Welby Jensen, MD
21 MR. WILSON: WE WOULD CALL DR. WELBY JENSEN TO THE
22 STAND AT THIS TIME, YOUR HONOR.
23 THE COURT: DR. JENSEN, WILL YOU STEP UP HERE,
24 PLEASE? IF YOU'D RAISE YOUR RIGHT HAND AND FACE THE CLERK,
25 SHE'LL PLACE YOU UNDER OATH.
1 WELBY JENSEN,
2 BEING FIRST DULY SWORN, WAS EXAMINED AND
3 TESTIFIED AS FOLLOWS:
4 THE COURT: HAVE A SEAT UP HERE, PLEASE.
5 IF YOU'LL GIVE US YOUR NAME, DOCTOR, AND SPELL YOUR LAST
6 NAME.
7 THE WITNESS: MY NAME IS WELBY NEAL JENSEN M.D.,
8 J-E-N-S-E-N.
9 THE COURT: YOU MAY PROCEED, MR. WILSON.
10 MR. WILSON: THANK YOU, YOUR HONOR.
11 DIRECT EXAMINATION
12 BY MR. WILSON:
13 Q. DR. JENSEN, MAYBE YOU COULD JUST BRIEFLY TELL US AS TO
14 WHEN AND WHERE YOU RECEIVED YOUR MEDICAL DEGREE.
15 A. I RECEIVED MY MEDICAL DEGREE FROM THE UNIVERSITY OF UTAH
16 MEDICAL SCHOOL.
17 Q. AND THAT WAS -- OKAY. WHAT YEAR WAS THAT, SIR?
18 A. 1987.
19 Q. ALL RIGHT. WHERE ARE YOU CURRENTLY PRACTICING?
20 A. I'M PRACTICING ON KODIAK ISLAND IN ALASKA.
21 Q. OKAY. AND BACK IN 1990 -- WELL, YOU SAID YOU -- YOU
22 RECEIVED YOUR MEDICAL DEGREE IN 1987? WAS THAT CORRECT?
23 A. YES. AND I COMPLETED MY PSYCHIATRIC RESIDENCY IN '91.
24 Q. OKAY. SO THAT WAS A FOUR-YEAR RESIDENCY?
25 A. YES.
1 Q. WHERE -- WHERE YOU DID YOU COMPLETE THAT, SIR?
2 A. UNIVERSITY OF UTAH AFFILIATED HOSPITALS.
3 Q. OKAY. ARE YOU BOARD CERTIFIED IN ANY SPECIALTIES?
4 A. I'M BOARD CERTIFIED IN PSYCHIATRY.
5 Q. IN PSYCHIATRY. AND WHEN DID YOU RECEIVE YOUR BOARD
6 CERTIFICATION, SIR?
7 A. '94.
8 Q. OKAY. WERE YOU EVER EMPLOYED -- WELL, SUBSEQUENT TO
9 YOUR -- YOUR INTERNSHIP IN PSYCHIATRY, WERE YOU EMPLOYED AS A
10 PSYCHIATRIST?
11 A. AFTER MY RESIDENCY?
12 Q. EXCUSE ME. YOUR RESIDENCY. YES.
13 A. I -- I WAS A PSYCHIATRIST FOR A LOCAL MENTAL HEALTH
14 GROUP.
15 Q. WHAT GROUP WAS THAT, SIR?
16 A. I WAS WITH F.H.P.
17 Q. OKAY. WERE YOU EVER EMPLOYED BY HORIZONS CORPORATION?
18 A. NO, I WAS NEVER EMPLOYED BY HORIZONS.
19 Q. OKAY.
20 A. I HAD AN INDEPENDENT CONTRACT WITH THEM.
21 Q. OKAY. CAN YOU TELL US THE CIRCUMSTANCES SURROUNDING YOUR
22 CONTRACT WITH HORIZONS?
23 A. I HAD NOTICED IN THE PAPER THAT THEY WERE TRYING TO START
24 A GERIATRIC PSYCHIATRY UNIT AT DAVIS HOSPITAL AND I HAD A LOT
25 OF INTEREST IN GERIATRICS SINCE I'D -- DURING MY RESIDENCY I
1 SERVED AT THE -- AS THE SENIOR RESIDENT AT THE V.A. HOSPITAL,
2 WHICH IS LIKE THE CHIEF RESIDENT, CHIEF CLINICAL RESIDENT AT
3 THE HOSPITAL. AND MANY OF THE VETERANS THAT WERE THERE WERE
4 SENIORS. AND I ALSO KNEW THAT THERE WASN'T REALLY A FACILITY
5 IN THE STATE OF UTAH THAT DEALT WITH SENIORS, SPECIFICALLY AS
6 FAR AS MEETING SOME OF THEIR PSYCHIATRIC NEEDS.
7 SO I HAD AN INTEREST IN THAT. EVEN THOUGH I HAD OTHER
8 WORK, I DECIDED TO JUST CONTACT, YOU KNOW, THE NUMBER AND
9 CONTACT PEOPLE THAT WAS -- PEOPLE ASSOCIATED WITH HORIZONS
10 MENTAL HEALTH --
11 Q. OKAY.
12 A. -- ABOUT WHAT THEY WERE TRYING TO DO IN THAT -- THAT UNIT
13 THEY WERE TRYING TO START.
14 Q. YOU SUBSEQUENTLY CONTRACTED THEM -- WITH THEM TO PROVIDE
15 SERVICES AS A PSYCHIATRIST?
16 A. YEAH, I WAS -- I WAS AN INDEPENDENT CONTRACTOR. THEY DID
17 PAY -- I DID RECEIVE -- I HAD AN AGREEMENT TO DO SOME
18 ADMINISTRATIVE WORK FOR THEM ON THE UNIT.
19 Q. WHAT WAS YOUR OFFICIAL POSITION WITH THE GEROPSYCH UNIT
20 AT DAVIS HOSPITAL?
21 A. WELL, INITIALLY I WAS THE MEDICAL DIRECTOR.
22 Q. OKAY. AND WHEN DID THAT OCCUR?
23 A. IN -- WOULD HAVE BEEN '94.
24 Q. OKAY. BACK IN 1994, CAN YOU DESCRIBE INITIALLY WHAT THE
25 UNIT WAS SET UP AS? HOW MANY BEDS WERE IN THE UNIT?
1 A. IT WAS A 10-BED UNIT. IT WAS LOCKED ON -- IT WAS A
2 LOCKED UNIT. YOU COULD HAVE AN ACCESS TO THE UNIT. IT WAS A
3 PSYCHIATRIC, SLASH, ALSO PROVIDED SOME MEDICAL NEEDS FOR
4 PATIENTS SINCE THEY WERE ELDERLY.
5 Q. OKAY. WHEN YOU SAY SOME MEDICAL NEEDS FOR PATIENTS, CAN
6 YOU DESCRIBE THE -- THE -- OR CHARACTERIZE FOR US THE LEVEL
7 OF MEDICAL CARE THAT WOULD BE REQUIRED FOR THOSE PATIENTS ON
8 THE UNIT?
9 A. I WOULD SAY THAT THE MEDICAL CARE THERE, TO COMPARE IT TO
10 OTHER PSYCHIATRIC FACILITIES, WAS AT A HIGHER LEVEL BECAUSE
11 OF THE NATURE OF WHEN PEOPLE CAME IN, THEY NOT ONLY HAD A
12 PSYCHIATRIST, BUT THEY HAD A FAMILY DOCTOR OR AN INTERNAL
13 MEDICINE PHYSICIAN THAT HELPED MANAGE A LOT OF THEIR MEDICAL
14 NEEDS.
15 ALSO THE UNIT COULD DO SOME THINGS THAT MOST PSYCHIATRIC
16 FACILITIES WOULD NOT DO LIKE IF SOMEONE NEEDED AN I.V. FOR
17 SOME REASON, THEY COULD DO THAT ON THE UNIT. SO THEY -- THEY
18 COULD DO SOME MEDICAL CARE ON THE UNIT, BUT IT WASN'T A
19 SKILLED NURSING FACILITY, IT WASN'T A MEDICAL-SURG UNIT OR AN
20 I.C.U. OR ANYTHING LIKE THAT. SO IT'S A STEP DOWN FROM OTHER
21 MEDICAL UNITS.
22 Q. IN YOUR CAPACITY AS THE -- AS THE DIRECTOR OF THE -- OR
23 THE MEDICAL DIRECTOR OF THE UNIT, CAN YOU DESCRIBE FOR US
24 WHAT YOUR -- YOUR DUTIES AND RESPONSIBILITIES WERE IN -- IN
25 RESPECT SPECIFICALLY TO THE PATIENTS?
1 A. WELL, FOR A WHILE I WAS THE ONLY PSYCHIATRIST, SO I WAS
2 THE ATTENDING PHYSICIAN FOR PATIENTS ON THE UNIT, AND I USED
3 ALL THE RESOURCES AVAILABLE WITHIN THE HOSPITAL AND -- AND
4 THE UNIT AS FAR AS THE -- THE OTHER PHYSICIANS, THE NURSING
5 STAFF, OCCUPATIONAL THERAPISTS, PHYSICAL THERAPISTS, OTHERS
6 FOLKS.
7 Q. I ASSUME YOU HAD CLINICAL PRIVILEGES AT THE HOSPITAL?
8 A. YES, I DID.
9 Q. OKAY. AND IN RESPECT TO THOSE -- THOSE PRIVILEGES, YOU
10 COULD DO CERTAIN THINGS; IS THAT CORRECT?
11 A. YES.
12 Q. OKAY. PRIMARILY THOSE BEING PSYCHIATRIC CARE; IS THAT
13 CORRECT?
14 A. YES, PRIMARILY.
15 Q. OKAY. AS TO THE -- THE PATIENTS THEMSELVES THAT WOULD --
16 WOULD BE ADMITTED TO THE UNIT, DID YOU HAVE ANY
17 RESPONSIBILITIES RELATIVE TO THEIR ADMISSION?
18 A. YES, I WAS INVOLVED IN THE ADMISSION PROCESS.
19 Q. OKAY. AND WHAT WAS -- WHAT WAS ESSENTIALLY YOUR FUNCTION
20 IN THE ADMISSION PROCESS?
21 A. TO BE INVOLVED AS RELATED TO SCREENING FOR THE
22 APPROPRIATENESS OF THE ADMISSION, IN PARTICULAR, WOULD BE ONE
23 THING.
24 Q. ALL RIGHT. HOW WOULD YOU -- HOW WOULD YOU ACCOMPLISH
25 THAT FUNCTION?
1 A. WELL, I THINK THAT THAT EVOLVED A LITTLE OVER TIME AS THE
2 UNIT STARTED. WE DID RELY ON SOME -- THERE WERE LIKE KIND OF
3 AN ADMISSION CHECKLIST AND EITHER ONE OF THE NURSES OR -- OR
4 SOCIAL WORKERS SOMETIMES WOULD -- WELL, THEY WOULD GO OVER
5 THAT LIST. AND WE'D ALSO TRY TO SCREEN FOR IF THERE WAS
6 SOMETHING THAT HADN'T BEEN DONE OR WE THOUGHT OTHER MEDICAL
7 THINGS NEEDED TO BE DONE, SOMETIMES BEFORE ADMISSION WE WOULD
8 GET TESTS DONE OR -- OR TALK -- SOMETIMES I'D TALK TO THE
9 PHYSICIAN, SOMETIMES I'D TALK TO ONE OF THE NURSES IN THE
10 CARE CENTER OR SOMEPLACE WHERE THE PATIENT WAS COMING FROM.
11 Q. AS TO THE DECISION AS TO WHETHER OR NOT A PATIENT WAS
12 ADMITTED, WHO MADE THAT -- THAT DECISION?
13 A. THE PHYSICIAN.
14 Q. THE PHYSICIAN?
15 A. RIGHT.
16 Q. AND THAT WOULD BE THE ATTENDING PHYSICIAN?
17 A. YES.
18 Q. AND INITIALLY THAT WOULD BE YOU.
19 A. YES.
20 Q. OKAY. AND IN RESPECT TO THAT -- THAT DECISION, SIR, CAN
21 YOU TELL US AS THE ATTENDING -- WHAT IT MEANS TO BE THE
22 ATTENDING PHYSICIAN.
23 A. THE ATTENDING PHYSICIAN IS BASICALLY THE PRIMARY PROVIDER
24 AS FAR AS A TEAM OF PROVIDERS THAT WERE WORKING ON THAT
25 CASE --
1 Q. WOULD IT BE --
2 A. -- OR PATIENT.
3 Q. -- A FAIR STATEMENT TO SAY THAT THE ATTENDING PHYSICIAN
4 MAKES THE FINAL DECISION RELATIVE TO THE CARE OF THE PATIENT?
5 A. WELL, WITH THE HELP OF THE CONSULTANTS AND FAMILY AND SO
6 FORTH, YES. I MEAN IT'S --
7 Q. OKAY.
8 A. -- THERE'S OTHER PEOPLE, BUT YEAH, I -- I THINK IF THERE
9 WAS -- IF THERE WERE TWO CHOICES AND -- AND IT WAS RELATED TO
10 WHO THE PROVIDERS WERE, THE ATTENDING PHYSICIAN WOULD MAKE A
11 FINAL DECISION.
12 Q. OKAY. DURING THE TIME PERIOD THAT YOU WERE AT THE -- THE
13 UNIT -- WELL, FIRST OF ALL, LET ME ASK YOU, HOW LONG DID YOU
14 CONTINUE TO BE A CONTRACT PSYCHIATRIST WITH THE UNIT ITSELF?
15 A. WELL, I STARTED TO PHASE OUT OF DOING MUCH IN THE WAY
16 OF -- OF HAVING ANY PATIENTS IN '95. AND THE REASON I -- I
17 STARTED TO PHASE OUT WAS THAT I WAS WORKING FULL TIME AS THE
18 MEDICAL DIRECTOR FOR F.H.P. BEHAVIORAL HEALTH IN UTAH AND I
19 DIDN'T HAVE TIME TO DO IN-PATIENT --
20 Q. OKAY.
21 A. -- WORK.
22 Q. SO YOU STARTED TO PHASE OUT. AND AS PART OF THAT
23 PROCESS, DID HORIZONS LOOK FOR AN ASSOCIATE TO ASSIST YOU IN
24 THE WORK AT THE UNIT?
25 A. THEY -- THEY WERE LOOKING ALL THE TIME SINCE THE UNIT
1 STARTED. I WAS THE ONLY PROVIDER THERE FOR A NUMBER OF
2 MONTHS. AND I STARTED TO PHASE OUT OR -- OR DO LESS WHEN
3 DR. WEITZEL BECAME A PROVIDER THERE. I HAD A -- HE HAD A
4 CONTRACT, TOO, WITH HORIZON.
5 Q. OKAY. NOW, I THINK YOU PREVIOUSLY TESTIFIED YOUR
6 CONTRACT -- NOT ONLY DID YOU HAVE CERTAIN RESPONSIBILITIES
7 RELATIVE TO THE CARE OF THE PATIENTS, BUT YOU ALSO HAD SOME
8 ADMINISTRATIVE RESPONSIBILITIES; IS THAT CORRECT?
9 A. YES, I WAS INVOLVED IN SOME ADMINISTRATIVE
10 RESPONSIBILITIES.
11 Q. AND THOSE ADMINISTRATIVE RESPONSIBILITIES WERE WHAT, SIR?
12 DO YOU REMEMBER?
13 A. OH, ANYTHING FROM PUBLIC RELATIONS TO QUALITY ASSURANCE
14 TO HELPING, YOU KNOW, MARKET THE UNIT SO THAT PEOPLE KNEW IT
15 WAS THERE AND WHAT WE DID. AND SOME EDUCATION OF THE STAFF,
16 THINGS LIKE THAT.
17 Q. THE -- THE PURPOSE OF THE UNIT WAS FOR WHAT -- WHAT
18 REASON?
19 A. WELL, IT WAS -- IT WAS CHIEFLY A PSYCHIATRIC UNIT TO HELP
20 MEET THE NEEDS OF BEHAVIORAL AND EMOTIONAL NEEDS OF GERIATRIC
21 PATIENTS.
22 Q. DURING YOUR TENURE THERE, WERE THESE 10 BEDS FILLED FOR
23 THE MOST PART?
24 A. YES, I -- I THINK THE AVERAGE CENSUS WAS PROBABLY AROUND
25 EIGHT.
1 Q. OKAY. AND I THINK YOU SAID YOU STARTED TO PHASE OUT, BUT
2 MAYBE I CUT YOU OFF. WHEN WAS YOUR LAST RECOLLECTION OF --
3 OF PARTICIPATING ON THE UNIT ITSELF?
4 A. I -- I WAS ON THE UNIT -- I STILL HAD PRIVILEGES AT THE
5 HOSPITAL. I WAS ON THE UNIT IN '96 --
6 Q. OKAY.
7 A. -- EARLY PART OF '96 JUST KIND OF FILLING IN. I THINK
8 THEY HAD TWO PROVIDERS THEN. BUT ANYWAY, I WAS -- I WAS
9 FILLING IN. I KNOW DR. WEITZEL WASN'T IN AT THE TIME.
10 Q. OKAY. NOW, DO YOU RECALL WHEN IT WAS DR. WEITZEL BECAME
11 A CONTRACT PHYSICIAN OR CONTRACT PSYCHIATRIST WITH THE
12 GEROPSYCH UNIT?
13 A. IT WAS ABOUT THE SPRING OF '95.
14 Q. OKAY. AND AT THAT TIME, JUST PRIOR TO THAT TIME, CAN YOU
15 TELL US RELATIVE TO -- TO THE CARE OF THESE PATIENTS, HOW
16 MUCH TIME YOU WERE SPENDING ON THE UNIT?
17 A. I WAS SPENDING APPROXIMATELY FOUR TO FIVE HOURS A NIGHT,
18 PLUS WEEKENDS.
19 Q. OKAY.
20 A. DURING THE DAY ON -- AT LEAST PART OF THE DAY ON SATURDAY
21 AND SUNDAY.
22 Q. WOULD THOSE BE CONTINUOUS HOURS OR WOULD THEY BE
23 INTERSPERSED HOURS THROUGHOUT THE DAY? WHAT -- WHAT WOULD BE
24 THE PRACTICE?
25 A. THEY WERE -- THEY WERE FAIRLY CONTINUOUS IN THE EVENINGS.
1 Q. OKAY.
2 A. BECAUSE I WOULD WORK ALL DAY AND THEN GO TO THE -- TO THE
3 UNIT IN THE EVENING.
4 Q. OKAY. AND WHEN -- DID THAT CHANGE WHEN DR. WEITZEL
5 CAME -- BECAME A CONTRACT PHYSICIAN?
6 A. YES. I STARTED TO TURN -- THE ADMISSIONS WERE -- WERE
7 GOING OVER TO DR. WEITZEL, AND THEY WERE -- I THINK THEY WERE
8 SHARED AT FIRST, BUT TO A POINT. BUT I WASN'T -- WHAT SHOULD
9 I SAY -- I WASN'T HESITANT TO TURN OVER ALMOST EVERYONE AT
10 THAT TIME AND HE -- HE FELT LIKE HE NEEDED MOST OF THE
11 PATIENTS, IF NOT ALL OF THE PATIENTS, TO KIND OF MAKE IT WORK
12 FOR HIM IN HIS SITUATION.
13 Q. DID YOU ACCOMMODATE HIM IN THAT RESPECT?
14 A. YES. YEAH, I'D -- I'D BEEN WORKING THERE FOR A NUMBER --
15 A NUMBER OF MONTHS ALL BY MYSELF AND WORKING FULL TIME AND
16 I -- I WAS READY FOR A -- YOU KNOW, FOR SOMEONE TO COME IN
17 AND -- AND TAKE OVER A LITTLE BIT.
18 Q. DID YOU ALSO RECEIVE AN ADVANCEMENT RELATIVE TO YOUR
19 EMPLOYMENT WITH F.H.P. AT THAT TIME?
20 A. YEAH, I -- I WAS MADE THE -- I WAS A STAFF PSYCHIATRIST
21 AND THEN I WAS A TEAM LEADER UP IN NORTHERN UTAH AND THEN I
22 BECAME THE MEDICAL DIRECTOR.
23 Q. OKAY.
24 A. FOR THE STATE.
25 Q. BUT YOU CONTINUED IN YOUR CAPACITY AS THE DIRECTOR OF THE
1 GEROPSYCH UNIT, AS I UNDERSTAND IT. IS THAT CORRECT?
2 A. YES.
3 Q. OKAY. WAS THERE AN AVERAGE PERIOD OF TIME THAT THESE
4 PATIENTS WOULD BE ON THE UNIT ITSELF FOR PURPOSES OF
5 TREATMENT?
6 A. THE AVERAGE LENGTH OF STAY FOR PATIENTS WAS
7 APPROXIMATELY, I DON'T KNOW, 17, 18 DAYS.
8 Q. OKAY.
9 A. AND THAT MAY HAVE CHANGED OVER THROUGH THE YEARS, BUT
10 THAT'S THE FIGURE THAT COMES TO MY MIND.
11 Q. NOW, IN PRIOR TESTIMONY YOU TALKED ABOUT A TERM D.R.G.
12 CAN YOU TELL US WHAT D.R.G. STANDS FOR?
13 A. WELL, IT'S -- IT'S A SYSTEM OF DIAGNOSTIC RELATED GROUPS
14 WHERE MEDICARE OR THE PAYING SOURCE WILL BASICALLY GIVE SO
15 MANY DAYS OF -- OF BENEFIT TO HELP PAY FOR MEDICAL CARE OR
16 PSYCHIATRIC CARE, DEPENDING ON THE DIAGNOSIS. SO IF SOMEONE
17 HAD A DIAGNOSIS OF SCHIZOPHRENIA, FOR EXAMPLE, THEY MAY PAY
18 FOR FIVE DAYS OF HOSPITALIZATION. AND IF THEY NEEDED MORE
19 TIME THAN FIVE DAYS, THEN IT WAS BASICALLY THE HOSPITAL JUST
20 KEPT THEM IN AS CHARITY OR, YOU KNOW, CONTINUED TO TAKE CARE
21 OF THEM.
22 Q. WAS THIS UNIT, THE GEROPSYCH UNIT, WAS IT SUBJECT TO
23 THOSE D.R.G. REGULATIONS?
24 A. NO -- NO, IT WASN'T.
25 Q. OKAY. THE UNIT BEING LOCATED IN THE HOSPITAL SETTING,
1 DID YOU SEE ANY SPECIFIC BENEFITS TO THAT PARTICULAR SETTING
2 OVER AN INDEPENDENT SETTING OR A SEPARATE SETTING?
3 A. OH, THE SETTING WAS A LOT BETTER SETTING FOR PSYCHIATRIC
4 PATIENTS, ESPECIALLY SENIOR PSYCHIATRIC PATIENTS COMPARED TO
5 LIKE A FREE-STANDING PSYCHIATRIC FACILITY THAT WOULD BE OUT
6 IN THE COMMUNITY AND WOULDN'T BE REALLY INTERLINKED OR
7 JUXTAPOSED TO A MEDICAL FACILITY.
8 SO NEXT DOOR TO THE GEROPSYCH UNIT THERE WAS A SKILLED
9 NURSING FACILITY. DOWN THE HALL THERE WAS A INTENSIVE CARE
10 UNIT. DOWNSTAIRS THERE WAS A MEDICAL-SURG UNIT, THINGS LIKE
11 THAT.
12 Q. AND WHY WOULD THAT BE A BENEFIT, SIR?
13 A. THE BENEFIT TO ACCESSING SPECIALISTS; BENEFIT TO
14 ACCESSING PATIENT'S, YOU KNOW, MEDICAL STATUS; TO RUN SOME
15 TESTS, ALL OF THAT WOULD BE LOCATED OR MOST THINGS THAT WOULD
16 NEED TO BE DONE FOR PEOPLE THAT ARE ELDERLY COULD BE PROVIDED
17 AT THE HOSPITAL.
18 Q. OKAY. I WANT TO GO BACK NOW JUST FOR A FEW MINUTES TO
19 THE ADMISSION PROCESS. I THINK YOU PREVIOUSLY TESTIFIED THAT
20 THERE WOULD BE A PHYSICAL EVALUATION OF THE PATIENT; IS THAT
21 CORRECT?
22 A. YES.
23 Q. AS WELL AS A PSYCHIATRIC EVALUATION OF THE PATIENT?
24 A. YES.
25 Q. AND THAT WOULD TAKE PLACE WITHIN HOW MANY HOURS OF THE
1 ADMISSION?
2 A. WITHIN A DAY.
3 Q. OKAY. AND IN RESPECT TO THESE PATIENTS, DOCTOR, IF A
4 PATIENT WAS MEDICALLY UNSTABLE, WHAT WOULD BE THE RESPONSE
5 THAT YOU WOULD MAKE TO THAT SITUATION?
6 A. IF THEY HAD JUST COME INTO THE FACILITY?
7 Q. UH-HUH.
8 A. I WOULD --
9 MS. ISAACSON: YOUR HONOR, OBJECTION. THIS CALLS
10 FOR SPECULATION ON A HYPOTHETICAL CALL. HE'S NOT AN EXPERT,
11 HE'S A FACT WITNESS.
12 THE COURT: OVERRULED. HE CAN SAY WHAT THEY DID ON
13 THE UNIT.
14 A. I WOULD SAY TYPICALLY I WOULD WORK WITH WHOEVER THE
15 INTERNIST OR FAMILY DOC IS TO DETERMINE IS THAT SOMETHING
16 THAT WE WOULD FEEL COMFORTABLE TREATING ON THE PSYCH UNIT OR
17 SHOULD WE TRANSFER THE PATIENT, AND IF THEY WERE APPROPRIATE
18 TO TRANSFER TO ONE OF THE MEDICAL UNITS, FOR THEM TO BE
19 STABILIZED AND THEN BRING THEM BACK TO THE PSYCHIATRIC UNIT.
20 Q. (BY MR. WILSON) NOW, IN -- IN DETERMINING CRITERIA,
21 WOULD YOU LOOK AT WHETHER OR NOT THE PATIENT WAS ESSENTIALLY
22 DIAGNOSED AS BEING TERMINAL PRIOR TO ADMISSION? MAYBE I --
23 A. YES, I'M NOT SURE -- TERMINAL CAN MEAN DIFFERENT THINGS
24 TO ME.
25 Q. OKAY. WHAT DOES -- WELL, IN TERMS OF A PATIENT BEING
1 DIAGNOSED AS TERMINAL, WHAT DOES THAT MEAN, MEDICALLY
2 SPEAKING?
3 A. IF IT WAS TERMINAL IN -- IN THE SENSE THAT -- IT COULD BE
4 ANYWHERE FROM HOURS TO DAYS TO YEARS, SOMEONE COULD BE
5 SEPTIC, THEY COULD HAVE A SEVERE INFECTION AND -- AND KNOW
6 THAT PROBABLY -- OR BE ON THE END STAGE OF CANCER OR RENAL
7 FAILURE AND KNOW THAT THEY'RE PROBABLY GOING TO DIE WITHIN,
8 YOU KNOW, HOURS OR A DAY OR TWO. OR YOU COULD HAVE SOMEONE
9 THAT'S TERMINAL THAT HAD ALZHEIMERS AND THAT MAY PROGRESS
10 OVER EIGHT YEARS.
11 Q. SO THE TIME PERIOD FOR THE EXPECTATION OF DEATH WOULD
12 BE -- WOULD BE VARIED ACCORDING TO WHATEVER THE DIAGNOSIS
13 WAS, I ASSUME, CORRECT?
14 A. YES.
15 Q. OKAY. DID THAT ENTER INTO YOUR DECISION-MAKING PROCESS
16 ON THAT UNIT AS TO WHETHER OR NOT THEY WOULD BE ACCEPTABLE AS
17 A PATIENT ON THE UNIT?
18 A. YES.
19 Q. OKAY. AND IN -- IN WHAT RESPECT? CAN YOU TELL US THAT?
20 A. WELL, CHIEFLY THEY COULD HAVE -- SOMEONE COULD HAVE
21 MEDICAL PROBLEMS, BUT THE IDEA WAS THAT WE COULD PROVIDE CARE
22 IN -- IN A VARIETY OF WAYS THAT WOULD BE, I THINK -- WELL,
23 WOULD GO ALONG WITH THE MISSION OF DOING SOMETHING
24 PSYCHIATRICALLY FOR THEM. I MEAN, THAT WAS -- THEY SHOULD BE
25 THERE TO RECEIVE SOME BENEFIT AS FAR AS THEIR PSYCHIATRIC
1 STATUS.
2 Q. WELL, I ASSUME, DOCTOR, THERE IS A LOT OF -- AS WE'VE
3 HEARD CHARACTERIZED AS COMORBIDITY ISSUES WITH PATIENTS, THE
4 ELDERLY PATIENTS; IS THAT CORRECT?
5 A. YES.
6 Q. COMORBIDITY MEANING WHAT?
7 A. THAT THEY OFTEN HAVE SEVERAL DIFFERENT MEDICAL PROBLEMS
8 THAT MAY BE RELATED TO EACH OTHER.
9 Q. SO DO YOU TAKE THAT FACTOR INTO CONSIDERATION WHEN YOU
10 TREAT THESE PATIENTS WITH THE -- WITH THE PSYCHIATRIC -- IN
11 THE -- IN THE PSYCHIATRIC TREATMENT PROCESS?
12 A. YES.
13 Q. OKAY. WHEN YOU -- IS THERE A COMMON TERM THAT IS USED
14 FOR THE MEDICATIONS THAT ARE USED IN TREATING PATIENTS IN A
15 PSYCHIATRIC SETTING?
16 A. WELL, COMMONLY PSYCHOTROPIC MEDICATION.
17 Q. AND COULD YOU TELL US AS TO SOME OF THE NAMES OF
18 PSYCHOTROPIC MEDICATIONS THAT YOU RECALL BEING IN USE ON THE
19 UNIT BACK IN 1995?
20 A. THERE WERE ALL TYPES OF -- OF DIFFERENT MEDICATIONS USED
21 ON THE UNIT. THERE'D BE CLASSES OF MEDICINES. THERE'D BE
22 ANTIDEPRESSANTS, ANTIANXIETY AGENTS, ANTIPSYCHOTICS, MOOD
23 STABILIZERS, SEDATIVE HYPNOTICS.
24 Q. OKAY. AND SOME OF THE SPECIFIC NAMES OF THOSE TYPES
25 OF -- OF MEDICATIONS WOULD BE WHAT?
1 A. RISPERDAL, HALDOL, PROZAC, ZOLOFT, LORAZEPAM --
2 Q. DID THE NUMBER --
3 A. -- JUST A NUMBER OF DIFFERENT MEDICINES.
4 Q. OKAY. DID THE NUMBER OF THOSE MEDICATIONS HAVE WHAT WE
5 CALL CENTRAL NERVOUS SYSTEM DEPRESSANT PROPERTIES TO THEM?
6 A. YES. THEY WORK -- THEY COULD HAVE HOPEFULLY POSITIVE
7 CENTRAL NERVOUS SYSTEM EFFECTS, OR POTENTIALLY NEGATIVE
8 EFFECTS.
9 Q. OKAY. NOW, DID YOU WORK -- DID YOU WORK CLOSELY WITH
10 DR. WEITZEL DURING THE TIME PERIOD THAT YOU WERE BOTH ON THE
11 UNIT ITSELF?
12 A. WHAT DO YOU MEAN?
13 Q. I MEAN, WHAT WAS THE NATURE OF YOUR ASSOCIATION? I MEAN,
14 YOU HAD YOUR PATIENTS, HE HAD HIS PATIENTS. I MEAN, WOULD
15 YOU SEE EACH OTHER FREQUENTLY? WOULD YOU CONSULT? WHAT WAS
16 THE NATURE OF YOUR RELATIONSHIP?
17 A. WELL, CHIEFLY HE HAD HIS PATIENTS AND I HAD MY PATIENTS.
18 AND WE WERE -- THERE WOULD BE SOME MEETINGS TOGETHER, SOME
19 TREATMENT TEAM MEETINGS. SOME -- SOME OF THAT WAS WITH THE
20 TEAM AND BOTH OF US WOULDN'T BE THERE. WE GAVE A
21 PRESENTATION TOGETHER OR WERE INVOLVED IN A PRESENTATION
22 ONCE.
23 Q. OKAY. ON THE AVERAGE HOW OFTEN DO YOU THINK YOU WOULD
24 SEE OR ASSOCIATE WITH DR. WEITZEL IN A WEEK'S TIMEFRAME? DO
25 YOU REMEMBER?
1 A. NOT VERY MUCH BECAUSE I CAME IN IN THE -- IN THE EVENINGS
2 WHEN I HAD PATIENTS AND I WORKED ALL DAY LONG.
3 Q. OKAY. AS THE DIRECTOR OF THE UNIT, DID YOU HAVE ANY KIND
4 OF SUPERVISORY RESPONSIBILITIES WITH -- IN CONNECTION WITH
5 THE DEFENDANT?
6 A. NO.
7 Q. OKAY. WERE YOU EVER -- DID YOU EVER HAVE A CONVERSATION
8 WITH TODD CHAMBERS RELATING TO A -- ALLEGATIONS OF
9 OVERMEDICATION?
10 A. YES.
11 Q. AND WAS THAT IN REFERENCE TO DR. WEITZEL?
12 A. YES.
13 Q. DID YOU -- AT THAT TIME WAS THERE A REQUEST MADE OF YOU
14 TO SPEAK TO HIM ABOUT THAT?
15 A. THERE WAS A REQUEST MADE FOR ME TO REVIEW SOME CHARTS.
16 Q. OKAY. AND DID YOU DO THAT?
17 A. YES.
18 Q. DO YOU RECALL APPROXIMATELY WHAT TIME PERIOD THAT WE'RE
19 TALKING ABOUT HERE WHEN YOU MADE THE REVIEW OF THOSE CHARTS?
20 A. I -- I DON'T KNOW. IN '95 I WOULD -- I DON'T -- I CAN'T
21 REALLY SPECULATE --
22 Q. OKAY.
23 A. -- OR -- OR ANSWER THAT. I CAN'T SPECULATE -- I CAN
24 SPECULATE, BUT I CAN'T REALLY PIN THAT DOWN TO A MONTH OR
25 ANYTHING.
1 Q. OKAY. CAN YOU -- CAN YOU TELL US WHETHER OR NOT THAT
2 CONVERSATION WOULD HAVE OCCURRED PRIOR TO THE REPORTED DEATHS
3 THAT WE'RE TALKING ABOUT HERE TODAY IN -- IN COURT?
4 A. YES.
5 Q. OKAY. BUT YOU CAN'T -- YOU CAN'T DEFINITELY TELL US
6 WHETHER IT WAS SIX MONTHS BEFORE OR FOUR MONTHS BEFORE OR
7 ANYTHING OF THAT NATURE?
8 A. I THINK IT WAS MONTHS BEFORE.
9 Q. OKAY.
10 A. MONTHS AND --
11 Q. ALL RIGHT. AND SO YOU REVIEWED THESE CHARTS; IS THAT
12 CORRECT?
13 A. YES.
14 Q. AND WAS THERE A CONCERN YOU HAD AFTER REVIEWING THOSE
15 CHARTS RELATIVE TO THE MEDICATION PRACTICES?
16 A. I -- I WAS CONCERNED ABOUT THE AMOUNT OF MEDICATIONS
17 GIVEN, THE DOSAGES AND THE NUMBER OF MEDICATIONS GIVEN.
18 Q. OKAY. AND DID YOU NOTICE ANY CONSISTENCY IN -- IN TERMS
19 OF THE NUMBERS AND THE MEDICATIONS THAT WERE GIVEN BETWEEN
20 ALL FIVE INDIVIDUALS THAT YOU REVIEWING THEIR CHARTS?
21 MS. ISAACSON: OBJECTION. I THINK THAT THAT
22 MISCHARACTERIZES --
23 THE COURT: SUSTAINED.
24 MS. ISAACSON: -- THE TESTIMONY.
25 MR. WILSON: EXCUSE ME.
1 Q. (BY MR. WILSON) WHAT WAS IT ABOUT THE CHARTS THAT CAUSED
2 YOU CONCERN, THE MEDICATIONS?
3 THE COURT: I THINK HE'S ALREADY ANSWERED THAT,
4 MR. WILSON.
5 Q. (BY MR. WILSON) OKAY. IN TERMS -- IN TERMS OF THE
6 NUMBERS OF MEDICATIONS THAT YOU'VE TESTIFIED TO, WHAT WAS IT
7 THAT CAUSED YOU CONCERN ABOUT THAT?
8 A. THAT JUST INITIALLY AFTER THE ADMISSION THAT -- THAT
9 THOSE CHARTS, THE ONES I REVIEWED, ALL HAD ABOUT FIVE
10 DIFFERENT PSYCHOTROPIC MEDICINES GIVEN RIGHT OFF THE BAT ON
11 ADMISSION.
12 Q. ON ADMISSION?
13 A. UH-HUH.
14 Q. DO YOU REMEMBER THE NAMES OF THOSE PARTICULAR SUBSTANCES?
15 A. THERE WAS A CONSISTENT PATTERN: SERZONE, TRAZODONE,
16 RISPERDAL, I THINK EVEN HALDOL WAS GIVEN AT THE SAME TIME. I
17 MAY NOT -- BUT THERE WAS -- THERE WAS FOUR OR FIVE MEDICINES
18 THAT WERE USED CONSISTENTLY, IT SEEMED.
19 Q. OKAY. AND SO YOU DID HAVE A CONVERSATION WITH -- WITH
20 THE DEFENDANT AT THAT TIME?
21 A. YES, I DID.
22 Q. DO YOU REMEMBER WHERE THAT TOOK PLACE?
23 A. IN THE HORIZONS -- THE OFFICE THAT WAS JUST OUTSIDE THE
24 UNIT.
25 Q. OKAY. AND WHO WAS PRESENT DURING THAT CONVERSATION, SIR?
1 A. MYSELF AND DR. WEITZEL.
2 Q. OKAY. WHAT IF ANYTHING DID YOU SAY TO HIM AT THAT TIME,
3 TO YOUR RECOLLECTION?
4 A. WAS -- WAS TALKING ABOUT THOSE CASES AND -- AND THE
5 MEDICATION WAS THE MAIN TOPIC.
6 Q. CAN YOU REMEMBER ANYTHING SPECIFICALLY THAT YOU TOLD HIM
7 ON THAT OCCASION?
8 A. WELL, AT ONE -- AT ONE TIME IN THE CONVERSATION I SAID TO
9 THE FACT THAT YOU NEED TO STOP BLASTING EVERYONE WITH ALL
10 THIS STUFF --
11 Q. OKAY.
12 A. -- STUFF REFERRING TO PSYCHOTROPIC MEDICATIONS.
13 Q. ALL RIGHT. AND HOW DID HE RESPOND TO THAT?
14 A. BEFORE I SAID THAT, I DON'T KNOW IF HE WAS BEING TOO
15 RESPONSIVE, BUT HE SEEMED TO -- YOU COULD ASK -- YOU'D HAVE
16 TO ASK HIM, BUT HE SEEMED LIKE HE KIND OF LISTENED AND --
17 WITH WHAT I WAS SAYING AND --
18 Q. OKAY. DID YOU -- DID YOU -- IN RESPECT TO TELLING HIM
19 YOU CAN'T BLAST THESE KIND OF PATIENTS MAKE ANY FURTHER
20 COMMENTS RELATIVE TO HOW HE SHOULD PROCEED?
21 A. NO. I THINK HE -- HE TALKED ABOUT, YOU KNOW, LOOKING AT
22 THE MEDICINES AND -- I DON'T REMEMBER EXACTLY WHAT HE SAID, I
23 GUESS.
24 Q. DID YOU ADVISE HIM AS TO ANY PROTOCOL THAT HE SHOULD
25 FOLLOW?
1 A. OH, WELL, YEAH. THE DICTUM OF KIND OF GO LOW AND GO
2 SLOW.
3 Q. OKAY. DID YOU EVER HAVE ANY FURTHER CONVERSATIONS WITH
4 HIM RELATED TO THOSE FILES OR RELATED TO ANY OVERMEDICATION
5 ISSUES?
6 A. NO.
7 Q. OKAY.
8 MR. WILSON: I DON'T THINK I HAVE ANY FURTHER
9 QUESTIONS AT THIS TIME, YOUR HONOR.
10 THE COURT: MS. ISAACSON?
11 CROSS-EXAMINATION
12 BY MS. ISAACSON:
13 Q. GOOD AFTERNOON DR. JENSEN. MY NAME IS TARA ISAACSON. I
14 REPRESENT DR. WEITZEL. A FEW FOLLOW-UP QUESTIONS.
15 NOW, PATIENTS CAME ON TO THIS UNIT IN A LOT OF
16 CIRCUMSTANCES BECAUSE THEIR BEHAVIOR COULD NOT BE CONTROLLED
17 ELSEWHERE.
18 A. THAT'S TRUE. I WOULD SAY ABOUT A THIRD, THIRD OF THE
19 PATIENTS.
20 Q. PATIENTS WHO WERE EITHER DANGEROUS TO SELVES THEMSELVES
21 OR DANGEROUS TO OTHER PEOPLE?
22 A. YES.
23 Q. AND FOR A LOT OF THESE PATIENTS, THE GEROPSYCHIATRIC UNIT
24 WAS KIND OF A LAST RESORT, ONE OF THE LAST PLACES THEY COULD
25 GO.
1 A. YEAH. YES, IT WAS FOR SOME.
2 Q. AND ON THIS UNIT, YOU COULD PRESCRIBE PSYCHOTROPIC
3 MEDICATIONS TO HELP CONTROL BEHAVIOR.
4 A. YES.
5 Q. AND A CERTAIN PERCENTAGE OF PATIENTS COMING TO THE UNIT
6 HAD DEMENTIA; IS THAT RIGHT?
7 A. YES, UH-HUH.
8 Q. AND DEMENTIA, KIND OF IN LAYMAN'S TERMS IS -- IS CAUSED
9 BY BRAIN DISEASE OR INJURY.
10 A. YES, YOU COULD SAY THAT, IN LAYMAN'S TERMS.
11 Q. AND I UNDERSTAND THAT THIS WHOLE CONCEPT OF DEMENTIA IS
12 PRETTY COMPLEX, BUT THE IDEA IS THAT THE BRAIN IS
13 DETERIORATING OVER TIME.
14 A. YES.
15 Q. AND IS GETTING PROGRESSIVELY WORSE OVER TIME.
16 A. YES.
17 Q. AND ALZHEIMERS IS ONE EXAMPLE -- WELL KNOWN EXAMPLE OF A
18 PROGRESSIVE DISEASE THAT CAUSES THE BRAIN TO DETERIORATE.
19 A. YES, IT IS.
20 Q. AND SOMETIMES HAVE YOU WOULD ALZHEIMERS-TYPE PATIENTS ON
21 THE UNIT.
22 A. YES.
23 Q. AND ULTIMATELY, DEMENTIA WILL BE TERMINAL.
24 A. ULTIMATELY. ESPECIALLY ALZHEIMERS-TYPE DEMENTIA.
25 Q. AT THIS TIME THERE IS NO CURE FOR DEMENTIA -- FOR MOST
1 DEMENTIAS.
2 A. YES.
3 Q. ALMOST ALL DEMENTIAS.
4 A. RIGHT. YES.
5 Q. OTHER THINGS THAT CAN CAUSE DEMENTIA ARE STROKES?
6 A. YES.
7 Q. TUMORS?
8 A. YES.
9 Q. PARKINSON'S DISEASE?
10 A. YES.
11 Q. TRAUMA?
12 A. YES.
13 Q. AND ULTIMATELY YOU CAN'T CURE PATIENTS WITH DEMENTIA.
14 A. YEAH, YOU CAN -- YOU CAN TREAT -- YOU CAN TREAT SYMPTOMS.
15 YOU CAN'T REVERSE THE LOSS OF MEMORY OR THINGS LIKE THAT --
16 THE PROGRESSION OF LOSS OF MEMORY, FOR EXAMPLE.
17 Q. NOW, IN REFERRING TO THIS DISCUSSION THAT YOU HAD WITH
18 DR. WEITZEL ABOUT THE USE OF PSYCHOTROPICS, DO YOU KNOW HOW
19 MANY FILES YOU REVIEWED?
20 A. I BELIEVE IT WAS FOUR OR FIVE.
21 Q. DID YOU MAKE ANY NOTES OR ANY REPORT ABOUT YOUR REVIEW?
22 A. I JUST SPOKE WITH TODD CHAMBERS.
23 Q. SO THE WHOLE THING WAS PRETTY INFORMAL.
24 A. WELL, THE REVIEW OF THE CHARTS WAS FORMAL. WHAT THEY DID
25 WITH THE INFORMATION I PROVIDED OR SAYING I'D -- I'D TALKED
1 TO HIM, I GUESS, WAS -- I ASSUMED HE WROTE IT DOWN.
2 Q. BUT YOU DIDN'T WRITE ANYTHING DOWN OR SUBMIT A WRITTEN
3 REPORT ABOUT YOUR THOUGHTS.
4 A. NO.
5 Q. NOW, WHEN YOU REVIEWED THE CHARTS AND YOU SPOKE WITH
6 DR. WEITZEL, YOU CERTAINLY DIDN'T THINK AT THAT TIME THAT
7 THERE WAS ANYTHING DANGEROUS ABOUT WHAT YOU SAW.
8 A. DEFINE DANGEROUS TO ME.
9 Q. WELL, IF YOU HAD -- IF YOU HAD LOOKED AT THE CHARTS AND
10 AFTER LOOKING AT THEM YOU THOUGHT, THIS IS DANGEROUS, YOU
11 WOULD HAVE REPORTED HIM. YOU WOULD HAVE DONE SOMETHING
12 DIFFERENT THAN JUST SPEAKING WITH HIM CASUALLY.
13 A. IF I THOUGHT THERE WAS AN IMMEDIATE RISK?
14 Q. WELL, EVEN IF YOU THOUGHT THERE WAS A FUTURE RISK.
15 A. WELL, YOU MEAN OF LIKE LETHALITY?
16 Q. YES.
17 A. NO, I DIDN'T THINK AT THAT TIME THERE WAS A RISK OF
18 LETHALITY.
19 Q. OKAY. AND YOU WOULD AGREE THAT EVERY CLINICIAN, EVERY
20 PSYCHIATRIST, EVERY PHYSICIAN HAS TO MAKE A JUDGMENT BASED ON
21 AN INDIVIDUAL PATIENT.
22 A. YES, THAT'S PRETTY STANDARD.
23 Q. OKAY. AND YOU HAD NO INVOLVEMENT IN THE FIVE PATIENTS
24 INVOLVED IN THIS CASE.
25 A. NO, I DIDN'T.
1 Q. AND YOU DIDN'T REVIEW THEIR CHARTS.
2 A. NO, I DIDN'T.
3 Q. AND THE TREATING PHYSICIAN HAS TO MAKE DECISIONS ABOUT
4 WHAT MEDICATIONS ARE APPROPRIATE FOR A GIVEN PATIENT?
5 A. YES.
6 Q. AND WHAT LEVELS OF MEDICATION ARE APPROPRIATE.
7 A. YES.
8 Q. AND WITH PATIENTS WHO HAVE EXTREME AGITATION OR PHYSICAL
9 ACTING OUT, THERE ARE TWO -- TWO SORTS OF WAYS THAT YOU CAN
10 DEAL WITH THAT AGITATION. ONE IS TO USE PHYSICAL RESTRAINTS;
11 IS THAT RIGHT?
12 A. YOU COULD USE SECLUSION, PHYSICAL RESTRAINTS. YOU COULD
13 USE -- WHAT WE CALL CHEMICAL RESTRAINTS WHICH TYPICALLY IS
14 TYPES OF PSYCHOTROPIC MEDICATION.
15 Q. AND YOU WOULD AGREE THAT IT'S PREFERABLE, IF YOU CAN, TO
16 USE MEDICATIONS INSTEAD OF TYING SOMEONE DOWN OR SECLUDING
17 THEM.
18 A. GENERALLY THOSE ARE THOUGHT OF AS -- AS MORE APPROPRIATE
19 OR -- FOR SOMEONE'S -- WHAT -- WHAT I THINK MOST PEOPLE WOULD
20 WANT, WHETHER THEY WERE ILL AT THE TIME OR NOT, IF THEY HAD
21 THEIR CHOICE -- IF THE PEOPLE IN THE COURTROOM HAD THEIR
22 CHOICE, THEY WOULD PROBABLY RATHER RECEIVE A MEDICATION MAYBE
23 THAN PUT IN PHYSICAL RESTRAINTS, FOR EXAMPLE.
24 Q. THANK YOU.
25 MS. ISAACSON: THAT'S ALL I HAVE.
1 THE COURT: REDIRECT?
2 MR. WILSON: I HAVE NO FURTHER QUESTIONS, YOUR
3 HONOR.
4 THE COURT: YOU MAY STEP DOWN, DR. JENSEN.
5 MAY THIS WITNESS BE EXCUSED, MR. WILSON?
6 MR. WILSON: YES, YOUR HONOR.
7 MS. ISAACSON: YES.
8 THE COURT: MS. ISAACSON?
9 YOU MAY BE EXCUSED, DOCTOR, AND THANK YOU FOR COMING AND
10 TESTIFYING.