Tracy Scholl
23 TRACY SCHOLL,
24 CALLED BY THE PLAINTIFF, HAVING BEEN DULY
25 SWORN, WAS EXAMINED AND TESTIFIED AS FOLLOWS:
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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
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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,
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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?
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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?
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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?
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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 LINKED. I
5 MEAN, EITHER -- IF THIS WITNESS IS GOING TO GIVE TESTIMONY
6 THAT YES, AFTER THAT MEETING THEN I HAD THESE DISCUSSIONS
7 WITH MY SUPERVISOR OR I HAD THIS DISCUSSION WITH DR. WEITZEL
8 OR WHATEVER, IS THAT WHAT WE'RE GOING TO DO?
9 MS. BARLOW: NOT WITH THIS WITNESS, YOUR HONOR. I
10 WANTED TO LAY THE FOUNDATION WITH HER THAT NURSES HAVE, YOU
11 KNOW, CAN DO THESE THINGS. BUT I ALSO WANT TO SHOW THAT
12 SOME OF THESE NURSES DIDN'T GO THROUGH THAT PROCEDURE
13 BECAUSE THEY KNEW IN THE END IT MEANT THEY WOULD LOSE THEIR
14 JOBS.
15 THE COURT: WELL, WHAT IS THIS WITNESS GOING TO SAY
16 IN REGARDS TO THAT?
17 MS. BARLOW: NOT SPECIFICALLY THAT, BUT WITH HER I
18 WANTED TO LAY THE FOUNDATION FOR, AS A NURSE, WHAT STEPS CAN
19 SHE TAKE --
20 THE COURT: WELL, IS THERE ANY OTHER NURSE THAT
21 IS -- THAT'S GOING TO TESTIFY THAT BASICALLY CAN SAY, I
22 DIDN'T DO THIS AND THE REASON I DIDN'T DO IT WAS BECAUSE --
23 THE FIRST TWO WITNESSES THAT TESTIFIED IN THIS TRIAL WERE
24 PEOPLE THAT WERE BEFORE OR AFTER, NURSES THAT WERE BEFORE OR
25 AFTER, I BELIEVE.
1311
1 MS. BARLOW: ONLY ONE NURSE AND SHE WAS BEFORE,
2 YES, YOUR HONOR. SHE WAS SHEILA MOORE.
3 THE COURT: WELL, SHEILA HEWARD, I GUESS, TALKED
4 ABOUT THINGS AFTER.
5 MS. BARLOW: SHE'S THE RECORDS KEEPER.
6 THE COURT: OKAY. WELL, SHEILA MOORE, THOUGH, WAS
7 THE PERSON THAT WAS BEFORE THESE INCIDENTS. OKAY. AND WHAT
8 I HAD MENTIONED AT THAT TIME IS THAT THERE WERE PEOPLE THAT
9 WERE GOING TO TESTIFY THAT WOULD SAY, I DIDN'T DO IT BECAUSE
10 I WAS AWARE OF SHEILA MOORE AND I SAID I WOULD LISTEN TO
11 THAT. BUT RIGHT HERE, IF WE'RE GOING TO HAVE ANOTHER
12 WITNESS THAT'S GOING TO DO THAT, WE DON'T HAVE TO HAVE SIX
13 WITNESSES. WE'VE ALREADY GOT ONE WITNESS THAT SAYS THE
14 NURSE WAS TO GO TO THE SUPERVISOR IF THEY DISAGREE WITH THE
15 DOCTOR. IF THEY CAN'T GET HELP THROUGH THEIR SUPERVISOR
16 THEY GO TO THE SUPERVISOR'S BOSS. IF THEY DON'T GET HELP
17 THERE THEY GO TO THE CHIEF NURSING OFFICER AND ULTIMATELY
18 THE ADMINISTRATOR OF THE HOSPITAL. THERE'S AN UNWRITTEN
19 RULE TO GO TO THE DOCTOR OR THE WRITTEN RULE IS TO GO UP
20 THIS LINE OF AUTHORITY AND THERE WAS AN UNWRITTEN RULE THAT
21 YOU SHOULD WORK IT OUT WITH THE DOCTOR.
22 MS. BARLOW: YOUR HONOR, I'VE TALKED TO A LOT OF
23 DIFFERENT PEOPLE.
24 Q. TRACY, DID YOU EVER GET TO THAT POINT WHERE YOU FELT
25 LIKE YOU NEEDED TO GO UP THE CHAIN?
1312
1 A. I DID NOT GO UP THE CHAIN.
2 Q. DID YOU FEEL LIKE YOU NEEDED TO?
3 A. WELL, ACTUALLY, I DID NOT GIVE A LOT OF MORPHINE AFTER
4 THIS PATIENT, AND SO I DIDN'T FEEL THE NEED TO --
5 MS. BARLOW: YOUR HONOR, I'LL SAVE IT FOR OTHER
6 WITNESSES THEN WHO --
7 THE COURT: OKAY. THEN LET'S GO TAKE A BREAK THEN
8 TILL FIVE AFTER 11.
9 (WHEREUPON, COURT WAS IN RECESS.)
10 THE COURT: PLEASE BE SEATED. THE RECORD SHOULD
11 REFLECT THAT THE JURY IS BACK AND THE PARTIES ARE PRESENT.
12 MISS BARLOW, WOULD YOU LIKE TO CONTINUE?
13 MS. BARLOW: YES, YOUR HONOR.
14 Q. AT THE MEETING THAT YOU TESTIFIED TO WHERE DR. WEITZEL
15 SAID, IF ANYBODY IS GOING TO WITHHOLD, AT THAT MEETING DID
16 YOU SEE DR. WEITZEL'S FACE AS HE SAID THAT?
17 A. YES. WE WERE SITTING KIND OF IN A CIRCLE AROUND THE
18 ROOM AND HE WAS DIRECTLY ACROSS FROM ME. AND HE SEEMED TO
19 FOCUS THE MEETING QUITE A BIT WITH HIS ATTENTION ON ME.
20 Q. AND WHAT DID HIS FACE LOOK LIKE AS HE SAID THIS?
21 A. WELL, HE WAS GLARING AT ME.
22 Q. THEN IF YOU WOULD TURN TO 477, THIS APPEARS TO BE --
23 APPEARS TO BE A PROGRESS NOTE. IF YOU COULD TELL THE JURY
24 JUST BRIEFLY WHAT A PROGRESS NOTE IS.
25 A. WELL, THE PROGRESS NOTES WERE WRITTEN BY VARIOUS MEMBERS
1313
1 OF THE TEAM: THE NUTRITION PEOPLE, THE DIETICIANS,
2 RECREATION THERAPISTS, THE OCCUPATIONAL. JUST PEOPLE THAT
3 CAME TO THE FLOOR AND DEALT WITH THE PATIENTS.
4 Q. ON 477, WHAT DATE IS THAT? I KNOW IT'S A LITTLE PUNCHED
5 OUT BECAUSE OF THE HOLE PUNCH, BUT WHAT DATE IS THAT?
6 A. THAT ONE IS JANUARY 3RD.
7 Q. AND WHO WROTE THAT NOTE?
8 A. DR. WEITZEL.
9 Q. WOULD YOU READ THAT NOTE FOR THE JURY, PLEASE?
10 A. DESPITE FIVE MILLIGRAMS OF I.M. M.S. AT 7:30 AND 9:30,
11 PATIENT HAS NOT RESPONDED AT ALL. EYES OPEN. GROANING,
12 APPEARS IN SOME PAIN. UNFORTUNATELY NURSING STAFF HAVE BEEN
13 HOLDING M.S. FOR LOW RESPIRATION RATE. REMAINS UNRESPONSIVE
14 TO ANY QUESTIONS. VITAL SIGNS -- ACTUALLY VITAL SIGNS
15 STABLE AND ACTUALLY -- AND SHE'S AFEBRILE.
16 Q. WHAT DOES THAT MEAN?
17 A. NO FEVER.
18 Q. WHAT DOES IT SAY?
19 A. STABLE. MORPHINE 25 MILLIGRAMS NOW AND CONTINUE FIVE
20 EVERY THREE HOURS. P.R.N. AS NEEDED.
21 Q. ON THE 4TH, CAN YOU READ THAT ONE?
22 A. PATIENT GIVEN LARGE AMOUNTS OF MORPHINE YESTERDAY
23 EVENING FOR COMFORT. FINALLY SHE EXPIRED AT EIGHT P.M.
24 APPEARED TO BE IN NO PAIN. RESPIRATIONS DECREASED. POOR
25 BLOOD PRESSURE SECONDARY TO DEHYDRATION AND THEN CARDIAC
1314
1 ARREST. RELEASED TO FAMILY.
2 Q. THANK YOU. LET'S NOW TURN TO ELLEN ANDERSON, THE LAST
3 OF THE FIVE PEOPLE WE'LL BE TALKING WITH YOU ABOUT TODAY.
4 NOW ELLEN, DO YOU RECALL ELLEN ANDERSON?
5 A. YES, I DO.
6 Q. AND WHY DO YOU RECALL HER?
7 A. TWO REASONS. ONE, SHE SEEMED TO BE IN A TREMENDOUS
8 AMOUNT OF PAIN AND THAT SHE DIED AFTER BEING THERE SUCH A
9 VERY SHORT PERIOD OF TIME.
10 Q. WERE YOU ON SHIFT WHEN SHE FIRST CAME IN?
11 A. NO, I WASN'T.
12 Q. DO YOU RECALL WHO WAS?
13 A. IT WAS A NURSE, LAURIE WILLSON.
14 Q. AS A NURSE WHEN YOU CHANGE SHIFTS, WHEN A NEW SHIFT OF
15 NURSES COMES IN, DOES THE SHIFT THAT'S LEAVING GIVE YOU NEW
16 INFORMATION ABOUT THE PATIENT?
17 A. YEAH. WE HAVE WHAT THEY CALL REPORTS AND WE MEET IN A
18 LITTLE ROOM AND THEN THEY JUST KIND OF GIVE US AN UPDATE ON
19 WHAT'S GOING ON WITH EACH PATIENT. AND ON NEW ADMISSIONS WE
20 GO INTO MORE DETAIL.
21 Q. DO YOU RECALL WHETHER LAURIE WILLSON FILLED YOU IN ON
22 ELLEN ANDERSON WHEN YOU CAME ON THAT NIGHT?
23 A. YES, SHE DID.
24 Q. DO YOU RECALL WHAT SHE SAID?
25 A. WELL, SHE WENT INTO THE NORMAL THINGS ABOUT THE
1315
1 PATIENT'S MENTAL STATE AND THEN SHE ALSO MENTIONED THAT SHE
2 HAD SEVERE OSTEOPOROSIS. THAT SHE HAD BEEN IN A GREAT DEAL
3 OF PAIN AND THAT SHE HAD GIVEN HER AN INJECTION OF MORPHINE.
4 IT WAS A ONE-TIME ORDER FOR THE PAIN. AND THAT DR. WEITZEL
5 HAD NOT SEEN HER YET, BUT THAT HE WOULD BE IN IN THE MORNING
6 TO SEE HER.
7 Q. DID DR. WEITZEL COME AND SEE ELLEN ANDERSON DURING YOUR
8 SHIFT?
9 A. NO, HE DID NOT.
10 Q. AND FROM THE NOTES, THE SPECIFICALLY 190, DO YOU KNOW
11 WHAT TIME THAT FIRST SHOT OF MORPHINE WAS GIVEN?
12 A. YOU KNOW, AT TWO DIFFERENT PLACES I THINK IT SAYS TWO
13 DIFFERENT THINGS. ONE PLACE IT SAYS 7:30 AND ONE SAYS EIGHT
14 O'CLOCK, SO SOMEWHERE BETWEEN THE TWO, I WOULD SAY.
15 Q. AND HOW MUCH WAS GIVEN?
16 A. TEN MILLIGRAMS.
17 Q. NOW, LET'S LOOK AT 191. THAT APPEARS TO BE THE 30TH OF
18 DECEMBER; IS THAT CORRECT?
19 A. YES, IT IS.
20 Q. AT ONE IN THE MORNING. AND WHAT DID YOU WRITE.
21 A. PATIENT RESPIRATIONS HAVE BEEN VERY ERRATIC AND RANGING
22 FROM EIGHT TO 16 A MINUTE. BLOOD PRESSURE WAS 70 OVER 50.
23 Q. CAN YOU TELL US ABOUT THAT BLOOD PRESSURE?
24 A. IT WAS LOW.
25 Q. BASED ON YOUR NURSING KNOWLEDGE, DO YOU KNOW WHAT CAUSES
1316
1 LOW BLOOD PRESSURE?
2 A. WELL, IT COULD BE A VARIETY OF THINGS AND I DID NOT KNOW
3 WHY HERS WAS LOW. I WAS CONCERNED.
4 Q. THANK YOU.
5 A. HER PULSE WAS 120.
6 Q. IS THAT NORMAL RANGE?
7 A. THAT WAS FAST. FREQUENTLY WHEN THE BLOOD PRESSURE IS
8 DOWN THE BODY WILL COMPENSATE. THE HEART RATE GOES UP TO
9 KIND OF TRY TO KEEP UP THE DEMAND. IT'S BEATING FASTER
10 BECAUSE OF A LOW BLOOD PRESSURE.
11 Q. THEN WHAT DID YOU WRITE?
12 A. DR. WEITZEL PAGED AND NURSING SUPERVISOR INFORMED OF
13 PATIENT'S CONDITION.
14 Q. AND THEN AT 3:15 YOU WROTE -- AGAIN, DO YOU HAVE ANY
15 RECOLLECTION, INDEPENDENT RECOLLECTION, OF WHAT HAPPENED
16 ABOUT ONE O'CLOCK AND 3:15 WHEN YOU NEXT NOTED SOMETHING?
17 A. WELL, NO. SHE WAS RESTING QUIETLY.
18 Q. THEN WHAT HAPPENED AT 3:15?
19 A. SHE WAKENED. IT SAYS HERE SHE WAS THRASHING HER ARMS IN
20 ATTEMPT TO THROW HER BODY. SHE WAS MOANING AND SCREAMING.
21 AND I PAGED DR. WEITZEL AGAIN.
22 Q. DID YOU EVER TALK TO HER DAUGHTERS AND TO ELLEN
23 ANDERSON'S DAUGHTERS ABOUT HER SYMPTOMS BEFORE YOU SAW HER?
24 A. I DID NOT.
25 Q. THEN AT 3:30, WHAT DID YOU WRITE?
1317
1 A. DR. WEITZEL RETURNED THE PAGE AND I INFORMED HIM OF THE
2 PATIENT'S CONDITION AND HE ORDERED MORPHINE 10 MILLIGRAMS
3 I.M. AND I GAVE THAT.
4 Q. AND THEN AT 6:30?
5 A. SHE APPEARED TO BE SLEEPING SINCE I HAD GIVEN HER THE
6 MORPHINE. HER RESPIRATION REMAINED ERRATIC. SHE HAD E.K.G.
7 AND CHEST X-RAYS DONE. HER SIDE RAILS WERE UP TIMES TWO.
8 AND THE BED CHECK MONITOR WAS IN PLACE.
9 Q. WHY DID YOU CALL DR. WEITZEL AT 3:15?
10 A. WELL, AT THAT TIME HE HAD NOT RETURNED THE PAGE FROM ONE
11 O'CLOCK SO I HAD BEEN UNABLE TO INFORM HIM OF THE PATIENT'S
12 VITAL SIGNS EARLIER IN THE SHIFT. AND THEN THERE WAS THE
13 ADDITIONAL PROBLEM THAT SHE AWAKENED WITH THE SCREAMING AND
14 MOANING AND THROWING HER BODY, AND TO ME SHE APPEARED TO BE
15 IN A GREAT DEAL OF PAIN.
16 Q. AND DID SHE TELL YOU SHE WAS IN PAIN?
17 A. NO, SHE DID NOT.
18 Q. WAS SHE ABLE TO COMMUNICATE VERBALLY WITH YOU AT ALL?
19 A. NO, SHE DID NOT.
20 Q. AND YOU SAY THE E.K.G. AND THE CHEST X-RAY WERE DONE AT
21 ABOUT 6:30 THAT MORNING?
22 A. YES.
23 Q. WHAT TIME DID YOU GO OFF SHIFT?
24 A. WELL, THE ONCOMING SHIFT CAME ON AT SEVEN AND THAT'S
25 WHEN WE WENT IN TO REPORT.
1318
1 Q. IF YOU TURN TO THE NEXT PAGE, 192. AND IN FACT AT THE
2 BOTTOM OF 191, IT LOOKS LIKE SOMEONE ELSE'S HANDWRITING FROM
3 7:30 ON; IS THAT CORRECT?
4 A. UH-HUH.
5 Q. WHEN SHE PASSED AWAY LATER THAT MORNING, YOU WERE NOT
6 THERE?
7 A. RIGHT.
8 Q. WERE YOU PRESENT WHEN ANY OF THESE PEOPLE PASSED AWAY?
9 A. NO, I WAS NOT.
10 Q. WHEN YOU CALLED DR. WEITZEL -- WELL, WHEN DR. WEITZEL
11 RETURNED THE CALL AT 3:30, DID HE ASK YOU -- OR WHAT
12 INFORMATION DID HE ASK YOU FOR, INFORMATION ABOUT THE
13 PATIENT BEFORE HE ORDERED THE MORPHINE?
14 A. WELL, I DON'T THINK HE SPECIFICALLY -- I INFORMED HIM OF
15 THE PATIENT'S CONDITION. LET HIM KNOW WHAT WAS GOING ON.
16 Q. SO YOU TOLD HIM ABOUT THE LOW RESPIRATION?
17 A. ABOUT HER VITAL SIGNS, WHAT THEY HAD BEEN AND THAT SHE
18 WAS -- APPEARED TO BE IN A GREAT DEAL OF PAIN.
19 Q. WITH ANY OF THE MORPHINE -- WELL, LET'S MAKE IT BROADER
20 THAN THAT. WOULD ANY OF THE MEDICATIONS THAT YOU GAVE TO
21 ANY OF THESE FIVE PEOPLE, DID YOU EVER QUESTION EITHER THEIR
22 NEED -- WELL, LET'S START WITH, DID YOU EVER QUESTION THE
23 NEED FOR THOSE MEDICATIONS?
24 A. THE ONES THAT I CHOSE NOT TO GIVE, I DID. THE ONES THAT
25 I GAVE, TO SOME EXTENT, MAYBE I WONDERED IF IT WERE REALLY
1319
1 THE BEST CHOICE, BUT IT WASN'T MY CHOICE TO MAKE AND I GAVE
2 THEM. Rather disingenuous answer.
3 Q. WHAT ABOUT THE DOSAGE AMOUNTS, DID YOU EVER QUESTION THE
4 DOSAGES ON ANY OF THE MEDICATIONS YOU GAVE TO THESE FIVE
5 PEOPLE?
6 A. THE MORPHINE DOSAGE --
7 MR. STIRBA: I'M SORRY. MAY I INTERRUPT. IT'S A
8 VAGUE AND AMBIGUOUS QUESTION IN TERMS OF QUESTIONING. THAT
9 COULD MEAN A LOT OF DIFFERENT THINGS. DID SHE TALK TO
10 SOMEBODY. IT'S A FACT. I DON'T KNOW WHAT THE QUESTION
11 MEANS.
12 THE COURT: OKAY. I THINK THE QUESTION IS
13 AMBIGUOUS, IF YOU WERE ASKING DID SHE TALK TO SOMEBODY ABOUT
14 IT, EITHER IN HER CHAIN OR HER DOCTOR.
15 Q. (BY MS. BARLOW) WELL, THEN I'M NOT SURE THAT'S WHAT I
16 MEANT BY THE QUESTION. I GOT TO THINK OF A BETTER WORD.
17 DID YOU PERSONALLY HAVE ANY CONCERNS ABOUT THE DOSAGE
18 AMOUNTS OF ANY OF THESE MEDICATIONS?
19 MR. STIRBA: OBJECTION, IRRELEVANT.
20 THE COURT: SUSTAINED.
21 Q. (BY MS. BARLOW) DID YOU EVER TALK TO ANYONE ABOUT THE
22 MEDICATIONS THAT WERE GIVEN TO THESE PATIENTS?
23 A. THE STAFF TALKS AMONGST THEMSELVES, YES.
24 Q. DID YOU EVER GO TO A NURSING SUPERVISOR ABOUT HOW YOU
25 FELT ABOUT THESE MEDICATIONS?
1320
1 A. I THINK SHEILA HANSEN, SHE WAS AWARE THAT WE WAS
2 CONCERNED.
3 Q. WHO'S SHEILA HANSEN?
4 A. SHE WAS THE HEAD NURSE OF THE FLOOR.
5 Q. SO YOU WERE ONE OF THE PEONS?
6 A. YES.
7 Q. AND SHE WAS THE HEAD NURSE?
8 A. UH-HUH.
9 Q. WHO WAS ABOVE HER IN THE CHAIN?
10 A. KAREN CHATELAIN.
11 Q. DID YOU EVER GO TO KAREN CHATELAIN?
12 A. I DID NOT.
13 MS. BARLOW: I THINK THAT'S ALL I HAVE, YOUR HONOR.
14 THE COURT: MR. STIRBA.
15 CROSS-EXAMINATION
16 BY MR. STIRBA:
17 Q. GOOD MORNING, MISS SCHOLL. YOU HAVE USED A TERM WHICH
18 IS NOT A NURSING TERM I BELIEVE IN TERMS OF LYDIA SMITH.
19 YOU CALLED HER FEISTY; IS THAT RIGHT?
20 A. YEAH, I DID.
21 Q. IT'S TRUE, IS IT NOT, THAT'S NOT A NURSING TERM, IS IT?
22 A. IT IS NOT.
23 Q. AND IN FACT, IF WE WENT THROUGH ALL OF YOUR RECORDS
24 INCLUDING MISS SMITH, WE WOULDN'T FIND YOU USING THE TERM
25 FEISTY, WOULD WE?
1321
1 A. NO, YOU WOULD NOT.
2 Q. IN FACT, DO YOU HAVE MISS SMITH'S BINDER THERE. AND I'M
3 PROBABLY BETTER AT SAYING, IF YOU COULD TURN TO THE NURSING
4 NOTES SECTION AND TURN TO YOUR ENTRY ON 1/5 OF '96. DO YOU
5 HAVE THAT IN FRONT OF YOU?
6 A. UH-HUH.
7 Q. AND IT'S TRUE THAT YOU OBSERVED A CHANGE IN MISS SMITH
8 ON THE 6TH OF JANUARY OF 1995, CORRECT?
9 A. FROM HER CONDITION ON JANUARY 5TH.
10 Q. AND HER CONDITION EVERY DAY BEFORE JANUARY 5TH WHEN YOU
11 HAD OCCASION TO OBSERVE HER AND TAKE CARE OF HER; ISN'T THAT
12 TRUE?
13 A. PREVIOUS TO THAT, LIKE FROM THE TIME OF HER ADMISSION,
14 SHE DID HAVE SOME TIMES WHEN SHE WAS, WHAT WOULD YOU SAY,
15 SLEPT MOST OF THE NIGHT.
16 Q. BUT THE 6TH IS WHEN YOU HAVE TESTIFIED YOU REALLY
17 NOTICED A CHANGE IN HER BEHAVIOR, TRUE?
18 A. IT WAS THE FIRST TIME WHEN SHE HAD A POTTY CHAIR AT HER
19 BEDSIDE, YES.
20 Q. SO THAT WAS SIGNIFICANT, TRUE?
21 A. YES.
22 Q. AND IN FACT, YOU SAW HER THE DAY BEFORE. YOU'VE ALREADY
23 TOLD US THAT THE 6TH WAS THE LAST DAY THAT YOU SAW HER,
24 CORRECT?
25 A. I'D HAVE TO CHECK. I DON'T REMEMBER THE DATES. THERE
1322
1 ARE SO MANY. BUT YES, THAT WAS THE LAST TIME.
2 Q. THAT WAS THE LAST DAY, BUT YOU SAW HER THE DAY BEFORE,
3 TRUE?
4 A. YES.
5 Q. AND THAT WOULD HAVE BEEN THE 5TH OF JANUARY, CORRECT?
6 A. RIGHT.
7 Q. NOW, YOU HAVE IN FRONT OF YOU YOUR NOTE ON THE 5TH,
8 CORRECT?
9 A. RIGHT.
10 Q. AND STARTING AT THE TOP HERE ON 1/5 OF '96. IT APPEARS
11 TO BE 1:30. DID I READ THAT CORRECTLY?
12 A. UH-HUH.
13 Q. IT SAYS MED ENTRY, PATIENT VERY AGITATED. MAKING
14 NUMEROUS ATTEMPTS TO GET OUT OF BED. STRIKING AT STAFF. I
15 CAN'T READ -- IT LOOKS LIKE SOMETHING ASSAULT. CAN YOU READ
16 THAT?
17 A. IT SAYS RESISTING ASSIST.
18 Q. RESISTING ASSIST TO BATHROOM. AND THEN YOU HAVE
19 SOMEBODY'S WRITTEN IN THERE -- IS THAT YOUR WRITING ABOUT AN
20 ATIVAN ENTRY, HALDOL. DO YOU SEE THAT?
21 A. RIGHT.
22 Q. AND YOU WROTE THAT IN THERE?
23 A. YES, I DID. I HAD ORIGINALLY WRITTEN ATIVAN AND THEN I
24 CHOSE TO GIVE HER HALDOL INSTEAD.
25 Q. ONE MILLIGRAM, TRUE?
1323
1 A. WELL, NO. ACTUALLY THE ATIVAN WOULD HAVE BEEN ONE
2 MILLIGRAM. THE HALDOL WAS ACTUALLY I BELIEVE, IF I'M NOT
3 CONFUSED ON WHAT WE'RE DOING HERE, I THINK FIVE MILLIGRAMS.
4 Q. IT LOOKS LIKE -- IS THAT I.V. OR I.M.?
5 A. I.M. I'M SURE.
6 Q. THEN IT SAYS, GIVEN FOR SEVERE AGITATION. AND THEN WE
7 HAVE YOUR INITIALS, CORRECT?
8 A. RIGHT.
9 Q. AND THEN AT 2:30 YOU SAY PATIENT HAS BEEN VERY -- IT
10 LOOKS LIKE SLEEPING. IS THAT RIGHT?
11 A. HAS BEEN SLEEPING.
12 Q. SLEEPING QUIETLY SINCE 1:45. IN OTHER WORDS, AFTER YOU
13 GAVE HER THE HALDOL, TRUE?
14 A. RIGHT.
15 Q. RESPIRATIONS EVEN AND UNLABORED. THEN YOU HAVE
16 SOMETHING TIMES TWO. WHAT DOES THAT STAND FOR?
17 A. SIDE RAILS UP TIMES TWO.
18 Q. THEN BED CHECK MONITOR IN PLACE AND THEN YOUR INITIALS,
19 CORRECT?
20 A. RIGHT.
21 Q. AND THEN THE LAST ENTRY WHICH APPEARS TO BE SEVEN
22 O'CLOCK, PATIENT CONTINUED TO TOSS AND TURN BUT LESS
23 RESTLESS AND DID SLEEP FOR SHORT PERIODS OF TIME AND THEN
24 YOUR INITIALS, CORRECT?
25 A. UH-HUH.
1324
1 Q. NOW, YOU ARE AWARE, ARE YOU NOT, FROM REVIEWING THE
2 RECORDS BEFORE YOU CAME HERE THAT THAT PARTICULAR DAY YOUR
3 ADMINISTRATION OF HALDOL WAS WHAT IS CALLED A P.R.N. ORDER?
4 ARE YOU AWARE OF THAT?
5 A. I WOULD GUESS THAT -- YES. I'M NOT POSITIVE, BUT --
6 WELL, YES. I AM SURE. I AM SURE.
7 Q. YOU ARE SURE ABOUT THAT. JUST SO WE'RE CLEAR AS FAR AS
8 WHAT P.R.N. MEANS, THERE ARE TIMES WHEN A DOCTOR ENTERS AN
9 ORDER AND IN THIS CASE IT WOULD BE AN ORDER THAT YOU'VE
10 ALREADY TESTIFIED TO FOR HALDOL P.R.N. WHICH BASICALLY MEANS
11 AS NEEDED, TRUE?
12 A. UH-HUH.
13 Q. AND THOSE ORDERS, WHEN THEY WERE GIVEN, ARE GIVEN AT THE
14 DISCRETION OF THE NURSE, TRUE?
15 A. TRUE.
16 Q. IN OTHER WORDS, YOU ARE THERE. YOU ARE SEEING MISS
17 SMITH. YOU ARE SEEING HER IN AN AGITATED STATE AND YOU
18 THINK SHE NEEDS TO BE SEDATED, TRUE?
19 A. YES.
20 Q. AND YOU ASSESS THAT AND THEN YOU WENT AND GAVE HER
21 HALDOL, TRUE?
22 A. THAT'S CORRECT.
23 Q. AND THAT'S WHAT ESSENTIALLY A P.R.N. ORDER IS, CORRECT?
24 A. AS NEEDED, YES.
25 Q. AS NEEDED. IN OTHER WORDS, THE DOCTOR GIVES THE ORDER,
1325
1 BUT THE NURSE DECIDES WHETHER OR NOT THE MEDICATION IS
2 ACTUALLY GOING TO BE GIVEN.
3 MS. BARLOW: OBJECTION. REPETITIVE. IT'S BEEN
4 ASKED AND ANSWERED, YOUR HONOR.
5 THE COURT: ANSWER THAT QUESTION.
6 THE WITNESS: THAT'S TRUE.
7 Q. (BY MR. STIRBA) THAT IS DIFFERENT FROM OTHER ORDERS
8 WHICH THE DOCTOR MAY ENTER WHICH ARE REFLECTED AS EITHER A
9 ROUTINE ORDER OR A STANDING ORDER. YOU ARE AWARE OF THAT?
10 A. YES.
11 Q. IN FACT, YOU'VE TESTIFIED TO SOME IN YOUR DIRECT
12 EXAMINATION; IS THAT RIGHT?
13 A. THAT'S TRUE.
14 Q. IN OTHER WORDS, WHERE A DOCTOR MAY SAY, I WANT A CERTAIN
15 MEDICATION GIVEN AT A CERTAIN TIME IN THE MORNING OR A
16 CERTAIN TIME IN THE EVENING EVERY DAY, THAT WOULD BE A
17 STANDING ORDER, TRUE?
18 A. THAT'S TRUE.
19 Q. AND THEN THERE ARE SOME TIMES HE MAY SAY EVERY THREE
20 HOURS OR EVERY FOUR HOURS AS THE CASE MAY BE, CORRECT?
21 A. THAT'S TRUE.
22 Q. AND THEN ALSO THE OTHER KIND OF ORDER WHICH I BELIEVE
23 YOU TESTIFIED TO ON DIRECT IS CALLED A NOW ORDER, TRUE?
24 A. THAT'S TRUE.
25 Q. AND A NOW ORDER IS WHERE PERHAPS -- AND I THINK YOU
1326
1 TESTIFIED TO IT -- THE NURSE WILL CALL UP THE DOCTOR OR THE
2 DOCTOR MAY CALL IN OR THE DOCTOR MAY BE THERE.
3 A. THAT'S TRUE.
4 Q. AND A NURSE MIGHT DESCRIBE SOME SITUATION LIKE YOU HAD
5 WITH MISS ANDERSON AND THE DOCTOR WOULD SAY, GIVE THE
6 MEDICATION NOW; IS THAT CORRECT?
7 A. THAT'S CORRECT.
8 Q. IN FACT, ISN'T THAT WHAT OCCURRED WITH MISS ANDERSON AT
9 ABOUT 3:30 ON THE 30TH OF DECEMBER IN THE MORNING. THAT WAS
10 A NOW ORDER, WASN'T IT?
11 A. THAT WAS, YES.
12 Q. BECAUSE WHAT HAPPENED IS YOU ARE NOT SURE WHETHER DR.
13 WEITZEL CALLED YOU OR YOU CALLED HIM AT THAT POINT --
14 MS. BARLOW: YOUR HONOR, THAT'S A
15 MISCHARACTERIZATION OF THE EVIDENCE. IT SAYS DR. WEITZEL
16 RETURNED THE PAGE.
17 Q. (BY MR. STIRBA) DR. WEITZEL RETURNS THE PAGE. YOU HAD
18 A CONVERSATION WITH THE DOCTOR. YOU INFORMED HIM WHAT YOU
19 INFORMED HIM OF INCLUDING THE FACT THAT YOU ASSESSED THAT
20 SHE WAS IN SEVERE PAIN AND THE DOCTOR THEN GAVE SOME
21 MEDICATION APPROPRIATE FOR THAT PAIN; ISN'T THAT TRUE?
22 A. HE ORDERED MORPHINE.
23 Q. YES. HE ORDERED MORPHINE AFTER THE CONVERSATION WITH
24 YOU, CORRECT?
25 A. I HAD REPORTED THE PATIENT'S CONDITION.
1327
1 Q. RIGHT. ONE OF THE THINGS YOU REPORTED, MA'AM, WAS THAT
2 SHE WAS IN SEVERE PAIN.
3 A. THAT'S TRUE.
4 Q. AND IT IS TRUE THAT MORPHINE, AT LEAST FROM THE BEST OF
5 YOUR UNDERSTANDING, IS IN FACT A PAIN MEDICATION; ISN'T THAT
6 CORRECT?
7 A. IT IS.
8 Q. AND IT IS TRUE THAT AFTER HE ORDERED TEN MILLIGRAMS OF
9 MORPHINE IN THE DISCUSSION WITH YOU, YOU WENT AND THEN GAVE
10 THAT SHOT. ISN'T THAT ALSO TRUE?
11 A. THAT'S TRUE.
12 Q. AND YOU UNDERSTAND THAT AS A NURSE THERE ARE CERTAIN
13 ETHICS IN THE PROFESSION, CORRECT?
14 MS. BARLOW: YOUR HONOR, THIS IS BEYOND THE SCOPE
15 OF DIRECT EXAMINATION.
16 MR. STIRBA: THIS WAS OPENED UP--
17 THE COURT: THIS IS CROSS-EXAMINATION. OVERRULED.
18 Q. (BY MR. STIRBA) YOU UNDERSTAND, MA'AM, THERE ARE
19 CERTAIN ETHICS IN THE NURSING PROFESSION, DON'T YOU?
20 A. YES.
21 Q. AND IN FACT, THE AMERICAN NURSES ASSOCIATION HAS
22 PROMULGATED A CODE --
23 MS. BARLOW: OBJECTION, YOUR HONOR. IF HE WANTS TO
24 BRING IN THAT CODE, THEN WE CAN PRESENT IT HERE. BUT SHE
25 CAN'T TESTIFY AS TO WHAT THE CODE SAYS.
1328
1 THE COURT: HE CAN ASK IF SHE'S FAMILIAR WITH IT.
2 OVERRULED.
3 Q. (BY MR. STIRBA) IN FACT, THE AMERICAN NURSES
4 ASSOCIATION HAS PROMULGATED A CODE CONTAINING THE ETHICS OF
5 THE NURSING PROFESSION; ISN'T THAT TRUE?
6 A. YOU KNOW, THE ONE THAT I'M FAMILIAR WITH IS THE UTAH --
7 I CAN'T THINK OF THE NAME OF IT, BUT IT'S THE STANDARDS SET
8 BY UTAH.
9 Q. AND YOU AGREE THAT ONE OF THOSE STANDARDS IS AT LEAST IN
10 THE NURSING PROFESSION THAT A NURSE, WHEN SHE DOES WHATEVER
11 SHE OR HE DOES, DOES NO HARM TO THE PATIENT; ISN'T THAT
12 TRUE?
13 A. NOT TO HARM THE PATIENT, NOT INTENTIONALLY TO HARM THE
14 PATIENT.
15 Q. YES. YOU DON'T HARM THE PATIENT, DO YOU?
16 A. NO.
17 Q. AND WOULD YOU AGREE WITH THE FACT THAT ONE OF THE THINGS
18 A NURSE ALSO NEEDS TO DO AS PART OF THE ETHICS OF THEIR
19 PROFESSION, THE DUTIES THAT YOU MAY HAVE, IS THAT YOU ARE TO
20 ACT TO SAFEGUARD THE PATIENT AND THE PUBLIC WHEN HEALTH AND
21 SAFETY ARE AFFECTED BY A COMPETE --
22 MS. BARLOW: YOUR HONOR, I OBJECT ON --
23 (BOTH COUNSEL OVERTALKING.)
24 MS. BARLOW: YOUR HONOR, I OBJECT TO HIM READING
25 FROM THAT DOCUMENT. WE DON'T KNOW WHAT IT IS.
1329
1 THE COURT: WHAT ARE YOU READING FROM?
2 MR. STIRBA: THE AMERICAN NURSES ASSOCIATION CODE,
3 AND I'M JUST ASKING HER IF SHE AGREES WITH IT.
4 MS. BARLOW: AND, YOUR HONOR, SHE'S ALREADY SAID
5 SHE DOESN'T -- SHE IS NOT FAMILIAR WITH THAT CODE.
6 MR. STIRBA: THIS IS CROSS, YOUR HONOR.
7 THE COURT: HOLD ON. SHE SAYS SHE IS MORE FAMILIAR
8 WITH THE UTAH CODE. YOU CAN ASK THE QUESTION WHETHER YOU
9 ARE READING IT OR YOU ARE ASKING FOR HER TO AGREE WITH THE
10 STATEMENT, WHETHER, YOU KNOW, WHERE IT COMES FROM NOW. GO
11 AHEAD AND ASK THE QUESTIONS.
12 Q. (BY MR. STIRBA) WOULD YOU AGREE, MISS SCHOLLS, THAT A
13 NURSE HAS AN OBLIGATION AND A DUTY AS PART OF HIS OR HER
14 PROFESSION TO ACT TO SAFEGUARD THE PATIENT AND THE PUBLIC
15 WHEN HEALTH AND SAFETY ARE AFFECTED BY INCOMPETENT,
16 UNETHICAL OR ILLEGAL PRACTICES OF ANY PERSON?
17 A. I WOULD SAY THAT'S TRUE.
18 Q. WOULD YOU ALSO AGREE WITH THE FACT THAT AS PART OF THE
19 ETHOS OR THE ETHICS OF THE NURSING PROFESSION THAT A NURSE
20 ASSUMES RESPONSIBILITY AND ACCOUNTABILITY FOR INDIVIDUAL
21 NURSING JUDGMENTS AND ACTIONS?
22 A. YES.
23 Q. NOW, IT'S TRUE, IS IT NOT, THAT IN TERMS OF THE WAY THE
24 RECORDS WERE KEPT AT THE DAVIS HOSPITAL AND PARTICULARLY
25 WITH RESPECT TO THESE FIVE INDIVIDUALS THAT YOU'VE TESTIFIED
1330
1 CONCERNING, WHEN A NURSE WOULD -- AND IN YOUR CASE WHEN YOU
2 WOULD PROVIDE MEDICATION, AND IT COULD BE ANY KIND OF
3 MEDICATION, YOU NEED TO DOCUMENT THAT IN THE CHART; IS THAT
4 RIGHT?
5 A. YES.
6 Q. AND IT'S TRUE, IS IT NOT, AND YOU'VE SEEN THIS IN THE
7 BINDERS, THAT THERE'S A SECTION WITH RESPECT TO EACH ONE OF
8 THESE PATIENTS THAT IS CALLED MEDICATION ADMINISTRATION
9 RECORD?
10 A. RIGHT. BUT WHILE THE PATIENT'S IN THE HOSPITAL, THAT
11 PARTICULAR SECTION IS NOT KEPT IN THE CHART. IT'S KEPT
12 SEPARATELY.
13 Q. AND THAT IS A PLACE, IS IT NOT, WHERE NURSES -- AND IN
14 YOUR CASE WHERE YOU DID IN FACT -- WOULD INDICATE WHAT
15 MEDICATIONS THAT WERE GIVEN; IS THAT TRUE?
16 A. THAT'S TRUE.
17 Q. FOR EXAMPLE, FORTUNATELY THERE IS ONE THAT HAS YOUR
18 INITIALS ON IT. BUT IT'S THE FIRST ONE THAT I FOUND ON, I
19 THINK, THIS IS MISS SMITH. NOW, THAT'S A DOCUMENT THAT IT
20 SAYS CAUTION, MULTIPLE M.A.R.S. M.A.R.S. STANDS FOR
21 MEDICATION ADMINISTRATION RECORD, RIGHT?
22 A. YES.
23 Q. AND THIS IS THE DOCUMENT WHERE NURSES, WHEN THEY WOULD
24 GIVE MEDICATIONS, WOULD HAVE THE OBLIGATION AND THE
25 RESPONSIBILITY TO IDENTIFY WHAT MEDICATIONS THEY GAVE AND
1331
1 THE TIME WHEN THEY GAVE THEM; IS THAT RIGHT?
2 A. THAT'S CORRECT.
3 Q. SO FOR EXAMPLE, WE MIGHT START AT THE TOP HERE AND I
4 DON'T THINK -- IT LOOKS LIKE K.C.I. IS THE MEDICATION, BUT
5 THERE'S A DATE UP THERE OF 1/5. YOU SEE THAT?
6 A. UH-HUH.
7 Q. AND THEN IT LOOKS LIKE THERE'S A TIME OVER HERE. IT
8 LOOKS LIKE 800 HOURS. DO YOU SEE THAT?
9 A. YES.
10 Q. AND THEN THERE'S SOME INITIALS, THAT LOOKS LIKE L.L. FOR
11 LYNN LONG?
12 A. CORRECT.
13 Q. THAT WOULD MEAN THAT LYNN LONG IS SAYING, I GAVE THAT
14 MEDICATION ON THAT DATE AT THAT TIME, TRUE?
15 A. THAT'S CORRECT.
16 Q. AND SIMILARLY WE HAVE ANOTHER INITIAL HERE THAT'S
17 PROBABLY EARLENE COZZEN. YOU'VE TESTIFIED ABOUT HER. DO
18 YOU RECOGNIZE HER INITIALS?
19 A. YES.
20 Q. THAT'S ALSO WHERE MISS COZZEN IS INDICATING ON THAT DATE
21 AT THAT TIME, I GAVE THE MEDICATION, TRUE?
22 A. YES.
23 Q. IT'S TRUE, IS IT NOT, THAT EVERYBODY IS SUPPOSED TO DO
24 THAT ON THE MEDICATION ADMINISTRATION RECORD WHEN THEY IN
25 FACT GIVE A MEDICATION, CORRECT?
1332
1 A. CORRECT.
2 Q. AND THEN IF WE GO DOWN TO THE BOTTOM AND IT'S KIND OF
3 OBLITERATED, BUT IT SAYS HERE, ROUTINE MEDICATION
4 ADMINISTRATION RECORD. AND WHEN IT SAYS ROUTINE, THAT'S
5 RELATING TO THOSE STANDING ORDERS; IS THAT RIGHT?
6 A. THAT'S RIGHT.
7 Q. AND THEN WE HAVE ANOTHER PART OF THE MEDICATION
8 ADMINISTRATION RECORD AND THIS IS A LITTLE BIT DIFFERENT
9 FORMAT THAN WHAT WE'VE JUST SEEN BECAUSE DOWN AT THE BOTTOM
10 THERE IT SAYS P.R.N. AND I.V. MEDICATION ADMINISTRATION
11 RECORD. DID I READ THAT CORRECTLY?
12 A. UH-HUH.
13 Q. AND THIS IS, FOR EXAMPLE, IF WE PULL THIS BACK UP, THIS
14 IS, FOR EXAMPLE, WHERE SOME OF THOSE P.R.N. T.O. AS NEEDED
15 MEDICATIONS WOULD BE CHARTED; IS THAT NOT TRUE?
16 A. THAT'S TRUE.
17 Q. SO FOR EXAMPLE, HERE -- IT'S VERY HARD TO READ, BUT THIS
18 ONE SAYS HALDOL. IT LOOKS LIKE THREE MILLIGRAMS I.M. IF
19 PATIENT REFUSES RISPERDAL P.O. DOSE, WHICH IS ORAL, AND THEN
20 WE HAVE A DAY HERE, A TIME, AND THEN IT'S VERY HARD TO READ,
21 BUT IT HAS THE ADMINISTRATION RECORD AND THEN THE -- THEN
22 THE INITIALS OF THE NURSE. THAT'S WHERE IT'S SUPPOSED TO BE
23 CHARTED; IS THAT CORRECT?
24 A. THAT'S CORRECT.
25 Q. AND WITH RESPECT TO THIS FORM, FINALLY THERE IS A PLACE
1333
1 AND IT'S BLANK WITH RESPECT TO MISS SMITH ON THIS SHEET,
2 BUT THIS IS A PLACE WHERE ACTUALLY WE HAVE MEDICATION, DOSE,
3 ROUTE OF ADMINISTRATION. THAT'S WHERE THOSE NOW ORDERS
4 WOULD BE PUT; IS THAT RIGHT?
5 A. THAT'S RIGHT.
6 Q. AND ONCE AGAIN, THERE SHOULD BE A CHART IN HERE OF THE
7 MEDICATION AND THEN THERE'S A DATE AND THERE IS A TIME AND
8 NURSES' INITIALS, TRUE?
9 A. TRUE.
10 Q. NOW, IF YOU COULD TURN TO THE BINDER THAT HAS IN IT
11 JUDITH LARSEN'S RECORDS, PLEASE. DO YOU HAVE THAT IN FRONT
12 OF YOU?
13 A. UH-HUH.
14 Q. AND YOU TESTIFIED ABOUT THE SEIZURE EVENT WHICH YOU DO
15 HAVE SOME RECOLLECTION OF ON THE 26TH OF DECEMBER, 1995,
16 TRUE?
17 A. YES.
18 Q. AND YOU RECALL THAT THERE WAS AN ORDER FOR DILANTIN AND
19 SOME ORDERS FOR ATIVAN BY DR. DIENHART TO STOP THE SEIZURE,
20 TRUE?
21 A. TRUE.
22 Q. AND YOU RECALL THAT SEIZURE -- YOU ACTUALLY SAW IT; IS
23 THAT RIGHT?
24 A. YES.
25 Q. AND IT'S TRUE, IS IT NOT, THAT YOU DESCRIBED IT AS A
1334
1 SEIZURE THAT WAS 40 OR 45 MINUTES IN LENGTH, CORRECT?
2 A. DR. DIENHART NOTED THAT IN HIS NOTES.
3 Q. AND HE GOT THAT INFORMATION FROM PROBABLY YOU, DID HE
4 NOT?
5 A. PROBABLY, BUT I WOULDN'T REMEMBER THAT WITHOUT READING
6 HIS NOTES.
7 Q. AND THAT SEIZURE EVENT TOOK PLACE ON YOUR SHIFT, SO THAT
8 WOULD HAVE BEEN THE 11 P.M. TO SEVEN O'CLOCK SHIFT, TRUE?
9 A. TRUE.
10 Q. IN FACT, AS YOU SEE THOSE RECORDS, YOU RECALL IT
11 ACTUALLY OCCURRED SOMETIME TOWARDS THE EARLY MORNING HOURS,
12 CORRECT?
13 A. CORRECT.
14 Q. AND IT'S TRUE, IS IT NOT, THAT AFTER THE SEIZURE
15 OCCURRED AND AFTER THE INTERVENTIONS BY DR. DIENHART, THAT
16 YOU DID NOT INDICATE IN ANY OF YOUR NOTES ON THE 27TH, THE
17 28TH OR THE 29TH OF DECEMBER THAT SHE EXPERIENCED ANY OTHER
18 SEIZURE EVENT; ISN'T THAT TRUE?
19 A. TO USE THE WORD SEIZURE, NO. I'M NOT SURE WHAT NIGHTS,
20 BUT THERE WERE OTHER ENTRIES ON OTHER DAYS. I WON'T KNOW
21 FOR SURE WHICH ONES --
22 Q. WELL, CERTAINLY THAT YOU HAD --
23 MS. BARLOW: MAY SHE BE ALLOWED TO FINISH HER
24 ANSWER?
25 THE COURT: WERE YOU DONE WITH YOUR ANSWER?
1335
1 THE WITNESS: WELL, I JUST WANTED TO MENTION THERE
2 ARE NOTES IN HERE WHERE PEOPLE WILL MENTION JERKING AT
3 TIMES.
4 Q. (BY MR. STIRBA) I WAS TALKING ABOUT YOU. IF YOU HAD
5 ASSESSED A SEIZURE EVENT POST DECEMBER 26 OF 1995, YOU
6 CERTAINLY WOULD HAVE CONTACTED A PHYSICIAN ABOUT THAT, WOULD
7 YOU HAVE NOT?
8 A. I WOULD PROBABLY HAVE, YES.
9 Q. AND IN FACT, YOU DIDN'T DO THAT AFTER THE 26TH UNTIL THE
10 29TH OF DECEMBER, DID YOU?
11 A. I DID NOT DO IT AGAIN, NO.
12 Q. IN FACT, IF WE LOOK AT WHAT YOU ASSESSED AND WHAT YOU
13 CHARTED STARTING FROM AFTER THE 26TH, IT APPEARS THAT ON THE
14 27TH YOU HAVE NO NOTES; IS THAT CORRECT?
15 A. THERE'S A NOTE ON THE 28TH.
16 Q. I DIDN'T ASK YOU THAT. I SAID ON THE 27TH OF DECEMBER
17 IT APPEARS THAT YOU DID NOT NOTE ANYTHING WITH RESPECT TO
18 THIS PATIENT; ISN'T THAT TRUE?
19 A. THAT IS TRUE.
20 Q. AND THEN WE HAVE ONE ON THE 28TH, TRUE?
21 A. TRUE.
22 Q. I JUST DISPLAYED THAT UP ON THE SCREEN HERE. AT THE TOP
23 IT SAYS DECEMBER 28, 1995, FREE TEXT AND THEN WE HAVE 11 TO
24 SEVEN, AND THAT'S YOUR NOTE, TRUE?
25 A. TRUE.
1336
1 Q. AND YOU STATE THERE, PATIENT SLEPT QUIETLY THROUGHOUT --
2 ONCE AGAIN -- N.O.C., NIGHT. 02, THAT STANDS FOR, ONCE
3 AGAIN, THAT OXYGEN THAT SHE WAS RECEIVING; IS THAT RIGHT?
4 PATIENT FREQUENTLY REMOVING OXYGEN. STAFF PUTTING BACK ON
5 BED.
6 A. NO. PUTTING THE OXYGEN BACK ON THE PATIENT.
7 Q. I'M SORRY. AND THEN IT SAYS MONITOR IN PLACE AND THEN
8 IT HAS S.R. INCREASED BY TWO.
9 A. SIDE RAILS UP TIMES TWO.
10 Q. I SEE. NO OTHER ENTRIES FOR THE 28TH, CORRECT?
11 A. CORRECT.
12 Q. AND THEN ON THE 29TH, WE HAVE ONE ENTRY. THIS IS A DAY
13 THAT THERE WAS DISCONTINUATION OF THE DILANTIN BECAUSE AS
14 THE NOTE WAS READ, THERE WERE CONCERNS ABOUT SEDATION,
15 CORRECT?
16 A. DR. WEITZEL'S NOTE, YES.
17 Q. YOU READ IT ON DIRECT AND DR. WEITZEL EXPRESSLY SAID HE
18 HAD CONCERNS ABOUT SEDATION AND THEREFORE HE WAS
19 DISCONTINUING THE DILANTIN. DIDN'T HE SAY THAT?
20 A. THAT'S TRUE.
21 Q. IN FACT, THERE IS A NOTE AT LEAST INDICATING THAT HE
22 D.C.'ED, DISCONTINUED, THE DILANTIN ON THE 29TH, TRUE?
23 A. RIGHT.
24 Q. AND YOUR NOTE ON THE 29TH RIGHT HERE 12/29, 11 -- ONCE
25 AGAIN, THOSE ARE YOUR INITIALS. IT SAYS 11 SEVEN FREE TEXT
1337
1 PATIENT AWAKE SEVERAL TIMES DURING THE NIGHT. WHAT IS THAT
2 ZERO WITH A LINE THROUGH IT?
3 A. ZERO.
4 Q. OKAY. ALL RIGHT. AND THEN YOU HAVE SOMETHING ELSE THAT
5 SAYS PAIN. DOES THAT MEAN WITHOUT PAIN?
6 A. SIGNS AND SYMPTOMS.
7 Q. NO -- SO NO SIGNS AND SYMPTOMS; IS THAT RIGHT?
8 A. YES.
9 Q. NO SIGNS AND SYMPTOMS OF PAIN OR DISTRESS NOTED.
10 OTHERWISE, APPEARED TO SLEEP QUIETLY. ONCE AGAIN, WE GO
11 INTO THE OXYGENATION REPORT. DOES THAT MEAN 02 SATS? IS
12 THAT 95 PERCENT. AM I READING THAT CORRECTLY?
13 A. YES, IT IS.
14 Q. SO ONCE AGAIN AS YOU TESTIFIED ON DIRECT, AT LEAST AS OF
15 THIS DATE WITH THAT 02 SAT OF 95 PERCENT, THAT'S QUITE GOOD,
16 TRUE?
17 A. THAT'S TRUE.
18 Q. AND THEN YOU PUT BED CHECK MONITOR IN PLACE AND THEN
19 YOUR INITIALS, CORRECT?
20 A. YES.
21 Q. ANY OTHER NOTES FOR THE 29TH FOR YOU?
22 A. NO.
23 Q. NOW, DO YOU HAVE THE BINDER FOR MR. ALLDREDGE?
24 A. MR. ALLDREDGE, IS THAT WHAT YOU SAID?
25 Q. YES. DO YOU HAVE THAT IN FRONT OF YOU, MA'AM?
1338
1 A. YES, I DO.
2 Q. MR. ALLDREDGE WAS A PATIENT THAT YOU TESTIFIED ON DIRECT
3 YOU DON'T HAVE A VERY GOOD RECOLLECTION OF; IS THAT RIGHT?
4 A. THAT'S RIGHT.
5 Q. AND THERE'S AN ENTRY I WANT TO ASK YOU ABOUT, THOUGH,
6 FROM YOU. IF YOU WOULD TURN TO -- IT'S AN ENTRY 1/11 OF '96
7 AND IT'S IN THE NURSES' NOTES SECTION.
8 MS. BARLOW: NUMBER 63.
9 THE WITNESS: I FOUND IT.
10 Q. (BY MR. STIRBA) DO YOU HAVE IT IN FRONT OF YOU, MA'AM?
11 A. YES, I DO.
12 Q. AND BEFORE WE GET THERE, I JUST WANT TO ASK YOU
13 SOMETHING ABOUT ALSO THE WAY THESE -- YOU'VE TESTIFIED TO IT
14 ON DIRECT -- ABOUT THE WAY THESE BINDERS ARE PUT TOGETHER
15 WHICH ARE THE MEDICAL RECORDS. FOR EXAMPLE, THIS IS A
16 DOCUMENT THAT IS A PART OF THE MED GRAPH SECTION IN THE
17 BINDER WHICH IS PART OF THE MEDICAL RECORDS, TRUE?
18 A. TRUE.
19 Q. AND YOU ARE FAMILIAR JUST GENERALLY WITH WHAT THIS GRAPH
20 IS AND WHAT IT PURPORTS TO REPRESENT?
21 A. YES.
22 Q. IT'S TRUE, IS IT NOT, THAT THE VITALS WERE AT LEAST
23 TAKEN ONCE PER SHIFT, WASN'T THAT PROTOCOL?
24 A. YOU KNOW, I DON'T REMEMBER. THAT'S BEEN A LONG TIME
25 AGO. I KNOW WE TOOK THEM IN THE MORNING AND I WOULD ASSUME
1339
1 EVERY SHIFT TOOK THEM, BUT SOMETIMES THEY CHANGED THAT
2 ORDER.
3 Q. OKAY. BUT AT LEAST IF IT WASN'T EVERY SHIFT, IT WAS
4 CERTAINLY ONCE PER DAY. THAT WAS THE STANDING ORDER; IS
5 THAT RIGHT?
6 A. AT LEAST ONCE PER DAY, YES.
7 Q. BY VITAL SIGNS, ONCE AGAIN, WE MEAN BLOOD PRESSURE,
8 RESPIRATION RATE, AND THINGS LIKE THAT?
9 A. YES.
10 Q. TRUE?
11 A. TRUE.
12 Q. AND THIS PARTICULAR DOCUMENT IS WHERE THOSE THINGS WERE
13 DOCUMENTED CONCERNING EACH PATIENT. AM I NOT CORRECT?
14 A. THAT'S CORRECT.
15 Q. AND FOR EXAMPLE, THIS IS FOR MR. ALLDREDGE AND WE HAVE A
16 TEMPERATURE TAKEN OVER HERE AND IT'S CHARTED BY GRAPH AS WE
17 GO THROUGH HERE THE DAYS THAT HE WAS IN THE HOSPITAL; IS
18 THAT CORRECT?
19 A. THAT'S CORRECT.
20 Q. AND THEN ALSO WE HAVE THE PULSE OVER HERE AND ONCE AGAIN
21 THAT IS CHARTED AS WELL; IS THAT RIGHT?
22 A. THAT'S RIGHT.
23 Q. AND THEN DOWN HERE WE HAVE RESPIRATION. YOU SEE THAT?
24 A. UH-HUH.
25 Q. MAYBE YOU CAN'T WITH MY --
1340
1 A. I KNOW IT'S THERE.
2 Q. OKAY. AND THAT'S A DOCUMENT -- A DOCUMENTATION RATHER,
3 OF HIS ACTUAL RESPIRATIONS PER MINUTE; ISN'T THAT TRUE?
4 A. THAT'S TRUE.
5 Q. FOR EXAMPLE, YOU TOLD THE JURY ABOUT RESPIRATION RATE
6 AND APPARENTLY BECAUSE OF THE CIRCUMSTANCES OF MISS LARSEN
7 ON THE 3RD OF DECEMBER -- I'M SORRY -- ON THE 3RD OF JANUARY
8 YOU DECIDED TO WITHHOLD THE MEDICATION; IS THAT CORRECT?
9 A. SAY THAT AGAIN?
10 Q. SURE. IN OTHER WORDS, YOU TOLD US A LITTLE BIT ABOUT
11 RESPIRATION RATE AND THAT'S SOMETHING NURSES DO. THEY
12 MONITOR THAT, TRUE?
13 A. YES.
14 Q. IT'S TRUE, IS IT NOT, THAT NURSES, WHEN THEY GIVE
15 MEDICATIONS, FOR EXAMPLE, LIKE MORPHINE OR OTHER KINDS OF
16 NARCOTIC MEDICATIONS, THEY HAVE A RESPONSIBILITY TO ACTUALLY
17 CHECK THE RESPIRATION RATES, DON'T THEY?
18 A. THAT'S TRUE.
19 Q. AND IN OTHER WORDS, TO MONITOR THE EFFECTS OF THE DRUGS
20 AND IF THE RESPIRATION RATES ARE TOO LOW, THEN THEY
21 SHOULDN'T NECESSARILY GIVE THE DRUG BECAUSE THAT MIGHT
22 COMPROMISE THE PATIENT; ISN'T THAT CORRECT?
23 A. THAT'S TRUE.
24 Q. AND ISN'T THAT PRECISELY WHAT YOU WERE DOING ON THE 3RD
25 OF JANUARY WITH MISS LARSEN? YOU WERE OBSERVING HER
1341
1 RESPIRATION RATES, AND I BELIEVE YOU TESTIFIED THEY WERE SIX
2 TO EIGHT; IS THAT RIGHT?
3 A. THAT'S CORRECT.
4 Q. AND THAT'S LOW, TRUE?
5 A. THAT'S TRUE.
6 Q. AND THEREFORE YOU DECIDED IT WOULD BE -- NOT BE
7 APPROPRIATE FROM A NURSING STANDPOINT TO ADMINISTER THE
8 MEDICATION, TRUE?
9 A. THAT'S TRUE.
10 Q. AND YOU CERTAINLY AGREE THAT THAT'S AN OBLIGATION THAT
11 EACH AND EVERY TIME, FOR EXAMPLE, WHEN A NARCOTIC MEDICATION
12 IS GIVEN TO A PATIENT THAT A NURSE HAS AN OBLIGATION TO DO
13 THAT, CORRECT?
14 A. TO KEEP AWARE OF THE PATIENT'S CONDITION, YES.
15 Q. RIGHT. AND IN FACT, MONITOR THE RESPIRATION RATE,
16 CORRECT?
17 A. CORRECT.
18 Q. BECAUSE YOU DON'T WANT TO GIVE A NARCOTIC MEDICATION
19 WHICH MIGHT COMPROMISE THE PATIENT IF THE RESPIRATION RATES
20 ARE TOO LOW, TRUE?
21 A. TRUE.
22 Q. AND IT IS ALSO TRUE, IS IT NOT, EACH AND EVERY TIME YOU
23 GAVE MEDICATION TO THESE PATIENTS AS PART OF YOUR NURSING
24 DUTY, NOT ONLY DID YOU HAVE A DUTY TO SEE HOW THEY WERE
25 BEFORE, BUT YOU ALSO HAD SOME OBLIGATION AND A DUTY TO SEE
1342
1 HOW THEY WERE AFTER; IS THAT CORRECT?
2 A. THAT'S CORRECT.
3 Q. IN OTHER WORDS, IF YOU ARE GOING TO GIVE MORPHINE TO
4 SOMEBODY OR A PSYCH MEDICATION TO SOMEBODY --
5 MS. BARLOW: YOUR HONOR, I OBJECT TO IN OTHER
6 WORDS. IT'S REPETITIVE. IT'S BEEN ASKED AND ANSWERED.
7 THE COURT: THIS IS CROSS-EXAMINATION. OVERRULED.
8 MR. STIRBA: THANK YOU, YOUR HONOR.
9 Q. IN OTHER WORDS, IF YOU GIVE MORPHINE TO SOMEBODY OR YOU
10 GIVE A PSYCH MEDICATION TO SOMEBODY OR ANY KIND OF SEDATING
11 OR SEDATIVE MEDICATION, YOU MONITOR BEFORE AND YOU MONITOR
12 AFTER, CORRECT?
13 A. CORRECT.
14 Q. AND THOSE RESPIRATION RATES, YOU UNDERSTAND THAT THE
15 NORMAL IS IN THE RANGE OF TEN TO 20 PER MINUTE?
16 A. YEAH. USUALLY A LITTLE HIGHER THAN TEN BUT, YEAH.
17 Q. WHEN YOU SAY USUALLY A LITTLE HIGHER, YOU THINK 12 TO
18 20?
19 A. IDEAL WOULD PROBABLY BE 16 TO 20 BUT LESS CAN BE OKAY. What species is she
20 I MEAN 12, MANY PEOPLE WHEN THEY WERE SLEEPING, 12 IS talking about?
21 PROBABLY JUST FINE.
22 Q. ALL RIGHT. AND THAT WAS SOMETHING THAT WAS MONITORED BY
23 THE NURSING STAFF WITH RESPECT TO EACH ONE OF THESE
24 PATIENTS, CORRECT?
25 A. TRUE.
1343
1 Q. AND FOR EXAMPLE, THIS LITTLE DOCUMENT HERE HAS
2 RESPIRATIONS AND IT'S IMPOSSIBLE TO SEE FROM HERE, BUT
3 BASICALLY THERE ARE NUMBERS THAT INDICATE THE RESPIRATION
4 RATES AS CHARTED BY THE NURSING STAFF. DO YOU SEE THOSE?
5 A. UH-HUH.
6 Q. IN FACT, ARE YOU LOOKING AT THIS DOCUMENT?
7 A. I THINK I AM. WHAT PAGE ARE YOU ON?
8 Q. OKAY. THIS SAYS MED-0041?
9 A. I'M ON THAT PAGE.
10 Q. LET'S TALK ABOUT THE FIRST NUMBER THAT APPEARS TO BE A
11 28. DO YOU SEE THAT?
12 A. THAT'S TRUE.
13 Q. AND THEN THEY HAVE BLOOD PRESSURE AND THERE'S NO MORE
14 INFORMATION THAT'S DOCUMENTED; IS THAT RIGHT?
15 A. UH-HUH.
16 Q. OKAY. AND THAT'S PART OF EACH PATIENT'S MEDICAL CHART?
17 A. TRUE.
18 THE COURT: YOU HAVE TO ANSWER OUT LOUD.
19 THE WITNESS: YES.
20 Q. (BY MR. STIRBA) NOW, WITH RESPECT TO MR. ALLDREDGE, I
21 WAS DIRECTING YOUR ATTENTION TO THE ENTRY ON 1/11/96, WHICH
22 IS IN THE NURSES' NOTES SECTION, AND DO YOU HAVE YOUR NOTE
23 IN FRONT OF YOU --
24 A. YES, I DO.
25 Q. -- THAT YOU WROTE ON THAT DAY? OKAY. PUT THAT UP ON
1344
1 THE SCREEN. NOW, WHERE YOU ARE STARTING FROM FOR YOUR NOTE
2 THAT DAY?
3 A. YES.
4 Q. OKAY. AND IT'S AT THE TOP. WE HAVE 1/11/96 THAT
5 APPEARS TO BE STARTING RIGHT ON TIME THAT DAY, 2400 HOURS,
6 RIGHT?
7 A. THAT'S WHEN THE FIRST ENTRY IS MADE. WE ACTUALLY HAD
8 BEEN THERE. SHIFT STARTED REALLY AT 11:30.
9 Q. THAT'S RIGHT. IT STARTED AT 11?
10 A. WELL, REPORTS WERE AT 11. WE ACTUALLY TAKE OVER AT
11 11:30.
12 Q. OKAY. ALL RIGHT. THEN YOU HAVE PATIENT RESTLESS,
13 POSEYED. POSEY UNDONE. PATIENT REPOSITIONED. SEE
14 RESTRAINT ADDENDUM RECORD FOR ADDITIONAL INFO. IT'S TRUE IN
15 TERMS OF RESTRAINTS -- AND YOU'VE DESCRIBED THAT POSEY AS
16 ESSENTIALLY -- IT'S A RESTRAINT, IS IT NOT?
17 A. YES.
18 Q. IT'S DONE FOR THE PROTECTION OF THE PATIENT, TRUE?
19 A. TRUE.
20 Q. IT'S TRUE, IS IT, NOT THAT IT IS DONE PURSUANT TO A
21 DOCTOR'S ORDER BUT ALSO, FOR EXAMPLE, OTHER PLACES IN
22 MR. ALLDREDGE'S CHART YOU'LL SEE TYPICALLY THERE WILL BE A
23 REQUEST FROM A NURSE THAT THE RESTRAINT'S ACTUALLY BEEN
24 DONE; IS THAT CORRECT?
25 A. THAT'S CORRECT.
1345
1 Q. IN OTHER WORDS, THERE'S A REQUEST FROM THE PHYSICIAN
2 BECAUSE YOU GUYS ARE THERE AND YOU ARE SEEING THE BEHAVIOR
3 AND IF YOU FEEL THAT A RESTRAINT IS REQUIRED BECAUSE OF THE
4 PATIENT'S BEHAVIOR, THEN YOU INITIATE A FORMAL REQUEST AND
5 THE DOCTOR ORDERS IT, CORRECT?
6 A. THAT'S CORRECT.
7 Q. AND THAT'S WHAT HAPPENED HERE.
8 A. YES.
9 Q. TRUE?
10 A. BUT ACTUALLY, HE HAD ALREADY BEEN IN A POSEY BEFORE I
11 CAME ON. THIS WAS ONGOING.
12 Q. I UNDERSTAND THAT. I'M JUST TALKING ABOUT HE'S
13 OBVIOUSLY IN A POSEY. BUT THE PROCEDURE FOR THAT IS A NURSE
14 OR SOMEBODY REQUESTS IT, THEN THE DOCTOR ORDERS IT.
15 A. CORRECT.
16 Q. OKAY. THEN WE HAVE -- I CAN'T READ THAT, THE TIME. CAN
17 YOU READ THAT?
18 A. THE NEXT ONE?
19 Q. YES.
20 A. 0200.
21 Q. OKAY. PATIENT CONTINUES RESTLESS, REMOVING BEDDING,
22 POSEY UNDONE.
23 A. R.O.M., RANGE OF MOTION.
24 Q. PARDON ME?
25 A. IT'S R.O.M., WHICH IS RANGE OF MOTION.
1346
1 Q. RANGE OF MOTION, AND PATIENT REPOSITIONED AND REPOSEYED
2 DUE TO AGITATION. SO YOU GO AND TRY TO PUT THE RESTRAINT
3 BACK ON MR. ALLDREDGE, TRUE?
4 A. WHAT WE DID WAS WE UNDID IT AND FIXED HIS BED ALL UP.
5 MOVED HIM AROUND TO KEEP HIS CIRCULATION GOING GOOD. GOT
6 ALL COMFORTABLE, REPOSITIONED, AND THEN PUT THE BELT BACK
7 ON.
8 Q. THAT LOOKS LIKE 400. THAT'S FOUR O'CLOCK IN THE
9 MORNING, CORRECT?
10 A. YES.
11 Q. PATIENT RESTLESS BUT SLEEPING. DIAPER REMAINS DRY.
12 POSEY OFF. PATIENT'S REPOSITIONED. AND THEN IT LOOKS
13 LIKE -- WHAT DOES THAT SAY THERE, MA'AM?
14 A. REPOSEYED.
15 Q. REPOSEYED. AND IS THIS THE -- WAS HE ON OXYGEN AT THE
16 TIME?
17 A. NO. THAT'S THE SIDE RAILS UP TIMES TWO.
18 Q. PARDON ME?
19 A. SIDE RAILS UP TIMES TWO.
20 Q. OKAY. MONITOR IN PLACE. THEN U.A. OBTAINED PER
21 STRAIGHT CATH. PATIENT VERY AGITATED. CRYING LOUDLY.
22 POSEY -- WHAT DOES THAT SAY?
23 A. REMOVED.
24 Q. REMOVED. ONCE AGAIN, THAT'S A RANGE OF MOTION
25 REPOSITION AND REPOSEYED AND THEN PUT -- SEE RESTRAINT
1347
1 ADDENDUM FOR ADDITIONAL INFORMATION. THAT THE DOCUMENT
2 WE'RE TALKING ABOUT WHERE THERE IS A REQUEST FOR RESTRAINT,
3 IS THAT THE RESTRAINT ADDENDUM?
4 A. NO. THAT IS WHERE -- AND, YOU KNOW, I'M NOT SURE WHERE
5 THEY ARE AT IN HERE, BUT IT'S WHERE THE -- WE KEEP A LOG
6 THAT WE ARE CHECKING THEM. IT'S BACK HERE IN THE VERY BACK
7 OF THESE BOOKS.
8 Q. IT IS IN THE BINDER THAT YOU HAVE IN FRONT OF YOU; IS
9 THAT RIGHT?
10 A. YES.
11 Q. NOW, DID YOU HAVE ANY OTHER ENTRIES ON THE -- ON THE
12 11TH, ANY OTHER NOTES THAT YOU MADE CONCERNING MR.
13 ALLDREDGE?
14 A. I DON'T.
15 Q. OKAY. DO YOU HAVE MISS CRANE'S BINDER IN FRONT OF YOU?
16 A. YES.
17 Q. AND THAT ALSO IS SOMEBODY THAT YOU DO NOT HAVE A VERY
18 GOOD RECOLLECTION OF BEYOND WHAT YOU HAVE INDICATED IN YOUR
19 NURSING NOTES; IS THAT CORRECT?
20 A. CORRECT.
21 Q. YOU TESTIFIED ABOUT MISS CRANE AND YOU TESTIFIED, I
22 BELIEVE, ABOUT YOU TRIED SOME TYLENOL AT ONE POINT FOR PAIN.
23 DO YOU REMEMBER THAT?
24 A. YES, I DO.
25 Q. AND YOU THEN CHARTED AND NOTE IN THAT TYLENOL WAS NOT
1348
1 EFFECTIVE.
2 A. THAT'S CORRECT.
3 Q. AND SHE COMPLAINED OF PAIN, ISN'T THAT TRUE?
4 A. THAT'S TRUE.
5 Q. AND AT THAT POINT I BELIEVE YOU ALSO TESTIFIED THAT SHE
6 RECEIVED MORPHINE; IS THAT CORRECT?
7 A. DO YOU KNOW WHAT PAGE IT'S ON?
8 Q. WELL, LET'S SEE IF WE CAN FIND IT. IT WILL BE THE
9 NURSING ENTRY ON 1/4.
10 MS. BARLOW: NUMBER 321.
11 THE WITNESS: DOES NOT MENTION IT IN THE NURSES'
12 NOTES. BUT LET ME LOOK AT THE MEDICATION SHEET. YES. IT IS
13 6:45, SHE RECEIVED FIVE MILLIGRAMS.
14 Q. AND THIS NOTE ON 1/4 OF '96, THIS IS THE NOTE I WAS
15 REFERRING TO WHERE YOU ASSESSED HER AS HAVING PAIN AND YOU
16 GAVE HER TYLENOL AS INDICATED IN YOUR NOTE, CORRECT?
17 A. RIGHT.
18 Q. AND THEN YOU CONTINUED TO CHART, I THINK, HERE THAT THE
19 TYLENOL HAD LITTLE EFFECT. IS THAT RIGHT?
20 A. THAT'S RIGHT.
21 Q. THE NOTE FOR THE MORPHINE AT 6:45, DO YOU RECALL WHETHER
22 THAT WAS A TELEPHONE ORDER OR WAS THAT AN ORDER GIVEN BY THE
23 DOCTOR WHEN DR. WEITZEL WAS IN THE HOSPITAL?
24 A. WELL, IT'S A NOW ORDER, SO LET ME CHECK AND SEE WHOSE
25 WRITING IT IS AND THAT MAY TELL ME. IT'S IN DR. WEITZEL'S
1349
1 WRITING, SO HE WAS PROBABLY IN THAT MORNING AND WROTE THE
2 ORDER WHILE HE WAS THERE WHEN I WAS RELATING TO HIM HOW THE
3 PATIENT HAD BEEN.
4 Q. OKAY. ONCE AGAIN, THIS WOULD HAVE BEEN A RESPONSE TO
5 SOMETHING THAT YOU AS A NURSE WOULD HAVE ASSESSED IN TERMS
6 OF MISS CRANE'S CONDITION; IS THAT RIGHT?
7 A. THAT'S RIGHT.
8 Q. IT'S TRUE, IS IT NOT, THAT AT LEAST WITH RESPECT TO YOUR
9 INTERACTION ON THESE FIVE PATIENTS, THIS WOULD NOT BE THE
10 FIRST AND ONLY TIME WHERE YOU WOULD HAVE ASSESSED CERTAIN
11 CIRCUMSTANCES AND IMPARTED INFORMATION TO DR. WEITZEL,
12 CORRECT?
13 A. THAT'S CORRECT.
14 Q. IN FACT, ISN'T THAT A NURSING FUNCTION?
15 A. THAT IS TRUE.
16 Q. IN OTHER WORDS, TO ASSESS CERTAIN THINGS AND THEN
17 PROVIDE INFORMATION TO THE PHYSICIAN?
18 A. THAT'S TRUE.
19 Q. AND YOU TESTIFIED A LITTLE BIT ABOUT CARE PLANS. IT'S
20 TRUE THAT NURSES HAVE IN FACT CARE PLANS FOR PATIENTS. YOU
21 ARE FAMILIAR WITH THAT TERM?
22 A. YES.
23 Q. AND YOU ARE AWARE THAT WITH RESPECT TO EACH ONE OF THESE
24 PATIENTS, THERE WAS A CARE PLAN?
25 A. THAT'S TRUE.
1350
1 Q. AND ARE YOU ALSO AWARE THAT AS PART OF THE CARE PLAN
2 THERE'S ALSO IN THE NURSING WORLD, THERE'S WHAT IS CALLED A
3 DEATH AND DYING -- IT'S NOT A CARE PLAN, BUT THE DEATH AND
4 DYING PROCESS IS A RECOGNIZED EVENT SO THAT A PLAN OF ACTION
5 IS THEN PROPOSED IN THE NURSING FIELD?
6 MS. BARLOW: YOUR HONOR, THIS IS OUTSIDE THE SCOPE
7 OF DIRECT EXAMINATION.
8 THE COURT: SUSTAINED.
9 Q. (BY MR. STIRBA) ARE YOU AWARE OF WHETHER OR NOT SUCH A
10 PLAN WAS CREATED WITH RESPECT TO ANY OF THESE PATIENTS?
11 MS. BARLOW: AGAIN, YOUR HONOR, IT'S BEYOND THE
12 SCOPE --
13 THE COURT: OVERRULED AS TO THESE PATIENTS.
14 THE WITNESS: IF THERE'S A COPY OF LIKE OF A LIVING
15 WILL, IS THAT WHAT WE'RE TALKING ABOUT?
16 THE COURT: HE'S ASKING IF YOU ARE AWARE IF THERE
17 WAS.
18 THE WITNESS: WITHOUT LOOKING, NO.
19 THE COURT: MR. STIRBA, HOW MUCH MORE TIME DO YOU
20 THINK YOU'LL BE WITH THIS WITNESS?
21 MR. STIRBA: I HAVE ABOUT TWO MINUTES, YOUR HONOR.
22 THE COURT: LADIES AND GENTLEMEN, I HOPE THAT WE'LL
23 BE ABLE TO HEAR THIS WITNESS AND REDIRECT BEFORE WE TAKE
24 LUNCH. SO MAYBE JUST ANOTHER 15 MINUTES OR SO AT THE MOST.
25 Q. (BY MR. STIRBA) LET ME SHOW YOU ANOTHER ENTRY FROM
1351
1 MR. ALLDREDGE. IT LOOKS LIKE THIS IS A NOTE ON 1/12/96. DO
2 YOU SEE THAT?
3 A. ALMOST, YES.
4 Q. AND IT LOOKS LIKE THIS IS YOUR NOTE RIGHT HERE; IS THAT
5 RIGHT?
6 A. ACTUALLY ON 1/12, MINE IS THAT WHOLE PAGE AND THEN GOES
7 ONTO THE NEXT PAGE.
8 Q. I SEE. OKAY. SO THE 2345 WE HAVE, PATIENT REMAINS
9 POSEYED. PATIENT HAD ONE LARGE B.M. HAS SMEARED FECES ALL
10 OVER INCLUDING FACE, BED RAILS AND PATIENT. CLEANED UP IN
11 RECLINER, BEDDING TRIANGLED, BACK TO BED AND POSEYED -- I
12 CAN'T READ THAT WORD?
13 A. RESECURED.
14 Q. PARDON ME?
15 A. RESECURED.
16 Q. RESECURED. AND THEN THOSE ARE YOUR INITIALS, RIGHT?
17 A. RIGHT.
18 Q. ONE O'CLOCK PATIENT RESTING QUIETLY. SLEEP STUDY IN
19 PROGRESS. DO YOU SEE THAT?
20 A. UH-HUH.
21 Q. IT'S TRUE WITH RESPECT TO THESE STUDIES, FOR EXAMPLE,
22 YOU'VE TESTIFIED ABOUT THE OXYGEN SATURATION MEASUREMENTS,
23 AND IT'S TRUE THAT IS A RESPIRATORY THERAPIST WHO'S ACTUALLY
24 CONDUCTING THAT?
25 THE COURT: YOU HAVE TO ANSWER OUT LOUD.
1352
1 THE WITNESS: YES, I'M SORRY.
2 Q. (BY MR. STIRBA) AND RESPIRATORY THERAPISTS ARE CALLED
3 IN BY THE PHYSICIANS TO DO THAT; ISN'T THAT TRUE?
4 A. WELL, AN ORDER IS WRITTEN AND THEN WHOEVER TAKES IT OFF
5 NOTIFIES RESPIRATORY.
6 Q. IT'S AN ORDER DONE BY THE PHYSICIAN?
7 A. YES.
8 Q. SIMILARLY WITH RESPECT TO THE OXYGEN, YOU'VE TESTIFIED
9 THAT I GUESS MISS LARSEN HAD AT SOME POINT AND MISS CRANE AT
10 SOME POINT, THAT'S ALSO DONE PURSUANT TO AN ORDER BY THE
11 PHYSICIAN; ISN'T THAT TRUE?
12 A. THAT'S TRUE.
13 Q. THEN PATIENT POSEY REMOVED. PATIENT REPOSITIONED.
14 POSEY -- I CAN'T READ THAT.
15 A. RESECURED.
16 Q. RESECURED. THEN WE HAVE THE SIDE RAILS UP AGAIN. BED
17 CHECK MONITOR IN PLACE. SEE RESTRAINT ADDENDUM RECORD FOR
18 ADDITIONAL INFO. AND THEN AT FOUR O'CLOCK, PATIENT HAS BEEN
19 AGITATED, RESTLESS, REMOVING DIAPER, REMOVE FINGER MONITOR,
20 UNABLE -- SOMETHING TO REPLACE. THAT STANDS FOR RESPIRATORY
21 THERAPIST, CORRECT?
22 A. CORRECT.
23 Q. POSEY REMOVED FROM, REPOSITIONED. POSEY SECURED. DID I
24 READ THAT CORRECTLY?
25 A. YES.
1353
1 Q. THEN YOU WERE ASKED ABOUT THIS ATIVAN ONE MILLIGRAM I.M.
2 GIVEN FOR AGITATION. DO YOU SEE THAT?
3 A. UH-HUH.
4 Q. AND RESPIRATORY THERAPIST IN, FINGER MONITOR IN PLACE,
5 CORRECT?
6 A. YES.
7 Q. THAT ATIVAN THAT WAS GIVEN, DO YOU RECALL WHETHER THAT
8 WAS A P.R.N. ORDER OR WAS THAT SOMETHING WHERE YOU CALLED
9 THE PHYSICIAN AND GOT ESSENTIALLY AN ORDER FROM THE
10 PHYSICIAN?
11 A. I WOULD HAVE TO LOOK TO KNOW FOR SURE.
12 Q. WHY DON'T YOU LOOK, PLEASE?
13 A. IT WAS A P.R.N. ORDER.
14 Q. A P.R.N. SO THAT WAS ONE OF THOSE TIMES WHEN YOU
15 ACTUALLY IN YOUR OWN DISCRETION JUDGED THAT THE ATIVAN WAS
16 APPROPRIATE TO GIVE TO MR. ALLDREDGE BECAUSE OF HIS
17 AGITATION, CORRECT?
18 A. THAT'S CORRECT.
19 Q. AND THE EFFECT OF THE ATIVAN WAS ATTEMPTING TO SEDATE
20 HIM AND TO CALM HIM DOWN FROM HIS AGITATION, CORRECT?
21 A. THAT'S TRUE.
22 MR. STIRBA: THAT'S ALL I HAVE, YOUR HONOR.
23 THE COURT: MISS BARLOW?
24 REDIRECT EXAMINATION
25 BY MS. BARLOW:
1354
1 Q. PROMISE NOT TO KEEP YOU MUCH LONGER HERE. IF YOU WILL
2 TURN TO 191.
3 A. IN?
4 Q. IN ANDERSON. AND THE 3:15 NOTE, DID IT SAY ANYTHING
5 THERE ABOUT SEVERE PAIN?
6 A. NO, IT DOESN'T. But she has just testified that the patient was in 'severe pain'!
7 Q. MR. STIRBA ASKED YOU ABOUT CARE PLANS. DID THE NURSES
8 ALONE PUT TOGETHER THAT CARE PLAN?
9 A. YEAH, THE NURSING CARE PLAN, YES.
10 Q. WERE THERE OTHER CARE PLANS THAT INVOLVED MORE THAN THE
11 NURSES?
12 A. WELL, THERE WAS WHAT WOULD BE REFERRED TO AS THE TEAM
13 WHICH WOULD MEET ONCE A WEEK, I BELIEVE. BUT AS A NIGHT
14 NURSE, I WASN'T INVOLVED IN THIS. BUT THEY DID MEET AND AS
15 A GROUP HAVE KIND OF A PLAN AND WHAT THEY HOPED TO ACHIEVE.
16 MS. BARLOW: THANK YOU. I HAVE NO FURTHER
17 QUESTIONS, YOUR HONOR.
18 MR. STIRBA: I HAVE NONE, YOUR HONOR. THANK YOU.
19 THE COURT: MAY THIS WITNESS BE EXCUSED?
20 MS. BARLOW: YOUR HONOR, IF SHE COULD JUST WAIT IN
21 THE BACK OF THE COURTROOM UNTIL AFTER THE JURY'S GONE OUT.
22 I WANT TALK TO THE COURT.
23 THE COURT: OKAY. ALL RIGHT. OKAY, LADIES AND
24 GENTLEMEN, THE BIG QUESTION IS, IS THIS POINTER WORKING FOR
25 YOU NOW. COUNSEL, IF YOU'LL JUST CONTINUE. I THOUGHT YOU
1355
1 DID A GOOD JOB OF USING THAT TO REFER TO THE PORTION OF THE
2 MEDICAL RECORD.
3 LADIES AND GENTLEMEN, WHAT WE'RE GOING TO DO, THERE'S
4 SOMETHING I NEED TO DISCUSS WITH THE ATTORNEYS. RATHER THAN
5 HAVING YOU COME BACK AT 1:30 AND WAIT, YOU ARE NOT GOING TO
6 BE WAITING UNTIL 2:30, BUT I'M GOING TO HAVE YOU COME BACK
7 AT TWO. SO YOU ARE GOING TO HAVE A LONGER LUNCH THAN NORMAL
8 BECAUSE WE KIND OF WENT OVER. AND DURING THIS TIME IT IS
9 YOUR DUTY NOT TO CONVERSE AMONG YOURSELVES OR TO CONVERSE
10 WITH OR ALLOW YOURSELVES TO BE ADDRESSED BY ANY OTHER PERSON
11 ON THE SUBJECT OF THIS TRIAL. IT'S ALSO YOUR DUTY NOT TO
12 FORM OR EXPRESS AN OPINION ON THE CASE UNTIL IT IS FINALLY
13 SUBMITTED TO YOU. AND AGAIN, RADIOS, TELEVISION, NEWS
14 REPORTS, NEWSPAPERS, ANY OTHER MEDIA COVERAGE ABOUT THIS
15 TRIAL. YOU ARE NOT TO READ OR LISTEN TO OR HEAR ABOUT IT
16 FROM ANYONE. SO WE'LL SEE YOU BACK PROMPTLY THEN AT TWO
17 P.M.
18 (JURY LEAVES THE COURTROOM.)
19 THE COURT: THE RECORD SHOULD REFLECT THE JURY HAS
20 GONE. WHAT I WOULD RATHER DO -- YESTERDAY I LEARNED FROM
21 SAD EXPERIENCE THAT WE START AT ONE THEN WE GOT DONE WAY
22 LATE. I WOULD RATHER, IF YOU WANT TO TAKE A SHORT BREAK,
23 AND THEN COME BACK, I WOULD LIKE TO DO THE ARGUMENT
24 REGARDING DR. CROOKSTON AND KATHLEEN KAUFMAN. SO IF YOU
25 NEED TO TALK TO A WITNESS OR SOMETHING YOU CAN TAKE FIVE
1356
1 MINUTES.
2 MS. BARLOW: WHAT I WANTED TO DO AT THIS POINT IS
3 TO MAKE A COUPLE OF PROFFERS OF MATERIAL THAT I DID NOT ASK
4 MISS SCHOLL BECAUSE I THOUGHT THEY WOULD BE OBJECTED TO AND
5 I DIDN'T WANT TO FIGHT IT OUT IN FRONT OF THE JURY.
6 THE COURT: THAT'S APPROPRIATE. WHERE IS OUR
7 WITNESS. CAN WE PROFFER IT RATHER THAN HAVE HER --
8 MR. STIRBA: SURE. I HAVE NO PROBLEM WITH PROFFER.
9 MS. BARLOW: THEN SHE CAN COME BACK AND TESTIFY,
10 FINE. THERE WERE TWO MATTERS THAT, BASED ON OBJECTIONS THAT
11 HAVE COME UP BEFORE, I DID NOT RAISE WITH HER. ONE THAT I
12 WOULD WANT HER TO TESTIFY TO IS THERE'S A TEST CALLED A
13 GUIAC, I BELIEVE IT'S SPELLED G-U-I-A-C.
14 THE COURT: G --
15 MS. BARLOW: G-U-I-A-C. AND WHAT THAT IS, IF A
16 NURSE THINKS THAT THERE MAY BE AN INTESTINAL PROBLEM; I.E.,
17 INTESTINAL BLEEDING, I BELIEVE IT IS, THEY WILL TAKE A
18 SAMPLE OF THAT FECES, PUT IT ON A -- ON THIS GUIAC TEST AND
19 THEN THEY WILL APPROACH THE DOCTOR AND ASK IF HE WILL ORDER
20 THIS TO BE TESTED. MISS SCHOLL WOULD TESTIFY, IF ALLOWED
21 TO, THAT SHE AT ONE POINT ASKED FOR -- TOOK A GUIAC SAMPLE
22 FROM A PATIENT. I DON'T THINK SHE CAN TESTIFY THAT IT WAS
23 SPECIFICALLY ONE OF THESE PATIENTS, BUT IT WAS ONE OF THE
24 PATIENTS DURING THE SAME TIME FRAME. AND THAT AFTER SHE
25 TOOK THE SAMPLE SHE APPROACHED DR. WEITZEL WITH -- I BELIEVE
1357
1 LEFT A NOTE FOR HIM ASKING FOR AN ORDER ALLOWING HER TO SEND
2 THAT SAMPLE TO BE TESTED. AND THE RESPONSE THAT SHE GOT
3 FROM DR. WEITZEL WAS, YOU KNOW, I THINK SHE ASKED WHAT
4 SHOULD I DO WITH THIS, AND THE RESPONSE SHE GOT -- AND I
5 CAN'T REMEMBER NOW IF IT WAS ORALLY OR IN WRITING -- WAS,
6 TAKE IT HOME AND EAT IT FOR SUPPER. AND I DIDN'T EVEN GET
7 INTO --
8 MR. STIRBA: YOUR HONOR, I'M GOING TO --
9 THE COURT: HOLD ON. IS THAT THE -- IS THERE
10 ANYTHING ELSE WITH THE PROFFER?
11 MS. BARLOW: YES. THE OTHER PROFFER WAS SHE WOULD
12 TESTIFY THAT ESPECIALLY DURING THE WINTER, DURING THE SKI
13 SEASON, DR. WEITZEL WOULD COME IN VERY EARLY IN THE MORNING,
14 ABOUT FIVE AND 5:30, WHICH WAS LONG BEFORE THE PATIENTS
15 AWOKE. WOULD ASK THE NURSES HOW ARE THEY DOING. WOULD
16 CHART WHAT THE NURSES SAID, AND THEN JUST LEAVE AND WOULD
17 NOT ACTUALLY SEE THE PATIENTS. AND THAT'S SOMETHING THAT WE
18 ATTEMPTED TO GET WITH SHEILA MOORE. AND RATHER THAN TRY TO
19 ARGUE IT IN FRONT OF THE JURY, I THOUGHT I WOULD MAKE THOSE
20 PROFFERS. AND THE PURPOSE OF THAT TESTIMONY IS TO SHOW THE
21 DEFENDANT'S STATE OF MIND, HIS CALLOUS DISREGARD FOR THESE
22 PEOPLE. THERE'S A POSSIBLE INTESTINAL BLEED AND WHAT HE
23 SAYS IS, WE'RE NOT GOING TO -- WE'RE NOT GOING TO TEST FOR
24 THAT. AND ALSO HIS DISREGARD FOR THESE PEOPLE. IT'S SKI
25 SEASON. HE'D COME IN WHEN THEY WEREN'T EVEN AWAKE. SO I AM
1358
1 PROFFERING THAT AND THEN -- AND IF THE COURT ALLOWS US TO
2 PUT IT IN, I WOULD ASK HER TO COME BACK THIS AFTERNOON AND
3 TESTIFY TO IT.
4 MR. STIRBA: WELL, IT'S BOTH IRRELEVANT AND
5 INADMISSIBLE. AND LET ME JUST SAY THIS TOO, JUDGE. WE GOT
6 A PACK FULL OF PEOPLE IN THE COURTROOM. IT'S AN OPEN
7 PROCEEDING. IF WE'RE GOING TO MAKE A PROFFER ON REAL ISSUES
8 OF EVIDENCE, I WOULD HOPE WE DO THAT. BUT JUST TO GO AHEAD
9 AND SAY BASICALLY IN A PUBLIC FORUM LIKE THIS ANY OLD THING
10 WHICH REALLY IN GOOD FAITH I THINK THOSE THINGS ARE CLEARLY
11 NOT GOING TO BE ADMISSIBLE AND CERTAINLY THE LATTER ISN'T
12 EVEN CASE IN CHIEF MATERIAL, IT SEEMS TO ME HIGHLY
13 INAPPROPRIATE. BECAUSE IF WE'RE GOING TO DO THAT, THEN WHAT
14 I'M GOING TO DO EVERY TIME THEY PUT ONE OF THEIR WITNESSES,
15 AND I KNOW THAT I HAVE, YOU KNOW, SOME REMOTE WEIRD ARGUMENT
16 ABOUT AN EVIDENCE WHICH I WILL NEVER BRING UP IN EXAMINATION
17 'CAUSE I THINK IT'S INAPPROPRIATE, I'M GOING TO MAKE MY
18 PROFFER. AND I JUST THINK IT'S INAPPROPRIATE. THOSE ARE
19 HIGHLY INFLAMMATORY COMMENTS ABOUT DR. WEITZEL WHICH,
20 CONSIDERING THE COURT'S RULINGS, I THINK IT'S CLEAR WOULD
21 NOT HAVE BEEN ADMITTED. AND I DON'T THINK THAT CLEARLY THEY
22 WERE APPROPRIATE FOR PROFFERS IN THIS CIRCUMSTANCE. SO I'LL
23 JUST SUBMIT IT ON THAT, JUDGE.
24 THE COURT: ANYTHING FURTHER?
25 MS. BARLOW: YOUR HONOR, THOSE ARE FACTS. THEY ARE
1359
1 NOT COMMENTS. I DIDN'T TRY TO GET THEM IN FRONT OF THE
2 JURY --
3 THE COURT: HERE'S ONE OF THE PROBLEMS THAT HAPPENS
4 WITH THIS: WE TOLD THE JURY NOT TO READ THE NEWSPAPER. WE
5 TOLD THE JURY NOT TO LISTEN TO THE NEWS. WHEN THE JURY IS
6 OUT AND EVERYONE IS HERE AND THE PRESS IS HERE, I MAKE
7 RULINGS. I SAY EVIDENCE IS IN. I SAY EVIDENCE IS OUT. BUT
8 THEN IT SHOWS UP IN THE PAPER. IT THEN SHOWS UP IN THE
9 NEWS. IT THEN IS ANOTHER PROBLEM THAT IF A JUROR DISREGARDS
10 MY RULING AND IS READING THE PAPER, YOU KNOW, THAT'S A
11 PROBLEM.
12 AS TO THE TEST WHERE YOU SAY IT'S ABOUT A PATIENT
13 DURING THE SAME TIME PERIOD BUT WASN'T ONE OF THESE
14 PATIENTS, I'M NOT GOING TO ALLOW THAT. AS TO THE OTHER
15 ISSUE AS TO WHEN HE CAME IN, THE ISSUE IS WHETHER HE KILLED
16 THESE PEOPLE. YOU KNOW, I'VE SAID THAT IF WE ARE TALKING
17 ABOUT WHAT MEDICATIONS HE'S DOING, THESE OTHER ITEMS, YOU
18 KNOW, WE CAN TALK ABOUT THAT. IF IT'S JUST HE COMES IN,
19 WHENEVER HE COMES IN, THAT IS NOT HELPFUL TO THE JURY AND
20 IT'S GOING TO BE CONFUSING AND GOES ON NEGLIGENCE ISSUE AS
21 OPPOSED TO THE FOUR ISSUES THAT YOU HAVE. AND SO THAT
22 YOU'VE MADE YOUR PROFFER, AND I'M NOT GOING TO ALLOW THE
23 EVIDENCE.
24 MS. BARLOW: OKAY, YOUR HONOR. THEN I JUST FOR THE
25 RECORD WANTED TO SAY THAT THE OTHER NURSES WOULD TESTIFY NOT
1360
1 NECESSARILY ABOUT THE SAMPLE, BUT ABOUT THE WINTER SKI
2 SEASON. I WILL PROFFER, BUT I WON'T --
3 THE COURT: I THINK A LOT OF THIS EVIDENCE CAN COME
4 IN IF YOU WANT TO HAVE THE EVIDENCE COME IN WHERE YOU SAY,
5 WHEN DID YOU TALK TO THE DOCTOR. IT WAS FIVE A.M. IT WAS
6 5:30. I DON'T HAVE ANY PROBLEM --
7 MS. BARLOW: IF THEY CAN REMEMBER.
8 THE COURT: -- IF THEY HAVE NOTED SOMETHING IN THE
9 RECORDS, MOST OF THESE CONVERSATIONS APPEAR TO BE REFLECTED
10 IN THE RECORDS. SO I MEAN, I'M NOT SAYING YOU CAN'T SAY
11 WHEN DID HE COME IN OR ANYTHING ELSE. I'M SAYING, TO SAY
12 THAT IN A BROAD SENSE, YOU KNOW, MAYBE -- AND I GUESS I'M
13 TRYING TO JUST KEEP THE CASE WHERE I THOUGHT IT IS. WE'RE
14 TALKING ABOUT THESE FIVE PATIENTS. WHAT, YOU KNOW, WHAT'S
15 HAPPENING TO THESE FIVE PATIENTS. OKAY.
16 MS. BARLOW: I JUST WANTED TO KNOW MY PARAMETERS,
17 YOUR HONOR.
18 THE COURT: THE OTHER THING THAT YOU CAN DO, YOU
19 CAN MAKE AN OFFER, YOU KNOW, OR PROFFER OR ASK THE WITNESS
20 TO STAY ON THE STAND AFTER THE JURY IS OUT AND MAKE A
21 PROFFER IF IT'S APPROPRIATE. I MEAN, IF IT'S THE SAME ONE,
22 I'M GOING TO HAVE THE SAME RESULT. I'M TRYING TO BE
23 CONSISTENT.
24 MS. BARLOW: IN FACT, YOUR HONOR, I WON'T MAKE THAT
25 PROFFER AFTER EVERY ONE. I WANTED ON THE RECORD THERE WOULD
1361
1 BE SIMILAR TESTIMONY WHICH I WON'T TRY TO GET INTO.
2 THE COURT: ARE WE PREPARED TO GO ON DR. CROOKSTON
3 AND NURSE KAUFMAN?
4 MS. BARLOW: IF WE COULD HAVE A FEW MINUTES.
5 THE COURT: WHY DON'T WE COME BACK LET'S SAY AT 25
6 AFTER.
7 (WHEREUPON, COURT WAS IN RECESS.)
8 THE COURT: DID WE SAY 12:25. WE'RE HERE TO
9 DISCUSS THE OTHER PARTS OF THE MOTION THAT WE DISCUSSED
10 YESTERDAY, DR. FEHLAUER AS AN EXPERT AND NOW THERE ARE TWO
11 OTHER ONES THAT WERE THE SUBJECT OF BOTH THE MEMOS THAT BOTH
12 SIDES SUBMITTED. AND ONE WAS FOR DR. MICHAEL J. CROOKSTON
13 AND THE OTHER WAS NURSE KATHLEEN M. KAUFMAN. SO I BELIEVE
14 YOU, MR. STIRBA, THESE ARE YOURS.
15 MR. STIRBA: YES, THEY ARE.
16 THE COURT: SO YOU GO FIRST AND THEN THE STATE.
17 MR. STIRBA: DR. CROOKSTON IS A PSYCHIATRIST AND
18 THE PROBLEM THAT WE HAVE IS PERHAPS IT'S THE SCOPE OF HIS
19 REPORT. I THINK TWO THINGS ARE FAIRLY EASY FOR THE COURT.
20 HE DOES THAT IN THAT REPORT REFERENCE SOME THINGS, OTHER
21 MATTERS, THAT HE'S BEEN INVOLVED WITH AS AN EXPERT WITNESS
22 THAT THE COURT HAS ALREADY ADDRESSED AND I DON'T THINK WE'RE
23 GOING TO GET INTO THAT. THAT'S ONE PROBLEM.
24 THE SECOND PROBLEM, HE MAKES AN OPINION AS TO HE KNOWS
25 WHY THE USE OR CHOICE OF MORPHINE IN THE SITUATIONS
1362
1 INVOLVING THIS CASE. I DON'T THINK HE HAS ANY PARTICULAR
2 EXPERTISE IN COMING UP WITH THAT OPINION. BUT I DON'T KNOW
3 WHETHER THAT'S EVEN GOING TO BE PART OF IT, BUT THE REAL
4 PROBLEM IS AS A PSYCHIATRIST HE IS REPORTING -- HE STARTS
5 WITH THE VERY FIRST DAY AND THE VERY FIRST PRESCRIPTION FOR
6 PSYCHOTROPIC MEDICATIONS WITH EACH PATIENT AND THEN PROCEEDS
7 TO CRITIQUE EACH AND EVERY PRESCRIPTION, EACH AND EVERY
8 PSYCH MEDICATION AND COMES UP WITH CERTAIN OPINIONS ABOUT
9 THEIR PROPRIETY ON THEIR DOSAGE LEVEL OR WHAT HAVE YOU. AND
10 THE REAL PROBLEM WITH THAT IS, JUDGE, IS THAT I'M NOT TRYING
11 TO BE INCONSISTENT WITH WHAT WE TALKED ABOUT, BUT THERE
12 REALISTICALLY IS NO MEDICAL NEXUS BETWEEN, FOR EXAMPLE, WHAT
13 MIGHT BE PRESCRIBED ON DAY ONE AND WHAT MIGHT BE PRESCRIBED
14 30 DAYS LATER OR 25 DAYS LATER, 20 DAYS LATER. BECAUSE, YOU
15 KNOW, ONE THING AS I AM SURE THE COURT CAN APPRECIATE, ALL
16 THESE DRUGS HAVE HALF-LIVES. I MEAN, IT'S NOT LIKE YOU GET
17 SERZONE OR YOU GET RISPERDAL OR YOU GET HALDOL AND FOR THE
18 REST OF YOUR LIFE YOU ARE UNDER THE INFLUENCE OF HALDOL OR
19 RISPERDAL OR SERZONE. THEY HAVE HALF-LIVES. AS QUICKLY AS
20 THEY MAY AFFECT THE BODY, THEY ARE AT THE SAME TIME
21 DEGRADING. AND SO IT SEEMS TO ME ALMOST IRRATIONAL TO THINK
22 THAT SOMEHOW WHAT HAPPENS ON DAY ONE IS PROBATIVE OF THE
23 EFFECT THAT MORPHINE MAY HAVE ON DAY 30 BECAUSE THERE WOULD
24 BE NO PHYSIOLOGICAL BASIS FOR THE INTERACTION OF THOSE
25 DRUGS. AND THAT'S OUR PROBLEM IN TERMS OF CRITIQUING EVERY
1363
1 SINGLE PRESCRIPTION. REALLY WHAT WE'RE TALKING ABOUT IN THE
2 FIVE PATIENTS, WE'RE TALKING ABOUT -- OBVIOUSLY YOU'VE
3 ALREADY HEARD THE TESTIMONY -- IT'S INDIVIDUALIZED
4 TREATMENT. THERE IS NO QUESTION ABOUT THAT. AND YOU HAVE
5 AN INDIVIDUAL CLINICAL JUDGMENT ABOUT THE PROPRIETY OF
6 CERTAIN MEDICATIONS. AND WE'RE GOING TO BE IN THAT SAME
7 SITUATION IF A PSYCHIATRIST IS GOING TO COME IN HERE AND
8 CRITIQUE FROM A PSYCHOTROPIC PERSPECTIVE EACH AND EVERY ACT
9 THAT DR. WEITZEL DID IN PRESCRIBING THE PSYCH MEDS. AND THE
10 OTHER THING IS I JUST POINT OUT TO THE COURT, YOU KNOW, THIS
11 CASE, I MEAN, IT'S SOMEWHAT -- IT'S SOMEWHAT ANOMALOUS TO ME
12 THAT WHEN WE KNOW WE HAVE PEOPLE GOING TO A PSYCH UNIT AND
13 WE KNOW BY THE TESTIMONY THEY HAVE ALL BEEN ON PSYCH MEDS,
14 THAT WE THEN ARE GOING TO START CRITIQUING AND CRITICIZING A
15 PSYCHIATRIST FOR PRESCRIBING IN SOME INSTANCES THE VERY SAME
16 PSYCH MEDS WHEN THEY GET TO THE HOSPITAL. AND THAT'S REALLY
17 WHAT THIS DR. CROOKSTON WANTS TO DO. AND I WOULD SUGGEST
18 THAT IT REALLY IS 403 MATERIAL. IT'S ALSO IRRELEVANT. I
19 THINK WHAT THEY HAVE TO PROVE IS THEY HAVE TO PROVE THE
20 DIRECT NEXUS BETWEEN, FOR EXAMPLE, LET'S TAKE MISS LARSEN,
21 IF SHE GETS RISPERDAL ON THE 6TH OF DECEMBER. WE'RE NOT
22 TALKING IN ONE OF THESE INSTANCES, EVEN WITH DR. CROOKSTON,
23 NOBODY IS SAYING THAT THE ROUTINE DOSE WOULD BE
24 50 MILLIGRAMS AND DR. WEITZEL PRESCRIBED 3000 MILLIGRAMS.
25 THAT ISN'T THIS CASE. THAT'S BEEN PART OF THE PROBLEM.
1364
1 IT'S LIKE WITH MORPHINE. NOBODY IS SAYING THAT THE MORPHINE
2 WAS -- IT SHOULD HAVE BEEN TWO MILLIGRAMS OR FIVE MILLIGRAMS
3 OR MAYBE EVEN TEN MILLIGRAMS. I'LL TELL YOU WHAT THE
4 TESTIMONY WAS BY DR. HARE. 2.5. AND 10 MILLIGRAMS. A
5 THERAPEUTIC DOSE. NOBODY IS SAYING DR. WEITZEL GAVE 5000
6 MILLIGRAMS OF MORPHINE. SO IT'S NOT LIKE IT'S ALL THAT
7 SELF-EVIDENT. SO IF -- SO IN THE PSYCHIATRIC WORLD -- AND
8 WHEN YOU HAVE DR. CROOKSTON COME IN HE'S GOING TO SAY, YOU
9 KNOW, THAT RISPERDAL, I WOULD HAVE STARTED 75 MILLIGRAMS AND
10 LET'S SAY HE STARTED AT 25 OR 50. THAT'S KIND OF WHAT HE'S
11 GOING TO DO. HE'LL SAY THAT'S A LITTLE BIT HIGH OR THAT'S A
12 LITTLE PROBLEMATIC. THAT TO ME IS MALPRACTICE FODDER, IF
13 YOU WANTED TO GIVE IT THAT KIND OF INTEGRITY, THAN IT IS A
14 CRIMINAL EVENT.
15 IT'S SORT OF LIKE WHEN DR. DIENHART SAYS, I AGREE WITH
16 THE MICRON DURAGESIC PATCH. HE AGREES WITH THE VERY THING
17 THAT THIS DOCTOR DID AND A FEW DAYS LATER HE SAYS, WELL, I
18 LOOKED AT HER. I THOUGHT SHE WAS TOO SEDATED SO I DECREASED
19 IT DOWN TO 25 MICRONS. FINE, YOU HAVE A DIFFERENCE BETWEEN
20 A PSYCHIATRIST AND THE INTERNAL MEDICINE GUY AS TO WHETHER
21 IT SHOULD BE 25 OR 50. BUT THERE REALLY ISN'T A FUNDAMENTAL
22 DIFFERENCE AS TO THE EFFICACY OF THE PATCH OR NEED FOR THE
23 PATCH OR USEFULNESS OF THE PATCH. THAT'S WHAT DR. CROOKSTON
24 IS GOING TO SAY. AND THAT'S PART OF THE PROBLEM IN THIS
25 CASE. IT IS SUBTLE. THESE DISTINCTIONS ARE NOT
1365
1 SELF-EVIDENT. IT'S NOT OUTRAGEOUS CONDUCT.
2 AND SO WHEN YOU HAVE SOMEBODY COME IN AND WANT TO SAY,
3 WELL, YOU KNOW, I THINK -- I THINK 150 -- AND IN FACT, IT'S
4 ALSO INTERESTING, JUDGE. I WILL TELL YOU THE TESTIMONY OF
5 SOME OF THE VERY TREATING PHYSICIANS ABOUT CERTAIN LEVELS OF
6 WHAT THEY PRESCRIBED FOR THE PATIENTS IS IN SOME INSTANCES
7 LESS THAN WHAT HE PRESCRIBED AND, YOU KNOW, YOU GET INTO
8 THIS WORLD OF JUDGMENT REALLY INTO WHETHER YOU SHOULD DO 50
9 OR 25 OR YOU SHOULD DO 100 OR 150. THAT'S ALL YOU ARE
10 TALKING ABOUT. AND THAT TO ME IS NOT THE KIND OF THING THAT
11 THE JURY NEEDS TO HEAR.
12 ARE WE JUST GOING TO GET INTO THAT CLOUDED ISSUE OF
13 WHAT IS CRIMINAL CONDUCT VERSUS WHAT IS ARGUABLE MEDICAL
14 MALPRACTICE KIND OF CONDUCT? AND THAT'S REALLY MY PROBLEM
15 WITH DR. CROOKSTON.
16 THE COURT: I WOULD LIKE TO ADDRESS EACH ONE OF
17 THESE SEPARATELY, SO WHY DON'T YOU GO AHEAD.
18 MS. BARLOW: YOUR HONOR, THANK YOU. AS TO MATERIAL
19 THAT DR. CROOKSTON PUT IN HIS OPINION LETTER THAT THE COURT
20 HAS RULED IS INADMISSIBLE, CERTAINLY WE'RE NOT GOING TO
21 BRING ANY OF THAT OUT. THERE'S NO QUESTION OF THAT.
22 THE COURT: ON THAT ISSUE, I MEAN, HE -- THOUGH
23 EXPERTS CAN RELY ON THINGS THAT ARE INADMISSIBLE.
24 MS. BARLOW: WE'RE NOT GOING TO. NO. WE
25 UNDERSTAND THE COURT'S RULING --
1366
1 THE COURT: AND DO YOU INTEND TO ASK DR. CROOKSTON
2 WHY DR. WEITZEL CHOSE MORPHINE IN PARTICULAR?
3 MS. BARLOW: NO.
4 THE COURT: THEN ADDRESS THE OTHER ISSUES THEN
5 REGARDING --
6 MS. BARLOW: I'M -- WHAT I'VE HEARD TODAY IS THERE
7 IS NO MEDICAL NEXUS BETWEEN THE FIRST DOSE AND THE LAST DOSE
8 AND THAT'S EXACTLY WHAT AN EXPERT WILL TESTIFY THAT
9 THERE'S --
10 THE COURT: JUST TELL ME THIS. I MEAN, CONSISTENT
11 WITH WHAT I'VE TALKED ABOUT YESTERDAY WITH THE OTHER EXPERT,
12 IS THIS DOCTOR GOING TO TESTIFY THAT, OKAY, THE DIFFERENT
13 DRUGS THAT WERE GIVEN UPON ADMISSION TO THESE PATIENTS
14 BASICALLY PUT THEM IN A COMPROMISED HEALTH SITUATION.
15 MS. BARLOW: YES.
16 THE COURT: THEN WHEN MORPHINE WAS GIVEN --
17 MS. BARLOW: I BELIEVE THAT IS, YEAH. THAT'S --
18 THE COURT: SO -- I MEAN, IN THE BROAD SCOPE I'VE
19 ALREADY SAID THAT THAT'S AVAILABLE. IF DR. CROOKSTON GETS
20 UP AND HE STARTS SAYING, WELL, I WOULDN'T HAVE DONE THIS OR
21 I WOULDN'T HAVE GIVEN THIS ONE OR GIVEN THAT ONE AS OPPOSED
22 TO GIVING THIS SORT OF PRESCRIPTION FOR MEDICATION UPON
23 ADMISSION HAD THIS EFFECT ON THIS PATIENT AND WHEN THAT
24 PATIENT WAS IN THAT CONDITION GIVING MORPHINE, YOU KNOW,
25 WHATEVER IT DID. IS THAT --
1367
1 MS. BARLOW: HE'S NOT GOING TO SAY, WELL, HE
2 WOULDN'T HAVE DONE THIS. I MEAN, THAT'S NOT WHAT AN EXPERT
3 IS THERE FOR. AN EXPERT -- I MEAN, AS MR. STIRBA SAID, IT'S
4 NOT SELF-EVIDENT WHAT THESE DRUGS DO TO A JURY, TO A LAY
5 PERSON. SO THE EXPERT WILL BE HERE TO TESTIFY WHAT THESE
6 DRUGS DO AND HOW THEY ACT IN CONJUNCTION. AND I THINK AS A
7 PSYCHIATRIST, DR. CROOKSTON CAN TESTIFY THAT IN THE
8 PSYCHIATRIC FIELD, YOU KNOW, WHAT USE IS MORPHINE AND THERE
9 MAY BE A USE AND IF SO THEN HE CAN TESTIFY IN THE
10 PSYCHIATRIC FIELD AND IN THE NORMAL COURSE OF THINGS THIS IS
11 WHAT YOU WOULD USE MORPHINE FOR IN THE PSYCHIATRIC FIELD.
12 OR HE CAN TESTIFY MORPHINE ISN'T USED FOR AGITATION BECAUSE
13 IN THE PSYCHIATRIC FIELD YOU DON'T DO THAT. YOU GO TO THE
14 ATIVAN OR THE HALDOL OR WHATEVER. SO I THINK WHAT HE HAS TO
15 SAY IS HIGHLY RELEVANT. AS I SAID, THE EXPERT TESTIFIES AS
16 TO THIS INFORMATION, BUT IT'S FOR THE JURY TO DECIDE. AND
17 WE ALL RECOGNIZE. WE ALL KNOW THAT IT'S FOR THE JURY TO
18 DECIDE, OKAY, HE TOLD ME THAT THESE DRUGS WILL DO THIS
19 THING, THESE THINGS. AND THEY WILL DO IT IN THIS
20 CONJUNCTION AND THIS IS WHAT THEIR HALF-LIFE IS OR WHATEVER
21 AND THEN THE DEFENDANT'S EXPERT CAME IN AND SAID WELL, NO,
22 THEY DO THIS OTHER THING. AND THAT'S WHAT JURIES DO. THEY
23 WEIGH IT AND THEY SAY, YOU KNOW, EITHER I DON'T UNDERSTAND
24 IT AND THROW IT ALL OUT OR THEY SAY, YOU KNOW, I BELIEVE
25 THIS BUT I DON'T BELIEVE THAT. THAT'S WHAT JURIES DO AND SO
1368
1 WE WOULD ASK THAT HE BE ALLOWED TO TESTIFY.
2 THE COURT: ALL RIGHT. ANYTHING FURTHER,
3 MR. STIRBA?
4 MR. STIRBA: NO, YOUR HONOR. I THINK I'VE COVERED
5 IT, AND I REALIZE IT'S DIFFICULT AND IN A VACUUM.
6 THE COURT: WHAT I'M GOING TO SAY REGARDING
7 DR. CROOKSTON, I MEAN, YOU ARE ASKING ME TO GIVE KIND OF AN
8 ADVISORY OPINION BEFORE WE HAVE A QUESTION WORDED, BUT I
9 THINK IT'S HELPFUL BECAUSE YOU NEED TO KNOW THE DIRECTION
10 WE'RE GOING. AND CONSISTENT WITH WHAT I SAID YESTERDAY, YOU
11 KNOW, WITNESSES, EXPERT WITNESSES CAN TESTIFY REGARDING, YOU
12 KNOW, WHAT MEDICATION WAS GIVEN, WHAT EFFECT THAT HAD ON
13 PEOPLE AND IF ALL THESE THINGS TAKEN TOGETHER CAUSE THE
14 DEATH, AND THE DOCTOR IN THAT POSITION WOULD KNOW THAT.
15 THEN THAT'S GOING TO BE ALLOWED. IF IT GETS INTO A
16 SITUATION WHERE WE HAVE A DOCTOR ON THE STAND WHO SAYS,
17 WELL, I DON'T THINK THAT'S BELOW THE STANDARD OF CARE OR I
18 WOULDN'T HAVE DONE THAT PERSONALLY AND THERE'S OBJECTION,
19 I'LL PROBABLY SUSTAIN IT. SO THAT WILL TAKE CARE OF
20 DR. CROOKSTON IN THE ABSENCE OF HIM BEING ON THE STAND AND
21 KNOWING QUESTIONS ARE GOING TO BE ASKED OR WHAT RESPONSES
22 HE'S GOING TO GIVE.
23 LET'S GO THEN TO THE THIRD WITNESS THAT WAS ON THIS
24 MOTION AND THAT IS NURSE KAUFMAN.
25 MR. STIRBA: YES, YOUR HONOR. AND I GOT HER REPORT
1369
1 AND ONCE AGAIN -- AND I DON'T HAVE IT UNFORTUNATELY RIGHT IN
2 FRONT OF ME. BUT THERE WERE TWO PROBLEMS WITH HER REPORT.
3 IT WAS RELATIVELY SHORT. BUT SHE CLEARLY MADE MEDICAL
4 OPINIONS WHICH A NURSE CANNOT DO. THEY ARE NOT QUALIFIED TO
5 DO THAT. AND I'M SORRY I DON'T HAVE IT RIGHT IN FRONT OF ME
6 BUT SHE COMMENTED ABOUT --
7 THE COURT: WELL, THE QUOTE IN YOUR MEMO SAYS NURSE
8 KAUFMAN OPINES THAT THERE SEEMS TO BE A LACK OF DOCUMENTED
9 EVIDENCE WHICH WOULD NORMALLY BE REQUIRED BY AN M.D. TO
10 TITRATE AND PARTICULARLY TO INCREASE NARCOTIC DOSAGES BASED
11 ON PATIENT CONDITION. AND LATER SHE RENDERED A DIAGNOSIS OF
12 SUCH MEDICAL CONDITIONS AS POOR OXYGENATION AND EMOTIONAL
13 DISTRESS.
14 MR. STIRBA: AND THAT'S IT. I THINK THOSE ARE
15 RESERVED --
16 THE COURT: THEN THERE WAS THE LAST ONE THAT SHE
17 HAD -- SHE HAS NO PERSONAL KNOWLEDGE OF WHETHER ORDERS WERE
18 INTIMIDATING TO THE NURSING STAFF.
19 MR. STIRBA: LET ME ADDRESS THAT ONE. SHE IS
20 BASICALLY TAKING THE MEDICAL RECORDS AND SHE IS
21 CHARACTERIZING THEM AND SAYING THAT THE NURSES WOULD HAVE
22 BEEN INTIMIDATED. AND JUDGE, RESPECTFULLY, I THINK WE HAVE
23 ALL THE NURSES WHO CAN TESTIFY. THEY ARE FACT WITNESSES.
24 THEY WERE THERE AND THEY CAN TESTIFY IF THAT WAS RELEVANT TO
25 THE IMPACT OF WHAT THEY DID. BUT I DON'T THINK WE NEED AN
1370
1 EXPERT WITNESS TO COME IN, LOOK AT THESE RECORDS AND THEN
2 KIND OF CHARACTERIZE WHAT THEY MEAN. THAT'S WHAT SHE HAS
3 DONE IN THAT INSTANCE. BUT I'M CONCERNED ALSO ABOUT HER
4 RENDERING MEDICAL OPINIONS WHICH ARE BEYOND THE SCOPE OF HER
5 LICENSE. SHE'S A NURSE AND NURSES CAN'T RENDER MEDICAL
6 OPINIONS.
7 MS. BARLOW: YOUR HONOR, SHE'S NOT RENDERING AN
8 OPINION AS A PHYSICIAN. SHE'S RENDERING AN OPINION AS A
9 NURSE, AND NURSES CAN MAKE CERTAIN MEDICAL OPINIONS OR
10 OBSERVATIONS, I GUESS.
11 THE COURT: WELL, TELL ME WHAT SHE IS GOING TO
12 GIVE, WHAT HER OPINIONS ARE GOING TO BE.
13 MS. BARLOW: I'M NOT SURE I CAN GIVE YOU THE
14 EXACT --
15 THE COURT: IS SHE GOING TO GIVE AN OPINION THAT
16 SAYS THERE SEEMS TO BE A LACK OF DOCUMENTED EVIDENCE WHICH
17 WOULD NORMALLY BE REQUIRED BY AN M.D. TO TITRATE AND
18 PARTICULARLY TO INCREASE NARCOTIC DOSAGES BASED ON PATIENT
19 CONDITION?
20 MS. BARLOW: I THINK WHAT SHE WILL TESTIFY TO IS
21 THAT, YOU KNOW, TAKEN OUT OF CONTEXT IT GETS A LITTLE HAZY
22 HERE, BUT THE CHARTING DOESN'T SHOW THE TITRATION THAT YOU
23 WOULD SEE IN A MEDICAL CHART. I MEAN, WE HAD MISS SCHOLL
24 TESTIFY THIS MORNING WHAT TITRATION MEANS. YOU START LOW
25 AND THEN -- AND THERE SEEMS TO BE A LACK OF THAT. AND IT'S
1371
1 MORE LOOKING AT WHAT IS IN THE DOCUMENTARY EVIDENCE THAT
2 SHE'S TALKING ABOUT HERE. SHE'S NOT SAYING WHAT -- GIVING A
3 MEDICAL DIAGNOSIS. SHE'S TALKING ABOUT WHAT IS LACKING IN
4 THE DOCUMENTS.
5 THE COURT: BUT ISN'T WHAT IS LACKING WHAT THE
6 DOCTOR DID OR DIDN'T DO?
7 MS. BARLOW: CAN BE.
8 THE COURT: OKAY THEN. WHY ISN'T THAT COMMENTING
9 UPON WHAT A DOCTOR'S DOING?
10 MS. BARLOW: WELL --
11 THE COURT: SHE'S MAKING A CRITICISM OF WHAT THE
12 DOCTOR DID, ISN'T SHE?
13 MS. BARLOW: AND TO THE EXTENT THAT SHE CAN AS A
14 NURSE AND SAY THAT IN THE FIELD OF NURSING, THIS IS WHAT
15 DOCTORS DO, THIS IS HOW DOCTORS TELL NURSES TO ACT, AND IT'S
16 NOT HERE. AND THAT IS, YOU KNOW, THAT IS FACT THAT GOES TO
17 THE DEFENDANT'S STATE OF MIND THAT IS RELEVANT IN THIS
18 PROCEEDING.
19 THE COURT: WELL, HOW DOES SHE, LOOKING AT RECORDS,
20 SAY WHAT'S RELEVANT IN THE DEFENDANT'S MIND BY WHAT IS OR IS
21 NOT IN THE RECORD?
22 MS. BARLOW: SHE WON'T BE SAYING WHAT'S RELEVANT.
23 I ADD THAT. SHE'LL JUST BE SAYING WHAT'S IN THE DOCUMENT.
24 THAT IN HER EXPERIENCE, MANY YEARS EXPERIENCE AS A NURSE,
25 THESE KINDS OF THINGS HAVE TO BE THERE FOR A NURSE TO ACT.
1372
1 AND THEY ARE LACKING HERE. AND THEN OUR ARGUMENT WILL BE
2 THE FACT THAT THEY ARE LACKING. NOT THAT SHE WILL TESTIFY
3 TO, BUT OUR ARGUMENT TO THE JURY, AND THEM OF COURSE MAKING
4 THE ULTIMATE CONCLUSION. SO THAT SHOWS HIS MENTAL STATE.
5 SHE WON'T TESTIFY TO THAT.
6 THE COURT: OKAY. WHAT ABOUT IS SHE GOING TO
7 TESTIFY REGARDING --
8 MS. BARLOW: MEDICAL CONDITIONS.
9 THE COURT: WELL, YEAH, MEDICAL CONDITIONS SUCH AS
10 POOR OXYGENATION AND EMOTIONAL DISCRETION?
11 MS. BARLOW: I THINK SHE CAN TESTIFY THAT BASED ON
12 HER EXPERIENCE AS A NURSE, SHE IS NOT DIAGNOSING POOR
13 OXYGENATION. SHE WAS LOOKING AT THE CHART AND SAYING THIS
14 WAS UNDER 90 PERCENT OXYGEN 02 SAT LEVEL AND THAT'S POOR
15 OXYGENATION. AND NURSES DO THAT. WE TALKED ABOUT --
16 THE COURT: HOW MANY NURSES ARE WE GOING TO HAVE
17 TESTIFY? NOT EXPERTS, BUT ARE WE GOING TO HAVE LIKE A
18 FLOCK -- YOU LISTED LIKE EIGHT OR TEN.
19 MS. BARLOW: WE AREN'T HAVING ALL OF THEM --
20 THE COURT: BUT WE'VE ONLY REALLY TALKED TO ONE --
21 MS. BARLOW: WE'VE TALKED --
22 THE COURT: SHEILA MOORE WAS BEFORE THE TIME. AND
23 TRACY SCHOLL.
24 MS. BARLOW: I THINK IT'S SIX, YOUR HONOR.
25 THE COURT: SO WE'RE GOING TO HAVE SIX NURSES AND
1373
1 THOSE SIX NURSES ARE GOING TO COME IN AND AREN'T THEY GOING
2 TO SAY WHAT THEY DID AND WHETHER THERE WAS EVIDENCE OF THIS
3 TITRATING OR INCREASING THE DOSAGE? AREN'T THEY GOING TO BE
4 ABLE TO COMMENT ABOUT THAT IN THE RECORD ABOUT THAT?
5 MS. BARLOW: WELL, THEY WON'T BE ABLE TO COMMENT
6 ABOUT THAT. THEY WILL BE ABLE TO TESTIFY AS TO WHAT
7 HAPPENED. BUT WE NEED AN EXPERT TO COME IN AND SAY IN THE
8 REALM OF NURSING, YOU KNOW, THIS ISN'T THE WAY DOCTORS DO.
9 THIS WAY DOESN'T HELP THE NURSES.
10 THE COURT: WELL, HOW IS THAT RELEVANT TO WHETHER
11 THE DEFENDANT COMMITTED MURDER?
12 MS. BARLOW: IT'S RELEVANT AS TO HIS STATE OF MIND.
13 THE COURT: WELL, YOU KNOW, JUST TAKE ME THROUGH
14 THAT PATH BECAUSE I DON'T SEE --
15 MS. BARLOW: WE HAVE CONDUCT ITSELF RELEVANT TO,
16 YOU KNOW, I THINK YOU GOT A FLAVOR WITH MISS SCHOLL A LITTLE
17 BIT ABOUT, YOU KNOW, THE NURSES HAVE AN OBLIGATION NOT TO DO
18 ANY HARM. OKAY. NOW --
19 THE COURT: AND SHE GAVE AN EXAMPLE OF WHERE SHE
20 SAW LOW RESPIRATION AND CHOSE NOT TO GIVE THE SHOT.
21 MS. BARLOW: RIGHT. THEN SHE TESTIFIED AS TO HOW
22 THE DEFENDANT REACTED TO THAT, AND WE PUT THAT IN BECAUSE
23 THAT'S RELEVANT TO THE STATE OF MIND. SHE WILL -- I START
24 LOSING MY TRAIN OF THOUGHT.
25 THE COURT: I'M TRYING TO ASK, JUST GET ME FROM
1374
1 WHAT NURSES DO, WHAT THESE NURSES DO AND IF IT'S NOT IN THE
2 RECORD HOW NURSES CAN DO WHAT THEY ARE SUPPOSED TO DO THEN
3 IS RELEVANT TO THIS DEFENDANT COMMITTING MURDER.
4 MS. BARLOW: WELL, THE WAY IT'S RELEVANT, YOUR
5 HONOR, IS BECAUSE YOU HAVE THE DOCUMENTS SHOW WHAT THE
6 NURSES DID AND WHAT THE DOCTOR DID AND --
7 THE COURT: AND ALL THE THOSE DOCUMENTS ARE IN
8 EVIDENCE. THE JURY WILL HAVE THEM. YOU'LL BE ABLE TO ARGUE
9 AND SAY, THIS DOCUMENT SHOWS THIS. THIS DOCUMENT SHOWS
10 THAT. THIS DOCUMENT SHOWS THIS.
11 MS. BARLOW: BUT -- SO THOSE ARE THE FACTS. THOSE
12 ARE THE FACTS FOR THE FACT PART OF CHARGING HOMICIDE. BUT
13 THERE IS IN ADDITION TO THE FACT PART OF CHARGING
14 HOMICIDE -- FACT IS NOT A GOOD -- I'M TRYING TO THINK OF THE
15 WORD. YOU'VE GOT MENS REA AND THEN YOU'VE GOT THE ACTUS
16 REUS, SO THAT'S THE ACTUS REUS.
17 THE COURT: YOU ARE BEING LIKE A DOCTOR. YOU TELL
18 WHAT THAT MEANS.
19 MS. BARLOW: WELL, THE ACT -- I'M TRYING TO DREDGE
20 UP MY LAW SCHOOL. OF THE ACTS THEMSELVES, THAT'S -- THOSE
21 ARE PART OF THE ELEMENTS, THAT OF CAUSING THE DEATH. BUT IN
22 ADDITION TO THE ACT, IN THE CONJUNCTION WITH THE ACT YOU
23 HAVE TO HAVE THE CULPABLE MENTAL STATE. AND WHAT SHE WILL
24 TESTIFY TO WILL HELP THE JURY TO LOOK AT THIS AND SAY, YOU
25 KNOW, HE DOES HAVE THE CULPABLE MENTAL STATE, HE IS --
1375
1 THE COURT: BY SAYING THAT HE HAS A CULPABLE MENTAL
2 STATE AND HAVING A NURSE GIVE AN OPINION AS TO WHAT THE
3 DOCTOR DID OR DIDN'T DO, WHEN SHE IS NOT A DOCTOR, HOW IS
4 THAT HELPFUL TO A JURY? I MEAN, AN EXPERT WITNESS IS
5 BECAUSE OF THEIR BACKGROUND, TRAINING AND EXPERIENCE CAN
6 COMMENT ON CERTAIN THINGS. WE LET THEM COMMENT ON CERTAIN
7 THINGS. SHE IS BASICALLY COMMENTING ON THE DOCTOR'S
8 BEHAVIOR.
9 MS. BARLOW: TO THE EXTENT THAT SHE AS AN EXPERT
10 WITNESS CAN DO SO. SHE IS NOT TALKING AS A MEDICAL DOCTOR.
11 THE COURT: WELL, RULE 702 OF UTAH RULES OF
12 EVIDENCE STATES THAT SCIENTIFIC, TECHNICAL OR OTHER
13 SPECIALIZED KNOWLEDGE WILL ASSIST THE TRYER OF FACT TO
14 UNDERSTAND THE EVIDENCE OR TO DETERMINE THE FACT IN ISSUE,
15 THEN THEY CAN TESTIFY. AND SO WHAT I'M TRYING TO SAY IS,
16 HOW IS THIS GOING TO ASSIST THE JURY OR HELP TO DETERMINE A
17 FACT THAT'S IN ISSUE WHERE SHE'S COMMENTING. AND I GUESS
18 THE PROBLEM I HAVE IS, YOU KNOW, DO YOU HAVE A DOCTOR OR ONE
19 OF THESE PSYCHIATRISTS OR SOMEBODY ELSE THAT'S GOING TO
20 COMMENT ABOUT THIS ISSUE --
21 MS. BARLOW: WELL --
22 THE COURT: -- ABOUT --
23 MS. BARLOW: -- THEY WILL TESTIFY IN RELATIONSHIP
24 TO AS A PSYCHIATRIST, AS A GERIATRICIAN WHICH IS WHAT
25 DR. FEHLAUER IS.
1376
1 THE COURT: ISN'T YOUR PSYCHIATRIST, DR. CROOKSTON,
2 GOING TO COME IN AND SAY, OKAY, DR. WEITZEL GAVE THE FIRST
3 PATIENT THIS DRUG. THIS WAS THE EFFECT OF THIS DRUG AND HOW
4 HE MODERATED IT OR TITRATED IT OR WHATEVER HE DID TO PUT IT
5 UP OR DOWN OR WHATEVER. THEN HE'S GOING TO EXPLAIN THAT AND
6 THEN ISN'T HE GOING TO SAY, YOU KNOW, TALK ABOUT THESE SAME
7 ISSUES?
8 MS. BARLOW: WELL --
9 THE COURT: HE'S A PSYCHIATRIST TALKING ABOUT A
10 PSYCHIATRIST.
11 MS. BARLOW: HE WILL TALK ABOUT THAT. THE NURSES,
12 THE NURSE EXPERT IS GOING TO TESTIFY. NOW, WE'VE HEARD THE
13 TALK ABOUT THE TEAM APPROACH. AND THAT'S WHAT SHE'S GOING
14 TO TALK ABOUT MORE THAN JUST, YOU KNOW, EITHER THE TITRATION
15 OR WHATEVER. SHE IS GOING TO TALK ABOUT THE CIRCUMSTANCES
16 THAT THESE NURSES WERE IN. AND --
17 THE COURT: LET ME HOLD YOU RIGHT THERE. WHO IS
18 THE BEST PERSON? YOU KNOW, LIKE -- I GUESS IT'S LIKE, YOU
19 KNOW, WATCHING A PLAY OR SOMETHING. YOU HAVE THE ACTORS IN
20 THE PLAY WHICH COULD BE ANALOGIZED TO WITNESSES. ARE THERE
21 THE WITNESSES THAT SAW IT. THE WITNESSES ARE GOING TO SAY,
22 YOU KNOW, WHAT THEY FELT, HOW THEY WERE. WHETHER OR NOT
23 THERE WERE PROBLEMS. WHETHER OR NOT THEY FELT INTIMIDATED
24 BECAUSE OF OTHER THINGS THAT HAVE HAPPENED AND WHY THEY
25 DIDN'T OR NOT APPROACH THE DOCTOR REGARDING GIVING THESE
1377
1 SHOTS OR THESE MEDICATIONS.
2 NOW, IF WE HAVE SIX OR SEVEN OF THEM ALL SAYING THAT,
3 WHY DOES THE JURY NEED AN EXPERT TO COME IN AND SAY, I'VE
4 REVIEWED THE NOTES AND, BOY, THIS WAS INTIMIDATING. WHERE
5 SHE, YOU KNOW -- THAT'S EXACTLY WHAT THE JURY CAN DO. WHY
6 IS THAT -- WHY IS THAT HELPFUL TO THE JURY TO HAVE AN EXPERT
7 TELL THEM THAT IT WAS INTIMIDATING WHEN YOU'VE GOT SIX
8 WITNESSES THAT HAVE ALL TESTIFIED AND THEN LET THE JURY FORM
9 THEIR CONCLUSION FROM WHAT THE EVIDENCE WAS BY ACTUAL
10 WITNESSES THAT HAVE KNOWLEDGE?
11 MS. BARLOW: WELL, BECAUSE THE ARGUMENT OF THE
12 DEFENDANT'S GOING TO BE THEY SHOULDN'T HAVE BEEN
13 INTIMIDATED. THEY HAVE THIS OBLIGATION TO DO NO HARM AND
14 THAT SHOULD HAVE -- THEY SHOULD HAVE JUST GIVEN UP THEIR
15 JOBS RATHER THAN--
16 THE COURT: HOW CAN ANYBODY SITTING OUT AND JUST
17 LOOKING AT RECORDS AND SAY WHETHER OR NOT SOMETHING THEY
18 WOULD HAVE BEEN INTIMIDATED, ACTUALLY INTIMIDATED?
19 MS. BARLOW: SHE ALSO WILL BE SITTING HERE HEARING
20 THEIR TESTIMONY AND SHE READ THEIR DEPOSITIONS.
21 THE COURT: OKAY. SO AND THAT'S HER OPINION. SHE
22 SAYS, BASED ON WHAT I HEARD, I THINK THEY WERE INTIMIDATED.
23 MS. BARLOW: WELL, I DON'T THINK -- I MEAN THE
24 EXPERT IS NOT GOING TO TESTIFY THEY WERE INTIMIDATED. THEY
25 CAN TESTIFY WHETHER THEY WERE INTIMIDATED OR NOT. WHAT THE
1378
1 EXPERT WILL TESTIFY TO IS THIS KIND OF INTIMIDATION CAN
2 CAUSE PEOPLE WHO NEED THEIR JOB TO GO AHEAD AND DO SOMETHING
3 EVEN THOUGH THEY ARE CONCERNED ABOUT WHAT THEY ARE DOING;
4 I.E., GIVING THE DRUG.
5 THE COURT: YEAH, BUT IS THAT BETTER TESTIMONY THAN
6 THE ACTUAL WITNESSES THEMSELVES TESTIFYING ABOUT THAT
7 SUBJECT?
8 MS. BARLOW: IT'S NOT BETTER BUT IT'S IN ADDITION
9 TO. IT'S EXPERT TESTIMONY FOR THIS JURY TO UNDERSTAND, HEY,
10 YOU KNOW -- I MEAN, THE JURY IS GOING TO LOOK AT IT AND SAY,
11 WELL, WHY DID THESE NURSES GIVE THESE DRUGS IF THEY HAD A
12 PROBLEM WITH IT. IT WILL HELP THEM UNDERSTAND FROM A
13 NURSING STANDPOINT WHY THEY DID IT EVEN THOUGH THEY HAD SOME
14 CONCERNS ABOUT THE DRUGS.
15 THE COURT: THAT'S LIKE SAYING ANOTHER ANALOGY THAT
16 WE MIGHT ABLE TO USE THAT A PERSON COMES IN AND TESTIFIES
17 FALSELY UNDER OATH AND THERE'S SOME REASON FOR THEM TO DO
18 THAT. AND EVEN SOMEBODY ELSE COMES IN AND COMMENTS YES, THE
19 REASON THEY TESTIFIED FALSELY UNDER OATH WAS THIS REASON
20 INSTEAD OF THE INDIVIDUAL SAYING, WHY DID I DO IT. IF WE
21 HAVE ALL SIX WITNESSES, SIX NURSES THAT CAN COME IN HERE AND
22 STATE THAT I EITHER BROUGHT THIS UP TO DR. WEITZEL OR I WAS
23 IN A MEETING WITH HIM OR I WAS AWARE BECAUSE OF THINGS THAT
24 HAVE HAPPENED BEFORE WHEN SOMEBODY TOOK IT UP THE LADDER,
25 THEY GOT KNOCKED DOWN, AND BASED UPON THAT, THAT'S WHY I
1379
1 GAVE THAT SHOT EVEN THOUGH I DIDN'T THINK SO. I MEAN, WHY
2 ISN'T THAT GOING TO BE THE REASON FOR THE JURY -- AND THE
3 JURY DOESN'T HAVE TO JUMP AT ANYTHING MORE THAN SAYING
4 THAT'S WHY THE NURSE GAVE THE SHOT.
5 MS. BARLOW: WELL, YOUR HONOR, AT THIS POINT, ALL I
6 CAN SAY, WE'VE MADE OUR ARGUMENT BOTH IN WRITING AND TO THE
7 COURT AND IT CLEARLY ISN'T CONVINCING THE COURT SO I'LL JUST
8 SUBMIT IT ON THAT.
9 THE COURT: WELL, THE CONCLUSION THAT I'M LOOKING
10 AT ARE QUOTES AND I ASSUME THAT THE QUOTES THAT ARE IN THE
11 DEFENDANT'S MEMO ARE THINGS THAT ARE IN HER REPORT.
12 MS. BARLOW: YOUR HONOR, IT'S BEEN A WHILE SINCE
13 I'VE READ IT.
14 MR. STIRBA: THEY ARE, JUDGE.
15 MS. BARLOW: I'M NOT SAYING THEY ARE NOT THERE.
16 MIGHT BE OTHER THINGS IN THERE, TOO, THAT ARE NOT LISTED
17 HERE, BUT I DON'T HAVE IT.
18 THE COURT: WELL, I AM NOT GOING TO SAY IF THERE
19 ARE SOMETHING -- AFTER THE NURSES TESTIFY AND IF THERE ARE
20 SOMETHING YOU COULD ADD, BUT I'M LOOKING AT THE QUOTE THAT'S
21 ON PAGE EIGHT OF THE DEFENDANT'S MEMO. IT SAYS, NURSE
22 KAUFMAN HAS NO PERSONAL KNOWLEDGE AS TO ORDERS WERE, QUOTE,
23 VERY INTIMIDATING TO A NURSING STAFF WHICH DOES NOT NORMALLY
24 DEAL WITH ACTIVELY DYING PATIENTS. AND SHE WASN'T A MEMBER
25 OF THE NURSING STAFF AND IS NOT QUALIFIED TO TESTIFY AS TO
1380
1 WHETHER ANY OF THE STAFF WAS, QUOTE, INTIMIDATED. AND I
2 GUESS THE PROBLEM THAT I HAVE WITH THAT IS THAT WE DON'T
3 NEED -- I DON'T THINK UNDER RULE 702 IT'S GOING TO ASSIST
4 THE TRYER OF FACT TO HAVE SOME OUTSIDER SAY, I'VE REVIEWED
5 THE DOCUMENTS AND I SAY THEY WERE INTIMIDATED. I THINK
6 THESE WITNESSES, IF THEY WERE INTIMIDATED THEY CAN COME IN
7 HERE AND SAY, NUMBER ONE, I DIDN'T GIVE THIS -- I GAVE THIS
8 SHOT OVER MY OWN GOOD ADVICE, OVER, YOU KNOW, VIOLATING MY
9 OWN ETHICS BECAUSE OF WHAT HAPPENED, WHAT HAD HAPPENED
10 BEFORE WITH THE DOCTOR OR WHAT HAD HAPPENED WITH OTHER
11 NURSES WHO CHALLENGED THE DOCTOR. THAT CAN ALL COME IN.
12 AND YOU CAN ALL SAY THAT. BUT I MEAN, AFTER FIVE OR SIX
13 NURSES TESTIFY ABOUT THAT, I DON'T NEED AND THIS JURY
14 DOESN'T NEED TO HAVE SOMEONE SAYING THEY WERE INTIMIDATED.
15 THEY CAN TESTIFY ABOUT INTIMIDATION. THEY CAN TESTIFY AS TO
16 THE REASONS. THE OTHER THING I'LL SAY AS A BROAD GENERAL
17 STATEMENT ABOUT HER, THAT CAN BE, YOU KNOW, BASICALLY
18 INTERPRETED AS CRITICISM OF A MEDICAL DOCTOR WHERE SHE IS A
19 NURSE. IT SEEMS TO ME THAT'S MORE APPROPRIATE FOR YOUR
20 PSYCHIATRIST EXPERT WITNESS, DR. CROOKSTON, OR SOMEBODY
21 ELSE. AND SO GENERALLY THAT'S THE GUIDELINE I'M GOING TO
22 GIVE ON THAT. I'M NOT SAYING THAT SHE CAN'T TESTIFY, BUT
23 THOSE ARE THE ISSUES THAT I SEE. I'M NOT GOING TO ALLOW HER
24 TO TESTIFY THAT BASED ON REVIEW OF RECORDS SHE THINKS THAT
25 PEOPLE ARE INTIMIDATED. IF WITNESSES ARE INTIMIDATED, THEY
1381
1 WERE INTIMIDATED. OR THAT NURSES, THESE NURSES WILL ALL BE
2 HERE ON THE STAND. THEY WILL BE ABLE TO SAY EXACTLY WHAT
3 THEY DID, WHY THEY DID IT AND WHY THEY DIDN'T DO THINGS.
4 ANY OTHER THINGS THAT WE HAVE TO DISCUSS THAT RELATES
5 TO EITHER DR. CROOKSTON OR NURSE KAUFMAN?
6 MR. STIRBA: I HAVE NOTHING.
7 MS. BARLOW: NOTHING.
8 THE COURT: AS I LOOKED AT THE PLAINTIFF'S WITNESS
9 LIST, THERE ARE THREE PHYSICIANS THAT HAVE NOT BEEN CALLED
10 YET. JOSEPH JENSEN, PAUL JENSEN, AND DAVID WILDING. AND I
11 KNOW WE HAD ONE OF THE JENSENS THAT WE WERE GOING TO DO
12 YESTERDAY AND WE RAN OUT OF TIME. DO WE HAVE THREE
13 PHYSICIANS LET TO TESTIFY?
14 MR. MAJOR: WE HAD ANTICIPATED CALLING PAUL JENSEN
15 THIS AFTERNOON. I'M NOT SURE WE'LL GET TO HIM BASED ON WHAT
16 WE HAVE WITH THE WITNESSES. WE RAN INTO THE SITUATION WITH
17 DR. WILDING. WE TALKED ABOUT DR. WILDING MAY NOT BE THE ONE
18 WE'D BE CALLING. IT WOULD BE DR. KELLER. AND WE RAN INTO
19 THAT SITUATION DEALING WITH THE FAMILY MEMBERS. BUT THAT'S
20 KIND OF WHERE WE ARE AT.
21 THE COURT: IS ONE OF THE OTHER JENSENS NOT GOING
22 TO TESTIFY THEN?
23 MR. MAJOR: I'LL LET THE COURT KNOW AT THE BREAK.
24 I CAN'T REMEMBER.
25 THE COURT: OKAY, THEN. WE'VE GONE THROUGH TWO OF
1382
1 THE NURSES ON YOUR LIST AND THERE'S 11 LEFT AND YOU SAY YOU
2 MIGHT CALL SIX OF THOSE?
3 MS. BARLOW: I THINK WE HAD SIX SCHEDULED FOR
4 TODAY. WE'RE NOT GOING TO GET THROUGH ALL SIX.
5 THE COURT: WE'LL TAKE WHATEVER TIME IT TAKES.
6 MS. BARLOW: I THINK WE HAVE FIVE, FIVE MORE NURSE
7 WITNESSES.
8 THE COURT: BUT ALL THE NURSES THAT YOU'VE LISTED,
9 YOU ARE NOT NECESSARILY GOING TO CALL THOSE?
10 MS. BARLOW: NO. AND IN FACT, SOME OF THEM WE
11 CAN'T FIND.
12 THE COURT: ALL RIGHT. AND THEN FAMILY MEMBERS, WE
13 HAVE MERLIN LARSEN AND HAROLD LARSEN DID YOU SAY ARE GOING
14 TO TESTIFY; IS THAT CORRECT?
15 MR. WILSON: WE HAVE MERLIN LARSEN AND HAROLD
16 LARSEN.
17 THE COURT: WERE THERE ANY OTHER FAMILY MEMBERS.
18 WE HAVE TWO FAMILY MEMBERS AND THEN YOU HAVE YOUR EXPERT AND
19 THEN ON THE OTHERS LIST, WE HAVE CALLED ABOUT FOUR OF THOSE.
20 ARE THERE ANY MORE OF THOSE WITNESSES GOING TO TESTIFY?
21 THEY WERE MARCEL BIBEAULT, TAMARA COLBY, JOHN FOSTER,
22 BEVERLY FULGER, ROBERT JOHNSON.
23 MR. WILSON: THERE ARE ONLY -- THERE MAY BE TWO OUT
24 OF THOSE WITNESSES, YOUR HONOR. BUT THIS IS A PROCESS THAT
25 WE GO THROUGH EVERY AFTERNOON.
1383
1 THE COURT: I'M TRYING TO JUST GENERALLY -- I'M NOT
2 TELLING YOU WHAT WE'RE DOING. I'M JUST WONDERING WHERE WE
3 ARE AT THEN.
4 THESE KEEPER OF THE RECORDS, IN LIGHT OF OUR
5 STIPULATION REGARDING MEDICAL RECORDS, IS THERE -- ARE THEY
6 GOING TO BE CALLED AS WITNESSES?
7 MR. WILSON: NO.
8 THE COURT: THEY WERE CUSTODIANS?
9 MR. WILSON: JUST LISTED FOR THAT PURPOSE.
10 THE COURT: ONE THING THAT WE ALSO NEED TO DISCUSS,
11 WE HAD -- WE TALKED ABOUT THIS ONE EXHIBIT, DAVIS COUNTY.
12 I'LL CALL IT THE TRANSLATION SHEET. YOU SAID YOU WERE GOING
13 TO LOOK THROUGH THAT.
14 MR. STIRBA: THE ONLY THING, I HAVE NO PROBLEM WITH
15 THE ABBREVIATIONS. I DO HAVE A PROBLEM WITH THE LANGUAGE.
16 THERE ARE TWO LITTLE PARAGRAPHS, IF WE COULD REDACT. THEY
17 ARE REALLY IMMATERIAL, BUT THEY COULD CONFUSE THE JURY.
18 THEN ALL THE ABBREVIATIONS IS FINE.
19 THE COURT: OKAY. WHAT IS YOUR VIEW OF THAT FOR
20 THE PROSECUTION?
21 MS. BARLOW: YOUR HONOR, THE PURPOSE OF THEM WAS
22 THE ABBREVIATIONS. WE CAN CERTAINLY TAKE OUT THOSE TWO
23 PARAGRAPHS.
24 THE COURT: WELL, IF YOU WANT TO REDACT THAT AND
25 THAT WILL BE RECEIVED.
1384
1 MR. STIRBA: WHAT NUMBER IS THAT?
2 THE COURT: PLAINTIFF'S EXHIBIT 17. IS THERE ANY
3 OTHER THINGS WE NEED TO DISCUSS BEFORE WE COME BACK AT TWO?
4 WE'LL SEE YOU AT TWO O'CLOCK.