0182 1 The State of Ohio, ) ) SS: 2 County of Summit. ) 3 - - - - - IN THE COURT OF COMMON PLEAS 4 - - - - - 5 MARK WILLIAMS, etc., ) ) 6 Plaintiff, ) ) 7 -vs- ) Case No. 406184 ) Judge Saffold 8 PARMA COMMUNITY GENERAL ) HOSPITAL, et al., ) 9 ) Defendant. ) 10 - - - - - 11 12 Continued videotaped deposition of 13 TUNG-CHANG_HSIEH,_M.D., a defendant herein, called __________ ______ ____ 14 by the plaintiff as if upon cross-examination 15 under the statute, and taken before 16 Suzanne Lamparter, Court Reporter and Notary 17 Public within and for the State of Ohio, pursuant 18 to the agreement of counsel, and pursuant to the 19 further stipulations of counsel herein contained, 20 on Wednesday, the 31st day of January, 2001, at 21 10:05 a.m., at the offices of Nurenberg, Plevin, 22 Heller & McCarthy Co., L.P.A., Standard Building, 23 First Floor, 1370 Ontario Street, City of 24 Cleveland, County of Cuyahoga and the State of 25 Ohio. 0183 1 APPEARANCES: 2 On behalf of the Plaintiff: 3 Nurenberg, Plevin, Heller & McCarthy Co., L.P.A., by: 4 HARLAN_M._GORDON,_ESQ. ______ __ _______ ____ Standard Building - First Floor 5 Cleveland, Ohio 44113 (216) 621-2300 6 On behalf of Defendants 7 Tung-Chang Hsieh, M.D., and Physician Staffing: 8 Hanna, Campbell & Powell 9 Co., L.P.A., by: JEFFREY_SCHOBERT,_ESQ. _______ _________ ____ 10 3737 Embassy Parkway Akron, Ohio 44334 11 (330) 668-8960 12 On behalf of Defendants William Hahn, M.D., and The Women's Wellness Center: 13 Bonezzi, Switzer, Murphy & Polito 14 Co., L.P.A., by: WILLIAM_BONEZZI,_ESQ. _______ ________ ____ 15 The Leader Building 526 Superior Avenue 16 Cleveland, Ohio 44114 (216) 875-2767 17 On behalf of Defendant Parma Community 18 General Hospital: 19 Weston, Hurd, Fallon, Paisley & Howley Co., L.P.A., by: 20 JOHN_W._JEFFERS,_ESQ. ____ __ ________ ____ 2500 Terminal Tower 21 Cleveland, Ohio 44113 (216) 241-6022 22 Also Present: 23 David Tackla, Videographer 24 - - - - - 25 0184 1 OBJECTIONS 2 - - - - - 3 ATTORNEY PAGE-LINE ________ _________ 4 5 Mr. Jeffers 204-05 6 Mr. Schobert 205-02 7 Mr. Bonezzi 208-09 8 Mr. Schobert 211-12 9 Mr. Schobert 211-22 10 Mr. Schobert 212-09 11 Mr. Schobert 212-23 12 Mr. Jeffers 213-09 13 Mr. Schobert 213-14 14 Mr. Schobert 213-21 15 Mr. Jeffers 214-01 16 - - - - - 17 18 19 20 21 22 23 24 25 0185 1 PROCEEDINGS 2 - - - - - 3 TUNG-CHANG_HSIEH,_M.D., a __________ ______ ____ 4 defendant herein, being of lawful age, having been 5 previously duly sworn according to law, deposes 6 and says as follows: 7 - - - - - 8 CONTINUED CROSS-EXAMINATION 9 BY MR. GORDON: 10 Q Good morning, Dr. Hsieh. 11 A Good morning. 12 Q Again, I'm Harley Gordon, one of the 13 attorneys representing the family of 14 Mary Williams. 15 As I indicated to you at your deposition 16 that we began December 1st, 2000, first of all, 17 make sure before you answer any of my questions 18 you understand the question. Do you understand 19 that, sir? 20 A Yes, sir. 21 Q If you don't understand the question, as you 22 did in your beginning portion of this deposition, 23 don't answer the question and tell me to repeat 24 the question, or rephrase it, or define a term. 25 Do you understand that? 0186 1 A Yes, sir. 2 Q And if you want to take a break, just tell 3 us and we'll take a break, okay? 4 A Thank you. 5 Q Now I want to talk to you about when you saw 6 the patient at somewhere around 12:20, 12:25 on 7 June 26, 1999. 8 When you went in to see the patient, did 9 you dis -- discuss with the patient anything in 10 regard to vaginal bleeding? 11 A I didn't recall specific talked to the 12 patient about this vaginal bleeding, but the nurse 13 asked me to go into the room to rule out any 14 vaginal bleed. 15 Q Customarily when you see a patient at a 16 nurse's request for vaginal bleeding, what 17 questions do you ask of the patient, if any? 18 A Usually I just go in, why I come into the 19 room to check the patient, what need to be 20 checking. 21 Do you understand? 22 Q No, I don't understand, so maybe -- 23 A Okay. When I go into the patient room, 24 usually I talk to the patient why I came in and 25 the nurse was introduce me, "Dr. Hsieh coming in 0187 1 to do these" -- whatever is necessary. 2 Q Then when you do go in for vaginal bleeding 3 do you, from your practice, talk to the patient 4 regarding the vaginal bleeding? 5 A Yes, I talk to the -- I talk to the patient. 6 The nurse introduce me first and I then I talk to 7 the patient, "I'm coming to check whether you have 8 any vaginal heavy bleeding or not." 9 Q Okay. And what do you ask the patient about 10 the vaginal bleeding? 11 A I didn't ask any specific question. I just 12 ask the nurse to get ready so I can check the 13 patient, like sterile glove and get the patient 14 ready. 15 Q When you check the patient for vaginal 16 bleeding -- let's check that. 17 When you checked the patient for vaginal 18 bleeding in this case did you examine her -- her 19 pad? 20 A Yes, I saw the pad at the same time. 21 Q Okay. 22 A At the time I remember the pad is more 23 moderate saturated. 24 Q Now with respect to vaginal bleeding you 25 evaluate the darkness of the blood; is that 0188 1 correct? 2 A The saturation of the pad is active bleeding 3 or not. 4 Q Okay. 5 A And -- 6 Q Do you look at anything else other than 7 looking at the pad to see if there was vaginal 8 bleeding? 9 A I then look at the -- the sheet, any 10 bleeding or not. Active bleeding, you can see 11 that if active bleeding. 12 Q Okay. Did you see any active bleeding on 13 the sheet? 14 A No. 15 Q Is it typical for a postpartum lady within 16 the first 24 hours to have moderate vaginal 17 bleeding? 18 A It's not unusual. 19 Q Did you ask Mrs. Williams whether or not she 20 had any rectal vaginal pressure? 21 A I didn't recall. 22 Q Okay. What would you have done if you found 23 active vaginal bleeding? 24 A If I -- I will review, check the hemoglobin, 25 hematocrit, the blood tests for -- check the CBC, 0189 1 you know, complete blood count, see how much the 2 globin, how much is bleeding. 3 Q Would you do anything else? 4 A And the vital signs. 5 Q Vital signs? 6 Anything else that you would do? 7 A And then do a vagina examination. 8 Q Would you do anything else? 9 A Palpation the -- palpation the fundus of the 10 uterus and see any blood clot in the vagina or in 11 the uterus. 12 Q Would you do anything else? 13 A Also, if necessary, I do a rectal 14 examination, too. 15 Q Did you find any blood clots when you 16 examined Mrs. Williams? 17 A No. 18 Q In your progress note you documented the lab 19 value for mag -- or magnesium sulfate in your 20 progress note of 12:25 a.m. Why did you document 21 the magnesium sulfate value if you were asked to 22 look at the patient for vaginal bleeding? 23 A You know, this patient with the 24 preeclampsia, she's on the treatment with the 25 magnesium sulfate. This why for the standard care 0190 1 we have to know how much the magnesium sulfate in 2 the system. That's why we check that all the 3 time. 4 Q Okay. So while you're checking for vaginal 5 bleeding, you felt while you're seeing the patient 6 and she was preeclamptic, you might as well check 7 the magnesium sulfate; is that what -- is that 8 what you're thinking? 9 A This again, sir, I answer you. When the 10 patient with the preeclampsia, we have to check 11 the -- the concentration of the magnesium in the 12 blood. 13 Q I understand that. But you went in to see 14 the patient you say for vaginal bleeding. So I 15 wanted to know why did you also look at the 16 magnesium sulfate value if you only went in to see 17 the patient for vaginal bleeding. Can you explain 18 that? 19 A My -- my -- my answer is said is my custom 20 and my routine when the patient under treatment 21 with that magnesium sulfate, I always want to know 22 the concentration. 23 Q Okay. So in other words you went beyond 24 what the -- the nurse requested you to do to 25 evaluate her vaginal bleeding; is that correct? 0191 1 A Not beyond the patient -- not beyond the 2 nurse asked, just my standard care. 3 Q Okay. So your standard care for -- a nurse 4 for instance calls you for vaginal bleeding, you 5 would also look at the patient to see whether or 6 not she has any signs or effects of preeclampsia 7 if she had been diagnosed preeclamptic; is that 8 correct? 9 A Yeah, generally care for the patient for 10 my -- my standard care. 11 Q Okay. Your progress note at 12:25 a.m., 12 found at page 189, also indicates that you 13 received information about the IV rate, 125 cc's 14 an hour, okay? 15 MR. SCHOBERT: Hang on. 16 Do you have that, 189? Next page, 17 IV rate. 18 Here it is. 19 Is that a question? Do you want him to 20 acknowledge that he noted that finding? 21 MR. GORDON: No, no, I wanted to 22 use that as a preface, basis for another 23 question. 24 MR. SCHOBERT: All right. 25 Q If you're evaluating a patient for vaginal 0192 1 bleeding, why do you want to know the IV rate? 2 A See, when you care the patient usually you 3 have to specifically know how much the patient 4 intake and output. That's a one of the standard 5 care. 6 Q So then in other words the input and output 7 of fluids is unrelated to the request to examine 8 the patient or assess the patient for vaginal 9 bleeding; is that right? 10 A You see, I put in this I prove that she had 11 no active bleeding. If there active bleeding, 12 the -- the urine output can be less than that. 13 Q No, but we're talking about the IV rate, how 14 much was being given to the patient. 15 A So that's why when you see the patient you 16 have to know intake and output, you know how much 17 the -- the fluid right now, when I saw that period 18 of time, how much is fluid given, be sure it's not 19 overloaded. 20 Q How does overloading of fluid relate to your 21 evaluation of the patient for vaginal bleeding? 22 A That is a general care, standard care. When 23 you see the patient, you want to know the standard 24 care, the vital signs and the -- the bleeding, 25 something to do with that. 0193 1 Q Okay. Did you find that there was retention 2 of fluid? 3 A No. 4 Q And what do you base that on? 5 A You can -- can -- can -- can look at the 6 urine output, you can look at the general 7 condition of the -- of the patient when you see 8 the -- see the patient, when you check -- 9 especially when I check the fundus of the uterus, 10 I couldn't -- when I checked the fundus of the 11 uterus I didn't see any skin, abdomen, any 12 (inaudible), whatever, water retention or swelling 13 of the leg, or feet, or whatever in that period of 14 time. 15 Q If the patient is having an IV at 125 cc's 16 an hour and the only urine output is 100 cc's in 17 the last two -- two hours, okay, isn't there -- 18 isn't the patient then retaining fluid? 19 A Not necessary because the -- the urine 20 output for average is about at least 60 cc an hour 21 normally. So this is a minimal difference. It's 22 not necessary you can see that clinically, 23 retention of the water. 24 Q In terms of the IV rate of 125 cc's an hour, 25 where did you get that information? 0194 1 A This customary we use that postpartum -- 2 postpartum patient when we give the fluid. That 3 is almost we give them that by standard. 4 Q The IV rate of 125 cc's an hour, is that 5 something that you saw in the record or that you 6 made the judgment that she was postpartum, she was 7 receiving 125 cc's an hour? 8 A I asked the nurse. 9 Q Okay. And with respect to the urine output 10 that you noted in your note, where did you get 11 that information? 12 A That I get from the nurse, too. At the same 13 time I did check the Foley, you know, drains are 14 good or not. 15 Q And you got the serum magnesium level from 16 the nurse; is that correct? 17 A Yes. 18 Q And the hematocrit and hemoglobin from the 19 nurse? 20 A Yes. 21 Q And then did you get any other information 22 from the nurse which is not recorded in your 23 progress note? 24 A I didn't recall. 25 Q With respect to the pulse rate of 125, okay, 0195 1 did you get that from the monitor, or did you 2 evaluate the patient yourself, or did you get it 3 from the nurse? 4 A I got that -- I -- as my best recollection, 5 I got that from the nurse. 6 Q Now with a postpartum patient such as 7 Mrs. Williams, what is the normal heart rate? 8 A Normal heart rate for -- usually between -- 9 again the question? 10 You said for specific this patient? 11 Q Right. 12 A Normally postpartum patient, variation time 13 to time. Usually if within 50 to 135 or 40, that 14 is very typical postpartum patient, especially for 15 this doctor -- Mrs. Williams. 16 Q So the normal range for a patient like 17 Mrs. Williams postpartum is a heart rate of 50 to 18 135 to 145? 19 MR. JEFFERS: 135 to 140 he said. 20 A I said for the postpartum, for her pulse 21 rate here, pulse rate here, 125 is normal limit. 22 Q Normal limit? 23 A Yeah, for average postpartum patient. 24 Q Okay. 25 A That's why for Williams is the -- within 0196 1 normal limits. 2 Q Okay. As Mr. Jeffers was saying, did you 3 say 140 or 145? 4 A I didn't hear. Pay attention what did he 5 say? 6 Q Okay. Did you say the normal range -- 7 A Normal range from 50 to 135 for postpartum 8 average -- 9 Q All right. 10 A -- is within normal limit. 11 Q And with respect to the blood pressure, is 12 that 137 over 65? 13 A 27. 14 Q 127? 15 MR. SCHOBERT: I think he testified 16 the last time, we got -- you know, I 17 remember we went and got a better copy of 18 the chart. 19 MR. GORDON: Okay. 20 MR. SCHOBERT: I think it's in 21 there, Harley, somewhere. 22 MR. GORDON: Okay. Whatever it 23 is. 24 MR. SCHOBERT: You already asked 25 him to read that note verbatim and I think 0197 1 he told you what he thought it was. 2 MR. BONEZZI: That's what he said 3 before, 65. 4 Q All right. And where did you get that 5 information from, the blood pressure? 6 A The blood pressure? From the -- from the -- 7 from the book, from textbook. 8 Q No. No. 9 MR. SCHOBERT: He's asking you 10 where did you get the specific reading. 11 A This one, this specific reading is from the 12 nurse. 13 Q Okay. And with respect to patient like 14 Mrs. Williams at this time, what is the normal 15 blood pressure? 16 A Just in record, in here is the normal -- 17 normal limit. 18 Q Okay. What is the normal range for a 19 patient like Mrs. Williams at this time? 20 A Between the diastolic is 60, systolic is 21 around 140. 22 Q 140 over 60? 23 A Yeah. 24 Q If you wanted to find out yourself what the 25 blood pressure was and the heart rate, could you 0198 1 use a monitor to determine that? 2 A You can use the monitor, you can use 3 checking by yourself. Yes, you can use the 4 monitor. 5 Q Did you determine the respiration rate at 6 that time? 7 A At that time I don't recall. 8 Q Did you determine the temperature at that 9 time? 10 A I don't recall. 11 Q Then if you did not find any vaginal 12 bleeding, did you arrive at any diagnosis? 13 A At that time I didn't -- I didn't write any 14 diagnosis, no, I did not. But I can rule out one 15 thing from any kind of infection because she have 16 no fundus tenderness, no smelling discharge. 17 Q So that's the way you rule in or rule out 18 infection? 19 A Clinical judgment. 20 Q But that is the way you rule in or rule out 21 infection, by evaluating the fundus -- 22 A Right -- 23 MR. SCHOBERT: Let him finish. 24 Q -- as well as seeing if there's any odor? 25 A Yeah, smell. 0199 1 Q All right. Did you look at the nurses' 2 notes for -- at or about the time you saw this 3 patient? 4 A Yes. 5 Q Okay. Let's turn to that. It's on 6 page 160. 7 MR. SCHOBERT: The page before I 8 think he wants you to look at. 9 Q On page 160, at the time -- or let me 10 rephrase the question. 11 At or about the time you saw the patient 12 is there any reference in the nurses' notes 13 regarding any concern of vaginal bleeding? 14 MR. JEFFERS: By inference or 15 otherwise? 16 MR. GORDON: Well, I didn't say 17 inference or otherwise. 18 MR. JEFFERS: Well, I don't know 19 if your question is fair if you read what it 20 says. 21 Q Let me put the question to you again. 22 MR. BONEZZI: Go off the record. 23 I've got a question for you. 24 THE VIDEOGRAPHER: Off the record. 25 - - - - - 0200 1 (Whereupon, discussion was held off the 2 record at this time.) 3 - - - - - 4 THE VIDEOGRAPHER: Back on the record. 5 MR. SCHOBERT: Let him ask -- he's 6 going to re-ask the question. Let him 7 re-ask the question, then you can answer. 8 Go ahead. 9 BY MR. GORDON: 10 Q Okay. Dr. Hsieh, I was asking you a 11 question and I want to repeat it. And on 12 page 160, okay, and we're looking at the nurses' 13 notes. Is there any reference in the nurses' 14 notes of any concern regarding vaginal bleeding at 15 or about the time you saw Mrs. Williams? 16 A Yes. 17 Q And where is that? 18 A Because the patient keep feeling rectal 19 pressure, vagina pressure. 20 Q And the -- and the last reference to rectal 21 vaginal pressure was at 22:15, or 10:15, on 22 June 25th; is that correct? 23 A June 25th -- let me see. 24 MR. SCHOBERT: I think he's looking 25 for the last reference prior to your seeing 0201 1 the patient from your review of those notes. 2 MR. JEFFERS: And he should look 3 at the same time at 00:30 when it says, 4 "Exam, rectal," with whatever inference that 5 might have. 6 MR. SCHOBERT: Go ahead, Doctor. 7 Answer as best you can. 8 A I forgot your question. 9 MR. SCHOBERT: He wants to know if 10 22:15 was the last reference to that 11 pressure you're referring to prior to your 12 seeing the patient. 13 A Yes, because I -- according to the record 14 here I can see. 15 Q All right. Could turn to page 141, please? 16 I'm going to refer you to what is found in the 17 right-hand column on page 141. 18 MR. SCHOBERT: 141, Doctor. Go 19 back to the nurses' section. 20 Q Under nursing notes. 21 MR. SCHOBERT: Keep going. There 22 you go. Keep going. There you go. 23 Right-hand column somewhere he wants you to 24 look at. 25 Q Okay. It's like in the middle of the column 0202 1 there's a reference to lochia. Do you see that? 2 A Okay, lochia. 3 Q Do you find that, Doctor? 4 A I saw the lochia in the middle. 5 Q Okay. What is lochia? 6 A Lochia is the small amount bleeding up to 7 normal deliver. 8 Q And okay. And what does rubra mean? 9 A Rubra, that mean red. 10 Q Okay. Is that a normal finding 11 post-delivery, that you have the lochia rubra? 12 A Yes. 13 Q Okay. Then you have underneath that, 14 "Lochia amount." What does that refer to? 15 A The amount of the bleeding -- 16 Q Okay. 17 A -- that refer to. 18 Q Okay. And it has moderate here? 19 A Yes. 20 Q Okay. Is moderate amount of lochia -- 21 lochia, is that a normal or abnormal finding 22 post-delivery? 23 A At this particular time it would be within 24 normal limit. 25 Q Okay. What does this mean underneath that, 0203 1 "Specified to large"? Do you know what that 2 means? 3 A I can see the word. 4 MR. SCHOBERT: Do you know what the 5 nurses are referring to? He's asking you 6 right there whether -- whether you know what 7 that refers to. 8 A The clot present is question mark. 9 Q I'm sorry, what? 10 A The blood -- the clot, C-L-O-T-S, clot, 11 clot. 12 MR. SCHOBERT: No, but he's asking 13 about the specified above that right there. 14 THE WITNESS: Oh, specified. 15 MR. SCHOBERT: "Too large," do you 16 know what the nurses are referring to or 17 what that refers to in that charting? 18 THE WITNESS: I'm not quite 19 understanding. 20 Q Okay. Fair enough. 21 And then when it says, "Clots present," 22 on that page 141, it says, "N." Does that mean 23 no? 24 A The question -- 25 Q When we refer to page 141 and in particular 0204 1 to the reference, "Clots present," and it has an 2 "N," that means no? 3 A I call it a question mark. She's not quite 4 sure. 5 MR. JEFFERS: I'll have an 6 objection to that. 7 MR. SCHOBERT: He's asking for what 8 he believes that means, that's all. 9 A Is my guess. 10 Q What does N mean? 11 A I didn't -- I didn't know. 12 Q You don't know. Okay. 13 In your practice do you see nurses' 14 notes which evaluate the lochia? 15 Let me rephrase the question. 16 Do you see similar nurses' notes 17 evaluating the lochia postpartum? 18 MR. SCHOBERT: He's asking you 19 generally do you see notes like this. 20 A I didn't -- I didn't see any kind of this -- 21 I didn't see any kind of this kind of note -- 22 Q Okay. 23 A -- in my practice. 24 Q Reading these notes on page 141, does this 25 reflect in any way the nurses' concern that there 0205 1 was vaginal bleeding? 2 MR. SCHOBERT: Objection. 3 Go ahead. 4 A Yes. 5 Q In what way? 6 A Because the question is clot present or not. 7 That mean sometimes bleeding not necessary just 8 gush out. Sometime can retain in the vagina or 9 retain in the uterus. 10 Q Did you in your progress note -- now I'm 11 changing the question. In your -- I'll change my 12 question. 13 In your progress note did you make any 14 reference to the fact that the patient had 15 complained of rectal vaginal pressure? 16 A No. 17 Q Why didn't you? 18 A At that time I just forgot to put it in -- 19 in the -- in the -- in the chart. 20 Q Okay. And you would agree that if you're 21 checking the patient for vaginal bleeding, a 22 complaint of rectal vaginal pressure would be a 23 significant complaint; is that correct? 24 A Not un -- unusual, especial vagina deliver. 25 Q So you're saying that if you have the 0206 1 complaint of rectal vaginal pressure, that's a 2 common finding postpartum? 3 A Not unusual when -- 4 Q Not unusual? 5 A Yes. 6 Q But you're saying that the complaint of 7 vaginal rectal pressure could be a sign of vaginal 8 bleeding? 9 A Yes. 10 Q Did you ask the patient whether or not she 11 had at that time when you saw her vaginal rectal 12 pressure? 13 A I don't recall. 14 Q If you had asked her, would you record it 15 one way or the other in your note whether she did 16 or did not have rectal vaginal pressure? 17 A If I asked, I have the answer, I will put on 18 the note. 19 Q Okay. Whether she answered yes or no, you 20 would put it in your note? 21 A The complaint I would put on the note. 22 Q Okay. Now did you give any instructions to 23 Nurse Prokop as to what to tell Dr. Hahn when she 24 called him? 25 A I didn't remember. 0207 1 Q Okay. Did you overhear the conversation 2 that Nurse Prokop had with Dr. Hahn? 3 A No. 4 MR. JEFFERS: You're now repeating 5 questions. You spent 20 pages on this 6 subject. You asked that question already. 7 We're now getting repetitious again. 8 MR. SCHOBERT: What was the 9 answer -- question -- or the answer to the 10 last question? I was -- 11 THE NOTARY: It was, "No." 12 MR. SCHOBERT: No? 13 And the question, just so I remember now 14 because I was listening -- 15 MR. JEFFERS: Instructions to 16 Prokop, no recall. 17 MR. GORDON: No, that wasn't the 18 question. 19 MR. SCHOBERT: No, that was the -- 20 that was the question before that. 21 - - - - - 22 (Whereupon, the question was read back 23 at this time.) 24 - - - - - 25 MR. SCHOBERT: That's what I 0208 1 thought it was. Okay. 2 And his answer was no. All right. 3 Q Then when the nurse had completed talking to 4 Dr. Hahn, apparently you had some conversation 5 with the nurse; is that correct? 6 A Correct. 7 Q Okay. What did Nurse Prokop say to you in 8 detail what she told Dr. Hahn? 9 MR. BONEZZI: Objection. 10 A I didn't recall what he -- what he did told 11 me, but he did told me he did get one order from 12 Dr. Hahn. 13 Q The only thing you remember today is that 14 the nurse told you that she got an order from 15 Dr. Hahn? 16 A Yes. 17 Q Okay. And what was that order? 18 A The order -- where's the orders in here? 19 MR. SCHOBERT: It says orders 20 somewhere along the side tab there. 21 It says orders somewhere. 22 Medications, medications -- 23 MR. JEFFERS: It's the bottom of 24 179, I think. 25 MR. SCHOBERT: Yeah, there, 0209 1 orders, right there. There you go. 2 A Okay. There was -- you want me to read? 3 Q No, you don't have to. 4 MR. SCHOBERT: He's asking you what 5 it is you recall the order being that the 6 nurse told you about. I think that was 7 the question. 8 Q That is the question. 9 A Yeah, they have just one order. The nurse 10 told me after she talked to Dr. Hahn, she got one 11 order from Dr. Hahn that may give Ativan, half 12 milligram IV stick, then -- and may repeat up to 13 one milligram Q eight hours, PRN. 14 Q For anxiety and restlessness? 15 A Yes. 16 Q Okay. Okay. So it's clear in your mind 17 today that the nurse told you that Dr. Hahn 18 ordered Ativan? 19 A Yes. 20 Q Okay. 21 A It is only I can remember very clear she 22 told me the order for anxiety, the medication. 23 Q Okay. Then when the nurse told you that 24 Dr. Hahn had ordered Ativan for anxiety and you 25 went in to see the patient for vaginal bleeding, 0210 1 did you have any concern at that time that the 2 patient was -- 3 A No, I -- 4 MR. SCHOBERT: Wait, let him 5 finish. 6 Q -- anxious? 7 MR. SCHOBERT: Sorry, Harley. 8 Go ahead. 9 Did you hear the whole question? 10 THE WITNESS: No. 11 MR. SCHOBERT: All right. Well, 12 then let him finish it before you answer and 13 then go ahead and repeat it. 14 Listen to her. 15 - - - - - 16 (Whereupon, the question was read back 17 at this time.) 18 - - - - - 19 MR. JEFFERS: That was it exactly. 20 MR. GORDON: I'll repeat the 21 question. 22 Q When you learned from the nurse that 23 Dr. Hahn had ordered Ativan for anxiety and you 24 had gone in to see the patient at the nurse's 25 request for vaginal bleeding, did you have any 0211 1 concern that the patient was anxious? 2 A My question here, I saw the patient first, 3 okay? And then the nurse called attending doctor 4 with the report, whatever necessary to attending, 5 and then the nurse talk to me, Dr. Hahn ordered 6 the medication Ativan for the anxiety. 7 Q Well, the question, if you knew that 8 Dr. Hahn had ordered Ativan for anxiety, okay, 9 weren't you concerned why Dr. Hahn had ordered 10 Ativan for anxiety since you had gone in just to 11 see the patient for vaginal bleeding? 12 MR. SCHOBERT: Objection. Asked 13 and answered. 14 Go ahead. 15 A Because the patient appear anxiety. The 16 nurse did not tell me anxiety, just asked me to 17 evaluation vagina bleeding. 18 Q Okay. Well, then after you learned that the 19 nurse received an order from Dr. Hahn for Ativan 20 for anxiety, didn't you ask the nurse, "Why didn't 21 you tell me that the patient was anxious?" 22 MR. SCHOBERT: Objection. I think 23 it's the same question. 24 Go ahead. 25 Asked and answered. 0212 1 Go ahead. One more time. 2 MR. GORDON: It was a different 3 question. 4 I'll -- would you repeat the question? 5 - - - - - 6 (Whereupon, the question was read back 7 at this time.) 8 - - - - - 9 MR. SCHOBERT: Objection. 10 Go ahead, Doctor. 11 A I didn't ask -- I didn't ask the nurse 12 because I checked the patient, everything is 13 stable; vital signs all right, no active bleeding. 14 That's why I didn't ask why, more question to the 15 nurse. 16 Q Well, when you saw the patient was she 17 anxious? 18 A At that -- at that time the patient just 19 restless, just not really any particular have to 20 do more, but I did. 21 Q All right. Is there any reason why you 22 didn't talk to Dr. Hahn at that time? 23 MR. SCHOBERT: I think that's been 24 asked and answered. I'll let him ask it -- 25 answer it one more time. 0213 1 Objection. 2 Go ahead. 3 A You see customarily not necessary everything 4 we have to talk to the attending. 5 Q All right. Okay. Now if indeed when you 6 saw the patient Nurse Prokop was aware of abnormal 7 lab values, would you have expected of her to tell 8 you that? 9 MR. JEFFERS: Objection. He has 10 already gone over this. 11 MR. SCHOBERT: Do you -- do you 12 understand what the question was? 13 THE WITNESS: Yes. 14 MR. SCHOBERT: I'll object. 15 You can answer. 16 A Yeah, if she know, it's nice to let -- let 17 me know what is going on. 18 Q Okay. Okay. If you had known that there 19 were abnormal lab values, including the CBC, would 20 you have had the nurse tell Dr. Hahn about that? 21 MR. SCHOBERT: I think that 22 has definitely been asked, but I'll let 23 him go one more time. 24 Objection. 25 Go ahead. 0214 1 MR. JEFFERS: I'm objecting again. 2 THE WITNESS: I did. 3 MR. SCHOBERT: You did, but that's 4 fine. I'll let him answer. 5 Go ahead. 6 THE WITNESS: You talking and I -- 7 MR. SCHOBERT: The question was if 8 you knew that, what would -- would you 9 instruct the nurse to tell Dr. Hahn. 10 A If I knew that, I will call myself or ask 11 the nurse talk to the Dr. Hahn what is the result 12 of the CBC did. 13 Q All right. Was the last time you saw the 14 patient sometime around 12:25, 12:30 a.m. on 15 June 26th -- 16 A Yes. 17 Q -- 1999? 18 A Yes, that's the last time I saw her. 19 Q Was there anyone else in the room when you 20 examined the patient other than yourself? 21 MR. SCHOBERT: At the second -- 22 second visit? 23 MR. GORDON: Right, 12:25 a.m. 24 MR. SCHOBERT: All right. 25 A With -- the nurse with me. 0215 1 Q And only the nurse? 2 A I -- if I best recall, her husband was 3 there -- 4 Q Okay. 5 A -- best I can remember. 6 Q Did you have any further contact with -- or 7 rephrase the question. Withdraw it. 8 Did you have any further involvement in 9 the care of Mary Williams after you saw her around 10 12:20, 12:25 a.m. on June 26th -- 11 A No. 12 Q -- 1999. 13 A No. No. 14 MR. SCHOBERT: Remember, let him -- 15 A The answer is no. 16 MR. SCHOBERT: Yeah, the answer is 17 no, but let him finish his question so the 18 record is clean. 19 Q Did you eventually learn that she had died? 20 A Yes. 21 Q And who did you learn that from? 22 A I don't remember. 23 Q At the time of your changeover when you 24 left -- when you were about to leave on 25 June 26, 1999, with the oncoming house physician 0216 1 for obstetrics, what did you tell that individual 2 regarding Mary Williams? 3 A I don't remember specific, but I did talk to 4 the -- to the coming house doctor. I said, "We 5 have a patient postpartum with the preeclampsia 6 under magnesium sulfate treatment and condition is 7 stable." 8 Q And when you gave that report to the 9 oncoming house physician did you look at her 10 chart, the chart of Mary Williams -- 11 A I don't -- 12 Q -- before you gave that information? 13 A Me, I didn't -- I didn't -- they didn't call 14 me. I didn't review the chart -- 15 Q Okay. 16 A -- before I talked to the next. 17 Q All right. And your changeover would have 18 been 7:00 to 7:30 the following morning? 19 A Yeah, 7:00 in the morning, 7:00, exactly 20 7:00 o'clock. 7:00 a.m. 21 Q But how long does the changeover report take 22 typically? 23 A How long it take? 24 Q Yes. 25 A Typically depend upon -- usually maybe 15, 0217 1 20 minutes. 2 Q When you told the house officer who was 3 going on duty at 7:00 a.m. that the patient was 4 stable, where did you obtain that information? 5 A That was from the last time I saw the 6 patient because I was not called again from the 7 nurse. 8 MR. GORDON: That's all I have. 9 MR. BONEZZI: I have no questions. 10 MR. SCHOBERT: Doctor, you're 11 done. 12 You have the right to review this 13 transcript. We've sort of been following 14 the rule of having 30 days. 15 Harley, can I have the rule of 30 days 16 in lieu of the -- you know, filing? 17 MR. GORDON: Yes, you can. Yes. 18 MR. SCHOBERT: Just indicate to the 19 court reporter you want to review the 20 transcript. Just tell her that. 21 THE WITNESS: Yeah, I want to 22 review the transcript. 23 MR. GORDON: How about review of 24 the video? 25 MR. SCHOBERT: No. I would like a 0218 1 copy of it, but we'll waive reviewing it. 2 And you can file it. You have my right 3 to file it if that's what you want to do. 4 THE VIDEOGRAPHER: You waive the 5 one-day filing requirement? 6 MR. SCHOBERT: Yes. 7 THE VIDEOGRAPHER: Thank you. 8 So you would want a copy of the video, 9 too? 10 MR. SCHOBERT: Yes. 11 - - - - - 12 (Whereupon, deposition was concluded at 13 11:00 a.m. and signature was not waived at 14 this time.) 15 - - - - - 16 17 ___________________ 18 Tung-Chang Hsieh, M.D. 19 - - - - - 20 21 22 23 24 25 0219 1 CERTIFICATE 2 3 The State of Ohio, ) 4 ) SS: 5 County of Cuyahoga. ) 6 7 I, Suzanne Lamparter, a Notary Public within 8 and for the State of Ohio, duly commissioned and 9 qualified, do hereby certify that the within-named 10 witness, TUNG-CHANG HSIEH, M.D., was by me first 11 duly sworn to testify the truth, the whole truth, 12 and nothing but the truth in the cause aforesaid; 13 that the testimony then given by the 14 above-referenced witness was by me reduced to 15 stenotype in the presence of said witness, 16 afterward transcribed, and that the foregoing is a 17 true and correct transcription of the testimony so 18 given by the above-referenced witness. 19 I do further certify that this deposition 20 was taken at the time and place in the foregoing 21 caption specified. 22 I do further certify that I am not a 23 relative, counsel, or attorney of either party, or 24 otherwise interested in the event of this action. 25 IN WITNESS WHEREOF, I have hereunto set my 0220 1 hand and affixed my seal of office at Cleveland, 2 Ohio, on this 1st day of February, A.D., 2001. 3 4 5 _________________________________________ 6 Suzanne Lamparter, Notary Public in and 7 for the State of Ohio. 8 My commission expires November 30, 2002. 9 - - - - - 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25