Todd Chambers
1 THE COURT: Call your first witness, Mr. Wilson.
2 The record should note that the parties and counsel are
3 present and the jury is in the box.
4 MR. WILSON: Call Mr. Todd Chambers, Your Honor.
5 THE COURT: Mr. Chambers, step up and raise your
6 right hand and face the clerk to be placed under oath.
7 TODD CHAMBERS,
8 being first duly sworn, was examined and
9 testified as follows:
10 MR. WILSON: Prior to starting with Mr. Chambers, I
11 just spoke with counsel. We would like to invoke the
12 exclusionary rule at this time. I do not know of any
13 witnesses the state has that are present at this time. Nor
14 do I know of any defense witnesses either, for that matter
15 THE COURT: Ladies and gentlemen of the jury, that
16 is a rule whereby counsel can request that witnesses remain
17 outside of the courtroom so that they do not hear each other
18 testify. They are further ordered not to discuss their
19 testimony before or after they have testified. The theory
20 behind that rule is to make sure that a witness is not
21 tainted by what they may hear other witnesses testify to. So
22 the court will invoke the exclusionary rule.
23 I'm not aware of, nor would I recognize, your witnesses,
24 so it's up to counsel to keep witnesses out of the courtroom
25 and explain to them that they are not to discuss their
1 testimony either before or after they have testified except
2 with counsel. That will be the order of the court.
3 Mr. Chambers, would you state your full name and spell
4 your last name.
5 THE WITNESS: Todd Martin Chambers.
6 C-h-a-m-b-e-r-s.
7 THE COURT: Thank you. You may proceed.
8 DIRECT EXAMINATION
9 BY MR. WILSON:
10 Q. Where do you currently reside, Mr. Chambers?
11 A. Highland Ranch, Colorado.
12 Q. And did you reside in Utah in the years of 1994 and 1995
13 and '96?
14 A. Yes, I did.
15 Q. And were you employed by any specific employer during the
16 year 1995?
17 A. Yes.
18 Q. And who was that, sir?
19 A. That was Horizon Mental Health Management.
20 Q. Okay. And what is Horizon Mental Health Management?
21 A. Horizon is a contract management company. They
22 specialize in starting up and running and managing
23 psychiatric inpatient units and other programs.
24 Q. Do you hold any degrees in that particular area?
25 A. Yes, I do.
1 Q. And what degrees are those?
2 A. I have a Bachelor degree, Bachelor of Science degree, in
3 sociology with a minor in gerontology. And a Master's Degree
4 in clinical social work.
5 Q. And where did you obtain those degrees?
6 A. My Bachelor's Degree was from Brigham Young University.
7 My Master's was at San Diego State University.
8 Q. You said something in reference to gerontology?
9 A. Yes. I had a minor in gerontology.
10 Q. Okay. Was that also at BYU?
11 A. Yes.
12 Q. And what years did you graduate with your Bachelor's
13 degree?
14 A. In 1986 and the Master's in 1989.
15 Q. Okay. Working up to the year 1995, what prior work
16 experience did you have in those fields?
17 A. Umm, immediately after graduating from college, or from
18 my Master's Degree program, I started to work for Charter
19 Hospital in San Diego, California. I was the psychiatric
20 social worker there on one of their inpatient units.
21 Following employment there I returned to Colorado. I worked
22 for Cheyenne Mesa as basically a psychiatric social worker.
23 I think a senior mental health therapist. Following that I
24 moved to Farmington and took a job working for Benchmark
25 Hospital as the director of social services for their
1 inpatient programs.
2 Then, after working for Benchmark, I worked for the
3 parent company that owns Benchmark Hospital, a company by the
4 name of Ramsey Health Care. I worked for -- I kind of moved
5 from working at the local hospital to working for the
6 corporate group for Ramsey. I essentially worked for their
7 contract management division, setting up geriatric and
8 psychiatric programs like Horizon does. I wrote many of the
9 policies and procedures for Ramsey's programs and set up
10 those.
11 Q. Speaking of a geropsych unit, what is -- can you describe
12 what a geropsych unit is?
13 A. It is a place that specializes in treating the
14 psychiatric and mental health needs of the elderly
15 population.
16 Q. Okay. And is there a specific age that you treat in a
17 geropsych unit?
18 A. I think we focused on patients age 55 and older.
19 Q. You indicated previously that there came a time that you
20 were under the employment of New Horizons. That occurred
21 when, sir, do you remember?
22 A. It was Horizon.
23 Q. Excuse me. Just Horizon?
24 A. Yes. Without my resume in front of me, I think it was in
25 March of 1994 or '95. '95.
1 Q. And what was the purpose of that employment at that time?
2 A. I was hired as the program director for the general
3 patient program up at Davis Hospital.
4 Q. Okay. Do you know how long that program had been in
5 place?
6 A. My understanding is that that contract began in the
7 summer or fall of 1994.
8 Q. Okay. So you were hired in March of, you think, 1995?
9 A. Yeah.
10 Q. At the time of your employment, can you describe for us
11 the nature of the relationship between Horizons and the
12 hospital, the Davis Hospital?
13 A. Yes. There was a lot of tension and difficulty between
14 Horizon and the hospital, the client hospital. There had
15 been some conflict between the nurses staff and some of the
16 Horizon staff. That was one of my main assignments was to
17 get that customer relationship smoothed out and working well.
18 Q. Okay. Now, when we talk about Horizon, they were the
19 ones that ran the program?
20 A. Yes.
21 Q. Would that be an accurate way of stating it?
22 A. Yes. Horizon brought all of the clinical expertise and
23 they brought the program, the structure, the policies. But
24 there were also nursing staff, chart nurses and others, who
25 were hired by the hospital who also ran the program. It was
1 a joint effort. Horizon definitely brought the program
2 expertise.
3 Q. So your employer was Horizon and then, as I understand
4 it, there were other employees who participated in the
5 program that would have been employees of the hospital, is
6 that correct?
7 A. That's right.
8 Q. And was there joint administration relative to how the
9 program operated?
10 A. Well, there was joint, but it probably wasn't -- it was
11 definitely a partnership. There was a very clear division of
12 labor, though. The nursing staff took care of the nursing
13 duties and the program staff ran the larger program. We also
14 hired other clinicians who did the clinical work.
15 Q. Okay. Specifically what were your duties as the program
16 director?
17 A. My responsibility was to provide leadership for the
18 program. Clinical leadership, administrative leadership.
19 Take care of the relationship between Horizon and the
20 hospital, to make sure that the hospital was happy with our
21 performance.
22 Q. Now, your customer was the hospital?
23 A. Absolutely.
24 Q. In terms of the clientele that would participate in the
25 program, did you have any responsibilities relating to them?
1 A. Absolutely. It was our responsibility to go out into the
2 community and make physicians, nursing homes, senior centers,
3 other similar facilities, aware of the service that Davis
4 Hospital now provided. Educate them about this new service
5 and how we could benefit their clients.
6 Q. Okay. When you speak of clinical leadership, what does
7 that mean?
8 A. I supervised the clinical social worker and I supervised
9 the intake coordinator. And the clinical social worker had
10 the responsibility to conduct assessments, to conduct family
11 therapy, individual therapy, group therapy. It was my
12 responsibility to make sure that those clinicians were
13 providing good clinical care.
14 Q. Did you exercise any leadership or supervision relative
15 to the psychiatric aspects of the unit?
16 A. Yes.
17 Q. And what was that?
18 A. It was primarily one of coordinating, managing, team
19 building. I didn't direct the clinical aspects of the
20 psychiatrists, but in terms of how much the medical directors
21 and psychiatrists worked with the team I was very involved.
22 Q. Was there a medical or a psychiatric director of the
23 program?
24 A. Yes. There was a medical director and an associate
25 medical director.
1 Q. Okay. And do you know at the time that you arrived in
2 March of '95 who the medical director was?
3 A. Yes. That was Dr. Welby Jensen.
4 Q. And to your recollection, was Dr. Weitzel subsequently
5 hired as part of the program?
6 A. Yes, he was.
7 Q. And do you recall what his designated status was at that
8 time?
9 A. He was the associate medical director.
10 Q. Okay. Can you differentiate for us what it means to be
11 an associate director vis-a-vis the director?
12 A. Umm, actually I think their duties were basically the
13 same. There were times when the medical director carried the
14 bulk of the clinical load and administrative load. In fact,
15 that's why the associate medical director was hired was to
16 help relieve that load and kind of spread that burden. But
17 both medical directors saw patients and both had other
18 administrative duties each month.
19 Q. So are they actual employees of the Horizon Corporation?
20 A. I'd have to look at the contract again. My recollection
21 is that they were hired as independent contractors.
22 Q. Okay. Now, the purpose of this unit -- well, strike
23 that.
24 This unit was set up in relationship to the hospital. Do
25 you know where it was actually physically located in the
1 hospital?
2 A. Yes. On the third floor.
3 Q. Okay. And can you recall how the unit itself was laid
4 out?
5 A. Yes, I can.
6 Q. Can you tell us that?
7 A. Umm, as you walked down the -- you entered the unit
8 through locked doors. There were five patient rooms on your
9 left, two beds in each room. On the opposite side of the
10 hall, about halfway down, was the nurses station and some
11 storage areas. All the way down the hall, continuing on the
12 left, on the same side as the patient rooms, was a large
13 community room where patients would eat their meals, have
14 group -- we would hold meetings in there. A kind of
15 multi-purpose room.
16 Q. Okay. And were there other services provided on that
17 third floor next to this unit, to your recollection?
18 A. Yes. There was a SNF unit and some regular medical floor
19 beds.
20 Q. When you say a SNF unit, what is that?
21 A. A skilled nursing facility.
22 Q. Okay. Was there an advantage to the unit being located
23 in that particular setting?
24 A. Umm, there may have been. It wouldn't have mattered much
25 if the SNF unit was on the other side of the hospital or on a
1 different floor. An in-hospital transfer would have been
2 easy to accomplish. There was no real advantage to my
3 recollection.
4 Q. But in conjunction with a unit being -- a geropsych unit
5 being located in a hospital setting, vis-a-vis an independent
6 setting, is there an advantage to that?
7 A. I think so, yes.
8 Q. Okay. What would that advantage be?
9 A. Well, you're more integrated into the medical community,
10 near other physicians. A free-standing psychiatric hospital
11 is not as integrated.
12 Q. Okay. Did you have anything to do with the recruitment
13 or the screening procedures and intake procedures related to
14 patients?
15 A. Yes. Screening and assessment. We didn't really -- I
16 don't like to think of it as recruiting.
17 Q. I apologize for that word. Screening and assessment.
18 How was that function handled and who handled it?
19 A. Primarily it was handled by the intake coordinator. It
20 was a Master's level clinician whose main responsibility was
21 to be out in the community, in doctor's offices and senior
22 centers and in nursing homes, educating each of those
23 entities about the benefits of our program and how we might
24 be able to assist them with their patients.
25 Then, as he was able to get the word out about our
1 program, they usually would call us and say, gee, we are
2 having difficulty with a patient. We have a patient who may
3 benefit from your program. Would you come out and assess him
4 or her and take a look and see if they meet your criteria for
5 the program.
6 MR. WILSON: May I approach the witness?
7 THE COURT: You may.
8 Q. (BY MR. WILSON) Mr. Chambers, I show you what is
9 marketed as state's exhibit number one. I'll ask you to take
10 a look at that particular exhibit if you would, please.
11 A. (Witness complied.)
12 Q. Have you seen that particular document before, sir?
13 A. Yes, I have.
14 Q. And can you tell us what that is?
15 A. It's the admission criteria for the geropsych unit,
16 policies and procedures.
17 Q. And that's on the first page of the particular document.
18 Are there other criteria that are contained on the second
19 page also?
20 A. Yes. There's admission criteria and then exclusionary
21 criteria.
22 Q. And in respect to those criteria, the document indicates
23 an effective date of 7/1 of '94. Do you recall whether those
24 were the criteria that were in effect in 1995 when you came
25 to the unit?
1 A. I believe that they were.
2 Q. Okay. And we spoke about the clinical or intake officer.
3 Who was that at the time?
4 A. That was Keith Perry.
5 Q. Keith Perry. Okay. Did you ever assist Mr. Perry in
6 that particular process?
7 A. Yes, I did.
8 Q. Okay. And specifically, if you can tell us, how would
9 you go about determining or screening a patient for admission
10 to the geropsych unit at the hospital?
11 A. A simple intake assessment would be conducted. If we
12 were assessing an individual in a nursing home, we'd consult
13 with the nursing staff. We'd read the chart at the nursing
14 home. We'd interview the patient, interview any family
15 members who may be nearby.
16 Q. Now, in respect to the types of patients, was there a
17 particular type of patient that you would normally see that
18 would be admitted to this particular unit?
19 A. Not one particular type. It could be any type. Just we
20 needed to assess their psychiatric need at that time.
21 Q. Okay. Would there usually be some type of precipitating
22 problem that would result in the individual being referred to
23 the geropsych unit?
24 A. Very often.
25 Q. Okay. And I assume that would have to do with some kind
1 of a mental health problem?
2 A. Yes.
3 Q. So you would look at these individuals and, as I
4 understand the criteria, first of all there has to be some
5 kind of a prognosis. It indicates a DSM 4 diagnosis. Can
6 you tell us what that means?
7 A. Yes. DSM 4 is an abbreviation for the Diagnostic and
8 Statistical Manual, the fourth edition. It is a book or a
9 manual which catalogs the known psychiatric disorders and
10 their symptoms and gives very general information about the
11 course of treatment and prognosis.
12 Q. Okay. So definitely part of that admission criteria is
13 there has to be some kind of a mental health diagnosis?
14 A. Yes.
15 Q. And you would go through that screening, you said, a lot
16 of times at the nursing home. You'd meet with family
17 members. Did you ever receive any telephone referrals?
18 A. Yes, I'm sure we did. We'd often get a phone call, but
19 normally there was still a face-to-face evaluation somewhere.
20 Q. So there would usually be a face-to-face evaluation
21 before anybody would present themselves at the unit itself,
22 is that correct?
23 A. Yes.
24 Q. What was the process you followed, after doing the
25 initial intake screening, relative to an individual?
1 A. We'd call one of the physicians and review the intake
2 information with the physician. Then the physician would
3 make a decision to admit or not admit.
4 Q. You say one of the physicians. Are we talking about
5 either Dr. Jensen or Dr. Weitzel?
6 A. Yes.
7 Q. And in respect to that discussion, would you provide them
8 with copies of your intake forms or what?
9 A. Umm, yes, we would. Very often that conversation was via
10 telephone, but we'd have the actual paperwork in hand and
11 bring that back to the unit and they could review that, the
12 general intake form, at a later date. But usually we'd cover
13 the high points over the phone and go from there.
14 Q. Okay. As the intake individual, when you do the initial
15 screening, and I want you to turn to page two of the
16 particular exhibit that you have there, please. There's a
17 list of exclusionary criteria.
18 A. (Witness complied.)
19 Q. In respect to those exclusionary criteria, if you in the
20 screening process identified any one of those exclusionary
21 criteria as being present would you even call the physician?
22 A. Yes, we may.
23 Q. Okay. And why would that be, sir?
24 A. These are guidelines, not hard and fast. We'd go in and
25 assess a patient and try and identify what their psychiatric
1 needs were at that time. We'd rely on the expertise of the
2 physician to help us determine whether this was someone we
3 could treat effectively at the time.
4 Q. Okay. Would there be a prior medical history that would
5 be part of that intake process that you would review with the
6 physician?
7 A. Yes.
8 Q. Okay. And how thorough would that particular medical
9 history be?
10 A. Umm, we would review the high points that we got from the
11 patient, from the nursing staff, from the family, from the
12 chart. Our expertise was primarily in identifying
13 psychiatric illness. When you work with the geriatric
14 population, you have to also have some understanding of the
15 general medical problems as well. So we would usually give
16 the information that we had, pass that on.
17 Q. So you would also identify any kind of, I think you
18 referred to in the past, co-morbidity problems that these
19 patients may be suffering with?
20 A. Yes.
21 Q. Can you define that for the jury?
22 A. A co-morbid condition is if there's more than one
23 illness. If an individual has more than one illness at the
24 same time, I believe that's a co-morbid condition.
25 Q. So it could be a combination of both physical and mental?
1 A. Yes.
2 Q. In respect to some of these patients, I assume if they
3 were suffering from dementia they would be difficult to
4 interview themselves, is that correct?
5 A. Yes.
6 Q. And so were you relying more on documentation from other
7 sources than you were from the patient interview itself?
8 A. Well, we'd also have -- if we were unable to have a
9 patient interview, we'd certainly have a patient observation.
10 So someone who was severely demented, we may still go in and
11 introduce ourselves, try and call them by name, touch them on
12 the arm. Try to see if you can get a little contact, a
13 little something. That's part of the observation, part of
14 the assessment. We would certainly rely upon the chart, the
15 family, the nursing staff at the nursing home.
16 Q. After you reviewed the matter with the physician, what
17 would be the next step in the procedure?
18 A. The physician would either ask us to obtain more
19 information before making a decision or make a decision right
20 then.
21 Q. And what would that decision be?
22 A. Admit or not admit.
23 Q. All right. Did anybody else have authority to override
24 the physician's decision relative to that admission process?
25 A. Not that I'm aware of.
1 Q. So if the physician --
2 A. Let me go back to that question. Excuse me. If we had a
3 very sick -- a number of patients on the unit who were very
4 sick and very demanding of the nursing staff and nurses aids,
5 then, even though a particular patient may meet the criteria,
6 if it's a bad patient mix, as a team with input from the
7 nurses, the clinicians, and in conjunction with the
8 physicians, we may decide not to take that person right now.
9 When we review a case with the physician sometimes we also
10 check with the unit, you know, because we don't -- it's very
11 demanding to treat these patients and the nurses take the
12 brunt of that, so we want to make sure we have a good mix.
13 Q. But it was essentially the physician's call, the
14 attending physician's call?
15 A. Yes.
16 Q. Once admitted, what were the processes that would take
17 place with a patient at that time?
18 A. Then the patient would be either transferred from another
19 floor in the hospital or transported from outside the
20 hospital. Usually they and their family would come to the
21 floor and the nursing staff would begin the nursing intake,
22 which was a lengthy, probably eight or ten page, nursing
23 assessment.
24 Q. So we have the initial screening that was conducted by
25 Horizon, I assume?
1 A. Yes.
2 Q. Was that screening made part of the medical record
3 itself?
4 A. I believe it was. But my job was to make this program be
5 seamless, so that there wasn't Horizon staff and Davis
6 hospital staff. It was just program staff. We tried very
7 much to function as a team, so we'd be out there doing the
8 assessment and then the patient would come in.
9 Q. And so there would be a nursing intake. Were there any
10 requirements that an individual be seen by an internist?
11 A. Yes, there were. All patients admitted to the program
12 were to be seen by a medical doctor. Usually an internist or
13 family practice doctor to obtain a history and physical,
14 which was a medical -- a good thorough medical workup.
15 Q. Okay.
16 A. As opposed to a psychiatric workup.
17 Q. And there was also a requirement as to the psychiatric
18 workup?
19 A. Yes. Both the history and physical and the psychiatric
20 evaluation needed to be completed within 24 hours, I believe.
21 Q. And in respect to the admission process, was that
22 supposed to take place within a certain period of time?
23 A. Yes. Within 24 hours.
24 Q. Okay.
25 A. The nursing assessment, I think, had to be done within
1 eight or ten hours. The history and physical and the
2 psychiatric evaluation within 24 hours. Then the
3 psychosocial evaluation by a social worker within 72 hours.
4 Q. Once a patient had gone through the nursing intake
5 process, were they placed in a room?
6 A. Yes. Sometimes before the assessment.
7 Q. Okay. And did you have anything to do further with the
8 patient at that point or in that process?
9 A. Umm, not specifically. Generally, if I was available, I
10 may answer questions that the family may have or I'd help out
11 on an assessment out in the field. I could help out in the
12 unit as well. Just wherever help was needed.
13 Q. I want you to again turn to the exhibit and go to page
14 two. I want to review with you the exclusionary criteria so
15 I have an understanding and the jury can have an
16 understanding. Item one of the exclusionary criteria talks
17 about a patient with a diagnosis of dementia but no acute
18 behavioral change, is that correct?
19 A. Patients with a substantiated diagnosis of dementia with
20 no known psychiatric disorder and no expectation for a
21 positive response to treatment.
22 Q. Okay. So they would be excluded from admission to the
23 program?
24 A. Yes. I think it's that last part, no expectation of a
25 positive response to treatment, then those patients would be
1 excluded.
2 Q. The second item, would you read that?
3 A. A patient with life-threatening -- will not be accepted
4 in the geropsych service. Number three, a patient with
5 terminal diseases, without a treatable psychiatric disorder,
6 will be referred to an appropriate hospice facility.
7 Q. Okay. When we talk about a treatable psychiatric
8 disorder, what are we talking about?
9 A. Well, we're talking about the expectation that our
10 interventions will be effective in treating the illness, the
11 psychiatric illness.
12 Q. Again, that would be, I assume, the psychiatrists call?
13 A. Yes.
14 Q. You also wouldn't have patients who are seeking
15 readmission, is that correct?
16 A. It's not quite that simple. We would have clients who
17 were readmitted, who would come back for readmission. But we
18 also had some who were not readmitted because we just didn't
19 feel like the program was going to benefit them.
20 Q. Item five talks about patients who are bedfast and cannot
21 participate in the treatment program. So you would not
22 accept somebody who was bedfast?
23 A. In general not. It would depend on how long and if there
24 was a reasonable expectation that they may still benefit from
25 some aspect of the program.
1 Q. In terms of the components of the program, not only do
2 you have the psychiatric component, but I think you testified
3 as to the therapeutic aspects of some of the training,
4 behavioral modification, being able to assist them in
5 developing life skills, is that correct?
6 A. I'm sorry?
7 Q. I'll rephrase the question. Was there a different
8 component other than just the psychiatric component to the
9 program?
10 A. Yes.
11 Q. And would you tell us what that was?
12 A. There were several different nursing services that the
13 nursing staff offered from education groups about
14 medications, education groups about psychiatric diagnoses,
15 education groups about the side effects of medications.
16 There were clinical groups conducted by the social worker
17 such as group therapy. There was individual and family
18 therapy provided when appropriate. There were also different
19 types of activity therapy and occupational therapy. Some was
20 provided by the nursing staff, some by the licensed
21 occupational therapy staff.
22 There were also adjunctive services. We could get a
23 consult from physical therapy to have somebody come in and
24 assist a patient.
25 Q. Item six indicates a patient with complex medical, slash,
1 surgical procedures. What is a patient with a complex
2 medical procedure?
3 A. I think an example would be someone with a serious heart
4 condition. Or it could be any medical condition. But if it
5 was severe enough in nature, or acute in nature, such that it
6 could deter them from benefitting from the psychiatric
7 intervention.
8 Q. Was there an anticipated time period or time frame in
9 which you would treat these patients?
10 A. Yes.
11 Q. And what was that anticipated time?
12 A. Usually ten to fourteen days.
13 Q. What does the term DRG exempt mean?
14 A. Let me think. I believe a DRG was -- I think it had to
15 do with a financial reimbursement associated with the
16 specific diagnostic group. I think DRG is a diagnostic
17 related group. If you have a broken arm, well, they treat so
18 many broken arms in the world that we know approximately how
19 much it costs to treat a broken arm. If we have a
20 straightforward case of depression or other type of disorder,
21 there is a cost associated with all of these services. So a
22 DRG exempt would mean that the particular course of treatment
23 was exempt from the diagnostic related group or the costs
24 associated with that admission.
25 Q. There is another items under the exclusion -- excuse me.
1 It's not under the exclusionary. In terms of this unit, I
2 think you previously testified it was a ten bed unit?
3 A. Yes, sir.
4 Q. During the time frame that you were there, and let's --
5 how long were you employed by Horizon at the Davis North
6 Hospital?
7 A. I believe I was employed just over a year.
8 Q. Do you recall --
9 A. About a year and a half.
10 Q. As I understand it, there was a contract between the
11 hospital and Horizon, is that correct?
12 A. Yes.
13 Q. Do you know when that contract expired?
14 A. I believe it was in October of 1996.
15 Q. Do you know whether or not they continued to -- whether
16 or not they renewed that contract in October of '96?
17 A. I believe they discontinued the contact and chose not to
18 renew the contract at that time.
19 Q. You indicated that you were employed a little over a
20 year. Did you terminate your employment or were you with
21 Horizon at that time?
22 A. No, sir. I was fired by Horizon about 45 minutes before
23 Davis Hospital handed their contract termination to Horizon.
24 Q. Okay. Do you have any recollection relating to the --
25 strike that.
1 Do you recall, sir, ever having a conversation with Dr.
2 Welby Jensen concerning medication practices by Dr. Weitzel?
3 A. Yes, I do.
4 Q. Do you recall approximately when that conversation took
5 place?
6 A. To be honest, it's hard to recall the exact time of that
7 conversation. I think that it was in the fall of '95.
8 Q. And did you, sir, make any specific requests of Dr.
9 Jensen at that time?
10 A. Yes. I asked him to review several charts of Dr. Weitzel
11 to look at the medication management of those patients.
12 Q. Do you know whether or not he in fact did that?
13 A. Yes, he did.
14 Q. Okay. In respect to the position that you held at the
15 clinic, were you also involved in addressing matters
16 specifically with Dr. Weitzel?
17 A. Yes, I was.
18 Q. Did you ever have occasion, sir, to observe his treatment
19 of a patient?
20 A. Yes, I did.
21 Q. And how many occasions would you say you did that?
22 A. Oh, many times.
23 Q. Okay. And was there any particular time period that you
24 would observe these -- his treatment of patients, or time of
25 day, let me put it that way?
1 A. Yes.
2 Q. Okay. What time of day was that?
3 A. Early in the morning, throughout the day, in the evening.
4 I tried to be on the unit at a number of different times
5 throughout the day to observe the treatment of the entire
6 team.
7 Q. Okay. And can you tell us, was there any particular
8 pattern that you observed relative to the time periods that
9 he would come and visit the patients?
10 A. Yes.
11 Q. And when was that, sir?
12 A. Umm, I guess there were different patterns. The times
13 that Dr. Weitzel would come in were what we called regular
14 business hours. Other times he'd make it a habit of coming
15 very early in the morning.
16 Q. Okay. And do you recall, on those early morning visits
17 did you observe him in the course of his treatment of those
18 patients?
19 A. Yes, I did.
20 Q. And can you tell us what you observed?
21 A. Dr. Weitzel was on the unit very early in the morning.
22 He would awake, arouse, the patients from their sleep to
23 check in with them, do early morning rounds.
24 Q. How early in the morning are we talking about?
25 A. 5:30, maybe; about that time. Sometimes six.
1 Q. Do you recall how long he would spend with each patient?
2 A. A few minutes.
3 Q. How long would he be on the unit during that time period?
4 A. Umm, approximately an hour. Maybe a little more, maybe a
5 little less.
6 Q. Did you ever have conversation with him about those
7 practices?
8 A. Yes, I did.
9 Q. And can you recall when that occurred?
10 A. It would have been in the winter.
11 Q. Of '95?
12 A. Yes.
13 Q. Okay. And can you tell me what you said and what his
14 response was to that?
15 A. I asked him why he was coming in so early and suggested
16 that I didn't think it was a good idea to come in that early.
17 Q. How did he respond?
18 A. He seemed to understand my concern and modified it
19 somewhat, modified the practice somewhat.
20 Q. Okay. Now, I don't know, but did you ever have any
21 specific conversations with him relating to the five patients
22 that we have in this case?
23 A. Repeat the question.
24 Q. Maybe I should rephrase that. Do you recall ever talking
25 to him about the deaths of these five patients that are the
1 subject matter of this prosecution?
2 A. Yes.
3 Q. And can you tell us when that occurred?
4 A. It occurred during that six week period. I think one or
5 two of the patients may have already died when it was really
6 brought to my attention.
7 Q. And who brought it to your attention?
8 A. I believe it was first one of the nursing staff.
9 Q. And where did you have a conversation with Dr. Weitzel
10 about that?
11 A. In my office and, I think, on the unit.
12 Q. And can you recall what he told you about their deaths at
13 that time?
14 A. He described how they had other complicated medical
15 problems. Some of them were in great pain, some were
16 agitated. That he was trying to help make them comfortable.
17 Q. Okay. You said that that conversation, you think,
18 occurred prior to the deaths of all of the patients?
19 A. No, sir, I don't think I said that. I think a couple of
20 the patients may have already died, but it was within that
21 six week period.
22 Q. Excuse me. Maybe I didn't phrase that right. Do you
23 know whether there were patients that died after that
24 conversation with Dr. Weitzel?
25 A. Yes.
1 Q. Okay. Did you talk with him again about the other
2 patients that passed away after that?
3 A. Yes, I did.
4 Q. And can you tell me what his response was on that
5 occasion?
6 A. I asked if these patients could or should have been
7 transferred to a medical floor. We discussed how the
8 families were here, they were already connected with our
9 staff. A therapeutic relationship, so to speak, was already
10 well established with our nursing staff and our treatment
11 providers. There were some pros and cons to keeping them
12 there or to moving them.
13 Q. Okay. You yourself did not make a review of any of the
14 medical records of these patients, did you?
15 A. Yes, I did.
16 Q. Was that before or after the conversations with Dr.
17 Weitzel?
18 A. It was both, before and after.
19 MR. WILSON: May I have a moment, Your Honor?
20 THE COURT: You may.
21 (Pause in the proceedings.)
22 MR. WILSON: I have no further questions at this
23 time, Your Honor
24 THE COURT: Let's take our lunch break at this time.
25 You may step down, if you would, please.
1 Ladies and gentlemen, we'll take our lunch break. We'll
2 be in recess until about 1:25. Ladies and gentlemen of the
3 jury, I remind you, as I have before, not to discuss the case
4 with anyone. Do not let anyone discuss it in your presence
5 or with you. You may be excused at this time. We'll see you
6 back at 1:25. Thank you, Mr. Chambers.
7 (Lunch recess.)
11-4-02 - AFTERNOON SESSION
THE COURT: THE RECORD SHOULD NOTE PARTIES AND
3 COUNSEL ARE PRESENT. THE JURY IS IN THE JURY BOX.
4 WE WILL ASK MR. CHAMBERS TO COME BACK TO THE STAND.
5 AND, MR. CHAMBERS, THE COURT REMINDS YOU THAT YOU'RE STILL
6 UNDER OATH.
7 THE WITNESS: YES.
8 THE COURT: YOU MAY PROCEED, MS. ISAACSON.
9 CROSS-EXAMINATION
10 BY MS. ISAACSON:
11 Q. GOOD AFTERNOON, MR. CHAMBERS.
12 A. GOOD AFTERNOON.
13 Q. MY NAME IS TARA ISAACSON AND I REPRESENT DR. WEITZEL. I
14 HAVE A FEW QUESTIONS FOR YOU.
15 IF I UNDERSTAND IT CORRECTLY, YOU WERE AN EMPLOYEE OF
16 HORIZON?
17 A. YES.
18 Q. THE NURSES WERE EMPLOYEES OF DAVIS HOSPITAL?
19 A. YES.
20 Q. AND ANY PHYSICIANS THAT YOU HAD COME OVER TO THE UNIT,
21 OTHER THAN THE PSYCHIATRISTS ON STAFF, WERE EMPLOYEES OF
22 DAVIS HOSPITAL?
23 A. I DON'T KNOW THAT THEY WERE EMPLOYEES OR NOT. I THINK
24 THEY MAY HAVE BEEN HOSPITAL -- PHYSICIANS WITH PRIVILEGES AT
25 THE HOSPITAL, BUT I DON'T KNOW THAT THEY WERE EMPLOYED BY THE
1 HOSPITAL.
2 Q. I UNDERSTAND. SO IF YOU HAD A SITUATION WHERE YOU NEEDED
3 A MEDICAL EVALUATION OR ANOTHER REASON TO HAVE A PHYSICIAN
4 OTHER THAN A PSYCHIATRIST COME TO THE UNIT, YOU HAD TO BORROW
5 SOMEONE FROM THE HOSPITAL; IS THAT RIGHT?
6 A. YES.
7 Q. AND DO I UNDERSTAND THAT IT WAS OFTEN VERY DIFFICULT FOR
8 YOU TO GET PHYSICIANS TO COME OVER FROM THE HOSPITAL?
9 A. THAT'S CORRECT.
10 Q. YOU SPOKE A LITTLE BIT WITH MR. WILSON ABOUT THE
11 ADMISSION CRITERIA AND THE TYPES OF PATIENTS THAT YOU WOULD
12 BRING ON TO THE UNIT. SOME OF THE THINGS THAT -- THAT WERE
13 LISTED ON THE CRITERIA WERE ACTING OUT AND HURTING OTHERS.
14 IS THAT ONE?
15 A. I -- I BELIEVE SO.
16 Q. AND -- AND JUST GENERALLY ENGAGING IN BEHAVIOR THAT WOULD
17 HURT THEMSELVES?
18 A. YES.
19 Q. SCREAMING, CRYING, HITTING, THOSE SORTS OF BEHAVIORS?
20 A. YES, THOSE KIND OF BEHAVIORS.
21 Q. SO IF YOU WERE ASSESSING OR LOOKING AT A PATIENT THAT YOU
22 MIGHT WANT TO HAVE COME ON TO THE UNIT, TRYING TO DECIDE IF
23 THEY'RE APPROPRIATE, IF THEY WERE EXHIBITING BEHAVIORS LIKE
24 WHAT I JUST MENTIONED -- SCREAMING, CRYING, HITTING, KICKING,
25 THAT SORT OF THING -- IS THAT WHAT YOU WOULD SOMETIMES SEE IN
1 THIS TYPE OF PATIENT THAT WOULD COME ON TO THE UNIT?
2 A. YES, WE'D SEE THOSE KIND OF BEHAVIORS.
3 Q. VIOLENCE TOWARDS OTHERS?
4 A. YES.
5 Q. AND THESE WERE PATIENTS WHO AT THE NURSING HOMES WERE OUT
6 OF CONTROL SOMETIMES?
7 A. YES.
8 Q. AND THE NURSING HOME SIMPLY COULDN'T DEAL WITH THEM
9 ANYMORE.
10 A. THAT'S TRUE.
11 Q. THESE WERE PATIENTS THAT IN THE NURSING HOMES WERE OFTEN
12 SO AGITATED THEY'D HAVE TO BE PHYSICALLY RESTRAINED OR TIED
13 DOWN.
14 A. YEAH, SOMETIMES.
15 Q. AND ONE OF THE BENEFITS TO THE GEROPSYCHIATRIC UNIT WAS
16 YOU HAD AN ALTERNATIVE TO TYING SOMEONE DOWN.
17 A. YES, WE DID. AND WE'D ALSO USE RESTRAINTS WHEN NECESSARY
18 ON THE UNIT.
19 Q. BUT YOU COULD USE MEDICATIONS AS A WAY TO CALM THE PERSON
20 DOWN SO YOU WOULDN'T HAVE TO TIE THEM UP; IS THAT RIGHT? OR
21 TIE THEM DOWN, EXCUSE ME.
22 A. YEAH, THAT'S -- THAT'S TRUE. I THINK THE NURSING HOMES
23 ALSO COULD PRESCRIBE MEDICATIONS, BUT WE HAD THE ADVANTAGE OF
24 HAVING A PSYCHIATRIC SPECIALIST WHO COULD, YOU KNOW, PROVIDE
25 THAT SPECIALITY OF MEDICINE THAT WAS NOT AVAILABLE AT THE
1 NURSING HOME.
2 Q. AND YOU INDICATED ON -- ON YOUR DIRECT EXAMINATION THAT
3 YOU WOULD LOOK AT EACH INDIVIDUAL -- POTENTIAL PATIENT AND
4 MAKE A JUDGMENT BASED UPON THAT INDIVIDUAL PATIENT WHETHER
5 THEY WERE APPROPRIATE.
6 A. YES.
7 Q. AND THERE WERE NO HARD AND FAST RULES ABOUT WHO WAS
8 PERFECT FOR THE GEROPSYCHIATRIC UNIT.
9 A. THAT'S TRUE.
10 Q. NOW, YOU HAD SOME SPECIFIC INVOLVEMENT IN -- IN TWO OF
11 THE PATIENT INVOLVED IN THIS CASE. DO YOU RECALL THE PATIENT
12 OF MARY CRANE?
13 A. YES, I DO.
14 Q. AND DID YOU PARTICIPATE IN THE INTAKE OF MARY CRANE?
15 A. I BELIEVE I TOOK -- I THINK I HELPED WITH PART OF IT.
16 Q. WOULD IT BE HELPFUL TO REFRESH YOUR RECOLLECTION TO TAKE
17 A LOOK AT THAT INTAKE DOCUMENT?
18 A. YES.
19 Q. I'M GOING TO PUT UP ON THE SCREEN HERE WHAT IS ENTITLED
20 THE GEROPSYCHIATRIC PHONE INTAKE FORM. DOES THAT FORM LOOK
21 FAMILIAR TO YOU?
22 A. YES. DO YOU HAVE A PAPER COPY THAT I COULD LOOK AT,
23 PLEASE?
24 Q. I SURE DO.
25 (MS. ISAACSON TENDERS DOCUMENT TO THE WITNESS.)
1 MS. ISAACSON: AND, COUNSEL, THIS IS MED 230.
2 MR. WILSON: THANK YOU.
3 Q. (BY MS. ISAACSON) IT MIGHT BE HELPFUL FOR BOTH YOU AND
4 THE JURY IF WE TURN OFF SOME OF THESE LIGHTS.
5 LET'S HAVE YOU LOOK AT THIS DOCUMENT. YOU CAN LOOK AT
6 EITHER THE HARD COPY OR THE COPY HERE. IS THIS A FORM THAT
7 YOU AT LEAST IN PART HELPED FILL OUT?
8 A. YES, IT IS.
9 Q. AND WOULD YOU HAVE BEEN COMMUNICATING WITH SOMEONE OVER
10 THE PHONE?
11 A. YES.
12 Q. AND IT LOOKS LIKE THE DATE UP IN THE UPPER LEFT-HAND
13 CORNER IS DECEMBER 12TH OF 1995?
14 A. UH-HUH.
15 Q. AND, AGAIN, THE PATIENT IS MARY CRANE?
16 A. YES.
17 Q. AND YOU'VE INDICATED -- IS THIS YOUR HANDWRITING IN THE
18 MIDDLE SECTION TALKING ABOUT PRESENTING PROBLEM?
19 A. NO.
20 Q. WHO'S HANDWRITING WOULD THAT BE?
21 A. I BELIEVE THAT'S KEITH PERRY'S.
22 Q. WHICH PORTION OF -- OF THE FORM IS IN YOUR HANDWRITING?
23 A. THE MESSY PART. I THINK THAT THIS -- I THINK THIS -- I
24 THINK THIS IS MINE, I THINK SOME OF THE NOTES UP THERE ARE
25 MINE. I THINK THIS IS MINE.
1 Q. AND WOULD YOU -- DOES THIS MEAN THAT YOU KIND OF TOOK
2 OVER THE INTAKE PROCESS?
3 A. YEAH. MR. PERRY WOULD -- HE COULD HAVE TWO OR THREE,
4 FOUR -- HE COULD HAVE HALF A DOZEN INTAKES IN VARYING STAGES
5 OF PROGRESSION AND HE MAY LEAVE -- IN FACT, HE WOULD
6 FREQUENTLY LEAVE TWO OR THREE OF THOSE ON HIS DESK VERY
7 NEATLY ORGANIZED. HE'D TOUCH BASE WITH ME, LET ME KNOW HOW
8 FAR INTO THE PROCESS HE WAS, WHAT ADDITIONAL INFORMATION WE
9 WERE WAITING TO HEAR BACK FROM. AND SO HE'D BE OUT DOING AN
10 IN-SERVICE, DOING A TRAINING, DOING ANOTHER ASSESSMENT, AND
11 THEN I COULD TAKE THE CALL AND FINISH THE ASSESSMENT OR
12 FINISH RETRIEVING SOME OF THE INTAKE INFORMATION FROM THE
13 OFFICE, OR I WOULD GO OUT AND DO THE -- THE PHYSICAL
14 FACE-TO-FACE ASSESSMENT MYSELF.
15 Q. OKAY. WITH REGARD TO THE THIS PATIENT, I'M GOING TO BLOW
16 UP THE SECTION THAT TALKS ABOUT THE PRESENTING PROBLEM. AND
17 CAN YOU EXPLAIN TO THE JURY --
18 THE COURT: COUNSEL, DOES THIS HAVE AN EXHIBIT
19 NUMBER?
20 MS. ISAACSON: IT DOES. THIS IS -- IT'S GOING TO BE
21 STATE'S EXHIBIT 3 -- 4?
22 MR. WILSON: THIS IS -- THIS IS MARY CRANE, YES, 4.
23 MR. MAJOR: SHOULD BE 4(C).
24 MR. WILSON: 4(C).
25 MS. ISAACSON: AND THE REFERENCE PAGE IS MED 230.
1 THE COURT: OKAY. FROM NOW ON WE NEED TO REFER TO
2 THOSE BY THE EXHIBIT NUMBER SO THE RECORD IS CLEAR.
3 MS. ISAACSON: OKAY. SURE.
4 THE COURT: YOU CAN REFER TO THEM ANY WAY YOU WANT
5 BETWEEN YOURSELVES. AS FAR AS THE RECORD IS CONCERNED, WE
6 NEED TO REFER TO THEM AS THE PROPER EXHIBIT NUMBER.
7 MS. ISAACSON: LET MEET JUST CONFIRM AND MAKE SURE
8 WE'RE ON THE --
9 MS. BARLOW: I BELIEVE IT'S 4(B)RATHER THAN 4(C).
10 MS. ISAACSON: 4(B).
11 Q. (BY MS. ISAACSON) AND THIS IS A DOCUMENT -- IF WE GO
12 BACK A LITTLE BIT, MR. CHAMBERS, THIS IS A DOCUMENT THAT
13 WOULD BE KEPT IN THE PATIENT'S MEDICAL FILE, RIGHT?
14 A. YES.
15 Q. AND EACH PATIENT ON THE GEROPSYCHIATRIC UNIT WOULD HAVE A
16 SET OF MEDICAL RECORDS THAT WOULD INCLUDE THIS DOCUMENT.
17 A. YES.
18 Q. AND THIS DOCUMENT EXPLAINS THE INTAKE PROCESS.
19 A. YES.
20 Q. OKAY. LET'S GO BACK TO THE PRESENTING PROBLEMS FOR MARY
21 CRANE. IT LOOKS LIKE SHE WAS COMING FROM AN ALZHEIMERS UNIT;
22 IS THAT CORRECT?
23 A. YES, IT IS.
24 Q. AND SOME OF THE BEHAVIORS SHE WAS EXHIBITING, THE REASONS
25 WHY YOU THOUGHT SHE MIGHT BE APPROPRIATE FOR THE UNIT, WOULD
1 BE THAT SHE WAS DRINKING OUT OF A TOILET, SHE WAS SPITTING,
2 USING MANIPULATION, HITTING, VERBALLY ABUSIVE, LOOKS LIKE
3 RUNS INTO OTHERS --
4 A. WITH HER WALKER.
5 Q. -- WITH HER WALKER. SCREAMING. ALSO, SEEKING FLUIDS
6 CONTINUALLY, STICKING FINGERS DOWN HER THROAT AND THROWING
7 UP. AND I GUESS THERE'S A NOTE HERE THERE WAS DEMENTIA.
8 WERE THESE THE -- BASED UPON YOUR REVIEW OF THIS FORM,
9 BASED UPON THE INTAKE THAT INITIALLY HAD BEEN STARTED BY YOUR
10 COWORKER, DID YOU THINK THAT SHE WAS SOMEONE WHO WAS
11 APPROPRIATE FOR THE UNIT?
12 A. YES, I DID.
13 Q. AND THE IDEA WAS THAT MEDICATIONS COULD BE USED TO
14 HOPEFULLY CONTROL THOSE BEHAVIORS?
15 A. YES. MEDICATIONS AND OTHER INTERVENTIONS.
16 Q. WHEN THESE PATIENTS INVOLVED IN THIS CASE DIED, YOU
17 REALIZED THAT SOME OF THEM THAT HAD BEEN ADMITTED WERE MORE
18 SERIOUS MEDICALLY THAN YOU HAD FIRST THOUGHT.
19 A. YES, I DID.
20 Q. AND YOU WOULD AGREE THAT THESE ASSESSMENTS DO NOT INVOLVE
21 A PRECISE SCIENCE?
22 A. YES.
23 Q. AND THERE ARE CERTAINLY COMPLICATIONS AND DIFFICULTIES
24 THAT CAN ARISE WITH ELDERLY PATIENTS THAT NO ONE CAN
25 NECESSARILY ANTICIPATE?
1 A. THAT'S TRUE -- THAT'S CORRECT.
2 Q. LET'S TALK ABOUT ENNIS ALLREDGE. I THINK HE'S ANOTHER
3 PATIENT THAT YOU WERE INVOLVED IN. DO YOU RECALL THAT
4 PATIENT?
5 A. I REMEMBER THE -- YES.
6 Q. DO YOU RECALL -- WELL, IS PART OF YOUR JOB, IN ADDITION
7 TO WHAT YOU'VE DESCRIBED FOR THE JURY, ALSO TO CONSULT AND
8 MEET WITH FAMILY MEMBERS OF PATIENTS?
9 A. YES, IT IS.
10 Q. AND DO YOU RECALL MEETING WITH THE ENNIS ALLREDGE FAMILY?
11 A. NOW THAT I SEE MY NOTE HERE, I RECALL, YES.
12 Q. WELL, WHY DON'T WE SHOW THE JURY THE NOTE AS WELL SO
13 THAT --
14 THE COURT: IS THIS AN EXHIBIT?
15 MS. ISAACSON: IT IS, YOUR HONOR. LET ME GO BACK,
16 MAKE SURE WE'RE ON THE SAME -- THIS WILL BE STATE'S POTENTIAL
17 EXHIBIT 6(B), ENNIS ALLREDGE.
18 AND, COUNSEL, FOR YOUR RECORD, THIS WILL BE PAGE MED 18.
19 Q. (BY MS. ISAACSON) THIS UP HERE, MR. CHAMBERS, IS THIS
20 YOUR NOTE?
21 A. YES, IT IS.
22 Q. AND WHERE WOULD THIS HAVE BEEN KEPT IN THE MEDICAL
23 RECORDS?
24 A. THIS WAS -- THIS WAS IN THE PATIENT'S MEDICAL RECORD,
25 PROBABLY UNDER THE GENERAL NOTES. SEE THERE'S A MEDICAL
1 NOTE, I BELIEVE, RIGHT ABOVE MINE, AND A NURSING NOTE RIGHT
2 BELOW MINE.
3 Q. AND IS THAT SOMETHING THAT YOU WOULD HAVE MADE RIGHT
4 AROUND THE TIME THAT YOU HAD THIS MEETING WITH THE FAMILY?
5 A. YES, IT IS.
6 Q. I'M GOING TO ZOOM IN ON THAT -- THAT SECTION. IS THIS
7 ALL IN YOUR HANDWRITING UP HERE ON THE SCREEN?
8 A. YES, IT IS.
9 Q. AND IT APPEARS THAT ON JANUARY 13TH OF 1996, YOU MET WITH
10 THE ENNIS ALLREDGE FAMILY?
11 A. (NODS HEAD.)
12 Q. DID YOU INDICATE HOW LONG YOU'D MET WITH THEM?
13 A. YES, I DID. FOR ONE AND A HALF HOURS.
14 Q. YOU ALSO INDICATED THAT -- WELL, GO AHEAD AND EXPLAIN TO
15 THE JURY WHAT YOU'VE INDICATED IN YOUR NOTE FROM YOUR
16 MEETING.
17 A. THE -- THE FAMILY ASKED ME TO CALL THE MORTUARY IN DELTA,
18 UTAH. I CONTACTED NICHOLS MORTUARY AND THEY AGREED TO COME
19 WITHIN TWO AND A HALF OR THREE AND A HALF HOURS -- OR THREE
20 HOURS OF BEING NOTIFIED. THE FAMILY WAS VERY SUPPORTIVE OF
21 THE MEASURES BEING TAKEN. THERE WERE ESPECIALLY GLAD THAT
22 THE PATIENT IS CLOSE BY IN DAVIS COUNTY SO THAT THEY DON'T
23 HAVE TO TRAVEL TO LOGAN.
24 I ATTEMPTED TO NOTIFY DR. DIENHART, AND AS OF -- WHAT IS
25 THAT, 8:10? NO, IT WOULD BE 10:10 IN THE MORNING. HE HAS
1 NOT ANSWERED THE PAGE. WILL TRY AT HOME IN ORDER TO NOTIFY
2 OF PATIENT'S CONDITION AND M.R.I. RESULTS. PLEASE NOTIFY ME
3 IF ANY FURTHER PROBLEMS ARISE.
4 Q. AND DR. DIENHART, WE'VE HEARD HIS NAME MENTIONED I THINK
5 ONCE OR TWICE. WHAT WAS HIS ROLE?
6 A. HE WAS ONE OF THE -- HE WAS -- HE'S AN INTERNIST AT THE
7 HOSPITAL. HE DID MANY OF THE HISTORIES AND PHYSICALS FOR OUR
8 PATIENTS.
9 Q. AND SO YOU -- AT THIS STAGE OBVIOUSLY YOU'RE MEETING WITH
10 THE FAMILY TO DISCUSS COMFORT CARE MEASURES WITH REGARD TO
11 THIS PATIENT?
12 A. I THINK I WAS MEETING WITH THEM TO DISCUSS THE MORTUARY
13 AND FUNERAL ARRANGEMENTS.
14 Q. OKAY. AND SO AT THIS POINT AT LEAST, HIS CONDITION IS
15 RAPIDLY DETERIORATING?
16 A. (NODS HEAD.)
17 Q. AND YOU'RE MEETING WITH THEM, TALKING TO THEM, AND YOU
18 ACTUALLY NOTE THE FAMILY IS VERY SUPPORTIVE OF THE MEASURES
19 BEING TAKEN.
20 A. YES.
21 Q. MEANING THE MEASURES BEING TAKEN ON THE UNIT.
22 A. YES.
23 MS. ISAACSON: I DON'T HAVE ANYTHING FURTHER.
24 THE COURT: REDIRECT?
25 *****
1 REDIRECT EXAMINATION
2 BY MR. WILSON:
3 Q. MR. TODD (SIC), WHEN YOU WERE ASKED THE QUESTION
4 CONCERNING THE CHEMICAL RESTRAINTS, THE AVAILABILITY OF
5 CHEMICAL RESTRAINTS AS WELL AS THE OTHER TYPES OF PHYSICAL
6 RESTRAINTS, I THINK YOUR ANSWER WAS -- IS THAT THERE WAS THAT
7 AVAILABILITY ON THE -- THE UNIT; IS THAT CORRECT?
8 A. I'M -- I'M NOT RECOLLECTING ANY MENTION OF CHEMICAL
9 RESTRAINTS -- TALKED ABOUT MEDICINES AND WE TALKED ABOUT
10 PHYSICAL RESTRAINTS.
11 Q. OKAY.
12 A. I'M NOT SURE I UNDERSTAND THE QUESTION.
13 Q. OKAY. IS THERE A DIFFERENCE BETWEEN A MEDICAL -- A
14 MEDICINE THAT RESTRAINS A PATIENT AND A -- AND A PHYSICAL
15 RESTRAINT?
16 A. YES, THERE IS.
17 Q. AND IN RETURN -- IN RESPECT TO THE -- TO THE -- LET ME
18 ASK THIS QUESTION. IN RESPECT TO THE TYPES OF MEDICATIONS
19 THAT ARE AVAILABLE FOR USE ON THE GEROPSYCH UNIT THAT WOULD
20 NOT BE FOR USE IN A NURSING HOME, LET'S SAY, WHAT ARE WE
21 TALKING ABOUT?
22 A. YOU KNOW, YOU'D NEED TO ASK A PHYSICIAN OR A NURSING HOME
23 ADMINISTRATOR, BUT WITH -- MY UNDERSTANDING IS THAT ALL THE
24 MEDICATIONS AVAILABLE ON THE PSYCHIATRIC UNIT ARE AVAILABLE
25 AT THE NURSING HOME.
1 Q. OKAY.
2 A. MOST, IF NOT ALL.
3 Q. ALL RIGHT.
4 A. AND SO IT'S JUST A MATTER OF THE -- UNFORTUNATELY AT OUR
5 NURSING HOMES PHYSICIANS DON'T COME AROUND THAT OFTEN AND
6 THEY CERTAINLY DON'T HAVE THE SPECIALIZATION TO DEAL WITH
7 PSYCHIATRIC DISORDERS THAT OUR PSYCHIATRISTS DO.
8 Q. OKAY. SO THAT'S ONE OF THE THINGS YOU OBVIOUSLY EVALUATE
9 IN TERMS OF A PATIENT'S BEHAVIOR IN A NURSING HOME
10 ENVIRONMENT, CORRECT?
11 A. YES.
12 Q. AND IN -- AND IN TERMS OF THOSE BEHAVIORS, WAS THAT
13 BEHAVIOR THAT RECORDED ON MARY CRANE AN UNUSUAL BEHAVIOR OR
14 DID YOU SEE THAT OFTEN?
15 A. I THINK -- THE BEHAVIOR IN THE INTAKE FORM THAT WE
16 REVIEWED?
17 Q. UH-HUH.
18 A. I THINK THAT WAS REPRESENTATIVE OF THE TYPE OF PATIENTS
19 THAT WE FREQUENTLY HAD.
20 Q. OKAY. SO IT WASN'T -- SHE -- SHE WASN'T SOMETHING THAT
21 WAS -- SOME TYPE OF BEHAVIOR THAT WAS ALL THAT UNUSUAL, I
22 TAKE IT?
23 A. THAT'S CORRECT.
24 Q. OKAY. IN TERMS OF -- OF RESTRAINING A PATIENT, AND YOU
25 INDICATED AT TIMES THERE WAS -- THERE WAS A NECESSITY TO
1 PHYSICALLY RESTRAIN A PATIENT; IS THAT CORRECT?
2 A. YES.
3 Q. WOULD THAT BE A LAST RESORT MEASURE?
4 A. YES, IN GENERAL. I MEAN, IF SOMEONE WAS STRIKING OUT OR
5 HURTING THEMSELVES OR TAKE -- TRYING TO REMOVE A -- A WOUND
6 DRESSING, YEAH, PHYSICAL RESTRAINTS WOULD BE NECESSARY AT
7 TIMES.
8 Q. WERE YOU EVER AWARE WHILE MARY CRANE WAS ON THE UNIT THAT
9 SHE WAS RESTRAINED EITHER IN A MEDICAL FASHION OR A PHYSICAL
10 FASHION?
11 A. I'M SORRY. YOU'RE ASKING ME IF I REMEMBER IF SHE WAS
12 RESTRAINED?
13 Q. YEAH. TO YOUR KNOWLEDGE.
14 A. I DON'T -- I DON'T RECOLLECT. SHE VERY WELL MAY HAVE
15 BEEN. I WOULD HAVE REVIEW THE -- THE MEDICAL RECORD --
16 Q. OKAY.
17 A. -- TO REFRESH MY MEMORY.
18 Q. SO YOU'RE NOT AWARE WHETHER THAT WAS EVER USED IN HER
19 TREATMENT?
20 A. IT -- IT'S ENTIRELY POSSIBLE THAT SHE WAS OR THAT SHE WAS
21 NOT. I JUST -- IT'S BEEN SO MANY YEARS.
22 Q. ALL RIGHT.
23 A. I'D HAVE TO REVIEW THE CHART.
24 Q. IN RESPECT TO THE NOTES RELATIVE TO ENNIS ALLREDGE, DO
25 YOU HAVE ANY INDEPENDENT RECOLLECTION AS TO WHO YOU MET WITH
1 ON THAT PARTICULAR DATE, ON JANUARY 13TH OF '90 -- '96?
2 A. WITH ALL RESPECT TO ANY FAMILY MEMBERS THAT MAY BE HERE,
3 I -- I DON'T RECALL IF I WAS WITH -- MEETING WITH A SPOUSE OR
4 WITH ADULT CHILDREN. I -- I DON'T REMEMBER.
5 Q. OKAY. SO YOU DON'T RECALL WHETHER IT WAS WITH JUST HIS
6 WIFE OR WHETHER IT WAS WITH OTHER CHILDREN WHO WERE --
7 A. I APOLOGIZE THAT I DON'T REMEMBER.
8 Q. OKAY. WELL, I -- I DON'T KNOW AS YOU TO APOLOGIZE FROM
9 THAT STANDPOINT. YOU MADE THE NOTE. I WAS JUST TESTING TO
10 SEE WHETHER OR NOT YOU HAD AN INDEPENDENT RECOLLECTION OF
11 THOSE EVENTS.
12 A. NO, SIR.
13 Q. OKAY. AND AS I TAKE IT, THE NOTE JUST REFLECTS THAT YOU
14 WERE ADVISED OR THAT YOU ADVISED THEM OF CERTAIN INFORMATION
15 AND THEY ASKED YOU TO CONTACT THE MORTUARY?
16 A. YES, THEY DID.
17 Q. APPARENTLY THERE WAS SOME DISCUSSION RELATIVE TO THE CARE
18 THAT WAS BEING GIVEN TO ENNIS.
19 A. YES.
20 Q. IS THAT CORRECT?
21 A. THAT IS CORRECT.
22 Q. BUT, AGAIN, YOU DON'T KNOW WHETHER THAT WAS JUST WITH ONE
23 PERSON OR WHETHER IT WAS WITH THE WHOLE FAMILY?
24 A. I MET WITH SEVERAL FAMILIES DURING THAT PERIOD OF TIME
25 AND I JUST DON'T REMEMBER.
1 Q. OKAY.
2 A. I DO REMEMBER GOING OVER THE GENERAL CONDITION OF THE
3 PATIENT AND HOW THINGS WERE -- YOU KNOW, THAT IT APPEARED
4 THAT THE PATIENT WAS COMING TO THE END OF THEIR LIFE AND THEN
5 OFFERING TO HELP, THEM ASKING ME TO MAKE A PHONE CALL.
6 Q. DID DR. WEITZEL PARTICIPATE IN THAT CONVERSATION?
7 A. I DON'T BELIEVE HE DID WITH ME AT THAT TIME.
8 Q. OKAY. DO YOU RECALL WHETHER THERE WAS ANY CONVERSATIONS
9 OF THAT NATURE -- REFERRING AGAIN TO ENNIS ALLREDGE -- THAT
10 DR. WEITZEL PARTICIPATED IN THE CONVERSATION, WHEN YOU WERE
11 PRESENT?
12 A. I RECOLLECT THAT HE SPOKE WITH THE FAMILY MEMBERS, BUT I
13 DON'T KNOW THAT HE DID THAT WHEN I WAS PRESENT.
14 Q. OKAY. SO --
15 A. OR -- OR WE MAY HAVE, I APOLOGIZE FOR THE BAD MEMORY.
16 Q. WELL, THAT'S -- I -- I APPRECIATE THAT. IT HAS BEEN
17 SEVEN YEARS AGO.
18 YOU -- YOU INDICATE A NOTE AS TO THE CONDITION AND THE
19 M.R.I. RESULTS. WHERE DID YOU RECEIVE THAT INFORMATION? DO
20 YOU REMEMBER?
21 A. YES. I REMEMBER ONE OF THE NURSES -- I RELIED HEAVILY ON
22 THE NURSES BECAUSE THEY'RE NURSES AND I'M A SOCIAL WORKER.
23 AND I RELIED ON ONE OF THEM TO REVIEW THAT AND THEY KIND OF
24 POINTED OUT IN THE CHART THE RESULTS.
25 Q. OKAY. AND -- BUT YOU DON'T REMEMBER THE PARTICULAR NOTE
1 OR WHERE THAT INFORMATION WAS SUPPLIED FROM?
2 A. IT WAS FROM THE MEDICAL RECORD.
3 Q. FROM THE MEDICAL RECORD?
4 A. YES.
5 Q. DID YOU -- DO YOU REMEMBER READING ANY RADIOLOGY NOTES
6 REGARDING THE M.R.I. ITSELF?
7 A. YES, I BELIEVE THAT'S WHAT WE WERE REVIEWING.
8 Q. OKAY.
9 A. NOT JUST THE FILM, SO TO SPEAK, BUT THE NOTE.
10 Q. OKAY. DO YOU REMEMBER ANY DISCUSSIONS ABOUT THE M.R.I.
11 BEING COMPROMISED?
12 A. NO.
13 Q. OKAY.
14 MR. WILSON: I HAVE NO FURTHER QUESTIONS, YOUR
15 HONOR.
16 THE COURT: RECROSS?
17 MS. ISAACSON: NOTHING FURTHER.
18 THE COURT: YOU MAY STEP DOWN, MR. CHAMBERS. THANK
19 FOR YOU TESTIFYING.
20 THE WITNESS: YOU'RE WELCOME.
21 THE COURT: MAY THIS WITNESS BE EXCUSED, MR. WILSON?
22 MR. WILSON: HE MAY, YOUR HONOR.
23 THE COURT: MR. BUGDEN?
24 MS. ISAACSON: YES.
25 THE COURT: EXCUSE ME, MS. ISAACSON.
1 YOU MAY BE EXCUSED. THANK YOU FOR COMING.