posted by admin on Mar 10
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1 Q. Okay. You mentioned earlier that since, I
2 think, ‘88 physicians have the option to use an
3 electronic fetal monitor or to auscultate every 15
4 minutes even in high-risk patients; is that correct?
5 A. Yes, that’s correct.
6 Q. Assume hypothetically a physician chooses
7 Option A, to use electronic fetal monitoring. Does a
8 nurse — is a nurse allowed under the applicable
9 standard of care to look at that monitor once every 15
10 minutes as if she was auscultating?
11 A. If a patient is in labor, that is — that
12 is true — as if she was auscultating. That’s how the
13 standard is written.
14 Q. Okay. When this parent, Ms. K., was
15 admitted to V.University Medical Center, were
16 you at all involved in her treatment?
17 A. No, I was not. It was one of my partners.
18 Q. Thomas Wheeler?
19 A. Correct.
20 Q. Did you discuss this case with Dr. Wheeler
21 when Ms. K. was an inpatient?
22 A. No, I did not.
23 Q. Did you know of her when she was an
24 inpatient?
25 A. No, I did not.
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1 Q. When did you first learn that your partner
2 treated Ms. K.?
3 A. When the medical records were sent to me, I
4 saw that Dr. D. had called Dr. Wheeler for transfer
5 so the mother could be with the baby. That was the
6 first time.
7 Q. Okay. And, of course, you’ve never
8 discussed this case with Dr. Wheeler; correct?
9 A. Correct.
10 Q. If hypothetically I had sent you a case
11 where I was suing Dr. D. — say even in another
12 case –
13 A. Uh-huh.
14 Q. – would you be willing to review the
15 records and give me an objective opinion about the
16 case?
17 A. No.
18 Q. Why not?
19 A. Well, you live in Israel. I mean, it’s so
20 far away — no.
21 I have made it a policy, Mr. Gershon, that
22 I do not take plaintiff cases for physicians who refer
23 to Vanderbilt. Because of my unique position here as
24 Director of Maternal-Fetal Medicine representing
25 Vanderbilt, I find it difficult to testify against
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1 physicians who call me up on the phone and tell me
2 exactly what’s going on and then send their patients to
3 me for management or consultation.
4 I think it’s — it would impede transfer of
5 these patients to us. It would set up a situation that
6 was very controversial or contentious. And I don’t
7 think it’s good politics, and I don’t think it helps
8 patients.
9 My job is to educate these doctors. If
10 they want to admit that they may have done something
11 wrong or they ask if they could have done something
12 differently and they speak openly and honestly with me,
13 I don’t want them ever to think that I will turn around
14 and use that against them.
15 So as a policy ever since I started
16 reviewing cases for lawyers since 1981, I have not
17 taken cases that fall into my catchment area, which is
18 the state of A., northern Alabama, and southern
19 K.. And …and Dr. D. are in that
20 catchment area.
21 Q. You would agree that a physician, when they
22 serve as a medical expert, needs to be completely
23 objective?
24 A. Oh, absolutely.
25 Q. Do you believe that you can be completely
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1 objective and unbiased when you review a case on behalf
2 of a physician that you have a professional
3 relationship with such as Dr. D.?
4 A. Sure. And I have done that and talked to
5 many attorneys and said that I would be unable to help
6 even though these were colleagues of mine or even in
7 some instances — well, colleagues — colleagues that I
8 work with side by side.
9 I have told attorneys that I cannot help
10 them if they have a significant problem. I feel like I
11 can be very objective.
12 Q. Would you agree with me, sir, that when you
13 have a relationship established with a health care
14 provider that, if nothing else, you’re gonna give the
15 health care provider the benefit of a doubt?
16 A. Well, I think I have written in a paper –
17 and maybe this is where you get the words — that when
18 there’s dispute that the patient says one thing
19 happened, the doctor says the other, or the nurse says
20 the other, if it — if it is consistent with what I
21 would expect the health care provider to do under
22 similar circumstances, I’ll give the health care
23 provider the doubt — the benefit of the doubt.
24 But as far as any other circumstance, I
25 don’t give anybody the benefit of the doubt and assume
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1 that just because I have a collegial relationship that
2 I’m gonna say something that is dishonest or
3 misrepresents the case just for the defense. I don’t
4 feel that’s my job, and it’s something that I work very
5 hard at not doing.
6 Q. Do you believe the nurses at V.are
7 trained to call you or not to call you as you believe
8 the standard of care existed in this particular case
9 for the nurses when to call Dr. D. or when not to?
10 A. I think the nurses here at Vanderbilt
11 represent a little bit of a different group of nurses
12 inasmuch as they’ve got chief residents and an
13 attending in the hospital constantly, and sometimes
14 they’ll run it by another physician before they call
15 me. So in that sense it’s a little different.
16 But assuming that it’s — that there are no
17 differences in who’s at the hospital, I think when the
18 nurses called Dr. D. they were calling at the
19 appropriate time. While I would have no problem if
20 they wanted to call earlier, that would have been fine
21 too. But I think as far as standard of care at
22 V.or at …that they acted
23 appropriately.
24 Q. Does your hospital have policies and
25 procedures on when nurses should call the doctor, when
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1 they shouldn’t call the doctor, that would be
2 consistent with your testimony today?
3 A. You know, I haven’t looked at our policies
4 and protocols in a long time. It might. I have
5 forgotten exactly the wording. So I have to plead that
6 I haven’t read it in such a long time that I don’t know
7 exactly how it’s worded. Certainly –
8 Q. Were you involved in the formulation of the
9 policies of when nurses should and shouldn’t call
10 doctors at your hospital?
11 A. Inasmuch as the nurses that run labor and
12 delivery will write them down. We have nurse
13 practitioners and others that spend a considerable
14 amount of time doing this. And then they give them to
15 me, and then I read them and approve them. I didn’t
16 actually write them. I may have changed a few
17 sentences or added or deleted a few things and then
18 eventually signed off on them.
19 I just, as we sit here, can’t cite line and
20 verse to answer that question.
21 Q. Okay. How difficult would it be for you to
22 obtain the policies and procedures for nurses, when
23 they should call doctors, that existed in your
24 institution that you approved, say, in 1996 when this
25 case was going on?
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1 A. Yeah, I probably could get that.
2 Q. Well, I’d ask you to please forward that to
3 Mr. R., as quickly as you could, and he’ll
4 hopefully send me a copy. Would that be okay?
5 A. Yes, it would.
6 MR. R.: That’s fine.
7 BY MR. GERSHON:
8 Q. Sir, is there anything else about standard
9 of care for the nurses that you intend to render
10 opinions about that I haven’t covered?
11 A. I don’t believe so.
12 Q. Are there any other areas that you’re going
13 to be defending the hospital in that we haven’t touched
14 upon?
15 A. I don’t believe so.
16 Q. Okay. I thank you very much for your time.
17 I don’t have any other questions.
18 THE WITNESS: Thank you.
19 MR. R.: Thanks.
20 (Proceedings adjourned at
21 1:15 p.m.)
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1 REPORTER’S CERTIFICATE
2 STATE OF A. )
3 COUNTY OF DAVIDSON )
4 I, Patricia W. Smith, Registered
5 Professional Reporter, with offices in N.,
6 A., hereby certify that I reported the foregoing
7 proceedings at the time and place set forth in the
8 caption thereof; that the proceedings were
9 stenographically reported by me; and that the foregoing
10 proceedings constitute a true and correct transcript of
11 said proceedings to the best of my ability.
12 I FURTHER CERTIFY that I am not
13 related to any of the parties named herein, nor their
14 counsel, and have no interest, financial or otherwise,
15 in the outcome or events of this action.
16 IN WITNESS WHEREOF, I have hereunto
17 affixed my official signature and seal of office this
18 12th day of March, 1999.
19
20
21
PATRICIA W. SMITH,
22 REGISTERED PROFESSIONAL REPORTER
AND NOTARY PUBLIC FOR THE STATE
23 OF A. AT LARGE
24 My Commission Expires:
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