Tracy Scholl
23 TRACY SCHOLL,
24 CALLED BY THE PLAINTIFF, HAVING BEEN DULY
25 SWORN, WAS EXAMINED AND TESTIFIED AS FOLLOWS:
1238
1 DIRECT EXAMINATION
2 BY MS. BARLOW:
3 Q. GOOD MORNING. THANK YOU FOR COMING IN WITH US TODAY.
4 WOULD YOU PLEASE STATE YOUR NAME AND SPELL IT FOR THE
5 RECORD?
6 A. TRACY SCHOLL. T-R-A-C-Y S-C-H-O-L-L.
7 Q. TRACY, WHAT IS YOUR OCCUPATION?
8 A. I'M AN R.N.
9 Q. R.N. MEANS?
10 A. REGISTERED NURSE.
11 Q. HOW LONG HAVE YOU BEEN A REGISTERED NURSE?
12 A. ELEVEN YEARS.
13 Q. WHAT TRAINING DID YOU RECEIVE TO BECOME AN R.N.?
14 A. I HAVE AN ASSOCIATE'S DEGREE FROM WEBER STATE.
15 Q. ARE THERE OTHER R.N. DEGREES AS FAR AS B.A. OR
16 BACHELOR'S --
17 A. YEAH. THERE'S BACHELOR'S AND MASTER'S. I SUPPOSE YOU
18 CAN GET YOUR DOCTOR'S ALSO.
19 Q. BUT THAT'S NOT REQUIRED TO BECOME A REGISTERED NURSE?
20 A. NO.
21 Q. AS A REGISTERED NURSE WHAT THINGS ARE YOU ALLOWED TO DO
22 IN THE MEDICAL ARENA?
23 A. WELL, WE MAKE ASSESSMENTS AND REPORT TO DOCTORS AND THEN
24 CARRY OUT THE ORDERS.
25 Q. ARE YOU ALLOWED TO MAKE ANY ORDERS FOR LIKE MEDICATIONS
1239
1 OR FOR CONSULTS OR ANY MEDICAL PROCEDURES?
2 A. NO.
3 Q. MAYBE JUST FOR THE EDIFICATION OF PEOPLE, THERE ARE
4 NURSE PRACTITIONERS?
5 A. THERE ARE.
6 Q. AND HOW IS THAT DIFFERENT FROM AN R.N.?
7 A. I THINK THEY NEED TO WORK UNDER A DOCTOR AND THEN THERE
8 ARE CERTAIN MEDICATIONS THAT THEY CAN PRESCRIBE, BUT THAT IS
9 ALSO LIMITED.
10 Q. WHAT ABOUT INJECTIONS, ARE YOU ALLOWED TO DO THAT AS AN
11 R.N.?
12 A. YES.
13 Q. ARE THERE OTHER LEVELS OF NURSES, L.P.N.? WHAT DOES
14 L.P.N. STAND FOR?
15 A. LICENSED PRACTICAL NURSE.
16 Q. ARE THEY ALLOWED TO GIVE INJECTIONS?
17 A. YES.
18 Q. AND THEN THERE'S C.N.A. WHAT DOES THAT STAND FOR?
19 A. CERTIFIED NURSE ASSISTANT.
20 Q. AND ARE THEY ALLOWED TO GIVE INJECTIONS.
21 A. NO, THEY ARE NOT.
22 Q. WHAT DO THEY DO?
23 A. BASICALLY JUST CARING FOR THE PATIENT AS FAR AS TAKING
24 CARE OF HYGIENE, CLEANING, BATHING, MAYBE GETTING THEM IN
25 AND OUT OF BED, ASSISTING THEM TO THE BATHROOM, FEEDING,
1240
1 THAT TYPE OF THING.
2 Q. WHAT ABOUT TAKING VITAL SIGNS? WHO CAN DO THAT?
3 A. C.N.A.'S DO THAT, ALSO NURSES, ANYONE.
4 Q. AND WHAT DOES IT MEAN TO TAKE VITAL SIGNS.
5 A. WE TAKE THE TEMPERATURE, THE PULSE, THE RESPIRATIONS AND
6 BLOOD PRESSURE.
7 Q. I THINK MOST OF US ARE FAMILIAR WITH THESE THINGS, BUT
8 HOW DO YOU TAKE RESPIRATION? WHAT DO YOU DO?
9 A. YOU COUNT HOW MANY BREATHS A PERSON TAKES IN ONE MINUTE.
10 Q. IT'S JUST A MATTER PHYSICALLY STANDING THERE?
11 A. AND WATCHING THE CHEST RISE AND FALL, YEAH.
12 Q. WHERE ARE YOU WORKING NOW? With Juror Gillette's wife.
13 A. I'M A SCHOOL NURSE WITH DAVIS COUNTY. Gillette's wife was a teacher there.
14 Q. ARE YOU FAMILIAR -- WELL, LET ME BACK UP. IN THE 11
15 YEARS THAT YOU'VE BEEN A NURSE, WHAT KIND OF NURSING
16 SETTINGS HAVE YOU BEEN IN?
17 A. WELL, I'VE ACTUALLY STARTED OUT AT DAVIS HOSPITAL AS A
18 L.P.N. FOR A YEAR AND THEN MY 11 YEARS OF AN R.N. I WAS AT
19 DAVIS ON THE MEDICAL FLOOR. THEN I WAS WITH AN INSURANCE
20 COMPANY FOR A YEAR AND THEN I SPENT TIME AT BENCHMARK
21 WORKING AS A PSYCHIATRIST NURSE AND THEN RETURNED TO DAVIS
22 ON THE GEROPSYCH FLOOR.
23 Q. AND WHEN DID YOU LEAVE DAVIS THAT TIME FROM THE
24 GEROPSYCH UNIT?
25 A. WHEN DID I?
1241
1 Q. WHEN DID YOU -- OR WELL, LET ME BACK UP JUST A LITTLE
2 BIT. I DON'T WANT TO CONFUSE MYSELF TOO MUCH HERE. AT
3 DAVIS YOU FIRST WORKED ON THE MEDICAL FLOOR. WHAT DOES THAT
4 MEAN?
5 A. PATIENTS WITH MEDICAL PROBLEMS AS OPPOSED TO SURGICAL
6 PATIENTS. SO PATIENTS LIKE MAYBE WITH CONGESTIVE HEART
7 FAILURE, HAD STROKES, RECOVERING FROM A HEART ATTACK, THOSE
8 TYPE OF PATIENTS.
9 Q. AND SURGICAL MEANS SURGICAL PEOPLE RECOVERING FROM --
10 A. RIGHT, HAVING HAD SURGERY OF SOME KIND, RIGHT.
11 Q. INCLUDING OPEN-HEART SURGERY?
12 A. YOU KNOW, I DON'T KNOW IF THEY DID OPEN-HEART SURGERY AT
13 DAVIS, I DON'T BELIEVE.
14 Q. UNIVERSITY OF UTAH MIGHT BE THE ONLY PLACE? Relevance?
15 A. YEAH.
16 Q. YOU WORKED FOR AN INSURANCE COMPANY. WHAT DID YOU DO
17 FOR THE INSURANCE COMPANY?
18 A. I WAS A CASE MANAGER WHERE WE DEALT WITH DOCTORS,
19 PATIENTS, THEIR FAMILIES, HOSPITALS. AND IT WAS KIND OF
20 SIMILAR TO AN H.M.O. WHERE WE WOULD ASSESS EACH CASE AND
21 DECIDE IF THEY HAVE -- THEY HAD MORE DAYS AVAILABLE THAT THE
22 PATIENT COULD STAY IN THE HOSPITAL.
23 Q. HAVE YOU WORKED FOR BENCHMARK ON THE PSYCH UNIT?
24 A. YES. IT'S A PSYCHIATRIC HOSPITAL.
25 Q. IT'S A PSYCHIATRIC HOSPITAL. THANK YOU. NOW, WHEN YOU
1242
1 WORKED ON THE MED UNIT, WHAT AGE GROUP DID YOU WORK WITH?
2 A. ALL AGE -- WELL, NOT CHILDREN, BUT SAY 18 ON UP.
3 Q. AND OF COURSE, WITH PEOPLE WITH HEART PROBLEMS OR
4 CONGESTIVE HEART OR STROKES, ARE THEY USUALLY ELDERLY?
5 A. WELL, USUALLY. AND IN FACT, PROBABLY THE MAJORITY OF
6 PATIENTS ON A MEDICAL FLOOR ARE USUALLY OLDER.
7 Q. WHAT ABOUT IN THE PSYCHIATRIC HOSPITAL AT BENCHMARK?
8 WHAT AGE GROUP DID YOU WORK WITH THERE?
9 A. I WORKED ON THE ADULT FLOOR AND THEY STARTED AS YOUNG AS
10 18 AND WENT ON UP. AND SOME PATIENTS WERE ELDERLY, BUT THE
11 MAJORITY WERE YOUNGER.
12 Q. THE ELDERLY PATIENTS THAT YOU WORKED WITH AT BENCHMARK,
13 WHAT KIND OF PSYCHIATRIC PROBLEMS DID THEY HAVE?
14 A. USUALLY DEPRESSION WOULD BE THE MOST COMMON. SOMETIMES
15 ANXIETY, SUICIDAL, BUT JUST DEPRESSION.
16 Q. WHAT ABOUT DEMENTIA, WOULD THAT --
17 A. NO.
18 Q. WOULDN'T TAKE CARE OF THAT AT BENCHMARK?
19 A. NO.
20 Q. IS THERE A DIFFERENCE THEN BETWEEN WORKING ON A MEDICAL
21 FLOOR AND A PSYCH FLOOR?
22 A. DEFINITELY, YEAH.
23 Q. WHAT'S THE DIFFERENCE?
24 A. A MEDICAL FLOOR YOU ARE REALLY TENDING TO A PERSON'S
25 MEDICAL NEEDS. YOU KNOW, ASSESSING CONTINUALLY THEIR NEEDS
1243
1 AS FAR AS I MEAN ARE THEIR VITAL SIGNS STABLE, THE
2 MEDICATION THEY CURRENTLY RECEIVE, MORE MEDICATIONS. PSYCH
3 FLOOR YOU WOULD GIVE -- USUALLY THE MEDICATIONS WOULD BE
4 MORE ALONG THE PSYCH LINE AND THEY DON'T GENERALLY HAVE THE
5 MEDICAL PROBLEMS. YOU KNOW, IF A PERSON WERE THAT ACUTELY
6 ILL, THEY ARE NOT GENERALLY ON THE PSYCH FLOOR.
7 Q. WHEN YOU SAY ACUTELY ILL, YOU MEAN MEDICALLY PHYSICALLY
8 ILL?
9 A. RIGHT. LIKE A FLARE-UP OF SOME KIND OF PROBLEM THEY
10 MIGHT HAVE. LIKE IF THEY WERE -- I DON'T KNOW -- LET'S SAY
11 IF THEIR CONGESTIVE HEART FAILURE WERE, YOU KNOW, AT A BAD
12 STATE, THEN THEY WOULD NOT BE ON A PSYCH WARD. GENERALLY
13 THEY WOULD BE ON A MEDICAL FLOOR.
14 Q. IN YOUR EXPERIENCE CAN, SAY, CONGESTIVE HEART FAILURE OR
15 MEDICAL PROBLEMS BRING ON PSYCHIATRIC PROBLEMS OR DEPRESSION
16 OR ANXIETY?
17 MR. STIRBA: YOUR HONOR, I THINK THAT'S BEYOND THE
18 SCOPE.
19 THE COURT: SUSTAINED.
20 Q. (BY MS. BARLOW) YOU SAY THAT YOU DID AT ONE POINT GO
21 BACK TO THE DAVIS NORTH TO THE GEROPSYCH UNIT?
22 A. YES.
23 Q. DO YOU RECALL WHEN THAT WAS?
24 A. IT WAS AFTER THANKSGIVING IN '95.
25 Q. AND WHAT BROUGHT YOU TO THAT PSYCH UNIT? DID YOU APPLY
1244
1 THERE? I MEAN, HOW DID YOU GO TO THAT UNIT?
2 A. I APPLIED THERE. MY JOB, THEY HAD CLOSED THE ADULT
3 FLOOR AT BENCHMARK SO I HAD PSYCH BACKGROUND AND I WAS
4 INTERESTED IN STAYING IN THAT FIELD. PLUS I ENJOY THE
5 ELDERLY, SO THAT'S WHY I WENT THERE.
6 Q. SO PART OF WHAT ENTICED YOU WAS THE FACT THAT IT WAS
7 GEROPSYCH, NOT JUST PSYCH?
8 A. WELL, PART OF IT. I MEAN, IT WAS NOT THAT MANY JOBS
9 AVAILABLE AT THE TIME. YOU WENT WHERE THEY WERE. BUT I WAS
10 INTERESTED IN THAT POSITION SPECIFICALLY.
11 Q. WITH THE ELDERLY, WHAT KIND OF PSYCHIATRIC CARE DID YOU
12 SEE GIVEN?
13 A. WELL, I WORKED NIGHTS. AND SO AS FAR AS WHAT WENT ON
14 DURING THE DAY, YOU KNOW, I MEAN I WAS AWARE THAT THEY HAD
15 GROUPS AND THINGS LIKE THAT, BUT I REALLY DIDN'T SEE THAT
16 VERY MUCH. AT NIGHT WHAT WE MOSTLY DID WAS JUST MONITOR THE
17 PATIENT AND IF THEY WERE HAVING PROBLEMS IN THE NIGHT WE
18 WOULD TAKE CARE OF THAT. AND MEDICATIONS, VITAL SIGNS AS
19 NEEDED, THAT KIND OF THING.
20 Q. WHAT KIND OF PROBLEMS WOULD YOU NEED TO TAKE CARE OF AT
21 NIGHT?
22 A. WELL, IF PATIENTS WEREN'T SLEEPING WELL. THEY WERE
23 AGITATED. YOU KNOW, GETTING IN AND OUT OF BED OR MAYBE
24 UPSET. JUST, YOU KNOW, WHATEVER WAS GOING ON.
25 Q. AND WHAT WOULD YOU DO TO TRY TO CARE FOR THESE PEOPLE
1245
1 THAT MAYBE WERE AGITATED, GETTING OUT OF BED, THAT SORT OF
2 THING?
3 A. IT WOULD VARY. SOMETIMES, YOU KNOW, FIRST YOU WOULD
4 MAYBE TRY TO SMOOTH THEM, CONSOLE THEM. YOU KNOW, MAYBE GET
5 THEM UP AND WALK THEM AROUND OR MAYBE THEY NEED TO USE THE
6 BATHROOM, THAT KIND OF THING. AND THEN THERE WERE
7 MEDICATIONS ORDERED IF, YOU KNOW, THEY WEREN'T CALMING AND
8 THEY WERE MAYBE NOT SAFE. THEY WERE CONTINUING TO TRY TO
9 GET OUT OF BED, THAT SOMETIMES WE WOULD USE MEDICATION.
10 Q. WERE THESE -- YOU SAY MEDICATIONS WERE ORDERED. WERE
11 THEY ORDERED AT THE TIME OR HOW DID THAT ORDER COME TO YOU?
12 A. WELL, BOTH. WHEN THE PATIENT WAS ADMITTED, THERE WOULD
13 BE WHAT WERE YOUR STANDARD ADMISSION ORDERS, AND THEN THE
14 DOCTOR WOULD VARY THOSE ACCORDING TO THE PATIENT'S NEEDS.
15 AND THEN EACH DAY THE PATIENT WOULD VISIT, AND SO THERE
16 WOULD BE ADDITIONAL ORDERS WRITTEN OR MAYBE SOME CHANGED.
17 AND THEN IF THERE WAS A PROBLEM AT THAT POINT THEN WE WOULD
18 CALL THE DOCTOR AND MAYBE GET AN ORDER FOR THAT SPECIFIC
19 PROBLEM AT THAT TIME.
20 Q. IN THE MEDICAL RECORDS, IN THE HOSPITAL RECORDS, THE
21 PHRASE IS USED "REDIRECTION WAS USED WITH THE PATIENT." ARE
22 YOU FAMILIAR WITH WHAT THAT MEANS?
23 A. IF YOU REDIRECTED A PATIENT?
24 Q. YES.
25 A. YEAH. REDIRECTED IF MAYBE THIS IS REALLY BOTHERSOME TO
1246
1 THEM. THERE'S SOMETHING GOING ON HERE AND THEY ARE REALLY
2 FOCUSED ON THAT AND THAT SEEMS TO BE CAUSING THEIR
3 AGITATION, YOU MIGHT TRY TO DIVERT THEM TO SOMETHING ELSE,
4 JUST KIND OF REDIRECT THEM TO HELP ALLEVIATE THEIR
5 AGITATION.
6 Q. DID THAT WORK?
7 A. WELL, NOT GENERALLY WITH THESE PATIENTS, NO.
8 MR. STIRBA: I'M SORRY. I'M GOING TO HAVE TO
9 OBJECT. IT'S VAGUE AND AMBIGUOUS. IT'S NOT REALLY
10 RELEVANT. I THINK IT'S BACKGROUND.
11 THE COURT: OKAY, WELL, LET'S --
12 MS. BARLOW: YOUR HONOR, IT IS BACKGROUND, BUT I
13 THINK THE JURY NEEDS TO BE EDUCATED AS TO WHAT THIS, YOU
14 KNOW, WHAT THE NURSES DID ON THIS UNIT. I DON'T INTEND TO
15 DO THIS WITH EVERY WITNESS, BUT I WOULD LIKE TO LAY SOME
16 BACKGROUND IN THAT AREA.
17 THE COURT: GO AHEAD.
18 Q. (BY MS. BARLOW) NOW, WE ALREADY KNOW THAT IT WAS A
19 TEN-BED UNIT. WAS THE UNIT USUALLY FULL WHILE YOU WERE
20 THERE?
21 A. WELL, SOMETIMES IT WAS FULL OR EIGHT PATIENTS, SOMETHING
22 LIKE THAT. IT WAS USUALLY NEAR FULL, IF IT WASN'T FULL.
23 Q. YOU SAID YOU WORKED NIGHTS. WHAT SHIFT WAS THAT?
24 A. ELEVEN TO SEVEN.
25 Q. AND HOW MANY DAYS A WEEK WOULD YOU WORK?
1247
1 A. WELL, IT WAS 40 HOURS, SO FIVE DAYS.
2 Q. SO YOU WORKED FULL-TIME?
3 A. YES.
4 Q. WOULD IT VARY WHICH DAYS OF THE WEEK YOU WOULD WORK?
5 A. NOT GENERALLY, BUT IT COULD.
6 Q. WHEN YOU WERE ON NIGHTS, WERE THERE OTHER NURSES OR
7 C.N.A. OR ANYTHING, ANY OTHER PEOPLE THAT WOULD WORK WITH
8 YOU WITH THOSE EIGHT TO TEN PATIENTS?
9 A. ON THAT PARTICULAR FLOOR THERE WAS JUST A NURSE AND A
10 C.N.A. AT NIGHT.
11 Q. DO YOU KNOW WHETHER THAT -- WHETHER THERE WAS A CHANGE
12 IN HOW MUCH -- HOW MANY PERSONNEL THERE WERE ON THE UNIT
13 DURING THE DAY?
14 A. THERE WAS ADDITIONAL STAFFING DURING THE DAY.
15 Q. WHY WOULD THERE BE A DIFFERENCE?
16 A. MORE IS GOING ON; THE GROUPS, YOU KNOW, PATIENTS UP AND
17 GOING TO MEALS AND GROUP. YOU KNOW, A LOT OF DIFFERENT
18 ACTIVITIES.
19 Q. YOU WERE HOPING THEY WOULD BE ASLEEP AND THE TWO OF YOU
20 COULD TAKE CARE OF IT AT NIGHT?
21 A. IDEALLY, YEAH.
22 Q. DID THAT USUALLY WORK OUT PRETTY WELL?
23 A. IT COULD.
24 Q. I WOULD LIKE TO ASK YOU, IN FRONT OF YOU ARE FIVE
25 BINDERS WHICH ARE THE MEDICAL RECORDS OF THE FIVE PEOPLE WHO
1248
1 THIS CASE IS ABOUT. ONE IS ENNIS ALLDREDGE. COULD YOU PULL
2 THAT BINDER? I THINK THE NAME IS ON THE FRONT OF IT. ENNIS
3 ALLDREDGE?
4 A. RIGHT HERE.
5 Q. DO YOU REMEMBER ENNIS ALLDREDGE COMING INTO THE UNIT?
6 A. I JUST MAYBE HAVE A VAGUE RECOLLECTION.
7 Q. I WOULD LIKE TO ASK YOU TO TURN TO PAGE -- OR TO WHAT IS
8 MARKED AT THE BOTTOM OF THE PAGE, MED-0012?
9 A. 0012.
10 Q. YES. THEY SHOULD BE IN NUMERICAL ORDER. HAVE YOU GOT
11 TO THAT PAGE?
12 A. YEAH.
13 Q. TO THE BENEFIT OF THE -- IF I CAN FIGURE OUT HOW TO USE
14 THIS THING -- RIGHT HERE AT THE TOP ARE A COUPLE OF
15 NOTATIONS THAT SAY 24 AND THEN IT LOOKS LIKE A DEGREE SIGN
16 AND A CHECK, AND OVER HERE TO THE SIDE IS A SET OF INITIALS.
17 DO YOU RECOGNIZE WHAT THAT IS?
18 A. YEAH. THAT SAYS 24-HOUR CHART, CHECKING THE DATE AND
19 THE TIME IT WAS DONE, AND THEN THAT WAS MY SIGNATURE.
20 Q. AND WHAT'S A CHART CHECK?
21 A. WELL, THERE WAS -- THERE WOULD JUST BE CERTAIN THINGS
22 AND WE WOULD GO THROUGH AND MAKE SURE ALL THE ORDERS WERE
23 TAKEN OFF AND CHECK MAYBE THE LABS THAT WERE DUE BACK FROM
24 THE LAB, IF THEY WERE PUT IN THE CHART. JUST ADDITIONAL
25 THINGS THAT NEEDED TO BE DONE.
1249
1 Q. SO THESE WERE NOT CHECKS OF THE PATIENT. THAT'S A CHECK
2 OF THE CHART ITSELF. SO PROBABLY WHAT YOU WERE DOING AT
3 1:30 IN THE MORNING WHEN THINGS WHERE HOPEFULLY CALM?
4 A. RIGHT.
5 Q. OVER HERE IS A RESPIRATORY PULSE OXIMETER SATURATION.
6 CAN YOU JUST VERY BRIEFLY TELL US WHAT THAT IS?
7 A. WELL, IT JUST MEANS THAT THE RESPIRATORY THERAPIST CAME
8 ON THE FLOOR AND CHECKED TO SEE WHERE THAT PERSON'S OXYGEN
9 SATURATION RATES WERE, AND IT WAS JUST AN ISOLATED ONE-TIME
10 CHECK, AND THIS PERSON WAS AT 96, WHICH IS RELATIVELY GOOD.
11 QUITE GOOD, ACTUALLY.
12 Q. AND THAT'S OXYGEN SATURATION IN WHAT?
13 A. THE BLOOD.
14 Q. THE BLOODSTREAM. AND YOU MAKE THE MOTION KIND OF
15 PINCHING YOUR FINGER.
16 A. THEY PUT A LITTLE THING ON THE -- MONITOR ON THE FINGER.
17 IT CLAMPS ON THERE. AND I DON'T KNOW HOW IT REALLY WORKS,
18 LIKE A LIGHT ON IT GIVES YOU A READING ON ANOTHER THING. IT
19 SHOWS WHAT THE PERCENT IS.
20 Q. YOU INDICATED THIS SAYS 96 PERCENT, WHICH IS GOOD. IF
21 ONE OF THESE -- AND ARE THESE CALLED O2 SATS?
22 A. UH-HUH.
23 Q. FOR OXYGEN SATURATION. IF ONE OF THESE 02 SATS, IF YOU
24 WERE TO SEE ONE OF THESE 02 SATS THAT HAD LESS THAN 96,
25 WOULD YOU HAVE BECOME CONCERNED?
1250
1 A. WELL, IF IT WERE LESS THAN 90 IT WOULD BE MORE OF A
2 CONCERN. AS LONG AS IT'S IN THE 90S WITH THESE PATIENTS,
3 OLDER, IT PROBABLY WOULD HAVE BEEN -- 96 IS REALLY GOOD FOR
4 AN OLDER PERSON PROBABLY.
5 Q. BUT IF IT FELL BELOW 90, WHAT WOULD YOU DO?
6 A. WELL, PROBABLY INFORM THE DOCTOR. BUT THE RESPIRATORY
7 THERAPIST WOULD BE INVOLVED IN THIS TOO BECAUSE THAT'S THEIR
8 SPECIALTY AND THEY WOULD PROBABLY ADVISE THE NURSE ON WHAT
9 THEY THOUGHT SHE SHOULD DO.
10 Q. APPRECIATE YOU IDENTIFYING THAT FOR US. WE WON'T BE
11 DOCTORS WHEN THIS IS OVER OR WE WON'T BE NURSES WHEN THIS IS
12 THROUGH. WOULD YOU NEXT TURN TO THE PAGE OR TO NUMBER 63.
13 DO YOU HAVE A DATE AT THE TOP?
14 A. JANUARY, IS IT 11TH, I BELIEVE, '96.
15 Q. AND IS YOUR HANDWRITING ON HERE AT ALL?
16 A. YES, IT IS.
17 Q. LET'S START WITH THIS. IT'S A DOCUMENT THAT HAS --
18 APPEARS TO HAVE A LOT OF PRINTING ON IT BEFORE YOU EVEN GET
19 TO IT; IS THAT CORRECT?
20 A. YES.
21 Q. AND WHAT IS THIS DOCUMENT?
22 A. WELL, IT'S WHAT WE DID OUR NURSES NOTES ON. THE PART ON
23 THE LEFT WHERE THE PRINTING IS, IS WHERE THE ASSESSMENT FOR
24 THE SHIFT WOULD BE. DAY SHIFT AND EVENING SHIFT WOULD
25 ASSESS THE PATIENT AND THIS WAS THE FORM THEY WOULD USE.
1251
1 Q. ASSESSMENT MEANING LIKE, SAY, ACTIVITIES, MOBILITIES,
2 THAT SORT OF THING?
3 A. WELL, IT HAS THOSE THINGS THERE. BUT ALSO BREATH
4 SOUNDS, HOW THEIR LUNGS SOUNDED, BOWEL SOUNDS, HOW THEIR
5 SKIN WAS, THAT TYPE OF THING. JUST THE CONDITION OF THE
6 PATIENT.
7 Q. AND ALSO IT LOOKS LIKE MAYBE EVEN THEIR BEHAVIOR AND
8 THEIR MENTAL STATUS; IS THAT CORRECT? IN THE CENTER PART,
9 I'M SORRY.
10 A. YEAH, UH-HUH.
11 Q. I GUESS IF I POINT TO IT AND IT'S NOT ON THE SCREEN, IT
12 DOESN'T HELP ANYBODY. WHO WOULD FILL OUT THE PRINTED FORM,
13 YOU KNOW, DO THE CIRCLES AND NUMBERS AND THAT SORT OF THING?
14 A. WELL, THE PART DOWN HERE WITH THE VITAL SIGNS,
15 FREQUENTLY THAT WAS PUT IN BY THE C.N.A.
16 Q. LET ME MAKE SURE I UNDERSTAND. RIGHT DOWN HERE?
17 A. YES. AND THE REST WAS -- WELL, AS FAR AS MEALS AND THAT
18 KIND OF THING, THAT COULD HAVE BEEN DONE BY THE C.N.A. ALSO.
19 BUT THE ACTUAL ASSESSMENT OF THE PHYSICAL CONDITION OF THE
20 PATIENT WAS DONE BY THE NURSE.
21 Q. INCLUDING THE CIRCLING OF DIFFERENT THINGS IN THE
22 CENTER?
23 A. YES, THE CENTER COLUMN.
24 Q. FOR EXAMPLE, IT SAYS EMOTIONS, AGITATED BEHAVIOR,
25 HOSTILE. THAT WOULD BE THE NURSE?
1252
1 A. YEAH.
2 Q. COULD THAT HAVE BEEN YOU FILLING THAT OUT?
3 A. WELL, NO. THIS WAS -- UNLESS I HAD WORKED THE DAY
4 SHIFT, NO. WE DIDN'T DO THIS ON THE NIGHT SHIFT. IF I
5 STAYED LATE FOR SOME REASON THEN YES, SOMETIMES I WOULD.
6 BUT NOT GENERALLY.
7 Q. AND WHY IS THAT THAT YOU WOULD NOT? THAT THE DAY SHIFT
8 WOULD BE FILLING OUT THE FIRST TWO COLUMNS THERE?
9 A. RIGHT.
10 Q. WHY WOULD THAT BE THAT THEY WOULD BE FILLING THAT OUT?
11 A. THAT WAS JUST THE WAY THE ASSIGNMENTS WERE SPREAD OUT
12 DURING THE DAY. THEY WOULD COME IN, GET A REPORT AND THEN
13 GO IMMEDIATELY AND CHECK ON THE PATIENT.
14 Q. OVER HERE ON THE RIGHT IS A COLUMN AND FIRST IT SAYS
15 PROBLEM P.R.O.B. NUMBER, THEN UNDER THAT IT HAS 2400.
16 WHAT --
17 A. WELL, ACTUALLY THAT'S THE TIME.
18 Q. OKAY. 2400 BEING?
19 A. MIDNIGHT.
20 Q. THAT'S WHEN YOU CAME ON THE SHIFT?
21 A. WELL, REALLY WE STARTED AT 11:30 GENERALLY.
22 Q. SO WITH MR. ALLDREDGE HERE, YOU INDICATE THAT HE WAS
23 RESTLESS AT MIDNIGHT. AND THEN WHAT IS THAT NEXT?
24 A. POSEYED.
25 Q. WHICH IS -- WHAT IS POSEYED?
1253
1 A. KIND OF LIKE A SEAT BELT. IT'S -- WELL, LIKE A SEAT
2 BELT. IT HOOKS ON TO EITHER LIKE A BED OR A CHAIR, AND THEN
3 IT COMES AROUND THE PATIENT'S WAIST AND HAS A BUCKLE THAT
4 YOU CLAMP DOWN, AND THEN IT ONLY OPENS WITH A KEY. AND IT'S
5 USED FOR THE PATIENT'S SAFETY. WE NEED TO HAVE A DOCTOR'S
6 ORDER TO USE THAT. AND THEN THEY REQUIRE SPECIAL CARE WHEN
7 THEY WERE POSEYED. WE NEED TO MAKE SURE THEY WERE REMOVED
8 OCCASIONALLY EVERY SO MANY HOURS AND THAT THEY CAN MOVE
9 AROUND FOR CIRCULATION AND THAT KIND OF THING.
10 Q. BUT YOU COULDN'T JUST DECIDE TO PUT THEM IN A POSEY?
11 A. IF WE FELT THEY WERE REALLY AT RISK FOR INJURY, WE COULD
12 PUT ONE ON THEM AND THEN WE NEEDED TO CONTACT THE DOCTOR AND
13 GET AN ORDER.
14 Q. THEN IT SAYS POSEY UNDONE. PATIENT REPOSITIONED. IS
15 THAT WHAT YOU WERE SAYING? YOU WOULD TAKE IT OFF ONCE IN A
16 WHILE?
17 A. RIGHT.
18 Q. THE NEXT TIME DOWN THERE, IS THAT 0200?
19 A. RIGHT.
20 Q. MEANING WHAT TIME? YOU USE MILITARY TIME?
21 A. TWO O'CLOCK IN THE MORNING.
22 Q. HE CONTINUES RESTLESS, REMOVING BEDDING.
23 A. POSEY UNDONE.
24 Q. REPOSEYING DUE TO AGITATION. THEN AT FOUR O'CLOCK
25 RESTLESS BUT SLEEPING. SIX O'CLOCK?
1254
1 A. IT SAYS U.A. OBTAINED PER STRAIGHT CATH, WHICH MEANS
2 THAT THERE HAD BEEN AN ORDER FOR A URINE SPECIMEN TO BE SENT
3 TO THE LAB AND THAT WE WERE TO OBTAIN IT WHEN WE WOULD
4 CATHETERIZE THE PATIENT TO GET IT.
5 Q. DO YOU KNOW WHETHER HE WAS HAVING ANY TROUBLE VOIDING AT
6 THAT TIME?
7 A. YEAH. I DON'T REMEMBER. BUT FREQUENTLY IF A PATIENT
8 WOULDN'T COOPERATE AND, YOU KNOW, WE COULDN'T GET THEM TO
9 GO, THAT THAT WOULD BE NOT UNCOMMON TO STRAIGHT CATH A
10 PATIENT FOR A U.A.
11 Q. IF HE WOULD GO TO THE BATHROOM NATURALLY YOU WOULD JUST
12 CAPTURE THE SAMPLE?
13 A. UH-HUH.
14 Q. IN YOUR EXPERIENCE AS A NURSE, DID A DISTENDED BLADDER
15 OR A FULL BLADDER AND NOT RELEASING THAT URINE EVER CAUSE
16 AGITATION OR PROBLEMS WITH A PATIENT?
17 A. WELL, IT COULD. SO?
18 Q. THEN IF YOU WOULD TURN OVER TO NUMBER 71. THIS APPEARS
19 TO BE WHAT DATE?
20 A. I'M SORRY.
21 Q. WHAT DATE IS THAT?
22 A. THIS IS JANUARY 12, THE NEXT DAY.
23 Q. SO THE NEXT DAY. AND IT APPEARS THAT HE WAS STILL
24 POSEYED. ONE O'CLOCK YOU SAY PATIENT RESTING QUIETLY.
25 SLEEP STUDY IN PROGRESS. WHAT'S A SLEEP STUDY?
1255
1 A. WELL, I THINK IT WAS BEING DONE ON THIS GENTLEMAN JUST
2 TO SEE HOW HIS BREATHING WAS AT NIGHT. THAT HE HAD PERIODS
3 WHERE HE WAS NOT BREATHING AND THEY WOULD JUST STUDY TO SEE
4 WHAT -- HOW HE WAS DOING. THE SLEEP STUDIES ARE NOT MY
5 SPECIALTY.
6 Q. WHAT WOULD BE YOUR RESPONSIBILITY WITH THE SLEEP STUDY?
7 A. TO MAKE SURE THAT THE LITTLE MONITORS WERE ON IN PLACE.
8 Q. WHAT KIND OF MONITOR WOULD THERE BE FOR A SLEEP STUDY?
9 A. I DON'T REMEMBER.
10 Q. THAT'S FINE. YOU INDICATE THAT SOMETIMES THE PATIENT
11 WOULD HAVE PERIODS WHERE THEY DIDN'T BREATHE. IS THERE A
12 NAME FOR THAT?
13 A. APNEA.
14 Q. APNEA. A-P-N-E-A. AND RESTING QUIETLY AT ONE O'CLOCK.
15 AND THEN AT FOUR O'CLOCK -- IS THIS YOUR WRITING?
16 A. UH-HUH.
17 Q. FOUR O'CLOCK YOU WROTE HE'S BEEN AGITATED, RESTLESS,
18 REMOVING DIAPERS, ET CETERA. WAS THAT UNCOMMON TO HAVE A
19 SHIFT LIKE THAT WITHIN THREE HOURS OF MOOD OR ATTITUDE OR
20 BEHAVIOR?
21 A. YES, IT WAS.
22 Q. I FORGOT. DID I ASK IF IT WAS COMMON OR UNCOMMON?
23 A. IF IT WERE COMMON, AND THAT WAS NOT UNUSUAL, NO.
24 Q. I ASKED THE QUESTION, THEN I FORGOT HOW I ASKED IT.
25 DOESN'T HELP US AT ALL. SO IS THERE ANYTHING REMARKABLE
1256
1 ABOUT THIS CHART, OUT OF THE ORDINARY FOR WHAT PATIENTS
2 WOULD BE LIKE?
3 A. WELL, SLEEP STUDY WAS NOT SOMETHING THAT WAS COMMON, BUT
4 IT WAS NOT UNHEARD OF.
5 Q. THEN MAYBE I SHOULD GO DOWN TO 4:15. COULD YOU READ
6 THAT FOR US?
7 A. SAYS ATIVAN, ONE MILLIGRAM I.M. GIVEN FOR AGITATION AND
8 THEN IT SAYS R.T., WHICH WOULD BE RESPIRATORY THERAPY, WAS
9 IN AND THE FINGER MONITOR WAS REPLACED. SO WE HAD A FINGER
10 MONITOR ON FOR THE SLEEP STUDY.
11 Q. WHAT IS ATIVAN?
12 A. SEDATIVE.
13 Q. AND WHY DID YOU GIVE HIM A SEDATIVE THAT NIGHT?
14 A. WELL, FOR HIS AGITATION. YOU KNOW, I THINK IT WAS
15 PARTLY PROBABLY RELATED TO THE SLEEP STUDY, THAT HE WASN'T
16 LEAVING THE MONITOR ON. AND SO IN HOPES THAT MAYBE IT WOULD
17 CALM HIM TO WHERE HE WOULD BE ABLE TO COMPLETE THE STUDY.
18 Q. AND WHO ORDERED THE ATIVAN TO BE GIVEN FOR THE
19 AGITATION?
20 A. DR. WEITZEL, I'M SURE. WELL, I'D HAVE TO LOOK AND SEE
21 ON THAT TO MAKE SURE, BUT THAT'S GENERALLY WHO WOULD WRITE
22 OUR ORDERS.
23 Q. IT WOULD BE A DOCTOR?
24 A. IT WOULD BE A DOCTOR.
25 Q. IT WOULDN'T BE YOU TO DECIDE TO GIVE HIM THIS DRUG; IS
1257
1 THAT CORRECT?
2 A. RIGHT. Actually, Ms. Scholl gave prn Ativan quite frequently.
3 Q. ONE MILLIGRAM. THAT'S JUST A DOSAGE AMOUNT?
4 A. RIGHT.
5 Q. WHAT DOES I.M. MEAN?
6 A. INTRAMUSCULAR, MEANS IT WOULD BE AN INJECTION.
7 Q. AND WHERE WOULD YOU PUT AN I.M. INJECTION?
8 A. IN THE HIP.
9 Q. AND THEN AT SIX O'CLOCK YOU WRITE, PATIENT CONTINUES TO
10 BE MILDLY AGITATED.
11 A. RIGHT.
12 Q. DID THAT -- DOES THAT INDICATE THAT THERE WAS A CHANGE
13 IN HIS BEHAVIOR?
14 A. I WOULD SAY IT SOUNDED FROM READING THIS -- 'CAUSE I
15 DON'T REMEMBER THIS INCIDENT SPECIFICALLY -- BUT THERE WAS
16 SOME IMPROVEMENT, ALTHOUGH IT WAS NOT TOTALLY TAKEN CARE OF.
17 Q. THEY JUST GO TO SLEEP?
18 A. RIGHT.
19 Q. THANK YOU. DID YOU EVER SEE MR. ALLDREDGE AGAIN AFTER
20 THIS NOTE, TO THE BEST OF YOUR KNOWLEDGE?
21 A. WELL --
22 Q. IF I REPRESENT TO YOU THAT THERE ARE NO OTHER NOTES WITH
23 YOUR HANDWRITING ON, WHAT WOULD THAT MEAN?
24 A. IT DOESN'T MEAN THAT I WASN'T NECESSARILY WORKING. I
25 MAY HAVE SEEN HIM. USUALLY -- OCCASIONALLY THE C.N.A.'S
1258
1 WOULD MAKE A NOTE, BUT THAT WAS USUALLY IF A PATIENT HAD HAD
2 A VERY QUIET NIGHT AND THERE WAS NOTHING NOTABLE. IF THERE
3 WAS SOMETHING OUT OF THE ORDINARY, THEN I WOULD MAKE THE
4 NOTE ON THE PATIENT FOR SURE THAT DAY.
5 Q. WERE YOU PRESENT WHEN HE PASSED AWAY ON THE 14TH OF
6 JANUARY?
7 A. NO.
8 Q. DO YOU RECALL A PATIENT NAMED MARY CRANE?
9 A. I REMEMBER THE NAME AND I THINK I MIGHT VAGUELY RECALL
10 HER, BUT --
11 Q. IF YOU WILL OPEN MARY CRANE'S TO MED NUMBER 00309. I
12 MAY FORGOT TO SAY THE OO BUT -- AND IS THAT YOUR INITIALS
13 DOWN AT THE BOTTOM?
14 A. UH-HUH.
15 Q. DID YOU WRITE ANYTHING ON THAT PAGE?
16 A. NO.
17 Q. WHY WOULD YOUR INITIALS BE ON THE BOTTOM IF YOU HADN'T
18 WRITTEN --
19 A. BECAUSE I HAD WORKED THAT SHIFT.
20 Q. AND DOES IT GO BACK TO WHAT YOU WERE SAYING EARLIER IF
21 IT WAS A QUIET SHIFT?
22 A. RIGHT.
23 Q. NOTHING OF IMPORTANCE.
24 A. WELL, OCCASIONALLY I WOULD WRITE A SHORT NOTE, BUT I
25 USUALLY I WOULD MAKE SURE THAT I WAS WRITING ON THE PATIENT
1259
1 WHO HAD HAD PROBLEMS DURING THE NIGHT.
2 Q. SO IF YOU DIDN'T WRITE ANYTHING, IT WOULD INDICATE THERE
3 HADN'T BEEN ANY PROBLEMS OR ANYTHING NOTABLE THAT YOU NEEDED
4 TO WRITE?
5 A. I WOULD THINK GENERALLY THAT'S TRUE.
6 MR. STIRBA: I'M GOING TO OBJECT. I THINK THAT'S
7 LEADING AND SUGGESTIVE.
8 THE COURT: JUST ASK ANOTHER QUESTION.
9 MS. BARLOW: I'LL GO ON, YOUR HONOR. IT'S NOT
10 SOMETHING -- IT'S NOT SOMETHING THAT'S -- IT WAS JUST BASIC
11 MATERIAL AND I DON'T NEED TO BELABOR THE POINT.
12 Q. WOULD YOU TURN TO 321. AND THIS IS ON MARY CRANE. AND
13 WHAT'S THE DATE?
14 A. JANUARY 4, '96.
15 Q. DID YOU WRITE THE FIRST NOTE THERE AT THE TOP?
16 A. YES, I DID.
17 Q. AND YOU INDICATE THAT 4:30 IN THE MORNING THE PATIENT
18 AWAKENED MOANING C.O. WHAT DOES C. SLASH O MEAN?
19 A. COMPLAINT OF.
20 Q. IS THAT PRETTY TYPICAL --
21 A. YEAH.
22 Q. -- ABBREVIATION, I GUESS?
23 A. YEAH.
24 Q. EVERY TIME YOU SEE A C. SLASH O. IT'S COMPLAINT --
25 A. COMPLAINT OF.
1260
1 Q. COMPLAINS -- MOANING OR MOANING, COMPLAINS OF PAIN.
2 WHAT DID YOU GIVE?
3 A. TYLENOL.
4 Q. THEN YOUR NEXT NOTE AT SIX O'CLOCK, WHAT DID YOU WRITE?
5 A. PATIENT CONTINUES TO MOAN. TYLENOL HAD LITTLE EFFECT.
6 Q. AND THEN GO ON FROM THERE. AWAKE MOST OF THE N.O.C.,
7 N-O-C?
8 A. NIGHTS.
9 Q. IS THAT ANOTHER TYPICAL ABBREVIATION?
10 A. IT'S NOCTURNAL, NIGHT. AND THEN MOANING. PATIENT
11 STATES, I HURT. UNABLE TO TELL PAIN LOCATION. 02 TWO
12 LITERS PER NASAL CANNULA.
13 Q. WHAT DOES THAT MEAN, O2 TWO NASAL?
14 A. PATIENT WAS ON OXYGEN TWO LITERS AND HAD THE LITTLE
15 THING WITH THE PRONGS THAT GO INTO THE NOSE.
16 Q. OKAY. THANK YOU. COLOR GOOD.
17 A. ASKED FOR A DRINK OF WATER AND A PILL. IT LOOKS LIKE
18 PILL'S WRITTEN TWICE.
19 Q. DO YOU HAVE ANY OR ANY RECOLLECTION OF WHETHER SHE
20 EVENTUALLY CALMED DOWN OR --
21 A. WELL, YOU KNOW, I DON'T. I BELIEVE SHE PROBABLY
22 RECEIVED ADDITIONAL MEDICATION.
23 Q. WOULD IT BE NOTED IN HERE IF SHE HAD?
24 A. YEAH. IT WOULD BE UNDER MEDICATIONS, WHICH I'M NOT
25 SEEING. JUST A SECOND. OH, MEDS. MEDS IN GRAPHS. YEAH.
1261
1 IN JANUARY 4, 0645, IT SAYS SHE WAS GIVEN M.S. FIVE
2 MILLIGRAMS I.M. NOW.
3 Q. WHAT NUMBER ARE YOU LOOKING AT?
4 A. 292.
5 Q. LET ME GET TO THAT ONE. I'M TRYING HARD NOT TO GET
6 EVERYTHING ALL CONFUSED. PUT THIS ONE ON THERE. IS THIS
7 THE ONE YOU ARE LOOKING AT, 292?
8 A. ACTUALLY BENEATH THERE. RIGHT IN THERE, YEAH.
9 Q. AND IT'S HARD TO READ THESE, BUT IT LOOKS LIKE THERE'S
10 1/4 AT 0645.
11 A. RIGHT.
12 Q. AND WHAT WAS GIVEN?
13 A. MORPHINE FIVE MILLIGRAMS I.M.
14 Q. DOES THAT SAY NOW?
15 A. YEAH. THAT INDICATES THAT IT WAS A ONE TIME ORDER AND
16 IT WAS TO BE GIVEN THEN.
17 Q. AND M.S. STANDS FOR MORPHINE?
18 A. MORPHINE, UH-HUH.
19 Q. THEN IT SAYS 1/4, 065, SO THAT'S 6:45 IN THE MORNING.
20 AND THEN IT HAS UNDER THE CODE SLASH INITIALS, IT SAYS I.M.
21 DOES THAT MEAN INTRAMUSCULAR?
22 A. RIGHT.
23 Q. AND THEN ARE THOSE YOUR INITIALS UNDERNEATH THERE?
24 A. RIGHT, UH-HUH.
25 Q. WHAT DOES THE FACT THAT YOU INITIALED IT, WHAT DOES THAT
1262
1 MEAN?
2 A. THAT I GAVE IT.
3 Q. YOU GAVE THAT MORPHINE SHOT?
4 A. YES.
5 Q. SO WHEN WE ARE LOOKING AT WHETHER MEDICATIONS WERE
6 GIVEN, WE CAN PERHAPS SEE IN NURSING NOTES, BUT SOMETIMES IT
7 WON'T BE IN NURSING NOTES BUT WOULD BE IN THE GENERAL?
8 A. GENERALLY IT WILL BE, BUT THAT NIGHT ENTRY HAS BEEN MADE
9 AND THE DOCTOR HAD COME IN. ORDERS HAD BEEN WRITTEN AND SO
10 IT DIDN'T GET LOGGED IN HERE, BUT IT DID ON THIS PAGE.
11 Q. AND AGAIN, IF YOU GAVE A SHOT OF MORPHINE, WHO HAD
12 ORDERED THAT SHOT?
13 A. THE DOCTOR.
14 MR. STIRBA: YOUR HONOR, I OBJECT. IT'S
15 IRRELEVANT. SPECIFICALLY THIS PATIENT, NO PROBLEM. IT'S
16 GENERALLY IF WHO WOULD HAVE ORDERED IS IRRELEVANT.
17 Q. (BY MS. BARLOW) I'LL FOCUS IN. THAT SHOT THAT YOU
18 INDICATE YOU GAVE --
19 A. WELL, I WOULD HAVE TO CHECK FOR SURE. JUST A SECOND.
20 IT WAS ORDERED ON JANUARY 4. IT WAS ORDERED BY DR. WEITZEL.
21 Q. AND WHAT DOCUMENT ARE YOU LOOKING AT?
22 A. PAGE 246.
23 Q. WHICH IS WHAT, UNDER THE PHYSICIAN'S ORDERS?
24 A. RIGHT.
25 Q. LET'S CLARIFY THAT. SO THIS IS PAGE MED-246. THE 4TH
1263
1 OR THE 3RD?
2 A. THE 4TH.
3 Q. DOWN HERE?
4 A. RIGHT THERE.
5 Q. AND I GUESS IT'S PROBABLY NUMBER TWO, M.S. FIVE
6 MILLIGRAM I.M. NOW AND THEN?
7 A. AND THEN THE OTHER SAYS A Q-4 HOURS P.R.N., WHICH MEANS
8 EVERY FOUR HOURS AS NEEDED.
9 Q. SO Q. MEANS EVERY?
10 A. RIGHT.
11 Q. P.R.N. MEANS WHAT?
12 A. AS NEEDED, AS NECESSARY.
13 Q. AND WHO DECIDED IF IT WAS NEEDED?
14 A. THE NURSE.
15 Q. SO HOW WOULD A P.R.N. ORDER AFFECT HOW YOU GAVE
16 MEDICATIONS?
17 A. WELL, WE WOULD ASSESS THE PATIENT AND THEN IF WE SAW --
18 LIKE THIS WAS ORDERED P.R.N. PAIN -- AND IF WE SAW PAIN
19 THAT WE FELT WOULD NOT BE HANDLED BY SOMETHING MAYBE OF A
20 LESSER STRENGTH, THEN WE COULD GO AHEAD AND GIVE THAT.
21 Q. THEN YOU WOULD MAKE THE DETERMINATION OF WHETHER
22 SOMETHING LESS WOULD TAKE CARE OF THE PAIN?
23 A. IF IT WERE ORDERED, WE COULD CHOOSE WHATEVER. THERE
24 WERE THREE THINGS ORDERED FOR PAIN THAT WE COULD MAKE A
25 DECISION ON WHICH ONE TO GIVE.
1264
1 Q. WHAT OTHER THINGS MIGHT BE ORDERED FOR PAIN?
2 A. WELL, LIKE ON THAT ONE PATIENT, THIS ONE WAS THAT WE
3 GAVE TYLENOL.
4 Q. RIGHT.
5 A. IT COULD BE ADVIL, MOTRIN TYPE THING. YOU KNOW, IT
6 COULD BE ANY KIND OF A PAIN RELIEVER.
7 Q. AND AS A NURSE WITH YOUR BACKGROUND AND EXPERIENCE, IF
8 YOU HAD TWO OR THREE CHOICES, YOU KNOW, TYLENOL WAS ONE AND
9 YOU KNOW, MORPHINE WAS ONE OF THE OTHER CHOICES, WOULD YOU
10 AUTOMATICALLY GO TO THE MORPHINE IF YOU WERE GOING TO --
11 MR. STIRBA: YOUR HONOR, I'M GOING TO OBJECT. IT'S
12 IRRELEVANT HYPOTHETICAL.
13 THE COURT: SUSTAINED.
14 Q. (BY MS. BARLOW) UP ABOVE ON THAT, THERE'S A STAMP HERE
15 AND WHILE WE'RE HERE, CAN YOU EXPLAIN TO US WHAT THAT STAMP
16 IS?
17 A. THAT IS WHERE THE NIGHT NURSE WOULD -- AS WE WERE DOING
18 CHART CHECKS, SHE WOULD LOOK TO SEE IF ANY OF THE PATIENTS
19 THAT WERE ORDERED ON A ROUTINE SCHEDULE, THAT IF THEY WERE
20 GOING TO EXPIRE, THEN WE WOULD PUT THAT THERE, AND THEN WHEN
21 THE DOCTOR LOOKED AT THE CHART HE WOULD SIGN IT, JUST
22 REORDERING THOSE MEDICATIONS.
23 Q. AND WHAT'S AN EXPIRATION ORDER ON THESE DRUGS?
24 A. IT WOULD VARY DEPENDING ON WHAT THE MEDICATION WAS, AND
25 I DON'T REMEMBER THE LENGTH OF TIME.
1265
1 Q. IS THAT HOSPITAL POLICY THEN? IF A DOCTOR COMES IN --
2 SAY DR. WEITZEL ORDERS SOME DRUGS, A DRUG -- LET'S JUST SAY
3 A DRUG FOR A PATIENT, WOULD ALL DRUGS HAVE THIS AUTOMATIC --
4 WHAT IS IT CALLED?
5 A. ALL DRUGS WOULD EVENTUALLY COME TO A STOP. SOME WOULD
6 COME TO A STOP SOONER.
7 Q. IF IT HAD A -- SAY, A THREE-DAYS EXPIRATION, WHAT
8 WOULD -- WHAT WOULD GO INTO THIS?
9 A. WELL, WHAT WE WOULD PUT ON THERE WOULD BE ANY THAT WERE
10 GOING TO EXPIRE WITHIN THE NEXT 24 HOURS OR SO, THAT THE
11 DOCTOR WOULD SIGN IT AND THERE WOULDN'T BE A LAPSE.
12 Q. IF THE DOCTOR SIGNED IT, DID THAT MEAN HE MEANT IT TO BE
13 REORDERED?
14 A. THAT EVERYTHING IN THAT WOULD HAVE BEEN REORDERED.
15 Q. THIS LOOKS LIKE IT SAYS DURAGESIC PATCH, 50 M.C.G.
16 WHAT'S THAT?
17 A. DO YOU KNOW, I CHANGED PAGES, BUT -- SO WHAT PAGE IS
18 THAT?
19 Q. I'M SORRY. THE 246.
20 A. IT SAYS 50 MICROGRAMS WOULD BE THE DOSE, AND THEN IT
21 SAYS TRANSDERMAL. SO THIS WAS A PATCH.
22 Q. WHAT'S THAT DELTA SIGN OR TRIANGLE?
23 A. CHANGE.
24 Q. SO DOES THE TRIANGLE ALWAYS MEAN CHANGE?
25 A. WELL, TO ME IT DOES. OKAY. AND IT MEANS TO CHANGE IT
1266
1 EVERY THREE DAYS IN THE EVENING.
2 Q. DO YOU KNOW WHAT A DURAGESIC PATCH IS?
3 A. IT'S FOR PAIN RELIEF. IT WOULD BE A NARCOTIC PAIN
4 RELIEVER.
5 Q. IS IT MORPHINE?
6 A. IT DOESN'T CONTAIN MORPHINE. I BELIEVE IT'S FENTANYL.
7 Q. YOU SAY THIS IS A NARCOTIC. IS MORPHINE A NARCOTIC OR
8 NON-NARCOTIC?
9 A. NO. No?
10 MR. STIRBA: YOUR HONOR, I GUESS THE RELEVANCY.
11 IT'S BEYOND THE SCOPE OF COMPETENCY. IF YOU WANT TO TALK
12 ABOUT SPECIFICS, FINE.
13 THE COURT: SUSTAINED.
14 Q. (BY MS. BARLOW) LET'S GO BACK TO THE NURSES' NOTES.
15 LET'S LOOK AT 324.
16 A. TO WHAT?
17 Q. 324.
18 A. 324. OKAY.
19 Q. WHAT DATE WAS THIS?
20 A. JANUARY 5, '96.
21 Q. AND IS THAT YOUR HANDWRITING?
22 A. AT THE TOP, YES.
23 Q. PATIENT SLEPT THROUGH THE NIGHT. PATIENT SOUNDED GURGLY
24 EARLY IN NIGHT. IS THAT SUCTIONED --
25 A. TIMES ONE.
1267
1 Q. X. ONE. WHAT DOES THAT MEAN?
2 A. THERE WOULD BE A SUCTION UNIT AT THE BEDSIDE USUALLY
3 HOOKED TO THE WALL AND THERE WOULD BE TUBING AND A LITTLE
4 TIP ON IT. AND YOU COULD STICK IT IN THE PATIENT'S MOUTH
5 AND SUCTION SECRETIONS OUT OF THEIR THROAT.
6 Q. AND YOU SAY SOUNDED GURGLY, WHAT DOES THAT MEAN?
7 A. GURGLY. I DON'T KNOW. JUST LIKE THERE WAS GUNK IN HER
8 THROAT THAT NEEDED TO BE REMOVED SO THAT SHE COULD BREATHE
9 EASIER.
10 Q. AND THEN COULD DO THE SUCTIONING?
11 A. YEAH.
12 Q. AND THE X. ONE MEANS WHAT?
13 A. TIMES ONE.
14 Q. AND WHAT DOES THAT MEAN?
15 A. ONCE. I DID IT.
16 Q. THEN IT LOOKS LIKE SHE WAS ON OXYGEN. I THINK YOU'VE
17 EXPLAINED IT BEFORE. TWO LITERS PER AND IT'S NASAL CANNULA?
18 A. UH-HUH.
19 Q. IT SAYS R.E.S.P. VERY ERRATIC. AND THERE IS A SYMBOL
20 AND PERIODS. WHAT DOES THAT PHRASE MEAN?
21 A. IT MEANS THAT HER RESPIRATIONS WEREN'T EVEN, THAT MAYBE
22 THEY WOULD BE FAST AND THEN IT WOULD BE SLOW OR MAYBE A
23 PAUSE. OR, YOU KNOW, THEY WERE NOT EVEN. AND THAT SHE HAD
24 PERIODS OF APNEA. SO THERE'S THE PART WHERE SHE WAS HAVING
25 PERIODS OF NO BREATHING.
1268
1 Q. WHAT IS THAT LITTLE C. WITH THE LINE OVER IT?
2 A. WITH.
3 Q. WITH. OKAY. YOU WILL TURN OVER TO 326? THIS APPEARS
4 TO BE THE 6TH OF JANUARY. FREE TEXT. WHAT DO YOU MEAN BY
5 FREE TEXT AS YOU WRITE THAT?
6 A. WELL, THE CHARTING BELOW, IF YOU CAN SEE, IT STARTS WITH
7 THE B. AND THEN IT HAS I.R.P. DOWN FURTHER. THAT IS --
8 THOSE MEAN BEHAVIOR INTERVENTION. I'M NOT THINKING. THE P.
9 IS PLAN. OH, THE R. MUST BE RESULT. AND FREE TEXT MEANS WE
10 JUST KIND OF WROTE A LITTLE NARRATIVE ON WHAT HAD GONE ON.
11 Q. YOU'VE SAID WHAT B.I.R.P. MEANS. WHY WAS IT WRITTEN ON
12 THERE?
13 A. WELL, PATIENTS HAVE WHAT WE CALL A CARE PLAN WITH GOALS.
14 THEY IDENTIFY NEEDS. AND THEN WE HAVE A PLAN HOW WE PLAN TO
15 ACHIEVE THAT. AND THIS TYPE OF CHARTING KIND OF ADDRESSES
16 IT THAT WAY.
17 Q. AND YOU AT THE TOP SAY PATIENT APPEARED TO SLEEP THROUGH
18 THE NIGHT AND, YOU KNOW, IF I'M NOT TRANSLATING CORRECTLY,
19 PLEASE STOP ME. R.E.S.P. RESPIRATIONS MORE FREQUENT.
20 THEN YOU HAVE E.T.
21 A. AND --
22 Q. AND THAT'S THE FRENCH FOR AND.
23 A. FREQUENT AND EVEN TONIGHT. AND THEN PATIENT STARTED
24 MOANING AT APPROXIMATELY SIX -- @ MEANS AT, I THINK PRETTY
25 STANDARD. M.S. FIVE MILLIGRAM I.M. GIVEN FOR PAIN AS
1269
1 ORDERED AT 6:15.
2 Q. WHAT DOES THAT MEAN?
3 A. THAT MUCH FOR THE MOANING WHICH WAS PROBABLY INTERPRETED
4 AS PAIN, THAT SHE WAS GIVEN MORPHINE WHICH HAD BEEN ORDERED
5 PREVIOUSLY BY THE DOCTOR. AND AS TIME WENT BY, IT LOOKED
6 LIKE THAT SHE APPEARED MORE COMFORTABLE. Naturally.
7 THE COURT: MISS BARLOW, HOW MUCH MORE TIME WITH
8 THIS WITNESS?
9 MS. BARLOW: IF I COULD JUST FINISH UP MARY CRANE
10 HERE, PROBABLY JUST ONE MORE QUESTION.
11 Q. WERE YOU PRESENT ON THE 7TH WHEN MARY CRANE PASSED AWAY?
12 A. NO.
13 MS. BARLOW: THAT'S ALL I HAVE. I CAN START ON
14 ANOTHER --
15 THE COURT: THEN LADIES AND GENTLEMEN, LET'S TAKE
16 OUR MORNING BREAK. DURING THIS BREAK, AGAIN IT'S YOUR DUTY
17 NOT TO CONVERSE AMONG YOURSELVES AND CONVERSE OR TO ALLOW
18 YOURSELF TO BE ADDRESSED BY ANY OTHER PERSON REGARDING
19 SUBJECT OF THIS TRIAL. IT'S ALSO YOUR DUTY NOT TO FORM OR
20 EXPRESS AN OPINION UNTIL THE CASE IS FINALLY SUBMITTED TO
21 YOU. WE'LL COME BACK AT TEN MINUTES TO TEN.
22 (JURY LEAVES THE COURTROOM.)
23 (WHEREUPON, COURT WAS IN RECESS.)
24 THE COURT: IF THE WITNESS WOULD LIKE TO COME
25 FORWARD. THE RECORD SHOULD REFLECT THAT THE COUNSEL, THE
1270
1 DEFENDANT AND THE JURORS ARE ALL PRESENT. MISS BARLOW, IF
2 YOU WOULD LIKE TO CONTINUE.
3 Q. (BY MS. BARLOW) MISS SCHOLL, DO YOU RECALL LYDIA
4 SMITH?
5 A. YES, I DO.
6 Q. HOW WELL DO YOU RECALL HER?
7 A. BETTER THAN THE TWO OTHER PATIENTS.
8 Q. I IMAGINE OVER THE 11 YEARS YOU'VE BEEN A NURSE, YOU'VE
9 SEEN A LOT OF PATIENTS?
10 A. QUITE A FEW PATIENTS.
11 Q. DO YOU REMEMBER THEM ALL BY NAME?
12 A. NO.
13 Q. YOU WOULD PULL OUT MISS SMITH. IF YOU WOULD TURN TO
14 759. THAT APPEARS TO BE DECEMBER 21ST, 1995. IS THAT YOUR
15 HANDWRITING AT THE TOP?
16 A. NO, IT IS NOT.
17 Q. OKAY. WHOSE HANDWRITING IS THAT?
18 A. OLA SHELTON. SHE'S A C.N.A.
19 Q. BUT THOSE ARE YOUR INITIALS AT THE BOTTOM?
20 A. RIGHT. SO I WORKED THE SHIFT WITH HER.
21 Q. DO YOU RECALL THE SPECIFIC NIGHT? AND MISS SHELTON
22 WRITES THAT PATIENT SLEPT WELL DURING THE NIGHT. NO C.O.
23 NO C.O. WHEN AWAKE.
24 A. YEAH. NO COMPLAINTS.
25 Q. NO COMPLAINTS. MOVING ABOUT IN BED. OFFERED WHAT?
1271
1 A. B.R. IS BATHROOM.
2 Q. BATHROOM. DO YOU RECALL THAT NIGHT PARTICULARLY?
3 A. NO.
4 Q. IS THAT UNUSUAL FOR MISS SMITH TO HAVE A PEACEFUL NIGHT
5 LIKE THAT?
6 MR. STIRBA: YOUR HONOR, I'M GOING TO OBJECT. I
7 DON'T THINK THERE'S ADEQUATE FOUNDATION FOR HER TO TESTIFY
8 AS TO ALL OF HER NIGHTS. I MEAN --
9 THE COURT: DO YOU WANT TO LAY A FOUNDATION. IF
10 YOU WANT TO DO THAT.
11 MS. BARLOW: I DON'T THINK I WILL, YOUR HONOR. I
12 THINK I'LL GO ON TO SOMETHING ELSE.
13 Q. IF YOU'D TURN TO 761. THIS APPEARS TO BE DECEMBER 22ND.
14 IS THAT YOUR HANDWRITING AT THE TOP?
15 A. YES, IT IS.
16 Q. AND WHAT HAVE YOU WRITTEN IN? P.T. IS THAT --
17 A. PATIENT.
18 Q. PATIENT. OKAY. WHAT HAVE YOU WRITTEN THERE?
19 A. PATIENT AGITATED. UP AND DOWN IN BED. ASSISTED TO
20 BATHROOM. VOIDED QUANTITIES SUFFICIENT.
21 Q. YOU SAY QUANTITIES SUFFICIENT. WHAT REALLY IS THERE?
22 A. WELL, THAT'S NOT REALLY A MEASUREMENT. IT JUST MEANS
23 THAT WHEN SHE URINATED THAT THERE'S AN ADEQUATE AMOUNT
24 THERE.
25 Q. WHAT IS THE ABBREVIATION, THOUGH, THAT YOU'VE WRITTEN?
1272
1 A. Q.S. QUANTITY SUFFICIENT.
2 Q. Q.S. PRETTY STANDARD ABBREVIATION?
3 A. IT WAS ACCEPTED ON THAT FLOOR.
4 Q. PEOPLE KNEW WHAT YOU MEANT WHEN YOU PUT Q.S.?
5 A. RIGHT.
6 Q. AND THEN GO ON FROM THERE.
7 A. CONTINUED TO BE AGITATED. ATIVAN I.M. ONE MILLIGRAM
8 I.M. GIVEN. PATIENT AMBULATED IN HALL WITH ASSISTANCE AND
9 RETURNED TO BED.
10 Q. AMBULATED MEANING?
11 A. WALKING.
12 Q. AND THEN WHAT?
13 A. CURRENTLY RESTING QUIETLY.
14 Q. WAS IT A COMMON OCCURRENCE? AGITATED, WALKED AROUND AND
15 THEN RESTED QUIETLY?
16 A. WELL, BUT SHE HAD ATIVAN ALSO. BUT SOMETIMES WALKING
17 WAS SUFFICIENT. BUT IN THIS CASE I WOULD SAY THAT THE
18 ATIVAN HELPED WITH THE AGITATION.
19 Q. THIS WAS AT WHAT, 1:30 IN THE MORNING?
20 A. YES.
21 Q. AND THEN THE NEXT IT LOOKS LIKE IS DURING THE --
22 PROBABLY THE DAY SHIFT, THE NEXT 1540?
23 A. YES.
24 Q. HOW CAN YOU RECALL SPECIFICALLY OF LYDIA SMITH. YOU SAY
25 YOU RECALL HER MORE THAN YOU DO THE OTHER TWO?
1273
1 A. WELL, SHE WAS -- I GUESS FEISTY MIGHT BE KIND OF A WORD.
2 I MEAN, SHE HAD MORE PERSONALITY. SHE WOULD KICK AND BITE
3 AND, YOU KNOW, GRAB AT YOU AND PULL YOUR CLOTHING OR YOUR
4 HAIR. HAD A LOT OF LIFE IN HER.
5 Q. DID YOU SEE THAT CHANGE OVER THE TIME SHE WAS ON THE
6 UNIT?
7 A. YEAH.
8 Q. IN WHAT WAY?
9 A. WELL, I WAS NOT WORKING JUST BEFORE SHE PASSED AWAY, SO
10 I DON'T REMEMBER HER AT THE VERY END. BUT SHE WOULD BE TO
11 WHERE SHE HAD THAT -- LESS OF THE FEISTINESS AND THEN THE
12 LAST FEW TIMES I SAW HER --
13 Q. LAST FEW TIMES YOU SAW HER, SHE WASN'T STRIKING OUT.
14 WAS SHE MOVING OR DO YOU RECALL?
15 A. WELL, I WOULD HAVE TO LOOK AT MY NOTES.
16 Q. LET'S KIND OF GO THROUGH THE NOTES AND THEN MAYBE WE CAN
17 WRAP IT UP. SO THAT WAS ON THE 22ND. LET'S TURN TO 777. I
18 BELIEVE THERE WERE -- IN FACT, I KNOW THAT THERE WERE OTHER
19 TIMES THAT PERHAPS YOU WERE ON IN BETWEEN THERE. IN THE
20 INTEREST OF TIME, LET'S LOOK AT 777. WHAT DATE WAS THAT?
21 A. DECEMBER 29.
22 Q. THIS WAS ABOUT A WEEK LATER?
23 A. UH-HUH.
24 Q. SO AT 2400 YOU WERE ON THE FIRST PART OF YOUR SHIFT.
25 WHAT DID YOU OBSERVE?
1274
1 A. WELL, PATIENT SLEEPING QUIETLY IN BED. AND SHE HAD BEEN
2 QUIET AND NOT AGITATED AT ALL. AND SO WE REMOVED HER POSEY
3 BECAUSE SHE DIDN'T SEEM AT RISK FOR FALLING OR CLIMBING OUT
4 OF BED. AND HER SIDE RAILS WERE BOTH UP AND SHE HAD A BED
5 CHECK MONITOR IN PLACE.
6 Q. WHAT WAS A BED CHECK MONITOR FOR?
7 A. WELL, YOU CAN SET IT FOR HOW MANY SECONDS BEFORE IT GOES
8 OFF. BUT IT'S AN ALARM THAT'S ON THE PATIENT'S MATTRESS,
9 AND THEN WHEN THEY WILL LIFT UP OFF OF THAT, AFTER SO MANY
10 SECONDS ELAPSE, THEN AN ALARM GOES OFF TO LET US KNOW THAT
11 THE PERSON IS MOVING AROUND IN BED.
12 Q. WHEN YOU SAY LIFT UP, IS THE PERSON TOTALLY GETTING OUT
13 OF BED OR JUST MOVING OR --
14 A. WELL, BOTH. DEPENDING ON IF THEY ARE LIFTING UP OFF OF
15 IT. EVEN IF THEY WEREN'T GETTING OUT OF BED, IT WOULD GO
16 OFF.
17 Q. AND WHAT WAS THE PURPOSE OF THAT?
18 A. IF A PERSON WAS AT RISK FOR FALLS OR FOR SOME REASON WE
19 FELT THEY MIGHT BE CLIMBING OUT OF BED, THEN WE WOULD PUT A
20 BED CHECK MONITOR ON THEIR BED.
21 Q. YOU CAN GET IN THERE BEFORE SOMETHING UNTOWARD HAPPENED?
22 A. PARDON.
23 Q. SO YOU COULD GET THERE BEFORE SOMETHING BAD HAPPENED?
24 A. RIGHT, EXACTLY.
25 Q. AND THEN AT 4:15, ABOUT FOUR HOURS LATER, WHAT DID YOU
1275
1 NOTE?
2 A. WELL, IT SAYS PATIENT UP TO BATHROOM WITH ASSIST.
3 PATIENT CONTINENT --
4 Q. WHAT DOES CONTINENT MEAN?
5 A. THAT MEANS SHE HAD NOT WET HER DIAPER OR PANTS.
6 Q. AND THE OPPOSITE OF THAT IS WHAT?
7 A. INCONTINENT.
8 Q. AND THAT MEANS WHAT?
9 A. THAT SHE WOULD HAVE BEEN WET.
10 Q. IF YOU CAN CONTROL YOURSELF, IT'S CONTINENT. IF YOU
11 CAN'T CONTROL YOUR BLADDER OR BOWELS --
12 A. WOULD BE INCONTINENT. ASSISTED BACK TO BED. SIDE RAILS
13 UP TIMES TWO. BED CHECK REMAINS IN PLACE.
14 Q. S.R. ARROW UP TIMES TWO MEANS SIDE RAILS UP?
15 A. TIMES TWO, BOTH SIDES.
16 Q. BOTH SIDES.
17 A. YEAH.
18 Q. I KNOW THIS ALL MEANS A LOT TO YOU, BUT WE'RE ALL
19 LEARNING HERE. AT 4:30, WHAT DID YOU FIND?
20 A. PATIENT FOUND SITTING ON THE FLOOR BY HER BED. BED
21 CHECK MONITOR MALFUNCTIONED. PATIENT COMBATIVE, STRIKING
22 OUT, KICKING, PULLING AT STAFF AND CLOTHING. ZERO BRUISING
23 OR REDNESS. REDDENED AREAS NOTED.
24 Q. LET'S GO BACK TO THIS ZERO. IS THAT ANOTHER
25 ABBREVIATION THAT'S PRETTY TYPICAL?
1276
1 A. YEAH.
2 Q. SO ZERO WITH A LINE THROUGH IT MEANS NONE OR ZERO?
3 A. RIGHT.
4 Q. AND WHY DID YOU NOTE THAT?
5 A. WELL, WE WOULD CHECK TO MAKE SURE THAT SHE WASN'T
6 INJURED.
7 Q. 'CAUSE SHE WAS OUT OF BED?
8 A. RIGHT.
9 Q. PUT HER BACK TO BED. DID YOU FEEL ANY NEED AT THAT TIME
10 TO GIVE HER ANY KIND OF MEDICATION?
11 A. WELL, WE DIDN'T GIVE HER ANY MEDICATION AND WITH HER --
12 WE PUT THE POSEY BELT BACK ON HER AND REPORTED THAT THE BED
13 CHECK HAD MALFUNCTIONED SO THAT WE COULD GET A NEW ONE. AND
14 I DON'T REMEMBER SPECIFICALLY, BUT SHE MUST HAVE BEEN CALMER
15 AND WE DID NOT MEDICATE HER.
16 Q. IT LOOKS LIKE AT 5:30 YOU NOTIFIED DR. WEITZEL. AND
17 WHAT WAS THE PURPOSE OF THAT?
18 A. WELL, BECAUSE I HAD TAKEN THE POSEY OFF EARLIER IN THE
19 EVENING. THAT MEANS THE ORDER WE HAD HAD BEFOREHAND WAS NO
20 LONGER A GOOD ORDER, SO WE HAD TO GET A NEW ORDER FOR THE
21 POSEY.
22 Q. AND YOU GOT THAT ORDER; IS THAT RIGHT?
23 A. RIGHT.
24 Q. LET'S TURN TO 791. WHAT DATE WAS THAT ONE WRITTEN?
25 A. IT WAS JANUARY 3RD AND I WAS WORKING.
1277
1 Q. WHAT WAS HER -- HOW WAS SHE ACTING THAT EVENING?
2 A. WELL, I DON'T RECALL. IT SAYS HERE, IT SAYS SHE WAS
3 RESTLESS, SITTING UP IN BED, REPEATEDLY ATTEMPTING TO GET
4 OUT OF BED. SO WE HAD HER UP IN THE HALL WALKING WITH
5 ASSISTANCE AND SHE WAS STRIKING OUT AND KICKING AT THE STAFF
6 AND ATTEMPTING TO -- IT LOOKS LIKE IT SAYS STEP ON THE
7 STAFF.
8 Q. STEP ON THE STAFF?
9 A. YEAH.
10 Q. AND THEN WHAT DID YOU DO?
11 A. I GAVE HER I.M. HALDOL.
12 Q. WHAT'S I.M. HALDOL?
13 A. WOULD BE AN INJECTION OF HALDOL WHICH IS AN
14 ANTIPSYCHOTIC.
15 Q. NOW, THE ATIVAN WAS A -- WHAT DID YOU SAY BEFORE IT WAS?
16 A. SEDATIVE.
17 Q. BUT THE HALDOL IS AN ANTIPSYCHOTIC? .
18 A. ANTIPSYCHOTIC.
19 Q. AND WHAT'S THE DIFFERENCE BETWEEN THE TWO?
20 A. WELL, I'M SURE -- THAT'S NOT REALLY MY -- OKAY.
21 Q. OKAY. DID YOU SEE ANY DIFFERENCE IN THE EFFECT BETWEEN
22 THE TWO ON THE PATIENT, ON THIS PATIENT?
23 A. WELL, I THINK THAT WE ACHIEVED THE SAME RESULT WITH THIS
24 MEDICATION.
25 Q. WHICH WAS -- WHICH WAS CALMING HER DOWN?
1278
1 A. RIGHT.
2 Q. LET'S GO BACK. IT SAYS AS ORDERED. LET'S LOOK AT 710,
3 I BELIEVE IT IS. WHEN YOU SAY AS ORDERED, WAS THAT ORDERED
4 ON THE 6TH OF JANUARY AS A NOW, MEANING A ONE TIME THING, OR
5 WAS THIS A STANDING ORDER OR DO YOU RECALL?
6 A. WELL, I GAVE IT ON THE 3RD AND THERE'S NOT AN ORDER FOR
7 IT ON THE 3RD SO IT WAS PROBABLY A STANDING ORDER FROM
8 BEFORE.
9 Q. PULL OUT 707. TURN TO 707. DO YOU SEE THERE A STANDING
10 ORDER FOR HALDOL?
11 A. ACTUALLY THERE'S TWO.
12 Q. PUT THAT ON. SO YOU'VE GOT THE ONE AT THE TOP WHICH WAS
13 ORDERED WHEN?
14 A. ORDERED WHEN?
15 Q. YEAH, WHAT DATE?
16 A. ON THE DECEMBER 25.
17 Q. IT SAYS T.O. NEXT TO DR. WEITZEL. WHAT DOES T. PERIOD
18 O. PERIOD MEAN?
19 A. A TELEPHONE ORDER, WHICH MEANS THAT EITHER THE DOCTOR
20 HAD CALLED US OR WE HAD CALLED HIM AND HE GAVE US AN ORDER
21 OVER THE PHONE.
22 Q. SO THAT ORDER WAS, IF PATIENT REFUSES RISPERDAL, GIVE
23 HALDOL TWO MILLIGRAMS I.M. WAS THAT CORRECT READING OF
24 THAT?
25 A. UH-HUH.
1279
1 Q. WHAT WAS RISPERDAL?
2 A. IT'S ANOTHER ANTIPSYCHOTIC.
3 Q. WHAT'S THE DIFFERENCE BETWEEN THE WAY THE RISPERDAL AND
4 HALDOL IS ORDERED?
5 A. RISPERDAL IS A PILL.
6 Q. SO GOES BY MOUTH?
7 A. UH-HUH.
8 Q. WHEN A PATIENT REFUSES, HOW WOULD A PATIENT REFUSE THE
9 RISPERDAL?
10 A. WELL, SPIT IT OUT, JUST CLOSE HER MOUTH, JUST ABSOLUTELY
11 REFUSING TO TAKE A PILL BY MOUTH.
12 Q. IF A PATIENT WERE SLEEPING WHEN THE PILL WAS TO BE GIVEN
13 AND DIDN'T WAKE UP, WOULD THAT BE CONSIDERED A REFUSAL?
14 A. WELL, I WOULD GUESS THAT WOULD BE THE INTERPRETATION OF
15 THE PERSON TRYING TO ADMINISTER IT.
16 Q. WOULD YOU HAVE INTERPRETED IT THAT WAY?
17 A. WELL, I WOULDN'T SEE IT AS REFUSING, NO.
18 Q. IF YOU WERE TO -- IF YOU WERE ORDERED TO GIVE RISPERDAL
19 AT SAY A CERTAIN TIME, FIVE P.M., EVERY FIVE P.M., AND THE
20 PERSON WAS UNABLE TO SWALLOW THE PILL, IF YOU HAD AN ORDER
21 LIKE THIS, IF A PATIENT REFUSES RISPERDAL TO GIVE HALDOL,
22 WHAT WOULD YOU DO IF THE PERSON WAS UNABLE TO SWALLOW THE
23 PILL?
24 MR. STIRBA: OBJECTION, IT'S IRRELEVANT, YOUR
25 HONOR.
1280
1 MS. BARLOW: YOUR HONOR, I THINK IT'S VERY
2 RELEVANT.
3 THE COURT: ASK IF IT HAPPENED WITH THIS PATIENT.
4 SUSTAINED.
5 Q. (BY MS. BARLOW) DO YOU KNOW WHETHER THAT HAPPENED WITH
6 THIS PATIENT?
7 A. WELL, I DON'T RECALL IT HAPPENING WHEN I WAS ON, AND I
8 WOULDN'T KNOW ABOUT ANYBODY ELSE.
9 Q. I UNDERSTAND. I'M JUST TALKING ABOUT YOUR KNOWLEDGE, SO
10 THANK YOU. LET'S GO DOWN TO THE BOTTOM THEN. AND IT LOOKS
11 LIKE WHAT, DECEMBER 29. AND WHO WROTE THIS AREA HERE TO THE
12 LEFT THERE WHERE IT SAYS 12/29/95, ONE DEPAKENE, DR.
13 WEITZEL.
14 Q. DO YOU RECOGNIZE HIS HANDWRITING?
15 A. UH-HUH.
16 Q. DO YOU KNOW WHAT DEPAKENE IS?
17 A. WELL, IT'S USUALLY I THINK REALLY LIKE AN ANTISEIZURE
18 MEDICATION, BUT IT'S USED A LOT IN PSYCHIATRIC TYPE
19 PRESCRIPTIONS.
20 Q. FOR WHAT EFFECT?
21 A. PROBABLY CALMING.
22 Q. SO WE HAVE THE DEPAKENE. AND THEN THERE'S A HALDOL
23 THREE MILLIGRAMS. DO YOU HAVE ANY IDEA WHAT THAT SAYS AFTER
24 THREE MILLIGRAMS?
25 A. I.M.
1281
1 Q. I.M. -- EXCUSE ME. AT -- WHAT WAS THAT? ONE A.M.?
2 A. UH-HUH.
3 Q. 1700 --
4 A. NO, WAIT A MINUTE. IT DOESN'T SAY ONE A.M. THAT'S THE
5 Q. COMING DOWN FROM ABOVE.
6 Q. OKAY, AT WHAT, THREE MILLIGRAM I.M. AT?
7 A. A.M. 1700 AND H.S.
8 Q. WHAT DOES A.M. MEAN?
9 A. WHENEVER -- LIKE ON THAT FLOOR A.M. MEDICATIONS WERE
10 GIVEN AT EIGHT O'CLOCK.
11 Q. AND THEN H.S., WHAT DOES THAT MEAN?
12 A. BEDTIME.
13 Q. MEANING?
14 A. WELL, AS I DIDN'T NORMALLY GIVE THOSE, I DON'T KNOW.
15 BUT USUALLY IT WOULD BE LIKE EIGHT OR TEN, WHATEVER.
16 Q. SO H.S. IS THE SHORT FOR BEDTIME. IF PATIENT REFUSES
17 ORAL RISPERDAL, THEN UNDERNEATH THAT IT SAYS HALDOL. IS
18 THAT POINT FIVE MILLIGRAMS OR FIVE MILLIGRAM OR CAN YOU
19 TELL?
20 A. FIVE MILLIGRAM.
21 Q. P.O., WHAT DOES THAT MEAN?
22 A. BY MOUTH.
23 Q. AND THEN NEXT TO THAT OR I.M. Q. SIX DEGREE?
24 A. IT'S Q. SIX HOURS OR EVERY SIX HOURS AS NEEDED FOR
25 SEVERE AGITATION.
1282
1 Q. WHEN YOU SEE THAT ORDER, YOU HAVE HALDOL THREE
2 MILLIGRAMS AT SET TIMES AND THEN YOU HAVE HALDOL FIVE
3 MILLIGRAMS, HOW WOULD YOU ADMINISTER THOSE DOSES?
4 A. WELL, THE ONE THAT'S LISTED AS NUMBER TWO, THAT'S -- THE
5 RISPERDAL IS A SCHEDULED MEDICATION WHERE THE PATIENT IS
6 RECEIVING IT AT SCHEDULED TIMES DURING THE DAY. SO THEY ARE
7 SAYING THAT IF THE PATIENT IS NOT RECEIVING THE SCHEDULED
8 DOSE, THEY WERE TO RECEIVE HALDOL INSTEAD.
9 Q. WHAT DOES THREE MEAN, THEN THE HALDOL FIVE MILLIGRAMS?
10 WHAT --
11 A. WELL, THAT WOULD BE JUST SPECIFICALLY FOR SEVERE
12 AGITATION.
13 Q. SO THAT WAS -- WAS THAT THE STANDING ORDER THEN BY THE
14 THIRD OF -- WOULD THAT BE THE ORDER UNDER WHICH YOU GAVE THE
15 HALDOL?
16 A. RIGHT.
17 Q. OKAY. LET'S TURN NOW TO -- AGAIN, I THINK I'LL SKIP
18 OVER SOME OF THE OTHER TIMES WHEN YOU'VE WRITTEN NOTES. BUT
19 LET'S TURN TO THE LAST NOTE THAT YOU WROTE. I BELIEVE IT'S
20 798. HAVE YOU FOUND IT?
21 A. UH-HUH.
22 Q. DOING BETTER THAN I. AND WHAT DATE WAS THIS?
23 A. JANUARY 6TH.
24 Q. AND THEN THIS, AS I INDICATED, I THINK IS THE LAST NOTE
25 THAT YOU WROTE. WOULD YOU READ THAT FOR US, THE NOTE THAT
1283
1 YOU WROTE ABOVE THERE?
2 A. IT'S A FREE TEXT NOTE. SAYS PATIENT AWAKENED ONCE
3 DURING THE NIGHT. ATTEMPTED TO REMOVE DIAPERS. TAKEN TO
4 BATHROOM ON POTTY CHAIR. VOIDED. QUANTITY -- I GUESS IT'S
5 QUANTITY SUFFICIENT. DOESN'T SAY THAT MUCH. THROUGH THE
6 NIGHT PATIENT RETURNED TO BED AND SLEPT QUIETLY REMAINDER OF
7 NIGHT. ZERO PROBLEMS NOTED.
8 Q. I ASKED YOU EARLIER ABOUT ANY CHANGE IN HER BEHAVIOR
9 OVER THE COURSE OF THE TIME THAT YOU WORKED WITH HER. THIS
10 APPEARS TO BE THE LAST TIME THAT YOU AT LEAST WROTE A NOTE.
11 WAS THERE ANY DIFFERENCE BETWEEN WHAT YOU SAW THAT NIGHT AND
12 WHAT YOU HAD SEEN WHEN SHE FIRST CAME IN, SAY, AND YOU FIRST
13 DEALT WITH HER?
14 A. WELL, SHE MAY HAVE HAD AN OCCASIONAL QUIET NIGHT BEFORE,
15 BUT HERE SHE WAS DEFINITELY NOT THE FEISTY PERSON THAT SHE
16 HAD BEEN BEFORE. AND THERE WAS A POTTY CHAIR THAT HAD BEEN
17 MOVED IN BY THE BED SO -- AND I WAS NOT THERE WHEN THAT
18 HAPPENED. BUT USUALLY THAT WILL BE BECAUSE THEY ARE HAVING
19 DIFFICULTY TO THE BATHROOM.
20 Q. THE LAST FEW TIMES THAT YOU DID SEE HER, WAS SHE
21 AMBULATORY, IF YOU RECALL?
22 A. I DON'T RECALL.
23 Q. DO YOU RECALL WITH MISS SMITH AN ORDER TO WITHHOLD ALL
24 MEDICATIONS EXCEPT THE MORPHINE? LET ME TURN YOU TO 711.
25 A. SEVEN WHAT.
1284
1 Q. 711.
2 THE COURT: IS THAT THE DATE OR THE PAGE?
3 MS. BARLOW: THE PAGE IS 711.
4 THE WITNESS: SEE, THIS WAS WRITTEN AFTER I HAD
5 GONE HOME. AND SO -- AND THEN I WASN'T BACK ON THE NEXT
6 NIGHT SO I DON'T RECALL THIS ORDER.
7 Q. (BY MISS BARLOW) WELL, I'LL GO AHEAD AND -- SO OF
8 COURSE YOU DIDN'T SEE THIS ORDER, YOU'VE JUST INDICATED, BUT
9 THE ORDER IS ON THE 7TH OF JANUARY FOR MORPHINE S.O. FOUR.
10 WHAT'S -- DO YOU KNOW WHAT THE S.O. FOUR IS?
11 A. SULFATE.
12 Q. THAT'S JUST THE NAME FOR IT OR WE ALL USE MORPHINE?
13 A. YEAH.
14 Q. FIVE MILLIGRAM I.M. Q. THREE, WHAT DOES THAT MEAN?
15 A. Q. THREE HOURS IS EVERY THREE HOURS.
16 Q. AROUND THE O'CLOCK. IS THAT WRITTEN BY DR. WEITZEL?
17 A. YES, IT IS.
18 Q. AND THEN 1/7, HOLD ALL OTHER MEDS OTHER THAN M.S.
19 A. RIGHT.
20 Q. IS THAT WHAT THAT SAYS?
21 A. YEAH, HOLD ALL OTHER MEDS OTHER THAN THE M.S.
22 Q. SO WHAT WOULD THAT MEAN TO YOU AS A NURSE TO READ THAT?
23 A. THAT THIS PATIENT WAS TO RECEIVE NO OTHER MEDICATION
24 OTHER THAN MORPHINE.
25 Q. AND THEN D.N.R. WHAT DOES THAT STAND FOR?
1285
1 A. DO NOT RESUSCITATE.
2 Q. IF YOU SAW THAT IN AN ORDER THERE, WHAT WOULD THAT MEAN
3 TO YOU AS A NURSE?
4 A. IF THE PERSON WAS TO QUIT BREATHING, THE HEART WERE TO
5 STOP, THAT YOU WOULD -- THAT YOU WOULD NOT MAKE ATTEMPTS TO
6 GET THEM GOING AGAIN.
7 Q. AND WHAT ATTEMPT WOULD YOU MAKE WITH SOMEONE YOU WERE
8 TRYING TO RESUSCITATE?
9 A. C.P.R.
10 Q. MAYBE JUST FOR CLARIFICATION, JUST TO EDUCATE THE JURY.
11 DOWN BELOW WHERE IT SAYS 1/8/95, IT'S GOT A TELEPHONE ORDER,
12 AND IT SAYS MISTAKEN ENTRY AND IT'S CROSSED OUT. DO YOU
13 KNOW WHAT THAT MEANS?
14 A. WELL, THAT SHE HAD MADE AN ERROR IN TAKING IT AND THEN
15 SHE CROSSED IT OUT SO THAT THERE WOULD BE NO CONFUSION, AND
16 THEN SHE TURNED THE PAGE AND WROTE A NEW ORDER ON THE NEXT
17 PAGE.
18 Q. LET'S GET TO THAT PAGE. THAT SOMETIMES HAPPENS, YOU
19 WRITE --
20 A. YEAH, IT DOES.
21 Q. THAT'S HOW YOU TAKE CARE OF IT. YOU DON'T TRY TO ERASE
22 IT?
23 A. IN FACT, YOU ARE NOT SUPPOSED TO SCRATCH SOMETHING OUT
24 SO IT'S NOT LEGIBLE.
25 Q. SO THIS OTHER ORDER -- AND AGAIN IT SAYS T.O., SO THAT
1286
1 MEANS WHAT?
2 A. I'M SORRY. IT SAYS WHAT?
3 Q. ON THE NEXT PAGE ON 712 T.O. DR. WEITZEL.
4 A. TELEPHONE ORDER.
5 Q. THEN I NOTICE THAT IT APPEARS TO BE DR. WEITZEL'S
6 SIGNATURE UNDERNEATH THAT.
7 A. IT IS.
8 Q. WHAT DOES THAT MEAN?
9 A. WELL, WHEN WE TAKE A TELEPHONE ORDER, THEN WE WILL SIGN
10 IT THAT WE HAVE TAKEN IT. AND THEN WHEN HE COMES IN, HE
11 WILL JUST SIGN IT TO MAKE IT OFFICIAL.
12 Q. AND THAT SAYS, NOTED 0900 1/8/95. THAT LOOKS LIKE S.
13 HANSEN.
14 A. AND YOU SEE ALL THROUGH HERE THAT THESE THINGS THAT HAVE
15 A NOTE THAT -- WHAT DOES THAT MEAN. TOOK THE ORDER OFF AND
16 THAT MEANS THEY HAVE TRANSFERRED THAT INFORMATION ONTO WHAT
17 WE WOULD CALL THE M.A.R., WHICH IS WHERE ALL OF THE
18 MEDICATIONS SHEETS ON THE PATIENTS GO. THIS PARTICULAR
19 ORDER WOULD GO ON THAT.
20 Q. THIS WOULD NOT BE THE ONLY PLACE THAT AN ORDER LIKE THAT
21 WOULD SHOW UP? I SHOULDN'T SAY AN ORDER LIKE THAT?
22 A. WELL, DEPENDING LIKE IF WE WERE TO GET AN ORDER FOR
23 E.K.G. OR L.A.X. OR WHATEVER, THOSE THINGS WOULD BE ENTERED
24 ON THE COMPUTER. WE WOULD MAKE NOTES ON KARDEXES AND
25 THINGS. BUT THIS IS A MEDICATION ORDER AND IT WOULD BE
1287
1 ENTERED IN ACTUALLY ON THE KARDEX AS WELL. BUT ON THE
2 M.A.R., WHICH IS THE MEDICATION -- I DON'T KNOW WHAT YOU
3 CALL IT -- BUT IT'S ALL THE MEDICATIONS THAT ALL THE
4 PATIENTS ARE RECEIVING. EACH PATIENT HAS A SECTION.
5 Q. KIND OF A DOUBLE, TRIPLE PROTECTION?
6 A. YEAH.
7 Q. SO THAT THAT'S NOTED IN SEVERAL DIFFERENT PLACES ABOUT
8 THE DRUGS THAT ARE BEING GIVEN?
9 A. RIGHT.
10 Q. SO THIS WAS TO CHANGE THE MORPHINE ORDER TO TEN
11 MILLIGRAMS EVERY THREE HOURS AROUND THE CLOCK; IS THAT
12 CORRECT?
13 A. RIGHT. IT HAD BEEN WRITTEN ORIGINALLY FOR FIVE
14 MILLIGRAMS AND THEN ON THE 8TH IT WAS INCREASED TO
15 10 MILLIGRAMS.
16 Q. THANK YOU. AND YOU DIDN'T SEE MISS SMITH AGAIN BEFORE
17 SHE PASSED AWAY ON THE 8TH; IS THAT CORRECT?
18 A. NO.
19 Q. LET ME ASK YOU IF YOU RECALL JUDITH LARSEN?
20 A. YES, I DO.
21 Q. AND WHY DO YOU RECALL HER?
22 A. WELL, COUPLE OF REASONS, BUT PRIMARILY, WHEN I WAS ON,
23 SHE HAD HAD A SEIZURE DURING THE SHIFT. AND, YOU KNOW, THAT
24 KIND OF CEMENTED IT IN MY MIND.
25 Q. WE'LL GET TO THAT SEIZURE IN A MINUTE. DID YOU OVER THE
1288
1 COURSE OF HER STAY IN THE HOSPITAL SEE ANY CHANGE IN HER
2 BEHAVIOR?
3 MR. STIRBA: I'M GOING TO OBJECT. FOUNDATION, YOUR
4 HONOR.
5 THE COURT: LAY A FOUNDATION.
6 MS. BARLOW: I'LL LAY A FOUNDATION. SHE CAME INTO
7 THE HOSPITAL, I BELIEVE IT WAS ON THE 6TH OF JULY, AND I
8 BELIEVE SHE PASSED AWAY --
9 THE COURT: 6TH OF JULY?
10 MS. BARLOW: EXCUSE ME --
11 MR. STIRBA: YOUR HONOR, I'M GOING TO OBJECT. IT'S
12 LEADING AND SUGGESTIVE. IT'S NOT A QUESTION.
13 THE COURT: ASK A QUESTION.
14 MS. BARLOW: WELL, IT'S PURELY FOUNDATIONAL. I
15 MEAN, WE HAVE THE RECORDS THAT SHOW THAT SHE CAME IN ON THE
16 6TH OF DECEMBER.
17 THE COURT: OKAY. GO AHEAD. JUST ASK THE
18 QUESTION.
19 Q. (BY MS. BARLOW) DO YOU RECALL THE LENGTH OF TIME THAT
20 MISS LARSEN WAS ON THE UNIT?
21 A. NOT EXACTLY, BUT IT WAS QUITE A WHILE. IT WAS SEVERAL
22 WEEKS.
23 Q. AND YOU WERE WORKING -- WERE YOU WORKING 40 HOURS A WEEK
24 DURING THAT TIME?
25 A. YES, BUT I HAD JUST STARTED AND I WAS STILL ACTUALLY IN
1289
1 ORIENTATION WHEN I FIRST MET JUDITH.
2 Q. JUDITH. HOW OFTEN DURING THAT TIME PERIOD THAT SHE WAS
3 IN THERE THAT YOU SAY WAS A LONGER PERIOD OF TIME, HOW OFTEN
4 DID YOU SEE HER?
5 A. WELL, EVERY FIVE NIGHTS A WEEK.
6 Q. AND DURING THE TIME THAT YOU SAW HER, DID YOU SEE A
7 CHANGE IN HER BEHAVIOR?
8 A. YEAH. SHE BECAME QUIETER, COMATOSE TOWARDS THE END.
9 Q. WHEN SHE FIRST CAME IN, WHAT WAS HER BEHAVIOR?
10 A. YOU KNOW, SEEING HER JUST ON NIGHTS, I DON'T THINK THAT
11 I WOULD PROBABLY SEE AS DRAMATIC A CHANGE AS MAYBE ANOTHER
12 SHIFT MIGHT HAVE. IN THE BEGINNING SHE PROBABLY WOKE UP
13 MORE AT NIGHT AND THAT, YOU KNOW, WE WOULD BE IN CHANGING
14 HER DIAPER BECAUSE SHE WOULD HAVE MORE FLUIDS. AND SHE WAS
15 MORE VOCAL IN THE BEGINNING.
16 Q. LET'S TURN TO WHAT YOU COMMENTED ABOUT THE SEIZURE, PAGE
17 567. WHAT DATE WAS THAT?
18 A. DECEMBER 26.
19 Q. AND DO YOU RECALL THIS EVENING WITHOUT LOOKING AT YOUR
20 NOTES, THIS EXPERIENCE?
21 A. WELL, YEAH. BUT I PROBABLY WOULD WANT TO VERIFY IT
22 WITH --
23 Q. AND DO YOU RECALL WHAT THE SEIZURE ACTIVITY YOU SAW WAS?
24 A. WELL, IT WAS CONFINED TO ONE SIDE OF HER BODY. I
25 REMEMBER THAT. AND IT WAS IT KIND OF A GRADUAL ONSET. AND
1290
1 SHE -- HER FACE AND HER ARM AND HER LEG STARTED TWITCHING,
2 JERKING.
3 Q. DO YOU HAVE ANY KNOWLEDGE BECAUSE OF YOUR EXPERIENCE AS
4 A NURSE AND YOUR TRAINING AS A NURSE WHAT CAUSES SEIZURES?
5 A. WELL --
6 MR. STIRBA: YOUR HONOR.
7 MS. BARLOW: I'M NOT ASKING FOR A MEDICAL
8 DIAGNOSIS. I'M JUST ASKING IF SHE HAS ANY KNOWLEDGE. SHE
9 DOESN'T --
10 MR. STIRBA: HER UNDERSTANDING MAYBE AS A NURSE.
11 THE COURT: I THINK THAT'S HOW THE QUESTION WAS
12 PHRASED. YOU CAN ANSWER THE QUESTION.
13 Q. (BY MS. BARLOW) AS A NURSE, DO YOU KNOW WHAT CAN CAUSE
14 SEIZURES?
15 A. WELL, YOU KNOW, A LOT OF DIFFERENT THINGS. I MEAN,
16 INJURIES, FEVER, MEDICATION. I DON'T KNOW. A LOT OF
17 THINGS. She knows very little, obviously.
18 Q. DID SHE HAVE AN INJURY THAT PRECEDED THIS SEIZURE
19 ACTIVITY?
20 A. NOT THAT I'M AWARE OF.
21 Q. DID YOU CHECK HER VITAL SIGNS TO SEE IF SHE HAD A FEVER?
22 A. WELL, AT THE BEGINNING OF THE SHIFT SHE WAS CHECKED AND
23 SHE DID HAVE A TEMP, IT LOOKS LIKE OF 99.1, WHICH WOULD BE
24 VERY MINIMAL.
25 Q. OKAY. WHAT DID YOU DO WHEN YOU SAW THIS SEIZURE
1291
1 ACTIVITY?
2 A. WELL, I NOTIFIED THE NURSING SUPERVISOR AND I CALLED
3 DR. DIENHART.
4 Q. WHEN YOU SAY YOU CALLED DR. DIENHART, DID YOU GET HIM ON
5 THE PHONE OR DID YOU PAGE HIM OR HOW DOES THAT WORK?
6 A. LOOKING HERE IT SAYS NOTIFIED, SO I PROBABLY CALLED HIS
7 HOME.
8 Q. AND I BELIEVE THAT'S PROBABLY RIGHT HERE WHERE IT SAYS
9 DIENHART NOTIFIED AND I.V. D-5 STARTED AS ORDERED. WHAT
10 DOES THAT MEAN?
11 A. THAT'S THE TYPE OF I.V. SOLUTION.
12 Q. AND I.V. MEANING WHAT?
13 A. INTRAVENOUS.
14 Q. AS OPPOSED TO IN THE MUSCLE, IT GOES INTO THE VEIN?
15 A. RIGHT, EXACTLY. I'M SORRY.
16 Q. AND WHO ORDERED THE I.V.?
17 A. DR. DIENHART.
18 Q. AND THEN ATIVAN THREE MILLIGRAM I.V. GIVEN. WHY DID YOU
19 GIVE ATIVAN AT THAT POINT?
20 A. IT HELPS CONTROLS SEIZURES.
21 Q. AND WHO TOLD YOU TO GIVE THE ATIVAN?
22 A. DR. DIENHART DID.
23 Q. AND IT SAYS, AND NO IMPROVEMENT NOTED. SO YOU CALLED
24 DR. DIENHART BACK?
25 A. UH-HUH.
1292
1 Q. AND WHAT DID HE TELL YOU?
2 A. TO GIVE HER AN ADDITIONAL MILLIGRAM OF ATIVAN THROUGH
3 THE I.V. Four milligrams now.
4 Q. DID YOU DO THAT?
5 A. YES, I DID.
6 Q. DID IT HAVE ANY EFFECT?
7 A. THEN SHE CALMED AND THE SEIZURE ACTIVITY STOPPED.
8 Q. THE NEXT SAYS R.E.S.P. IS THAT RESPIRATIONS?
9 A. RIGHT.
10 Q. FREE AND EASY. NO PROBLEM. I.V. CHANGED. IS THAT WHAT
11 THE TRIANGLE IS?
12 A. YEAH. CHANGED TO N.S., WHICH IS NORMAL SALINE.
13 Q. AND IS IT --
14 A. DILANTIN WAS STARTED. AND THE REASON FOR THE CHANGE IS
15 I'M SURE BECAUSE YOU CAN'T RUN DILANTIN THROUGH THE OTHER
16 I.V. FLUIDS, BUT IT NEEDS TO BE THROUGH N.S.
17 Q. SO WHEN SOMEONE IS GIVEN SOMETHING I.V., I MEAN SOME
18 THINGS YOU CAN JUST INJECT I.V. WITHOUT ANYTHING ELSE OR --
19 AND SOME THINGS HAVE TO BE IN A SOLUTION. I GUESS I DON'T
20 FULLY UNDERSTAND.
21 A. WELL, DILANTIN, WHEN YOU RUN IT THROUGH AN I.V., IT WILL
22 PRECIPITATE OUT. I GUESS KIND OF LIKE CRYSTALLIZE IF IT'S
23 IN THE WRONG SOLUTION. SO WE NEEDED TO CHANGE THE
24 SOLUTION TO N.S.
25 Q. SO YOU HAD AN I.V. GOING, BUT YOU HAVE TO CHANGE WHAT
1293
1 KIND?
2 A. RIGHT, JUST THE BAG.
3 Q. DO YOU RECALL WHAT TIME IT WAS THAT THESE ORDERS WERE
4 ENTERED?
5 A. WELL, IT WAS EARLY IN THE MORNING -- WELL, CLOSE TO THE
6 END OF THE SHIFT, SOMEWHERE BETWEEN FIVE, SIX, SEVEN, DURING
7 THAT PERIOD.
8 Q. LET'S SEE IF WE CAN TURN BACK TO THE PHYSICIAN'S ORDERS
9 FOR THAT DAY. I BELIEVE IT'S 462.
10 A. YEAH. IT IS 462.
11 Q. OKAY. THE JURY'S KIND OF SEEN HIS HANDWRITING BEFORE.
12 IT'S GOING TO BE INTERESTING HERE. OKAY. UP AT THE TOP
13 HERE IT SAYS 12/26 6:05. TELEPHONE ORDER. DR. DIENHART.
14 IS THAT YOUR --
15 A. YEAH, THAT'S ME.
16 Q. THAT'S YOUR INITIAL I.V. D- FIVE. AND THEN IT LOOKS
17 LIKE DIENHART HAD COME IN AND SIGNED IT; IS THAT CORRECT?
18 A. RIGHT.
19 Q. VERIFYING THE ORDER?
20 A. RIGHT.
21 Q. ATIVAN I.V. WHAT IS THAT WORD?
22 A. WELL, THAT'S TITRATE.
23 Q. WHAT DOES TITRATE MEAN?
24 A. WELL, TO ADJUST. I MEAN, IF THE SEIZURE ACTIVITY WERE
25 TO STOP AFTER WE JUST GIVE ONE MILLIGRAM, THERE WOULD BE NO
1294
1 REASON TO GIVE HER THE ADDITIONAL TWO.
2 Q. IS THAT STANDARD PROCEDURE FOR YOU TO TITRATE?
3 A. YEAH.
4 Q. ONE TO THREE MILLIGRAMS. SO YOU START AT THE ONE, IF
5 THAT DIDN'T WORK YOU WOULD INCREASE IT, IS THAT WHAT YOU ARE
6 SAYING?
7 A. RIGHT.
8 Q. OVER FIVE MINUTES TILL SEIZURE STOPPED. 0620 TELEPHONE
9 ORDER. DR. DIENHART GIVE ADDITIONAL ONE MILLIGRAM ATIVAN
10 NOW. DOES THIS COMPORT WITH WHAT --
11 A. RIGHT.
12 Q. THEN WE HAVE AT SEVEN A.M., IT LOOKS LIKE THE
13 HANDWRITING OF DR. DIENHART. DO YOU RECALL HIM COMING IN AT
14 SEVEN?
15 A. YES, I DO.
16 Q. AND WHAT DID HE ORDER AT THAT SEVEN O'CLOCK?
17 A. WELL, THERE WERE A LOT OF THINGS. WE STARTED HER ON
18 OXYGEN AND HE WANTED US TO ADJUST IT TO KEEP HER SATS AT 90
19 OR GREATER.
20 Q. THAT'S THE OXYGEN SATURATION?
21 A. RIGHT. AND THE I.V. WE'RE DEALING WITH A DIFFERENT
22 SOLUTION THERE, AND THE DILANTIN SHE WAS TO RECEIVE ONE
23 GRAM. AND OVER FORTY MINUTES AND THEN WE WERE TO GIVE HER
24 100 MILLIGRAMS I.V. EVERY EIGHT HOURS. SHE WAS TO GET
25 E.K.G. AND THEN HAVE SOME LABS DRAWN WHICH WOULD BE A CHEM
1295
1 20 HERE AND C.B.C. SHE HAD A CAT SCAN OF HER HEAD AND --
2 OH, IT SAYS RULE OUT CEREBRAL BLEED, AND THAT WAS --
3 Q. THIS IS R.O., TO RULE OUT?
4 A. RIGHT.
5 Q. RULE OUT CEREBRAL BLEED?
6 A. RIGHT. THAT WAS THE PURPOSE OF THE CAT SCAN. AND THEN
7 IT SAYS DILANTIN LEVEL AT NINE A.M. AND THEN IT LOOKS LIKE
8 IT SAYS BLOOD PRESSURE EVERY TEN MINUTES DURING THE DILANTIN
9 INFUSION.
10 Q. AND WHY WOULD HE ORDER BLOOD PRESSURE TAKEN THAT OFTEN?
11 A. JUST BECAUSE --
12 MR. STIRBA: I OBJECT, YOUR HONOR. IT'S A DOCTOR'S
13 ORDER.
14 THE COURT: IT'S SPECULATION. SUSTAINED.
15 Q. (BY MS. BARLOW) DILANTIN LEVEL AT NINE A.M.?
16 A. RIGHT.
17 Q. WHAT IS DILANTIN LEVEL?
18 A. WHEN THEY WOULD DRAW BLOOD TO SEE HOW MUCH DILANTIN WAS
19 IN THE BLOOD.
20 Q. WHAT DOES DILANTIN DO? WHAT KIND OF MEDICINE IS IT?
21 A. ANTISEIZURE.
22 Q. SO DID YOU FOLLOW THESE ORDERS?
23 A. YES.
24 Q. LET'S TURN TO MEDICAL NUMBER 463 WHICH IS THE NEXT PAGE.
25 SO WE HAVE DR. DIENHART ORDER AT SEVEN A.M. ON THE 26TH.
1296
1 AND THEN ON THE NEXT PAGE WE HAVE ALSO ON THE 26TH,
2 TELEPHONE ORDER, DR. WEITZEL. GIVE MORPHINE TWO MILLIGRAM
3 I.M. NOW. STOP I.V. THERAPY. OBSERVE FOR -- WHAT'S S.X.?
4 A. SYMPTOMS.
5 Q. SYMPTOMS OF PAIN. TELEPHONE ORDER, DR. WEITZEL. AND
6 THAT IS NOTED AT EIGHT A.M.; IS THAT CORRECT?
7 A. RIGHT.
8 Q. SO AT EIGHT A.M. THERE'S AN ORDER TO -- ORDER NOTED TO
9 STOP THE I.V. THERAPY. WHAT WOULD THAT DO TO THE DILANTIN?
10 A. WELL, SHE WOULD NOT BE RECEIVING ANY MORE.
11 Q. IS THERE ANY OTHER WAY OF GIVING DILANTIN?
12 A. I BELIEVE YOU CAN GIVE ORAL DILANTIN.
13 Q. WAS THERE ANY ORDER FOR ORAL DILANTIN?
14 A. NO, THERE WAS NOT.
15 Q. THAT WAS ON THE 26TH. SO AT THAT POINT WAS SHE GETTING
16 ANY MORE DILANTIN?
17 A. NO, SHE WAS NOT.
18 Q. YOU LOOKED AT THESE RECORDS. DO YOU SEE HER EVER
19 GETTING ANY MORE DILANTIN?
20 A. SHE WAS NOT RECEIVING ANY MORE DILANTIN.
21 Q. NOW, LET'S TURN TO 475. LOOK DOWN TWO-THIRDS DOWN THE
22 PAGE. IT LOOKS LIKE THAT'S 12/28, AND IS THAT DR. WEITZEL'S
23 HANDWRITING?
24 A. YES, IT IS.
25 Q. AND IT SAYS THAT DILANTIN APPEARS TO BE CAUSING SOME
1297
1 SEDATION. THE LETHARGY CONTINUES. WAS SHE RECEIVING
2 DILANTIN AFTER EIGHT O'CLOCK ON THE 26TH OF --
3 A. SHE WAS NOT.
4 MR. STIRBA: I'M GOING TO OBJECT. I DON'T THINK
5 THIS WITNESS IS IN THE POSITION TO KNOW THAT.
6 THE COURT: LAY THE FOUNDATION. LAY A FOUNDATION
7 ABOUT THIS WITNESS' KNOWLEDGE.
8 Q. (BY MS. BARLOW) HAVE YOU LOOKED AT THESE RECORDS FROM
9 THE 26TH THROUGH THE 28TH, THESE MEDICAL RECORDS?
10 A. UH-HUH.
11 Q. DURING THE TIME FROM THE -- FROM THE TIME THAT THE
12 DILANTIN WAS STOPPED ON THE 26TH AT EIGHT A.M. UNTIL THE
13 28TH, HAVE YOU SEEN ANY OTHER ORDERS FOR DILANTIN FOR THIS
14 PERSON, FOR JUDITH LARSEN?
15 A. NO, THERE WAS NOT. THERE WAS A NOTE IN THE ORDERS FOR
16 ON THE 29TH, I BELIEVE, TO D.C. THE DILANTIN, BUT THE
17 DILANTIN HAD NOT NOT BEEN GIVEN SINCE THE MORNING --
18 MR. STIRBA: YOUR HONOR, ONCE AGAIN SHE'S
19 TESTIFYING AND THERE'S INADEQUATE FOUNDATION.
20 MS. BARLOW: YOUR HONOR, SHE'S TESTIFYING FROM THE
21 RECORDS.
22 MR. STIRBA: MAY I VOIR DIRE?
23 THE COURT: YES.
24 VOIR DIRE EXAMINATION
25 BY MR. STIRBA:
1298
1 Q. DURING THE TIME PERIOD BETWEEN THE 28TH AND 29TH, FROM
2 REVIEW OF THE RECORDS, MISS SCHOLL, CAN YOU TELL US WHETHER
3 OR NOT YOU WERE WORKING THE EVENING OF THE 26TH, THE EVENING
4 OF THE 27TH, THE EVENING OF THE 28TH?
5 A. I WORKED NO EVENINGS, JUST NIGHTS.
6 Q. THAT'S WHAT I'M TALKING ABOUT. ELEVEN THROUGH SEVEN
7 SHIFT.
8 A. I WAS NOT. WELL, MIGHT HAVE BEEN THERE ON THE ELEVEN TO
9 SEVEN SHIFT. I'D HAVE TO LOOK AND SEE.
10 Q. CAN YOU TELL US AS YOU SIT HERE RIGHT NOW WHETHER OR NOT
11 YOU WERE EVEN THERE PROVIDING NURSING CARE ON THE ELEVEN TO
12 SEVEN SHIFT THE NIGHTS I'VE JUST INDICATED.
13 A. NOT WITHOUT LOOKING.
14 MS. BARLOW: YOUR HONOR, SHE WOULDN'T BE IN A
15 POSITION TO KNOW. SHE CAN TESTIFY FROM THE RECORDS, WHICH I
16 BELIEVE ARE IN EVIDENCE.
17 THE COURT: WELL, I BELIEVE SHE'S TESTIFIED ABOUT
18 WHAT HER REVIEW OF THE RECORDS HAVE SAID. SO WHAT'S THE
19 NEXT QUESTION.
20 MS. BARLOW: WELL, THE QUESTION WAS, IS BASED ON
21 THE RECORDS, WAS ANY DILANTIN GIVEN BETWEEN THE 26TH AND THE
22 28TH.
23 MR. STIRBA: YOUR HONOR, I'M GOING TO OBJECT.
24 SHE'S NOT HERE AS A REVIEWER OF THE RECORDS. SHE PROVIDED
25 PRESUMABLY TREATMENT WHICH SHE DOCUMENTED. SHE CAN TESTIFY
1299
1 ABOUT THAT. BUT TO ACT AS IF SHE WERE A REVIEWER OF THE
2 RECORDS, IT'S JUST NOT A COMPETENT WITNESS TO DO THAT.
3 THE COURT: OKAY. JUST ASK THIS QUESTION AND LET'S
4 GET ON WITH IT. I THINK WE'RE BOGGING DOWN HERE.
5 MS. BARLOW: WELL, I GUESS MY QUESTION IS, CAN SHE
6 ANSWER THAT QUESTION.
7 THE COURT: ASK THAT QUESTION AND LET'S GET ON WITH
8 IT. I THINK WE'RE SLOWING DOWN.
9 MS. BARLOW: THAT'S ALL I ATTEMPTED TO DO, YOUR
10 HONOR.
11 DIRECT EXAMINATION, CONT'D
12 BY MS. BARLOW:
13 Q. BETWEEN THE 26TH AND THE 28TH,BASED ON THE RECORDS, DID
14 JUDITH LARSEN RECEIVE ANY DILANTIN?
15 A. NOT AFTER THE MORNING OF THE 26TH.
16 MR. STIRBA: I'M GOING TO OBJECT. SHE CAN'T SAY
17 WHETHER SHE DID RECEIVE. SHE CAN SAY WHAT THE RECORDS SHOW.
18 THE COURT: THAT'S WHAT SHE SAID. LET'S GET ON.
19 Q. (BY MS. BARLOW) THERE CAME A TIME PERIOD IN THE
20 RECORDS, AND IT'S ABOUT 576 I BELIEVE, WHEN THERE WAS AN
21 EPISODE OF VOMITING. DO YOU RECALL THAT WITHOUT LOOKING AT
22 THE RECORDS OR EVEN I GUESS WITH LOOKING AT THE RECORDS?
23 A. WELL, I RECALL, BUT I WOULD MORE VIVIDLY RECALL LOOKING
24 AT THE RECORDS.
25 Q. LET'S THEN TURN TO 576. WHAT DATE WAS THAT?
1300
1 A. DECEMBER 30.
2 Q. SO YOU'VE GOT FREE TEXT AT MIDNIGHT. PATIENT VOMITING
3 EMESIS COFFEE-GROUND LIKE IN APPEARANCE. WHAT'S EMESIS?
4 A. WELL, IT'S PATIENT VOMITING. QUITE COMMON. AND THEN
5 EMESIS WHICH IS THE VOMIT ITSELF, COFFEE-GROUND LIKE IN
6 APPEARANCE WITH PASTY TEXTURE.
7 Q. BASED ON YOUR KNOWLEDGE, BASED ON YOUR EXPERIENCE AS A
8 NURSE, DO YOU KNOW WHAT WAS CAUSING THIS VOMITING?
9 A. COFFEE-GROUND LIKE EMESIS FREQUENTLY INDICATES THERE'S
10 BLOOD PRESENT.
11 Q. COFFEE-GROUND LIKE, THAT MEANS IT LOOKS LIKE COFFEE
12 GROUNDS?
13 A. RIGHT.
14 Q. AND IT LOOKS LIKE YOU PAGED BOTH DR. WEITZEL AND
15 DR. DIENHART. SHE VOMITED AGAIN AT ONE O'CLOCK AND YOU
16 PAGED DR. WEITZEL AGAIN AND THE NURSING SUPERVISOR WAS
17 INFORMED. WHO WAS THE NURSING SUPERVISOR?
18 A. YOU KNOW, THERE WERE SEVERAL, AND I DON'T KNOW WHO IT
19 WOULD HAVE BEEN THAT NIGHT.
20 Q. AND THEN DR. WEITZEL CALLED AT 3:30 AND IS AWARE OF THE
21 PATIENT'S CONDITION. AND AT 5:30, PATIENT VOMITED AGAIN.
22 DO YOU HAVE ANY OTHER RECOLLECTION OF WHAT HAPPENED DURING
23 THIS TIME PERIOD?
24 A. DURING MY SHIFT?
25 Q. YES, DURING YOUR SHIFT.
1301
1 A. WELL, NO. SHE WAS JUST HAVING THESE BOUTS OF VOMITING.
2 AND I WAS CONCERNED BECAUSE OF THE POSSIBILITY OF THERE
3 BEING BLOOD PRESENT. THAT'S WHY I NOTIFIED THE DOCTORS.
4 Q. AND WHILE YOU WERE THERE, DID YOU RECEIVE ANY ORDERS TO
5 DO ANYTHING ABOUT THIS VOMITING?
6 A. NO, I DID NOT.
7 Q. LET'S GO OVER -- LET'S TURN OVER TO RECORD 589, WHICH I
8 THINK IS PROBABLY THE LAST TIME THAT YOU SAW JUDITH LARSEN
9 OR WERE ON THE LAST SHIFT YOU HAD WITH HER. WHAT HAVE YOU
10 WRITTEN THERE ON THE 3RD OF JANUARY?
11 A. PATIENT MONITORED CLOSELY THROUGHOUT THE NIGHT. THE
12 ROUTINE MORPHINE WHICH WAS THE MORPHINE SHE WAS RECEIVING
13 AROUND THE CLOCK WAS HELD THREE TIMES DUE TO HER
14 RESPIRATIONS BEING ONLY FIVE TO EIGHT PER MINUTE.
15 Q. WHAT'S A NORMAL RESPIRATION PERIOD OR RESPIRATION AMOUNT
16 FOR PEOPLE?
17 A. SIXTEEN TO TWENTY. !!!
18 Q. AND SO WHEN IT'S FIVE TO EIGHT CAUSED YOU CONCERN?
19 A. YEAH, IT DID.
20 Q. AND M.S. HELD. WHAT DOES THAT MEAN?
21 A. I DID NOT GIVE THE MORPHINE. MORPHINE WILL DEPRESS THE
22 RESPIRATIONS AND SINCE THEY WERE ALREADY SO LOW, I DIDN'T
23 FEEL THAT I SHOULD GO AHEAD AND GIVE ADDITIONAL FOR FEAR
24 THEN THAT THEY WOULD GO DOWN LOWER. SLIGHT TWITCHING NOTED
25 FOR SHORT PERIODS TWICE. HER EXTREMITIES WERE WARM.
1302
1 Q. TIMES FOUR?
2 A. YEAH.
3 Q. ALL FOUR EXTREMITIES?
4 A. AND HER FINGERS WERE CYANOTIC, WHICH MEANS THEY WERE
5 BLUE COLORED.
6 Q. WHAT DOES THAT SIGNIFY?
7 A. OXYGEN LOW. AND EARLY IN THE SHIFT THEY WERE CYANOTIC,
8 BUT THEY WERE MUCH IMPROVED THROUGH THE NIGHT, MEANING THAT
9 THEY WERE GETTING A PINK COLOR BACK TO THEM. SHE HAD NO
10 MOTTLING.
11 Q. WHAT'S MOTTLING?
12 A. DISCOLORATION LIKE THE SKIN WILL TURN KIND OF AN ODD
13 COLOR, PURPLISH.
14 Q. WHAT CAUSES MOTTLING?
15 A. WELL, I WOULD SAY POOR CIRCULATION.
16 Q. AND THAT'S M-O-T-T-L-I-N-G?
17 A. RIGHT. AND I DID NOT OBSERVE ANY. SHE WAS TURNED EVERY
18 TWO HOURS AND WE TOOK HER VITAL SIGNS EVERY FOUR HOURS. PUT
19 A COOL WET CLOTH TO HER EYES FOR COMFORT. OTHERWISE, SHE
20 JUST HAD THEM OPEN AND STARING AND THEY WILL DRY OUT. SO WE
21 KEPT A COOL WET CLOTH ON HER EYES.
22 Q. WHEN SOMEONE'S EYES ARE DRYING OUT, DO YOU HAVE ANY
23 MEDICATION YOU CAN GIVE THEM FOR THAT?
24 A. THERE ARE DROPS SOMETIMES THAT CAN BE ORDERED TO KIND OF
25 MOISTURIZE THEM.
1303
1 Q. DO THEY HAVE TO BE ORDERED IN ORDER FOR THEM TO GIVE
2 THEM?
3 A. YES, THEY DO.
4 Q. WERE YOU -- WERE YOU GIVEN ANY ORDERS TO USE THESE DROPS
5 ON JUDITH LARSEN?
6 A. NO.
7 Q. THEN OTHERWISE EYES ARE OPEN AND STARING. THEN WHAT?
8 A. DOES NOT RESPOND WHEN SPOKEN TO. ZERO TRACKING, MEANING
9 HER EYES -- SHE WOULDN'T FOLLOW WITH HER EYES. WE DID ORAL
10 CARE FOR HER, WHICH MEANS WE JUST CLEANED HER MOUTH. IT WAS
11 VERY DRY BECAUSE SHE WASN'T DRINKING ANYTHING AND SO SHE WAS
12 VERY DRY.
13 Q. WAS SHE ON ANY I.V. FOR FLUIDS? Family had ordered no IV.
14 A. AT THIS TIME SHE WAS NOT. THEN IT SAYS, PATIENT
15 MOTIONED TO MOUTH THIS MORNING AND A FEW SIPS OF WATER WERE
16 TAKEN. SO SHE WAS JUST, YOU KNOW, I INTERPRETED IT AS SHE
17 WAS INDICATING THAT SHE WAS THIRSTY.
18 Q. NOW, YOU WITHHELD THE MORPHINE DURING THAT NIGHT SHIFT.
19 DID DR. WEITZEL EVER TALK TO YOU ABOUT WITHHOLDING THAT
20 MORPHINE?
21 A. NOT PERSONALLY.
22 MR. STIRBA: I'LL OBJECT, YOUR HONOR. SHE SAID NOT
23 PERSONALLY. SHE HAD A CONVERSATION OR SHE DIDN'T. JUST
24 ANSWER THE QUESTION.
25 Q. (BY MS. BARLOW) THEN I'LL ASK THE NEXT QUESTION. HE
1304
1 DIDN'T TALK TO YOU PERSONALLY. DID HE EVER TALK TO YOU IN A
2 GROUP ABOUT WITHHOLDING MORPHINE?
3 A. YES. WE HAD A STAFF MEETING THAT WAS CALLED, AN
4 UNSCHEDULED ONE THAT WAS CALLED ONE MORNING A DAY OR TWO
5 AFTER THIS. AND HE ADDRESSED --
6 THE COURT: LET'S LAY A FOUNDATION OF WHO.
7 Q. (BY MS. BARLOW) WHERE WAS THAT STAFF MEETING?
8 A. IN THE REPORT ROOM ON THE FLOOR, WHICH IS JUST A ROOM
9 DOWN NEAR THE NURSES' STATION.
10 Q. DO YOU RECALL WHAT TIME OF DAY IT WAS?
11 A. AT THE END OF MY SHIFT THAT MORNING.
12 Q. WHICH WOULD BE ABOUT SEVEN?
13 A. EIGHT.
14 Q. EIGHT. THANK YOU. YOU SAY IT'S WITHIN A COUPLE OF DAYS
15 AFTER THIS. CAN YOU PIN IT DOWN TO ANY MORE CLOSER DATE
16 THAN THAT?
17 A. WELL, IT WAS NOT THIS PARTICULAR MORNING. OKAY. AND IT
18 WOULD HAVE BEEN LIKE ONE OR TWO DAYS AFTER THAT, WOULD BE
19 THE CLOSEST I COULD SAY.
20 Q. WAS ANYONE ELSE PRESENT DURING THAT STAFF MEETING?
21 A. I WOULD SAY SOME OF THE NURSING STAFF; NOT ALL, BUT A
22 LOT OF THEM.
23 Q. DO YOU RECALL BY NAME ANY WHO WERE THERE?
24 A. I WOULDN'T WANT TO SAY SPECIFICALLY. IT WAS JUST THE
25 NORMAL FACES THAT WE'D SEE.
1305
1 Q. NURSES FROM THAT UNIT?
2 A. ONLY THAT UNIT, YES.
3 Q. AND DR. WEITZEL, WAS HE THERE?
4 A. YES, HE WAS.
5 THE COURT: WELL, DOES SHE KNOW WHO THEY WERE AND
6 DOESN'T WANT TO SAY OR DOES SHE NOT KNOW WHO THEY WERE.
7 IT'S IMPORTANT THAT WE KNOW WHO WAS THERE BY NAME, IF SHE
8 KNOWS IT. DO YOU KNOW WHO THEY WERE?
9 THE WITNESS: WELL, I WOULD SAY -- I'M JUST --
10 WELL, I WOULD SAY EARLENE COZZENS. AND SEE, I'M NOT
11 POSITIVE.
12 THE COURT: WELL, SAY THE BEST MEMORY OF WHO YOU
13 KNOW WAS THERE.
14 THE WITNESS: WELL, I WOULD SAY LYNN LONG AND
15 EARLENE COZZENS. AND THOSE ARE THE ONLY TWO THAT I WOULD
16 WANT TO SAY ABSOLUTELY POSITIVELY.
17 THE COURT: OKAY. GO AHEAD.
18 Q. (BY MS. BARLOW) WERE THERE OTHERS THERE THAT YOU ARE
19 NOT POSITIVE?
20 A. YES.
21 Q. WHAT, IF ANYTHING, DID DR. WEITZEL SAY IN THAT CONTEXT
22 TO YOU AND THE REST OF THE GROUP ABOUT WITHHOLDING MORPHINE?
23 A. THAT WE WERE TO NOT WITHHOLD IT UNLESS WE CALLED AND
24 SPOKE WITH HIM FIRST. THAT AROUND THE CLOCK MEDICATIONS
25 WERE TO BE GIVEN.
1306
1 Q. AS A NURSE, DO YOU HAVE THE RIGHT TO NOT GIVE
2 MEDICATION?
3 A. YEAH.
4 Q. IN WHAT CONTEXT?
5 A. WELL, IF WE FEEL IT'S UNSAFE. IF PERHAPS IT MIGHT HARM
6 THE PATIENT. IF THE PATIENT APPEARS OVERLY SEDATED, YOU
7 PROBABLY WOULDN'T WANT TO GIVE THEM ADDITIONAL SEDATIVES.
8 Q. AND WHAT HAPPENS, DO YOU NOTE IT? YOU CHART IT WHEN YOU
9 DON'T GIVE A DOSE, IS THAT CORRECT?
10 A. YES.
11 Q. IF IN THIS CONTEXT THAT HAPPENED AND THEN YOU, IN
12 CONJUNCTION WITH EVERYBODY ELSE, WERE TOLD NOT TO WITHHOLD
13 MORPHINE --
14 MR. STIRBA: I'D OBJECT TO -- MISCHARACTERIZES
15 MORPHINE --
16 MS. BARLOW: EXCUSE ME --
17 THE COURT: LET'S ASK A NON-LEADING QUESTION.
18 MS. BARLOW: THAT WAS MERELY FOUNDATIONAL. I'LL
19 TRY TO REPHRASE IT, YOUR HONOR.
20 Q. IF YOU WITHHOLD AND A DOCTOR TELLS YOU TO GIVE IT, DO
21 YOU HAVE THE RIGHT TO STILL NOT GIVE THE MEDICATION?
22 MR. STIRBA: YOUR HONOR, I'M GOING TO OBJECT. I
23 THINK IT'S AN IRRELEVANT HYPOTHETICAL.
24 MS. BARLOW: YOUR HONOR, IT'S VERY RELEVANT.
25 THE COURT: LADIES AND GENTLEMEN, I THINK WE'VE
1307
1 BEEN GOING FOR AN HOUR. THIS WILL BE A GOOD OPPORTUNITY TO
2 TAKE OUR LAST MORNING BREAK. WHAT WE'LL DO IS, LET'S COME
3 BACK ABOUT 11:05 AND THEN WE'LL GO TILL APPROXIMATELY NOON.
4 DURING THIS TIME THAT YOU ARE OUT ON THIS BREAK REMEMBER
5 IT'S YOUR DUTY NOT TO CONVERSE AMONG YOURSELVES OR TO
6 CONVERSE WITH ANYONE ELSE OR ALLOW YOURSELVES TO BE
7 ADDRESSED BY ANY OTHER PERSON ON THE SUBJECT OF THIS TRIAL.
8 IT'S ALSO YOUR DUTY NOT TO FORM OR EXPRESS AN OPINION UNTIL
9 THE CASE IS FINALLY SUBMITTED TO YOU AFTER YOU'VE HEARD ALL
10 OF THE EVIDENCE. SO IF YOU WOULD PLEASE COME BACK AT 11:05.
11 (THE JURY LEAVES THE COURTROOM.)
12 THE COURT: YOU MAY BE SEATED. THE RECORD SHOULD
13 REFLECT THAT THE JURY HAS LEFT ON A BREAK. OKAY. LET'S GO
14 BACK OVER WHAT THE QUESTION WAS. WOULD YOU JUST REPEAT THE
15 QUESTION YOU ASKED, MISS BARLOW, AND WHAT THE OBJECTION WAS.
16 MS. BARLOW: I THINK IT WAS -- IT'S HARD TO GET IT
17 VERBATIM. I THINK IT WAS, DO YOU HAVE THE RIGHT -- WELL,
18 OKAY. IF AS A NURSE YOU WITHHOLD MEDICATION AND A DOCTOR
19 ORDERS YOU TO GIVE IT ANYWAY -- I CAN'T REMEMBER WHAT I SAID
20 AFTER THAT. WHAT CAN YOU DO AT THAT POINT?
21 THE COURT: OKAY. WHAT WAS THE OBJECTION?
22 MR. STIRBA: WELL, THE TESTIMONY RELATED TO A STAFF
23 MEETING, IF I UNDERSTOOD WHAT MISS SCHOLL SAID, IS THAT DR.
24 WEITZEL SAID TO THE NURSES WHO WERE PRESENT THAT WHEN
25 MORPHINE WAS GOING TO BE WITHHELD, THEY SHOULD TALK TO HIM
1308
1 FIRST. THAT'S WHAT I UNDERSTOOD SHE SAID. AND SO WE'RE NOW
2 POSING A HYPOTHETICAL BASED UPON NOT EVEN FACTS WHICH THE
3 WITNESS TESTIFIED TO BECAUSE NOBODY SUGGESTED -- AT LEAST
4 THE TESTIMONY WASN'T THAT SHE SAID ANYTHING DIFFERENT THAN
5 WHAT I'VE JUST SAID. THAT'S THE FIRST PROBLEM.
6 SECOND PROBLEM IS I HAVE NO PROBLEM IF YOU WANT TO
7 ELICIT FROM THIS WITNESS OR ANY OTHER NURSE WITNESS WHAT
8 THEIR DUTIES ARE IN THEIR PROFESSION BECAUSE OBVIOUSLY THEY
9 ARE NURSES. THEY HAVE PROFESSIONAL ETHICS AND
10 RESPONSIBILITIES AND WHAT THOSE DUTIES ARE, BUT THEN TO GO
11 BEYOND THAT INTO ESSENTIALLY A HYPOTHETICAL WHICH ISN'T EVEN
12 THE FACTS OF THIS CASE AND DOESN'T RELATE TO THE FIVE
13 PATIENTS, I THINK IS IRRELEVANT. AND REALLY WHAT YOU ARE
14 TALKING ABOUT ULTIMATELY, JUDGE, IS ONCE YOU ELICIT WHAT THE
15 FACTS ARE FOR, EXAMPLE, MISS SCHOLL COULD SAY WHAT HER
16 DUTIES ARE AND WHATEVER THE FACTS ARE, THEN AFTER THAT IT'S
17 ARGUMENT. AND SO ESSENTIALLY WE'RE TRYING TO TAKE A
18 HYPOTHETICAL WHICH I THINK IS NOT CONSISTENT WITH THE FACTS
19 AND SORT OF TRYING TO MAKE AN ARGUMENT OUT OF IT
20 TESTIMONIALLY. I JUST THINK THAT'S IMPROPER. SHE CAN
21 OBVIOUSLY SAY AS A NURSE THIS IS WHAT I DO, THIS IS WHAT MY
22 ETHICS ARE. THIS IS WHY I DID WHAT I DID WITH THIS PATIENT.
23 IF SHE WANTED TO SAY THAT, I THINK SHE'S ALREADY TESTIFIED
24 TO THAT, THAT'S FINE. BUT TO GO BEYOND THAT IS, AS I HAVE
25 JUST INDICATED, I THINK IRRELEVANT AND IMPROPER AND IT'S
1309
1 REALLY THE PROVINCE, IF YOU WILL, OF ARGUMENT AT THE CLOSE
2 OF THE CASE WHATEVER THE FACTS ARE.
3 MS. BARLOW: YES, YOUR HONOR. WHAT I AM WANTING TO
4 GET INTO GOES DIRECTLY TO A DEFENSE THAT WAS RAISED AT
5 PRELIMINARY HEARING AND I PRESUME WILL BE RAISED AT TRIAL
6 AND THAT DEFENSE WAS THESE NURSES HAVE THEIR OWN OBLIGATION
7 TO DO NO HARM TO THE PATIENTS. AND BASED ON THAT OBLIGATION
8 THEY SHOULD HAVE REFUSED TO GIVE THE MEDICATION. AND WHAT I
9 WANT TO GET INTO WITH EACH OF THESE NURSES IS WHAT WOULD
10 HAPPEN TO YOU IF YOU DID REFUSE. YOU KNOW, IT STARTS OUT
11 AS, YOU DON'T THINK IT'S APPROPRIATE. THE DOCTOR ORDERED
12 IT. YOU TELL THE DOCTOR YOU DON'T THINK IT'S APPROPRIATE.
13 IF HE SAYS, I'M THE DOCTOR. YOU ARE NOT. YOU'LL DO WHAT I
14 SAY. WHAT NEXT -- WHAT'S THE NEXT RECOURSE THAT SHE HAS.
15 THE COURT: WELL, I GUESS THE QUESTION I HAVE IS
16 THAT, FIRST OF ALL, WE HAVE THE DISCUSSION OF THE NURSES
17 MEETING WHERE THE DOCTOR -- WHERE SHE TESTIFIES THE DOCTOR
18 SAYS, YOU KNOW, DON'T NOT GIVE THESE MORPHINE SHOTS UNTIL
19 YOU TALK TO ME. THAT'S THE TESTIMONY OF THE MEETING. NOW,
20 DO WE HAVE ANY EVIDENCE THAT AFTER THAT TOOK PLACE THAT THEY
21 EITHER REFUSED OR DID THEY TALK OR THEY WENT LIKE YOUR FIRST
22 WITNESS SAYS, THEY GO TO THEIR SUPERVISOR OR BOSS OF THE
23 SUPERVISOR, THE CHIEF NURSING OFFICER OR THE ADMINISTRATOR
24 OF THE HOSPITAL, YOU KNOW, THOSE TYPE OF THINGS RATHER THAN,
25 YOU KNOW, LIKE, FOR EXAMPLE, IF YOU ALLOW -- IF WE ALLOW THE
1310
1 JURY TO HEAR THEY HAD THIS MEETING AND WHAT WAS SAID -- WE
2 JUST DESCRIBED WHAT WAS SAID AT THIS MEETING AND THE NEXT
3 QUESTION IS NOW, IF A DOCTOR DOESN'T DO THIS, I MEAN, THEY
4 PUT THOSE TWO THINGS TOGETHER AND THEY ARE NOT LINKE