHT.
20 Q. SORRY, IN HER BLOOD. AND THIS WAS A CONDITION WHERE SHE
21 WOULD DRINK EXCESSIVE AMOUNTS OF WATER, IS THAT RIGHT?
22 A. THAT'S RIGHT.
23 Q. AND IF YOU DRINK TO THE EXTREME, THAT CAN DROP YOUR
24 BLOOD SODIUM LEVEL IS THAT RIGHT?
25 A. IT CAN.
1 Q. SO THIS PATIENT MRS. CRANE HAD TO BE ON FLUID INTAKE
2 RESTRICTION, IS THAT RIGHT?
3 A. THE STAFF ATTEMPTED TO DO THAT.
4 Q. AND SHE ALSO HAD A HISTORY OF PEPTIC ULCER DISORDER, IS
5 THAT RIGHT?
6 A. PEPTIC ULCER DISEASE.
7 Q. DISEASE. RIGHT HERE, IS THAT RIGHT?
8 A. RIGHT.
9 Q. AND CAN THAT BE A PAINFUL CONDITION FOR THE PATIENT NOW?
10 A. WELL, IT COULD BE.
11 Q. IN THIS PATIENT, HADN'T THEY -- WASN'T IT NECESSARY TO
12 REMOVE PART OF HER STOMACH? HADN'T SHE HAD AN OPERATION --
13 A. RIGHT. QUITE SOME TIME BEFORE I MET HER.
14 Q. OKAY. AND SHE ALSO HAD LUMBAR DISK SURGERY, IS THAT
15 RIGHT?
16 A. RIGHT, ALSO BEFORE I KNEW HER.
17 Q. BUT THAT WAS SOMETHING THAT YOU WERE ABLE TO CONFIRM AND
18 YOU COULD SEE THE SCAR I SUPPOSE --
19 A. RIGHT, RIGHT.
20 Q. -- RIGHT?. AND SHE ALSO HAD, YOU TOLD US, SUFFERED FROM
21 DEPRESSION WITH PSYCHOTIC MOOD DISORDER IS THAT RIGHT?
22 A. RIGHT.
23 Q. WHAT DOES PSYCHOTIC MOOD DISORDER MEAN? WHAT DOES THAT
24 MEAN FOR US?
25 A. WELL, I -- WHAT I WOULD USUALLY -- THE TERM I WOULD
1 USUALLY USE IS DEPRESSION WITH PSYCHOTIC FEATURES. SHE HAD
2 DEPRESSION SYMPTOMS BUT HAD RELATED TO THIS ALSO HAD SOME
3 PSYCHOSIS, SOME DELUSIONAL THOUGHTS AND DELUSIONAL BEHAVIOR.
4 Q. OKAY. AND THEN DR. I'M GONNA ASK YOU TO TURN TO WHAT I
5 THINK SHOULD BE THE NEXT SLIDE FOR YOU OR THE NEXT EXHIBIT.
6 AND THIS IS THE DISCHARGE SURGERY AGAIN FROM T HE SANDY
7 REGIONAL CARE CENTER. DO YOU RECOGNIZE THAT DR. ? AND WHAT
8 I'D LIKE TO ASK YOU IS -- ARE SOME QUESTIONS ABOUT WHETHER OR
9 NOT MARY CRANE WAS RECEIVING MEDICATIONS FOR PAIN.
10 A. OKAY.
11 Q. AND IF YOU'D TURN TO NUMBER 7 IN THE LOWER RIGHT-HAND
12 CORNER. ARE YOU THERE, DOCTOR?
13 A. YES.
14 Q. OKAY. THANK YOU. MARY CRANE, YOU TOLD US SHE WOULD
15 COMPLAIN OF HEADACHES, IS WHAT YOU'VE SAID, IS THAT RIGHT?
16 A. SHE FREQUENTLY COMPLAINED OF HEADACHES.
17 Q. OKAY. AND YOU HAD PRESCRIBED A DRUG CALLED HYPHEN, IS
18 THAT RIGHT?
19 A. RIGHT.
20 Q. HYPHEN'S A PAIN MEDICATION, ISN'T IT?
21 A. IT IS.
22 Q. AND IT'S ALSO SOMETIMES CALLED HYDROCODONE IS THAT
23 RIGHT?
24 A. THAT'S RIGHT.
25 Q. IT'S ALSO CALLED LORTAB, IS THAT RIGHT?
1 A. THAT'S ANOTHER BRAND NAME FOR IT.
2 Q. IT'S AN OPIATE, ISN'T IT?
3 A. IT IS.
4 Q. IT'S LIKE MORPHINE OR FENTANYL, ISN'T IT?
5 A. THEY'RE ALL OPIATE PAIN MEDICATIONS.
6 Q. OPIATE PAIN MEDICATIONS. OKAY. AND SHE ALSO WAS TAKING
7 XANAX, IS THAT RIGHT?
8 A. RIGHT.
9 Q. AND THAT'S AND ANTIANXIETY MEDICATION, ISN'T IT, MA'AM?
10 A. YES.
11 Q. AND IT'S ALSO A CENTRAL NERVOUS SYSTEM DEPRESSANT, ISN'T
12 IT?
13 A. YES.
14 Q. OKAY. AND IN OTHER WORDS, THAT HAS SOME SEDATING
15 EFFECTS OR MEDICATION -- MEDICATING EFFECTS?
16 A. IT CAN.
17 Q. OKAY. AND UNDER -- LET'S SEE, WAS SHE ALSO TAKING
18 TRAN -- IS IT TRANS --
19 A. TRANXENE.
20 Q. TRANXENE. AND THAT'S ALSO A SEDATING MEDICATION.
21 A. RIGHT, IT CAN BE.
22 Q. AND THESE WERE ALL THE -- SOME OF THE MEDICATIONS THAT
23 YOU HAD HER ON, IS THAT RIGHT?
24 A. THAT'S RIGHT.
25 Q. AND THE TRANXENE, THAT'S AND ANTIANXIETY MEDICATION, IS
1 THAT RIGHT?
2 A. RIGHT.
3 Q. OKAY. NOW, LET ME TAKE YOU TO ONE OF YOUR OFFICE NOTES,
4 DOCTOR, AND THIS IS DATED 7/14, OF 1005. IT'S THE VERY NEXT
5 PAGE, DR. STUBBS.
6 A. OKAY.
7 Q. HAVE YOU FLIPPED THERE?
8 A. YES.
9 Q. THANK YOU. UNDER PSYCH MEDS. ARE YOU THERE? I'M GONNA
10 SHOW THE JURY WHERE I'M GONNA LOOK.
11 A. I AM.
12 Q. I'M GONNA LOOK HERE PLEASE. SHE WAS TAKING -- YOU HAD
13 HER TAKING ZOLOFT, IS THAT RIGHT?
14 A. CORRECT.
15 Q. THAT'S AN ANTIDEPRESSANT, IS THAT RIGHT?
16 A. THAT'S.
17 Q. AND THAT HAS SEDATING QUALITIES, ISN'T THAT RIGHT?
18 A. WELL, IT COULD IN SOME PATIENTS.
19 Q. AND THEN THORAZINE, IS THAT RIGHT?
20 A. RIGHT.
21 Q. THAT'S AN ANTIPSYCHOTIC, IS THAT RIGHT?
22 A. THAT'S RIGHT.
23 Q. AND LET ME TAKE YOU TO NURSING HOME RECORD 577. I THINK
24 THAT'S THE VERY NEXT PAGE, DR. I THINK YOU JUST HAVE TO GO
25 ONE PAGE.
1 A. OKAY.
2 Q. AND THIS IS CALLED THE PHYSICIANS ORDERS AT THE NURSING
3 HOME IS THAT RIGHT?
4 A. RIGHT.
5 Q. SO THESE WOULD BE THE MEDICINES THAT YOU WOULD PRESCRIBE
6 FOR MRS. CRANE IS THAT RIGHT?
7 A. RIGHT.
8 Q. AND THERE'S AN ENTRY, THE DATE'S HARD TO READ -- WELL,
9 NO, IT'S NOT HARD TO READ HERE. 12/20 OF 1994. CALCIUM, IS
10 THAT RIGHT?
11 A. RIGHT.
12 Q. A CALCIUM PILL IS A PLACEBO, ISN'T IT?
13 A. WELL, CALCIUM IS USED MEDICINALLY BUT IN THIS CAUSE, IN
14 THE CASE OF MARY CRANE IT WAS USED AS A PLACEBO.
15 Q. WELL, IT'S SAYS CALCIUM, 250 MILLIGRAMS ONE P.O., WHAT
16 IS THAT?
17 A. EVERY FOUR HOURS AS NEEDED.
18 Q. AS NEEDED. FOR PAIN, FOR HEADACHE PAIN, IS THAT RIGHT?
19 A. RIGHT.
20 Q. SO WHAT YOU WOULD PRESCRIBE FOR THIS WOMAN WHO HAD
21 HEADACHE PAIN WAS THAT THE NURSE COULD GIVE HER A PLACEBO IF
22 SHE COMPLAIND OF A HEAD HEADACHE PAIN, IS THAT RIGHT?
23 A. YES. THE SUGGESTION WAS MADE BY HER FAMILY. MARY HAD,
24 BECAUSE OF HER PSYCHOSIS, SHE HAD A TENDENCY TO REPETITIVELY
25 SAY THINGS AND, ONE OF THE THINGS SHE REPETITIVELY WOULD SAY
1 IS I HAVE A HEADACHE. AND OFTEN THE FAMILY WHO WERE WITH HER
2 QUITE A BIT AND THE NURSING STAFF WOULD FEEL THAT MARY WAS
3 NOT REALLY HAVING A HEADACHE.
4 Q. OKAY. LET ME MAKE SURE I UNDERSTAND WHAT YOU'RE TELLING
5 ME. SO FIRST LET ME JUST MAKE SURE WE'RE ON THE SAME PAGE.
6 IN THIS CASE, THE CALCIUM PILLS THAT YOU PRESCRIBED, YOU
7 AGREE THAT IT WAS JUST A PLACEBO. IT WAS NOT REALLY A PAIN
8 MEDICATION.
9 A. RIGHT.
10 Q. IT WAS SOMETHING TO JUST PLACATE THIS WOMAN TO MAKE HER
11 THINK SHE WAS RECEIVING A PAIN MEDICATION, IS THAT RIGHT?
12 A. RIGHT.
13 Q. AND THE REASON THAT YOU PRESCRIBED A PLACEBO IS BECAUSE
14 YOU BELIEVED HER DAUGHTER KAREN BRINGHURST WHO TOLD YOU THAT
15 SHE DIDN'T REALLY THINK HER MOTHER HAD PAIN, SHE DIDN'T
16 REALLY THINK MOM WAS IN -- HAD A TERRIBLE HEADACHE, IS THAT
17 RIGHT?
18 A. KAREN AS WELL AS THE --
19 Q. NURSING STAFF.
20 A. -- NURSING STAFF WOULD SAY THAT AT TIMES -- AT TIMES
21 THEY DID BELIEVE THAT MARY HAD A HEADACHE OR BACK PAIN OR
22 SOME TYPE OF PAIN. AT OTHER TIMES THEY BELIEVED THAT SHE WAS
23 GETTING INTO THIS REPETITIVE BEHAVIOR --
24 Q. OKAY, LET'S -- LET'S STOP FOR JUST A SECOND. MARY CRANE
25 SUFFERED FROM DEMENTIA, RIGHT?
1 A. RIGHT.
2 Q. SO PEOPLE WITH DEMENTIA AND PEOPLE WHO PERSEVERATE, WHO
3 REPEAT THEMSELVES OVER AND OVER AND OVER AGAIN, THEY ARE NOT
4 PEOPLE THAT CAN SELF-REPORT PAIN, ISN'T THAT TRUE? OR
5 SOMETIMES THEY CAN'T SELF-REPORT PAIN, WOULD THAT BE RIGHT?
6 A. IT DOES MAKE IT SOMETIMES DIFFICULT TO TELL.
7 Q. OKAY. AND THEN WHEN THEY DO SELF-REPORT PAIN, BECAUSE
8 OF THEIR SELF-REPORTED DEMENTIA, IN THIS CASE, YOU AND THE
9 DAUGHTER KAREN BRINGHURST AND THE NURSING STAFF JUST DIDN'T
10 BELIEVE HER. IS THAT WHAT YOU JUST SAID?
11 A. WELL, AT TIMES --
12 Q. AT TIMES.
13 A. -- SOMETIMES THEY DID BELIEVE SHE HAD A HEADACHE.
14 Q. AND THEN WHEN THEY DID BELIEVE SHE HAD HEADACHES, THAT'S
15 WHEN SHE GOT HYPHEN, WHICH IS THE NARCOTIC PAIN MEDICATION.
16 A. OR TYLENOL. MORE OFTEN TYLENOL.
17 Q. BUT YOU HAD PRESCRIBED HYPHEN, A NARCOTIC OPIATE FOR
18 HER?
19 A. SHE TOOK THAT OCCASIONALLY.
20 Q. AND SO ON THOSE OCCASIONS THAT THIS PATIENT HAPPENED TO
21 BE ABLE TO PERSUADE THE NURSING STAFF THAT SHE REALLY DID
22 HAVE A HEADACHE, THEN SHE WOULD GET A REAL PAIN MEDICATION,
23 HYPHEN, IS THAT RIGHT?
24 A. IF THEY THOUGHT SHE WAS -- IF --
25 Q. IT HAD TO DO WITH THEM INTERPRETING WHETHER OR NOT HER
1 CRYING OUT FOR PAIN MEDICATION WAS REAL OR WHETHER OR NOT IT
2 WAS JUST MAKE BELIEVE, RIGHT?
3 A. YES. AND THEY WOULD GIVE HER HYPHEN IF THEY THOUGHT SHE
4 WAS HAVING MORE SEVERE PAIN.
5 Q. OKAY. WOULD YOU AGREE, DOCTOR, THAT PERHAPS THE BEST
6 EVIDENCE OF WHETHER OR NOT MARY CRANE WHILE AT THE NURSING
7 HOME WAS IN PAIN WOULD BE WHETHER OR NOT SHE WAS RECEIVING ON
8 A DAY BY DAY BASIS A PAIN MEDICATION PRESCRIBED OR GIVEN BY
9 THE NURSES ON A P.R.N. BASIS? LET ME -- LET ME -- THAT WAS
10 REALLY A BAD QUESTION. LET ME START AGAIN. YOU'RE NOT --
11 YOU'RE NOT AT THE NURSING HOME --
12 A. RIGHT.
13 Q. -- AT ALL REALLY. I MEAN YOU WOULD SEE HER IN YOUR
14 OFFICE, IS THAT RIGHT?
15 A. THAT'S RIGHT.
16 Q. AND SO THE NURSING STAFF, THEY'RE THE PEOPLE THAT ARE
17 WITH MARY CRANE 24, SEVEN?
18 A. RIGHT.
19 Q. AND THEY'RE THE PEOPLE THAT ARE INTERPRETING, FOR
20 EXAMPLE, YOUR P.R.N. ORDER FOR CALCIUM OR THEY'RE THE PEOPLE
21 THAT ARE INTERPRETING YOUR ORDER FOR PAIN MEDICATION HYPHEN,
22 IS THAT RIGHT?
23 A. RIGHT. THE NURSING STAFF AND HER FAMILY.
24 Q. OH, FAMILY WAS ALSO INEXTRICABLY INTERTWINED IN MAKING
25 THE DECISION ABOUT WHETHER MOM WILL GET A PAIN MEDICATION --
1 MR. WILSON: YOUR HONOR, I THINK THAT'S ARGUMENTATIVE.
2 THE COURT: OVERRULED.
3 Q. (BY MR. BUGDEN) THAT MEANS YOU SHOULD ANSWER MY QUESTION
4 PLEASE.
5 A. THE FAMILY IF THEY BELIEVE SHE WAS HAVING PAIN WOULD SAY
6 TO THE NURSES, I THINK MOM'S HAVING PAIN AND ASK THAT SHE BE
7 GIVEN SOMETHING.
8 Q. DO YOU KNOW WHETHER OR NOT THE FAMILY MEMBERS HAD ANY
9 PARTICULAR TRAINING IN IDENTIFYING SYMPTOMS OF PAIN IN A
10 COGNITIVELY DEMENTED PATIENT?
11 A. WELL, HER DAUGHTER KAREN IS A REGISTERED NURSE AND
12 CERTAINLY HAS SOME TRAINING IN EVALUATING WHETHER PATIENTS
13 ARE IN PAIN.
14 Q. HOW ABOUT COGNITIVELY IMPAIRED, DEMENTED PATIENTS, DO
15 YOU KNOW IF SHE HAD THAT EXPERTISE?
16 A. WELL, I CAN'T ANSWER THAT QUESTION.
17 Q. OKAY. BUT WOULD YOU AGREE THAT AT LEAST ONE INDICATION
18 OF WHETHER OR NOT THIS WOMAN HAD AT LEAST PERSUADED SOMEONE
19 AT THE NURSING HOME THAT SHE WAS IN PAIN WOULD BE TO LOOK AT
20 WHETHER OR NOT THE NURSING STAFF DID GIVE HER PAIN MEDICATION
21 AT THE NURSING HOME?
22 A. THAT WOULD BE ONE INDICATION, YES.
23 Q. LET'S LOOK AT HER NURSING HOME RECORDS IN THE CHARTS OF
24 HER PAIN MEDICATION IF WE COULD.
25 Q. OKAY. DOCTOR, YOU'VE GOT THE PAGES THERE SO THAT YOU
1 CAN LOOK.
2 A. RIGHT.
3 Q. I'M GONNA JUST SHOW THE JURY THIS -- THEY CAN'T SEE
4 THIS, BUT AT THE TOP, IT DOES SAY UP RIGHT UP AT THE TOP,
5 SAYS NARCOTIC RECORD, DOES -- ON YOUR PAGE, DOESN'T IT?
6 A. IT DOES.
7 Q. THIS IS A RECORD, A NARCOTIC RECORD THAT WAS KEPT AT THE
8 NURSING HOME OF THE MEDICATIONS THAT WERE GIVEN TO MARY
9 CRANE, IS THAT RIGHT?
10 A. RIGHT.
11 Q. OKAY. AND ON THE RIGHT-HAND SIDE OF THIS PAGE, YOU CAN
12 SEE THAT THIS IS N.H. --
13 MS. ISAACSON: 851.
14 MR. BUGDEN: THANK YOU.
15 BY MR. BUGDEN:
16 Q. SAYS HYDROCODONE. SO THIS IS THE -- THIS IS HYPHEN
17 WE'RE TALKING ABOUT, RIGHT?
18 A. RIGHT.
19 Q. AND ON THE LEFT-HAND SIDE -- I'M SORRY, JURORS AND
20 WITNESS, JUDGE. ON THE LEFT-HAND SIDE, IT'S DATED, ISN'T
21 THAT RIGHT?
22 A. RIGHT.
23 Q. SO WE CAN SEE THAT AT THE END OF OCTOBER THEN EXTENDING
24 INTO NOVEMBER, FINISHING OUT 11 -- NOVEMBER 22ND, EVERY TIME
25 THERE'S A CHECK MARK, THAT MEANS THAT THE NURSING STAFF DID
1 GIVE MARY CRANE A LORTAB OR A HYDROCODONE, RIGHT?
2 A. RIGHT.
3 Q. AND THEN CAN WE SEE THE NEXT SLIDE? I THINK THAT WE
4 COULD ALSO TAKE A LOOK AT IN DECEMBER WHETHER OR NOT THIS
5 WOMAN WAS RECEIVING PAIN MEDICATION. AND IN FACT, IN
6 DECEMBER, SEE THE END -- WE HAVE THE LAST FEW DAYS OF
7 NOVEMBER, AND THEN WE HAVE JUST RIGHT UP UNTIL DECEMBER 27,
8 THE DAY BEFORE SHE WENT TO THE DAVIS GERO-PSYCHIATRIC UNIT,
9 SHE BASICALLY WAS RECEIVING LORTAB EVERY DAY, WASN'T SHE?
10 A. FROM THIS RECORD IT LOOKED LIKE SHE RECEIVED ON AVERAGE
11 AROUND ONE PAIN PILL PER DAY.
12 Q. PER DAY. NOW, YOU DID NOT SEE HER THE DAY BEFORE SHE
13 WAS ADMITTED TO THE HOSPITAL DID YOU?
14 A. I DIDN'T. I --
15 Q. YOU DON'T KNOW WHAT CONDITION SHE WAS IN, DO YOU?
16 A. NO.
17 Q. AND THEN LET ME JUST -- JUST ABOUT FINISHED HERE, DR.
18 STUBBS. CAN YOU RECALL THAT MARY CRANE WAS TAKEN TO THE ALTA
19 VIEW HOSPITAL ON MARCH THIRD OF 1994 COMPLAINING OF CHEST
20 PAIN AND ALSO WHAT TURNED OUT TO BE A URINARY TRACT
21 INFECTION? DO YOU REMEMBER THAT?
22 A. I DON'T SPECIFICALLY REMEMBER THAT, NO.
23 Q. COULD YOU JUST TURN TO VERY NEXT PAGE? AND UNDER THE
24 MANAGEMENT SECTION, I'D LIKE TO ASK YOU SOME QUESTIONS ABOUT
25 THAT IF I COULD. IT SAYS HERE -- IT'S PAGE 15 FOR YOU, DR.
1 STUBBS?
2 A. OKAY.
3 A. OKAY.
4 Q. IT SAYS THAT -- AND THIS IS A MEDICAL RECORD ACTUALLY
5 THAT WAS PREPARED BY DR. -- LET'S SEE, WHO WAS THE
6 DOCTOR THAT SPOKE TO YOU HERE? DR. BOYD, IS THAT RIGHT?
7 A. WELL, I --
8 Q. YOU CAN'T SEE THAT?
9 A. I CAN'T SEE THAT ON HERE.
10 Q. LET'S SEE IF THIS REFRESHES YOUR RECOLLECTION, DR. THIS
11 NOTE INDICATES THAT THE DOCTOR -- I'VE HAD A -- I'VE
12 DISCUSSED THIS PATIENT WITH DR. RACHEL STUBBS WHO'S THE
13 PATIENT'S INTERNIST. IT IS FELT THAT WE'LL START THE PATIENT
14 ON ROCEPHIN. WHAT'S THAT FOR?
15 A. THAT'S AN INTRAVENOUS ANTIBIOTIC.
16 Q. OKAY. AND THEN IT SAYS, IN ADDITION THE PATIENT
17 RECEIVED A LITTLE -- WHAT'S THAT WORD?
18 A. INAPSINE.
19 Q. WHAT'S THAT?
20 A. IT'S A MEDICATION USED FOR NAUSEA.
21 Q. THANK YOU. AND THEN IT SAYS, IN MORPHINE TITRATED TO
22 PAIN. MAINLY THE HEADACHE WHICH THE PATIENT IS COMPLAINING
23 OF. DO YOU SEE THAT?
24 A. YES.
25 Q. DO YOU REMEMBER THAT YOU HAD THIS CONVERSATION WITH A
1 DR. AT ALTA VIEW WHO DECIDED THAT IT WAS IN THE BEST
2 INTERESTS OF MARY TO GIVE HER MORPHINE FOR HER HEADACHE?
3 A. I DO NOW RECALL HAVING A CONVERSATION BUT I DON'T
4 BELIEVE THAT PAIN MEDICATION WAS DISCUSSED SPECIFICALLY WITH
5 ME. HE TALKED TO ME ABOUT THE I.V. ANTIBIOTICS AND THE PAIN
6 MEDICATION. THAT WAS ENTIRELY DECIDED BY HIM, NOT ME.
7 Q. OKAY. SO THAT WAS HIS CALL.
8 A. RIGHT.
9 Q. OKAY. AND THEN IT SAYS THE PATIENT HAS LIVING WILL AND
10 DOES NOT WANT ANY AGGRESSIVE MANEUVERS PERFORMED IF SHE
11 SHOULD DETERIORATE. THAT WAS ALSO YOUR UNDERSTANDING
12 THROUGHOUT YOUR TREATMENT OF THIS PATIENT, ISN'T THAT RIGHT?
13 A. THAT'S RIGHT.
14 Q. AND WE CAN LOOK AT THE NEXT SLIDE. IS THERE A BLOW UP
15 OF THAT? THE PATIENT RECEIVED -- M.S. STANDS FOR MORPHINE
16 SULFATE, DOESN'T IT, DR. STUBBS?
17 A. THAT'S RIGHT.
18 Q. SO SHE --
19 MS. BARLOW: YOUR HONOR, CAN WE KNOW PAGE HE'S ON AND
20 WHAT DOCUMENT?
21 THE COURT: MR. BUGDEN.
22 MS. BARLOW: WE'RE HAVING TROUBLE KEEPING WITH UP WITH
23 HIM. WE DON'T HAVE ALL THE PAGE NUMBERS.
24 MR. BUGDEN: THIS IS FROM ALTA VIEW HOSPITAL. EXHIBIT
25 NUMBER 7. AND THIS IS ALTA VIEW HOSPITAL.
1 THE COURT: THINK IT'S NUMBER 8.
2 MR. BUGDEN: OH, NOW IT'S 8. OKAY. THANK YOU JUDGE.
3 MS. BARLOW: THANK YOU, YOUR HONOR. I'M SORRY WE'RE
4 HAVING TROUBLE KEEPING WITH HIM. HE'S GOT DIFFERENT
5 NUMBERING.
6 Q. (BY MR. BUGDEN) ACCORDING TO THE NOTE THE PATIENT
7 RECEIVED FIRST FIVE MILLIGRAMS AN I.V.P. THAT STANDS FOR
8 I.V. PUSH, IS THAT RIGHT, DR. STUBBS?
9 A. THAT'S RIGHT.
10 Q. AND THEN AN HOUR LATER THREE MORE MILLIGRAMS WERE GIVEN,
11 IS THAT RIGHT, OF MORPHINE?
12 A. THAT'S RIGHT.
13 Q. SO THE PATIENT RECEIVED IN THAT TWO-HOUR TIME, EIGHT
14 MILLIGRAMS FOR A HEADACHE. IS THAT RIGHT?
15 A. I DON'T KNOW WHY THEY GAVE IT TO HER. I WASN'T THERE.
16 AND THEY DIDN'T DISCUSS HER PAIN --
17 Q. WELL, YOU DON'T -- YOU THINK THE CHART NOTE'S WRONG
18 WHERE IT SAYS THAT THEY TALKED TO YOU ABOUT IT --
19 A. THEY --
20 Q. -- BECAUSE YOU DON'T --
21 A. WELL, IT DOESN'T SAY THEY SPECIFICALLY TALKED TO ME
22 ABOUT PAIN. IT SAYS, I DISCUSSED THIS PATIENT WITH
23 DR. RACHAEL STUBBS. AND THEY DID DISCUSS THE ANTIBIOTIC WITH
24 ME.
25 Q. THANK YOU VERY MUCH DR. STUBBS?
1 THE COURT: REDIRECT, MR. WILSON.
2 REDIRECT EXAMINATION
3 BY MR. WILSON:
4 Q. IN FACT, DOCTOR AT ONE TIME THERE WAS A -- AT THAT
5 PARTICULAR TIME, YOU ORDERED SOME ANTIBIOTICS ACCORDING TO
6 THAT NOTE DIDN'T YOU?
7 A. RIGHT.
8 Q. THOSE WERE TO BE ADMINISTERED AT THE NURSING HOME?
9 A. THAT'S RIGHT.
10 Q. YOU DID NOT ORDER ANY MORPHINE AT THAT TIME, DID YOU,
11 DOCTOR?
12 A. NO.
13 Q. IF YOU WOULD TURN TO PAGE 13, 12 AND 13 OF THE EXHIBIT
14 THAT YOU HAVE THAT DEFENSE PROVIDED TO YOU OF THE
15 DIFFERENT --
16 THE COURT: PAGE 13 OF WHAT EXHIBIT, MR. WILSON?
17 MR. WILSON: I ASSUME THIS IS A -- WELL, PAGES 12 AND 13
18 YOUR HONOR. AND I ASSUME THIS IS DEFENDANT'S EXHIBIT --
19 MS. ISAACSON: IT'S DEFENDANT'S -- OR IT'S ACTUALLY YOUR
20 4-A. IT'S NURSING HOME 851.
21 MR. WILSON: NURSING HOME RECORDS 4-A, YOUR HONOR, OF
22 MARY CRANE.
23 Q. (BY MR. WILSON) HAVE YOU GOT THAT IN FRONT OF YOU?
24 A. I DO.
25 Q. THIS WAS THE EXHIBIT THAT SHOWED THE DOSAGES OF
1 HYDROCODONE THAT WERE GIVEN TO MARY CRANE, IS THAT CORRECT?
2 A. THAT'S RIGHT.
3 Q. ON THE RIGHT-HAND SIDE, THERE IS A COLUMN THAT TALKS
4 ABOUT REMAINING NUMBER.
5 A. RIGHT.
6 Q. CAN YOU TELL US WHAT THAT COLUMN MEANS?
7 A. IT LOOKS LIKE THE PHARMACY WOULD SEND THE NURSING HOME
8 30 TABLETS AT A TIME, AND EVERY TIME THE PATIENT IS GIVEN A
9 NARCOTIC PAIN MEDICATION, THE NURSES HAVE TO CHART THAT AND
10 THEN -- AND THEN THEY -- BECAUSE OF REGULATIONS THEY HAVE TO
11 COUNT NARCOTIC PAIN MEDICATION AND -- AND SO THEY'RE CHARTING
12 THERE HOW MANY ARE REMAINING AT THAT TIME.
13 Q. WHEN YOU ISSUED THE ORDER FOR THE HYPHEN, DO YOU RECALL
14 HOW OFTEN YOU WOULD -- YOU WOULD PROVIDE FOR THAT PAIN
15 MEDICATION TO BE DISPENSED?
16 A. WELL, LOOKING AT ONE OF THESE PAGES HERE, IT LOOKED LIKE
17 THE ORDER SAID THAT SHE COULD RECEIVE THEM UP TO EVERY FOUR
18 HOURS IF NEEDED.
19 Q. OKAY. DOES THE -- DOES THE EXHIBIT ON PAGE 12 ALSO
20 CONTAIN THE AMOUNT OR THE DOSAGE AMOUNT OF HYPHEN OR
21 HYDROCODONE THAT YOU PRESCRIBED FOR MARY CRANE?
22 A. IT SAYS THE DOSAGE. IT DOESN'T SAY THE -- I DON'T SEE
23 THAT IT SAYS THE FREQUENCY WITH WHICH SHE COULD TAKE THEM.
24 Q. OKAY. BUT IN TERMS OF THE DOSAGE ITSELF, WHAT WAS --
25 WHAT WAS THE STRENGTH OF THE DOSE?
1 A. IT WAS A 5-MILLIGRAM HYDROCODONE.
2 Q. CAN YOU CHARACTERIZE THE STRENGTH FOR US, IF YOU WOULD,
3 AS TO WHAT A 5-MILLIGRAM DOSAGE IS? WHAT IT COMES IN IN
4 HYDROCODONE?
5 A. WELL, HYDROCODONE, THE LOWEST DOSE THAT THAT COMES IN IS
6 A 2.5-MILLIGRAM TABLET. AND THERE'S 5-MILLIGRAMS,
7 7.5-MILLIGRAMS, 10-MILLIGRAM.
8 Q. OKAY. THE FACT THAT THEY WERE GIVING HER ONE
9 HYDROCODONE A DAY, IS THAT A SIGNIFICANT AMOUNT OF
10 HYDROCODONE IN YOUR MIND?
11 MR. BUGDEN: OBJECTION. LEADING.
12 THE COURT: SUSTAINED.
13 Q. (BY MR. WILSON) HOW MANY -- HOW MANY -- FROM THOSE
14 RECORDS ON PAGES 12 AND 13, CAN YOU TELL US HOW MANY TABLETS
15 SHE WAS GETTING ON AN AVERAGE PER DAY?
16 A. WELL, IT LOOKS LIKE SHE WAS -- THAT PAGE 12 HAS THE
17 DATES ARE FROM 10/21 TO 11/22, SO THAT'S JUST OVER A MONTH
18 AND SHE USED 30 TABLETS IN JUST OVER A MONTH.
19 Q. OKAY.
20 A. SO ABOUT ONE A DAY.
21 Q. IN RESPECT TO PAGE 13, CAN YOU TELL US HOW MANY
22 HYDROCODONE WERE DISPENSED DURING THAT TIME PERIOD?
23 A. A LITTLE BIT LESS THAN THAT. IT GOES FROM 11/23 TO
24 12/27 AND -- AND 30 WERE USED DURING -- IN JUST OVER A MONTH.
25 SO A LITTLE LESS THAN ONE PER DAY.
1 Q. NOW, DID YOU EVER DIAGNOSIS THIS PATIENT AS SUFFERING
2 FROM DEMENTIA?
3 A. MARY DID DEFINITELY HAVE SOME COGNITIVE IMPAIRMENT.
4 SOME CONFUSION.
5 Q. OKAY. AND CAN YOU CHARACTERIZE IN THE -- WELL, STRIKE
6 THAT. DID YOU SEE -- DID YOU SEE A INCREASE OR DID YOU
7 OBSERVE ANY INCREASE IN THE -- IN HER CONFUSION DURING THE
8 TIME PERIOD THAT YOU WERE TREATING HER?
9 A. ONLY -- NOT OVERALL, I DIDN'T SEE A SIGNIFICANT CHANGE.
10 THE ONLY TIMES I WOULD SEE HER BE MORE CONFUSED IS IF SHE
11 WOULD HAVE AN INFECTION, SUCH AS ONE OF HER BLADDER
12 INFECTIONS.
13 Q. I HAVE NO FURTHER QUESTIONS YOUR HONOR.
14 MR. BUGDEN: I HAVE NO QUESTIONS.
15 THE COURT: YOU MAY STEP DOWN DR. STUBBS AND THANK YOU
16 FOR TESTIFYING. MAY THIS WITNESS BE EXCUSED MR. WILSON.
17 MR. WILSON: SHE MAY YOUR HONOR.
18 THE COURT: MR. BUGDEN.
19 MR. BUGDEN: YES, SIR.