0001
 1              IN THE COURT OF COMMON PLEAS
 2                 OF SUMMIT COUNTY, OHIO
 3                       - - - - -
 4   DONNA JOHNSON, et al.,
 5         Plaintiffs,
 6         vs              Case No. 2008 01 0862
                           Judge Patricia Cosgrove
 7   ST. THOMAS HOSPITAL,
     et al.,
 8   
           Defendants.
 9   
10                       - - - - -
11         DEPOSITION OF HUGH A. SCHUCKMAN, M.D.
12                THURSDAY, JULY 3, 2008
13                       - - - - -
14        Deposition of HUGH A. SCHUCKMAN, M.D., a
15   Witness herein, called by counsel on behalf of
16   the Plaintiff for examination under the statute,
17   taken before me, Vivian L. Gordon, a Registered
18   Diplomate Reporter and Notary Public in and for
19   the State of Ohio, pursuant to agreement of
20   counsel, at the offices of Hanna, Campbell &
21   Powell, 3737 Embassy Parkway, Akron, Ohio,
22   commencing at 10:20 o'clock a.m. on the day and
23   date above set forth.
24                       - - - - -
25   
0002
 1   APPEARANCES
 2   On behalf of the Plaintiffs
           Becker & Mishkind
 3         HOWARD D. MISHKIND, ESQ.
           Skylight Office Tower Suite 660
 4         1660 W. 2nd Street
           Cleveland, Ohio 44113
 5         216-241-2600
 6   On behalf of the Defendants Summa Emergency
     Associates, Inc., Hugh Schuckman, M.D. and
 7   Todd Harris, PA-C
           Hanna, Campbell & Powell
 8         JEFFREY E. SCHOBERT, ESQ.
           3737 Embassy Parkway
 9         P. O. Box 5521
           Akron, Ohio 44334
10         330-670-7300
11   
     On behalf of the Defendants St. Thomas Hospital,
12   Summa Health System and Summa Health System
     Hospitals
13         Hanna, Campbell & Powell
           FRANK G. MAZGAJ, ESQ.
14         3737 Embassy Parkway
           P. O. Box 5521
15         Akron, Ohio 44334
           330-670-7300
16   
17   
                    - - - - -
18   
19   
20   
21   
22   
23   
24   
25   
0003
 1         HUGH A. SCHUCKMAN, M.D., a witness herein,
 2   called for examination, as provided by the Ohio
 3   Rules of Civil Procedure, being by me first duly
 4   sworn, as hereinafter certified, was deposed and
 5   said as follows:
 6     EXAMINATION OF HUGH A. SCHUCKMAN, M.D.
 7   BY MR. MISHKIND:
 8         Q.    State your name, please.
 9         A.    Hugh Schuckman.
10         Q.    Dr. Schuckman, you sat through
11   Todd's deposition that was taken this morning;
12   is that true?
13         A.    Yes.
14         Q.    The same admonitions that I gave to
15   him will apply to you.  Will you follow those,
16   as well?
17         A.    Yes.
18         Q.    Have you had your deposition taken
19   before, sir?
20         A.    Yes.
21         Q.    How many times?
22         A.    Numerous times, because I have
23   testified for drug cases for Summit County and
24   different things, so probably 15, 20 times.
25         Q.    Drug cases --
0004
 1         A.    I work with a program I set up where
 2   we have cut the death rate of people abusing
 3   substances from 25 percent to 3 percent, but it
 4   involves drug screening people requesting
 5   narcotics in the emergency department.  And we
 6   have an agreement with the court system where if
 7   they plead guilty, they don't get a charge and
 8   get treatment in lieu of conviction.  And we
 9   have cut our death rate 25 percent to 3 percent.
10   It's actually worked well enough I was invited
11   last week to speak in Germany at the
12   International Drug Abuse Council about it.
13         Q.    Aside from those cases where you
14   have testified, have you ever been named as a
15   defendant in a medical negligence case and given
16   deposition testimony?
17         A.    Yes.
18               MR. SCHOBERT:  I have a continuing
19   objection to all those questions.  Go ahead,
20   then.
21         A.    Yes.
22         Q.    First, how many times have you been
23   named as a defendant in a medical negligence
24   case?
25         A.    If I remember, I think there were
0005
 1   two where it was either dropped at the time of
 2   my deposition, but I don't remember the details
 3   of those.
 4               One was in about 1982 with a head
 5   injury and another was a patient with abdominal
 6   pain.  Both were settled for less than $10,000.
 7   At the time it was recommended that it would be
 8   less -- the rule was if it was cheaper to
 9   settle, just to settle than to go through
10   everything.
11               And then I had one case ruled in my
12   favor involving a patient that was DNR that the
13   question was whether they were really DNR or
14   not.  There was another with an airway case
15   which was a split verdict of the jury, but it
16   was found in favor of the plaintiff.  And
17   currently there is a trauma patient that I'm
18   named in a case, but the problem occurred after
19   the patient was admitted, so it's not clear.  It
20   was dropped once and they refiled, so I'm not
21   sure what the status of that is but it was just
22   refiled.
23         Q.    Does that cover all of the cases to
24   your knowledge that you have been named in?
25         A.    I don't remember.
0006
 1               MR. SCHOBERT:  To your knowledge.
 2         A.    I don't remember any others.
 3         Q.    Fair enough.  Doctor, the cases that
 4   you have referenced, were they all in Summit
 5   County?
 6         A.    Yes.  All either at Akron City or
 7   St. Thomas Hospital.
 8                     - - - - -
 9              (Thereupon, SCHUCKMAN Deposition
10               Exhibit 2 was marked for
11               purposes of identification.)
12                    - - - - -
13         Q.    I have marked for identification and
14   placed in front of you Exhibit 2.  I believe
15   it's Exhibit 2 for your deposition.  Prior to
16   the deposition, I had marked a copy of your CV
17   and then you provided me with a more current
18   one.
19         A.    Right.
20         Q.    If you will tell me what we have
21   marked as Exhibit 2, how that differs from the
22   CV that you had previously provided your
23   attorney and he provided to me?
24         A.    The revised date has an error on
25   this one because I revised it this morning, so
0007
 1   it would be revised --
 2         Q.    You don't need to mark it.  But
 3   revised as of July 3, 2008?
 4         A.    And the only difference was I'm
 5   working fewer hours in the ICU now than I was on
 6   that and I also had been awarded outstanding
 7   emergency faculty of the year for NEOUCUM and I
 8   added that on.
 9         Q.    You do some publishing for Griffiths
10   5 Minute Diagnostics?
11         A.    Yes.
12         Q.    Have you ever published on the use
13   of opiates or narcotics in emergency room
14   patients?
15         A.    On home-going prescriptions of
16   narcotics obtained by deception I have
17   published, but my other publications have to do
18   with endocrine topics, which would be
19   hyperparathyroidism, hypoparathyroidism,
20   Cushing's disease, and I have published on
21   steroids and asthma and obtaining narcotics by
22   deception and history taking and chronic pain.
23         Q.    Given your reference early on in
24   terms of your work with drug cases and the
25   diversion program or whatever in lieu of
0008
 1   conviction --
 2         A.    Right.
 3         Q.    -- it sounds like you have a fairly
 4   strong background on the use and abuse of
 5   narcotics.
 6         A.    Yes.  And one of the laboratories
 7   that I teach for the residents and med students
 8   is in pain management.
 9         Q.    Fair enough.  Would you agree that
10   opiates could affect cognition and psychomotor
11   function?
12         A.    Yes.
13         Q.    Would you also agree that opiates
14   can result in potentially hazardous consequences
15   to patients due to their effects on psychomotor
16   performance?
17         A.    Yes.
18         Q.    Would you also agree that the use of
19   opiates and their effect on cognition and
20   psychomotor function can have hazardous
21   consequences especially in the acute phase of
22   the treatment?
23               MR. SCHOBERT:  I'm going to object,
24   but go ahead.
25         A.    Yes.  The word especially being in
0009
 1   there, I'm not sure what you mean by especially,
 2   but in general, I agree.
 3         Q.    Doctor, have you ever had your
 4   privileges suspended, revoked or called into
 5   question?
 6         A.    No.
 7         Q.    You heard Todd's testimony as it
 8   relates to his functioning under your
 9   supervision.  Was he accurate with regard to how
10   that functions?
11         A.    That he works under me, yes.
12         Q.    Sometimes lawyers' questions, you
13   wonder whether they are ever going to end.  In
14   fairness to you, and I suppose to me, let me
15   finish first, because I don't want you to give
16   me a yes to something that might be a no, okay?
17         A.    Yes.
18         Q.    And when you're answering, just as I
19   have done thus far, even though you might have
20   gone far afield in responding to my question, I
21   will never interrupt you.  I will never cut you
22   off if you feel you need to answer a question in
23   a certain way.
24         A.    You have been more than affable,
25   yes.
0010
 1         Q.    Good.  Anything that Todd did while
 2   you were the attending was under your
 3   supervision; correct?
 4         A.    Yes.
 5         Q.    And even though he may have seen the
 6   patient at certain points in time independently
 7   of you, are you ultimately responsible for that
 8   which he does in the emergency room?
 9         A.    Yes.
10         Q.    Have you in your experience as an
11   emergency room doctor ever had a patient fall in
12   the emergency room at the time of discharge and
13   fracture a limb?
14         A.    No.  Other than this case.
15         Q.    Fair enough.  I'm not going to go
16   through all of the details that I have already
17   gone through with Todd, but I do want to find
18   out what you recall and perhaps fill in some
19   areas that he may not recall or may not be
20   competent to testify to.
21               So I won't go through line and verse
22   what we talked about with Todd, but I will give
23   you every opportunity to tell me what you recall
24   and certain decision-making issues, okay?
25         A.    Yes.
0011
 1         Q.    The same rule applies.  I want to be
 2   fair to you.  I want to at the end of the
 3   deposition make sure that you have been able to
 4   tell me everything that you recall about this
 5   patient and everything that you have learned in
 6   talking with any of the nurses as it relates to
 7   how this incident occurred.
 8         A.    Yes.
 9         Q.    When the patient arrived at the
10   emergency room, was Todd, when he did his
11   assessment, was he accompanied by you or did he
12   do the initial assessment that's recorded on
13   page 4 of Exhibit 1?
14               MR. SCHOBERT:  Why don't you just go
15   ahead and use Exhibit 1 for now since that seems
16   to have the bates stamps on them.
17         A.    I have very little independent
18   recollection.  However, by the way the
19   department normally runs and by the things in
20   the record, I think I can put things together a
21   little bit more.
22               When there's back pain in someone
23   that is over the age of 50, the initial radio
24   calls taken at Akron City, they will fax and
25   also have a pager that goes off with an alpha
0012
 1   page.  They type a little message in.  If it's
 2   something like that, normally I'll see the
 3   patient and talk to the paramedics before the
 4   patient is even put in the bed, for the reason,
 5   what we always worry about is an abdominal
 6   aortic aneurysm.  I put the initial time on the
 7   order street --
 8               THE WITNESS:  Which page is that,
 9   Jeff?
10               MR. SCHOBERT:  I'll give you the one
11   that I have marked up.
12         A.    I just need a page.  It's that order
13   sheet.  Oh, the first page, sorry.
14         Q.    That's okay.
15         A.    So that's my initial, my time right
16   there.
17         Q.    And for the record, that's page 1 of
18   Exhibit 1 --
19         A.    Yes.
20         Q.    -- in the upper left-hand corner?
21         A.    Yes.
22         Q.    Okay.  And what time is that?
23         A.    It says 1405.  But that's when the
24   chart would have been ready.  I would've seen
25   the patient before that.  And when they had a
0013
 1   chart, they would've handed it to me and put
 2   whatever the time the chart was completed on
 3   there.
 4               But normally I'll see the patient,
 5   make sure there is no aneurysm.  And also some
 6   of the patients, if they have kidney stones and
 7   things like that, that are in severe pain
 8   whether they are at rest or moving.  If somebody
 9   as Todd indicated in his record is pain severe
10   when they move and milder when they are at rest,
11   then they are more comfortable and they can wait
12   to get some more assessment before receiving
13   their analgesics.
14               So I would've seen her.  Then Todd
15   would've done his assessment, and then I
16   would've gone in after she had the pain
17   medication and reexamined her.  And the best
18   evidence I would have for my assuming that is
19   that all this is my writing, and with the way I
20   have written it, this is what I would've done
21   after I had reviewed the initial assessment and
22   paramedic run sheet, which as a matter of course
23   I don't discharge people or admit them without
24   reading the run sheet first.
25         Q.    Let me back up for a moment and
0014
 1   clarify a few things that you said.
 2               Page 3 of Exhibit 1 is what you
 3   reference that you would have completed?
 4         A.    Yes.  That's all my writing on the
 5   page except for the patient's signature and
 6   Susan Pearch's signature.
 7         Q.    There is an X next to under
 8   home-going instructions where it indicates you
 9   have received medication which may make you
10   sleepy.  Is that the morphine?
11         A.    Yes.
12         Q.    The Phenergan also?
13         A.    Phenergan will also make people
14   sleepy.
15         Q.    And is one of the side effects of
16   morphine, in addition to making them sleepy, is
17   a side effect with a normal dose also drowsiness
18   and confusion?
19         A.    It depends on the degree of pain.  I
20   have taken care of a lot of terminal cancer
21   patients and I have given 100 milligrams of
22   morphine every 30 minutes IV and had the person
23   sit and talk to me in a normal conversation.
24               So it's dependent on the amount of
25   pain, the person's tolerance of narcotic, and
0015
 1   multiple other factors.
 2         Q.    Are you able to tell me in this
 3   particular case with this patient what her
 4   tolerance was for pain?
 5         A.    She rated her pain when moving at a
 6   ten.  The dose that I would standardly use in a
 7   person like that in most of the articles I have
 8   read would be about ten milligrams of morphine.
 9   Because she was 67, but healthy, and she was
10   over 110 pounds, then we would cut it a little
11   bit and use eight milligrams.
12         Q.    In terms of her tolerance to the
13   morphine -- strike that.
14               First, did you give her a slightly
15   lower dose of morphine because of her age?
16         A.    Yes.
17         Q.    Elderly patients -- and I don't mean
18   to say that 66 is elderly, because it gets
19   younger and younger, but 66 is still an age
20   population that you recognize that you have to
21   be careful, more careful with the administration
22   of morphine than in a younger patient?
23               MR. SCHOBERT:  Objection.
24         A.    I believe I was careful in cutting
25   it to eight milligrams.
0016
 1         Q.    I'm not suggesting --
 2         A.    I'm just saying, but the question is
 3   whether I violated this standard of care.  And
 4   in my training, experience, eight milligrams
 5   would be slightly lower, which from lectures I
 6   have attended in pain management and lectures I
 7   have given in pain management would be about the
 8   amount we would do in a healthy 66-year-old.
 9               If somebody cut my dose of pain
10   medication because of my age -- I figure I'm
11   still tougher than most of the 30-year-olds -- I
12   would be mad at them.
13         Q.    But the reason that you --
14         A.    I picked eight instead of ten was
15   because of her being 67.
16         Q.    Fair enough.  Thanks.
17               Going back to just a general
18   principle in terms of the use of morphine, one
19   of the side effects and special precautions that
20   you are aware of is that morphine in normal
21   doses can cause drowsiness and confusion; true?
22               MR. SCHOBERT:  Objection.  Asked and
23   answered.  But go ahead.
24         A.    Yes.
25         Q.    Did you assess the patient at any
0017
 1   time after she was given the morphine to
 2   determine whether or not she was drowsy or
 3   confused?
 4         A.    Yes.
 5         Q.    Where is your assessment?
 6         A.    I can tell you that because of the
 7   way the home-going are written and --
 8               THE WITNESS:  Where is the nurse's
 9   orders?
10               MR. SCHOBERT:  If you are more
11   comfortable the way I have got it.  Go ahead.
12   That's in a more logical order rather than
13   scattered around.
14               (Discussion off the record.)
15         A.    At the time the Kenalog here is
16   given at 1530 --
17               MR. SCHOBERT:  Wait.  Let him catch
18   up.
19         Q.    Doctor, do me a favor.  Especially
20   because your attorney has a tendency of talking
21   over you, as well -- and I have always accused
22   him of doing that, I want you to know -- but for
23   purposes of our discussion today, we are now
24   referring to page 2 of Exhibit 1, are we not?
25         A.    Yes.
0018
 1         Q.    Okay.  Now continue.  Because I
 2   think a moment ago I was asking you in terms of
 3   the assessment of the patient in terms of any
 4   level that she might have had with regard to
 5   drowsiness and confusion, and just to sort of
 6   come back full circle, I had asked you did you
 7   assess the patient in terms of how she had
 8   responded to the eight milligrams of morphine.
 9   Please go ahead.
10         A.    Okay.
11         Q.    Page 2?
12         A.    On page 2, it says the Kenalog
13   having been given at 1530 and on page -- what
14   page is this?
15               MR. SCHOBERT:  Just use the last
16   number there.
17         A.    01, page 01 it says Kenalog 40 IM.
18   Verbal order Dr. Schuckman, Sue Pearch, and it
19   doesn't have a time there.  I would assume it
20   was between 1520 and 1530 since it was given at
21   1530 and I wrote the 1520 urine CNS here and I
22   would presume that at this time I would have
23   written the Kenalog if I had already seen her.
24   So between 1520 and 1030 I would've gone into
25   the room.
0019
 1               At this point I would have talked to
 2   her about whether she could go home or not and
 3   how drowsy she was and made an assessment.
 4               I will sometimes send people back
 5   home with back pain in an ambulance.  If they
 6   have people to help her at home and if her pain
 7   was relieved with this dosage, then we pretty
 8   much can say we have a high success rate of
 9   going home and having their pain managed with
10   Percocet.  If her pain wasn't relieved or didn't
11   have somebody to help her at home, I would've
12   made arrangements to have her admitted.
13         Q.    Where on page 1 of Exhibit 1, which
14   you just referred to, or page 2 of Exhibit 1
15   does it indicate that you assessed the patient
16   from the standpoint of whether she was
17   exhibiting any signs of drowsiness or confusion?
18         A.    If she had respiratory depression or
19   anything looked more serious, I would not have
20   written her home-going at that time.
21               I have seen about 170,000 patient
22   visits and when I assess somebody, if everything
23   looks okay, I'm not going to put a note.  If
24   something looks abnormal or I'm concerned, then
25   I would put a note and watch her another hour,
0020
 1   something such as that.
 2               So I would assess her and say, do
 3   you have somebody to help you at home; you
 4   couldn't walk when you came in; you had some
 5   falls, do you think you could manage at home?
 6   If she seemed alert enough where she understood
 7   what was going on, was able to go through the
 8   exam with me, which I would've done to order the
 9   Kenalog, I would've had to have flexed her at
10   the hip and externally rotated her to assume the
11   Kenalog would've helped her with that and that's
12   how we would have determined it was sciatica and
13   that's my standard practice.
14         Q.    But going back to my initial
15   question, can we agree that in terms of anything
16   noted by way of progress notes, that there is
17   nothing that you wrote in the record that
18   indicates whether or not she was in any way
19   drowsy or confused or sleepy after the eight
20   milligrams of morphine had been administered?
21         A.    If I didn't think she understood the
22   instructions, I would've held off and gone back
23   and rewritten -- gone over them again.  And so
24   the fact that I have the home-going written
25   would indicate to me from my standard practice
0021
 1   that I had talked to her.  There is the
 2   indication that there was the milk of magnesia.
 3   We checked the drowsy while driving.  And her
 4   follow-up, that's on 003.
 5         Q.    But again, doctor, just so that we
 6   are clear, in terms of a notation that she was
 7   not drowsy or confused or sleepy, even though
 8   you have told me why you didn't believe that she
 9   was drowsy or confused, there is nothing
10   indicating that you did an actual assessment of
11   her psychomotor status; is that a fair
12   statement?
13               MR. SCHOBERT:  Objection.
14               MR. MAZGAJ:  Objection.
15         A.    No.  Because I don't think that --
16   if I answer yes, I'm not telling the truth and
17   I'm supposed to tell the truth.  I'm not trying
18   to be obstreperous.  I wouldn't have written
19   this unless I went over and felt she was awake
20   and alert enough to do this.
21               And no matter how you ask it, this
22   is my indication in the record of that.  I would
23   only put it otherwise -- you know, in a busy
24   emergency department, you know, I'm going to
25   assess her.  If she answers questions and seems
0022
 1   functionally adequate, that's not something that
 2   normally I would note in the record or isn't a
 3   standard of care for me to note.
 4         Q.    How busy was the emergency room on
 5   this particular day?
 6         A.    I have no independent recollection
 7   of that.
 8         Q.    You mentioned a moment ago about the
 9   communication that you would've had when the
10   ambulance was transporting the patient.  They
11   would have, I think you said, they would've
12   contacted Akron City first?
13         A.    Yes.  Radio calls go through Akron
14   City, and it would appear that Dr. Georgio took
15   the call from the sheet, which --
16               MR. SCHOBERT:  I'm sorry, Howard, I
17   don't have a stamp on that.
18               MR. MISHKIND: Don't worry about it,
19   I'll catch up with you.
20               MR. SCHOBERT: You had it before
21   because you asked Todd about it.
22               MR. MISHKIND: Page, it looks like
23   page 11.
24               MR. SCHOBERT:  We will agree that's
25   what it is.
0023
 1         Q.    And you mentioned Dr. Georgio.  And
 2   there is a signature, ED, M.D., Dr. Georgio?
 3         A.    Yes.
 4         Q.    And who is he?
 5         A.    One of my partners.
 6         Q.    So he would've had the EMS phone
 7   communication?
 8         A.    Yes.
 9         Q.    And this information then would have
10   been brought to your attention?
11         A.    Yes.
12         Q.    So you would've known when you saw
13   the patient that she had back pain; that she
14   couldn't walk or get out of bed; true?
15         A.    Yes.
16         Q.    You also mentioned a moment ago
17   about a history of falls and we had talked about
18   that with Todd in my questioning of him.  That
19   would have been obtained by the nurses?
20         A.    Yes.
21         Q.    And that again would have been
22   information that would have been available to
23   you, as well; correct?
24         A.    Yes.  That's my standard practice
25   before discharging a patient; to read everything
0024
 1   on page 1 of 4 or page 15.
 2         Q.    The initial assessment which is page
 3   1 of 4.  So you would've been aware that the
 4   patient had a history of falls in the past two
 5   months; correct?
 6         A.    Yes.
 7         Q.    Would it be your normal practice to
 8   ask the patient more questions about that
 9   history?
10         A.    Yes.
11         Q.    Do you recall doing that in this
12   case?
13         A.    I have no independent recollection.
14         Q.    Tell me why it would be important in
15   the setting of this patient with her back pain,
16   not being able to walk, and then also the
17   history of some numbness in her left leg, why it
18   would have been important for you to inquire
19   about her falls in the past two months?
20               MR. SCHOBERT:  Objection to the form
21   of the question.  Go ahead.
22         A.    Because if that's the case, the
23   indications for admission of the patient are two
24   once we have ascertained there's nothing more
25   serious going on.
0025
 1               And one would be we couldn't control
 2   her pain, which is why I picked the dose of
 3   morphine I did was because given that dose, if I
 4   had to go to a higher dose than that, I couldn't
 5   adequately control her pain at home.  And when I
 6   reassessed her she said her pain was controlled
 7   and they had written zero for her reassessment
 8   pain scale.
 9               The second thing is that I would
10   expect somebody to be at home to help her so
11   that she wouldn't fall.
12         Q.    Doctor, after the assessment that
13   you had done, it looks like is that 1520?
14         A.    Yes.
15         Q.    She would've already had the
16   morphine on board; true?
17         A.    Yes.
18         Q.    And what you told me was that if she
19   was having any what you perceived to be side
20   effects from the morphine, that's something that
21   you would've noted; true?
22         A.    Yes.
23         Q.    Okay.  I presume the patient was
24   laying on the examining table at that particular
25   time?
0026
 1         A.    On the gurney, yes.
 2         Q.    You didn't actually see her
 3   ambulate, did you?
 4         A.    No.
 5         Q.    Do you recall whether the patient at
 6   any time during this emergency room encounter
 7   was accompanied by any family members?
 8         A.    Only in the note that family --
 9               MR. SCHOBERT:  He is asking if you
10   recall.
11         A.    If I recall.  I'm sorry.  No.
12         Q.    You started to mention there is a
13   note referencing a particular family member.
14   Which note are you referring to?
15         A.    Page 6.  1705.  While patient was
16   getting dressed, patient had witnessed fall to
17   floor after putting on a sandal -- something by
18   family. It's a hard copy to read.
19         Q.    That's okay.  You are reading the
20   Nurse Susan's note; correct?
21         A.    Yes.
22         Q.    Does that note referencing a family
23   member, does that cause you to have any
24   recollection or be able to picture meeting a
25   family member?
0027
 1         A.    No.  I would've asked the patient --
 2   the fact that Todd dictated under Dr. Mencl
 3   would indicate to me I was out of the department
 4   by the time this happened.  And I don't remember
 5   anything happening while I was still in the
 6   department and have a vague recollection of Todd
 7   telling me that when I worked with him the next
 8   time that she had fallen and broken her ankle.
 9         Q.    Do you have a vague recollection of
10   him telling you that?
11         A.    Yes.
12         Q.    Being that this was 5:00 o'clock or
13   thereabouts, tell me how the shifts work when
14   you are working in the emergency room.
15         A.    My shift ended at 3:00 o'clock and
16   when I completed the patients that I had, I
17   would've gone home, which could be anywhere from
18   3:30 to some days 6:00 or 7:00 o'clock,
19   depending on how busy it was.
20         Q.    Is it fair to say that in all
21   likelihood, at or around 5 p.m. that you were no
22   longer the attending for Donna?
23         A.    Yes.
24         Q.    And that Dr. Mencl had taken over as
25   the attending because of shift change?
0028
 1         A.    Yes.
 2         Q.    Is it further fair to say that the
 3   discharge process in terms of assisting the
 4   patient from the emergency room and giving the
 5   patient the actual discharge instructions that
 6   you have, the home-going instructions, that that
 7   is a nursing function?
 8         A.    Your question is after I have
 9   written it and talked to the patient?
10         Q.    Yes.
11         A.    Because I always go over the
12   discharge myself initially and then it's gone
13   over with the patient a second time with the
14   nurse with the hopes that if the patient had a
15   question she didn't ask, she would ask the
16   nurse.  Or if there is a question of something
17   that the patient remembered later, it's not
18   uncommon for me to go back and see a patient
19   again if there is a question arising.
20         Q.    Okay.  So at about -- what time
21   would you have written your home-going
22   instructions?  Can you tell?
23         A.    I can't tell.  Depending on how busy
24   I was, it would have been sometime after the
25   Kenalog shot was given.
0029
 1         Q.    And the Kenalog, again, was given at
 2   1530?
 3         A.    Yes.
 4         Q.    So we are talking 3:30?
 5         A.    Yes.
 6         Q.    And the patient was in the ER at
 7   around 1:05 or thereabouts?
 8               MR. SCHOBERT:  Tell him what page
 9   you are looking at.
10               (Discussion off the record.)
11               MR. SCHOBERT:  Tell him what page
12   number.  Take your time.
13         A.    This is page 15 and time is 1342,
14   which would have been the patient would have
15   theoretically arrived three to five minutes
16   before that and this would have been the time
17   they would have been put onto the gurney.
18         Q.    Okay.  So in normal nonmilitary
19   time, we are talking about 1:42 that the patient
20   is in the emergency department having been
21   transferred from the ambulance folks into your
22   jurisdiction, if you will, your venue?
23         A.    That would be 1:42 p.m.
24         Q.    And then by 3:30 p.m., the patient
25   had already had x-rays, medication, had been
0030
 1   assessed, and discharge instructions had been
 2   given relative to her home-going instructions;
 3   true?
 4         A.    True.
 5         Q.    So within a two hour period, the
 6   patient, other than the process of assessing
 7   whether or not she could be discharged and then
 8   making sure that she was safely transported out
 9   of the emergency room, within a two hour period,
10   all of the clinical assessments and treatment
11   had been completed; is that a fair statement?
12         A.    Yes.
13         Q.    Okay.  Can you explain to me why
14   there are no vital signs recorded in the record
15   at the time that the patient was administered
16   the morphine?
17         A.    There are vital signs.  Mr. Harris
18   was in error, I believe.
19               MR. SCHOBERT:  Take your time and go
20   through.  Find the page first so he can see what
21   you are looking at.
22         A.    Page 6, before they would've gotten
23   her up, the vital signs would have been done.
24   Mr. Harris doesn't have the nurses come to him
25   with discharge vital signs.  But before any
0031
 1   patient is discharged after medication, the
 2   nurses will come to me.
 3               It would appear that at 1650 when
 4   Sue Pearch had written the patient discharge and
 5   then crossed it out, she probably had written in
 6   the vital signs at that time and then crossed it
 7   out.  The vital signs apply to either of these.
 8   But whether the patient is admitted or
 9   discharged is this line.  Do you see it?
10         Q.    Doctor, let's go through that for a
11   moment.  Because we know that at 1650, which is
12   again, 4:50 p.m., Susan was filling out the
13   discharge section, whereas the patient was still
14   in the examining room and had not actually been
15   discharged; correct?
16         A.    Yes.
17         Q.    So she was actually filling this out
18   in advance of the patient being transported out
19   of the examining room; correct?
20         A.    Yes.
21         Q.    And her intent was, when she was
22   discharged, for the patient to be discharged in
23   a wheelchair; correct?
24         A.    Yes.
25         Q.    Why is that?
0032
 1         A.    Somebody coming in with back pain
 2   that couldn't walk, I would rather have them
 3   resting.  I don't want them walking any more
 4   than absolutely necessary.
 5         Q.    So we know that because of numbness
 6   in her leg, that standard procedure would be to
 7   have this patient discharged to either their car
 8   or whatever, transporting by way of wheelchair;
 9   correct?
10         A.    Yes.
11         Q.    And does the process in terms of
12   discharging a patient also include appropriate
13   assistance in terms of dressing and getting from
14   the bed into the wheelchair?
15         A.    I'll answer yes with it being a
16   vague question, because I'm not sure what you
17   are implying by the word appropriate, but in
18   general term, I would answer yes to that.
19         Q.    Do you expect nurses, when they are
20   discharging a patient, after the medications
21   have been given, home-going instructions
22   provided, that reasonable precautions are taken
23   so that the patient is safely assisted to the
24   wheelchair?
25               MR. MAZGAJ:  Objection.
0033
 1         A.    Again, words like appropriate are
 2   very vague, so I would have to answer that yes
 3   or no depending on what you mean by appropriate.
 4         Q.    Would you expect that reasonable
 5   precautions should be taken by any nurse in
 6   assisting a patient from an examining bed into a
 7   wheelchair under the circumstances that we have
 8   in this case?
 9               MR. MAZGAJ: Objection.
10         A.    Again, depending on what is meant by
11   reasonable, I would answer yes or no to that.
12         Q.    Well, what do you expect in terms of
13   reasonable steps being taken by a nurse in
14   assisting a patient that is to be discharged by
15   wheelchair, what assist --
16         A.    Our --
17               MR. SCHOBERT:  Let him finish his
18   question and let him get his objection -- hang
19   on, he is still finishing his question.
20               THE WITNESS:  I'm very sorry.
21         Q.    Doctor, what are your expectations
22   of the nurses in terms of the procedures that
23   should be followed in assisting a patient into a
24   wheelchair at the time of discharge?
25               MR. MAZGAJ:  Objection.
0034
 1         A.    I would expect if the patient
 2   suddenly experienced pain, that they would come
 3   and get me.  Or if they got dizzy or lightheaded
 4   or often a family member will come and say,
 5   well, you know, they just aren't going to be
 6   able to make it at home, somebody would come.
 7               Because when I'm discharging
 8   somebody with back pain, it's not uncommon for
 9   me to send them home by ambulance because the
10   people have a tiny car and the person can't get
11   in the seat.  And they say, oh, I thought you
12   were bringing the van and they bring the sports
13   car or whatever and so I'll send them home by
14   ambulance.
15               If the person seems excessively
16   drowsy, then I would expect them to tell me the
17   patient is not ready to go home.  And just from
18   my interaction of the writing, I don't think it
19   was the case in this case, but that would be one
20   thing I would expect.  And if the patient said
21   that they felt like they were unable to do
22   something, that they would help them with it.
23         Q.    Let's go back for a moment to what
24   we were talking about relative to the vital
25   signs.  The vital signs -- we talked about Susan
0035
 1   filling out the discharge with home-going
 2   instructions at 1650 and we know even before she
 3   crossed that out that that was filled out before
 4   the patient was actually discharged; correct?
 5         A.    It would have been as she was
 6   getting ready since that was going to be her
 7   discharge time, so that would have been filled
 8   out at the proximity to that, probably within
 9   five to seven minutes before that.
10         Q.    And we know that at that particular
11   point in time, at least with this particular
12   entry, the plan was to discharge her not
13   ambulatory, but in a wheelchair; correct?
14         A.    Correct.
15         Q.    Do you know what form of assistance
16   was in the examining room to get the patient
17   from the bed or the gurney, whatever you want to
18   refer to it as, into the wheelchair?
19         A.    I don't understand the question.
20   I'm sorry.
21         Q.    Not a problem.  What method was to
22   be used to get the patient from the bed into the
23   wheelchair?  In other words, was the patient,
24   given her condition, was it expected that she
25   would step down off the bed, ambulate and step
0036
 1   into the wheelchair, or given the clinical
 2   history with her numbness in her leg, her pain,
 3   was it expected that she would be assisted into
 4   the wheelchair and nonambulatory?
 5               MR. MAZGAJ:  Objection.
 6               MR. SCHOBERT:  I'll object to the
 7   form of the question.  Go ahead.
 8         A.    I think that's something that Susan
 9   Pearch would've made an assessment on the
10   patient.  If it seemed reasonable for her to
11   stand, she would've let her stand, and if it
12   didn't, if she had any concerns, Susan is
13   excellent in judgment as a nurse with my dealing
14   with her and I would trust her to make an
15   adequate assessment.
16         Q.    Would it be her responsibility to
17   observe the patient and make that determination
18   at the time that the patient is being discharged
19   as opposed to being out of the room making that
20   assessment?
21               MR. MAZGAJ:  Objection.
22         A.    That assessment would have been made
23   by her whether it was at that time or not.
24   There is no reason if there is somebody there
25   with the patient that she couldn't have made the
0037
 1   assessment that the patient felt well enough and
 2   felt capable of getting up.
 3         Q.    I want to continue with this because
 4   you mentioned that vital signs were taken at the
 5   time that she was discharged.  You had corrected
 6   Todd when I asked about the only one set of
 7   vital signs being 1710, which would be two hours
 8   after, two hours and ten minutes after she had
 9   been given the morphine.  And we talked about
10   the one set of vital signs at 1710.  That would
11   have been after she fell; correct?
12               MR. SCHOBERT:  Objection as to the
13   form of the question.  Go ahead, you can answer.
14         A.    The vital signs here that they take
15   to the floor, these are vital signs on this page
16   that you take.  Todd doesn't have any
17   responsibility at that point with that, so he
18   doesn't have any reason that he would know that
19   because that's not part of the chart that he
20   would see, because once that's done, the chart
21   is gone and doesn't come back to him.
22               But these are the vital signs if
23   somebody's blood pressure is high or low or
24   heart rate fast or slow they bring to me if they
25   are being discharged and those are the ones if
0038
 1   they are being admitted.
 2         Q.    So the vital signs on page 2 at 1710
 3   which correspond within a ten minute period of a
 4   fall, those would be for what purpose?
 5         A.    Those would have been afterwards and
 6   those are probably her vital signs that they
 7   would've used for her because she was being
 8   admitted.  These are 123 over 61 blood pressure
 9   on page 6 and on page 2 it's 160 over 80, so
10   obviously they are different vital signs.  This
11   vital sign would have been her discharge vital
12   signs of 123 over 61 and after the injury, they
13   would've taken another set of vital signs after
14   she fell.
15         Q.    I want to make sure I'm clear with
16   what your testimony is.  You are suggesting that
17   on page 6 the vital sign of BP of 123 over --
18         A.    61.
19         Q.    -- 61 and the pulse of 82 and
20   respiration of 20, that would have been at the
21   time that she was being discharged but prior to
22   her fall?
23         A.    Yes.
24         Q.    Even though that is in the section
25   right below where it says verbal report given to
0039
 1   some other nurse?
 2         A.    There is no physician initial by
 3   this, so this wasn't the vital sign for -- these
 4   vital signs go for admit or discharge, either
 5   one.
 6               It would make the most sense to me
 7   to think that these were the vital signs done
 8   prior to discharge and the vital signs over here
 9   since they were continuing the chart would have
10   been done afterwards.
11         Q.    After the fall?
12         A.    Yes.
13         Q.    Now, doctor, isn't it a fact that
14   the vital signs on page 6, which you are
15   referring to as discharge instructions,
16   discharge vital signs before her fall, actually
17   are in the section that says patient transferred
18   to room 718?
19               MR. SCHOBERT:  Objection.  Asked and
20   answered, but go ahead.
21         A.    No.  I have already told you.  These
22   vital signs pertain to discharge or admitted.
23         Q.    Okay.  But you don't know in this
24   case whether or not these vital signs were taken
25   after the decision was made for the patient to
0040
 1   be admitted to the hospital, do you?
 2               MR. SCHOBERT:  Objection.
 3               MR. MISHKIND: Jeff, don't testify.
 4   If you want to, object.  I want him to clarify.
 5         Q.    Can you tell me?
 6         A.    If I were reading this chart and
 7   when I read this chart I would assume those were
 8   the vital signs done at the time of discharge.
 9         Q.    But they are not timed, are they?
10         A.    No.
11         Q.    And equally considering it's in the
12   section where the patient is transferred to room
13   718 being admitted, those vital signs could
14   equally apply to after the point in time that
15   the patient fractured her leg and a decision had
16   already been made that she needed to be admitted
17   to the hospital; correct?
18               MR. MAZGAJ:  Objection.
19               MR. SCHOBERT:  Objection.  Asked and
20   answered.
21         A.    Potentially they could, but she
22   would've had to have had vital signs in here for
23   discharge before, so I think it highly unlikely.
24         Q.    In any event, the only vital sign
25   that is recorded in the emergency progress note
0041
 1   that we have a timing on is at 1710 after her
 2   fall?
 3         A.    Yes.
 4         Q.    We don't have any vital signs
 5   recorded at the time that she was given the
 6   morphine at 3 p.m.; true?
 7         A.    True.
 8         Q.    And we don't have any vital signs to
 9   see how she responded to the morphine for the
10   next two hours and ten minutes; true?
11         A.    True.
12         Q.    Now, we talked about personnel who
13   may have been in the emergency room.  What I'm
14   trying to understand is, on that particular day,
15   I have been led to believe, and hopefully you
16   can correct me or not -- I was led to believe
17   that there were some students that were working
18   in the emergency department that were nurses or
19   nursing students that somehow had an interaction
20   with Donna Johnson at the time of her discharge.
21   Do you have any knowledge directly or indirectly
22   about that?
23         A.    No.
24               MR. SCHOBERT:  And again, I don't
25   know what discussions I have had with him.  I
0042
 1   just wanted to make sure if he answered, it
 2   reflected --
 3         A.    No.
 4         Q.    In talking with Susan -- strike
 5   that.
 6               You said that Todd told you the next
 7   day that she fell?
 8         A.    Yes.
 9         Q.    When did Susan --
10         A.    I don't know that -- pardon me.
11   I'll let you finish your question.  He told me
12   the next time we worked together.
13         Q.    Fair enough.  It could have been the
14   next day, could have been X number of days
15   later.
16               Did Susan tell you about the fall,
17   either the next day or the next time that you
18   worked together?
19         A.    No.  I have no recollection of her
20   talking to me about it at all.
21         Q.    Have you seen situations where
22   students, nurses aides, or nursing students are
23   provided some education by working in the
24   emergency department?
25         A.    I'm not clear what you are asking,
0043
 1   I'm sorry.
 2         Q.    Have there ever been occasions where
 3   nursing students are working under the direction
 4   of a physician or a nurse in the emergency
 5   department?
 6         A.    Yes.
 7         Q.    Is this through a nursing school
 8   that they come for internship or on-the-job
 9   training?
10         A.    Yes.
11         Q.    And that happens not infrequently at
12   St. Thomas Hospital?
13         A.    Correct.
14         Q.    So is it fair, at least, to consider
15   that there may have been some students that were
16   working, getting training and experience in the
17   emergency room on this particular day?
18         A.    Yes.
19         Q.    Have you ever been able to confirm
20   in any way with either your colleague who took
21   over for you, Dr. Mencl, or any of the other
22   physicians in the emergency room who, in fact,
23   was present at the point in time that Donna
24   fell?
25         A.    No.
0044
 1         Q.    If a nurse delegates responsibility
 2   to a nursing student to perform a nursing
 3   function, is that nurse still responsible?
 4               MR. MAZGAJ:  Objection.
 5               MR. SCHOBERT:  Objection.
 6         A.    That's not my area and any answer I
 7   would give would be supposition.
 8         Q.    If you delegate to a physician's
 9   assistant to do an assessment or to take a
10   history, are you responsible for that
11   physician's assistant?
12         A.    Yes.
13         Q.    Do you have any reason to believe
14   that a nurse would be any less responsible for a
15   nursing student than you would be for a
16   physician's assistant?
17               MR. MAZGAJ:  Objection.
18         A.    No.
19         Q.    After learning about Donna's injury,
20   whenever it was that you were on shift next, did
21   you ever talk with Dr. Alexander about her
22   condition?
23         A.    I may have, but I don't remember.
24         Q.    Did you ever see Donna Johnson after
25   this emergency room visit?
0045
 1         A.    No, not to my knowledge.
 2         Q.    On page 6 at 1705 -- and I recognize
 3   that you were not there at that particular point
 4   in time -- but it says supervisor aware.  Do you
 5   see that?  Right before we get to the 1730.
 6         A.    Yes.
 7         Q.    Who is the supervisor that would
 8   have been made aware?
 9         A.    It would be the nursing supervisor
10   for the hospital.
11         Q.    And who would that have been?
12         A.    Any number of people.  It's a
13   different person on -- probably seven or eight
14   people it could have been.
15         Q.    Doctor, in your dictated note,
16   first, when did you dictate your note?
17         A.    I didn't dictate it.
18         Q.    That would have been Todd that
19   would've dictated for you?
20         A.    Yes.
21               MR. SCHOBERT:  What page is that?
22               MR. MISHKIND:  7 and 8.
23         Q.    I presume even though Todd would've
24   dictated it, you were responsible for making
25   sure that it was accurate; correct?
0046
 1         A.    Yes.
 2         Q.    The history of the present illness,
 3   would his statement in that dictation that she
 4   has a little bit of numbness to the left foot,
 5   would that be an accurate reflection of her
 6   status at the time of her emergency room
 7   presentation?
 8         A.    Yes.
 9         Q.    And do you know whether the numbness
10   was eliminated prior to her discharge?
11         A.    I would doubt that it had been.
12         Q.    If anything, the pain may have been
13   reduced or treated based upon the morphine at
14   that point, but the numbness itself wouldn't
15   have responded to eight milligrams of morphine;
16   is that a fair statement?
17         A.    That's a fair statement.
18         Q.    So the underlying pathology that
19   caused her symptoms, whether it was sciatica, in
20   all likelihood she still would've had some
21   numbness at the point in time that she would
22   have been prepared for discharge; true?
23         A.    Correct.
24         Q.    Would you have still considered the
25   patient, given her medical history, the acute
0047
 1   onset of this ten out of ten back pain that
 2   brought her to the emergency room, and her prior
 3   history of falls, would you have still
 4   considered her to be a risk for fall in the
 5   emergency room?
 6               MR. MAZGAJ:  Objection.
 7               MR. SCHOBERT:  Objection.
 8         A.    Yes.
 9         Q.    And requiring reasonable observation
10   throughout her emergency room stay?
11               MR. SCHOBERT:  Objection.
12               MR. MAZGAJ:  Objection.
13         A.    My answer to that would be dependent
14   on the word reasonable, which has different
15   meanings to different people, but assessment.
16         Q.    What type of reasonable precautions
17   would you expect of yourself or anyone that's
18   caring for the patient in terms of making sure
19   that a patient who is a fall risk to keep them
20   safe in the emergency department?
21               MR. MAZGAJ:  Objection.
22         A.    That you would have personnel
23   available to help her if she needed it when she
24   was getting up.
25         Q.    And who makes that determination as
0048
 1   to whether or not the patient needs assistance
 2   when they are getting up?
 3         A.    If she has respiratory depression or
 4   she seemed markedly cognitively impaired, I
 5   would be involved; but otherwise it's normally
 6   going to be the nurse that's going to make the
 7   assessment on them.
 8         Q.    If the patient wasn't experiencing
 9   any psychomotor effects from the morphine at the
10   time of discharge, what risk would there be to
11   just simply allowing the patient to walk out of
12   the examining room as opposed to putting the
13   patient in a wheelchair?
14               MR. SCHOBERT:  Objection.
15               MR. MAZGAJ:  Objection.
16         A.    The way you worded the question is a
17   supposition, if she hadn't received the
18   morphine; correct?  You started by saying if she
19   had no psychomotor impairment.  I'm sure she had
20   some psychomotor impairment from the morphine.
21   I'm not sure what you are asking me.
22         Q.    Your response is a good one.  Thank
23   you.
24               Is the psychomotor effects of the
25   morphine, is that a reason why you want the
0049
 1   patient to be discharged in a wheelchair?
 2               MR. MAZGAJ:  Objection.
 3         A.    My decision would be to discharge
 4   her in a wheelchair or by ambulance, depending
 5   on whether she had a car to get into and if the
 6   family thought they could help her from the car
 7   to the house.
 8               As far as somebody that comes in
 9   with back pain and they can't walk, I'm really
10   not big on them walking around a whole lot at
11   home or in the emergency department the first
12   day after that.  We try to get people up and
13   move them about, but after she has just had an
14   acute episode, I want her to rest for the day.
15         Q.    So you would want the patient in the
16   emergency room and for the next day to be
17   nonambulatory; is that a fair statement?
18         A.    Unless somebody was there to help
19   her.
20         Q.    And that would be what, with an arm
21   assist?
22         A.    Or to be available.  Some people are
23   able after doses of morphine, their pain is
24   relieved and they are more alert than they were
25   with the problem they had with their pain, so
0050
 1   you have to assess that on the individual
 2   patient.
 3         Q.    Do you expect that in terms of doing
 4   the assessment that the assist should be in
 5   close proximity to the patient so if they need
 6   assistance when they attempt to ambulate that
 7   the assistance is immediately there?
 8               MR. MAZGAJ:  Objection.
 9         A.    Again, close proximity means
10   different things to different people, so I would
11   expect the person to be within a reasonable
12   distance.
13         Q.    So that if there is an ambulation
14   problem, that patient can be immediately
15   assisted?
16               MR. MAZGAJ:  Objection.
17         A.    If they feel unsteady or feel they
18   need help so somebody could help them.
19         Q.    Anything about this patient that you
20   recall, either independently or after looking at
21   the record, that we have not already discussed,
22   doctor?
23         A.    No.
24         Q.    And in terms of her emergency room
25   stay for the acute event that brought her
0051
 1   there -- and that is the low back pain and the
 2   left foot numbness -- regardless of what
 3   happened when she was being discharged, you felt
 4   that she was an appropriate patient to be
 5   discharged; true?
 6         A.    True.
 7         Q.    As to whether or not she was
 8   appropriately monitored and assisted at the time
 9   that she was dressed or getting dressed and
10   being assisted to the wheelchair, do you have
11   any way of saying whether the nurses provided
12   standard measures to safely get her from the bed
13   to the wheelchair?
14               MR. MAZGAJ:  Objection.
15               MR. SCHOBERT:  Objection.  Go ahead.
16         A.    I'm just making sure.  You paused
17   and then I started answering.  So I wanted to
18   make sure.
19               As far as there were people
20   available to her if she needed help, it sounds
21   from reading this note like she went to put her
22   sandal on and I think it said, patient has
23   nonskid socks under sandal.  And reading that, I
24   would think from having worn these when I have
25   been a patient that probably the nonskid part
0052
 1   didn't slide down her sandal and she fell.
 2         Q.    Do you know who allowed her to put a
 3   sandal on?
 4         A.    I was gone and there is nothing in
 5   the note to tell me.
 6         Q.    Would you expect that it would be
 7   somebody's responsibility to advise the patient
 8   not to put a sandal on over a nonskid sock?
 9               MR. MAZGAJ:  Objection.
10         A.    No.  I would say most people would
11   wear their nonskid socks with a sandal.  Once
12   the sandal is on, it sounds like as she was
13   putting it on it caught.  I'm making a
14   supposition if what I'm saying is true or not,
15   but I see people put those socks under shoes and
16   go home with them.  Usually the emergency
17   department is either 30 degrees or 100 degrees
18   and probably her feet were cold and that's the
19   reason to wear the socks.
20         Q.    So you wouldn't be critical of the
21   patient for putting a sandal on over the nonskid
22   socks; true?
23         A.    No, I have no criticism of the
24   patient.
25         Q.    And as far as whether or not the
0053
 1   patient was appropriately assisted at the time
 2   or needed assistance at the time that she was
 3   putting the sandal on so as to prevent the fall,
 4   do you know whether she was appropriately or
 5   inappropriately assisted by any nursing staff at
 6   the time?
 7               MR. MAZGAJ:  I'll object to the
 8   first part of your question.  You said
 9   appropriate or needed and then left out needed
10   in the second part.  Objection.
11         A.    Can you rephrase the question?
12         Q.    Do you have any basis to say whether
13   or not the patient was appropriately or
14   inappropriately assisted at the point in time
15   immediately before she was permitted to fall and
16   break her leg?
17               MR. MAZGAJ:  Objection.
18               MR. SCHOBERT:  Objection to the form
19   of the question.  Go ahead.
20         A.    I would say the word permitted, I
21   would disagree with.
22               So in answering the question,
23   personnel were available.  The word permitted --
24   sometimes accidents happen, and as near as I can
25   tell, her sock caught and she fell.  It would
0054
 1   sound from this like it probably happened very
 2   quickly and may have just been something that
 3   even if you are doing everything appropriately,
 4   accidents happen.
 5         Q.    Let me rephrase it.  Do you know in
 6   this case whether or not she was appropriately
 7   or inappropriately assisted at the time that she
 8   was getting dressed?
 9               MR. MAZGAJ:  Objection.
10               MR. SCHOBERT:  Objection.  Go ahead
11   and answer the question.
12         A.    I wasn't there and there is not
13   enough in the record that I'm able to read here
14   to determine that.  I have no reason to think
15   with people standing there available that it was
16   not appropriate.
17         Q.    You have no way to say one way or
18   another; is that a fair statement?
19               MR. SCHOBERT:  Objection.
20         A.    The information I have sounds like
21   everything that we normally do was done is a
22   fair statement.  As far as the particulars, I
23   don't have a way to know.
24               MR. MISHKIND: Fair enough.  Doctor,
25   I'm done.  Thanks.
0055
 1         EXAMINATION OF HUGH A. SCHUCKMAN, M.D.
 2   BY MR. MAZGAJ:
 3         Q.    Doctor, I have a couple questions.
 4   I would ask you to go to page 6 that you have in
 5   front of you.
 6               Doctor, at 1530, it has there
 7   waiting for ride.  Do you see that?
 8         A.    1530, yes.
 9         Q.    And if I'm reading that correctly,
10   if the plaintiff had had a family member there
11   or a ride available to her, you would've allowed
12   her, or the physician who was on call at that
13   time, which I think was still you, would've
14   permitted her to go home at that time; correct?
15         A.    Yes.
16         Q.    And it looks like, doctor, she
17   remained in the emergency room for another hour
18   and 20 minutes; is that correct?
19         A.    Yes.
20         Q.    And doctor, given your understanding
21   of the emergency room configuration, it would
22   not be unusual for nurses or other emergency
23   room personnel to be walking past her or to be
24   checking on her during that hour and 20 minutes;
25   is that correct?
0056
 1               MR. MISHKIND:  Objection.  Go ahead.
 2         A.    The configuration is such that her
 3   bed was the first bed.  When anybody came into
 4   the emergency department, they would go past.
 5   And Sue Pearch was on side two, which means she
 6   would be dealing with four patients which would
 7   be as close as you and I are sitting right now
 8   and Mr. Mishkind is sitting and the other end of
 9   the table.  So the beds are all -- she would be
10   taking care of four beds that were within 20
11   feet of each other.
12         Q.    And doctor, if the plaintiff had any
13   concerns that she wanted to express or that she
14   did express to any of the nursing staff or other
15   staff regarding her condition and so forth, if
16   there were problems, would you have expected
17   that that would have been noted between 1530 and
18   1650?
19               MR. MISHKIND:  Objection.
20         A.    Yes, it would have been noted.
21         Q.    Now, doctor, she was administered
22   the morphine at 3 p.m.; is that correct?
23         A.    Yes.
24         Q.    And again, if you could explain for
25   us, why is it that you would not have given the
0057
 1   Kenalog if there were any adverse reactions to
 2   the morphine? Did I say that correctly?
 3         A.    Correct.  When I assessed her, it's
 4   not that I wouldn't have given her the Kenalog,
 5   I would've wanted to get the pain better to give
 6   a good exam.  But I wouldn't have done
 7   home-going instructions on her until I felt that
 8   she was alert enough to understand what I was
 9   saying.
10               And some people get morphine and
11   they get a lot drowsier than other people and
12   that's the reason when I work with any of the
13   physician assistants, I normally let them do the
14   initial assessment.  And for the majority of
15   patients, unless there is an ankle sprain or
16   something very simple, I end up doing the
17   home-going and the reassessments.
18         Q.    And doctor, if she was having what
19   you believe to be any type of adverse reactions
20   to the morphine, would you have signed the
21   home-going instructions?
22               MR. MISHKIND:  Objection.
23         A.    If she were so groggy or had
24   respiratory depression or if she looked like she
25   couldn't move around in the bed well enough to
0058
 1   be comfortable and still take care of herself
 2   and I didn't think she had somebody that could
 3   take care of her at home, I wouldn't have
 4   discharged her.
 5               MR. MAZGAJ:  Those are all the
 6   questions I have.  Thank you, doctor.
 7         EXAMINATION OF HUGH A. SCHUCKMAN, M.D.
 8   BY MR. MISHKIND:
 9         Q.    A positive dip stick, she would've
10   had a UTI?
11         A.    Yes.
12         Q.    Did the UTI in any way contribute to
13   any of her symptoms, her pain symptoms?
14         A.    On the assessment, I don't think so.
15   I think it was asymptomatic pyuria, which for a
16   diabetic will happen sometimes.
17         Q.    So this was sort of an incidental
18   finding of no clinical significance in this
19   case?
20         A.    An incidental finding which
21   clinically I felt needed to be treated but I
22   didn't think was the cause of her pain going
23   down her leg.
24         Q.    Now, after 1530 when she is waiting
25   for a ride, can we agree that there are no
0059
 1   entries over the next hour and 20 minutes by any
 2   nurses, physicians, physician assistants as to
 3   the patient's vital signs or level of pain while
 4   she was waiting for clothes to be brought?
 5               MR. SCHOBERT:  On this page you are
 6   asking?
 7               MR. MISHKIND:  Anywhere between 1530
 8   and 1650.   I'm sorry, I apologize.  Go ahead.
 9         Q.    Can we agree?
10         A.    You are so affable.
11         Q.    We try to be.
12         A.    Actually, you succeed.
13               My statement on this since I have to
14   tell the truth would be if there were a note in
15   here other than what's here and there wasn't
16   anything wrong, I would think it was probably
17   done by a student nurse, because normally a
18   nurse is not going to note that in the emergency
19   department.
20               From there, until she is doing
21   something with her, if she is making notes like
22   that, then she didn't have enough -- I didn't
23   write enough orders for her to have things to
24   do.
25         Q.    She was still operating under the
0060
 1   half life of the morphine at that particular
 2   point; correct?
 3         A.    Yes, but she was in bed and unless
 4   she had -- if she was going to get respiratory
 5   depression, typically she is going to get it in
 6   the first 30 minutes.
 7         Q.    What about any grogginess or any
 8   motor drowsiness or any confusion, aside from
 9   respiratory depression, would you expect that
10   that would be exhibited during the half life of
11   the morphine?
12         A.    I would expect if your pain is ten
13   out of ten, you would want to sleep.  And I
14   would think that that would be a side effect
15   that we had hoped for so she could get some
16   rest.
17         Q.    And then the first physical
18   manifestation that one would see if she was
19   resting, waiting for clothes -- strike that.
20               One would want to observe the
21   patient after the clothes arrived to see how she
22   is able to sit up; correct?
23         A.    Yes.
24         Q.    How she is able to put her clothes
25   on; correct?
0061
 1         A.    Yes.
 2         Q.    And because she was going to be
 3   discharged by wheelchair, to keep a close eye on
 4   how she swings her legs off the gurney and
 5   prepares to stand on the floor; correct?
 6               MR. MAZGAJ:  Objection.
 7         A.    There is so many details in there
 8   that I would say Sue Pearch would make an
 9   assessment of her.  As far as the details you
10   are going through, she would make the initial
11   assessment with how she was getting dressed and
12   then they would, she or whoever was there, would
13   be assessing her to make sure she was steady on
14   her feet.
15         Q.    That's an important thing to do; to
16   assess whether or not a patient is steady on
17   their feet, given the treatment and the pain
18   level that the patient had; is that an accurate
19   statement?
20               MR. SCHOBERT:  Objection.
21         A.    Assessing her if she is getting up
22   to be sure she can take care of herself would be
23   what would be required.
24         Q.    Fair enough.  Last question for you,
25   and I think I know the answer, but the reason
0062
 1   the patient didn't have any clothes with her, it
 2   appears because she was brought by ambulance and
 3   was being discharged in a private vehicle that
 4   someone had to go get clothes for her?
 5         A.    Yes.
 6         Q.    Is that an unusual phenomenon that a
 7   patient is brought in by ambulance, is ready to
 8   be discharged but has to remain in the emergency
 9   room until they have appropriate outer clothing
10   to go home?
11         A.    Waiting for clothes and rides occurs
12   many times a day in the emergency department.  I
13   would say somebody coming in by ambulance and is
14   discharged home, that's more the rule than the
15   exception.
16         Q.    But the patient would've still been
17   in an examining room under examination or under
18   observation over that next hour and 20 minutes
19   while she was waiting for her clothes as opposed
20   to sitting out in the waiting room?
21         A.    Yes.
22               MR. MISHKIND: Okay.  Thanks, doctor.
23   Nothing further.
24         EXAMINATION OF HUGH A. SCHUCKMAN, M.D.
25   BY MR. MAZGAJ:
0063
 1         Q.    Doctor, briefly, at page 6, 1505,
 2   the patient was taken to the rest room?
 3         A.    Yes.
 4         Q.    Do you know if Susan Pearch was the
 5   one that took her to the rest room?
 6         A.    No.
 7         Q.    Do you know what observations, if
 8   any, if Susan Pearch was the person that took
 9   her to the rest room, she made concerning the
10   plaintiff's ability to get out of the
11   wheelchair, go into the rest room on her own,
12   that type of thing?
13         A.    I wouldn't have any of that
14   information.
15         Q.    Given your understanding of the
16   plaintiff's condition, would you have any
17   criticism of Ms. Pearch allowing the plaintiff
18   to go to the rest room and Ms. Pearch being with
19   her at 1505?
20               MR. MISHKIND:  Objection.
21         A.    No.
22               MR. MAZGAJ: That's all I have.
23   Thank you.
24     EXAMINATION OF HUGH A. SCHUCKMAN, M.D.
25   BY MR. MISHKIND:
0064
 1         Q.    One more question.  If there was any
 2   difficulty encountered in going to the bathroom
 3   that was brought to the nurse's attention, would
 4   you expect that a reasonable and prudent nurse
 5   would note that in the record?
 6               MR. SCHOBERT:  I'm going to object,
 7   but go ahead.
 8         A.    Yes.
 9         Q.    And would that be something that a
10   reasonable and prudent nurse should bring to a
11   physician's attention?
12               MR. MAZGAJ:  Objection.
13         A.    Depending on the severity of what
14   the problem was.
15               MR. MISHKIND: Thanks.  Nothing
16   further.
17               MR. SCHOBERT:  You are done.
18   Indicate you want to read.
19                      - - - - -
20          (Deposition concluded at 11:40 a.m.)
21                 (Signature not waived.)
22                      - - - - -
23   
24   
25   
0065
 1                       AFFIDAVIT
 2         I have read the foregoing transcript from
 3   page 1 through 64 and note the following
 4   corrections:
 5   PAGE  LINE     REQUESTED CHANGE
 6   
 7   
 8   
 9   
10   
11   
12   
13   
14   
15   
16   
17   
18   
19   
20                  HUGH A. SCHUCKMAN, M.D.
21   
22         Subscribed and sworn to before me this
     day of          , 2008.
23   
     Notary Public
24   My commission expires            .
25   
0066
 1                     CERTIFICATE
 2   State of Ohio,
                        SS:
 3   County of Cuyahoga.
 4   
           I, Vivian L. Gordon, a Notary Public
 5   within and for the State of Ohio, duly
     commissioned and qualified, do hereby certify
 6   that the within named HUGH A. SCHUCKMAN, M.D.
     was by me first duly sworn to testify to the
 7   truth, the whole truth and nothing but the truth
     in the cause aforesaid; that the testimony as
 8   above set forth was by me reduced to stenotypy,
     afterwards transcribed, and that the foregoing
 9   is a true and correct transcription of the
     testimony.
10   
           I do further certify that this deposition
11   was taken at the time and place specified and
     was completed without adjournment; that I am not
12   a relative or attorney for either party or
     otherwise interested in the event of this
13   action.  I am not, nor is the court reporting
     firm with which I am affiliated, under a
14   contract as defined in Civil Rule 28(D).
15         IN WITNESS WHEREOF, I have hereunto set my
     hand and affixed my seal of office at Cleveland,
16   Ohio, on this 9th day of July, 2008.
17   
18   
19   
                     Vivian L. Gordon, Notary Public
20                   Within and for the State of Ohio
21   My commission expires June 8, 2009.
22   
23   
24   
25   
0067
 1                       INDEX
 2         EXAMINATION OF HUGH A. SCHUCKMAN, M.D.
 3   
 4     BY MR. MISHKIND:              3        7
 5     BY MR. MAZGAJ:                55       2
 6     BY MR. MISHKIND:              58       8
 7     BY MR. MAZGAJ:                62       25
 8     BY MR. MISHKIND:              63       25
 9   
10                       EXHIBITS
11   
12     Exhibit 1 was marked          6        10
13   
14   
15   
16   
17   
18   
19   
20   
21   
22   
23   
24   
25