Prosecution Opening Statement

6             THE COURT:  SO, MS. BARLOW, IF YOU WISH TO GIVE
       7    YOUR OPENING STATEMENT.
       8             MS. BARLOW:  THANK YOU, YOUR HONOR.
       9         MAY IT PLEASE THE COURT, LADIES AND GENTLEMEN OF THE
      10    JURY.  ON BEHALF OF THE STATE OF UTAH, I WOULD LIKE TO THANK
      11    YOU FOR YOUR WILLINGNESS TO SERVE HERE TODAY.  AS INDICATED,
      12    I THINK THAT WE'VE ALL INTRODUCED OURSELVES DURING THE
      13    COURSE OF JURY SELECTION BUT I WOULD LIKE TO REINTRODUCE THE
      14    TEAM, AS IT WERE, FOR THE STATE HERE.  MEL WILSON IS SEATED
      15    OVER HERE, HE'S THE DAVIS COUNTY ATTORNEY AND HE IS LEAD
      16    COUNSEL IN THIS MATTER FOR THE STATE.  MY NAME IS CHARLENE
      17    BARLOW, I'M ASSISTING.  STEVE MAJOR IS A DEPUTY COUNTY
      18    ATTORNEY WHO IS ALSO ASSISTING MR. WILSON IN THIS CASE.
      19         I WANT TO THANK YOU FOR BEING HERE.  IT IS PART OF THE
      20    BEAUTY OF OUR CONSTITUTIONAL SYSTEM THAT WE HAVE THIS
      21    SYSTEM.  YOU -- I MEAN, PROBABLY NONE OF US THOUGHT THIS IS
      22    THE WAY WE WOULD BE SPENDING THE FIRST PART OF OUR SUMMER,
      23    BUT THIS IS A CONSTITUTIONAL RIGHT THAT IS PROVIDED FOR A
      24    TRIAL BY JURY AND A SPEEDY TRIAL BY JURY.  AND SO WE'RE
      25    GOING TO TRY AND KEEP THIS WITH ALL DELIBERATE SPEED MOVING


                                                                       11



       1    ALONG SO THAT YOU CAN HEAR THE EVIDENCE THAT COMES IN SO
       2    THAT YOU CAN UNDERSTAND WHAT HAS HAPPENED IN THIS MATTER.
       3         YOU'LL SEE THAT THERE ARE ATTORNEYS ON BOTH SIDES.
       4    YOU'LL SEE THERE ARE A NUMBER OF ATTORNEYS ON BOTH SIDES.
       5    THIS IS A VERY SERIOUS CASE.  WE ARE TALKING ABOUT CHARGES
       6    OF HOMICIDE.  NOBODY TAKES THOSE CHARGES LIGHTLY ON EITHER
       7    SIDE.  THIS WAS AN EXTENSIVE CASE.  THERE ARE FIVE VICTIMS
       8    IN THIS MATTER.  THERE WAS AN EXTENSIVE INVESTIGATION.
       9    THERE WILL BE MANY WITNESSES THAT YOU WILL SEE OVER THE
      10    COURSE OF THE NEXT FEW WEEKS.  AND BECAUSE OF THAT,
      11    SOMETIMES YOU MAY SEE ONE OR THE OTHER OF THE ATTORNEYS THAT
      12    ARE NOT HERE AND YOU MIGHT BE, WELL, WHERE ARE THEY?  I'M
      13    SITTING HERE, WHY AREN'T THEY SITTING HERE?  BUT IN ORDER TO
      14    KEEP THE CASE MOVING SMOOTHLY AND TO MAKE SURE THE WITNESSES
      15    ARE AVAILABLE AND HERE AND EVERYTHING CAN KEEP MOVING
      16    SMOOTHLY, THERE ARE TIMES WHEN MAYBE ONE OR THE OTHER OF US
      17    MAY NOT BE HERE, BUT REST ASSURED WE WILL BE WORKING ON THE
      18    CASE.
      19         YOU MAY HAVE WONDERED AS YOU READ THE JURY
      20    QUESTIONNAIRE THAT YOU FILLED OUT, YOU KNOW, WHAT IS THIS
      21    CASE ABOUT?  AND SOME OF THE QUESTIONS MIGHT MAKE YOU THINK,
      22    WELL, YOU KNOW, MAYBE IT'S ABOUT THIS OR MAYBE IT'S ABOUT
      23    THAT.  I WANT TO TELL YOU A FEW THINGS THAT MIGHT HAVE BEEN
      24    RAISED IN THE JURY QUESTIONNAIRE IN YOUR MIND THAT IT'S NOT
      25    ABOUT.


                                                                       12



       1         THIS IS NOT A CASE ABOUT ASSISTED SUICIDE.  THIS IS NOT
       2    A MATTER OF ANYONE COMING TO THE DEFENDANT AND SAYING I
       3    DON'T LIKE MY LIFE ANYMORE, WOULD YOU PLEASE HELP ME END IT.
       4    THERE'S NO EVIDENCE OF THAT.  SO PLEASE SET ASIDE ANY
       5    THOUGHT OF IS THIS AN ASSISTED SUICIDE CASE.  IT IS NOT.
       6         IT'S NOT A CASE ABOUT MERCY KILLING, EITHER.  MERCY
       7    KILLING IS THE IMPRESSION OF, YOU KNOW, THIS POOR PERSON'S
       8    LIFE IS NOT GOOD, I FEEL SORRY FOR THEM, I WILL HELP THEM
       9    LEAVE THIS LIFE BECAUSE THEIR LIFE IS SO UNHAPPY OR
      10    UNPLEASANT, THEIR QUALITY OF LIFE IS SO POOR.  THAT PRESUMES
      11    AN ATTITUDE ON THE PART OF THE PERSON HELPING OF BEING
      12    MERCIFUL, AND I THINK OUR EVIDENCE IS GOING TO SHOW YOU THAT
      13    ATTITUDE IS NOT PRESENT IN THIS CASE.
      14         IT IS A CASE ABOUT EUTHANASIA.  IT IS A CASE ABOUT
      15    HASTENING DEATH.  EUTHANASIA IS NOT LAWFUL IN THE STATE OF
      16    UTAH.  SOMEONE'S LIFE MAY BE VERY POOR QUALITY, SOMEONE MAY
      17    BE DEMENTED, SOMEONE MAY BE IN A LOT OF PROBLEMS AND A LOT
      18    OF TROUBLE AND MAY NOT BE HAPPY WITH THEIR LIFE OR MAY NOT
      19    EVEN BE AWARE OF WHAT THEIR LIFE IS, BUT THE LAW DOES NOT
      20    ALLOW ANYONE TO TAKE THEIR LIFE, NO MATTER HOW POOR THE
      21    QUALITY OF LIFE MAY BE.  AND I'M NOT SAYING THAT THE QUALITY
      22    OF LIFE IN THESE PEOPLE WAS THAT POOR.  BUT I WANT TO LET
      23    YOU KNOW THE STATE DOES NOT ALLOW ANYONE TO TAKE SOMEONE
      24    ELSE'S LIFE JUST BECAUSE THEIR QUALITY OF LIFE IS NOT WHAT
      25    SOMEONE ELSE THINKS IT OUGHT TO BE.


                                                                       13



       1         EVIDENCE IS GOING TO COME IN WITNESS BY WITNESS.  WE
       2    HAVE TELEVISION MONITORS HERE.  YOU WON'T BE WATCHING THE
       3    SHOW.  YOU WON'T BE WATCHING, YOU KNOW, SOMETHING THAT'S
       4    GOING TO BE WRAPPED UP IN A HALF OR OUR HOUR LONG OR EVEN A
       5    TWO-HOUR MOVIE.  YOU WON'T BE WATCHING SOMETHING WHERE YOU
       6    CAN PICTURE HOW THINGS HAPPEN BECAUSE THAT'S THE WAY THEY
       7    SHOW IT ON TV.  YOU ARE GOING TO BE HEARING WHAT HAPPENED
       8    WITNESS BY WITNESS.  WE'RE GOING TO DO OUR BEST TO MAKE IT A
       9    VERY LOGICAL PROGRESSION WITH THE WITNESSES, BUT, YOU KNOW,
      10    ONE PERSON WILL SEE THIS PART OF IT BUT THEY WON'T SEE
      11    ANOTHER PART OF IT, SO ANOTHER WITNESS WILL COME IN AND SAY
      12    I SAW THIS OTHER PART OF IT.  SO YOU'RE GOING TO HAVE TO
      13    LISTEN CAREFULLY AND NOT FORM ANY OPINION BUT TO LISTEN
      14    CAREFULLY ALL THE WAY THROUGH AND SAY, OKAY, THIS WITNESS
      15    TOLD ME THIS, THIS WITNESS TOLD ME THAT.  BUT THAT'S THE WAY
      16    IT'S GOING TO COME TOGETHER.  AND, AGAIN, WE'RE GOING TO TRY
      17    TO MAKE IT JUST AS LOGICAL AS POSSIBLE SO, YOU KNOW, WE HAVE
      18    A PROGRESSION THERE AND IT MAKES SENSE TO YOU AS WE'RE GOING
      19    FORWARD.
      20         YOU WILL HEAR FROM EXPERT WITNESSES.  YOU WILL HEAR
      21    FROM DOCTORS AND NURSES WHO WERE NOT INVOLVED IN THIS CASE
      22    OTHER THAN AS WHAT'S CALLED AN EXPERT WITNESS.  THEY HAVE
      23    BEEN GIVEN INFORMATION, THEY HAVE LOOKED AT THAT
      24    INFORMATION, THEY HAVE FORMULATED CERTAIN OPINIONS ABOUT
      25    WHAT HAPPENED IN THIS MATTER WHICH THEY WILL GIVE TO YOU AND


                                                                       14



       1    THEN YOU WILL MAKE THE FINAL DETERMINATION.  I MEAN, WE'RE
       2    ALL HERE -- YOU KNOW, THE JUDGE HAS HIS ROLE, WE HAVE OUR
       3    ROLE, DEFENSE HAS THEIR ROLE.  YOU HAVE THE MOST IMPORTANT
       4    ROLE IN THIS MATTER AND THAT IS TO DECIDE WHERE THE TRUTH
       5    LIES, WHETHER THE DEFENDANT IS GUILTY OR NOT.  AND PART OF
       6    THAT, PART OF WHAT YOU WILL NEED TO DECIDE IS WHAT MENTAL
       7    STATE DID THE DEFENDANT HAVE WHEN HE DID THE THINGS THAT HE
       8    DID.
       9         YOU WILL GET INSTRUCTIONS FROM THE COURT ON THIS AND
      10    THEY WILL EXPLAIN TO YOU WHAT MENTAL STATE MEANS.  I THINK
      11    WE ALL UNDERSTAND WHAT A MENTAL STATE IS.  IN THE LAW IT'S
      12    CALLED A CULPABLE STATE.  IT'S A MENTAL STATE OF, YOU KNOW,
      13    YOU KIND OF KNOW WHAT YOU ARE DOING.  THESE CHARGES ARE
      14    BASED ON THREE POSSIBLE MENTAL STATES AND YOU WILL BE THE
      15    ONES TO DECIDE WHETHER ANY OR ALL OF THESE MEET THE MENTAL
      16    STATES FIT IN THIS CIRCUMSTANCE.
      17         THE FIRST IS INTENT AND THE JURY INSTRUCTION WILL TELL
      18    YOU WITH MUCH MORE SPECIFICITY BUT INTENT IS DEFINED AS A
      19    CONSCIOUS OBJECTIVE TO DO THE CONDUCT OR CAUSE THE RESULT.
      20    SO THAT IS ONE OF THE MENTAL STATES WE'LL BE PRESENTING TO
      21    YOU.
      22         ANOTHER MENTAL STATE THAT -- AND IF YOU DON'T THINK
      23    IT'S INTENTIONAL, YOU MIGHT FIND THAT IT'S KNOWING, AND
      24    KNOWINGLY IS BEING DEFINED AS BEING AWARE THAT THE CONDUCT
      25    IS REASONABLY CERTAIN TO CAUSE A PARTICULAR RESULT.  SO


                                                                       15



       1    WE'LL ASK YOU TO LOOK AND SEE IF THERE'S EVIDENCE THAT
       2    PERHAPS THIS CONDUCT WAS DONE KNOWINGLY.
       3         AND FINALLY, THERE IS THE THIRD MENTAL STATE AND THAT
       4    IS CALLED DEPRAVED INDIFFERENCE, LEGAL TERMS.  BUT AS
       5    DEFINED IT'S THE DEFENDANT DOES CERTAIN CONDUCT CREATED
       6    TO -- EXCUSE ME -- CONDUCT THAT CREATES A GRAVE RISK OF
       7    DEATH AND THEN DOES CAUSE THE DEATH BY THAT CONDUCT.
       8         AGAIN, I'M JUST GIVING YOU AN OVERVIEW OF THAT.  IN
       9    FACT, I'LL BE JUST GIVING YOU AN OVERVIEW OF EVIDENCE TODAY.
      10    I'M NOT GOING TO HIT ON EVERY PIECE OF EVIDENCE YOU'RE GOING
      11    TO HEAR IN THE NEXT SEVERAL WEEKS, YOU KNOW.  I CLEARLY
      12    COULDN'T DO THAT.  BUT IN ORDER TO GIVE YOU AN OVERVIEW OF
      13    WHAT WE'RE LOOKING AT HERE, WE'RE LOOKING AT THE DEATHS OF
      14    FIVE PEOPLE AND WE'RE LOOKING AT CERTAIN MENTAL STATES ON
      15    BEHALF OF THE DEFENDANT AS THESE DEATHS WERE CAUSED.
      16         THESE HAPPENED AT DAVIS NORTH HOSPITAL IN WHAT IS
      17    CALLED THE GEROPSYCH UNIT, THE GEROPSYCHIATRIC UNIT.  GERO
      18    IS FROM THE ROOT OF GERIATRIC DEALING WITH ELDERLY PEOPLE.
      19    PSYCHIATRIC, WE KNOW WHAT THAT IS.  THE PURPOSE OF THE
      20    GEROPSYCH UNIT -- IT WAS SET UP I GUESS IT WAS MID 1994 AND
      21    YOU'LL HEAR EVIDENCE THAT, YOU KNOW, THERE WASN'T A
      22    GEROPSYCH UNIT IN THE SURROUNDING STATES AND SO THERE WAS A
      23    DECISION TO CREATE A GEROPSYCH UNIT AND IT WAS DONE THERE IN
      24    DAVIS HOSPITAL.
      25         YOU'LL HEAR THAT THERE'S KIND OF A DIVISION OF


                                                                       16



       1    RESPONSIBILITIES AS IT WERE.  THE HOSPITAL HIRED THE NURSES
       2    AND CONTROLLED THE NURSES.  THE GEROPSYCH UNIT WAS MANAGED
       3    BY A PSYCHIATRIST WHO WAS HIRED BY A COMPANY CALLED HORIZON.
       4    AND HORIZON EVIDENTLY HAS SET UP THESE UNITS IN OTHER AREAS,
       5    CAME IN HERE SAID WE'VE GOT THIS GREAT IDEA FOR A UNIT, WE
       6    WILL HIRE THE PSYCHIATRIST, WE WILL RUN THE UNIT, MANAGE --
       7    THIS PSYCHIATRIST WILL MANAGE THE UNIT, YOU'LL PROVIDE THE
       8    NURSES AND WE'LL HAVE A UNIT THAT -- THE PURPOSE OF THIS
       9    UNIT WILL BE TO HELP ELDERLY PEOPLE WHOSE BEHAVIOR IS
      10    CAUSING SUCH PROBLEMS THAT PERHAPS THEY CAN'T STAY IN THE
      11    SETTING WHERE THEY ALREADY ARE.
      12         YOU KNOW, UNFORTUNATELY AS WE GET OLDER, OUR MEMORIES
      13    GO, YOU KNOW, TO DIFFERING DEGREES.  AND UNFORTUNATELY OUR
      14    HUMAN BODIES ARE SUCH THAT SOMETIMES THE MEMORIES GO VERY
      15    POORLY.  THIS IS CALLED DEMENTIA.  IT'S ALSO CALLED
      16    ALZHEIMERS.  YOU KNOW, WHETHER IT'S SENILE DEMENTIA OR
      17    ALZHEIMERS, THAT'S NOT REALLY THE POINT HERE.  BUT THE POINT
      18    IS WE HAVE PEOPLE THAT IN THE COURSE OF THEIR LIVES START TO
      19    LOSE THEIR RECOLLECTION, LOSE THEIR MEMORY, LOSE THEIR
      20    ABILITY TO PERFORM DAILY FUNCTION, DAILY LIVING MATTERS, YOU
      21    KNOW, AND DIFFERENT THINGS ARE DONE IN THOSE CIRCUMSTANCES.
      22    SOMETIMES PEOPLE ARE ABLE TO KEEP THEM AT HOME.  OTHER TIMES
      23    THEY ARE ABLE TO KEEP THEM AT HOME FOR A WHILE BUT THEN THEY
      24    JUST CAN'T HANDLE WHAT'S GOING ON ANY LONGER AND PUT THEM
      25    INTO A LONG-TERM CARE FACILITY.


                                                                       17



       1         DEMENTIA IS SUCH THAT IT'S A GRADUAL ONSET.  IT'S A
       2    GRADUAL DECLINING OF A PERSON'S ABILITY.  YOU'LL HEAR
       3    EXPERTS TESTIFY AS TO -- AND THEY'VE BEEN ABLE TO PRETTY
       4    MUCH CHART, YOU KNOW, IF A PERSON CAN DO THESE THINGS BUT IS
       5    KIND OF LOSING IT A LITTLE BIT, YOU KNOW.  THEY MAY HAVE
       6    ANOTHER 12, 15, 20 YEARS TO LIVE.  A PERSON AS THEY  
       7    GRADUALLY LOSE THEIR ABILITY TO FUNCTION IN -- NOT JUST IN
       8    SOCIETY BUT JUST IN DAILY LIVING AND THEY CAN CHART HOW, YOU
       9    KNOW, WHICH ABILITIES GO AT WHAT POINT UNTIL, YOU KNOW, YOU
      10    GET TO THE POINT WHERE THEY CAN NO LONGER EVEN SIT UP.  AND
      11    IF THEY CAN NO LONGER EVEN SIT UP, DEATH IS VERY IMMINENT.
      12    AND ONE OF THEM IS EVEN LOSING THE ABILITY TO SMILE, THAT'S
      13    ONE OF THE LAST THINGS TO GO IS THE ABILITY TO SMILE.  AND
      14    SO YOU HAVE DEMENTIA, BUT THAT ISN'T WHAT THE GEROPSYCH UNIT
      15    WAS FOR.  
      16         LONG-TERM CARE FACILITIES TAKE CARE OF PEOPLE WHO
      17    BECOME DEMENTED.  BUT UNFORTUNATELY WHAT HAPPENS SOMETIMES
      18    IN PEOPLE WHO ARE LOSING THEIR ABILITY TO FUNCTION THERE IS
      19    AN ACUTE -- I MEAN, THIS IS CALLED CHRONIC.  IT'S SOMETHING
      20    THAT LASTS OVER TIME.  YOU ARE NOT GOING TO BE ABLE TO CURE
      21    IT AND THAT'S WHY IT'S CALLED CHRONIC.  THAT'S A MEDICAL
      22    TERM THAT I'VE LEARNED OVER THE LAST LITTLE WHILE.
      23         BUT SOMETIMES WITH PEOPLE, EVEN THOUGH THEY HAVE THIS
      24    CHRONIC PROBLEM AND THEY ARE GRADUALLY DECLINING, SOME
      25    PEOPLE WILL HAVE AN ACUTE EVENT, AN EVENT THAT COMES


                                                                       18



       1    SUDDENLY, AN EVENT THAT IS NOT JUST THIS GRADUAL DECLINE,
       2    BUT SUDDENLY SOMETHING HAPPENS AND THEIR BEHAVIOR REALLY
       3    CHANGES AND THAT'S WHAT WE HAD WITH THESE FIVE PEOPLE.  YOU
       4    KNOW, IT MIGHT BE A HIP FRACTURE, IT MIGHT BE A FALL AND A
       5    LACERATION ON THE HEAD.  IT MIGHT BE A STROKE, YOU KNOW,
       6    THERE MIGHT BE SOME EVENT THAT TRIGGERS SOME BEHAVIOR
       7    CHANGES.  AND SO INSTEAD OF BEING ABLE TO STAY IN A
       8    LONG-TERM CARE FACILITY, WHICH BLESS THEIR HEARTS, AS MUCH
       9    AS THEY WANT TO AND AS GOOD AS THEY ARE, CANNOT GIVE A LOT
      10    OF ONE-ON-ONE.  I MEAN, THEY HAVE AS MUCH STAFF AS THEY CAN
      11    GET AND AS GOOD AS STAFF AS THEY CAN GET IN LONG-TERM CARE
      12    FACILITIES AND THEY TRY TO GIVE THE BEST CARE THAT THEY CAN,
      13    BUT THEY JUST LITERALLY CANNOT GIVE A LOT OF ONE-ON-ONE WITH
      14    PEOPLE WHO ARE LOSING THEIR ABILITY TO FUNCTION.
      15         SO THE GEROPSYCH UNIT WAS SET UP, TEN BEDS ON THIS UNIT
      16    AND THERE WOULD BE ANYWHERE FROM TWO TO THREE NURSES.  THERE
      17    WERE A LOT OF SOCIAL WORKERS, YOU KNOW, THEY WOULD DO GROUP
      18    THERAPY.  THERE WAS THE ABILITY TO HAVE A LOT MORE
      19    ONE-ON-ONE IN THIS GEROPSYCH UNIT.  SO A LONG-TERM CARE
      20    FACILITY MIGHT HAVE AN INDIVIDUAL IN THERE WHO ALL OF A
      21    SUDDEN HAS AN ACUTE EVENT, BEHAVIOR BECOMES VERY POOR, THEY
      22    ARE COMBATIVE, THEY ARE AGITATED, THEY BECOME DEPRESSED,
      23    SOMETHING HAPPENS AND THE LONG-TERM CARE FACILITY SAYS, YOU
      24    KNOW, WE'RE NOT GOING TO BE ABLE TO CONTINUE TO HELP THIS
      25    PERSON BECAUSE WE CAN'T DO AS MUCH ONE-ON-ONE AS THIS PERSON


                                                                       19



       1    NEEDS.
       2         SO THE GEROPSYCH UNIT WAS ESTABLISHED TO MOVE THESE
       3    PEOPLE INTO THAT UNIT FOR TWO TO THREE WEEKS.  IT WAS NEVER
       4    INTENDED TO BE LONG-TERM.  MOVE THEM INTO THAT UNIT WHERE
       5    THEY GET ONE-ON-ONE, THEY CAN GET GROUP THERAPY, THEIR
       6    MEDICATIONS CAN BE ADJUSTED BECAUSE YOU'LL HEAR EXPERTS WHO
       7    WILL SAY THAT THERE ARE TIMES WHEN THAT THE MEDICATION THAT
       8    THE ELDERLY ARE USING BECAUSE THEY ARE ELDERLY AND THERE'S A
       9    DIFFERENT EFFECT, YOU KNOW, BECAUSE MEDICATIONS IN THE
      10    ELDERLY BUILD UP, THEY DON'T DISSIPATE AS QUICKLY.
      11    SOMETIMES THESE MEDICATIONS CAN CAUSE THE VERY PROBLEM THAT
      12    WE WANT TO DEAL WITH, THE AGITATION.  
      13         PSYCHOTROPIC DRUGS CAN CAUSE THE AGITATION THAT THEY
      14    ARE MEANT TO CONTROL.  SO YOU HAVE SOMEONE WHO IS COMBATIVE, 
      15    WHO IS DIFFICULT TO HANDLE, PUT THEM INTO THE GEROPSYCH
      16    UNIT, ADJUST THEIR MEDICATIONS -- IN FACT, YOU KNOW, YOU'LL
      17    HEAR TESTIMONY EVEN GIVE THEM A DRUG HOLIDAY.  TAKE AWAY ALL
      18    OF THEIR MEDICATIONS TO SEE IF SOMETHING IN THEIR MEDICATION
      19    IS TRIGGERING WHAT THIS PROBLEM IS.  SO ADJUST THEIR
      20    MEDICATIONS, TRY TO ADJUST THEIR BEHAVIOR, GET -- AND IN
      21    OTHER TIMES YOU DO GIVE THEM MEDICATION TO ADJUST THE
      22    BEHAVIOR.
      23         I'M NOT SAYING THAT GIVING MEDICATIONS NECESSARILY
      24    CAUSES THE PROBLEMS.  SOMETIMES IT DOES SOLVE THE PROBLEM.
      25    BUT GET THEIR BEHAVIOR ADJUSTED SO THAT THEY CAN GO BACK TO


                                                                       20



       1    THE LONG-TERM CARE FACILITY OR BACK TO THEIR HOME AND BE
       2    SOMEONE THAT YOU CAN WORK WITH, SOMEONE THAT IS NOT GOING TO
       3    BE HITTING OR STRIKING, BITING, KICKING OR UNFORTUNATELY
       4    SOME OF THE OTHER THINGS THAT WERE GOING ON.
       5         THE GEROPSYCH UNIT WAS A TWO TO THREE-WEEK STAY.  IN
       6    FACT, YOU KNOW, THE DEFENDANT DID THE PSYCHOLOGICAL
       7    EVALUATION ON ALL FIVE PEOPLE THAT WE'RE DEALING WITH IN
       8    THIS TRIAL AND EACH TIME HE SAID HE EXPECTED THEM TO STAY
       9    TWO TO THREE WEEKS.  HE EXPECTED THEM TO GO BACK TO THE
      10    LONG-TERM CARE FACILITY WITH A CHANGE IN BEHAVIOR, A CHANGE
      11    IN MOOD.  YOU WILL SEE THAT BECAUSE RECORDS WILL BE
      12    PRESENTED TO YOU AS EVIDENCE.  THIS IS NOT A HOSPICE
      13    CIRCUMSTANCE.  
      14         NOW WHAT'S A HOSPICE?  A HOSPICE IS A MEDICAL UNIT THAT
      15    HAS COME UP OVER THE LAST FEW YEARS.  THERE ARE PEOPLE WHO,
      16    YOU KNOW, PERHAPS HAVE CANCER OR DEMENTIA THAT ARE SO CLOSE
      17    TO THE END OF THEIR LIVES THAT YOU NEED TO PUT THEM IN A
      18    CARE CIRCUMSTANCE WHERE THEY CAN BE KEPT COMFORTABLE, YOU
      19    KNOW YOU ARE NOT GOING TO MAKE THIS PERSON BETTER.  THEY MAY
      20    BE IN EXTREME PAIN.  I MEAN, OFTEN CANCER PATIENTS ARE IN
      21    HOSPICE CIRCUMSTANCES TOWARD THE END OF THEIR LIFE.  IF IT'S
      22    INCURABLE, THEY MAY BE IN EXTREME PAIN AND IN A HOSPICE
      23    SITUATION YOU ARE GIVING THEM MEDICATION TO COMFORT THEM.
      24    YOU ARE GIVING THEM MEDICATION TO ALLEVIATE THE PAIN, TO TRY
      25    TO MAKE THEIR LAST DAYS AS COMFORTABLE AS POSSIBLE.  THIS


                                                                       21



       1    UNIT WAS NOT HOSPICE.  IT WAS NOT INTENDED TO BE SOMEPLACE
       2    TO KEEP THE DYING COMFORTABLE.
       3         IT WAS NOT A MEDICAL UNIT.  IT WAS NOT A PLACE WHERE 
       4    PEOPLE WHO HAD SEVERE MEDICAL PROBLEMS THAT NEEDED ATTENTION
       5    FROM A MEDICAL DOCTOR WERE PLACED.  IT WAS A PSYCHIATRIC 
       6    UNIT, WE WANT TO WORK ON BEHAVIOR.  IF SOMEONE HAS AN ACUTE
       7    MEDICAL PROBLEM, THEY WERE NOT SUPPOSED TO BE ON THAT UNIT.
       8    THEY SHOULD HAVE BEEN IN THE HOSPITAL AND IT WAS PART OF THE
       9    HOSPITAL, THIS UNIT.  THEY SHOULD HAVE BEEN IN THE HOSPITAL
      10    TO TAKE CARE OF THAT MEDICAL PROBLEM.  IF THEY HAD A STROKE,
      11    IF THEY HAD A HEART ATTACK, PUT THEM IN THE MEDICAL UNIT
      12    WHERE THEY CAN TAKE CARE OF THAT PROBLEM.
      13         YOU'LL HEAR FROM DR. WELBY JENSEN WHO WAS THE FIRST
      14    DOCTOR TO BECOME THE DIRECTOR OF THIS UNIT.  YOU WILL HEAR
      15    FROM THE NURSES ON THE UNIT.  THE MAJORITY OF THE NURSES AND
      16    THE ONES WE'VE BEEN ABLE TO FIND, YOU WILL HEAR FROM THEM.
      17    AS I INDICATED, THE DOCTORS WHO RAN THIS UNIT WERE
      18    PSYCHIATRISTS.
      19         NOW, PSYCHOLOGISTS AND PSYCHIATRISTS, YOU KNOW, ARE
      20    TERMS YOU HEAR ALMOST USED INTERCHANGEABLY.  THEY ARE NOT
      21    THE SAME.  A PSYCHOLOGIST GETS A PH.D. IN PSYCHOLOGY.  A
      22    PSYCHIATRIST GETS A MEDICAL DEGREE JUST AS ANY OTHER DOCTOR
      23    BUT THEN SPECIALIZES IN PSYCHIATRY.  SO A PSYCHIATRIST CAN
      24    PRESCRIBE MEDICINE, A PSYCHOLOGIST CANNOT.  SO AS YOU HEAR
      25    THOSE TERMS, YOU WILL UNDERSTAND THAT, YOU KNOW, THE


                                                                       22



       1    DEFENDANT AS A PSYCHIATRIST DID HAVE A MEDICAL DEGREE,
       2    ALTHOUGH HE HAD SPECIALIZED IN PSYCHIATRY. 
       3         YOU'LL HEAR ABOUT PATIENT CARE.  CLEARLY THESE FIVE
       4    PEOPLE WHO DIED WERE NOT THE ONLY PATIENTS THAT WERE ON THIS
       5    UNIT FROM 1994 ON.  THESE ARE THE ONES WE'LL BE TALKING
       6    ABOUT BUT YOU WILL HEAR THAT THE PEOPLE WHO CAME IN, MOST
       7    BUT NOT ALL, WERE DEMENTED.  MOST BUT NOT ALL OF THESE FIVE
       8    PEOPLE WERE DEMENTED AND DEMENTIA IS A TERMINAL ILLNESS BUT
       9    IT'S NOT ONE THAT'S GOING TO TAKE YOU INTO A FEW WEEKS
      10    USUALLY, UNLESS YOU ARE AT THE VERY END OF THE DEMENTIA AND
      11    YOU CAN NO LONGER SMILE, NO LONGER SIT UP, THAT SORT OF
      12    THING.  THESE PEOPLE WERE NOT THAT DEMENTED.  THEY WERE NOT
      13    AT THE END OF THIS DEMENTIA SCALE.
      14         THE DEFENDANT WOULD GIVE THEM A PSYCHOLOGICAL
      15    EVALUATION AND ON EACH ONE OF THEM.  HE WOULD SAY TWO TO
      16    THREE WEEKS WE EXPECT THEM TO BE HERE AND THEN THEY'LL GO
      17    BACK TO THE LONG-TERM CARE CENTER WITH THEIR BEHAVIOR UNDER
      18    CONTROL.  NONE OF THESE PEOPLE WERE TERMINAL WHEN THEY CAME
      19    IN, NONE WERE HOSPICE.  THE NURSES WERE ON THE FRONT LINES
      20    IN THIS MATTER, AS YOU CAN IMAGINE.  THE NURSES ARE THE ONES
      21    WHO ARE THERE FOR THE FULL SHIFT AND MOST OF YOU KNOW HOW
      22    DOCTORS COME IN AND OUT AND THAT'S, YOU KNOW, PRETTY
      23    STANDARD.
      24         BUT WHAT YOU'LL HEAR IS THAT THE DEFENDANT WOULD COME
      25    IN EITHER REALLY, REALLY EARLY, MAYBE FIVE OR 5:30 IN THE


                                                                       23



       1    MORNING.  ESPECIALLY DURING THE WINTER WHEN HE WANTED TO GO
       2    SKIING, HE WOULD COME IN AT FIVE OR 5:30 IN THE MORNING OR
       3    HE WOULD COME IN LATER, YOU KNOW, MUCH LATER IN THE EVENING,
       4    SOMETIMES OFTEN AFTER THE PATIENTS HAD GONE TO BED.  NOW
       5    FIVE OR 5:30 IN THE MORNING, MOST OF THESE PEOPLE WERE
       6    ASLEEP.  LATER IN THE EVENING, I MEAN MOST OF THEM WERE PUT
       7    TO BED 8:30, NINE.  I MEAN THAT'S PRETTY TYPICAL I THINK FOR
       8    ELDERLY PEOPLE SUCH AS THIS.  HE WOULD COME IN, HE WOULD
       9    LOOK IN AT THE PATIENT WHO MIGHT BE SLEEPING OR SOMETIMES HE
      10    WOULD COME DURING GROUPS AND HE WOULD LOOK IN AND THEY
      11    WOULD -- THERE WOULD BE A GROUP OF THE PEOPLE SITTING
      12    TOGETHER, EITHER INTERACTING TO THE EXTENT THEY COULD OR
      13    WATCHING A MOVIE.  I MEAN, THE IDEA WAS TO PUT THEM IN
      14    GROUPS TO SEE IF THEY COULD GET THEM TO INTERACT AND ADJUST
      15    THEIR BEHAVIOR SO THEY WEREN'T BITING AND KICKING AND
      16    STRIKING OUT OR IT WAS JUST TO PUT THEM IN GROUPS BECAUSE
      17    YOU'VE ONLY GOT TWO OR THREE NURSES THERE AND IF YOU HAVE
      18    THEM IN THE ROOM TOGETHER, IT'S EASIER TO KEEP TRACK OF THEM
      19    OTHER THAN HAVING THEM ALL IN SEPARATE ROOMS.
      20         THE DEFENDANT MIGHT COME IN AND HE WOULD COME IN AND
      21    LOOK AT HOW THEY WERE DOING IN GROUPS OR HE'D, YOU KNOW,
      22    SCRUNCH DOWN NEXT TO ONE OF THE PATIENTS.  THESE ARE NOT
      23    PEOPLE THAT YOU USUALLY COULD CARRY ON A LONG CONVERSATION
      24    WITH OR HE MIGHT JUST PULL THEM OUT IN THE HALLWAY AND, YOU
      25    KNOW, RUN SOME TESTS TO SEE WHAT THEIR PSYCHOLOGICAL STATE


                                                                       24



       1    WAS.  BUT HE DIDN'T SPEND A LOT OF TIME WITH THEM.  AND IN
       2    FACT WHAT YOU WILL SEE WITH ONE PERSON, HE NEVER EVEN MET
       3    THE WOMAN.  SHE CAME INTO THE UNIT LATER ONE AFTERNOON AND
       4    BY 9 O'CLOCK THE NEXT MORNING, SHE WAS GONE.  HE WROTE A
       5    PSYCHOLOGICAL EVALUATION ON HER BUT HE NEVER EVEN MET HER OR
       6    TALKED TO HER.  
       7         AND THE NURSES WILL TELL AND YOU THE SOME -- WELL, IT
       8    WON'T BE AIDES, THEY ARE CNA'S, CERTIFIED NURSING
       9    ASSISTANTS, WILL TELL YOU THEY'D SAY HE WOULD COME IN AND
      10    LOOK IN THE ROOM AND SEE IF THE PATIENT WAS IN THE BED,
      11    PATIENT MIGHT BE SLEEPING, HE WOULD WALK OVER, TALK TO THE
      12    NURSE A LITTLE BIT AND THEN HE WOULD WRITE HIS CHART.  OKAY,
      13    AND THIS IS WHAT'S GOING ON WITH THIS PERSON AT THIS TIME.
      14    NOT FROM ANY OF HIS OWN PERSONAL OBSERVATIONS BUT FROM WHAT
      15    THE NURSES HAD TOLD HIM.
      16         THE NURSES WILL TELL YOU, NOT ALL OF THEM, BUT SOME OF
      17    THEM -- I'LL SAY SOME OF THEM.  I THINK PROBABLY THE
      18    MAJORITY, BUT I'LL JUST STICK WITH SOME OF THEM WILL SAY HE
      19    WAS A VERY INTIMIDATING MAN.  HE WAS THE DOCTOR AND YOU
      20    BETTER DO WHAT HE SAID.  YOU KNOW, HE -- HE'D TALK ABOUT A
      21    TEAM EFFORT, HOW THIS WAS A TEAM EFFORT.  BUT THEY'LL TELL
      22    YOU TEAM TO HIM MEANT, YOU DO WHAT I TELL YOU TO DO.  I'M
      23    THE DOCTOR, YOU DO WHAT I TELL YOU TO DO.
      24         SOME OF THESE NURSES SAID -- WILL TELL YOU THESE PEOPLE
      25    WOULD COME IN FEISTY, FIGHTING, I MEAN, THAT'S KIND OF WHAT


                                                                       25



       1    YOU ARE TRYING TO TAKE CARE OF.  YOU DON'T MIND THEM BEING
       2    FEISTY, THAT'S FINE BUT YOU DON'T WANT THE FIGHTING AND
       3    BITING AND KICKING AND THAT SORT OF THING.  BUT THEY WOULD
       4    COME IN FEISTY, THEY WOULD GET MASSIVE DOSES OF PSYCHOTROPIC
       5    OF DRUGS -- WELL, I SHOULDN'T SAY MASSIVE, I'M SORRY, THEY
       6    WOULD GET DOSES OF PSYCHOTROPIC DRUGS WHICH EXPERTS WILL
       7    TELL YOU WHILE THEY MIGHT HAVE BEEN APPROPRIATE FOR A NORMAL
       8    ADULT 30 TO 40 YEARS OLD, WERE TOO HIGH FOR ELDERLY PEOPLE
       9    WHO HAVE PROBLEMS EXPELLING THE DRUGS.
      10         SO THEY WOULD -- PATIENTS WOULD COME IN, THEY WOULD BE,
      11    YOU KNOW, PERHAPS AMBULATORY, YOU KNOW, WALKING.  SOME
      12    NURSES WOULD HAVE TO ALMOST RUN DOWN THE HALLWAY TO FOLLOW
      13    THEM TO KEEP UP WITH THEM.  THEY WOULD GET THESE DRUGS, THEY
      14    WOULD BECOME VERY SEDATED BECAUSE OF THE EFFECT OF THE
      15    DRUGS.  THEN THERE WOULD COME A POINT WHERE THE DEFENDANT
      16    WOULD GO TO THE FAMILY MEMBERS AND SAY YOUR MOTHER OR FATHER
      17    OR GRANDMOTHER ARE OR GRANDFATHER IS DYING, DO YOU WANT ME
      18    TO KEEP HER OR HIM COMFORTABLE.  AND OF COURSE THE FAMILY
      19    MEMBERS WOULD SAY, YES.  OF COURSE THEY SAY YES AND THEY
      20    TRUST THE DEFENDANT BECAUSE HE'S A DOCTOR.  AND HE SAYS THAT
      21    IT'S TERMINAL, DO YOU WANT ME TO JUST KEEP THEM COMFORTABLE
      22    AND THEY SAY YES.  AND THEN HE WOULD START MORPHINE WITH
      23    THESE PEOPLE.
      24         AND YOU WILL HEAR FROM WITNESSES WHO SAY THE USE OF
      25    MORPHINE IS USUALLY FOR POSTOPERATIVE PAIN, FOR BROKEN BONE


                                                                       26



       1    PAIN SOMETIMES, FOR CANCER PAIN, FOR EXTREME PAIN.  THESE
       2    ARE ALL PEOPLE WHO HAD HAD PAIN BEFORE AT ONE TIME OR
       3    ANOTHER AND IT HAD BEEN HANDLED WITH TYLENOL, WITH LORTAB,
       4    WITH DRUGS THAT DON'T HAVE THE EFFECT THAT MORPHINE HAS. 
       5         MORPHINE DEPRESSES THE CENTRAL NERVOUS SYSTEM WHICH
       6    INCLUDES THE ABILITY TO BREATHE.  THE DEFENDANT WOULD CHART
       7    THAT THESE PEOPLE APPEARED TO BE IN PAIN, YOU'LL HAVE THE
       8    MEDICAL RECORDS AND YOU'LL BE ABLE TO COMPARE.  ON SUCH AND
       9    SUCH A DATE, PATIENT APPEARS TO BE IN PAIN, GIVE MORPHINE
      10    INTRAMUSCULARLY, YOU KNOW, SHOOT IT INTO A MUSCLE.  YOU'LL
      11    LOOK AT THE NURSING NOTES AND YOU'LL SEE, PATIENT LETHARGIC,
      12    UNRESPONSIVE, UNABLE TO EAT, MAY BE MOANING.  AND PERHAPS
      13    THEN, YOU KNOW, TO GIVE HIM THE BENEFIT OF THE DOUBT, MAYBE
      14    HE SAYS, OKAY, WELL, IF THEY ARE MOANING, THEY MUST BE IN
      15    PAIN.
      16         WHAT YOU'LL HEAR FROM THE EXPERTS IS MORPHINE DEPRESSES
      17    THE CENTRAL NERVE SYSTEM, DEPRESSES THE ABILITY TO SWALLOW,
      18    THE ABILITY TO BREATHE AND IF ANY OF YOU HAVE TRIED TO HOLD
      19    YOUR BREATH OR BEEN SWIMMING UNDER WATER OR ANYTHING LIKE
      20    THAT, THE FIGHT TO BREATHE IS MASSIVE.  IF YOU ARE RUNNING
      21    OUT OF OXYGEN YOUR BODY IS FIGHTING TO BREATHE AND PERHAPS
      22    THE MOANING AND GROWING IS HYPOXIA, THE LACK OF OXYGEN.  SO
      23    WHAT DO YOU DO WHEN A PERSON IS MOANING OR PERHAPS THRASHING
      24    AND PERHAPS THEY CAN'T BREATHE?  YOU GIVE THEM MORE MORPHINE
      25    TO SUPPRESS THEIR BREATHING.  I MEAN, THAT ISN'T WHY HE


                                                                       27



       1    WOULD SAY HE GAVE THE MORPHINE, BUT THAT WOULD BE THE EFFECT
       2    OF IT.  YOU GIVE THEM MORE MORPHINE BECAUSE THEY APPEAR TO
       3    BE IN PAIN. 
       4         THESE FIVE PEOPLE CAME INTO THE UNIT AND SOMETIMES
       5    SIGHT UNSEEN HE WOULD START ORDERING DRUGS, PSYCHOTROPIC
       6    DRUGS IN DOSES THAT THE EXPERTS WILL TELL YOU THAT WERE TOO
       7    HIGH FOR GERIATRIC PATIENTS.  INAPPROPRIATE AMOUNTS.  AND
       8    THEN THE DRUGS WOULD BE TO CALM THE AGITATION.  BUT WE WILL
       9    PRESENT EVIDENCE TO YOU THAT SHOWS THAT SOME OF THESE DRUGS
      10    ONE OF THE SIDE EFFECTS IS AGITATION.  
      11         SO, YOU KNOW, AND I WON'T GET INTO A LOT OF DETAIL
      12    HERE, YOU'LL HEAR IT FROM THE WITNESSES BUT I WANT YOU TO
      13    LISTEN FOR THAT.  THESE DRUGS WOULD SOMETIMES CAUSE BY SIDE
      14    EFFECTS THE VERY PROBLEM THEY WERE SUPPOSED TO BE
      15    CORRECTING.  OKAY.  SO THE PROBLEM INCREASES, SO YOU GIVE
      16    THEM MORE DRUGS, SOMETIMES SIGHT UNSEEN.  A LOT OF TIMES
      17    YOU'LL SEE T.O., TELEPHONE ORDER.  YOU KNOW, THE DEFENDANT
      18    DIDN'T EVEN COME IN TO LOOK AT THESE PEOPLE.  HE WOULD JUST
      19    ORDER OVER THE TELEPHONE THAT THEY BE GIVEN THESE DRUGS.
      20         THE PATIENT'S HEALTH DECLINED FROM THE DRUGS THAT THEY
      21    WERE GIVEN.  AS I SAID, THEY CAME IN, YOU'LL HEAR EVIDENCE
      22    THEY CAME IN FEISTY, FIGHTING.  YOU KNOW, THESE WERE PEOPLE
      23    IN THEIR 70'S, 80'S AND 90S, OBVIOUSLY HAVE FOUGHT LONG AND
      24    HARD TO GET TO THE AGE THAT THEY ARE, THAT THEY WERE.  THEY
      25    WOULD BE GIVEN THESE MASSIVE AMOUNTS OF DRUGS THAT HAVE


                                                                       28



       1    THESE SIDE EFFECTS AND THEN YOU WILL SEE IN THE NOTES HOW
       2    THEY BECAME LETHARGIC.  YOU WILL ALSO SEE THAT THEY KIND OF
       3    WENT UP AND DOWN, YOU KNOW, THEY WOULD BE AGITATED, THEN
       4    THEY'D BE LETHARGIC; THEY WOULD BE AGITATED, THEN LETHARGIC.
       5    THIS YOU WILL HEAR EXPERT TESTIMONY OF WHAT THAT MEANS, WHAT
       6    CAN CAUSE THAT IN THIS CIRCUMSTANCE.
       7         WHEN THE PATIENTS DECLINED, DEFENDANT WOULD APPROACH
       8    FAMILY MEMBERS, DO YOU WANT COMFORT CARE.  OF COURSE THEY
       9    SAID YES.  I MEAN THERE'S -- THAT'S UNDERSTANDABLE, THEY
      10    TRUST THE DOCTOR.  MORPHINE WOULD BE STARTED, NOT P.R.N.,
      11    WHICH IS AS NEEDED FOR PAIN, WHICH IS THE WAY MORPHINE IS
      12    USUALLY GIVEN.  YOU KNOW, IN A CANCER PATIENT WHO HAS
      13    INCURABLE CANCER AND IS IN GREAT PAIN THEY WILL OFTEN PUT
      14    WHAT'S CALLED A PUMP ON AND THAT PUMP WILL ALLOW THE PATIENT
      15    WHEN THEY FEEL PAIN TO PUSH A BUTTON AND IT WILL RELEASE THE
      16    MORPHINE AND THEN IT LOCKS SO THEY COULDN'T, YOU KNOW,
      17    CONTINUE TO GIVE THEMSELVES DOSES AT INAPPROPRIATE
      18    INTERVALS.  BUT MORPHINE IS TO BE GIVEN AS NEEDED FOR PAIN.
      19         BUT WHAT THE DEFENDANT WOULD DO IS SAY YOU WILL GIVE
      20    MORPHINE TO THESE PEOPLE EVERY THREE OR FOUR HOURS SCHEDULED
      21    AROUND THE CLOCK.  SOME OF THE NURSES WOULD LOOK AT A PERSON
      22    LYING THERE, OUT OF IT, I MEAN, CLEARLY NOT IN ANY PAIN,
      23    WOULD NOT GIVE THE MORPHINE DOSE AND THE DEFENDANT BECAME
      24    VERY ANGRY AT THAT.  THEY HAD A STAFF MEETING AND HE MADE IT
      25    VERY CLEAR AND EVEN WROTE IT IN SOME OF HIS NOTES, YOU WILL


                                                                       29



       1    NOT -- HE DIDN'T PUT IT THAT WAY, EXCUSE ME.  IF YOU ARE
       2    GOING TO WITHHOLD ANY OF THESE MEDS, AND ESPECIALLY
       3    MORPHINE, YOU WILL CALL ME FIRST.
       4         ONE NURSE IS GOING TO TESTIFY THAT SHE -- YOU KNOW, SHE
       5    WENT TO THE DEFENDANT AND SAID, THIS PERSON IS NOT IN PAIN,
       6    THIS PERSON IS BASICALLY UNCONSCIOUS.  HE SAID, HOW DO YOU
       7    KNOW WHETHER THEY ARE IN PAIN?  I'M THE DOCTOR, I'M THE
       8    EXPERT, HOW DO YOU KNOW?  THIS PERSON IS DYING, YOU KNOW,
       9    THEY COULD BE IN PAIN, DO YOU WANT TO BE RESPONSIBLE FOR
      10    THIS PERSON DYING IN PAIN?  THE INTIMIDATION FACTOR WAS SUCH
      11    THAT THE NURSE THOUGHT, HE'S THE EXPERT AND I DON'T WANT
      12    THIS PERSON TO BE IN PAIN.  I DON'T SEE ANY PAIN, I THINK
      13    THEY ARE UNCONSCIOUS, BUT SO SHE WENT AHEAD AND GAVE THE 
      14    DOSE.  AND ONE NURSE WILL TELL YOU, I WOULDN'T GIVE IT SO
      15    ANOTHER NURSE CAME IN AND DID IT, AND I WANT YOU TO REMEMBER
      16    THAT TOO AS YOU LISTEN TO THE NURSES.
      17         NURSES HAVE A RESPONSIBILITY JUST LIKE A DOCTOR DOES TO
      18    DO NO HARM.  THESE NURSES MOST OF THEM WERE NOT MEDICAL
      19    NURSES, I.E., THEY WERE PSYCH NURSES.  THEY UNDERSTOOD
      20    PSYCHIATRIC MATTERS BUT NOT NECESSARILY MEDICAL MATTERS.  I 
      21    MEAN, I THINK EVERYBODY PRETTY MUCH KNOWS WHAT MORPHINE WILL
      22    DO.  BUT THESE NURSES WERE INTIMIDATED, THEY -- I MEAN, THEY
      23    EVEN WENT UP THROUGH THE CHAIN IN THE HOSPITAL, UP THROUGH
      24    THEIR CHAIN OF COMMAND.  YOU KNOW, I DON'T LIKE THE KIND OF 
      25    MEDS THAT HE'S GIVING THESE PEOPLE, WHAT'S HAPPENING TO       


                                                                       30



       1    THESE PEOPLE HOW THEY COME IN FEISTY AND THEN GO DOWN HILL
       2    WITH ALL THESE MEDICATIONS AND THEY WERE BASICALLY TOLD DO
       3    WHAT THE DOCTOR TELLS YOU.
       4         SO THEY ARE KIND OF BETWEEN A ROCK AND A HARD SPOT.
       5    WHAT ARE THEY DO -- WHAT DO THEY DO?  THE DOCTOR TELLS THEM,
       6    I KNOW BETTER THAN YOU, I AM THE DOCTOR, I HAVE THE MEDICAL
       7    DEGREE, YOU WILL DO WHAT I SAY, BUT ON THE OTHER HAND, THEY
       8    ARE THINKING THIS PERSON DOESN'T NEED THAT.  SOME, AS I
       9    SAID, WITHHELD AND WERE TOLD ON NO UNCERTAIN TERMS NOT TO DO
      10    THAT ANYMORE.
      11         WHAT CAN A NURSE DO IF SHE DOESN'T GET ANY BACKUP FROM
      12    HER CHAIN OF COMMAND?  THEY JUST SAY GO AHEAD AND DO WHAT
      13    THE DOCTOR TELLS YOU.  THEIR JOB IS TO GO TO THE DOCTOR
      14    FIRST AND SAY, DOCTOR, I DON'T THINK THAT THIS IS
      15    APPROPRIATE.  BUT IF THE DOCTOR SAYS YOU DO IT BECAUSE I'M
      16    TELLING YOU TO DO IT, THEN THEY GO THROUGH THE CHAIN OF
      17    COMMAND AND THAT DOESN'T WORK, WHAT CAN THEY DO?  THEY CAN
      18    GET FIRED.  THEY CAN REFUSE TO GIVE THE DRUG AND BE FIRED
      19    FOR REFUSING TO GIVE THE DRUG. 
      20         WHAT HAPPENS WHEN THE PATIENT -- WHEN THAT NURSE IS
      21    FIRED FOR REFUSING TO GIVE THE DRUG?  THE NEXT NURSE IS
      22    HANDED THE SYRINGE BASICALLY OR TOLD YOU WILL GIVE THE DRUG.
      23    AND THAT NURSE EITHER LOOKS AT WHAT HAPPENED TO THE FIRST
      24    NURSE FOR REFUSING AND SAYS, I CAN'T LOSE MY JOB AND GIVES
      25    THE DRUG OR SAYS, NO, I WON'T GIVE IT EITHER.  AND WHAT


                                                                       31



       1    HAPPENS THEN?  YOU'VE GOT TWO NURSES OUT OF WORK AND IT'S
       2    GIVEN TO A THIRD NURSE.  YOU KNOW, YOU COULD HAVE GONE
       3    THROUGH EVERY NURSE THAT WAS THERE AND THEY COULD ALL QUIT
       4    AND EVENTUALLY THERE WOULD HAVE BEEN AND THERE WAS A TIME
       5    THAT EVENTUALLY THERE WILL BE A NURSE WHO WILL GIVE THE
       6    SHOT.  IT DOESN'T SAVE THE PATIENT FOR THE NURSE TO LOSE HER
       7    JOB.  THAT IS A GENERAL OVERVIEW OF IN GENERAL WHAT WAS
       8    GOING ON HERE.
       9             THE COURT:  YOU MAY WANT TO KEEP UP YOUR VOICE.  I
      10    DON'T KNOW WHAT'S GOING ON OUTSIDE.
      11             MS. BARLOW:  OH, THE AIR CONDITIONING RUNNING, I
      12    GUESS.
      13         THE FIRST PATIENT OF THESE FIVE, OF COURSE NOT THE
      14    FIRST PATIENT ON THE UNIT, BUT THE FIRST PATIENT OF THESE
      15    FIVE TO COME INTO THIS UNIT WAS JUDITH LARSEN.  JUDITH -- OF
      16    COURSE THIS IS NOT A PICTURE FROM WHEN SHE WAS IN THE
      17    HOSPITAL BUT AROUND THE TIME.  JUDITH CAME ON TO THE UNIT
      18    DECEMBER 6TH OF 1995.  SHE HAD BEEN IN THE CARE CENTER.  SHE
      19    HAD HAD A HABIT OF CLIMBING OUT OF THE BED AND FALLING.  SHE
      20    WAS HAVING TO HAVE STITCHES IN HER HEAD FROM FALLING.  SHE
      21    HAD A STROKE IN JANUARY OF 1995.  SHE WAS BECOMING MORE
      22    AGITATED, MORE DIFFICULT TO HANDLE IN THE LONG-TERM CARE
      23    CENTER.
      24         SO SHE CAME IN THE 6TH OF DECEMBER 1995.  A
      25    PSYCHOLOGICAL EVALUATION SAYS, YOU KNOW, SHE'S DEMENTED.


                                                                       32



       1    SHE DOES HAVE PHYSICAL HEALTH PROBLEMS.  YOU WILL HEAR FROM
       2    THE PRIOR DOCTORS FOR ALL OF THESE PEOPLE ABOUT WHAT OTHER
       3    HEALTH PROBLEMS THEY HAD.  SHE WAS TO BE THERE FOR TWO
       4    WEEKS, THAT'S WHAT THE DEFENDANT WROTE IN THE PSYCH 
       5    EVALUATION.  THEY WERE GOING TO DECREASE HER PSYCHOSES AND
       6    DECREASE HER DEPRESSION AND SHE WAS TO GO BACK TO THE
       7    LONG-TERM CARE CENTER.  SHE WAS IMMEDIATELY GIVEN
       8    PSYCHOTROPIC DRUGS TO CONTROL HER BEHAVIOR.  JUDITH WAS 93
       9    YEARS OLD.  JUDITH HAD A VERY STRONG CONSTITUTION.
      10         DURING THE MONTH OF DECEMBER, EVEN THOUGH I DON'T
      11    BELIEVE YOU'LL FIND ANYTHING IN THE NURSING NOTES THAT SAYS
      12    THERE WAS ANY INDICATION OF PAIN, JUDITH WAS GIVEN MORPHINE. 
      13    ONE OF THE NURSES WILL TELL THAT YOU SHE CAME TO THE DOCTOR,
      14    THIS NURSE IS ONE WHO DID HAVE A MEDICAL/SURGICAL
      15    BACKGROUND.  SHE WASN'T A PSYCH NURSE, SHE WAS A MED/SURG
      16    NURSE AND SHE WENT TO THE DEFENDANT AND SHE SAID THIS WOMAN
      17    DOESN'T NEED MORPHINE AND THE DEFENDANT DISCONTINUED THE
      18    MORPHINE FOR A PERIOD OF TIME.
      19         TOWARDS THE END OF DECEMBER, SO WE'RE NOW LOOKING AT
      20    THREE OR FOUR WEEKS INTO HER STAY OF WHAT WAS TO BE A TWO OR
      21    THREE-WEEK STAY, SHE STARTS HAVING SOME MEDICAL PROBLEMS.
      22    SHE STARTS VOMITING.  THE NURSE CALLS -- AND IT STARTED
      23    DURING THE EVENING AND THE NURSE KEPT CALLING THE DEFENDANT
      24    WHO DID NOT RESPOND FOR QUITE SOME TIME.  AND THERE'S A REAL
      25    CONCERN WITH DEHYDRATION WITH ELDERLY PEOPLE BUT ESPECIALLY


                                                                       33



       1    WITH VOMITING, YOU KNOW, I THINK, YOU KNOW, MOST OF US
       2    RECOGNIZE THAT AND THE NURSE HELD THE MEDS.  SHE DIDN'T GIVE
       3    THE MEDICATION THAT HAD BEEN ORDERED. 
       4         WELL, ON THE 31ST OF DECEMBER MORPHINE WAS ORDERED FOR
       5    EVERY 12 HOURS AROUND THE CLOCK.  NOT P.R.N., NOT ACCORDING
       6    TO THE PAIN, NOT IF YOU SAW ANY PAIN OR INDICATIONS OF PAIN,
       7    BUT JUST GIVE IT EVERY FOUR HOURS AROUND THE CLOCK.  AT THAT
       8    TIME, THE NURSES SAY SHE WAS UNRESPONSIVE, SHE WAS MOANING
       9    WHEN TURNED, SHE MOANED WHEN SHE WAS GIVEN THE SHOT, YOU
      10    KNOW, SO SHE WAS RESPONSIVE TO MOTION AND THAT SORT OF
      11    THING.  BUT AT THIS POINT WE'RE TALKING IS HER RESPIRATORY
      12    SYSTEM BEING SUPPRESSED SUCH THAT THE MOANING IS INDICATIVE
      13    OF, I'M NOT GETTING ENOUGH OXYGEN BUT I AM SO SEDATED BY THE
      14    DRUGS THAT YOU GAVE ME I CAN'T EVEN TELL YOU WHAT MY PROBLEM
      15    IS?
      16             THE COURT:  EXCUSE ME, LADIES AND GENTLEMEN, ARE
      17    YOU ABLE TO HEAR WITH THE RAIN AND EVERYTHING?  OKAY.  IF
      18    YOU NEED TO MOVE CLOSER, YOU KNOW, FEEL FREE TO DO THAT.
      19             MS. BARLOW:  I'LL TRY TO USE A SCHOOL TEACHER
      20    VOICE.
      21             THE COURT:  OKAY.
      22             MS. BARLOW:  DRUGS CONTINUED.  THE MORPHINE
      23    CONTINUED THROUGH THE 31ST OF DECEMBER, THE 1ST, THE 2ND AND
      24    INTO THE 3RD OF JANUARY.  NOW MORPHINE IS GIVEN, YOU KNOW,
      25    MAYBE 1 MILLIGRAM TO 2 MILLIGRAMS.  THESE ARE PEOPLE WHO  


                                                                       34



       1    WEREN'T USED TO GETTING MORPHINE.  I MEAN, PEOPLE WHO ARE
       2    USED TO GETTING MORPHINE YOU CAN GIVE THEM LARGE DOSES.
       3    PEOPLE IN TERMINAL PAIN WHO HAVE BEEN GETTING MORPHINE FOR A
       4    TIME, YOU CONTINUE TO INCREASE THE DOSE TO HANDLE THE PAIN.
       5    THESE PEOPLE STARTED OUT WITH MAYBE ONE OR 2 MILLIGRAMS OF
       6    MORPHINE, MAYBE 5 MILLIGRAMS, WHICH IS, YOU KNOW, A NORMAL
       7    DOSE IN A NORMAL HEALTHY ADULT.
       8         JUDITH LARSEN THE LAST -- FROM MIDNIGHT, MIDNIGHT AND
       9    THEN 12:01 ON THE 3RD OF JANUARY UNTIL 8 O'CLOCK THAT
      10    EVENING WHEN SHE PASSED AWAY, HAD OVER 100 MILLIGRAMS OF
      11    MORPHINE ADMINISTERED TO HER.  THEY WEREN'T 5 MILLIGRAMS
      12    SHOTS.  THEY BECAME 25 MILLIGRAMS, 30 MILLIGRAMS,
      13    40 MILLIGRAMS OF MORPHINE.  AND THE NURSING NOTES WILL SHOW 
      14    YOU SHE WAS IN NO PAIN, SHE WAS NOT CONSCIOUS, SHE COULD NOT  
      15    HAVE BEEN IN PAIN, AND YET THE DRUG DOSES JUST KEPT
      16    INCREASING.  AND SOMETIMES THEY WERE GIVEN MORE QUICKLY THAN
      17    THE THREE HOURS.  JUDITH LARSEN WAS THERE ALMOST A MONTH,
      18    SHE DID NOT GO WILLINGLY.  I'LL SET THIS OVER HERE.
      19         THE NEXT PATIENT IN TERMS OF TIME COMING ON THE UNIT
      20    DURING THIS TIME FRAME -- NOW, REMEMBER, SHE PASSED AWAY THE
      21    3RD OF JANUARY, JUDITH LARSEN DID.
      22         THE NEXT WOMAN TO COME IN WAS LYDIA SMITH.  SHE CAME IN
      23    THE ON THE 20TH OF DECEMBER.  THE NURSES WILL TELL YOU SHE
      24    HAD A LONG BRAID OF HAIR THAT YOU DON'T REALLY SEE IN THIS
      25    PICTURE, BUT IT WAS PULLED AND BRAIDED AND A LOT OF THEM


                                                                       35



       1    WILL REMEMBER HER BECAUSE OF HER LONG BRAID OF HAIR AND SHE
       2    WAS FEISTY.  SHE WAS SMALL, SHE WAS THINNER THAN THIS BUT
       3    SHE WAS REALLY FEISTY AND UP AND GOING AND -- YOU KNOW, ONE
       4    NURSE WILL SAY, YOU KNOW, SHE WANTED TO TAKE ON THE WHOLE
       5    STAFF.  SHE WAS 90 YEARS OLD AND SHE WAS STILL PRETTY FEISTY
       6    BUT, AGAIN, DEMENTED.  HER QUALITY OF LIFE WAS GOING DOWN, I
       7    MEAN, THERE'S NO QUESTION OF THAT.
       8         SHE HAD HAD A STROKE IN MID NOVEMBER THAT HAD CAUSED AN
       9    ACUTE CHANGE IN HER BEHAVIOR.  SHE WAS AGITATED, SHE WAS
      10    DEPRESSED.  THE DEFENDANT DOES A PSYCHOLOGICAL EVALUATION,
      11    SAYS SHE'LL BE HERE THREE WEEKS AND WHEN SHE LEAVES SHE'LL
      12    HAVE AN IMPROVED MOOD.  STARTED GIVING THE PSYCHOTROPIC
      13    DRUGS IMMEDIATELY AND, AGAIN, I MEAN SHE'S AGITATED AND
      14    SHE'S AGGRESSIVE, SOMETIMES THESE DRUGS WILL INCREASE THAT  
      15    AND IT -- THE NURSING NOTES WILL SHOW YOU SHE IS AGGRESSIVE
      16    AND SHE'S ACTIVE AND SHE'S FEISTY.  THERE'S NO APPARENT
      17    PAIN.  I MEAN, PAIN YOU USUALLY -- YOU KNOW, IF YOU HAVE A
      18    HEADACHE YOU JUST DON'T MOVE ME, BUT SHE WAS AGGRESSIVE AND
      19    SHE WAS FEISTY.  SO THAT WAS ON THE 20TH OF DECEMBER.
      20         SHE GOES ALONG GETTING THE REGULAR MEDICATIONS, BECOMES
      21    IN DECLINING HEALTH, BECOMES SEDATED, BECOMES LETHARGIC,
      22    BECOMES UNRESPONSIVE, ALL SIDE EFFECTS OF THESE PSYCHOTROPIC
      23    DRUGS.  THE MEDICAL NOTES WILL SHOW YOU FROM THE 4TH THROUGH
      24    THE 7TH SHE'S QUIET, SHE BECOMES AGITATED AND THEN LETHARGIC
      25    AGAIN ONE DAY.  SHE SLEEPS MOST OF ONE DAY, SHE'S QUIET AND


                                                                       36



       1    LETHARGIC ON THE 7TH.  THERE ARE SOME CONCERNS ABOUT
       2    BREATHING.  THE DEFENDANT IS CALLED A COUPLE OF TIMES,
       3    DOESN'T CALL BACK.
       4         EVENTUALLY THE DEFENDANT CALLS BACK.  HE ORDERS
       5    MORPHINE EVERY THREE HOURS AND IT WAS LATER IN THE DAY ON
       6    THE 7TH THAT HE ORDERED THAT.  THREE OF THE FOUR DOSES THAT
       7    WERE ROUTINE, SCHEDULED WERE GIVEN.  THE FOURTH WAS HELD
       8    BECAUSE OF HER STATE.  I MEAN THERE WAS NO APPEARANCE OF
       9    PAIN TO THE NURSE, SO SHE HELD THAT.  THAT WAS 5 MILLIGRAMS,
      10    THOSE DOSES WERE 5 MILLIGRAMS EACH.
      11         ON THE 8TH HE UPPED IT TO 10 MILLIGRAMS.  THIS WOMAN IS
      12    UNRESPONSIVE, SHE'S QUIET, SHE'S LETHARGIC, THERE'S NO
      13    APPARENT APPEARANCE OF PAIN AND YET HE INCREASES THE
      14    MORPHINE.  SHE'S GIVEN A MORPHINE SHOT AT NINE IN THE
      15    MORNING, AGAIN AT 12 NOON, AND BY 12:45, SHE HAD PASSED
      16    AWAY.  THE EXPERTS WILL TELL THAT YOU THERE AREN'T REALLY
      17    ANY MEDICAL REASONS FOR THESE PEOPLE TO DIE OTHER THAN THEIR
      18    CENTRAL NERVOUS SYSTEM IS SO DEPRESSED AND THEY ARE HAVING
      19    TROUBLE GETTING OXYGEN, HAVING TROUBLE BREATHING.  THIS IS
      20    LYDIA SMITH.
      21         THE THIRD PERSON TO COME ON THE UNIT DURING THIS TIME
      22    FRAME WAS MARY CRANE.  SHE CAME ONTO THE UNIT ON THE 28TH OF
      23    DECEMBER.  SHE'S 72 YEARS OLD.  SHE HAD HAD A STROKE IN
      24    1989.  SHE HAD A HERNIATED DISK AND DID HAVE SOME LOW BACK
      25    PAIN.  IN THE NURSING HOME THAT HAD BEEN TAKEN CARE OF


                                                                       37



       1    THROUGH TYLENOL, LORTAB, YOU KNOW, SOME OF THE LESS SEVERE
       2    PAIN MEDICATIONS, HAD CONTROLLED HER PAIN IN THE NURSING
       3    HOME.  SHE COMES IN AND, AGAIN, SHE HAS A PSYCHOLOGICAL
       4    EVALUATION.  SHE'S GOING TO BE THERE TWO TO THREE WEEKS, YOU
       5    KNOW, AND HER BEHAVIOR IS GOING TO BE MODIFIED BY THE TIME
       6    SHE IS RELEASED AGAIN. 
       7         SHE IS GIVEN WHAT'S CALLED A DURAGESIC PATCH FOR THE
       8    PAIN OF HER LOWER BACK.  IT'S A PATCH THAT IS PLACED ON AND
       9    LEFT ON FOR THREE DAYS AND IT HAS A PAIN MEDICATION THAT IS
      10    RELEASED THROUGH THE SKIN AND YOU'LL HEAR A LOT OF TESTIMONY
      11    ABOUT JUST HOW THIS WORKS.  IT'S THE KIND OF THING THAT IT
      12    RELEASES THE PAIN MEDICATION AND AFTER YOU TAKE THE PATCH
      13    OFF, THE PAIN MEDICATION IS STILL GOING INTO YOUR SYSTEM FOR
      14    AN EXTENDED PERIOD OF TIME.  AND WITH THE ELDERLY IT'S AN
      15    EVEN MORE EXTENDED PERIOD OF TIME AFTER THE PATCH IS GONE.
      16         A 25 MILLIGRAM PATCH IS PLACED ON WHICH IS A NORMAL 
      17    DOSE.  IT FELL OFF THE NEXT MORNING FOR WHATEVER REASON AND
      18    ANOTHER PATCH WAS PUT ON IMMEDIATELY NOT ALLOWING THE
      19    MEDICATION THAT WAS STILL IN THE SYSTEM FROM THE FIRST PATCH
      20    TO DISSIPATE.  AND THESE ARE THREE-DAY PATCHES, YOU KNOW,
      21    AND IF YOU STICK MORE THAN ONE ON, YOU KNOW, YOU STILL GOT
      22    WHAT'S GOING FROM THE FIRST PATCH IN THE SYSTEM.  THERE'S A
      23    MEDICAL CONSULT.  DR. DIENHART IS CALLED IN TO TALK TO MARY
      24    CRANE TO LOOK AT MARY CRANE'S PHYSICAL CONDITION.  THAT
      25    OCCURRED ON THE FIRST -- OKAY, LET ME BACK UP A LITTLE BIT.


                                                                       38



       1         SO THE FIRST PATCH WAS 25 MILLIGRAMS.  WHEN THE SECOND
       2    PATCH WAS PUT ON THE DEFENDANT INCREASED THAT TO
       3    50 MILLIGRAMS, EVEN THOUGH NOTHING HAD REALLY CHANGED
       4    BECAUSE IT WAS AROUND THE SAME TIME, YOU KNOW, WITHIN 24
       5    HOURS, HE SAYS PUT ON A 50 MILLIGRAMS WHICH IS GETTING UP
       6    THERE IN DOSAGE FOR A GERIATRIC PERSON. 
       7         ON THE 1ST OF JANUARY DR. DIENHART, I THINK HE'S AN
       8    INTERNIST, YOU'LL HEAR FROM HIM AND HE'LL TELL YOU EXACTLY
       9    WHAT HIS SPECIALTY IS, BUT HE DEALS WITH MEDICAL CONDITIONS,
      10    NOT PSYCHOLOGICAL CONDITIONS.  HE SAW HER ON THE 1ST OF
      11    JANUARY AND DECREASED THE DOSAGE BACK DOWN TO 25.  THE
      12    DEFENDANT THE VERY SAME DAY WITHIN AN HOUR HAD THEM TAKE
      13    THAT PATCH OFF AND PUT -- PROBABLY NOT TAKE IT OFF, BUT PUT
      14    SOMETHING ON SO THAT SHE HAD 50 AGAIN.  SO YOU'VE GOT THE
      15    MEDICAL DOCTOR SAYING 25 IS PLENTY, YOU'VE GOT THE
      16    PSYCHIATRIST WHO IS AN M.D. SAYING, NO, I'M GOING BACK UP TO
      17    50, WITHIN AN HOUR.  SO THE DURAGESIC PATCH IS THERE FOR THE
      18    LOWER BACK PAIN AND THERE'S NO INDICATION THAT SHE'S IN
      19    EXCRUCIATING PAIN.  YOU KNOW, THE DURAGESIC PATCH WILL TAKE
      20    CARE OF THE LOWER BACK PAIN.  - ??
      21         ON THE 3RD OF JANUARY, THE DEFENDANT ORDERS MORPHINE
      22    AND A COUPLE OF SHOTS OF MORPHINE ARE GIVEN.  ON THE 4TH OF
      23    JANUARY ANOTHER SHOT OF MORPHINE AT 6:30 IN THE MORNING.
      24    NOW THIS IS ON TOP OF THE DURAGESIC PATCH.  THAT DAY THE
      25    DEFENDANT UPS THE DURAGESIC TO 75 MILLIGRAMS WHICH IS THREE


                                                                       39



       1    TIMES WHAT A GERIATRIC DOSE OUGHT TO BE.  ON THE 7TH OF 
       2    JANUARY, THE DURAGESIC PATCHES ARE THERE, MORPHINE IS BEING
       3    ADMINISTERED, ROUTINELY, SCHEDULED AROUND THE CLOCK.
       4    DEFENDANT SAYS HOLD ALL THE OTHER DRUGS EXCEPT THE MORPHINE
       5    AND THE DURAGESIC, DON'T GIVE ANY OF THE OTHER DRUGS, YOU
       6    KNOW, FOR ANY OTHER MEDICAL CONDITION. 
       7         THERE'S A MEDICAL CONSULT DR. DIENHART COMES IN, HE
       8    LOOKS AT THIS WOMAN AND HE WRITES IN THE NOTES, SHE MAY DIE
       9    SOON, AND INDEED SHE DID DIE THAT DAY AT 11:35 IN THE
      10    MORNING.  AGAIN, A CIRCUMSTANCE WHERE SHE COMES IN, GETS
      11    LOADED UP WITH PSYCHOTROPIC DRUGS, DECLINES IN HEALTH AND HE
      12    GOES TO THE FAMILY MEMBERS AND SAYS, DO YOU WANT COMFORT
      13    CARE AND OF COURSE THEY SAY YES AND THEN HE STARTS GIVING
      14    MORPHINE ON TOP OF THE DURAGESIC WHICH IS ALREADY THREE 
      15    TIMES THE DOSAGE THAT IT OUGHT TO BE AND SHE DIES.  THAT'S
      16    MARY CRANE.
      17         ELLEN ANDERSON CAME IN THE ON THE 29TH OF DECEMBER AND
      18    17 HOURS LATER SHE WAS GONE.  SHE HAD HAD A HIP FRACTURE.
      19    SHE DID HAVE OSTEOPOROSIS WHICH IS -- CAN BE PAINFUL.  SHE 
      20    HAD HAD A HIP FRACTURE IN JUNE OF '95, HAD HAD THAT
      21    REPAIRED, HAD HAD AN OPERATION ON IT.  BUT COMING OUT OF
      22    THAT OPERATION SHE HAD COME OUT ANXIOUS AND DEPRESSED, HATED
      23    TO BE LEFT ALONE AND, OF COURSE, THAT CAUSES PROBLEMS WITH
      24    CARE GIVERS EITHER AT HOME OR AT A LONG-TERM CARE FACILITY
      25    BECAUSE, YOU KNOW, YOU CAN'T SPEND EVERY MINUTE WITH PEOPLE.


                                                                       40



       1    IT'S JUST -- WE ALL HAVE LIVES UNFORTUNATELY.  NOT
       2    UNFORTUNATELY, WE DO HAVE THEM -- FORTUNATELY, I GUESS.
       3         SHE CAME IN, SHE WAS GIVEN BY TELEPHONE ORDER
       4    PSYCHOTROPIC MEDICATIONS AND TYLENOL AND MORPHINE WERE
       5    ORDERED FOR PAIN.  SHE RECEIVED A MORPHINE SHOT AT NINE --
       6    1930 THE EVENING OF THE 29TH, WHICH IS 7:30 IN THE EVENING.
       7    SHE CAME IN AT 4 O'CLOCK THAT EVENING.  AT ONE IN THE
       8    MORNING HER BREATHING WAS ERRATIC.  HER BREATHING WAS EIGHT
       9    TO 16 BREATHS PER MINUTE.  SIXTEEN IS NORMAL, EIGHT IS LOW.
      10    THERE'S A PROBLEM.  THE CENTRAL NERVOUS SYSTEM IS
      11    SUPPRESSED, AND, YOU KNOW, SHE MIGHT ONLY BE TAKING EIGHT
      12    BREATHS A MINUTE BECAUSE THAT AUTOMATIC SYSTEM ISN'T WORKING
      13    BECAUSE OF THE MEDICATION THAT IS SUPPRESSING IT.
      14         DEFENDANT WAS PAGED AT ONE IN THE MORNING, NO RESPONSE.
      15    AT 3:15 SHE WOKE UP, SHE WAS THRASHING, THE NURSE THOUGHT
      16    SHE WAS IN PAIN BECAUSE OF HER THRASHING.  WAS IT PAIN OR 
      17    WAS IT LACK OF OXYGEN WHICH CAN ALSO CAUSE A PERSON TO FIGHT
      18    FOR BREATH.  DEFENDANT WAS PAGED AGAIN AT 3:15.  AT 3:30 HE
      19    CALLED BACK AND SAID GIVE HER A SHOT OF MORPHINE WHICH THE
      20    NURSE DID.  AT 6:30 THE NURSE SAID SHE'S BEEN SLEEPING SINCE
      21    THEN.
      22         AT 6:30 IN THE MORNING AN E.K.G. AND A CHEST X-RAY IS
      23    DONE.  THE BREATHING IS STILL ERRATIC, YOU HAVE THE MORPHINE
      24    ON BOARD AS THEY SAY, IN THE SYSTEM.  THE E.K.G. SHOWS THAT
      25    THERE IS AN ARRHYTHMIA, THAT THE HEART IS NOT PUMPING LIKE


                                                                       41



       1    IT OUGHT TO BE PUMPING.  SHE'S HAD TWO SHOTS OF MORPHINE.
       2    BY 8:55 THAT MORNING SHE WAS GONE. 
       3         THE DEFENDANT NEVER SAW HER.  HE ORDERED THE DRUGS
       4    WITHOUT EVER SEEING HER AND AFTER THE FACT -- IT'S
       5    INTERESTING AS YOU READ IN HIS NOTES, HE INDICATES SHE CAME
       6    IN ON 12/29, HAD AN E.K.G. UPON ADMISSION, AND I GUESS
       7    TECHNICALLY THEY SAY THAT IF IT'S WITHIN 24 HOURS OF
       8    ADMISSION, IT'S STILL CALLED ON ADMISSION.  BUT THAT E.K.G.
       9    WAS AFTER THE MORPHINE AND THE ARRHYTHMIA, THE IRREGULAR
      10    RHYTHM WAS AFTER THE MORPHINE.  BUT IN HIS REPORT HE WRITES,
      11    WELL, SHE HAS ARRHYTHMIA UPON ADMISSION.  THAT WAS AFTER THE
      12    MORPHINE, BUT HE DOESN'T SAY THAT, HE DOESN'T WRITE THAT IN
      13    HIS REPORT.
      14         HE WROTE THE PSYCHOLOGICAL EVALUATION AFTER SHE DIED.
      15    HE NEVER TALKED TO HER BUT HE JUST LOOKED AT, YOU KNOW,
      16    WHATEVER ELSE HAD BEEN WRITTEN AND WRITES A PSYCHOLOGICAL
      17    EVALUATION.  HE IN HIS NOTES SAYS IT WAS DICTATED THE DAY
      18    THAT SHE CAME IN.  THAT'S NOT TRUE.  IT WAS DICTATED AND
      19    WRITTEN AFTER SHE DIED.
      20         AND THAT POINTS OUT SOMETHING I WANT YOU TO PAY CLOSE
      21    ATTENTION TO AS YOU GET THE MEDICAL RECORDS HERE.  LOOK AT
      22    WHO SAYS THESE PEOPLE ARE IN PAIN.  THERE'S ONE OR TWO
      23    NURSES THAT YOU WILL SEE THAT INDICATE SOME PAIN.  BUT MOST
      24    OF THE TIME YOU WILL SEE THAT IT'S THE DEFENDANT WHO WRITES,
      25    APPEARS TO BE IN PAIN.  YOU LOOK AT THE COMPARABLE NURSING

      
                                                                       42



       1    NOTES FOR THAT TIME PERIOD, THE NURSES AREN'T SAYING THAT.
       2    HE WAS JUSTIFYING GIVING THE MORPHINE.  THAT'S ELLEN
       3    ANDERSON.
       4         ENNIS ALLDREDGE CAME INTO THE UNIT ON THE 10TH OF
       5    JANUARY OF 1996.  HE WAS 82 YEARS OLD WHEN HE CAME INTO THE
       6    UNIT.  HE WAS AGGRESSIVE, HE WAS COMBATIVE, HE HAD BEEN
       7    HITTING PEOPLE AT THE LONG-TERM CARE FACILITY.  HE HAD ONLY
       8    BEEN IN THE NURSING HOME SINCE SEPTEMBER OF 1995 AND, AGAIN,
       9    THERE WAS AN ACUTE EVENT THAT HIS BEHAVIOR BECAME SUCH THAT
      10    THEY COULD NOT CONTROL IT, COULDN'T HANDLE IT.  HE WAS
      11    DEMENTED.
      12         HE CAME IN, A PSYCHOLOGICAL EVALUATION WAS DONE.  HE'S
      13    INTENDED TO STAY AT THE UNIT TWO TO THREE WEEKS.  IT WAS
      14    INTENDED THAT HE WOULD LEAVE THE UNIT WITH BEHAVIOR UNDER
      15    CONTROL.  IMMEDIATELY GIVEN PSYCHOTROPIC DRUGS THAT HAVE THE
      16    SIDE EFFECTS OF SEDATION AND DEPRESSION OF THE CENTRAL
      17    NERVOUS SYSTEM, COULD EVEN CAUSE THE AGITATION BECAUSE THEY
      18    KEEP A PERSON FROM GETTING OXYGEN.  HE BECAME UNRESPONSIVE
      19    OVER TIME.  HE WAS ONLY THERE FOUR DAYS, LABORED BREATHING,
      20    ALL THE EXPERTS WILL TELL YOU AS A CONSEQUENCE OF THE
      21    OVERMEDICATION THAT WAS HAPPENING HERE.
      22         HIS FAMILY WAS TOLD HE IS TERMINAL, YOU KNOW, HE'S COME
      23    IN FEISTY AND COMBATIVE, HE'S GIVEN THE DRUGS, HE DROPS, THE
      24    DEFENDANT SAYS HE'S TERMINAL, DO YOU WANT ME TO KEEP HIM
      25    COMFORTABLE?  OF COURSE THE FAMILY SAYS YES.  NOBODY WANTS


                                                                       43



       1    THEIR FAMILY MEMBERS TO SUFFER OR THEIR LIVES PROLONGED SO
       2    THEY CAN SUFFER SO THEY AGREE TO WHAT'S CALLED PALLIATIVE
       3    CARE, COMFORT CARE, WHICH IN THE DEFENDANT'S MIND MEANS
       4    MORPHINE.  HE IS GIVEN MORPHINE EVERY THREE HOURS STARTING
       5    ON THE 13TH AND ON THE 14TH HE PASSES AWAY.  THIS IS ENNIS
       6    ALLDREDGE.
       7         YOU WILL HEAR TESTIMONY OF THEIR PRIOR MEDICAL
       8    HISTORIES.  YOU'LL HEAR TESTIMONY OF WHAT MEDICAL PROBLEMS
       9    THEY HAD.  YOU WILL HEAR TESTIMONY OF WHAT KILLED THEM.  YOU
      10    WILL HEAR TESTIMONY FROM FAMILY MEMBERS ABOUT WHAT THEIR
      11    FATHER AND MOTHERS WERE LIKE.  YOU'LL HEAR EXPERTS TELL YOU
      12    ABOUT THESE DOSES OF DRUGS AND THE EFFECTS OF THESE DRUGS IN
      13    THE ELDERLY AND I HOPE YOU'LL PAY PARTICULAR ATTENTION TO
      14    THAT.
      15         AND I'M GLAD THAT YOU HAVE NOTE PADS BECAUSE, YOU KNOW,
      16    WE TRY TO MAKE IT -- YOU KNOW, WE TRY TO GET DOCTORS TO TALK
      17    IN OUR LANGUAGE, YOU KNOW, AND HOPEFULLY WE CAN MAKE IT
      18    COMPREHENSIBLE.  BUT THERE'S GOING TO BE A LOT OF
      19    INFORMATION THAT COMES TO YOU OVER THE NEXT FEW WEEKS AND I
      20    HOPE THAT YOU'LL BE ABLE TO ABSORB IT AND KEEP IT ALL IN
      21    MIND AS YOU GO TO DELIBERATE.
      22         THE LAW DOES NOT REQUIRE TO US TO PROVE TO YOU OR TO
      23    GIVE YOU EVIDENCE OF WHY THE DEFENDANT DID WHAT HE DID.
      24    THAT'S NOT ONE OF THE ELEMENTS OF THE CRIME.  MENTAL STATE
      25    IS, BUT NOT WHY.  BUT YOU HAVE TO THINK WHY.  I THINK AS YOU


                                                                       44



       1    LISTEN TO THE EVIDENCE YOU WILL GET A FEELING FOR WHY.  AND
       2    THE WHY IS NOT BECAUSE HE FEELS SYMPATHETIC FOR THESE PEOPLE
       3    WHOSE QUALITY OF LIFE HAS GONE DOWNHILL.  THERE'S NO
       4    QUESTION OF THAT.  THEY ARE DEMENTED.  MOST OF THEM, NOT ALL
       5    OF THEM, BUT MOST OF THEM ARE DEMENTED, BUT THEY WEREN'T AS
       6    BAD COMING IN AS THEY BECAME AFTER HE STARTED MEDICATING
       7    THEM.
       8         SO WHY DID HE DO IT?  I THINK YOU'LL SEE EVIDENCE OF
       9    MONEY IS PART OF IT BUT, YOU KNOW, AND AS MUCH AS YOU HATE
      10    TO SEE IT, I THINK THAT YOU'LL SEE THE REASON IS HE DIDN'T
      11    LIKE THESE PEOPLE.  THEY WERE OLD.  THEY DIDN'T HAVE MUCH
      12    USE ON THE EARTH ANYMORE.  NOT OUT OF SYMPATHY FOR THEM, BUT
      13    AARRH JUST SEND THEM ON.  NOT ONLY THAT BUT SEND THEM ON SO
      14    I CAN GET SOMEBODY ELSE INTO THIS BED BECAUSE AS I DO THE
      15    PSYCHOLOGICAL EVALUATIONS AND ALL THE TESTING UP FRONT, I
      16    GET PAID MORE. 
      17         I THINK IT'S HARD TO UNDERSTAND THAT ANYONE COULD DO
      18    THAT FOR THOSE REASONS AND I THINK THE EVIDENCE WILL SHOW
      19    YOU THAT THAT'S EXACTLY WHAT HAPPENED.  BUT REMEMBER, IT IS
      20    NOT OUR BURDEN TO SHOW TO YOU WHY HE DID THIS, ONLY THAT HE
      21    DID DO IT WITH THE REQUISITE MENTAL STATE.  BUT I MEAN
      22    THERE'S GOT TO BE SOMETHING THAT WE ALL THINK WHY ON EARTH
      23    WOULD SOMEONE DO THIS?  THERE'S NO UNDERSTANDING TO WHY
      24    SOMETIMES PEOPLE DO WHAT THEY DO, BUT I THINK YOU WILL GET A
      25    SENSE OF THAT AS YOU HEAR THE EVIDENCE.


                                                                       45



       1         I APPRECIATE YOUR ATTENTIVENESS.  I APPRECIATE IN
       2    ADVANCE YOUR ATTENTIVENESS DURING THIS TRIAL.  AS THE
       3    WITNESSES COME ON AND AT THE CONCLUSION OF THE TRIAL, WE
       4    WILL BE ASKING YOU TO DELIBERATE AND TO COME BACK WITH A
       5    VERDICT OF GUILTY OF ALL FIVE COUNTS OF HOMICIDE.  THANK
       6    YOU.

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