Tracy Scholl
19 MS. BARLOW: NEXT WITNESS IS TRACY SCHOLL.
20 THE COURT: MS. TRACY SCHOLL. MS. SCHOLL, IF YOU'LL
21 STEP UP HERE PLEASE. IF YOU'LL COME RIGHT UP HERE. RAISE
22 YOUR RIGHT HAND AND FACE THE CLERK PLEASE.
23 TRACY SCHOLL,
24 BEING FIRST DULY SWORN, WAS EXAMINED
25 AND TESTIFIED AS FOLLOWS:
1 THE COURT: IF YOU'LL HAVE A SEAT UP HERE PLEASE. AND,
2 MS. SCHOLL, IF YOU'LL STATE YOUR FULL NAME AND SPELL YOUR
3 LAST NAME FOR US.
4 THE WITNESS: TRACY SCHOLL. TRACY, T-R-A-C-Y,
5 S-C-H-O-L-L.
6 THE COURT: THANK YOU.
7 DIRECT EXAMINATION
8 BY MS. BARLOW:
9 Q. THANK YOU, MRS. SCHOLL. SOMETHING ABOUT SITTING IN THAT
10 CHAIR, YOU FORGET YOUR OWN NAME, DON'T YOU?
11 A. YES.
12 Q. WHAT CITY DO YOU LIVE IN, MRS. SCHOLL?
13 A. CLINTON.
14 Q. CLINTON?
15 A. UH-HUH.
16 Q. OKAY. YOU'LL HAVE TO SPEAK UP. THESE MICROPHONES
17 ARE --
18 A. AND YOU, TOO.
19 Q. OKAY. I'LL -- I WILL DO THAT. AND WHAT IS YOUR
20 OCCUPATION?
21 A. I'M A REGISTERED NURSE.
22 Q. HOW LONG HAVE YOU BEEN A REGISTERED NURSE?
23 A. THIRTEEN YEARS.
24 Q. WHAT TRAINING AND EDUCATION DID YOU RECEIVE TO BECOME A
25 NURSE?
1 A. I HAVE AN ASSOCIATE'S DEGREE FROM WEBER STATE FOR
2 NURSING.
3 Q. OKAY. AND THEN HAVE YOU HAD ON-THE-JOB TRAINING SINCE
4 THEN?
5 A. PART OF THE NURSING PROGRAM IS GOING -- YOU DO A
6 MENTORSHIP WITH A NURSE AND SO YOU DO SPEND TIME IN THE
7 HOSPITAL. A LOT OF CLINICALS. AND THEN I DID A YEAR AS AN
8 L.P.N. ALSO BEFORE I BECAME AN R.N.
9 Q. AND WHAT'S AN L.P.N.?
10 A. A LICENSED PRACTICAL NURSE.
11 Q. IS THERE A DIFFERENCE BETWEEN WHAT AN L.P.N. AND A
12 REGISTERED NURSE CAN DO AS FAR AS PATIENT HANDLING,
13 TREATMENT, CARE?
14 A. WELL, THAT VARIES BY THE HOSPITAL THAT YOU WORK AT, BUT
15 ONE OF THE BIGGEST DUTIES DIFFERENCE IS IN ASSESSING THE
16 PATIENTS, THE RESPONSIBILITY FOR THE FLOOR, THAT ULTIMATELY
17 FALLS ON THE R.N.
18 Q. WHAT WAS YOUR -- WHEN DID YOU RECEIVE YOUR ASSOCIATE'S
19 DEGREE?
20 A. IN '89.
21 Q. WHEN DID YOU RECEIVE YOUR L.P.N.
22 A. '88.
23 Q. AND WHAT ABOUT YOUR R.N.?
24 A. WELL, THAT WOULD HAVE BEEN '89 ALSO.
25 Q. IN '89 WHEN YOU RECEIVED YOUR ASSOCIATE'S. THANK YOU.
1 WHAT HAS BEEN YOUR PROFESSIONAL EXPERIENCE AS A NURSE SINCE,
2 LET'S SAY, YOU GOT YOUR R.N. IN 1989?
3 A. KIND OF A GENERAL OVERVIEW OF MY EXPERIENCE --
4 Q. WHEN DID YOU START WORKING --
5 A. I STARTED AT DAVIS WHEN IT WAS HUMANA, AND I WORKED ON
6 THE MEDICAL FLOOR. AND I LEFT THERE '91, '92 AND I WENT TO
7 WORK FOR AN INSURANCE COMPANY. IT WAS ACTUALLY WHAT THEY
8 CALL THIRD PARTY ADMINISTRATOR, KIND OF DEALT WITH INSURANCE
9 DOWN IN SALT LAKE WHERE I WAS A CASE MANAGER. AND THEN FROM
10 THERE I WENT TO BENCHMARK WHICH AT THAT TIME HAD AN ADULT
11 PSYCHIATRIC UNIT. AND THEN FROM THERE, I WENT TO DAVIS ON
12 THE GEROPSYCH UNIT.
13 Q. SO HOW MANY YEARS OF PSYCHIATRIC NURSING EXPERIENCE DID
14 YOU HAVE BEFORE YOU WENT TO DAVIS NORTH?
15 A. OH, ALMOST FOUR.
16 Q. WAS THAT ADULT PSYCHIATRIC OR CHILDREN?
17 A. ADULT.
18 Q. HAD YOU DEALT WITH DEMENTED PATIENTS OR ELDERLY
19 GERIATRIC PSYCHIATRIC PATIENTS AT BENCHMARK?
20 A. WE DID HAVE A FEW, NOT A LOT, BUT FROM TIME TO TIME WE
21 HAD SOMEONE THAT WOULD BE OLDER.
22 Q. WHEN DID YOU START WORKING AT DAVIS NORTH?
23 A. FIRST TIME?
24 Q. YES -- WELL, NO --
25 A. THE SECOND --
1 Q. -- SAY THE GEROPSYCH UNIT.
2 A. IT WAS JUST AFTER THANKSGIVING IN '95.
3 Q. WAS IT STILL IN NOVEMBER?
4 A. YEAH.
5 Q. SO IT WAS WHAT, JUST A FEW WEEKS BEFORE SOME OF THESE
6 PATIENTS BEGAN TO PASS AWAY?
7 A. RIGHT. JUDITY WAS ADMITTED A SHORT WHILE AFTER I
8 STARTED.
9 Q. JUDITH LARSEN?
10 A. UH-HUH.
11 Q. WHAT SHIFT DID YOU WORK?
12 A. NIGHT SHIFT.
13 Q. AND WHEN WAS THAT?
14 A. WELL, WE CAME ON FOR REPORT AT ELEVEN AND GOT OFF ABOUT
15 7:30 IN THE MORNING.
16 Q. HOW MANY NIGHTS A WEEK WOULD YOU WORK?
17 A. HOW MANY WHAT?
18 Q. NIGHTS A WEEK.
19 A. FIVE NIGHTS. I WORKED FULL TIME.
20 Q. WERE THERE ANY OTHER NURSES ON NIGHTS WITH YOU?
21 A. NO. ON OUR FLOOR THERE WAS JUST THE NURSE AND THE
22 NURSE'S AIDE.
23 Q. SO YOU WERE BASICALLY RESPONSIBLE TO TELL THE NURSE'S
24 AIDE WHAT TO DO, MAKE SURE THINGS HAPPENED AS THEY WERE
25 SUPPOSED TO HAPPEN ON THE SHIFT --
1 A. RIGHT.
2 Q. -- THAT YOU WERE THERE? OKAY. DO YOU KNOW -- I'LL JUST
3 MENTION SOME NAMES OF SOME NURSES AND ASK YOU IF YOU ARE
4 FAMILIAR WITH THESE NURSES. ONE IS LAURIE WILLSON?
5 A. UH-HUH, YES, I REMEMBER HER.
6 Q. DO YOU KNOW WHAT SHIFT SHE WORKED?
7 A. I BELIEVE SHE WORKED MOSTLY EVENINGS AND SOME NIGHTS. I
8 THINK MAYBE EVEN SHE DID SOME WEEKENDS, KIND OF A -- JUST
9 PICKED UP A LOT OF WEEKEND SHIFTS.
10 Q. WHAT ABOUT SHEILA HANSEN, DO YOU REMEMBER SHEILA?
11 A. SHE WAS DAYS.
12 Q. SHE WAS DAYS?
13 A. UH-HUH.
14 Q. AND DAYS WERE WHAT, SEVEN TO THREE?
15 A. BASICALLY, YEAH.
16 Q. EARLENE COZZINS?
17 A. DAYS.
18 Q. BONNIE HARDY.
19 A. EVENINGS.
20 Q. EVENINGS BEING WHAT TIME?
21 A. WELL, THREE TO ELEVEN, 11:30.
22 Q. DORENE KLEI?
23 A. EVENINGS.
24 Q. LYNN LONG?
25 A. SHE'S OF LIKE LAURIE IN THAT I THINK SHE WORKS SOME
1 NIGHTS, SOME EVENINGS, AND MAYBE LIKE DAYS ON THE WEEKENDS.
2 Q. WHAT ABOUT RICHARD CLARK, DID YOU KNOW RICHARD CLARK?
3 A. I KIND OF REMEMBER HIM. I -- HE WAS ON THE FLOOR QUITE
4 A BIT. I DON'T KNOW THAT HE WAS ACTUALLY ASSIGNED TO OUR
5 FLOOR, IF HE WAS SCHEDULED OFF OF THERE OR HE WAS A FLOAT. I
6 THINK ORIGINALLY HE WAS A FLOAT AND THEN HE MAYBE BECAME A --
7 ON OUR STAFF.
8 Q. A FLOAT MEANING SOMEONE WHO WOULD GO WHERE NEEDED?
9 A. RIGHT, UH-HUH.
10 Q. OKAY. THANK YOU. AS A NURSE, ARE YOU REQUIRED TO DO
11 ASSESSMENT OF PATIENTS?
12 A. YES, UH-HUH.
13 Q. DO YOU DO ANY DIAGNOSING OF PATIENTS?
14 A. NOT MEDICAL DIAGNOSIS, NO.
15 Q. WHAT KIND OF DIAGNOSIS DO YOU DO?
16 A. WELL, NURSES HAVE WHAT THEY CALL NURSING DIAGNOSES,
17 WHERE IT'S KIND OF WHAT THEY USE IN MAKING HEALTH CARE PLANS.
18 Q. WHAT KIND OF ASSESSING DO YOU DO AS A NURSE OF A
19 PATIENT?
20 A. WELL, ESPECIALLY IN A PSYCH UNIT LIKE THAT, WE WOULD DO
21 PHYSICAL AND, YOU KNOW, EMOTIONAL, WHAT WE SAW, THE PATIENTS,
22 THEIR BEHAVIOR.
23 Q. AND WOULD YOU CHART THOSE?
24 A. IN A CHART THERE IS A PAGE, I DON'T KNOW WHAT IT'S
25 CALLED, BUT WHERE IT HAD COLUMNS FOR THE NURSING ASSESSMENT
1 AND IT HAD A LOT OF BOXES THAT YOU COULD CHECK AND THAT WAS
2 DONE BY THE DAY AND EVENING SHIFT.
3 Q. AND WAS THERE AN OCCASION TO WRITE A NARRATIVE CHART AT
4 ALL?
5 A. RIGHT, THERE WAS A COLUMN ALONG THE SIDE AND THAT'S
6 WHERE THE NARRATIVE WAS WRITTEN.
7 Q. WHAT WAS YOUR RESPONSIBILITY AS FAR AS ORDERS FOR THE
8 ADMINISTRATION OF MEDICATION?
9 A. WELL, IF A DOCTOR ORDERED MEDICATION, YOU KNOW, WE WOULD
10 TAKE THE ORDER OFF AND THEN PHARMACY WOULD BRING UP THE
11 MEDICATION IF IT WAS SOMETHING WE DIDN'T HAVE ON THE FLOOR,
12 AND THEN ACCORDING TO THE SCHEDULE THAT THE MEDICATION WAS
13 ORDERED FOR, THEN WE WOULD GIVE THAT TO THE PATIENT.
14 Q. WERE YOU ALWAYS THE ONE THAT GAVE THE SHOTS AT NIGHT?
15 A. AT NIGHT, YES, UH-HUH.
16 Q. DID YOU HAVE ANY RESPONSIBILITY AS A NURSE TO NOT GIVE
17 EITHER -- A MEDICATION THAT WAS ORDERED?
18 A. DID THAT HAPPEN?
19 Q. DO YOU HAVE A --
20 A. OH --
21 Q. -- RESPONSIBILITY AS A NURSE?
22 A. -- YES, UH-HUH.
23 Q. AND WHAT IS THAT RESPONSIBILITY?
24 A. WELL, TO KEEP THE PATIENT SAFE, TO TAKE CARE OF THE
25 PATIENT.
1 Q. WHAT IF YOU SAW A PATIENT THAT YOU DIDN'T THINK THE
2 DOSAGE OR -- WELL, NOT JUST THE DOSAGE, BUT THAT MEDICATION
3 AT THAT TIME WAS APPROPRIATE FOR, WHAT WOULD BE YOUR
4 RESPONSIBILITY?
5 A. TO NOT GIVE IT.
6 Q. AND THEN WHAT WOULD DO YOU AS FAR AS THE DOCTOR'S ORDER?
7 A. WELL --
8 Q. WOULD YOU SPEAK WITH ANYONE ABOUT NOT GIVING IT?
9 A. I'M NOT SURE I UNDERSTAND WHAT YOU MEAN, BUT WHAT I'LL
10 SAY IS THAT IF -- IF YOU CHOSE NOT TO GIVE IT, THEN IDEALLY
11 YOU WOULD NOTIFY THE DOCTOR AND LET HIM KNOW THAT YOU DID NOT
12 GIVE IT.
13 Q. AND DID YOU EXPLAIN WHY YOU DIDN'T GIVE IT TO THE
14 DOCTOR?
15 A. WELL, YES, UH-HUH.
16 Q. AND IF YOU AND THE DOCTOR HAD A DIFFERENCE OF OPINION
17 ABOUT WHETHER THAT PATIENT SHOULD BE RECEIVING THAT
18 MEDICATION AT THAT TIME, WOULD YOU EXPRESS THAT TO THE
19 DOCTOR?
20 A. WELL, YOU KNOW, YES AND NO. IT WOULD DEPEND ON THE
21 SITUATION. YOU KNOW, I MEAN IT WOULD BE -- WHETHER YOU'D
22 HAVE THE OPPORTUNITY, WHAT KIND OF REACTION YOU MIGHT GET
23 FROM THE DOCTOR. YOU COULD GO TO SOMEONE ELSE AND DISCUSS
24 YOUR CONCERNS.
25 Q. WHO ELSE COULD YOU GO TO IF YOU HAD A CONCERNS ABOUT
1 WHETHER YOU SHOULD GIVE A MEDICATION OR NOT?
2 A. WELL, YOU KNOW, I GUESS I WOULD START THINKING OF
3 PROBABLY THE HEAD NURSE ON THE FLOOR. SHE WOULD BE YOUR
4 IMMEDIATE SUPERVISOR. AND THEN THERE WOULD BE THE DIRECTOR
5 OF NURSING WHO WOULD BE OVER ALL THE FLOORS, ALL THE NURSES.
6 Q. I'D LIKE TO CALL YOUR ATTENTION TO THE WINTER OF 1995,
7 1996, SPECIFICALLY AFTER YOU JOINED THE GEROPSYCH UNIT. AND
8 SO WE'RE TALKING ABOUT DECEMBER OF '95 AND JANUARY OF '96.
9 YOU WERE WORKING FULL TIME, YOU SAY, DURING THAT TIME?
10 A. UH-HUH, YES.
11 Q. WHO WAS THE DOCTOR IN CHARGE OF THE UNIT?
12 A. DR. WEITZEL.
13 Q. AND HE'S THE MAN SITTING BACK HERE?
14 A. UH-HUH.
15 Q. TO THE LET OF MY SHOULDER?
16 A. YES.
17 Q. DO YOU RECALL SEEING DR. WEITZEL COME IN TO VISIT THE
18 PATIENT DURING THE TIME THAT YOU WERE ON DUTY?
19 A. YES.
20 Q. DO YOU RECALL DURING THE WINTER -- WELL, LET'S SAY
21 DECEMBER OF '95, JANUARY '96, WHAT TIME OF DAY HE WOULD
22 USUALLY COME IN TO SEE THE PATIENTS?
23 MR. BUGDEN: YOUR HONOR, I WONDER IF WE COULD SOME
24 CLARIFICATION AND ASK THAT TESTIMONY BE ISOLATED TO THE
25 PERIOD OF TIME THAT WE'RE TALKING ABOUT IN THIS CASE --
1 THE COURT: SUSTAINED.
2 MR. BUGDEN: -- DECEMBER AND EARLY JANUARY.
3 THE COURT: I'LL SUSTAIN THE OBJECTION.
4 Q. (BY MS. BARLOW) I THOUGHT I HAD SAID THAT, BUT I WILL
5 SAY IT AGAIN. DECEMBER '95 TO JANUARY '96, DURING JUST THOSE
6 TWO MONTHS, DO YOU RECALL WHEN DR. WEITZEL WOULD COME IN TO
7 SEE THE PATIENTS?
8 A. WELL, NOW, IF HE -- IF I WERE TO SEE HIM, IT WOULD
9 EITHER BE VERY LATE OR VERY EARLY BECAUSE THAT'S WHEN I WAS
10 THERE.
11 Q. SO IT WOULD HAVE TO BE EITHER AFTER ELEVEN OR BEFORE
12 7:30 --
13 A. RIGHT, UH-HUH.
14 Q. -- THERE. OKAY. DO YOU RECALL SEEING DR. WEITZEL
15 MAKE -- WRITE ANY PROGRESS NOTES ON ANY OF THE PATIENTS THAT
16 YOU WERE DEALING WITH DURING DECEMBER '95 AND JANUARY OF '96?
17 A. DO I -- WATCHING HIM WRITE PROGRESS NOTES, IS THAT --
18 Q. YES.
19 A. -- WHAT YOU SAID?
20 Q. YES.
21 A. YES, UH-HUH.
22 Q. DID YOU HAVE OCCASION TO SEE HOW -- WELL, WHEN YOU WERE
23 THERE, AND HE WAS THERE CHECKING ON THE PATIENTS, WHAT IF
24 ANYTHING WOULD HE DO TO ACTUALLY EVALUATE THE PATIENT?
25 A. WELL, WHEN HE WOULD COME IN -- NOW, LIKE I SAID, IF I
1 WAS WORKING IT WAS EITHER EARLY OR LATE, AND IT WAS NOT
2 UNCOMMON FOR ME TO SEE HIM EARLY IN THE MORNING AND THE
3 PATIENTS WOULD STILL BE IN BED AND PROBABLY STILL SLEEPING
4 AND HE WOULD COME DOWN THE HALL AND MAYBE GLANCE INTO THE
5 ROOMS ON HIS WAY DOWN THE HALL. AND THEN AT THE DESK, HE
6 WOULD ASK ME HOW THEY WERE DOING AND I WOULD LET HIM KNOW,
7 YOU KNOW, HOW THEIR NIGHT HAD GONE. AND THEN, YOU KNOW, HE
8 WOULD WRITE HIS NOTE AFTER THAT.
9 Q. THEN WHAT WOULD HE DO AFTER HE WROTE THE NOTE?
10 A. TELL ME THAT -- FREQUENTLY THAT HE WAS GOING TO BE OFF
11 SKIING AND HAVE A GOOD DAY.
12 Q. DO YOU -- YOU DON'T HAVE ANY IDEA AFTER YOU LEFT WHETHER
13 HE CAME BACK --
14 A. NO.
15 Q. -- DURING THOSE DAYS. DID YOU HAVE ANY CONCERN ABOUT
16 THIS WAY OF DR. WEITZEL DOING THE NOTES, JUST BASICALLY
17 LOOKING IN, ASKING YOU, AND THEN WRITING A NOTE, DID YOU HAVE
18 ANY CONCERNS ABOUT THAT?
19 MR. BUGDEN: YOUR HONOR, OBJECTION AS TO HER CONCERNS.
20 I DON'T THINK THEY'RE RELEVANT.
21 THE COURT: OVERRULED.
22 Q. (BY MS. BARLOW) DID YOU HAVE ANY CONCERNS?
23 A. YES, I ACTUALLY DISCUSSED IT WITH TODD CHAMBERS ONCE. I
24 JUST WAS UNCOMFORTABLE WITH FEELING THAT, YOU KNOW, THE --
25 WHAT THE DOCTOR WAS SEEING WAS ACTUALLY WHAT I WAS SEEING.
1 YOU KNOW, LIMITED TO THAT.
2 Q. NOW, WHEN YOU WERE ON IN THE NIGHTS, PATIENTS WERE NOT
3 GOING TO GROUPS OR ANYTHING OF THAT SORT --
4 A. NO, UH-UH.
5 Q. -- WERE THEY?
6 Q. AND WHO IS TODD CHAMBERS?
7 A. HE WAS THE HEAD OF THE UNIT WITH HORIZONS.
8 Q. WERE THERE ANY CHANGES IN THIS BEHAVIOR AFTER YOU
9 REPORTED IT TO MR. CHAMBERS?
10 A. I DON'T RECALL ANY.
11 Q. LET US TURN TO ONE OF THE PATIENTS. WELL, FIRST,
12 ANOTHER GENERAL QUESTION. IN CHARTING, DID THE DEFENDANT
13 EVER GIVE YOU ANY DIRECTIONS ABOUT WHAT TO PUT INTO CHARTS?
14 A. SAY THAT AGAIN.
15 Q. DID THE DEFENDANT EVER GIVE YOU ANY DIRECTION ABOUT WHAT
16 TO PUT INTO CHARTS?
17 A. NO.
18 Q. OKAY.
19 A. NO.
20 Q. DID HE EVER TALK TO YOU ABOUT LOOKING FOR OR EVALUATING
21 PAIN, ANYTHING OF THAT SORT?
22 A. NO. THERE WERE TIMES I HAD REPORTED THAT I THOUGHT A
23 PATIENT APPEARED TO BE IN PAIN, BUT IT DIDN'T GO BEYOND THAT.
24 Q. LET'S TURN IT ON AGAIN. OKAY. DO YOU RECALL ELLEN
25 ANDERSON AS A PATIENT?
1 A. YES, I DO.
2 Q. AND WHAT IS IT THAT YOU RECALL OF MRS. ANDERSON?
3 A. WELL, ONE, THAT SHE WAS WITH US FOR SUCH A SHORT WHILE,
4 AND TWO, THAT SHE -- SHE, WELL, WAS -- APPEARED TO ME AT THE
5 TIME TO BE IN A LOT OF PAIN.
6 Q. WERE YOU ON THE UNIT WHEN MRS. ANDERSON CAME ON?
7 A. NO, I WASN'T.
8 Q. DO YOU RECALL WHO WAS THE NURSE THAT DID THE NURSING
9 ASSESSMENT AND BROUGHT MRS. ANDERSON INTO THE UNIT?
10 A. LAURIE WILLSON.
11 Q. DID YOU TALK -- WHEN YOU CAME ON, DID YOU TALK WITH
12 MS. WILLSON ABOUT ELLEN ANDERSON?
13 A. YES, WE HAVE REPORT WHEN WE COME ON SHIFT, AND
14 ESPECIALLY WHEN WE HAVE A NEW PATIENT, YOU KNOW, WE KIND OF
15 SPEND MORE TIME ON THAT PATIENT, FILLING THE OTHER ONE, THE
16 ONCOMING NURSE, YOU KNOW, WITH KIND OF THE CONDITION OF THE
17 PATIENT, WHAT'S GONE ON SO FAR, THAT KIND OF THING.
18 Q. WHAT IF ANYTHING DID MS. WILLSON TELL YOU ABOUT ELLEN
19 ANDERSON'S PAIN?
20 A. WELL, SHE SAID THAT SHE WAS IN SEVERE PAIN AND THAT SHE
21 HAD OSTEOPOROSIS REALLY BAD. AND THAT SHE HAD BEEN MAKING A
22 LOT OF NOISE AND IT SEEMED LIKE THRASHING ABOUT. AND SHE HAD
23 GOTTEN AN ORDER FOR MORPHINE AND -- A ONE-TIME ORDER AND HAD
24 GIVEN HER THAT.
25 Q. DID SHE SAY ANYTHING TO YOU ABOUT WHAT MRS. ANDERSON'S
1 DAUGHTERS HAD TOLD HER MRS. ANDERSON'S PROBLEMS WERE?
2 A. I DON'T RECALL THAT SPECIFICALLY, NO.
3 Q. DID SHE SAY ANYTHING ABOUT MRS. ANDERSON'S ANXIETY AND
4 FEAR OF BEING LEFT ALONE?
5 A. NO. SHE -- REALLY, IT WAS BASICALLY WE TALKED ABOUT --
6 OH, LOSING MY TRAIN OF THOUGHT HERE -- THE PAIN, THE
7 OSTEOPOROSIS AND, YOU KNOW, SHE'D HAD QUITE A HISTORY OF
8 THAT, AND I BELIEVE BACK FRACTURES, MAYBE WITH HER HIP
9 INVOLVED OR SOMETHING AND -- AND, YOU KNOW, IT SOUNDED QUITE
10 EXTENSIVE WHAT SHE HAD TOLD ME.
11 Q. WHEN YOU FIRST SAW MRS. ANDERSON, WHERE WAS SHE?
12 A. WELL, WHEN I CAME OUT OF REPORT, WE GO AROUND AND CHECK
13 ON ALL THE PATIENTS, AND MRS. ANDERSON'S BED WAS IN WHAT WE
14 CALL THE SECLUSION ROOM. AND THAT SHE HAD PUT HER BED IN
15 THERE BECAUSE SHE HAD BEEN MAKING A LOT OF NOISE AND WAS, YOU
16 KNOW, CAUSING A LOT OF RACKET IN THE ROOM THAT SHE WAS IN
17 WHICH SHE WAS SHARING WITH ANOTHER PATIENT. SO TO MAKE IT
18 QUIETER FOR THE OTHER PATIENT, SHE HAD MOVED HER BED IN THE
19 SECLUSION ROOM.
20 Q. WHAT WERE THE CONDITIONS IN THE SECLUSION ROOM THAT DAY
21 OR NIGHT?
22 A. WELL, IT'S -- IT'S A BARE ROOM. AND THEN YOU JUST MOVE
23 THE BED IN THERE. AND IT WAS REALLY VERY, VERY COLD IN
24 THERE, AND I FELT MRS. ANDERSON AND SHE FELT REALLY COLD, AND
25 SO I WENT TO GET WARM BLANKETS, COVERED HER UP, YOU KNOW,
1 TUCKING WARM BLANKETS AROUND HER IN AN ATTEMPT TO WARM HER,
2 AND THEN MOVED HER BED BACK INTO HER ROOM.
3 Q. WAS SHE AT THAT POINT THRASHING OR MAKING NOISES?
4 A. NO. SHE WAS SLEEPING VERY QUIETLY.
5 Q. AND THAT WAS APPROXIMATELY ELEVEN O'CLOCK WHEN YOU CAME
6 ON?
7 A. WELL, NO. PROBABLY THAT WAS MORE LIKE MIDNIGHT.
8 Q. OKAY. DID YOU HAVE OCCASION TO WRITE A NOTE ABOUT
9 MRS. ANDERSON'S CONDITION AT ABOUT ONE O'CLOCK THAT MORNING,
10 THAT NEXT MORNING?
11 A. YEAH. AS I RECALL, SHE -- HER RESPIRATIONS WERE
12 ERRATIC, YOU KNOW, THEY WEREN'T EVEN, LIKE WE THINK OF A
13 PERSON NORMALLY HAVING. AND SO I TOOK HER VITAL SIGNS AND
14 COUNTED HER RESPIRATIONS MORE THAN ONCE BECAUSE OF THE
15 ERRATIC-NESS, AND THEY RANGED FROM LIKE EIGHT A MINUTE TO 16
16 A MINUTE. AND HER BLOOD PRESSURE WAS QUITE LOW, 70 OVER 50
17 MAYBE. AND HER PULSE WAS REALLY HIGH, TOO, I'M THINKING. IT
18 WAS OVER A HUNDRED.
19 Q. WE HAVE YOUR NOTE HERE. IT SAYS O100, PATIENT'S
20 RESPIRATIONS HAVE BEEN -- AND THINK IT'S --
21 THE COURT: EXHIBIT, COUNSEL?
22 MS. BARLOW: OH, EXCUSE ME. THIS IS EXHIBIT 2-H. AND
23 IT'S MED PAGE NUMBER 191.
24 Q. (BY MS. BARLOW) IT SAYS RESPIRATIONS BEEN VERY ERRATIC.
25 E.T. WHAT DOES THAT --
1 A. AND.
2 Q. AND RANGING FROM EIGHT TO TEN -- OR 16 PER MINUTE. IS
3 THERE ANYTHING THAT CAUSED YOU CONCERN ABOUT THIS RESPIRATION
4 THAT YOU WERE SEEING?
5 A. WELL, ERRATIC RESPIRATIONS IS PROBABLY NOT A GOOD SIGN.
6 YOU KNOW, IT COULD BE -- THERE'S WHAT THEY CALL CHEYNE-STOKES
7 BREATHING WHICH SOMETIMES IS A BREATHING PATTERN BEFORE
8 PEOPLE DIE. I DIDN'T NECESS -- IT WAS -- I DON'T KNOW, I
9 JUST REMEMBER THAT IT WAS -- IT CONCERNED ME, HER BREATHING.
10 Q. AND THEN THE BLOOD PRESSURE WAS 70 OVER 50. PULSE, 120.
11 ANYTHING UNUSUAL ABOUT EITHER OF THOSE?
12 A. WELL, THE BLOOD PRESSURE WAS LOW AND THE PULSE WAS HIGH,
13 WHICH A LOT OF TIMES AS THE BLOOD PRESSURE GOES DOWN, THE
14 PULSE WILL INCREASE. IT KIND OF HELPS TO COMPENSATE, SO --
15 Q. DID YOU HAVE AT ANY TIME ANY IDEA WHAT WAS CAUSING THIS
16 PROBLEM?
17 A. AT THAT TIME, I REALLY HADN'T THOUGHT BEYOND JUST
18 CONCERN, AND SO THEN I PAGED DR. WEITZEL, AND THE NURSING
19 SUPERVISOR, I LET HER KNOW THAT I WAS CONCERNED.
20 Q. WHY DID YOU PAGE DR. WEITZEL?
21 A. TO LET HIM KNOW HOW THE PATIENT WAS DOING.
22 Q. DID DR. WEITZEL CALL YOU BACK AROUND -- RIGHT AFTER YOUR
23 PAGE?
24 A. NO, NOT AT THAT TIME. IT WAS LATER THAT I HAD THE --
25 SHE WOKE UP AND WAS THRASHING, THROWING HERSELF IN THE BED,
1 RATHER VIOLENT LOOKING AND SCREAMING, MOANING. AND SO I WAS
2 CONCERNED AGAIN AND SO I PAGED HIM AGAIN TO LET HIM KNOW.
3 Q. AND THAT WAS AT 3:15 IN THE MORNING?
4 A. I CAN'T REALLY SEE IT FROM THIS ANGLE.
5 Q. OKAY.
6 THE COURT: YOU CAN MOVE YOUR CHAIR OVER IF YOU NEED TO.
7 THE WITNESS: OH.
8 Q. (BY MS. BARLOW) CAN YOU SEE IT BETTER NOW?
9 A. 3:15, UH-HUH.
10 Q. NOW, AT THAT TIME, DID YOU CONSIDER THAT MRS. ANDERSON
11 MIGHT BE IN PAIN?
12 A. WELL, YES, I DID. LAURIE HAD MENTIONED, YOU KNOW, THAT
13 SHE HAD BEEN IN SO MUCH PAIN, AND SO I WAS KIND OF PROGRAM
14 THINKING ALONG THE LINES OF PAIN AND I WAS -- SHE WAS MOANING
15 AND SCREAMING, AND SO I -- WHEN DR. WEITZEL DID CALL AT 3:30,
16 YOU KNOW, I LET HIM KNOW ABOUT HOW HER VITAL SIGNS HAD BEEN
17 EARLIER YEAR IN THE SHIFT, THE RESPIRATIONS AND THE PULSE AND
18 BLOOD PRESSURE. AND THEN LET HIM KNOW THAT SHE APPEARED TO
19 BE IN PAIN. AND HE DID GIVE ME AN ORDER FOR MORPHINE.
20 Q. SO YOU DID TELL HIM ABOUT WHAT YOU'D SEEN AT 0100.
21 A. YES.
22 Q. YOU DIDN'T JUST IGNORE THAT PART AND GO TO THE --
23 A. NO, THAT WAS STILL A CONCERN, BUT THEN I WAS ALSO
24 CONCERNED ABOUT, YOU KNOW, HER BEHAVIOR AT THIS TIME, TOO.
25 Q. LOOKS LIKE 0330 DR. WEITZEL RETURNED THE PAGE. INFORMED
1 OF PATIENT'S CONDITION. I'M ASSUMING YOU INFORMED HIM OF
2 PATIENT -- OF THE PATIENT'S CONDITION.
3 A. YES, UH-HUH.
4 Q. AND HE ORDERED MORPHINE 10-MILLIGRAM I.M.,
5 INTRAMUSCULARLY, IS THAT CORRECT?
6 A. RIGHT, UH-HUH.
7 Q. THEN AT 0630, YOUR WRITING, PATIENT HAS APPEARED TO
8 SLEEP SINCE RECEIVING M.S., WHICH IS THE MORPHINE.
9 RESPIRATIONS REMAIN ERRATIC. DO YOU RECALL -- DO YOU RECALL
10 THAT CONDITION?
11 A. DID YOU KNOW, I MORE STRONGLY REMEMBER THE FIRST -- WHEN
12 I FIRST NOTICED IT. THEY WERE -- REMAINED ERRATIC, BUT I --
13 YOU KNOW, I'M JUST GUESSING THAT THEY MAY NOT HAVE BEEN QUITE
14 AS SEVERE BE -- OTHERWISE, I MIGHT HAVE INDICATED, YOU KNOW,
15 WORSENING OR REMAINS -- OF COURSE IF THEY -- I DON'T KNOW.
16 Q. OKAY.
17 A. OKAY.
18 Q. DID THAT CAUSE YOU CONCERN AT THAT TIME?
19 A. YES, I WAS STILL CONCERNED ABOUT HER.
20 Q. AND THEN AN E.K.G. AND A CHEST X-RAY WERE DONE. DO YOU
21 RECALL WHY THOSE WERE DONE?
22 A. THOSE WERE ADMISSION ORDERS THAT WERE WRITTEN WHEN SHE
23 CAME IN.
24 Q. SO WHEN SHE CAME IN, AN ORDER AS WRITTEN FOR THESE
25 THINGS, BUT IT WASN'T DONE UNTIL THE NEXT MORNING AT 5:30?
1 A. RIGHT, RIGHT, YEAH.
2 Q. AND THEN YOU'VE GOT S.R. UP TIMES TWO. WHAT DOES THAT
3 MEAN?
4 A. SIDE RAILS ON THE BED ON BOTH SIDES WERE UP.
5 Q. OKAY. BED CHECK MONITOR IN PLACE?
6 A. RIGHT.
7 Q. WHAT DOES THAT MEAN?
8 A. A BED CHECK MONITOR IS A PAD THAT LAYS ON T HE BED AND
9 IT HAS WIRES THAT GO TO A LITTLE UNIT WHERE YOU SET A LENGTH
10 OF TIME, AND THE PATIENT'S WEIGHT, AS LONG AS IT'S ON THAT
11 PAD ON THE BED, THE ALARM DOESN'T GO OFF. BUT IF THEY LIFT
12 THEIR BODY OFF OF IT FOR HOWEVER MANY SECONDS THAT IS SET
13 FOR, THEN THE ALARM WILL GO OFF, AND IT JUST LETS US KNOW
14 THAT A PATIENT IS EITHER REALLY MOVING AROUND IN BED A LOT OR
15 ATTEMPTING TO GET OUT OF BED.
16 Q. THIS WAS JUST BEFORE YOU WENT OFF SHIFT, IS THAT
17 CORRECT?
18 A. RIGHT, UH-HUH.
19 Q. WERE YOU PRESENT WHEN MRS. ANDERSON PASSED AWAY AT 8:55
20 THAT MORNING?
21 A. NO, I WASN'T.
22 Q. DID YOU BECOME AWARE THAT SHE HAD PASSED AWAY?
23 A. YEAH, NEXT TIME I CAME ON, UH-HUH.
24 Q. LET ME MAKE SURE I'VE COVERED. DO YOU RECALL WHETHER
25 YOU WERE CARING FOR ANOTHER PATIENT GOING THROUGH A CRISIS
1 DURING THIS SAME NIGHT PERIOD?
2 A. YES, JUDITH LARSEN HAD BEEN HAVING TROUBLE WITH VOMITING
3 FROM THE TIME I CAME ON AND THROUGH THE NIGHT.
4 THE COURT: THIS MIGHT BE A GOOD TIME TO STOP THIS
5 EVENING. ARE YOU GOING TO START MS. LARSEN?
6 MS. BARLOW: NO, I -- I WAS GONNA ASK THAT QUESTION,
7 THEN I WAS GONNA ASK IF WE COULD STOP BECAUSE I THINK NEXT
8 WE'LL BE STARTING WITH MS. LARSEN.
9 THE COURT: OKAY. GO AHEAD. GO AHEAD WITH THAT.
10 MS. BARLOW: AND IN FACT, I'M DONE, YOUR HONOR, AS FAR
11 AS THAT. THE NEXT SUBJECT --
12 THE COURT: WELL, MAYBE ASK THAT QUESTION, I'M --
13 MS. BARLOW: IT WAS JUST THAT QUESTION, WHETHER SHE WAS
14 DEALING WITH SOMEONE ELSE, AND SHE'S ANSWERED THAT AND WITH
15 THAT, I THINK WE'RE THROUGH FOR THE EVENING IF --
16 THE COURT: ALL RIGHT.
17 MS. BARLOW: -- THAT'S OKAY WITH THE COURT.
18 THE COURT: YOU MAY STEP DOWN IF YOU'D LIKE TO PLEASE.
19 WE'LL ASK YOU TO COME BACK TOMORROW AND REPORT BACK AT 8:30
20 IN THE MORNING.
21 THE WITNESS: OKAY.
22 THE COURT: LADIES AND GENTLEMEN, WE'LL EXCUSE YOU AT
23 THIS. AND WE'D LIKE YOU BACK AT 8:30 IN THE MORNING ALSO.
24 AGAIN REMIND YOU OF MY PRIOR ADMONITION. WE'LL SEE YOU BACK
25 THEN. AND THANKS FOR YOUR ATTENTION TODAY.
1 (THE JURY LEAVES THE COURTROOM.)
2 THE COURT: RECORD SHOULD NOTE THAT THE JURY IS OUT OF
3 THE COURTROOM. MR. WILSON, WHAT WITNESSES CAN WE EXPECT
4 TOMORROW?
5 MR. WILSON: YOUR HONOR, I DON'T HAVE MY LIST IN --
6 THE COURT: OTHER THAN --
7 MR. BUGDEN: I HAVE A LIST IF IT WOULD HELP YOU.
8 MS. BARLOW: TRACY SCHOLL WILL FINISH UP, THEN IT'LL BE
9 EARLENE COZZINS-COOPER, AND THEN BONNIE HARDEY. THEN I THINK
10 THERE'S MARCEL BIBEAULT AND DR. MAUREEN FRIKKE.
11 THE COURT: THINK WE CAN FINISH THOSE TOMORROW?
12 MS. BARLOW: I THINK WE CAN, YOUR HONOR.
13 THE COURT: ALL RIGHT.
14 MS. BARLOW: IF MR. BUGDEN WILL JUST KEEP IT CALM.
15 THE COURT: HE'S DOING WELL.
16 MS. BARLOW: I KNOW. HE'S BEEN VERY QUIET TODAY.
17 MR. BUGDEN: WELL, THAT MEANS I'M RESTED.
18 MS. BARLOW: OH, NO.
19 MR. BUGDEN: READY TO GO.
20 THE COURT: WE'LL SEE YOU ALL IN THE MORNING THEN AT
21 8:30. AND THANK YOU ALL.
11 – 14 – 2002 a. m.
THE COURT: GOODS MORNING, LADIES AND GENTLEMEN.
INVITE YOU ALL BACK THIS MORNING. GLAD TO SEE YOU'RE HERE.
WE'LL CONTINUE THE TESTIMONY OF MS. SCHOLL IN THIS MATTER.
WOULD YOU STEP BACK UP, PLEASE? THE RECORD SHOULD NOTE THE
PARTIES AND COUNSEL ARE PRESENT. MS. SCHOLL, WE'LL ASK YOU
TO RAISE YOUR HAND AND BE RESWORN FOR TODAY'S TESTIMONY,
PLEASE.
TRACY SCHOLL,
HAVING BEEN DULY SWORN, WAS EXAMINED AND
TESTIFIED AS FOLLOWS:
THE COURT: THANK YOU. IF YOU'LL STEP UP HERE,
PLEASE. YOU WERE JUST BEGINNING THE EXAMINATION IN REGARDS
TO JUDITH LARSEN.
MS. BARLOW: YES, YOUR HONOR. I DID HAVE ONE
QUESTION I NEGLECTED TO ASK, A COUPLE OF QUESTIONS ON ELLEN
ANDERSON THAT I WAS GOING TO FOLLOW UP WITH TODAY.
THE COURT: YOU MAY DO THAT.
DIRECT EXAMINATION
BY MS. BARLOW:
Q. NOW, TRACY, YOU CAME ON AT 11 O'CLOCK ON THE 29TH OF
DECEMBER WHEN ELLEN ANDERSON -- AFTER ELLEN ANDERSON HAD BEEN
ADMITTED TO THE HOSPITAL; IS THAT CORRECT?
A. THAT'S TRUE.
Q. AND LAURIE WILSON WAS THE NURSE THAT BASICALLY HANDED THE
PATIENTS OVER TO YOU?
A. YES, UH-HUH.
Q. DID YOU ASK LAURIE IF THE DEFENDANT HAD BEEN IN TO SEE
ELLEN ANDERSON?
A. AS PART OF REPORT SHE JUST SAID THAT DR. WEITZEL HAD NOT
BEEN IN AND THAT HE WOULD BE IN THE MORNING.
Q. DID YOU SEE HIM AT ALL DURING YOUR SHIFT COME IN AND SEE
ELLEN ANDERSON?
A. NO.
Q. THANK YOU.
I'D LIKE TO NEXT TURN TO JUDITH LARSEN.
MS. BARLOW: YOUR HONOR, IF I MAY GIVE HER THE
EXHIBIT WHICH IS 3-B IT'S THE MEDICAL RECORDS OF JUDITH
LARSEN, PERHAPS SHE CAN READ ALONG A LITTLE BETTER THAN WHAT
WE'D SEE UP ON THE SCREEN.
THE COURT: THAT'S FINE.
Q. (BY MS. BARLOW) DO YOU RECALL JUDITH LARSEN AS A PATIENT
AT THE GEROPSYCH UNIT?
A. YES, I DO.
Q. AND WHAT IS THERE THAT YOU RECALL ABOUT JUDITH LARSEN?
A. WELL, SHE WAS THERE QUITE AWHILE. THAT IS NOT
NECESSARILY TYPICAL IN THAT TYPE OF A UNIT AND SHE HAD A
COUPLE OF MEDICAL THINGS THAT OCCURRED WHILE SHE WAS THERE ON
MY SHIFT.
Q. NOW SHE WAS ADMITTED ON THE 6TH OF DECEMBER AND YOU SAID
YESTERDAY THAT THAT WAS SHORTLY AFTER YOU STARTED ON THE
UNIT?
A. RIGHT, UH-HUH.
Q. IF YOU WOULD -- THIS IS EXHIBIT 3-B. AND THEN I WOULD
ALSO LIKE TO PUT UP EXHIBIT 3-H WHICH IS THE MEDICATION CHART
FOR JUDITH LARSEN AS WE'RE TALKING ALONG HERE.
I WILL BE SHOWING -- I WILL BE SHOW SOME MEDICAL RECORDS
UP HERE. YOU HAVE THE EXACT MEDICAL RECORDS IN FRONT OF YOU
AND MAYBE IF IT'S EASIER TO READ IT ON THE SCREEN, FINE. IF
FOR THE NOT, I'LL TELL YOU WHICH PAGE WE'RE GOING TO GO TO.
IN FACT, WE'LL START WITH PAGE 531.
THE COURT: OF 3-B?
MS. BARLOW: OF 3-B. AND THIS IS IN THE NURSING
NOTES PORTION OF THE MEDICAL RECORDS.
Q. (BY MS. BARLOW) NOW, DOWN AT THE BOTTOM OF THAT PAGE --
GET IT FOCUSED A LITTLE BIT HERE MAYBE -- ARE THE INITIALS
TSW. WELL, MAYBE IT'S NOT TSW. WHAT IS THAT?
A. ACTUALLY, THAT WAS MY SIGNATURE AT THE TIME.
Q. OH, I SEE. T. SCHOLL, IS THAT THE WAY YOU --
A. YEAH, UH-HUH.
Q. SO WHAT DOES YOUR INITIAL OR YOUR NAME DOWN THERE
SIGNATURE DOWN AT THE BOTTOM INDICATE?
A. THAT I HAD WORKED THAT SHIFT.
Q. AND AT THE TOP WE CAN SEE THAT THIS SAYS THE A.M. SHIFT.
BUT OVER HERE WE HAVE -- APPEARS TO BE YOUR HANDWRITING THE
MORNING; IS THAT CORRECT?
A. RIGHT AT THE TOP, YES, UH-HUH.
Q. THIS WAS ON THE 9TH OF DECEMBER AND WHAT DID YOU WRITE ON
THE 9TH OF DECEMBER?
A. PRN ATIVAN GIVEN FOR AGITATION AT 0300, EFFECTIVE FOR
APPROXIMATELY ONE AND A HALF HOURS.
Q. SO WHAT HAD YOU SEEN WITH MRS. LARSEN AT 3 O'CLOCK IN THE
MORNING ON THE 9TH?
A. THAT SHE HAD BEEN AGITATED. YOU KNOW, I DON'T RECALL
SPECIFICALLY WHAT I WAS SEEING.
Q. THE PRN ATIVAN MEANS WHAT?
A. PRN MEANS AS NEEDED.
Q. SO YOU HAD A STANDING ORDER?
A. IT'S A STANDING ORDER BUT IT'S NOT A ROUTINE ORDER. IT'S
ONE THAT IS ORDERED SO THAT AS WE SEE SYMPTOMS IN A PATIENT
AT OUR DISCRETION WE CAN GIVE THAT.
Q. AND YOU INDICATED IT WAS EFFECTIVE FOR AT LEAST A PERIOD
OF TIME?
A. RIGHT, UH-HUH.
Q. NOW, THERE WAS A PERIOD OF TIME WITH ELLEN ANDERSON, IF
YOU WOULD TURN TO --
MS. BARLOW: IT'S THE SAME EXHIBIT, YOUR HONOR, MED
PAGES 502 AND 503.
MR. BUGDEN: DID YOU MEAN ELLEN ANDERSON?
MS. BARLOW: EXCUSE ME. I MET JUDITH LARSEN. THANK
YOU.
Q. (BY MS. BARLOW) SHOW YOU AND THE JURY THESE PAGES?
A. NOW WHICH PAGES DO YOU HAVE?
Q. 502. THERE ARE DATES AT THE TOP, IT LOOKS LIKE 12/10,
12/11, 12/12. THESE TWO DRUGS ARE SERZONE AND RISPERDAL, DO
YOU AS A NURSE KNOW WHAT THOSE DRUGS ARE FOR?
A. RISPERDAL IS AN ANTIPSYCHOTIC. AND IF I RECALL, SERZONE
IS AN ANTIDEPRESSANT.
Q. AND DO THEY HAVE SEDATIVE SIDE EFFECTS?
A. THEY COULD, YES, UH-HUH.
Q. NOW, IT APPEARS THAT THESE WERE ROUTINE ORDERS; IS THAT
CORRECT?
A. RIGHT.
Q. THEY WERE TO BE GIVEN AT EIGHT IN THE MORNING, EIGHT AT
NIGHT FOR THE SERZONE; EIGHT IN THE MORNING; 5 P.M. AND 8
P.M. FOR THE RISPERDAL. NOW, ON THE 11TH WERE ANY OF THESE
DRUGS HELD?
A. YES. THE 8 O'CLOCK DOSE OF RISPERDAL WAS HELD. AND I
HAVE NOTE THERE HAD CODES FIVE AND SIX, WHICH IF YOU LOOK UP
AT THE TOP IT SAYS THAT SHE WAS ASLEEP AND OTHER, SO IT WAS
PROBABLY ADDRESSED IN THE NURSING NOTES.
Q. SO ON THE 11TH THE EIGHT P.M. OF SERZONE AND THE 8 P.M.
OF RISPERDAL WERE HELD YOU INDICATED BECAUSE SHE WAS ASLEEP?
A. ONE REASON SHE'S ASLEEP. THE OTHER -- THE SIX I'M NOT
SURE WHAT THAT INDICATES.
Q. AND THEN I NOTICE THAT ON 12/12, THESE ARE NOT YOUR
INITIALS. BUT THERE ARE SOME OTHER INITIALS THAT WERE
CIRCLED AND WHAT DID THAT MEAN ON THE 12TH?
A. THAT ON BOTH OF THOSE DAYS THAT SHE DIDN'T RECEIVE EITHER
EVENING DOSE OF THE RISPERDAL OR THE SERZONE.
Q. THEN IF YOU'LL TURN TO PAGE 503. AGAIN, SOME ROUTINE
ORDERS FOR MEDICATIONS. RISPERDAL IS WRITTEN AT THE TOP BUT
IT LOOKS LIKE THE ORDERS WERE DISCONTINUED ON 12/11 FOR THOSE
AMOUNTS OF RISPERDAL. THEN WE HAVE TRAZODONE ON THE 11TH AND
ON THE 12TH. DO YOU KNOW WHAT TRAZADONE IS?
A. IT'S AN ANTIDEPRESSANT. FREQUENTLY IT'S GIVEN IN THE
EVENING BECAUSE ONE OF THE EFFECTS IS THAT IT CASES
DROWSINESS.
Q. DO YOU KNOW WHY THE TRAZODONE WAS HELD AT 8 P.M. ON BOTH
THE 11TH AND 12TH?
A. ONCE AGAIN, IT'S REASONS FIVE AND SIX WHICH THE FIVE
WOULD INDICATE THAT SHE WAS ASLEEP.
Q. AND THEN BELOW THAT WE HAVE KLONOPIN THAT WAS TO BE GIVEN
AT EIGHT IN THE MORNING AND EIGHT IN THE EVENING, DOES IT
HAVE ANY SIDE EFFECTS?
A. YES. IT IS AN ANTIANXIETY MEDICATION AND IT COULD CAUSE
DROWSINESS.
Q. AND IT APPEARS THAT THE 8 P.M. WAS HELD ON BOTH THE 11TH
AND 12TH, DO YOU KNOW WHY?
A. I'M NOT SURE WHAT THAT SAYS, IT SAYS GIVE AND THEN IT'S
SOMETHING TIMES ONE. I DON'T KNOW WHAT IT SAYS.
Q. OKAY. WELL, I'M LOOKING AT THE KLONOPIN UNDER 12/11.
A. OH, IT SAYS TIMES ONE WEEK. OKAY. SO IT WAS JUST
ORDERED FOR A WEEK.
Q. IT SAYS OVER HERE THROUGH 12/12. BUT YOU HAVE INITIALED
THE 8 P.M. OF KLONOPIN ON THE -- ARE YOU LOOKING ON PAGE 503?
A. YEAH. AND THE -- ON THE 13TH.
Q. I'M LOOKING AT THE 11TH.
A. OH, I'M SORRY. ON THE KLONOPIN UP ON THE 11TH IT WAS
HELD, YES, THE 8 O'CLOCK DOSE WAS.
Q. FOR WHAT REASON?
A. ASLEEP AND WHATEVER THE SIX WOULD INDICATE.
Q. SIX MEANS OTHER SO YOU'D HAVE TO LOOK BACK IN THE NURSING
NOTES TO DECIDE THAT?
A. RIGHT, UH-HUH.
Q. AND AGAIN, ON THE 12TH IT WAS HELD?
A. RIGHT, UH-HUH.
Q. IF YOU WOULD TURN TO 469. THAT PAGE HAS THE
CORRESPONDING PROGRESS NOTES WRITTEN BY THE PHYSICIAN FOR THE
DATES THAT WE'VE JUST BEEN TALKING ABOUT. DO YOU SEE THAT
PAGE?
A. UH-HUH.
Q. CAN YOU READ WHAT WAS WRITTEN FOR THE 11TH OF DECEMBER?
A. IT SAYS PATIENT IS TAKING FLUIDS VERY POORLY, O2 SAT WAS
77.
Q. NOW, WOULD AN O2 SAT, OXYGEN SATURATION OF 77 CAUSE YOU
ANY CONCERN?
A. YEAH. ANYTHING BELOW 90 WOULD BE CAUSE FOR CONCERN.
Q. AND WHY IS THAT?
A. THAT'S -- I DON'T -- IT WOULDN'T BE ENOUGH OXYGEN IN THE
BLOOD TO BE OXYGENATING AS ADEQUATELY.
Q. AND THEN UNDERNEATH THAT IT LOOKS LIKE --
A. I'M NOT SURE WHAT THAT SAYS. DOES IT SAY MASTER
TREATMENT PLAN, MTP I THINK. PRESCRIBES IV. NO INTELLIGIBLE
RESPONSES NOTED. SL SPOKE WITH HER SON MERLIN AND EXPLAINED
THE SITUATION. HE --
Q. I BELIEVE IT'S I SPOKE. I THINK THAT'S AN I RATHER THAN
AN SL BUT -- I THOUGHT IT WAS SL AT FIRST TOO.
A. OH, OKAY. EXPLAINED THE SITUATION. HE REITERATES A
DESIRE TO FOLLOW HER WISHES AND LET HER GO. A, STABLE. P
CONTINUE CURRENT MEDS.
Q. DO YOU KNOW A WHAT A MEANS?
A. ACTION. I DON'T KNOW.
Q. AND P?
A. P WAS PLAN.
Q. PLAN. SO THE PLAN WAS TO CONTINUE THE CURRENT
MEDICATIONS?
A. RIGHT.
Q. AND WE'RE NOW TALKING ON THE 11TH. AND THEN O.T., WHAT
DOES THAT MEAN?
A. OCCUPATIONAL THERAPY.
Q. WHAT DID THE OCCUPATIONAL THERAPIST WRITE?
A. AN ATTEMPT WAS MADE TO CONTINUE WITH EVAL. PATIENT WAS
UNABLE TO COMPLY SECONDARY TO MEDS PREVENTING AROUSAL. O.T.
WILL ATTEMPT TO COMMUNICATE WITH HER TOMORROW.
Q. AND THEN THE SIGNATURE OF THE THERAPIST. AND THEN WE
HAVE ON THE 12TH, WHAT DID DR. WEITZEL WRITE?
A. PUTTING OUT SOME URINE.
Q. DESPITE.
A. DESPITE POOR FLUID INTAKE. VITAL SIGNS STABLE.
AFEBRILE.
Q. WHAT DOES AFEBRILE MEAN?
A. NO FEVER.
Q. NO FEVER? THANK YOU.
A. VERY DEMENTED. RISPERDAL SEEMS TO BE CONTROLLING MOST OF
HER AGITATION. STABLE. CONTINUE CURRENT CARE.
Q. DOES THAT GIVE YOU ANY IDEA WHY -- OR RELATE TO THE FACT
THAT YOU HELD CERTAIN SEDATING MEDICATIONS FOR JUDITH LARSEN
ON THE 11TH AND 12TH, GIVEN WHAT'S BEEN WRITTEN HERE?
A. WELL, IT SEEMS LIKE IN SPITE OF THOSE BEING HELD THAT SHE
STILL WAS NOT AGITATED, WOULD BE WHAT I WOULD SEE.
Q. AND, IN FACT, THE OCCUPATIONAL THERAPIST SAID COULDN'T
EVEN AROUSE HER; IS THAT CORRECT?
A. RIGHT.
Q. DO YOU RECALL THIS PERIOD OF TIME AND HER CONDITION AT
THIS TIME?
A. NOT SPECIFICALLY.
Q. DID SHE HAVE TIMES WHEN SHE WAS UP AND TIMES WHEN SHE WAS
DOWN THE MONTH THAT SHE WAS ON THE UNIT?
A. ON MY SHIFT I THINK FOR THE MOST PART SHE REALLY WAS
CALM.
Q. BECAUSE YOU WERE THE NIGHT SHIFT?
A. YEAH, RIGHT, UH-HUH.
Q. THEN LET'S GO TO THE 13TH WHICH IS AFTER SOME OF THE
MEDICATIONS HAVE BEEN HELD. IF YOU WOULD TURN TO PAGE 470.
I BELIEVE THIS IS THE 13TH AND DR. WEITZEL HAS MADE A NOTE AT
THE TOP COULD YOU READ THAT FOR US?
A. ANSWERED ONE QUESTION INTELLIGIBLY TODAY, HOW ARE YOU. I
FEEL BAD, THEN REFUSED TO ANSWER. EATING AND TAKING FLUIDS
NOW. VITAL SIGNS STABLE. AFEBRILE. APPEARS TO BE IN SOME
PAIN. REMAINS FAIRLY PROFOUNDLY DEMENTED. MDD WITH
PSYCHOTIC FEATURES. CONTINUE KLONOPIN, TAPER AND SEIZURE --
NO. SERZONE, RISPERDAL.
Q. THEN I DON'T KNOW WHAT THAT WORD IS AND MAYBE IT'S
CROSSED OUT, BUT THEN AFTER THAT ONE WORD?
A. MORPHINE FOR PAIN.
Q. AND WHAT DID THE OCCUPATIONAL THERAPIST WRITE FOR THAT
DAY?
A. PATIENT WAS UNABLE TO BE ASSESSED TODAY SECONDARY TO
MEDICATION.
Q. THEN ON THE 14TH, DR. WEITZEL MAKES ANOTHER NOTE, CAN YOU
READ THAT FOR US?
A. HAS MADE A MIRACULOUS RECOVERY AND AMBULATED YESTERDAY,
TAKING FOOD WELL. VITAL SIGNS STABLE. AFEBRILE. DOING MUCH
BETTER, REMAINS DEMENTED. CONTINUE TREATMENT.
Q. T.X. IS TREATMENT?
A. T.X. IS TREATMENT, YES, UH-HUH.
Q. DO YOU -- WERE YOU ON THE UNIT WHEN DR. WEITZEL WROTE
THIS, MADE THIS NOTE?
A. WAS I WORKING THAT DAY?
Q. OR WERE YOU THERE? DO YOU REMEMBER HIM MAKING THAT NOTE?
A. NOT SPECIFICALLY, NO.
Q. DO YOU RECALL HER MAKING SUCH A RECOVERY FROM BEING
LETHARGIC, UP AGAIN?
A. IT DOES SEEM LIKE THERE WAS A PERIOD OF TIME WHEN SHE --
WE WERE ALL KIND OF SURPRISED THAT SHE WAS DOING SO MUCH
BETTER.
Q. NOW, THERE WAS THE NOTED M.S. OR MORPHINE FOR PAIN ON THE
13TH. DO YOU EVER RECALL GIVING JUDITH LARSEN MORPHINE FOR
PAIN FROM THE THE 13TH TO SAY ABOUT THE 19TH OF DECEMBER?
A. YOU KNOW, I DON'T BELIEVE -- I DON'T THINK I ACTUALLY
EVER GAVE MORPHINE TO JUDITH .
Q. NOW, YOU WERE ON NIGHTS AND YOU SAY SHE WAS PRETTY MUCH
CALM AND I THINK THAT THE NURSING NOTES BEAR THAT OUT FROM
ABOUT THE 16TH TO THE 26TH. IF YOU'D NOW TURN BACK TO THE
NURSING NOTES TO PAGE 567. WERE YOU ON DUTY THAT NIGHT?
A. YES, I WAS.
Q. AND IT'S THE 11 TO 7 SHIFT. DID YOU WRITE THIS NOTE TO
THE RIGHT OF THIS SHEET OF PAPER?
A. YES, UH-HUH.
Q. AND WOULD YOU READ THAT FOR US?
A. SEIZURE ACTIVITY. PATIENT CHECKED FREQUENTLY THROUGHOUT
THE NIGHT, RESTING QUIETLY WITH EYES OPEN. RESPIRATIONS EVEN
AND UNLABOURED. WOULD TRACK WITH EYES -- WOULD TRACK WITH
EYES WHEN SPOKEN TO. AT 0540 PATIENT BEGAN TO GRUNT AND
GRADUALLY PATIENT'S RIGHT SIDE BEGAN TO JERK. RIGHT LEG,
ARM, FACE, ET CETERA. VITAL SIGNS, HER BLOOD PRESSURE WAS
160 OVER 100, PULSE 92 AND HER TEMP WAS 99.1.
Q. LET'S STOP THERE FOR A MOMENT. DO YOU RECALL THIS
EXPERIENCE?
A. YES, I DO.
Q. IS IT SOMETHING YOU HAD SEEN OFTEN ON THE UNIT?
A. NO.
Q. THEN YOU TOOK HER VITAL SIGNS 160 OVER 100. HOW IS THAT
AS FAR AS BLOOD PRESSURE IS CONCERNED?
A. IT'S ON THE HIGH SIDE.
Q. PULSE 92, WHAT IS THAT AS FAR AS NORMAL PULSE?
A. WELL, IT'S PROBABLY ON THE HIGHER SIDE OF NORMAL.
Q. AND 99 FOR TEMPERATURE?
A. YOU KNOW, IT'S PROBABLY CONSIDERED NOT A FEVER. HIGHER
SIDE OF NORMAL.
Q. DID THIS EXPERIENCE OR THIS OBSERVATION CAUSE YOU
CONCERN?
A. YES. I FELT SHE WAS HAVING A SEIZURE.
Q. AND SO WHAT DID YOU DO WHEN YOU MADE THAT DETERMINATION?
A. WELL, SHOULD I READ?
Q. YEAH. GO AHEAD AND READ WHAT YOU DID NEXT.
A. OKAY. HOUSE SUPERVISOR NOTIFIED.
Q. NOW, WHO IS THE HOUSE SUPERVISOR?
A. THAT NIGHT I RECALL IT WAS KENNY -- KENNY WAS HIS FIRST
NAME. I DON'T REMEMBER HIS LAST NAME.
Q. WHAT IS HIS POSITION IN THE HOSPITAL?
A. HE'S THE NURSING SUPERVISOR.
Q. NURSING SUPERVISOR.
A. FOR THE ENTIRE HOSPITAL.
Q. FOR THE ENTIRE HOSPITAL. YOUR IMMEDIATE SUPERVISOR ON
THAT SHIFT?
A. RIGHT.
Q. OKAY. THANK YOU.
AND THEN WHAT DID YOU DO NEXT?
A. DR. DIENHART NOTIFIED AND I.V. D-5 STARTED AS ORDERED
ATIVAN 3 MILLIGRAMS I.V. GIVEN AND NO IMPROVEMENT NOTED.
Q. YOU CALLED DR. DIENHART. WHY DID YOU CALL HIM RATHER
THAN DR. WEITZEL?
A. YOU KNOW, IT WAS A MEDICAL THING GOING ON AND, YOU KNOW,
MY FIRST REACTION PROBABLY WAS I WOULD CALL THE DOCTOR WHO
WAS HANDLING THE MEDICAL ASPECTS OF THE PATIENT, THE ONE THAT
DID HER MEDICAL HISTORY AND PHYSICAL WHEN SHE WAS ADMITTED.
Q. SO DR. DIENHART GAVE YOU SPECIFIC ORDERS TO START AN
I.V.; IS THAT CORRECT?
A. RIGHT.
Q. WHAT'S D-5?
A. IT'S THE I.V. SOLUTION.
Q. IS IT A MEDICATION OF ANY KIND?
A. NO. IT WOULD BE THE DEXTROSE IN -- YOU KNOW, IT'S SUGAR
IN THE WATER.
Q. AND THEN ATIVAN 3 MILLIGRAMS GIVEN, IS THAT WHAT YOU WERE
ORDER BY DR. DIENHART?
A. RIGHT. AND ATIVAN HELPS CONTROL SEIZURE ACTIVITY ALSO.
Q. NOW THE THREE MILLIGRAM DIDN'T APPEAR TO HELP SO THEN
WHAT HAPPENED IF YOU'D READ THAT?
A. OH, I CALLED DR. DIENHART AGAIN AND ADDITIONAL ONE
MILLIGRAM ATIVAN GIVEN AND PATIENT DID CALM. ZERO JERKING.
HER RESPIRATIONS WERE FREE AND EASY AND HE HAD INSTRUCTED ME
TO CHANGE THE I.V. TO N.S. AND TO GIVE HER DILANTIN ONE GRAM
AND TO INFUSE IT OVER 40 MINUTES.
Q. LET'S KIND OF BACK UP A LITTLE BIT. SO YOU SAW AN
IMPROVEMENT IN HER HEALTH OR CONDITION I GUESS --
A. WELL, THE SEIZURE STOPPED.
Q. THE SEIZURE STOPPED. CHANGED THE I.V. TO N.S. WHAT DOES
THAT MEAN?
A. NORMAL SALINE.
Q. AND THEN YOU WERE TO START ADMINISTERING DILANTIN, WHAT
DOES DILANTIN DO?
A. IT'S AN ANTI-SEIZURE MEDICATION.
Q. SO THE DILANTIN WAS GOING -- IN WHAT ROUTE WAS IT BEING
ADMINISTERED?
A. THROUGH THE I.V.
Q. THEN I THINK YOU TOOK HER BLOOD PRESSURE AGAIN AND HER
RESPIRATIONS AND WHAT WERE THEY?
A. BLOOD PRESSURE WAS 104 OVER 60 AND HER RESPIRATIONS WERE
20.
Q. THE 104 OVER 60, HOW DOES THAT COMPARE WITH THE EARLIER
BLOOD PRESSURE?
A. IT HAD COME DOWN.
Q. IS IT IN A NORMAL RANGE?
A. IT IS THERE, UH-HUH.
Q. NOW, THE DILANTIN WAS WHAT ONE GRAM, YOU SAY, IS THAT --
OR AM I READING THAT WRONG?
A. LET ME FIND IT HERE.
Q. HOW MUCH DILANTIN?
A. ONE GRAM WAS TO INFUSE OVER 40 MINUTES.
Q. SO YOU DIDN'T WANT TO PUSH IT FAST?
A. WELL, NO. ACTUALLY, THAT WAS A DRIP.
Q. A DRIP?
A. SO IT WOULD DRIP INTO THE LINE.
Q. OKAY. THEN WHAT DID YOU WRITE?
A. DR. DIENHART WAS IN TO SEE THE PATIENT. SHE HAD OXYGEN
AT TWO LITERS PER NASAL CANULA.
Q. MEANING WHAT?
A. THE LITTLE TUBING THAT COMES AROUND AND GOES IN THE NOSE
THAT SHE WAS GETTING OXYGEN AT TWO LITERS.
Q. OKAY.
A. THEN SHE WAS TAKEN TO X-RAY ON A CART FOR C.A.T. SCAN AND
HER O2 SATS WERE 90 PERCENT ON TWO LITERS. AND THEN SHE HAD
AN E.K.G. DONE AND HER I.V. WAS CHANGED TO D-5 AND A HALF
N.S. WHICH IS ANOTHER I.V. SOLUTION AND THAT WAS RUNNING AT
70 C.C.S AN HOUR. AND SHE RETURNED FROM X-RAY AND THEN THE
I.V. WAS D.C.'D.
Q. D.C. MEANING WHAT?
A. PARDON ME?
Q. WHAT DOES D.C. MEAN? I.V. --
A. IT WAS STOPPED, TAKEN OUT.
Q. STOPPED.
A. YOU KNOW, THE WHOLE THING OUT OF THE HAND WAS REMOVED.
Q. THE NEEDLE AND EVERYTHING WAS TAKEN OUT?
A. YEAH. AND HER BLOOD PRESSURE HAD GONE DOWN CONSIDERABLY
TO 70 OVER 40 WHICH IS GETTING TO BE QUITE LOW.
Q. SO WAS THAT CAUSING YOU ANY CONCERN?
A. YES. BUT DR. DIENHART WAS THERE AT THAT TIME AND SO HE
WAS INVOLVED IN MONITORING THE PATIENT. AND SHE WAS HAVING
PERIODS OF APNEA SO, YOU KNOW, WHEN SHE WAS NOT BREATHING.
AND DR. WEITZEL WAS CALLED TO LET HIM KNOW HOW SHE WAS DOING.
Q. DID DR. WEITZEL SAY ANYTHING TO YOU ABOUT CALLING
DR. DIENHART IN ON THIS EMERGENCY?
A. I DON'T RECALL ANYTHING SPECIFIC.
Q. NOW, DR. DIENHART HAS PREVIOUSLY TESTIFIED. BUT IN ORDER
TO REFRESH YOUR RECOLLECTION, IF YOU'D TURN TO 462 IN THE
PHYSICIAN'S ORDERS.
A. OKAY.
Q. CAN YOU READ DR. DIENHART'S WRITING BETTER THAN I?
A. IT'S A CHALLENGE.
Q. IN THE MIDDLE OF THE LEFT-HAND COLUMN -- WELL, ACTUALLY
RIGHT BEFORE THAT BREAK AT THE TOP THIRD, IT SAYS, DILANTIN
ONE GRAM I.V. DOES THAT COMPORT WITH WHAT YOU WERE ORDERED
TO DO FOR JUDITH LARSEN?
A. YES, UH-HUH.
Q. WHAT -- WHAT WAS THE REST OF HIS ORDER THEN? IT WAS TO
BE GIVEN OVER 40 MINUTES IN N.S. LINE, AND THEN WHAT WAS THE
REST OF THE ORDER FOR DILANTIN?
A. DOWN FURTHER IT SAYS DILANTIN LEVEL AT 9 A.M. AND --
Q. LET'S GO BACK UP HERE. IT SAYS DILANTIN ONE GRAM?
A. OH, OKAY. IT SAYS THEN 100 MILLIGRAMS I.V. EVERY EIGHT
HOURS.
Q. WHAT DID THAT MEAN?
A. AFTER THAT INITIAL DOSE THEN SHE WAS TO RECEIVE ANOTHER
BAG TO DRIP -- TO BE HUNG EVERY EIGHT HOURS WITH 100
MILLIGRAMS IN IT.
Q. AND COULD YOU TELL WHAT TIME THIS ORDER WAS NOTED WAS
TAKEN OFF?
A. AT 8 O'CLOCK THAT MORNING.
Q. IF YOU'LL TURN TO THE NEXT PAGE WHICH IS 463. YOU'LL SEE
UP AT THE TOP A NOTATION OF 12/26/95, WOULD YOU READ THAT
NOTATION FOR US?
A. SORRY. SAY THAT AGAIN.
Q. AT THE TOP ON 12/26 -- ON PAGE 463 THE TELEPHONE ORDER AT
THE TOP HAND LEFT.
A. YOU WANT ME TO READ THE ORDER?
Q. YES.
A. I'M SORRY. I DIDN'T UNDERSTAND. IT WAS TO GIVE MORPHINE
TWO MILLIGRAMS I.M. NOW. STOP THE I.V. THERAPY AND OBSERVE
FOR SYMPTOMS OF PAIN.
Q. AND DID THIS -- WHOSE HANDWRITING IS THAT?
A. SHEILA HANSEN'S.
Q. SO IT WAS GIVEN IN A TELEPHONE ORDER?
A. YES, UH-HUH.
Q. AND WHAT TIME WAS THAT NOTED?
A. AT 8 O'CLOCK ALSO.
Q. SO WHEN THE I.V. WAS STOPPED, WHAT HAPPENED TO THE
DILANTIN?
A. WELL, IT SAYS TO STOP I.V. THERAPY. SO, YOU KNOW, IF
WE'VE TAKEN OUT THE ACCESS TO THE VEIN THEN I WOULD ASSUME
THAT THAT WOULD MEAN ANY I.V. MEDICATIONS WOULD ALSO BE
STOPPED BECAUSE THERE WOULD NOT BE A ROUTE TO GIVE IT.
Q. THEN AT THE BOTTOM OF THAT PAGE ON THE LEFT 12/29,
DR. WEITZEL, WHAT DID HE WRITE ABOUT THE DILANTIN?
A. TO STOP THE DILANTIN, D.C. THE DILANTIN.
Q. WAS ANY DILANTIN GOING INTO MRS. LARSEN BY I.V. FROM THE
26TH TO THE 29TH?
A. WELL, IF I WERE TO LOOK AT THE PAGES THAT THE MEDICATIONS
ARE ON --
Q. BUT I MEAN BY I.V.
A. RIGHT. AND I WAS JUST GOING TO -- YOU KNOW, JUST MAKE
ABSOLUTELY SURE THAT THERE WAS NOT AN I.V. RUNNING. AND, YOU
KNOW, AFTER THE I.V. WAS STOPPED ON THE 26TH, SHE DID NOT
HAVE AN I.V. AT ALL SO IF -- SHE WOULD NOT HAVE BEEN
RECEIVING DILANTIN BY I.V.
Q. BUT SHE HAD NO MORE SEIZURE ACTIVITY THAT YOU'RE AWARE OF
DURING THAT TIME PERIOD?
A. NO.
Q. LET'S NOW TURN TO THE 29TH OF DECEMBER WHICH IS ON MED
PAGE 574, IS THE NURSE'S NOTES. NOW, THIS IS THE NIGHT THAT
YOU WERE ALREADY DEALING WITH ELLEN ANDERSON, IS THAT
CORRECT?
A. ON THE 29TH? YES. BUT ON --
Q. ACTUALLY --
A. ACTUALLY IT STARTS ON THE 30TH, I THINK.
Q. RIGHT.
A. AT MIDNIGHT ON THE 30TH.
Q. OKAY. MIDNIGHT ON THE 30TH WHICH IS PAGE 575.
A. 576.
Q. YOU'RE -- I WANT TO, YOU KNOW YOUR WRITING IS ON 576, IF
YOU WOULD TURN TO 575. I RECOGNIZE THIS IS NOT YOUR WRITING
BUT IN ORDER TO GET A CONTINUITY HERE.
A. SORRY.
Q. ON THE 29TH OF DECEMBER BEFORE YOU CAME ON SHIFT, WAS
THERE SOMETHING GOING ON WITH MRS. LARSEN MEDICALLY?
A. SHE -- YEAH. SHE HAD BEEN VOMITING IT SAYS.
Q. IT APPEARS ON THE THIRD LINE -- WELL, IT SAYS ATTENDED
GROUPS BUT SLEPT THROUGH THEM AT 1600 WHICH IS WHAT 4 P.M.?
A. RIGHT, UH-HUH.
Q. PATIENT BEGAN A FIVE HOUR CYCLES OF SEVERE EMESIS TIMES
SEVEN. WHAT DOES THAT MEAN FOR A NURSE?
A. THAT'S SEVEN TIMES SHE VOMITED.
Q. AND IT WAS CONSIDERED TO BE SEVERE BY THE C.N.A. WHO
WROTE THIS NOTE. TEMPERATURE 99.5 AT 2200. LARGE AMOUNTS OF
EMESIS. CHANGE BED TIMES THREE. THEN LET'S GO DOWN TO LOOKS
LIKE 1900.
NOW, THIS APPEARS TO BE LAURIE WILSON'S HANDWRITING; IS
THAT CORRECT?
A. YES, UH-HUH.
Q. WHAT DID SHE WRITE AT 1900?
A. PAGED DR. WEITZEL TO NOTIFY HIM OF PATIENT'S PERSISTENT
NAUSEA AND VOMITING. VITAL SIGNS STABLE. PATIENT IS AWAKE.
VOMITUS IS CLEAR, YELLOW WITH FOOD PARTICLES.
Q. WHAT DID SHE WRITE AT 2000?
A. PAGED DR. WEITZEL AGAIN PATIENT CONTINUES TO VOMIT.
Q. AND 2130?
A. PAGED DR. WEITZEL AGAIN PATIENT CONTINUES TO VOMIT. HAS
BEEN N.P.O. SINCE 530.
Q. WHAT'S N.P.O.?
A. NO FOOD, NOTHING BY MOUTH.
Q. NOTHING BY MOUTH. CAN WE READ THAT LAST LITTLE BIT?
A. IT SAYS MEDICATIONS HELD.
Q. MEDICATIONS HELD. OKAY. THEN LET'S TURN TO THE NEXT
PAGE WHICH IS THE ONE WITH YOUR HANDWRITING WHEN YOU CAME ON
THE UNIT. DID YOU WRITE IN FREE TEXT AND -- WHAT IF YOU'D GO
AHEAD AND READ WHAT YOU WROTE AT 2400.
A. PATIENT VOMITING, HER EMESIS WAS COFFEE GROUND LIKE IN
APPEARANCE WITH PASTY TEXTURE.
Q. SO THE APPEARANCE OF THE VOMIT HAS CHANGED FROM WHAT YOU
READ BEFORE?
A. YES, UH-HUH.
Q. WHAT'S COFFEE GROUND LIKE MEAN TO YOU AS A NURSE?
A. IT COULD INDICATE THAT THERE WAS BLOOD PRESENT.
Q. AND THEN PASTY IN TEXTURE. THEN WHAT DID YOU WRITE?
A. HER VITAL SIGNS WERE STABLE. DR. WEITZEL AND
DR. DIENHART WERE PAGED. PATIENT CLEANED UP AND BED CHANGED.
Q. AT 1 O'CLOCK, WHAT DID YOU WRITE?
A. PATIENT VOMITED AGAIN, EMESIS SIMILAR IN APPEARANCE.
DR. WEITZEL PAGED AGAIN. NURSING SUPERVISOR INFORMED.
Q. AND AT 3:30?
A. DR. WEITZEL CALLED, AWARE OF PATIENT'S CONDITION.
Q. DID YOU MAKE HIM AWARE OF THE PATIENT'S CONDITION AT THAT
TIME?
A. YES, I DID, UH-HUH.
Q. NOW, YOU ALSO WERE DEALING WITH ELLEN ANDERSON. IS THIS
THE SAME TIME YOU HAD TOLD HIM WHAT HAD GONE ON WITH ELLEN
ANDERSON?
A. YES, IT IS.
Q. WHAT IF ANYTHING DID DR. WEITZEL TELL YOU TO DO FOR THIS
VOMITING?
A. HE DIDN'T GIVE ME ANY INSTRUCTIONS FOR HER.
Q. IS THERE ANYTHING THAT CAN BE GIVEN FOR VOMITING?
A. THERE ARE MEDICATIONS, YES.
Q. AND THEN AT 0530, WHAT DID YOU WRITE?
A. PATIENT VOMITED AGAIN, CONTINUES WITH HER HEAD ELEVATED
AND HEAD TO SIDE. AND HER VITAL SIGNS WERE 99.4, 70, 18 AND
112 OVER 80 WHICH ARE STABLE.
Q. AND THEN YOU WENT OFF SHIFT SHORTLY THEREAFTER?
A. RIGHT, UH-HUH.
Q. IF YOU WOULD STILL JUST GO AHEAD AND READ 9:20. EVEN
THOUGH THAT'S NOT YOUR HANDWRITING, WHAT WAS WRITTEN AT 9:20
AS GOING TO THE CONDITION OF THE PATIENT AT THAT TIME?
A. IT SAYS PATIENT WAS APPROXIMATELY 100 C.C.S OF EMESIS
DARK BROWN COFFEE GROUNDS COMING FROM NARIS AND MOUTH.
Q. LET'S STOP THERE IF YOU WOULD. SO THE VOMITING CONTINUES
UNTIL 9:20 OR AT LEAST 9:20?
A. YEAH. AT LEAST, UH-HUH.
Q. DID YOU -- IN WHAT YOU'VE READ THERE AND THEN WHAT YOU
SAW THAT NIGHT, DID YOU SEE ANY SIGNS OR SYMPTOMS OF PAIN IN
MRS. LARSEN?
A. NOT PAIN. YOU KNOW NAUSEA, WHICH, YOU KNOW, I DON'T
THINK OF AS PAIN BUT NAUSEA, YOU KNOW, IS A HORRIBLE WAY TO
FEEL. BUT NO PAIN OTHER THAN JUST HER NAUSEA.
Q. DID YOU SEE ANY PAIN THAT YOU THOUGHT MORPHINE WOULD BE
APPROPRIATE FOR?
A. NO, BECAUSE I DIDN'T SEE PAIN.
Q. LET US TURN BACK TO IN THE MEDICAL ORDERS GET TO A PAGE
NUMBER IN JUST A SECOND HERE. AS I RECALL THESE MEDICAL
PAGES ARE A LITTLE OUT OF ORDER SO IT GETS A LITTLE
CONFUSING. IF YOU WOULD TURN TO PAGE 497 IN THE MEDS AND
PARAGRAPHS. GO CLEAR TO THE TOP I GUESS.
HAVE YOU GOT THAT PAGE?
A. 497?
Q. 497.
A. OKAY.
Q. NOW, AT THE TOP IT LOOKS LIKE THE FIRST COLUMN IS 12/30
WHICH IS THE 30TH OF DECEMBER, CORRECT?
A. UH-HUH.
Q. AND YOU'VE GOT SEVERAL MEDICATIONS IT LOOKS LIKE THAT
WERE HELD, OF COURSE THE SERZONE, THE RISPERDAL, ET CETERA.
AND THEN DOWN AT THE BOTTOM IS A NEW ORDER FOR MORPHINE AND
WHEN WAS THAT ORDER TO BE BEGIN? WELL, WHEN WAS THE FIRST
MORPHINE SHOT GIVEN ON THE 30TH?
A. IT WAS GIVEN AT 2:30.
Q. 2:30 IN THE AFTERNOON?
A. YES, UH-HUH.
Q. THEN IT CONTINUES OVER THE NEXT COUPLE OF DAYS; IS THAT
CORRECT?
A. RIGHT, UH-HUH.
Q. HOW MUCH WAS THAT MORPHINE ORDER FOR? WHEN WAS IT TO BE
GIVEN? WHAT WAS THE ROUTINE? BECAUSE THIS WAS ROUTINE THIS
WASN'T PRN; IS THAT CORRECT?
A. RIGHT. THIS WAS I.M. INJECTIONS FIVE MILLIGRAMS EVERY
FOUR HOURS AROUND THE CLOCK.
Q. SO IT APPEARS THAT THAT ENDED, THE LAST SHOT ON THAT PAGE
WAS -- FOR MORPHINE WAS GIVEN AT 1430 ON THE 1ST OF JANUARY;
IS THAT CORRECT?
A. YES, UH-HUH.
Q. THEN IF YOU'LL TURN TO 507 WHICH IS ANOTHER ROUTINE PAGE.
WAS THERE A CHANGE IN THE MORPHINE ORDER ON THE -- IT LOOKS
LIKE THE 1ST OF JANUARY?
A. YES. IT WAS INCREASED FROM EVERY FOUR HOURS TO EVERY
THREE HOURS.
Q. SAME AMOUNT?
A. SAME AMOUNT.
Q. WHAT'S THE AFFECT OF GIVING IT AN HOUR EARLIER?
MR. BUGDEN: YOUR HONOR, I'M GOING TO OBJECT. I
THINK THAT SHE'S NOT QUALIFIED, NOT THE RIGHT WITNESS TO BE
COMMENTING ON THAT.
THE COURT: SUSTAINED.
Q. (BY MS. BARLOW) WE'LL GO ON. SO THAT ORDER CONTINUES.
NOW, ON THE 3RD OF JANUARY, THE INITIALS T.S. ARE NEXT TO THE
030, WHICH IS WHAT 12/30, RIGHT AFTER MIDNIGHT; IS THAT
CORRECT?
A. RIGHT, UH-HUH.
Q. AND THE 030 YOUR INITIALS ARE THERE; IS THAT CORRECT?
A. RIGHT.
Q. WHAT IS THE SIGNIFICANCE OF YOUR INITIALS BEING THERE AND
IN THE FASHION THAT THEY ARE?
A. WELL, THE DOSES WERE DUE ON MY SHIFT BUT I DID NOT GIVE
THEM. THE CIRCLE AROUND IT INDICATES IT WASN'T GIVEN. AND
THEN THE NUMBER SIX THAT'S NEXT TO THAT, IT LET'S YOU KNOW
THAT MY NOTES BACK ON THE NURSING PAGES THAT -- WHY I DIDN'T
GIVE IT. AND I DIDN'T GIVE IT BECAUSE HER RESPIRATIONS WERE
SO LOW.
Q. LET'S TURN TO YOUR NURSING NOTES -- DO YOU RECALL THIS
NIGHT?
A. YES, I DO.
Q. SEE IF I CAN GET TO THE RIGHT NURSING PAGE, ON THE 3RD;
IS THAT CORRECT?
IT'S MED PAGE 589. ARE THESE YOUR NURSING NOTES?
A. YES, THEY ARE.
Q. NOW, THIS IS WHAT YOU WROTE TO EXPLAIN THE HOLDING OF THE
MORPHINE.
A. YES.
Q. WHAT DID YOU WRITE?
A. PATIENT MONITORED CLOSELY THROUGHOUT THE NIGHT. ROUTINE
MORPHINE HELD TIMES THREE DUE TO HER RESPIRATIONS BEING FIVE
TO EIGHT.
Q. FIVE TO EIGHT PER MINUTE?
A. YES, UH-HUH.
Q. IS THAT GOOD? BAD? FAST? SLOW? WHAT IS IT?
A. WELL, IT'S VERY LOW.
Q. VERY LOW. THANK YOU.
A. SLIGHT TWITCHING NOTED FOR SHORT PERIOD TWICE.
EXTREMITIES WERE WARM, ALL FOUR OF THEM. HER FINGERS WERE
CYANOTIC EARLY IN THE SHIFT WHICH MEANT THEY WERE BLUE SO
THAT, YOU KNOW, OXYGEN WAS DOWN, SHE WASN'T FUSING OUT TO HER
FINGERS. FINGERS CYANOTIC NOT EARLY IN THE SHIFT. MUCH
IMPROVED THROUGH THE NIGHT. NO MODELING OBSERVED.
Q. WHAT'S MODELING?
A. DISCOLORATION OF THE SKIN, KIND OF PURPLE COLORING THAT
YOU SEE. CAN BE MAYBE SHORTLY BEFORE A PERSON DIES OR POOR
CIRCULATION, JUST THAT KIND OF THING.
Q. OKAY.
A. PATIENT TURNED EVERY TWO HOURS. HER VITAL SIGNS WERE
EVERY FOUR HOURS. A COOL CLOTH WET WAS TO HER EYES FOR
COMFORT, OTHERWISE HER EYES WERE OPEN AND STARING. SHE DID
NOT RESPOND WHEN SPOKEN TO AND SHE DID NOT TRACK WITH HER
EYES. WE DID ORAL CARE --
Q. WHAT IS ORAL CARE?
A. CLEANED HER MOUTH OUT, MOISTENED IT WITH -- THERE'S A
COUPLE OF DIFFERENT THINGS THAT WE CAN USE JUST TO KIND OF
FRESHEN THE MOUTH AND MOISTEN IT.
Q. WHY DO YOU DO THAT?
A. BECAUSE HER MOUTH WAS SO VERY DRY.
Q. IS THAT UNCOMFORTABLE OR COMFORT?
A. VERY UNCOMFORTABLE.
Q. THEN WHAT DID YOU DO?
A. PATIENT MOTIONED TO MOUTH THIS MORNING, A FEW SIPS OF
WATER WERE TAKEN.
Q. DO YOU RECALL THAT EXPERIENCE?
A. I DO. BECAUSE IT JUST SEEMS KIND OF, YOU KNOW, SHE WAS
SO THIRSTY IT WAS KIND OF SAD.
Q. WAS SHE ABLE TO SWALLOW?
A. YEAH. SHE DID TAKE A FEW SIPS, UH-HUH.
Q. DID DR. WEITZEL EVER SAY ANYTHING TO YOU ABOUT GIVING HER
WATER?
A. NOT THAT I RECALL.
Q. DID YOU SEE ANY SIGNS OR SYMPTOMS OF PAIN ON THAT DAY, ON
THE 3RD OF JANUARY?
A. NO.
Q. WAS SHE GETTING ROUTINE MORPHINE ON THAT DAY?
A. SHE -- WELL, YEAH. BEFORE I CAME ON AND AFTER I WENT
OFF, YES, UH-HUH.
Q. BUT YOU DIDN'T GIVE ANY WHILE YOU WERE ON; IS THAT RIGHT?
A. NO, I DIDN'T.
Q. DID DR. WEITZEL EVER SPEAK TO YOU ABOUT HOLDING THAT
MORPHINE?
A. NOT TO ME INDIVIDUALLY. THERE WAS A -- EITHER MAYBE THE
NEXT MORNING OR MORNING AFTER THAT THAT THEY HAD CALLED AN
UNSCHEDULED STAFF MEETING AT THE MORNING SHIFT CHANGE AND HE
WAS AT THAT MEETING.
Q. WERE YOU AT THAT MEETING?
A. YES, I WAS, UH-HUH.
Q. DO YOU RECALL IF ANY OTHER NURSES WERE THERE?
A. THE ONCOMING SHIFT WAS THERE AND THE ONLY ONES THAT I
SPECIFICALLY RECALL BEING THERE WOULD BE EARLENE AND LYNN
LONG.
Q. AND LYNN LONG?
A. UH-HUH.
Q. THANK YOU.
DID DR. WEITZEL CALL THAT MEETING?
A. YOU KNOW, I DON'T KNOW WHO CALLED IT BUT HE WAS THE ONE
THAT SPOKE TO US FIRST.
Q. WHAT, IF ANYTHING, DID HE SAY ABOUT MORPHINE?
A. OH, HE INSTRUCTED US THAT IT WAS NOT OKAY TO HOLD THE
MORPHINE. IF WE FELT THAT WE NEEDED TO, THAT WE NEEDED TO
CALL HIM FIRST.
Q. TRYING TO FIND A CERTAIN NOTE HERE.
MS. BARLOW: EXCUSE ME, YOUR HONOR, IF I COULD HAVE
JUST A MINUTE.
Q. (BY MS. BARLOW) IF YOU WOULD TURN TO MED 477. BEFORE WE
GET TO THAT, AS A NURSE WHAT ARE YOU TAUGHT -- I MEAN, YOU
TAKE VITAL SIGNS, YOU CHECK RESPIRATIONS, THAT SORT OF THING.
AS A NURSE, WHAT ARE YOU TAUGHT TO DO WITH SEDATING
MEDICATIONS IF YOU SEE A CHANGE IN A PERSON'S CONDITION? DID
THAT MAKE SENSE?
A. WELL, YOU KNOW, IF YOU FELT LIKE THEY WERE COMPROMISED BY
THE MEDICATION THEN YOU WOULD NOTIFY THE DOCTOR OR WITHHOLD
THE MEDICATION FIRST AND THEN NOTIFY THE DOCTOR SO THAT YOU
DIDN'T WORSEN THEIR CONDITION.
Q. WHAT WAS THERE ABOUT THE LOW RESPIRATION RATES WITH
MRS. ANDERSON THAT MORNING THAT CAUSED YOU TO HOLD THOSE
MEDS?
A. WELL, MORPHINE CAN CAUSE LOW RESPIRATIONS.
Q. YOU INDICATED THAT THERE WAS A MEETING WHICH DR. WEITZEL
SPOKE TO YOU ABOUT HOLDING MEDS. WOULD YOU READ ON THE 3RD
OF JANUARY HIS NOTE?
A. DESPITE FIVE MILLIGRAMS OF I.M. M.S. AT 0730 AND 0930
PATIENT HAS NOT RESPONDED AT ALL. EYES OPEN, GROANING,
APPEARS IN SOME PAIN. UNFORTUNATELY NURSING STAFF HAD BEEN
HOLDING MORPHINE FOR LOW RESPIRATION RATE. PATIENT REMAINS
UNRESPONSIVE TO ANY QUESTIONS. VITAL SIGNS STABLE
ACTUALLY -- VITAL SIGNS STABLE ACTUALLY AND SHE'S AFEBRILE.
STABLE. MORPHINE 25 NOW AND CONTINUE WITH FIVE MILLIGRAMS
EVERY THREE HOURS P.R.N. -- DOES THAT SAY AS NEEDED?
Q. EITHER P.R.N. OR PAIN, I CAN'T TELL FOR SURE.
A. OH, PAIN AS NEEDED, THAT'S WHAT IT IS.
Q. NOW, DID YOU SEE SIGNS OR SYMPTOMS OF PAIN IN MRS. LARSEN
DURING YOUR SHIFT THAT TRANSPIRED JUST BEFORE THIS NOTE?
A. ACTUALLY, I DON'T RECALL JUDITH EVER BEING IN PAIN.
Q. AND YOU SAID UNFORTUNATELY YOU'D BEEN HOLDING FOR LOW
RESPIRATION RATE. WHAT ARE YOU TAUGHT TO DO IF IT'S A LOW
RESPIRATION RATE WITH PAIN MEDS?
MR. BUGDEN: WELL, THAT'S BEEN ASKED AND ANSWERED,
YOUR HONOR.
THE COURT: IT IS REPETITIVE. GO ON TO SOMETHING
ELSE.
MS. BARLOW: WE'LL GO ON TO SOMETHING ELSE THEN.
Q. (BY MS. BARLOW) THEN IS THE ORDER FOR ANOTHER 25
MILLIGRAMS MORPHINE. IT SAYS NOW, WHAT DOES THAT MEAN?
A. IT'S A ONE-TIME ORDER. JUST TO DO IT NOW.
Q. WERE YOU THERE WHEN SHE DIED ON THE 4TH OF JANUARY?
A. NO, I WASN'T.
Q. DID YOU SEE HER AGAIN BEFORE SHE PASSED AWAY?
A. I WOULD HAVE TO LOOK TO SEE BUT I DON'T BELIEVE SO.
Q. LET'S GO ON AND TALK ABOUT MARY CRANE. AND I BELIEVE
THAT THIS IS 4B, YOUR HONOR. YES IT IS 4B.
DO YOU RECALL MARY CRANE AS A PATIENT?
A. I DID BUT NOT AS WELL AS SOME OF THE OTHERS.
Q. DID YOU SEE ANY CHANGE IN HER CONDITION OVER THE TIME SHE
WAS IN THE HOSPITAL?
A. I DON'T RECALL THAT WELL, OKAY.
Q. IF YOU WOULD TURN TO PAGE 307 AND AT THE BOTTOM IS YOUR
NAME. DID YOU WRITE ANYTHING?
A. NO, I DIDN'T.
Q. PARDON?
A. I DID NOT.
Q. YOU DID NOT. WHAT DOES THAT TELL YOU THAT THE FACT THAT
MAYBE THE C.N.A. WROTE RATHER THAN YOU?
A. AS THE NURSE ON THE FLOOR I WOULD DESIGNATE WHO CHARTED
ON WHO AND I WOULD TRY TO -- IF A PATIENT HAD ANYTHING
UNUSUAL DURING THE NIGHT THAT I WOULD MAKE IT A POINT TO
CHART ON THAT PATIENT AND THE C.N.A. WOULD GENERALLY GIVE THE
ONES THAT HAD A VERY QUIET NIGHT.
Q. SO THAT TELLS YOU THIS WAS PERHAPS A QUIET NIGHT FOR MARY
CRANE?
A. YES, UH-HUH.
Q. DO YOU RECALL WHETHER SHE WAS ON A DURAGESIC PATCH?
A. WELL, THE NEXT NOTE DOWN IT SAYS IT CAME OFF AND A NEW
ONE WAS APPLIED, SO.
Q. BUT YOU DON'T HAVE ANY PERSONAL RECOLLECTION OF IT
BEING --
A. NO.
Q. NOW THIS WAS THE 29TH -- WELL, LET'S TURN OVER TO 309.
AGAIN, YOUR NAME IS AT THE BOTTOM. NOW THIS WAS THE NIGHT OF
THE 29TH AND 30TH, WERE YOU CARING FOR OTHER PATIENTS AT THAT
TIME?
A. THAT WAS THE NIGHT THAT JUDITH HAD HER SEIZURE AND ELLEN
WAS DOING SO POORLY.
Q. DID YOU WRITE ANYTHING FOR MRS. CRANE?
A. I DID NOT ON THIS ONE, NO.
Q. IF YOU HAD TURN TO PAGE 321. I BELIEVE YOU PROBABLY SAW
HER IN BETWEEN, BUT WE'LL GO TO 321 BECAUSE THIS IS WHERE
YOU'VE WRITTEN A NOTE. WHAT DATE WAS THIS?
A. JANUARY 4TH.
Q. YOU'VE WRITTEN A MED NOTE, WHAT TIME IS THAT NOTE?
A. 0430, 4:30 IN THE MORNING.
Q. WHAT DID YOU WRITE?
A. PATIENT AWAKENED MOANING, COMPLAINING OF PAIN, TYLENOL
GIVEN AS ORDERED. THEN AN HOUR AND A HALF LATER, 6 O'CLOCK,
PATIENT CONTINUED TO MOAN. TYLENOL HAD LITTLE EFFECT.
Q. AND I THINK THE NEXT NOTE EVEN THOUGH IT'S SIMILAR TO
YOUR HANDWRITING IT'S NOT YOUR HANDWRITING BUT IF YOU'D READ
THE REST OF IT I BELIEVE IT'S SHELTON, A C.N.A. WROTE THIS.
A. YES. SHE WAS WORKING WITH ME.
Q. WHAT DID SHE WRITE?
A. AWAKE MOST OF THE NIGHT MOANING. PATIENT STATES, I HURT.
UNABLE TO TELL PAIN LOCATION. O2 AT TWO LITERS PER NASAL
CANNULA.
Q. MEANING SHE HAD OXYGEN?
A. YES, UH-HUH. THEN I THINK IT SAYS COLOR GOOD. ASKED FOR
A DRINK OF WATER AND A PILL. PILL IS WRITTEN TWICE.
Q. WELL, BEFORE I LEAVE THAT. NOW THERE'S -- NO ONE HAS
WRITTEN WHETHER THAT PILL HAD ANY EFFECT; IS THAT CORRECT?
A. WELL, THE TYLENOL THAT I HAD GIVEN HER I HAD INDICATED
THAT IT WASN'T EFFECTIVE. AND WHAT SHE HAD MENTIONED TO THE
C.N.A. I DON'T BELIEVE THERE WAS A PILL GIVEN BECAUSE SHE WAS
JUST ASKING THE C.N.A. FOR ONE AND IT WOULDN'T HAVE BEEN TIME
FOR ADDITIONAL TYLENOL.
Q. BUT AT 1430 SOMEONE ELSE HAS WRITTEN PATIENT HAS HAD A
FLAT AFFECT TODAY. WHAT IS A FLAT AFFECT?
A. NOT SHOWING EMOTIONS, YOU KNOW, JUST KIND OF A FLAT, LOW
RESPONSE, NO HAPPINESS OR THAT KIND OF THING.
Q. LET'S NEXT TURN TO 324. YOU WROTE A NOTE THERE, WHAT DID
YOU WRITE?
A. PATIENT SLEPT THROUGH THE NIGHT, PATIENT SOUNDED GURGGLY
EARLIER IN THE NIGHT AND SHE WAS SUCTIONED ONCE. HER O2 WAS
STILL AT TWO LITERS PER NASAL CANNULA. HER RESPIRATIONS WERE
VERY ERRATIC WITH PERIODS OF APNEA. HER RESPIRATIONS WERE 8
TO 12. HER TEMPERATURE WAS 100.5.
Q. DID YOU SEE ANYTHING THAT CAUSED YOU CONCERN ABOUT HER
CONDITION AT THIS TIME?
A. YES. SHE -- DEFINITELY WAS NOT DOING NEAR AS WELL AS SHE
HAD BEEN DOING. THE RESPIRATIONS WOULD HAVE BEEN CAUSE FOR
CONCERN AND SHE ACTUALLY HAD A FEVER AT THIS POINT.
Q. DO YOU RECALL WHETHER ANY MEDICATION OR ANY INTERVENTION
WAS DONE FOR HER FEVER?
A. I DON'T RECALL THAT SPECIFICALLY.
Q. AND THEN 326 I BELIEVE IS THE LAST PAGE THAT YOU TALK
ABOUT WITH MRS. CRANE. WHAT DID YOU WRITE ON I BELIEVE THIS
IS THE 6TH OF JANUARY.
A. PATIENT APPEARED TO SLEEP THROUGH THE NIGHT, RESPIRATIONS
MORE FREQUENT AND EVEN TONIGHT. HER O2 WAS AT TWO LITERS PER
NASAL CANNULA. PATIENT STARTED MOANING AT APPROXIMATELY
0600. MORPHINE FIVE MILLIGRAMS WAS GIVEN FOR PAIN AS ORDERED
AT 0615. PATIENT APPEARS MORE COMFORTABLE AFTER RECEIVING
THE MORPHINE.
Q. WAS THIS A P.R.N. OR AN AS NEEDED ORDER FOR MORPHINE?
A. I'D HAVE TO LOOK, BUT I THINK IT IS AS AN AS NEEDED.
Q. LET'S LOOK AT THE MED DRAFT FOR 1/6. ACTUALLY, I CAN'T
FIND IT THAT QUICKLY SO WE'LL JUST MOVE ON.
SO THE MORPHINE WAS HELPFUL; IS THAT CORRECT?
A. YES, IT WAS.
Q. ARE THERE THINGS OTHER THAN PAIN THAT CAN CAUSE A PATIENT
TO MOAN?
A. YES, THERE COULD BE.
Q. WHAT OTHER KINDS OF THINGS CAUSE A PATIENT TO MOAN?
A. IT COULD BE EMOTIONAL. YOU KNOW, I DON'T KNOW. THAT'S A
HARD ONE.
Q. THANK YOU. I'LL GO ON TO I BELIEVE MRS. SMITH AT THIS
TIME. I'LL GIVE YOU EXHIBIT 5B.
DO YOU RECALL LYDIA SMITH?
A. YES, I DO.
Q. WHAT DO YOU RECALL OF LYDIA SMITH?
A. SHE WAS A LITTLE TINY LITTLE WOMAN WITH A LOT OF SPUNK.
SHE WAS A REAL FEISTY, KIND OF A REAL FIGHTER.
Q. DO YOU RECALL HOW SHE CAME INTO THE UNIT? WHAT HER
CONDITION WAS WHEN SHE CAME INTO THE UNIT?
A. SHE WAS -- SHE WOULD STRIKE OUT AND TRY TO STEP ON YOU
AND, YOU KNOW, I MEAN, SHE WAS VERY ALIVE.
Q. WAS SHE IN A WHEELCHAIR OR WAS SHE WALKING?
A. SHE WAS WALKING.
Q. DID SHE -- DID YOU EVER -- YOU WERE ON NIGHTS. DID YOU
EVER HAVE OCCASION TO HELP HER WALK OR DID SHE NEED HELP OR
WHAT?
A. WELL, AT NIGHT WE FREQUENTLY GOT HER UP TO THE BATHROOM
AND WE WOULD JUST WALK WITH HER TO MAKE SURE SHE WAS STEADY
TO GO TO THE BATHROOM. AND THEN SOMETIMES WHEN SHE WOULD BE
AGITATED AT NIGHT, WE WOULD WALK WITH HER IN HOPES THAT THAT
MIGHT HELP CALM HER DOWN.
Q. DID IT HELP?
A. SOMETIMES A LITTLE BIT. FOR THE MOST PART, IT WASN'T
REAL EFFECTIVE.
Q. 761 IT APPEARS THAT YOU WERE ON DUTY THAT NIGHT. WHAT
DID YOU WRITE FOR MRS. SMITH?
A. AT 1:30 PATIENT WAS AGITATED, UP AND DOWN IN BED.
ASSISTED TO THE BATHROOM. SHE VOIDED A QUANTITY SUFFICIENT
AND CONTINUED TO BE AGITATED. ATIVAN ONE MILLIGRAM I.M.
GIVEN. PATIENT AMBULATED IN THE HALL WITH ASSISTANCE AND
RETURNED TO BED. CURRENTLY RESTING QUIETLY.
Q. SO WAS THE ATIVAN EFFECTIVE IN DEALING WITH HER AGITATION
AT LEAST THAT NIGHT?
A. YES, IT WAS.
Q. DID HER CONDITION CHANGE OVER TIME?
A. YES, IT DID. TO WHEN LATE IN HER ADMISSION SHE HAD A
POTTY CHAIR BY HER BED TO WHERE -- YOU KNOW, IT WAS TO WHERE
IT WAS I GUESS SHE WAS NO LONGER ABLE TO MAKE IT CLEAR TO THE
BATHROOM TO GO TO THE BATHROOM AT NIGHT.
Q. AS A NURSE, WHAT DOES THAT TELL YOU ABOUT HER PHYSICAL
CONDITION?
A. THAT SHE WAS DETERIORATING.
Q. RATHER THAN GO DAY BY DAY, LET'S TURN TO PAGE 777, WHICH
IS THE 29TH. I THINK THE PREVIOUS ONE -- PREVIOUS PAGE WE
WERE TALKING ABOUT WAS THE 22ND. NOW IF YOU'LL TURN TO THE
29TH, PAGE 777. WHAT DID YOU WRITE FOR MRS. SMITH ON THE
29TH OF DECEMBER?
A. WELL, AT MIDNIGHT PATIENT WAS SLEEPING QUIETLY IN BED.
IT SAYS POSEY WAS REMOVED AND HER --
Q. WHAT IS A POSEY?
A. IT'S A RESTRAINT THAT'S USED FOR PATIENT'S SAFETY. IT'S
SIMILAR TO A SEAT BELT AND YOU CAN PUT IT AROUND A BED OR
CHAIR AND IT HAS A BUCKLE ON IT THAT YOU NEED A KEY TO UNLOCK
IT, BUT IF A PATIENT IS CONFUSED, THAT TYPE OF THING, THAT IT
CAN KEEP THEM FROM FALLING OUT OF BED.
Q. OKAY. IF YOU WOULD READ THE REST OF THAT NOTE.
A. POSEY REMOVED, SIDE RAILS WERE UP TIMES TWO. SHE HAD A
BED CHECK MONITOR ON HER BED AND IT WAS IN PLACE. AND THEN
0415, PATIENT WAS UP TO THE BATHROOM WITH ASSIST. SHE WAS
CONTINENT AND SHE WAS ASSISTED BACK TO BED. SIDE RAILS WERE
BOTH PUT BACK UP AND HER BED CHECK WAS STILL THERE IN THE
BED.
Q. THEN AT 4:30 WAS THERE A CHANGE IN HER ACTIVITY?
A. YES. SHE WAS SHE WAS FOUND SITTING ON THE FLOOR BY HER
BED. THE BED CHECK MONITOR HAD MALFUNCTIONED. SHE WAS
COMBATIVE, STRIKING OUT, KICKING, PULLING AT STAFF, PULLING
AT STAFF CLOTHING. IN EXAMINING, YOU KNOW, HER BODY WE FOUND
ZERO BRUISING OR REDDENED AREAS. SHE WAS ASSISTED BACK TO
BED AND THE POSEY WAS PUT BACK ON HER. HER SIDE RAILS WERE
UP TIMES TWO AND A BED CHECK MONITOR WAS IN PLACE. NURSING
SUPERVISOR AND HEAD NURSE WERE NOTIFIED.
Q. WHY DID YOU NOTIFY THE HEAD NURSE AND THE NURSING
SUPERVISOR ABOUT HER ACTIVITIES THAT NIGHT?
A. WELL, FINDING A PATIENT ON THE FLOOR JUST, YOU KNOW, IS
SOMETHING THAT WE WOULD ROUTINELY REPORT.
Q. DID SHE APPEAR TO HAVE FALLEN?
A. WELL, EITHER THAT OR CLIMBED OUT OF BED. SINCE NO ONE
OBSERVED IT, WE DON'T KNOW HOW SHE GOT THERE, BUT THERE WAS
NO REDDENED OR BRUISED AREAS SO IT'S POSSIBLE THAT SHE HAD
JUST CLIMBED OUT.
Q. I WON'T SHOW THIS BUT IF YOU'LL TURN TO 791 AGAIN SOME
TIME HAS PASSED. THIS IS NOW THE 3RD OF JANUARY. NOT
READING IT, BUT WHAT WAS HER GENERAL CONDITION -- I MEAN, NOT
READING IT VERBATIM, BUT JUST TO READ IT TO YOURSELF, WHAT
WAS HER GENERAL CONDITION THAT NIGHT?
A. IT SAYS THAT SHE WAS VERY AGITATED.
Q. DID YOU GIVE HER ANY MEDICATION FOR THAT?
A. YES. I.M. HALDOL WAS GIVEN FOR SEVERE AGITATION.
Q. AND WHAT WAS THE RESULT?
A. IT SAYS THAT SHE SLEPT QUIETLY REMAINDER OF THE NIGHT
WITH HER RESPIRATIONS EVEN AND UNLABOURED.
Q. WHY WOULD YOU BE NOTING HER RESPIRATIONS?
A. JUST KIND OF A ROUTINE KIND OF THING TO DO BASICALLY AND
JUST BECAUSE OF MEDICATIONS. BUT IT --
Q. EXCUSE ME.
A. -- I WOULD SAY IT'S A VERY ROUTINE THING JUST TO DO AS A
NURSE.
Q. WHAT DAY WAS THAT?
A. JANUARY 3RD.
Q. THEN IF YOU'LL TURN PAGE 794, AGAIN, I WON'T SHOW IT.
BUT DID YOU HAVE OCCASION TO GIVE MEDICATION THAT MORNING,
EARLY MORNING?
A. YES, I DID.
Q. AND WHY?
A. IT SAYS PATIENT WAS TOSSING AND TURNING AND THAT SHE WAS
UP TO THE BATHROOM AND WAS BITING AT THE STAFF, STRIKING OUT
AND KICKING.
Q. WHAT DID YOU GIVE HER?
A. I.M. ATIVAN.
Q. DID IT HAVE ANY EFFECT?
A. YES. SHE WAS CALMER AFTER THAT, BUT SHE DID STILL
CONTINUE TO HAVE DIFFICULTY SLEEPING.
Q. WHAT DAY WAS THAT?
A. JANUARY 4TH.
Q. THEN 796. WHAT DAY IS THIS ENTRY?
A. JANUARY 5TH.
Q. DID YOU SEE ANY AGITATION THAT EARLY MORNING?
A. YES. SHE WAS VERY AGITATED AND MAKING NUMEROUS ATTEMPTS
TO GET OUT OF BED, STRIKING AT THE STAFF. RESISTING ASSIST
TO THE BATHROOM.
Q. WHAT DID YOU DO IN ORDER TO RELIEVE HER AGITATION?
A. WELL, WE HAD TRIED TO AMBULATE HER AND THAT WASN'T
WORKING AND SO I HAD GIVEN HER I.M. HALDOL.
Q. WAS THAT EFFECTIVE?
A. YES, IT WAS. IT SAYS THAT SHE CONTINUED TO TOSS AND TURN
BUT WAS LESS RESTLESS AND DID SLEEP FOR SHORT PERIODS OF
TIME.
Q. THEN TWO DAYS -- WELL, NO. I GUESS A DAY LATER ON THE
6TH OF JANUARY, PAGE 798, WHAT WAS HER CONDITION AT THAT
TIME? WAS SHE AGITATED AT ALL? LET'S PUT IT THAT WAY.
A. NO. IT DOESN'T LOOK LIKE SHE WAS AT ALL.
Q. WERE YOU THERE WHEN SHE PASSED AWAY ON THE 8TH OF
JANUARY?
A. NO, I WASN'T.
Q. NOW, LET'S TURN TO ENNIS ALLDREDGE. THIS IS FROM 6-B.
DO YOU RECALL MR. ALLDREDGE?
A. VAGUELY, YES.
Q. DO YOU RECALL A CHANGE IN HIS -- IN HIS CONDITION DURING
THE TIME THAT HE WAS THERE?
A. DO YOU KNOW, I REALLY DON'T. I DON'T THINK I SAW HIM AS
OFTEN AS I DID SOME OF THE OTHER PATIENTS.
Q. IF YOU'D LOOK AT PAGE 63. AND IF YOU WOULD READ THAT
WHOLE LINE THAT YOU -- LINE OF NARRATION THAT YOU PUT IN
THERE.
A. PATIENT RESTLESS. SHE WAS -- HE WAS POSEY. THE POSEY
WAS UNDONE. PATIENT REPOSITIONED. SEE RESTRAINT ADDENDUM
RECORD FOR ADDITIONAL INFORMATION. AT 2 O'CLOCK PATIENT
CONTINUES RESTLESS, REMOVING BEDDING, POSEY WAS UNDONE.
RANGE OF MOTION WAS DONE AND PATIENT REPOSITIONED AND
REPOSEYED. WHEN A PATIENT IS IN A POSEY, IT'S POLICY THAT
EVERY TWO HOURS WE HAVE TO UNDO THAT AND JUST KIND OF, YOU
KNOW, MOVE THEIR LIMBS AROUND AND MAKE SURE THEY'RE
COMFORTABLE AND THEIR NEEDS ARE MET AND THEN WE CAN PUT IT
BACK ON THEM.
4 O'CLOCK PATIENT RESTLESS BUT SLEEPING. DIAPER REMAINS
DRY. POSEY WAS OFF AND PATIENT REPOSITIONED TO BE POSEY AND
SIDE RAILS UP AND BED CHECK MONITOR IN PLACE. AT 6 O'CLOCK A
UA WAS OBTAINED PER STRAIGHT CATH --
Q. LET'S STOP THERE. A U.A. IS WHAT?
A. A URINARY -- WHAT WAS -- IT WAS URINE THAT WAS OBTAINED
FOR A URINALYSIS.
Q. AND WHAT'S A STRAIGHT CATH?
A. INSTEAD OF HOOKING -- IT'S JUST A TUBE, A CATHETER IS
INSERTED TO DRAIN OUT THE URINE AND THEN IT'S IMMEDIATELY
REMOVED.
Q. THAT'S WHAT A CLEAN CATCH, DO THEY CALL THAT?
A. NO. THAT WOULD BE A STRAIGHT CATH.
Q. OH, SORRY. I DON'T KNOW MUCH ABOUT MEDICINE.
A. OKAY.
Q. YOU HAD IF YOU'D READ THE REST OF THAT.
A. LET'S SEE, IT SAYS PATIENT VERY AGITATED, CRYING LOUDLY.
POSEY REMOVED, RANGE OF MOTION. REPOSITIONED AND REPOSYED.
SEE RESTRAINT ADDENDUM, PATIENT TOLERATED CATHETER PROCEDURE
WELL.
Q. A CATHETER PROCEDURE IS NOT NECESSARILY A PLEASANT
ACTIVITY FOR A PATIENT?
A. NOT PARTICULARLY.
Q. IF YOU HAD IF YOU'D TURN TO 71 I BELIEVE IS THE LAST DAY
THAT YOU SAW MR. ALLDREDGE, I WON'T PUT IT ON HERE. WHAT DAY
WAS THAT?
A. JANUARY 12TH.
Q. AND IF YOU WOULD JUST READ THE 0400 AND 0415 FOR US,
PLEASE.
A. PATIENT HAS BEEN AGITATED, RESTLESS, REMOVING DIAPER
REMOVED FINGER MONITOR, UNABLE TO REPLACE SO I CALLED
RESPIRATORY THERAPY. AND POSEY WAS REMOVED. RANGE OF
MOTION, REPOSITIONED. POSEY RESECURED. 0415 I.M. ATIVAN
GIVEN FOR AGITATION. RESPIRATORY WAS IN AND FINGER MONITOR
WAS REPLACED.
Q. AND THEN 0600 WITHOUT READING IT, WAS THE ATIVAN
SUCCESSFUL OR EFFECTIVE?
A. IT WAS SOMEWHAT EFFECTIVE.
MS. BARLOW: I BELIEVE THAT'S ALL I HAVE OF THIS
WITNESS, YOUR HONOR.
THE COURT: LET'S TAKE OUR BREAK AT THIS TIME, GIVE
EVERYBODY A CHANCE TO STRETCH. WE'LL TAKE A 20 MINUTE BREAK.
WE'LL RECONVENE AT FIVE AFTER 10. YOU MAY STEP DOWN IF YOU'D
LIKE, PLEASE. AND LADIES AND GENTLEMEN, I REMIND OF MY PRIOR
DIRECTION. WE'LL BE IN RECESS.
(A RECESS WAS TAKEN.)
THE COURT: PARTIES AND COUNSEL ARE PRESENT. THE
JURY IS IN THE JURY BOX. MS. SCHOLL IS STILL ON THE STAND
AND YOU MAY CROSS-EXAMINE. WOULD THAT BE YOU MR. BUGDEN?
MR. BUGDEN: YES, SIR.
CROSS-EXAMINATION
BY MR. BUGDEN:
Q. MS. SCHOLL, MY NAME IS WALLY BUDGEN. I'M ONE OF THE
LAWYERS REPRESENTING DR. WEITZEL AND I'M GOING TO ASK YOU
SOME QUESTIONS. AND LET ME SHOW YOU HOW WE'RE GOING TO HOW
I'LL TRY TO ASK YOU QUESTIONS. I'M GOING TO GIVE YOU A
DIFFERENT ORGANIZATION OF DOCUMENTS THAT YOU'VE ALREADY
TALKED ABOUT ACTUALLY BUT THEY'RE JUST IN A DIFFERENT FORMAT.
AND AT DIFFERENT TIMES WHEN I'M TRYING TO COMMUNICATE
WITH YOU, I'LL TALK ABOUT THE NUMBER IN THE LOWER RIGHT-HAND
PAGE, LOWER RIGHT-HAND CORNER. I MAY ALSO USE DIFFERENT
NUMBERS THAT YOU DON'T HAVE TO BE WORRIED ABOUT WHEN I'LL BE
TALKING TO THE JUDGE OR TALKING TO THE PROSECUTOR, IS THAT
OKAY?
A. UH-HUH.
Q. MA'AM, AS I UNDERSTAND IT, YOU WORKED FOR ALL OF THIS
RELEVANT TIME PERIOD THE NIGHT SHIFT; IS THAT RIGHT?
A. YES.
Q. AND THAT WAS 11 TO 7?
A. RIGHT.
Q. YOU WOULD HANDLE MEDICATIONS, CHECKED FOR VITAL SIGNS; IS
THAT RIGHT?
A. VITAL SIGNS WERE ACTUALLY ORDERED TWICE A DAY ROUTINELY
AND SO THEY WEREN'T CHECKED ON MY SHIFT UNLESS WE USUALLY HAD
A CONCERN.
Q. THEY WEREN'T -- THEY WERE ONLY CHECKED IF THERE WAS A
SPECIAL CONCERN?
A. RIGHT.
Q. AND OF COURSE YOU AND THE OTHER NURSES WOULD CHART YOUR
OBSERVATIONS IN THE MEDICAL RECORDS; IS THAT RIGHT?
A. RIGHT.
Q. AND AS A GENERAL STATEMENT, AM I CORRECT THAT IT WAS VERY
COMMON ON THE GEOPSYCHIATRIC UNIT FOR YOU TO BE TREATING
PATIENTS WITH AGITATION?
A. YES, UH-HUH.
Q. AND ONE OF THE TECHNIQUES THAT CAN USED WITH AGITATION IN
A PSYCHIATRIC WARD IS TO TRY TO REDIRECT THE ATTENTION OF THE
PATIENT; IS THAT RIGHT, MA'AM?
A. YES, UH-HUH.
Q. AND WHEN YOU REDIRECT YOU'RE JUST SORT OF TRYING TO
DIVERT ATTENTION OR TO CHANGE ATTENTION FROM A PARTICULAR
BEHAVIOR?
A. RIGHT, UH-HUH.
Q. AM I ALSO CORRECT THAT GENERALLY SPEAKING WITH THE FIVE
PATIENTS THAT WE'RE GOING TO TALK ABOUT THAT THE CONCEPT OF
REDIRECTION WAS GENERALLY NOT EFFECTIVE WITH THESE PATIENTS?
A. SOMETIMES IT WOULD BE MAYBE MILDLY EFFECTIVE FOR THE
SHORT PERIOD OF TIME, BUT FOR THE MOST PART IT WAS NOT.
Q. NURSE SCHOLL, AM I CORRECT THAT PRIOR TO WORKING ON THE
GEOPSYCHIATRIC WARD YOU PERSONALLY HAD NOT HAD ANY
SPECIALIZED TRAINING IN THE RECOGNITION OF PAIN IN A DEMENTED
PATIENT?
A. NO, I HAD NOT.
Q. I'D LIKE TO BEGIN BY TALKING TO YOU ABOUT MR. ALLDREDGE.
AND I BELIEVE YOU INDICATED TO THE JURY YOU HAVE ONLY A VAGUE
RECOLLECTION OF THIS PATIENT; IS THAT RIGHT?
A. YES.
Q. DOES IT SOUND CORRECT TO YOU, MA'AM, AS A GENERAL
STATEMENT BEFORE WE LOOK AT THE RECORDS TOGETHER, THAT THIS
PATIENT WAS AGITATED THROUGHOUT THE FOUR DAYS OF HIS
HOSPITALIZATION?
A. I COULDN'T SAY OTHER THAN WHAT I HAD OBSERVED, BUT I DID
SEE HIM TWICE THAT I RECALL AND BOTH TIMES HE WAS AGITATED.
Q. OKAY. AND I'M SORRY. BOTH TIMES THAT YOU TREATED HIM,
HE WAS AGITATED?
A. IT SEEMS THAT'S WHAT I RECALL, YES.
Q. LET ME ASK YOU AS A GENERAL STATEMENT, WHEN YOU COME ON
SHIFT, WHEN YOU COME ON YOUR NIGHT SHIFT, WOULD IT BE NORMAL
FOR YOU OR ANY OTHER -- WELL, JUST YOU. LET'S TALK ABOUT
YOU.
WOULD IT BE NORMAL FOR YOU TO CHECK WITH THE NURSES THAT
WERE PASSING THE GAUNTLET TO YOU, PASSING OFF THE CARE AND
BRINGING YOU UP TO SPEED ON SPECIAL PROBLEMS WITH PATIENTS?
A. THAT'S WHAT WE DO IS CALL REPORT, AND THAT'S STANDARD
PROCEDURE IS THEY RUN THROUGH WHAT'S GONE ON DURING ON
THROUGH THE NIGHT AND HOW EACH PATIENT'S BEEN.
Q. I REMEMBER YESTERDAY -- IT SEEMS LIKE A LONG TIME AGO
NOW. BUT LAST NIGHT YOU TOLD US THAT WITH ELLEN ANDERSON FOR
EXAMPLE THAT LAURIE WILSON, NURSE WILSON TOLD YOU ABOUT SOME
SEVERE PAIN WITH THAT PATIENT?
A. YES, UH-HUH.
Q. AND THAT WOULD BE THE KIND OF REPORTING THAT WE'RE
TALKING ABOUT?
A. THAT WOULD BE INCLUDED, YEAH.
Q. FROM NURSE TO NURSE?
A. RIGHT, UH-HUH.
Q. AND IN THE CASE OF MR. ALLDREDGE, AM I CORRECT THAT
SOMEONE WOULD HAVE ADVISED YOU -- OR DOES IT SOUND CORRECT TO
YOU THAT WHEN YOU CAME ON YOUR SHIFT ON JANUARY 11TH THAT YOU
WERE ADVISED BY THE PRIOR NURSE OR THE NURSE YOU WERE TAKING
OVER FROM THAT MR. ALLDREDGE HAD BEEN AGITATED?
A. CAN I LOOK?
Q. WELL, WE'LL LOOK TOGETHER I THINK PROBABLY. IF YOU DON'T
HAVE A MEMORY --
A. I DON'T HAVE ANY SPECIFIC RECOLLECTION, NO.
Q. OKAY. LET'S LOOK AT JANUARY 10TH AND I'M GOING TO TELL
YOU WHERE TO GO IN JUST A SECOND IF YOU'LL HOLD ON.
MR. BUGDEN: AND JUDGE, THIS IS EXHIBIT 6-B, THE
MEDICAL RECORDS AND --
Q. (BY MR. BUGDEN) NOW I UNDERSTAND THAT JANUARY 11TH WAS
THE DAY THAT YOU STARTED TREATING THE PATIENT. BUT I'D LIKE
TO LOOK AT -- WE NEED TO SORT OF LOOK AT JANUARY 10TH, THEN,
AGAIN TO HAVE THE CONTINUUM OF HIS BEHAVIOR WHEN YOU TOOK
OVER HIS CARE, SO THAT'S WHY WE'RE GOING TO LOOK AT JANUARY
10TH, MS. SCHOLL.
JANUARY 10TH I'LL JUST TELL YOU WAS HIS FIRST HOSPITAL
DAY. AND IF I COULD HAVE YOU LOOK AT YOUR PAGE 3.
MR. BUGDEN: JUDGE, THIS IS MEDICAL RECORD 60 OF THE
SAME EXHIBIT AND I'LL BE TALKING ABOUT THIS SAME 6-B FOR A
LITTLE WHILE, JUDGE.
Q. (BY MR. BUGDEN) AND THERE IS A BLOWUP IF YOU COULD TURN
TO THE VERY NEXT PAGE. AND FREQUENTLY, MS. SCHOLL, THAT'S
WHAT I'LL DO IS THE FIRST PAGE WOULD BE JUST TO ORIENT
EVERYONE TO WHAT PAGE WE'RE ON AND THEN I'LL GENERALLY ASK
YOU TO TURN TO THE SECOND PAGE BECAUSE IT'S EASIER TO READ.
NO MATTER WHOSE WRITING IT IS IT WILL BE EASIER FOR YOU TO
READ. AND THE NOTE INDICATES THAT THE PATIENT WAS VERY
COMBATIVE AND AGITATED, PATIENT NOT ORIENTED TO TIME, PLACE,
OR PERSON OR SITUATION.
WOULD THAT HAVE BEEN THE KIND OF NOTE -- OR DO YOU THINK
YOU WOULD HAVE REVIEWED THAT NOTE WHEN YOU TOOK OVER THE CARE
OF MR. ALLDREDGE?
A. NOT SPECIFICALLY.
Q. YOU CAN'T REMEMBER TODAY SEVEN YEARS AGO?
A. WELL, IS THIS A NOTE FROM THE DAY SHIFT, IS IT NOT, AND I
WOULD HAVE BEEN RECEIVING A REPORT FROM THE EVENING SHIFT
NURSE. SO THEY MIGHT HAVE GIVEN ME KIND OF A BRIEF SYNOPSIS
OF WHAT DAY WAS, BUT IT WOULD NOT HAVE BEEN THIS PERSON.
Q. OKAY. LET'S LOOK AT THE NEXT NOTE WHICH IS FOR YOU,
MA'AM, PAGE 5.
MR. BUGDEN: IT'S MED 62, JUDGE.
Q. (BY MR. BUGDEN) AND I BELIEVE THERE'S A BLOWUP OF THIS.
THIS AGAIN IS ON JANUARY 10TH AND IT INDICATES THAT THE
PATIENT'S RESTRAINT HAD OR WAS REAPPLIED AS PATIENT WAS
TRYING TO GET UP. AND DOES THAT MEAN WITH ASSIST OR WITHOUT
ASSIST?
A. IF A PATIENT WAS TRYING TO GET UP I WOULD SAY THAT THAT
MEANT THAT HE WAS TRYING TO GET UP WHEN HE SHOULDN'T HAVE
BEEN, YOU KNOW.
Q. PLUS IS ASSAULTIVE TOWARDS STAFF, HITTING, TRYING TO KICK
AND BITE. WOULD YOU -- WHEN YOU HAD THIS KIND OF A PATIENT,
WOULD IT BE NORMAL FOR THE NURSING STAFF TO GIVE YOU A HEADS
UP AND JUST SAY YOU NEED TO BE CAREFUL FOR YOUR OWN SAFETY?
A. YEAH. REALLY JUST REVIEWING HIS BEHAVIOR, YOU KNOW, WHAT
THEY'D BEEN OBSERVING.
Q. AND YOU'LL SEE LATER ON THE IN THE NOTE THAT IT TALKS
ABOUT THE POSEY RESTRAINT BEING REAPPLIED. WHEN YOU DEALT
WITH THIS PATIENT, YOU ALSO HAD TO KEEP HIM IN A POSEY
RESTRAINT; IS THAT RIGHT?
A. YES, UH-HUH.
Q. NOW, LET'S LOOK AT JANUARY 11TH, WHICH IS THE NEXT PAGE,
MA'AM. AND AGAIN, SO YOU CAME ON AT 11, AND THEN YOU WROTE A
NOTE, IF YOU'D TURN TO PAGE 8 --
MR. BUGDEN: JUDGE, THIS IS MED PAGE 63.
Q. (BY MR. BUGDEN) AT MIDNIGHT THEN, AN HOUR AFTER YOU CAME
ON SHIFT, CAN YOU READ YOUR NOTE FOR US?
A. PATIENT RESTLESS, POSEY. POSEY UNDONE. PATIENT
REPOSITIONED. SEE RESTRAINT ADDENDUM RECORD FOR ADDITIONAL
INFO.
Q. YOU HAD TO -- YOU MOVED HIM -- IT'S A SAFETY ISSUE TO
REPOSITION HIM BUT THEN YOU HAVE TO APPLY THE POSEY
RESTRAINTS; AM I RIGHT?
A. RIGHT.
Q. OKAY. AND THEN AT 2 O'CLOCK, IT'S JUST THE VERY NEXT
PAGE FOR YOU, IT'S THE SAME PAGE, JUDGE, CAN YOU READ YOUR --
WELL, I GUESS JUST SIMPLY THAT AT TWO A.M. THE PATIENT
CONTINUED RESTLESS, REMOVING BEDDING, POSEY UNDONE -- AND I'M
NOT SURE WHAT THAT WORD IS.
A. IT'S ROM FOR RANGE OF MOTION.
Q. WOULD YOU READ THE REST OF IT FOR US?
A. AND PATIENT REPOSITIONED AND REPOSEYED DUE TO AGITATION.
Q. OKAY.
MR. BUGDEN: THEN IF WE COULD GO STILL I THINK THE
SAME PAGE, JUDGE.
Q. (BY MR. BUGDEN) 6 O'CLOCK IN THE MORNING, YOU'RE ALMOST
OFF SHIFT NOW AND AGAIN WITH THE PATIENT WAS STILL AGITATED,
AM I RIGHT? PATIENT VERY AGITATED, CRYING LOUDLY, DO YOU SEE
THAT, MA'AM?
A. YES, UH-HUH.
Q. AND THAT'S YOUR NOTE AS WELL?
A. RIGHT.
Q. SO AS YOU WERE GOING OFF SHIFT AT SEVEN, THE AGITATION
SYMPTOMS HAD CONTINUED THROUGHOUT YOUR SHIFT?
A. RIGHT.
Q. WOULD THAT BE FAIR TO SAY?
A. YES, UH-HUH.
Q. AND THE FIRST DAY THAT HE WAS ADMITTED WAS JANUARY 10TH
AND LET'S SEE --
MR. BUGDEN: MAY I APPROACH THE WITNESS FROM TIME TO
TIME?
THE COURT: YOU MAY.
Q. (BY MR. BUGDEN) SO ON JANUARY 10TH, THE PATIENT HAD
RECEIVED A NUMBER OF HALDOL DOSES AND THEN JANUARY 11TH IS
THE DAY THAT WE HAVE BEEN TALKING ABOUT?
THE COURT: DO YOU WANT HER TO USE MY EXHIBIT WOULD
THAT HELP AND YOU CAN STAY THERE.
MR. BUGDEN: THANKS, JUDGE.
THE COURT: WHY DON'T YOU TAKE THESE. THEY'RE A
COPY OF ALL OF THE CHARTS AND THAT'S MR. ALLDREDGE'S.
MR. BUGDEN: THANK YOU.
Q. (BY MR. BUGDEN) AND THEN THAT SECOND DAY, JANUARY 11TH,
THAT'S THE DAY WE'VE BEEN TALKING ABOUT. AND THAT DAY THE
AGITATION SYMPTOMS CONTINUED THROUGH OUT YOUR SHIFT, THAT'S
WHAT WE'VE JUST SAID; IS THAT RIGHT?
A. I'M SORRY. I WAS STUDYING THIS. SAY -- SAY IT AGAIN.
Q. I'M JUST ASKING YOU: WE JUST REVIEWED TOGETHER JANUARY
11TH?
A. UH-HUH.
Q. AND ON JANUARY 11TH HIS AGITATION CONTINUED?
A. BUT WAS MY JANUARY 11TH THE MORNING -- THE GOING INTO THE
11TH?
Q. JANUARY 11TH WAS THE THREE NURSING NOTES THAT YOU'VE JUST
READ TO THE JURY.
A. RIGHT. BUT IT WAS STARTING AT MIDNIGHT THAT MORNING ON
THE 11TH.
Q. RIGHT.
A. OKAY.
THE COURT: IS THIS ANOTHER QUESTION?
MR. BUGDEN: YEAH. I'LL JUST ASK YOU THE NEXT
QUESTION.
THE WITNESS: OKAY.
Q. (BY MR. BUGDEN) WE'VE JUST GONE THROUGH THE THREE NOTES.
THEN ON JANUARY 12TH, DID YOU TREAT MR. ALLDREDGE ON
JANUARY 12TH?
A. YES, I DID.
Q. OKAY. AND BEFORE YOU CAME ON SHIFT ON JANUARY 12TH,
COULD I ASK YOU TO TURN TO PAGE 11 OF THE DOCUMENTS I'VE
GIVEN YOU.
A. UH-HUH.
Q. AND I GUESS AT EIGHT IN THE MORNING SO THAT'S JUST AN
HOUR AFTER YOU'D GONE OFF SHIFT, MR. ALLDREDGE WAS OFFERED
LIQUIDS AND BREAKFAST AND THE PATIENT JUST SPIT EVERYTHING
OUT, PULLED OFF -- I'M NOT SURE IF I CAN READ THAT -- PULLED
UP AND STRAIGHTENED UP IN CHAIR?
A. IN CHAIR, YEAH.
Q. AND THEN LATER -- I GUESS IS THAT 2 O'CLOCK? WOULD THAT
BE 2 O'CLOCK?
A. YES, UH-HUH.
Q. PATIENT HAS BEEN AGITATED, HITTING AND SPITTING. SO
BEFORE YOU DEALT WITH THE PATIENT ON JANUARY 12TH, HE WAS
STILL AGITATED AND THEN YOU CAME ON SHIFT AT 11. AND THEN IF
WE COULD LOOK AT PAGE MED-71 THEN THERE'S A BLOWUP AT 2345,
SO THAT'S 45 MINUTES AFTER YOU CAME ON SHIFT, AM I RIGHT?
A. YEAH, UH-HUH.
Q. AND HE WAS STILL POSEYED; IS THAT RIGHT?
A. YES, UH-HUH.
Q. AND HE WAS STILL AGITATED AND RESTLESS, AM I RIGHT?
A. RIGHT.
Q. AND SADLY ON THAT OCCASION MR. ALLDREDGE, ACCORDING TO
THE NOTE, HAD SMEARED FECES ALL OVER HIMSELF AND HIS FACE; IS
THAT RIGHT?
A. YES, UH-HUH.
Q. SO WOULD YOU AGREE AS WE'VE LOOKED AT THESE NURSING NOTES
TOGETHER THAT MR. ALLDREDGE HAD REMAINED AGITATED THROUGHOUT
THESE LAST FEW DAYS, WE'VE LOOKED AT TOGETHER?
A. YES, UH-HUH.
Q. AND WOULD YOU AGREE, MA'AM, THAT THE PSYCHOTROPIC
MEDICATION HAD NOT REALLY PUT A DENTS IN AGITATION AT LEAST
AS WE'VE LOOKED AT THESE NOTES TOGETHER?
A. WELL, LOOKING AT THE NOTES IT DOES NOT INDICATE THAT, NO.
Q. PARDON ME?
A. IT DOESN'T INDICATE THAT HE WAS, YOU KNOW --
Q. SEDATED?
A. RIGHT.
Q. OKAY. THEN AT 4:15 THAT'S PAGE 14 FOR YOU.
MR. BUGDEN: IT'S EXHIBIT OR PAGE 71, JUDGE OF THE
MED RECORD THAT WE'RE TALKING ABOUT.
Q. (BY MR. BUGDEN) THEN AT 4:15 YOU ADMINISTERED ATIVAN FOR
MR. ALLDREDGE'S AGITATION, AM I RIGHT?
A. YES, UH-HUH.
Q. AND THIS WAS A P.R.N. ORDER, AN AS NEEDED ORDER; IS THAT
RIGHT?
A. RIGHT, UH-HUH.
Q. OKAY. AND -- OKAY. I THINK THAT THAT'S THE LAST TIME
YOU TREATED THIS PATIENT; IS THAT RIGHT?
A. AS FAR AS I REMEMBER, YES.
Q. NOW, WE'RE GOING TO TALK ABOUT JUDITH LARSEN. NOW, ON
DIRECT EXAMINATION YOU EXPLAINED TO US THAT MR -- OR I'M
SORRY, THAT JUDITH HAD A SEIZURE. WHAT WAS THE DATE THAT SHE
HAD THE SEIZURE, CAN YOU REMEMBER THAT? WAS IT DECEMBER
26TH?
A. YES, UH-HUH.
Q. AND YOU CONTACTED DR. DIENHART, AM I RIGHT?
A. YES, I DID.
Q. AND DID YOU THAT BECAUSE AS YOU'VE EXPLAINED TO US THIS
MORNING, EARLIER THIS MORNING THIS WAS REALLY KIND OF A
MEDICAL ISSUE AND IT JUST MADE SENSE TO YOU TO CONTACT THE
INTERNIST?
A. YES, UH-HUH.
Q. AND DR. DIENHART STARTED THE PATIENT ON AN I.V. FLUIDS;
IS THAT RIGHT?
A. YES, UH-HUH.
Q. THREE MILLIGRAMS OF ATIVAN AND THEN WHEN THAT DIDN'T
PRODUCE THE DESIRED RESULT, HE ADDED ANOTHER MILLIGRAM OF
ATIVAN, AM I RIGHT?
A. YES, UH-HUH.
Q. AND THEN I BELIEVE YOU'VE TOLD US THAT DR. DIENHART WAS
PRESENT, LOOKED AT THE PATIENT, EXAMINED THE PATIENT AT SOME
POINT?
A. YES. YES, HE DID, UH-HUH.
Q. AND THEN CAME A TIME WHEN THE I.V. WAS DISCONTINUED, AM I
RIGHT?
A. YES, UH-HUH.
Q. AND IN FACT, MRS. LARSEN NEVER DID HAVE ANOTHER SEIZURE?
SHE HAD THE ONE SEIZURE WE'VE TALKED ABOUT, SHE DIDN'T HAVE
ANOTHER SEIZURE?
A. NOT THAT WAS NOTED, NO.
Q. AND THEN I BELIEVE YOU ALSO TOLD US I THINK IT MIGHT HAVE
BEEN JANUARY -- OR I'M SORRY DECEMBER 29TH. THERE WAS THE
OCCASION THAT MRS. LARSEN HAD THE VOMITING AS WELL AND YOU
WERE ON CALL?
A. YES, UH-HUH.
Q. I'M SORRY ON DUTY. AND AM I CORRECT, MA'AM, THAT SHE WAS
ON RISPERDAL AT THE SAME TIME THAT SHE WAS HAVING HER BOUT OF
VOMITING?
A. YOU KNOW, I WOULD HAVE TO LOOK AND SEE.
Q. IF SHE WAS ON RISPERDAL -- AND WE MIGHT BE ABLE TO FIND
THAT WHILE I'M ASKING YOU THIS QUESTION -- BUT LET'S JUST
ASSUME FOR A MOMENT THAT SHE WAS ON RISPERDAL AT THE TIME.
RISPERDAL IS OR HAS AS A CONSEQUENCE THAT IT'S AN
ANTI-VOMITING ANTI-EMETIC, ISN'T IT?
A. YOU'RE ASKING ME?
Q. DO YOU KNOW THAT?
A. I DID NOT KNOW THAT, NO.
Q. OKAY. COULD WE SEE MRS. LARSEN'S MEDICAL TREATMENT PLAN?
NOW, IN REVIEWING THE -- THAT'S PAGE 18 FOR YOU, MA'AM.
THE COURT: WHAT EXHIBIT IS IT?
MR. BUGDEN: IT'S 3-B, PAGE 597, JUDGE.
Q. (BY MR. BUGDEN) HAVE YOU FOUND THAT, MA'AM?
A. YES, UH-HUH.
Q. OKAY. WOULD THAT HAVE BEEN -- ALTHOUGH I'M SURE YOU'RE
NOT FAMILIAR WITH IT OR YOU DIDN'T PARTICULAR REMEMBER IT OFF
THE TOP OF YOUR HEAD RIGHT NOW, BUT BACK WHEN YOU WERE
TREATING THE PATIENT WOULD YOU CUSTOMARILY AS A NURSE
PROVIDING CARE TO A PATIENT BE FAMILIAR WITH THE MEDICAL
TREATMENT PLANS FOR PATIENTS?
A. GENERALLY THEY WERE IN THE CHART.
Q. PARDON ME?
A. THEY WERE USUALLY IN THE CHART.
Q. AND SO, I UNDERSTAND THAT THIS IS MANY YEARS AGO, BUT DO
YOU BELIEVE WHEN YOU WERE TREATING THE PATIENT, YOU WOULD
HAVE BEEN AWARE THAT THIS PATIENT DID HAVE A MEDICAL
TREATMENT PLAN IN PLACE?
A. YES.
Q. OKAY. AND THEN THERE'S A BLOWUP I THINK ON THE VERY NEXT
PAGE. SO WOULD YOU HAVE BEEN AWARE THEN, MA'AM, THAT THE
MEDICAL TREATMENT PLAN THAT WAS IN PLACE FOR THIS PATIENT
PROVIDED FOR NO C.P.R. NO I.V.S FOR NUTRITION, HYDRATION,
MEDICATION. WOULD YOU HAVE BEEN AWARE OF THAT, DO YOU THINK?
A. YES. THIS -- BUT I BELIEVE THERE WAS ANOTHER ONE THAT
WAS ACTUALLY SIGNED BY JUDITH HERSELF IN THE CHART, WAS THERE
NOT?
Q. BUT I'M ASKING YOU ABOUT THIS PARTICULAR EXHIBIT. WERE
YOU FAMILIAR WITH THIS EXHIBIT?
A. YES, UH-HUH.
Q. NOW, LET ME ALSO ASK YOU, YOU'VE TOLD US THAT YOU WOULD
HAVE REVIEWED MEDICAL RECORDS TO BE FAMILIAR WITH YOUR
PATIENTS THAT YOU WERE TREATING.
MR. BUGDEN: COULD WE SEE THE NURSING ASSESSMENT
PAGE? AND FOR YOU, MA'AM, THAT'S PAGE 20? THIS IS STILL
3-B, JUDGE. AND THIS IS PAGE MED NUMBER 512, JUDGE.
Q. (BY MR. BUGDEN) AND AT THE TOP OF THE PAGE, MS. SCHOLL,
DO YOU SEE WHERE IT SAYS -- AND THIS IS THE NURSING
ASSESSMENT THAT'S DONE WHEN THE PATIENT COMES ON TO THE UNIT;
IS THAT RIGHT?
A. RIGHT, UH-HUH.
Q. AND DO YOU SEE WHERE AT THE TOP PAGE IT SAYS -- IS THERE
A BLOWUP OF THAT -- THAT THE SON SAYS, WE HAVE HOPES -- BUT
IT'S PAGE 20 TO YOU, MA'AM.
A. YES.
Q. WE HAVE HOPES BUT NOT FANTASIES IN REGARD TO PATIENT'S
CHANCES FOR IMPROVEMENT, WOULD THAT HAVE BEEN SOMETHING THAT
YOU THINK YOU MIGHT HAVE BEEN AWARE OF WHEN YOU WERE TREATING
THIS PATIENT?
A. POSSIBLY.
Q. YOU MIGHT HAVE BEEN AWARE OF THAT?
A. YES, UH-HUH.
Q. AND THEN ON DECEMBER 11TH THERE IS A NOTE WRITTEN BY
BONNIE HARDY, SHE WAS ONE OF THE OTHER NURSES YOU WORKED
WITH; IS THAT RIGHT?
A. YES.
Q. AND IT'S -- I BELIEVE IT'S PAGE --
A. TWENTY-FOUR.
Q. I THINK IT'S 536, LET'S SEE.
A. YEAH, IT'S MY 24.
Q. OKAY. BONNIE -- SO THIS IS A BONNIE HARDY NOTE AND THERE
SHOULD BE A BLOWUP THAT YOU CAN TAKE A LOOK AT.
MR. BUGDEN: JUDGE, THIS IS MED 536.
Q. (BY MR. BUGDEN) THEN AT 730, COULD YOU READ THE NOTE FOR
US, MA'AM?
A. PATIENT'S FAMILY MEMBER CALLED AND REQUESTED INFORMATION
ON PATIENT'S STATUS. FAMILY CONTINUES TO NOT --
Q. WOULD YOU KEEP YOUR VOICE UP JUST A LITTLE BIT LOUDER?
A. OH. CONTINUES TO NOT WANT I.V.S, FEEDING TUBES, ET
CETERA, AS PER LIVING WILL. O2 -- I DON'T KNOW WHAT THAT
SAYS.
Q. I BET IT'S OKAY.
A. OH. OKAY. FAMILY RELEASED TO HEAR --
Q. COULD IT BE RELIEVED?
A. I'M BETTER OFF READING NOT BLOWN UP ONE. JUST A SECOND.
LET ME FIND IT ON HERE. MAYBE I CAN'T FIND IT ON THERE.
Q. FAMILY RELIEVED TO HEAR PATIENT IS NOT SCREAMING OUT OR
AGITATED CURRENTLY, DO YOU NOT SEE THAT?
A. YES, OKAY. I DO NOW.
Q. OKAY. SO YOU WOULD HAVE UNDERSTOOD AS A NURSE THAT YOU
NEEDED TO HONOR THE FAMILY'S WISHES WHEN THE FAMILY HAD
NOTIFIED, FOR EXAMPLE IN THIS CASE, YOUR FELLOW NURSE, BONNIE
HARDY AND TOLD HER ON DECEMBER 11TH THAT WE AS THE FAMILY
DON'T WANT I.V.S, YOU WOULD HAVE BEEN OBLIGATED TO HONOR
THAT, WOULDN'T YOU?
A. WELL, UNLESS THERE WAS A CHANGE SOMEWHERE LATER.
Q. UNLESS THEY CHANGED IT; IS THAT RIGHT?
A. YES, UH-HUH.
Q. AND THEN ON DECEMBER 30TH MED PAGE 578, MA'AM.
A. UH-HUH.
Q. AND FOR YOU THERE'S A BLOWUP ON PAGE, YOU CAN LOOK AT
WHICHEVER PAGE YOU'RE MORE COMFORTABLE READING. BUT THERE'S
PAGE 12/30 -- I'M SORRY, PAGE MED 578 ON DECEMBER 30TH.
THEN THERE'S THE BLOWUP. THAT'S THE ONE I'M GOING TO LOOK
AT, BUT YOU CAN LOOK AT WHICHEVER ONE IS MORE COMFORTABLE FOR
YOU.
ARE YOU THERE?
A. UH-HUH.
Q. FAMILY -- PATIENT FAMILY IN TO SEE PATIENT, AWARE OF
PHYSICAL STATUS AND THEN CAN YOU READ THAT FOR US -- THE NEXT
SENTENCE?
A. FAMILY STATES THEY WANT D.N.R. STATUS MAINTAINED AND
COMFORT MEASURES GIVEN.
Q. OKAY. SO FROM DECEMBER 10TH UNTIL DECEMBER 30TH, IT'S
PRETTY CLEAR FROM THESE NURSING NOTES THAT THE FAMILY STILL
WANTS THE D.N.R. STATUS MAINTAINED, RIGHT? THAT'S WHAT IT
SAYS.
A. YES.
Q. D.N.R. MEANS DO NOT RESUSCITATE; IS THAT RIGHT?
A. YES, UH-HUH.
Q. AND THEN IF WE COULD LOOK AT 577 AT 9 O'CLOCK AT NIGHT.
DO YOU SEE THAT NOTE, MA'AM? PAGE 29 TO YOU.
A. YES.
Q. AND CALLED SON GAVE STATUS REPORT ON PATIENT'S CONDITION.
SON MERLIN STRESSED THAT, QUOTE, ONLY WISHED TO KEEP HER
COMFORTABLE, END QUOTE. AND I THINK THAT MIGHT BE SIGNED BY
NURSE KLEI, DID I READ IT CORRECTLY?
A. YES, UH-HUH.
Q. SO WOULD THAT TOO HAVE BEEN A NOTE THAT YOU WOULD HAVE
BEEN AWARE OF THAT THE SON HAD DECIDED THAT THEY ONLY WANTED
TO KEEP THEIR MOTHER COMFORTABLE? WOULD THAT HAVE BEEN
SOMETHING THAT YOU AS A TREATING NURSE WOULD HAVE BEEN AWARE
OF THIS PROGRESSION OF NOTES WHERE THE FAMILY SAID THREE OR
FOUR TIMES THAT WE'VE JUST READ TOGETHER WE DON'T WANT
ANYTHING DONE, WE JUST WANT TO LET HER GO, WE WANT COMFORT
CARE? WOULD YOU HAVE BEEN FAMILIAR WITH THOSE NOTES, MA'AM?
A. WELL, I DON'T KNOW WHETHER I WOULD HAVE SPECIFICALLY READ
THE NOTE BUT THE INFORMATION, KIND OF THE GIST OF IT WOULD
HAVE BEEN PASSED ON IN REPORT.
Q. OKAY. BUT YOU MAY NOT HAVE ACTUALLY SPECIFICALLY READ
THESE NOTES SO YOU MIGHT NOT HAVE BEEN ATTUNED TO THE FACT
THAT THE LARSEN'S HAD SAID THREE OR FOUR DIFFERENT TIMES WHAT
WE'VE JUST READ TOGETHER? YOU MIGHT NOT HAVE KNOWN THAT?
A. WELL, NO. I WOULD SAY -- I WOULDN'T SAY I KNEW THAT. I
JUST DIDN'T SPECIFICALLY READ EACH AND EVERY NOTE.
Q. OKAY. AND WOULD YOU AGREE, MA'AM, THAT WHEN A PATIENT'S
FAMILY MEMBER, A SON IN THIS CASE, SAYS WE ONLY WISH TO KEEP
HER COMFORTABLE, WOULD YOU UNDERSTAND THAT TO MEAN CONSISTENT
WITH THIS SERIES OF NOTES THAT THE FAMILY HAD ACCEPTED THAT
THEIR LOVED ONE WAS GOING TO DIE?
A. IT WOULD APPEAR THAT WAY.
Q. WOULD YOU TRY TO KEEP YOUR VOICE UP?
A. I'M SORRY. IT WOULD APPEAR THAT WAY.
Q. AND SO FOR THIS FAMILY, THE DEATH OF MRS. LARSEN CLEARLY
BY THIS NOTE ON DECEMBER 30TH, THE DEATH OF THEIR MOTHER WAS
FORESEEABLE?
MS. BARLOW: OBJECTION. I THINK THAT'S CALLING FOR
SPECULATION ABOUT WHAT THE FAMILY WAS FEELING OR KNOWING AND
THIS IS NOT HER NOTE.
THE COURT: OVERRULED.
Q. (BY MR. BUGDEN) THAT MEANS YOU SHOULD ANSWER THAT
QUESTION, PLEASE.
A. SAY IT AGAIN.
Q. THE FAMILY HAD ACCEPTED DEATH, YOU AGREE WITH THAT, FROM
THIS NOTE?
A. IT WOULD APPEAR THAT WAY, YES, UH-HUH.
Q. THAT THE DEATH OF THEIR MOTHER WAS FORESEEABLE NOW?
A. IT WOULD APPEAR THAT WAY, YES.
Q. AND THAT DEATH OF THEIR MOTHER IT COULD BE TOMORROW, IT
COULD BE TWO DAYS FROM NOW, WE CAN'T REALLY SAY AT THAT
POINT, CAN WE?
A. RIGHT.
Q. AT THE POINT THAT THE FAMILY TELLS THE NURSING STAFF AND
THE DOCTOR THAT THEY ARE NO -- THAT THEY ONLY WANT COMFORT
CARE, THIS NOTE RIGHT HERE, ONLY WISHED TO KEEP HER
COMFORTABLE, WOULDN'T YOU AGREE, MA'AM THAT WE ARE NO LONGER
TALKING ABOUT CURING THE PATIENT, WOULDN'T YOU AGREE WITH
THAT?
A. THAT'S TRUE.
Q. AND THE FAMILY WAS NO LONGER TRYING TO PROLONG
MRS. LARSEN'S LIFE, WOULDN'T YOU AGREE WITH THAT?
A. YES.
Q. AND WOULDN'T YOU AGREE THAT THE FAMILY WAS NO LONGER
TRYING TO PROLONG HER PROCESS OF DYING?
A. THAT'S TRUE.
Q. INSTEAD, THIS FAMILY WAS FOCUSING ON PROVIDING THEIR
MOTHER WITH A PEACEFUL, PAIN-FREE DEATH, ISN'T THAT WHAT THAT
MEANS, MA'AM?
A. YES, UH-HUH.
Q. NOW, WHEN THE FAMILY HAS ISSUED DIRECTIVES TO THE
HEALTHCARE PROVIDER THAT THEY KNOW THAT THEIR LOVED ONE --
THAT THEIR LOVED ONE'S DEATH IS FORESEEABLE AND THEY WANT
THAT PERSON TO MERELY BE KEPT COMFORTABLE, VITAL SIGNS REALLY
DON'T MAKE A DIFFERENCE WHEN THE FAMILY'S ACCEPTED THAT
MOTHER OR FATHER IS GOING TO DIE, ISN'T THAT TRUE?
A. YES.
Q. THANK YOU.
AND IN JUDITH LARSEN'S CASE, WHAT HAPPENED WAS THAT ON
JANUARY 3RD YOU CHECKED HER VITAL SIGNS AND YOU CONCLUDED
THAT BECAUSE HER RES -- AND ONE OF THE VITAL SIGNS -- A
RESPIRATION RATE IS CONSIDERED A VITAL SIGN IN THE NURSING
PROFESSION, AM A RIGHT?
A. YES, UH-HUH.
Q. SO ON JANUARY 3RD, YOU WITHHELD MORPHINE THREE TIMES.
THE FAMILY HAD SAID THEY WANTED THEIR MOTHER TO ONLY BE KEPT
COMFORTABLE, BUT ON JANUARY 3RD YOU WITH HELD MORPHINE THREE
TIMES BECAUSE HER RESPIRATION RATE WAS DANGEROUSLY LOW IN
YOUR OPINION, IS THAT RIGHT?
A. THAT'S CORRECT.
Q. IN OTHER WORDS, YOU CHECKED THIS VITAL SIGN AND IT
APPEARED TO YOU THIS WOMAN'S DEATH WAS IMMINENT OR THAT THE
RESPIRATION RATE WAS SO LOW THAT IT LOOKED LIKE SHE WAS GOING
TO DIE; IS THAT RIGHT?
A. I FELT THAT IF SHE WERE TO RECEIVE FURTHER MORPHINE THAT
I WOULD BE ADMINISTERING SOMETHING THAT WOULD KILL HER, YES.
Q. BUT THE FAMILY AS WE'VE JUST REVIEWED TOGETHER, THEY HAD
TOLD YOUR STAFF WHAT THEY WANTED AND WHAT THEY WANTED WAS A
PEACEFUL PASSING FOR THEIR MOTHER; ISN'T THAT RIGHT?
A. THAT'S WHAT IT SAYS. BUT I COULD NOT KNOWINGLY DO THAT.
Q. YOU HAD A DIFFERENT VIEW?
A. I JUST COULD NOT KNOWINGLY GIVE SOMEBODY SOMETHING THAT
WOULD KILL THEM.
Q. DO YOU AGREE THAT WITH PAIN MANAGEMENT, MA'AM, AND I
UNDERSTAND THAT YOU DIDN'T BELIEVE THIS PATIENT WAS IN PAIN,
YOU'VE MADE -- WE HEARD THAT ON DIRECT EXAMINATION. BUT DO
YOU AGREE, MA'AM, THAT WITH PAIN MANAGEMENT, THE GOAL WITH
PAIN MANAGEMENT IS TO PREVENT PAIN FROM RETURNING? DO YOU
AGREE THAT THAT IS A GOAL?
A. YES, UH-HUH.
Q. AND DO YOU AGREE THAT PART OF THE METHODOLOGY BY WHICH WE
PREVENT PAIN FROM RETURNING TO PATIENTS IS THAT YOU ESTABLISH
A CONTINUOUS LEVEL OF PAIN MEDICATION SO THAT THE PAIN WILL
NOT RETURN, DO YOU AGREE WITH THAT, MA'AM?
A. THAT'S TRUE.
Q. AND DO YOU AGREE, MA'AM, THAT BY WITHHOLDING MORPHINE
THREE TIMES THAT HAD BEEN ORDERED FOR THIS PATIENT, THE
EFFECT OF THAT WAS THAT YOU DROPPED THE FLOOR OUT FROM
UNDERNEATH THE CONTINUOUS DOSING LEVEL?
MS. BARLOW: OBJECTION. I THINK THE FORM OF THE
QUESTION IS ARGUMENTATIVE.
THE COURT: OVERRULED. YOU MAY ANSWER.
MR. BUGDEN: WOULD YOU ANSWER THE QUESTION, PLEASE?
THE WITNESS: WELL, IF SHE WERE IN PAIN.
Q. (BY MR. BUGDEN) NOW, I BELIEVE YOU TOLD US BOTH
YESTERDAY IN ANSWER TO ONE OF MS. BARLOW'S QUESTIONS AND I
BELIEVE YOU TOLD US AGAIN TODAY THAT A NURSE DOES HAVE AN
OBLIGATION WHEN THEY WITHHOLD MEDICATIONS TO NOTIFY THE
DOCTOR; IS THAT RIGHT?
A. YES, UH-HUH.
Q. THE DOCTOR, WITH ALL DUE RESPECT AND I SAY THAT DUTIFULLY
OR RESPECTFULLY TO YOU, BUT THE NURSE IS THE NURSE AND THE
DOCTOR IS THE CAPITAN OF THE SHIP; IS THAT RIGHT?
A. TRUE.
Q. AND SO THE NURSE DOES HAVE AN OBLIGATION, A NURSING
OBLIGATION, IF THEY EXERCISE THEIR JUDGMENT THAT THEY WANT TO
WITHHOLD MEDICATION TO NOTIFY THE DOCTOR; ISN'T THAT RIGHT?
A. YES. BUT HE WAS NOTIFIED.
Q. YOU'VE THEN TOLD US ABOUT A GROUP MEETING THAT TOOK PLACE
THE NEXT DAY WITH -- AND DR. WEITZEL SPOKE AT THAT MEETING;
IS THAT RIGHT?
A. IT MAY NOT HAVE BEEN THE VERY NEXT DAY BUT IT WAS SOON
THEREAFTER.
Q. OKAY. AND DR. WEITZEL ADVISED THOSE IN ATTENDANCE, IF
YOU'RE GOING TO WITHHOLD MEDICATION, CALL ME FIRST, LET ME
KNOW; IS THAT CORRECT?
A. WELL, IT WASN'T "IF", IT WAS "DON'T UNLESS".
Q. OKAY. LET'S LOOK AT THE NOTE THAT WAS WRITTEN I BELIEVE
IT'S MED 466. IS THERE A BLOWUP?
A. WELL, MY --
Q. HOLD ON, MA'AM. I'M NOT WITH YOU AND NEITHER IS MY
ASSISTANT. I BELIEVE FOR YOU, MA'AM, IT'S PAGE 43. ARE YOU
THERE?
A. UH-HUH.
Q. AM I READING THIS CORRECTLY, IF ANY MORPHINE SULPHATE IS
TO BE WITHHELD, PLEASE CALL ME FIRST. IS THAT WHAT IT READS?
A. YES, IT IS.
Q. THANK YOU.
I'D LIKE TO ASK YOU SOME QUESTIONS ABOUT MARY CRANE NOW.
AM I RIGHT, MA'AM, YOU THAT YOU ONLY REALLY HAVE A VAGUE
RECALL OF THIS PATIENT?
A. YES, UH-HUH.
Q. AND YOUR MEMORY IS GOING TO BE BASED VERY MUCH ON JUST
WHATEVER THE NURSING NOTES SAY?
A. PRETTY MUCH, YES.
Q. ON 12/29 I BELIEVE YOU TESTIFIED ABOUT THE PATIENT
BEING -- AND I'VE GOT TO ASK YOU TO HOLD ON FOR JUST A MINUTE
THERE'S NOT ACTUALLY A PAGE IN FRONT OF YOU. BUT IF WE COULD
TRY TO PULL UP PAGE 307.
BUT I BELIEVE IN, AGAIN, YOUR EXAMINATION THIS MORNING,
YOU INDICATED THAT THE PATIENT WAS QUIET. LET'S -- DOWN
HERE, CAN YOU READ THAT FROM WHERE YOU ARE?
THE COURT: YOU CAN SLIDE OVER IF YOU NEED TO,
MS. SCHOLL.
Q. (BY MR. BUGDEN) SOMEONE ON THE STAFF HAS INDICATED THAT
SHE WAS UNCOOPERATIVE AND AGITATED. NOW, HOW DO THESE GET
FILLED OUT? HOW IS THAT DONE?
A. THE DAY NURSE FILLED THAT OUT.
Q. THE DAY NURSE FILLED THAT OUT. NOW YOU TOOK CARE OF THIS
PATIENT ON JANUARY 4TH; AM I RIGHT?
A. YES, UH-HUH.
MR. BUGDEN: AND THIS IS EXHIBIT 4-B, JUDGE.
Q. (BY MR. BUGDEN) AND ON JANUARY 4TH AT 430 IN THE MORNING
YOUR NOTE INDICATES THE PATIENT AWAKENED MOANING, COMPLAINS
OF PAIN, AM I RIGHT?
A. UH-HUH.
Q. AND TYLENOL WAS GIVEN AS ORDERED, THAT'S WHAT YOUR NOTE
INDICATES, AM I RIGHT?
A. YES.
Q. BUT THE TYLENOL WASN'T REALLY VERY EFFECTIVE, AM I RIGHT?
A. RIGHT.
Q. AND THEN AT 6 O'CLOCK YOU'VE WRITTEN THAT THE PATIENT
CONTINUED TO MOAN. THE TYLENOL HAD LITTLE EFFECT; IS THAT
RIGHT?
A. YES.
Q. AND I'M SORRY. ALSO I WONDER IF WE COULD SEE 321, PAGE
321. AND I THINK IT'S -- YOU DON'T HAVE IT THERE, MA'AM.
I BELIEVE THAT THE PATIENT REPORTED THAT SHE HURT. IS
THIS STILL ON YOUR SHIFT AT SIX?
A. RIGHT. THE AIDE WROTE THAT.
Q. PARDON ME?
A. THE AIDE WROTE THAT.
Q. BUT SHE WAS WORKING WITH YOU?
A. UH-HUH.
Q. SO TYLENOL HAD BEEN TRIED, SHE REPORTED THAT SHE STILL
HURT, YOU COULD SEE THAT IT HADN'T HAD MUCH OF AN EFFECT, AND
THEN YOU GOT WHAT'S CALLED A NOW ORDER OF MORPHINE FROM
DR. WEITZEL; IS THAT RIGHT?
A. RIGHT. HE HAD COME IN.
Q. HE WAS THERE AT THAT TIME?
A. RIGHT. AND WROTE THE ORDER.
Q. OKAY. AND CAN YOU REMEMBER, DID THE PATIENT RESPOND OR
DID YOU GO OFF SHIFT THEN PROBABLY?
A. WELL, I'VE NOT WRITTEN AGAIN SO WE PROBABLY LEFT BEFORE
WE HAD NOTICED.
Q. OKAY. AND THEN JANUARY 6TH YOU SAW THE PATIENT THAT DAY
AS WELL. I BELIEVE IT'S PAGE 53, MS. SCHOLL. IN LOOKING AT
THAT PAGE. DOES THAT APPEAR TO BE YOUR NOTE?
A. YES, UH-HUH.
THE COURT: WHAT'S THE COURT'S PAGE MR. BUGDEN?
MR. BUGDEN: 326 OF 4-B.
Q. (BY MR. BUGDEN) AND AT 6 A.M. THE PATIENT WAS MOANING,
AM I RIGHT?
A. YES.
Q. AND THEN AT 6:15 YOU ADMINISTERED A FIVE MILLIGRAM DOSE
OF MORPHINE, AM I RIGHT?
A. YES, UH-HUH.
Q. THAT WAS A P.R.N. ORDER, AN AS-NEEDED ORDER; IS THAT
RIGHT?
A. RIGHT.
Q. AND YOUR NOTE INDICATES THAT THE PATIENT APPEARS MORE
COMFORTABLE AFTER RECEIVING THE MORPHINE; IS THAT RIGHT?
A. RIGHT, UH-HUH.
Q. SO THE MORPHINE, YOU WOULD AGREE, DID HELP THIS PATIENT,
MADE THIS PATIENT FEEL BETTER?
A. YES, IT DID.
Q. AND THIS MORPHINE, THE P.R.N. ORDER THAT YOU CALLED IN
FOR -- OR I'M SORRY. I SAID THAT WRONG.
THIS P.R.N. ORDER OF MORPHINE THAT YOU GAVE, THIS WAS ON
TOP OF A DURAGESIC PATCH BECAUSE THIS PATIENT, MARY CRANE,
HAD A DURAGESIC PATCH; IS THAT RIGHT?
A. AND SHE HAD IT ON AT THIS TIME?
Q. RIGHT.
A. SHE WOULD HAVE IN ADDITION TO.
Q. SO IN OTHER WORDS SHE WAS RECEIVING CONTINUOUS DOSING
FROM THE DURAGESIC PATCH, SHE HAD THIS EPISODE OF
BREAKTHROUGH PAIN EVEN WITH A DURAGESIC PATCH, AND THEN YOU
FELT IT APPROPRIATE USING YOUR NURSING DISCRETION TO
ADMINISTER A FIVE MILLIGRAM P.R.N. ORDER OF MORPHINE, RIGHT?
A. RIGHT.
Q. THANK YOU. NOW I'M GOING TO ASK YOU SOME QUESTIONS ABOUT
LYDIA SMITH, PLEASE.
NOW, THIS IS A PATIENT THAT DID SHOW QUITE A BIT OF
AGITATION, ISN'T THAT TRUE, MA'AM?
A. YES.
Q. YOU DESCRIBED IT THAT SHE WAS FEISTY OR -- AM I RIGHT?
A. THAT'S ONE OF THE WORDS, UH-HUH.
Q. LET'S LOOK AT DECEMBER 22ND. THIS IS EXHIBIT 5-B PAGE
761. AND FOR YOU, MA'AM, IT WOULD BE PAGE 56.
ARE YOU THERE?
A. UH-HUH.
Q. AND THIS IS YOUR NOTE, AM I RIGHT?
A. UH-HUH.
Q. AND AT 1:30 IN THE MORNING, AM I READING THAT RIGHT?
A. RIGHT, UH-HUH.
Q. THE PATIENT WAS AGITATED UP AND DOWN IN BED; IS THAT
RIGHT?
A. RIGHT.
Q. AND IF WE COULD TURN TO DECEMBER 26TH, WHICH IS I BELIEVE
THE NEXT DAY THAT YOU WORKED WITH THIS PATIENT. PAGE 769.
MR. BUGDEN: MED NUMBER 769, JUDGE.
Q. (BY MR. BUGDEN) AND I BELIEVE THERE WILL BE A BLOWUP IF
YOU CAN LOOK AT IT. WHAT I WANT TO SHOW HERE -- WOULD YOU GO
BACK TO THE LAST PAGE FOR JUST A MOMENT? I JUST WANT TO SHOW
YOU AGAIN SO WE HAVE A CONTINUUM BEFORE YOU COME ON. THIS IS
ACTUALLY CHRISTMAS DAY, DECEMBER 25TH, DO YOU SEE THAT? I
THINK I'M READING IT RIGHT.
A. UH-HUH.
Q. THE PATIENT WAS THROWING MILK CARTONS AT PATIENTS AND
STAFF, ATTEMPTING TO BITE, STRIKING OUT, PULLING ARMS OF
ANOTHER PATIENT, SPITTING, GRABBING, AND ATIVAN WAS GIVEN BY
BONNIE HARDEY, DO YOU SEE THAT?
A. UH-HUH.
Q. AND THEN AT 8:30, JUST 45 MINUTES LATER, ARE YOU THERE?
A. NOW I AM.
Q. THANK YOU VERY MUCH.
THIS IS JUST 45 MINUTES LATER THE PATIENT ALTHOUGH HAS
HAD THE ATIVAN WAS SLAPPING AT HANDS, CLENCHING TEETH AND SO
HALDOL WAS GIVEN, A P.R.N. ORDER OF HALDOL WAS GIVEN.
MR. BUGDEN: THIS IS PAGE 769, JUDGE.
Q. (BY MR. BUGDEN) DO YOU SEE THAT, MA'AM?
A. YES, I DO.
Q. AND THEN AFTER RECEIVING THE HALDOL, THE PATIENT'S
AGGRESSIVE ACTS DECREASED; IS THAT RIGHT?
A. YES, UH-HUH.
Q. THEN DECEMBER 26, THEN THAT THEN I THINK IS THE NEXT DAY
THAT YOU WORK WITH HER. AND AT 2 A.M., WHICH IS PAGE 770 AND
LET'S SEE I THINK IT'S PAGE 62, FOR YOU, MA'AM.
A. UH-HUH.
Q. GOOD. YOU'RE THERE. THANK YOU.
SO AT 2 A.M. -- THERE MIGHT BE A BLOWUP. THE PATIENT --
YOU WROTE THAT THE PATIENT WAS AGITATED, REPEATEDLY TRYING TO
GET OUT OF BED, KICKING, THROWING CLOTHING, AM I RIGHT?
A. UH-HUH.
Q. AND THEN YOU ADMINISTERED ONE MILLIGRAM OF ATIVAN AND
THEN THE PATIENT WAS CALMER AFTER THE ATIVAN, CALMED DOWN?
A. UH-HUH.
Q. IS THAT RIGHT?
A. THAT'S RIGHT.
Q. AND I THINK MAYBE THE NEXT DAY THAT YOU DEALT WITH
MS. CRANE -- MRS. CRANE WAS DECEMBER 29TH. THAT'S PAGE 777.
AGAIN, THERE'S I THINK A BLOWUP.
THE PATIENT WAS COMBATIVE, STRIKING OUT, KICKING, PULLING
AT STAFF CLOTHING, AND HAD TO BE RESTRAINED OR WAS -- HAD THE
POSEY BELT; IS THAT RIGHT?
A. RIGHT.
Q. THEN AT 6:30 THE SAME DAY YOU'VE WRITTEN A NOTE THAT THE
POSEY WAS OFF TO ALLOW PATIENT MOVEMENT BUT THE PATIENT HAD
INCREASING AGITATION; IS THAT RIGHT?
A. RIGHT.
Q. THEN ON JANUARY 3RD I BELIEVE YOU TESTIFIED EARLIER THAT
THE PATIENT WAS EXTREMELY AGITATED THAT DAY AND THAT'S WHEN
HALDOL WAS GIVEN TO THE PATIENT. DO YOU REMEMBER THAT FROM
THIS MORNING BEFORE THE BREAK?
A. WAS THAT THE ONE THAT SAYS PAGE 67? MY 67?
Q. I THINK IT'S -- RIGHT. YOU ARE RIGHT.
A. OKAY. BECAUSE THAT WAS GIVEN BY SOMEONE ELSE.
Q. BUT HALDOL, TWO MILLIGRAMS OF HALDOL WAS GIVEN
INTRAMUSCULARLY, IS THAT RIGHT, BY SHEILA HANSEN, IS IT?
A. RIGHT, UH-HUH.
Q. AND THAT WAS BECAUSE HER AGITATION WAS OUT OF CONTROL AT
THAT POINT; IS THAT RIGHT?
A. IT SAYS BECAUSE SHE WAS REFUSING HER MEDS.
Q. OKAY. THEN ON JANUARY 4TH, IF YOU COULD LOOK AT THAT
THAT'S MED PAGE 794. AND AT 4:45 IN THE MORNING YOU'VE
INDICATED -- ON JANUARY 4TH AT 4:45 YOU INDICATED THAT SHE
WAS RESTLESS, BITING AT THE STAFF, STRIKING OUT, KICKING SO
I.M. INTRAMUSCULAR ATIVAN WAS ORDERED?
A. RIGHT.
Q. WHEN YOU SAY ORDERED IT WAS A P.R.N. IS THAT RIGHT?
A. RIGHT.
Q. SO YOU BELIEVED IT WAS NECESSARY TO TREAT THIS PATIENT
WITH THE ATIVAN, AGAIN, TO TRY TO GET HER AGITATION UNDER
CONTROL; ISN'T THAT RIGHT?
A. RIGHT.
Q. AND THEN I BELIEVE YOU INDICATED AT 6 O'CLOCK IN THE
MORNING THAT SHE WAS CALMER BUT THAT SHE CONTINUED TO HAVE
DIFFICULTY SLEEPING.
MR. BUGDEN: THAT'S PAGE 794, JUDGE.
Q. (BY MR. BUGDEN) 72, FOR YOU MA'AM. HAVE YOU MOVED TO
72? ARE YOU THERE?
A. WELL, I LIKE THE LITTLE PAGE BETTER.
Q. AM I RIGHT?
A. UH-HUH, YES.
Q. THAT SHE WAS CALMER BUT SHE DID HAVE DIFFICULTY SLEEPING?
A. RIGHT.
Q. SO THE ATIVAN DID HELP THIS PATIENT; IS THAT RIGHT?
A. YES, IT DID.
Q. WOULD YOU AGREE AS WE LOOK AT THE ATIVAN AND THE HALDOL
THAT HAD TO BE GIVEN SOMETIMES P.R.N. MEANING AS NEEDED THAT
THIS WAS A -- THAT MRS. SMITH WAS A DIFFICULT TO TREAT
PATIENT?
A. USUALLY TRYING TO DIVERT HER WAS NOT EFFECTIVE, THAT'S
TRUE.
Q. PARDON ME?
A. TRYING TO DIVERT HER AND REDIRECT HER WAS GENERALLY NOT
EFFECTIVE, THAT'S TRUE.
Q. AND WHEN YOU WERE ADMINISTERING OR EXERCISING YOUR
DISCRETION IN GIVING A P.R.N. SHOT OF ATIVAN, YOU CERTAINLY
DIDN'T THINK THAT YOU WERE HURTING THE PATIENT, DID YOU?
A. NO, I DIDN'T.
Q. AND THEN ON JANUARY 5TH --
MR. BUGDEN: PAGE 796, JUDGE.
Q. (BY MR. BUGDEN) -- AT 1:30 IN THE MORNING, PATIENT WAS
VERY AGITATED, STRIKING OUT AT THE STAFF; IS THAT RIGHT?
A. YES, UH-HUH.
Q. AND HALDOL -- ONE MILLIGRAM OF HALDOL WAS GIVEN FOR THIS
AGITATION THAT YOU'VE NOTED?
A. RIGHT.
Q. AGAIN, THIS WAS A P.R.N. ORDER, THIS WAS AN ORDER THAT
YOU'VE DECIDED NEEDED TO BE -- THE MEDICATION NEEDED TO BE
GIVEN BECAUSE OF HER AGITATION?
A. RIGHT.
Q. OKAY. THEN THE LAST PERSON WE NEED TO TALK ABOUT IS
ELLEN ANDERSON. AND YESTERDAY YOU TOLD MS. BARLOW THAT THE
TWO THINGS THAT STUCK OUT IN YOUR MIND ABOUT THIS PATIENT
WERE THAT THIS PATIENT WAS ONLY ON THE UNIT A VERY SHORT TIME
AND THAT SHE WAS IN SEVERE PAIN, AM I RIGHT?
A. APPEARED TO BE, YES, UH-HUH.
Q. AND WHEN YOU CAME ON SHIFT, LAURIE WILSON EXPLAINED TO
YOU THAT THIS PATIENT HAD DEMONSTRATED OR EXHIBITED TO HER
SEVERE PAIN SYMPTOMS; IS THAT RIGHT?
A. RIGHT.
Q. SHE POINTED OUT THAT THIS WOMAN HAD OSTEOPOROSIS; IS THAT
RIGHT?
A. RIGHT.
Q. AND SO ONCE AGAIN, YOU CAME ON SHIFT AT 1 O'CLOCK, LAURIE
BROUGHT YOU UP TO SPEED ABOUT HOW MUCH PAIN SHE HAD SEEN IN
THIS PATIENT AND I GUESS SHE HAD TOLD YOU THAT SHE HAD GIVEN
HER A SHOT AT 7:30 OR EIGHT THAT NIGHT; IS THAT RIGHT?
A. RIGHT, UH-HUH.
Q. AND DO YOU THINK SHE TOLD THAT YOU THE PATIENT WAS CALMER
AFTER SHE GOT THE MORPHINE?
A. YES, SHE DID.
Q. OKAY. SO IT APPEARED TO HAVE ITS DESIRED EFFECT OF
HELPING TO RELIEVE THE SYMPTOM OF PAIN; IS THAT RIGHT?
A. YES.
Q. AND THEN AT 1 O'CLOCK -- AM I RIGHT, WAS SHE -- WAS
MRS. ANDERSON SLEEPING AT THAT TIME?
A. AT ONE?
Q. TWELVE OR ONE.
A. YES. YES, SHE WAS.
Q. SO SHE WAS RESTING AT 12 O'CLOCK AT NIGHT, THAT'S A GOOD
THING, ISN'T IT? THAT WOULD BE EXPECTED, WOULDN'T IT?
A. YES.
Q. AND THEN YOU'VE TOLD US THAT SHE HAD RESPIRATION RATE OF
EIGHT TO 16, THAT'S -- AND THAT'S IN THE NORMAL RANGE, RIGHT?
A. WELL, THE 16 IS. THE EIGHT WOULD NOT.
Q. DR. DIENHART TESTIFIED LAST WEEK THAT EIGHT TO 20 WOULD
BE A NORMAL RESPIRATION RATE. DO YOU DISAGREE WITH
DR. DIENHART?
A. WELL, I'LL TELL YOU NURSING SCHOOL, LIKE YOU POINTED OUT,
IS DIFFERENT THAN DOCTOR SCHOOL.
Q. OKAY. THANK YOU VERY MUCH. THEN AT 3:15 MRS. ANDERSON
AWAKENED; IS THAT RIGHT?
A. YES.
Q. AND SHE -- LET'S SEE. I BELIEVE IT'S PAGE 86 MS. SCHOLL.
A. UH-HUH.
THE COURT: WHAT PAGE IS IT FOR THE RECORD?
MR. BUGDEN: THANK YOU, JUDGE. 191.
Q. (BY MR. BUGDEN) I BELIEVE THERE'S A BLOWUP THAT HELPS
ME AT 315. THE PATIENT AWAKENED AND YOU'VE WRITTEN THRASHING
ARMS, ATTEMPTING TO THROW BODY, PATIENT MOANING AND
SCREAMING, THAT'S WHAT YOU'VE WRITTEN; IS THAT RIGHT?
A. RIGHT.
Q. AND YOU BELIEVE THAT THIS PATIENT WAS IN EXTREME PAIN AT
THAT POINT; ISN'T THAT RIGHT?
A. YES, I DID.
Q. AND BECAUSE YOU SAW HER THRASHING ABOUT AND SCREAMING AND
LET ME STOP YOU -- EVEN THOUGH I RECOGNIZE AND I APPRECIATE
YOU SHARING WITH US THAT YOU'VE NOT HAD ANY SPECIALIZED
TRAINING IN RECOGNIZING SYMPTOMS OF PAIN IN DEMENTED
PATIENTS, WOULD I BE RIGHT THAT SCREAMING AND WRITHING ARE
PRETTY UNIVERSALLY RECOGNIZED --
MS. BARLOW: YOUR HONOR, I OBJECT TO WRITHING.
THERE'S NO INDICATION OF WRITHING.
THE COURT: SUSTAINED.
Q. (BY MR. BUGDEN) THRASHING. SCREAMING AND THRASHING ARE
PRETTY UNIVERSALLY ACCEPTED TO BE SYMPTOMS OF PAIN? WOULD
YOU AGREE WITH THAT?
A. YOU KNOW, I -- THAT NIGHT I INTERPRETED IT THAT WAY.
Q. THANK YOU.
AND IT WAS OBVIOUS ENOUGH TO YOU THAT SHE WAS IN PAIN
THAT YOU CONTACTED DR. WEITZEL, RIGHT?
A. YES.
Q. REPORTED TO HIM HER VITAL SIGNS, RIGHT?
A. RIGHT.
Q. TOLD HIM THAT SHE IS IN EXTREME PAIN, CORRECT?
A. YES.
Q. WANTED HIM TO KNOW THAT THIS PATIENT WAS VERY
UNCOMFORTABLE, RIGHT?
A. RIGHT.
Q. AND HE ORDERED A SHOT OF MORPHINE, AM I RIGHT?
A. RIGHT.
MR. BUGDEN: THAT'S ALL I HAVE FOR THIS WITNESS.
THANK YOU.
THE COURT: REDIRECT.
MS. BARLOW: YES, YOUR HONOR. THANK YOU.
REDIRECT EXAMINATION
BY MS. BARLOW:
Q. LET'S WORK BACKWARDS FROM WHAT YOU JUST HAD DONE. AT
3:15 YOU NOTICED THRASHING?
THE COURT: WITH REGARDS TO WHOM?
MS. BARLOW: OH, EXCUSE ME. WITH ELLEN ANDERSON.
AND THIS IS EXHIBIT 2-C -- NO. YES. 2-C.
Q. (BY MS. BARLOW) WITH ELLEN ANDERSON YOU JUST TESTIFIED
THAT YOU SAW THRASHING. HAD MS. WILSON TOLD YOU ANYTHING
ABOUT HOW THE FAMILY MEMBERS HAD EXPLAINED MRS. ANDERSON'S
CONDITION OR HER ACTIVITIES OR BEHAVIORS BEFORE SHE CAME TO
THE HOSPITAL?
A. NO. SHE JUST FOCUSED ON THE PAIN. TALKED ABOUT THE
SERIOUS SEVERE OSTEOPOROSIS THAT SHE HAD.
Q. LET'S NEXT TALK ABOUT MRS. SMITH.
MS. BARLOW: THIS, YOUR HONOR, IS 5-B. I THINK YOU
HAVE HER EXHIBIT UP THERE.
Q. (BY MS. BARLOW) NOW, YOU TESTIFIED THAT ON THE 25TH AND
THE 26TH YOU DID SEE AGITATION AND THAT YOU ADMINISTERED
ATIVAN, HALDOL. DID THE ATIVAN AND THE HALDOL WORK? WAS IT
EFFECTIVE WITH MRS. SMITH?
A. WHAT PAGE ARE WE ON?
Q. WELL, LET'S SAY 769.
A. AS I RECALL IT SEEMED TO BE HELPFUL. MAYBE NOT
COMPLETELY BUT IT DID CALM HER SOMEWHAT. ON DECEMBER 26TH,
YES, IT SAYS SHE SLEPT QUIETLY THE REST OF THE NIGHT.
Q. NOW, YOU HAD TESTIFIED ON DIRECT THAT SHE WAS FEISTY.
DOES THAT EQUATE TO AGITATION IN YOUR MIND?
A. NOT THE FEISTINESS THAT I WAS THINKING OF. I MEAN, IT I
SUPPOSE COULD HAVE BEEN. TO ME IT WAS KIND OF MORE OF A JUST
HER PERSONALITY.
Q. SO WHEN YOU'RE TALKING ABOUT OR NOTING AGITATION, YOU
WEREN'T TALKING ABOUT THE FEISTINESS THAT YOU SAW IN HER AS A
NORMAL PERSONALITY TRAIT?
A. NO. BECAUSE I WOULD SAY THE FEISTINESS WAS AWARE THERE
PROBABLY ALL THE TIME UNLESS SHE WAS SLEEPING, BUT SOMETIMES
IT WAS SEVERE WHERE IT WAS SHE WAS REALLY COMBATIVE AND THAT
KIND OF THING. SHE WAS NOT ALWAYS.
Q. IF YOU'D TURN TO 794. NOW YOU HAD WRITTEN TOSSING AND
TURNING AT 4:45, ATIVAN GIVEN AS ORDERED. SHE WAS CALMER AT
6 O'CLOCK. 11:07 FREE TEXT, PATIENT APPEARS TO BE SLEEPING
QUIETLY --
THE COURT: SLOW DOWN, PLEASE.
MS. BARLOW: EXCUSE ME. I SHOULD KNOW BETTER TO DO
THAT TO THE COURT REPORTER.
Q. (BY MS. BARLOW) BELOW YOUR NOTATION IS ANOTHER NOTATION
WRITTEN IT APPEARS BY TYLER SPRUAGE, DO YOU KNOW WHO TYLER
SPRUAGE IS?
A. YES, UH-HUH.
Q. AND WHO IS THAT?
A. HE WAS A C.N.A. THAT WORKED ON THE FLOOR.
Q. WAS HE ON THE SAME SHIFT AS YOU?
A. NO. HE CAME ON FOR DAY SHIFT.
Q. SO HE HAS WRITTEN A NOTE AFTER YOUR'S, SO WOULD YOU
ASSUME THAT THAT'S THE DAY SHIFT?
A. YES, UH-HUH.
Q. AND THIS NOTE HAS A B AND A CIRCLE, I IN A CIRCLE, R IN A
CIRCLE AND P IN A CIRCLE. DO YOU KNOW WHAT THOSE FOUR
LETTERS MEAN?
A. THE B IS BEHAVIOR; THE I WOULD BE INTERVENTIONS; THE R
WOULD BE RESPONSE; AND P WOULD BE THE PLAN.
Q. WOULD YOU READ THE BEHAVIOR THAT HE NOTED ON THE DAY
SHIFT AFTER THE ATIVAN WAS GIVEN AT I BELIEVE IT WAS, WHAT
4:45 THAT MORNING?
A. PATIENT HAS BEEN LETHARGIC DURING THIS SHIFT. PATIENT
HAS BEEN UNRESPONSIVE TO STAFF. PATIENT HAS BEEN SLEEPING
ALL SHIFT.
Q. THEN WOULD YOU READ R?
A. PATIENT NEEDED MAXIMUM ASSIST WITH HER ACTIVITIES OF
DAILY LIVING. PATIENT ATE -- DOES THAT SAY ZERO PERCENT?
Q. IT LOOKS LIKE ZERO PERCENT TO ME.
A. -- OF MEALS BECAUSE PATIENT WOULD NOT AROUSE FOR MEALS.
PATIENT ATTENDED GROUP BUT SLEPT THROUGH GROUP.
Q. HOW LONG WERE GROUPS DURING THE DAY?
A. DO YOU KNOW, I DON'T KNOW.
Q. OH, THAT'S RIGHT. YOU WORKED NIGHTS, EXCUSE ME.
AND THEN WHAT WAS THE PLAN? I GUESS THAT'S THE PLAN OF
WHAT YOU WANTED THIS PERSON TO DO?
A. RIGHT. IN HERE IT SAYS FOLLOW CARE PLAN, ENCOURAGE
PATIENT TO STAY AWAKE AND EAT MEALS.
Q. AND THAT'S DURING THE DAY SHIFT, WHICH WAS WHAT TIME?
A. DAY SHIFT ENDED AT -- WELL, REPORT STARTED AT THREE AND
THEN EVENINGS TOOK OVER AT 3:30.
Q. 795 YOU'VE TESTIFIED AGAIN THAT SHE WAS ACTING OUT AT
1:30 IN THE MORNING -- AGITATED I SHOULD SAY THAT'S PROBABLY
A BETTER WORD -- AND YOU ADMINISTERED HALDOL. AND THEN AT
2:30 SHE'S SLEEPING QUIETLY SINCE 1:45. WOULD YOU READ WHAT
LYNN LONG WROTE FOR THE DAY SHIFT, HER ACTIVITY LATER IN THE
DAY?
A. PATIENT VERY LETHARGIC THIS SHIFT, SITTING WITH EYES
CLOSED, TRYING TO REMOVE CLOTHING, SOCKS, BATTING AWAY ANY
OFFERED SNACK OR BEVERAGE, MUMBLING INCOHERENTLY.
Q. AND THEN R FOR RESPONSE.
A. PATIENT UNRESPONSIVE VERBALLY AND HIT OUT WHENEVER CARE
GIVEN OR FOOD OFFERED.
Q. SO CAN YOU SEE A DIFFERENCE IN THAT DAY IN THE CHARTING
OF MRS. SMITH'S LEVEL OF AGITATION?
A. YES. IT WAS ALMOST APPEARED THAT THE SEDATION WOULD SET
IN LATER AND THEN SHE WOULD BE SEDATED DURING THE DAY.
Q. NOW, LET'S TURN TO MRS. CRANE.
MS. BARLOW: YOUR HONOR, THIS IS 4-B.
Q. (BY MS. BARLOW) COUNSEL POINTED OUT PAGE 307 TO YOU
WHICH WAS THE 12/29 SHIFT -- OR EXCUSE ME DATE -- AND POINTED
OUT IN THE CENTER COLUMN, EMOTIONS AGITATED WAS CIRCLED,
UNCOOPERATIVE WAS CIRCLED AND THIS APPEARS TO READ THAT IT'S
THE A.M. SHIFT. WOULD THAT HAVE BEEN YOUR SHIFT OR WOULD
THAT HAVE BEEN THE DAY SHIFT?
A. IT WOULD BE DAYS.
Q. DAY SHIFT. SO SOMEONE NOT YOU CIRCLED AGITATED AND THEN
UNCOOPERATIVE?
A. RIGHT.
Q. LET'S LOOK TO THE RIGHT OF THAT WHICH IS THE NARRATIVE,
AGAIN, THIS IS NOT YOUR WRITING IT LOOKS LIKE ANN HANCOCK,
C.N.A.. WOULD YOU READ THE B THE BEHAVIOR PART OF THAT NOTE?
A. PATIENT HAS CONTINUALLY ASKED FOR FLUIDS AND TO GO TO HER
AND ROOM LIE DOWN. PATIENT HAS BEEN CONFUSED AND HAS NOT
BEEN ABLE TO FIGURE OUT WHERE SHE IS OR WHAT SHE SHOULD BE
DOING.
Q. WHAT ABOUT UNDER THE R FOR RESPONSE?
A. PATIENT ATE 100 PERCENT OF ALL MEALS. PATIENT ATTENDED
GROUPS BUT DID NOT PARTICIPATE.
Q. SO IN THE NARRATIVE PART DO YOU SEE ANY AGITATION NOTED?
A. NOT THERE, NO.
Q. 321 THE FIRST PART IS YOUR NOTE THE MOANING, COMPLAINED
OF PAIN. AND THEN THE C.N.A. MS. SHELTON WRITES, PATIENT
STATES I HURT, UNABLE TO TELL PAIN LOCATION. IF A PATIENT
TELLS YOU, YOU KNOW PARTICULARLY A PATIENT WHO IS NOT
COMMUNICATING WELL AS THESE PATIENTS WERE, THE PATIENT TELLS
YOU THAT THEY HAVE PAIN, WHAT IF ANYTHING DO YOU DO TO
DETERMINE WHERE THE PAIN IS, WHAT'S CAUSING THE PAIN, THAT
SORT OF THING?
A. WELL, IT WOULD BE COMMON TO ASK THEM WHERE THEY HURT.
Q. OKAY.
A. AND SHE WAS UNABLE TO IDENTIFY AND I DON'T KNOW, YOU
KNOW, MAYBE IT WAS GENERALIZED PAIN OR WHATEVER. IT'S HARD
TO TELL.
Q. THERE WAS AN ORDER FOR MORPHINE. DO YOU KNOW -- DO YOU
HAVE ANY KNOWLEDGE FROM THE RECORDS WHETHER MRS. CRANE WAS
RECEIVING LORTAB OR SOMETHING OTHER THAN MORPHINE BEFORE SHE
CAME TO THE HOSPITAL?
A. THAT WOULD BE IN THE BOOK BUT I DON'T KNOW SPECIFICALLY
WHAT SHE WAS RECEIVING.
Q. YOU DON'T HAVE ANY PERSONAL RECOLLECTION OF THAT?
A. IT WASN'T MORPHINE, THAT'S ALL I KNOW.
Q. WERE YOU INFORMED BY ANY FAMILY MEMBERS OR ANY NURSE THAT
SPOKE WITH FAMILY MEMBERS OR BY THE RECORD OF ANY HISTORY OF
PAIN COMPLAINTS WITHOUT ANY PARTICULAR CAUSE WITH MRS. CRANE?
IS THAT A CONVOLUTED QUESTION?
A. WELL, I WAS GOING TO SAY I'M NOT -- NOTHING COMES TO
MIND.
Q. THEN IN SPEAKING OF MRS. LARSEN, YOU WERE BASICALLY ASKED
ON CROSS-EXAMINATION, I MEAN YOU'RE THE NURSE, HE'S THE
CAPTAIN OF THE SHIP, DO YOU HAVE ANY INDEPENDENT OBLIGATION
TO THESE PATIENTS INDEPENDENT OF WHAT A DOCTOR ORDERS YOU TO
DO?
A. IF YOU FELT LIKE SOMETHING WAS REALLY WRONG, IT'S -- YOUR
RESPONSIBILITY IS TO THE PATIENT AND SO THAT YOU WOULD REFUSE
TO DO SOMETHING. THAT WOULD BE THE PROPER THING TO DO.
Q. AND IF YOU REFUSED TO GIVE SOME MEDICATION, WOULD YOU
NOTIFY THE DOCTOR?
A. YEAH.
Q. AND DID YOU WHEN YOU SAY HELD THE MEDICATIONS ON JUDITH
LARSEN?
A. I DID. I DID AFTER THE FACT, BUT I DID.
Q. NOW, YOU RECALL THE CONVERSATION -- NOW THE NOTE THAT WAS
READ TO YOU ON 466 --
MS. BARLOW: AND YOUR HONOR, THAT WOULD BE EXHIBIT
3-B --
Q. (BY MS. BARLOW) THE NOTE THAT WAS READ TO YOU WAS THE
NOTE WRITTEN BY DR. WEITZEL AND HE SAYS, IF ANY MORPHINE IS
TO BE HELD CONTACT HIM FIRST; IS THAT CORRECT?
A. YES, UH-HUH.
Q. DO YOU RECALL THAT -- DO YOU RECALL HIS EXACT WORDS IN
THE MEETING THAT YOU HAD?
A. WELL, IT WASN'T IF. IT WAS NO MORPHINE WILL BE HELD
UNLESS YOU NOTIFY ME FIRST.
Q. WHEN YOU HELD THE MORPHINE ON THE 3RD OF JANUARY, WAS
MRS. LARSEN UNCOMFORTABLE? WAS SHE IN ANY PAIN?
A. I WOULD SAY WHAT I THOUGHT THAT SEEMED TO BE DISCOMFORT
WAS THAT SHE WAS THIRSTY.
Q. WAS SHE IN PAIN THAT NEEDED MORPHINE AT THAT TIME THAT
YOU THOUGHT?
MR. BUGDEN: I'M GOING TO OBJECT, YOUR HONOR.
THE COURT: SUSTAINED.
MS. BARLOW: DON'T ANSWER THAT. I'LL PHRASE
SOMETHING ELSE HERE.
Q. (BY MS. BARLOW) WHY DID YOU NOT GIVE THE MORPHINE TO
MRS. LARSEN THAT MORNING?
A. BECAUSE OF HER LOW RESPIRATIONS.
Q. WHAT WAS YOUR FEAR IF YOU GAVE IT TO HER WITH THE LOW
RESPIRATION RATE?
A. THAT SHE WOULD DIE.
Q. YOU'VE HEARD THAT THE FAMILY WANTED HER KEPT COMFORTABLE
AND BE ALLOWED TO DIE NATURALLY, DID THE FAMILY WANT TO YOU
KILL HER WITH MORPHINE?
MR. BUGDEN: OBJECTION, YOUR HONOR, ARGUMENTATIVE.
THE COURT: SUSTAINED.
MS. BARLOW: DON'T ANSWER THAT.
Q. (BY MS. BARLOW) IF YOU WOULD TURN TO 597.
MS. BARLOW: AGAIN, YOUR HONOR, THIS IS 3-B. I
THINK YOU WERE SHOWN A MEDICAL TREATMENT PLAN.
Q. (BY MR. BUGDEN) ARE YOU AT THAT PAGE?
A. YES.
Q. WHO WAS THE ATTENDING PHYSICIAN FOR THAT MEDICAL
TREATMENT PLAN, THE NAME OF THE PHYSICIAN AT THE TOP
CERTIFYING THAT HE'S THE ATTENDING PHYSICIAN?
A. DR. GREGORY STEVENS.
Q. DO YOU KNOW WHO THAT IS?
A. NO, I DON'T.
Q. IS HE AFFILIATED WITH THE GEROPSYCH UNIT AT ALL?
A. NO.
Q. AND IT'S A FORM BASICALLY IT CERTIFIED, I'M THE ATTENDING
PHYSICIAN FOR JUDITH LARSEN. AND IT DOES IT SAY WHEN SHE WAS
UNDER HIS CARE?
A. DOES IT SAY THAT SHE WAS?
Q. DOES IT -- WHO IS PRESENTLY UNDER MY CARE THIS BLANK DAY
OF BLANK, DOES IT SAY WHEN?
A. NO.
Q. THE DECLARANT, THE ABOVE-NAMED PATIENT IS CURRENTLY
SUFFERING FROM THE ABOVE-NAMED INJURY, DISEASE OR ILLNESS, IS
THAT FILLED IN?
A. NO, IT'S NOT.
Q. THEN DOWN BELOW I CERTIFY THAT THE DECLARANT AS A
PHYSICAL OR MENTAL CONDITION THAT RENDERS HER UNABLE TO GIVE
PERSONAL DIRECTIONS, THAT'S CHECKED. WHAT'S THE DATE ON THAT
MEDICAL TREATMENT PLAN?
A. SEPTEMBER 19TH, 1985.
Q. DID YOU HAVE OCCASION TO LOOK AT THIS AND TO CALL FAMILY
MEMBERS TO SEE IF THAT WAS AN INCORRECT DATE?
A. I DIDN'T.
Q. NOW, YOU ALSO INDICATED AND THERE IS ON PAGE 599 IN THE
RECORD ANOTHER DOCUMENT THAT IS BASICALLY A MEDICAL
DIRECTIVE; IS THAT CORRECT?
A. YES, UH-HUH.
Q. WHAT IS THAT?
A. WHAT IS WHAT?
Q. WHAT'S IT CALLED?
A. A LIVING WILL.
Q. AND WHAT'S THE DATE ON THAT LIVING WILL?
A. MAY 25TH OF '95.
Q. OF 19 WHAT? EXCUSE ME IF YOU'D SAY THAT AGAIN.
A. '95. MAY 25TH, '95.
Q. AND IS THIS SIGNED BY JUDITH LARSEN HERSELF?
A. YES, IT IS.
Q. UNDER NUMBER FOUR IT SAYS, I UNDERSTAND THE TERM
LIFE-SUSTAINING PROCEDURE INCLUDES ARTIFICIAL NUTRITION
HYDRATION AND OTHER PROCEDURES. AND THEN SHE SPECIFIES
CERTAIN THINGS THAT SHE WANTS DONE OR NOT DONE. COULD YOU
READ THAT FOR US, PLEASE?
A. IF MY CONDITION IS CERTIFIED TO BE TERMINAL AS IN
PARAGRAPH 2, I REQUEST THAT SUSTENANCE MEANING THAT NUTRITION
AND HYDRATION AND RESPIRATION BE TERMINATED OR WITHHELD.
MEDICATION TO RELIEVE MY PAIN MAY BE GIVEN IF OBVIOUSLY
NEEDED.
Q. SO THAT'S SOMETHING THAT MRS. LARSEN HAD CHOSEN WHEN SHE
WAS STILL COMPETENT IT APPEARS?
A. YES.
Q. IF YOU'D TURN 575, YOU WERE ASKED TO IT MAY NOT BE THE
CORRECT NUMBER. EXCUSE ME. 497?
A. 497?
Q. 497. YOU WERE ASKED ABOUT RISPERDAL YOU SAID YOU DIDN'T
KNOW IF IT WAS AN ANTI-EMETIC. NOW WE'RE TALKING ABOUT THE
29TH AND 30TH OF DECEMBER WHEN MRS. LARSEN WAS HAVING HER
EPISODE OF VOMITING. IF YOU WOULD LOOK ON 497, IS THE 30TH
OF DECEMBER INDICATED ON THERE?
A. YES, UH-HUH.
Q. RISPERDAL IS ORDERED; IS THAT CORRECT?
A. TRUE.
Q. WAS IT GIVEN THAT DAY?
A. IT WAS NOT.
Q. HOW DO YOU KNOW THAT?
A. BECAUSE IT'S CIRCLED.
Q. THEN IF YOU'D TURN TO PAGE 498 WHICH UNFORTUNATELY WE'RE
KIND OF GOING BACKWARDS HERE. TO THE RIGHT HAND IS THE 12/29
DATED THE 29TH OF DECEMBER WAS RISPERDAL ORDERED FOR THAT
DAY?
A. IT WAS ORDERED BUT NOT GIVEN.
Q. AND HOW DO YOU KNOW IT WAS NOT GIVEN?
A. IT WAS CIRCLED AGAIN.
Q. AND THEN FINALLY, WE'LL GO TO MR. ALLDREDGE.
MS. BARLOW: THIS IS EXHIBIT 6-B.
Q. (BY MS. BARLOW) YOU WERE ASKED TO READ SOME NOTATIONS
ABOUT AGITATION THAT WERE NOT YOUR NOTATIONS?
A. WHICH PATIENT?
Q. ALLDREDGE.
A. OH, OKAY.
Q. SPECIFICALLY YOU WERE ASKED ABOUT PAGE 60 AND PAGE 71. I
WOULD LIKE FOR YOU TO TURN TO PAGE 60 AND I'M NOT GOING TO
READ EVERY PAGE. BUT IF WE COULD LOOK AT SOME OF THE OTHER
CONDITIONS OF THAT PATIENT THAT DAY.
ON THE 10TH OF JANUARY IS WHEN HE CAME IN. YOU ON PAGE
60 WERE POINTED TO A NOTE THAT SAID PATIENT IS VERY COMBATIVE
AND AGITATED, NOT ORIENTED TO TIME, PLACE, PERSON OR
SITUATION. IF YOU WOULD TURN TO THE NEXT PAGE 61. WOULD YOU
READ THE FIRST SENTENCE -- TWO SENTENCES?
A. PATIENT HAS BEEN LETHARGIC AND UNRESPONSIVE TO STAFF.
Q. WHAT TIME WERE WE TALKING ABOUT THEN?
A. THAT WOULD BE DAY SHIFT.
Q. AND THEN IF YOU WOULD TURN BACK AND KEEP YOUR FINGER
THERE BECAUSE WE'RE GOING TO COME BACK. IF YOU WOULD TURN TO
PAGE 11 THERE'S A MEDICAL CONSULT WITH DR. DIENHART THAT WAS
AT 9 P.M. ON THE 10TH OF JANUARY IF YOU'LL READ ABOUT TWO
THIRDS OF THE WAY DOWN ON THE RIGHT-HAND SIDE WHERE IT SAYS
CURRENTLY?
A. CURRENTLY LETHARGIC -- I DON'T KNOW THAT WORD.
Q. I THINK THAT'S AROUSABLE.
A. SO IS IT AROUSABLE OR UNAROUSABLE?
Q. I THINK IT'S AROUSABLE ONLY.
A. OH, OKAY. AROUSABLE ONLY TO PAINFUL STIMULUS.
Q. WELL, I'LL HELP YOU. DR. DIENHART --
A. OKAY.
Q. -- FOLLOWING ATIVAN, HALDOL INJECTION, MORE
COMBATIVENESS. SO WAS THERE A DIFFERENCE IN MR. ALLDREDGE'S
CONDITION EVEN DURING THE COURSE OF THE 10TH OF JANUARY?
A. YES.
Q. YOU HAD TESTIFIED THAT THERE WAS NO DENT IN THE AGITATION
BETWEEN PAGE 60 AND PAGE 71, BUT THAT WAS JUST READING THE
CERTAIN PORTIONS. LET'S JUST BRIEFLY LOOK AT SOME OF THE
OTHER -- IF YOU WOULD TURN TO PAGE 64. WOULD YOU READ WHAT
WAS -- AND THIS IS THE 11TH OF JANUARY. WHAT WAS LISTED
UNDER R?
A. SAY THAT AGAIN. WHAT WAS --
Q. ON PAGE 64, 11TH OF JANUARY, THIS IS A CONTINUATION OF A
PRIOR NOTE?
A. OH, OKAY.
Q. AND YOU HAVE THE B, I AND HERE IS THE R?
A. OKAY.
Q. IF YOU WOULD READ THAT FIRST SENTENCE.
A. IT SAYS ATTENDED GROUPS BUT SLEPT WHEN OFFERED MEAL, KEPT
SPITTING IT OUT.
Q. IF YOU WOULD TURN TO THE NEXT PAGE, 65, AGAIN ON THE 11TH
AND READ THE 1500 JUST THE FIRST SENTENCE.
A. PATIENT SITTING QUIETLY IN THE CHAIR IN HALL WITH POSEY
RESTRAINT IN PLACE --
Q. IF YOU'D -- EXCUSE ME. AND THEN IF YOU'D READ 1900 AT 7
P.M. PAY --
A. PATIENT FALLING ASLEEP IN CHAIR, TAKEN TO BED.
Q. AND THEN 2000, 8 P.M. THAT EVENING?
A. PATIENT ASLEEP, WOULD NOT AWAKEN TO TAKE HIS H.S. MEDS.
Q. SO THAT WAS THE 11TH. AND ON THE 12TH ON PAGE 69, IF YOU
WOULD JUST READ THE FIRST CLAUSE THERE OF 1500 UNDER B.
A. SO PATIENT HAS BEEN AGITATED, LETHARGIC, ALTERNATELY ALL
SHIFT.
Q. YEAH. IN YOU'D JUST STOP WITH THAT. I THINK HAVING READ
THOSE, WAS THERE A CHANGE IN HIS CONDITION OVER TIME OR WAS
IT JUST COMBATIVE THE WHOLE TIME PERIOD?
A. NO. THERE WERE PERIODS OF SOUNDS LIKE LETHARGY AND TIMES
OF AGITATION.
Q. DID YOU SEE THAT KIND OF ACTIVITY WITH THESE PATIENTS UP
AND DOWN?
MR. BUGDEN: OBJECTION, LEADING.
THE WITNESS: SOMETIMES, YES.
THE COURT: SUSTAINED. STRICKEN.
MS. BARLOW: I DON'T HAVE ANY FURTHER QUESTIONS.
MR. BUGDEN: I DON'T HAVE ANY QUESTIONS.
THE COURT: YOU MAY STEP DOWN, MS. SCHOLL. THANK
YOU FOR TESTIFYING.