0001
 1   THE STATE of OHIO,   )
 2   COUNTY of CUYAHOGA.  )  SS:
 3                    - - - - -
 4          IN THE COURT OF COMMON PLEAS
 5                    - - - - -
 6   MARY WILLIAMS, etc.,      )
 7                plaintiff,   )
 8         vs.                 ) Case No.
 9                             ) 406184
10   PARMA COMMUNITY GENERAL   )
11   HOSPITAL, et al.,         )
12                defendants.  )
13                    - - - - -
14             Videotaped deposition of
15   MARY HEATHER HULVALCHICK, R.N., a witness
16   herein, called by the plaintiff as if upon
17   cross-examination, and taken before David J.
18   Collier, RPR, Notary Public within and for
19   the State of Ohio, pursuant to agreement of
20   counsel, and pursuant to the further
21   stipulations of counsel herein contained, on
22   Tuesday, the 30th day of January, 2001, at
23   2:16 p.m., at Parma Community General
24   Hospital, City of Parma, County of Cuyahoga
25   and the State of Ohio.
0002
 1   APPEARANCES:
 2   ON BEHALF OF THE PLAINTIFF:
 3   Harlan Gordon, Esq.
     David Paris, Esq.
 4   Nurenberg, Plevin, Heller & McCarthy
     Standard Building - First Floor
 5   Cleveland, Ohio  44113
     (216) 621-2300
 6   
 7   ON BEHALF OF THE DEFENDANT PARMA COMMUNITY
     GENERAL HOSPITAL:
 8   
     John W. Jeffers, Esq.
 9   Weston, Hurd, Fallon, Paisley & Howley
     2500 Terminal Tower
10   Cleveland, Ohio  44113
     (216) 241-6022
11   
12   ON BEHALF OF THE DEFENDANTS WILLIAM HAHN,
     M.D. and THE WOMEN'S WELLNESS CENTER:
13   
     Patrick J. Murphy, Esq.
14   Bonezzi, Switzer, Murphy & Polito
     1400 Leader Building
15   Cleveland, Ohio  44114
     (216) 875-2767
16   
17   ON BEHALF OF THE DEFENDANTS TUNG-CHANG
     HSIEH, M.D. and PHYSICIAN STAFFING:
18   
     Jeffrey E. Schobert, Esq.
19   Hanna, Campbell & Powell
     3737 Embassy Parkway
20   Akron, Ohio  44334
     (330) 668-8960
21   
22   ALSO PRESENT:
23   Monica Keile
24   A. David Tackla, Videographer
25   
0003
 1   
                       I N D E X
 2   
 3   WITNESS:      MARY HEATHER HULVALCHICK, R.N.
 4                                           PAGE
 5   Cross-examination by Mr. Gordon            5
 6   Cross-examination by Mr. Murphy           87
 7   Recross-examination by Mr. Gordon         94
 8   
                        - - - - -
 9   
10                INDEX OF OBJECTIONS
11   BY MR. JEFFERS:
12      PAGE/LINE      PAGE/LINE      PAGE/LINE
13        26/19          65/25          79/10
          27/2           67/1           80/9
14        28/21          68/18          81/1
          57/8           68/21          82/7
15        58/5           77/1           82/25
          62/24          77/19          86/5
16        65/10          77/22          91/6
17   
     BY MR. MURPHY:                   PAGE/LINE
18   
                                        44/5
19                                      44/23
20   BY MR. SCHOBERT:                 PAGE/LINE
21                                      57/10
                                        58/4
22                                      62/9
                                        62/25
23   
24   
25   
0004
 1          MARY HEATHER HULVALCHICK, R.N.
 2   of lawful age, having been first duly sworn,
 3   as hereinafter certified, was examined and
 4   testified as follows:
 5                    - - - - -
 6             MR. GORDON:       Are we ready?
 7             Good afternoon.  My name is Harley
 8   Gordon.  Seated next to me is my partner,
 9   David Paris.  We represent the family of
10   Mary Elizabeth Williams.  Today I'll be
11   asking you questions primarily regarding
12   your involvement in the care and treatment
13   of Mary Williams at Parma Community General
14   Hospital.  During the course of my
15   questioning, please make sure that before
16   you answer any of my questions, that you
17   understand the question.  Do you understand
18   that?
19             THE WITNESS:      Um-hum.  Yes, I
20   do.
21             MR. GORDON:       Okay.  And as
22   you just did, you have to answer your
23   questions out loud.
24             THE WITNESS:      All right.
25             MR. GORDON:       If you don't
0005
 1   understand any question, don't answer and
 2   tell me to rephrase it or repeat it or
 3   whatever.  Do you understand that?
 4             THE WITNESS:      Yes.
 5             MR. GORDON:       And if you want
 6   to take a break, just stop us and we'll take
 7   a break, okay?
 8             THE WITNESS:      Okay.  Yes.
 9                    - - - - -
10                CROSS-EXAMINATION
11   BY MR. GORDON:
12   Q    First off, just briefly regarding your
13   background, could you tell us your full
14   name, please?
15   A    Okay.  Mary Heather Hulvalchick.
16   Q    And your maiden name?
17   A    Was Blakemore.
18   Q    And where do you presently live?
19   A    Parma, Ohio.
20   Q    What's your home address?
21   A    It's 10581 Erin Drive, and that's
22   44130.
23   Q    Did you live there in 1999?
24   A    Yes.
25   Q    What is your date of birth?
0006
 1   A    December 10th, 1969.
 2   Q    Where were you born?
 3   A    Cleveland.
 4   Q    Are you married?
 5   A    Yes.
 6   Q    Is your husband in the medical field?
 7   A    No, he is not.
 8   Q    Do you have any children?
 9   A    Yes.
10   Q    How many children do you have?
11   A    I have two children.
12   Q    Where did you graduate from
13   high school?
14   A    Brunswick High School, Brunswick, Ohio.
15   Q    In what year was that?
16   A    1988.
17   Q    Then at some point did you take college
18   courses to become a nurse?
19   A    Yes, I did.
20   Q    When did that take place?
21   A    1988 through 1994.
22   Q    And where did you take your courses to
23   become a nurse, what -- what institution?
24   A    I started at University of Akron and
25   then finished up at Kent State.
0007
 1   Q    So you graduated approximately the
 2   spring of 1994?
 3   A    Yes.
 4   Q    The degree that you received from Kent
 5   State University, is that a four year
 6   degree?
 7   A    Yes, Bachelor's of Science in nursing.
 8   Q    Then during the summer you sat for --
 9   in order to become a registered nurse?
10   A    Yes.
11   Q    And did you pass it on your first
12   attempt?
13   A    Yes.
14   Q    Okay.  Then you've been a registered
15   nurse in the State of Ohio since 1994 to the
16   present?
17   A    Yes.
18   Q    When did you begin your employment with
19   Parma Community General Hospital?
20   A    In September of 1997.
21   Q    And have you been continuously employed
22   as a nurse with Parma Community General
23   Hospital since September of 1997?
24   A    Yes.
25   Q    Before you began working for Parma
0008
 1   Community General Hospital, did you work in
 2   any other hospitals?
 3   A    Yes.
 4   Q    What hospital or hospitals did you work
 5   in?
 6   A    Hillcrest Hospital.
 7   Q    For what time frame?
 8   A    From 1995, September of 1995, through
 9   when I started here, September of 1997.
10   Q    At Hillcrest Hospital, did you work as
11   an obstetrical nurse?
12   A    I worked on postpartum.
13   Q    Postpartum.  Postpartum means the time
14   frame after the delivery of the baby --
15   A    Yes.
16   Q    -- is that correct?
17             Then in terms of your career with
18   Parma Community General Hospital, have you
19   likewise worked in postpartum?
20   A    I worked all three areas.
21   Q    Okay.  What -- those three areas would
22   consist of, one, postpartum?
23   A    Yes.
24   Q    The other is labor and delivery?
25   A    Labor and delivery and then nursery
0009
 1   also.
 2   Q    Okay.  Are you a member of any
 3   professional associations in nursing?
 4   A    No.
 5   Q    Have you ever taught nursing?
 6   A    No.
 7   Q    When you took care of Mary Williams,
 8   you were acting as an employee of Parma
 9   Community General Hospital; is that correct?
10   A    Yes.
11   Q    Have you ever testified before?
12   A    No.
13   Q    This is the first time you ever had
14   your deposition --
15   A    Yes.
16   Q    -- taken?  Okay.
17             In order to prepare your --
18   prepare yourself for your deposition today,
19   did you look at any materials?
20   A    The chart.  I reviewed the chart and
21   read some articles about what depositions
22   were about.
23   Q    You --
24             MR. JEFFERS:      These are
25   articles provided by counsel about what to
0010
 1   anticipate at deposition.
 2             MR. GORDON:       Okay.
 3             MR. JEFFERS:      All nice about
 4   you.
 5             MR. GORDON:       Thank you.
 6   Q    Then, to go on further, did you read
 7   any depositions or deposition summaries --
 8   A    No.
 9   Q    -- of any individuals?
10   A    No.
11   Q    So the extent of your preparation for
12   this deposition in terms of the facts in the
13   case is reviewing the chart --
14   A    Yes.
15   Q    -- is that correct?
16   A    Yes.
17   Q    Okay.  And before the deposition I
18   indicated to you that we have excerpted
19   certain portions of the chart and we've
20   marked them as Exhibit 5, and I noted for
21   your reference that there are page numbers
22   at the bottom of each page; is that correct?
23   A    Yes.
24   Q    Okay.  So we're going to be referring
25   to that momentarily.
0011
 1             Are you presently still employed
 2   in -- in Parma Community General Hospital in
 3   postpartum?
 4   A    Yes.
 5   Q    All right.  We have reviewed the chart
 6   relating to Mary Williams, and the chart
 7   indicates records that you prepared in the
 8   chart; am I correct?
 9   A    Yes.
10   Q    Okay.  We know that you wrote nurse's
11   notes; is that correct?
12   A    Yes.
13   Q    And also you put entries regarding
14   vital signs in your assessment of this
15   patient; is that correct?
16   A    Yes.
17   Q    Taking away the chart in which you
18   wrote entries, did you prepare any personal
19   notes regarding your involvement of -- in
20   the care of Mary Williams?
21   A    No.
22   Q    So whatever you wrote regarding Mary
23   Williams, the only thing that exists today
24   is what is found in the chart?
25   A    Yes.
0012
 1   Q    Okay.  In June of 1999, what hours did
 2   you work?
 3   A    I worked from 7:00 a.m. to 7:00 p.m.
 4   Q    And what days of the week did you
 5   typically work?
 6   A    Can you rephrase the question?
 7   Q    What days of the week did you work
 8   in -- in June of 1999?  In other words, did
 9   you work weekdays or did you also work
10   weekends?
11   A    I worked both, weekdays and weekends.
12   Q    The records of Mary Williams indicate
13   that you first saw Mary Williams on
14   June 26th, 1999.  Are the records correct in
15   that regard?
16   A    No.
17   Q    Why is that incorrect?
18   A    I took care of her in labor, the date
19   is -- was a Thursday, it was the Thursday
20   before the 26th, so the 23rd, I saw her in
21   labor.  I took care of her in labor.
22   Q    Okay.  We have she was admitted to
23   Parma Community General --
24   A    Maybe it was the 24th.
25   Q    -- hospital on June 24th, okay?
0013
 1   A    Yes.
 2   Q    So does that refresh --
 3   A    That was the 24th.  I'm sorry.  That's
 4   correct.  The 24th.
 5   Q    Does that refresh your recollection?
 6   A    Yes.
 7             MR. JEFFERS:      You told her to
 8   try to do it by memory --
 9             THE WITNESS:      Yeah.
10             MR. JEFFERS:      -- and not look
11   at the chart yet, so she's not looking at
12   the chart to ascertain, you know, what she's
13   testifying to right now.
14             MR. GORDON:       Right.  I
15   understand.
16   Q    And June 24th is a Thursday.
17   A    Yes.
18   Q    And then June 25th is a Friday and June
19   26th is a Saturday.  So for -- that's for
20   your reference.
21             So to go back where we left off,
22   in terms of the labor and delivery, just
23   generally speaking, did you participate in
24   both the labor and delivery or one or the
25   other or both?
0014
 1   A    Just the labor.
 2   Q    Okay.  Then on June 24th, would you
 3   have also worked 7:00 a.m. to 7:00 p.m. that
 4   day?
 5   A    No, actually I worked from 7:00 p.m.
 6   until 7:00 a.m.
 7   Q    Okay.  So according to my records you
 8   were there then when she had the spontaneous
 9   rupture of membranes at 10:45 p.m.; is that
10   correct?
11   A    Yes, that is correct.
12   Q    However, you were not there for the
13   delivery which took place on Friday,
14   June 25th, approximately 9:21 a.m.?
15   A    That is correct.  I was not there for
16   the delivery.
17   Q    All right.  And was Mrs. Williams a
18   cooperative patient?
19   A    Yes.
20   Q    Was she looking forward to having the
21   baby?
22   A    Yes.
23   Q    Okay.  Was her husband with her?
24   A    Yes.
25   Q    Then let's turn to Friday, June 25th,
0015
 1   1999.  Did you work that day?
 2   A    Friday the 25th.  No, I did not.
 3   Q    Did you have any contact at all with
 4   Mary Williams or her care on June 25th,
 5   1999?
 6   A    No, I did not.
 7   Q    Excuse me.
 8             Then the next involvement you had
 9   with Mary Williams then was on Saturday,
10   June 26th, 1999; is that correct?
11   A    Yes.
12   Q    Now, your shift began at 7:00 a.m., but
13   did you arrive at the hospital and go to --
14   strike that.
15             Where was Mary Williams confined
16   on June 26th, 1999?  Was she still on the
17   labor and delivery floor?
18   A    I can't answer that with yes or no.
19   Our floor is -- all three areas consist on
20   the same floor.
21   Q    Okay.  So on the third floor would be
22   labor and delivery, postpartum and the
23   nursery?
24   A    Yes.
25   Q    Okay.  Then what time did you report to
0016
 1   work on June 26th, 1999?
 2   A    7:00 a.m.
 3   Q    Now, at the time you reported to work,
 4   what nurse was taking care of Mary Williams?
 5   A    On June 26th?  Is that the day you're
 6   asking me?
 7   Q    Yes, when you reported to work on
 8   June 26th, 1999 at 7:00 a.m., what nurse was
 9   taking care of her at that time?
10   A    Paulette Prokop.
11             MR. MURPHY:       What was the
12   last name?  I'm sorry.
13             THE WITNESS:      Prokop.
14             MR. JEFFERS:      P-R-O-K-O-P.
15             MR. MURPHY:       Thank you.
16   Q    Am I correct that there was a
17   changeover between Paulette Prokop and you
18   in terms of the care of Mary Williams, or --
19   A    Yes.
20   Q    Okay.  That's called a changeover
21   period, or what do you call it at Parma
22   Community general?
23   A    Report.
24   Q    Report.  Report for -- would have taken
25   place at what time that day?
0017
 1   A    Approximately 7:00 a.m.
 2   Q    7:00 a.m.
 3             And during -- and how long did
 4   that report period last?
 5   A    It lasts approximately a half hour.
 6   Q    Okay.  And during that half an hour
 7   period, you would receive information
 8   verbally, orally, from Ms. Prokop regarding
 9   the patients that she had taken care of?
10   A    Yes.
11   Q    How many patients had she taken care
12   of?
13   A    That was her only patient.
14   Q    Okay.  So for a half an hour you went
15   over with Paulette Prokop the care that she
16   had rendered to Mary Williams?
17   A    Not necessarily.  We get report on the
18   whole floor.  They all sit and report around
19   a table.  We all get report on the whole
20   floor.
21   Q    Oh, I see.  In the event you have to
22   take care of another patient --
23   A    Yes.
24   Q    -- is that right?  Okay.
25             But Paulette Prokop presented the
0018
 1   care that she had afforded Mary Williams
 2   during this meeting?
 3   A    Yes.
 4   Q    And who attended that meeting?
 5   A    Oh, boy.
 6   Q    Without names, were the -- were the --
 7   the other nurses --
 8   A    Nurses --
 9   Q    Okay.
10   A    -- that were working on the floor.
11   Q    Would the charge nurse or supervisor be
12   also in that meeting?
13   A    Just the charge nurse.
14   Q    And who was that?
15   A    I do not recall.
16   Q    All right.  In as great a detail as
17   possible, can you tell me what Paulette
18   Prokop said regarding her care of Mary
19   Williams at this report meeting?
20   A    I can't give you specifics.  I mean, I
21   can generally tell you what we give report
22   about.  I don't recall specifics.
23   Q    Okay.  So today you can't tell me what
24   indeed Paulette Prokop said regarding Mary
25   Williams during this report period; is that
0019
 1   correct?  Is --
 2   A    Yes.
 3   Q    Okay.  Then --
 4   A    That's right.
 5   Q    -- let's change the question.
 6   A    Okay.
 7   Q    Customarily, in this type of patient,
 8   what is customarily discussed at the time of
 9   report?
10   A    We would discuss her actions, how she's
11   acting, her vital signs, if they're
12   unusual.  Any unusual circumstances we would
13   talk about, especially if there's lab work.
14   Q    Would you customarily discuss
15   communications with a physician?
16   A    Yes.
17   Q    Would you discuss customarily physician
18   orders regarding a patient?
19   A    Yes.
20   Q    If there was vaginal bleeding of the
21   patient, would that have been discussed
22   during the report period?
23   A    Not necessarily.
24   Q    Okay.  If the patient had become
25   restless or anxious, would that have been
0020
 1   discussed customarily during report?
 2   A    Yes.
 3   Q    And why?
 4   A    Because that's unusual for a patient of
 5   ours.
 6   Q    Why is that unusual?
 7   A    Because our patients are all alert and
 8   oriented.  It's unusual to have a patient
 9   confused on our floor.
10   Q    So then if indeed Mary Williams was
11   restless and anxious sometime during Nurse
12   Prokop's shift, that would customarily have
13   been discussed at the time of report?
14   A    Yes.
15   Q    I know there's a reference to -- in the
16   records to a Kardex.  What is a Kardex?
17   It's K-A-R-D-E-X.
18   A    The Kardex is where we put -- combine
19   all our information about a patient.
20   Q    Okay.
21   A    Time of delivery, boy or girl, weight,
22   breast feeding or bottle feeding,
23   pediatricians and such.
24   Q    How about orders by a physician?
25   A    Not necessarily.
0021
 1   Q    How about lab values?
 2   A    No.
 3   Q    Do you know whether or not the -- the
 4   Kardex regarding Mary Williams is still in
 5   existence?
 6   A    I don't recall if it is.  I don't --
 7   Q    The Kardex at that time, was it
 8   prepared in writing or on a computer?
 9   A    In writing.
10   Q    Now, could you please turn to page 42?
11   It's under labs.  Lab reports.  Do you have
12   that in front of you?
13   A    Yes.
14   Q    Okay.  During Ms. Prokop's shift there
15   were two sets of hematology labs, one at
16   2330 and the other one at 5:30.  Do you see
17   that?
18   A    Yes.
19   Q    Would these lab results, would they
20   have, according to custom and practice, been
21   discussed at -- at the time of report?
22   A    Customarily -- not necessarily, unless
23   they were out of range of normals.
24   Q    Okay.  All right.  So let's look at the
25   labs under 2330 on page 42.  The bands are
0022
 1   52.  That's abnormal?
 2   A    Um-hum.
 3   Q    Is that correct?
 4   A    Yes.
 5   Q    That's out of range; is that correct?
 6   A    Yes.
 7   Q    The metamyelocytes of six, that's
 8   abnormal?
 9   A    Yes.
10   Q    That's out of range; is that correct?
11   A    Yes.
12   Q    What is the normal for metamyelocytes?
13   A    I don't recall.
14   Q    What is the normal for bands?
15   A    I don't recall off the top of my head.
16   Q    Okay.  Well, you make nursing
17   diagnoses?
18   A    Do we make nursing diagnoses?
19   Q    Yes.
20   A    Yes.
21   Q    Okay.  And you've diagnosed bandemia
22   before?
23   A    Yes.
24   Q    And looking at 52 bands at the -- under
25   the labs at 2330, this would indicate the
0023
 1   patient had bandemia; is that correct?
 2   A    Yes.
 3   Q    And bandemia is a sign of infection, is
 4   that correct, from your -- from you as a
 5   nurse?
 6   A    Yes.
 7   Q    Okay.  Then would the band values have
 8   been discussed at the time of report --
 9   A    I don't re --
10   Q    -- according to customary practices?
11   A    I don't recall.
12   Q    Also under 2330 you have neutrophils of
13   33.  Is that abnormal?
14   A    Yes.
15   Q    And also the 33, the neutrophils is out
16   of range; is that correct?
17   A    Yes.
18   Q    Okay.  Now, you also indicated that the
19   vital signs are -- are customarily discussed
20   at report; is that correct?
21   A    Yes.
22   Q    Whether they're normal or abnormal?
23   A    If they're abnormal, we discuss it.  If
24   they're normal -- within normal limits, we
25   don't necessarily discuss them, no.
0024
 1   Q    Okay.  Why don't you turn to page 142.
 2             MR. MURPHY:       What part of the
 3   chart have you got, Harley?  Just --
 4             MR. GORDON:       I'm sorry?
 5             MR. MURPHY:       Nursing notes?
 6             MR. SCHOBERT:     Nurse's notes.
 7             MR. MURPHY:       Thanks.
 8             MR. GORDON:       You didn't bring
 9   your copy?
10             MR. SCHOBERT:     He didn't bring
11   the handy-dandy Harley packet.
12             MR. MURPHY:       No.
13             MR. SCHOBERT:     It helps.
14   Q    Are you on page 142?  We're talking --
15   A    Yes.
16   Q    -- in the right-hand column.
17             MR. JEFFERS:      Pat, do you have
18   it yet?
19             MR. MURPHY:       Yes.
20             MR. SCHOBERT:     Okay.  You got
21   it?
22   Q    Let's look at the vital signs at --
23   June 26th at 12:30 a.m., and we have a pulse
24   of 128?
25             MR. JEFFERS:      What -- where --
0025
 1             THE WITNESS:      Yeah, I was
 2   going to say --
 3             MR. JEFFERS:      What time are
 4   you looking at?
 5             MR. GORDON:       12:30 a.m.
 6   Q    And the pulse is at -- it's on the
 7   right-hand side.  You should be on page
 8   142.
 9   A    Yes.
10   Q    You're on the right-hand side.
11   A    Oh, here it is.  I'm sorry.
12             MR. JEFFERS:      Okay.  What
13   time, Harley?
14             MR. GORDON:       At 12:30 a.m.,
15   okay?
16             MR. JEFFERS:      Okay.
17   Q    Is the pulse of 128 for this type of
18   patient normal or ab -- or abnormal?
19   A    It depends.  Depends on where she is
20   before this time period.
21   Q    Where --
22   A    I mean.
23   Q    Being what?
24   A    Does she normally run that high.
25   Q    If she didn't normally run that high,
0026
 1   that would be abnormal?
 2   A    Not necessarily.
 3   Q    What do you consider the normal range
 4   of heart rate?
 5             MR. JEFFERS:      For this type of
 6   patient?
 7   Q    Yeah, for this type of patient.
 8   Postpartum.
 9   A    Anywhere from 60's to 100.
10   Q    Okay.  If you go over to page 141, you
11   have, on the left-hand side, at 2200 on
12   June 25th a pulse rate of 112, okay?  So --
13             MR. JEFFERS:      This is 2100?
14             MR. GORDON:       Yes.
15   Q    So from that you can -- can we
16   reasonably conclude she -- that Mary
17   Williams did not have a typical heart rate
18   of 128?
19             MR. JEFFERS:      Objection.
20   A    Can you rephrase the question, please?
21   Q    Based upon the fact that Mary Williams
22   had a heart rate of 112 the day before,
23   June 25th, at 2200, now she has a heart rate
24   of 128, can we reasonably conclude that
25   her -- normal heart rate for Mary Williams
0027
 1   is not 128?
 2             MR. JEFFERS:      Objection.  Go
 3   ahead.
 4   A    I would say -- I'm sorry.  Rephrase the
 5   question again.
 6                     - - - - -
 7                 (Question read.)
 8                     - - - - -
 9   A    No, because her heart -- that's --
10   that's one episode of the heart -- I mean,
11   that's one point in time.
12   Q    Okay.  Would a temperature as found on
13   page 140 of 101.6 degrees Fahrenheit, found
14   June 25th at 1925, be abnormal?  The bottom
15   left-hand corner.
16   A    The temperature of 101.6?
17   Q    Yes.
18   A    That would be abnormal.
19   Q    And why would it be abnormal?
20   A    Because it's elevated.
21   Q    What do you consider a normal
22   temperature for postpartum --
23   A    Normal temperature?
24   Q    Yes, for a postpartum labor.
25   A    For postpartum.  Temperature on a
0028
 1   postpartum patient can slightly elevate,
 2   specifically when they get an epidural.
 3   Anything greater than 100.5 I would consider
 4   abnormal.
 5   Q    Okay.  Was the temperature --
 6             MR. JEFFERS:      Hold it.  After
 7   what temperature?
 8             THE WITNESS:      100.5.
 9             MR. JEFFERS:      Okay.  Thank
10   you.
11   Q    Would a temperature of 100.6 be
12   customarily discussed at report?
13             MR. JEFFERS:      100.6 now?
14             MR. GORDON:       Yes.
15             MR. JEFFERS:      Okay.
16   A    Would that customarily -- yes.
17   Q    And then could you turn to page 143.
18   Under 2:15 a.m. on June 26th, there's blood
19   pressure readings, one of which is 88 over
20   53 -- 88 over 53.  Is that abnormal?
21             MR. JEFFERS:      I'm going to
22   object because there's a recheck and there's
23   three blood pressures given at that exact
24   time and I don't think you've given her
25   enough information.
0029
 1   A    Can you rephrase the question?
 2   Q    Is the blood pressure of 88 over 53
 3   found on page 143 at 2:15 a.m. on June 26th
 4   abnormal?
 5   A    That specific blood pressure I would
 6   say is abnormal, but then the repeat was
 7   then normal.
 8   Q    What is the normal range for a
 9   postpartum lady?
10   A    Range?
11   Q    Yes.  Normal range.
12   A    Anywhere from -- gosh.  Some patients
13    -- it depends on the patient.  Some
14   patients run low prior to delivery and then
15   some patients run on a higher end.  Anywhere
16   from 90's over 60's to 1 -- sometimes 130's
17   over 80's.
18   Q    Okay.  Turning -- on the same page, on
19   143, you have at 3:15 a.m. on June 26th a
20   blood pressure of 80 over 52.  Is that
21   abnormal?
22   A    Where are we looking?  I'm sorry.
23             MR. JEFFERS:      Where?
24   Q    On page 143 under vital signs at
25   3:15 a.m. on June 26th, a blood pressure of
0030
 1   80 over 42.  Is that abnormal?
 2             MR. JEFFERS:      I'm trying to
 3   find it and I haven't found it yet.
 4             MR. GORDON:       It's at the
 5   bottom of the page.
 6             MR. JEFFERS:      Okay.  I'm with
 7   you.
 8   Q    Is that abnormal?
 9   A    Yes.
10   Q    Okay.  Would then an abnormal blood
11   pressure reading or readings that occurred
12   on Ms. Prokop's shift, would that have been
13   customarily reported at -- at the time of
14   the report?
15   A    Yes.
16   Q    Okay.  Now, what is a normal
17   respiration rate for a postpartum lady?
18   A    Respiration?  Anywhere from 16 to 24.
19   Q    And what's a normal pulse oximeter
20   reading for a postpartum lady?
21   A    95 to 100 percent.
22   Q    Without oxygen, obviously.
23   A    Without oxygen.
24   Q    Okay.  Then during report would you
25   have taken notes?
0031
 1   A    Yes.
 2   Q    And then this is in a note pad or
 3   something like that, or a piece of paper?
 4   A    We have report sheets that we fill out.
 5   Q    Okay.  Are those report sheets
 6   retained?
 7   A    No.
 8   Q    Then after your report, would --
 9   what -- what did you do that day after your
10   report was completed?
11   A    I went out to see the patient.
12   Q    Then -- let's see.  Let's turn to --
13   let's turn to page 160.  All right?
14   A    Okay.
15   Q    And the right-hand side, okay?
16   A    Um-hum.
17   Q    Could you go to the -- it's a little --
18   it's close to the top of the page, at 7:30.
19   It has an entry, June 26th, '99 at 7:30; do
20   you see that?
21   A    Yes.
22   Q    Okay.  And it says, Dr. Hahn called and
23   notified of patient status and lab results.
24   Orders received.  Patient denies complaint
25   of headache but states she has fuzzy
0032
 1   vision.  Were you in the hospital with the
 2   patient when these events took place?
 3   A    Yes.
 4   Q    Okay.  So Paulette Prokop called
 5   Dr. Hahn at that time?
 6   A    Yes.
 7   Q    At 7:30?  And did you overhear the
 8   conversation?
 9   A    No, I did not.
10   Q    Would you aware -- but you were aware
11   that Ms. Prokop had called Dr. Hahn?
12   A    Yes.
13   Q    Do you know where she called Dr. Hahn?
14   She calls at the nursing station, is that
15   it?
16   A    Yes.
17   Q    Do you know where Dr. -- did you
18   receive any information where Dr. Hahn was
19   at 7:30?
20   A    No, I did not.
21   Q    Okay.  Did your -- did you see the
22   patient before or after 7:30?
23   A    Shortly after 7:30.
24   Q    And Ms. Prokop would have told you that
25   she had called Dr. Hahn and notified him of
0033
 1   the patient's status and lab results; is
 2   that correct?
 3   A    Yes.
 4   Q    And you would have been aware of the
 5   orders that were received?
 6   A    Yes.
 7   Q    Okay.  Did Ms. Cro -- Prokop tell you
 8   anything regarding that conversation she had
 9   with Dr. Hahn?
10   A    I don't recall.
11   Q    Okay.  Then according to these records,
12   you did an assessment of the patient around
13   7:50 a.m., and this is found on page 147; is
14   that -- am I correct, you did assess the
15   patient -- patient at 7:50 a.m.?
16             MR. JEFFERS:      What time?
17             MR. GORDON:       7:50 a.m.
18   A    What page are we on?  I'm sorry.
19   Q    You're on -- we're going to look at
20   two pages.  We're going to look at 146 and
21   then 147.
22   A    Okay.  Yes.
23   Q    Okay.  So what did you do between 7:30
24   and 7:50 a.m., if you recall?
25   A    I recall speaking to her husband in the
0034
 1   hallway.
 2   Q    Okay.  And what -- what information, if
 3   any, did you receive from her husband?
 4   A    Her husband stated to me that she had
 5   been restless all night and had been unable
 6   to sleep and that could we -- and he was
 7   also unable to sleep all night and could we
 8   please do something for her.
 9             MR. JEFFERS:      It's not fair
10   that she doesn't get to look at page 0160
11   where she has notes about what happened at
12   0745, now that you're talking about what
13   went on between the two.  You just said
14   0750, what went on between, so --
15             MR. GORDON:       No, I -- you
16   missed the -- I asked her what did she do
17   between 7:30 and 7:50, and she --
18             MR. JEFFERS:      Okay.
19             MR. GORDON:       And the witness
20   reported that she talked to the husband.
21             MR. JEFFERS:      Okay.  Well, the
22   record, if she's able to go back and refresh
23   herself with --
24             MR. GORDON:       Absolutely.
25             MR. JEFFERS:      -- all the
0035
 1   pages, which you've limited -- you told her
 2   146 and 147; 160 gives a fuller one to help
 3   her refresh her memory.
 4             MR. GORDON:       I'm talking
 5   about her assessment.  I stopped at -- I
 6   stopped at 7:50 and I went back to ask the
 7   witness what she was doing between 7:30 and
 8   7:50.
 9             MR. JEFFERS:      And that
10   information is on page 160.
11             MR. GORDON:       Okay.
12   Q    So let's turn to page 160, okay?  At --
13   and then we see during that time frame,
14   between 7:30 and 7:50, there's an entry at
15   7:45; is that correct?
16   A    Yeah.
17   Q    Then it says, in to assess patient at
18   this time.  Patient confused and disoriented
19   at this time, or at this times.  Motrin
20   given for patient, complaining cramping and
21   lower abdominal pain; is that right?  Am I
22   reading that right?
23   A    Yes.
24   Q    Husband at bedside.  Peri care done at
25   this time.  Am I reading --
0036
 1   A    Yes.
 2   Q    -- that correctly?  And all that was
 3   done around 7:45 a.m.; is that correct?
 4   A    Yes.
 5   Q    What is petty -- strike that.
 6             What is peri care?
 7   A    Cleaning of the patient's bottom,
 8   changing her perineal pads.
 9   Q    Okay.  So to complete what we just
10   started with my question, what did you do
11   between 7:30 and 7:50, did you talk to the
12   husband.
13   A    Um-hum.
14   Q    And you -- is that all you remember,
15   what you report about she -- Mary Williams
16   was restless all night and he was -- did you
17   say he was restless too?
18   A    Unable to sleep.
19   Q    Unable to sleep.  Okay.  Could you do
20   something.  Okay.  Is there anything else
21   you remember of that conversation?
22   A    No, that was it, basically.
23   Q    Okay.  Now, you reported in your
24   nurse's notes at 7:45 a.m. that the patient
25   was confused and disoriented at this time.
0037
 1   Okay.  What did you base that on?
 2   A    Statements that she would say.
 3   Q    Do you remember those statements?
 4   A    I don't recall.
 5   Q    Is this type of confusion and
 6   disorientation normal or abnormal for this
 7   type of patient?
 8   A    With this type of patient, sometimes
 9   you can see slight confusion with magnesium
10   infusions.
11   Q    Okay.  Did you in your own mind feel it
12   was normal or abnormal, this confusion and
13   disorientation?
14   A    I felt it was abnormal.
15   Q    Why?
16   A    Because -- because of -- because of the
17   restlessness that she had also, along with
18   the confusion.  She would say lucid comments
19   and then she would say very confusing
20   comments, so --
21   Q    Okay.  The specific comments, do you
22   remember those today?
23   A    No, I don't recall.
24   Q    All right.  Now, going back to your
25   assessment, that's found on page 147 for
0038
 1   your assessment at 7:50 a.m.; is that
 2   correct?
 3   A    Yes.
 4   Q    Okay.  And you noted, number -- first
 5   of all, that the patient was confused, under
 6   cognitive and perceptual column; is that
 7   correct?
 8   A    Yes.
 9   Q    And then her thought process, you note
10   inappropriate at times; is that correct?
11   A    Yes.
12   Q    Skin color was pale; is that right?
13   A    Yes.
14   Q    Skin temperature cool; is that right?
15   A    Yes.
16   Q    And then, comment, cool legs and feet,
17   that -- that's what you noted, and that's
18   what was taking place at the time of your
19   assessment at 7:50 a.m. --
20   A    Yes.
21   Q    -- is that correct?  And also you --
22   her -- you found her abdomen distended --
23   A    Yes.
24   Q    -- at that time; is that correct?
25   A    Yes, I did.
0039
 1   Q    You also took some vital signs at 7 --
 2   around 7:50, actually it's 7:45 according to
 3   the records, and this is found on page 146;
 4   is that correct?
 5   A    Yes.
 6   Q    Did you take a temperature?  The reason
 7   I'm saying is it's not recorded here.
 8   A    Yeah.  I was going to say --
 9   Q    I don't know if it was taken and not
10   recorded or you didn't take it, or -- or you
11   don't know?
12   A    I can't recall.
13   Q    Okay.  And then the vital signs at
14   7:45 a.m. included a respiration rate of
15   36.  Is this abnormal?
16   A    Yes, but she was in pain.
17   Q    And the patient was in -- complaining
18   of pain from what area of her body, if you
19   can recall?
20   A    She was -- generalized lower abdominal.
21   Q    Okay.  Now, with respect to your
22   assessment, is there anything else that you
23   can recall today regarding your assessment
24   of the patient around 7:45, 7:50 a.m. which
25   we haven't covered?
0040
 1             MR. JEFFERS:      We're down to --
 2   back to 160?
 3             MR. GORDON:       No, we're --
 4   we're going beyond that.  It's a --
 5   A    Can you rephrase the question?
 6   Q    We've gone over the written records
 7   that you prepared at 7:45 a.m. and
 8   7:50 a.m., okay?  Is there anything else
 9   that you remember that occurred around
10   7:45 a.m., 7:50 a.m. which you remember
11   today which is not recorded in your records?
12   A    No.
13   Q    Okay.  Now, the next entry we have in
14   your nurse's notes is at eight o'clock; is
15   that correct?
16   A    Yes.
17   Q    This is found on page 160.  Did your
18   assessment take approximately 15 minutes or
19   so?
20   A    And -- and peri care for her, yes.
21   Q    Okay.  Then at eight o'clock you
22   indicate in the nurse's notes on page 160,
23   I.V. Ativan 1 milligrams given to patient
24   for restlessness.  Husband remains at
25   bedside.  Is that correct?
0041
 1   A    Yes.
 2   Q    So and -- and that's what occurred at
 3   that time?
 4   A    Yes.
 5   Q    Okay.  Then the next entry we have is
 6   at 8:15 a.m. on that day; is that correct?
 7   A    Yes.
 8   Q    Is there anything else that you can
 9   remember that occurred between 8:00 a.m. and
10   8:15 a.m. which is not recorded in these
11   records?
12   A    No.
13   Q    Okay.  Then on page 160, at 8:15 a.m.,
14   on June 26th, reads:  Dr. Hahn called.
15   Notified of patient status and confused
16   state and nurses' concern.  Doctor on way to
17   hospital at this time.  Okay.  Is this what
18   you wrote?
19   A    Yes.
20   Q    And this is what occurred at that time?
21   A    Yes.
22   Q    Okay.  Why did you call Dr. Hahn at
23   that time, 8:15 a.m.?
24   A    Because I felt he should come in and
25   see the patient.
0042
 1   Q    Okay.  And why did you feel that
 2   Dr. Hahn should come in and see the patient?
 3   A    Because of her confused state.  I
 4   thought maybe something was really going on.
 5   Q    And what did you tell Dr. Hahn, in your
 6   language?
 7   A    I told him that I was concerned about
 8   her and I asked if he was coming in to see
 9   her soon, and -- and that's when he told me
10   he would be on his way in.  I told him she
11   was confused and stating things that --
12   saying very confusing statements.
13   Q    Anything else you -- you can recall
14   that you told Dr. Hahn at 8:15 a.m.?
15   A    No.
16   Q    Where did you reach Dr. Hahn?
17   A    I -- I believed it was at home.
18   Q    Did Dr. Hahn ask of you anything
19   regarding the patient?
20   A    He asked me why I was concerned, and
21   I -- and I said -- I said I -- I -- she's
22   just not -- she's very confused and -- and
23   it frightens me.
24   Q    Did Dr. Hahn ask you anything else
25   regarding the patient?
0043
 1   A    Uh-uh.
 2   Q    No?
 3   A    No.
 4   Q    Did you give any information to
 5   Dr. Hahn regarding lab results at that time,
 6   at 8:15?
 7   A    Not that I recall.
 8   Q    Did you give Dr. Hahn any information
 9   regarding vital signs at 8:15 a.m. when you
10   talked to Dr. Hahn?
11   A    Not that I recall.
12   Q    At this point in time, at 8:15 a.m.,
13   would you have reviewed the lab results?
14   A    My routine would be to re -- to review
15   the lab work.  I do not recall if I
16   specifically did.
17   Q    Okay.  And in your routine, if you had
18   identified abnormal lab values, would you
19   have, according to your routine, reported
20   them to Dr. Hahn at 8:15 a.m.?
21   A    If I would have observed abnormals,
22   yes, I would have given those to him on the
23   phone.
24   Q    Okay.  And if you had identified
25   abnormal vital signs, according to your
0044
 1   routine, would you have, in this telephone
 2   conversation of 8 -- 8:15 a.m. with
 3   Dr. Hahn, have given him information about
 4   abnormal vital signs?
 5             MR. MURPHY:       Just note an
 6   objection, because she said before she had
 7   no rec -- recollection of telling Dr. Hahn
 8   about lab results or vital signs, so --
 9             MR. JEFFERS:      He's asking her
10   routine now.
11             MR. GORDON:       Right.
12             MR. MURPHY:       I understand.
13             MR. JEFFERS:      You may
14   proceed.
15   A    Rephrase that again.  I'm sorry.
16   Q    Okay.  That was a hard question.  Let
17   me see if I can.
18             If in your routine you identified
19   abnormal vital signs, would you have,
20   according to your routine, indicated those
21   abnormal vital signs to Dr. Hahn when you
22   called him at 8:15 a.m.?
23             MR. MURPHY:       Objection.
24             MR. JEFFERS:      Go ahead.
25   A    Not necessarily, because he stated he
0045
 1   was on his way in.
 2   Q    Okay.  And then the next entry we have
 3   is at 8:30 a.m. on June 26th; is that
 4   correct?
 5   A    Yes.
 6   Q    Okay.  And the entries beginning at
 7   7:45 a.m. in the morning on page 160 through
 8   those that are found at the bottom of the
 9   page at 10:54 are all your entries; is that
10   correct?
11   A    Yes.
12   Q    Okay.  And when you place these entries
13   in the computer, you try to be as accurate
14   as possible?
15   A    Yes.
16   Q    And you try to be as accurate in terms
17   of when these events occurred?
18   A    Yes.
19   Q    At -- at 8:30, you indicated, nurse in
20   bathroom to dip urine.  Patient got -- is
21   that out of bed?
22   A    Out of bed.
23   Q    By self and stood at bedside.  Patient
24   helped back to bed.  Nurse to stay at
25   bedside.  That's what occurred at 8:30 a.m.?
0046
 1   A    Yes.
 2   Q    What happened between 8:15 a.m. and
 3   8:30 a.m. after you called Dr. Hahn?
 4   A    I do not recall.
 5   Q    And why did you stay at the bedside at
 6   8:30 a.m.?
 7   A    Because the patient was getting out of
 8   bed -- out of bed by herself and there was
 9   nobody in the room but the patient and
10   myself.
11   Q    Then you have an entry at 8:50 a.m.; is
12   that correct?
13   A    Yes.
14   Q    It says, mother at bedside to see
15   patient.  Mother concerned, asking for
16   Dr. Hahn.  Instructed he is on his way in.
17   Is that what occurred at 8:50 a.m.?
18   A    Yes.
19   Q    Okay.  How did the mother express her
20   concern?
21   A    She was upset, telling me that this was
22   not her daughter and that she wanted to see
23   Dr. Hahn right away, and that's when I
24   explained he was on his way and would be
25   there shortly.
0047
 1   Q    Did the mother of Mary Williams tell
 2   you why this was not her daughter, what --
 3   in what way she was acting or speaking --
 4   A    Yes, by the way she was speaking and --
 5   and -- and -- and saying very confusing
 6   statements.
 7   Q    And did the mother of Mary Williams
 8   express any reason why she wanted to talk to
 9   Dr. Hahn?
10   A    She wanted to know what was going on.
11   Q    Was the mother of Mary Williams present
12   when you arrived that morning at 7:00 a.m.?
13   A    No, she wasn't.
14   Q    Okay.  Is there anything else that
15   occurred at 8:50 a.m. which you can remember
16   today which is not recorded?
17   A    No.
18   Q    Okay.  And then at 9:00 a.m. you have
19   written, Dr. Hahn in to see patient.
20   Portable bedside ultrasound done per him.
21   Decision to send to radiology for abdominal
22   CT or CAT scan.  Is that correct?
23   A    Yes.
24   Q    Okay.  So the first time you saw
25   Dr. Hahn was at 9:00 a.m. in the morning?
0048
 1   A    Yes.
 2   Q    Did you remain with the patient from
 3   8:30 until 9:00 a.m.?
 4   A    Yes.  I -- I was in and out.
 5   Q    Doing what?
 6   A    Helping another nurse with another
 7   patient.  But when I left her bedside I had
 8   another nurse come in and watch her.
 9   Q    And what nurse was that?
10   A    Joanne Jennings.
11   Q    Okay.  The first time you then saw
12   Dr. Hahn go into the patient's room was at
13   nine o'clock?
14   A    Yes.
15   Q    Did Dr. Hahn ask of you of -- about the
16   patient's status when he first saw you?
17   A    Yes.
18   Q    What -- and what did you tell Dr. Hahn?
19   A    I stated that she was very confused,
20   her abdomen was very distended, she was
21   complaining of lower abdominal pain, she had
22   absent bowel sounds, and I showed him the
23   vital signs.  She had a datascope next to
24   her bed which automatically would re -- take
25   her vital signs.
0049
 1   Q    And what did -- did you give him any
 2   other -- any other information, such as lab
 3   values?
 4   A    Not at that time, no.
 5   Q    Now, let's stop here for a minute.
 6   When you say a datascope, that's like --
 7   it's a monitor?
 8   A    Not a cardiac monitor.  It's a -- a
 9   machine that automatically pumps up the
10   blood pressure every 15 minutes and -- or
11   however many minutes you program it to, and
12   takes the pulse oximeter and the heart rate
13   at this -- continuously.
14   Q    And what was the datascope set for in
15   terms of this patient, every 15 min --
16   A    Every 15 minutes.
17   Q    And the datascope would show the pulse
18   oximeter reading?
19   A    Um-hum.  Yes.
20   Q    The heart rate?
21   A    Heart rate.
22   Q    And the blood pressure?
23   A    And blood pressure.
24   Q    How about the respiration rate?
25   A    No, it would not.
0050
 1   Q    How about the temperature?
 2   A    No, it would not.
 3   Q    Okay.  And when you say you showed to
 4   Dr. Hahn what was on the datascope, it was
 5   on the monitor or --
 6   A    Yes, it -- it reads it right on a -- a
 7   screen.
 8   Q    Okay.  And what did the datascope show
 9   at that time?
10   A    All her vital signs that had been
11   taken, so --
12   Q    Do you remember what vital signs?
13   Let's look -- let's turn to page 146, okay?
14   There's vital signs information at
15   nine o'clock.
16   A    Yes.
17   Q    Am I correct?
18   A    Yes.
19   Q    And you have the blood pressure at
20   94 over 50.  That's abnormal?
21   A    Yes.
22   Q    The blood -- the pulse is 100; is that
23   correct?
24   A    Yes.
25   Q    And the respiration rate is 40, that
0051
 1   would be abnormal?
 2   A    Yes.
 3   Q    And that information would have been on
 4   the datascope?
 5   A    Yes, it would.
 6   Q    Okay.  Did Dr. Hahn, when he came in,
 7   ever ask you what do you think, what's going
 8   on with this patient?
 9   A    No.
10   Q    Did you offer to him what was going on
11   with this patient, giving him any type of
12   nursing diagnosis?
13   A    I -- I -- hmmm.  I stated to him about
14   her bowel sound being absence -- absent,
15   which would be abnormal, and her abdomen
16   being distended.
17   Q    Okay.  Did you stay with the patient
18   then after 9:00 a.m.?
19   A    Yes.
20   Q    Until what, 10:54?
21   A    Yes.
22             MR. JEFFERS:      She has a note
23   at 10:55 also.
24   Q    Okay.  So you stayed with the patient
25   until --
0052
 1   A    Yeah.
 2   Q    -- 10:55, until she was transferred to
 3   the intensive care unit; is that correct?
 4   A    I can't answer that with yes or no.  I
 5   cared for that patient until 10 -- until
 6   eleven o'clock, when I transferred her to
 7   ICU, but I stayed with that patient longer
 8   in ICU --
 9   Q    Okay.
10   A    -- than eleven o'clock.
11   Q    Okay.  There's an entry at 9:15 -- by
12   the way, your initials are MHH?
13   A    Yes.
14   Q    It says, a.m. lab results given to
15   Dr. Hahn.  Informed of urine output.  I.V.
16   bolus ordered.  When you say the -- the a.m.
17   labs, and if you'd turn to page 42 --
18   A    Yes.
19   Q    Are these the labs under the 5:30
20   column?
21   A    Yes.
22   Q    Then in that regard, how did you
23   present the labs to Dr. Hahn?  In other
24   words, would you have given him a document
25   or would you have verbally -- verbally gone
0053
 1   over the labs with him?
 2   A    I would have printed it up and given
 3   him a paper.
 4   Q    Okay.  And did that --
 5   A    Hard copy.
 6   Q    Hard copy.  Did that hard copy include
 7   not only the labs at 5:30 but previously?
 8   A    I do not recall.
 9   Q    Okay.  Customarily when you print labs
10   do the prior labs come up as well?
11   A    I can't answer that with yes or no.  It
12   depends on which screen you print up.
13   Routinely it would probably just print up
14   5:30's.
15   Q    Okay.  Did Dr. Hahn ask you to print up
16   the previous labs before 5:30 a.m.?
17   A    No, but at that same time he was
18   sitting down at the computer to chart and
19   look in -- at all the labs.  I'm -- I can't
20   say for sure, but he was looking in the
21   computer himself.
22   Q    Okay.  Just stop here for a moment.
23   Typically when you -- I'm going to talk
24   about June 25th, June 26th and before that.
25   When a physician such as a attending OB like
0054
 1   Dr. Hahn or a house physician asks you for
 2   lab values, how do you typically present the
 3   lab values to that doctor?
 4   A    There's a couple different ways.  We
 5   can bring them up on the screen for them to
 6   visualize themselves, they can actually get
 7   them themselves, or we can print up copies
 8   for them.
 9   Q    So let's take a situation, the doctor
10   says, I'd like to be informed of the lab
11   values.  Then you ask the doctor, how do you
12   want them, do you want them in paper, or do
13   you want to put the screen --
14   A    Yeah, you -- yes.  Yes.
15   Q    Then the doctor tells you how he wants
16   them?
17   A    Yes.
18   Q    Is that correct?
19   A    Yes.
20   Q    And then when you do print up the labs,
21   you give them to the doctor; before you do
22   that do you look at the lab values?
23   A    Yes.
24   Q    And then, in looking at the lab values,
25   do you point out to the doctor before he
0055
 1   gets the sheet there are some abnormal
 2   values on these, on the sheet?
 3   A    Yes.
 4   Q    For instance, if they're on -- let's
 5   turn to page 42, okay?
 6   A    Okay.
 7   Q    Here, let me help you.
 8   A    Oh, all the way to 42?
 9   Q    Yeah.  There you go.  All right.
10             For instance, if you were the
11   nurse that were giving to a doctor the lab
12   values done at 2330 and a printout was
13   prepared, would you have told the doctor
14   that the bands were abnormal?
15   A    If I looked at them and saw that they
16   were abnormal, yes, I would tell him.
17   Q    Why?
18   A    Well, I would see that they were out of
19   normal range and I would point it out to
20   him.
21   Q    Okay.  From your -- you have worked
22   with house physicians --
23   A    Um-hum.
24   Q    -- before June 25th, June 26th, 1999;
25   is that correct?
0056
 1   A    Yes.
 2   Q    Do you still work with Dr. Hsieh?
 3   A    Yes.
 4   Q    Do you still work with Dr. Hahn?
 5   A    Yes.
 6   Q    With respect to the house physicians
 7   like Dr. Hsieh, to your knowledge, or --
 8   strike that.  Let me phrase the question
 9   differently.
10             Before June 25th, 1999, did you
11   ever see Dr. Hsieh go to the computer and
12   access lab values?
13   A    No.
14   Q    Did you ever see Dr. Hsieh actually use
15   the computer?
16   A    Medatech system, no.  We have two
17   systems on our -- on our floor.
18   Q    Okay.  What are the two systems?
19   A    We have Watch Child, which is --
20   Q    What's that?
21   A    Watch Child, which is our labor --
22   Q    Okay.
23   A    -- system, and then Medatech is our --
24   once they come to postpartum, they go in
25   Medatech.
0057
 1   Q    And are the lab values on the Medatech?
 2   A    Yes.
 3   Q    Okay.  Have you seen house physicians,
 4   let's say other than Dr. Hsieh, use
 5   Medatech?
 6   A    Have I seen other house physicians?
 7   Q    Yes.
 8             MR. JEFFERS:      Objection.  Go
 9   ahead.
10             MR. SCHOBERT:     Yeah, object.
11   A    I don't recall.
12   Q    Have you had instances in which house
13   physicians order lab values at times in
14   which you did not give the house physician
15   like a sheet or report -- a sheet of lab
16   values or report verbally to the house
17   physician lab values?
18             MR. JEFFERS:      Hold it.  Read
19   it back, please.
20             MR. GORDON:       I'll rephrase
21   it.
22             MR. JEFFERS:      Thank you.
23   Q    Have you ever had instances in which
24   you were aware that a house physician knew
25   of the results of the labs even though you
0058
 1   did not tell the house officer the lab
 2   values or provide the house officer a sheet
 3   or printout of the lab values?
 4             MR. SCHOBERT:     Objection.
 5             MR. JEFFERS:      Object.  Go
 6   ahead.  I don't know how she knows that.
 7   A    Can you rephrase the question again,
 8   please?  I'm sorry.
 9             MR. GORDON:       Could you repeat
10   the question?
11                     - - - - -
12                 (Question read.)
13                     - - - - -
14             MR. JEFFERS:      I don't know
15   that that's answerable the way it was put,
16   so, I mean --
17             MR. GORDON:       It is
18   answerable.
19             MR. JEFFERS:      Unless you're --
20             MR. GORDON:       It is
21   answerable.
22             MR. JEFFERS:      Unless you're
23   the Shadow and you look into men's minds.  I
24   don't know.  If you can answer it, answer
25   it.
0059
 1   A    House physicians can get lab results
 2   from somebody other than myself, so if they
 3   have lab results other than me telling them
 4   or giving them a hard copy, they -- yes,
 5   they can get it from somebody else.
 6   Q    And how do they get lab values from
 7   someone else?
 8   A    A secretary, another nurse.
 9   Q    Okay.
10             MR. PARIS:        You see, John,
11   that wasn't so hard.
12             MR. JEFFERS:      Well, it was not
13   articulately put, which is very strange for
14   Harley, who is so articulate, on occasion.
15   Q    Have you ever had a patient who had
16   vaginal bleeding postpartum?
17   A    Yes.  All our patients have vaginal
18   bleeding postpartum.
19   Q    They do?
20   A    (Nodding head.)
21   Q    Do you record when a patient has
22   vaginal bleeding?
23   A    Yes.
24   Q    Why do you do that?
25   A    Because we state the amount, the color.
0060
 1   Q    The amount and color.  Why do you state
 2   the amount of vaginal bleeding?
 3   A    To differentiate between normal vaginal
 4   bleeding and hemorrhage.
 5   Q    And why do you state the color?
 6   A    To, once again, differentiate between
 7   hemorrhage and normal vaginal bleeding.
 8   Q    And you characterize the amount by what
 9   terminology?
10   A    Scant, small, moderate, large.
11   Q    And you characterize the color by what
12   terminology?
13   A    Well, rubra for normal, but if --
14   bright red bleeding for hemorrhage or --
15   Q    Is there actually -- I mean, I'm -- I'm
16   looking myself, but you're --
17   A    Oh.
18   Q    -- better at this than I am in terms of
19   what's in these records or what you put on a
20   computer.  For instance, is there on the
21   computer, if there is vaginal bleeding, some
22   entries that a nurse makes?
23   A    Yes, there's an entry.
24   Q    Okay.  Are those entries on the
25   assessment sheet?
0061
 1   A    Yes.
 2   Q    Let's -- let's turn to page 141.  Maybe
 3   that can help you.
 4   A    Okay.
 5   Q    Is there -- on this page, 141, is there
 6   any area in which if there is vaginal
 7   bleeding a nurse would document that?
 8   A    Yes.
 9   Q    Where -- where is that?  Could you --
10   could you tell us where it is?
11   A    On the right-hand side of the page in
12   the middle, it's called lochia.
13             MR. JEFFERS:      Dead center,
14   Harlan.
15             MR. GORDON:       Okay.
16   Q    And what is -- okay.  Where you have --
17   what's rubra mean?
18   A    Rubra.  Red.
19   Q    Okay.  And lochia amount?
20   A    Moderate amount.
21   Q    Okay.  Does the nurse also put in in
22   the nurse's notes if she -- let me go back
23   to this amount.  Is that a normal amount?
24   A    Moderate?
25   Q    Yeah.
0062
 1   A    Can be, yes.
 2   Q    Okay.  In terms of your practice, if
 3   you are concerned with a postpartum patient
 4   who has vaginal bleeding to such an extent
 5   that your concern is such that you call the
 6   house officer or house physician, do you
 7   document the degree of vaginal bleeding in
 8   that instance --
 9             MR. SCHOBERT:     Objection.
10   Q    -- in your nurse's notes?
11   A    Can you rephrase that again?
12   Q    Okay.  Do you document in your nurse's
13   notes, such as we have on page 160, that you
14   have such a concern of vaginal bleeding that
15   you call the house physician to see the
16   patient?
17   A    Yes.
18   Q    And why do you do that?
19   A    We would document why you were calling
20   the house physician out.
21   Q    So you would document -- what would you
22   document if you called the house physician
23   because you had vaginal bleeding?
24             MR. JEFFERS:      Objection.
25             MR. SCHOBERT:     Objection.
0063
 1             MR. JEFFERS:      That was a
 2   hypothetical?
 3             MR. PARIS:        Sure.
 4             MR. GORDON:       Hypothetical,
 5   yeah.  Sure.
 6             MR. JEFFERS:      Okay.  Because
 7   that's not the reason the house doctor was
 8   called in this case.
 9             MR. GORDON:       I'm talking
10   about hypothetically.
11             MR. JEFFERS:      I know, but we
12   ought to keep it somewhere near the case,
13   but go ahead.
14   Q    Hypothetically, if you had a patient
15   who had vaginal bleeding to such an extent
16   that you called the house officer to see the
17   patient, how would you have documented that?
18   A    House doctor called to bedside for,
19   hypothetically, large amount of bleeding.
20   Q    Okay.  Is that what the nurses at Parma
21   Community General Hospital are told to do in
22   terms of if there is a concern about vaginal
23   bleeding and a house off -- house physician
24   is called?
25   A    Yes, if we have a concern for abnormal
0064
 1   vaginal bleeding, we would call the house
 2   physician.
 3   Q    And document that?
 4   A    Yes.
 5   Q    Okay.  Let's see.  Now, in terms of
 6   your duties as a nurse dealing with a
 7   postpartum patient as it existed in June of
 8   1999, was it your duty to tell a physician
 9   of abnormal lab values?
10             MR. JEFFERS:      You want that as
11   an isolated question?
12             MR. GORDON:       Yeah, general
13   question.
14             MR. JEFFERS:      Without
15   anything --
16             MR. GORDON:       General
17   question.
18             MR. JEFFERS:      -- about the
19   clinical status or anything?
20             MR. GORDON:       General
21   question.
22             MR. JEFFERS:      You may try to
23   answer it.
24   A    Yes.
25   Q    And why do you -- why do you then tell
0065
 1   the physician of abnormal lab values?
 2   A    Because we would report abnormal lab
 3   values to a physician for further order or
 4   care.
 5   Q    Okay.  And just hypothetically, if a
 6   nurse did not tell a physician of ab -- of
 7   abnormal lab values, would that be a breach
 8   of her duty to tell the physician of
 9   abnormal lab values?
10             MR. JEFFERS:      Objection.  He's
11   on a hypothetical --
12   Q    Yes.  Hypothetical.
13             MR. JEFFERS:      That's without
14   any other ramifications of clinical
15   situation?
16             MR. GORDON:       Absolutely.
17   A    Hypothetically, yes.
18   Q    It would be a breach?
19   A    Yes.
20             MR. JEFFERS:      She said that,
21   hypothetically.
22   Q    All right.  Well, similarly, again,
23   generally speaking, does a nurse have a duty
24   to tell a physician of abnormal vital signs?
25             MR. JEFFERS:      I'll just have a
0066
 1   continuing objection to this, and you go to
 2   your heart's content, okay?
 3             MR. GORDON:       Yes.
 4             MR. JEFFERS:      Okay.  Go ahead.
 5             MR. GORDON:       And I think I
 6   will.
 7             MR. JEFFERS:      I know you will,
 8   but I might get tired of it.
 9   A    Yes.
10   Q    Okay.  And it would be a breach of a
11   nurse's duty not to tell a physician of an
12   abnormal vital sign; is that correct?
13   A    Can you rephrase the question?
14   Q    Would it be a breach of a nurse's duty
15   to fail to tell a physician of an abnormal
16   vital sign, generally speaking?
17   A    Yes.
18   Q    Okay.  Is it the duty of a nurse in the
19   postpartum delivery to write down the orders
20   that are given -- I'll rephrase it.
21             Is it the duty of a nurse to write
22   down the orders as given by a physician?
23             MR. JEFFERS:      Are we now doing
24   rhetorical questions?
25             MR. PARIS:        Is that an
0067
 1   objection, John, because --
 2             MR. JEFFERS:      Yes, it's an
 3   objection.
 4             MR. PARIS:        Okay.
 5   Q    Okay.  And the breach -- strike that.
 6             It would be a breach of the duty
 7   of the nurse not to write down the orders as
 8   the order was given to her by the physician;
 9   is that correct?
10   A    Yes.
11   Q    Okay.  Now, was there in place at Parma
12   Community General Hospital in June of 1999 a
13   protocol for the nursing staff in which if a
14   nurse felt that a physician was not treating
15   a patient appropriately, it gave the nurse
16   authority to take some action by, for
17   instance, calling a nursing supervisor or
18   someone else?
19   A    I don't recall if we have a specific
20   written policy.
21   Q    Okay.  Was there unwritten policy in
22   that regard?
23   A    Yes.
24   Q    And what was the policy?
25   A    If we don't agree -- if nursing doesn't
0068
 1   agree with the care the physician is giving,
 2   we could call our chief of staff
 3   physician -- physician-wise.  Excuse me.
 4   Q    Okay.  24 hours a day?
 5   A    Yes.
 6   Q    And ask then -- ask the -- when you
 7   say -- I missed the terminology.  Chief
 8   what?
 9   A    Chief of staff.
10   Q    Chief of staff.  And you -- then you
11   can ask the chief of staff to intervene; is
12   that correct?
13   A    Yes.
14   Q    Okay.  Have you ever used that policy?
15   A    No.
16   Q    Have you ever seen others use that
17   policy --
18             MR. JEFFERS:      Objection.
19   Q    -- here at Parma Community General
20   Hospital?
21             MR. JEFFERS:      Objection.  Go
22   ahead.
23   A    Not that I recall.
24   Q    Okay.  You know, in other words, have
25   you ever heard of the word chain of
0069
 1   command?
 2   A    Yes.
 3   Q    Okay.  You've never heard of a chain of
 4   command protocol here at Parma?
 5   A    I've never seen it written, no.
 6   Q    Okay.  All right.  Did you have any
 7   further discussions with Mr. Williams that
 8   you can recall --
 9             MR. JEFFERS:      You can look at
10   your notes.  Page 160.
11   Q    -- that took place on June 26th, 1999?
12   A    No, I don't recall any more
13   conversations with him.
14   Q    Did you have any discussions or
15   conversations with the mother of Mary
16   Williams, other than one we -- that was
17   identified in your -- your notes, let's see,
18   what time was that?  At 8:50.
19   A    Yes.
20   Q    You did have another conversation?
21   A    Yes.  An ongoing conversation.
22   Q    And, by the way, did you know the
23   mother of Mary Williams before June 25th,
24   1999?
25   A    No, I did not.
0070
 1   Q    Okay.  And what other conversation did
 2   you have with the mother of Mary Williams?
 3   A    I can't recall the exact time, but the
 4   mother was uncomfortable with her staying on
 5   the floor and wanted her transferred to ICU,
 6   and I agreed with her at that time and --
 7   and told her I would speak to Dr. Hahn about
 8   it.
 9   Q    When did that conversation take place,
10   with the mother?
11             MR. JEFFERS:      What's your best
12   estimate?
13   A    I -- that's what I'm looking at, to
14   see.  Approximately 10:15.
15   Q    Okay.  And what do you base that on?
16   A    When she started complaining of having
17   chest pain.  10:15, 10:20 the conversation
18   took place.
19   Q    With the mother?
20   A    Yes.
21   Q    And then did you then talk to Dr. Hahn
22   about transferring the patient to intensive
23   care unit?
24   A    Yes.
25   Q    What -- and when did that conversation
0071
 1   take place?
 2   A    Shortly thereafter.  10:20, 10:22.
 3   Q    Okay.  And what -- and how did you
 4   phrase it to Dr. Hahn to have the patient
 5   transferred to the intensive care unit?
 6   A    I stated that the mother was concerned
 7   and would prefer the patient go to ICU and
 8   that I possibly would feel more comfortable
 9   with her going to ICU also.
10   Q    And what did Dr. Hahn say?
11   A    He stated that she was stable enough to
12   stay on our floor.
13   Q    Why did you feel uncomfortable?
14   A    Because at that time he was ordering
15   Heparin drips to be given, and I felt she
16   would get better care going up to ICU,
17   getting a Heparin drip.
18   Q    Why?
19   A    Because we routinely don't do Heparin
20   drips on our floor.
21   Q    Okay.  And when Dr. Hahn said that he
22   felt she was stable, did he give you any
23   reason why he -- he felt, that is, Dr. Hahn
24   felt, that the patient was stable?
25   A    He didn't -- no.
0072
 1   Q    Did you have any further conversations
 2   with the mother of Mary Williams?
 3   A    The one short conversation before she
 4   decided she was going to take her upstairs
 5   was that she wanted -- she wanted her to go
 6   upstairs right then and there and that she
 7   was going to have to move her herself, and
 8   that's when I helped her move the patient
 9   then, at that time.  So it was approximately
10   around the time of 10:55.
11             MR. MURPHY:       That time refers
12   to the next conversation with the mother?
13   A    Yes.
14             MR. MURPHY:       Is that what the
15   question --
16   A    The next conversation with --
17             MR. MURPHY:       Okay.
18   A    -- the mother was at 10 --
19   approximately 10:55, when the mother was
20   very insistent to move the patient to the
21   floor and started moving the patient to
22   the -- to the floor herself, so I assisted
23   and --
24   Q    Well, let me ask you this then:  Was
25   the order to transfer the patient to the
0073
 1   intensive care unit, was that before or
 2   after the mother started moving the bed to
 3   the -- towards the intensive care unit?
 4   A    I -- I can't give you a yes or no
 5   answer for that.
 6   Q    Okay.
 7   A    Dr. Hahn was -- at the time we were
 8   wheeling the patient past the nursing
 9   station, he was on the phone to get a
10   consult to move the patient to ICU.
11   Q    Where is the ICU, what floor?
12   A    On the 8th floor, I do believe.
13   Q    Okay.  According to these records at --
14   on page 160, at 9:30, there was a reference
15   to the lab here to draw ordered labs, okay?
16   A    Yes.
17   Q    Then -- and maybe I'm missing
18   something.  There's no reference that --
19   here that you -- you told Dr. Hahn of the
20   lab results that were drawn at 9:30 a.m.  Am
21   I correct or incorrect?
22   A    Rephrase that question, please?
23   Q    Okay.  Is there any reference in these
24   records on -- let's see, on page 160, that
25   you told Dr. Hahn of the lab results of the
0074
 1   labs drawn at 9:30?
 2   A    No, I did not.
 3   Q    Okay.  Could you turn to page 42,
 4   please?  Okay.  Looking at the labs under
 5   9:24 a.m., did you report to Dr. Hahn the
 6   results of the labs under this column of
 7   9:24 a.m.?
 8             MR. JEFFERS:      Well, we don't
 9   know if the clocks are the same.  9:15 --
10             MR. GORDON:       Yeah.  It --
11             MR. JEFFERS:      -- it shows
12   results given, on your nursing notes at 0915
13   on 6-26, and now you're talking about more
14   labs.
15   Q    So maybe you can help me, okay?
16   A    Okay.
17   Q    Because he's throwing it into another
18   issue.  The labs that says a.m. lab results
19   given at 9:15 a.m., which labs were those,
20   looking at page 42?
21   A    Those were the 5:30 lab work.
22   Q    Okay.  And how do you know that?
23   A    Because 9:30 was when they came up to
24   draw the lab work.
25   Q    For the ones reported at 9:24?
0075
 1             MR. JEFFERS:      What do you mean
 2   "reported"?  Oh.  Oh.
 3             MR. GORDON:       I mean that --
 4             MR. PARIS:        That are -- that
 5   are listed on page 42.
 6   Q    That are listed as 9:24.
 7   A    9:24.
 8             MR. JEFFERS:      All right.
 9   Okay.
10   Q    Now, I want you to turn to 160 and 161
11   for the notes that you wrote --
12   A    Okay.
13   Q    -- from 9:15 to 10:55.  You wrote these
14   as accurately as possible; is that correct?
15   A    Yeah.
16   Q    At the times indicated, for the times
17   indicated; is that right?
18   A    Yes.
19   Q    Is there anything else you remember
20   that occurred between let's say 9:15 until
21   the patient was transferred to the intensive
22   care unit?  That's --
23   A    Other than what my notes state?
24   Q    Right.  In other words, in the vital
25   signs.
0076
 1   A    No.
 2             MR. GORDON:       Let me just take
 3   a short break.  I think I'm almost done.
 4                     - - - - -
 5                   (Recess had.)
 6                     - - - - -
 7             MR. GORDON:       We're back on
 8   the record.
 9   Q    What was the patient's condition the
10   last time you saw Mary Williams?
11             MR. JEFFERS:      You mean in ICU?
12             MR. GORDON:       Yeah.
13             MR. JEFFERS:      Okay.
14   A    Very unstable.
15   Q    Unstable in what way?
16   A    They were unable to read her blood
17   pressures even by a manual blood pressure,
18   they had to Doppler her blood pressures.
19   Q    Did you subsequently learn that she had
20   passed away?
21   A    I was still working that day when I had
22   heard she had passed away.
23   Q    Okay.  Did you receive any information
24   as to what disease process was going on
25   which caused her to pass away?
0077
 1             MR. JEFFERS:      Objection.
 2   She's not going to testify to what the
 3   disease process was.  It's not within her
 4   realm.  Unless you're going to ask her if
 5   some doctor who is a party to this case
 6   stated it.
 7             MR. GORDON:       Wait a minute.
 8   Could you repeat my question, please?
 9                     - - - - -
10                 (Question read.)
11                     - - - - -
12   Q    By any -- by any physician or other --
13             MR. JEFFERS:      Who is a party,
14   or I object, because then it's irrelevant.
15   Q    All right.  Let me -- let me start
16   over.  Okay.
17             Did anyone tell you why she had
18   passed away?
19             MR. JEFFERS:      Object.  Go
20   ahead.
21   A    I had -- Dr. Rabaki speculated --
22             MR. JEFFERS:      Okay.
23   Objection.  You don't speculate.
24             THE WITNESS:      Okay.
25             MR. PARIS:        Look, this is a
0078
 1   discovery deposition.
 2             MR. JEFFERS:      I don't care.
 3             MR. PARIS:        Just state your
 4   objection, don't tell her --
 5             MR. JEFFERS:      I don't know --
 6             MR. PARIS:        -- not to answer
 7   a question.
 8             MR. JEFFERS:      Sure I can,
 9   because --
10             MR. PARIS:        If it's not
11   privileged, John, she's entitled to answer a
12   question.
13             MR. JEFFERS:      No, because
14   she's going to talk about what somebody who
15   is not a party had to say, and that's not
16   admissible.
17             MR. PARIS:        You're
18   absolutely right.
19             MR. JEFFERS:      And it won't
20   lead to anything admissible.
21             MR. PARIS:        Well, John,
22   let's let the Court make that decision.  Let
23   us engage in discovery.
24             MR. JEFFERS:      All right.
25   I'll -- I'll allow that because I'm such a
0079
 1   wonderful human being today.
 2             MR. PARIS:        Okay.
 3             MR. JEFFERS:      Even though it's
 4   totally improper.
 5             All right.  Who?  Dr. Who?
 6             THE WITNESS:      Babaki.
 7             MR. JEFFERS:      Who is he?
 8             THE WITNESS:      The intensivist.
 9   Q    And what did he say?
10             MR. JEFFERS:      Objection.
11   Continuing, right?
12             MR. GORDON:       Yes.  Right.
13   Absolutely.
14   A    He thought it was toxic shock
15   syndrome --
16   Q    Okay.
17   A    -- that was causing it.  She hadn't
18   passed away at that time.
19   Q    Okay.
20             MR. JEFFERS:      For the record,
21   will you spell Rabaki?
22   Q    Or Bobaki.  I don't know.  What is it?
23   A    Babaki.
24   Q    Babaki.
25             MR. JEFFERS:      Babaki.
0080
 1   A    I don't know how it's spelled.
 2   B-A-B --
 3             MR. PARIS:        A-K-I.
 4   A    -- A-K-I.
 5   Q    Had you had in your career any other
 6   patients who -- who died from a -- let's say
 7   a postpartum infection or toxic shock
 8   syndrome?
 9             MR. JEFFERS:      Objection.  Go
10   ahead.
11   Q    No?
12   A    No.
13   Q    Okay.  After the patient died, have you
14   had any conversations with any of the family
15   members?
16   A    No.
17   Q    After the patient died, have you had
18   any conversations with any physicians
19   regarding Mary Williams?
20   A    Yes.
21   Q    And who is -- who was that physician?
22   A    Dr. Hahn and Dr. Zebrowitz.
23   Q    Okay.
24             MR. JEFFERS:      And who?
25             THE WITNESS:      Dr. Zebrowitz.
0081
 1             MR. JEFFERS:      Objection to the
 2   latter.
 3   Q    How do you spell Dr. Zebrowitz's name?
 4   A    Z-E-B -- E-B-R-O-W-I-T-Z.
 5   Q    Okay.  When did you have a conversation
 6   with Dr. Hahn after the patient --
 7   A    Died.
 8   Q    -- died?
 9   A    After the patient died.  Did you want
10   specifics?  I mean --
11   Q    Yes.
12   A    A couple of days.  A day or two.
13   Day -- probably a day after.
14   Q    And what was discussed?
15   A    I was asking questions about the pro --
16   I mean, what happened, the process of what
17   toxic shock is and how -- you know, what
18   happens to a person when they get toxic
19   shock, those type of questions.
20   Q    And what did Dr. Hahn say?
21   A    The one thing that I -- the only thing
22   I recall is that there was an
23   85 percent mortality, that's the only thing
24   I can recall.
25   Q    From what, toxic shock?
0082
 1   A    Um-hum.
 2   Q    Is that what he said?
 3   A    Yes.
 4   Q    Okay.  Did Dr. Hahn ever indicate to
 5   you that he was not given the appropriate
 6   lab results?
 7             MR. JEFFERS:      Objection.  Go
 8   ahead.
 9   Q    By the nursing staff.
10   A    No, he never discussed that with me.
11   Q    Is that your only conversation with
12   Dr. Hahn about Mary Williams after the
13   patient died?
14   A    Yes.
15   Q    Now, you mentioned a conversation you
16   had with Dr. Zebrowitz.
17   A    Um-hum.
18   Q    Who is Dr. Zebrowitz or what position
19   does he have?
20   A    He used to be a house physician on our
21   floor.
22   Q    Okay.  And when did you have a
23   conversation with Dr. Zebrowitz?
24             MR. JEFFERS:      Objection.  Go
25   ahead.  To all those.
0083
 1   A    When did I?
 2   Q    Yes.
 3   A    A few days after her passing.
 4   Q    And what was discussed?
 5             MR. JEFFERS:      Can I have a
 6   continuing on this point?
 7             MR. GORDON:       Yes.
 8             MR. JEFFERS:      Thank you.
 9   A    I asked if he had ever seen this happen
10   and he had stated yes --
11   Q    Okay.
12   A    -- in a case that he had had where he
13   was a resident.
14   Q    Okay.  Did you have any further
15   conversations with Dr. Zebrowitz?
16   A    No.
17   Q    Did you have any conversation with any
18   other physicians?
19   A    No.
20   Q    Did you have any conversations with any
21   member of the nursing staff regarding Mary
22   Williams after Mary Williams died?
23   A    About her case?
24   Q    Yes.
25   A    No.
0084
 1   Q    About her care.
 2   A    Yes.
 3   Q    Who did you talk to?
 4   A    I -- I don't recall who it was I talked
 5   to specifically.
 6   Q    Okay.  But it was a member of the
 7   nursing staff at Parma Community General
 8   Hospital?
 9   A    Yes.
10   Q    Was it a nursing serving -- supervising
11   or was it a floor nurse?
12   A    Oh, a floor nurse.
13   Q    But you don't remember who the nurse
14   was.
15             What generally was discussed?
16   A    What had happened during that day.
17   Q    Yeah.  All right.  That nurse was --
18   was that nurse Nurse Prokop?
19   A    No.
20   Q    Nurse Bazzo?
21   A    No.
22   Q    Okay.  Have you given anyone a written
23   statement about your knowledge involving
24   your care and treatment of Mary Williams?
25   A    No.
0085
 1   Q    What is meant by a phone check?
 2             MR. JEFFERS:      A what?
 3   Q    Phone check.
 4   A    I don't understand what you mean by
 5   that.
 6   Q    Here.  In the records, for instance,
 7   for example, let's say turn to page 160,
 8   okay, on the left-hand column, on June 25th,
 9   '99 at 2024 it says phone check with
10   Dr. Hahn, okay?
11             MR. JEFFERS:      By Bazzo.
12             MR. GORDON:       Right, but
13   what --
14   A    Yes.
15   Q    What does phone check mean?
16             MR. JEFFERS:      Why not ask her?
17             MR. GORDON:       Well, what does
18   she -- I mean, I can ask her what she
19   understands that means.
20   A    That she spoke with Dr. Hahn on the
21   phone.
22   Q    Do you use the terminology "phone
23   check"?
24   A    Not that specific terminology, no.
25   Q    What terminology do you use?
0086
 1   A    Phone call made to Dr. Hahn.
 2   Q    Okay.  You've indicated you've worked
 3   with Dr. Hsieh.  Do you have any difficulty
 4   understanding what Dr. Hsieh is saying?
 5             MR. JEFFERS:      Object.  Go
 6   ahead.
 7   A    I can't answer that with yes or no,
 8   but -- yes, at times, but then I repeat what
 9   he says to clarify that I understand what he
10   wants and he understands what I want.
11   Q    Okay.
12             MR. GORDON:       That's all I
13   have.
14             MR. JEFFERS:      Other questions
15   by anybody?
16             MR. MURPHY:       I may have a
17   couple, John.
18             MR. JEFFERS:      Jeff, do you
19   have any?
20             MR. SCHOBERT:     I don't have
21   any.
22             MR. JEFFERS:      Pat Murphy is
23   here representing Dr. Hahn.
24                    - - - - -
25                CROSS-EXAMINATION
0087
 1   BY MR. MURPHY:
 2   Q    You have a note written at 8:15 a.m. on
 3   June 26th referencing your phone call to
 4   Dr. Hahn.
 5             MR. JEFFERS:      What time, Pat?
 6             MR. MURPHY:       8:15 a.m.
 7             MR. JEFFERS:      Okay.
 8   Q    With your concern about the patient.
 9   Do you see that?
10   A    Yes.
11   Q    You said earlier that you had an
12   impression or a sus -- I forget the term you
13   used, but your impression was that Dr. Hahn
14   was still at home.  He had a recollection
15   that he was in the car when he got that
16   phone call.  Is there any reason you would
17   dispute his recollection over yours, or --
18   A    The -- the conversation was very clear,
19   it wasn't broken up or like a -- like a car
20   or cell phone would be.
21   Q    That's why you thought he was at home
22   then?
23   A    Yes.
24   Q    On a regular phone?
25   A    Yes.
0088
 1   Q    As opposed to a cell phone?
 2   A    As opposed to a cell phone.
 3   Q    Okay.  He indicated, however, that he
 4   would be right into the hospital after you
 5   called him?
 6   A    Yes.
 7   Q    With respect to -- I'm going to use the
 8   term narrative charting.  I don't know --
 9   what do you call these sheets?
10   A    Narrative charting.
11   Q    Narrative charting?  You've gone to
12   computer charting, obviously.  Where is the
13   keyboard where -- on which you would enter
14   your notations in relationship to the
15   patient's room?
16   A    In relationship to this patient's room
17   was probably -- she was in the first room
18   next -- next to the nurse's desk.
19   Q    So very --
20   A    20 feet.
21   Q    Okay.
22   A    Very close.
23   Q    Is that where the keyboard is, at the
24   nurse's desk, to make these notes?
25   A    Yes.
0089
 1   Q    Are there a number of them there?
 2   A    At the time I believe there was two.
 3   Q    When you make an entry regarding some
 4   finding or some -- something you have
 5   observed with respect to a patient, does the
 6   computer automatically put the time in or do
 7   you have to enter the time itself?
 8   A    When I write a note, you have to put
 9   the time that it actually occurred --
10   Q    Okay.
11   A    -- in, you actually punch it in.
12   Q    Is the set-up such that if -- if you're
13   typing a note -- let's -- for example, just
14   8:50 a.m., I just grabbed that for no
15   particular reason, but if you're entering a
16   note and don't put in a specific time
17   manually, would the computer not accept the
18   note or would it put the time in that you
19   actually physically put that note in, or --
20   A    No, it wouldn't accept the note.
21   Q    Okay.
22   A    You have to actually put the time in.
23   Q    You have to put in the time.  Okay.
24             You have a note that you entered,
25   the time of the note is 10:45 a.m., and it
0090
 1   states in part, Dr. Hahn made decision to
 2   transfer patient to ICU.  Dr. Wilson called
 3   on consult.  Dr. Wilson is an ICU physician,
 4   is he?
 5   A    Yes.
 6   Q    And for you to get the -- for you to
 7   have the knowledge that Dr. Hahn had decided
 8   at that time to transfer the patient, is
 9   that something he verbalized to you, that
10   I've decided to move her up to ICU or
11   something to that effect?
12   A    Yes, I believe he did state that.
13   Q    You indicated that the patient's mother
14   apparently actually started moving her bed
15   physically?
16   A    Yes.
17   Q    Before the appropriate transfer team
18   was there to do so, I gather?
19   A    Yes.
20   Q    And you assisted her then in doing that
21   when you saw her?
22   A    Yes.
23   Q    Were you aware at that time that
24   Dr. Hahn had already made his decision to
25   transfer the patient to the ICU?  It looks
0091
 1   like it from the timing of the notes, but I
 2   wanted to confirm that.
 3   A    Yes.
 4             MR. JEFFERS:      Pardon me?
 5             THE WITNESS:      Go ahead.
 6             MR. JEFFERS:      Objection.  Now
 7   go ahead.
 8   A    Yes, but as we were wheeling past the
 9   desk he was still on the phone.
10   Q    Okay.
11   A    He hadn't finished his transaction
12   or --
13   Q    Okay.  Your note about the mom being
14   transferred was timed here at 10 -- or not
15   about the mother being transferred, the
16   mother of the baby being transferred, was at
17   10:55 a.m., and since you were actually
18   assisting her mother in moving the bed at
19   that time, the question I have is whether
20   you actually made that notation at that time
21   or did you go back later and put it in --
22   A    Oh.  I had to --
23   Q    -- approximately --
24   A    -- go back later and put it in.
25   Q    To put that time in?
0092
 1   A    Yes.  But I do recall looking at the
 2   clock when we were rolling past the desk and
 3   it being five to 11:00.
 4   Q    Okay.  Do you usually get the times for
 5   your noting from the clock by the nurse's
 6   desk or from your watch, or is there any
 7   particular routine?
 8   A    If I'm at the desk, I look at the desk
 9   clock, but if I'm not anywhere where there's
10   a clock, I look at my watch.
11   Q    Dr. Babaki's comment to you about his
12   impression of toxic shock, I just couldn't
13   hear you before, did he make that statement
14   to you even prior to the patient passing
15   away?
16   A    Yes.
17   Q    I thought that's what you said.  Okay.
18             And was that done at a time when
19   you were still up in the ICU after taking
20   the patient up there and kind of waiting
21   around to see what was going to happen?
22   A    It was actually done at a later time
23   when I was up there charting.
24   Q    You went back up again to chart or
25   something?
0093
 1   A    I had to go back up there to chart,
 2   because her name leaves our computer, we
 3   can't chart on our floor anymore once she's
 4   upstairs.
 5   Q    I see.
 6   A    So I had to go back up and chart on
 7   her.
 8   Q    I see.  Okay.  Do you have a
 9   recollection of what time that was that you
10   went back up?
11   A    Yeah, I can --
12             MR. JEFFERS:      The time when
13   which, Pat?
14             MR. MURPHY:       When she --
15   A    I was charting.
16             MR. MURPHY:       -- went back up
17   to the ICU so she could finish her charting.
18             MR. JEFFERS:      Okay.
19   A    Approximately 2:45 in the afternoon.
20             MR. MURPHY:       Okay.  Thanks.
21   That's all I have.
22             MR. JEFFERS:      Anybody else?
23             MR. GORDON:       Yeah, one
24   thing.
25                     - - - - -
0094
 1                RECROSS-EXAMINATION
 2   BY MR. GORDON:
 3   Q    Do you have any information why Mary
 4   Williams was placed in the first room next
 5   to the nurse's station?
 6   A    Yes.  I was -- to keep a closer eye on
 7   her, I was told.  She was moved, I -- I
 8   don't -- I can't recall when she was moved,
 9   but it was prior to my shift.
10   Q    What do you understand why there was a
11   need to have a closer watch over Mary
12   Williams?
13   A    Because of her confused state and
14   complaints that she had during the night.
15             MR. GORDON:       Okay.  That's
16   all I have.
17             MR. TACKLA:       Off the record.
18             MR. JEFFERS:      May we have
19   30 days to get the signature?
20             MR. GORDON:       Sure.
21             MR. JEFFERS:      Please send this
22   to Monica Keile.
23             MR. TACKLA:       Do we waive the
24   viewing of watching the videotape?
25             MR. JEFFERS:      I don't want her
0095
 1   to see the videotape.
 2             MR. TACKLA:       Thank you.  Do
 3   you waive the one day filing requirement of
 4   the videotape?
 5             MR. JEFFERS:      Nobody's said
 6   they're going to file it yet.
 7             MR. GORDON:       Assume that's
 8   likely, that we do intend to file it.
 9             MR. JEFFERS:      Then I would.
10             MR. TACKLA:       Thank you.  I'll
11   hold on to the custody of the original
12   then.
13                     - - - - -
14        (Deposition concluded at 4:07 p.m.;
15               signature not waived)
16                     - - - - -
17   
18   
19   MARY HEATHER HULVALCHICK, R.N.
20   
21   
22   
23   
24   
25   
0096
 1               C E R T I F I C A T E
 2   
 3   The State of Ohio,   )
 4   County of Cuyahoga.  )  SS:
 5   
 6         I, David J. Collier, Registered
 7   Professional Reporter, Notary Public within
 8   and for the State of Ohio, duly commissioned
 9   and qualified, do hereby certify that the
10   within named witness, MARY HEATHER
11   HULVALCHICK, R.N., was by me first duly
12   sworn to testify the truth, the whole truth
13   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   
22         I do further certify that this
23   deposition was taken at the time and place
24   as in the foregoing caption specified, and
25   was completed without adjournment.
0097
 1         I do further certify that I am not a
 2   relative, counsel or attorney for either
 3   party, or otherwise interested in the
 4   outcome of this action.
 5   
 6             IN WITNESS WHEREOF, I have
 7   hereunto set my hand and affixed my seal of
 8   office at Cleveland, Ohio, this 2nd day of
 9   February, 2001.
10   
11   _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
12   David J. Collier, RPR,
13   Notary Public/State of Ohio.
14   Commission expiration:  April 26, 2001.
15   
16   
17   
18   
19   
20   
21   
22   
23   
24   
25