1 1 The State of Ohio, ) 2 ) SS: 3 County of Cuyahoga. ) 4 IN THE COURT OF COMMON PLEAS 5 MARK WILLIAMS, ETC., ) 6 Plaintiffs, ) 7 -vs- ) Case No. 8 PARMA COMMUNITY GENERAL ) 406184 9 HOSPITAL, ET AL., ) 10 Defendants. ) 11 _ _ _ _ _ 12 Deposition of TUNG-CHANG HSIEH, M.D., a 13 witness herein, called by the Plaintiffs as 14 if upon cross-examination under the statute, 15 and taken before Luann Z. Cawley, RPR, a 16 Notary Public within and for the State of 17 Ohio, pursuant to the agreement of counsel, 18 and pursuant to the further stipulations of 19 counsel herein contained, on Friday, the 1st 20 day of December, 2000, at 10:00 a.m., at the 21 law offices of Nurenberg, Plevin, Heller & 22 McCarthy, 1370 Ontario Street, Suite 100, 23 City of Cleveland, County of Cuyahoga and 24 the State of Ohio. 25 _ _ _ _ _ 2 1 APPEARANCES: 2 3 On behalf of the Plaintiffs: Nurenberg, Plevin, Heller & 4 McCarthy, by: Harlan M. Gordon, Esq. 5 David M. Paris, Esq. 6 7 On behalf of Defendant Physician Staffing, Inc.: 8 Hanna, Campbell & Powell, by: Jeffrey E. Schobert, Esq. 9 On behalf of Defendant Parma Community 10 Hospital: Weston, Hurd, Fallon, Paisley & 11 Howley, by: John W. Jeffers, Esq. 12 On behalf of Defendants William K. 13 Hahn, Jr., M.D. and Women & Wellness Center: 14 Bonezzi, Switzer, Murphy & Polito, by: 15 Susan M. Reinker, Esq. _ _ _ _ _ 16 17 ALSO PRESENT: 18 A. David Tackla, videographer. 19 _ _ _ _ _ 20 21 22 23 24 25 3 1 I N D E X 2 OBJECTION BY: PAGE LINE 3 MR. SCHOBERT 11 12 4 MR. JEFFERS 15 19 5 MR. JEFFERS 17 25 6 MR. SCHOBERT 18 1 7 MR. SCHOBERT 18 17 8 MR. JEFFERS 19 20 9 MR. SCHOBERT 20 12 10 MR. SCHOBERT 22 14 11 MR. JEFFERS 22 17 12 MR. JEFFERS 23 11 13 MR. SCHOBERT 24 17 14 MR. SCHOBERT 29 13 15 MR. SCHOBERT 29 17 16 MR. SCHOBERT 31 16 17 MR. SCHOBERT 31 23 18 MR. SCHOBERT 32 25 19 MR. SCHOBERT 34 9 20 MR. JEFFERS 36 4 21 MR. SCHOBERT 40 4 22 MR. SCHOBERT 40 21 23 MR. SCHOBERT 41 20 24 MR. JEFFERS 42 9 25 4 1 I N D E X 2 OBJECTION BY: PAGE LINE 3 MR. SCHOBERT 42 10 4 MR. JEFFERS 42 11 5 MR. SCHOBERT 45 14 6 MR. SCHOBERT 47 3 7 MR. SCHOBERT 47 11 8 MR. SCHOBERT 47 14 9 MR. JEFFERS 47 17 10 MR. JEFFERS 47 22 11 MR. SCHOBERT 48 3 12 MR. SCHOBERT 48 22 13 MR. SCHOBERT 51 1 14 MR. SCHOBERT 52 2 15 MS. REINKER 53 16 16 MR. SCHOBERT 56 20 17 MR. SCHOBERT 59 23 18 MR. SCHOBERT 60 5 19 MR. SCHOBERT 67 21 20 MR. SCHOBERT 68 3 21 MR. SCHOBERT 69 21 22 MR. SCHOBERT 70 1 23 MR. JEFFERS 70 9 24 MR. SCHOBERT 70 10 25 MS. REINKER 70 11 5 1 I N D E X 2 OBJECTION BY: PAGE LINE 3 MR. SCHOBERT 70 17 4 MR. JEFFERS 71 3 5 MS. REINKER 71 4 6 MR. SCHOBERT 71 5 7 MR. JEFFERS 71 7 8 MR. SCHOBERT 71 13 9 MS. REINKER 71 14 10 MR. SCHOBERT 96 5 11 MS. REINKER 97 13 12 MR. SCHOBERT 97 14 13 MR. SCHOBERT 104 25 14 MR. SCHOBERT 111 18 15 MR. SCHOBERT 112 7 16 MR. JEFFERS 113 6 17 MR. SCHOBERT 113 18 18 MR. SCHOBERT 114 5 19 MR. SCHOBERT 114 17 20 MR. SCHOBERT 115 5 21 MR. SCHOBERT 117 1 22 MR. SCHOBERT 117 22 23 MR. SCHOBERT 118 9 24 MR. SCHOBERT 121 23 25 MR. SCHOBERT 131 22 6 1 I N D E X 2 OBJECTION BY: PAGE LINE 3 MR. SCHOBERT 137 6 4 MR. SCHOBERT 145 8 5 MR. SCHOBERT 145 17 6 MR. JEFFERS 145 25 7 MR. SCHOBERT 146 1 8 MR. SCHOBERT 152 10 9 MR. SCHOBERT 153 1 10 MR. SCHOBERT 154 16 11 MR. JEFFERS 154 17 12 MR. SCHOBERT 156 11 13 MR. SCHOBERT 156 18 14 MR. SCHOBERT 157 6 15 MR. SCHOBERT 157 11 16 MR. SCHOBERT 157 24 17 MR. SCHOBERT 158 8 18 MR. SCHOBERT 159 7 19 MS. REINKER 159 8 20 MR. SCHOBERT 163 3 21 MR. SCHOBERT 167 19 22 MR. SCHOBERT 168 6 23 MR. JEFFERS 168 7 24 MR. JEFFERS 168 23 25 MR. JEFFERS 169 2 7 1 I N D E X 2 OBJECTION BY: PAGE LINE 3 MR. SCHOBERT 169 3 4 MR. JEFFERS 169 24 5 MR. SCHOBERT 169 25 6 MR. SCHOBERT 171 5 7 MS. REINKER 171 15 8 MR. SCHOBERT 171 16 9 MR. SCHOBERT 172 2 10 MS. REINKER 172 3 11 MR. SCHOBERT 172 11 12 MS. REINKER 172 14 13 MR. SCHOBERT 172 25 14 MR. JEFFERS 173 2 15 MR. SCHOBERT 173 8 16 MR. SCHOBERT 174 22 17 MS. REINKER 174 24 18 MR. SCHOBERT 175 7 19 MR. SCHOBERT 175 10 20 MR. JEFFERS 175 11 21 MR. JEFFERS 175 14 22 MR. SCHOBERT 176 2 23 MR. SCHOBERT 176 13 24 MR. JEFFERS 179 5 25 8 1 P R O C E E D I N G S 2 _ _ _ _ _ 3 TUNG-CHANG HSIEH, M.D., a 4 witness herein, being of lawful age, 5 having been first duly sworn according 6 to law, deposes and says as follows: 7 _ _ _ _ _ 8 MR. GORDON: Good morning, 9 Dr. Hsieh. My name's Harlan Gordon. 10 Seated next to me is my partner David 11 Paris. We represent the estate of Mary 12 Williams in this matter. This morning 13 I'm gonna ask you questions regarding 14 your involvement in the care and 15 treatment of Mary Williams at Parma 16 General Community Hospital. During the 17 course of my questioning, Doctor, 18 please make sure you understand the 19 question before you answer it; do you 20 understand that, sir? 21 THE WITNESS: (Witness 22 nodding head.) 23 MR. GORDON: You have to 24 answer, also -- 25 THE WITNESS: Yes, yes. 9 1 MR. GORDON: Like you did, 2 you have to answer out loud; okay. 3 THE WITNESS: Yes. 4 MR. GORDON: If, for 5 whatever reason, you don't understand 6 my question, please don't answer it. 7 Tell me to rephrase it or define a 8 term; do you understand that, sir? 9 THE WITNESS: Yes. 10 MR. GORDON: If you want to 11 take a break, for whatever reason, 12 please stop me and we'll take a break; 13 do you understand that, sir? 14 THE WITNESS: Yes. 15 CROSS-EXAMINATION OF 16 TUNG-CHANG HSIEH, M.D. 17 BY MR. GORDON: 18 Q Okay. First of all, I'd like to go 19 into your background. And we'd begin with, 20 of course, is your full name and home 21 address. 22 A My last name is Hsieh, H-S-I-E-H. 23 First name, T-U-N-G, hyphen, C-H-A-N-G. 24 Q And how do you pronounce that? 25 A Hsieh. 10 1 Q No, your first name. 2 A Tung-Chang. 3 Q What is your address at the present 4 time? 5 A 6871 Ames Road, A-M-E-S, R-O-A-D, Road, 6 Apartment 721, Parma, Ohio 44129. 7 Q Did you live at that Ames Road address 8 in 1999? 9 A Yes. 10 Q What is your business address? 11 A I don't have. 12 Q Dr. Hsieh, Mr. Schobert provided us 13 with a copy of your resume, or curriculum 14 vitae, which I have marked as Exhibit 1. 15 I'm handing it to you right now. Is Exhibit 16 1 a -- a copy of your curriculum vitae or 17 resume? 18 MR. SCHOBERT: He wants to 19 know if that -- that's a copy. 20 A Yes, it's a copy. 21 Q Okay. Are the statements and facts 22 contained in Exhibit 1 true and correct, to 23 the best of your knowledge? 24 A Yes. 25 Q Are there any corrections or 11 1 modifications you -- that you would like to 2 make to Exhibit 1, at the present time, to 3 make it current and up-to-date? 4 A No. You see, I working for the last 5 one up-to-date. I work for Physician 6 Staffing up to today still working. 7 Q Okay. But we'll -- we'll get into 8 that. But your curriculum vitae, Exhibit 1, 9 indicates that from, approximately, early 10 1991 until today you have worked for 11 Physician Staffing, Inc.; is that correct? 12 MR. SCHOBERT: Objection to 13 the, "working for," but go ahead, 14 Doctor. You can answer the question. 15 A Yes, I work for Physician Staffing. 16 Q During that time frame? 17 A From 1991 until today. 18 Q Okay. I'm gonna get back to that 19 shortly, but I wanted to go into further 20 areas of your background. You were born in 21 1939? 22 A Yes. 23 Q What's your date of birth? 24 A May 4. 25 Q And where were you born? 12 1 A China. 2 Q Mainland China or Taiwan? 3 A Mainland China. 4 Q Okay. And then, let's see, are you 5 married? 6 A Yes. 7 Q And -- 8 A Remarried. 9 Q Pardon? 10 A Remarried. 11 Q Okay. Is your wife in the medical 12 profession? 13 A Nurse. 14 Q She is a nurse? 15 A Yeah. 16 Q And where is she a nurse? 17 A Out of state, New York State. 18 Q Okay. Are you still married -- what's 19 your wife's name? 20 A Blin. 21 Q Okay. Are you still married to Blin? 22 A Yeah. 23 Q Do you have any children? 24 A No. 25 Q What's your Social Security number, 13 1 please? 2 MR. SCHOBERT: Can we do that 3 off the record? I'll have give it -- 4 have him give it to you? 5 MR. GORDON: Yes, that's 6 okay. 7 MR. SCHOBERT: Doctor -- 8 MR. PARIS: Off the -- 9 MR. SCHOBERT: You want to go 10 off it now, or we can just give it to 11 you after? Here, just put it on a 12 piece of paper right here, write your 13 Social Security number down and give to 14 it Mr. Gordon. 15 THE WITNESS: (Witness 16 indicating.) 17 MR. SCHOBERT: All right. Go 18 ahead. 19 BY MR. GORDON: 20 Q Now, you were, first of all, educated 21 in Indonesia? 22 A When I was high school, yes. 23 Q Okay. And then, after that, you 24 received your medical education and training 25 in Taipei, Taiwan; is that correct? 14 1 A Yes. 2 Q And you graduated with a Bachelor of 3 Medicine in March of 1968? 4 A Yes. 5 Q Then, also, in Taiwan you -- you had a 6 rotating internship, then later a chest 7 medicine residency in Taiwan until April of 8 1971? 9 A Yes. 10 Q Then you came to the United States? 11 A Yes. 12 Q Why did you come to the United States? 13 A Say that again. 14 Q Why did you come to the United States? 15 A Come for more training. 16 Q Then in the United States you had a 17 rotating intern -- internship at Fairview 18 General Hospital from July '71 through June 19 of 1972? 20 A Yes. 21 Q Then you began an OB/G -- an OB/GYN 22 residency, or a residency in obstet -- 23 obstetrics and gynecology at -- at Fairview 24 General Hospital and the Cleveland Clinic 25 from July of 1972 through June of 1975? 15 1 A Yes. 2 Q Now let me stop there. Are you 3 presently board certified in obstetrics and 4 gynecology? 5 A Yes. 6 Q And you were board certified in 1981; 7 is that correct? 8 A Yes. 9 Q Your CV indicates that you passed the 10 written portion of the exam for the American 11 Board of Obstetrics and Gynecology in June 12 of 1976; is that correct? 13 A Yes. 14 Q And then did you fail or -- 15 A No. 16 Q -- the oral portion of the exam at that 17 time? 18 A No, I didn't. 19 MR. JEFFERS: Objection. Go 20 ahead. 21 BY MR. GORDON: 22 Q Pardon? 23 A Just one time I pass. Your question -- 24 Q Did you ever fail the oral portion of 25 the exam? 16 1 A No. 2 Q Okay. Then you passed the oral exam 3 portion of the American Board of 4 Obstetricians and Gynecologists in 1981? 5 A Yes. 6 Q Why did you wait five years to complete 7 the certification with the American Board of 8 Obstetrics and Gynecology? 9 A At that time I was working as a house 10 physician. Also, I'm quite busy in try to 11 find a job. 12 Q Are you board certified in any other 13 areas? 14 A No. 15 Q Do you have to be recertified in 16 obstetric -- obstetrics and gynecology? 17 A No. 18 Q Now, going back to your career now, you 19 were a resident house physician at Marymount 20 Hospital here in Cleveland; is that correct? 21 A Yes. 22 Q You initially were a house -- the 23 resident house physician from August of 1975 24 to October of 1977, and what did you do as a 25 resident house physician at that time? 17 1 A Same thing. Just do the job when they 2 need me, call me. 3 Q Did you care for patients not only in 4 obstetrics and gynecology, but in other 5 areas of medicine during that time frame? 6 A No, just OB/GYN patient. 7 Q Okay. Then there was a break in your 8 service as a resident house physician at 9 Marymount and you began private practice as 10 an obstetrician and gynecologist at Fayette 11 County Memorial Hospital in Washington Court 12 House, Ohio? 13 A Yes. 14 Q And did you -- and you had a private 15 practice? 16 A Yeah, at that time. 17 Q Okay. And you did -- you had your 18 private practice until April of '91? 19 A Yeah. 20 Q And why did you leave the private 21 practice? 22 A Because I want to change my life. 23 Q In what way? 24 A Just -- 25 MR. JEFFERS: Object. 18 1 MR. SCHOBERT: Objection. Go 2 ahead. 3 A Just working in a hospital. 4 Q Do you like the hospital setting? 5 A No. I'm just work for the house 6 physician. More on my own time. 7 Q Okay. While you're in the private 8 practice of obstetrics and gynecology, in 9 1979 you also worked as a resident house 10 physician at Marymount Hospital? 11 A That was just a couple month and then I 12 return to -- to practice. 13 Q Okay. Then that brings us up to your 14 working for Physician Staffing, Inc.; is 15 that correct? 16 A Yes. 17 MR. SCHOBERT: Objection, 18 again, to working for them. Go ahead. 19 BY MR. GORDON: 20 Q Do you have any specialization in the 21 area of obstetrics and gynecology? 22 A Ask question again. 23 Q Do you have any specialization in the 24 area of obstetrics and gynecology? 25 A I'm board certified obstetrician. 19 1 Q Do you have any special interests in 2 the area of obstetrics and gynecology? 3 A (Witness shaking head.) 4 MR. SCHOBERT: He didn't 5 verbalize that answer, did he? You've 6 got -- even though you're on the 7 video, you need to, for the court 8 reporter, verbalize it and say no. 9 A No. 10 Q In 1999 were you licensed to practice 11 medicine in the State of Ohio? 12 A Yes. 13 Q When did you first obtain your license 14 to practice medicine in the State of Ohio; 15 is that February of 1975? 16 A Yes. 17 Q Has your -- excuse me -- license to 18 practice medicine ever been revoked or 19 suspended for any reason? 20 MR. JEFFERS: Object to that. 21 A No. 22 Q Are you a member of any professional 23 associations? 24 A Yes. 25 Q What professional associations are you 20 1 a member of? 2 A ACOG. 3 Q ACOG? 4 A Yeah. 5 Q That's the American College of 6 Obstetrics and Gynecology? 7 A Yes. 8 Q Do you read their publications? 9 A What's the question? 10 Q I -- is it correct you read their 11 publications from ACOG? 12 MR. SCHOBERT: Objection. Go 13 ahead. 14 A Yes. 15 Q Have you ever taught in the area of 16 medicine? 17 A Question again? 18 Q Have you ever taught in the area of 19 medicine? 20 A I'm not quite understand your question. 21 Q Okay. From my experience, when you're 22 a chief resident you teach the junior 23 residents and interns; is that correct? 24 A During the training, yes. 25 Q Okay. Do you hold any academic 21 1 appointment with any institution? 2 A No. 3 Q Have you? 4 A No. 5 Q Have you published any articles? 6 A No. 7 Q In 1999 you had privileges at Parma 8 Community General Hospital to practice 9 obstetrics and gynecology; is that correct? 10 A Not private practice. Just privilege 11 working as a house officer. 12 Q In the area of obstetrics and 13 gynecology -- 14 A Yes. 15 Q -- is that correct? 16 A Yes. 17 Q And were your privileges limited to 18 working as a house officer in obstetrics and 19 gynecology? 20 A No. 21 Q You could do other things at Parma? 22 A No. We just -- according to the 23 contract, we just under the supervise of the 24 attending doctor. 25 Q The question was directed to, 22 1 specifically, other than practicing as a 2 house officer in obstetrics and gynecology. 3 Could you practice in any other area at 4 Parma General Community Hospital? 5 A No. 6 Q Did you have privileges at any other 7 hospitals other than Parma Community General 8 Hospital in 1999? 9 A No. 10 Q Between 1991, and let's say July of 11 1999, what other hospitals did you work at 12 for Physician Staffing, Inc., other than 13 Parma General Community Hospital? 14 MR. SCHOBERT: Objection to 15 "working for." Go ahead, Doctor. 16 A I don't recall. 17 MR. JEFFERS: Can we have 18 a -- a standing objection for Jeff on 19 that issue of the legal theory of who 20 he's working for and then we -- he 21 won't have to interrupt you? 22 MR. GORDON: I would ask, 23 Jeff, Mr. Schobert, if you don't like 24 the word, "work," what would you 25 propose? 23 1 MR. SCHOBERT: Well, 2 according to the contracts you've been 3 provided, at least on paper, the 4 relationship is, he's an independent 5 contractor with Physician Staffing, who 6 maintains a contract with Parma 7 Hospital to provide independent 8 contracting physicians for house 9 officer positions. That's what the 10 contracts you were provided indicate. 11 MR. JEFFERS: So you're 12 gonna give us a standing objection over 13 the whole thing? 14 MR. GORDON: Yeah, I would 15 do that, but he still hasn't answered 16 what other word we're -- 17 BY MR. GORDON: 18 Q Okay. Has your privileges at Parma 19 Community General Hospital ever been revoked 20 or suspended for whatever reason? 21 A No. 22 Q Has you -- have you ever consulted as 23 an expert in a medical malpractice case? 24 A No. 25 Q Have you ever testified -- 24 1 A No. 2 Q -- before -- 3 MR. SCHOBERT: Wait, wait. 4 Let him finish -- let him finish the 5 question. 6 BY MR. GORDON: 7 Q Have you -- 8 MR. SCHOBERT: It'll make 9 things go better. Go ahead. 10 BY MR. GORDON: 11 Q Working for Physician Staffing, Inc., 12 have you ever testified before in a 13 deposition or any other matter? 14 A Deposition, yes, I have been. 15 Q Okay. And did that case involve a 16 claim of medical malpractice? 17 A Yes. 18 MR. SCHOBERT: Objection. Go 19 ahead. 20 MR. GORDON: Could we take 21 a continuing objection? 22 MR. SCHOBERT: Yeah, that's 23 fine. 24 MR. JEFFERS: I'll take one, 25 too. 25 1 MR. GORDON: All right. 2 MR. SCHOBERT: Okay. Go 3 ahead then. 4 BY MR. GORDON: 5 Q With respect to that matter, where did 6 that case arise from; is that from Parma 7 Community General Hospital? 8 A I -- I was just testify. I was not 9 being sued. 10 Q Okay. You were a witness? 11 MR. JEFFERS: Right. 12 MR. SCHOBERT: Right. 13 A Yeah. 14 Q Okay. And do you know the name of that 15 case? 16 A No, I don't remember. 17 MR. JEFFERS: It was a long 18 time ago, apparently. 19 BY MR. GORDON: 20 Q Do you -- and do you know what the 21 claim of medical malpractice was in this 22 case? 23 A I could not remember -- recall. 24 Q Was Dr. Hahn involved in that case? 25 A I don't think so. 26 1 MR. JEFFERS: He was not. 2 MR. SCHOBERT: Before my 3 time, so I don't know the answer 4 either. 5 MR. JEFFERS: I go back 33 6 years and -- 7 BY MR. GORDON: 8 Q So in your whole life you've give -- 9 only given one deposition? 10 A No. 11 Q You gave a deposition in another 12 matter? 13 A I don't remember. I have been 14 deposition, but I do not remember when. 15 Q Was that in a medical malpractice case? 16 A Yes. 17 Q Was that medical malpractice case, did 18 that involve any claim of medical 19 malpractice against you? 20 A Yes. 21 Q Okay. And when was that case? 22 A A long time ago. I don't remember. 23 Q Was that before or after you started 24 working for Physician Staffing, Inc.? 25 A Before that. Long time ago. 27 1 Q Okay. In Ohio? 2 A In Ohio. 3 MR. SCHOBERT: There's some 4 reference to that, Harley, in the 5 interrogatory answers. 6 MR. GORDON: Huh? 7 MR. SCHOBERT: There's some 8 reference to that in the interrogatory 9 answers. 10 BY MR. GORDON: 11 Q Okay. And other than -- you've talked 12 about two other time you've been deposed, is 13 there any other times you've ever -- ever 14 been deposed in your life? 15 A What's the question? 16 Q You've told us that you have now been, 17 up to today, deposed twice before in your 18 life. Is there any other times you've ever 19 been deposed? 20 A Deposition, you mean? 21 Q Yes. 22 A Oh. Let -- I don't remember. This is 23 long time ago. 24 Q Okay. Can I assume then, because 25 you've been involved in the deposition 28 1 process before, you're somewhat familiar 2 with the process? 3 A It's a long time. You just cannot 4 remember it. 5 MR. SCHOBERT: His question 6 was more general. That since you've 7 been deposed at least twice -- 8 THE WITNESS: Yeah. 9 MR. SCHOBERT: -- do you 10 understand the process? 11 A Yeah, I do. 12 Q Okay. Have you ever been represented 13 by Mr. Schobert before -- 14 A No. 15 Q -- today, other than in this 16 litigation? 17 A No. 18 Q Okay. Have you ever been represented 19 by the law firm of Weston & Hurd in 20 Cleveland, Ohio? 21 A No. 22 Q Now, in your practice do you refer, 23 from time to time, to any publications, be 24 they text -- textbooks or periodicals? 25 A No. 29 1 Q Have you heard of "Williams On 2 Obstetrics"? 3 A Yes. 4 Q Do you ever read "Williams On 5 Obstetrics"? 6 A Yes. 7 Q Do you consider Williams a reliable 8 authority in the -- in the area of 9 obstetrics? 10 A One of reference of many. 11 Q So does that mean you do consider 12 Williams a reliable authority in -- in 13 obstetrics? 14 MR. SCHOBERT: Objection. Go 15 ahead, Doctor. 16 A One -- one of the reference. 17 Q The reference being what? 18 MR. SCHOBERT: Objection. Go 19 ahead. 20 A Refer to reference for the -- for the 21 -- for the treatment of the obstetrician 22 patient. 23 Q Dr. Hsieh, I'm handing you what has 24 been marked Exhibit 2. Is Exhibit 2 your 25 agreement with Physician Staffing, Inc. 30 1 which covers the period of the time you were 2 involved in the care of Mary Williams in 3 June of 1999? 4 MR. SCHOBERT: Take a look, 5 make sure. I don't know how many 6 agreements you've signed with them, but 7 just double-check. That's what was 8 provided to us. 9 MR. JEFFERS: Jeff, was that 10 part of the Interrogatory -- Answers to 11 Interrogatories? 12 MR. SCHOBERT: Yeah, we 13 provided it, I think, with production 14 requests. 15 MR. JEFFERS: All right. 16 THE WITNESS: Yeah, here. 17 MR. SCHOBERT: Well, then 18 tell them yes. That's fine. 19 A Yes. 20 MR. JEFFERS: You don't have 21 an extra one, do you, Harlan? I don't 22 see it on the back of mine of Dr. 23 Hsieh's response. Would you send me 24 one eventually -- 25 MR. GORDON: Yeah. 31 1 MR. JEFFERS: -- please? 2 MS. REINKER: I didn't see 3 it in my file. 4 MR. SCHOBERT: We'll yell at 5 Janice. 6 MS. REINKER: Okay. 7 MR. SCHOBERT: All right. 8 I'll send those. Send Exhibit 2. 9 BY MR. GORDON: 10 Q Now let's talk a little bit about 11 Physician Staffing, Inc. First of all, 12 where are they located? 13 A I don't remember the -- the -- the 14 address of Physician Staffing. 15 Q Okay. Do you know who the owner of 16 Physician Staffing, Inc. is? 17 MR. SCHOBERT: Objection. Go 18 ahead. 19 A I don't know, but I just saw the signed 20 contract is John S. Martin, III. 21 Q Okay. Have you met -- have you ever met 22 any individual in your close to nine-year 23 career with Physician Staffing, Inc.? 24 MR. SCHOBERT: Objection. Go 25 ahead. 32 1 A No, I didn't. I just working. No. 2 Q You're telling me that -- that in this 3 time frame that you've been working for 4 Physician Staffing, Inc., from April 1st, 5 1991 -- 6 A One. 7 Q -- 1991 -- 8 A Yeah. 9 Q -- to the present you've never 10 personally met anybody from Physician 11 Staffing, Inc.? 12 A Oh, yes. I just -- just -- just meet a 13 couple time John Martin, III. 14 Q Okay. 15 A And then the rest official. 16 Q Who? 17 A Official, like Lisa. 18 Q And who's Lisa? 19 A Lisa Baker, the secretary. 20 Q Okay. Is Mr. -- is Mr. Martin a 21 physician? 22 A As far as -- I don't know. As far as I 23 know, he's not. 24 Q Do you know what the nature of the 25 business of Physician Staffing, Inc. is? 33 1 MR. SCHOBERT: Objection. Go 2 ahead. 3 A I don't know. Just -- I don't know. 4 Just working as a physician for -- for them, 5 put on schedule. What is their business, I 6 don't know. 7 Q Okay. And you receive your paychecks 8 from Physician Staffing, Inc.? 9 A Yes. 10 Q In terms of your paycheck, do they take 11 out Social Security from your paycheck? 12 A No. 13 Q You pay it yourself? 14 A Yes. 15 Q What benefits, generally, do you 16 receive from Physician Staffing, Inc.? 17 A Just pay by hour. 18 Q How much do you get paid per hour? 19 A Right now, $50 an hour. Oh, I -- I 20 take back, $50.50 an hour now. 21 Q Do you get a bonus at the end of the 22 year? 23 A No. 24 Q Okay. In terms of your schedule, from 25 whom do you receive your schedule for hours 34 1 to work at Parma Community General Hospital? 2 A From Physician Staffing. 3 Q And they tell you through the schedule 4 what hours you're supposed to work? 5 A Yes. 6 Q Okay. Did Physician Staffing, Inc. 7 provide you with any written materials 8 regarding how to treat certain conditions in 9 the area of obstetrics and gynecology? 10 MR. SCHOBERT: Objection. Go 11 ahead. 12 A No. Just the agreement -- the 13 agreement, what -- what supposed to do. 14 Q Now, I'm gonna hand you Exhibit 3, 15 which is a document referring to the duties 16 of a house physician. Therefore, in that 17 regard, with respect to Exhibit 3, have you 18 ever seen this document before? 19 A Yes. 20 Q And as of June of 1999, you knew that 21 the duties that are described in Exhibit 3 22 would the -- would be the duties that you 23 would be charged with as a house physician 24 at Parma General Community Hospital; is that 25 correct? 35 1 A That day I work, I was scheduled and 2 working. 3 MR. SCHOBERT: Well, I don't 4 think that -- better repeat your 5 question. 6 THE WITNESS: Question. 7 BY MR. GORDON: 8 Q All right. 9 A Repeat question. 10 Q Yeah. With respect to Exhibit 3, which 11 lists your duties as a house physician; am I 12 correct? 13 A Yes. 14 Q Okay. And you were aware that all of 15 -- you were -- strike that. 16 You were aware, before June of 17 1999, of these duties that are indicated in 18 Exhibit 3? 19 A Yes. 20 Q Okay. And who provided you Exhibit 3, 21 was it Physician Staffing, Inc., or was it 22 Parma General Community Hospital, or someone 23 else? 24 A The hospital. 25 Q Okay. Is Exhibit 3, then, a document 36 1 prepared by someone at Parma General 2 Community Hospital, to the best of your 3 knowledge? 4 A I don't know. 5 MR. JEFFERS: Or -- 6 objection. Or it could have been 7 prepared by medical -- the person in 8 charge of the medical staff and -- 9 A I don't know. 10 MR. JEFFERS: -- OB/GYN. 11 MR. SCHOBERT: He's answered 12 the question. 13 MR. JEFFERS: He didn't 14 know. 15 MR. SCHOBERT: He didn't know 16 who provided it. 17 BY MR. GORDON: 18 Q All right. Now, as part as your -- 19 part as -- strike that. 20 As part of your duties as a house 21 physician in obstetrics and gynecology did 22 you deliver babies? 23 A When emergency. 24 Q Okay. As part of your duties as house 25 physician in obstetrics and gynecology did 37 1 you participate in the delivery of babies? 2 A No. When they need it, they call. 3 Q Okay. So if you were called, you were 4 the physician in charge of the delivery? 5 A I'm not in charge. When I -- when they 6 need the emergency doctor and then they call 7 house physician to take care until the 8 attending doctor arrival. 9 Q Okay. And if the attending doctor is 10 not present when the baby is delivered, you 11 deliver the baby? 12 A Yes. 13 Q Okay. In a yearly period how 14 frequently, on average, do you participate 15 in a delivery? 16 MR. SCHOBERT: Objection. 17 A I couldn't remember. 18 Q Okay. Now, in Exhibit 3, one of the 19 things, as of June of 1999, you were 20 responsible or -- for was to take histories, 21 do physical exams, admission notes, and 22 orders where necessary on all 23 obstetric/gynecology admissions; is that 24 correct? 25 A I didn't do the admission for this 38 1 patient. 2 MR. SCHOBERT: But he wants 3 to know in general. 4 A In general, yes, I am -- my 5 responsibility, when the patient come in, we 6 did a physical and history. 7 Q Okay. And with respect to Mary 8 Williams, you did not do the admitting 9 physical and history; is that correct? 10 A No. 11 Q Another of your responsibilities was to 12 make rounds on all assigned units; is that 13 correct? 14 MR. JEFFERS: Which one are 15 you reading from? 16 MR. SCHOBERT: No. 2. 17 MR. JEFFERS: Okay. 18 A According to that, is assignment -- 19 assignment unit. 20 Q Where are they referring to -- I mean, 21 you agree with that, that was one of your 22 duties in June of 1999; is that correct? 23 A Yeah. 24 Q What is an assigned unit? 25 A When they need you, they call you in. 39 1 Q And that would be in obstetrics and 2 gynecology? 3 A Yes. 4 Q The labor and delivery floor at Parma 5 General Community Hospital was located on 6 what floor or floors? 7 A Third floor. 8 Q The third floor? 9 A Yeah. 10 Q And did you see obstetrics and 11 gynecology patients in areas other than the 12 third floor? 13 A No, because -- and I take it back. Of 14 newborn, with the newborn nursery. 15 Q And where's the nursery, what floor? 16 A Third floor. 17 Q Okay. And Mary Williams was on the 18 third floor? 19 A Yes. 20 Q Another one of your duties as of June 21 of 1999 was to respond to calls from 22 assigned areas and take appropriate action; 23 is that correct? 24 A Yes. 25 Q And you understood this to mean that, 40 1 when you were called to an assigned area, 2 you would take a history from the patient, 3 do a physical exam, and make treatment 4 decisions; is that correct? 5 MR. SCHOBERT: Objection. Go 6 ahead. 7 A For the admission. When the patient 8 come admission, our duty is do the history 9 and physical for the patient. 10 Q All right. When you were called to an 11 assigned area for a issue regarding an 12 obstetric/gynecological patient, you made 13 treatment decisions regarding that patient; 14 is that correct? 15 A We -- right -- except emergency. 16 Otherwise we have to through the attending 17 doctor to get the order. 18 Q So you're saying, when you're -- go to 19 an assigned area, you yourself, as the 20 obstetrician/gynecologist, make some 21 diagnoses of the condition; is that correct? 22 MR. SCHOBERT: Objection. Go 23 ahead. 24 A Yes. 25 Q Okay. And then, with those diagnoses, 41 1 you consult with the attending physician? 2 A Yes. 3 Q And then the attending physician, or 4 the attending obstetrician or gynecologist 5 tells you what to do? 6 A Yes, the order. 7 Q Now, can you, without the approval of 8 an obstetrician/gynecologist, issue orders? 9 A For emergency. Like a emergency. 10 Q Where do you believe that only in 11 emergencies you can issue orders? 12 A Usually we -- we -- our responsibility 13 is manage emergency. 14 Q Okay. But when we go back to what it 15 says in your duties here, "Respond to calls 16 from assigned areas and take appropriate 17 action," doesn't this mean that you can 18 issue orders by yourself when it says, 19 "appropriate action"? 20 A That is -- 21 MR. SCHOBERT: Objection. 22 He's answered that question. 23 A Emergency -- 24 MR. SCHOBERT: Now you're 25 playing word games. 42 1 BY MR. GORDON: 2 Q Pardon? 3 A Emergency, we would manage that. 4 Q So your -- it's your position that when 5 this document says, regarding your duties to 6 take appropriate action, you can only take 7 appropriate action, and that is order things 8 by yourself, make independent diagnoses, 9 when there's an emergency; is that correct 10 MR. JEFFERS: Objection. 11 MR. SCHOBERT: Objection. 12 MR. JEFFERS: Objection. 13 You put two things in there and he has 14 responded differently to each, as far 15 as I can tell. 16 MR. SCHOBERT: Go ahead. I 17 have objected. He answered -- if you 18 understand, answer it. 19 MR. PARIS: Ask a clean 20 question and get a clean answer. 21 BY MR. GORDON: 22 Q Okay. Is it your position that, even 23 though Exhibit 3 says that when you're 24 called to an assigned area and it says, 25 "take appropriate action," it's your 43 1 position that only in emergencies can you 2 make independent decisions, including giving 3 independent orders without the approval of 4 an obstetrician? 5 A Yes. 6 Q Then number four on Exhibit 3, it says, 7 "Respond to all acute emergencies and take 8 appropriate action;" do you see that? 9 A Yes. 10 Q And then we -- that's in a situation 11 when you have an emergency, then you, as the 12 house physician, can make independent 13 decisions and give orders and instructions? 14 A Yes. 15 MR. JEFFERS: Excuse -- 16 BY MR. GORDON: 17 Q And work up -- and work up a patient; 18 is that correct? 19 A My real responsibility is to assist the 20 attending when they need us, house 21 physician, we -- we do the work, what they 22 want. 23 MR. JEFFERS: Please, hands 24 me Exhibit 3. I would like to -- 25 MS. REINKER: Can we take -- 44 1 stop a moment and make a couples copy 2 of that? I don't have it either. 3 MR. GORDON: Okay. Why 4 don't we take a -- why don't we go off 5 the record? 6 VIDEOGRAPHER: Off the 7 record. 8 _ _ _ _ _ 9 (Brief break.) 10 _ _ _ _ _ 11 BY MR. GORDON: 12 Q Dr. Hsieh, before we briefly recessed 13 we were talking about documentation regard 14 -- regarding your duties as a house 15 physician as an -- as an obstetrician and 16 gynecologist. The counsel for Parma General 17 Community Hospital has provided us Exhibit 18 6, which is in front of you, relating to 19 description, qualifications of OB house 20 physician. You do understand OB means 21 obstetrician/gynecologist; is that correct? 22 A Yes. 23 Q Okay. Looking at Exhibit 6, have you 24 ever seen this document before? 25 A I don't remember. 45 1 Q Okay. 2 MR. SCHOBERT: Six, John. 3 BY MR. GORDON: 4 Q Are you telling me that you might have 5 looked at this document, Exhibit 6, but you 6 just forgot about it; is that it? 7 A I -- I'm not quite sure. I no 8 remember. 9 Q Okay. Well, and as a house physician 10 in obstetrics and gynecology at Parma 11 Community General Hospital, would you agree, 12 part of your responsibilities would -- would 13 be to determine what the hospital considered 14 your duties and responsibilities to be? 15 MR. SCHOBERT: Objection. Go 16 ahead. 17 A Take care of emergency. 18 Q Okay. I'll -- I'll rephrase it. Okay. 19 Have you read, at any time before July of 20 1999, any written materials which were 21 provided to you by Parma Community General 22 Hospital describing your duties and 23 responsibilities as a house officer? 24 A I -- I don't remember. 25 Q Okay. Were you told by Parma General 46 1 Community Hospital that you had to follow 2 certain protocols while working as a house 3 physician prior to July of 1999? 4 A I don't recall. 5 Q Okay. Looking at Exhibit 6, and I want 6 to direct your attention to the section 7 under, "Duties," Paragraph 3, and let me 8 read it to you, "Examines patients at the 9 request of the nurse; discuss findings with 10 attending/consultant physician; write the 11 findings in the progress notes." 12 A Yes. 13 Q Okay. Did you understand that what I 14 just read to you was one of your duties and 15 responsibilities as a house officer in June 16 of 1999? 17 A Yes. 18 Q Okay. Now, with respect to Mary 19 Williams, you had a physician-patient 20 relationship with her in June of 1999; is 21 that correct? 22 A I'm -- I'm working at the hospital. 23 She's not my private patient. I have to 24 say, yes, because I'm working that day. 25 Q So you would agree that you had a 47 1 physician-patient relationship with Mary 2 Williams in June of 1999? 3 A Yes. 4 MR. SCHOBERT: Objection. 5 BY MR. GORDON: 6 Q Okay. Had you ever treated Mary 7 Williams before June of 1999? 8 A No. 9 Q Is it correct that Mary Williams did 10 not select you as her doctor to see her in 11 June of 1999 -- 12 MR. SCHOBERT: Objection. 13 BY MR. GORDON: 14 Q -- is that correct? 15 MR. SCHOBERT: Objection. 16 But go ahead. 17 A I'm not -- 18 MR. JEFFERS: I'll object. 19 A -- not understand your question. 20 Q Okay. Am I correct that Mary Williams 21 did not select you as her physician when you 22 saw her in June of 1999? 23 MR. JEFFERS: I object for 24 two reasons; one, is he wouldn't -- he 25 may not know; but two, you have to look 48 1 at the consent that she signed as to 2 what she authorized and he may not have 3 seen the consent. 4 MR. SCHOBERT: I'll object, 5 but go ahead and answer that question. 6 MR. PARIS: And giving you 7 that standing objection, John, we will 8 now ask a clean question and try to get 9 a clean answer. 10 MR. JEFFERS: Okay. 11 A I not quite -- 12 MR. PARIS: Go ahead, 13 reask the question, Harley. 14 A I'm not quite understanding the 15 question -- 16 Q Okay. 17 A -- really. 18 Q All right. I'll rephrase -- I will 19 rephrase it. You, as a private 20 obstetrician/gynecologist, have patients 21 select you as their physicians; is that 22 correct? 23 MR. SCHOBERT: Now you're 24 really gonna confuse it. Objection. 25 Go ahead. 49 1 A What is this "select"? 2 Q Pick out. Picked you as her -- as a 3 physician. You don't -- okay. 4 Did Mary Williams pick you as her 5 physician? 6 A No. 7 Q Okay. The reason you saw Mary Williams 8 is because you were the obstetrician/ 9 gynecologist house officer on duty at that 10 time? 11 A Yes. 12 Q Okay. Did you ever tell Mary Williams 13 that you were not employed by Parma 14 Community General Hospital? 15 A I didn't talk to her, no. 16 Q When you saw Mary Williams did you wear 17 a coat? 18 A I wore -- wore the -- I wear the white 19 coat and the scrub -- scrub shirt. 20 Q Was there anywhere on your coat or 21 scrub uniform to indicate that you were 22 employed by Parma Community General 23 Hospital? 24 A No. 25 Q Did there -- was there any decals? 50 1 A Just my name. (Witness indicating.) 2 Q And that's it? 3 A Uh-huh. 4 Q Is that correct? 5 A Yeah, name tag. 6 MR. JEFFERS: Because we're 7 getting into a legal issue, I'm gonna 8 state for the record that the consent 9 form says: Physicians who render 10 professional services to you at Parma 11 Community Hospital are independent 12 practitioners and not employees or 13 agents of the hospital and is not -- 14 and that Parma Community General 15 Hospital is not responsible for the 16 acts or omissions of the physicians 17 that are not directly controlled by 18 Parma Community General Hospital, 19 signed by Mary J. Williams. 20 BY MR. GORDON: 21 Q Okay. And as I could understand, then, 22 after we've gone over your duties and 23 responsibilities, then when you see a 24 patient you do a -- a on-hands evaluation of 25 the patient as a house officer; is that 51 1 correct? 2 MR. SCHOBERT: Objection. Go 3 ahead. 4 A Question again. 5 Q When you see a patient as a house 6 officer, you do a -- a hands-on evaluation 7 of what's going on with the patient? 8 A Clinical examination; is that the 9 question? 10 Q You do a clinical examination and you, 11 like any other physician, arrive at a 12 working diagnosis; is that correct? 13 A I'm not quite understand. You make it 14 clear the sentence before I can answer. I'm 15 not quite -- 16 Q Do you have a problem hearing what I'm 17 asking? 18 A No problem, but the question I'm not 19 understood. 20 Q Okay. 21 A That's why I need to be -- answer you 22 what you really want me to answer. 23 Q Okay. When you see a patient after 24 your hands-on evaluation you arrive at an 25 assessment or working diagnosis; is that 52 1 correct? 2 A Yeah. 3 MR. SCHOBERT: Objection. 4 BY MR. GORDON: 5 Q Okay. With respect to Mary Williams, 6 what role did you play in her care and 7 treatment? 8 A I was called by the nurse two -- two 9 times; first time, patient to rule out 10 convulsion; the second time was rule out 11 vaginal bleeding. That's it. 12 Q And I -- the -- when you were called in 13 the second time, this was after midnight on 14 June 26th, 1999? 15 A Yes. 16 Q Okay. And that was an acute emergency; 17 is that -- am I correct on that? 18 A No. 19 Q It wasn't an acute emergency? 20 A No. 21 Q And why wasn't it an acute emergency? 22 A Because she just want to check out any 23 vaginal bleeding. 24 Q Now, before we get into that, let me -- 25 let me follow through, I have a thought in 53 1 mind. Are you saying that you were under 2 the supervision and direction of Dr. Hahn 3 when you saw Mary Williams on those two 4 occasions? 5 A I -- if I want to -- if I write a 6 order, I have to through Dr. Hahn. 7 Q Okay. Earlier you said you were -- as 8 part of your duties as an obstetrician/ 9 gynecologist house officer you were under 10 the supervision of the attending 11 obstetrician; is that correct? 12 A Yes. 13 Q Now, were you under the supervision of 14 the attending obstetrician, Dr. Hahn, when 15 you saw the patient the two times that you 16 did in June of 1999? 17 MS. REINKER: Objection. 18 A Say that again, the question. 19 MR. GORDON: Could you 20 repeat the question? 21 _ _ _ _ _ 22 (Question read back.) 23 _ _ _ _ _ 24 A Yes. 25 Q Had you worked with Dr. Hahn before, 54 1 let's say July of 1999? 2 A Yes. 3 Q On a number of occasions? 4 A I don't remember. 5 Q Okay. Do you still work with Dr. Hahn? 6 A Yes. 7 Q One of the nurses identified that took 8 care of Mary Williams was a nurse by the 9 name of Ms. Prokop. Do you know Ms. Prokop? 10 A Right. 11 Q Do you work with her? 12 A Yeah. 13 Q And before July of 1999 you worked with 14 her? 15 A Yes. 16 Q And you still work with -- 17 A Yes. 18 Q -- Ms. Prokop; is that correct? 19 A Yes. 20 Q As we sit here today, do you have any 21 recollection of Mary Williams? 22 A Not really. 23 Q Did you ever meet Mary Williams's 24 husband? 25 A I don't -- I don't remember. I think 55 1 maybe the first time when I saw the patient 2 he was in the bedside, he was in bedside. 3 Q Did you have any conversations with Mr. 4 Williams that you can remember today? 5 A No, I could not remember. 6 Q Excuse me. To prepare yourself today 7 for your deposition did you look at any 8 materials? 9 A Yes. 10 Q What materials did you look at? 11 A This here. This something like -- 12 (Witness indicating.) 13 MR. SCHOBERT: You've gotta 14 tell him what it is that you're 15 referring to. 16 A This is a Parma community General 17 Hospital Mary Elizabeth William medical 18 record. 19 Q Okay. And did you look at the complete 20 chart? 21 A No. 22 Q What portions of the chart did you 23 review? 24 A I just look at -- until the 20 -- 26th 25 of November, 035 a.m. 56 1 MR. SCHOBERT: Did you say 2 12:30 a.m., is that what you said? 3 THE WITNESS: Yeah, 12 -- 4 this 26th -- 5 MR. SCHOBERT: I wasn't sure 6 I understood you. 7 MR. GORDON: Let me -- I'll 8 -- I'll -- 9 MR. SCHOBERT: All right. I 10 wasn't sure he understood. 11 MR. GORDON: I think he 12 misstated the month, too, but -- okay. 13 MR. SCHOBERT: Okay. Go 14 ahead, Harley. 15 BY MR. GORDON: 16 Q So you're -- tell me if I'm correct or 17 incorrect. Okay. You looked at the chart 18 of Mary Williams through the time frame of 19 12:30 or thereabouts; is that -- is that 20 what you're saying? 21 MR. SCHOBERT: Object. 22 A Yeah. 23 MR. SCHOBERT: On the 26th? 24 BY MR. GORDON: 25 Q From the 25th to the 26th? 57 1 A Yeah. 2 Q Of 1999? 3 A 26th, 0035 -- at O45. I'm sorry. 4 Q Now you've got me confused. 5 A You see, the 12, after that, 12:00, by 6 military time is 24; right? After that 7 start the next day. 8 Q I understand that. 9 A That's why I -- I -- the last time I 10 saw the -- I -- I looked at record until the 11 26, 030 -- 45. 12 MR. SCHOBERT: Okay. I know 13 what he's saying now. 14 BY MR. GORDON: 15 Q Okay. So you looked at -- 16 MR. SCHOBERT: 045. 17 A Yeah. 18 Q But let me -- so you looked through the 19 chart through the time frame of 12:30 or 20 12:45 a.m. on January 26th, 1999? 21 A Should be -- should be right. 22 Q Is that correct? 23 A That is correct. 24 Q Okay. Why is it you didn't look at the 25 chart after, say 12:45 a.m., on June 26th, 58 1 1999? Did you hear my question? 2 A Yes. I'm -- I'm thinking. 3 Q Okay. 4 A I did not look at detail, but I just 5 look very fast, something like that. Okay. 6 Q Did you read any portions of the chart 7 after 12:45 a.m. on June 26th, 1999? 8 A No. You mean in the hospital? I -- I 9 was off. No. 10 Q Okay. Did you look at the autopsy 11 report? 12 A Yes. 13 Q Okay. And did you read the autopsy? 14 A Yes. 15 MR. GORDON: Okay. I 16 would like to mark the autopsy report. 17 _ _ _ _ _ 18 (Plaintiffs' Exhibit 7 marked.) 19 _ _ _ _ _ 20 MR. SCHOBERT: It's in that 21 packet, Doctor. There's the records 22 right there. 23 MR. GORDON: What number is 24 that, please? 25 COURT REPORTER:Number seven. 59 1 BY MR. GORDON: 2 Q Okay. Looking at Exhibit 7, this is 3 the autopsy protocol and report of coroner's 4 verdict relating to Mary Williams; is that 5 correct? 6 A Yes. 7 Q Okay. Could you, please, turn to the 8 very last page -- I'm sorry. Could you, 9 please, turn to the second last page of 10 these documents; do you have that in front 11 of you? 12 MR. SCHOBERT: Which? 13 A Which one? 14 MR. SCHOBERT: Yeah. 15 BY MR. GORDON: 16 Q Okay. It's Page 2 of the coroner's 17 verdict. 18 A Right. 19 Q Okay. Could you look down to the 20 middle of the page where it says, "Cause of 21 death"? 22 A Yes. 23 Q Okay. Can you read that for me? 24 MR. SCHOBERT: Objection. Go 25 ahead. 60 1 A "Parametrial sepsis and septic shock 2 syndrome with disseminated intravascular 3 coagulation." 4 Q Okay. Can you tell me what parametrial 5 sepsis is? 6 MR. SCHOBERT: Objection. Go 7 ahead. 8 A Infection in the -- in the line of the 9 uterus and then go to the blood. 10 Q Go to the what? 11 A Blood. 12 Q Okay. Is -- do you define sepsis as a 13 bloodborne infection? 14 A No. 15 Q How do you define sepsis? 16 A You mean, clinically define the sepsis? 17 The patient with elevated temperature and 18 abnormal blood count and the blood culture 19 show the bacteria. 20 Q When you talk about the abnormal blood 21 count, you're referring to the white blood 22 count? 23 A Yes. 24 Q What is the white blood count? 25 A White blood cell, leukocyte. 61 1 Q And is the purpose, among other 2 reasons, of a white blood cell is to fight 3 bacteria and infection? 4 A This a human respond when bacteria come 5 in their blood count, blood -- white blood 6 cell, you know, increase, elevated the 7 count. 8 Q Do you understand that white blood 9 cells fight bacteria and kill bacteria? 10 A Yes. 11 Q Okay. Have you heard of the term 12 neutrophils? 13 A Yes. 14 Q What are neutrophils? 15 A It's the -- one of the white blood 16 cell. 17 Q Have you ever heard the terminology 18 mature, or immature white blood cells? 19 A Yes. 20 Q Is -- what is a neutrophil, is it a 21 mature or immature white blood cell? 22 A Ask again the question. 23 Q Is a neutrophil a mature or immature 24 white blood cell? 25 A It's the mature. 62 1 Q Have you ever heard of the terminology 2 "bands"? 3 A Yes. 4 Q What are -- what are bands? 5 A It is a -- it's a premature neutrophil. 6 Q What's the difference between a 7 premature or a mature white blood cell? 8 A Mature white blood cell, the -- the -- 9 the nuclei is normal chromos -- okay, and 10 premature, the -- the nuclear is more big, 11 larger. 12 Q Did you understand, let's say as of 13 June of 1999, when the body is fighting an 14 infection that there can be premature cells 15 being sent out to fight the infection? 16 A Yes. 17 Q Do you know what a metamyelocyte is? 18 A Yes. 19 Q What is a metamyelocyte? 20 A The -- you see, the -- the neutrophil 21 is formed from the blood stream cell and 22 then, in the process, okay, myelocyte and 23 metamyelocyte and then finally become the -- 24 the neutrophil. Just in the process, one of 25 the -- of the process of the neutrophil 63 1 formation. 2 Q Then the neutrophils are the -- 3 A Mature. 4 Q -- mature white blood cells? 5 A Yeah. 6 Q The bands are the premature white blood 7 cells and the metamyelocytes are even more 8 premature white blood cells -- 9 A Yes. 10 Q -- is that correct? 11 A Yes. 12 Q Have you ever heard of the terminology 13 "left shift"? 14 A Yes. 15 Q What is meant by a left shift? 16 A Left shift is sign of infection. 17 Q Why is a left -- left shift relates to 18 the white blood count? 19 A Left shift, because the -- the -- the 20 premature cell is more, that's why they call 21 -- go to the left side in the process. 22 Q Why is a left shift a sign of 23 infection? 24 A Ask -- 25 Q Why is a left shift a sign of 64 1 infection? 2 A Because the human respond. The -- the 3 formation of the neutrophil respond, that's 4 why it's more, more premature cell. 5 Q In other words, the body is creating 6 more premature cells to go out and fight the 7 infection? 8 A Yes. 9 Q In your career, before the time you saw 10 Mary Williams, had you ever diagnosed a 11 patient with a postdelivery infection? 12 A Yes. 13 Q Can we agree then, that as of the time 14 you treated Mary Williams, you were aware of 15 the signs and symptoms of a postdelivery 16 infection? 17 A No. 18 Q Why can't we agree with that? 19 A Because I did a pelvic examination. 20 Clinically it's no foul smelling, it's no 21 tenderness. Okay. My -- my -- my 22 professional judgment, clinical judgment, at 23 that time she had no sign of any kind of 24 infection. 25 Q I think you took us one step ahead. 65 1 But the question is not specific to Mary 2 Williams, Doctor, and let me repeat the 3 question. Before you treated Mary Williams, 4 okay, were you aware of the signs and 5 symptoms, generally, of a postdelivery 6 infection? 7 A Yes. 8 Q Okay. Is a postdelivery infection also 9 called a postpartum infection? 10 A Postpartum -- depend upon where -- 11 where is the infection. What is the 12 question again? 13 Q Okay. Doctor, if you don't understand 14 my question, or you missed a word -- 15 A You told me repeat -- 16 Q Just ask -- 17 A -- that's why I repeat. 18 Q That's okay. 19 A Be patient. I'm sorry. 20 Q No, I am. I'm trying to be very 21 patient. And -- okay. Is a postdelivery 22 infection the same thing as a postpartum 23 infection? 24 A Yes. 25 Q Okay. Then can you tell me what the 66 1 signs and symptoms are, that you were aware 2 of in June of 1999, of a postdelivery 3 infection? 4 A Your question is point to the patient 5 or in general? 6 Q Generally. 7 A Okay. Usually postpartum infection 8 should be happening after 24 to 1 -- 24 9 hours to 1 week. Okay. 10 Q You say usually? 11 MR. SCHOBERT: Yeah, that's 12 what he said. 13 A Usually. 14 Q Usually? 15 A Yeah. 16 Q Okay. 17 A And you will find smell discharge and 18 you will find tenderness of the uterus. 19 Sometimes even you will find bleeding. 20 MR. JEFFERS: I need to see 21 that. 22 MR. GORDON: He -- smell, 23 discharge, tenderness. 24 BY MR. GORDON: 25 Q Any other signs and symptoms? 67 1 A It's a fever. 2 Q Are there any other signs or symptoms, 3 such as lab values? 4 A Just you mention -- we mention before 5 that, you know, leukocyte -- elevated white 6 blood cell. 7 Q And when you said the white blood cell, 8 that would include a left shift? 9 A Yes. 10 Q Okay. But from your career, not every 11 postpartum or postdelivery infection 12 presents in the typical way; is that 13 correct? 14 A Not necessarily. See, you have 15 infection, you must be have smell and 16 tenderness. 17 Q The items that you have told me 18 regarding a postdelivery infection, are you 19 saying that you have to have all these items 20 at all times before you -- you can have a 21 postdelivery infection? 22 MR. SCHOBERT: Objection. 23 Asked and answered. Go ahead. 24 A Not necessarily. 25 Q Okay. Okay. Now, so going back to my 68 1 question, you have seen patients who had 2 postdelivery infections before, let's say 3 June 26th, 1999? 4 MR. SCHOBERT: Objection. 5 Asked and answered. Go ahead. 6 A Clinically, at that time, I didn't find 7 out any infection for this patient. 8 MR. SCHOBERT: Well, he's not 9 -- he's asking you the same general 10 question he asked you once before. 11 A Give me the -- the question -- sorry. 12 MR. SCHOBERT: That's all 13 right, Doctor. 14 BY MR. GORDON: 15 Q Before June 25th, 26th, 1999 -- 16 A Yeah. 17 Q -- you would agree that you had seen 18 patients that had postdelivery infections; 19 agreed? 20 A Yes, postpartum endometritis. 21 Q And as a house officer, when you did 22 see a patient with a postdelivery infection, 23 you treated the patient? 24 A No. I called the attending and then 25 attending give me the order. 69 1 Q Before June 25th, June 26th, 1999, you 2 had treated obstetrical patients that had a 3 fever postdelivery; is that correct? 4 A My duty, any order specific to treat 5 the patient have to go through the attending 6 doctor. 7 Q But this is a general question. Okay. 8 Before June 25th, 26th, 1999, you had seen 9 patients that had a fever postdelivery; is 10 that correct? 11 A Yes. 12 Q Within 24 -- the -- strike that. 13 And you have seen patients, before 14 June 25th, 26th, 1999, that had a fever 15 within 24 hours of the delivery; is that 16 correct? 17 A Yes. 18 Q In terms of what's in the autopsy 19 coroner's verdict dealing with the cause of 20 death, Mary Williams had a postdelivery 21 infection; is that correct? 22 MR. SCHOBERT: Objection. Go 23 ahead. 24 A Yes. 25 Q Okay. And she died from that 70 1 postdelivery infection; is that correct? 2 MR. SCHOBERT: Objection. 3 A Yes. 4 Q And would you agree with me, when you 5 saw the patient on June 26th, 1999, after 6 midnight she did have, retrospectively, 7 looking at the coroner's verdict, she had a 8 postdelivery infection at the time you saw 9 her? 10 MR. JEFFERS: Objection. 11 MR. SCHOBERT: Objection. 12 MS. REINKER: Objection. 13 A No. Because clinically I didn't see 14 any sign of infection. 15 Q When, in your opinion, did the 16 postdelivery infection develop in Mary 17 Williams? 18 MR. SCHOBERT: Objection. 19 A I don't know. 20 Q Are you saying that the postdelivery 21 infection developed in Mary Williams after 22 you saw her on June 26th, 1999? 23 A I don't know. 24 Q So it's -- 25 A I can't tell you answer. I don't know. 71 1 Q Doctor, is it possible that the -- Mary 2 Williams had the postdelivery infection when 3 you saw her? 4 MR. JEFFERS: Objection. 5 MS. REINKER: Objection. 6 MR. SCHOBERT: Objection. 7 A I don't know. 8 MR. JEFFERS: Objection. 9 BY MR. GORDON: 10 Q Am I correct -- strike that. 11 You agree with the cause of death 12 as indicated in the coroner's verdict; is 13 that correct? 14 MR. SCHOBERT: Objection. 15 MS. REINKER: Objection. 16 A According -- according to the -- to the 17 report, pathology report. 18 Q Okay. What is meant by septic shock 19 syndrome? 20 A What this mean? 21 Q Yes. 22 A Lower blood pressure, acidosis, 23 shortness of breath, and bleeding, DIC, 24 disseminated intravascular coagulation, and 25 oliguria. 72 1 Q "Oli" what? 2 A Oliguria. Just output decrease, urine 3 output decrease. 4 Q When did you learn that Mary Williams 5 died? 6 A I don't remember, because I -- after 7 that I off for several day -- for -- for 8 some time. I don't know. I don't remember. 9 Q Now, we've gone over the -- the fact 10 that you looked at a portion of the chart, 11 you looked at the autopsy report. Is there 12 any other materials you looked at to prepare 13 yourself for your deposition today? 14 A No. I -- I just look at -- 15 MR. SCHOBERT: He means 16 beyond that, Doctor. He's asking you 17 other things. 18 A No, I didn't read any other thing. 19 Q For instance, did you do any research? 20 A No. 21 Q Did you discuss this case, at any time 22 after the death of Mary Williams, with any 23 physician? 24 A No. 25 Q Have you had any contact with Mary Will 73 1 -- Mary Williams's husband -- 2 A No. 3 Q -- after -- 4 MR. SCHOBERT: Wait. Wait 5 until he's done. Go ahead, Harlan. 6 BY MR. GORDON: 7 Q -- after you saw Mary Williams on June 8 26th, 1999? 9 A No. 10 Q In the chart, am I correct, Doctor, you 11 wrote certain progress notes -- 12 A Yes. 13 Q -- and orders; is that correct? 14 A That order is under Dr. Hahn order, 15 yes. 16 Q But you did write that? 17 A Yeah. I ask him -- 18 Q Okay. 19 A -- under his name, under his 20 permission. 21 Q So at this point I'd like for you to 22 take -- 23 MR. SCHOBERT: He's got the 24 small packet here. This might be a 25 little easier for you to look through. 74 1 BY MR. GORDON: 2 Q -- Exhibit 5, which I prepared, which 3 are documents taken out of the complete 4 chart, Exhibit 4, which I believe are 5 relevant to your testimony today. And if -- 6 if you wish, please, look at Exhibit 5. 7 MR. JEFFERS: Do you have a 8 copy of Exhibit 5 for me? 9 MR. GORDON: No, I don't. 10 MR. JEFFERS: So you've got 11 an exhibit that's going in that I don't 12 have a copy of? 13 MR. GORDON: You will get 14 it. 15 MR. JEFFERS: Well, we're 16 going to have testimony now. 17 MR. GORDON: No. You have 18 -- you have -- it doesn't matter. It's 19 an exhibit, I'll put on the record, 20 Exhibit 5 was taken out of Exhibit 4, 21 so you could follow along. 22 MR. SCHOBERT: If you want -- 23 MR. PARIS: And they're 24 Bates stamped, too, for you, John. 25 MR. SCHOBERT: Let -- let's 75 1 use Exhibit 4, if you want, that'll 2 make life easier. That way nobody has 3 anything different. I don't want to 4 spend -- get another copy made. Here. 5 What do you want him to look at, 6 Harlan? 7 MR. GORDON: Hold on. 8 Let's look at Exhibit 5. It's gonna 9 take -- it'll be easier because it's 10 excerpts and it's easier for the 11 witness. 12 MR. SCHOBERT: All right. 13 MR. GORDON: He doesn't 14 have to turn through a number of pages. 15 Okay. 16 MR. JEFFERS: Give me a 17 number. 18 MS. REINKER: Well, the rest 19 of us don't -- 20 MR. SCHOBERT: Well, he 21 hasn't asked him -- done anything yet. 22 So ask a question and let's go from 23 there. 24 MR. GORDON: I'd be happy 25 to ask him a question. 76 1 BY MR. GORDON: 2 Q Now, let's turn to the order first. 3 MR. SCHOBERT: This one here? 4 I'll look at this one while you're 5 looking at the small one. He's got in 6 front of him, for everybody's 7 edification, 179. 8 MS. REINKER: My pages are 9 not -- 10 MR. SCHOBERT: Well, Bill 11 didn't send you with the packet that 12 they gave us last time. It starts -- 13 THE WITNESS: Can -- can I 14 drink some water? Thank you. 15 MS. REINKER: Just tell me 16 what it is. 17 MR. SCHOBERT: The first 18 order at the top is 6-25. 19 MS. REINKER: Okay. 20 MR. SCHOBERT: 1500 hours. 21 MS. REINKER: Got it. 22 BY MR. GORDON: 23 Q Okay. Now let's look at Page 179. 24 This is from the order section of the chart; 25 is that correct? 77 1 A Yes. 2 Q And could you read the order that you 3 wrote at June 25th, 1999, at 1550 p.m.? 4 A 6-25-99 at 1550 p.m. Repeat serum 5 magnesium sulfate at 17 p.m. and C.B.C. 6 Signed Hsieh under Dr. Hahn. 7 Q The 17 p.m. means 1700 hours military 8 time? 9 A Yes. 10 Q Is that correct? 11 A Yes, five p.m. 12 Q Am I correct, Dr. Hsieh, the order that 13 you wrote on Page 179 is the only order that 14 you wrote relative to Mary Williams? 15 A Yes. 16 Q You also wrote two progress notes? 17 A Yes. 18 Q And is the first progress note found on 19 Page 188, dated June 25th, 1999 at 1550 20 p.m.? 21 A Yes. 22 Q Dr. Hsieh, with respect to your 23 progress note, which is on Page 1 -- 188, 24 could you read for us your note in its 25 entirety and, if there's any a 78 1 abbreviations, could you interpret those 2 abbreviations; okay? 3 A "06-25-99, 1550 p.m. Patient appeared 4 shaky and disappeared shortly. Blood 5 pressure 95 over 78 millimeter -- millimeter 6 mercury. Pulse rate at 82 per minute. Deep 7 tendon reflects two plus. Urine protein one 8 plus. Urine output 100 CC per hour. Serum 9 magnesium sulfate -- that's serum magnesium 10 on 06-25-99 at 11 a.m. was 6.6 milligram per 11 DL. On magnesium sulfate two gram IV per 12 hour. Dr. Hahn was reporter -- reported 13 order repeat magnesium at 1700 p.m." 14 Q Okay. Just to clarify one thing, the 15 order that you read on Page 179 relates to 16 the events indicated in your progress note 17 on Page 188; is that correct? 18 A Yes. 19 Q In your order on Page 179 you 20 indicated, as you did in your progress note, 21 about a repeat mag -- magnesium; is that 22 correct? 23 A Yes. 24 Q But in your note you do not put in the 25 order for the complete blood count; is there 79 1 any reason for that? 2 A I just forgot, whatever, that time, you 3 know. 4 Q Well, the question is -- 5 A Yes, I -- I -- I understand you. I 6 just forgot. I don't remember. 7 Q Could it be that you took it upon 8 yourself to order your -- by your own the 9 complete blood count? 10 A No. That is definite order from Dr. 11 Hahn. 12 Q But with the progress notes that you do 13 write, you try to be complete and accurate 14 as possible? 15 A Yes. 16 Q Okay. Now, the other progress note, 17 Dr. Hsieh, that you wrote, that's found on 18 Page 189; is that correct? 19 A Yes. 20 Q And this is a note that you wrote June 21 26th, 1999, at 0025 a.m., or 12:25 a.m. in 22 the morning; is that correct? 23 A Yes. 24 Q That -- the time here, 0025 a.m., is 25 the time -- is that the time you wrote the 80 1 note, or is that the time you saw the 2 patient? 3 A After I saw the -- saw the patient, 4 okay, I wrote the note just right away. So 5 the -- the watch sometime can be variation. 6 MR. SCHOBERT: He just wants 7 to know if you know -- 8 THE WITNESS: I saw -- 9 MR. SCHOBERT: -- does the 10 time reflect the time you wrote the 11 note or the time you saw the patient as 12 that time. 13 A I don't know the -- I don't remember 14 exactly, but I saw -- after I you saw the 15 patient I just write -- wrote the note. 16 Q So you can't tell us today whether the 17 0025 a.m. time on Page 189 is the time you 18 saw the patient or the time you wrote the 19 note? 20 A Yes, I saw the patient. After that 21 I -- I just follow up, then write a note. 22 Q So your practice is to see the patient 23 and then write the note? 24 A Go out -- out on the desk and write a 25 note. 81 1 Q And what time do you put down on your 2 progress note is the time you saw the 3 patient or the time you write the note? 4 A I would say I saw the patient. 5 Q At 12:25 a.m. in the morning? 6 A Yeah. 7 Q Okay. Now, with respect to the -- this 8 progress note on Page 189, could you read it 9 in its entirety and -- and please abbreviate 10 -- please tell us what the abbreviations 11 mean, if there are any. 12 A This is general -- it's -- you see, 13 this is zero, it's -- you see, this zero is 14 very, very hard to see. See the other one. 15 MR. SCHOBERT: He's having 16 trouble reading the copy of the -- 17 THE WITNESS: Thirty -- 18 thirty-seven, I think. 19 MR. SCHOBERT: He's looking 20 at the blood pressure one, he's not 21 sure if it's a zero or a three, I 22 guess. 23 THE WITNESS: I -- I think 24 it's 37. 25 MR. SCHOBERT: Well, we could 82 1 go -- does John have a better copy? 2 THE WITNESS: Original -- 3 original chart? 4 MR. JEFFERS: I may have a 5 color copy. Do you guys have your 6 color copy here? Then again, I may not 7 have it. 8 MR. PARIS: Let's go off 9 the record. 10 VIDEOGRAPHER: Off the 11 record. 12 _ _ _ _ _ 13 (Brief break.) 14 _ _ _ _ _ 15 VIDEOGRAPHER: Back on the 16 record. 17 BY MR. GORDON: 18 Q Dr. Hsieh, we were beginning, before we 19 broke for a recess, for you to read what is 20 found on Page 89 and we got a better copy of 21 the chart for you to read, or at least that 22 page. So could you now begin reading what's 23 -- what you wrote on Page 189. 24 A "06-26-99, 0025 a.m., blood pressure 25 127 per 65 millimeter mercury. Pulse rate 83 1 125 per minute. No active bleeding from 2 vagina. Fundus of uterus firm. Hemoglobin 3 13.5 gram per DL. Hematocrit 39.6 percent. 4 Serum magnesium sulfate 7.1 milli -- 5 milligram per DL. Urine output 100 CC last 6 two hours. IV now 125 CC per hour." 7 Q Then you signed it over here? 8 A Yeah, I sign over there. 9 Q And why'd you sign at that point? 10 A At that time I -- I -- after I finish 11 sign -- finished it and then I sign. And 12 then after, if my recollection -- after I 13 talked to the nurse: Did you call the 14 attending -- did you call the attending 15 already, what my -- my finding? She said 16 yes. That's why I just hurry, hurry, just 17 did not put on the -- the date, the timing. 18 So I just add it at the same time I ask him 19 to -- how about oral fluid intake. He said 20 oral fluid intake good. And then Dr. Hahn 21 was reported by nurse and ask order. That's 22 why the sign-in twice. Actually, this is -- 23 this writing is not the same time. 24 Different times. 25 Q All right. So is it unusual for you to 84 1 have your signature twice on one progress 2 note? 3 A Well, when your -- sometime your 4 routine, you just don't remember. Sometime 5 after finish up the habit, you know, just 6 sign it and then after talk to the nurse and 7 then I just forget to put on there the -- 8 the date, the timing, and then I just write 9 this two line, three line and then I just 10 sign again. That is just -- sometime you 11 just forget to put in the timing. 12 Q All right. So let me see if I 13 understand you. You initially signed the 14 chart after you wrote 12500 an hour; is that 15 correct? 16 A I write that, yeah, 25 an hour. 17 MR. SCHOBERT: No, no. He's 18 looking at this. He's looking at that 19 one. His question -- 20 A Yeah, "IV -- IV now." Okay. 21 Q Yeah. You wrote the -- 22 A The -- the -- yeah, this is first -- 23 yeah, until here I -- I -- I finished it. 24 Okay. 25 Q Okay. Then, after the nurse talked to 85 1 Dr. Hahn, you wrote the rest of the -- the 2 items on Page 189? 3 A Yes. 4 Q And you signed it? 5 A Yes. 6 Q And why did -- why did you write that? 7 A Why I write that? 8 Q Yeah. 9 A Because -- because sometime you hurry, 10 hurry. You just forgot to put on the 11 timing. You see, different time. Different 12 time write a different thing. 13 Q When you put the language in, "Dr. Hahn 14 was reported by nurse," that means the nurse 15 called Dr. Hahn and talked to him? 16 A Yes. That was after 25 a.m., see, 17 because after she -- I check her and then 18 nurse call Dr. Hahn, report the lab result 19 and my physical finding, and then I talk to 20 the nurse, you know, did you call doctor, 21 report to Dr. Hahn? He is very, very good 22 nurse. She say yes. That's why at the same 23 time I just ask him -- ask her how about 24 oral fluid intake. He say good. So that's 25 why I put the two line here, two sentence 86 1 here, forget to put on this timing. 2 (Witness indicating.) 3 Q Okay. So you wrote that note after the 4 nurse talked to Dr. Hahn? 5 A Just the -- the last two. 6 Q Right. Now, could you look at -- so we 7 could time that, could you look at Page 160 8 under the nurse's notes? 9 A One -- 136? 10 Q No, 160. 11 MR. SCHOBERT: 160. 12 MR. JEFFERS: 0045? 13 A 160. Okay. 14 Q It's in the left-hand column. 15 A Yes. 16 MR. SCHOBERT: This one. 17 (Indicating.) 18 MR. JEFFERS: It may be 19 different for him. 20 A Yes. 21 MR. GORDON: Looking at 22 160. 23 MR. SCHOBERT: Okay. John, 24 what entry -- what entry are you 25 looking for, Harley, on that page? 87 1 MR. JEFFERS: Oh, okay. 2 MR. GORDON: At the bottom 3 of the page, 0045. 4 MR. SCHOBERT: "0045." 5 MR. GORDON: What? I 6 understand that. I -- 7 MR. SCHOBERT: Okay. 8 BY MR. GORDON: 9 Q So the nurse's notes indicate at 0045, 10 or 12:45 a.m., on June 26th, the nurse 11 called Dr. Hahn; is that correct? 12 A Yes. 13 Q So your note -- 14 A Is -- 15 MR. SCHOBERT: Let him for 16 finish the question. 17 BY MR. GORDON: 18 Q Your note on Page 189, the second 19 portion of it -- 20 A Yeah. 21 Q -- was written sometime after 12:40 -- 22 12:45 a.m. on June 26th? 23 A Yes. 24 Q Okay. Now, it was your decision not to 25 talk to Dr. Hahn after you saw the patient 88 1 on June 26th, 1999; is that correct? 2 A Customarily, usually -- usually, 3 customarily the nurse report the condition 4 of the patient to the attending doctor. 5 Okay. After I check on this patient, it's 6 no active bleeding, it's not anything -- 7 anything positive. So this nurse is very, 8 very competent nurse, so she call Dr. Hahn 9 to report my physical finding and the lab 10 report. 11 Q The question is, you decided not to 12 talk to Dr. Hahn; is that correct? 13 A Usually, as I say, the nurse report to 14 the attending doctor. She already talk to 15 attending doctor. 16 Q But you did -- if you wanted to -- 17 strike that. 18 If you wanted to, you could have 19 talked to Dr. Hahn -- 20 A Yes. 21 Q -- is that correct? 22 A Yes. 23 Q But you decided against that; is that 24 correct? 25 A I'm not a -- I'm not against it. But 89 1 usually, you know, care of the patient, if 2 you need the order, usually the nurse call 3 the attending, talk to attending, the 4 condition of the patient and get a -- and 5 get a order. 6 Q Looking at Exhibit 6. Okay. Let's go 7 back to Exhibit 6, No. 3, where it says, 8 "Examines patients at the request of the 9 nurse; discuss findings with attending 10 consultant/physician; writes the findings in 11 the progress note." Did -- did you follow 12 that with me? 13 A Yes. 14 Q Okay. So what you did at June 26th, 15 1999, around 12:30 morning, you examined 16 Mary Will -- Williams at the request of the 17 nurse; is that correct? 18 A Yes. 19 Q And you did not discuss your findings 20 with the attending physician; is that 21 correct? 22 A Yes. 23 Q Okay. But you did write your findings 24 in the progress note? 25 A Yes. 90 1 Q So with respect to this document, 2 Exhibit 6, am I correct that you did not 3 comply with the duties outlined under 4 Paragraph 3, which I have read to you, 5 because you not -- you did not discuss your 6 findings with Dr. Hahn, the attending 7 physician? 8 A Yes. Usually the order and the report, 9 not necessarily every time the house 10 physician call the attending. Okay. The 11 nurse can call the attending, too. 12 Q Okay. Did you feel it was your 13 obligation as a house officer to talk to Dr. 14 Hahn after you saw the patient around 12:25, 15 12:30 a.m. on June 26th, 1999? 16 A You see, at that time the nurse is very 17 competent nurse. I talked to the nurse what 18 I -- I find -- I found and talked to Dr. 19 Hahn. That's why we work like that. House 20 doctor not always required to discuss with 21 the attending doctor. 22 Q So you're -- 23 A Except -- except there is anything 24 unusual. 25 Q So are you saying, then, that you 91 1 didn't find anything unusual with Mary 2 Williams at the time you saw her on June 3 26th, around 12:30 a.m., that's why you 4 didn't talk to Dr. Hahn? 5 A Not -- the nurse already -- when I 6 wrote that, the nurse already talk to the 7 Dr. Hahn, okay, report the lab finding and 8 the -- my physical finding. 9 Q When you say, "left finding," are you 10 talking about a left shift? 11 MR. SCHOBERT: No, he didn't. 12 He said "lab." 13 BY MR. GORDON: 14 Q Lab finding? 15 A Lab finding. See, that's why I said -- 16 MR. SCHOBERT: That's all 17 right. Just wait for the next 18 question. 19 THE WITNESS: Uh-huh. 20 BY MR. GORDON: 21 Q When you said -- you're saying lab 22 finding? 23 A Yeah, lab finding. 24 Q All right. Now, is there any other 25 materials that you wrote in Mary Williams's 92 1 chart? 2 A No. 3 Q Did you write any personal notes 4 regarding Mary Williams which, for whatever 5 reason, didn't make it to the chart? 6 A No. 7 Q Did you ever drop a written statement 8 to anyone regarding your knowledge of your 9 treatment of Mary Williams? 10 A No. 11 Q Okay. Now -- now let's go to the time 12 that you saw Mary Williams at 1550, or 3:50 13 p.m. on -- on June 25th. As a -- as 14 background to that, Dr. Hahn -- Doctor -- 15 strike -- Dr. Hsieh, what time did you 16 report to work? 17 A 7:00 in the morning. 18 Q And that June 20 -- 19 A June 25th. 20 Q Which is a Friday? 21 A Yeah. 22 Q So -- and -- 23 A I remember. Yeah, 25th. 24 Q And you -- were you working a 12 or 25 24-hour shift? 93 1 A Twenty-four-hour shift. 2 MR. JEFFERS: Can I have the 3 time? I didn't hear the time. 4 MR. GORDON: He started at 5 seven a.m. -- 6 MR. JEFFERS: I didn't get 7 that. 8 MR. GORDON: -- on June 9 25th. 10 MR. JEFFERS: Thank you. 11 BY MR. GORDON: 12 Q Okay. And then -- now, you were called 13 to see Mary Williams; is that correct? 14 A I don't recall. 15 Q The nurse -- 16 A She -- she was -- 17 Q Let me finish my question. 18 MR. SCHOBERT: Yeah. 19 BY MR. GORDON: 20 Q The nurse called you around 3:50 in the 21 afternoon on June 25th to see Mary Williams? 22 A Oh, yes. I thought you -- admission, 23 no. 24 Q Where were you at that time? 25 A I was in on-call room. 94 1 Q And the on-call room is -- is on the 2 third floor? 3 A Yes. 4 Q Had you seen any other patients that 5 day? 6 A I don't remember. 7 Q Do you know how many patients were in 8 the -- being confined on the third floor? 9 A I do not remember. 10 Q Okay. All right. Tell me why you were 11 called to see Mary Williams at 3:50 p.m. 12 A Because the patient shaky. That's why 13 they call me, to see shaky. 14 Q The nurse called you? 15 A Yes. 16 Q If -- could you turn to Page 159 under 17 nurse's notes? 18 MR. SCHOBERT: He's gonna ask 19 you to look right there. (Indicating.) 20 BY MR. GORDON: 21 Q Okay. At the bottom of the page 22 there's a note at 1550, or 3:50 p.m. for 23 June 25th, it says, "Called the patient's 24 room by husband." Husband -- strike that. 25 "Patient noted to be shaking, shivering at 95 1 this time. Patient alert and oriented, 2 answers questions appropriately. Complains 3 of not feeling well. No large move -- 4 muscle movements noted. Dr. Hsieh into room 5 to assess patient." Okay? 6 A Yes. 7 Q So were you called into the room not 8 only because the patient was shaking, but 9 also shivering? 10 A When I arrival I saw patient shake -- 11 shaking like that. (Witness indicating.) 12 And then for a while, I don't remember how 13 long, maybe -- my guess, maybe 10, 20 second 14 and then disappear. 15 Q Now turn to Page 160 at the top the 16 page. 17 MR. JEFFERS: What page? 18 MR. PARIS: 160. 19 BY MR. GORDON: 20 Q Now, there's a note at 1555, that's 21 3:55 p.m.; is that correct? 22 A Yeah, that -- that is 3:55. 23 Q Okay. And then it says, "Patient 24 remained alert and oriented. Reflexes 25 per -- per Dr. Hsieh three plus. No clonus. 96 1 Patient continues to shake and shiver. 2 Patient denied headache, blurred vision. 3 See vital signs intervention." So according 4 to the nurse's notes, this shaking and 5 shivering continued for five minutes? 6 MR. SCHOBERT: Objection. 7 BY MR. GORDON: 8 Q And you're saying it continued for -- 9 MR. SCHOBERT: Wait, wait 10 wait, wait, wait, wait. You made a 11 statement. Are you asking him that -- 12 a question? 13 MR. GORDON: Yeah, I'm -- 14 I'm asking -- 15 MR. SCHOBERT: Well, then 16 stop and ask him the first question 17 before you go to the second one. 18 BY MR. GORDON: 19 Q So can you be mistaken that the shaking 20 and shivering continued more than 20 21 seconds? 22 A Let me answer your question first. 23 I -- the first time I saw her there was in 24 1555, according to -- to this note here. 25 (Witness indicating.) Okay. Okay. Before 97 1 that I didn't -- I didn't see her on this, 2 what -- what is that, 15:10? I did not see 3 her. 4 Q Okay. Now let's go on to Page 160 5 again. The note at 1605, or 4:05 p.m., June 6 25th. It says, "Patient shaking and 7 shivering ceased. Alert and oriented. 8 Patient voicing concern over not being able 9 to nurse infant at this time. Dr. Hsieh 10 speaking with Dr. Hahn on patient status. 11 Orders received." Okay. Do you agree that 12 what is described here in the nurse's notes 13 indeed occurred? 14 MS. REINKER: Objection. 15 MR. SCHOBERT: Object. 16 A See, when I saw the patient -- 17 MR. SCHOBERT: Wait, wait 18 wait. The question is, he's asking 19 you, everything that he just read, can 20 you verify that that occurred? That 21 was the question. 22 A Yes, it disappear. 23 Q Okay. And therefore, comparing the 24 1605 nurse's notes to the 1555 nurse's 25 notes, the shaking ceased within five -- 98 1 five to ten minutes? 2 A I didn't -- when I saw the patient, 3 maybe just 10, 15 seconds shaking like that. 4 (Witness indicating.) And then disappear 5 when I arrival. 6 Q So you disagreed that the shaking 7 continued more than seconds; is that 8 correct? 9 A Yes. 10 Q Okay. 11 A What I saw. Okay. Before that I 12 didn't know. 13 Q Is it unusual to see a postdelivery 14 patient, such as Mrs. Williams, shaking and 15 shivering? 16 A Not unusual. 17 Q Why isn't it unusual? 18 A She -- even normal delivery can 19 shaking. (Witness indicating.) 20 Q Did you consider Mrs. Williams' shaking 21 and shivering to be unusual? 22 A Not unusual. 23 Q What did you consider to be the cause 24 of the shaking and shivering? 25 A I'm considered to rule out any 99 1 eclampsia convulsion. 2 MR. JEFFERS: Can you read 3 that back to me, please? 4 COURT REPORTER:I -- I'm not 5 sure what the last part of that was, 6 Doctor. Could you say that one more 7 time? 8 MR. PARIS: Convulsion. 9 MR. SCHOBERT: Yes. 10 MR. JEFFERS: Now would you 11 read it back to me, please? 12 BY MR. GORDON: 13 Q Now -- 14 MR. JEFFERS: Wait, wait. 15 She's reading it back to me. 16 _ _ _ _ _ 17 (Answer read back.) 18 _ _ _ _ _ 19 A Yeah. 20 Q Thank you. 21 A To rule out convulsion. 22 Q Do -- from your experience, do nurses 23 normally call you to see patients 24 postdelivery when they're shaking or 25 shivering? 100 1 A Sometime. 2 Q Okay. 3 A Not always. 4 Q Why were you called rather than the 5 attending physician? 6 A At that time she have this 7 preeclampsia, I -- I think the attending 8 should know the condition of the patient. 9 Q I'll rephrases the question. Why -- do 10 you have any knowledge of why you were 11 called rather than the attending physician? 12 A I don't remember, but at that time I 13 think attending should know, so I call 14 myself, because sometime the nurse is busy 15 or whatever. You know, if I available, I 16 just call. But customarily, usually most 17 the time anything necessary is the nurse 18 call. 19 Q Now, when you go -- strike that. 20 Did you consider this an acute 21 emergency when you saw Mrs. Williams at this 22 time? 23 A After -- 24 MR. SCHOBERT: Wait for him 25 to finish the question. Okay. All 101 1 right. 2 MR. PARIS: Reask the 3 question. 4 BY MR. GORDON: 5 Q Did you consider this to be an acute 6 emergency when you saw Mrs. Williams at 3:50 7 p.m.? 8 A Not really. 9 Q All right. Now, when you see -- when 10 you saw Mrs. Williams did you attempt to -- 11 let me backtrack. 12 This is the first time you'd seen 13 the patient; is that correct? 14 A Yes. 15 Q So, when you saw the patient, did you 16 attempt to get information about her from 17 the chart, or from the nurse, or both? 18 A I didn't see -- not from the chart. 19 From the -- the -- the nurse from the -- the 20 house doctor before -- before me and -- who 21 wrote the history told me, you know, the 22 patient condition. She was admitted for 23 induction because of preeclampsia. 24 Q Who is the previous house officer? 25 A In -- in -- in the chart. Who wrote 102 1 the -- I don't remember the name in the 2 chart. 3 Q So when you -- you didn't participate 4 in the delivery of Mrs. -- 5 A No. 6 Q -- Williams' baby? 7 A No. 8 Q But at the time you had a changeover 9 with the previous house officer -- 10 A Yeah. 11 Q -- he told you that she had been 12 inducted for pre -- preeclampsia? 13 A Yeah. 14 Q Did you even know, after 9:20 a.m. -- 15 9:21 a.m., when she had delivered, that -- 16 that Mrs. Williams had a baby? 17 A I do remember. 18 Q Okay. So at least you know, when you 19 went and saw her, that she would -- had 20 inducted -- had been inducted for 21 preeclampsia; is that right? 22 A When I saw her, she already deliver. 23 The nurse call me to check out her shaking. 24 Before that I didn't -- I didn't see the 25 patient. 103 1 Q All right. We know that. But the -- 2 A Yeah. 3 Q When you went and saw her you would 4 know that she had a history of preeclampsia? 5 A Yeah, I saw -- saw -- she was under 6 treatment with the -- with the magnesium 7 sulfate. 8 Q Then is it your custom and practice, 9 when you go and see a patient like this, 10 Mary Williams, at 3:50 p.m., do you look at 11 the chart the see what is happening -- what 12 has happened to the patient? 13 A I -- I don't remember I -- I specific 14 look at any certain -- certain part of the 15 -- the patient. 16 Q Could you repeat that question -- 17 answer? 18 _ _ _ _ _ 19 (Answer read back.) 20 _ _ _ _ _ 21 BY MR. GORDON: 22 Q The question is different than that. 23 It just -- from your custom and practice, do 24 you normally, when you see a patient for the 25 first time, look at the chart? 104 1 A Customarily, yes, I look at the chart, 2 but for this patient I don't remember. 3 Q Okay. 4 MR. SCHOBERT: Well, you've 5 and his question. 6 BY MR. GORDON: 7 Q All right. And customarily, when you 8 look at the chart, do you look and read the 9 progress notes? 10 A Progress -- yes. 11 Q Okay. And customarily, when you see 12 such a patient, do you -- do you look at the 13 orders? 14 A Yes. 15 Q Okay. And customarily, when you see 16 such a patient, do you look at the nurse's 17 notes? 18 A Not necessarily. Sometime the patient 19 -- the nurse told you what's going on the 20 patient, you -- you already, you know, 21 knowing what is situation of the patient. 22 Q Okay. But if this is the first time 23 that you see a patient, do you customarily, 24 under those circumstances, look at the 25 nurse's notes? 105 1 MR. SCHOBERT: Objection. 2 Asked and answered. Go ahead again. 3 A No, I didn't see that. They just told 4 me the evaluation, the patient is shivering. 5 Q Patient and what? 6 A Shivering. 7 Q Okay. So you don't know if you looked 8 at the nurse's notes? 9 A I didn't -- I didn't remember I read 10 the -- the nursing note, but they just 11 called me, patient have this shiver -- 12 shivering. (Witness indicating.) 13 Q Okay. Did you -- do you customarily 14 look at information regarding the vital 15 signs? 16 A I ask -- most the time I ask the -- the 17 nurse. 18 Q Okay. Most of the time. Do you also 19 look at the chart for -- to find out the 20 vital signs? 21 A If I -- if the nurse did not remember, 22 I find out in the chart. If the nurse 23 remember, tell me, you know, I -- I look at 24 -- if I want the information I look at the 25 chart. 106 1 Q Do you look at the -- customarily, the 2 medications when you see a patient like 3 this? 4 A Yes, I see the medication. 5 Q Now, in this case did you -- did you 6 learn what the patient's vital signs were 7 when you saw her at 3:50 p.m.? 8 A That's why I -- I -- I wrote here -- 9 MR. SCHOBERT: It's the page 10 before. 11 A See, when I saw that, I -- I wrote -- I 12 wrote in the chart. (Witness indicating.) 13 MR. SCHOBERT: Just tell him 14 what you wrote in the chart. 15 A Blood pressure 95, 78 millimeter 16 mercury and pulse rate 82 per minute. 17 Q Okay. 18 A Deep tendon reflex plus two. Urine 19 protein one plus. 20 MR. SCHOBERT: That's fine. 21 He's -- he's just asking vitals. 22 BY MR. GORDON: 23 Q Then what information did you get from 24 the nurse regarding the vital signs? 25 A From these vital signs, the patient is 107 1 stable. 2 Q No, you didn't hear my question. What 3 information did the nurse tell you about the 4 patient's vital signs at that time, 3:50 5 p.m.? 6 A From the vital sign? 7 Q Yeah. What did the nurse -- strike 8 that. 9 Did the nurse tell you anything 10 about the patient's vital signs at 3:50 11 p.m.? 12 MR. JEFFERS: If you recall. 13 A Just in here. (Witness indicating.) 14 Q Okay. So in other words, she -- the 15 nurse told you that the patient had a blood 16 pressure of 90 -- 95 over 78? 17 A Yeah. 18 Q The nurse told? 19 A Pulse rate -- pulse rate 82. 20 Q Okay. In other words, you yourself 21 didn't do a blood pressure reading; is that 22 correct? 23 A Yes. 24 Q You yourself didn't do -- check the 25 patient's heart for a heart rate, is that 108 1 correct, or -- or check her hand or wrist 2 for a heart rate; is that correct? 3 A Yes. 4 Q All right. 5 MR. PARIS: Take a 6 one-minute break. 7 MR. SCHOBERT: Okay. 8 MR. PARIS: We've only got 9 a few minutes left on the tape. Let's 10 go off the record. 11 VIDEOGRAPHER: Off the 12 record. 13 MR. PARIS: Change the 14 tape. 15 _ _ _ _ _ 16 (Brief break.) 17 _ _ _ _ _ 18 VIDEOGRAPHER: Back on the 19 record. 20 BY MR. GORDON: 21 Q When you learned the -- the blood 22 pressure of 95 over 78 from the nurse did 23 you make any determination what her baseline 24 blood pressure was? 25 A At that time I don't remember. 109 1 Q Is that something that you would have 2 done from your custom and practice? 3 A Usually, after the -- the nurse taking 4 the -- the blood pressure, you know, if I'm 5 suspected anything unusual I would take it 6 myself. 7 Q Did you -- 8 A But in this patient I don't remember 9 whether I did -- did it or not. 10 Q And -- and if you did, you would have 11 looked at the chart to see what her blood 12 pressures were up until that point; is that 13 correct? 14 A That's correct. 15 Q Okay. Now, in that regard, looking at 16 Page 137, on the left column there is a 17 blood pressure reading at 1500, or 3 p.m. on 18 that day of 124 over 87. 19 A 137 -- 20 MR. SCHOBERT: Wait a second. 21 He's not up with you yet. 22 MR. JEFFERS: Give me that 23 figure again. 24 MR. SCHOBERT: Which -- which 25 entry, Harley? I've got it in front of 110 1 me. He can look at mine. What date -- 2 what entry on 137? 3 BY MR. GORDON: 4 Q I'll repeat that. On Page 137 at 1500, 5 or 3 p.m. on that day there's a blood 6 pressure reading of 124 over 87, Doctor; is 7 that correct? 8 A Yes, one -- 9 Q Okay. And if you had looked in the 10 chart you would have seen that; is that 11 correct? 12 A I do not remember if I see -- see the 13 chart. 14 Q Okay. Now, using this blood pressure 15 of 124 over 87 at 1500 -- and you have -- 16 and you have in your progress note a blood 17 pressure of 95 over 78. There is a drop in 18 the blood pressure; is that correct? 19 A Yes. 20 Q And what would -- what did you account 21 for the drop in the blood pressure? 22 A That can be -- the check in time to 23 time can be difference. Okay. Another -- 24 that's only thing I can -- I can -- I can 25 tell you, because the blood pressure, even 111 1 second to second the check, change can be 2 difference. 3 Q Okay. If you had known about the drop 4 in the blood pressure from 125 -- 124 over 5 87 on Page 137 to 95 over -- over 78, would 6 that have concerned you? 7 A I -- anyway, I -- I will close 8 follow-up. 9 Q You were what? 10 A Close follow-up. 11 Q Okay. And is the drop of the blood 12 pressure from 124 over 87 to 95 over 78 a 13 sign of an infection? 14 A Not necessarily. 15 Q But it can be? 16 A Well, I'm not sure, because not every 17 infection gonna be low blood pressure. 18 Q But it can be? 19 MR. SCHOBERT: Objection. 20 Asked and answered. 21 A I'm not sure. 22 Q Okay. You're not sure. Going back to 23 what your custom and practice would be with 24 this type of patient, would you customarily, 25 with this type of patient, look at the lab 112 1 values before you saw the patient? 2 A Depend upon what they request to see, 3 request to -- to check. Okay. They request 4 me to check the shaking, that's why I'm 5 checking to rule out convulsion. 6 Q So then you would have checked the lab 7 values; is that correct? 8 MR. SCHOBERT: Objection. 9 A I don't remember. 10 Q All right. In your note at 1550, or 11 3:50 p.m., you do note the serum magnesium. 12 All right. 13 A Right. 14 Q Where did you get that information? 15 A I don't remember. Can be from the 16 nurse. But anyway, they want -- they want 17 to -- me to check out any convulsion, that's 18 why I specific see the prophylactic level of 19 the magnesium is therapeutic dose. 20 Q Are you testifying today that the nurse 21 gave you the lab values for the serum 22 magnesium that you recorded on Page 188? 23 A That time so long, I -- I couldn't 24 remember. Sometime I just ask the nurse 25 report what the -- what the report, I just 113 1 wrote it out. 2 Q Report of what? 3 A The report of the -- of the -- of the 4 blood tests. 5 Q Okay. So do you customarily ask the 6 nurse to give you the lab values? 7 MR. JEFFERS: Objection. 8 That's not what he said. 9 BY MR. GORDON: 10 Q That's what I want to find out. Do you 11 customarily -- 12 MR. JEFFERS: He answered. 13 MR. SCHOBERT: He's answered 14 your question. 15 MR. PARIS: Hold on. 16 BY MR. GORDON: 17 Q -- ask the nurse to give you the lab 18 values? 19 MR. SCHOBERT: Objection. Go 20 ahead. 21 A The question, I'm not -- 22 MR. SCHOBERT: Just answer 23 that question, if you can. Just answer 24 that question. 25 A Yeah, I -- I don't remember. 114 1 Q No. But I'm not talking about 2 remembered. Customarily, when you see a 3 patient like this, do you ask the nurse: 4 Give me the lab values? 5 A Usually -- 6 MR. SCHOBERT: Objection. Go 7 ahead. 8 A Usually we ask them first how -- how 9 the -- the blood test. 10 Q Okay. That includes the magnesium and, 11 also, the complete blood count -- 12 A Yes. 13 Q -- is that correct? 14 A Yes. 15 Q And the nurse, she verbally tells you 16 all the blood -- all the lab values, or does 17 she tell you only the abnormal ones? 18 MR. SCHOBERT: Objection. 19 A If abnormal, she will tell you 20 specifically abnormal. If normal, they will 21 tell you -- whatever it is, they know to 22 tell you. Normal, abnormal, they'll tell 23 you. If you ask -- ask the nurse what is 24 the magnesium sulfate concentration, they 25 will tell you -- they will -- the nurse will 115 1 tell you. 2 Q Besides asking the nurse for the 3 magnesium sulfate value, would you 4 customarily ask the nurse to give you all 5 the lab values? 6 MR. SCHOBERT: Objection. 7 Either make it specific to the case or 8 give more information, Harley. This 9 going back and forth, it -- it's a 10 pain. You're doing this on purpose. 11 Now either give a hypothetical with all 12 the facts you want him to customarily 13 respond to, or give this specific case. 14 MR. GORDON: No, no -- 15 well, with all due respect, I don't 16 have to -- 17 MR. SCHOBERT: Well, I know, 18 but -- but -- 19 MR. GORDON: -- and I'm not 20 doing this on purpose. 21 MR. SCHOBERT: Well, it's 22 confusing to me and I know it's 23 confusing to him. So either give him a 24 hypothetical and say what would you do 25 customarily in that situation, or ask 116 1 him about this case. 2 MR. PARIS: Ask him 3 generally. 4 MR. GORDON: Yeah, I am. 5 BY MR. GORDON: 6 Q Generally, okay, when you go and see a 7 patient do you ask the nurse to give you the 8 lab values? 9 A Usually I ask the nurse, give me some 10 information. 11 Q Okay. And the -- and you expect the 12 nurse to give you both the normal and 13 abnormal lab values? 14 A Case to case, we ask the -- what they 15 know. What the result, they tell you. 16 Q You didn't understand my question. Did 17 you -- do you expect the nurse who you asked 18 to give you the lab values to give you both 19 the, normal or abnormal value -- lab values? 20 A The -- the result they give you. They 21 are very, very competent nurse. You ask 22 them what is the report that -- they can 23 tell you. 24 Q And from the report they tell you both 25 the normal and abnormal lab values; is that 117 1 right? 2 MR. SCHOBERT: Objection. 3 Asked and answered. 4 A I'm not understand your -- your 5 question. What normal, abnormal. You ask 6 the nurse what you want to know, the -- the 7 result. They'll let you know. Okay. 8 Whatever the result is there, they just tell 9 you. 10 Q Okay. Do you ask specifically for a 11 lab value; in other words, give me the 12 magnesium value? 13 A Yes, because -- yes, I specific ask 14 them because this patient was under 15 treatment with magnesium sulfate. 16 Q Okay. 17 A You want to know the therapeutic dose 18 of the magnesium sulfate. 19 Q Okay. Now generally, customarily, do 20 you ask the nurse, you come and see the 21 patient: Give me the lab values of the 22 complete blood count? 23 MR. SCHOBERT: Objection. 24 A Depend upon the nurse, what you are 25 checking for. The nurse ask me to check on 118 1 the shaking, so I go to rule out a 2 convulsion. Okay. And then when you want 3 to know more detail, the magnesium sulfate, 4 have to know the concentration so you know 5 that therapeutic is affected or not. That's 6 why I specific ask her magnesium sulfate. 7 Q In this case did you ask the nurse at 8 3:50 p.m. to give you the lab values 9 relating to the complete blood count? 10 MR. SCHOBERT: Objection. 11 A I don't remember. 12 Q You might, you might not have? 13 A I don't remember. 14 Q Okay. All right. With respect to the 15 3:50 time that you saw the patient, did you 16 look at the computer screen relative to the 17 lab values? 18 A No, because I have no access -- access 19 to go -- I have no access. 20 Q No what? 21 A Access, access. 22 Q Access? 23 MR. SCHOBERT: Access. 24 A Okay. Access to go into the computer. 25 Because you go into the computer in the 119 1 hospital lab report, you have to pass words, 2 you know, pass -- P-A-S-S-W-O-R-D, password, 3 to get into it. 4 Q So I could understand you -- 5 A You can understand now? 6 Q Yeah. 7 MR. SCHOBERT: He'll ask you 8 three more questions, but he 9 understands now. 10 BY MR. GORDON: 11 Q No, I'm -- 12 A I appreciate for that, your patience. 13 Q Are you telling me that you don't have 14 a password for you to find out lab values on 15 the computer screen; is that what you're 16 saying? 17 A Yes, I don't have the access. 18 Q Okay. Access? 19 A Yeah. 20 Q And in order to get the lab values you 21 have to ask a nurse or a physician to do 22 that? 23 A All the report all the nurse -- yeah, 24 I -- I get information. You know, when you 25 have a report in the chart, or you ask the 120 1 nurse, nurse will tell you. 2 Q Okay. Do you ever -- have you ever 3 asked a nurse to give you a printout of the 4 lab values from the computer? 5 A I don't -- I don't remember. 6 Q Have you ever done that? 7 MR. SCHOBERT: He's asking in 8 general now. He -- 9 A In general -- 10 Q I'm just -- 11 A In general, yes. When -- when you -- 12 you -- you -- some other occasion you want 13 to know, you can ask the secretary or ask 14 the nurse to -- to print the -- the -- the 15 report. 16 Q Looking at Page 42 under lab reports -- 17 MR. JEFFERS: Page what? 18 MR. GORDON: Page 42. 19 MR. JEFFERS: Remember, you 20 have the short chart and I don't. 21 BY MR. GORDON: 22 Q Do you have Page 42? 23 A Yes. 24 Q Okay. Looking at Page 42, under 25 "Hematology," this relates to the complete 121 1 blood count; is that correct? 2 A Yes. 3 Q Okay. There is lab values under 11 -- 4 1100, do you see that, that's marked No. 2? 5 A Yeah. 6 Q Okay. Did you see the lab values under 7 1100 when you saw the patient at 3:50 p.m.? 8 A I don't remember. 9 Q Okay. Would they have been in the 10 chart at the time you saw the patient? 11 A I don't know. 12 Q And the white blood count under 1100 is 13 17.3; is that correct? 14 A Written here is -- is right. 15 Q And that's abnormal? 16 A Not necessarily. Postpartum, because 17 of reaction, can be -- can be a high -- the 18 -- the white blood cell. 19 Q The normal range is 4 to 10.8? 20 A Yes. 21 Q Is that what you consider -- you use 22 that as your normal? 23 A The lab -- 24 MR. SCHOBERT: Objection. 25 MS. REINKER: The 122 1 postpartum, or are you talking about -- 2 MR. GORDON: The normal -- 3 I say the normal range in -- 4 MR. SCHOBERT: In the lab 5 slip, if that's -- 6 MR. GORDON: Yeah, right. 7 MR. SCHOBERT: He wants to 8 know what the normal -- 9 MR. GORDON: All right. 10 MR. SCHOBERT: -- range on 11 this piece of paper is. 12 MR. GORDON: I'll 13 rephrase -- 14 A These -- 15 Q Wait. 16 A These are -- these here -- 17 Q Wait a minute. Stop. I'm gonna give 18 you another question so we have a clear 19 question. Okay. The normal -- the normal 20 range, as indicated on Page 42, is 4 to 21 10.8; is that correct? 22 A That is for non -- nonpregnancy. 23 Q Okay. So the 17.3 would be outside of 24 the range, as indicated on Page 42? 25 A Can be a variation. That's what I told 123 1 you before, postpartum or during labor, 2 whatever, the -- the white blood cell can be 3 beyond limitation, beyond the -- the -- 4 the -- what you say, in the -- in the -- in 5 the -- in the normal range. Still normal. 6 Q You're saying that in -- in a 7 postdelivery woman -- 8 A Yes. 9 Q -- that the white blood count can be 10 above the normal range? 11 A Yes. 12 Q For how long, for what time frame after 13 delivery? 14 A I can't tell you. 15 Q Okay. 16 A I'm not sure. 17 Q What, then, is the normal range for a 18 postpartum, postdelivery lady in terms of a 19 white blood count? 20 A Can be variation. 21 Q Give me the range. 22 A I cannot tell you. 23 Q What causes an elevation in the white 24 blood count beyond normal in a postpartum 25 lady? 124 1 A Just a human reaction. 2 Q Reaction to what? 3 A To the -- to the -- you know, labor 4 process itself can be stimulation and these 5 white cell increase. 6 Q And how long does that elevation in 7 white blood count last after delivery? 8 A So I can -- I -- I have no recollection 9 how long, but it did happen. 10 Q Now, going down on Page 42 under where 11 -- there's a -- it says letters, "MDIF," do 12 you understand that to be manual 13 differential? 14 A Yeah. 15 Q Okay. By the way, have you ever seen a 16 computer screen at Parma General Community 17 Hospital which shows the actual lab values? 18 A No. 19 Q Okay. Underneath that, right -- 1100 20 has MDIF as bands eight; do you see that? 21 A Yeah. 22 Q And has neutrophils 87; is that 23 correct? 24 A Yes. 25 Q With respect to the bands, is that 125 1 normal or abnormal for a postdelivery lady? 2 A The band is -- in the hospital is below 3 -- less than 15 is normal. 4 Q And where do you get the less than 15 5 is normal? 6 A In the lab -- lab standard, in the 7 Parma Hospital standard. 8 Q Now, less than 15, is that for a normal 9 individual, or is that for a postpartum 10 lady? 11 A That is -- I -- I'm -- I cannot tell 12 you. 13 Q Okay. Now, with respect to the 14 magnesium sulfate, why -- why is magnesium 15 sulfate given for preeclampsia? 16 A Prophylactic -- prophylactic con -- 17 convulsion. Prevent convulsion. 18 Q Have you ordered magnesium sulfate 19 without the direction of an attending 20 obstetrician? 21 A No. 22 Q What level of magnesium sulfate in this 23 patient were you attempting to -- to reach? 24 A You can reach between four to eight 25 milligram. 126 1 Q And then what happens if you're beyond 2 eight milligrams? 3 A Well, they can be a side effect. 4 Q There can be what? 5 A Side effect. 6 MR. JEFFERS: Side 7 effects. 8 BY MR. GORDON: 9 Q What type of side effects? 10 A Like a respiration depressed. Sometime 11 blood pressure drop. Even -- even worse, 12 can cause cardiac arrest if you're beyond 13 the -- the -- 14 Q Does the -- giving a postpartum lady 15 magnesium sulfate increase the temperature, 16 if you know? 17 A I -- I can -- I -- I -- as far as I 18 know, I don't know. 19 Q Does giving magnesium sulfate increase 20 the blood pressure? 21 A No. 22 Q Does the giving of the magnesium 23 sulfate affect, in any way, the complete 24 blood count? 25 A As far as -- as far as I -- I'm aware, 127 1 I don't know. 2 Q Now, then you had a discussion with Dr. 3 Hahn after you saw the patient? 4 A Yes. 5 Q Before you saw Doctor -- before you 6 talked to Dr. Hahn did you have any 7 diagnosis or impression as to what was going 8 on with the patient? 9 A Before I saw that I just want to -- I 10 just rule out convulsion. 11 Q Then did you rule out convulsions? 12 A Yes. 13 Q How did you rule out convulsions? 14 A See, usually convulsion -- usually they 15 start in the small muscle. (Witness 16 indicating.) 17 Q The small what? 18 A Small muscle of the face. 19 Q Oh -- 20 A Twitching. 21 Q --small muscle of the face? 22 A Twitching. 23 Q Okay. 24 A And then crush the hand and continual 25 contraction of the hand and the -- and the 128 1 feet. If it were severe, you can open and 2 close the mouth even by the tongue and even 3 protrusion your eyes. (Witness indicating.) 4 Okay. That is typical convulsion from the 5 eclampsia. That's why they asked me to rule 6 out eclampsia. So I went there, I checked 7 everything and I rule out. So I call Dr. 8 Hahn, I let him -- let him know. So he just 9 order -- ask me to order C.B.C. and 10 magnesium sulfate level. 11 Q The signs that you're describing from 12 twitching, et cetera, regarding convulsion, 13 the -- Mary Williams did not have it at 3:50 14 p.m.; is that correct? 15 A Yes. 16 Q Okay. If she didn't have the signs of 17 a convulsion, what did you think was causing 18 the shaking and shivering? 19 A Again, I told you before, can be just 20 normal postpartum can happen like that. 21 Q Then -- I just want to backtrack. The 22 nurse calls you to -- specifically for the 23 reason -- strike that. 24 Did the nurse specifically tell 25 you that she wanted you to rule in or rule 129 1 out convulsions? 2 A Yes. 3 Q Then when you -- then you -- after you 4 saw the patient, you talked to Dr. Hahn over 5 the telephone or -- or -- or was he in the 6 hospital? 7 MR. SCHOBERT: Okay. Go 8 ahead. 9 A Over the phone. 10 Q Okay. And what did you tell Dr. Hahn? 11 A I tell Dr. Hahn what I -- I read in -- 12 in -- in here, in the chart. (Witness 13 indicating.) 14 Q And then did you tell Dr. Hahn that you 15 had ruled out convulsions; is that correct? 16 A Yes. 17 Q You would have told Dr. Hahn of the 18 shaking and shivering? 19 MR. SCHOBERT: Told -- I'm 20 sorry. Could you repeat your question? 21 BY MR. GORDON: 22 Q You would have told Dr. Hahn about the 23 shaking and shivering? 24 MR. SCHOBERT: Okay. 25 A Yes, I did tell him disappear when I 130 1 saw -- saw him. 2 Q Okay. Did you tell Dr. Hahn about any 3 of the vital signs? 4 A What I -- I -- I talk to him what I 5 wrote in here. (Witness indicating.) 6 Q About the blood pressure and the pulse 7 rate? 8 A Yes. 9 Q And that's it? 10 A And the -- and the -- the -- the serum, 11 magnesium serum concentration. 12 Q Okay. And did Dr. Hahn ask you to 13 check any other lab values? 14 A No. 15 Q Why is it you called Dr. Hahn rather 16 than Dr. Shagawat? 17 A Because I called the office, the office 18 just give me -- let me talk to Dr. Hahn. 19 Q Okay. Why did you talk to Dr. Hahn 20 rather than the nurse? 21 A I think in this situation Dr. Hahn need 22 to know, so that's why I -- the attend -- 23 not specific attending -- the attending 24 should know what the situation of the 25 patient, that's why I thought -- at that 131 1 time I don't remember whether nurse was busy 2 or whatever. Usually the nurse directly 3 call the attending to get the order, but for 4 this particular situation I don't remember, 5 so I -- I call myself. 6 Q All right. Did Dr. Hahn tell you why 7 you were ordering the complete blood count? 8 A No. 9 Q What did you understand the reason for 10 ordering the complete blood count? 11 A We just want to -- to check out, follow 12 up closely, see what -- to follow up the 13 patient closely, see what the -- the -- you 14 see, in the preeclampsia the platelet count 15 is also important. That's complete count 16 including the platelet. That's why I think 17 he's gonna follow up, see any potential low 18 platelet count cause the bleeding. 19 Q Since you ordered the serum magnesium 20 level and the complete blood count, was it 21 your obligation to find out the results of 22 those tests? 23 MR. SCHOBERT: Objection as 24 to the form of the question. Go ahead. 25 A See, the nurse is not calling me. The 132 1 nurse did not report to me. At that time, 2 also, I saw the Dr. Shagawat making the 3 round -- making the round for that 4 particular time for do the test. 5 Q So, generally speaking, okay, when you 6 normal -- when you order a test, is it your 7 duty as a house officer to find out the 8 results of that test? 9 A Not necessarily, because sometime the 10 nurse tell you. You see, we are working 11 under the attending doctor, not primary in 12 charge the patient. 13 Q Did you ever find out the results of 14 the complete blood count that was ordered? 15 A Yes, I -- I -- I-- I -- when I went to 16 see that, I saw the Dr. Shagawat making 17 round, I -- in -- in -- in the chart, the 18 timing, you see that progress note? 19 Q Page 188, it's at 1730 on June 25th, so 20 you -- 21 A Yeah, see, I saw -- saw her making 22 round, so that's why I didn't -- I didn't -- 23 I didn't further look at the report for this 24 particular patient. 25 Q All right. So it's your testimony you 133 1 never found out the results of the complete 2 blood count that was to be performed at 1700 3 hours that you ordered? 4 A After the -- I saw Dr. Shagawat I did 5 look at the -- the -- the chart, what Dr. 6 Shagawat did for the patient. 7 Q Okay. That would be sometime after 8 1730, but before you saw the patient again 9 at around 12:30 a.m. in the morning? 10 A That -- that -- that -- that is -- that 11 is right, because you see, when sometime you 12 have some other thing call you in, you see 13 the nurse station. Okay. And then you will 14 look at the attending coming, you see the 15 attending look at the patient, what he did. 16 Okay. So the attending direct take care of 17 the patient already. 18 Q All right. So you were aware, before 19 12:30 a.m., that the patient had a white 20 blood count of 16.1, as indicated in -- 21 A I -- 22 Q -- Dr. Shagawat's note? 23 A At that time -- I did not remember that 24 time exactly, the -- the -- the -- the -- 25 the report. 134 1 Q Did you ever see the patient again 2 before you saw her at 12:25, 12:30 a.m.? 3 A No. They -- 4 Q Did anybody -- 5 A They didn't call me. 6 Q Okay. Now, so the next time you saw 7 the patient was around 12:25, 12:30 a.m.; is 8 that correct? 9 A Yes, I call according to the -- the 10 note, I saw -- saw her, it was 25. 11 Q Okay. Could you turn to Page 160, 12 please? 13 MR. JEFFERS: 160? 14 MR. GORDON: Yes, the 15 left-hand side, the bottom of the page. 16 A Nursing note? 17 MR. SCHOBERT: Yeah. 18 BY MR. GORDON: 19 Q Yes. 20 MR. SCHOBERT: I've got it 21 right here. 22 A Let me see here. 23 MR. SCHOBERT: What time do 24 you want him to look at, Harley? 25 MR. GORDON: We're gonna 135 1 begin at June 26th, 1999 at 0030, or 2 12:30 a.m. in the morning. 3 A Page 160 in the left corner here. 4 Okay. 5 Q Okay. It says here, "Dr. Hsieh called 6 to room to evaluate patient due to anxiety, 7 output, vital signs, et cetera. Vaginal 8 exam, rectal exam, palpated and foley 9 checked per doctor." Okay. Now let me ask 10 you questions about that. You would agree, 11 then, you were called to see Mrs. Williams 12 due to anxiety because of her output and 13 vital signs; is that correct? 14 A She -- she was call -- call -- call me 15 to -- to rule out -- also rule out vaginal 16 bleeding. 17 Q So when you -- the nurse called you to 18 evaluate the patient for vaginal bleeding, 19 as well as the anxiety -- 20 A I don't -- I don't -- 21 MR. SCHOBERT: Wait. Let him 22 finish. Go ahead. 23 BY MR. GORDON: 24 Q All right. The nurse called you to see 25 Mrs. Williams in order to rule out vaginal 136 1 bleeding, but also to evaluate her and 2 consider her anxiety, her output and vital 3 signs? 4 A I don't remember the anxiety, but he 5 did call -- call me to evaluation the 6 vaginal bleeding. 7 Q Okay. So the -- are you denying that 8 the nurse called you in order to evaluate 9 the patient -- 10 MR. SCHOBERT: Let him 11 finish. 12 BY MR. GORDON: 13 Q -- for anxiety or output and her vital 14 signs? 15 A I don't -- I don't remember. I do 16 remember she ask me to rule out any 17 bleeding. 18 Q So that you're saying today that the 19 nurse might have asked you to evaluate the 20 patient because of anxiety, output, and the 21 vital signs, but you don't remember? 22 A She -- I remember ask me to rule out 23 bleeding, because in my -- my recollection, 24 just check out any -- any abnormal bleeding. 25 Q Okay. 137 1 A They call me that time. 2 Q That's your testimony. But I just want 3 to clarify that today you don't remember 4 whether the nurse asked you to see the 5 patient and evaluate the patient for 6 anxiety, her output, and her vital signs? 7 MR. SCHOBERT: Objection. 8 A I don't remember. 9 Q Okay. Now, would it be unusual for you 10 to be called to evaluate a patient for 11 anxiety or restlessness, generally speaking? 12 A Not -- not very unusual, because a lot 13 of time after deliver, patient can a little 14 bit irritate -- irritability, you know, it 15 can cause you -- it can cause you to see -- 16 check it out. 17 Q Then what causes this restlessness or 18 irritability in a postpartum patient -- 19 postdelivery patient? 20 A What specific cause I cannot tell you. 21 Q Okay. 22 A I don't know. 23 Q Did you recall that Nurse Prokop was 24 the nurse on duty when you saw the patient 25 around 12:25 a.m.? 138 1 A Yes. 2 Q Okay. Did Nurse Prokop tell you that 3 she was concerned about the patient? 4 A She did not -- I don't remember. She 5 just ask me, call me -- I was in on-call 6 room, to check any vaginal bleeding. 7 Q Okay. 8 A I don't recall. 9 Q Okay. But you don't -- do you deny 10 that Nurse Prokop told you that she was 11 concerned about the patient? 12 A I do not remember. 13 Q Okay. What information did you receive 14 from the nurse when you saw the patient? 15 A She -- she just called me to rule out 16 any vaginal bleeding. 17 Q Then when you went over there to the 18 room -- 19 A Yeah. 20 Q -- did you talk to the nurse to get 21 some information about the patient? 22 A I don't remember. I just -- I just 23 went in to -- if my -- the best 24 recollection, I just went there to check the 25 patient. 139 1 Q So today you don't remember talking to 2 the nurse about the patient -- 3 MR. SCHOBERT: Well -- 4 BY MR. GORDON: 5 Q --when you went and saw the patient? 6 MR. SCHOBERT: Okay. That's 7 a little more clarification. But go 8 ahead. 9 BY MR. GORDON: 10 Q Is that correct? 11 A They call me, the nurse call me. I 12 just went there to ask the nurse again. She 13 said: We want to be sure she is not 14 bleeding. 15 Q Did that take place over the phone call 16 or when you saw the patient? 17 A When I saw the -- saw the -- saw the 18 patient, if I best recollection, just to 19 check out any -- any bleeding. 20 Q And then did you ask any questions of 21 the nurse about that bleeding? 22 A Yes, I did ask -- I ask them how much 23 bleeding. She says moderate, whatever, 24 so -- 25 Q What -- what did you say? 140 1 A Moderate. 2 Q Moderate? 3 A Yeah. That's why I -- I just check her 4 vaginally and check her rectumly, be sure 5 it's no hematoma. And then I checked the 6 fundus of the uterus is firm, confirm that 7 the uterus no relaxation, and then at the 8 same time I didn't find any smell discharge, 9 and clinically I didn't see any sign of 10 infection from what I was checking at that 11 time. 12 Q Then did you ask the nurse when the 13 bleeding began? 14 A She -- the nurse -- I don't remember 15 when -- when was the -- when was the -- the 16 bleeding began. I don't remember. 17 Q You don't remember asking the nurse 18 that? 19 A No. 20 Q You saw no evidence -- 21 A When I -- I went there she said she had 22 moderate -- she had moderate bleeding. So I 23 do the pelvic and the rectal examination 24 and, also, at the same time I check the 25 fundus. Okay. Fundus is firm, it's no 141 1 tenderness, and then no smell in discharge 2 at that -- that point. Clinically no sign 3 of any kind of infection. 4 Q So you were concerned that the patient 5 might have an infection? 6 A No. This is a -- the routine, when you 7 check evaluation, what you find -- what you 8 looking for. I just check her to rule out 9 any bleeding. 10 Q So why were you concerned about any 11 foul smelling discharge? 12 A This is a routine. When you're -- 13 when you're postpartum -- when you're 14 postpartum patient, you know, routinely you 15 want to know what is going on with the 16 patient. 17 Q Did you -- strike that. 18 In your progress note you 19 indicated blood pressure reading and a pulse 20 reading; is that correct? 21 A Yes. 22 Q The blood pressure reading, did you 23 take that yourself or did you get that from 24 the nurse? 25 A From the nurse. 142 1 Q Okay. Did the nurse give you any 2 information regarding the blood pressure 3 readings that were taken before 12:25 4 a.m. -- 5 A I don't remember. 6 Q -- during the day? 7 A I don't remember. 8 Q Is that -- 9 A When I went in, I just ask him -- ask 10 her what is the blood pressure, what is the 11 pulse rate. 12 Q That's all you asked her -- 13 A And then -- 14 Q -- about vital signs? 15 A I say: How much -- how much bleeding? 16 She say: Moderate. 17 MR. SCHOBERT: Well, he just 18 asked about vital signs. 19 BY MR. GORDON: 20 Q Did you ask the nurse to give you the 21 vital signs? 22 A I don't remember. 23 Q Do you customarily ask the nurse to 24 give you vital signs? 25 A Yeah, vital sign is the blood pressure 143 1 and the pulse rate. 2 Q Well, in this -- this situation -- 3 A Yeah. 4 Q -- do you customarily -- this is at 5 12:25 a.m. 6 A Yeah. 7 Q When you go in to -- to evaluate a 8 patient for vaginal bleeding do you 9 customarily ask the nurse for the vital 10 signs? 11 A Yeah, the blood pressure and the pulse 12 rate. 13 Q Do you ask her to give you the 14 temperature? 15 A I don't remember. 16 Q Do you customarily ask the nurse to 17 give you the temperature? 18 A Depend upon what the situation. 19 Q And what would cause you to ask the 20 nurse to ask for the temperature? 21 A I do not remember whether I -- I -- I 22 -- 23 MR. SCHOBERT: No. He's 24 asking you customarily, not 25 specifically. 144 1 A Yeah, customarily, yes, you -- you -- 2 you -- you -- you -- first thing, you come 3 in, you -- you ask the patient the vital 4 sign, including blood pressure, pulse rate, 5 and respiration rate, and -- and the 6 temperature. 7 Q Okay. And that would have been done in 8 this patient then? 9 A I don't -- I don't remember I -- I did 10 ask that time. 11 Q Now, with respect to the temperature, I 12 want you to turn to the nurse's notes, this 13 is on Page 140. Okay. We'll begin there. 14 On the left-hand side under vital signs at 15 1925, or 7:25 p.m. there is a temperature of 16 101.6; is that correct? 17 MR. SCHOBERT: I'm sorry, 18 what's the entry again, Harley? I'm -- 19 MR. PARIS: 7:25 p.m. 20 MR. SCHOBERT: 7 -- 1925? 21 MR. PARIS: Correct. 22 MR. SCHOBERT: 1925, they're 23 asking to you will at, Doctor. Right 24 here. (Indicating.) Go ahead. Would 25 you ask the question again, please? 145 1 BY MR. GORDON: 2 Q On Page 140 there's recorded at 1925, 3 or 7:25 p.m. a temperature of 101.6; is that 4 correct? 5 A In here written is correct. 6 Q Okay. You were aware of that 7 temperature of 101.6 when you saw the 8 patient at 12:25 a.m.; is that correct? 9 MR. SCHOBERT: Objection. 10 A I don't remember. I didn't -- I didn't 11 see her at -- at -- at 8:00. This is in the 12 -- in the -- in the evening. Okay. Twenty 13 -- 14 Q On June 26th at 12:25 a.m., when you 15 saw the patient, you would have been aware 16 of this 101.6 temperature, which was taken 17 at 7:25 p.m. the previous day? 18 MR. SCHOBERT: Objection. 19 A I do not remember. 20 MR. SCHOBERT: Asked and 21 answered. 22 A I do not remember. 23 Q All right. With respect to the 101.6 24 temperature, that temperature is abnormal; 25 is that correct? 146 1 MR. JEFFERS: Objection. 2 MR. SCHOBERT: Objection. 3 A Postpartum, within 20, 48 hour can be 4 temperature like that. 5 Q And why can you have a temperature of 6 101.6, what causes that? 7 A I don't know, because -- because after 8 postpartum can be -- can be happen the 9 temperature elevated like that. 10 MR. GORDON: Why don't you 11 mark this. Could you have her mark 12 this? 13 _ _ _ _ _ 14 (Plaintiff's Exhibit 8 marked.) 15 _ _ _ _ _ 16 MR. JEFFERS: Are there ones 17 for all of us? 18 MR. GORDON: No. No, the 19 only thing I have is the -- 20 MR. SCHOBERT: I want to see 21 it before the Doctor does. 22 MR. GORDON: A fever -- 23 MR. JEFFERS: What exhibit 24 is this? 25 COURT REPORTER:Exhibit 8, 147 1 Plaintiff's Exhibit 8. 2 MR. JEFFERS: And what is it 3 classified as? 4 MR. PARIS: It's a 5 conversion chart. 6 MR. GORDON: It's a 7 conversion chart, that's all. 8 MR. JEFFERS: Oh, okay. 9 MR. SCHOBERT: All right. 10 Okay. Apparently these are 11 converting -- wait. He's gonna want 12 you to look at it, I guess, unless you 13 can do it in your head. Go ahead. 14 BY MR. GORDON: 15 Q A temperature of 101.6 Fahrenheit 16 converts to 38.7 degrees centigrade; is that 17 correct? 18 A 101.6, 38.7. 19 MR. JEFFERS: What is it? 20 MR. SCHOBERT: 38.7, he 21 said -- 22 MR. JEFFERS: Okay. 23 MR. SCHOBERT: -- degrees. 24 BY MR. GORDON: 25 Q Centigrade. Okay. Now, at what level 148 1 do you consider a patient to have a fever 2 normally? 3 MR. SCHOBERT: Nonpostpartum? 4 MR. GORDON: Nonpostpartum. 5 MR. SCHOBERT: Okay. Go 6 ahead, Doctor. 7 A After 37. 8 Q After 37 degrees centigrade? 9 A Yes. 10 Q And that would correspond to 98.6 11 degrees Fahrenheit? 12 A Yes. 13 Q Okay. In a postpartum woman, within 24 14 hours after delivery, what do you consider a 15 fever to be in terms of Fahrenheit or 16 centigrade? 17 MR. JEFFERS: A fever? 18 MR. GORDON: Yes, a fever. 19 MR. JEFFERS: Yeah, I 20 gotcha. 21 A That is not very unusual postpartum, 22 the temperature elevated like that. 23 Q I didn't ask you that. I -- let me ask 24 you again. 25 What do you consider to be a fever 149 1 in a postpartum layer -- lady within 24 2 hours after delivery in terms of Fahrenheit 3 or centigrade? 4 MR. JEFFERS: Within 24 5 hours? 6 MR. GORDON: Within 24 7 hours. 8 A What is your question again? 9 MR. SCHOBERT: He's asking 10 you, generally, do you have a number, 11 within 24 hours, what you consider to 12 be a fever in a postpartum woman? Can 13 you give him a number, a range, or 14 whatever? 15 A Range, 37. 16 Q Okay. 17 MR. SCHOBERT: In a 18 postpartum woman -- 19 THE WITNESS: Yeah. 20 MR. SCHOBERT: -- within 24 21 hours? 22 THE WITNESS: Yeah. 23 BY MR. GORDON: 24 Q Okay. That's 37 degrees centigrade or 25 98.6 degrees Fahrenheit. Now, how about -- 150 1 I'm changing the question. In a postpartum 2 woman what do you consider to be a fever 3 within the time frame after 24 to 48 hours 4 after the delivery? 5 A What is the question? What -- 6 Q In a postpartum woman, okay, who is 7 between 24 hours and 48 hours after 8 delivery, what do you consider to be a fever 9 in terms of centigrade or Fahrenheit? 10 A Yeah, it's higher -- higher than 37. 11 Q And what would be the range -- higher 12 than 37. Okay. Now, if you had known of 13 this -- 14 A Can I -- can I add one -- one thing 15 about the temperature postpartum? 16 Q Yes. What? 17 A Usually, within 24-hour, if the 18 temperature more than 38 centigrade, and 19 then you consider this is a fever. 20 Q What do you consider a temperature of 21 30 -- 38 degrees centigrade within 24 hours? 22 A Thirty -- thirty-eight, that is 23 considered fever. 24 Q Okay. Now, then with a fever you have 25 to evaluate the cause of the fever, is that 151 1 correct, in a postpartum lady -- lady within 2 20 -- 24 hours after delivery; is that 3 correct? 4 A Usually, within 24-hour, if you -- you 5 have less than twice temperature more than 6 38 you just observation. 7 Q If you have a reading of 38 degrees 8 centigrades or greater within the 24 hours, 9 after the second reading you've got to 10 determine the cause of the fever; is that 11 correct? 12 A Not the second time. The third time. 13 See, within twice time you just observation. 14 Q And where do you -- where in the 15 literature does that, to your knowledge, say 16 that if you have a temperature of 38 degrees 17 centigrade or -- or greater only two times, 18 you only -- you wait for -- you look and 19 have evaluation? 20 A You can see in the William textbook. I 21 don't know what -- what page. That's called 22 pueperium mobility. 23 Q Okay. Does that mean, then, when you 24 have two temperatures 38 degrees or greater 25 within the first 24 hours after delivery, 152 1 does that mean that you don't take any 2 efforts to artificially lower the 3 temperature during that time frame? 4 A That time, that's what I'm saying, we 5 close observation the -- the patient. 6 Q But you don't -- during that period, if 7 you have a temperature of 38 degrees 8 centigrade or greater during -- within the 9 first 24 hours, you don't take any efforts 10 to reduce the temperature; is that correct? 11 MR. SCHOBERT: Objection. Go 12 ahead, if you understand. 13 A Usually it's -- it's -- it's -- it's 14 less than -- less than 38, you -- you don't 15 -- you don't -- you don't treat the patient. 16 Q Okay. If it's 38 or greater -- 17 A Or greater, 39, whatever, you maybe 18 give her some medication, the -- the 19 temperature. (Witness indicating.) 20 Q To reduce the temperature? 21 A Yeah. 22 Q Even within the first 24 hours? 23 A Not necessarily. If more than 38, you 24 -- you -- you -- you can do that. 25 Q You can give medication to reduce the 153 1 temperature within the first 24 hours? 2 MR. SCHOBERT: Objection. Go 3 ahead. 4 A If your temperature, within -- again, I 5 told you, within 24 hour, if your 6 temperature around 38, usually you don't 7 treat, you just observe. 8 Q Okay. And you observe to see whether 9 or not the temperature's gonna stay the same 10 or increase? 11 A Or become increased. 12 Q Okay. So you in -- in those 13 circumstances you don't want to give the 14 patient anything to decrease the 15 temperature; is that correct? 16 A No, just around that 38, something like 17 that, you don't -- you don't treat that. 18 Q Okay. And you don't want to reduce the 19 temperature -- 20 A Yeah, because -- 21 Q -- because you -- you want the 22 temperature to develop to see where it's 23 going? 24 A Yeah. 25 Q Okay. All right. Now, would you agree 154 1 that, if you give a patient Tylenol, that 2 suppresses or decreases the temperature? 3 A Yes. 4 Q Okay. When you give a patient -- a 5 patient ice to the back of the head, that 6 suppresses or decreases the temperature? 7 A Yes. 8 Q Okay. If you had given a patient 9 Tylenol -- strike that. 10 In this case Tylenol was given to 11 this patient at 1700. Okay. And the 12 reading we have here is 1925, which is 13 101.6. So the Tylenol -- the effect of the 14 Tylenol was to reduce the temperature. So 15 the temperature could have been higher; is 16 that correct? 17 MR. SCHOBERT: Objection. Go 18 ahead. 19 MR. JEFFERS: Objection. 20 A I'm not sure. 21 Q Did -- on Page 142, on the right-hand 22 side at 12:30 there's a temperature of 100.4 23 degrees Fahrenheit, or 38 degrees 24 centigrade; okay? 25 MR. SCHOBERT: I'm -- which 155 1 time again, Harley? 2 A Which time? 3 MR. SCHOBERT: I didn't hear 4 your time. I'm on the page. 12:30, is 5 that what you said? 6 MR. GORDON: Yes. 7 MR. SCHOBERT: Okay. 8 BY MR. GORDON: 9 Q Did you see that? 10 MR. SCHOBERT: 100.4. 11 A Yeah. 12 MR. SCHOBERT: All right. 13 BY MR. GORDON: 14 Q The 100.4 degree Fahrenheit is 38 15 degrees centigrade? 16 A Yeah. 17 Q Is that correct? 18 A Yes. 19 Q You were aware of that 100.4 degrees 20 Fahrenheit temperature when you saw the 21 patient at 12:20? 22 A I don't remember. 23 Q Okay. If you were aware of that 24 temperature of 100.4 degrees Fahrenheit, 25 would you -- would that have concerned you? 156 1 A I'm still close observation. 2 Q And what would you do to closely 3 observe the patient? 4 A Just -- just double-check in the -- 5 the -- in the four hours later check another 6 one. 7 Q To see if the temperature increased? 8 A See what's going on. 9 Q And if the temperature was, also, 38 10 degrees centigrade 4 hours later what would 11 -- what would you have done? 12 MR. SCHOBERT: Objection. 13 A Just observation. 14 Q Okay. Would you have, if you had known 15 of the 100.4 degrees Fahrenheit temperature, 16 which is 38 degrees centigrade, would -- if 17 the patient was given ice on the back of her 18 neck, would you have stopped that? 19 MR. SCHOBERT: Objection. Go 20 ahead. 21 A I would -- I would -- I would close 22 watch. 23 MR. JEFFERS: I didn't hear 24 the answer. 25 MR. GORDON: He would have 157 1 closely watched. 2 MR. SCHOBERT: Closely 3 watched. 4 BY MR. GORDON: 5 Q Would you have stopped ice packs on the 6 back of her neck? 7 MR. SCHOBERT: Objection. 8 A Again, I just close the watching. 9 Q In close watching her, you -- then you 10 would have permitted the use of ice packs on 11 her neck -- 12 MR. SCHOBERT: Objection. 13 BY MR. GORDON: 14 Q -- is that correct? 15 A If I know -- if I know she has ice 16 pack, I will -- I will -- I would stop 17 the -- the thing if I know. 18 Q All right. Why would you stop that? 19 A I know, if -- because that can -- can 20 affect the -- the -- the -- the -- the body 21 temperature. 22 Q Okay. If the patient was being given 23 Tylenol and you had a temperature of 100.4, 24 would you have stopped the Tylenol? 25 MR. SCHOBERT: Objection. 158 1 A If I know I would. I didn't know that. 2 Q But why would you stop the Tylenol? 3 A I didn't know she have a Tylenol. 4 Q No. Assume hypothetically that she was 5 being given Tylenol and she had a 6 temperature of 1 -- 100.4 degrees 7 Fahrenheit, you would have stopped the 8 Tylenol; is that correct? 9 MR. SCHOBERT: Objection. 10 A Theoretically you want to see what the 11 temperature, yes, you have stop. 12 Q Okay. 13 A But I didn't know this patient have the 14 -- on Tylenol. 15 Q The time of evaluation of a -- a 16 temperature, is that within 24 hours of the 17 time of the delivery, or the 24 hours of the 18 rupture of membranes? 19 A After deliver 24 hours. 20 Q Why do you use that time rather than 21 rupture of membranes? 22 A They just -- they just come from the -- 23 from the people's study. 24 Q Rupture of membranes, however, can be a 25 source of bacteria -- or you can have 159 1 bacteria going into the vaginal area and 2 uterus after you have rupture of membranes, 3 can you not? 4 A Yes. 5 Q This -- the temperature of 101.6 and 6 the later one of 100.4 is consistent with an 7 infection; is that correct? 8 MR. SCHOBERT: Objection. 9 MS. REINKER: Objection. 10 A I'm not sure. 11 BY MR. GORDON: 12 Q Why aren't you sure? 13 A Because that can be happen, elevated 14 temperature, after deliver within 24 hour. 15 Q How do you know -- 16 A And then clinically -- 17 MR. SCHOBERT: Go ahead, 18 Doctor. 19 A Clinically I didn't see any -- any sign 20 of infection as I check her again. 21 Q And the only thing you were looking for 22 was foul smelling odor? 23 A Foul smell and tenderness of the 24 uterus. 25 Q Would you agree, generally speaking, 160 1 that one of the potential causes of a 2 postdelivery fever, even within 24 hours, is 3 an infection of the uterus? 4 A Not necessarily. 5 Q But it can be; is that correct? 6 A Can be. 7 Q And not all the fevers that you have in 8 a postpartum lady, within 24 hours after 9 delivery, are caused by the natural course 10 of the labor and delivery process; is that 11 correct? 12 A Ask your question again. 13 MR. GORDON: Why don't you 14 repeat the question? 15 _ _ _ _ _ 16 (Question read back.) 17 _ _ _ _ _ 18 A Not necessarily. 19 Q But possibly; is that correct? 20 A Possibly. 21 Q Okay. What, specific -- 22 MR. JEFFERS: Harley's the 23 master of rhetorical questions. 24 MR. GORDON: Now you lost 25 my train of thought. 161 1 MR. SCHOBERT: Just to give 2 you some indication, my watch says 3 about 1:25, and I am very sincere, I 4 will leave at about ten minutes to two. 5 I have to be -- 6 MR. PARIS: You said two. 7 MR. SCHOBERT: I have to be 8 in Wadsworth at 3:00. 9 MR. GORDON: Then -- we're 10 not gonna argue. 11 MR. SCHOBERT: I'm not trying 12 to be bad about it, I'm just saying I 13 have to be there for an important 14 family appointment. 15 MR. GORDON: I understand 16 that. 17 MR. SCHOBERT: Okay. 18 MR. GORDON: And I 19 anticipate we're not going to finish 20 then, okay, but it's not -- 21 MR. SCHOBERT: That's fine. 22 I just wanted to -- we just took a 23 brief moment, I just wanted to make 24 sure you were aware of that. 25 MR. GORDON: No, I 162 1 understand that. 2 MR. SCHOBERT: Okay. 3 MR. GORDON: I'm thankful 4 that you clarified that. 5 MR. SCHOBERT: Okay. 6 MR. GORDON: I appreciate 7 that so I can know what I have to do. 8 Okay. 9 BY MR. GORDON: 10 Q Now let's go to another area. Okay. 11 Let's turn to the lab values, the complete 12 blood count that is found on Page 42. Do 13 you have that in front of you, Doctor? 14 MR. JEFFERS: Page what? 15 A Yes. 16 MR. GORDON: Page 42. 17 MR. JEFFERS: Okay. 18 BY MR. GORDON: 19 Q Okay. We took Nurse Prokop's 20 deposition, are you aware of that? 21 A Yes. 22 Q Did you read her deposition? 23 A No. 24 Q Okay. She testified that she -- you 25 would have been aware of the complete blood 163 1 count, including the white blood count, as 2 well as the components of the manual 3 differential? 4 MR. SCHOBERT: I'm going to 5 object. I'm not sure that was her 6 exact testimony -- 7 MR. GORDON: Okay. 8 MR. SCHOBERT: -- but why 9 don't you ask him to assume that -- 10 MR. GORDON: All right. 11 MR. SCHOBERT: -- instead of 12 telling him that's what the testimony 13 was? 14 BY MR. GORDON: 15 Q Do you -- were you told about the 16 complete blood count, including the manual 17 differential, when you saw Mrs. Williams at 18 12:25 a.m.? 19 A I do not remember. 20 Q Okay. Does that mean you don't deny 21 that you were aware of the complete blood 22 count, as well as the manual differential -- 23 A Yes -- 24 Q -- at that time? 25 A -- I don't remember. 164 1 Q So you can't deny that? 2 MR. SCHOBERT: Well -- 3 A I told you, I cannot remember. 4 MR. SCHOBERT: Harley, just 5 accept his statement. Jesus. 6 BY MR. GORDON: 7 Q Were you -- were you provided at 12:25 8 a.m. a printout of the complete blood count, 9 including the manual differential by Nurse 10 Prokop? 11 A No. 12 Q And how do you know that? 13 A I -- I didn't see that. I didn't -- 14 ask your question. I don't remember she 15 told me anything. I didn't see anything, 16 the report of the -- of the complete blood 17 count. 18 Q So it's your testimony today that you 19 don't recall receiving any information, 20 either looking at it yourself or receiving 21 information from Nurse Prokop verbally or by 22 a printout of the complete blood count -- 23 A Yes. 24 Q -- including the manual differential? 25 A Yes. 165 1 Q Did you ask to see the complete blood 2 count? 3 A I do not remember. 4 Q Okay. Now, let's go over the complete 5 blood count. Looking at Page 42, and we're 6 gonna look at the one at 1700 or 5:00, and 7 the one at 2300, or 12 -- 11:30 p.m. Do you 8 see those two times? 9 MR. JEFFERS: 2330? 10 MR. GORDON: Yeah, 2330. 11 BY MR. GORDON: 12 Q Do you see those two times? 13 A Yes. 14 Q Okay. At June 25th at 1700 you have a 15 white blood count of 16.1; is that correct? 16 A Yeah. 17 Q And then you now have a white blood 18 count of 4.6, a drop in the white blood 19 count; is that correct? 20 A Yes. 21 Q Am I correct then, you have a drop in 22 the white blood count from 16.1 to 4.6, a 23 physician should consider that the patient 24 has an infection? 25 A Not necessarily, because she's still 166 1 within normal, 4 -- 4.0 to 10.8 is still 2 within normal limit. 3 Q All right. Then what would be the 4 potential causes of the drop in the white 5 blood count from 16.1 to 4.6? 6 A This is -- this checking, we do not 7 know because a lot of time after patient 8 with the IV fluid can be dilute, the 9 concentration of the WBC. That's why this 10 drop, these, what the cause I can tell you 11 -- I cannot tell you exactly what the cause 12 for that. But I -- I can tell you that the 13 4.6 still is normal, this is normal here, is 14 4.0 to 10.8. 15 Q To answer my question, you say one of 16 the causes of the drop of the white blood 17 count from 16.1 to 4.6 is that the blood is 18 being diluted by the fluids that were -- 19 A Yes -- 20 Q -- that were -- 21 A -- she have the fluid the whole day. 22 Can be -- this I'm not -- one of the -- the 23 cause, but I'm not exactly what the cause of 24 that. But according to -- to this report 25 here, 4.6 still within the normal -- the 167 1 norm -- normal. 2 Q What other potential causes could there 3 have been of the drop in the white blood 4 cell count from 16.1 to 4.6, other than 5 dilution of the blood? 6 A I can't tell, because multiple factor. 7 Q You what? 8 A Multiple factor, a lot of factor. I 9 cannot specific which is cause for that. 10 Q What other factors? 11 A For instance, virus infection, or 12 bacterial infection can be -- can be caused 13 like that, but I'm not specific -- I'm not 14 specific because of that from the infection. 15 Q And then, in your opinion, what was the 16 cause of the drop in white blood count from 17 16.1 to 4.6? 18 A I can't tell -- 19 MR. SCHOBERT: Objection. 20 A -- because -- 21 Q Knowing -- 22 A -- because clinically everything is no 23 sign of infection. 24 Q Okay. 25 A I -- I couldn't -- I couldn't tell you. 168 1 Q Knowing that the patient died from 2 sepsis and septic shock, taking that into 3 account, in your opinion, would the drop in 4 the white blood count from 16.1 to 4.6 be -- 5 one of the potential causes be infection? 6 MR. SCHOBERT: Objection. 7 MR. JEFFERS: Objection. 8 A At that time, that report, 9 concentration like that, I -- I can't tell 10 you what the -- what the cause of that drop, 11 the white blood cell, but 4.6 still within 12 normal limits in -- in -- in here, report. 13 Q Again, would you repeat -- let me 14 repeat the question. 15 Taking into account what we have 16 on the autopsy protocol and coroner's 17 verdict in which this patient died from 18 sepsis and septic shock syndrome, taking 19 that into account, knowing that, in your 20 opinion, could the drop of the white blood 21 count from 16.1 to 4.6, one of the potential 22 causes be that she was infected? 23 MR. JEFFERS: Objection. 24 BY MR. GORDON: 25 Q She had an infection at the time the 169 1 blood was drawn at 2330? 2 MR. JEFFERS: Objection. 3 MR. SCHOBERT: Objection. 4 Go ahead, Doctor. 5 A I'm not quite sure again. I cannot 6 specific -- that -- that white cell drop is 7 exactly -- is exactly from this kind of a 8 infection. I'm not quite sure at that time, 9 because -- because time to time dynamic 10 changes. I am not -- not -- not quite sure, 11 because of this infection, that this was 12 caused by the infection, because still 13 within normal. 14 MR. SCHOBERT: You've given 15 your answer. 16 BY MR. GORDON: 17 Q All right. Now let me change the 18 question. Taking into account that the 19 patient died from sepsis and she -- and also 20 septic shock syndrome, is there a 21 possibility, Doctor, that the drop in white 22 blood count from 16.1 to 4.6 was caused by 23 an infection? 24 MR. JEFFERS: Object. 25 MR. SCHOBERT: Object. Go 170 1 ahead. 2 A I'm not quite -- quite sure for that, 3 because that is period of time. 4 Q All right. Now here, on Page 42, 5 looking under, "Bands," we have 52 bands; is 6 that correct? 7 A Yes. 8 Q And at 1700 we have 13 bands; is that 9 correct? 10 A Yes. 11 Q You also have at 1700 neutrophils of 75 12 and now at 2330 you have neutrophils of 33; 13 is that correct? 14 A Yes. 15 Q Okay. Now with respect to the band 16 count at 2330 of 52, that's abnormal? 17 A That's abnormal. 18 Q And the band count of 52, Doctor, 19 indicates that the patient had an infection? 20 A Yes, can be -- can be -- can be -- can 21 be a lot of cause. Can be like a virus 22 infection. Can be -- can be bacterial 23 infection, but I'm not sure this patient is 24 because of that -- low is caused by that. 25 Q All right. And if -- if you had known 171 1 about the bands of 52, when you saw the 2 patient at 12:25 a.m. would you have taken 3 any action, in terms to determine the cause 4 of the elevated band count? 5 MR. SCHOBERT: Objection. Go 6 ahead, you can answer. 7 A If I know this report, everything, I 8 would call attending doctor, report to him, 9 get the order, see what need to be done. 10 Q Okay. And if the doctor -- if the 11 attending doctor, after hearing this 12 information about the band count, if he had 13 ordered antibiotics, you would have given 14 the patient antibiotics? 15 MS. REINKER: Objection. 16 MR. SCHOBERT: Objection. Go 17 ahead. You can answer. 18 A If doctor -- attending doctor want to 19 put on antibiotic, yes, he order. He know 20 -- he should know -- if he know everything, 21 he -- he order antibiotic, he's primary take 22 care of the patient. Okay. 23 Q Okay. And if there was not an 24 attending available, for -- for what reason, 25 you would have ordered antibiotics if you 172 1 had the band count of 52; is that correct? 2 MR. SCHOBERT: Objection. 3 MS. REINKER: Objection. 4 A Your question is again? I just 5 couldn't get it. Can you, please -- 6 Q If, for whatever reason, an attending 7 physician was unavailable, okay, and you 8 were aware of the band count of 52, you 9 yourself would have ordered antibiotics for 10 the safety of this patient -- 11 MR. SCHOBERT: Objection. 12 BY MR. GORDON: 13 Q -- is that correct? 14 MS. REINKER: Objection. 15 A I will further evaluation to do the 16 blood culture, the test, watch closely if 17 further changes, and then I will start do 18 some antibiotic treatment. 19 Q But not at that time? 20 A If -- if I -- your question ask me, if 21 attending not available, I would do -- do 22 the -- do the -- more study. 23 Q You would order tests and studies, then 24 give the patient antibiotics? 25 MR. SCHOBERT: Objection. 173 1 That's not what he stated. 2 MR. JEFFERS: Objection. He 3 said he'd watch the changes. 4 A I will -- I will -- I will watch, you 5 know. Okay. And then follow up, see what's 6 going on. 7 Q And not give the patient antibiotics? 8 MR. SCHOBERT: Objection. He 9 stated that. 10 MR. PARIS: I want a clean 11 question and a clean answer without any 12 interruptions here. 13 MR. JEFFERS: Wait, hold on. 14 If it's -- 15 MR. SCHOBERT: You can't 16 instruct me not to interrupt, David. 17 MR. PARIS: I'm not. You 18 can object all you want. I would just 19 like a clean question and a clean 20 answer. 21 THE WITNESS: I -- 22 MR. SCHOBERT: Wait, wait, 23 wait. No, you're -- you -- you just be 24 quiet. 25 MR. PARIS: This videotape 174 1 is a mess, fellas, and -- and -- and 2 it'll speak for itself, but for once, 3 I'm only interjecting one time, I'd 4 like a clean question and a clean 5 answer. 6 MR. JEFFERS: I think he 7 gave a very extensive clean answer. 8 MR. PARIS: No, no, no, 9 but -- 10 MS. REINKER: I think the 11 doctor's answered this. 12 MR. GORDON: I don't think 13 so, either, but answer -- 14 MR. PARIS: Well -- 15 BY MR. GORDON: 16 Q If you were aware of this band count of 17 52 and the -- and the attending physician 18 was not available, for whatever reason, 19 would you have given antibiotics right then 20 and there or, instead, continued to evaluate 21 the patient? 22 MR. SCHOBERT: Objection. 23 Asked and answered. 24 MS. REINKER: Objection. 25 You're saying based on the bands alone? 175 1 MR. GORDON: Yeah. 2 A I watch further evaluation. 3 Q Okay. That's all. All right. And 4 what's -- what, specifically, would you have 5 done to evaluate the patient -- 6 MR. SCHOBERT: Objection. 7 BY MR. GORDON: 8 Q -- under those circumstances? 9 MR. SCHOBERT: Objection. 10 MR. JEFFERS: Objection. 11 MR. SCHOBERT: Asked and 12 answered. Go ahead. 13 MR. JEFFERS: Objection. 14 A Conduct blood culture and check. 15 That's it. The most -- most important, the 16 blood culture specific any -- any -- any 17 infection. 18 Q Would you have ordered a gram stain? 19 MS. REINKER: May I ask of 20 what? 21 MR. GORDON: What? 22 MS. REINKER: Of what, a 23 gram stain of what? 24 MR. GORDON: Of the blood. 25 A gram stain of the blood. 176 1 MR. SCHOBERT: Objection. Go 2 ahead. 3 MR. JEFFERS: Strictly on 4 52? 5 MR. GORDON: Yeah. 6 A You see, clinically it's not -- not -- 7 not in -- clinically not infection. Okay. 8 I just watch -- watch her very, very 9 closely. 10 Q Okay. At what point would you have 11 ordered antibiotics in this patient? 12 MR. SCHOBERT: Objection. Go 13 ahead. 14 A If -- if I -- I find out -- if I find 15 -- found out the clinical side -- side of 16 this kind of drop in blood pressure, and 17 breathing acidosis, in that situation I 18 would -- I would start the antibiotic. 19 Before that I have to evaluation, but in 20 the -- in -- in -- in the clinical symptom 21 appear, that situation, as I said, you know, 22 acidosis, breathing increased, blood 23 pressure drop, at that point I'm going to -- 24 to start antibiotic. 25 Q Now, on Page 42 the neutrophils are 33; 177 1 that's abnormal? 2 MR. SCHOBERT: At 2330 he's 3 looking at. 4 BY MR. GORDON: 5 Q Yeah, 2330, that's abnormal, the 33 6 neutro -- neutrophils? 7 A This is -- is still very close to 8 normal, just very -- very close to it -- to 9 the normal, 41, 33. 10 Q Okay. So in your -- if you had known 11 of the neutrophil value of 33 you would 12 consider that close to normal? 13 A Yeah, very close to normal. 14 Q Okay. 15 A A variation. 16 Q Now, there is 6 metamyelocytes, is that 17 normal or abnormal, at 2330? 18 A Six metamyelocyte, I think that is -- 19 that is normal. 20 Q Okay. Now, you would agree that, based 21 upon the bands of 52 at 2330, the patient 22 had a left shift? 23 A Yes. 24 Q Now, their platelet count is 114; is 25 that correct? 178 1 MR. SCHOBERT: At 2330, 2 again? 3 MR. GORDON: 2330. 4 A Yes. 5 Q And normal is 130 to 400, is that for a 6 normal person who's not postdelivery? 7 A You see, this patient have a 8 preeclampsia, the blood count -- blood -- 9 blood type low, we don not know whether it's 10 from the preeclampsia or something else. So 11 that's why this -- this low, because her 12 underlying, this kind of a preeclampsia 13 disease. 14 Q All right. What is the normal range for 15 -- of the platelet count for a postdelivery 16 woman? 17 A In -- in here, see, normally 130 and 40 18 -- 130 or 400. 19 Q Okay. What is the normal range of a 20 platelet for a postdelivery woman who has 21 preeclampsia? 22 A Preeclampsia is not -- it's not 23 necessarily low. Can be borderline. Can go 24 either way. See, this is not a specific, 25 just one of the indicator. 179 1 Q Can the blood -- strike that. 2 Can the platelet count of 114 at 2330 3 be a sign of infection? 4 MR. JEFFERS: Object. 5 A She had this kind of preeclampsia. 6 Okay. We can't tell exactly what the cause 7 for that, that it be low, this kind of 8 platelet count. 9 MR. GORDON: Just one 10 minute. I want to take a short break 11 and see, maybe we'll ressess it here. 12 VIDEOGRAPHER: Off the 13 record. 14 _ _ _ _ _ 15 (Deposition adjourned at 1:45 p.m.) 16 _ _ _ _ _ 17 18 19 20 21 22 23 24 25 180 1 CERTIFICATE 2 3 The State of Ohio, ) 4 ) SS: 5 County of Cuyahoga. ) 6 7 I, Luann Z. Cawley, RPR, a Notary 8 Public within and for the State of Ohio, 9 duly commissioned and qualified, do hereby 10 certify that the within-named witness, 11 TUNG-CHANG HSIEH, M.D., was by me first duly 12 sworn to testify to the truth, the whole 13 truth and nothing but the truth in the cause 14 aforesaid; that the testimony then given by 15 the above-referenced witness was by me 16 reduced to stenotypy in the presence of said 17 witness; afterwards transcribed, and that 18 the foregoing is a true and correct 19 transcription of the testimony so given by 20 the above-referenced witness. 21 I do further certify that this 22 deposition was taken at the time and place 23 in the foregoing caption specified. 24 25 181 1 I do further certify that I am not a 2 relative, counsel or attorney for either 3 party, or otherwise interested in the event 4 of this action. 5 IN WITNESS WHEREOF, I have hereunto set 6 my hand and affixed my seal of office at 7 Cleveland, Ohio, this 5th day of December, 8 A.D., 2000. 9 10 11 ____________________________________ 12 Luann Z. Cawley, RPR, Notary Public 13 Within and for the State of Ohio 14 My Commission Expires 8-8-05 15 _ _ _ _ _ 16 17 18 19 20 21 22 23 24 25