Todd Chambers
2 MR. MAJOR: WE WOULD CALL TODD CHAMBERS TO THE
3 STAND, YOUR HONOR.
4 THE COURT: IF YOU'D LIKE TO COME FORWARD TO THE
5 CLERK AND BE SWORN, PLEASE.
6 TODD CHAMBERS,
7 BEING FIRST DULY SWORN, WAS EXAMINED AND TESTIFIED
8 AS FOLLOWS:
9 DIRECT EXAMINATION
10 BY MR. MAJOR:
11 Q. COULD YOU PLEASE STATE YOUR FULL NAME FOR THE RECORD?
12 A. TODD MARTIN CHAMBERS.
13 Q. AND MR. CHAMBERS, I'D LIKE TO RECALL YOUR ATTENTION BACK
14 TO A PERIOD OF TIME AROUND DECEMBER OF 1995 AND ASK YOU
15 WHERE WERE YOU EMPLOYED AROUND THAT PARTICULAR PERIOD OF
16 TIME?
17 A. I WORKED FOR HORIZON MENTAL HEALTH MANAGEMENT AT DAVIS
18 HOSPITAL.
19 Q. OKAY. AND WHAT WERE YOUR SPECIFIC DUTIES AT THAT TIME?
20 A. I WAS THE PROGRAM DIRECTOR FOR THE GERIATRICS --
21 GERIATRIC PSYCHIATRY INPATIENT UNIT. MY MAIN
22 RESPONSIBILITIES WERE TO PROVIDE LEADERSHIP FOR THE PROGRAM,
23 BOTH CLINICAL LEADERSHIP AS WELL AS ADMINISTRATIVE OR
24 FINANCIAL LEADERSHIP, AND ALSO TO -- TO REALLY MEET -- TO
25 SERVE THE CUSTOMER, THE CLIENT HOSPITAL.
189
1 Q. OKAY. THANK YOU. NOW, I'D LIKE TO GET INTO A LITTLE
2 BIT ABOUT YOUR TRAINING AND BACKGROUND PRIOR TO GETTING INTO
3 SOME DETAILS ABOUT YOUR WORK THERE. DID YOU GRADUATE FROM
4 COLLEGE?
5 A. YES.
6 Q. AND WHERE -- WHEN DID -- WHERE DID YOU GRADUATE?
7 A. FROM BRIGHAM YOUNG UNIVERSITY AND SAN DIEGO STATE
8 UNIVERSITY.
9 Q. OKAY. AND WHAT YEARS DID YOU GRADUATE?
10 A. I GRADUATED FROM B.Y.U. IN -- GEE, WHAT WAS IT?
11 Q. APPROXIMATELY HOW LONG --
12 A. 1986.
13 Q. IN WHAT DID YOU GRADUATE?
14 A. HAD A BACHELOR'S DEGREE IN SOCIOLOGY AND A MINOR DEGREE
15 IN GERONTOLOGY.
16 Q. OKAY. AND THEN FROM B.Y.U. DID YOU GO TO SAN DIEGO?
17 A. YEAH. TO SAN DIEGO STATE AND I GRADUATED FROM THERE IN
18 1989 WITH A MASTER'S DEGREE IN CLINICAL SOCIAL WORK.
19 Q. OKAY. AND AFTER GRADUATING FROM SAN DIEGO STATE, DID
20 YOU FIND EMPLOYMENT?
21 A. YES, I DID.
22 Q. WHERE DID YOU WORK?
23 A. I DON'T HAVE MY RESUME IN FRONT OF ME, BUT AS I RECALL,
24 I FIRST -- MY FIRST JOB WAS FOR CHARTER HOSPITAL IN -- OF
25 SAN DIEGO. I WORKED THERE FOR APPROXIMATELY A YEAR AND A
190
1 HALF OR TWO YEARS.
2 Q. AND WHAT WERE YOUR GENERAL DUTIES THERE?
3 A. I WAS A PSYCHIATRIC SOCIAL WORKER AND WAS RESPONSIBLE
4 FOR ASSESSMENTS -- PSYCHOSOCIAL ASSESSMENTS, PSYCHOTHERAPY,
5 FAMILY THERAPY, THAT SORT OF THING.
6 Q. OKAY. AND WHERE DID YOU GO FROM SAN DIEGO?
7 A. TO CHEYENNE MESA IN COLORADO SPRINGS. IT'S A --
8 Q. AND WHAT WERE YOUR DUTIES THERE?
9 A. I WAS A SENIOR MENTAL HEALTH CLINICIAN.
10 Q. AND WHAT WERE YOUR DUTIES AS A CLINICIAN?
11 A. TO PROVIDE -- AGAIN, CONDUCT PSYCHOSOCIAL ASSESSMENTS,
12 TREATMENT -- OVERSEE THE TREATMENT PLANNING PROCESS, AS WELL
13 AS CONDUCTING -- CONDUCTING INDIVIDUAL GROUP AND FAMILY
14 THERAPY.
15 Q. WHERE DID YOU GO FROM THERE?
16 A. FROM THERE I CAME TO BENCHMARK HOSPITAL -- YEAH, I THINK
17 THAT'S -- TO BENCHMARK HOSPITAL RIGHT OVER HERE IN WOODS
18 CROSS.
19 Q. AND WHAT WERE YOUR DUTIES AT BENCHMARK?
20 A. I WAS THE DIRECTOR OF SOCIAL SERVICES THERE. AND HERE
21 AGAIN, I WAS RESPONSIBLE FOR CONDUCTING PSYCHOSOCIAL
22 ASSESSMENTS, TREATMENT PLANNING, INDIVIDUAL GROUP AND FAMILY
23 THERAPY AND MULTIFAMILY THERAPY, AS WELL AS SUPERVISION OF
24 OTHER CLINICIANS.
25 Q. OKAY. AND THEN FROM BENCHMARK DID YOU GO TO DAVIS?
191
1 A. NOT EXACTLY. I WORKED FOR A BRIEF TIME FOR RAMSAY
2 HEALTH CARE WHICH WAS THE PARENT COMPANY OF BENCHMARK
3 HOSPITAL AT THE TIME. AND I DID A NUMBER OF THINGS FOR
4 THEM. I SET UP GERO -- GEROPSYCH UNITS, I WROTE POLICIES
5 AND PROCEDURES FOR THEIR GERIATRIC PSYCHIATRY PROGRAMS.
6 Q. OKAY. AND WHAT HAPPENED AFTER THAT? WHERE DID YOU GO?
7 A. THEN FROM THERE I WENT TO WORK FOR HORIZON AT DAVIS
8 HOSPITAL.
9 Q. OKAY. NOW, YOU'VE MENTIONED THAT PART OF THIS WORK
10 BACKGROUND THAT YOU HAD THAT YOU DID PSYCHOSOCIAL
11 EVALUATIONS?
12 A. UH-HUH.
13 Q. FOR THE JURY'S BENEFIT, CAN YOU EXPLAIN WHAT THOSE ARE?
14 A. A PSYCHOSOCIAL EVALUATION IS AN ASSESSMENT OF A PERSON'S
15 CONDITION. YOU LOOK AT THEIR -- THEIR MENTAL STATUS, ANY
16 PSYCHIATRIC SYMPTOMS THEY MAY BE EXPERIENCING. YOU TRY TO
17 DOCUMENT THOSE AND UNDERSTAND THE NATURE AND EXTENT OF THOSE
18 SYMPTOMS, AS WELL AS LOOKING INTO THEIR -- THEIR COMMUNITY
19 SUPPORT, THEIR FAMILY SUPPORT, MEDICAL CONDITION, THEIR --
20 THEIR FAMILY HISTORY FOR MENTAL ILLNESS, DRUG HISTORY, LEGAL
21 HISTORY. IT'S A FAIRLY BROAD ASSESSMENT WITH -- WITH
22 PARTICULAR EMPHASIS ON THEIR PSYCHIATRIC FUNCTIONING OR
23 THEIR MENTAL HEALTH FUNCTIONING.
24 Q. AND WHY ARE THESE DONE?
25 A. WELL, THEY'RE REALLY DONE -- IN ORDER TO TREAT PATIENTS
192
1 EFFECTIVELY YOU HAVE TO HAVE A GOOD ASSESSMENT SO YOU CAN
2 HAVE -- SO YOU CAN UNDERSTAND THE -- IT'S REALLY TO HELP
3 UNDERSTAND THE NATURE OF THE PROBLEM. AND AFTER YOU
4 UNDERSTAND THE NATURE OF THE PROBLEM, THEN YOU CAN DEVELOP A
5 TREATMENT PLAN THAT IS FOCUSSED AND PROCEED WITH ACTIVE
6 TREATMENT.
7 Q. OKAY. AND DURING THIS PERIOD OF TIME, DID YOU WORK WITH
8 DOCTORS, PSYCHIATRISTS?
9 A. THE WHOLE TIME.
10 Q. THE WHOLE TIME. THANK YOU. AND DURING THIS PERIOD OF
11 TIME PRIOR TO COMING TO -- TO THE DAVIS HOSPITAL, DID YOU
12 HAVE AN OPPORTUNITY TO WORK WITH ELDERLY PATIENTS?
13 A. YES, I DID.
14 Q. AND HOW -- HOW MUCH OF YOUR PRACTICE -- OR I SHOULD SAY
15 YOUR WORK WAS INVOLVED WITH ELDERLY PATIENTS?
16 A. OH, I'D SAY MAYBE 25 PERCENT PRIOR TO WORKING FOR
17 RAMSAY; AND THEN 100 PERCENT; AND THEN OBVIOUSLY 100 PERCENT
18 WITH -- AT DAVIS HOSPITAL.
19 Q. DAVIS HOSPITAL. AND IN DEALING WITH THESE ELDERLY
20 PATIENTS, WHAT WAS THEIR GENERAL MENTAL PROBLEMS THAT YOU
21 WERE DEALING WITH?
22 A. VARIETY OF PROBLEMS: DEPRESSION, ANXIETY, AGITATION,
23 PSYCHOTIC PROBLEMS.
24 Q. ALZHEIMER'S?
25 A. YES.
193
1 Q. AND ALL OF THE -- ALL OF THE -- I UNDERSTAND ALZHEIMER'S
2 IS A FAIRLY LARGE CATEGORY.
3 A. YEAH.
4 Q. BUT YOU DEALT WITH THAT AS WELL?
5 A. UH-HUH.
6 Q. OKAY. NOW, DO YOU REMEMBER APPROXIMATELY WHEN IT WAS
7 THAT YOU BEGAN WORKING AT DAVIS NORTH, DAVIS MENTAL --
8 MEDICAL CENTER?
9 A. I BELIEVE IT WAS IN MARCH OF 1995.
10 Q. AND CAN YOU DESCRIBE THIS UNIT? WHAT WAS THE NATURE OF
11 THE UNIT?
12 A. IT WAS A GERIATRIC PSYCHIATRIC INPATIENT UNIT. WE
13 CALLED IT A GEROPSYCH UNIT. AND IT WAS SPECIFICALLY
14 DESIGNED TO MEET THE PSYCHIATRIC NEEDS OF THE ELDERLY
15 POPULATION.
16 Q. OKAY. AND WHAT TYPE OF CARE DID IT PROVIDE?
17 A. A COMBINATION OF MEDICAL AND PSYCHIATRIC CARE --
18 PRIMARILY PSYCHIATRIC CARE, INDIVIDUAL THERAPY, GROUP
19 THERAPY, FAMILY THERAPY, MEDICATIONS, ET CETERA.
20 Q. OKAY. HOW LARGE -- HOW LARGE OF A UNIT WAS IT? DO YOU
21 RECALL?
22 A. I BELIEVE IT WAS A TEN-BED UNIT.
23 Q. AND HOW WERE THE PATIENTS SELECTED TO COME ONTO THIS
24 UNIT?
25 A. HOW WERE THEY SELECTED?
194
1 Q. YEAH. HOW DID -- HOW DID IT COME ABOUT THAT THE
2 PATIENTS WOULD COME ON THIS UNIT?
3 A. NORMALLY -- WELL, FIRST OF ALL, WE HAD A STAFF. WE HAD
4 AN ADMISSION COORDINATOR AND HE AND MYSELF, PRIMARILY, WERE
5 INVOLVED IN LETTING -- LETTING REFERRAL SOURCES IN THE
6 COMMUNITY KNOW ABOUT THE PROGRAM. AND THEN AS THOSE
7 REFERRAL SOURCES THOUGHT THAT THEY HAD A PATIENT WHO MAY --
8 WHO THEY WERE HAVING DIFFICULTY WITH THAT MAY QUALIFY FOR
9 THE PROGRAM, THEY WOULD CALL US.
10 WE WOULD TAKE DOWN SOME INITIAL INFORMATION AND THEN WE
11 WOULD GO OUT TO THE -- THE PERSON'S HOME WITH -- TO THE
12 NURSING HOME, COULD BE TO A -- COULD HAVE BEEN TO A
13 COMMUNITY CENTER, VARIETY OF PLACES. AND WE'D DO A -- WE'D
14 DO AN INITIAL ASSESSMENT WHICH WAS KIND OF LIKE AN
15 ABBREVIATED PSYCHOSOCIAL ASSESSMENT THAT I DESCRIBED
16 EARLIER. IF WE FOUND PSYCHIATRIC IMPAIRMENT THAT SEEMED TO
17 BE WITHIN THE BALLPARK OF WHAT WOULD CONSTITUTE A PROPER
18 ADMISSION TO THE PROGRAM, THEN WE WOULD CONTACT THE
19 ATTENDING PHYSICIAN, RUN -- GIVE A SUMMARY OF THOSE
20 FINDINGS, AND THEN WE WOULD EITHER -- THEN THE ATTENDING
21 PHYSICIAN WOULD MAKE A DECISION WHETHER TO ADMIT OR NOT.
22 Q. OKAY. AND SO YOU WERE ACTUALLY INVOLVED IN GOING OUT
23 AND MEETING WITH PATIENTS?
24 A. YES, I WAS, FROM -- FROM TIME TO TIME. IT WAS NOT MY
25 PRIMARY RESPONSIBILITY, BUT I DID A FAIR AMOUNT OF IT.
195
1 Q. OKAY. WHAT WAS YOUR PRIMARY RESPONSIBILITY WITH THE
2 UNIT?
3 A. WELL, I HAD TO OVERSEE THE WHOLE OPERATION. SO I HAD TO
4 COORDINATE THE -- MAKE SURE THE ADMISSION COORDINATOR WAS
5 DOING WHAT HE SHOULD HAVE DONE, COORDINATE WITH THE
6 HOSPITAL, COORDINATE THINGS WITH THE CHARGE NURSE, THE -- AS
7 WELL AS THE -- THE SOCIAL WORKERS AND CLINICIANS TO MAKE
8 SURE THAT WE WERE MEETING THE NEEDS OF THE PATIENT.
9 Q. OKAY. NOW, YOU MENTIONED IN THE BEGINNING THAT YOU WERE
10 ACTUALLY WORKING FOR ANOTHER -- FOR ANOTHER COMPANY. WHAT
11 WAS THE NAME OF THAT COMPANY?
12 A. RAMSAY HEALTH CARE.
13 Q. OKAY. AND THEN WHAT WERE THE CIRCUMSTANCES OF YOUR
14 COMING TO DAVIS HOSPITAL?
15 A. I WAS CONTACTED BY A HORIZON PERSON AND I -- I KNEW
16 SEVERAL EMPLOYEES AT DAVIS HOSPITAL FROM MY WORK AT
17 BENCHMARK HOSPITAL, AND THEY HAD RECOMMENDED ME. AND SO
18 HORIZON CONTACTED ME AND INTERVIEWED ME AND OFFERED ME THE
19 JOB. I ACCEPTED THE JOB.
20 Q. OKAY. NOW, YOU MENTIONED THAT IT WAS HORIZONS WHO HIRED
21 YOU. CAN YOU EXPLAIN A LITTLE BIT ABOUT HORIZONS, WHAT
22 HORIZONS IS -- OR WAS, I GUESS?
23 A. SURE. HORIZON -- HORIZON MENTAL HEALTH MANAGEMENT, SO
24 HORIZON IS SHORT FOR HORIZON MENTAL HEALTH MANAGEMENT,
25 WAS -- WAS EXPERT IN SETTING UP THESE GERIATRIC PSYCHIATRY
196
1 INPATIENT UNITS. AND SO THEY WOULD PULL TOGETHER THE
2 STRUCTURE FOR THE PROGRAM, THEY'D HIRE SOME OF THE
3 EMPLOYEES. THEY WERE NORMALLY -- THEY WERE NORMALLY -- THEY
4 WERE HIRED BY THE HOSPITAL TO HELP SET UP THE PROGRAM. THE
5 HOSPITAL HAD EMPLOYEES AND HORIZON HAD EMPLOYEES AND
6 TOGETHER THEY FORMED A TEAM AND RAN THE UNIT.
7 Q. OKAY. SO YOU ACTUALLY WORKED FOR HORIZONS; IS THAT
8 CORRECT?
9 A. THAT'S TRUE.
10 Q. AND CAN YOU GET INTO A LITTLE MORE DETAIL? WHAT WAS THE
11 RELATIONSHIP BETWEEN HORIZONS THEN AND DAVIS HOSPITAL?
12 A. HORIZON WAS -- WAS THERE TO RUN THE UNIT AND HELP
13 SUPPORT THE HOSPITAL. IT WAS THE HOSPITAL'S -- IT WAS THE
14 HOSPITAL'S PROGRAM.
15 Q. OKAY. SO THEY WERE KIND OF LIKE INDEPENDENT
16 CONTRACTORS?
17 A. SURE.
18 Q. OF THAT NATURE. AND WHAT TYPE OF STAFFING DID THEY HAVE
19 AT THE -- ON THE UNIT?
20 A. WELL, THERE WAS A PROGRAM DIRECTOR, THERE WAS ONE OR TWO
21 SOCIAL WORKERS, THERE WAS A COMMUNITY RELATIONS PERSON WHO
22 DID THE MAJORITY OF THESE ASSESSMENTS. AND THE -- AND
23 THEY -- AND THEN THERE WAS THE -- HORIZON HAD A RELATIONSHIP
24 WITH A MEDICAL DIRECTOR AND ASSOCIATE MEDICAL DIRECTOR AS
25 WELL.
197
1 Q. OKAY. AND WERE THEY USUALLY THE PSYCHIATRISTS?
2 A. YES.
3 Q. AND WHAT ABOUT THE NURSING STAFF AND THOSE TYPE OF
4 STAFFS? WHO ACTUALLY HIRED THOSE?
5 A. THE NURSING STAFF WERE HOSPITAL EMPLOYEES.
6 Q. OKAY. WERE THERE ANY OTHER HOSPITAL EMPLOYEES THAT
7 WORKED ON THE UNIT, OTHER THAN THE NURSING STUFF?
8 A. OH, YES. THERE WERE NURSING AIDES, THERE WERE KIND OF
9 AUXILLIARY SERVICES, PHYSICAL THERAPY AND A NUMBER OF
10 OTHER -- NUTRITION. ALL THESE WERE HOSPITAL EMPLOYEES. SO
11 IF WE NEEDED A PHYSICAL THERAPY CONSULT OR A NUTRITION
12 CONSULT OR OCCUPATIONAL THERAPY CONSULT, THESE OTHER
13 DEPARTMENTS OF THE HOSPITAL WOULD PROVIDE, YOU KNOW, THE --
14 THOSE EMPLOYEES WOULD COME AND HELP AS WELL.
15 Q. OKAY. DO YOU RECALL FROM YOUR WORKING ON THE -- ON THE
16 PARTICULAR UNIT WHEN THIS UNIT WAS ACTUALLY FORMED?
17 A. I BELIEVE IT WAS FORMED IN THE FALL OF 1994.
18 Q. OKAY. AND WHO WAS THE -- WHEN YOU FIRST BEGAN ON THIS
19 UNIT, WHO WAS THE INITIAL DOCTOR WORKING ON THE UNIT?
20 A. DR. JENSEN WAS -- DR. WELBY JENSEN WAS THE MEDICAL
21 DIRECTOR.
22 Q. OKAY. AND WHAT WAS HIS DUTIES ON THE UNIT?
23 A. WELL, AS THE MEDICAL DIRECTOR HE RECEIVED -- HE HAD SOME
24 ADMINISTRATIVE DUTIES, BUT PRIMARILY HE SERVED AS THE
25 ATTENDING PHYSICIAN WHO ADMITTED PATIENTS AND TREATED
198
1 PATIENTS AND SUPERVISED THE TREATMENT OF THE PATIENTS.
2 Q. OKAY. AND HOW LONG DID HE REMAIN ON THE UNIT? DO YOU
3 RECALL?
4 A. NO, I DON'T RECALL THE EXACT DATE. HE WAS STILL SEEING
5 PATIENTS WHEN I WAS THERE. HE -- I WOULD -- I WOULD GUESS
6 SOMETIME WITHIN -- THERE WAS A TRANSITION PERIOD WHEN
7 DOCTOR -- WHEN I CAME IN AND DR. JENSEN WAS KIND OF PHASING
8 OUT, AS I RECALL.
9 Q. AND WAS THERE A PERIOD OF TIME WHEN DR. WEITZEL BECAME
10 ON THE UNIT?
11 A. YES.
12 Q. DO YOU RECALL WHEN THAT WAS?
13 A. IT WAS AT -- I DON'T RECALL THE EXACT TIME. I THINK
14 DR. WEITZEL STARTED IN AND AROUND THE TIME THAT I WAS HIRED,
15 BUT I BELIEVE THERE WAS A TRANSITION WHERE BOTH DR. JENSEN
16 AND DR. WEITZEL WERE SEEING PATIENTS AT THE SAME TIME.
17 Q. OKAY. WERE YOU INVOLVED IN THE HIRING OF DR. WEITZEL OR
18 HAVING --
19 A. I WAS -- I WAS PERIPHERALLY. I BELIEVE MY PREDECESSOR
20 PROGRAM DIRECTOR WAS MORE INVOLVED. I REMEMBER GOING OUT TO
21 A RESTAURANT WITH DR. WEITZEL AND MY BOSS JUST -- JUST PRIOR
22 TO HIS COMING ON.
23 Q. OKAY. WHAT WERE THE REASONS AND CIRCUMSTANCES OF
24 DR. WEITZEL COMING ONTO THE UNIT?
25 A. WE NEEDED ANOTHER ATTENDING PHYSICIAN.
199
1 Q. AND WHY WAS THAT?
2 A. BECAUSE DR. JENSEN -- COUPLE OF REASONS. DR. JENSEN WAS
3 BURNED OUT, HE WAS TIRED. HE HAD A FULL TIME DAY JOB AND HE
4 WAS WORKING DAY AND NIGHT AND COULDN'T -- YOU KNOW, IT WAS
5 TOO MUCH OF A LOAD. WE NEEDED ANOTHER ATTENDING PHYSICIAN
6 TO SHARE THE LOAD.
7 Q. OKAY. AND DO YOU KNOW HOW LONG -- HOW LONG IT WAS
8 APPROXIMATELY THAT THERE WAS THIS JOINT WORKING
9 RELATIONSHIP?
10 A. I -- I DON'T REMEMBER SPECIFICALLY. I MEAN, IT COULD
11 HAVE BEEN ONE MONTH, IT COULD HAVE BEEN THREE MONTHS.
12 Q. THERE DID COME A TIME THOUGH WHEN DR. WEITZEL TOOK OVER
13 COMPLETELY ON THE UNIT?
14 A. WELL, HE -- YES, THERE WAS. I THINK DR. JENSEN ALWAYS
15 WAS A BACK UP. I THINK THE MAJORITY OF THE TIME DR. JENSEN
16 HAD ONE OR TWO PATIENTS. THERE MAY HAVE BEEN A TIME WHEN
17 DR. WEITZEL HAD ALL OF THE PATIENTS, BUT IT SEEMED LIKE
18 DR. JENSEN HAD PERIPHERAL INVOLVEMENT MUCH OF THE TIME.
19 Q. OKAY. NOW, GETTING BACK A LITTLE BIT TO THE FUNCTIONING
20 OF THIS PARTICULAR UNIT, WHEN A PATIENT WOULD COME ONTO THE
21 UNIT, WHAT WAS THE USUAL LENGTH OF STAY?
22 A. OUR AVERAGE LENGTH OF STAY WAS AROUND 14 DAYS, 10 TO 14
23 DAYS, AS I RECALL.
24 Q. OKAY. WAS THERE ANY LIMIT ON THAT PARTICULAR TIME
25 FRAME?
200
1 A. NOT REALLY. IT WAS DRIVEN PRIMARILY BY THE -- THE
2 PATIENT'S CLINICAL NEED.
3 Q. OKAY. AND YOU INDICATED A LITTLE BIT ABOUT WHAT THE
4 STEPS WERE IT WOULD TAKE TO GET A PATIENT ON THE UNIT. WHO
5 WOULD INITIALLY MAKE THE CONTACT WITH THE PATIENT?
6 A. NORMALLY THAT WOULD BE KEITH PERRY OR MYSELF. PRIMARY
7 KEITH. HE'D -- AS I MENTIONED, THE NURSING HOME MAY CALL,
8 THEY MAY HAVE A PATIENT THAT WAS EXPERIENCING SOME PROBLEMS.
9 THEY'D CALL US, ASK US TO COME OUT AND -- AND DO AN
10 ASSESSMENT. KEITH PRIMARILY WOULD GO OUT AND DO THE
11 ASSESSMENT.
12 Q. OKAY. AND -- BUT YOU WERE ALSO INVOLVED IN DOING THE
13 ASSESSMENTS.
14 A. ABSOLUTELY.
15 Q. WAS THERE ANY CRITERIA OR ANY SPECIFIC THINGS THAT YOU
16 WERE TRAINED TO DO WHEN MAKING THESE ASSESSMENTS?
17 A. WELL, YEAH. THAT WAS -- YOU KNOW, WE'D TRY TO GET TO
18 THE -- TRIED TO DO THE PSYCHO -- YOU KNOW, WE CALLED THEM
19 INTAKE OR AN -- AN INITIAL ASSESSMENT, BUT ESSENTIALLY IT
20 WAS VERY SIMILAR TO THE PSYCHOSOCIAL ASSESSMENT I DESCRIBED.
21 WE NEEDED TO -- TO REALLY IDENTIFY WERE THEIR PSYCHIATRIC
22 SYMPTOMS THAT WERE AMENABLE TO INPATIENT TREATMENT.
23 Q. UH-HUH.
24 A. AND OTHER CIRCUMSTANCES.
25 Q. AND DID YOU -- DID YOU OR MR. PERRY ACTUALLY GO OUT AND
201
1 I GUESS RECRUIT PATIENTS? I MEAN, HOW DID THAT ALL WORK?
2 HOW DID YOU --
3 A. WE DIDN'T RECRUIT PATIENTS. WE ASSESSED PATIENTS.
4 Q. WHAT I'M GETTING AT IS HOW WOULD THE NURSING HOME LEARN
5 ABOUT THE PARTICULAR UNIT OR, YOU KNOW, HOW WOULD THAT
6 HAPPEN?
7 A. OH, ABSOLUTELY. WE -- WE WERE GOING OUT. WE'D DO --
8 WE'D CONDUCT IN-SERVICES FOR PHYSICIANS' STAFFS, FOR THE
9 COMMUNITY -- THE COMMUNITY CENTER, ELDERLY CENTER -- SENIOR
10 CENTER, I GUESS YOU CALL THEM. WE'D GO TO THE NURSING
11 HOMES. WE WOULD DO A LOT OF EDUCATION IN THE COMMUNITY TO
12 HELP MAKE PEOPLE AWARE OF THIS GROWING SEGMENT OF OUR
13 POPULATION AND THE PSYCHIATRIC PROBLEMS THAT THEY MAY BE
14 RECEIVING.
15 AND SO WE WERE -- MOST OF THEM CONSIDERED US KIND OF A
16 VALUE-ADDED SERVICE TO HELP THEM DEAL WITH PATIENTS THAT
17 WERE HAVING PROBLEMS.
18 Q. OKAY. NOW, GOING BACK A LITTLE BIT BACK TO THE INITIAL
19 INTAKE FOR THESE PATIENTS, AS YOU INDICATED, YOU AND KEITH
20 PERRY WOULD GO OUT WITH THEM. WHEN YOU WOULD FIRST GO OUT
21 TO MEET WITH A PATIENT, JUST AS KIND OF AN OVERALL
22 SITUATION, WHAT WOULD INITIALLY BE THE FIRST THINGS THAT YOU
23 WOULD DO?
24 A. WELL, AS I RECALL, WE'D TALK TO THE -- IF IT WAS AT A
25 PERSON'S HOME, WE'D TALK TO THE FAMILY MEMBER THAT WAS WITH
202
1 THEM. IF IT WAS IN A NURSING HOME, WE'D TALK TO THE
2 STAFF, WE'D TALK TO THE -- THE NURSING STAFF. WE'D TALK TO
3 THE -- THE PERSON THAT INITIATED CONTACT WITH US, TRY AND
4 GET A LITTLE MORE -- YOU KNOW, THEY'D GIVE US SOME GENERAL
5 INFORMATION OVER THE TELEPHONE, AND THEN WE'D COME OUT AND
6 WANT TO KIND OF CONFIRM WHAT THEY'D SAID OVER THE PHONE, GET
7 A LITTLE BIT MORE -- MORE -- MORE INFORMATION ABOUT THE
8 PATIENT AND THE SITUATION. THEN WE WOULD INTERVIEW THE
9 PATIENT AND TRY AND DETERMINE IF THEY WERE DEPRESSED, IF
10 THEY WERE ANXIOUS, IF THEY WERE PSYCHOTIC, IF THEY WERE
11 AGITATED, JUST WHAT WAS THEIR CONDITION, THEN WE'D -- AND
12 DOCUMENT THAT.
13 Q. WOULD YOU REVIEW MEDICAL RECORDS AND THOSE TYPE OF
14 THINGS?
15 A. YES.
16 Q. WHAT TYPE OF RECORDS WOULD YOU REVIEW?
17 A. WELL, IF IT WAS AT A NURSING HOME WE'D TAKE A LOOK AT
18 THE CHART, TRY AND -- YOU KNOW, IF SOMEONE HAD BEEN HAVING
19 SOME DIFFICULTY THEN NORMALLY THE -- THE MORE RECENT CHART
20 NOTES IN THE NURSING HOME RECORD WOULD INDICATE THAT THEY'D
21 BEEN HAVING DIFFICULTIES, SO IT'S KIND OF A GOOD CROSS
22 CHECK.
23 WE'D LOOK AT THE -- WE'D SCAN THE HISTORY AND PHYSICAL
24 THAT WAS DONE IN THE NURSING HOME. YOU KNOW, WE'D -- YOU'D
25 THUMB THROUGH THE CHART AND TRY AND SEE WHAT YOU -- YOU
203
1 KNOW, GET A BROADER UNDERSTANDING OF THIS PATIENT AND HOW
2 LONG THEY'D BEEN IN THE NURSING HOME OR THAT SORT OF THING.
3 Q. NOW, WHEN YOU WERE DOING THIS, WERE YOU MOSTLY CONCERNED
4 WITH THEIR MENTAL STATUS OR WERE THERE OTHER THINGS THAT YOU
5 WERE LOOKING AT WITH THESE PATIENTS?
6 A. THERE WERE OTHER THINGS. IT WAS -- MENTAL STATUS WAS
7 CERTAINLY WHERE MOST OF OUR TRAINING WAS AND UNDERSTANDING
8 THE MENTAL HEALTH PART OF THEIR FUNCTIONING. WE'D ALSO FIND
9 OUT ABOUT THEIR FAMILY SITUATION, WE'D FIND OUT ABOUT
10 THEIR -- ANY MEDICAL CONDITION OR MEDICAL ILLNESS THEY MAY
11 HAVE.
12 Q. OKAY. WOULD YOU MAKE ANY NOTES OF THE MEDICAL
13 CONDITIONS THEY HAD?
14 A. YES.
15 Q. WERE THERE ANY CRITERIA THAT -- THAT THE HOSPITAL HAD OR
16 THE UNIT HAD AS FAR AS MEDICAL CONDITIONS FOR THESE
17 PATIENTS?
18 A. YES. IN -- IN GENERAL, WE WANTED PATIENTS WHO WERE ABLE
19 TO BENEFIT FROM INPATIENT TREATMENT. IN OTHER WORDS, IF
20 THEIR MEDICAL CONDITIONS WERE SO SERIOUS THAT THEY WEREN'T
21 ABLE TO BENEFIT FROM PSYCHIATRIC TREATMENT THEN WE -- WE'D
22 PREFER TO -- WELL, NOT PREFER. WE NEEDED TO GET THOSE
23 MEDICAL SITUATIONS STABILIZED BEFORE -- SO THAT THEY COULD
24 THEN COME AND PARTICIPATE IN ACTIVE PSYCHIATRIC TREATMENT.
25 Q. LET ME SHOW YOU WHAT'S BEEN MARKED FOR IDENTIFICATION AS
204
1 PLAINTIFF'S EXHIBIT NUMBER 2 AND ASK YOU IF YOU CAN IDENTIFY
2 THAT?
3 A. YES, I CAN.
4 Q. AND WHAT IS THAT?
5 A. DID YOU ASK ME A QUESTION?
6 Q. YEAH. I'M SORRY. DO YOU RECOGNIZE THAT?
7 A. YES.
8 Q. AND WHAT IS THAT?
9 A. IT'S THE -- IT'S THE INTAKE AND ADMISSION POLICY FROM
10 DAVIS HOSPITAL FOR THE GEROPSYCHIATRIC UNIT.
11 Q. OKAY. AND WAS -- AND WAS THAT THE INTAKE AND ADMISSION
12 POLICY THAT WAS IN FORCE AT THE TIME YOU WERE ON THE UNIT?
13 A. YES, IT WAS.
14 Q. NOW, PROBABLY FORGOT TO ASK YOU -- AND I BETTER DO THAT
15 RIGHT NOW. YOU WORKED ON THE UNIT YOU SAID SOME TIME FROM
16 MARCH OF '95. APPROXIMATELY WHAT TIME DID YOU LEAVE?
17 A. I BELIEVE IT WAS IN SEPTEMBER OF '96.
18 Q. OKAY. AND -- THANK YOU. NOW, GOING BACK TO THIS INTAKE
19 AND ADMISSIONS POLICY, DOES IT DESCRIBE WHAT THE ADMISSIONS
20 CRITERIA ARE?
21 A. YES.
22 Q. AND DOES IT ALSO INDICATE CERTAIN CRITERIA THAT WOULD BE
23 EXCLUSIONARY?
24 A. YES.
25 Q. IN OTHER WORDS, CRITERIA THAT WOULD KEEP THE PATIENT
205
1 FROM BEING ON THE UNIT.
2 A. YES.
3 Q. NOW, LET ME SHOW YOU A COPY --
4 MR. STIRBA: YOUR HONOR -- YOUR HONOR, I DON'T
5 BELIEVE IT'S BEEN OFFERED INTO EVIDENCE AS OF YET.
6 MR. MAJOR: YOUR HONOR, IF THAT'S THE CASE WE WOULD
7 MOVE TO --
8 MR. STIRBA: MAY I JUST VOIR DIRE, YOUR HONOR,
9 BRIEFLY?
10 MR. MAJOR: WELL, UNDER WHAT PARTICULAR AREA DO YOU
11 WANT TO VOIR DIRE ON? DO WE HAVE A FOUNDATIONAL PROBLEM
12 HERE OR --
13 MR. STIRBA: YEAH, WE DO. I WANT TO OBJECT AS TO
14 FOUNDATION.
15 MR. MAJOR: AND WHAT IS THE OBJECTION SPECIFICALLY?
16 MR. STIRBA: YOUR HONOR, I DON'T BELIEVE A COLLOQUY
17 WITH COUNSEL IS APPROPRIATE.
18 THE COURT: OKAY. WHAT -- OKAY. LAY A FOUNDATION.
19 MR. MAJOR: YOUR HONOR, THAT'S MY QUESTION. I'M
20 NOT SURE EXACTLY WHAT FOUNDATION WE NEED TO LAY. HE'S
21 INDICATED THAT HE WAS THE DIRECTOR OF THE UNIT, THAT THIS IS
22 THE POLICY THAT WAS IN EFFECT, THE POLICY THAT HE FOLLOWED
23 AT THE TIME OF THE GERIATRIC UNIT. I'M NOT SURE EXACTLY
24 WHAT --
25 THE COURT: I DON'T BELIEVE THERE'S BEEN ANY
206
1 TIME -- TIME WHEN THIS WAS USED, WHETHER IT WAS USED IN
2 DECEMBER OF '95 AND JANUARY OF '96.
3 MR. MAJOR: I'LL ASK HIM.
4 Q. (BY MR. MAJOR) WAS THIS USED DURING THE PERIOD OF TIME
5 THAT YOU WERE ON THE UNIT?
6 A. THE EFFECTIVE DATE OF THE POLICY IS JULY 1, '94, REVISED
7 JANUARY OF '96.
8 Q. SO THIS WAS THE POLICY THAT WAS IN EFFECT AT THE TIME
9 THAT YOU WERE ON THIS UNIT?
10 A. I -- I BELIEVE SO.
11 Q. THIS WAS THE POLICY THAT YOU AND KEITH PERRY AND THE
12 OTHER MEMBERS OF THE UNIT WOULD FOLLOW IN ADMITTING
13 PATIENTS?
14 A. I BELIEVE -- I BELIEVE SO.
15 MR. MAJOR: WITH THAT, YOUR HONOR, WE'D AGAIN MOVE
16 FOR THE ADMISSION OF EXHIBIT NUMBER 2.
17 MR. STIRBA: NO OBJECTION, YOUR HONOR.
18 THE COURT: IT'S RECEIVED.
19 Q. (BY MR. MAJOR) OKAY. LET ME SHOW YOU A COPY OF
20 WHAT -- YOU HAVE THE ACTUAL EXHIBIT, I ASSUME?
21 MS. BARLOW: YOUR HONOR, DO WE NEED TO TURN ON THE
22 T.V.'S?
23 THE COURT: YEAH. IF YOU DON'T TURN ON THE T.V.'S,
24 THAT WON'T SHOW UP. IT WILL ONLY SHOW ON THE SCREEN. I
25 THINK THERE'S A CONTROL THERE.
207
1 MS. BARLOW: OH, YOU'VE GOT THE REMOTE CONTROL.
2 THE COURT: OKAY. IS IT ON ALL THE SCREENS? OKAY.
3 GO AHEAD.
4 Q. (BY MR. MAJOR) SO MR. CHAMBERS, I'D LIKE TO AGAIN
5 REFER YOU, THIS IS A TRUE AND CORRECT COPY OF WHAT YOU HAVE
6 IN YOUR HAND; IS THAT CORRECT.
7 A. YES.
8 Q. AND SO WHAT ARE THE -- THE INITIAL FOUR CRITERIA IN
9 WHICH YOU WOULD -- THOSE FOUR CRITERIA WHICH YOU WOULD
10 ACCEPT A PATIENT FOR?
11 A. THE ADMISSION TO THE PROGRAM ARE INDICATED FOR PATIENTS
12 OVER 55 WHO HAVE A D.S.M.-IV DIAGNOSIS AND IN ADDITION MEET
13 ONE OR MORE OF THE FOLLOWING CRITERIA: SUICIDAL BEHAVIOR
14 AND/OR IDEATION -- DO YOU WANT ME TO READ THESE?
15 Q. I JUST -- JUST BRIEFLY. JUST --
16 THE COURT: IT MIGHT BE HELPFUL TO THE JURY IF
17 YOU'D EXPLAIN WHAT A D.S.M.-IV DIAGNOSIS IS.
18 MR. MAJOR: THAT WAS MY NEXT QUESTION.
19 Q. (BY MR. MAJOR) IF YOU COULD EXPLAIN WHAT THE D.S.M.-IV
20 IS.
21 A. D.S.M. STANDS FOR THE DIAGNOSTIC AND STATISTICAL MANUAL
22 OF MENTAL DISORDERS, 4TH EDITION. AND THIS IS THE -- IT'S
23 BASICALLY A MANUAL OR A HANDBOOK THAT LISTS ALL THE
24 PSYCHIATRIC DIAGNOSIS AND ALL OF THEIR CRITERIA, SO --
25 Q. OKAY. SO THE FIRST ONE -- FIRST CRITERIA THAT YOU --
208
1 THAT WOULD ALLOW A PATIENT TO BE ADMITTED TO WAS NUMBER ONE;
2 IS THAT CORRECT?
3 A. YES.
4 Q. AND WHAT IS THAT?
5 A. THE FIRST CRITERIA IS IN THE PARAGRAPH WHICH STATES THEY
6 HAVE TO HAVE -- THERE SHOULD BE REASONABLE EVIDENCE THAT
7 THERE'S A -- A PSYCHIATRIC DIAGNOSIS.
8 Q. RIGHT.
9 A. AND THEN IN ADDITION TO THAT, ONE OF THE FOLLOWING FOUR
10 THINGS.
11 Q. OKAY. AND THEY ALSO HAVE TO BE OVER 65 YEARS OF AGE.
12 A. YEAH, 55, I BELIEVE.
13 Q. FIFTY-FIVE. I'M SORRY. I CAN'T READ THAT. SO WE HAVE
14 AN AGE LIMIT, DIAGNOSTIC REQUIREMENT, AND THEN THOSE FOUR.
15 A. YEAH, AND THEN ONE OF THE FOUR WHICH -- SUICIDAL
16 BEHAVIOR OR IDEATION, ASSAULTIVE BEHAVIOR, POTENTIAL FOR
17 SELF-MUTILATION, AND ACUTE ONSET OR INTENSIFICATION OF SOME
18 OF THEIR SYMPTOMS THAT'S DISRUPTIVE TO THEIR LIFESTYLE.
19 Q. NOW, NUMBER FOUR, THAT'S KIND OF WHAT WE ASSOCIATE WITH
20 ALZHEIMER'S, I'M ASSUMING?
21 A. YES, BUT ALSO, I THINK -- I HAVEN'T READ THIS FOR A
22 WHILE. ALZHEIMER'S, YES, BUT ALSO A NUMBER OF PSYCHOTIC
23 DISORDERS AS WELL.
24 Q. YEAH. IN ORDER WORDS, THIS HOSPITAL WASN'T SIMPLY
25 LIMITED TO PEOPLE WITH ALZHEIMER'S --
209
1 A. NO.
2 Q. -- PROBLEMS.
3 A. NO.
4 Q. WHAT TYPE OF -- YOU MENTIONED DEPRESSION. FOR EXAMPLE,
5 WHAT TYPE OF DEPRESSION WOULD AN ELDERLY PATIENT SUFFER THAT
6 YOU WOULD ADMIT TO THIS UNIT?
7 A. AN ELDERLY PERSON, LIKE A YOUNGER PERSON, CAN SUFFER
8 FROM A -- A MAJOR DEPRESSIVE DISORDER WHICH HAS A WHOLE LIST
9 OF SYMPTOMS THAT MAKE -- INCLUDING FREQUENT SUICIDAL
10 IDEATION, THAT USUALLY INVOLVES LACK OF PLEASURE IN NORMAL
11 ACTIVITIES, SLEEP DISTURBANCE, APPETITE DISTURBANCE, A WHOLE
12 NUMBER OF SYMPTOMS. AND IT WOULD BE THE SAME FOR AN ELDERLY
13 PERSON -- VERY SIMILAR FOR AN ELDERLY PERSON AS IT WOULD
14 ANOTHER PERSON.
15 Q. THANK YOU. NOW, YOU ALSO INDICATED ON THIS -- WE'RE
16 GOING ON. ON DOWN HERE THERE'S ALSO ANOTHER, I BELIEVE,
17 FIVE THROUGH NINE. CAN YOU TELL THE JURY JUST BRIEFLY WHAT
18 THOSE CONDITIONS ARE, WHAT THOSE REQUIREMENTS ARE? AND I'M
19 KIND OF ASKING YOU MORE TO EXPLAIN, YOU KNOW, IN LAYMEN'S
20 TERMS WHAT THOSE MEAN.
21 A. OKAY.
22 Q. IF YOU CAN READ THEM.
23 A. WELL, THE LITTLE PARAGRAPH ABOVE NUMBER FIVE, THE
24 SENTENCE ABOVE NUMBER FIVE JUST INDICATES THAT IF -- IF
25 POSSIBLE WE'D PREFER, YOU KNOW, TO NOT HAVE A PERSON BE
210
1 HOSPITALIZED. BUT IF THEIR CONDITION WAS SO BAD THAT THEY
2 NEEDED TO BE HOSPITALIZED, THEN WE WOULD DO SO. IF THEIR
3 CONDITION COULD BE TREATED AT A LOWER LEVEL OF CARE, AN
4 OUT-PATIENT, THEN THAT IS ALWAYS MORE DESIRABLE.
5 AND THEN FIVE THROUGH NINE INDICATE ADDITIONAL CRITERIA
6 THAT IF THERE'S BEEN AN ACUTE OR A SUDDEN ONSET, IF THERE'S
7 BEEN A RAPID CHANGE IN BEHAVIOR, THAT NORMALLY IS SOMETHING
8 YOU WANT TO COME TAKE A CLOSER LOOK AT ON AN INPATIENT
9 BASIS.
10 IF SOMEBODY'S HAVING DIFFICULTY WITH THEIR ACTIVITIES
11 OF DAILY LIVING, SPECIFICALLY PSYCHOMOTOR RETARDATION, THESE
12 ARE JUST, YOU KNOW, VERY -- IT'S KIND OF THE OPPOSITE OF
13 BEING AGITATED, JUST VERY LITTLE MOVEMENT, VERY LITTLE
14 ACTIVITY. ANOREXIA HAS TO DO WITH WEIGHT LOSS; INSOMNIA HAS
15 TO DO WITH THE INABILITY TO SLEEP.
16 AND THEN PSYCHOSIS OR PSYCHOTIC PROBLEMS, PEOPLE ARE
17 HEARING THINGS OR SEEING -- SEEING THINGS THAT ARE NOT BASED
18 ON REALITY. THEN THAT'S -- YOU WANT TO GET THEM IN. IF
19 THEY'RE HAVING TOXIC EFFECTS OR SIDE -- SEVERE -- TOXIC
20 EFFECTS WOULD IMPLY SEVERE SIDE EFFECTS TO A MEDICATION,
21 YOU'D WANT TO GET THEM IN. OR IF THERE WAS A NEED FOR 24
22 HOUR CARE, OBVIOUSLY YOU'D WANT TO GET THEM IN.
23 Q. NOW, I WANT TO GO BACK A LITTLE BIT. WHEN YOU TALK
24 ABOUT NUMBER FIVE, THE ACUTE ONSET OF -- INTENSIFICATION OF
25 THEIR AGITATED BEHAVIORS, JUST FOR THE JURY'S BENEFIT AND
211
1 FOR MY BENEFIT, THERE'S A DIFFERENCE BETWEEN ACUTE AND
2 CHRONIC BASED ON YOUR UNDERSTANDING; IS THAT CORRECT?
3 A. YES.
4 Q. WHAT IS THE DIFFERENCE?
5 A. WELL, A CHRONIC CONDITION IS AN ENDURING CONDITION. AN
6 ACUTE OR SUDDEN ONSET MEANS THERE'S A RAPID OR SUDDEN CHANGE
7 IN SOMEBODY'S BEHAVIOR OR PRESENTATION.
8 Q. OKAY. AND IN THIS CRITERIA, WAS THERE ANY PARTICULAR
9 LIMIT ON HOW -- WHAT PERIOD OF TIME THIS ACUTE CONDITION
10 WOULD TAKE PLACE? I MEAN, WOULD YOU SAY IF SOMEBODY HAD
11 GONE DOWNHILL IN THREE MONTHS OR SIX MONTHS OR A YEAR -- SEE
12 WHAT I'M SAYING?
13 A. WELL, IF THEY'D GONE DOWNHILL IN A YEAR, YOU JUST
14 WOULDN'T CALL IT ACUTE OR SUDDEN, BUT -- YOU KNOW, I'D SAY
15 REALLY WE JUST TRIED TO LOOK AT THE PATIENT AT THEIR CURRENT
16 CONDITION. IF IT WAS A SUDDEN ONSET, THAT WAS -- THAT WAS
17 HELPFUL INFORMATION. AND IF THEIR -- IF THEIR BEHAVIOR OR
18 FUNCTIONING PRIOR TO THAT SUDDEN ONSET WAS -- IF THEY WERE
19 FUNCTIONING AT A HIGHER LEVEL AND THEN THEY HAD A SUDDEN
20 ONSET, AND NOW WITHIN 24 HOURS OR WITHIN THREE DAYS, WITHIN
21 A WEEK'S PERIOD OF TIME THEY'VE GONE FROM A HIGH LEVEL OF
22 FUNCTIONING TO A LOW LEVEL OF FUNCTIONING, THAT'S A CONCERN.
23 I BELIEVE THAT IMPLIES THERE'S -- YOU KNOW, IT'S AN
24 ADVANCEMENT OF A PSYCHIATRIC OR OTHER DISEASE PROCESS.
25 Q. NOW, MOVING DOWN QUICKLY TO NUMBER EIGHT, YOU INDICATE
212
1 THE TOXIC EFFECTS FROM THE THERAPEUTIC PSYCHOSOMATIC (SIC)
2 MEDICATION?
3 A. PSYCHOTROPIC.
4 Q. PSYCHOTROPIC MEDICATION. WHAT IS THAT, BASICALLY?
5 A. I'M NOT A PHYSICIAN. A PHYSICIAN COULD SAY MORE ABOUT
6 WHAT TOXIC EFFECTS OF PSYCHOTROPIC MEDICATION MEANS.
7 Q. WELL, AND FOR THE RECORD I UNDERSTAND THAT. I'M JUST
8 ASKING BASED ON YOUR TRAINING AND EXPERIENCE.
9 A. YEAH. I BELIEVE THAT MEANS THAT TOXIC SIDE -- I THINK
10 IT MEANS SEVERE SIDE EFFECTS. SOME MEDICATIONS HAVE SIDE
11 EFFECTS, AND IF YOU'RE HAVING TOXIC EFFECTS, THAT MEANS
12 THERE'S PROBABLY TOO MUCH OF THE MEDICATION IN YOUR SYSTEM
13 OR IT'S AT LEAST CONSIDERED A TOXIC RESPONSE IF YOU'RE
14 HAVING A VERY BAD RESPONSE TO MEDICATION.
15 Q. AND --
16 A. SUCH THAT YOU NEED TO GET THEM IN A 24-HOUR FACILITY
17 WHERE YOU CAN TAKE A CLOSER LOOK, OR IF NOT A 24-HOUR
18 FACILITY, VERY CLOSE MONITORING OF THEM SO YOU CAN ASCERTAIN
19 WHAT MEDICINE IS BEING ADMINISTERED AND WHAT -- IN A
20 CLINICAL -- IN A DETAILED CLINICAL SENSE, WHAT ARE THE --
21 WHAT ARE THE EFFECTS OF THE MEDICATION.
22 Q. AND THAT WOULD INVOLVE ADJUSTING THE MEDICATIONS -- THE
23 LEVELS OF MEDICATION GIVEN AND THE TYPES OF MEDICATION
24 GIVEN?
25 A. THAT -- THE DISCONTINUATION OF MEDICINE, THE ADJUSTING
213
1 OF MEDICINE. IT --
2 Q. AND THOSE ARE ALL THE TYPES OF THINGS THIS UNIT WAS SET
3 UP TO DO?
4 A. UH-HUH. YES.
5 Q. NOW, GOING ON TO PAGE TWO OF THIS EXHIBIT NUMBER 2,
6 THERE'S ALSO SOME EXCLUSIONARY CRITERIA. WHAT -- WHAT --
7 JUST IN GENERAL TERMS, WHAT DID THAT MEAN? WHAT DOES IT
8 MEAN, EXCLUSIONARY CRITERIA?
9 A. WELL, THERE ARE -- THERE ARE REASONS WHY YOU CAN ADMIT
10 SOMEONE AND THERE ARE REASONS WHY YOU SHOULDN'T ADMIT
11 SOMEONE. THE EXCLUSIONARY CRITERIA ARE THOSE CRITERIA WHY
12 YOU PROBABLY SHOULD NOT.
13 Q. SO IF PATIENTS WERE TO FALL UNDER THIS -- THIS
14 PARTICULAR AREA, THEY WOULD NOT BE ADMITTED?
15 A. IN GENERAL.
16 Q. AND, BASICALLY, WHAT WERE SOME OF THOSE CRITERIA?
17 A. THE -- IF YOU LOOK AT NUMBER ONE I THINK THE SECOND --
18 THE END OF THE SECOND SENTENCE IS THE MOST IMPORTANT PART.
19 IF THERE'S NO EXPECTATION FOR A POSITIVE RESPONSE FOR
20 TREATMENT, THEN REGARDLESS OF THE SITUATION -- WELL, NOT
21 REGARDLESS, BUT IN GENERAL, IF THERE'S NOT -- IF THERE'S NO
22 EXPECTATION FOR A POSITIVE RESPONSE TO TREATMENT, THEN YOU
23 DON'T WANT -- IN GENERAL, YOU DON'T ADMIT THOSE PEOPLE.
24 Q. SO IF YOU CAN'T CURE THE PATIENT, YOU DON'T WANT THEM TO
25 COME ON THE UNIT?
214
1 A. WELL, IF WE CAN'T HELP THEM.
2 Q. OKAY. WE HAVE DIFFERENT -- IF YOU CAN'T HELP THEM, YOU
3 DON'T WANT THEM TO COME ON THE UNIT. OKAY. I UNDERSTAND
4 THERE'S A DIFFERENCE BETWEEN CURE FOR A LAYMAN AND CURE FOR
5 A MEDICAL PROFESSIONAL.
6 A. OKAY.
7 Q. AND WHAT ABOUT NUMBER TWO?
8 A. IF SOMEONE HAS A LIFE-THREATENING ILLNESS, THEY
9 SHOULDN'T -- THEY DON'T BELONG ON A PSYCHIATRIC UNIT.
10 Q. AND NUMBER THREE?
11 A. I GUESS I SHOULD SAY A LIFE-THREATENING MEDICAL ILLNESS
12 AS OPPOSED TO A LIFE-THREATENING PSYCHIATRIC ILLNESS.
13 Q. OKAY.
14 A. WE'RE DESIGNED TO TREAT LIFE-THREATENING PSYCHIATRIC
15 ILLNESSES. WE WERE NOT SET UP TO TREAT LIFE-THREATENING
16 MEDICAL ILLNESSES.
17 Q. CAN YOU BRIEFLY -- AGAIN, FOR US LAYMEN, CAN YOU BRIEFLY
18 DESCRIBE THE DIFFERENCE BETWEEN A LIFE-THREATENING PHYSICAL
19 AND A LIFE-THREATENING MENTAL?
20 A. WELL, A LIFE-THREATENING MENTAL ILLNESS IS NORMALLY
21 SOME -- ASSOCIATED WITH SUICIDALITY (SIC). IF SOMEBODY'S
22 MADE A LETHAL SUICIDE ATTEMPT OR IF SOMEONE IS AT HIGH RISK
23 TO MAKE A LETHAL SUICIDE ATTEMPT, WHICH -- WHICH IS TO SAY
24 THEY HAVE THE INTENT AND THEY HAVE THE ABILITY TO COMPLETE A
25 SUICIDE, THEN THAT'S CONSIDERED A LIFE-THREATENING
215
1 PSYCHIATRIC ILLNESS.
2 IN TERMS OF A LIFE-THREATENING MEDICAL ILLNESS I WOULD
3 GUESS THAT -- THAT WOULD MEAN SOMEONE WHO'S GOT A HEART
4 CONDITION THAT IS SO FRAGILE, YOU KNOW, THEY -- THERE COULD
5 BE A VARIETY OF MEDICAL CONDITIONS THAT WOULD NEED TO BE
6 STABILIZED BEFORE THEY WOULD BE ABLE TO ACTIVELY PARTICIPATE
7 IN PSYCHIATRIC TREATMENT.
8 Q. OKAY. AND THEN NUMBER THREE INDICATES: PATIENTS WITH
9 TERMINAL DISEASE WITHOUT A TREATABLE PSYCHIATRIC DISORDER.
10 CAN YOU EXPLAIN THAT A LITTLE BIT?
11 A. YEAH. AND THAT "WITHOUT" IS THE MOST IMPORTANT PART.
12 IF SOMEBODY HAS A TERMINAL ILLNESS -- I THINK WE KNOW WHAT
13 THAT MEANS. IF THEY HAVE A TERMINAL ILLNESS, BUT NO
14 PSYCHIATRIC DISORDER -- WITHOUT A TREATABLE PSYCHIATRIC
15 DISORDER, THEY SHOULD GO TO THE APPROPRIATE HOSPICE OR OTHER
16 FACILITY.
17 Q. NOW, IN THAT PARTICULAR SITUATION, WHEN YOU'RE TALKING
18 ABOUT A TERMINAL DISEASE -- I'M UNDERSTANDING THAT THAT
19 MEANS END OF LIFE. YOUR UNIT WAS A VERY SHORT-TERM STAY, I
20 TAKE IT?
21 A. REPEAT THE FIRST PART OF WHAT YOU SAID.
22 Q. WELL, A TERMINAL -- A TERMINAL DISEASE IS BASICALLY
23 SOMETHING THAT'S GOING TO END OR TERMINATE THE PERSON'S
24 LIFE.
25 A. RIGHT.
216
1 Q. AND YOUR UNIT WAS MAINLY FOR A VERY SHORT STAY -- SHORT
2 STAY.
3 A. YEAH. SOMEONE COULD NOT -- THAT'S RIGHT. IT WAS A --
4 IT WAS AN INPATIENT -- ACUTE INPATIENT TREATMENT FACILITY OR
5 PROGRAM SO WE -- OUR JOB WAS TO STABILIZE PEOPLE,
6 PSYCHIATRICALLY, SO THEY COULD GO TO A LESSER LEVEL OF CARE
7 OR GO BACK TO THE -- YOU KNOW, TO A NON-HOSPITAL -- YOU
8 KNOW, TO THE NURSING HOME, TO THEIR HOME, TO A LESSER LEVEL
9 OF CARE.
10 Q. AND SO GIVEN THE FACT THAT YOU'VE GOT -- YOU'RE
11 INDICATING THAT YOU'RE TALKING ABOUT A TERMINAL DISEASE
12 WHICH MAY CAUSE END OF LIFE AND --
13 MR. STIRBA: YOUR HONOR -- YOUR HONOR, I'M GOING TO
14 OBJECT. LEADING AND SUGGESTIVE. THIS IS DIRECT
15 EXAMINATION.
16 THE COURT: SUSTAINED.
17 MR. MAJOR: YOUR HONOR, I DON'T BELIEVE -- IF I
18 MIGHT, JUST BASICALLY I'M JUST TRYING TO SET THE FOUNDATION
19 SO THAT HE UNDERSTANDS SPECIFICALLY WHERE THE QUESTION IS
20 GOING TO BE GOING.
21 THE COURT: THE OBJECTION IS SUSTAINED.
22 MR. MAJOR: THANK YOU.
23 Q. (BY MR. MAJOR) SO WAS THERE ANY PERIOD OF TIME ON
24 WHICH YOU WOULD MAKE A DETERMINATION ON HOW LONG THIS
25 PATIENT HAD TO SURVIVE? IF YOU HAVE A TERMINALLY ILL
217
1 PATIENT COMING ON THE UNIT, WAS THERE A LIMIT ON THE LENGTH
2 OF ANTICIPATION BEFORE THEIR DEATH? SEE WHAT I'M GETTING
3 AT?
4 A. TERMINAL DISEASE CAN -- YOU KNOW, SOMEONE CAN HAVE A
5 TERMINAL DISEASE AND HAVE A LONG PERIOD OF TIME TO LIVE OR A
6 SHORT TIME -- PERIOD OF TIME TO LIVE. IT'S NOT AN EXACT
7 SCIENCE IN MEDICINE OR PSYCHIATRY, BUT I DON'T -- I DON'T
8 REMEMBER -- WOULD YOU REPEAT THE QUESTION?
9 Q. YEAH.
10 A. I DON'T KNOW IF I'M ANSWERING THE QUESTION.
11 Q. LET ME ASK IT THIS WAY. LET ME GIVE YOU A HYPOTHETICAL
12 QUESTION. IF YOU HAD AN INDIVIDUAL WHO SAY DIDN'T HAVE A
13 MENTAL DISORDER, HAD A TERMINAL ILLNESS AND THE DOCTOR
14 INDICATED THEY MAY HAVE TWO OR THREE YEARS LEFT, WOULD THEY
15 QUALITY FOR THE UNIT?
16 MR. STIRBA: YOUR HONOR, I'M GOING TO OBJECT. SAME
17 OBJECTION. LEADING AND SUGGESTIVE. HE'S NOT QUALIFIED AS
18 AN EXPERT, HE'S NOT TREATING HIM AS AN EXPERT. IT'S AN
19 INAPPROPRIATE HYPOTHETICAL.
20 MR. MAJOR: YOUR HONOR, I'M NOT ASKING HIM AS AN
21 EXPERT. I'M ASKING HIM AS A PERSON WHO WAS INVOLVED WITH
22 THE INTAKE OF THESE PATIENTS. WE'RE TRYING TO ESTABLISH
23 WHAT THE CRITERIA WAS FOR THE INTAKE OF THESE PARTICULAR
24 PATIENTS.
25 MR. STIRBA: WELL, THE CRITERIA IS RIGHT IN THE
218
1 POLICY. IT SPEAKS FOR ITSELF, YOUR HONOR.
2 MR. MAJOR: NO. THE QUESTION -- IF I MIGHT PROFFER
3 THE QUESTION TO THE COURT. THE QUESTION SIMPLY IS WE HAVE A
4 SHORT-TERM PATIENT. WOULD HE ACCEPT A PATIENT THAT HAD
5 PERHAPS AN ESTIMATED LIFE SPAN OF TWO YEARS VERSUS A PATIENT
6 WHERE THE DOCTOR SAYS THIS PATIENT HAS MAYBE TWO WEEKS,
7 THREE WEEKS TO LIVE?
8 THE COURT: WELL, I THINK THE FIRST QUESTION IS
9 DOES HE MAKE THE DETERMINATION WHICH PATIENTS ARE ACCEPTED?
10 MR. MAJOR: AND THAT WAS HIS -- YES. AND THAT
11 WAS -- HE WENT OUT AND DID THE EVALUATION AND MADE THE
12 RECOMMENDATION. THAT WAS HIS TESTIMONY. HE MADE THE
13 RECOMMENDATION THAT THESE PATIENTS WERE THE ONES THAT COME
14 ON THE UNIT.
15 THE WITNESS: LET ME --
16 MR. STIRBA: YOUR HONOR, RESPECTFULLY, I THINK HE'S
17 ALREADY TESTIFIED WHO MADE THE ADMISSIONS. AND I DON'T
18 THINK ANYBODY OTHER THAN A PHYSICIAN CAN ADMIT ANYBODY TO A
19 HOSPITAL.
20 MR. MAJOR: AND THAT'S CORRECT. BUT HE WAS -- AND
21 IF I MIGHT ASK HIM ONE FURTHER QUESTION THEN.
22 THE COURT: WELL, WHY DON'T YOU REPHRASE THE
23 QUESTION.
24 MR. MAJOR: NEVER MIND, YOUR HONOR. WE'LL JUST
25 SKIP OVER THAT QUESTION.
219
1 Q. (BY MR. MAJOR) WHAT WAS THE NEXT -- WHAT'S THE NEXT
2 REQUIREMENT AS YOUR UNDERSTANDING FOR ADMISSION TO THE UNIT?
3 A. THE NEXT EXCLUSIONARY CRITERIA?
4 Q. UH-HUH.
5 A. THE NEXT EXCLUSIONARY CRITERIA REFERS TO RE -- THE
6 READMISSION OF PATIENTS WHO HAVE ALREADY -- IF WE'D ALREADY
7 TREATED SOMEONE AND THEY'D BENEFITTED AS MUCH AS -- WE'D
8 GIVEN THEM ALL WE HAD TO OFFER AND THERE WAS -- IT WASN'T
9 ANTICIPATED WE COULD DO ANYTHING MORE TO HELP THEM, OR
10 THEY'D BEEN SO DISRUPTIVE THAT IT REALLY WAS NOT IN THE BEST
11 INTEREST OF THE OTHER PATIENTS THAT THEY BE TREATED THERE --
12 Q. OKAY.
13 A. -- OR PEOPLE HAD REFUSED TO PARTICIPATE IN THE TREATMENT
14 THE FIRST TIME, THESE WERE EXCLUDED.
15 Q. AND NUMBER FIVE INDICATES PATIENTS THAT ARE BEDRIDDEN OR
16 CANNOT PARTICIPATE IN THE TREATMENT PROGRAM.
17 A. YES.
18 Q. AND WHY WOULD THAT NOT -- WHY WOULD THAT BE A LACK OF
19 QUALIFICATION?
20 A. IF SOMEONE'S BEDRIDDEN IT'S DIFFICULT FOR THEM TO
21 ACTIVELY PARTICIPATE, EVEN IN PSYCHIATRIC TREATMENT.
22 Q. OKAY. AND THE NEXT ONE IS SIX IS PATIENTS WITH COMPLEX
23 MEDICAL AND SURGICAL PROCEDURES. AND THAT'S KIND OF THE
24 SAME AS BEING -- SOME OF THE OTHER PROBLEMS WE'VE TALKED
25 ABOUT.
220
1 A. YES.
2 Q. OKAY. NOW YOU, YOURSELF, AREN'T -- DO NOT ADMIT THE
3 PATIENTS TO THE UNIT; IS THAT CORRECT?
4 A. I DO NOT ADMIT THE PATIENTS.
5 Q. YOU DON'T HAVE THE AUTHORITY TO ADMIT PATIENTS ONTO THE
6 UNIT?
7 A. NO.
8 Q. DID YOU HAVE AUTHORITY AT THIS TIME TO REJECT PATIENTS
9 FOR THE UNIT?
10 A. NO.
11 Q. SO IF AN INDIVIDUAL WERE TO CALL YOU UP FROM A REST
12 HOME --
13 MR. STIRBA: OBJECT. LEADING AND SUGGESTIVE, YOUR
14 HONOR.
15 MR. MAJOR: YOUR HONOR, IT'S JUST SIMPLY
16 ESTABLISHING --
17 THE COURT: FINISH THE QUESTION. I DIDN'T HEAR THE
18 QUESTION.
19 Q. (BY MR. MAJOR) IF AN INDIVIDUAL WERE TO CALL YOU OUT
20 TO A REST HOME, INDICATED THEY HAD A PATIENT, THEN WHAT WAS
21 THE PROCEDURE THAT YOU WOULD FOLLOW?
22 A. WE WOULD CONDUCT AN INITIAL ASSESSMENT OF THE PATIENT
23 AND TRY TO DETERMINE TO THE BEST OF OUR ABILITY WHETHER THEY
24 WOULD BENEFIT FROM INPATIENT PSYCHIATRIC TREATMENT OR OTHER
25 TREATMENT. IF WE FELT THAT THEY WOULD BENEFIT FROM
221
1 INPATIENT PSYCHIATRIC TREATMENT, WE WOULD CALL THE ATTENDING
2 PHYSICIAN, GIVE THAT PHYSICIAN A SUMMARY OF OUR FINDINGS,
3 AND THEN THE ATTENDING PHYSICIAN WOULD MAKE A DECISION.
4 Q. WOULD YOU DO THAT IF THE PATIENT THAT YOU WERE LOOKING
5 AT FELL IN ONE OF THESE CATEGORIES -- ONE OF THESE SIX
6 CATEGORIES WE JUST DISCUSSED?
7 A. WE MAY. WE'D -- WE'D -- WE'D REALLY HAVE TO LOOK AT THE
8 PATIENT RIGHT THEN AND THERE. AND THESE -- THESE WERE
9 GUIDELINES. THEY WERE NOT HARD AND FAST.
10 Q. UH-HUH.
11 A. YOU KNOW, WE WOULDN'T ASSESS SOMEONE BECAUSE THEY FELL
12 INTO THIS CATEGORY OR THAT. WE'D STILL MAKE THE ASSESSMENT,
13 WE'D TRY AND GET ADDITIONAL INFORMATION, AND DO WHAT WAS --
14 WHAT WE FELT WAS BEST FOR THE PATIENT.
15 Q. OKAY. AND WHEN YOU -- YOU CONTACTED THE PHYSICIAN, WHO
16 WOULD THAT BE?
17 A. THAT WOULD BE DR. JENSEN OR DR. WEITZEL.
18 Q. WHAT INFORMATION WOULD YOU PROVIDE TO THEM?
19 A. A SUMMARY OF OUR FINDINGS. WE HAD AN INTAKE FORM THAT
20 WE WOULD FILL OUT AND THAT -- THAT -- THAT FORM WOULD HELP
21 US SUMMARIZE THE FINDINGS OF OUR ASSESSMENT AND WE'D -- WE
22 WOULD REPEAT THOSE OR SUMMARIZE THOSE TO -- FOR THE
23 PHYSICIAN.
24 Q. WOULD YOU SPEAK PERSONALLY WITH THE PHYSICIANS?
25 A. YES.
222
1 Q. AND WOULD YOU RAISE ANY QUESTIONS THAT YOU HAD ON THE
2 PATIENTS?
3 A. YES.
4 Q. AND WOULD YOU DISCUSS MEDICAL CONDITIONS WITH THEM?
5 A. YES.
6 Q. WOULD YOU DISCUSS THE PSYCHOLOGICAL CONDITIONS WITH
7 THEM?
8 A. YES.
9 Q. WOULD YOU DISCUSS YOUR -- THE ABILITY OF THE PATIENT TO
10 RECEIVE TREATMENT ON THE UNIT?
11 A. WE MAY.
12 Q. AND TO HELP ON THE UNIT?
13 A. WE -- WE MAY. MORE THE FORMER THAN THAT SPECIFICALLY.
14 Q. OKAY. THEN WHAT WOULD HAPPEN AFTER YOU HAD THIS
15 DISCUSSION WITH THE DOCTOR?
16 A. THE PHYSICIAN WOULD MAKE A DECISION TO ADMIT OR TO NOT
17 ADMIT OR TO GET MORE INFORMATION.
18 Q. OKAY. AND IF THE -- THE PHYSICIAN AT THAT POINT IN TIME
19 DETERMINED TO ADMIT THE PATIENT, WHAT WOULD OCCUR?
20 A. I BELIEVE THEN WE WOULD GO AHEAD -- I THINK THE
21 PHYSICIAN WOULD CALL THE NURSE OR WE WOULD CALL THE NURSE
22 BACK AT THE HOSPITAL AND SAY WE GOT APPROVAL FROM THE
23 PSYCHIATRIST, AND THEN WE'D INITIATE THE ADMISSION
24 PROCEDURES WHICH WOULD INVOLVE TRANSFERRING THE PATIENT OR
25 THE PATIENT BEING TRANSPORTED TO THE HOSPITAL. THEY WOULD
223
1 THEN GO THROUGH A -- REALLY THE FIRST THING THEY WOULD DO
2 WHEN THEY'D HIT THE DOOR IS HAVE A NURSING ASSESSMENT. THE
3 NURSING STAFF WOULD CONDUCT, YOU KNOW, THAT FIRST ASSESSMENT
4 ON THE UNIT.
5 Q. AND DO YOU KNOW, BASED ON YOUR EXPERIENCE WITH THE
6 HOSPITAL, WHAT THAT ENTAILED?
7 A. YES. IT WAS -- IT WAS FAIRLY DETAILED. AGAIN, MANY OF
8 THE SAME CATEGORIES I'VE ALREADY MENTIONED BUT IN GREATER
9 DETAIL. THEY'D INTERVIEW THE FAMILY AND THE PATIENT TO TRY
10 AND FILL OUT, YOU KNOW, IT MAY HAVE BEEN A SIX OR EIGHT PAGE
11 FORM, THE NURSING --
12 Q. WHAT ELSE -- PARDON ME. WHAT ELSE WOULD TAKE PLACE ONCE
13 THE PATIENT HAD BEEN ACCEPTED?
14 A. USUALLY WITHIN 24 HOURS THERE'D BE A PSYCHIATRIC
15 EVALUATION BY THE PSYCHIATRIST, AS WELL AS A HISTORY AND
16 PHYSICAL BY ONE OF THE OTHER MEMBERS OF THE MEDICAL STAFF AT
17 THE HOSPITAL. IT WOULD EITHER BE AN INTERNIST OR A FAMILY
18 PRACTITIONER.
19 Q. OKAY. THIS WOULD BE A PHYSICIAN THEN?
20 A. YEAH.
21 Q. AND THAT WAS WITHIN WHAT PERIOD OF TIME? I MISSED THAT.
22 A. THE HISTORY AND PHYSICAL WAS TO OCCUR WITHIN 24 HOURS
23 AND THE PSYCHIATRIC EVAL WAS TO OCCUR WITHIN 24 HOURS.
24 Q. OKAY. AND THEN WHAT WOULD HAPPEN?
25 A. WELL, THERE'S -- THE NURSING ASSESSMENT, PSYCH EVAL, AND
224
1 H&P WERE TO OCCUR WITHIN THE FIRST 24 HOURS OF ADMISSION. I
2 THINK THE NURSING ASSESSMENT WAS TO OCCUR WITHIN THE FIRST
3 SIX HOURS OR EIGHT HOURS OF TREATMENT. AND THEN THE SOCIAL
4 WORKER WAS TO COMPLETE A -- A FORMAL PSYCHOSOCIAL EVALUATION
5 WITHIN 72 HOURS OF ADMISSION. AND AN INITIAL TREATMENT PLAN
6 WOULD BE DEVELOPED FOR THE PATIENT WITHIN THE FIRST 24
7 HOURS, USUALLY BASED ON THE NURSING ASSESSMENT AND THE
8 INTAKE, AND THEN TREATMENT WOULD COMMENCE.
9 Q. OKAY. WOULD THE NURSING STAFF AND THE DOCTOR -- THE
10 PSYCHIATRIST ON THE UNIT HAVE ACCESS TO THE PHYSICAL EXAMS
11 THAT WERE CONDUCTED?
12 A. YES. THE -- NORMALLY THE PHYSICIAN CONDUCTING THE
13 HISTORY AND PHYSICAL WOULD WRITE A CHART NOTE AS WELL AS A
14 DICTATION, MAYBE A FORM THAT WAS IN THE CHART. THERE WAS
15 SOME VARIATION THERE, BUT CERTAINLY A DICTATED HISTORY AND
16 PHYSICAL OR A HANDWRITTEN HISTORY AND PHYSICAL WOULD BE
17 AVAILABLE WITHIN THE -- USUALLY WITHIN A REASONABLE PERIOD
18 OF TIME.
19 Q. OKAY. AND NATURALLY AS THE PATIENTS WERE ON THIS UNIT,
20 I GUESS SOMETIMES THEIR HEALTH COULD DETERIORATE? WHAT WAS
21 THE NORMAL PROCEDURE IF A PATIENT BECAME ILL ON THE UNIT?
22 A. TO TREAT THE ILLNESS.
23 Q. OKAY. AND IF THE ILLNESS WAS SERIOUS?
24 A. AGAIN, WE'D -- WE'D -- WE WOULD TREAT SERIOUS ILLNESS,
25 MEDICAL AND PSYCHIATRIC ILLNESS ON THIS UNIT. IF THE
225
1 ILLNESS BECAME -- IF THE MEDICAL PROBLEM BECAME SO ACUTE
2 THAT THEY COULD NOT BENEFIT FROM PSYCHIATRIC TREATMENT WE
3 WOULD -- SOMETIMES WE WOULD TRANSFER THE PATIENT TO A
4 MEDICAL FLOOR SO THEY COULD BE STABILIZED OR HAVE AGGRESSIVE
5 TREATMENT FOR THE MEDICAL CONDITION, THEN TRANSFER THEM BACK
6 TO FINISH THE PSYCHIATRIC TREATMENT, IF NECESSARY.
7 Q. OKAY. NOW, YOU'RE FAMILIAR WITH THE TERM HOSPICE, ARE
8 YOU NOT?
9 A. UH-HUH.
10 Q. AND WHAT IS HOSPICE?
11 A. HOSPICE IS USUALLY A PROGRAM OF CARE AND SUPPORT GIVEN
12 TO PATIENTS AND THEIR FAMILIES WHEN THEY REACH KIND OF A
13 CRITICAL, TERMINAL PHASE OF THEIR ILLNESS.
14 Q. WAS THIS UNIT DESIGNED OR SET UP FOR ANY TYPE OF HOSPICE
15 TREATMENT?
16 A. WE HAD RELATED HOSPICE SERVICES, BUT NOT -- WE WERE NOT
17 A HOSPICE UNIT.
18 Q. YOU'RE ALSO FAMILIAR WITH THE TERM OF "COMFORT CAR," ARE
19 YOU NOT?
20 A. YES.
21 Q. AND WHAT IS YOUR UNDERSTANDING OF THAT TERM?
22 A. MEDICAL TREATMENT TO REALLY KEEP A PATIENT COMFORTABLE
23 DURING A -- EITHER A PAINFUL OR -- WELL, USUALLY A CRITICAL,
24 TERMINAL PHASE OF TREATMENT IS MY UNDERSTANDING.
25 Q. OKAY. WAS THIS UNIT SET UP TO TAKE CARE OF OR HANDLE
226
1 COMFORT CARE?
2 A. IT WAS NOT SET UP FOR THAT PURPOSE.
3 Q. THANK YOU. NOW, DURING THE COURSE OF A PATIENT'S STAY
4 WHILE YOU WERE THE DIRECTOR, WAS THERE TIMES WHEN YOU WOULD
5 HAVE STAFF MEETINGS TO DISCUSS THE PATIENT'S CARE?
6 A. WELL, WE'D HAVE STAFF MEETINGS TO TALK ABOUT STAFF
7 ISSUES. WE'D HAVE TREATMENT PLANNING MEETINGS TO DISCUSS
8 THE TREATMENT OF THE PATIENTS.
9 Q. OKAY. SO THERE IS THAT DISTINCTION. WHEN I -- I SAY
10 STAFF MEETINGS, GENERALLY EVERYBODY GETS TOGETHER AND TALKS.
11 BUT THERE WAS A DISTINCTION BETWEEN THE TWO TYPES?
12 A. YES.
13 Q. OKAY. AND WHEN YOU HAD THE TREATMENT CARE -- STAFF --
14 OR I SHOULDN'T SAY STAFF -- TREATMENT CARE MEETINGS, WHO WAS
15 INVOLVED IN THOSE?
16 A. THE TREATMENT TEAM. USUALLY THE CHARGE NURSE, THE
17 SOCIAL WORKER, THE PROGRAM DIRECTOR, THE PHYSICIAN, THE
18 INTAKE PERSON I'VE REFERRED TO. USUALLY THE WHOLE TREATMENT
19 TEAM WOULD PARTICIPATE.
20 Q. AND HOW OFTEN WOULD THEY MEET?
21 A. AS I RECALL IT WOULD BE TWO OR -- TWO OR -- I WOULD
22 GUESS TWO TIMES A WEEK, MAYBE MORE OFTEN.
23 Q. AND, GENERALLY, WHAT WAS DISCUSSED IN THESE MEETINGS?
24 A. WE'D REVIEW EACH OF THE PATIENTS AND THEIR TREATMENT
25 PLAN AND HOW THINGS WERE GOING AND DISCUSS -- YOU KNOW, KIND
227
1 OF -- IT WAS A TIME WHERE WE COULD ALL BE IN THE SAME ROOM
2 AND DISCUSS ASPECTS OF CARE THAT NEEDED TO BE COORDINATED.
3 Q. OKAY. NOW, DURING THE PERIOD OF TIME FROM DECEMBER OF
4 1995 AND JANUARY OF 1996, THERE WERE APPROXIMATELY FIVE
5 PATIENTS WHO DIED ON THIS UNIT. WERE YOU AWARE OF THAT?
6 A. YES.
7 Q. AND HOW DID YOU BECOME AWARE OF THAT? WHAT WERE THE
8 CIRCUMSTANCES?
9 A. NURSING STAFF INFORMED ME.
10 Q. AND DO YOU RECALL WHEN THAT WAS OR WHAT THE
11 CIRCUMSTANCES OF THEM INFORMING YOU?
12 A. I GUESS -- I MEAN, I WAS AT WORK DOING MY JOB. I THINK
13 IT WAS EARLY IN THE MORNING. YOU KNOW, THAT'S JUST KIND OF
14 A BLUR ABOUT THE CIRCUMSTANCES OF HOW THEY INFORMED ME. THE
15 NURSING STAFF CAME TO MY OFFICE AND SAID DO YOU KNOW WHAT
16 HAPPENED OR DO YOU KNOW WHAT'S GOING ON? SOMEONE IS REALLY
17 GOING DOWNHILL FAST. I THINK I WAS INFORMED OF CLIENTS THAT
18 WERE GOING DOWNHILL QUICKLY, AS WELL AS AFTER THE FACT WHEN
19 SOME DEATHS HAD ALREADY OCCURRED.
20 Q. OKAY. NOW, DURING THIS PERIOD OF TIME I ASSUME YOU WERE
21 HAVING THE TREATMENT MEETINGS, AGAIN, WITH THE DOCTOR --
22 WITH DR. WEITZEL AND THE OTHER NURSING STAFF; IS THAT
23 CORRECT?
24 A. YES.
25 Q. DURING ANY OF THESE TREATMENT MEETINGS, SPECIFICALLY IN
228
1 THE PERIOD OF TIME OF DECEMBER OF 1995 AND JANUARY OF 1996
2 AND TO SOME EXTENT AFTER THAT PERIOD OF TIME, WAS THERE ANY
3 DISCUSSIONS EVER MADE ABOUT THE INTAKE POLICY OF THE
4 HOSPITAL FOR THESE PATIENTS?
5 A. WELL, WE MAY HAVE ASKED IF THESE -- WE MAY HAVE ASKED
6 OURSELVES IF THESE WERE APPROPRIATE ADMISSIONS AND KIND OF
7 REVIEWED THE INITIAL FINDINGS, YOU KNOW. YOU KNOW, WE MAY
8 HAVE CHECKED OURSELVES. THERE MAY HAVE BEEN SOME -- SOME
9 DISCUSSION.
10 Q. DID DR. WEITZEL EVER INDICATE TO YOU THAT HE FELT THERE
11 WAS A PROBLEM WITH THE INTAKE?
12 A. NOT THE INTAKE SPECIFICALLY. I THINK AFTER SOME OF THE
13 ADMISSIONS OCCURRED WE ALL FELT LIKE THEY WERE PRETTY
14 SERIOUS -- SOME OF THEM WERE MORE SERIOUS MEDICALLY THAN WE
15 HAD FIRST THOUGHT.
16 Q. AND WHERE DID THAT INFORMATION COME FROM?
17 A. WELL, FROM THE -- FROM THE PATIENT THEMSELVES, FROM THE
18 HISTORY AND PHYSICAL PERFORMED. YOU KNOW, FROM THE PATIENT
19 ASSESS -- YOU KNOW, DAILY ONGOING ASSESSMENT OF THE
20 PATIENT'S CONDITION.
21 Q. OKAY. WAS ANY CRITERIA CHANGED AS FAR AS ADMISSION OF
22 PATIENTS WERE CONCERNED? AFTER -- AFTER THESE DEATHS?
23 A. THERE WAS NEW -- THERE WAS SOME ADDITIONAL EMPHASIS
24 GIVEN TO MEDICAL CONDITION, BUT THE POLICIES -- IT'S MY
25 RECOLLECTION THEY GENERALLY STAYED THE SAME. !!
229
1 Q. OKAY. THANK YOU.
2 MR. MAJOR: MAY I HAVE JUST ONE MINUTE, YOUR HONOR?
3 THE COURT: YES.
4 (WHEREUPON, THERE'S AN OFF-THE-RECORD DISCUSSION.)
5 Q. (BY MR. MAJOR) A COUPLE OF QUESTIONS JUST TO FOLLOW
6 UP. IN GOING BACK TO KIND OF WHAT WE WERE TALKING ABOUT
7 WITH TERMINAL ILLNESS. IF YOU DID AN ASSESSMENT ON A
8 PATIENT, BASED ON YOUR TRAINING AND EXPERIENCE, AND IT WERE
9 DETERMINED IN THAT ASSESSMENT THAT PATIENT HAD SIX MONTHS TO
10 LIVE, WOULD THAT PATIENT QUALIFY TO COME ON TO THIS UNIT?
11 MR. STIRBA: YOUR HONOR, I'M GOING TO OBJECT.
12 IRRELEVANT AND I BELIEVE THE POLICY SPEAKS FOR ITSELF. IT'S
13 ALREADY BEEN ADMITTED INTO EVIDENCE.
14 MR. MAJOR: YOUR HONOR, IF I MIGHT, THE POLICY JUST
15 INDICATES TERMINAL ILLNESS AND IT INDICATES --
16 THE COURT: WELL, ARE YOU ASKING WHAT
17 RECOMMENDATION HE WOULD MAKE?
18 MR. MAJOR: THAT'S -- THAT WAS THE NATURE OF MY
19 QUESTION.
20 THE COURT: OKAY. OVERRULED.
21 Q. (BY MR. MAJOR) IF THAT WERE THE CASE, AS WE MENTIONED,
22 THERE WAS SIX MONTHS OR LESS TO LIVE, WHAT RECOMMENDATION
23 WOULD YOU MAKE ON THAT PATIENT?
24 A. I DON'T KNOW IF WE WOULD MAKE A RECOMMENDATION AS MUCH
25 AS WE WOULD GIVE A SUMMARY OF OUR FINDINGS OF THEIR MENTAL
230
1 CONDITION AND THEIR MEDICAL CONDITION BASED ON OUR INTAKE.
2 WE -- WE WOULD -- WE'D GET A CALL TO GO OUT, WE WOULD MAKE
3 AN ASSESSMENT, WE WOULD PRESENT THAT MATERIAL TO THE
4 PHYSICIAN TO MAKE A DECISION.
5 Q. AND SO YOU'RE INDICATING THAT THAT WOULD BE THE
6 PHYSICIAN'S CALL?
7 A. YES.
8 Q. SO --
9 A. EVEN IF WE KNEW THEY HAD SIX MONTHS -- WERE TOLD THEY
10 HAD SIX MONTHS TO LIVE, THAT WOULD BE THE PHYSICIAN'S CALL
11 TO -- WE'D STILL PRESENT THAT INFORMATION AND THE PHYSICIAN
12 WOULD MAKE A DECISION.
13 Q. AND DOING THIS, DURING THE PERIOD OF TIME THAT YOU WERE
14 WORKING WITH DR. WEITZEL, BASED ON YOUR TRAINING AND
15 EXPERIENCE, BASED ON YOUR UNDERSTANDING OF THE POLICIES AND
16 YOUR PSYCHO -- INTERVIEWS WITH THE PATIENTS, DID YOU HAVE
17 ANY CONCERNS ABOUT DR. WEITZEL'S ACCEPTING OR DENYING
18 PATIENTS COMING ONTO THE UNIT?
19 MR. STIRBA: YOUR HONOR, I'LL OBJECT. IRRELEVANT
20 WITH RESPECT TO THESE FIVE PATIENTS ONLY.
21 THE COURT: SUSTAINED.
22 Q. (BY MR. MAJOR) DO YOU RECALL THE ADMISSIONS OF THESE
23 FIVE PATIENTS?
24 A. NO. I MEAN, IT'S --
25 Q. AND IS DR. WEITZEL, THE DOCTOR THAT YOU DEALT WITH ON
231
1 THIS OCCASION, IS HE IN THE COURTROOM TODAY?
2 A. YES.
3 Q. CAN YOU IDENTIFY HIM FOR THE RECORD?
4 A. RIGHT THERE IN THE MIDDLE OF THE --
5 MR. MAJOR: MAY THE RECORD -- MAY THE RECORD
6 REFLECT HE'S IDENTIFIED THE DEFENDANT, YOUR HONOR?
7 THE COURT: YES.
8 MR. MAJOR: WE HAVE NO FURTHER QUESTIONS AT THIS
9 TIME.
10 THE COURT: OKAY. LADIES AND GENTLEMEN, WE'VE BEEN
11 GOING FOR ABOUT AN HOUR. WHY DON'T WE TAKE A 15 MINUTE
12 BREAK AT THIS TIME.
13 DURING THAT BREAK IT'S YOUR DUTY NOT TO CONVERSE AMONG
14 YOURSELVES OR TO CONVERSE WITH OR ALLOW YOURSELVES TO BE
15 ADDRESSED BY ANY OTHER PERSON ON ANY SUBJECT OF THIS TRIAL.
16 IT'S ALSO YOUR DUTY NOT TO FORM OR EXPRESS AN OPINION UNTIL
17 THE CASE IS FINALLY SUBMITTED TO YOU.
18 SO WE'LL COME BACK AT 9:45.
19 (WHEREUPON, AT THIS TIME THE JURY LEAVES COURTROOM,
20 AFTER WHICH PROCEEDINGS RESUME, AS FOLLOWS:)
21 THE COURT: THE RECORD SHOULD REFLECT THAT THE JURY
22 HAS LEFT.
23 WHEN DO YOU WISH TO ADDRESS THIS ONE ISSUE REGARDING
24 THE HOSPITAL POLICIES? I MEAN -- ARE WE GOING TO HAVE THIS
25 WITNESS CROSS-EXAMINED OR DO YOU HAVE ANOTHER WITNESS THAT
232
1 IS NOT GOING TO BE AFFECTED BY THAT MOTION?
2 MR. MAJOR: YOUR HONOR, I BELIEVE AT THIS POINT IN
3 TIME -- WITHOUT MR. WILSON HERE, I'M NOT SURE WHAT HIS
4 DESIRES ARE. I THINK HE HAS GONE BACK -- THIS IS THE FIRST
5 TIME WE'VE HAD A CHANCE TO SEE THOSE MOTIONS.
6 THE COURT: SURE.
7 MR. MAJOR: I THINK HE IS RIGHT NOW REVIEWING THOSE
8 MOTIONS AND GETTING READY.
9 THE COURT: OKAY. WELL, WHY DON'T YOU -- I THOUGHT
10 HE SAID YOU HAD TWO WITNESSES, AND SO IF YOU HAVE ONE OTHER
11 ONE --
12 MR. MAJOR: YEAH.
13 THE COURT: -- WE MIGHT WAIT, YOU KNOW, UNTIL LATER
14 AND THEN -- HOW LONG DO YOU THINK YOU'RE GOING TO BE ON
15 CROSS-EXAMINATION?
16 MR. STIRBA: OH, 20 MINUTES, HALF AN HOUR, I'D
17 EXPECT.
18 THE COURT: OKAY.
19 MR. MAJOR: AND THEN OUR NEXT WITNESS WE ANTICIPATE
20 WILL BE WELBY -- DR. WELBY JENSEN, YOUR HONOR, AND I'M NOT
21 SURE HOW LONG HE WOULD TAKE, SPECIFICALLY.
22 THE COURT: OKAY. BUT HE WOULD NOT NECESSARILY
23 SPEAK TO THIS -- THE ISSUE OF THIS MOTION?
24 MR. MAJOR: NO, I DON'T BELIEVE SO.
25 THE COURT: OKAY. WELL THEN MAYBE WE'LL DO IT
233
1 AFTER HIM. WE'LL DO IT SOMETIME. SO WE'LL BE BACK --
2 MR. MAJOR: PERHAPS WE COULD BREAK A HALF HOUR
3 EARLY FOR LUNCH AND --
4 THE COURT: WELL, THAT'S WHAT I'M TRYING TO THINK
5 OF, DEPENDING ON WHERE WE ARE WITH THE WITNESSES.
6 OKAY. THEN LET'S COME BACK AT 9:45.
7 (WHEREUPON, AT THIS TIME THERE'S A RECESS, AFTER WHICH
8 PROCEEDINGS RESUME IN THE HEARING OF THE JURY, AS FOLLOWS:)
9 THE COURT: OKAY. THE RECORD SHOULD REFLECT THAT
10 COUNSEL ARE PRESENT WITH DEFENDANT, AND THE JURY ARE ALL
11 PRESENT.
12 MR. STIRBA?
13 MR. STIRBA: THANK YOU, YOUR HONOR.
14 CROSS-EXAMINATION
15 BY MR. STIRBA:
16 Q. GOOD MORNING, MR. CHAMBERS.
17 A. GOOD MORNING.
18 Q. YOU TESTIFIED EARLIER ABOUT A NUMBER OF ASSESSMENTS THAT
19 TYPICALLY WERE DONE WITH PATIENTS WHO WERE ADMITTED TO THE
20 UNIT. DO YOU RECALL THAT?
21 A. YES.
22 Q. AND IT'S TRUE, IS IT NOT, THAT ONE OF THE ASSESSMENTS
23 THAT WAS TO BE DONE -- OR AN EVALUATION WAS TO BE DONE BY A
24 MEDICAL DOCTOR, TYPICALLY AN INTERNAL MEDICINE DOCTOR, AND
25 THAT WAS THE HISTORY AND PHYSICAL OF THE PATIENT; IS THAT
234
1 CORRECT?
2 A. YES.
3 Q. AND IT'S TRUE THAT THAT DOCTOR WAS SUPPOSED TO DO THAT
4 WITHIN 24 HOURS OF THE ADMISSION OF A PATIENT ON TO THE
5 UNIT, CORRECT?
6 A. YES.
7 Q. AND ONE OF THE PURPOSES CERTAINLY OF DOING THAT HISTORY
8 AND PHYSICAL WAS TO PROVIDE CERTAIN MEDICAL INFORMATION, IF
9 YOU WILL, THAT MIGHT BE HELPFUL AND USEFUL FOR PURPOSES OF
10 TREATMENT, CORRECT?
11 A. THAT'S MY UNDERSTANDING.
12 Q. FOR EXAMPLE, THAT MEDICAL DOCTOR WOULD CONDUCT
13 ESSENTIALLY A SYSTEMS REVIEW, TRUE?
14 A. YES.
15 Q. AND WOULD GO OVER THE PREVIOUS MEDICATIONS THAT THE
16 PATIENT HAD BEEN ON, TRUE?
17 A. YES.
18 Q. AND, ALSO, WOULD DO A COMPREHENSIVE PHYSICAL AND
19 COMPREHENSIVE HISTORY; ISN'T THAT TRUE?
20 A. THAT'S TRUE.
21 Q. AND ALL THAT INFORMATION THEN WOULD BE GENERATED AND
22 WOULD BECOME PART OF THE PATIENT'S CHART, CORRECT?
23 A. YES.
24 Q. AND CERTAINLY THAT WOULD BE HELPFUL AND CERTAINLY COULD
25 BE HELPFUL FOR PURPOSES OF ANY PSYCHIATRIC TREATMENT,
235
1 CORRECT?
2 A. YES.
3 Q. NOW, THAT WAS ONE ASSESSMENT, AND THEN THERE WAS ANOTHER
4 ASSESSMENT THAT YOU TESTIFIED TO THAT WAS DONE BY A SOCIAL
5 WORKER, CORRECT?
6 A. YES.
7 Q. AND THAT SOCIAL WORKER, I BELIEVE YOU TESTIFIED, HAD TO
8 DO HIS OR HER ASSESSMENT WITHIN 72 HOURS, TRUE?
9 A. YES.
10 Q. AND ONCE AGAIN, THAT WOULD BE A -- A REVIEW, I GUESS, OF
11 THE PATIENT'S SITUATION FROM THE EXPERTISE AND PERSPECTIVE
12 OF A SOCIAL WORKER, CORRECT?
13 A. YES.
14 Q. AND THAT WAS ALSO WRITTEN AND -- AND -- AND THERE WAS A
15 DOCUMENT CREATED THAT WAS CALLED A SOCIAL WORK ASSESSMENT ON
16 THE PATIENT, TRUE?
17 A. I BELIEVE SO.
18 Q. AND THAT DOCUMENT, TOO, WAS ALL PART OF THE PROCESS AND
19 COULD BE HELPFUL FOR PURPOSES OF PROVIDING APPROPRIATE
20 PSYCHIATRIC TREATMENT OR CARE, CORRECT?
21 A. YES.
22 Q. AND THEN YOU TOLD US ABOUT A NURSING ASSESSMENT.
23 REMEMBER THAT?
24 A. YES.
25 Q. AND THAT WAS AN ASSESSMENT THAT WOULD BE DONE TYPICALLY
236
1 EITHER ON ADMISSION OR WITHIN A SHORT TIME THEREAFTER,
2 CORRECT?
3 A. YES.
4 Q. AND IT'S TRUE, IS IT NOT, THAT THERE WAS A FAIRLY
5 LENGTHY FORM, IN OTHER WORDS, MORE THAN 10 PAGES, WHERE A
6 NURSE WOULD OTHERWISE CHART OR REFLECT ANSWERS TO VARIOUS
7 QUESTIONS BASED UPON HIS OR HER ASSESSMENT, CORRECT?
8 A. YES. I DON'T REMEMBER THE EXACT NUMBER OF PAGES.
9 Q. BUT THERE WAS A FORM, TRUE?
10 A. IT WAS A LENGTHY FORM.
11 Q. AND -- AND THE INFORMATION THERE WAS PARTLY MEDICAL,
12 CORRECT?
13 A. YES.
14 Q. AND ALSO DEALT WITH THE PATIENT'S FAMILY, TRUE?
15 A. YEAH. THE FAMILY STUFF WAS MORE IN THE SOCIAL WORK
16 ASSESSMENT THAN IN THE NURSING ASSESSMENT, BUT THERE'S
17 PROBABLY SOME IN THE NURSING ASSESSMENT.
18 Q. AND THERE WAS SOME ISSUE THERE IN THE NURSING ASSESSMENT
19 ABOUT DAILY LIVING ABILITIES AND WHAT HAVE YOU; IS THAT
20 TRUE?
21 A. YES.
22 Q. AND THERE WAS ALSO A PLACE THERE FOR, ONCE AGAIN, A
23 REVIEW OF THE MEDICATIONS THAT THE PATIENT WAS ON ON
24 ADMISSION, CORRECT?
25 A. YES.
237
1 Q. AND ALSO THERE WAS A PLACE WHERE THE HISTORY, THE
2 MEDICAL HISTORY OF THE PATIENT WAS ALSO REVIEWED AND
3 CHARTED, TRUE?
4 A. YES.
5 Q. AND ONCE AGAIN, THAT NURSING ASSESSMENT FORM WAS PART OF
6 THE MEDICAL RECORD AND MIGHT BE HELPFUL AND USEFUL FOR
7 PURPOSE OF PROVIDING PSYCHIATRIC CARE, TRUE?
8 A. YES.
9 Q. AND IT'S TRUE, IS IT NOT, THAT WHEN A PATIENT WAS
10 ADMITTED TO THE UNIT, THEY WOULD RECEIVE ON A DAILY BASIS,
11 IF ABLE, ESSENTIALLY CERTAIN TREATMENT IN THE TERMS OF GROUP
12 THERAPY AND THE LIKE, CORRECT?
13 A. YES.
14 Q. FOR EXAMPLE, THERE WAS AN OCCUPATIONAL THERAPIST WHO
15 WOULD CONSULT WITH THE PATIENTS EVERY ONCE IN A WHILE; ISN'T
16 THAT TRUE?
17 A. YES, WHEN APPROPRIATE.
18 Q. AND THOSE -- THOSE TREATMENT GROUPS, THERAPY, THEY WOULD
19 BE PROVIDED TO THE PATIENTS AS WELL; IS THAT RIGHT?
20 A. YES.
21 Q. AND WERE THERE OTHER FORMS OF GROUP THERAPY PROVIDED IN
22 ADDITION TO AN OCCUPATIONAL THERAPY CONSULT?
23 A. YES.
24 Q. TELL US, PLEASE, WHAT THOSE ADDITIONAL GROUP THERAPIES
25 WERE.
238
1 A. THERE WAS THE GROUP PSYCHOTHERAPY CONDUCTED BY THE
2 SOCIAL WORKER; THERE COULD BE A NURSING EDUCATION GROUP
3 ABOUT MEDICATION, PSYCHIATRIC DIAGNOSIS, SIDE EFFECTS,
4 CONDUCTED BY THE NURSES. AND THEN THE -- KIND OF AN
5 ACTIVITY THERAPY SORT OF GROUP, ALSO -- I THINK IT WAS ALSO
6 CONDUCTED BY THE NURSING STAFF AS WELL.
7 Q. AND ALL THAT INFORMATION, ONCE AGAIN, WOULD HAVE BEEN
8 DOCUMENTED AND PLACED IN THE MEDICAL CHART OF THE PATIENT;
9 IS THAT RIGHT?
10 A. YES.
11 Q. AND IT'S TRUE, IS IT NOT, THAT IF YOU'RE A NURSE WORKING
12 ON THE UNIT, YOU WOULD HAVE FULL ACCESS TO THE PATIENT'S
13 MEDICAL CHART, CORRECT?
14 A. YES.
15 Q. AND IT'S TRUE THAT, FOR EXAMPLE, IN YOUR POSITION AS THE
16 PROGRAM DIRECTOR, YOU HAD FULL ACCESS TO THE PATIENT'S
17 CHART, TRUE?
18 A. YES.
19 Q. AND IT'S TRUE, IS IT NOT, THAT PHYSICIANS, WHETHER THEY
20 BE INTERNAL MEDICINE DOCTORS OR PSYCHIATRISTS WOULD HAVE
21 FULL ACCESS TO THE MEDICAL CHART, CORRECT?
22 A. YES.
23 Q. AND IT'S TRUE, IS IT NOT, THAT THERE WERE TIMES WHEN A
24 MEDICAL SITUATION WOULD ARISE SUCH THAT A PSYCHIATRIST OR
25 SOMEONE ELSE WOULD ASK FOR AN OUTSIDE CONSULT FROM A MEDICAL
239
1 DOCTOR, CORRECT?
2 A. YES.
3 Q. FOR EXAMPLE, IF THERE WAS A GYNECOLOGICAL ISSUE, IT
4 WOULD NOT BE UNHEARD OF TO HAVE A GYNECOLOGIST COME IN AND
5 PROVIDE A CONSULT WITH RESPECT TO THAT MEDICAL PROBLEM,
6 TRUE?
7 A. THAT'S TRUE.
8 Q. AND SIMILARLY, THOSE -- THOSE CONSULTS AND THE RESULTS
9 OF THOSE CONSULTS, THEY WOULD BE ASSESSABLE BY ANYBODY WHO
10 WAS PART OF THE TREATMENT TEAM, TRUE?
11 A. YES.
12 Q. AND THEY WOULD ALL BE IN PART OF THAT MEDICAL FILE FOR
13 THE PATIENT, CORRECT?
14 A. YES.
15 Q. IT'S TRUE, IS IT NOT, THAT ESSENTIALLY THE WAY CARE WAS
16 BEING PROVIDED, IT WAS BEING PROVIDED BASED UPON A TEAM
17 APPROACH, CORRECT?
18 A. YES.
19 Q. IN OTHER WORDS, YOU TOOK A BUNCH OF FOLKS WHO HAD
20 VARIOUS SPECIALITIES IN VARIOUS AREAS TO ESSENTIALLY TEAM
21 MANAGE THE PSYCHIATRIC PROBLEM, CORRECT?
22 A. TRUE.
23 Q. AND CERTAINLY ONE OF -- ONE OF THE PLAYERS, IF YOU WILL,
24 IN THAT TEAM WOULD HAVE BEEN THE PSYCHIATRIST, CORRECT?
25 A. YES. THE PSYCHIATRIST WAS THE LEAD PLAYER.
240
1 Q. AND, IN FACT, THE PSYCHIATRIST, BECAUSE OF THEIR
2 POSITION AS A MEDICAL DOCTOR, THEY CERTAINLY WERE NEEDED
3 BECAUSE IF YOU'RE DEALING WITH PSYCHOTROPIC OR PSYCHIATRIC
4 MEDICATIONS, THAT COULD ONLY BE PRESCRIBED OR ORDERED BY A
5 PHYSICIAN, CORRECT?
6 A. YES.
7 Q. AND IT'S TRUE, IS IT NOT, THAT SOCIAL WORKERS WERE
8 INVOLVED IN THE TEAM, CORRECT?
9 A. YES.
10 Q. NURSES WERE INVOLVED IN THE TEAM, CORRECT?
11 A. YES.
12 Q. OCCUPATIONAL THERAPISTS WERE INVOLVED IN THE TEAM,
13 CORRECT?
14 A. YES.
15 Q. NURSES' AIDES WERE PART OF THE TEAM, TRUE?
16 A. YES.
17 Q. RESPIRATORY THERAPISTS AT TIMES WERE PART OF THE TEAM,
18 TRUE?
19 A. AT TIMES.
20 Q. AND ALL THESE PEOPLE ESSENTIALLY HAD ONE GOAL AND THAT
21 IS TO TRY TO PROVIDE, TO THE BEST OF ANYONE'S JUDGMENT, THE
22 BEST CARE THAT COULD BE PROVIDED FOR THE PATIENT GIVEN THEIR
23 PARTICULAR CIRCUMSTANCE; ISN'T THAT TRUE?
24 A. YES.
25 Q. NOW, YOU TOLD US ABOUT THE -- THE POLICIES AND YOU WERE
241
1 SHOWN, I GUESS, AN EXHIBIT. AND I THOUGHT, IF I HEARD YOU
2 CORRECTLY, YOU TESTIFIED THAT THOSE POLICIES THAT YOU SAW
3 WERE, IN FACT, IN EFFECT IN DECEMBER OF 1995 AND JANUARY OF
4 1996, CORRECT?
5 A. YES.
6 Q. AND I THOUGHT YOU SAID THAT THEY WERE IN EFFECT, BUT
7 ESSENTIALLY THEY WERE GUIDELINES, NOT NECESSARILY HARD AND
8 FAST IN ALL CASES; IS THAT CORRECT?
9 A. THAT'S CORRECT.
10 Q. AND -- AND THE REASON FOR THAT, IS IT NOT, IS BECAUSE
11 WHEN YOU AND -- AND, FOR INSTANCE, MR. PERRY WOULD GO OUT
12 AND MAKE AN ASSESSMENT, A PSYCHOSOCIAL ASSESSMENT, YOU --
13 YOU UNDERSTAND THAT THAT IS NOT NECESSARILY ALWAYS A PRECISE
14 SCIENCE, CORRECT?
15 A. YES.
16 Q. CERTAINLY THERE ARE COMPLICATIONS, DIFFICULTIES, MATTERS
17 FOR WHICH YOU OR NO ONE ELSE COULD NECESSARILY ANTICIPATE,
18 TRUE?
19 A. TRUE.
20 Q. AND IT'S TRUE, IS IT NOT, THAT WHEN YOU WENT OUT AND
21 MADE A PSYCHOSOCIAL ASSESSMENT, YOU HAD A FORM, DID YOU NOT,
22 ESSENTIALLY AN INTAKE FORM THAT WAS PROVIDED WHICH WOULD
23 HAVE BEEN PART OF THE MEDICAL RECORD, CORRECT?
24 A. YES.
25 MR. STIRBA: IF I MAY APPROACH, YOUR HONOR?
242
1 THE COURT: YES.
2 Q. (BY MR. STIRBA) MR. CHAMBERS, I'M GOING TO SHOW YOU
3 WHAT IS PART OF A MEDICAL FILE AND IT'S DOCUMENT MED --
4 MED-00230 WHICH IS PART OF THE MEDICAL FILE FOR, I BELIEVE,
5 MARY CRANE. DO YOU SEE THAT?
6 A. YES.
7 Q. AND ON THAT DOCUMENT, DO YOU SEE SOME WRITING THAT IS
8 YOURS?
9 A. YES.
10 Q. AND IS YOUR SIGNATURE ON THAT DOCUMENT?
11 A. YES.
12 Q. AND TELL US GENERALLY WHAT THAT DOCUMENT IS.
13 A. THIS IS A INTAKE FORM. THE -- THE FIRST PART OF THE
14 FORM ABOVE THE HEAVY LINE WAS WHERE WE WOULD DOCUMENT A
15 PHONE CALL SAY FROM A NURSING HOME. THEY'D GIVE US SOME
16 PRELIMINARY INFORMATION, WE'D WRITE THAT DOWN.
17 THE INFORMATION BELOW THE HEAVY LINE WAS -- WERE OUR
18 FINDINGS BASED ON A FACE-TO-FACE ASSESSMENT. I -- AS I
19 RECALL, THAT'S HOW THIS FORM WAS USED.
20 Q. DO YOU HAVE -- AS YOU SIT HERE TODAY, DO YOU HAVE ANY
21 RECOLLECTION SPECIFICALLY OF TALKING TO DR. WEITZEL OR
22 ANYONE ELSE FOR THAT MATTER ABOUT MARY CRANE?
23 A. NO, NOT MARY CRANE SPECIFICALLY.
24 Q. AND WOULD THE SAME BE TRUE WITH RESPECT TO PATIENT
25 JUDITH -- JUDITH LARSEN?
243
1 A. NO SPECIFIC RECOLLECTION.
2 Q. AND WOULD THE SAME BE TRUE WITH RESPECT TO PATIENT LYDIA
3 SMITH?
4 A. YES.
5 Q. WOULD THE SAME BE TRUE WITH RESPECT TO PATIENT ELLEN
6 ANDERSON?
7 A. YES.
8 Q. AND WOULD THE SAME BE TRUE WITH RESPECT TO PATIENT ENNIS
9 ALLDREDGE?
10 A. YES.
11 MR. STIRBA: YOUR HONOR, I WOULD LIKE TO DISPLAY
12 THIS TO THE JURY. WE HAVE A STIPULATION AS TO MEDICAL
13 RECORDS. THIS IS PART OF ONE OF THE STIPULATED DOCUMENTS.
14 I DON'T WANT TO OFFER IT AS A SEPARATE EXHIBIT, BUT --
15 THE COURT: IS THERE ANY OBJECTION TO HAVE THAT
16 BEING SHOWN?
17 MR. MAJOR: NO OBJECTION, YOUR HONOR. I'M ONLY A
18 LITTLE CONCERNED THAT APPARENTLY IT HAS BEEN MARKED.
19 MR. STIRBA: THESE MARKINGS WILL NOT BE DISPLAYED,
20 I HOPE, ON THE ELMO.
21 MR. MAJOR: I HAVE NO OBJECTION TO THAT, YOUR
22 HONOR.
23 THE COURT: OKAY. GO AHEAD.
24 Q. (BY MR. STIRBA) NOW, THAT'S THE DOCUMENT YOU WERE JUST
25 TESTIFYING TO AND IT SAYS AT THE TOP, PSYCHIATRIC PHONE
244
1 INTAKE. DO YOU SEE THAT?
2 A. YEAH. IT ACTUALLY SAYS -- YOU CAN'T SEE IT BECAUSE OF
3 THE HOLE PUNCH MARK.
4 Q. OH, OKAY.
5 A. IT SAYS GEROPSYCHIATRIC PHONE INTAKE.
6 Q. THANK YOU. AND YOU HAVE A REFERENCE TO A PATIENT NAMED
7 MARY CRANE UP IN THE RIGHT-HAND CORNER, CORRECT?
8 A. MARY CRANE'S NAME --
9 Q. RIGHT-HAND SIDE.
10 A. YOU SAID YOU. MOST OF THIS HANDWRITING IS BY KEITH
11 PERRY.
12 Q. I -- I WAS GOING TO GET TO THAT. I'M JUST TALKING ABOUT
13 THE DOCUMENT.
14 A. OKAY. WELL, YEAH, MARY -- GOT YOU.
15 Q. OKAY. I APPRECIATE THE CLARIFICATION. AND THEN THERE
16 IS THAT SIGNATURE, AND IT HAS K.P. THAT STANDS FOR KEITH
17 PERRY.
18 A. YES.
19 Q. SO YOU DON'T WANT TO TAKE CREDIT FOR AUTHORING THIS
20 DOCUMENT.
21 A. I -- ONLY THE VERY BAD WRITING IS MINE.
22 Q. OKAY.
23 A. SOME OF MY WRITING IS ON THERE.
24 Q. WE'LL GET TO THE BAD WRITING SHORTLY. AND THE INTAKE
25 EVALUATION WHERE I'M POINTING TO THERE, CAN YOU JUST
245
1 GENERALLY TELL US WHAT -- WHAT THAT IS PURPORTING TO BE, WHY
2 THAT INFORMATION IS THERE?
3 A. YEAH. THIS WAS THE MECHANISM WE USED TO DOCUMENT OUR
4 FINDINGS WHEN WE GO OUT TO ASSESS A POTENTIAL PATIENT.
5 Q. WELL, IF I PUT THE DOCUMENT UP LIKE THAT, HAVE WE GOTTEN
6 TO SOME WRITING WHICH YOU BELIEVE IS YOURS?
7 A. YES.
8 Q. AND PERHAPS IF YOU COULD JUST MAYBE APPROACH THE WHITE
9 BOARD AND POINT OUT WHAT WRITING IS YOURS.
10 A. THIS IS THE TAIL END OF MY SIGNATURE. EDEMA,
11 HYPERTENSION, THESE -- THIS -- THIS IS MY WRITING. 60 DAYS
12 IS CIRCLED UP THERE, THAT WAS MY WRITING.
13 Q. AND WAS THERE A PARTICULAR REASON ON THIS DOCUMENT THAT
14 YOU WOULD HAVE WRITTEN ON IT SUCH THAT YOU JUST DESCRIBED?
15 A. YES. KEITH PERRY MAY HAVE HALF A DOZEN OF THESE INTAKE
16 FORMS IN VARYING DEGREES OF PROGRESS ON HIS DESK. AND HE
17 MAY HAVE APPOINTMENTS OR AN IN-SERVICE OR A TRAINING TO GIVE
18 THROUGHOUT THE DAY ALL OVER THE -- THE AREA.
19 AND SO HE WOULD LEAVE TWO OR -- HE'D TAKE HIS TWO OR
20 THREE FORMS AND GO TO HIS APPOINTMENTS. HE'D HAVE TWO OR
21 THREE LEFT ON HIS DESK AND SAY TODD, WE MAY BE EXPECTING A
22 CALL FROM SO AND SO. IF SO, HERE'S THE SITUATION, HERE'S
23 THE ADDITIONAL INFORMATION WE STILL NEED, AND SO FORTH. AND
24 SO I'D GET THE PHONE CALL OR I WOULD GO OUT AND -- AND
25 FOLLOW UP ON AN ASSESSMENT AND I WOULD ADD MY FINDINGS TO
246
1 HIS FINDINGS.
2 Q. NOW, ON THIS PARTICULAR FORM, IF -- IF I LOOK ON THE
3 DOCUMENT YOU SEE A PLACE WHERE IT SAYS MEDICATIONS. DO YOU
4 SEE THAT?
5 A. YES.
6 Q. AND THOSE MEDICATIONS ARE A LISTING, AT LEAST AS
7 REPORTED TO MR. PERRY, OF WHAT MEDICATIONS MS. CRANE WOULD
8 HAVE BEEN ON PRIOR TO ADMISSION; IS THAT CORRECT?
9 A. THAT'S MY UNDERSTANDING.
10 Q. AND THEN ALSO I NOTICE IN THE MIDDLE SECTION WHERE IT
11 SAYS PRESENTING PROBLEM, DO YOU SEE THAT?
12 A. YES.
13 Q. IT SAYS A-L-Z UNIT -- I PRESUME THAT STANDS FOR
14 ALZHEIMER'S UNIT?
15 A. AT THE NURSING HOME.
16 Q. AND THEN THERE'S POST-STROKE '89. DO YOU SEE THAT?
17 A. YES.
18 Q. AND IS THIS AN AREA WHERE MR. PERRY'S REPRESENTING HIS
19 UNDERSTANDING OF THE CIRCUMSTANCES SUCH THAT MR. CRANE IS
20 SEEKING ADMISSION TO THE UNIT?
21 A. YES.
22 Q. FOR EXAMPLE, HE WRITES: FLUID RESTRICTION DIET,
23 DRINKING OUT OF TOILET, SPITTING, MANIPULATION, PATIENT
24 SEEKING FLUIDS CONTINUALLY, HITTING, VERBALLY ABUSIVE, RUNS
25 INTO OTHER -- LOOKS LIKE WITH WHEELCHAIR -- SCREAMING.
247
1 PATIENT SEEKING FLUIDS CONTINUALLY. STUCK FINGERS DOWN
2 THROAT, AND THEN THERE'S AN ARROW, THROW-UP. AND I REALLY
3 CAN'T READ THE REST OF THAT.
4 WOULD THOSE BE THE KINDS OF BEHAVIORS THAT -- THAT YOU
5 WOULD ASSOCIATE WITH AN APPROPRIATE ADMISSION TO THE
6 GEROPSYCH UNIT?
7 A. YES.
8 Q. NOW, YOU'RE AWARE, ARE YOU NOT, MR. CHAMBERS, OF AN
9 EXISTENCE OF A CONTRACT BETWEEN HORIZON AND THE HOSPITAL?
10 A. YES, I AM.
11 Q. AND IT'S TRUE, IS IT NOT, THAT WHEN HORIZON STARTED TO
12 PROVIDE SERVICES TO THE HOSPITAL, THEY HAD A WRITTEN
13 DOCUMENT, A WRITTEN CONTRACT WHICH DELINEATED, I GUESS, THE
14 RESPONSIBILITIES OF HORIZON AND THE RESPONSIBILITIES OF THE
15 HOSPITAL; ISN'T THAT TRUE?
16 A. YES.
17 MR. STIRBA: MAY I APPROACH, YOUR HONOR?
18 THE COURT: YES.
19 Q. (BY MR. STIRBA) I'M GOING TO SHOW YOU WHAT HAS BEEN
20 MARKED AS D-1 AND ASK IF YOU CAN IDENTIFY THAT DOCUMENT.
21 A. THIS LOOKS LIKE THE CONTRACT BETWEEN HORIZON --
22 MR. MAJOR: YOUR HONOR --
23 THE WITNESS: PARDON ME?
24 MR. MAJOR: -- WE HAVE NOT SEEN THAT DOCUMENT. DO
25 WE HAVE A COPY OF THAT?
248
1 MR. STIRBA: I BELIEVE IT WAS PRODUCED BY THE
2 COUNTY ATTORNEY'S OFFICE, AND I WAS GOING TO SHOW IT TO THEM
3 IF I OFFERED IT, YOUR HONOR.
4 THE COURT: OKAY.
5 MR. MAJOR: THANK YOU.
6 A. I BELIEVE THIS IS THE CONTRACT BETWEEN DAVIS HOSPITAL
7 AND HORIZON MENTAL HEALTH MANAGEMENT. IT SAYS JULY 1994 ON
8 THE FRONT, AND I -- THAT'S -- THE SIGNATURES AREN'T DATED,
9 BUT I'D JUST HAVE TO CHECK MY RESUME OR MY TIME FRAMES. IT
10 SEEMS EARLY.
11 Q. (BY MR. STIRBA) DO YOU BELIEVE THAT IS THE CONTRACT
12 THEN BETWEEN THE HOSPITAL AND HORIZON WHEREBY HORIZON
13 PROVIDED CERTAIN SERVICES AND THE HOSPITAL PROVIDED CERTAIN
14 SUPPORT FOR THOSE SERVICES?
15 A. YES.
16 MR. MAJOR: YOUR HONOR, I --
17 MR. STIRBA: WE'D OFFER D-1, YOUR HONOR.
18 MR. MAJOR: WE HAVE NO OBJECTION, YOUR HONOR.
19 THE COURT: OKAY. EXHIBIT D-1 IS RECEIVED.
20 MR. STIRBA: I'LL HAND THAT BACK TO YOU, SIR.
21 THE WITNESS: THANK YOU.
22 MR. MAJOR: COULD WE HAVE A COPY OF THAT, YOUR
23 HONOR?
24 (WHEREUPON, MR. STIRBA TENDERS DOCUMENT TO MR. MAJOR.)
25 Q. (BY MR. STIRBA) NOW, THAT CONTRACT -- IF YOU LOOK AT
249
1 THE FRONT PAGE IT STATES -- SAYS GENERAL HOSPITALS OF GALEN,
2 INC, D/B/A DAVIS HOSPITAL AND MEDICAL CENTER, LAYTON, UTAH.
3 AND THEN IT HAS COLUMBIA H.C.A. HEALTH CARE CORPORATION.
4 AND THEN UNDERNEATH THAT HORIZON MENTAL HEALTH SERVICES, SAN
5 FRANCISCO, CALIFORNIA, JULY 1994.
6 DID I READ THAT CORRECTLY?
7 A. YES.
8 Q. AND YOU WERE EMPLOYED BY HORIZON MENTAL HEALTH SERVICES?
9 A. I WAS EMPLOYED BY HORIZON MENTAL HEALTH MANAGEMENT WHICH
10 I BELIEVE IS A SUBSIDIARY OF HORIZON MENTAL HEALTH SERVICES.
11 Q. IF YOU WOULD TURN TO PAGE 4, PLEASE. AND THERE IT HAS A
12 SECTION CALLED COVENANTS OF HORIZON. DO YOU SEE THAT?
13 A. YES.
14 Q. AND IF YOU GO DOWN TO SUBSECTION (C), IT HAS MEDICAL
15 DIRECTOR(S), DIRECTORS. DO YOU SEE THAT?
16 A. YES.
17 Q. AND IT -- IT SAYS PART-TIME, TRUE?
18 A. TRUE.
19 Q. I MEAN, DO YOU UNDERSTAND AS YOU SIT HERE THAT BOTH
20 DR. JENSEN AND DR. WEITZEL HAD A CONTRACT THAT DELINEATED
21 THEIR OBLIGATIONS AND RESPONSIBILITIES WITH HORIZON?
22 A. YES, I DID.
23 Q. YOU UNDERSTAND THAT TO BE THE CASE?
24 A. YES.
25 Q. ALL RIGHT. THEN IF YOU'D TURN TO PAGE 6, PLEASE.
250
1 A. UH-HUH.
2 Q. SUBSECTION (C). DO YOU SEE THAT?
3 A. YES.
4 Q. IT STATES: HORIZON SHALL CONSULT WITH HOSPITAL IN THE
5 SELECTION OF ITS PROGRAM DIRECTOR, MEDICAL DIRECTOR, AND ALL
6 MEMBERS OF ITS PROGRAM STAFF FOR THE PROGRAM.
7 HORIZON SHALL NOT OFFER EMPLOYMENT OR CONTINUE TO
8 EMPLOYEE ON -- ON THE JOB SITE ANY INDIVIDUAL, NOR SHALL
9 HORIZON HIRE ANY INDEPENDENT CONTRACTOR, OR CONTINUE TO
10 ENGAGE ANY INDEPENDENT CONTRACTOR TO -- TO WHOM THE HOSPITAL
11 REASONABLY OBJECTS.
12 DID I READ THAT CORRECTLY?
13 A. YES.
14 Q. AND THEN IT SAYS AT THE BOTTOM OF THAT PARAGRAPH,
15 NOTWITHSTANDING ANYTHING TO THE CONTRARY, IT IS AGREED THAT
16 ANY PROGRAM EMPLOYEE OR CONTRACTOR SHALL BE IMMEDIATELY
17 REMOVED FROM THE PROGRAM IF HOSPITAL DETERMINES THAT THE
18 INDIVIDUAL CONSTITUTES A THREAT TO PATIENT SAFETY OR
19 WELFARE.
20 DID I READ THAT CORRECTLY?
21 A. YES.
22 Q. AND THEN IF YOU'LL FLIP TO PAGE 7, WHICH IS THE NEXT
23 PAGE, IT TALKS ABOUT THE FEES THAT HORIZON IS TO RECEIVE,
24 CORRECT?
25 A. YES.
251
1 Q. AND IT'S TRUE, IS IT NOT, THAT THERE IS A -- A FORMULA
2 THAT IS CONTAINED IN THAT SUBSECTION?
3 A. YES.
4 Q. AND IT'S TRUE, IS IT NOT, THAT THAT FORMULA IS IN PART
5 BASED UPON THE NUMBER OF PATIENTS THAT THE UNIT HAS AT ANY
6 ONE TIME OVER A PERIOD OF TIME?
7 A. YES. I THINK -- I BELIEVE -- MY UNDERSTANDING IS THE
8 RATE WENT UP OR DOWN DEPENDING ON THE AVERAGE DAILY CENSUS.
9 Q. THANK YOU. THAT'S ALL I'M GOING TO ASK YOU ABOUT THIS
10 EXHIBIT.
11 NOW, MR. CHAMBERS --
12 MR. STIRBA: MAY I APPROACH, YOUR HONOR?
13 THE COURT: YES.
14 Q. (BY MR. STIRBA) I'M GOING TO SHOW YOU WHAT HAS BEEN
15 MARKED AS D-23, ASK YOU IF YOU'VE SEEN THAT BEFORE?
16 A. YES, I HAVE.
17 Q. AND JUST GENERALLY TELL US, PLEASE --
18 MR. MAJOR: YOUR HONOR, WE'D LIKE TO AT LEAST HAVE
19 AN OPPORTUNITY TO EXAMINE THAT DOCUMENT BEFORE IT'S
20 INTRODUCED. WE MAY HAVE AN OBJECTION IF IT'S WHAT I'M
21 THINKING IT IS.
22 THE COURT: OKAY. WELL, I THINK IT NEEDS TO BE
23 IDENTIFIED AND THEN --
24 MR. STIRBA: WELL, I'LL -- I'LL GIVE COUNSEL A
25 COPY.
252
1 THE COURT: OKAY.
2 (WHEREUPON, MR. STIRBA TENDERS DOCUMENT TO MR. MAJOR.)
3 Q. (BY MR. STIRBA) AND COULD YOU GENERALLY, PLEASE,
4 IDENTIFY --
5 MR. MAJOR: YOUR HONOR, I THINK WE HAVE AN
6 OBJECTION TO THIS DOCUMENT, IF WE MIGHT HAVE JUST ONE
7 MINUTE.
8 THE COURT: WELL, IT HASN'T BEEN OFFERED YET, SO
9 LET'S SEE IF HE CAN IDENTIFY THE DOCUMENT FIRST.
10 MR. MAJOR: WELL, THAT'S PART OF THE PROBLEM WE
11 HAVE. IF WE MIGHT APPROACH THE BENCH, YOUR HONOR?
12 THE COURT: YES.
13 (WHEREUPON, THERE'S AN OFF-THE-RECORD DISCUSSION AT THE
14 BENCH.)
9 MR. STIRBA?
10 MR. STIRBA: THANK YOU, YOUR HONOR.
11 Q. (BY MR. STIRBA) MR. -- MR. CHAMBERS, YOU PREVIOUSLY
12 WERE TESTIFYING ABOUT THE POLICIES AND YOU -- YOU TESTIFIED
13 THAT -- THAT IN MANY INSTANCES THERE ARE GUIDELINES THAT ARE
14 NOT HARD AND FAST GIVEN THE DIFFICULTIES OF PREDICTING
15 CERTAIN MEDICAL EVENTS; IS THAT RIGHT?
16 A. YES.
17 Q. AND ONE OF THOSE POLICIES THAT YOU READ AND TERMED AN
18 EXCLUSIONARY CRITERIA EARLIER SAID THAT PATIENTS WHO HAD A
19 TERMINAL DISEASE WITHOUT A TREATABLE PSYCHIATRIC ILLNESS,
20 AND THEN IT WENT ON TO SAY, ESSENTIALLY, WILL BE REFERRED
21 FOR HOSPICE CARE. AND I BELIEVE YOU EMPHASIZED THE
22 "WITHOUT" EARLIER ON DIRECT; IS THAT RIGHT?
23 A. YES.
24 Q. AND IT'S TRUE, IS IT NOT, THE REASON WHY YOU EMPHASIZED
25 THAT IS BECAUSE THERE WERE CIRCUMSTANCES WHERE IF A PATIENT
268
1 HAD A TERMINAL DISEASE AND YET TREATMENT COULD STILL BE
2 PROVIDED THAT MIGHT BE EFFECTIVE OR HELPFUL, IT WAS
3 APPROPRIATE TO TREAT THEM ON THE UNIT; ISN'T THAT TRUE?
4 A. YES.
5 MR. STIRBA: THAT'S ALL I HAVE, YOUR HONOR. THANK
6 YOU.
7 THE COURT: ANY REDIRECT?
8 MR. MAJOR: YES, YOUR HONOR.
9 REDIRECT EXAMINATION
10 BY MR. MAJOR:
11 Q. MR. CHAMBERS, IT WAS INDICATED IF YOU HAD A PATIENT THAT
12 HAD A TERMINAL ILLNESS, THAT DIDN'T NECESSARILY DISQUALIFY
13 THEM FROM BEING ON THE UNIT.
14 A. THAT'S CORRECT.
15 Q. HOWEVER, IF YOU DID HAVE A PATIENT WITH A TERMINAL
16 ILLNESS, WOULD THAT BE REFLECTED IN YOUR NOTES?
17 A. IT -- IT -- IT CERTAINLY WOULD BE REFLECTED IN THE
18 HISTORY AND PHYSICAL. IT PROBABLY SHOULD BE REFLECTED IN MY
19 NOTES.
20 Q. IF IT WAS A SIGNIFICANT -- SIGNIFICANT EVENT?
21 A. I WOULD HOPE SO.
22 Q. WOULD THAT BE SOMETHING THAT MIGHT BE PASSED ON TO THE
23 DOCTOR?
24 A. ABSOLUTELY.
25 Q. THANK YOU. NOW, AS INDICATED ALSO ON CROSS-EXAMINATION,
269
1 THIS WAS A TEAM EFFORT. DID YOU CONSIDER YOURSELF TO BE
2 PART OF THE TEAM?
3 A. YES.
4 Q. WHAT DO YOU DEFINE -- HOW DO YOU DEFINE A TEAM?
5 THE COURT: IN THIS CONTEXT?
6 Q. (BY MR. MAJOR) IN THIS CONTEXT, OR HIS UNDERSTANDING.
7 WHEN THEY SAY YOU'RE PART OF TEAM, WHAT'S YOUR UNDERSTANDING
8 OF WHAT THAT MEANT?
9 A. WE WERE ALL WORKING TOGETHER FOR A COMMON GOAL, TO -- TO
10 TREAT AND SERVE THESE PATIENTS.
11 Q. OKAY. AS YOUR POSITION AS DIRECTOR, DID YOU ALSO HAVE
12 AN OPPORTUNITY TO RECEIVE COMPLAINTS FROM TEAM MEMBERS?
13 A. YES.
14 Q. DID YOU HAVE AN OPPORTUNITY TO RECEIVE COMPLAINTS FROM
15 NURSES?
16 MR. STIRBA: YOUR HONOR, I'M GOING TO OBJECT.
17 IRRELEVANT.
18 MR. MAJOR: MAY WE APPROACH, YOUR HONOR?
19 (WHEREUPON, THERE'S AN OFF-THE-RECORD DISCUSSION AT THE
20 BENCH.)
21 MR. OWENS: YOUR HONOR, WE -- WE CAN HEAR SOME OF
22 THIS CONVERSATION. I THOUGHT YOU'D LIKE TO KNOW.
23 THE COURT: OKAY. I'M GOING TO SUSTAIN THE
24 OBJECTION.
25 MR. MAJOR: THANK YOU. WE HAVE NO FURTHER
270
1 QUESTIONS THEN, YOUR HONOR.
2 MR. STIRBA: JUST BRIEFLY, YOUR HONOR.
3 THE COURT: OKAY.
4 RECROSS-EXAMINATION
5 BY MR. STIRBA:
6 Q. IT'S TRUE, IS IT NOT, THAT WHEN YOU WOULD MAKE AN
7 ASSESSMENT, YOU TRIED TO MAKE AN ASSESSMENT BASED ON THE
8 MEDICAL CONDITIONS AND CIRCUMSTANCES OF WHICH YOU WERE AWARE
9 AT THE TIME, TRUE?
10 A. TRUE.
11 Q. AND THEN THERE WERE SOME TIMES WHEN THINGS COULD CHANGE
12 UPON ADMISSION; ISN'T THAT CORRECT?
13 A. TRUE.
14 Q. THANK YOU.
15 MR. STIRBA: NOTHING FURTHER.
16 MR. MAJOR: NOTHING FURTHER OF THIS WITNESS, YOUR
17 HONOR.