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Trial Transcript Vols. 1- 3
1 IN THE DISTRICT COURT OF DAVIS COUNTY
STATE OF UTAH
3 *****
4 STATE OF UTAH, )
)
5 PLAINTIFF, )
) REPORTER'S TRANSCRIPT
6 VS. )
) CASE NO. 991700983
7 ROBERT ALLEN WEITZEL, )
)
8 DEFENDANT. )
9 *****
10
11 TRIAL - VOLUME 1 OF 21
12 JUNE 9, 2000
13 HONORABLE THOMAS L. KAY
14
15 *****
16 APPEARANCES:
17 FOR THE STATE: MR. MELVIN C. WILSON
MR. STEVEN V. MAJOR
18 MS. CHARLENE BARLOW
19 FOR THE DEFENDANT: MR. PETER STIRBA
MR. JOHN WARREN MAY
20
21
22
23
24
25
1 INDEX
2 WITNESSES PAGE
3 SHEILA K. HEWARD
DIRECT EXAMINATION BY MR. WILSON 86
4 VOIR DIRE EXAMINATION BY MR. STIRBA 90
DIRECT EXAMINATION, CONT'D BY MR. WILSON 91
5 CROSS-EXAMINATION BY MR. STIRBA 114
REDIRECT EXAMINATION BY MR. WILSON 130
6
SHEILA MOORE
7 DIRECT EXAMINATION BY MS. BARLOW 138
VOIR DIRE EXAMINATION BY MR. STIRBA 151
8 DIRECT EXAMINATION, CONT'D BY MS. BARLOW 152
DIRECT EXAMINATION, CONT'D BY MS. BARLOW 170
9
TODD CHAMBERS
10 DIRECT EXAMINATION BY MR. MAJOR 188
CROSS-EXAMINATION BY MR. STIRBA 233
11 REDIRECT EXAMINATION BY MR. MAJOR 268
RECROSS-EXAMINATION BY MR. STIRBA 270
12
WELBY NEAL JENSEN
13 DIRECT EXAMINATION BY MR. WILSON 271
DIRECT EXAMINATION, CONT'D BY MR. WILSON 333
14 CROSS-EXAMINATION BY MR. STIRBA 336
15 JOSEPH MORRISON
DIRECT EXAMINATION BY MR. WILSON 345
16
KATHY CHARLESWORTH
17 DIRECT EXAMINATION BY MR. WILSON 357
CROSS-EXAMINATION BY MR. STIRBA 379
18 REDIRECT EXAMINATION BY MR. WILSON 405
19 RACHEL STUBBS
DIRECT EXAMINATION BY MR. MAJOR 408
20 CROSS-EXAMINATION BY MR. STIRBA 434
VOIR DIRE EXAMINATION BY MR. MAJOR 436
21 CROSS-EXAMINATION, CONT'D BY MR. STIRBA 439
REDIRECT EXAMINATION BY MR. MAJOR 466
22 RECROSS-EXAMINATION BY MR. STIRBA 472
23 KAREN BRINGHURST
DIRECT EXAMINATION BY MR. WILSON 525
24 CROSS-EXAMINATION BY MR. STIRBA 552
REDIRECT EXAMINATION BY MR. WILSON 574
25 RECROSS-EXAMINATION BY MR. STIRBA 582
1 INDEX
2 WITNESSES PAGE
3 SCOTT SOUTHWORTH
DIRECT EXAMINATION BY MR. WILSON 583
4 CROSS-EXAMINATION BY MR. STIRBA 597
REDIRECT EXAMINATION BY MR. WILSON 613
5 RECROSS-EXAMINATION BY MR. STIRBA 616
6 SHARON OSSMEN SMITH
DIRECT EXAMINATION BY MR. WILSON 628
7 CROSS-EXAMINATION BY MR. STIRBA 650
REDIRECT EXAMINATION BY MR. WILSON 655
8
KENT DEAN SMITH
9 DIRECT EXAMINATION BY MR. WILSON 656
CROSS-EXAMINATION BY MR. STIRBA 670
10 REDIRECT EXAMINATION BY MR. WILSON 677
11 BONNIE SMITH WEIGHT
DIRECT EXAMINATION BY MR. WILSON 678
12 CROSS-EXAMINATION BY MR. STIRBA 690
13 MICHAEL H. SUMKO
DIRECT EXAMINATION BY MR. MAJOR 700
14 CROSS-EXAMINATION BY MR. STIRBA 725
15 ALAN J. ACORD
DIRECT EXAMINATION BY MR. MAJOR 738
16 CROSS-EXAMINATION BY MR. STIRBA 747
17 BARBARA POHLMAN
DIRECT EXAMINATION BY MR. MAJOR 768
18 CROSS-EXAMINATION BY MR. STIRBA 794
REDIRECT EXAMINATION BY MR. MAJOR 822
19
DIANE MARIAH
20 DIRECT EXAMINATION BY MR. MAJOR 825
21 SCOTT CUNNINGHAM
DIRECT EXAMINATION BY MR. MAJOR 853
22 CROSS-EXAMINATION BY MR. STIRBA 868
REDIRECT EXAMINATION BY MR. MAJOR 914
23 RECROSS-EXAMINATION BY MR. STIRBA 918
24
25
1 INDEX
2 WITNESSES PAGE
3 VONDA ALLDREDGE
DIRECT EXAMINATION BY MR. MAJOR 923
4 CROSS-EXAMINATION BY MR. STIRBA 940
REDIRECT EXAMINATION BY MR. MAJOR 949
5 RECROSS-EXAMINATION BY MR. STIRBA 953
6 GREGORY STEVENS
DIRECT EXAMINATION BY MR. WILSON 967
7 CROSS-EXAMINATION BY MR. STIRBA 982
REDIRECT EXAMINATION BY MR. WILSON 1000
8
JAMES PEARCE
9 DIRECT EXAMINATION BY MR. WILSON 1006
CROSS-EXAMINATION BY MR. STIRBA 1013
10 REDIRECT EXAMINATION BY MR. WILSON 1028
11 DAVID DIENHART
DIRECT EXAMINATION BY MR. WILSON 1045
12 CROSS-EXAMINATION BY MR. STIRBA 1093
REDIRECT EXAMINATION BY MR. WILSON 1138
13
ROBERT FELT BITNER
14 DIRECT EXAMINATION BY MR. WILSON 1141
CROSS-EXAMINATION BY MR. STIRBA 1150
15
NEAL CLINGER
16 DIRECT EXAMINATION BY MR. MAJOR 1156
CROSS-EXAMINATION BY MR. STIRBA 1174
17
STEVEN MEEK
18 DIRECT EXAMINATION BY MR. WILSON 1229
CROSS-EXAMINATION BY MR. STIRBA 1233
19
TRACY SCHOLL
20 DIRECT EXAMINATION BY MS. BARLOW 1238
VOIR DIRE EXAMINATION BY MR. STIRBA 1297
21 DIRECT EXAMINATION, CONT'D BY MS. BARLOW 1299
CROSS-EXAMINATION BY MR. STIRBA 1320
22 REDIRECT EXAMINATION BY MS. BARLOW 1353
23 DORENE KLEI
DIRECT EXAMINATION BY MS. BARLOW 1386
24 CROSS-EXAMINATION BY MR. STIRBA 1403
REDIRECT EXAMINATION BY MS. BARLOW 1411
25 RECROSS-EXAMINATION BY MR. STIRBA 1414
1 INDEX
2 WITNESSES PAGE
3 EARLENE COZZENS COOPER
DIRECT EXAMINATION BY MS. BARLOW 1417
4 DIRECT EXAMINATION, CONT'D BY MS. BARLOW 1480
CROSS-EXAMINATION BY MR. STIRBA 1536
5 REDIRECT EXAMINATION BY MS. BARLOW 1579
RECROSS-EXAMINATION BY MR. STIRBA 1585
6
RICHARD B. CLARK
7 DIRECT EXAMINATION BY MS. BARLOW 1590
CROSS-EXAMINATION BY MR. STIRBA 1596
8
BONITA HARDEY
9 DIRECT EXAMINATION BY MS. BARLOW 1604
DIRECT EXAMINATION, CONT'D BY MS. BARLOW 1719
10 CROSS-EXAMINATION BY MR. STIRBA 1758
REDIRECT EXAMINATION BY MS. BARLOW 1804
11 RECROSS-EXAMINATION BY MR. STIRBA 1814
FURTHER REDIRECT EXAMINATION BY MS. BARLOW 1815
12
PAUL R. JENSEN
13 DIRECT EXAMINATION BY MR. MAJOR 1816
CROSS-EXAMINATION BY MR. STIRBA 1834
14 REDIRECT EXAMINATION BY MR. MAJOR 1842
15 MARCEL BIBEAULT
DIRECT EXAMINATION BY MR. MAJOR 1843
16 CROSS-EXAMINATION BY MR. STIRBA 1845
REDIRECT EXAMINATION BY MR. MAJOR 1847
17 RECROSS-EXAMINATION BY MR. STIRBA 1848
18 HAROLD LARSEN
DIRECT EXAMINATION BY MR. WILSON 1850
19
MERLIN LARSEN
20 DIRECT EXAMINATION BY MR. WILSON 1862
CROSS-EXAMINATION BY MR. STIRBA 1886
21 REDIRECT EXAMINATION BY MR. WILSON 1899
RECROSS-EXAMINATION BY MR. STIRBA 1902
22
TODD CAMERON GREY
23 DIRECT EXAMINATION BY MR. MAJOR 1909
VOIR DIRE EXAMINATION BY MR. STIRBA 1931
24 DIRECT EXAMINATION, CONT'D BY MR. MAJOR 1932
CROSS-EXAMINATION BY MR. STIRBA 1976
25 REDIRECT EXAMINATION BY MR. MAJOR 2012
RECROSS-EXAMINATION BY MR. STIRBA 2026
1 INDEX
2 WITNESSES PAGE
3 MAUREEN JANE FRIKKE
DIRECT EXAMINATION BY MR. MAJOR 2028
4 CROSS-EXAMINATION BY MR. STIRBA 2047
REDIRECT EXAMINATION BY MR. MAJOR 2058
5
CHARLES FEHLAUER
6 DIRECT EXAMINATION BY MS. BARLOW 2182
VOIR DIRE EXAMINATION BY MR. STIRBA 2241
7 DIRECT EXAMINATION, CONT'D BY MS. BARLOW 2242
DIRECT EXAMINATION, CONT'D BY MS. BARLOW 2275
8 VOIR DIRE EXAMINATION BY MR. STIRBA 2305
DIRECT EXAMINATION, CONT'D BY MS. BARLOW 2306
9 DIRECT EXAMINATION, CONT'D BY MS. BARLOW 2386
CROSS-EXAMINATION BY MR. STIRBA 2444
10 REDIRECT EXAMINATION BY MS. BARLOW 2498
REDIRECT EXAMINATION, CONT'D BY MS. BARLOW 2515
11 RECROSS-EXAMINATION BY MR. STIRBA 2522
FURTHER REDIRECT EXAMINATION BY MS. BARLOW 2527
12
BRADFORD HARE
13 DIRECT EXAMINATION BY MR. WILSON 2529
CROSS-EXAMINATION BY MR. STIRBA 2634
14 REDIRECT EXAMINATION BY MR. WILSON 2718
RECROSS-EXAMINATION BY MR. STIRBA 2735
15
MICHAEL CROOKSTON
16 DIRECT EXAMINATION BY MR. WILSON 2747
CROSS-EXAMINATION BY MR. STIRBA 2815
17 REDIRECT EXAMINATION BY MR. WILSON 2859
RECROSS-EXAMINATION BY MR. STIRBA 2869
18 FURTHER REDIRECT EXAMINATION BY MR. WILSON 2875
19 LAUREL HERMANSON HERBST
DIRECT EXAMINATION BY MR. STIRBA 2966
20 CROSS-EXAMINATION BY MR. WILSON 3030
REDIRECT EXAMINATION BY MR. STIRBA 3095
21 RECROSS-EXAMINATION BY MR. WILSON 3098
22 LAURIE STEVENSON
DIRECT EXAMINATION BY MR. STIRBA 3102
23 CROSS-EXAMINATION BY MS. BARLOW 3174
CROSS-EXAMINATION, CONT'D BY MS. BARLOW 3201
24 REDIRECT EXAMINATION BY MR. STIRBA 3236
RECROSS-EXAMINATION BY MS. BARLOW 3241
25
1 INDEX
2 WITNESSES PAGE
3 ROBERT KEITH ROTHFEDER
DIRECT EXAMINATION BY MR. STIRBA 3243
4 VOIR DIRE EXAMINATION BY MR. MAJOR 3249
DIRECT EXAMINATION, CONT'D BY MR. STIRBA 3262
5 DIRECT EXAMINATION, CONT'D BY MR. STIRBA 3324
CROSS-EXAMINATION BY MR. MAJOR 3360
6 REDIRECT EXAMINATION BY MR. STIRBA 3408
RECROSS-EXAMINATION BY MR. MAJOR 3410
7 REDIRECT EXAMINATION BY MR. STIRBA 3411
RECROSS-EXAMINATION BY MR. MAJOR 3413
8
SHEILA HANSEN
9 DIRECT EXAMINATION BY MR. STIRBA 3420
CROSS-EXAMINATION BY MS. BARLOW 3442
10 REDIRECT EXAMINATION BY MR. STIRBA 3469
11 JOHN CANNON
DIRECT EXAMINATION BY MR. STIRBA 3470
12 CROSS-EXAMINATION BY MS. BARLOW 3489
REDIRECT EXAMINATION BY MR. STIRBA 3514
13 RECROSS-EXAMINATION BY MS. BARLOW 3518
14 ROBERT SUPERNAW
DIRECT EXAMINATION BY MR. STIRBA 3519
15 DIRECT EXAMINATION, CONT'D BY MR. STIRBA 3543
CROSS-EXAMINATION BY MS. BARLOW 3552
16 REDIRECT EXAMINATION BY MR. STIRBA 3574
RECROSS-EXAMINATION BY MS. BARLOW 3574
17
C. STRATTON HILL
18 DIRECT EXAMINATION BY MR. STIRBA 3576
CROSS-EXAMINATION BY MR. WILSON 3608
19 REDIRECT EXAMINATION BY MR. STIRBA 3641
20 ROBERT WEITZEL
DIRECT EXAMINATION BY MR. STIRBA 3745
21 CROSS-EXAMINATION BY MR. WILSON 3843
REDIRECT EXAMINATION BY MR. STIRBA 4041
22
BRADFORD HARE
23 DIRECT EXAMINATION BY MR. WILSON 4085
CROSS-EXAMINATION BY MR. STIRBA 4117
24 REDIRECT EXAMINATION BY MR. WILSON 4125
25
1 INDEX
2 WITNESSES PAGE
3 BARBARA POHLMAN
DIRECT EXAMINATION BY MR. MAJOR 4169
4 CROSS-EXAMINATION BY MR. STIRBA 4172
REDIRECT EXAMINATION BY MR. MAJOR 4176
5 RECROSS-EXAMINATION BY MR. STIRBA 4177
6 JAY POHLMAN
DIRECT EXAMINATION BY MR. MAJOR 4180
7 CROSS-EXAMINATION BY MR. STIRBA 4185
8 BONITA HARDEY
DIRECT EXAMINATION BY MS. BARLOW 4188
9
MICHAEL CROOKSTON
10 DIRECT EXAMINATION BY MR. WILSON 4194
CROSS-EXAMINATION BY MR. STIRBA 4202
11
CHARLES STEVEN FEHLAUER
12 DIRECT EXAMINATION BY MS. BARLOW 4207
CROSS-EXAMINATION BY MR. STIRBA 4223
13 REDIRECT EXAMINATION BY MS. BARLOW 4230
RECROSS-EXAMINATION BY MR. STIRBA 4234
14
ROBERT KEITH ROTHFEDER
15 DIRECT EXAMINATION BY MR. STIRBA 4241
CROSS-EXAMINATION BY MR. MAJOR 4244
16 REDIRECT EXAMINATION BY MR. STIRBA 4251
RECROSS-EXAMINATION BY MR. MAJOR 4253
17
18
19
20
21
22
23
24
25
9
1 (WHEREUPON, THE MORNING SESSION BEGINS.)
2 THE COURT: OKAY. PLEASE BE SEATED. THIS IS THE
3 CASE OF THE STATE OF UTAH VERSUS ROBERT ALLEN WEITZEL. THE
4 RECORD SHOULD REFLECT THAT THE ATTORNEYS FOR THE PARTIES ARE
5 ALL PRESENT, THE DEFENDANT IS PRESENT AND ALL THE JURORS ARE
6 PRESENT. AND I WOULD JUST LIKE TO EXPRESS TO THE JURY, I'M
7 VERY GRATEFUL THAT YOU WERE ON TIME. I THINK OUR FIRST
8 JUROR GOT HERE AT FIVE MINUTES TO EIGHT AND THE LAST ONE AT
9 25 AFTER WHICH I ASKED YOU AND I VERY MUCH APPRECIATE THAT
10 AND COUNSEL.
11 MEMBERS THE JURY, WE ARE ABOUT TO BEGIN THE TRIAL OF
12 THIS CASE. YOU MAY HAVE HEARD SOME DETAILS ABOUT THE CASE
13 DURING THE PROCESS OF JURY SELECTION. BEFORE THE TRIAL
14 BEGINS, HOWEVER, THERE ARE CERTAIN INSTRUCTIONS YOU SHOULD
15 HAVE TO BETTER UNDERSTAND WHAT WILL BE PRESENTED TO YOU AND
16 HOW YOU SHOULD CONDUCT YOURSELF DURING THIS TRIAL. THE
17 PARTY WHO BRINGS THE LAWSUIT IS CALLED THE PLAINTIFF...
18 (WHEREUPON PRELIMINARY JURY INSTRUCTIONS WERE READ.)
19 THE COURT: AND I WOULD JUST ADD, LADIES AND
20 GENTLEMEN, WHAT I'VE SAID TO YOU BEFORE AND WHAT I'VE SAID
21 TO THE ATTORNEYS IS THAT I WANT TO START ON TIME AND I WANT
22 TO END ON TIME. AND IF THE ATTORNEYS HAVE THINGS THAT THEY
23 NEED TO DISCUSS WITH ME, WE WANT TO DISCUSS THOSE THINGS
24 WHEN YOU ARE EITHER AT LUNCH OR BEFORE YOU GET HERE OR AFTER
25 YOU LEAVE. AND SO HOPEFULLY THE TIMES THAT YOU'LL BE --
10
1 HOPEFULLY ALL THE TIME THAT YOU ARE GOING TO BE HERE OTHER
2 THAN BREAKS AND FOR LUNCH ARE GOING TO BE HERE IN THE
3 COURTROOM HEARING EVIDENCE. THE CASE WILL PROCEED IN THE
4 FOLLOWING ORDER:
5 (WHEREUPON PRELIMINARY JURY INSTRUCTIONS CONTINUED.)
6 THE COURT: SO, MS. BARLOW, IF YOU WISH TO GIVE
7 YOUR OPENING STATEMENT.
8 MS. BARLOW: THANK YOU, YOUR HONOR.
9 MAY IT PLEASE THE COURT, LADIES AND GENTLEMEN OF THE
10 JURY. ON BEHALF OF THE STATE OF UTAH, I WOULD LIKE TO THANK
11 YOU FOR YOUR WILLINGNESS TO SERVE HERE TODAY. AS INDICATED,
12 I THINK THAT WE'VE ALL INTRODUCED OURSELVES DURING THE
13 COURSE OF JURY SELECTION BUT I WOULD LIKE TO REINTRODUCE THE
14 TEAM, AS IT WERE, FOR THE STATE HERE. MEL WILSON IS SEATED
15 OVER HERE, HE'S THE DAVIS COUNTY ATTORNEY AND HE IS LEAD
16 COUNSEL IN THIS MATTER FOR THE STATE. MY NAME IS CHARLENE
17 BARLOW, I'M ASSISTING. STEVE MAJOR IS A DEPUTY COUNTY
18 ATTORNEY WHO IS ALSO ASSISTING MR. WILSON IN THIS CASE.
19 I WANT TO THANK YOU FOR BEING HERE. IT IS PART OF THE
20 BEAUTY OF OUR CONSTITUTIONAL SYSTEM THAT WE HAVE THIS
21 SYSTEM. YOU -- I MEAN, PROBABLY NONE OF US THOUGHT THIS IS
22 THE WAY WE WOULD BE SPENDING THE FIRST PART OF OUR SUMMER,
23 BUT THIS IS A CONSTITUTIONAL RIGHT THAT IS PROVIDED FOR A
24 TRIAL BY JURY AND A SPEEDY TRIAL BY JURY. AND SO WE'RE
25 GOING TO TRY AND KEEP THIS WITH ALL DELIBERATE SPEED MOVING
11
1 ALONG SO THAT YOU CAN HEAR THE EVIDENCE THAT COMES IN SO
2 THAT YOU CAN UNDERSTAND WHAT HAS HAPPENED IN THIS MATTER.
3 YOU'LL SEE THAT THERE ARE ATTORNEYS ON BOTH SIDES.
4 YOU'LL SEE THERE ARE A NUMBER OF ATTORNEYS ON BOTH SIDES.
5 THIS IS A VERY SERIOUS CASE. WE ARE TALKING ABOUT CHARGES
6 OF HOMICIDE. NOBODY TAKES THOSE CHARGES LIGHTLY ON EITHER
7 SIDE. THIS WAS AN EXTENSIVE CASE. THERE ARE FIVE VICTIMS
8 IN THIS MATTER. THERE WAS AN EXTENSIVE INVESTIGATION.
9 THERE WILL BE MANY WITNESSES THAT YOU WILL SEE OVER THE
10 COURSE OF THE NEXT FEW WEEKS. AND BECAUSE OF THAT,
11 SOMETIMES YOU MAY SEE ONE OR THE OTHER OF THE ATTORNEYS THAT
12 ARE NOT HERE AND YOU MIGHT BE, WELL, WHERE ARE THEY? I'M
13 SITTING HERE, WHY AREN'T THEY SITTING HERE? BUT IN ORDER TO
14 KEEP THE CASE MOVING SMOOTHLY AND TO MAKE SURE THE WITNESSES
15 ARE AVAILABLE AND HERE AND EVERYTHING CAN KEEP MOVING
16 SMOOTHLY, THERE ARE TIMES WHEN MAYBE ONE OR THE OTHER OF US
17 MAY NOT BE HERE, BUT REST ASSURED WE WILL BE WORKING ON THE
18 CASE.
19 YOU MAY HAVE WONDERED AS YOU READ THE JURY
20 QUESTIONNAIRE THAT YOU FILLED OUT, YOU KNOW, WHAT IS THIS
21 CASE ABOUT? AND SOME OF THE QUESTIONS MIGHT MAKE YOU THINK,
22 WELL, YOU KNOW, MAYBE IT'S ABOUT THIS OR MAYBE IT'S ABOUT
23 THAT. I WANT TO TELL YOU A FEW THINGS THAT MIGHT HAVE BEEN
24 RAISED IN THE JURY QUESTIONNAIRE IN YOUR MIND THAT IT'S NOT
25 ABOUT.
12
1 THIS IS NOT A CASE ABOUT ASSISTED SUICIDE. THIS IS NOT
2 A MATTER OF ANYONE COMING TO THE DEFENDANT AND SAYING I
3 DON'T LIKE MY LIFE ANYMORE, WOULD YOU PLEASE HELP ME END IT.
4 THERE'S NO EVIDENCE OF THAT. SO PLEASE SET ASIDE ANY
5 THOUGHT OF IS THIS AN ASSISTED SUICIDE CASE. IT IS NOT.
6 IT'S NOT A CASE ABOUT MERCY KILLING, EITHER. MERCY
7 KILLING IS THE IMPRESSION OF, YOU KNOW, THIS POOR PERSON'S
8 LIFE IS NOT GOOD, I FEEL SORRY FOR THEM, I WILL HELP THEM
9 LEAVE THIS LIFE BECAUSE THEIR LIFE IS SO UNHAPPY OR
10 UNPLEASANT, THEIR QUALITY OF LIFE IS SO POOR. THAT PRESUMES
11 AN ATTITUDE ON THE PART OF THE PERSON HELPING OF BEING
12 MERCIFUL, AND I THINK OUR EVIDENCE IS GOING TO SHOW YOU THAT
13 ATTITUDE IS NOT PRESENT IN THIS CASE.
14 IT IS A CASE ABOUT EUTHANASIA. IT IS A CASE ABOUT
15 HASTENING DEATH. EUTHANASIA IS NOT LAWFUL IN THE STATE OF
16 UTAH. SOMEONE'S LIFE MAY BE VERY POOR QUALITY, SOMEONE MAY
17 BE DEMENTED, SOMEONE MAY BE IN A LOT OF PROBLEMS AND A LOT
18 OF TROUBLE AND MAY NOT BE HAPPY WITH THEIR LIFE OR MAY NOT
19 EVEN BE AWARE OF WHAT THEIR LIFE IS, BUT THE LAW DOES NOT
20 ALLOW ANYONE TO TAKE THEIR LIFE, NO MATTER HOW POOR THE
21 QUALITY OF LIFE MAY BE. AND I'M NOT SAYING THAT THE QUALITY
22 OF LIFE IN THESE PEOPLE WAS THAT POOR. BUT I WANT TO LET
23 YOU KNOW THE STATE DOES NOT ALLOW ANYONE TO TAKE SOMEONE
24 ELSE'S LIFE JUST BECAUSE THEIR QUALITY OF LIFE IS NOT WHAT
25 SOMEONE ELSE THINKS IT OUGHT TO BE.
13
1 EVIDENCE IS GOING TO COME IN WITNESS BY WITNESS. WE
2 HAVE TELEVISION MONITORS HERE. YOU WON'T BE WATCHING THE
3 SHOW. YOU WON'T BE WATCHING, YOU KNOW, SOMETHING THAT'S
4 GOING TO BE WRAPPED UP IN A HALF OR OUR HOUR LONG OR EVEN A
5 TWO-HOUR MOVIE. YOU WON'T BE WATCHING SOMETHING WHERE YOU
6 CAN PICTURE HOW THINGS HAPPEN BECAUSE THAT'S THE WAY THEY
7 SHOW IT ON TV. YOU ARE GOING TO BE HEARING WHAT HAPPENED
8 WITNESS BY WITNESS. WE'RE GOING TO DO OUR BEST TO MAKE IT A
9 VERY LOGICAL PROGRESSION WITH THE WITNESSES, BUT, YOU KNOW,
10 ONE PERSON WILL SEE THIS PART OF IT BUT THEY WON'T SEE
11 ANOTHER PART OF IT, SO ANOTHER WITNESS WILL COME IN AND SAY
12 I SAW THIS OTHER PART OF IT. SO YOU'RE GOING TO HAVE TO
13 LISTEN CAREFULLY AND NOT FORM ANY OPINION BUT TO LISTEN
14 CAREFULLY ALL THE WAY THROUGH AND SAY, OKAY, THIS WITNESS
15 TOLD ME THIS, THIS WITNESS TOLD ME THAT. BUT THAT'S THE WAY
16 IT'S GOING TO COME TOGETHER. AND, AGAIN, WE'RE GOING TO TRY
17 TO MAKE IT JUST AS LOGICAL AS POSSIBLE SO, YOU KNOW, WE HAVE
18 A PROGRESSION THERE AND IT MAKES SENSE TO YOU AS WE'RE GOING
19 FORWARD.
20 YOU WILL HEAR FROM EXPERT WITNESSES. YOU WILL HEAR
21 FROM DOCTORS AND NURSES WHO WERE NOT INVOLVED IN THIS CASE
22 OTHER THAN AS WHAT'S CALLED AN EXPERT WITNESS. THEY HAVE
23 BEEN GIVEN INFORMATION, THEY HAVE LOOKED AT THAT
24 INFORMATION, THEY HAVE FORMULATED CERTAIN OPINIONS ABOUT
25 WHAT HAPPENED IN THIS MATTER WHICH THEY WILL GIVE TO YOU AND
14
1 THEN YOU WILL MAKE THE FINAL DETERMINATION. I MEAN, WE'RE
2 ALL HERE -- YOU KNOW, THE JUDGE HAS HIS ROLE, WE HAVE OUR
3 ROLE, DEFENSE HAS THEIR ROLE. YOU HAVE THE MOST IMPORTANT
4 ROLE IN THIS MATTER AND THAT IS TO DECIDE WHERE THE TRUTH
5 LIES, WHETHER THE DEFENDANT IS GUILTY OR NOT. AND PART OF
6 THAT, PART OF WHAT YOU WILL NEED TO DECIDE IS WHAT MENTAL
7 STATE DID THE DEFENDANT HAVE WHEN HE DID THE THINGS THAT HE
8 DID.
9 YOU WILL GET INSTRUCTIONS FROM THE COURT ON THIS AND
10 THEY WILL EXPLAIN TO YOU WHAT MENTAL STATE MEANS. I THINK
11 WE ALL UNDERSTAND WHAT A MENTAL STATE IS. IN THE LAW IT'S
12 CALLED A CULPABLE STATE. IT'S A MENTAL STATE OF, YOU KNOW,
13 YOU KIND OF KNOW WHAT YOU ARE DOING. THESE CHARGES ARE
14 BASED ON THREE POSSIBLE MENTAL STATES AND YOU WILL BE THE
15 ONES TO DECIDE WHETHER ANY OR ALL OF THESE MEET THE MENTAL
16 STATES FIT IN THIS CIRCUMSTANCE.
17 THE FIRST IS INTENT AND THE JURY INSTRUCTION WILL TELL
18 YOU WITH MUCH MORE SPECIFICITY BUT INTENT IS DEFINED AS A
19 CONSCIOUS OBJECTIVE TO DO THE CONDUCT OR CAUSE THE RESULT.
20 SO THAT IS ONE OF THE MENTAL STATES WE'LL BE PRESENTING TO
21 YOU.
22 ANOTHER MENTAL STATE THAT -- AND IF YOU DON'T THINK
23 IT'S INTENTIONAL, YOU MIGHT FIND THAT IT'S KNOWING, AND
24 KNOWINGLY IS BEING DEFINED AS BEING AWARE THAT THE CONDUCT
25 IS REASONABLY CERTAIN TO CAUSE A PARTICULAR RESULT. SO
15
1 WE'LL ASK YOU TO LOOK AND SEE IF THERE'S EVIDENCE THAT
2 PERHAPS THIS CONDUCT WAS DONE KNOWINGLY.
3 AND FINALLY, THERE IS THE THIRD MENTAL STATE AND THAT
4 IS CALLED DEPRAVED INDIFFERENCE, LEGAL TERMS. BUT AS
5 DEFINED IT'S THE DEFENDANT DOES CERTAIN CONDUCT CREATED
6 TO -- EXCUSE ME -- CONDUCT THAT CREATES A GRAVE RISK OF
7 DEATH AND THEN DOES CAUSE THE DEATH BY THAT CONDUCT.
8 AGAIN, I'M JUST GIVING YOU AN OVERVIEW OF THAT. IN
9 FACT, I'LL BE JUST GIVING YOU AN OVERVIEW OF EVIDENCE TODAY.
10 I'M NOT GOING TO HIT ON EVERY PIECE OF EVIDENCE YOU'RE GOING
11 TO HEAR IN THE NEXT SEVERAL WEEKS, YOU KNOW. I CLEARLY
12 COULDN'T DO THAT. BUT IN ORDER TO GIVE YOU AN OVERVIEW OF
13 WHAT WE'RE LOOKING AT HERE, WE'RE LOOKING AT THE DEATHS OF
14 FIVE PEOPLE AND WE'RE LOOKING AT CERTAIN MENTAL STATES ON
15 BEHALF OF THE DEFENDANT AS THESE DEATHS WERE CAUSED.
16 THESE HAPPENED AT DAVIS NORTH HOSPITAL IN WHAT IS
17 CALLED THE GEROPSYCH UNIT, THE GEROPSYCHIATRIC UNIT. GERO
18 IS FROM THE ROOT OF GERIATRIC DEALING WITH ELDERLY PEOPLE.
19 PSYCHIATRIC, WE KNOW WHAT THAT IS. THE PURPOSE OF THE
20 GEROPSYCH UNIT -- IT WAS SET UP I GUESS IT WAS MID 1994 AND
21 YOU'LL HEAR EVIDENCE THAT, YOU KNOW, THERE WASN'T A
22 GEROPSYCH UNIT IN THE SURROUNDING STATES AND SO THERE WAS A
23 DECISION TO CREATE A GEROPSYCH UNIT AND IT WAS DONE THERE IN
24 DAVIS HOSPITAL.
25 YOU'LL HEAR THAT THERE'S KIND OF A DIVISION OF
16
1 RESPONSIBILITIES AS IT WERE. THE HOSPITAL HIRED THE NURSES
2 AND CONTROLLED THE NURSES. THE GEROPSYCH UNIT WAS MANAGED
3 BY A PSYCHIATRIST WHO WAS HIRED BY A COMPANY CALLED HORIZON.
4 AND HORIZON EVIDENTLY HAS SET UP THESE UNITS IN OTHER AREAS,
5 CAME IN HERE SAID WE'VE GOT THIS GREAT IDEA FOR A UNIT, WE
6 WILL HIRE THE PSYCHIATRIST, WE WILL RUN THE UNIT, MANAGE --
7 THIS PSYCHIATRIST WILL MANAGE THE UNIT, YOU'LL PROVIDE THE
8 NURSES AND WE'LL HAVE A UNIT THAT -- THE PURPOSE OF THIS
9 UNIT WILL BE TO HELP ELDERLY PEOPLE WHOSE BEHAVIOR IS
10 CAUSING SUCH PROBLEMS THAT PERHAPS THEY CAN'T STAY IN THE
11 SETTING WHERE THEY ALREADY ARE.
12 YOU KNOW, UNFORTUNATELY AS WE GET OLDER, OUR MEMORIES
13 GO, YOU KNOW, TO DIFFERING DEGREES. AND UNFORTUNATELY OUR
14 HUMAN BODIES ARE SUCH THAT SOMETIMES THE MEMORIES GO VERY
15 POORLY. THIS IS CALLED DEMENTIA. IT'S ALSO CALLED
16 ALZHEIMERS. YOU KNOW, WHETHER IT'S SENILE DEMENTIA OR
17 ALZHEIMERS, THAT'S NOT REALLY THE POINT HERE. BUT THE POINT
18 IS WE HAVE PEOPLE THAT IN THE COURSE OF THEIR LIVES START TO
19 LOSE THEIR RECOLLECTION, LOSE THEIR MEMORY, LOSE THEIR
20 ABILITY TO PERFORM DAILY FUNCTION, DAILY LIVING MATTERS, YOU
21 KNOW, AND DIFFERENT THINGS ARE DONE IN THOSE CIRCUMSTANCES.
22 SOMETIMES PEOPLE ARE ABLE TO KEEP THEM AT HOME. OTHER TIMES
23 THEY ARE ABLE TO KEEP THEM AT HOME FOR A WHILE BUT THEN THEY
24 JUST CAN'T HANDLE WHAT'S GOING ON ANY LONGER AND PUT THEM
25 INTO A LONG-TERM CARE FACILITY.
17
1 DEMENTIA IS SUCH THAT IT'S A GRADUAL ONSET. IT'S A
2 GRADUAL DECLINING OF A PERSON'S ABILITY. YOU'LL HEAR
3 EXPERTS TESTIFY AS TO -- AND THEY'VE BEEN ABLE TO PRETTY
4 MUCH CHART, YOU KNOW, IF A PERSON CAN DO THESE THINGS BUT IS
5 KIND OF LOSING IT A LITTLE BIT, YOU KNOW. THEY MAY HAVE
6 ANOTHER 12, 15, 20 YEARS TO LIVE. A PERSON AS THEY
7 GRADUALLY LOSE THEIR ABILITY TO FUNCTION IN -- NOT JUST IN
8 SOCIETY BUT JUST IN DAILY LIVING AND THEY CAN CHART HOW, YOU
9 KNOW, WHICH ABILITIES GO AT WHAT POINT UNTIL, YOU KNOW, YOU
10 GET TO THE POINT WHERE THEY CAN NO LONGER EVEN SIT UP. AND
11 IF THEY CAN NO LONGER EVEN SIT UP, DEATH IS VERY IMMINENT.
12 AND ONE OF THEM IS EVEN LOSING THE ABILITY TO SMILE, THAT'S
13 ONE OF THE LAST THINGS TO GO IS THE ABILITY TO SMILE. AND
14 SO YOU HAVE DEMENTIA, BUT THAT ISN'T WHAT THE GEROPSYCH UNIT
15 WAS FOR.
16 LONG-TERM CARE FACILITIES TAKE CARE OF PEOPLE WHO
17 BECOME DEMENTED. BUT UNFORTUNATELY WHAT HAPPENS SOMETIMES
18 IN PEOPLE WHO ARE LOSING THEIR ABILITY TO FUNCTION THERE IS
19 AN ACUTE -- I MEAN, THIS IS CALLED CHRONIC. IT'S SOMETHING
20 THAT LASTS OVER TIME. YOU ARE NOT GOING TO BE ABLE TO CURE
21 IT AND THAT'S WHY IT'S CALLED CHRONIC. THAT'S A MEDICAL
22 TERM THAT I'VE LEARNED OVER THE LAST LITTLE WHILE.
23 BUT SOMETIMES WITH PEOPLE, EVEN THOUGH THEY HAVE THIS
24 CHRONIC PROBLEM AND THEY ARE GRADUALLY DECLINING, SOME
25 PEOPLE WILL HAVE AN ACUTE EVENT, AN EVENT THAT COMES
18
1 SUDDENLY, AN EVENT THAT IS NOT JUST THIS GRADUAL DECLINE,
2 BUT SUDDENLY SOMETHING HAPPENS AND THEIR BEHAVIOR REALLY
3 CHANGES AND THAT'S WHAT WE HAD WITH THESE FIVE PEOPLE. YOU
4 KNOW, IT MIGHT BE A HIP FRACTURE, IT MIGHT BE A FALL AND A
5 LACERATION ON THE HEAD. IT MIGHT BE A STROKE, YOU KNOW,
6 THERE MIGHT BE SOME EVENT THAT TRIGGERS SOME BEHAVIOR
7 CHANGES. AND SO INSTEAD OF BEING ABLE TO STAY IN A
8 LONG-TERM CARE FACILITY, WHICH BLESS THEIR HEARTS, AS MUCH
9 AS THEY WANT TO AND AS GOOD AS THEY ARE, CANNOT GIVE A LOT
10 OF ONE-ON-ONE. I MEAN, THEY HAVE AS MUCH STAFF AS THEY CAN
11 GET AND AS GOOD AS STAFF AS THEY CAN GET IN LONG-TERM CARE
12 FACILITIES AND THEY TRY TO GIVE THE BEST CARE THAT THEY CAN,
13 BUT THEY JUST LITERALLY CANNOT GIVE A LOT OF ONE-ON-ONE WITH
14 PEOPLE WHO ARE LOSING THEIR ABILITY TO FUNCTION.
15 SO THE GEROPSYCH UNIT WAS SET UP, TEN BEDS ON THIS UNIT
16 AND THERE WOULD BE ANYWHERE FROM TWO TO THREE NURSES. THERE
17 WERE A LOT OF SOCIAL WORKERS, YOU KNOW, THEY WOULD DO GROUP
18 THERAPY. THERE WAS THE ABILITY TO HAVE A LOT MORE
19 ONE-ON-ONE IN THIS GEROPSYCH UNIT. SO A LONG-TERM CARE
20 FACILITY MIGHT HAVE AN INDIVIDUAL IN THERE WHO ALL OF A
21 SUDDEN HAS AN ACUTE EVENT, BEHAVIOR BECOMES VERY POOR, THEY
22 ARE COMBATIVE, THEY ARE AGITATED, THEY BECOME DEPRESSED,
23 SOMETHING HAPPENS AND THE LONG-TERM CARE FACILITY SAYS, YOU
24 KNOW, WE'RE NOT GOING TO BE ABLE TO CONTINUE TO HELP THIS
25 PERSON BECAUSE WE CAN'T DO AS MUCH ONE-ON-ONE AS THIS PERSON
19
1 NEEDS.
2 SO THE GEROPSYCH UNIT WAS ESTABLISHED TO MOVE THESE
3 PEOPLE INTO THAT UNIT FOR TWO TO THREE WEEKS. IT WAS NEVER
4 INTENDED TO BE LONG-TERM. MOVE THEM INTO THAT UNIT WHERE
5 THEY GET ONE-ON-ONE, THEY CAN GET GROUP THERAPY, THEIR
6 MEDICATIONS CAN BE ADJUSTED BECAUSE YOU'LL HEAR EXPERTS WHO
7 WILL SAY THAT THERE ARE TIMES WHEN THAT THE MEDICATION THAT
8 THE ELDERLY ARE USING BECAUSE THEY ARE ELDERLY AND THERE'S A
9 DIFFERENT EFFECT, YOU KNOW, BECAUSE MEDICATIONS IN THE
10 ELDERLY BUILD UP, THEY DON'T DISSIPATE AS QUICKLY.
11 SOMETIMES THESE MEDICATIONS CAN CAUSE THE VERY PROBLEM THAT
12 WE WANT TO DEAL WITH, THE AGITATION.
13 PSYCHOTROPIC DRUGS CAN CAUSE THE AGITATION THAT THEY
14 ARE MEANT TO CONTROL. SO YOU HAVE SOMEONE WHO IS COMBATIVE,
15 WHO IS DIFFICULT TO HANDLE, PUT THEM INTO THE GEROPSYCH
16 UNIT, ADJUST THEIR MEDICATIONS -- IN FACT, YOU KNOW, YOU'LL
17 HEAR TESTIMONY EVEN GIVE THEM A DRUG HOLIDAY. TAKE AWAY ALL
18 OF THEIR MEDICATIONS TO SEE IF SOMETHING IN THEIR MEDICATION
19 IS TRIGGERING WHAT THIS PROBLEM IS. SO ADJUST THEIR
20 MEDICATIONS, TRY TO ADJUST THEIR BEHAVIOR, GET -- AND IN
21 OTHER TIMES YOU DO GIVE THEM MEDICATION TO ADJUST THE
22 BEHAVIOR.
23 I'M NOT SAYING THAT GIVING MEDICATIONS NECESSARILY
24 CAUSES THE PROBLEMS. SOMETIMES IT DOES SOLVE THE PROBLEM.
25 BUT GET THEIR BEHAVIOR ADJUSTED SO THAT THEY CAN GO BACK TO
20
1 THE LONG-TERM CARE FACILITY OR BACK TO THEIR HOME AND BE
2 SOMEONE THAT YOU CAN WORK WITH, SOMEONE THAT IS NOT GOING TO
3 BE HITTING OR STRIKING, BITING, KICKING OR UNFORTUNATELY
4 SOME OF THE OTHER THINGS THAT WERE GOING ON.
5 THE GEROPSYCH UNIT WAS A TWO TO THREE-WEEK STAY. IN
6 FACT, YOU KNOW, THE DEFENDANT DID THE PSYCHOLOGICAL
7 EVALUATION ON ALL FIVE PEOPLE THAT WE'RE DEALING WITH IN
8 THIS TRIAL AND EACH TIME HE SAID HE EXPECTED THEM TO STAY
9 TWO TO THREE WEEKS. HE EXPECTED THEM TO GO BACK TO THE
10 LONG-TERM CARE FACILITY WITH A CHANGE IN BEHAVIOR, A CHANGE
11 IN MOOD. YOU WILL SEE THAT BECAUSE RECORDS WILL BE
12 PRESENTED TO YOU AS EVIDENCE. THIS IS NOT A HOSPICE
13 CIRCUMSTANCE.
14 NOW WHAT'S A HOSPICE? A HOSPICE IS A MEDICAL UNIT THAT
15 HAS COME UP OVER THE LAST FEW YEARS. THERE ARE PEOPLE WHO,
16 YOU KNOW, PERHAPS HAVE CANCER OR DEMENTIA THAT ARE SO CLOSE
17 TO THE END OF THEIR LIVES THAT YOU NEED TO PUT THEM IN A
18 CARE CIRCUMSTANCE WHERE THEY CAN BE KEPT COMFORTABLE, YOU
19 KNOW YOU ARE NOT GOING TO MAKE THIS PERSON BETTER. THEY MAY
20 BE IN EXTREME PAIN. I MEAN, OFTEN CANCER PATIENTS ARE IN
21 HOSPICE CIRCUMSTANCES TOWARD THE END OF THEIR LIFE. IF IT'S
22 INCURABLE, THEY MAY BE IN EXTREME PAIN AND IN A HOSPICE
23 SITUATION YOU ARE GIVING THEM MEDICATION TO COMFORT THEM.
24 YOU ARE GIVING THEM MEDICATION TO ALLEVIATE THE PAIN, TO TRY
25 TO MAKE THEIR LAST DAYS AS COMFORTABLE AS POSSIBLE. THIS
21
1 UNIT WAS NOT HOSPICE. IT WAS NOT INTENDED TO BE SOMEPLACE
2 TO KEEP THE DYING COMFORTABLE.
3 IT WAS NOT A MEDICAL UNIT. IT WAS NOT A PLACE WHERE
4 PEOPLE WHO HAD SEVERE MEDICAL PROBLEMS THAT NEEDED ATTENTION
5 FROM A MEDICAL DOCTOR WERE PLACED. IT WAS A PSYCHIATRIC
6 UNIT, WE WANT TO WORK ON BEHAVIOR. IF SOMEONE HAS AN ACUTE
7 MEDICAL PROBLEM, THEY WERE NOT SUPPOSED TO BE ON THAT UNIT.
8 THEY SHOULD HAVE BEEN IN THE HOSPITAL AND IT WAS PART OF THE
9 HOSPITAL, THIS UNIT. THEY SHOULD HAVE BEEN IN THE HOSPITAL
10 TO TAKE CARE OF THAT MEDICAL PROBLEM. IF THEY HAD A STROKE,
11 IF THEY HAD A HEART ATTACK, PUT THEM IN THE MEDICAL UNIT
12 WHERE THEY CAN TAKE CARE OF THAT PROBLEM.
13 YOU'LL HEAR FROM DR. WELBY JENSEN WHO WAS THE FIRST
14 DOCTOR TO BECOME THE DIRECTOR OF THIS UNIT. YOU WILL HEAR
15 FROM THE NURSES ON THE UNIT. THE MAJORITY OF THE NURSES AND
16 THE ONES WE'VE BEEN ABLE TO FIND, YOU WILL HEAR FROM THEM.
17 AS I INDICATED, THE DOCTORS WHO RAN THIS UNIT WERE
18 PSYCHIATRISTS.
19 NOW, PSYCHOLOGISTS AND PSYCHIATRISTS, YOU KNOW, ARE
20 TERMS YOU HEAR ALMOST USED INTERCHANGEABLY. THEY ARE NOT
21 THE SAME. A PSYCHOLOGIST GETS A PH.D. IN PSYCHOLOGY. A
22 PSYCHIATRIST GETS A MEDICAL DEGREE JUST AS ANY OTHER DOCTOR
23 BUT THEN SPECIALIZES IN PSYCHIATRY. SO A PSYCHIATRIST CAN
24 PRESCRIBE MEDICINE, A PSYCHOLOGIST CANNOT. SO AS YOU HEAR
25 THOSE TERMS, YOU WILL UNDERSTAND THAT, YOU KNOW, THE
22
1 DEFENDANT AS A PSYCHIATRIST DID HAVE A MEDICAL DEGREE,
2 ALTHOUGH HE HAD SPECIALIZED IN PSYCHIATRY.
3 YOU'LL HEAR ABOUT PATIENT CARE. CLEARLY THESE FIVE
4 PEOPLE WHO DIED WERE NOT THE ONLY PATIENTS THAT WERE ON THIS
5 UNIT FROM 1994 ON. THESE ARE THE ONES WE'LL BE TALKING
6 ABOUT BUT YOU WILL HEAR THAT THE PEOPLE WHO CAME IN, MOST
7 BUT NOT ALL, WERE DEMENTED. MOST BUT NOT ALL OF THESE FIVE
8 PEOPLE WERE DEMENTED AND DEMENTIA IS A TERMINAL ILLNESS BUT
9 IT'S NOT ONE THAT'S GOING TO TAKE YOU INTO A FEW WEEKS
10 USUALLY, UNLESS YOU ARE AT THE VERY END OF THE DEMENTIA AND
11 YOU CAN NO LONGER SMILE, NO LONGER SIT UP, THAT SORT OF
12 THING. THESE PEOPLE WERE NOT THAT DEMENTED. THEY WERE NOT
13 AT THE END OF THIS DEMENTIA SCALE.
14 THE DEFENDANT WOULD GIVE THEM A PSYCHOLOGICAL
15 EVALUATION AND ON EACH ONE OF THEM. HE WOULD SAY TWO TO
16 THREE WEEKS WE EXPECT THEM TO BE HERE AND THEN THEY'LL GO
17 BACK TO THE LONG-TERM CARE CENTER WITH THEIR BEHAVIOR UNDER
18 CONTROL. NONE OF THESE PEOPLE WERE TERMINAL WHEN THEY CAME
19 IN, NONE WERE HOSPICE. THE NURSES WERE ON THE FRONT LINES
20 IN THIS MATTER, AS YOU CAN IMAGINE. THE NURSES ARE THE ONES
21 WHO ARE THERE FOR THE FULL SHIFT AND MOST OF YOU KNOW HOW
22 DOCTORS COME IN AND OUT AND THAT'S, YOU KNOW, PRETTY
23 STANDARD.
24 BUT WHAT YOU'LL HEAR IS THAT THE DEFENDANT WOULD COME
25 IN EITHER REALLY, REALLY EARLY, MAYBE FIVE OR 5:30 IN THE
23
1 MORNING. ESPECIALLY DURING THE WINTER WHEN HE WANTED TO GO
2 SKIING, HE WOULD COME IN AT FIVE OR 5:30 IN THE MORNING OR
3 HE WOULD COME IN LATER, YOU KNOW, MUCH LATER IN THE EVENING,
4 SOMETIMES OFTEN AFTER THE PATIENTS HAD GONE TO BED. NOW
5 FIVE OR 5:30 IN THE MORNING, MOST OF THESE PEOPLE WERE
6 ASLEEP. LATER IN THE EVENING, I MEAN MOST OF THEM WERE PUT
7 TO BED 8:30, NINE. I MEAN THAT'S PRETTY TYPICAL I THINK FOR
8 ELDERLY PEOPLE SUCH AS THIS. HE WOULD COME IN, HE WOULD
9 LOOK IN AT THE PATIENT WHO MIGHT BE SLEEPING OR SOMETIMES HE
10 WOULD COME DURING GROUPS AND HE WOULD LOOK IN AND THEY
11 WOULD -- THERE WOULD BE A GROUP OF THE PEOPLE SITTING
12 TOGETHER, EITHER INTERACTING TO THE EXTENT THEY COULD OR
13 WATCHING A MOVIE. I MEAN, THE IDEA WAS TO PUT THEM IN
14 GROUPS TO SEE IF THEY COULD GET THEM TO INTERACT AND ADJUST
15 THEIR BEHAVIOR SO THEY WEREN'T BITING AND KICKING AND
16 STRIKING OUT OR IT WAS JUST TO PUT THEM IN GROUPS BECAUSE
17 YOU'VE ONLY GOT TWO OR THREE NURSES THERE AND IF YOU HAVE
18 THEM IN THE ROOM TOGETHER, IT'S EASIER TO KEEP TRACK OF THEM
19 OTHER THAN HAVING THEM ALL IN SEPARATE ROOMS.
20 THE DEFENDANT MIGHT COME IN AND HE WOULD COME IN AND
21 LOOK AT HOW THEY WERE DOING IN GROUPS OR HE'D, YOU KNOW,
22 SCRUNCH DOWN NEXT TO ONE OF THE PATIENTS. THESE ARE NOT
23 PEOPLE THAT YOU USUALLY COULD CARRY ON A LONG CONVERSATION
24 WITH OR HE MIGHT JUST PULL THEM OUT IN THE HALLWAY AND, YOU
25 KNOW, RUN SOME TESTS TO SEE WHAT THEIR PSYCHOLOGICAL STATE
24
1 WAS. BUT HE DIDN'T SPEND A LOT OF TIME WITH THEM. AND IN
2 FACT WHAT YOU WILL SEE WITH ONE PERSON, HE NEVER EVEN MET
3 THE WOMAN. SHE CAME INTO THE UNIT LATER ONE AFTERNOON AND
4 BY 9 O'CLOCK THE NEXT MORNING, SHE WAS GONE. HE WROTE A
5 PSYCHOLOGICAL EVALUATION ON HER BUT HE NEVER EVEN MET HER OR
6 TALKED TO HER.
7 AND THE NURSES WILL TELL AND YOU THE SOME -- WELL, IT
8 WON'T BE AIDES, THEY ARE CNA'S, CERTIFIED NURSING
9 ASSISTANTS, WILL TELL YOU THEY'D SAY HE WOULD COME IN AND
10 LOOK IN THE ROOM AND SEE IF THE PATIENT WAS IN THE BED,
11 PATIENT MIGHT BE SLEEPING, HE WOULD WALK OVER, TALK TO THE
12 NURSE A LITTLE BIT AND THEN HE WOULD WRITE HIS CHART. OKAY,
13 AND THIS IS WHAT'S GOING ON WITH THIS PERSON AT THIS TIME.
14 NOT FROM ANY OF HIS OWN PERSONAL OBSERVATIONS BUT FROM WHAT
15 THE NURSES HAD TOLD HIM.
16 THE NURSES WILL TELL YOU, NOT ALL OF THEM, BUT SOME OF
17 THEM -- I'LL SAY SOME OF THEM. I THINK PROBABLY THE
18 MAJORITY, BUT I'LL JUST STICK WITH SOME OF THEM WILL SAY HE
19 WAS A VERY INTIMIDATING MAN. HE WAS THE DOCTOR AND YOU
20 BETTER DO WHAT HE SAID. YOU KNOW, HE -- HE'D TALK ABOUT A
21 TEAM EFFORT, HOW THIS WAS A TEAM EFFORT. BUT THEY'LL TELL
22 YOU TEAM TO HIM MEANT, YOU DO WHAT I TELL YOU TO DO. I'M
23 THE DOCTOR, YOU DO WHAT I TELL YOU TO DO.
24 SOME OF THESE NURSES SAID -- WILL TELL YOU THESE PEOPLE
25 WOULD COME IN FEISTY, FIGHTING, I MEAN, THAT'S KIND OF WHAT
25
1 YOU ARE TRYING TO TAKE CARE OF. YOU DON'T MIND THEM BEING
2 FEISTY, THAT'S FINE BUT YOU DON'T WANT THE FIGHTING AND
3 BITING AND KICKING AND THAT SORT OF THING. BUT THEY WOULD
4 COME IN FEISTY, THEY WOULD GET MASSIVE DOSES OF PSYCHOTROPIC
5 OF DRUGS -- WELL, I SHOULDN'T SAY MASSIVE, I'M SORRY, THEY
6 WOULD GET DOSES OF PSYCHOTROPIC DRUGS WHICH EXPERTS WILL
7 TELL YOU WHILE THEY MIGHT HAVE BEEN APPROPRIATE FOR A NORMAL
8 ADULT 30 TO 40 YEARS OLD, WERE TOO HIGH FOR ELDERLY PEOPLE
9 WHO HAVE PROBLEMS EXPELLING THE DRUGS.
10 SO THEY WOULD -- PATIENTS WOULD COME IN, THEY WOULD BE,
11 YOU KNOW, PERHAPS AMBULATORY, YOU KNOW, WALKING. SOME
12 NURSES WOULD HAVE TO ALMOST RUN DOWN THE HALLWAY TO FOLLOW
13 THEM TO KEEP UP WITH THEM. THEY WOULD GET THESE DRUGS, THEY
14 WOULD BECOME VERY SEDATED BECAUSE OF THE EFFECT OF THE
15 DRUGS. THEN THERE WOULD COME A POINT WHERE THE DEFENDANT
16 WOULD GO TO THE FAMILY MEMBERS AND SAY YOUR MOTHER OR FATHER
17 OR GRANDMOTHER ARE OR GRANDFATHER IS DYING, DO YOU WANT ME
18 TO KEEP HER OR HIM COMFORTABLE. AND OF COURSE THE FAMILY
19 MEMBERS WOULD SAY, YES. OF COURSE THEY SAY YES AND THEY
20 TRUST THE DEFENDANT BECAUSE HE'S A DOCTOR. AND HE SAYS THAT
21 IT'S TERMINAL, DO YOU WANT ME TO JUST KEEP THEM COMFORTABLE
22 AND THEY SAY YES. AND THEN HE WOULD START MORPHINE WITH
23 THESE PEOPLE.
24 AND YOU WILL HEAR FROM WITNESSES WHO SAY THE USE OF
25 MORPHINE IS USUALLY FOR POSTOPERATIVE PAIN, FOR BROKEN BONE
26
1 PAIN SOMETIMES, FOR CANCER PAIN, FOR EXTREME PAIN. THESE
2 ARE ALL PEOPLE WHO HAD HAD PAIN BEFORE AT ONE TIME OR
3 ANOTHER AND IT HAD BEEN HANDLED WITH TYLENOL, WITH LORTAB,
4 WITH DRUGS THAT DON'T HAVE THE EFFECT THAT MORPHINE HAS.
5 MORPHINE DEPRESSES THE CENTRAL NERVOUS SYSTEM WHICH
6 INCLUDES THE ABILITY TO BREATHE. THE DEFENDANT WOULD CHART
7 THAT THESE PEOPLE APPEARED TO BE IN PAIN, YOU'LL HAVE THE
8 MEDICAL RECORDS AND YOU'LL BE ABLE TO COMPARE. ON SUCH AND
9 SUCH A DATE, PATIENT APPEARS TO BE IN PAIN, GIVE MORPHINE
10 INTRAMUSCULARLY, YOU KNOW, SHOOT IT INTO A MUSCLE. YOU'LL
11 LOOK AT THE NURSING NOTES AND YOU'LL SEE, PATIENT LETHARGIC,
12 UNRESPONSIVE, UNABLE TO EAT, MAY BE MOANING. AND PERHAPS
13 THEN, YOU KNOW, TO GIVE HIM THE BENEFIT OF THE DOUBT, MAYBE
14 HE SAYS, OKAY, WELL, IF THEY ARE MOANING, THEY MUST BE IN
15 PAIN.
16 WHAT YOU'LL HEAR FROM THE EXPERTS IS MORPHINE DEPRESSES
17 THE CENTRAL NERVE SYSTEM, DEPRESSES THE ABILITY TO SWALLOW,
18 THE ABILITY TO BREATHE AND IF ANY OF YOU HAVE TRIED TO HOLD
19 YOUR BREATH OR BEEN SWIMMING UNDER WATER OR ANYTHING LIKE
20 THAT, THE FIGHT TO BREATHE IS MASSIVE. IF YOU ARE RUNNING
21 OUT OF OXYGEN YOUR BODY IS FIGHTING TO BREATHE AND PERHAPS
22 THE MOANING AND GROWING IS HYPOXIA, THE LACK OF OXYGEN. SO
23 WHAT DO YOU DO WHEN A PERSON IS MOANING OR PERHAPS THRASHING
24 AND PERHAPS THEY CAN'T BREATHE? YOU GIVE THEM MORE MORPHINE
25 TO SUPPRESS THEIR BREATHING. I MEAN, THAT ISN'T WHY HE
27
1 WOULD SAY HE GAVE THE MORPHINE, BUT THAT WOULD BE THE EFFECT
2 OF IT. YOU GIVE THEM MORE MORPHINE BECAUSE THEY APPEAR TO
3 BE IN PAIN.
4 THESE FIVE PEOPLE CAME INTO THE UNIT AND SOMETIMES
5 SIGHT UNSEEN HE WOULD START ORDERING DRUGS, PSYCHOTROPIC
6 DRUGS IN DOSES THAT THE EXPERTS WILL TELL YOU THAT WERE TOO
7 HIGH FOR GERIATRIC PATIENTS. INAPPROPRIATE AMOUNTS. AND
8 THEN THE DRUGS WOULD BE TO CALM THE AGITATION. BUT WE WILL
9 PRESENT EVIDENCE TO YOU THAT SHOWS THAT SOME OF THESE DRUGS
10 ONE OF THE SIDE EFFECTS IS AGITATION.
11 SO, YOU KNOW, AND I WON'T GET INTO A LOT OF DETAIL
12 HERE, YOU'LL HEAR IT FROM THE WITNESSES BUT I WANT YOU TO
13 LISTEN FOR THAT. THESE DRUGS WOULD SOMETIMES CAUSE BY SIDE
14 EFFECTS THE VERY PROBLEM THEY WERE SUPPOSED TO BE
15 CORRECTING. OKAY. SO THE PROBLEM INCREASES, SO YOU GIVE
16 THEM MORE DRUGS, SOMETIMES SIGHT UNSEEN. A LOT OF TIMES
17 YOU'LL SEE T.O., TELEPHONE ORDER. YOU KNOW, THE DEFENDANT
18 DIDN'T EVEN COME IN TO LOOK AT THESE PEOPLE. HE WOULD JUST
19 ORDER OVER THE TELEPHONE THAT THEY BE GIVEN THESE DRUGS.
20 THE PATIENT'S HEALTH DECLINED FROM THE DRUGS THAT THEY
21 WERE GIVEN. AS I SAID, THEY CAME IN, YOU'LL HEAR EVIDENCE
22 THEY CAME IN FEISTY, FIGHTING. YOU KNOW, THESE WERE PEOPLE
23 IN THEIR 70'S, 80'S AND 90S, OBVIOUSLY HAVE FOUGHT LONG AND
24 HARD TO GET TO THE AGE THAT THEY ARE, THAT THEY WERE. THEY
25 WOULD BE GIVEN THESE MASSIVE AMOUNTS OF DRUGS THAT HAVE
28
1 THESE SIDE EFFECTS AND THEN YOU WILL SEE IN THE NOTES HOW
2 THEY BECAME LETHARGIC. YOU WILL ALSO SEE THAT THEY KIND OF
3 WENT UP AND DOWN, YOU KNOW, THEY WOULD BE AGITATED, THEN
4 THEY'D BE LETHARGIC; THEY WOULD BE AGITATED, THEN LETHARGIC.
5 THIS YOU WILL HEAR EXPERT TESTIMONY OF WHAT THAT MEANS, WHAT
6 CAN CAUSE THAT IN THIS CIRCUMSTANCE.
7 WHEN THE PATIENTS DECLINED, DEFENDANT WOULD APPROACH
8 FAMILY MEMBERS, DO YOU WANT COMFORT CARE. OF COURSE THEY
9 SAID YES. I MEAN THERE'S -- THAT'S UNDERSTANDABLE, THEY
10 TRUST THE DOCTOR. MORPHINE WOULD BE STARTED, NOT P.R.N.,
11 WHICH IS AS NEEDED FOR PAIN, WHICH IS THE WAY MORPHINE IS
12 USUALLY GIVEN. YOU KNOW, IN A CANCER PATIENT WHO HAS
13 INCURABLE CANCER AND IS IN GREAT PAIN THEY WILL OFTEN PUT
14 WHAT'S CALLED A PUMP ON AND THAT PUMP WILL ALLOW THE PATIENT
15 WHEN THEY FEEL PAIN TO PUSH A BUTTON AND IT WILL RELEASE THE
16 MORPHINE AND THEN IT LOCKS SO THEY COULDN'T, YOU KNOW,
17 CONTINUE TO GIVE THEMSELVES DOSES AT INAPPROPRIATE
18 INTERVALS. BUT MORPHINE IS TO BE GIVEN AS NEEDED FOR PAIN.
19 BUT WHAT THE DEFENDANT WOULD DO IS SAY YOU WILL GIVE
20 MORPHINE TO THESE PEOPLE EVERY THREE OR FOUR HOURS SCHEDULED
21 AROUND THE CLOCK. SOME OF THE NURSES WOULD LOOK AT A PERSON
22 LYING THERE, OUT OF IT, I MEAN, CLEARLY NOT IN ANY PAIN,
23 WOULD NOT GIVE THE MORPHINE DOSE AND THE DEFENDANT BECAME
24 VERY ANGRY AT THAT. THEY HAD A STAFF MEETING AND HE MADE IT
25 VERY CLEAR AND EVEN WROTE IT IN SOME OF HIS NOTES, YOU WILL
29
1 NOT -- HE DIDN'T PUT IT THAT WAY, EXCUSE ME. IF YOU ARE
2 GOING TO WITHHOLD ANY OF THESE MEDS, AND ESPECIALLY
3 MORPHINE, YOU WILL CALL ME FIRST.
4 ONE NURSE IS GOING TO TESTIFY THAT SHE -- YOU KNOW, SHE
5 WENT TO THE DEFENDANT AND SAID, THIS PERSON IS NOT IN PAIN,
6 THIS PERSON IS BASICALLY UNCONSCIOUS. HE SAID, HOW DO YOU
7 KNOW WHETHER THEY ARE IN PAIN? I'M THE DOCTOR, I'M THE
8 EXPERT, HOW DO YOU KNOW? THIS PERSON IS DYING, YOU KNOW,
9 THEY COULD BE IN PAIN, DO YOU WANT TO BE RESPONSIBLE FOR
10 THIS PERSON DYING IN PAIN? THE INTIMIDATION FACTOR WAS SUCH
11 THAT THE NURSE THOUGHT, HE'S THE EXPERT AND I DON'T WANT
12 THIS PERSON TO BE IN PAIN. I DON'T SEE ANY PAIN, I THINK
13 THEY ARE UNCONSCIOUS, BUT SO SHE WENT AHEAD AND GAVE THE
14 DOSE. AND ONE NURSE WILL TELL YOU, I WOULDN'T GIVE IT SO
15 ANOTHER NURSE CAME IN AND DID IT, AND I WANT YOU TO REMEMBER
16 THAT TOO AS YOU LISTEN TO THE NURSES.
17 NURSES HAVE A RESPONSIBILITY JUST LIKE A DOCTOR DOES TO
18 DO NO HARM. THESE NURSES MOST OF THEM WERE NOT MEDICAL
19 NURSES, I.E., THEY WERE PSYCH NURSES. THEY UNDERSTOOD
20 PSYCHIATRIC MATTERS BUT NOT NECESSARILY MEDICAL MATTERS. I
21 MEAN, I THINK EVERYBODY PRETTY MUCH KNOWS WHAT MORPHINE WILL
22 DO. BUT THESE NURSES WERE INTIMIDATED, THEY -- I MEAN, THEY
23 EVEN WENT UP THROUGH THE CHAIN IN THE HOSPITAL, UP THROUGH
24 THEIR CHAIN OF COMMAND. YOU KNOW, I DON'T LIKE THE KIND OF
25 MEDS THAT HE'S GIVING THESE PEOPLE, WHAT'S HAPPENING TO
30
1 THESE PEOPLE HOW THEY COME IN FEISTY AND THEN GO DOWN HILL
2 WITH ALL THESE MEDICATIONS AND THEY WERE BASICALLY TOLD DO
3 WHAT THE DOCTOR TELLS YOU.
4 SO THEY ARE KIND OF BETWEEN A ROCK AND A HARD SPOT.
5 WHAT ARE THEY DO -- WHAT DO THEY DO? THE DOCTOR TELLS THEM,
6 I KNOW BETTER THAN YOU, I AM THE DOCTOR, I HAVE THE MEDICAL
7 DEGREE, YOU WILL DO WHAT I SAY, BUT ON THE OTHER HAND, THEY
8 ARE THINKING THIS PERSON DOESN'T NEED THAT. SOME, AS I
9 SAID, WITHHELD AND WERE TOLD ON NO UNCERTAIN TERMS NOT TO DO
10 THAT ANYMORE.
11 WHAT CAN A NURSE DO IF SHE DOESN'T GET ANY BACKUP FROM
12 HER CHAIN OF COMMAND? THEY JUST SAY GO AHEAD AND DO WHAT
13 THE DOCTOR TELLS YOU. THEIR JOB IS TO GO TO THE DOCTOR
14 FIRST AND SAY, DOCTOR, I DON'T THINK THAT THIS IS
15 APPROPRIATE. BUT IF THE DOCTOR SAYS YOU DO IT BECAUSE I'M
16 TELLING YOU TO DO IT, THEN THEY GO THROUGH THE CHAIN OF
17 COMMAND AND THAT DOESN'T WORK, WHAT CAN THEY DO? THEY CAN
18 GET FIRED. THEY CAN REFUSE TO GIVE THE DRUG AND BE FIRED
19 FOR REFUSING TO GIVE THE DRUG.
20 WHAT HAPPENS WHEN THE PATIENT -- WHEN THAT NURSE IS
21 FIRED FOR REFUSING TO GIVE THE DRUG? THE NEXT NURSE IS
22 HANDED THE SYRINGE BASICALLY OR TOLD YOU WILL GIVE THE DRUG.
23 AND THAT NURSE EITHER LOOKS AT WHAT HAPPENED TO THE FIRST
24 NURSE FOR REFUSING AND SAYS, I CAN'T LOSE MY JOB AND GIVES
25 THE DRUG OR SAYS, NO, I WON'T GIVE IT EITHER. AND WHAT
31
1 HAPPENS THEN? YOU'VE GOT TWO NURSES OUT OF WORK AND IT'S
2 GIVEN TO A THIRD NURSE. YOU KNOW, YOU COULD HAVE GONE
3 THROUGH EVERY NURSE THAT WAS THERE AND THEY COULD ALL QUIT
4 AND EVENTUALLY THERE WOULD HAVE BEEN AND THERE WAS A TIME
5 THAT EVENTUALLY THERE WILL BE A NURSE WHO WILL GIVE THE
6 SHOT. IT DOESN'T SAVE THE PATIENT FOR THE NURSE TO LOSE HER
7 JOB. THAT IS A GENERAL OVERVIEW OF IN GENERAL WHAT WAS
8 GOING ON HERE.
9 THE COURT: YOU MAY WANT TO KEEP UP YOUR VOICE. I
10 DON'T KNOW WHAT'S GOING ON OUTSIDE.
11 MS. BARLOW: OH, THE AIR CONDITIONING RUNNING, I
12 GUESS.
13 THE FIRST PATIENT OF THESE FIVE, OF COURSE NOT THE
14 FIRST PATIENT ON THE UNIT, BUT THE FIRST PATIENT OF THESE
15 FIVE TO COME INTO THIS UNIT WAS JUDITH LARSEN. JUDITH -- OF
16 COURSE THIS IS NOT A PICTURE FROM WHEN SHE WAS IN THE
17 HOSPITAL BUT AROUND THE TIME. JUDITH CAME ON TO THE UNIT
18 DECEMBER 6TH OF 1995. SHE HAD BEEN IN THE CARE CENTER. SHE
19 HAD HAD A HABIT OF CLIMBING OUT OF THE BED AND FALLING. SHE
20 WAS HAVING TO HAVE STITCHES IN HER HEAD FROM FALLING. SHE
21 HAD A STROKE IN JANUARY OF 1995. SHE WAS BECOMING MORE
22 AGITATED, MORE DIFFICULT TO HANDLE IN THE LONG-TERM CARE
23 CENTER.
24 SO SHE CAME IN THE 6TH OF DECEMBER 1995. A
25 PSYCHOLOGICAL EVALUATION SAYS, YOU KNOW, SHE'S DEMENTED.
32
1 SHE DOES HAVE PHYSICAL HEALTH PROBLEMS. YOU WILL HEAR FROM
2 THE PRIOR DOCTORS FOR ALL OF THESE PEOPLE ABOUT WHAT OTHER
3 HEALTH PROBLEMS THEY HAD. SHE WAS TO BE THERE FOR TWO
4 WEEKS, THAT'S WHAT THE DEFENDANT WROTE IN THE PSYCH
5 EVALUATION. THEY WERE GOING TO DECREASE HER PSYCHOSES AND
6 DECREASE HER DEPRESSION AND SHE WAS TO GO BACK TO THE
7 LONG-TERM CARE CENTER. SHE WAS IMMEDIATELY GIVEN
8 PSYCHOTROPIC DRUGS TO CONTROL HER BEHAVIOR. JUDITH WAS 93
9 YEARS OLD. JUDITH HAD A VERY STRONG CONSTITUTION.
10 DURING THE MONTH OF DECEMBER, EVEN THOUGH I DON'T
11 BELIEVE YOU'LL FIND ANYTHING IN THE NURSING NOTES THAT SAYS
12 THERE WAS ANY INDICATION OF PAIN, JUDITH WAS GIVEN MORPHINE.
13 ONE OF THE NURSES WILL TELL THAT YOU SHE CAME TO THE DOCTOR,
14 THIS NURSE IS ONE WHO DID HAVE A MEDICAL/SURGICAL
15 BACKGROUND. SHE WASN'T A PSYCH NURSE, SHE WAS A MED/SURG
16 NURSE AND SHE WENT TO THE DEFENDANT AND SHE SAID THIS WOMAN
17 DOESN'T NEED MORPHINE AND THE DEFENDANT DISCONTINUED THE
18 MORPHINE FOR A PERIOD OF TIME.
19 TOWARDS THE END OF DECEMBER, SO WE'RE NOW LOOKING AT
20 THREE OR FOUR WEEKS INTO HER STAY OF WHAT WAS TO BE A TWO OR
21 THREE-WEEK STAY, SHE STARTS HAVING SOME MEDICAL PROBLEMS.
22 SHE STARTS VOMITING. THE NURSE CALLS -- AND IT STARTED
23 DURING THE EVENING AND THE NURSE KEPT CALLING THE DEFENDANT
24 WHO DID NOT RESPOND FOR QUITE SOME TIME. AND THERE'S A REAL
25 CONCERN WITH DEHYDRATION WITH ELDERLY PEOPLE BUT ESPECIALLY
33
1 WITH VOMITING, YOU KNOW, I THINK, YOU KNOW, MOST OF US
2 RECOGNIZE THAT AND THE NURSE HELD THE MEDS. SHE DIDN'T GIVE
3 THE MEDICATION THAT HAD BEEN ORDERED.
4 WELL, ON THE 31ST OF DECEMBER MORPHINE WAS ORDERED FOR
5 EVERY 12 HOURS AROUND THE CLOCK. NOT P.R.N., NOT ACCORDING
6 TO THE PAIN, NOT IF YOU SAW ANY PAIN OR INDICATIONS OF PAIN,
7 BUT JUST GIVE IT EVERY FOUR HOURS AROUND THE CLOCK. AT THAT
8 TIME, THE NURSES SAY SHE WAS UNRESPONSIVE, SHE WAS MOANING
9 WHEN TURNED, SHE MOANED WHEN SHE WAS GIVEN THE SHOT, YOU
10 KNOW, SO SHE WAS RESPONSIVE TO MOTION AND THAT SORT OF
11 THING. BUT AT THIS POINT WE'RE TALKING IS HER RESPIRATORY
12 SYSTEM BEING SUPPRESSED SUCH THAT THE MOANING IS INDICATIVE
13 OF, I'M NOT GETTING ENOUGH OXYGEN BUT I AM SO SEDATED BY THE
14 DRUGS THAT YOU GAVE ME I CAN'T EVEN TELL YOU WHAT MY PROBLEM
15 IS?
16 THE COURT: EXCUSE ME, LADIES AND GENTLEMEN, ARE
17 YOU ABLE TO HEAR WITH THE RAIN AND EVERYTHING? OKAY. IF
18 YOU NEED TO MOVE CLOSER, YOU KNOW, FEEL FREE TO DO THAT.
19 MS. BARLOW: I'LL TRY TO USE A SCHOOL TEACHER
20 VOICE.
21 THE COURT: OKAY.
22 MS. BARLOW: DRUGS CONTINUED. THE MORPHINE
23 CONTINUED THROUGH THE 31ST OF DECEMBER, THE 1ST, THE 2ND AND
24 INTO THE 3RD OF JANUARY. NOW MORPHINE IS GIVEN, YOU KNOW,
25 MAYBE 1 MILLIGRAM TO 2 MILLIGRAMS. THESE ARE PEOPLE WHO
34
1 WEREN'T USED TO GETTING MORPHINE. I MEAN, PEOPLE WHO ARE
2 USED TO GETTING MORPHINE YOU CAN GIVE THEM LARGE DOSES.
3 PEOPLE IN TERMINAL PAIN WHO HAVE BEEN GETTING MORPHINE FOR A
4 TIME, YOU CONTINUE TO INCREASE THE DOSE TO HANDLE THE PAIN.
5 THESE PEOPLE STARTED OUT WITH MAYBE ONE OR 2 MILLIGRAMS OF
6 MORPHINE, MAYBE 5 MILLIGRAMS, WHICH IS, YOU KNOW, A NORMAL
7 DOSE IN A NORMAL HEALTHY ADULT.
8 JUDITH LARSEN THE LAST -- FROM MIDNIGHT, MIDNIGHT AND
9 THEN 12:01 ON THE 3RD OF JANUARY UNTIL 8 O'CLOCK THAT
10 EVENING WHEN SHE PASSED AWAY, HAD OVER 100 MILLIGRAMS OF
11 MORPHINE ADMINISTERED TO HER. THEY WEREN'T 5 MILLIGRAMS
12 SHOTS. THEY BECAME 25 MILLIGRAMS, 30 MILLIGRAMS,
13 40 MILLIGRAMS OF MORPHINE. AND THE NURSING NOTES WILL SHOW
14 YOU SHE WAS IN NO PAIN, SHE WAS NOT CONSCIOUS, SHE COULD NOT
15 HAVE BEEN IN PAIN, AND YET THE DRUG DOSES JUST KEPT
16 INCREASING. AND SOMETIMES THEY WERE GIVEN MORE QUICKLY THAN
17 THE THREE HOURS. JUDITH LARSEN WAS THERE ALMOST A MONTH,
18 SHE DID NOT GO WILLINGLY. I'LL SET THIS OVER HERE.
19 THE NEXT PATIENT IN TERMS OF TIME COMING ON THE UNIT
20 DURING THIS TIME FRAME -- NOW, REMEMBER, SHE PASSED AWAY THE
21 3RD OF JANUARY, JUDITH LARSEN DID.
22 THE NEXT WOMAN TO COME IN WAS LYDIA SMITH. SHE CAME IN
23 THE ON THE 20TH OF DECEMBER. THE NURSES WILL TELL YOU SHE
24 HAD A LONG BRAID OF HAIR THAT YOU DON'T REALLY SEE IN THIS
25 PICTURE, BUT IT WAS PULLED AND BRAIDED AND A LOT OF THEM
35
1 WILL REMEMBER HER BECAUSE OF HER LONG BRAID OF HAIR AND SHE
2 WAS FEISTY. SHE WAS SMALL, SHE WAS THINNER THAN THIS BUT
3 SHE WAS REALLY FEISTY AND UP AND GOING AND -- YOU KNOW, ONE
4 NURSE WILL SAY, YOU KNOW, SHE WANTED TO TAKE ON THE WHOLE
5 STAFF. SHE WAS 90 YEARS OLD AND SHE WAS STILL PRETTY FEISTY
6 BUT, AGAIN, DEMENTED. HER QUALITY OF LIFE WAS GOING DOWN, I
7 MEAN, THERE'S NO QUESTION OF THAT.
8 SHE HAD HAD A STROKE IN MID NOVEMBER THAT HAD CAUSED AN
9 ACUTE CHANGE IN HER BEHAVIOR. SHE WAS AGITATED, SHE WAS
10 DEPRESSED. THE DEFENDANT DOES A PSYCHOLOGICAL EVALUATION,
11 SAYS SHE'LL BE HERE THREE WEEKS AND WHEN SHE LEAVES SHE'LL
12 HAVE AN IMPROVED MOOD. STARTED GIVING THE PSYCHOTROPIC
13 DRUGS IMMEDIATELY AND, AGAIN, I MEAN SHE'S AGITATED AND
14 SHE'S AGGRESSIVE, SOMETIMES THESE DRUGS WILL INCREASE THAT
15 AND IT -- THE NURSING NOTES WILL SHOW YOU SHE IS AGGRESSIVE
16 AND SHE'S ACTIVE AND SHE'S FEISTY. THERE'S NO APPARENT
17 PAIN. I MEAN, PAIN YOU USUALLY -- YOU KNOW, IF YOU HAVE A
18 HEADACHE YOU JUST DON'T MOVE ME, BUT SHE WAS AGGRESSIVE AND
19 SHE WAS FEISTY. SO THAT WAS ON THE 20TH OF DECEMBER.
20 SHE GOES ALONG GETTING THE REGULAR MEDICATIONS, BECOMES
21 IN DECLINING HEALTH, BECOMES SEDATED, BECOMES LETHARGIC,
22 BECOMES UNRESPONSIVE, ALL SIDE EFFECTS OF THESE PSYCHOTROPIC
23 DRUGS. THE MEDICAL NOTES WILL SHOW YOU FROM THE 4TH THROUGH
24 THE 7TH SHE'S QUIET, SHE BECOMES AGITATED AND THEN LETHARGIC
25 AGAIN ONE DAY. SHE SLEEPS MOST OF ONE DAY, SHE'S QUIET AND
36
1 LETHARGIC ON THE 7TH. THERE ARE SOME CONCERNS ABOUT
2 BREATHING. THE DEFENDANT IS CALLED A COUPLE OF TIMES,
3 DOESN'T CALL BACK.
4 EVENTUALLY THE DEFENDANT CALLS BACK. HE ORDERS
5 MORPHINE EVERY THREE HOURS AND IT WAS LATER IN THE DAY ON
6 THE 7TH THAT HE ORDERED THAT. THREE OF THE FOUR DOSES THAT
7 WERE ROUTINE, SCHEDULED WERE GIVEN. THE FOURTH WAS HELD
8 BECAUSE OF HER STATE. I MEAN THERE WAS NO APPEARANCE OF
9 PAIN TO THE NURSE, SO SHE HELD THAT. THAT WAS 5 MILLIGRAMS,
10 THOSE DOSES WERE 5 MILLIGRAMS EACH.
11 ON THE 8TH HE UPPED IT TO 10 MILLIGRAMS. THIS WOMAN IS
12 UNRESPONSIVE, SHE'S QUIET, SHE'S LETHARGIC, THERE'S NO
13 APPARENT APPEARANCE OF PAIN AND YET HE INCREASES THE
14 MORPHINE. SHE'S GIVEN A MORPHINE SHOT AT NINE IN THE
15 MORNING, AGAIN AT 12 NOON, AND BY 12:45, SHE HAD PASSED
16 AWAY. THE EXPERTS WILL TELL THAT YOU THERE AREN'T REALLY
17 ANY MEDICAL REASONS FOR THESE PEOPLE TO DIE OTHER THAN THEIR
18 CENTRAL NERVOUS SYSTEM IS SO DEPRESSED AND THEY ARE HAVING
19 TROUBLE GETTING OXYGEN, HAVING TROUBLE BREATHING. THIS IS
20 LYDIA SMITH.
21 THE THIRD PERSON TO COME ON THE UNIT DURING THIS TIME
22 FRAME WAS MARY CRANE. SHE CAME ONTO THE UNIT ON THE 28TH OF
23 DECEMBER. SHE'S 72 YEARS OLD. SHE HAD HAD A STROKE IN
24 1989. SHE HAD A HERNIATED DISK AND DID HAVE SOME LOW BACK
25 PAIN. IN THE NURSING HOME THAT HAD BEEN TAKEN CARE OF
37
1 THROUGH TYLENOL, LORTAB, YOU KNOW, SOME OF THE LESS SEVERE
2 PAIN MEDICATIONS, HAD CONTROLLED HER PAIN IN THE NURSING
3 HOME. SHE COMES IN AND, AGAIN, SHE HAS A PSYCHOLOGICAL
4 EVALUATION. SHE'S GOING TO BE THERE TWO TO THREE WEEKS, YOU
5 KNOW, AND HER BEHAVIOR IS GOING TO BE MODIFIED BY THE TIME
6 SHE IS RELEASED AGAIN.
7 SHE IS GIVEN WHAT'S CALLED A DURAGESIC PATCH FOR THE
8 PAIN OF HER LOWER BACK. IT'S A PATCH THAT IS PLACED ON AND
9 LEFT ON FOR THREE DAYS AND IT HAS A PAIN MEDICATION THAT IS
10 RELEASED THROUGH THE SKIN AND YOU'LL HEAR A LOT OF TESTIMONY
11 ABOUT JUST HOW THIS WORKS. IT'S THE KIND OF THING THAT IT
12 RELEASES THE PAIN MEDICATION AND AFTER YOU TAKE THE PATCH
13 OFF, THE PAIN MEDICATION IS STILL GOING INTO YOUR SYSTEM FOR
14 AN EXTENDED PERIOD OF TIME. AND WITH THE ELDERLY IT'S AN
15 EVEN MORE EXTENDED PERIOD OF TIME AFTER THE PATCH IS GONE.
16 A 25 MILLIGRAM PATCH IS PLACED ON WHICH IS A NORMAL
17 DOSE. IT FELL OFF THE NEXT MORNING FOR WHATEVER REASON AND
18 ANOTHER PATCH WAS PUT ON IMMEDIATELY NOT ALLOWING THE
19 MEDICATION THAT WAS STILL IN THE SYSTEM FROM THE FIRST PATCH
20 TO DISSIPATE. AND THESE ARE THREE-DAY PATCHES, YOU KNOW,
21 AND IF YOU STICK MORE THAN ONE ON, YOU KNOW, YOU STILL GOT
22 WHAT'S GOING FROM THE FIRST PATCH IN THE SYSTEM. THERE'S A
23 MEDICAL CONSULT. DR. DIENHART IS CALLED IN TO TALK TO MARY
24 CRANE TO LOOK AT MARY CRANE'S PHYSICAL CONDITION. THAT
25 OCCURRED ON THE FIRST -- OKAY, LET ME BACK UP A LITTLE BIT.
38
1 SO THE FIRST PATCH WAS 25 MILLIGRAMS. WHEN THE SECOND
2 PATCH WAS PUT ON THE DEFENDANT INCREASED THAT TO
3 50 MILLIGRAMS, EVEN THOUGH NOTHING HAD REALLY CHANGED
4 BECAUSE IT WAS AROUND THE SAME TIME, YOU KNOW, WITHIN 24
5 HOURS, HE SAYS PUT ON A 50 MILLIGRAMS WHICH IS GETTING UP
6 THERE IN DOSAGE FOR A GERIATRIC PERSON.
7 ON THE 1ST OF JANUARY DR. DIENHART, I THINK HE'S AN
8 INTERNIST, YOU'LL HEAR FROM HIM AND HE'LL TELL YOU EXACTLY
9 WHAT HIS SPECIALTY IS, BUT HE DEALS WITH MEDICAL CONDITIONS,
10 NOT PSYCHOLOGICAL CONDITIONS. HE SAW HER ON THE 1ST OF
11 JANUARY AND DECREASED THE DOSAGE BACK DOWN TO 25. THE
12 DEFENDANT THE VERY SAME DAY WITHIN AN HOUR HAD THEM TAKE
13 THAT PATCH OFF AND PUT -- PROBABLY NOT TAKE IT OFF, BUT PUT
14 SOMETHING ON SO THAT SHE HAD 50 AGAIN. SO YOU'VE GOT THE
15 MEDICAL DOCTOR SAYING 25 IS PLENTY, YOU'VE GOT THE
16 PSYCHIATRIST WHO IS AN M.D. SAYING, NO, I'M GOING BACK UP TO
17 50, WITHIN AN HOUR. SO THE DURAGESIC PATCH IS THERE FOR THE
18 LOWER BACK PAIN AND THERE'S NO INDICATION THAT SHE'S IN
19 EXCRUCIATING PAIN. YOU KNOW, THE DURAGESIC PATCH WILL TAKE
20 CARE OF THE LOWER BACK PAIN. - ??
21 ON THE 3RD OF JANUARY, THE DEFENDANT ORDERS MORPHINE
22 AND A COUPLE OF SHOTS OF MORPHINE ARE GIVEN. ON THE 4TH OF
23 JANUARY ANOTHER SHOT OF MORPHINE AT 6:30 IN THE MORNING.
24 NOW THIS IS ON TOP OF THE DURAGESIC PATCH. THAT DAY THE
25 DEFENDANT UPS THE DURAGESIC TO 75 MILLIGRAMS WHICH IS THREE
39
1 TIMES WHAT A GERIATRIC DOSE OUGHT TO BE. ON THE 7TH OF
2 JANUARY, THE DURAGESIC PATCHES ARE THERE, MORPHINE IS BEING
3 ADMINISTERED, ROUTINELY, SCHEDULED AROUND THE CLOCK.
4 DEFENDANT SAYS HOLD ALL THE OTHER DRUGS EXCEPT THE MORPHINE
5 AND THE DURAGESIC, DON'T GIVE ANY OF THE OTHER DRUGS, YOU
6 KNOW, FOR ANY OTHER MEDICAL CONDITION.
7 THERE'S A MEDICAL CONSULT DR. DIENHART COMES IN, HE
8 LOOKS AT THIS WOMAN AND HE WRITES IN THE NOTES, SHE MAY DIE
9 SOON, AND INDEED SHE DID DIE THAT DAY AT 11:35 IN THE
10 MORNING. AGAIN, A CIRCUMSTANCE WHERE SHE COMES IN, GETS
11 LOADED UP WITH PSYCHOTROPIC DRUGS, DECLINES IN HEALTH AND HE
12 GOES TO THE FAMILY MEMBERS AND SAYS, DO YOU WANT COMFORT
13 CARE AND OF COURSE THEY SAY YES AND THEN HE STARTS GIVING
14 MORPHINE ON TOP OF THE DURAGESIC WHICH IS ALREADY THREE
15 TIMES THE DOSAGE THAT IT OUGHT TO BE AND SHE DIES. THAT'S
16 MARY CRANE.
17 ELLEN ANDERSON CAME IN THE ON THE 29TH OF DECEMBER AND
18 17 HOURS LATER SHE WAS GONE. SHE HAD HAD A HIP FRACTURE.
19 SHE DID HAVE OSTEOPOROSIS WHICH IS -- CAN BE PAINFUL. SHE
20 HAD HAD A HIP FRACTURE IN JUNE OF '95, HAD HAD THAT
21 REPAIRED, HAD HAD AN OPERATION ON IT. BUT COMING OUT OF
22 THAT OPERATION SHE HAD COME OUT ANXIOUS AND DEPRESSED, HATED
23 TO BE LEFT ALONE AND, OF COURSE, THAT CAUSES PROBLEMS WITH
24 CARE GIVERS EITHER AT HOME OR AT A LONG-TERM CARE FACILITY
25 BECAUSE, YOU KNOW, YOU CAN'T SPEND EVERY MINUTE WITH PEOPLE.
40
1 IT'S JUST -- WE ALL HAVE LIVES UNFORTUNATELY. NOT
2 UNFORTUNATELY, WE DO HAVE THEM -- FORTUNATELY, I GUESS.
3 SHE CAME IN, SHE WAS GIVEN BY TELEPHONE ORDER
4 PSYCHOTROPIC MEDICATIONS AND TYLENOL AND MORPHINE WERE
5 ORDERED FOR PAIN. SHE RECEIVED A MORPHINE SHOT AT NINE --
6 1930 THE EVENING OF THE 29TH, WHICH IS 7:30 IN THE EVENING.
7 SHE CAME IN AT 4 O'CLOCK THAT EVENING. AT ONE IN THE
8 MORNING HER BREATHING WAS ERRATIC. HER BREATHING WAS EIGHT
9 TO 16 BREATHS PER MINUTE. SIXTEEN IS NORMAL, EIGHT IS LOW.
10 THERE'S A PROBLEM. THE CENTRAL NERVOUS SYSTEM IS
11 SUPPRESSED, AND, YOU KNOW, SHE MIGHT ONLY BE TAKING EIGHT
12 BREATHS A MINUTE BECAUSE THAT AUTOMATIC SYSTEM ISN'T WORKING
13 BECAUSE OF THE MEDICATION THAT IS SUPPRESSING IT.
14 DEFENDANT WAS PAGED AT ONE IN THE MORNING, NO RESPONSE.
15 AT 3:15 SHE WOKE UP, SHE WAS THRASHING, THE NURSE THOUGHT
16 SHE WAS IN PAIN BECAUSE OF HER THRASHING. WAS IT PAIN OR
17 WAS IT LACK OF OXYGEN WHICH CAN ALSO CAUSE A PERSON TO FIGHT
18 FOR BREATH. DEFENDANT WAS PAGED AGAIN AT 3:15. AT 3:30 HE
19 CALLED BACK AND SAID GIVE HER A SHOT OF MORPHINE WHICH THE
20 NURSE DID. AT 6:30 THE NURSE SAID SHE'S BEEN SLEEPING SINCE
21 THEN.
22 AT 6:30 IN THE MORNING AN E.K.G. AND A CHEST X-RAY IS
23 DONE. THE BREATHING IS STILL ERRATIC, YOU HAVE THE MORPHINE
24 ON BOARD AS THEY SAY, IN THE SYSTEM. THE E.K.G. SHOWS THAT
25 THERE IS AN ARRHYTHMIA, THAT THE HEART IS NOT PUMPING LIKE
41
1 IT OUGHT TO BE PUMPING. SHE'S HAD TWO SHOTS OF MORPHINE.
2 BY 8:55 THAT MORNING SHE WAS GONE.
3 THE DEFENDANT NEVER SAW HER. HE ORDERED THE DRUGS
4 WITHOUT EVER SEEING HER AND AFTER THE FACT -- IT'S
5 INTERESTING AS YOU READ IN HIS NOTES, HE INDICATES SHE CAME
6 IN ON 12/29, HAD AN E.K.G. UPON ADMISSION, AND I GUESS
7 TECHNICALLY THEY SAY THAT IF IT'S WITHIN 24 HOURS OF
8 ADMISSION, IT'S STILL CALLED ON ADMISSION. BUT THAT E.K.G.
9 WAS AFTER THE MORPHINE AND THE ARRHYTHMIA, THE IRREGULAR
10 RHYTHM WAS AFTER THE MORPHINE. BUT IN HIS REPORT HE WRITES,
11 WELL, SHE HAS ARRHYTHMIA UPON ADMISSION. THAT WAS AFTER THE
12 MORPHINE, BUT HE DOESN'T SAY THAT, HE DOESN'T WRITE THAT IN
13 HIS REPORT.
14 HE WROTE THE PSYCHOLOGICAL EVALUATION AFTER SHE DIED.
15 HE NEVER TALKED TO HER BUT HE JUST LOOKED AT, YOU KNOW,
16 WHATEVER ELSE HAD BEEN WRITTEN AND WRITES A PSYCHOLOGICAL
17 EVALUATION. HE IN HIS NOTES SAYS IT WAS DICTATED THE DAY
18 THAT SHE CAME IN. THAT'S NOT TRUE. IT WAS DICTATED AND
19 WRITTEN AFTER SHE DIED.
20 AND THAT POINTS OUT SOMETHING I WANT YOU TO PAY CLOSE
21 ATTENTION TO AS YOU GET THE MEDICAL RECORDS HERE. LOOK AT
22 WHO SAYS THESE PEOPLE ARE IN PAIN. THERE'S ONE OR TWO
23 NURSES THAT YOU WILL SEE THAT INDICATE SOME PAIN. BUT MOST
24 OF THE TIME YOU WILL SEE THAT IT'S THE DEFENDANT WHO WRITES,
25 APPEARS TO BE IN PAIN. YOU LOOK AT THE COMPARABLE NURSING
42
1 NOTES FOR THAT TIME PERIOD, THE NURSES AREN'T SAYING THAT.
2 HE WAS JUSTIFYING GIVING THE MORPHINE. THAT'S ELLEN
3 ANDERSON.
4 ENNIS ALLDREDGE CAME INTO THE UNIT ON THE 10TH OF
5 JANUARY OF 1996. HE WAS 82 YEARS OLD WHEN HE CAME INTO THE
6 UNIT. HE WAS AGGRESSIVE, HE WAS COMBATIVE, HE HAD BEEN
7 HITTING PEOPLE AT THE LONG-TERM CARE FACILITY. HE HAD ONLY
8 BEEN IN THE NURSING HOME SINCE SEPTEMBER OF 1995 AND, AGAIN,
9 THERE WAS AN ACUTE EVENT THAT HIS BEHAVIOR BECAME SUCH THAT
10 THEY COULD NOT CONTROL IT, COULDN'T HANDLE IT. HE WAS
11 DEMENTED.
12 HE CAME IN, A PSYCHOLOGICAL EVALUATION WAS DONE. HE'S
13 INTENDED TO STAY AT THE UNIT TWO TO THREE WEEKS. IT WAS
14 INTENDED THAT HE WOULD LEAVE THE UNIT WITH BEHAVIOR UNDER
15 CONTROL. IMMEDIATELY GIVEN PSYCHOTROPIC DRUGS THAT HAVE THE
16 SIDE EFFECTS OF SEDATION AND DEPRESSION OF THE CENTRAL
17 NERVOUS SYSTEM, COULD EVEN CAUSE THE AGITATION BECAUSE THEY
18 KEEP A PERSON FROM GETTING OXYGEN. HE BECAME UNRESPONSIVE
19 OVER TIME. HE WAS ONLY THERE FOUR DAYS, LABORED BREATHING,
20 ALL THE EXPERTS WILL TELL YOU AS A CONSEQUENCE OF THE
21 OVERMEDICATION THAT WAS HAPPENING HERE.
22 HIS FAMILY WAS TOLD HE IS TERMINAL, YOU KNOW, HE'S COME
23 IN FEISTY AND COMBATIVE, HE'S GIVEN THE DRUGS, HE DROPS, THE
24 DEFENDANT SAYS HE'S TERMINAL, DO YOU WANT ME TO KEEP HIM
25 COMFORTABLE? OF COURSE THE FAMILY SAYS YES. NOBODY WANTS
43
1 THEIR FAMILY MEMBERS TO SUFFER OR THEIR LIVES PROLONGED SO
2 THEY CAN SUFFER SO THEY AGREE TO WHAT'S CALLED PALLIATIVE
3 CARE, COMFORT CARE, WHICH IN THE DEFENDANT'S MIND MEANS
4 MORPHINE. HE IS GIVEN MORPHINE EVERY THREE HOURS STARTING
5 ON THE 13TH AND ON THE 14TH HE PASSES AWAY. THIS IS ENNIS
6 ALLDREDGE.
7 YOU WILL HEAR TESTIMONY OF THEIR PRIOR MEDICAL
8 HISTORIES. YOU'LL HEAR TESTIMONY OF WHAT MEDICAL PROBLEMS
9 THEY HAD. YOU WILL HEAR TESTIMONY OF WHAT KILLED THEM. YOU
10 WILL HEAR TESTIMONY FROM FAMILY MEMBERS ABOUT WHAT THEIR
11 FATHER AND MOTHERS WERE LIKE. YOU'LL HEAR EXPERTS TELL YOU
12 ABOUT THESE DOSES OF DRUGS AND THE EFFECTS OF THESE DRUGS IN
13 THE ELDERLY AND I HOPE YOU'LL PAY PARTICULAR ATTENTION TO
14 THAT.
15 AND I'M GLAD THAT YOU HAVE NOTE PADS BECAUSE, YOU KNOW,
16 WE TRY TO MAKE IT -- YOU KNOW, WE TRY TO GET DOCTORS TO TALK
17 IN OUR LANGUAGE, YOU KNOW, AND HOPEFULLY WE CAN MAKE IT
18 COMPREHENSIBLE. BUT THERE'S GOING TO BE A LOT OF
19 INFORMATION THAT COMES TO YOU OVER THE NEXT FEW WEEKS AND I
20 HOPE THAT YOU'LL BE ABLE TO ABSORB IT AND KEEP IT ALL IN
21 MIND AS YOU GO TO DELIBERATE.
22 THE LAW DOES NOT REQUIRE TO US TO PROVE TO YOU OR TO
23 GIVE YOU EVIDENCE OF WHY THE DEFENDANT DID WHAT HE DID.
24 THAT'S NOT ONE OF THE ELEMENTS OF THE CRIME. MENTAL STATE
25 IS, BUT NOT WHY. BUT YOU HAVE TO THINK WHY. I THINK AS YOU
44
1 LISTEN TO THE EVIDENCE YOU WILL GET A FEELING FOR WHY. AND
2 THE WHY IS NOT BECAUSE HE FEELS SYMPATHETIC FOR THESE PEOPLE
3 WHOSE QUALITY OF LIFE HAS GONE DOWNHILL. THERE'S NO
4 QUESTION OF THAT. THEY ARE DEMENTED. MOST OF THEM, NOT ALL
5 OF THEM, BUT MOST OF THEM ARE DEMENTED, BUT THEY WEREN'T AS
6 BAD COMING IN AS THEY BECAME AFTER HE STARTED MEDICATING
7 THEM.
8 SO WHY DID HE DO IT? I THINK YOU'LL SEE EVIDENCE OF
9 MONEY IS PART OF IT BUT, YOU KNOW, AND AS MUCH AS YOU HATE
10 TO SEE IT, I THINK THAT YOU'LL SEE THE REASON IS HE DIDN'T
11 LIKE THESE PEOPLE. THEY WERE OLD. THEY DIDN'T HAVE MUCH
12 USE ON THE EARTH ANYMORE. NOT OUT OF SYMPATHY FOR THEM, BUT
13 AARRH JUST SEND THEM ON. NOT ONLY THAT BUT SEND THEM ON SO
14 I CAN GET SOMEBODY ELSE INTO THIS BED BECAUSE AS I DO THE
15 PSYCHOLOGICAL EVALUATIONS AND ALL THE TESTING UP FRONT, I
16 GET PAID MORE.
17 I THINK IT'S HARD TO UNDERSTAND THAT ANYONE COULD DO
18 THAT FOR THOSE REASONS AND I THINK THE EVIDENCE WILL SHOW
19 YOU THAT THAT'S EXACTLY WHAT HAPPENED. BUT REMEMBER, IT IS
20 NOT OUR BURDEN TO SHOW TO YOU WHY HE DID THIS, ONLY THAT HE
21 DID DO IT WITH THE REQUISITE MENTAL STATE. BUT I MEAN
22 THERE'S GOT TO BE SOMETHING THAT WE ALL THINK WHY ON EARTH
23 WOULD SOMEONE DO THIS? THERE'S NO UNDERSTANDING TO WHY
24 SOMETIMES PEOPLE DO WHAT THEY DO, BUT I THINK YOU WILL GET A
25 SENSE OF THAT AS YOU HEAR THE EVIDENCE.
45
1 I APPRECIATE YOUR ATTENTIVENESS. I APPRECIATE IN
2 ADVANCE YOUR ATTENTIVENESS DURING THIS TRIAL. AS THE
3 WITNESSES COME ON AND AT THE CONCLUSION OF THE TRIAL, WE
4 WILL BE ASKING YOU TO DELIBERATE AND TO COME BACK WITH A
5 VERDICT OF GUILTY OF ALL FIVE COUNTS OF HOMICIDE. THANK
6 YOU.
7 THE COURT: THANK YOU. OKAY. LADIES AND
8 GENTLEMEN, WE'RE NOW GOING TO TAKE A BREAK. AND AT EACH
9 RECESS I'M GOING TO BE TELLING YOU THIS AND I HOPE THAT JUST
10 BECAUSE I TELL YOU THIS AT EACH RECESS YOU STILL LISTEN TO
11 IT. IT IS YOUR DUTY NOT TO CONVERSE AMONG YOURSELVES OR TO
12 CONVERSE WITH OR ALLOW YOURSELVES TO BE ADDRESSED BY ANY
13 OTHER PERSON ON ANY SUBJECT OF THE TRIAL, AND THAT IT IS
14 YOUR DUTY NOT TO FORM OR EXPRESS AN OPINION UNTIL THE CASE
15 IS FINALLY SUBMITTED TO YOU.
16 I THINK THE RAIN HAS STOPPED AND SO ANYBODY WHO WANTS
17 TO GO OUTSIDE YOU CAN GO OUTSIDE THE DOOR THAT YOU CAME IN.
18 THE ONLY THING I WOULD ASK YOU TO DO IS IF YOU WOULD NOT
19 CONGREGATE RIGHT AT THAT DOOR. THAT YOU WOULD GO EITHER ON
20 THE GRASS OR OUT IN THE PARKING LOT SIMPLY BECAUSE COURT
21 PERSONNEL AND THE EMPLOYEES FROM THE CLERK'S OFFICE WHEN
22 THEY TAKE THEIR BREAKS, THEY SOMETIMES GO OUT THERE TOO AND
23 WE'VE TRIED TO TELL THEM NOT TO TALK TO ANY OF YOU. SO IF
24 YOU ARE NOT RIGHT THERE BY THE DOOR, I THINK THAT WILL BE
25 THE BEST WAY.
46
1 SO LET'S TAKE A BREAK UNTIL -- LET'S GO TO 10:05 AND
2 THEN THAT WILL GIVE US ENOUGH TIME TO STRETCH OUR LEGS AND
3 ANYTHING ELSE YOU NEED TO DO AND THEN WE'LL COME BACK AT
4 THAT POINT. EVERYONE PLEASE STAND.
5 (WHEREUPON THE JURY WAS EXCUSED.)
6 (A BRIEF RECESS WAS TAKEN.)
7 THE COURT: OKAY. PLEASE BE SEATED.
8 MR. WILSON: YOUR HONOR, MAY WE APPROACH FOR JUST A
9 SECOND, MR. STIRBA AND MYSELF I THINK WILL BE FINE, JUST A
10 MATTER I WANTED...
11 (DISCUSSION WAS HELD OFF THE RECORD.)
12 MR. WILSON: THANK YOU, JUDGE.
13 THE COURT: OKAY. LADIES AND GENTLEMEN, WE WERE
14 JUST TALKING ABOUT THE ISSUE OF IF THERE WERE SOME CHARTS
15 GOING TO BE SHOWN IN AN OPENING STATEMENT. I'M GOING TO
16 ALLOW COUNSEL FOR THE STATE TO MOVE OVER SO THAT YOU CAN SEE
17 THE CHARTS BUT SO THAT THEY CAN ALSO SEE THEM, RATHER THAN
18 TURNING THEM SO BOTH COULD HARDLY SEE HALF OF THEM.
19 MR. STIRBA, DO YOU WISH TO GIVE AN OPENING STATEMENT?
20 MR. STIRBA: I DO, YOUR HONOR. THANK YOU.
21 THE COURT: OKAY. PROCEED.
22 MR. STIRBA: MAY IT PLEASE THE COURT, COUNSEL, DR.
23 WEITZEL, LADIES AND GENTLEMEN OF THE JURY. THIS IS GOING TO
24 BE A DIFFICULT CASE. AND THE REASON WHY IT'S GOING TO BE A
25 DIFFICULT CASE IS BECAUSE WE'RE GOING TO BE DEALING WITH
47
1 FIVE PEOPLE WHO ARE AT THE END OF THEIR LIVES AND WERE IN
2 THE DYING PROCESS. AND NOT ONLY WERE THESE FIVE PEOPLE
3 SUFFERING FROM PSYCHIATRIC PROBLEMS, BUT THEY WERE SEVERELY
4 DEMENTED AND HAD A COMPLETE INABILITY TO COMMUNICATE AND TO
5 EXPRESS THEMSELVES.
6 THEY ALSO HAD MULTIPLE MEDICAL PROBLEMS. THE PROBLEMS
7 RANGE FROM VASCULAR DISEASE, HEART DISEASE, LUNG DYSFUNCTION
8 AND OTHER MEDICAL, SERIOUS MEDICAL PROBLEMS. AND ON TOP OF
9 ALL OF THIS, THEY WERE AT THE DAVIS HOSPITAL BECAUSE THE
10 NURSING HOME WHERE THEY WERE COULD NO LONGER HANDLE THEM.
11 THEY WERE COMBATIVE, UNCONTROLLABLE, ASSAULTIVE, AND THE
12 NURSING HOME COULD NO LONGER DEAL WITH THE BEHAVIOR
13 PROBLEMS. AND IN THE MIDST OF ALL THIS, THE FAMILIES HAD TO
14 MAKE VERY DIFFICULT, AND I EMPHASIZE DIFFICULT, JUDGMENTS AT
15 THE END ABOUT WHAT KIND OF CARE THEY WERE GOING TO RECEIVE
16 AT THE HOSPITAL AND WHAT CARE THEY WEREN'T GOING TO RECEIVE.
17 AND I HOPE THAT AT THE END OF THE OPENING STATEMENT
18 WHEN I SIT DOWN, AND HOPEFULLY IT WON'T BE TOO LONG FROM
19 NOW, THAT YOU REMEMBER THE CONTEXT IN WHICH TO VIEW THIS
20 CASE AND THE EVIDENCE IN THIS CASE. AND THE CONTEXT IS YOU
21 HAVE A DOCTOR WHO IS PART OF A MEDICAL TEAM PROVIDING CARE
22 TO VERY SERIOUSLY ILL AND VERY SERIOUSLY SICK, ELDERLY
23 PATIENTS IN A HOSPITAL SETTING WHERE THE FAMILIES HAVE MADE
24 CERTAIN LIMITATIONS IN ADVANCE UPON WHAT CARE SHOULD BE
25 GIVEN AND WHAT CARE SHOULD BE WITHHELD.
48
1 NOW, YOU ARE GOING TO HEAR EVIDENCE IN THIS CASE,
2 LADIES AND GENTLEMEN, ABOUT PAIN AND ABOUT SUFFERING. AND
3 YOU ARE GOING TO SEE THAT THE EVIDENCE WILL SHOW THAT DR.
4 WEITZEL AS PART OF A MEDICAL TEAM HAD AS HIS ONLY PURPOSE TO
5 ALLEVIATE PAIN AND SUFFERING. YOU ARE GOING TO ALSO HEAR
6 ABOUT FAMILIES AND THE DIFFICULT CHOICES THEY HAD TO MAKE IN
7 TERMS OF WHAT THEY WERE GOING TO DO WITH THEIR LOVED ONE
8 GIVEN THE CIRCUMSTANCES IN THE HOSPITAL WHERE HOME CARE AND
9 NURSING HOME CARE WERE NO LONGER OPTIONS.
10 YOU ARE GOING TO HEAR ALSO ABOUT THE FIVE VERY SICK AND
11 ELDERLY PATIENTS AND THE MEDICAL PROBLEMS THEY HAD AND THE
12 DIFFICULT AND COMPLICATED CARE THAT WAS REQUIRED, GIVEN THE
13 FACT THAT THEY WERE ELDERLY, GIVEN THE FACT THAT THEY WERE
14 DEMENTED, GIVEN THE FACT THAT THEIR CONDITIONS CHANGED, NOT
15 ONLY FROM DAY TO DAY, BUT FROM HOUR TO HOUR AND FROM MINUTE
16 TO MINUTE, AND NOW, LADIES AND GENTLEMEN, ALMOST FIVE YEARS
17 LATER THE STATE WANTS TO PICK APART WITH PERFECT 20/20
18 HINDSIGHT ALL THAT MEDICAL CARE AND CALL IT FIRST DEGREE
19 MURDER.
20 THE EVIDENCE WILL SHOW THAT NONE OF THIS WAS MURDER,
21 THAT THERE'S REASONABLE DOUBT WRITTEN ALL OVER THIS CASE AND
22 WHAT YOU HAVE AND WHAT THE EVIDENCE WILL SHOW IS YOU HAVE A
23 PHYSICIAN AND I'LL TELL YOU RIGHT NOW, NOT A PERFECT
24 PHYSICIAN, BUT A WELL-INTENTIONED PHYSICIAN AND A WHOLE
25 MEDICAL TEAM PROVIDING END-OF-LIFE CARE, NOTHING MORE,
49
1 NOTHING LESS.
2 YOU'LL ALSO SEE AND THE EVIDENCE WILL SHOW THAT THE
3 SOLE PURPOSE AND THE ONLY GOAL OF THIS MEDICAL TEAM WAS TO
4 PROVIDE COMFORT CARE AND MAKE SOMEBODY COMFORTABLE IN THE
5 LAST DAYS OF THEIR LIFE. AND FINALLY, LADIES AND GENTLEMEN,
6 THE EVIDENCE WILL SHOW THAT DR. WEITZEL DIDN'T CAUSE ANY OF
7 THESE DEATHS. IF HE DID ANYTHING, HE WAS ATTEMPTING TO
8 BRING COMFORT AND DIGNITY TO EACH ONE OF THEM.
9 ONE OF THE PATIENTS AT THE HOSPITAL WAS A WOMAN NAMED
10 JUDITH LARSEN, YOU SAW HER PHOTOGRAPH ON OPENING STATEMENT.
11 JUDITH WAS 93 YEARS OLD WHEN SHE WAS ADMITTED TO THE
12 HOSPITAL ON DECEMBER 6TH OF 1995. IN JANUARY OF 1995 SHE
13 HAD A VERY ACUTE SERIOUS STROKE AND SHE WAS HOSPITALIZED
14 FIRST AT LDS HOSPITAL IN SALT LAKE AND THEN AT COTTONWOOD
15 HOSPITAL AS A RESULT OF THAT STROKE. AND THAT STROKE CAUSED
16 JUDITH NOT ONLY TO BECOME CONFUSED, NOT ONLY TO BECOME
17 DISORIENTED, BUT ALSO DEPRIVED OF HER OF A GREAT ABILITY TO
18 COMMUNICATE. IT ALSO CAUSED HER OTHER IMPAIRMENTS IN TERMS
19 OF HER ABILITY TO WALK AND DO THE NORMALLY DAILY TASKS OF
20 EVERYDAY LIVING.
21 IN JULY OF 1995 SHE STARTED TO GET ILL AND SHE WAS SO
22 ILL, SHE WAS SICK, SHE WAS VOMITING, SHE WAS ONCE AGAIN
23 HOSPITALIZED AT COTTONWOOD HOSPITAL. AND IN AUGUST, THE
24 LATER PART OF AUGUST OF 1995, SHE HAD ANOTHER STROKE AND
25 THIS WAS ONCE AGAIN ANOTHER ACUTE STROKE, VERY SERIOUS
50
1 STROKE AND SHE WAS HOSPITALIZED AT COTTONWOOD HOSPITAL.
2 AND TO PUT THIS CASE IN SOME CONTEXT, I WANT TO READ TO
3 YOU THE ACTUAL ENTRY MADE BY DR. PEARCE AND THIS WILL BE IN
4 EVIDENCE IN THIS CASE. THIS IS IN AUGUST OF 1995 AND DR.
5 PEARCE IS THE DOCTOR AT COTTONWOOD WHO IS TAKING CARE OF
6 JUDITH AND HE WRITES IN HIS DISCHARGE SUMMARY, ASSESSMENT:
7 DEMENTIA, WHICH BY THE WAY, YOU'LL HEAR EVIDENCE IS A
8 TERMINAL CONDITION. TWO: NEW STROKE SYNDROME WITH APHASIA.
9 APHASIA IS A FANCY WORD FOR CAN'T SPEAK VERY WELL, YOU HAVE
10 DIFFICULTY COMMUNICATING. AND WITH LOSS OF INTEREST IN
11 SWALLOWING EITHER FOOD OR FLUIDS. THREE: PAST HISTORY OF
12 HYPERTENSION. FOUR: QUESTION OF ISCHEMIC HEART DISEASE.
13 HE GOES ON TO SAY, PLAN: IN DISCUSSION WITH THE
14 FAMILY, IT IS DECIDED THAT THE LAST SIX MONTHS OF HER LIFE
15 HAVE BEEN VERY POOR QUALITY. IN FACT, NO QUALITY AT ALL.
16 WITH POOR RECOGNITION OF PEOPLE, NO CONVERSATION, NO
17 DECISION-MAKING. THE OPTION AT THE TIME OF DISCHARGE IS TO
18 PLACE A FEEDING TUBE, PERIPHERAL NUTRITION OR N.G. TUBE,
19 N.G. STANDS FOR I THINK IT'S NASAL GASTRIC, IT'S A TUBE TO
20 ALLOW YOU TO EAT, AND THE FAMILY FEELS THAT THIS WOULD BE
21 AGGRESSIVE AND INAPPROPRIATE. THEY ALSO WANTED NO TREATMENT
22 OF INFECTION, SUCH AS URINARY INFECTIONS, PULMONARY, ET
23 CETERA. DISPOSITION: SHE WILL BE TRANSFERRED TO A NURSING
24 HOME FOR TERMINAL CARE.
25 JUDITH WENT TO A NURSING HOME AND SHE WENT TO THE
51
1 HOLLADAY CARE CENTER WHICH IS IN HOLLADAY AND THERE SHE
2 REBOUNDED. BUT WHILE SHE WAS AT THE NURSING HOME, SHE
3 BECAME VERY, VERY UNCONTROLLABLE AND THIS WAS A BIG PROBLEM.
4 AND YOU'LL SEE IN THE NURSING HOME NOTES, SOME OF THE MORE
5 POIGNANT NOTES I THINK ABOUT THIS CASE, BECAUSE HER SON
6 MERLIN -- WHAT HAPPENED IS JUDITH WOULD HAVE FALLS AND SHE
7 WOULD BE HOSPITALIZED. AND FALLS, AS YOU CAN IMAGINE, FOR
8 SOMEBODY OF 93 IS A PRETTY SERIOUS MATTER.
9 IN ONE FALL SHE HAD -- SHE SUFFERED A CONCUSSION.
10 ANOTHER FALL SHE HAD SHE HAD A THREE-INCH GASH IN HER HEAD.
11 AND YOU'LL SEE IN THE NOTES THAT HER SON MERLIN IS SAYING
12 SEDATE HER AND SEDATE HER MORE. WHY? BECAUSE HE'S
13 CONCERNED, OBVIOUSLY, ABOUT THE IMPACT OF A FALL ON A
14 93-YEAR-OLD MOTHER IN A NURSING HOME AND HE'S BEEN TO THE
15 HOSPITAL AND HE KNOWS WHAT'S HAPPENING. BUT SHE IS
16 UNCONTROLLABLE. THEY PUT RESTRAINTS ON HER, SHE GETS OUT OF
17 HER RESTRAINTS, SHE FALLS. SO FINALLY THE NURSING HOME SAYS
18 SEND HER TO DAVIS FOR AN EVALUATION.
19 SHE ARRIVES ON DECEMBER 6TH. AND I WOULD SAY THE FIRST
20 FEW WEEKS OF HER HOSPITAL STAY I WOULD SAY ARE RELATIVELY
21 UNEVENTFUL. HOWEVER, ON THE 26TH, ON OR ABOUT THE 26TH OF
22 DECEMBER, SHE HAS A SEIZURE AND IT'S A GRAND MAL SEIZURE AND
23 THEN SHE STARTS THROWING UP AND SHE THROWS UP CONTINUOUSLY
24 FOR 26 HOURS STRAIGHT. AND ONE OF THE THINGS THAT THEY
25 NOTICE WHEN SHE'S THROWING UP IS SHE'S THROWING UP WHAT THEY
52
1 CALL COFFEE GROUNDS. AND I ALWAYS HAVE A DIFFICULT TIME
2 WITH THIS WORD, EMESIS. AND WHAT THAT MEANS IS THAT'S A
3 FANCY WAY OF SAYING SHE HAS BLOOD IN HER VOMIT AND WHAT THAT
4 MEANS IS SHE'S BLEEDING INTERNALLY.
5 DR. WEITZEL TALKS TO MERLIN AND HE GOES OVER THE
6 SITUATION WITH HIS 93-YEAR-OLD MOM WHO HAS BEEN THROUGH THE
7 YEAR THAT SHE HAS JUST BEEN THROUGH. AND MERLIN SAYS,
8 CONSISTENT WITH WHAT HE SAID BACK IN AUGUST AND CONSISTENT
9 WITH EVERYTHING ELSE THAT YOU'LL SEE IN THE CHARTS, HE SAYS,
10 JUST KEEP HER COMFORTABLE IS ALL I WANT YOU TO DO. AND
11 THAT'S PRECISELY WHAT NOT ONLY DR. WEITZEL DID BUT THE WHOLE
12 NURSING STAFF THAT WAS ATTENDING TO HER. THEY KEPT HER
13 COMFORTABLE UNTIL SHE DIED ON JANUARY 3RD OF 1996.
14 AND PART OF COMFORT CARE -- AND YOU'LL HEAR EXPERTS.
15 AND THE GREAT THING ABOUT THIS CASE, IF YOU WANT TO HEAR A
16 LOT OF EXPERTS, YOU ARE IN A PERFECT POSITION BECAUSE THERE
17 WILL BE A LOT OF THEM IN THIS CASE. WE'LL CALL SOME, THE
18 STATE WILL CALL SOME. BUT THERE'S GOING TO BE A GENERAL
19 AGREEMENT NOT ONLY WITH OUR EXPERTS BUT ALSO THE STATE'S
20 EXPERTS, SOME OF THEM, AND THEY ARE GOING TO TELL YOU, THAT
21 COMFORT CARE OR END-OF-LIFE CARE INVOLVES A LOT OF THINGS.
22 AND ONE OF THE THINGS IT INVOLVES IS MEDICATION. AND
23 THE REASON WHY IS BECAUSE PEOPLE ARE EITHER IN PAIN OR THEY
24 ARE SUFFERING FOR A LOT OF DIFFERENT REASONS AND THAT'S AN
25 APPROPRIATE THING TO DO IS TO KEEP THEM COMFORTABLE. AND
53
1 THEY ARE GOING TO TELL YOU THAT MORPHINE AS A MEDICATION IS
2 SORT OF LIKE THE GOLD STANDARD, IF YOU WILL, IN TERMS OF A
3 MEDICATION THAT ROUTINELY IS USED IN END-OF-LIFE CARE. AND
4 THEY ARE GOING TO TELL YOU A PHYSICIAN HAS AN ABSOLUTE DUTY,
5 IN OTHER WORDS, IT'S ETHICAL AND IT'S ETHICALLY REQUIRED
6 THAT IF A PHYSICIAN SEES SOMEBODY IN PAIN OR A PHYSICIAN HAS
7 A PATIENT WHO IS SUFFERING, A PHYSICIAN HAS AN ABSOLUTE
8 ETHICAL RESPONSIBILITY TO DO SOMETHING ABOUT IT.
9 AND ALSO THEY ARE GOING TO TELL YOU THAT IF A PHYSICIAN
10 IN END-OF-LIFE CARE HAS TO PRESCRIBE MEDICATION TO PROVIDE
11 COMFORT, AND EVEN IF THAT PHYSICIAN KNOWS THAT THAT MIGHT
12 HAVE A TENDENCY TO HASTEN A DEATH, THAT'S STILL ETHICALLY
13 APPROPRIATE AND A PHYSICIAN IS OBLIGATED TO DO IT IF THE
14 PURPOSE OF ADMINISTERING AND PRESCRIBING THE MEDICATION IS
15 TO KEEP SOMEBODY COMFORTABLE AND TO ALLEVIATE PAIN AND
16 SUFFERING.
17 NOW, YOU HAVE FIVE CASES, FIVE COUNTS. IT'S ALMOST
18 LIKE WE HAVE FIVE DIFFERENT CASES, AND WE DO. THERE IS ONE
19 CASE THAT IS DIFFERENT THAN THE OTHER FOUR AND THAT'S THE
20 CASE OF ELLEN ANDERSON, PATIENT ELLEN ANDERSON. BECAUSE
21 ELLEN ANDERSON IS NOT REALLY A CASE AND THE FACTS WILL SHOW
22 THIS, THE EVIDENCE WILL SHOW THIS OF END-OF-LIFE CARE, ELLEN
23 ANDERSON IS PURELY AND SIMPLY, IF YOU WILL, A PAIN CASE
24 WHERE MEDICATION IS PRESCRIBED FOR PAIN. AND LET ME GIVE
25 YOU A LITTLE HISTORY ABOUT ELLEN BECAUSE I THINK THIS IS
54
1 IMPORTANT. REMEMBER, THERE'S GOING TO BE A LOT OF MEDICAL
2 TESTIMONY HERE BUT EVERY PATIENT HAS A HISTORY AND THAT
3 CIRCUMSTANCE OF GOING INTO THE HOSPITAL IS VERY IMPORTANT.
4 BUT BRIEFLY, ELLEN DID HAVE A HIP FRACTURE IN JUNE OF
5 1995 AND SHE LOST 30 POUNDS BY THE TIME WE HIT DECEMBER OF
6 1995 AND SHE WASN'T A VERY LARGE WOMAN TO BEGIN WITH. AND
7 HER FAMILY IS GOING TO TELL YOU THAT THEY HAD HER IN A
8 NURSING HOME AND AS THEY DESCRIBE IT FOR ABOUT SIX MONTHS
9 SHE WAS IN WHAT THEY WOULD CALL AN ACUTE PANIC ATTACK
10 CONSTANTLY, NEVER A MINUTE WASN'T SHE IN THIS STATE. AND
11 SHE WOULD SCREAM AND SHE WOULD SCREAM UNCONTROLLABLY AND SHE
12 WAS ABSOLUTELY TERRIFIED. AND THE FAMILY IS STRUGGLING
13 DEALING WITH THIS.
14 AND FINALLY ONE OF HER DAUGHTERS, DIANE, COMES INTO THE
15 NURSING HOME AT THE END OF DECEMBER OF 1995 AFTER HAVING
16 DEALT WITH THIS FOR SIX MONTHS AND SEEING THEIR POOR MOM IN
17 THAT SITUATION AND SAYS, I'VE HAD ENOUGH, I DON'T WANT HER
18 HERE ANYMORE BECAUSE WHATEVER YOU ARE GIVING HER ISN'T
19 WORKING. AND YOU KNOW WHAT? I WANT HER TO GET MORPHINE AND
20 HOW CAN I GET HER TO GET MORPHINE? I CAN'T DO IT IN A
21 NURSING HOME, BUT IF WE HOSPITALIZE HER, MAYBE SHE CAN GET
22 SOME MORPHINE BECAUSE WE'VE TRIED EVERYTHING ELSE AND AT
23 LEAST MAYBE MORPHINE WILL HAVE A SEDATING EFFECT. SO ELLEN
24 IS THEN TRANSFERRED TO THE DAVIS HOSPITAL.
25 AND I'M GOING TO PUT THIS UP THEN WE'LL GO THROUGH A
55
1 NUMBER OF THESE. CAN EVERYBODY SEE THAT? I DON'T KNOW IF
2 THIS IS THE BEST POSITION, BUT ANYWAY, THIS IS NOT A TIME
3 LINE BECAUSE ELLEN WAS IN THE HOSPITAL FROM 12/29 THROUGH
4 12/30. THIS IS ALL FROM THE MEDICAL RECORDS. THIS IS WHAT
5 THE ENTRIES ARE.
6 AND AS YOU CAN SEE IN THIS PARTICULAR CASE AND YOU'LL
7 SEE OTHERS, AND I'LL TELL YOU THEY ALL SORT OF -- THE
8 RECORDS ARE ALL SORT OF THE SAME, YOU CAN FOLLOW THEM.
9 THERE'S ALWAYS AN ADMISSION/EVALUATION AND OF COURSE THERE'S
10 SOME MEDICAL HISTORY THAT'S TAKEN BECAUSE OBVIOUSLY THAT'S
11 IMPORTANT FOR THE HEALTHCARE PROVIDERS. AND THEN THERE'S
12 USUALLY AN INDICATION OF WHAT MEDICATIONS THE PATIENTS WERE
13 ON ON ADMISSION BECAUSE OBVIOUSLY THAT'S IMPORTANT.
14 AND I'LL TELL YOU RIGHT NOW XANAX, THAT'S AN
15 ANTIANXIETY DRUG, IT'S A SEDATING DRUG, IT'S A SEDATIVE.
16 AMITRIPTYLINE IS A SEDATING DRUG, THAT'S AN ANTIDEPRESSANT.
17 AMBIEN IS ALSO A SEDATING DRUG. LORTAB IS A PAIN MEDICATION
18 AND YOU'LL HEAR DOCS TELL YOU ABOUT THIS, BUT I'M JUST
19 SAYING THESE ARE THE KIND OF THINGS YOU'LL SEE. AND THEN
20 THERE'S ALWAYS AN INITIAL ADMISSION NOTE THAT YOU'LL SEE FOR
21 EACH ONE, IT'S USUALLY DONE BY THE NURSES.
22 AND I JUST WANT YOU TO SEE AS WE GO THROUGH THESE TIME
23 LINES THERE ARE GOING TO BE ENTRIES IN THE MEDICAL RECORDS.
24 AND ONE THING WE'VE DONE WHICH HOPEFULLY WILL BE HELPFUL IS
25 INSTEAD OF HAVING TO READ THE CHICKEN SCRATCH OF SOME
56
1 PHYSICIAN, WE HAD THEM TRANSCRIBED AND TYPED UP SO YOU HAVE
2 THE PAGE IN FRONT OF AND YOU CAN SEE WHAT THE DOCTORS AND
3 NURSE WROTE AND RIGHT ACROSS IT WILL BE TYPED SO IT'S EASY
4 TO READ. ANYWAY, YOU'LL SEE ENTRIES BY DR. WEITZEL AND
5 ENTRIES BY NURSES AND THERE'S A WHOLE SERIES OF NURSES AND
6 THESE ARE IN THE NURSES' NOTES.
7 BUT THESE ARE THE FACTS WITH MS. ANDERSON. SHE COMES
8 IN AND SHE ARRIVED I BELIEVE AT ABOUT 4 O'CLOCK IN THE
9 AFTERNOON. AND I'LL TELL YOU DR. WEITZEL IS FULLY PREPARED
10 TO NOT ONLY DOCUMENT THAT HE SAW HER THE DAY SHE ARRIVED, HE
11 ACTUALLY SAW HER AND HE CAN DOCUMENT THAT, BUT HE'LL TELL
12 YOU ABOUT HIS EVALUATION. AND THIS IS WHAT HE PUTS IN HIS
13 INITIAL EVALUATION, GENERALLY THE OVERVIEW OF HER MEDICAL
14 SITUATION.
15 AND THEN HERE THE NURSE -- THIS IS WHAT THE NURSE
16 STATES, PATIENT ADMITTED IN COMPANY OF DAUGHTER FROM CARE
17 CENTER. DETERIORATING OVER THE PAST THREE WEEKS. CRYING
18 AND SCREAMING INCONSOLABLY EVEN WHEN FAMILY IS PRESENT.
19 MORPHINE 10 MILLIGRAMS, S.O. 4 BY THE WAY, I HAVE TO PUT IT
20 IN THERE BECAUSE IT'S IN THERE, IT MEANS -- IT'S SULFATE.
21 IT'S JUST -- THAT'S WHAT THEY ALWAYS PUT IN, S.O. 4 FOR
22 MORPHINE, BUT THAT'S WHAT WE'RE TALKING ABOUT, INTRAMUSCULAR
23 FOR SEVERE PAIN. PATIENT BECOMES RIGID AND SCREAMS WHEN
24 TOUCHED RELATED TO PROFOUND OSTEOPOROSIS WHICH CAUSED HER TO
25 HAVE A SERIES OF FRACTURES. SHE HAD A NUMBER OF COMPRESSION
57
1 FRACTURES BECAUSE THE BONES -- YOUR BONES ARE VERY BRITTLE
2 AND IT'S VERY PAINFUL WHEN YOU HAVE THOSE FRACTURES. SO
3 THAT IS THE FIRST MEDICATION.
4 THEN WE GO OVER TO THE NEXT DAY AT 1 O'CLOCK THE NURSE
5 CHARTS, PATIENT'S RESPIRATION IS VERY ERRATIC, 8 TO 16.
6 BLOOD PRESSURE 75/50. DR. WEITZEL PAGED, A NURSING
7 SUPERVISOR INFORMED OF PATIENT'S CONDITION. THE NURSING
8 SUPERVISOR IS ALWAYS NOTIFIED WHEN A NURSE BELIEVES THAT
9 SOMEONE IS ABOUT TO DIE, THAT WAS HOSPITAL PROTOCOL AND
10 THAT'S THE SIGNIFICANCE OF THAT ENTRY. AND THEN AT 3:15,
11 PATIENT AWAKENED, THRASHING ARMS AND ATTEMPTING TO THROW
12 BODY. PATIENT MOANING AND SCREAMING. DR. WEITZEL PAGED
13 AGAIN, THIS IS BY TRACY SCHOLL, A NURSE. AND THEN AT 3:30,
14 DR. WEITZEL RETURNS PAGE, INFORMED OF PATIENT'S CONDITION.
15 IN OTHER WORDS, ALL THROUGHOUT HERE AND COUNSEL IS
16 QUITE RIGHT IN HER OPENING STATEMENT, THE NURSES THERE ARE
17 PROVIDING MOST OF THE CARE. AND SO THEY ARE GIVING
18 INFORMATION TO THE DOCTORS ABOUT WHAT THEY ARE ASSESSING IS
19 THE CLINICAL POSITION OF THE PATIENT AND THAT'S WHAT NURSE
20 SCHOLL IS DOING HERE. SHE TELLS DR. WEITZEL AND THEN
21 MORPHINE IS GIVEN INTRAMUSCULAR PER THE DOCTOR'S ORDERS AND
22 THEN THAT'S WHAT HAPPENS, AND THEN MS. ANDERSON DIED AT 8:55
23 A.M.
24 THE FACTS IN THIS CASE AND THIS MS. ANDERSON WAS
25 AUTOPSIED BY THE MEDICAL EXAMINER AND HE'LL TESTIFY AND
58
1 HE'LL TELL YOU THAT IN HIS EXAMINATION SHE HAD ACUTE
2 PNEUMONIA. IN OTHER WORDS, REMEMBER, THERE WAS A CHEST
3 X-RAY DONE AT ABOUT FIVE OR SIX IN THE MORNING AND THERE WAS
4 AN E.K.G. THAT WAS DONE THAT WAS ABNORMAL. AND HE'LL TELL
5 YOU THAT THERE ARE AT LEAST FOUR OR FIVE REASONS, HE
6 COULDN'T TELL EXACTLY, BUT FOUR OR FIVE REASONS ALL OF WHICH
7 COULD HAVE CAUSED HER DEATH. HE DOES NOT KNOW BECAUSE ANY
8 ONE OF THEM WOULD BE BEEN SUFFICIENT, AND ONE OF THEM WAS
9 SHE HAD ACUTE PNEUMONIA UPON ADMISSION WHICH YOU'LL SEE IN
10 THE X-RAY. IT IS SHOWN RIGHT THERE IN THE X-RAY WHAT THE
11 PROBLEM IS AND THERE ARE OTHER THINGS, CARDIAC AND WHAT HAVE
12 YOU, RELATED TO THE CIRCUMSTANCES OF HER DEATH. AND WE'LL
13 HAVE OUR OWN EXPERT WHO IS GOING TO TELL YOU THAT SHE DIDN'T
14 DIE AT ALL ANYTHING RELATED TO MORPHINE.
15 NOW, YOU ARE GOING TO SEE A PATTERN HERE BUT IT'S A
16 PATTERN OF CIRCUMSTANCE. IT'S NOT GOING TO BE A PATTERN OF
17 CRIMINALITY. FOR EXAMPLE, YOU ARE GOING TO SEE IN THE OTHER
18 FOUR CASES THAT ALL OF THESE PATIENTS ARE SUFFERING FROM
19 SEVERE DEMENTIA OR ALZHEIMERS AND CAN'T COMMUNICATE. AND
20 YOU ARE GOING TO SEE THAT THEY ARE ALL ADMITTED BECAUSE THEY
21 NEED TO BE SEDATED. AND YOU'LL SEE IN THE PROGRESS NOTES
22 AND THE NURSING NOTES FROM THE NURSING HOMES THAT THEY ARE
23 ALL BEING SEDATED EITHER WITH ATIVAN OR HALDOL WHICH IS
24 ANOTHER SEDATING MEDICATION OR SOMETHING LIKE THAT. WHY?
25 BECAUSE THIS IS AN ATTEMPT TO CONTROL THEIR BEHAVIOR. SO
59
1 WHEN THEY ARE GOING INTO THE HOSPITAL THEY ARE ALL ON PSYCH
2 MEDS AND THEY ARE ALL ON SEDATING CONTROL MEDS.
3 YOU ARE ALSO GOING TO SEE THAT THEY ARE ALL HIGH-RISK
4 PATIENTS GIVEN THE NATURE OF THEIR AGE, THEIR DEMENTIA AND
5 THEIR OTHER MEDICAL COMPLICATIONS. AND YOU ARE GOING TO SEE
6 AND I THINK SIGNIFICANTLY THAT THEY ALL HAD, THEY ALL HAD --
7 THE OTHER FOUR ALL HAD LIVING WILLS OR MEDICAL DIRECTIVES
8 WHICH THEY PROVIDED TO THE HOSPITAL WHICH LIMITED THE KIND
9 OF CARE THEY COULD GET.
10 NOW, LET'S LOOK AT SOME OTHERS AND WE'LL GO THROUGH
11 THEM IN SORT OF A TIME LINE SO YOU CAN GET SOME FEEL FOR
12 WHAT THE FACTS WILL BE IN THIS CASE. HOW IS THAT? IS THAT
13 SOMETHING YOU ALL CAN SEE?
14 NOW, THIS IS -- THIS IS PATIENT ENNIS ALLDREDGE AND
15 YOU'LL SEE THESE AGAIN. BUT ONCE AGAIN, THEY ALL START WITH
16 THE DAY HE'S ADMITTED AND THEY GO THROUGH THE TIME OF THE
17 DEATH AT 1/14 IN THIS CASE OF '96. AND WHAT WE'VE ATTEMPTED
18 TO DO IS TO PROVIDE IN COLOR -- IN THE GREEN, THESE ARE THE
19 PSYCH MEDS THAT WERE ORDERED AND ACTUALLY GIVEN AT THE
20 HOSPITAL. THE BLUE IS THE MORPHINE WHICH WAS GIVEN TO THE
21 PATIENT AT THE HOSPITAL. AND IF YOU LOOK AT THIS ONE, ONCE
22 AGAIN IF WE START OUT WITH THE ADMISSION, WE HAVE AN
23 83-YEAR-OLD WHITE MALE ADMITTED AND ORIENTED TO THE UNIT.
24 PATIENT ACCOMPANIED BY HIS WIFE OF SEVEN YEARS. PATIENT IS
25 VERY COMBATIVE AND AGITATED. PATIENT NOT ORIENTED TO TIME,
60
1 PLACE OR SITUATION, AND IT GOES ON FROM THERE. AND EVEN
2 SAYS, IS VERY STRONG AND GRABS AT STAFF, HURTING STAFF.
3 THAT'S THE SIGNIFICANCE OF THE DIFFICULTY OF THE BEHAVIOR.
4 THEN WE HAVE HIS HISTORY, ALZHEIMERS, T-CELL LYMPHOMA,
5 WHICH IS A FORM OF CANCER, DIABETES WHICH WAS UNCONTROLLABLE
6 FOR 25 YEARS, HE WAS ON INSULIN. HERNIA REPAIR,
7 HYPERTENSION, AND HE HAD PREVIOUS BYPASS SURGERY. HE HAD
8 CORONARY ARTERY DISEASE ON ADMISSION. AND THEN HIS
9 MEDICATIONS ON ADMISSION, ATIVAN WHICH IS, ONCE AGAIN, A
10 SEDATING ANTIANXIETY MEDICATION. THIS WAS ALL THAT WAS
11 GIVEN WHEN HE WAS AT THE NURSING HOME. THIS HAS NOTHING TO
12 DO WITH THE HOSPITAL. RISPERDAL, WHICH IS A PSYCH
13 MEDICATION WHICH I BELIEVE HE ALSO GOT WHEN HE WAS IN THE
14 HOSPITAL. VOLMAX IS ANOTHER PSYCH MEDICATION, HYTRIN IS
15 ANOTHER ONE, BUSPAR IS ANOTHER ONE AND THEN HE ALSO GOT
16 MELLARIL AND HALDOL AT THE NURSING HOME. ONCE AGAIN, THESE
17 ARE ALL PSYCH MEDS THAT WERE PROVIDED. THEY ARE ALL
18 SEDATING TO HIM IN AN ATTEMPT TO CONTROL HIM. D.N.R., DO
19 NOT RESUSCITATE. HE HAD A LIVING WILL AND THERE WERE
20 MEDICAL DIRECTIVES LIMITING THE CARE.
21 NOW, SIGNIFICANTLY IF WE FLIP OVER TO HERE TO GIVE YOU
22 SOME IDEA HOW DIFFICULT THIS WAS. THIS IS -- TRACY SCHOLL
23 IS THE NURSE AGAIN, SHE STATES, PATIENT REMAINS POSEY. THEY
24 HAD TO PUT HIM IN A RESTRAINT BECAUSE HE WAS VIOLENT AND
25 COMBATIVE SO HE'S IN AN ACTUAL RESTRAINT IN THE BED AND
61
1 THAT'S WHAT THE POSEY IS. PATIENT HAD LARGE BOWEL MOVEMENT,
2 HAS SMEARED FECES ALL OVER, INCLUDING FACE, BED RAILS, ET