1 1 IN THE COURT OF COMMON PLEAS 2 CUYAHOGA COUNTY, OHIO 3 TONI L. BIANCHI, Executrix of the Estate of FRANCES R. 4 BRONCACCIO, Deceased, 5 Plaintiff, 6 -vs- CASE NO. 370551 7 8 KAISER FOUNDATION HEALTH PLAN OF OHIO, et al., 9 Defendants. 10 11 - - - - 12 Deposition of RICHARD GAJDOWSKI, M.D., taken as 13 if upon cross-examination before Laura L. Ware, a 14 Notary Public within and for the State of Ohio, at 15 Kaiser Permanente Medical Center, 12301 Snow Road, 16 2nd Floor, Administration Conference Room, 17 Cleveland, Ohio, at 4:00 p.m. on Wednesday, August 18 18, 1999, pursuant to notice and/or stipulations of 19 counsel, on behalf of the Plaintiff in this cause. 20 21 - - - - 22 WARE REPORTING SERVICE 23 3860 WOOSTER ROAD ROCKY RIVER, OH 44116 24 (216) 533-7606 FAX (440) 333-0745 25 2 1 APPEARANCES: 2 Mark W. Ruf, Esq. Hoyt Block Building, Suite 300 3 700 West St. Clair Avenue Cleveland, Ohio 44113 4 (216) 687-1999, 5 - and - 6 David Malik, Esq. Law Offices of David Malik 7 8228 Mayfield Road Chesterland, Ohio 44026 8 (440) 729-8260, 9 On behalf of the Plaintiff; 10 Susan M. Reinker, Esq. Bonezzi, Switzer, Murphy & Polito 11 1400 Leader Building 526 Superior Avenue 12 Cleveland, Ohio 44114 (216) 875-2767, 13 On behalf of the Defendants. 14 15 E X H I B I T I N D E X 16 PAGE 17 Plaintiff's Exhibit 6 8 18 19 20 21 22 23 24 25 3 1 RICHARD GAJDOWSKI, M.D., of lawful age, 2 called by the Plaintiff for the purpose of 3 cross-examination, as provided by the Rules of Civil 4 Procedure, being by me first duly sworn, as 5 hereinafter certified, deposed and said as follows: 6 CROSS-EXAMINATION OF RICHARD GAJDOWSKI, M.D. 7 BY MR. RUF: 8 Q. Would you please state your name and spell your 9 name. 10 A. My name is Richard Gajdowski, last name is spelled 11 G-A-J-D-O-W-S-K-I. 12 Q. And what is your address? 13 A. You misspelled it there. I'll help you out again. 14 G-A-J-D, as in Douglas, O-W-S-K-I. 15 Q. Thank you. What is your address? 16 A. Home address? 17 Q. Yes. 18 A. 8898 Michaels Lane, Broadview Heights, Ohio, 44147. 19 Q. Dr. Gajdowski, my name is Mark Ruf. I represent the 20 Estate of Frances Broncaccio. 21 If at any time I ask you a question and you did 22 not understand my question, please tell me. If you 23 give me an answer to a question, I'll assume that 24 you understood the question. Okay? 25 A. That's fine. 4 1 Q. Who is your employer? 2 A. Ohio Permanente Medical Group. 3 Q. And what is your position with Ohio Permanente 4 Medical Group? 5 A. I'm an emergency physician at Kaiser Parma. 6 Q. How long have you been an emergency physician at 7 Kaiser Parma? 8 A. Just over five years. 9 Q. When did you graduate from medical school? 10 A. 1984. 11 Q. What did you do between '84 and 1994? 12 A. '84 and 1994? 13 Q. Have you been working at the Kaiser Permanente ER 14 since -- 15 A. For five years, correct. 16 Q. Since '94? 17 A. Five years back from today, that's correct. 18 Q. What did you do from '84 to '94? 19 A. I've basically had a full-time career in emergency 20 medicine. I did a three-year residency in emergency 21 medicine and have worked at various emergency 22 departments between then and now. 23 Q. Are you board certified in any area of medicine? 24 A. In emergency medicine. 25 Q. When were you board certified? 5 1 A. 1991. 2 Q. Did you pass your boards the first time you took 3 them? 4 A. That's correct. 5 Q. Was Frances Broncaccio a patient of yours? 6 A. She was. I wasn't specifically assigned to her. My 7 only connection with her was when I was called to 8 the arrest code in the CDU. 9 Q. You did not see, examine or treat her before the 10 arrest code? 11 A. That's correct. 12 Q. Did you speak with the family after her death? 13 A. I don't recall that I did. 14 Q. Was there a physician that spoke with the family 15 after Frances Broncaccio's death? 16 A. I don't have any firsthand knowledge of that. 17 Q. Were you the only physician that treated her for the 18 arrest, or were there other physicians involved? 19 And if you need to, refer to the records. 20 A. Yes, please, if you don't mind. Well, if anybody 21 spoke to the family it was probably Dr. Rider. I 22 assume that because he was the CDU physician of the 23 day. 24 Q. Does Dr. Rider still work here at Kaiser? 25 A. Yes, he does. 6 1 Q. Was Dr. Rider the physician in charge of her care 2 while she was in the CDU? 3 A. He would have -- if he was the physician of the day, 4 and I believe the arrest was called around 1:00, 5 then he would have been the physician in charge of 6 her care. 7 Q. So would you say it's more likely than not that Dr. 8 Rider spoke with the family as opposed to yourself? 9 A. That's correct. 10 Q. Do you know what Dr. Rider's shift was the day of 11 the 8th? 12 A. I don't know the specific hours. I assume that he 13 was day shift CDU physician, and that's generally 14 from about 9:00 to about 5:00 p.m. 15 Q. Do you know what kind of doctor Dr. Rider is? 16 A. Dr. Rider is board certified in internal medicine. 17 Q. Did you have any conversations with Dr. Rider about 18 Frances Broncaccio? 19 A. I think the only brief conversation we had was 20 related to the immediate part of the arrest. We 21 didn't have any detailed discussion of her case at 22 any time. 23 Q. Do you know if Dr. Rider saw Frances Broncaccio in 24 the CDU? 25 A. I would have to refer to her notes to tell you 7 1 whether he did or didn't see her or what he did. Do 2 you want me to do that at this time? 3 MS. REINKER: He just asked you if you 4 know. 5 Q. Do you know? 6 A. Well, I don't know firsthand. I've reviewed parts 7 of the chart, but I haven't reviewed his care, the 8 times or dates. 9 Q. What is Dr. Rider's full name? 10 A. Steven Rider. I don't know what his middle name 11 is. 12 Q. And he was also involved in treating Frances 13 Broncaccio for the arrest? 14 A. He was present at the time, yeah. 15 Q. Do you remember speaking with Robert Bianchi? 16 A. Who's Robert Bianchi? 17 Q. He's the son-in-law of Frances Broncaccio. 18 A. I don't recall, no. 19 Q. Did you tell anyone that it was your educated guess 20 that Frances Broncaccio died from an aortic 21 aneurysm? 22 A. Did I ever tell anyone that? 23 Q. Yes. 24 A. No. 25 Q. Did you ever tell anyone that that is something that 8 1 is commonly missed? 2 A. No. 3 Q. Is the progress sheet for 12-8 at 13:14 your 4 writing? 5 A. 12-8 at 13:14, right here? 6 MS. REINKER: The next page. 7 A. I see it. No. 8 Q. Whose writing is that? 9 A. Well, I'm looking at the signature and that would be 10 Steven Rider's. 11 - - - - 12 (Thereupon, Plaintiff's Exhibit 6 was 13 mark'd for purposes of identification.) 14 - - - - 15 Q. I'm handing you what's been marked as Plaintiff's 16 Exhibit 6. Could you please identify that 17 document. 18 A. That is my supplemental note as a result of me being 19 called for the arrest, resuscitation in the CDU. 20 Q. Why was it written as a supplemental note? 21 A. The dictation system that we use assumes that 22 whenever we use that dictation system that we are 23 dictating an ER note, so the template that is set 24 up, chief complaint, so on and so forth, assumes 25 that the patient is presenting to the ED. 9 1 For the incident that I'm dictating for when I 2 say supplemental note, I am writing a note, a 3 function that is not within the confines of the 4 emergency department. 5 Q. Well, I don't understand. Why does it say emergency 6 department on the note? 7 A. Because that's essentially where the dictation is 8 going to come out, what printer it's going to come 9 out. That's where I physically dictated the chart. 10 In contrast, the emergency department record is 11 set up along guidelines or a template. In other 12 words, there would be different headings as opposed 13 to a simple note. 14 Q. Your supplemental note states that the patient was 15 found unresponsive in her room. Do you know who 16 found her unresponsive? 17 A. I don't know whether it was the nursing staff or Dr. 18 Rider. 19 Q. Or family members? 20 A. I don't know. 21 Q. Were the family members in Frances Broncaccio's room 22 when you arrived in her room? 23 A. I don't believe so. 24 Q. Do you have a specific recollection of that? 25 A. No. 10 1 Q. Do you have a specific recollection of Frances 2 Broncaccio? 3 A. Not really. 4 Q. At the time you found Frances Broncaccio, she was 5 not breathing; is that correct? 6 A. Let me refer to my note. Yeah, that's what I 7 dictated. She was making no respiratory effort, 8 that's what I wrote. 9 Q. And you checked her carotid pulse? 10 A. Correct. 11 Q. And what did you find? 12 A. Weak and thready. 13 Q. Where did you obtain the information that she had a 14 history of hypertension and aortic insufficiency? 15 A. It would have been from her medical record after the 16 arrest. 17 Q. Do you know what part of the medical record you 18 checked? 19 A. I don't know what specific part. It may have been 20 from Dr. Haluska's admitting note. There it is. 21 Hypertension, aortic insufficiency, as dictated by 22 Dr. Haluska. 23 Q. At the time you responded to the code, what was 24 Frances Broncaccio's condition? 25 A. At the time I responded she was obviously moribund. 11 1 She was making no respiratory effort and had a weak 2 and thready pulse. 3 Q. Do you have any opinion as to how long she had the 4 weak, thready pulse? 5 A. I don't think for very long. It had to have been a 6 fairly acute event. 7 Q. What did your physical examination reveal? 8 A. Reading from my notes, patient had prominent neck 9 veins, cyanosis about the lips, had essentially no 10 airway, protective reflexes, minimal respiratory 11 effort, soft abdomen, mottled lower extremities. 12 Q. Based on her condition at the time you arrived in 13 her room, what were Frances Broncaccio's chances of 14 survival? 15 A. Minimal. 16 Q. Why do you say they were minimal? 17 A. She was already moribund. She was making no 18 respiratory effort and already had a weak, thready 19 carotid pulse. 20 Q. So by the time you arrived it was more probable than 21 not that she was going to die? 22 A. That is correct. 23 Q. Do you know how long she had been in that 24 condition? 25 A. I don't know offhand how long she was in that 12 1 condition. Based on her presenting symptomatology, 2 she couldn't have been in that position for more 3 than a few minutes. 4 Q. Were you specifically called on this arrest? How 5 was it that you went to Frances Broncaccio's room? 6 A. Because the CDU is right next to the ER, and when a 7 code is called I'm a responder. 8 Q. Do you always respond to any code that's called in 9 the CDU? 10 A. Yes. 11 Q. Other than responding to a code in the CDU, do you 12 have any involvement in patient care while a patient 13 is in the CDU? 14 A. The only time that I have involvement on a routine 15 basis is to cover for emergencies after the CDU 16 rounding person goes home for the day. 17 Q. What was your shift on December 8th? 18 A. I was obviously working day shift. 19 Q. Which is from when to when? 20 A. A 7:00 to 5:00. 7:00 to 4:00, I should say. 21 Q. So other than responding to an emergency in the CDU, 22 you would not have any involvement in patient care 23 in the CDU? 24 A. No. 25 Q. What time was the code called? 13 1 MS. REINKER: Would it be on there? 2 A. It appears shortly after 1:00. 3 Q. 1:00 p.m.? 4 A. That's correct. 5 Q. And when did you arrive in the room? 6 A. It would appear sometime between 13:05 and 13:08. 7 Q. Was there any type of emergency call for Frances 8 Broncaccio before 1:00 p.m.? 9 A. Not that I see. 10 Q. Down at the bottom of your supplemental note you 11 state patient's course seems to suggest a primary 12 cardiac event. What did you mean by that? 13 A. An acute cardiac ischemia or a heart attack. 14 Q. Did you make any type of determination as to what 15 Frances Broncaccio died from? 16 A. I didn't attempt to make any firsthand 17 determination. 18 Q. Were you aware of what her symptoms were prior to 19 the code being called? 20 A. When I reviewed the chart for this case, she was 21 admitted for some vague complaints which included 22 diarrhea, nausea, complained of some mild chest 23 pain. 24 Q. Your supplemental note states she did complain of 25 chest pain, correct? 14 1 A. Yes. 2 Q. Where did you get that information from? 3 A. I gleaned that from the chart. 4 Q. Do you know where in the chart you obtained that 5 from? 6 A. It would have been Joe Haluska's note. 7 Q. His note of what? 8 A. He had an admitting ER note, 12-7-97. 9 Q. What does his note state? 10 A. Chief complaint was chest pain and unresponsive. 11 Q. I noticed in Dr. Rider's note there's a note at 12 14:07, nurse reports patient complaint of chest pain 13 and lower back pain. Did any nurse report that to 14 you? 15 A. No. I'm a bit confused. Dr. Rider dictates a note 16 that the patient complained of pain, lower back 17 pain. This is after the patient is dead. 18 Q. Were you involved in the discussion between Dr. 19 Rider and the nurse after Frances Broncaccio's 20 death? 21 A. No. 22 Q. Did you have any discussion with Dr. Rider as to the 23 cause of Frances Broncaccio's death? 24 A. No. 25 Q. Did you discuss with any physician or nurse that 15 1 Frances Broncaccio might have died from an abdominal 2 aortic aneurysm rupture? 3 A. No. I think I say in my note that I doubt she died 4 of that. 5 Q. Why did you doubt that she died from -- 6 A. A ruptured aortic aneurysm? 7 Q. Yes. 8 A. Because her neck veins were full. If someone 9 ruptures from a ruptured abdominal aortic aneurysm, 10 I would expect them to be hypovolemic and their neck 11 veins to be flat. 12 Q. Why is that? 13 A. Because the cause of death is exsanguinating 14 hemorrhage. 15 Q. As an ER physician, do you send patients to the CDU? 16 A. Yes. 17 Q. Under what circumstances would you send a patient 18 who is suspected of a cardiac event to the CDU? 19 A. If my index of suspicion is fairly low when the 20 patient is stable, then the patient is a candidate 21 for CDU. If somebody has a high probability for a 22 cardiac event, then they will, more likely than not, 23 be admitted to the Cleveland Clinic. 24 Q. And why is that? 25 A. For instance, if somebody is definitely having a 16 1 myocardial infarct, the patient has ongoing severe 2 chest pain, then it's more likely than not they're 3 having a primary cardiac event and need to be ruled 4 out in a more acute care facility. 5 Q. Is the Kaiser Parma facility equipped to treat a 6 patient that is suffering from a myocardial 7 infarction or an aortic dissection? 8 A. Initially, obviously, that person is going to need 9 to be -- we're initially to stabilize and treat the 10 condition. A person having those conditions are 11 going to need definitive care in a patient setting. 12 Q. So the Kaiser Parma facility is only equipped to 13 initially treat and stabilize a patient? 14 A. Correct. We have an observation unit, as you can 15 see, we have a CDU. We don't have inpatient 16 facilities to admit patients for days on end. 17 Q. You do not have a cardiothoracic surgeon here at the 18 Parma facility, do you? 19 A. No. 20 Q. When you transfer a patient to the Clinic that is 21 having a primary cardiac event, is that an ER to ER 22 transfer? 23 A. You're talking about unstable angina or myocardial 24 infarct? 25 Q. Yes. 17 1 A. No. 2 Q. What type of transfer is that? 3 A. It would be a critical care transfer, and that 4 patient would be going to a cardiac unit. 5 Q. As an ER physician do you have the authority to make 6 a critical care transfer? 7 A. Yes. 8 Q. Do you need any authority from somebody at the 9 Cleveland Clinic to do that? 10 A. Obviously I need an accepting physician. 11 Q. Is there somebody in particular that you call to 12 transfer a patient to the Clinic? 13 A. Depends on what the problem is. 14 Q. For a patient suffering a primary cardiac event. 15 Who would you call for somebody who is having 16 unstable angina or myocardial infarct? 17 A. I would call my cardiologist on call. 18 Q. Is the cardiologist on call a Clinic employee or a 19 Kaiser employee? 20 A. Kaiser employee, an OPMG employee. 21 Q. Isn't there a Kaiser cardiology department at the 22 Cleveland Clinic? 23 A. There is a Kaiser cardiology department, and that 24 department staffs the Cleveland Clinic and Parma. 25 Q. Do you know if the Kaiser cardiology department is 18 1 privileged to admit a patient at the Cleveland 2 Clinic? 3 A. Yes. 4 Q. They are privileged to admit at the Cleveland 5 Clinic? 6 A. Yes. I'm privileged to admit at the Cleveland 7 Clinic. 8 Q. Is any ER physician at the Kaiser Parma facility 9 privileged to admit at the Clinic? 10 A. Yes. 11 Q. Do you work evening shifts in the ER? 12 A. Yes. 13 Q. If you wanted to obtain a cardiology consult in the 14 ER during an evening shift, what would you do? 15 A. For somebody to come into the -- for a cardiologist 16 to come into the ER? 17 Q. Well, in the evening there is not a cardiologist 18 around in this facility, is there? 19 A. Correct. 20 Q. So would you have to page -- 21 A. Yes. 22 Q. -- a cardiologist? 23 A. Yes. 24 Q. And they would have to come in if you wanted a 25 consult? 19 1 A. That's correct. 2 Q. Have you ever written either your history or 3 physical exam on a plain piece of paper? 4 A. Ever in my life, ever in my career? 5 Q. During the time you've worked for Kaiser. 6 A. Yes. 7 Q. Are there forms that can be used to write down a 8 history or physical if you have to hand write them? 9 A. Yes. 10 Q. Have you ever had only your physical exam cut out of 11 your dictation? 12 A. I've had sections of my dictation cut out, yes. 13 Q. If part of your dictation does not come out, does 14 the whole section not come out or only parts of it? 15 A. It depends. My dictation system can malfunction for 16 a number of reasons in a number of ways. 17 Q. But based on your experience, you've had parts of 18 your dictation cut out? 19 A. It's happened, yes. 20 Q. Does that happen on a frequent basis? 21 A. Depends how you define frequent. 22 Q. Well, how often has it happened to you? 23 A. I would say maybe 15, 20, 25 times. You're talking 24 about entire paragraphs? 25 Q. Yes. 20 1 A. Maybe 15, 20 times maybe. 2 Q. That's during the last five years you've worked 3 here? 4 A. Approximately. With this particular dictation 5 service? 6 Q. Yes. 7 A. Probably about five or ten times. It's happened 8 with all dictation services we've used. 9 Q. Have you ever just had one particular section cut 10 out of the dictation? 11 A. Yes. 12 Q. At the time you reviewed the records was there a 13 physical exam in the records from Dr. Haluska? 14 A. A physical exam from Dr. Haluska? 15 Q. Yes. 16 A. I don't recall. 17 Q. Did you review -- 18 A. I don't recall. 19 Q. -- all of Dr. Haluska's notes following the death? 20 A. No. 21 Q. Do you know if you reviewed his emergency department 22 note? 23 A. I reviewed parts of it. 24 Q. If you have a patient in which you suspect that 25 patient is suffering from an aortic dissection, do 21 1 you keep the patient here at the Kaiser Parma 2 facility or do you transfer that patient? 3 A. That I suspect? 4 Q. Yes. 5 A. If I suspected abdominal aortic dissection, I'd 6 investigate them properly to rule in or rule out 7 that suspicion and transfer them as necessary. 8 Q. And what would you do to rule in or rule out an 9 aortic dissection? 10 A. At Kaiser Parma? 11 Q. Yes. 12 A. Depends on the time of day. The availability of 13 radiology services is not uniform, depending on 14 whether it's day or night. During the day I'd be 15 able to get a CT of the chest. An aortogram I 16 wouldn't be able to get. 17 Q. Is the CT the test you would use to rule in or rule 18 out an aortic dissection? 19 A. At Kaiser Parma that's what I would use primarily. 20 Q. During the evening is a CT of the chest available? 21 A. It's available on an on-call basis, and after 22 discussing with the radiologist that might be 23 available. I don't know what specific criteria were 24 in place at the time this happened. 25 Q. Do you remember back in December of '97 what you 22 1 would have to do if you wanted to get a CT of the 2 chest in the evening? 3 A. I would call the radiologist on call. 4 Q. Would someone have to be called in to perform a CT 5 of the chest? 6 A. Yes. 7 Q. There is not a radiologist available here at the 8 Kaiser Parma facility in the evening hours? 9 A. There is not one present, no. 10 Q. Is there one present on the premises in the evening 11 that could perform a CT scan? 12 A. Not at all times. Generally someone needs to be 13 called in. 14 Q. Generally how long does it take a radiologist to get 15 to this facility that's called in? 16 MS. REINKER: Objection. 17 A. I have no idea. I don't know where my radiologists 18 live. 19 Q. Have you regularly called in radiologists in the 20 evening? 21 A. No. 22 Q. Is there any other test that you would perform here 23 at the Kaiser Parma facility to rule out an aortic 24 dissection? 25 A. Nothing, other than what I've mentioned to you 23 1 already. 2 Q. You said an aortogram is not available here at the 3 Kaiser Parma facility? 4 A. Generally speaking, if there's a strong index of 5 suspicion for an aortic problem that patient would 6 be transferred out to the Cleveland Clinic, and if 7 an aortagram is indicated one would be performed 8 there. 9 Q. Do you have an Intensive Care Unit here at the 10 Kaiser Parma facility? 11 A. No. 12 Q. If a patient had to be transferred to an Intensive 13 Care Unit, where would they be transferred to? 14 A. Depends on the stability of the patient. If the 15 patient was stable enough for transfer to the 16 Cleveland Clinic, that's where they would go 17 primarily. 18 If they were unstable for transfer, they would 19 go generally to the closest facility available. 20 Q. Is there equipment in the ER or CDU to monitor 21 cardiac rhythm? 22 A. To monitor cardiac rhythm? 23 Q. Yes. 24 A. There are EKG machines and there's monitoring. 25 Q. Is there any equipment to monitor central venous 24 1 pressure? 2 A. In the ED, not in the CDU. 3 Q. Is there any equipment to measure urine output? 4 A. Yes. 5 Q. In both the ED and CDU? 6 A. Yeah. 7 Q. Is there any equipment to monitor pulmonary wedge 8 pressure? 9 A. No. 10 Q. In neither the CDU or ER? 11 A. That's correct. If you're talking about Swan-Ganz 12 insertion, the answer is no. 13 Q. Is there any equipment to monitor cardiac output? 14 A. No. 15 Q. And that's neither the CDU nor the ER? 16 A. That's correct. 17 Q. If those things needed to be monitored, would the 18 patient have to be transferred to the Clinic? 19 A. Yes. 20 Q. Do you agree that the CDU here at the Kaiser Parma 21 facility is not equipped to monitor a patient for an 22 aortic dissection? 23 MS. REINKER: Objection. 24 A. After they've been proven to have an aortic 25 dissection? I'm not sure what you're asking me. 25 1 Q. Is the equipment in the CDU appropriate to monitor a 2 patient who is suspected of having a primary cardiac 3 event? 4 A. What event, cardiac event, are you talking about? 5 Q. Well, for a patient with chest pain an aortic 6 dissection or myocardial infarction is part of the 7 differential, correct? 8 A. Not in all cases. 9 Q. In what cases would both of those be part of the 10 differential? 11 A. It correlates to index of suspicion. If you truly 12 believe somebody is having unstable angina or an MI, 13 that's a different story than if somebody has a low 14 index of suspicion for a cardiac event. 15 Q. If somebody has a low index of suspicion for either 16 an MI or an aortic dissection, what type of 17 equipment could be used to monitor the patient in 18 either the ER or CDU? 19 A. I'm not sure what you're asking. We're not -- I'm 20 not working back from a diagnosis, I'm monitoring a 21 patient based on their presenting complaints. 22 Q. On the autopsy report a blunt impact is noted to 23 Frances Broncaccio's head. Was there any blunt 24 impact that occurred during the time of the 25 resuscitation? 26 1 A. I haven't seen the autopsy report. A blunt impact 2 to where? 3 MS. REINKER: He said to the head. 4 THE WITNESS: Well, where in the head? 5 MS. REINKER: Oh, I'm sorry. 6 Q. Here, let me hand you the coroner's report. 7 A. Right parietal scalp contusion, right temporalis 8 muscle hemorrhage. What was your question? 9 Q. Did anything occur during the resuscitation that it 10 could have caused the blunt impact to the head 11 listed in the autopsy report? 12 A. Not that I'm aware of. Is there a more detailed 13 description in this autopsy of what exactly the size 14 and dimensions of this contusion and temporalis 15 muscle hemorrhage is? 16 Q. Yes, there is, and you're free to look at it. 17 A. I'm having trouble locating details of this 18 particular contusion. Is there someplace -- 19 MS. REINKER: I think his only question 20 is do you know if that happened during the 21 resuscitation. 22 I don't know if you want to spend time 23 on it. Do you want him to spend time on it, 24 Mark? 25 MR. RUF: No. 27 1 Q. To the best of your recollection, nothing happened 2 that would have caused the general description 3 listed in the autopsy report? 4 A. No. There isn't a detailed description. Contusion 5 and hemorrhage are mentioned, but in the parietal 6 area that would be an unusual area to be traumatized 7 during a resuscitation. 8 Q. During the evening shift is an echocardiogram 9 available? 10 A. Not generally. 11 Q. Is a transesophageal echocardiogram available? 12 A. No echocardiogram of any type is available. 13 Q. Is angiography available? 14 A. No. I assume you're referring to coronary 15 angiography, aortic angiography, any kind of 16 angiography? 17 Q. Either one. 18 A. Neither nor. 19 Q. Have you diagnosed aortic dissections? 20 A. Yes. 21 Q. Based on your experience, do you know what 22 percentage of patients with aortic dissections 23 survive? 24 A. What percentage of patients that I've diagnosed have 25 survived? 28 1 Q. Yes. 2 A. I don't have a percentage number that I can give you 3 at this time. 4 Q. Do you know the survival rate for patients who are 5 suffering from aortic dissections? 6 A. Depends on the classification of dissections and 7 what caused it in the first place. 8 Q. The Kaiser Parma facility is not equipped to treat 9 an aortic dissection; is that correct? 10 A. If surgical therapy for aortic dissection is 11 indicated, no. 12 Q. Who would make the determination as to whether 13 surgical therapy was indicated? 14 A. A cardiovascular surgeon. 15 Q. And a cardiovascular surgeon would have to be paged 16 or called in if you were on the evening shift? 17 A. A cardiovascular surgeon wouldn't come in to Parma. 18 There would be no reason for him to do so. 19 Q. So the patient would have to be referred somewhere 20 else for that determination to be made? 21 A. Correct. A patient in that state would be 22 transferred to another facility. 23 Q. What about a drug therapy for an aortic dissection? 24 A. The patient would still have to be admitted with an 25 aortic dissection in either case and would be 29 1 therefore transferred out of Kaiser Parma. 2 Q. So whether or not drug therapy was indicated or 3 surgical therapy was indicated, the patient would 4 have to be transferred from this facility? 5 A. Once the diagnosis of aortic dissection was made, 6 that is correct. 7 Q. Did you have any discussions with anyone regarding 8 Frances Broncaccio that we have not covered? 9 A. I've had discussions with -- 10 MS. REINKER: Other than consulting 11 with counsel. 12 A. That's all. 13 MR. RUF: Thank you, Doctor. That's 14 all I have. 15 MS. REINKER: You have the right to 16 read the transcript of your deposition. 17 THE WITNESS: I'll waive that right. 18 MS. REINKER: No. 19 THE WITNESS: Oh, I won't waive that 20 right? 21 MS. REINKER: I would suggest that you 22 not waive it, that you at least look it through 23 and make sure there aren't any problems with 24 it. Okay? We're not waiving signature. 25 - - - - 30 1 (Thereupon, a discussion was had off 2 the record.) 3 - - - - 4 MS. REINKER: I'd like an agreement on 5 the record when you request it, or if you do, 6 you send me a copy and I'll get it to the 7 doctor. 8 THE WITNESS: And I will review the 9 transcript. 10 MS. REINKER: That way he will not have 11 to come to the Court Reporter's office within 12 seven days to review the transcript. 13 MR. RUF: That's fine. 14 15 RICHARD GAJDOWSKI, M.D. 16 17 18 19 20 21 22 23 24 25 31 1 2 C E R T I F I C A T E 3 The State of Ohio, ) SS: 4 County of Cuyahoga.) 5 6 I, Laura L. Ware, a Notary Public within and for the State of Ohio, do hereby certify that the 7 within named witness, RICHARD GAJDOWSKI, M.D., was by me first duly sworn to testify the truth, the 8 whole truth, and nothing but the truth in the cause aforesaid; that the testimony then given was reduced 9 by me to stenotypy in the presence of said witness, subsequently transcribed into typewriting under my 10 direction, and that the foregoing is a true and correct transcript of the testimony so given as 11 aforesaid. 12 I do further certify that this deposition was taken at the time and place as specified in the 13 foregoing caption, and that I am not a relative, counsel or attorney of either party or otherwise 14 interested in the outcome of this action. 15 IN WITNESS WHEREOF, I have hereunto set my hand and affixed my seal of office at Cleveland, 16 Ohio, this day of , 1999. 17 18 Laura L. Ware, Ware Reporting Service 19 3860 Wooster Road, Rocky River, Ohio 44116 My commission expires May 17, 2003. 20 21 22 23 24 25