1 IN THE COURT OF COMMON PLEAS OF CUYAHOGA COUNTY, OHIO JULIE GREGORY, etc., et al., Plaintiffs, vs. Case No. SANDUSKY OBSTETRICS 98-CV-380 & GYNECOLOGY, INC., et al., Defendants. ~ ~ ~ ~ ~ Deposition of SUE SANFORD, called for examination under the statute, taken before me, Barbara J. Watowicz, a Registered Professional Reporter and Notary Public in and for the State of Ohio, pursuant to notice and stipulations of counsel, at Providence Hospital, 912 Hayes Avenue, Sandusky, Ohio, on Tuesday, March 6, 2001, at 9:30 a.m. ~ ~ ~ ~ ~ 2 1 APPEARANCES: 2 3 On behalf of the Plaintiff: 4 Hermann, Cahn & Schneider, by 5 KENT B. SCHNEIDER, ESQ. 6 500 Erieview Tower 7 1301 East Ninth Street 8 Cleveland, Ohio 44114 9 (216) 781-5515 10 11 On behalf of the Defendants 12 Sandusky Obstetrics & Gynecology, Inc., 13 William D. Bruner, D.O.; Brian Printy, 14 M.D., Glenn McLaughlin, M.D.: 15 Bonezzi Switzer Murphy 16 & Polito Co., L.P.A., by 17 DOUGLAS G. LEAK, ESQ. 18 Leader Building, Suite 1400 19 526 Superior Avenue 20 Cleveland, Ohio 44114-1491 21 (216) 875-2767 22 23 24 25 3 1 APPEARANCES, Continued: 2 3 On behalf of the Defendant 4 Providence Hospital: 5 Shumaker, Loop & Kendrick, LLP, by 6 JOHN C. BARRON, ESQ. 7 North Courthouse Square 8 Toledo, Ohio 43624 9 (419) 241-9000 10 ~ ~ ~ ~ ~ 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 4 1 SUE SANFORD, of lawful age, called for 2 examination, as provided by the Ohio Rules of 3 Civil Procedure, being by me first duly sworn, 4 as hereinafter certified, deposed and said as 5 follows: 6 EXAMINATION OF SUE SANFORD 7 BY MR. SCHNEIDER: 8 Q. Would you state your name, please? 9 A. Susan Sanford. 10 Q. Mrs. Sanford, what is your 11 residence address? 12 A. 4103 Billings Road, Castalia, Ohio. 13 Q. What is your work address? 14 A. 1912 Hayes Avenue, Sandusky. 15 Q. Providence Hospital? 16 A. That's correct. 17 Q. What is your position at Providence 18 Hospital? 19 A. I'm the director of obstetrical 20 services. 21 Q. Is that obstetrical services as it 22 relates to nursing? 23 A. Yes. 24 Q. How long have you been at 25 Providence? 5 1 A. Five years. 2 Q. Have you had that title the whole 3 five years? 4 A. Yes. 5 Q. Do you know who you replaced? 6 A. They did not have obstetrics since 7 1978, so I was the new kid on the block opening 8 the unit in 1995. 9 Q. Okay. So they just started back 10 with obstetrical services in 1995? 11 A. That's correct. 12 Q. Tell me if you would your 13 educational background starting with college 14 and then just run through your jobs for me up 15 until now if you would. 16 A. Okay. I graduated in 1977 from 17 Harrington Technical College with an associates 18 degree in nursing. From there I was employed 19 by Fox Run Manor which is a nursing home in 20 Findlay for a brief period of time until I had 21 my first child. And then in March of '78 I 22 worked at Wyandotte Memorial Hospital. I was 23 there until August of 199 -- or '86. 24 Q. In what capacity? 25 A. I was a staff nurse in OB. 6 1 From August of '86 to 1995 I was 2 the manager of -- maternity manager at Harden 3 Memorial Hospital in Kenton, Ohio. 4 Q. Say that again. Paternity? 5 A. Maternity. 6 Q. Oh, maternity. I'm sorry. Go 7 ahead. 8 A. Since 1995 I've been here at 9 Providence. 10 Q. What caused you to leave the job 11 that you had before coming here? 12 A. Well, a head hunter called and told 13 me about opening the new unit, building the new 14 unit, just making an offer. I really didn't 15 think I was all that interested. But my 16 husband worked in Fremont at the time and it 17 was actually kind of closer if we lived up here 18 rather than driving to Fremont from where we 19 were living at the time which was upper 20 Sandusky. So I looked at the position, 21 interviewed, the rest is history. No real 22 reason, just personal growth. 23 Q. What are your duties as the 24 director of obstetrical services? 25 A. Well, I manage about 11-and-a-half 7 1 full-time equivalents. That's nursing hours in 2 lay terms. I have 16 staff members who 3 provide -- 4 Q. Say that again, you manage what 5 about? 6 A. 11-and-a-half full-time 7 equivalents. That's just nursing jargon for 8 the number of hours that I manage that a nurse 9 provides me in nursing care hours. 10 Q. You mean -- 11 A. I might have 16 nurses, but I have 12 11 full-time equivalents which means that I 13 have the equivalent almost of 11-and-a-half 14 full-time people working even though not all of 15 those bodies are full-time people. Some are 16 part-time, PRN, or they come as needed. 17 Q. You are just describing the number 18 of people you supervise? 19 A. That's correct. I'm also 20 responsible for board reporting. Quality. 21 Budgetary. Management. I delegate several 22 duties. Scheduling. Staffing. Orientation. 23 I'm responsible for purchases of equipment and 24 evaluations of those kinds of things. And as 25 far as licensure, meeting the requirements for 8 1 seeing that the unit meets the requirements for 2 maternity licensure for the State of Ohio. 3 Q. Do you do reviews of the nurses? 4 A. Yes. 5 Q. Is that part of your job? 6 A. Yes. Annual performance 7 appraisals. 8 Q. It just you that does those or 9 anybody else? 10 A. It depends. If the nurse only works 11 for me, then it would be only me. I would get 12 input from like the other supervisors if they 13 do not work on the day shift. But primarily, 14 yes, it's me that does these. 15 Q. Is there also a shift supervisor on 16 duty? 17 A. No, no. When the manager is in the 18 house they have done away with the shift 19 supervisor's position because we are 20 accessible. So the supervisor starts at 8:00 21 p.m. and works until 6:00 a.m. every day. 22 Q. Every day? 23 A. Every day, yes. 24 Q. Who are other shift supervisors 25 here at the hospital? 9 1 A. Mary Pajoli. Paula Wicker. Della 2 Brown. Those are the primary three. 3 Q. You know, of course, that we're 4 here about a birth that occurred back in March 5 of 1997? 6 A. Yes. 7 Q. Do you know who the shift 8 supervisors were back then? 9 A. No, I don't. I know two. I don't 10 know if both of them retired or one just went 11 to dialysis. I know Nancy Blake retired. I 12 don't know if it was before or after that. I 13 can't really tell you. 14 Q. But you know she was a shift 15 supervisor? 16 A. Yes. 17 Q. And who else? 18 A. Mary Alice Ryder. I'm not even 19 sure on the name on that one. I think she 20 works in hemodialysis now unless she retired 21 from there. 22 Q. Was Diane Halek a shift supervisor? 23 A. She was an OB unit charge nurse, 24 not a shift supervisor. The shift supervisor 25 takes care of the entire building as nursing 10 1 manager. 2 Q. Oh, I see. Okay. Diane Halek was 3 an OB charge nurse? 4 A. Yes. She was actually the clinical 5 coordinator at that time which meant that she 6 was me when I was not here kind of thing. 7 Q. So in your absence she would have 8 the authority to do the things you would do? 9 A. Some of them, yes. 10 Q. Is she still here? 11 A. No. 12 Q. When did she leave? 13 A. Less than a year ago. She went to 14 the new surgical center. 15 Q. Where is that? 16 A. That's just down the street on 17 Hayes. 18 Q. Who owns the new surgical center? 19 A. It's owned by -- I can't remember 20 the name of it. North Ohio Surgical Center. 21 Q. She left on good terms? 22 A. Yes. She's remained PRN for us 23 which means that she's available for us if we 24 get in a bind kind of thing as far as staffing 25 goes. 11 1 Q. Were there other OB charge nurses 2 besides her in March of 1997? 3 A. Each shift has a charge nurse, but 4 she's the clinical coordinator which is really 5 a step above that. It gives her a little more 6 responsibility. 7 Q. You said that you are in charge 8 of -- you help with licensing of the hospital, 9 is that right? 10 A. Yes. 11 Q. Am I, do I understand correctly 12 that this is now a Level II OB hospital? 13 A. Yes. 14 Q. When did that happen? 15 A. That happened one year ago. 16 Q. So it was in the year 2000? 17 A. That's correct. 18 Q. What occurred to take it from Level 19 I to Level II? How did that come about? 20 A. There was a bulk of requirements 21 that needed to be met that is provided by the 22 Ohio Department of Health. They give you a 23 list of requirements that you need to meet to 24 up your level. 25 Level III hospitals are the 12 1 regional district care centers. So we felt 2 that there was enough need in the community. 3 We had so many parents driving to Toledo and 4 Cleveland for intermediate care. So they 5 really didn't need to drive to University 6 Hospital or Toledo, they needed something in 7 between so the babies, especially premature 8 children, could grow, and they didn't have to 9 drive or live up there, we wanted to be the 10 middle man. We wanted to be able to support 11 that. So what this took was a great deal of 12 staff education. And it's very detailed. They 13 took a lot of tough courses. They went to 14 Toledo and worked. 15 Q. You are talking about the OB 16 nurses? 17 A. That's correct. Yes. So there was 18 a lot of education. Some physical preparation. 19 Not a great deal. We had to change some 20 signage, a few things like that. But as far as 21 the actual physical structure, not a lot of 22 physical change, but a lot of education. 23 Q. Can you give me a little more 24 detail about the type of education that the 25 nurses had to undergo, the OB nurses? 13 1 A. They underwent more specialized 2 neonatal intensive care training. It's the 3 University of Virginia program. It is a very 4 detailed program. It takes a year to complete. 5 Most of them got it done sooner than that, but 6 it's a vary in-depth study about conditions in 7 the newborn, those kinds of things. Ventilator 8 use. Just things that we had not used here 9 because there hadn't been a need because those 10 kinds of patients were sent somewhere else. 11 So now in order to provide that service in 12 a middle-type capacity, that's where we had 13 to go. 14 Q. Can you expand upon your services 15 available in terms of things you provided 16 during labor and delivery? 17 MR. BARRON: Kent, can I just have 18 a continuing objection to any questions dealing 19 with events after this delivery? 20 MR. SCHNEIDER: Yes. 21 MR. BARRON: Okay. Go ahead. 22 A. What was your question again? 23 Q. Can you expand upon your available 24 services that are provided during labor and 25 delivery? For instance, did you make fetal 14 1 scalp pH's available? 2 A. No. 3 Q. Any other changes in labor and 4 delivery practices that occurred? 5 A. Because of Level II? 6 Q. Yes. 7 A. Not specifically, no. No. Because 8 each room on the floor was adequate size 9 already. Those kinds of requirements as far as 10 physical structure were not necessary. Because 11 the unit was so new for one thing that was to 12 our advantage. 13 Q. Does the hospital now have internal 14 monitors for the mother's contractions 15 available here? 16 A. Yes. They always have had that. 17 Q. They have? 18 A. Yes. It was just a physician 19 preference as to whether it's used or not. 20 Q. Even back in March of 1997 you did 21 have on the premises internal monitors that 22 could have monitored the mother's contractions? 23 A. That's correct. 24 Q. And I take it you would have 25 expected all of your OB nurses to know that 15 1 they were available? 2 A. Oh, yes. 3 Q. And to be experienced with them? 4 A. Experienced to a point. They 5 are -- their role is minimal in that the 6 physician inserts that. It's just a matter of 7 plugging it into the machine. They need to 8 know the principle behind it, certainly, yes. 9 But it's not a nursing procedure. 10 Q. Have the nurses here since you have 11 been here had discretion to place internal 12 monitors on the baby? 13 A. Yes. 14 Q. That is not a physician procedure 15 here? 16 A. No. 17 Q. And they have discretion to remove 18 the internal monitors as they see fit? 19 A. The nurses? 20 Q. Yes. 21 A. Yes. Because a lot times there is 22 a lot of artifact and that would be an 23 indication of whether they would take it off 24 and replace it. 25 Q. Have you ever been deposed before? 16 1 A. Yes. 2 Q. Under what circumstances? 3 A. One very similar to this. The 4 other was a robbery that actually took place on 5 the floor at a hospital, at Wyandotte Memorial. 6 Q. When you say one very similar to 7 this, what do you mean? 8 A. I mean there was a question about 9 medical practice. 10 Q. What was the question? What was 11 the case about? 12 A. The case was about a baby who died 13 secondary to a prolapsed umbilical cord. 14 Q. It was issues related to whether 15 the delivery was handled properly? 16 A. There were many issues. 17 Q. Where were you working at the time? 18 A. Harden Memorial Hospital in Kenton. 19 Q. And about what year was that that 20 you were deposed? 21 A. Oh, boy. Let me think. '90 maybe. 22 Q. Why were you deposed? 23 A. I was deposed as the unit manager. 24 Q. Were you the one caring for the 25 baby during the time? 17 1 A. No, I wasn't even present. 2 Q. So they wanted to talk to you about 3 policies and procedures, things of that nature? 4 A. That's correct. 5 Q. What did you do to prepare for this 6 deposition? 7 A. I researched the articles given to 8 me as far as the depositions and the medical 9 record. 10 Q. When you say the articles, what are 11 you referring to? 12 A. These articles. These depositions. 13 The medical record. 14 Q. Okay. In other words, you are not 15 talking about medical literature articles, you 16 are talking about -- 17 A. No. I'm talking about these. 18 Q. So you have reviewed deposition 19 transcripts? 20 A. Yes. 21 MR. BARRON: And she referenced the 22 medical chart. 23 Q. And you looked at the baby's and 24 the mother's medical chart? 25 A. Yes. 18 1 Q. Providence Hospital chart? 2 A. Yes. 3 Q. Any other charts? 4 A. Fetal monitoring strip. 5 Q. Okay. How about the chart of the 6 baby or the mother from anywhere else? 7 A. No. 8 Q. And we have in front of us here the 9 depositions that you read? 10 A. Yes. 11 Q. May I take a look at them, please? 12 A. Sure. 13 MR. SCHNEIDER: Would you note for 14 the record, please, we have the deposition of 15 William Bruner. And Jacqueline Ledge. Holly 16 Durbin. Dwight Gregory and Julie Gregory. 17 MR. BARRON: Actually, I think you 18 skipped one here. If you'll keep going down 19 there is a sheet here which covers another 20 deposition of somebody. 21 THE WITNESS: Jane Richie. 22 MR. SCHNEIDER: Jane Richie. 23 MR. BARRON: And then the chart. 24 MR. SCHNEIDER: Thank you. 25 Q. You reviewed Dr. Bruner's 19 1 deposition, right? 2 A. Yes. 3 Q. Did you make any notes regarding 4 any of the depositions anywhere? 5 A. Specifically, no. 6 Q. What do you mean specifically, no? 7 A. I didn't find anything that was 8 unreasonable in any of them. 9 Q. In terms of what was said? 10 A. In terms of their perception. 11 Q. My question is, did you make any 12 notes of any type at any time? 13 A. No. Not handwritten notes, no. 14 Mental notes, yes. 15 Q. Okay. But nothing in writing? 16 A. Yes, you are correct. 17 Q. When you read Dr. Bruner's 18 deposition did it strike you that he was not in 19 anyway critical of any of the nursing staff? 20 MR. BARRON: I'm going to object to 21 the question to the extent it calls upon a 22 witness to characterize the testimony of 23 another witness. 24 Subject to my objection if you have 25 an answer to the question, Sue, go ahead and 20 1 give it. 2 A. Not particularly, no. 3 Q. So you did not make any mental 4 notes yourself when you read that deposition 5 that struck you as him being in anyway critical 6 of the conduct of any of the nurses? 7 A. Not particularly, no. 8 Q. Did -- 9 A. He makes a statement saying that in 10 certain situations he is normally called. 11 Those kinds of statements. But he did not make 12 anything that I felt was extremely derogatory 13 or negative about a particular nurse or a 14 situation. 15 Q. Well, did you get the sense that he 16 said he should have been called -- 17 MR. BARRON: Same objection. 18 Q. -- by Holly at any time as opposed 19 to I get normally called under these 20 circumstances? 21 MR. BARRON: I want to show an 22 objection to the extent that this is asking 23 somebody to interpret somebody's intent rather 24 than whatever their statement was. 25 Subject to my objection, Sue, if 21 1 you have an answer to the question you may give 2 it. If you don't recall the question because 3 of the objection you can have the reporter read 4 it back. 5 A. I remember the question. I don't, 6 I don't feel that he pointed fingers blatantly 7 at anyone. 8 Q. My question was, did you get the 9 impression that he was saying that she should 10 have called him at a time that she didn't? 11 MR. BARRON: Same objection. 12 Q. Whether you characterize that as 13 blatantly pointing a finger or not is not my 14 question. 15 MR. BARRON: Same objection. 16 Go ahead. 17 A. I'm trying to recall the exact 18 words that he had in the deposition. And I 19 can't really do that right now. I know it was 20 very similar to what I said before. I really, 21 I really don't think that that's the case, that 22 he feels that somebody should have called him. 23 No. I don't feel that at all. 24 Q. Okay. You have not talked to 25 Dr. Bruner about this case, have you? 22 1 A. No. Other than there is a case. 2 Q. Well, what do you mean other than? 3 What did you talk about? 4 A. We just said there is a case. 5 Q. When was that? 6 A. When we were notified a hundred 7 years ago or whenever it was. I don't know how 8 many years it's been now. Three. 9 MR. BARRON: You mean at the outset 10 of the -- 11 THE WITNESS: Yes. Whenever that 12 was. 13 Q. Have you talked to Holly about this 14 case at all? 15 A. No. 16 Q. Any of the other nurses that were 17 involved? 18 A. No. We talked about the issue if 19 there were some that it would have taken place 20 immediately and to my recollection there were 21 none. 22 Q. Say that again. I'm sorry. What? 23 A. If there had been circumstances 24 that we felt needed discussed we would have 25 done it immediately after Trent's birth, not 23 1 when, you know, waiting for litigation. 2 Q. Do you recall -- well, do you 3 remember talking about it after Trent's birth 4 with any of the nurses? 5 A. We review every case where there is 6 a baby transferred so yes, it does become 7 discussed. 8 Q. Well, who was it discussed between? 9 A. It would have been -- 10 MR. BARRON: Just a second. For 11 purposes of this question we need to draw a 12 distinction between peer review proceedings and 13 other types of discussions. If what you are 14 talking about falls within peer review 15 proceedings then I would instruct you to not 16 discuss that. If it has to do with something 17 separate from the peer review process then 18 please provide it. 19 A. No. It's related to peer review. 20 Q. It was all in the context of a peer 21 review? 22 A. Yes. 23 Q. Do you recall Dr. Bruner saying 24 that he would have -- well, strike that. 25 You read Jane Richie's deposition, 24 1 right? 2 A. Yes. 3 Q. And I take it you, you looked at 4 that document that showed when calls were made 5 by the health line operator and when she 6 received calls, things of that nature? 7 A. Yes. 8 Q. Showing you the document entitled 9 emergency surgery call notification list. Is 10 that what you were just referring to? 11 A. Yes. 12 Q. Yes. Okay. Thank you. 13 Do you have anyway of knowing 14 either because you recall at the time or 15 because you have inquired later as to who 16 exactly would have placed the call to Jane 17 Richie in the health line operator position 18 that day? 19 A. I believe it was Holly. 20 Q. Okay. How do you know that? 21 A. Because that would be normal 22 procedure for her to do that. 23 Q. Now, if you would look at this with 24 me as we talk about it for a moment. It 25 indicates that the call was received at 3:44 by 25 1 Jane Richie, is that correct? 2 A. That's what it states. 3 Q. You read her deposition when she 4 said that would have been when she got the 5 call, right? 6 A. Yes. 7 Q. Now, you are telling me that it's 8 your assumption that Holly was the person that 9 made the call because that's what protocol 10 required at that time? 11 A. Yes. Plus she documented it on the 12 medical record, OR, C-section called, those 13 kinds of things, so. 14 Q. Where did she document it? 15 A. It's on the fetal monitor tracing. 16 Q. Pull it out for me, please, if you 17 have it. 18 MR. BARRON: Well, maybe to speed 19 this thing up. She's not referring to some 20 previously unknown to you reference. She's 21 just referring to the notations on the chart 22 regarding to OR. She's not referring to the 23 telephone call to Jane Richie. 24 A. Right. I'm talking about the 25 time -- 26 1 Q. You are saying that, that what? 2 A. That Holly documented that the, 3 that the order was given to her for a stat 4 section, for a fairly progressed section and 5 then a stat section. 6 Q. By virtue of the fact that you see 7 documentation of, of two C-section orders, that 8 allows you to conclude that Holly is the one 9 that made the call? 10 A. She would be responsible for seeing 11 the call was carried out. She could delegate 12 that to someone else if she was tied up, but 13 it's my understanding that she made the call. 14 Q. And my question to you is, is your 15 understanding based entirely on what you have 16 told me about, those notations in the record? 17 A. No. It's also talking to Holly 18 after the situation occurred. 19 Q. That's what I wanted to know. 20 A. Oh, I'm sorry. 21 Q. You are telling me that Holly told 22 you -- 23 A. Yes. 24 Q. -- shortly before Trent's birth 25 that she was the one who made the call to the 27 1 health line operator? 2 A. Yes. 3 Q. Did you and her discuss the timing 4 of the call in anyway? 5 A. No. 6 Q. No. I take it at that point in 7 time of course you did not have this document 8 in front of you to know when the call was made, 9 right? 10 A. Right. But we knew that the time 11 was not relevant because we knew this -- we 12 made the 30 minute window. 13 Q. In terms of delivery? 14 A. Incision time. Decision to 15 incision, not delivery. 16 Q. And now say for me what you just 17 said again. What was irrelevant or relevant? 18 What was -- 19 A. The actual numbers of the time did 20 not matter as far as I'm concerned as to what 21 the health line reported. We know from the 22 time that we called the C-section, the 23 emergency C-section -- 24 Q. We meaning who? 25 A. We the hospital. We the staff. 28 1 Documented fetal monitor time. We know that we 2 made it within our 30 minute widow. So that 3 would not have been an issue. 4 Q. And that is because as long as you 5 make it within the 30 minute window you are 6 satisfied that everything was done properly 7 simply because it's done within the 30 minute 8 window? 9 A. Yes. That is, that is what is 10 mandated for maternity hospitals. 11 Q. Is there anything at this hospital 12 that mandates that you do it as quickly as 13 possible, even quicker than the 30 minutes if 14 you can? 15 A. Oh, of course. You would do that 16 in any situation. You would try to do it as 17 expeditiously as possible without jeopardizing 18 patient quality. I mean you still know that 19 you need to do a C-section, but if you don't 20 have to hurry it's better to make sure your i's 21 are dotted and your t's are crossed. But in an 22 emergency situation when it is your goal to get 23 the baby delivered you bypass those steps 24 because the only treatment is delivery. 25 Q. And when that happens, I take it 29 1 that you as a supervisor when looking back at 2 people's conduct look to see if it was done as 3 quickly as it possibly could have been done 4 without regard to the 30 minute window, is that 5 a fair statement? 6 A. I would suppose that is a fair 7 statement, yes. We like to see where we can 8 improve. But we certainly have to meet the 9 requirements. 10 Q. Well, that's the outside limit, 11 isn't it, 30 minutes? 12 A. Yes. 13 Q. You mean 30 minutes is the worse 14 case, you have to have it done within 30 15 minutes? 16 A. Right. 17 Q. From decision to incision, right? 18 A. Yes. 19 Q. All right. So that's not the 20 optimum situation, is it? 21 A. No, no. 22 Q. And you teach your nurses and you 23 expect your nurses and your employees to do as 24 best they can to deliver optimum care? 25 A. That's correct. 30 1 MR. BARRON: Wait. I'm going to 2 state an objection to the question because this 3 reference to optimum care is not legally 4 relevant to this procedure. It does not 5 constitute the standard of care. I object to 6 the question. 7 Subject to my objection, if you can 8 answer the question you may give your answer. 9 A. I would say that the goal of any 10 person providing healthcare wants to give 11 optimal care. 12 Q. All right. And isn't it true that 13 the standard of care for your nurses requires 14 them to do what is reasonable to perform the 15 delivery as quickly as possible? 16 A. Yes. 17 Q. And that's without regard to any 30 18 minute window, isn't it? 19 A. Yes. 20 Q. All right. Just to use an example 21 that I recognize to be extreme, but I want to 22 make sure we're on the same page. You have 23 indicated that you have 30 minutes as the 24 outside limit and that's what the regulations 25 require of you in terms of performing 31 1 C-sections. 2 MR. BARRON: She said emergency 3 C-sections. 4 Q. Emergency C-sections. I take it 5 you would agree with me that if there was an 6 emergency C-section called and a nurse decided 7 she wanted to take a ten minute break at that 8 point in time for personal reasons and then 9 returned and managed to get the baby delivered 10 within 30 minutes that would not be reasonable, 11 would it, even though you got it done within 30 12 minutes? 13 A. That's correct. 14 Q. That would be a deviation from the 15 standard of care, wouldn't it? 16 A. Yes. 17 Q. And any unnecessary delay by your 18 nurses that prevent the delivery of the baby as 19 quickly as possible is also a deviation, isn't 20 it? 21 A. If it's truly unnecessary, yes. 22 Q. Are there regulations that govern 23 what occurs at this hospital when a doctor 24 calls for a C-section? 25 A. Regulations? Format? Protocol? 32 1 Guidelines? 2 Q. Yeah. I'm sorry. I'm drawing a 3 blank on the word I want. Is there anything in 4 writing for instance that governs what they are 5 supposed to do? 6 A. Yes. 7 Q. Okay. What is that? 8 A. It's a guideline in our policy and 9 procedure manual. 10 Q. Do you have that here by any 11 chance? 12 A. No, I did not bring that with me. 13 Q. Well, I think I might have it. I'm 14 going to look for it. But tell me about that 15 guideline, what it says and does. 16 A. The C-section protocol is a list of 17 delineated things that ideally are followed 18 through with prior to a section. Like surgical 19 consent. Placement of an IV line. There are 20 nursing procedure lists. Notification lists. 21 Those kinds of things. And then there is an 22 emergency C-section list in addition to that 23 where it says that these steps may be omitted 24 in an emergent situation. Whereas if delivery 25 is your goal and speed is the issue, then we 33 1 might be able to bypass a couple of things like 2 bracelet or something to that effect. 3 Q. This is contained in the manual 4 that we were provided? 5 A. Uh-huh. 6 Q. Would you take a look at that? 7 A. Yes. 8 Q. Is that a listing of the C-section 9 procedures that you were referring to? 10 A. Yes. 11 MR. SCHNEIDER: Would you mark that, 12 please? 13 ~ ~ ~ ~ ~ 14 (Thereupon, Plaintiff's Deposition 15 Exhibit 1 was marked for purposes of 16 identification.) 17 ~ ~ ~ ~ ~ 18 Q. Now, this talks about C-section 19 procedures. And it does not differentiate 20 between stat or a nonstat procedure, correct? 21 A. This particular document does not. 22 Q. Right. I take it then that it 23 applies to both to the extent that in a stat 24 case you may -- there may be certain things you 25 can eliminate if the baby's health requires it? 34 1 A. That's correct. 2 Q. Now, I notice that the first thing 3 listed below C-section procedures has to do 4 with notifications, am I correct? 5 You have to answer verbally. 6 A. Yes. 7 Q. And is that because that's the 8 first thing that is to be done in order to 9 begin the process of completing the section? 10 A. It would be the first thing that 11 would be done in an emergency, not always in a 12 scheduled section. 13 Q. Let's talk for a moment if we could 14 to make sure we understand each other. So 15 you're saying certainly in an emergency 16 procedure those notifications are up at the top 17 because that's the first thing you do? 18 A. Yes. 19 Q. That's because unless do you those 20 things nothing else is going to happen? 21 A. That's correct. 22 Q. Now, am I correct that at certain 23 times surgical teams of nurses are on the 24 premises and at certain times they have to be 25 brought in from home? 35 1 A. That's correct. 2 Q. And so the notification procedure 3 becomes obviously more lengthy if the nurses 4 aren't on the premises? 5 A. Correct, yes. 6 Q. And, of course, all of your nurses 7 are taught that, right? 8 A. Yes. 9 Q. So I assume that if there is a 10 C-section, a stat C-section called for at a 11 time when the nurses know that the surgical 12 nurses are not on the premises, that they all 13 understand that the need for them to get the 14 ball rolling immediately to assemble that 15 surgical team is greater than if the nurses are 16 on the premises? 17 A. That's correct. 18 Q. And I take it you expect no delay 19 in that regard from your nurses? 20 A. Right. Because we have taken even 21 that a step further and setup a special call 22 team of people that live in town. 23 Q. When did you do that? 24 A. That was in place then. Since day 25 one I believe. 36 1 Q. So when you say you have special 2 call teams of people who are in town, you mean 3 you try to schedule your nurses who live 4 closest to the hospital so they can get here 5 quickly? 6 A. Yes. 7 Q. In the event of a stat C? 8 A. That's correct. 9 Q. You still do that today? 10 A. Yes. It's getting more and more 11 difficult because nobody wants to move. 12 Q. We were talking a minute ago about 13 what, what order things need to be done in and 14 you said to me that in the event of a stat 15 C-section, yes, this notification issue is 16 number one. But you said in the event of a 17 scheduled C-section that may not be the case? 18 A. That's correct. 19 Q. In this case as you know we have 20 something that, that I need to work with you to 21 define so we know what we are talking about. 22 At 3:30 you recall Dr. Bruner called for a 23 C-section? 24 A. Yes. 25 Q. But he did not use the word stat, 37 1 correct? 2 A. Right. 3 Q. Now, can we -- that's not a 4 scheduled C-section either, is it? 5 A. No. 6 Q. That he called for? 7 A. No. 8 Q. So we have a different category of 9 C-section than either scheduled or emergency, 10 and I want to know how to define that so you 11 and I can talk about it for purposes of 12 discussing what should be done. 13 A. In that particular situation that 14 would be considered an unscheduled 15 nonemergency. 16 Q. Okay. Now, am I correct that your 17 nurses are taught what to do in the event of a 18 stat C-section in terms of what they do in what 19 order and are they taught what to do in the 20 event of an unscheduled nonemergency? 21 A. Yes. 22 Q. And in what order -- what is it -- 23 is this the list that they are supposed to 24 follow what's been marked as Exhibit 1? 25 A. Yes. 38 1 Q. And if they have an unscheduled 2 nonemergency C-section should they then also 3 begin the process of notification of the 4 people, surgical team to come in if they are 5 not on the premises immediately? 6 A. Certainly. 7 Q. So they should begin that 8 immediately? 9 Answer yes, please. 10 A. Yes. 11 Q. Okay. And let's talk about March of 12 1997. The way that a nurse who is working at a 13 time when the surgical team is not on the 14 premises, for instance a weekend like this was, 15 a weekend afternoon, the way that she is to 16 begin the notification process for assembling 17 the personnel for an unscheduled nonemergency 18 C-section was to do what? 19 A. Just exactly what you said. 20 Q. Notify the health line operator? 21 A. Notify the health line operator. 22 It depends on the patient's condition for one 23 thing. If they walk in the door they don't 24 have their IV running. They don't have 25 anesthesia available. There are certain things 39 1 that need to be done in a nonemergency 2 situation. I would still mobilize the team. 3 But we have to wait an hour sometimes to get a 4 liter of IV fluid in the patient before 5 anesthesia can be provided. To get the best 6 outcome for the patient in that particular 7 situation as the nurse I would want to get that 8 line up and running, then go make my calls, 9 because the IV is going to be running wide 10 open. I need the patient to have hydration 11 before anesthesia and I need to take nursing 12 steps before I even call my people. 13 Q. Okay. All right. Let's talk about 14 the type of situation that we're here about 15 today where the patient had been in labor for a 16 number of hours, the IV is setup, the 17 anesthesia is in place, the epidural is in. 18 A. Okay. 19 Q. And the doctor comes into the room 20 and for whatever reason in his wisdom he calls 21 for the C-section. He does not say stat. 22 A. That's correct. 23 Q. Under those circumstances having 24 already accomplished many of the things that 25 you said a walk-in would need, I'm correct, 40 1 aren't I, that the first job of the nurse is to 2 notify the people who are responsible for 3 assembling the surgical team assuming they are 4 off the premises? 5 A. Meaning calling the health line? 6 Q. Yes. 7 A. Because they are not off the 8 premises. 9 Q. I don't mean the health line is off 10 the premises. I mean the surgical team is off 11 the premises. 12 A. Yes. The other thing is, I would 13 get the Foley catheter in place. 14 Q. Now, is there a phone in the labor 15 room where the nurse can call the health line 16 operator from? 17 A. Yes. But she probably would choose 18 not to do that. 19 Q. Why? 20 A. Because she would be giving the 21 patient's information and they would be asking 22 questions. It would just make more sense to 23 have the medical record and to be at the desk 24 in case of a birth date question, those kinds 25 of things. 41 1 Q. I don't understand. Why -- 2 A. Because the surgery staff needs to 3 know the patient's age, blood type, those kinds 4 of things. She may not have all of that with 5 her at bedside. So I would have to go -- I 6 would -- I would prefer they go to the desk 7 instead of running back and forth. 8 Q. When she calls the health line 9 operator she does not tell the health line 10 operator all of that information, does she? 11 She just says assemble the surgical team? 12 A. No. In an emergency situation she 13 would just say that, yes. Otherwise, she would 14 give some information. On occasion the surgery 15 staff will ask how old is the patient. What 16 blood type. They need to prepare for when they 17 go right to the OR. So they will, you know, 18 lessen their steps if they have that 19 information ahead of time. 20 Q. Now, what is your reason for her 21 not being able to make the phone call from the 22 room? You said she'd need to be giving the 23 patient information? 24 A. Yeah. She may need to give patient 25 information and she might not have all of it on 42 1 the flow sheet. The flow sheet is usually kept 2 at bedside with the patient. The entire 3 medical record, the prenatal history, those 4 things are the bulk of the chart which is at 5 the nurses' station. 6 Q. So are you telling me there is a 7 form that the health line operator has that has 8 all of the additional information on it that 9 you just described to me that she would convey 10 to the surgical nurses when she called them? 11 A. I don't know if she documented it, 12 but there is information often asked of us, 13 like the patient's name and blood type. That's 14 what I'm saying. So we're assuming that that 15 is the surgical staff requesting that because 16 the health line has no need for that 17 information. 18 Q. You are telling me as the director 19 of obstetrical services that you have no idea 20 whether the health line has any documentation 21 of any of that type of information that you 22 provide to them? 23 A. I don't provide that documentation. 24 Q. The nurses provide it to them? 25 A. I provide them with the 43 1 information. I don't know what they do with 2 it. The documentation, no, I don't. 3 Q. So my question is -- the answer is, 4 you have no idea whether they have any type of 5 form on which they record that type of 6 information? 7 A. No, I don't. I don't have that 8 information. That would be up to surgery. 9 Q. Is the health line still in 10 operation here? 11 A. It's called central scheduling now. 12 But it still exists, yes. 13 Q. Well, let me -- back in '97, in 14 March of 1997 you and I have talked about the 15 fact that there were times when the nurse would 16 have to call the health line operator to 17 assemble the surgical team if they were not on 18 the premises, is that correct? 19 A. That is correct. 20 Q. Am I correct that they would also 21 at times call the health line operator to 22 assemble the surgical team even if they were on 23 the premises, that the health line operator 24 would make the call to the -- 25 A. Not necessarily. 44 1 Q. How would they assemble the 2 surgical team if they were on the premises? 3 A. Usually the surgical team has to 4 let us know that they are in the building. 5 Especially if we have anybody in labor. So we 6 are well aware of that. In the case where we 7 might be having a C-section, we try to keep 8 them in-house so if we have somebody who is 9 looking like they have not made a great deal of 10 progress over a day's time we'll give them a 11 heads up and say, hey, before you leave for the 12 day check with us, that kind thing. 13 Q. So you just page them or something? 14 A. Yes. 15 Q. Okay. 16 A. And they are really good about 17 checking with us before they leave the 18 building. 19 Q. The time when the surgical team was 20 not on the premises back in March of 1997, that 21 time period, was there any other method of 22 contacting the surgical staff to assist with a 23 C-section when they were off the premises other 24 than the health line operator? 25 A. Not to my knowledge. 45 1 Q. It wasn't the job of the nursing 2 supervisor at all, it was always the health 3 line? 4 A. The supervisor takes over for the 5 health line when the health line is not here. 6 The health line is not here 24/7. 7 Q. That's what I'm talking about. 8 Explain to me what mechanism there was for 9 assembling a surgical team besides the health 10 line operator. 11 A. That would have been the house 12 supervisor. 13 Q. The house supervisor meaning the OB 14 supervisor or the whole house? 15 A. The whole house. 16 Q. So that the nurse, the labor nurse, 17 would contact the house supervisor? 18 A. That's correct. 19 Q. And tell them to assemble the 20 surgical team? 21 A. That's correct. 22 Q. I take it they were supposed to 23 notify them immediately as they were the health 24 line operator when they needed a surgical team? 25 A. That's correct. 46 1 Q. That's for an unscheduled 2 nonemergency section and a stat section? 3 A. That's correct. 4 Q. You told me that -- you did not 5 exactly say that the health line is not in 6 existence in anymore, you said it's now called 7 central scheduling, right? 8 A. Yes. 9 Q. Is that the same thing as health 10 line with just a new name? 11 A. No. Health line provided a lot of 12 information to the community about medical 13 concerns. People could call in to the health 14 line and get general information. That's why 15 it's called the health line. That part is no 16 longer available. The part of scheduling 17 patients where they are scheduled for all of 18 the physicians, for radiology, the kinds of 19 laboratory tests that require advanced notice, 20 ultrasound examinations, all of the testing 21 that is done by the hospital is scheduled 22 through central scheduling. It's like the 23 master schedule for the house. 24 Q. Are you telling me that the person 25 at central scheduling makes the phone calls to 47 1 patients to tell them when to come in? 2 A. Often times, yes. 3 Q. And they receive notification from 4 the various departments so they can put them on 5 their schedule of tests to be performed? 6 A. Yes. 7 Q. So if you want to know anything 8 that is going on in the hospital on any given 9 day central scheduling has it? 10 A. Yes. 11 Q. And the health line used to do that 12 also, didn't they? 13 A. They did it in combination. 14 Q. But what has been eliminated now is 15 the function of that person, that operator 16 let's call them, no longer takes calls from the 17 public about health inquiries of a general 18 nature as well as those other duties? 19 MR. BARRON: Can I have a 20 continuing objection as to post-event issues? 21 MR. SCHNEIDER: Yes. 22 MR. BARRON: Go ahead. 23 A. We have I think a contract service 24 now that provides that piece for us. We 25 physically do not provide that anymore, you are 48 1 right. 2 Q. So the point is, it's been 3 eliminated from the function of the operator 4 who does the scheduling and notification of the 5 surgical team? 6 A. Correct. 7 Q. All right. Back in March of 1997 8 for instance if a nurse wanted or a doctor 9 wanted a surgical team assembled they called 10 the health line operator, the health line 11 operator had to make the phone calls but could 12 also be receiving phone calls from the public 13 in that same time period, correct? 14 A. She could, yes. 15 Q. All right. And her job was to take 16 those calls and answer the public's general 17 health concerns as best that person could as 18 well as making the notification to the surgical 19 team? 20 A. That's correct. 21 Q. All right. Do you know why that 22 function was eliminated from the health line as 23 a priority where the central scheduling people 24 no longer take those health questions? 25 A. I can't say for sure. I thought it 49 1 was cost. But I can't say for sure. 2 Q. I take it that you would agree with 3 me that -- well, you have already told me that 4 it's important for the nurse to notify the 5 health line operator immediately to assemble 6 the surgical team, correct? 7 A. Yes. 8 Q. I take it you would also agree with 9 me that it's important for the health line 10 operator to make the calls to the surgical team 11 as quickly as possible because in the absence 12 of those calls you can't get the team in, fair 13 statement? 14 A. That's correct. Yes. 15 Q. And I take it you would agree with 16 me that the standard of care would require the 17 health line operator to make those calls as 18 quickly as possible? 19 A. Yes. 20 Q. Now, if the health line operator 21 has to delay making calls to a surgical team 22 member because a women is calling in and saying 23 for instance that Johnny has a runny nose and I 24 don't know whether to give him an antihistamine 25 or an aspirin and she has to take that call and 50 1 spend a couple of minutes talking to that 2 person and therefore delays in contacting a 3 surgical member for another couple of minutes 4 because of that, does that trouble you? 5 MR. BARRON: Let me show an 6 objection as to the lack of foundation for that 7 event. Calls for speculation. 8 Subject to my objection if you have 9 an answer to the question give it. 10 Q. From a healthcare provider's 11 perspective and obstetrical nurse in the OB 12 unit, does that trouble you that that delay 13 exists in contacting a surgical team member 14 because the health line operator has to take 15 the kind of call I just described -- 16 MR. BARRON: Same objection. 17 Q. -- in the interim? 18 MR. BARRON: Same objection. Calls 19 for speculation. 20 Go ahead. 21 A. I would assume that that would not 22 happen. That if indeed a call is made to the 23 health line while she's in the process of doing 24 that she would put that call on hold and do the 25 calling for the OR team first. 51 1 Q. So you're saying it would be 2 inappropriate in your professional judgment for 3 the health line operator to be taking those 4 types of calls from the public and delaying 5 their contacting of the surgical team that was 6 needed for a section? 7 A. I would hope that would not happen. 8 Q. All right. And, therefore, it does 9 trouble you if it does happen, doesn't it? You 10 would consider that to be troubling? 11 A. Yes, I would assume that they would 12 not do that. 13 Q. You read Jane Richie's deposition, 14 yes? 15 A. Yes. 16 Q. And she described that something 17 like that might have been occurring during that 18 period? 19 A. Might have been. 20 Q. The hospital was certainly setup to 21 permit that to occur, wasn't it? 22 A. That's not my understanding. 23 That's what her perception may be, but that's 24 not my understanding. 25 Q. Your understanding is that the 52 1 health line operator would not be performing 2 their duties as required by the hospital if 3 they did what Jane Richie said? 4 MR. BARRON: Objection. There is 5 no testimony that exists that says that in fact 6 occurred. You are creating a hypothetical. 7 There is no testimony that that in fact 8 occurred. 9 Q. Let me try it this way. 10 Assume for the moment that Jane 11 Richie's understanding was that if she received 12 phone calls from the public with health 13 questions after having received a request to 14 notify a surgical team that she would take 15 those calls in the interim, perhaps call one 16 surgical member, take another call from the 17 public, and then call another surgical member, 18 assume for the moment that that's her 19 understanding of what was permissible in terms 20 of the performance of her job, are you telling 21 me that as you understand it that's contrary to 22 Providence Hospital's policy in terms of the 23 performance of that job? 24 MR. BARRON: I want to seek 25 clarification. When you use the term take the 53 1 call, are you referring to picking up the line 2 or are you referring to conducting a 3 substantive discussion? 4 MR. SCHNEIDER: I'm going to ask her 5 to assume that it's a substantive discussion 6 and for your benefit I believe that's exactly 7 what she testified to. It could have occurred 8 on occasion. 9 Q. But assume that, yes, she takes a 10 call and spends a couple of minutes in a 11 substantive discussion with somebody calling 12 with a health question and thereby delays 13 contacting the next nurse on the surgical team. 14 Now, is it your understanding that that would 15 be contrary to the policy of Providence 16 Hospital? 17 A. I believe that Providence Hospital 18 has provided her with an outlet should that 19 occur. 20 Q. So the answer is yes, that's not 21 what she is supposed to do, she's supposed to 22 do something else? 23 A. She's supposed to take care of 24 needs at hand. The phone calls coming in she 25 can send to the emergency room for an answer. 54 1 It's not like the patient calling in can't be 2 referred somewhere else. She is obligated to 3 call the staff as requested. 4 Q. The surgical team? 5 A. Yes. 6 Q. That's her first priority, correct? 7 A. Yes. 8 Q. Nothing should delay it? 9 A. Other than maybe picking up the 10 phone like I said because there is a call 11 coming in, but no substantive discussion with 12 the caller. 13 Q. A second delay would be all right 14 you are saying? 15 A. Yes. 16 Q. Now, is there anything in writing 17 that you know of in this hospital that would 18 reference me to the requirements of the health 19 line and the operator, the way it's operated, 20 et cetera? Have you ever seen any writing that 21 instructs the health line operator how to do 22 that or anything about it? 23 A. I have not. 24 Q. Does that lead you to believe that 25 it does not exist or you just would not be 55 1 privy to it? 2 A. It's usually that anything related 3 to like the surgery call team would be provided 4 by surgery. I do not know how they mobilize or 5 where they live. Those kinds of things. So 6 the surgery people would provide that to the 7 health line. 8 Q. Just for my own clarification I 9 want to make sure I do understand one thing. 10 It's certainly possible if there is an 11 emergency situation for a nurse to pickup the 12 phone in the labor room and call the health 13 line operator and say stat C-section now, 14 right? 15 A. Yes. There is a phone in there. 16 Q. And if it's a stat C-section you 17 don't have any trouble with the nurse doing 18 whatever is best to expedite the process of 19 contacting the health line operator by picking 20 up the phone in the labor room? 21 A. No, certainly not. 22 Q. In fact, it's the right thing to do 23 if it's quicker? 24 A. I'm not sure it's quicker. 25 Q. Let's assume it's quicker. If we 56 1 assume it would be quicker then it would be the 2 right thing to do, correct? 3 A. Anything that can expedite the 4 procedure is a value, yes. 5 Q. And under that circumstance when 6 it's a stat you don't care if she has patient 7 information available particularly if the baby 8 is in a difficult, compromised position? 9 A. That's correct. However, I would 10 like to the benefit of her going to the desk to 11 make the call so she can also make the call to 12 the pediatrician. 13 Q. Which she'll do immediately? 14 A. She would not do from the room. 15 Q. Why? 16 A. Because the numbers aren't there. 17 She needs to notify the answering service. 18 Usually on weekends that's the number. 19 Q. So I mean she's supposed to make 20 that call to the pediatrician at the same time 21 that she makes the call to the health line 22 operator? 23 A. If it has been requested that the 24 pediatrician be contacted, yes. 25 Q. Can't she just tell the health line 57 1 operator to contact the pediatrician? 2 A. Not always. 3 Q. Why not? 4 A. Because there are two different 5 pediatric groups. Well, actually, then there 6 was only one. They only had one then. 7 Q. In fact you say Jane Richie is the 8 one that contacted the pediatrician in this 9 case? 10 MR. BARRON: Objection. It's 11 contrary to the evidence. Subject to my 12 objection if you want to ask her -- 13 Q. I'm sorry. I'm sorry. You are 14 correct. 15 A. No. The nurse needs to call the 16 pediatrician and she needs to provide him with 17 information. 18 Q. I take it you agree with me that 19 it's more important that the first call go to 20 the surgical team I mean the health line 21 operator to contact the surgical team? 22 A. Right. That's important, yes. 23 Q. All right. All right. Is it the 24 physician's job to tell the nurse if she needs 25 to contact a pediatrician -- 58 1 MR. LEAK: Objection. 2 Q. -- in a stat C-section? 3 A. Not always. 4 Q. So that's the nurse's judgment? 5 A. Not always. 6 Q. How about in this case -- 7 MR. LEAK: Objection. 8 Q. -- was it Dr. Bruner's job to tell 9 Holly to contact the pediatrician? 10 MR. LEAK: Objection. 11 A. No. 12 Q. Was it Holly's job to contact the 13 pediatrician? 14 A. Yes. 15 Q. When should she have contacted the 16 pediatrician then? 17 A. As soon as she could after the 18 section was called. 19 Q. The first section, the unscheduled 20 nonemergency? 21 A. The first section, no. 22 Q. The stat C-section? 23 A. Yes. 24 Q. The records that we have in front 25 of us indicate that Dr. Bruner called for an 59 1 unscheduled nonemergency C-section at 3:30, do 2 you agree with me? 3 A. I can't tell you exact times. 4 Q. Take a look. Feel free to look at 5 the records. 6 MR. BARRON: I think he's referring 7 to that note. 8 A. Yes. 9 Q. Okay. And Jane Richie's records 10 indicate that the health line operator was not 11 notified until 3:44, 14 minutes later, correct? 12 A. Yes. 13 Q. Do you know why Holly did not 14 notify the health line operator for 14 minutes? 15 MR. BARRON: You are asking her 16 based on her review of the depositions? 17 Q. I want to know based on your review 18 of the depositions, your discussions with 19 Holly, any information you have, as to why 20 Holly did not notify the health line operator 21 from 3:30 to 3:44? 22 MR. BARRON: Let me just show an 23 objection as to calling for a state of mind or 24 interpretation of testimony. Subject to that 25 objection if you have an answer to the question 60 1 and it's not based upon peer review proceedings 2 you may provide it. 3 A. I believe that the discussion 4 occurred in a peer review setting. 5 Q. So you are telling me that there 6 was a discussion in a peer review setting 7 about -- 8 A. No. 9 MR. BARRON: Just let him complete 10 his question. 11 Q. You are telling me that the only 12 discussion you know about occurring as to why 13 the call was not made for 14 minutes occurred 14 in a peer review session? 15 MR. BARRON: Whatever information 16 you have regarding this matter that occurred 17 through the peer review process can't be 18 disclosed. So if you don't have anything other 19 to respond to his question, you need to simply 20 indicate I don't have any information to 21 provide to you under that guideline. If that's 22 the situation. If you do have other 23 information you can provide it. 24 A. I don't have the information. 25 Q. Well, let's talk about not what 61 1 occurred during peer review but what you have 2 learned based upon your review of the record 3 and the testimony that you have read. 4 A. Okay. 5 Q. Can you explain to me based upon 6 that information why it took Holly 14 minutes 7 to contact the health line operator? 8 MR. BARRON: Again, let me show an 9 objection as to calling for a witness to give 10 testimony regarding the state of mind or the 11 thought process of another witness. Subject to 12 that objection if you have an answer that you 13 can provide based on the depositions, go ahead. 14 A. Yes. The only other information 15 that I have is the fact that it was stated that 16 she went for a piece of equipment or a supply 17 item in the process. After the initial section 18 for failure to progress was called she went to 19 the storeroom to get a piece of equipment, a 20 supply. 21 Q. That was a Foley catheter? 22 A. Specifically I can't say. 23 Q. Okay. Do you know where the closet 24 is that she was going to or the place that she 25 was going to get that equipment? 62 1 A. Yes. 2 Q. Where is it in relation to the 3 labor room that she was in? 4 A. It's attached. 5 Q. It's right next door? 6 A. Yes. 7 Q. You can walk right through? 8 A. Yes. 9 Q. Would you agree with me that it 10 shouldn't have taken no more a minute to get 11 the piece of equipment giving her all the time 12 in the world to do it? 13 A. Right, yes. 14 Q. So you can only tell me that you 15 know that it's reasonable for her to go get the 16 equipment? 17 A. Yes. 18 Q. For her to get the equipment and 19 spend a minute out of the room was okay? 20 A. Right. 21 Q. Right. And then she should return 22 to the room, right? 23 A. Well, essentially she has not 24 really left the room. Yes. 25 Q. Can she see the patient from where 63 1 she's getting the Foley catheter? 2 A. Just about. 3 Q. Can she hear the monitor? 4 A. Yes. 5 Q. So she's really still able to 6 monitor what's going on with the patient while 7 she's getting the Foley catheter, correct? 8 A. That's correct. 9 Q. And that total process should not 10 under any circumstance take more than one 11 minute, correct? 12 A. Right. 13 Q. And then she should be back at the 14 patient's bedside, right? 15 A. Unless the phone rang or a call 16 light went off. That was not the only patient 17 that we had that day. So she would have to 18 fulfill her other duties. 19 Q. Didn't she say that was the only 20 patient that she was taking care of? Do you 21 remember her deposition? 22 A. That doesn't mean that you ignore 23 the other patients. Just because this patient 24 is your patient doesn't mean you don't respond 25 to the needs of other patients. 64 1 Q. Well, she doesn't say anywhere that 2 there were any other calls made to her, any 3 other patient obligation that she had, did she? 4 A. She did not mention that, no. 5 Q. So you are just assuming that that 6 may have happened? 7 MR. BARRON: You asked her a 8 question regarding somebody else's conduct that 9 she was not present for and you are asking her 10 to explain it. She's explaining one possible 11 scenario. Now, if you want to ask her about 12 stuff she personally observed she can be 13 precise. If you want her to engage in an 14 analysis of events that she was not present 15 for, then that's what's going to happen. 16 MR. SCHNEIDER: I want her to do 17 that. I want to cross-examine her on it. 18 That's what I think I'm doing. 19 MR. BARRON: Okay. Go ahead. 20 Q. I said to you generously we'd give 21 her a minute to get the Foley catheter and then 22 she should be back in the room at the patient's 23 bedside. You said yes unless she's got some 24 other call or another patient to tend to, 25 correct? 65 1 A. That's correct. 2 Q. You have no reason to believe in 3 this circumstance that that occurred, do you? 4 A. I know that there were other 5 patients on the floor. It's her responsibility 6 to answer call lights and answer the phone. 7 Just because she was with one other patient 8 doesn't resolve her of all of her other duties. 9 Q. I understand that. What I'm saying 10 to you as we sit here today is, you have no 11 information that leads you to believe that 12 that's what occurred during that time period, 13 do you? 14 A. I have no specific information. 15 Q. And for purposes of my next 16 question let's assume that she didn't get a 17 call from any other patient or a call light to 18 deal with, assume that for my purposes in this 19 case, she would be back at the bedside within a 20 minute, right? 21 Answer verbally. 22 A. Yes. 23 Q. Okay. Now, this all began by you 24 telling me that the only thing you could see in 25 the record that would explain the delay from 66 1 3:30 to 3:44 in contacting the health line 2 operator was that she had to get a piece of 3 equipment, correct? 4 A. It's one of the potentials, yes. 5 Q. We have now agreed amongst 6 ourselves that's no longer than one minute? 7 A. Right. 8 Q. Do you have any explanation based 9 on what you have seen in the record or in the 10 depositions for what could have caused the 11 other 13 minute delay for Holly contacting the 12 health line operator? 13 A. In the record specifically, no. 14 Q. All right. 15 A. But it's not going to be in the 16 record. We don't write all of the other duties 17 that we respond to in the medical record of a 18 patient. 19 MR. SCHNEIDER: Okay. Now, John, I 20 would like to ask this question and I want you 21 to know where I'm going to leave it if you'll 22 permit me to ask it. 23 MR. BARRON: I can't stop you from 24 asking the question. 25 MR. SCHNEIDER: What I want to ask 67 1 is whether or not Holly has provided the 2 witness with an explanation of what occurred 3 during that 14 minutes. And if the answer is 4 yes, I'm going to leave it at that. If the 5 answer is no, I'm going to leave it at that. 6 I'm not going to inquire assuming it occurred 7 in a peer review setting as to what the answer 8 was. I mean what the information was. And 9 then I want to depose Holly again if the answer 10 is yes, she did tell me what was occurring and 11 what she did during that time period. So I 12 don't want to invade the substance of the peer 13 review process, but I want to know if there is 14 information out there that I did not get from 15 Holly at time of the deposition that the 16 witness has gotten from Holly on this very 17 important point. 18 MR. BARRON: Well, I mean I 19 appreciate first the courtesy of explaining 20 what your thought process is. You know, the 21 question though of whether or not there is 22 going to be any subsequent deposition of Holly 23 I think is something that you and I can talk 24 about and whether or not it -- and what topics 25 would be permitted would be another issue that 68 1 you and I can hash out when we are done here. 2 Regarding the peer review issue, my position is 3 and my instruction to the witness is that if 4 you received information regarding any question 5 Mr. Schneider asks you that you got through the 6 peer review process that ought to be deleted. 7 And if you have no other information other than 8 that, your response ought to be I have no 9 information to provide you, sir, given the 10 guidelines given to me by my counsel. If you 11 have other information such as he's asking 12 about, Holly's version of events, then you may 13 give it. Do you understand my instructions? 14 THE WITNESS: I hope. 15 MR. BARRON: In other words, you 16 need to delete anything that you have found out 17 during peer review. If outside of the peer 18 review process there was information given to 19 you by Holly regarding these events, other than 20 contained in her deposition or the medical 21 records, you should provide Mr. Schneider with 22 this information, a response to his question. 23 A. Okay. No, I have no other 24 information. 25 MR. SCHNEIDER: I just want to make 69 1 sure. I'm going to ask this question and then 2 you can tell her again. 3 Q. Did Holly ever explain to you why 4 there was a 14 minute delay in contacting the 5 health line operator? 6 MR. BARRON: Well, okay. 7 Q. And what she was doing during that 8 time period? 9 MR. BARRON: I'm going to object on 10 the same ground and I'm also going to say I 11 don't think you have been entirely complete in 12 your recitation regarding what the deposition 13 shows. There is a lot of testimony as to what 14 happened with Holly after she went to the 15 supply room. Now, if you want this witness to 16 comment on it, I think that that's again asking 17 one witness to comment on somebody else's 18 testimony. But if you are seeking that, 19 subject to my objection, you know, you can ask 20 the witness to comment on the subsequent 21 events. But there is a lot of testimony 22 regarding what she was doing after she went to 23 the supply room, so. 24 Q. Do you recall other testimony about 25 what she was doing after she went to the supply 70 1 room? 2 A. I know there is testimony. 3 Specifically I can't recall what she said. 4 Q. Isn't it true that you have read 5 the deposition, you have read the records, 6 there is no explanation that you see in there 7 for her not making that phone call for 14 8 minutes after the initial C-section that you 9 think is reasonable? 10 MR. BARRON: I object. She's just 11 testified that she does not recall what Holly 12 testified to as occurring between the time she 13 went to go get the supply and the time that she 14 made the telephone call or the telephone call 15 was made to the health line operator, so. 16 MR. SCHNEIDER: And I understand 17 your objection. 18 Q. My question is, having reviewed the 19 record and the deposition based on whatever 20 mental notes you have and your function as 21 director of obstetrical services at this 22 hospital at that time, isn't it unreasonable 23 for there to have been a 14 minute delay from 24 Holly being told about the C-section until the 25 time she called the health line operator? 71 1 MR. BARRON: I'm going to object to 2 the question. You are essentially asking this 3 witness to say even though you don't remember 4 anything of what Holly said occurred between X 5 and Y it isn't as though there isn't any 6 explanation as to what occurred between X and Y 7 and whether it was justified. 8 MR. SCHNEIDER: I'm not saying there 9 isn't any explanation as to what occurred. I'm 10 saying I don't care what the explanation is. 11 Q. Based on the policies of this 12 hospital and what the nurses are supposed to do 13 after a C-section is called, isn't it true that 14 regardless of what she was doing a 14 minute 15 delay in calling the health line operator is 16 unreasonable? 17 MR. BARRON: It all depends on -- 18 well -- 19 Q. Isn't that true? 20 MR. BARRON: No. 21 MR. SCHNEIDER: She can answer the 22 question. 23 MR. BARRON: She can't answer the 24 question if she doesn't recall what Holly 25 testified to. 72 1 MR. SCHNEIDER: I don't care if 2 Holly went to the bathroom or went to get a 3 coffee break. 4 MR. BARRON: How -- 5 MR. SCHNEIDER: Or had a heart 6 attack. 7 MR. BARRON: How about if she 8 engaged in intrauterine resuscitation efforts 9 in response to the husband coming back to grab 10 her and bring her back into the room to 11 determine whether or not there was a fetal 12 heart rate or maternal heart rate and tried to 13 resuscitate the baby and was unable to and then 14 go get Dr. Bruner who then attempted to do the 15 same thing. How about that? 16 MR. SCHNEIDER: You are talking 17 about the time period between 3:36 and 3:38, I 18 take it? Not 3:30 to 3:34? 19 MR. BARRON: I'm talking about the 20 events that occurred after. 21 MR. SCHNEIDER: You have now 22 refreshed the witness' recollection about the 23 events. I want to know -- 24 MR. BARRON: You are asking her to 25 express an opinion regarding events. You are 73 1 not providing her with any of the information 2 as to what the witness said occurred between 3 the two events. 4 MR. SCHNEIDER: The witness has been 5 provided with all of that information. You 6 have now reminded her of what she's been 7 provided with with respect to that. 8 Q. I want to know if your hospital 9 with the nurses and your services under the 10 circumstances you have seen in this case or any 11 other is it reasonable for there to be a 14 12 minute delay in making the call to the health 13 line operator from the time the C is called? 14 MR. BARRON: From the time the 15 nonstat C is called? 16 MR. SCHNEIDER: The unscheduled 17 emergency, yeah. Unscheduled nonemergency C. 18 MR. BARRON: Are you asking her to 19 assume the other facts that occurred in Holly 20 Durbin's deposition that she says she can not 21 recall as to what occurred? 22 MR. SCHNEIDER: Yes. 23 MR. BARRON: Okay. Then it's an 24 incomplete hypothetical because you are not 25 providing her with information that you are 74 1 saying is relevant to this issue or at least 2 I'm saying -- 3 MR. SCHNEIDER: Your objection is 4 noted. 5 Q. Now, you can answer the question. 6 MR. BARRON: Note an objection in 7 that there is no information provided in this 8 question regarding the events that occurred in 9 that 14 minute time period. 10 MR. SCHNEIDER: That's the fifth 11 time you have said it. 12 Q. Go ahead. 13 MR. BARRON: I'm going to say it 14 because it's outrageous. 15 If you don't recall the question, 16 the court reporter will read it back. 17 THE WITNESS: Please read it back. 18 Q. All right. Let me do it again. We 19 have a 14 minute delay from the time the C is 20 called to the time the health line operator is 21 called. My question to you simply put is, 22 that's not reasonable for your nurses, is it, 23 that time period, that delay? 24 MR. BARRON: And I'm objecting. A 25 nonemergency C-section? You are -- 75 1 Q. Unscheduled nonemergency C, that's 2 not reasonable? 3 A. Unless there is some underlying 4 circumstance that needs a prior attention. 5 Q. Okay. So the answer is? 6 MR. BARRON: Wait a minute. You are 7 not going to cut her off. 8 Q. Go ahead. 9 A. My answer is in a nonemergency 10 situation you want the ultimate outcome. You 11 want to take your time, do everything right. 12 This is where your i's are dotted and your t's 13 are crossed. So then we are -- yes, we are 14 getting the -- physically we are getting things 15 assembled. We are talking to people. Trying 16 to make arrangements. Staffing, of course, is 17 a priority, but if there is things close by 18 that is what I would do, I would grab the 19 Foley, get it in, get that done. If, if the 20 phone rings I still have to answer it. If the 21 call lights goes off you have to still answer 22 it. When you are in a nonemergency situation 23 where the physician is present, he's present in 24 my department, there is no urgency here. We 25 are -- we want to be expeditious because we are 76 1 compassionate. We don't want the patient in 2 labor any longer. Those kinds of things. When 3 it's not an emergency we want the best possible 4 outcome. We take the time and do it right. 5 Q. You told me before with a 6 nonscheduled nonemergency C it's still the 7 function of the nurse -- the first thing they 8 are supposed to do is call the health line 9 operator when the C is called, you told me that 10 before, right? 11 A. Ideally, yes. 12 Q. Okay. And that's their job, 13 assuming there is nothing prohibiting, 14 preventing them from doing it, that is what 15 you're supposed to do? 16 A. Let me say this. I'd say that all 17 of those things need to occur in rapid 18 sequence. Many times nurses are doing more 19 than one thing at the same time. It's like 20 when you want to call for a fire truck and the 21 line is busy. Well, do you just wait and not 22 call 911 because you called the regular number? 23 I mean, you know, there is, there are too many 24 variables here. I don't know for sure what she 25 was doing, but I know what her responsibilities 77 1 are because I have delineated them for her. So 2 I know that she responds to the other patients 3 even though it's not her patient for the day. 4 She still has other responsibilities. If the 5 call light goes off and Diane's in the bathroom 6 somebody has to answer the call light. If, if 7 this had been called an emergency situation 8 right off the bat it would have been different. 9 Q. What do you do then, immediately 10 call the health line operator? 11 A. Yeah. 12 Q. Right? 13 A. Yes, yes. You want the surgical 14 team here because that is your cure, if you 15 will. In this situation, in a nonemergency 16 situation, your physician has just been at 17 bedside, he's made the call, go ahead and call 18 the team in, I'm going to see another patient. 19 He's got another patient in labor. So if I'm 20 looking at the big picture, correct, there are 21 many responsibilities that have taken place 22 here. She has, she has responsibility to him. 23 She has responsibility to the documentation. 24 She has responsibility to the patient, of 25 course, as far as comfort. The Foley. She, 78 1 you know, has he given her a directive about 2 the Pitocin? There are many things that the 3 nurse is doing simultaneously in order to 4 prepare for this. Just because she went to get 5 the Foley catheter first before she called the 6 health line does not change the time factor at 7 all. 8 Q. Well, the only explanation she 9 could give me about why she left the room was 10 to get the Foley catheter and the abdominal 11 prep. Do you recall her testifying to that? 12 A. I recall her testifying period. I 13 can't remember the specifics. I read too many 14 in the last few days. 15 MR. BARRON: Kent, you have just 16 provided her with what appeared to be from my 17 vantage point a description of Holly's 18 testimony explaining the events that occurred 19 between 15:30 and 15:44. 20 MR. SCHNEIDER: 15:36. 21 MR. BARRON: And you left out 22 crucial information in providing that 23 chronology. You did not identify to this 24 witness that the father came to get the 25 mother -- to get the nurse in response to his 79 1 concerns of the mother's concerns and that she 2 went back to the room and undertook a number of 3 nursing steps and then sought out Dr. Bruner. 4 These are all things that are occurring during 5 this time frame. And you are not -- 6 MR. SCHNEIDER: You and I are in a 7 different time frame. I was talking about 8 15:30 to 15:36. Where you came up with 15:44 9 for that question I don't know. That's not 10 what I was talking about. Let me continue if I 11 could. 12 Q. My recollection is that Holly could 13 not recall anything else in her deposition, 14 anything she was doing in the time period of 15 15:30 to 15:36 when the husband came out to get 16 her other than going to get the equipment we 17 have discussed. Now, do you have a different 18 recollection of her deposition? 19 A. No, sir, but that's not what you 20 said prior. You did say 14 minutes. That's 21 only six. 22 Q. That was a different question. I'm 23 now talking about this question. 24 A. All right. 25 Q. Okay. Now, she told me under oath 80 1 that she had no recollection of anything else 2 she was doing during that time period. So all 3 of those things you said about what she might 4 have been doing she does not have a 5 recollection of that, can we agree on that? 6 MR. BARRON: Well, I mean she 7 testified to what she testified to. If you 8 want to ask her if that's your recollection of 9 the deposition. 10 Q. Let's just assume that the only 11 thing she did between 15:30 and 15:36 was go 12 get the Foley catheter and abdominal prep which 13 is all she recalled, okay? 14 A. Okay. 15 Q. Assuming that to be the case, is 16 there any reason why she could not have called 17 the health line operator during that six minute 18 period as well? 19 MR. BARRON: You are asking her to 20 assume that it was precisely a six minute time 21 period. 22 MR. SCHNEIDER: That's correct. 23 Q. Is there any reason why she 24 wouldn't have made the call to the health line 25 operator during that time period? 81 1 A. I would say that was on the top of 2 the list of priorities. 3 Q. The answer is yes she should have 4 made the call? 5 MR. BARRON: Objection. Contrary 6 to the evidence. You have asked her to assume 7 the things that she said may have occurred. 8 Subject to my objection. 9 Q. Isn't that what she should have 10 done? 11 A. I would think that, yes, one of the 12 priorities would be for her to call the health 13 line. 14 Q. Top priority, right? 15 A. It's nonemergent. You are still in 16 a nonemergency situation. It's not forcing 17 your hand as much as an emergency would. 18 Q. I'm not comparing it to that. I'm 19 saying it's still the right thing to do, isn't 20 it? That's the first and right thing to do, 21 there is no reason to wait six minutes, is 22 there? 23 A. I can't -- there are too many 24 variables. I can not say that. 25 Q. I asked you to assume that she 82 1 doesn't have anything to do during that time 2 period except to get the Foley. 3 A. Absolutely nothing to do but the 4 Foley and the prep kit? 5 Q. That's right. 6 A. She would call the health line. 7 Q. Within that time period? 8 A. Within six minutes. That may be 9 ample time. 10 Q. It only takes a minute to call the 11 health line, doesn't it? 12 A. Yes. 13 Q. Why would you say that may be ample 14 time? That's five times as much time as she 15 would need, isn't it? It only takes a minute 16 to get the Foley catheter. She's got five 17 minutes. That's a whole lot more time than she 18 needs, isn't it? Isn't it? 19 A. I can't say that. I don't -- time 20 goes by so quickly that you can't really say 21 that. 22 Q. Let me make sure I understand your 23 testimony. You are telling me that you can't 24 say that five minutes is way too much time to 25 pickup the phone and call the health line 83 1 operator and say stat C-section, that's your 2 testimony? 3 A. No. You are talking not stat. 4 Q. To just call up and say C-section, 5 you are telling me five minutes may not be 6 enough time to do that? 7 MR. BARRON: She's saying that she 8 doesn't know what occurred in the five minutes. 9 Q. No. This is a simple question. 10 You are telling me you can't be sure, time goes 11 so fast, five minutes may not be too much, you 12 know, more time than needed to call the health 13 line operator and say we have a C-section, is 14 that your testimony? 15 A. In an ideal situation, that's 16 correct. 17 Q. That's what, that's plenty of time? 18 A. That's ample time in an ideal 19 situation, yes. 20 Q. A minute is enough time, right? 21 A. I can't say that. 22 Q. To call the health line operator? 23 60 seconds? 24 A. It depends on the situation. 25 Q. Well, this situation. You see the 84 1 situation. You have read the records. Why 2 would it take more than a minute to call the 3 health line operator here? 4 A. Because there are other priorities. 5 Q. No, no. Assuming she doesn't have 6 anything else to do. I've asked you to assume 7 that. Why would it take more than a minute? 8 A. I don't know why it would take more 9 than a minute. But I know that it can. 10 Q. It shouldn't, should it? 11 A. But -- 12 MR. BARRON: You need to dial the 13 phone. 14 Q. Yeah. 15 A. To physically pick up the phone. 16 Q. To go to wherever you have to go, 17 be it the front desk or in the labor room and 18 contact the health line? 19 A. No. To physically actually just do 20 that no, no, that shouldn't take more than a 21 minute. 22 Q. She has nothing else to do and 23 that's causing you to say it's not enough time? 24 A. I can't imagine that she had 25 nothing else to do. 85 1 Q. Because she has these other 2 patients to care for? 3 A. If she sees people at the door, we 4 have to answer the door. You know, there are 5 so many -- 6 Q. Answer what door? 7 A. The door to our department. 8 Q. She's got to be out there answering 9 the door? What do you mean? Help me with 10 that, please. 11 A. We are a secured unit. It's 12 locked. You can not access it. There are just 13 so many things. If you have made a phone call, 14 for example, to anesthesia for pain control, 15 you know, these people are coming through the 16 door. We want -- I can't tell you all of the 17 responsibilities that an OB nurse has in that 18 department. But I can tell you there is 19 certainly plenty of room for deviation from 20 what is ideal because of those 21 responsibilities. I can't recall how many 22 times I've answered the phone in a day. It's 23 not something I track, nor do I remember every 24 time I respond to down the hall when someone 25 asks me a question. I'm saying that there is 86 1 room in that six minute period that we're 2 focused on that she could have been diverted 3 for many things. Can I say that it takes -- 4 it's too long? Sure. Just to make the phone 5 call. I don't know if she went to get the 6 Foley tray. If it was the wrong size glove for 7 her. You know, I can't -- there are too many 8 variables. I can say that strictly from a time 9 management standpoint it shouldn't take more 10 than one minute to call the health line. 11 Yes, I can say that -- I can say 12 that in a nonemergent situation it is still 13 appropriate to get the surgical team here. Is 14 it number one on my list? It varies. It 15 depends on how close I am to the phone and if 16 it -- what is at hand. If I can provide a 17 better outcome by doing this Foley right now 18 I'm doing that. If the patient needs IV fluids 19 I'm doing that. If it's nonemergent. I'm 20 going to call health line. The window of time 21 is relevant in a nonemergency situation. 22 Ideally we like to do it as quickly as possible 23 for the sake of compassion for the patient. We 24 don't want her to be in labor any longer. 25 Those kinds of things. But it's best to take 87 1 the time and do it right. I'm not hung up on 2 whether during that six minute window she 3 called the health line first or put the Foley 4 in first. It was accomplished. It was 5 accomplished. 6 Q. What, calling the health line 7 operator was accomplished? 8 A. Yes. 9 Q. Not in that six minute window, was 10 it? 11 A. That's because what happened though 12 at the end of that six minutes? What happened 13 beyond that that changed your course? 14 MR. BARRON: She was called back to 15 the room by the father. 16 A. Yeah. That changed her plan. She 17 was diverted. 18 Q. I see. Of course. 19 A. And it's quite fortunate that she 20 wasn't -- she didn't call the health line 21 operator. 22 Q. Why is that? 23 A. Because if she had called them 24 immediately they would have been en route and 25 not reachable by phone. 88 1 Q. And why is that bad? 2 A. Why is that bad? 3 Q. Yes. That was my question. 4 A. They wouldn't have been in a hurry. 5 It was a nonemergency case. 6 Q. What do they do in a nonemergency 7 case? They just come in whenever? What's the 8 policy? 9 A. The policy is that we call the 10 people on call. And in an emergency case we 11 call the people in town. 12 Q. You are so telling me different 13 people got called here than would have been 14 called? 15 A. Yes. 16 Q. You are sure of that? Did you 17 check to see if that's true? 18 A. That's the way it's handled. 19 Q. Do you think different people got 20 called here than would have been called if it 21 was a nonemergency C? 22 A. That's correct. 23 Q. And those people would have been 24 further away and this would have taken longer? 25 A. That's correct. 89 1 Q. How long does it take? 2 A. What do you mean? 3 Q. Well, what's the hospital policy? 4 Do you call people that live an hour away if 5 it's a nonemergency C? 6 A. The call team has to be able to 7 respond within 30 minutes. 8 Q. You mean be on the premises within 9 30 minutes? 10 A. Yes. 11 Q. Okay. 12 A. And you know what it's like living 13 up here. 14 Q. No, I don't. 15 MR. BARRON: Just wait for a 16 question. 17 Q. As you said she's got other things 18 to do, that she has to prioritize when it's 19 nonemergent. When it's an emergency then, you 20 know, you got to get to that health line 21 operator right away, get the surgical team in, 22 right? 23 A. Yes. 24 Q. Explain to me, if you can answer 25 this, was it reasonable for her to not contact 90 1 the health line operator for six minutes after 2 he called the emergency at 15:38? 3 MR. BARRON: You are asking her in 4 this question to assume that the order for the 5 stat C-section was given precisely at 15:38? 6 MR. SCHNEIDER: That's correct. 7 Q. Was it reasonable for her to wait 8 another six minutes before she contacted the 9 health line operator at that point in time? 10 MR. BARRON: And you are asking her 11 to assume that the call to the health line 12 operator occurred precisely at 15:44? 13 MR. SCHNEIDER: As reflected in the 14 health line operator's records. 15 MR. BARRON: That's what you are 16 asking her to assume? 17 MR. SCHNEIDER: Absolutely. 18 MR. BARRON: Okay. 19 Q. Is that reasonable? 20 A. Six minutes? 21 Q. Another six minutes, yeah. 22 A. I would have -- I would expect it 23 to be done as soon as possible. 24 Q. Less than six minutes, wouldn't 25 you? 91 1 A. If she had to provide intrauterine 2 resuscitation that may have been a priority. 3 Q. What makes you think she had to 4 provide intrauterine resuscitation? The doctor 5 was in the room. 6 A. Well, the nurse still has a 7 responsibility to keep the patient on her left 8 side. Discontinue the Pitocin. Turn the IV 9 wide open. Provide oxygen to the mother. 10 Q. She did all of that between 15:36 11 and 15:38? 12 MR. BARRON: Again, you are asking 13 her to assume? 14 MR. SCHNEIDER: Exactly. 15 Q. What I'm asking is, assume she did 16 that between 15:36 and 15:38. Is there any 17 reason for it to take another six minutes for 18 her to notify the health line operator at 19 15:44? 20 A. Not unless there was some other 21 diversion that we don't know about. 22 Q. What diversion in your opinion 23 would be reasonable for her to not make the 24 call for six for minutes in terms of her 25 prioritization? What could it have been that 92 1 would cause her to reasonably wait another six 2 minutes? 3 A. What could it have been? 4 Q. Yeah. 5 A. Well -- 6 Q. In light of the fact that we now 7 have a stat C-section, no surgical team? 8 A. It could be the fact that the 9 physician is at bedside. It could be that you 10 are trying to move the patient out of the room. 11 You have to unplug things from the wall. You 12 are getting the monitor disconnected. You are 13 doing things physically in the room to expedite 14 travel to the OR. 15 Q. What's the point of rushing the 16 patient to the OR by the nurse if you don't 17 have a surgical team coming? You've got plenty 18 of time once you've made the call, don't you, 19 to move her to the OR? 20 A. There is surgical staff people that 21 are very close by. 22 Q. So they get here within a few 23 minutes? 24 A. Yes. 25 Q. Do you expect them to be here 93 1 within five minutes? 2 A. A good portion of them. 3 Q. So the whole operation can be done 4 within ten minutes, baby out? 5 A. It can be. 6 MR. BARRON: Objection. Calls for 7 speculation. 8 A. It can be. In the ideal. In the 9 ideal world. 10 Q. So you're saying prioritywise it's 11 more important for her help the physician move 12 the patient to the OR first before she calls 13 the surgical -- the health line operator to 14 call the surgical team? 15 A. More important? 16 Q. Yeah. We've got to prioritize, 17 don't we? That's their job. 18 A. It's the directive of the physician 19 for one thing. 20 Q. So it's the physician. If the 21 physician tells her you do this first, then, of 22 course, she should do it, right? Well, let me 23 backup. The physician does not need to order 24 her to call the health line, does he? That's 25 her job? 94 1 A. No. But she's at the bedside. If 2 the physician says let's get her to the OR they 3 are pulling monitor cords out and he wants to 4 go right now, then she's assisting him in that. 5 Q. But my question is, the physician 6 does not need to order her to call the health 7 line, that's her independent job, right? 8 A. Right. 9 Q. And he has a right to assume that 10 she goes to do that as soon as she possibly can 11 in order to get that surgical team in, doesn't 12 he? 13 A. That's correct. Yes. 14 MR. SCHNEIDER: Can we take a break? 15 (Recess had.) 16 Q. I take it that your OB nurses are 17 well trained enough that by the time they are 18 caring for a patient in labor on their own like 19 Holly was that you'd expect them to know and 20 understand when they see signs that a baby is 21 in trouble, is that a fair statement? 22 A. That's correct. 23 Q. And I take it you would agree with 24 me that it's obvious in this case when you look 25 at the fetal monitor strips that at about 15:36 95 1 when Holly came back in the room and you see 2 the bradycardia, it's obvious at that point 3 that the baby is in trouble, isn't it? 4 MR. BARRON: Here's 15:30. He's 5 referring to 15:36. 6 A. Yes. 7 Q. All right. And, of course, you 8 would expect Holly to know that? 9 A. Yes. 10 Q. And that when she comes in and sees 11 that bradycardia, that's very ominous, isn't 12 it, is that a fair statement? 13 A. It's certainly not something that 14 we want to see, that's correct. 15 Q. You would agree that it's ominous? 16 A. Yes. 17 Q. And Holly should know all on her 18 own right then whether the doctor -- Holly 19 should know at that point in time independently 20 of anything the doctor tells her that it's 21 critical to get that baby out as quickly as 22 possible, shouldn't she? 23 A. That's probably not a fair 24 statement. There are, there are physicians who 25 would want to try intrauterine resuscitation 96 1 matters beyond that depending on the dilatation 2 of the patient. There are other things that 3 can be done instead of a C-section. For 4 example, if she's closer to being delivered 5 vaginally it may be more expeditious to apply 6 forceps and deliver the baby more quickly that 7 way. So C-section is not -- 8 Q. I didn't say a C-section. It's 9 critical to get the baby out. 10 A. To get the baby out. Okay. Yes, 11 you are right, yes. 12 Q. As quickly as possible? 13 A. Yes. 14 Q. Okay. And certainly in this case 15 it should have been obvious to Holly or any of 16 the other OB nurses when they see an ominous 17 bradycardia that it's critical that the 18 C-section be accomplished as quickly as 19 possible, that's going to be the method of 20 delivery? 21 A. Not -- they don't make the call. 22 Q. No, I understand that the doctor 23 makes the call. But what I'm saying is, by 24 virtue of seeing what they see on the strips 25 they really should realize if they are at all 97 1 competent that it's critical that the C-section 2 be performed as quickly as possible? 3 A. Yes. 4 Q. And therefore you would agree with 5 me that the nurse should realize looking at 6 that strip after the doctor called it a stat 7 that it's critical that the surgical team be 8 assembled as quickly as possible? 9 A. Yes. 10 Q. I take it you would agree with me 11 that Holly was a very inexperienced labor and 12 delivery nurse at the time of this delivery, is 13 that a fair statement? 14 A. Inexperienced by number of months? 15 Years? In practice? Inexperienced because 16 she -- 17 Q. Well, inexperienced because she'd 18 only been working for a handful of weekends as 19 a labor and delivery nurse here on her own 20 before this delivery? 21 A. Yes. 22 MR. BARRON: Referring to 23 post-training? 24 MR. SCHNEIDER: Yes. 25 MR. BARRON: Okay. 98 1 A. As far as see, I define experience 2 very differently than you. It's not number of 3 weeks. It's number of patients, so. 4 Q. How many patients had Holly had? 5 A. She'd been working full-time during 6 her orientation. She got a bulk of patients. 7 I don't remember the exact number. But that is 8 critical before they function on their own. 9 Q. When you say she had a bulk of 10 patients, it's not that she was responsible for 11 them, but some other nurse was responsible for 12 them and she observed? 13 A. Well, certainly she was responsible 14 for them, but the other nurse backed up, 15 secured, those kinds of things. 16 Q. The other nurse stayed with her? 17 A. Yes. But she mostly was 18 responsible for the patient unless something 19 changed that the other nurse needed to 20 intervene, then Holly was on her own. 21 Q. That was from the first day she 22 started her orientation in the labor and 23 delivery room? 24 A. She had some procedures that she 25 needed to observe strictly yet. And then as 99 1 soon as she had observed them and understood 2 the principles behind them then she was allowed 3 to perform them with supervision. 4 Q. During the time that she's in that 5 orientation you would call her inexperienced, 6 wouldn't you? 7 A. Yes. 8 Q. And how long was the orientation? 9 A. Oh, I can't give you specific 10 dates. It's usually at least six weeks. 11 Q. So I mean a grand total of six 12 weeks orientation wouldn't you agree still 13 leaves her as an inexperienced OB nurse, right? 14 A. Yes. 15 Q. All right. And how many shifts did 16 she work before this baby was born? 17 A. I couldn't tell you that. 18 Q. You have no idea? 19 A. No. I would have to go count them. 20 Q. Well, assume that she started 21 sometime in January working the shift on her 22 own and she only worked every other weekend? 23 A. Yes. 24 Q. As of the middle of March that 25 would still leave her pretty much an 100 1 inexperienced OB nurse, doesn't it? 2 A. Number of shiftwise? 3 Q. And patientwise? 4 A. Well, it depends. Yes. You can 5 have a lot of patients in a short period of 6 time. She worked 16 hours on every weekend. 7 So essentially she's working 16 hours. So it's 8 two shifts every weekend. 9 Q. So if she did that eight or ten 10 times she's got one hundred hours or a hundred 11 some hours of OB nursing. Does that leave her 12 in your mind to be an inexperienced OB nurse or 13 an experienced OB nurse? 14 A. She's definitely not experienced 15 because there are too many things that takes 16 years to encounter. But she was an excellent 17 study. So I would say that she was 18 inexperienced but well versed. 19 Q. And did you work with her? 20 A. Yes. 21 Q. When did you work with her? 22 A. When she was on orientation during 23 the week. 24 Q. How often? 25 A. Every day, Monday through Friday. 101 1 Q. With the patients? 2 A. Yes. 3 Q. What did you observe her do? 4 A. Many things. 5 Q. Like? 6 A. Telephone interaction. Physician 7 orders. IV starts. Fetal monitoring. 8 Neonatal blood draws. It was just a wealth of 9 things. She had a preceptor in addition to me. 10 I was just present and watched her perform. 11 Q. Who was the preceptor? 12 A. Diane Halek I believe. 13 Q. Would you agree with me that OB 14 nursing is an art form? 15 A. Art form? 16 MR. BARRON: You don't have to 17 accept his terminology. If you agree with it. 18 If you agree. 19 Q. I mean there is some art to it? 20 A. I never really looked at it that 21 way, but I suppose you could say that. 22 Q. And, of course, you would expect to 23 get better and better at it as you do it for 24 years and years? 25 A. Definitely. 102 1 Q. More confident as time goes on, 2 would you agree? 3 A. Yes. 4 Q. More confident in terms of your 5 knowledge of when and how to interact with the 6 physicians? 7 A. Yes. Certainly. 8 Q. And I mean am I right that, you 9 know, doctors can be a little bit intimidating 10 and it takes time to develop confidence as an 11 OB nurse to really feel comfortable in knowing 12 when and how to assert yourself? 13 A. Well, there is some merit to that. 14 Q. Have you been told what any of the 15 Plaintiff's experts have said in this case? 16 A. No. 17 Q. Am I correct that you still work as 18 a labor and delivery nurse here on occasion? 19 A. Yes. 20 Q. You take care of a patient 21 yourself? 22 A. Yes. 23 Q. You interface with the doctors? 24 A. Correct. 25 Q. Do the doctors typically write 103 1 progress notes at this hospital? 2 A. Typically. 3 Q. Are you familiar with any doctors' 4 whose custom it is not to write progress notes? 5 A. Occasionally they skip one that 6 maybe the med student did and they'll come back 7 and do it. 8 Q. Skip one note you are saying or one 9 page or just a note? 10 A. No, just a note. 11 Q. But you can't think of a doctor who 12 doesn't make progress notes as a rule here? 13 A. No, I cannot. 14 Q. And those progress notes are made 15 during the labor as opposed to subsequently? 16 A. It depends. Sometimes if a labor 17 and delivery happens too quickly. 18 Q. You understand that if a mother 19 labors for a number of hours and the physician 20 sees her during that time it's your experience 21 that the progress notes are made 22 contemporaneously with the visits from the 23 physician? 24 A. Not always. But usually, yes. 25 MR. SCHNEIDER: Do you have a copy 104 1 of the monitor strips here, John? 2 MR. BARRON: Yeah, I do. 3 MR. SCHNEIDER: And a copy of the 4 labor and delivery records for the witness, 5 please? 6 MR. BARRON: Well, we'll have to 7 flip back and forth I think. 8 MR. SCHNEIDER: Okay. 9 Q. Flip if you would to 74086 and 87 10 which is around 11:50. I want to direct your 11 attention also to the record itself, the labor 12 and delivery note of the nurse. I'm going to 13 read to you -- 14 MR. BARRON: I'm going to find the 15 copy. 16 MR. SCHNEIDER: Go ahead. 17 MR. BARRON: So she can have both 18 available to her. 19 Q. Take a look at the 12:00 entry over 20 there because I'm just going to go through a 21 couple of things with you. The 12 and 12:05 22 entry. 23 A. Okay. 24 Q. Okay. I take it that you would 25 agree with me that the nurse did the right 105 1 thing as she records at 12:00 in turning off 2 the Pitocin, putting the oxygen on high and the 3 IV wide open and putting the mom on the left 4 side? 5 A. Yes. 6 Q. Those were appropriate nursing 7 interventions? 8 A. That's correct. 9 Q. Now, I take it that you would also 10 agree with me that the monitor strips directly 11 above her writing starting a little after 086 12 and proceeding on to the next page, that those 13 patterns that we see in that time frame are 14 what you would describe as nonreassuring for 15 which she makes the appropriate intervention? 16 A. Yes. 17 Q. And in the face of that 18 nonreassuring pattern her job is to implement 19 the exact nursing interventions that she did, 20 correct? 21 A. Yes. 22 Q. Am I correct if we look at the 23 monitor strips from like a little bit between 24 086 and 087 that what we see beginning there 25 and carrying over on to the next page are 106 1 decelerations? 2 A. Yes. 3 Q. Are you able to characterize them 4 as late or variable or early based on what you 5 see on the strip or is the strip not readable 6 in that regard? 7 A. It's very difficult to read. The 8 tendency would be variable because it kind of 9 happens in the middle of nowhere. It's 10 relatively long after the peek of the 11 contraction, so you really wouldn't say late. 12 It's one of those that you describe more so 13 then I guess it starts out as a moderate 14 variable because it's not that deep, but -- and 15 it has variable components to it. So I guess 16 if you have to call it, you would call it in 17 the variable range. But it is very difficult 18 to read. 19 Q. Okay. Nevertheless, her 20 interventions were appropriate? 21 A. That's correct. 22 Q. Why is it that a deceleration like 23 that is considered to be nonreassuring? 24 A. Well, usually in this particular 25 situation if it's variable related that means 107 1 that the umbilical cord can be pinched 2 somewhere. Most often the children, of course, 3 that are moving around in the uterus can do 4 that themselves. They roll over on their own 5 cords. So it's something that we see from time 6 to time. It just means cord compression if 7 it's a variable component. Early deceleration 8 can occur during labor as the head is 9 compressed going through the pelvis. Those are 10 not particularly ominous. Late decelerations 11 usually occur because the placental function is 12 lessening. So those occur late beyond the peak 13 of the contraction and are usually, usually 14 within normal heart rate range, so they are a 15 little more subtle. 16 Q. We know at 3:30 that Dr. Bruner 17 came in and called for the unscheduled 18 nonemergency C-section, correct? 19 A. Yes, that's correct. 20 Q. Do you have any fault of Dr. Bruner 21 for him leaving the room at that point in time? 22 A. No. 23 MR. LEAK: Objection. 24 MR. BARRON: Wait a minute. I want 25 to object and say that this question goes to a 108 1 medical determination and I don't believe there 2 is a foundation with this witness for the 3 question. 4 MR. LEAK: Same objection. 5 MR. BARRON: Subject to my 6 objection if you have an answer you can 7 give it. 8 Q. My next question is more within 9 your area I think. Is it fair to say that 10 Dr. Bruner is entitled at that point in time to 11 rely upon the fact that the nurse will continue 12 to monitor the patient rather than the doctor 13 being required to remain there to do so? 14 A. Well, yes. They order to continue 15 to use the electronic fetal monitor. That's 16 the purpose of that intervention. 17 Q. What I'm talking about is even 18 after 3:30. 19 A. Yes. 20 Q. He's entitled to rely upon the fact 21 that the nurse will continue to properly 22 monitor that patient? 23 A. That's correct. 24 Q. And report to him if anything 25 untoward occurs? 109 1 A. Yes. 2 Q. Is it your impression from your 3 review of the records that Dr. Bruner did not 4 come in the room between 7:40 and 14:30? 5 A. According to the records that's not 6 necessarily true. I believe the Gregories said 7 that Dr. Bruner was there about noon. 8 Q. That's the testimony, but I'm 9 talking about the record. It's the medical 10 records. 11 A. The medical records, no, you are 12 right, it does not demonstrate that he was 13 present at that time. 14 Q. And you recall that Holly said she 15 recorded every time he came in the room. Do 16 you recall her testimony in that regard? 17 A. I really can't. 18 Q. Let's just assume then for purposes 19 of my question that Dr. Bruner did not come 20 into the room between 7:40 and 14:30. 21 A. Okay. 22 Q. All right. When he came in at 23 14:30 should Holly have verbally reported to 24 him what occurred at noon in terms of the 25 nonreassuring pattern and the nursing 110 1 intervention that occurred? In other words, 2 she should have told him at 2:30 by the way, 3 doctor, I want you to know back at 12:00 the 4 following occurred? 5 A. Well, my take on that is what she 6 was seeing at 2:30 was more important than what 7 happened at 12:00. 8 Q. I'm going to get to that. I'm 9 asking you about whether she should have 10 reported to him verbally what had occurred at 11 noon in addition to discussing with him what 12 was occurring just prior to 2:30? 13 MR. BARRON: You are asking her in 14 this question to assume that Dr. Bruner did not 15 look at the strip as it pertained to the noon 16 time period? 17 MR. SCHNEIDER: Yeah. Well, I'm 18 asking her not to assume anything in that 19 regard. I'm asking her to just -- if it's the 20 type of thing Holly should have brought up to 21 him orally as the nurse that is in charge of 22 this labor. 23 Q. Should she just say nothing and 24 rely upon him to look back at the strips? 25 A. I would say normally with the 111 1 resuscitation that occurred, because she did 2 all of those interventions, had the pattern 3 continued it would have been more of a red flag 4 to her. It would have stood out to her. It's 5 one incident. Sometimes the kids do rollover 6 on their own cords. It recovered. She put the 7 scalp electrode on thinking let me get a better 8 tracing. She took the appropriate steps. I'm 9 thinking if I'm Holly looking at this strip 10 that what happened at 2:30 matters more to me 11 than what happened at noon. So she might say, 12 oh, by the way, yeah, she had a funky episode 13 back at noon, but it recovered and the 14 variability was fine, yadda, yadda, yadda. 15 Because it is. After that everything looks 16 fine. So it, it's a call sometimes made, not 17 always. I'm not sure I would say, yeah, hello, 18 doctor, we had this one episode but it 19 recovered and the variability looks great. At 20 2:30 that would not be my concern. My 21 interventions worked. So I would be working 22 with the task at hand. I would -- ideally, 23 yeah, in the ideal world if he lived here in 24 the building we probably would have told him. 25 Q. Do you know if he was in the 112 1 building at around that time, at noon when it 2 happened? 3 A. It's my understanding that it's 4 possible that he was in the building. I was 5 not here, so. 6 Q. We don't know? 7 A. We don't know for sure. 8 Q. So you say your concerns would have 9 been greater about what was going on before 10 2:30, why is that? 11 A. No. At 2:30. 12 Q. Yeah. At 2:30. It's 74138. 13 A. Yes. Because then they are 14 starting to resemble a pattern. They are more 15 suspicious, if you will. Just because they 16 are -- these two are almost coupled. 17 Q. You are referring to 74137 and 18 74138, in that neighborhood? 19 A. Yes, that's correct. 20 Q. And so Holly did the right thing 21 when she advised him of those late and variable 22 decelerations as she recorded in the chart? 23 A. Yes. 24 Q. Now, do you have an understanding 25 of what Dr. Bruner and Holly discussed at 2:30 113 1 beyond what you see in the record right there 2 about him being advised about the late and 3 variable decelerations? 4 A. Say that again. 5 Q. Yeah. Do you have any 6 understanding of what was discussed between 7 Dr. Bruner and Holly at 2:30 when he came into 8 the room beyond that which she recorded which 9 is that he was advised of the late and variable 10 decelerations? 11 MR. BARRON: Again, any information 12 that you might have obtained through the peer 13 review process would not be subject to your 14 answer. But if you have other sources other 15 than the peer review process, and other than 16 what is charted in the chart, you can give it 17 to Mr. Schneider. 18 A. I don't have that information. 19 Q. Okay. For instance, and there is a 20 point I want to get to with you, we know from 21 Dr. Bruner's testimony that he concluded in his 22 own mind, he testified, that he was going to 23 give her another hour to labor? 24 A. Correct. 25 Q. And then if she did not make 114 1 progress or whatever, he was going to make his 2 decision at 3:30. You don't have any reason to 3 believe that he communicated that to Holly, do 4 you? 5 MR. BARRON: You mean other than 6 his testimony? 7 MR. SCHNEIDER: His testimony does 8 not indicate that he communicated it to Holly. 9 MR. BARRON: I disagree with that. 10 He testified that he believes that that was 11 somehow communicated. 12 MR. SCHNEIDER: I don't believe 13 that's true, but. 14 Q. Do you have any reason to believe 15 that he told Holly I'm going to give her 16 another hour and then I'm going to make a 17 decision? 18 A. That would be customary for him. 19 Q. Do you have any reason to believe 20 in this case that he did that? 21 MR. BARRON: You mean other than 22 his testimony? Whatever it is? 23 MR. SCHNEIDER: All the testimony. 24 Holly's as well. 25 A. You are asking me to recall again. 115 1 I believe that he -- 2 MR. BARRON: He's just asking you 3 if you have any other sources of information 4 other than what you have testified as to custom 5 and what is contained in the depositions. 6 A. No, I don't, because I have his 7 deposition. 8 Q. Do you recall that Holly had no 9 recollection of him telling her that he was 10 going to give her another hour? 11 A. I really don't recall that either, 12 so I'm sorry. 13 Q. Please look with me at the strips 14 moving forward. Can we agree that at 74141 we 15 have a deceleration? 16 A. Yes. 17 Q. How would you characterize the 18 deceleration? 19 A. The first one? 20 Q. 74141. 21 A. Okay. That would appear it has a 22 variable component, but it's late. 23 Q. So we're in agreement that it's a 24 late deceleration? 25 A. Yes. Some would call it variable. 116 1 But, yes. 2 Q. Yes? 3 A. I agree that it's a late. 4 Q. All right. And the one next to it, 5 the second one, would you agree with me that we 6 just can't tell if that's a late because of the 7 tracing of the mother's uterine contraction not 8 permitting us to? 9 A. That's correct. 10 Q. So we certainly can't assume it 11 isn't a late, can we? 12 A. We can't. 13 Q. We can't assume it is not a late? 14 A. You are correct. 15 Q. There are about four negatives in 16 there. 17 I take it we can agree that those 18 are nonreassuring patterns? 19 A. Yes. 20 Q. And similarly as we go on to the 21 next page we continue to see some decelerations 22 which are greater, the first one then the later 23 ones? 24 A. Right. 25 Q. And am I correct that the later 117 1 ones even though they might be as significant 2 are still of the late variety? 3 A. Those are, yes. 4 Q. You can clearly state those are 5 late decelerations? 6 A. Yes. 7 Q. And as we move over, right now 8 we're in the concluding the page that's in the 9 14:50 time frame and we move over on to the 10 next page and we see continuing -- 11 MR. BARRON: You better give a 12 strip number. 13 Q. I apologize. The page that ends in 14 74145. 15 A. Ends in 45. 16 Q. Ends in 145, has what we agreed to 17 be late decelerations and we move over on to 18 the next page and we see continuing late 19 decelerations, don't we? 20 A. The first two, yes. This one, you 21 really can't tell if that's a contraction. 22 It's a little deep for a late. 23 Q. So the one under 74146 and to its 24 left we can agree are late decelerations 25 because you can tell that the mother's 118 1 contraction is when it is? 2 A. Right. 3 Q. The one, the 74147 we simply can't 4 be sure because we can't get a good reading on 5 the mother's contraction? 6 A. That's correct. 7 Q. And, of course, we can't assume it 8 is not a late? 9 A. Right. 10 Q. And again, we have this continuing 11 pattern of nonreassuring pattern? 12 A. Right. 13 Q. Correct? 14 And moving on to the next page 15 would you agree with me that we see a 16 continuing pattern of decelerations? This is 17 beginning at 74149. 18 A. Yes. But the variability is still 19 very good. 20 Q. But the decelerations continue to 21 exist and they are late? 22 A. Yes. In my opinion. 23 Q. Now, would you agree with me that, 24 that based on your review of the monitor strips 25 this is the longest stretch of continuing late 119 1 decelerations we have seen in this mother's 2 labor? 3 A. Yes. 4 Q. And that causes one to be concerned 5 that the baby may be decompensating to some 6 extent, is that a fair characterization? 7 A. Well, variable is really a primary 8 indicator of that. There is definitely 9 something occurring with the placenta at this 10 point in time. 11 Q. It is of concern? 12 A. Yes. But you can't say for sure 13 that the baby is decompensating, not at this 14 point. 15 Q. You can clearly say that we have 16 the longest nonreassuring pattern that we have 17 seen in this mother's labor? 18 A. Yes. 19 Q. And we can say that the 20 decelerations we can identify are late and 21 therefore of concern? 22 A. The bulk of them are late. There 23 are some that are variable, yes. 24 Q. Is it fair to say that as the 25 decelerations become more pronounced the level 120 1 of concern rises as it relates to the baby? 2 MR. BARRON: When you are using the 3 term pronounced do you want to explain what you 4 mean by pronounced? 5 Q. The decelerations become greater. 6 A. Greater in depth? Greater in 7 frequency? 8 Q. Yes. Greater in depth. 9 A. Greater in depth would indicate a 10 late frequency. Late existence is a concern on 11 its own. We judge variability by their depth 12 and length. So, yes, in a variable situation 13 the deeper they become the more frequent they 14 become, the more cause for concern. You can 15 pretty much assume that there is a cord out of 16 place somewhere. 17 Q. How about when they are late? 18 A. When they are late it's basically 19 an oxygenation issue of placenta or placental 20 blood flow. There can be various reasons for 21 that. It could be maternal. 22 Q. And your level of concern rises as 23 they become what? 24 A. It does not -- it does not change. 25 Their existence keeps the same level of 121 1 concern. It's when you lose the variability in 2 addition to the late decelerations that there 3 is a fetal implication. 4 Q. What if you have -- what if the 5 variability suddenly becomes increased in the 6 late deceleration, is that a bad sign? 7 A. Not necessarily. Marked increase 8 might. If it's markedly increased it might. 9 There are many ways to interpret fetal monitor 10 tracings, so. 11 Q. Well, let's just take a look here 12 again at the page with 74149 up at the top 13 above 1500. 14 A. Okay. 15 Q. Can we agree that these 16 decelerations are continuing across that page 17 and on to the next page including through 154? 18 A. Yes. 19 Q. And around 152 we have a little 20 deeper deceleration just after 152? 21 A. Yes. 22 Q. And that's a late? 23 A. It's a, it's a, it's possibly a 24 late with a variable component. It's almost 25 too deep to be a late. 122 1 Q. It's not a reassuring sign either? 2 A. Neither, neither are, right. 3 Q. 154 looks like it's even deeper? 4 A. Yes. 5 Q. Now -- 6 A. What you can see of it, yeah. 7 Q. Now, is it fair to say then as we 8 move through, go ahead and take a look through 9 all the way up to 15:30 which is 74158 and 10 nine, in that area? 11 A. Yes. 12 Q. It's safe to say that the strip 13 starts to look worse? 14 A. Yes. 15 Q. And it's sort of deteriorated 16 throughout this hour, hasn't it? 17 A. Well. 18 Q. Go ahead and look. We have had 19 these, these late -- 20 MR. BARRON: Why don't you let her 21 look and then you can qualify it. 22 Q. Go ahead. 23 MR. BARRON: He's asking you about 24 the whole hour. 25 A. Yes. So if I started at 14:30. 123 1 Q. Right. 2 MR. BARRON: You need to start 3 there and flip forward. 4 Q. As you are looking at that, what I 5 want to say in addition to that is we have 6 agreed that there is a continuing pattern of 7 late and variable decelerations throughout that 8 hour and they are getting worse as we close in 9 at 15:30. 10 MR. BARRON: That's the question. 11 Now, take a look at it and then you can give 12 your answer. 13 A. My interpretation of this tracing 14 is at 14:40 the decelerations that I see are, 15 are in depth much worse than the page, the 16 subsequent page. 17 Q. They continue, but -- 18 A. But they are more of a variable 19 component to these at 14:40. 20 Q. Hold on a minute. As opposed to a 21 late component? 22 A. No. They have both. They have 23 both. But if you are going to look from a 24 variable standpoint at the depth, these are 25 deeper than these on this page with the 124 1 exception of the one at 74. I don't know what 2 that number is. 143. Right before 74143. 3 Q. What's different about the depth if 4 we're not sure if they are variable or late? 5 If they are late the depth doesn't matter? 6 A. Well, what I'm saying is it does 7 matter in a variable. If we look at it as 8 both, which is what I'm saying, they are a 9 combination of the two, and because we have to 10 say that because there are several that we 11 don't have contractions to put them up against, 12 I'm saying that there is not a great deal of 13 difference. If you'll look at 74149, at page 14 74150, it actually looks better because the 15 variability component is almost absent. So the 16 pattern changes I say is what I'm saying at 17 74155 and previous. 18 Q. 74155 you are saying? 19 A. Yes. And that would be about 20 15:20. And there is not -- 21 Q. The pattern changes in what way? 22 A. You have marked variability. You 23 have deeper -- to my opinion the deceleration 24 is occurring late. If, if you indeed can 25 identify the contractions I'm sticking with 125 1 variable components. These look more like 2 variable decelerations. Like there is a cord 3 event. 4 Q. You know, I am impressed with your 5 ability to distinguish the fine points of these 6 contractions. Is that something that you have 7 acquired over your how many years of 8 obstetrical practice? 9 A. 25. 10 Q. All right. And am I -- is it fair 11 for me to say that those are nuances that you 12 have grown to learn over the course of that 25 13 year period? 14 A. Not really. 15 Q. You knew it as well when you 16 started 25 years ago as you do today? 17 A. Oh, yeah. Marked variability. 18 Yeah, that's, that's fairly straight forward. 19 Forefront. 20 Q. You are telling me that you are 21 able to interpret strips just as well years ago 22 when you started as you are today? 23 A. Yeah. The only thing that has 24 changed is the terminology that is used. 25 Q. Okay. 126 1 A. Anyway -- 2 MR. BARRON: Wait a minute. I may 3 be confused as to whether or not there is a 4 question pending. Do you remember the 5 question? 6 A. Yes. So my interpretation of this 7 was if they are late it's hard to tell because 8 of the contractions and inability to pick them 9 up at this point in time for whatever reason. 10 Q. Where are you now? 11 A. 74155. So we have marked 12 variability. 13 Q. Meaning increased? 14 A. Increased as -- 15 Q. That's not a good sign there, is 16 it? 17 A. That's a stress response. 18 Q. So what you are referring to, 19 increased variability can be a bad sign, right? 20 A. Yes. 21 Q. Here we clearly see it? 22 A. Right. And the depth of the 23 deceleration is deeper than it had been in the 24 previous two sheets. 25 Q. Those are ominous signs, aren't 127 1 they? 2 A. Yes. 3 Q. Those are ominous contractions. 4 I'm sorry. I'm sorry. It's ominous heart 5 tracings? 6 A. Well, it's better than having the 7 variability absent. 8 Q. Well, there is more than one 9 ominous type of tracing, isn't there? 10 A. Yes. 11 Q. These are ominous right here? 12 A. This is cause for action, yes. 13 Q. 74155? 14 A. Yes. 15 Q. Okay. And action meaning contact 16 the physician? 17 A. Yes. 18 Q. So the physician should have been 19 contacted not later than 74155, is that right? 20 A. Well, no. I'd probably still watch 21 it for a little while because we did recover 22 here. At 7415 the deceleration is not as deep. 23 Yes, you have some stress response in the baby, 24 but you still have variability, so it's not 25 absent. With it continuing by the next page 128 1 though I'd probably be, I'd probably be ringing 2 his bell. 3 Q. So you are telling me that, that 4 the physician did not need to be contacted 5 until when, 15:30? 6 A. I'm saying -- all I'm saying is 7 that indeed he needs to be notified certainly 8 at this point because they have continued. 9 Q. By 15:30? 10 A. Right. We are, we are trained that 11 you certainly need to observe at least ten 12 minutes of a tracing and with that there has 13 already been a pattern which he's already aware 14 of. So with a worsening effect I would want to 15 provide my interventions and then if they 16 continued throughout the interventions then 17 certainly notify him. 18 Q. Now -- so I'm confused. If we go 19 back to 74155. 20 A. Yes. 21 Q. Are you telling me that there was 22 no need for her to contact the physician at 23 that point in time? 24 A. I -- okay. I'm trying to look 25 at -- you have the whole thing in front of you. 129 1 I'm trying to be the nurse who is seeing one 2 frame at a time of this tracing coming out. 3 MR. BARRON: Wait a minute. You 4 get to finish your answer. 5 Q. Go ahead. 6 MR. BARRON: You get to finish your 7 answer. 8 A. Okay. So I would be waiting. I 9 would be waiting. This page would all be in 10 front of me and probably some of the next 11 before I would make that decision to call him. 12 Q. But the nurse had in front of her 13 this whole preceding hours of decelerations. 14 A. But she knows he's already aware of 15 that. So she's just -- she's just observing to 16 see to what extent these are going to occur. 17 Does she need to call him? Does she need to do 18 something else as far as her own her 19 interpretations? 20 Q. What causes you to say that she 21 knows that the physician is aware of these late 22 and variable decelerations that are occurring 23 from 2:30 to 3:30? 24 A. Because he's been in the room. 25 Q. He was in the room at 2:30, 130 1 correct? 2 A. I can't remember the times. 3 Q. Well, assume he was in the room at 4 2:30. 5 MR. BARRON: Let's take a deep 6 breath. You don't need to rush through it. 7 He's asking you to assume that this note is 8 accurate, the 14:30 note. 9 THE WITNESS: Right. 10 MR. BARRON: Now he's going to ask 11 you a question. 12 THE WITNESS: Okay. 13 Q. Now, we have evidence that 14 Dr. Bruner was in the room at 2:30? 15 A. Yes. 16 Q. And advised of the late and 17 variable decelerations that preceded that? 18 A. Yes. 19 Q. Okay. What makes you believe that 20 he was aware of the fact that these late and 21 variable decelerations continued to occur and 22 ultimately -- well, continued to occur from 23 2:30 to 3:30? Why do you think he was aware of 24 that? 25 A. I'm confused. 131 1 MR. BARRON: I think she was 2 referring to the awareness at 2:30 regarding 3 late and variable decelerations. 4 Q. Well, I want to make sure I 5 understand. 6 A. Yeah. Because he was already 7 advised that they existed. 8 Q. At 2:30? 9 A. Yes. 10 Q. You have no reason to believe that 11 he was aware of whatever the trainings had on 12 them or showed from 2:30 forward until 3:30, do 13 you? You have no reason to believe that he 14 knew what was on those strips? 15 A. My, my sense tells me that they 16 don't go away. They weren't going away. So he 17 certainly knows they are there. 18 MR. LEAK: Move to strike. 19 Q. So what you are saying to me is you 20 assume that the doctor was assuming that the 21 late, that the decelerations that occurred 22 before 2:30 were continuing on from 2:30 to 23 3:30? 24 A. Right. 25 MR. LEAK: Objection. 132 1 Q. And therefore there was no need for 2 the nurse to notify him of the fact that they 3 continued during that time period because you 4 assume he was aware of it? 5 A. Yes. 6 MR. LEAK: Objection. Move to 7 strike. 8 Q. You think it's fair for the nurse 9 to assume that at that time the doctor would 10 have assumed that the late and variables 11 continued from 2:30 on? 12 MR. LEAK: Objection. 13 Q. Is that right? 14 A. Yes. 15 Q. Now, if we assume that the doctor 16 was in the room at 2:30, take a look at 74138. 17 A. Okay. 18 Q. When is the next deceleration after 19 2:30 that you see? 20 MR. BARRON: Of any kind? 21 Q. Yeah. How many minutes later? 22 A. About eight. 23 Q. 74141? 24 A. Uh-huh. 25 Q. So if Dr. Bruner was in the room 133 1 for some period of time after 2:30 it was less 2 than eight minutes. Would you agree with me 3 that if he was observing the strip he would not 4 have seen the continuation of decelerations 5 during that time, correct? 6 A. It's possible. 7 Q. And but you are telling me that you 8 think that he should have assumed that they 9 were going to recommence and continue 10 thereafter throughout that hour, that's a fair 11 nursing assumption? 12 A. Normally lates don't go away. So 13 my assumption is that he's well aware of that. 14 Without some intervention they just don't go 15 away. 16 MR. LEAK: Move to strike. 17 Q. And therefore there would be no 18 need for Holly to notify him of the fact that 19 those lates continued throughout that following 20 hour? 21 A. That would depend on if she knew he 22 was coming back. 23 Q. Let's assume she didn't know he was 24 coming back. Is she still entitled to know that 25 he knows that they are continuing and he'll 134 1 take care of it? 2 A. This, this particular -- this is 3 not -- I just feel that he was well aware that 4 they existed. I don't think that they were 5 alarming, so. 6 Q. Up until when? 7 A. Up until -- 8 Q. Even up until -- 9 MR. BARRON: Wait a minute. You 10 asked her up until when. She's going to answer 11 the question. 12 A. I don't think they are alarming 13 until 15:15 or 15 -- no. 15:20. 15:27. 14 Q. Nothing is alarming up until 15:27? 15 A. Not alarming. Concerning. There 16 is reason for concern. Certainly a need to pay 17 attention to the tracing. But it actually 18 improves because she has less contractions so 19 they are less frequent at 74152. 20 Q. What's less frequent? 21 A. The lates. Back on page -- this 22 one doesn't have a time on it either. Back at 23 74146. They are rather recurrent based on her 24 contraction pattern. So once the Pitocin was 25 discontinued they spaced out. So you have 135 1 actually improved the situation by lessening 2 the frequency, so. 3 Q. Once the Pitocin was what? 4 A. Is shut off. 5 Q. When was that? 6 MR. BARRON: If you know. 7 A. I don't know. 8 MR. BARRON: If you want to take a 9 look or you can say I don't know. 10 A. I don't know. 11 Q. Where were you looking at the strip 12 and saying that the Pitocin had been turned 13 off? What number is that? 14 A. That was way back here. Maybe it 15 just never got turned back on. Maybe that's 16 what I'm thinking. I don't know. I thought it 17 was turn off somewhere around 2:30. 18 Q. Okay. 19 A. I don't know why that is. 20 Q. You say you think it got better 21 when the Pitocin was turned off? 22 A. Yes. Because her contraction 23 frequency lessened. 24 Q. So it was an appropriate nursing 25 intervention to turn off the Pitocin. That 136 1 would explain the improvement in the strips? 2 A. That would be one thing that would 3 help. 4 Q. Okay. 5 A. That would be one thing. It would 6 certainly help with the variable component. 7 Q. And that's your explanation of the 8 improvement? 9 A. Yes. However, then when you get to 10 page -- or 15:20, this was 15 -- so about 15:20 11 as the nurse sees these coming out of the 12 monitor she's also hearing this, these, taking 13 into consideration the things that she needs to 14 do to improve this. 15 Q. Like what? 16 A. Like 02. Left side. Increase the 17 IV. 18 Q. Well, she didn't do any of that, 19 did she? 20 MR. BARRON: You mean at that point 21 in time? 22 Q. Yes. She didn't do anything? 23 A. Okay. The only other thing I can 24 say is that -- 25 Q. Am I correct, she didn't do 137 1 anything? 2 MR. BARRON: There's nothing 3 charted. 4 A. There's nothing documented to that 5 effect. 6 Q. So she just watches them? 7 A. If she was present, yes. 8 Q. Well, you have no reason to believe 9 that she was not present, do you? 10 MR. BARRON: You are assuming that 11 she's in the room. 12 A. We don't stay with the patient 13 24/7. 14 Q. She testified she was present. 15 A. Through the whole labor? 16 Q. Through -- at this point in time, 17 74155, 3:20, absolutely. 18 A. I don't know where that's 19 documented. 20 Q. Well, are you telling me that she 21 shouldn't have been there? I mean she didn't 22 have to be there? 23 A. No. She didn't have to be there. 24 Q. So you don't know if she was there 25 or not? 138 1 A. No. 2 Q. That might explain why she didn't 3 do anything? 4 A. That's correct. 5 Q. Let's just assume for moment that 6 she was there. There were interventions that 7 should have occurred around 74155, right? 8 A. Yes. 9 Q. That should have been Pit off, 02 10 on, IV wide open, notify the doctor? 11 A. Yes. 12 MR. LEAK: What time does that 13 translate to? 14 MR. SCHNEIDER: That's about 3:20. 15 Okay. 16 MR. LEAK: Thank you. 17 Q. Now, of course, if she'd already 18 turn the Pit off at 2:30 it wouldn't be 19 necessary to turn the Pit off then, right? 20 A. Right. Because it's really hard to 21 tell what kind of contraction pattern there is. 22 Q. I have a health line question for 23 you. I'm not sure if you know the answer to 24 it, but do you know who the health line 25 operator is instructed to call in what order? 139 1 In other words, do you know if the health line 2 operator is supposed to call the surgery nurses 3 first, anesthesia second, etc? 4 MR. BARRON: If you know. 5 A. I think it's anesthesia first. And 6 then the surgical team. 7 Q. Is there anyway for a doctor to 8 know, let's says a doctor like Dr. Bruner, to 9 know when he comes in and he's got a laboring 10 patient, is there anyway for him to know 11 whether the labor and delivery nurse that is on 12 the job is experienced, inexperienced, new, 13 been there for a long period, short period, 14 anyway for him to know that? 15 A. He can ask. 16 Q. Is there any other way other than 17 that he is given information by the hospital? 18 A. No, I don't think so. 19 Q. I mean is he told, hey, by the way, 20 you've got a fairly inexperienced nurse here on 21 the job. We just want to let you know. 22 A. No. 23 Q. When Mrs. Gregory was discontinued 24 from the things that she was hooked up to in 25 the labor room and taken from that labor room 140 1 should the OB nurses have continued to monitor 2 the baby's heart rate while the mother was in 3 the operating room at any time from the time 4 she left the labor room up until the time of 5 delivery? 6 A. No. There is no point. 7 Q. And you say the reason there is no 8 point is that you can't do anything anyway at 9 that point to expedite things other than what 10 you have already done? 11 A. You have made the decision as to 12 what the ultimate decision is. That is the 13 surgery itself. So rather than take time to 14 auscultate fetal heart tones -- 15 Q. You mean with a Doppler device? 16 A. Yes, that's correct. Just do the 17 surgery and get the baby out. 18 Q. There is no point in checking, 19 therefore they are not required to do so? 20 A. Right. That would be further 21 delay. If a physician asked for somebody to 22 check them we certainly will. 23 Q. In the absence of that rule you are 24 waiting for the procedure to begin? 25 A. It's not like you are standing 141 1 there with nothing to do. You are preparing for 2 the delivery, so. 3 Q. Well, do you recall Dr. Bruner's 4 testimony that in this case he was literally 5 standing around in the operating room waiting 6 for 18 minutes to be able to begin the 7 procedure? Do you recall reading that? 8 A. I don't recall that, no. 9 Q. Well, I want you to assume for the 10 moment that he said that, that's what he 11 testified to, that he was standing and waiting 12 in the operating room essentially with his 13 hands in his pockets and unable to do anything 14 for 18 minutes and waiting for people to 15 arrive. 16 MR. BARRON: I'm going to object. 17 I don't think that accurately reflects the 18 testimony. 19 MR. SCHNEIDER: You are right. He 20 didn't say he had his hands in his pockets. 21 That was my embellishment. 22 Q. He did say that he was standing 23 around waiting for 18 minutes. Assume that to 24 be the case. In your experience at this 25 hospital have you seen that occur before with 142 1 doctors standing around waiting for that period 2 of time to perform a stat C-section? 3 A. No. 4 Q. That would be extremely out of the 5 ordinary? 6 A. Usually they are helping us get 7 whatever we need to get done to get ready for 8 the delivery. 9 Q. So there is not usually a period 10 where the doctor is simply standing around for 11 more than ten minutes let's say waiting for the 12 surgery team to arrive and unable to do 13 anything when he wants to perform a stat 14 C-section? 15 MR. BARRON: You mean and him not 16 assisting in the process? You mean doing 17 nothing? 18 Q. Doing nothing. That all the 19 preparation is done. He's just waiting for the 20 surgical team. 21 A. No. 22 Q. That does not happen? 23 A. I have not personally seen that 24 happen. 25 Q. You have not seen that? 143 1 A. No. The docs have been great at 2 helping us get ready. They don't stand there. 3 Q. Have there been times when the 4 preparation that you can do, the OB nurses are 5 completed, but you can't go any further because 6 the surgical team has not arrived? 7 A. No. I have not been aware of any 8 of those cases. 9 Q. So in your experience there has not 10 been a time where after the OB nurses finish 11 their portion of the prep there was any waiting 12 period for the surgical nurses to perform a 13 stat C-section? 14 A. Not to my knowledge. 15 Q. And if that occurred in this 16 instance that would be extraordinary in your 17 experience? 18 A. Yes. 19 Q. I just want to make sure I 20 understand one thing about those fetal monitor 21 strips. Would you agree with me that what you 22 see in the pattern in that last ten or 12 23 minutes, before 3:30, the 41530, you can detect 24 that, that the baby is becoming more hypoxic 25 during that time period based on your 144 1 knowledge? 2 A. I can't say that without a scalp 3 pH. There is no way to ascertain that. 4 Q. In other words, you can't gather 5 that from just the way the strips look? 6 A. No. Not for certain. 7 Q. Okay. You are aware of the fact 8 that a sponge was left in the mother here? 9 A. Yes. 10 Q. Do you fault any of your nursing 11 staff for that? 12 MR. BARRON: I'm going to object. 13 There isn't any foundation for this question 14 because her realm is OB nursing and her nurses 15 are the OB nurses. 16 MR. SCHNEIDER: I know. Yeah, I 17 understand that. 18 MR. BARRON: Okay. 19 MR. SCHNEIDER: I understand that. 20 MR. BARRON: So your question is do 21 you think the OB nurse's have any 22 responsibility regarding surgical sponges? 23 MR. SCHNEIDER: Right. 24 A. No. 25 Q. Okay. Have you been involved in 145 1 any surgeries here where a physician has left a 2 sponge in? 3 A. No. 4 Q. Is this the only one you have heard 5 about in your tenure at this hospital? 6 A. Yes. 7 MR. SCHNEIDER: Bear with me for a 8 moment, please. 9 MR. BARRON: Sure. 10 EXAMINATION OF SUE SANFORD 11 BY MR. LEAK: 12 MR. LEAK: I do have one question 13 to clarify something. 14 Q. Early on in your testimony I 15 thought I heard you say that at 3:30 when the 16 decision was made to do the unscheduled 17 nonemergency C-section that Dr. Bruner went to 18 see other patients. Did I hear that correctly, 19 that that's what he did at 3:30? 20 A. Right. 21 Q. What's the basis of you making that 22 statement? How do you know that he went to see 23 other patients at 3:30? 24 A. Because there was another patient 25 on the floor in labor. 146 1 Q. But I guess what I'm trying to ask 2 you is, how do you know that that's what 3 Dr. Bruner did at 3:30? 4 MR. BARRON: She read Holly 5 Durbin's deposition. 6 A. Yes. And I also know who has 7 delivered on the floor. 8 Q. I know. But I just want to pin it 9 down for 3:30. Are you relying upon Holly's 10 testimony that Dr. Bruner went to see this 11 other patient at 3:30 when that decision was 12 made? 13 A. Yes. 14 Q. Okay. Do you recall what Dr. 15 Bruner testified as to what he was doing at 16 3:30? 17 MR. BARRON: You are talking at 18 3:30 or after? 19 Q. Right. When the decision was made. 20 That it's my understanding when the decision 21 was made to do the nonscheduled nonemergency 22 C-section. 23 A. Do I recall what he was doing? 24 Q. No. You read his deposition. Do 25 you recall what he testified to as to what he 147 1 was doing? 2 A. No. 3 Q. Would you agree that between 2:30 4 and 3:30 there was a sense of urgency as to the 5 fetal heart tracings? 6 A. There was cause for concern. 7 Q. Okay. And it's your testimony that 8 you believe interventions or notification to 9 Dr. Bruner was not warranted until 3:20 p.m.? 10 A. Well, it's my understanding that 11 the interventions were already done earlier, 12 so. 13 MR. BARRON: You are talking about 14 turning the Pit off? 15 THE WITNESS: Yes. 16 Q. What was it about 3:20? I thought 17 I heard that is when you believed something -- 18 A. 3:20, I believe that's the type of 19 deceleration -- that deceleration type changed. 20 They are more pronounced. The variability is 21 marked. So that indicates a more express 22 response from the baby. 23 Q. And you believe that Dr. Bruner 24 should have been called at that time, 3:20? 25 A. It's my understanding that he was. 148 1 He's in the building at that time. So he would 2 have been. 3 MR. BARRON: You are talking about 4 3:20 or 3:30? 5 MR. SCHNEIDER: 3:20. 6 A. 3:20. Well, by the time the paper 7 came out of the machine and she observed it, it 8 would have been 3:30. So then he was present 9 in the building. 10 Q. Mr. Schneider asked you those 11 questions about assuming what the nurse -- 12 assuming what Dr. Bruner knew about what was 13 occurring between 2:30 and 3:30. So it's your 14 testimony that you believe that Dr. Bruner 15 should have been or was aware that there would 16 have been continued patterns of decelerations 17 going on. I just want to make sure that I'm 18 clear on what assumption you are making. 19 A. My assumption is that he saw the 20 deceleration pattern. The pattern was not 21 going away. 22 Q. Okay. And you believe that he 23 should have assumed that that pattern remained 24 or even got worse subsequent to 2:30 until 3:30 25 without the necessity of being notified by a 149 1 nurse? 2 A. Well, my opinion is that it 3 actually improved in some places between that 4 point. So, no, I don't think it was necessary 5 that she get on the horn and say those lates 6 that you saw are still there. 7 Q. Well, let's take that one step 8 further. If there were improvements you'll 9 agree then that after those periods of 10 improvement Dr. Bruner should have been 11 informed by the nurse that despite this 12 improvement now we're back to a troublesome 13 pattern? 14 A. I believe that's what occurred at 15 3:30 when he was in the building. 16 Q. It wasn't necessary any earlier 17 than that time that you -- 18 A. Not -- no. In my opinion, no. 19 Q. Okay. And with regard to the 20 health line call, just so I'm straight on this, 21 you are saying if a call was made at 3:30 to 22 the health line different people would have 23 been called because it was a nonscheduled, 24 nonemergency C-section as opposed to 3:44 when 25 the call got a stat? 150 1 A. That's correct. 2 Q. Is there any documentation as to 3 those two scenarios who would have been called 4 at 3:30 as opposed to 3:46? 5 A. The surgery people would have that 6 information. I don't provide them with that 7 information. Surgery does. 8 Q. But there is a protocol that says, 9 that distinguishes between who the health line 10 will call for a nonemergent C-section and a 11 stat C-section? 12 A. That's correct. 13 Q. Once again where could we find that 14 documentation? 15 A. That would be up to the surgery 16 people. I can't tell you. 17 Q. Okay. 18 A. They should provide that to the 19 health line. 20 MR. LEAK: That's all I have. 21 MR. SCHNEIDER: I have nothing 22 further. Thank you very much. 23 MR. BARRON: We'll reserve 24 signature. 25 (Deposition concluded at 12:30 p.m.) 151 1 CERTIFICATE 2 The State of Ohio, ) 3 SS: 4 County of Cuyahoga. ) 5 6 I, Barbara J. Watowicz, a Notary 7 Public within and for the State of Ohio, duly 8 commissioned and qualified, do hereby certify 9 that the within named witness, SUE SANFORD, was 10 by me first duly sworn to testify the truth, 11 the whole truth and nothing but the truth in 12 the cause aforesaid; that the testimony then 13 given by the above-referenced witness was by me 14 reduced to stenotypy in the presence of said 15 witness; afterwards transcribed, and that the 16 foregoing is a true and correct transcription 17 of the testimony so given by the 18 above-referenced witness. 19 I do further certify that this 20 deposition was taken at the time and place in 21 the foregoing caption specified and was 22 completed without adjournment. 23 24 25 152 1 I do further certify that I am not 2 a relative, counsel or attorney for either 3 party, or otherwise interested in the event of 4 this action. 5 IN WITNESS WHEREOF, I have hereunto 6 set my hand and affixed my seal of office at 7 Cleveland, Ohio, on this day of 8 , 2001. 9 10 11 12 13 14 Barbara J. Watowicz, Notary Public 15 within and for the State of Ohio 16 17 My commission expires March 20, 2002. 18 19 20 21 22 23 24 25 153 1 I N D E X 2 3 EXAMINATION OF SUE SANFORD 4 BY MR. SCHNEIDER.......................... 4:6 5 6 EXAMINATION OF SUE SANFORD 7 BY MR. LEAK............................ 145:10 8 9 Exhibit 1 was marked.................... 33:15 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 154 1 SIGNATURE OF WITNESS 2 3 4 5 6 The deposition of SUE SANFORD, 7 taken in the matter, on the date, and at the 8 time and place set out on the title page 9 hereof. 10 It was requested that the 11 deposition be taken by the reporter and that 12 same be reduced to typewritten form. 13 It was agreed by and between 14 counsel and the parties that the Deponent will 15 read and sign the transcript of said 16 deposition. 17 18 19 20 21 22 23 24 25 155 1 AFFIDAVIT 2 The State of Ohio, ) 3 ) SS: 4 County of Cuyahoga ) 5 6 7 8 Before me, a Notary Public in and for 9 said County and State, personally appeared SUE 10 SANFORD, who acknowledged that he/she did read 11 his/her transcript in the above-captioned 12 matter, listed any necessary corrections on the 13 accompanying errata sheet, and did sign the 14 foregoing sworn statement and that the same is 15 his/her free act and deed. 16 In the TESTIMONY WHEREOF, I have hereunto 17 affixed my name and official seal at this 18 day of A.D 2001. 19 20 21 22 Notary Public 23 24 25 My Commission Expires: 156 1 DEPOSITION ERRATA SHEET 2 3 RE: JULIE GREGORY, ETC., ET AL. VS. 4 SANDUSKY OBSTETRICS AND GYNECOLOGY, 5 INC., ET AL. 6 RRS File No.: 1930 7 Deponent: SUE SANFORD 8 Deposition Date: MARCH 6, 2001 9 10 To the Reporter: 11 I have read the entire transcript of my 12 Deposition taken in the captioned matter or the 13 same has been read to me. I request that the 14 following changes be entered upon the record 15 for the reasons indicated. I have signed my 16 name to the Errata Sheet and the appropriate 17 Certificate and authorize you to attach both to 18 the original transcript. 19 20 21 22 23 24 25