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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?
6 Q. COUNSEL COULD ASK -- I'LL REPRESENT TO YOU THERE ISN'T.
7 A. OKAY.
8 Q. I THINK THE DOCUMENT WAS DISPLAYED.
9 A. OKAY.
10 Q. NOW, WITH RESPECT TO MS. CRANE -- WELL, LET ME ASK YOU
11 THIS: YOU ASK ABOUT TIME. CAN YOU TELL THE JURY WHAT TIME
12 YOU AFFIXED YOUR SIGNATURE TWICE ON THE DIRECTIVES FOR THE
13 SMITHS?
14 A. IT WOULD HAVE BEEN AFTER DR. WEITZEL TALKED TO THEM THAT
15 DAY AND AFTER THE FAMILY CAME IN AND I WAS ABLE TO TALK TO
16 THEM, SO IT WOULD HAVE BEEN LATER IN THE SHIFT.
17 Q. RIGHT. AND THERE'S NO QUESTION IN YOUR MIND THAT THAT
18 WAS SIGNED BY YOU AND ALSO SIGNED BY A FAMILY REPRESENTATIVE
19 CORRECT?
20 A. YES.
21 Q. NOW, WITH RESPECT TO MS. CRANE, WE HAVE ANOTHER SIMILAR
22 DOCUMENT AND UP AT THE TOP WE HAVE 12/28/95, DID YOU WRITE
23 THAT?
24 A. I WOULD HAVE TO SEE THE SIGNATURE. IT LOOKS LIKE MY
25 WRITING BUT I THINK MY SIGNATURE --
1551
1 Q. WELL, LET ME HELP YOU HERE. DOWN AT THE BOTTOM --
2 A. THAT'S MY SIGNATURE, YES.
3 Q. THAT'S YOUR SIGNATURE, SO YOU AGREE, DO YOU NOT, THAT
4 THAT 12/28/95 WAS PUT THERE BY YOU?
5 A. YES.
6 Q. AND, IN FACT, YOU PUT THAT THERE ON 12/28/95, TRUE?
7 A. YES.
8 Q. AND THEN, ONCE AGAIN, THIS PARTICULAR DOCUMENT, THAT'S
9 DR. WEITZEL'S SIGNATURE, TRUE?
10 A. YES.
11 Q. APPEARS TO BE HE SIGNED IT ON 12/30/95, CORRECT?
12 A. YES.
13 Q. AND THEN THERE'S ALSO A SIGNATURE HERE IT LOOKS LIKE A
14 KAREN BRINGHURST, BUT ANYWAY IT'S A SIGNATURE OF THE FAMILY
15 REPRESENTATIVE, CORRECT?
16 A. YES.
17 Q. AND THAT'S YOUR SIGNATURE OVER THERE WHERE I'M POINTING,
18 CORRECT?
19 A. YES.
20 Q. AND, ONCE AGAIN, WE HAVE A SIMILAR SITUATION WHERE
21 CERTAIN THINGS ARE TOLD IN TERMS OF CARE AND TREATMENT THAT
22 ARE GOING TO BE PROVIDED AND CERTAIN THINGS AREN'T; ISN'T
23 THAT TRUE?
24 A. YES.
25 Q. SPECIFICALLY WITH RESPECT TO SURGERY IT SAYS, NO, IT HAS
1552
1 ADVISED FAMILY, DO YOU SEE THAT?
2 A. YES.
3 Q. NOW, IT'S TRUE, IS IT NOT, THAT MARY CRANE YOU TESTIFIED
4 YOU OBSERVED ON THE 7TH OF JANUARY; IS THAT RIGHT?
5 A. YES.
6 Q. AND, IN FACT, YOU HAVE A NOTE AT ABOUT 2 O'CLOCK IN THE
7 AFTERNOON WHERE YOU INDICATE THAT YOU NOTIFIED DR. DIENHART,
8 TRUE?
9 A. YES.
10 Q. AND IT'S TRUE, IS IT NOT, AS YOU'VE TOLD US THE REASON
11 WHY YOU NOTIFIED DR. DIENHART IS BECAUSE YOU WERE VERY
12 CONCERNED ABOUT MARY'S CONDITION AT THAT TIME, CORRECT?
13 A. YES.
14 Q. IN FACT, YOU THOUGHT MARY WAS SERIOUSLY ILL?
15 A. YES.
16 Q. AND, IN FACT, THAT'S WHY YOU ASKED DR. DIENHART TO
17 PROVIDE SOME CARE; IS THAT RIGHT?
18 A. YES, YES.
19 Q. AND, IN FACT, WHAT DR. DIENHART DID, HE DID THREE THINGS
20 AS YOU'VE TESTIFIED PURSUANT TO HIS ORDER. FIRST, HE ASKED
21 FOR AN OXYGEN SYMMETRY TEST TO BE DONE, TRUE?
22 A. YES.
23 Q. IN OTHER WORDS, THAT'S WHERE BASICALLY SOMEBODY COMES
24 IN, THEY CHECK OUT THE OXYGEN SATURATION TO BASICALLY SEE IF
25 THE PATIENT, OR IN THIS CASE MS. CRANE, WAS SUFFICIENTLY
1553
1 OXYGENATED; ISN'T THAT RIGHT?
2 A. YES.
3 Q. SO YOU TESTIFIED TO THIS, YOU ARE NOT AN EXPERT IN IT,
4 SOMEBODY CAME IN, RAN THE TEST AND THEN THEY CAME UP WITH A
5 FIGURE AND I BELIEVE THAT FIGURE WAS 86 PERCENT; ISN'T THAT
6 CORRECT?
7 A. I DON'T REMEMBER THE EXACT FIGURE. I WROTE HERE S.A.T.
8 LEVEL 80 TO 70.
9 Q. THAT'S NOT ON THE REPORT, IS IT, MA'AM? THE REPORT SAYS
10 86, DOESN'T IT?
11 A. I DON'T KNOW WHERE YOU ARE LOOKING. I'M LOOKING AT MY
12 NURSE'S NOTES.
13 Q. AND THEN THE OTHER THING HE DID, HE ORDERED A CHEST
14 X-RAY; ISN'T THAT CORRECT?
15 A. LET ME LOOK AT HIS ORDERS HERE. I SEEM TO REMEMBER HE
16 DID, YES.
17 Q. PARDON ME?
18 A. I WOULD HAVE TO LOOK AT THE ORDER FOR SURE, BUT I SEEM
19 TO REMEMBER THAT HE DID. DO YOU HAVE A PAGE NUMBER?
20 Q. AND THAT CHEST X-RAY WAS ACTUALLY DONE, WAS IT NOT?
21 A. I DON'T RECALL.
22 Q. DID YOU EVER SEE A REPORT OF THAT CHEST X-RAY?
23 A. I DON'T RECALL.
24 Q. IT WAS DONE ON THE 7TH, CORRECT?
25 MS. BARLOW: YOUR HONOR, THAT'S BEEN ASKED AND
1554
1 ANSWERED, SHE DOESN'T RECALL. I OBJECT.
2 MR. STIRBA: I'LL MOVE ON YOUR HONOR. I'LL MOVE
3 ON.
4 Q. (BY MR. STIRBA) NOW, THIS IS AN X-RAY REPORT FROM HER
5 FILE.
6 A. I CAN'T READ THAT. DO YOU WANT TO TELL ME WHAT PAGE
7 WE'RE ON AND I'LL LOOK IT UP?
8 Q. OH, SURE. MED 00272.
9 A. OKAY.
10 Q. YOU GOT THAT IN FRONT OF YOU?
11 A. I DO.
12 Q. AND THAT APPEARS TO BE A CHEST X-RAY REPORT DATE OF EXAM
13 IS 1/7/96, CORRECT?
14 A. YES.
15 Q. AND THAT IMPRESSION WAS, STABLE APPEARANCE OF THE CHEST,
16 HEART SIZE APPEARS MILDLY PROMINENT AND NO LOBAR APICITIS
17 IDENTIFIED, DO YOU SEE THAT?
18 A. I DO.
19 Q. MORE PARTICULARLY, LUNGS ARE CLEAR WITHOUT EVIDENCE OF
20 FOCAL INFILTRATES, DID I READ THAT CORRECTLY?
21 A. YES, CLOSE ENOUGH.
22 Q. AND THEN THE OTHER THING THAT DR. DIENHART DID IN HIS
23 ORDER IS HE ORDERED BASICALLY A BLOOD TEST, TRUE? IF YOU
24 WANT TO LOOK AT HIS ORDER IT'S MED-00249.
25 A. YES. HE ORDERED WHAT? I'M SORRY, I'M --
1555
1 Q. IN FACT, JUST SO WE HAVE THE RECORD CLEAR, I PLACED THAT
2 PARTICULAR PAGE ON THE ELMO AND I'M REFERRING TO UP HERE
3 WHAT HE ORDERED THOSE THREE THINGS; ONE A BLOOD TEST; TWO,
4 THE OXYGEN SATURATION TEST; AND THREE, THE CHEST X-RAY,
5 CORRECT?
6 A. YES.
7 Q. AND THEN YOU HAVE NOTED IT RIGHT HERE; IS THAT RIGHT?
8 A. YES, YES.
9 Q. NOW, HERE IS THE OXYGEN S.A.T. TEST THAT I WAS REFERRING
10 TO AND
11 A. UH-HUH.
12 Q. NOW, THE BLOOD TEST THAT WAS ORDERED BY DR. DIENHART WAS
13 CALLED A S.M.A.C.; IS THAT RIGHT?
14 A. S.M.A.C., YEAH, S.M.A.
15 Q. NOW, HERE IS A REPORT OF THAT PARTICULAR TEST
16 SPECIFICALLY I'LL DIRECT YOUR ATTENTION TO IT LOOKS LIKE
17 1/7/96, THIS IS MED-00261. DO YOU SEE THAT?
18 A. I ACTUALLY CAN'T SEE THAT. DO YOU WANT TO GIVE ME A
19 PAGE NUMBER AGAIN?
20 Q. YEAH, 00261.
21 A. OKAY.
22 Q. AND THERE IS THE FINDING, IT'S 1/7 AND THERE IS A TIME
23 1335 SO THAT APPEARS AT 1:30 P.M THEY ACTUALLY DID THAT
24 TEST. IS THAT A FAIR STATEMENT?
25 A. YES.
1556
1 Q. AND THERE'S SOME FINDINGS THERE, SPECIFICALLY N.A.
2 STANDS FOR SODIUM, DO YOU SEE THAT?
3 A. YES.
4 Q. AND IT SAYS 159 IT HAS THAT IN THE HIGH LEVEL, "H" FOR
5 HIGH, DO YOU SEE THAT?
6 A. I DO.
7 Q. AND THEN THERE'S SOME OTHER FINDINGS, MOST OF WHICH ARE
8 IN THE HIGH LEVEL; ISN'T THAT TRUE?
9 A. YES.
10 Q. AND ALSO IF I COULD GO BACK JUST TO THIS ONE PAGE THAT I
11 SHOWED YOU BEFORE MED-249, THERE'S A TIME ALSO WHEN THE
12 OXYGEN SATURATION WAS DONE AT 1445, SO THAT'S 2:45 P.M.,
13 TRUE?
14 A. I HAVEN'T FOUND THAT RECORD YET. WHAT NUMBER IS IT?
15 Q. WELL, LET ME ASK YOU THIS, MA'AM: WE HAVE A BLOOD TEST
16 THAT WAS DONE AT 1:35 IN THE AFTERNOON --
17 A. UH-HUH.
18 Q. -- PURSUANT TO THE ORDER --
19 A. UH-HUH.
20 Q. -- BY DR. DIENHART. WE HAVE AN OXYGEN SATURATION TEST
21 THAT WAS DONE AT 2:45 IN THE AFTERNOON PURSUANT TO THE
22 ORDER. IS IT FAIR TO SAY THAT YOU WOULD HAVE TALKED TO DR.
23 DIENHART BEFORE THE BLOOD TEST WAS DONE?
24 A. YES.
25 Q. SO IN OTHER WORDS, SOMETIME PRIOR LET'S SAY 1:30 P.M. IN
1557
1 THE AFTERNOON ON THE 7TH, YOU WERE CONCERNED ABOUT
2 MS. CRANE'S CONDITION AND YOU CONTACTED DR. DIENHART; ISN'T
3 THAT CORRECT?
4 A. YES.
5 Q. AND THEN -- AND I WANT YOU TO TURN TO THIS PAGE BECAUSE
6 YOU ARE PROBABLY GOING TO HAVE TO SEE IT. THIS IS MED-249.
7 A. OKAY.
8 Q. DO YOU HAVE THAT IN FRONT OF YOU?
9 A. I DO.
10 Q. NOW THAT'S DR. DIENHART'S CONSULT NOTE, IS IT NOT?
11 A. IT IS. IT --
12 Q. ON THE RIGHT-HAND SIDE. AND I WON'T EVEN BEGIN TO ASK
13 YOU TO READ IT, BUT UP HERE AT THE TOP IT SAYS 1/7/96 3:10
14 P.M., 3:10, DO YOU SEE THAT?
15 A. I DO.
16 Q. AND THAT'S THE TIME THAT DR. DIENHART ACTUALLY CAME AND
17 SAW MS. CRANE FOR PURPOSES OF MAKING HIS EXAMINATION; ISN'T
18 THAT RIGHT?
19 A. YOU WOULD HAVE TO ASK HIM BUT THAT'S THE TIME THAT'S
20 THERE.
21 Q. AND HAVE YOU REVIEWED THAT NOTE TO DETERMINE THAT, IN
22 FACT, HE STATED ON THE NEXT PAGE THAT HE THOUGHT THE PATIENT
23 WAS DYING? IT'S ON THE NEXT PAGE.
24 MS. BARLOW: YOUR HONOR, I OBJECT. IT'S A
25 MISCHARACTERIZATION OF WHAT IT SAYS.
1558
1 Q. (BY MR. STIRBA) TURN TO THE NEXT PAGE, PLEASE, MA'AM.
2 A. UH-HUH.
3 Q. DO YOU HAVE UP AT THE TOP DR. DIENHART SAYS, THINKS
4 PATIENT IS DYING; ISN'T THAT RIGHT?
5 MS. BARLOW: YOUR HONOR, THAT'S A
6 MISCHARACTERIZATION OF WHAT IT SAYS.
7 Q. (BY MR. STIRBA) ALL RIGHT. WELL, LET'S GET OUT AND
8 WE'LL SEE EXACTLY WHAT HE SAID.
9 IT'S PROBABLY 250, ISN'T IT, MA'AM, MED-250?
10 A. YES.
11 Q. IT SAYS RIGHT HERE, ONCE AGAIN, HE HAS 1/7/96, 3:10
12 P.M., IT SAYS RIGHT HERE, I SUSPECT SHE MAY DIE SOON. DID I
13 READ THAT CORRECTLY?
14 A. YES.
15 Q. SO IT'S TRUE AT LEAST AS OF THIS DATE AND TIME DR.
16 DIENHART HAS ALREADY OPINED THAT HE SUSPECTS THAT SHE MAY
17 DIE SHORTLY BASED UPON WHAT HE HAS NOW ASSESSED AND
18 DETERMINED; ISN'T THAT TRUE?
19 A. YES.
20 Q. AND IT'S TRUE, IS IT NOT, THAT YOU PERSONALLY, BASED
21 UPON YOUR NURSING EXPERIENCE AND BACKGROUND, HAD CONCERNS AS
22 OF THAT POINT THAT SHE WAS DYING AS WELL; ISN'T THAT
23 CORRECT?
24 A. YES.
25 Q. AND THEN IT'S TRUE, IS IT NOT, THAT YOU PROCEED TO HAVE
1559
1 A CONVERSATION AND NOTE AN ORDER BY DR. WEITZEL THAT SAME
2 DAY, CORRECT?
3 A. YES.
4 Q. GO TO MED 00249.
5 A. UH-HUH.
6 Q. AND IT'S TRUE, IS IT NOT, THAT YOU NOTE THAT ORDER BY
7 DR. WEITZEL AT APPROXIMATELY 2130 THAT EVENING, TRUE?
8 A. THAT'S WHEN THE ORDER WAS DONE.
9 Q. THAT'S WHEN YOU NOTED IT, TRUE?
10 A. YES.
11 Q. SO IN OTHER WORDS, WE HAVE ALMOST A FIVE-HOUR LAPSE OF
12 TIME BETWEEN THE TIME THAT DR. DIENHART HAD SUSPICIONS THAT
13 THE PATIENT WAS DYING, YOU HAD SUSPICIONS THAT THE PATIENT
14 WAS DYING, AND YOU NOTE AN ORDER BY DR. WEITZEL; ISN'T THAT
15 CORRECT?
16 A. THE FACT THAT THIS IS NOTED AT 2100 DOES NOT MEAN THAT'S
17 WHEN HE WROTE IT. HE WOULD HAVE WROTE IT MUCH EARLIER.
18 Q. NO, I'M TALKING ABOUT WHEN YOU NOTED IT. YOU NOTED IT
19 AT 2130, DID YOU NOT?
20 A. 2100.
21 Q. 2100. THAT'S WHEN YOU NOTED THE ORDER, TRUE?
22 A. YES.
23 Q. AND IS IT TRUE, IS IT NOT, THAT THERE WERE CERTAIN
24 THINGS THAT OCCURRED WITH RESPECT TO HER CARE BETWEEN THE
25 TIME WHEN YOU AND DR. DIENHART THOUGHT THAT MS. CRANE WAS
1560
1 DYING AND THE TIME THAT YOU ACTUALLY NOTED THAT ORDER; ISN'T
2 THAT CORRECT?
3 A. I'M SORRY, SAY THAT AGAIN.
4 Q. SURE. THERE WERE CERTAIN THINGS THAT OCCURRED BETWEEN
5 3:10 P.M. ON THE 7TH AND WHEN YOU NOTED THAT ORDER AT 2100;
6 ISN'T THAT CORRECT?
7 A. THINGS OCCURRED, I'M --
8 Q. YEAH. FOR EXAMPLE, YOU RECALL THAT DR. DIENHART IN HIS
9 NOTE ADVISED, THE FAMILY SHOULD BE NOTIFIED, DO YOU REMEMBER
10 THAT?
11 A. I DID NOTIFY THE FAMILY.
12 Q. AND, IN FACT, THE FAMILY CAME IN, DID THEY NOT?
13 A. THEY WERE THERE.
14 Q. AND, IN FACT, THERE WAS A CONVERSATION WITH THE FAMILY
15 INVOLVING DR. WEITZEL AND CERTAIN FAMILY MEMBERS; ISN'T THAT
16 TRUE?
17 A. I'M NOT SURE WHAT CONVERSATION YOU ARE REFERRING TO.
18 Q. YOU WEREN'T PART OF THAT CONVERSATION, IS THAT WHAT YOU
19 ARE TELLING US?
20 A. I DON'T KNOW WHAT CONVERSATION YOU ARE REFERRING TO.
21 Q. YOU JUST KNOW THERE WAS A CONVERSATION THAT THE FAMILY
22 CAME IN, TRUE?
23 A. A CONVERSATION BETWEEN WHO, DR. WEITZEL, MYSELF? WHO?
24 Q. NO, LET ME REPHRASE, MA'AM.
25 YOU JUST TOLD US, I THOUGHT, THAT YOU ARE AWARE THAT
1561
1 THE FAMILY OF MARY CRANE CAME TO THE HOSPITAL?
2 A. YES.
3 Q. AFTER DR. DIENHART'S NOTE OF 3:10 P.M. ON THE 7TH?
4 A. I'M NOT SURE WHEN THEY CAME IN. THEY COULD HAVE --
5 Q. I DIDN'T ASK YOU THAT. I SAID, ARE YOU AWARE THEY CAME
6 IN AFTER THAT NOTE AFTER 3:10 P.M.? ISN'T THAT TRUE?
7 A. THEY COULD HAVE BEEN THERE BEFORE THAT NOTE, I DON'T
8 RECALL.
9 Q. AND YOU ARE NOT AWARE THEN THAT DR. WEITZEL TALKED TO
10 THE FAMILY AFTER DR. DIENHART MADE HIS ASSESSMENT AT 3:10
11 P.M.?
12 A. DR. WEITZEL DID TALK TO THE FAMILY.
13 Q. YOU ARE AWARE OF THAT?
14 A. YES.
15 Q. OKAY. AND YOU'RE ALSO AWARE THAT THE ORDER THAT FOR
16 MORPHINE THAT YOU HAVE IDENTIFIED WAS NOTED AT 2100 HOURS,
17 RIGHT?
18 A. YES.
19 Q. THAT'S YOUR SIGNATURE, TRUE?
20 A. YES.
21 Q. 2100 HOURS, DO YOU SEE THAT?
22 A. I DO.
23 MS. BARLOW: YOUR HONOR, THAT'S BEEN ASKED AND
24 ANSWERED.
25 THE COURT: OVERRULED.
1562
1 Q. (BY MR. STIRBA) AND IT'S ALSO TRUE, IS IT NOT, THAT
2 ACCORDING TO THE MEDICATION ADMINISTRATION RECORDS, THAT THE
3 FIRST MORPHINE OF 5 MILLIGRAMS WHICH WAS GIVEN WAS AT 2100
4 HOURS; ISN'T THAT CORRECT?
5 A. I BELIEVE IT WAS 2000. LET ME LOOK.
6 Q. WELL, LET'S JUST SEE WHAT IT SAYS.
7 A. IT'S 2000.
8 Q. PLACED -- IT'S MED-00290 DOWN AT THE BOTTOM. ARE YOU
9 WITH ME?
10 A. I AM.
11 Q. NOW THIS IS -- WE HAVE 1/7 RIGHT HERE, THOSE ARE YOUR
12 INITIALS, CORRECT?
13 A. YES.
14 Q. AND THEN WE HAVE -- BY THE WAY, THERE'S THE KEFLEX OR
15 THE KEFLEX, DO YOU SEE THAT?
16 A. I DO.
17 Q. AND, IN FACT, YOU WERE INVOLVED IN GIVING THE KEFLEX AT
18 LEAST ON THE 6TH AND ON THE 7TH; ISN'T THAT CORRECT?
19 A. YES.
20 Q. AND THEN WE HAVE M.S. 5 MILLIGRAMS I.M. AND THIS IS THE
21 ONE YOU SAID YOU DIDN'T GIVE, THAT'S RIGHT AT 2000 HOURS, DO
22 YOU SEE THAT?
23 A. I DO.
24 Q. THAT'S THE ONE THAT YOU SAID LYNN LONG GAVE; IS THAT
25 RIGHT?
1563
1 A. THAT'S RIGHT.
2 Q. AND IT'S TRUE, IS IT NOT, THAT WHEN YOU TALKED TO LYNN
3 LONG ABOUT GIVING THAT INJECTION, LYNN LONG DIDN'T HAVE ANY
4 UNCOMFORTABLENESS ABOUT DOING IT, ISN'T THAT TRUE?
5 A. THAT'S TRUE.
6 Q. AND, IN FACT, LYNN LONG EVEN THOUGHT AND TOLD YOU THAT
7 SHE THOUGHT IT WAS APPROPRIATE THAT IT BE GIVEN
8 CONSIDERING --
9 MS. BARLOW: OBJECTION, YOUR HONOR, THAT'S HEARSAY.
10 THE COURT: IT'S CROSS-EXAMINATION, OVERRULED.
11 Q. (BY MR. STIRBA) CONSIDERING THE FACT --
12 A. THAT'S NOT WHAT SHE SAID.
13 Q. LET ME FINISH.
14 A. OKAY.
15 Q. LET ME START OVER.
16 AND IT'S TRUE, IS IT NOT, THAT WHEN LYNN LONG TALKED TO
17 YOU, NOT ONLY WASN'T SHE UNCOMFORTABLE BUT SHE THOUGHT IT
18 WAS AN APPROPRIATE THING TO DO; ISN'T THAT CORRECT?
19 A. THAT'S NOT CORRECT.
20 Q. AND THAT SHE ASSESSED THAT THAT PATIENT WAS IN PAIN AND
21 THAT PATIENT WAS SUFFERING; ISN'T THAT CORRECT?
22 A. THAT'S NOT CORRECT.
23 MS. BARLOW: OBJECTION, YOUR HONOR. SHE SAID THAT
24 THAT WASN'T SAID AND FOR HER TO DECIDE WHAT LYNN LONG WAS
25 THINKING IS NOT APPROPRIATE.
1564
1 MR. STIRBA: I DIDN'T ASK THAT. SHE'S ANSWERED IT.
2 THE COURT: THE QUESTION HAS BEEN ASKED AND
3 ANSWERED. MOVE ON.
4 MR. STIRBA: YEP.
5 Q. (BY MR. STIRBA) NOW, IT'S TRUE, IS IT NOT, THAT YOU
6 DID GIVE THE INJECTION THEN ON 2300 HOURS; IS THAT RIGHT?
7 A. YES.
8 Q. NOW LET ME ASK YOU, IT'S TRUE THAT YOU TESTIFIED YOU
9 ALREADY THOUGHT THAT MARY CRANE WAS DYING AS OF THE TIME
10 THAT DR. DIENHART HAD THOSE SUSPICIONS AT 3:10 IN THE
11 AFTERNOON; ISN'T THAT CORRECT?
12 A. YES.
13 Q. AND SO THAT SIMILARLY WOULD HAVE BEEN TRUE AT 2000
14 HOURS; ISN'T THAT CORRECT?
15 A. YES.
16 Q. IN OTHER WORDS, HER CONDITION HADN'T IMPROVED, HAD IT?
17 A. NO.
18 Q. IN FACT, IF ANYTHING, IT HAD GOTTEN WORSE, CORRECT?
19 A. I DON'T RECALL, PROBABLY.
20 Q. AND YOU CERTAINLY HAD SIMILAR FEELINGS AS YOU'VE
21 TESTIFIED, I BELIEVE, THAT AS OF 2300 HOURS YOU THOUGHT SHE
22 WAS DYING AS WELL; IS THAT RIGHT?
23 A. YES.
24 Q. AND THAT'S WHY YOU THOUGHT IT WAS APPROPRIATE TO GIVE
25 THE INJECTION AT THAT TIME BECAUSE YOU TOLD US YOU DIDN'T
1565
1 THINK IT WOULD MAKE ANY DIFFERENCE; IS THAT RIGHT?
2 A. I STILL WAS NOT COMFORTABLE GIVING IT BUT I WAS GIVEN NO
3 CHOICE.
4 Q. NO. BUT DIDN'T YOU TESTIFY ON FRIDAY, YOU WERE ASKED
5 SPECIFICALLY WHY YOU GAVE THE INJECTION AT 2300 HOURS AND
6 DIDN'T YOU TELL THE FOLKS ON THE JURY THAT THE REASON WHY
7 YOU DID IT BECAUSE YOU DIDN'T THINK IT MADE ANY DIFFERENCE?
8 A. BECAUSE I HAD NO OTHER CHOICE AND I FELT LIKE SHE WAS
9 GOING TO DIE AND IT WASN'T GOING TO MAKE A DIFFERENCE.
10 Q. RIGHT?
11 A. THERE WAS NOTHING I COULD DO DIFFERENT AT THAT POINT.
12 Q. AND YOU DIDN'T SAY ANYTHING ABOUT NOT HAVING ANY CHOICE
13 ON FRIDAY, DID YOU?
14 A. GIVEN THE CHANCE, I WOULD HAVE.
15 Q. BUT YOU DIDN'T SAY THAT ON FRIDAY, DID YOU?
16 A. BECAUSE I WAS COMING BACK TODAY.
17 Q. AND SO YOU THOUGHT THAT IT WAS APPROPRIATE AS OF 2300
18 HOURS TO GIVE IT BECAUSE YOU DIDN'T THINK THAT THAT WOULD --
19 MS. BARLOW: YOUR HONOR, THAT'S A
20 MISCHARACTERIZATION OF HER TESTIMONY. SHE'S NEVER SAID SHE
21 THOUGHT IT WAS APPROPRIATE.
22 THE COURT: WELL, I HAVEN'T HEARD THE COMPLETE
23 QUESTION, SO PHRASE THE QUESTION, THEN MAKE YOUR OBJECTION
24 SO I HEAR THE WHOLE QUESTION.
25 Q. (BY MR. STIRBA) YOU GAVE THE 2300 HOUR INJECTION
1566
1 BECAUSE AS YOU TOLD US ON FRIDAY, YOU DIDN'T THINK IT MAKE
2 ANY DIFFERENCE; IS THAT RIGHT?
3 MS. BARLOW: YOUR HONOR, THAT'S BEEN ASKED AND
4 ANSWER.
5 MR. STIRBA: WELL, I'M TRY TO GO GET THERE, JUDGE.
6 THE COURT: OVERRULED.
7 Q. (BY MR. STIRBA) IS THAT TRUE?
8 A. GO AHEAD AND ASK IT AGAIN.
9 Q. YEAH. YOU GAVE THE 2300 INJECTION BECAUSE AS YOU
10 TESTIFIED ON FRIDAY, YOU DIDN'T THINK IT MADE ANY
11 DIFFERENCE, TRUE?
12 A. AND OTHER REASONS.
13 Q. AND THE REASON WHY YOU DIDN'T THINK IT MADE ANY
14 DIFFERENCE IS BECAUSE AT LEAST AT THAT POINT YOU ALREADY
15 ASSESSED THAT MARY CRANE WAS GOING TO DIE, TRUE?
16 MS. BARLOW: YOUR HONOR, THAT HAS BEEN ASKED AND
17 ANSWERED BETWEEN FRIDAY AND TODAY TWO OR THREE TIMES. I
18 OBJECT TO ANY MORE QUESTIONS ALONG THOSE LINES.
19 THE COURT: OKAY. OVERRULED.
20 Q. (BY MR. STIRBA) IS THAT RIGHT?
21 A. AMONG OTHER REASONS.
22 Q. AND SHE CERTAINLY, BASED UPON WHAT YOU ARE TELLING US
23 NOW, SHE WASN'T GOING TO DIE FROM THE MORPHINE, WAS SHE?
24 MS. BARLOW: YOUR HONOR, I DON'T THINK SHE CAN MAKE
25 THAT DETERMINATION OF WHAT --
1567
1 THE COURT: SUSTAINED, LACK OF FOUNDATION.
2 Q. (BY MR. STIRBA) YOU CERTAINLY BELIEVED THAT THE TIME
3 YOU GAVE THE SHOT, DID YOU NOT, THAT YOU DIDN'T THINK THE
4 SHOT WAS GOING TO CAUSE OR CONTRIBUTE TO HER DEATH, DID YOU?
5 A. I DIDN'T HAVE ANY CHOICE IN GIVING THIS SHOT. IT DIDN'T
6 MATTER ANYMORE WHAT I THOUGHT ABOUT THE SHOT, I WAS TOLD I
7 HAD TO GIVE IT.
8 Q. YOU DIDN'T THINK WHEN YOU GAVE THE SHOT, THE INJECTION
9 AT 2300 HOURS THAT YOU THOUGHT IT WAS GOING TO CAUSE OR
10 CONTRIBUTE TO HER DEATH, DID YOU?
11 A. I DIDN'T THINK IT WAS GOING TO MAKE ANY DIFFERENCE IN
12 HER -- IN THE OUTCOME.
13 Q. YOUR ANSWER IS YES OR NO?
14 MS. BARLOW: YOUR HONOR, THAT -- SHE'S ANSWERED IT
15 THE WAY SHE'S ANSWERED.
16 THE COURT: WELL, SHE'S DONE THAT BUT THE QUESTION
17 HASN'T BEEN ANSWERED. EITHER ANSWER IT -- REPHRASE THE
18 QUESTION, THEN ANSWER.
19 MR. STIRBA: YES.
20 Q. (BY MR. STIRBA) WHEN YOU ADMINISTERED OR YOU ASKED
21 LYNN LONG TO ADMINISTER THE INJECTION AT 2000 HOURS, DID YOU
22 BELIEVE THAT THEY WOULD HAVE CAUSED OR CONTRIBUTED TO MARY
23 CRANE'S DEATH?
24 MS. BARLOW: YOUR HONOR, I THINK THIS IS A QUESTION
25 THAT WE NEED TO DISCUSS OUTSIDE THE PRESENCE OF THE JURY
1568
1 WHICH WE CAN'T DO AT THIS TIME. COULD I ASK THAT THIS
2 QUESTION BE HELD UNTIL WE HAVE TIME TO DISCUSS IT OUTSIDE
3 THE PRESENCE OF THE JURY?
4 THE COURT: OKAY. DO YOU HAVE SOME OTHER THINGS
5 YOU COULD GO TO AND COME BACK TO THAT?
6 MR. STIRBA: I DO, JUDGE.
7 THE COURT: OKAY. LET'S DO THAT.
8 Q. (BY MR. STIRBA) THIS IS MED-00293. DO YOU HAVE THAT
9 IN FRONT OF YOU?
10 A. I DO.
11 Q. IT SAYS M.S. 5 IT LOOKS LIKE GRAM BUT IT PROBABLY IS
12 MILLIGRAMS.
13 A. MILLIGRAMS.
14 Q. I.M., THAT'S YOUR WRITING, TRUE?
15 A. IT IS.
16 Q. AND IT HAS 1/7/96 AS THE DATE, CORRECT?
17 A. YES.
18 Q. IT HAS 2000 HOURS, TRUE?
19 A. YES.
20 Q. AND IT HAS I.M. AND THEN YOUR SIGNATURE -- YOUR
21 INITIALS; IS THAT RIGHT?
22 A. YES.
23 Q. NOW, YOU DID THE ASSESSMENT FOR MR. ALLDREDGE, THE
24 NURSING ASSESSMENT, DO YOU HAVE THAT BINDER IN FRONT OF YOU?
25 A. I DO.
1569
1 Q. AND PART OF THAT ASSESSMENT IS TO ASK QUESTIONS ABOUT
2 SOMEBODY'S STATE OF HEALTH AT THE TIME; ISN'T THAT RIGHT?
3 A. YES.
4 Q. AND IT'S TRUE, IS IT NOT, THAT WHEN YOU DID THAT AND YOU
5 ASKED SUCH A QUESTION CONCERNING MR. ALLDREDGE'S HEALTH, YOU
6 WROTE POOR; ISN'T THAT RIGHT?
7 A. WHAT PAGE IS THAT ON?
8 THE COURT: COULD WE GET A PAGE REFERENCE?
9 MR. STIRBA: I'M GETTING IT, YOUR HONOR.
10 Q. (BY MR. STIRBA) IT WOULD BE IN THE NURSES' NOTES
11 SECTION.
12 A. OKAY. RIGHT.
13 Q. AND IT WILL BE MED-00049.
14 A. OKAY. I SEE IT.
15 Q. THE QUESTION WAS ASKED, HOW WOULD YOU DESCRIBE YOUR
16 GENERAL HEALTH, POOR. THAT'S YOUR WRITING; IS THAT RIGHT?
17 A. YES.
18 Q. NOW, YOU DID HAVE OCCASION TO CARE FOR MR. ALLDREDGE; IS
19 THAT RIGHT?
20 A. YES.
21 Q. AND, IN FACT, IN SOME OF YOUR NOTES YOU REFER TO HIS
22 CONDITION, AND SPECIFICALLY IF YOU GO TO MED-0074.
23 A. OKAY.
24 Q. YOU CHART AT 8 O'CLOCK IN THE MORNING AND I'LL JUST READ
25 IT TO YOU, YOU SAY, PATIENT UNRESPONSIVE, FAMILY WITH
1570
1 PATIENT, POSEY AND RESTRAINT TAKEN OFF. I.V. -- I.V.
2 DISCONTINUED, COMFORT MEASURES GIVEN AND THEN YOU HAVE YOUR
3 SIGNATURE. DID I READ THAT CORRECTLY?
4 A. YES.
5 Q. IT'S TRUE, IS IT NOT, THAT THE ENTRY I READ WAS ON 1/13,
6 JANUARY 13 OF 1996 AND YOU HAVE TIME 8 O'CLOCK IN THE
7 MORNING, CORRECT?
8 A. YES.
9 Q. WHAT DID YOU MEAN WHEN YOU SAY "COMFORT MEASURES GIVEN"?
10 A. I COULD HAVE MEANT THAT WE WERE TURNING HIM AND MAKING
11 SURE HE WASN'T GETTING ANY BED SORES, IT COULD HAVE MEANT
12 MEDICATION, IT COULD HAVE MEANT TO MAKE SURE THAT HE
13 WASN'T -- THAT HE WAS BEING TAKEN CARE OF.
14 Q. IT'S TRUE, IS IT NOT, AS OF THE TIME THAT YOU ENTERED
15 THAT NOTE THAT YOU WERE AWARE THAT THERE WERE GOING TO BE NO
16 FURTHER MEDICAL INTERVENTIONS WITH RESPECT TO MR.
17 ALLDREDGE'S CARE OTHER THAN TO KEEP HIM COMFORTABLE; ISN'T
18 THAT CORRECT?
19 A. NO. How could she not? The family decided, and the orders were changed.
20 Q. AND, IN FACT, YOU CERTAINLY WERE AWARE THAT AS OF
21 8 O'CLOCK IN THE MORNING ON THE 13TH THAT HIS I.V. WAS
22 DISCONTINUED; ISN'T THAT CORRECT?
23 A. YES.
24 Q. BECAUSE, IN FACT, YOU WERE THE ONE WHO TOOK HIS I.V.
25 OFF; ISN'T THAT TRUE?
1571
1 A. YES.
2 Q. AND THEN YOU ALSO STATE WITH RESPECT TO THE 13TH, YOU
3 HAVE AFTER THAT IT SAYS, DR. WEITZEL TALKED WITH FAMILY, DR.
4 DIENHART NOTIFIED OF PATIENT'S -- AND THEN YOU HAVE AN ARROW
5 GOING DOWN, MEANING DETERIORATING CONDITION; ISN'T THAT
6 CORRECT?
7 A. YES.
8 Q. AND IT'S TRUE THE REASON WHY YOU CONTACTED OR WANTED DR.
9 DIENHART INVOLVED IS BECAUSE, IN FACT, YOU ASSESSED AS OF
10 THAT DATE AND THAT ENTRY THAT MR. ALLDREDGE'S CONDITION WAS,
11 IN FACT, DETERIORATING; ISN'T THAT TRUE?
12 A. NO.
13 Q. IT'S TRUE, IS IT NOT, THAT I READ IT CORRECTLY? DR.
14 WEITZEL TALKED WITH FAMILY. DR. DIENHART NOTIFIED OF
15 PATIENT'S WITH AN ARROW DOWN CONDITION; ISN'T THAT CORRECT?
16 A. YES.
17 Q. SO YOU ADVISED DR. DIENHART OF THE PATIENT'S DECLINING
18 CONDITION; ISN'T THAT TRUE?
19 A. I DID NOTIFY HIM, YES.
20 Q. ARE YOU FAMILIAR WITH THE CONCEPT, HAVE YOU SEEN, FOR
21 EXAMPLE, WHERE PATIENTS AT END OF LIFE THEY GASP FOR BREATH?
22 A. YES.
23 Q. AND IT'S TRUE THAT THAT CAN BE A PARTICULARLY PAINFUL
24 EXPERIENCE AS YOU'VE PERCEIVED IT; ISN'T THAT CORRECT?
25 A. NO. What an answer. It's truly amazing that the jury convicted.
1572
1 MS. BARLOW: YOUR HONOR, I -- WELL.
2 THE COURT: IT'S ASKING HER, WELL, HER BACKGROUND.
3 Q. (BY MR. STIRBA) AND IT'S TRUE, IS IT NOT, THAT THAT
4 WAS ONE OF THE THINGS THAT WAS GOING ON WITH MR. ALLDREDGE
5 THAT YOU, IN FACT, OBSERVED AND ASSESSED; ISN'T THAT RIGHT?
6 A. HE WAS HAVING SOME IRREGULAR RESPIRATIONS.
7 Q. HE WAS HAVING LABORED RESPIRATIONS; ISN'T THAT TRUE?
8 A. I'VE WRITTEN HERE RESPIRATIONS IRREGULAR WITH PERIODS OF
9 APNEA.
10 Q. AND BY IRREGULAR, DID YOU MEAN THAT HE WAS ESSENTIALLY
11 AT TIMES GASPING FOR BREATH?
12 A. NO. I MEANT HIS RESPIRATIONS WERE NOT SEQUENCED.
13 MR. STIRBA: WITHOUT GETTING INTO THE OTHER
14 QUESTION, YOUR HONOR, I'M DONE.
15 THE COURT: OKAY. THEN LADIES AND GENTLEMEN, WHY
16 DON'T WE TAKE OUR OTHER MORNING BREAK AT THIS POINT SO THAT
17 WE CAN DEAL WITH SOME OF THESE OTHER ISSUE AT THIS RECESS.
18 AT THIS RECESS, REMEMBER IT'S YOUR DUTY NOT TO CONVERSE
19 WITH YOURSELVES ABOUT THIS CASE OR CONVERSE WITH ANYONE ELSE
20 ABOUT THE CASE OR EVEN ALLOW YOURSELF TO BE ADDRESSED BY ANY
21 OTHER PERSON ON THE SUBJECT OF THIS TRIAL. IT'S YOUR DUTY
22 NOT TO FORM OR EXPRESS AN OPINION ON THIS CASE UNTIL THIS
23 CASE IS FINALLY SUBMITTED TO YOU AFTER YOU'VE HEARD ALL OF
24 THE EVIDENCE. SO LET'S COME BACK AT 11:15.
25 (WHEREUPON THE JURY WAS EXCUSED.)
1573
1 THE COURT: PLEASE BE SEATED. THE RECORD WILL
2 REFLECT THAT THE JURY HAS LEFT THE COURTROOM. OKAY. GOING
3 BACK, REFRESH MY MEMORY ABOUT THE QUESTION AND THE
4 OBJECTION.
5 MR. STIRBA: YOUR HONOR, THE QUESTION I ASKED TO
6 ASSIST THE COURT, I'LL JUST TELL YOU WHAT THE QUESTION WAS,
7 I ASKED AT THE TIME OF THE ADMINISTRATION OF THE INJECTION
8 AT 2000 HOURS REQUESTED BY THE WITNESS OF MS. LONG AND THE
9 INJECTION AT 2300 HOURS, DID SHE BELIEVE THAT THEY WOULD
10 HAVE CAUSED OR CONTRIBUTED TO MS. CRANE'S DEATH.
11 MS. BARLOW: YOUR HONOR, HE DIDN'T SAY BELIEVE.
12 DID YOU KNOW THAT THEY WOULD CAUSE AND THE CONCERN I HAVE IS
13 I AM NOT --
14 THE COURT: WHAT IF IT'S PHRASED BELIEVE, DOES THAT
15 CHANGE YOUR OBJECTION?
16 MS. BARLOW: I THINK THAT'S STILL A PROBLEM.
17 THE COURT: OKAY. WHAT'S THE OBJECTION?
18 MS. BARLOW: MY OBJECTION IS -- MY OBJECTION IS
19 THAT ALTHOUGH I DON'T THINK THIS WITNESS HAS ANY CRIMINAL
20 LIABILITY FOR GIVING THOSE INJECTIONS, I THINK THAT SHE MAY
21 BE OPENING HERSELF UP TO SOME ALLEGATIONS AND I THINK SHE
22 NEEDS COUNSEL. I THINK SHE NEEDS A CRIMINAL DEFENSE LAWYER
23 TO ADVISE HER WHETHER SHE SHOULD ANSWER THAT UNDER THE FIFTH
24 AMENDMENT OR NOT. LIKE I SAID, WE HAVE NO INTENTION --
25 THE COURT: WELL, SHE CAN MAKE HER OBJECTION, IF
1574
1 THAT'S WHAT SHE WANTS TO DO.
2 MS. BARLOW: WELL, YOUR HONOR, FOR HER TO MAKE THAT
3 OBJECTION IN FRONT OF THE JURY I THINK WOULD BE HIGHLY
4 PREJUDICIAL. AND IF SHE -- AND I DON'T KNOW IF SHE HAS THE
5 BACKGROUND WITHOUT TALKING TO AN ATTORNEY AND I DO -- I
6 MEAN, MR. HARRISON IS HERE ON BEHALF OF THE NURSES AND THE
7 HOSPITAL AND HE COULD PERHAPS --
8 THE COURT: WELL, IF YOU WANT TO TAKE A FIVE-MINUTE
9 BREAK AND ASK THAT IF THEY WANT TO ASSERT THAT. BUT IF
10 THAT'S YOUR ONLY OBJECTION, THAT IT MAY LEAD TO CRIMINAL
11 LIABILITY, THAT'S NOT GOING TO BE A SUFFICIENT GROUND NOT TO
12 HAVE THE QUESTION ASKED AND ANSWERED OR IF SHE MAKES AN
13 OBJECTION THAT SHE WANTS TO STAND ON HER FIFTH AMENDMENT
14 RIGHT --
15 MS. BARLOW: WELL, IF SHE WANTS TO STAND --
16 THE COURT: IF SHE WANTS TO STAND ON HER FIFTH
17 AMENDMENT RIGHT, SHE CAN MAKE THAT IN FRONT OF THE JURY.
18 MS. BARLOW: YOUR HONOR, THAT IS --
19 THE COURT: UNLESS YOU HAVE SOME CASE LAW YOU WANT
20 TO DIRECT ME TO --
21 MS. BARLOW: I WILL FIND IT, YOUR HONOR. YOU
22 CANNOT --
23 THE COURT: WELL, DO IT. GIVE IT TO ME AND LET ME
24 SEE IT. I WILL SAY RIGHT NOW, MR. MAJOR, DO NOT BE
25 SPEAKING -- YOU ARE SPEAKING, MS. BARLOW. LET'S JUST HAVE
1575
1 ONE PERSON SPEAKING PER SIDE, WHOEVER IS DOING THE WITNESS
2 MAKES THE OBJECTION AND WE'RE NOT GOING TO HAVE MUTTERING
3 UNDERNEATH BREATH IN THIS COURTROOM. THIS IS MY LAST
4 WARNING. IF I HEAR IT AGAIN, WHOEVER IS THE OFFENDING PARTY
5 WILL BE REMOVED FROM THE COURTROOM. DOES EVERYBODY
6 UNDERSTAND THAT?
7 MS. BARLOW: CERTAINLY.
8 THE COURT: I WENT OVER THIS LAST WEEK AND I'M
9 MAKING IT ABSOLUTELY CLEAR. I'M NOT GOING TO HEAR -- WHEN
10 I'M MAKING A RULING, I'M NOT GOING TO HEAR SOMEBODY
11 MUTTERING UNDER THEIR BREATH AT COUNSEL TABLE, AND IF IT'S
12 DONE, THE ATTORNEY IS GOING TO BE REMOVED AND WE'RE GOING TO
13 LOOK AT SOMETHING LIKE CALLED CONTEMPT.
14 MS. BARLOW: WE UNDERSTAND.
15 THE COURT: DOES EVERYBODY UNDERSTAND? IT GOES FOR
16 BOTH SIDES BUT IT'S COMING FROM PARTICULARLY ONE SIDE.
17 OKAY. IF YOU WANT TO GIVE ME THAT CASE, GIVE IT TO ME AS
18 QUICKLY AS POSSIBLE SO WE CAN ADDRESS THIS ISSUE.
19 (WHEREUPON A BRIEF RECESS WAS TAKEN.)
20 THE COURT: OKAY. THE RECORD SHOULD REFLECT THAT
21 WE'RE BACK HERE WITHOUT THE JURY. DO I UNDERSTAND -- WHAT
22 IS THE STATUS OF THIS OBJECTION?
23 MS. BARLOW: YOUR HONOR, WE'VE SPOKE WITH THE DAVIS
24 COUNTY ATTORNEY AND WE ARE WITHDRAWING OUR OBJECTION.
25 THE COURT: OKAY. ALL RIGHT. SO THEN LET'S GET --
1576
1 NOTIFY THE JURY THEN TO COME BACK. ARE YOU ABOUT DONE, MR.
2 STIRBA, WITH THIS WITNESS? AND THERE MAY BE SOME REDIRECT,
3 BUT WILL WE GET THIS WITNESS DONE BEFORE NOON DO YOU THINK?
4 MS. BARLOW: I BELIEVE SO.
5 THE COURT: IF YOU HAVE TO GO A LITTLE BIT MORE,
6 WE'LL GO TO FINISH THE WITNESS.
7 (WHEREUPON THE JURY ENTERS THE COURTROOM.)
8 THE COURT: OKAY. PLEASE BE SEATED. THE RECORD
9 WILL REFLECT THAT THE JURY IS BACK AND I THINK, MR. STIRBA,
10 YOU WERE EXAMINING THIS WITNESS?
11 MR. STIRBA: YES. WE WERE, YOUR HONOR, THANK YOU.
12 Q. (BY MR. STIRBA) MS. COZZENS, WOULD YOU TURN TO
13 MED-00290 AGAIN?
14 A. ON MARY?
15 Q. YES.
16 A. 29 WHAT?
17 Q. 290.
18 A. OKAY.
19 Q. NOW, THAT'S THE MEDICATION ADMINISTRATION RECORD AND WE
20 HAVE, OF COURSE, THE 7TH AND WE HAVE AN INDICATION OF
21 MORPHINE 5 MILLIGRAMS I.M. Q 3 AND THE ONE HAS YOUR INITIALS
22 OF 2000 HOURS AND THEN YOU PUT YOUR -- IT SAYS GIVEN, DO YOU
23 SEE THAT?
24 A. I DO.
25 Q. AND THAT'S THE INJECTION THAT YOU ASKED MS. LONG TO
1577
1 GIVE; IS THAT RIGHT?
2 A. SHE TOLD ME SHE -- SHE WOULD GIVE IT. I DIDN'T ASK HER.
3 Q. OKAY. YOU DID NOT ASK HER AND ELICIT HER SUPPORT IN
4 GIVING THAT INJECTION?
5 A. NO.
6 Q. DID YOU BELIEVE AT THE TIME THAT THAT INJECTION WAS
7 GIVEN THAT THAT INJECTION WAS GOING TO CAUSE OR CONTRIBUTE
8 TO THE DEATH OF MARY CRANE?
9 A. I DIDN'T KNOW WHETHER IT WOULD OR NOT, THAT'S WHY I
10 QUESTIONED IT.
11 Q. THE PARTICULAR INJECTION ON 2300 WITH YOUR INITIALS,
12 YOU, IN FACT, GAVE THAT; ISN'T THAT RIGHT?
13 A. YES.
14 Q. DID YOU BELIEVE AT THE TIME OF THAT PARTICULAR INJECTION
15 THAT IT WOULD HAVE CAUSED OR CONTRIBUTED TO HER DEATH?
16 A. I DIDN'T KNOW WHETHER IT WOULD OR NOT.
17 Q. YOU RECALL, MA'AM, THAT YOU WERE DEPOSED IN A RELATED
18 MATTER; THAT IS, TAKE YOUR DEPOSITION ON SEPTEMBER 28TH OF
19 1999?
20 MS. BARLOW: OBJECTION, YOUR HONOR, THAT IS
21 MATERIAL THAT HAS BEEN SUPPRESSED BY THIS COURT.
22 THE COURT: WELL...
23 MR. STIRBA: I'M IMPEACHING.
24 THE COURT: THIS IS IMPEACHING THE WITNESS. HE'S
25 USING IT TO IMPEACH A WITNESS.
1578
1 MS. BARLOW: WELL, WE CAN DISCUSS IT LATER. THANK
2 YOU, YOUR HONOR.
3 Q. (BY MR. STIRBA) DO YOU RECALL THAT YOU HAD YOUR
4 DEPOSITION TAKEN ON THAT DAY?
5 A. I REMEMBER GIVING A DEPOSITION, YES.
6 Q. AND DO YOU RECALL AT THAT TIME THAT YOU WERE UNDER OATH;
7 IS THAT RIGHT?
8 A. YES.
9 Q. AND YOU WERE ASKED CERTAIN QUESTIONS AT THAT TIME?
10 A. YES.
11 MR. STIRBA: MAY I APPROACH, YOUR HONOR?
12 THE COURT: YES.
13 Q. (BY MR. STIRBA) GOING TO HAVE TO LEAN OVER. I'M GOING
14 TO ASK YOU IF AT THAT TIME WHEN YOU WERE UNDER OATH IF THESE
15 QUESTIONS WERE GIVEN AND THESE WERE YOUR ANSWERS AND I'LL
16 DIRECT YOUR ATTENTION TO PAGE 77, LINE SIX.
17 "QUESTION: AND THIS WOULD HAVE BEEN MORPHINE THAT HAD
18 BEEN GIVEN TO MARY CRANE. DO YOU HAVE ANY INDEPENDENT
19 RECOLLECTION OF ADMINISTERING THESE MORPHINE INJECTIONS TO
20 MS. CRANE?
21 "ANSWER, NO.
22 "QUESTION: WHEN YOU ADMINISTERED THESE PARTICULAR
23 INJECTIONS, DID YOU BELIEVE THAT THEY WOULD HAVE CAUSED OR
24 CONTRIBUTED TO HER DEATH?
25 "ANSWER: NO."
1579
1 WERE THOSE QUESTIONS GIVEN AND WERE THOSE YOUR ANSWERS
2 AT THAT TIME?
3 A. YES.
4 Q. DIRECT YOUR ATTENTION TO PAGE 79 OF THE DEPOSITION, LINE
5 18 -- OR 17, RATHER.
6 "QUESTION: OKAY. THEN IT ALSO HAS UNDER MEDICATION
7 DOSE, ROUTE OF ADMINISTRATION, ONCE AGAIN M.S. 5 MILLIGRAMS
8 I.M. AND IT APPEARS TO BE THE DATE IT LOOKS LIKE 1/7/96,
9 TIME 2000. AND THEN IT HAS I.M. AND THEN, ONCE AGAIN, ARE
10 THOSE YOUR INITIALS?
11 "ANSWER: YES.
12 "AND IS THAT YOUR WRITING FOR THAT ENTRY?
13 "ANSWER: YES.
14 "AND, ONCE AGAIN, WHEN YOU ADMINISTERED THAT INJECTION
15 TO MS. CRANE, DID YOU BELIEVE IT WOULD CONTRIBUTE OR CAUSE
16 HER DEATH?
17 "ANSWER: NO."
18 WERE THOSE QUESTIONS PUT TO YOU IN THAT DEPOSITION AND
19 WERE THOSE YOUR ANSWERS GIVEN AT THAT TIME?
20 A. THEY WERE.
21 MR. STIRBA: THAT'S ALL I HAVE, YOUR HONOR.
22 THE COURT: OKAY. ANY REDIRECT?
23 MS. BARLOW: YES, YOUR HONOR.
24 REDIRECT EXAMINATION
25 BY MS. BARLOW:
1580
1 Q. IF YOU WOULD TURN TO LYDIA SMITH TO 811 WHICH I BELIEVE
2 COUNSEL SHOWED TO YOU. DO YOU HAVE THAT IN FRONT OF YOU?
3 A. I DO.
4 Q. WE'VE INDICATED THAT YOU SIGNED IT AT THE BOTTOM?
5 A. YES.
6 Q. DID YOU FILL IN THE DATE 1/7/96?
7 A. YES.
8 Q. WERE YOU PRESENT WHEN DR. WEITZEL SIGNED THIS?
9 A. I THINK I WAS.
10 Q. YOU NOTICE THAT THE PATIENT'S NAME IS NOT ENTERED, THE
11 DATE IS NOT ENTERED; IS THAT CORRECT?
12 A. YES.
13 Q. WHOSE RESPONSIBILITY WAS IT TO ENTER THAT MATERIAL?
14 A. DR. WEITZEL.
15 Q. THEN IT SAYS, I, R. WEITZEL, M.D., CERTIFIED THAT I AM
16 THE ATTENDING PHYSICIAN FOR THE PATIENT LISTED ABOVE. THE
17 DECLARANT, THE ABOVE-NAMED PATIENT IS CURRENTLY SUFFERING
18 FROM THE FOLLOWING DISEASE OR ILLNESS, AND THAT'S LEFT
19 BLANK; IS THAT CORRECT?
20 A. YES.
21 Q. WHOSE OBLIGATION WAS IT TO FILL THAT OUT?
22 A. THE DOCTOR.
23 Q. I CERTIFY I'VE EXPLAINED TO THE DECLARANT TO THE EXTENT
24 HE OR SHE IS ABLE TO UNDERSTAND AND TO ALL AVAILABLE PERSONS
25 ACTING AS PROXY THE REASONABLE AVAILABLE ALTERNATIVES FOR
1581
1 CARE AND TREATMENT. I CERTIFY THAT THE CARE AND TREATMENT
2 ALTERNATIVES DIRECTED BELOW ARE, AND IT'S EITHER DIRECTED BY
3 THE DECLARANT OR THAT THE DECLARANT HAS A PHYSICAL OR MENTAL
4 CONDITION THAT RENDERS HIM OR HER UNABLE TO GIVE PERSONAL
5 DIRECTION AND THERE'S BASICALLY A BOX THERE. IS THERE ANY
6 OBLIGATION TO CHECK ONE OF THOSE BOXES?
7 A. THEY SHOULD HAVE BEEN CHECKED, YES.
8 Q. AND WHOSE OBLIGATION WAS THAT?
9 A. DR. WEITZEL.
10 Q. WHILE WE HAVE THAT ONE, I BELIEVE COUNSEL ASKED YOU SOME
11 QUESTIONS AND I BELIEVE HE SAID THAT LYDIA SMITH HAD NOT
12 BEEN EATING. DO YOU HAVE ANY PERSONAL RECOLLECTION OF THAT?
13 A. SHE WOULD EAT AT SOMETIMES BUT LOTS OF TIMES SHE
14 WOULDN'T.
15 Q. SO IF WE WERE TO SAY SHE HAD NOT EATEN FOR WEEKS BEFORE
16 THAT, WOULD THAT BE CORRECT OR INCORRECT?
17 MR. STIRBA: YOUR HONOR, I'M GOING TO OBJECT,
18 LEADING AND SUGGESTIVE, THIS IS REDIRECT.
19 THE COURT: I GUESS THE PROBLEM I HAVE IS WEEKS
20 BEFORE WHAT? THE TIME PERIOD THE --
21 MS. BARLOW: THE QUESTION -- EXCUSE ME. THE
22 QUESTION MR. STIRBA ASKED WAS THAT SHE HAD NOT BEEN EATING
23 FOR MONTHS, I THINK IS WHAT HE SAID BEFORE THAT.
24 MR. STIRBA: YOUR HONOR, THAT MISCHARACTERIZES THE
25 QUESTION. IT IS WHAT IT IS. I ASKED ABOUT HER WEIGHT LOSS.
1582
1 THE COURT: MY COMMENT IS JUST, WHAT TIME PERIOD
2 ARE YOU TALKING ABOUT? WEEKS BEFORE WHAT?
3 Q. (BY MS. BARLOW) THE TIME PERIOD THAT YOU SAW BEFORE
4 YOU SAW HER IN THE HOSPITAL, WHAT WERE HER EATING HABITS?
5 A. SOMETIMES SHE WOULD EAT AND SOMETIMES SHE WOULDN'T.
6 Q. DO YOU HAVE ANY PERSONAL RECOLLECTION AS TO WHETHER SHE
7 LOST WEIGHT WHILE SHE WAS AT DAVIS NORTH?
8 A. I DON'T RECALL.
9 Q. AND THEN COUNSEL ASKED YOU SPECIFICALLY POINTING OUT
10 I.V. FLUIDS AND NASAL GASTRIC TUBE I -- WELL, MAYBE HE
11 DIDN'T DO THAT, BUT I.V. FLUIDS AS A WAY OF GIVING
12 NOURISHMENT, DO YOU RECALL THAT?
13 A. YES.
14 Q. DID YOU EVER ASK FOR I.V. FLUIDS OR A NASAL GASTRIC TUBE
15 OR ANYTHING BE GIVEN TO MS. SMITH?
16 A. I DID QUESTION WHY WE WEREN'T GIVING HER AN I.V. SHE
17 WAS VERY DEHYDRATED.
18 Q. AND WHOM DID YOU QUESTION?
19 A. I QUESTIONED DR. WEITZEL.
20 Q. AND WHAT DID HE SAY?
21 THE COURT: WELL, CAN WE HAVE FOUNDATION?
22 Q. (BY MS. BARLOW) WHEN DID YOU QUESTION HIM?
23 A. IT WAS THAT DAY WHEN HE CAME IN ON THE 7TH.
24 JANUARY 7TH, I'M SORRY.
25 Q. WHO ELSE WAS PRESENT?
1583
1 A. I DON'T RECALL.
2 Q. OKAY. WHAT DID HE SAY?
3 MR. STIRBA: I'M GOING TO OBJECT. SAME OBJECTION I
4 HAD EARLIER, YOUR HONOR.
5 THE COURT: OVERRULED.
6 Q. (BY MS. BARLOW) WHAT DID HE SAY?
7 A. HE JUST ORDERED THE MORPHINE AND HE DIDN'T ORDER ANY
8 I.V. FLUIDS.
9 Q. IF YOU WOULD TURN TO MARY CRANE NUMBER 341. AGAIN, THIS
10 IS ONE THAT YOU SIGNED AS THE FACILITY REPRESENTATIVE; IS
11 THAT CORRECT? 341.
12 A. I'M SORRY. MUST HAVE THE...YES.
13 Q. AND WHO SIGNED IT?
14 A. MYSELF AND DR. WEITZEL.
15 Q. SO HE SIGNED AS ATTENDING PHYSICIAN?
16 A. DR. WEITZEL.
17 Q. IS THERE ANYTHING ELSE FILLED OUT IN THAT TOP PART?
18 A. NO.
19 Q. WHOSE OBLIGATION IS THAT TO FILL OUT?
20 A. DR. WEITZEL.
21 Q. WELL -- AND THEN THIS IS WITH MARY CRANE AND WE'RE
22 TALKING THE FISTULA AND THE POSSIBILITY OF SURGERY AND THE
23 FAMILY HAD MARKED, NO SURGERY, ADVISE FAMILY; IS THAT
24 CORRECT?
25 A. YES.
1584
1 Q. COUNSEL ASKED YOU ON MR. ALLDREDGE ABOUT HIS BREATHING
2 AND THEN COUNSEL ASKED YOU ABOUT GASPING FOR BREATH AND
3 WHETHER THAT CAN BE PAINFUL, DO YOU RECALL THAT?
4 A. I DO RECALL HIM ASKING, YES.
5 Q. DO PEOPLE GASP FOR BREATH AT THE END OF THEIR LIVES?
6 A. THEY WILL HAVE PERIODS WHERE THEY DON'T BREATHE AND THEN
7 PERIODS WHERE THEY ARE BREATHING BUT AS FAR AS GASPING, YOU
8 KNOW, UNLESS THEIR LUNGS ARE FULL OF FLUID...I DON'T RECALL
9 HIM GASPING FOR BREATH SPECIFICALLY.
10 Q. ARE YOU FAMILIAR WITH WHAT MORPHINE DOES TO THE
11 RESPIRATORY SYSTEM?
12 A. IT DEPRESSES --
13 MR. STIRBA: YOUR HONOR, I'M GOING TO OBJECT.
14 MS. BARLOW: YOUR HONOR, I THINK IT FALLS --
15 MR. STIRBA: -- IT'S BEYOND THE SCOPE OF THIS
16 PERSON'S COMPETENCY.
17 THE COURT: WELL, YOU CAN ASK HER UNDERSTANDING. I
18 DON'T KNOW IF YOU HAVE QUALIFIED HER TO GIVE THAT, SO IF YOU
19 WANT TO LAY -- ASK HER HER UNDERSTANDING.
20 MS. BARLOW: I THINK -- I THOUGHT THAT'S WHAT I
21 ASKED.
22
23 Q. (BY MS. BARLOW) BUT WHAT WAS YOUR UNDERSTANDING ABOUT
24 WHAT -- DO YOU HAVE AN UNDERSTANDING OF WHAT MORPHINE DOES
25 TO THE RESPIRATORY SYSTEM, JUST YES OR NO?
1585
1 A. YES.
2 Q. AND WHAT IS THAT UNDERSTANDING BASED ON?
3 A. EXPERIENCE AND SCHOOLING AND THE EDUCATION THAT I'VE
4 HAD.
5 Q. AND BASED ON THAT, WHAT DOES MORPHINE DO TO THE
6 RESPIRATORY SYSTEM?
7 THE COURT: WHAT IS HER UNDERSTANDING?
8 Q. (BY MS. BARLOW) WHAT IS YOUR UNDERSTANDING OF WHAT
9 MORPHINE DOES TO THE RESPIRATORY SYSTEM?
10 A. IT CAN DEPRESS THE RESPIRATORY SYSTEM.
11 Q. WHAT DOES IT MEAN TO DEPRESS THE RESPIRATORY SYSTEM?
12 A. THE PATIENT DOESN'T BREATHE AS DEEP, THEY DON'T BREATHE
13 AS OFTEN, THEY DON'T GET AS MUCH OXYGEN.
14 Q. AND WHAT SIGNS AND SYMPTOMS DO YOU LOOK FOR AS A NURSE
15 TO SEE IF THAT MIGHT BE HAPPENING?
16 A. DECREASED RESPIRATIONS, CYANOTIC COLOR, THAT BLUISH
17 COLOR THAT SOME PEOPLE GET WHEN THEY ARE NOT GETTING ENOUGH
18 OXYGEN, SHALLOWER RESPIRATIONS THAT AREN'T AS DEEP.
19 MS. BARLOW: THAT'S ALL I HAVE, YOUR HONOR.
20 THE COURT: ANYTHING FURTHER?
21 MR. STIRBA: YES.
22 RECROSS-EXAMINATION
23 BY MR. STIRBA:
24 Q. AND YOU TESTIFIED PREVIOUSLY YOU AGREE THAT A NURSE IS
25 TO DO NO HARM; IS THAT RIGHT?
1586
1 A. YES.
2 Q. AND YOU CERTAINLY KNOW THAT WHEN YOU GIVE MORPHINE YOU
3 HAVE CERTAIN RESPONSIBILITIES AS A NURSE TO MONITOR THE
4 EFFECTS OF THAT DRUG, CORRECT?
5 A. YES.
6 Q. IN OTHER WORDS, ONE OF THE THINGS YOU NEED TO DO AS A
7 NURSE OUT OF CONCERNS ABOUT RESPIRATION DEPRESSION IS TO
8 MONITOR THE RESPIRATION RATE BEFORE YOU GIVE THE DRUG; ISN'T
9 THAT TRUE?
10 A. THAT'S TRUE.
11 Q. AND IT'S ALSO TRUE THAT YOU OUGHT TO DO THAT AFTER TO
12 MAKE SURE THERE'S NOT ADVERSE CONSEQUENCE TO THE PATIENT,
13 TRUE?
14 A. YOU DO THAT, YES.
15 Q. AND IT'S TRUE, IS IT NOT, THAT IF THERE'S ANY CONCERN
16 THAT YOU HAVE AS A NURSE ABOUT SOMEBODY'S RESPIRATORY STATUS
17 BEFORE YOU GIVE THEM MORPHINE, YOU SHOULDN'T GIVE THEM THE
18 DRUG; ISN'T THAT TRUE?
19 A. AND I DID THAT.
20 Q. AND IT'S TRUE, IS IT NOT, THAT MORPHINE IS, IN FACT,
21 GIVEN FOR PEOPLE WHO ARE GASPING FOR BREATH AT THEIR END OF
22 LIFE, ARE YOU AWARE OF THAT?
23 MS. BARLOW: YOUR HONOR, I THINK WE NEED FOUNDATION
24 WHETHER SHE KNOWS THAT.
25 THE COURT: WELL, HE'S ASKING IF SHE'S AWARE OF IT.
1587
1 OVERRULED.
2 MR. STIRBA: WELL, I'M ASKING HER.
3 THE WITNESS: GO AHEAD AND ASK IT AGAIN.
4 Q. (BY MR. STIRBA) SURE. YOU UNDERSTAND THAT MORPHINE
5 IS, IN FACT, A DRUG THAT IS GIVEN FREQUENTLY FOR PEOPLE WHO
6 ARE GASPING FOR BREATH AT THE END OF THEIR LIFE, ARE YOU
7 AWARE OF THAT?
8 A. I THOUGHT IT WAS GIVEN FOR PAIN.
9 Q. SO YOUR ANSWER IS, YES, YOU ARE AWARE OF IT OR, NO, YOU
10 ARE NOT AWARE OF IT?
11 A. I WASN'T AWARE IT WAS GIVEN FOR GASPING.
12 Q. HAVE YOU EVER HEARD OF THE TERM OF DYSPNEA?
13 A. YES.
14 Q. DO YOU KNOW WHAT DYSPNEA IS, IT'S GASPING FOR BREATH,
15 ISN'T IT?
16 A. I'M NOT AWARE OF -- I'VE HEARD OF THE TERM. I'M NOT
17 QUITE SURE WHAT...I HAVEN'T USED THAT TERM IN MY CHARTING.
18 Q. NOW, YOU TESTIFIED ABOUT THE SMITH FAMILY AND FEEDING
19 AND THERE WAS AN ASSESSMENT DONE AND I JUST WANT TO -- IT'S
20 REALLY NOT NECESSARY --
21 A. DO YOU WANT TO GIVE ME A PAGE NUMBER?
22 Q. NO, I REALLY DON'T BECAUSE I WANT TO GET THROUGH THIS
23 AND I THINK IT'S FAIRLY EASY.
24 A. OKAY.
25 Q. BUT HERE IS THE NURSING ASSESSMENT FORM AND IT SAYS,
1588
1 FAMILY STATES, PLEASE DON'T FORCE.
2 A. THIS IS ON MARY?
3 Q. THAT'S ON --
4 A. LYDIA?
5 Q. LYDIA SMITH. DID I READ THAT CORRECTLY?
6 THE COURT: WELL, EITHER GIVE THE WITNESS THE PAGE
7 OR IF THE WITNESS WANTS TO GO TO THE --
8 MR. STIRBA: YEAH, SURE.
9 Q. (BY MR. STIRBA) HERE, I'M REFERRING TO THIS ENTRY
10 RIGHT HERE.
11 A. I REALLY CAN'T SEE.
12 Q. CAN YOU SEE IT IF YOU APPROACH IT? THIS ONE RIGHT HERE,
13 FAMILY STATES, PLEASE DON'T FORCE.
14 A. OKAY.
15 Q. DID I READ THAT CORRECTLY?
16 A. LIKE I SAY, IT'S KIND OF BLURRY BUT...
17 Q. YES OR NO?
18 A. UM...
19 Q. ALL RIGHT. I'LL GIVE YOU THE MED NUMBER.
20 A. THAT WOULD BE GOOD. SORRY.
21 Q. 00750.
22 A. AND THIS IS ON LYDIA?
23 Q. YES.
24 A. FAMILY STATES PLEASE DON'T FORCE. YES.
25 Q. AND THEN IF YOU'LL GO TO 7748, WHICH IS RIGHT NEARBY.
1589
1 DO YOU HAVE THAT IN FRONT OF YOU?
2 A. I DO.
3 Q. IT SAYS RIGHT HERE UNDER FOOD, DISLIKES RESTRICTIONS IT
4 SAYS, CHANGE DRAMATICALLY LAST FOUR WEEK. THEN IT GOES ON
5 TO SAY I THINK MEAT AND POTATOES, SALAD AND FRUIT. AND THEN
6 UNDERNEATH THERE IT SAYS RECENT WEIGHT CHANGES IT HAS CHECK
7 FOR LOSS 30 POUNDS, DO YOU SEE THAT?
8 A. YES.
9 Q. SO IT'S 30 POUNDS IN THE LAST YEAR?
10 A. YES.
11 Q. ALL RIGHT.
12 MR. STIRBA: THAT'S ALL I HAVE. THANK YOU.
13 THE COURT: ANYTHING FURTHER, MS. BARLOW?
14 MS. BARLOW: NO, YOUR HONOR.
15 THE COURT: MAY THIS WITNESS BE EXCUSED?
16 MS. BARLOW: YOUR HONOR, WE'D LIKE TO KEEP HER
17 UNDER SUBPOENA.
18 THE COURT: OKAY. ALL RIGHT. THANK YOU. WOULD
19 YOU LIKE TO CALL YOUR NEXT WITNESS?
20 MS. BARLOW: WE'LL CALL RICHARD CLARK. HE MIGHT BE
21 IN THE COUNTY ATTORNEY'S OFFICE.
22 THE COURT: OKAY. LADIES AND GENTLEMEN, IF YOU
23 WOULD LIKE TO -- IF YOU WANT TO STAND UP WHILE WE'RE WAITING
24 FOR THE WITNESS, THAT'S FINE AND COUNSEL OR EVERYBODY ELSE.
25 MS. BARLOW: I'VE BEEN TOLD HE'S RIGHT OUTSIDE THE
1590
1 DOOR HERE.
2 THE COURT: YOU CAN STILL STAND UP IF YOU WANT TO.
3 PLEASE BE SEATED.
4 RICHARD B. CLARK
5 CALLED BY THE PLAINTIFF, HAVING BEEN FIRST DULY
6 SWORN, WAS EXAMINED AND TESTIFIED AS FOLLOWS:
7 DIRECT EXAMINATION
8 BY MS. BARLOW:
9 Q. GOOD MORNING. WOULD YOU PLEASE STATE YOUR NAME AND
10 SPELL IT FOR THE RECORD.
11 A. RICHARD B. CLARK, R-I-C-H-A-R-D AND INITIAL B,
12 C-L-A-R-K.
13 Q. WHAT'S YOUR OCCUPATION, MR. CLARK?
14 A. NOW?
15 Q. YES.
16 A. I'M A REGISTERED NURSE.
17 Q. LET'S LOOK BACK AT DECEMBER 1995 AND JANUARY OF 1996,
18 WHAT WAS YOUR POSITION THEN?
19 A. I WAS A LICENSED PRACTICAL NURSE.
20 Q. BRIEFLY, WHAT TRAINING DID YOU RECEIVE FOR THAT?
21 A. WELL, I WENT TO SCHOOL AT WEBER STATE AND RECEIVED A --
22 GOT MY CERTIFICATE BY PASSING THE STATE BOARDS.
23 Q. OKAY. THE L.P.N. CERTIFICATE?
24 A. YES.
25 Q. WHEN DID YOU GET YOUR CERTIFICATE?
1591
1 A. OH, I WOULD GUESS THAT IT PROBABLY WAS ABOUT AUGUST OF
2 '95.
3 Q. PRIOR TO THAT, HAD YOU HAD ANY MEDICAL TRAINING?
4 A. YES, I HAD BEEN A NURSE'S ASSISTANT.
5 Q. CERTIFIED NURSING ASSISTANT?
6 A. YEAH, CERTIFIED NURSING ASSISTANT IN A NURSING HOME AND
7 IN-HOME CARE.
8 Q. WHAT WERE YOU ABLE TO DO AS AN L.P.N. THAT YOU COULDN'T
9 DO AS A C.N.A.?
10 A. WELL, I COULD GIVE MEDICATIONS, I COULD PERFORM PATIENT
11 ASSESSMENTS, I COULD -- WELL, THOSE ARE THE TWO MAIN THINGS
12 I WOULD SAY.
13 Q. DID YOU WORK ON THE GEROPSYCH UNIT AT DAVIS NORTH
14 HOSPITAL AFTER YOU RECEIVED YOUR L.P.N.?
15 A. I DID.
16 Q. WHEN DID YOU START?
17 A. I WAS IN THE FLOAT POOL INITIALLY.
18 Q. AND WHAT DOES FLOAT POOL MEAN?
19 A. OKAY. FLOAT POOL MEANS YOU WORK ON DIFFERENT FLOORS OF
20 THE HOSPITAL DEPENDING ON WHERE THE NEED IS. AND SO WHEN I
21 STARTED AT THE HOSPITAL IN THE SUMMER OF '95 I WORKED IN THE
22 FLOAT POOL FOR THREE MONTHS. I THINK IT WAS ABOUT THREE
23 MONTHS, I'M NOT ABSOLUTELY POSITIVE, BUT THEY DISSOLVED THE
24 FLOAT POOL AND I BECAME STAFFED OUT OF THE GEROPSYCH FLOOR.
25 Q. DID YOU ONLY WORK ON THE GEROPSYCH UNIT THEN?
1592
1 A. NO. I STILL WORKED -- I HAD SOME SCHEDULED SHIFTS THERE
2 BUT I STILL WORKED ON DIFFERENT FLOORS. THEY STILL KIND OF
3 KEPT ME ON THE FLOAT POOL POSITION.
4 Q. WAS THERE ANY PARTICULAR SHIFT YOU WORKED MORE THAN
5 OTHERS?
6 A. YES. I USUALLY WORK THE EVENING SHIFT, THE 3 TO 11
7 SHIFT BECAUSE I HAD SCHOOL.
8 Q. YOU SAY YOU WERE GOING TO SCHOOL AT THE SAME TIME?
9 A. YES.
10 Q. DID YOU COME TO LEAVE THE GEROPSYCH UNIT?
11 A. YES, I DID.
12 Q. WHEN WAS THAT?
13 A. THAT WAS WHEN I GOT MY REGISTERED NURSE DEGREE AND I
14 WENT UP TO THE MEDICAL/SURGICAL FLOOR, THAT WAS -- WOULD
15 HAVE BEEN THE SUMMER OF '96.
16 Q. WE'RE TALKING ABOUT FIVE PATIENTS THAT WERE ON THE
17 GEROPSYCH UNIT IN DECEMBER AND JANUARY OF '95 AND '96.
18 A. UH-HUH.
19 Q. IF I GIVE YOU THEIR NAMES, WILL YOU TELL US ONE BY ONE
20 WHEN YOU RECALL THESE PATIENTS?
21 A. YES, I WILL.
22 Q. ONE IS ENNIS ALLDREDGE?
23 A. NO, I DON'T.
24 Q. ANOTHER IS ELLEN ANDERSON?
25 A. I DO NOT.
1593
1 Q. MARY CRANE?
2 A. I REMEMBER HER. AFTER LOOKING OVER HER MEDICAL RECORDS,
3 I DO REMEMBER SOME OF THE SITUATIONS SHE WAS INVOLVED IN,
4 YES.
5 Q. WHAT IS IT ABOUT HER SITUATION THAT REMINDED YOU OF HER?
6 A. I REMEMBER DR. DIENHART COMING INTO SEE HER THAT SHE HAD
7 A RECTAL VAGINAL FISTULA. I REMEMBER THAT SITUATION.
8 Q. OKAY. AND WHAT ABOUT JUDITH LARSEN?
9 A. JUDITH LARSEN, I DON'T RECALL HER PARTICULAR
10 CIRCUMSTANCES, NO. BUT I DO --
11 Q. EXCUSE ME.
12 A. I DO -- I DO RECALL AND I LOOKED IN THE RECORDS AND SEEN
13 THAT I HAVE BEEN INVOLVED WITH HER CARE, YES.
14 Q. BUT YOU DON'T HAVE INDEPENDENT RECOLLECTION?
15 A. NO.
16 Q. WHAT ABOUT LYDIA SMITH?
17 A. LYDIA SMITH, I DON'T RECALL.
18 Q. YOU'VE LOOKED AT THE RECORDS, IS THAT WHAT YOU ARE
19 SAYING?
20 A. YES.
21 Q. DID YOU HAVE OCCASION TO SEE WHETHER YOU HAD
22 ADMINISTERED ANY OF THE MORPHINE IN THESE CASES?
23 A. I DID.
24 Q. DO YOU RECALL WHY YOU ADMINISTERED THAT MORPHINE?
25 A. I...
1594
1 MR. STIRBA: YOUR HONOR, I'M GOING TO OBJECT. I
2 BELIEVE HE SAID HE HAS NO RECOLLECTION INDEPENDENT. I GUESS
3 I FEEL LIKE --
4 THE COURT: COULD YOU REPHRASE THE QUESTION?
5 MR. STIRBA: -- IF YOU DIDN'T KNOW THE PATIENT...
6 MS. BARLOW: IF YOU WOULD OPEN JUDITH LARSEN'S TO I
7 THINK IT'S 507.
8 Q. (BY MS. BARLOW) DO YOU HAVE JUDITH LARSEN'S I'M SORRY.
9 I FORGET THAT YOU ARE A NEW WITNESS. A BINDER TO 507?
10 A. I DO. ARE THEY PAGED? ARE THEY NUMBERED.
11 Q. THERE'S A MED-NUMBER AT THE BOTTOM OF EACH PAGE.
12 A. OKAY. 507.
13 Q. YES, AND IT'S UNDER THE --
14 A. OKAY. OKAY.
15 Q. AND ON 507, DID YOU HAVE OCCASION -- THIS IS WITH JUDITH
16 LARSEN -- TO ADMINISTER ANY DOSES OF MORPHINE?
17 A. YES, I DID.
18 Q. DO YOU RECALL WHEN THEY WERE?
19 A. I CAN RECALL FROM THE RECORD HERE.
20 Q. FROM THE RECORD, CAN YOU TELL US WHEN THEY WERE?
21 A. THEY WERE 1700 HOURS ON THE 3RD AND 1830 ON THE 3RD AS
22 WELL.
23 Q. WITH JUDITH LARSEN, DO YOU RECALL HER STATE ON THE 3RD
24 OF JANUARY, HER PHYSICAL CONDITION, I SHOULD SAY?
25 A. NO.
1595
1 Q. DID YOU EVER WITH ANY OF THESE FIVE PATIENTS WITHHOLD
2 ANY MORPHINE?
3 A. NO, NOT THAT I RECALL. I THINK THE RECORD WOULD SHOW IF
4 I DID.
5 Q. DO YOU RECALL WHETHER THERE WAS ANY -- WERE YOU PRESENT
6 AT ANY MEETING WHERE THE DISCUSSION OF WITHHOLDING MORPHINE
7 TOOK PLACE?
8 A. NOT THAT I RECALL.
9 Q. DID YOU EVER -- WERE YOU EVER MADE AWARE OF IT?
10 A. THERE WAS A GENERAL FEELING --
11 MR. STIRBA: YOUR HONOR, YOUR HONOR, I'LL OBJECT,
12 IT'S HEARSAY.
13 THE COURT: SUSTAINED.
14 Q. (BY MS. BARLOW) DID YOU HAVE ANY INFORMATION ABOUT
15 WHETHER YOU COULD WITHHOLD OR NOT WITHHOLD MORPHINE IN THE
16 GEROPSYCH UNIT DURING THIS TIME PERIOD WITH THESE FIVE
17 PATIENTS?
18 MR. STIRBA: OBJECTION, VAGUE AND AMBIGUOUS,
19 INVITES HEARSAY.
20 THE COURT: REPHRASE IT.
21 MS. BARLOW: I'M NOT SURE I KNOW HOW TO.
22 THE COURT: OR REPEAT THE QUESTION.
23 MS. BARLOW: I'M NOT SURE I CAN REPEAT IT AT THIS
24 POINT. CAN IT BE READ BACK TO ME? I'M SORRY.
25 THE COURT: OKAY. THAT'S FINE. THIS IS THE TEST
1596
1 FOR THE COURT REPORTER.
2 MS. BARLOW: SHE THINKS SHE CAN JUST SIT THERE AND
3 BE QUIET.
4 (THE LAST QUESTION PUT TO THE WITNESS WAS READ BACK.)
5 THE COURT: THAT'S PERSONAL KNOWLEDGE OF I GUESS
6 WITH SUPERVISORS AS OPPOSED TO JUST HEARSAY ON FROM NURSES.
7 Q. (BY MS. BARLOW) WITH THAT, DID YOU HAVE ANY PERSONAL
8 KNOWLEDGE ABOUT WHETHER YOU COULD WITHHOLD MORPHINE WITH
9 THESE FIVE PATIENTS?
10 A. WELL, THERE WAS AN ORDER THAT WAS WRITTEN THAT IF WE
11 WERE TO HOLD ANY DOSES OF MORPHINE WE WERE TO CALL DR.
12 WEITZEL.
13 Q. AND WHO WROTE THAT ON THERE?
14 A. DR. WEITZEL.
15 MS. BARLOW: THAT'S ALL I HAVE, YOUR HONOR.
16 THE COURT: OKAY. ANY CROSS?
17 MR. STIRBA: YES.
18 CROSS-EXAMINATION
19 BY MR. STIRBA:
20 Q. THAT ORDER YOU ARE REFERRING TO, IS THAT SOMETHING
21 YOU'VE JUST SEEN RECENTLY TO REFRESH YOUR RECOLLECTION?
22 A. YES, YES.
23 Q. THAT'S SOMETHING THE STATE SHOWED YOU IN REVIEWING THE
24 RECORDS?
25 A. YES.
1597
1 Q. AND IT'S TRUE, IS IT NOT, THAT THAT IS AN ORDER IN THE
2 JUDITH LARSEN BINDER?
3 A. YES.
4 Q. IN OTHER WORDS, IT WAS AN ORDER THAT RELATED TO HER
5 CARE?
6 A. YES.
7 Q. AND IT HAD REALLY -- DIDN'T RELATE TO THE OTHER FOUR?
8 A. YES.
9 Q. PARDON ME?
10 A. YES.
11 Q. THAT'S RIGHT, IT RELATED TO JUDITH LARSEN AND NOT THE
12 OTHER FOUR BECAUSE IT WAS IN HER BINDER, IN HER CHART; IS
13 THAT RIGHT?
14 A. THAT'S CORRECT.
15 MR. STIRBA: THAT'S ALL I HAVE.
16 MS. BARLOW: I HAVE NOTHING FURTHER.
17 THE COURT: OKAY. MAY THIS WITNESS BE EXCUSED?
18 MS. BARLOW: YES, PLEASE.
19 THE COURT: YOU ARE THE WORLD'S SHORTEST WITNESS IN
20 THIS TRIAL. OKAY. WOULD YOU LIKE TO CALL YOUR NEXT
21 WITNESS?
22 MS. BARLOW: YOUR HONOR, GIVEN THE TIME AND OUR
23 NEXT WITNESS IS GOING TO BE BONNIE HARDEY AND SHE'S GOING TO
24 TAKE AN EXTENSIVE PERIOD OF TIME.
25 THE COURT: ALL RIGHT. LADIES AND GENTLEMEN, THIS
1598
1 IS AN APPROPRIATE TIME FOR US TO TAKE OUR LUNCH BREAK. WHAT
2 WE'LL DO IS I THINK WE'LL COME BACK -- LET'S JUST COME BACK
3 AT 1:30. YOU'LL HAVE AN EXTRA TEN MINUTES TODAY.
4 DURING THE TIME THAT YOU ARE TAKING THIS BREAK,
5 REMEMBER NOT TO LISTEN TO ANY RADIO, TELEVISION REPORTS,
6 ANYTHING IN NEWSPAPERS, MAGAZINES OR THE INTERNET AND
7 ANYTHING ON ANY SORT OF ELECTRONIC MEDIA. ALSO IT'S YOUR
8 DUTY, DON'T CONVERSE AMONG YOURSELVES ABOUT THIS CASE OR
9 TALK TO ANYBODY ABOUT THE CASE OR HAVE ANYONE ADDRESS YOU
10 ABOUT THIS CASE. IT'S ALSO YOUR DUTY NOT TO FORM OR EXPRESS
11 AN OPINION UNTIL THE CASE IS FINALLY SUBMITTED TO YOU, SO
12 PLEASE BE BACK HERE AT 1:30. THANK YOU.
13 (WHEREUPON THE JURY WAS EXCUSED.)
14 THE COURT: ALL RIGHT. YOU MAY BE SEATED THE
15 RECORD WILL REFLECT THAT THE JURY HAS LEFT THE COURTROOM.
16 HOW LONG DO YOU THINK THIS NEXT WITNESS WILL BE? BECAUSE,
17 AS I SAID, WE HAD THAT MOTION ON BEVERLY FULGER, IS THAT
18 SOMEBODY WE'RE GOING TO GET TO TODAY OR NOT GET TO TODAY?
19 MS. BARLOW: I SUSPECT WE PROBABLY WON'T. BONNIE
20 HARDEY WILL PROBABLY TAKE AS EARLENE COOPER DID.
21 THE COURT: OKAY. AND SHE TOOK SOME TIME FRIDAY
22 AND THEN MOST OF THE MORNING.
23 MS. BARLOW: RIGHT.
24 THE COURT: THEN MAYBE AT THE END OF THE DAY --
25 WILL SHE BE THE NEXT DAY?
1599
1 MS. BARLOW: SHE WOULD BE -- IF WE CALL HER, SHE
2 WOULD BE TOMORROW.
3 THE COURT: OKAY. ALL RIGHT. WELL, THEN, WE'LL
4 EITHER RESOLVE THAT -- YOU LET US KNOW AT THE END OF THE DAY
5 WHETHER SHE'LL BE CALLED OR WHETHER OR NOT YOU WANT TO
6 DISCUSS THAT MOTION. BUT IF YOU WANT TO GIVE ME -- IF YOU
7 GIVE TO ME, YOU KNOW, BEFORE THE AFTERNOON. IF YOU HAVE A
8 CASE THAT YOU WANT TO GIVE ME JUST TIME LINE IT.
9 IS THERE ANYTHING ELSE WE NEED IT DISCUSS RIGHT NOW
10 BEFORE WE COME BACK AT 1:30?
11 MR. STIRBA: I HAVE NOTHING, JUDGE.
12 MS. BARLOW: I HAVE NOTHING. BUT I WOULD LIKE TO
13 TALK TO COUNSEL AFTERWARDS. I THINK THERE'S SOME MATERIAL
14 THAT I WANT TO MAKE SURE THAT HE IS AWARE OF SO HE WON'T BE
15 UNFAIRLY SURPRISED.
16 THE COURT: OKAY. YOU CAN DISCUSS THAT. OKAY.
17 THEN WE'LL SEE YOU AT 1:30.
18 (WHEREUPON, THE MORNING SESSION ENDS.)
19
20
21
22
23
24
25
1600
1 (WHEREUPON, THE AFTERNOON SESSION BEGINS.)
2 THE COURT: OKAY. THE RECORD SHOULD REFLECT THAT
3 THE JURY IS NOT PRESENT. WAS THERE SOMETHING TO DISCUSS
4 BEFORE THE JURY COMES IN?
5 MR. STIRBA: YES, YOUR HONOR. BEFORE WE LEFT FOR
6 LUNCH COUNSEL, MS. BARLOW, ADVISED ME OF CERTAIN
7 CONVERSATIONS THAT MS. HARDEY, I GUESS, IS PREPARED TO
8 TESTIFY ABOUT, SOME OF WHICH WERE NOT PART OF ANY INTERVIEW
9 SUMMARY THAT I'VE PREVIOUSLY BEEN PROVIDED.
10 ONE PARTICULARLY CONCERNS ME IN TERMS OF ITS RELEVANCE.
11 APPARENTLY THERE WAS A CONVERSATION AT SOME POINT CONCERNING
12 MS. LARSEN'S CARE. AS I UNDERSTAND IT, MS. HARDEY IS
13 PREPARED TO TESTIFY THAT DR. WEITZEL SAID SOMETHING TO THE
14 EFFECT OF I NEED SIX PATIENTS TO MAKE IT WORTH MY WHILE, OR
15 SOMETHING LIKE THAT.
16 I JUST DON'T SEE -- EVEN IF THAT IS AN ADMISSION, I
17 DON'T SEE THE PROBATIVE VALUE OF THAT PARTICULAR COMMENT
18 GIVEN THE EVIDENCE THAT THE COURT HAS ALREADY HEARD IN THIS
19 CASE. I BELIEVE DR. JENSEN AND OTHERS HAVE TESTIFIED THAT
20 THE UNIT ITSELF WAS TYPICALLY FULL, OR REASONABLY FULL, AND
21 I JUST DON'T SEE THE PROBATIVE VALUE OF THAT. IT SEEMS TO
22 ME IT'S GOING TO CLOUD THE ISSUES BEFORE THE CASE.
23 SO THAT'S ONE THAT STANDS OUT IN MY MIND THAT I HAVE
24 SOME CONCERNS ABOUT IN TERMS OF ITS RELEVANCY. BUT IN ANY
25 EVENT I WANTED TO BRING THAT TO THE COURT'S ATTENTION.
1601
1 THERE WERE A COUPLE OF OTHER CONVERSATIONS, SOME OF WHICH
2 MAY BE REMOTELY RELEVANT, BUT THAT ONE PARTICULARLY
3 CONCERNED ME.
4 THE COURT: OKAY.
5 MS. BARLOW: I THINK IT GOES TO THE MOTIVE THAT WE
6 SPOKE ABOUT IN OPENING STATEMENT. PART OF THAT WAS, WE
7 THINK, FINANCIAL. SO I THINK IT DOES GO TO HIS MOTIVE IN
8 THE MATTER.
9 THE COURT: OKAY. WHAT IS THE ISSUE -- OKAY.
10 YOU'VE SAID EARLIER THAT YOU DON'T -- YOU HAVE NO OBLIGATION
11 TO PROVE MOTIVE?
12 MS. BARLOW: NO, BUT IT IS HELPFUL FOR A JURY, I
13 THINK, TO GET A SENSE OF WHY A PERSON DOES WHAT THEY DO.
14 THE COURT: OKAY. HAS THE TESTIMONY -- MY MEMORY
15 IS THAT THE TESTIMONY HAS BEEN THAT THEY'RE USUALLY -- THE
16 TEN BEDS THAT WERE THERE WERE MOSTLY FULL, OR EIGHT WERE
17 FILLED. NOW, IS THAT DIFFERENT? IF WE HAVE THIS, ARE WE
18 GOING TO HAVE OTHER WITNESSES THAT WILL COME IN AND SAY NO,
19 THERE WERE ALWAYS EIGHT OR MORE?
20 MS. BARLOW: NO.
21 THE COURT: I'M GOING TO THINK THIS OVER. I
22 WOULDN'T HAVE THAT BE YOUR FIRST QUESTION.
23 MS. BARLOW: IT WON'T, YOUR HONOR.
24 THE COURT: ANYTHING ELSE TO DISCUSS BEFORE THE
25 JURY COMES IN?
1602
1 MS. BARLOW: I WOULD LIKE TO PRESENT TO THE COURT A
2 CASE. I DON'T THINK THAT THIS ISSUE IS GOING TO COME UP
3 AGAIN. WITH MS. COOPER THE COUNTY ATTORNEY WAS WILLING TO
4 GIVE HER A GRANT OF IMMUNITY SO WE DIDN'T HAVE TO ARGUE THE
5 MATTER OF WHETHER SHE SHOULD BE COMPELLED TO TESTIFY IN
6 FRONT OF THE JURY ABOUT ANY FIFTH AMENDMENT RIGHT SHE MIGHT
7 BE ASSERTING.
8 BUT THIS CASE, WHICH IS STATE VERSUS WHITE, 671 PACIFIC
9 SECOND 191, A 1983 UTAH SUPREME COURT CASE, ON THE SECOND
10 PAGE, AND THIS IS NOT, OF COURSE, THE PACIFIC REPORTER. IT
11 CAME OFF OF UTAH LAW AND DISK, I THINK.
12 THE COURT: WHICH PARAGRAPH?
13 MS. BARLOW: THE SECOND TO THE LAST. THE LAST FULL
14 PARAGRAPH THAT SAYS "THERE'S NO MERIT TO THE APPELLANT'S
15 CONTENTION THAT DEFENSE COUNSEL COULD NOT CALL LATHAM TO
16 TESTIFY BECAUSE SHE KNEW LATHAM WOULD INVOKE HIS FIFTH
17 AMENDMENT PRIVILEGE. A LAWYER CONDUCTS HIMSELF
18 UNPROFESSIONALLY WHEN, FOR THE PURPOSE OF IMPRESSING UPON
19 THE JURY THE FACT OF A CLAIM OF PRIVILEGE, HE CALLS A
20 WITNESS TO TESTIFY WHEN HE KNOWS THE WITNESS WILL CLAIM A
21 VALID PRIVILEGE NOT TO TESTIFY." HE DID NOT CALL HER.
22 MR. STIRBA DID NOT CALL MS. COOPER, WE DID. BUT I
23 SUBMIT THAT THEN ASKING QUESTIONS THAT ARE GOING TO ELICIT A
24 FIFTH AMENDMENT RIGHT AGAINST SELF-INCRIMINATION WOULD BE
25 UNPROFESSIONAL, WOULD BE UNETHICAL. AGAIN, I DON'T THINK
1603
1 THAT THIS MATTER WILL COME UP AGAIN, BUT I JUST WANTED THE
2 COURT TO HAVE THE BENEFIT OF THIS CASE IN CASE IT DID.
3 THE COURT: OKAY. I HAD REVIEWED THAT CASE DURING
4 THE BREAK, SO I WAS AWARE OF IT. I GUESS, UNLESS -- THERE'S
5 NOT A REASON TO ARGUE THAT CASE RIGHT NOW, BUT IF IT COMES
6 UP AGAIN I APPRECIATE IT.
7 ANYTHING ELSE TO DISCUSS?
8 MR. STIRBA: IF I MIGHT, IF I UNDERSTOOD WHAT
9 COUNSEL JUST SAID, THAT MS. COZZEN WAS GIVEN A GRANT OF
10 IMMUNITY BY THE COUNTY ATTORNEY'S OFFICE WHICH ALLOWED HER,
11 PRESUMABLY, TO TESTIFY WITHOUT WAIVING ANY FIFTH AMENDMENT
12 PRIVILEGE, THAT ALL MAY BE FINE, BUT COULD I HAVE SOME
13 INDICATION THAT THAT IN FACT OCCURRED? I MEAN, IF THERE'S
14 SOME FORMAL WAY THAT THIS HAS BEEN DONE I THINK THE DEFENSE
15 IS ENTITLED TO HAVE THAT DOCUMENT. SHE WAS NOT EXCUSED AS A
16 WITNESS. I THINK I'M ENTITLED TO HAVE THAT.
17 MS. BARLOW: I SHOULD SAY HE OFFERED. THERE IS NO
18 FORMAL -- FRANKLY, AFTER SHE ACTUALLY TESTIFIED, I DON'T
19 THINK THAT SHE NEEDS ANY IMMUNITY BECAUSE HER TESTIMONY WAS
20 THAT -- I DON'T THINK WAS INCRIMINATING. BUT IT WAS AN
21 OFFER, EXCUSE ME. IT WAS AN OFFER OF IMMUNITY. THERE IS NO
22 FORMAL GRANT OF IMMUNITY. AND AS I SAY, AFTER SHE TESTIFIED
23 I DON'T THINK THERE'S ANY NEED FOR IMMUNITY.
24 THE COURT: OKAY. IS THERE ANYTHING FURTHER WE
25 NEED TO DISCUSS?
1604
1 MR. STIRBA: NO, YOUR HONOR.
2 THE COURT: OKAY. WHY DON'T YOU CALL THE JURY IN.
3 LET'S HAVE OUR NEXT WITNESS READY.
4 MS. BARLOW: YES. BEFORE THE JURY COMES IN CAN I
5 MAKE SURE. SHE WAS GOING TO BE BACK AT 20 AFTER.
6 (PAUSE IN THE PROCEEDINGS.)
7 MS. BARLOW: SHE IS HERE, YOUR HONOR.
8 THE COURT: OKAY.
9 (JURY RETURNED TO THE COURTROOM.)
10 THE COURT: THE RECORD WILL REFLECT THAT THE
11 ATTORNEYS FOR THE PARTIES ARE PRESENT. THE DEFENDANT IS
12 HERE AND THE JURY HAS RETURNED.
13 WOULD YOU LIKE TO CALL YOUR NEXT WITNESS?
14 MS. BARLOW: YES. THE STATE CALLS BONNIE HARDEY.
15 THE COURT: PLEASE COME FORWARD AND BE SWORN.
16 BONITA HARDEY,
17 CALLED AS A WITNESS, BEING FIRST DULY SWORN TO TELL THE
18 TRUTH, WAS EXAMINED AND TESTIFIED AS FOLLOWS:
19 DIRECT EXAMINATION
20 BY MS. BARLOW:
21 Q. GOOD AFTERNOON. WOULD YOU PLEASE STATE YOUR NAME AND
22 SPELL IT FOR THE RECORD.
23 A. BONITA, B-O-N-I-T-A; HARDEY, H-A-R-D-E-Y.
24 Q. AND WHAT IS YOUR OCCUPATION, MS. HARDEY?
25 A. A REGISTERED NURSE.
1605
1 Q. HOW LONG HAVE YOU BEEN A REGISTERED NURSE?
2 A. SINCE 1993.
3 Q. AND DID YOU HAVE ANY MEDICAL TRAINING PRIOR TO THAT?
4 A. YES. I WAS AN L.P.N. SINCE 1980.
5 Q. WHAT TRAINING DID YOU HAVE TO RECEIVE TO GET YOUR R.N.?
6 A. UMM, I GRADUATED FROM WEBER STATE UNIVERSITY. PRIOR TO
7 THAT I WAS AN L.P.N. I GOT MY TRAINING THROUGH THE UNITED
8 STATES AIR FORCE.
9 Q. DO YOU HAVE A BACHELOR'S DEGREE?
10 A. NO. I HAVE AN ASSOCIATES.
11 Q. THANK YOU. YOUR TRAINING THROUGH THE AIR FORCE, WAS
12 THAT PRIOR TO 1980, THEN?
13 A. IT WAS 1980 UP UNTIL 1987 WHEN I GOT OUT.
14 Q. OKAY. WHAT EXPERIENCE HAVE YOU HAD IN THE MEDICAL FIELD
15 SINCE, SAY, YOU GOT YOUR R.N.?
16 A. SINCE THE R.N. I'VE WORKED AT ST. BENEDICT'S HOSPITAL IN
17 THE FLOAT POOL. I WAS THE DIRECTOR OF NURSING OVER AT A
18 GERIATRIC NURSING HOME IN BOUNTIFUL. THEN I WENT TO DAVIS
19 HOSPITAL AND WORKED ON THE GERO-PSYCH UNIT. AND CURRENTLY
20 I'M WORKING AT MCKAY-DEE ON THE SURGICAL FLOOR.
21 Q. LET'S GO BACK TO WAS IT ST. BENEDICT'S?
22 A. YES.
23 Q. WHAT YEAR WAS THAT?
24 A. 1993.
25 Q. AND YOU WERE IN THE FLOAT POOL?
1606
1 A. YES.
2 Q. AND WHAT DID THAT ENTAIL?
3 A. VARIOUS UNITS. YOU GO AND FLOAT LIKE I.C.U., MED
4 SEARCH, PSYCH. ANYPLACE THAT THEY NEEDED YOU.
5 Q. DO YOU RECALL HOW MUCH YOU WORKED ON THE PSYCH UNIT AT
6 ST. BENEDICT'S?
7 A. PROBABLY THREE MONTHS TOTAL AT THAT TIME.
8 Q. AND AFTER THAT YOU WENT WHERE?
9 A. I WENT TO ROCKY MOUNTAIN NURSING HOME. I WAS DIRECTOR
10 OF NURSING THERE.
11 Q. AND WHERE IS THAT?
12 A. IN BOUNTIFUL.
13 Q. AS DIRECTOR OF NURSING WHAT WERE YOUR RESPONSIBILITIES?
14 A. THE CARE OF GERIATRIC PATIENTS, THE STAFF. BASICALLY
15 RUNNING THE NURSING HOME.
16 Q. HOW LONG WERE YOU THERE AS DIRECTOR OF NURSING?
17 A. APPROXIMATELY A YEAR.
18 Q. AND THEN WHERE DID YOU GO?
19 A. I WENT TO THE GERO-PSYCH UNIT AT DAVIS.
20 Q. AND WHEN WAS THAT?
21 A. DECEMBER OF '94.
22 Q. DO YOU RECALL WHO WAS DIRECTOR OF NURSING OVER THE PSYCH
23 UNIT AT DAVIS NORTH?
24 A. WHEN I FIRST ARRIVED IT WAS SHEILA MOORE.
25 Q. AND DID IT CHANGE?
1607
1 A. SEVERAL TIMES, YES. FROM SHEILA MOORE IT WENT TO SHEILA
2 HANSEN AND THEN SHANNON. I DON'T RECALL HER LAST NAME. SHE
3 WAS THE LAST DIRECTOR BEFORE I LEFT.
4 Q. IN THE PSYCH UNIT?
5 A. YES.
6 Q. WAS THERE A DIRECTOR OF NURSING ABOVE THE PSYCH UNIT?
7 A. YES. THAT WOULD BE KAREN CHAPMAN.
8 Q. WHEN YOU REPORTED, THEN, TO THE NURSING, IS THAT THE
9 ROUTE YOU WOULD GO?
10 A. I WOULD GO THROUGH THE IMMEDIATE SUPERVISOR, WHICH WOULD
11 BE SHEILA HANSEN OR SHEILA MOORE. THEN THEY WOULD REPORT TO
12 KAREN CHAPMAN. OR SOMETIMES, IF WE WERE INCLINED, WE WOULD
13 GO TO KAREN OURSELF IF SHE WAS AVAILABLE.
14 Q. DID YOU LEAVE THE GERO-PSYCH UNIT?
15 A. YES.
16 Q. AND WHEN WAS THAT?
17 A. OCTOBER OF '96.
18 Q. WHY DID YOU --
19 MR. STIRBA: OBJECTION. I'M SORRY. I DIDN'T MEAN
20 TO INTERRUPT.
21 THE COURT: GO AHEAD. ASK YOUR QUESTION.
22 Q. (BY MS. BARLOW) WHY DID YOU GO TO THE GERO-PSYCH UNIT?
23 WHAT CAUSED YOU TO APPLY THERE?
24 A. THE CONDITIONS ON THE GERO-PSYCH UNIT --
25 Q. NOT LEAVING. WHY DID YOU GO TO THE PSYCH UNIT?
1608
1 A. OH, GO TO THE PSYCH UNIT?
2 Q. YES.
3 A. WHILE I WAS DIRECTOR OF NURSING I RECEIVED A BROCHURE
4 INVITING ALL OF THE DIRECTORS TO COME VIEW THE NEW UNIT. AS
5 A DIRECTOR OF NURSING I KNEW THAT THERE WAS A NEED OUT THERE
6 FOR THE GERO-PSYCH PATIENT. THERE WASN'T REALLY A CURRENT
7 PROGRAM IN THE AREA. I HAD EXPERIENCED THAT THE GERIATRIC
8 PATIENT DID HAVE PSYCHOLOGICAL PROBLEMS THAT WEREN'T ABLE TO
9 BE HANDLED PROPERLY IN THE NURSING ENVIRONMENT, SO I WAS
10 PRETTY MATTER EXCITED ABOUT OBTAINING THE EXPERIENCE AND
11 GOING THERE AND HELPING THESE PEOPLE.
12 Q. WHAT SHIFTS DID YOU WORK AT THE GERO-PSYCH UNIT?
13 A. DAY SHIFT OR THREE TO 11.
14 Q. SO DAY WAS SEVEN TO THREE?
15 A. SEVEN TO THREE OR THREE TO 11.
16 Q. HOW MANY DAYS A WEEK DID YOU WORK?
17 A. I WAS -- I STARTED OFF PART TIME FOR A COUPLE OF MONTHS
18 AND THEN EVOLVED TO FULL TIME, 40 HOURS.
19 Q. WHEN DID YOU BECOME FULL TIME?
20 A. UMM, PROBABLY THE SUMMER OF '95.
21 Q. WAS THERE ANY TRAINING, ON-THE-JOB TRAINING, AT THE
22 GERO-PSYCH UNIT?
23 A. YES. THEY HAD DIFFERENT IN-SERVICES. WE HAD A LOT OF
24 LITERATURE AVAILABLE. PRIOR TO THAT, AT ROCKY MOUNTAIN
25 CARE, I TOOK ADVANTAGE OF A LOT OF THE IN-SERVICE GIVEN BY
1609
1 SPECIALTY PEOPLE IN THE GERIATRIC AREA.
2 Q. IF I GO THROUGH THE NAMES OF THE FIVE PATIENTS THAT ARE
3 INVOLVED IN THIS CASE, CAN YOU TELL ME IF YOU REMEMBER THESE
4 PATIENTS BY NAME, EACH ONE?
5 A. YES.
6 Q. ELLEN ANDERSON?
7 A. YES.
8 Q. JUDITH LARSEN?
9 A. YES.
10 Q. MARY CRANE?
11 A. YES.
12 Q. LYDIA SMITH?
13 A. YES.
14 Q. AND ENNIS ALLDREDGE?
15 A. YES.
16 Q. LET'S TALK FIRST ABOUT MRS. ANDERSON. WERE YOU PRESENT
17 WHEN MRS. ANDERSON WAS ADMITTED TO THE UNIT?
18 A. I WAS PRESENT AT THE END OF THE SHIFT. I WAS ON THREE
19 SHIFTS AFTER HER ADMISSION. SO THERE WERE TWO PRIOR R.N.'S.
20 ONE WHO ADMITTED HER; ONE WHO CARED FOR HER THROUGH THE
21 NIGHT; AND THEN I CAME ON.
22 Q. IF YOU WOULD OPEN UP MRS. ANDERSON'S BINDER THERE.
23 A. (WITNESS COMPLIED.)
24 Q. IF YOU WOULD OPEN TO MED-PAGE 178.
25 A. MEDICAL LEGAL?
1610
1 Q. NO. I'M SORRY. UNDER THE NURSE'S NOTES.
2 A. AND WHAT WERE YOU WANTING?
3 Q. 178, THE VERY FIRST PAGE.
4 A. OKAY.
5 Q. CAN YOU TELL FROM THAT DOCUMENT WHO WAS THE FIRST NURSE?
6 A. LAURIE. WILLIAMS WAS HER LAST NAME.
7 Q. IF YOU WOULD TURN OVER TO MED NUMBER 190.
8 A. OKAY.
9 Q. WHEN YOU CAME ONTO THE UNIT, YOU SAY THREE SHIFTS LATER,
10 DID YOU HAVE OCCASION TO GO BACK AND LOOK AT ANY OF THESE
11 PREVIOUS NURSING NOTES?
12 A. IT DEPENDED ON THE TIME OF DAY WHEN YOU ACTUALLY GOT ON
13 SHIFT WHAT TIME YOU WOULD SIT DOWN AND BE ABLE TO PERUSE
14 BACK OVER THE OTHER NOTES. USUALLY YOU RELIED UPON THE
15 NURSE BEFORE YOU TO GIVE YOU A SHIFT REPORT AND SUMMARIZE
16 WHAT HAD GONE ON AND THEN GO FROM THERE.
17 Q. OKAY. DO YOU RECALL EVER GOING BACK AND LOOKING AT 190,
18 WHICH WAS WHAT LAURIE WILLSON HAD WRITTEN?
19 A. I RECALL READING IT, BUT THE TIME FRAME I WOULDN'T BE
20 ABLE TO TELL YOU EXACTLY.
21 Q. THEN THE NEXT PAGE, 191, IT APPEARS TO BE HANDWRITING.
22 IN FACT, I THINK TRACY SCHOLL HAS IDENTIFIED IT AS HER
23 HANDWRITING. THAT IS WHO WAS ON JUST BEFORE YOU?
24 A. YES, IT WAS.
25 Q. DO YOU REMEMBER TALKING TO TRACY ABOUT ELLEN ANDERSON'S
1611
1 CONDITION WHEN YOU CAME ON?
2 A. YES, I DO.
3 Q. DO YOU RECALL WHAT SHE TOLD YOU?
4 MR. STIRBA: I'LL OBJECT. HEARSAY, YOUR HONOR.
5 THE COURT: SUSTAINED.
6 Q. (BY MS. BARLOW) IS WHAT SHE TOLD YOU CONSISTENT --
7 DON'T TELL US WHAT IT IS, BUT CONSISTENT WITH WHAT YOU READ
8 IN 191 ABOUT ELLEN'S CONDITION?
9 A. THAT AND A LITTLE MORE.
10 Q. AND THEN THERE'S SOME HANDWRITING THAT WE GET INTO THAT
11 APPEARS TO BE YOURS, IS THAT CORRECT?
12 A. IT IS.
13 Q. SO ON 191, DOWN AT THE BOTTOM HERE, WHICH IS 0730, SO
14 WHAT SHIFT WERE YOU ON?
15 A. THAT WAS DAY SHIFT THAT DAY.
16 Q. WHAT DID YOU WRITE THEN ABOUT ELLEN'S CONDITION THAT
17 MORNING AT 7:30?
18 A. I'LL READ FROM THE TEXT HERE. "PATIENT RESTING IN BED.
19 VITAL SIGNS 97.9." THAT WOULD BE THE TEMPERATURE.
20 RESPIRATION IS 12. 60, UNABLE TO GET BP.
21 Q. WHAT IS BP?
22 A. BLOOD PRESSURE.
23 Q. OKAY.
24 A. "PATIENT NOT RESPONSIVE TO VERBAL OR TACTILE TOUCH.
25 PATIENT ABLE TO BLINK EYES. FAMILY NOTIFIED IN BRIGHAM CITY
1612
1 OF PATIENT," AND THE ARROW DECLINED. "GOT ANSWERING MACHINE
2 AND LEFT MESSAGE TO CONTACT DAVIS HOSPITAL."
3 Q. OKAY. THEN WE GET INTO THE NEXT PAGE. LET ME PUT THAT
4 HERE WHERE IT CAN BE SEEN. IT'S A CONTINUATION OF WHAT
5 YOU'VE WRITTEN THERE?
6 A. CORRECT.
7 Q. AND WHAT DID YOU WRITE?
8 A. AT 0855 PATIENT WITHOUT RESPIRATIONS. NO HEART RATE
9 TIMES FIVE MINUTES. DR. WEITZEL NOTIFIED. NURSING
10 SUPERVISOR NOTIFIED. AWAITING RETURN CALL FROM ONLY
11 RELATIVE LISTED IN THE CHART WITH PHONE NUMBER.
12 Q. OKAY. LET'S STOP THERE. DO YOU RECALL MS. ANDERSON AND
13 THIS CIRCUMSTANCE THAT YOU'VE CHARTED HERE?
14 A. YES.
15 Q. WHAT DID YOU FIND WITH MS. ANDERSON WHEN YOU ARRIVED?
16 A. UMM, A PATIENT WHO WASN'T VERY RESPONSIVE.
17 Q. OKAY. THE RESPIRATIONS WERE 12, YOU INDICATED?
18 A. YES.
19 Q. BASED ON YOUR EXPERIENCE AND TRAINING AS A NURSE, WHERE
20 DOES THAT FALL IN THE RANGE OF NORMAL, ABNORMAL, THAT SORT
21 OF THING?
22 A. 16 WOULD BE A NORMAL RANGE THAT WE'RE SHOOTING FOR. 12
23 IS JUST WHERE IT STARTS TO GO A LITTLE TOWARDS THE LOW END,
24 WHERE WE DON'T LIKE IT TO GO.
25 Q. OKAY. AND WHAT ARE YOUR CONCERNS AS A NURSE WHEN YOU
1613
1 SEE A 12 BREATHS PER MINUTE?
2 A. THAT PERHAPS SHE'S NOT GETTING ENOUGH OXYGEN.
3 Q. DID YOU KNOW WHAT MEDICATIONS, IF ANY, SHE'D BEEN GIVEN
4 WITHIN THE PREVIOUS EIGHT HOURS?
5 A. TRACY DID TELL ME THAT SHE WAS GIVEN MORPHINE.
6 Q. AND BASED ON YOUR TRAINING AND EXPERIENCE AS A NURSE, DO
7 YOU KNOW, YES OR NO, WHAT MORPHINE DOES TO THE RESPIRATION?
8 A. YES, I DO.
9 Q. AND WHAT DOES IT DO TO THE RESPIRATION SYSTEM?
10 MR. STIRBA: YOUR HONOR, HER UNDERSTANDING IS
11 BEYOND THE SCOPE.
12 MS. BARLOW: BASED ON HER --
13 THE COURT: YOU CAN ASK HER UNDERSTANDING. YOU
14 RAISED THE QUESTION OF WHAT DOES IT DO. YOU CAN ASK HER
15 UNDERSTANDING.
16 Q. (BY MS. BARLOW) WHAT IS YOUR UNDERSTANDING, BASED ON
17 YOUR TRAINING AND EXPERIENCE, OF WHAT MORPHINE DOES TO THE
18 RESPIRATORY SYSTEM?
19 A. ONE OF THE FIRST THINGS WE'RE POINTED OUT IN NURSING
20 SCHOOL IS IF RESPIRATION GOES LOW YOU NEED TO BE CONCERNED
21 BECAUSE MORPHINE DOES SEDATE THEM AND THAT'S THE FIRST SIGN
22 OF RESPIRATORY FAILURE.
23 Q. OKAY. YOU NOTIFIED THE FAMILY. WHY DID YOU DO THAT?
24 A. BECAUSE I FELT AS THOUGH HER CONDITION, BASED ON -- FOR
25 HER TO COME TO THE UNIT SHE HAD TO BE FAIRLY HEALTHY.
1614
1 MR. STIRBA: I'LL OBJECT AND MOVE TO STRIKE THAT
2 LAST AS NOT RESPONSIVE. THE QUESTION IS WHY DID YOU NOTIFY
3 THE FAMILY.
4 MS. BARLOW: I WILL GET INTO THE REST OF IT.
5 THE WITNESS: I FELT THERE WAS A DECLINE IN THE
6 PATIENT'S CONDITION.
7 Q. (BY MS. BARLOW) LET'S BACK UP. WERE YOU FAMILIAR WITH
8 THE CRITERIA FOR PEOPLE TO COME ON THE UNIT?
9 A. YES, I WAS.
10 Q. AND HOW WERE YOU FAMILIAR WITH THAT?
11 A. USUALLY THROUGH GROUP MEETINGS, DISCUSSIONS, SOCIAL
12 WORKER INTAKE, INFORMATION THEY WOULD TRY TO GATHER FROM US
13 AND WE WOULD QUESTION THEM. THE SOCIAL WORKER WAS USUALLY
14 THE PERSON WHO WENT TO THE NURSING HOME AND OBTAINED THE
15 INFORMATION AND COORDINATED THROUGH THE DOCTOR ABOUT
16 ADMISSION.
17 Q. AND BASED ON YOUR -- ON ALL THE INFORMATION THAT CAME TO
18 YOU ABOUT CRITERIA FOR ADMISSION ON THE UNIT, WHAT WAS THE
19 CRITERIA AS FAR AS PHYSICAL CONDITION?
20 MR. STIRBA: I'LL OBJECT. THE BEST EVIDENCE OF
21 THAT IS THE POLICY THAT'S IN EVIDENCE. IF SHE WANTS TO ASK
22 AN UNDERSTANDING, FINE, BUT THE BEST EVIDENCE IS IN
23 EVIDENCE.
24 Q. (BY MS. BARLOW) WHAT IS YOUR UNDERSTANDING OF WHAT THE
25 CRITERIA WAS FOR A PHYSICAL CONDITION TO COME ONTO THE UNIT?
1615
1 A. THEIR PSYCHO-SOCIAL NEEDS HAD TO BE GREATER THAN THEIR
2 MEDICAL NEEDS.
3 Q. WHEN YOU SAW MRS. ANDERSON AT 7:30 ON THE 30TH OF
4 DECEMBER DID SHE FIT THAT CRITERIA?
5 MR. STIRBA: OBJECTION. IRRELEVANT, YOUR HONOR.
6 THE COURT: SUSTAINED.
7 Q. (BY MS. BARLOW) HOW DID HER PSYCHO-SOCIAL NEEDS
8 COMPARE WITH HER PHYSICAL CONDITION AT THAT TIME?
9 MR. STIRBA: I'LL OBJECT. LACK OF FOUNDATION.
10 THE COURT: LAY A FOUNDATION.
11 Q. (BY MS. BARLOW) WHAT DID YOU SEE OF HER PHYSICAL NEEDS
12 AT 7:30 ON THE MORNING OF THE 30TH?
13 A. HER VITAL SIGNS, WHICH ARE THE FOREMOST THING TO LOOK AT
14 AS A NURSE, WERE DECLINING.
15 Q. WHAT DID YOU SEE OF HER PSYCHO-SOCIAL NEEDS AT THAT
16 POINT?
17 A. THEY TOOK SECOND PLACE TO HER MEDICAL NEEDS.
18 Q. WERE YOU ABLE TO COMMUNICATE WITH HER?
19 A. NO.
20 Q. IN ORDER TO MEET HER PSYCHO-SOCIAL NEEDS, WHAT DID YOU
21 NEED OUT OF HER AS FAR AS RESPONSIVENESS?
22 MR. STIRBA: I'M GOING TO OBJECT. IRRELEVANT.
23 THE COURT: WHAT DO YOU CLAIM THE RELEVANCY IS?
24 MS. BARLOW: I THINK IT LAYS THE FOUNDATION FOR THE
25 QUESTION I ASKED EARLIER ABOUT WHETHER SHE MET THE CRITERIA.
1616
1 THE COURT: SUSTAINED.
2 Q. (BY MS. BARLOW) AT 8:55 YOU MADE THIS NOTATION. WOULD
3 YOU READ THAT, PLEASE.
4 A. 8:55. "PATIENT WITHOUT RESPIRATIONS. NO HEART RATE
5 TIMES FIVE MINUTES. DR. WEITZEL NOTIFIED. NURSING
6 SUPERVISOR NOTIFIED. AWAITING RETURN CALL FROM ONLY
7 RELATIVE LISTED IN CHART WITH PHONE NUMBER."
8 Q. NO RESPIRATIONS, NO HEART RATE FOR FIVE MINUTES. WHAT
9 DID THAT MEAN?
10 A. TO MY INTERPRETATION, DEATH.
11 Q. DEATH?
12 A. DEATH.
13 Q. I'M SORRY. SOMETIMES I GET OVER BY THIS MACHINE AND I
14 CAN'T HEAR VERY WELL.
15 A YES OR NO QUESTION. DID YOU EVER TALK TO DR. WEITZEL
16 ABOUT WHAT HAD HAPPENED TO ELLEN ANDERSON?
17 A. NO.
18 Q. THANK YOU. NOW LET'S LOOK AT JUDITH LARSEN. IF YOU
19 WOULD PULL HER BINDER OUT.
20 A. (WITNESS COMPLIED.)
21 Q. DO YOU RECALL JUDITH LARSEN?
22 A. YES, I DO.
23 Q. AND WHY IS IT THAT YOU RECALL HER?
24 A. SHE WAS THERE A PRETTY LONG TIME.
25 Q. DID YOU HAVE AN UNDERSTANDING OF WHAT WAS THE INTENDED
1617
1 LENGTH OF STAY OF ANY OF THESE FIVE PEOPLE IN THE UNIT, YES
2 OR NO?
3 A. YES.
4 Q. AND WHAT WAS YOUR UNDERSTANDING BASED ON?
5 A. USUALLY, AFTER THE DOCTOR'S INITIAL EVALUATION, IT WOULD
6 BE CONVEYED TO US THROUGH THE NURSING STAFF WHAT THE LENGTH
7 OF TIME WAS. WE COULD READ HIS EVALUATION AND SEE WHAT HE
8 ANTICIPATED THE LENGTH OF TIME TO BE.
9 Q. AND IS THAT EVALUATION THE ONE THAT'S LISTED UNDER PSYCH
10 EVALUATION, 444 AND 445?
11 A. YES.
12 Q. AND LET'S PULL OUT 446. WHO WROTE THIS EVALUATION?
13 A. I ASSUME DR. WEITZEL.
14 Q. DOES IT HAVE HIS NAME AT THE TOP?
15 A. AT THE END OF IT AND AT THE TOP.
16 Q. AND WHAT WAS THE ESTIMATED LENGTH OF HOSPITALIZATION?
17 A. HE GAVE NO TYPE OF THING, BUT JUST BACK TO HOLLADAY.
18 Q. LET'S LOOK AT 446.
19 A. OH, TWO WEEKS. I'M SORRY.
20 Q. AND THERE WAS A DISCHARGE PLAN?
21 A. CORRECT.
22 Q. AND WHAT IS A DISCHARGE PLAN?
23 A. WHAT THE INTENTIONS ARE ONCE THE PATIENT IS DISMISSED
24 FROM THE HOSPITAL.
25 Q. IF YOU WOULD TURN TO PAGE 451.
1618
1 A. (WITNESS COMPLIED.)
2 Q. THIS IS, AGAIN, REGARDING JUDITH LARSEN. WHAT DATE WAS
3 THAT?
4 A. 12/6/95.
5 Q. IS THAT THE DATE THAT MRS. LARSEN CAME IN?
6 A. THAT WOULD BE.
7 Q. THERE'S A V.O. HERE. WHAT DOES THAT MEAN?
8 A. VERBAL ORDER.
9 Q. DR. WEITZEL TO LYNN LONG?
10 A. YES.
11 Q. DO YOU KNOW WHO LYNN LONG IS?
12 A. YES, I DO.
13 Q. WHO IS SHE?
14 A. SHE WAS ANOTHER REGISTERED NURSE ON THE GERO-PSYCH UNIT
15 AT THAT TIME.
16 Q. THERE ARE SEVERAL MEDICATIONS LISTED FURTHER DOWN HERE.
17 LET'S LOOK RIGHT HERE UNDER MEDS. IT SAYS TYLENOL AND THEN
18 IT HAS TWO FUNNY SYMBOLS. IT LOOKS LIKE A T WITH A DOT OVER
19 IT AND THEN TWO T'S WITH TWO DOTS OVER IT. DO YOU SEE WHERE
20 I'M LOOKING AT, ABOUT A THIRD OF THE WAY DOWN UNDER VS:BID?
21 A. OH, UP HERE. TYLENOL, ONE OR TWO TABS.
22 Q. IS THAT WHAT THOSE SYMBOLS MEAN?
23 A. YES.
24 Q. ONE OR TWO TABS. WHAT IS P.R.N.?
25 A. AS NEEDED, AS NECESSARY.
1619
1 Q. AND THEN WE HAVE MYLANTA FOR DYSPEPSIA. WHAT IS
2 DYSPEPSIA?
3 A. STOMACH UPSET.
4 Q. WHAT IS M.O.M.?
5 A. MILK OF MAGNESIA.
6 Q. I GUESS THAT'S FOR P.R.N., IF THEY HAVE -- I MEAN, IF A
7 PERSON HAD CONSTIPATION YOU COULDN'T JUST GIVE THEM MILK OF
8 MAGNESIA?
9 A. WE COULD.
10 Q. WITHOUT AN ORDER?
11 A. WITHOUT AN ORDER, NO. WE HAD TO HAVE A P.R.N. ORDER.
12 Q. OKAY. AND YOU HAVE SPECIAL PRECAUTIONS, EVERY 15 MINUTE
13 CHECK. DO YOU KNOW WHAT THAT IS?
14 A. YES. USUALLY ON A PSYCH UNIT YOU'LL HAVE, FOR THE FIRST
15 24 HOURS, A SUICIDAL TYPE WATCH, WHERE YOU WATCH THEM EVERY
16 15 MINUTES FOR THE FIRST 24, BECAUSE IT'S A CRUCIAL TIME
17 PERIOD.
18 Q. DO YOU KNOW WHAT BETAGAN IS, YES OR NO?
19 A. YES.
20 Q. WHAT IS IT?
21 A. EYE DROPS FOR GLAUCOMA.
22 Q. WHAT ABOUT SURFAK?
23 A. IT'S A STOOL SOFTENER.
24 Q. AND THEN KLONOPIN, DO YOU KNOW WHAT THAT IS?
25 A. KLONOPIN CAN BE USED IN TWO WAYS. AS AN ANTI-CONVULSIVE
1620
1 AND ALSO THEY USE IT FOR PSYCHOSIS SOMETIMES.
2 Q. AND THEN TRAZODONE, DO YOU KNOW WHAT THAT IS?
3 A. TRAZODONE CAN BE USED -- FOR THE GERIATRIC POPULATION
4 THEY USE IT A LOT OF TIMES FOR A SLEEPER AND ALSO AN
5 ANTIDEPRESSANT.
6 Q. WHAT ABOUT SYNTHROID, DO YOU KNOW WHAT THAT IS?
7 A. A THYROID MEDICATION.
8 Q. AND THEN BABY A.S.A.?
9 A. BABY ASPIRIN IS USUALLY USED AS A PROPHYLACTIC TO
10 PREVENT CARDIOVASCULAR -- KEEP THE BLOOD A LITTLE THIN FOR
11 HEART PROBLEMS, THINGS LIKE THAT.
12 Q. ISOSORBIDE?
13 A. THAT WOULD BE USED FOR HIGH BLOOD PRESSURE.
14 Q. AND THEN WE HAVE ATIVAN AND THAT'S ONE OR TWO
15 MILLIGRAMS?
16 A. YES.
17 Q. AND WHAT IS ATIVAN?
18 A. IN THIS CASE IT'S USED FOR AGITATION. IT'S MORE OF --
19 IT'S ANOTHER FORM OF A HYPNOTIC TYPE OF DRUG, SEDATION.
20 Q. AND THEN WE HAVE ANOTHER TRAZODONE. HOW DOES THAT
21 RELATE TO THE EARLIER TRAZODONE?
22 A. IF THE SCHEDULED TRAZODONE GIVEN IN THE EVENING DOESN'T
23 HELP THEM -- THIS IS FOR INSOMNIA, MEANING IF THEY CAN'T
24 SLEEP YOU'RE ALLOWED TO GIVE ONE MORE DOSE AFTER THE EVENING
25 DOSE IS GIVEN.
1621
1 Q. AND THEN ZANTAC, DO YOU KNOW WHAT THAT IS?
2 A. ZANTAC IS FOR STOMACH -- IT'S AN H-2 BLOCKER WHICH
3 DECREASES ACID IN THE STOMACH.
4 Q. AND THEN D.N.R. IS WRITTEN OUT TO THE SIDE. DO YOU KNOW
5 WHAT THAT IS?
6 A. DO NOT RESUSCITATE.
7 Q. AND WHAT DOES IT MEAN TO NOT RESUSCITATE?
8 A. UMM, USUALLY PATIENTS HAVE A FORM, THE MAJORITY OF THE
9 TIME, THAT THEY FILL OUT. IN CASE THEY'RE TERMINALLY ILL
10 THEY DON'T WANT CERTAIN PROCEDURES DONE TO THEM TO PROLONG
11 THEIR LIFE.
12 Q. NOW, THAT WAS THE 6TH OF DECEMBER. WOULD YOU TURN OVER
13 TO 456.
14 A. (WITNESS COMPLIED.)
15 Q. DO YOU RECOGNIZE WHAT THAT IS?
16 A. WHICH ONE?
17 Q. WHAT THAT DOCUMENT IS?
18 A. ON 456, YES.
19 Q. WHAT IS THE DOCUMENT ITSELF, THE WHOLE DOCUMENT?
20 A. IT'S A PHYSICIAN'S ORDER SHEET.
21 Q. UP AT THE TOP WE HAVE THE DATE, WHICH IS WHAT?
22 A. 12/13/95.
23 Q. AND THEN IT SAYS, AND READ THAT FOR US?
24 A. M.S., 15 MILLIGRAMS; I.M., Q FOUR HOURS, P.R.N., SEVERE
25 PAIN OR AGITATION.
1622
1 Q. SO THAT IS P.R.N., IS THAT CORRECT?
2 A. CORRECT.
3 Q. THIS MIGHT GET A LITTLE CONFUSING. WE'VE GOT TO TURN
4 NOW TO THE MEDICAL RECORDS FOR AFTER THE 13TH OF DECEMBER.
5 HAVE YOU HAD OCCASION TO LOOK AT THE MEDICINE ADMINISTRATION
6 RECORDS IN THIS CASE?
7 A. OKAY.
8 Q. DO YOU RECALL LOOKING AT THOSE PREVIOUSLY?
9 A. YES.
10 Q. LET'S LOOK THROUGH UNTIL WE GET TO THE FIRST TIME THAT
11 WE SEE THE ACTUAL ADMINISTRATION OF MORPHINE. WELL, LET'S
12 LOOK AT 497 FIRST.
13 A. 497?
14 Q. YES.
15 A. OKAY.
16 Q. WHEN WAS MORPHINE ADMINISTERED UNDER THAT ORDER? WELL,
17 I SHOULDN'T SAY UNDER THIS ORDER, ON THIS PAGE?
18 A. ON THIS PAGE?
19 Q. YES.
20 A. IT WAS ADMINISTERED ON 12/30.
21 Q. OKAY.
22 A. AT 2:30 IN THE AFTERNOON, 6:30 IN THE EVENING, AND 10:30
23 AT NIGHT.
24 Q. LET ME PUT THAT ON HERE. NOW, THERE ARE LINES DRAWN
25 ACROSS HERE. DOES THAT INDICATE THAT IT WAS GIVEN OR NOT
1623
1 GIVEN?
2 A. YOU MEAN THE DARKENED AREA THAT GOES ACROSS?
3 Q. YES.
4 A. THAT MEANS IT WAS GIVEN -- WHAT WE DO IS WHEN THE ORDER
5 IS CHANGED WE HAVE TO YELLOW OUT THAT ENTRY AND THEN REWRITE
6 IT IN ANOTHER AREA. SO THAT WOULD JUST BE THE YELLOW MARKER
7 THAT'S REFLECTING ON THERE.
8 Q. LET'S LOOK THROUGH -- TURN TO 507.
9 A. (WITNESS COMPLIED.)
10 Q. DOES THAT RECORD SHOW ANY ADMINISTRATION OF MORPHINE?
11 A. YES, IT DOES.
12 Q. AND ON THIS RECORD WHAT WAS THE FIRST DAY THAT MORPHINE
13 WAS ADMINISTERED?
14 A. ON 1/1/95.
15 Q. AND THAT WAS DONE AT 1830?
16 A. YES.
17 Q. IF YOU WILL LOOK NOW AT 509. WAS MORPHINE ADMINISTERED
18 AND RECORDED ON THAT RECORD?
19 A. YES, IT WAS.
20 Q. AND WHAT DATE?
21 A. 1/3 AT 1830.
22 Q. THE NEXT PAGE IS 510. DOES THAT RECORD SHOW THE
23 ADMINISTRATION OF MORPHINE?
24 A. YES, IT DOES.
25 Q. WHAT DATES?
1624
1 A. UMM --
2 Q. LET'S START WITH THIS ONE RIGHT UP HERE.
3 A. ON 1/1 AT 2245. AT 1/2 AT 1630. AND THEN --
4 Q. THESE ARE THE REGULARLY SCHEDULED ONES?
5 A. NO. THESE WERE P.R.N., AS NEEDED.
6 Q. OKAY. THEN DOWN HERE UNDERNEATH THERE ARE SOME MORE.
7 A. THOSE WERE "NOW" ORDERS, WHICH MEANS IT WAS GIVEN
8 ADDITIONALLY.
9 Q. AND WHAT DATES WERE THOSE GIVEN?
10 A. 12/31 AT 1930; 1/1 AT 1730; 1/1 AT 2330; 1/3 AT TEN
11 O'CLOCK; 1/3 AT ELEVEN O'CLOCK; 1/3 AT 1445.
12 Q. AND THEN FINALLY THE NEXT PAGE, 511.
13 A. MORPHINE ALSO?
14 Q. IT LOOKS LIKE TYLENOL; BUT DOWN AT THE BOTTOM DO YOU SEE
15 MORPHINE BEING ADMINISTERED?
16 A. YES. MORPHINE ON 12/25 AT 0730. 12/25 AT 0930. 12/25
17 AT -- I CAN'T REALLY MAKE THAT OUT. 1-1-3.
18 Q. THESE DON'T COME OUT VERY WELL. IT LOOKS LIKE MAYBE
19 11:30.
20 A. THEN ON 12/26 AT 0810.
21 Q. LET'S LOOK BACK, THEN. THERE HAD BEEN THE ORDER THAT
22 YOU POINTED OUT ON THE 13TH. DOES IT APPEAR THAT ANY
23 MORPHINE WAS EVER GIVEN ON THE 13TH?
24 A. NOT ON THE 13TH. THE 13TH OF DECEMBER?
25 Q. YES.
1625
1 A. NO.
2 Q. WOULD YOU LOOK FOR THE 14TH, 15TH, 16TH, 17TH AND 18TH
3 WHILE YOU'RE GOING THROUGH THERE?
4 A. (PAUSE.) NO, IT WAS NOT.
5 Q. WOULD YOU TURN TO 458.
6 A. (WITNESS COMPLIED.)
7 Q. DO YOU SEE THIS BOTTOM NOTATION?
8 A. YES.
9 Q. WHAT DOES IT SAY?
10 A. D.C., M.S., P.R.N. THANKS, R. WEITZEL, M.D.
11 Q. WHAT DATE WAS THAT?
12 A. 12/19.
13 Q. WHAT DOES D.C. MEAN?
14 A. DISCONTINUE.
15 Q. AND THAT IS NOTED BY WHOM?
16 A. BY ME.
17 Q. WHAT TIME?
18 A. AT 2300. ELEVEN P.M. AT NIGHT ON THE 19TH.
19 Q. DO YOU HAVE ANY RECOLLECTION, OTHER THAN THESE NOTES,
20 ABOUT THAT DISCONTINUATION OF THE MORPHINE ON THE 19TH OF
21 DECEMBER?
22 A. YES, I DO.
23 Q. WHAT'S THAT RECOLLECTION BASED ON?
24 A. MY INTERACTION WITH DR. WEITZEL.
25 Q. WERE YOU AWARE, FROM THE 13TH TO THE 19TH, THAT MORPHINE
1626
1 HAD BEEN ORDERED?
2 A. YES, I WAS.
3 Q. ARE YOU AWARE WHETHER IT WAS EVER ADMINISTERED?
4 A. I WAS AWARE IT WAS NOT ADMINISTERED.
5 Q. DID YOU BRING THAT TO ANYONE'S ATTENTION?
6 A. YES.
7 Q. AND TO WHOM'S ATTENTION?
8 A. DR. WEITZEL'S.
9 Q. AND WHAT DAY WAS IT THAT YOU BROUGHT THAT TO HIS
10 ATTENTION?
11 A. ON THE 19TH.
12 Q. WHERE WERE YOU WHEN YOU TALKED TO HIM?
13 A. THE GERO-PSYCH UNIT, NURSING STATION.
14 Q. WAS ANYONE ELSE PRESENT?
15 A. I DON'T RECALL.
16 Q. WHAT DID YOU SAY TO DR. WEITZEL ON THE 19TH?
17 A. USUALLY IN THE EVENING HOURS, WHEN I HAVE A SLOW TIME,
18 I'LL GO THROUGH THE PATIENTS' RECORDS AND THEIR MEDICATIONS
19 AND LOOK THEM UP IN THE GERATOLOGY BOOK, LOOK AT THEIR
20 DOSES, JUST TO REVIEW. I NOTICED THAT THE MEDICATIONS THAT
21 SHE WAS CURRENTLY ON WERE A LITTLE -- WERE ABOVE THE LEVELS
22 THAT THE GERATOLOGY BOOK RECOMMENDED AND --
23 MR. STIRBA: YOUR HONOR, I'M GOING TO OBJECT.
24 THE COURT: THE QUESTION WAS WHAT DID YOU SAY TO
25 DR. WEITZEL.
1627
1 THE WITNESS: I EXPRESSED MY CONCERNS THAT MORPHINE
2 WOULD ENHANCE THE EFFECTS OF THESE OTHER ANTI-PSYCHOTROPICS
3 THAT SHE WAS CURRENTLY ON AND SHE WASN'T USING THE MORPHINE.
4 I DIDN'T THINK IT WOULD BE WISE TO KEEP IT ON THE M.A.R.,
5 SINCE IF IT WAS USED IT COULD MAKE --
6 MR. STIRBA: I'M GOING TO OBJECT AGAIN. I DON'T
7 THINK WE'RE IN A CONVERSATION. I THINK SHE'S EXPLAINING HER
8 STATEMENT TO DR. WEITZEL.
9 THE COURT: PHRASE THE QUESTION AS WHAT DID HE SAY,
10 WHAT DID I SAY.
11 MS. BARLOW: I WILL DO THAT.
12 THE COURT: AND THEN ANSWER THE QUESTION ABOUT WHAT
13 WAS SAID, NOT WHAT WAS THOUGHT.
14 Q. (BY MS. BARLOW) SO YOU SAID TO DR. WEITZEL -- WHAT
15 EXACTLY DID YOU SAY TO DR. WEITZEL? JUST LIMIT IT TO WHAT
16 YOU SAID.
17 A. I SAID THAT I'M CONCERNED ABOUT THE MORPHINE BEING ON
18 THE SHEET WITH THE PSYCHOTROPIC MEDICATIONS.
19 Q. AND WHAT DID HE SAY?
20 A. HE JUST KIND OF BENT HIS HEAD DOWN AND LOOKED OVER HIS
21 GLASSES AND STARED AT ME.
22 Q. DID HE SAY ANYTHING?
23 A. WELL, I CONTINUED TO EXPRESS MY CONCERNS, SAYING I HAD
24 LOOKED IT UP. HE SAID, I'M THE DOCTOR, I PRESCRIBE. YOU'RE
25 THE NURSE. THEN WHEN HE LEFT HE WROTE IN THE BOOK AND THEN
1628
1 JUST PUSHED IT AT ME AND SAID THERE. THAT WAS THE END OF
2 THE CONVERSATION.
3 Q. AND WAS THAT THE D.C. NOTE?
4 A. YES.
5 Q. WHAT WAS BEHIND YOUR CONCERN?
6 MR. STIRBA: I'M GOING TO OBJECT AS TO RELEVANCE.
7 THE COURT: CAN YOU MOVE ON TO SOMETHING ELSE AND
8 WE'LL DISCUSS THAT AT THE BREAK?
9 MS. BARLOW: I'LL DO THAT.
10 Q. (BY MS. BARLOW) DID YOU OBSERVE MRS. LARSEN DURING
11 THIS TIME?
12 A. YES.
13 Q. I MEAN, THE 13TH THROUGH THE 19TH?
14 A. YES.
15 Q. DO YOU RECALL WHAT HER MENTAL CONDITION WAS AT THAT
16 TIME?
17 A. SHE WOULD HAVE MOMENTS OF AGITATION, BUT AT THE SAME
18 TIME SHE'D BE CLEAR WHERE SHE WOULD MAKE A BREAK THROUGH AND
19 CONNECT AND DO THINGS APPROPRIATELY. SO SHE WAS MAKING SOME
20 HEADWAY IN THAT ASPECT. SHE WAS ATTENDING GROUP AND THAT
21 WAS A VERY IMPORTANT PART OF BEING ON THE UNIT, WAS BEING
22 ABLE TO ATTEND THE GROUPS.
23 Q. IF YOU WOULD TURN TO 546.
24 A. (WITNESS COMPLIED.)
25 Q. IS YOUR HANDWRITING ON THAT DOCUMENT?
1629
1 A. 546. I'M SORRY. (PAUSE.) YES, IT IS.
2 Q. WHAT DATE WAS THAT?
3 A. THAT WAS ON 12/16.
4 Q. AND WHAT TIME ARE WE TALKING ABOUT?
5 A. AT THREE O'CLOCK IN THE AFTERNOON.
6 Q. AND WHAT DID YOU WRITE?
7 A. THIS IS A CONTINUATION, IT LOOKS LIKE, OF ANOTHER PAGE,
8 BECAUSE I HAVE C.O.N.T. BEFORE THAT FAMILY STATES.
9 THE COURT: DO YOU WANT THE OTHER PAGE?
10 Q. (BY MS. BARLOW) LET'S START WITH 545, WHICH IT LOOKS
11 LIKE IS THE 15TH. WE'VE HAD PEOPLE TELL US WHAT B.I.R.P.
12 MEANS, BUT WHAT WAS THE BEHAVIOR YOU OBSERVED ON THE 15TH?
13 A. THE 15TH?
14 Q. THE DAY BEFORE, ON 545. YOU KNOW, I THINK -- LET ME
15 LOOK.
16 MR. STIRBA: IT'S NOT HER NOTE.
17 THE COURT: I THOUGHT SHE SAID THERE WAS A
18 CONTINUATION. WAS IT CONTINUED FROM ANOTHER --
19 THE WITNESS: IT LOOKS LIKE PAGE 548 IS WHERE I
20 INITIALLY STARTED.
21 MS. BARLOW: SO WHAT WE HAVE ARE SOME THINGS OUT OF
22 ORDER. YES, IT IS. 548 IS THE ONE WE WANT TO LOOK AT.
23 THANK YOU.
24 Q. (BY MS. BARLOW) 548, WHAT DATE IS THAT?
25 A. 12/16.
1630
1 Q. IT LOOKS LIKE 1500?
2 A. YES. USUALLY, WHEN WE PUT 1500, WE DO A SHIFT EVAL AT
3 THE END OF THE SHIFT.
4 Q. AND THAT'S THREE P.M.?
5 A. CORRECT.
6 Q. WHAT DID YOU WRITE AS AN EVALUATION OF THE SHIFT THAT
7 DAY?
8 A. BEHAVIOR, THAT'S THE B CIRCLED. "PATIENT BECAME
9 AGITATED TIMES ONE DURING SHIFT. PATIENT WAS LETHARGIC AT
10 START OF SHIFT. INCREASED ALERTNESS AS SHIFT PROGRESSED.
11 PATIENT SAT THROUGH ENTIRE MOVIE AND EXPRESSED EMOTIONAL
12 APPROPRIATENESS AT TIMES. PATIENT FED SELF LUNCH. PATIENT
13 INCREASED AGITATION AFTER LUNCH, WANTING TO LEAVE THIS
14 PLACE. ATTEMPTING TO AMBULATE ON OWN. STAFF ASSISTED
15 PATIENT TO FEET AND AMBULATED PATIENT WITH TWO PERSON
16 ASSIST."
17 Q. WHAT DOES AMBULATE WITH TWO PERSON ASSIST MEAN?
18 A. THAT MEANS TWO PEOPLE HELPED HER WALK TO MAKE SURE SHE
19 WAS STEADY AND SAFE. "PATIENT MADE STATEMENTS I GO FROM ONE
20 PLACE TO ANOTHER. I CAN GO WHERE I WAS YESTERDAY. FAMILY
21 IN TO VISIT. FAMILY STATES PATIENT IS MUCH IMPROVED FROM
22 LAST WEEK AND HOPES THIS PROGRESS WILL CONTINUE."
23 INTERVENTION IS WHAT THE I STANDS FOR. "GAVE P.R.N.
24 MEDICATIONS." THAT'S THE AS NECESSARY MEDICATIONS.
25 "PROVIDED ASSISTANCE WITH AMBULATION. ONE ON ONE TO ALLOW
1631
1 PATIENT TO VERBALIZE FRUSTRATION."
2 R WOULD BE THE RESPONSE OF THE PATIENT. "PATIENT
3 VOCALIZED A LOT, BUT UNSENSICAL RAMBLING AT TIMES. PATIENT
4 NEEDED ONE ON ONE TO REMAIN SEATED AND SAFE. PLAN, CONTINUE
5 TO PROVIDE SAFE ENVIRONMENT AND MONITOR BEHAVIOR."
6 Q. DID YOU NOTE ANY INDICATIONS OF PAIN?
7 A. NO, I DID NOT.
8 Q. LET'S TURN NOW TO 460.
9 A. (WITNESS COMPLIED.)
10 Q. DO YOU GET CONFUSED GOING BACK AND FORTH BETWEEN ALL OF
11 THESE RECORDS IN THE CHART? OKAY. ON 460 -- BETWEEN THE
12 19TH AND THE DATE ON THIS, WHICH IS THE 25TH, DO YOU KNOW
13 WHETHER MRS. LARSEN RECEIVED ANY MORPHINE AFTER THE D.C.?
14 A. NO, SHE DID NOT.
15 Q. NOW WE HAVE THE 25TH OF DECEMBER. THIS IS NUMBER 460.
16 WHAT WAS THE ORDER ON THE 25TH OF DECEMBER?
17 A. 12/25/95 AT 0930. T.O., MEANING A TELEPHONE ORDER. DR.
18 WEITZEL TO LYNN LONG. M.S., TWO MILLIGRAMS; I.M. NOW.
19 Q. OKAY. THAT'S DOWN AT THE BOTTOM ONE. I'M SORRY.
20 A. THE NEXT ONE ON 12/25. ABOVE THAT IS M.S., TWO
21 MILLIGRAMS; I.M. NOW. THAT WAS 0150 ON THE 25TH.
22 Q. AND YOU JUST READ THE TWO MILLIGRAMS, I.M. NOW AT 9:30?
23 A. I MEAN 7:30. THE 0150 WAS FROM TRACY. SO THE FIRST
24 I.M. WAS AT 0730. THE SECOND ONE WAS AT 0930.
25 Q. LET'S LOOK BACK AT THE NURSING NOTES FOR THE 25TH OF
1632
1 DECEMBER. IN FACT, LET'S LOOK AT THE 24TH FIRST, WHICH IS
2 564. IS YOUR HANDWRITING THERE IN THE NARRATIVE PART?
3 A. YES, IT IS, UP ON THE TOP.
4 Q. THE 2030?
5 A. AT 2030, CORRECT.
6 Q. WHAT SHIFT WOULD YOU HAVE BEEN ON?
7 A. THE THREE TO ELEVEN SHIFT.
8 Q. AFTER THAT, AT 2245, THIS IS NOT YOUR WRITING, BUT WHAT
9 WAS WRITTEN FOR BEHAVIOR? WOULD THAT BE FOR THE WHOLE
10 SHIFT?
11 A. THAT WOULD BE FOR THE THREE TO ELEVEN SHIFT, CORRECT.
12 Q. OKAY. SO THE SHIFT YOU WERE ON?
13 A. CORRECT.
14 Q. ALTHOUGH YOU DIDN'T WRITE IT?
15 A. CORRECT.
16 Q. WHO DID WRITE IT?
17 A. IT WOULD BE LYNNETTE, I BELIEVE HER NAME WAS. SHE WAS A
18 C.N.A. WE WOULD DIVIDE UP THE CHARTS. C.N.A.'S WOULD CHART
19 ON SOME PEOPLE AND THE R.N.'S ON THE OTHER. IT WOULD
20 USUALLY BE FIVE AND FIVE.
21 Q. DID YOU TALK BETWEEN YOURSELVES ABOUT WHAT TO CHART?
22 A. NOT WHAT TO CHART, BUT WE WOULD DISCUSS THE PATIENT'S
23 BEHAVIOR THROUGH THE SHIFT AND THEN THEY WOULD GO AHEAD AND
24 DERIVE ON THEIR OWN HOW THEY WERE GOING TO NARRATE IT.
25 Q. AND LET'S LOOK AT JUST THE BEHAVIOR PART OF HOW MRS.
1633
1 LARSEN HAD BEEN DURING THAT SHIFT?
2 A. "PATIENT WAS VERY SLEEPY. SHE DIDN'T PARTICIPATE IN
3 ACTIVITY BECAUSE SHE WAS TIRED. PATIENT SHOWED NO SIGNS OF
4 AGITATION."
5 Q. NOW LET'S GO TO THE NEXT ONE, WHICH IS 565, WHICH IS THE
6 25TH OF DECEMBER. WERE YOU ON SHIFT ON THIS ONE AT ALL?
7 A. ON THE 25TH, I BELIEVE I WAS ON SHIFT ON THREE TO ELEVEN
8 THAT DAY.
9 Q. SO THIS THAT WAS SEVEN TO 1300 WAS NOT WHILE YOU WERE ON
10 SHIFT?
11 A. NO, IT WASN'T.
12 Q. WOULD YOU STILL READ THE BEHAVIOR?
13 A. "PATIENT BECAME INCREASED ALERTNESS AS SHIFT PROGRESSED,
14 BUT MADE NO VERBALIZATIONS, ALTHOUGH SHE WOULD TURN HER HEAD
15 TO LEFT OR RIGHT WHEN ASKED."
16 Q. AND THEN DOWN HERE IT SAYS MEDICAL, OR MED NOTE. WOULD
17 YOU READ THAT.
18 A. "WAS MEDICATED WITH M.S., TWO MILLIGRAMS, I.M. AT 0730,
19 0930 AND 1130, WITH PATIENT'S LEVEL OF ALERTNESS INCREASING
20 THROUGHOUT THE MORNING AND CONTINUING THROUGHOUT THE SHIFT."
21 Q. OKAY. DO YOU SEE ANYTHING IN THAT CHART INDICATING THAT
22 THERE WAS ANY PAIN?
23 A. NO, I DO NOT.
24 Q. AND THE DAY BEFORE, WHEN YOU SAW HER ON THE 24TH, DID
25 YOU NOTE ANY INDICATIONS OF PAIN?
1634
1 A. NO, I DID NOT.
2 Q. NOW LET'S GO TO 566. WHAT DATE IS THIS?
3 A. THIS IS DECEMBER 25TH.
4 Q. AND WHOSE HANDWRITING IS THAT?
5 A. MINE.
6 Q. AND WHAT WAS THE BEHAVIOR THAT YOU NOTED?
7 A. "PATIENT HAD NO AGITATED BEHAVIOR. PATIENT DID NOT
8 COMMUNICATE VERBALLY. PATIENT BECAME VERY TEARFUL DURING
9 WRAP-UP GROUP. WHEN STAFF HELD PATIENT'S HAND PATIENT
10 REFUSED TO EAT DINNER. TOOK TOWEL OFF LAP AND PLACED IT
11 OVER TRAY AND PUSHED TRAY AWAY. PATIENT WOULD NOT ALLOW
12 STAFF TO FEED HER, WHICH SHE COMMUNICATED BY CLENCHING HER
13 TEETH. PATIENT SPIT P.O. MEDICATIONS," BY MOUTH
14 MEDICATIONS, "OUT, WHICH WERE CRUSHED AND PLACED IN
15 APPLESAUCE."
16 Q. DOES THAT MEAN IT WOULD HAVE BEEN GIVEN WHEN SHE SPIT IT
17 OUT?
18 A. SPIT OUT MEDICATION. NO. SHE SPIT THEM OUT.
19 Q. THEN I WONDERED ABOUT THE CRUSHED?
20 A. THEY WERE CRUSHED AND SHE SPIT THEM OUT.
21 Q. OKAY.
22 A. "PATIENT PLACED IN BED WITH TWO SIDE RAILS AND BED
23 MONITOR IN PLACE. PATIENT RIGID, KEEPING EYES OPEN. COLD
24 ICE APPLIED TO EXTREMITIES AND FOREHEAD. PATIENT RESPONDED
25 WITH DECREASED FACIAL TIGHTNESS AND MOVEMENT OF EYES.
1635
1 PATIENT REFUSED WATER."
2 Q. WOULD YOU EXPLAIN TO US -- SO SHE'S RIGID AND YOU PUT
3 COLD ICE ON EXTREMITIES AND ON THE FOREHEAD. WHY DID YOU DO
4 THAT?
5 A. TO TRY AND RELAX HER. SOMETIMES THEY GET A LITTLE
6 DIAPHORETIC.
7 Q. WHAT IS DIAPHORETIC?
8 A. THEY GET A LITTLE PERSPIRATION ON THEM. AND USUALLY
9 SHE'S JUST A LITTLE TENSE AND WE'LL TRIAL TO RELAX HER,
10 SOOTHE HER WITH OTHER THINGS THAN MEDICATION. WE'LL TRY THE
11 LEAST DRASTIC APPROACH, I GUESS, TO CALM HER DOWN.
12 Q. DID THAT WORK HERE?
13 A. YES, IT DID.
14 Q. DID YOU NOTE ANY SYMPTOMS OF PAIN IN THAT CHART?
15 A. NO, I DID NOT.
16 Q. WHAT ABOUT THE RIGIDITY?
17 A. THAT CAN BE HER WAY OF REFUSING THINGS. I MEAN, YOU
18 JUST WATCH THEIR BEHAVIOR, YOU TRY THE LEAST --
19 MR. STIRBA: YOUR HONOR, I'M GOING TO OBJECT. I
20 DON'T THINK THIS IS RESPONSIVE.
21 THE COURT: WHY DON'T YOU JUST ASK THE QUESTION
22 AGAIN.
23 MS. BARLOW: I ASKED WHAT ABOUT THE RIGIDITY.
24 THE COURT: MAYBE THAT'S A KIND OF VAGUE QUESTION.
25 CAN YOU CLARIFY IT?
1636
1 Q. (BY MS. BARLOW) COULD THE RIGIDITY BE A SIGN OF PAIN?
2 A. IT DEPENDS ON THE INTERPRETER, HOW THEY INTERPRET IT.
3 Q. AND DID YOU INTERPRET THAT RIGIDITY AS PAIN?
4 A. NO, I DID NOT.
5 Q. DID YOU GIVE ANY PAIN MEDICATION FOR THE RIGIDITY?
6 A. NO, I DID NOT.
7 Q. DID THE RIGIDITY RESOLVE?
8 A. IT SUBSIDED, YES.
9 Q. WERE YOU PRESENT WHEN JUDITH LARSEN HAD A SEIZURE?
10 A. THE SEIZURE, SHE WAS GIVEN DILANTIN FOR THAT ONE.
11 Q. ON THE 26TH OF DECEMBER, WHICH IS NUMBER 568, DID YOU
12 CHART THAT DAY?
13 A. YES, I DID.
14 Q. AGAIN, THIS IS THE B.I.R.P. WHEN WAS THAT WRITTEN?
15 A. THAT WAS WRITTEN ON THE 26TH. THAT WOULD HAVE BEEN THE
16 THREE TO ELEVEN SHIFT.
17 Q. AND WHEN DID YOU WRITE IT DURING THE SHIFT?
18 A. USUALLY YOU'LL WRITE IT AT THE END OF THE SHIFT.
19 Q. WHAT WAS THE BEHAVIOR THAT YOU SAW?
20 A. "PATIENT HAS HAD NO AGITATION THIS SHIFT. PATIENT
21 REMAINED IN BED ENTIRE SHIFT. PATIENT WITH 02 AT TWO
22 LITERS."
23 Q. AND WHAT DOES THAT MEAN?
24 A. OXYGEN AT TWO LITERS.
25 Q. AND HOW WAS THAT ADMINISTERED?
1637
1 A. THROUGH THE NASAL CANNULA, A TUBE THROUGH THE NOSE.
2 Q. NOT A MASK, BUT A --
3 A. CORRECT.
4 Q. OKAY. THANK YOU.
5 A. "NO DISTRESS NOTED. PATIENT OPENED EYES OCCASIONALLY
6 DURING CARES. NO VERBALIZATION. PATIENT REMAINS VERY
7 LETHARGIC. PATIENT ABLE TO P.O. 60 PERCENT," WHICH MEANS
8 INTAKE. "60 PERCENT OF MEAL WITH STAFF. INCREASED
9 ENCOURAGEMENT AND SMALL LIQUID. FIVE PORTIONS GIVEN.
10 PATIENT NOT ABLE TO TURN SELF. STAFF REPOSITIONED, Q TWO
11 HOURS," MEANING EVERY TWO HOURS. "GAVE SIPS OF H20,"
12 MEANING WATER. "PATIENT DID NOT MOAN OR MAKE ANY VERBAL
13 COMMUNICATIONS."
14 Q. DID YOU SEE ANY OR CHART ANY SYMPTOMS OF PAIN?
15 A. NO, I DID NOT.
16 Q. DO YOU RECALL SEEING ANY SYMPTOMS OF PAIN?
17 A. NO, I DID NOT.
18 Q. 569 IS THE NEXT PAGE. WHAT DATE IS THAT?
19 A. 12/26.
20 Q. AND THAT WAS AT WHAT TIME THAT FIRST ONE?
21 A. THE MORNING SHIFT THERE.
22 Q. AND THE FIRST NOTATION IS NOT YOURS?
23 A. NO, IT IS NOT.
24 Q. WERE YOU STILL ON SHIFT?
25 A. THAT MORNING, NO.
1638
1 Q. SO THE FIRST NOTATION IS AT WHAT TIME?
2 A. 0800.
3 Q. WHAT IS THE NOTATION?
4 A. M.S., TWO MILLIGRAMS, I.M. I TAKE IT THAT'S RIGHT
5 GLUTEAL. I DON'T KNOW. "COMPLAINS OF MOANING. APPEARS TO
6 BE IN SOME DISCOMFORT."
7 Q. HAD YOU SEEN ANY DISCOMFORT BEFORE YOU LEFT YOUR SHIFT?
8 A. NO, I DID NOT.
9 Q. LET'S GO ON. AT NINE O'CLOCK WHAT WAS WRITTEN?
10 A. PATIENT GIVEN -- I DON'T KNOW WHAT THAT IS.
11 "UNRESPONSIVE TO EVEN DEEP PAINFUL STIMULI. ALL COMFORT
12 MEASURES CONTINUED."
13 Q. DO YOU KNOW WHAT IT MEANS TO SAY UNRESPONSIVE TO EVEN
14 DEEP PAINFUL STIMULI?
15 A. USUALLY DEEP --
16 MR. STIRBA: YOUR HONOR --
17 MS. BARLOW: I ASKED IF SHE KNOWS WHAT IT MEANS.
18 THE WITNESS: YES.
19 MR. STIRBA: BUT IN THE CONTEXT OF A NOTE SHE
20 DIDN'T CREATE I THINK IT'S BEYOND HER ABILITY TO SPECULATE.
21 MS. BARLOW: PERHAPS IF I COULD LAY SOME
22 FOUNDATION.
23 THE COURT: GO AHEAD.
24 Q. (BY MS. BARLOW) RESPONSIVE TO DEEP PAINFUL STIMULI.
25 DOES THAT HAVE ANY PARTICULAR SIGNIFICANCE IN A NURSING
1639
1 CONTEXT?
2 A. YES, IT DOES.
3 Q. AND WHERE DO YOU LEARN WHAT THAT SIGNIFICANCE IS?
4 A. DURING NURSING SCHOOL YOU'RE INSTRUCTED ON HOW TO
5 STIMULATE DEEP PAINFUL STIMULI ON A PATIENT TO SEE WHAT THE
6 RESPONSIVE LEVEL IS.
7 Q. AND THEN WE HAVE 1400. WOULD YOU READ WHAT B SAYS IN
8 1400?
9 A. BEHAVIOR. "PATIENT UNRESPONSIVE AS YET, BUT APPEARS TO
10 BE," AND I DON'T KNOW WHAT THAT IS. LIGHTER. I DON'T KNOW.
11 "NOT MOVING IN BED BUT MAKING VERBAL NOISE IN RESPONSE TO
12 CONVERSATION WITH HER."
13 Q. OKAY. STOP THERE. IN THE NURSING PROFESSION IS THERE A
14 PARTICULAR MEANING, YES OR NO, TO THE TERM LIGHTER?
15 A. NOT THAT I'M AWARE OF.
16 Q. WERE YOU ON SHIFT WHEN A VOMITING SPELL HAPPENED?
17 A. I WAS AWARE OF THE VOMITING SPELL WITH JUDITH.
18 Q. LET'S TURN TO 575.
19 A. (WITNESS COMPLIED.)
20 Q. WHAT DATE WAS THAT?
21 A. ON 575?
22 Q. YES.
23 A. 12/29.
24 Q. AND THIS FIRST PART WAS WRITTEN WHEN?
25 A. AT THE END OF THE THREE TO ELEVEN SHIFT.
1640
1 Q. WHAT IS THE BEHAVIOR THAT WAS NOTED THERE?
2 A. "PATIENT ATTENDING GROUP BUT SLEPT THROUGH THEM. AT
3 1600 PATIENT BEGAN A FIVE HOUR CYCLE OF SEVERE EMESIS."
4 Q. WHAT IS EMESIS?
5 A. THROWING UP. TIMES SEVEN.
6 Q. WHAT DOES TIMES SEVEN MEAN?
7 A. IT MEANS SEVEN TIMES, SEVEN EPISODES. "AND DIAPHORETIC
8 SKIN TO TOUCH," MEANING PERSPIRATION. "VITAL SIGNS TAKEN.
9 TEMP ROSE TO 99.5 AT 2200. LARGE AMOUNTS OF EMESIS.
10 CHANGED BED TIMES THREE," MEANING THREE TIMES. "WAS PUT TO
11 BED AT 1700. DID NOT EAT ANY DINNER. VOMITED MEDS."
12 Q. LET'S LOOK DOWN TO -- WELL, WHAT IS THE I? FOR
13 INTERVENTION?
14 A. YES. "ATTENDED GROUP AT BEGINNING OF SHIFT. DID NOT
15 PARTICIPATE. RESPONSE. EMESIS CONTINUED AFTER BEING PUT IN
16 BED. RAISED HEAD OF BED TO 90 DEGREES TO PREVENT CHOKING.
17 WAS UNABLE TO KEEP ANYTHING DOWN INCLUDING LIQUIDS. IS
18 PRESENTLY SLEEPING. NO EMESIS SINCE 2100. WILL CONTINUE TO
19 MONITOR."
20 Q. DOWN HERE AT 1900, AGAIN, AND I RECOGNIZE THAT'S NOT
21 YOUR WRITING, BUT WHAT WAS CHARTED?
22 A. "PAGED DR. WEITZEL TO NOTIFY HIM OF PATIENT'S PERSISTENT
23 NAUSEA AND VOMITING. VITAL SIGNS. PATIENT IS AWAKE.
24 VOMITUS CLEAR, YELLOW, WITH FOOD PARTICLES."
25 Q. AND THEN WHAT IS THIS NEXT LINE?
1641
1 A. IT'S HARD TO READ. IT LOOKS LIKE 2000. IT'S DIFFICULT
2 TO READ. "PAGED DR. WEITZEL AGAIN. PATIENT CONTINUES TO
3 VOMIT."
4 Q. 2130?
5 A. "PAGED DR. WEITZEL AGAIN. PATIENT CONTINUES TO VOMIT.
6 HAS BEEN N.P.O.," MEANING NOTHING BY MOUTH, "SINCE 1730."
7 Q. IT'S HARD TO READ THE REST.
8 A. MEDICATIONS HELD.
9 Q. HELD?
10 A. HELD.
11 Q. OKAY. THEN AT MIDNIGHT ON THE 30TH WHAT WAS HAPPENING?
12 A. "PATIENT WAS VOMITING. EMESIS COFFEE GROUND LIKE IN
13 APPEARANCE WITH PASTY TEXTURE. VITAL SIGNS. DR. WEITZEL
14 AND DR. DIENHART PAGED. PATIENT CLEANED UP AND BEDDING
15 CHANGED."
16 Q. WAS THIS, THEN, A CONTINUANCE OF --
17 A. THIS WAS A NEW SHIFT STARTING AT ELEVEN. THEN SHE WAS
18 JUST FREE TEXTING IN SOMETHING THAT WAS CRITICAL THAT SHE
19 NEEDED TO CHART, I GUESS, AS SHE WAS GOING ALONG IN HER
20 SHIFT.
21 Q. DOWN HERE -- I RECOGNIZE THIS STILL ISN'T YOUR
22 HANDWRITING. WE HAD TRACY SCHOLL HERE TO TESTIFY. BY THE
23 TIME 7:30 CAME AROUND WHAT DID YOU SEE AS BEHAVIOR?
24 A. "PATIENT UNRESPONSIVE TO VERBAL STIMULI. PATIENT WEAK.
25 HEART RATE IRREGULAR. RESPIRATIONS EVEN, NOT LABORED AT
1642
1 THIS TIME. PATIENT'S DIAPER CHANGED TIMES ONE WITH URINE
2 OUTPUT. PATIENT NOT ABLE TO P.O. INTAKE. DR. WEITZEL
3 NOTIFIED OF CONDITION. DOCTOR STATED HE WOULD BE ARRIVING
4 SOON."
5 THE COURT: IS THIS AN APPROPRIATE TIME TO TAKE A
6 BREAK?
7 MS. BARLOW: IT IS, YOUR HONOR. IT WILL PROBABLY
8 TAKE A WHILE WITH THIS.
9 THE COURT: LADIES AND GENTLEMEN, WE'VE BEEN GOING
10 FOR ABOUT AN HOUR. LET'S COME BACK ABOUT TEN -- AT TEN
11 MINUTES TO THREE. DURING THE TIME THAT YOU ARE OUT PLEASE
12 REMEMBER THAT IT'S YOUR DUTY TO NOT CONVERSE AMONG
13 YOURSELVES OR TO CONVERSE WITH ANYONE ELSE, BE ADDRESSED BY
14 ANY PERSON ON THE SUBJECT OF THIS TRIAL. IT IS ALSO YOUR
15 DUTY NOT TO FORM OR EXPRESS AN OPINION ON THIS CASE UNTIL
16 THE CASE IS FINALLY SUBMITTED TO YOU. IF YOU'LL PLEASE COME
17 BACK AT TEN MINUTES TO THREE.
18 (JURY LEFT THE COURTROOM.)
19 THE COURT: THE RECORD SHOULD REFLECT THAT THE JURY
20 IS GONE. I WOULD LIKE TO HAVE COUNSEL BACK HERE AT 15
21 MINUTES TO AND THEN TALK ABOUT THAT ONE OBJECTION AND THAT
22 OTHER ISSUE THAT WE TALKED ABOUT BEFORE. IF YOU CAN COME
23 BACK AT QUARTER TO AND I'LL HAVE THE JURY BACK AT TEN TO.
24 (SHORT RECESS.)
25 THE COURT: WE HAD TWO ISSUES. ONE FROM EARLIER
1643
1 REGARDING THE SIX PATIENT COMMENTS. AND THEN THE ONE THAT
2 THERE WAS AN OBJECTION ABOUT RELEVANCE REGARDING THE
3 CONVERSATION THAT THIS LAST WITNESS HAD WITH DR. WEITZEL
4 REGARDING JUDITH LARSEN AND THE MORPHINE. THERE WAS A
5 QUESTION THAT SAID WHAT WAS BEHIND YOUR CONCERN. IS THAT
6 THE QUESTION? THAT'S WHAT I WROTE DOWN.
7 MS. BARLOW: I THINK SO.
8 THE COURT: DO YOU WANT TO EXPRESS -- YOUR
9 OBJECTION WAS RELEVANCE. HOW DO YOU SAY IT'S NOT RELEVANT?
10 MR. STIRBA: WELL, SHE TESTIFIED AS TO THE
11 CONVERSATION. HER NURSING OPINION ABOUT SOMETHING IS REALLY
12 IRRELEVANT. I MEAN, I'M SURE THERE ARE AS MANY OPINIONS
13 ABOUT THE CARE AS YOU HAD NURSES. IF WE'RE GOING TO HAVE
14 EVERY SINGLE NURSE TESTIFY ABOUT THESE ISSUES, THEN IT SEEMS
15 TO ME THAT THESE ARE COLLATERAL ISSUES WHICH ARE NOT
16 RELEVANT TO THE FUNDAMENTAL FACT OF DID THIS GENTLEMAN, DR.
17 WEITZEL, COMMIT THE CRIMES CHARGED, WHICH HAS TO DO WITH
18 PRECISELY HIS CARE.
19 SHE CAN TESTIFY ABOUT WHAT SHE DID, CONVERSATIONS SHE
20 HAD, BUT HER OWN SORT OF PERSONAL INNER CONCERN IS REALLY
21 IRRELEVANT AND OF NO MOMENT.
22 THE COURT: MS. BARLOW, YOUR RESPONSE TO THAT.
23 MS. BARLOW: YES. I THINK SHE SHOULD BE ALLOWED TO
24 TESTIFY AS TO HER BACKGROUND AND WHAT IN HER BACKGROUND
25 RAISED THE -- BROUGHT ABOUT THE CONVERSATION. THE
1644
1 CONVERSATION IS RELEVANT BECAUSE IT GOES TO THE DEFENDANT'S
2 KNOWLEDGE.
3 THE COURT: THE CONVERSATIONS ARE IN AND SHE'S
4 TESTIFIED ABOUT THEM.
5 MS. BARLOW: RIGHT. I THINK SHE SHOULD BE ALLOWED
6 TO TESTIFY AS TO, IN HER NURSING BACKGROUND AND IN HER
7 MEDICAL TRAINING, WHY THESE WERE PROBLEMS. I THINK THEY
8 ALSO GO TO THE FACT THAT THE DEFENDANT AS A DOCTOR SHOULD
9 ALSO KNOW WHY THESE ARE PROBLEMS, BECAUSE IT'S A STANDARD
10 MEDICAL -- I MEAN, EVEN NURSES KNOW, AS IT WERE, THAT THESE
11 ARE PROBLEMS.
12 MR. STIRBA: ONE OTHER THING. SEE, WE'RE BACK INTO
13 THAT SAME PROBLEM OF SHE'S RENDERING ESSENTIALLY AN OPINION.
14 WE'RE GOING TO HAVE PLENTY OF EXPERTS COME IN AND CRITIQUE
15 WHATEVER HAPPENED. BUT HER OPINION IS NOT REALLY RELEVANT.
16 I MEAN, WHAT SHE DID IS REALLY THE BEST EVIDENCE OF ANYTHING
17 THAT MAY BE PROBATIVE IN THIS CASE. BUT TO GO FIVE YEARS
18 LATER AND SAY BY THE WAY WHAT WAS YOUR CONCERN, SHE'S
19 ESSENTIALLY RENDERING AN OPINION FOR WHICH WE DON'T HAVE ANY
20 EXPERT FOUNDATION. AND REALLY SHE'S NOT HERE AS AN EXPERT,
21 SHE'S HERE AS A FACT WITNESS. SHE'S TESTIFYING TO
22 CONVERSATIONS, WHAT SHE DID, WHAT SHE OBSERVED, WHAT SHE
23 ASSESSED AND ESSENTIALLY WHAT FACTUALLY TRANSPIRED FOR WHICH
24 SHE WAS PERSONALLY INVOLVED.
25 MS. BARLOW: I DON'T THINK IT'S OPINION TESTIMONY
1645
1 AT ALL. IT'S WHY SHE DID WHAT SHE DID.
2 THE COURT: OKAY. DO YOU THINK IT'S -- WHAT STRUCK
3 ME AS A LITTLE ODD IS IF SHE HAD THAT CONCERN, SHE HASN'T
4 SAID THAT THAT CONCERN WAS EXPRESSED TO THE DOCTOR, FROM MY
5 LISTENING TO HER CONVERSATION. SHE BASICALLY SAID -- SHE
6 DIDN'T SAY I HAVE THIS CONCERN AND MY CONCERN IS THIS. SHE
7 DID SAY I DON'T THINK SHE SHOULD HAVE THIS MORPHINE, BUT NOT
8 WHAT WAS BEHIND HER STATEMENT. IF SHE SAID THAT TO THE
9 DOCTOR, THAT SHOULD CLEARLY COME IN. SHE DIDN'T SAY IT TO
10 THE DOCTOR.
11 MS. BARLOW: THE WHY SHE DIDN'T SAY TO THE DOCTOR,
12 IS THAT WHAT YOU'RE SAYING?
13 THE COURT: YES. IF SHE SAID THE WHY, THAT SHOULD
14 COME IN, IF IT WAS IN A CONVERSATION. IF SHE DIDN'T, IT
15 WON'T COME IN.
16 AS TO THE ISSUE ABOUT THE JUDITH LARSEN CARE REGARDING
17 THE STATEMENT ABOUT I NEED SIX PATIENTS TO MAKE IT
18 WORTHWHILE, I'LL ALLOW THAT TO BE ASKED.
19 MS. BARLOW: YOU SAY YOU WILL?
20 THE COURT: I'LL ALLOW THAT QUESTION TO BE ASKED.
21 I'LL OVERRULE THE OBJECTION.
22 IS THERE ANYTHING ELSE TO DISCUSS BEFORE WE HAVE THE
23 JURY COME BACK? THOSE WERE THE TWO THINGS THAT I HAD.
24 MS. BARLOW: RIGHT. SO IF SHE CAN TESTIFY THAT SHE
25 DID EXPRESS WHY SHE HAD CONCERNS, THE COURT WILL ALLOW THAT?
1646
1 THE COURT: WHATEVER WAS EXPRESSED TO THE DOCTOR.
2 MS. BARLOW: THANK YOU.
3 THE COURT: OKAY. IF THERE'S NOTHING ELSE, LET'S
4 ASK TO HAVE THE JURY BACK.
5 (JURY RETURNED TO THE COURTROOM.)
6 THE COURT: THE RECORD WILL REFLECT THAT THE JURY
7 HAS RETURNED. MS. BARLOW, IF YOU WOULD LIKE TO PROCEED.
8 MS. BARLOW: THANK YOU, YOUR HONOR.
9 Q. (BY MS. BARLOW) MS. HARDEY, WE HAD TALKED A LITTLE BIT
10 EARLIER ABOUT YOU EXPRESSING YOUR CONCERNS TO THE DEFENDANT
11 ABOUT MORPHINE BEING ORDERED FOR JUDITH LARSEN EARLIER IN
12 DECEMBER. DO YOU RECALL THAT?
13 A. YES, I DO.
14 Q. DID YOU EXPRESS TO HIM WHY YOU WERE CONCERNED ABOUT THAT
15 MORPHINE ORDER?
16 A. YES, I DID. I PROBABLY DIDN'T MAKE MYSELF CLEAR THE
17 LAST TIME I SPOKE.
18 Q. WELL, WHEN DID YOU EXPRESS YOURSELF TO HIM?
19 A. ON THE 19TH, WHEN HE DISCONTINUED THE MORPHINE. I WENT
20 INTO THE DISCUSSION OF WHY I WAS CONCERNED, BECAUSE I HAD
21 LOOKED UP THE MEDICATIONS AND I THOUGHT MORPHINE WOULD
22 POTENTIATE THE EFFECT OF WHAT MEDICATIONS SHE WAS CURRENTLY
23 ON.
24 Q. WHAT DOES POTENTIATE MEAN?
25 A. WOULD INCREASE WHAT THEY'RE DOING, THE LEVELS OF WHAT
1647
1 THEY WERE MEANT TO DO.
2 Q. AND DID YOU TELL THE DEFENDANT THAT?
3 A. YES, I DID.
4 Q. DID YOU TELL HIM ANYTHING MORE ABOUT YOUR CONCERNS?
5 A. UMM, JUST THAT I WAS CONCERNED ABOUT HER RESPONSIVENESS
6 TO THAT IN CASE IT WAS INTRODUCED. IT HADN'T BEEN GIVEN AT
7 THAT POINT. I DID NOT SEE ANY PAIN AND I WAS CONCERNED
8 ABOUT IT BEING GIVEN.
9 MR. STIRBA: YOUR HONOR, I'M GOING TO OBJECT. I
10 THINK THIS ISN'T RESPONSIVE TO THE QUESTION ABOUT WHAT WAS
11 SAID.
12 Q. (BY MS. BARLOW) IS THAT WHAT YOU SAID?
13 A. THIS IS WHEN I WAS SPEAKING TO HIM. I'M SORRY I'M NOT
14 PUTTING IT IN THE RIGHT FORMAT. I WAS DISCUSSING IT WITH
15 HIM IN THIS MANNER. MY CONCERN WAS THE MORPHINE AND IT
16 INTERACTING WITH THE OTHER MEDICATIONS. I TOLD HIM I DIDN'T
17 THINK IT WOULD BE SAFE TO KEEP IT AS A SCHEDULED P.R.N. MED.
18 Q. AND THEN YOU ALREADY SAID WHAT HIS RESPONSE WAS?
19 A. YES.
20 Q. AT THE BREAK WE WERE TALKING ABOUT COFFEE GROUND EMESIS
21 LIKE -- WELL, EMESIS, COFFEE GROUND LIKE IN APPEARANCE.
22 BASED ON YOUR NURSING BACKGROUND, IS THERE ANY WAY OF
23 NARROWING DOWN WHAT CAUSES THAT KIND OF PROBLEM, YES OR NO?
24 A. YES, THERE IS.
25 Q. AND IN YOUR NURSING BACKGROUND, HOW DO YOU NARROW DOWN
1648
1 WHAT CAUSES THAT KIND OF PROBLEM?
2 A. FIRST WE WOULD DISTINGUISH WHAT EXACTLY THE EMESIS IS
3 RELATED TO.
4 MR. STIRBA: I WOULD OBJECT AS TO RELEVANCY. WHAT
5 SHE DID IS FINE, BUT SHE'S RENDERING AN OPINION NOW.
6 THE COURT: SUSTAINED.
7 Q. (BY MS. BARLOW) DID YOU YOURSELF SEE ANY OF THIS
8 VOMITING THAT SHE DID?
9 A. YES, I DID. I SAW THE AFTER RESULTS, NOT HER ACTUALLY
10 DOING IT.
11 Q. WHAT WERE -- WHEN DID YOU SEE THOSE AFTER RESULTS?
12 A. ON THE 30TH OF DECEMBER.
13 Q. AND WHAT PAGE IS THAT ON?
14 A. PAGE 576.
15 Q. IS THAT DOWN AT THE BOTTOM HERE?
16 A. YES, IT IS.
17 Q. 9:20 IN THE EVENING?
18 A. YES, IT IS.
19 Q. AND WHAT DID YOU CHART AT THAT TIME?
20 A. OKAY. PAGE 578 IS OUT OF ORDER. THAT SHOULD GO IN
21 FRONT OF 577 BECAUSE IT'S A CONTINUATION. AT 0920,
22 APPROXIMATELY 100 CC'S OF EMESIS, DARK BROWN, COFFEE GROUND,
23 COMING FROM NARES AND MOUTH. NARES MEANING NOSE.
24 Q. HOW MUCH IS A HUNDRED CC'S?
25 A. IT'S ABOUT THIS MUCH. ABOUT UP TO HERE.
1649
1 Q. YOU'RE INDICATING A SMALL CUP, MAYBE A 6-OUNCE CUP, AND
2 ABOUT HALF OF THAT?
3 A. YES.
4 Q. THANK YOU. COMING FROM NARES AND MOUTH. AND YOU SAID
5 THAT WAS WHAT?
6 A. NARES REFERS TO THE NOSE.
7 Q. AND THEN WHAT DID YOU WRITE?
8 A. "PATIENT CLEANSED. NO RESPONSE. HEART RATE TACHY,
9 IRREGULAR."
10 Q. EXCUSE ME. WHAT IS TACHY?
11 A. TACHY MEANS HIGH PACED, RAPID.
12 Q. TACHY AND IRREGULAR, WHAT DOES THAT MEAN?
13 A. IRREGULAR, NOT A REGULAR BEAT.
14 Q. OKAY. AND THEN WHAT DID YOU WRITE?
15 A. "RESPIRATIONS WERE EVEN AND UNLABORED AND SHALLOW."
16 Q. DID YOU INFORM THE DEFENDANT OF THIS VOMITING EPISODE
17 THAT YOU SAW THE RESULTS OF?
18 A. YES, I DID.
19 Q. WHEN DID YOU DO THAT?
20 A. WHEN HE PHONED ME BACK.
21 Q. AND WHEN WAS THAT?
22 A. AT 1400.
23 Q. THAT IS ON 578?
24 A. YES, IT IS.
25 Q. WHAT DID YOU CHART AT 1400?
1650
1 A. "DR. WEITZEL ORDERED M.S., I.M., TO BE GIVEN Q FOUR
2 HOURS ROUND THE CLOCK. PATIENT NOT P.O. INTAKE," MEANING
3 NOT TAKING ANYTHING BY MOUTH. "ORAL CARE GIVEN AND POSITION
4 CHANGED."
5 Q. DO YOU RECALL THAT CONVERSATION WITH THE DEFENDANT?
6 A. YES, I DO.
7 Q. YOU SAY IT HAPPENED -- WAS IT FACE TO FACE OR TELEPHONE?
8 A. OVER THE PHONE.
9 Q. HOW DID YOU GET HIM ON THE PHONE?
10 A. I PAGED HIM EARLIER AND THEN HE FINALLY CALLED BACK.
11 Q. WHAT DID YOU TELL HIM ABOUT MRS. LARSEN'S CONDITION AT
12 THAT TIME?
13 A. THE TACHY HEART RATE, THE COFFEE GROUND EMESIS.
14 Q. AND WHAT DID HE SAY BACK?
15 A. HE SAID GIVE HER THE MORPHINE AND I REITERATED AGAIN HER
16 CONDITION IS THIS. AND HE SAYS I SAID TO GIVE THE MORPHINE.
17 I SAID SHE'S NOT IN PAIN. THEN HE SAID I WANT THE MORPHINE
18 GIVEN ROUND THE CLOCK. I SAID DO YOU WANT ANYTHING DONE
19 ABOUT THE EMESIS. HE SAID I WANT THE MORPHINE GIVEN ROUND
20 THE CLOCK.
21 Q. DID YOU GIVE MORPHINE THAT DAY?
22 A. I'LL HAVE TO REFER BACK TO THE --
23 Q. BACK TO THE M.A.R.S.
24 A. (PAUSE.) I DID NOT. THE ORDER WAS WRITTEN, THOUGH, IN
25 THE M.A.R.
1651
1 Q. WHERE WAS THE ORDER WRITTEN?
2 A. ON PAGE 497.
3 Q. WHO WROTE THAT ORDER IN?
4 A. I WROTE THE ORDER IN BECAUSE I HAD BEEN THE PERSON WHO
5 HAD TAKEN IT OVER THE PHONE.
6 Q. THIS IS 497. WHICH ORDER? THERE APPEAR TO BE TWO.
7 A. I STARTED RIGHT THERE, BUT THE TIME FRAME I WANTED TO
8 REWRITE IT SO THAT IT WAS WRITTEN IN THE PROPER ORDER WITH
9 THE EARLIEST DOSE BEING AT 0230. THIS WAS THE ACTUAL TRUE
10 TRANSCRIPTION ON THE BOTTOM. AT 1430 WAS THE START OF THE
11 FIRST DOSE.
12 Q. AND WHOSE WRITING IS THAT?
13 A. I DON'T RECALL WHOSE INITIALS THOSE ARE.
14 Q. AND THIS WAS FIVE MILLIGRAMS ROUND THE CLOCK?
15 A. CORRECT.
16 Q. DID YOU GIVE ANY OF THOSE DOSES ON THAT DAY?
17 A. NO, I DID NOT.
18 Q. WHAT ABOUT THE NEXT DAY ON THE 31ST?
19 A. NO, I DID NOT.
20 Q. THE NEXT DAY ON THE 1ST?
21 A. NO, I DID NOT.
22 Q. WERE YOU JUST NOT ON SHIFT DURING THOSE DAYS?
23 A. WELL, I DIDN'T -- THE DAY I RECEIVED THE ORDER I DID NOT
24 SEE THE NEED FOR THE MORPHINE, SO I WROTE THE ORDER AND WENT
25 HOME AFTER I GAVE THE REPORT.
1652
1 Q. SO WAS THE ORDER GIVEN CLOSE TO THE END OF YOUR SHIFT?
2 A. YES, IT WAS.
3 Q. DID YOU TELL DR. WEITZEL YOU DIDN'T GIVE THAT ORDER?
4 A. NO, I DID NOT.
5 Q. IT APPEARS SOMEONE ELSE CAME IN AND DID GIVE IT, IS THAT
6 CORRECT?
7 A. YES, THEY DID.
8 Q. IF YOU WOULD TURN TO 580.
9 A. (WITNESS COMPLIED.)
10 Q. NOW, THE 31ST OF DECEMBER, DO YOU KNOW WHAT SHIFT YOU
11 WORKED?
12 A. THE 31ST OF DECEMBER?
13 Q. YES.
14 A. THAT WOULD BE A DAY SHIFT.
15 Q. AND THE TIME WAS SEVEN TO THREE?
16 A. YES.
17 Q. LET'S LOOK AT 581 FIRST. IN FACT, I THINK THIS MAY BE
18 ANOTHER ONE OF THOSE WHERE WE'RE OUT OF ORDER. LET'S LOOK
19 AT 582.
20 A. OKAY.
21 Q. IS YOUR HANDWRITING ON 582?
22 A. YES, IT IS.
23 Q. WOULD YOU LOOK THROUGH THAT AND THE CONTINUATION FROM
24 THE NEXT DAY -- WELL, LET'S GO BACK. SO, 7:30, WHAT DID YOU
25 WRITE?
1653
1 A. "PATIENT WITH EYES OPEN."
2 Q. I'M SORRY. LET'S START FIRST WITH WHAT DAY IS THIS?
3 A. THE 31ST OF DECEMBER.
4 Q. OKAY. WHAT DID YOU WRITE AT 7:30?
5 A. "PATIENT WITH EYES OPEN. NO BLINKING. NOT RESPONDING
6 TO VERBAL STIMULI. NO TACTILE STIMULI."
7 Q. WHAT IS VERBAL STIMULI?
8 A. WHERE YOU JUST GO UP AND MENTION THEIR NAME. THEY'LL
9 USUALLY RESPOND TO A NAME.
10 Q. WHAT ABOUT TACTILE?
11 A. USUALLY YOU TOUCH THEM. YOU DO SOME MOVEMENT ON THE
12 STERNUM AREA, THE CHEST, MIDSECTION. THAT'S VERY SENSITIVE
13 TO A PERSON.
14 Q. AND THE MOVEMENT YOU'RE MAKING IS WITH YOUR KNUCKLES?
15 A. CORRECT. THAT'S FOR DEEP STIMULUS.
16 Q. AND WHAT DID YOU DO THAT FOR?
17 A. TO SEE IF THEY'RE RESPONSIVE. TO SEE IF THEIR CENTRAL
18 NERVOUS SYSTEM IS COMPROMISED.
19 Q. DID YOU GET ANY RESPONSE?
20 A. NO.
21 Q. WHAT DID YOU WRITE?
22 A. "NO OUTPUT," REFERRING TO URINE OUTPUT. "PATIENT TURNED
23 IN POSITION. ORAL CARE PROVIDED."
24 Q. WHAT IS PATIENT TURNED IN POSITION?
25 A. USUALLY, IF THEY'RE NOT MOVING THEMSELVES, AS A NURSE
1654
1 YOU TURN AND POSITION THEM TO PREVENT BED SORES FROM
2 HAPPENING.
3 Q. OKAY. WHAT IS ORAL CARE?
4 A. ORAL CARE, YOU USUALLY TAKE A SWAB AND CLEANSE THEIR
5 MOUTH. IF THEY'RE NOT TAKING ANY WATER IN THEY USUALLY GET
6 VERY DRY. IT'S UNCOMFORTABLE. IT'S BASICALLY A COMFORT
7 MEASURE.
8 Q. AND THEN WHAT DID YOU WRITE?
9 A. "MOIST CLOTH TO COVER EYES TO PREVENT DRYING OUT,"
10 BECAUSE SHE WAS STARING AND NOT CLOSING HER EYES. I PUT A
11 MOIST CLOTH ON FOR EYE COMFORT.
12 "SON TELEPHONED CONCERNED ABOUT PATIENT'S MEDICAL
13 CONDITION. WANTED TO KNOW WHEN PATIENT WOULD BE DYING.
14 STAFF NURSE TOLD SON PATIENT'S MEDICAL STATUS AND RESPONSES
15 TO CARE AND MEDICATIONS BEING GIVEN. FAMILY MEMBER UPSET
16 THAT STAFF NURSE WOULD NOT STATE PATIENT WAS DYING. PATIENT
17 CONDITION POOR."
18 Q. DID YOU -- ARE YOU ONE WHO TALKED TO THE SON?
19 A. YES.
20 Q. DO YOU REMEMBER THAT CONVERSATION?
21 A. A LITTLE.
22 Q. LET'S GO NOW TO THE CONTINUATION ON 581. WHAT DID YOU
23 WRITE?
24 A. "SON CONCERNED THAT FAMILY MEMBERS WERE FLYING IN FROM
25 OUT OF STATE DUE TO NIGHT SHIFT NURSE'S REPORT TO SON ON
1655
1 12/30/95."
2 Q. AND THEN DID YOU TAKE THE VITAL STATS?
3 A. YES.
4 Q. AND WHAT DID YOU FIND?
5 A. 99.1 TEMP. 88 OVER 52 BLOOD PRESSURE. 60 PULSE. 16
6 RESPIRATIONS.
7 Q. THE 99.1, IS THAT WITHIN NORMAL RANGE FOR TEMPERATURE?
8 A. SLIGHTLY ELEVATED.
9 Q. WHAT ABOUT 88 OVER 52?
10 A. SLIGHTLY LOW.
11 Q. WHAT ABOUT 60?
12 A. THAT'S ABOUT NORMAL.
13 Q. FOR A PULSE?
14 A. A LITTLE ON THE LOW SIDE, BUT AN ACCEPTABLE RANGE.
15 Q. WHAT ABOUT 16?
16 A. THAT'S ACCEPTABLE.
17 Q. THEN WHAT DID YOU WRITE AT 9:45?
18 A. "PATIENT TURNED IN POSITION. ORAL CARE PROVIDED. NO
19 URINE OUTPUT. PATIENT NOT RESPONDING TO TACTILE OR VERBAL
20 STIMULI. RESPIRATIONS EVEN. PATIENT CONTINUES WITH EYES
21 OPEN."
22 Q. LET'S JUMP DOWN TO 1430. WHAT DID YOU WRITE THEN?
23 A. "PATIENT TURNED IN POSITION. ORAL CARE GIVEN. PATIENT
24 NONRESPONSIVE TO VERBAL, TACTILE TOUCH. VITAL SIGNS, 98
25 OVER 50; 22 RESPIRATIONS; 88 HEART RATE; 99.2 TEMPERATURE."
1656
1 Q. WHAT ABOUT THAT BLOOD PRESSURE?
2 A. IT'S ACCEPTABLE RANGE.
3 Q. WHAT ABOUT THE 22 RESPIRATIONS?
4 A. SLIGHTLY ELEVATED.
5 Q. AND 88?
6 A. THAT'S JUST A LITTLE ABOVE WHAT WE WOULD CONSIDER
7 NORMAL.
8 Q. AND THE TEMPERATURE?
9 A. THE SAME, SLIGHTLY ABOVE NORMAL.
10 Q. AND THE FAMILY WAS IN TO VISIT. DO YOU RECALL THIS DAY?
11 A. SOMEWHAT.
12 Q. DO YOU RECALL WHETHER YOU SAW ANY SIGNS AND SYMPTOMS OF
13 PAIN?
14 A. NO, I DID NOT.
15 Q. DID YOU CHART ANY?
16 A. NO, I DID NOT.
17 Q. NOW WE HAVE SOME EVENING SHIFT NURSING NOTES, WHICH IS
18 580. UNFORTUNATELY, OUR DATES UP AT THE TOP LOOK LIKE
19 THEY'VE BEEN STAMPED OUT WITH HOLE PUNCHES. WE HAVE AGAIN
20 THE B.I.R.P. WHAT WAS THE BEHAVIOR?
21 A. "PATIENT HAS BEEN UNRESPONSIVE THIS SHIFT, EXCEPT TO
22 MAKE SMALL GLUTEAL NOISE." I DON'T KNOW. "I.M. SHOTS GIVEN
23 PER DOCTOR'S ORDERS."
24 Q. DID YOU WRITE THAT?
25 A. NO.
1657
1 Q. WHO DID?
2 A. LYNN LONG.
3 Q. ON THE 31ST DID YOU GIVE ANY MORPHINE SHOTS? IF YOU
4 WILL LOOK AT 510.
5 A. (PAUSE.) NO, I DID NOT.
6 Q. SO LYNN LONG WROTE THESE ORDERS HERE AT 1830. WHAT DID
7 SHE WRITE?
8 A. WHAT PAGE?
9 Q. I'M SORRY. 580. SORRY WE HAVE TO GO BACK AND FORTH.
10 A. OKAY.
11 Q. WHAT DID SHE WRITE FOR 1830?
12 A. FREE TEXT. "VITAL SIGNS 118 OVER 60. 12 RESPIRATIONS.
13 72 HEART RATE. 96.7 TEMPERATURE. MORPHINE, FIVE
14 MILLIGRAMS, I.M., GIVEN RIGHT GLUTEUS."
15 Q. DID SHE CHART ANY PAIN AT THAT TIME?
16 A. NO, SHE DID NOT.
17 Q. LET'S LOOK AT 1930, AN HOUR LATER. WHAT DID SHE CHART?
18 A. FREE TEXT. "VITAL SIGNS, 115 OVER 65. 12 RESPIRATIONS.
19 92 PULSE RATE. 97.3 TEMP. M.S., FIVE MILLIGRAMS, I.M.,
20 GIVEN LEFT GLUTEUS PER DOCTOR'S NOW ORDER. PATIENT MOANING
21 SLIGHTLY WHEN TURNED FOR INJECTION."
22 Q. DID SHE CHART ANY PAIN?
23 A. NO, SHE DID NOT.
24 Q. AND 2230, THREE HOURS LATER, WHAT DID SHE CHART?
25 A. FREE TEXT. "VITAL SIGNS, 120 OVER 65. RESPIRATIONS,
1658
1 12. HEART RATE, 100. 99.4 TEMP. M.S., FIVE MILLIGRAMS,
2 I.M., RIGHT GLUTEUS. RESPIRATIONS EVEN AT 12 A MINUTE."
3 Q. 120 OVER 65, IS THAT WITHIN THE RANGE?
4 A. ACCEPTABLE, YES.
5 Q. WHAT ABOUT 12?
6 A. SLIGHTLY LOW.
7 Q. WHAT ABOUT 100 FOR THE PULSE RATE?
8 A. YOU'RE STARTING TO GET WHAT WE CONSIDER TACHY, AN
9 ELEVATED HEART RATE.
10 Q. AND THE 99.4?
11 A. SLIGHTLY ELEVATED.
12 Q. DID YOU SEE JUDITH ON THE 1ST OF JANUARY?
13 A. YES, I DID.
14 Q. WHAT SHIFT WAS THAT?
15 A. THAT WOULD BE THE MORNING SHIFT.
16 Q. IS THAT PAGE NUMBER 583?
17 A. CORRECT.
18 Q. AT 7:30 WHAT DID YOU SEE?
19 A. "PATIENT REPOSITIONED. ORAL CARE GIVEN. SKIN WARM TO
20 TOUCH. PATIENT RIGID WITH EXTREMITY MOVEMENT."
21 Q. WHAT DOES THAT MEAN?
22 A. SHE WAS RIGID, KIND OF STIFF.
23 Q. WHAT DOES EXTREMITY MOVEMENT MEAN?
24 A. HER ARMS AND LEGS ARE MOVING.
25 Q. ARE THEY MOVING -- IS SHE MOVING THEM?
1659
1 A. SHE'S WILLFULLY MOVING THEM. IT IS AN INVOLUNTARY
2 MOVEMENT, HOWEVER. SHE WAS DIAPERED AT THIS TIME AND IT WAS
3 DRY.
4 Q. AND THEN AT 9:35?
5 A. "PATIENT REPOSITIONED. ORAL CARE GIVEN. PULSE SLOW AND
6 IRREGULAR. EVEN UNLABORED BREATHING."
7 Q. AND THEN YOU TAKE THE VITALS?
8 A. YES. 112 OVER 78. 14 RESPIRATIONS. 66 HEART RATE AND
9 103 TEMPERATURE.
10 Q. ANY OF THOSE OUTSIDE THE RANGE OF NORMAL?
11 A. THE TEMPERATURE AND THE RESPIRATIONS.
12 Q. AND THEN WHAT DID YOU WRITE AT 11:30?
13 A. "PATIENT REPOSITIONED. ORAL CARE GIVEN. DUODERM
14 REMAINS IN PLACE." THAT IS A DRESSING THAT IS USUALLY
15 APPLIED TO A SKIN THAT IS STARTING TO GET COMPROMISED
16 BECAUSE OF BREAKDOWN IN PRESSURE IN THAT AREA.
17 Q. WHAT DOES THAT MEAN IN LAYMAN'S LANGUAGE?
18 A. IT MEANS THAT THE SKIN IS BEING PRESSURED FROM LAYING IN
19 THE BED AND WE PUT LIKE A SECOND SKIN ON IT. IT'S CALLED A
20 DUODERM. IT'S LIKE A SOFT SPONGE THAT ADHERES TO THE SKIN
21 AND PREVENTS FURTHER BREAKDOWN.
22 Q. AND THEN CAN YOU FIGURE OUT WHAT IS WRITTEN JUST ABOVE
23 YOUR SIGNATURE?
24 A. COCCYX. THAT WOULD BE THE TAIL BONE.
25 Q. OKAY. THANK YOU. I HADN'T BEEN ABLE TO READ THAT.
1660
1 THEN THE NEXT PAGE, WHICH IS THE CONTINUATION?
2 A. "FAMILY IN TO VISIT. PATIENT WITHOUT PAIN. MORPHINE
3 GIVEN Q FOUR AS SCHEDULED. COMFORT MEASURES PROVIDED. NO
4 P.O. INTAKE," MEANING ORAL INTAKE.
5 Q. IT SAYS PATIENT WITHOUT PAIN. M.S. GIVEN. DID YOU GIVE
6 THE MORPHINE SHOT?
7 A. NO, I DID NOT.
8 Q. WHO DID?
9 A. RICHARD CLARK.
10 Q. AND WHAT PAGE NUMBER ARE YOU FINDING THAT ON?
11 A. ON PAGE 497.
12 Q. WHO'S RICHARD CLARK?
13 A. HE WAS AN L.P.N. THAT WAS ON THE UNIT THAT DAY.
14 Q. AND DO YOU HAVE ANY PERSONAL KNOWLEDGE AS TO WHY HE GAVE
15 IT INSTEAD OF YOU?
16 MR. STIRBA: I'LL OBJECT, YOUR HONOR. SHE CAN'T
17 SPECULATE FOR HIM. HE WAS A WITNESS HERE AND HE DIDN'T EVEN
18 KNOW.
19 THE COURT: SUSTAINED.
20 Q. (BY MS. BARLOW) DID YOU MAKE ANY STATEMENTS ABOUT
21 GIVING THIS SHOT?
22 MR. STIRBA: OBJECTION. IRRELEVANT. HEARSAY.
23 THE COURT: OVERRULED.
24 Q. (BY MS. BARLOW) DID YOU MAKE ANY STATEMENTS ABOUT
25 GIVING THIS SHOT?
1661
1 A. RICHARD CLARK WAS IN CHARGE OF GIVING THE MEDICATIONS.
2 MR. STIRBA: I'LL OBJECT.
3 THE COURT: IT'S NOT RESPONSIVE. SUSTAINED.
4 Q. (BY MS. BARLOW) WAS IT YOUR OBLIGATION AT THAT TIME TO
5 GIVE THE SHOT?
6 A. NO, IT WAS NOT.
7 Q. OKAY. THANK YOU. DID YOU SEE IT GIVEN?
8 A. NO, I DID NOT.
9 Q. THEN AT 1400 WHAT DID YOU WRITE?
10 A. THIS IS THE END OF SHIFT REPORT. "PATIENT GIVEN COMFORT
11 CARE. RIGID MOVEMENTS WITH EXTREMITIES. PROVIDED
12 MEDICATION, INJECTIONS, COMFORT CARES. PATIENT REMAINS
13 UNRESPONSIVE TO STIMULI. EYES OPEN, STARING. CONTINUE
14 COMFORT MEASURES."
15 Q. AND THEN WE SHIFT TO SOMEONE ELSE'S WRITING?
16 A. YES. THAT'S LYNN LONG.
17 Q. WHAT DID SHE WRITE FOR BEHAVIOR?
18 A. "PATIENT UNRESPONSIVE EXCEPT TO PAINFUL STIMULI. GROANS
19 AS INJECTIONS GIVEN. PATIENT OFTEN GROANED WHEN TURNED FOR
20 PERI MOUTH CARE OR SHOTS. GAVE M.S. AS SCHEDULED. N.P.R.N.
21 WHEN PATIENT GROANING. PATIENT TURNED Q TWO HOURS. COMFORT
22 CARE IS GIVEN. PATIENT RESPONDED AS DESCRIBED ABOVE. EYES
23 OPENED, STARING. COMFORT MEASURES."
24 Q. I'M SORRY. I KEEP FORGETTING THAT WHAT I SEE HERE IS
25 NOT NECESSARILY GOING UP THERE. I'M TRYING TO FOLLOW ALONG.
1662
1 WHEN WAS THAT THAT SHE WROTE THESE?
2 A. THAT WOULD HAVE BEEN ON THE THREE TO ELEVEN SHIFT ON
3 1/1.
4 Q. DID YOU SEE ANY SIGNS OR SYMPTOMS OF PAIN CHARTED THERE?
5 MR. STIRBA: I'M GOING TO OBJECT. IT CALLS FOR HER
6 TO CHARACTERIZE THE RECORD. IT'S NOT HER RECORD.
7 THE COURT: SUSTAINED.
8 Q. (BY MS. BARLOW) LET'S TURN TO 587. DID YOU MAKE ANY
9 NOTATIONS ON THE 2ND OF JANUARY?
10 A. YES, I DID.
11 Q. AT WHAT TIME?
12 A. AT 1630.
13 Q. WHAT DID YOU SEE AT -- AT LEAST NOTE AT 1630?
14 A. "PATIENT WITH EYES OPEN, STARING. JERKING ALL
15 EXTREMITIES. MOANING. FIVE MILLIGRAMS M.S. P.R.N. GIVEN,
16 I.M. PATIENT TURNED AND POSITIONED. ORAL CARE GIVEN."
17 Q. DID YOU GIVE THAT MORPHINE SHOT?
18 A. YES, I DID.
19 Q. AND WHAT NUMBER?
20 A. PAGE 510.
21 Q. I GUESS I'M CONFUSED. OH, I SEE. DID YOU GIVE ANY
22 OTHER MORPHINE SHOTS ON THE 2ND OF JANUARY?
23 A. ON THE 2ND?
24 Q. YES.
25 A. YES, I DID.
1663
1 Q. WHAT PAGE ARE YOU LOOKING AT NOW?
2 A. PAGE 507.
3 Q. HOW MANY SHOTS OF MORPHINE DID YOU GIVE THAT DAY?
4 A. I GAVE THE ONE AT 1630 AND ONE AT 1830.
5 Q. WHY DID YOU GIVE THOSE SHOTS?
6 A. BECAUSE THEY WERE SCHEDULED.
7 Q. DO YOU RECALL SEEING ANY SIGNS OR SYMPTOMS OF PAIN?
8 A. NO, I DID NOT.
9 Q. DID YOU TALK TO DR. WEITZEL ABOUT GIVING THE SHOTS
10 BEFORE YOU GAVE THEM?
11 A. NO, I DID NOT.
12 Q. THAT WAS THE 2ND, I BELIEVE, OF JANUARY. DID YOU SEE
13 JUDITH LARSEN ON THE 3RD OF JANUARY?
14 A. YES, I DID.
15 Q. IS THAT 590?
16 A. YES, IT IS.
17 Q. WHAT DID YOU WRITE? FIRST, YOU'VE GOT WHAT TIME?
18 A. 1530. 3:30 IN THE AFTERNOON.
19 Q. AND WHAT DID YOU WRITE?
20 A. FREE TEXT. "FIVE MILLIGRAMS M.S. I.M. GIVEN PER
21 SCHEDULED DOSE BY L.P.N."
22 Q. DID YOU SEE ANY SYMPTOMS OF PAIN?
23 A. NO, I DID NOT.
24 Q. AND THEN AT 1440 WHAT DID YOU NOTE?
25 A. AT 1740.
1664
1 Q. 1740, YES, EXCUSE ME.
2 A. THAT'S 5:40 IN THE AFTERNOON. "PATIENT REPOSITIONED.
3 ORAL CARE GIVEN. PATIENT WITH CYANOTIC EXTREMITIES.
4 MOTTLING EVIDENT ON LOWER EXTREMITIES AND BACK."
5 Q. WHAT DOES CYANOTIC EXTREMITIES MEAN?
6 A. TURNING BLUE.
7 Q. AND WHAT CAUSES THEM TO TURN BLUE?
8 A. POOR CIRCULATION OF THE BLOOD TO THOSE EXTREMITIES.
9 Q. WHAT ABOUT MOTTLING EVIDENT ON LOWER EXTREMITIES AND
10 BACK?
11 A. THAT IS USUALLY THEY GET VERY PALE AND A RING OF
12 REDNESS, WHICH IS ANOTHER SIGN OF DECREASED CIRCULATION.
13 Q. AT 1800 WHAT DID YOU WRITE?
14 A. "PATIENT WITH LOUD MOANING. EXTREMITIES TWITCHING.
15 PATIENT POSITIONED. ORAL CARE GIVEN."
16 Q. 1830?
17 A. "RECEIVED DOCTOR'S ORDERS PER M.S., 15 MILLIGRAMS I.M.
18 NOW AND INCREASE M.S. TO TEN MILLIGRAMS EVERY THREE HOURS
19 DUE TO PATIENT'S AGITATED STATE."
20 Q. HOW DID THAT CONVERSATION COME ABOUT?
21 A. I TELEPHONED HIM BECAUSE OF THE TWITCHING. CAN I SAY
22 HOW I FELT, WHAT I WAS THINKING?
23 Q. NO. LET ME ASK SOME QUESTIONS. YOU TELEPHONED HIM?
24 A. YES.
25 Q. BASED ON YOUR NURSING EXPERIENCE, DID YOU TELL DR.
1665
1 WEITZEL WHAT YOU THOUGHT WAS GOING ON?
2 A. YES, I DID.
3 Q. AND WHEN DID THIS CONVERSATION TAKE PLACE?
4 A. IT WAS RIGHT AT 6:30 THAT AFTERNOON.
5 Q. OKAY. WHAT DID YOU TELL DR. WEITZEL WAS GOING ON?
6 A. I TOLD HIM I WAS CONCERNED ABOUT HER TWITCHING, HER
7 HISTORY OF SEIZURES AND TOLD HER -- TOLD HIM WHAT HER
8 PHYSICAL STATE WAS AT THAT TIME.
9 Q. WHAT WAS HIS RESPONSE?
10 A. HE GAVE THE MORPHINE ORDER.
11 Q. DID YOU SAY ANYTHING FURTHER TO HIM AFTER HE GAVE THE
12 ORDER FOR MORPHINE?
13 A. I MENTIONED THAT SHE'D BEEN ON DILANTIN BEFORE AND I HAD
14 NO RESPONSE FROM HIM.
15 Q. AND WHAT IS THE PURPOSE OF DILANTIN?
16 A. TO TREAT SEIZURES.
17 Q. DID YOU GIVE THE MORPHINE?
18 A. (PAUSE.) RICHARD CLARK DID.
19 Q. WHEN YOU WROTE THAT MORPHINE WAS INCREASED TO -- 15
20 MILLIGRAMS NOW AND INCREASED TO TEN MILLIGRAMS EVERY THREE
21 HOURS, AND IS THAT DUE TO?
22 A. YES, DUE TO.
23 Q. PATIENT'S AGITATED STATE?
24 A. UH-HUH.
25 Q. WHO DETERMINED SHE WAS AGITATED?
1666
1 A. DR. WEITZEL DETERMINED IT WAS AGITATION.
2 Q. AND THEN WHAT HAPPENED AFTER THAT?
3 A. AFTER THE INJECTION?
4 Q. AFTER THE INJECTION.
5 A. IT SAYS, "PATIENT RESTING WITH EYES CLOSED. NO
6 TWITCHING. DEEP RESPIRATIONS NOTED."
7 Q. WHAT DID YOU FIND AT 2000 HOURS?
8 A. "PATIENT WITH DECREASED HEART RATE AND DEEP
9 RESPIRATIONS, TEN," WHICH IS GETTING AT A CRITICAL VALUE.
10 Q. TEN WHAT?
11 A. BREATHS PER MINUTE. "WITH MOMENTS OF DEEP SIGHS AND
12 IRREGULARITY WITHOUT TWITCHING MOVEMENT."
13 Q. AND WHAT DID YOU WRITE AT 2010?
14 A. "PATIENT WITHOUT VITAL SIGNS PRESENT. LISTENED TIMES
15 FIVE MINUTES FOR HEART RATE AND RESPIRATIONS. NONE NOTED.
16 SUPERVISOR, DOCTOR, SOCIAL WORKER NOTIFIED."
17 Q. WHAT DID YOU DETERMINE WHEN SHE WAS WITHOUT VITAL SIGNS?
18 A. THAT SHE HAD DIED.
19 Q. HAVE YOU HAD OCCASION TO GO BACK AND LOOK AT THE
20 MORPHINE SHOTS THAT WERE GIVEN ON THE 3RD OF JANUARY TO
21 JUDITH LARSEN?
22 A. YES.
23 Q. LET'S GET TO THE RIGHT PAGE HERE. LET'S LOOK AT 507.
24 EVIDENTLY THIS WAS WRITTEN UP HERE AT 1/1 AND DOWN HERE AT
25 1/3. WHY IS IT WRITTEN IN TWO DIFFERENT PLACES LIKE THAT?
1667
1 A. THE FIRST ORDER WAS MORPHINE AT FIVE MILLIGRAMS. AND
2 THEN, WHEN I RECEIVED THE ORDER TO INCREASE IT TO TEN, I HAD
3 TO YELLOW OUT THE STOP SECTION AND REWRITE THE CURRENT NEW
4 ORDER.
5 Q. AND THEN THE ACTUAL DATE THAT THEY WERE GIVEN IS WRITTEN
6 ACROSS THE TOP, IS THAT CORRECT?
7 A. CORRECT. ON THE VERY TOP WHERE IT SAYS 1/3.
8 Q. OKAY. AT 1/3 WE HAVE FIVE MILLIGRAMS AND YOU HAVE T.S.
9 AT 0030, OR 12:30 IN THE MORNING?
10 A. UH-HUH.
11 Q. T.S., BUT IT'S CIRCLED. WHAT DOES THAT MEAN?
12 A. IT WASN'T GIVEN.
13 Q. IS THAT TRACY SCHOLL?
14 A. YES, IT IS.
15 Q. AND THEN YOU HAVE AT 3:30 T.S., AND AGAIN CIRCLED.
16 AGAIN, WHAT DOES THAT MEAN?
17 A. NOT GIVEN.
18 Q. DID YOU EVER -- WERE YOU AT ANY MEETING WHERE THE
19 WITHHOLDING OF MORPHINE WAS DISCUSSED WITH DR. WEITZEL?
20 A. YES.
21 Q. DO YOU RECALL WHEN THAT WAS IN RELATIONSHIP TO THE 3RD
22 OF JANUARY?
23 A. IT WAS THAT DAY.
24 Q. AT WHAT TIME?
25 A. IN BETWEEN SHIFT CHANGES.
1668
1 Q. THERE'S SEVERAL SHIFTS.
2 A. RIGHT AROUND 1500.
3 Q. AND WHO WAS PRESENT AT THAT MEETING?
4 A. UMM, SHEILA HANSEN, OUR BOSS. TODD CHAMBERS WAS IN ON
5 IT FOR A SHORT TIME. MYSELF, TRACY, LYNN LONG. I'M TRYING
6 TO THINK. THERE WERE A COUPLE OF OTHER NURSES. I THINK
7 EARLENE COZZEN WAS. ONE OTHER NURSE. I CAN'T THINK OF HER
8 NAME.
9 Q. DO YOU RECALL WHAT THE DEFENDANT SAID AT THAT MEETING
10 ABOUT WITHHOLDING MORPHINE?
11 A. HE TOLD US THAT YOU WILL NOT HOLD MORPHINE IF
12 RESPIRATIONS ARE LOW. YOU WILL GIVE IT ROUND THE CLOCK. IF
13 YOU DON'T GIVE IT YOU WILL CALL ME FIRST.
14 Q. THEN WE HAVE AT 6:30 THAT MORNING L.L. WHO IS THAT?
15 A. LYNN LONG.
16 Q. WHAT TIME DID SHE GIVE IT?
17 A. AT 7:30.
18 Q. WHAT ABOUT 9:30?
19 A. SHE GAVE IT AGAIN.
20 Q. 12:30?
21 A. SHE GAVE IT AGAIN.
22 Q. 1530?
23 A. RICHARD CLARK GAVE THAT DOSE AT 1700.
24 Q. AND THEN WE HAVE NOTHING FURTHER THERE. WHY IS THAT?
25 IF YOU LOOK DOWN TO THE BOTTOM PART.
1669
1 A. OKAY. THE 1830, THAT WAS WHEN DR. WEITZEL WAS CALLED
2 AND HE INCREASED THE DOSE TO 10 MILLIGRAMS.
3 Q. SO THAT'S WHAT IS CHARTED DOWN BELOW?
4 A. CORRECT.
5 Q. WAS THAT DOSE GIVEN AT 1830?
6 A. YES, IT WAS.
7 Q. WAS THE DOSE GIVEN AT 2130?
8 A. NO, IT WAS NOT.
9 Q. DO YOU KNOW WHY IT WASN'T GIVEN AT 2130?
10 A. THE PATIENT WAS DECEASED, OR CLOSE TO. SHE WAS DECEASED
11 AT 2010 ACCORDING TO THIS RECORD.
12 Q. THIS WAS WHAT YOU CALL A SCHEDULED DOSE?
13 A. YES.
14 Q. WERE THERE ANY OTHER DOSES GIVEN ON THE 3RD OF JANUARY?
15 LET'S LOOK AT NUMBER 509.
16 A. THERE WERE A TOTAL OF NINE INJECTIONS GIVEN ON THE 3RD
17 OF MORPHINE.
18 Q. OKAY. WE HAD THIS ONE, THAT LOOKS LIKE RICHARD CLARK,
19 CHARTED AS GIVING 10 MILLIGRAMS AT 1830?
20 A. CORRECT.
21 Q. NOW LET'S LOOK AT 509. DO YOU SEE ANY CHARTING OF
22 MORPHINE ON THAT?
23 A. YES. THAT WAS THE 15 MILLIGRAMS NOW ORDERED. THAT WAS
24 A VERBAL ORDER.
25 Q. AT WHAT TIME?
1670
1 A. IT WAS GIVEN AT 1830.
2 Q. SO THE SAME TIME?
3 A. CORRECT.
4 Q. NOW LET'S LOOK AT 510. DO YOU SEE ANY DOSAGES ON THE
5 3RD OF JANUARY ON THIS DOCUMENT?
6 A. YES. THREE DOSAGES GIVEN ON THE 3RD.
7 Q. WHAT TIME WAS THE FIRST ONE?
8 A. IT LOOKS LIKE TEN O'CLOCK.
9 Q. WHO GAVE THAT ONE?
10 A. LYNN LONG.
11 Q. HOW MUCH WAS IT?
12 A. 25 MILLIGRAMS.
13 Q. WHAT'S THE NEXT ONE?
14 A. 30 MILLIGRAMS AT ELEVEN O'CLOCK.
15 Q. WHO GAVE THAT ONE?
16 A. LYNN LONG.
17 Q. WHAT ABOUT THE NEXT ONE?
18 A. 30 MILLIGRAMS GIVEN AT 2:45 THAT AFTERNOON BY LYNN LONG.
19 Q. WERE THOSE IN ADDITION TO THOSE LISTED ON THE SCHEDULE?
20 A. YES. THOSE ARE ADDITIONAL ONES WHEN THEY'RE PUT IN THAT
21 AREA.
22 Q. DID YOU HAVE OCCASION TO GO THROUGH AND ADD UP HOW MANY
23 MILLIGRAMS WERE GIVEN ON THE 3RD OF JANUARY?
24 A. I HAVE NOT ADDED UP THE MILLIGRAMS, JUST THE AMOUNT OF
25 INJECTIONS, OR THE NUMBER, I MEAN.
1671
1 Q. BUT THE INJECTIONS WERE DIFFERENT, IS THAT CORRECT,
2 DIFFERENT AMOUNTS?
3 A. DIFFERENT AMOUNTS, YES.
4 Q. LET'S LOOK AT 507 AND ADD THEM UP. WE HAVE THE TWO FIVE
5 MILLIGRAMS AT --
6 A. WHAT TIME FRAME?
7 Q. 507. WE'RE TALKING FROM, IT LOOKS LIKE, MIDNIGHT ON THE
8 3RD OF JANUARY.
9 A. OKAY.
10 Q. LET'S ADD THEM UP TOGETHER. SO THE FIRST TWO FIVE
11 MILLIGRAMS WERE NOT GIVEN?
12 A. CORRECT.
13 Q. SO WE HAVE 5, 10, 15, 20 GIVEN UP TO 1530. AND THEN AT
14 1830 ANOTHER TEN, IS THAT WHAT --
15 A. 30 TOTAL.
16 Q. SO 30 TOTAL. THEN WE HAVE THE ADDITIONAL 1830 THAT WAS
17 15 MILLIGRAMS. HOW MUCH IS THAT NOW?
18 A. 45.
19 Q. THEN WE HAVE THREE MORE HERE. WE HAVE 25.
20 A. SO 65.
21 Q. 60 OR 65. AND THEN 30 MORE?
22 A. ANOTHER 90.
23 Q. UP TO 90. THEN YOU HAVE ANOTHER 30 OVER HERE AT 1445.
24 A. THAT'S 120 MILLIGRAMS.
25 MS. BARLOW: IF I MAY HAVE A MOMENT, YOUR HONOR?
1672
1 THE COURT: YOU MAY.
2 (PAUSE IN THE PROCEEDINGS.)
3 Q. (BY MS. BARLOW) IF YOU WILL PULL OUT -- LET ME --
4 BEFORE WE LEAVE JUDITH LARSEN, ON THE 3RD OF JANUARY, WHILE
5 YOU WERE ON SHIFT, DID YOU SEE ANY SIGNS OR SYMPTOMS OF
6 PAIN?
7 A. NO, I DID NOT.
8 Q. LET'S PULL MARY CRANE'S BINDER.
9 A. (WITNESS COMPLIED.)
10 Q. DO YOU RECALL MARY CRANE?
11 A. YES, I DO.
12 Q. DID YOU WORK WHILE SHE WAS THERE?
13 A. I BELIEVE I DID. I CAN CHECK. (PAUSE.) YES.
14 Q. DO YOU RECALL WHAT DAY SHE CAME ON THE UNIT?
15 A. JUST FROM HER PAPERWORK HERE. IT WOULD HAVE BEEN ON THE
16 28TH OF DECEMBER.
17 Q. AT WHAT TIME?
18 A. AT 1500.
19 Q. IF YOU WOULD TURN TO PAGE 231.
20 A. (WITNESS COMPLIED.)
21 Q. WHAT IS 231? WELL, 231, 232 AND 233, WHAT ARE THOSE?
22 A. THAT'S DR. WEITZEL'S PSYCHIATRIC EVALUATION.
23 Q. DO YOU RECOGNIZE WHAT THIS DOCUMENT IS? WELL, I THINK
24 YOU JUST ANSWERED THAT. I'M SORRY. I'LL GO TO SOMETHING
25 THAT'S NOT REPETITIVE.
1673
1 PAST PSYCHIATRIC HISTORY ON 231. THERE'S SOME WORDS IN
2 THERE THAT IF YOU CAN HELP US WITH THEM I'D APPRECIATE THAT.
3 APPARENT PSYCHOGENIC POLYDIPSIA?
4 A. YES.
5 Q. DO YOU KNOW WHAT THAT IS?
6 A. POLYDIPSIA IS AN EXCESSIVE AMOUNT OF WATER INTAKE.
7 Q. OKAY. WITH HYPONATREMIA. WHAT'S THAT?
8 A. HYPONATREMIA IS LOW SODIUM IN THE BLOOD.
9 Q. AND ARE THOSE TWO CONNECTED?
10 A. YES, THEY ARE.
11 Q. AND THEN WE'VE GOT, DOWN AT THE BOTTOM, SOME SIGN OF
12 TARDY DYSKINESIA. WHAT IS THAT?
13 A. THAT IS USUALLY A SYMPTOM, AFTER THEY'VE BEEN ON SOME
14 PSYCHOTROPICS, THAT THEY EXHIBIT. IT'S AN ADVERSE EFFECT.
15 Q. WHAT'S THE SYMPTOM THAT SHOWS?
16 A. THEY CAN HAVE SOME SHUFFLING OF THEIR FEET; A RIGIDNESS
17 WHERE THEY'RE KIND OF JERKY AS THEY MOVE.
18 Q. GOING TO THE NEXT PAGE, 232, IF YOU'LL HELP US WITH SOME
19 WORDS. THE WORD DYSPHORIC. "SPEECH IS NORMAL IN RATE,
20 RHYTHM, FLUENCY. MOOD IS QUITE DYSPHORIC." WHAT'S THAT?
21 A. ACTUALLY NOT RESPONDING, KIND OF FLAT, DESPONDENT.
22 Q. KIND OF QUIET?
23 A. DEPRESSED.
24 Q. OKAY. AFFECT SLIGHTLY LABILE?
25 A. IT GOES FROM HAPPY TO SAD. IT'S NOT AT A CONSISTENT
1674
1 LEVEL. IT KIND OF GOES BACK AND FORTH.
2 Q. WHAT IS AFFECT?
3 A. AFFECT IS THE FACIAL, THEIR POSTURE. HOW THEY POSITION
4 THEMSELVES, HOW THEY PRESENT THEMSELVES PHYSICALLY TO YOU.
5 Q. LET'S GO TO THE NEXT PAGE. RIGHT IN THE CENTER THERE,
6 WHAT WAS THE ESTIMATED LENGTH OF HOSPITALIZATION?
7 A. TWO TO THREE WEEKS.
8 Q. IF YOU'LL TURN TO 238, PLEASE.
9 A. (WITNESS COMPLIED.)
10 Q. CAN YOU TELL US WHAT THIS IS?
11 A. THAT'S THE ADMISSION ORDER.
12 Q. AND CAN YOU TELL WHO TOOK THIS ORDER?
13 A. LAURIE WILLSON.
14 Q. WAS IT BY TELEPHONE OR IN PERSON OR DO YOU KNOW?
15 A. IT'S A TELEPHONE ORDER, ACCORDING TO HER ANNOTATION.
16 Q. MAYBE JUST BRIEFLY, WE TALKED ABOUT TYLENOL AND MYLANTA
17 AND MILK OF MAGNESIA AND ZANTAC. WHAT'S LOPRESSOR?
18 A. YOU'RE BASICALLY GIVING THAT FOR BLOOD PRESSURE, HEART
19 CONDITIONS.
20 Q. AND GLUCOTROL?
21 A. THAT'S A DIABETIC MEDICATION.
22 Q. ACCU-CHECK?
23 A. THAT'S WHERE WE TEST THE BLOOD SUGAR.
24 Q. DYAZIDE?
25 A. DYAZIDE IS A DIURETIC, WHICH MEANS WE TAKE OFF EXCESS
1675
1 FLUID. IT HELPS WITH HEART RATE, BLOOD PRESSURE.
2 Q. ARTIFICIAL TEARS?
3 A. THAT'S JUST TO KEEP THE EYES FROM DRYING OUT.
4 Q. IS IT CARAFATE?
5 A. CORRECT.
6 Q. WHAT'S THAT FOR?
7 A. ANOTHER MEDICATION FOR STOMACH UPSET, LIKE A ZANTAC, BUT
8 A LITTLE GENTLER.
9 Q. WHAT ABOUT LASIX?
10 A. THAT'S ANOTHER DIURETIC WHICH GETS RID OF EXCESS FLUID.
11 Q. YOU HAVE TWO DIURETICS. ONE SAYS EVEN, ONE SAYS ODD.
12 A. THEY KIND OF SWITCH. LASIX, WHEN YOU GIVE IT YOU
13 SOMETIMES DEPLETE THE BODY OF POTASSIUM, A NECESSARY ELEMENT
14 IN YOUR BODY. THEY KIND OF TAPER IT BETWEEN THE TWO SO YOU
15 DON'T GET TOO LOW IN POTASSIUM.
16 Q. WOULD THAT BE EVEN AND ODD DAYS?
17 A. CORRECT.
18 Q. AND THEN FERROUS SULFATE?
19 A. AN IRON PILL.
20 Q. METAMUCIL?
21 A. THAT'S TO HELP WITH STOOLS.
22 Q. WHAT IS RISPERDAL?
23 A. AN ANTI-PSYCHOTROPIC.
24 Q. HOW ABOUT SERZONE?
25 A. IT'S THE OTHER ONE, AN ANTIDEPRESSANT.
1676
1 Q. AND THERE'S TWO THINGS FOR SERZONE. YOU HAVE 50
2 MILLIGRAMS TWICE A DAY FOR TWO DAYS, THEN INCREASE TO 100
3 MILLIGRAMS. AM I READING THAT CORRECTLY?
4 A. CORRECT.
5 Q. TRAZODONE?
6 A. THAT'S ANOTHER ANTIDEPRESSANT SLEEPER.
7 Q. AND WHAT IS M.R.P.T.?
8 A. MAY REPEAT. WELL, IT'S SUPPOSED TO BE MAY REPEAT TIMES
9 ONE.
10 Q. IS THAT THE TRAZODONE?
11 A. YES.
12 Q. SIMILAR TO WHAT WE READ ON JUDITH LARSEN?
13 A. YES.
14 Q. IF YOU'LL TURN TO 239.
15 A. (WITNESS COMPLIED.)
16 Q. WHAT IS THAT TOP ORDER?
17 A. DURAGESIC PATCH, 25 MILLIGRAMS, TRANSDERMAL.
18 Q. WHAT DOES THAT MEAN?
19 A. TRANSDERMAL MEANS AN EXTERIOR PATCH. YOUR BODY
20 NATURALLY ABSORBS IT THROUGH THE SKIN. IT'S A DOSING TO
21 HAVE A LEVEL TYPE OF DOSING FOR PAIN.
22 Q. SO DURAGESIC PATCHES ARE FOR WHAT?
23 A. FOR PAIN.
24 Q. THAT'S A VERBAL ORDER?
25 A. YES, THAT IS.
1677
1 Q. AND THEN D.N.R. IS?
2 A. DO NOT RESUSCITATE.
3 Q. THEN IT LOOKS LIKE WE HAVE RELAFEN. WHAT IS THAT FOR?
4 A. THEY USE IT FOR ARTHRITIC PAINS, THINGS LIKE THAT. A
5 THOUSAND MILLIGRAMS WITH FOOD IT SAYS.
6 Q. UP HERE WE HAVE THIS ONE NOTED AT WHAT TIME, THE
7 DURAGESIC PATCH?
8 A. IT LOOKS LIKE -- I DON'T KNOW. THE ORDER WAS TAKEN AT
9 1950. I DON'T KNOW WHAT TIME SHE SIGNED IT OFF. IT LOOKS
10 LIKE 1900.
11 Q. AND THEN WE HAVE HERE ON THE SAME DATE CHANGED DURAGESIC
12 TO WHAT?
13 A. TO 50 MEGS.
14 Q. WHAT IS THAT?
15 A. JUST LIKE A MILLIGRAM. IT'S A DOSING.
16 Q. DO YOU KNOW WHEN THAT WAS NOTED?
17 A. THAT WAS NOTED ON 12/28 AT 2100 BY LAURIE WILLSON.
18 Q. LET'S TURN TO THE NURSING NOTES.
19 A. (WITNESS COMPLIED.)
20 Q. ON 12/28, WHICH IS NUMBER 306, DID YOU WRITE THAT AT THE
21 TOP?
22 A. NO, I DID NOT.
23 Q. OKAY. BUT WHAT IS CHARTED THERE?
24 A. "P.R.N. MED GIVEN," MEANING AS NECESSARY," TYLENOL 650
25 MILLIGRAMS, P.O.," BY MOUTH, "GIVEN AS ORDERED AS PATIENT
1678
1 COMPLAINS OF HEADACHE."
2 Q. SO C.O. AND H.A. IS COMPLAINS OF HEADACHE?
3 A. CORRECT.
4 Q. AND WHAT WAS CHARTED AT 2000 HOURS?
5 A. "TYLENOL HELPFUL. PATIENT COMPLAINS STILL HAS HEADACHE
6 BUT IT'S BETTER."
7 Q. IS TYLENOL 650 A PRESCRIPTION MEDICINE?
8 A. IT'S AN OVER-THE-COUNTER MEDICATION, BUT THAT'S A NORMAL
9 DOSE FOR IT.
10 Q. THEN IF YOU WOULD TURN TO 307. AT THE TOP, AT 6:45,
11 "PATIENT SLEPT ALL SHIFT." THEN IT LOOKS LIKE AT 800
12 SOMETHING HAPPENED. CAN YOU READ WHAT HAPPENED?
13 A. LET'S SEE. AT THE VERY TOP IT SAYS, "PATIENT SLEPT ALL
14 SHIFT UNTIL SHE WAS AWOKEN FOR -- AWAKENED FOR HER CHEST
15 X-RAY. NO PROBLEMS NOTED IN SHIFT." THEN AT 0800,
16 "DURAGESIC PATCH CAME OFF. NEW DURAGESIC APPLIED."
17 Q. ON 311, WHICH WAS 12/31, THAT APPEARS TO BE THE FIRST
18 TIME THAT YOU -- YOUR SIGNATURE APPEARS ON IT?
19 A. UH-HUH.
20 Q. NOW, THIS WAS THREE DAYS AFTER SHE CAME IN?
21 A. CORRECT.
22 Q. DO YOU RECALL WHETHER YOU WORKED THOSE THREE DAYS AT
23 ALL?
24 A. I DON'T RECALL UNLESS THERE'S AN ANNOTATION. LET ME
25 CHECK THAT. NO, THERE IS NOTHING PRIOR TO THAT.
1679
1 Q. ON THE -- THIS IS DECEMBER 31ST?
2 A. CORRECT.
3 Q. IS THIS YOUR HANDWRITING IN THE CENTER?
4 A. AT 1030, YES.
5 Q. AND WHAT DID YOU WRITE?
6 A. "PATIENT VERY DROWSY, NOT ABLE TO STAY AWAKE."
7 Q. DO YOU SEE ANY SIGNS OR SYMPTOMS -- DID YOU SEE ANY
8 SIGNS OR SYMPTOMS OF PAIN WITH HER THAT DAY?
9 A. NO.
10 Q. AND THEN FOR A DIFFERENT SHIFT HERE, ON NUMBER 312, IT
11 APPEARS AS THE 1625 TO 2300 SHIFT, WHO WROTE THAT?
12 A. LYNN LONG.
13 Q. AND WHAT DID SHE WRITE?
14 A. FREE TEXT. "PATIENT WAS INCREASED AGITATED FROM 1900
15 ON. SCREAMING, TRYING TO HIT. HITTING C.N.A." THAT'S THE
16 CERTIFIED NURSING ASSISTANT. "DOCTOR NOTIFIED. PATIENT
17 MEDICATED WITH ATIVAN, TWO MILLIGRAMS, I.M., WITH GOOD
18 RESULTS. PATIENT SETTLED DOWN AND AGREED TO TAKE HER P.M.
19 MEDS."
20 Q. IS THERE ANY NOTATION OF PAIN IN THAT?
21 A. NO.
22 Q. ON THE NEXT DAY, 313 AND 314, DID YOU SEE THE PATIENT
23 THAT DAY ON THE 1ST OF JANUARY?
24 A. YES, I DID.
25 Q. WERE YOU THE ONE WHO NOTICED THE FECAL MATERIAL COMING
1680
1 FROM THE VAGINA?
2 A. YES.
3 Q. AND WHEN DID THAT OCCUR?
4 A. UMM, THAT OCCURRED WHEN WE WERE DOING THE PERI CARE
5 AFTER SHE'D HAD A BOWEL MOVEMENT.
6 Q. WHAT IS PERI CARE?
7 A. WHERE YOU CLEANSE THE PRIVATE AREA OF A PATIENT.
8 Q. OKAY. DO YOU RECALL ANY SIGNS OR SYMPTOMS OF PAIN AS
9 YOU WERE NOTICING THIS FECAL MATERIAL?
10 A. NO, I DID NOT.
11 Q. WHAT DID YOU DO?
12 A. I CONTACTED DR. DIENHART.
13 Q. DID YOU TELL -- DID YOU EVER -- AFTER YOU FOUND THIS AND
14 YOU CONTACTED DR. DIENHART, DID YOU TELL DR. WEITZEL THAT
15 YOU HAD CONTACTED DR. DIENHART?
16 A. YES, I DID.
17 Q. WHEN DID YOU TELL HIM THAT?
18 A. I CAN'T RECALL THE EXACT TIME.
19 Q. WAS IT THE SAME DAY?
20 A. I WOULDN'T BE ABLE TO TELL YOU THAT.
21 Q. WAS IT WITHIN A SHORT TIME PERIOD?
22 A. YEAH, BECAUSE WE HAD -- HE HAD AGREED TO HAVE A
23 GYNECOLOGIST COME IN AND TAKE AN EXAM, HAVE ANOTHER OPINION.
24 Q. DID YOU HAVE ANY DISCUSSION WITH THE DEFENDANT ABOUT
25 CALLING IN DR. DIENHART FOR THIS CONSULTATION, OR YOU MAKING
1681
1 THIS PHONE CALL, I GUESS, TO DR. DIENHART?
2 A. ON THIS PARTICULAR PATIENT, NO, THERE WAS NO
3 CONFRONTATION OR ANYTHING ABOUT IT.
4 THE COURT: HOW MUCH MORE TIME DO YOU HAVE WITH
5 THIS WITNESS?
6 MS. BARLOW: I THINK IT WILL TAKE QUITE A WHILE.
7 THE COURT: OKAY. LADIES AND GENTLEMEN, LET'S TAKE
8 OUR LAST BREAK FOR THE DAY. REMEMBER THAT WHILE ON THE
9 BREAK IT'S YOUR DUTY NOT TO CONVERSE AMONG YOURSELVES OR TO
10 CONVERSE WITH ANYONE ELSE REGARDING THE SUBJECT OF THIS
11 TRIAL. IT'S YOUR DUTY NOT TO FORM OR EXPRESS AN OPINION
12 UNTIL THE CASE IS FINALLY SUBMITTED TO YOU. LET'S COME BACK
13 AT 4:05.
14 (JURY OUT OF THE COURTROOM.)
15 THE COURT: WHERE ARE WE AT IN TERMS OF -- ARE WE
16 GOING TO GET THIS WITNESS DONE TODAY?
17 MS. BARLOW: I DON'T THINK WE ARE, ESPECIALLY WITH
18 CROSS-EXAMINATION.
19 THE COURT: OKAY. LAST WEEK I THOUGHT YOU WERE
20 TELLING ME THAT YOU THOUGHT -- WE DIDN'T SAY THIS TO THE
21 JURY, BUT THAT THE PLAINTIFF'S CASE MIGHT BE DONE BY
22 THURSDAY. WHAT ARE WE LOOKING AT NOW IN LIGHT OF HOW IT'S
23 MOVING?
24 MR. WILSON: YOUR HONOR, IT IS A LITTLE BIT
25 DIFFICULT TO SAY. I THINK THERE HAVE BEEN A NUMBER OF
1682
1 THINGS THAT HAVE OCCURRED AS A RESULT OF SOME OF THE RULINGS
2 ON OUR MOTIONS SO THAT WE'VE HAD TO REVISE SOME OF OUR
3 EXHIBITS. I'M STILL HOPEFUL THAT WE CAN FINISH UP SOMETIME
4 THIS WEEK.
5 THE COURT: OKAY. ONE OF THE LAST THINGS THAT THE
6 WITNESS READ WAS IT SAID PATIENT VERY DROWSY, NOT ABLE TO
7 STAY AWAKE. I THINK THAT DESCRIBES EVERYBODY HERE. I'VE
8 NOTICED FOR THE FIRST TIME TWO JURORS KIND OF NODDING THEIR
9 HEADS LIKE THIS. SO WHATEVER YOU CAN DO TO KEEP THEM AWAKE
10 AND KEEP EVERYBODY AWAKE WOULD HELP. I THINK THEY ARE
11 GETTING DROWSY. WE'RE TAKING REGULAR ONE HOUR BREAKS, BUT
12 LET'S TRY TO DO AS MUCH AS WE CAN TO KEEP THEM AWAKE. IF
13 YOU SEE ANY OF THEM SLEEPING, RAISE YOUR VOICE OR SOMETHING.
14 OKAY. WE'LL SEE YOU AT 4:05 ALSO.
15 (SHORT RECESS.)
16 THE COURT: WAS THERE SOMETHING TO ADDRESS BEFORE
17 THE JURY COMES BACK?
18 MR. STIRBA: YES, YOUR HONOR. ONE OF OUR LONG-TIME
19 EMPLOYEES HAD A FAMILY TRAGEDY LAST WEEK. HER GRANDDAUGHTER
20 IS GOING TO BE BURIED AND THERE'S A FUNERAL TOMORROW. IT
21 STARTS AT ELEVEN O'CLOCK IN RIVERTON. ALL OF US, AS PART OF
22 THE DEFENSE TEAM, FEEL THAT IT'S IMPORTANT THAT WE ATTEND
23 THAT FUNERAL. I'M WONDERING IF THE COURT -- WITH THE
24 COURT'S PERMISSION, PERHAPS WE COULD BE EXCUSED AT TEN
25 O'CLOCK. THE FUNERAL STARTS AT ELEVEN. THEN MAYBE
1683
1 RECONVENE HERE AT MAYBE TWO O'CLOCK, GIVEN THE NATURE OF THE
2 DISTANCES AND THE CIRCUMSTANCES. THAT'S THE SCHEDULING
3 ISSUE.
4 THE COURT: HOW ARE PEOPLE ABOUT STARTING EARLIER?
5 MR. STIRBA: THAT'S FINE WITH ME, JUDGE.
6 THE COURT: I MEAN, I'M HERE AT SEVEN.
7 MS. BARLOW: EIGHT O'CLOCK IS FINE. I DRIVE UP
8 FROM UTAH COUNTY.
9 THE COURT: THAT'S A LONG WAY. OKAY. SO WHAT
10 ABOUT GOING EIGHT TO TEN AND THEN TWO TO FIVE? THAT IS WHAT
11 YOU'RE SAYING?
12 MR. STIRBA: THAT WOULD BE GREAT IF THE COURT WOULD
13 ACCOMMODATE US.
14 THE COURT: IS THAT ALL RIGHT WITH YOU?
15 MS. BARLOW: THAT IS FINE, JUDGE.
16 THE COURT: OKAY. LET'S TALK TO THE JURY ABOUT
17 THAT BEFORE THEY LEAVE.
18 MR. STIRBA: THANK YOU, JUDGE.
19 THE COURT: ANYTHING ELSE TO DISCUSS OR CAN WE
20 BRING THEM BACK?
21 MS. BARLOW: THE STATE IS FINE.
22 THE COURT: OKAY. BRING THE JURY IN.
23 (JURY RETURNED TO THE COURTROOM.)
24 THE COURT: LADIES AND GENTLEMEN, WE HAD A
25 DISCUSSION BEFORE YOU CAME IN REGARDING THAT SOME OF THE
1684
1 PEOPLE THAT ARE INVOLVED IN THIS TRIAL HAVE A FUNERAL OF
2 SOMEBODY CLOSE TO THEM TOMORROW. THIS FUNERAL IS AT ELEVEN
3 A.M. IN RIVERTON. RIVERTON IS SOUTH OF SALT LAKE CITY SO IT
4 TAKES A WHILE TO GET THERE.
5 THEY'RE PROPOSING, IN LIGHT OF THAT, AND BOTH SIDES
6 HAVE AGREED AND THE WITNESS SAID SHE COULD ALSO BE HERE, IF
7 WE CAN GO FROM EIGHT TO TEN TOMORROW AND THEN TWO TO FIVE.
8 IS THAT GOING TO CREATE ANY HUGE GRIEF FOR ANYONE? IT WOULD
9 MEAN THAT YOU WOULD BE FREE FROM TEN O'CLOCK UNTIL TWO. IF
10 THAT'S NOT GOING TO CAUSE ANY GRIEF THEN WE WOULD ASK YOU TO
11 BE HERE AT EIGHT O'CLOCK TOMORROW MORNING.
12 I SUGGEST THAT SINCE WE'RE ONLY GOING TO GO FOR TWO
13 HOURS, LET'S TRY TO MAKE IT TWO HOURS. IF YOU NEED TO STAND
14 UP, STAND UP BETWEEN WITNESSES. IF YOU NEED A REST ROOM
15 BREAK, WE'LL DO THAT. BUT IF WE CAN GO EIGHT TO TEN AND
16 HAVE TWO HOURS, THEN MAYBE TAKE ONE BREAK IN THE AFTERNOON,
17 SO WE CAN GET AS MANY WITNESSES DONE TO MAKE UP FOR THE TIME
18 THAT WE'RE NOT IN COURT.
19 LET'S JUST PLAN ON THAT, EIGHT A.M. TOMORROW TO TEN AND
20 THEN TWO P.M. UNTIL FIVE. I APPRECIATE THAT. MS. BARLOW.
21 MS. BARLOW: THANK YOU, YOUR HONOR. I THINK I
22 NOTICED SOME SMILES ON THE JURY'S FACES.
23 THE COURT: BECAUSE THEY WANT TO COME EARLIER. WE
24 CAN COME AT SEVEN.
25 MS. BARLOW: NO. I DON'T KNOW THAT THAT WOULD
1685
1 BRING ANY SMILES.
2 Q. (BY MS. BARLOW) WE WERE TALKING ABOUT MARY CRANE. I
3 THINK THAT WE WERE TALKING ABOUT THE 1ST OF JANUARY.
4 A. WHAT PAGE WAS THAT, AGAIN?
5 Q. 313.
6 A. OKAY.
7 Q. YOU MADE A NOTATION AT 12 NOON AND WHAT IS THAT
8 NOTATION?
9 A. "DR. DIENHART IN TO SEE PATIENT. RECEIVED ORDERS FOR A
10 C.B.C. WITH DIFF AND A G.Y.N. CONSULT."
11 Q. WHAT'S A C.B.C. WITH DIFF?
12 A. A LAB THAT TESTS YOUR BLOOD FOR THE RED BLOOD CELLS, THE
13 WHITE BLOOD CELLS, INFECTION, THINGS LIKE THAT.
14 Q. AND THEN WHAT HAVE YOU WRITTEN AFTER?
15 A. N.G.Y.N. CONSULT. THAT A GYNECOLOGY CONSULT.
16 Q. AND WHAT NEXT?
17 A. DECREASE DURAGESIC PATCH TO 25 MEGS.
18 Q. OKAY. LET'S SEE IF WE CAN FIND THAT IN THE MEDICAL
19 NOTES. (PAUSE.) 284, DO YOU HAVE THAT?
20 A. OKAY.
21 Q. IT SAYS 1/1 ORDER DATE. WAS THE DURAGESIC PATCH
22 ORDERED?
23 A. THAT WAS WHEN IT WAS ORDERED, BUT IT'S ALSO YELLOWED
24 THROUGH.
25 Q. AND WHAT DOES THAT MEAN?
1686
1 A. THAT MEANS IT WAS DISCONTINUED. ORDERED THAT DAY AND
2 DISCONTINUED.
3 Q. OKAY. LET'S SEE IF WE CAN MAKE SENSE OUT OF THAT.
4 LET'S TURN TO THE PROGRESS -- NO, TO THE PHYSICIAN'S ORDERS.
5 A. PAGE 242.
6 Q. THANK YOU. I'D GONE TOO FAR. MY BIGGEST PROBLEM IS I
7 DON'T HAVE 242. CAN I PULL IT OUT OF YOURS SO I CAN SHOW IT
8 TO THE JURY?
9 A. (WITNESS COMPLIED.)
10 Q. I KNOW IT'S HARD TO READ. THIS IS DR. DIENHART'S?
11 A. THAT'S WHO I CALLED FOR A CONSULT ON HER.
12 Q. AND HE WROTE WHAT?
13 A. "DECREASE DURAGESIC PATCH TO 25 MEGS, Q THREE DAYS."
14 THAT MEANS CHANGE IT EVERY THREE DAYS. THAT'S THE
15 TRANSDERMAL PATCH ON THE OUTSIDE. HE ORDERED A C.B.C. TODAY
16 WITH A DIFFERENTIAL."
17 Q. AND DID YOU NOTE THIS?
18 A. YES, I DID.
19 Q. AND WHAT TIME DID YOU NOTE IT?
20 A. AT 1210.
21 Q. NOW, IF YOU HAVE 243, WHICH I ALSO SEEM TO BE MISSING.
22 WHAT TIME WAS THAT, AGAIN?
23 A. 1210.
24 Q. 1210. NOW WE HAVE, ON 1/1 -- WHO WROTE THIS NOTE, OR
25 THIS ORDER?
1687
1 A. THIS IS DR. WEITZEL'S WRITING.
2 Q. ACCU-CHECK TO CONTINUE FOR THE DIABETES?
3 A. UH-HUH.
4 Q. WHAT'S THE INSULIN SLIDING SCALE?
5 A. THAT'S TO COVER THE BLOOD SUGARS. IN CASE THEY WERE
6 ELEVATED GIVE INSULIN TO BRING THEM DOWN.
7 Q. AND THEN NUMBER THREE SAYS -- WHAT DOES THAT SAY?
8 A. "DURAGESIC, 15 MEGS. Q THREE DAYS." THAT'S AN INCREASE
9 ON THE DURAGESIC PATCH.
10 Q. AND WHEN WAS THAT NOTED?
11 A. THAT WAS NOTED AT 1700. FIVE O'CLOCK THAT AFTERNOON.
12 Q. THAT WAS ON THE 1ST, IS THAT CORRECT?
13 A. YES.
14 Q. I'LL GIVE YOU THAT BACK. DO YOU KNOW IF THAT PATCH
15 WAS -- IF EITHER OF THOSE PATCHES WERE ACTUALLY PLACED ON?
16 A. I KNOW THE 25 WAS NEVER DECREASED BEFORE IT WAS
17 DISCONTINUED. IT WAS YELLOWED OUT AND THERE WAS NO
18 ANNOTATION THAT IT WAS PUT ON.
19 Q. AND THAT'S ON 284?
20 A. YES.
21 Q. AND HOW DO YOU KNOW IT WASN'T DONE?
22 A. BECAUSE IT WASN'T INITIALED. USUALLY WE DON'T KEEP
23 THOSE IN STOCK. BY THE TIME WE GET THE PHARMACY TO BRING
24 THEM UP IT COULD BE A WHILE.
25 Q. LET'S LOOK AT 285 NOW. LET'S DON'T. THAT'S AN EARLIER
1688
1 ONE THAT WON'T HELP US. LET'S LOOK AT 286.
2 A. YES.
3 Q. WAS THE DURAGESIC PATCH PLACED ON?
4 A. YES, IT WAS.
5 Q. AND THAT WAS WHAT DAY?
6 A. ON THE 1ST.
7 Q. AT WHAT TIME?
8 A. AT SEVEN O'CLOCK THAT NIGHT.
9 Q. WHO DID IT?
10 A. LYNN LONG.
11 Q. WHILE WE'RE TALKING ABOUT DURAGESIC PATCHES, THAT DAY
12 WAS WHAT?
13 A. ON THE 1ST.
14 Q. LET'S LOOK AT 287, THE MEDICAL RECORD. CAN YOU TELL US
15 WHAT HAPPENED WITH THE DURAGESIC PATCH ON THIS DOCUMENT?
16 A. ON THE 4TH IT LOOKS LIKE IT WAS INCREASED AGAIN TO 75.
17 Q. AND AT WHAT TIME?
18 A. THAT WAS DONE AT 0800.
19 Q. AND WE HAVE SOME INITIALS HERE. WHAT DOES THAT MEAN?
20 A. THAT IT WAS GIVEN, PLACED.
21 Q. DO YOU KNOW WHOSE INITIALS THOSE ARE?
22 A. I BELIEVE THAT'S A GAL WE CALL SUSAN. I'M NOT REAL SURE
23 ON THAT ONE.
24 Q. LET'S GO BACK TO THE NURSE'S NOTES. WE'VE HAD THE
25 DURAGESIC PATCH INCREASED ON THE 1ST OF JANUARY, RIGHT?
1689
1 A. YES. FIRST IT WAS DECREASED BY DR. DIENHART.
2 Q. BUT THAT WAS NEVER PLACED ON?
3 A. THAT WAS NEVER DONE.
4 Q. LET'S LOOK AT 315. WHAT DATE WAS THIS?
5 A. 1/2/96.
6 Q. AND THE FREE TEXT SOMEONE WROTE ON 315?
7 A. ON PAGE 315?
8 Q. YES.
9 A. FREE TEXT, NIGHT SHIFT, "PATIENT RESTED WELL ALL NIGHT.
10 DID NOT GET UP OR MAKE ANY COMPLAINTS."
11 Q. DO YOU KNOW WHOSE SIGNATURE THAT IS?
12 A. NICKI HANCOCK. SHE'S A CERTIFIED NURSING ASSISTANT.
13 Q. AND THEN SOMEONE ELSE AND IT LOOKS LIKE TYLER SPRIG?
14 A. YES.
15 Q. HE WROTE THE B.I.R.P.?
16 A. YES.
17 Q. WHAT DID HE WRITE FOR BEHAVIOR?
18 A. "PATIENT HAS BEEN HITTING, THROWING FOOD, TRAY, ON FLOOR
19 AND KICKING STAFF. PATIENT HAS BEEN UNCOOPERATIVE WITH
20 STAFF. PATIENT HAS BEEN ALERT AND DISORIENTED."
21 Q. NOW, THOSE ARE BOTH WRITTEN FOR THE SAME TIME FRAME, IS
22 THAT CORRECT?
23 A. NO. THE NIGHT SHIFT WAS NICKI AND TYLER WOULD HAVE BEEN
24 ON THE DAY SHIFT, BECAUSE THEY ONLY HAVE ONE C.N.A. ON AT
25 NIGHTS.
1690
1 Q. SO WE JUST DON'T HAVE THE TIME?
2 A. CORRECT.
3 Q. OKAY. ON 316 THERE IS YOUR SIGNATURE AT THE BOTTOM?
4 A. CORRECT.
5 Q. DID YOU WRITE ANYTHING ON IT?
6 A. I DID THE INITIAL PHYSICAL ASSESSMENT.
7 Q. OVER HERE UNDER NEUROLOGICAL, DID YOU DO THAT?
8 A. UMM, CORRECT.
9 Q. WHAT DID YOU SEE IN MARY CRANE THAT DAY?
10 A. SHE WAS ALERT AND ALSO DISORIENTED.
11 Q. DID YOU CHART ANY SIGNS OR SYMPTOMS OF PAIN?
12 A. NO, I DID NOT.
13 Q. AND THAT'S THE 2ND OF JANUARY?
14 A. YES.
15 Q. CAN YOU LOOK AT 317.
16 A. (WITNESS COMPLIED.)
17 Q. THIS IS THE DAY SHIFT. WERE YOU ON THAT DAY OR DURING
18 THE DAY SHIFT, THAT SHIFT?
19 A. PAGE 317. LET'S SEE. I WOULD HAVE BEEN ON THE THREE TO
20 ELEVEN SHIFT ON THE 2ND. ON THE 3RD I WAS NOT ON. WELL,
21 YES, I WAS.
22 Q. WHAT TIME DID YOU COME ON?
23 A. ON PAGE 320 I WAS DOING A THREE P. THAT'S A THREE P.M.
24 TO ELEVEN P.M. SHIFT ON THE 3RD.
25 Q. LET'S LOOK AT 317.
1691
1 A. OKAY.
2 Q. FREE TEXT AT NOON.
3 A. FREE TEXT, LATE ENTRY. "PATIENT WAS CALM AFTER LUNCH.
4 TOOK A NAP. MORPHINE EFFECTIVE WITH DECREASE IN PAIN."
5 Q. OKAY. DO YOU HAVE ANY IDEA WHAT A.E.B. IS?
6 A. NO, I DO NOT.
7 Q. SO GO ON FROM THERE.
8 A. "PATIENT SAYING, WHEN ASKED IF SHE STILL HAS PAIN, NO."
9 Q. WHO WROTE THAT?
10 A. LYNN LONG.
11 Q. AND THEN AT 1400?
12 A. FREE TEXT?
13 Q. FREE TEXT.
14 A. LATE ENTRY. "PATIENT AWOKE FROM NAP YELLING. WHEN
15 ASKED IF SHE HAD PAIN SHE SAID YES. WHEN ASKED IF HER TUMMY
16 HURT PATIENT SAID NO. ASKED IF SHE HAD A HEADACHE PATIENT
17 SAID YES. THEN PATIENT YELLED OH, OH, OH, HURRY. DOCTOR
18 NOTIFIED. PATIENT MEDICATED WITH MORPHINE, FIVE MILLIGRAMS,
19 PER DOCTOR'S ORDER."
20 Q. AND THEN AT 1530, AN HOUR AND A HALF LATER, FREE TEXT
21 AND WHAT WAS NOTED?
22 A. "PATIENT ASKED IF SHE WAS STILL IN PAIN. PATIENT SAID
23 YES. PATIENT ASKED IF SHE HAD HEAD OR TUMMY PAIN. PATIENT
24 RESPONDED YES, ALTHOUGH HER DIMINISHED MENTAL CONDITION
25 MAKES HER RESPONSE SUSPECT AS FAR AS ACCURACY GOES."
1692
1 Q. DO YOU UNDERSTAND WHAT THAT -- WELL, LET'S NOT PUT IT
2 THAT WAY. DID YOU EVER ASK ANY OF THESE PATIENTS IF THEY
3 WERE IN PAIN?
4 A. UMM, NOT REALLY. BECAUSE OF THE COGNITIVE STATUS YOU
5 COULDN'T REALLY RELY A LOT ON A YES OR NO. IF THEY'RE ALERT
6 AND DISORIENTED, THEY'RE NOT ABLE TO PROCESS -- NORMALLY
7 WHAT A NURSE WOULD SAY --
8 MR. STIRBA: I'LL OBJECT. I THINK THE QUESTION WAS
9 DID YOU EVER ASK IF THESE PATIENTS WERE IN PAIN. NOW WE'RE
10 HAVING A NARRATIVE.
11 THE COURT: GO AHEAD.
12 Q. (BY MS. BARLOW) WHY DID YOU NOT ASK IF THEY WERE IN
13 PAIN?
14 A. I DIDN'T THINK --
15 MR. STIRBA: I'LL OBJECT. IRRELEVANT.
16 MS. BARLOW: I THINK IT'S VERY RELEVANT TO THIS
17 NOTATION.
18 MR. STIRBA: YEAH, BUT IT'S A COMMENT AND IT'S LAY
19 OPINION. IT'S NOT RELEVANT.
20 THE COURT: SUSTAINED.
21 Q. (BY MS. BARLOW) AS A NURSE DO YOU LOOK FOR SIGNS AND
22 SYMPTOMS OF PAIN?
23 A. YES, I DO.
24 Q. DO YOU ASK PATIENTS IF THEY'RE IN PAIN?
25 A. IF THEY'RE COGNITIVELY ABLE TO ANSWER YES OR NO.
1693
1 Q. IF A PATIENT'S COGNITIVE FUNCTION IS DECREASED, DO YOU
2 RELY ON --
3 MR. STIRBA: I'LL OBJECT, YOUR HONOR. IT'S
4 IRRELEVANT. IT'S NOT WITH RESPECT TO THESE FIVE PATIENTS.
5 THE COURT: I HAVEN'T HEARD THE QUESTION.
6 MR. STIRBA: I'M SORRY, YOUR HONOR.
7 Q. (BY MS. BARLOW) LET'S TALK ABOUT THESE FIVE PATIENTS.
8 WERE THESE FIVE PATIENTS COGNITIVELY DIMINISHED?
9 MR. STIRBA: OBJECTION. CALLS FOR AN OPINION SHE'S
10 NOT COMPETENT TO MAKE.
11 THE COURT: LAY A FOUNDATION. I THINK THE QUESTION
12 IS WHETHER SHE ASKED THEM ABOUT PAIN. WASN'T THAT WHAT YOU
13 WERE ASKING?
14 MS. BARLOW: THAT WAS THE INITIAL QUESTION, YES.
15 Q. (BY MS. BARLOW) DID YOU ASK ANY OF THESE PATIENTS
16 ABOUT PAIN?
17 A. NO, I DID NOT.
18 Q. AS A NURSE, BASED ON YOUR EXPERIENCE -- I NEED TO FIGURE
19 OUT HOW TO PHRASE THIS.
20 DID YOU HAVE OCCASION TO ASSESS THESE FIVE PATIENTS'
21 ABILITY TO UNDERSTAND WHAT WAS GOING ON, JUST YES OR NO?
22 A. YES.
23 Q. OKAY. AND WHAT DID YOU USE TO BASE THAT ASSESSMENT ON?
24 A. YOU WOULD WORK BY ASKING SIMPLE QUESTIONS. THE DATE, DO
25 THEY KNOW WHERE THEY'RE AT, THEIR NAME. BASIC ORIENTATION
1694
1 TYPE QUESTIONS TO SEE WHERE THEIR LEVEL OF UNDERSTANDING IS
2 AT.
3 Q. WITH THESE FIVE PATIENTS DID YOU DO THAT KIND OF AN
4 ASSESSMENT?
5 A. YES, I DID.
6 Q. AND WHAT DID YOU FIND, LET'S SAY WITH MARY CRANE, ABOUT
7 HER ABILITY TO ANSWER THOSE KINDS OF QUESTIONS?
8 A. SHE WAS ORIENTED TO SELF, MEANING THAT SHE KNEW WHO SHE
9 WAS. SHE WAS NOT ORIENTED TO TIME, PLACE OR THAT DAY'S
10 ENVIRONMENT.
11 Q. BASED ON THAT DID YOU MAKE A DETERMINATION AS TO WHETHER
12 TO ASK MARY CRANE WHETHER SHE WAS IN PAIN OR NOT?
13 A. YES.
14 Q. AND WHAT WAS YOUR DETERMINATION?
15 A. THAT SHE WOULD NOT BE ABLE TO ANSWER THAT APPROPRIATELY.
16 Q. THANK YOU. WHEN NEXT DID YOU SEE MARY CRANE AFTER THE
17 1ST OF JANUARY, 1996?
18 A. ON THE 3RD I DID HER ASSESSMENT.
19 Q. AND THAT IS NUMBER 320?
20 A. CORRECT.
21 Q. OVER TO THE RIGHT HERE IT SAYS MISTAKEN ENTRY AND IT
22 LOOKS LIKE R. CLARK, SO WE WON'T -- WELL, I WON'T ASSUME
23 ANYTHING. WHAT DOES THAT MEAN?
24 A. THAT MEANS THAT HE INADVERTENTLY CHARTED ON ANOTHER
25 PATIENT BY MISTAKE.
1695
1 Q. SO THAT HAS NOTHING TO DO WITH MARY CRANE?
2 A. NOTHING.
3 Q. WHAT PART, THEN, DID YOU FILL OUT OF THIS FORM?
4 A. THE PHYSICAL ASSESSMENT, WHERE IT STARTS WITH
5 NEUROLOGICAL.
6 Q. DOWN AT THE BOTTOM HERE?
7 A. YES. AND ALL THE WAY UP THROUGH ALL OF THE AREAS OF
8 PHYSICAL ASSESSMENT.
9 Q. WHAT DID YOU FIND ABOUT HER NEUROLOGICALLY?
10 A. SHE WAS ALERT AND DISORIENTED.
11 Q. DID YOU DO HER PSYCHO-SOCIAL ASSESSMENT?
12 A. YES.
13 Q. AND WHAT DID YOU FIND?
14 A. THAT SHE WAS ANXIOUS AND AGITATED; UNCOOPERATIVE WITH
15 THE SUPPORTIVE FAMILY.
16 Q. DID YOU CHART ANY PAIN ON THE 3RD OF JANUARY?
17 A. NO, I DID NOT.
18 Q. DO YOU RECALL SEEING ANY PAIN ON THE 3RD OF JANUARY?
19 A. NO, I DID NOT.
20 Q. WHEN NEXT DID YOU SEE MARY CRANE?
21 A. (PAUSE.) I DID NOT SEE HER AGAIN.
22 Q. DID YOU BECOME AWARE THAT SHE HAD DIED?
23 A. YES, I DID.
24 Q. NOW IF YOU WILL PULL OUT LYDIA SMITH'S BINDER.
25 A. (WITNESS COMPLIED.)
1696
1 Q. WHEN WAS LYDIA SMITH ADMITTED TO THE UNIT?
2 A. SHE WAS ADMITTED ON 12/20 AT 3:57 P.M. IN THE AFTERNOON.
3 Q. AND IF YOU'LL TURN TO 700.
4 A. (WITNESS COMPLIED.)
5 Q. WHAT IS THAT DOCUMENT?
6 A. THAT IS DR. WEITZEL'S PSYCH EVAL.
7 Q. LET'S TURN TO THE LAST PAGE OF IT. THAT'S NUMBER 702.
8 WHAT WAS THE ESTIMATED LENGTH OF HOSPITALIZATION?
9 A. THREE WEEKS.
10 Q. WHAT'S THE DISCHARGE CRITERIA?
11 A. NO AGGRESSIVENESS AND IMPROVED MOOD.
12 Q. WHAT DOES IT MEAN BY DISCHARGE CRITERIA?
13 A. WHAT WE HOPE FOR HER TO ACHIEVE TO BE DISCHARGED.
14 Q. AND THE DISCHARGE PLAN?
15 A. BACK TO THE ROCKY MOUNTAIN CARE CENTER.
16 Q. MAYBE, WHILE WE HAVE THAT IN FRONT OF YOU, DOWN HERE ARE
17 SOME INITIALS. DO YOU KNOW WHAT THE D STANDS FOR?
18 A. THAT'S THE DATE IT WAS DICTATED AND THE TIME.
19 Q. SO 12/21/95 AT 2238?
20 A. CORRECT.
21 Q. DO YOU KNOW HOW THAT TIME IS INDICATED FOR WHOEVER
22 WRITES THIS?
23 A. THE MACHINE PICKS IT UP WHEN HE TALKS ON THE PHONE AND
24 DICTATES. IT'S ALL DONE BY MACHINE.
25 Q. AND THEN WHAT IS THE T?
1697
1 A. THAT'S THE DATE THAT IT'S ACTUALLY TYPED BY THE
2 TRANSCRIPTIONIST.
3 Q. IS THAT THE SAME ON ALL OF THESE PSYCHIATRIC
4 EVALUATIONS?
5 A. YES, IT IS.
6 Q. LET'S TURN TO THE PHYSICIAN'S ORDER, WHICH IS 705.
7 WHAT'S THAT?
8 A. THAT THE ADMISSION ORDER, STANDING ORDER.
9 Q. AND WHO WROTE THIS?
10 A. UMM, I WROTE THE MEDICATION PART OF IT.
11 Q. DID YOU WRITE THIS TOP PART?
12 A. NO, I DID NOT.
13 Q. DO YOU KNOW WHO DID?
14 A. NO, I DO NOT. THOSE ARE STANDING ORDERS. THOSE ARE FOR
15 EVERYONE THAT COMES INTO THE UNIT, THAT FIRST SECTION.
16 Q. ABOUT THE E.K.G. AND THE TESTS?
17 A. THOSE ARE STANDING ORDERS FOR EVERYBODY THAT ENTERS THE
18 UNIT.
19 Q. WHEN WE GET DOWN HERE TO THE MEDS, WE WON'T GO THROUGH
20 TYLENOL AND MYLANTA, MILK OF MAGNESIA, SPECIAL PRECAUTIONS.
21 WHAT'S THE C.X.R.?
22 A. THAT'S A CHEST X-RAY.
23 Q. ABOVE THAT WHAT IS V.S., B.I.D.?
24 A. VITAL SIGNS TWICE A DAY.
25 Q. MEANING YOU ARE TO TAKE THE VITAL SIGNS?
1698
1 A. CORRECT.
2 Q. LASIX WE'VE TALKED ABOUT. K.C.L. IS WHAT?
3 A. POTASSIUM.
4 Q. AND WHY IS THAT ORDERED?
5 A. USUALLY, WHEN YOU'RE GIVEN LASIX, THE LASIX DEPLETES THE
6 BODY OF POTASSIUM SO YOU NEED TO REPLACE IT WITH AN ORAL
7 MEDICATION OR I.V. MEDICATION.
8 Q. WHAT'S LEVOXINE?
9 A. A HEART MEDICATION. IT SLOWS DOWN THE HEART TO PUMP
10 BETTER.
11 Q. NORMODYNE?
12 A. ALSO A HEART MEDICATION AND BLOOD PRESSURE.
13 Q. VASOTEC?
14 A. THE SAME THING.
15 Q. WE'VE TALKED ABOUT RISPERDAL. WE TALKED ABOUT SERZONE
16 AND ATIVAN. THIS IS A TELEPHONE ORDER HERE?
17 A. CORRECT.
18 Q. WHAT TIME DID YOU NOTE IT?
19 A. 6:15 THAT EVENING.
20 Q. LET'S LOOK AT THE NEXT ONE, 706. ON THE NEXT DAY
21 THERE'S AN ORDER FOR CIPRO?
22 A. CIPRO, 500 MILLIGRAMS. THAT'S AN ANTIBIOTIC.
23 Q. AND DOWN BELOW THAT, IT LOOKS LIKE THREE DAYS LATER,
24 U.A.?
25 A. YES. "U.A. TOMORROW. C.N.S. IF INDICATED." THAT'S A
1699
1 CULTURE AND SENSITIVITY IF INDICATED.
2 Q. WHAT DO THESE ORDERS MEAN TO YOU?
3 A. HE WAS TREATING HER FOR A URINARY TRACT INFECTION.
4 Q. 707 IS THE ORDER ON CHRISTMAS, 12/25. WHO TOOK THAT
5 ORDER?
6 A. LYNN LONG.
7 Q. AND WHAT DOES IT SAY?
8 A. IT SAYS, "T.O. DR. WEITZEL TO LYNN LONG. IF PATIENT
9 REFUSES RISPERDAL GIVE HALDOL, TWO MILLIGRAMS I.M."
10 Q. WHAT'S RISPERDAL?
11 A. AN ANTI-PSYCHOTROPIC.
12 Q. AND HOW IS IT ADMINISTERED?
13 A. USUALLY BY MOUTH.
14 Q. AND HALDOL IS WHAT?
15 A. AN I.M. INJECTION. IT'S ALSO AN ANTI-PSYCHOTROPIC, AN
16 OLDER ONE.
17 Q. DID YOU HAVE WITH ANY OF THESE PATIENTS AN OCCASION
18 WHERE THEY REFUSED THE RISPERDAL?
19 A. YES.
20 Q. AND WHAT WOULD YOU DO?
21 A. USUALLY DR. WEITZEL COVERED THEM WITH THE HALDOL
22 INJECTION.
23 Q. DOWN AT THE BOTTOM HERE IT SAYS 12/29, DEPAKENE. DO YOU
24 KNOW WHAT THAT IS?
25 A. YES, I DO.
1700
1 Q. WHAT IS IT?
2 A. IT'S -- WELL, ITS AN ANTICONVULSIVE. IT HAS BEEN USED
3 WITH TREATMENTS OF PEOPLE WHO HAVE PSYCHOTIC DISORDERS.
4 IT'S KIND OF A NEW THING.
5 Q. THEN IT LOOKS LIKE COGENTIN?
6 A. YES.
7 Q. WHAT IS THAT?
8 A. THAT USUALLY REVERSES LIKE THE TARDY DYSKINESIA THAT WE
9 TALKED ABOUT, THOSE ADVERSE REACTIONS THAT WE DON'T WANT THE
10 PATIENT HAVING. IF WE NOTICE THEM RIGHT AWAY WE GIVE THE
11 COGENTIN AND IT KIND OF REVERSES IT. IF YOU DON'T TREAT IT
12 IT'S A LONG-TERM THING AND THEY CAN NEVER GET RID OF THAT.
13 Q. THESE MEDICATIONS HAVE SIDE EFFECTS?
14 A. YES, THEY DO.
15 Q. LET'S PULL OUT 710. DOWN AT THE BOTTOM, ON THE 3RD OF
16 JANUARY, THERE'S A QUINIDINE, TRANSDERMAL PATCH. DO YOU
17 KNOW WHAT THAT IS?
18 A. YES. THAT'S FOR BLOOD PRESSURE MEDICATION. USUALLY
19 THEY PUT THE PATCH ON TO TRY AND KEEP THE BLOOD PRESSURE
20 DOWN TO A MORE UNIFORM LEVEL.
21 Q. OKAY. AND THEN ON THE 7TH OF JANUARY, NUMBER 711,
22 WHAT'S THAT -- WELL, WE TALKED ABOUT THESE CHECKS. WHAT WAS
23 THE ORDER ON THE 7TH OF JANUARY?
24 A. MORPHINE SULFATE, FIVE MILLIGRAMS, IM, Q THREE HOURS
25 AROUND THE CLOCK.
1701
1 Q. AND THEN UNDERNEATH THAT WHAT IS WRITTEN?
2 A. "HOLD ALL OTHER MEDS." I DON'T KNOW WHAT THAT IS.
3 Q. IS IT OTHER THAN?
4 A. OTHER THAN MORPHINE, YES.
5 Q. AND WHAT IS UNDER THAT?
6 A. D.N.R., DO NOT RESUSCITATE.
7 Q. WHEN WAS THAT NOTED?
8 A. THAT WAS NOTED AT 9:30 THAT NIGHT.
9 Q. DOWN BELOW WE HAVE ONE THAT SAYS MISTAKEN ENTRY?
10 A. THAT HAS NOTHING TO DO WITH THIS PATIENT.
11 Q. THE NEXT PAGE, JANUARY 8TH, WHAT'S THAT ORDER?
12 A. "CHANGE MORPHINE ORDER TO M.S., 10 MILLIGRAMS, Q THREE,
13 ROUND THE CLOCK. TELEPHONE ORDER, DR. WEITZEL, NOTED AT
14 0900."
15 Q. DO YOU KNOW WHAT HAPPENED AFTER -- WELL, ON THE 8TH OF
16 JANUARY TO LYDIA SMITH?
17 A. UMM, I WOULDN'T KNOW UNLESS I READ THE NOTES.
18 Q. OKAY. LET'S TURN TO THE NOTES. 746, WHAT IS THAT?
19 A. THAT'S THE BASIC NURSING ASSESSMENT THAT WE DO UPON
20 ADMISSION.
21 Q. AND WHO FILLED THIS ONE OUT?
22 A. THIS ONE WAS FILLED OUT BY A FAMILY MEMBER AND MYSELF.
23 Q. THE INFORMATION THAT YOU PUT ON HERE, WHERE DID YOU GET
24 IT?
25 A. FROM THE FAMILY.
1702
1 Q. 758, WHAT DATE WAS THIS?
2 A. THIS WAS ON 12/20 AT 5:30.
3 Q. AND WHO WROTE THIS NOTE?
4 A. I DID.
5 Q. WHAT DID YOU WRITE?
6 A. "ADMIT NOTE. 90 YEAR OLD FEMALE ADMITTED FROM SOUTH
7 DAVIS HOSPITAL TO ROOM 311, BED TWO. PATIENT ACCOMPANIED BY
8 SEVERAL FAMILY MEMBERS. SON SIGNED ALL PAPERWORK. PATIENT
9 WAS AT" -- I DON'T KNOW. "LAKEVIEW HOSPITAL, NOVEMBER 1995,
10 DUE TO SUDDEN CONFUSION. WEAK AND INCONTINENT. INCREASED
11 FEVER WITH EXPRESSIVE APHASIA."
12 Q. WHAT IS EXPRESSIVE APHASIA?
13 A. NOT ABLE TO TALK. "C.T. SCAN REVEALED HEMORRHAGING.
14 PATIENT PLACED IN LONG-TERM CARE WHERE SHE BECAME SEVERELY
15 AGITATED, COMBATIVE. PATIENT CALMED DURING INTAKE PROCESS."
16 Q. SO WHAT YOU SAW OF HER THEN, WAS THERE ANY PROBLEM IN
17 HER MOOD OR HER ACTIONS?
18 A. NOT DURING INTAKE, NO.
19 Q. AND THEN AT 2000 WHAT DID YOU WRITE?
20 A. "PATIENT UP, AMBULATING, BANGING ON DOOR. STAFF
21 REDIRECTED SEVERAL TIMES."
22 Q. AND TWO HOURS LATER?
23 A. "PATIENT OUT OF BED. PATIENT GIVEN NOURISHMENT. SPEECH
24 GARBLED AND UNINTELLIGIBLE. PATIENT RESPONDED TO
25 REDIRECTION WITH SPITTING, KICKING, STRIKING OUT. ATIVAN,
1703
1 ONE MILLIGRAM I.M., GIVEN."
2 Q. AND THEN FINALLY AT 2330?
3 A. "PATIENT RESTING IN BED, NO DISTRESS NOTED."
4 Q. DO YOU RECALL LYDIA SMITH?
5 A. YES, I DO.
6 Q. IS THERE ANY ONE THING THAT BRINGS HER TO MIND?
7 A. SHE HAD REAL PRETTY HAIR.
8 Q. DID SHE? WHAT WAS HER HAIR?
9 A. IT WAS PRETTY AND LONG.
10 Q. DO YOU RECALL HER ATTITUDE AS SHE FIRST CAME IN?
11 A. WHEN SHE FIRST CAME IN SHE WAS QUIET. THEN THE NORMAL
12 AGITATED STATE, WHICH A LOT OF PATIENTS DO WHEN THEY'RE
13 ADMITTED BECAUSE OF THE UNFAMILIAR SURROUNDINGS.
14 Q. DO YOU RECALL WHEN YOU NEXT SAW LYDIA SMITH?
15 A. IT APPEARS TO BE ON THE 24TH OF DECEMBER.
16 Q. AND THAT'S 766?
17 A. CORRECT.
18 Q. WHAT BEHAVIOR DID YOU SEE ON THE 24TH OF DECEMBER?
19 A. "PATIENT VERY AGGRESSIVE, HITTING STAFF, SPITTING AT
20 STAFF. PATIENT GETTING OUT OF CHAIR, LAYING ON FLOOR,
21 REFUSING STAFF'S ASSISTANCE AND REDIRECTION. POSEY ORDERED
22 TO PROVIDE SAFETY FOR PATIENT AND PREVENT INJURY. PATIENT
23 REFUSED FLUIDS."
24 Q. AND THEN AT 2100?
25 A. "PATIENT OFFERED FLUIDS AND MEDICATION. PATIENT SPIT AT
1704
1 STAFF, CLENCHED TEETH. REFUSED ASSISTANCE WITH ADL'S."
2 THOSE ARE ACTIVITIES OF DAILY LIVING.
3 Q. WHAT KINDS OF THINGS?
4 A. THAT WOULD INCLUDE BRUSHING HER TEETH AT NIGHT, GETTING
5 HER CLEANED UP FOR BED. DEPENDING ON THE TYPE OF DAY WHAT
6 WE ASSIST THEM WITH.
7 Q. AND THEN 2130?
8 A. "PATIENT IN BED, RESTING WITH EYES CLOSED. POSEY BELT
9 REMOVED. WILL MONITOR WITH BED CHECK AND SIDE RAILS."
10 Q. DO YOU RECALL ANY AGITATION THAT NIGHT WITH HER?
11 A. UMM, NOT AFTER THAT.
12 Q. DID YOU NOTE ANY?
13 A. JUST AT THE BEGINNING WITH THE AGITATION AND WE TOOK THE
14 APPROPRIATE LESS AGGRESSIVE MEASURES TO TRY TO REDIRECT HER
15 AND CALM HER DOWN.
16 Q. DID THAT WORK?
17 A. YES, IT DID.
18 Q. DID YOU NOTE ANY PAIN?
19 A. NO, I DID NOT.
20 Q. WHEN NEXT DID YOU SEE MS. SMITH?
21 A. ON THE 25TH OF DECEMBER.
22 Q. AND THAT IS 767. WHAT TIME OF DAY WERE YOU WORKING?
23 A. I THINK LIKE THE THREE TO ELEVEN SHIFT.
24 Q. SO WE HAVE LYNN LONG AND WHERE DOES YOUR -- DID YOU
25 WRITE ANYTHING?
1705
1 A. YES, I DID. PAGE 769.
2 Q. I'M SORRY. I DON'T HAVE THE CORRECT ONE UP THERE.
3 OKAY. WHAT WAS LYDIA DOING THAT DAY?
4 A. "PATIENT THROWING MILK CARTONS AT PATIENTS. ATTEMPTING
5 TO BITE STAFF, STRIKING OUT AT STAFF. PATIENT PULLING ARM
6 OF ANOTHER PATIENT. NOT RESPONDING TO STAFF'S REDIRECTIONS.
7 SPITTING AND GRABBING AT STAFF WHEN THEY COME WITHIN
8 REACHING DISTANCE. ATIVAN, ONE MILLIGRAM, GIVEN I.M. THREE
9 PERSON ASSIST TO GET PATIENT POSITIONED."
10 Q. IT TOOK THREE PEOPLE TO HOLD HER?
11 A. YES. SO WE COULD GIVE HER THE INJECTION.
12 Q. OKAY. AND WHAT DID YOU WRITE?
13 A. AND THEN "PATIENT REFUSES TO TAKE P.O. MEDICATION.
14 SLAPS AT NURSES."
15 Q. LET'S BACK UP. AFTER THE ATIVAN WHAT DID YOU WRITE?
16 A. "PATIENT TOLERATED PROCEDURE WELL." THAT MEANS THERE
17 WAS NO HARM DONE DURING THE INJECTION.
18 Q. AND 2030?
19 A. "PATIENT REFUSES TO TAKE P.O. MEDICATIONS. SLAPS AT
20 NURSE'S HAND. CLENCHING TEETH. I.M. HELD. ALL TWO
21 MILLIGRAMS GIVEN PER DOCTOR'S ORDERS IF PATIENT REFUSES P.O.
22 MEDICATION."
23 Q. AND THEN WHAT?
24 A. "PATIENT PLACED IN BED WITH TWO SIDE RAILS UP AND BED
25 MONITORED."
1706
1 Q. WHEN NEXT DID YOU SEE LYDIA SMITH?
2 A. ON THE 26TH I DID THE PHYSICAL ASSESSMENT.
3 Q. AND THAT'S 771?
4 A. CORRECT.
5 Q. WHAT WERE THE ASSESSMENTS THAT YOU POINTED OUT FOR
6 NEUROLOGICAL AND ALSO PSYCHO-SOCIAL?
7 A. NEUROLOGICAL WAS THAT SHE WAS ALERT AND DISORIENTED.
8 PSYCHO-SOCIAL, AGITATED, UNCOOPERATIVE.
9 Q. WHEN NEXT DID YOU SEE HER?
10 A. IT LOOKS LIKE MY SIGNATURE ON 12/27.
11 Q. DID YOU DO ANY FREE TEXT ON THAT DAY?
12 A. NO, I DID NOT.
13 Q. ON THE 26TH AND THE 27TH DID YOU SEE ANY SIGNS OR
14 SYMPTOMS OF PAIN? DID YOU CHART ANY?
15 A. NO. I DID THE PHYSICAL ASSESSMENT AGAIN AND DID NOT
16 CHART ANY PAIN.
17 Q. WHEN NEXT DID YOU SEE LYDIA SMITH?
18 A. ON THE 30TH.
19 Q. THAT'S NUMBER 781?
20 A. CORRECT.
21 Q. WHAT BEHAVIOR DID YOU CHART IN THAT SHIFT?
22 A. "PATIENT HAD NO AGGRESSIVE BEHAVIOR THIS SHIFT. SHE GOT
23 UP IN A.M. AND AMBULATED TO BATHROOM TO VOID. ATE BREAKFAST
24 WITHOUT STAFF CUEING," MEANING SHE JUST ATE IT ON HER OWN
25 WITHOUT US HAVING TO PUT THE SPOON UP TO HER MOUTH.
1707
1 "PATIENT DID NOT GRAB AT PATIENTS OR STAFF. DAUGHTER IN TO
2 VISIT. PLEASED WITH PATIENT'S PROGRESS.
3 "PATIENT UPSET THAT DAUGHTER HAD A NECK BRACE ON AND
4 TOLD DAUGHTER TO REMOVE BRACE." THAT MEANS THAT SHE WAS
5 CONNECTING WITH THE OUTSIDE, SO IT WAS IMPORTANT TO CHART
6 THAT TYPE OF THING.
7 "PATIENT REQUESTED PAPER AND PEN TO WRITE." THAT WAS
8 ANOTHER BREAKTHROUGH, THAT SHE WAS ACTUALLY REALIZING WHAT A
9 PEN AND PAPER WERE USED FOR.
10 "PATIENT SET OFF DOOR ALARM TIMES ONE," WHICH WAS AN
11 EXIT DOOR THAT IF THEY PRESSED THE HANDLE IT SENDS OFF AN
12 ALARM.
13 Q. DO YOU RECALL THIS DAY?
14 A. JUST FROM THE ANNOTATIONS HERE.
15 Q. WHAT WAS LYDIA LIKE THAT DAY?
16 A. SHE WAS DOING QUITE WELL. WE WERE QUITE PLEASED.
17 Q. WHEN NEXT DID YOU SEE LYDIA?
18 A. ON THE 30TH.
19 Q. I'M SORRY. 783 IS A DUPLICATE. LET'S SKIP THAT.
20 A. OKAY.
21 Q. 785.
22 A. OKAY. I DID THE PHYSICAL ASSESSMENT.
23 Q. AND WHAT WAS SHE LIKE THAT DAY?
24 A. SHE WAS LETHARGIC, DISORIENTED. ON THE PSYCHO-SOCIAL
25 SHE WAS DROWSY.
1708
1 Q. AND WAS THIS DIFFERENT FROM WHAT YOU'D CHARTED BEFORE
2 WITH HER?
3 A. YES, IT WAS.
4 Q. WHAT DID YOU SEE AS A CHANGE IN HER BEHAVIOR?
5 A. HER ALERTNESS WAS DECREASING. HER -- SHE JUST WASN'T
6 RESPONDING AS WELL AS SHE HAD THE PREVIOUS DAYS.
7 Q. THIS WAS WHAT DAY IN RELATIONSHIP TO THE LAST CHART?
8 A. THIS WAS THE 31ST AND THAT WAS THE 30TH, SO ONE DAY.
9 Q. WHEN NEXT DID YOU SEE HER?
10 A. ON THE 1ST I DID THE PHYSICAL ASSESSMENT.
11 Q. AND WHAT WAS HER BEHAVIOR LIKE ON THAT DAY?
12 A. SHE WAS ALERT, DISORIENTED, AGITATED. UNCOOPERATIVE
13 WITH THE SUPPORTIVE FAMILY.
14 Q. AND WHEN NEXT DID YOU SEE HER?
15 A. ON THE 2ND.
16 Q. AND THAT'S NUMBER 790?
17 A. YES.
18 Q. WHAT DID YOU WRITE ABOUT BEHAVIOR ON THE 2ND OF JANUARY?
19 A. "PATIENT VERY DROWSY DURING FIRST HALF OF SHIFT. DURING
20 SECOND HALF PATIENT AGITATED. REFUSED MEDICATIONS BY MOUTH.
21 FAMILY MEMBER TRIED TO FEED PATIENT FOOD. PATIENT STILL
22 REFUSED TO OPEN MOUTH FOR ANYTHING. NO DINNER EATEN.
23 PATIENT UP, AMBULATING IN HALLWAY WITH UNSTEADY GAIT." THAT
24 MEANS HER BALANCE.
25 "HELD OFF FIVE MILLIGRAMS I.M. GIVEN PER DOCTOR ORDER
1709
1 WHEN SHE REFUSES HER BY MOUTH RISPERDAL. PATIENT GOT OUT OF
2 BED TIMES THREE. DRESSED SELF AND PULLED GOWN UP. PATIENT
3 SLEEPING CURRENTLY. GAVE PATIENT A.D.L.'S." THAT'S THE
4 DAILY LIVING CARE. "ATTEMPTED TO GIVE BY MOUTH MEDICATIONS
5 AND PROVIDED P.R.N.," AS NECESSARY, "MEDICATIONS AND
6 REDIRECTED HER TWICE."
7 Q. DID YOU NOTE ANY PAIN ON THE 2ND OF JANUARY?
8 A. NO, I DID NOT.
9 Q. WHEN NEXT DID YOU SEE HER?
10 A. ON THE 3RD OF JANUARY.
11 Q. AND WHAT WAS SHE LIKE THAT DAY?
12 A. SHE WAS LETHARGIC, DISORIENTED, DROWSY, WITH -- SHE
13 APPEARED ANXIOUS AT NIGHT.
14 Q. AND THE NEXT TIME?
15 A. THAT WAS THE LAST TIME.
16 Q. YOU WERE NOT PRESENT WHEN SHE PASSED AWAY?
17 A. NO, I WAS NOT.
18 Q. WHAT DAY DID SHE PASS AWAY?
19 A. IT LOOKS LIKE THE 8TH OF JANUARY.
20 Q. LET'S TURN BACK TO THE PHYSICIAN'S ORDERS. I THINK WE
21 TALKED ABOUT THEM. 711, THERE WAS AN ORDER FOR MORPHINE, IS
22 THAT CORRECT?
23 A. YES.
24 Q. AND LET'S TURN TO THE MED CHARTS. DID YOU GIVE ANY OF
25 THOSE INJECTIONS? I BELIEVE IT'S ON 742.
1710
1 A. NO, I DID NOT.
2 Q. IT LOOKS LIKE THIS CONTAINS THE ORDERS FOR BOTH THE 7TH
3 AND THE 8TH. SO ON THE 7TH A SHOT WAS GIVEN AT WHAT TIME?
4 A. ON THE 7TH IT LOOKS LIKE SHE WAS GIVEN MORPHINE, FIVE
5 MILLIGRAMS, AT NINE O'CLOCK.
6 Q. AND THEN WHAT HAPPENED AT MIDNIGHT?
7 A. MIDNIGHT, LAURIE WILLSON DID NOT GIVE THE MEDICATION. I
8 MEAN WILLIAMS.
9 Q. AND THEN THREE O'CLOCK?
10 A. MEDICATION WAS GIVEN BY LAURIE WILLIAMS, FIVE
11 MILLIGRAMS.
12 Q. AND AT SIX O'CLOCK?
13 A. FIVE MILLIGRAMS OF MORPHINE BY LAURIE WILLIAMS.
14 Q. AND DOWN HERE WE HAVE 1/8 TO THE LEFT. WHY IS THERE A
15 CHANGE BETWEEN --
16 A. THE FIVE MILLIGRAMS WAS DISCONTINUED AND TEN MILLIGRAMS
17 WAS ORDERED. AN INCREASE IN DOSAGE.
18 Q. AND THEN THIS SAYS NINE A.M.?
19 A. CORRECT.
20 Q. IS THAT ON THE 7TH OR WAS IT ON THE 8TH?
21 A. UMM, I'M NOT SURE.
22 Q. IT APPEARS TO BE CHARTED UNDER THE 7TH, BUT WAS WRITTEN
23 ON THE 8TH, IS THAT CORRECT?
24 A. I'D HAVE TO LOOK BACK. (PAUSE.) THAT WAS WRITTEN ON
25 THE 8TH AT 0800.
1711
1 Q. SOMETIMES MISTAKES HAPPEN AND IT GETS PUT IN THE WRONG
2 BOX?
3 A. YEAH.
4 Q. SO WE HAVE NINE AND TWELVE, SHOT WAS GIVEN?
5 A. CORRECT.
6 Q. BY WHOM?
7 A. BY SHEILA HANSEN. I DON'T RECOGNIZE THAT OTHER ONE,
8 THAT ONE INITIAL.
9 Q. LET'S LOOK AT THE NURSE'S NOTES FOR THE 7TH. LET'S
10 START WITH THE 6TH, ACTUALLY, 799. WHAT IS THE BEHAVIOR
11 NOTED UP THERE AT 2130?
12 A. "PATIENT HAS BEEN QUIET THIS SHIFT. RESTED QUIET WITH
13 EYES CLOSED MOST OF SHIFT. RESPIRATIONS EVEN AND UNLABORED.
14 ATE NOTHING, NO SUPPER. NO EPISODES OF COMBATIVENESS. TOOK
15 MEDS AS ORDERED."
16 Q. AND DROP DOWN TO R, THE RESPONSE.
17 A. "PATIENT APPEARED TO SLEEP MOST OF THIS SHIFT. RESTING
18 QUIETLY WITH EYES CLOSED. RESPIRATIONS EVEN AND UNLABORED.
19 SLEPT IN CHAIR. ATE SUPPER. TOOK MEDS AS ORDERED. DID NOT
20 INTERACT IN GROUP. NO COMBATIVE EPISODES NOTED THIS SHIFT."
21 Q. ZERO COMBATIVE EPISODES THIS SHIFT?
22 A. CORRECT.
23 Q. LET'S GO TO THE NEXT DAY. THE NOTATIONS FOR THE 7TH,
24 WHAT SHIFT IS THIS?
25 A. AT THE START OF THAT THAT'S THE NIGHT SHIFT.
1712
1 Q. CAN YOU READ WHAT IT SAYS ON THE SECOND AND THIRD LINES?
2 A. OKAY. NIGHT SHIFT, FREE TEXT. "PATIENT RESTED QUIETLY
3 THROUGHOUT SHIFT."
4 Q. AND DROP DOWN TO 1400 HOURS.
5 A. "PATIENT NOT ABLE TO TAKE MEDS. PATIENT LETHARGIC,"
6 WHICH MEANS VERY DROWSY. "PATIENT UNRESPONSIVE. PATIENT
7 NOT SWALLOWING OR RESPONDING TO STAFF."
8 Q. DO YOU SEE ANY CHARTING OF PAIN?
9 A. NO, I DO NOT.
10 Q. LET'S GO OVER TO THE 8TH, WHICH IS NUMBER 802. CAN YOU
11 READ WHAT THEY SAID ON THE ELEVEN TO SEVEN SHIFT?
12 A. THAT'S THE NIGHT SHIFT. FREE TEXT. "PATIENT LYING IN
13 BED WITH EYES OPEN THROUGHOUT SHIFT. DEMONSTRATES MUCH" --
14 I CAN'T MAKE THAT OUT. REFLEXES OR SOMETHING. "GRASPING IN
15 RESPONSE TO PHYSICAL STIMULI. UNABLE TO MAKE ANY VERBAL
16 RESPONSE. MORPHINE, Q THREE, IM, AS SCHEDULED FOR COMFORT.
17 2400 DOSE OMITTED DUE TO PATIENT APPEARED IN NO ACUTE
18 DISTRESS AT THIS TIME. NURSING STAFF WAS ATTENDING ANOTHER
19 DYING PATIENT AND HER FAMILY. 0300 DOSE WAS GIVEN AT 2:30.
20 RESPIRATION RATE WAS 10 TO 12," WHICH IS BELOW NORMAL.
21 MR. STIRBA: YOUR HONOR, IF THE WITNESS WOULD JUST
22 ANSWER THE QUESTION AND NOT EDITORIALIZE. THIS ISN'T EVEN
23 HER NOTE.
24 THE COURT: ASK HER ANOTHER QUESTION.
25 Q. (BY MS. BARLOW) THE RATE SAYS WHAT?
1713
1 A. TEN TO 20 SECONDS.
2 Q. BASED ON YOUR NURSING EXPERIENCE, IS THAT A NORMAL RATE?
3 A. APNEIC PERIODS, MEANING THEY TAKE A DEEP BREATH AND
4 DON'T BREATH FOR A WHILE. THEY KIND OF HOLD THEIR BREATH.
5 Q. SO THAT'S WHAT THIS LINE IS?
6 A. UH-HUH. FOR 10 TO 20 SECONDS. IT'S LIKE HOLDING YOUR
7 BREATH AND COUNTING TO 10 OR 20.
8 Q. OKAY. THANK YOU. AND THEN LONG PERIODS OF AND WHAT IS
9 THAT? IN FACT, I'M NOT SURE WE CAN READ THAT.
10 A. SHALLOW RESPIRATIONS.
11 Q. AND THEN AT 1245, RECOGNIZING THAT THIS ISN'T YOUR NOTE,
12 WHAT WAS WRITTEN?
13 A. "PATIENT'S DAUGHTER REQUESTED US TO CHECK PATIENT
14 STATUS. I DON'T THINK SHE'S BREATHING. PATIENT CHECKED.
15 NO RESPIRATIONS, NO PULSE. PATIENT PLACED ON HER BACK WITH
16 HANDS TO SIDE. TEETH PLACED IN MOUTH."
17 Q. IN THOSE NOTES FOR THOSE LAST TWO DAYS, WERE THERE ANY
18 NOTATIONS OF PAIN ON THE 7TH AND 8TH?
19 A. NO.
20 MS. BARLOW: YOUR HONOR, THIS WOULD PROBABLY BE A
21 GOOD TIME TO BREAK BEFORE I GET INTO THE FINAL PATIENT.
22 THE COURT: ALL RIGHT. LADIES AND GENTLEMEN, AS
23 YOU GO HOME TONIGHT REMEMBER THAT IT'S YOUR DUTY NOT TO
24 CONVERSE AMONG YOUR SEVERAL OR CONVERSE WITH ANYONE
25 REGARDING THE SUBJECT OF THIS TRIAL OR ALLOW YOURSELF TO BE
1714
1 ADDRESSED BY ANY OTHER PERSON. IT'S ALSO YOUR DUTY NOT TO
2 FORM OR EXPRESS AN OPINION UNTIL YOU'VE HEARD THE ENTIRE
3 CASE AND IT IS FINALLY SUBMITTED TO YOU.
4 SINCE THIS IS ALSO THE END OF THE DAY, REMEMBER THAT
5 RADIO, TELEVISION, NEWSPAPERS, YOU ARE NOT TO READ ANY
6 ACCOUNTS OR LISTEN TO ANY ACCOUNTS OR EVEN WATCH ACCOUNTS
7 WITH THE SOUND DOWN. YOU SHOULD HEAR EVERYTHING ABOUT THIS
8 CASE FROM THE COURTROOM AND NOT OUTSIDE OF IT.
9 SO WE WILL SEE YOU WITH THAT ABBREVIATED SCHEDULE
10 TOMORROW. BE HERE AT EIGHT A.M. UNTIL TEN AND THEN TWO TO
11 FIVE TOMORROW. WE'LL SEE YOU AT EIGHT A.M. TOMORROW
12 MORNING.
13 (JURY OUT OF THE COURTROOM.)
14 THE COURT: THE RECORD SHOULD REFLECT THAT THE JURY
15 HAS LEFT THE COURTROOM. DO YOU HAVE YOUR WITNESSES FOR
16 TUESDAY WHO YOU ANTICIPATE CALLING? I MEAN, STARTING AFTER
17 THIS WITNESS.
18 MR. WILSON: I ANTICIPATE AND WE -- I BECAME AWARE
19 THAT THERE HAD BEEN A SITUATION ARISE WHICH NECESSITATED THE
20 ABBREVIATED SCHEDULE FOR TOMORROW. THIS DOES CREATE
21 PROBLEMS WITH OUR SCHEDULING AND WE'RE TRYING TO WORK THOSE
22 SCHEDULES OUT. WE HAVE THE REMAINING WITNESSES THAT WE
23 LISTED. HOWEVER, WE ALSO HAVE A PROBLEM WITH THE MEDICAL
24 EXAMINER ON HIS AVAILABILITY.
25 WE WOULD ANTICIPATE TOMORROW MORNING CONTINUING WITH
1715
1 THIS PARTICULAR WITNESS. I WOULD ASSUME THAT AT THE VERY
2 MOST WE PROBABLY WOULD FINISH UP WITH THIS WITNESS POSSIBLY
3 BY TEN O'CLOCK.
4 THE COURT: OKAY.
5 MR. WILSON: IN THE AFTERNOON WE'VE TRIED TO WORK
6 OUT SOMETHING WITH THE MEDICAL EXAMINER'S OFFICE. WE'D HAVE
7 MAUREEN FRIKKE POSSIBLY, OR WE MAY HAVE TO SUBSTITUTE SOME
8 OF THE OTHER WITNESSES. WE'LL TRY TO ACCOMMODATE THE
9 SCHEDULING. IT IS WORKING A HARDSHIP, PARTICULARLY WHEN WE
10 DON'T HAVE THE AVAILABILITY OF MOVING THE MEDICAL EXAMINER
11 OVER TO WEDNESDAY, OR AT LEAST FOR MAUREEN FRIKKE. AND WE
12 DO HAVE A TIGHT TIME LINE ON WEDNESDAY WITH THE MEDICAL
13 EXAMINER. SO IF THE COURT WOULD GRANT ME SOME LATITUDE I
14 WOULD APPRECIATE IT.
15 THE COURT: SURE. WHEN I RAISED THE ISSUE ABOUT
16 THE FUNERAL, I ASKED IF THAT WAS ALL RIGHT. YOU WEREN'T
17 HERE. MS. BARLOW SAID OKAY. I DIDN'T KNOW THAT THERE WOULD
18 BE A PROBLEM.
19 WHAT ABOUT THESE OTHER WITNESSES? YOU HAD PAUL JENSEN
20 AND THE LARSENS THAT YOU MENTIONED MIGHT BE WITNESSES TODAY.
21 CAN THEY BE AVAILABLE TOMORROW?
22 MR. WILSON: THEY CAN BE. WE JUST HAVE THOSE
23 PROBLEMS WITH THE MEDICAL EXAMINER AS I INDICATED TO THE
24 COURT. THERE MAY HAVE TO BE SOME ACCOMMODATION SOME WAY OR
25 ANOTHER ON THAT. WE WILL TRY TO PUT ON SUFFICIENT WITNESSES
1716
1 TO KEEP GOING TOMORROW, YOUR HONOR.
2 THE COURT: OKAY. DID YOU SAY YOU MAY OR MAY NOT
3 HAVE THIS ONE PERSON FROM THE MEDICAL EXAMINER TOMORROW,
4 DEPENDING ON THEIR SCHEDULE?
5 MR. WILSON: THAT'S TRUE. WE'RE JUST TRYING TO
6 WORK THAT OUT.
7 THE COURT: IF THERE'S ANY OTHER THING -- I MEAN,
8 IF YOU SAY THEY CAN'T BE HERE WEDNESDAY, IS THERE ANY
9 PROBLEM WITH THURSDAY OR FRIDAY FOR THAT WITNESS?
10 MR. WILSON: THERE IS. HE'S SUPPOSED TO BE IN
11 SUMMIT COUNTY ALL DAY THURSDAY. WE'LL WORK WITH THAT. I
12 THINK THERE'S A POSSIBILITY THAT WE CAN TAKE HIM FIRST THING
13 WEDNESDAY AND THAT'S WHAT WE ANTICIPATE, WITH TODD GREY.
14 THE COURT: ALL RIGHT. SO RIGHT NOW YOU ANTICIPATE
15 COMPLETING THIS WITNESS; POSSIBLY PAUL JENSEN; NORMA AND
16 HAROLD LARSON. DR. PAUL JENSEN, IS THAT THE LAST TREATER
17 THAT WE HAVE?
18 MR. WILSON: THAT'S CORRECT.
19 THE COURT: DO YOU PLAN ON HAVING THIS BEVERLY
20 FULGER TOMORROW OR NOT?
21 MR. WILSON: WE DO NOT PLAN TO HAVE HER TOMORROW AT
22 THIS TIME.
23 THE COURT: OKAY. THEN WE'LL SEE EVERYBODY BACK AT
24 EIGHT A.M. TOMORROW AND WE'LL GO UNTIL TEN; TAKE THE BREAK
25 AND GO FROM TWO TO FIVE.
1717
1 MR. STIRBA: THANK YOU, YOUR HONOR.
2 THE COURT: THANK YOU.
3 (WHEREUPON, THE AFTERNOON SESSION ENDS.)
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1718
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 8 OF 21
12 JUNE 20, 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
1719
1 (WHEREUPON, THE MORNING SESSION BEGINS.)
2 THE COURT: WILL YOU PLEASE BE SEATED? OKAY. THE
3 RECORD SHOULD REFLECT THAT THE PARTIES ARE PRESENT. THE
4 JURY IS HERE. AND I APPRECIATE EVERYONE, THE WITNESS, THE
5 ATTORNEYS, AND THE JURY, BEING HERE AT THE EARLIER HOUR. GO
6 AHEAD, MISS BARLOW.
7 MS. BARLOW: THANK YOU, YOUR HONOR.
8 BONITA HARDEY,
9 DIRECT EXAMINATION, CONT'D
10 BY MS. BARLOW:
11 Q. GOOD MORNING, BONNIE.
12 A. MORNING.
13 Q. DO YOU HAVE THE BINDER FOR ENNIS ALLDREDGE THERE?
14 A. YES.
15 Q. DO YOU RECALL MR. ALLDREDGE?
16 A. YES, I DO.
17 Q. WHAT DAY DID HE COME INTO THE HOSPITAL?
18 A. HE CAME IN ON JANUARY 10TH AT 12:03 P.M.
19 Q. DO YOU RECALL WHETHER YOU WERE THERE WHEN HE FIRST CAME
20 IN?
21 A. I WAS ON DUTY ON THAT DAY, YES.
22 Q. LET'S TURN TO THE PHYSICIAN ORDERS WHICH IS MED PAGE
23 NUMBER 10. WHAT DATE -- WHOOPS, BETTER HIT THE -- THERE.
24 WHAT DATE WERE THOSE ORDERS WRITTEN?
25 A. ON 1/10 AT 1300.
1720
1 Q. EXCUSE ME. CAN YOU TELL WHO WROTE THEM?
2 A. LYNN LONG.
3 Q. WE HAVE THE TOP PART THERE. WHAT WAS THAT TOP PART?
4 A. WHICH TOP PART?
5 Q. THE FIRST SECTION HERE, DOWN TO THAT FIRST --
6 A. OH, VITAL SIGNS B.I.D. TWICE A DAY.
7 Q. THAT WHOLE SECTION THERE, WHAT WAS THAT WRITTEN FOR?
8 A. THE SPECIAL PRECAUTIONS.
9 Q. WELL, THE WHOLE SECTION, THAT WHOLE TOP SECTION.
10 A. I'M SORRY.
11 Q. I'M SORRY, THIS WHOLE TOP SECTION DOWN TO THIS LINE.
12 A. OH, WHAT WAS THAT WRITTEN FOR?
13 Q. YES.
14 A. THAT'S YOUR BASIC ADMITTING ORDERS THAT THEY HAD, AND IT
15 WOULD TELL YOU WHAT DIAGNOSIS THEY HAD. DID YOU WANT ME
16 READ THAT OR --
17 Q. NO. BUT LET'S DO LOOK AT THE PRELIMINARY, IS THAT --
18 D.X., WHAT'S D.X.?
19 A. DIAGNOSIS.
20 Q. AND WHAT DOES THAT -- WHAT WAS THE PRELIMINARY
21 DIAGNOSIS?
22 A. PSYCHOSIS.
23 Q. AND DO YOU KNOW WHAT N.O.S. WAS?
24 A. UNKNOWN ORIGIN TYPE OF THING.
25 Q. LET'S GO DOWN. WE HAVE LOOKS LIKE MEDICATIONS THAT WERE
1721
1 ORDERED. THE STANDARD TYLENOL, MYLANTA, MILK OF MAGNESIA.
2 INSULIN WAS ORDERED. WHAT DOES THAT TELL YOU ABOUT
3 MR. ALLDREDGE?
4 A. THAT HE IS A DIABETIC.
5 Q. WE HAVE RISPERDAL. I THINK WE TALKED ABOUT THAT
6 YESTERDAY. PEPCID. WHAT IS THAT?
7 A. IT'S FOR STOMACH.
8 Q. AND L-THYROXINE?
9 A. IT'S FOR THYROID.
10 Q. TRAZODONE, WE TALKED ABOUT. HOW DO YOU PRONOUNCE, BU --
11 A. BUMETADINE --
12 Q. BUMET -- BUMETADINE?
13 A. YEAH, IT'S --
14 Q. OKAY. THANK YOU. WHAT'S THAT FOR?
15 A. IT'S FOR BLOOD PRESSURE, HEART.
16 Q. AND THEN WE HAVE E.C.A.S.A.
17 A. THAT IS EXTENDED RELEASE ASPIRIN.
18 Q. AND OXYBUTYNIN.
19 A. THAT IS FOR LIKE PROSTATE, WHERE THEY'RE NOT ABLE TO
20 EMPTY THEIR BLADDER.
21 Q. DOES IT ALLOW VOIDING THEN?
22 A. YES, IT MAKES IT A LITTLE MORE COMFORTABLE.
23 Q. WHAT'S MICRO-K?
24 A. IT'S POTASSIUM.
25 Q. AND AGAIN, WHY WOULD YOU HAVE POTASSIUM?
1722
1 A. IF THEY'RE ON A DIURETIC, THAT DEPLETES THEIR POTASSIUM.
2 Q. AND A DIURETIC IS WHAT?
3 A. IT RELEASES FLUID FROM THE BODY SO THEY DON'T SWELL UP,
4 THEIR LEGS, AND MAKES IT EASIER FOR THEIR HEART TO PUMP.
5 Q. WHAT'S HYTRIN?
6 A. IT'S ALSO USED LIKE FOR PROSTATE PROBLEMS.
7 Q. AND THEN D.S.S.?
8 A. THAT'S A STOOL SOFTENER.
9 Q. AND BUSPAR?
10 A. IS A -- ALSO A PSYCHOTROPIC MEDICATION.
11 Q. THEN OF COURSE WE HAVE THE D.N.R. AGAIN. NOW, TURN TO
12 THE PSYCHOLOGICAL EVALUATION WHICH IS PAGE NUMBER 3. AND
13 THE THIRD PAGE OF THAT WHICH IS PAGE NUMBER 5, WHAT WAS THE
14 ESTIMATED LENGTH OF HOSPITALIZATION?
15 A. TWO TO THREE WEEKS.
16 Q. AND DISCHARGE CRITERIA?
17 A. BACK TO SUNSHINE TERRACE.
18 Q. OH, THE CRITERIA IS?
19 A. OH, NO COMBATIVENESS.
20 Q. AND THEN THE PLAN.
21 A. BACK TO SUNSHINE TERRACE.
22 Q. ARE YOU FAMILIAR WITH THE TERM HOSPICE CARE?
23 A. YES, I AM.
24 Q. AND HOW ARE YOU FAMILIAR WITH IT?
25 A. THROUGH THE HOSPITAL USUALLY WHERE I WORK.
1723
1 Q. AND WHAT IS HOSPICE CARE?
2 A. YOU'RE GIVING COMFORT CARE TO TERMINALLY ILL PEOPLE,
3 PATIENTS.
4 Q. AND DO YOU HAVE ANY DISCHARGE CRITERIA FOR HOSPICE CARE?
5 MR. STIRBA: YOUR HONOR, I'M GONNA OBJECT TO
6 RELEVANCE.
7 THE COURT: SUSTAINED.
8 MS. BARLOW: IF YOU WOULD TURN TO MED PAGE NUMBER
9 11, THE UPPER LEFT-HAND CORNER, THERE'S SOME WRITING. WHO
10 WROTE THAT?
11 A. THAT WAS WOULD BE DR. WEITZEL.
12 Q. AND WHAT HAS HE ORDERED HERE?
13 A. ATIVAN 1 MILLIGRAM AND HALDOL 10 MILLIGRAMS I.M. NOW.
14 Q. MEANING TO GIVE IT IMMEDIATELY, IS THAT CORRECT?
15 A. CORRECT.
16 Q. THEN WHAT ELSE?
17 A. ATIVAN 1 TO 2 MILLIGRAMS I.M. Q-4 HOURS P.R.N. SEVERE
18 AGITATION.
19 Q. AND THAT MEANS WHAT?
20 A. TO BE GIVEN AS NECESSARY IF THE PATIENT BECOMES
21 AGITATED.
22 Q. AND THE NEXT ONE?
23 A. HALDOL, 5 MILLIGRAMS, I.M. Q-A.M. 1700. N.H.S. MEANING
24 IN THE EVENING.
25 Q. WHAT DOES A.M. 1700 N.H.S. ALL TOGETHER MEAN?
1724
1 A. USUALLY A DOSE AT 8:00 O'CLOCK IN THE MORNING, 5:00
2 O'CLOCK IN THE AFTERNOON, AND ONE ABOUT 9:00 O'CLOCK IN THE
3 EVENING.
4 Q. AND CAN YOU TELL WHAT --
5 A. TO BE GIVEN P.R.N. IF PATIENT REFUSES RISPERDAL.
6 Q. DO YOU KNOW WHAT ATIVAN IS FOR?
7 A. WE USUALLY USE IT FOR AGITATION.
8 Q. AND WHAT ABOUT HALDOL?
9 A. IT'S A -- A PSYCHOTROPIC THAT CAN BE GIVEN I.M. WHEREAS
10 RISPERDAL CAN BE GIVEN ONLY P.O.
11 Q. DO YOU KNOW IF THERE'S ANY DIFFERENCE BETWEEN WHAT
12 ATIVAN'S SUPPOSED TO DEAL WITH AND WHAT HALDOL IS SUPPOSED
13 TO DEAL WITH?
14 MR. STIRBA: YOUR HONOR --
15 MS. BARLOW: I ASKED IF SHE NEW. IF SHE DOESN'T
16 KNOW, THEN SHE DOESN'T KNOW.
17 MR. STIRBA: WELL --
18 THE COURT: GO AHEAD.
19 THE WITNESS: YES, I DO.
20 Q. (BY MS. BARLOW) AND WHAT IS THAT KNOWLEDGE BASED ON?
21 A. FROM READING PHARMACOLOGY BOOKS, OF PRIOR EXPERIENCE
22 USING THE MEDICATION.
23 Q. WHAT ARE PHARMACOLOGY BOOKS?
24 A. DRUG BOOKS THAT THE NURSES USE TO LOOK UP MEDICATIONS,
25 LOOK FOR THEIR ADVERSE EFFECTS, WHAT THEY'RE USED FOR.
1725
1 Q. BASED ON THAT, WHAT -- WHAT IS -- IS THERE ANY
2 DIFFERENCE BETWEEN THE USE OF ATIVAN AND HALDOL?
3 MR. STIRBA: YOUR HONOR, I'M GONNA OBJECT.
4 IRRELEVANT AND -- IT'S IRRELEVANT HYPOTHETICAL.
5 THE COURT: OVERRULED.
6 Q. (BY MS. BARLOW) IS THERE ANY DIFFERENCE IN THE USE OF
7 ATIVAN AND HALDOL?
8 A. THE USE THAT WE NORMAL USE ATIVAN FOR IS FOR EXTREME
9 AGITATION IN A PATIENT. HALDOL IS USUALLY USED FOR A
10 PSYCHOTROPIC EFFECT WHERE YOU'RE TRYING TO CALM DOWN THEIR
11 MAIN -- MANIC TYPE OF EPISODES. MOOD, USUALLY FOR A MOOD.
12 Q. IF YOU'D TURN TO THE NEXT PAGE, PAGE 12, IN THE UPPER
13 LEFT-HAND CORNER IS THE DATE 1/12/96. WHAT WAS THE ORDER
14 CHANGE AT THAT POINT?
15 A. INCREASE HALDOL TO 10 MILLIGRAMS I.M. P.R.N. PATIENT
16 REFUSING ORAL MEDICATIONS. GIVE IT A.M. 1700, MEANING
17 5:00 P.M. AND H.S., MEANING 9:00 O'CLOCK P.R.N.
18 Q. WHAT HAD BEEN THE DOSAGE BEFORE?
19 A. I BELIEVE IT WAS 5 MILLIGRAMS.
20 Q. AND DID YOU NOTE THAT?
21 A. YES, I DID NOTE THAT.
22 Q. AT WHAT TIME?
23 A. AT 10:45 A.M.
24 Q. THE NEXT NOTE, WHAT IS THAT?
25 A. M.R.I.
1726
1 Q. WHAT IS AN M.R.I.?
2 A. IT'S WHERE THEY GO AND DO A SCAN OF THE BRAIN, WHERE
3 THEY'RE IN A MACHINE AND IT DOES AN IMAGE OF THE INTERIOR
4 PART OF THE BRAIN.
5 Q. AND THEN THE BOTTOM PART, WHAT WAS THAT ORDER?
6 A. ATIVAN 1 MILLIGRAM I.M. NOW, HALDOL 5 MILLIGRAMS I.M.
7 NOW, TELEPHONE ORDER FROM DR. WEITZEL.
8 Q. AT WHAT TIME?
9 A. AT 1325.
10 Q. AND THE FIRST ONE WAS AT 10:45, SO THAT'S WHAT, LESS
11 THAN THREE HOURS?
12 A. YES.
13 Q. LET'S TURN OVER TO THE NURSING NOTES. SPECIFICALLY
14 NUMBER 60, DID YOU DO ANY CHARTING ON NUMBER 60 WHICH LOOKS
15 TO BE THE FIRST TIME MR. ALLDREDGE CAME IN?
16 A. NO, I DID NOT.
17 Q. LET'S LOOK AT 61. WHAT DATE WAS THIS?
18 A. THIS IS 1/10 ALSO.
19 Q. WHAT SHIFT?
20 A. THAT WOULD BE THE 3:00 TO 11:00 SHIFT.
21 Q. DID YOU WORK THAT SHIFT?
22 A. YES, I DID.
23 Q. HOW DO YOU KNOW YOU WORKED IT?
24 A. BECAUSE MY INITIALS ARE ON THE BOTTOM OF THE PAGE.
25 Q. LOOKS LIKE IT'S PARTIALLY COVERED. IS THAT YOUR NAME,
1727
1 YOUR INITIALS?
2 A. YES.
3 Q. WHAT PART OF THIS FORM DID YOU FILL OUT?
4 A. I USUALLY CO-SIGNED THE L.P.N. AND HE DID THE INITIAL
5 ASSESSMENT AND I WAS JUST CONCURRING THAT I AGREED WITH HIS
6 ASSESSMENT.
7 Q. OVER HERE UNDER NEUROLOGICAL, HOW DID MR. ALLDREDGE
8 APPEAR AT THE 3:00 TO 11:00 SHIFT.
9 A. LETHARGIC AND UNRESPONSIVE.
10 Q. AND UNDER PSYCHO -- PSYCHOSOCIAL AND EMOTIONS, WHAT WAS
11 WRITTEN IN THERE?
12 A. SLEEPY.
13 Q. WHO WAS THE L.P.N. THAT WROTE THIS?
14 A. RICHARD CLARK.
15 Q. WHAT DID HE WRITE ABOUT THE -- IN FREE TEXT ABOUT THE
16 STATE OF MR. ALLDREDGE AT THAT POINT -- OR THAT AFTERNOON,
17 EXCUSE ME?
18 A. OKAY. THE PERSON WHO WROTE THAT WAS TYLER SPRAGUE AT
19 THE TOP.
20 Q. OKAY.
21 A. THE NARRATIVE PART. GO AHEAD AND READ THAT --
22 Q. WHO WAS TYLER SPRAGUE?
23 A. HE WAS A CERTIFIED NURSING ASSISTANT ON THE FLOOR.
24 Q. AND BY SIGNING THIS, DID YOU CONCUR IN WHAT HE WROTE?
25 A. CORRECT.
1728
1 Q. WHAT DID HE WRITE?
2 A. PATIENT HAS BEEN LETHARGIC AND UNRESPONSIVE TO STAFF.
3 PATIENT HAS BEEN IN BED WITH RESTRAINTS ON BECAUSE OF
4 AGITATION. PATIENT HAS BEEN CHECKED EVERY TWO HOURS AND
5 RESTRAINT HAS BEEN RELEASED. OFFERED PATIENT WATER. RANGE
6 OF MOTION. PATIENT REFUSED WATER AND WAS RESTRAINED --
7 RESISTANT WITH RANGE OF MOTION AND COMBATIVE AT TIMES WITH
8 STAFF. FOLLOW CARE PLAN, REDIRECT PATIENT WHEN AGGRESSIVE
9 AND AGITATED.
10 Q. DID YOU SEE ANY SIGNS OR SYMPTOMS OF PAIN?
11 A. NO, I DID NOT.
12 Q. WOULD YOU LOOK OVER 62? WHAT IS THIS?
13 A. THIS IS USUALLY AN EXTENSION OF THE FORM IN FRONT WHEN
14 WE DON'T HAVE ROOM TO COMPLETE EVERYTHING ON THE ONE SHEET
15 THAT HAS THIS SMALL NARRATIVE SECTION, WE DO A CONTINUATION
16 SHEET.
17 Q. WHO WROTE THESE?
18 A. FIRST ENTRY WAS BY LYNN LONG.
19 Q. AND THEN THE OTHER ENTRIES?
20 A. THEY WERE BY TYLER SPRAGUE.
21 Q. CAN YOU QUICKLY LOOK THROUGH THAT?
22 A. OKAY.
23 Q. DID YOU SEE ANY SIGNS OF CHARTING OF SIGNS OR SYMPTOMS
24 OF PAIN? Once again, relevance?
25 MR. STIRBA: YOUR HONOR, I'M GONNA OBJECT --
1729
1 THE COURT: SUSTAINED.
2 MR. STIRBA: -- TO THE FORM OF THAT --
3 Q. (BY MS. BARLOW) WELL, LET'S GET SPECIFIC THEN. SECOND
4 LINE DOWN, WOULD YOU READ THE SENTENCE THAT STARTS WITH,
5 PATIENT RESTRAINT REAPPLIED?
6 A. PATIENT'S RESTRAINT REAPPLIED AS PATIENT IS TRYING TO
7 GET UP WITHOUT ASSISTANCE, PLUS IS ASSAULTIVE TOWARDS STAFF.
8 HITTING, TRYING TO KICK, BITE.
9 Q. LET'S GO ON TO THE NEXT DAY. WOULD YOU LOOK AT NUMBER
10 63?
11 A. UH-HUH.
12 Q. WHAT DAY IS THIS?
13 A. THIS IS JANUARY 11TH.
14 Q. DID YOU FILL OUT ANY OF THIS?
15 A. NO, I DID NOT.
16 Q. 2400, WHAT WAS THE FIRST THING CHARTED?
17 A. PATIENT RESTLESS. POSEY --
18 Q. THEN LET'S JUMP DOWN TO -- IS THAT O200? WHAT'S THE
19 FIRST LINE CHARTED?
20 A. 0200, PATIENT CONTINUES RESTLESS, REMOVING BEDDING,
21 POSEY UNDONE.
22 Q. LET'S JUMP DOWN TO 0400?
23 A. PATIENT RESTLESS, BUT SLEEPING.
24 Q. 0600? WHAT'S THE FIRST -- DOWN TO RANGE OF MOTION,
25 WHAT -- WOULD YOU READ DOWN TO THERE?
1730
1 A. OKAY. THAT FIRST PART -- OH, U.A. OBTAINED PER STRAIGHT
2 CATH.
3 Q. WHAT DOES THAT MEAN?
4 A. THAT MEANS THAT THEY OBTAINED A SPECIMEN OF HIS URINE BY
5 INSERTING A TUBE INTO HIS BLADDER SO THAT THEY COULD GET A
6 CLEAN CATCH. PATIENT VERY AGITATED, CRYING LOUDLY. POSEY
7 REMOVED.
8 Q. WHEN WE GET DOWN HERE I -- THIS APPARENTLY IS LATER IN
9 THE DAY. IS THAT 2100?
10 A. 0800 --
11 Q. THERE'S 08, AND THEN WHAT'S THE NEXT ONE? I GUESS YOU
12 CAN'T TELL FOR SURE WHAT --
13 WOULD YOU READ THE BEHAVIOR RIGHT THERE AT THE BOTTOM
14 NEXT TO THAT?
15 A. PATIENT HAS BEEN AGITATED, HITTING, SPITTING.
16 Q. DO YOU SEE ANYTHING ON THIS CHART INDICATING PAIN?
17 MR. STIRBA: YOUR HONOR, I'M GONNA OBJECT.
18 THE COURT: SUSTAINED. THE DOCUMENT SPEAKS FOR
19 ITSELF.
20 Q. (BY MS. BARLOW) LET'S GO OVER TO THE NEXT PAGE, WHICH
21 IS TO BE A CONTINUATION, THIS IS NUMBER 64. LOOKS LIKE
22 THERE'S A BEHAVIOR LISTED UP THERE. WOULD YOU READ WHAT
23 THAT BEHAVIOR WAS?
24 A. IT'S RESPONSE.
25 Q. RESPONSE, EXCUSE ME.
1731
1 A. ATTENDED GROUPS, BUT SLEPT. WHEN OFFERED MEALS, KEPT
2 SPITTING IT OUT.
3 Q. LET'S GO OVER TO NUMBER 68. THE FIRST DATE HAS BEEN
4 PUNCHED, BUT THE OTHER DATES DOWN THE PAGE ARE WHAT?
5 A. JANUARY 12TH.
6 Q. 8:00 O'CLOCK. WHAT'S THE FREE TEXT?
7 A. POSEY RESTRAINT RELEASED FOR RANGE OF MOTION,
8 CIRCULATION --
9 Q. WHAT IS RANGE OF MOTION?
10 A. WHERE YOU MOVE THEIR WRIST BACK AND FORTH AND JUST TO
11 GIVE THEM SOME MOVEMENT SO THEY DON'T GET CONTRACTED WHERE
12 THEIR HANDS START DRAWING UP FOR CIRCULATION.
13 Q. THANK YOU. SO RELEASE FOR RANGE OF MOTION.
14 A. CIRCULATION CHECKED. PERI CARE, MEANING TAKING CARE OF
15 THE PRIVATE AREA. OFFER OF FOOD AND WATER. PATIENT TRYING
16 TO HIT AND SPIT AT STAFF AND TRYING TO GET UP WITHOUT
17 ASSISTANCE. REDIRECTION ATTEMPTED, BUT PATIENT UNRESPONSIVE
18 TO VERBAL CUES. POSEY BELT REAPPLIED FOR PATIENT SAFETY.
19 PATIENT HELPED TO DAY ROOM FOR BREAKFAST IN CHAIR WITH POSEY
20 ON.
21 Q. THEN AT 8:20 THERE'S ANOTHER FREE TEXT.
22 A. PATIENT REFUSED ALL ORAL MEDICATIONS BY SPITTING OUT
23 ANYTHING PUT HIS MOUTH. TRYING TO SLAP AWAY R.N.'S HANDS.
24 MUTTER -- MUTTERING ANGRILY. PATIENT MEDICATED WITH HALDOL.
25 5 MILLIGRAMS I.M.
1732
1 Q. AND THEN LOOKS LIKE 10:00 O'CLOCK?
2 A. PATIENT CONTINUES TO REFUSE ALL ORAL OFFERINGS AND
3 CONTINUES TO GET UP WITHOUT ASSISTANCE. POSEY RESTRAINT
4 RELEASED FOR PERI-CARE, CIRCULATION CHECK, RANGE OF MOTION,
5 OFFERED WATER AND FOOD. RESTRAINT REAPPLIED FOR PATIENT
6 SAFETY. PATIENT CONTINUES TO SPIT OUT ALL ORAL MATERIALS;
7 I.E., FOODS, MEDS, WATER.
8 Q. WHO HAS WRITTEN THESE NOTES?
9 A. LYNN LONG.
10 Q. AND WHAT ABOUT 12:00 O'CLOCK?
11 A. PATIENT RELEASED FROM RESTRAINT FOR CIRCULATION CHECK,
12 RANGE OF MOTION, PERI CARE. OFFER OF WATER AND FOOD.
13 PATIENT CONTINUES TO BE AGITATED. TRYING TO GET UP WITHOUT
14 ASSISTANCE. AND SPITTING, HITTING AT STAFF. RESTRAINT
15 REAPPLIED FOR PATIENT SAFETY.
16 Q. THEN AT 12:45?
17 A. PATIENT MEDICATED WITH ATIVAN 2 MILLIGRAMS I.M. FOR
18 EXTREME AGITATION PRIOR TO M.R.I. AND THAT WAS THE SCAN THAT
19 THEY DO FOR THE BRAIN, SCHEDULED FOR 1300, THAT'S 1:00
20 O'CLOCK IN THE AFTERNOON.
21 Q. THEN AT 1330, WHAT DID SHE WRITE?
22 A. M.R.I. PERSONNEL REPORT REMAINS AGITATED. PATIENT
23 MEDICATED WITH ATIVAN 1 MILLIGRAM, I.M. AND HALDOL 5
24 MILLIGRAMS I.M. PER DOCTOR'S ORDERS. RESULTS PENDING ON
25 MEDICATION.
1733
1 Q. THEN AT 1410, LET'S SEE, I'VE GOT THIS -- IT'S CONTINUED
2 HERE, BUT IF YOU'D READ THAT LINE?
3 A. PATIENT RETURNED FROM M.R.I. ROOM --
4 Q. AND THEN WHAT DID SHE CONTINUE TO WRITE?
5 A. -- BY M.R.I. PERSONNEL WHO REPORTED PATIENT REMAINS TOO
6 AGITATED TO CONDUCT M.R.I. PATIENT'S RESTRAINT RELEASED FOR
7 RANGE OF MOTION, PERI CARE, CIRCULATION CHECK. OFFER OF
8 WATER AND FOOD AND JUICE. PATIENT REFUSING EVERYTHING BY
9 MOUTH. CLENCHING TEETH. TRYING TO HIT STAFF, TRYING TO GET
10 UP WITHOUT ASSISTANCE. POSEY REAPPLIED FOR PATIENT SAFETY.
11 Q. LET'S JUMP DOWN TO THE BOTTOM, SAME DATE. 1800. CAN
12 YOU TELL WHO THIS WAS WRITTEN BY?
13 A. THAT LOOKS LIKE LAURIE. YEAH, LAURIE WILLIAMS.
14 Q. WHAT DID SHE WRITE AT 1800?
15 A. M.R.I. DR. CLINGER CALLED TO REPORT EVIDENCE OF
16 POSSIBLE NEW INFARCT WITH LEFT OCCIPITAL LOBE.
17 Q. WHAT'S AN INFARCT?
18 A. WHERE THERE'S DECREASED BLOOD FLOW TO A CERTAIN AREA OF
19 THE BRAIN. Not really.
20 Q. AND WHAT'S THE OCCIPITAL LOBE?
21 A. IT'S A SECTION OF THE BRAIN. IN THE BACK.
22 Q. WHAT DID SHE CONTINUE TO WRITE?
23 A. PATIENT REMAINS RESTLESS, AND MINIMALLY RESPONSIVE
24 EXCEPT TO DISCOMFORT. DR. WEITZEL HAS BEEN NOTIFIED OF
25 M.R.I. RESULTS.
1734
1 Q. LET'S -- LET'S -- WELL, LET'S GO AHEAD, YEAH, GO AHEAD
2 AND --
3 A. IN VIEW OF PATIENT'S DIABETES AND POSSIBLE DEHYDRATION,
4 DOCTOR HAS ORDERED I.V. D. 5 AND A HALF N.S. AT 100 C.C.S AN
5 HOUR. DR. WEITZEL PLANS TO TALK WITH FAMILY IN A.M.
6 REGARDING M.R.I. RESULTS AND PLANNED CARE. PATIENT RELEASED
7 -- I CAN'T READ THAT OUT. SOMETHING RESTRAINTS -- FROM
8 RESTRAINTS.
9 Q. AND THEN AT 2000, WHAT WAS WRITTEN?
10 A. AT 8:00 P.M., AN I.V. STICK VERY DIFFICULT. THIS R.N.
11 ATTEMPTED ONE TIME IN THE LEFT WRIST. PATIENT ROTATED AWAY
12 AS NEEDLE WAS IN THE VEIN. PRESSURE APPLIED TO LEFT WRIST
13 SITE. I.C.U. NURSE CALLED TO ASSIST WITH FUTURE NEEDLE
14 STICK WHILE GERO STAFF RESTRAINED THE PATIENT. PATIENT IS
15 NOT VERBALLY RESPONSIVE. SLOWS -- I DON'T KNOW WHAT THAT
16 IS. STRONG LIMB MOVEMENTS IN RESPONSE TO PAINFUL STIMULI.
17 I.C.U. NURSE ATTEMPTED THREE NEEDLE STICKS BEFORE SUCCESSFUL
18 STICK IN LEFT FOREARM. PATIENT HANDS HAVE BEEN LOOSELY
19 RESTRAINED IN ORDER TO PREVENT DISRUPTION OF I.V. SITE.
20 PATIENT REMAINS VERBALLY UNRESPONSIVE, WITH STRONG RANDOM
21 LIMB MOVEMENTS. I.V. INFUSING D. 5 AND A HALF IN 100 C.C.S
22 AN HOUR WITH A 22 GAUGE NEEDLE.
23 Q. AND THEN IF YOU'D READ THE FIRST TWO SENTENCES OF 2200.
24 A. PATIENT IS CALM AND THREE POINT RESTRAINT. ALL ORAL
25 MEDICATIONS HAVE BEEN HELD THIS EVENING DUE TO PATIENT'S
1735
1 INABILITY TO SWALLOW.
2 Q. AND THEN WHAT DID HE WRITE? OR SHE WRITE?
3 A. I.M. MEDICATIONS NOT UTILIZED DUE TO PATIENT'S EXTREME
4 SEDATION AND ALTERED MENTAL STATUS.
5 Q. WHAT IS SEDATION?
6 A. MEANS THAT THEIR LEVEL OF CONSCIOUSNESS IS -- IS LOW.
7 THEY'RE NOT ALERT, THEY'RE DROWSY.
8 Q. DID YOU SEE MR. ALLDREDGE ON THE 12TH?
9 A. YES, I DID.
10 Q. WHAT SHIFT?
11 A. THAT WOULD HAVE BEEN -- LET'S SEE, DAY SHIFT, I BELIEVE.
12 YES. I DID THE PHYSICAL ASSESSMENT THAT DAY.
13 Q. IS THAT ON NUMBER 71?
14 A. YES, IT IS.
15 Q. AND WHAT DID YOU WRITE ABOUT HIS -- OR WHAT DID YOU
16 INDICATE ABOUT HIS NEUROLOGICAL STATUS?
17 A. HE WAS LETHARGIC, MEANING VERY, VERY DROWSY.
18 Q. WHAT ABOUT HIS PSYCHOSOCIAL?
19 A. PSYCHOSOCIAL, AGAIN, HE WAS LETHARGIC.
20 Q. DO YOU RECALL THAT THIS WAS HIS STATUS AT THE TIME?
21 A. YES.
22 Q. LET'S THEN GO TO THE 13TH. DID YOU SEE HIM ON THE 13TH?
23 A. NOT ON THE 13TH.
24 Q. LET'S LOOK AT THE CHART NUMBER 74. PAGE NUMBER 74.
25 A. OKAY.
1736
1 Q. WHICH IS THE 13TH. AT 0800 WHAT WAS CHARTED?
2 A. PATIENT UNRESPONSIVE. FAMILY WITH PATIENT. POSEY
3 RESTRAINTS TAKEN OFF. I.V.'S DISCONTINUED. COMFORT
4 MEASURES GIVEN. DR. WEITZEL TALKED WITH FAMILY.
5 DR. DIENHART NOTIFIED OF PATIENT'S DECLINING CONDITION.
6 Q. AND WHAT WAS THE BEHAVIOR NOTICED AT 1500 HOURS?
7 A. PATIENT HAS BEEN UNRESPONSIVE THE WHOLE NIGHT, THE WHOLE
8 SHIFT.
9 Q. AND WHAT WAS THE RESPONSE?
10 A. RESPIRATIONS WERE IRREGULAR WITH PERIODS OF APNEA.
11 COLOR, PALE.
12 Q. LET'S TURN BACK TO THE PHYSICIAN'S ORDER -- ORDERS FOR
13 THE 13TH. THAT WOULD BE PAGE NUMBER 13. IN THE CENTER OF
14 THE PAGE THERE ON THE LEFT ARE SOME WRITTEN ORDERS. CAN YOU
15 READ WHAT THOSE ARE?
16 A. ON WHAT, JANUARY 13TH?
17 Q. JANUARY 13TH, YES.
18 A. DISCONTINUE I.V.
19 Q. WHAT WAS THE I.V. IN PLACE FOR?
20 A. FOR DEHYDRATION, AND HE WAS -- HE WAS TAKING NO ORAL
21 FOOD OR ANYTHING DURING THAT TIME. AND HE WAS A DIABETIC,
22 SO IT WAS IMPORTANT THAT HE HAVE SOME TYPE OF NOURISHMENT TO
23 MAKE SURE THAT THE INSULIN THAT WE WERE GIVING HIM HAD
24 SOMETHING TO BIND TO, BASICALLY, SOME TYPE OF GLUCOSE.
25 Q. SO I.V. WAS DISCONTINUED.
1737
1 A. YES, IT WAS.
2 Q. AND THEN WHAT ELSE WAS ORDERED?
3 A. MORPHINE SULFATE 10 MILLIGRAMS I.M. EVERY THREE HOURS.
4 ATIVAN .5 MILLIGRAMS I.M. EVERY THREE HOURS. DISCONTINUE
5 ALL ORAL MEDICATIONS. DISCONTINUE HALDOL AS NECESSARY, AS
6 WRITTEN.
7 Q. THAT'S P.R.N. AS NECESSARY?
8 A. YES. HALDOL 10 MILLIGRAMS I.M. EVERY FOUR HOURS.
9 P.R.N. SEVERE AGITATION. AND DID YOU WANNA READ FURTHER?
10 Q. WELL, IF YOU'D TELL US WHEN THIS ORDER WAS NOTED.
11 A. IT WAS NOTED AT 0800 THAT MORNING.
12 Q. HAD YOU SEEN ANY CHARTING OF PAIN ON THE 13TH?
13 MR. STIRBA: YOUR HONOR, I'M GONNA OBJECT.
14 THE COURT: SUSTAINED.
15 Q. (BY MS. BARLOW) YOU DON'T NEED TO ANSWER THAT ONE.
16 A. OKAY.
17 Q. THE OBJECTION HAS BEEN SUSTAINED. SO LET'S LOOK AT
18 NUMBER 75 WHICH IS BACK TO THE NURSES' NOTES. WHAT DATE WAS
19 THIS?
20 A. THAT WAS JANUARY 13TH.
21 Q. AND WHO WROTE IT?
22 A. LYNN LONG.
23 Q. WHAT WAS THE BEHAVIOR NOTED?
24 A. PATIENT UNRESPONSIVE THIS SHIFT DURING CARES AND I.M.
25 MEDICATION ADMINISTRATION. NO RESPONSE TO ADMINISTRATION.
1738
1 SOMETHING FAMILY MEMBER -- AT BEDSIDE.
2 Q. IT'S CUT OFF. MAYBE IT'S PRESENT AT BEDSIDE.
3 A. OH, PRESENT AT BEDSIDE, YEAH.
4 Q. LET'S GO DOWN TO THE RESPONSE.
5 A. RESPONSE IS PATIENT UNRESPONSIVE WITH LONG PERIODS OF
6 APNEA EVERY ONE TWO MINUTES.
7 Q. WHAT'S LONG PERIODS OF APNEA EVERY ONE TO TWO MINUTES?
8 A. AGAIN, WHERE YOU HOLD YOUR BREATH, DON'T BREATHE FOR A
9 FEW SECONDS, AND SHE WAS SAYING IT WAS GOING EVERY ONE TO
10 TWO MINUTES --
11 MR. STIRBA: YOUR HONOR, I'M GONNA OBJECT TO HER
12 INTERPRETING THE NOTE. THE NOTE --
13 THE COURT: LET'S -- GO ON.
14 Q. (BY MS. BARLOW) AND THEN WHAT DID SHE WRITE AFTER THE
15 APNEA?
16 A. NO DISCOMFORT NOTED DURING CARES.
17 Q. AND THEN THE PLAN?
18 A. MEDS AS ORDERED, COMFORT CARE.
19 Q. LET'S GO TO -- WELL, LET'S MOVE ON. WOULD YOU TURN TO
20 MED NUMBER 77? DO YOU HAVE THAT?
21 A. YES, I DO.
22 Q. OKAY. THANK YOU. WHAT DATE WAS THAT?
23 A. JANUARY 14TH.
24 Q. DID YOU SEE MR. ALLDREDGE THAT DAY?
25 A. YES, I DID.
1739
1 Q. WHAT SHIFT?
2 A. DAY SHIFT.
3 Q. FIRST ON 77, WE HAVE THE NIGHT SHIFT WAS WRITTEN, IS
4 THAT CORRECT?
5 A. YES.
6 Q. WOULD YOU READ THAT FOR US?
7 A. AT THE VERY TOP?
8 Q. YES.
9 A. NIGHT SHIFT FREE TEXT NOTE. PATIENT'S LEVEL OF
10 AWARENESS HAS BEEN PROGRESSIVELY SINKING OVER SHIFT. ALL
11 FAMILY MEMBERS HAVE BEEN PRESENT INTERMITTENTLY. WIFE HAS
12 REMAINED AT BEDSIDE THROUGHOUT SHIFT. THEN 0500 DOSE OF
13 MORPHINE. 10 MILLIGRAMS AND ATIVAN 0.5 MILLIGRAMS WERE
14 GIVEN AT 0430 DUE TO PATIENT GRIMACING AND LABORED
15 BREATHING. INDICATE -- I CAN'T MAKE OUT THAT ONE --
16 Q. I THINK INDICATING --
17 A. HIS -- HIS LEVEL OF DISTRESS. CHEYNE-STOKING.
18 Q. WHAT ARE CHEYNE-STOKES RESPIRATIONS?
19 A. AGAIN. IT'S A PATTERN OF BREATHING WHERE IT'S NOT
20 REGULAR LIKE A NORMAL BREATH, HE'S KIND OF GASPING FOR AIR.
21 Q. SO CHEYNE-STOKES RESPIRATION IS --
22 A. CONTINUE WITH PERIODS APNEA LASTING UP TO 30 SECONDS.
23 PATIENT WAS GIVEN NASAL TRACHEAL SUCTIONING BY RESPIRATORY
24 THERAPY.
25 Q. WHAT DOES THAT -- WHAT DOES NASAL TRACHEAL SUCTIONING
1740
1 MEAN?
2 A. USUALLY IF THEY HAVE SECRETIONS IN THEIR THROAT THAT
3 THEY'RE NOT ABLE TO SWALLOW ON THEIR OWN, THEY TAKE A
4 PLASTIC TUBE THAT'S CONNECTED TO AIR AND IT SUCTIONS AND
5 CLEARS OUT THEIR THROAT BECAUSE THEY'RE NOT ABLE TO DO IT
6 THEMSELVES, TO TRY AND MAINTAIN AIRWAY.
7 Q. SIMILAR TO WHAT YOU HAVE IN A DENTIST'S OFFICE WHERE
8 THEY --
9 A. YES.
10 Q. OKAY.
11 A. VERY SIMILAR. CONTINUE TO HAVE DEEP CHEST RATTLE AS OF
12 0600.
13 Q. THEN AT 0600 --
14 A. DOCTOR --
15 Q. -- WHAT WAS NOTED?
16 A. DR. WEITZEL GAVE TELEPHONE ORDER FOR MORPHINE 10
17 MILLIGRAMS I.M. GIVEN IN LEFT GLUTEUS WHICH IS THE --
18 Q. WHAT'S THE GLUTEUS?
19 A. IT'S YOUR BUTTOCKS AREA. NO RESPONSE FROM PATIENT TO
20 THAT NEEDLE STICK. FAMILY REMAINS WITH PATIENT COMFORTING
21 HIM AND TALKING WITH HIM, ASKING HIM TO LET GO.
22 Q. AND WHO WROTE THAT NOTE?
23 A. LAURIE WILLIAMS.
24 Q. AND DOWN AT THE BOTTOM, WHO STARTED WRITING?
25 A. THAT'S MY WRITING.
1741
1 Q. THAT'S --
2 A. 0735 IN THE MORNING.
3 Q. WHAT DID YOU SEE AT 0735 IN THE MORNING?
4 A. PATIENT DEEP LABORED RESPIRATIONS. PATIENT TURNED,
5 MOANING DURING TURNING PROCEDURE.
6 Q. SO THE TURNING WAS DONE BY WHOM?
7 A. BY MYSELF AND A CERTIFIED NURSING ASSISTANT.
8 Q. THEN THE NEXT PAGE, WHICH IS 78?
9 A. PATIENT HAS THICK MUCOUS DRAINAGE FROM MOUTH. ORAL CARE
10 GIVEN. LUNGS WITH RALES THROUGHOUT.
11 Q. WHAT ARE RALES?
12 A. IT'S A SOUND YOU HEAR WHEN YOU'RE TAKING A DEEP BREATH.
13 IT'S USUALLY INDICATING LIKE A FLUID BUILDUP IN THE LUNGS SO
14 THEY'RE NOT FULLY TAKING IN OXYGEN.
15 Q. SO THOSE SOUNDS WERE HEARD THROUGHOUT, AND THEN WHAT?
16 A. CYANOTIC EXTREMITIES. FAMILY MEMBERS AT BEDSIDE.
17 Q. AND AT 0800, WHAT DID YOU WRITE? FIRST, WHAT DID YOU
18 WRITE DOWN IN THIS SMALL SECTION HERE UNDER 0800?
19 A. VITAL SIGNS.
20 Q. WHAT WERE HIS VITAL SIGNS?
21 A. HIS TEMP WAS 101.8. HIS HEART RATE WAS 84.
22 RESPIRATIONS WERE 16. AND HIS BLOOD PRESSURE WAS 110 OVER
23 72.
24 Q. ANY OF THOSE OUTSIDE THE RANGE OF NORMAL?
25 A. THE TEMPERATURE.
1742
1 Q. WHAT DID YOU WRITE IN THE FREE TEXT?
2 A. PATIENT GIVEN 10 MILLIGRAMS MORPHINE I.M. DUE TO
3 CONTINUED MOANING. PATIENT'S RESPIRATIONS REMAIN LABORED.
4 PATIENT WITH EYES OPEN, STARING. FAMILY REMAINS AT BEDSIDE.
5 Q. AND THEN AT 9:20?
6 A. PATIENT TO BE GIVEN NOW ORDER OF MORPHINE I.M. AND
7 ATIVAN 0.5.
8 Q. DO YOU KNOW HOW THIS -- DO YOU RECALL HOW THIS NOW ORDER
9 CAME INTO PLACE?
10 A. THAT WAS FROM THE DOCTOR.
11 Q. DID YOU CALL HIM OR DO YOU RECALL?
12 A. YES, I CALLED HIM BECAUSE OF THE DECLINING CONDITION OF
13 THE PATIENT.
14 Q. WHAT DID YOU TELL HIM, THE DEFENDANT, THE CONDITION WAS?
15 A. PARDON?
16 Q. WHAT DO YOU TELL THE DEFENDANT THE CONDITION WAS?
17 A. HOW HIS BREATHING PATTERN WAS. HOW HE WAS -- HIS
18 EXTREMITIES WERE TURNING BLUE. HE WAS HAVING A HARD TIME
19 BREATHING.
20 Q. WHAT DID THE DEFENDANT SAY TO YOU IN THAT TELEPHONE
21 CONVERSATION?
22 A. HE ASKED IF I HAD BEEN GIVING THE SCHEDULED MORPHINE.
23 AND I SAID YES. AND THEN HE SAID TO GIVE A NOW ORDER OF
24 MORPHINE AND ATIVAN.
25 Q. DID YOU QUESTION HIM ABOUT THAT ORDER?
1743
1 A. I'VE LEARNED NOT TO QUESTION HIM ABOUT AFTER THAT --
2 Q. WELL, FIRST, DID YOU QUESTION HIM: YES OR NO?
3 A. NO.
4 Q. AND WHY DID YOU NOT QUESTION HIM?
5 MR. STIRBA: I'M GONNA OBJECT, YOUR HONOR.
6 IRRELEVANT.
7 THE COURT: OVERRULED.
8 Q. (BY MS. BARLOW) WHY DID YOU NOT QUESTION HIM?
9 A. BECAUSE IN THE PAST WHEN I HAVE QUESTIONED HIM ABOUT
10 MEDICATIONS, HE DIDN'T RESPOND APPROPRIATELY TO ME.
11 Q. WELL, YOU'VE GOTTA TELL WHAT --
12 A. OH.
13 Q. -- THE RESPONSE WAS --
14 MR. STIRBA: YOUR HONOR --
15 Q. (BY MS. BARLOW) -- NOT HOW YOU FELT --
16 MR. STIRBA: -- IM GONNA OBJECT. THIS IS -- THIS
17 IS IRRELEVANT AND --
18 THE COURT: EITHER ANS -- QUESTION HAS TO BE
19 ANSWERED, NOT A SPEECH.
20 Q. (BY MS. BARLOW) RIGHT. SO NOT -- NOT HOW YOU FELT
21 ABOUT HIS --
22 A. OH.
23 Q. -- RESPONSE, BUT WHAT WAS HIS RESPONSE IN THE PAST WHEN
24 YOU QUESTIONED HIM?
25 MR. STIRBA: YOUR HONOR, I'M GONNA OBJECT. IT'S
1744
1 HEARSAY, IT'S IRRELEVANT, IT'S 403, AND THIS IS --
2 THE COURT: THE LAST PART OF WHAT HE SAID IN THE
3 PAST HAS BEEN ASKED AND ANSWERED.
4 Q. (BY MS. BARLOW) SO YOU ADMINISTERED A DOSE OF MORPHINE
5 AT 9:20?
6 A. NO, I DID NOT.
7 Q. WHO DID?
8 A. IT WASN'T GIVEN, I BELIEVE.
9 Q. LET'S TURN -- I GUESS IT'S THE MED CHARTS, IS THAT WHAT
10 WE'D LOOK AT TO FOUND FIND OUT ABOUT THE ADMINISTRATION OF
11 THE MORPHINE?
12 A. UH-HUH. THAT WOULD HAVE BEEN ON PAGE 46.
13 Q. OKAY. LET ME GET THAT PULLED OUT HERE. THAT'S IN THE
14 CENTER OF THE PAGE. THERE SEEMS TO BE TWO -- TWO ORDERS FOR
15 MORPHINE. THE FIRST ONE --
16 A. THE SCHEDULED DOSE AT 8:00 O'CLOCK, I GAVE.
17 Q. IS THAT YOUR INITIALS THEN?
18 A. ON PAGE 47.
19 Q. OH, ON 47?
20 A. THAT WAS THE SCHEDULED DOSE THAT WE --
21 Q. OKAY.
22 A. -- HAD TO GIVE.
23 Q. LET ME GET THAT ONE ON HERE SO WE CAN --
24 A. AND THEN THE NOW ORDER THAT HE TOLD ME TO GIVE IN
25 ADDITION, I DID NOT GIVE. AND THAT'S ON PAGE 46 WHERE I PUT
1745
1 NOT GIVEN.
2 Q. WELL, FIRST, LET'S LOOK -- OKAY. LET ME GET TO THE
3 RIGHT ONE. THIS IS PAGE 47.
4 A. THAT'S THE SCHEDULED DOSE IN THERE AT 8:00 O'CLOCK. MY
5 INITIALS ARE RIGHT THERE WHERE --
6 Q. AND IT'S UNDER 114, SO THAT WAS THE ONE YOU GAVE AT
7 8:00 O'CLOCK, IS THAT CORRECT?
8 A. YES, THAT WAS THE SCHEDULED DOSE.
9 Q. OKAY. SO THIS WAS A SEPARATE --
10 A. THAT'S THE ONE --
11 Q. -- DOSE.
12 A. -- HE TOLD ME TO GIVE IN ADDITION. AND I DIDN'T GIVE
13 IT.
14 Q. DID YOU TELL DR. WEITZEL YOU DIDN'T GIVE IT?
15 A. NO.
16 Q. WHY DID YOU NOT GIVE IT?
17 MR. STIRBA: I'M GONNA OBJECT, YOUR HONOR.
18 IRRELEVANT.
19 MS. BARLOW: YOUR HONOR, I THINK IT'S VERY
20 RELEVANT.
21 MR. STIRBA: SHE SAID WHAT SHE DIDN'T DO. WHY SHE
22 DIDN'T DO IT IS IRRELEVANT. IT'S WAY AFTER THE FACT, YOUR
23 HONOR.
24 THE COURT: OKAY. SUSTAINED.
25 Q. (BY MS. BARLOW) SO LET'S GO BACK TO PAGE 78. OKAY.
1746
1 NOW, DOWN HERE YOU'VE CHARTED AT 9:20 FIRST THAT PATIENT TO
2 BE GIVEN. AND THEN WHAT DID YOU WRITE AFTER THAT?
3 A. PATIENT TO BE GIVEN NOW ORDER OF 10 MILLIGRAMS MORPHINE
4 I.M. AND ATIVAN 0.5. PATIENT WITH DECREASED FUNCTIONS.
5 APNEA EVERY 60 SECONDS. THAT MEANT HE WAS HOLDING HIS
6 BREATH FOR ABOUT 60 SECONDS WITHOUT BREATHING. HEART RATE
7 WAS TACHY, WHICH MEANT IT WAS -- IT WAS VERY FAST. AND
8 THREADY, MEANING IT WASN'T VERY STRONG, IT WAS JUST WEEK.
9 MEDICATION HELD. THERE WERE NO PERIPHERAL PULSES IN ANY
10 EXTREMITIES.
11 Q. WHAT ARE PERIPHERAL PULSES?
12 A. PULSES BY THE WRIST, THE ANKLES.
13 Q. SO YOU COULDN'T GET HIS PULSE, IS THAT --
14 A. ON THOSE EXTREMITIES. YOU COULD HEAR A HEART RATE, BUT
15 THE BLOOD, YOU COULDN'T FEEL IT FLOWING TO THE EXTREMITIES.
16 Q. THEN WHAT DID YOU WRITE?
17 A. CYANOTIC EXTREMITIES. FAMILY AT BEDSIDE. AWARE OF
18 DECLINING CONDITION. WIFE AWOKEN FROM SLEEP TO BE WITH
19 PATIENT.
20 Q. AND THEN AT 9:30, WHAT DID YOU WRITE?
21 A. PATIENT CONDITION DECLINING. RESPIRATIONS EVERY 80
22 SECONDS WITH GASPING NOTED. HEART RATE TACHY AND WEAK,
23 APICALLY, MEANING OVER THE HEART.
24 Q. WHAT DOES THAT MEAN?
25 A. THAT MEANS SINCE I COULDN'T GET A HEART PULSE FROM HIS
1747
1 EXTREMITIES, I WOULD PUT MY STETHOSCOPE ON HIS HEART AND
2 LISTEN THERE.
3 Q. AND THEN AT 9:36, WHAT DID YOU WRITE?
4 A. PATIENT HAS HAD NO HEART RATE, NO RESPIRATIONS, NO BLOOD
5 PRESSURE.
6 Q. WHAT DID THAT MEAN?
7 A. WELL, HE HAD DIED.
8 Q. CAN YOU TELL US AT THIS -- DURING THIS TIME PERIOD HOW
9 MORPHINE INJECTIONS WERE DISPENSED ON THE UNIT?
10 A. DURING THIS TIME?
11 Q. YES, DURING DECEMBER -- WELL, FROM DECEMBER 6TH, 1995 TO
12 JANUARY 14TH OF 1996.
13 A. THEY START --
14 MR. STIRBA: RELEVANCY, YOUR HONOR.
15 MS. BARLOW: YOUR HONOR, I THINK IT'S -- I THINK
16 THE JURY NEEDS TO KNOW HOW MORPHINE WAS DISPENSED BECAUSE
17 THAT'S WHAT'S AT ISSUE IN THIS CASE.
18 THE COURT: OVERRULED.
19 Q. (BY MS. BARLOW) HOW WAS IT DISPENSED?
20 A. IT WAS DISPENSED IN -- YOU MEAN WHAT TYPE OF PACKAGING
21 DID IT COME IN?
22 Q. YES.
23 A. IT CAME IN PREPACKAGED SYRINGES, 2 MILLIGRAMS,
24 4 MILLIGRAMS, 10 MILLIGRAMS. SOMETIMES 8, DEPENDING ON WHAT
25 THE PHARMACY HAD AVAILABLE.
1748
1 Q. YOU SAY THE PHARMACY. WAS IT KEPT ON THE UNIT?
2 A. IT WAS -- IT WAS A CONTROLLED ITEM, SO THAT MEANT IT WAS
3 UNDER LOCK AND KEY.
4 Q. ON THE UNIT?
5 A. ON THE UNIT. PRIOR TO DECEMBER, THOUGH, THEY DIDN'T
6 HAVE IT ON THE UNIT.
7 Q. WELL, WE CAN ONLY TALK --
8 THE COURT: OKAY. JUST -- JUST ANSWER THE QUESTION
9 THAT'S ASKED.
10 Q. (BY MS. BARLOW) LET'S SEE, WE'VE ALREADY COVERED THAT.
11 IN REGARDS TO MR. ALLDREDGE, AFTER MR. ALLDREDGE DIED, DID
12 YOU -- JUST YES OR NO -- DID YOU GO TO ANYONE AT HORIZON --
13 A. YES.
14 Q. -- ABOUT THE DEATH OF THIS PATIENT?
15 A. YES.
16 Q. TO WHOM DID YOU GO?
17 A. TODD CHAMBERS.
18 Q. AND WHO'S TODD CHAMBERS?
19 A. HE WAS THE DIRECTOR OF HORIZONS.
20 Q. WHEN DID THAT HAPPEN?
21 A. I FIRST WENT TO HIM ABOUT TWO DAYS BEFORE
22 MR. ALLDREDGE'S DEATH, AND THEN AGAIN AFTER.
23 Q. WAS ANYONE ELSE PRESENT AT EITHER OF THESE MEETINGS?
24 A. NO.
25 Q. WHERE DID THEY TAKE PLACE?
1749
1 A. IN HIS OFFICE.
2 Q. THE MEETING THAT HAPPENED TWO DAYS BEFORE THE DEATH ON
3 THE 12TH, WHAT DID YOU TELL MR. CHAMBERS?
4 A. THAT I WAS CONCERNED ABOUT THE PATIENT'S DECLINE IN
5 CONDITION AND HESITANT ABOUT GIVING MORPHINE DUE TO THIS
6 DECLINE IN CONDITION.
7 Q. WHAT RESPONSE DID YOU GET?
8 A. HE SAID HE WOULD LOOK INTO THE MATTER.
9 Q. DID HE EVER COME BACK TO YOU WITH ANY RESULTS?
10 A. HE JUST TOLD ME THEY WERE STILL CHECKING ON IT.
11 Q. WHAT ABOUT AFTER THE DEATH OF MR. ALLDREDGE, DID YOU --
12 YOU SAY YOU WENT TO MR. CHAMBERS.
13 A. I WENT TO MR. CHAMBERS AGAIN BECAUSE I WAS EXTREMELY
14 UPSET, AND TOLD HIM THAT IT NEEDED TO STOP.
15 Q. AND WHAT DID YOU MEAN BY IT NEEDED TO STOP?
16 A. ALL THESE DEATHS ON THE UNIT.
17 Q. DID YOU GET ANY RESPONSE FROM MR. CHAMBERS?
18 A. HE -- HE WAS CONCERNED, BUT HE DIDN'T VERBALIZE WHAT HE
19 WAS GONNA DO. HE SAID HE'D LOOK INTO THE MATTER, BUT HE
20 DIDN'T SAY HOW HE WAS GONNA DO THAT.
21 Q. DID YOU EVER TALK TO THE DEFENDANT ABOUT MR. ALLDREDGE
22 PRIOR TO HIS DEATH?
23 A. YES.
24 Q. WHEN DID THAT TAKE PLACE?
25 A. USUALLY WHEN I WOULD CALL HIM ABOUT HIS DECLINING
1750
1 CONDITION, I WOULD TRY TO EMPHASIZE HIS RESPIRATION RATE
2 BEING LOW -- LOWER THAN NORMAL AND ASK IF WE NEEDED TO GIVE
3 THE MORPHINE.
4 Q. AND WHAT WAS THE DEFENDANT'S RESPONSE?
5 A. WE HAD TO GIVE THE MORPHINE. IT WAS SCHEDULED AROUND
6 THE CLOCK.
7 Q. WERE YOU SEEING ANY SIGNS OR SYMPTOMS OF PAIN IN MR.
8 ALLDREDGE?
9 A. NO.
10 Q. DURING THE PERIOD OF THE 6TH OF DECEMBER, 1995 THROUGH
11 THE 14TH OF JANUARY, 1996, DID YOU EVER TALK TO THE
12 DEFENDANT ABOUT MOVING ANY OF THESE PATIENTS OFF OF THE
13 UNIT?
14 A. YES, I DID.
15 Q. DO YOU RECALL WHEN THAT CONVERSATION TOOK PLACE?
16 A. THE FIRST WAS WITH MARY CRANE.
17 Q. AFTER HER DEATH OR DURING HER DEATH OR I GUESS --
18 A. BEFORE HER DEATH.
19 Q. BEFORE HER DEATH. DO YOU RECALL WHEN THAT CONVERSATION
20 WAS?
21 A. IT WAS AFTER I HAD DISCOVERED THE FISTULA, WHICH WAS THE
22 OPENING BETWEEN HER RECTUM AND HER VAGINA SO THE STOOL WAS
23 GOING IN BETWEEN. I EXPRESSED CONCERN THAT SHE COULD, YOU
24 KNOW, GO SEPTIC BECAUSE OF THIS.
25 Q. LET'S BACK UP A LITTLE BIT. WHERE DID THIS CONVERSATION
1751
1 TAKE PLACE?
2 A. IT WAS ON THE PHONE THE DAY AFTER DR. DIENHART CAME IN
3 AND EXAMINED HER. I HAD CALLED ABOUT ANOTHER PATIENT.
4 Q. AND YOU TALKED TO DR. WEITZEL ABOUT MARY CRANE?
5 A. YES.
6 Q. AND WHAT DOES IT MEAN TO GO SEPTIC ON ME?
7 A. IT MEANS THAT YOUR WHITE BLOOD COUNT -- AND THAT'S THE
8 PART OF YOUR BLOOD THAT FIGHTS INFECTION -- IT STARTS
9 ELEVATING. AND WHEN IT GETS OUT OF CONTROL, YOUR BLOOD
10 PRESSURE STARTS DROPPING AND YOUR SYSTEMS JUST BASICALLY SIT
11 DOWN -- SHUT DOWN, AND IT COULD CAUSE DEATH.
12 Q. DID YOU EXPRESS THIS CONCERN TO THE DEFENDANT?
13 A. YES.
14 Q. IS THAT IN A TELEPHONE CONVERSATION?
15 A. YES.
16 Q. WAS ANYONE ELSE PRESENT IN THAT CONVERSATION?
17 A. NOT THAT I KNOW OF, I DON'T KNOW.
18 Q. WHAT WAS THE DEFENDANT'S RESPONSE?
19 A. THAT HE WAS THE DOCTOR AND I WAS THE NURSE.
20 Q. DID HE TELL YOU WHAT TO DO?
21 A. NO.
22 Q. SPEAKING -- WELL, LET'S -- LET ME BACKTRACK A LITTLE BIT
23 OR LET ME FOLLOW THAT LINE. DID YOU TALK TO THE DEFENDANT
24 ABOUT ANY OTHER OF THESE PATIENTS, CONCERNS YOU HAD?
25 MR. STIRBA: YOUR HONOR -- YOUR HONOR, VAGUE AND
1752
1 AMBIGUOUS. AND THIS IS UNFAIR SURPRISE AT THIS POINT. IT'S
2 NOT -- THIS IS -- THERE -- THE COURT HAS ADDRESSED THIS
3 ISSUE AND THIS IS UNFAIR SURPRISE, THESE CONVERSATIONS.
4 THE COURT: GO ON TO SOMETHING ELSE. WE'LL TALK
5 ABOUT THAT.
6 Q. (BY MS. BARLOW) DID YOU EVER TALK TO DEFENDANT ABOUT
7 THE NUMBER OF PATIENTS ON THE UNIT?
8 A. THE NUMBER OF PATIENTS, COULD YOU --
9 Q. WELL, IT WAS A TEN-BED UNIT.
10 A. YES, IT WAS.
11 Q. WE'VE HEARD THAT.
12 A. YES.
13 Q. DID YOU EVER TALK TO HIM ABOUT HOW MANY PATIENTS WERE ON
14 THE UNIT AT ANY ONE TIME?
15 A. IT WAS DISCUSSED IN A DISCUSSION ONCE, IT WAS BROUGHT
16 UP.
17 Q. WHEN WAS THAT DISCUSSION?
18 A. IT WAS THIS TIME FRAME.
19 Q. WAS IT A FACE-TO-FACE CONVERSATION?
20 A. YES.
21 Q. WAS ANYONE ELSE PRESENT?
22 A. I DON'T RECALL.
23 Q. WHERE DID THIS CONVERSATION TAKE PLACE?
24 A. AT THE NURSES' STATION.
25 Q. DO YOU RECALL WHAT BROUGHT THE CONVERSATION UP?
1753
1 A. IT WAS A DISCUSSION ABOUT PATIENTS NOT BEING MEDICALLY
2 APPROPRIATE AND ME WANTING TO TRANSFER THEM --
3 MR. STIRBA: YOUR HONOR --
4 THE WITNESS: -- OUT OF THE UNIT.
5 MR. STIRBA: YOUR HONOR, I'M GONNA OBJECT. THIS IS
6 UNFAIR SURPRISE AND I OBJECT TO THE RELEVANCY.
7 MS. BARLOW: YOUR HONOR --
8 THE COURT: LET'S -- LET'S --
9 MS. BARLOW: -- THIS IS MATERIAL WE TALKED ABOUT
10 YESTERDAY.
11 THE COURT: WELL, OKAY. DO YOU HAVE ANYTHING ELSE
12 THAT YOU'RE GONNA ASK THIS --
13 MS. BARLOW: NO. I MEAN THIS IS MATERIAL THE COURT
14 RULED ON YESTERDAY.
15 THE COURT: NO, BUT DO YOU HAVE ANY OTHER QUESTIONS
16 YOU WANNA ASK THIS WITNESS?
17 MS. BARLOW: NO, THIS IS --
18 THE COURT: OKAY. LADIES AND GENTLEMEN, WHY DON'T
19 WE TAKE JUST A FIVE-MINUTE BREAK SO THAT WE CAN DISCUSS THIS
20 LEGAL ISSUE.
21 (THE COURT ADMONISHED THE JURY, FOLLOWING
22 WHICH THE JURY LEFT THE COURTROOM.)
23 THE COURT: OKAY. YOU MAY BE SEATED. THE RECORD
24 SHOULD REFLECT THAT THE JURY HAS LEFT THE COURTROOM. OKAY.
25 THERE WERE TWO ISSUES. OKAY. THIS LAST ITEM, YES, WE
1754
1 DISCUSSED YESTERDAY A COMMENT ABOUT THE SIX, YOU KNOW,
2 NEEDED SIX TO MAKE IT WORK OR SOMETHING, BUT WHAT WAS YOUR
3 OBJECTION?
4 MR. STIRBA: WELL, I MEAN I HAD NO IDEA THAT ALL OF
5 THE SUDDEN THE WITNESS WAS GONNA VOLUNTEER. THE CONTEXT OF
6 THIS DISCUSSION WAS ABOUT INAPPROPRIATE CARE OF THESE
7 PATIENTS DURING THE RELEVANT TIME. I'M ENTITLED, IF THE
8 COURT SAYS THAT THESE PEOPLE HAVE TO GIVE ME SOME INDICATION
9 OF WHAT A CONVERSATION IS, I'M ENTITLED TO GET ALL THE
10 CONVERSATION. IT'S IMPOSSIBLE, JUDGE, FOR ME TO SIT HERE IN
11 FRONT OF THIS JURY AND ATTEMPT TO DEAL WITH THESE VERY
12 DIFFICULT ISSUES IF I'M NOT GIVEN A FULL PROFFER AS TO WHAT
13 HAPPENED. THE ONLY THING I WAS TOLD YESTERDAY WAS THAT
14 THERE WAS SOME CONVERSATION AND THE CONVERSATION WAS ABOUT,
15 I TOLD THE COURT WHAT I UNDERSTOOD. THAT'S WHAT I
16 UNDERSTOOD. I DIDN'T KNOW THAT WE WERE GONNA GET IN
17 ADDITION TO THAT THE WITNESS SAYING, OH, YEAH, IT WAS ABOUT
18 ALL THE INAPPROPRIATE CONCERNS AND INAPPROPRIATE CARE AND
19 ALL THIS KIND OF THING. AND I'M TELLING YOU, THIS SHOULD
20 NOT BE A TRIAL BY AMBUSH. THIS IS TOO IMPORTANT OF A CASE.
21 AND I'M SITTING THERE AND I'M TRYING MY GUTS OUT FOR MY
22 CLIENT, BUT IT'S IMPOSSIBLE IF I'M NOT GIVEN ADEQUATE
23 WARNING. THE COURT HAS ALREADY RULED ON 404(B). AND GIVEN
24 ADEQUATE WARNING OF WHAT PEOPLE ARE GONNA SAY AND WHEN
25 THEY'RE GONNA SAY IT. THIS WITNESS OBVIOUSLY -- WE'VE
1755
1 ALREADY HAD IT THIS MORNING -- WANTS TO VOLUNTEER ALL KINDS
2 OF WONDERFUL THINGS ABOUT THIS DEFENDANT. OBVIOUSLY HAS
3 STRONG FEELINGS ABOUT HIM. THAT'S FINE. BUT QUITE FRANKLY,
4 SHE OUGHT NOT TO BE ABLE TO GET AWAY WITH IT, A., AND B., I
5 OUGHT NOT TO BE AMBUSHED ABOUT THESE CONVERSATIONS. SO
6 THAT'S MY FIRST PROBLEM.
7 MY SECOND PROBLEM WITH THE QUESTION WAS, WE DID HAVE --
8 SHE TALKED ABOUT THE CONVERSATION ABOUT THE MOVEMENT OF
9 PATIENTS. SHE TESTIFIED TO IT. AND THEN THERE WAS ANOTHER
10 QUESTION OF, WELL, DID YOU HAVE OTHER CONCERNS ABOUT OR
11 OTHER CONVERSATIONS ABOUT OTHER PATIENTS. JUDGE, IT'S SO
12 VAGUE, I CAN'T EVEN BEGIN TO ADDRESS IT. IT'S NEVER BEEN
13 DISCLOSED TO ME. I HAVE NO REPORT ON THIS WITNESS. WELL, I
14 TAKE IT BACK. I HAVE TWO POLICE REPORTS ON THIS WITNESS.
15 THIS WITNESS IN THOSE TWO POLICE REPORTS NEVER ONCE, NEVER
16 ONCE MENTIONED ONE CONVERSATION THAT SHE HAD WITH THAT MAN
17 RIGHT OVER THERE. BUT SHE WALKS INTO THIS COURTROOM AND NOW
18 SHE HAS ALL KINDS OF CONVERSATIONS SHE'S WILLING TO
19 VOLUNTEER AND TESTIFY ABOUT. AND THE COURT'S DEALT WITH IT
20 AND THE COURT SAID, OKAY, TELL DEFENSE COUNSEL ABOUT THESE
21 CONVERSATIONS. I'M ENTITLED TO KNOW. WELL, I'M ENTITLED TO
22 KNOW THE FULL SCOPE OF THE CONVERSATIONS NOT JUST A LITTLE
23 SLICE, AND THEN WE KIND OF SLIDE INTO SOME OTHER, QUITE
24 FRANKLY, PREJUDICIAL INFORMATION. I JUST THINK THAT'S
25 PATENTLY UNFAIR. AND THAT'S MY PROBLEM AND THAT'S WHY I
1756
1 OBJECTED.
2 THE COURT: OKAY. MISS BARLOW.
3 MS. BARLOW: YOUR HONOR, I'VE GOT A COUPLE OF
4 RESPONSES. NUMBER ONE, THIS WITNESS WAS DEPOSED
5 EXTENSIVELY --
6 MR. STIRBA: NEVER DEPOSED HER EVER. NEVER TOOK
7 HER DEPOSITION, NEVER.
8 MS. BARLOW: EXCUSE ME, YOUR HONOR, I MISSPOKE. I
9 APOLOGIZE FOR THAT. I WAS UNDER THE IMPRESSION SHE HAD
10 BEEN.
11 THE COURT: WELL, WHETHER SHE'D BEEN DEPOSED OR
12 NOT, YESTERDAY I SAID THAT I'D ALLOWED YOU WITH THE OTHER
13 WITNESS TO HAVE THOSE CONVERSATIONS. I SAID FROM NOW ON IF
14 THERE ARE CONVERSATIONS, YOU'LL DISCLOSE THAT. AND THAT
15 DIDN'T MATTER WHETHER THERE WAS A DEPOSITION OR NOT. I JUST
16 SAID THAT WILL BE DISCLOSED. AND I AGREE THAT YESTERDAY WE
17 SAID SHE COULD TESTIFY REGARDING, IF I DIDN'T HAVE SIX
18 PEOPLE IN THIS UNIT, YOU KNOW, BUT THEN THE QUESTION WAS
19 ASKED, YOU KNOW, WHAT BROUGHT THAT ABOUT, AND THEN THAT WAS
20 SOMETHING NEW THAT I'D NEVER HEARD ABOUT.
21 MS. BARLOW: WELL, YOUR HONOR, I WAS JUST TRYING TO
22 LAY FOUNDATION FOR THE CONVERSATION. IF I CAN JUST JUMP TO
23 THE QUESTION AND WHAT DID HE SAY TO YOU ABOUT HOW MANY
24 PATIENTS HAD TO BE, I'LL DO THAT.
25 THE COURT: OKAY. IF THAT -- DO YOU HAVE ANY
1757
1 OBJECTION TO THAT?
2 MR. STIRBA: WELL, WE --
3 THE COURT: I MEAN BESIDES THE OBJECTION YOU STATED
4 YESTERDAY ABOUT THE SUBJECT ITSELF.
5 MR. STIRBA: NO, JUDGE. JUST WITH THE
6 UNDERSTANDING, I MEAN THE WITNESS IS HERE, SHE'S HEARD WHAT
7 WE'RE GOING OVER. AND THE IMPORTANCE OF JUST TESTIFYING AS
8 TO WHAT WAS SAID. AND NOT EDITORIALIZING OR GIVING
9 ADDITIONAL INFORMATION. BECAUSE THAT JUST WOULD NOT BE
10 RIGHT.
11 THE COURT: OKAY. ALL RIGHT. OKAY. WELL, THAT
12 TAKES CARE OF THAT ONE QUESTION. THE OTHER QUESTION YOU'RE
13 GONNA HAVE TO REFRESH MY MEMORY WHAT IT WAS ABOUT, JUST
14 OTHER CONVERSATIONS. NOW, SHE TESTIFIED ABOUT -- ARE THERE
15 OTHER CONVERSATIONS IN ADDITION TO WHAT SHE SAID?
16 MS. BARLOW: I'LL WITHDRAW THE QUESTION BECAUSE,
17 FRANKLY, YOUR HONOR, I CAN'T EVEN REMEMBER THE QUESTION
18 EITHER.
19 THE COURT: OKAY. ALL RIGHT. SO IS THERE ANYTHING
20 ELSE BESIDES THIS ONE QUESTION WE HAVE TO DEAL WITH?
21 MS. BARLOW: IF I MAY HAVE JUST A MOMENT.
22 THE COURT: OKAY.
23 MS. BARLOW: THAT'S THE ONLY QUESTION I WILL HAVE,
24 YOUR HONOR.
25 THE COURT: OKAY. THEN WHY DON'T WE HAVE THE JURY
1758
1 COME BACK?
2 (THE JURY RETURNS TO THE COURTROOM.)
3 THE COURT: OKAY. PLEASE BE SEATED. THE RECORD
4 WILL REFLECT THAT THE JURY HAS COME BACK. MISS BARLOW.
5 MS. BARLOW: OKAY. THANK YOU, YOUR HONOR.
6 Q. MISS HARDEY, IN THE CONVERSATION THAT HAD YOU WITH THE
7 DEFENDANT, DID HE EVER SAY ANYTHING TO YOU ABOUT HOW MANY
8 PATIENTS NEEDED TO BE ON THE UNIT?
9 A. YES, HE DID.
10 Q. AND WHAT DID HE SAY?
11 A. HE SAID HE NEEDED SIX PATIENTS ON THE UNIT TO MAKE IT
12 WORTH HIS WHILE TO COME DOWN FROM SALT LAKE.
13 MS. BARLOW: THOSE ARE ALL THE QUESTIONS I HAVE AT
14 THIS TIME, YOUR HONOR.
15 THE COURT: OKAY. MR. STIRBA.
16 MR. STIRBA: THANK YOU, YOUR HONOR.
17 CROSS-EXAMINATION
18 BY MR. STIRBA:
19 Q. YOU TESTIFIED ABOUT GOING TO MR. CHAMBERS, AND THAT
20 WOULD HAVE BEEN IN JANUARY OF 1996, IS THAT RIGHT?
21 A. THAT IS CORRECT.
22 Q. AND YOU SUPPOSEDLY WENT TO MR. CHAMBERS BECAUSE YOU WERE
23 CONCERNED ABOUT CIRCUMSTANCES ON THE UNIT, TRUE?
24 A. I WAS CONCERNED.
25 Q. AND IN FACT, AREN'T YOU AWARE, MA'AM, THAT HORIZONS DID
1759
1 AN INVESTIGATION OF THE VERY THINGS THAT YOU WERE CONCERNED
2 ABOUT, DO YOU UNDERSTAND THAT?
3 MS. BARLOW: YOUR HONOR, I'M GOING TO OBJECT TO
4 THIS LINE OF QUESTIONING AND ASK THAT HE NOT GET INTO IT
5 UNTIL WE'VE HAD TIME TO DISCUSS IT.
6 MR. STIRBA: THEY OPENED IT UP.
7 THE COURT: YOU ASKED THE QUESTION ABOUT
8 MR. CHAMBERS --
9 MS. BARLOW: YES, BUT THE INVESTIGATION WE NEED TO
10 DISCUSS OUTSIDE THE PRESENCE OF THE JURY, YOUR HONOR.
11 THE COURT: OKAY. LADIES AND GENTLEMEN, I'M GOING
12 TO TAKE JUST A REAL SHORT BREAK BECAUSE I WANT TO DO THIS
13 RIGHT NOW.
14 (THE COURT ADMONISHED THE JURY, FOLLOWING
15 WHICH THE JURY LEFT THE COURTROOM.)
16 THE COURT: YOU MAY BE SEATED. RECORD WILL REFLECT
17 THE JURY HAS LEFT THE COURTROOM. OKAY. WHAT IS THE
18 OBJECTION?
19 MS. BARLOW: YOUR HONOR, I'M SORRY TO SEND THEM OUT
20 AGAIN, BUT THIS IS THE REPORT OF AN INVESTIGATION THAT WE
21 DISCUSSED AT LENGTH FIRST OR SECOND DAY OF TRIAL. THE
22 MATERIAL --
23 THE COURT: I'M AWARE OF THE -- I'M AWARE OF IT.
24 I'M AWARE THAT THEY OFFERED FIVE SHEETS. I REFUSED TO HAVE
25 THEM BECAUSE WE DIDN'T HAVE EVERYTHING. THEN YOU ASKED A
1760
1 QUESTION THAT MR. CHAM -- DID YOU GO TO HORIZONS AND ASK
2 THAT THIS BE INVESTIGATED, AND WHAT DID HE SAY HE WOULD DO?
3 HE SAID THAT HE WOULD LOOK INTO IT. SO WE HAVE THAT
4 TESTIMONY OF THIS WITNESS. AND HOW IS THAT NOT OPENING THE
5 DOOR BECAUSE SHE HAS NOW SAID, I WENT TO HIM AND HE
6 BASICALLY DIDN'T SAY ANYTHING. I'LL LOOK INTO IT. AND NOW,
7 WHY ISN'T THE DOOR OPENED?
8 MS. BARLOW: BECAUSE WE HAVE NOT BEEN ALLOWED TO
9 HAVE THE RESULTS OF THAT REPORT. THAT WAS THE REPORT THAT
10 BOTH THE HOSPITAL -- EXCUSE ME, BOTH HORIZONS AND THE
11 DEFENDANT HAD TO --
12 THE COURT: WELL, THE QUESTION IS NOT WHETHER THE
13 REPORT'S COME IN OR NOT. THE QUESTION TO THIS WITNESS WAS,
14 WERE YOU AWARE THAT AN INVESTIGATION WAS DONE ABOUT THESE
15 ALLEGATIONS THAT YOU BROUGHT UP TO TODD CHAMBERS.
16 MS. BARLOW: AND IF SHE -- I HAVE NO PROBLEM WITH
17 HER TESTIFYING AS TO WHETHER SHE'S AWARE, BUT I DO NOT WANT
18 TO GET INTO THE RESULTS OF THAT INVESTIGATION BECAUSE SHE
19 WOULD NOT -- HAVE NO PERSONAL KNOWLEDGE OF IT. IT WOULD BE
20 HEARSAY, ANYTHING THAT SHE HEARD, IF SHE HEARD ANYTHING. I
21 DON'T KNOW IF SHE'S EVEN HEARD ANYTHING. IT WOULD BE
22 HEARSAY, NUMBER ONE. NUMBER TWO, WE DON'T HAVE ACCESS TO
23 THAT REPORT AND THAT REPORT IS -- THE COURT HAS ALREADY
24 RULED WILL NOT BE ALLOWED INTO EVIDENCE. AND SO I -- I
25 GUESS MY CONCERN IS GOING BEYOND DID SHE -- IS SHE AWARE OF
1761
1 IT. YOU KNOW, SHE CAN SAY WHETHER SHE'S AWARE OF IT, BUT I
2 WILL STRENUOUSLY OBJECT TO ANY QUESTIONS ABOUT WHAT WERE THE
3 RESULTS OF THAT, THAT INVESTIGATION.
4 THE COURT: OKAY. ALL RIGHT. MR. STIRBA.
5 MR. STIRBA: YOUR HONOR, THEY RAISED IT. I DIDN'T
6 RAISE IT. I'M ENTITLED TO GO INTO IT. AND I'LL TELL YOU,
7 I'M ENTITLED TO CROSS-EXAMINE THE WAY I WANNA CROSS-EXAMINE.
8 IF THE WITNESS DOESN'T KNOW, THE WITNESS WILL TELL ME, AND
9 I'LL MOVE ON. BUT I'M ENTITLED TO ASK QUESTIONS. SHE
10 RAISED IT BECAUSE THEY WANNA RAISE AN INNUENDO, QUITE
11 FRANKLY, THAT SOMETHING WAS AMISS HERE BY HER COMPLAINT.
12 AND I'M GONNA DISPEL THAT INNUENDO THROUGH THIS WITNESS.
13 AND I'M ENTITLED TO DO THAT. I DIDN'T BRING IT UP.
14 THE COURT: OKAY. ANYTHING FURTHER?
15 MS. BARLOW: YES, YOUR HONOR. SHE TESTIFIED TO HER
16 CONVERSATIONS WITH MR. CHAMBERS. SHE DIDN'T TESTIFY AS TO
17 WHAT THE RESULTS OF THAT INVESTIGATION WERE. AND FRANKLY,
18 IF WE'RE GOING TO GET INTO THAT, THEN, YOU KNOW, WE -- WE
19 WANT TO PUT THE WHOLE THING IN, WHICH INCLUDES THAT THERE
20 WERE THINGS THAT HAPPENED AND CAME OUT OF THIS
21 INVESTIGATION --
22 THE COURT: WELL, AS TO THIS --
23 MS. BARLOW: -- BUT -- WELL, YOU KNOW --
24 THE COURT: -- MATTER, WHATEVER SORT OF
25 INVESTIGATION WAS DONE IS BEYOND WHAT THIS WITNESS -- THE
1762
1 QUESTION TO THIS WITNESS WAS, WERE YOU AWARE THAT THE THINGS
2 THAT YOU BROUGHT UP WERE INVESTIGATED BY HORIZONS. AND WHAT
3 WERE THE RESULTS. AND IF SHE KNOWS IT, SHE DOESN'T KNOW IT.
4 BUT I MEAN YOU -- YOU ASKED THE QUESTION. YOUR QUESTION
5 WASN'T, DID YOU GO TO TODD CHAMBERS. YOUR QUESTION IS, DID
6 YOU GO TO HORIZON ABOUT THIS AND COMPLAIN TO HORIZON. AND
7 SO IT'S LEFT OUT THERE FOR THE JURY TO SAY -- AND THEN --
8 AND THEN YOU'RE SAYING, OKAY, THAT'S FINE, YOU CAN ANSWER
9 THAT QUESTION, BUT WE'RE NOT GONNA LET THE DEFENSE, YOU
10 KNOW, SAY INTO ANYTHING, YOU KNOW --
11 MS. BARLOW: WELL, IF -- IF THE DEFENSE GETS IN
12 THAT THERE WAS SOME RESULT, THEN WE WANT TO BE ABLE TO,
13 NUMBER ONE, GET -- GET THE REPORT OF THE --
14 THE COURT: WELL, WE'LL DO IT ONE QUESTION AT A
15 TIME. AS TO THE QUESTION ABOUT IN -- WHAT HAPPENED OR WHAT
16 SHE KNOWS ABOUT ANY INVESTIGATION AFTER SHE TALKED TO
17 HORIZON AND TODD CHAMBERS, THAT CAN BE ASKED.
18 MS. BARLOW: YOUR HONOR, THEN WE WOULD -- WE WOULD
19 LIKE TO RECEIVE A COPY OF THAT REPORT, AND THEN I GUESS
20 WE'LL PROBABLY HAVE TO GET SOME ORDER TO -- WOULDN'T BE THE
21 HOSPITAL, IT WOULD BE HORIZONS --
22 MR. MAJOR: BOTH HORIZON AND THE HOSPITAL.
23 THE COURT: WELL, THAT ISSUE IS NOT GONNA BE WITH
24 THIS WITNESS. WE CAN DISCUSS THAT AT A LATER TIME --
25 MS. BARLOW: THAT'S TRUE, BUT IT WILL OPEN UP
1763
1 BRINGING IN A LOT MORE WITNESSES ON --
2 THE COURT: WELL, WHEN YOU TALK ABOUT OPENING UP,
3 THE QUESTION -- YOU RAISED THE QUESTIONS ABOUT DID
4 HORIZON -- DID YOU TALK TO HORIZON ABOUT ALL THIS STUFF.
5 AND SO YOU OPENED IT.
6 OKAY. LET'S HAVE OF THE JURY COME BACK.
7 (THE JURY RETURNED TO THE COURTROOM.)
8 THE COURT: OKAY. PLEASE BE SEATED. THE RECORD
9 WILL REFLECT THAT THE JURY HAS RETURNED. MR. STIRBA, IF
10 YOU'D LIKE TO GO AHEAD.
11 MR. STIRBA: THANK YOU.
12 Q. YOU TESTIFIED, MISS HARDEY, THAT YOU TALKED TO
13 MR. CHAMBERS AND HE SAID HE'D LOOK INTO IT, TRUE?
14 A. CORRECT.
15 Q. AND IN FACT, HORIZON DID LOOK INTO IT, DID THEY NOT?
16 A. I HAVE NO KNOWLEDGE OF THAT.
17 Q. AND IN FACT, AFTER HORIZON LOOKED INTO IT, THEY DIDN'T
18 DISCIPLINE --
19 MS. BARLOW: OBJECTION, YOUR HONOR --
20 Q. (BY MR. STIRBA) -- DR. WEITZEL, DID THEY?
21 MS. BARLOW: -- SHE SAID SHE DIDN'T KNOW IF THEY
22 DID LOOK INTO IT AND HE SAID AFTER THEY LOOKED INTO IT, AND
23 I OBJECT TO ANY QUESTIONS ALONG THAT LINE.
24 THE COURT: OKAY. OVERRULED.
25 Q. (BY MR. STIRBA) THEY DIDN'T DISCIPLINE DR. WEITZEL TO
1764
1 YOUR KNOWLEDGE, DID THEY?
2 A. I HAVE NO IDEA.
3 Q. IN FACT, DR. WEITZEL CONTINUED TO WORK IN FEBRUARY AND
4 MARCH AND APRIL AND JULY ON THE UNIT, DIDN'T HE?
5 A. I HAVE NO KNOWLEDGE OF WHAT YOU'RE DISCUSSING RIGHT NOW.
6 Q. YOU HAVE NO KNOWLEDGE THAT DR. WEITZEL CONTINUED TO WORK
7 ON THE UNIT AFTER JANUARY OF 1996 DURING THE SAME TIME
8 PERIOD, MA'AM, WHEN YOU WERE WORKING THERE? YOU HAVE NO
9 KNOWLEDGE OF THAT?
10 A. THAT I DO.
11 Q. AND IN FACT, THAT'S TRUE, HE WORKED THERE IN FEBRUARY,
12 MARCH, APRIL, MAY, AND JUNE, ISN'T THAT TRUE?
13 A. THAT IS TRUE, HE WORKED.
14 Q. IN 1996, CORRECT?
15 A. YES.
16 Q. AND IT'S TRUE, IS IT NOT, MA'AM, THAT YOU FOLLOW THE
17 CODE AS A PROFESSIONAL NURSE OF THE AMERICAN NURSES'
18 ASSOCIATION?
19 A. YES, I DO.
20 Q. AND IT'S TRUE, IS IT NOT, THAT YOU BELIEVE THAT IT'S THE
21 PROFESSIONAL RESPONSIBILITY OF A NURSE TO SAFEGUARD THE
22 PATIENT AND THE PUBLIC WHEN HEALTH AND SAFETY ARE AFFECTED
23 BY INCOMPETENT, UNETHICAL, OR ILLEGAL PRACTICES OF ANY
24 PERSON?
25 A. THE BEST OF MY ABILITY.
1765
1 Q. AND YOU BELIEVE ALSO THAT A NURSE ASSUMES RESPONSIBILITY
2 AND ACCOUNTABILITY FOR INDIVIDUAL NURSING JUDGMENTS AND
3 ACTIONS?
4 A. YES, I DO.
5 Q. AND YOU CERTAINLY AGREE, DO YOU NOT, THAT ONE OF THE
6 FUNDAMENTAL REQUIREMENTS OF A NURSE IS THAT A NURSE DO NO
7 HARM. WOULD YOU AGREE WITH THAT?
8 A. I WOULD AGREE WITH THAT.
9 Q. AND IT'S TRUE, IS NOT, THAT WHEN YOU GAVE A P.R.N.
10 MORPHINE INJECTION ON THE 2ND OF JANUARY OF 1996 TO JUDITH
11 LARSEN, YOU DIDN'T BELIEVE YOU WERE DOING ANY HARM, ISN'T
12 THAT TRUE?
13 A. I'LL HAVE TO LOOK THAT UP. WHAT PAGE IS THAT ON?
14 Q. WELL, YOU HAVE THE BINDER IN FRONT OF YOU.
15 A. DO YOU HAVE A PAGE NUMBER?
16 Q. YOU KNOW WHERE THE MARS ARE. IS THERE ANY DOUBT IN YOUR
17 MIND, MA'AM, WHETHER OR NOT WHEN YOU GAVE --
18 A. I WOULD LIKE TO BE --
19 Q. -- THAT P.R.N. INJECTION --
20 MS. BARLOW: YOUR HONOR, HE'S ASKING --
21 THE COURT: OKAY. LET'S WAIT, LET HER LOOK.
22 MS. BARLOW: -- SECOND QUESTION.
23 THE WITNESS: THAT WAS NOT A P.R.N. INJECTION.
24 THAT WAS PART OF A SCHEDULED INJECTION AT 1530 THAT WAS NOT
25 REPORTED.
1766
1 Q. (BY MR. STIRBA) YOUR TESTIMONY THEN IS, MA'AM, YOU DID
2 NOT GIVE A P.R.N. INJECTION TO JUDITH LARSEN ON THE 2ND OF
3 JANUARY?
4 A. IF YOU LOOK AT PAGE 507, THERE WAS A 1530 SCHEDULED M.S.
5 ORDER THAT IS NOT ANNOTATED THERE.
6 Q. I'M TALKING ABOUT A P.R.N. ORDER, MA'AM.
7 A. RIGHT. THAT WAS NOT CONSIDERED A P.R.N. ORDER
8 BECAUSE --
9 Q. OKAY. THAT --
10 A. -- THE SCHEDULED DOSE WAS NOT GIVEN.
11 Q. MA'AM, MA'AM, IF IT'S NOT A P.R.N. ORDER, THEN I'M NOT
12 TALKING ABOUT IT. I'M TALKING ABOUT A P.R.N. ORDER --
13 A. I GAVE --
14 Q. -- ARE YOU TELLING THIS JURY -- I WANNA KNOW, ARE YOU
15 TELLING THIS JURY, DID YOU GIVE A P.R.N. ORDER FOR MORPHINE
16 TO JUDITH LARSEN ON THE 2ND OF JANUARY OF 1996?
17 A. I'M TELLING YOU I GAVE A DOSE OF MORPHINE 5 MILLIGRAMS
18 AT 1630 THAT WAS ANNOTATED BY THE P.R.N. SHEET ON PAGE 510,
19 BUT ON 507 THE SCHEDULED MORPHINE DOSE WAS NOT GIVEN, SO
20 THAT WAS IN PLACE OF THAT ONE THAT WAS NOT GIVEN AS
21 SCHEDULED.
22 Q. A P.R.N. ORDER IS ONE THAT'S GIVEN AT THE DISCRETION OF
23 THE NURSE, IS THAT RIGHT?
24 A. CORRECT.
25 Q. AND THERE'S A SECTION, IS THERE NOT, IN THE MEDICATION
1767
1 ADMINISTRATION RECORDS THAT DEALS WITH P.R.N. ORDERS OR NON
2 ROUTINE MEDICATIONS?
3 A. YES.
4 Q. AND IN FACT, THERE IS IN THE P.R.N. SECTION FOR MISS
5 LARSEN AN ENTRY ON 1/2 OF 1996 FOR MORPHINE, IS THAT RIGHT?
6 A. CORRECT.
7 Q. IN FACT, 5 MILLIGRAMS OF MORPHINE, TRUE?
8 A. CORRECT.
9 Q. AND IT'S INITIALLED BY YOU, IS IT NOT?
10 A. YES, IT IS.
11 Q. AND IT SAYS 1630.
12 A. CORRECT.
13 Q. NOW, I'M POINTING OUT RIGHT HERE, DOWN HERE AT THE
14 BOTTOM, THIS PARTICULAR SHEET SAYS P.R.N. AND I.V.
15 MEDICATION ADMINISTRATIVE RECORD, CORRECT?
16 A. CORRECT.
17 Q. AND WHAT I'M POINTING OUT IS AN ENTRY RIGHT HERE, SAYS
18 M.S. 5 MILLIGRAMS, Q-2, P.R.N., PAIN. DID I READ THAT
19 CORRECTLY?
20 A. YOU DID.
21 Q. AND THEN I GO OVER AND I FIND AND ENTRY WHICH RIGHT UP
22 THERE SAYS 1/2 OF '96, TRUE?
23 A. CORRECT.
24 Q. AND UNDERNEATH THAT IT SAYS 1630 HOURS, CORRECT?
25 MS. BARLOW: YOUR HONOR, THIS HAS BEEN ASKED AND
1768
1 ANSWERED. SHE SAID SHE GAVE IT.
2 THE COURT: OVERRULED.
3 Q. (BY MR. STIRBA) 1630 HOURS, TRUE?
4 A. YES.
5 Q. THAT'S YOUR WRITING, TRUE?
6 A. YES.
7 Q. IS IT?
8 A. YES, IT IS.
9 Q. AND THEN WE HAVE I.M. THAT MEANS INTRAMUSCULAR,
10 CORRECT?
11 A. CORRECT.
12 Q. AND THEN WE HAVE INITIALS, AND THOSE ARE YOURS.
13 A. YES, THEY ARE.
14 Q. TRUE?
15 A. YES.
16 Q. AND IT'S TRUE, IS IT NOT, THAT THE MEDICATION
17 ADMINISTRATIVE -- ADMINISTRATION RECORD FOR ROUTINE
18 MEDICATIONS FOR MORPHINE FOR MISS LARSEN ALSO SHOW, DO THEY
19 NOT, THAT YOU INITIALLED AT 1530 AND 1830 ON THE 2ND, GIVING
20 ALSO INJECTIONS FOR MORPHINE, CORRECT?
21 A. AT 1530 MY INITIALS ARE CROSSED OUT. WOULD YOU LIKE TO
22 KNOW THE CIRCUMSTANCES WHY?
23 Q. FOR EXAMPLE, IF WE LOOK AT THIS FORM, HERE IS THE 2ND.
24 A. CORRECT.
25 Q. AND THEN UNDER 1530, THOSE ARE YOUR INITIALS, ARE THEY
1769
1 NOT?
2 A. THEY'RE CROSSED OUT.
3 Q. YOU SAY THEY'RE CROSSED OUT.
4 A. YES, THEY ARE.
5 Q. OKAY. AND THEN AT 1830, THAT'S ALSO YOUR INITIALS,
6 TRUE?
7 A. THAT'S THE SCHEDULED DOSE, CORRECT.
8 Q. NOW, ARE YOU TELLING US, MA'AM, THAT THE P.R.N. ORDER
9 WHICH I JUST ASKED YOU ABOUT --
10 A. UH-HUH.
11 Q. -- WHICH IS IN THE P.R.N. SECTION OF THE MEDICATION
12 ADMINISTRATIVE RECORD FOR MISS LARSEN, YOU'RE SAYING THAT
13 YOU DID NOT GIVE THAT AS A P.R.N. FOR PAIN ON THE 2ND AT
14 1630 HOURS?
15 A. YOUR HONOR, CAN I EXPLAIN HOW THAT CAME ABOUT? I'M NOT
16 ABLE TO --
17 THE COURT: YOU ANSWER HIS QUESTION.
18 THE WITNESS: OKAY.
19 Q. (BY MR. STIRBA) THERE'S THE DOCUMENT. ARE YOU TELLING
20 THIS JURY ON THAT FORM WITH YOUR EXPERIENCE, YOU DIDN'T GIVE
21 THAT AS A P.R.N. AT 1630 HOURS ON 1/2/1996 FOR PAIN TO
22 JUDITH LARSEN; YES OR NO?
23 A. THAT DOSE WAS GIVEN AT 1630.
24 Q. IT WAS GIVEN AT 1630. THAT WASN'T MY QUESTION. MY
25 QUESTION IS, ARE YOU TELLING THIS JURY, EVEN THOUGH YOU
1770
1 FILLED OUT THIS FORM, WHICH IS CONCEDEDLY M.S. 5 MILLIGRAMS
2 Q-2 HOURS, P.R.N. PAIN, WITH YOUR INITIALS, AND YOU DATING
3 IT, AND YOU INDICATING IT WAS GIVEN, ARE YOU TELLING THIS
4 JURY NOW FIVE YEARS LATER THAT YOU DIDN'T GIVE A P.R.N. AT
5 1630 HOURS --
6 A. I'M SAYING --
7 Q. -- TO MISS LARSEN? YES OR NO, MA'AM, DID YOU OR DIDN'T
8 YOU?
9 A. I GAVE A DOSE OF MORPHINE CHARTED ON THE P.R.N. SHEET
10 AND NOT CHARTED ON THE SCHEDULED SHEET.
11 Q. SO YOU'RE SAYING THAT THIS PARTICULAR ENTRY IS A
12 MISREPRESENTATION OF FACT?
13 A. I WOULD NOT SAY IT WAS A MISREPRESENTATION --
14 Q. WELL, IT WASN'T --
15 A. -- BECAUSE 5 MILLIGRAMS WAS GIVEN.
16 Q. IT WASN'T A P.R.N. ORDER, WAS IT, MA'AM? THAT'S NOT
17 TRUE, IS IT?
18 A. MORPHINE IS USUALLY GIVEN P.R.N. WHEN I CAME OUT OF
19 REPORT, THE NURSE COMING ON SAID, YOU BETTER MAKE SURE --
20 BECAUSE WE WERE LATE WITH REPORT, SHE SAID, YOU BETTER MAKE
21 SURE YOU GIVE THAT MORPHINE OR DR. WEITZEL'S GONNA BE ANGRY.
22 SO I CAME OUT -- MORPHINE IS NORMALLY SCHEDULED AS A P.R.N.
23 IT IS NEVER SCHEDULED AROUND THE CLOCK LIKE THAT I.M. ON
24 PATIENTS. SO I TURNED TO THE P.R.N. SHEET BECAUSE THAT'S
25 WHERE YOU NORMALLY WOULD LOOK FOR MORPHINE. I ANNOTATED IT,
1771
1 GAVE THE MORPHINE SO THAT DR. WEITZEL WOULDN'T BE MAD. CAME
2 BACK. LOOKED AT THE M.R.I. SAW IT ON THE SCHEDULED PORTION
3 OF THE M.R.I. AND SAID, WELL, AS LONG AS IT'S ANNOTATED ON
4 THE OTHER SIDE, THEN IT'S OKAY. IT WAS ADMINISTERED IS THE
5 MAIN THING. I WASN'T ACCUSTOMED TO HAVING MORPHINE
6 SCHEDULED AND LOOKING AT THE SCHEDULED SHEET. I IMMEDIATELY
7 TURNED TO THE P.R.N. SECTION OF THE MARS TO GIVE THAT DOSE
8 OF MORPHINE SO THAT DR. WEITZEL WOULD BE NOT ANGRY THAT WE
9 DIDN'T GIVE IT.
10 Q. OKAY. I'M GONNA ASK MY QUESTION ONE MORE TIME. THIS
11 PARTICULAR ENTRY, WHICH IS P.R.N., WHICH YOU CERTAINLY KNOW
12 WITH THAT MEANS, DO YOU NOT?
13 A. YES, I DO.
14 Q. THAT MEDICATION AS YOU CHARTED IT THERE, WASN'T GIVEN
15 P.R.N., WAS IT? IS THAT YOUR TESTIMONY?
16 A. I'M SAYING I GAVE 5 MILLIGRAMS OF MORPHINE THAT WAS
17 SCHEDULED TO BE GIVEN AT 1530. I GAVE IT AT 1630 BECAUSE I
18 CAME OUT OF REPORT LATE.
19 Q. I'LL TRY ONE MORE TIME. DID YOU GIVE A P.R.N. ORDER AS
20 YOU DOCUMENTED HERE IN YOUR OWN HANDWRITING AT 15 -- I'M
21 SORRY, 1630 HOURS FOR 5 MILLIGRAMS OF MORPHINE TO JUDITH
22 LARSEN?
23 A. IT WAS GIVEN AS THE SCHEDULED DOSE, ANNOTATED IN THE
24 P.R.N. SECTION.
25 Q. THAT ENTRY, MA'AM, AS YOU INDICATED THERE, IS NOT TRUE,
1772
1 CORRECT?
2 MS. BARLOW: YOU KNOW, I THINK THAT'S AMBIGUOUS.
3 WHAT -- WHAT DOES IT MEAN --
4 THE COURT: OVERRULED.
5 Q. (BY MR. STIRBA) IT'S NOT TRUE, IS IT, MA'AM?
6 A. I GAVE IT AS A MORPHINE 5 MILLIGRAMS.
7 Q. BUT YOU DIDN'T GIVE IT AS A P.R.N., DID YOU?
8 A. IT WAS GIVEN AS A SCHEDULED DOSE WRITTEN IN THE P.R.N.
9 SECTION.
10 Q. BUT YOU DIDN'T GIVE IT AS A P.R.N., DID YOU?
11 A. NO.