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Trial Transcript Vols. 7 - 9
1 IN THE DISTRICT COURT OF DAVIS COUNTY
2 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 7 OF 21
12 JUNE 19, 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
1478
1 (WHEREUPON, THE MORNING SESSION BEGINS.)
2 THE COURT: OKAY. BEFORE WE BROUGHT THE JURY OUT,
3 THERE WERE A COUPLE OF THINGS THAT I THOUGHT WOULD BE
4 HELPFUL JUST FOR KIND OF PROCEDURE IN THE FUTURE; THAT IS,
5 FIRST OF ALL, ON OBJECTIONS, I THINK WE NEED TO MAKE SURE
6 THAT WHEN WE HAVE OBJECTIONS, THAT SOMEBODY MAKES AN
7 OBJECTION, THE OBJECTION IS NOT A SPEECH. IT WILL BE
8 SOMETHING LIKE LEADING OR RELEVANCE. THE OTHER SIDE IF IT'S
9 RELEVANT, SAY IT'S RELEVANT TO "X" BUT WE'RE NOT GOING TO
10 HAVE ARGUMENTS IN FRONT OF A JURY.
11 IF THERE IS AN OBJECTION AND IT'S SUSTAINED AND
12 SOMEBODY SAYS CAN WE APPROACH THE BENCH THE ANSWER IS GOING
13 TO BE NO. NUMBER ONE, WE'VE APPROACHED THE BENCH, THESE
14 MICROPHONES CAN PICK UP WHATEVER WE'RE SAYING, EITHER --
15 IT'S NOT A VERY USEFUL WAY TO DO THINGS. SO WHAT I WANT TO
16 DO IS IF THERE'S ANY REASON THAT WE NEED TO HAVE A BENCH
17 CONFERENCE OR TO SPEAK OUTSIDE THE PRESENCE OF THE JURY, I
18 WOULD LIKE YOU TO GO ON WITH YOUR EXAMINATION OF THE WITNESS
19 AND THEN WHEN WE HAVE A BREAK, WE CAN ADDRESS THAT ISSUE AND
20 THEN YOU CAN GO BACK AND ASK THE WITNESS THAT QUESTION AFTER
21 IT'S RESOLVED.
22 AGAIN, IF YOU HAVE ANYTHING THAT YOU WANT TO BRING UP
23 EARLIER LATER, YOU KNOW, WE CAN BRING IT UP. I NOTE THAT --
24 WHEN IS BEVERLY FULGER PLANNING TO TESTIFY, IS THAT THIS
25 MORNING OR AFTERNOON?
1479
1 MR. WILSON: WELL, IT WILL DEPEND, YOUR HONOR,
2 SHE'S ON OUR LIST. WE MAY HAVE TO -- WE MAY NOT GET TO HER
3 UNTIL THIS AFTERNOON.
4 THE COURT: OKAY. WELL, THEN, SO THERE WAS A
5 MOTION THAT I JUST RECEIVED THIS MORNING REGARDING HER SO
6 THAT NEEDS TO BE RESOLVED BEFORE SHE TESTIFIES. SO IF IT'S
7 GOING TO BE -- JUST TELL ME WHEN IT'S GOING TO BE SO IF WE
8 HAVE A BREAK OR AT NOON. IS THERE ANYTHING ELSE WE NEED TO
9 DISCUSS BEFORE THE JURY COMES IN?
10 MR. STIRBA: I HAVE NOTHING, JUDGE.
11 THE COURT: OKAY. THEN WOULD YOU LIKE TO HAVE THE
12 JURY COME IN THEN?
13 (WHEREUPON THE JURY ENTERS THE COURTROOM.)
14 THE COURT: AND I BELIEVE WE HAD -- WHOEVER WAS THE
15 WITNESS WHO WAS ON FRIDAY?
16 MS. BARLOW: THAT'S CORRECT, YOUR HONOR.
17 THE COURT: OKAY. PLEASE BE SEATED.
18 NOW, THE RECORD WILL REFLECT THAT THE ATTORNEYS,
19 DEFENDANT AND THE JURY ARE ALL PRESENT. LADIES AND
20 GENTLEMEN, WE WISH TO WELCOME YOU BACK. I HOPE YOU HAD A
21 GOOD WEEKEND AND ANY FATHERS HAD A HAPPY FATHER'S DAY.
22 WOULD YOU LIKE TO CONTINUE THEN, MS. BARLOW, WITH THE
23 WITNESS WHO WAS ON THE STAND WHO LEFT ON FRIDAY?
24 MS. BARLOW: YES, YOUR HONOR. WE'D RECALL EARLENE
25 COOPER.
1480
1 THE COURT: IF YOU'D COME FORWARD. YOU ARE STILL
2 UNDER OATH.
3 DIRECT EXAMINATION, CONT'D
4 BY MS. BARLOW:
5 Q. MORNING.
6 WE WERE TALKING ON FRIDAY ABOUT -- WELL, PERHAPS IF YOU
7 WOULD RESTATE YOUR NAME FOR THE RECORD.
8 A. EARLENE COZZENS-COOPER.
9 Q. WE WERE SPEAKING OF YOUR EMPLOYMENT AT THE GEROPSYCH
10 UNIT AT THE DAVIS NORTH HOSPITAL LAST FRIDAY. I WOULD LIKE
11 TO TURN YOUR ATTENTION TO SOME MATTERS IN THE MEDICAL
12 RECORDS INVOLVING SOME OF THESE PATIENTS. DO YOU HAVE THE
13 MEDICAL RECORDS UP THERE?
14 A. I DO.
15 Q. WOULD YOU PULL OUT MARY CRANE'S MEDICAL RECORD, PLEASE.
16 AND I THINK FOR THE PURPOSE OF EDIFYING THE JURY A LITTLE
17 BIT, WOULD YOU TURN TO PAGE 231, MEDICAL NUMBER 231. IT'S
18 WAY BACK UNDER PSYCH EVAL.
19 A. OKAY.
20 Q. IT'S ONE OF THE FIRST DOCUMENTS.
21 A. OH, THERE IT IS.
22 Q. AND WHAT IS THAT DOCUMENT?
23 A. IT'S THE -- IT'S DR. WEITZEL'S EVALUATION OF THE
24 PATIENT.
25 Q. DO YOU KNOW WHETHER SUCH AN EVALUATION WAS STANDARD
1481
1 PROCEDURE WITH THESE PATIENTS?
2 A. YES, IT WAS.
3 Q. DO YOU KNOW WHEN THAT WAS DONE IN RELATIONSHIP TO THEIR
4 ADMISSION TO THE UNIT?
5 A. AS SOON AS POSSIBLE.
6 Q. AND THEN THERE'S THE NEXT CATEGORY THERE ARE THESE TABS
7 SAYS CONSULTATION, THE FIRST ONE THERE IS 234.
8 A. WHAT PAGE AGAIN?
9 Q. 234.
10 A. OKAY.
11 Q. REPORT OF CONSULTATION, WHAT IS THAT?
12 A. I WOULD ASSUME THAT ANOTHER PHYSICIAN WOULD HAVE COME IN
13 AND DONE A HISTORY AND PHYSICAL ON HER.
14 Q. WAS THAT A STANDARD PROCEDURE?
15 A. YES.
16 Q. WITH THESE PATIENTS?
17 A. YES.
18 Q. AND THAT HISTORY AND PHYSICAL, WHAT WAS THE PURPOSE OF
19 THAT?
20 A. TO MAKE SURE THAT THE PATIENT WAS HEALTHY ENOUGH TO BE
21 ON THE UNIT.
22 Q. THEN THE NEXT CATEGORY IS CALLED PHYSICIAN'S ORDERS, 238
23 IS THE PAGE NUMBER.
24 A. OKAY.
25 Q. WHAT ARE THOSE?
1482
1 A. THOSE ARE THE ORDERS THE DOCTOR GIVES US TO FOLLOW TO
2 TAKE CARE OF THE PATIENT.
3 Q. AND WHAT KINDS OF ORDERS WOULD THOSE BE?
4 A. MEDICATION ORDERS, LAB ORDERS, VITAL SIGN ORDERS, DIET
5 ORDERS, EVERYTHING THAT HAS TO DO WITH A PATIENT.
6 EVERYTHING YOU DO WITH A PATIENT, THE DOCTOR ORDERS.
7 Q. AND LAB ORDERS ARE USUALLY, I MEAN, WHAT KINDS OF
8 THINGS?
9 A. C.B.C.'S, S.M.A.'S.
10 Q. WHAT'S A C.B.C?
11 A. BLOOD COUNT.
12 Q. WHAT'S IT --
13 A. A CELLULAR BLOOD COUNT. Actually, complete blood count.
14 Q. AND S.M.A., IS THAT WHAT YOU SAID NEXT?
15 A. THAT'S A CHEMISTRY THAT LOOKS AT THE DIFFERENT
16 CHEMISTRIES OF THE BODY.
17 Q. SO DIFFERENT KINDS OF TESTS THE ORDERS WOULD SHOW UP ON
18 THESE DOCUMENTS; IS THAT CORRECT?
19 A. YES, THEY WOULD.
20 Q. THE NEXT CATEGORY IS CALLED PROGRESS NOTES AND THAT'S
21 251.
22 A. YES, I HAVE THAT.
23 Q. WHAT IS THAT?
24 A. THIS IS -- WHENEVER THE DOCTOR CAME AND SAW THE PATIENT
25 HE WOULD UPDATE THE PROGRESS OF THAT PATIENT IN THESE OR THE
1483
1 DIETICIAN WOULD OR THE SOCIAL WORKER. IT WAS A PROGRESS
2 NOTE OF THE PATIENT.
3 Q. WHAT ABOUT OCCUPATIONAL THERAPIST OR RECREATIONAL
4 THERAPIST, DID YOU HAVE ANY OF THOSE ON THIS UNIT?
5 A. YES, AND THEY COULD DOCUMENT THESE PROGRESS NOTES ALSO.
6 Q. THEN LET'S JUMP OVER, WE HAVE LABS, 257.
7 A. YES.
8 Q. WHAT'S THAT CATEGORY OF DOCUMENTS?
9 A. THIS IS THE LABORATORY THAT WAS DRAWN AND AFTER WE GET
10 THOSE RESULTS BACK, THIS IS THE RESULTS OF THAT BLOOD THAT
11 WAS DRAWN.
12 Q. OR THE BLOOD TEST?
13 A. OR THE URINE OR WHATEVER LAB TEST YOU WERE DOING.
14 Q. THEN THE NEXT ONE IS RADIOLOGY AT 270. WHAT ARE THOSE
15 DOCUMENTS?
16 A. THEY ARE DOCUMENTATION OF ANY X-RAYS, M.R.I.'S, C.A.T.
17 SCANS, ANYTHING LIKE THAT WOULD GO IN THIS CATEGORY, ANY
18 PROCEDURES LIKE THAT.
19 Q. WHAT'S AN M.R.I.?
20 A. MAGNETIC RADIANCE IMAGERY IT'S --
21 Q. WHAT'S ITS PURPOSE?
22 A. TO LOOK AND SEE IF THERE'S ANY ABNORMALITIES IN EITHER
23 THE HEAD OR YOU CAN DO AN M.R.I. ON ANY PART OF THE BODY TO
24 LOOK FOR ABNORMALITIES.
25 Q. WHAT ABOUT A C.A.T. SCAN, DO YOU KNOW HOW A M.R.I. AND A
1484
1 C.A.T. SCAN CORRELATE?
2 MR. STIRBA: YOUR HONOR, I'M GOING TO OBJECT,
3 BEYOND THE SCOPE OF HER COMPETENCY.
4 MS. BARLOW: YOUR HONOR, I ASKED HER IF SHE KNEW.
5 IT'S A YES OR NO QUESTION.
6 THE COURT: OKAY. OVERRULED.
7 Q. (BY MS. BARLOW) BASED ON YOUR TRAINING, DO YOU HAVE
8 ANY KNOWLEDGE OR AM I GETTING FURTHER AFIELD THAN REALLY YOU
9 GET INTO?
10 A. IT'S A LITTLE BIT OUT OF MY FIELD BUT I KNOW THEY ARE
11 DIFFERENT.
12 Q. OKAY. AND THEN THE NEXT WE HAVE CATEGORY IS E.K.G.
13 SWALLOW AND E.E.G. WHAT'S AN E.K.G.?
14 A. IT'S A HEART, YOU ARE LOOKING AT THE HEART TO LOOK AT
15 THE RHYTHMS OF THE HEART, THE ELECTRICAL TRANSMISSION OF THE
16 HEART.
17 Q. AND THEN IT SAYS SWALLOW, WHAT WOULD THAT BE?
18 A. THAT WAS DONE BY SOMEONE WHO COULD FIND OUT IF A PATIENT
19 HAD ANY ABNORMALITIES IN THEIR ESOPHAGUS OR THROAT OR TO TRY
20 TO FIND OUT IF THERE WAS ANYTHING PHYSICALLY WRONG THAT WAS
21 PREVENTING THEM FROM EATING AND SWALLOWING.
22 Q. IS SWALLOWING A PROBLEM WITH THESE PATIENTS?
23 MR. STIRBA: YOUR HONOR, I'LL OBJECT, RELEVANCY.
24 Q. (BY MS. BARLOW) WITH THESE FIVE PATIENTS, WAS
25 SWALLOWING A PROBLEM?
1485
1 MR. STIRBA: I'LL OBJECT, LACK OF FOUNDATION.
2 THE COURT: WHAT'S THE FOUNDATION THAT SHE SAW ALL
3 FIVE PATIENTS?
4 Q. (BY MS. BARLOW) DID YOU SEE ALL FIVE OF THESE
5 PATIENTS?
6 A. YES.
7 Q. WELL, LET'S SEE, ELLEN ANDERSON, DID YOU SEE --
8 A. NO, I DIDN'T.
9 Q. OKAY. THE OTHER FOUR DID YOU SEE?
10 A. YES.
11 Q. DID YOU SEE AT ANY TIME ANY DIFFICULTY THEY HAD
12 SWALLOWING? CAN YOU SPECIFICALLY REMEMBER IF ANY HAD
13 DIFFICULTY SWALLOWING?
14 A. I REMEMBER THEY WOULDN'T EAT AND THE SWALLOWING EVAL WAS
15 DONE OUT TO FIND OUT WHY, IF IT WAS BECAUSE OF DIFFICULTY
16 SWALLOWING AND I DON'T REMEMBER SPECIFICALLY WHETHER THEY
17 DID OR NOT.
18 Q. LET'S GO BACK TO THE CATEGORY E.E.G., I MEAN, IT'S IN
19 THE SAME CATEGORY BUT E.E.G.?
20 A. THAT WOULD BE -- YOU WERE LOOKING AT THE ELECTRICAL
21 FUNCTIONING OF THE BRAIN.
22 Q. AND --
23 A. IT WOULD DENOTE SEIZURES OR SOMETHING LIKE THAT. AN
24 ABNORMAL E.E.G., WOULD BE YOU WOULD BE LOOKING FOR SEIZURES
25 OR ABNORMAL ELECTRICAL ACTIVITY IN THE BRAIN.
1486
1 Q. NOW THESE -- YOU DIDN'T GIVE THESE TESTS; IS THAT
2 CORRECT?
3 A. NO.
4 Q. WOULD YOU READ THESE TESTS?
5 A. NO, THE DOCTOR WOULD.
6 Q. WHAT DOCTOR WOULD READ AN E.K.G.?
7 A. IT COULD BE THE MEDICAL DOCTOR OR IT COULD BE --
8 SOMETIMES THEY HAD DOCTORS SPECIFICALLY IN THAT AREA THAT
9 WOULD READ THEM AND INTERPRET THEM.
10 Q. WHAT ABOUT AN E.E.G., WOULD YOU READ THAT?
11 A. NO.
12 Q. WHO WOULD READ THAT?
13 A. IT WOULD BE A DOCTOR.
14 Q. THEN OUR NEXT CATEGORY IS MEDS AND GRAPHS, WHAT IS THAT?
15 AND THAT'S 279.
16 A. THIS IS THE PATIENT'S VITAL SIGNS, THEIR TEMPERATURE,
17 RESPIRATION, PULSE AND THE MEDICATIONS THAT THEY RECEIVED.
18 Q. THERE'S TWO PAGES AT LEAST IN HERE APPEAR TO BE GRAPHS,
19 I THINK WE'VE SEEN THOSE BEFORE. AND THEN 281, WHAT IS THAT
20 CHART?
21 A. THAT IS AN INSULIN -- RECORD OF INSULIN, A BLOOD SUGAR
22 RECORD.
23 Q. IT SAYS DIABETIC CHART. WHAT WOULD YOU DO TO FILL OUT
24 THIS CHART?
25 A. YOU WOULD CHECK THE PATIENT'S BLOOD SUGAR WITH AN
1487
1 ACCUCHECK, THAT A.C.C.U. STANDS FOR ACCUCHECK. IT'S A
2 MACHINE YOU HAVE. YOU GET A DROP OF BLOOD AND IT INDICATES
3 TO YOU WHAT THEIR BLOOD SUGAR IS WHETHER IT'S HIGH OR LOW.
4 Q. AND IF IT WERE HIGH, WHAT WOULD YOU DO?
5 A. GENERALLY YOU WOULD GET AN INSULIN ORDER, OR YOU WOULD
6 HAVE A STANDING INSULIN ORDER TO GIVE THEM INSULIN.
7 Q. YOU WOULDN'T DO IT AUTOMATICALLY, YOU WOULD HAVE TO HAVE
8 AN ORDER?
9 A. YOU WOULD HAVE TO HAVE AN ORDER, YES.
10 Q. WHAT IF IT WERE LOW?
11 A. YOU WOULD GIVE WHAT WE CALL GLUCAGON OR YOU WOULD GIVE
12 THEM SOME ORANGE JUICE OR SOMETHING LIKE THAT TO SEE --
13 Q. TO RAISE THEIR BLOOD SUGAR?
14 A. TO RAISE THEIR BLOOD SUGAR.
15 Q. AND WE'VE HAD A LITTLE BIT OF TESTIMONY AND I'LL JUST
16 TAKE 282 AS AN EXAMPLE OF SOMETHING THAT'S CALLED A M.A.R.S.
17 AND THIS IS CALLED A MULTIPLE M.A.R.S. IT APPEARS, WHAT IS
18 THAT?
19 A. THAT'S THE MEDICATION THE PATIENT WAS RECEIVING AND A
20 RECORD OF WHEN THEY RECEIVED IT AND WHO GAVE THOSE
21 MEDICATIONS.
22 Q. WHO WOULD PUT THE KINDS OF MEDICATION ON THIS M.A.R.S.?
23 A. THE NURSE WOULD LOOK AT THE DOCTOR'S ORDER AND THEN TAKE
24 THOSE DOCTOR'S ORDERS AND PUT THEM ON HERE ON THE RECORD SO
25 WE COULD HAVE A RECORD OF WHEN THEY WERE TYPICALLY GIVEN.
1488
1 Q. I THINK YOU SAID THERE'S AN ORDER DATE AND A STOP DATE.
2 A. YES.
3 Q. THE NAME OF THE MEDICATION. AND THEN WHAT'S 0817HS?
4 A. THOSE ARE THE TIMES. 8 O'CLOCK WOULD BE 8 O'CLOCK IN
5 THE MORNING. SEVENTEEN WOULD BE FIVE IN THE AFTERNOON.
6 H.S. WAS USUALLY EIGHT AT NIGHT OR NINE AT NIGHT AT BEDTIME.
7 H.S. MEANS BEDTIME.
8 Q. THEN THE TIMES ARE WRITTEN DOWN HERE.
9 A. UH-HUH.
10 Q. AND THEN THERE'S AN INITIAL NEXT TO -- APPEARS TO BE --
11 IT LOOKED LIKE IT WAS 2000, NOW IT'S 2100. WHAT WOULD THAT
12 MEAN?
13 A. THAT MEANS THAT SHE GOT THIS MEDICATION AT BEDTIME.
14 Q. WHOSE INITIALS WOULD THAT BE?
15 A. THAT LOOKS LIKE DO'S.
16 Q. DORENE KLEI?
17 A. YES.
18 Q. AND AT THE TOP THAT SAYS 12/28. THE NEXT ONE OVER HERE
19 SAYS 12/29 IS THAT HOW YOU CHARTED WHETHER THESE DOSES WERE
20 GIVEN?
21 A. YES.
22 Q. DOWN HERE IT SAYS A DURAGESIC PATCH 50 MILLIGRAMS.
23 A. UH-HUH.
24 Q. THERE'S A SQUARE AND THIS ONE HAS INITIALS IN IT, THIS
25 ONE DOES NOT HAVE INITIALS IN IT. DO YOU KNOW WHAT THAT
1489
1 SQUARE MEANT?
2 A. THAT'S WHEN WE WERE TO GIVE THE DOSE. THE OTHER ONES
3 WERE CROSSED OFF BECAUSE YOU ONLY GAVE IT EVERY THREE DAYS
4 SO YOU WANTED TO MAKE SURE THAT IT WASN'T -- SO YOU DIDN'T
5 WANT TO GIVE IT EVERY DAY. YOU MADE A SQUARE TO KNOW THAT
6 WAS THE DAY YOU WERE TO GIVE THE DOSE.
7 Q. JUST AGAIN FOR POINT OF REFERENCE, IF YOU TURN TO 284.
8 A. OKAY.
9 Q. LET'S SEE, WE HAVE THIS MUST BE ACCUCHECK; IS THAT
10 CORRECT?
11 A. YES.
12 Q. SO EVEN WHEN YOU CHECKED THEIR BLOOD SUGAR IT HAD TO
13 COME OFF THIS; IS THAT CORRECT?
14 A. YES.
15 Q. SO THESE LINES THROUGH MEANT THAT AT 7 IN THE MORNING
16 AND 11 IN THE MORNING IT DIDN'T HAPPEN; IS THAT CORRECT?
17 A. YES.
18 Q. AND THEN I DON'T KNOW WHY -- ARE THOSE THE NUMBERS OF
19 THEIR BLOOD SUGAR?
20 A. THAT WOULD BE HIS BLOOD SUGAR OR HER BLOOD SUGAR, YES.
21 Q. I WANTED TO POINT OUT DOWN HERE ON THE 1ST OF JANUARY
22 THERE ARE A COUPLE OF PLACES WHERE THE INITIALS L.L. ARE.
23 A. UH-HUH.
24 Q. DO YOU KNOW WHO THAT IS?
25 A. THAT'S LYNN LONG.
1490
1 Q. AND THEY ARE CIRCLED?
2 A. YES.
3 Q. DO YOU KNOW WHAT THAT MEANS?
4 A. IT MEANS THAT THEY WEREN'T GIVEN AND THERE'S A LITTLE
5 CODE UP HERE IN THE MIDDLE THAT TELLS -- IT HAS A NUMBER BY
6 IT.
7 Q. AND THAT CODE IS SIX?
8 A. SHE'S WRITTEN OTHER, SEE THE NURSES' NOTES. SO SHE'S
9 WRITTEN A REASON WHY SHE DIDN'T GIVE THAT.
10 Q. IN THE NURSES' NOTES?
11 A. IN THE NURSES' NOTES.
12 Q. THE NEXT CATEGORY THAT WE HAVE IS CALLED NURSES' NOTES,
13 294.
14 A. UH-HUH.
15 Q. AND I THINK WE TALKED AND I WON'T GET INTO THIS A GREAT
16 DEAL, BUT THE FIRST THING IN THE NURSES' NOTES IS THIS
17 ASSESSMENT?
18 A. YES.
19 Q. AND I THINK YOU TESTIFIED YOU DID THIS ONE?
20 A. YES.
21 Q. NOW, BEHIND THE ASSESSMENT AND, AGAIN, I THINK YOU --
22 JUST TO SHOW -- I GUESS I SHOULD FINISH MY SENTENCES.
23 JUST TO SHOW WHERE WE ARE WITH THIS. THIS IS THE FIRST
24 PAGE AFTER THE ASSESSMENT AND LET'S NOT GOING INTO GREAT
25 DETAIL BECAUSE YOU DID LAST WEEK BUT WHAT IS THIS AGAIN?
1491
1 A. THIS IS THE NURSES' NOTES AND NURSING ASSESSMENT.
2 Q. THE NEXT SECTION IS CALLED CARDEX. CAN YOU TELL US WHAT
3 THE CARDEX WAS JUST IN GENERAL?
4 A. IT WAS HELD SEPARATE FROM THE CHART AND IT WAS A -- YOU
5 HAD ALL THE PATIENTS' CARDEX TOGETHER AND BASICALLY IT TOLD
6 YOU THE MEDICATIONS THE PATIENT WAS ON, THE DIET SO YOU
7 COULD HAVE A QUICK REFERENCE TO LOOK AT ALL THE PATIENTS AND
8 CHECK ORDERS AND STUFF, RATHER THAN HAVING TO GO THROUGH THE
9 CHART EVERY SINGLE TIME.
10 Q. SO IF YOU WANTED TO MAKE SURE ABOUT THE ORDER YOU
11 WOULDN'T HAVE TO GO BACK TO THE PHYSICIAN'S ORDERS, YOU
12 COULD LOOK AT THE CARDEX?
13 A. YOU COULD LOOK AT THE CARDEX, YES.
14 Q. AND THEY ARE SUPPOSED TO COINCIDE?
15 A. THEY ARE.
16 Q. NOW THE NEXT SECTION IS TERMED MEDICAL/LEGAL. CAN YOU
17 TELL US WHAT IS IN THAT SECTION?
18 A. THIS IS ALL THE CONSENTS TO TREAT. THIS IS ALL THE
19 CONSENTS TO HAVE ANY TEST DONE, THESE ARE THE CONCEPTS TO
20 WHO TO CONTACT, THE FAMILY THAT HAS THE RIGHT TO SAY WHAT
21 GOES ON WITH THE PATIENT.
22 Q. AND THEN THE MASTER TREATMENT PLAN IS THE NEXT SECTION,
23 347.
24 A. UH-HUH.
25 Q. CAN YOU TELL THE JURY WHAT THAT IS?
1492
1 A. YOU WOULD HAVE WHAT YOU CALL TEAM MEETINGS AND YOU WOULD
2 GET TOGETHER AND GO OVER THIS TO TRY AND FIND THE BEST PLAN
3 TO TREAT THIS PATIENT AND TO COME UP WITH WHAT ARE WE GOING
4 TO DO FOR THIS PATIENT, WHAT'S WRONG WITH THE PATIENT AND
5 WHAT ARE WE GOING TO DO ABOUT IT.
6 Q. WHEN YOU SAY TEAM MEETINGS, WHO WOULD BE AT THOSE TEAM
7 MEETINGS?
8 A. GENERALLY A NURSE, THE SOCIAL WORKER, THE DOCTOR, O.T.
9 COULD GO, RECREATIONAL THERAPY.
10 Q. O.T., WHAT IS --
11 A. OCCUPATIONAL THERAPY, I'M SORRY. THE SPEECH THERAPIST
12 COULD GO. IT WAS JUST SO WE COULD SIT DOWN AND LOOK AT THIS
13 PATIENT AND FIGURE OUT AS A TEAM WHAT WAS THE BEST THING TO
14 DO FOR THEM.
15 Q. AND COULD THIS TREATMENT PLAN CHANGE OVER TIME?
16 A. YES, IT WAS MEANT TO CHANGE. IT WAS MEANT TO CHANGE AS
17 THE PATIENT CHANGED, AS THEIR NEEDS CHANGED.
18 Q. AND THEN WE HAVE THE DISCHARGE SUMMARY ON 353, WHAT IS
19 THAT?
20 A. I BELIEVE THIS WAS DONE AFTER THEY WERE DISCHARGED.
21 Q. DID YOU EVER SEE THESE?
22 A. YES, I HAVE SEEN THEM BEFORE BUT IT'S BEEN LONG ENOUGH I
23 DON'T REMEMBER EXACTLY WHEN THEY DID THESE.
24 Q. THANK YOU. LET'S TURN BACK -- NOW THAT WE'VE BEEN
25 THROUGH THE BASICS, LET'S TURN BACK TO 470.
1493
1 A. WHAT'S THAT NUMBER?
2 Q. I'M SORRY, 470 DOESN'T LOOK LIKE THE RIGHT NUMBER FOR
3 ME.
4 A. OKAY.
5 Q. LET ME SEE IF I CAN'T GET A BETTER NUMBER HERE.
6 MS. BARLOW: I APOLOGIZE, YOUR HONOR. I THOUGHT I
7 HAD THE CORRECT NUMBER BUT LET'S SEE IF I CAN'T FIND A
8 BETTER ONE. OH, I RECOGNIZE MY PROBLEM. WE SHOULD BE IN
9 THE JUDITH LARSEN. I'M SORRY, THAT'S WHY THE NUMBER IS
10 CORRECT BUT I'M IN THE WRONG BOOK.
11 Q. (BY MS. BARLOW) DO YOU HAVE JUDITH LARSEN?
12 A. I DO.
13 Q. 470?
14 A. UH-HUH.
15 Q. NOW, THIS IS IN THE SECTION CALLED PROGRESS NOTES AND
16 WHAT IS THAT AGAIN?
17 A. THAT'S WHERE THE DOCTOR WOULD OR THE OCCUPATIONAL
18 THERAPIST WOULD DOCUMENT WHAT'S -- IT'S A RUNNING RECORD OF
19 THE PATIENT.
20 Q. ON 470 THEN WE HAVE SEVERAL WRITINGS ON IT AT 12/14/95
21 O.T., WHAT IS THAT?
22 A. OCCUPATIONAL THERAPY.
23 Q. AND THE OCCUPATIONAL THERAPISTS WRITES, PATIENT WAS
24 UNABLE TO BE ASSESSED TODAY TWO DEGREE MARK MEDICATION.
25 WHAT DOES THAT MEAN?
1494
1 A. I WOULD THINK THAT THE PATIENT WAS NOT AS ALERT TO --
2 MR. STIRBA: YOUR HONOR, YOUR HONOR, I'M GOING TO
3 OBJECT, NOT RESPONSIVE.
4 THE COURT: SUSTAINED.
5 Q. (BY MS. BARLOW) WHAT DOES THE TWO AND THEN THE DEGREE
6 MARK MEAN?
7 A. I'M NOT SURE WHAT HE MEANT.
8 Q. OKAY. THANK YOU.
9 LET'S GO DOWN TO 12/14/95. WHO WROTE THIS?
10 A. THIS IS DR. WEITZEL.
11 Q. AND WHAT DOES IT SAY?
12 A. IT SAYS, HAS MADE A MIRACULOUS RECOVERY, AMBULATED
13 YESTERDAY, TAKING GOOD -- FOOD WELL, VITAL SIGNS ARE
14 AFEBRILE, THAT MEANS SHE DIDN'T HAVE A TEMPERATURE, DOING
15 MUCH BETTER REMAINS -- AND I'M NOT SURE WHAT THAT WORD IS,
16 CONTINUE CURRENT TREATMENT.
17 Q. T.X. IS TREATMENT --
18 A. DEMENTED, THAT'S WHAT THAT WORD IS, REMAINS DEMENTED.
19 Q. T.X. MEANS TREATMENT?
20 A. YES.
21 Q. DO YOU RECALL DOCTOR -- DR. WEITZEL WRITING THAT NOTE?
22 A. I DO.
23 Q. AND IT WAS WHAT, THE 14TH OF DECEMBER, DID YOU SEE HIM
24 WRITE IT?
25 A. YES, I DID.
1495
1 Q. WHERE WERE YOU WHEN YOU SAW HIM WRITE THIS?
2 A. AT THE NURSES' DESK.
3 Q. AND WAS ANYONE ELSE PRESENT?
4 A. YES, BUT I DON'T REMEMBER EXACT NAMES.
5 Q. WHAT DID DR. WEITZEL -- DID HE SAY ANYTHING BEFORE HE
6 WROTE THIS NOTE?
7 A. HE ASKED HOW JUDITH WAS DOING AND WE GAVE HIM THE REPORT
8 THAT SHE WAS -- SHE WAS DOING BETTER, THAT SHE HAD WOKEN UP
9 AND SHE HAD STARTED EATING AND THAT SHE HAD WALKED THE DAY
10 BEFORE AND THIS WAS A BIG IMPROVEMENT FOR JUDITH.
11 Q. WHAT, IF ANYTHING, DID HE SAY TO THAT?
12 A. HE GRABBED THE CHART AND HE SAYS, AREN'T YOU NURSES
13 GOOD, AREN'T YOU JUST PROUD OF YOURSELF AND HE LIFTS IT UP
14 LIKE THIS AND HE WRITES, HAS MADE A MIRACULOUS RECOVERY, HE
15 GOES LIKE THAT AND PUTS THE EXPLANATION POINT AND SAYS
16 AREN'T YOU PROUD.
17 Q. DID HE SAY ANYTHING MORE AFTER THAT?
18 A. NOT THAT I RECALL.
19 Q. DID YOU SAY ANYTHING IN RESPONSE TO THAT?
20 A. NO.
21 Q. WHAT WAS HIS TONE OF VOICE AS HE SAID THAT?
22 MR. STIRBA: YOUR HONOR, I'M GOING TO OBJECT.
23 THE COURT: SUSTAINED.
24 Q. (BY MS. BARLOW) YOU TESTIFIED FRIDAY THAT YOU HAD
25 QUESTIONED MORPHINE BEING GIVEN TO MARY CRANE. DO YOU
1496
1 RECALL WHEN MARY CRANE WAS DIAGNOSED AS HAVING A FISTULA?
2 A. I DON'T KNOW THE EXACT DATE. I COULD LOOK IT UP IN
3 HERE, IT'S DOCUMENTED.
4 Q. IF YOU WOULD, PLEASE.
5 A. OKAY.
6 Q. IF YOU LOOKED AT 244, I THINK THAT WOULD HELP.
7 A. OKAY. IT'S JANUARY 2ND OF '96 THAT WE HAVE A CONSULT ON
8 THAT.
9 Q. THAT'S WHEN DR. DIENHART CHECKED HER FISTULA?
10 A. IT LOOKS LIKE A STEVEN MECHAM.
11 Q. THAT'S RIGHT. NOT DR. DIENHART. DR. MEEKS. THANK YOU.
12 A. YES.
13 Q. WERE YOU THERE WHEN DEFENDANT LEARNED ABOUT THIS
14 FISTULA?
15 A. YES, I WAS.
16 Q. AND WHERE WAS THAT?
17 A. IT WAS AT THE NURSES' DESK.
18 Q. WAS ANYONE ELSE PRESENT?
19 A. I DON'T RECALL.
20 Q. WHEN WAS THAT IN RELATIONSHIP TO THIS CONSULT, DO YOU
21 KNOW?
22 A. IT WAS BEFORE THIS CONSULT. IT WAS PROBABLY A DAY OR
23 TWO BEFORE.
24 Q. AND HOW DID -- HOW DID THE DEFENDANT LEARN ABOUT THE
25 FISTULA?
1497
1 A. ONE OF THE NURSES WAS TELLING HIM, I BELIEVE IT WAS
2 LYNN, BUT I'M NOT POSITIVE.
3 Q. LYNN LONG?
4 A. I BELIEVE SO.
5 Q. WHAT WAS THE DEFENDANT'S RESPONSE WHEN HE LEARNED OF
6 THIS FISTULA?
7 MR. STIRBA: YOUR HONOR, I'M GOING TO OBJECT,
8 UNFAIR SURPRISE.
9 THE COURT: GO AHEAD. WE'RE GOING TO HAVE TO DEAL
10 WITH THAT AT A LATER TIME. WHY DON'T YOU GO ON TO SOMETHING
11 ELSE AND WE CAN DISCUSS THAT AT A LATER TIME.
12 Q. (BY MS. BARLOW) YOU TESTIFIED ON FRIDAY ABOUT
13 APPROACHING THE DEFENDANT ABOUT MARY CRANE BEING IN PAIN.
14 A. YES.
15 Q. DO YOU RECALL THAT?
16 A. I DO.
17 Q. LET'S NOW TURN TO LYDIA SMITH. DO YOU RECALL WHEN MARY
18 CRANE PASSED WAY?
19 A. IT WAS 2330 -- 11:30 ON THE 7TH, JANUARY 7TH.
20 Q. WHEN DID LYDIA SMITH PASS AWAY?
21 A. SHE PASSED AWAY ON THE 8TH AT LIKE 12:45 IN THE
22 AFTERNOON.
23 Q. SO IT WAS A LITTLE OVER 12 HOURS LATER?
24 A. UH-HUH.
25 Q. WERE YOU ON DUTY THAT NIGHT THAT MARY CRANE PASSED AWAY?
1498
1 A. YEAH, JANUARY 7TH, YES.
2 Q. IS THAT WHEN YOU HAD THE CONFRONTATION WITH DR. WEITZEL
3 ABOUT --
4 MR. STIRBA: YOUR HONOR, I'M GOING TO OBJECT, IT'S
5 A LEADING AND SUGGESTIVE CHARACTERIZATION.
6 THE COURT: SUSTAINED.
7 Q. (BY MS. BARLOW) YOU WERE ON DUTY?
8 A. YES.
9 Q. DID YOU HAVE OCCASION TO TALK TO DR. WEITZEL ABOUT THE
10 ADMINISTRATION OF MORPHINE TO MARY CRANE?
11 A. YES.
12 MR. STIRBA: I'M GOING TO OBJECT, ASKED AND
13 ANSWERED, YOUR HONOR, SHE'S ALREADY TESTIFIED.
14 MS. BARLOW: YOUR HONOR, IT'S FOUNDATIONAL.
15 THE COURT: ISN'T THIS WHAT WE DID ON FRIDAY?
16 MS. BARLOW: YES, BUT I'M USING IT AS FOUNDATION TO
17 ASK THE NEXT QUESTION, YOUR HONOR.
18 THE COURT: WELL, JUST ASK THE NEXT QUESTION.
19 Q. (BY MS. BARLOW) WAS DEFENDANT PRESENT WHEN YOU --
20 AFTER TALKING TO THE PHARMACY WHEN YOU CAME BACK AND SAID
21 YOU WEREN'T COMFORTABLE?
22 A. YES, HE WAS.
23 Q. AND WHAT, IF ANYTHING, DID HE SAY WHEN YOU SAID --
24 MR. STIRBA: YOUR HONOR, I'M GOING TO OBJECT, IT'S
25 GONE OVER.
1499
1 THE COURT: PARDON?
2 MR. STIRBA: IT'S ASKED AND ANSWERED, YOUR HONOR.
3 THE COURT: ISN'T THIS WHAT WE DISCUSSED LAST
4 FRIDAY?
5 MR. STIRBA: YES.
6 MS. BARLOW: YOUR HONOR, LAST FRIDAY SHE HADN'T
7 TESTIFIED THAT THE DEFENDANT WAS PRESENT WHEN SHE --
8 EXPRESSED HER DISCOMFORT WITH GIVING IT. YOUR HONOR, I'LL
9 GO ON. IT'S NOT -- I WAS TRYING TO BE FOUNDATIONAL. I WILL
10 JUST GO STRAIGHT ON.
11 THE COURT: OKAY.
12 Q. (BY MS. BARLOW) AFTER ALL OF THAT HAPPENED, DID YOU
13 SEE ANY ORDERS FOR MORPHINE FOR ANYBODY ELSE?
14 A. YES, I DID.
15 Q. WHEN DID THAT HAPPEN?
16 A. IT WAS RIGHT AFTER LYNN HAD GIVEN THE SHOT TO MARY CRANE
17 I OPENED THE CHART AND THERE'S AN ORDER ON LYDIA TO GET THE
18 MORPHINE.
19 Q. AND DID YOU HAVE -- WELL, DID YOU EXPRESS ANY CONCERN
20 ABOUT THAT?
21 A. I DID.
22 Q. TO WHOM?
23 MR. STIRBA: YOUR HONOR, YOUR HONOR, I'M GOING TO
24 OBJECT. THIS IS UNFAIR SURPRISE.
25 THE COURT: OKAY. LET'S -- WE'LL BE ABLE TO TAKE A
1500
1 BREAK WHEN THE JURY IS NOT HERE AND WE'LL BE ABLE TO DISCUSS
2 THAT AND THE OTHER ISSUE, SO GO ON TO SOMETHING ELSE AND
3 WE'LL COME BACK TO THAT.
4 Q. (BY MS. BARLOW) LET'S TALK ABOUT LYDIA SMITH, THEN, IN
5 TERMS OF HER RECORDS. DO YOU RECALL LYDIA SMITH?
6 A. I DO.
7 Q. AND WAS THERE ANYTHING IN PARTICULAR ABOUT HER THAT MADE
8 YOU RECALL HER?
9 A. THERE WERE A LOT OF THINGS ABOUT LYDIA.
10 Q. NAME SOME OF THEM.
11 A. THIS WOMAN WAS A VERY FEISTY ALIVE WOMAN WHEN SHE CAME
12 ON TO THE UNIT. THIS WOMAN WAS VERY ACTIVE ON THE UNIT, SHE
13 WOULD PACE, SHE WOULD GO AROUND CONSTANTLY TRYING THE DOORS
14 ON THE UNIT. SHE WOULD GO OVER TO JUDITH AND HOLD JUDITH'S
15 HAND. SHE WOULD WANDER INTO THE PATIENTS' ROOMS. SHE WAS
16 VERY, VERY ACTIVE ON THE UNIT. AND AT ONE POINT WE HAD TO
17 POSEY HER BECAUSE WE WERE AFRAID SHE WOULD WANDER INTO THIS
18 MALE PATIENT'S ROOM, WE WERE AFRAID SHE WOULD GET HURT.
19 ALSO WHEN YOU WOULD TAKE CARE OF JUDITH --
20 MR. STIRBA: YOUR HONOR, I'M GOING TO OBJECT. I
21 DON'T THINK IT'S RESPONSIVE AT THIS POINT.
22 THE COURT: LET'S JUST PROCEED BY QUESTION AND
23 ANSWER.
24 Q. (BY MS. BARLOW) IS THERE ANYTHING ELSE THAT YOU WOULD
25 DO WITH JUDITH?
1501
1 MR. STIRBA: IRRELEVANT, YOUR HONOR.
2 MS. BARLOW: YOUR HONOR, SHE'S TESTIFIED --
3 THE COURT: OVERRULED.
4 MS. BARLOW: -- WHY SHE REMEMBERED. THANK YOU.
5 Q. (BY MS. BARLOW) WAS THERE ANYTHING ELSE THAT YOU WOULD
6 DO WITH JUDY?
7 A. WHEN JUDITH WOULD CRY OUT AND STUFF SHE WOULD BECOME
8 VERY UPSET AND AGITATED HERSELF AND ULTIMATELY THAT ENDED UP
9 HAVING TO HAVE HER TO BE IN A POSEY AND THIS WAS BECAUSE SHE
10 WAS SO FEISTY AND ALIVE. IT WASN'T BECAUSE SHE WAS UNSTEADY
11 AT THAT POINT OR ANYTHING.
12 Q. COULD SHE WALK BY HERSELF?
13 A. YES.
14 Q. WERE SHE AND JUDITH IN THE SAME ROOM?
15 A. YES.
16 Q. SHE WAS ADMITTED TO THE UNIT ON WHAT DAY IF YOU LOOK AT
17 698 IN LYDIA SMITH'S?
18 A. OKAY. SHE WOULD HAVE BEEN -- IT SAYS 12/20/95 SO THAT
19 WOULD HAVE BEEN DECEMBER 20TH OF '95.
20 Q. DO YOU RECALL WHETHER SHE CHANGED OVER THE TIME THAT YOU
21 WERE WORKING WITH HER?
22 A. YES.
23 MR. STIRBA: OBJECTION, LACK OF FOUNDATION, VAGUE
24 AND AMBIGUOUS.
25 THE COURT: LAY THE FOUNDATION.
1502
1 Q. (BY MS. BARLOW) WHEN DID YOU WORK WITH LYDIA?
2 A. I WORKED WITH LYDIA SEVERAL TIMES. I WAS THERE WHEN SHE
3 WAS ADMITTED AND I WAS THERE AS SHE STARTED GOING -- WHEN
4 SHE STARTED TO WHERE SHE COULDN'T FUNCTION AND HAD CHANGED.
5 Q. LET'S TURN TO 791, I BELIEVE, IN THE NURSING NOTES. DID
6 YOU WRITE ANYTHING ON THIS?
7 A. I DID.
8 Q. AT THE TOP WE HAVE 11 TO 7?
9 A. YES.
10 Q. WHAT DID THAT MEAN?
11 A. THAT WAS THE NIGHT SHIFT, THAT WAS 11 AT NIGHT UNTIL 7
12 IN THE MORNING.
13 Q. SO THINGS THAT WERE WRITTEN DURING ON THAT TIME PERIOD
14 WEREN'T LIMITED TO ANY PARTICULAR HOUR, IS THAT --
15 A. NO. JUST TO THAT NIGHT SHIFT HOURS.
16 Q. AND THEN AT 1300, IS THAT YOUR HANDWRITING?
17 A. YES, IT IS.
18 Q. AND WE HAVE "B",WHAT DOES THAT STAND FOR?
19 A. BEHAVIOR.
20 Q. AND WHAT WAS HER BEHAVIOR?
21 A. PATIENT REFUSED HER A.M. MEDS. PATIENT HAS BEEN VERY
22 AGGRESSIVE, HITTING AND KICKING AND BITING STAFF. PATIENT
23 VERY DIFFICULT TO REDIRECT.
24 Q. WHAT DO YOU MEAN BY REDIRECT?
25 A. WHEN SHE WOULD BECOME AGITATED SOMETIMES YOU COULD
1503
1 SETTLE HER DOWN, SOMETIMES YOU COULD TALK HER DOWN.
2 SOMETIMES LIKE IF SHE WAS BOTHERING ANOTHER PATIENT, YOU
3 COULD REDIRECT HER INTO ANOTHER ROOM, BUT SHE AT THIS POINT
4 DID NOT WANT TO LEAVE THAT ROOM OR DID NOT WANT TO BE -- WAS
5 NOT ABLE TO BE REDIRECTED EASILY.
6 Q. THEN "I" STANDS FOR WHAT?
7 A. INTERVENTION.
8 Q. AND WHAT DOES THAT -- WHAT DID YOU DO THERE?
9 A. SUPPORT, ONE-TO-ONE TIME, I.M. MEDICATIONS, SAFE
10 ENVIRONMENT PROVIDED.
11 Q. WHAT DOES THAT ALL MEAN?
12 A. IT MEANS WE SPENT SOME TIME WITH HER. WE TRIED TO
13 REDIRECT HER AND TALK WITH HER. WE GAVE HER THE MEDICATION
14 AS ORDERED AND WE MADE SURE THAT SHE DIDN'T WANDER INTO
15 ANOTHER PATIENT'S ROOM SO THAT THEY WOULD HARM HER AND WE
16 ALSO MADE SURE THAT SHE DIDN'T HARM OTHER PATIENTS. SO WE
17 PROVIDED A SAFE ENVIRONMENT WHERE SHE OR THE OTHER PATIENTS
18 WOULDN'T BE INJURED.
19 Q. AND THEN "R" STANDS FOR WHAT?
20 A. HER RESPONSE.
21 Q. AND WHAT WAS HER RESPONSE?
22 A. SHE WAS VERY AGGRESSIVE AND AGITATED, SHE WAS PACING AND
23 VERY CONFUSED. SHE WAS NOT ORIENTED TO TIME, PLACE OR
24 PERSON.
25 Q. AND THEN "P" STANDS FOR WHAT?
1504
1 A. THE PLAN.
2 Q. AND WHAT IS THE PLAN?
3 A. MEDICATIONS AS PER DOCTOR, SAFE THERAPEUTIC ENVIRONMENT.
4 SAFE THERAPEUTIC MEANS WE WERE GOING TO PROVIDE GROUPS FOR
5 HER AND HAVE HER INVOLVED IN THE UNIT ACTIVITIES.
6 Q. NOW, THIS WAS THE 3RD OF JANUARY AND IT SAYS MEDS AS PER
7 DOCTOR. CAN WE LOOK BACK AND FIND OUT WHAT THE MEDS WERE
8 THAT THE DOCTOR HAD ORDERED?
9 A. YES.
10 Q. PHYSICIAN'S ORDER START AT 705. IT LOOKS LIKE 710
11 INCLUDES ONE THROUGH...
12 A. 710?
13 Q. UH-HUH.
14 A. OH, AND THIS IS ON LYDIA.
15 Q. YES, WE'RE ON LYDIA.
16 A. MY 710 IS A DOCTOR'S ORDER SHEET, IS THAT WHAT I'M
17 LOOKING AT?
18 Q. YES. YES, I'M SORRY. IS THIS WHAT YOU ARE LOOKING AT?
19 A. YES, IT IS.
20 Q. DOWN HERE AT THE BOTTOM ARE SOME DOCTOR'S ORDERS. WHOSE
21 HANDWRITING IS THAT?
22 A. THAT'S DR. WEITZEL.
23 Q. AND IT'S THE 3RD OF JANUARY, DO WE KNOW WHAT TIME THOSE
24 ORDERS WERE TAKEN OFF OR NOTED?
25 A. IT LOOKS LIKE NOON BUT I DON'T SEE -- THE SIGNATURE IS
1505
1 CUT OFF ON THE BOTTOM OF MINE.
2 Q. SO THE MEDS ARE SERZONE, TRAZODONE, DEPAKENE AND A
3 CLONIDINE PATCH; IS THAT CORRECT?
4 A. YES.
5 Q. ARE THOSE THE MEDS THAT YOU HAD PROVIDED FOR HER?
6 A. YES.
7 Q. DO YOU KNOW WHAT SERZONE IS USED FOR?
8 A. IT'S FOR AGITATION.
9 Q. LET'S TURN BACK TO THE NURSES' NOTES. AFTER THAT
10 AGITATION, LET'S LOOK AT 793, THIS ALSO APPEARS TO BE THE
11 3RD OF JANUARY 1996. WHAT WAS THE CONDITION OF THE PATIENT
12 AT THAT TIME?
13 MR. STIRBA: YOUR HONOR, I'LL OBJECT TO FOUNDATION.
14 THE COURT: OKAY. LET'S LAY A FOUNDATION.
15 Q. (BY MS. BARLOW) WHAT IS THIS DOCUMENT?
16 A. IT'S THE NURSES' NOTES.
17 Q. AND WHO WRITES THESE NURSES' NOTES?
18 A. THE NURSES.
19 Q. DO YOU KNOW WHO WROTE THIS NOTE?
20 A. BONNIE HARDEY.
21 Q. IS THIS KEPT IN THE ORDINARY COURSE OF MEDICAL
22 TREATMENT?
23 A. YES.
24 MS. BARLOW: YOUR HONOR, THESE HAVE BEEN
25 ADMITTED --
1506
1 MR. STIRBA: BUT THE NOTE IS BEST EVIDENCE, YOUR
2 HONOR. SHE DIDN'T WRITE IT, IT'S RIGHT THERE, I MEAN --
3 THE COURT: ARE YOU GOING TO ASK HER TO READ THE
4 NOTE?
5 MS. BARLOW: I WAS GOING TO ASK HER TO READ AT
6 LEAST THE FIRST PART OF IT.
7 THE COURT: OKAY. LET -- HAVE HER READ THE FIRST
8 PART OF IT. IT'S ALREADY IN EVIDENCE.
9 Q. (BY MS. BARLOW) WOULD YOU READ THE FIRST PART OF THAT
10 NOTE DOWN TO ABOUT HERE -- SORRY, DOWN TO THE "I," IF YOU
11 WOULD READ THE "B".
12 A. PATIENT IS VERY DROWSY, IN GERI-CHAIR AT START OF SHIFT.
13 PATIENT DID NOT EAT DINNER. I DON'T KNOW WHAT -- SHE'S
14 LETHARGIC, SHE'S IN A LETHARGIC STATE. PATIENT PLACED
15 IN...AND I'M NOT SURE WHAT THAT WORD IS. WHEN TAKEN TO THE
16 BATHROOM, PATIENT WOULD PICK UP BOTH LEGS AND BEND THEM,
17 STAFF HAD TO SUPPORT FOR ENTIRE AMBULATION TRANSACTION.
18 Q. (BY MS. BARLOW) AND THEN UNDER "I" THE INTERVENTION
19 WAS WHAT?
20 A. GIVE HALDOL, I.M. I'M NOT SURE WHAT THE NEXT PART IS.
21 PATIENT NOT TAKING MEDICATIONS P.O.
22 Q. P.O. MEANS BY MOUTH?
23 A. BY MOUTH.
24 Q. WAS THIS DIFFERENT FROM HOW YOU HAD SEEN HER EARLIER IN
25 THE DAY ON THE 3RD?
1507
1 A. YES.
2 Q. IF YOU TURN TO 794. WHAT DATE IS THAT?
3 A. THE 4TH, JANUARY 4TH.
4 Q. AND THE FIRST TIME IS AT WHAT TIME, FIRST NOTE?
5 A. 4:45 IN THE MORNING.
6 Q. AND WHAT'S THAT FIRST NOTE?
7 A. PATIENT RESTLESS, TOSSING AND TURNING, UP TO THE
8 BATHROOM, BITING AT STAFF, STRIKING OUT, KICKING. I'M NOT
9 SURE -- TO BED, I.M. ATIVAN GIVEN AS ORDERED.
10 Q. AND THEN AT 6 O'CLOCK, WHAT WAS THE NOTE?
11 A. PATIENT CALMER BUT CONTINUES TO HAVE DIFFICULTY
12 SLEEPING.
13 Q. WHEN WE GET DOWN HERE 11 TO 7 AND WHAT DOES IT SAY UNDER
14 "B"?
15 A. PATIENT HAS BEEN LETHARGIC DURING THE SHIFT. PATIENT
16 HAS BEEN UNRESPONSIVE TO STAFF, PATIENT HAS BEEN SLEEPING
17 ALL SHIFT.
18 Q. IS THAT THE WAY SHE APPEARED TO YOU ON THE 3RD OF
19 JANUARY?
20 A. NO.
21 Q. LET'S LOOK AT 796. WHAT DATE IS THAT?
22 A. THE 5TH, IT'S JANUARY 5TH OF '96.
23 Q. AND THE FIRST TIME UP THERE?
24 A. IS 1:30 IN THE MORNING.
25 Q. AND THAT ENTRY IS WHAT?
1508
1 A. A MEDICATION ENTRY. IT'S, PATIENT IS VERY AGITATED,
2 MAKING NUMEROUS ATTEMPTS TO GET OUT OF BED -- I'M NOT SURE,
3 SOMETHING WITH STAFF -- STRUGGLING WITH STAFF. RESTRAINT --
4 I'M NOT SURE WHAT THAT WORD IS. ASSISTED TO THE BATHROOM.
5 Q. SOMETHING IS CROSSED OUT HERE IT LOOKS LIKE ATIVAN AND
6 THEN SOMETHING IS WRITTEN OVER THERE, CAN YOU READ THAT?
7 A. HALDOL ONE MILLIGRAM I.M. GIVEN FOR SEVERE AGITATION.
8 Q. AND THEN AT 2:30 AN HOUR LATER, WHAT WAS THE EFFECT?
9 A. PATIENT HAS BEEN SLEEPING QUIETLY SINCE 1:45,
10 RESPIRATIONS EVEN, I'M NOT SURE -- UNLABORED.
11 Q. THAT'S FAR ENOUGH WITH THAT.
12 A. OKAY.
13 Q. LET'S COME DOWN TO WHAT'S THAT THE 7 TO 3 SHIFT?
14 A. YES.
15 Q. SO AFTER THESE THINGS ARE WRITTEN THIS IS THE SEVEN TO
16 THREE SHIFT, WHAT IS "B" FOR, BEHAVIOR?
17 A. YES, BEHAVIOR.
18 Q. OKAY. AND WHAT THAT WAS HER BEHAVIOR?
19 A. PATIENT WAS VERY LETHARGIC THIS SHIFT, SITTING WITH EYES
20 CLOSED TRYING TO REMOVE CLOTHING, SOCKS, BATTING AWAY ANY
21 OFFERED SNACK OR BEVERAGE, MUMBLING INCOHERENTLY.
22 Q. LET'S JUMP DOWN TO "R" AND WHAT WAS THE RESPONSE?
23 A. PATIENT WAS UNRESPONSIVE VERBALLY, HITTING OUT WHENEVER
24 CARE IS GIVEN. I'M NOT SURE WHAT THAT IS, IT'S CUT OFF, BUT
25 FOOD THAT WAS OFFERED.
1509
1 Q. IS THAT THE WAY YOU HAD SEEN HER ON THE 3RD?
2 A. NO.
3 Q. LET'S LOOK AT 797. WHAT DATE IS THIS?
4 A. MY 797 IS STILL JANUARY 5TH.
5 Q. OKAY. IT'S NOT EASY TO READ THESE, IS IT? LET'S JUMP
6 DOWN TO UNDER THE "R" AND IF YOU WOULD READ UNDER "R" WHAT
7 THE RESPONSE WAS.
8 A. PATIENT DOES NOT APPEAR TO TOLERATE LIQUID -- I'M NOT
9 SURE WHAT THAT NEXT WORD IS -- VERY WELL. WILL NOTIFY M.D.,
10 REMAINS SOMNOLENT AND AVOIDANT OF PHYSICAL CONTACT,
11 REFLECTIVE MANNER AT COMBATIVE BEHAVIOR, I'M NOT SURE WHAT
12 THAT MEANS.
13 Q. DO YOU KNOW WHAT THE WORD SOMNOLENT MEANS?
14 A. SHE'S NOT HAVING THE AGGRESSIVE BEHAVIOR. SHE'S VERY
15 LAID BACK, THERE'S NOT A LOT OF ACTIVITY GOING ON.
16 Q. IS THIS THE WAY SHE HAD BEEN WHEN YOU HAD SEEN HER ON
17 THE THIRD?
18 A. NO.
19 Q. LET'S LOOK AT 798. WHAT DATE IS THAT?
20 A. THAT IS JANUARY 6TH.
21 Q. AND THE 11 TO 7 SHIFT, WOULD YOU READ THAT FOR US?
22 A. PATIENT AWAKEN TIMES ONE DURING THE NIGHT ATTEMPTING TO
23 REMOVE DIAPERS, TAKEN TO THE BATHROOM ON POTTY CHAIR, VOIDED
24 CONTINENT THROUGHOUT THE NIGHT.
25 Q. WHAT DOES CONTINENT MEAN?
1510
1 A. IT MEANS SHE DIDN'T NEED THE DIAPER. SHE DIDN'T WET THE
2 BED, SHE WAS ABLE TO GO TO THE BATHROOM.
3 Q. OKAY.
4 A. PATIENT RETURNED TO BED, SLEPT QUIETLY, REMAINS --
5 Q. REMAINDER?
6 A. -- DRY, I'M NOT SURE WHAT THAT -- REMAINS, I'M NOT SURE,
7 REMAINDER OF THE NIGHT, OKAY. ZERO PROBLEMS NOTED.
8 Q. AND THEN AT 1450 WE HAVE THE BEHAVIOR AGAIN. WHAT WAS
9 THE BEHAVIOR?
10 A. PATIENT HAS NOT BEEN AGGRESSIVE, SHE HAS BEEN SLEEPING
11 MOST OF THE DAY IS WHAT I'M ASSUMING THAT SAYS. WHEN AWAKE
12 SHE HAS...AND I'M NOT SURE WHAT THAT SAYS. WHEN OFFERED
13 MEALS, SHE HAS SPIT IT OUT AT US.
14 Q. AND WHAT WAS THE INTERVENTION?
15 A. OFFERED GROUPS AND MEALS.
16 Q. AND THE RESPONSE?
17 A. CONTINUES TO --
18 Q. UP HERE AT THE R?
19 A. OH, PATIENT SLEPT, UNRESPONSIVE MOST...WHAT'S THAT? I'M
20 NOT SURE.
21 Q. MOST EVERYTHING. I RECOGNIZE, THIS ISN'T YOUR
22 HANDWRITING.
23 A. WELL, AND IT'S KIND OF CUT OFF ON MY COPY A LITTLE BIT.
24 Q. IS THAT THE WAY YOU HAD SEEN HER ON THE 3RD?
25 A. NO.
1511
1 Q. DID YOU SEE ANYTHING IN THERE INDICATING ANY PAIN?
2 A. NO. I DON'T SEE ANYTHING THAT INDICATES ANY PAIN.
3 MR. STIRBA: YOUR HONOR, I'M GOING TO OBJECT.
4 SHE'S ALREADY ANSWER THE QUESTION. IT'S NONRESPONSIVE, MOVE
5 TO STRIKE.
6 THE COURT: THAT WILL BE STRICKEN, AND MEMBERS OF
7 THE JURY, IF YOU'LL DISREGARD THE LAST STATEMENT.
8 Q. (BY MS. BARLOW) LET'S LOOK AT 799 AND THIS IS WHAT
9 DATE?
10 A. THIS IS JANUARY 6TH.
11 Q. AND THE TIME IS WHAT TIME?
12 A. IT'S 2130, THAT'S 9:30 AT NIGHT.
13 Q. WOULD YOU READ THE "B," BEHAVIOR?
14 A. PATIENT HAS BEEN QUIET THIS SHIFT, RESTED QUIET WITH
15 EYES CLOSED MOST OF THE SHIFT. RESPIRATIONS EVEN AND
16 UNLABORED, ATE ZERO OF SUPER. ZERO EPISODES OF COMBATIVE.
17 I'M NOT SURE WHAT THE NEXT WORD IS. TOOK MEDS AS ORDERED.
18 Q. AND THEN "R--" WELL, WHAT WAS THE INTERVENTION, THE "I"?
19 A. ADMINISTERED MEDS AS ORDERED, PROVIDED GROUP, MONITORED
20 BEHAVIOR.
21 Q. WHAT HAVE THE RESPONSE?
22 A. PATIENT APPEARED TO SLEEP MOST OF THIS SHIFT. I DON'T
23 KNOW WHAT THOSE INITIALS ARE. RESTING QUIETLY WITH EYES
24 CLOSED, RESPIRATIONS EVEN AND UNLABORED, SLEPT IN THE CHAIR
25 AT SUPPER, ATE ZERO PERCENT, TOOK MEDS AS ORDERED, DID NOT
1512
1 INTERACT IN GROUP, ZERO COMBATIVE EPISODES THIS SHIFT.
2 Q. AND "P"?
3 A. CONTINUE TO ADMINISTER MEDICATION AS ORDERED, PROVIDE
4 GROUPS, MONITOR BEHAVIOR, BEHAVIORS CONDITION, REORIENT,
5 REDIRECTION AS NEEDED.
6 Q. DO YOU SEE ANY NOTES OF PAIN ON THAT?
7 A. NO.
8 Q. NOW, ON 800, WHAT DATE WAS THIS?
9 A. THIS WAS JANUARY 7TH.
10 Q. YOU HAD THE 11 TO 7 SHIFT, JUST READ THE FIRST THREE
11 LINES.
12 A. PATIENT RESTING QUIETLY THROUGH THE SHIFT, MINIMAL
13 RESPONSE TO A.M. CARE.
14 Q. OKAY. LET'S JUMP DOWN TO 1400.
15 A. OKAY.
16 Q. WHO WROTE THAT?
17 A. I DID.
18 Q. WHAT WAS THE BEHAVIOR THAT YOU SAW?
19 A. PATIENT NOT ABLE TO TAKE HER MEDS, PATIENT LETHARGIC,
20 MEANS SHE WAS VERY SLEEPY AND UNRESPONSIVE. PATIENT NOT
21 SWALLOWING OR RESPONDING TO STAFF.
22 Q. WHAT INTERVENTION?
23 A. THE FAMILY WAS NOTIFIED OF THE PATIENT'S CONDITION. THE
24 PATIENT WAS IN TO BE WITH THE PATIENT -- THE FAMILY WAS IN
25 TO BE WITH THE PATIENT, ORAL CARE WAS GIVEN. DOCTOR HAD
1513
1 BEEN CALLED TIMES TWO WITH OUT CALLING BACK. NO WET
2 DIAPERS, NO P.O. INTAKE.
3 Q. WHAT'S P.O.?
4 A. SHE WOULDN'T TAKE ANYTHING BY MOUTH, SHE HAD HAD NOTHING
5 TO EITHER EAT OR DRINK.
6 Q. OKAY. WHAT WAS YOUR PLAN?
7 A. TO TURN HER EVERY TWO HOURS, TO GIVE GOOD ACTIVITIES OF
8 DAILY LIVING CARE, THAT MEANS BATHING HER, MAKING SURE SHE
9 WAS CLEAN AND FOLLOWING THE DOCTOR'S ORDERS.
10 Q. DO YOU RECALL SPECIFICALLY WHAT LYDIA SMITH WAS LIKE AT
11 THIS TIME?
12 A. SHE WAS VERY, VERY UNRESPONSIVE. THIS WAS NOT THE LYDIA
13 I KNEW, THAT'S WHY I HAD TRIED TO CALL THE DOCTOR. I WAS
14 VERY CONCERNED ABOUT LYDIA AT THIS POINT.
15 Q. WHEN YOU WROTE, PLAN WAS TO FOLLOW THE DOCTOR'S ORDERS,
16 DO YOU RECALL ANY SPECIFIC ORDERS THAT YOU MEANT?
17 A. I WOULD HAVE TO LOOK AT THE ORDERS, I DON'T RECALL.
18 Q. THEN THE 801, WE HAVE AGAIN IN YOUR WRITING, WHAT IS
19 THAT, 2200 HOURS?
20 A. YES.
21 Q. WHAT DID YOU WRITE THERE?
22 A. PATIENT NOT ABLE TO TAKE ANY MEDICATION, PATIENT IS
23 UNRESPONSIVE MOST OF THE SHIFT. FOR INTERVENTION WE DID
24 SUPPORT, WE SPENT ONE-TO-ONE TIME WITH HER. MEDICATIONS AS
25 PER DOCTOR. FAMILY AND DOCTOR NOTIFIED OF PATIENT'S
1514
1 CONDITION, FAMILY AND DR. WEITZEL IN TO SEE THE PATIENT,
2 RESPIRATION SHALLOW, COMPLY WITH COMFORT MEASURES.
3 Q. WHEN DID LYDIA SMITH PASS AWAY?
4 A. IT WAS THE NEXT DAY.
5 Q. YOU WERE NOT ON DUTY THEN?
6 A. I WASN'T.
7 Q. YOU ALSO WRITE HERE MEDS AS HER DOCTOR, DO YOU USUALLY
8 WRITE IT THAT WAY?
9 A. YEAH, I DO.
10 Q. LET'S GO BACK THEN AND LOOK AT THE PHYSICIAN'S ORDERS
11 FOR THE 7TH OF JANUARY. WE HAD TALKED ON 710 THAT THERE
12 WERE ORDERS ON THE 3RD OF JANUARY FOR SERZONE, TRAZODONE,
13 CLONOPIN. IF YOU'LL LOOK AT 710 AND 711, WERE THERE ANY
14 OTHER MEDICINES ORDERED BETWEEN THE 3RD OF JANUARY AND THE
15 7TH OF JANUARY?
16 A. THERE WAS A CLONIDINE PATCH ORDERED.
17 Q. DO YOU KNOW WHAT A CLONIDINE PATCH IS FOR?
18 A. I DON'T RECALL.
19 Q. THAT'S FINE. ANYTHING ELSE BETWEEN THE 3RD AND THE 7TH?
20 MR. STIRBA: I'M SORRY, YOUR HONOR, I'M LOST WHERE
21 WE ARE. COUNSEL, COULD YOU HELP ME?
22 MS. BARLOW: 710 AND 711 IN THE ORDERS.
23 Q. (BY MS. BARLOW) DID YOU SEE ANY OTHER DRUGS ORDERED
24 BETWEEN THE 3RD AND THE 7TH OF JANUARY?
25 A. NO.
1515
1 Q. NOW, THE TIMES THAT YOU SAW LYDIA SMITH BETWEEN THE 3RD
2 AND THE 7TH OF JANUARY, DID YOU NOTE ANY INDICATIONS OF
3 PAIN?
4 A. NO.
5 Q. IN THE NOTES FROM ANY OTHER NURSES IN THESE NURSING
6 NOTES, DID YOU SEE ANY INDICATIONS OF PAIN?
7 MR. STIRBA: YOUR HONOR, I'M GOING TO OBJECT,
8 THAT'S CHARACTERIZING A CHART.
9 THE COURT: SUSTAINED.
10 Q. (BY MS. BARLOW) DID YOU SEE ANYTHING WRITTEN ON THERE
11 SAYING THE WORD PAIN?
12 A. NO.
13 Q. SO 711, WHICH IS THE 7TH OF JANUARY, WHAT'S THAT TOP
14 ORDER THERE?
15 A. IT'S MORPHINE SULFATE 5 MILLIGRAMS I.M. Q 3 HOURS AROUND
16 THE CLOCK.
17 Q. WHAT DOES THAT MEAN?
18 A. THAT MEANS HE WANTS US TO GIVE THAT MORPHINE EVERY THREE
19 HOURS, DR. WEITZEL HAS WRITTEN THAT.
20 Q. THERE'S NO P.R.N. THERE, WHAT DOES THAT MEAN?
21 A. THAT MEANS YOU GIVE IT EVERY THREE HOURS.
22 Q. AND DID YOU GIVE IT --
23 A. THERE'S NOT AN OPTION WHETHER YOU GIVE IT OR NOT.
24 MR. STIRBA: YOUR HONOR, I'M GOING TO OBJECT, IT'S
25 NOT RESPONSIVE.
1516
1 THE COURT: PLEASE, LISTEN TO THE QUESTION AND
2 THEN -- PHRASE YOUR NEXT QUESTION, PLEASE.
3 Q. (BY MS. BARLOW) AND THEN UNDERNEATH THAT IT SAYS HOLD
4 ALL OTHER MEDS OTHER THAN M.S., WHICH IS?
5 A. THE MORPHINE.
6 Q. IT SAYS D.N.R., DO YOU KNOW WHAT D.N.R. MEANS?
7 A. DO NOT RESUSCITATE.
8 Q. WHAT DOES DO NOT RESUSCITATE MEAN?
9 A. IT MEANS WE'RE NOT GOING TO DO ANY HEART COMPRESSIONS,
10 WE'RE NOT GOING TO DO ANY RESPIRATIONS ON HER. SHE STOPS
11 BREATHING, WE'RE NOT GOING TO INTERVENE.
12 Q. DO YOU KNOW WHEN THIS WAS WRITTEN OR NOTED AT LEAST?
13 A. I TOOK THAT OFF AT 2130 WHICH IS 9:30 AT NIGHT.
14 Q. DID YOU ADMINISTER ANY OF THE MORPHINE PURSUANT TO THIS
15 ORDER?
16 A. I DID.
17 Q. AND WHY DID YOU DO THAT?
18 A. I WAS TOLD I HAD TO.
19 Q. BY WHO?
20 A. BY DR. WEITZEL.
21 Q. NOW LET'S LOOK AT 712, WHAT DATE WAS THAT?
22 A. JANUARY 8TH OF '95 -- '96 EXCUSE ME.
23 Q. '96. IT LOOKS LIKE THEY WROTE '95 AND THEN CHANGED IT.
24 WHAT TIME OF DAY WAS IT?
25 A. NINE IN THE MORNING.
1517
1 Q. IS THAT DR. WEITZEL'S HANDWRITING?
2 A. YES.
3 Q. WELL, CHECK AGAIN.
4 A. YEAH, RIGHT HERE. OH, IT'S A TELEPHONE ORDER BUT THAT'S
5 HIS SIGNATURE SIGNING IT OFF.
6 Q. OH, IT'S HIS SIGNATURE. OKAY. THANK YOU.
7 HOW DID THIS TELEPHONE ORDER COME AT NINE IN THE
8 MORNING?
9 A. DR. WEITZEL OR IT WOULD HAVE BEEN OVER THE TELEPHONE.
10 Q. AND WHAT IS THE ORDER?
11 A. CHANGE MORPHINE SULFATE ORDER TO MORPHINE SULFATE
12 10 MILLIGRAMS Q 3 HOURS AROUND THE CLOCK.
13 Q. AGAIN, THERE'S NO P.R.N. THERE?
14 A. NO.
15 Q. LET'S GO BACK TO THE NURSES' NOTES TO THAT LAST DAY.
16 802 IS THE NUMBER I'M LOOKING AT SEE IF WE CAN DECIPHER THIS
17 HANDWRITING. THE 11 TO 7 SHIFT, STARTING WITH THE SECOND
18 LINE THERE, WOULD YOU READ THAT?
19 A. PATIENT LYING IN BED WITH EYES OPEN THROUGHOUT --
20 WITH -- OKAY, WITH EYES OPEN THROUGHOUT THE SHIFT.
21 SOMETHING ABOUT THE REFLEXES, GRASPING IN RESPONSE TO
22 PHYSICAL STIMULI, UNABLE TO MAKE ANY VERBAL RESPONSE.
23 MORPHINE SULFATE Q 3 HOURS I.M., AND THEN I'M NOT SURE,
24 SCHEDULED FOR -- AND I'M NOT SURE WHAT THAT IS, 24-HOUR DOSE
25 OMITTED.
1518
1 Q. SO THE MIDNIGHT DOSE WAS NOT GIVEN, IS THAT WHAT THAT
2 MEANS?
3 A. YES.
4 Q. AND READ UNDER THAT -- SO 2400 DOSE OMITTED, DUE...
5 A. DUE TO PATIENT APPEARS IN NO ACUTE DISTRESS AT THIS TIME
6 AND NURSING STAFF WAS ATTENDING ANOTHER DYING PATIENT.
7 Q. WHO WAS THAT OTHER DYING PATIENT?
8 A. MARY CRANE.
9 Q. IF YOU WOULD READ ON THROUGH THAT, DO YOU SEE ANY
10 NOTATIONS OF PAIN OR DISTRESS?
11 A. NOT THAT I CAN SEE. IT'S HARD TO READ.
12 Q. SORRY TO KEEP JUMPING YOU BACK AND FORTH BUT THAT'S THE
13 WAY THE RECORDS ARE WRITTEN.
14 A. THAT'S OKAY.
15 Q. IF YOU WOULD TURN TO 742.
16 A. OKAY.
17 Q. THIS IS THE M.A.R.S.?
18 A. UH-HUH.
19 Q. THAT WE'VE BEEN TALKING ABOUT EARLIER AND WHAT IS THIS
20 JUST BRIEFLY AGAIN?
21 A. MEDICAL RECORD -- THE MEDICATION RECORD.
22 Q. OKAY. SO WE HAVE ON 1/7/96 THE ORDER OF 5 MILLIGRAMS?
23 A. YES.
24 Q. OF MORPHINE. 2100, WHO GAVE THAT ONE?
25 A. I DID.
1519
1 Q. 2400, IT'S CIRCLED, WHAT DOES THAT MEAN?
2 A. THAT MEANS LAURIE DIDN'T GIVE IT, THAT IT WASN'T GIVEN.
3 Q. WHICH IS WHAT WE JUST READ IN THE NURSES' NOTES?
4 A. IN THE NURSES' NOTES.
5 Q. AND THEN AT THREE IN THE MORNING, WHAT DOES THAT MEAN?
6 A. THAT IT WAS GIVEN.
7 Q. AND THEN AT SIX IN THE MORNING, WHAT DOES THAT MEAN?
8 A. THAT LYDIA GOT THE 5 MILLIGRAMS OF MORPHINE.
9 Q. AND LET'S JUMP DOWN HERE TO 1/8, IS THERE A CHANGE IN
10 THE ORDER?
11 A. YES.
12 Q. HOW MUCH?
13 A. TO 10 MILLIGRAMS.
14 Q. NOW, EVEN THOUGH THIS IS WRITTEN UNDER 1/7, AT NINE IN
15 THE MORNING, WAS THAT 10 MILLIGRAMS GIVEN?
16 A. YES.
17 Q. AND WHAT --
18 A. ON THE 8TH.
19 Q. WHAT ABOUT NOON?
20 A. YES.
21 Q. AND DO YOU KNOW WHOSE INITIALS THOSE ARE?
22 A. SHEILA HANSEN.
23 Q. AND TIME DID LYDIA SMITH DIE?
24 A. 12:45.
25 Q. IN THE AFTERNOON?
1520
1 A. YES.
2 MS. BARLOW: YOUR HONOR, I THINK THOSE ARE ALL THE
3 QUESTIONS I HAVE OTHER THAN TO ADDRESS THE TWO THAT WERE --
4 THE COURT: OKAY. LADIES AND GENTLEMEN, WHY DON'T
5 WE TAKE A BREAK. WE'VE BEEN GOING FOR ABOUT AN HOUR. WHILE
6 YOU TAKE THIS BREAK, REMEMBER IT'S YOUR DUTY NOT TO CONVERSE
7 WITH YOURSELVES OR WITH ANYONE ELSE OR ALLOW YOURSELVES TO
8 BE ADDRESSED ON ANY SUBJECT OF THIS TRIAL. IT'S ALSO YOUR
9 DUTY NOT TO FORM OR EXPRESS AN OPINION UNTIL THE CASE IS
10 FINALLY SUBMITTED TO YOU. SO WHY DON'T WE COME BACK TO TEN
11 MINUTES TO TEN.
12 (WHEREUPON THE JURY WAS EXCUSED.)
13 THE COURT: YOU MAY BE SEATED. THE RECORD WILL
14 REFLECT THAT THE JURY IS NOT PRESENT. OKAY. WE HAD TWO
15 OBJECTIONS OF UNFAIR SURPRISE THAT WERE MADE. AS I RECALL,
16 ONE HAD TO DO I THINK WITH THIS FISTULA AND ONE HAD TO DO
17 WITH A MORPHINE SHOT TO LYDIA SMITH, IS THAT WHEN THE
18 OBJECTIONS WERE MADE?
19 MR. STIRBA: YES. YES, YOUR HONOR.
20 THE COURT: OKAY. TELL ME WHAT YOUR OBJECTION IS.
21 MR. STIRBA: YES. WE HAVE REQUESTED INTERVIEW
22 SUMMARIES NOT ONCE BUT TWICE OF WITNESSES AND THESE TWO
23 CONVERSATIONS ARE THE FIRST TIME I'VE HEARD ABOUT THEM WAS
24 RIGHT HERE WHEN THEY WERE GOING TO BE ASKED ABOUT, AND I
25 THINK THERE'S AN OBLIGATION TO PROVIDE THIS INFORMATION.
1521
1 THE COURT IS WELL AWARE THAT WE GOT SOME INTERVIEW SUMMARIES
2 JUST AFTER THE TRIAL STARTED. MS. COZZENS WASN'T PART OF
3 THAT. I'VE NEVER SEEN AN INTERVIEW SUMMARY OF MS. COZZENS,
4 QUITE FRANKLY, AND I'VE CERTAINLY NEVER HEARD ABOUT THESE
5 CONVERSATIONS SO I THINK IT'S UNFAIR SURPRISE. THIS IS NOT
6 SUPPOSED TO BE A TRIAL BY AMBUSH AND ESSENTIALLY THAT'S WHAT
7 THIS IS BY THESE CONVERSATIONS.
8 THE COURT: OKAY. MS. BARLOW?
9 MS. BARLOW: THANK YOU, YOUR HONOR. WE HAVE
10 PROVIDED ALL OF THE INTERVIEW SUMMARIES TO OPPOSING COUNSEL.
11 THESE ARE STATEMENTS THAT HAVE COME TO OUR ATTENTION JUST AS
12 WE WERE PREPARING FOR TRIAL. THEY WERE NOT PART OF ANY
13 INTERVIEW BY ANY DETECTIVE. IT'S JUST AS WE WERE TALKING
14 WITH HER IN RELATIONSHIP TO TRIAL THESE MATTERS CAME TO OUR
15 ATTENTION.
16 THE COURT: OKAY. WELL, HOW DOES THE DEFENDANT --
17 WELL, WHAT IS YOUR UNDERSTANDING OF WHAT THE LAW OF UNFAIR
18 SURPRISE IS IF YOU FIND OUT SOMETHING THE DAY BEFORE YOU ARE
19 GOING TO ASK THIS WITNESS THE QUESTION, THEN YOU ASK THE
20 QUESTION AND THE DEFENDANT DOESN'T HAVE ANY ABILITY TO BE
21 PREPARED FOR THAT.
22 MS. BARLOW: WELL, YOUR HONOR, I DON'T THINK THAT
23 THIS IS OUTSIDE THE REALM OF WHAT HE HAS BEEN INFORMED OF IN
24 DISCOVERY. WE ARE OBLIGATED TO GIVE HIM DISCOVERY. WE'RE
25 OBLIGATED TO TELL HIM WHO OUR WITNESSES ARE AND IF WE HAVE
1522
1 INTERVIEWS, IF WE HAVE POLICE INTERVIEWS WITH THOSE PEOPLE.
2 WE DON'T HAVE TO GIVE OUR WORK PRODUCT. BUT IF WE HAVE
3 POLICE INTERVIEWS, WE ARE, OF COURSE, SUPPOSED TO GIVE THAT.
4 THE DEFENDANT IS ENTIRELY ENTITLED TO TALK TO THESE
5 WITNESSES, NOT THE DEFENDANT, BUT HIS ATTORNEY CAN TALK TO
6 THESE WITNESSES AND FIND OUT THIS SAME MATERIAL. DISCOVERY
7 REQUIRES THAT WE TURN OVER ALL THE INFORMATION THAT WE HAVE,
8 WHICH WE DID. IT DOESN'T REQUIRE THAT WE TURN OVER OUR WORK
9 PRODUCT. AND AS I SAY, DEFENSE COUNSEL HAD EVERY RIGHT TO
10 CALL MS. COOPER AND, IN FACT, I BELIEVE HE'S DONE A
11 DEPOSITION OF HER IN ANOTHER MATTER AND SO HE HAS HAD EVERY
12 OPPORTUNITY TO FIND OUT WHAT SHE WOULD SAY TODAY.
13 AND THESE CONVERSATIONS ARE NOT OUTSIDE THE REALM OF
14 OUR THEORY OF THE CASE, OF THE INFORMATION THAT SHE HAS
15 PRESENTED TO THE POLICE OFFICER AND IN THIS DEPOSITION. IN
16 FACT, I'M NOT SURE IF THE DETECTIVE EVER DID INTERVIEW HER.
17 IF HE DIDN'T PROVIDE A SUMMARY OF THAT INTERVIEW, THEN HE
18 DIDN'T INTERVIEW HER.
19 THE COURT: OKAY. WHAT IS THE -- ON THE FIRST
20 OBJECTION, WHAT IS THE TESTIMONY GOING TO BE? WHAT IS --
21 THE QUESTION WAS ABOUT -- REMIND ME WHAT THE QUESTION WAS
22 AND WHAT THE ANSWER IS GOING TO BE.
23 MS. BARLOW: IF I CAN SAY ONE OTHER THING. THESE
24 ARE CONVERSATIONS THAT SHE HAD WITH THE DEFENDANT. IT'S
25 HARD TO SAY HE WAS UNFAIRLY SURPRISED WHEN HE WAS PART OF
1523
1 THE CONVERSATION, I WANT TO THROW THAT IN. THE FIRST WAS
2 ABOUT THE FISTULA AND I CAN HAVE HER GO THROUGH THAT
3 INFORMATION.
4 THE COURT: WELL, WAS IT -- IT WAS A CONVERSATION,
5 JUST TELL ME WHAT --
6 MS. BARLOW: OKAY. THE CONVERSATION WAS AFTER
7 DEFENDANT WAS INFORMED OF THE FISTULA HE -- I CAN'T REMEMBER
8 THE EXACT WORDS BUT HE WANTED NOTHING MORE TO DO WITH HER.
9 THERE WAS ALSO CONVERSATION ABOUT CALLING IN A SECOND
10 OPINION BECAUSE DOCTOR -- EITHER DR. DIENHART OR DR. MEEKS
11 WAS CALLED IN. I THINK DR. DIENHART WAS CALLED IN FIRST AND
12 THE DEFENDANT WAS VERY ANGRY THAT A SECOND PERSON HAD BEEN
13 CALLED IN -- I'M CONFUSING THIS, YOUR HONOR. LET ME STEP
14 BACK AND LAY IT OUT IN THE TIME FRAME.
15 THE FISTULA WAS -- THE FISTULA WAS NOT FOUND YET.
16 THERE WAS EVIDENCE OF A POSSIBLE FISTULA, THE FECAL MATERIAL
17 COMING OUT THE VAGINA INSTEAD OF THE RECTUM. DEFENDANT WAS
18 INFORMED OF THAT. I BELIEVE THE NURSES CALLED IN DR.
19 DIENHART FOR A CONSULTATION ON THAT. WHEN THE DEFENDANT
20 BEFORE FINDING OUT WHAT THE PROBLEM WAS HEARD THAT DR.
21 DIENHART HAD BEEN CALLED IN, HE BECAME ANGRY, DIDN'T WANT
22 SOMEONE ELSE CALLED IN. AND THEN WHEN HE FOUND OUT WHAT IT
23 WAS AND THEN WHEN IT WAS DIAGNOSED BY DR. MEEKS, HE THEN
24 WANTED -- DIDN'T REALLY WANT TO DEAL DIRECTLY WITH MARY
25 CRANE AFTER THAT. SO THAT'S -- THAT'S THE FIRST ISSUE.
1524
1 THAT'S THE FIRST QUESTION AND AREA THAT I WAS GOING TO GET
2 INTO. AND IT GOES TO SHOW -- IT GOES TO SHOW THE
3 DEFENDANT'S KNOWLEDGE OF THE PROBLEM THAT -- THAT THIS WOMAN
4 HAD, IT GOES TO SHOW HIS INTENT, IT GOES TO SHOW KIND OF
5 MOTIVE, EVEN THOUGH WE AREN'T REQUIRED TO --
6 THE COURT: IT SHOWS KNOWLEDGE AND INTENT OF WHAT?
7 WHAT DOES IT SHOW KNOWLEDGE OF? WHAT DOES IT SHOW INTENT
8 OF?
9 MS. BARLOW: IT SHOWS HIS INTENT TO -- IT'S HARD TO
10 SAY THAT. IT REALLY GOES TO MOTIVE, RATHER THAN TO
11 KNOWLEDGE AND INTENT. IT SHOWS HIS DISLIKE OF THIS PERSON,
12 HOW HIS CONDUCT TOWARD HER CHANGED AFTER SHE DEVELOPED THIS
13 PROBLEM THAT WAS NOT A PLEASANT PROBLEM, PHYSICAL PROBLEM.
14 AND SO THAT IT GOES TO -- IT SHOWS THAT -- HIS CONDUCT
15 TOWARDS HER AND HIS ATTITUDE TOWARDS HER.
16 THE COURT: OKAY. WHAT ABOUT THE OTHER ONE
17 REGARDING LYDIA SMITH, WHAT --
18 MS. BARLOW: REGARDING LYDIA SMITH, MS. COOPER
19 WOULD TESTIFY THAT WHEN SHE -- AFTER SHE HAD HAD THE
20 CONFRONTATION REGARDING GIVING MARY CRANE THE MORPHINE, SHE
21 OPENED UP THE CHART AND SEES MORPHINE ORDERED FOR LYDIA
22 SMITH AND SAYS, WELL, NOW WAIT A MINUTE. WHY DO WE HAVE
23 LYDIA SMITH GETTING MORPHINE, I KNOW THERE'S NO --
24 THE COURT: THIS IS A CONVERSATION WITH THE DOCTOR?
25 MS. BARLOW: THAT SHE HAD WITH THE DEFENDANT.
1525
1 THE COURT: OKAY.
2 MS. BARLOW: AND AGAIN --
3 THE COURT: AND WHAT IS SAID?
4 MS. BARLOW: AND WHAT IS SAID IS ALONG THE LINES OF
5 WHAT SHE SAID WITH MARY CRANE. SHE DOESN'T NEED IT, THERE
6 IS NO PAIN HERE AND THEN THEY GET INTO THE COLLOQUY LIKE
7 THEY DID BEFORE WITH MARY CRANE, HOW DO YOU KNOW THEY ARE
8 NOT IN ANY PAIN. AND EVENTUALLY IT COMES TO, WELL, THE
9 FAMILY MEMBERS ARE IN THERE WITH HER, ARE YOU GOING TO GO IN
10 THERE AND TELL THEM SHE ISN'T HAVING ANY PAIN.
11 THE COURT: ALL RIGHT. MR. STIRBA?
12 MR. STIRBA: YES, YOUR HONOR. I THINK THERE'S AN
13 ABSOLUTE ETHICAL OBLIGATION TO DISCLOSE MATERIAL
14 CONVERSATIONS LIKE THIS ONCE THE STATE BECOMES AWARE OF THEM
15 IN A CRITICAL WITNESS, CRITICAL CONVERSATIONS WITH THE
16 DEFENDANT. TO SUGGEST THAT WE SOMEHOW SHOULD KNOW ABOUT IT
17 BECAUSE IT'S A CONVERSATION WITH HIM, THAT PRESUPPOSES IT'S
18 TRUTHFUL, IT PRESUPPOSES IT HAPPENED.
19 THE FACT OF THE MATTER IS THEY'VE KNOWN ABOUT THIS NOT
20 JUST THIS MORNING. THIS WITNESS WAS ON THE STAND ON FRIDAY,
21 THEY'VE KNOWN ABOUT THIS FOR A FEW DAYS. THEY COME IN HERE,
22 ASK THE QUESTIONS, I DON'T HAVE A CLUE. AND I THINK IT'S
23 CLEARLY UNFAIR SURPRISE, IT'S CLEARLY SOMETHING THAT SHOULD
24 HAVE BEEN DISCLOSED AND CLEARLY IT'S A MATERIAL
25 CONVERSATION.
1526
1 AND ALSO WOULD POINT OUT, YOUR HONOR, THAT HERE WE HAVE
2 A WITNESS AND WE'RE GOING BACK HOW MANY YEARS AND WE'RE
3 TAKING ABOUT RECALLING CONVERSATIONS? AND IT SEEMS TO ME
4 THAT THERE'S NOTHING IN THE DOCUMENTS, THERE'S NO WAY THAT I
5 COULD POSSIBLY SURMISE OR DIVINE THAT SHE WAS GOING TO SAY
6 ANYTHING LIKE THIS. THERE'S NOTHING IN THE DOCUMENTS,
7 THERE'S NOTHING IN ANY OF THE RECORDS THAT WOULD SUGGEST
8 THAT THESE CONVERSATIONS TOOK PLACE. SO THE FIRST TIME I
9 HEAR THEM IS THIS MORNING IN OPEN COURT AND I WOULD SUGGEST
10 THAT IT'S UNFAIR SURPRISE AND THERE REALLY IS NO REASON WHY
11 I WASN'T TOLD ABOUT THESE CONVERSATIONS AND CERTAINLY THEY
12 ARE MATERIAL. IF THEY WERE LESS MATERIAL, PERHAPS IT'S A
13 DIFFERENT ISSUE, BUT THEY ARE CLEARLY MATERIAL FOR PURPOSES
14 OF THIS CASE.
15 THE COURT: OKAY. ANYTHING FURTHER, MS. BARLOW?
16 MS. BARLOW: YES, YOUR HONOR. RULE 16 OF THE UTAH
17 RULES OF CRIMINAL PROCEDURE PROVIDE THAT THE PROSECUTOR
18 SHALL DISCLOSE TO THE DEFENSE UPON REQUEST THE FOLLOWING
19 MATERIAL OR INFORMATION OF WHICH HE HAS KNOWLEDGE.
20 THE COURT: OKAY. WHICH SUBPARAGRAPH ARE YOU
21 READING?
22 MS. BARLOW: I'M STARTING WITH A OF RULE 16.
23 THE COURT: OKAY.
24 MS. BARLOW: RULES OF DISCOVERY. RELEVANT WRITTEN
25 OR RECORDED STATEMENTS OF THE DEFENDANT, WE DON'T HAVE THAT
1527
1 HERE. THE CRIMINAL RECORD OF THE DEFENDANT, WE DON'T HAVE
2 THAT. PHYSICAL EVIDENCE SEIZED FROM THE DEFENDANT, WE DON'T
3 HAVE THAT. SO NUMBER FOUR, EVIDENCE KNOWN TO THE PROSECUTOR
4 THAT TENDS TO NEGATE THE GUILT OF THE ACCUSED, MITIGATE THE
5 GUILT OF THE DEFENDANT OR MITIGATE THE DEGREE OF THE OFFENSE
6 FOR A REDUCED PUNISHMENT, WE DON'T HAVE THAT HERE, THIS IS
7 NOT EXCULPATORY. AND FIVE, ANY OTHER ITEM OF EVIDENCE WHICH
8 THE COURT DETERMINES ON GOOD CAUSE SHOWN SHALL BE MADE
9 AVAILABLE TO THE DEFENDANT IN ORDER FOR THE DEFENDANT TO
10 ADEQUATELY PREPARE HIS DEFENSE.
11 WE HAVE GONE BEYOND JUST NUMBER FOUR HERE BY GIVING --
12 WE HAD AN OPEN FILE. WE HAVE GIVEN EVERYTHING THAT WE HAVE.
13 NOW, THIS MATERIAL CAME TO ME, CAME TO MY ATTENTION JUST
14 THIS WEEKEND AND WE ARE PRESENTING IT IN COURT TODAY. WE
15 DON'T HAVE AN OBLIGATION TO FIND OUT EVERY WORD THAT A
16 WITNESS IS GOING TO SAY AND TURN IT OVER TO THE DEFENDANT
17 BEFORE TRIAL.
18 THE COURT: NO. BUT I GUESS THE QUESTION IS IF YOU
19 FOUND OUT ABOUT IT THIS WEEKEND, DO YOU THINK YOU HAVE AN
20 OBLIGATION OR NOT OBLIGATION TO CALL THE DEFENSE LAWYER AND
21 SAY WE FOUND OUT ABOUT THIS AND WE'RE GOING TO BE
22 QUESTIONING THIS?
23 MS. BARLOW: I DON'T THINK WE HAVE ANY OBLIGATION
24 TO DO THAT. HE HAS THE -- HE HAS THE OPPORTUNITY TO TALK TO
25 THIS WITNESS, JUST AS WE HAD THE OPPORTUNITY TO TALK TO THIS
1528
1 WITNESS PRIOR TO TRIAL.
2 MR. STIRBA: YOUR HONOR, MAY I MAKE ONE OTHER SMALL
3 POINT? I'M NOT SURE -- I'M NOT GOING TO MAKE THE ARGUMENT.
4 I THINK THIS IS BRADY MATERIAL. IF I UNDERSTOOD THE
5 PROFFER, AT LEAST WITH RESPECT TO ONE OF THE CONVERSATIONS,
6 THAT CONVERSATION CERTAINLY CAN BE INTERPRETED TWO DIFFERENT
7 WAYS. AND I THINK BRADY CLEARLY CALLS UPON THE PROSECUTOR
8 TO ASSUME THAT IT IS EXCULPATORY EVEN THOUGH THEY MAY THINK
9 IT'S NOT AND PROVIDE US THAT INFORMATION, WHICH IT WASN'T.
10 IT WAS, AFTER ALL, AS I UNDERSTOOD THE CONVERSATION, IT
11 IS -- IT'S CERTAINLY NOT RADICALLY INCULPATORY AND THERE'S
12 ELEMENTS OF IT WHICH CLEARLY COULD BE EXCULPATORY.
13 MS. BARLOW: I GUESS I DON'T KNOW WHICH STATEMENT
14 HE'S TALKING ABOUT AND --
15 MR. STIRBA: WELL, THE ONE WITH RESPECT TO LYDIA
16 SMITH PROVIDED US WITH PROFFER.
17 MS. BARLOW: WELL, IF THE -- I DON'T SEE HOW IT'S
18 EXCULPATORY BUT I GUESS WE SEE IT DIFFERENTLY.
19 THE COURT: ALL RIGHT. WELL, I'M GOING TO HAVE TO
20 GO LOOK AT SOME CASES. WE MIGHT BE MORE THAN BEFORE TEN TO
21 BUT I'LL LET THE CLERK TELL YOU WHEN I'M READY.
22 (A BRIEF RECESS WAS TAKEN.)
23 THE COURT: DID YOU CALL THEM? DO YOU WANT TO TRY
24 CALLING THEM AGAIN?
25 MS. BARLOW: YOUR HONOR, BEFORE YOU PRONOUNCE YOUR
1529
1 RULING, I HATE TO THROW THE COURT A CURVE BUT MS. COOPER
2 TOLD ME AFTER WE WALKED OUT THAT REMEMBERS SPECIFICALLY IN
3 THE DEPOSITION THAT DEFENSE COUNSEL DID OF HER IN ANOTHER
4 MATTER THIS WAS BROUGHT UP BY DEFENSE COUNSEL, THIS LYDIA
5 SMITH MATERIAL. AND I'M SORRY, I DIDN'T KNOW THAT BEFORE WE
6 BROKE.
7 THE COURT: WELL, BEING AN OLD BASEBALL PLAYER, I
8 CAN HIT FAST BALLS AND CURVES.
9 MS. BARLOW: OKAY.
10 THE COURT: AND HERE IS WHAT I'M GOING TO DO, I'M
11 NOT GOING TO GET INTO ALL OF THE IF PEOPLE KNEW IT OR DIDN'T
12 KNOW IT IN THE FUTURE. AS TO THESE TWO QUESTIONS, I'M GOING
13 TO OVERRULE THE OBJECTIONS AND THEN HERE'S HOW WE'RE GOING
14 TO PROCEED IN THE FUTURE:
15 UNDER RULE 16.5 OF THE UTAH RULES OF CRIMINAL PROCEDURE
16 WHERE IT SAYS, "ANY OTHER ITEM OF EVIDENCE WHICH THE COURT
17 DETERMINES ON GOOD CAUSE SHOULD BE MADE AVAILABLE TO THE
18 DEFENDANT IN ORDER FOR THE DEFENDANT TO ADEQUATELY PREPARE
19 HIS DEFENSE," THAT'S ONE OF THE SUBSECTIONS WHERE IT SAYS,
20 "THE PROSECUTOR SHALL DISCLOSE TO THE DEFENSE," I'M JUST
21 GOING TO SAY IN THE FUTURE, IF THERE ARE NOT INTERVIEWS AND
22 THERE ARE SITUATIONS WHERE WITNESSES ARE GOING TO TESTIFY
23 ABOUT CONVERSATIONS WITH THE DEFENDANT ABOUT ISSUES OF
24 MEDICATION OF MORPHINE OR TREATMENT OF THESE FIVE PATIENTS,
25 THAT THAT INFORMATION IS GOING TO BE MADE AVAILABLE TO THE
1530
1 DEFENDANT PURSUANT TO RULE 16.5 IN THE FUTURE.
2 I'M GOING TO ALLOW THESE TWO AREAS TO BE ADDRESSED.
3 I'VE OVERRULED THE OBJECTION, THEY WILL BE DONE. IN THE
4 FUTURE, THEY ARE GOING TO BE NOTIFIED. IF THEY ARE NOT
5 NOTIFIED IN THE FUTURE AND IT'S NOT IN THE -- ANYTHING THAT
6 WAS PROVIDED, THEN THE UNFAIR SURPRISE IS PROBABLY GOING TO
7 BE SUSTAINED. SO IS EVERYONE CLEAR ON THAT?
8 MS. BARLOW: YES, YOUR HONOR. THANK YOU.
9 MR. STIRBA: YES, YOUR HONOR.
10 THE COURT: OKAY. DO YOU WANT TO HAVE THE JURY
11 BACK IN?
12 (WHEREUPON THE JURY ENTERS THE COURTROOM.)
13 THE COURT: PLEASE BE SEATED. THE RECORD WILL
14 REFLECT THAT THE JURY HAS RETURNED. THE WITNESS SHOULD TAKE
15 THE STAND. AND, MS. BARLOW, IF YOU'LL CONTINUE.
16 MS. BARLOW: THANK YOU, YOUR HONOR.
17 Q. (BY MS. BARLOW) MS. COOPER, WITH MARY CRANE DID YOU
18 HAVE A CONVERSATION WITH THE DEFENDANT ABOUT THE FECAL
19 MATERIAL THAT WAS COMING OUT OF THE VAGINA?
20 A. THAT WAS ON JUDITH.
21 Q. OH, I'M SORRY. ARE WE SURE ABOUT THAT? LET'S MAKE SURE
22 WE'VE GOT THE RIGHT PATIENT. SORRY ABOUT THAT. I GUESS I
23 WAS CONFUSED HERE. IF YOU WOULD OPEN MARY CRANE'S TO 244.
24 DO YOU NOTICE THE GYNECOLOGICAL CONSULT THERE?
25 A. OH, IT WAS ON MARY. I'M SORRY.
1531
1 Q. THAT'S OKAY. I JUST WANT TO MAKE SURE WE'RE NOT
2 CONFUSING THE JURY.
3 SO WITH MARY CRANE DID YOU -- WERE YOU PRESENT WHEN
4 DEFENDANT WAS INFORMED OF THIS WHAT TURNED OUT TO BE A
5 FISTULA?
6 A. YES.
7 Q. WHAT WAS DONE WHEN THE PROBLEM WAS FIRST SEEN OR
8 NOTICED?
9 A. DR. WEITZEL WROTE AN ORDER FOR ONE OF THE OTHER
10 PHYSICIANS TO COME IN AND CONSULT ON HER.
11 Q. AFTER THE OTHER PHYSICIAN CAME IN AND DID THE CONSULT
12 WHICH IT LOOKED LIKE IT WAS DR. MEEKS.
13 A. UH-HUH.
14 Q. DID YOU HAVE ANY CONVERSATIONS WITH THE DEFENDANT ABOUT
15 THE TREATMENT OF MARY CRANE FOR THIS FISTULA?
16 A. IT WAS NO LONGER --
17 THE COURT: WELL, THAT'S A YES OR NO.
18 Q. (BY MS. BARLOW) YES. DID YOU HAVE ANY CONVERSATIONS?
19 A. YES.
20 Q. YES. WHEN DID THAT FIRST CONVERSATION TAKE PLACE?
21 A. I DON'T RECALL EXACTLY.
22 Q. WAS IT WITHIN DAYS AFTER OR...
23 A. YES.
24 Q. OKAY. AND WHERE DID IT TAKE PLACE?
25 A. AT THE NURSES' STATION.
1532
1 Q. WHO WAS PRESENT?
2 A. MYSELF AND DR. WEITZEL. I DON'T RECALL WHO ELSE WOULD
3 HAVE BEEN PRESENT.
4 Q. AND WHAT WAS THAT CONVERSATION, WHAT DID YOU SAY TO DR.
5 WEITZEL?
6 A. IT WAS ACTUALLY ANOTHER NURSE THAT WAS TALKING TO DR.
7 WEITZEL. I WAS JUST OVERHEARING THE CONVERSATION.
8 Q. DO YOU RECALL WHO THAT OTHER NURSE IS?
9 A. I DON'T.
10 Q. OKAY. OKAY. WHAT -- WHO SPOKE FIRST, THE DEFENDANT OR
11 THE OTHER NURSE?
12 A. I BELIEVE THE NURSE WAS JUST TALKING ABOUT THIS FISTULA
13 AND WHAT SHOULD BE DONE ABOUT IT.
14 Q. AND WHAT DID THE DEFENDANT SAY?
15 A. HE DIDN'T WANT ANYTHING TO DO WITH IT, THAT --
16 THE COURT: WELL, SAY WHAT HE SAID.
17 Q. (BY MS. BARLOW) WHAT DID HE SAY?
18 A. I DON'T REMEMBER EXACT WORDS. HE WAS...
19 Q. AFTER THAT CONVERSATION, DID YOU SEE ANY CHANGE IN
20 DEFENDANT'S BEHAVIOR TOWARDS MARY CRANE?
21 MR. STIRBA: YOUR HONOR, I'M GOING TO OBJECT,
22 IRRELEVANT, NOT HELPFUL TO THE JURY. IT'S LAY OPINION.
23 THE COURT: WELL, WITHOUT MORE FOUNDATION, IT'S
24 SUSTAINED.
25 Q. (BY MS. BARLOW) WHAT HAD -- HAD YOU SEEN DEFENDANT'S
1533
1 CONDUCT TOWARD MARY CRANE PRIOR TO THIS CONVERSATION?
2 MR. STIRBA: YOUR HONOR, I'LL OBJECT, IRRELEVANT.
3 MS. BARLOW: YOUR HONOR, IT GOES TO THE SAME
4 RELEVANCE THAT WE ARGUED.
5 THE COURT: WHAT ARE YOU SAYING CONDUCT? I MEAN, I
6 THINK IT'S AMBIGUOUS. WHAT DO YOU MEAN CONDUCT?
7 MS. BARLOW: WELL, HOW HE TREATED HER.
8 THE COURT: ARE YOU ASKING THIS WITNESS WHETHER OR
9 NOT THIS WITNESS OBSERVED INTERACTIONS BETWEEN DR. WEITZEL
10 AND MARY CRANE?
11 MS. BARLOW: YES.
12 THE COURT: OKAY. WELL, THEN LET'S ASK IT THAT
13 WAY.
14 Q. (BY MS. BARLOW) DID YOU OBSERVE -- PRIOR TO THIS
15 FISTULA, DID YOU OBSERVE INTERACTION BETWEEN THE DEFENDANT
16 AND MARY CRANE?
17 A. I DID, YES.
18 Q. AND WHAT WERE THOSE INTERACTIONS?
19 MR. STIRBA: FOUNDATION, YOUR HONOR.
20 THE COURT: OKAY. WELL, I THINK HOPEFULLY SHE'LL
21 LAY THE FOUNDATION AS SHE TALKS ABOUT THEM. OVERRULED.
22 Q. (BY MS. BARLOW) WHAT WERE THESE INTERACTIONS?
23 A. THERE WAS NO HESITATION IN GOING INTO HER ROOM. HE
24 OPENLY WOULD LISTEN TO WHAT YOU HAD TO SAY ABOUT HER.
25 Q. DID THAT CHANGE AFTER THE FISTULA?
1534
1 A. IT DID.
2 Q. IN WHAT WAY?
3 A. HE WAS HESITANT TO GO INTO HER ROOM. HE DIDN'T WANT TO
4 DISCUSS THAT PART OF IT. THAT WAS FOR SOMEBODY ELSE TO DEAL
5 WITH.
6 Q. NOW, JUST A LITTLE FOUNDATION, AFTER YOU TALKED -- YOU
7 KNOW, YOU TALKED LAST FRIDAY ABOUT DEALING WITH HIM ABOUT
8 MARY CRANE BEING IN PAIN. DID YOU FIND ANY RECORDS
9 REGARDING MORPHINE FOR LYDIA SMITH?
10 A. YES, I DID.
11 Q. DO YOU RECALL WHEN THAT WAS?
12 A. THAT WAS JANUARY 7TH AND IT WAS RIGHT AFTER LYNN HAD
13 GIVEN THE SHOT TO MARY -- TO MARY.
14 Q. AND WHAT DID YOU FIND?
15 A. THAT HE HAD WRITTEN ANOTHER ORDER FOR LYDIA TO RECEIVE
16 5 MILLIGRAMS OF MORPHINE EVERY THREE HOURS.
17 Q. DID YOU CONFRONT HIM WITH THAT?
18 A. I DID.
19 Q. AND WHERE DID THAT TAKE PLACE?
20 A. AT THE NURSES' STATION.
21 Q. WHO WAS PRESENT?
22 A. MYSELF AND LYNN AND DR. WEITZEL.
23 Q. WHAT DID YOU SAY TO THE DEFENDANT?
24 A. I SAID, OKAY, YOU TOLD ME MARY CRANE IS IN PAIN, BUT WHY
25 IS LYDIA GOT A MORPHINE ORDER TOO BECAUSE I KNOW SHE'S NOT
1535
1 IN PAIN.
2 Q. WHAT DID YOU SAY?
3 A. HE SAID, HOW DO YOU KNOW SHE'S NOT IN PAIN.
4 Q. WHAT DID HE SAY?
5 A. I SAID, I KNOW SHE'S NOT. AND HE SAID, DID SHE TELL YOU
6 SHE WASN'T? AND OF COURSE LYDIA IS NOT ABLE TO ANSWER ME
7 EITHER.
8 MR. STIRBA: YOUR HONOR, YOUR HONOR, I'M GOING TO
9 OBJECT NOT RESPONSIVE.
10 THE COURT: LET'S JUST GO -- WE'RE TRYING TO ASK
11 WHAT THE CONVERSATION WAS BETWEEN YOU AND DR. WEITZEL ABOUT
12 LYDIA SMITH.
13 THE WITNESS: OKAY.
14 Q. (BY MS. BARLOW) WHEN HE ASKED YOU, DID SHE TELL YOU
15 THAT SHE WAS NOT IN PAIN, WHAT DID YOU RESPOND?
16 A. I RESPONDED THAT, NO, SHE DIDN'T TELL ME BUT I KNOW
17 SHE'S NOT IN PAIN.
18 Q. AND WHAT IS THAT KNOWLEDGE, AS IT WERE, BASED ON?
19 A. SHE HAD NEVER COMPLAINED OF PAIN PREVIOUSLY. SHE --
20 THERE WAS NO MOANING, THERE WAS -- I SAW NO SIGNS OF PAIN.
21 Q. ARE YOU TRAINED TO LOOK FOR SIGNS OF PAIN?
22 A. YES.
23 Q. AFTER YOU SAID THAT, WHAT DID DR. WEITZEL SAY?
24 A. HE SAID, WELL, I'VE GONE AND TALKED TO THE FAMILY AND
25 TOLD THEM THAT YOU WILL BE INTO GIVE HER SOMETHING FOR PAIN.
1536
1 Q. AND WHAT DID YOU SAY?
2 A. WELL, THEN HE CONTINUED AND HE SAID, ARE YOU WILLING TO
3 GO TELL THAT FAMILY THAT YOU DON'T THINK THAT SHE'S IN PAIN
4 AND YOU ARE WILLING TO LET HER SUFFER BECAUSE YOU DON'T
5 THINK SHE IS.
6 Q. AND DID YOU SAY ANYTHING TO THAT?
7 A. I DIDN'T.
8 Q. WHAT DID YOU DO?
9 A. I WENT AND GAVE THE SHOT.
10 MS. BARLOW: THAT'S ALL I HAVE, YOUR HONOR.
11 THE COURT: OKAY. MR. STIRBA?
12 MR. STIRBA: YES, YOUR HONOR. THANK YOU.
13 CROSS-EXAMINATION
14 BY MR. STIRBA:
15 Q. ON MS. CRANE, YOU ARE AWARE, ARE YOU NOT, FROM YOUR
16 REVIEW OF THE RECORDS THAT AFTER THE CONSULT BY GYNECOLOGIST
17 THERE WAS AN ORDER ENTERED BY DR. WEITZEL TO HAVE LYNN LONG
18 CONTACT DR. DIENHART; ISN'T THAT TRUE?
19 A. IF IT'S HERE IN THE RECORD. I DON'T RECALL.
20 Q. YOU DON'T RECALL THAT?
21 A. I WOULD HAVE TO LOOK.
22 Q. AND THAT TOOK PLACE ON AFTER THE CONSULT WHICH OCCURRED
23 ON THE 2ND OF JANUARY OF 1996, DO YOU REMEMBER THAT?
24 A. I'M NOT SURE WHAT YOU ARE ASKING, WAS THERE A QUESTION
25 THERE? I'M NOT SURE.
1537
1 Q. YEAH. ARE YOU AWARE THAT AFTER THE CONSULT WHICH TOOK
2 PLACE ON THE 2ND OF JANUARY --
3 A. OKAY.
4 Q. -- OF 1996 THAT DR. WEITZEL ENTERED AN ORDER DIRECTING
5 NURSE LYNN LONG TO CONTACT DR. DIENHART TO TELL DR. DIENHART
6 ABOUT WHAT THE GYNECOLOGIST SAID? ARE YOU AWARE OF THAT?
7 A. OKAY. YOU WANT TO TELL ME WHAT PAGE THAT'S ON AND I'LL
8 LOOK?
9 Q. NO, I'M ASKING THE QUESTION: ARE YOU AWARE OF THAT,
10 MA'AM?
11 MS. BARLOW: YOUR HONOR, OBVIOUSLY THAT QUESTION IS
12 CONFUSING TO HER. CAN HE REPHRASE IT?
13 THE COURT: WELL, SHE CAN -- SHE CAN SAY IF IT'S
14 CONFUSING TO HER. THE QUESTION HAS BEEN ASKED.
15 THE WITNESS: IT'S CONFUSING TO ME. I HEAR ABOUT
16 FIVE QUESTIONS IN THERE, I'M NOT SURE WHICH ONE YOU WANT ME
17 TO ANSWER.
18 Q. (BY MR. STIRBA) SO ARE YOU TELLING THIS JURY THAT
19 UNLESS YOU REVIEW THE RECORDS RIGHT THERE AS YOU SIT THERE
20 ON THE WITNESS STAND, YOU DON'T KNOW WHETHER, IN FACT, THAT
21 OCCURRED, IS THAT WHAT YOU ARE TELLING THE JURY?
22 A. THAT WHAT OCCURRED, THAT SHE RECEIVED A CONSULT?
23 Q. NO. THAT DR. WEITZEL TOLD AND GAVE AN ORDER TO LYNN
24 LONG TO CONTACT DR. DIENHART ON THE 3RD TO ADVISE DR.
25 DIENHART'S OFFICE ABOUT THE CONSULT BY DR. MEEKS?
1538
1 MS. BARLOW: OBJECTION.
2 MR. STIRBA: ARE YOU AWARE OF THAT?
3 MS. BARLOW: OBJECTION, FOUNDATION, YOUR HONOR.
4 THE COURT: OVERRULED.
5 Q. (BY MR. STIRBA) WERE YOU AWARE OF THAT?
6 A. I DON'T RECALL HIM GIVING AN ORDER TO LYNN TO CALL DR.
7 DIENHART.
8 Q. DO YOU RECALL ALSO THAT ON THE 5TH OF JANUARY OF 1996
9 THAT DR. WEITZEL GAVE AN ORDER FOR KEFLEX FOR MARY CRANE,
10 ARE YOU AWARE OF THAT?
11 A. IF IT'S IN THE RECORD. I WOULD HAVE TO LOOK AT THE
12 RECORD.
13 Q. AND KEFLEX, YOU UNDERSTAND IS AN ANTIBIOTIC, ISN'T IT?
14 A. YES, IT IS.
15 Q. AND, IN FACT, ARE YOU AWARE THAT HE ORDERED KEFLEX ON
16 THE 5TH OF JANUARY FOR MARY CRANE TO TREAT THE VAGINAL
17 FISTULA, ARE YOU AWARE OF THAT?
18 A. IF I LOOKED AT THE RECORD AND COULD CONFIRM THAT.
19 Q. ARE YOU AWARE THAT THE CONSULT IN FACT SAID BY
20 DR. MEEKS, ESSENTIALLY IF WE'RE NOT GOING TO DO SURGERY,
21 WE'RE GOING TO TREAT IT WITH A BROAD-SPECTRUM ANTIBIOTIC,
22 ARE YOU AWARE OF THAT?
23 A. YES, I WAS AWARE OF THAT.
24 Q. AND YOU AGREE WITH ME THAT KEFLEX IS A BROAD-SPECTRUM
25 ANTIBIOTIC, ISN'T IT?
1539
1 A. YES, IT IS.
2 Q. NOW, YOU USED THE TERM FEISTY, DID YOU NOT, IN YOUR
3 CHARACTERIZATION OF LYDIA SMITH?
4 A. I DID.
5 Q. FEISTY IS NOWHERES TO BE FOUND IN THE CHARTING WITH
6 RESPECT TO LYDIA SMITH, IS IT?
7 A. I DON'T RECALL.
8 Q. IN FACT, YOU WHEN YOU SAW HER AND CHARTED ABOUT FOUR OR
9 FIVE TIMES, YOU NEVER USED THE WORD FEISTY, DID YOU?
10 A. NOT THAT I RECALL.
11 Q. IN FACT, FEISTY IS NOT A WORD THAT YOU TYPICALLY WOULD
12 ASSOCIATE WITH NURSE CHARTING OR MEDICAL RECORDS, IS IT?
13 A. YOU COULD CHART IT, IT WOULDN'T...IT'S NOT BANNED BY ANY
14 REASON.
15 Q. IS FEISTY A WORD THAT SOMEBODY TOLD YOU TO USE FOR
16 PURPOSES OF YOUR TESTIMONY?
17 A. NO.
18 Q. NOW YOU ARE AWARE, ARE YOU NOT, AS A NURSE THAT YOU HAVE
19 SOME INDEPENDENT DUTIES, CORRECT?
20 MS. BARLOW: YOUR HONOR, I THINK THAT'S AN
21 AMBIGUOUS QUESTION. INDEPENDENT OF WHAT?
22 THE COURT: WELL...
23 MR. STIRBA: I'LL REPHRASE.
24 Q. (BY MR. STIRBA) YOU ARE AWARE AS A NURSE, MA'AM, THAT
25 YOU ARE A PROFESSIONAL CHARGED WITH SOME VERY IMPORTANT
1540
1 RESPONSIBILITIES. YOU ARE AWARE OF, AREN'T YOU?
2 A. YES.
3 Q. AND YOU ARE AWARE THAT THE NURSING PROFESSION, IN FACT,
4 HAS CERTAIN ETHICAL CANNONS OR ETHICAL DIRECTIVES FOR
5 PURPOSES OF THE KIND OF -- THE WAY YOU DO YOUR JOB, YOU ARE
6 AWARE OF THAT?
7 A. YES.
8 Q. AND YOU ARE CERTAINLY AWARE AND YOU AGREE THAT ONE OF
9 THE FUNDAMENTAL FACTS ABOUT NURSING CARE IS YOU ARE NOT
10 SUPPOSED TO DO ANY HARM TO THE PATIENTS, TRUE?
11 A. YES.
12 Q. AND YOU ALSO AGREE, DO YOU NOT, THAT A NURSE MUST BE
13 RESPONSIBLE FOR HIS OR HER OWN ACTIONS, TRUE?
14 A. YES.
15 Q. NOW, YOU ALSO ARE AWARE THAT NURSES WHEN THEY DO THEIR
16 JOB, THEY, OF COURSE, HAVE TO WRITE THINGS DOWN BASED UPON
17 WHAT THEY OBSERVED, TRUE?
18 A. YES.
19 Q. IN FACT, YOU'VE READ A BUNCH OF NURSES' NOTES IN THIS
20 CASE BASED UPON PERCEPTIONS THAT YOU MADE, CORRECT?
21 A. YES.
22 Q. AND IT'S TRUE, IS IT NOT, THAT WHEN YOU TRY AS A NURSE
23 TO CHART CERTAIN THINGS YOU CERTAINLY HAVE A DESIRE TO BE
24 ACCURATE, CORRECT?
25 A. YES.
1541
1 Q. IN FACT, ISN'T THAT A STANDARD IN NURSING CARE THAT WHEN
2 YOU WRITE SOMETHING DOWN YOU ARE SUPPOSED TO BE ACCURATE
3 BASED UPON WHAT YOU PERCEIVE, TRUE?
4 A. YOU TRY AND BE ACCURATE.
5 Q. IN OTHER WORDS, THOSE NURSES' NOTES ARE VERY IMPORTANT
6 FOR PURPOSES OF PATIENT CARE, AREN'T THEY?
7 A. THEY DOCUMENT THE PATIENT CARE.
8 Q. THEY DOCUMENT -- AND ALSO TELL FOLKS WHO ARE COMING ON
9 BOARD KIND OF WHAT HAS GONE ON BEFORE, TRUE?
10 A. YES.
11 Q. AND THAT MIGHT BE VERY IMPORTANT TO A PHYSICIAN OR A
12 NURSE WHO IS CONDUCTING CARE TO SEE WHAT HAS GONE ON BEFORE
13 WITH THE PATIENT; ISN'T THAT CORRECT?
14 A. YES.
15 Q. AND YOU CERTAINLY WANT TO HAVE ACCURATE INFORMATION IN
16 THERE IN ORDER TO MAKE SURE THAT CARE IS APPROPRIATE, ISN'T
17 THAT TRUE?
18 A. YES.
19 Q. AND THAT'S CERTAINLY WHAT YOU TRY TO DO WHEN YOU PUT
20 DOWN YOUR NURSE'S NOTES WITH RESPECT TO EACH ONE OF THESE
21 FIVE PATIENTS; ISN'T THAT CORRECT?
22 A. THERE'S LIKE FIVE QUESTIONS BEFORE THAT, I'M NOT SURE.
23 YOU'LL HAVE TO RESTATE.
24 Q. I WAS ONLY ASKING YOU ONE.
25 A. ASK IT AGAIN.
1542
1 Q. WHEN YOU DID AND CHARTED AND WROTE IN THE NURSES' NOTES
2 WITH RESPECT TO THESE FIVE PATIENTS WHAT YOU DID, YOU
3 CERTAINLY TRIED TO BE ACCURATE; ISN'T THAT CORRECT?
4 A. YES, I DID.
5 Q. CERTAINLY DIDN'T WANT TO MISREPRESENT ANYTHING IN THOSE
6 RECORDS, DID YOU?
7 A. NO.
8 Q. AND THAT WOULD BE BELOW THE STANDARD OF THE NURSING
9 PROFESSION?
10 MS. BARLOW: YOUR HONOR, I OBJECT TO TALK OF
11 STANDARD OF CARE.
12 THE COURT: OVERRULED.
13 MR. STIRBA: I HAVEN'T FINISH THE QUESTION.
14 Q. (BY MR. STIRBA) THAT WOULD BE BELOW THE STANDARD IN
15 THE NURSING PROFESSION TO BASICALLY WRITE SOMETHING IN A
16 MEDICAL RECORD THAT WASN'T TRUE; ISN'T THAT CORRECT?
17 A. YES.
18 Q. NOW, THERE WERE A NUMBER OF PEOPLE WHO WORKED ON THE
19 GEROPSYCH UNIT AS NURSES, CORRECT?
20 A. YES.
21 Q. FOR EXAMPLE, YOU REMEMBER SHEILA HANSEN WORKING THERE
22 DURING DECEMBER AND JANUARY OF '95 AND '96?
23 A. YES.
24 Q. AND SHEILA HANSEN WAS, IN FACT, THE LEAD OR CHARGE NURSE
25 OF THE UNIT DURING THAT TIME, WASN'T SHE?
1543
1 A. YES, SHE WAS.
2 Q. IN OTHER WORDS, SHE WAS SUPERIOR TO YOU ESSENTIALLY IN
3 THE PECKING ORDER; ISN'T THAT CORRECT?
4 A. SHE HAD MORE AUTHORITY.
5 Q. PARDON ME?
6 A. SHE HAD MORE AUTHORITY.
7 Q. SURE. SHE HAD A TITLE, DIDN'T SHE?
8 A. SHE WAS HIGHER IN THE CHAIN.
9 Q. SHE HAD A TITLE, DIDN'T SHE?
10 A. YES.
11 Q. SHE WAS THE CHARGE NURSE OR THE HEAD OF THE UNIT,
12 CORRECT?
13 A. YES.
14 Q. AND YOU REMEMBER LYNN LONG WORKED THERE AS WELL; IS THAT
15 RIGHT?
16 A. YES.
17 Q. AND LYNN LONG ALSO WAS A R.N. JUST LIKE YOU, A
18 REGISTERED NURSE, TRUE?
19 A. YES.
20 Q. AND YOU REMEMBER THAT LAURIE WILLSON WORKED THERE AS
21 WELL, DIDN'T SHE?
22 A. SHE DID.
23 Q. AND LAURIE ALSO WAS AN R.N. OR REGISTERED NURSE, TRUE?
24 A. YES.
25 Q. IN FACT, LAURIE HAD SOME ADDITIONAL SCHOOLING, DIDN'T
1544
1 SHE, IN THAT SHE HAD A MASTER'S IN NURSING DURING THIS TIME
2 PERIOD; ISN'T THAT CORRECT?
3 A. I DON'T KNOW HER EXACT CREDENTIALS.
4 Q. AND IT'S TRUE, IS IT NOT, THAT YOU WEREN'T PRIVY -- IN
5 OTHER WORDS, WHEN YOU WORKED THERE, YOU WEREN'T PRIVY TO
6 EVERY CONVERSATION THAT WENT ON BETWEEN THE DOCTOR AND OTHER
7 NURSES, TRUE?
8 A. TRUE.
9 Q. AND IT'S TRUE, IS IT NOT, THAT THERE WERE CONVERSATIONS
10 THAT WENT ON WITH FAMILY MEMBERS WHICH YOU WEREN'T PRIVY TO
11 OR WERE A PART OF; ISN'T THAT CORRECT?
12 A. YES.
13 Q. FOR EXAMPLE, IN JUDITH LARSEN'S CASE, YOU NEVER SPOKE TO
14 MERLIN LARSEN, DID YOU?
15 A. I DON'T RECALL.
16 Q. THAT WOULD BE JUDITH'S SON?
17 A. OKAY.
18 Q. AND, IN FACT, YOU DON'T KNOW AS YOU SIT HERE TODAY ABOUT
19 CONVERSATIONS THAT MR. LARSEN, THAT IS MERLIN LARSEN HAD,
20 WITH DR. WEITZEL ABOUT HIS MOM'S CARE, DO YOU?
21 MS. BARLOW: YOUR HONOR, I OBJECT ON THE BASIS OF
22 RELEVANCE.
23 THE COURT: OVERRULED.
24 Q. (BY MR. STIRBA) YOU DON'T KNOW AS SIT HERE TODAY ABOUT
25 CONVERSATIONS THAT MERLIN LARSEN HAD ABOUT HIS MOM'S CARE
1545
1 WITH DR. WEITZEL, DO YOU?
2 A. I DON'T RECALL.
3 Q. IN FACT, YOU DON'T EVEN KNOW AS YOU SIT HERE TODAY
4 WHETHER OR NOT MERLIN LARSEN, JUDITH LARSEN'S SON, WANTED
5 HIS MOM MOVED OFF THE UNIT, DO YOU?
6 A. I DON'T RECALL.
7 Q. WELL, YOU DON'T RECALL -- DID YOU EVER HAVE A
8 CONVERSATION WITH HIM LIKE THAT?
9 A. I DON'T RECALL.
10 Q. NOW, YOU ARE ALSO AWARE, ARE YOU NOT, THAT AS A NURSE ON
11 THE UNIT, YOU HAD FREE ACCESS TO THE ENTIRE MEDICAL CHART;
12 ISN'T THAT CORRECT?
13 A. YES.
14 Q. FOR EXAMPLE, IF YOU WANTED TO KNOW ABOUT WHAT HAD
15 HAPPENED PRIOR WITH MS. LARSEN, YOU -- OF COURSE, AS A
16 NURSE, YOU COULD GO BACK AND READ ALL THE NURSES' NOTES AND
17 YOU COULD GO OVER ALL THE VARIOUS THINGS ABOUT HER CARE;
18 ISN'T THAT CORRECT?
19 A. YES.
20 Q. AND THAT WOULD BE TRUE WITH RESPECT TO EACH ONE OF THE
21 PATIENTS; ISN'T THAT TRUE?
22 A. YES.
23 Q. AND, IN FACT, THERE WERE TIMES THAT YOU WOULD DO THAT TO
24 HELP YOU DO YOUR JOB; ISN'T THAT CORRECT?
25 A. I WOULD ASSUME I DID.
1546
1 Q. NOW, YOU ARE ALSO AWARE, ARE YOU NOT, THAT THERE WERE
2 CERTAIN DIRECTIVES ABOUT MEDICAL CARE GIVEN BY THE FAMILY
3 TO --
4 MS. BARLOW: OBJECTION, BEYOND THE SCOPE OF DIRECT
5 EXAMINATION, YOUR HONOR.
6 THE COURT: OKAY. WHAT'S YOUR RESPONSE?
7 MR. STIRBA: WELL, I GUESS IT'S RELEVANT IN TERMS
8 OF THE CARE THAT WAS PROVIDED, YOUR HONOR. I MEAN, I'M
9 GOING TO HAVE TO RECALL HER, SHE'S HERE AND THIS IS ALL PART
10 OF THE MEDICAL FILE.
11 THE COURT: OKAY. WHAT DO YOU WANT TO DO? DO YOU
12 WANT TO HAVE THIS WITNESS RECALLED OR JUST --
13 MS. BARLOW: NO, YOUR HONOR.
14 THE COURT: OKAY. WELL, THEN JUST GO ON.
15 Q. (BY MR. STIRBA) NOW YOU ARE AWARE, ARE YOU NOT, THAT
16 THERE WERE CERTAIN DIRECTIVES THAT WERE PART OF THESE FILES,
17 MEDICAL FILES WHERE THE PATIENT'S FAMILY WOULD DIRECT THE
18 HOSPITAL AND THE PHYSICIANS ABOUT CERTAIN CARE THEY WANTED
19 OR THEY DIDN'T WANT; ISN'T THAT TRUE?
20 A. YES.
21 Q. AND YOU ARE CERTAINLY AWARE THAT IN LYDIA SMITH'S CASE,
22 THERE WAS A DIRECTIVE GIVEN TO THE -- GIVEN BY THE FAMILY,
23 RATHER, TO THE HOSPITAL AND THE DOCTOR ABOUT WHAT CARE SHE
24 WAS GOING TO GET; ISN'T THAT TRUE?
25 A. YES.
1547
1 Q. AND, IN FACT, THAT PARTICULAR DIRECTIVE YOU WOULD BE
2 AWARE OF BECAUSE YOU, IN FACT, SIGNED IT; ISN'T THAT
3 CORRECT?
4 A. I WOULD HAVE TO LOOK AT IT BUT...
5 Q. YOU GOT MS. SMITH'S BINDER THERE? ACTUALLY, MAYBE IT'S
6 EASIER, MA'AM, LET'S DO IT THIS WAY, I'LL JUST DISPLAY IT
7 AND YOU CAN PROBABLY SEE IT FROM WHERE YOU ARE. PUT A
8 LITTLE...
9 NOW, THIS IS A MEDICAL TREATMENT PLAN, IS A HOSPITAL
10 FORM, DO YOU RECOGNIZE THAT?
11 A. YES.
12 Q. AND IF I GO DOWN HERE TO THE BOTTOM, THAT'S YOUR
13 SIGNATURE?
14 A. IT IS.
15 Q. CORRECT?
16 A. YES.
17 Q. UNDER FACILITY REPRESENTATIVE, TRUE?
18 A. YES.
19 Q. AND YOU NOTICE THAT THE DATE OVER HERE SIGNED BY
20 APPARENTLY THE DECLARANT OR AUTHORIZED AGENT IS 1/7 OF '96,
21 DO YOU SEE THAT?
22 A. YES.
23 Q. AND NOW NOTICE IN TERMS WHEN IT SAYS THE FOLLOWING CARE
24 AND TREATMENT IS DIRECTED WITH RESPECT TO THE DECLARANT, YOU
25 UNDERSTAND THAT'S WHERE THE SMITH FAMILY WAS BASICALLY
1548
1 TELLING THE PEOPLE WHO WERE TAKING CARE OF THEIR MOM, THIS
2 IS WHAT WE WANT YOU TO DO AND THIS IS WHAT WE DON'T WANT YOU
3 TO DO, DO YOU UNDERSTAND THAT?
4 A. I DO.
5 Q. AND THAT'S ALSO YOUR SIGNATURE THERE; IS IT NOT?
6 A. IT IS.
7 Q. AND IT SAYS R.N., TRUE?
8 A. YES, YES.
9 Q. NOW, IT SAYS THAT THIS IS WHAT THE FAMILY INDICATED AT
10 THE TIME AND THERE'S A BUNCH CHECKS FOR YES AND THAT MEANS
11 THEY DON'T WANT A RESUSCITATION OF THEIR MOM IN THE EVENT
12 THAT WAS NEEDED; IS THAT RIGHT?
13 A. YES.
14 Q. AND THEN THEY GO DOWN AND THEY ELIMINATE A BUNCH OF
15 OTHER THINGS DOWN HERE WHERE THEY CHECK NO, TRUE?
16 A. YES.
17 Q. BUT MORE IMPORTANTLY, IF YOU GO OVER HERE, THEY SAY
18 RIGHT THERE, NO I.V. FLUIDS, DO YOU UNDERSTAND THAT?
19 A. I DO.
20 Q. AND THEY ALSO SAY NO N.G., NASAL GASTRIC TUBE FOR FLUIDS
21 FEEDING, DO YOU SEE THAT?
22 A. I DO.
23 Q. NOW IT'S TRUE, IS IT NOT, THAT LYDIA SMITH AS YOU'VE
24 CHARTED AND AS YOU'VE READ TO THE LADIES AND GENTLEMEN OF
25 THE JURY, SHE WASN'T EATING, ISN'T THAT RIGHT?
1549
1 A. SHE WASN'T.
2 Q. IN FACT, LYDIA SMITH HASN'T BEEN EATING FOR QUITE SOME
3 PERIOD OF TIME BEFORE SHE EVER GOT TO THE HOSPITAL, ISN'T
4 THAT TRUE?
5 A. THAT'S TRUE.
6 Q. IN FACT, SHE HAD LOST OVER 30 POUNDS IN THE LAST YEAR;
7 ISN'T THAT CORRECT?
8 A. SHE HAD.
9 Q. NOW, IT'S TRUE, IS IT NOT, THAT IF SOME INDIVIDUAL LIKE
10 LYDIA ISN'T EATING, THE ONLY WAY YOU ARE GOING TO GET
11 NOURISHMENT AND FLUIDS TO HER IS THROUGH I.V.'S; ISN'T THAT
12 CORRECT?
13 A. THERE'S OTHER WAYS, BUT, YEAH, THAT'S THE WAY YOU
14 BASICALLY DO IT.
15 Q. AND THE OTHER WAY MIGHT BE RIGHT HERE WHERE IT NASAL
16 GASTRIC TUBE FOR FLUIDS FEEDING, TRUE?
17 A. YES.
18 Q. BUT THAT'S SOMETHING THAT AT LEAST AS FAR AS THIS
19 DIRECTIVE WAS CONCERNED IS ELIMINATED BY THE FAMILY, YOU SEE
20 THAT?
21 A. I DO.
22 Q. AND YOU FELT -- WELL, LET ME STRIKE THAT.
23 YOU BELIEVE THAT THIS IS BINDING WITH RESPECT TO THE
24 PHYSICIAN AND OTHERS WHO ARE PROVIDING CARE TO LYDIA SMITH?
25 A. I DO.
1550
1 Q. NOW --
2 A. COULD YOU JUST --
3 Q. -- SIMILARLY WITH RESPECT TO MS. CRANE --
4 A. JUST ON LYDIA CAN I JUST ASK IF THERE'S A TIME WHEN THAT
5 WAS SIGNED? DID IT HAVE ANY TIME WRITTEN ON THERE?